bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of the Emerging Financial Holding Company Model on Small Business Borrowers' Financial Welfare: Contemporary Evidence from Nigeria Based on the Monti‐Klein Approach
Authors: Asogwa Cosmas Ikechukwu , Uzuagu Anthonia Uju , Okereke Godwin Keres Okoro , Omeje Hyginus , Abolarinwa Samson Ige , Azubuike Roseline Nkemakolam , Chukwuma Joseph Ndozianyichukwu
Published: April 2018

This study exploits the adequacy of the Monti‐Klein model to analyse the banking firms' lending behaviour and uses the geometric lag analytic model to detect the lifespan of bank conglomeration impacts on small business financial welfare. We find that, although the impact of emerging conglomerate banks on lending to small businesses is significantly negative (δ = −0.6897;p < 0.01), the effect reverses to a pre‐conglomerate positive status within one year. Hence, bank conglomeration does not negatively affect the financial welfare of small business borrowers in the long run. Contrary to the widespread belief and fear, the negative effects are not permanent. Large banks are feared to have no time for mid‐sized businesses. We find, however, that mere increases in size, as may be caused by economic or internal growth, do not pose a threat to small businesses. Large‐sized banking firms positively and significantly correlate with small and predictable risks (δ = 1.7935;p < 0.01). Hence, contrary to what regulators fear, there is no real issue surrounding the idea that building diversifying banks will influence small business loans negatively. What matters is the means through which large banks emerge. Therefore, regulators ought to exercise caution so that they do not discourage their emergence.
Volatilité de l'inflation, gouvernance et investissements directs étrangers entrants en Afrique sub‐saharienne
Authors: Bobbo Amadou
Published: April 2018

L'objectif de cet article est d'analyser les effets de l'interaction entre la volatilité de l'inflation et la qualité de la gouvernance sur les investissements directs étrangers (IDE) d'un échantillon de 34 pays de l'Afrique subsaharienne sur la période 1996‐2014. Pour cela, en nous appuyant sur la méthodologie d'Okada (), nous spécifions en panel dynamique, la relation qui définit les IDE en fonction de ses principaux déterminants. L'estimation par la méthode des moments généralisés en différences et en système (Diff‐GMM et Sys‐GMM) de ladite relation aboutit à deux principaux résultats: (1) la volatilité de l'inflation affecte négativement l'attractivité des IDE, (2) l'amélioration de la qualité de la gouvernance diminue l'impact négatif de la volatilité de l'inflation sur l'attractivité des IDE. Ces résultats invitent les autorités politiques africaines à améliorer la qualité de leurs institutions, à l'effet d'attirer davantage les IDE et faciliter l'accession de leurs pays au club des économies émergentes.
Developmental toxicity of flucytosine following administration to pregnant rats at a specific time point of organogenesis
Authors: Fujii Sakiko , Yabe Kaoru , Kariwano‐Kimura Yuki , Furukawa Masatoshi , Itoh Kouta , Matsuura Masao , Horimoto Masao
Published: April 2018

To investigate the abnormalities that are specific to administration of flucytosine at one time point during embryonic organogenesis, flucytosine was administered orally to pregnant Sprague Dawley (SD) rats in a single dose on day 11 of pregnancy at 25 or 35 mg/kg. Fetuses on day 20 of pregnancy were externally, viscerally, and skeletally examined. Maternal body weight gain and food consumption were suppressed the day after administration of a 35 mg/kg. Fetal examinations revealed various alterations in both dose groups: externally preaxial polydactyly in the hind limb; skeletally fused lumbar centrum, absent sacral centrum, supernumerary sacral vertebra, and absent ribs. Our findings indicated that specific types of external and skeletal anomalies were induced following flucytosine administration on day 11 of pregnancy.
Performative Progressiveness: Accounting for New Forms of Inequality in the Gayborhood
Authors: Brodyn Adriana , Ghaziani Amin
Published: April 2018

Attitudes toward homosexuality have liberalized considerably, but these positive public opinions conceal the persistence of prejudice at an interpersonal level. We use interviews with heterosexual residents of Chicago gayborhoods—urban districts that offer ample opportunities for contact and thus precisely the setting in which we would least expect bias to appear—to analyze this new form of inequality. Our findings show four strategies that liberal–minded straights use to manage the dilemmas they experience when they encounter their gay and lesbian neighbors on the streets: spatial entitlements, rhetorical moves, political absolution, and affect. Each expression captures the empirical variability of performative progressiveness, a concept that describes the co–occurrence of progressive attitudes alongside homonegative actions. Our analyses have implications more broadly for how conflicting visions of diversity affect placemaking efforts; how residents with power and privilege redefine cultural enclaves in the city; and the mechanisms that undermine equality in a climate of increasing acceptance.
Estimation of glycaemic control in the past month using ratio of glycated albumin to HbA1c
Authors: Musha I. , Mochizuki M. , Kikuchi T. , Akatsuka J. , Ohtake A. , Kobayashi K. , Kikuchi N. , Kawamura T. , Yokota I. , Urakami T. , Sugihara S. , Amemiya S. ,   the Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes
Published: April 2018

Aims

To evaluate comprehensively the use of the glycated albumin to HbA1c ratio for estimation of glycaemic control in the previous month.

Methods

A total of 306 children with Type 1 diabetes mellitus underwent ≥10 simultaneous measurements of glycated albumin and HbA1c. Correlation and concordance rates were examined between HbA1c measurements taken 1 month apart (ΔHbA1c) and glycated albumin/HbA1c ratio fluctuations were calculated as Z‐scores from the cohort value at enrolment of this study cohort (method A) or the percent difference from the individual mean over time (method B).

Results

Fluctuations in glycated albumin/HbA1c ratio (using both methods) were weakly but significantly correlated with ΔHbA1c, whereas concordance rates were significant for glycaemic deterioration but not for glycaemic improvement. Concordance rates were higher using method B than method A.

Conclusions

The glycated albumin/HbA1c ratio was able to estimate glycaemic deterioration in the previous month, while estimation of glycaemic improvement in the preceding month was limited. Because method B provided a better estimate of recent glycaemic control than method A, the individual mean of several measurements of the glycated albumin/HbA1c ratio over time may also identify individuals with high or low haemoglobin glycation phenotypes in a given population, such as Japanese children with Type 1 diabetes, thereby allowing more effective diabetes management.
Fostering Constructive Action by Peers and Bystanders in Organizations and Communities
Authors: Rowe Mary
Published: April 2018

Peers and bystanders play important roles in organizational and community conflict management. Bystanders often learn relevant information and have opportunities to act in ways that can affect three of the basic functions of a conflict management system (CMS.) They can help (or not help) to identify, assess, and manage behaviors that the organization or community deems to be “unacceptable.” Examples in which bystanders play important roles include sexual and racial harassment, safety violations, unethical research, national security violations and insider threats, cyber‐bullying and cyber‐sabotage, violence, fraud, theft, intimidation and retaliation, and gross negligence. Bystanders often are a missing link in conflict systems.

For the purposes of this article, I define peers and bystanders as people who observe or learn about unacceptable behavior by others, but who are not the relevant supervisors, or who knowingly engage in planning or executing that behavior. I define CMS managers as all those people, including line managers, who have responsibility for managing conflicts. Conflict managers face many challenges in fostering constructive behavior from bystanders. The interests of bystanders may or may not coincide with the interests of conflict systems managers in an organization or community. Bystanders often have multiple, idiosyncratic, and conflicting interests, and experience painful dilemmas. In addition, peers and bystanders, and their contexts – often differ greatly from each other. Blanket rules about how all bystanders should behave, such as requirements for mandatory reporting, are often ineffective or lead to perverse results.

Bystanders are regularly equated with “do‐nothings,” in the popular press. In real life, however, helpful bystander actions are common. Many bystanders report a wide variety of constructive initiatives, including private, informal interventions. In this article, I report on forty‐five years of observations on bystanders in many milieus. I present what bystanders have said are the reasons that they did not – or did – take action, and what can be learned to help organizations and communities to support bystanders to be more effective when faced with unacceptable behavior.
Physical and Physiological Demands of Elite Rugby Union Officials
Authors: Blair Matthew R. , Elsworthy Nathan , Rehrer Nancy J. , Button Chris , Gill Nicholas D.
Published: April 2018

Purpose: To examine the movement and physiological demands of rugby union officiating in elite competition. Methods: Movement demands of 9 elite officials across 12 Super Rugby matches were calculated, using global positioning system devices. Total distance (in m), relative distance (in m·min−1), and percentage time spent in various speed zones were calculated across a match. Heart-rate (HR) responses were also recorded throughout each match. Cohen d effect sizes were reported to examine the within-match variations. Results: The total distance covered was 8030 (506) m, with a relative distance of 83 (5) m·min−1 and with no differences observed between halves. Most game time was spent at lower movement speeds (76% [2%]; <2.0 m·s−1), with large effects for time spent >7.0 m·s−1 between halves (d = 2.85). Mean HR was 154 (10) beats·min−1 (83.8 [2.9]%HRmax), with no differences observed between the first and second halves. Most game time was spent between 81%HRmax and 90%HRmax (40.5% [7.5%]) with no observable differences between halves. Distances covered above 5.1 m·s−1 were highest during the first 10 min of a match, while distance at speeds 3.7 to 5 m·s−1 decreased during the final 10 min of play. Conclusions: These findings highlight the highly demanding and intermittent nature of rugby union officiating, with only some minor variations in physical and physiological demands across a match. These results have implications for the physical preparation of professional rugby union referees.
Strong coupling superconductivity in a quasiperiodic host-guest structure
Authors: Brown Philip , Semeniuk Konstantin , Wang Diandian , Monserrat Bartomeu , Pickard Chris J. , Grosche F. Malte
Published: April 2018

The quasiperiodic structure of high-pressure bismuth gives rise to unusually strong electron-phonon coupling.
High-performance and scalable metal-chalcogenide semiconductors and devices via chalco-gel routes
Authors: Kwon Sung Min , Won Jong Kook , Jo Jeong-Wan , Kim Jaehyun , Kim Hee-Joong , Kwon Hyuck-In , Kim Jaekyun , Ahn Sangdoo , Kim Yong-Hoon , Lee Myoung-Jae , Lee Hyung-ik , Marks Tobin J. , Kim Myung-Gil , Park Sung Kyu
Published: April 2018

Chalco-gel–based metal-chalcogenide semiconductors and scalable high-performance electronic devices were demonstrated.
Antimicrobial and Antibiofilm Efficacy of Graphene Oxide against Chronic Wound Microorganisms
Authors: Di Giulio Mara , Zappacosta Romina , Di Lodovico Silvia , Di Campli Emanuela , Siani Gabriella , Fontana Antonella , Cellini Luigina
Published: April 2018

Chronic wounds represent an increasing problem worldwide. Graphene oxide (GO) has been reported to exhibit strong antibacterial activity toward both Gram-positive and Gram-negative bacteria. The aim of this work was to investigate the
in vitro
antimicrobial and antibiofilm efficacy of GO against wound pathogens.
Staphylococcus aureus
PECHA 10,
Pseudomonas aeruginosa
PECHA 4, and
Candida albicans
X3 clinical isolates were incubated with 50 mg/liter of GO for 2 and 24 h to evaluate the antimicrobial effect. Optical and atomic force microscopy images were performed to visualize the effect of GO on microbial cells. Moreover, the antibiofilm effect of GO was tested on biofilms, both in formation and mature. Compared to the respective time controls, GO significantly reduced the
S. aureus
growth both at 2 and 24 h in a time-dependent way, and it displayed a bacteriostatic effect in respect to the GO
t
= 0; an immediate (after 2 h) slowdown of bacterial growth was detected for
P. aeruginosa
, whereas a tardive effect (after 24 h) was recorded for
C. albicans
. Atomic force microscopy images showed the complete wrapping of
S. aureus
and
C. albicans
with GO sheets, which explains its antimicrobial activity. Moreover, significant inhibition of biofilm formation and a reduction of mature biofilm were recorded for each detected microorganism. The antibacterial and antibiofilm properties of GO against chronic wound microorganisms make it an interesting candidate to incorporate into wound bandages to treat and/or prevent microbial infections.
Characterizing Blood-Stage Antimalarial Drug MIC Values
In Vivo
Using Reinfection Patterns
Authors: Watson James , Chu Cindy S. , Tarning Joel , White Nicholas J.
Published: April 2018

The MIC is an essential quantitative measure of the asexual blood-stage effect of an antimalarial drug. In areas of high malaria transmission, and thus frequent individual infection, patients who are treated with slowly eliminated antimalarials become reinfected as drug concentrations decline. In the frequent relapse forms of
Plasmodium vivax
and in
Plasmodium ovale
malaria, recurrent infection occurs from relapses which begin to emerge from the liver approximately 2 weeks after the primary illness. An important determinant of the interval from starting treatment of a symptomatic infection to the patency of these recurrent infections is the
in vivo
concentration-response relationship and thus the
in vivo
MIC. Using mechanistic knowledge of parasite asexual replication and the pharmacokinetic and pharmacodynamic properties of the antimalarial drugs, a generative statistical model was derived which relates the concentration-response relationship to time of reinfection patency. This model was used to estimate the
in vivo
MIC of chloroquine in the treatment of
Plasmodium vivax
malaria.
Antimicrobial Resistance inChlamydiales,Rickettsia,Coxiella, and Other Intracellular Pathogens
Authors: Vanrompay Daisy , Nguyen Thi Loan Anh , Cutler Sally J. , Butaye Patrick
Published: April 2018

This article will provide current insights into antimicrobial susceptibilities and resistance of an important group of bacterial pathogens that are not phylogenetically related but share lifestyle similarities in that they are generally considered to be obligate intracellular microbes. As such, there are shared challenges regarding methods for their detection and subsequent clinical management. Similarly, from the laboratory perspective, susceptibility testing is rarely undertaken, though molecular approaches might provide new insights. One should also bear in mind that the highly specialized microbial lifestyle restricts the opportunity for lateral gene transfer and, consequently, acquisition of resistance.
Tracking the Rules of Transmission and Introgression with Networks
Authors: Vigliotti* Chloé , Bicep* Cédric , Bapteste Eric , Lopez Philippe , Corel Eduardo
Published: April 2018

Understanding how an animal organism and its gut microbes form an integrated biological organization, known as a holobiont, is becoming a central issue in biological studies. Such an organization inevitably involves a complex web of transmission processes that occur on different scales in time and space, across microbes and hosts. Network-based models are introduced in this chapter to tackle aspects of this complexity and to better take into account vertical and horizontal dimensions of transmission. Two types of network-based models are presented, sequence similarity networks and bipartite graphs. One interest of these networks is that they can consider a rich diversity of important players in microbial evolution that are usually excluded from evolutionary studies, like plasmids and viruses. These methods bring forward the notion of “gene externalization,” which is defined as the presence of redundant copies of prokaryotic genes on mobile genetic elements (MGEs), and therefore emphasizes a related although distinct process from lateral gene transfer between microbial cells. This chapter introduces guidelines to the construction of these networks, reviews their analysis, and illustrates their possible biological interpretations and uses. The application to human gut microbiomes shows that sequences present in a higher diversity of MGEs have both biased functions and a broader microbial and human host range. These results suggest that an “externalized gut metagenome” is partly common to humans and benefits the gut microbial community. We conclude that testing relationships between microbial genes, microbes, and their animal hosts, using network-based methods, could help to unravel additional mechanisms of transmission in holobionts.
RNases and Helicases in Gram-Positive Bacteria
Authors: Durand Sylvain , Condon Ciaran
Published: April 2018

RNases are key enzymes involved in RNA maturation and degradation. Although they play a crucial role in all domains of life, bacteria, archaea, and eukaryotes have evolved with their own sets of RNases and proteins modulating their activities. In bacteria, these enzymes allow modulation of gene expression to adapt to rapidly changing environments. Today, >20 RNases have been identified in both
Escherichia coli
and
Bacillus subtilis
, the paradigms of the Gram-negative and Gram-positive bacteria, respectively. However, only a handful of these enzymes are common to these two organisms and some of them are essential to only one. Moreover, although sets of RNases can be very similar in closely related bacteria such as the
Firmicutes Staphylococcus aureus
and
B. subtilis
, the relative importance of individual enzymes in posttranscriptional regulation in these organisms varies. In this review, we detail the role of the main RNases involved in RNA maturation and degradation in Gram-positive bacteria, with an emphasis on the roles of RNase J1, RNase III, and RNase Y. We also discuss how other proteins such as helicases can modulate the RNA-degradation activities of these enzymes.
Liver Failure in Advanced Adult-onset Polycystic Kidney Disease
Authors: Awad Christina , Gallimore Grant Gardner
Published: April 2018

Polycystic liver disease is the most common extrarenal manifestation of autosomal dominant polycystic kidney disease (ADPKD). Hepatic cysts are typically incidental findings, with occasional complications including cyst haemorrhage, infection and rupture. In contrast to the typically benign course of polycystic liver disease, we present a rare case of fatal decompensated liver failure in a patient with ADPKD. This is a case of a 58-year-old man with end-stage renal disease on haemodialysis presenting with new-onset ascites and decompensated liver failure following bilateral nephrectomy. Cirrhosis in ADPKD is a late manifestation of the disease, but it should be considered in the perioperative risk of patients with ADPKD.
Supporting capacity for research on malaria in Africa
Authors: Greenwood Brian , Gaye Oumar , Kamya Moses R , Kibiki Gibson , Mwapasa Victor , Phiri Kamija S , Tagbor Harry , Terlouw Dianne , Bates Imelda , Craig Alister , Magnussen Pascal , Theander Thor G , Bhasin Amit , McCullough Hazel , Schellenberg David
Published: April 2018

Substantial progress has been made in the control of malaria in Africa but much remains to be done before malaria elimination on the continent can be achieved. Further progress can be made by enhancing uptake of existing control tools but, in high transmission areas, additional tools will be needed. Development and evaluation of these new tools will require a substantial cadre of African scientists well trained in many different disciplines. This paper describes the activities undertaken by the Malaria Capacity Development Consortium (MCDC) to support the careers of PhD students and postdoctoral fellows undertaking research on malaria at five African universities. A systematic assessment of constraints on PhD training and research support systems was undertaken at each partner African university at the beginning of the programme and many of these constraints were remedied. The success of the programme is shown by the fact that 18 of the 21 PhD students recruited to the programme completed their theses successfully within a 4-year period and that all 27 scientists recruited to the postdoctoral programme were still working in Africa on its completion. The work of the consortium will be continued through Career Development Groups established at each partner university and at an affiliated institution at the University of Nairobi and through the Developing Excellence in Leadership, Training and Science award from the Wellcome Trust made to one of the African partners. Lessons learnt during the MCDC programme may help the planning and execution of other research capacity development programmes in Africa.
Pleasure and practice: a qualitative study of the individual and social underpinnings of shisha use in cafes among youth in the UK
Authors: Mugyenyi Ambrose Evarls K , Haberer Jessica E , O’Neil Ivy
Published: April 2018

Objectives

To explore (1) the social function of shisha cafes for young people living in the UK and (2) other alternative activities (existing or potential) that do not involve tobacco smoking.

Methods

We conducted qualitative interviews with young adults (age 18–30) in Leeds, UK. Snowballing sampling was used in selecting the participants. Interviews were audio-recorded and explored the perspectives and experiences of young people in as well as potential alternative activities. Data were transcribed and analysed thematically.

Results

Shisha use plays a central role in social interactions. Youth described using shisha because of emotional and sensory pleasure. Shisha use was implicitly endorsed by respected professionals, such as doctors and university lecturers, who were seen smoking it. Most, but not all, shisha smokers acknowledged that shisha use is harmful. Suggestions for reducing shisha use included use of non- tobacco alternatives, legislation to reduce access and alternative means for socialising, such as sports.

Conclusion

For young people in the UK, the known health dangers of shisha are outweighed by its social benefits and shisha is perceived as acceptable. Interventions to reverse the increase in shisha cafes should focus on both individual smoker as well as the community, without sacrificing the importance of social interactions.
Cardiac implant registries 2006–2016: a systematic review and summary of global experiences
Authors: Zhang Shixuan , Gaiser Sebastian , Kolominsky-Rabas Peter L
Published: April 2018

Objectives

The importance of Cardiac Implant Registry (CIR) for ensuring a long-term follow-up in postmarket surveillance has been recognised and approved, but there is lack of consensus standards on how to establish a CIR. The aim of this study is to investigate the structure and key elements of CIRs in the past decade (2006–2016) and to provide recommendations on ‘best practice’ approaches.

Settings and participants

A systematic search on CIR was employed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The following databases were searched: the PubMed (Medline), ScienceDirect and the Scopus database, EMBASE. After identifying the existing CIRs, an aggregative approach will be used to explore key elements emerging in the identified registries.

Results

The following 82 registries were identified: 18 implantable cardioverterdefibrillator (ICD) registries, 7 cardiac resynchronisation therapy (CRT) registries, 5 pacemaker registries and 6 cardiovascular implantable electronic device registries which combined ICD, pacemaker and CRT implantation data; as well as 22 coronary stent registries and 24 transcatheteraortic heart valve implantation registries. While 71 national or local registries are from a single country, 44 are from European countries and 9 are located in USA. The following criteria have been summarised from the identified registries, including: registry working group, ethic issues, transparency, research objective, inclusion criteria, compulsory participation, endpoint, sample size, data collection basement, data collection methods, data entry, data validation and statistical analysis.

Conclusions

Registries provide a ‘real-world’ picture for patients, physicians, manufacturers, payers, decision-makers and other stakeholders. CIRs are important for regulatory decisions concerning the safety and therefore approval issues of the medical device; for payers CIRs provide evidence on the medical device benefit and drive the decision whether the product should be reimbursed or not; for hospitals CIRs’ data are important for sound procurement decisions, and CIRs also help patients and their physicians to joint decision-making which of the products is the most appropriate.
Regional South Australia Health (RESONATE) survey: study protocol
Authors: Leach Matthew J , Jones Martin , Gillam Marianne , May Esther
Published: April 2018

Introduction

Access to quality healthcare services is considered a moral right. However, for people living in regional locations, timely access to the services that they need may not always be possible because of structural and attitudinal barriers. This suggests that people living in regional areas may have unmet healthcare needs. The aim of this research will be to examine the healthcare needs, expectations and experiences of regional South Australians.

Methods and analysis

The Regional South Australia Health (RESONATE) survey is a cross-sectional study of adult health consumers living in any private or non-private dwelling, in any regional, rural, remote or very remote area of South Australia and with an understanding of written English. Data will be collected using a 45-item, multidimensional, self-administered instrument, designed to measure healthcare need, barriers to healthcare access and health service utilisation, attitudes, experiences and satisfaction. The instrument has demonstrated acceptable psychometric properties, including good content validity and internal reliability, good test–retest reliability and a high level of acceptability. The survey will be administered online and in hard-copy, with at least 1832 survey participants to be recruited over a 12-month period, using a comprehensive, multimodal recruitment campaign.

Ethics and dissemination

The study has been reviewed and approved by the Human Research Ethics Committee of the University of South Australia. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, broadcast media, print media, the internet and various community/stakeholder engagement activities.
Reducing early infant mortality in India: results of a prospective cohort of pregnant women using emergency medical services
Authors: Bills Corey B , Newberry Jennifer A , Darmstadt Gary , Pirrotta Elizabeth A , Rao G V Ramana , Mahadevan S V , Strehlow Matthew C
Published: April 2018

Objectives

To describe the demographic characteristics and clinical outcomes of neonates born within 7 days of public ambulance transport to hospitals across five states in India.

Design

Prospective observational study.

Setting

Five Indian states using a centralised emergency medical services (EMS) agency that transported 3.1 million pregnant women in 2014.

Participants

Over 6 weeks in 2014, this study followed a convenience sample of 1431 neonates born to women using a public-private ambulance service for a ‘pregnancy-related’ problem. Initial calls were deemed ‘pregnancy related’ if categorised by EMS dispatchers as ‘pregnancy’, ‘childbirth’, ‘miscarriage’ or ‘labour pains’. Interfacility transfers, patients absent on ambulance arrival, refusal of care and neonates born to women beyond 7 days of using the service were excluded.

Main outcome measures: death at 2, 7 and 42 days after delivery.

Results

Among 1684 women, 1411 gave birth to 1431 newborns within 7 days of initial ambulance transport. Median maternal age at delivery was 23 years (IQR 21–25). Most mothers were from rural/tribal areas (92.5%) and lower social (79.9%) and economic status (69.9%). Follow-up rates at 2, 7 and 42 days were 99.8%, 99.3% and 94.1%, respectively. Cumulative mortality rates at 2, 7 and 42 days follow-up were 43, 53 and 62 per 1000 births, respectively. The perinatal mortality rate (PMR) was 53 per 1000. Preterm birth (OR 2.89, 95% CI 1.67 to 5.00), twin deliveries (OR 2.80, 95% CI 1.10 to 7.15) and caesarean section (OR 2.21, 95% CI 1.15 to 4.23) were the strongest predictors of mortality.

Conclusions

The perinatal mortality rate associated with this cohort of patients with high-acuity conditions of pregnancy was nearly two times the most recent rate for India as a whole (28 per 1000 births). EMS data have the potential to provide more robust estimates of PMR, reduce inequities in timely access to healthcare and increase facility-based care through service of marginalised populations.
Awareness of diabetic retinopathy and its association with attendance for systematic screening at the public primary care setting: a cross-sectional study in Hong Kong
Authors: Lian JinXiao , McGhee Sarah M , Gangwani Rita A , Lam Cindy L K , Yap Maurice K H , Wong David S H
Published: April 2018

Objective

To assess the association between awareness of diabetic retinopathy (DR) and actual attendance for DR screening.

Design

Cross-sectional study.

Setting

Two public general outpatient clinics.

Participants

The subjects were people with diabetes mellitus (DM) who participated in a randomised controlled trial, set up in 2008, to test the impact of a copayment on attendance for DR screening.

Primary and secondary outcome measures

The subjects’ awareness of DR was evaluated using a structured questionnaire conducted via a telephone interview. The attendance for screening was from the actual attendance data. Association between awareness and attendance for screening was determined using multivariate logistic regression model and was reported as ORs.

Results

A total of 2593 participants completed the questionnaire. A total of 42.9% (1113/2593) said they would worry if they had any vision loss and 79.6% (2063/2593) knew that DM could cause blindness. Only 17.5% (453/2593) knew that treatment was available for DR and 11.5% (297/2593) knew that early DR could be asymptomatic. The importance of having a regular eye examination was acknowledged by 75.7% (1964/2593), but 34% (881/2593) did not know how frequently their eyes should be examined. Worry about vision loss (OR=1.72, P<0.001), awareness of the importance of regular eye examination (OR=1.83, P=0.002) and awareness of the frequency of eye examinations (‘every year’ (OR=2.64, P<0.001) or ‘every 6 months’ (OR=3.27, P<0.001)) were the most significant factors associated with attendance.

Conclusions

Deficits in knowledge of DR and screening were found among subjects with DM, and three awareness factors were associated with attendance for screening. These factors could be targeted for future interventions.
Cost of hospitalised patients due to complicated urinary tract infections: a retrospective observational study in countries with high prevalence of multidrug-resistant Gram-negative bacteria: the COMBACTE-MAGNET, RESCUING study
Authors: Vallejo-Torres Laura , Pujol Miquel , Shaw Evelyn , Wiegand Irith , Vigo Joan Miquel , Stoddart Margaret , Grier Sally , Gibbs Julie , Vank Christiane , Cuperus Nienke , van den Heuvel Leo , Eliakim-Raz Noa , Carratala Jordi , Vuong Cuong , MacGowan Alasdair , Babich Tanya , Leibovici Leonard , Addy Ibironke , Morris Stephen
Published: April 2018

Objective

Complicated urinary tract infections (cUTIs) impose a high burden on healthcare systems and are a frequent cause of hospitalisation. The aims of this paper are to estimate the cost per episode of patients hospitalised due to cUTI and to explore the factors associated with cUTI-related healthcare costs in eight countries with high prevalence of multidrug resistance (MDR).

Design

This is a multinational observational, retrospective study. The mean cost per episode was computed by multiplying the volume of healthcare use for each patient by the unit cost of each item of care and summing across all components. Costs were measured from the hospital perspective. Patient-level regression analyses were used to identify the factors explaining variation in cUTI-related costs.

Setting

The study was conducted in 20 hospitals in eight countries with high prevalence of multidrug resistant Gram-negative bacteria (Bulgaria, Greece, Hungary, Israel, Italy, Romania, Spain and Turkey).

Participants

Data were obtained from 644 episodes of patients hospitalised due to cUTI.

Results

The mean cost per case was €5700, with considerable variation between countries (largest value €7740 in Turkey; lowest value €4028 in Israel), mainly due to differences in length of hospital stay. Factors associated with higher costs per patient were: type of admission, infection source, infection severity, the Charlson comorbidity index and presence of MDR.

Conclusions

The mean cost per hospitalised case of cUTI was substantial and varied significantly between countries. A better knowledge of the reasons for variations in length of stays could facilitate a better standardised quality of care for patients with cUTI and allow a more efficient allocation of healthcare resources. Urgent admissions, infections due to an indwelling urinary catheterisation, resulting in septic shock or severe sepsis, in patients with comorbidities and presenting MDR were related to a higher cost.
Dementia in UK South Asians: a scoping review of the literature
Authors: Blakemore Amy , Kenning Cassandra , Mirza Nadine , Daker-White Gavin , Panagioti Maria , Waheed Waquas
Published: April 2018

Objective

Over 850 000 people live with dementia in the UK. A proportion of these people are South Asians, who make up over 5% of the total UK population. Little is known about the prevalence, experience and treatment of dementia in the UK South Asian population. The aim of this scoping review is to identify dementia studies conducted in the UK South Asian population to highlight gaps in the literature which need to be addressed in future research.

Method

Databases were systematically searched using a comprehensive search strategy to identify studies. A methodological framework for conducting scoping reviews was followed. An extraction form was developed to chart data and collate study characteristics and findings. Studies were then grouped into six categories: prevalence and characteristics; diagnosis validation and screening; knowledge, understanding and attitudes; help-seeking; experience of dementia; service organisation and delivery.

Results

A total of 6483 studies were identified, 27 studies were eligible for inclusion in the scoping review. We found that studies of prevalence, diagnosis and service organisation and delivery in UK South Asians are limited. We did not find any clinical trials of culturally appropriate interventions for South Asians with dementia in the UK. The existing evidence comes from small-scale service evaluations and case studies.

Conclusions

This is the first scoping review of the literature to identify priority areas for research to improve care for UK South Asians with dementia. Future research should first focus on developing and validating culturally appropriate diagnostic tools for the UK South Asians and then conducting high-quality epidemiological studies in order to accurately identify the prevalence of dementia in this group. The cultural adaptation of interventions for dementia and testing in randomised controlled trials is also vital to ensure that there are appropriate treatments available for the UK South Asians to access.
Enablers and barriers to improving worksite canteen nutrition in Pudong, China: a mixed-methods formative research study
Authors: Li Ruoran , Wu You , Jing Limei , Jaacks Lindsay M
Published: April 2018

Objective

To identify individual-level and organisation-level enablers and barriers to the provision and consumption of healthier foods at worksite canteens in China and to develop a theoretical framework and evidence-based, specific, practical intervention strategies.

Design

Mixed-methods formative research, with in-depth interviews, focus group discussions and quantitative questionnaires.

Setting

Two community health centres (CHCs) in Pudong, Shanghai, China.

Participants

In-depth interviews with three CHC administrators and three canteen managers and staff. Six focus groups with a total of 19 male and 36 female employees, aged 25–67 years.

Results

Three subthemes were identified as important for influencing individual food choice: the cultural perception of ‘eating well’, the need to balance taste preferences and nutrition, and the emphasis on food safety in healthfulness. At the organisation level, two related subthemes emerged: the balance of canteen budget and food safety with the variety and quality of offerings, and the interplay between key stakeholders. Key barriers included cost, poor communication between employees and management, individuals’ emphasis on taste over healthfulness, variation in individual preferences and discordance between perceived and actual weight status, particularly among men. Key enablers included strong, positive food culture in China and trust in canteen food. An ecological framework to describe determinants of worksite food environment in Shanghai was developed and intervention strategies were mapped onto this framework.

Conclusions

A balancing act occurs at multiple levels and ultimately determines the worksite food environment and employee food choice at CHCs in Shanghai of China. There is a need to implement these findings and evaluate their impact on diet and health.
The validity of the Rx-Risk Comorbidity Index using medicines mapped to the Anatomical Therapeutic Chemical (ATC) Classification System
Authors: Pratt Nicole L , Kerr Mhairi , Barratt John D , Kemp-Casey Anna , Kalisch Ellett Lisa M , Ramsay Emmae , Roughead Elizabeth Ellen
Published: April 2018

Objectives

To provide a map of Anatomical Therapeutic Chemical (ATC) Classification System codes to individual Rx-Risk comorbidities and to validate the Rx-Risk Comorbidity Index.

Design

The 46 comorbidities in the Rx-Risk Index were mapped to dispensing’s indicative of each condition using ATC codes. Prescription dispensing claims in 2014 were used to calculate the Rx-Risk. A baseline logistic regression model was fitted using age and gender as covariates. Rx-Risk was added to the base model as an (1) unweighted score, (2) weighted score and as (3) individual comorbidity categories indicating the presence or absence of each condition. The Akaike information criterion and c-statistic were used to compare the models.

Setting

Models were developed in the Australian Government Department of Veterans’ Affairs health claims data, and external validation was undertaken in a 10% sample of the Australian Pharmaceutical Benefits Scheme Data.

Participants

Subjects aged 65 years or older.

Outcome measures

Death within 1 year (eg, 2015).

Results

Compared with the base model (c-statistic 0.738, 95% CI 0.734 to 0.742), including Rx-Risk improved prediction of mortality; unweighted score 0.751, 95% CI 0.747 to 0.754, weighted score 0.786, 95% CI 0.782 to 0.789 and individual comorbidities 0.791, 95% CI 0.788 to 0.795. External validation confirmed the utility of the weighted index (c-statistic=0.833).

Conclusions

The updated Rx-Risk Comorbidity Score was predictive of 1-year mortality and may be useful in practice to adjust for confounding in observational studies using medication claims data.
Study protocol to assess the effectiveness and safety of a flexible family visitation model for delirium prevention in adult intensive care units: a cluster-randomised, crossover trial (The ICU Visits Study)
Authors: Rosa Regis Goulart , Falavigna Maicon , Robinson Caroline Cabral , da Silva Daiana Barbosa , Kochhann Renata , de Moura Rafaela Moraes , Santos Mariana Martins Siqueira , Sganzerla Daniel , Giordani Natalia Elis , Eugênio Cláudia , Ribeiro Tarissa , Cavalcanti Alexandre Biasi , Bozza Fernando , Azevedo Luciano Cesar Pontes , Machado Flávia Ribeiro , Salluh Jorge Ibrain Figueira , Pellegrini José Augusto Santos , Moraes Rafael Barberena , Hochegger Taís , Amaral Alexandre , Teles José Mario Meira , da Luz Lucas Gobetti , Barbosa Mirceli Goulart , Birriel Daniella Cunha , Ferraz Iris de Lima , Nobre Vandack , Valentim Helen Martins , Corrêa e Castro Livia , Duarte Péricles Almeida Delfino , Tregnago Rogério , Barilli Sofia Louise Santin , Brandão Nilton , Giannini Alberto , Teixeira Cassiano
Published: April 2018

Introduction

Flexible intensive care unit (ICU) visiting hours have been proposed as a means to improve patient-centred and family-centred care. However, randomised trials evaluating the effects of flexible family visitation models (FFVMs) are scarce. This study aims to compare the effectiveness and safety of an FFVM versus a restrictive family visitation model (RFVM) on delirium prevention among ICU patients, as well as to analyse its potential effects on family members and ICU professionals.

Methods and analysis

A cluster-randomised crossover trial involving adult ICU patients, family members and ICU professionals will be conducted. Forty medical-surgical Brazilian ICUs with RFVMs (<4.5 hours/day) will be randomly assigned to either an RFVM (visits according to local policies) or an FFVM (visitation during 12 consecutive hours per day) group at a 1:1 ratio. After enrolment and follow-up of 25 patients, each ICU will be switched over to the other visitation model, until 25 more patients per site are enrolled and followed. The primary outcome will be the cumulative incidence of delirium among ICU patients, measured twice a day using the Confusion Assessment Method for the ICU. Secondary outcome measures will include daily hazard of delirium, ventilator-free days, any ICU-acquired infections, ICU length of stay and hospital mortality among the patients; symptoms of anxiety and depression and satisfaction among the family members; and prevalence of burnout symptoms among the ICU professionals. Tertiary outcomes will include need for antipsychotic agents and/or mechanical restraints, coma-free days, unplanned loss of invasive devices and ICU-acquired pneumonia, urinary tract infection or bloodstream infection among the patients; self-perception of involvement in patient care among the family members; and satisfaction among the ICU professionals.

Ethics and dissemination

The study protocol has been approved by the research ethics committee of all participant institutions. We aim to disseminate the findings through conferences and peer-reviewed journals.

Trial registration

NCT02932358.
HOMETOWN-SPECIFIC BARGAINING POWER IN AN EXPERIMENTAL MARKET IN CHINA
Authors: QIN XIANGDONG , SHEN JUNYI , SHIMOMURA KEN-ICHI , YAMATO TAKEHIKO
Published: April 2018

We conducted a market experiment in China to examine potential effects of subjects’ hometowns on their behaviors as well as potential differences between team and individual trades. We observed that group size affected bargaining power and subsequently payoffs in different directions according to where the subjects were from. In particular, teamwork strengthened the bargaining power of the subjects from coastal areas but weakened that of the subjects from inland areas when commodity exchanges were conducted between subjects from different areas. This finding suggests that it is important to take one’s hometown into account when comparing economic behavior or decision-making between teams and individuals, especially in the countries or regions where hometown diversity plays a central role in explaining differences in business management and local market performance.
AN ASSESSMENT OF ENTREPRENEURIAL DISPOSITION AND CULTURE IN SUB-SAHARAN AFRICA: SOME LESSONS FROM GHANA
Authors: ADOM KWAME , CHIRI NEWMAN , QUAYE DANIEL , AWUAH-WEREKOH KWASI
Published: April 2018

This paper assesses the impact of Ghanaian culture on the entrepreneurial disposition of Higher National Diploma (HND) graduates of Accra Polytechnic from 2007 to 2012. Since the turn of the millennium, there has been more attention given to job creation than job seeking, especially among the youth, to address unemployment in developing countries. This is because of governments' inability to match the growing number of job seekers to job creation across the globe. One way to address this deficit in Ghana is the introduction of courses in entrepreneurship in almost all tertiary institutions, coupled with the setting up of institutions such as Ghana Youth Employment and Entrepreneurship Development Agency (GYEEDA), National Youth Employment Program (NYEP), Youth Entrepreneurship Agency (YEA), Youth Entrepreneurship Support (YES), among others. Reporting on 2015 data from Accra, the main finding was that collectivistic culture has negative effects on capital accumulation, human resource management and the urgency the unemployed graduates attached to self-employment. Therefore, this paper calls for some ways to address the issue of graduates' inability to be enterprising.
Controlled Release Electrochemical Synthesis and Cytotoxicity Study of Copper(II) Nanoparticles in Copper(II) Decanoate Complex
Authors: Nordin Norazzizi , Samad Wan Zurina , Kardia Egi , Yahaya Badrul Hisham , Yusop Muhammad Rahimi , Othman Mohamed Rozali
Published: April 2018

In the present study, a controlled release electrochemical (CRE) technique based on the controlled release of Cu[Formula: see text] ion from Cu anode in the presence of decanoic acid (HDe) has been used to synthesize Cu(II) decanoate (CuDe2) complex. The effect of applied voltages (1–10[Formula: see text]V) and electrolyte concentrations (0.1–2.0[Formula: see text]M CH3COONH4) during the electrolysis on the nanoparticles obtained was studied using TEM. The results reveal that small-sized nanoparticles ([Formula: see text][Formula: see text]nm) were obtained by using lowest applied voltage and CH3COONH4 concentration (1[Formula: see text]V and 0.1[Formula: see text]M, respectively). The smallest nanoparticle obtained was then used in the cytotoxicity study against A549 and HeLa cells. The synthesized complex gives moderate cytotoxic effect on the selected cells (IC[Formula: see text]M and 20.89[Formula: see text][Formula: see text]M, respectively) and low cytotoxic effect on normal cells (IMR90). Apoptosis is the mode of cell death based on the apoptosis assay that has been conducted.