bluuebunny/crossref_metadata_2025 huggingface dataset:
3D gait analysis, haemophilia joint health score, leg muscle laterality and biomarkers of joint damage: A cross‐sectional comparative assessment of haemophilic arthropathy
Authors: Putz Peter , Durstberger Sebastian , Kaufmann Christina , Klinger Meike , Plessl Kerstin , Rejtö Judit , Widhalm Klaus , Male Christoph , Pabinger Ingrid
Published: October 2020

Introduction

3D gait analysis has been proposed as a reproducible and valid method to assess abnormal gait patterns and to monitor disease progression in patients with haemophilia (PWH).

Aim

This study aimed at comparing Gait Deviation Index (GDI) between adult PWH and healthy controls, and at assessing the agreement between outcome measures of haemophilic arthropathy.

Methods

Male PWH aged 18‐49 years (prespecified subgroups: 18‐25 vs 26‐49 years) on prophylactic replacement therapy, and male healthy age‐matched controls passed through a cross‐sectional assessment panel. Besides the 3D gait analysis derived GDI, secondary outcomes included kinematic, kinetic and spatio‐temporal gait parameters, the Haemophilia Joint Health Score (HJHS), electric impedance derived leg muscle laterality and inflammatory biomarkers.

Results

Patients with haemophilia (n = 18) walked slower, in shorter steps and accordingly with less functional range of motion in the hips and ankles, as compared to healthy controls (n = 24). Overall, PWH did not differ significantly in GDI and specific gait parameters. PWH had a higher mean HJHS (18.8 vs 2.6, P = .000) and leg muscle laterality (4.3% vs 1.5%, P = .004). A subgroup analysis revealed progressed gait pathology in PWH aged 26‐49 years (not statistically significant). Leg muscle laterality was strongly correlated with HJHS (r = .76, P = .000), whereas GDI just moderately (r = −.39, P = .110). PWH had higher levels of the inflammatory markers CRP and IL‐6.

Conclusion

Progressed gait pathology was found in PWH, mainly those aged 26‐49 years. Leg muscle laterality correlated strongly with HJHS and was identified as a promising tool for detecting progression and physiological consequences of haemophilic joint arthropathy.
No “Wearing‐Off Effect” Seen in Quarterly or Monthly Dosing of Fremanezumab: Subanalysis of a Randomized Long‐Term Study
Authors: Blumenfeld Andrew M. , Stevanovic Darko M. , Ortega Mario , Cohen Joshua M. , Seminerio Michael J. , Yang Ronghua , Jiang Bo , Tepper Stewart J.
Published: October 2020

Objective

To evaluate whether quarterly or monthly administration of fremanezumab for migraine prevention exhibits a pattern of decreased efficacy toward the end of the dosing interval (wearing‐off effect).

Background

The main goals of migraine preventive treatment are to reduce the frequency, severity, and duration of migraine attacks, and migraine‐associated disability. Wearing‐off refers to the phenomenon whereby clinical symptoms return or worsen before the next dose of a drug is due and has been reported previously with migraine preventive medications.

Design and Methods

This was a long‐term, 12‐month, multicenter, randomized, double‐blind, parallel‐group phase 3 study (NCT02638103) that included chronic (CM) and episodic migraine (EM) patients who rolled over from the 12‐week phase 3 HALO CM (NCT02621931) and EM trials (NCT02629861), as well as an additional subset of 312 new patients. Patients with CM or EM received fremanezumab either monthly or quarterly. In this post hoc analysis, for selected months, the difference in the average number of migraine days between weeks 1‐2 and weeks 3‐4, between weeks 1‐3 and week 4, and between weeks 1‐2 and weeks 11‐12 were calculated.

Results

A total of 1890 patients (CM, 1110; EM, 780) were enrolled. At months 3, 6, 9, and 15, there were no substantial differences in mean weekly migraine days between weeks 1‐2 and weeks 3‐4 or between weeks 1‐3 and week 4 with quarterly or monthly fremanezumab in the CM or EM subgroups. There were no substantial increases in mean weekly migraine days between weeks 1‐2 and weeks 11‐12 during the first quarter of treatment (months 1‐3) or the second quarter of treatment (months 4‐6) with quarterly or monthly fremanezumab in the CM or EM subgroups. Across both dosing subgroups in CM and EM patients, the mean weekly number of migraine days decreased substantially (30%‐42%) during the first 2 weeks; decreases in weekly migraine days remained steady during the last 2 weeks of the first quarter, with a similar maintenance of response during the second quarter.

Conclusions

This analysis of data from a long‐term, phase 3 study showed that patients receiving quarterly fremanezumab or monthly fremanezumab did not experience a wearing‐off effect toward the end of the dosing interval.
Using citizen science to assess drivers of Common House Martin Delichon urbicum breeding performance
Authors: Kettel Esther F. , Woodward Ian D. , Balmer Dawn E. , Noble David G.
Published: October 2020

Many hirundine (swallows and martins) species are declining throughout their ranges. The Common House Martin Delichon urbicum is a migratory hirundine that breeds throughout Europe but has shown recent declines in some parts of the UK, particularly in the south. We conducted a large‐scale citizen science survey to assess how the breeding performance of House Martins, measured by the number of attempted broods and nest success, is influenced by nest‐specific, landscape and weather factors. Pairs in eastern parts of the UK started breeding earlier than those in the west, and breeding performance was higher in eastern regions. There was no effect of latitude on either aspect of breeding performance, so our measures of breeding performance alone do not help to explain differences in population trends across the UK. The probability of attempting multiple broods and producing successful nests was higher in previously used nests than in newly built nests, and in artificial nests than in natural nests. Nests built on plastic soffits of buildings were less likely to be multi‐brooded and less likely to be successful compared with other materials. Suggested conservation measures therefore include discouraging the removal of old nests and encouraging the installation of artificial nests, particularly on buildings with plastic soffits. This study provides comprehensive insight into the breeding biology of House Martins, and although our findings do not show conclusively that breeding performance is the sole driver of population trends, they go some way to explain declines in House Martins and ultimately provide information that may help conserve this species.
Phenotypic divergence in two sibling species of shorebird: Common Snipe and Wilson’s Snipe (Charadriiformes: Scolopacidae)
Authors: Rodrigues Tiago M. , Miller Edward H. , Drovetski Sergei V. , Zink Robert M. , Fjeldså Jon , Gonçalves David
Published: October 2020

Natural and social selection are among the main shapers of biological diversity but their relative importance in divergence remains understudied. Additionally, although neutral evolutionary processes may promote phenotypic divergence, their potential contribution in speciation is often overlooked in studies of comparative morphology. In this study, we investigated phenotypic differentiation in two allopatric shorebirds: the Palaearctic Common Snipe Gallinago gallinago and the Nearctic Wilson's Snipe Gallinago delicata. Specimens of Common Snipe (n = 355 skins, n = 163 skeletons) and Wilson's Snipe (n = 403 skins, n = 141 skeletons) in natural history collections were examined to quantify differences in skeletal and external measurements, and measures of wing and tail plumage variables. The species do not differ in skeletal variables except for the relatively larger sternum of the Common Snipe. The two species do not differ in multivariate wing size or shape (pointedness). Previously known plumage differences between these species were confirmed: the Common Snipe has fewer rectrices, longer and wider outermost rectrices, more extensive white on tips of the secondary feathers, and more white in the axillaries. Between‐species variance in skeleton, primary length and plumage variables was greater than expected if drift was mainly responsible for phenotypic divergence, suggesting a role of selective processes. However, drift could not be rejected after adjusting for multiple comparisons. Differences in plumage traits were greater than in skeletal or external measurements. Because snipe use plumage traits in signalling, the results suggest a more rapid divergence in socially selected traits between these species than in traits related to resource use.
Discovery of a morphologically and genetically distinct population of Black‐tailed Godwits in the East Asian‐Australasian Flyway
Authors: Zhu Bing‐Run , Verkuil Yvonne I. , Conklin Jesse R. , Yang Ailin , Lei Weipan , Alves José A. , Hassell Chris J. , Dorofeev Dmitry , Zhang Zhengwang , Piersma Theunis
Published: October 2020

Occurring across Eurasia, the Black‐tailed Godwit Limosa limosa has three recognized subspecies, melanuroides, limosa and islandica from east to west, respectively. With the smallest body size, melanuroides has been considered the only subspecies in the East Asian‐Australasian Flyway. Yet, observations along the Chinese coast indicated the presence of distinctively large individuals. Here we compared the morphometrics of these larger birds captured in northern Bohai Bay, China, with those of the three known subspecies and explore the genetic population structuring of Black‐tailed Godwits based on the control region of the mitochondrial genome (mtDNA). We found that the Bohai Godwits were indeed significantly larger than melanuroides, resembling limosa more than islandica, but with relatively longer bills than islandica. The level of genetic differentiation between Bohai Godwits and the three recognized subspecies was of similar magnitude to the differentiation among previously recognized subspecies. Based on these segregating morphological and genetic characteristics, we propose that these birds belong to a distinct population, which may be treated and described as a new subspecies.
Cytomegalovirus in inflammatory bowel disease: a clinical approach
Authors: Gilmore Robert B. , Taylor Kirstin M. , Morrissey C. Orla , Gardiner Bradley J.
Published: October 2020

Cytomegalovirus (CMV) infection can be a challenging clinical problem in patients with inflammatory bowel disease (IBD), particularly ulcerative colitis. Clinical presentation is difficult to distinguish from an underlying disease flare. Several diagnostic modalities are now available and when combined can aid clinicians in the identification of patients who are most likely to benefit from antiviral therapy. The aim of this article is to review the available literature and outline a practical approach to the diagnosis and management of CMV in patients with IBD.
Inpatient usage of faecal calprotectin in a tertiary hospital
Authors: Barnes Alex , Spizzo Paul , Mountifield Réme
Published: October 2020

Background

Faecal calprotectin (FCP) is a highly sensitive non‐invasive marker of intestinal inflammation that has evidence‐based roles in outpatient diagnosis and management of inflammatory bowel disease.

Aims

To examine indications for FCP in a tertiary inpatient population and its role in inpatient management and subsequent investigations.

Methods

An electronic database was used to identify all patients over the age of 18 years who had FCP performed during a hospital admission over a 3‐year period from March 2016 to the end of March 2019. Electronic records and case notes were reviewed with follow up to March 2020, seeking indication for testing, healthcare units requesting, and subsequent investigations and treatment resulting from FCP.

Results

Over a 3‐year period, 111 FCP inpatient results were identified. There were three changes in management based on the FCP result that led to further investigations that did not lead to any clinically significant pathology. There was no observable difference in the number of colonoscopies performed based on FCP level. The numerical FCP value was associated with clinically significant findings on colonoscopy. Negative predictive value of FCP level (≤50 μg/g) for clinically significant finding on colonoscopy was 64%.

Conclusion

Non‐guideline‐based hospital inpatient usage of FCP rarely changes inpatient management and had no observable difference in the usage of subsequent diagnostic colonoscopy. Regardless, the FCP level remained a strong predictor of clinically significant pathology on colonoscopy.
Improved prediction of HLA antigen presentation hotspots: Applications for immunogenicity risk assessment of therapeutic proteins
Authors: Attermann Anders Steenholdt , Barra Carolina , Reynisson Birkir , Schultz Heidi Schiøler , Leurs Ulrike , Lamberth Kasper , Nielsen Morten
Published: October 2020

Immunogenicity risk assessment is a critical element in protein drug development. Currently, the risk assessment is most often performed using MHC‐associated peptide proteomics (MAPPs) and/or T‐cell activation assays. However, this is a highly costly procedure that encompasses limited sensitivity imposed by sample sizes, the MHC repertoire of the tested donor cohort and the experimental procedures applied. Recent work has suggested that these techniques could be complemented by accurate, high‐throughput and cost‐effective prediction of in silico models. However, this work covered a very limited set of therapeutic proteins and eluted ligand (EL) data. Here, we resolved these limitations by showcasing, in a broader setting, the versatility of in silico models for assessment of protein drug immunogenicity. A method for prediction of MHC class II antigen presentation was developed on the hereto largest available mass spectrometry (MS) HLA‐DR EL data set. Using independent test sets, the performance of the method for prediction of HLA‐DR antigen presentation hotspots was benchmarked. In particular, the method was showcased on a set of protein sequences including four therapeutic proteins and demonstrated to accurately predict the experimental MS hotspot regions at a significantly lower false‐positive rate compared with other methods. This gain in performance was particularly pronounced when compared to the NetMHCIIpan‐3.2 method trained on binding affinity data. These results suggest that in silico methods trained on MS HLA EL data can effectively and accurately be used to complement MAPPs assays for the risk assessment of protein drugs.
Coupling distinct MOLP interactive approaches with a novel DEA hybrid model
Authors: Henriques Carla , Luque Mariano , Marcenaro‐Gutierrez Oscar
Published: October 2020

We propose a modelling framework which allows considering different priorities and individual expansion and contraction scales for distinct types of inputs and outputs, through the Weighted Russell Directional Distance Model (WRDDM). An equivalence model between the WRDDM and the super‐ideal point model has also been established, which is then incorporated into several interactive Multiobjective Linear Programming (MOLP) approaches. The use of these diverse interactive methodologies allows obtaining the benchmark Decision Making Units (DMUs) which best suit the decision maker's (DM) preferences. This feature can be useful since traditional Data Envelopment Analysis (DEA) models tend to completely neglect the DM's preferences and value judgements in the computation of the DMUs used as a reference of best practices. Therefore, with this tool the DMs have the possibility of translating into the decision‐making process management constraints (namely, budgetary) and aspiration levels regarding the inputs and outputs, providing much more realistic support for actual decision‐making.
The association between mindfulness and health promotion in undergraduate nursing students: A serial multiple mediator analysis
Authors: Rababah Jehad A. , Al‐Hammouri Mohammed M. , Drew Barbara L.
Published: October 2020

Aim

This study was conducted to examine the association between mindfulness and health promotion among undergraduate nursing students and explore the mediation effect of certain factors (perceived stress, depressive symptoms, self‐care agency, and impulsivity) on this relationship.

Design

Cross‐sectional quantitative design.

Methods

A total of 195 undergraduate nursing students from a public university in Jordan participated in this study. A demographic questionnaire was used in addition to using well‐established, validated tools to measure health promotion, mindfulness, perceived stress, depressive symptoms, impulsivity, and self‐care agency. Data were collected between March and November 2018. Data were analysed using PROCESS macros.

Results

The direct association between mindfulness and health promotion was positive but not statistically significant. Simple mediation analysis showed that perceived stress is the only statistically significant mediator (effect = 0.03; 95% CI: LL = 0.008, UL = 0.057). The serial multiple mediator analyses revealed that three combinations of the mediators made the mindfulness effect on health promotion statistically significant; perceived stress and self‐care agency (effect = −0.01, 95% CI: LL = −0.022, UL = −0.01); depressive symptoms and self‐care agency (effect = 0.016, 95% CI: LL = 0.006, UL = 0.03); and perceived stress with depressive symptoms and self‐care agency (effect = 0.006, 95% CI: LL = 0.002, UL = 0.013).

Conclusions

The results of this study add to the literature evidence concerning the mediation role of perceived stress, depressive symptoms, and self‐care agency on the relationship between mindfulness and health promotion among nursing students.

Impact

This study examined the complex relationship between mindfulness and health promotion. There is a mediation effect of nursing students’ perceived stress, depressive symptoms, and self‐care agency on the relationship between mindfulness and health promotion. Researchers interested in designing mindfulness‐based interventions to optimize health promotion of nursing students could benefit from the findings of this study.
The relevance, feasibility and benchmarking of nursing quality indicators: A Delphi study
Authors: Koch Daniel , Kutz Alexander , Conca Antoinette , Wenke Juliane , Schuetz Philipp , Mueller Beat
Published: October 2020

Aims

To identify indicators of nursing care performance by identifying structures, processes, and outcomes that are relevant, feasible and have the potential for benchmarking in Swiss acute hospitals.

Design

A modified Delphi‐Consensus Technique.

Methods

We examined 19 indicators based on the current evidence and that were pre‐selected by nursing scientists. Between August–October 2019, a consortium of experts (representatives of different cantons, hospitals, and healthcare roles in Switzerland) determined the relevance, feasibility, and suitability for benchmarking these indicators in two‐round modus of digital survey. Consensus was defined a priori by at least 75% agreement on the highest level of a 3‐point Likert‐type scale.

Results

The response rate was 70.4% in the first and 68.4% in the second round. In round one consensus was reached for three indicators on relevance but for none of the indicators regarding feasibility or potential for benchmarking. For round two, the experts suggested two additional indicators (new total of 21 indicators). Of 21 indicators, consensus was reached on twelve regarding relevance, seven regarding feasibility, and two regarding the potential for benchmarking.

Conclusion

A national expert consortium defined 12 of 21 nursing care indicators as relevant. Feasibility, however, was estimated only among seven indicators and a consensus on suitability for benchmarking was reached for two nursing‐sensitive indicators.

Impact

The results show how the indicators to evaluate nursing care performance, which have been identified as priority by Canadian nursing scientists, are assessed in a different setting. There are many overlaps, but also some differences in the assessment of the indicators between the different settings. Different health systems prioritize the indicators to evaluate nursing care performance differently, which is why national surveys are important for the compilation of their own (priority) indicator sets.
Peripheral intravenous catheter non‐infectious complications in adults: A systematic review and meta‐analysis
Authors: Marsh Nicole , Webster Joan , Ullman Amanda J. , Mihala Gabor , Cooke Marie , Chopra Vineet , Rickard Claire M.
Published: October 2020

Aims

The aim of this systematic review and meta‐analysis was to summarize and quantify peripheral intravenous catheter‐related complications.

Design

This systematic review is reported by means of the Cochrane process for randomized controlled trials and the Meta‐analysis of Observation Studies in Epidemiology for cohort studies.

Data sources

The Cochrane Central Register of Controlled Trials, PubMed, CINAHL and EMBASE databases, clinical trial registries such as ClinicalTrials.gov and the reference list of included studies were searched from 2000 ‐April 2019.

Review Methods

Using a purpose designed data extraction tool, two authors independently identified studies for full review, data extraction and quality assessment. Dichotomous outcomes were pooled after Freeman–Tukey double arcsine transformation using random‐effects meta‐analysis; estimates of heterogeneity were taken from inverse‐variance fixed‐effect models.

Results

Seventy observational studies and 33 randomized controlled trials were included (76,977 catheters). Peripheral intravenous catheter‐related complications were as follows: phlebitis (with definition) 19.3%, phlebitis (without definition) 4.5%, infiltration/extravasation 13.7%, occlusion 8%, leakage 7.3%, pain 6.4% and dislodgement 6.0%. Subgroup analysis found infiltration/extravasation for emergency department‐inserted catheters was significantly higher (25.2%; p = .022) than for those inserted in other departments and pain was significantly higher (p < .001) in countries with developing economies compared with developed economies.

Conclusion

Peripheral intravenous catheter complications are unacceptably common worldwide. This review suggests substantial and multi‐specialty efforts are needed to address the sequalae associated with complications. The potential benefits for patients and health services are considerable if complications are reduced.

Impact

Peripheral intravenous complications interrupt important treatment which can be distressing for patients and result in longer hospital stays with increased healthcare costs. This review found phlebitis and infiltration are the most prevalent reason for catheter failure. These results provide nurses with a strong evidence base for the development of effective interventions for practice which are vital for preventing poor outcomes for patients with peripheral intravenous catheters.
Effect of a compassion fatigue resiliency program on nurses’ professional quality of life, perceived stress, resilience: A randomized controlled trial
Authors: Pehlivan Tuğba , Güner Perihan
Published: October 2020

Aims

This study aimed to conduct a short‐ and long‐term Compassion Fatigue Resiliency Program and compare its impact on nurses’ professional quality of life, perceived stress, and resilience.

Design

The research was conducted between January 2017 January 2019 as a randomized controlled trial.

Methods

The sample comprised 125 oncology–haematology nurses randomly assigned to a Experimental I, Experimental II, or control group. The Compassion Fatigue Resiliency Program was conducted with the nurses as an intervention. Experimental I received a short‐term program (5 hr per day for 2 days, 10 hr in total) while Experimental II received a long‐term one (5 weeks, 2 hr per week, 10 hr in total). Measurements were obtained during pre‐ and post‐test and at 3‐, 6‐, and 12‐month follow‐ups. Research hypotheses were analysed using multilevel models.

Results

The results of multilevel model analyses showed there was no statistically significant difference between mean scores for compassion fatigue, burnout, perceived stress, and resilience of nurses in the short‐ or long‐term groups or of those in the control group. Mean compassion satisfaction scores of nurses in the short‐ or long‐term groups were significantly higher than those in the control group. Mean compassion satisfaction scores of nurses in the short‐ or long‐term groups were significantly higher than the control group's pre‐test mean after 6 and 12 months.

Conclusion

This study concluded that short‐ or long‐term programs had no influence on compassion fatigue, burnout, perceived stress, and resilience; however, both programs positively affected compassion satisfaction. We recommend that further studies be conducted, which will help determine the effectiveness of new programs.

Impact

Caring for patients with cancer can generate work‐related stress that can negatively affect oncology nurses’ physical and emotional health, which could lead to compassion fatigue. The program provided nurses with an opportunity to improve their compassion satisfaction. Because there was no difference between both programs regarding mean compassion satisfaction scores, a short‐term program may be preferred to encourage more participation among nurses. We also recommend further studies should be conducted that include environmental improvements along with the training programs.

Trial registered at ClinicalTrials.gov (The name of the trial register: Effect of a Compassion Fatigue Resiliency Program; the clinical trial registration number: NCT04372303).
Effects of upright positions during the second stage of labour for women without epidural analgesia: A meta‐analysis
Authors: Zang Yu , Lu Hong , Zhang Huixin , Huang Jing , Ren Lihua , Li Chunying
Published: October 2020

Aims

To assess the effects of upright positions on maternal outcomes for women without epidural analgesia in comparison with recumbent positions during the second stage of labour.

Background

Upright positions have many physiological advantages. The underlying benefits and risks of upright positions during the second stage of labour have been reported in many studies but the results are divergent.

Design

A meta‐analysis of randomized controlled trials.

Data sources

The Cochrane Library, PubMed, Embase, CINAHL and ProQuest databases were systematically searched from inception to 17 June 2019.

Review methods

We conducted the quality appraisal using the Cochrane Collaboration's tool and performed meta‐analyses using the Review Manager 5.3 software. The primary outcomes were instrumental vaginal delivery and the duration of the second stage of labour.

Results

Overall, 12 studies including 4,314 women were included. Upright positions significantly decreased the rate of instrumental vaginal delivery (risk ratio [RR] = 0.74, 95% CI 0.59–0.93), shortened the active pushing phase (mean difference [MD] = −8.16 min, 95% CI −16.29 to −0.02), decreased the rate of severe perineal trauma (RR = 0.35, 95% CI 0.14–0.87) and episiotomy (RR = 0.52, 95% CI 0.29–0.92), but significantly increased the rate of second‐degree perineal trauma (RR = 1.45, 95% CI 1.10–1.90). However, there was no significant difference in the duration of the second stage of labour or postpartum haemorrhage.

Conclusions

Upright positions are beneficial for improving maternal outcomes. Several results should be considered with caution. Researchers need to clarify the definition of upright positions and conduct large, robust studies in the future to provide stronger evidence.

Impact

This meta‐analysis explores a crucial issue in intrapartum care and clarifies the benefits and possible risks of upright positions in the second stage of labour. Midwives and obstetricians are encouraged to apply upright positions depending on women's preferences and labour progress but should take measures to prevent perineal trauma.
Ethical leadership and decision authority effects on nurses’ engagement, exhaustion, and turnover intention
Authors: McKenna Jayne , Jeske Debora
Published: October 2020

Aim

The aim of the present study was to investigate emotional exhaustion, work engagement, and turnover intention in the nursing profession by exploring the antecedent effects of ethical leadership and job components such as decision authority.

Background

Emotional exhaustion, low work engagement, and high turnover intention are prevalent issues in the nursing profession. The experience of feeling overworked has led to feelings of burnout and low morale among nurses in Ireland, which has prompted the authors to identify potential variables that reduce these outcomes—in this case, ethical leadership and decision authority.

Design

A descriptive, cross‐sectional survey design was used across three hospital sites.

Methods

A cross‐sectional sample of 89 nurses was recruited from three Irish hospitals to capture the experience of nurses between December 2017 ‐ February 2018. Hypotheses were tested using path model analysis.

Results

Ethical leadership positively predicted decision authority among nurses. Ethical leadership also had an indirect effect on all three outcome variables (work engagement, exhaustion, and turnover intention). Further effects were noted in relation to the mediators in relation to the three outcome variables. Decision authority had a positive effect on work engagement and related to lower turnover intention.

Conclusions

The present study demonstrated the role of ethical leadership as a mechanism to positively affect job control and work experience outcomes for nurses at work. Ethical leadership style in hospitals and providing nurses with the authority to make decisions can improve their work experience and help to engage, support, and retain nurses.

Impact

The study found support for the positive role of ethical leadership in relation to decision authority and as a positive predictor of work engagement, negative predictor of emotional exhaustion, and turnover intention among nurses.
Does Social Trust Justify the Public Justification Principle?
Authors: Tahzib Collis
Published: October 2020

According to public reason liberalism, the state must abide by a principle of public justification. This principle holds that the laws and institutions of society must be in some sense justifiable to, or acceptable to, all reasonable citizens. But why accept the public justification principle? Recently, Kevin Vallier has developed an interesting and empirically informed argument from social trust to public justification. Sustaining a system of social trust within diverse and large‐scale societies, argues Vallier, requires adherence to the public justification principle. After summarizing Vallier’s argument (Section 1), I argue that Vallier’s defence of public justification does not succeed because there are alternative conceptions of democratic discourse and decision‐making that lack a public justification principle yet that could still sustain social trust (Section 2). I then defend this argument against two objections: that alternatives to public justification would produce less social trust (Section 3) and that such alternatives would not produce social trust in the right way (Section 4).
Clinical, electrocardiographic and electrophysiological characteristics, and catheter ablation results of left upper septal premature ventricular complexes
Authors: Kose Sedat , Vurgun Veysel K. , Gokoglan Yalcin , Balli Mehmet , Kabul Hasan K.
Published: October 2020

Background

To investigate the clinical, electrocardiographic and electrophysiological characteristics, and results of catheter ablation of left upper septal (LUS) premature ventricular complexes (PVCs) arising from the proximal left fascicular system.

Methods

Thirty‐one patients who had undergone radiofrequency catheter ablation (RFCA) for idiopathic PVCs were enrolled in the study. All PVCs presented with narrow QRS complexes (<110 ms) with precordial QRS morphology of incomplete right bundle branch block type or identical to the sinus rhythm (SR) QRS morphology. RFCA was applied to the LUS area where the earliest fascicular potential (FP) was recorded during mapping.

Results

The mean QRS duration during SR and PVCs were 92.3 ± 7.9 and 103.2 ± 7.3 ms, respectively. The mean fascicular potential‐ventricular interval during PVC at the target site was 32.7 ± 2.7 ms. The mean His‐ventricular (H‐V) interval during SR and PVCs were 45.1 ± 2.7 and 21.3 ± 3.6 ms, respectively. Left anterior hemiblock/left posterior hemiblock and left bundle branch block (LBBB) were observed in 16 (53.3%) and 4 (12.9%) patients after RFCA, respectively. The His to FP interval in SR and H‐V interval during PVC were found as significant markers for predicting the postablation LBBB. RFCA was acutely successful in 29 of 31 patients (93.5%) in the first procedure. Two patients had a recurrence of PVCs during follow‐up and one of them underwent a second successful ablation. The overall success rate was 90.3% (28/31) in a mean follow‐up duration of 24.3 ± 15.4 months.

Conclusions

LUS‐PVCs have distinctive electrocardiographic and electrophysiologic characteristics and can be managed successfully by focal RFCA with detailed FP mapping of the left upper septum with a mild risk of left bundle branch injury.
Topographical anatomy of the right atrial appendage vestibule and its isthmuses
Authors: Hołda Jakub , Słodowska Katarzyna , Tyrak Kamil , Bolechała Filip , Jasińska Katarzyna A. , Koziej Mateusz , Hołda Mateusz K. , Walocha Jerzy A.
Published: October 2020

Introduction

The right atrial appendage (RAA) vestibule is an area located in the right atrium between the RAA orifice and the right atrioventricular valve annulus and may be a target for invasive transcatheter procedures.

Methods and Results

We examined 200 autopsied human hearts. Three isthmuses (an inferior, a middle, and a superior isthmus) were detected. The average length of the vestibule was 67.4 ± 10.1 mm. Crevices and diverticula were observed within the vestibule in 15.3% of specimens. The isthmuses had varying heights: superior: 14.0 ± 3.4 mm, middle: 11.2 ± 3.1 mm, and inferior: 10.1 ± 2.7 mm (p < .001). The superior isthmus had the thickest atrial wall (at midlevel: 16.7 ± 5.6 mm), the middle isthmus had the second thickest wall (13.5 ± 4.2 mm), and the inferior isthmus had the thinnest wall (9.3 ± 3.0 mm; p < .001). This same pattern was observed when analyzing the thickness of the adipose layer (superior isthmus had a thickness of 15.4 ± 5.6 mm, middle: 11.7 ± 4.1 mm and inferior: 7.1 ± 3.1 mm; p < .001). The average myocardial thickness did not vary between isthmuses (superior isthmus: 1.3 ± 0.5 mm, middle isthmus: 1.8 ± 0.8 mm, inferior isthmus: 1.6 ± 0.5 mm; p > .05). Within each isthmus, there were variations in the thickness of the entire atrial wall and of the adipose layer. These were thickest near the valve annulus and thinnest near the RAA orifice (p < .001). The thickness of the myocardial layer followed an inverse trend (p < .001).

Conclusions

This study was the first to describe the detailed topographical anatomy of the RAA vestibule and that of its adjoining isthmuses. The substantial variability in the structure and dimensions of the RAA isthmuses may play a role in planning interventions within this anatomic region.
Changes in the expression and function of the PDE5 pathway in the obstructed urinary bladder
Authors: He Weixiang , Xiang Han , Liu Daoquan , Liu Jianmin , Li Mingzhou , Wang Qian , Qian Qiaofeng , Li Yan , Fu Xun , Chen Ping , Guo Yuming , Zeng Guang , Wu Zhonghua , Zhan Daxing , Wang Xinghuan , DiSanto Michael E. , Zhang Xinhua
Published: October 2020

Our study aims to explore changes in bladder contractility and the phosphodiesterase type 5 (PDE5) signalling pathway in response to partial bladder outlet obstruction (PBOO). A surgically induced male rat PBOO model and human obstructed bladder tissues were used. Histological changes were examined by H&E and Masson's trichrome staining. Bladder strip contractility was measured via organ bath. The expressions of nitric oxide synthase (NOS) isoforms, PDE5, muscarinic cholinergic receptor (CHRM) isoforms and PDE4 isoforms in bladder were detected by RT‐PCR and Western blotting. The immunolocalization of the PDE5 protein and its functional activity were also determined. PBOO bladder tissue exhibited significant SM hypertrophy and elevated responsiveness to KCl depolarization and the muscarinic receptor agonist carbachol. NOS isoforms, PDE5, CHRM2, CHRM3 and PDE4A were up‐regulated in obstructed bladder tissue, whereas no change in PDE4B and PDE4D isoform expression was observed. With regard to PDE5, it was expressed in the SM bundles of bladder. Interestingly, obstructed bladder exhibited less relaxation responsiveness to sodium nitroprusside (SNP), but an exaggerated PDE5 inhibition effect. The up‐regulation of PDE5 could contribute to the lack of effect on Qmax for benign prostatic hyperplasia/lower urinary tract symptom (BPH/LUTS) patients treated with PDE5 inhibitors. Moreover, PDE5 (with presence of NO) and PDE4 may serve as new therapeutic targets for bladder diseases such as BPH‐induced LUTS and overactive bladder (OAB).
Are cystic fibrosis mutation carriers a potentially highly vulnerable group to COVID‐19?
Authors: Sarantis Panagiotis , Koustas Evangelos , Papavassiliou Athanasios G. , Karamouzis Michalis V.
Published: October 2020

Undoubtedly, the new SARS‐CoV‐2 virus poses a grave health threat, plaguing the health and socio‐economic sectors. COVID‐19 disease must be treated quickly and effectively as soon as possible. The main axes in this direction are establishing vaccines, drugs, diagnostic tests, as well as identifying the most vulnerable groups. Probably, there is a correlation between COVID‐19 and cystic fibrosis. Our interest is focused on cystic fibrosis carriers that, due to limited tests, remain undetectable. There is an activation of the inflammatory response in the carriers, as well as in cystic fibrosis patients. First of all, a striking similarity lies between the inflammatory response in COVID‐19 and cystic fibrosis carriers. Notably, ACE‐2 plays the same role in both cases and a similar geographical distribution is observed in both diseases. In conclusion, we suggest that cystic fibrosis mutation carriers are potential members of a certain vulnerable group and the detection of such mutations in the population might be vital for the prevention of SARS‐CoV‐2 virus, and more specifically to limit its serious complications.
Evaluating the appropriateness of clinical decision support alerts: A case study
Authors: Olakotan Olufisayo O. , Yusof Maryati M.
Published: October 2020

Rationale, aims, and objectives

Clinical decision support (CDS) generates excessive alerts that disrupt the workflow of clinicians. Therefore, inefficient clinical processes that contribute to the misfit between CDS alert and workflow must be evaluated. This study evaluates the appropriateness of CDS alerts in supporting clinical workflow from a socio‐technical perspective.

Method

A qualitative case study evaluation was conducted at a 620‐bed public teaching hospital in Malaysia using interview, observation, and document analysis to investigate the features and functions of alert appropriateness and workflow‐related issues in cardiological and dermatological settings. The current state map for medication prescribing process was also modelled to identify problems pertinent to CDS alert appropriateness.

Results

The main findings showed that CDS was not well designed to fit into a clinician's workflow due to influencing factors such as technology (usability, alert content, and alert timing), human (training, perception, knowledge, and skills), organizational (rules and regulations, privacy, and security), and processes (documenting patient information, overriding default option, waste, and delay) impeding the use of CDS with its alert function. We illustrated how alert affect workflow in clinical processes using a Lean tool known as value stream mapping. This study also proposes how CDS alerts should be integrated into clinical workflows to optimize their potential to enhance patient safety.

Conclusion

The design and implementation of CDS alerts should be aligned with and incorporate socio‐technical factors. Process improvement methods such as Lean can be used to enhance the appropriateness of CDS alerts by identifying inefficient clinical processes that impede the fit of these alerts into clinical workflow.
Tooth‐cusp preservation with lithium disilicate onlay restorations: A fatigue resistance study
Authors: Griffis Elizabeth , Abd Alraheam Islam , Boushell Lee , Donovan Terrence , Fasbinder Dennis , Sulaiman Taiseer A.
Published: October 2020

Objectives

This study examined the in vitro fatigue resistance of maxillary premolars with 2 mm or 3 mm preserved cusp thicknesses restored with lithium disilicate onlays.

Materials and Methods

Premolars(N = 48) were divided into six groups. Onlays for groups 1 to 4 preserved a 3 mm functional (G1), 2 mm functional (G2), 3 mm nonfunctional (G3), or 2 mm nonfunctional (G4) buccal‐lingual cusp width. Onlays for group 5 (G5, control) replaced both cusps. Group 6 (G6) samples were identical to G1 with added retentive boxes. Lithium disilicate onlays were exposed to thermocycling (10 000 cycles, 5°C‐55°C, 30s/cycle) and mechanical loading (1.2 million cycles at 1.4 Hz and 70 N). All samples were examined for onlay debonding or cusp or onlay fracture.

Results

Failure rates were 75%(G1), 0.0%(G2), 12.5%(G3), 0.0%(G4), 0.0%(G5), and 0.0%(G6). The difference in percent failure between the groups preserving the functional cusps (37.5%) and the groups preserving the nonfunctional cusps (6.3%) was statistically significant (P = .04; 95%CI:2.11‐55.66). No cusp or restoration fractures were observed; all failures were due to debonding of the restoration.

Conclusion

Teeth with thin remaining cusps that were restored with bonded lithium disilicate onlay restorations were not prone to fracture. Retentive preparation features that physically eliminated lateral displacement prevented onlay debonding even though the ceramic‐enamel margin was directly at the occlusal contact.

Clinical significance

The use of adhesively retained lithium disilicate ceramic onlays may be a viable alternative to full coverage restorations and may challenge traditionally accepted principals related to preparation resistance and retention form of ceramic partial coverage restorations.
Utilizing grass for the biological production of polyhydroxyalkanoates (PHAs) via green biorefining: Material and energy flows
Authors: Patterson Tim , Massanet‐Nicolau Jaime , Jones Rhys , Boldrin Alessio , Valentino Francesco , Dinsdale Richard , Guwy Alan
Published: October 2020

The meat and dairy industry across Europe is dependent on the production of grass. However, faced with competing pressures to reduce the environmental impact of agriculture, a potential future reduction of meat and dairy consumption in western diets, and pressure to minimize food production costs, grass could be used to produce alternative products. The biological production of polyhydroxyalkanoates (PHA) by using grass as the primary carbon source in a novel mixed culture process has been studied. A total of 30,000 t of fresh grass would yield approximately 403.65 t of dried biopolymer granules. On the basis of this early stage, non‐optimized process, the cumulative energy demand (CED) of PHA produced from waste grass and cultivated grass was found to be 248.4 MJ/kg and 271.8 MJ/kg, respectively, which is the same order of magnitude as fossil‐carbon‐based polymers. Improvements in volatile fatty acid yields, reduction in chemical and water inputs, and using residues to make other products will reduce the CED. Given the future requirement to produce polymers with little or no fossil‐carbon feedstock, an optimized version of the process could provide a viable future production option that also contributes to the long‐term sustainability of agricultural communities.
Planning and implementing quality improvement projects in clinical practice: Third‐year nursing students’ learning experiences
Authors: Strand Kari , Tveit Bodil
Published: October 2020

Aims and objectives

To evaluate the impact of an educational design to develop nursing students’ competence to work systematically with quality improvement in clinical practice.

Background

Competence in how to improve the quality and safety of healthcare services based on new knowledge is crucial for healthcare quality. Nursing education should give students opportunities to engage in quality improvement projects to gain this competence.

Design

This project qualitatively evaluated the impact of the course on students’ ability to plan and implement a quality improvement project in their clinical placement.

Methods

Data from retrospective focus group interviews and written project reports were analysed by means of qualitative content analysis. Fifty‐five students participated in the study. COREQ reporting guidelines were used.

Results

Three themes were derived from the analysis: (a) the importance of anchoring the quality improvement project in the clinic; (b) experiencing the steps of a quality improvement project; and (c) challenging student role.

Conclusions

Course design that facilitates student‐run small‐scale quality improvement projects under supervision can enhance nurse students’ competence in quality improvement work, as well as raise the students’ awareness of the responsibility they will undertake as future nurses.

Relevance to clinical practice

Nursing students work on quality improvement project in clinical placement may enhance their awareness and competence in developing quality and safety of healthcare services as future nurses.
Perceptions of managers regarding prerequisites for the development of professional competence of newly graduated nurses: A qualitative study
Authors: Södersved Källestedt Marie‐Louise , Asp Margareta , Letterstål Anna , Widarsson Margareta
Published: October 2020

Aim and objectives

To describe perceptions of managers regarding prerequisites for professional competence development of newly graduated nurses following a 1‐year residency programme.

Background

In general, managers are unsatisfied with the professional competence of newly graduated nurses. Therefore, they have been involved in residency programmes to support the nurses’ transition from being nursing students to professional nurses. However, perceptions of managers regarding the professional competence development of nurses have been sparingly studied.

Design/Methods

Qualitative, descriptive study with a data‐driven inductive approach with content analysis to obtain an understanding of the perceptions of nine managers through interviews. EQUATOR checklist COREQ is used (see File S1).

Results

Three themes emerged: (a) the nurses’ relationships with their teams and patients, (b) expectations regarding the development of practical skills and leadership skills and (c) prerequisites for continuing learning by supportive structures and a mutual responsibility between the manager and the nurse. Reflection was perceived by the managers as a cornerstone in the learning and development of professional competence. Learning theory was important, but learning practical clinical skills was essential for the nurses to develop competence and be able to perform their work, including being a leader of the team. Some structures discouraged continued learning in the development of professional competence, indicating a gap between the healthcare settings and the basic nursing programme.

Conclusions

There is a gap between the university and the healthcare settings in maintaining a structure for continued learning, which requires cooperation. This gap and tension can be a driving force for the learning process of competence development. Relationships with team members and patients are considered fundamental for developing professional competence.

Relevance to clinical practice

To overcome the gap between the university and the healthcare settings, the managers can facilitate nurses’ continued learning by creating structures for reflection.