bluuebunny/crossref_metadata_2025 huggingface dataset:
Beyond Eschatology: Environmental Pessimism and the Future of Human Hoping
Authors: Swenson‐Lengyel Willa
Published: August 2017

In much environmentally concerned literature, there is a burgeoning concern for the status and sustainability of human hope. Within Christian circles, this attention has often taken the form of eschatological reflection. While there is important warrant for attention to eschatology in Christian examinations of hope, I claim that to move so quickly from hope to eschatology is to confuse a species of Christian hope for a definition of hope itself; as such, it is important for theological ethicists to examine hope also from the experiential perspective of the human hoper. In particular, this is important today given the shortcomings of an eschatological focus in addressing anxieties arising due to the environmental crisis. Through examining hope as a fallible human activity, one can come to better understand hope's importance to human life, its profound ambiguity, and the potential threat that the environmental crisis poses to it.
Which Teacher Should I Choose?: A Xunzian Approach to Distinguishing Moral Experts from Fanatics
Authors: Harris Eirik Lang
Published: August 2017

This essay examines whether an invocation of an epistemological privilege on the part of supposed moral experts prevents potential students from being able to evaluate among potential candidates for the role of plausible moral teacher. Throughout, it works to demonstrate that it is possible for even the untutored student to distinguish between a fanatic and a moral expert. In particular, this essay focuses on the version of virtue ethics espoused by the early Chinese philosopher Xunzi. It argues that by reflecting on the attributes of fanatics, as well as on Xunzi's ideas and arguments about students and teachers, it is possible to arrive at a general set of principles that provide beginners with the tools necessary to distinguish dangerous fanatics from plausible moral teachers, even given the fact that both claim for themselves an epistemological privilege.
A Loss of Judgment: The Dismissal of the Judicial Conscience in Recent Christian Ethics
Authors: Morgan Jeffrey
Published: August 2017

Christian ethicists have neglected conscience, understood as an individual's moral self‐awareness before a locus of accountability and judgment, over the last few decades. The aim of this essay is to suggest how this neglect came about. I draw on the work of Paul Lehmann and Oliver O'Donovan to illustrate how ethicists in the twentieth century became suspicious of conscience because of its association with the alleged ahistorical individualism of Immanuel Kant's work. I argue that a social‐historicist conception of conscience, such as H. Richard Niebuhr offered, attempts to save conscience from this suspicion. Ironically, however, Stanley Hauerwas's development of Niebuhr's historicist, communitarian approach to conscience, appears to have led to a dismissal of conscience. I conclude with a brief comment about what this dismissal has cost contemporary Christian ethics, namely the Christian tradition's basic commitment to the singularity of an individual's accountability before God.
Just War Moralities
Authors: Palmer‐Fernández Gabriel
Published: August 2017

This essay discusses four recent books on the Western, and one book on the classical Chinese, traditions of just war. It concentrates on the jus ad bellum moral criteria (legitimate authority, just cause, and right intention), giving attention to the centrality of the state in just war morality, to some challenges in reconceptualizing the jus ad bellum in the context of non‐state agents, and to controversies over a “presumption against war.”
Serum Thymidine Kinase 1, Canine‐C‐Reactive Protein, Haptoglobin, and Vitamin D Concentrations in Dogs with Immune‐Mediated Hemolytic Anemia, Thrombocytopenia, and Polyarthropathy
Authors: Grobman M. , Outi H. , Rindt H. , Reinero C.
Published: August 2017

Background

Relapses of immune‐mediated hemolytic anemia (IMHA), thrombocytopenia (ITP), or polyarthropathy (IMPA) occur despite normal hematologic and cytologic parameters. Thymidine kinase 1 (TK1), canine C‐reactive protein (c‐CRP), haptoglobin (HPT), and 25‐Hydroxyvitamin‐D(25(OH)D) might be adjunct to current monitoring strategies.

Hypothesis/Objectives

Compare serum concentrations ofTK1, c‐CRP,HPT, and 25(OH)D in dogs with well‐ and poorly controlled primaryIMHA,ITP, orIMPA.

Animals

Thirty‐eight client‐owned dogs.

Methods

Prospective descriptive study. Dogs diagnosed withIMHA,ITP, orIMPAhad serum biomarker concentrations measured commercially. Disease control was assessed by hematocrit/PCVand reticulocyte count, platelet count, and synovial fluid cytology forIMHA,ITP, andIMPA, respectively. Statistical analysis performed by Mann‐Whitney rank‐sum tests and receiver operating characteristic curves.

Results

TK1 and c‐CRP, but notHPTsignificantly decreased with well‐ versus poorly controlledIMHA(P= 0.047,P= 0.028,P= 0.37). C‐CRP, but notTKorHPTwas significantly lower with well‐ versus poorly controlledIMPA(P= 0.05,P= 0.28,P= 0.84). Sensitivity and specificity ofTKand c‐CRP(simultaneously) for detecting dogs with poorly controlledIMHAwere 88 and 100%, respectively. Sensitivity and specificity of c‐CRPfor detecting poorly controlled dogs withIMPAwere 13 and 100%, respectively. 92% of dogs were vitamin D insufficient (<100 ng/mL) regardless of disease control.

Conclusions and Clinical Importance

CombiningTK1 and c‐CRPmight act markers of disease control in dogs withIMHA. Canine‐CRPcannot be recommended as an independent marker of disease control inIMPA. 25(OH)D insufficiency in immune‐mediated disorders might benefit from further study to determine if supplementation could improve therapeutic response or reduce disease risk.
Pre‐ and Post‐Transfusion Alloimmunization in Dogs Characterized by 2 Antiglobulin‐Enhanced Cross‐match Tests
Authors: Goy‐Thollot I. , Giger U. , Boisvineau C. , Perrin R. , Guidetti M. , Chaprier B. , Barthélemy A. , Pouzot‐Nevoret C. , Canard B.
Published: August 2017

Background

When dogs are transfused, blood compatibility testing varies widely but may includedog erythrocyte antigen(DEA)1typing and rarely cross‐matching.

Objectives

Prospective study to examine naturally occurring alloantibodies against red blood cells (RBCs) and alloimmunization by transfusion using 2 antiglobulin‐enhanced cross‐match tests.

Animals

Eighty client‐owned anemic, 72 donor, and 7 control dogs.

Methods

All dogs were typed forDEA1and some also forDEA4andDEA7. Major cross‐match tests with canine antiglobulin‐enhanced immunochromatographic strip and gel columns were performed 26–129 days post‐transfusion (median, 39 days); some dogs had an additional early evaluation 11–22 days post‐transfusion (median, 16 days). Plasma from alloimmunized recipients was cross‐matched againstRBCs from 34 donor and control dogs.

Results

The 2 cross‐match methods gave entirely concordant results. All 126 pretransfusion cross‐match results for the 80 anemic recipients were compatible, but 54 dogs died or were lost to follow up. Among the 26 recipients with follow‐up, 1 dog accidently receivedDEA1‐mismatched blood and became cross‐match‐incompatible post‐transfusion. Eleven of the 25DEA1‐matched recipients (44%) became incompatible against otherRBCantigens. No naturally occurringanti‐DEA7alloantibodies were detected inDEA7−dogs.

Conclusions and clinical importance

The antiglobulin‐enhanced immunochromatographic strip cross‐match and laboratory gel column techniques identified no naturally occurring alloantibodies againstRBCantigens, but a high degree of post‐transfusion alloimmunization in dogs. Cross‐matching is warranted in any dog that has been previously transfused independent of initialDEA1typing and cross‐matching results before the first transfusion event.
Effects of polymyxin‐B on TNF‐α production in equine whole blood stimulated with three different bacterial toxins
Authors: Bauquier J. R. , Tennent‐Brown B. S. , Tudor E. , Bailey S. R.
Published: August 2017

Polymyxin‐B is used to treat equine systemic inflammation. Bacterial toxins other than lipopolysaccharide (LPS) contribute to systemic inflammation but the effects of polymyxin‐B on these are poorly defined. Whole blood aliquots from six healthy horses diluted 1:1 with RPMI were incubated for 21 hr with 1 μg/ml of LPS, lipoteichoic acid (LTA) or peptidoglycan (PGN) in the presence of increasing concentrations of polymyxin‐B (10–3000 μg/ml). A murine L929 fibroblast bioassay was used to measure TNF‐α activity. Polymyxin‐B significantly inhibited the effects of all three bacterial toxins. Analysis of variance showed the IC50 value for polymyxin‐B for TNF‐α inhibition caused by LTA (11.19 ± 2.89 μg/ml polymyxin‐B) was significantly lower (p = .009) than the values for LPS (46.48 ± 9.93 μg/ml) and PGN (54.44 ± 8.97 μg/ml). There was no significant difference in IC50 values between LPS and PGN (p > .05). Maximum inhibition of TNF‐α was 77.4%, 73.0% and 82.7% for LPS, PGN and LTA, respectively and was not significantly different between toxins. At the two highest concentrations of polymyxin‐B, TNF‐α began to increase. These data suggest that polymyxin‐B may inhibit the effects of bacterial toxins other than LPS and might be a more potent inhibitor of LTA than LPS or PGN.
The Agrobacterium VirE2 effector interacts with multiple members of the Arabidopsis VIP1 protein family
Authors: Wang Luyao , Lacroix Benoît , Guo Jianhua , Citovsky Vitaly
Published: August 2017

T‐DNA transfer from Agrobacterium to its host plant genome relies on multiple interactions between plant proteins and bacterial effectors. One such plant protein is the Arabidopsis VirE2 interacting protein (AtVIP1), a transcription factor that binds Agrobacterium tumefaciens C58 VirE2, potentially acting as an adaptor between VirE2 and several other host factors. It remains unknown, however, whether the same VirE2 protein has evolved to interact with multiple VIP1 homologues in the same host, and whether VirE2 homologues encoded by different bacterial strains/species recognize AtVIP1 or its homologues. Here, we addressed these questions by systematic analysis (using the yeast two‐hybrid and co‐immunoprecipitation approaches) of interactions between VirE2 proteins encoded by four major representatives of known bacterial species/strains with functional T‐DNA transfer machineries and eight VIP1 homologues from Arabidopsis and tobacco. We also analysed the determinants of the VirE2 sequence involved in these interactions. These experiments showed that the VirE2 interaction is degenerate: the same VirE2 protein has evolved to interact with multiple VIP1 homologues in the same host, and different and mutually independent VirE2 domains are involved in interactions with different VIP1 homologues. Furthermore, the VIP1 functionality related to the interaction with VirE2 is independent of its function as a transcriptional regulator. These observations suggest that the ability of VirE2 to interact with VIP1 homologues is deeply ingrained into the process of Agrobacterium infection. Indeed, mutations that abolished VirE2 interaction with AtVIP1 produced no statistically significant effects on interactions with VIP1 homologues or on the efficiency of genetic transformation.
Rome III vs Rome IV criteria for irritable bowel syndrome: A comparison of clinical characteristics in a large cohort study
Authors: Vork L. , Weerts Z. Z. R. M. , Mujagic Z. , Kruimel J. W. , Hesselink M. A. M. , Muris J. W. M. , Keszthelyi D. , Jonkers D. M. A. E. , Masclee A. A. M.
Published: August 2017

Background

The Rome criteria for irritable bowel syndrome (IBS) have been revised and are expected to apply only to the subset of Rome III IBS subjects with abdominal pain as predominant symptom, occurring at least once a week. The aim of this study was to determine the percentage of Rome III IBS subjects that fulfills Rome IV criteria and to evaluate differences between Rome IV‐positive and Rome IV‐negative subjects.

Methods

Four hundred and four Rome III IBS subjects completed a 14‐day end‐of‐day symptom diary, the Gastrointestinal Symptom Rating Scale (GSRS), Hospital Anxiety and Depression Scale, and RAND 36‐item Short‐Form Health Survey (SF‐36). Diary‐based surrogate Rome IV criteria were defined as occurrence of abdominal pain at least 1 day each week with a severity of ≥2 (mild; definition 1) or ≥3 (considerable; definition 2).

Key Results

Using surrogate Rome IV criteria, 353 (87.4%, definition 1) and 249 (61.6%, definition 2) subjects were defined as Rome IV positive. These patients were more often female, younger, and recruited from secondary/tertiary care compared with Rome IV‐negative subjects. They also presented with higher abdominal pain scores and gastrointestinal (GI) symptom severity on both end‐of‐day diary and GSRS, higher psychological symptom scores, and lower quality of life compared with Rome IV‐negative subjects.

Conclusions and Inferences

The Rome IV IBS population likely reflects a subgroup of Rome III IBS patients with more severe GI symptomatology, psychological comorbidities, and lower quality of life. This implies that results from Rome III IBS studies may not be directly comparable to those from Rome IV IBS populations.
Zika Virus Disease in Children in Colombia, August 2015 to May 2016
Authors: Tolosa Natalia , Tinker Sarah C. , Pacheco Oscar , Valencia Diana , Botero Daniela Salas , Tong Van T. , Mercado Marcela , Gilboa Suzanne M. , Gonzalez Maritza , Nelson Christina A. , Pardo Lissethe , Rao Carol Y. , Rico Angélica , Moore Meredith , Parra Edgar , Honein Margaret A. , Ospina Martínez Martha L.
Published: August 2017

Background

Children are considered a potentially vulnerable population for Zika virus infection. However, data on paediatric Zika virus infection are sparse.

Methods

We analysed data from Colombia's national surveillance system during the 2015–2016 Zika virus outbreak on patients meeting the clinical case definition of Zika virus disease (ZVD) among children aged 1 month to 18 years to estimate incidence by demographic characteristics and characterize the occurrence of selected complications.

Results

Between August 14, 2015, and May 28, 2016, there were 18 576 reported cases of postnatal ZVD among children aged 1 month to 18 years. Laboratory testing was prioritized for high‐risk patients (infants, pregnant women, adults aged ≥65 years, and persons with serious co‐morbidities); among 1655 that were tested by real‐time reverse transcriptase polymerase chain reaction, 1207 (72.9%) were positive. The cumulative incidence of reported ZVD was 114.4 per 100 000. The incidence differed by sex, depending on age group; the largest difference was observed for 15–18 year olds, with females having a higher incidence than males (cumulative incidence ratio 2.5, 95% confidence interval 2.3, 2.7). At the time of report to the surveillance system, 631 patients (3.4%) were hospitalised and 96 (0.5%) had a report of an accompanying neurological diagnosis, including Guillain‐Barré syndrome in 40 patients.

Conclusions

Only a small proportion of reported paediatric ZVD cases in Colombia were hospitalized or had reported neurological conditions following ZVD. However, the potential for some serious outcomes demonstrates the importance of preventing Zika virus infection in children.
Influence of practitioner expertise during early pregnancy diagnosis on pregnancy loss rate: A controlled, blinded trial
Authors: Patron R , López‐Helguera I , Sebastián F , Pesantez‐Pacheco J‐L , Pérez‐Villalobos N , Vicente González Martín J , Fargas O , Astiz S
Published: August 2017

Contents

A controlled field trial was conducted to assess the potential influence of practitioner inexperience during early pregnancy diagnosis with ultrasound (PD‐US) on the risk of pregnancy loss. A veterinarian with more than 10 years’ experience in PD‐US (Vet‐A) and a veterinarian with fewer than 12 months’ experience at the start of the study (Vet‐B) visited the same dairy farm once a week for 33 and 26 weeks, respectively. The two veterinarians did not interact with each other at any time during the study, nor did they know that their data would later be used in this study. Using the same farm scanner, they performed PD‐US at 28–34 day after breeding, together diagnosing 915 pregnancies. All cows were re‐checked at 49–56 day after artificial insemination, and cows no longer pregnant were recorded as having suffered pregnancy loss. Although Vet‐A and Vet‐B diagnosed a similar proportion of pregnancies (58.44 ± 16% vs 56.96 ± 18%, p > .05), the rate of pregnancy loss was significantly higher among cows diagnosed by Vet‐B (10.41 ± 11.2% vs 4.87 ± 9.0, p = .029). In addition, among cows diagnosed by Vet‐B, the rate of pregnancy loss was significantly higher among cows diagnosed, while he had fewer than 12 months’ PD‐US experience (11.17 ± 12.14%) than among cows that he diagnosed later (7.14 ± 11.01%, p = .038); in fact, this latter loss rate was comparable to that among cows diagnosed by Vet‐A during the same period (3.51 ± 9.83%, p = .620). These results suggest that inexperience with PD‐US during the late embryonic period can increase risk of early pregnancy loss, supporting the need for proper training.
Muscle thickness correlates to muscle cross‐sectional area in the assessment of strength training‐induced hypertrophy
Authors: Franchi M. V. , Longo S. , Mallinson J. , Quinlan J. I. , Taylor T. , Greenhaff P. L. , Narici M. V.
Published: August 2017

Muscle thickness (MT) measured by ultrasound has been used to estimate cross‐sectional area (measured by CT and MRI) at a single time point. We tested whether MT could be used as a valid marker of MRI determined muscle anatomical cross‐sectional area (ACSA) and volume changes following resistance training (RT). Nine healthy, young, male volunteers (24 ± 2 y.o., BMI 24.1 ± 2.8 kg/m2) had vastus lateralis (VL) muscle volume (VOL) and ACSAmid (at 50% of femur length, FL) assessed by MRI, and VL MT measured by ultrasound at 50% FL. Measurements were taken at baseline and after 12 weeks of isokinetic RT. Differences between baseline and post‐training were assessed by Student's paired t test. The relationships between MRI and ultrasound measurements were tested by Pearson's correlation. After RT, MT increased by 7.5 ± 6.1% (P < .001), ACSAmid by 5.2 ± 5% (P < .001), and VOL by 5.0 ± 6.9% (P < .05) (values: means ± SD). Positive correlations were found, at baseline and 12 weeks, between MT and ACSAmid (r = .82, P < .001 and r = .73, P < .001, respectively), and between MT and VOL (r = .76, P < .001 and r = .73, P < .001, respectively). The % change in MT with training was correlated with % change in ACSAmid (r = .69, P < .01), but not % change in VOL (r = .33, P > .05). These data support evidence that MT is a reliable index of muscle ACSAmid and VOL at a single time point. MT changes following RT are associated with parallel changes in muscle ACSAmid but not with the changes in VOL, highlighting the impact of RT on regional hypertrophy.
What happens in the pith stays in the pith: tissue‐localized defense responses facilitate chemical niche differentiation between two spatially separated herbivores
Authors: Lee Gisuk , Joo Youngsung , Kim Sang‐Gyu , Baldwin Ian T.
Published: August 2017

Herbivore attack is known to elicit systemic defense responses that spread throughout the host plant and influence the performance of other herbivores. While these plant‐mediated indirect competitive interactions are well described, and the co‐existence of herbivores from different feeding guilds is common, the mechanisms of co‐existence are poorly understood. In both field and glasshouse experiments with a native tobacco, Nicotiana attenuata, we found no evidence of negative interactions when plants were simultaneously attacked by two spatially separated herbivores: a leaf chewer Manduca sexta and a stem borer Trichobaris mucorea. T. mucorea attack elicited jasmonic acid (JA) and jasmonoyl‐l‐isoleucine bursts in the pith of attacked stems similar to those that occur in leaves when M. sexta attacks N. attenuata leaves. Pith chlorogenic acid (CGA) levels increased 1000‐fold to levels 6‐fold higher than leaf levels after T. mucorea attack; these increases in pith CGA levels, which did not occur in M. sexta‐attacked leaves, required JA signaling. With plants silenced in CGA biosynthesis (irHQT plants), CGA, as well as other caffeic acid conjugates, was demonstrated in both glasshouse and field experiments to function as a direct defense protecting piths against T. mucorea attack, but not against leaf chewers or sucking insects. T. mucorea attack does not systemically activate JA signaling in leaves, while M. sexta leaf‐attack transiently induces detectable but minor pith JA levels that are dwarfed by local responses. We conclude that tissue‐localized defense responses allow tissue‐specialized herbivores to share the same host and occupy different chemical defense niches in the same hostplant.
Dynamic mass density of resonant metamaterials with homogeneous inclusions
Authors: Bonnet Guy , Monchiet Vincent
Published: August 2017

The occurrence of a negative dynamic mass density is a striking property of metamaterials. It appears when an inner local resonance is present. Results coming from an asymptotic theory are recalled briefly, showing the scaling of physical properties leading to inner resonance in elastic composites containing homogeneous soft inclusions, with negligible scattering of waves traveling through the matrix. This appears for a large contrast of elastic properties between matrix and inclusion. The frequency-dependent dynamic mass density depends on the resonance frequencies of the inner inclusions and on their related participation factors. Having solved the dynamic elasticity problem, these physical quantities are provided in the case of homogeneous cylindrical and spherical inclusions. It is shown that numerous resonance frequencies do not contribute to the dynamic mass density or have small participation factors, which simplifies significantly the physics involved in the concerned inner resonance phenomena. Finally, non-dimensional resonance frequencies and participation factors are given for both cases of inclusions as functions of the Poisson's ratio, defining completely the dynamic mass density.
“They Hired a Baseball Guy”: Media Framing and Its Influence on the Isomorphic Tendencies of Organizational Management in Professional Football
Authors: Cassilo David , Sanderson Jimmy
Published: August 2017

Many professional sport franchises have undergone shifts in talent evaluation strategies by moving to analytic and data-driven approaches. However, National Football League (NFL) franchises have been resistant to fully embrace the analytical model, as NFL organizational management structures tend to be isomorphic. In 2016, the Cleveland Browns initiated an ideological break from this system by hiring “moneyball” guru Paul DePodesta, a move that signaled a shift to an analytics-based model in organizational management. A textual analysis of 120 online media articles was carried out to determine how media reports framed this philosophical shift. Results revealed that frames predominantly portrayed analytics as being in direct opposition to normalized operational structures in the NFL. The results illustrate how difficult it is to change the discourse and embrace new management ideas that are perceived to contrast with dominant ideologies.
Slow dynamics of electrons at a metal–Mott insulator boundary in an organic system with disorder
Authors: Itou Tetsuaki , Watanabe Eri , Maegawa Satoru , Tajima Akiko , Tajima Naoya , Kubo Kazuya , Kato Reizo , Kanoda Kazushi
Published: August 2017

NMR captures unusual slow dynamics of electrons on Mott transition with disorder, suggesting an electronic Griffiths phase.
In search of multipath interference using large molecules
Authors: Cotter Joseph P. , Brand Christian , Knobloch Christian , Lilach Yigal , Cheshnovsky Ori , Arndt Markus
Published: August 2017

Matter waves pass multipath interference test.
A molecular quantum spin network controlled by a single qubit
Authors: Schlipf Lukas , Oeckinghaus Thomas , Xu Kebiao , Dasari Durga Bhaktavatsala Rao , Zappe Andrea , de Oliveira Felipe Fávaro , Kern Bastian , Azarkh Mykhailo , Drescher Malte , Ternes Markus , Kern Klaus , Wrachtrup Jörg , Finkler Amit
Published: August 2017

Control of molecular spins and their readout with a solid-state qubit are described as a unit cell in a quantum spin network.
Primary Sjogren’s syndrome and the risk of acute pancreatitis: a nationwide cohort study
Authors: Chang Chi-Ching , Chang Yu-Sheng , Wang Shu-Hung , Lin Shyr-Yi , Chen Yi-Hsuan , Chen Jin Hua
Published: August 2017

Objective

Studies on the risk of acute pancreatitis in patients with primary Sjogren’s syndrome (pSS) are limited. We evaluated the effects of pSS on the risk of acute pancreatitis in a nationwide, population-based cohort in Taiwan.

Study design

Population-based retrospective cohort study.

Setting

We studied the claims data of the >97% Taiwan population from 2002 to 2012.

Participants

We identified 9468 patients with pSS by using the catastrophic illness registry of the National Health Insurance Database in Taiwan. We also selected 37 872 controls that were randomly frequency matched by age (in 5 year bands), sex and index year from the general population.

Primary outcome measure

We analysed the risk of acute pancreatitis by using Cox proportional hazards regression models including sex, age and comorbidities.

Results

From 23.74 million people in the cohort, 9468 patients with pSS (87% women, mean age=55.6 years) and 37 872 controls were followed-up for 4.64 and 4.74 years, respectively. A total of 44 cases of acute pancreatitis were identified in the pSS cohort versus 105 cases in the non-pSS cohort. Multivariate Cox regression analysis indicated that the incidence rate of acute pancreatitis was significantly higher in the pSS cohort than in the non-pSS cohort (adjusted HR (aHR) 1.48, 95% CI 1.03 to 2.12). Cyclophosphamide use increased the risk of acute pancreatitis (aHR 5.27, 95% CI 1.16 to 23.86). By contrast, hydroxychloroquine reduced the risk of acute pancreatitis (aHR 0.23, 95% CI 0.09 to 0.55).

Conclusion

This nationwide, retrospective cohort study demonstrated that the risk of acute pancreatitis was significantly higher in patients with pSS than in the general population.
The role of nurse specialists in the delivery of integrated diabetes care: a cross-sectional survey of diabetes nurse specialist services
Authors: Riordan Fiona , McHugh Sheena M , Murphy Katie , Barrett Julie , Kearney Patricia M
Published: August 2017

Objectives

International evidence suggests the diabetes nurse specialist (DNS) has a key role in supporting integrated management of diabetes. We examine whether hospital and community DNS currently support the integration of care, examine regional variation in aspects of the service relevant to the delivery of integrated care and identify barriers to service delivery and areas for improvement.

Design

A cross-sectional survey of hospital and community-based DNS in Ireland.

Methods

Between September 2015 and April 2016, a 67-item online survey, comprising closed and open questions on their clinical role, diabetes clinics, multidisciplinary working, and barriers and facilitators to service delivery, was administered to all eligible DNS (n=152) in Ireland. DNS were excluded if they were retired or on maternity leave or extended leave.

Results

The response rate was 66.4% (n=101): 60.6% (n=74) and 89.3% (n=25) among hospital and community DNS, respectively. Most DNS had patients with stable (81.8%) and complicated type 2 diabetes mellitus (89.9%) attending their service. The majority were delivering nurse-led clinics (81.1%). Almost all DNS had a role liaising with (91%), and providing support and education to (95%), other professionals. However, only a third reported that there was local agreement on how their service should operate between the hospital and primary care. Barriers to service delivery that were experienced by DNS included deficits in the availability of specialist staff (allied health professionals, endocrinologists and DNS), insufficient space for clinics, structured education and issues with integration.

Conclusions

Delivering integrated diabetes care through a nurse specialist-led approach requires that wider service issues, including regional disparities in access to specialist resources and formalising agreements and protocols on multidisciplinary working between settings, be explicitly addressed.
HIV prevalence and factors associated with HIV infection among transgender women in Cambodia: results from a national Integrated Biological and Behavioral Survey
Authors: Chhim Srean , Ngin Chanrith , Chhoun Pheak , Tuot Sovannary , Ly Cheaty , Mun Phalkun , Pal Khondyla , Macom John , Dousset Jean-Philippe , Mburu Gitau , Yi Siyan
Published: August 2017

Objective

To examine factors associated with HIV infection among transgender women in Cambodia.

Design

Cross-sectional study.

Settings

HIV high-burden sites including the capital city and 12 provinces.

Participants

This study included 1375 sexually active transgender women with a mean age of 25.9 years (SD 7.1), recruited by using respondent-driven sampling for structured questionnaire interviews and rapid finger-prick HIV testing.

Primary outcome measure

HIV infection detected by using Determine antibody test.

Results

HIV prevalence among this population was 5.9%. After adjustment for other covariates, participants living in urban areas were twice as likely to be HIV infected as those living in rural areas. Participants with primary education were 1.7 times as likely to be infected compared with those with high school education. HIV infection increased with age; compared with those aged 18–24 years, the odds of being HIV infected were twice as high among transgender women aged 25–34 years and 2.8 times higher among those aged ≥35 years. Self-injection of gender affirming hormones was associated with a fourfold increase in the odds of HIV infection. A history of genital sores over the previous 12 months increased the odds of HIV infection by threefold. Transgender women with stronger feminine identity, dressing as a woman all the time, were twice as likely to be HIV infected compared with those who did not dress as a woman all the time. Having never used online services developed for transgender women in the past six months was also associated with higher odds of being HIV infected.

Conclusions

Transgender women in Cambodia are at high risk of HIV. To achieve the goal of eliminating HIV in Cambodia, effective combination prevention strategies addressing the above risk factors among transgender women should be strengthened.
A randomised controlled pilot trial evaluating feasibility and acceptability of a computer-based tool to identify and reduce harmful and hazardous drinking among adolescents with alcohol-related presentations in Canadian pediatric emergency departments
Authors: Newton Amanda S , Dow Nadia , Dong Kathryn , Fitzpatrick Eleanor , Cameron Wild T , Johnson David W , Ali Samina , Colman Ian , Rosychuk Rhonda J
Published: August 2017

Objective

This study piloted procedures and obtained data on intervention acceptability to determine the feasibility of a definitive randomised controlled trial (RCT) of the effectiveness of a computer-based brief intervention in the emergency department (ED).

Design

Two-arm, multi-site, pilot RCT.

Setting and participants

Adolescents aged 12–17 years presenting to three Canadian pediatric EDs from July 2010 to January 2013 for an alcohol-related complaint.

Interventions

Standard medical care plus computer-based screening and personalised assessment feedback (experimental group) or standard care plus computer-based sham (control group). ED and research staff, and adolescents were blinded to allocation.

Outcomes

Main: change in alcohol consumption from baseline to 1- and 3 months post-intervention. Secondary: recruitment and retention rates, intervention acceptability and feasibility, perception of group allocation among ED and research staff, and change in health and social services utilisation.

Results

Of the 340 adolescents screened, 117 adolescents were eligible and 44 participated in the study (37.6% recruitment rate). Adolescents allocated to the intervention found it easy, quick and informative, but were divided on the credibility of the feedback provided (agreed it was credible: 44.4%, disagreed: 16.7%, unsure: 16.7%, no response: 22.2%). We found no evidence of a statistically significant relationship between which interventions adolescents were allocated to and which interventions staff thought they received. Alcohol consumption, and health and social services data were largely incomplete due to modest study retention rates of 47.7% and 40.9% at 1- and 3 months post-intervention, respectively.

Conclusions

A computer-based intervention was acceptable to adolescents and delivery was feasible in the ED in terms of time to use and ease of use. However, adjustments are needed to the intervention to improve its credibility. A definitive RCT will be feasible if protocol adjustments are made to improve recruitment and retention rates; and increase the number of study sites and research staff.

Trial registration

clinicaltrials.govNCT01146665
Speak-up culture in an intensive care unit in Hong Kong: a cross-sectional survey exploring the communication openness perceptions of Chinese doctors and nurses
Authors: Ng George Wing Yiu , Pun Jack Kwok Hung , So Eric Hang Kwong , Chiu Wendy Wai Hang , Leung Avis Siu Ha , Stone Yuk Han , Lam Chung Ling , Lai Sarah Pui Wa , Leung Rowlina Pui Wah , Luk Hing Wah , Leung Anne Kit Hung , Au Yeung Kin Wah , Lai Kang Yiu , Slade Diana , Chan Engle Angela
Published: August 2017

Objectives

Despite growing recognition of the importance of speaking up to protect patient safety in critical care, little research has been performed in this area in an intensive care unit (ICU) context. This study explored the communication openness perceptions of Chinese doctors and nurses and identified their perceptions of issues in ICU communication, their reasons for speaking up and the possible factors and strategies involved in promoting the practice of speaking up.

Design

A mixed-methods design with quantitative and sequential qualitative components was used.

Setting and participants

Eighty ICU staff members from a large public hospital in Hong Kong completed a questionnaire regarding their perceptions of communication openness. Ten clinicians whose survey responses indicated support for open communication were then interviewed about their speak-up practices.

Results

The participating ICU staff members had similar perceptions of their openness to communication. However, the doctors responded more positively than the nurses to many aspects of communication openness. The two groups also had different perceptions of speaking up. The interviewed ICU staff members who indicated a high level of communication openness reported that their primary reasons for speaking up were to seek and clarify information, which was achieved by asking questions. Other factors perceived to influence the motivation to speak up included seniority, relationships and familiarity with patient cases.

Conclusions

Creating an atmosphere of safety and equality in which team members feel confident in expressing their personal views without fear of reprisal or embarrassment is necessary to encourage ICU staff members, regardless of their position, to speak up. Because harmony and saving face is valued in Chinese culture, training nurses and doctors to speak up by focusing on human factors and values rather than simply addressing conflict management is desirable in this context.
Randomised feasibility trial into the effects of low-frequency electrical muscle stimulation in advanced heart failure patients
Authors: Ennis Stuart , McGregor Gordon , Hamborg Thomas , Jones Helen , Shave Robert , Singh Sally J , Banerjee Prithwish
Published: August 2017

Objectives

Low-frequency electrical muscle stimulation (LF-EMS) may have the potential to reduce breathlessness and increase exercise capacity in the chronic heart failure population who struggle to adhere to conventional exercise. The study’s aim was to establish if a randomised controlled trial of LF-EMS was feasible.

Design and setting

Double blind (participants, outcome assessors), randomised study in a secondary care outpatient cardiac rehabilitation programme.

Participants

Patients with severe heart failure (New York Heart Association class III–IV) having left ventricular ejection fraction <40% documented by echocardiography were eligible.

Interventions

Participants were randomised (remotely by computer) to 8 weeks (5×60 mins per week) of either LF-EMS intervention (4 Hz, continuous, n=30) or sham placebo (skin level stimulation only, n=30) of the quadriceps and hamstrings muscles. Participants used the LF-EMS straps at home and were supervised weekly

Outcome measures

Recruitment, adherence and tolerability to the intervention were measured during the trial as well as physiological outcomes (primary outcome: 6 min walk, secondary outcomes: quadriceps strength, quality of life and physical activity).

Results

Sixty of 171 eligible participants (35.08%) were recruited to the trial. 12 (20%) of the 60 patients (4 LF-EMS and 8 sham) withdrew. Forty-one patients (68.3%), adhered to the protocol for at least 70% of the sessions. The physiological measures indicated no significant differences between groups in 6 min walk distance(p=0.13) and quality of life (p=0.55) although both outcomes improved more with LF-EMS.

Conclusion

Patients with severe heart failure can be recruited to and tolerate LF-EMS studies. A larger randomised controlled trial (RCT) in the advanced heart failure population is technically feasible, although adherence to follow-up would be challenging. The preliminary improvements in exercise capacity and quality of life were minimal and this should be considered if planning a larger trial.

Trial registration number

ISRCTN16749049
Comparative efficacy and acceptability of antidepressants, psychological interventions, and their combination for depressive disorder in children and adolescents: protocol for a network meta-analysis
Authors: Zhou Xinyu , Cipriani Andrea , Zhang Yuqing , Cuijpers Pim , Hetrick Sarah E , Weisz John R , Pu Juncai , Giovane Cinzia Del , Furukawa Toshiaki A , Barth Jürgen , Coghill David , Leucht Stefan , Yang Lining , Ravindran Arun V , Xie Peng
Published: August 2017

Introduction

Depressive disorder is common in children and adolescents, with important consequences and serious impairments in terms of personal and social functioning. While both pharmacological and psychological interventions have been shown to be effective, there is still uncertainty about the balance between these and what treatment strategy should be preferred in clinical practice. Therefore, we aim to compare and rank in a network meta-analysis (NMA) the commonly used psychological, pharmacological and combined interventions for depressive disorder in children and adolescents.

Methods and analysis

We will update the literature search of two previous NMAs for the identification of trials of antidepressant and psychotherapy alone for depressive disorder in children and adolescents. For identification of trials of combination interventions, seven databases (PubMed, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, PsycINFO, CINAHL, LiLACS) will be searched from date of inception. We will also search ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and check relevant reports on the US Food and Drug Administration website for unpublished data. Building on our previous findings in the field, we will include any commonly prescribed oral antidepressants and any manualised or structured psychotherapies, as well as their combinations. Randomised controlled trials assessing any active intervention against active comparator or pill placebo/psychological controls in acute treatment for depressive disorder in children and adolescents will be included. The primary outcomes will be efficacy (mean change in depressive symptoms), and acceptability of treatment (dropout rate due to any cause). The secondary outcomes will be remission rate, tolerability of treatment (dropouts for adverse events), as well as suicide-related outcomes (suicidal behaviour or ideation). We will perform Bayesian NMAs for all relative outcome measures. Subgroup analyses and sensitivity analyses will be conducted to assess the robustness of the findings.

Dissemination

This NMA will provide the most up to date and clinically useful information about the comparative efficacy and acceptability of antidepressants, psychological intervention and their combination in the acute treatment of children and adolescents with depressive disorder. This is the newest NMA and therefore these results are very important in terms of evidence-based medicine. The results will be disseminated through peer-reviewed publication.

Protocol registration

PROSPERO CRD42015020841.
Effect of Community ART Groups on retention-in-care among patients on ART in Tete Province, Mozambique: a cohort study
Authors: Decroo Tom , Telfer Barbara , Dores Carla Das , White Richard A , Santos Natacha Dos , Mkwamba Alec , Dezembro Sergio , Joffrisse Mariano , Ellman Tom , Metcalf Carol
Published: August 2017

Objectives

Estimate the effect of participation in Community ART Groups (CAG) versus individual care on retention-in-care (RIC) on antiretroviral therapy (ART).

Design

Retrospective cohort study.

Setting

High levels of attrition (death or loss-to-follow-up (LTFU) combined) on ART indicate that delivery models need to adapt in sub-Saharan Africa. In 2008, patients more than 6 months on ART began forming CAG, and took turns to collect ART refills at the health facility, in Tete Province, Mozambique,.

Participants

2406 adult patients, retained in care for at least 6 months after starting ART, during the study period (date of CAG introduction at the health facility—30 April 2012).

Methods

Data up to 30 April 2012 were collected from patient records at eight health facilities. Survival analysis was used to compare RIC among patients in CAG and patients in individual care, with joining a CAG treated as an irreversible time-dependent variable. Multivariable Cox regression was used to estimate the effect of CAG on RIC, adjusted for age, sex and health facility type and stratified by calendar cohort.

Results

12-month and 24-monthRIC from the time of eligibility were, respectively, 89.5% and 82.3% among patients in individual care and 99.1% and 97.5% among those in CAGs (p<0.0001). CAG members had a greater than fivefold reduction in risk of dying or being LTFU (adjusted HR: 0.18, 95% CI 0.11 to 0.29).

Conclusions

Among patients on ART, RIC was substantially better among those in CAGs than those in individual care. This study confirms that patient-driven ART distribution through CAGs results in higher RIC among patients who are stable on ART.
Baseline data from a planned RCT on attitudes to female genital cutting after migration: when are interventions justified?
Authors: Wahlberg Anna , Johnsdotter Sara , Selling Katarina Ekholm , Källestål Carina , Essén Birgitta
Published: August 2017

Objectives

To present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration.

Design

Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as facilitators of change among those newly arrived, data were stratified into years of residency in Sweden.

Setting

Sweden.

Participants

372 Somali men and women, 206 newly arrived (0–4 years), 166 established (>4 years).

Primary outcome measures

Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent.

Results

The support for anatomical change of girls and women’s genitals ranged from 0% to 2% among established and from 4% to 8% among newly arrived. Among those supporting no anatomical change, 75%–83% among established and 53%–67% among newly arrived opposed all forms of FGC, with the remaining supporting pricking of the skin with no removal of tissue. Among newly arrived, 37% stated that pricking was acceptable, 39% said they wanted their daughter to be pricked and 26% reported they wanted pricking to continue being practised. Those who had lived in Sweden ≤ 2 years had highest odds of supporting FGC; thereafter, the opposition towards FGC increased over time after migration.

Conclusion

A majority of Somali immigrants, including those newly arrived, opposed all forms of FGC with increased opposition over time after migration. The majority of proponents of FGC supported pricking. We argue that it would have been unethical to proceed with the intervention as it, with this baseline, would have been difficult to detect a change in attitudes given that a majority opposed all forms of FGC together with the evidence that a strong attitude change is already happening. Therefore, we decided not to implement the planned intervention.

Trial registration number

Trial registration numberNCT02335697;Pre-results.
Changes in prevalence of workplace violence against doctors in all medical specialties in Norway between 1993 and 2014: a repeated cross-sectional survey
Authors: Johansen Ingrid Hjulstad , Baste Valborg , Rosta Judith , Aasland Olaf G , Morken Tone
Published: August 2017

Objectives

The aim of this study was to investigate whether reported prevalence of experienced threats, real acts of violence and debilitating fear of violence among Norwegian doctors have increased over the last two decades.

Design

Repeated cross-sectional survey.

Setting

All healthcare levels and medical specialties in Norway.

Participants

Representative samples of Norwegian doctors in 1993 (n=2628) and 2014 (n=1158).

Main outcome measures

Relative risk (RR) of self-reported prevalence of work-time experiences of threats and real acts of violence, and of being physically or psychologically unfit during the last 12 months due to fear of violence, in 2014 compared with 1993, adjusted by age, gender and medical specialty.

Results

There were no differences in self-reported threats (adjusted RR=1.01, 95% CI 0.95 to 1.08) or real acts (adjusted RR=0.90, 95% CI 0.80 to 1.03) of violence when comparing 2014 with 1993. The proportion of doctors who had felt unfit due to fear of violence decreased from 1993 to 2014 (adjusted RR=0.53, 95% CI 0.39 to 0.73). Although still above average, the proportion of doctors in psychiatry who reported real acts of violence decreased substantially from 1993 to 2014 (adjusted RR=0.75, 95% CI 0.60 to 0.95).

Conclusions

A substantial proportion of doctors experience threats and real acts of violence during their work-time career, but there was no evidence that workplace violence has increased over the last two decades. Still, the issue needs to be addressed as part of the doctors’ education and within work settings.