bluuebunny/crossref_metadata_2025 huggingface dataset:
Subverting organizational IS policy with feral systems: a case in China
Authors: Davison Robert M. , Ou Carol X.J.
Published: February 2018

Purpose

The purpose of this paper is to investigate how selected employees in China deliberately subvert organizational information systems (IS) policy by developing feral working practices in order to gain access to the applications that they believe essential to work.

Design/methodology/approach

Interpretive case study.

Findings

Employees cannot accept the limited IT policy/environment imposed by corporate management and develop their own workarounds that subvert the organizational IT policy so as to ensure that they can get work done.

Research limitations/implications

The authors draw on elements of punctuated equilibrium theory to conceptualize the findings into four theoretical propositions. The authors encourage researchers to probe these organizational practices and solutions in depth.

Practical implications

Organizations cannot expect their digital native employees to leave their social media culture at home when they come to work. Social media penetrates all aspects of their lives and in all locations. Therefore, organizations must find a way to permit its use at work.

Originality/value

Subversion is a topic rarely studied in IS research, or in business/management more generally. The focus on the subversive behavior of organizational employees is original and important. The authors suggest that subversive behavior may be more common than the limited literature suggests.
Understanding adoption of intelligent personal assistants
Authors: Han Sangyeal , Yang Heetae
Published: February 2018

Purpose

The purpose of this paper is to develop a comprehensive research model that can explain customers’ continuance intentions to adopt and use intelligent personal assistants (IPAs).

Design/methodology/approach

This study proposes and validates a new theoretical model that extends the parasocial relationship (PSR) theory. Partial least squares analysis is employed to test the research model and corresponding hypotheses on data collected from 304 survey samples.

Findings

Interpersonal attraction (task attraction, social attraction, and physical attraction) and security/privacy risk are important factors affecting the adoption of IPAs.

Research limitations/implications

First, this is the first empirical study to examine user acceptance of IPAs. Second, to the authors’ knowledge, no research has been conducted to test the role of PSR in the context of IPAs. Third, this study verified the robustness of the proposed model by introducing new antecedents reflecting risk-related attributes, which has not been investigated in prior PSR research. But this study has limitations that future research may address. First, key findings of this research are based only on data from users in the USA. Second, individual differences among the survey respondents were not examined.

Practical implications

To increase the adoption of IPAs, manufacturers should focus on developing “human-like” and “professional” assistants, in consideration of the important role of PSR and task attraction. R&D should continuously strive to realize artificial intelligence technology advances so that IPAs can better recognize the user’s voice and speak naturally like a person. Collaboration with third-party companies or individual developers is essential in this field, as manufacturers are unable to independently develop applications that support the specific tasks of various industries. It is also necessary to enhance IPA device design and its user interface to enhance physical attraction.

Originality/value

This study is the first empirical attempt to examine user acceptance of IPAs, as most of the prior literature has concerned analysis of usage patterns or technical features.
Strategic response to Industry 4.0: an empirical investigation on the Chinese automotive industry
Authors: Lin Danping , Lee C.K.M. , Lau Henry , Yang Yang
Published: February 2018

Purpose

The purpose of this paper is to examine the strategic response to Industry 4.0 for Chinese automotive industry and to identify the critical factors for its successful implementation.

Design/methodology/approach

A technological, organizational, and environmental framework is used to build the structural models, and statistical tools are used to validate the model. The data analysis helps to determine which factors have impact on the strategic response and whether their relationships are positive or negative. Interpretive structural modeling method is applied to further analyze these derived factors for depicting the relationship.

Findings

The result shows that company size and nature do not increase the use of advanced production technologies, while other factors have positive impacts on improving the technology adoption among the companies surveyed.

Practical implications

A strategic response to Industry 4.0 not only helps in improving organizational competitiveness, but it also has social and economic implications. For this purpose, empirical data are collected to measure the understanding of Industry 4.0 in the Chinese automotive industry.

Originality/value

Despite the fact that the Chinese Government has proposed the “Made in China 2025” approach as a way to promote smart manufacturing, little empirical evidence exists in the literature validating company’s perspective toward Industry 4.0. This paper is to fill the research gap.
Earnings quality across different reporting regimes
Authors: Liu Siming , Skerratt Len
Published: February 2018

Purpose

Since the UK Companies Act 1981, different reporting standards have developed for different classes of company to reduce the reporting burden on non-listed companies. There are now different regimes for listed, large private, medium-sized, small and micro companies. This strategy raises the issue of whether earnings quality across the different classes of company is comparable. The paper aims to discuss this issue.

Design/methodology/approach

The paper uses the smoothness of earnings to measure reporting quality across the different types of companies from 2006 to 2013, based on 514,000 observations. Smoothness is an indicator of poor quality.

Findings

The authors find that listed companies have the highest earnings quality, closely followed by small and micro companies. In contrast, large private and medium-sized companies have much lower earnings quality. Overall, the authors find companies which switch between reporting regimes have lower earnings quality. The authors also find that earnings quality is not affected by the small company exemption from audit.

Research limitations/implications

Companies filing abbreviated accounts are excluded since they do not file an income statement. The recent revisions to UK GAAP (FRS 102 and FRS 105) are not examined due to insufficient data.

Practical implications

The Financial Reporting Council’s (FRC) strategy of reducing the financial reporting and auditing obligations for small companies seems not to have significantly affected earnings quality. However, the FRC may need to review the reporting requirements of large private and medium-sized companies and also the option of companies to switch between reporting regimes; in these settings earnings quality appears to be weaker.

Originality/value

The paper studies the effect of earnings quality across the different reporting regimes in the UK. Novel and important features of the study are that the sample covers a wide variety of small and micro companies which have not been analyzed previously; the results are disaggregated by year, for assurance that the results are not driven by a single rogue year; and the authors also address the small company exemption from audit, and the flexibility of non-listed companies to switch between regimes.
The impact of impinging TiO2 nanoparticles in Prandtl nanofluid along with endoscopic and variable magnetic field effects on peristaltic blood flow
Authors: Abdelsalam Sara I. , Bhatti Muhammad Mubashir
Published: February 2018

Purpose

The purpose of this paper is to study the variable magnetic field and endoscope effects on peristaltic blood flow of nanofluid containing TiO2 nanoparticles (NPs) through a porous annulus. The Prandtl fluid model is taken into account for the present flow. The mathematical modelling comprises the temperature, continuity, NP concentration, and equations of motion which are further simplified by taking a long peristaltic wave and creeping flow regime.

Design/methodology/approach

After using the long wavelength approximation, the obtained highly non-linear partial differential equations are solved using the homotopy perturbation scheme. The inclusion of the pertinent parameters is discussed mathematically and graphically for the pressure rise, friction forces, temperature profile, and concentration profile. The trapping phenomenon is also investigated with the help of contours.

Findings

Results show that the maximum velocity distribution exists near the centre of the annulus, whereas the average time flow boosts the velocity profile. It has also been shown that flow can pass readily without enormous pressure gradient imposed on the endoscope tube unlike the case of the slim section of the problem.

Practical implications

The nanofluids containing titanium NPs are increasingly utilised since such type of NPs is used by several manufacturers in sunscreen blockers and different types of endoscopy. In endoscopy, the variable magnetic field is used at the tip in order to detect or treat diseases. The NPs are used since they acquire specific thermal properties as compared with base fluids. The present study provides qualitative results showing the effect of inner tube of annulus on the fluid flow, the effect of variable magnetic field, and the change in the temperature profile on the flow field.

Originality/value

A new model is introduced that shows the utmost pressure that works against the positive peristaltic pump. It studies the blood flow that results in extremely non-linear partial differential equations that are solved by the homotopy perturbation method. The titanium NPs are being used in blocking the rays that penetrate the epidermis causing skin burns and short ultraviolet ageing rays that cause visible wrinkles, and thus are used in the manufacturing of sunscreens that are partially absorbed through the skin.
What is the ‘good’ forensic accountant? A virtue ethics perspective
Authors: Howieson Bryan
Published: February 2018

Purpose

The aim of this paper is to explore how virtue ethics might inform our understanding about what constitutes “good” practice in forensic accounting. In particular, the paper explores the concept of phronesis (or practical wisdom) as a basis for guiding the application of professional judgement in forensic accounting practice.

Design/methodology/approach

The paper draws on a review of relevant literature.

Findings

Prior literature has identified a number of technical and personal characteristics and attributes that are desirable in forensic accounting practitioners. Although being ethical is identified as an important characteristic, the question of what constitutes a “good” forensic accountant has not hitherto been investigated. Because of the profession’s multi-disciplinary and highly technical nature, forensic accountants are significantly at risk of conflating ethics with compliance with the law. The paper suggests that an understanding of virtue ethics and especially the virtue of “phronesis” or practical wisdom will help forensic accountants maintain public confidence and quality in their services and provide practical guidance on the exercise of professional judgement.

Practical implications

The paper suggests that the primacy currently given in forensic accounting literature and practice to a commercial logic, technical competencies and legal compliance risks damaging the professional standing of forensic accountants and, over time, reduces the ability of forensic accountants to exercise professional judgement in complex unstructured situations. Virtue ethics can act as a useful counter point to these threats.

Social implications

A recognition of the need for the forensic accounting profession to collectively develop phronesis would re-establish the primacy of the profession’s public interest logic and maintain public trust and quality in forensic accounting services.

Originality/value

There appears to be no prior literature in forensic accounting which explores the application of virtue ethics in this field. In addition, although virtue ethics has been the subject of some prior papers in accounting per se, the importance of phronesis as a basis for understanding the nature and application of professional judgement has not been addressed.
Related party transactions and finance company failure: New Zealand evidence
Authors: Bhuiyan Md. Borhan Uddin , Roudaki Jamal
Published: February 2018

Purpose

This paper aims to examine the existence of related party transactions (RPTs) in failed financial companies in New Zealand when firms have interlocking directors on the board. We also examine the role of auditors in the review of RPTs. We anticipate that inter-company director relationships promote RPTs, while reputable large auditors (i.e. Big4) restrict the practice.

Design/methodology/approach

This study uses multivariate analysis to examine the determinants of RPTs. We use an unique, hand-collected database of New Zealand finance companies all of which collapsed during the years 2006-2011.

Findings

Using a sample of 65 firms (including 38 failed finance firms) and 219 firm-year observations, we found that almost half of the failed finance firms were engaged in RPTs. For the failed firms, those that were engaged in RPTs were mostly represented by interlocking directors and were audited by non-Big4 auditors, implying lower monitoring quality may facilitate RPTs. Using a sub-sample, we also found evidence that firms engaged in RPTs were later convicted of questionable accounting and disclosure practices.

Practical implications

This research is beneficial to regulators and audit professionals in understanding the potential for adverse outcomes associated with interlocking directors and undisclosed RPTs. While interlocking directors could enrich the external connections of a firm which might facilitate capital resourcing, this study suggests regulators might encourage firms to disclose RPTs when the firm has higher interlocked directors.

Originality/value

This study is the first to examine the association between RPTs and interlocking directors using a sample of failed finance companies. RPTs and lack of disclosure were widely attributed with being the determinants of corporate failure in the finance sector. However, failed finance firms remain widely under-researched because of a lack of available data. This study circumvent this limitation by using print media and business news portals to collate information on RPTs and interlocking directors. While prior research indicates that weak corporate governance leads to poor accounting practice, using the interlocking board as a proxy for weak corporate governance, this study is the first to substantiate the adverse effect of interlocking boards and undisclosed RPTs with corporate failure.
Exploring evidence to develop a nomenclature for forensic accounting
Authors: Botes Vida , Saadeh Ahmed
Published: February 2018

Purpose

Large-scale financial scandals in business have increased public awareness of fraud and the need for forensic accounting (FA) services. Despite a steadily growing body of knowledge of FA, Huber (2012) argued that the term FA is ill defined. This paper aims to support the development of a nomenclature for FA by gathering evidence on the prevalence of the term in the Southern Hemisphere. Hence the authors ask how, when, where and in which context the term FA appears. In analysing the evidence gathered, the authors also aim to identify changes to the use of the term. Finally, they intend to make suggestions for future development and research relating to the term to advance knowledge. The authors also aim to suggest a definition for the term FA.

Design/methodology/approach

To obtain evidence to support the development of an accepted definition for FA, a rigorous search of the literature is performed, using a structured review framework.

Findings

The findings of this paper demonstrate the prevalence of the term FA in publications in Australia, New Zealand and South Africa, but that limited publications from SA create opportunities for researchers from emerging economies to publish in the FA field. This meta-analysis shows among others a strong focus on the role of FA in fraud prevention and increased reliance on websites (in contrast to reliance on academic literature) for information on FA. This research identifies changes to the use of the term and concludes that the narrow definition of FA prevails. Delivering on the third objective of this paper, the authors provide insights into future developments in FA and find that a need exists to explore FA in a much wider context.

Research limitations/implications

The research is limited to Australia, New Zealand and South Africa. Limitations exist in that the authors focused particularly on high-quality journals and excluded other journals from our search. As they were specifically searching for the use of the term “forensic accounting”, they excluded any other term, e.g. fraud auditing, from the research. Future research may well expand the search terminology.

Practical implications

Without an established definition of the commonly used term forensic accounting, the general public will be confused about the services that can be expected from forensic accountants. To date, FA definitions have been formulated mostly intuitively; however, if FA is to grow as a field, an accepted definition needs to be formulated.

Social implications

FA offers a new area of growth in the accounting field. Clarification of exactly what is meant by the term has implications for future careers in the field of accounting.

Originality/value

To date, no study of this nature has been undertaken anywhere in the world.
Supporting the direct involvement of students with disabilities in functional assessment through use of Talking Mats®
Authors: Bradshaw Jill , Gore Nick , Darvell Cathy
Published: February 2018

Purpose

Bowring et al. describe ways of using the Behavior Problems Inventory – Short Form, illustrating how to use clinical norms to evaluate change. This commentary focuses on the importance of considering information gained directly from people with intellectual and developmental disabilities (IDD) during assessment. The paper aims to discuss these issues.

Design/methodology/approach

A pilot project involved interviews with four children with IDD. A Talking Mats® (TM) framework was used to gather children’s views regarding challenging behaviours (CBs) and variables relevant to a functional behavioural assessment, such as things they found to be reinforcing, things that set the occasion for CB and things that helped prevent this.

Findings

The children were able to provide information and insight into several areas that are influential in the maintenance of behaviour that challenges. Some of this information may not have been obtainable from other sources or informants using traditional assessment methods alone.

Originality/value

Gathering the views of people with IDD is important. The Convention on the Rights of Persons with Disabilities (United Nations, 2009) states that people have the right to be heard. Many people with IDD have difficulties communicating. A TM framework is one method by which people may be able to express their views. Taking the views of the individual into account during the process of gathering information about behaviours that challenge should lead to greater understanding of the functions of any behaviours and therefore to more targeted, acceptable and effective forms of support.
Commentary on “Evaluating service users’ experiences of using Talking Mats®”
Authors: Harding Celia , Stewart Alison
Published: February 2018

Purpose

The purpose of this paper is to provide some thoughts following on from reading “Evaluating service users’ experiences of using Talking Mats®”.

Design/methodology/approach

This commentary outlines some considerations for the continued discussions about how to engage people who have profound and multiple learning disabilities.

Findings

The literature is not clear on the involvement of people with more profound and multiple learning disabilities, or for those who do not use much spoken language. Some papers have explored the notions of involvement and interpretation of pre-intentional communicators’ desires and interests.

Originality/value

There needs to be a robust discussion across carer, academic and service user communities to consider what the communication rights and needs are for people who have profound and multiple disabilities.
Full and equal equality
Authors: Redley Marcus
Published: February 2018

Purpose

This commentary takes the article, “Participation of adults with learning disabilities in the 2015 United Kingdom General Election”, as a jumping-off point for considering a tension between the aim of full and equal equality for all people with disabilities as set out in the Convention on the Rights of Persons with Disabilities and more traditional beliefs, that on occasion, it is necessary to deny legal autonomy of men and women with intellectual disabilities in order to protect them. The paper aims to discuss these issues.

Design/methodology/approach

This issue is explored by reviewing the multiple and often conflicting ways in which disability and intellectual disability are conceptualised.

Findings

Given the multiple and contradictory ways in which both disability and intellectual disability are understood, any discussion of the rights of persons with disabilities is going to be highly problematic.

Originality/value

Equal recognition before the law and the presumption that all persons with intellectual disabilities can – with support – make autonomous decisions could be treated as an empirical question.
Generating functions on covering groups
Authors: Ginzburg David
Published: February 2018

In this paper we prove a conjecture relating the Whittaker function of a certain generating function with the Whittaker function of the theta representation $\unicode[STIX]{x1D6E9}_{n}^{(n)}$. This enables us to establish that a certain global integral is factorizable and hence deduce the meromorphic continuation of the standard partial $L$ function $L^{S}(s,\unicode[STIX]{x1D70B}^{(n)})$. In fact we prove that this partial $L$ function has at most a simple pole at $s=1$. Here, $\unicode[STIX]{x1D70B}^{(n)}$ is a genuine irreducible cuspidal representation of the group $\text{GL}_{r}^{(n)}(\mathbf{A})$.
Gravitational waves from orbiting binaries without general relativity
Authors: Hilborn Robert C.
Published: February 2018

Using analogies with electromagnetic radiation, we present a calculation of the properties of gravitational radiation emitted by orbiting binary objects. The calculation produces results that have the same dependence on the masses of the orbiting objects, the orbital frequency, and the mass separation as do the results from the linear version of general relativity (GR). However, the calculation yields polarization, angular distributions, and overall power results that differ from those of GR. Nevertheless, the calculation produces waveforms that are very similar to those observed by the Laser Interferometer Gravitational-Wave Observatory (LIGO-VIRGO) gravitational wave collaboration in 2015 up to the point at which the binary merger occurs. The details of the calculation should be understandable by upper-level physics students and physicists who are not experts in GR.
Modeling analysis of ultrasonic attenuation and angular scattering measurements of suspended particles
Authors: Fleckenstein Peter , Storti Giuseppe , Deschwanden Fabian , Gruber Peter , Lattuada Marco
Published: February 2018

A combination of two models previously developed by Faran, and Atkinson and Kytömaa (Faran-AK model) was used to calculate the ultrasonic attenuation and the backscattering signal of a suspension of particles. The model of Atkinson and Kytömaa yielded the viscoelastic contributions while the model of Faran yielded the scattering contribution. A comparison with the more fundamental model by Epstein, Carhart, Allegra, and Hawley validated the combination, where the combination used here proved to be computationally less intensive and more stable. The Faran-AK model outputs were also compared with ultrasound measurements of glass beads with two different particle size distributions and varying concentrations. The comparison showed a very reasonable agreement of model and experiment.
Artificial intelligence faces reproducibility crisis
Authors: Hutson Matthew
Published: February 2018

Unpublished code and sensitivity to training conditions make many claims hard to verify.
U.K. moms are turning parenting into an experiment
Authors: Rabesandratana Tania
Published: February 2018

Unusual collaboration studies human milk, baby temperature, and schooling.
Isotope cloud linked to failed neutrino source
Authors: Cartlidge Edwin
Published: February 2018

Mishandling of spent fuel in Russia may have caused radioactivity to spread across Europe.
Wrapping with a splash: High-speed encapsulation with ultrathin sheets
Authors: Kumar Deepak , Paulsen Joseph D. , Russell Thomas P. , Menon Narayanan
Published: February 2018

It's a wrap

Whether an object has a regular or irregular shape, wrapping it with a thin film can be challenging. Kumar
et al.
released droplets of oil above thin polymer sheets floating on water (see the Perspective by Amstad). With sufficient impact force, the polymer wrapped around the droplet with near perfect seams. The shape of the resulting enclosed drop depended on the shape of the sheet initially placed at the air-liquid interphase.

Science
, this issue p.
775
; see also p.
743
Species turnover promotes the importance of bee diversity for crop pollination at regional scales
Authors: Winfree Rachael , Reilly James R. , Bartomeus Ignasi , Cariveau Daniel P. , Williams Neal M. , Gibbs Jason
Published: February 2018

Many, many more pollinators needed

Numerous studies have shown that biodiversity is necessary for ecosystem function. The majority of these, however, have taken place at relatively small experimental scales. Winfree
et al.
looked across more than 3000 square kilometers for relationships between biodiversity and crop pollination (see the Perspective by Kremen). The number of wild bee species required for successful pollination rapidly increased with spatial scale, largely owing to variation in the species present across sites and the degree to which the most abundant species played a role. In the end, more than an order of magnitude more species than predicted by smaller-scale experiments were required for full ecosystem functioning.

Science
, this issue p.
791
; see also p.
741
Was there ever really a “sugar conspiracy”?
Authors: Johns David Merritt , Oppenheimer Gerald M.
Published: February 2018

Twists and turns in science and policy are not necessarily products of malevolence
Response to Comment on “Selective anaerobic oxidation of methane enables direct synthesis of methanol”
Authors: Sushkevich Vitaly L. , Palagin Dennis , Ranocchiari Marco , van Bokhoven Jeroen A.
Published: February 2018

Labinger argues that stepwise reaction of methane with water to produce methanol and hydrogen will never be commercially feasible because of its substoichiometric basis with respect to the active site and the requirement of a large temperature swing. This comment is not touching any new ground, beyond describing the thermodynamic feasibility, thermal cycling, and the role of water as discussed previously. Most important, it does not have a solid numerical basis.
Coordinating the overall stomatal response of plants: Rapid leaf-to-leaf communication during light stress
Authors: Devireddy Amith R. , Zandalinas Sara I. , Gómez-Cadenas Aurelio , Blumwald Eduardo , Mittler Ron
Published: February 2018

Light stress in one part of a plant is communicated to other leaves to coordinate stomatal responses.
Condemned by metabolism
Authors: Wong Wei
Published: February 2018

The kinase RIP3 increases aerobic flux to produce reactive oxygen species, which enhances necrosome formation and necroptosis.
Jjj1 Is a Negative Regulator of Pdr1-Mediated Fluconazole Resistance in Candida glabrata
Authors: Whaley Sarah G. , Caudle Kelly E. , Simonicova Lucia , Zhang Qing , Moye-Rowley W. Scott , Rogers P. David
Published: February 2018

Candida glabrata
is the second most common species of
Candida
recovered from patients with invasive candidiasis. The increasing number of infections due to
C. glabrata
, combined with its high rates of resistance to the commonly used, well-tolerated azole class of antifungal agents, has limited the use of this antifungal class. This has led to the preferential use of echinocandins as empirical treatment for serious
Candida
infections. The primary mechanism of resistance found in clinical isolates is the presence of an activating mutation in the gene encoding the transcription factor Pdr1 that results in upregulation of one or more of the efflux pumps Cdr1, Pdh1, and Snq2. By developing a better understanding of this mechanism of resistance to the azoles, it will be possible to develop strategies for reclaiming the utility of the azole antifungals against this important fungal pathogen.
Antibiotic Stimulation of a Bacillus subtilis Migratory Response
Authors: Liu Yongjin , Kyle Steven , Straight Paul D.
Published: February 2018

Antibiotic resistance is a major challenge for the effective treatment of infectious diseases. Identifying adaptive mechanisms that bacteria use to survive low levels of antibiotic stress is important for understanding pathways to antibiotic resistance. Furthermore, little is known about the effects of individual bacterial interactions on multispecies communities. This work demonstrates that subinhibitory amounts of some antibiotics produced by streptomycetes induce active motility in
B. subtilis
, which may alter species interaction dynamics among species-diverse bacterial communities in natural environments. The use of antibiotics at subinhibitory concentrations results in many changes in bacteria, including changes in biofilm formation, small-colony variants, formation of persisters, and motility. Identifying the mechanistic bases of these adaptations is crucial for understanding how bacterial communities are impacted by antibiotics.
Evaluation of research on interventions aligned to WHO ‘Best Buys’ for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015
Authors: Allen Luke N , Pullar Jessica , Wickramasinghe Kremlin Khamarj , Williams Julianne , Roberts Nia , Mikkelsen Bente , Varghese Cherian , Townsend Nick
Published: February 2018

Background

Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, with low-income and middle-income countries experiencing a disproportionately high burden. Since 2010 WHO has promoted 24 highly cost-effective interventions for NCDs, dubbed ‘best buys’. It is unclear whether these interventions have been evaluated in low-income and lower-middle-income countries (LLMICs).

Aim

To systematically review research on interventions aligned to WHO ‘best buys’ for NCDs in LLMICs.

Methods

We searched 13 major databases and included papers conducted in the 83 World Bank-defined LLMICs, published between 1 January 1990 and 5 February 2015. Two reviewers independently screened papers and assessed risk of bias. We adopted a narrative approach to data synthesis. The primary outcomes were NCD-related mortality and morbidity, and risk factor prevalence.

Results

We identified 2672 records, of which 36 were included (608 940 participants). No studies on ‘best buys’ were found in 89% of LLMICs. Nineteen of the 36 studies reported on the effectiveness of tobacco-related ‘best buys’, presenting good evidence for group interventions in reducing tobacco use but weaker evidence for interventions targeting individuals. There were fewer studies on smoking bans, warning labels and mass media campaigns, and no studies on taxes or marketing restrictions. There was supportive evidence that cervical screening and hepatitis B immunisation prevent cancer in LLMICs. A single randomised controlled trial supported polypharmacy for cardiovascular disease. Fourteen of the ‘best buy’ interventions did not have any good evidence for effectiveness in LLMICs.

Conclusions

We found studies on only 11 of the 24 interventions aligned with the WHO ‘best buys’ from LLMIC settings. Most LLMICs have not conducted research on these interventions in their populations. LLMICs should take action to implement and evaluate ‘best buys’ in their national context, based on national priorities, and starting with interventions with the strongest evidence base.
Achieving universal health coverage in small island states: could importing health services provide a solution?
Authors: Suzana Mariyam , Walls Helen , Smith Richard , Hanefeld Johanna
Published: February 2018

Background

Universal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health services, rather than focus on domestic production. This paper provides empirical analysis of the potential impact of this option.

Methods

Analysis was based on publicly accessible data for 14 SIDS, covering health-related travel and health indicators for the period 2003–2013, together with in-depth review of medical travel schemes for the two highest importing SIDS—the Maldives and Tuvalu.

Findings

Medical travel from SIDS is accelerating. The SIDS studied generally lacked health infrastructure and technologies, and the majority of them had lower than the recommended number of physicians in a country, which limits their capacity for achieving UHC. Tuvalu and the Maldives were the highest importers of healthcare and notably have public schemes that facilitate medical travel and help lower the out-of-pocket expenditure on medical travel. Although different in approach, design and performance, the medical travel schemes in Tuvalu and the Maldives are both examples of measures used to increase access to health services that cannot feasibly be provided in SIDS.

Interpretation

Our findings suggest that importing health services (through schemes to facilitate medical travel) is a potential mechanism to help achieve universal healthcare for SIDS but requires due diligence over cost, equity and quality control.
Ethical implications of excessive cluster sizes in cluster randomised trials
Authors: Hemming Karla , Taljaard Monica , Forbes Gordon , Eldridge Sandra M , Weijer Charles
Published: February 2018

The cluster randomised trial (CRT) is commonly used in healthcare research. It is the gold-standard study design for evaluating healthcare policy interventions. A key characteristic of this design is that as more participants are included, in a fixed number of clusters, the increase in achievable power will level off. CRTs with cluster sizes that exceed the point of levelling-off will have excessive numbers of participants, even if they do not achieve nominal levels of power. Excessively large cluster sizes may have ethical implications due to exposing trial participants unnecessarily to the burdens of both participating in the trial and the potential risks of harm associated with the intervention. We explore these issues through the use of two case studies. Where data are routinely collected, available at minimum cost and the intervention poses low risk, the ethical implications of excessively large cluster sizes are likely to be low (case study 1). However, to maximise the social benefit of the study, identification of excessive cluster sizes can allow for prespecified and fully powered secondary analyses. In the second case study, while there is no burden through trial participation (because the outcome data are routinely collected and non-identifiable), the intervention might be considered to pose some indirect risk to patients and risks to the healthcare workers. In this case study it is therefore important that the inclusion of excessively large cluster sizes is justifiable on other grounds (perhaps to show sustainability). In any randomised controlled trial, including evaluations of health policy interventions, it is important to minimise the burdens and risks to participants. Funders, researchers and research ethics committees should be aware of the ethical issues of excessively large cluster sizes in cluster trials.
Patterns and management of chronic obstructive pulmonary disease in urban and rural China: a community-based survey of 25 000 adults across 10 regions
Authors: Kurmi Om P , Davis Kourtney J , Hubert Lam Kin Bong , Guo Yu , Vaucher Julien , Bennett Derrick , Wang Jenny , Bian Zheng , Du Huaidong , Li Liming , Clarke Robert , Chen Zhengming
Published: February 2018

Introduction

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with COPD deaths in China accounting for one-third of all such deaths. However, there is limited available evidence on the management of COPD in China.

Methods

A random sample of 25 011 participants in the China Kadoorie Biobank, aged 38–87 years, from 10 regions in China was surveyed in 2013–2014. Data were collected using interviewer-administered questionnaires on the diagnosis (‘doctor-diagnosed’ or ‘symptoms-based’) and management of COPD (including use of medication and other healthcare resources), awareness of diagnosis and severity of symptoms in COPD cases.

Results

Overall, 6.3% of the study population were identified as COPD cases (doctor-diagnosed cases: 4.8% and symptom-based cases: 2.4%). The proportion having COPD was higher in men than in women (7.9% vs 5.3%) and varied by about threefold (3.7%–10.0%) across the 10 regions. Among those with COPD, 54% sought medical advice during the last 12 months, but <10% reported having received treatment for COPD. The rates of hospitalisation for COPD, use of oxygen therapy at home and influenza or pneumococcal vaccinations in the previous year were 15%, 3% and 4%, respectively. Of those with COPD, half had moderate or severe respiratory symptoms, and over 80% had limited understanding of their disease and need for treatment.

Conclusion

Despite a high prevalence of COPD in China and its substantial impact on activities of daily living, knowledge about COPD and its management were limited.
Impact of frequent premature ventricular contractions on pregnancy outcomes
Authors: Tong Calvin , Kiess Marla , Deyell Marc William , Qiu Michael , Orgad Merav , Rychel Valerie , Claman Ariel , Hardwick Emma , McCarthy Beverly , Silversides Candice K , Grewal Jasmine
Published: February 2018

Objectives

To determine cardiac and fetal/neonatal event rates among pregnant women with premature ventricular contractions (PVCs) and compare with control groups.

Methods

Prospective case–control cohort study: 53 consecutive pregnancies in 49 women referred to the St. Paul’s Hospital between 2010 and 2016 with PVC burden >1% in women without underlying cardiac disease. Maternal cardiac and fetal/neonatal outcomes were compared with two pregnant control groups: (1) supraventricular tachycardia (SVT) group of 53 women referred for a history of SVT/SVT in the current pregnancy and (2) low-risk group of 53 women with no cardiac disease.

Results

The maximal PVC burden was 9.2% (range 1.1%–58.7%). Six of 53 (11%) pregnancies were complicated by a maternal cardiac event: heart failure n=1 and sustained ventricular tachycardia requiring therapy n=5 as compared with no cardiac events in both control groups. All women with an adverse event had a PVC burden >5%. Seven (13%) pregnancies were complicated by an adverse fetal and/or neonatal event and this was similar to the normal control group (5 (9%), P=0.45) and significantly less than the SVT group (16 (30%), P=0.03). The adverse fetal event was driven by small for gestational age neonates and preterm delivery.

Conclusions

In our cohort of pregnant women with a structurally normal heart and ‘high’ PVC burden, we found an adverse maternal event rate of 11%, and all events were successfully managed with medical therapy. The rate of adverse fetal events in the PVC group was similar to the normal control group.
Long-term impact of chronic total occlusion recanalisation in patients with ST-elevation myocardial infarction
Authors: Elias Joëlle , van Dongen Ivo M , Råmunddal Truls , Laanmets Peep , Eriksen Erlend , Meuwissen Martijn , Michels H Rolf , Bax Matthijs , Ioanes Dan , Suttorp Maarten Jan , Strauss Bradley H , Barbato Emanuele , Marques Koen M , Claessen Bimmer E P M , Hirsch Alexander , van der Schaaf René J , Tijssen Jan G P , Henriques José P S , Hoebers Loes P
Published: February 2018

Background

During primary percutaneous coronary intervention (PCI), a concurrent chronic total occlusion (CTO) is found in 10% of patients with ST-elevation myocardial infarction (STEMI). Long-term benefits of CTO-PCI have been suggested; however, randomised data are lacking. Our aim was to determine mid-term and long-term clinical outcome of CTO-PCI versus CTO-No PCI in patients with STEMI with a concurrent CTO.

Methods

The Evaluating Xience and left ventricular function in PCI on occlusiOns afteR STEMI (EXPLORE) was a multicentre randomised trial that included 302 patients with STEMI after successful primary PCI with a concurrent CTO. Patients were randomised to either CTO-PCI or CTO-No PCI. The primary end point of the current study was occurrence of major adverse cardiac events (MACE): cardiac death, coronary artery bypass grafting and MI. Other end points were 1-year left ventricular function (LVF); LV-ejection fraction and LV end-diastolic volume and angina status.

Results

The median long-term follow-up was 3.9 (2.1–5.0) years. MACE was not significantly different between both arms (13.5% vs 12.3%, HR 1.03, 95% CI 0.54 to 1.98; P=0.93). Cardiac death was more frequent in the CTO-PCI arm (6.0% vs 1.0%, P=0.02) with no difference in all-cause mortality (12.9% vs 6.2%, HR 2.07, 95% CI 0.84 to 5.14; P=0.11). One-year LVF did not differ between both arms. However, there were more patients with freedom of angina in the CTO-PCI arm at 1 year (94% vs 87%, P=0.03).

Conclusions

In this randomised trial involving patients with STEMI with a concurrent CTO, CTO-PCI was not associated with a reduction in long-term MACE compared to CTO-No PCI. One-year LVF was comparable between both treatment arms. The finding that there were more patients with freedom of angina after CTO-PCI at 1-year follow-up needs further investigation.

Clinical trial registration

EXPLORE trial number NTR1108 www.trialregister.nl.
Evaluation of the quality of RNA extracted from archival FFPE glioblastoma and epilepsy surgical samples for gene expression assays
Authors: Haynes Harry R , Killick-Cole Clare L , Hares Kelly M , Redondo Juliana , Kemp Kevin C , Moutasim Karwan A , Faulkner Claire , Wilkins Alastair , Kurian Kathreena M
Published: February 2018

Aims

Histopathological tissue samples are being increasingly used as sources of nucleic acids in molecular pathology translational research. This study investigated the suitability of glioblastoma and control central nervous system (CNS) formalin-fixed paraffin embedded (FFPE) tissue-derived RNA for gene expression analyses.

Methods

Total RNA was extracted from control (temporal lobe resection tissue) and glioblastoma FFPE tissue samples. RNA purity (260/280 ratios) was determined and RNA integrity number (RIN) analysis was performed. RNA was subsequently used for RT-qPCR for two reference genes,18SandGAPDH.

Results

Reference gene expression was equivalent between control and glioblastoma tissue when using RNA extracted from FFPE tissue, which has key implications for biological normalisation for CNS gene expression studies. There was a significant difference between the mean RIN values of control and glioblastoma FFPE tissue. There was no significant correlation between 260/280 or RIN values versus total RNA yield. The age of the tissue blocks did not influence RNA yield, fragmentation or purity. There was no significant correlation between RIN or 260/280 ratios and mean qPCR cycle threshold for either reference gene.

Conclusions

This study showed that routinely available CNS FFPE tissue is suitable for RNA extraction and downstream gene expression studies, even after 60 months of storage. Substantial RNA fragmentation associated with glioblastoma and control FFPE tissue blocks did not preclude downstream RT-qPCR gene expression analyses. Cross validation with both archival and prospectively collated FFPE specimens is required to further demonstrate that CNS tissue blocks can be used in novel translational molecular biomarker studies.
Post-Brexit views of European Union doctors on their future in the NHS: a qualitative study
Authors: Chick William , Exworthy Mark
Published: February 2018

Background/aim

Following large-scale surveys suggesting that large proportions of European doctors are considering leaving the National Health Service (NHS) following the Brexit referendum, this was the first qualitative study assessing if, and how, Brexit has affected European Union (EU) doctors’ views of working in the NHS and their future intentions.

Methods

Data were collected from 17 semistructured, qualitative interviews with doctors working at two NHS England trusts, who either had citizenship or had received their primary medical qualification from a member state of the European Economic Area. Transcripts from the interviews were then subjected to thematic content analysis.

Results

Despite the majority of EU doctors believing that Brexit would not affect their jobs or rights in the UK, for many the referendum itself and its political handling had made them feel unwanted, undervalued and uncertain about their futures in the NHS. Most doctors intended to remain working in the UK; however, for several interviewees, this, along with fears regarding their future working conditions, had led to them considering leaving the NHS.

Conclusions

Some European doctors are now considering leaving the NHS following the Brexit referendum, and their retention will be partly dependent on whether the government and the NHS can persuade them that they are both wanted and valued in the UK, and that their future working conditions will not be significantly affected.