bluuebunny/crossref_metadata_2025 huggingface dataset:
Value of smartphone videos for diagnosis of seizures: Everyone owns half an epilepsy monitoring unit
Authors: Amin Ushtar , Primiani Christopher T. , MacIver Stephanie , Rivera‐Cruz Angélica , Frontera Alfred T. , Benbadis Selim R.
Published: July 2021

The diagnosis of epilepsy is primarily based on the history and the verbal description of the events in question. Smartphone videos are increasingly used to assist in the diagnosis. The purpose of this study is to evaluate their value for the diagnosis of seizures. We prospectively collected smartphone videos from patients who presented to our epilepsy center over two years. The video‐based diagnosis was then compared to the eventual diagnosis based on video‐electroencephalographic (EEG) monitoring with recorded episodes. Video‐EEG studies and smartphone videos were reviewed by two separate physicians, each blinded to the other's interpretation. Fifty‐four patients were included in the final analysis (mean age = 34.7 years, SD = 17 years). Data (either smartphone video or video‐EEG monitoring) were inconclusive in 18 patients. Of the 36 patients with conclusive data, 34 (94%) were in agreement. Smartphone video interpretation can be a useful adjunctive tool in the diagnosis of seizure‐like events.
Trophic and non‐trophic effects of fish and macroinvertebrates on carbon emissions
Authors: Colina Maite , Meerhoff Mariana , Pérez Germán , Veraart Annelies J. , Bodelier Paul , van der Horst Antoon , Kosten Sarian
Published: July 2021

Shallow aquatic systems exchange large amounts of carbon dioxide (CO2) and methane (CH4) with the atmosphere. The production and consumption of both gases is determined by the interplay between abiotic (such as oxygen availability) and biotic (such as community structure and trophic interactions) factors.

Fish communities play a key role in driving carbon fluxes in benthic and pelagic habitats. Previous studies indicate that trophic interactions in the water column, as well as in the benthic zone can strongly affect aquatic CO2 and CH4 net emissions. However, the overall effect of fish on both pelagic and benthic processes remains largely unresolved, representing the main focus of our experimental study.

We evaluated the effects of benthic and pelagic fish on zooplankton and macroinvertebrates; on CO2 and CH4 diffusion and ebullition, as well as on CH4 production and oxidation, using a full‐factorial aquarium experiment. We compared five treatments: absence of fish (control); permanent presence of benthivorous fish (common carps, benthic) or zooplanktivorous fish (sticklebacks, pelagic); and intermittent presence of carps or sticklebacks.

We found trophic and non‐trophic effects of fish on CO2 and CH4 emissions. Intermittent presence of benthivorous fish promoted a short‐term increase in CH4 ebullition, probably due to the physical disturbance of the sediment. As CH4 ebullition was the major contributor to the total greenhouse gas (GHG) emissions, incidental bioturbation by benthivorous fish was a key factor triggering total carbon emissions from our aquariums.

Trophic effects impacted GHG dynamics in different ways in the water column and the sediment. Fish predation on zooplankton led to a top‐down trophic cascade effect on methane‐oxidising bacteria. This effect was, however, not strong enough as to substantially alter CH4 diffusion rates. Top‐down trophic effects of zooplanktivorous and benthivorous fish on benthic macroinvertebrates, however, were more pronounced. Continuous fish predation reduced benthic macroinvertebrates biomass decreasing the oxygen penetration depth, which in turn strongly reduced water–atmosphere CO2 fluxes while it increased CH4 emission.

Our work shows that fish can strongly impact GHG production and consumption processes as well as emission pathways, through trophic and non‐trophic effects. Furthermore, our findings suggest their impact on benthic organisms is an important factor regulating carbon (CO2 and CH4) emissions.
Influence of bunch maturation and chemical precursors on acrylamide formation in starchy banana chips
Authors: Udomkun Patchimaporn , Swennen Rony , Masso Cargele , Innawong Bhundit , Fotso Kuate Apollin , Alakonya Amos , Vanlauwe Bernard
Published: July 2021

The present study investigated the effect of ripening stages and chemical precursors on acrylamide formation in deep‐fried chips of five plantains and one cooking banana. The highest level of acrylamide was found in the cooking banana, followed by False Horn plantain and French plantain, respectively. French plantain hybrids exhibited a significantly lower (P < 0.05) level of acrylamide when compared to French plantain. The ripening stage demonstrated a positive Pearson correlation (P < 0.05, r = 0.57) with acrylamide formation. As ripening progressed, the levels of glucose and fructose significantly increased (P < 0.05) and showed a positive correlation with acrylamide formation (r = 0.85 and 0.96, respectively). The level of the amino acid asparagine during ripening was not correlated with acrylamide formation. In contrast, the level of histidine, arginine, iso‐leucine and cystine during ripening was positively correlated (P < 0.05, r > 0.60) with acrylamide formation in fried chips. The higher level of TP was significantly related (P < 0.05) to the lower level of acrylamide (r = −0.62). The reduced levels of carotenoid isomers, except lutein, during fruit ripening were positively correlated (P < 0.05) with acrylamide formation, especially trans‐BC (r = 0.72) and 9‐cis‐BC(r = 0.64).
Origin and transit migration of Afghans and Syrians to Germany: The influential actors and factors behind the destination choice
Authors: Torfa Masooma , Almohamed Salwa , Birner Regina
Published: July 2021

We use Process Net‐Maps to visualize the irregular migration patterns of refugees and identify influential actors/factors shaping their decisions. A qualitative case study was used that included 87 Afghan and Syrian refugees (52 individual in‐depth interviews and 35 participants in five focus group discussions) residing in Stuttgart, Germany. Results show a typical pattern for respondents to first migrate to a neighboring country, and then a mixture of decisive factors induce them to migrate onward. The perspective of refugees in the destination country covers the migration processes between transit and destination countries which is vital information for the stakeholders in international migration management, and policy developments on asylum migration, integration and repatriation.
Strengthening boron carbide by doping Si into grain boundaries
Authors: Shen Yidi , Yang Moon Young , Goddard William A. , An Qi
Published: July 2021

Grain boundaries, ubiquitous in real materials, play an important role in the mechanical properties of ceramics. Using boron carbide as a typical superhard but brittle material under hypervelocity impact, we report atomistic reactive molecular dynamics simulations using the ReaxFF reactive force field fitted to quantum mechanics to examine grain‐boundary engineering strategies aimed at improving the mechanical properties. In particular, we examine the dynamical mechanical response of two grain‐boundary models with or without doped Si as a function of finite shear deformation. Our simulations show that doping Si into the grain boundary significantly increases the shear strength and stress threshold for amorphization and failure for both grain‐boundary structures. These results provide validation of our suggestions that Si doping provides a promising approach to mitigate amorphous band formation and failure in superhard boron carbide.
Life Interrupted: Experiences of adolescents, young adults and their family living with malignant melanoma
Authors: McInally Wendy , Gray‐Brunton Carol , Chouliara Zoe , Kyle Richard G.
Published: July 2021

Aim

Melanoma is one of the most common human malignancies; yet, it is often thought of as a disease of adulthood rather than one affecting adolescents and young adults. This study sought to understand the experiences of adolescents, young adults and their family living with malignant melanoma.

Design

A qualitative study using Interpretive Phenomenological Analysis, through a multi‐perspective design.

Methods

Data collection was conducted between January and August 2018 in each participant's Primary Care Centre when they were attending for an outpatient appointment. Each young person and a nominated family member were interviewed (n = 10) either individually (n = 4) or as a dyad (n = 6) according to their personal choice. In‐depth semi‐structured interviews were conducted and audio‐recorded with the participant's consent. Interview data were transcribed verbatim and analysed.

Findings

The metanarrative ‘Life Interrupted’ was the core conceptual thread woven throughout the findings. It represents the interconnections and interrelationships between the adolescent or young adult and their family. Being able to recognize the disease and seek support was challenging with often limited physical, emotional or social support resulting in feelings of fear and isolation. Four super‐ordinate themes were identified: (a) ‘Is it Serious’, (b) ‘Too Much too Young’, (c) ‘Not the Same’ and (d) ‘Time to Live’.

Conclusions

With the rising incidence of MM in the adolescents and young adults population globally, there are demands to improve healthcare professionals and nurse's knowledge and understanding of MM. As young people with MM experience their journey outside specialist cancer services, the care delivery for this patient group and their families require stronger links between services.

Impact

This study will inform the improvement of care delivery for MM in order that this patient group is provided with the same access to service delivery as other adolescents and young adults with cancer.
Being an older nurse or midwife in the healthcare workplace– A qualitative descriptive study
Authors: Denton Julie , Evans David , Xu Qunyan
Published: July 2021

Aim

To explore the experiences of being an older nurse or midwife employed in the healthcare workplace.

Design

A qualitative descriptive study.

Method

Semi‐structured interviews were conducted with nurses and midwives who self‐identified as older workers. All Australian states were represented and given recruitment was undertaken nationally, most interviews were conducted via telephone. Data were collected between November 2018 and October 2019. Audio recordings were transcribed verbatim and then thematically analysed.

Results

A total of 50 nurses and midwives were recruited, aged between 46 and 74 years. Three themes were identified. Ageing body: Being an older worker meant increased fatigue and physical changes affecting their ability to function at full capacity. Youth focus: For many, being an older worker was about being viewed as a poor‐quality worker, with limited access to education and promotional opportunities because of their age. Wise worker: For a small number of older nurses and midwives, it was about being valued and respected for their knowledge, experience and skills.

Conclusion

Participants self‐identifying as older nurses or midwives represented a wide age range. Spanning across the age spectrum, many experienced fatigue, physical changes or loss of value to the workplace which often impacted on their working lives. The findings contributed to an understanding about what it is to be an older nurse or midwife in terms of how their contribution is regarded and valued by others in the workplace.

Impact

This study highlighted there is a need for support of older nurses and midwives in managing age‐related fatigue and physical changes. It also suggests consideration of a wise‐worker model as a means to recognize the important contribution that older workers can offer.
Late dislodgement of left bundle branch pacing lead and successful extraction
Authors: Ponnusamy Shunmuga Sundaram , Vijayaraman Pugazhendhi
Published: July 2021

A 61‐years‐old male underwent left bundle branch pacing for nonischemic dilated cardiomyopathy with recurrent heart failure. Left bundle branch pacing (LBBP) resulted in reduction in QRS duration along with improvement in left ventricular ejection fraction (LVEF) to 64% during follow‐up. Two years after implantation he had recurrence of symptoms along with decline in LVEF to 51%. Late lead dislodgement was diagnosed and re‐do LBBP was planned. The lead was extracted en‐masse without complication and a new 3830 lead was positioned deep inside the proximal septum to capture the left bundle. Postprocedure echocardiography showed no ventricular septal defect or damage to tricuspid leaflet.
When amputation is not the end of the challenge: A successful therapy for osteomyelitis and soft tissue infection in a patient with type 1 diabetes
Authors: Caruso Paola , Gicchino Maurizio , Longo Miriam , Scappaticcio Lorenzo , Campitiello Ferdinando , Esposito Katherine
Published: July 2021

Infection is a common complication in patients with diabetic foot ulcer, leading to lower extremities amputation and healing failure. In this article, we report the case of a 39‐year‐old man with diabetes who developed a severe soft tissue infection and osteomyelitis after experiencing a major amputation for wet gangrene of both the foot and the ankle.
Mitochondrial haplogroups have a better correlation to insulin requirement than nuclear genetic variants for type 2 diabetes mellitus in Taiwanese individuals
Authors: Shen Feng‐Chih , Weng Shao‐Wen , Tsai Meng‐Han , Su Yu‐Jih , Li Sung‐Chou , Chang Shun‐Jen , Chen Jung‐Fu , Chang Yen‐Hsiang , Liou Chia‐Wei , Lin Tsu‐Kung , Chuang Jiin‐Haur , Lin Ching‐Yi , Wang Pei‐Wen
Published: July 2021

Aims/Introduction

Identifying diabetes‐susceptible genetic variants will help to provide personalized therapy for the management of type 2 diabetes. Previous studies have reported a genetic risk score (GRS), computed by the sum of nuclear DNA (nDNA) risk alleles, that may predict the future requirement for insulin therapy. Although mitochondrial dysfunction has a close association with insulin resistance (IR), there are few studies investigating whether genetic variants of mitochondrial DNA (mtDNA) will affect the clinical characteristics of type 2 diabetes.

Materials and Methods

Mitochondrial haplogroups were determined using mtDNA whole genome next generation sequencing and 13 single nucleotide polymorphisms (SNPs) in nDNA susceptibility loci of 13 genes in 604 Taiwanese subjects with type 2 diabetes. A GRS of nDNA was computed by summation of the number of risk alleles. The correlation between the mtDNA haplogroup and the clinical characteristics of type 2 diabetes was assessed by logistic regression analysis. The results were compared with the GRS subgroups for the risk of insulin requirement.

Results

Mitochondrial haplogroups modulate the clinical characteristics of type 2 diabetes, in which patients harboring haplogroup D4, compared with those harboring non‐D4 haplotypes, were less prone to require insulin treatment, after adjusting for age, gender, and diabetes duration. However, there was no association between insulin requirement and GRS calculated from nuclear genetic variants.

Conclusions

Mitochondrial haplogroups, but not nuclear genetic variants, have a better association with the insulin requirement. The results highlight the role of mitochondria in the management of common metabolic diseases.
A comprehensive biochemical characterization of settlement stage leptocephalus larvae of bonefish (Albula vulpes)
Authors: Uribe Victoria , Wills Paul S. , Shenker Jon M. , Adams Aaron J. , Mejri Sahar
Published: July 2021

Little is known about early development of the near‐threatened bonefish (Albula vulpes), a member of superorder Elopomorpha. Members of Elopomorpha are partially defined by their synapomorphic leptocephalus larval stage, for which the nutritional requirements are not well understood. Characterizing the nutritional profile, including major nutrients (such as lipids) used for energetic processes, can help to gain a better understanding of the nutritional requirements for leptocephalus larvae. A total of 24 settlement stage A. vulpes leptocephalus larvae were collected at Long Caye Island, Belize. Samples were used to determine various biochemical characteristics including lipid class, fatty acid and glycosaminoglycan compositions. Each of these biochemical components plays a role in early developmental processes such as cellular membrane formation and is crucial for healthy development. Biochemical characteristics of settlement stage A. vulpes leptocephalus are presented in this study for the first time. The dominant lipid classes and fatty acids detected in these samples were consistent with prior studies using closely related species like the Japanese eel, indicating possible similarities in diets at this stage. In the future, similar analyses can be applied to other species that share the leptocephalus life stage to determine if nutritional requirements at this stage of development are unique to this species. The findings in this study will also help to facilitate the establishment of adequate aquaculture systems for captive bonefish, ultimately leading to improved management strategies for wild bonefish habitats.
Enhancing knowledge on low‐value fishing species: the distinct reproductive strategy of two gurnard species
Authors: Neves Ana , Sousa Inês , Sequeira Vera , Vieira Ana Rita , Silva Elisabete , Silva Frederica , Duarte Ana Marta , Mendes Susana , Ganhão Rui , Assis Carlos , Rebelo Rui , Magalhães Maria Filomena , Gil Maria Manuel , Gordo Leonel Serrano
Published: July 2021

The depletion and overexploitation of several fish stock demands for a valorisation of non‐target and discarded species. Nonetheless, such species are often poorly studied, and information on their biological parameters must be gathered for effective population management. For 1 year, the reproductive strategy of the piper gurnard Trigla lyra and the red gurnard Chelidonichthys cuculus was studied by monthly samples obtained from commercial boats operating on western Portuguese coast. Both species showed a biased sex ratio towards females, especially for larger length classes. Length at first maturity could be estimated only for red gurnard (22.1 and 19.9 cm for females and males, respectively) because all piper gurnard individuals caught were mature. Piper gurnard showed determinate fecundity and a short spawning season, from November to February with a peak in January, whereas red gurnard showed indeterminate fecundity and a wide spawning season, from late December to May. The relative annual fecundity estimated for red gurnard (1893 ± 728 oocytes × g−1 eviscerated weight [EW]) was higher than the one estimated for piper gurnard (1018 ± 250 oocytes×g−1 EW). Although important information for understanding the species dynamics is presented in this study, additional information on other life‐history parameters and of species landings is required.
Impact of dementia: Health disparities, population trends, care interventions, and economic costs
Authors: Aranda María P. , Kremer Ian N. , Hinton Ladson , Zissimopoulos Julie , Whitmer Rachel A. , Hummel Cynthia Huling , Trejo Laura , Fabius Chanee
Published: July 2021

Introduction

The dementia experience is not a monolithic phenomenon—and while core elements of dementia are considered universal—people living with dementia experience the disorder differently. Understanding the patterning of Alzheimer's disease and related dementias (ADRD) in the population with regards to incidence, risk factors, impacts on dementia care, and economic costs associated with ADRD can provide clues to target risk and protective factors for all populations as well as addressing health disparities.

Methods

We discuss information presented at the 2020 National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers, Theme 1: Impact of Dementia. In this article, we describe select population trends, care interventions, and economic impacts, health disparities and implications for future research from the perspective of our diverse panel comprised of academic stakeholders, and persons living with dementia, and care partners.

Results

Dementia incidence is decreasing yet the advances in population health are uneven. Studies examining the educational, geographic and race/ethnic distribution of ADRD have identified clear disparities. Disparities in health and healthcare may be amplified by significant gaps in the evidence base for pharmacological and non‐pharmacological interventions. The economic costs for persons living with dementia and the value of family care partners' time are high, and may persist into future generations.

Conclusions

Significant research gaps remain. Ensuring that ADRD healthcare services and long‐term care services and supports are accessible, affordable, and effective for all segments of our population is essential for health equity. Policy‐level interventions are in short supply to redress broad unmet needs and systemic sources of disparities. Whole of society challenges demand research producing whole of society solutions. The urgency, complexity, and scale merit a “whole of government” approach involving collaboration across numerous federal agencies.
Antecedent infections inGuillain‐Barrésyndrome patients from south India
Authors: Dutta Debprasad , Debnath Monojit , Nagappa Madhu , Das Sumit Kumar , Wahatule Rahul , Sinha Sanjib , Taly Arun B. , Ravi Vasanthapuram
Published: July 2021

Guillain‐Barré syndrome (GBS) is the commonest post‐infectious inflammatory peripheral neuropathy with undiscerned aetiology. The commonly reported antecedent infections implicated in India includeCampylobacter jejuni, chikungunya, dengue, and Japanese encephalitis (JE). In this study from south India, we investigated the role of these four agents in triggering GBS. This case‐control study was performed on 150 treatment‐naive patients with GBS and 150 age and sex‐matched controls from the same community. IgM immunoreactivity forC. jejuni, chikungunya, and dengue was detected by enzyme‐linked immunosorbent assay (ELISA) in serum of patients with GBS and control subjects. Immunoreactivity against JE was detected in serum as well as cerebrospinal fluid (CSF) from patients (n = 150) and orthopaedic control (n = 45) subjects. The immunoreactivity against infections was compared between demyelinating and axonal subtypes of GBS. Overall, 119/150 patients with GBS had serological evidence of antecedent infection. Amongst those with evidence of antecedent infection, 24 (16%), 8 (5%), and 9 (6%) patients were exclusively immunoreactive to chikungunya, JE, andC. jejuni, respectively. In the remaining patients (78/119), immunoreactivity to multiple pathogens was noted. Immunoreactivity toC. jejuniinfection was found in 32% of GBS patients compared to 2.7% controls (P < .001), whereas to chikungunya virus was reported in 66.7% of patients with GBS compared to 44.7% controls (P = .006). Anti‐dengue immunoreactivity was significantly associated with the demyelinating subtype of GBS. Patients positive for JE IgM (CSF) manifested demyelinating electrophysiology. In this large case‐control study, immunoreactivity against multiple infectious agents was observed in a subset of patients. Chikungunya was the commonest antecedent infection, followed byC. jejuni.
Changes in the avascular area of the meniscus using mesenchymal stem cells and growth plate chondrocytes in a pig model
Authors: Tomaszewski Ryszard , Rost‐Roszkowska Magdalena , Wilczek Grażyna , Gap Artur , Wiktor Łukasz
Published: July 2021

Menisci are wedge‐shaped cartilage discs that are divided into two parts: the avascular and vascular regions. They are formed by fibrocartilage tissue, which contains round cartilage‐like cells and extracellular matrix. Meniscus injury in animals is a common orthopedic problem, but data on the natural healing process mainly deals with the vascular zone. The healing processes in the avascular zone of the meniscus are significantly limited. Thus, this study aimed to evaluate autologous growth plate chondrocytes' impact on the healing process of a damaged meniscus in the avascular zone based on a growing animal model. The study group consisted of 10 pigs at about three months of age. From each animal, chondrocytes from the iliac growth plate and from concentrated bone marrow were taken. Knee joints were divided into right (R) and left (L). The medial meniscus of the R knee joint was treated with a hyaluronic acid based scaffold incubated with bone marrow cells from marrow aspirates (nCHON). The medial meniscus of the L knee joint was treated with a hyaluronic acid based scaffold incubated with bone marrow cells from marrow aspirates supplemented with immature chondrocytes isolated from growth plates (wCHON). The meniscus was damaged in the avascular zone in both knee joints. Followingly, the damaged part of the meniscus was filled with a scaffold with cells from the concentrated bone marrow and from growth plate chondrocytes. In the control group, a scaffold with concentrated bone marrow cells was used. After three months the animals were euthanized and preparations (microscopic slides) were made from the meniscus' damaged part. A qualitative and quantitative analysis have been prepared. The wCHON group in comparison with the nCHON group showed a statistically significantly higher number of fusiform cells on the surface of the graft as well as better healing of the graft. In addition, the degree of vascularization was higher in specimens from the wCHON group than in the nCHON group. The results of our research on immature pig knees revealed that mesenchymal stem cell and growth plate chondrocytes could be treated as the cell source for meniscus reconstruction, and growth plate chondrocytes enhance healing processes in the avascular zone of the injured meniscus.
Target‐Specific Sandwich Technique: Facial rejuvenation leveraging CPM technology
Authors: Lim Tingsong , Frank Konstantin , Hadjab Basste
Published: July 2021

Injectable rejuvenation treatments used in Caucasians might not always suit Asians as the visible signs of aging manifest differently, underscoring a need for Asian‐specific strategies that correct underlying structural deficiencies and cumulative age‐related changes. The presented Target‐Specific Sandwich Technique (TSST) aims to simultaneously restore, rejuvenate, and enhance faces through the distribution of minute amounts of different fillers with different rheologies, using a minimal number of entry points in strategic facial areas and different soft tissue layers in Asians.

A total of 14 patients underwent the presented TSST and were subsequently assessed for satisfaction with the treatment and the outcome of the treatment.

With 3 cc of fillers, patients experienced a rejuvenated appearance with brow support, brow ridge softening, less severe nasolabial folds, and corrected tear trough hollows. Fillers in the lateral canthal and mandibular angles lifted mouth corners, improved submandibular jowls, and defined the lower face. Although the prejowl sulcus received minimal filler, it appeared subtler, relaxed, and had fewer lines visible while smiling.

Overall, patients appeared less tense, rejuvenated, and had improved light reflection and firmer skin. These were due to tissues being supported upward and laterally by fillers in areas of bone resorption–induced volume loss.
COVID‐19 preparedness in aged care: A qualitative study exploring residential aged care facility managers experiences planning for a pandemic
Authors: Sunner Carla , Giles Michelle , Parker Vicki , Kable Ashley , Foureur Maralyn
Published: July 2021

Aims and Objectives

The study aims to understand the changing context of RACFs and the role of RACF managers in preparing to confront the COVID‐19 pandemic and to provide insights into how the use of visual telehealth consultation might be incorporated to assist with managing whatever might arise.

Design

An interpretive descriptive study design was employed, and data were collected using semi‐structured interviews conducted via telephone or videoconference. Purposive recruitment targeted clinical managers responsible for the COVID‐19 response in RACFs.

Methods

RACF clinical managers were invited to discuss their responses to COVID‐19 including the management of RACF and staff. Semi‐structured interviews explored the COVID‐19‐related challenges, the response to these challenges and how telehealth might assist in overcoming some of these challenges. This study followed Thorne's (2008) three‐stage process of interpretive description. The COREQ checklist was used in preparing this manuscript.

Results

Two main themes were identified. The first theme ‘keeping people safe’ was comprised of three subthemes; fear and uncertainty, managing the risks and retaining and recruiting staff. The second theme was ‘keeping people connected’, had two subthemes; being disconnected and isolated and embracing technology.

Conclusion

Findings from this study provide valuable insight into understanding the context and the challenges for RACFs and the staff as they attempt to keep residents safe and connected with healthcare providers and the outside world.

Relevance to Clinical Practice

Understanding the experiences of RACF managers in preparing to respond to the pandemic will better inform practice development in aged care in particular the use of telehealth and safe practices during COVID‐19. Increased awareness of the challenges faced by RACFs during a pandemic provides policymakers with valuable insights for future planning of pandemic responses.
Non‐pharmacological interventions for pain management in patients with dementia: A mixed‐methods systematic review
Authors: Bao Zhuming , Landers Margaret
Published: July 2021

Aims and objectives

To systematically identify, summarise and compare evidence from studies related to the non‐pharmacological interventions used to manage pain in patients with dementia. Secondly, this study aims to provide evidence on the effectiveness of non‐pharmacological interventions used to manage pain in patients with dementia.

Background

The number of people diagnosed with dementia is rising rapidly in the context of ageing. Pain is considered to be one of the most common neuropsychiatric symptoms of dementia. To date, little research has focused on non‐pharmacological interventions to manage pain in patients with dementia. Therefore, a systematic review on the non‐pharmacological interventions used to manage pain in patients with dementia and how effective these interventions are, is warranted.

Method

The extensive search strategy included electronic database searches for CINAHL, MEDLINE and PsycINFO from January 2009 to February 2020. A mixed‐methods systematic review was undertaken in accordance with the PRISMA statement and relevant papers were chosen based on inclusion criteria and quality assessment measures. Eligibility criteria defined the characteristics of inclusion studies using the PICO framework. Results were extracted to a synthesis table. The quality appraisal was conducted using JBI and CASP checklist.

Results

Eight studies met the inclusion criteria. These included six randomised controlled trials, one quasi‐experimental study and one qualitative descriptive study. The current review identified various non‐pharmacological interventions for pain management in patients with dementia including singing, painting, massage, ear acupressure, play activities program and robot. The most common intervention was massage while the most effective intervention was play activities program. All studies provided evidence that non‐pharmacological interventions have an effect on pain management in patients with dementia or that there was a tendency for non‐pharmacological intervention to reduce pain in patients with dementia. Overall, the quality of the included studies was interpreted as strong (n = 8).

Conclusions

Overall, interactive pharmacological interventions were more effective than non‐interactive non‐pharmacological interventions. While this review highlighted a limited number of studies investigating the use of non‐pharmacological interventions to manage pain in patients with dementia, it did however uncover a range of non‐pharmacological interventions used to manage pain in these patients along with their level of effectiveness.

Relevance to clinical practice

Further research is required to explore which non‐pharmacological interventions are most effective in the management of pain in patients with varying degrees of cognitive impairment. Further qualitative research is also needed to explore nurses' views on the use of non‐pharmacological interventions to manage pain in patients with dementia.
Maternal serum calprotectin level in intrahepatic cholestasis of pregnancy
Authors: Agaoglu Recep Taha , Celik Ozge Yucel , Yakut Kadriye , Celen Sevki , Caglar Ali Turhan
Published: July 2021

Aim

This study aimed to investigate maternal serum levels of calprotectin in patients with intrahepatic cholestasis of pregnancy (ICP) and to compare these with serum calprotectin levels in healthy pregnant women.

Methods

Ninety pregnant women (ICP group, n = 45; healthy control group, n = 45) were included in the study. The gestational age and body mass index of the participants in the two groups were similar. This prospective cross‐sectional study was conducted between November 2019 and May 2020 in the perinatology department of University of Health Sciences Doctor Zekai Tahir Burak Women's Education Hospital, Ankara, Turkey. Patients were recruited from those attending the perinatology outpatient and inpatient clinics. Biochemical (alanine aminotransferase (ALT), aspartate transaminase (AST), lactate dehydrogenase (LDH), total bilirubin), fasting bile acid, hemogram, and calprotectin parameters of maternal blood were evaluated.

Results

The mean fasting bile acid value in the ICP group was 30.3 ± 27.3 μmol, with severe ICP present in 11 (24.4%) patients. ALT, AST, LDH, total bilirubin, and mean platelet volume (MPV) values in the ICP group were higher and the red cell distribution width (RDW) value was lower than those in the control group (p < 0.001). The mean serum calprotectin levels in the control group and ICP group were 48.0 ± 10.4 and 765.4 ± 126.8 μg, respectively (p < 0.001). There was no significant correlation between serum fasting bile acid levels and serum calprotectin levels in the ICP group (p > 0.005).

Conclusion

Serum levels of calprotectin in patients with ICP were higher than those in healthy pregnant women. The serum calprotectin level may be an important diagnostic marker of ICP.
Maternal deaths due to COVID‐19 disease: The cases in a single center pandemic hospital in the south east of Turkey
Authors: Bağlı İhsan , Öcal Ece , Yavuz Mustafa , Uzundere Osman , Bozkurt Fatma
Published: July 2021

Coronavirus‐19 disease is still a pandemic health problem and uncertainty in the management of severe or critically ill pregnant women confuses continually the obstetricians. The nationwide maternal mortality rate due to covid‐19 still has not been presented in any study in Turkey. The study includes four maternal mortality cases in a referral single pandemic center in our country. Case 1, a 34‐year‐old, 34 weeks of gestation with moderate disease. The cesarean section was performed due to nonreassuring nonstress tests. She died on the postpartum seventh day. Case 2, a 37‐year‐old, at 36 weeks of gestation. The symptoms consisted of dry cough, shortness of breath and labor pain, and 3 cm cervical opening. Her second cesarean section was performed and she died at postpartum ninth day. Case 3, 33 years old, 33 weeks of gestation with moderate/severe stage of the disease. A few days after the treatment, CS was performed due to her severe condition and she died at postpartum 15th day. Case 4, 39 years old, 35 weeks of gestation, she was at a severe stage of the disease. On the second day after the treatment, CS was performed due to her severe condition and she died at postpartum seventh day. The postpartum period after cesarean section should be followed cautiously under the appropriate treatment of the COVID‐19 disease. Unfortunately, the reason for this rapid deterioration which we observed in our cases is not well known and appropriate medications and algorithms should be established as soon as possible.
Quantitative sensory testing of mandibular somatosensory function following orthognathic surgery—A pilot study in Chinese with class III malocclusion
Authors: He Jiayi , Chen Xin , Yuan Hua , Zhang Ping , Jiang Hongbing , Wang Kelun , Svensson Peter
Published: July 2021

Background

Somatosensory changes after sagittal split ramus osteotomy (SSRO) have not been fully studied in Chinese patients by the latest technologies.

Objective

To provide a comprehensive analysis of somatosensory function at the lower lip and chin at different time points following SSRO in a Chinese population.

Methods

A total of 22 patients (18–27 years; nine men) with skeletal III malocclusion and scheduled for SSRO were recruited. Quantitative sensory testing (QST) was performed at pre‐operation (baseline), 1 week (1W), 1, 3 and 6 months (1M, 3M, 6M) post‐operatively. Cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), mechanical detection threshold (MDT), mechanical pain threshold (MPT), pressure pain threshold (PPT) and two‐point discrimination threshold (2PD) were tested at the lower lip and chin.

Results

Except for PPT at both test sides at 1W and 1M, all QST values indicated a significantly reduced sensitivity (p < .05). All values had returned to baseline values at 3M with exception of HPT at the right chin which, however, had recovered at 6M (p > .05).

Conclusions

Somatosensory function at the lower lip and chin appears to be fully recovered in the majority of young Chinese adults 6 months after SSRO for skeletal class III malocclusion.
Portfolio diversification and model uncertainty: A robust dynamic mean‐variance approach
Authors: Pham Huyên , Wei Xiaoli , Zhou Chao
Published: July 2021

This paper focuses on a dynamic multi‐asset mean‐variance portfolio selection problem under model uncertainty. We develop a continuous time framework for taking into account ambiguity aversion about both expected return rates and correlation matrix of the assets, and for studying the join effects on portfolio diversification. The dynamic setting allows us to consider time varying ambiguity sets, which include the cases where the drift and correlation are estimated on a rolling window of historical data or when the investor takes into account learning on the ambiguity. In this context, we prove a general separation principle for the associated robust control problem, which allows us to reduce the determination of the optimal dynamic strategy to the parametric computation of the minimal risk premium function. Our results provide a justification for under‐diversification, as documented in empirical studies and in the static models. Furthermore, we explicitly quantify the degree of under‐diversification in terms of correlation bounds and Sharpe ratios proximities, and emphasize the different features induced by drift and correlation ambiguity. In particular, we show that an investor with a poor confidence in the expected return estimation does not hold any risky asset, and on the other hand, trades only one risky asset when the level of ambiguity on correlation matrix is large. We also provide a complete picture of the diversification for the optimal robust portfolio in the three‐asset case.
Interbank lending with benchmark rates: Pareto optima for a class of singular control games
Authors: Cont Rama , Guo Xin , Xu Renyuan
Published: July 2021

We analyze a class of stochastic differential games of singular control, motivated by the study of a dynamic model of interbank lending with benchmark rates. We describe Pareto optima for this game and show how they may be achieved through the intervention of a regulator, whose policy is a solution to a singular stochastic control problem. Pareto optima are characterized in terms of the solutions to a new class of Skorokhod problems with piecewise‐continuous free boundary. Pareto optimal policies are shown to correspond to the enforcement of endogenous bounds on interbank lending rates. Analytical comparison between Pareto optima and Nash equilibria provides insight into the impact of regulatory intervention on the stability of interbank rates.
Primary central nervous system lymphomas with massive intratumoral hemorrhage: Clinical, radiological, pathological, and molecular features of six cases
Authors: Yamada Seiji , Muto Jun , Iba Sachiko , Shiogama Kazuya , Tsuyuki Yuta , Satou Akira , Ohba Shigeo , Murayama Kazuhiro , Sugita Yasuo , Nakamura Shigeo , Yokoo Hideaki , Tomita Akihiro , Hirose Yuichi , Tsukamoto Tetsuya , Abe Masato
Published: July 2021

Primary central nervous system lymphomas (PCNSLs) rarely exhibit intratumoral hemorrhage. The differential diagnosis of hemorrhagic neoplasms of the central nervous system (CNS) currently includes metastatic carcinomas, melanomas, choriocarcinomas, oligodendrogliomas, and glioblastomas. Here we present the clinical, radiological, pathological, and molecular genetic features of six cases of PCNSL associated with intratumoral hemorrhage. The median age of patients was 75 years, with male predominance. While conventional PCNSLs were associated with low cerebral blood volume (CBV), perfusion magnetic resonance imaging (MRI) revealed elevated CBV in three cases, consistent with vascular proliferation. All six cases were diagnosed pathologically as having diffuse large B‐cell lymphoma (DLBCL) with a non‐germinal center B‐cell‐like (non‐GCB) phenotype; marked histiocytic infiltrates and abundant non‐neoplastic T‐cells were observed in most cases. Expression of vascular endothelial growth factor and CD105 in the lymphoma cells and the small vessels, respectively, suggested angiogenesis within the neoplasms. Neoplastic cells were immunohistochemically negative for programmed cell death ligand 1 (PD‐L1), while immune cells in the microenvironment were positive for PD‐L1. Mutations in the MYD88 gene (MYD88) (L265P) and the CD79B gene (CD79B) were detected in five and one case, respectively. As therapeutic modalities used for PCNSLs differ from those that target conventional hemorrhagic neoplasms, full tissue diagnoses of all hemorrhagic CNS tumors are clearly warranted.
Narrative diaries in the paediatric intensive care unit: A thematic analysis
Authors: Sansone Vincenza , Cancani Federica , Gagliardi Chiara , Satta Tiziana , Cecchetti Corrado , de Ranieri Cristiana , Di Nardo Matteo , Rossi Angela , Dall'Oglio Immacolata , Alvaro Rosaria , Tiozzo Emanuela , Gawronski Orsola
Published: July 2021

Background

The paediatric intensive care unit (PICU) diary is a shared tool, kept at the patient bedside, written by relatives and health care providers. There is little evidence about its feasibility and how it supports the families of children admitted to the PICU. Currently, there is no evidence about how the PICU diary is used and what we can learn from it.

Aim

To explore the contents of narrative PICU diaries in an Italian PICU.

Study design

Qualitative study of PICU diaries conducted with a narrative research approach.

Methods

Children sedated and mechanically ventilated for >48 hours were enrolled in a six‐bed Italian PICU of a tertiary care paediatric hospital. During the child's PICU admission, caregivers, relatives, friends, and health care providers were invited to report events, thoughts, and messages, and attach drawings/pictures for the child in the PICU diary. A thematic analysis of the PICU diary contents was performed.

Results

Thirteen PICU diaries were completed between August and December 2020, mainly by parents (n = 95; 45%) and health care providers (n = 52; 25%). Three main themes emerged: “Social and spiritual support,” “Caregiver's emotions, feelings and distress,” and “PICU life.” Diaries offer insight into caregivers' emotions, social support, clinical activities, and interactions with health care providers, and on progression towards recovery.

Conclusion

PICU diaries are valuable in facilitating family‐centred care by providing a space for the written account of the child's admission by parents, other visitors, and health care providers.

Relevance to clinical practice

PICU diaries support the relationship and the communication between the family and the team; they provide an informal account of the emotions and needs of parents that has the potential to improve mutual understanding and family‐centred care. Social support and spiritual support are key elements reported by parents for coping with their child's PICU admission.
Association analysis of SNPs in GRHL3, FAF1, and KCNJ2 with NSCPO sub‐phenotypes in Han Chinese
Authors: Sun Jia‐Lin , Shi Jia‐Yu , Yin Bin , Lin Yan‐Song , Shi Bing , Jia Zhong‐Lin
Published: July 2021

Objectives

Non‐syndromic cleft palate only (NSCPO) is a common congenital deformity with complex etiologies. GRHL3, FAF1, and KCNJ2 have been reported to be involved in the pathogenesis of NSCPO. Up till now, there have been no replication studies based on large Han Chinese. Therefore, this study aimed to investigate associations between GRHL3, FAF1, KCNJ2, and NSCPO sub‐phenotypes patients in Han Chinese.

Materials and Methods

Firstly, we selected 2 SNPs based on previous literatures: FAF1 (rs3827730) and GRHL3 (rs41268753). Also, we selected 8 tagSNPs in GRHL3 (rs557811, rs609352, rs10903078, rs6659209, rs12401714, rs12568599, rs3887581, rs12024148) and 2 tagSNPs in KCNJ2 (rs75855040 and rs236514). Afterward, we evaluated these SNPs among 1668 NSCPO patients and 1811 normal controls from Han Chinese. Following data were analyzed by PLINK and Haploview program.

Results

Association analysis under additive model showed that allele A at rs12568599 in GRHL3 gene is significantly associated with NSCPO (p = 0.0034, OR = 1.38 and 95%CI: 1.11–1.72) and its sub‐phenotype incomplete cleft palate (ICP) (p = 0.0039, OR = 1.4 and 95%CI: 1.11–1.75), and it could increase the risk of both NSCPO and ICP.

Conclusions

This study firstly found that rs12568599 in GRHL3 is associated with NSCPO and ICP in Han Chinese, indicating that sub‐phenotypes of NSCPO have different etiologies.
Target‐setting, political incentives, and the tricky trade‐off between economic development and environmental protection
Authors: Du Juan , Yi Hongtao
Published: July 2021

Disentangling the relationship between economic development and environmental protection has attracted much attention from public administration scholars. While traditionally scholars approach the relationship from either a substitutive or a complementary perspective, we offer a nuanced perspective by examining how the target‐setting on economic growth shapes environmental performance. This article proposes an explanation for the impacts of gross domestic product growth targets on environmental performance based on a yardstick competition model, where the upper‐level governments use relative performance to create competition among lower‐level governments. We argue that a trade‐off exists between economic development and environmental performance; however, the substitutive relationship tends to transit to a complementary relationship when environmental performance is incorporated into the cadre evaluation system. Analyzing a panel dataset of economic targets and PM2.5 air pollution across Chinese cities from 2001 to 2010, we confirm the relationship between economic targets and environmental performance by highlighting local leaders' political incentives.