bluuebunny/crossref_metadata_2025 huggingface dataset:
Robustness of the Carhart four-factor and the Fama-French three-factor models on the South African stock market
Authors: Boamah Nicholas Addai
Published: November 2015

Purpose

– The purpose of this study is to explore the applicability of the Fama–French and Carhart models on the South African stock market (SASM). It examines the ability of the models to capture size, book-to-market (BM) and momentum effects on the SASM. The paper, additionally, explores the ability of the Fama–French–Carhart factors to predict the future growth of the South African economy.

Design/methodology/approach

– The paper relies on data of 848 firms from January 1996 to April 2012 to examine the size, BM and momentum effects on the SASM. The paper constructs the test assets from a 3 × 3 sort on size and BM and a 3 × 3 sort on size and momentum. The paper estimates momentum as the past six-months’ cumulative return. The momentum portfolios are monthly rebalanced. Additionally, the size and BM portfolios are formed annually at the end of each June.

Findings

– Evidence is provided that size, BM and momentum effects exist on the SASM; also, the small- and high-BM firm portfolios, respectively, appear riskier than the big- and low-BM firm portfolios. The paper provides evidence of past winners outperforming past losers aside from the small-firm group. Additionally, the models only partially capture the size and value effects on the SASM. The Carhart model partly captures the momentum effects, but the Fama–French model is unable to describe the returns to the momentum-sorted portfolios. The evidence shows that the models’ factors predict future gross domestic product growth.

Originality/value

– The models do not fully describe returns on the SASM; any application of the models on the SASM should be done with caution. The Carhart model better describes returns than the Fama–French model on the SASM. The Fama–French–Carhart factors may relate to the underlying economic risk of the South African economy.
Are micro-cap mutual funds indeed riskier?
Authors: Rodriguez Javier
Published: November 2015

Purpose

– This study aims to examine the cross-sectional variation in risk of US-based micro-cap open-end mutual funds. Micro-cap mutual funds allow investors to access very low-priced stocks issued by the smallest of companies. The stock of these firms is usually not traded in major exchanges, and their financial information is not readily available and, thus, regarded as risky investments.

Design/methodology/approach

– The author examines the cross-sectional variation in risk and higher moments of US-based micro-cap mutual funds in comparison with that of small-cap and mid-cap mutual funds. Total, systematic and idiosyncratic risk metrics, along with higher moments, are estimated before, during and after the 2008 financial crisis.

Findings

– The author finds that, indeed, based on total and idiosyncratic risk metrics, the sample of micro-cap funds is riskier than the size-matched samples of small-cap and mid-cap funds. The author also reports that the sample of micro-cap funds fail to generate higher excess returns than the less risky small-cap and mid-cap funds.

Originality/value

– To the best of the author’s knowledge, this is the first time that the risk of small-cap mutual funds has been examined.
Crossing the bridge – connecting with people in the later stages of dementia
Authors: Bradley Andy
Published: November 2015

Purpose

– The purpose of this paper is to provoke reflection on the risks of people in the later stages of dementia being marginalised in care settings and to set out some key principles and approaches which enable ongoing connection. The paper provides practice examples to illuminate ways in which connected relationships can be maintained.

Design/methodology/approach

– This is a view point paper based on both a personal perspective (the writer grew up in a care home) and professional experience in the field of care work and culture change.

Findings

– Connecting with people who are in the later stages of dementia is of central importance in offering person-centred relational care.

Originality/value

– The PACE principles described are original and are published here for the first time.
Screening adult patients with a tracheostomy tube for dysphagia: a mixed‐methods study of practice in the UK
Authors: Ginnelly Aeron , Greenwood Nan
Published: November 2015

Background

Patients with tracheostomy tubes are at risk of aspiration and swallowing problems (dysphagia), and because of their medical acuity, complications in this patient population can be severe. It is well recognized that swallow screening in stroke significantly reduces potential complications by allowing early identification and appropriate management of patients at risk (by health professionals), thereby reducing delays in commencing oral intake and preventing unnecessary, costly interventions by speech and language therapists (SLTs). However, there is no standardized swallow screen for the tracheostomised population and there is a paucity of literature regarding either current or best practice in this area.

Aims

To investigate current UK practice for dysphagia screening in adult patients with tracheostomy tubes and to explore and describe health professionals’ perceptions of their current practice or current systems used.

Methods & Procedures

A mixed‐methods approach was adopted comprising a semi‐structured online questionnaire and recorded follow‐up telephone interviews. Participants were SLTs, nurses and physiotherapists working with patients with tracheostomies. Responses were analysed to determine current practice with regard to swallow screening. Thematic analysis of interviews allowed further exploration and clarification of the questionnaire findings.

Outcomes & Results

A total of 221 questionnaires were completed. Approximately half (45%) the participants worked in trusts with formal swallow screens, whilst the remainder used a variety of other approaches to identify patients at risk, often relying on informal links with multidisciplinary teams (MDT). In line with current evidence, patients with neurological diagnoses and a tracheostomy were consistently referred directly to speech and language therapy (SLT). Only one‐quarter of questionnaire participants thought their current system was effective at identifying patients at risk of swallowing problems. Eleven questionnaire participants were interviewed. They highlighted the important role of MDT team working here, emphasizing both its strengths and weaknesses when working with these patients.

Conclusions & Implications

Current practice in the UK for screening patients with a tracheostomy for swallow problems is varied and often suboptimal. Despite the evidence for enhancing outcomes, MDT working is still perceived as problematic. A swallow screening tool for use with this population, to enhance MDT working whilst also ensuring that practice fits in line with current evidence, may improve patient safety and care.
Exploratory investigation of communication management in residential‐aged care: a comparison of staff knowledge, documentation and observed resident–staff communication
Authors: Bennett Michelle K. , Ward Elizabeth C. , Scarinci Nerina A.
Published: November 2015

Background

There is a high prevalence of communication difficulty among older people living in residential‐aged care. Such functional deficits can have a negative impact on resident quality of life, staff workplace satisfaction and the provision of quality care. Systematic research investigating the nature of communication management in residential‐aged care and factors impacting optimal communication management is lacking.

Aims

To use data triangulation across multiple sources to describe resident–staff communication and communication management in residential‐aged care.

Methods & Procedures

Participants included a sample of 14 residents and 29 staff directly involved in communication interactions with residents. Data were obtained from: (1) resident file review (n = 14), (2) observation of resident–staff communication (n = 14), (3) resident surveys (n = 14) and (4) staff surveys (n = 29). Data from each source were examined separately then triangulated.

Outcomes & Results

All residents had limited opportunity for meaningful communication with staff. Documentation of residents’ communication needs and strategies to facilitate resident–staff communication was insufficient to provide individualized recommendations. Although staff were observed to use various strategies to facilitate communication with residents, staff agreement about the applicability of these strategies to individual residents was inconsistent. Differences in resident–staff communication for residents who experience nil/mild versus moderate/severe communication difficulty were also found.

Conclusions & Implications

Resident–staff communication and communication management in residential‐aged care is limited in scope and challenged in meeting residents’ individual communication needs. Improvements in both documentation and staff knowledge of residents’ communication needs are necessary. Strategies to facilitate communication with individual residents must be tailored, evidence based, documented in care plans and delivered to staff through ongoing education. Increased involvement of specialist providers such as speech pathologists to support better communication management in residential‐aged care may provide one way of facilitating such change.
The glutathione peroxidase‐mediated reactive oxygen species resistance, fungicide sensitivity and cell wall construction in the citrus fungal pathogen Alternaria alternata
Authors: Yang Siwy Ling , Yu Pei‐Ling , Chung Kuang‐Ren
Published: November 2015

The ability to detoxify reactive oxygen species (ROS) is critical for pathogenicity in the necrotrophic fungus Alternaria alternata. We report a glutathione peroxidase 3 (AaGPx3) involved in the complex signalling network that is essential for the detoxification of cellular stresses induced by ROS and for A. alternata pathogenesis in citrus. AaGPx3 deletion mutants displayed increased sensitivity to H2O2 and many ROS‐generating compounds. AaGPx3 is required for correct fungal development as the AaGPx3 mutant strains showed a severe reduction in conidiation. AaGPx3 mutants accumulated higher chitin content than the wild‐type and were less sensitive to the cell wall‐targeting compounds calcofluor white and Congo red, as well as the fungicides fludioxonil and vinclozolin, suggesting a role of the glutathione systems in fungal cell wall construction. Virulence assays revealed that AaGPx3 is required for full virulence. The expression of AaGPx3 was downregulated in fungal strains carrying defective NADPH oxidase (Nox) or the oxidative stress responsive regulators YAP1 and HOG1, all implicated in ROS resistance. These results further support the important role of ROS detoxification during A. alternata pathogenesis in citrus. Overall, our study provides genetic evidence to define the central role of AaGPx3 in the biological and pathological functions of A. alternata.
Transcriptional and metabolic regulation of denitrification in Paracoccus denitrificans allows low but significant activity of nitrous oxide reductase under oxic conditions
Authors: Qu Zhi , Bakken Lars R. , Molstad Lars , Frostegård Åsa , Bergaust Linda L.
Published: November 2015

Oxygen is known to repress denitrification at the transcriptional and metabolic levels. It has been a common notion that nitrous oxide reductase (N2OR) is the most sensitive enzyme among the four N‐oxide reductases involved in denitrification, potentially leading to increased N2O production under suboxic or fluctuating oxygen conditions. We present detailed gas kinetics and transcription patterns from batch culture experiments with Paracoccus denitrificans, allowing in vivo estimation of e−‐flow to O2 and N2O under various O2 regimes. Transcription of nosZ took place concomitantly with that of narG under suboxic conditions, whereas transcription of nirS and norB was inhibited until O2 levels approached 0 μM in the liquid. Catalytically functional N2OR was synthesized and active in aerobically raised cells transferred to vials with 7 vol% O2 in headspace, but N2O reduction rates were 10 times higher when anaerobic pre‐cultures were subjected to the same conditions. Upon oxygen exposure, there was an incomplete and transient inactivation of N2OR that could be ascribed to its lower ability to compete for electrons compared with terminal oxidases. The demonstrated reduction of N2O at high O2 partial pressure and low N2O concentrations by a bacterium not known as a typical aerobic denitrifier may provide one clue to the understanding of why some soils appear to act as sinks rather than sources for atmospheric N2O.
Race, Crime, and the Micro‐Ecology of Deadly Force
Authors: Klinger David , Rosenfeld Richard , Isom Daniel , Deckard Michael
Published: November 2015

Research Summary

Limitations in data and research on the use of firearms by police officers in the United States preclude sound understanding of the determinants of deadly force in police work. The current study addresses these limitations with detailed case attributes and a microspatial analysis of police shootings in St. Louis, MO, between 2003 and 2012. The results indicate that neither the racial composition of neighborhoods nor their level of economic disadvantage directly increase the frequency of police shootings, whereas levels of violent crime do—but only to a point. Police shootings are less frequent in areas with the highest levels of criminal violence than in those with midlevels of violence. We offer a provisional interpretation of these results and call for replications in other settings.

Policy Implications

Nationwide replications of the current research will require the establishment of a national database of police shootings. Informative assessments of a single agency's policies and practices require comparative information from other agencies. We recommend specific data elements to be included in such an information system that would shed further empirical light on the interconnections among race, crime, and police use of deadly force. The database also would contribute to the development of evidence‐based policies and procedures on deadly force—an urgent public priority in light of recent controversial police shootings across the United States.
Ukip, the 2015 General Election and Britain's EU Referendum
Authors: Goodwin Matthew J.
Published: November 2015

2015 was not the breakthrough election for Ukip and Nigel Farage that some predicted. But the party emerged as the third largest in Britain and the political agenda remains favourable for its populist message, writes Matthew Goodwin.
Emergency Department Diagnostic Imaging: The Journey to Quality
Authors: Kanzaria Hemal K. , Hall M. Kennedy , Moore Christopher L. , Burstin Helen
Published: November 2015

Priorities in health care delivery are shifting, with a greater focus on enhancing value, incentivizing quality, and advancing population health. While measurement of quality in emergency department (ED) care is still in its infancy, performance measures are increasingly being linked to reimbursement to encourage the delivery of high‐value care. With such changes, there will be growing oversight of diagnostic imaging in all clinical settings, including the ED. Here, the authors examine the current state of quality measurement as it pertains to ED imaging. The authors review relevant policies and discuss both the associated challenges and the facilitators of using quality measures to help optimize ED imaging. Understanding such factors will help ensure the delivery of diagnostic imaging that is appropriate, high‐quality, and patient‐centered.
Implant salvage in breast reconstruction with severe peri‐prosthetic infection
Authors: Meybodi Farid , Sedaghat Negin , French James , Keighley Caitlin , Mitchell David , Elder Elisabeth
Published: November 2015

Background

Although treatment of mild peri‐prosthetic infection in implant‐based breast reconstruction results in high rates of resolution, successful management of severe peri‐prosthetic infection remains a significant challenge.

Methods

In this case series, a protocol utilizing a novel dressing – negative pressure wound therapy with instillation (NPWTi) – for the management of severe peri‐prosthetic infection in breast reconstruction patients is described. This is an operative technique involving: (i) explantation of the breast prosthesis and application of the NPWTi dressing to the implant pocket; (ii) change of the NPWTi dressing; (iii) intraoperative fluid/tissue cultures; and (iv) reimplantation of the breast prosthesis when cultures yield no growth.

Results

This protocol was utilized in six cases of severe peri‐prosthetic infection in five patients with immediate breast reconstruction for breast cancer or risk‐reducing surgery. Cultures of fluid/tissue grew typical and/or unusual organisms. Only one case did not yield an organism. The hospital length of stay upon completion of the protocol ranged from 7–16 days (mean, 12 days). Successful implant salvage was achieved in five of six cases. The protocol was aborted in one case to allow for completion of adjuvant chemotherapy.

Conclusions

Early findings from this case series suggest that in cases of severe peri‐prosthetic infection this novel operative protocol may result in successful implant salvage for breast reconstruction patients. Further studies are needed to more fully elaborate the role of NPWTi to achieve implant salvage in challenging cases of peri‐prosthetic infection.
Rethinking Whiteness and Masculinity in Geography: Drinking Alcohol in the Field in Vietnam
Authors: Gillen Jamie
Published: November 2015

This paper evaluates the spatial politics of fieldwork in Vietnam in order to think through the connections between whiteness, masculinity, and geography. In drawing attention to how the consumption of alcohol underwrites daily activities in Vietnam, as well as fieldwork activities, I show that research ethics are underpinned by unique spatial contexts that do not conform to conventional accounts of masculinity and whiteness in the global North. I make three interrelated arguments. First, I argue that debates in geography about whiteness and masculinity must be understood alongside fieldwork experiences in the global South. Second, I invite geographers to think through how research ethics are shaped by spatially contingent productions of whiteness and masculinity. Lastly, I challenge geographers to keep pace with how disruptive categories like whiteness and masculinity are produced outside of the global North.
Uterine electromyography during active phase compared with latent phase of labor at term
Authors: Trojner Bregar Andreja , Lucovnik Miha , Verdenik Ivan , Jager Franc , Gersak Ksenija , Garfield Robert E.
Published: November 2015

Introduction

In a prospective study in a tertiary university hospital we wanted to determine whether uterine electromyography (EMG) can differentiate between the active and latent phase of labor.

Material and methods

Thirty women presenting at ≥370/7 weeks of gestation with regular uterine contractions, intact membranes, and a Bishop score <6. EMG was recorded from the abdominal surface for 30 min. Latent phase was defined as no cervical change within at least 4 h. Student's t‐test was used for statistical analysis (p ≤ 0.05 significant). Diagnostic accuracy of EMG was determined by receiver operator characteristics (ROC) analysis. The integral of the amplitudes of the power density spectrum (PDS) corresponding to the PDS energy within the “bursts” of uterine EMG activity was compared between the active and latent labor groups.

Results

Seventeen (57%) women were found to be in the active phase of labor and 13 (43%) were in the latent phase. The EMG PDS integral was significantly higher (p = 0.02) in the active (mean 3.40 ± 0.82 μV) compared with the latent (mean 1.17 ± 0.33 μV) phase of labor. The PDS integral had an area under the ROC curve (AUC) of 0.80 to distinguish between active and latent phases of labor, compared with number of contractions on tocodynamometry (AUC = 0.79), and Bishop score (AUC = 0.78). The combination (sum) of PDS integral, tocodynamometry, and Bishop score predicted active phase of labor with an AUC of 0.90.

Conclusions

Adding uterine EMG measurements to the methods currently used in the clinics could improve the accuracy of diagnosing active labor.
Differences in sperm morphology in foam‐nesting leptodactyline frogs (Anura, Leptodactylidae)
Authors: Salles Natália M. E. , Zara Fernando J. , Prado Cynthia P. A.
Published: November 2015

Sperm morphology is diverse among vertebrates and is influenced by the reproductive strategies adopted by species. In anurans, sperm morphology is associated with reproductive modes and mating systems. Here, we describe the sperm morphology of 11 frog species in the genus Leptodactylus and that of Lithodytes lineatus and discuss the relationship between sperm morphology and species' mating systems. We observed two distinct sperm morphotypes among the leptodactyline species, which differed mostly in head morphology. Type I sperm had triangular head, discrete acrosome vesicle with posterior margin not clearly visible; type II sperm had elongated head, clear acrosomal vesicle with posterior margin clearly visible. These sperm types do not seem to be associated with phylogeny; instead, type II sperm was observed in all polyandrous species analysed and in species with evidences of polyandry. Moreover, sperm of all species presented tail with undulating membrane connected to the axial fibre. We suggest that differences in sperm morphology might be associated with sperm competition to what polyandrous species are subjected. However, natural history observations on polyandrous mating in some species presenting type II sperm and phylogenetic comparative studies are need to elucidate the role of mating systems in the evolution of sperm morphology in leptodactylines.
A comparison of the intrasubject variation in drug exposure between generic and brand‐name drugs: a retrospective analysis of replicate design trials
Authors: Yu Yang , Teerenstra Steven , Neef Cees , Burger David , Maliepaard Marc
Published: November 2015

AIMS

The aim of the present study was to investigate whether differences in total and peak drug exposure upon generic substitution are due to differences between formulations or to intrasubject pharmacokinetic variability of the active substance.

Methods

The study was designed as a retrospective reanalysis of existing studies. Nine replicate design bioequivalence studies representing six drug classes – i.e. for alendronate, atorvastatin, cyclosporin, ebastine, exemestane, mycophenolate mofetil, and ropinirole – were retrieved from the Dutch Medicines Regulatory Authority.

Results

In most studies, the intrasubject variability in total and peak drug exposure was comparable for the brand‐name [in the range 0.01–0.24 for area under the concentration–time curve (AUCt) and 0.02–0.29 for peak plasma concentration (Cmax) on a log scale] and generic (0.01–0.23 for AUCt and 0.08–0.33 for Cmax) drugs, and was comparable with the intrasubject variability upon switching between those drugs (0.01–0.23 for AUCt and 0.06–0.33 for Cmax). The variance related to subject‐by‐formulation interaction could be considered negligible (–0.069 to 0.047 for AUCt and –0.091 to 0.02 for Cmax).

Conclusion

In the investigated studies, the variation in total and peak exposure seen when a patient is switched from a brand‐name to a generic drug is comparable with that seen following repeated administration of the brand‐name drug in the patient. Only the intrasubject variability seems to play a crucial and decisive role in the variation in drug exposure seen; no additional formulation‐dependent variation in exposure is observed upon switching. Thus, our data support that, for the medicines that were included in the present investigation, from a clinical pharmacological perspective, the benefit–risk balance of a generic drug is comparable with that of the brand‐name drug.
Variability of Voriconazole Trough Levels in Haematological Patients: Influence of Comedications with cytochrome P450(CYP) Inhibitors and/or with CYP Inhibitors plus CYP Inducers
Authors: Cojutti Piergiorgio , Candoni Anna , Forghieri Fabio , Isola Miriam , Zannier Maria Elena , Bigliardi Sara , Luppi Mario , Fanin Renato , Pea Federico
Published: November 2015

Voriconazole plasma exposure greatly varies among haematological patients. The purpose of this study was to identify the magnitude of influence of comedications with CYP inhibitors and/or with CYP inhibitors plus CYP inducers on voriconazole trough level (Cmin). Voriconazole Cmin was retrospectively assessed among haematological patients who underwent therapeutic drug monitoring (TDM). Univariate and multivariate linear mixed‐effect regression analyses were performed to identify the independent predictors of normalized Cmin. Of the 83 included patients, 35 had comedications with CYP inhibitors (omeprazole or pantoprazole) and 21 with CYP inhibitors (omeprazole or pantoprazole) plus CYP inducers (methylprednisolone, dexamethasone, phenobarbital, rifampin or carbamazepine). Median Cmin value (n = 199) was 2.4 mg/L with a wide range of distribution (<0.2–13.5 mg/L). Median (IQR) normalized voriconazole Cmin value was significantly higher in the presence of CYP inhibitors (4.20 mg/L, 3.23–5.51 mg/L) than either in the absence of interacting cotreatments (2.55 mg/L, 1.54–3.47 mg/L) or in the presence of CYP inhibitors plus CYP inducers (2.16 mg/L, 1.19–3.09 mg/L). The presence of CYP inhibitors was highly significantly associated with Cmin >5.5 mg/L (OR: 23.22, 95% CI: 3.01–179.09, p = 0.003). No significant association emerged when CYP inhibitors were coadministered with CYP inducers (OR: 3.53, 95% CI: 0.36–34.95, p = 0.280). The amount of expected Cmin increase was significantly influenced by both the type and the dose of the administered proton pump inhibitor. The study highlights that the benefit from TDM of voriconazole may be maximal in those patients who are cotreated with CYP inhibitors and/or with CYP inhibitors plus CYP inducers, especially when receiving proton pump inhibitors (PPIs) at very high dosages intravenously.
Enhanced Precision in the Analysis of Randomized Trials with Ordinal Outcomes
Authors: Díaz Iván , Colantuoni Elizabeth , Rosenblum Michael
Published: November 2015

We present a general method for estimating the effect of a treatment on an ordinal outcome in randomized trials. The method is robust in that it does not rely on the proportional odds assumption. Our estimator leverages information in prognostic baseline variables, and has all of the following properties: (i) it is consistent; (ii) it is locally efficient; (iii) it is guaranteed to have equal or better asymptotic precision than both the inverse probability-weighted and the unadjusted estimators. To the best of our knowledge, this is the first estimator of the causal relation between a treatment and an ordinal outcome to satisfy these properties. We demonstrate the estimator in simulations based on resampling from a completed randomized clinical trial of a new treatment for stroke; we show potential gains of up to 39% in relative efficiency compared to the unadjusted estimator. The proposed estimator could be a useful tool for analyzing randomized trials with ordinal outcomes, since existing methods either rely on model assumptions that are untenable in many practical applications, or lack the efficiency properties of the proposed estimator. We provide R code implementing the estimator.
Implementation of an inter‐agency transition model for youth with spina bifida
Authors: Lindsay S. , Cruickshank H. , McPherson A. C. , Maxwell J.
Published: November 2015

Background

To address gaps in transfer of care and transition support, a paediatric hospital and adult community health care centre partnered to implement an inter‐agency transition model for youth with spina bifida. Our objective was to understand the enablers and challenges experienced in the implementation of the model.

Methods

Using a descriptive, qualitative design, we conducted semi‐structured interviews, in‐person or over the phone, with 12 clinicians and nine key informants involved in implementing the spina bifida transition model. We recruited all 21 participants from an urban area of Ontario, Canada.

Results

Clinicians and key informants experienced several enablers and challenges in implementing the spina bifida transition model. Enablers included dedicated leadership, advocacy, funding, inter‐agency partnerships, cross‐appointed staff and gaps in co‐ordinated care to connect youth to adult services. Challenges included gaps in the availability of adult specialty services, limited geographical catchment of adult services, limited engagement of front‐line staff, gaps in communication and role clarity.

Conclusions

Although the transition model has realized some initial successes, there are still many challenges to overcome in transferring youth with spina bifida to adult health care and transitioning to adulthood.
Subcutaneous infusion of kisspeptin‐54 stimulates gonadotrophin release in women and the response correlates with basal oestradiol levels
Authors: Narayanaswamy Shakunthala , Jayasena Channa N. , Ng Noel , Ratnasabapathy Risheka , Prague Julia K. , Papadopoulou Deborah , Abbara Ali , Comninos Alexander N. , Bassett Paul , Bloom Stephen R. , Veldhuis Johannes D. , Dhillo Waljit S.
Published: November 2015

Background and objective

Kisspeptin stimulates hypothalamic GnRH secretion resulting in gonadotrophin release and has potential as a future therapeutic. Chronic subcutaneous infusion of kisspeptin via a pump (similar to an insulin pump) may provide an alternative route of administration in the future. We investigated for the first time in humans, the gonadotrophin response to subcutaneous (SC) infusions of kisspeptin‐54 in healthy women. Women are markedly more responsive to exogenous kisspeptin in the late follicular phase preovulation when oestradiol levels are naturally high. Therefore, we further investigated whether there was a correlation between baseline oestradiol levels and LH response to kisspeptin.

Design and patients

A prospective, single‐blinded placebo‐controlled study. Healthy women (n = 4) received an 8‐h SC infusion of kisspeptin‐54 0·1, 0·3 or 1·0 nmol/kg/h or saline in the early follicular phase of 4 separate menstrual cycles. Gonadotrophins and oestradiol were measured every 10 min during the infusions.

Results

SC infusion of kisspeptin‐54 increased LH and FSH. The LH response to SC infusion of kisspeptin‐54 (0·3 and 1·0 nmol/kg/h) positively correlated with baseline oestradiol levels (P < 0·001). Further statistical analyses showed that in the 1·0 nmol/kg/h group, a 100pmol/l rise in baseline oestradiol was associated with a 1·0 IU/l increase in LH.

Conclusions

Kisspeptin administered via a SC infusion could be a viable future therapeutic route of administration for patients with infertility. Baseline oestradiol levels may be an important determinant of the gonadotrophin response to kisspeptin treatment in women and should be taken into consideration when evaluating gonadotrophin response.
Evaluation of a national reform in the Israeli child protection practice designed to improve children's participation in decision‐making
Authors: Alfandari Ravit
Published: November 2015

A national reform of child protection practice in Israel includes the ambition of strengthening children's participation in intervention decisions carried out in formal committees, called planning, intervention and evaluation committees. A qualitative study was conducted of how well this was being achieved by following 21 case studies of families referred to the committees over 6 months. Data were collected from interviews with social workers, field observations of the committees and a document review. A systems approach was undertaken as a conceptual framework in order to allow a whole‐organizational understanding of what is happening in the field, and why. The key finding was a very limited realization of the reform's aim. Only seven children attended the committees, and they had little influence on decisions, which appears to have made them less co‐operative in implementing them. Those who did not attend rarely had their views conveyed to the committee by their social workers. The reform's lack of success is explained by being ill suited to the organizational working environment and culture. The analysis identified a number of systemic factors influencing the failure to give greater priority to children's views, including lack of skill and time, organizational messages about practice priorities and paternalistic ideology.
Endoscopic resection of advanced and laterally spreading duodenal papillary tumors
Authors: Klein Amir , Tutticci Nicholas , Bourke Michael J
Published: November 2015

Historically, neoplasia of the duodenal papilla has been managed surgically, which may be associated with substantial morbidity and mortality. In the absence of invasive cancer, even lesions with extensive lateral duodenal wall involvement, or limited intraductal extension may be cured endoscopically with a superior safety profile. Endoscopic papillectomy is associated with greater risks of adverse events such as bleeding than resection elsewhere in the gastrointestinal tract. Additionally site‐specific complications such as pancreatitis exist. A structured approach to lesion assessment, adherence to technical aspects of resection, endoscopic management of complications and post‐resection surveillance is required. Advances have been made in all facets of endoscopic papillary resection since its introduction in the 1980s; extending the boundaries of endoscopic cure, optimizing outcomes and enhancing patient safety. These will be the focus of the present review.
Important first encounter: Service user experience of pathways to care and early detection in first‐episode psychosis
Authors: Jansen Jens Einar , Pedersen Marlene Buch , Hastrup Lene Halling , Haahr Ulrik Helt , Simonsen Erik
Published: November 2015

Background

Long duration of untreated psychosis is associated with poor clinical and functional outcomes. However, few systematic attempts have been made to reduce this delay and little is known of service users' experience of early detection efforts.

Aim

We explored service users' experience of an early detection service and transition to specialized treatment service, including pathway to care, understanding of illness and barriers to adequate assessment and treatment.

Methods

In‐depth interviews were conducted with 10 service users (median age 21, range 18–27, five males and five females) who were diagnosed with a first‐episode non‐affective psychosis and who were seen by an early detection team (TOP) and currently enrolled in a specialized early intervention service for this disorder (OPUS).

Results

Stigma and fear of the ‘psychiatric system’ were reported as significant barriers to help seeking, while family members were seen as a crucial support. Moreover, the impact of traumatic events on the experience and development of psychosis was highlighted. Finally, participants were relieved by the prospect of receiving help and the early detection team seemed to create a trusting relationship by offering a friendly, ‘anti‐stigmatized’ space, where long‐term symptomatology could be disclosed through accurate and validating questioning.

Conclusions

Early detection services have two important functions. One is to make accurate assessments and referrals. The other is to instil hope and trust, and to facilitate further treatment by forming an early therapeutic alliance. The findings in this study provide important insights into the way in which early detection efforts and pathways to care are experienced by service users, with direct implications for improving psychiatric services.
Reference intervals for biochemical and haematological parameters in mature domestic donkeys (Equus asinus) in the UK
Authors: Burden F. A. , Hazell‐Smith E. , Mulugeta G. , Patrick V. , Trawford R. , Brooks Brownlie H. W.
Published: November 2015

Reference intervals (RIs) for haematology and serum biochemistry for donkeys in a temperate climate have been previously published using blood sample results from the resident population of a large donkey shelter in the UK. Periodic review of reference intervals is recommended to ensure their applicability to the patient population and changes in laboratory methods and technologies. The current study aimed to revise the previously published haematology and serum biochemistry values for the adult domestic donkey (Equus asinus) in the UK in the light of a change in analytical equipment at the Donkey Sanctuary laboratory, but also to refine the demography of the sample population with respect to age, physiology and clinical history. Clinical pathology results from 138 clinically healthy mature (4–24 years inclusive) female and castrated male donkeys selected from the resident population of the Donkey Sanctuary, were analysed retrospectively. The animals were blood sampled during the period February 2008 to June 2011 as part of a routine health screen prior to rehoming. Results for a total of 38 biochemical and haematological parameters were analysed including 3 previously unreferenced parameters in addition to those assessed in the previous study. The new reference intervals and median values show very poor transferability with recently derived reference intervals for non‐Thoroughbred horses and only limited transferability with reference intervals previously published for donkeys in the UK. Of particular note is a marked reduction in the upper reference limit for triglycerides of 2.8 mmol/l (from 4.3 mmol/l) since this parameter is used to decide when donkeys are at risk of developing hyperlipaemia. This study demonstrates the value of intermittent review of reference intervals and refinement of study populations. Notwithstanding the caution with which reference interval data from different laboratories should be compared, the lack of transferability of results between donkeys and horses highlights the importance of use of species‐appropriate reference intervals for clinical decision‐making.
A devolved model for public involvement in the field of mental health research: case study learning
Authors: Moule Pam , Davies Rosie
Published: November 2015

Background

Patient and public involvement in all aspects of research is espoused and there is a continued interest in understanding its wider impact. Existing investigations have identified both beneficial outcomes and remaining issues. This paper presents the impact of public involvement in one case study led by a mental health charity conducted as part of a larger research project. The case study used a devolved model of working, contracting with service user‐led organizations to maximize the benefits of local knowledge on the implementation of personalized budgets, support recruitment and local user‐led organizations.

Objective

To understand the processes and impact of public involvement in a devolved model of working with user‐led organizations.

Design

Multiple data collection methods were employed throughout 2012. These included interviews with the researchers (n = 10) and research partners (n = 5), observation of two case study meetings and the review of key case study documentation. Analysis was conducted in NVivo10 using a coding framework developed following a literature review.

Findings

Five key themes emerged from the data; Devolved model, Nature of involvement, Enabling factors, Implementation challenges and Impact. While there were some challenges of implementing the devolved model it is clear that our findings add to the growing understanding of the positive benefits research partners can bring to complex research.

Conclusions

A devolved model can support the involvement of user‐led organizations in research if there is a clear understanding of the underpinning philosophy and support mechanisms are in place.
Oxidative stress – a key emerging impact factor in health, ageing, lifestyle and aesthetics
Authors: Kandola K. , Bowman A. , Birch‐Machin M. A.
Published: November 2015

Oxidative stress is the resultant damage that arises due to redox imbalances, more specifically an increase in destructive free radicals and reduction in protection from antioxidants and the antioxidant defence pathways. Oxidation of lipids by reactive oxygen species (ROS) can damage cellular structures and result in premature cell death. At low levels, ROS‐induced oxidative stress can be prevented through the action of antioxidants, however, when ROS are present in excess, inflammation and cytotoxicity eventually results leading to cellular oxidative stress damage. Increasing evidence for the role of oxidative stress in various diseases including neurological, dermatological, and cardiovascular diseases is now emerging. Mitochondria are the principal source (90%) of ROS in the cell, with superoxide radicals being generated when molecular oxygen is combined with free electrons. Given the key role of mitochondria in the generation of cellular oxidative stress it is worth considering this organelle and the process in more detail and to provide methods of intervention.
The role of oxidative damage in poor scalp health: ramifications to causality and associated hair growth
Authors: Schwartz J. R. , Henry J. P. , Kerr K. M. , Mizoguchi H. , Li L.
Published: November 2015

The oxidative stress element of unhealthy scalp leads to compromised pre‐emergent hair formation and poorly formed hair as it grows. Only cosmetic solutions can minimize the impact of unhealthy hair and to achieve healthy looking and feeling hair, the scalp health must be normalized first. The objectives of this research were to both investigate whether oxidative stress was a relevant aetiological element in scalp dandruff and seborrhoeic dermatitis and whether scalp condition affects the quality of hair that grows from it. Further, this research was designed to determine whether an effective anti‐dandruff shampoo would repair and protect the scalp and pre‐emergent hair from oxidative stress. This study demonstrated that oxidative stress is an aetiological element relevant to the dandruff condition and that a potentiated ZPT shampoo effectively improves scalp condition, including a reduction in oxidative stress. The compromised hair condition associated with dandruff is concomitantly improved when the scalp condition is improved. It appears that there is a direct link between hair quality and scalp health.
The ‘Dispersal Rate’ – a product dependent characteristic to predict the reliability of the calibrated in vitro SPF on WW5 plates
Authors: Batzer J. , Bleckmann A. , Lerg H. , Schwanke F. , Schläger T.
Published: November 2015

Objectives

The evaluation of the SPF by the measurement of light transmission through a thin film on PMMA plates is an interesting alternative to the conventional in vivo method. However, during the last years an internationally acknowledged in vitro SPF measurement could not be established mainly due to bad reproducibility. With this work, we would like to give new suggestions for an improved reproducibility and to open new space for discussion.

Methods

A total of 22 o/w emulsions with well‐established in vivo SPF were measured in vitro close to the international Standard ISO 24443 on two different substrates (PMMA plates: WW5 and HD6). For each product, the ratio ‘in vitro SPFraw/in vivo SPF’ was calculated. The composition of the products was analysed regarding a parameter that correlates with the aforementioned ratio. Additionally seven suitable calibration products were determined to transfer the in vitro SPFraw to the calibrated in vitro SPFcal.

Results

We could show that the results for the SPFcal matched very well for 19 measured o/w emulsions on WW5 plates. However, we found two products where the in vitro SPF was much lower than the in vivo SPF. The Dispersal Rate allows us to identify a product characteristic parameter to predict too low measured in vitro SPFs on WW5 plates. This parameter mainly refers to the ratio of water to lipids in an emulsion. We found that products with few emollients and few emulsifiers are measured too low in vitro.

Conclusion

We suggest implementing an individual calibration of the in vitro SPF to improve the reproducibility of in vitro SPF measurements between different laboratories. Considering the Dispersal Rate helps to estimate the reliability of the in vitro SPF measured on WW5 plates. In order to evaluate whether those products with a high Dispersal Rate can also be calibrated with special standards, further measurements need to be done. We demonstrate that, besides the known parameter, also the composition of the products should be considered for the interpretation of the in vitro SPF. Our findings could explain some multiple reported problems in correlation between in vitro and in vivo SPF, especially for higher SPFs (Personal Care, November, 2014, 27).
DNA double‐strand breaks caused by new and contemporary endodontic sealers
Authors: Eldeniz A. U. , Shehata M. , Högg C. , Reichl F. X.
Published: November 2015

Aim

To investigate the cytotoxicity and genotoxicity of a new silicate‐based BioRoot RCS® sealer in comparison with contemporary sealers.

Methodology

A periodontal ligament cell line using lentiviral gene transfer of human telomerase reverse transcriptase (hTERT) was used and exposed to subtoxic concentrations of 24‐h eluates from two epoxy resin‐based (AH Plus Jet® and Acroseal®), four various methacrylate‐based endodontic sealers (EndoREZ®, RealSeal®, RealSeal SE® and Hybrid Root SEAL®) and three silicate‐based sealers (BioRoot RCS®, iRootSP® and MTA Fillapex®). The XTT‐based cell viability assay was used for cytotoxicity screening of materials. The γ‐H2AX assay was used for genotoxicity screening. In the γ‐H2AX immunofluorescence assay, PDL‐hTERT cells were exposed to eluates of the substances for 6 h and DNA double‐strand breaks (DSB) were detected microscopically. Induced foci represented DSBs, which can induce ATM‐dependent phosphorylation of the histone H2AX. The statistical significance of the differences between the experimental groups was compared using the Student's t‐test (P < 0.05).

Results

The cytotoxicity of the 24‐h eluates could be ranked in the following order: Hybrid Root SEAL®>RealSeal®>Acroseal®>RealSeal SE®≥ AH Plus Jet®> EndoREZ®>MTA Fillapex®> iRoot SP®>BioRoot RCS®. In negative controls (cells which received medium only) 4.08 ± 0.53 DSB foci (mean ± SEM) whilst in positive controls 10.76 ± 4.05 DSB foci/cell were found. BioRoot RCS® and RealSeal SE® exhibited significant differences in foci formation at 1/3 EC50 compared with their 1/10 EC50 concentration (P < 0.05). Both concentrations (1/10 and 1/3 of EC50) of AH Plus Jet®, Acroseal®, RealSeal® and MTA Fillapex® sealers were not significantly different when compared with the medium control (P < 0.05).

Conclusions

New BioRoot RCS® was not toxic whilst Hybrid Root SEAL® demonstrated more toxicity and DNA double‐strand breaks when compared with other resin‐ and silicate‐based root canal sealers.