bluuebunny/crossref_metadata_2025 huggingface dataset:
An institutional experience with The Paris System: A paradigm shift from ambiguous terminology to more objective criteria for reporting urine cytology
Authors: Roy M. , Kaushal S. , Jain D. , Seth A. , Iyer V. K. , Mathur S. R.
Published: August 2017

Background

Urine cytology is a highly specific modality for diagnosing high‐grade urothelial carcinoma (HGUC), but plagued by low sensitivity and wide inter‐observer variability mainly ascribed to the lack of an established template of reporting. The Paris System (TPS) working group proposed such a template at the 2013 International Congress of Cytology, replete with objective criteria for categorising specimens into one of the seven categories: non‐diagnostic, negative for HGUC, atypical urothelial cells, suspicious for HGUC, HGUC, low‐grade urothelial neoplasm and others (including non‐malignant entities). This study was undertaken to determine the impact of TPS criteria in the morphological interpretation of urine samples.

Methods

A total of 255 voided urine specimens from 97 patients who had follow‐up biopsies were re‐assessed according to TPS criteria and correlated with the final histological diagnosis.

Results

Sixty‐three patients were diagnosed with HGUC, and 34 had low‐grade papillary UC on biopsy. Earlier samples from 40 (41.2%) patients were categorised as merely “atypical” wheereas the “positive for malignancy” category was assigned to 33 (34%) patients. After re‐evaluation of the same cases using TPS criteria, cytological features in 44 (69.8%) out of 63 HGUC patients were correctly recognised as HGUC and samples from additional seven patients were re‐categorised as suspicious for HGUC (total 81%). The sensitivity of the HGUC category in predicting HGUC was 69.8% which rose to 81% when HGUC was grouped with suspicious for HGUC category.

Conclusion

The criteria outlined by TPS facilitated the standardisation of urine cytology reporting and significantly increased the sensitivity of diagnosing HGUC.
Emergency department visits for children with cerebral palsy: what triggers the call for help?
Authors: Murphy Nancy
Published: August 2017

This commentary is on the original article by Meehan et al. on pages 1188–1195 of this issue.
The thoracic duct and the Fontan patient
Authors: Sung Cassandra , Bass John L. , Berry James M. , Shepard Charles W. , Lindgren Bruce , Kochilas Lazaros K.
Published: August 2017

Background

Ultrasound imaging of adults with heart failure and increased central venous pressure (CVP) has shown significant thoracic duct (TD) dilation from impedance in lymphatic drainage. Elevated CVP and abnormal lymphatic drainage are implicated in severe Fontan complications, including protein losing enteropathy (PLE) and plastic bronchitis (PB). Systematic studies of TD and lymphatic circulation in children are limited, and their cervical TD normative values have not been established.

Methods

Thoracic duct imaging was attempted prospectively during routine echocardiograms performed 7/2014–9/2016 in children 5–21 years old with normal cardiovascular physiology and Fontan palliation. TD insertion to the central venous system (lympho‐venous junction) was assessed with an S12‐4 MHz transducer. For the first 34 patients, only TD ostia were measured, but ostium shape variability at the lympho‐venous junction led to including the TD arch 5–10 mm proximal to the ostium for the remaining cohort.

Results

Seventy‐nine total subjects were studied: 58 controls, 13 Fontan patients with normal systemic ventricular ejection fraction (EF) (>50%), and 8 Fontan patients with decreased EF (≤50%). Combined Fontan subjects had larger TD ostial diameters compared to controls when normalized by body surface area (median 2.6 mm/m2 vs. 2 mm/m2) (P=.04).

Conclusion

To our knowledge, this is the first systematic study of ultrasonographic TD imaging in children. Fontan patients have larger TD diameters, reflecting the impaired lymphatic circulation in patients with this physiology. Further research may provide important associations between sonographic TD features with the functional status of patients with Fontan circulation.
Modeling of coarctation of aorta in human fetuses using 3D/4D fetal echocardiography and computational fluid dynamics
Authors: Chen Zhuo , Zhou Yue , Wang Jingying , Liu Xiaowei , Ge Shuping , He Yihua
Published: August 2017

Objectives

We sought to develop a hemodynamic model of aortic and ductal arches using computational fluid dynamics (CFD) and 3D/4D spatio‐temporal image correlation (STIC) fetal echocardiography and to investigate the hemodynamics of coarctation of aorta (CoA) in human fetuses using this approach.

Methods

We obtained 3D/4D STIC fetal echocardiographic images of the aortic and ductal arches (DA) in five normal fetuses. Based on these images, we simulated the hemodynamics in the two arches using CFD. Subsequently, we reduced the dimensions of aortic isthmus from 100% to 85%, 70%, 55%, 40%, and 25% of the original dimension digitally. Numerical simulation was repeated in each condition, and flow profile, velocity, pressure, and wall shear stress (WSS) were compared with those of the baseline normal aortic and ductal arches.

Results

With the progressive narrowing in the aortic isthmus, there were alterations in the flow profile, velocity, pressure, and WSS. The downstream vortexes disappeared, and the double helix profile became single helix. When the aortic isthmus reduced by 55% in dimension, there was an exponential increase in velocity and WSS and decrease in pressure.

Conclusions

The aortic and ductal arch geometry and flow lead to the alterations in flow profile, velocity, pressure, and WSS in the aortic isthmus in normal and CoA models, which are conductive of ductal issue migration into these areas. A 55% reduction in the dimension of aortic isthmus is associated with exponential change in velocity, pressure, and WSS, a probable threshold for hemodynamically significant CoA.
A distinct clinicopathological variant of focal cortical dysplasia IIId characterized by loss of layer 4 in the occipital lobe in 12 children with remote hypoxic–ischemic injury
Authors: Wang Dan‐Dan , Piao Yue‐Shan , Blumcke Ingmar , Coras Roland , Zhou Wen‐Jing , Gui Qiu‐Ping , Liu Cui‐Cui , Hu Jing‐Xia , Cao Li‐Zhen , Zhang Guo‐Jun , Lu De‐Hong
Published: August 2017

Objective

In 2011, the International League Against Epilepsy (ILAE) proposed a consensus classification system of focal cortical dysplasia (FCD) to distinguish clinicopathological subtypes, for example, “isolated” FCD type Ia–c and IIa–b, versus “associated” FCD type IIIa–d. The histopathological differentiation of FCD type I and III variants remains, however, a challenging issue in everyday practice. We present a unique histopathological pattern in patients with difficult‐to‐diagnose FCD, which highlights this dilemma, but also helps to refine the current ILAE classification scheme of FCD.

Methods

We present a retrospective series of 11 male and one female patient with early onset pharmacoresistant epilepsy of the posterior quadrant (mean age at seizure onset = 4.6 years). All surgical specimens were reviewed. Clinical histories were retrieved and extracted from archival patient files.

Results

Microscopic inspection revealed abnormalities in cortical architecture with complete loss of layer 4 in all surgical samples of the occipital lobe, as confirmed by semiquantitative measurements (p < 0.01). Clinical history reported early transient hypoxic condition in nine patients (75%). Magnetic resonance imaging (MRI) revealed abnormal signals in the occipital lobe in all patients, and signal changes suggestive of subcortical encephalomalacia were found in seven patients. Surgical treatment achieved favorable seizure control (Engel class I and II) in seven patients with an available follow‐up period of 6.1 years.

Significance

Prominent disorganization of cortical layering and lack of any other microscopically visible principle lesion in the surgical specimen would result in this neuropathological pattern hitherto being classified as FCD ILAE type Ib. However, perinatal hypoxia with distinctive MRI changes suggested primarily a hypoxemic lesion and acquired pathomechanism of neuronal cell loss in the occipital lobe of our patient series. We propose, therefore, classifying this distinctive clinicopathological pattern as a separate variant of FCD ILAE type IIId.
Non‐profit vulnerability: An exploratory study
Authors: Zhai Rong Linda , Watson John , Gilchrist David , Newby Rick
Published: August 2017

This mixed‐method study explores the symptoms and potential causes of non‐profit vulnerability within the Australian context. Following two focus groups with CEOs and Chairs of non‐profit organizations, an online survey was developed, pilot tested and distributed to non‐profit CEOs. Our findings suggest three symptoms that might be particularly useful in identifying non‐profit vulnerability: a substantial increase in unit costs/delivery hours; a substantial increase in the proportion of administration to program expenses; and a reduced ability to pursue the organization's mission. The results also suggest various potential causes of non‐profit vulnerability; in particular, Board inadequacies; External environmental threats; Project management issues; and Funding constraints.
Alien freshwater fish species in the Balkans—Vectors and pathways of introduction
Authors: Piria Marina , Simonović Predrag , Kalogianni Eleni , Vardakas Leonidas , Koutsikos Nicholas , Zanella Davor , Ristovska Milica , Apostolou Apostolos , Adrović Avdul , Mrdak Danilo , Tarkan Ali Serhan , Milošević Dragana , Zanella Linda N , Bakiu Rigers , Ekmekçi F Güler , Povž Metka , Korro Kastriot , Nikolić Vera , Škrijelj Rifat , Kostov Vasil , Gregori Andrej , Joy Michael K
Published: August 2017

Fish introductions, particularly in areas of high biological diversity and endemism, represent a major threat for biodiversity. In the Balkan Peninsula, 60 fish species have been introduced to date, of which 36 have become naturalized in inland waters. Since the Balkans are one of the world's 35 biodiversity hot spots, this large presence of alien fish species poses a serious threat for the stability of freshwater ecosystems and the survival of the native ichthyofauna and of aquatic biodiversity in general. The motivation for the introductions, and the historical timeline, varies among the Balkan states. Despite recent attempts to implement and align legislation aimed at preventing the introduction of potentially invasive species, and the implementation of rigorous controls of introductions and increased protection of open waters, the majority of current introductions remain intentional, primarily via aquaculture. This review article provides a historical overview of freshwater fish introductions, the motivation behind them and the current distribution of alien freshwater fishes in the Balkans. The ecological implications and future perspectives concerning alien fish species in the region are also discussed.
Manipulating waterbody hydroperiod affects movement behaviour and occupancy dynamics in an amphibian
Authors: Tournier Emilie , Besnard Aurélien , Tournier Virginia , Cayuela Hugo
Published: August 2017

Species that occur in ephemeral habitats such as temporary waterbodies have evolved specific strategies that allow them to respond to spatial and temporal variations in water availability and quality. Their life‐history strategies, involving complex life cycles, have evolved to allow individuals to escape deteriorating environmental conditions when a waterbody dries up. These adaptations have led to the emergence of complex movement behaviour, which might then be expected to affect the spatiotemporal dynamics of reproduction.

To date, few empirical studies have investigated how the risks of waterbody drying out affects movement behaviour at the individual level and how movement decisions then shape waterbody occupancy dynamics. In this study, we examined this issue in an endangered amphibian, the yellow‐bellied toad (Bombina variegata). For this purpose, we experimentally manipulated waterbody hydroperiod and collected capture–recapture and presence–absence data in 334 waterbodies located in 15 B. variegata populations in the region of Geneva (Switzerland) during a 5‐year period (2012–2016).

The results of our analyses reveal that the waterbody hydroperiod affects this species' movement behaviour. Adults were less likely to leave waterbodies with a long hydroperiod both intra‐ and inter‐annually. In addition, breeding occupancy strongly depended on a waterbody's hydroperiod. In particular, interannual changes in breeding occurrence were less frequent in waterbodies with a long hydroperiod.

Our findings show that the hydroperiod strongly affects ecological processes at different levels, from individuals' movement decisions to waterbody occupancy dynamics. The results demonstrate that adults adjust their movement decisions according to the risk of breeding failure driven by the hydroperiod, which then affects the waterbody occupancy dynamics.
Influence of experimental, environmental, and geographic factors on nutrient‐diffusing substrate experiments in running waters
Authors: Beck Whitney S. , Rugenski Amanda T. , Poff N. LeRoy
Published: August 2017

Freshwater algal growth is often limited by the availability of nitrogen (N), phosphorus (P), or both nutrients (NP). For over 30 years, investigators have conducted nutrient‐diffusing substrate (NDS) experiments to quantify algal nutrient limitation or co‐limitation in rivers and streams. Previous meta‐analyses of NDS have shown that algae are commonly co‐limited by N and P and that water column nutrients are weakly predictive of limitation. These analyses have not, however, comprehensively addressed the experimental, environmental, and geographic covariates affecting nutrient limitation results.

We surveyed the literature and extracted data for algal biomass effect sizes and a suite of covariates across a total of 649 experiments. We built meta‐regression models to identify important controls on NDS results and to gain insights about algal nutrient limitation patterns over space and time. We also reviewed potential mechanisms for the reported result that NDS N and P treatments can inhibit algal growth.

Experimental variables including substrate type, chemical concentration, and experimental length significantly affected P and NP effect sizes, while NDS chemical compound influenced N, P, and NP effect sizes. We also found that environmental variables such as in‐stream nutrients and riparian canopy cover significantly affected limitation by N, P, and NP. Temperature, stream discharge, and stream velocity only affected limitation by NP. Land use, ecoregion, and season showed clear trends in nutrient limitation for all treatments that could generally be tied to environmental factors like in‐stream nutrients and riparian canopy cover.

Most experimental and environmental variables that were statistically significant in the meta‐regression models produced very low R2 index values, indicating that the models explained little variation in among‐site effect sizes. Spatial factors including stream order, ecoregion, and climate classification had the highest R2 index values, but these models still produced a large amount of unexplained variance.

In light of these findings, we provide recommendations for improving NDS experimental design and pursuing future research avenues using NDS. We also highlight the need for future experiments to consider algal stressors that may interact with nutrient limitation experiments.
Comparison of periphyton communities on natural and artificial macrophytes with contrasting morphological structures
Authors: Hao Beibei , Wu Haoping , Cao Yu , Xing Wei , Jeppesen Erik , Li Wei
Published: August 2017

It remains an open question whether or not artificial macrophytes are good alternatives to natural macrophytes in studies of periphyton abundance and composition in lakes. Here, a mesocosm experiment was conducted in winter (when plant growth is low) to compare simultaneously the periphyton community on three submerged macrophytes (Potamogeton lucens, Vallisneria sp. and Cabomba caroliniana) with contrasting leaf structural complexities (leaf fractal dimension = 1.12, 1.17 and 1.37, respectively) and on three types of artificial macrophytes with similar morphologies as the natural plants. We also compared intertreatment differences in phytoplankton sampled from mesocosms.

Both for natural and artificial macrophytes, the periphyton chlorophyll a (Chl‐a) was positively associated with leaf fractal dimension. Although the morphological structure of natural and artificial plants and the physicochemical characteristics of the water were similar, the periphyton community differed between natural and artificial macrophytes, with the difference being dependent on the leaf structural complexity of the macrophytes. For leaves with a simple structural complexity, the abundance and composition of periphyton on natural and artificial plants were not statistically different. In addition, periphyton Chl‐a, density and biovolume were higher on the adaxial side than on the abaxial side of natural P. lucens leaves, but no differences were found between sides of the artificial leaves.

For leaves with a medium structural complexity, the abundance of periphyton was lower on the natural than artificial plants, and the proportion of diatoms to the total community differed. For leaves with a high structural complexity, periphyton Chl‐a of the artificial plants was notably higher than on the natural plants, while no significant differences were found for periphyton density, biovolume, and the proportion of diatoms and green algae.

Permutational multivariate analysis of periphyton genus composition confirmed that periphyton composition on the artificial plants (medium and high leaf structural complexities) was different overall from that on the natural plants.

Phytoplankton Chl‐a, density, biovolume, and diversity did not show any pronounced differences among treatments.

Our results suggest that artificial macrophytes cannot fully substitute for natural plants even when they are morphologically similar. Artificial macrophytes should therefore be used with caution when investigating the periphyton community on macrophytes.
Population density–range size relationship revisited
Authors: Novosolov Maria , Rodda Gordon H. , North Alexandra C. , Butchart Stuart H. M. , Tallowin Oliver J. S. , Gainsbury Alison M. , Meiri Shai
Published: August 2017

Aim

The species population density–range size relationship posits that locally abundant species are widely distributed. However, this proposed pattern has been insufficiently tested. The few tests conducted were usually limited in scale and gave conflicting results. We tested the generality of the positive population density–range size relationship. We then studied whether similar environmental niche requirements are correlated with range size and with population density to search for mechanisms driving the hypothesized link between population density and range size.

Location

Worldwide.

Methods

We collected data on population density, range size and environmental niche for a global dataset of 192 lizard, 893 bird and 350 mammal species. Assessing the relationship between population density and range size and environmental niche parameters, we corrected for phylogenetic relationships, body mass, diet and study area.

Results

Our findings reveal that density had a weak negative correlation with bird range size and was unrelated to lizard and mammal range size. These trends were consistent at the global scale and across the biogeographical realms. Range size was related to relatively similar environmental niche parameters in all groups. Population density, however, was explained by taxon‐specific factors and was therefore unrelated to range size by common causation.

Main conclusions

We suggest that the positive relationship between population density and range size identified in previous studies might be an artefact arising through incomplete sampling of range sizes. Our results indicate that the mechanisms shaping population density and range size may be independent.
Does Administrative Status Matter for Urban Growth? Evidence from Present and Former County Capitals in East Germany
Authors: Heider Bastian , Rosenfeld Martin T. W. , Kauffmann Albrecht
Published: August 2017

Public sector activities are often neglected in the economic approaches used to analyze the driving forces behind urban growth. The institutional status of a regional capital is a crucial aspect of public sector activities. This paper reports on a quasi‐natural experiment on county towns in East Germany. Since 1990, East German cities have demonstrated remarkable differences in population development. During this same period, many towns have lost their status as a county seat due to several administrative reforms. Using a difference‐in‐differences approach, we compare the annual population development of former county capitals to population change in towns that have successfully held on to their capital status throughout the observed period. The estimations show that losing county capital status has a statistically significant negative effect on annual changes in population. This effect continues to increase over time after the respective reforms have been implemented.
Protective efficacy of a hydroxy fatty acid against gastric Helicobacter infections
Authors: Matsui Hidenori , Takahashi Tetsufumi , Murayama Somay Y. , Kawaguchi Marina , Matsuo Koichi , Nakamura Masahiko
Published: August 2017

Background

We have previously revealed that omega‐3 polyunsaturated fatty acids can prevent Helicobacter pylori infection by blocking the futalosine pathway, an alternative route for menaquinone (MK) biosynthesis.

Materials and Methods

1, Different H. pylori strains were grown in liquid media supplemented with linoleic acid, an omega‐6 fatty acid, or its 10‐hydroxy derivative, 10‐hydroxy‐cis‐12‐octadecenoic acid (HYA), in the presence or absence of MK. The bacterial numbers in the media were estimated by plating; 2, C57BL/6NCrl mice received drinking water supplemented with different fatty acids starting from 1 week before infection with H. pylori or Helicobacter suis until the end of the experiment. The gastric colonization levels of H. pylori or H. suis were determined 2 weeks after infection by plating or quantitative PCR, respectively; 3, Mice were given HYA, starting 1 week before infection with H. suis and continuing until 6 months after infection, for analysis of the gastric conditions.

Results

1, A low concentration (20 μmol/L) of HYA in culture broth suppressed the growth of H. pylori, and this inhibition was reduced by MK supplementation; 2, HYA treatment protected mice against H. pylori or H. suis infection; 3, HYA treatment suppressed the formation of lymphoid follicles in the gastric mucus layer after H. suis infection.

Conclusions

HYA prevents gastric Helicobacter infections by blocking their futalosine pathways. Daily HYA supplementation is effective for the prevention of gastric mucosa‐associated lymphoid tissue lymphoma induced by persistent infection with H. suis.
Interleukin‐10 secreted by mesenchymal stem cells attenuates acute liver failure through inhibiting pyroptosis
Authors: Wang Jinglin , Ren Haozhen , Yuan Xianwen , Ma Hucheng , Shi Xiaolei , Ding Yitao
Published: August 2017

Aim

Recently, the benefit of mesenchymal stem cells (MSCs) as a cell‐based therapy for acute liver failure (ALF) has gained much attention, although the mechanism of action of MSCs in the treatment of ALF remains elusive. Pyroptosis is a novel form of programmed cell death with an intense inflammatory response. The aim of the present study was to explore the soluble cytokines secreted by MSCs and their therapeutic effects through inhibiting pyroptosis in ALF.

Methods

Mesenchymal stem cells obtained from C57BL/6 mice were isolated and cultured according to an established protocol. The MSCs were transplanted into mice with D‐galactosamine (D‐Gal)‐induced ALF. Liver function, survival rate, histology, and inflammatory factors were determined. Exogenous recombinant rat interleukin (IL)‐10, ShIL‐RNA, and MCC950 (NLRP3 inhibitor) were given to the mice to explore the therapeutic mechanism of MSCs. Statistical analyses were carried out with spss version 19.0, and all data were analyzed by independent‐samples t‐test.

Results

Injection of IL‐10 or MSC transplantation ameliorated D‐Gal‐induced increase in alanine aminotransferase, aspartate aminotransferase, total bilirubin, NH3, and inflammatory cytokines. Blockage of IL‐10 confirmed the therapeutic significance of this cytokine.

Conclusion

Pyroptosis was inhibited after IL‐10 infusion and inhibition of NLRP3 by MCC950 reversed liver dysfunction.
Pharmacist awareness and views towards counterfeit medicine in Lebanon
Authors: Sholy Lydia , Gard Paul , Williams Sian , MacAdam Angela
Published: August 2017

Background

Pharmacists, as healthcare professionals, have patients' well-being and safety as their primary concern. However, the safety and efficacy of treatments may be compromised by the availability of counterfeit medicine (CFM) which could have serious consequences for public health.

Objectives

To assess pharmacist awareness and views towards CFM in Lebanon.

Methods

The study used convenience sampling and selected pharmacists based on their willingness to participate and used a questionnaire as a tool to determine their experiences and views towards CFM. The questionnaires were completed in different regions in Lebanon.

Key findings

A total of 223 pharmacists participated in the study, and all were able to define CFM, however were inconsistent in their definitions. The majority reported identifying CFM by the medicine’s effect (67.7%), followed by cost (66.8%). Almost 43% reported knowing of pharmacists who dispensed CFM. Additionally, participants reported that they believed that pharmacists who dealt with CFM were unprofessional (89.2%) and unethical (86.5%), and that they did it for the ‘easy money’ (87.9%) and large profit (86.5%).

Conclusion

The study highlighted the need for additional CFM awareness campaigns with an emphasis on the role that pharmacists have in protecting patients from using CFM. In addition, there is a need for an official CFM definition that distinguishes between the different types of counterfeiting. Furthermore, the Lebanese Ministry of Public Health and regulatory authorities should control and secure the supply chain of medicine in the country and enforce the law.
Persistence and adherence to overactive bladder medications in Japan: A large nationwide real‐world analysis
Authors: Kato Daisuke , Uno Satoshi , Van Schyndle James , Fan Alan , Kimura Tomomi
Published: August 2017

Objectives

To evaluate persistence and adherence to mirabegron and antimuscarinics in Japan using data from two administrative databases.

Methods

The present retrospective study evaluated insurance claims for employees and dependents aged ≤75 years, and pharmacy claims for outpatients. From October 2012 to September 2014, new users of mirabegron or five individual antimuscarinics indicated for overactive bladder in Japan (fesoterodine, imidafenacin, propiverine, solifenacin and tolterodine) were identified and followed for 1 year. Persistence with mirabegron and antimuscarinics were evaluated using Kaplan–Meier methods. Any associations between baseline characteristics (age, sex and previous medication use) and persistence were explored. Adherence was assessed using the medication possession ratio.

Results

In total, 3970 and 16 648 patients were included from the insurance and pharmacy claims databases, respectively. Mirabegron treatment was associated with longer median persistence compared with antimuscarinics (insurance claims: 44 [95% confidence intervals 37–56] vs 21 [14–28] to 30 [30–33] days, pharmacy claims: 105 [96–113] vs 62 [56–77] to 84 [77–86] days). The results were consistent when patients were stratified by age, sex and previous medication. Persistence rate at 1 year was higher for mirabegron (insurance claims: 14.0% [11.5–16.8%] vs 5.4% [4.1–7.0%] to 9.1% [5.3–14.2%], pharmacy claims: 25.9% [24.6–27.3%] vs 16.3% [14.0–18.6%] to 21.3% [20.2–22.4%]). Compared with each antimuscarinic, a higher proportion of mirabegron‐treated patients had medication possession ratios ≥0.8.

Conclusions

This large nationwide Japanese study shows that persistence and adherence are greater with mirabegron compared with five antimuscarinics.
Barrier‐free communication in maternity care of allophone migrants: BRIDGE study protocol
Authors: Origlia Ikhilor Paola , Hasenberg Gabriele , Kurth Elisabeth , Stocker Kalberer Barbara , Cignacco Eva , Pehlke‐Milde Jessica
Published: August 2017

Aim

To describe communication and access barriers encountered by allophone women of different migration backgrounds in the Swiss maternity care services, from the perspective of users, healthcare professionals and intercultural interpreters.

Background

In addition to the challenges of maternal adjustment, pregnant migrant women must also deal with an unfamiliar health service system. Some must overcome language barriers and the stress of uncertain residence status. Limited access to maternity care increases perinatal morbidity and mortality. Almost 10% of foreigners speak none of Switzerland's official languages. Factors that facilitate or hinder communication between migrant women and perinatal healthcare professionals are under‐studied and must be understood if we are to overcome those barriers in clinical practice.

Design

Qualitative exploratory study with quantitative sub‐study.

Methods

Participants will be drawn from German to speaking regions of Switzerland. We will conduct focus group discussions and semi‐structured interviews with users in their own language (Albanian and Tigrinya) and with healthcare professionals and intercultural interpreters (March–June 2016), then perform Thematic Analysis on the data. In the sub‐study, midwives will report their experience of using a telephone interpreting service during postnatal home visits in a questionnaire (October 2013–March 2016). Data will be analysed with descriptive statistics.

Discussion

Our study will reveal patterns in communications between allophone migrant women and healthcare providers and communication barriers. By incorporating multiple perspectives, we will describe the challenges all parties face. Our results will inform those who draft recommendations to improve provision of maternity care to allophone women and their families.

Trial Registration

ClinicalTrials.gov ID: BernUAS NCT02695316.
Clinical evaluation of a new pressure ulcer risk assessment instrument, the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T)
Authors: Coleman Susanne , Smith Isabelle L. , McGinnis Elizabeth , Keen Justin , Muir Delia , Wilson Lyn , Stubbs Nikki , Dealey Carol , Brown Sarah , Nelson E. Andrea , Nixon Jane
Published: August 2017

Aim

To test the psychometric properties and clinical usability of a new Pressure Ulcer Risk Assessment Instrument including inter‐rater and test–retest reliability, convergent validity and data completeness.

Background

Methodological and practical limitations associated with traditional Pressure Ulcer Risk Assessment Instruments, prompted a programme to work to develop a new instrument, as part of the National Institute for Health Research funded, Pressure UlceR Programme Of reSEarch (RP‐PG‐0407‐10056).

Design

Observational field test.

Method

For this clinical evaluation 230 patients were purposefully sampled across four broad levels of pressure ulcer risk with representation from four secondary care and four community NHS Trusts in England. Blinded and simultaneous paired (ward/community nurse and expert nurse) PURPOSE‐T assessments were undertaken. Follow‐up retest was undertaken by the expert nurse. Field notes of PURPOSE‐T use were collected. Data were collected October 2012–January 2013.

Results

The clinical evaluation demonstrated “very good” (kappa) inter‐rater and test–retest agreement for PURPOSE‐T assessment decision overall. The percentage agreement for “problem/no problem” was over 75% for the main risk factors. Convergent validity demonstrated moderate to high associations with other measures of similar constructs.

Conclusion

The PURPOSE‐T evaluation facilitated the initial validation and clinical usability of the instrument and demonstrated that PURPOSE‐T is suitable of use in clinical practice. Further study is needed to evaluate the impact of using the instrument on care processes and outcomes.
Genetic testing in intellectual disability psychiatry: Opinions and practices of UK child and intellectual disability psychiatrists
Authors: Wolfe Kate , Stueber Kerstin , McQuillin Andrew , Jichi Fatima , Patch Christine , Flinter Frances , Strydom André , Bass Nick
Published: August 2017

Background

An increasing number of genetic causes of intellectual disabilities (ID) are identifiable by clinical genetic testing, offering the prospect of bespoke patient management. However, little is known about the practices of psychiatrists and their views on genetic testing.

Method

We undertook an online survey of 215 psychiatrists, who were contacted via the Royal College of Psychiatrist's Child and Adolescent and Intellectual Disability Psychiatry mailing lists.

Results

In comparison with child and adolescent psychiatrists, intellectual disability psychiatrists ordered more genetic tests, referred more patients to genetic services, and were overall more confident in the genetic testing process. Respondents tended to agree that genetic diagnoses can help patient management; however, management changes were infrequently found in clinical practice.

Conclusions

Differences are apparent in the existing views and practices of child and adolescent and intellectual disability psychiatrists. Developing training and collaboration with colleagues working in genetic services could help to reduce discrepancies and improve clinical practice.
The transition to adulthood of young adults with IDD: Parents’ joint projects
Authors: Young Richard A. , Marshall Sheila K. , Stainton Tim , Wall Jessie M. , Curle Deirdre , Zhu Ma , Munro David , Murray John , El Bouhali Asmae , Parada Filomena , Zaidman‐Zait Anat
Published: August 2017

INTRODUCTION

Parents have found the transition to adulthood for their sons or daughters with intellectual and/or developmental disabilities (IDD) particularly challenging. The literature has not examined how parents work together and with others in face of this transition nor has it highlighted parental goals in this process. This study used a perspective based on joint, goal‐direct action to describe the projects that Canadian parents engaged in together and with others relative to this transition.

Methods

Using the qualitative action‐project method, joint projects between parents and with others were identified from their conversations and followed for 6 months.

Findings

Three groups of projects were described: equipping the young adult for adult life, connecting for personal support and managing day‐to‐day while planning for the future.

Conclusions

Parents act together and with others relative to the transition to adulthood of their young adult children with IDD. These projects are complex and differ in goals, steps, resources and emotional regulation and motivation.
Stress in caregivers of individuals with intellectual or developmental disabilities: A systematic review of mindfulness‐based interventions
Authors: Ó Donnchadha Seán
Published: August 2017

Background

The efficacy of mindfulness‐based interventions (MBIs) for stress and psychological distress in professional caregivers supporting individuals with intellectual or developmental disabilities (IDDs) is reviewed.

Methods

Eight studies met inclusion criteria and were systematically reviewed, including RCTs and single‐group designs.

Results

As per Reichow, Volkmar, and Cicchetti (Journal of Autism and Developmental Disorders, 38, 2008), three studies were classified as “adequate quality” and five were classified as “weak.” There were inconsistent findings in relation to stress, with significant reductions or increases reported by caregivers following MBIs. MBIs consistently improved caregivers’ ratings of distress. Process outcomes suggested increased mindful awareness, increased cognitive defusion and reduced thought suppression. Treatment effects were maintained or continued to grow at follow‐up.

Conclusions

Caregivers of individuals with IDDs face multiple challenges on a daily basis. This review supports, at least, short‐term benefits for MBIs in the management of stress and distress in caregivers of individuals with IDDs.
Self‐ and proxy‐rated needs in adults with mild to moderate intellectual disabilities: Perspective matters
Authors: Schützwohl Matthias , Voß Elke , Salize Hans Joachim , Stiawa Maja , Puschner Bernd , Koch Andrea
Published: August 2017

Background

Adults with an intellectual disability should be supported according to their individual needs. The perception of need, however, is influenced by the values and expectations of the judging person.

Method

Using the Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities, self‐ and proxy‐rated needs of n = 193 adults with mild to moderate intellectual disability were compared.

Results

Mean total needs and met needs, but not unmet needs, differed significantly between perspectives. As concerns the assessment of specific areas of need, indices revealed a complex and multifaceted pattern of agreement and disagreement.

Conclusion

Different viewpoints should be considered when assessing needs among adults with intellectual disability. With respect to areas other than basic, everyday areas of need, involvement of the adult with intellectual disability is strongly recommended. The assessment of mental health problems requires the involvement of clinical professionals, assessing problem behavior broad diagnostic measures beyond a standardized instrument.
Implications of SNP weighting on single‐step genomic predictions for different reference population sizes
Authors: Lourenco D. A. L. , Fragomeni B. O. , Bradford H. L. , Menezes I. R. , Ferraz J. B. S. , Aguilar I. , Tsuruta S. , Misztal I.
Published: August 2017

We investigated the importance of SNP weighting in populations with 2,000 to 25,000 genotyped animals. Populations were simulated with two effective sizes (20 or 100) and three numbers of QTL (10, 50 or 500). Pedigree information was available for six generations; phenotypes were recorded for the four middle generations. Animals from the last three generations were genotyped for 45,000 SNP. Single‐step genomic BLUP (ssGBLUP) and weighted ssGBLUP (WssGBLUP) were used to estimate genomic EBV using a genomic relationship matrix (G). The WssGBLUP performed better in small genotyped populations; however, any advantage for WssGBLUP was reduced or eliminated when more animals were genotyped. WssGBLUP had greater resolution for genome‐wide association (GWA) as did increasing the number of genotyped animals. For few QTL, accuracy was greater for WssGBLUP than ssGBLUP; however, for many QTL, accuracy was the same for both methods. The largest genotyped set was used to assess the dimensionality of genomic information (number of effective SNP). The number of effective SNP was considerably less in weighted G than in unweighted G. Once the number of independent SNP is well represented in the genotyped population, the impact of SNP weighting becomes less important.
Evaluating hypotheses of expansion from refugia through comparative phylogeography of south‐eastern Coastal Plain amphibians
Authors: Barrow Lisa N. , Soto‐Centeno J. Angel , Warwick Alexa R. , Lemmon Alan R. , Moriarty Lemmon Emily
Published: August 2017

Aim

Early genetic studies in the south‐eastern United States provided the foundation for ideas in the field of comparative phylogeography, but few direct comparisons with consistent sampling across taxa exist for this region. We investigate the influence of historical processes and species‐level characteristics on phylogeographic structure within four anuran species, evaluate previously described biogeographic patterns, and test three hypotheses of expansion from putative glacial refugia.

Location

South‐eastern United States Coastal Plain.

Methods

We sampled four anuran species from the same 36 localities, assembled mitochondrial genomes from Illumina sequence data and estimated phylogenetic relationships and divergence times within each species. We used spatially explicit phylogeographic analyses and ecological niche models (ENMs) to test predictions about expansion from putative glacial refugia and estimate species‐specific parameters including dispersal, migration direction and centre of origin. ENMs for four different time periods were compared within species to assess niche stability.

Results

Species differ in patterns of mitochondrial divergence, with only one species displaying a pattern consistent with the previously described Alabama suture zone. Few predictions for hypotheses of expansion from putative glacial refugia were met. ENMs suggest that species have responded differently to historical changes in climate, possibly contributing to discordant genetic patterns. Two species with deep mitochondrial divergences (>2.5 Ma) had low niche stability through time and potentially isolated regions of suitable habitat, whereas the two species with relatively stable, continuous niches exhibit less genetic structure.

Main conclusions

These Coastal Plain anurans appear to have been affected by historical climate change, but were not necessarily isolated in glacial refugia. Different natural history characteristics have likely produced discordant patterns in these species, with more generalist, ephemeral breeders exhibiting greater niche stability and lower phylogeographic structure.
The sawtooth EKG pattern of typical atrial flutter is not related to slow conduction velocity at the cavotricuspid isthmus
Authors: Sau Arunashis , Sikkel Markus B. , Luther Vishal , Wright Ian , Guerrero Fernando , Koa‐Wing Michael , Lefroy David , Linton Nicholas , Qureshi Norman , Whinnett Zachary , Lim Phang Boon , Kanagaratnam Prapa , Peters Nicholas S. , Davies D. Wyn
Published: August 2017

Introduction

We hypothesized that very high‐density mapping of typical atrial flutter (AFL) would facilitate a more complete understanding of its circuit. Such very high‐density mapping was performed with the RhythmiaTM (Boston Scientific) mapping system using its 64 electrode basket catheter.

Methods and results

Data were acquired from 13 patients in AFL. Functional anatomy of the right atrium (RA) was readily identified during mapping including the Crista Terminalis and Eustachian ridge. The leading edge of the activation wavefront was identified without interruption and its conduction velocity (CV) was calculated. CV was not different at the cavotricuspid isthmus (CTI) compared to the remainder of the RA (1.02 vs. 1.03 m/s, P = 0.93). The sawtooth pattern of the surface electrocardiogram (EKG) flutter waves was compared to the position of the dominant wavefront. The downslope of the surface EKG flutter waves represented on average 73% ± 9% of the total flutter cycle length. During the downslope, the activation wavefront traveled significantly further than during the upslope (182 ± 21 milliseconds vs. 68 ± 29 milliseconds, P < 0.0001) with no change in CV between the two phases (0.88 vs. 0.91 m/s, P = 0.79).

Conclusion

CV at the CTI is not slower than other RA regions during typical AFL. The gradual downslope of the sawtooth EKG  is not due to slow conduction at the CTI suggesting that success of ablation at this site relates to anatomical properties rather than the presence of a “slow isthmus.”
Loss‐of‐function mutations in filaggrin gene and malignant melanoma: a case–control study
Authors: Thyssen J.P. , Andersen Y.M.F. , Balslev E. , Szecsi P.B. , Stender S. , Kaae J. , Linneberg A. , Skov L.
Published: August 2017

Background

Loss‐of‐function mutations in filaggrin gene (FLG) have been suggested to increase the susceptibility of skin malignancies due to reduced levels of epidermal filaggrin and its degradation products, urocanic acid, which may be protective against ultraviolet irradiation.

Objective

We aimed to investigate the association between FLG mutation status and the occurrence of malignant melanoma (MM) in Danish adults.

Methods

The prevalence of FLG mutations in a sample of MM biopsies was compared with a FLG‐genotyped cohort from two general population studies. Pearson's chi‐squared and Fisher's exact tests were used to compare the two groups.

Results

A total of 867 MM biopsies and 9965 general population controls were genotyped, respectively. In the MM sample, two (0.23%) individuals were homozygous and 80 (9.4%) were heterozygous mutation carriers. In the general population controls, the prevalence of FLG mutations was 18 (0.18%) and 835 (8.4%) for homozygous and heterozygous mutations, respectively. Fisher's exact test and Pearson's chi‐squared test yielded non‐significant P‐values when the groups were compared.

Conclusion

FLG mutation was not associated with MM in the studied populations. This finding indicates that epidermal deficiency of filaggrin and its degradation products does not influence the risk of MM significantly.
Moderate to severe hidradenitis suppurativa patients do not have an altered bacterial composition in peripheral blood compared to healthy controls
Authors: Ring H.C. , Thorsen J. , Saunte D.M. , Lilje B. , Bay L. , Theut Riis P. , Larsen N. , O'Brien Andersen L. , Vedel Nielsen H. , Miller I.M. , Bjarnsholt T. , Fuursted K. , Jemec G.B.
Published: August 2017

Background

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease defined by recurrent nodules, tunnels and scarring involving the intertriginous skin. Patients with HS often report an array of systemic symptoms such as fatigue and malaise. The aetiology of these symptoms remains unclear. Previously, various bacteria have been associated with mature HS lesions, and bacteraemia has been reported in patients with HS using traditional culturing methods. Thus, we hypothesized that a low‐grade bacteraemia contributes to the symptomatology in patients with HS.

Objective

To explore the potential presence of bacteraemia in patients with HS and healthy controls.

Method

A case–control study. Compositions of bacteria in the blood of 27 moderate to severe HS patients and 26 healthy controls were investigated using next‐generation 16S ribosomal RNA gene sequencing (NGS) and routine anaerobic and aerobic blood culturing.

None of the participants received any antibiotics (systemic or topical therapy) within 1 month prior to the study. HS patients with a recent flare were randomly selected by consecutive recruitment of eligible patients from the Department of Dermatology, Zealand University Hospital, Denmark. Healthy controls were recruited from the University of Copenhagen as well as from the healthcare staff.

Results

The different bacterial compositions were investigated using NGS and traditional anaerobic and aerobic blood culturing. Our NGS analysis provided a previously unreported characterization of the bacterial composition in peripheral blood from patients with HS and healthy controls. Overall, our data demonstrated that patients with HS do not have a different bacterial composition in their peripheral blood than healthy controls.

Conclusion

The study suggests that the self‐reported symptoms in HS such as malaise and fatigue may not be linked to bacteraemia.