bluuebunny/crossref_metadata_2025 huggingface dataset:
Time use of parents raising children with severe or profound intellectual and multiple disabilities
Authors: Luijkx J. , van der Putten A. A. J. , Vlaskamp C.
Published: February 2017

Background

Raising children with severe or profound intellectual and multiple disabilities (PIMD) is expected to put extreme pressure on parental time use patterns. The aim of this study was to examine the total time use of mothers and fathers raising children with PIMD and compare it with the time use of parents of typically developing children.

Method

Twenty‐seven fathers and 30 mothers raising children with PIMD completed a time use diary on a mobile phone or tablet app, as did 66 fathers and 109 mothers of typically developing children. Independent t‐tests and Mann–Whitney tests were performed to compare mean time use.

Results

There are no differences in the time use of parents of children with PIMD on contracted time (paid work and educational activities) and necessary time (personal care, eating and drinking and sleeping) when compared with parents of typically developing children. There are significant differences between the parents of children with PIMD and the parents of typically developing children in terms of committed time (time for domestic work and the care and supervision of their children) and free time. The mothers of children with PIMD spend significantly less time on domestic work and more time on care and supervision than mothers of typically developing children.

Conclusions

This study shows that the parents of children with PIMD have to spend a significant amount of time on care tasks and have on average 1.5 h less free time per day than parents of typically developing children. This is a striking difference, because leisure time can substantially contribute to well‐being. Therefore, it is important not only to consider a child with PIMD's support needs but also to identify what parents need to continue their children's daily care and supervision.
Endoscopic ultrasound‐guided celiac plexus block and neurolysis
Authors: Yasuda Ichiro , Wang Hsiu‐Po
Published: February 2017

Endoscopic ultrasound‐guided celiac plexus neurolysis (EUS‐CPN) is widely used for reducing pain originating from upper abdominal organs. It is mainly indicated to treat pancreatic cancer pain, but also to relieve pain as a result of chronic pancreatitis. Real‐time guidance and color Doppler imaging by EUS made the procedure easier and safer, resulting in greater pain relief. Currently, two techniques are used for EUS‐CPN. The classic approach, known as the central technique, involves injection of a neurolytic agent at the base of the celiac axis. In the bilateral technique, the neurolytic agent is injected on both sides of the celiac axis. In addition, EUS‐guided direct celiac ganglia neurolysis (EUS‐CGN) was introduced recently. Pain relief is achieved by EUS‐CPN in 70–80% of patients with pancreatic cancer and in 50–60% of those with chronic pancreatitis. The bilateral technique may be more efficient than the central technique, although the central technique is easier and possibly safer. Moreover, EUS‐CGN may provide greater pain relief than conventional EUS‐CPN. Procedure‐related complications include transient pain exacerbation, transient hypotension, transient diarrhea, and inebriation. Although most complications are not serious, major adverse events such as retroperitoneal bleeding, abscess, and ischemic complications occasionally occur.
Learning across languages: bilingual experience supports dual language statistical word segmentation
Authors: Antovich Dylan M. , Graf Estes Katharine
Published: February 2017

Bilingual acquisition presents learning challenges beyond those found in monolingual environments, including the need to segment speech in two languages. Infants may use statistical cues, such as syllable‐level transitional probabilities, to segment words from fluent speech. In the present study we assessed monolingual and bilingual 14‐month‐olds’ abilities to segment two artificial languages using transitional probability cues. In Experiment 1, monolingual infants successfully segmented the speech streams when the languages were presented individually. However, monolinguals did not segment the same language stimuli when they were presented together in interleaved segments, mimicking the language switches inherent to bilingual speech. To assess the effect of real‐world bilingual experience on dual language speech segmentation, Experiment 2 tested infants with regular exposure to two languages using the same interleaved language stimuli as Experiment 1. The bilingual infants in Experiment 2 successfully segmented the languages, indicating that early exposure to two languages supports infants’ abilities to segment dual language speech using transitional probability cues. These findings support the notion that early bilingual exposure prepares infants to navigate challenging aspects of dual language environments as they begin to acquire two languages.
Scriptaid enhances skeletal muscle insulin action and cardiac function in obese mice
Authors: Gaur Vidhi , Connor Timothy , Venardos Kylie , Henstridge Darren C. , Martin Sheree D. , Swinton Courtney , Morrison Shona , Aston‐Mourney Kathryn , Gehrig Stefan M. , van Ewijk Roelof , Lynch Gordon S. , Febbraio Mark A. , Steinberg Gregory R. , Hargreaves Mark , Walder Ken R. , McGee Sean L.
Published: February 2017

Aim

To determine the effect of Scriptaid, a compound that can replicate aspects of the exercise adaptive response through disruption of the class IIa histone deacetylase (HDAC) corepressor complex, on muscle insulin action in obesity.

Materials and methods

Diet‐induced obese mice were administered Scriptaid (1 mg/kg) via daily intraperitoneal injection for 4 weeks. Whole‐body and skeletal muscle metabolic phenotyping of mice was performed, in addition to echocardiography, to assess cardiac morphology and function.

Results

Scriptaid treatment had no effect on body weight or composition, but did increase energy expenditure, supported by increased lipid oxidation, while food intake was also increased. Scriptaid enhanced the expression of oxidative genes and proteins, increased fatty acid oxidation and reduced triglycerides and diacylglycerides in skeletal muscle. Furthermore, ex vivo insulin‐stimulated glucose uptake by skeletal muscle was enhanced. Surprisingly, heart weight was reduced in Scriptaid‐treated mice and was associated with enhanced expression of genes involved in oxidative metabolism in the heart. Scriptaid also improved indices of both diastolic and systolic cardiac function.

Conclusion

These data show that pharmacological targeting of the class IIa HDAC corepressor complex with Scriptaid could be used to enhance muscle insulin action and cardiac function in obesity.
Thermal tolerance of Liothrips tractabilis, a biological control agent of Campuloclinium macrocephalum recently established in South Africa
Authors: Ramanand Hiresh , McConnachie Andrew J. , Olckers Terence
Published: January 2017

The South American herb Campuloclinium macrocephalum (Less.) DC. (Asteraceae; pompom weed), which invades grasslands, savannas, and wetlands in South Africa, is a recent target for biological control. A foliage‐deforming thrips, Liothrips tractabilis Mound & Pereyra (Thysanoptera: Phlaeothripidae), was released in South Africa in 2013, following confirmation of its host specificity and damage potential in quarantine. However, weed biocontrol agents sometimes fail to establish or have the desired impact because they are poorly suited to the climate of the new range. Thermal tolerance trials, within the range of 15–32.5 °C, were conducted prior to the thrips’ release to determine its developmental threshold and to generate a degree‐day model to highlight areas best suited for its establishment in South Africa. These laboratory data were validated by outdoor trials. The thrips completed development from egg to adulthood at all except the lowest and highest laboratory test temperatures, with developmental duration decreasing with increasing temperature. The lower developmental threshold was estimated at 9.6 °C with 546.9 degree days required to complete development. Within the regions invaded by C. macrocephalum in South Africa, the thrips was predicted to complete 3–9 annual generations. Developmental times in the outdoor trials were largely consistent with those in the laboratory. Liothrips tractabilis is largely compatible with the broader South African climate and seems likely to establish and proliferate on C. macrocephalum populations throughout the country. These predictions have partially been verified in that L. tractabilis has become established at several sites in South Africa, many of these in colder, high‐altitude areas which were predicted to support fewer annual generations.
Aspiration and dysphagia screening in acute stroke – the Gugging Swallowing Screen revisited
Authors: Warnecke T. , Im S. , Kaiser C. , Hamacher C. , Oelenberg S. , Dziewas R.
Published: February 2017

Background and purpose

The Gugging Swallowing Screen (GUSS) is a tool to screen aspiration risk in acute stroke. We aimed to replicate its validity in a larger second cohort of patients with acute stroke, including the more severe with a National Institutes of Health Stroke Scale (NIHSS) ≥ 15.

Methods

In a prospective, double‐blind design, the GUSS was validated with the Fiberoptic Endoscopic Evaluation of Swallowing scale. Patients were categorized into different stroke severities as assessed by the NIHSS, and the diagnostic properties were calculated separately for each subgroup.

Results

A total of 100 patients with acute stroke were evaluated consecutively at a mean 1.7 ± 2.2 days after stroke. With the GUSS cut‐off value of 14 points, the GUSS screened aspiration risk with a 96.5% sensitivity and 55.8% specificity (area under the curve, 0.76; 95% CI, 0.67–0.84), which corresponded well with the original publication. In the NIHSS < 5 group, the sensitivity and specificity levels were 71.4% and 88.8%, respectively. In the NIHSS ≥ 15 group, these levels changed to 100% and 20%, respectively. The high failure rate in completing the first part of the GUSS in the latter group was related to the low specificity. Diet recommendations following the GUSS were more conservative than those after Fiberoptic Endoscopic Evaluation of Swallowing. In particular, the GUSS overestimated the need for nasogastric tube feeding.

Conclusions

This is the first time that a swallowing screening tool for patients with acute stroke has been revalidated in a larger population from another stroke center. The validity of a swallow screening test may vary according to different stroke severities.
Excessive angiogenesis associated with psoriasis as a cause for cardiovascular ischaemia
Authors: Malecic Nina , Young Helen S.
Published: February 2017

Psoriasis, a common disease affecting 2%‐3% of the UK population, produces significant impairment of quality of life and is an immense burden on sufferers and their families. Psoriasis is associated with significant cardiovascular comorbidity and the metabolic syndrome. Angiogenesis, a relatively under‐researched component of psoriasis, is a key factor in pathogenesis of psoriasis and also contributes to the development of atherosclerosis. Vascular endothelial growth factor (VEGF) is a well‐established mediator of pathological angiogenesis which is upregulated in psoriasis. It is possible that, in patients with psoriasis, cutaneous angiogenesis may be both a marker for systemic vascular pathology and a novel therapeutic target. In this viewpoint study, the role of VEGF‐mediated angiogenesis as a cause for cardiovascular events in patients with psoriasis is explored.
Fisher's preferences and trade‐offs between management options
Authors: Fitzpatrick Mike , Maravelias Christos D , Eigaard Ole Ritzau , Hynes Stephen , Reid David
Published: February 2017

Failure to understand the potential responses of fishers to management measures creates a significant risk of revisiting the familiar scenario of perverse and unintended consequences of those measures. This paper reports on a choice experiment survey to evaluate fisher's preferences for various management measures proposed under the EU Common Fisheries Policy (CFP) reform process, but the conclusions have wider relevance as similar measures are used by comparable fleets in fisheries globally. The survey was conducted with fishers involved in mixed pelagic and demersal fisheries in Ireland, pelagic fisheries in Denmark and demersal fisheries in Greece. Fisheries management policies were characterized by five attributes designed both to cover the principal CFP reform proposals and to integrate ecological, social, economic and institutional factors affecting fisher's decisions. The study uses a random utility modelling framework to reveal the preferences of the fishers across the alternative policy attributes. Results show that while there are generally preferences both for healthy stocks and for maintaining the importance of fishing to the local community, strong interfishery preference differences exist. These differences are most notable in relation to a discard ban and to the use of individual transferable fishing rights, favoured in Denmark, but not in Ireland for instance. The strength of these interfishery differences supports the assertion that there are no panaceas in fisheries management and that solutions should be tailored within the context of specific fisheries. Not doing so could create a significant risk of inappropriately managed fisheries that may lead to unsustainable outcomes.
Exploring connectivity between spawning and nursery areas of Mullus barbatus (L., 1758) in the Mediterranean through a dispersal model
Authors: Gargano Francesco , Garofalo Germana , Fiorentino Fabio
Published: February 2017

Connectivity between spawning and nursery areas plays a major role in determining the spatial structure of fish populations and the boundaries of stock units. Here, the potential effects of surface current on a red mullet population in the Central Mediterranean were simulated using a physical oceanographic model. Red mullet larvae were represented as Lagrangian drifters released in known spawning areas of the Strait of Sicily (SoS), which represents one of the most productive demersal fishing‐grounds of the Mediterranean. To consider the effect of inter‐annual variability of oceanographic patterns, numerical simulations were performed for the spawning seasons from 1999 to 2012. The main goal was to explore connectivity between population subunits, in terms of spawning and nursery areas, inhabiting the northern (Sicilian‐Maltese) and southern (African) continental shelves of the SoS. The numerical simulations revealed a certain degree of connectivity between the Sicilian–Maltese and the African sides of the SoS. Connectivity is present in both directions, but it is stronger from the Sicilian–Maltese spawning areas to the African nurseries owing to the marine circulation features of the region. However, because the majority of the larvae are transported to areas unsuitable for settlement or outside the SoS, the dispersal process is characterized by a strong loss of potential settlers born in the spawning areas. These results are in agreement with the low genetic heterogeneity reported for this species in the Mediterranean Sea and support the existence of a metapopulation structure of red mullet in the SoS and the adjacent areas.
Role of the MT1 and MT2 melatonin receptors in mediating depressive‐ and anxiety‐like behaviors in C3H/HeN mice
Authors: Liu J. , Clough S. J. , Dubocovich M. L.
Published: February 2017

Melatonin is a neurohormone primarily synthesized by the pineal gland following a circadian rhythm with a high level during the night and a low level during the day. Alterations in the synthesis and secretion of melatonin have been reported in various mood disorders, including major depressive disorder. However, the role of endogenous melatonin in the pathophysiology of depressive disorder is unclear. Melatonin primarily acts through two G protein‐coupled receptors, termed MT1 and MT2. The present study investigated the effect of genetic deletion of the MT1 and/or MT2 receptors on tests associated with depression‐ and anxiety‐like behaviors in C3H/HeN mice. Deletion of the MT1 and/or MT2 receptors caused a deficit in hedonic and social interaction behavior, and increased anxiety‐like behavior. It is likely that dysregulations of the MT1 and/or MT2 melatonin receptors could be involved in the pathophysiology of depression and anxiety.
Trade‐offs in arthropod conservation between productive and non‐productive agri‐environmental schemes along a landscape complexity gradient
Authors: Mader Viktoria , Diehl Eva , Fiedler Daniela , Thorn Simon , Wolters Volkmar , Birkhofer Klaus
Published: February 2017

Productive and non‐productive agri‐environmental schemes (AES) were developed to support farmland biodiversity. This study compares arthropod predators between productive (organic farming) and non‐productive (sown flowering fields) AES along a landscape complexity gradient.

We compared species richness, community composition and community weighted mean body sizes of 12 306 carabids and 4868 spiders in organically managed cereal fields and flowering fields along a landscape complexity gradient. These data were used to evaluate the conservation success of different AES types for a number of exclusive species, financial incentives and benefits for farmers.

Carabids only responded to the AES type and their communities had higher species richness in flowering fields. Spider species richness increased with landscape complexity. Community composition differed between AES types for all predator groups, with the composition of ground‐dwelling spiders being additionally affected by landscape complexity. The mean body size of web‐building spiders decreased with landscape complexity and the mean body size of female spiders was larger in flowering fields.

Both AES types can contribute to the conservation of predator communities. Species richness increased with non‐productive AES. Agrobiont species occurred more frequently in productive AES. The overall number of exclusive predator species was lower in flowering fields.

We emphasise that there is an additive effect of establishing productive and non‐productive AES within the landscape, and a diverse mosaic of different AES types holds the greatest potential to provide a large regional species pool of arthropod predators, while simultaneously guaranteeing financial benefits for farmers from production and subsidies.
Mental health nursing: Daring to be different, special and leading recovery‐focused care?
Authors: Santangelo Peter , Procter Nicholas , Fassett Denise
Published: February 2017

How mental health nursing is differentiated from other disciplines and professions, and what special contribution mental health nurses make to health services, is a question at the heart of contemporary practice. One of the significant challenges for mental health nurses is identifying, developing and advancing those aspects of their practice that they consider differentiate them in the multi‐disciplinary mental health care team and to articulate clearly what a mental health nurse is and does. This paper draws on data from interviews with 36 mental health nurses in Australia who identified their practice as autonomous. Participants were asked the question, “What's special about mental health nursing?” Constructivist grounded theory techniques were applied to the research process. Findings were formulated and expressed as the ‘Ten P's of the professional profile that is mental health nursing’, which are ‘present’, ‘personal’, ‘participant partnering’, ‘professional’, ‘phenomenological’, ‘pragmatic’, ‘power‐sharing’, ‘psycho‐therapeutic’, ‘proud’ and ‘profound’. The combined elements of the findings present a theoretical construct of mental health nursing practice as something distinctive and special. It provides a model and exemplar for contemporary practice in mental health nursing, embracing the role of mental health nurses in the health care workforce as being well placed as providers of productive and effective care.
Functional changes of neural circuits in stroke patients with dysphagia: A meta‐analysis
Authors: Liu Lu , Xiao Yuan , Zhang Wenjing , Yao Li , Gao Xin , Chandan Shah , Lui Su
Published: February 2017

Objective

Dysphagia is a common problem in stroke patients with unclear pathogenesis. Several recent functional magnetic resonance imaging (fMRI) studies had been carried out to explore the cerebral functional changes in dysphagic stroke patients. The aim of this study was to analysis these imaging findings using a meta‐analysis.

Methods

We used seed‐based d mapping (SDM) to conduct a meta‐analysis for dysphagic stroke patients prior to any kind of special treatment for dysphagia. A systematic search was conducted for the relevant studies. SDM meta‐analysis method was used to examine regions of increased and decreased functional activation between dysphagic stroke patients and healthy controls.

Results

Finally, six studies including 81 stroke patients with dysphagia and 78 healthy controls met the inclusion standards. When compared with healthy controls, stroke patients with dysphagia showed hyperactivation in left cingulate gyrus, left precentral gyrus and right posterior cingulate gyrus, and hypoactivation in right cuneus and left middle frontal gyrus.

Conclusions

The hyperactivity of precentral gyrus is crucial in stroke patients with dysphagia and may be associated with the severity of stroke. Besides the motor areas, the default‐mode network regions (DMN) and affective network regions (AN) circuits are also involved in dysphagia after stroke.
Indicators for assessing quality of drug use: A systematic literature review
Authors: Song Jie , Zhang Lingli , Li Youping , Zeng Linan , Hu Die , Liang Yi , Liu Dan
Published: February 2017

Objective

We searched and described existing drug‐related indicators, and provided helps for using indicators for quality assessment of drug use and developing new indicators.

Methods

We searched 8 databases and 41 official WebPages of national pharmaceutical administration department or academic organizations to obtain literature on drug‐related indicators. Researchers extracted data including basic information (countries, issue time et al.), target population, categories, and various characters of indicators. We finally conducted a descriptive analysis to summarize these indicators.

Results

A total of 3598 literatures were retrieved, 39 of which were finally included. a) A total of 876 indicators were identified. Of which, 9.5% were structure indicator, 83.6% were process indicator and 6.9% were outcome indicator. b) Evaluation dimensions of indicators could be summarized as prescribing quality, patients' experience, pharmacy administration, drug‐therapy process and cost. c) In included indicator sets, 9 were developed for specific drug, 7 were for specific disease and 6 were for specific population. d) Instructions of indicator sets were identified. 7 terms of instructions were included such as rationale, prerequisite and definition of indicators.

Conclusions

Most study suggest that prescribing quality is an essential dimension and process indicator was greatly considered in drug use evaluation. Drug‐related indicators for general adults were relatively well‐developed. There was an urgent need for investigation of drug use indicators for children and pregnant women.
US Physician and Midwife Adherence to Active Management of the Third Stage of Labor International Recommendations
Authors: Schorn Mavis N. , Dietrich Mary S. , Donaghey Beth , Minnick Ann F.
Published: January 2017

Introduction

The prevalence of postpartum hemorrhage has increased in the United States despite the international promotion of active management of the third stage of labor. Adherence to the international recommendations in the United States is unclear. It is also not known how the components of active management are related to other practices that may be used during the third stage of labor. The purpose of this study was to determine routine practice patterns for managing the third stage of labor in the United States.

Methods

A randomized national survey was conducted of certified nurse‐midwives/certified midwives, certified professional midwives, obstetricians, and family physicians who self‐reported third‐stage practices. Descriptive analyses and partial correlations were used to determine differences in practice patterns between midwives and physicians. A 2‐step clustering algorithm was used to identify clusters of third‐stage practices.

Results

A total of 1243 clinicians responded. Uterine massage after placenta expulsion was reportedly used at almost every birth by all provider types. Median use of cord traction and oxytocin administration by all provider types was 80% and 90% of births, respectively. Cluster analysis of these and other interventions used during the third stage of labor revealed 4 distinct clusters of practices ranging from primarily a hands‐off at one extreme to high‐intervention approaches at the other extreme. The other 2 clusters were defined by practices that fell between those extremes.

Discussion

Determination of how, and under what conditions, clinicians decide when to use particular techniques to manage the third stage of labor and how these techniques influence the incidence of postpartum hemorrhage, is necessary. The clusters of practice combinations that emerged in this study suggest that there are extreme variations in clinician practices during management of the third stage of labor.
Assessment of skin pigmentation by confocal microscopy: Influence of solar exposure and protection habits on cutaneous hyperchromias
Authors: Martini Ana Paula M , Mercurio Daiane G , Maia Campos Patrícia M B G
Published: February 2017

Background

Cutaneous hyperchromias are disorders of skin pigmentation involving an increase of melanin production and its irregular accumulation in skin cells. It is known that the use of sunscreens helps to prevent changes in the skin pigmentation pattern, but the structural and morphological alterations that occur in the different types of hyperpigmentations need better elucidation.

Objective

To assess the influence of solar exposure and protection habits on the pattern of skin pigmentation using reflectance confocal microscopy (RCM).

Methods

Forty volunteers aged 18‐39 years with skin hyperpigmentation participated in the study. Skin characterization was performed by imaging techniques and by assessing the habits of solar exposure and protection by applying questionnaires to the volunteers. RCM was used to record sequences of confocal sections at areas of interest and to examine cell shape and brightness in the basal cell layer of the lesion and in normal perilesional skin. Furthermore, high‐resolution images were obtained for analysis of the spots.

Results

Sunlight influences the number and location of spots as the face of volunteers with higher solar exposure was covered with spots, whereas volunteers with less exposure had fewer spots located in the nose and cheeks region due to greater exposure of these areas to the sun.

Conclusion

The data showed the importance of sun protection for preventing changes in the pattern of skin pigmentation, and RCM proved to be an important tool for skin characterization.
Hedging Longevity Risk in Life Settlements Using Biomedical Research‐Backed Obligations
Authors: MacMinn Richard D. , Zhu Nan
Published: February 2017

In the life settlement market, mortality risk is transferred from life insurance policyholders to third‐party life settlement firms. This risk transfer occurs in conjunction with an information transfer that is relevant not only for pricing, but also for risk management. In this analysis, we compare the efficiency of two different hedging instruments in managing the mortality risk of the life settlement firm. First, we claim and then demonstrate that conventional longevity‐linked securities do not perform as effectively in the secondary life market, that is, life settlement market, as in the annuity and pension markets due to the basis risk that exists between the general population and the life settlement subgroup. Second, we show that the unique risk exposure of the life settlement firm can be specifically targeted using a new instrument—the biomedical research‐backed obligations. Our finding connects two seemingly independent markets and can promote the healthy development of both.
Urethral Stenting for Obstructive Uropathy Utilizing Digital Radiography for Guidance: Feasibility and Clinical Outcome in 26 Dogs
Authors: Radhakrishnan A.
Published: January 2017

Background

Urethral stent placement is an interventional treatment option to alleviate urethral outflow obstruction. It has been described utilizing fluoroscopy, but fluoroscopy is not as readily available in private practice as digital radiography.

Objectives

To describe the use of digital radiography for urethral stent placement in dogs with obstructive uropathy.

Animals

Twenty‐six client‐owned dogs presented for dysuria associated with benign and malignant causes of obstructive uropathy that underwent urethral stent placement.

Methods

Retrospective study.

Results

Causes of obstructive uropathy included transitional cell carcinoma, prostatic carcinoma, hemangiosarcoma, obstructive proliferative urethritis, compressive vaginal leiomyosarcoma, and detrusor‐sphincter dyssynergia. Survival time range was 1–48 months (median, 5 months). All dogs were discharged from the hospital with urine outflow restored. Intraprocedural complications included guide wire penetration of the urethral wall in 1 dog and improper stent placement in a second dog. Both complications were successfully managed at the time of the procedure with no follow‐up problems noted in either patient.

Conclusion and Clinical Importance

Urethral stent placement can be successfully performed utilizing digital radiography. The complications experienced can be avoided by more cautious progression with each step through the procedure and serial radiography. The application of digital radiography may allow treatment of urethral obstruction to become more readily available.
Validating, deconstructing and refining Baveno criteria for ruling out high‐risk varices in patients with compensated cirrhosis
Authors: Jangouk Parastoo , Turco Laura , De Oliveira Ana , Schepis Filippo , Villa Erica , Garcia‐Tsao Guadalupe
Published: February 2017

Background

Guidelines recommend variceal screening in patients with cirrhosis to identify varices at high risk of bleeding requiring primary prophylaxis. Non‐invasive criteria to rule out high‐risk varices will avoid unnecessary endoscopies. Recent Baveno VI criteria define patients with compensated cirrhosis in whom endoscopy can be avoided as those with a liver stiffness by transient elastography <20 kPa and a platelet count >150 000/mm3.

Aims

To validate Baveno criteria in two cohorts with a different prevalence of high‐risk varices and to determine whether alternate parameters not including liver stiffness would be equal/more accurate in ruling out high‐risk varices.

Methods

Retrospective study evaluating patients with liver stiffness >10 kPa who had liver stiffness and endoscopy within 1 year of each other.

Results

This study included 161 patients from the US cohort (14 [9%] with high‐risk varices) and 101 patients from an Italian cohort (17 [17%] with high‐risk varices). Of patients meeting Baveno criteria (41 in the US, 16 in Italy), none had high‐risk varices and therefore 26% (US) and 16% (Italy) endoscopies could have been avoided. Sensitivity and negative predictive value were 100%. A stepwise strategy using platelet count >150 000 and MELD=6, increased the number of endoscopies avoided to 54% (US) while maintaining a sensitivity and negative predictive value of 100%. Excellent sensitivity and negative predictive value were validated in the Italian cohort and in another cohort of patients with a clinical diagnosis of cirrhosis.

Conclusions

This study validates Baveno VI criteria, particularly in sites with a low prevalence of high‐risk varices and describes a new accurate strategy that does not include liver stiffness.
Fluoroless Catheter Ablation of Cardiac Arrhythmias: A 5‐Year Experience
Authors: RAZMINIA MANSOUR , WILLOUGHBY MICHAEL CAMERON , DEMO HANY , KESHMIRI HESAM , WANG THEODORE , D'SILVA OLIVER J. , ZHEUTLIN TERRY A. , JIBAWI HAKEEM , OKHUMALE PAUL , KEHOE RICHARD F.
Published: February 2017

Background

Catheter ablations have been traditionally performed with the use of fluoroscopic guidance, which exposes the patient and staff to the inherent risks of radiation. We have developed techniques to eliminate the use of fluoroscopy during cardiac ablations and have been performing completely fluoroless catheter ablations on our patients for over 5 years.

Methods

We present a retrospective analysis of the safety, efficacy, and feasibility data from 500 consecutive patients who underwent nonfluoroscopic catheter ablation, targeting a total of 639 arrhythmias, including atrioventricular reciprocating tachycardia (AVRT), atrioventricular nodal reentrant tachycardia (AVNRT), atrial tachycardia (AT), atrial fibrillation (AF), premature ventricular contractions (PVCs), and ventricular tachycardia (VT). We perform fluoroless ablations using intracardiac electrograms, electroanatomic mapping, and for most cases intracardiac echocardiography. Our experience includes exclusively endocardial cardiac ablations.

Results

The mean follow‐up was 20.5 months. Recurrence rate for AVRT was 6.5%, for AVNRT 2.5%, for macro‐reentrant AT 6.4%, for focal AT 5.4%, for AF 22.6%, for PVC 6.7%, and for VT 21.4%. Major complications occurred in five patients (1.0%); minor complications occurred in three patients (0.6%). No deaths occurred. Fluoroscopy was used in one instance, for 0.3 minutes, to confirm venous access.

Conclusions

Completely fluoroless catheter ablations may be routinely performed for all endocardial ablations without compromising safety, efficacy, or procedural duration.
Synthesis of bacteriophage lytic proteins against Streptococcus pneumoniae in the chloroplast of Chlamydomonas reinhardtii
Authors: Stoffels Laura , Taunt Henry N. , Charalambous Bambos , Purton Saul
Published: February 2017

There is a pressing need to develop novel antibacterial agents given the widespread antibiotic resistance among pathogenic bacteria and the low specificity of the drugs available. Endolysins are antibacterial proteins that are produced by bacteriophage‐infected cells to digest the bacterial cell wall for phage progeny release at the end of the lytic cycle. These highly efficient enzymes show a considerable degree of specificity for the target bacterium of the phage. Furthermore, the emergence of resistance against endolysins appears to be rare as the enzymes have evolved to target molecules in the cell wall that are essential for bacterial viability. Taken together, these factors make recombinant endolysins promising novel antibacterial agents. The chloroplast of the green unicellular alga Chlamydomonas reinhardtii represents an attractive platform for production of therapeutic proteins in general, not least due to the availability of established techniques for foreign gene expression, a lack of endotoxins or potentially infectious agents in the algal host, and low cost of cultivation. The chloroplast is particularly well suited to the production of endolysins as it mimics the native bacterial expression environment of these proteins while being devoid of their cell wall target. In this study, the endolysins Cpl‐1 and Pal, specific to the major human pathogen Streptococcus pneumoniae, were produced in the C. reinhardtii chloroplast. The antibacterial activity of cell lysates and the isolated endolysins was demonstrated against different serotypes of S. pneumoniae, including clinical isolates and total recombinant protein yield was quantified at ~1.3 mg/g algal dry weight.
Dual herbivore attack and herbivore density affect metabolic profiles of Brassica nigra leaves
Authors: Ponzio Camille , Papazian Stefano , Albrectsen Benedicte R. , Dicke Marcel , Gols Rieta
Published: February 2017

Plant responses to dual herbivore attack are increasingly studied, but effects on the metabolome have largely been restricted to volatile metabolites and defence‐related non‐volatile metabolites. However, plants subjected to stress, such as herbivory, undergo major changes in both primary and secondary metabolism. Using a naturally occurring system, we investigated metabolome‐wide effects of single or dual herbivory on Brassica nigra plants by Brevicoryne brassicae aphids and Pieris brassicae caterpillars, while also considering the effect of aphid density. Metabolomic analysis of leaf material showed that single and dual herbivory had strong effects on the plant metabolome, with caterpillar feeding having the strongest influence. Additionally, aphid‐density‐dependent effects were found in both the single and dual infestation scenarios. Multivariate analysis revealed treatment‐specific metabolomic profiles, and effects were largely driven by alterations in the glucosinolate and sugar pools. Our work shows that analysing the plant metabolome as a single entity rather than as individual metabolites provides new insights into the subcellular processes underlying plant defence against multiple herbivore attackers. These processes appear to be importantly influenced by insect density.
Outcomes of children, adolescents, and young adults following allogeneic stem cell transplantation for secondary acute myeloid leukemia and myelodysplastic syndromes—The MD Anderson Cancer Center experience
Authors: Maher Ossama M. , Silva Jorge Galvez , Wu Jimin , Liu Diane , Cooper Laurence J.N. , Tarek Nidale , Worth Laura , Lee Dean A. , Petropoulos Demetrios , Franklin Anna R.K. , Zweidler‐Mckay Patrick , Wells Robert J. , Rondon Gabriela , Champlin Richard E. , Tewari Priti
Published: February 2017

We conducted a retrospective analysis of outcomes for children and young adults with sAML/sMDS who underwent HSCT at our institution. Thirty‐two patients (median age 20 years) with sAML (n=24) and sMDS (n=8) received HSCT between 1990 and 2013. The median time from sAML/sMDS diagnosis to HSCT was 4.1 months (range: 1.2‐27.2 months). The transplant regimens were primarily busulfan based (n=19). BM was the primary donor source (n=15). Eleven recipients were transplanted with residual disease. At a median follow‐up of 62.3 months (range: 0.4‐250.9 months), 14 patients had disease recurrence. Acute GVHD, grade III/IV, occurred in three patients. Causes of death were as follows: disease relapse (n=12), infection (n=2), pneumonia (n=1), pulmonary hemorrhage (n=1), acute GVHD (n=1), and graft failure (n=1). A PS of ≥90% at the time of HSCT had a significant impact on PFS (P=.02). Patients achieving pretransplant primary CR (n=8) and those with sMDS and RA (n=6) had prolonged PFS (P=.04). On multivariate analysis, shorter time to transplantation (≤6 months from diagnosis of sAML/sMDS) was associated with superior OS (P=.0018) and PFS (P=.0005).
Staff experiences of appreciative management in the institutional care of people with intellectual and developmental disabilities – a cross‐sectional study
Authors: Astala Lena , Roos Mervi , Harmoinen Merja , Suominen Tarja
Published: February 2017

Purpose/Design

This cross‐sectional descriptive study describes staff experiences of appreciative management.

Methods

Data were collected by way of e‐survey from staff (n = 87) working in the institutional care of people with intellectual and developmental disabilities. The Appreciative Management Scale (AMS 1.0) was used and data were analysed by statistical methods.

Findings

Overall, respondents experienced appreciative management as being well implemented, with equality as the best implemented dimension and systematic management the worst. The promotion of well‐being at work was associated with age. Appreciation staff received from management had a positive correlation with systematic management, equality, appreciation of know‐how and the promotion of well‐being at work.

Conclusions

The knowledge of weak systematic management in this study may be utilised in developing management strategies. The managers should use the concept of appreciative management to help young and less experienced nurses to increase their competency and willingness to work in this field.
In vivo fascicle behavior of the flexor hallucis longus muscle at different walking speeds
Authors: Péter A. , Hegyi A. , Finni T. , Cronin N. J.
Published: February 2017

Ankle plantar flexor muscles support and propel the body in the stance phase of locomotion. Besides the triceps surae, flexor hallucis longus muscle (FHL) may also contribute to this role, but very few in vivo studies have examined FHL function during walking. Here, we investigated FHL fascicle behavior at different walking speeds. Ten healthy males walked overground at three different speeds while FHL fascicle length changes were recorded with ultrasound and muscle activity was recorded with surface electromyography (EMG). Fascicle length at heel strike at toe off and at peak EMG activity did not change with speed. Range of FHL fascicle length change (3.5‐4.5 and 1.9‐2.9 mm on average in stance and push‐off phase, respectively), as well as minimum (53.5‐54.9 and 53.8‐55.7 mm) and maximum (58‐58.4 and 56.8‐57.7 mm) fascicle length did not change with speed in the stance or push‐off phase. Mean fascicle velocity did not change in the stance phase, but increased significantly in the push‐off phase between slow and fast walking speeds (P=.021). EMG activity increased significantly in both phases from slow to preferred and preferred to fast speed (P<.02 in all cases). FHL muscle fascicles worked near‐isometrically during the whole stance phase (at least during slow walking) and operated at approximately the same length at different walking speeds. FHL and medial gastrocnemius (MG) have similar fiber length to muscle belly length ratios and, according to our results, also exhibit similar fascicle behavior at different walking speeds.
The Role of Domestic Employment Policies in Shaping Precarious Work
Authors: Jokela Merita
Published: February 2017

This article compares policy approaches regarding domestic employment in affluent countries and examines their impact on precarious work. Drawing on secondary literature and policy documents, this study identifies five policy approaches commonly applied in affluent countries to regulate and develop domestic employment: (1) affordable services; (2) simplifying use; (3) regulating employment; (4) regulating labour migration; and (5) no policy. The comparative analysis of different policy types shows that policy design is crucial in regulating employment conditions and the level of precariousness in paid domestic labour.

Based on a literature review, three dimensions of precarious work are studied: (1) the nature of employment (formal/informal); (2) the employment relationship; and (3) the form of employment (temporary or permanent, part time or full time). I argue that the current policy measures in place may increase precariousness either directly by promoting, for example, informal and irregular work, or indirectly through households (offering incentives for households that weaken workers' positions). The analysis also identifies positive measures that contribute to creating more secure employment conditions in domestic work through formalizing the sector. While there are differences in the outcomes of the different policy types, the findings suggest that across welfare states, domestic employment policies are still mostly demand driven and sustain the traditional, special nature of domestic work – often at the workers' expense.
From the Cradle of ‘Solidarity’ to the Land of Cheap Labour and the Home of Precarious. Strategic Discourse on Labour Arrangements in Post‐socialist Poland
Authors: Rek‐Woźniak Magdalena , Woźniak Wojciech
Published: February 2017

The labour market in Poland is characterized by low wages, long working hours, the largest share of fixed‐term contacts among EU countries, and a low share of unemployed entitled to very low benefits.

In a country being the cradle of the Solidarność labour movement, union density is currently distinctively low and the position of labour unions weak, particularly in the private sector. The massive post‐accession migration can be partially explained by dissatisfaction with labour arrangements constructed throughout the socio‐economic transformation into capitalism.

The article tracks the main features of strategic discourse surrounding labour market reforms in Poland after 1989. The analysis of documents published by subsequent Polish Governments allowed for reconstruction of the elements of discursive processes that paved the way for radical liberalization of the labour arrangements. The review of strategic documents was organized around three questions: the rationale and the construction of policy agenda, its normative and axiological fundaments and the discursive tools forcing consent around proposed measures.

The consistency of beliefs in the proposed solutions disregarding changing internal (measurable outcomes of the policies) and external (growing criticism of neo‐liberalism in the aftermath of the global financial crisis) circumstances fit the criteria of ‘master’ discourse, as defined by Vivian A. Schmidt. We argue that these cognitive and normative aspects of Polish discourse mirrored, to a large extent, the processes occurring in the UK under Thatcher's rule as reconstructed by Schmidt.
Do cover crops change the lability of phosphorus in a clayey subtropical soil under different phosphate fertilizers?
Authors: Teles A. P. B. , Rodrigues M. , Bejarano Herrera W. F. , Soltangheisi A. , Sartor L. R. , Withers P. J. A. , Pavinato P. S.
Published: February 2017

Plants have developed different mechanisms to absorb and solubilize phosphorus (P) in the soil, especially in environments with low P availability. This study evaluated the effects of different winter cover crops on soil P availability in a clayey subtropical (Hapludox) soil receiving soluble P fertilizer and a rock phosphate applied to the summer crop, under no‐tillage. The experiment was carried out over 3 yrs (2009–2011) with five different cover crop species: common vetch, fodder radish, ryegrass, black oat, white clover and fallow as control. The soil was sampled after the third year of cover crop cultivation and analysed for inorganic and organic P forms according to the well‐established Hedley fractionation procedure. Phosphate fertilizers promoted accumulation of both labile and nonlabile P pools in soil in the near surface layer, especially under rock phosphate. Fertilizer applications were not able to change P fractions in deeper layers, emphasizing that the Brazilian clayey soils are a sink of P from fertilizer and its mobility is almost nil. Although the cover crops recycled a great amount of P in tissue, in a short‐term evaluation (3 yrs) they only changed the content of moderately labile P in soil, indicating that long‐term studies are needed for more conclusive results.