bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital entrepreneurship: towards a knowledge management perspective
Authors: Liu Weiwei , Liu Yuqi , Zhu Xiaoyu , Nespoli Pantaleone , Profita Francesca , Huang Lei , Xu Yimeng
Published: May 2023

Purpose

This study aims to present the critical role of knowledge management in digital entrepreneurship by reviewing the literature and proposing future research directions for digital entrepreneurship and knowledge management through an interdisciplinary framework.

Design/methodology/approach

This study uses the Derwent Data Analyzer to identify and visualise the extant studies on digital entrepreneurship. This study qualitatively analyses the hot topics and trends in digital entrepreneurship research to understand digital entrepreneurship from the knowledge management perspective.

Findings

The authors found two dominant trends in existing research: logical and development trend exploration at the theoretical background and empirical research at the practical dimension. To understand digital entrepreneurship from a knowledge management perspective, the authors summarised the theoretical logic and internal and external reasons why knowledge management is required in digital entrepreneurship. Moreover, the authors analysed the new features of digital entrepreneurship under five aspects: management concept, object, content, scope and focus. The authors concluded that existing research on integrating knowledge management and digital entrepreneurship is primarily conducted from three perspectives: technology, platform and ecosystem.

Originality/value

This study provides an in-depth analysis of digital entrepreneurship from a knowledge management perspective. The findings can further promote the theoretical research and practical development of digital entrepreneurship and knowledge management. This approach provides a new direction for interdisciplinary study and enriches entrepreneurship research. In addition, this study proposes a knowledge management framework for digital entrepreneurship research. The findings contribute to understanding the role and function of knowledge management in digital entrepreneurship.
Product and business process innovation, competitive advantage and export performance
Authors: Piñera-Salmerón José , Sanz-Valle Raquel , Jiménez-Jiménez Daniel
Published: May 2023

Purpose

This paper aims to contribute to the understanding of the relationship between innovation and export performance by examining the effect of different types of innovation on export performance and testing the assumption underlying most studies in the field that competitive advantage mediates this relationship.

Design/methodology/approach

From the literature review, this paper proposes a research model that is estimated using a sample of 200 Spanish exporting manufacturing companies. Data for this study were collected with an ad hoc questionnaire, and the partial least squares structural equation modeling technique was chosen to analyze the data.

Findings

The results show that there is a positive relationship between product and business process innovation and export performance and that competitive advantage mediates this relationship, but only when it is based on costs, not on differentiation.

Originality/value

This paper provides evidence that product and business process innovation are positively related to export performance and that competitive advantage mediates these relationships, but only when the advantage is low cost. Unexpectedly, this paper finds that differentiation is neither related to export performance nor explains the relationship between innovation and export performance.
Probability of default and political instability in the MENA region
Authors: Aliyu Sirajo , Mohammad Ahmed Rufai , Wahab Norazlina Abd.
Published: May 2023

Purpose

This study aims to empirically investigate the impact of political instability on the banking stability of the dual banking system in the Middle East and North African (MENA) countries.

Design/methodology/approach

The study measures banking stability with probability of default (PD) and Zscore by employing the generalised method of moment (GMM) between 2007 and 2021 on the dual banking system in the region. The authors further estimate short-long-run situations coupled with a robustness test using a generalised least square (GLS) model.

Findings

The authors' findings indicate that institutional factors of political stability, crisis period, high-crisis countries, law and order and macroeconomic indicators influence the two types of banking stability in the region. The authors found the consistency of the factors explaining stability in the region in both short-and long-run situations. Consequently, the study also reveals the adverse effects of crisis periods and high-crisis countries on banking stability.

Practical implications

The results of this study explicitly identify the critical need for sustaining political stability and abiding by laws and order to achieve dual banking stability in the region. Therefore, policymakers may consider allowing the region's banks to operate beyond retail banking since diversification enhances banking stability.

Originality/value

The authors' study balances by employing dual stability measurement in predicting the impact of political instability, law and order and other indicators on the MENA region's two banking models. This study uncovers the effect of the global crisis period on banking stability and high-crisis countries in the region and verifies the models' robustness.
The relationship between job burnout and intention to change occupation in the accounting profession: the mediating role of psychological well-being
Authors: Çollaku Lum , Aliu Muhamet , Ahmeti Skender
Published: May 2023

Purpose

This study aims to examine the relationship between job burnout, psychological well-being and intention to change occupation among accounting professionals. It focuses on the role of psychological well-being in explaining the link between job burnout and intention to change occupation.

Design/methodology/approach

Data were collected with the help of a structured questionnaire. The final sample includes 218 accounting professionals in the private sector. To test the hypothesized model in this study, IBM AMOS ver26 was used to perform the structural equation modeling (SEM).

Findings

The results of this study show that job burnout has a positive impact on the intention to change occupation and a negative impact on psychological well-being. In addition, psychological well-being was found to mediate the relationship between job burnout and intention to change occupation.

Practical implications

This study provides important implications for accounting firms and recommends that they implement the necessary practices to increase the psychological well-being of accounting staff to reduce job burnout and intention to change occupation.

Originality/value

This work complements current studies in the field of accounting by highlighting the intermediary role of psychological well-being on the relationship between job burnout and intention to change profession among accounting professionals.
Iranian traditional kefir beverage: isolation and identification of beneficial microorganisms and evaluation of antimicrobial activity against food-borne pathogens
Authors: Moghimani Minoo , Salari Afsaneh , Hashemi Mohammad , Soleimanpour Saman , Ranjbar Golnaz , Afshari Asma
Published: May 2023

Purpose

Kefir is a traditional fermented dairy beverage that has numerous health benefits due to the presence of bacteria and yeasts in an exopolysaccharide matrix. This study aims to isolate and identify beneficial microorganisms and evaluate the antimicrobial activity of kefir beverage against two important food-borne pathogens including Salmonella Typhimurium and Listeria monocytogenes.

Design/methodology/approach

Microorganisms were identified by the polymerase chain reaction with specific primers, and antimicrobial activity was evaluated by the disk diffusion method.

Findings

The following microorganisms were identified as natural inhabitants of the kefir grains: Leuconostoc lactis, Lactococcus lactis subspecies lactis, Streptococcus cremoris, Enterococcus faecalis, Enterococcus faecium, Lactobacillus helveticus, Leuconostoc mesenteroides, Lactobacillus fermentum, Lactobacillus reuteri, Lactobacillus plantarum, Lactobacillus casei, Bifidobacterium langum, Saccharomyces cerevisiae and Pichia fermentas. Also, the results obtained from the disk diffusion method showed the inhibitory effect of kefir milk on Salmonella Typhimurium and Listeria monocytogenes with an inhibitory average diameter of 8.3 ± 4–9.1 ± 2.8 and 3.4 ± 3–6.6 ± 3 mm, respectively.

Originality/value

The results of this study showed that Iranian traditional kefir beverage contained different species of lactic acid bacteria and yeasts and has antimicrobial activity against two important food-borne pathogens, Salmonella Typhimurium and Listeria monocytogenes, which the highest inhibitory effect was observed against Salmonella Typhimurium.
The mediating role of self-efficacy in the relationship between job satisfaction and commitment of employees working in the textile industry
Authors: Nanjundeswaraswamy T.S. , P. Nagesh , Bharath Sindu , K.M. Vignesh
Published: May 2023

Purpose

This study aims to explore the mediating role of self-efficacy and the relationship between job satisfaction and employee commitment.

Design/methodology/approach

The study is designed based on social cognitive theory. To collect the data, survey method is used in the present study. Questionnaires were distributed to the 75 randomly selected textile industry registered and located in Bengaluru city, India. Employees of 71 organizations participated in the survey. Out of 700 employees who received the email survey, 452 valid responses were considered for the data analysis. To examine the defined research hypothesis, a structural equation model is used.

Findings

The mediating analysis explored that the direct effect is 0.700, the indirect effect is 0.1730 and the total effect is 0.8731; it indicated that self-efficacy mediates the relationship between job satisfaction and employee commitment. Research also reveals that there is a positive relationship between self-efficacy, employee commitment and job satisfaction of employees working in the textile industry. The proposed measurement model statistics are as follows: CMIN = 2.322; df = 49; GFI = 0.958; AGFI = 0.934; NFI = 0.943; RFI = 0.923; IFI = 0.967; TLI = 0.955; CFI = 0.966. All these indices were nearer to unity.

Practical implications

The research findings provide insights to the management, practitioners and employers about the status of job satisfaction, self-efficacy and commitment of employees in textile organizations which will help make the strategies to increase the overall performance of the organization by enhancing the levels of job satisfaction, self-efficacy and commitment of textile industry employees.

Originality/value

To the best of the authors’ knowledge, this is the first study that tests the relationship among self-efficacy, job satisfaction and the mediating effect of self-efficacy of employees in Indian textile industries.
A novel hybrid approach GREG-fuzzy-GA for minimizing work piece temperature during 2.5D milling of Inconel625 super alloy
Authors: Kumar Satish , Gupta Arun , Kumar Anish , Chandna Pankaj , Bhushan Gian
Published: May 2023

Purpose

Milling is a flexible creation process for the manufacturing of dies and aeronautical parts. While machining thin-walled parts, heat generation during machining essentially affects the accuracy. The workpiece temperature (WT), as well as the responses like material removal rate (MRR) and surface roughness (SR) for input parameters like cutting speed (CS), feed rate (F), depth-of-cut (DOC), step over (SO) and tool diameter (TD), becomes critical for sustaining the accuracy of the thin walls.

Design/methodology/approach

Response surface methodology was used to make 46 tests. To convert the multi-character problem into a single-character problem, the weightage was assessed using the entropy approach and the grey relational coefficient (GRC) was determined. To investigate the connection among input parameters and single-objective (GRC), a fuzzy mathematical modelling technique was used. The optimal performance of process parameters was estimated by grey relational entropy grade (GREG)-fuzzy and genetic algorithm (GA) optimization.

Findings

SR was found to be a significant process parameter, with CS, feed and DOC, respectively. Similarly, F, DOC and TD were found to be significant process parameters with MRR, respectively, and F, DOC, SO and TD were found to be significant process parameters with WT, respectively. GREG-fuzzy-GA found more suitable for minimizing the WT with the constraint s of SR and MRR and provide maximum desirability of 0.665. The projected and experimental values have a good agreement, with a standard error of 5.85%, and so the responses predicted by the suggested method are better optimized.

Originality/value

The GREG-fuzzy-GA is a new hybrid technique for analysing Inconel625 behaviour during machining in a 2.5D milling process.
A note on disease burden and pharmaceutical R&D
Authors: Mohan Vijay , Nabin Munirul
Published: May 2023

We examine the relationship between research and development (R&D) expenditures and the expected impact of diseases in a simple theoretical framework that allows for intellectual property rights (IPR) protection to be strong or weak. In our theoretical model, an agent forms an expectation of the impact of a disease using a publicly available statistic on the (population level) disease burden, such as disability‐adjusted life year. We show that a profit‐maximising firm will exert relatively more R&D effort on diseases with intermediate expected impacts. We also discuss how a weak IPR regime alters the pattern of R&D investment.
Investigation of exopolysaccharide formation and its impact on anaerobic succinate production with Vibrio natriegens
Authors: Schulze Clarissa , Hädrich Maurice , Borger Jennifer , Rühmann Broder , Döring Manuel , Sieber Volker , Thoma Felix , Blombach Bastian
Published: May 2023

Vibrio natriegens is an emerging host for biotechnology due to its high growth and substrate consumption rates. In industrial processes typically fed‐batch processes are applied to obtain high space‐time yields. In this study, we established an aerobic glucose‐limited fed‐batch fermentation with the wild type (wt) of V. natriegens which yielded biomass concentrations of up to 28.4 gX L−1. However, we observed that the viscosity of the culture broth increased by a factor of 800 at the end of the cultivation due to the formation of 157 ± 20 mg exopolysaccharides (EPS) L−1. Analysis of the genomic repertoire revealed several genes and gene clusters associated with EPS formation. Deletion of the transcriptional regulator cpsR in V. natriegens wt did not reduce EPS formation, however, it resulted in a constantly low viscosity of the culture broth and altered the carbohydrate content of the EPS. A mutant lacking the cps cluster secreted two‐fold less EPS compared to the wt accompanied by an overall low viscosity and a changed EPS composition. When we cultivated the succinate producer V. natriegens Δlldh Δdldh Δpfl Δald Δdns::pycCg (Succ1) under anaerobic conditions on glucose, we also observed an increased viscosity at the end of the cultivation. Deletion of cpsR and the cps cluster in V. natriegens Succ1 reduced the viscosity five‐ to six‐fold which remained at the same level observed at the start of the cultivation. V. natriegens Succ1 ΔcpsR and V. natriegens Succ1 Δcps achieved final succinate concentrations of 51 and 46 g L−1 with a volumetric productivity of 8.5 and 7.7 gSuc L−1 h−1, respectively. Both strains showed a product yield of about 1.4 molSuc molGlc−1, which is 27% higher compared with that of V. natriegens Succ1 and corresponds to 81% of the theoretical maximum.
Alterations of bovine nucleus pulposus cells with aging
Authors: Molinos Maria , Fiordalisi Morena F. , Caldeira Joana , Almeida Catarina R. , Barbosa Mário A. , Gonçalves Raquel M.
Published: May 2023

Aging is one of the major etiological factors driving intervertebral disc (IVD) degeneration, the main cause of low back pain. The nucleus pulposus (NP) includes a heterogeneous cell population, which is still poorly characterized. Here, we aimed to uncover main alterations in NP cells with aging. For that, bovine coccygeal discs from young (12 months) and old (10–16 years old) animals were dissected and primary NP cells were isolated. Gene expression and proteomics of fresh NP cells were performed. NP cells were labelled with propidium iodide and analysed by flow cytometry for the expression of CD29, CD44, CD45, CD146, GD2, Tie2, CD34 and Stro‐1. Morphological cell features were also dissected by imaging flow cytometry. Elder NP cells (up‐regulated bIL‐6 and bMMP1 gene expression) presented lower percentages of CD29+, CD44+, CD45+ and Tie2+ cells compared with young NP cells (upregulated bIL‐8, bCOL2A1 and bACAN gene expression), while GD2, CD146, Stro‐1 and CD34 expression were maintained with age. NP cellulome showed an upregulation of proteins related to endoplasmic reticulum (ER) and melanosome independently of age, whereas proteins upregulated in elder NP cells were also associated with glycosylation and disulfide bonds. Flow cytometry analysis of NP cells disclosed the existence of 4 subpopulations with distinct auto‐fluorescence and size with different dynamics along aging. Regarding cell morphology, aging increases NP cell area, diameter and vesicles. These results contribute to a better understanding of NP cells aging and highlighting potential anti‐aging targets that can help to mitigate age‐related disc disease.
Age of Eucalyptus plantations differentially affects assemblages of surface‐active arthropods
Authors: Yekwayo Inam , Mwabvu Tarombera
Published: May 2023

Microhabitats and environmental conditions in eucalypts vary depending on the growth phase. Response of surface‐active arthropods to eucalypt growth phases is unclear; yet, it can be an important contribution in forest management. Thus, we investigated the response of surface‐active arthropods to three eucalypt age groups. We collected arthropods in a 7‐month‐old, 18‐month‐old, and 53‐month‐old eucalypts since planting. Eucalyptus age did not affect species richness. However, assemblages differed between the 53‐month‐old and 7‐month‐old eucalypts. Therefore, different eucalypt ages can enhance arthropod conservation, since they differ in terms of microhabitats and environmental conditions.
Trends in female sterilisations in New South Wales, 2010–2019
Authors: Yusuf Farhat , Leeder Stephen Ross
Published: May 2023

Background

Female sterilisation remains a common contraceptive method in many countries.

Aims

The aim is to analyse the recent changes in the incidence of female sterilisation in New South Wales (NSW).

Methods

Data were obtained from the NSW Admitted Patients Data Collection for all female patients who had undergone one of the five sterilisation procedures in a public or private hospitals in NSW during 2010 and 2019. Denominators for calculating sterilisation rates were estimated using census and other population data.

Results

The number of sterilisation cases dropped from 3407 in 2010 to 2561 in 2019, and the sterilisation rate declined from 22.6 per 10 000 females aged 20–49 in 2010 to 15.4 in 2019. Incidence was at its peak in the 35–39 age group in both years. Indigenous females had higher sterilisation rates than non‐Indigenous females born in Australia or overseas. While some foreign‐born females had higher sterilisation rates than for those who were in Australia or overseas on average their rates were lower than those who were born in Australia or overseas. There was a clear socio‐economic gradient such that females living in the most disadvantaged areas had much higher sterilisation rates than those living in the least disadvantaged areas. The Indigenous, ethnic and socio‐economic differences in sterilisation rates persisted in both years of this study.

Conclusion

Although fertility rates in NSW changed little over the 10‐year interval a steady decline in sterilisation occurred, consistent with other forms of contraception (particularly long‐acting reversible types) increasing concurrently in popularity.
(Farmer) Producer Companies in India as new generation cooperatives: Case studies of performance and impact from West Bengal, India
Authors: Singh Sukhpal
Published: May 2023

One of the innovative alternatives to the traditional cooperative structure has been the new generation cooperatives or cooperative companies, known as producer companies (PCs) in India since the early 2000s. This paper examines the impact of PCs on the member farmer livelihoods, which is not well studied, with the help of member and non‐member farmer interview survey in the Indian state of West Bengal. It is found that though the PCs were inclusive of small farmers in their membership, the PC interface with members for farm inputs was not very strong and the output linkage was poor, reaching only a small proportion of member farmers. The Sufal Bangla public supermarket franchise by some PCs was found to make a large difference to the PC performance and its impact on member farmers. The small size of membership in most case study PCs hindered the equity size, leading to working capital and market interface constraints. Therefore, it is important to encourage members to contribute more equity and to reward their output linkage.
Dynamics of domestic violence in Kashmir: An interplay of multiple factors
Authors: Bashir Aadil , Rafiq Misbah
Published: May 2023

Domestic violence is a widely prevalent phenomenon in the world. However, some of its features are culture‐specific. This study, therefore, attempts to study domestic violence in the context of Kashmir's culture. It draws on data collected through interviews with victims of domestic violence who were identified during a survey in Kashmir. The interview transcripts were analyzed and themes were drawn using the axial coding method (Corbin and Strauss). Classification of the themes into categories was based on similarities that they share and on the frequency with which they co‐occur. These categories gave a sense of dynamics of domestic violence operating in Kashmir. Data reveals that the causes of domestic violence in Kashmir operate at various levels, like individual, social, and cultural. Moreover, qualitative analysis of the interview transcripts visualize domestic violence in Kashmir as the interplay of the following categories, personal factors, communication factors, power factors, interpersonal factors, cultural factors, and situational factors. It is the geo‐political and social context of Kashmir that results in the unique dynamic of these causal factors which will help in designing and tailoring culture‐specific interventions to address the issue of domestic violence in Kashmir.
Implant survival/success and peri‐implant outcomes of titanium‐zirconium mini implants for mandibular overdentures: Results from a 1‐year randomized clinical trial
Authors: Curado Thalita Fernandes Fleury , Silva Jésio Rodrigues , Nascimento Lays Noleto , Leles José Luiz Rodrigues , McKenna Gerald , Schimmel Martin , Leles Cláudio Rodrigues
Published: May 2023

Objective

To report the 1‐year implant survival/success and peri‐implant outcomes of mandibular overdentures retained by four titanium‐zirconium mini implants (Straumann® Mini Implant System), and to assess how surgery and loading protocols influence these outcomes.

Materials and Methods

A 2 × 2 factorial randomized clinical trial (RCT) tested the combined effects of two loading protocols (immediate or delayed) and two surgical approaches (flapless or flapped) on the success/survival of the mini implants, and peri‐implant parameters (plaque, bleeding, sulcus depth, gingival position, and marginal bone loss). Outcomes were assessed up to 1‐year after loading, and generalized estimating equations (GEEs) were used to analyze longitudinal and within‐patient clustered data.

Results

Two hundred and ninety‐six implants were placed in 74 patients. The implant survival/success rates after 1 year were 100%, and no major biological complications were observed. After 1‐year, descriptive data suggest no noticeable changes in plaque scores, whilst a reduction in bleeding scores at the 6‐month and 1‐year follow‐ups compared to baseline. Good longitudinal stability was observed for the probing depth and gingival margin height measures. Overall mean marginal bone loss was 0.68 (±0.68) mm after 3 months and 0.89 (±0.75) mm after 1‐year. The flapless protocol showed better results on soft tissue stability and health but a slightly higher risk for marginal bone loss.

Conclusion

The results of this RCT suggest that mandibular overdentures retained by this novel mini implant system represent a safe and predictable treatment option as confirmed by implant survival/success and peri‐implant outcomes, even when flapless surgery and immediate loading protocols are adopted.
Incidence, characteristics, risk factors and outcomes of diabetic ketoacidosis in COVID‐19 patients: Comparison with influenza and pre‐pandemic data
Authors: Dell'Aquila Kevin , Lee Jeylin , Wang Stephen H. , Alamuri Tharun T. , Jennings Rebecca , Tang Helen , Mahesh Sandhya , Leong Taylor Jan , Fleysher Roman , Henninger Erin M. , Veeraraghavan Sudhakar , Mirhaji Parsa , Hou Wei , Herold Kevan C. , Duong Tim Q.
Published: May 2023

Aims

This study characterized incidence, patient profiles, risk factors and outcomes of in‐hospital diabetic ketoacidosis (DKA) in patients with COVID‐19 compared with influenza and pre‐pandemic data.

Methods

This study consisted of 13 383 hospitalized patients with COVID‐19 (March 2020‐July 2022), 19 165 hospitalized patients with influenza (January 2018‐July 2022) and 35 000 randomly sampled hospitalized pre‐pandemic patients (January 2017‐December 2019) in Montefiore Health System, Bronx, NY, USA. Primary outcomes were incidence of in‐hospital DKA, in‐hospital mortality, and insulin use at 3 and 6 months post‐infection. Risk factors for developing DKA were identified.

Results

The overall incidence of DKA in patients with COVID‐19 and influenza, and pre‐pandemic were 2.1%, 1.4% and 0.5%, respectively (p < .05 pairwise). Patients with COVID‐19 with DKA had worse acute outcomes (p < .05) and higher incidence of new insulin treatment 3 and 6 months post‐infection compared with patients with influenza with DKA (p < .05). The incidence of DKA in patients with COVID‐19 was highest among patients with type 1 diabetes (12.8%), followed by patients with insulin‐dependent type 2 diabetes (T2D; 5.2%), non‐insulin dependent T2D (2.3%) and, lastly, patients without T2D (1.3%). Patients with COVID‐19 with DKA had worse disease severity and higher mortality [odds ratio = 6.178 (4.428‐8.590), p < .0001] compared with those without DKA. Type 1 diabetes, steroid therapy for COVID‐19, COVID‐19 status, black race and male gender were associated with increased risk of DKA.

Conclusions

The incidence of DKA was higher in COVID‐19 cohort compared to the influenza and pre‐pandemic cohort. Patients with COVID‐19 with DKA had worse outcomes compared with those without. Many COVID‐19 survivors who developed DKA during hospitalization became insulin dependent. Identification of risk factors for DKA and new insulin‐dependency could enable careful monitoring and timely intervention.
Clinical outcomes associated with drugs for obesity and overweight: A systematic review and network meta‐analysis of randomized controlled trials
Authors: Iannone Andrea , Natale Patrizia , Palmer Suetonia C. , Nicolucci Antonio , Rendina Maria , Giorgino Francesco , Laviola Luigi , Di Leo Alfredo , Strippoli Giovanni F. M.
Published: May 2023

Aim

To compare the benefits and harms of drugs approved for weight management in adults with obesity or overweight.

Materials and Methods

We performed a systematic review of drugs approved for treating obesity and overweight. We searched MEDLINE, Embase and CENTRAL through 26 February 2023. Random‐effects network meta‐analysis was applied.

Results

A total of 168 trials (97 938 patients) were included. There was no evidence that drugs approved for weight management had different associations with cardiovascular death (69 trials, 59 037 participants). Naltrexone/bupropion was associated with lower cardiovascular mortality than placebo (odds ratio [OR], 0.62 [95% CI: 0.39, 0.99]; low certainty evidence). All drugs were associated with greater weight loss at 12 months than placebo (33 trials, 37 616 participants), mainly semaglutide (mean difference [MD], −9.02 kg [95% CI: −10.42, −7.63]; moderate certainty) and phentermine/topiramate (MD, −8.10 kg [95% CI: −10.14, −6.05]; high certainty); and with greater waist circumference reduction at 12 months than placebo (24 trials, 35 733 participants), mainly semaglutide (MD, −7.84 cm [95% CI: −9.34, −6.34]; moderate certainty) and phentermine/topiramate (MD, −6.20 cm [95% CI: −7.46, −4.94]; high certainty). Semaglutide and phentermine/topiramate were associated with lower or no difference in the odds of treatment withdrawal compared with all other drugs (87 trials, 70 860 participants).

Conclusions

Among adults with obesity or overweight, semaglutide and phentermine/topiramate were associated with greater body weight loss and waist circumference reduction at 12 months than all other drugs, and lower or no significant difference in risks of withdrawal. There was no evidence that drugs approved for weight management had different associations with cardiovascular death.
Glycaemic patterns of male professional athletes with type 1 diabetes during exercise, recovery and sleep: Retrospective, observational study over an entire competitive season
Authors: van Weenen Eva , Banholzer Nicolas , Föll Simon , Zueger Thomas , Fontana Federico Y. , Skroce Kristina , Hayes Charlotte , Kraus Mathias , Feuerriegel Stefan , Lehmann Vera , Scott Sam N. , Wortmann Felix , Stettler Christoph
Published: May 2023

Aims

To analyse glycaemic patterns of professional athletes with type 1 diabetes during a competitive season.

Materials and Methods

We analysed continuous glucose monitoring data of 12 professional male cyclists with type 1 diabetes during exercise, recovery and sleep on days with competitive exercise (CE) and non‐competitive exercise (NCE). We assessed whether differences exist between CE and NCE days and analysed associations between exercise and dysglycaemia.

Results

The mean glycated haemoglobin was 50 ± 5 mmol/mol (6.7 ± 0.5%). The athletes cycled on 280.8 ± 28.1 days (entire season 332.6 ± 18.8 days). Overall, time in range (3.9‐10 mmol/L) was 70.0 ± 13.7%, time in hypoglycaemia (<3.9 mmol/L) was 6.4 ± 4.7% and time in hyperglycaemia (>10 mmol/L) was 23.6 ± 12.5%. During the nights of NCE days, athletes spent 10.1 ± 7.4% of time in hypoglycaemia, particularly after exercise in the endurance zones. The CE days were characterized by a higher time in hyperglycaemia compared with NCE days (25.2 ± 12.5% vs. 22.2 ± 12.1%, p = .012). This was driven by the CE phase, where time in range dropped to 60.4 ± 13.0% and time in hyperglycaemia was elevated (38.5 ± 12.9%). Mean glucose was higher during CE compared with NCE sessions (9.6 ± 0.9 mmol/L vs. 7.8 ± 1.1 mmol/L, p < .001). The probability of hyperglycaemia during exercise was particularly increased with longer duration, higher intensity and higher variability of exercise.

Conclusions

The analysis of glycaemic patterns of professional endurance athletes revealed that overall glycaemia was generally within targets. For further improvement, athletes, team staff and caregivers may focus on hyperglycaemia during competitions and nocturnal hypoglycaemia after NCE.
Assessment of the mechanism of mitral valve prolapse in children: An echocardiography study
Authors: Sabry Ayman F. , Reller Mark D. , Evers Patrick D. , Madriago Erin J.
Published: May 2023

Background

The high complexity of mitral valve anatomy and function in mitral valve prolapse (MVP) is not yet fully understood.

Objective

The purpose of this study was to analyze each part of the mitral valve apparatus in children to determine its impact on the presence of MVP and to assess the interaction between the coaptation length (CL) and mitral regurgitation severity.

Methods

We prospectively analyzed transthoracic echocardiograms of 60 patients with MVP (mean age 9.8 ± 3.1 years). We compared these patients with 60 control patients without disease. We determined length of leaflets, chordal length, tenting area, coaptation CL, the intrapapillary muscle distance (IPMD) and relation between CL and severity of mitral regurgitation (MR).

Results

For patients with MVP, the posterior mitral leaflet (PML) was significantly enlarged 13.9 ± 4.1 mm versus 10.7 ± 3.5 mm (p < .01), the primary chordal length was significantly decreased 15.4 ± 3.61 mm versus 17.6 ± 3.8 mm (p < .02), and IPMD was significantly greater 18.1 ± 2.7 mm versus 16.6 ± 4.3 mm (p < .03). The difference between CL for both the anterior and posterior mitral leaflets correlated positively with MR (r = .249, p < .05). A greater than 4 mm CL correlated with at least MR (sensitivity 100%, specificity 72%) and greater than 5 mm correlated with at least moderate MR (sensitivity 100%, specificity 60%).

Conclusion

The majority of pediatric patients with mitral valve prolapse have structural abnormalities that are defined well by echocardiography. In addition to the presence of prolapse and regurgitation, routine assessment of leaflet length, thickness, chordal length and papillary muscle distance is fundamental for patients with MVP.
Venetoclax‐based salvage therapy for adult patients with relapsed/refractory acute lymphoblastic leukemia
Authors: Canaani Jonathan , Frisch Avraham , Pollyea Daniel A. , Schwartz Marc , Aumann Shlomzion , Ganzel Chezi , Haran Arnon , Even‐Zohar Noa Gross , Shaulov Adir , Vainstein Vladimir , Moshe Yakir , Ofran Yishai , Wolach Ofir , Nachmias Boaz
Published: May 2023

Objectives

Dysregulation of BCL‐2 family members has been reported in acute lymphocytic leukemia (ALL), with various BH3‐dependencies of the leukemic clone. We conducted a multicenter retrospective cohort of patients with relapsed/refractory B or T ALL, with ven‐chemotherapy or ven‐navitoclax combinations, to assess efficacy and safety.

Methods

Seventeen patients were included in the analysis, median age was 32 years, with 6 B‐ALL and 11 T‐ALL patients. Nine patients received venetoclax combined with chemotherapy, and 13 patients received venetoclax in combination with navitoclax, vincristine and asparaginase, of which 5 were already exposed to venetoclax in previous lines.

Results

ORR was 55% and 46% among the ven‐chemotherapy and the ven‐navitoclax‐chemotherapy, respectively. Most of the responders proceeded to an allogenic bone marrow transplant in both cohorts. The most common adverse effects of the ven‐navitoclax combination were infectious complications and hepatotoxicity.

Conclusions

Our data demonstrated the possible efficacy of ven‐chemotherapy and ven‐navitoclax in r/r ALL with moderate toxicity.
Increased demand for FAD synthesis in differentiated and stem pancreatic cancer cells is accomplished by modulating FLAD1 gene expression: the inhibitory effect of Chicago Sky Blue
Authors: Nisco Alessia , Carvalho Tiago M. A. , Tolomeo Maria , Di Molfetta Daria , Leone Piero , Galluccio Michele , Medina Milagros , Indiveri Cesare , Reshkin Stephan Joel , Cardone Rosa Angela , Barile Maria
Published: May 2023

FLAD1, along with its FAD synthase (FADS, EC 2.7.7.2) product, is crucial for flavin homeostasis and, due to its role in the mitochondrial respiratory chain and nuclear epigenetics, is closely related to cellular metabolism. Therefore, it is not surprising that it could be correlated with cancer. To our knowledge, no previous study has investigated FLAD1 prognostic significance in pancreatic ductal adenocarcinoma (PDAC). Thus, in the present work, the FAD synthesis process was evaluated in two PDAC cell lines: (a) PANC‐1‐ and PANC‐1‐derived cancer stem cells (CSCs), presenting the R273H mutation in the oncosuppressor p53, and (b) MiaPaca2 and MiaPaca2‐derived CSCs, presenting the R248W mutation in p53. As a control, HPDE cells expressing wt‐p53 were used. FADS expression/activity increase was found with malignancy and even more with stemness. An increased FAD synthesis rate in cancer cell lines is presumably demanded by the increase in the FAD‐dependent lysine demethylase 1 protein amount as well as by the increased expression levels of the flavoprotein subunit of complex II of the mitochondrial respiratory chain, namely succinate dehydrogenase. With the aim of proposing FADS as a novel target for cancer therapy, the inhibitory effect of Chicago Sky Blue on FADS enzymatic activity was tested on the recombinant 6His‐hFADS2 (IC50 = 1.2 μm) and PANC‐1‐derived CSCs' lysate (IC50 = 2–10 μm). This molecule was found effective in inhibiting the growth of PANC‐1 and even more of its derived CSC line, thus assessing its role as a potential chemotherapeutic drug.
Beyond “greening” and “browning”: Trends in grassland ground cover fractions across Eurasia that account for spatial and temporal autocorrelation
Authors: Lewińska Katarzyna Ewa , Ives Anthony R. , Morrow Clay J. , Rogova Natalia , Yin He , Elsen Paul R. , de Beurs Kirsten , Hostert Patrick , Radeloff Volker C.
Published: May 2023

Grassland ecosystems cover up to 40% of the global land area and provide many ecosystem services directly supporting the livelihoods of over 1 billion people. Monitoring long‐term changes in grasslands is crucial for food security, biodiversity conservation, achieving Land Degradation Neutrality goals, and modeling the global carbon budget. Although long‐term grassland monitoring using remote sensing is extensive, it is typically based on a single vegetation index and does not account for temporal and spatial autocorrelation, which means that some trends are falsely identified while others are missed. Our goal was to analyze trends in grasslands in Eurasia, the largest continuous grassland ecosystems on Earth. To do so, we calculated Cumulative Endmember Fractions (annual sums of monthly ground cover fractions) derived from MODIS 2002–2020 time series, and applied a new statistical approach PARTS that explicitly accounts for temporal and spatial autocorrelation in trends. We examined trends in green vegetation, non‐photosynthetic vegetation, and soil ground cover fractions considering their independent change trajectories and relations among fractions over time. We derived temporally uncorrelated pixel‐based trend maps and statistically tested whether observed trends could be explained by elevation, land cover, SPEI3, climate, country, and their combinations, all while accounting for spatial autocorrelation. We found no statistical evidence for a decrease in vegetation cover in grasslands in Eurasia. Instead, there was a significant map‐level increase in non‐photosynthetic vegetation across the region and local increases in green vegetation with a concomitant decrease in soil fraction. Independent environmental variables affected trends significantly, but effects varied by region. Overall, our analyses show in a statistically robust manner that Eurasian grasslands have changed considerably over the past two decades. Our approach enhances remote sensing‐based monitoring of trends in grasslands so that underlying processes can be discerned.
Efficacy of laparoscopic liver resection for small hepatocellular carcinoma located in the posterosuperior segments: A multi‐institutional study using propensity score matching by the Kyushu Study Group of Liver Surgery
Authors: Tokumitsu Yukio , Nagano Hiroaki , Yamashita Yo‐ichi , Yoshizumi Tomoharu , Hisaka Toru , Nanashima Atsushi , Kuroki Tamotsu , Ide Takao , Endo Yuichi , Utsunomiya Tohru , Kitahara Kenji , Kawasaki Yota , Sakota Masahiko , Okamoto Kohji , Takami Yuko , Kajiwara Masatoshi , Takatsuki Mitsuhisa , Beppu Toru , Eguchi Susumu
Published: May 2023

Aim

Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) located in the posterosuperior segments (PS) have generally been considered more difficult than those for HCC in anterolateral segments (AL), but may be safe and feasible for selected patients with accumulated experience. In the present study, we investigated the effectiveness of LLR for single nodular HCCs ≤3 cm located in PS.

Methods

In total, 473 patients who underwent partial liver resection for single nodular HCCs ≤3 cm at the 18 institutions belonging to the Kyusyu Study Group of Liver Surgery from January 2010 to December 2018 were enrolled. The short‐term outcomes of laparoscopic partial liver resection and open liver resection (OLR) for HCCs ≤3 cm, with subgroup analysis of PS and AL, were compared using propensity score‐matching analysis. Furthermore, results were also compared between LLR‐PS and LLR‐AL.

Results

The original cohort of patients with HCC ≤3 cm included 328 patients with LLR and 145 with OLR. After matching, 140 patients with LLR and 140 with OLR were analyzed. Significant differences were found between groups in terms of volume of blood loss (median, 55 vs. 287 ml, p < 0.001), postoperative complications (0.71 vs. 8.57%, p = 0.003), and postoperative hospital stay (median, 9 vs. 14 days, p < 0.001). The results of subgroup analysis of PS were similar. Short‐term outcomes did not differ significantly between LLR‐PS and LLR‐AL after matching.

Conclusions

Laparoscopic partial resection could be the preferred option for single nodular HCCs ≤3 cm located in PS.
Factors influencing decisions people with motor neuron disease make about gastrostomy placement and ventilation: A qualitative evidence synthesis
Authors: White Sean , O'Cathain Alicia , Halliday Vanessa , Croot Liz , McDermott Christopher J.
Published: May 2023

Background

People with motor neuron disease (pwMND) are routinely offered gastrostomy feeding tube placement and (non‐invasive and invasive) ventilation to manage the functional decline associated with the disease. This study aimed to synthesise the findings from the qualitative literature to understand how individual, clinical team and organisational factors influence pwMND decisions about these interventions.

Methods

The study design was guided by the enhancing transparency in reporting the synthesis of qualitative research (ENTREC) statement. The search of five bibliography databases and an extensive supplementary search strategy identified 27 papers that included qualitative accounts of pwMND, caregivers and healthcare professionals' (HCPs) experiences of making decisions about gastrostomy and ventilation. The findings from each study were included in a thematic synthesis.

Findings

Making decisions about interventions is an emotional rather than simply a functional issue for pwMND. The interventions can signal an end to normality, and increasing dependence, where pwMND consider the balance between quality of life and extending survival. Interactions with multiple HCPs and caregivers can influence the process of decision‐making and the decisions made. These interactions contribute to the autonomy pwMND are able to exert during decision‐making. HCPs can both promote and threaten pwMND perceived agency over decisions through how they approach discussions about these interventions. Though there is uncertainty over the timing of interventions, pwMND who agree to interventions report reaching a tipping point where they accept the need for change.

Conclusion

Discussion of gastrostomy and ventilation options generate an emotional response in pwMND. Decisions are the consequence of interactions with multiple external agents, including HCPs treading a complex ethical path when trying to improve health outcomes while respecting pwMND right to autonomy. Future decision support interventions that address the emotional response and seek to support autonomy have the potential to enable pwMND to make informed and timely decisions about gastrostomy placement and ventilation.

Patient or Public Contribution

The lead author collaborated with several patient and participant involvement (PPI) groups with regards to the conceptualisation and design of this project. Decisions that have been influenced by discussions with multiple PPI panels include widening the scope of decisions about ventilation in addition to gastrostomy placement and the perceptions of all stakeholders involved (i.e., pwMND, caregivers and HCPs).
Understanding barriers of eating unfamiliar fruits and vegetables in children using ‘Sensory Play’: a narrative review
Authors: Crawford Brooke , Low Julia Y.Q. , Newman Lisa
Published: May 2023

This narrative review focuses on the effects of ‘Sensory Play’ on young children's willingness to try new nutritious foods, particularly fruits and vegetables. Young children are often fussy when it comes to trying new nutritious foods. ‘Sensory Play’ is a type of early childhood sensory education that stimulates one, or more, of the five senses: taste, touch, smell, sight and sound. This review examines the literature on sensory‐based education and its effects on children's willingness to taste fruits and vegetables. Previous research has explored the use of ‘Sensory Play’ to introduce fruits and vegetables to young children, with promising results in increasing intake. However, there is a gap in research on the potential use of non‐taste exposure activities (i.e. activities that use the sense of touch, smell, sight and sound, but not taste) to increase children's willingness to try unfamiliar fruits and vegetables. The outcomes of this review explored the potential of how these sensory‐based educational tools can be used to decrease barriers of fruits and vegetables acceptance.
Encapsulated powders of Alcea flower polyphenol‐rich extract by different hydrocolloid carriers: characterisation, antioxidant activity and chemical structures
Authors: Kalajahi Sina Ghadimi , Malekjani Narjes , Samborska Katarzyna , Akbarbaglu Zahra , Gharehbeglou Pouria , Sarabandi Khashayar , Jafari Seid Mahdi
Published: May 2023

Alcea flower (as a natural source of antioxidants and colour) polyphenols might be easily deteriorated during processing and preservation. So, encapsulation is a suitable approach to overcome this problem. In this study, Alcea flower extract (AFE) was encapsulated using different carriers (maltodextrin (MD) and MD with gum arabic (GA), whey protein concentrate (WPC), and GA‐WPC). The production yield (~70%) was higher when MD‐WPC mixture or MD alone were used. The moisture content, water activity (aw), and wettability time of samples containing MD were less than other samples while their solubility was higher. Bulk and tapped density and also hygroscopicity were lowest in the samples produced using MD‐WPC, with improved flowability. The morphological characteristics of particles (matrix‐type particles with smooth and spherical surfaces in MD samples and wrinkled and indented in protein carriers) were affected by the carrier composition. Chemical structure evaluation (FTIR) indicated the successful coating of polyphenols in the carrier matrix. Generally, TPC (0.93 mg GAE mL−1) and retention of DPPH (82.4%), ABTS (94.1%), hydroxyl radical scavenging (77.2%) and reducing power (87.5%) of the samples produced with MD‐WPC were higher than other carriers.