bluuebunny/crossref_metadata_2025 huggingface dataset:
Generation Y consumer online repurchase intention in Bangkok
Authors: Zhu Bing , Kowatthanakul Suwanna , Satanasavapak Punnaluck
Published: September 2019

Purpose

The rapid growth of e-commerce has encouraged online retailers to adapt to the purchase behaviour of Generation Y consumers. For this purchase, the purpose of this paper is to investigate Generation Y online consumer repurchase intention in Thai context based on Stimuli-Organism-Response (SOR) model.

Design/methodology/approach

Data were used to test the hypotheses that Generation Y consumer online response is influenced by online environment cues and organism. In total, 401 questionnaires were collected in Bangkok through judgemental sampling and convenient sampling. SPSS 24 was used to analyse Generation Y consumers’ demographic information and reliability test. Amos 24 was utilized to examine measurement model and structural equation model.

Findings

The findings finally revealed that website security presents the strongest influence on Generation Y consumers trust. Also, online promotion possesses the weakest association with Generation Y consumers trust. More importantly, Generation Y consumer online repurchase intention is positively influenced by the degree of trust they have towards websites. The implications of the findings for marketers are discussed.

Research limitations/implications

The empirical data are limited to generate findings from a limited number of Generation Y consumers in Bangkok only. Also, the study limits itself to explore only inter-relationship in the scope of SOR.

Practical implications

It is suggested that in order to draw attention from and retain Generation Y consumers, online retailers should aim at strengthening trust-building in the online buyer–seller context as well as a dynamic promotional campaign. Moreover, a constellation of relevant marketing strategies is recommended.

Originality/value

Since there is a lack of implementation of SOR model based on the Thai context, this paper fills the gap by illustrating how SOR works in Thailand with updating findings.
Dividend policy and earnings quality in Vietnam
Authors: Nguyen Trang Thi Ngoc , Bui Phuong Kim
Published: September 2019

Purpose

The purpose of this paper is to examine the relationship between dividend policy and earnings quality of Vietnamese listed firms.

Design/methodology/approach

The sample includes firms listed on Vietnam stock exchange during the period between 2010 and 2016. Two measures of earnings quality are the annual firm-specific absolute value of residuals from Dechow and Dichev’s (2002) model and from Dechow and Dichev (2002) as modified by McNichols’s (2002) model. The firms’ dividend policy is captured by dividend paying status. This is a dummy variable that takes the value of 1 if the firm pays dividends and 0 otherwise. In addition, dividend yield and dividend payout ratio, which are continuous variables, are also used in this paper as alternative proxies for dividend policy.

Findings

Using panel data analysis, this paper documents that dividend payers have higher earnings quality than dividend non-payers. Dividends are an indicator of earnings quality. These findings are consistent with prior studies. After controlling for variables that may be related to earnings quality as well as for the year and industry fixed effects, this relation remains unchanged. In addition, this result is also robust after controlling for firm fixed effects.

Originality/value

This paper offers the empirical evidence on the relation between dividend policy and earnings quality in Vietnam, which is a frontier market.
You touched it and I’m relieved! The effect of online review’s tactile cues on consumer’s purchase intention
Authors: Huang Jing , Guo Yulang , Wang Cheng , Yan Lei
Published: September 2019

Purpose

The purpose of this paper is to examine the role of online review’s tactile cues in consumer’s purchase intention, given the absence of direct experience in online shopping.

Design/methodology/approach

Based on four empirical studies, the authors examine the role of online review’s tactile cues in consumer’s purchase intention. A secondary data analysis on Taobao and three experiments were conducted.

Findings

First, this research demonstrates that tactile cues in online reviews are sure to have a significant influence on consumers’ purchase intention. Second, the purchase intention of consumers is easily influenced by the reviews of holistic tactile cues of the search product, which affects the final purchase intention through the way of outcome simulation. Consumers’ purchase intention is also easily influenced by concrete tactile cues of experience product, which affects the final purchase intention through the way of process simulation. Temporal distance is the boundary condition.

Practical implications

A seller should manage the order of online review or labels related to corresponding tactile cues, in order to encourage consumers to comment on the relevant tactile features. Besides, in the aspect of website design, a seller can also encourage consumers to image about the process and the result of using so as to promote his sales volume.

Social implications

The conclusion may give a solution on how to deal with the absence of direct experience in online shopping.

Originality/value

There has been little research about the influences of others' tactile behaviors on consumers' behaviors. The authors focus the other tactile experience in online review. The previous studies on online reviews focus on the its influences of valence, quantity and sentiment polarity on the usefulness of reviews and sales volume. However, few studies are explored on contents of reviews. The authors focus on the content such as tactile cues.
How does intellectual capital align with cyber security?
Authors: Renaud Karen , Von Solms Basie , Von Solms Rossouw
Published: September 2019

Purpose

The purpose of this paper is to position the preservation and protection of intellectual capital as a cyber security concern. The paper outlines the security requirements of intellectual capital to help boards of directors (BoDs) and executive management teams to understand their responsibilities and accountabilities in this respect.

Design/methodology/approach

The research methodology is desk research. In other words, we gathered facts and existing research publications that helped us to define key terms, to formulate arguments to convince BoDs of the need to secure their intellectual capital and to outline actions to be taken by BoDs to do so.

Findings

Intellectual capital, as a valuable business resource, is related to information, knowledge and cyber security. Hence, preservation thereof is also related to cyber security governance and merits attention from BoDs.

Research limitations/implications

This paper clarifies BoDs intellectual capital governance responsibilities, which encompass information, knowledge and cyber security governance.

Practical implications

The authors hope that BoDs will benefit from the clarifications, and especially from the positioning of intellectual capital in cyber space.

Social implications

If BoDs know how to embrace their intellectual capital governance responsibilities, this will help to ensure that such intellectual capital is preserved and secured.

Originality/value

This paper extends a previous paper published by Von Solms and Von Solms, which clarified the key terms of information and cyber security, and the governance thereof. The originality and value is the focus on the securing of intellectual capital, a topic that has not yet received a great deal of attention from security researchers.
Unpacking the black box of systemic risks in banking
Authors: Hoffmann Christian Hugo
Published: September 2019

Purpose

Systemic risks affect financial market participants in many ways. However, the literature insists firmly that they are and, in fact, should be of little concern to (private) banks (as opposed to regulators). The purpose of this paper is to argue for the relevance of systemic risks for private banks as opposed to regulators only by making use of causal loop models as being traditionally used in the discipline of systems dynamics. In contrast to the starting point for all common risk-management frameworks in banks, which is the classification of risks into risk categories, the authors show that risk has been compartmentalized too much and provide a strong case for a really holistic approach.

Design/methodology/approach

Systems thinking, causal loop models and conceptual approach.

Findings

Relevance of systemic risks for private banks as opposed to regulators only. In contrast to the starting point for all common risk-management frameworks in banks, which is the classification of risks into risk categories, the authors show that risk has been compartmentalized too much and provide a strong case for a really holistic approach, which stems from using explanatory models such as causal loop diagrams. On top of that more explanatory models ought to be used for risk management purposes while banks currently rely too much on statistical-descriptive approaches.

Originality/value

Integration of systems thinking into risk management, which is novel: in contrast to the starting point for all common risk-management frameworks in banks, which is the classification of risks into risk categories, the authors show that risk has been compartmentalized too much and provide a strong case for a really holistic approach.
The effect of a multidisciplinary care bundle on the incidence of delirium after hip fracture surgery: a quality improvement study
Authors: Chuan A. , Zhao L. , Tillekeratne N. , Alani S. , Middleton P. M. , Harris I. A. , McEvoy L. , Ní Chróinín D.
Published: September 2019

Delirium is a common complication following hip fracture surgery. We introduced a peri‐operative care bundle that standardised management in the emergency department, operating theatre and ward. This incorporated: use of fascia iliaca blocks; rationalisation of analgesia; avoidance of drugs known to trigger delirium; a regular education program for staff; and continuous auditing of compliance. The study was conducted between June 2017 and December 2018. We recruited 150 patients before (control group) and 150 patients after (care bundle group) the introduction of the care bundle. In patients having surgery for a hip fracture, there was a lower incidence of delirium on the third postoperative day in the care bundle group compared with the control group (33 patients (22%) vs. 49 patients (33%)), respectively; p = 0.04). Patients in the care bundle group had an adjusted OR of 2.2 (95%CI 1.1–4.4) (p = 0.03) for the avoidance of delirium on the third postoperative day. There was no difference between groups for the secondary outcome measures (measured at 30 days postoperatively) including: all‐cause mortality; composite morbidity; institutionalisation; and walking status. During the study period, compliance with elements of the care bundle improved in the emergency department (49 patients (33%) compared with 85 patients (59%); p < 0.001) and anaesthetic department (40 patients (27%) compared with 104 patients (69%); p < 0.001), while orthogeriatrics maintained a high level of compliance (140 patients (93%) compared with 143 patients (95%); p = 0.45). There was a clinically and statistically significant reduction in the incidence of delirium following hip fracture surgery in patients treated with a multidisciplinary care bundle.
Reduced regional strain rate is the most accurate dysfunction in predicting culprit lesions in patients with acute coronary syndrome
Authors: Shenouda Rafik B. , Bytyçi Ibadete , Sobhy Mohammed , Henein Michael Y.
Published: September 2019

Background and Aim

Predicting culprit lesions in acute coronary syndrome (ACS) could be a challenge. The aim of this study was to assess the accuracy of regional wall motion abnormalities (RWMA) using various echocardiographic techniques and ECG changes in predicting the culprit coronary lesion in a group of patients with ACS.

Methods

In 80 consecutive patients with ACS (age 55·7 ± 9·4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle (LV) RWMA, tissue Doppler imaging (TDI) and speckle tracking myocardial strain and strain rate (SR) were performed before intervention.

Results

Of the 80 patients, one‐vessel stenosis (>70%) was present in 53 (66%), two‐vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). About 51% of patients had hypertension, 40% diabetes and 23% dyslipidaemia. There was no relationship between individual segmental RWMA and SR. Mean regional SR, but not peak strain, correlated with culprit lesion branch: left anterior descending – LAD (r = 0·35, P = 0·005), circumflex LCx (r = 0·32, P = 0·03) and right coronary RCA (r = 0·37, P = 0·01). Only ECG changes in the LAD territory (r = 0·26, P = 0·04) correlated with the culprit lesion. SR of LAD territories ≤−0·74 was 71% sensitive and 70% specific (AUC = 0·70, CI = 0·67–0·93, P = 0·01), SR of LCx territories of ≤−0·67 was 75% sensitive and 63% specific (AUC = 0·72, CI = 0·58–0·87, P = 0·02) and SR of RCA territories ≤−0·83 was 73% sensitive and 71% specific (AUC = 0·80, CI = 0·66–0·93, P = 0·001) in predicting significant stenosis. SR was more accurate than all other techniques in predicting the culprit lesion.

Conclusion

In ACS, mean regional speckle tracking SR is more sensitive than peak strain, TDI, ECG changes and wall motion abnormalities in detecting significant coronary artery stenosis.
Paternal transgenerational epigenetic mechanisms mediating stress phenotypes of offspring
Authors: Cunningham Ashley M. , Walker Deena M. , Nestler Eric J.
Published: September 2019

Depression and anxiety risk are highly influenced by both genetic and environmental factors. Recently, it has been proposed that epigenetic mechanisms may also contribute to the transmission of both depression‐ and anxiety‐related behaviors across multiple generations. This review highlights long‐lasting epigenetic alterations observed in offspring of fathers, including some distinct effects on male and female offspring, in animal models. Available evidence emphasizes how both the developmental time point and the type of paternal stress (social vs. asocial) influence the complex transmission patterns of these phenotypes to future generations. This research is critical in understanding the factors that influence risk for depression and anxiety disorders and has the potential to contribute to the development of innovative treatments that can more precisely target vulnerable populations.
How green defaults promote environmentally friendly decisions: Attitude‐conditional default acceptance but attitude‐unconditional effects on actual choices
Authors: Taube Oliver , Vetter Max
Published: September 2019

Defaults (i.e., options that become effective without an active choice) have been found to be powerful tools to influence decision‐making in a range of behavioral domains. However, seemingly conflicting assumptions have been expressed regarding the interplay of defaults with individual attitudes. Whereas some expect attitude‐conditional effects (i.e., a statistical default‐by‐attitude interaction), others assume an attitude‐unconditional effectiveness of defaults (i.e., statistically additive effects). Integrating both assumptions, we argue that the interplay of defaults and attitudes depends on what is considered a default effect. Specifically, whereas default acceptance is likely to be attitude‐conditional, we predicted that defaults and attitudes would add up in explaining people's actual choices. We tested these hypotheses in an online shopping scenario presenting environmentally friendly or conventional default products to 231 participants. Participants’ environmental attitude was assessed with the General Ecological Behavior scale and actual product choices were identified if participants rejected a given default product. In line with our hypotheses, default acceptance was predicted by a default‐by‐attitude interaction. In contrast, actual environmentally friendly product choices were found to be an additive function of defaults and participants’ environmental attitude. From an applied perspective, our findings suggest that defaults can readily be applied even in attitude‐heterogeneous target populations. Concurrently, however, our findings also speak of the importance of people's attitudes for understanding individual decision‐making.
Economic impact of contact force sensing in catheter ablation for atrial fibrillation
Authors: Mansour Moussa , Reddy Vivek Y. , Karst Edward , Heist Edwin Kevin , Packer Douglas L. , Dalal Nirav , Agarwal Rahul , Calkins Hugh , Ruskin Jeremy N. , Mahapatra Srijoy
Published: September 2019

Aims

The TactiCath Contact Force Ablation Catheter Study for Atrial Fibrillation (TOCCASTAR) clinical trial compared clinical outcomes using a contact force (CF) sensing ablation catheter (TactiCath) with a catheter that lacked CF measurement. This analysis links recorded events in the TOCCASTAR study and a large claims database, IBM MarketScan®, to determine the economic impact of using CF sensing during atrial fibrillation (AF) ablation.

Methods and Results

Clinical events including repeat ablation, use of antiarrhythmic drugs, hospitalization, perforation, pericarditis, pneumothorax, pulmonary edema, pulmonary vein stenosis, tamponade, and vascular access complications were adjudicated in the year after ablation. CF was characterized as optimal if greater than or equal to 90% lesion was performed with greater than or equal to 10 g of CF. A probabilistic 1:1 linkage was created for subjects in MarketScan® with the same events in the year after ablation, and the cost was evaluated over 10 000 iterations. Of the 279 subjects in TOCCASTAR, 145 were ablated using CF (57% with optimal CF), and 134 were ablated without CF. In the MarketScan® cohort, 9811 subjects who underwent AF ablation were used to determine events and costs. For subjects ablated with optimal CF, total cost was $19 271 ± 3705 in the year after ablation. For ablation lacking CF measurement, cost was $22 673 ± 3079 (difference of $3402, P < .001). In 73% of simulations, optimal CF was associated with lower cost in the year after ablation.

Conclusion

Compared to ablation without CF, there was a decrease in healthcare cost of $3402 per subject in the first year after the procedure when optimal CF was used.
Sociolinguistics going ‘wild’: The construction of auratic fields
Authors: Spitzmüller Jürgen
Published: September 2019

This paper sets out to focus the “linguistic construction of publics” (Gal & Woolard, 2014 [2001]: 1) in a sense of the word that is often excluded from sociolinguistic discussion of linguistic action in the public sphere: it discusses how the public is constructed as an indexical (‘auratic’) arena, and a field for positioning, in sociolinguistic research. The paper attempts to point out how the public is (and has been for a long time), on the one hand, envisaged as a sort of counter‐field for academic linguistics (associated with “threatening” metalinguistic practices such as prescriptivism; Cameron, 1995: 5) and thereby juxtaposed to linguistics itself as an allegedly separate field of action, and on the other hand as that appealing place of ‘authentic’ linguistic practice (‘the field,’ ‘the real world,’ etc.) socially oriented linguists ultimately want to explore. The notions ofwild publicsandcreativityare discussed as cases in point.
Bradykinin signaling regulates solute permeability and cellular junction organization in lymphatic endothelial cells
Authors: Kempe Sybille , Fois Giorgio , Brunner Cornelia , Hoffmann Thomas K. , Hahn Janina , Greve Jens
Published: September 2019

Objective

Determine the effect of bradykinin on solute permeability and cellular junctional proteins in human dermis microvascular endothelial cells.

Methods

Cells were characterized by immunofluorescence and fluorescence‐activated cell sorting. Macromolecular transport of dextran and albumin was monitored. Junctional protein expression and phosphorylation were determined by immunoblot analyses. Intracellular calcium and cAMP levels were evaluated. Target gene expression at mRNA and protein levels was determined.

Results

Human dermis microvascular endothelial cells comprised 97% lymphatic endothelial cells. Bradykinin increased the permeability to dextran in a concentration‐dependent manner, while reduced the permeability to albumin. Bradykinin treatment down‐regulated VE‐cadherin expression and affected its phosphorylation status at Tyr731. It also down‐regulated claudin‐5 expression at the transcriptional level through bradykinin‐2‐receptor signaling. An increase in the intracellular calcium levels and a reduction in the cAMP concentration were associated effects. Finally, bradykinin induced the up‐regulation of vascular endothelial growth factor‐C protein which was found increased in BK‐induced human dermis microvascular endothelial cells culture supernates.

Conclusions

Human dermis microvascular endothelial cells represent a model of lymphatic endothelial cells, in which bradykinin‐2‐receptor is expressed. Bradykinin‐induced bradykinin‐2‐receptor signaling through intracellular calcium mobilization and reduction in cAMP levels, triggered changes in solute permeability and cellular junction expression. It further up‐regulated vascular endothelial growth factors‐C protein expression, which is a key modulator of lymphatic vessels function and lymphangiogenesis.
Localized acquired lymphangiectasias after breast surgery: Enhanced non‐invasive diagnosis using dermoscopy and reflectance confocal microscopy
Authors: Verzì Anna Elisa , Lacarrubba Francesco , Tedeschi Aurora , Micali Giuseppe
Published: September 2019

Background

Acquired lymphangiectasias represent cystic dilatations of the cutaneous lymphatic vessels resulting from damage and/or obstruction of previously normal lymphatics, usually secondary to surgery, radiotherapy, and/or infections.

Materials and Methods

The clinical, dermoscopic, and confocal microscopy features of three cases of acquired lymphangiectasias occurring after breast surgery are described along with histopathological correlations.

Results

Polarized dermoscopy revealed in all lesions the presence of well‐circumscribed, white‐yellowish lacunae surrounded by pale septa. In addition, some lesions showed scattered reddish areas and red lacunae. Confocal microscopy showed in the upper dermis numerous, roundish dark cavities separated by thin septa. These features corresponded histopathologically to saccular dilations and ectatic lymphatic vessels lined by a single layer of endothelial cells in the papillary/reticular dermis.

Conclusion

The use of non‐invasive diagnostic techniques may be addressed to an enhanced non‐invasive diagnosis of acquired lymphangiectasias by showing peculiar features, thus avoiding the need for skin biopsy.
Implications of habitual endurance and resistance exercise for dynamic cerebral autoregulation
Authors: Perry Blake G. , Cotter James D. , Korad Stephanie , Lark Sally , Labrecque Lawrence , Brassard Patrice , Paquette Myriam , Le Blanc Olivier , Lucas Samuel J. E.
Published: September 2019

New Findings

What is the central question of this study?

Does habitual resistance and endurance exercise modify dynamic cerebral autoregulation?

What is the main finding and its importance?

To the authors’ knowledge, this is the first study to directly assess dynamic cerebral autoregulation in resistance‐trained individuals, and potential differences between exercise training modalities. Forced oscillations in blood pressure were induced by repeated squat–stands, from which dynamic cerebral autoregulation was assessed using transfer function analysis. These data indicate that dynamic cerebral autoregulatory function is largely unaffected by habitual exercise type, and further document the systemic circulatory effects of regular exercise.

Regular endurance and resistance exercise produce differential but desirable physiological adaptations in both healthy and clinical populations. The chronic effect of these different exercise modalities on cerebral vessels’ ability to respond to rapid changes in blood pressure (BP) had not been examined. We examined dynamic cerebral autoregulation (dCA) in 12 resistance‐trained (mean ± SD, 25 ± 6 years), 12 endurance‐trained (28 ± 9 years) and 12 sedentary (26 ± 6 years) volunteers. The dCA was assessed using transfer function analysis of forced oscillations in BP vs. middle cerebral artery blood velocity (MCAv), induced via repeated squat–stands at 0.05 and 0.10 Hz. Resting BP and MCAv were similar between groups (interaction: both P ≥ 0.544). The partial pressure of end‐tidal carbon dioxide () was unchanged (P = 0.561) across squat–stand manoeuvres (grouped mean for absolute change +0.6 ± 2.3 mmHg). Gain and normalized gain were similar between groups across all frequencies (both P ≥ 0.261). Phase showed a frequency‐specific effect between groups (P = 0.043), tending to be lower in resistance‐trained (0.63 ± 0.21 radians) than in endurance‐trained (0.90 ± 0.41, P = 0.052) and ‐untrained (0.85 ± 0.38, P = 0.081) groups at slower frequency (0.05 Hz) oscillations. Squat–stands induced mean arterial pressure perturbations differed between groups (interaction: P = 0.031), with greater changes in the resistance (P < 0.001) and endurance (P = 0.001) groups compared with the sedentary group at 0.05 Hz (56 ± 13 and 49 ± 11 vs. 35 ± 11 mmHg, respectively). The differences persisted at 0.1 Hz between resistance and sedentary groups (49 ± 12 vs. 33 ± 7 mmHg, P < 0.001). These results indicate that dCA remains largely unaltered by habitual endurance and resistance exercise with a trend for phase to be lower in the resistance exercise group at lower fequencies.
Discrimination of the phase of amplitude modulation applied to different carriers: Effects of modulation rate and modulation depth for young and older subjects
Authors: Moore Brian C. J. , Sęk Aleksander P.
Published: September 2019

The discrimination of amplitude modulation (AM) from frequency modulation (FM) of a 1000-Hz carrier, with equally detectable AM and FM, is better for a 2-Hz than for a 10-Hz modulation rate. This might reflect greater sensitivity to temporal fine structure for low than for high rates. Alternatively, AM-FM discrimination may depend on comparing fluctuations in excitation level on the two sides of the excitation pattern, which are in phase for AM and out of phase for FM. Discrimination of the relative phase of fluctuations might worsen with increasing rate, which could account for the effect of rate on AM-FM discrimination. To test this, discrimination of the phase of AM applied to two sinusoidal carriers was assessed, with a band of noise between the two carriers to prevent use of within-channel cues. Young and older subjects with normal hearing were tested. Performance was almost constant for AM rates from 2 to 10 Hz, but worsened at 20 Hz. Performance was near chance for AM depths near the detection threshold. The results suggest that the superior AM-FM discrimination at 2 Hz cannot be explained in terms of comparison of the phase of fluctuations on the two sides of the excitation pattern.
A systems mechanism for KRAS mutant allele–specific responses to targeted therapy
Authors: McFall Thomas , Diedrich Jolene K. , Mengistu Meron , Littlechild Stacy L. , Paskvan Kendra V. , Sisk-Hackworth Laura , Moresco James J. , Shaw Andrey S. , Stites Edward C.
Published: September 2019

A weak KRAS
G13D
-NF1 interaction explains why EGFR inhibitors show efficacy in certain CRC patients.
Direct Microscopic Observation of Human Neutrophil-Staphylococcus aureus Interaction
In Vitro
Suggests a Potential Mechanism for Initiation of Biofilm Infection on an Implanted Medical Device
Authors: Ghimire Niranjan , Pettygrove Brian A. , Pallister Kyler B. , Stangeland James , Stanhope Shelby , Klapper Isaac , Voyich Jovanka M. , Stewart Philip S.
Published: September 2019

The ability of human neutrophils to clear newly attached
Staphylococcus aureus
bacteria from a serum-coated glass surface was examined
in vitro
using time-lapse confocal scanning laser microscopy. Quantitative image analysis was used to measure the temporal change in bacterial biomass, neutrophil motility, and fraction of the surface area policed by neutrophils. In control experiments in which the surface was inoculated with bacteria but no neutrophils were added, prolific bacterial growth was observed.
Regulation of Cell Division in Bacteria by Monitoring Genome Integrity and DNA Replication Status
Authors: Burby Peter E. , Simmons Lyle A.
Published: September 2019

All organisms regulate cell cycle progression by coordinating cell division with DNA replication status. In eukaryotes, DNA damage or problems with replication fork progression induce the DNA damage response (DDR), causing cyclin-dependent kinases to remain active, preventing further cell cycle progression until replication and repair are complete.
Lethal Infection of Lassa Virus Isolated from a Human Clinical Sample in Outbred Guinea Pigs without Adaptation
Authors: Maruyama Junki , Manning John T. , Mateer Elizabeth J. , Sattler Rachel , Bukreyeva Natalya , Huang Cheng , Paessler Slobodan
Published: September 2019

Lassa virus, the causative agent of Lassa fever, is a zoonotic pathogen causing annual outbreaks in West African countries. Human patients can develop lethal hemorrhagic fever in severe cases. Although Lassa virus is one of the most alarming pathogens from a public health perspective, there are few available countermeasures, such as antiviral drugs or vaccines. Moreover, the fact that animal models are not readily accessible and the fact that mostly laboratory viruses, which have been passaged many times after isolation, are used for studies further limits the successful development of countermeasures. In this study, we demonstrate that a human isolate of Lassa virus causes lethal infection uniformly in Hartley guinea pigs. This novel animal model of Lassa fever may contribute to Lassa fever research and the development of vaccines and therapeutics.
Identification of a Polyketide Synthase Gene Responsible for Ascochitine Biosynthesis in
Ascochyta fabae
and Its Abrogation in Sister Taxa
Authors: Kim Wonyong , Lichtenzveig Judith , Syme Robert A. , Williams Angela H. , Peever Tobin L. , Chen Weidong
Published: September 2019

Fungi produce a diverse array of secondary metabolites, many of which are of pharmacological importance whereas many others are noted for mycotoxins, such as aflatoxin and citrinin, that can threaten human and animal health. The polyketide-derived compound ascochitine, which is structurally similar to citrinin mycotoxin, has been considered to be important for pathogenicity of legume-associated
Ascochyta
species. Here, we identified the ascochitine polyketide synthase (PKS) gene in
Ascochyta fabae
and its neighboring genes that may be involved in ascochitine biosynthesis. Interestingly, the ascochitine PKS genes in other legume-associated
Ascochyta
species have been mutated, encoding truncated PKSs. This indicated that point mutations may have contributed to genetic diversity for secondary metabolite production in these fungi. We also demonstrated that ascochitine is not a pathogenicity factor in
A. fabae
. The antifungal activities and production of ascochitine during sporulation suggested that it may play a role in competition with other saprobic fungi in nature.
Biological effect of tissue plasminogen activator (t-PA) and DNase intrapleural delivery in pleural infection patients
Authors: Kanellakis Nikolaos I , Wrightson John M , Hallifax Rob , Bedawi Eihab O , Mercer Rachel , Hassan Maged , Asciak Rachelle , Hedley Emma , Dobson Melissa , Dong Tao , Psallidas Ioannis , Rahman Najib M
Published: September 2019

Background

Pleural infection (PI) is a major global disease with an increasing incidence, and pleural fluid (PF) drainage is essential for the successful treatment. The MIST2 study demonstrated that intrapleural administration of tissue plasminogen activator (t-PA) and DNase, or t-PA alone increased the volume of drained PF. Mouse model studies have suggested that the volume increase is due to the interaction of the pleura with the t-PA via the monocyte chemoattractant protein 1 (MCP-1) pathway. We designed a study to determine the time frame of drained PF volume induction on intrapleural delivery of t-PA±DNase in humans, and to test the hypothesis that the induction is mediated by the MCP-1 pathway.

Methods

Data and samples from the MIST2 study were used (210 PI patients randomised to receive for 3 days either: t-PA and DNase, t-PA and placebo, DNase and placebo or double placebo). PF MCP-1 levels were measured by ELISA. One-way and two-way analysis of variance (ANOVA) with Tukey’s post hoc tests were used to estimate statistical significance. Pearson’s correlation coefficient was used to assess linear correlation.

Results

Intrapleural administration of t-PA±DNase stimulated a statistically significant rise in the volume of drained PF during the treatment period (days 1–3). No significant difference was detected between any groups during the post-treatment period (days 5–7). Intrapleural administration of t-PA increased MCP-1 PF levels during treatment; however, no statistically significant difference was detected between patients who received t-PA and those who did not. PF MCP-1 expression was not correlated to the drug given nor the volume of drained PF.

Conclusions

We conclude that the PF volume drainage increment seen with the administration of t-PA does not appear to act solely via activation of the MCP-1 pathway.
PP23 Evaluation of pre-hospital use of a valsalva assist device (VAD) in the Emergency treatment of supraventricular tachycardia (SVT). A randomised controlled feasibility trial [EVADE]
Authors: Green Jonathan , Ewings Paul , Appelboam Andy
Published: September 2019

Background

Supraventricular tachycardia (SVT) is a common heart rhythm disorder. The Valsalva Manoeuvre (VM) is a safe, internationally recommended, initial treatment, but has a low success rate in normal practice. Recent studies have shown much better cardioversion rates, approaching 50%, can be achieved using a postural modification (the modified VM) and a manometer controlled 40 mmHg strain. Successful cardioversion could avoid hospital conveyance and unpleasant treatments, such as adenosine. Routine use of a manometer is not practical out of hospital. Blowing on an empty syringe has been suggested as an alternative but is unreliable in providing correct and consistent pressures. A Valsalva Assist Device (VAD), designed to provide a 40 mmHg strain resistance has been developed. It is small, portable, can be packaged with instructions for the modified VM and if successful, may be left with the patient.

Methods

We conducted a pragmatic, randomised controlled feasibility trial, comparing VAD versus standard practice delivered VMs. All other aspects of care were according to SWASFT guidelines. Participants were followed up to ask their views on trial procedures.

Interim results (month 5 of 6)

23 volunteer Station Leads recruited 22 Study Clinicians from 27 ambulance stations. 29 patients were enrolled over 5 months, 19 in the last 2 months (the first 3 months included steady recruitment and setup). The later enrolment rate extrapolates to a presentation rate of approximately 220 eligible patients to SWASFT each year. Complete data sets were available in 100% of participants. When followed up, participants reported verbal consent to be widely acceptable, although SVT symptoms were substantially distracting for many during this process.

Conclusion

Our experience of recruitment and data collection suggest a definitive trial, using similar methodology, is possible, but the low occurrence rate may challenge feasibility. Consent taking methods may require refinement for a larger trial.
PP24 Lay understanding of head injury and when an ambulance might be needed: a mixed methods study
Authors: Halter Mary , Kulnik Stefan Tino , Hilton Ann , Baron Aidan , Garner Stuart , Jarman Heather
Published: September 2019

Background

Head injury results in a high use of emergency services, although most people with head injuries do not require hospitalisation. Conversely, some evidence suggests that lay recognition of the seriousness of head injury can be problematic, for example in sports settings.

Aim

To investigate how members of the public - parents of young children, school staff, sports coaches, informal carers of older adults, young adults and other adults - understood head injury terminology and when an emergency ambulance/999 call was required for head injury, against UK public guidance.

Methods

A mixed methods exploratory study, comprising of electronic and paper self-completion surveys across the UK and focus groups or interviews. Survey data were analysed statistically against the outcomes of understanding of terms and selection of the correct action by symptom. Focus group/interview data were analysed thematically.

Results

We received 520 survey responses, with respondents from across gender, age group, ethnicity and first aid experience. Out of 19 given signs and symptoms of head injury, participants could differentiate the most serious (e.g. unconsciousness 92% call 999) from those that could be observed (e.g. nausea 5%, and altered behaviour 5–30% call 999). The proportion of ‘correct’ actions ranged from just below half to almost 100%. Those aged 18–24 had a lower percentage of correct answers. Focus groups and/or interviews were held with 44 participants. Hypothetical scenarios elicited a range of responses, from calling 999 in any instance, to not calling in serious situations. Participants described ‘life experience’ as influential in the decision whether to call 999 or feel confident to observe.

Conclusion

Distinguishing severity of head injury was reported as difficult and confidence about the best course of action was low. The study was limited by regional recruitment biases, but supports the need for public health guidance in head injury.
PP26 Incidence of acute respiratory failure cases in west midlands ambulance service (WMAS) – sub-study of ACUTE (ambulance CPAP: use, treatment effect and economics) trial
Authors: Gunson Imogen M , Herbert Esther , Fuller Gordon
Published: September 2019

Background

Acute respiratory failure (ARF) is a life-threatening emergency and pre-hospital CPAP may improve outcomes. A CPAP cost-effectiveness determinant is the incidence of eligible patients with ARF. This sub-study of the ACUTE trial aimed to determine the number of adults with ARF potentially suitable for CPAP, presenting to WMAS.

Methods

This observational study was conducted between 1stAugust 2017 and 31stJuly 2018. Adult patients presenting with SpO2 <94% were identified from WMAS electronic patient records. Electronic filters applied ACUTE trial inclusion and exclusion criteria, with subsequent manual clinical review by a research paramedic. A second research paramedic checked a sub-sample for inter-rater agreement. Overall and monthly incidence rates were calculated, census data provided the population denominator.

Results

108,391 potential patients were identified from electronic patient records (EPR), after filter application 4,526 cases were eligible for review (Figure 1). After review, 1017 cases were considered CPAP candidates. Inter-rater agreement was 86%. Overall incidence was 17.35 per 100,000 population per year (95%CI 16.3–18.5). Marked seasonal variation was present, increasing over winter (Figure 2). Urban areas had the highest proportion of eligible patients (67.6% v 18.3% Rural v 14.2% semi-rural); and 53.0% of all eligible were male.

Conclusions

The incidence of eligible ARF patients impacts on the cost-effectiveness of pre-hospital CPAP, but previous reports have been variable, using sub-optimal methods or from non-UK settings. We report a valid NHS estimate of 17 patients per 100,000 who do not respond to current pre-hospital ARF management and could be candidates for CPAP.
PP29 ‘Breaking down Barriers: experiences from the first year of an ED to EMS feedback ‘Postbox
Authors: Sommers Nicola , Evans Lauren , Collingwood Terry , Dykes Linda
Published: September 2019

Background

‘Closing the feedback loop’ is an important part of clinical reflective practice, but case feedback can be difficult for EMS staff to access. Our ‘Paramedic Postbox’ opened in July 2017, enabling paramedics to request case feedback directly from Emergency Department doctors.

Aims

To review utilisation of our Postbox

To assess user satisfaction and user–reported educational benefits of the feedback

Method

The first 12 months of feedback requests were analysed.

User satisfaction data was obtained by inviting participation in an online survey (consent was obtained at the time of the feedback requests(s)).

Results

There were 148 feedback requests from 60 individuals in the first year. 76% used the Postbox more than once, with 15% using it more than five times. 33/60 Postbox users responded to the user survey, of which 32 had received their requested feedback and completed the questionnaire. All respondents were satisfied with the service (75% excellent, 25% good), would use it again, and recommend it to colleagues. User-reported goals when requesting feedback were to check their pre-hospital diagnosis (67%) or treatment given (39%), ascertain patient outcome (64%), as a specific question (15%) and all of these in 36%.

Two-thirds of users agreed the Postbox had allowed them to reflect on a case or clarify something they were unsure about, and half said they’d learned something new. 42% agreed their ‘practice had changed’ as a result. Free-text comments confirmed the Postbox is encouraging learning and changing behaviour.

Discussion

This feedback system is now well established in our ED and has been adopted by multiple other UK Emergency Departments. We are encouraged by the positive reception our Postbox has received, and especially the high rate of repeat use. In time, we hope to identify topics where paramedics feel under-confident, and explore the characteristics of the 15% ‘super-reflectors’.
OP7 Palliative care in paramedic practice: a retrospective cohort study
Authors: Lord Bill , Andrew Emily , Smith Karen , Henderson Amanda , Anderson David J , Bernard Stephen
Published: September 2019

Introduction

Paramedics may be involved in the care of patients experiencing a health crisis associated with palliative care. However, little is known about the paramedic’s role in the care of these patients. This study therefore aimed to describe the incidence and nature of cases attended by paramedics, the treatment provided, and the transport destination if transported, where the reason for attendance was associated with a history of palliative care.

Methods

This retrospective cohort study included all adult patients (aged > 17 years) attended by paramedics in the Australian state of Victoria between 1 July 2015 and 30 June 2016 where terms associated with palliative care, dying or end of life were recorded in the patient care record. Secondary transfers were excluded. Descriptive statistics were used to analyse the sample. Categorical data are presented as frequencies and proportions, with comparisons made using the χ2 test.

Results

4,348 cases met inclusion criteria. Most patients were aged between 61–80 years (47.9%). The most common assessments recorded by paramedics were ‘respiratory’ (20.1%), ‘pain’ (15.8%), and ‘deceased’ (7.9%). 54.0% (n=2,346) received treatment from the paramedics, and 74.4% (n=3,237) were transported, with the most common destination a hospital (99.5%, n=3,221). Of those with pain as the primary impression, 359 (53.9%) received an analgesic. Nausea and/or vomiting was documented in 15.6% (n=680) of cases attended. Antiemetics administered in these cases included metoclopramide (n=71, 10.4%), prochlorperazine (n=21, 3.1%), and ondansetron (n=9, 1.3%). Resuscitation was attempted in 98 (29.1%) of the 337 cases coded as cardiac arrest. Among non-transported cases, there were 105 (9.6%) cases where paramedics re-attended the patient within 24 hours of the previous attendance.

Discussion and conclusion

Paramedics may become involved in the care of patients receiving palliative care due to exacerbation of symptoms or a new health emergency. As such, the paramedic has a key role in managing symptoms or liaising with other members of the patient’s palliative care team to provide appropriate care. The results should inform integrated systems of care that involve ambulance services in the planning and delivery of community-based palliative care.
Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis
Authors: Cui Huiru , Jiang Lijuan , Wei Yanyan , Li Wei , Li Hui , Zhu Junjuan , Pang Jiaoyan , Wang Jijun , Li Chunbo
Published: September 2019

Background

Pharmacological and conventional non-pharmacological treatments are only moderately effective in treating generalised anxiety disorder (GAD). Recently, repetitive transcranial magnetic stimulation (rTMS) has attracted interest because of its potential therapeutic value.

Aim

To investigate the efficacy and safety of rTMS treatment for GAD.

Methods

Literature studies published in English or Chinese were screened in 10 electronic databases up to 5 December 2018. The included studies’ bias risk was assessed using Cochrane risk of bias assessment tool. Meta-analysis was performed to compute the standardised mean difference (SMD) and risk ratio (RR) along with its 95% CIs through using RevMan V.5.3. Heterogeneity was inspected by I2and the χ2test. We performed subgroup analysis and meta-regression to investigate heterogeneity. We used funnel plot to assess publication bias. We used the GRADE approach to assess the whole quality of evidence.

Results

Twenty-one studies, with a total sample size of 1481, were analysed. The risk of bias in most studies included is moderate, the majority of which are lacking of blinding methods of treatment allocation. The treatment had beneficial effects in the rTMS group compared with the control group in mean anxiety score (SMD=−0.68; 95% CI −0.89 to −0.46). None of the 21 studies included here reported severe adverse events. As for dropout rates, there are no statistically significant differences between the two groups (RR 1.14, 95% CI 0.72 to 1.82) or adverse events (RR 0.95, 95% CI 0.77 to 1.18). No particular influence on the heterogeneity of any variable was observed. The risk of publication bias was low. According to the GRADE approach, the evidence levels of primary outcome (treatment effects) and secondary outcomes (acceptability and safety) were rated as ‘medium’.

Conclusion

The use of rTMS combined with medication treatment may have a significant positive anti-anxiety effect on patients with GAD. However, we should interpret the results cautiously due to the relatively high heterogeneity of the meta-analysis. Future high-quality clinical trials are needed to confirm our results.