bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance of over‐reading ambulatory ECG‐based microvolt T‐wave alternans to eliminate three main sources of measurement error
Authors: Takasugi Nobuhiro , Matsuno Hiroko , Takasugi Mieko , Shinoda Koichi , Watanabe Takatomo , Ito Hiroyasu , Okura Hiroyuki , Verrier Richard L.
Published: June 2019

Background

Ambulatory electrocardiogram (ECG)‐based microvolt T‐wave alternans values measured by the modified moving average method (MMA‐TWA) can be disrupted by T‐wave changes that mimic true repolarization alternans.

Methods

We investigated potential sources of measurement error by studying 19 healthy subjects (12 men; median age, 25) free of known heart disease with 36‐month follow‐up to establish freedom from significant arrhythmia or syncope. All participants underwent 24‐hr continuous 12‐lead ECG monitoring. Causes of automated MMA‐TWA ≥42 µV episodes were classified based on visual inspection.

Results

A total of 2,189 episodes of automated MMA‐TWA episodes ≥42 µV were observed in all subjects (peak MMA‐TWA: median, 94 μV; interquartile range, 81–112 μV). All episodes included one or more beats with T‐wave deformation which lacked “repeating ABAB pattern” and therefore were identified as TWA measurement error. Causes of such error were categorized as: (a) artifact [72.6% (1,589/2,189), observed in 19 (100%) subjects], more frequently in limb than precordial leads; (b) T‐wave changes due to changes in heart/body position [25.5% (559/2,189), observed in 14 (73.7%) subjects], frequently observed in leads V1‐2; and (c) postextrasystolic T‐wave changes [1.9% (41/2,189), observed in 2 (10.5%) subjects].

Conclusions

Relying only on automated MMA‐TWA values obtained during ambulatory ECG monitoring can lead to incorrect measurement of TWA. Our findings offer the potential to reduce false‐positive TWA results and to achieve more accurate detection of true repolarization alternans.
S1‐Leitlinie Dermatofibrosarcoma protuberans (DFSP) – Update 2018
Authors: Ugurel Selma , Kortmann Rolf‐Dieter , Mohr Peter , Mentzel Thomas , Garbe Claus , Breuninger Helmut , Bauer Sebastian , Grabbe Stephan
Published: June 2019

Das Dermatofibrosarcoma protuberans (DFSP) ist eine sehr seltene Tumorentität. Nichtsdestotrotz stellt es das häufigste kutane Sarkom dar. Das DFSP ist ein Tumor fibroblastischen Ursprungs und durch ein langsames, unterminierendes, lokal destruktives Wachstum charakterisiert. Eine Metastasierung ist selten. Das klinische Bild ist uncharakteristisch, so dass die Erstdiagnose oftmals verzögert gestellt wird. Die Biopsie und anschließende histopathologische Untersuchung ist daher von essenzieller Bedeutung für die Diagnosestellung eines DFSP. Die Standardtherapie im Primärtumorstadium ist die chirurgische Exzision mit einem Sicherheitsabstand von 1 bis 2 cm. Kleinere Sicherheitsabstände sind mit einem erhöhten Lokalrezidivrisiko verbunden. Inoperable oder metastasierte Tumoren können bestrahlt werden. Bei 80–90 % der DFSP liegt eine Genfusion vor, die zu einer konstitutiven Aktivierung des PDGF‐b‐Signalweges führt. Daher ist die molekular zielgerichtete Therapie gegen PDGF‐β eine wirksame Therapieoption bei inoperabel ausgedehnten oder metastasierten DFSP. Die erste und bislang einzige Substanz mit einer Zulassung zur Systemtherapie des DFSP ist der Multikinaseinhibitor Imatinib mit einer objektiven Ansprechrate von 50 % im Rahmen klinischer Studien.
Extragenitale kutane Warzen – Klinik, Diagnose und Therapie
Authors: Abeck Dietrich , Tetsch Larissa , Lüftl Matthias , Biedermann Tilo
Published: June 2019

Extragenitale Warzen sind durch humane Papillomviren (HPV) ausgelöste gutartige Tumoren der Epidermis, die typ‐ und lokalisationsabhängig sehr unterschiedliche klinische Manifestationsformen ausbilden und ein häufiger Konsultationsgrund sind. In der Regel sind sie selbstlimitierend, so dass ein Abwarten gerechtfertigt ist. Schmerzen sie jedoch oder belasten sie psychisch, besteht immer die Indikation zur Behandlung, wobei der individuelle Leidensdruck, das Alter des Betroffenen, die Warzenlokalisation, die Zahl der Läsionen und die Bestehensdauer berücksichtigt werden müssen. Destruktive Verfahren tragen entweder chemisch oder physikalisch das Warzengewebe ab. Antimitotische und antivirale Wirkstoffe verhindern nichtdestruktiv die Vermehrung infizierter Keratinozyten beziehungsweise der Viren in den Keratinozyten. Verschiedene Immuntherapien wirken örtlich begrenzt oder systemisch. Letzteres hat den Vorteil, dass auch weit vom Injektionsort entfernte Warzen abheilen. Aus diesem Grund ist diese Form der Immuntherapie vor allem bei Patienten mit Warzen in mehreren Lokalisationen zu favorisieren. Bei Therapieresistenz im Erwachsenenalter ist vor allem die intraläsionale Immuntherapie mit dem Masern‐Mumps‐Röteln‐Impfstoff ein vielversprechender Therapieansatz, bei Kindern und Jugendlichen dagegen die Impfung gegen humane Papillomviren zur Krebsvorsorge, auch wenn diese Impfung bislang nicht zur Behandlung von Warzen zugelassen ist. Zurzeit kann kein Therapieverfahren eine vollständige Abheilung garantieren. Für zahlreiche, auch häufig eingesetzte Therapien fehlen derzeit aussagekräftige klinische Studien.
Lutte contre les chenilles des noctuelles défoliatrices de la culture de la menthe verte (Mentha spicata L.) au Maroc
Authors: El Fakhouri K. , Lhaloui S. , Faouzi B. , El Bouhssini M. , Sabraoui A. , Rochd M.
Published: June 2019

Les chenilles des noctuelles défoliatrices, notamment les espèces Helicoverpa armigera, Spodoptera littoralis, Chrysodeixis chalcites et les vers gris Agrotis ipsilon et A. segetum, sont parmi les insectes ravageurs les plus destructifs de la culture de la menthe verte au Maroc. Pour contrôler ces ravageurs, les producteurs appliquent, à différentes reprises, des insecticides non sélectifs lesquels sont parfois non homologués. Ce travail étudie l'efficacité de différents insecticides sélectifs issus de la chimie de synthèse ainsi que d'autres insecticides autorisés en agriculture biologique sur ces chenilles, permettant une meilleure protection et limitant les problèmes de résidus de pesticides. Deux insecticides autorisées en agriculture biologique et 4 issus de la chimie de synthèse ont été testés en plein champ sur les chenilles défoliatrices, suivant un dispositif expérimental en blocs aléatoires complets avec 3 répétitions. L’étude comparative de l'efficacité des produits testés a montré une réduction moyenne du nombre des chenilles de 89,4%, 82,5% et 68,1% correspondant à une réduction moyenne de la défoliation de 57,1%, 53,8% et 43,9%, et ce respectivement pour les deux insecticides sélectifs, le chlorantraniliprole (15 cc hL−1) et l’émamectine benzoate (250 g ha−1), ainsi que pour un insecticide biologique à base de spinosad (30 cc hL−1). Un gain de poids frais total par rapport au témoin non traité a été enregistré, de 48,3%, 50,9%, et 40,4% respectivement pour le chlorantraniliprole, l'émamectine benzoate, et le spinosad. Le chlorantraniliprole, l’émamectine benzoate et le spinosad pourraient donc se substituer aux insecticides de synthèse à large spectre fréquemment utilisés sur la menthe verte au Maroc.
Cross‐genus adoptions in delphinids: One example with taxonomic discussion
Authors: Carzon Pamela , Delfour Fabienne , Dudzinski Kathleen , Oremus Marc , Clua Éric
Published: June 2019

Although relatively rare, adoptions have been reported in a number of mammals, involving almost exclusively individuals of the same species, and hardly ever between species or across genera. Adoption remains poorly documented and its proximate causes are controversial. Here, we describe a unique case of a cross‐genus adoption within a small community of common bottlenose dolphins (Tursiops truncatus) at Rangiroa Atoll in French Polynesia. It involves a foster female adopting a presumed melon‐headed whale (Peponocephala electra) calf while already mothering its presumed biological offspring. While the inclusive fitness hypothesis can be rejected for this adult female mother, acquisition of parental skills is also unlikely to have driven adoption in parallel to natural motherhood. We argue that the primiparous foster mother’s inexperience and personality may have contributed to factors driving such non‐adaptive behavior. We also propose that the adoptee’s persistence in initiating and maintaining an association with the adult female bottlenose dolphin could have played a major role in the adoption’s ultimate success, as well as the persistence of this cross‐genus adoption after the disappearance of the biological offspring. A brief discussion of adoption and hybridization within the Delphinidae taxon is included to identify how this cross‐genus adoption fits into context of marine mammal parental care.
Key roles of Rho GTPases, YAP, and Mutant P53 in anti‐neoplastic effects of statins
Authors: Ji Lixia , Liu Chaolong , Yuan Yanting , Gao Hui , Tang Zhen‐xue , Yang Zhihong , Liu Zhan‐tao , Jiang Guo‐hui
Published: June 2019

Emerging epidemiological and preclinical studies have focused on statins and mevalonate pathway to identify potential therapeutic target and clarify the underlying mechanism of the anti‐neoplastic effects. Reductions of mevalonate or isoprenoids, caused by statins, would further decrease the isoprenylation of Rho GTPases which is the crucial step for Rho GTPases to anchor on inner cellular membrane. Following anchoring, activated Rho GTPases can mediate a series of cellular activities such as cytoskeleton reprogramming, front–rear polarity, and cell‐ECM adhesion. These changes not only facilitate tumor cell detachment and migration but also bring great mechanical changes to directly activate YAP, the major nuclear mechanotransducer, to translocate into nucleus. Recently, statins have been identified as potent inhibitors of YAP. Once entering nucleus, YAP would combine TEADs to promote the transcription of about 100 genes, which are involved in cell proliferation, cell cycle regulation, stemness, invasion, and metastasis. Besides, statins are able to promote the degradation of misfolded mutant p53 (mutp53), which is an oncogene in a variety of human malignancies. Reduction in mevalonate‐5‐phosphate (MVP), also induced by statins, would impair the stability of DNAJA1‐mutp53 complex; then, elevated C terminus of Hsc70‐interacting protein (CHIP) mediates the nuclear export and degradation of misfolded mutp53 through ubiquitin–proteasome pathway. It is worth noted that YAP, mutp53, and mevalonate pathway form two positive feedback loops. It is reasonable to believe that Rho GTPases, YAP, and mutp53 are determinants for statins as anti‐cancer agents: tumor cells harboring mutp53 and nuclear‐located YAP would be more sensitive to statins.
Towards a performative understanding of deservingness: Merit, gender and the BBC pay dispute
Authors: Simpson Ruth , Kumra Savita , Lewis Patricia , Rumens Nick
Published: June 2019

Drawing largely on a high‐profile case of unequal pay at the BBC (British Broadcasting Corporation) as an illustrative example, this conceptual article considers differences and interrelationships between merit and deservingness, where the latter captures how, through appropriate performances, merit is given recognition and value. We propose a performative understanding of deservingness that highlights its gendered and embodied dimensions. Informed by Judith Butler's account of gender performativity, we show that, while merit is conventionally conceptualized as a relatively fixed set of attributes (qualifications, skill) 'attached' to the individual, deservingness captures how, in gendered terms, value and recognition are both claimed and conferred. As we argue, a gendered, deserving subject does not pre‐exist but is performatively constituted through embodied practices and performances of what is seen as worthy in a particular time and place.
Understanding how and why adding valid predictors can decrease the validity of selection composites: A generalization of Sackett, Dahlke, Shewach, and Kuncel (2017)
Authors: Murphy Kevin R.
Published: June 2019

It is usually assumed that adding more valid predictors will increase the predictive power of a selection test battery. Sackett, Dahlke, Shewach, and Kuncel showed that when selection tests are combined using unit weights, adding a valid predictor can lead to a decrease in validity. Situating the Sackett et al. approach in a more general multivariate framework I show how: (a) it is the tradeoff between predictor validity and predictor intercorrelations, and not the differences in predictor validities that determines whether adding a valid predictor to a composite will cause the validity of that composite to increase or decrease; and (b) this same dynamic applies across a wide range of non‐optimal schemes for weighting predictors and/or criteria.
To identify the factors that influence the recognizing and responding to adult patient deterioration in acute hospitals
Authors: Treacy Michelle , Caroline Stayt Louise
Published: June 2019

Aims

To identify factors that influence recognition and response to adult patient deterioration in acute hospitals.

Design

A mixed‐studies systematic review.

Data Sources

CINAHL, Medline, and Web of Science were searched for relevant literature published between 2007 – 2018.

Review Methods

Studies were critically appraised, data extracted and thematically analysed.

Results

Thirteen papers met the inclusion criteria. Three main themes were identified: (a) Knowledge and understanding of clinical deterioration; (b) Organizational factors; managing deterioration and staffing levels; and (c) Communication; inter‐professional relationships and professional‐patient communication.

Conclusion

Despite national guidelines, the review findings suggest that the recognition and response to adult patient deterioration in acute hospital settings is sub‐optimal. A multitude of factors influencing the recognition and response to adult patient deterioration emerged from the findings.

Impact

Patients are receiving sub‐optimal care due to failure in recognizing and responding to patient deterioration in an appropriate and timely manner. Nurses lack knowledge and understanding of deterioration. Organizational factors contribute to inadequate care and communication among professionals was highlighted as challenging. The factors that influence the recognizing and responding to patient deterioration in acute hospitals are multi‐faceted, however this review highlights immediate recommendations for professionals in the acute care setting.
Repeat pregnancies in teenage mothers: An exploratory study
Authors: Bucknall Amy , Bick Debra
Published: June 2019

Aim

To explore young mothers' experience of rapid repeat pregnancy.

Background

Despite a reduction in teenage pregnancies in England over the last two decades, the number of repeat pregnancies remains high, accounting for around 25% of teenage pregnancies. There is a lack of qualitative evidence of teenage perspectives making planning appropriate interventions challenging.

Design

Exploratory design.

Methods

Six young women were purposively sampled from a Family Nurse Partnership programme in the South London. Semi‐structured interviews conducted in spring 2017 elicited experiences of repeat pregnancy.

Findings

Each repeat pregnancy was unplanned and accounted for by participants' rejection of Long Acting Reversible Contraceptives and inconsistent use of non‐ Long Acting Reversible Contraceptives. Misinformation about Long Acting Reversible Contraceptives contributed to their rejection and staff delivery of contraceptive advice was influential. Motherhood was initially prioritised over other life goals to make sense of second pregnancy. Discharge from the Family Nurse Partnership may lead to fractured service contacts. Peer support and health professional contact through social media were proposed as “stepping stones” out of the service.

Conclusions

Practice developments working in partnership with young mothers to reduce the risk of a repeat teenage pregnancy are highlighted. Further research is recommended.

Impact

Understanding the experiences of teenage mothers who are at risk of rapid repeat pregnancy can assist nurses to provide preventative care and support. Structured advice through social media platforms can provide “stepping stones” that bridge gaps in provision as young mothers transition through services. Further research and development into the role of social media and contraceptive counselling are necessary.
Factors that influence the development and performance of academic oral presentations using a blended learning environment
Authors: Barrett Neil Edward , Liu Gi‐Zen
Published: June 2019

This study investigated how students designed English academic oral presentations via a blended language learning environment. Data were collected from focus group interviews, observations of students, and instructor perspectives to explore how students develop academic presentation skills. In addition, a total of 36 oral presentations were assessed by a rubric and frequency counts of presentation language and features. By adopting an ecological approach, we identified the interactions between different factors that influenced learning. Interview findings and observations suggested students welcomed the immediacy of the technology and demonstrated signs of autonomous learning by self‐selecting the chat application Line for group collaboration. Participants preferred both online and face‐to‐face collaboration, as students discovered the limits of online communication. Results indicated that group oral presentations improved, with stronger introductions, linking devices, and visual elements. However, students had problems constructing conclusions and trouble linking the main ideas to the content.
Longitudinal association between serum uric acid levels and multiterritorial atherosclerosis
Authors: Song Meiyue , Li Na , Yao Yan , Wang Kaile , Yang Jichun , Cui Qinghua , Geng Bin , Chen Jianxin , Wang Youxin , Cheng Wenli , Zhou Yong
Published: June 2019

Multiterritorial atherosclerosis has dramatically increased annual risk of adverse cardiovascular events than atherosclerotic disease with single‐artery affected. Serum uric acid (SUA) is an important predictor of stroke and atherosclerosis; however, which is supported by few direct evidence based on cohort studies. A prospective cohort study including 2644 North Chinese adults aged ≥40 years was performed in 2010‐2012 to investigate the association between SUA and multiterritorial vascular stenosis. Hyperuricaemia was defined as SUA levels >6 and >7 mg/dL for males and females, respectively. All participants underwent twice transcranial Doppler (TCD) and bilateral carotid duplex ultrasound to evaluate intracranial artery stenosis (ICAS) and extracranial arterial stenosis (ECAS) and peripheral arterial disease (PAD) was determined by ankle‐brachial index (ABI) on January 2010 and January 2012 based on regular health check‐ups. The cumulative incidence of vascular stenosis was significantly higher in subjects with hyperuricaemia than in those without hyperuricaemia (54.1% vs. 34.7%, P < 0.001). The adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for new on‐set vascular stenosis due to hyperuricaemia and a 1‐mg/dL change in SUA level were 1.75 (1.32‐2.31) and 1.29 (1.21‐1.38), respectively. Furthermore, in the gender‐stratified analysis, the association between SUA levels and ICAS was statistically significant in males (OR: 2.02; 95% CI: 1.18‐3.46), but not females (OR: 0.85, 95% CI: 0.41‐1.76, P for interaction: 0.026).
Effect of high hydrostatic pressure in physicochemical properties and in vitro digestibility of cornstarch by nuclear magnetic resonance relaxometry
Authors: Okur Ilhami , Ozel Baris , Oztop Mecit H. , Alpas Hami
Published: June 2019

Starch is the major polysaccharide consumed by human being. It is not classified as a dietary fiber as it is digestible by the enzymes present in the saliva and small intestines. However, it is possible to modify starch with thermal and nonthermal techniques. High hydrostatic pressure (HHP) is a cold pasteurization technique that has increased application in food industry with minimum effect on nutritional quality of the food products. It is hypothesized that the use of HHP could be a modification strategy for starch. In this study, effects of different HHP parameters (400 and 500 MPa) at different temperatures (20, 30, and 40°C) for 5, 15, and 30 min on in vitro digestibility and physicochemical properties of cornstarch were studied by Nuclear magnetic resonance (NMR) relaxometry. Results showed that HHP treatment increased slowly digestible starch (SDS) and rapid digestible starch (RDS) significantly with pressure and temperature (p < .05). In addition, it was shown that HHP treatment decreased the solubility and swelling power of the cornstarch and it is proposed that 30 min HHP treatment at 500 MPa and 40°C is the onset for cornstarch gelatinization according to NMR relaxometry results.

Practical Applications

High hydrostatic pressure (HHP) is a nonthermal processing technology that is commonly used in the food industry for extending the shelf life of food products by destroying vegetative cells, enzymes, microorganisms effectively, and it can modify the starch so the aim of this study was to investigate the effects of different HHP parameters on in vitro digestibility and physicochemical properties of cornstarch by nuclear magnetic resonance relaxometry.
Impact of Social Network on the Risk and Consequences of Injurious Falls in Older Adults
Authors: Trevisan Caterina , Rizzuto Debora , Maggi Stefania , Sergi Giuseppe , Wang Hui‐Xin , Fratiglioni Laura , Welmer Anna‐Karin
Published: June 2019

OBJECTIVES

A smaller social network is associated with worse health‐related outcomes in older people. We examined the impact of social connections and social support on the risk of injurious fall and on fall‐related functional decline and mortality.

DESIGN

Prospective study with 6‐year follow‐up.

SETTING

Community.

PARTICIPANTS

A total of 2630 participants (aged ≥60 years) from the Swedish National Study on Aging and Care in Kungsholmen.

MEASUREMENTS

Social connections (social network size and contact frequency) and social support (social resource perception and satisfaction) were assessed through validated questionnaires. Data on injurious falls (falls requiring inpatient or outpatient care) and mortality came from official registers. We defined injurious falls as severe if they caused fracture and/or intracranial injury and as multiple if two or more occurred during the 6‐year follow‐up. Functional decline was defined as the loss of ability to perform one or more activities of daily living during the follow‐up.

RESULTS

During the follow‐up, 322 participants experienced injurious falls. After adjusting for potential confounders, the hazard ratio of injurious falls was 1.7 (95% confidence interval [CI] = 1.1‐2.4) for people with poor social connections and 1.5 (95% CI = 1.1‐2.1) for people with moderate social connections (reference: rich social connections). Social support was not associated with fall risk. The odds of functional decline among those with severe/multiple falls and (1) poor social connections (odds ratio [OR] = 5.2 [95% CI = 2.1‐12.9]) or (2) poor social support (OR = 4.5 [95% CI = 1.7‐12.0]) was up to twice as high as among those with severe/multiple falls and (3) rich social connections (OR = 2.5 [95% CI = .9‐6.6]) or (4) rich social support (OR = 2.7 [95% CI = 1.2‐6.3]). Similar but more attenuated results emerged for mortality.

CONCLUSIONS

Social network may influence fall risk and fall‐related functional decline and mortality. J Am Geriatr Soc 67:1851–1858, 2019
Care of Pregnant Women: Experience from a Maternity‐Specific Ebola Isolation Unit in Sierra Leone
Authors: Garde Diana Leigh , Kahn Rebecca J. , Mesman Annelies W. , Koroma Alimamy Philip , Marsh Regan H.
Published: June 2019

Introduction

The Ebola virus disease epidemic was devastating to the West African region, particularly for pregnant women. Prior to the epidemic, maternal mortality in this region was among the highest in the world. Throughout the region, screening of patients with Ebola was difficult, as the symptoms of malaria or typhoid mimicked Ebola, but even more difficult for pregnant women, because of the large overlap between Ebola symptoms and pregnancy‐related complications. In November 2014, the world's first maternity‐specific isolation and screening system, to our knowledge, was created at the Princess Christian Maternity Hospital in Freetown to meet the emergent needs of the population of pregnant women during the epidemic.

Process

Starting in December 2014 through June 2016, in collaboration with hospital leadership and the Ministry of Health and Sanitation, Partners In Health supported Princess Christian Maternity Hospital in creating a safer health care environment with the shared goal of improving safety and health outcomes and of addressing the unique needs of pregnant women, by focusing on improving 4 key areas: 1) screening, 2) isolation, 3) laboratory diagnostics, and 4) clinical service delivery in isolation, including human resource management and training.

Outcomes

The screening guidelines were adapted to include maternal health care considerations, a new screening area was constructed, the laboratory result turnaround time was reduced, and the isolation unit was improved to enhance safety and care delivery. Human resources were supported with additional staff hired and trainings on infection prevention and control, overall resulting in better preparing Princess Christian Maternity Hospital to provide care for pregnant women during outbreaks.

Discussion

The authors’ experience at Princess Christian Maternity Hospital provides a model of screening, isolation, and care specifically for maternity patients, and directly addresses infection risk and mortality. The recommendations we provide can be used in future outbreaks.
Treatment of atrophic acne scars using autologous platelet‐rich plasma vs combined subcision and autologous platelet‐rich plasma: A split‐face comparative study
Authors: Hassan Akmal Saad , El‐Hawary Marwa Safwat , Abdel Raheem Heba Mohammed , Abdallah Samar Hassan , El‐Komy Mohamed Medhat
Published: June 2019

Background

Multiple therapeutic approaches are usually required when treating atrophic acne scars. Subcision was reported to be of value in improving rolling scars. Autologous platelet‐rich plasma (PRP) has recently been proposed as an adjuvant treatment option for atrophic acne scars with few reports evaluating its efficacy.

Objective

Our objective was to compare the effect of intradermal injection of PRP vs combined PRP and subcision in the treatment of atrophic acne scars.

Methods

Thirty patients with bilateral atrophic acne scars were enrolled. Each patient received three monthly sessions. Each side of the face was randomly treated either with intradermal PRP alone or with combined treatment with subcision followed by PRP injection. Patients were assessed at 3 and 6 months following the last treatment session. Evaluation of serial photographs was performed by two blinded investigators.

Results

Platelet‐rich plasma alone showed a better response, fewer side effects, and shorter downtime compared to combined subcision and PRP.

Conclusion

Autologous PRP injection can be a therapeutic option in the treatment of atrophic acne scars, with fewer complications and better tolerability than combined subcision and autologous PRP.
12‐hr shifts in nursing: Do they remove unproductive time and information loss or do they reduce education and discussion opportunities for nurses? A cross‐sectional study in 12 European countries
Authors: Dall’Ora Chiara , Griffiths Peter , Emmanuel Talia , Rafferty Anne Marie , Ewings Sean ,   the RN4CAST Consortium
Published: June 2019

Aims and objectives

To examine the association between registered nurses' (referred to as “nurses” for brevity) shifts of 12 hr or more and presence of continuing educational programmes; ability to discuss patient care with other nurses; assignments that foster continuity of care; and patient care information being lost during handovers.

Background

The introduction of long shifts (i.e., shifts of 12 hr or more) remains controversial. While there are claims of efficiency, studies have shown long shifts to be associated with adverse effects on quality of care. Efficiency claims are predicated on the assumption that long shifts reduce overlaps between shifts; these overlaps are believed to be unproductive and dangerous. However, there are potentially valuable educational and communication activities that occur during these overlaps.

Design

Cross‐sectional survey of 31,627 nurses within 487 hospitals in 12 European countries.

Methods

The associations were measured through generalised linear mixed models. The study methods were compliant with the STROBE checklist.

Results

When nurses worked shifts of 12 hr or more, they were less likely to report having continuing educational programmes; and time to discuss patient care with other nurses, compared to nurses working 8 hr or less. Nurses working shifts of 12 hr or more were less likely to report assignments that foster continuity of care, albeit the association was not significant. Similarly, working long shifts was associated with reports of patient care information being lost during handovers, although association was not significant.

Conclusion

Working shifts of 12 hr or more is associated with reduced educational activities and fewer opportunities to discuss patient care, with potential negative consequences for safe and effective care.

Relevance to clinical practice

Implementation of long shifts should be questioned, as reduced opportunity to discuss care or participate in educational activities may jeopardise the quality and safety of care for patients.
Nurses' decision‐making about intravenous administration set replacement: A qualitative study
Authors: Ray‐Barruel Gillian , Woods Christine , Larsen Emily N. , Marsh Nicole , Ullman Amanda J. , Rickard Claire M.
Published: June 2019

Aims and objectives

To explore nurses' decision‐making regarding intravenous administration set replacement for vascular access device infusions in paediatric and adult clinical settings.

Background

Intravenous administration sets are routinely replaced at regular intervals in clinical practice with the goal of preventing catheter‐related bloodstream infection; however, emerging evidence is challenging traditional hang‐time durations. Nurses' perceptions and contextual factors affecting decision‐making for administration set replacement have not been assessed previously.

Design

Qualitative study using focus groups with contextualism methodology and inductive analysis.

Method

During November–December 2016, eight semi‐structured focus groups were conducted with 38 nurses at two metropolitan hospitals in Queensland, Australia. Interviews were audio‐recorded and transcribed. Two authors independently reviewed transcripts and extracted significant statements using Braun and Clarke's 7‐step method of thematic analysis. The COREQ checklist provided a framework to report the study methods, context, findings, analysis and interpretation.

Results

Five key themes emerged from the analysis: (a) infection prevention, (b) physical safety, (c) patient preference, (d) clinical knowledge and beliefs, and (e) workload. Administration set replacement can be a complex task, particularly when patients have multiple infusions and incompatible medications. Nurses drew on perceptions of patient preference, as well as previous experience, knowledge of peer experts and local policies, to aid their decisions.

Conclusions

Nurses use clinical reasoning to balance patient safety and preferences with competing workplace demands when undertaking administration set replacement. Nurses rely on previous experience, hospital and medication manufacturer policies, and peer experts to guide their practice.

Relevance to clinical practice

Nurses at times deviate from clinical guidelines in the interests of patient acuity, nurses' experience and workload. The findings of this study indicate nurses also balance considerations of patient preference and safety with these competing demands.
Chromosomal aberrations in women with primary and secondary amenorrhea: A cross‐sectional study
Authors: Al‐Jaroudi Dania , Hijazi Ayah , Bashir Mohammed , Heena Humariya , Tashkandi Soha A.
Published: June 2019

Aim

Among women of childbearing age, about 2–5% are affected by amenorrhea that is either primary or secondary. However, there are no data regarding the frequency and type of chromosomal abnormalities associated with amenorrhea in Saudi women. The present study aims to establish the frequency and pattern of chromosomal abnormalities in primary amenorrhea (PA) and secondary amenorrhea (SA) cases in a tertiary care center, Riyadh, Saudi Arabia.

Methods

This cross‐sectional study was conducted between 2013 and 2016 on women referred to the Reproductive Endocrine and Infertility Medicine Department at a tertiary care center in Riyadh. Women were divided into two groups: PA and SA. After the initial diagnosis of amenorrhea based on medical history, physical examination, hormonal profile and ultrasonography, chromosome karyotype analysis was conducted on metaphase preparations following routine cytogenetics culture and harvest methods.

Results

Chromosomal tests were performed for 53 patients (42 with PA and 11 with SA) out of 79 referred patients with amenorrhea. About 19% of the 42 patients with PA and 1 patient (9.1%) diagnosed as SA showed an abnormal karyotype. The most common abnormal karyotypes observed were 46, XY and 45, X.

Conclusion

The present study indicates that the chromosomal analysis after the exclusion of nongenetic causes should be essentially considered for the precise diagnosis and the development of more successful management for females with amenorrhea. This study also revealed that the prevalence of chromosomal abnormalities in women with PA and SA is similar to that reported in the literature.
Ectophoma iranica sp. nov. and new hosts and records of Allophoma spp. in Iran
Authors: Larki Reihaneh , Mehrabi‐Koushki Mehdi , Farokhinejad Reza
Published: June 2019

A survey was conducted to identify fungi associated with leaf diseases of ornamental herbs, including Christ plant, dracaena, rose geranium, rose periwinkle and treasure flower, in Ahvaz, southwestern Iran. Twenty‐five symptomatic herbs were collected and studied, which led to the isolation of seven Phoma‐like strains belonging to four taxa. These fungi were characterised based on DNA sequence data for the partial large subunit 28S nrDNA (LSU‐D1/D2), the internal transcribed spacer 1 and 2 and 5.8S nrDNA (ITS) and part of the β‐tubulin (tub2) gene regions. A multi‐locus‐based phylogeny, in combination with morphology, allowed for the identification of Allophoma hayatii, A. labilis, A. tropica and a novel species of the genus Ectophoma. Ectophoma iranica sp. nov. is morphologically and genetically distinctive from previously described species. In pathogenicity tests, the two strains of E. iranica (CBS 144681 and IRAN 3354C) caused leaf spot symptoms on leaves of Catharanthus roseus. New host plant species and records for A. hayatii, A. labilis and A. tropica are reported, plus further emended characterization of A. hayatii.
Dietary guidelines for children under 2 years of age in the context of nurturing care
Authors: Pérez‐Escamilla Rafael , Segura‐Pérez Sofia , Hall Moran Victoria
Published: June 2019

Dietary guidelines provide advice on what to eat to different subsets of the population but often do not take into account the “how” to eat. Responsive feeding is a key dimension of responsive parenting involving reciprocity between the child and caregiver during the feeding process and is characterized by caregiver guidance and recognition of the child's cues of hunger and satiety. Evidence indicates that providing responsive feeding guidance to mothers on how to recognize and respond appropriately to children's hunger and satiety cues can lead to improved feeding practices and weight status and developmental outcomes among infants and young children. In addition, early and nurturing exposures to foods with different tastes and textures and positive role modelling help children to learn to eat healthy foods. The importance of improving caregiver's responsive feeding behaviours to ensure the adequate introduction of complementary foods is becoming increasing recognized, but responsive feeding principles have not been taken into account in a comprehensive way in the development of dietary guidelines. The incorporation of all responsive feeding principles into dietary guidelines has a strong potential to enhance their impact on early childhood development outcomes for infants and young children but will require adaptation to the different contexts across countries to ensure that they are culturally sensitive and grounded in a deep understanding of the types of foods and other resources available to diverse communities.
Breastfeeding experiences and support for women who are overweight or obese: A mixed‐methods systematic review
Authors: Chang Yan‐Shing , Glaria Amaia Artazcoz , Davie Philippa , Beake Sarah , Bick Debra
Published: June 2019

Women who are overweight or obese have increased health risks during and beyond pregnancy, with consequences for their infants' shorter and longer term health. Exclusive breastfeeding to 6 months has many benefits for women and their infants. However, women who are overweight or obese have lower rates of breastfeeding intention, initiation, and duration compared with women with normal weight. This systematic review aimed to examine evidence of (a) breastfeeding barriers and support experienced and perceived by women who are overweight or obese, (b) support shown to be effective in increasing breastfeeding initiation and duration among these women, and (c) perceptions of health care professionals, peer supporters, partners, and family members regarding providing breastfeeding support to these women. Sixteen quantitative and qualitative papers were included and critically appraised. Thematic synthesis was undertaken to obtain findings. Maternal physical barriers such as larger breasts, difficulties of positioning to breastfeed, delayed onset of lactation, perceived insufficient supply of breast milk, and impact of caesarean birth were evident. Maternal psychological barriers including low confidence in ability to breastfeed, negative body image, embarrassment at breastfeeding in public, and experiencing stigma of obesity were also described. Support from health care professionals and family members influenced breastfeeding outcomes. Education for maternity care professionals is needed to enable them to provide tailored, evidence‐based support to women who are overweight or obese who want to breastfeed. Research on health care professionals, partners, and family members' experiences and views on supporting this group of women to breastfeed is needed to support development of appropriate interventions.
Is the Capgras delusion an endorsement of experience?
Authors: Bongiorno Federico
Published: June 2019

There is evidence indicating that the Capgras delusion is grounded in some kind of anomalous experience. According to the endorsement model, the content of the delusion is already encoded in the Capgras subject's experience, and the delusion is formed simply by endorsing that content as veridical. Elisabeth Pacherie and Sam Wilkinson have in different ways attempted to articulate a comprehensive defence of this strategy, but here I argue that the endorsement model cannot be defended along the lines envisioned by either of them. I then offer a more promising way of spelling out the model, according to which the anomalous experience implicated in Capgras is metaphorical in character.
Mutagenesis of GmFT2a and GmFT5a mediated by CRISPR/Cas9 contributes for expanding the regional adaptability of soybean
Authors: Cai Yupeng , Wang Liwei , Chen Li , Wu Tingting , Liu Luping , Sun Shi , Wu Cunxiang , Yao Weiwei , Jiang Bingjun , Yuan Shan , Han Tianfu , Hou Wensheng
Published: June 2019

Flowering time is a key agronomic trait that directly influences the successful adaptation of soybean (Glycine max) to diverse latitudes and farming systems. GmFT2a and GmFT5a have been extensively identified as flowering activators and integrators in soybean. Here, we identified two quantitative trait loci (QTLs) regions harbouring GmFT2a and GmFT5a, respectively, associated with different genetic effects on flowering under different photoperiods. We analysed the flowering time of transgenic plants overexpressing GmFT2a or GmFT5a, ft2a mutants, ft5a mutants and ft2aft5a double mutants under long‐day (LD) and short‐day (SD) conditions. We confirmed that GmFT2a and GmFT5a are not redundant, they collectively regulate flowering time, and the effect of GmFT2a is more prominent than that of GmFT5a under SD conditions whereas GmFT5a has more significant effects than GmFT2a under LD conditions. GmFT5a, not GmFT2a, was essential for soybean to adapt to high latitude regions. The ft2aft5a double mutants showed late flowering by about 31.3 days under SD conditions and produced significantly increased numbers of pods and seeds per plant compared to the wild type. We speculate that these mutants may have enormous yield potential for the tropics. In addition, we examined the sequences of these two loci in 202 soybean accessions and investigated the flowering phenotypes, geographical distributions and maturity groups within major haplotypes. These results will contribute to soybean breeding and regional adaptability.
An unusual cause of graft loss in pediatric liver transplant recipient—Fasciola hepatica
Authors: Kelgeri Chaya , Valamparampil Joseph , Shanmugam Naresh , Srinivas Reddy Mettu , Swaminathan Subramanian , Rela Mohamed
Published: June 2019

Fascioliasis is caused by the trematode liver fluke Fasciola hepatica. Humans are accidental hosts getting infected after ingesting contaminated plants or water. 90 million people in 75 nations are at risk of infection with F hepatica. Immunosuppressed patients are higher risk of acquiring infection and may present with atypical manifestations. Patients can present with hepatic involvement, biliary features or a combination of both. Confirmation of the diagnosis is by demonstration of live parasites or eggs in bile or feces, serology (immunoelectrophoresis, indirect immunofluorescence, indirect hemagglutination), ELISA, typical imaging findings or a combination of any of the above. The drug of choice for treatment is triclabendazole. Fascioliasis should always be considered as a possibility in post‐LT patients with findings of hepatobiliary disorder from endemic areas. Unfamiliarity with this infection in non‐endemic areas often eludes prompt diagnosis thereby increasing the morbidity. We report the first case of fascioliasis in a pediatric liver transplant recipient leading to graft loss and mortality.
An account of subjective probability judgment for joint events: Conjunctive and disjunctive
Authors: Fisk John E. , Marshall Dean A. , Rogers Paul , Stock Rosemary
Published: June 2019

Probability judgment is a vital part of many aspects of everyday life. In the present paper, we present a new theory of the way in which individuals produce probability estimates for joint events: conjunctive and disjunctive. We propose that a majority of individuals produce conjunctive (disjunctive) estimates by making a quasi‐random adjustment, positive or negative, from the less (more) likely component probability with the other component playing no obvious role. In two studies, we produce evidence supporting propositions that follow from our theory. First, the component probabilities do appear to play the distinct roles we propose in determining the joint event probabilities. Second, contrary to probability theory and other accounts of probability judgment, we show that the conjunctive‐less likely probability difference is unrelated to the more likely disjunctive probability difference (in normative theory these quantities are identical). In conclusion, while violating the norms of probability judgment, we argue that estimates produced in the manner we propose will be close enough to the normative values especially given the changing nature of the external environment and the incomplete nature of available information.
Intellectual functioning and executive functions in children and adolescents with attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD)
Authors: Faedda Noemi , Romani Maria , Rossetti Serena , Vigliante Miriam , Pezzuti Lina , Cardona Francesco , Guidetti Vincenzo
Published: June 2019

Several studies have shown neuropsychological deficits across multiple domains in attention deficit hyperactivity disorder (ADHD) and specific learning disorder (SLD), but differences and similarities between these disorders have been little considered. We were interested in analyzing the intellectual and executive profiles in a sample of children and adolescents, divided according to the diagnosis into the ADHD group and the SLD group, and in identifying the differences and similarities between these disorders. The sample included two clinical groups: the first included 36 children and adolescents with a diagnosis of ADHD (5–15 years; mean = 9.42; SD = 2.22) while the second included 36 children and adolescents with a diagnosis of SLD (7–15 years; mean = 9.43; SD = 2.25). The WISC‐IV was used to measure intellectual ability and the NEPSY‐II was employed to measure executive functions. The results showed that the SLD group had significantly higher scores than the ADHD group on the NEPSY‐II in the inhibition, cognitive flexibility, short‐term verbal memory and verbal working memory domains. The ANCOVA showed differences regarding the FSIQ of WISC‐IV, in that the SLD group obtaining higher scores than ADHD group. Findings showed that ADHD children are more impaired than SLD children, in particular in cognitive inhibition, cognitive flexibility, verbal memory, working memory and intellectual functioning. The recognition of the strengths and weaknesses of children and adolescents with ADHD and SLD allows to outline an educational and clinical intervention focused on their specific executive and intellectual functioning.
Are we underestimating reverse TRALI?
Authors: De Clippel Dorien , Emonds Marie‐Paule , Compernolle Veerle
Published: June 2019

BACKGROUND

Transfusion‐related acute lung injury (TRALI) is a rare but serious adverse transfusion reaction and is known to be related to anti–human leukocyte antigen (HLA) or anti–human neutrophil antigen (HNA) antibodies in donor plasma. In 2016, four of eight reported TRALI cases could not be explained by donor antibodies. It is assumed that fewer than 10% of TRALI cases are triggered by anti‐HLA or anti‐HNA antibodies in the patient's plasma (reverse TRALI).

STUDY DESIGN AND METHODS

Three cases of red blood cell (RBC)‐associated and one case of granulocyte‐associated TRALI were investigated. Data were collected on the clinical aspects of the patient and the concerned blood product. Patient's HLA antibodies were determined and the implicated donor was contacted for HLA typing. The HLA antibody identification and strength were assessed using a bead assay (Luminex Single Antigen bead assay, Immucor). For HLA typing, a polymerase chain reaction–sequence‐specific oligonucleotide method was used that also included Luminex detection.

RESULTS

In three RBC‐associated TRALI cases, HLA Class I and II antibodies found in the patient's plasma were specific for the HLA type of the transfused leukoreduced blood product. In a fourth case, HLA antibodies were found in a patient who developed TRALI after repeated granulocyte infusions. The HLA antibodies were directed against HLA antigens present on the donor WBCs.

CONCLUSION

The diagnosis of reverse TRALI was retained in four cases, suggesting that reverse TRALI is more frequent than described in the literature, especially in patients with an increased risk for having HLA antibodies.