bluuebunny/crossref_metadata_2025 huggingface dataset:
Global variation in nonstructural carbohydrate stores in response to climate
Authors: Blumstein Meghan , Gersony Jessica , Martínez‐Vilalta Jordi , Sala Anna
Published: December 2022

Woody plant species store nonstructural carbohydrates (NSCs) for many functions. While known to buffer against fluctuations in photosynthetic supply, such as at night, NSC stores are also thought to buffer against environmental extremes, such as drought or freezing temperatures by serving as either back‐up energy reserves or osmolytes. However, a clear picture of how NSCs are shaped by climate is still lacking. Here, we update and leverage a unique global database of seasonal NSC storage measurements to examine whether maximum total NSC stores and the amount of soluble sugars are associated with clinal patterns in low temperatures or aridity, indicating they may confer a benefit under freezing or drought conditions. We examine patterns using the average climate at each study site and the unique climatic conditions at the time and place in which the sample was taken. Altogether, our results support the idea that NSC stores act as critical osmolytes. Soluble Sugars increase with both colder and drier conditions in aboveground tissues, indicating they can plastically increase a plants' tolerance of cold or arid conditions. However, maximum total NSCs increased, rather than decreased, with average site temperature and had no relationship to average site aridity. This result suggests that the total amount of NSC a plant stores may be more strongly determined by its capacity to assimilate carbon than by environmental stress. Thus, NSCs are unlikely to serve as reservoir of energy. This study is the most comprehensive synthesis to date of global NSC variation in relation to climate and supports the idea that NSC stores likely serve as buffers against environmental stress. By clarifying their role in cold and drought tolerance, we improve our ability to predict plant response to environment.
Caring masculinities at work in later life: Exploring relational care work in retirement
Authors: Leontowitsch Miranda
Published: December 2022

The paper reports on research that investigates older men's care practices and how their caring for others opens new ways of exploring the intersections of aging, gender, and care work. Using the concept caring masculinities as a sensitizing concept, the onus is on exploring patterns of power, interdependence, and relationality within men's care practices. Aging masculinities often remain constructed around paid‐for occupational work (in opposition to unpaid care work) despite the transition into retirement. Little work exists on how caring is at work in later life potentially transforming gender relations and enacted masculinities. Moreover, much of the research on aging masculinities have not considered the expansiveness of retirement and the discourses as well as subjective expectations around the activity in later life that create an uncertain terrain of socioculturally structured mandates to be navigated. This paper draws on data from two qualitative interview studies conducted with retired men in England and Germany, in which the role of caregiving emerged as an inductive theme in their narratives. The paper makes a specific contribution to developing empirical and theoretical knowledge of caring masculinities and power relations by providing insights on men's trajectories into caring, and how they make sense of their caring for and about others.
Prognostic significance for recurrence of fibroblast growth factor receptor 2 in intrahepatic cholangiocarcinoma patients undergoing curative hepatic resection
Authors: Toshida Katsuya , Itoh Shinji , Yugawa Kyohei , Kosai Yukiko , Tomino Takahiro , Yoshiya Shohei , Nagao Yoshihiro , Kayashima Hiroto , Harada Noboru , Kohashi Kenichi , Oda Yoshinao , Yoshizumi Tomoharu
Published: December 2022

Aims

The fibroblast growth factor receptor 2 (FGFR2) fusion gene is frequently found as a genetic abnormality in the FGFR pathway in patients with intrahepatic cholangiocarcinoma (ICC). The FGFR fusion protein, produced from the FGFR fusion gene, is thought to cause tumor cell growth. To date, there have been few reports on the relationship between pathologic FGFR2 expression and prognosis in patients who have undergone hepatectomy for ICC, and on the relationship between FGFR2 and tumor‐infiltrating lymphocytes (TILs).

Methods and Results

We enrolled 92 patients who underwent hepatectomy for ICC and performed immunohistochemical staining for FGFR2 and cluster of differentiation 8, and hematoxylin and eosin staining for evaluating TILSs. The relationships between the FGFR2 and clinicopathological characteristics and outcomes were analyzed, and patients were classified into positive (n = 18) and negative (n = 74) FGFR2 groups. The FGFR2‐positive group contained more men (p < 0.0001) and had lower serum albumin (p = 0.0355) and higher carcinoembryonic antigen (p = 0.0099). Furthermore, multivariable analyses revealed that the FGFR2‐positive group had worse disease‐free survival (DFS) (p = 0.0002). Multivariate analysis showed that the independent prognostic factors for DFS were maximum tumor size (≥5 cm) (p = 0.0011), tumor localization (perihilar type) (p = 0.0180), and FGFR2 positivity (p = 0.0029). There was no significant difference in TILs count between the two groups.

Conclusion

We showed that FGFR2 high expression was an independent prognostic factor for recurrence of resected ICC.
Cross‐cultural differences in the use of the “?” Response category of the Job Descriptive Index: An application of the item response tree model
Authors: Lee Philseok , Joo Sean , Jia Zihao
Published: December 2022

Historically, the “?” response category (i.e., the question mark response category) has been criticized because of the ambiguity of its interpretation. Previous empirical studies of the appropriateness of the “?” response category have generally used methods that cannot disentangle the response style from target psychological traits and have also exclusively focused on Western samples. To further develop our understanding of the “?” response category, we examined the differing use of the “?” response category in the Job Descriptive Index (JDI) between U.S. and Korean samples by using the recently proposed item response tree (IRTree) models. Our research showed that the Korean group more strongly prefers the “?” response category, while the U.S. group more strongly prefers the directional response category (i.e., Yes). In addition, the Korean group tended to interpret the “?” response category as mild agreement, while the U.S. group tended to interpret it as mild disagreement. Our study adds to the scientific body of knowledge on the “?” response category in a cross‐cultural context. We hope that our findings presented herein provide valuable insights for researchers and practitioners who want to better understand the “?” response category and develop various psychological assessments in cross‐cultural settings.
Dementia literacy in an ageing world
Authors: Smith Graeme Drummond , Ho Ken , Lee Allen , Lam Linda , Chan Sally
Published: December 2022

Aims

This discursive article aims to capture and explore the most pertinent nursing aspects of dementia literacy (DL).

Background

Older people constitute a rapidly increasing proportion of the global population, experiencing higher risk of developing chronic disease, including dementia. It is important that older adults receive and understand reliable health‐related information, as age‐related changes may affect the level of health literacy in an older person. It has been suggested that older adults may have poorer health literacy than younger adults, associated with poorer health outcomes. Health literacy, how people receive, interpret and act on health information, play a significant role in dementia‐related disorders, both as a possible predicter of onset of dementia and as a potential modifier of cognitive decline. Dementia literacy constitutes one aspect of health literacy in relation to nursing care, related to knowledge of dementia‐related disorders and approaches towards older people with dementia.

Design

This discursive article explores the importance of DL for the nursing profession, including dementia‐related assessment, education and interventions.

Method

This article is informed by analysis of relevant descriptive and empirical literature and policy documents related to DL, an increasingly important aspect of dementia‐related nursing care. Valid assessment tools that can accurately assess aspects an individuals' DL are examined; these have the potential to help nurses detect dementia‐related symptoms. With early detection and prevention of dementia, older people may have better chance of benefiting from evolving treatment options.

Conclusion

Greater attention needs to be given to the issue of DL in older people, especially in terms of nursing assessment and care. Globally, increased DL‐related education is urgently required to improve knowledge of this concept; this includes public awareness initiatives to better understanding this chronic condition.

Implication nursing practice

Enhancing DL has the potential to empower older people to have greater access to healthcare services and to make more informed decisions about their health care.

Patient or public contribution

No patient or public contribution, as this is a discursive article.
Early life stress induces visual dysfunction and retinal structural alterations in adult mice
Authors: Calanni Juan S. , Dieguez Hernán H. , González Fleitas María F. , Canepa Eduardo , Berardino Bruno , Repetto Esteban M. , Villarreal Alejandro , Dorfman Damian , Rosenstein Ruth E.
Published: December 2022

Early life stress (ELS) is defined as a period of severe and/or chronic trauma, as well as environmental/social deprivation or neglect in the prenatal/early postnatal stage. Presently, the impact of ELS on the retina in the adult stage is unknown. The long‐term consequences of ELS at retinal level were analyzed in an animal model of maternal separation with early weaning (MSEW), which mimics early life maternal neglect. For this purpose, mice were separated from the dams for 2 h at postnatal days (PNDs) 4–6, for 3 h at PNDs 7–9, for 4 h at PNDs 10–12, for 6 h at PNDs 13–16, and weaned at PND17. At the end of each separation period, mothers were subjected to movement restriction for 10 min. Control pups were left undisturbed from PND0, and weaned at PND21. Electroretinograms, visual evoked potentials, vision‐guided behavioral tests, retinal anterograde transport, and retinal histopathology were examined at PNDs 60–80. MSEW induced long‐lasting functional and histological effects at retinal level, including decreased retinal ganglion cell function and alterations in vision‐guided behaviors, likely associated to decreased synaptophysin content, retina‐superior colliculus communication deficit, increased microglial phagocytic activity, and retinal ganglion cell loss through a corticoid‐dependent mechanism. A treatment with mifepristone, injected every 3 days between PNDs 4 and16, prevented functional and structural alterations induced by MSEW. These results suggest that retinal alterations might be included among the childhood adversity‐induced threats to life quality, and that an early intervention with mifepristone avoided ELS‐induced retinal disturbances.

image
Experiencing and witnessing disruptive behaviors toward nurses in COVID‐19 teams, patient safety, and errors in care
Authors: Shafran Tikva Sigal , Gabay Gillie , Asraf Liron , Kluger Avraham N. , Lerman Yulia
Published: December 2022

Background

Nurse managers and team co‐workers' disruptive behaviors (DBs) are negatively associated with a perceived safe climate. Moreover, DBs are a risk factor for patients' safety. Yet, it remains unknown whether and to what extent these effects were prevalent in COVID‐19 wards and among witnesses of DBs.

Design

A cross‐sectional study.

Methods

A questionnaire was distributed on social networks and completed by nurses in various Israeli healthcare organizations using snowball sampling between October and December 2021. The questionnaire included seven previously published measures and a question checking whether the participants had worked in a COVID‐19 ward. The minimal sample size for any analysis was 236. Hypotheses were tested with correlations and structural equation modeling.

Results

DBs of nurse managers and team co‐workers toward nurses were higher in COVID‐19 teams. As hypothesized, DBs were negatively correlated with a safe climate and positively with patient safety (fewer errors). The data were consistent with a model suggesting that a safe climate is related to fewer DBs and DBs largely mediate the effects of safe climate on errors. Surprisingly and importantly, the strongest predictor of errors, including preventable mortality, is witnessing DBs and not being a victim of DBs.

Conclusions

DBs may impede open communication and collaboration among co‐workers, particularly in COVID‐19 teams. This study shows the links between nurse shaping of a safe climate, DBs toward nurses, and patient safety.

Clinical relevance

Nurse managers who create a safe climate and show zero tolerance for DBs could reduce the risk of errors in care.
There is no fusion fascia in the abdomen and extraperitoneal fascia always surrounds the mesentery
Authors: Chen Shicai , Yang Guohua , Li Qiqi , Zhang Jiangyu , Yu Nanrong
Published: December 2022

Toldt's fascia has always been described as a fusion fascia formed by two layers of visceral peritoneum when the mesentery attaches to the posterior abdominal wall. However, there is still no consensus about the mesentery and its surrounding fascia based on the current anatomic theories. This study aimed to determine the anatomical structures of the abdomen and provide a correct surgical plane for mesenteric‐based surgery. Surgical videos of 121 patients who underwent laparoscopic operations of the digestive tract were reviewed to identify and compare the anatomical structures of the mesentery and associated fascia. Twenty‐one postoperative specimens were stained with hematoxylin and eosin to indicate the histological appearance of the mesentery and its surrounding fascia. Furthermore, dynamic models had been established to explain the formation mechanism of the associated histological structures in different regions during the progression of mesenteric attachment. The fasciae surrounding the mesentery, including the submesothelial connective tissue, the subserosal connective tissue, Toldt's fascia, and “angel hair,” have the same histological characteristic to extraperitoneal fascia. The general anatomical structure of the abdomen can be divided into three layers (abdominal wall, urogenital system, and digestive system) and two interlayers (transversalis fascia and extraperitoneal fascia). The extraperitoneal fascia surrounds the entire digestive system and is the natural layer separating adjacent structures from each other. Typical histological structures in the regions of posterior attachment include the fascia propria of the mesentery, mesofascial plane, extraperitoneal fascia, retrofascial plane, and anterior renal fascia. The urogenital system is surrounded by similar histological structures. There is no fusion fascia in the abdomen due to retreat of the visceral peritoneum, and all of the fasciae surrounding the mesentery are extraperitoneal fascia. This study demonstrates that the typical histological structures in the regions of attachment and mesofascial plane are the correct anatomic interface for mesenteric‐based surgery.
Risk factors for liver‐related and non‐liver‐related mortality following a sustained virological response after direct‐acting antiviral treatment for hepatitis C virus infection in a real‐world cohort
Authors: Kozuka Ritsuzo , Tamori Akihiro , Enomoto Masaru , Muto‐Yukawa Yoshimi , Odagiri Naoshi , Kotani Kohei , Motoyama Hiroyuki , Kawamura Etsushi , Hagihara Atsushi , Fujii Hideki , Uchida‐Kobayashi Sawako , Kawada Norifumi
Published: December 2022

A direct‐acting antiviral (DAA)‐induced sustained virological response (SVR) reduces the risk of mortality. However, the risk factors associated with liver‐related and non‐liver‐related mortality following a SVR after DAA treatment are unclear. We assessed the incidence and risk factors of liver‐related and non‐liver‐related mortality in 1180 patients who achieved a SVR after DAA treatment. During the follow‐up period after DAA treatment (median duration, 1099 [range: 84–2345] days), 53 (4.5%) patients died: 15 due to liver‐related mortality, 25 due to non‐liver‐related mortality and 13 due to unknown causes. The all‐cause, liver‐related and non‐liver‐related mortality rates were 14.9, 4.2 and 7.0/1000 person‐years, respectively. In a multivariate analysis, the development of hepatocellular carcinoma (HCC) after DAA treatment (p = .009; hazard ratio [HR], 31.484), an estimated glomerular filtration rate (eGFR) at baseline ≤61.68 ml/min/1.73 m2 (p = .015; HR, 6.607), and an α‐fetoprotein level post‐treatment ≥7.6 ng/ml (p = .041; HR, 18.490) were significantly associated with liver‐related mortality. Furthermore, eGFR ≤67.94 ml/min/1.73 m2 at baseline (p = .012; HR, 3.407) and albumin–bilirubin (ALBI) grade ≥ 2 at SVR (p = .024; HR, 3.449) were significantly associated with non‐liver‐related mortality. Early diagnosis and therapeutic interventions for HCC development after DAA treatment are important to reduce liver‐related mortality. The ALBI grade, which reflects the hepatic functional reserve, is a useful predictor of non‐liver‐related mortality after a SVR induced by DAA treatment. Furthermore, the renal dysfunction caused by metabolic syndrome may affect prognosis even after eliminating hepatitis C virus.
Comparing the performance of the common used eumycetoma diagnostic tests
Authors: Siddig Emmanuel Edwar , Nyuykonge Bertrand , Mhmoud Najwa Adam , Abdallah Omnia Babekir , Bahar Mustafa El Nour , Ahmed Eiman Siddig , Nyaoke Borna , Zijlstra Eduard E. , Verbon Annelies , Bakhiet Sahar Mubarak , Fahal Ahmed Hassan , van de Sande Wendy W. J.
Published: December 2022

Objectives

Mycetoma is a neglected tropical implantation disease caused by 70 different infectious agents. Identifying the causative organism to the species level is essential for appropriate patient management. Ultrasound, histopathology, culture and two species‐specific PCRs are most the commonly used methods for species identification in endemic regions. The aim of this study was to compare the diagnostic performance of these commonly used assays using sequencing of barcoding genes as the gold standard.

Methods

This descriptive cross‐sectional study was conducted at the Mycetoma Research Centre, University of Khartoum, Sudan. It included 222 patients suspected of fungal mycetoma caused by Madurella mycetomatis.

Results

154 (69.3%) were correctly identified by ultrasound, histology, culture and both species‐specific PCRs. In 60 patients, at least one of the diagnostic tests failed to identify M. mycetomatis. Five patients had no evidence of eumycetoma, and for three, only the ultrasound was indicative of mycetoma. The two species‐specific PCRs were the most sensitive and specific methods, followed by culture and histology. Ultrasound was the least specific as it only allowed differentiation between actinomycetoma and eumycetoma. The time to result was 9.38 minutes for ultrasound, 3.76 hours for PCR, 8.5 days for histopathology and 21 days for grain culturing.

Conclusion

Currently, PCR directly on DNA isolated from grains is the most rapid and reliable diagnostic tool to identify M. mycetomatis eumycetoma.
Changes in relative peripheral refraction in children who switched from single‐vision lenses to Defocus Incorporated Multiple Segments lenses
Authors: Zhang Han Yu , Lam Carly Siu Yin , Tang Wing Chun , Lee Paul H. , Tse Dennis Y. , To Chi Ho
Published: December 2022

Purpose

To investigate changes in relative peripheral refraction (RPR) associated with myopia progression in children who wore single‐vision (SV) lenses for 2 years and switched to Defocus Incorporated Multiple Segments (DIMS) lenses in the third year versus children who wore DIMS lenses for 3 years.

Methods

In the first 2 years, children were allocated randomly to wear either DIMS or SV lenses. In the third year, children in the DIMS group continued to wear these lenses, while those in the SV group were switched to DIMS lenses (Control‐to‐DIMS group). Central and peripheral refraction and axial length were monitored every 6 months.

Results

Over 3 years, the DIMS group (n = 65) showed good myopia control and maintained a relatively constant and symmetrical RPR profile without significant changes. In the first 2 years, children who wore SV lenses (n = 55) showed asymmetrical RPR changes, with significant increases in hyperopic RPR at 20° nasal (N) (mean difference: 0.88 ± 1.06 D,p < 0.0001) and 30N (mean difference: 1.07 ± 1.09 D,p < 0.0001). The Control‐to‐DIMS group showed significant myopia retardation after wearing DIMS lenses in the third year. When compared with the RPR changes in the first 2 years, significant reductions in hyperopic RPR were observed at 20N (mean difference: −1.14 ± 1.93 D,p < 0.0001) and 30N (mean difference: −1.07 ± 1.17 D,p < 0.0001) in the third year. However, no significant difference between the RPR changes found in the nasal retina and temporal retina (p > 0.05) was noted in the third year.

Conclusion

Symmetrical changes in RPR were found in children switching from SV to DIMS lenses, and a symmetrical pattern of RPR was noted in children who wore DIMS for 3 years. Myopia control using myopic defocus in the mid‐periphery influenced the RPR changes and retarded myopia progression by altering the eye's growth pattern.
Inactivation of RPX1 in Arabidopsis confers resistance to Plutella xylostella through the accumulation of the homoterpene DMNT
Authors: Chen Hongyi , Chen Chen , Huang Shijie , Zhao Mengjie , Wang Tengyue , Jiang Taoshan , Wang Chuanhong , Tao Zhen , Zhang Yan , Wang Yunhe , Wang Wanyi , Tang Qingfeng , Li Peijin
Published: December 2022

The lepidopteran crop pest Plutella xylostella causes severe constraints on Brassica cultivation. Here, we report a novel role for RPX1 (resistance to P. xylostella) in resistance to this pest in Arabidopsis thaliana. The rpx1‐1 mutant repels P. xylostella larvae, and feeding on the rpx1‐1 mutant severely damages the peritrophic matrix structure in the midgut of the larvae, thereby negatively affecting larval growth and pupation. This resistance results from the accumulation of defence compounds, including the homoterpene (3E)−4,8‐dimethyl‐1,3,7‐nonatriene (DMNT), due to the upregulation of PENTACYCLIC TRITERPENE SYNTHASE 1 (PEN1), which encodes a key DMNT biosynthetic enzyme. P. xylostella infestation and wounding induce RPX1 protein degradation, which may confer a rapid response to insect infestation. RPX1 inactivation and PEN1 overexpression are not associated with negative trade‐offs for plant growth but have much higher seed production than the wild‐type in the presence of P. xylostella infestation. This study offers a new strategy for plant molecular breeding against P. xylostella.
Donkey semen cryopreservation: Alternatives with permeable, non‐permeable cryoprotectants and seminal plasma
Authors: Montoya Páez Juan David , Úsuga Suarez Alexandra , Restrepo Betancur Giovanni
Published: December 2022

Cryopreservation of semen is an important technique to preserve genetic material. Yet, pregnancy rates in jennies after artificial insemination with frozen–thawed donkey semen are poor. This condition has been attributed to the impact of permeable cryoprotectants, that could cause high post‐breeding endometritis. Removal of seminal plasma (SP) prior to semen freezing process is another contributing factor. SP is involved in a multitude of sperm functions and events preceding fertilization and has a mediating effect of sperm capacitation and postcoital uterine inflammatory response. The aim of this study was to evaluate different alternatives in donkey semen cryopreservation with permeable, non‐permeable cryoprotectants, BSA and SP. Thirty ejaculates from 10 donkeys were cryopreserved with different combinations of dimethylformamide (DMF, 5%), sucrose (SUC, 200 mM) and homologous SP (10%): DMF (T1), DMF/SP (T2), SUC/BSA (T3), SUC/BSA/SP (T4), DMF/SUC/BSA (T5), DMF/SUC/BSA/SP (T6), DMF/BSA (T7) and DMF/BSA/SP (T8). After thawing, sperm motility and kinetics were assessed by computerized semen analysis. Sperm vitality (SV) was evaluated by fluorescence microscopy, functional membrane integrity (FMI) by the HOST test, abnormal morphology by eosin‐nigrosin staining and sperm membrane stability by flow cytometry. For statistical analysis, sperm quality indexes (SQi) were obtained, general linear models were carried out and mean comparisons were made by the Tukey test. T1, T2, T5, T6, and T7 had higher and equivalent results for motility, most kinetic parameters and function membrane integrity. Cryopreservation of donkey semen without permeable cryoprotectant (T3 and T4) showed a reduction in motility, kinetics, SV, FMI and SQi. T5 showed a reduction in progressive motility, sperm velocities, IMF and SQi compared to other DMF treatments. T6 and T8 achieved higher SQi values compared to T1, but they were not different compared to T2 and T7. T1 had a smaller sperm population with low‐M540 compared to T3. It is concluded that the use of permeable cryoprotectant is essential to achieve higher post‐thaw quality of donkey semen. In addition, the combined use of BSA, SUC and/or PS may provide additional sperm protection compared to the individual use of DMF.
Registered nurses' efforts to ensure safety for home‐dwelling older patients
Authors: Lindberg Catharina , Fock Jenni , Nilsen Per , Schildmeijer Kristina
Published: December 2022

Background

The international development of health care, an ageing population and rapid technical development mean that more care is being performed in patient homes. This care environment is often unpredictable and involves both formal and informal caregivers, making it potentially unsafe. There is sparse knowledge about how patient safety is protected in home health care in Sweden and how registered nurses work to prevent risks and promote safe care.

Aim

The aim of the study was to explore registered nurses' efforts to reduce perceived risks for home‐dwelling older patients and ensure safe home health care.

Method

We used a qualitative design with individual interviews with 13 registered nurses working in municipalities in southeast Sweden. The narratives were analysed with inductive content analysis.

Findings

The findings showed that the registered nurses tried to secure a safe care environment and took an active role in care, striving to stay one step ahead of the patient. These three types of efforts are likely interdependent, suggesting they are all needed to reduce perceived risks for home‐dwelling older patients and ensure patient safety in home health care.

Conclusions

It is a challenge for registered nurses to maintain patient safety when performing care in patient homes. Continuity of care is required and must be based not only on self‐reliance among registered nurses but also on trusting relationships with patients, next of kin, colleagues and other personnel, as well as on the development of organisational conditions adapted to patient needs.
Transcriptome sequencing reveals two subtypes of cortisol‐secreting adrenocortical tumours in dogs and identifies CYP26B1 as a potential new therapeutic target
Authors: Sanders Karin , Kooistra Hans S. , van den Heuvel Marieke , Mokry Michal , Grinwis Guy C. M. , van den Dungen Noortje A. M. , van Steenbeek Frank G. , Galac Sara
Published: December 2022

Cushing's syndrome (CS) is a serious endocrine disorder that is relatively common in dogs, but rare in humans. In ~15%–20% of cases, CS is caused by a cortisol‐secreting adrenocortical tumour (csACT). To identify differentially expressed genes that can improve prognostic predictions after surgery and represent novel treatment targets, we performed RNA sequencing on csACTs (n = 48) and normal adrenal cortices (NACs; n = 10) of dogs. A gene was declared differentially expressed when the adjusted p‐value was <.05 and the log2 fold change was >2 or < −2. Between NACs and csACTs, 98 genes were differentially expressed. Based on the principal component analysis (PCA) the csACTs were separated in two groups, of which Group 1 had significantly better survival after adrenalectomy (p = .002) than Group 2. Between csACT Group G1 and Group 2, 77 genes were differentially expressed. One of these, cytochrome P450 26B1 (CYP26B1), was significantly associated with survival in both our canine csACTs and in a publicly available data set of 33 human cortisol‐secreting adrenocortical carcinomas. In the validation cohort, CYP26B1 was also expressed significantly higher (p = .012) in canine csACTs compared with NACs. In future studies it would be interesting to determine whether CYP26B1 inhibitors could inhibit csACT growth in both dogs and humans.
Determining role of W+ ions in the densification of TiAlWN thin films grown by hybrid HiPIMS/DCMS technique with no external heating
Authors: Li Xiao , Petrov Ivan , Hultman Lars , Greczynski Grzegorz
Published: December 2022

Hybrid high-power impulse and dc magnetron co-sputtering (HiPIMS/DCMS) with substrate bias synchronized to the high mass metal-ion fluxes was previously proposed as a solution to reduce energy consumption during physical vapor deposition processing and enable coatings on temperature-sensitive substrates. In this approach, no substrate heating is used (substrate temperature is lower than 150 oC) and the thermally activated adatom mobility, necessary to grow dense films, is substituted by overlapping collision cascades induced by heavy ion bombardment and consisting predominantly of low-energy recoils. Here, we present direct evidence for the crucial role of W+ ion irradiation in the densification of Ti0.31Al0.60W0.09N films grown by the hybrid W-HiPIMS/TiAl-DCMS co-sputtering. The peak target current density Jmax on the W target is varied from 0.06 to 0.78 A/cm2 resulting in more than fivefold increase in the number of W+ ions per deposited metal atom, η = W+/(W + Al + Ti) determined by time-resolved ion mass spectrometry analyses performed at the substrate plane under conditions identical to those during film growth. The DCMS is adjusted appropriately to maintain the W content in the films constant at Ti0.31Al0.60W0.09N. The degree of porosity, assessed qualitatively from cross-sectional SEM images and quantitatively from oxygen concentration profiles as well as nanoindentation hardness, is a strong function of η(Jmax). Layers grown with low η values are porous and soft, while those deposited under conditions of high η are dense and hard. Nanoindentation hardness of Ti0.31Al0.60W0.09N films with the highest density is ∼33 GPa, which is very similar to values reported for layers deposited at much higher temperatures (420–500 oC) by conventional metal-ion-based techniques. These results prove that the hybrid HiPIMS/DCMS co-sputtering with bias pulses synchronized to high mass metal ion irradiation can be successfully used to replace conventional solutions. The large energy losses associated with heating of the entire vacuum chamber are avoided, by focusing the energy input to where it is in fact needed, i.e., the workpiece to be coated.
Efficacy and safety of abatacept to treat active birdshot uveitis: a prospective open label interventional proof-of-concept trial
Authors: Schauwvlieghe PP , Van Calster Joachim , Herbort Carl Peter , Kestelyn Philippe A , de Vlam Kurt
Published: December 2022

Background/aims

Birdshot uveitis (BU) is a chronic autoimmune posterior uveitis, mostly affecting middle-aged Caucasians. There is a strong association with HLA-A29 and T-cell activation. Safety and efficacy of abatacept, an inhibitor of T-cell costimulation, is tested in active BU.

Methods

Fifteen patients with active BU were treated with monotherapy of weekly subcutaneous injections of abatacept 125 mg/mL. Time-to-treatment failure was evaluated as a primary outcome. The secondary objective was to evaluate the utility of different outcome measures to monitor disease activity. Safety was evaluated by adverse event reporting and serial blood analyses.

Results

At the year-1 endpoint, there was significant improvement in vitreous haze grade (p=0.0014), central choroidal thickness (CCT) (p=0.0011), Fluorescein Angiography (FA) Score (p=0.0014), Indocyanine Green Angiography (ICGA) Score (p<0.001) and total dual FA-ICGA Score (p<0.001). Best corrected visual acuity (BCVA) (p=0.8354) and central retinal thickness (CRT) (p=0.3549) did not change significantly. There were no serious adverse events reported. In total, 4 out of 15 patients left the trial during year 1 of whom 2 experienced treatment failure.

Conclusions

Abatacept is very efficacious to treat both retinal vasculitis and choroiditis in patients with BU and is well tolerated. BCVA and CRT are inadequate to monitor disease activity. On the other hand, CCT is a promising non-invasive tool to detect treatment response in early active BU and dual FA-ICGA Score is very helpful to evaluate retinal vasculitis and choroiditis quantitatively.

Trial registration number

NCT03871361.
Availability and prioritisation of COVID-19 vaccines among patients with advanced chronic kidney disease and kidney failure during the height of the pandemic: a global survey by the International Society of Nephrology
Authors: Wijewickrama Eranga S , Abdul Hafidz Muhammad Iqbal , Robinson Bruce M , Johnson David W , Liew Adrian , Dreyer Gavin , Caskey Fergus J , Bello Aminu K , Zaidi Deenaz , Damster Sandrine , Salaro Silvia , Luyckx Valerie Ann , Bajpai Divya
Published: December 2022

Objective

Patients with advanced chronic kidney disease (CKD) or kidney failure receiving replacement therapy (KFRT) are highly vulnerable to COVID-19 infection, morbidity and mortality. Vaccination is effective, but access differs around the world. We aimed to ascertain the availability, readiness and prioritisation of COVID-19 vaccines for this group of patients globally.

Setting and participants

Collaborators from the International Society of Nephrology (ISN), Dialysis Outcomes and Practice Patterns Study and ISN-Global Kidney Health Atlas developed an online survey that was administered electronically to key nephrology leaders in 174 countries between 2 July and 4 August 2021.

Results

Survey responses were received from 99 of 174 countries from all 10 ISN regions, among which 88/174 (50%) were complete. At least one vaccine was available in 96/99 (97%) countries. In 71% of the countries surveyed, patients on dialysis were prioritised for vaccination, followed by patients living with a kidney transplant (KT) (62%) and stage 4/5 CKD (51%). Healthcare workers were the most common high priority group for vaccination. At least 50% of patients receiving in-centre haemodialysis, peritoneal dialysis or KT were estimated to have completed vaccination at the time of the survey in 55%, 64% and 51% of countries, respectively. At least 50% of patients in all three patient groups had been vaccinated in >70% of high-income countries and in 100% of respondent countries in Western Europe.

The most common barriers to vaccination of patients were vaccine hesitancy (74%), vaccine shortages (61%) and mass vaccine distribution challenges (48%). These were reported more in low-income and lower middle-income countries compared with high-income countries.

Conclusion

Patients with advanced CKD or KFRT were prioritised in COVID-19 vaccination in most countries. Multiple barriers led to substantial variability in the successful achievement of COVID-19 vaccination across the world, with high-income countries achieving the most access and success.
Collaboration and coordination of health and care services for older people with dementia by multidisciplinary health and care providers: a scoping review protocol
Authors: Österholm Johannes , Nedlund Ann-Charlotte , Larsson Ranada Åsa
Published: December 2022

Introduction

Collaboration and coordination of health and care services are key to catering for the diverse needs of a growing population of older people with dementia. When multidisciplinary health and care providers work together, they have the possibility to use resources in a fair, accurate and effective way and thereby do the right thing, at the right time, for the right individual. The aim of this scoping review is to map how different care-providing agencies collaborate and coordinate health and care services for older people with dementia.

Methods and analysis

A scoping review will be carried out following the proposed methodology by Joanna Briggs Institute and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Systematic searches will be carried out in scientific databases. Studies published within the last 10 years will be included based on certain eligibility criteria. All included studies will be critically appraised using the Research Pyramid. Data from included studies will be charted and subjected to content analysis.

Ethics and dissemination

Ethics approval is not required for scoping reviews. The dissemination of findings will be conducted through conference presentations and publication in international scientific journals.
Factors influencing the integration of self-management in daily life routines in chronic conditions: a scoping review of qualitative evidence
Authors: Qama Enxhi , Rubinelli Sara , Diviani Nicola
Published: December 2022

Objective

Self-management of chronic diseases is regarded as dynamic experience which is always evolving and that requires constant adjustment. As unexpected and new shifts in diseases occur, patients tend to abandon acquired behaviours calling into question their sustainability over time. Developing a daily self-management routine as a response to lifestyle changes is considered to facilitate self-management performance. However, fitting self-management recommendations in one’s daily life activities is a constant challenge. In this review, we describe the performance of self-management routines within daily settings in people living with chronic conditions with the aim of identifying factors that challenge its integration in daily life.

Design

Scoping review.

Data sources

We searched PubMed, Web of Science, CINAHL and PsycINFO on February 2022.

Eligibility criteria

We included qualitative studies on self-management experience, in English, with adult participants, original and peer-reviewed, and depicting the performance of self-management activities in one’s own environment.

Data extraction and synthesis

Two reviewers independently screened titles and abstracts. After agreement, one reviewer screened the full text of relevant articles and extracted the data. The data were synthesised and analysed thematically. PRISMA Extension for Scoping Reviews checklist was used for reporting the steps.

Results

Twenty-two studies were included. The thematic analysis brought up two overreaching themes. The first one is the Environment support with three subthemes: family and cultural norms; health professionals and guiding communication; and society and disease perceptions. The second theme is comprehension gap with two subthemes: reading the body and applying information.

Conclusions

The integration of self-management requirements in a daily routine is affected by the patients’ inability to apply disease knowledge in different context and by the challenge of understanding body symptoms and predicting body reactions in advance.
Non-clinical uses of antipsychotics in resource-constrained long-term care facilities: ethically justifiable as lesser of two evils?
Authors: Soofi Hojjat
Published: December 2022

Residents with dementia in long-term care facilities (LTCFs) often receive antipsychotic (AP) medications without clear clinical indications. One non-clinical factor influencing the use of APs in LTCFs is low staff levels. Often, using APs is viewed and rationalised by healthcare professionals in LTCFs as a lesser evil option to manage low staff levels. This paper investigates the ethical plausibility of using APs as a lesser of two evils in resource-constrained LTCFs. I examine the practice vis-à-vis the three frequently invoked conditions of lesser evil justifications as specified in the wider philosophical literature. These conditions include (1) the necessity condition, (2) the condition of sensitivity to both deontic (ie, constraint-based) and non-deontic (ie, outcome-based) considerations and (3) the commensurability condition. I argue that there are considerable difficulties in demonstrating that the practice in question satisfies the conditions of lesser evil justifications. In particular, there are major difficulties in satisfying the condition of sensitivity to deontic and outcome-based considerations, and the commensurability condition. I also argue that the current philosophical debate on lesser-evil justifications is not straightforwardly applicable to the practice of using APs for non-clinical purposes in LTCFs. I contend that caregivers are not so-called ‘generic’ agents, and the assumed rarity of lesser evil cases is questionable. I conclude that until further work is done to resolve these issues, the lesser evil reasoning cannot be, at least routinely, used to formulate robust moral justifications for the practice in question.
The Jew’s penis: circumcision and sexual pathology in eighteenth-century England
Authors: Gallagher Noelle
Published: December 2022

This essay explores the contradictory, prejudicial attitudes towards circumcision and Jewish male sexuality circulating in eighteenth-century English print culture. I argue that while Jewish men had long been accused of lustfulness, effeminacy and sexual deviance, eighteenth-century culture added to these concerns a unique interest in sexual pathology, borne in part from the growing medical anxiety around venereal disease. Consequently, while Jewish men were still widely condemned for their lechery, they were also increasingly ridiculed for a range of penile and sexual disorders that were believed to make sex unsatisfying, difficult or even impossible—most notably impotence, a condition often associated with venereal disease. I link these paradoxical eighteenth-century characterisations of Jewish male sexuality with a similarly paradoxical understanding of circumcision as a procedure that could prevent, but also cause, various penile or sexual disorders. I conclude that these prejudices not only constitute an example of what Sander Gilman has identified as the ‘bipolar’ nature of anti-Semitism; they also indicate a darker trend towards the pathologising of the Jewish body.
Empirical Bioethics and the Health ‘Brain-Drain’: a qualitative study of the experiential and ethical landscape of compulsory community service for a group of South African doctors
Authors: Gardiner Caitlin Victoria
Published: December 2022

The health ‘brain drain’ (HBD) is an issue of significant global bioethical concern, resulting in severe maldistribution of healthcare workers (HCWs) and gross inequities in health service provision. The ethics of the HBD and its possible mitigation strategies are, however, complex and areas of active ongoing bioethical debate. South Africa faces a dire and worsening HBD crisis, and use a mitigation strategy of compulsory community service, or ‘comserve’, for most HCWs. While there is some literature on HCWs’ comserve experiences and the various ‘push and pull’ factors affecting their migratory decisions, there is a notable gap regarding their personal values, beliefs and ethics regarding the HBD and comserve, which, as this research supports, play a prominent role in migratory decisions. This empirical bioethics research aims to explore this among a group of South African doctors who recently completed comserve, as well as how their experiences affected their situation on the individualist-collectivist continuum. This was done qualitatively using semistructured interviews with 11 participants and analysed using reflexive thematic analysis under a methodology of critical realism. Themes identified were ‘Special Duties’; ‘Freedom and Autonomy’; ‘Justice and Accountability’; and ‘The Individualist-Collectivist Continuum’. Participants use a variety of ethical theories to discuss the HBD and oppose or support comserve, which play a significant role in their migratory decisions. Most find the policy to be theoretically ethically justifiable but note that procedures undermine this. There are also several factors that appear to affect participants’ position on the individualist-collectivist continuum, with some paradoxical effects on the HBD.
Contribution of sexual health services to hepatitis B detection and control (Netherlands, 2008–2016)
Authors: Raven Stijn , Hautvast Jeannine , Yiek Wing-Kee , Veldhuijzen Irene , van Steenbergen Jim , van Aar Fleur , Hoebe Christian J P A
Published: December 2022

Objectives

Case finding is one of the priority actions to reduce the disease burden of chronic hepatitis B (CHB). We estimated the contribution of CHB case finding at sexual health centres (SHCs) to the total national number of newly diagnosed CHB cases in the Netherlands and determined the characteristics of CHB cases detected at SHCs.

Methods

This observational study used surveillance data from all outpatient SHCs in the Netherlands (SOAP database) and the number of CHB from national notification data (Osiris) from 2008 to 2016. The proportion of CHB notifications (hepatitis B surface antigen positive serology) detected at SHCs was calculated. SHC consultations without hepatitis B virus (HBV) testing (n=669 308), with acute hepatitis B diagnosis (n=73), with HBV vaccination only (n=182) or an inconclusive hepatitis B diagnosis (n=24) were excluded. Univariable and multivariable logistic regression analyses were performed, stratified by gender and sexual preference, to analyse patient characteristics associated with CHB.

Results

During the study period, 12 149 CHB cases were notified. 405 646 SHC consultations were included in the analysis and 1452 CHB cases (0.4%) were detected at SHCs. The proportion of CHB cases detected at SHCs in relation to the national notified number ranged between 12.4% (200 of 1613) in 2008 and 10.8% (106 of 980) in 2016. 87% of CHB cases were among first-generation migrants (FGMs) originating from high endemic countries for sexually transmitted infections or men who have sex with men (MSM). In multivariable analysis, an older age category, migration background and being a commercial sex worker (CSW) were associated with CHB in all stratified analyses.

Conclusions

The contribution of SHCs is relevant to case finding of CHB in the Netherlands. SHCs should therefore be considered as an important health setting to screen for HBV in high-risk groups, especially among MSM, CSW and FGM, to achieve a reduction in the HBV-related disease burden.
New benchmark models for heavy neutral lepton searches
Authors: Drewes M. , Klarić J. , López-Pavón J.
Published: December 2022

The sensitivity of direct searches for heavy neutral leptons (HNLs) in accelerator-based experiments depends strongly on the particles properties. Commonly used benchmark scenarios are important to ensure comparability and consistency between experimental searches, re-interpretations, and sensitivity studies for different facilities. In models where the HNLs are primarily produced and decay through the weak interaction, benchmarks are in particular defined by fixing the relative strengths of their mixing with SM neutrinos of different flavours, and the interpretation of experimental data is known to strongly depend on those ratios. The commonly used benchmarks in which a single HNL flavour exclusively interacts with one Standard Model generation do not reflect what is found in realistic neutrino mass models. We identify two additional benchmarks for accelerator-based direct HNL searches, which we primarily select based on the requirement to provide a better approximation for the phenomenology of realistic neutrino mass models in view of present and future neutrino oscillation data.