bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of sardine (Sardina pilchardus) regime shifts in the Iberian Atlantic shelf waters
Authors: Cabrero Águeda , González‐Nuevo Gonzalo , Gago Jesús , Cabanas Jose Manuel
Published: November 2018

Sardine fisheries in the Iberian Atlantic shelf (36°N–44.5°N) show decadal‐scale cycles. In the late 1990s, a positive phase in sardine stock was expected; on the contrary, catches have declined until now. Regime shifts in climatic and oceanographic variables on different scales (as forcing factor) and shifts in sardine stock (as result) have been used with the aim of identifying the physical variables that explain most of the sardine population variance in the region. Circa 1998, when last sardine regime shift was detected, the main patterns of large‐scale atmospheric circulation in the Northern Hemisphere with influence in the study area namely Northern Atlantic Oscillation (NAO) and East Atlantic (EA) pattern changed and coupled in a combination that led to a rise in sea surface temperature and a decline in the coastal upwelling intensity. Several years with a downwelling situation in average in the main spawning and feeding Iberian sardine areas would have affected the stock abundance, averting the return to the projected positive regime. The sardine negative regime shift was detected first in the regions of the study located further north. The regional variable latent heat flux that groups a set of environmental processes related to the ocean–atmosphere heat exchanges and so with the turbulence manages to explain the 72% of sardine recruitment.
Bridging the divide between human and physical geography: Potential avenues for collaborative research on climate modeling
Authors: Colven Emma , Thomson Marcus J.
Published: November 2018

Despite repeated calls for greater collaboration between physical and human geographers, the unique interdisciplinary potential of geography remains largely underutilized. Yet geographers are well positioned to take a leading role in the interdisciplinary turn in climate‐related research. This paper explores the possibilities for physical and human geographers to collaborate within and beyond the discipline, specifically on the topic of climate modeling. We first examine geographical research critically examining the production and circulation of climate knowledge. Drawing on insights from a recent literature called “Critical Physical Geography,” we then outline how geographers might engage in collaborative and interdisciplinary work in order to promote more democratic practices of producing climate knowledge, enrich understandings of climate change, and more effectively serve goals of social and environmental justice. We argue that both the discipline of geography and the field of climate research stand to gain enormously from geographers' efforts to talk across the divide between social and natural science within and beyond the boundaries of geography.
The effect of emicizumab prophylaxis on health‐related outcomes in persons with haemophilia A with inhibitors: HAVEN 1 Study
Authors: Oldenburg Johannes , Mahlangu Johnny N. , Bujan Willem , Trask Peter , Callaghan Michael U. , Young Guy , Asikanius Elina , Peyvandi Flora , Santagostino Elena , Kruse‐Jarres Rebecca , Negrier Claude , Kessler Craig , Xu Jin , Windyga Jerzy , Shima Midori , von Mackensen Sylvia
Published: November 2018

Introduction

Persons with haemophilia A (PwHA) with inhibitors to factor VIII often experience decreased health‐related outcomes. In HAVEN 1 (NCT02622321), there was a statistically significant reduction in bleeding with emicizumab prophylaxis versus no prophylaxis.

Aim

Describe health‐related outcomes in PwHA with inhibitors in HAVEN 1.

Methods

PwHA with inhibitors aged ≥12 years previously on episodic bypassing agents (BPAs) were randomized to emicizumab prophylaxis (Arm A; n = 35) or no prophylaxis (Arm B; n = 18); participants previously on BPA prophylaxis received emicizumab prophylaxis (Arm C; n = 49). Health‐related outcomes assessed at baseline and monthly thereafter: Haemophilia Quality of Life Questionnaire for Adults (Haem‐A‐QoL), Haemophilia‐specific Quality of Life Questionnaire for Children Short Form (Haemo‐QoL SF), EuroQol 5‐Dimensions 5‐Levels (EQ‐5D‐5L) index utility score (IUS) and visual analogue scale (EQ‐VAS) and work/school days. Days hospitalized also recorded.

Results

At week 25, differences (ANCOVA) in adjusted mean scores (95% confidence interval) favoured Arm A versus B for Haem‐A‐QoL “Total” score (14.0 [5.6, 22.5]; P = 0.002) and “Physical Health” (21.6 [7.9, 35.2]; P = 0.003); EQ‐VAS (−9.7 [−17.6, −1.82]; P = 0.017); and IUS (−0.16 [−0.25, −0.07]; P = 0.001); mean scores are comparable in Arms A and C. Throughout the study, a greater proportion of participants on emicizumab prophylaxis than no prophylaxis exceeded questionnaire‐specific responder thresholds. Mean proportion of missed work days and number of days hospitalized were lower with emicizumab prophylaxis than no prophylaxis.

Conclusions

In PwHA with inhibitors, emicizumab prophylaxis was associated with substantial and meaningful improvements in health‐related outcomes.
Prevalence of FVIII inhibitors in severe haemophilia A patients: Effect of treatment and genetic factors in an Indian population
Authors: David Sachin , Nair Sukesh C. , Singh G. Surender , Alex Ansu Abu , Ganesan Saravanan , Palani Hamenth Kumar , Balasundaram Nithya , Lakshmi Kavitha M. , Joshi Aditi , Kannan S. , Korula Anu , Nambiatheyil Aboobacker Fouzia , Abraham Aby , George Biju , Apte Shashikant Janardan , Srivastava Alok , Mathews Vikram
Published: November 2018

Introduction

Factor replacement therapy in treatment of haemophilia A is complicated by the production of neutralising antibodies known as inhibitors. The formation of inhibitors is multifactorial being associated with both genetic and environmental factors.

Aim

To document the prevalence of inhibitors in severe haemophilia in the community where most patients receive only infrequent episodic replacement therapy and evaluate the factors which could be contributing to it.

Methods

Community based camps were conducted in different parts of the country. Patients were assessed through a structured questionnaire and blood samples were obtained for laboratory evaluation of inhibitors and defined immunological parameters.

Results

Inhibitors were present in 87/447 (19.5%) of the evaluated patients. High‐titre inhibitor (>5 Bethesda Units [BU]) was identified in 31 (35.6%) patients. HLA DRB1‐13‐positive cases (RR = 2.04; 95% CI 1.06‐3.911; P = 0.033) had an increased risk of inhibitor formation which was retained in the high‐titre subset. A decreased risk of inhibitor formation was noted with heterozygous IL4‐590 C/T allele (RR = 0.22; 95% CI 0.108‐0.442: P = 0.000). There were no significant correlations between any of the evaluated environmental factors and the development of inhibitors in this study.

Conclusion

The overall prevalence of inhibitors in patients with severe haemophilia A is similar to that reported among patients receiving regular replacement therapy. The data from this study, limited by its retrospective and cross‐sectional study design, would suggest that genetic rather than environmental are more likely to impact the development of inhibitors.
Photoprotection against visible light‐induced pigmentation
Authors: Ruvolo Eduardo , Fair Michael , Hutson Ashley , Liebel Frank
Published: November 2018

Objective

This paper presents in vivo an in vitro studies demonstrating the induction of pigmentation in human skin by visible light which can be blocked by using formulation containing the correct amount of yellow iron oxide (YIO).

Methods

An in vitro absorption method was developed to determine the protection provided by a test formulation containing 4.5% YIO using an IPD UVA‐VIS action spectrum. Following the development of the in vitro method and in vivo study with 10 normal healthy volunteers with Fitzpatrick skin phototypes IV to VI was conducted to verify if the predictive model.

Results

The in vitro model for visible light protection provided a protection factor of 2.5 using the in vitro absorption spectrum of 4.5% of YIO with a very similar result from the in vivo study with a protection factor of 3.0. Multiple daily exposures of visible light have shown increase in skin pigmentation and the application of YIO provide less development of pigmentation when compared to unprotected skin.

Conclusion

In vitro testing of the absorbance of the pigmented formulation using a proposed action spectrum for immediate pigment darkening (IPD) response in the visible light range supports the in vivo protection observations for persistent pigment darkening (PPD) and can be used as predictor for skin pigmentation induced by visible light.
Factors shaping the financial capability of low‐income consumers from rural regions of Poland
Authors: Potocki Tomasz , Cierpiał‐Wolan Marek
Published: November 2018

The two‐fold purpose of this study was to explore the financial capability of low‐income consumers from rural regions of Poland, using Xiao’s financial capability index, while accounting for their poverty status, demographic and financial characteristics. To test the relevant hypothesis of the study, a micro database of low‐income consumers was used. Factor, descriptive and correlation analyses were employed for preliminary examinations. One‐way ANOVA was used to examine the impact of different poverty indicators on financial capability index variables. Multiple OLS regressions were used to examine the influence of the selected factors on the level of financial capability. Six sets of linear regression models were used to explore the effects of factors associated with the financial capability variables. The findings of our study suggest that financial inclusion is an essential component of the financial capability index. The results also show that all five variables play a significant role in the financial capability index. Therefore, Xiao’s financial capability index captures a specific combination of financial literacy and financial behaviour of low‐income consumers from rural regions of Poland.
Heterogeneous human capital, inequality and growth: The role of patience and skills
Authors: Borissov Kirill , Bosi Stefano , Ha‐Huy Thai , Modesto Leonor
Published: November 2018

We extend the Lucas (1988) model, introducing two classes of agents with heterogeneous skills, discount factors and initial human capital endowments. We consider two regimes according to the planner's political constraints. In the meritocratic regime, the planner faces individual constraints. In the redistributive regime, the planner faces an aggregate constraint. We find that heterogeneity matters, particularly with redistribution. In the meritocratic regime, the optimal solution coincides with the balanced growth path (BGP) found by Lucas (1988) for the representative agent's case. In contrast, in the case of redistribution, the solution for time devoted to capital accumulation is never interior for both agents. Either the less talented agents do not accumulate human capital or the more skilled agents do not work. Moreover, social welfare under the redistributive regime is always higher than under meritocracy, and it is optimal to exploit existing differences. Finally, we find that inequality in human capital distribution increases in time and that, in the long run, inequality always promotes growth.
Predictors and outcomes of nurse professional autonomy: A cross‐sectional study
Authors: Labrague Leodoro J. , McEnroe‐Petitte Denise M. , Tsaras Konstantinos
Published: November 2018

Aims

This paper is a report examining the level of professional autonomy as well as its predictors and outcomes among practicing nurses in the Philippines.

Methods

This study adopted a descriptive, cross‐sectional research design. One hundred sixty‐six (n = 166) nurses participated in the study or a response rate of 83% during the months of January 2017 to May 2017. Seven self‐reported scales were used for this study: the Nurse Autonomy Scale, Job Stress Scale, Burnout Measure Scale, Job Satisfaction Index, Organizational Commitment Questionnaire, Turnover Intention Inventory Scale, and the Six Dimension Scale of Nursing Performance. Inferential and descriptive statistics were used to analyse the collected data.

Results

Nurses demonstrated moderate levels of professional autonomy with education and hospital bed capacity as strong predictors. Regression analysis showed positive effects of professional autonomy on nurses' job outcomes such as organizational commitment, job satisfaction, and work performance.

Conclusion

Consistent to international studies, nurses in the Philippines demonstrated moderate levels of professional autonomy. Nurses who had higher levels of autonomy tended to be high performing, satisfied, and committed in their jobs. Organizational efforts are critically important to foster autonomy in practicing nurses through adequate support, education, training, and developed policies.
Recent trends in cyclic vomiting syndrome‐associated hospitalisations with liberalisation of cannabis use in the state of Colorado
Authors: Bhandari Sanjay , Jha Pinky , Lisdahl Krista M. , Hillard Cecilia J. , Venkatesan Thangam
Published: November 2018

Background

Currently, 33 states in the United States along with the District of Columbia have legalised cannabis in some forms. There is a paucity of data on the impact of legalisation of cannabis use on hospitalisations due to cyclic vomiting syndrome (CVS).

Aim

To study the trends in CVS‐related hospitalisations and cannabis use in CVS in relation to legalisation of recreational cannabis use in Colorado.

Methods

All hospital admissions in Colorado between 2010 and 2014 with the diagnosis of CVS were identified using the Colorado State Inpatient Database. Five‐year trends in CVS‐related hospitalisations along with the cannabis use were analysed. Multivariate logistic regression analysis was performed to determine predictors of cannabis use in CVS.

Results

There was a significant increase in CVS‐related hospitalisations by 46% from 806 in 2010 to 1180 in 2014 when CVS was included as all‐listed diagnoses (P < 0.001). The overall prevalence of cannabis use in CVS (13% with CVS as primary diagnosis and 17% with CVS as all‐listed diagnoses) was much higher than non‐CVS‐related hospitalisations (1.7%) (P < 0.001 for both comparisons). Cannabis use increased dramatically in both CVS and non‐CVS‐related hospitalisations following legalisation of cannabis for recreational use in 2012.

Conclusion

Our study shows a significant increase in CVS‐related hospitalisations concomitant with an increase in cannabis use with its liberalisation in Colorado. Future studies on the relationship between cannabis use and hyperemesis are warranted, especially with its ongoing legalisation in the United States.
‘Looking after the survivors’: the health of a cohort of long‐term human immunodeficiency virus patients 25 years on
Authors: McNeil Thomas , Rowe Emily
Published: November 2018

Background

Patients with human immunodeficiency virus (HIV) infection have higher rates of cardiovascular disease, metabolic disorders and malignancy than their uninfected peers.

Aim

To survey the health of a South Australian cohort of long‐term HIV patients, who had been diagnosed with HIV prior to the availability of combination antiretroviral therapy.

Methods

Data from 88 patients were collected retrospectively across four domains: demographics, HIV history, antiretroviral medication and medical comorbidity.

Results

There were high rates of cardiovascular risk factors, in particular active smoking, dyslipidaemia and diabetes mellitus, which translated into a high rate of ischaemic heart disease and cerebrovascular accidents. A large proportion of the patients suffered depression and cognitive impairment. Approximately one‐fifth of the cohort had been diagnosed with a malignancy, with anal cancer being the most prevalent. Many patients had experienced permanent toxicity from antiretroviral therapy.

Conclusion

The present study showed high rates of ‘non‐HIV morbidity’ in a group of long‐term HIV patients in South Australia. Clinicians should aggressively modify cardiovascular risk factors, ensure appropriate immunisations, monitor mental health and consider targeted malignancy screening in these patients. A robust clinical infrastructure and multidisciplinary team is required to facilitate the complex care needs of long‐term HIV patients.
Risk Information Disclosure and Bank Soundness: Does Regulation Matter? Evidence from China*
Authors: Wang Zongrun , Chen Jiangyan , Zhao Xiaofei
Published: November 2018

This paper examines the impact of the Regulation for Commercial Bank Capital Management in China on banks’ risk taking and disclosure behavior. We construct a risk disclosure index for Chinese commercial banks around this Regulation and find that compliance with the Regulation through a higher risk disclosure index improves bank soundness. We also find that the component of the risk disclosure index associated with risk compensation is the main driving factor of our findings. Moreover, our results show the effect of the Regulation is much smaller for publicly listed banks, suggesting a substituting regulation effect of the public capital market.
Return Synchronicity and Insider Trading Profitability*
Authors: Liang Claire Y.C. , Tang Zhenyang , Xu Xiaowei
Published: November 2018

We investigate the association between stock return synchronicity and insider trading profitability. Morck, Yeung and Yu (2000) suggest that greater stock return synchronicity (or R2) reflects less firm‐specific information in stock prices. Consistent with the view, we find significantly higher insider profitability in firms with greater return synchronicity. The results mainly reside in opportunistic trades rather than in routine trades, and are more pronounced for trades by key insiders such as officers and directors. Furthermore, our results are weaker for industry bellwether firms, and stronger for firms with more opaque earnings or lower institutional ownership. We also document significantly more insider purchasing activity in firms with greater return synchronicity. Overall, our results support the view that greater return synchronicity means less firm‐specific information in stock prices, and suggest that insiders take advantage of this by trading and profiting more from firms with greater return synchronicity.
Frost response in wheat and early detection using proximal sensors
Authors: Nuttall James G. , Perry Eileen M. , Delahunty Audrey J. , O'Leary Garry J. , Barlow Kirsten M. , Wallace Ashley J.
Published: November 2018

Frost can significantly reduce production of field crops grown in Mediterranean‐type environments, where significant economic losses for Australian wheat occur annually. If non‐destructive sensors could make rapid, spatial assessment of frost damage, this could limit economic losses through timely management decisions. This paper reports on a methodology for imposing frost treatments to wheat under field conditions and the utility of canopy reflectance data for detecting early crop damage. Purpose‐built chambers using stepped additions of dry ice allowed for a range of frost scenarios to be tested when applied at wheat heading and anthesis. For frost treatments applied at anthesis, grain number and yield were reduced by 8.8% and 7.2%, respectively, for every degree Celsius below zero (down to −4°C). This effect was additive over two consecutive nights. For cold load equivalent, there was a 2.2% and 1.9% reduction in grain number and yield, respectively, per °C hr (below 0°C). For wheat, spectral indices PRI and NDVI (reflectance) and FRF_G and SFR_G (fluorescence) showed significant relationships, with cold load applied for heading treatments. Next steps include targeting frost intensities equivalent to cold loads between 20 and 80°C hr and testing the utility of these proposed indices in a commercial paddock setting.
Phosphoric acid‐modified magnesium oxychloride: Study of water stability, kinetics, and pair distribution function
Authors: Góchez Roque , Chapman Karena W. , Wambaugh Jim , Kitchens Christopher L.
Published: November 2018

Magnesium oxychloride (MOC) excels in performance applications due to inherent structural strength, fire retardant properties, and numerous other attributes. To avoid the slow degradation of MOC when exposed to water, phosphoric acid is usually added, effectively increasing retention of structural properties (water stability). While this is an effective method, it is poorly understood. Additions of 2.5 wt.% and above had positive impacts on the water stability, preserving ~50 wt.% crystalline MOC after water stability tests. Phosphoric acid addition also impacted the reaction kinetics, increasing the activation energy of curing from 72.2 to 87.6‐95.2 kJ/mol. Using synchrotron X‐ray scattering and pair distribution function analysis, we identified an unreported amorphous phase formed when phosphoric acid is added; this phase contains structural motifs related to MgHPO4·3H2O (newberyte), Mg2P2O7·3.5H2O (magnesium pyrophosphate), and amorphous MOC phase. The short‐range order of the samples show a prominent peak at ~3.2 Å that grows with increasing acid addition, believed to be a combination of newberyte (~3.4 Å Mg–P), pyrophosphate (~3.25 Å Mg–P), and MOC (~3.15 Å Mg–Mg). We propose that the increased water stability observed is due to this combined amorphous phase, which retains the low water solubility properties of MgHPO4·3H2O and Mg2P2O7·3.5H2O, effectively protecting the MOC crystalline phase.
Bias in heritability estimates from genomic restricted maximum likelihood methods under different genotyping strategies
Authors: Cesarani Alberto , Pocrnic Ivan , Macciotta Nicolò P. P. , Fragomeni Breno O. , Misztal Ignacy , Lourenco Daniela A. L.
Published: November 2018

We investigated the effects of different strategies for genotyping populations on variance components and heritabilities estimated with an animal model under restricted maximum likelihood (REML), genomic REML (GREML), and single‐step GREML (ssGREML). A population with 10 generations was simulated. Animals from the last one, two or three generations were genotyped with 45,116 SNP evenly distributed on 27 chromosomes. Animals to be genotyped were chosen randomly or based on EBV. Each scenario was replicated five times. A single trait was simulated with three heritability levels (low, moderate, high). Phenotypes were simulated for only females to mimic dairy sheep and also for both sexes to mimic meat sheep. Variance component estimates from genomic data and phenotypes for one or two generations were more biased than from three generations. Estimates in the scenario without selection were the most accurate across heritability levels and methods. When selection was present in the simulations, the best option was to use genotypes of randomly selected animals. For selective genotyping, heritabilities from GREML were more biased compared to those estimated by ssGREML, because ssGREML was less affected by selective or limited genotyping.
Learning with elaborative interrogations and the impact of learners' emotional states
Authors: Navratil Sabrina D. , Kühl Tim
Published: November 2018

Self‐generated learning (SGL) activities are characterized as an active learning strategy that functions as a support for deeper comprehension. However, the question arises which factors could be essential to fully exploit the effectiveness of SGL activities. One possible factor may be the emotional state of learners during learning. Because different emotional states are associated with different styles of information processing, in turn, they may support learning with SGL activities. Consequently, this study addresses learning with a type of SGL activities, answering elaborative interrogations, and the impact of learners' emotional states. German students (N = 123) were assigned to one of four conditions, resulting from a 2 × 2 design with instructional material (elaborative interrogations vs. no elaborative interrogations) and emotional state (positive vs. negative) as independent variables. Results showed that learners learning with elaborative interrogations experienced the instructional material as more difficult than without elaborative interrogations. Learning with them led to a better transfer learning outcome of concepts that had to be generated by interrogations (not for concepts that were already readable in the text) and had no effect for retention. Unexpectedly, neither an influence of the learners' emotional state nor an interaction of both independent variables could be shown.
A multicenter cross‐sectional study of episiotomy practice in Romania
Authors: Pasc Andrada , Navolan Dan , Pușcașiu Lucian , Ionescu Cringu Antoniu , Szasz Florin Adrian , Carabineanu Adrian , Dimitriu Mihai , Călin Daniel , Bohilțea Roxana , Ples Liana , Nemescu Dragoș
Published: November 2018

Rationale, aims, and objectives

The aim of this study was to focus attention on episiotomy practice in Romanian maternity units in order to identify factors associated with the very high rate of the procedure in Romania and to consider strategies to reduce it.

Methods

In this clustered cross‐sectional study, a total of 11 863 patients were recorded in eight Romanian maternity units to assess the prevalence of episiotomy. A random effects Poisson model was used to estimate the prevalence rate in univariate and multivariate models.

Results

Among the 11 863 patients included for analysis, 8475 (71.4%) had an episiotomy. The prevalence of episiotomy was 92.7% for the first vaginal birth, 73.2% for the second vaginal birth, and 35% for the third vaginal birth. The overall rate of suturing was higher than the episiotomy rate for all patients (total rate 79.2%). The likelihood of exiting the maternity ward with an intact perineum after the first vaginal birth was less than 5% at the first vaginal birth.

Conclusions

In conclusion, routine episiotomy is the norm in Romanian maternity units, with episiotomy rates among the highest in Europe. Episiotomy use is mainly driven by local professional norms, experiences, previous training, and practitioners' decisions rather than evidence, guidelines, or variations in patient needs at the time of vaginal birth.
Quantitative analysis of the core 2D arrangement and distribution of enamel rods in cross‐sections of mandibular mouse incisors
Authors: Smith Charles E. , Hu Yuanyuan , Hu Jan C‐C. , Simmer James P.
Published: November 2018

Considerable descriptive information about the overall organization of mouse mandibular incisor enamel is available but almost nothing is known about the quantitative characteristics of enamel rod arrangement and distribution in these teeth. This has important implications concerning cell movement during the secretory stage because each ameloblast makes one enamel rod. Knowing how many enamel rods are cut open in a cross‐section of the enamel layer could provide insights into understanding the dynamics of how groups of ameloblasts form the enamel layer. In this study, cross‐sections of fully mineralized enamel were cut on 24 mandibular mouse incisors, polished and etched, and imaged by scanning electron microscopy in backscatter mode. Montaged maps of the entire enamel layer were made at high magnification and the enamel rod profiles in each map were color‐coded based upon rod category. Quantitative analyses of each color layer in the maps were then performed using standard routines available in imagej. The data indicated that that there were on average 7233 ± 575 enamel rod profiles per cross‐section in mandibular incisors of 7‐week‐old mice, with 70% located in the inner enamel layer, 27% located in the outer enamel layer, and 3% positioned near the mesial and lateral cementoenamel junctions. All enamel rod profiles showed progressive increases in tilt angles, some very large in magnitude, from the lateral to mesial sides of the enamel layer, whereas only minor variations in tilt angle were found relative to enamel thickness at given locations across the enamel layer. The decussation angle between alternating rows of rod profiles within the inner enamel layer was fairly constant from the lateral to central labial sides of the enamel layer, but it increased dramatically in the mesial region of the enamel layer. The packing density of all rod profiles decreased from lateral to central labial regions of the enamel layer and then in progressing mesially, decreased slightly (inner enamel, mesial tilt), increased slightly (outer enamel layer) or almost doubled in magnitude (inner enamel, lateral tilt). It was concluded that these variations in rod tilt angle and packing densities are adaptations that allow the tooth to maintain a sharp incisal edge and shovel‐shape as renewing segments formed by around 7200 ameloblasts are brought onto the occluding surface of the tooth by continuous renewal.
How do nurses use the early warning score in their practice? A case study from an acute medical unit
Authors: Foley Claire , Dowling Maura
Published: November 2018

Aims and objectives

This study aimed to describe how nurses use the early warning score (EWS) in an acute medical ward and their compliance with the EWS and explore their views and experiences of the EWS.

Background

early warning score systems have been implemented in response to upward trends in mortality rates. Nurses play a central role in the use of EWS systems. However, barriers to their use have been identified and include behavioural, cultural and organisational approaches to adherence. Improvement strategies including education and training and electronic devices have assisted in compliance with the system.

Design

A holistic single descriptive case study design was used.

Methods

Data triangulation was used including non‐participant observation, semi‐structured interviews with nurses and document analysis. Nurses were observed using EWS and were subsequently interviewed. Data analysis was guided by systematic text condensation (STC), an approach underpinned by Giorgi's phenomenological method, where meaning units and themes are identified. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines.

Results

Three themes with associated meaning units were found. Protocol Adherence vs. Clinical Judgement addresses nurses’ knowledge, skill and experience and patient assessment. Parameter Adjustment and Escalation included parameters not being adjusted or reviewed, junior doctors not being authorised to set parameters and escalation. The final theme Culture highlighted a task‐driven approach and deficient communication processes.

Conclusion

This study highlights the need for ongoing training, behavioural change and a cultural shift by healthcare professionals and organisations to ensure adherence with EWS escalation protocols.

Relevance to clinical practice

Improvements in education and training into recognition, management and communication of a deteriorating patient are required. Also, a cultural shift is needed to improve compliance and adherence with EWS practice. The potential use of electronic data should be explored.
Short‐term outcomes of robotic‐assisted versus conventional laparoscopic radical hysterectomy for early‐stage cervical cancer: A single‐center study
Authors: Oyama Keisuke , Kanno Kiyoshi , Kojima Ryuji , Shirane Akira , Yanai Shiori , Ota Yoshiaki , Andou Masaaki
Published: November 2018

Aim

Our hospital adopted laparoscopic surgery for early‐stage cervical cancer in August 1998, with robot‐assisted surgery implemented in October 2013. This study aimed to compare short‐term outcomes for conventional laparoscopic radical hysterectomy (LRH) and robot‐assisted radical hysterectomy (RARH) and assess the technical feasibility of RARH for early‐stage cervical cancer.

Methods

We retrospectively compared operative time, blood loss, number of resected lymph nodes, length of postoperative hospital stay, rate of positive vaginal margin and perioperative complications between two groups of 121 patients (LRH group, n = 57; RARH group, n = 64) with stage IA2 to IIB, among 164 patients who underwent endoscopic radical hysterectomy for early‐stage cervical cancer performed between January 2010 and December 2017 by an expert surgeon, excluding cases of para‐aortic lymphadenectomy.

Results

No differences in patient background, in terms of age and body mass index, were identified. For the LRH/RARH groups (mean ± standard deviation), results obtained were as follows: operative time, 211 ± 38/280 ± 59 min (P < 0.01); blood loss, 219 ± 114/370 ± 231 mL (P < 0.01); number of resected lymph nodes, 38.5 ± 15.9/50.2 ± 18.2 (P < 0.01); length of postoperative hospital stay, 11.6 ± 3.3/11.3 ± 4.8 days (P = 0.67); and perioperative complications with Clavien‐Dindo classification of grade III or higher, 1.8/7.8% (P = 0.13).

Conclusion

The operative time was significantly longer and blood loss greater in the RARH than LRH group. A greater number of lymph nodes were removed in the RARH group. However, these differences seem to be within a clinically acceptable range, showing that RARH is as feasible and safe as LRH in terms of short‐term outcomes.
Mandibular Implant‐Retained Overdentures: Potential Accelerator of Bone Loss in the Anterior Maxilla?
Authors: Alsrouji Mohamed Samih , Ahmad Rohana , Rajali Aiemeeza , Mustafa Nor Wati Nur Atikah , Ibrahim Norliza , Baba Nadim Z.
Published: November 2018

Purpose

To compare the residual ridge resorption (RRR) of the anterior maxillary bone beneath complete dentures when opposed by mandibular complete dentures (CD) and implant‐retained overdentures (IRO).

Materials and Methods

18 patients were rehabilitated with maxillary CD opposing mandibular IRO, and 4 patients were prescribed with conventional CD. Cone beam computed tomography (CBCT) scans of the maxilla were acquired before and 1 year post‐treatment and converted into 3D models using Mimics research software. RRR was quantified by measuring the changes in bone volume following superimpositioning and sectioning of these models at the anterior maxillary region. Subsequently, the sectioned 3D models of the anterior maxilla were exported to 3‐Matic software to reveal the predominant region and depth of RRR.

Results

The mean reduction in bone volume of the anterior maxilla in the CD group was 2.60% (SD = 1.71%, range = −4.89 % to −0.92%, median = −2.30%), while the mean reduction in the IRO group was almost three times higher at 7.25% (SD = 3.16%, range = −13.25 to −1.50, median = −7.15%). The predominant areas of RRR were on the buccal and occlusal ridge of the anterior maxilla.

Conclusion

Within the limits of this study, it may be concluded that an IRO caused significantly higher RRR of the anterior maxilla than a CD.
Not Just a National Issue: Effect of State‐Level Reception of Immigrants and Population Changes on Intergroup Attitudes of Whites, Latinos, and Asians in the United States
Authors: Huo Yuen J. , Dovidio John F. , Jiménez Tomás R. , Schildkraut Deborah J.
Published: November 2018

National discourse about immigration in the United States has become increasingly unwelcoming. In two studies, we examine whether regional‐level (state) information about welcoming (vs. unwelcoming) immigrant policies in the context of either stable or increasing rate of immigration can influence intergroup relations in receiving communities. Among Whites (Study 1), welcoming policy proposals elicited more positive attitudes toward immigrants generally and toward Latinos, the ethnic group most closely associated with immigration in the United States, but only when rate of immigration is constant. In contrast, among Latinos (Study 2), an unwelcoming reception led to more positive attitudes toward immigrants (legal and undocumented) but again only when rate of immigration is constant. Asians’ attitudes (Study 2) toward immigrants were not affected by contextual information about immigration. Together, these findings suggest that local conditions can affect community members’ attitudes toward immigrants and toward specific ethnic groups associated with immigration.
Metabolic response and volatile profile induced by temperature, on Colletotrichum fragariae and Rhizopus stolonifer
Authors: Rojas‐Flores Claudia , Ventura‐Aguilar Rosa Isela , Bautista‐Baños Silvia
Published: November 2018

During growth, fungi usually synthesize and emit different metabolic products. The objective of this work was to determine the metabolic activity of Colletotrichum fragariae and Rhizopus stolonifer isolated from strawberries, based on their biomass production, the synthesis of ergosterol and their respiration rate, and to identify their volatile profile, during an incubation period of up to 30 days at 10 and 20°C. For C. fragariae and R. stolonifer, the biomass production at the end of incubation was 30% and 25% higher at 10°C than at 20°C, respectively, and ergosterol production was higher at 10°C than at 20°C. Regardless of the incubation temperature, the typical respiration rate pattern was shown. Terpenes were the major chemical group identified in both fungi, accounting for 41% and 84% of the volatile composition of C. fragariae at 10 and 20°C, respectively, while in the case of R. stolonifer, they represented 59% and 45% at 10 and 20°C, respectively; α‐terpineol was detected during the growing period of C. fragariae and R. stolonifer at 10 and 20°C, whereas γ‐terpinene was emitted only by R. stolonifer at 20°C. Therefore, they might serve as specific indicators of the presence of these two fungi.
Reward motivation normalises temporal attention after sleep deprivation
Authors: Sasmita Karen , Massar Stijn A. A. , Lim Julian , Chee Michael W. L.
Published: November 2018

Preparation of attention facilitates speeded responding at time points with a high probability of target occurrence. Conversely, time points with low target probability are disadvantaged due to lower readiness. When targets are uniformly distributed in time, this effect results in higher readiness after longer preparation times (foreperiods). During sleep deprivation, this temporal bias is amplified, resulting in greater performance decrement when stimuli occur at unfavourable times. In this study, we examined whether reward motivation could modulate this increased temporal bias in response speed. Participants (n = 24) performed the psychomotor vigilance task under four reward conditions (0, 1, 5 or 15c per fast response), both after normal sleep (rested wakefulness) and sleep deprivation. To assess temporal preparation (foreperiod‐effect), trials were binned based on the lead time prior to target presentation (short foreperiod: 1–6 s; long foreperiod: 6–10 s). As previously observed, the foreperiod‐effect (slower reaction time for short foreperiod trials) increased after sleep deprivation. However, this state effect was attenuated with reward, reaching a response speed comparable to that observed in the unrewarded, well‐rested condition. The current findings, therefore, suggest that reward improves overall response performance and normalises temporal attention in sleep‐deprived individuals.
From evidence to national scale: An implementation framework for micronutrient powders in Rwanda
Authors: McLean Judy , Northrup‐Lyons Martina , Reid Robert J. , Smith Lauren , Ho Kathy , Mucumbitsi Alexis , Kayumba Josephine , Omwega Abiud , McDonald Christine , Schauer Claudia , Zlotkin Stanley
Published: November 2018

Micronutrient powders (MNP) are an efficacious intervention in terms of reducing anaemia among young children, yet challenges remain regarding implementation at scale. Research that can guide effective implementation of nutrition interventions and facilitate integration into existing health care platforms is needed. This paper seeks to advance the implementation science knowledge base by presenting our multiphased strategy and findings for scaling‐up MNP in Rwanda. The multiphased implementation strategy, spanning a 5‐year period (2011–2016), included (a) a feasibility study involving formative research, (b) a 30‐day trial of improved practices (n = 60 households), (c) a 12‐month pilot that included an effectiveness study (n = 1,066 caregiver/child pairs), and (d) a staggered approach to national scale‐up. At the end of Phase 4, the programme had been implemented in 19 of Rwanda's 30 districts with the scale‐up in the final 11 districts completed in the following year. The caregivers of over 270,000 eligible children 6–23 months of age received a box of 30 MNP sachets in the final 3‐month assessment period, representing a coverage rate of 87%. Initial problems with the supply chain and distribution and ongoing challenges to monitoring and reporting have been the largest obstacles. Continued success will be dependent on adequate resources for capacity development, refresher training, and responsive monitoring. Rwanda is one of the first countries to successfully scale‐up home fortification subnationally with MNP. Lessons learned have implications for other countries.
Genetic diversity mirrors trophic ecology in coral reef fish feeding guilds
Authors: Gajdzik Laura , Bernardi Giacomo , Lepoint Gilles , Frédérich Bruno
Published: November 2018

Genetic diversity is essential for species persistence because it provides the raw material for evolution. For marine organisms, short pelagic larval duration (PLD) and small population size are characteristics generally assumed to associate with low genetic diversity. The ecological diversity of organisms may also affect genetic diversity with an expected corollary that more restricted habitat and dietary requirements could lead to a reduced genetic diversity because of pronounced genetic structuring. Here, we tested whether groups of species with narrower trophic niches displayed lower genetic diversity than those with broader niches. In order to test those predictions, we used different trophic guilds (i.e., groups of species having similar trophic habits) of coral reef damselfishes in Moorea (French Polynesia) for which we determined their genetic diversity using restriction site‐associated DNA sequencing (RADseq) and their trophic ecology with stomach contents and stable isotope data. We found that pelagic feeders‐ the guild picking zooplankton in the water column‐ exhibited the lowest genetic diversity despite having the longest PLD and the largest population size. This guild had also the lowest variation in habitat characteristics and dietary composition compared to benthic feeders (i.e., those mainly grazing on algae) and the intermediate group (i.e., those feeding on zooplankton, filamentous algae and small benthic invertebrates). Our findings highlight the association between trophic ecology and genetic diversity that should be more commonly investigated in population genetics.
The role of parasite dispersal in shaping a host–parasite system at multiple evolutionary scales
Authors: Sweet Andrew D. , Johnson Kevin P.
Published: November 2018

Parasite dispersal can shape host–parasite interactions at both deep and shallow timescales. One approach to understanding the effects of dispersal is to study parasite lineages that differ in dispersal capability but are from the same group of hosts. In this study, we compared phylogenetic and population genetic patterns of wing and body lice from ground‐doves. Wing lice are more capable of dispersal than body lice. We sequenced full genomes of individual lice for multiple representatives of several wing and body louse species. From these data, we assembled genes for phylogenetic analysis and called SNPs for population genetic analysis. At the phylogenetic level, body lice showed more codivergence with their hosts than did wing lice. However, both wing and body lice exhibited some phylogenetic congruence with their hosts. Within species, body lice showed more population genetic structure than wing lice, although both types of lice showed some structure according to biogeography. Body lice also had significantly lower heterozygosity than wing lice, suggesting more inbreeding. Our results demonstrate that dispersal can shape a host–parasite system across evolutionary time, but also that other factors (e.g., host association and biogeography) can have varying degrees of influence on different groups of parasites and at different evolutionary scales.
Holobiont suture zones: Parasite evidence across the European house mouse hybrid zone
Authors: Goüy de Bellocq Joëlle , Wasimuddin  , Ribas Alexis , Bryja Josef , Piálek Jaroslav , Baird Stuart J. E.
Published: November 2018

Parasite hybrid zones resulting from host secondary contact have never been described in nature although parasite hybridization is well known and secondary contact should affect them similarly to free‐living organisms. When host populations are isolated, diverge and recontact, intimate parasites (host specific, direct life cycle) carried during isolation will also meet and so may form parasite hybrid zones. If so, we hypothesize these should be narrower than the host’s hybrid zone as shorter parasite generation time allows potentially higher divergence. We investigate multilocus genetics of two parasites across the European house mouse hybrid zone. We find each host taxon harbours its own parasite taxa. These also hybridize: Parasite hybrid zones are significantly narrower than the host’s. Here, we show a host hybrid zone is a suture zone for a subset of its parasite community and highlight the potential of such systems as windows on the evolutionary processes of host–parasite interactions and recombinant pathogen emergence.
Approaches to integrating genetic data into ecological networks
Authors: Clare Elizabeth L. , Fazekas Aron J. , Ivanova Natalia V. , Floyd Robin M. , Hebert Paul D. N. , Adams Amanda M. , Nagel Juliet , Girton Rebecca , Newmaster Steven G. , Fenton M. Brock
Published: November 2018

As molecular tools for assessing trophic interactions become common, research is increasingly focused on the construction of interaction networks. Here, we demonstrate three key methods for incorporating DNA data into network ecology and discuss analytical considerations using a model consisting of plants, insects, bats and their parasites from the Costa Rica dry forest. The simplest method involves the use of Sanger sequencing to acquire long sequences to validate or refine field identifications, for example of bats and their parasites, where one specimen yields one sequence and one identification. This method can be fully quantified and resolved and these data resemble traditional ecological networks. For more complex taxonomic identifications, we target multiple DNA loci, for example from a seed or fruit pulp sample in faeces. These networks are also well resolved but gene targets vary in resolution and quantification is difficult. Finally, for mixed templates such as faecal contents of insectivorous bats, we use DNA metabarcoding targeting two sequence lengths (157 and 407 bp) of one gene region and a MOTU, BLAST and BIN association approach to resolve nodes. This network type is complex to generate and analyse, and we discuss the implications of this type of resolution on network analysis. Using these data, we construct the first molecular‐based network of networks containing 3,304 interactions between 762 nodes of eight trophic functions and involving parasitic, mutualistic and predatory interactions. We provide a comparison of the relative strengths and weaknesses of these data types in network ecology.
When I say… moral distress as a teaching point
Authors: Waldman Reid A , Waldman Steven D , Carter Brian S
Published: November 2018

The authors explore the concept of moral distress to encourage educators to use it as a teaching point that empowers resident physicians to best take care of patients.