The Concept of Organizational Routines and Its Potential for Investigating Educational Initiatives in Practice:A Systematic Review of the Literature

This review examines the concept of organizational routines and its potential for investigating educational initiatives in practice. The studies in our review revealed three different approaches to routines: (1) examining organizational routines as entities, (2) (also) examining conversational routines, and (3) examining the internal structure of organizational routines. Current definitions, operationalizations, and examinations can lack clarity and validity. At present, the concept of organizational routines not only holds potential but is also ambiguous. To bolster the potential of the concept, two working definitions of organizational routines are formalized that best allow researchers to investigate initiatives in practice. These working definitions are needed to create clarity regarding the concept and for it to be able to deliver on its promise for providing meaningful and relevant information on how new initiatives actually work and unfold in practice

Perspectives on local government’s place in federal systems and central–local relations

To expand on the themes identified by Tomas Hachard’s paper 'Capacity, voice and opportunity: advancing municipal engagement in Canadian federal relations', the Journal commissioned six personal ‘perspectives’ from a diverse group of other Commonwealth countries – Australia, India, New Zealand, Nigeria, South Africa and the United Kingdom. This replicated the model adopted in Issue 26 for Zack Taylor’s paper on 'Regionalism from above: intergovernmental relations in Canadian metropolitan governance'. Similarly, the purpose was to establish a broader picture of issues and trends across the Commonwealth, rather than ‘review’ Hachard’s work

The Neuromodulatory and Hormonal Effects of Transcutaneous Vagus Nerve Stimulation as Evidenced by Salivary Alpha Amylase, Salivary Cortisol, Pupil Diameter, and the P3 Event-Related Potential

Background Transcutaneous vagus nerve stimulation (tVNS) is a new, non-invasive technique being investigated as an intervention for a variety of clinical disorders, including epilepsy and depression. It is thought to exert its therapeutic effect by increasing central norepinephrine (NE) activity, but the evidence supporting this notion is limited. Objective In order to test for an impact of tVNS on psychophysiological and hormonal indices of noradrenergic function, we applied tVNS in concert with assessment of salivary alpha amylase (SAA) and cortisol, pupil size, and electroencephalograph (EEG) recordings. Methods Across three experiments, we applied real and sham tVNS to 61 healthy participants while they performed a set of simple stimulus-discrimination tasks. Before and after the task, as well as during one break, participants provided saliva samples and had their pupil size recorded. EEG was recorded throughout the task. The target for tVNS was the cymba conchae, which is heavily innervated by the auricular branch of the vagus nerve. Sham stimulation was applied to the ear lobe. Results P3 amplitude was not affected by tVNS (Experiment 1A: N = 24; Experiment 1B: N = 20; Bayes factor supporting null model = 4.53), nor was pupil size (Experiment 2: N = 16; interaction of treatment and time: p = .79). However, tVNS increased SAA (Experiments 1A and 2: N = 25) and attenuated the decline of salivary cortisol compared to sham (Experiment 2: N = 17), as indicated by significant interactions involving treatment and time (p = .023 and p = .040, respectively). Conclusion These findings suggest that tVNS modulates hormonal indices but not psychophysiological indices of noradrenergic function

Mental health issues and illness and substance use disorder (non-)disclosure to a supervisor:A cross-sectional study on beliefs, attitudes and needs of military personnel

Objectives Research suggests that military personnel frequently delay disclosing mental health issues and illness (MHI), including substance use disorder, to supervisors. This delay causes missed opportunities for support and workplace accommodations which may help to avoid adverse occupational outcomes. The current study aims to examine disclosure-related beliefs, attitudes and needs, to create a better understanding of personnel’s disclosure decision making.Design A cross-sectional questionnaire study among military personnel with and without MHI. Beliefs, attitudes and needs regarding the (non-)disclosure decision to a supervisor were examined, including factors associated with (non-)disclosure intentions and decisions. Descriptive and regression (logistic and ordinal) analyses were performed.Setting The study took place within the Dutch military.Participants Military personnel with MHI (n=324) and without MHI (n=554) were participated in this study.Outcome measure (Non-)disclosure intentions and decisions.Results Common beliefs and attitudes pro non-disclosure were the preference to solve one’s own problems (68.3%), the preference for privacy (58.9%) and a variety of stigma-related concerns. Common beliefs and attitudes pro disclosure were that personnel wanted to be their true authentic selves (93.3%) and the desire to act responsibly towards work colleagues (84.5%). The most reported need for future disclosure (96.8%) was having a supervisor who shows an understanding for MHI. The following factors were associated both with non-disclosure intentions and decisions: higher preference for privacy (OR (95% CI))=(1.99 (1.50 to 2.65)intention, 2.05 (1.12 to 3.76)decision) and self-management (OR (95% CI))=(1.64 (1.20 to 2.23)intention, 1.79 (1.00 to 3.20)decision), higher stigma-related concerns (OR (95% CI))=(1.76 (1.12 to 2.77)intention, 2.21 (1.02 to 4.79)decision) and lower quality of supervisor–employee relationship (OR (95% CI))=(0.25 (0.15 to 0.42)intention, 0.47 (0.25 to 0.87)decision).Conclusion To facilitate (early-)disclosure to a supervisor, creating opportunities for workplace support, interventions should focus on decreasing stigma and discrimination and align with personnels’ preference for self-management. Furthermore, training is needed for supervisors on how to recognise, and effectively communicate with, personnel with MHI. Focus should also be on improving supervisor–employee relationships

Language differences in qualitative research: is meaning lost in translation?

This article discusses challenges of language differences in qualitative research, when participants and the main researcher have the same non-English native language and the non-English data lead to an English publication. Challenges of translation are discussed from the perspective that interpretation of meaning is the core of qualitative research. As translation is also an interpretive act, meaning may get lost in the translation process. Recommendations are suggested, aiming to contribute to the best possible representation and understanding of the interpreted experiences of the participants and thereby to the validity of qualitative research

Clustering of dystonia in some pedigrees with autosomal dominant essential tremor suggests the existence of a distinct subtype of essential tremor

<p>Abstract</p> <p>Background</p> <p>There is an ongoing debate whether essential tremor (ET) represents a monosymptomatic disorder or other neurologic symptoms are compatible with the diagnosis of ET. Many patients with clinically definite ET develop dystonia. It remains unknown whether tremor associated with dystonia represent a subtype of ET. We hypothesized that ET with dystonia represents a distinct subtype of ET.</p> <p>Methods</p> <p>We studied patients diagnosed with familial ET and dystonia. We included only those patients whose first-degree relatives met diagnostic criteria for ET or dystonia with tremor. This cohort was ascertained for the presence of focal, segmental, multifocal, hemidystonia or generalized dystonia, and ET.</p> <p>Results</p> <p>We included 463 patients from 97 kindreds with autosomal dominant mode of inheritance (AD), defined by the vertical transmission of the disease. ET was the predominant phenotype in every ascertained family and each was phenotypically classified as AD ET. "Pure" ET was present in 365 individuals. Focal or segmental dystonia was present in 98 of the 463 patients; 87 of the 98 patients had ET associated with dystonia, one had dystonic tremor and ten had isolated dystonia. The age of onset and tremor severity did not differ between patients with "pure" ET and ET associated with dystonia. We did not observe a random distribution of dystonia in AD ET pedigrees and all patients with dystonia associated with ET were clustered in 28% of all included pedigrees (27/97, p < 0.001).</p> <p>Conclusions</p> <p>Our results suggest that familial ET associated with dystonia may represent a distinct subtype of ET.</p

Prognostic Value of [¹⁸F]FDG PET Radiomics to Detect Peritoneal and Distant Metastases in Locally Advanced Gastric Cancer—A Side Study of the Prospective Multicentre PLASTIC Study

Aim: To improve identification of peritoneal and distant metastases in locally advanced gastric cancer using [18F]FDG-PET radiomics. Methods: [18F]FDG-PET scans of 206 patients acquired in 16 different Dutch hospitals in the prospective multicentre PLASTIC-study were analysed. Tumours were delineated and 105 radiomic features were extracted. Three classification models were developed to identify peritoneal and distant metastases (incidence: 21%): a model with clinical variables, a model with radiomic features, and a clinicoradiomic model, combining clinical variables and radiomic features. A least absolute shrinkage and selection operator (LASSO) regression classifier was trained and evaluated in a 100-times repeated random split, stratified for the presence of peritoneal and distant metastases. To exclude features with high mutual correlations, redundancy filtering of the Pearson correlation matrix was performed (r = 0.9). Model performances were expressed by the area under the receiver operating characteristic curve (AUC). In addition, subgroup analyses based on Lauren classification were performed. Results: None of the models could identify metastases with low AUCs of 0.59, 0.51, and 0.56, for the clinical, radiomic, and clinicoradiomic model, respectively. Subgroup analysis of intestinal and mixed-type tumours resulted in low AUCs of 0.67 and 0.60 for the clinical and radiomic models, and a moderate AUC of 0.71 in the clinicoradiomic model. Subgroup analysis of diffuse-type tumours did not improve the classification performance. Conclusion: Overall, [18F]FDG-PET-based radiomics did not contribute to the preoperative identification of peritoneal and distant metastases in patients with locally advanced gastric carcinoma. In intestinal and mixed-type tumours, the classification performance of the clinical model slightly improved with the addition of radiomic features, but this slight improvement does not outweigh the laborious radiomic analysis.</p

Macrophage-derived IL-1β and TNF-α regulate arginine metabolism in neuroblastoma

© 2018 American Association for Cancer Research. Neuroblastoma is the most common childhood solid tumor, yet the prognosis for high-risk disease remains poor. We demonstrate here that arginase 2 (ARG2) drives neuroblastoma cell proliferation via regulation of arginine metabolism. Targeting arginine metabolism, either by blocking cationic amino acid transporter 1 (CAT-1)-dependent arginine uptake in vitro or therapeutic depletion of arginine by pegylated recombinant arginase BCT-100, significantly delayed tumor development and prolonged murine survival. Tumor cells polarized infiltrating monocytes to an M1-macrophage phenotype, which released IL1b and TNFa in a RAC-alpha serine/threonine-protein kinase (AKT)-dependent manner. IL1b and TNFa established a feedback loop to upregulate ARG2 expression via p38 and extracellular regulated kinases 1/2 (ERK1/2) signaling in neuroblastoma and neural crest-derived cells. Proteomic analysis revealed that enrichment of IL1b and TNFa in stage IV human tumor microenvironments was associated with a worse prognosis. These data thus describe an immune-metabolic regulatory loop between tumor cells and infiltrating myeloid cells regulating ARG2, which can be clinically exploited

Midtrimester preterm prelabour rupture of membranes (PPROM):expectant management or amnioinfusion for improving perinatal outcomes (PPROMEXIL - III trial)

BACKGROUND: Babies born after midtrimester preterm prelabour rupture of membranes (PPROM) are at risk to develop neonatal pulmonary hypoplasia. Perinatal mortality and morbidity after this complication is high. Oligohydramnios in the midtrimester following PPROM is considered to cause a delay in lung development. Repeated transabdominal amnioinfusion with the objective to alleviate oligohydramnios might prevent this complication and might improve neonatal outcome. METHODS/DESIGN: Women with PPROM and persisting oligohydramnios between 16 and 24 weeks gestational age will be asked to participate in a multi-centre randomised controlled trial. Intervention: random allocation to (repeated) abdominal amnioinfusion (intervention) or expectant management (control). The primary outcome is perinatal mortality. Secondary outcomes are lethal pulmonary hypoplasia, non-lethal pulmonary hypoplasia, survival till discharge from NICU, neonatal mortality, chronic lung disease (CLD), number of days ventilatory support, necrotizing enterocolitis (NEC), periventricular leucomalacia (PVL) more than grade I, severe intraventricular hemorrhage (IVH) more than grade II, proven neonatal sepsis, gestational age at delivery, time to delivery, indication for delivery, successful amnioinfusion, placental abruption, cord prolapse, chorioamnionitis, fetal trauma due to puncture. The study will be evaluated according to intention to treat. To show a decrease in perinatal mortality from 70% to 35%, we need to randomise two groups of 28 women (two sided test, β-error 0.2 and α-error 0.05). DISCUSSION: This study will answer the question if (repeated) abdominal amnioinfusion after midtrimester PPROM with associated oligohydramnios improves perinatal survival and prevents pulmonary hypoplasia and other neonatal morbidities. Moreover, it will assess the risks associated with this procedure. TRIAL REGISTRATION: NTR3492 Dutch Trial Register (http://www.trialregister.nl)

Functional Subsystems and Quantum Redundancy in Photosynthetic Light Harvesting

The Fenna-Matthews-Olson (FMO) antennae complex, responsible for light harvesting in green sulfur bacteria, consists of three monomers, each with seven chromophores. Here we show that multiple subsystems of the seven chromophores can transfer energy from either chromophore 1 or 6 to the reaction center with an efficiency matching or in many cases exceeding that of the full seven chromophore system. In the FMO complex these functional subsystems support multiple quantum pathways for efficient energy transfer that provide a built-in quantum redundancy. There are many instances of redundancy in nature, providing reliability and protection, and in photosynthetic light harvesting this quantum redundancy provides protection against the temporary or permanent loss of one or more chromophores. The complete characterization of functional subsystems within the FMO complex offers a detailed map of the energy flow within the FMO complex, which has potential applications to the design of more efficient photovoltaic devices