bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of “us”—Expressions of togetherness in couples where one spouse has dementia
Authors: Swall Anna , Williams Christine , Marmstål Hammar Lena
Published: December 2019

Background

Living with dementia involves both illness and health, and self‐care and care from others. As most persons with dementia live in their own homes, dementia affects not only the person with the disease, but also family, commonly the partner. Research shows that spousal carers feel as though they are losing their partners since they can no longer share thoughts, feelings and experiences as a couple.

Aim

The aim of the study was to describe the sense of togetherness of the spouses when one spouse has dementia.

Method

The sample consists of 18 recorded conversations between 15 persons with dementia and their spouses. The filmed conversations were transcribed verbatim and then analysed using qualitative content analysis.

Findings

One overarching theme arose: Dementia preserved and challenged the value of “us.” It can be challenging for a couple in which one partner has dementia to preserve a sense of togetherness and to have the relationship they wish for.

Conclusion

Based on our results, we suggest that practitioners should help couples to strengthen their bond as a couple so as to maintain a sense of well‐being. Future studies should examine couplehood under differing conditions, such as long‐ versus short‐term relationships. Prior relationship quality may also be a factor that influences the sense of couplehood following a serious health challenge, such as dementia.

Implication for practice

When spouses were able to live together, their relationship was enriched at many levels. Their love for each other strengthened them as a unit – as an “us” – where togetherness seemed to be strong. Future studies need to examine whether the sense of couplehood varies depending on the length of the relationship (i.e., a relationship of many years or a relatively new relationship).
What are we asking for when requesting “Specialling” for the confused hospitalised older person? A concept analysis
Authors: Coyle Miriam Anne , Wilson Valerie , Lapkin Samuel , Traynor Victoria
Published: December 2019

Background and/or rationale

“Specialling” is a common nursing practice in hospitals which entails the allocation of extra staff to be with an older person who is confused to maintain safety. Despite ongoing use, this practice has little evidence of effectiveness. To facilitate further investigation, a concept analysis of “specialling” was undertaken.

Aims

The aim of this paper was to report on a concept analysis on the practice of “specialling” pertaining to older people who have cognitive impairment when in hospital.

Methods

This study used Rodgers evolutionary approach to concept analysis to clarify the attributes, antecedents and consequences of the concept to determine a definition of “specialling.” Web of Science (Core Collection and Web of Science Medline), CINAHL and SCOPUS databases were searched to identify relevant literature. Due to the scarcity of papers, the search was broadened to include all sources that could add understanding.

Findings

A total of (n = 43) sources were identified. The attributes were themed to 5 categories: Labels and descriptions; the “Special” role; Patient safety; Patient care; and Communication. The antecedents to 2 themes: Patient characteristics; and Organisational risk. The consequences of “specialling” were diverse with 6 themes: the “Special” role; the Older persons experience; Costly; “Special” use and nursing beliefs; Safety outcomes; and Opportunities.

Discussion

The process of concept analysis provided a means to identify knowledge gaps and practice challenges. The definition determined from this analysis has provided a reflective opportunity for clinicians and researchers to consider when implementing care initiatives to support older people in hospital. Important is the lack of person‐centred approaches and the opportunities in developing nurse leadership through empowerment. The findings from this analysis will inform a PhD study.

Implications for practice

Nurses have an opportunity to lead care improvements by ensuring person‐centred approaches in the care of older people with cognitive impairment.
Pediatric airway management education and training
Authors: Hunyady Agnes , Polaner David
Published: December 2019

Education in medicine, informed by research findings, is moving away from the traditional apprenticeship model and increasingly embraces new, active learning methodologies. In this article, we will review these methodologies along with adult learning theories; we explore the available evidence on acquisition and maintenance of pediatric airway management skills, including technical and nontechnical skills. We recall the elements of a competency‐based curriculum and how they can be applied in pediatric airway skill training and suggest mapping strategies based on research evidence. We propose future directions in education and educational research in the field.
Making Peace Visible: Colors in Visual Peace Research
Authors: Vuori Juha A. , Guillaume Xavier T. , Andersen Rune S.
Published: December 2019

Peace is not an absence, but rather a visibly identifiable set of norms. This visualization can take place through internationally recognized signs such as the white flag and the blue helmet. These representations of norms are united in their ability to be distinguished from similar objects or signs through their use of colors. The identificatory use of color avoids confusion between parties embroiled in a conflict, making an organization or envoy stand out and creating the expectation that they are encompassed by the specific norms of warfare, which these colors make visible. Through establishing such “dumb signs” of peace, as Grotius put it, the colors of peace have, we argue, played a notable part in establishing customary international law. The aim of our contribution is to offer an illustrative chromatological analysis of how peace and its norms are made visible through objects and symbols which are not connected with peace beyond their coloring (e.g., emblems, flags, helmets, or warzone vehicles). We show how certain colors, in their situated use, come to both symbolize and enact peace in terms of international politics.
Novel treatment of refractory / recurrent pulmonary hepatoblastoma
Authors: Zhang Yu‐Tong , Chang Jian , Yao Yun‐ming , Li Ya‐nan , Zhong Xiao‐dan , Liu Zi‐ling
Published: December 2019

Background

There is no consensus about how to manage pulmonary metastasis in patients with hepatoblastoma. We reviewed a treatment with a combination of oxaliplatin, vincristine, and topotecan (OVT) paired with radiofrequency ablation (RFA) of 12 patients with multiple refractory / recurrent pulmonary hepatoblastoma.

Methods

The medical records from patients with ≤21 years of age presenting with multiple deposits (≥2) of refractory / recurrent pulmonary hepatoblastoma were reviewed. The following data were extracted from each patient: age, gender, histological subtyping, cycles of OVT, tumor size, biomarkers, chemotherapy regimen and dosage, RFA details, treatment response, follow up, and patient outcomes. The primary outcome measure was the complete response (CR) of pulmonary diseases, and secondary outcomes were event‐free survival rate and overall survival rate.

Results

Of 12 assessable patients, three (25%) (95% CI, 46.3–104) patients achieved PR (partial resopnse) after they finished OVT. After RFA, five (41.7%) (95% CI, 8.95–74.4) patients achieved CR (complete response). The 2 year event‐free survival rate was 33% (95% CI, 20.5–64.6). The 2 year overall survival for the study group was 41.7% (95% CI, 8.9–74.4). All toxicity events were handled satisfactorily and no toxic related deaths were observed.

Conclusions

Our review report shows that OVT combined with RFA can be a successful treatment modality for previously heavily treated refractory / recurrent pulmonary metastatic lesions from hepatoblastoma.
Generalized and specific anxiety in adolescents following heart transplant
Authors: McCormick Amanda D. , Schumacher Kurt R. , Zamberlan Mary , Uzark Karen , Yu Sunkyung , Lowery Ray , Rottach Nichole , Cousino Melissa K.
Published: December 2019

Mental health concerns are associated with worse outcomes after adult heart transplant. Illness‐specific anxiety is associated with worsened psychological well‐being after other solid organ transplants but has never been characterized after pediatric heart transplant. This single‐center cross‐sectional study aimed to evaluate illness‐specific and generalized anxiety after heart transplantation in adolescents. A novel 12‐item PHTF, GAD‐7, and the PedsQL were administered. Univariate associations of demographics, clinical features, and medication adherence as measured by immunosuppression standard deviation with the PHTF and GAD‐7 scores were evaluated. Internal consistency and validity of the PHTF were examined. In total, 30 patients participated. The most common illness‐specific fears were retransplantation, rejection, and more generally post‐transplant complications. The PHTF had good internal consistency (Cronbach α = .88). Construct validity was demonstrated between PHTF and GAD‐7 (r = .62) and PedsQL (r = −.54 to −.62). 23% endorsed moderate to severe generalized anxiety symptoms. More severe symptoms were associated with older age at survey (P = .03), older age at listing (P = .01) and having post‐transplant complications (P = .004). Patients with moderate or severe symptoms were more likely to report late immunosuppression doses (P = .004). Illness‐specific and generalized anxiety may be prevalent after pediatric heart transplant. Screening for anxiety in adolescents post‐transplant may identify those at risk for adverse outcomes including non‐adherence. The PHTF is a brief, valid, and reliable instrument identifying illness‐specific anxiety in this population.
Cryptosporidiosis among solid organ transplant recipient attendees at a summer camp
Authors: McAteer John , Jernigan Stephanie , Mao Chad , Gonzalez Mark D. , Watson Renee J. , Liverman Rochelle , Tobin‐D Angelo Melissa , Dishman M. Hope , Shane Andi , Yildirim Inci
Published: December 2019

We report a cluster of pediatric cryptosporidiosis infections among solid organ transplant recipients at a summer camp in Georgia, USA. A retrospective cohort study was conducted to investigate the risk factors for infection. A total of 118 campers attended the camp during July 23‐28, 2017. The overall attack rate among campers during the outbreak was 11% (13/118). Sanger‐based amplicon sequencing of stool specimens from 7 (80%) campers identified Cryptosporidium hominis as the suspected etiologic agent. All infected campers were heart or kidney transplant recipients receiving immunosuppressive therapy. The median reported symptom duration was 12 days (range 6‐18 days) and 9 (69.2%) were hospitalized for at least one night (median length of stay 5 days, range 2‐16 days). There were no deaths or acute rejection events attributed to infection. The results of the epidemiologic and environmental investigation suggest a recreational pool as the presumed source, although there was no direct evidence to support this. Many long‐term interventions were implemented, and there have been no further outbreaks at the camp in the following two years. This outbreak demonstrates that cryptosporidiosis may be associated with notable burden in pediatric transplant recipients, and illustrates the challenges associated with source identification and containment.
Photodynamic Therapy for Gastrointestinal Cancer
Authors: Yano Tomonori , Wang Kenneth K.
Published: December 2019

The clinical application of photodynamic therapy (PDT) for gastrointestinal (GI) neoplastic lesions has been developed with appreciation for the great efforts and kind support of Dr. Tom Dougherty and his followers’ contributions. There are several published studies on clinical PDT in the field of GI oncology. Esophageal cancer was one of the first clinical indications for PDT that was approved as an endoscopic procedure in both the United States and Japan. PDT was initially used as a palliative local treatment for patients with obstructive esophageal cancer. PDT is also indicated for eradicative therapy for dysplastic Barret’s esophagus, which is the precursor state of esophageal adenocarcinoma, with the support of level one evidence. In Japan, PDT was approved as a curative treatment for superficial esophageal carcinoma lesions, which are difficult to treat with endoscopic resection. Further, PDT using second‐generation photosensitizers is approved for early local failure after radiotherapy, for which treatment with other modalities is difficult. PDT has also been assessed in other GI cancers, including gastric cancer, biliary cancer and pancreatic cancer. In this review, we overview the history and state of PDT for GI cancer.
EGY3: homologue of S2P protease located in chloroplasts
Authors: Adamiec M. , Misztal L. , Kasprowicz‐Maluśki A. , Luciński R.
Published: December 2019

The EGY3 protein is a homologue of site‐2 proteases, which are intramembrane zinc metalloproteases. EGY3 itself lacks proteolytic activity due to the absence of a zinc‐binding motif. Plentiful evidence indicates that such intramembrane ‘pseudoproteases’ play significant roles in many diverse processes occurring within the cell. However, the physiological functions of EGY3, as well as its subcellular localization, remain unknown.

The subcellular localization of EGY3 protein was investigated using Arabidopsis thaliana protoplasts transformed with EGY3‐GFP fusion protein, and immunoblot experiments using the total leaf protein extract, as well as highly purified chloroplasts and fractions of stroma, envelope and thylakoid membrane proteins. The physiological role of EGY3 was studied using two A. thaliana mutant lines devoid of EGY3 protein. Chlorophyll a fluorescence measurement was performed and the egy3 mutant sensitivity to photoinhibition was investigated. Additionally, the abundance of thylakoid membrane complexes was established using blue native gel electrophoresis.

We present experimental evidence for thylakoid membrane localization of the EGY3 protein.

We show that egy3 mutants display increased value of the non‐photochemical quenching parameter and significantly slower recovery rate after photoinhibitory treatment. This was associated with a decrease in the level of proteases involved in photosystem II recovery, Deg1 and FtsH2/8.
The Paradox Between Integration and Perceived Discrimination Among American Muslims
Authors: Lajevardi Nazita , Oskooii Kassra A. R. , Walker Hannah L. , Westfall Aubrey L.
Published: December 2019

Muslim Americans are increasingly integrated into American life, displaying high socioeconomic status, political participation, and adherence to American values. However, they are evaluated more negatively than many other racial, ethnic, and religious minorities and are frequent targets of discrimination. This article examines the mismatch between the integration of Muslims and their poor reception. Drawing on theories of cultural fluency and cognitive dissonance, we argue that cultural integration can exacerbate, rather than mitigate, perceived discrimination because integrated individuals are socialized to expect fair treatment and can recognize and decode even subtle forms of discrimination due to high levels of cultural and language fluency. Using three nationally representative surveys and an opt‐in, online study of American Muslims between 2007 and 2017, we find that integrated Muslims are consistently more likely than their counterparts to report individual‐ and group‐level societal and political discrimination. The paradox between adopting the host culture and feeling marginalized poses a challenge to the assumption that integration naturally leads to a sense of belonging among minorities, with important implications for liberal democracies.
A phylogenetically distinct lineage of Pyrenopeziza brassicae associated with chlorotic leaf spot of Brassicaceae in North America
Authors: Carmody Shannon M. , King Kevin M. , Ocamb Cynthia M. , Fraaije Bart A. , West Jon S. , du Toit Lindsey J.
Published: December 2019

Light leaf spot, caused by the ascomycete Pyrenopeziza brassicae, is an established disease of Brassicaceae in the United Kingdom (UK), continental Europe, and Oceania (OC, including New Zealand and Australia). The disease was reported in North America (NA) for the first time in 2014 on Brassica spp. in the Willamette Valley of western Oregon, followed by detection in Brassica juncea cover crops and on Brassica rapa weeds in northwestern Washington in 2016. Preliminary DNA sequence data and field observations suggest that isolates of the pathogen present in NA might be distinct from those in the UK, continental Europe, and OC. Comparisons of isolates from these regions using genetic (multilocus sequence analysis, MAT gene sequences, and rep‐PCR DNA fingerprinting), pathogenic (B. rapa inoculation studies), biological (sexual compatibility), and morphological (colony and conidial morphology) analyses demonstrated two genetically distinct evolutionary lineages. Lineage 1 comprised isolates from the UK, continental Europe, and OC, and included the P. brassicae type specimen. Lineage 2 contained the NA isolates associated with recent disease outbreaks in the Pacific Northwest region of the USA. Symptoms caused by isolates of the two lineages on B. rapa and B. juncea differed, and therefore “chlorotic leaf spot” is proposed for the disease caused by Lineage 2 isolates of P. brassicae. Isolates of the two lineages differed in genetic diversity as well as sensitivity to the fungicides carbendazim and prothioconazole.
Effects of cryopreservation on stallion sperm protamine messenger RNAs
Authors: Kadivar Ali , Shams Esfandabadi Naser , Dehghani Nazhvani Ehsan , Shirazi Abolfazl , Ahmadi Ebrahim
Published: December 2019

Protamines substitute DNA‐binding histones during late spermatogenesis in sperm nucleus. Stallion sperm contains all three variants of these arginine‐rich and positively charged nuclear proteins (P1, P2 and P3). Two variants of protamine‐2, that is P2 and P3, constitute approximately 15% of the entire protamine content. Also, the ratio of protamine‐1 to protamine‐2 varies among different mammalian species, and abnormal protamine ratios and protamine content are correlated with male infertility. In this study, changes in protamine mRNA abundance for all three protamines were investigated in stallion sperm during cryopreservation. Twelve ejaculates were collected from six sexually mature stallions. Sperm samples were divided into two parts for total mRNA extraction: one as fresh and the other as cryopreserved sample. Levels of three protamine transcripts were determined by real‐time reverse transcriptase polymerase chain reaction. Results of relative expression showed that cryopreservation can significantly alter protamine transcripts: protamine 2 was downregulated, while protamine 3 was upregulated in cryopreserved samples relative to the control. Changes in protamine 1 were not significant after cryopreservation. This study is the first to evaluate changes in mRNA abundance of protamine genes in stallion sperm following cryopreservation. Such evaluations are important in finding transcriptomic markers for success in fertilization and assisted reproductive techniques.
Recent developments in school social control
Authors: Ramey David M.
Published: December 2019

In the U.S., decisions regarding social control are increasingly modeled on two dominant institutions: the criminal justice and medical/healthcare systems. Sociologists and other scholars refer to this adoption of legal and/or medical terminology and technologies as criminalization and medicalization. These models of social control are particular evident in how America defines and manages child behavior. Public schools borrow from both the criminal justice and medical systems as part of the routine educational setting. In this article, I provide the first synthesis and review of the school criminalization and medicalization literatures. In doing so, I argue that criminalized school social controls provide harsh, repressive responses to student misbehavior, while medicalized school social controls provide rehabilitative and restitutive responses. Given these fundamentally different approaches to student behavior, I argue that the disproportionate use of criminalized and medicalized social control across racial/ethnic groups and children from different socioeconomic backgrounds entrenches inequalities and functions to channel racial/ethnic minorities and poor children into the school‐to‐prison pipeline while keeping socially advantaged children in school and away from the problems associated with criminalized social control.
Attitudes Toward Immigration: Ethnicity Trumps Skills But Not Legality?
Authors: España‐Nájera Annabella , Vera David
Published: December 2019

Objective

The objectives of this study were to parse the effect of ethnicity as a potential driver of public perception of immigrants from previous finding on the labor market competition hypothesis (e.g., Hainmueller and Hiscox, 2010; Hainmueller and Hopkins, 2015).

Methods

We rely on survey experiments to analyze the effect of ethnicity on attitude formation toward immigrants. In a first experiment, we test whether favoritism for high‐skilled immigrants diminishes when we add the Hispanic descriptor. In a second experiment, we examine whether public opinion toward undocumented immigrants is affected by region of origin.

Results

We find that favoritism for high‐skilled immigrants drops when we add the Hispanic descriptor, but that legal status outweighs any possible anti‐Hispanic sentiment.

Conclusion

Our study provides a novel setup to study the interaction between economic factors and ethnicity as drivers of attitudes toward immigration among California's voters. We find some evidence that supports our hypothesis that anti‐Hispanic sentiment drives attitude formation toward immigrants and immigration.
Transcription‐mediated amplification blood donation screening for Babesia
Authors: Tonnetti Laura , Young Carolyn , Kessler Debra A. , Williamson Phillip C. , Reik Rita , Proctor Melanie C. , Brès Vanessa , Deisting Barbara , Bakkour Sonia , Schneider William , Diner Samara , Busch Michael P. , Stramer Susan L. , Linnen Jeffrey M.
Published: December 2019

BACKGROUND

Transfusion‐transmitted Babesia microti is well recognized in the Northeast and upper Midwestern United States. Blood donation screening in Babesia‐endemic states has occurred under investigational protocols prior to US Food and Drug Administration–licensed test availability. Here, we provide a prospective screening summary of nucleic acid testing (NAT) as part of a multicenter Babesia pivotal trial followed by extended investigational use.

METHODS

From June 2017 to February 2018, 176,928 donation samples were tested with Procleix Babesia Assay (Grifols Diagnostic Solutions), a blood screening NAT for Babesia species ribosomal RNA detection using whole blood samples. During the pivotal trial, donations were collected in 11 endemic states plus Washington, DC, and Florida (nonendemic). Whole blood lysate samples were either tested in pools of 16 or individually. Reactive samples were confirmed by Babesia microti antibody and polymerase chain reaction (PCR) testing. If unconfirmed, further testing used a second PCR assay capable of detecting multiple Babesia species. Follow‐up samples were also tested. Extended investigational testing followed pivotal trial completion.

RESULTS

The pivotal trial identified 61 confirmed positives (176,608 donations): 35 (57%) PCR positive, 59 (97%) antibody positive, and two (3%) NAT positive/antibody negative, for a total yield of one positive per 2895 donations, including one Florida resident; others were from seven endemic states. During extended investigational testing of 496,270 donations in endemic states through January 2019, 211 (1:2351) repeat reactive donations were identified.

CONCLUSIONS

Babesia was detected in donors from multiple US states, including one previously not associated with positive blood donors. This study supports the use of the Procleix Babesia Assay using individual testing or pools of up to 16.
Knowledge, attitude and practices of obstetric care providers towards maternal red‐blood‐cell immunization during pregnancy
Authors: Slootweg Yolentha M. , Walg Chawa , Koelewijn Joke M. , Van Kamp Inge L. , De Haas Masja
Published: December 2019

Background and objectives

A successful routine RBC alloantibody screening programme should not lead to unnecessary emotional burden during pregnancy due to inadequate counselling on the risk of severe haemolytic disease of the foetus and the newborn (HDFN). Rareness of this disease may result in insufficient knowledge and subsequent inadequate information transfer to women, diagnosed with RBC antibodies. We investigated the current knowledge, views and experiences of Dutch obstetric care providers regarding RBC alloimmunization during pregnancy.

Materials and methods

We performed a quantitative cross‐sectional study, using a structured digital questionnaire to measure knowledge, attitude and practices (KAP) regarding maternal RBC alloimmunization among Dutch obstetric care providers in 2016.

Results

About 10% of obstetric care providers completed the questionnaire. A sufficient level of knowledge was found in 7% of all participants (N = 329). Knowledge about RhD immunisation and prophylaxis was sufficient in 60% of the responders. Knowledge gaps were found concerning the relevance of non‐RhD RBC antibodies, the indications for giving extra RhD prophylaxis and the interpretation of laboratory test results. Healthcare providers estimated their own level of knowledge ‘sufficient’ (primary/secondary care) to ‘good’ (tertiary care), and all participants considered their professional role important within the screening programme.

Conclusion

Dutch obstetric care providers showed a lack of knowledge regarding maternal RBC immunization. Awareness of the lack of knowledge is necessary to help obstetric care providers to be careful in giving information and even to decide to contact the expert centre before counselling the patient.
Electrical and optical properties of copper oxide thin films prepared by DC magnetron sputtering
Authors: Shukor Anmar H. , Alhattab Haider A. , Takano Ichiro
Published: December 2019

Copper oxides (CuO, Cu2O) have promising application potential in sensors or solar cells. In this study, copper oxide thin films were prepared by reactive DC magnetron sputtering using helicon plasma. A pure copper target was sputtered with Ar gas in an O2 atmosphere with a DC sputtering power in the range of 10–40 W, while the other fabrication conditions were kept constant. X-ray diffraction and x-ray photoelectron spectroscopy were used to investigate the effect of the sputtering power on the structure and the chemical state of the fabricated films. Atomic force microscopy was used to determine the relationship between the film's surface morphology and its structure. Hall effect measurements were employed to measure the semiconductor's properties, and the optical bandgap was determined by UV-Vis spectroscopy. The copper oxide film could be continuously tuned from n-type CuO to p-type Cu2O by changing the DC magnetron sputtering power.
Individual predictors of response to biofeedback training for second-language production
Authors: Li Joanne Jingwen , Ayala Samantha , Harel Daphna , Shiller Douglas M. , McAllister Tara
Published: December 2019

While recent research suggests that visual biofeedback can facilitate speech production training in clinical populations and second language (L2) learners, individual learners' responsiveness to biofeedback is highly variable. This study investigated the hypothesis that the type of biofeedback provided, visual-acoustic versus ultrasound, could interact with individuals' acuity in auditory and somatosensory domains. Specifically, it was hypothesized that learners with lower acuity in a sensory domain would show greater learning in response to biofeedback targeting that domain. Production variability and phonological awareness were also investigated as predictors. Sixty female native speakers of English received 30 min of training, randomly assigned to feature visual-acoustic or ultrasound biofeedback, for each of two Mandarin vowels. On average, participants showed a moderate magnitude of improvement (decrease in Euclidean distance from a native-speaker target) across both vowels and biofeedback conditions. The hypothesis of an interaction between sensory acuity and biofeedback type was not supported, but phonological awareness and production variability were predictive of learning gains, consistent with previous research. Specifically, high phonological awareness and low production variability post-training were associated with better outcomes, although these effects were mediated by vowel target. This line of research could have implications for personalized learning in both L2 pedagogy and clinical practice.
Indices of Resting Metabolic Rate Accurately Reflect Energy Deficiency in Exercising Women
Authors: Strock Nicole C.A. , Koltun Kristen J. , Southmayd Emily A. , Williams Nancy I. , De Souza Mary Jane
Published: December 2019

Energy deficiency in exercising women can lead to physiological consequences. No gold standard exists to accurately estimate energy deficiency, but measured-to-predicted resting metabolic rate (RMR) ratio has been used to categorize women as energy deficient. The purpose of the study was to (a) evaluate the accuracy of RMR prediction methods, (b) determine the relationships with physiological consequences of energy deficiency, and (c) evaluate ratio thresholds in a cross-sectional comparison of ovulatory, amenorrheic, or subclinical menstrual disturbances in exercising women (n = 217). Dual-energy X-ray absorptiometry (DXA) and indirect calorimetry provided data on anthropometrics and energy expenditure. Harris–Benedict, DXA, and Cunningham (1980 and 1991) equations were used to estimate RMR and RMR ratio. Group differences were assessed (analysis of variance and Kruskal–Wallis tests); logistic regression and Spearman correlations related ratios with consequences of energy deficiency (i.e., low total triiodothyronine; TT3). Sensitivity and specificity calculations evaluated ratio thresholds. Amenorrheic women had lower RMR (p < .05), DXA ratio (p < .01), Cunningham1980 (p < .05) and Cunningham1991 (p < .05) ratio, and TT3 (p < .01) compared with the ovulatory group. Each prediction equation overestimated measured RMR (p < .001), but predicted (p < .001) and positively correlated with TT3 (r = .329–.453). A 0.90 ratio threshold yielded highest sensitivity for Cunningham1980 (0.90) and Harris–Benedict (0.87) methods, but a higher ratio threshold was best for DXA (0.94) and Cunningham1991 (0.92) methods to yield a sensitivity of 0.80. In conclusion, each ratio predicted and correlated with TT3, supporting the use of RMR ratio as an alternative assessment of energetic status in exercising women. However, a 0.90 ratio cutoff is not universal across RMR estimation methods.
Inadvertent iatrogenic insulin detemir 1000 units overdose in a hospitalised patient
Authors: Thapa Sudan , Fahim Germin , Ganne Sudha
Published: December 2019

A 69-year-old woman with uncontrolled type 2 diabetes mellitus was admitted in the hospital for the management of urosepsis. Patient was overdosed with detemir insulin 1000 units inadvertently. Care provider was confused with volume and dose of the insulin by using insulin vial. Blood sugars were monitored closely every 30 min–1 hour for 24 hours. Patient was treated with dextrose 5% and 10% continuous infusion; and hydrocortisone 75 mg every 6 hours for 24 hours. The lowest blood sugar reached was 142 mg/dL (7.9 mmo/L). Patient did not develop hypoglycaemia. Proper safety measures and mandatory nurse education about administration of insulin were implemented to prevent future occurrences.
Unexpected rupture of an expectantly managed tubal ectopic pregnancy: a reminder for enhanced diligence
Authors: Davis Amenda Ann , Lata Kusum , Panwar Akshita , Kriplani Alka
Published: December 2019

Expectant management of tubal ectopic pregnancies is a feasible and possibly preferable method of management in asymptomatic women with low serum β-human chorionic gonadotropin (hCG). This involves serial monitoring of β-hCG until negative, after which it is deemed as spontaneously resolved ectopic pregnancy. We describe a case of tubal ectopic pregnancy which was expectantly managed with an initial β-hCG of 585 mIU/mL until undetectable. This patient presented with ruptured ectopic pregnancy 8 weeks after the original diagnosis, at the level of 5 mIU/mL. This highlights the importance of close monitoring in the expectant management of tubal ectopic pregnancies, with the incorporation of imaging, even when serial β-hCG shows a persistently reducing trend.
Unique clinical spectrum with distinguishing diagnostic features in Vogt-Koyanagi-Harada syndrome
Authors: Sultan Mamoona , Khan Adeena , Habib Syed Shahid , Abdulsalam Dheyab
Published: December 2019

A 36-year-old ulcerative colitis male patient on treatment for 7 years was referred to dermatology with resistant alopecia universalis and hypopigmented patches on limbs for 5 months. During this time he also reported to ophthalmology with acute bilateral decreased vision for 5 days. His examination revealed hyperaemic discs, multifocal retinal detachments and choroidal granulomas. Taking into account the revised diagnostic criteria, atypical course of disease in the form of early cutaneous presentation followed by ophthalmic manifestations was attributed to Vogt-Koyanagi-Harada syndrome (VKHS) which was supported by relevant investigations including ophthalmic imaging, MRI and nerve conduction studies. Subclinical nerve conduction abnormalities and white matter demyelination were also seen for the first time in a patient of VKHS. Appropriate treatment was required to prevent visual complications; therefore, systemic corticosteroids with steroid sparing immunosuppressive drug therapy showed significant improvement in vision on follow-up. Cutaneous manifestations were resilient to the entire regimen.
A Challenging diagnosis that eventually results in a life-threatening condition: Addison’s disease and adrenal crisis
Authors: Joersjö Philippa , Block Linda
Published: December 2019

A young man endures many years with classic symptoms of Addison’s disease due to difficulties in distinguishing this rare condition, whose features are non-specific and insidious in nature. With all facts on hand, the patient’s notable history of psychiatric disorders, namely depression, anxiety and social isolation, as well as signs of extreme fatigue and syncope may well have been caused by a gradual onset of primary adrenal insufficiency. Long delays in diagnosis are not uncommon, as in this case where the actual condition was identified just in time when the patient presented with a life-threatening cardiovascular collapse.
STEMI: rare initial presentation of a mediastinal mass supplied by the RCA
Authors: Claxton Benjamin B , Loloi Justin , Mrowczynski Oliver D , Abdulbasit Muhammad
Published: December 2019

In the setting of severe septic shock, a 70-year-old woman had an ST segment myocardial infarction with ST elevations in the inferolateral leads. On cardiac catheterisation, no obstructive pathology was noted. Chest imaging revealed a large mediastinal mass measuring 8.5×6.5×7.5 cm in the visceral compartment of the mediastinum, with contrast enhancement from the right coronary artery (RCA). A biopsy was preformed and cytology was consistent with a well-differentiated neuroendocrine neoplasm. On review of the cardiac catherisation, it was noted that the mass was deriving blood supply from the RCA. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a rare but well-documented phenomenon. In this case, MINOCA was caused by coronary steal syndrome in the setting of profound hypotension. Immediate management is with haemodynamic support; there is no role for coronary intervention.
Spontaneous heparin-induced thrombocytopenia syndrome presenting as bilateral adrenal infarction after knee arthroplasty
Authors: VanderVeer Elysha A , Torbiak Raymond P , Prebtani Ally PH , Warkentin Theodore E
Published: December 2019

Adrenal gland infarction resulting from adrenal vein thrombosis is an infrequently recognised entity with a limited differential diagnosis. When bilateral, it can result in acute life-threatening adrenal failure. Heparin-induced thrombocytopenia (HIT) is an antibody-mediated, prothrombotic state that represents an important cause of adrenal vein thrombosis leading to associated infarction. Sometimes, the clinical picture of HIT—including the presence of HIT antibodies—occurs despite absence of proximate heparin exposure (‘spontaneous HIT syndrome’). We report a case of nearly missed adrenal failure secondary to bilateral adrenal infarction that evolved during the second week following knee arthroplasty (a known trigger of spontaneous HIT syndrome). The combination of bilateral adrenal infarction, thrombocytopenia and presence of platelet-activating HIT antibodies not explainable by preceding heparin exposure led to a diagnosis of postknee arthroplasty spontaneous HIT syndrome. The case also highlights the clinical and laboratory findings associated with rapidly progressive acute adrenal failure.
Arteriovenous vascular malformation of the submandibular gland masquerading as Küttner’s tumour
Authors: Boyes Holly , Jones Aaron , Cheng Leo
Published: December 2019

Chronic sclerosing sialadenitis, also known as Küttner’s tumour, is a chronic inflammatory condition affecting the salivary glands. We present the case of an arteriovenous vascular malformation (AVM) of the right submandibular gland mimicking a Küttner’s tumour on ultrasound scan in a 63-year-old woman. Examination revealed a 2 cm firm, mobile, non-pulsatile, right-sided submandibular mass with no overlying skin changes but with mild tenderness to palpation. Histological appearances revealed an AVM associated with localised fatty metaplasia and glandular atrophy. Although rare, AVMs should be considered a differential diagnosis for a submandibular gland mass that gives unclear or unusual radiological appearances.
C reactive protein testing in general practice safely reduces antibiotic use for flare-ups of COPD
Authors: Cook Rob , Lyon-Maris Johnny , White Alicia
Published: December 2019

The study

Butler CC, Gillespie D, White P, et al. C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations. N Engl J Med 2019;381:111-20.

This research was funded by the NIHR Technology Assessment Programme (project number 12/33/12). The testing machines used in the study were loaned to researchers by the manufacturer, who also provided training on their use. The manufacturer had no other role in any part of the trial.

To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000820/crp-testing-safely-reduces-antibiotic-use-for-copd-flare-ups
Partial knee replacement could be first choice for some patients with osteoarthritis
Authors: Cook Rob , Davidson Peter , White Alicia
Published: December 2019

The study

Beard D, Davies L, Cook J, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet 2019;394:746-56.

The study was funded by the NIHR Health Technology Assessment Programme (project number 08/14/08).

To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000824/partial-knee-replacement-could-be-first-choice-in-some-patients
Women’s health-related vulnerabilities in natural disasters: a systematic review protocol
Authors: Riyad Fatema Syadani , Islam Md. Shahidul , East Leah , Usher Kim
Published: December 2019

Introduction

There is a paucity of evidence identifying both the physical and psychological health risks and underlying causes of women’s health-related vulnerabilities related to natural disasters. Therefore, this systematic review will be conducted to determine the impact of natural disasters on women’s health from a global perspective.

Methods and analysis

Five electronic databases of health research, including ProQuest, ProQuest Health and Medicine, PubMed, PsycINFO and CINAHL, will be searched to retrieve relevant literature where Medical Subject Headings terms and keywords will be used depending on the search method of each database. Google Scholar will also be searched for preliminary information on the topic and to check for further evidence that may have been missed. Inclusion and exclusion criteria will be developed and refined by the research team. We will restrict our search for empirical full-text articles published in the English language peer-reviewed journals between July 2008 and June 2018 to ensure contemporary evidence is retrieved. Two authors will participate in each step in the process, including title, abstract and full-text screening against inclusion criteria, data extraction and quality appraisal. The quality of selected studies will be assessed using the Mixed Method Appraisal Tool. Data synthesis will follow a sequential explanatory approach. Finally, the quantitative and qualitative findings will be merged under themes and described using a narrative approach.

Ethics and dissemination

Formal ethical approval is not required as primary data will not be collected. The results will be published in an international peer-reviewed journal and presented at national and international conferences.

PROSPERO registration number

CRD42019123809.
Healthcare utilisation for eating disorders among patients with depression: a cross-sectional study in Taiwan
Authors: Yan Chiu-Lan , Kao Li-Ting , Yeh Ming-kung , Chien Wu-Chien , Yeh Chin-Bin
Published: December 2019

Objectives

Although depressed patients may have a comorbid eating disorder (ED), to date, no study has focused on healthcare utilisation among this population. This study was designed to investigate the characteristics of healthcare service utilisation among depressed patients with ED.

Design

A cross-sectional study.

Setting

This population-based study used claims data from Taiwan’s National Health Insurance Research database between 2001 and 2012.

Participants

The study involved 1270 participants. These included 254 depressed individuals with ED and 1016 propensity score-matched depressed individuals without ED.

Outcome measures

We tracked each patient for a 1 year period to evaluate their healthcare service utilisation, including outpatient visits, inpatient days, and costs for psychiatry and non-psychiatry services. We performed a Mann-Whitney U test to compare outcome variables in healthcare service utilisation between the two groups.

Results

Patients with both depression and ED had significantly more outpatient visits (32.2 vs 28.9, p=0.023), outpatient costs (US$1089 vs US$877, p<0.001) and total costs (US$1356 vs US$1296, p<0.001) than comparison patients. For psychiatric services, patients with depression and ED had more outpatient visits (11.0 vs 6.8, p<0.001), outpatient costs (US$584 vs US$320, p<0.001) and total costs (US$657 vs US$568, p<0.001) than those without ED. For non-psychiatric services, there was no significant difference for all utilisation. This indicates that the total costs were about 1.0-fold greater for depression patient with ED than those without ED.

Conclusion

Depression patients with ED had more outpatient visits, outpatient costs and total costs of healthcare services than those without ED.
Hospital climate actions and assessment tools: a scoping review protocol
Authors: Gan Connie Cai Ru , Banwell Nicola , Pascual Ramon San , Chu Cordia , Wang Ying Wei
Published: December 2019

Introduction

Health and climate change are inexorably linked through the exacerbation of health risks and the contribution of the health sector to greenhouse gas emissions. Climate action in healthcare settings is critical to reduce risks and impacts of climate change through the smarter use of energy, minimising waste and enhancing disaster preparedness. Globally, hospital climate action is growing; however, the potential for further progress and impacts remains. The literature on this topic lacks synthesis, and this poses challenges for hospital leadership in tracking the impact of climate action. This scoping review will summarise the current knowledge about hospital climate action and existing tools to measure progress in this area.

Methods and analysis

This scoping review will be conducted applying the six-stage protocol proposed by Arksey and O’Malley. The study includes literature of how hospitals have addressed climate change (mitigation and adaptation) since the Kyoto Protocol was signed in 1997. All identified studies indexed in Medline, Scopus, Embase and CINAHL will be examined. The search strategy will also include Google Scholar to capture relevant grey literature. Quantitative and thematic analysis will be used to evaluate and categorise the study results.

Ethics and dissemination

This scoping review is part of the climate-smart healthcare initiative which will provide a valuable synthesis to aid understanding of hospitals’ climate actions, and tools used to measure its implementation. As such it will contribute to mobilising and accelerating the implementation of climate action in hospitals. The findings will be disseminated with all members of the International Health Promoting Hospital and Health Services (HPH) and the Global Green and Healthy Hospital network. Dissemination will occur through peer-reviewed publications; and with the HPH and GGHH members through its annual conference and newsletter.