Effect of hyperbaric oxygen in hepatopulmonary syndrome: an innovative experimental study

OBJECTIVE

This study aimed to analyze the effect of hyperbaric oxygen treatment (HBOT) in hepatopulmonary syndrome (HPS).

MATERIALS AND METHODS

Five-month-old female Wistar-Albino rats were randomly divided into three groups: Group I, the control group; Group II, the cirrhosis group; and Group III, the cirrhosis group + HBOT group. Rats were exposed to HBO sessions (2.4 atm./60 min) for 20 days. Animals were sacrificed 24 hours after the last HBO session. Biochemical analysis, oxygenation parameters, NO and NO synthase (NOS) levels, histopathological changes in the liver and lungs, and pulmonary artery diameter were measured.

RESULTS

A total of 24 rats (10 rats were included in Group I, six rats in Group II, and eight rats in Group III) weighing 220-250 g were included in the study. Significant differences were observed for NO and NOS (9.10±1.05 to 12.17±1.85 μmol/L, p<0.05 and 0.46±0.31 to 1.17±0.39 U/ml, p<0.05, respectively) at baseline and day 36 only in group II. Inflammatory cell infiltration and bronchial injury were significantly increased in group II compared to group I (p=0.007 and p=0.008, respectively) but not in group III (p=0.266 and p=0.275, respectively). Pulmonary artery diameter was significantly lower in group III compared with group II at all sites in both lungs (p<0.05).

CONCLUSIONS

HBOT may be a promising treatment for HPS by reducing NO and NOS activity, perialveolar arteriolar dilation, lung inflammation, and injury and guiding future clinical trials.

Evolution of pulmonary hypertension in interstitial lung disease: a journey through past, present, and future

Interstitial lung diseases (ILD) are a spectrum of disorders often complicated by pulmonary hypertension (PH) in its course. The pathophysiologic mechanism of WHO group 3 PH is different to other forms of PH. The advent of PH is a harbinger for adverse events like mortality and morbidity, implying that the PH component of disease expedites deteriorated clinical outcomes. In fact, WHO group 3 PH due to ILD has the worse prognosis among all groups of PH. Hence, early detection of PH by a comprehensive screening method is paramount. Given considerable overlap in clinical manifestations between ILD and PH, early detection of PH is often elusive. Despite, the treatment of PH due to ILD has been frustrating until recently. Clinical trials utilizing PAH-specific pulmonary vasodilators have been ongoing for years without desired results. Eventually, the INCREASE study (2018) demonstrated beneficial effect of inhaled Treprostinil to treat PH in ILD. In view of this pioneering development, a paradigm shift in clinical approach to this disease phenotype is happening. There is a renewed vigor to develop a well validated screening tool for early detection and management. Currently inhaled Treprostinil is the only FDA approved therapy to treat this phenotype, but emergence of a therapy has opened a plethora of research toward new drug developments. Regardless of all these recent developments, the overall outlook still remains grim in this condition. This review article dwells on the current state of knowledge of pre-capillary PH due to ILD, especially its diagnosis and management, the recent progresses, and future evolutions in this field.

A multilevel conceptual framework on green practices: Transforming policies into actionable leadership and employee behavior

As organizations have recognized their cause/solution relationship with the environment, increasing attention is being given to the role of employees make in achieving green organizational objectives. Even though, business sustainability initiatives are often led by leaders; employee green behavior (EGB) plays a vital role in success of such initiatives. The current paper focuses on relatively less researched topic of EGB. It uses a narrative review approach to develop a multi-level conceptual framework that draws upon the connectivity of leadership influence at firm and team levels, and how this influences individual level EGB. The paper offers a holistic approach to influencing effective green strategies in organizational contexts. By doing so, it contributes to the larger debate on different dimensions, mechanisms, and levels of environmentally responsible behavior in organizational settings and opens up new avenues for multi-level and cross-layer empirical research.

Exploring the limits of mindfulness during the COVID-19 pandemic: qualitative evidence from African context

Purpose

This paper is one of the first studies to examine specificities, including limits of mindfulness at work in an African organisational context, whilst dealing with the ongoing COVID-19 pandemic. It specifically addresses the role of organisational and managerial support systems in restoring employee wellbeing, social connectedness and attachment to their organisations, in order to overcome the exclusion caused by the ongoing pandemic.

Design/methodology/approach

The study uses a qualitative research methodology that includes interviews as the main data source. The sample comprises of 20 entrepreneurs (organisational leaders) from Ghana and Nigeria.

Findings

The authors found that COVID-19-induced worries restricted the practice of mindfulness, and this was prevalent at the peak of the pandemic, particularly due to very tough economic conditions caused by reduction in salaries, and intensified by pre-existing general economic and social insecurities, and institutional voids in Africa. This aspect further resulted in lack of engagement and lack of commitment, which affected overall team performance and restricted employees’ mindfulness at work. Hence, quietness by employees even though can be linked to mindfulness was linked to larger psychological stress that they were facing. The authors also found leaders/manager’s emotional intelligence, social skills and organisational support systems to be helpful in such circumstances. However, their effectiveness varied among the cases.

Originality/value

This paper is one of the first studies to establish a link between the COVID-19 pandemic and mindfulness limitations. Moreover, it is a pioneering study specifically highlighting the damaging impact of COVID-19-induced concerns on leader–member exchange (LMX) and team–member exchange (TMX) relationships, particularly in the African context. It further brings in a unique discussion on the mitigating mechanisms of such COVID-19-induced concerns in organisations and highlights the roles of manager’s/leader’s emotional intelligence, social skills and supportive intervention patterns. Finally, the authors offer an in-depth assessment of the effectiveness of organisational interventions and supportive relational systems in restoring social connectedness following a social exclusion caused by COVID-19-induced worries.

Responsible leadership practices in the hospitality sector family businesses: evidence from an emerging market

Purpose

The study aims to find out the extent to which hospitality sector family-owned businesses in Egypt feel committed to responsible leadership practices and subsequently meet their stakeholders' expectations.

Design/methodology/approach

The authors conducted semi-structured interviews with 24 owners of family restaurants in Egypt. Thematic analysis was undertaken on the collected data resulting in four major themes.

Findings

The authors find that the four dimensions (aggregation of virtuousness, stakeholder involvement, individual competencies and ethical contributions) are not fully exercised by the owners despite their readiness to behave correctly according to social norms. Furthermore, the respondents elaborated that they do not fully understand how to commence playing a role in contributing to the common good in their societies.

Originality/value

To the best of the authors’ knowledge, the present study is the first to empirically investigate responsible leadership practices in the context of small and medium-sized family businesses (restaurants in this case), particularly in the emerging market and non-Western contexts.

Sustainable entrepreneurship development in Oman: a multi-stakeholder qualitative study

Purpose

Even though sustainable entrepreneurship has increasingly received researchers’ attention in recent years, the topic remains rather under-researched in natural resources’ rich Gulf countries such as Oman. Hence, this paper aims to fill this gap in the literature and, to the best of the authors’ knowledge, is one of the first attempts to assess the state of sustainable entrepreneurship development in Oman from a multi-stakeholder perspective.

Design/methodology/approach

This paper uses a qualitative research approach where in-depth semi-structured interviews were undertaken with 12 respondents representing relevant stakeholders of sustainable entrepreneurship development in Oman. The interviewees included four sustainable entrepreneurs, four policymakers and four educationists representing entrepreneurial skills development institutes in Oman.

Findings

This papers’ findings highlight that despite some positive improvements, several critical challenges remain, which hinder sustainable entrepreneurship development. The authors further found the role of FinTech to be critical in this concern by all stakeholders, though its usage and acceptance remain low. Also, the costs associated with the post-carbon (sustainable) economy and different profitability evolution have resulted in a slow change in the policy development in this concern. From an educational (skills development) perspective, a lack of context-specific training programmes and culture-based hesitations appeared to be hindering achieving sustainable entrepreneurship possibilities in Oman. The nascent entrepreneurial ecosystem, bureaucracy and lack of human capital (attraction as well as retention) appeared to be significant challenges for entrepreneurs. Finally, the findings highlighted the need for cross-sector collaboration with clear benchmarks for effective policy development concerning sustainable entrepreneurship in Oman.

Originality/value

To the best of the authors’ knowledge, this paper is the first academic study explicitly highlighting the state of sustainable entrepreneurship in Oman by incorporating the development initiatives as well as the major challenges in the analysis. Secondly, this study is also a pioneering work specifying the interlinkage between financing (FinTech), policy initiatives and skills development and the development of a sustainable entrepreneurship ecosystem in an under-researched context of Oman. Finally, the transition to a sustainable economy is challenging in natural resources’ dependent economies like Oman, as it needs to be supported by the mindset change in the larger society (legitimacy). In this concern, this paper, to the best of the authors’ knowledge, is one of the first academic endeavours to also specify the role of legitimacy from the perspective of different stakeholders (and larger society) for sustainable entrepreneurship development in such contexts.

Extreme work environment and career commitment of nurses: empirical evidence from Egypt and Peru

Purpose

This paper aim to analyse the motives behind the commitment of nurses to their profession despite their intense job duties during the COVID-19 pandemic.

Design/methodology/approach

The empirical sample comprises of 35 semi-structured interviews with public sector hospital nurses in under-researched contexts of Egypt and Peru.

Findings

Three types of motives were found to play a critical role in nurses’ commitment to their profession despite the difficulties associated with extreme work conditions. These factors include cultural (religious values, governmental coercion), contextual (limited education, organisational support) and personal (good nurse identity, submissive nature) dimensions.

Originality/value

This paper is one of the pioneering works to link existing literature streams on career commitment, extreme jobs, extreme context and management under disruptions (particularly COVID-19) by analysing these aspects in the under-researched Peruvian and Egyptian contexts.

The incidence and clinical features of anticancer therapy induced atrial fibrillation in patients with breast cancer without previously established cardiac disorder

Background/Introduction

Anthracyclines (ATC), alkylating (AAg) and anti-microtubule (AMA) agents are established chemotherapeutics in management of breast cancer. Both agents might reveal cardiotoxicity, as well as cancer treatment–induced-arrhythmias at varying established rates and by complex mechanisms. Atrial fibrillation (AF) is one of the debilitating dysrhythmias encountered throughout the cancer treatment with a significant impact on mortality and morbidity.

Purpose

To reveal the incidence and clinical features of new onset AF episodes detected in breast cancer patients using different conventional chemotherapeutic regiments.

Methods

All consecutive adult women diagnosed with breast-carcinoma and getting the first chemotherapy treatment with either ATC+AMA or AAg+AMA were prospectively evaluated for 6 months. Clinical, echocardiographic and ECG parameters (QTc by Bazett's-formula) were obtained and evaluated on baseline, first month and 6th month. Patients with Structural/coronary-heart-disease, complete-bundle-branch-block, non-sinus-rhythms and acute-coronary-syndrome in follow-up were excluded. “AF” is diagnosed on 12-lead-ECG or at least 30s of AF on Rhythm/Holter monitoring indicated by palpitation symptoms.

Results

Of 192 cases, 140 women ([mean±SD] age, 64±12, [range] 36–86 years) were enrolled for analysis. 76 patients received the AAg (cyclophosphamide) and 64 received ATC (daunorubicin) in addition to AMA (docetaxel). Mean follow up time was 4.2±2 months (Min–Max 1–6 months). Incident AF was diagnosed in 38 patients (27.1%) at the end of the 6 month follow up. The clinical findings are presented in picture-1. In patients receiving ATC treatment, incident AF was significantly more common (35.9% vs 19.7, p=0,032) and mostly observed in the first month of ATC-chemotherapy compared with AAg-regiments respectively (69% vs 33% of AF events occurred in first month, P&lt;0,001). Incident AF patients were significantly older, and ATC-receiving patients demonstrated significantly greater heart-rate and PR-interval changes from baseline. Age, ATC use, Delta-PR &gt;10 ms, Delta-QTC &gt;50 ms and Delta HR &gt;10 ms from baseline significantly predicted incident AF in the 6 month follow up in univariate-regression-analysis. However, only age and more significantly Anthracyclin use was found to predict Incident AF in multivariate regression analyses (picture 2) [(OR 3.7 (95% CI 1.2–10) (p=0.02)].

Conclusion(s)

Compared with alkylating-agents, anthracycline-regimens seem to induce significantly more incident-AF-events and profound ECG changes on the acute phase of chemotherapy for breast-cancer in women. They seem to exert their effects irrespective of conventional AF risk-factors apart from advanced-age. Affected ECG-parameters of delayed-conduction and repolarization-heterogeneity might be suggested as a surrogate for multiple-ion-channel-interactions and a possible mechanism underlying higher incident-AF.

Funding Acknowledgement

Type of funding sources: None.

The value of potential immunohistochemical biomarkers and clinicopathological findings in predicting response to neoadjuvant chemotherapy in breast cancer

OBJECTIVE

Following neoadjuvant chemotherapy (NAC) in breast cancer (BC), complete treatment response is achieved in some patients, while treatment response is limited in others. Predicting non-responder patients can prevent exposure to adverse effects associated with chemotherapeutic agents and delays in selecting other treatment modalities. In this study, we aimed at identifying predictive factors related to tumor regression in patients with BC who received NAC.

PATIENTS AND METHODS

This single-center cohort included 91 patients with BC who underwent surgery following NAC based on pretreatment tumor biopsy. According to BC molecular subtype, tumor regression grade (TRG) was determined using the Miller-Payne scoring system in patients who received standard NAC. Immunohistochemical stainings for VEGFR3 and CD44 were applied to needle core biopsies obtained prior to NAC in these patients.

RESULTS

Pathological complete response (pCR) was achieved in 20 patients (22%). In univariate analysis, high Ki-67 expression, ER negativity, and HER2 positivity were determined to be predictive factors of TRG (p < 0.05). In multivariate analysis, Ki-67 was the single independent predictor of TRG, with a 1.05-fold effect size. CD44 and VEGFR3 levels did not affect TRG or survival (p > 0.05). There was a significant difference in TRG according to molecular subtype of BC (p < 0.001). The treatment response was 5.5-fold higher in HER2-positive patients compared with HER2-negative patients.

CONCLUSIONS

pCR rates were significantly higher in TNBC, HER2, and luminal HER2+ subtypes when compared with luminal HER2- subtype. Ki-67 >25% and ER negativity had a favorable effect on TRG after NAC. CD44 and VEGFR3 were not effective in predicting treatment response.

The interplay between servant leadership, psychological safety, trust in a leader and burnout: assessing causal relationships through a three-wave longitudinal study

COVID-19 pandemic has brought unprecedented psychological challenges for frontline healthcare workers, especially nurses, causing anxiety and depression leading to burnout. The responsibility of healthcare leaders has increased manyfold to deal with such challenges. This study attempts to employ the conservation of resources theory to examine the relationship between servant leadership and nurses' burnout, with the mediating role of psychological safety and the moderating effect of trust in leader. A three-wave longitudinal design was employed for data collection from 1204 nurses from 27 hospitals in China. The partial least squares structural equation modeling technique was used for data analyses with SmartPLS version 3.2.8. The findings endorse that servant leadership at time 1 significantly reduces nurses' burnout measured at time 3 through the mediating role of psychological safety measured at time 2, and that a higher level of trust in the leader enhances the impact of servant leadership in reducing nurses' burnout.

The impact of corporate support programs on environmental and social innovation: empirical insights from the food and beverage industry

Purpose

The purpose of this paper is to analyze the influence of corporate support programs on managers' environmental and social innovation behaviors. To offer a more comprehensive understanding of these relationships, the moderating role of technological reflectiveness and business moral values is also accounted for.

Design/methodology/approach

A scenario-based experimental study to test the impact of corporate support programs on environmental and social innovation behaviors is also adopted. After running a pretest to verify the effectiveness of alternative scenarios through 100 respondents with managerial experience residing in the UK and EU countries, we collected data from a sample of 220 senior managers of firms from the Australian food and beverage industry for the main study. One-way analysis of variance (ANOVA) with Dunnett's test to investigate direct relationships and the PROCESS Model to test the moderating role of technological reflectiveness and business moral values were used.

Findings

The findings reveal time provision, budget provision and advice provision as salient forms of corporate support programs that positively impact managers' environmental and social innovation behaviors. It is found that technological reflectiveness positively moderates the link between time provision and managers' social innovation behavior and negatively moderates the link between advice provision and managers' social innovation behavior. Furthermore, it is found that business moral values positively moderate the relationships between time and budget provisions and managers' environmental innovation behavior and between budget and advice provisions and managers' social innovation behavior.

Originality/value

The authors contribute to innovation and operations management research by adopting a behavioral operations management perspective and empirically analyzing the influences of managers' technological reflectiveness and business moral values on the relationship between organizational corporate support programs and managers' environmental and social innovation behavior in the context of the food and beverage industry.

Evaluation of IL-17A expressions in high-grade glial tumors receiving radiotherapy

Aim

In this study, we aimed to investigate the interleukin-17A (IL-17A) levels in patients with high-grade glial tumors before receiving radiotherapy, immediately after radiotherapy, and 3 months after radiotherapy.

Patients and Methods

A total of 33 patients who applied to Adana City Training and Research Hospital, Department of Radiation Oncology between December 2016 and May 2018 was included in this study. A total of three blood samples was taken from each patient to assess IL-17A levels before and after radiotherapy and 3 months after the completion of radiotherapy.

Results

The differences in IL-17A levels between genders were not statistically significant. IL-17A levels progressively decreased after the radiotherapy and 3 months after the radiotherapy as compared to the levels before radiotherapy. However, this was not statistically significant. IL-17A levels in the non-surviving patients were high before and after radiotherapy as compared to the surviving ones, but this was also not statistically significant.

Conclusion

As compared to the period before radiotherapy, IL-17A levels tend to decrease in the period of acute and chronic phases of radiotherapy in all patient groups.

Digital Innovation, Data Analytics, and Supply Chain Resiliency: A Bibliometric-based Systematic Literature Review

In recent times, the literature has seen considerable growth in research at the intersection of digital innovation, data analytics, and supply chain resilience. While the number of studies on the topic has been burgeoning, due to the absence of a comprehensive literature review, it remains unclear what aspects of the subject have already been investigated and what are the avenues for impactful future research. Integrating bibliometric analysis with a systematic review approach, this paper offers the review of 262 articles at the nexus of innovative technologies, data analytics, and supply chain resiliency. The analysis uncovers the critical research clusters, the evolution of research over time, knowledge trajectories and methodological development in the area. Our thorough analysis enriches contemporary knowledge on the subject by consolidating the dispersed literature on the significance of innovative technologies, data analytics and supply chain resilience thereby recognizing major research clusters or domains and fruitful paths for future research. The review also helps improve practitioners' awareness of the recent research on the topic by recapping key findings of a large amount of literature in one place.

Impact of human capital and financial globalization on environmental degradation in OBOR countries: Critical role of national cultural orientations

As regional economic integration and climate change are among the most important phenomena influencing economic and social sustainability in the modern world, a huge volume of research is directed towards these topics nowadays. The aim of this study is to explore the impact of financial globalization and human capital on environmental degradation in One Belt One Road (OBOR) countries in a cultural context that is largely under-explored in spite of being immensely crucial for fulfilling the United Nations' agenda on climate change mitigation. Owing to the presence of vast cultural differences, we check if the national scores on "Power Distance Index" and "Uncertainty Avoidance" in these countries matter for the environment. To this end, we use the latest and annual data set comprising 31 OBOR countries from 1996 to 2018, and employ panel econometric techniques that effectively deal with the threat of endogeneity. Results show that human capital improves environment while financial globalization deteriorates it. Interestingly, high power distance and uncertainty avoidance can reverse the positive impact of human capital. Similarly, financial globalization is favorable for environment in countries with low power distance and uncertainty avoidance. The findings are robust to the use of alternative specifications. Theoretical underpinnings and implications are discussed arising from the interesting reversal of traditional impacts in different cultural scenarios. Specifically, we recommend a culture of entrepreneurship, innovation, and inclusivity, promoted through increased tolerance towards risk-taking and participative decision-making to reap the benefits of human capital and globalization in improving the environment. Our results have important implications for climate change mitigation endeavors in OBOR countries and understanding the cultural context in this regard. Additionally, our study opens a vast avenue for the related research work in the future.

Comparison of clinical features and the impact of reproductive factors on by age at diagnosis young and elderly breast cancer patients in the middle Anatolian region of Turkey

OBJECTIVE

Reproductive risk factors have been shown to influence breast cancer etiology for women of different origin worldwide; most studies in young/older patients have been limited to analyzing survival or tumor characteristics within their age group. This study aimed to compare the clinicopathological characteristics, treatment regimens, survival outcomes, and the impact of reproductive risk factors on young and elderly breast cancer patients.

PATIENTS AND METHODS

The data were collected retrospectively between October 2015 and March 2021, where 77 young patients (≤ 40 years) and 107 elderly patients (>65 years) were included out of a total of 567 patients undergoing treatment at Kayseri City Training and Research Hospital General Surgery Clinic, Turkey. Logistic regression analysis was performed to assess the impact of risk factors according to age.

RESULTS

Luminal-like tumors were in the majority in both age groups; there was no difference in diagnostic stages and survival between groups. The nulliparity ratio, total breastfeeding duration, number of biological children, first full-term pregnancy age, body mass index (BMI), and breast density distribution were significantly statistically different between groups. According to the multiple binary logistic regression analysis results for age, the most significant factors with risk effects were variables age of menarche OR= 3.36 (95% CI: 1.44-7.86) and child number OR= 2.58 (95% CI: 1.75-3.79), respectively.

CONCLUSIONS

The importance of looking at the impact of different risk factors on breast cancer risk lies in the potential to develop valid risk prediction models that can allow targeted screening and preventive interventions for high-risk women. By identifying more influential risk factors in different geographical profiles, risk-based screening, and targeted prevention efforts can be encouraged, and these factors can be included in risk prediction models.

Unlocking the relationships between strategic planning, leadership and technology transfer competence: the mediating role of strategic quality management

Purpose

This study aims to investigate the relationships between firms’ strategic planning (SP), leadership and technology transfer competence (TTC) by specifically incorporating the mediating role of strategic quality management (SQM).

Design/methodology/approach

This study performs structural equation modeling using AMOS on survey data collected from 200 Turkish firms operating in multiple industries and sectors.

Findings

This study finds that leadership in Turkish firms operating in multiple sectors is positively associated with SQM. This study further finds that SQM positively influences Turkish firms’ TTC and mediates the roles of SP and leadership in TTC.

Research limitations/implications

A key research implication from this study relates to the mediating role of SQM in TTC in an emerging economy context. This study highlights that SP and leadership can play an essential role in TTC through the mediating mechanism of SQM. Consequently, SQM emerges as a crucial linking pin in conveying the impact of quality management practices on technology transfer in emerging markets.

Practical implications

An essential managerial implication of this study relates to the critical roles of leadership, SP and SQM in TTC. For the managers of firms operating in a relatively uncertain emerging context such as Turkey, it is essential to adopt a supportive and empowering leadership style, where open communication and innovative activities are viewed positively and SQM is adopted holistically. Also, SP should be streamlined throughout the firm and followed by SQM to support TTC.

Originality/value

This paper links the technology (and knowledge) management and the strategy and leadership literature streams by focusing on the mechanisms of technology transfer and delving into the linkages between SQM, leadership, SP and TTC. It specifically presents SP and leadership as precursors to SQM in their joint influence on TTC. Accordingly, this research bridges technology, strategy and leadership research and provides a broader picture of technology transfer that encompasses the joint role of different processes in firms’ TTC.

Reimagining global food value chains through effective resilience to COVID-19 shocks and similar future events: A dynamic capability perspective

The restructuring of global value/supply chains gained increasing attention as the unprecedented COVID-19 echoed around the world. Yet, the COVID-19 related theory-driven, large scale quantitative, and empirical studies are relatively scarce. This study advances the extant literature by empirically investigating how do firms in the global food value chains (GFVCs) re-imagine their businesses structure in response to the COVID-19-becoming more resilient and competitive to the current pandemic and similar future events. We leverage a unique data of 231 senior managers of the Australian GFVCs and examine their firms' response strategies. Drawing upon key insights from the dynamic capability view, we find that GFVCs' competitiveness is achieved when exposure to COVID-19 shocks elicits dynamic capabilities-readiness, response, recovery-and these capabilities work jointly and sequentially to cultivate resilience. A key finding of this study is that firms with domestic plus global value chain partners are more resilient than those having only global business partners. This finding implies that excessive reliance on offshoring sometimes becomes lethal, especially amid unexpected and prolonged global shocks and, therefore, companies should strike a balance between domestic and global business partners to remain competitive. These findings offer important contributions to theory, practice, and UN sustainable development goals.

Firm absorptive capacity: multidimensionality, drivers and contextual conditions

Purpose

This paper aims to enrich absorptive capacity literature by specifically highlighting and adding environmental conditions and internationalisation process to the original conceptualisation.

Design/methodology/approach

The authors undertake a conceptual analysis and present an enhanced framework of absorptive capacity by integrating multiple literature streams. The authors have analysed the most relevant literature to provide underlying justifications for the proposed conceptual model.

Findings

Absorptive capacity ensures the long-term survival and success of a business. To develop absorptive capacity successfully, firms should focus on its various dimensions and existing intangible assets and external environment. The multidimensionality and richness of absorptive capacity is an under-explored area in the existing literature. The authors revisit the conceptualisation of absorptive capacity and add environmental conditions and the internationalisation process to the original conceptualisation. Absorptive capacity does not lead to a competitive advantage independent of its environment. To successfully develop it, firms have to adopt a holistic approach by considering the multi-dimensions, drivers and contextual conditions of absorptive capacity.

Originality/value

This study contributes by conceptualising absorptive capacity as a dynamic capability. It is one of the first studies to specifically propose a framework that combines antecedents (prior knowledge, combinative capabilities and IT capabilities), moderators (environmental conditions, namely, market and technological turbulence, competitiveness and the internationalisation process) and consequences (competitive advantage). The study offers a unique conceptualisation with implications for researchers and managers. As a result, managers will have a well-defined blueprint to create value by using firm capabilities.

COVID-19 driven challenges in international B2B customer relationship management: empirical insights from Finnish high-tech industrial microenterprises

Purpose

This paper aims to focus on the influences of the COVID-19 pandemic on business-to-business (B2B) firms’ relationship initiation and customer relationship management in an under-explored and unique context of high-tech industrial microenterprises. The authors analyze the challenges posed by the COVID-19 pandemic in the specific context of B2B relationship initiation and customer relationship management dynamics by examining Finnish B2B industrial microenterprises.

Design/methodology/approach

The paper uses exploratory in-depth case studies undertaken in three Finnish industrial microenterprises to analyze the influences of the COVID-19 pandemic on their new business relationship initiation and relationship management with the current customers.

Findings

The case firms quickly adjusted to the “new normal” and used a number of technological resources, including online meetings and three-dimensional demonstrations, among others. A key reason for this quick adjustment was them being microenterprises. However, despite this, lack of access to customer sites remained a hindrance as their products need to fit certain production processes, which cannot be done without physical visits. Furthermore, the development of trust with new customers, especially those based in emerging markets, was challenging due to the lack of physical meetings and site visits.

Research limitations/implications

The research highlights the challenges posed by the COVID-19 pandemic to B2B relationships and gives an account of the changing dynamics of relationship initiation and customer relationship management amid technological and societal disruptions. It also highlights the continued role of personal relationships and psychical meetings in such relationships. As such, the research informs B2B research that examines the role of personal relationships in B2B marketing.

Practical implications

The study offers industrial microenterprise executives insights into how to face and tackle COVID-19 driven challenges in B2B customer relationship management and how to integrate technological tools in relationship management practices while understanding where face-to-face meetings are indispensable.

Originality/value

The study demonstrates areas in which virtual tools can and cannot be substitutes for conventional means of B2B relationship initiation and customer relationship management across developed and emerging markets. It also highlights the specificities of industrial microenterprises and their business development and customer relationship management dynamics mechanisms, a research area that has been rather ignored by prior studies.

A Rare Case of Bleeding Epiphrenic Esophageal Diverticulum From Arteriovenous Malformations

Epiphrenic esophageal diverticula (EED) is a rare condition that usually presents with dysphagia in patients with a known motility disorder. In this article, we present a unique case of EED presenting with hemoptysis with clinical workup negative for any pulmonary pathology. Esophagogastroduodenoscopy revealed arteriovenous malformations within the EED successfully managed with argon plasma coagulation (APC), leading to a resolution of the patient’s symptoms.

Effects of combined the trendelenburg and passive leg raising positions on the cross-sectional area of the right internal jugular vein

Objective

The primary aim of this study was to assess the effects of a combination of the passive leg raising (PLR) and Trendelenburg positions on the cross-sectional area (CSA) of the right internal jugular vein (RIJV) using ultrasound measurement in awake patients.

Methods

This prospective observational cross-over study measured the CSA of RIJV in patients in supine (Supine-I), Trendelenburg, Trendelenburg with passive leg raising (T + PLR position), and repeated supine position (Supine-II). The CSA and vertical and horizontal diameters of the RIJVs were compared before and after each position.

Results

A total of 120 adult patients were enrolled in the study. The mean CSA of the RIJV significantly increased from 91.2 ± 31.7 mm² to 110.4 ± 38.2 mm² in the Trendelenburg position compared to the supine position (P < 0.05). However, there were no statistically significant differences in CSA were observed between the Trendelenburg and Trendelenburg + PLR positions.

Conclusion

Although the PLR + Trendelenburg position increased the jugular vein diameter relative to the supine position, its clinical usefulness is limited as this increase was still lower than that achieved with the Trendelenburg position alone.

Civil society organisations’ management dynamics and social value creation in the post-conflict volatile contexts pre and during COVID-19

Purpose

The current paper aims to address the management dynamics of civil society organisations (CSOs) in volatile contexts. Along with analysing CSOs’ management dynamics at a general level, it also offers specific insights into their management strategies in response to COVID-19 pandemic.

Design/methodology/approach

This study uses a qualitative research design, where in-depth case studies are undertaken with four CSOs operating in post-conflict volatile Sub-Saharan African economies of Liberia and Sierra Leone.

Findings

Findings revealed that multiple stakeholder management plays an important role in social value creation by CSOs. The findings further state that, in volatile contexts, CSOs appear to have more legitimacy than state functionaries due to their capabilities in dealing with political pressures and conflict sensitivities. The findings also revealed that case CSOs operating in Liberia and Sierra Leone were quick to respond to the COVID-19 pandemic by adjusting their working routines accordingly by switching to online working where possible and repurposing their management strategies. This repurposing of management strategies focussed on minimising economic disruptions caused by COVID-19 and continuing to create social value by helping youth and farmers particularly.

Originality/value

This paper contributes to the extant literature by being one of the first studies, highlighting the specificities of CSO management in volatile (especially Sub-Saharan African post-conflict) contexts and contributes to the literature streams on multiple stakeholder management and social value creation. To the best of the authors’ knowledge, the current paper is also one the first study to address the management strategies of case CSOs in response to the ongoing Covid-19 pandemic in Liberia and Sierra Leone.

834 Help Me Stop Eating Please…

Introduction

Sleep related eating disorder (SRED) is an uncommon NREM parasomnia, predominantly seen in females in their 20s and 30s and is commonly associated with sleep walking, daytime eating disorders (anorexia and bulimia) and use of certain sedative-hypnotics. Here, we describe a case of unique therapeutic dilemma in a middle-aged female, in whom SRED affected the use of continuous positive airway pressure device (CPAP) for her obstructive sleep apnea (OSA) which lead to worsening sleep quality and daytime functionality.

Report of case(s)

42-year-old female with history of migraines and OSA, came to the clinic with 6-month history of SRED which started after the demise of her husband and was associated with significant weight gain and injuries. During typical episode, she would take CPAP mask off, walk down the stairs and eat in the kitchen area and then fall asleep in the living area. She denied predilection for particular food, food allergies, consumption of inedible materials or use of offending drugs. Upon further inquiry, she reported recent unsuccessful attempts at smoking cessation, frequent nighttime smoking, significant body image issues and discontinuation of topiramate use for her migraines recently. Telemedicine visit limited the physical examination but included increase in BMI from 32 to 35 kg/m2. Compliance report, sleep diary and surveillance videos were consistent with the history with compliance report showing 17% of nights with optimal usage and 59% of nights with any usage. Beside locking the food, safety measures and napping, we recommended her to use clonazepam 1.5 mg. Unfortunately, she continued to have episodes. She was then started on Topiramate 50 mg which was gradually increased to 100 mg with reduction in her episodes and increase in her compliance to 60%.

Conclusion

In sleep medicine, treatment of OSA usually precede the treatment of comorbid conditions. However, SRED with comorbid OSA, requires a reverse strategy where improvement in compliance and coexisting daytime symptoms requires the treatment of SRED first. Moreover, detailed history to investigate the potential precipitating factors, co-existing medical and sleep conditions can help with choice of therapy e.g. patients with depression and SRED can benefit from Selective Serotonin Reuptake Inhibitors rather than other choices.

Support (if any):

Clinical comparison of patients with angiography: Negative perimesencephalic and nonperimesencephalic subarachnoid hemorrhages

Aims

This study aimed to compare the clinical courses, complications, and clinical outcome scores of patients with perimesencephalic (PM) and nonperimesencephalic (n-PM) subarachnoid hemorrhage (SAH) with no vascular pathology observed on cerebral angiography.

Materials and Methods

This retrospective study included 52 of 310 patients who underwent cerebral digital subtraction angiography for SAH between October 2016 and April 2018. The patients were categorized into PM and n-PM groups based on the type of hemorrhage observed on brain CT. The patients Fischer's grades, Glasgow Coma Scale scores, and World Federation of Neurosurgical Societies SAH grades were recorded. Hydrocephalus, vasospasm findings in both groups, and modified Rankin scale (mRS) scores were assessed, and vascular pathology factors (diabetes mellitus, hypertension, and smoking) were compared between the patient groups.

Results

The PM group included 30 patients, the n-PM group 22 patients. Minimal hydrocephalus was observed in two patients in the PM group and six patients developed apparent hydrocephalus in the n-PM group. Angiographic vasospasm was observed in four patients in the n-PM group but none of the patients in the PM group. On discharge, all patients in the PM group had mRS scores of 0. One patient in the n-PM group become exitus and 18 patients were discharged mRS 0, 2 for two patients, and 3 for one patient.

Conclusion

The patients with PM SAH experienced a benign course, whereas those with n-PM SAH showed a higher risk of vasospasm and hydrocephalus as well as worse exit scores.

Impact of Body Mass Index on COVID-19-Related In-Hospital Outcomes and Mortality

BACKGROUND

Given the high prevalence of obesity around the globe, patients with coronavirus disease 2019 (COVID-19) are at an increased risk of devastating complications.

METHODS

A retrospective cohort study was performed to determine the association of basal metabolic index (body mass index (BMI)) with the need for invasive mechanical ventilation (IMV), dialysis, upgrade to an intensive care unit (ICU) and mortality. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aORs) with its 95% confidence interval (CI), respectively.

RESULTS

A total of 176 consecutive patients with confirmed COVID-19 diagnosis were included. The mean age was 62.2 years, with 51% being male patients. The mean BMI for non-surviving patients was significantly higher compared to patients surviving on the seventh day of hospitalization (35 vs. 30 kg/m2, P = 0.022). Similarly, patients requiring IMV had a higher BMI (33 vs. 29, P = 0.002) compared to non-intubated patients. The unadjusted OR for patients with a higher BMI requiring IMV (56% vs. 28%, OR: 3.3, 95% CI: 1.6 - 7.0, P = 0.002) and upgrade to ICU (46% vs. 28%, OR; 2.2, 1.07 - 4.6, P = 0.04) were significantly higher compared to patients with a lower BMI. Similarly, patients with a higher BMI had higher in-hospital mortality (21% vs. 9%, OR: 3.2, 95% CI: 1.3 - 8.2, P = 0.01) compared to patients with a normal BMI. Despite a numerical advantage in the lower BMI group, there was no significant difference between the two groups in terms of the need for dialysis (5% vs. 13%, OR: 3.8, 13% vs. 4%, 1.1 - 14.1, P = 0.07). aORs controlled for baseline comorbidities and medications mirrored the overall results, except for the need to upgrade to ICU.

CONCLUSIONS

In patients with confirmed COVID-19, morbid obesity serves as an independent risk factor of high in-hospital mortality and the need for IMV.

How long should we run the code? Survival analysis based on location and duration of cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest

Background: The duration of cardiopulmonary resuscitation (CPR) significantly affects long-term survival in patients with in-hospital cardiac arrests (IHCA). In this study, we questioned the long-term clinical benefits of extending CPR beyond twenty minutes for patients with in-hospital cardiac arrest. Additionally, we aimed to compare the outcomes of CPR at different locations of a large tertiary care community hospital.

Methods: This study was a retrospective chart review of 169 patients with IHCA recorded between 1 January 2016, and 31 December 2018, at a large volume tertiary care community hospital.

Results: Of the 169 patients suffering from cardiac arrest during hospitalization, 44.4% arrested in the intensive care unit (ICU) and 55.6% in a non-critical care setting. Return of spontaneous circulation (ROSC) was achieved in 60% of ICU and 70.2% of non-ICU patients. While only 20% of ICU patients survived the cardiac arrest, the overall survival for non-ICU patients was 31.9%. Despite the significant difference in percentage survival, survival difference did not reach statistical significance (p = 0.082) due to the small sample size. Overall survival was 26.6%. An initial shockable rhythm was associated with improved survival compared to a non-shockable rhythm (41% vs. 22.5%, p = 0.022).

In patients who had cardiac arrest for less than 20 minutes, 60.9% of patients achieved ROSC, compared to 37.9% who arrested for more than 20 minutes. Survival to hospital discharge was significantly lower for patients who had cardiac arrest for more than 20 minutes, compared to patients who were arrested for less than 20 minutes (3.1% vs. 41.3%, p = <0.0001). For patients who had a cardiac arrest for more than 30 minutes, ROSC was achieved in only 14.8% of patients. None of these patients survived to be discharged from the hospital (p = <0.0001).

The mean age for the patients in this study was 70 years. 52.6% of subjects were male, and 47.4% were females. Older age was not related to shorter duration of CPR (Pearson correlation: 0.030, P = 0.69).

Conclusion: Survival was significantly lower when CPR was unsuccessful for twenty minutes, and there is no survival benefit of extending CRP for more than 30 minutes. Lowest survival after a cardiac arrest on the general medical floor, compared to telemetry and ICU, may be related to delay in recognizing cardiac arrest and barriers in implementing standardized advanced cardiac life support (ACLS) protocol.

Endoscopic treatment of suprasellar arachnoid cysts indenting third ventricle with obstructive hydrocephalus in children: Thirteen cases

Aims

The present study aimed to evaluate the clinical usefulness of endoscopic treatment of suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus and discuss the clinical features and outcomes of thirteen children treated at our institution.

Method

We treated thirteen pediatric cases of suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus between January 2012 and September 2018. Five female and eight male patients were enrolled in the study. The patients had increased intracranial pressure symptoms due to hydrocephaly. Endoscopic treatment was performed in all cases.

Results

The patients were followed-up for an average of 36.8 months. The postoperative intracranial pressure findings improved. There was a reduction in the size of the cyst and ventricles and enlargement of the cortical sulci. One patient suffered transient oculomotor nerve deficit. No further surgical interventions, such as shunt placement, were required during the follow-up period. The head circumference of two of the patients with macrocephaly were stable during the follow-up. There were no postoperative recurrences detected.

Conclusions

Endoscopic cyst fenestration and third ventriculostomy are less invasive, safer, and more effective ways to treat suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus in children with hydrocephaly.

Knowledge sharing motives and value co-creation behavior of the consumers in physiotherapy services: a cross-cultural study

Purpose

This study aims to investigate the role of consumers’ (patients) motives in knowledge sharing and value co-creation with the service provider in the context of physiotherapy services.

Design/methodology/approach

The authors used partial least squares structural equation modeling for the analysis of the physiotherapy services users’ data from Germany and Pakistan.

Findings

The results show that in both consumer groups, individualizing, empowering and development motives are common influences on the willingness to share knowledge leading to value co-creation. However, the relating, ethical and concerted motives show varying influences in the data set.

Research limitations/implications

A key research implication relates to specifying the link between consumer knowledge sharing and value creation and the role of cultural factors in this context. It is one of the first studies to undertake a comparative analysis in this specific context by highlighting the changing role of consumers from collective and individualistic societies, in influencing service provision through participation in the service exchange.

Practical implications

For the managerial audience, this paper highlights the importance of being sensitive to cultural elements as they tend to influence personal knowledge sharing by the consumer, especially in the well-being sector, which ultimately influences the value co-creation.

Originality/value

To the best of the authors’ knowledge, the current paper is one of the first studies focusing on the knowledge sharing motives of consumers in the specific context of physiotherapy services leading to value co-creation. Moreover, specific focus on individual consumer’s motives and their role in comparative, cross-cultural settings, adds further value to the contribution of this study.

Ahead of the Curve: Leveraging Antecedents of Corporate Entrepreneurship to Pull Off Competitive Advantage

Entrepreneurship is a highly dynamic and important endeavor that spills over to economic, technological, and social canvas of a society in this rapidly changing globalized economy. The purpose of the present quantitative study is to investigate the associations among information and communication technologies, innovation, absorptive capacity, CEO’s temporal leadership, and competitive advantage by considering corporate entrepreneurship as a mediator. These factors have been incorporated because they play a predominant role to vie in a competitive environment for entrepreneurial success and economic growth. We used the response of 460 organizations, acquired on a Likert scale, to examine how antecedents of corporate entrepreneurship contribute toward competitive advantage. Structural equation modeling was employed to analyze the measurement and structural relationships including the mediation effects of corporate entrepreneurship. All the relationships with corporate entrepreneurship were found significant except the direct effect of absorptive capacity on competitive advantage. Hence, the results established corporate entrepreneurship as a mediator to predict competitive advantage partially by information and communication technologies (ICT) use, innovation, and temporal leadership. The findings also reveal that absorptive capacity reaps an entire competitive advantage only through corporate entrepreneurship. Practically, the study would be invaluable for organizations, entrepreneurs, and managers to capture a lot of opportunities in effectively managing scarce resources.

Comparison of 1-year results of single transforaminal epidural steroid injection among patients with different spinal pathologies-related radicular pain

Aims

This study aims to investigate the effectiveness of transforaminal epidural steroid injection (TFESI) in patients with lumbar radicular pain or radiculopathy caused by different spinal pathologies.

Methods

One hundred and seventy seven patients who underwent single transforaminal epidural steroid injection were included in the study group and divided into 3 subgroups (central spinal stenosis + lateral recess stenosis, foraminal stenosis, lumbar disc herniation) according to existing spinal pathology. Patients' visuel analogue scale (VAS) measures and Oswestry Disability Index (ODI) scores were recorded and the patients who give favourable response to treatment were called respondents and who were not called as non-respondents. Subgroups were compared statistically at the end of 12 months.

Results

Sixty patients (33.9%) were considered as respondents and 117 patients (66.1%) were non-respondents in the entire study group. Patients with foraminal stenosis included the vast majority of the respondents and showed better results of pain relief as opposed to patients of other groups at the end of 12 months (P < 0.001).

Conclusion

TFESI was an effective treatment modality for pain relief and functional improvement in patients with foraminal stenosis. However, it could not produce the same results in patients with central spinal stenosis and lumbar disc herniations.

Silibinin and ellagic acid increase the expression of insulin receptor substrate 1 protein in ultraviolet irradiated rat skin

Daily exposure to ultraviolet (UV) light induces inflammation and tumorigenesis in the skin. Silibinin and ellagic acid are natural products that exhibit anti-inflammatory and anti-tumorigenic properties. Insulin receptor substrate protein 1 (IRS1) is important for skin homeostasis and physiology, but its activity following UV radiation remains unclear. We investigated the effects of ellagic acid and silibinin on IRS1 expression in ultraviolet A (UVA) and ultraviolet B (UVB) irradiated rat skin. Forty-two female Wistar rats were divided randomly into six groups of seven animals. The dorsal skin of rats was exposed to UVA + UVB, then treated with ellagic acid and silibinin by gavage. IRS1 expression in skin tissues was determined by western blot analysis. IRS1 expression increased significantly following treatment with ellagic acid and silibinin in UVA + UVB irradiated skin compared to the UVA + UVB only group. After UVA + UVB treatment, ellagic acid effected greater induction of IRS1 expression than silibinin. Our findings suggest that the photoprotective roles of ellagic acid and silibinin may be due to induction of IRS1 expression in UVA + UVB treated rat skin.

Unexpected Outcome of Daptomycin-induced Eosinophilic Pneumonia: Rarity Within a Rarity

Eosinophilic pneumonia comprises a group of lung diseases in which eosinophils appear in increased numbers in the lungs and sometimes in the bloodstream. Among several causes of pulmonary eosinophilia, drug-induced pulmonary eosinophilia and subsequent pneumonia is a well-known side effect of many medications. Daptomycin is now being increasingly recognized culprit medication in patients with eosinophilic pneumonia. Here we present a patient with daptomycin-induced acute eosinophilic pneumonia, who had an unusual response to usual treatment.

Resilient agility in volatile economies: institutional and organizational antecedents

Purpose

The purpose of this paper is to scrutinize the interplay between resilience and agility in explicating the concept of resilient agility and discuss institutional and organizational antecedents of resilient agility in volatile economies.

Design/methodology/approach

The authors develop a conceptual framework that offers an original account of underlying means of ambidextrous capabilities for organizational change and behaviors in volatile economies and how firms stay both resilient and agile in such contexts.

Findings

The authors suggest that resilient agility, an ambidextrous capability of sensing and acting on environmental changes nimbly while withstanding unfavorable disruptions, can explain entrepreneurial firms’ survival and prosperity. The authors then address institutional (instability and estrangement) and organizational (entrepreneurial orientation (EO) and bricolage) antecedents of resilient agility in volatile economies.

Originality/value

The authors highlight that unfavorable conditions in volatile economies might have bright sides for firms that can leverage them as entrepreneurial opportunities and propose that firms can achieve increased resilient agility when high levels of institutional instability and estrangement are matched with high levels of EO and bricolage.

Using intra-articular tranexamic acid in total knee replacement surgery with and without bleeding control: a prospective randomized double blind study

OBJECTIVE

To investigate the effectiveness of tranexamic acid (TA) application in two techniques: in the first one wound closure is performed before the tourniquet is released; in the second one, wound closure is performed after the tourniquet is released.

PATIENTS AND METHODS

The study is conducted on four groups of patients: (1) TA + TNR (tourniquet not released) where there is no bleeding control and TA is applied after wound closure without tourniquet release; (2) TA - TNR where placebo is applied after wound closure without tourniquet release; (3) TA + TR (tourniquet released) where tourniquet is released first and TA is applied after bleeding control and wound closure; and (4) TA - TR where tourniquet release is followed by bleeding control and placebo application.

RESULTS

The amount of hemorrhage in hemovac drains in each group was as follows: 217.4 ± 99.6 (100-590) ml in the TA + TNR group; 411.6 ± 133.7 (175-850) ml in the TA - TNR group; 291.2 ± 89.5 (160-650) ml in the TA + TR group; and 458.2 ± 138.6 (200-920) ml in the TA - TR group (p<0.0001). The TA + TNR group differed significantly from other groups in terms of the hemorrhage in drains.  Similarly, the TA + TNR group was notably different from the TA - TNR and TA - TR groups with regard to the hemoglobin and hematocrit values.

CONCLUSIONS

The study reveals that the amount of blood in hemovac drains is reduced significantly after the application of tranexamic acid to the suprapatellar space in the technique where wound closure is performed without bleeding control and before the tourniquet is released.

Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may be superior to C-reactive protein (CRP) for predicting the occurrence of differentiated thyroid cancer

OBJECTIVES

NLR (neutrophil-lymphocyte ratio) and PLR (platelet-lymphocyte ratio) are prognostic markers of differentiated thyroid cancers. In our study, we evaluated NLR, PLR and C-reactive protein (CRP) for predicting the occurence of differentiated thyroid cancer. This is the first study that compares NLR and PLR to C-reactive protein indifferantiated thyroid cancer not only papillary cancer but also folliculer cancer.

METHODS

This study includes 51 papillary carcinoma, 42 papillary microcarcinoma and 31 folliculer carcinoma patients attending to our outpatient Endocrinology Clinic at Erzurum Region Training and Research Hospital between 2009 and 2014. The control group include 50 age, sex and body mass index matched healty subjects. Blood counts and CRP were measured at the day before surgery. Thyroglobulin was measured after 6 months of operation.

RESULTS

There were positive correlations between tumor diameter, age, white blood cell (WBC) and thyroglobulin levels. There were also positive correlation between NLR, PLR and CRP levels.

CONCLUSION

In our study, we found out that higher NLR and PLR was associated with higher levels of thyroglobulin which indicates worse survival. CRP levels were also associated with poorer tumor profile but the determining rate was lower according to ROC analysis.

Methotrexate and doxycycline interaction: a rare cause of pancytopenia

Methotrexate (MTX) was originally formulated as one of the first antitumour drugs due to its ability to alter folate metabolism, which renders it to be an antiproliferative agent. Classically, the higher dosage is administered via parenteral route, in a cyclical fashion, to achieve antitumour effects. Patients on high doses of MTX are prone to develop rare complications of myelosuppression and pancytopenia, in a dose-dependent fashion, secondary to altered folate metabolism. ¹ Herein, we present a unique case of rheumatoid arthritis presented with pancytopenia due to low-dose MTX and doxycycline drug interaction. We also report the successful management of pancytopenia and oral ulcers with combination therapy of leucovorin and granulocyte colony-stimulating factor.

YouTube as a source of patient education in idiopathic pulmonary fibrosis: a media content analysis

Purpose: Idiopathic pulmonary fibrosis (IPF) is a common cause of pulmonary fibrosis, with millions of individuals affected in the world. Patients may use multiple resources to educate themselves regarding their illness, including popular social media video hosting site YouTube. We set out to determine the quality of patient education material discussing IPF available on YouTube.

Methods: 100 consecutive videos were surveyed for review, of which 59 were included in the final analysis. Three independent blinded reviewers were assigned to score each video on a scoring system designed along patient education material available publicly at the American Thoracic Society and the American College of Chest Physicians. Scores by each reviewer were compared to others using means, standard deviation, Cohen’s Kappa, and intra-class reliability.

Results: Video content had a mean score of 5.9, SD 3.96 out of a maximum of 20 points. Cohen’s Kappa between the three raters was calculated to a value of 0.92 and Interclass reliability was 0.79 (0.70–0.86, 95% CI) indicating appropriateness of comparison between the three raters.

Conclusion: Patient education material regarding IPF on YouTube was found deficient in quantity and quality. Providers should be aware of the best information resources available and utilize these to educate their patients.

Postpartum depression and affecting factors in primary care

Aim

The aim of this study was to determine the frequency and affecting factors of postpartum depression (PPD) in Edirne city center. This cross-sectional study was conducted among 111 pregnant women in their third trimester in Family Health Centers in Edirne, Turkey.

Materials and Methods

The participants filled out a questionnaire on sociodemographic factors developed by the researchers along with the Beck Depression Inventory for Primary Care (BDI-PC) before childbirth. Women with a probability of depression, determined with the BDI-PC, were excluded, and the remaining 100 participants were applied the Edinburgh postpartum depression scale (EPDS) in the first and second months after childbirth.

Results

The frequency of PPD was 14% (n = 14) in the first month and 17% (n = 17) in the second month of delivery. Thus, 24 different mothers out of 100 were determined to have PPD in the first two months after childbirth. The probability of PPD, measured with EPDS, was significantly higher among younger mothers, mothers with unemployed husbands, mothers with lower income, mothers with a health problem of the child, and mothers who do not breastfeed. There was no significant relationship between PPD and mother's education status, marriage age, the age of first labor, PPD after previous childbirth, psychiatric disorders in first-degree relatives, higher number of children, method of delivery, and unwanted pregnancies.

Conclusion

PPD is an important community problem. Thus, it is useful to monitor the risky mothers in primary care and screen them with the practical EPDS in order to prevent the negative effects on the baby and the mother.

Mechanical and tribological performance of a hybrid MMC coating deposited on Al-17Si piston alloy by laser composite surfacing technique

Laser composite surfacing (LCS) is a photon driven manufacturing technology that can be utilized for depositing hybrid metal matrix composite coatings (HMMC) on softer Ti/Al/Mg alloys to enhance their tribo-mechanical properties. LCS offers the advantages of higher directionality, localized microstructural refinement and higher metallurgical bonding between coating and substrate. The current research presents the tribo-mechanical evaluation and characterization of solid lubricant based Ni–WC coatings deposited by LCS on Al–Si piston alloy by varying the concentration of graphite between 5-to-15-weight percentage. The tribological behavior of LCS samples was investigated using a ball-on-plate tribometer. Results indicate that the surface hardness, wear rate and friction coefficient of the Al–Si hypereutectic piston alloy were improved after LCS of graphite based HMMC coatings. The maximum surface hardness of 781H_v was acquired for the Ni–WC coating containing 5 wt% graphite. The friction coefficient of Al–Si under dry sliding conditions was reduced from 0.47 to 0.21. The reduction in the friction coefficient was attributed to the formation of a shearable transfer layer, which prevented delamination and reduced adhesion, abrasion and fatigue cracking.

The addition of graphite as solid lubricant has significantly reduced the friction coefficient and wear of a Ni–WC composite coating.