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Background Esophagogastroduodenoscopy is very useful in diagnosing and treating upper gastrointestinal mucosal disorders, but too much foam and water in stomach decrease its diagnostic efficiency. Simethicone administration can help remove excessive foam. Aims To determine the optimal simethicone administration strategies in a comparative randomized controlled clinical trial. Methods Adult outpatients with indications for esophagogastroduodenoscopy were enrolled and randomly divided into group 1 (simethicone solution intake 20–30 min before procedure, n = 110), group 2 (simethicone solution intake 31–60 min before procedure, n = 92), and group 3 (simethicone solution intake > 60 min before procedure). Primary and secondary outcomes were procedure time and the patients’ satisfaction after the examination. All symptoms like abdominal pain and distension were recorded. Results No statistically significant differences were found on the patients’ demographic and clinical features and mean examination time (all P values > 0.05). The distribution of patients with different endoscopic and pathological diagnosis was comparable among three groups, respectively (P = 0.607; P = 0.289). However, the proportion of patients with Gastric Cleanness Grade A was most in group 2 (n = 73, 79.3%), and patient proportion with Gastric Cleanness Grade C was most found in group 1 (n = 72, 65.5%), which was greatly different (P < 0.001). There was no statistically significant difference on the satisfaction scores [immediately 6 (3–8) vs. 6 (1–10) vs. 6 (1-9), P = 0.533; 2 h after 10 (8–10) vs. 10 (10–10) vs. 10 (8-10), P = 0.463]. Conclusion Simethicone solution intake 31–60 min before esophagogastroduodenoscopy can help obtain the best gastric cleanness, which is recommended in clinical practice (registered at ClinicalTrials.gov, NCT03776916 on December 13, 2018).

Effective governance is crucial for developing various renewable energies, especially in their early stages. After the spectacular growth of onshore wind in the past decade, offshore wind is attracting an increasing amount of attention globally. As an archipelago and facing electricity shortage after the 2011 Fukushima nuclear accident, Japan has been accelerating its pace of developing offshore wind. However, the Japanese government encounters the challenge of adapting its old institution to the new governance demand. This research analyzes the evolution of offshore wind policies and evaluates the progress of inter-ministerial collaboration in Japan. It is found that from the initial potential surveys to the final setting of offshore wind feed-in tariff, the relations between relevant agencies were more characterized by inter-ministerial competitions than collaborations. The deeply rooted traditional sectionalism continues to affect the development of offshore wind and may slow down the progress of energy transition in Japan.

Previous studies on the science–policy interface concentrate mostly on institutional arrangements that facilitate the information exchange between scientists and policymakers, but few address the internal structure of the scientist community and its impact on policy-making. Considering that science emerges from academic competition, the examination of the power balance within the scientist community is crucial for understanding political outcomes in the science–policy interface. This study applies social network analysis to the scientist community of grassland management in China and demonstrates that the structure of the scientist community exerts a significant influence on the formation of environmental policies. The dominance of ecologists inside the community led to the prevalence of the overgrazing-causes-degradation narrative. Though anthropologists later questioned the narrative, their capacity to challenge the authority of ecologists was circumscribed by their small group size, weak intra-group connection, and limited political affiliation. This resulted in the persistence of biased policies that continue to blame local communities for environmental problems.

Due to significant cost advantages, wind energy penetrated the energy mix of most large countries much faster than solar PV did until the recent decade. However, Japan has been almost one-sidedly leaning toward the more expensive solar PV. For using solar PV electricity, the Japanese consumers are also paying sizably higher tariffs than those in other countries, especially after the Fukushima nuclear accident in 2011 that led to the sudden suspension of all nuclear power plants. Japan's energy transition towards renewables is accordingly largely single legged, rather than more balanced to take advantage of both wind turbines and solar PV. This article explains the puzzle on why renewable energy development in Japan has created such a wide distance from more economically optimal situations. We focus on the initiation, formation and impacts of the solar lobby that comprises bureaucracies, politicians, solar PV manufacturers, and independent power producers. Policy implications are drawn for Japan and other countries on the importance of controlling political lobby to achieve less costly energy transition.

Propofol sedation has been applied during esophagogastroduodenoscopy procedures, but whether topical pharyngeal anesthesia should be administered at the same time has rarely been reported. Our study examined the role of topical pharyngeal anesthesia in sedated endoscopies in a randomized controlled double-blinded clinical trial. A total of 626 patients who underwent sedated esophagogastroduodenoscopy were randomized into the experimental group (n = 313) or the control group (n = 313). The discomfort score, immediately and one day after the procedure, was not statistically significant [7.2 (5–9) vs. 7.5 (6–9), P = 0.210; 2.3 (0–3) vs. 2.6 (0–4), P = 0.095, respectively]. Two patients in the experimental group and three patients in the control group needed oral medication for pharyngeal discomfort (P = 0.354). The satisfaction score was 9.2 (8–10) in the experimental group and 8.9 (7–10) in the control group (P = 0.778). Lidocaine topical pharyngeal anesthesia in propofol-sedated esophagogastroduodenoscopy did not further reduce the pharyngeal discomfort or improve the satisfaction. This clinical trial was registered at ClinicalTrials.gov (ClinicalTrials.gov ID: NCT03070379).

The increase in workforce diversity is a global phenomenon and puts extra pressure on organizations to manage employee diversity. This organizational challenge is reflected in the 2019 All-Academy theme, “Understanding the Inclusive Organization.” However, despite a strong body of research on employee experiences and diversity climate, diversity scholars have not been as prolific at providing practitioners robust evidence-based advice regarding organizational-level diversity efforts. This symposium has brought together researchers who are using various methodologies to examine organizational level, “above the line” elements of diversity management systems. Specifically, the first two papers in our symposium develop measurements of “above the line” diversity paradigms, which can help HR professionals identify their organizational expectations and values regarding diversity and inclusion. The third paper extends this work by qualitatively examining secondary data to show that organizations with more strategic focus on gender equality also have more robust diversity efforts throughout the organization. The next three papers examine various ways that managers can connect organizational level initiatives to employee experiences “below the line,” culminating in specific strategies for HR personnel. Taken together, these papers extend the research in diversity, human resource management and organizational behavior to provide a more comprehensive picture of the complete diversity management system across various levels of the organization.