bluuebunny/crossref_metadata_2025 huggingface dataset:
Structure‐Dependent Microwave Dielectric Properties and Middle‐Temperature Sintering of Forsterite (Mg1–xNix)2SiO4 Ceramics
Authors: Zhang Chen , Zuo Ruzhong , Zhang Jian , Wang Yang
Published: November 2014

The crystal structure, microstructure, and microwave dielectric properties of forsterite‐based (Mg1–xNix)2SiO4 (x = 0.02–0.20) ceramics were systematically investigated. All samples present a single forsterite phase of an orthorhombic structure with a space group Pbnm except for a little MgSiO3 secondary phase as x > 0.08. Lattice parameters in all axes decrease linearly with increasing Ni content due to the smaller ionic radius of Ni2+ compared to Mg2+. The substitution of an appropriate amount of Ni2+ could greatly improve the sintering behavior and produce a uniform and closely packed microstructure of the Mg2SiO4 ceramics such that a superior Q × f value (152 300 GHz) can be achieved as x = 0.05. The τf value was found to increase with increasing A‐site ionic bond valences. In addition, various additives were used as sintering aids to lower the sintering temperature from 1500°C to the middle sintering temperature range. Excellent microwave dielectric properties of εr~6.9, Q × f~99800 GHz and τf~−50 ppm/°C can be obtained for 12 wt% Li2CO3‐V2O5‐doped (Mg0.95Ni0.05)2SiO4 ceramics sintered at 1150°C for 4 h.
Influence of the Processing Route on the Carbon Nanotubes Dispersion and Creep Resistance of 3YTZP/SWCNTs Nanocomposites
Authors: Castillo‐Rodríguez Miguel , Muñoz Antonio , Morales‐Rodríguez Ana , Poyato Rosalía , Gallardo‐López Ángela , Domínguez‐Rodríguez Arturo
Published: November 2014

3YTZP matrix composites containing 2.5 vol% of single‐walled carbon nanotubes (SWCNT) were fabricated by Spark Plasma Sintering (SPS) at 1250°C, following different processing routines with the aim of optimizing the SWCNTs dispersion throughout the ceramic matrix. Microstructural characterization of the as‐fabricated samples has been performed by means of scanning electron microscopy (SEM). The specimens have been crept at 1200°C to correlate creep resistance and SWCNTs distribution. There are no creep experimental results on these nanocomposites reported in literature. Mechanical results show that the incorporation of SWCNTs into a 3YTZP matrix produces an increase in the strain rate at high temperature with respect to monolithic zirconia. The creep resistance of these nanocomposites decreases with the improvement of the SWCNTs dispersion, where a smaller SWCNTs agglomerate size and consequently a higher concentration of carbon nanotubes surrounding the 3YTZP grain boundaries is found. This fact indicates that SWCNTs act as a lubricant making grain‐boundary sliding easier during deformation of these composites.
Strong Red Emissions in Pr3+‐Doped (K0.5Na0.5)NbO3–CaTiO3 Diphase Ceramics
Authors: Sun Haiqin , Zhang Qiwei , Wang Xusheng , Bulin Chaoke
Published: November 2014

The photoluminescence and temperature sensing properties based on down‐shifting emission of Pr3+‐doped (K0.5Na0.5)NbO3–yCaTiO3 (KNN: yCT) diphasic materials were systematically investigated. Under 447‐nm excitation, Pr3+‐doped KNN: yCT samples exhibited significantly enhanced red emission at 603 nm assigned to 1D2→3H4 transitions of Pr3+ ions. The red emission intensities reached the optimum value with y = 0.05 near the polymorphic phase transition region. The origin of the enhanced red emission is mainly ascribed to the doping‐induced lattice symmetry change. The energy level transitions from the typical f–f transitions to the valence‐to‐conduction transitions were observed as CaTiO3 concentration increases above a critical concentration of y = 0.05. Furthermore, the sample with y = 0.05 also possessed excellent temperature response properties in a wide temperature range 300–473 K and the maximum sensing sensitivity was 0.016 K−1. The Pr3+‐doped (K0.5Na0.5)NbO3–yCaTiO3 red emission materials with admirable intrinsic piezoelectric properties may have important technological promise in novel multifunctional devices.
Evolutionary dynamics of interlinked public goods traits: an experimental study of siderophore production in Pseudomonas aeruginosa
Authors: Ross‐Gillespie A. , Dumas Z. , Kümmerli R.
Published: November 2014

Public goods cooperation is common in microbes, and there is much interest in understanding how such traits evolve. Research in recent years has identified several important factors that shape the evolutionary dynamics of such systems, yet few studies have investigated scenarios involving interactions between multiple public goods. Here, we offer general predictions about the evolutionary trajectories of two public goods traits having positive, negative or neutral regulatory influence on one another's expression, and we report on a test of some of our predictions in the context of Pseudomonas aeruginosa's production of two interlinked iron‐scavenging siderophores. First, we confirmed that both pyoverdine and pyochelin siderophores do operate as public goods under appropriate environmental conditions. We then tracked their production in lines experimentally evolved under different iron‐limitation regimes known to favour different siderophore expression profiles. Under strong iron limitation, where pyoverdine represses pyochelin, we saw a decline in pyoverdine and a concomitant increase in pyochelin – consistent with expansion of pyoverdine‐defective cheats derepressed for pyochelin. Under moderate iron limitation, pyochelin declined – again consistent with an expected cheat invasion scenario – but there was no concomitant shift in pyoverdine because cross‐suppression between the traits is unidirectional only. Alternating exposure to strong and moderate iron limitation caused qualitatively similar though lesser shifts compared to the constant‐environment regimes. Our results confirm that the regulatory interconnections between public goods traits can significantly modulate the course of evolution, yet also suggest how we can start to predict the impacts such complexities will have on phenotypic divergence and community stability.
Form and function of the intervertebral disc in health and disease: a morphological and stain comparison study
Authors: Walter B. A. , Torre O. M. , Laudier D. , Naidich T. P. , Hecht A. C. , Iatridis J. C.
Published: November 2014

Multiple histologic measurements are commonly used to assess degenerative changes in intervertebral disc (IVD) structure; however, there is no consensus on which stains offer the clearest visualization of specific areas within the IVD. The objective of this study was to compare multiple tinctorial stains, evaluate their ability to highlight structural features within the IVD, and investigate how they influence the capacity to implement a degeneration scoring system. Lumbar IVDs from seven human autopsy specimens were stained using six commonly used stains (Hematoxylin/Eosin, Toluidine Blue, Safranin‐O/Fast Green, Extended FAST, modified Gomori's Trichrome, and Picrosirius Red Alcian Blue). All IVDs were evaluated by three separate graders to independently determine which stains (i) were most effective at discerning different structural features within different regions of the IVDs and (ii) allowed for the most reproducible assessment of degeneration grade, as assessed via the Rutges histological scoring system (Rutges et al. A validated new histological classification for intervertebral disc degeneration. Osteoarthritis Cartilage, 21, 2039‐47). Although Trichrome, XFAST and PR/AB stains were all effective at highlighting different regions of whole IVDs, we recommend the use of PR/AB because it had the highest degree of rater agreement on assigned degeneration grade, allowed greater resolution of degeneration grade, has an inferential relationship between color and composition, and allowed clear differentiation of the different regions and structural disruptions within the IVD. The use of a standard set of stains together with a histological grading scheme can aid in the characterization of structural changes in different regions of the IVD and may simplify comparisons across the field. This collection of human IVD histological images highlights how IVD degeneration is not a single disease but a composite of multiple processes such as aging, injury, repair, and disease, each of which are unique to the individual.
Investigating the adequacy of the Competence‐Turnover Intention Model: how does nursing competence affect nurses’ turnover intention?
Authors: Takase Miyuki , Teraoka Sachiko , Kousuke Yabase
Published: November 2014

Aims and objectives

The aim of this study was to test the adequacy of the Competence‐Turnover Intention Model, which was developed to identify how nursing competence could affect nurses’ turnover intention (nurses’ intention to voluntarily leave an organisation).

Background

Recent studies have suggested that the level of nursing competence is negatively related to nurses’ intention to leave their jobs, suggesting that a lack of competence threatens both the quality and quantity of the nursing workforce. However, the mechanism of how nursing competence affects nurses’ turnover intention has not been explored previously.

Design

A cross‐sectional survey design was used.

Methods

Surveys were distributed to 1337 Japanese registered nurses/midwives in October, 2013. The adequacy of the model was analysed using structural equation modelling.

Results

In total, 766 questionnaires were returned, with a return rate of 57%. The model fitted well with the data. The results showed that the level of nursing competence was related positively to the quantity of organisational rewards they felt they had received, and negatively related to the level of exhaustion they experienced. Moreover, the perceived organisational rewards and exhaustion were correlated with nurses’ turnover intention through affective commitment.

Conclusions

The Competence‐Turnover Intention Model is useful for explaining how nursing competence impacts on their turnover intention.

Relevance to clinical practice

Clinical implications derived from the findings are that: promoting nursing competence is key to improving not only the quality of care provided by nurses, but also to retaining the nursing workforce, and the model can be used to develop strategies that would mitigate their turnover intention.
Effects of stigma on Chinese women's attitudes towards seeking treatment for urinary incontinence
Authors: Wang Cuili , Li Jingjing , Wan Xiaojuan , Wang Xiaojuan , Kane Robert L. , Wang Kefang
Published: November 2014

Aims and objectives

To examine whether and how stigma influences attitudes towards seeking treatment for urinary incontinence, and whether its effect varies by symptom severity.

Background

Urinary incontinence is prevalent among women, but few seek treatment. Negative attitudes towards urinary incontinence treatment inhibit from seeking care. Urinary incontinence is a stigmatised attribute. However, the relationship between stigma and attitudes towards seeking treatment for urinary incontinence has not been well understood.

Design

This was a cross‐sectional community‐based study.

Methods

We enrolled a sample of 305 women aged 40–65 years with stress urinary incontinence from three communities in a Chinese city between May–October in 2011. Data were collected on socio‐demographic characteristics, urinary incontinence symptoms, stigma and attitudes towards seeking treatment for urinary incontinence using a self‐reported questionnaire. Effects of stigma were analysed using path analysis.

Results

Attitudes towards seeking treatment for urinary incontinence were generally negative. For the total sample, all the stigma domains of social rejection, social isolation and internalised shame had direct negative effects on treatment‐seeking attitudes. The public stigma domain of social rejection also indirectly affected treatment‐seeking attitudes through increasing social isolation, as well as through increasing social isolation and then internalised shame. The final model accounted for 28% of the variance of treatment‐seeking attitudes. Symptom severity influenced the strength of paths: the effect of internalised shame was higher in women with more severe urinary incontinence.

Conclusions

Stigma enhances the formation of negative attitudes towards seeking treatment for urinary incontinence; public stigma affects treatment‐seeking attitudes through internalisation of social messages.

Relevance to clinical practice

Stigma reduction may help incontinent women to form positive treatment‐seeking attitudes and engage them in treatment. Interventions should specifically target the self‐stigma domains of social isolation and internalised shame in women with urinary incontinence to most efficiently increase their use of health care.
The experience of self‐management following venous leg ulcer healing
Authors: Kapp Suzanne , Miller Charne
Published: November 2014

Aims and objectives

The aim of the study was to explore the experiences of older people as they self‐managed following venous leg ulcer healing. The objectives were to describe the beliefs, attitudes, actions, enablers and barriers to self‐management and to consider the impact of an e‐learning client education package on how people approach recurrence prevention.

Background

Venous leg ulcers affect 1% of people worldwide and more than 3% of older people. Up to 70% of ulcers reoccur. Appreciation of the experience of self‐management following healing can equip health services to more effectively prepare people for self‐management in the longer term.

Design

A descriptive exploratory design was used.

Methods

Older people who had received an e‐learning education programme while their venous ulcer was active were interviewed after healing from July–September 2010. Interviews were recorded, transcribed and thematically analysed.

Results

Participants believed in the efficacy of compression therapy, skin care, activity and exercise and healthy eating to prevent recurrence, and engage in activities that reflect recommendations of the education. As beliefs and conduct of self‐management activities can change over time, regular professional monitoring and support would assist people to refine health goals, plan self‐management activities and prevent recurrence.

Conclusions

Participation in a standardised education programme completed prior to healing informed successful self‐management strategies among people who seek to prevent venous leg ulcer recurrence. Further research should consider the benefits of regular, ongoing professional monitoring and support among this group.

Relevance to clinical practice

Clinicians have a role in supporting their clients to know about, perform and believe in the importance of self‐management strategies for healing and recurrence prevention. Clinicians require the capacity to support clients which standardised client education tools can facilitate.
Patients and nursing staff views of using the education needs assessment tool in rheumatology clinics: a qualitative study
Authors: Hardware Bernadette , Johnson Dawn , Hale Claire , Ndosi Mwidimi , Adebajo Adewale
Published: November 2014

Aims and objectives

To evaluate the usability of the educational needs assessment tool in clinical practice, from a practitioner and patient perspective and to establish whether patients perceive that they are getting an equally good or equally inadequate education service for their needs.

Background

The educational needs assessment tool was developed to enable patients with Rheumatoid Arthritis to assess their education needs prior to a consultation with a health professional. The educational needs assessment tool has been translated into nine languages and measurement properties have been established, however, its usability in clinical practice has not been studied.

Design

A qualitative study embedded into a multicentre RCT in which patients had been randomised into either educational needs assessment tool‐focused education (Experimental Group) or usual care (control group).

Methods

Both groups were seen by a clinical nurse specialist. Sixteen patients and four clinical nurse specialists were recruited from the Rheumatology Outpatient Departments of three Acute Hospitals within the U K. Data were collected by interviews with patients and clinical nurse specialist. Analysis followed the Framework approach.

Results

Patients and clinical nurse specialist found completion of the educational needs assessment tool straightforward, comprehensive and easy to use. Completing the educational needs assessment tool helped patients to focus on what they needed to know from the clinical nurse specialist. Patients in both the control group and the experimental group felt supported and reassured by their clinical nurse specialist and perceived that they received a good and adequate education provision.

Conclusion

This study provides useful insights into the ability of the educational needs assessment tool to assess the educational needs of patients with rheumatoid arthritis in routine clinical practice.

Relevance to clinical practice

The educational needs assessment tool would be useful as a structured guide for nurses when assessing and meeting individual patient educational needs. This has the potential to improve patient‐centred care, involve patients more actively in their care and enhance the long‐term effects of patient education provision.
Interobserver reliability of attending physicians and bedside nurses when using an inpatient paediatric respiratory score
Authors: Biondi Eric A. , Gottfried Julie Albright , Dutko Fioravanti Irene , Schriefer Jan A. , Aligne Claude Andrew , Leonard Michael S.
Published: November 2014

Aims and objectives

This study aimed to determine the interobserver reliability between bedside nurses and attending physicians for a paediatric respiratory score as part of an asthma Integrated Care Pathway implementation.

Background

An Integrated Care Pathway is one approach to improving quality of care for children hospitalised with asthma. Prior to implementation of the integrated care pathway, it was necessary to train nursing staff on the use of a respiratory assessment tool and to evaluate the interobserver reliability use of this tool.

Design

Prospective study using a convenience sample of children hospitalised for a respiratory illness in an academic medical centre.

Methods

The respiratory assessment used was the Paediatric Asthma Score. Bedside nurse‐attending physician (27 different RNs and three attending paediatric hospitalists) pairs performed 71 simultaneous patient assessments on 20 patients. Intraclass correlation coefficient and kappa statistics were used to assess interobserver reliability.

Results

The overall intraclass correlation coefficient was nearly perfect where κ = 0·95, 95% CI (0·92, 0·97) and overall kappa for reliability based on clinically relevant score breakpoints was also high with κ = 0·82, 95% CI (0·75, 0·90). The majority of subgroup analyses revealed substantial to almost perfect agreement across a variety of diagnoses, age ranges, and individual score components.

Conclusions

Bedside nurses, with support and training from attending physicians, can perform respiratory assessments that agree almost perfectly with those of attending physicians.

Relevance to clinical practice

The use of an Integrated Care Pathway allows for optimal interprofessional collaboration between bedside nurses and attending physicians.
Acute fatty liver of pregnancy associated with fetal mitochondrial trifunctional protein deficiency
Authors: Kobayashi Tomoko , Minami Sawako , Mitani Ayuki , Tanizaki Yuko , Booka Mina , Okutani Takahiro , Yamaguchi Seiji , Ino Kazuhiko
Published: November 2014

Acute fatty liver of pregnancy (AFLP) is a devastating disorder of the maternal liver in the third trimester. Recent studies have demonstrated an association between AFLP and fetal fatty acid oxidation disorders. Here, we report a case of AFLP caused by fetal mitochondrial trifunctional protein (TFP) deficiency. A 21‐year‐old parous woman presented with nausea, genital bleeding and abdominal pain at 33 weeks of gestation. Laboratory data revealed hepatic failure and disseminated intravascular coagulopathy. The patient underwent emergency cesarean section and was diagnosed with AFLP from the clinical characteristics. She was successfully treated with frequent plasma exchange. The newborn presented severe heart failure and died on the 39th day after birth. Tandem mass spectrometry indicated long‐chain fatty acid oxidation disorder. Gene analysis demonstrated homozygous mutation in exon 13 of HADHB, the gene responsible for mitochondrial TFP deficiency. The parents carried a heterozygous mutation at the same location in HADHB.
Gestrinone combined with ultrasound‐guided aspiration and ethanol injection for treatment of chocolate cyst of ovary
Authors: Wu Xiaoyun , Xu Yun
Published: November 2014

Aim

The aim of this study was to determine clinical performance of gestrinone combined with ultrasound‐guided aspiration and ethanol injection in treating chocolate cyst of ovary.

Methods

Sixty‐eight patients enrolled in this study were randomly divided into two groups: control group and combination treatment group. In the control group, 34 patients were treated with ultrasound‐guided aspiration and ethanol injection. In the combination treatment group, 34 patients received gestrinone p.o. following ultrasound‐guided aspiration and ethanol injection.

Results

The recurrence rate of chocolate cyst was 10‐fold lower in the combination treatment group (2.94%, 1/34) than in the control group (29.4%, 10/34) at 12 months. The effective rate for reduction of chocolate cyst was significantly higher in the combination treatment group (94.12%, 32/34) than in the control group (64.71%, 22/34) (P = 0.009).

Conclusion

Gestrinone combined with ultrasound‐guided aspiration and ethanol injection therapy is an effective treatment for ovarian chocolate cyst with low recurrence rate.
In women with thyroid autoimmunity, does low‐dose prednisolone administration, compared with no adjuvant therapy, improve in vitro fertilization clinical results?
Authors: Litwicka Katarzyna , Arrivi Cristiana , Varricchio Maria Teresa , Mencacci Cecilia , Greco Ermanno
Published: November 2014

Aim

The objective of the study was to verify if prednisolone treatment may influence the in vitro fertilization (IVF) outcome in euthyroid women affected by thyroid autoimmunity.

Methods

One hundred and ninety‐four patients including 60 positive for antithyroid antibodies (ATA) underwent the ovarian stimulation in the standard long protocol for IVF and 30 women received the low‐dose prednisolone from the day of oocyte retrieval.

Results

The overall, clinical pregnancy and live birth rate in ATA‐positive patients receiving prednisolone supplementation was significantly higher when confronted with ATA‐positive untreated subjects (60.0% vs 30.0%, P = 0.02; 46.6% vs 16.6%, P = 0.03; and 46.6% vs 20.0%, P = 0.05, respectively). The same parameters in ATA‐positive untreated women were significantly lower than in the controls (30.0% vs 50.7%, P = 0.0001; 16.6% vs 38.1%, P = 0.04; and 20.0% vs 40.3%, P = 0.04, respectively).

Conclusion

There is a strong association between the presence of thyroid autoantibodies and poor IVF outcome. The prednisolone co‐treatment may improve the clinical pregnancy rate and reduce the miscarriage rate after IVF in women affected by thyroid autoimmunity.
Positive peritoneal cytology at interval surgery is a poor prognostic factor in patients with stage T3c advanced ovarian carcinoma: A retrospective study
Authors: Nagasaka Kazunori , Kawana Kei , Tomio Kensuke , Tsuruga Tetsushi , Mori‐Uchino Mayuyo , Miura Shiho , Tanikawa Michihiro , Miyamoto Yuichiro , Ikeda Yuji , Sone Kenbun , Adachi Katsuyuki , Matsumoto Yoko , Arimoto Takahide , Oda Katsutoshi , Osuga Yutaka , Fujii Tomoyuki
Published: November 2014

Aim

The purpose of our study is to investigate clinically significant prognostic factors at the time of interval surgery (IS), comprising interval look surgery and interval debulking surgery, for T3c (International Federation of Gynecology and Obstetrics stage IIIc to IV) advanced ovarian cancer (AOC) patients during primary treatment.

Methods

We reviewed records of patients with T3c AOC who underwent IS following neoadjuvant chemotherapy or up‐front primary debulking surgery with adjuvant chemotherapy at our institution between January 1996 and December 2010. For analysis of prognostic factors, cytology of peritoneal exfoliative cells at IS was added to clinicopathological variables.

Results

A retrospective analysis was performed on 50 cases. The median age was 61.1 years (range, 38–78), with median follow‐up of 45.9 months (range, 12–122). Macroscopic tumors were completely resected in 32 cases (64%) at IS. Univariate analyses of clinicopathological factors for IS identified preoperative serum cancer antigen‐125 levels (≥20 IU/mL; P = 0.0539), number of residual lesions at IS (≥20; P = 0.0554), incomplete surgery at IS (P = 0.0171) and positive peritoneal cytology at IS (P = 0.0015) as significant factors for prognosis regarding progression‐free survival (PFS). Multivariate analysis identified positive peritoneal cytology (P = 0.0303) as a unique independent predictor of poor prognosis in PFS.

Conclusion

Positive peritoneal cytology at IS appears to be a significant factor for poor prognosis in PFS, which may provide useful information for post‐IS chemotherapy planning. IS in the treatment of AOC may be useful for not only complete resection, but also for identification of patients with poor prognosis.
Percutaneous Implantation of a Second Device in Patients with Residual Right‐to‐Left Shunt after Patent Foramen Ovale Closure
Authors: ROVERA CHIARA , BIASCO LUIGI , ORZAN FULVIO , BELLI RICCARDO , OMEDÈ PIERLUIGI , GAITA FIORENZO
Published: November 2014

Introduction

The management of patients with residual right‐to‐left shunt (rRLS) after percutaneous patent foramen ovale (PFO) closure is debated. The aim of this study was to define the incidence of moderate‐to‐large rRLS and to report the feasibility, safety and long‐term clinical outcome of transcatheter closure of rRLS.

Methods and Results

From June 2000 to March 2013, 322 subjects underwent percutaneous PFO closure. In 39 patients (12.1%) with moderate‐to‐large rRLS on transcranial Doppler (TCD) and/or transesophageal echocardiogram a second cardiac catheterization was performed with the aim of completing the closure. A second closure device was implanted in 21 patients (53.8%). In the remaining 18 (46.2%), a second device was not delivered for the following reasons: in 13 (72.2%) no residual passage could be crossed, in 5 (27.8%) the residual shunt was deemed to be negligible. No complications occurred. After the second procedure, complete closure was proved by TCD in 16/21 (76.2%) subjects. One patient received a third device. During follow‐up (41 ± 19 months), no cerebrovascular ischemic accidents occurred.

Conclusion

A second percutaneous PFO occlusion device can be safely implanted in patients with significant rRLS. However, a moderate‐to‐large rRLS on TCD and/or TEE may not necessarily represent a significant risk of further paradoxical embolization.
A reverse Warburg metabolism in oral squamous cell carcinoma is not dependent upon myofibroblasts
Authors: Jensen David H. , Therkildsen Marianne H. , Dabelsteen Erik
Published: November 2014

Background

The reverse Warburg effect describes the phenomenon that epithelial cancer cells take advantage of the metabolic machinery from nearby cancer‐associated fibroblast, inducing them to produce lactate and ketones to fuel the high metabolic demands of the epithelial tumour tissues. This is in breast cancer observed as a lack of stromal caveolin‐1 (CAV‐1) and an increased expression of monocarboxylate transporter 4 (MCT‐4) in the tumour stroma, with a concomitant increase in the expression of monocarboxylate transporter 1 (MCT‐1) in the epithelial, tumour compartment. The lack of CAV‐1 and increased expression of MCT‐4 have been shown to have prognostic importance, primarily in patients with breast cancer. However, this phenomenon has only scarcely been described in oral squamous cell carcinoma (OSCC). Given the prognostic importance of myofibroblasts in OSCC, we also examined a potential relationship between the expression of MCT‐4 and the presence of myofibroblasts.

Methods

Paraffin‐embedded tissues from 30 patients with OSCC were immunostained with antibodies towards MCT‐1, MCT‐4, Cav‐1, GLUT‐1, α‐SMA, TOMM20 and KI‐67, and evaluated for their specific epithelial and stromal expression.

Results and conclusions

In patients with OSCC, we find an increased expression of MCT‐1 and MCT‐4 in both the epithelial and stromal compartment, with almost no overlap in their spatial expression. We found a large spatial overlap between α‐SMA and MCT‐1 in the stroma compartment, but no relationship between MCT‐4 and myofibroblasts. Interestingly, we did not observe any relationship between the absence of CAV‐1 and the presence of MCT‐4 as has been shown in breast carcinomas.
Only the Brave: Product Innovation, Service Business Model Innovation, and Their Impact on Performance
Authors: Visnjic Ivanka , Wiengarten Frank , Neely Andy
Published: November 2014

Recent empirical findings concerning the performance effects of service business model innovation (servitization) and its interplay with product innovation are mixed. Using the lenses of the demand‐based view on value creation and complementarity, the performance impact of two key service business models is examined: the product‐oriented model and the customer‐oriented model, implemented jointly with product innovation. Results indicate that the interplay between service business model innovation and product innovation results in long‐term performance benefits coupled with a degree of short‐term performance sacrifice. Service business model innovation in isolation from product innovation results in short‐term profit gains but long‐term knowledge loss and, thus, market performance decline. Our study suggests that firms need to look beyond the evidence on short‐term effects in order to achieve superior performance in the long run.
Clitoral Reconstruction After Female Genital Mutilation/Cutting: Case Studies
Authors: Abdulcadir Jasmine , Rodriguez Maria I. , Petignat Patrick , Say Lale
Published: November 2014

Introduction

Clitoral reconstruction following female genital mutilation/cutting (FGM/C) is a new surgical technique reported to be a feasible and effective strategy to reduce clitoral pain, improve sexual pleasure, and restore a vulvar appearance similar to uncircumcised women. However, data on safety, care offered, and evaluation of sexual and pain outcomes are still limited.

Aims

This study aims to present the care offered and clinical outcomes of two women who received multidisciplinary care, including psychosexual treatment, with clitoral reconstruction. We report their long-term outcomes, and the histology of the removed periclitoral fibrosis.

Methods

We report the cases of two women with FGM/C types II and III who requested clitoral reconstruction for different reasons. One woman hoped to improve her chronic vulvar pain, as well as improve her sexual response. The other woman requested surgery due to a desire to reverse a procedure that was performed without her consent, and a wish to have a genital appearance similar to non infibulated women. They both underwent psychosexual evaluation and therapy and surgery. The histology of the periclitoral fibrosis removed during surgery was analyzed.

Results

At 1-year postoperatively, the first woman reported complete disappearance of vulvar pain and improved sexual pleasure, including orgasm. Our second patient also described improved sexuality at 1-year follow-up (increased sexual desire, lubrication, vulvar pleasure, and sensitiveness), which she attributed to a better self body image and confidence. Both women reported feeling satisfied, happy, and more beautiful.

Conclusion

We show a positive outcome in pain reduction and improved sexual function, self body image, and gender after psychosexual therapy and clitoral reconstruction. More evidence is needed about clitoral reconstruction to develop guidelines on best practices. Until research is conducted that rigorously evaluates clitoral reconstruction for its impact on pain and sexuality, we advise always offering a multidisciplinary care, including sexual therapy before and after the surgery.
Treating Immune‐tolerant Hepatitis B
Authors: Tseng T.‐C. , Kao J.‐H.
Published: November 2014

Hepatitis B virus (HBV) infection is a major cause of cirrhosis and hepatocellular carcinoma worldwide. On the basis of virus–host interactions, the natural history of HBV carriers can be divided into four chronological phases. In the first immune tolerance phase, HBV carriers are positive for hepatitis B e antigen (HBeAg) and have high HBV replication activity, normal ALT levels as well as minimal liver disease. Ample evidence has shown that patients in the immune tolerance phase have very low viral evolution and minimal risk of fibrosis progression. However, recent immunological studies argued that HBV‐specific immune responses already exist in a proportion of immune‐tolerant patients and the immune activities are comparable to those in the immune clearance phase. Regarding antiviral therapy, whether these immune‐tolerant patients are indicated for treatment remains debated. Previous studies showed that HBeAg‐positive patients with normal or near‐normal ALT levels, who are assumed to be in the immune tolerance phase, have a lower HBeAg seroconversion rate receiving either pegylated interferon or nucleos(t)ide analogue treatment. The latest clinical trial focusing on‐treatment response of immune‐tolerant patients with tenofovir disoproxil fumarate‐based therapy also confirmed the results. The HBeAg seroconversion rates are <5% at 4 years of treatment. Considering the minimal risk of disease progression and low treatment response rates in immune‐tolerant patients, current antiviral therapy should not be recommended unless the patients have advanced liver fibrosis. In addition, novel agents targeting the HBV template known as covalently closed circular DNA and aiming to reduce or eliminate it are urgently required.
Breastfeeding in England: time trends 2005–2006 to 2012–2013 and inequalities by area profile
Authors: Oakley Laura L. , Kurinczuk Jennifer J. , Renfrew Mary J. , Quigley Maria A.
Published: November 2014

Breastfeeding rates in England have risen steadily since the 1970s, but rates remain low and little is known about area‐based trends. We report an ecological analysis of time trends in area breastfeeding rates in England using annual data on breastfeeding initiation (2005–2006 to 2012–2013) and any breastfeeding at 6–8 weeks (2008–2009 to 2012–2013) for 151 primary care trusts (PCTs). Overall, breastfeeding initiation rose from 65.5% in 2005–2006 to 72.4% in 2012–2013 (average annual absolute increase 0.9%). There was a statistically significantly higher (interaction P < 0.001) annual increase in initiation in PCTs in the most deprived (1.2%) compared with the least deprived tertile (0.7%), and in PCTs with low baseline breastfeeding initiation (2005–2006; 1.4%) compared with high baseline initiation (0.6%). Similar trends were observed when PCTs were stratified by the proportion of teenage mothers and maternal smoking, but not when stratified by ethnicity. Although breastfeeding prevalence at 6–8 weeks also increased significantly over the observed time period (41.2% in 2008–2009, 43.7% in 2012–2013; annual increase 0.7%), there was no difference in the average increase by deprivation profile, ethnicity, teenage mothers and maternal smoking. However, PCTs with low baseline prevalence in 2008–2009 saw a significantly larger annual increase (0.8%) compared with PCTs with high baseline prevalence (0.07%). In conclusion, breastfeeding initiation and prevalence have seen higher increases in areas with low initial breastfeeding, and for initiation, more disadvantaged areas. Although these results suggest that inequalities in breastfeeding have narrowed, rates have plateaued since 2010–2011. Sustained efforts are needed to address breastfeeding inequalities.
In‐home fortification with 2.5 mg iron as NaFeEDTA does not reduce anaemia but increases weight gain: a randomised controlled trial in Kenyan infants
Authors: Barth‐Jaeggi Tanja , Moretti Diego , Kvalsvig Jane , Holding Penny A. , Njenga Jane , Mwangi Alice , Chhagan Meera K. , Lacroix Christophe , Zimmermann Michael B.
Published: November 2014

In‐home fortification of infants with micronutrient powders (MNPs) containing 12.5 mg iron may increase morbidity from infections; therefore, an efficacious low‐dose iron‐containing MNP might be advantageous. Effects of iron‐containing MNPs on infant growth are unclear. We assessed the efficacy of a low‐iron MNP on iron status and growth and monitored safety in a randomised, controlled, double‐blind 1‐year trial in 6‐month‐old infants (n = 287) consuming daily a maize porridge fortified with either a MNP including 2.5 mg iron as NaFeEDTA (MNP + Fe) or the same MNP without iron (MNP − Fe). At baseline, after 6 and 12 months, we determined haemoglobin (Hb), iron status [serum ferritin (SF), soluble transferrin receptor (sTfR) and zinc protoporphyrin (ZPP)], inflammation [C‐reactive protein (CRP)] and anthropometrics. We investigated safety using weekly morbidity questionnaires asking for diarrhoea, cough, flu, bloody or mucus‐containing stool and dyspnoea, and recorded any other illness. Furthermore, feeding history and compliance were assessed weekly. At baseline, 71% of the infants were anaemic and 22% iron deficient; prevalence of inflammation was high (31% had an elevated CRP). Over the 1 year, Hb increased and SF decreased in both groups, without significant treatment effects of the iron fortification. At end point, the weight of infants consuming MNP + Fe was greater than in the MNP − Fe group (9.9 vs. 9.5 kg, P = 0.038). Mothers of infants in the MNP + Fe group reported more infant days spent with cough (P = 0.003) and dyspnoea (P = 0.0002); there were no significant differences on any other of the weekly morbidity measures. In this study, low‐dose iron‐containing MNP did not improve infant's iron status or reduce anaemia prevalence, likely because absorption was inadequate due to the high prevalence of infections and the low‐iron dose.
Characteristics of successful alien plants
Authors: van Kleunen M. , Dawson W. , Maurel N.
Published: November 2014

Herbert Baker arguably initiated the search for species characteristics determining alien plant invasion success, with his formulation of the ‘ideal weed’. Today, a profusion of studies has tested a myriad of traits for their importance in explaining success of alien plants, but the multiple, not always appropriate, approaches used have led to some confusion and criticism. We argue that a greater understanding of the characteristics explaining alien plant success requires a refined approach that respects the multistage, multiscale nature of the invasion process. We present a schema of questions we can ask regarding the success of alien species, with the answering of one question in the schema being conditional on the answer of preceding questions (thus acknowledging the nested nature of invasion stages). For each question, we identify traits and attributes of species we believe are likely to be most important in explaining species success, and we make predictions as to how we expect successful aliens to differ from natives and from unsuccessful aliens in their characteristics. We organize the findings of empirical studies according to the questions in our schema that they have addressed, to assess the extent to which they support our predictions. We believe that research on plant traits of alien species has already told us a lot about why some alien species become successful after introduction. However, if we ask the right questions at the appropriate scale and use appropriate comparators, research on traits may tell us whether they are really important or not, and if so under which conditions.
Hypoxia‐induced localization of chemotaxis‐related signaling proteins in Vibrio cholerae
Authors: Hiremath Geetha , Hyakutake Akihiro , Yamamoto Kentaro , Ebisawa Tatsuaki , Nakamura Tomoyuki , Nishiyama So‐ichiro , Homma Michio , Kawagishi Ikuro
Published: November 2014

Vibrio cholerae has three sets of chemotaxis‐related signaling proteins, of which only System II has been shown to be involved in chemotaxis. Here, we examined localization of green fluorescent protein (GFP)‐fused components of System I. The histidine kinase (CheA1) and the adaptor (CheW0) of System I localized to polar and lateral membrane regions with standing incubation (microaerobic conditions), but their localization was lost after shaking (aerobic conditions). A transmembrane receptor of System I also showed polar and lateral localization with standing incubation. By contrast, GFP‐fused components of System II localized constitutively to the flagellated pole. Nitrogen gas, sodium azide or carbonylcyanide m‐chlorophenylhydrazone induced localization of CheA1‐GFP even with shaking incubation, suggesting that the localization is controlled in response to changes in energy metabolism. Fluorescently labeled tetracysteine‐tagged CheA1 also showed azide‐induced localization, arguing against artifactual effects of GFP fusions. These results suggest that System I components are assembled into the supramolecular signaling complex in response to reduced cellular energy states, raising the possibility that the System I complex plays a role in sensing and signaling under microaerobic environments, such as in the host intestine.
Cryptococcus and Cryptococcosis in Cuba. A minireview
Authors: Illnait‐Zaragozi María T. , Martínez‐Machín Gerardo F. , Fernández‐Andreu Carlos M. , Perurena‐Lancha Mayda R. , Hagen Ferry , Meis Jacques F.
Published: November 2014

Cryptococcosis has emerged as an important public health problem in Africa, Asia and the Americas due to the increasing numbers of persons at risk of this infection and the adaptation of its aetiological agents to new environments. The proper management requires early recognition ofCryptococcus neoformans/C. gattiispecies complex infection, familiarity with the use and limitations of diagnostic tests and knowledge of the available treatment options. This review will address these issues with the goal of providing sufficient information to suspect, diagnose and treat patients with cryptococcosis based on Cuban data and review of the literature.
Extensive grey matter pathology in the cerebellum in multiple sclerosis is linked to inflammation in the subarachnoid space
Authors: Howell Owain W. , Schulz‐Trieglaff Elena Katharina , Carassiti Daniele , Gentleman Steven M. , Nicholas Richard , Roncaroli Federico , Reynolds Richard
Published: November 2014

Aims

Multiple sclerosis (MS) is a progressive inflammatory neurological disease affecting myelin, neurons and glia. Demyelination and neurodegeneration of cortical grey matter contribute to a more severe disease, and inflammation of the forebrain meninges associates with pathology of the underlying neocortical grey matter, particularly in deep sulci. We assessed the extent of meningeal inflammation of the cerebellum, another structure with a deeply folded anatomy, to better understand the association between subarachnoid inflammation and grey matter pathology in progressive MS.

Methods

We examined demyelinating and neuronal pathology in the context of meningeal inflammation in cerebellar tissue blocks from a cohort of 27 progressive MS cases previously characterized on the basis of the absence/presence of lymphoid‐like aggregates in the forebrain meninges, in comparison with 11 non‐neurological controls.

Results

Demyelination and meningeal inflammation of the cerebellum was greatest in those cases previously characterized as harbouring lymphoid‐like structures in the forebrain regions. Meningeal inflammation was mild to moderate in cerebellar tissue blocks, and no lymphoid‐like structures were seen. Quantification of meningeal macrophages, CD4+, CD8+ T lymphocytes, B cells and plasma cells revealed that the density of meningeal macrophages associated with microglial activation in the grey matter, and the extent of grey matter demyelination correlated with the density of macrophages and plasma cells in the overlying meninges, and activated microglia of the parenchyma.

Conclusions

These data suggest that chronic inflammation is widespread throughout the subarachnoid space and contributes to a more severe subpial demyelinating pathology in the cerebellum.
‘Mental mobility’ in the digital age: entrepreneurs and the online home‐based business
Authors: Di Domenico MariaLaura , Daniel Elizabeth , Nunan Daniel
Published: November 2014

Home‐based online business ventures are an increasingly pervasive yet under‐researched phenomenon. The experiences and mindset of entrepreneurs setting up and running such enterprises require better understanding. Using data from a qualitative study of 23 online home‐based business entrepreneurs, we propose the augmented concept of ‘mental mobility’ to encapsulate how they approach their business activities. Drawing on Howard P. Becker's early theorising of mobility, together with Victor Turner's later notion of liminality, we conceptualise mental mobility as the process through which individuals navigate the liminal spaces between the physical and digital spheres of work and the overlapping home/workplace, enabling them to manipulate and partially reconcile the spatial, temporal and emotional tensions that are present in such work environments. Our research also holds important applications for alternative employment contexts and broader social orderings because of the increasingly pervasive and disruptive influence of technology on experiences of remunerated work.
The osteoblastic niche in the context of multiple myeloma
Authors: Toscani Denise , Bolzoni Marina , Accardi Fabrizio , Aversa Franco , Giuliani Nicola
Published: November 2014

The osteoblastic niche has a critical role in the regulation of hemopoietic stem cell (HSC) quiescence and self‐renewal and in the support of hematopoiesis. Several mechanisms are involved in the crosstalk between stem cells and osteoblasts, including soluble cytokines, adhesion molecules, and signal pathways such as the wingless‐Int (Wnt), Notch, and parathyroid hormone pathways. According to the most recent evidence, there is an overlap between osteoblastic and perivascular niches that affects HSC function involving mesenchymal stromal and endothelial cells and a gradient of oxygen regulated by hypoxia inducible factor (HIF)‐1α. Derived from plasma cells, multiple myeloma (MM) is a hematopoietic malignancy characterized by a peculiar dependency on the bone microenvironment. Quiescent MM cells may reside in the osteoblastic niche for protection from apoptotic stimuli; in turn, MM cells suppress osteoblast formation and function, leading to impairment of bone formation and the development of osteolytic lesions. Several recent studies have investigated the mechanisms involved in the relationship between osteoblasts and MM cells and identified potential therapeutic targets in the osteoblastic niche, including the HIF‐1α, Runx2, and Wnt (both canonical and noncanonical) signaling pathways.