bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of lidocaine plaster prescribing reduction strategies: A comparison of two national health services in Europe
Authors: Mattsson Molly , Boland Fiona , Kirke Ciara , Flood Michelle , Wallace Emma , Walsh Mary E. , Corrigan Derek , Fahey Tom , Croker Richard , Bacon Sebastian C. J. , Inglesby Peter , Evans David , Goldacre Ben , MacKenna Brian , Moriarty Frank
Published: May 2023

Aims

In 2017, two distinct interventions were implemented in Ireland and England to reduce prescribing of lidocaine medicated plasters. In Ireland, restrictions on reimbursement were introduced through implementation of an application system for reimbursement. In England, updated guidance on items which should not be routinely prescribed in primary care, including lidocaine plasters, was published. This study aims to compare how the interventions impacted prescribing of lidocaine plasters in these countries.

Methods

We conducted an interrupted time‐series study using general practice data. For Ireland, monthly dispensing data (2015–2019) from the means‐tested General Medical Services (GMS) scheme was used. For England, data covered all patients. Outcomes were the rate of dispensings, quantity and costs of lidocaine plasters, and we modelled level and trend changes from the first full month of the policy/guidance change.

Results

Ireland had higher rates of lidocaine dispensings compared to England throughout the study period; this was 15.22/1000 population immediately pre‐intervention, and there was equivalent to a 97.2% immediate reduction following the intervention. In England, the immediate pre‐intervention dispensing rate was 0.36/1000, with an immediate reduction of 0.0251/1000 (a 5.8% decrease), followed by a small but significant decrease in the monthly trend relative to the pre‐intervention trend of 0.0057 per month.

Conclusions

Among two different interventions aiming to decrease low‐value lidocaine plaster prescribing, there was a substantially larger impact in Ireland of reimbursement restriction compared to issuing guidance in England. However, this is in the context of much higher baseline rates of use in Ireland compared to England.
A sequential Bayesian changepoint detection procedure for aberrant behaviours in computerized testing
Authors: Lu Jing , Wang Chun , Zhang Jiwei , Wang Xue
Published: May 2023

Changepoints are abrupt variations in a sequence of data in statistical inference. In educational and psychological assessments, it is essential to properly differentiate examinees' aberrant behaviours from solution behaviour to ensure test reliability and validity. In this paper, we propose a sequential Bayesian changepoint detection algorithm to monitor the locations of changepoints for response times in real time and, subsequently, further identify types of aberrant behaviours in conjunction with response patterns. Two simulation studies were conducted to investigate the efficiency and accuracy of the proposed detection procedure in terms of identifying one or multiple changepoints at different locations. In addition to manipulating the number and locations of changepoints, two types of aberrant behaviours were also considered: rapid guessing behaviour and cheating behaviour. Simulation results indicate that ability estimates could be improved after removing responses from aberrant behaviours identified by our approach. Two empirical examples were analysed to illustrate the application of the proposed sequential Bayesian changepoint detection procedure.
The sodium‐glucose cotransporter‐2 inhibitor canagliflozin does not increase risk of non‐genital skin and soft tissue infections in people with type 2 diabetes mellitus: A pooled post hoc analysis from the CANVAS Program and CREDENCE randomized double‐blind trials
Authors: Kang Amy , Smyth Brendan , Neuen Brendon L. , Heerspink Hiddo J. L. , Di Tanna Gian Luca , Zhang Hong , Arnott Clare , Hockham Carinna , Agarwal Rajiv , Bakris George , Charytan David M. , de Zeeuw Dick , Greene Tom , Levin Adeera , Pollock Carol , Wheeler David C. , Mahaffey Kenneth W. , Perkovic Vlado , Jardine Meg J.
Published: May 2023

Aims

To assess whether the sodium‐glucose cotransporter‐2 (SGLT2) inhibitor canagliflozin affects risk of non‐genital skin and soft tissue infections (SSTIs).

Materials and methods

We performed a post hoc pooled individual participant analysis of the CANVAS Program and CREDENCE trials that randomized people with type 2 diabetes at high cardiovascular risk and/or with chronic kidney disease to either canagliflozin or placebo. Investigator‐reported adverse events were assessed by two blinded authors following predetermined criteria for non‐genital SSTIs. Risks of non‐genital SSTIs, overall and within prespecified subgroups, and risk of non‐genital fungal SSTIs, were analysed using Cox regression models. Factors associated with non‐genital SSTIs were assessed using multivariable Cox regression models.

Results

Overall, 903 of 14 531 participants (6%) experienced non‐genital SSTIs over a median follow‐up of 26 months. No difference was observed in non‐genital SSTI rates between canagliflozin and placebo (24.0 events/1000 person‐years vs. 23.9 events/1000 person‐years, respectively; hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.85‐1.11; P = 0.70), with consistent results across subgroups (all P interaction > 0.05). The risk of recurrent events and non‐genital fungal infection also did not differ significantly between canagliflozin and placebo (HR 1.06, 95% CI 0.94‐1.19 [P = 0.32] and HR 1.18, 95% CI 0.88‐1.60 [P = 0.27], respectively). Baseline factors independently associated with non‐genital SSTIs were younger age, male sex, higher body mass index, higher glycated haemoglobin, lower estimated glomerular filtration rate (eGFR), established peripheral vascular disease, and history of neuropathy.

Conclusions

Canagliflozin did not affect risk of non‐genital SSTIs or non‐genital fungal SSTIs compared with placebo. These findings suggest that any SGLT2 inhibitor‐mediated change in skin microenvironment is unlikely to have meaningful clinical consequences.
The views of European students on the inclusion of research in undergraduate Oral Health Professional curricula
Authors: Serban Christa , Dixon Jonathan , Adam Marta , Par Matej , Ligusovà Ivana , Field James
Published: May 2023

Introduction

The education of Oral Health Professionals (OHPs) is variable across Europe and consequently, there is concern that research skills are not consistently or optimally integrated into European OHP curricula. The aim of this study is to investigate the perspectives of European OHP students regarding the inclusion of research in the undergraduate curriculum.

Materials and Methods

A 21‐question online survey was administered to dental, dental hygiene, and dental hygiene and therapy students across Europe. Informed consent was obtained from participants and all responses remained confidential. Quantitative and qualitative methods were used to analyse the data.

Results

A total of 825 student responses to the survey from 33 European countries were eligible for inclusion. The results demonstrated that OHP students recognise the importance of research in the dental field and value the inclusion of research in the curriculum. Although students indicated that they are interested to learn more about research, the survey results also showed that students had neutral opinions towards the existing curriculum providing enough training about research.

Conclusion

European OHP students agree on the need for an open and explicit research curriculum in OHP education. The development of a research domain within an open curriculum framework would help to harmonise the teaching and assessment of OHP research skills across Europe and ultimately improve graduating OHP's research skills.
Molecular changes in hippocampal energy metabolism in mice selectively bred for extremes in stress reactivity: Relevance of mitochondrial dysfunction for affective disorders
Authors: Rappeneau Virginie , Koti Prasanna , Wilmes Lars , Widner‐Andrae Regina , Busch Karin , Touma Chadi
Published: May 2023

Affective disorders, such as major depression, are frequently associated with metabolic disturbances involving mitochondria. Although dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis is known to alter energy metabolism, the precise mechanisms linking stress and metabolic disturbances are not sufficiently understood. We used a mouse model of affective disorders to investigate the impact of a genetic predisposition for extremes in stress reactivity on behavioural and metabolic phenotypes as well as energy metabolism. Adult males of three independent mouse lines selectively bred for high, intermediate or low HPA axis reactivity were tested for exploratory and locomotor activity as well as stress‐coping behaviour. Additionally, basal and stress‐induced plasma corticosterone levels, body weight, food intake and body composition were measured. At the molecular level, the hippocampal transcriptome was analysed using microarray, serial analysis of gene expression and qRT‐PCR. Finally, mitochondrial DNA copy number, damages and mitochondrial respiration were assessed. We found clear effects of the differential stress reactivity on the behavioural, morphometric and metabolic measures. Remarkably, the hyperactive behavioural and neuroendocrine stress‐coping style of high‐reactivity mice was associated with significant changes in the expression of an extended list of genes involved in energy metabolism and several mitochondrial functions. Yet, only minor changes were found in mitochondrial DNA copy number, damages and respiration. Thus, our findings support a prominent role of glucocorticoids in shaping the major endophenotypes of the stress reactivity mouse model and contribute towards understanding the important role of HPA axis dysregulation and changes in energy metabolism in the pathophysiology of affective disorders.
Adversarial interspecies relationships facilitate population suppression by gene drive in spatially explicit models
Authors: Liu Yiran , Teo WeiJian , Yang Haochen , Champer Jackson
Published: May 2023

Suppression gene drives bias their inheritance to spread through a population, potentially eliminating it when they reach high frequency. CRISPR homing suppression drives have already seen success in the laboratory, but several models predict that success may be elusive in population with realistic spatial structure due to extinction‐recolonization cycles. Here, we extend our continuous space framework to include two competing species or predator–prey pairs. We find that in both general and mosquito‐specific models, competing species or predators can facilitate drive‐based suppression, albeit at the cost of an increased rate of drive loss outcomes. These results are robust in mosquito models with seasonal fluctuations. Our study illustrates the difficulty of predicting outcomes in complex ecosystems. However, our results are promising for the prospects of less powerful suppression gene drives to successfully eliminate target mosquito and other pest populations.
Implications of Internal Funds Surplus for Determining Agency Spending of SEO Proceeds and Timing Incentives
Authors: Bazrafshan Ebrahim
Published: May 2023

According to the pecking order theory, firms with potential investment projects should raise external capital if and only if sufficient internal funds are not available. The theory can be violated if equity issuers are motivated by market timing and increasing funds for insiders’ benefits, indicating that firms may already have internal funds surplus without including external funds, but still issue equity. By controlling for future funds needs, the analyses show that issuers that engage in market timing and spend the SEO proceeds on value‐destroying projects are strongly associated with their internal funds surplus. Moreover, SEO announcement returns are lower for issuers with internal funds surplus. This pattern strongly supports the predictive ability of internal funds surplus to detect the need for external capital and ultimately to determine timing incentives and agency spending of SEO proceeds.
Flow and thermal regimes altered by a dam caused failure of fish recruitment in the upper Mekong River
Authors: Ding Chengzhi , Sun Jie , Huang Minrui , Bond Nick , Ding Liuyong , Tao Juan
Published: May 2023

Riverine fishes have been increasingly threatened by the global proliferation of both small dams and large hydropower projects to meet the soaring water, energy and food demands from growing human populations and urbanisation. However, empirical evidence of the direct effects on a specific species before and after dam construction and operation is rare. Causes of population decline vary among species and, although little known, they are of great importance for successful environmental flow regulation.

We monitored the hydroenvironment and population dynamics of a Schizothoracinae fish (Schizothorax lissolabiatus) for 9 years before and after dam (i.e., Dahuaqiao) construction in the upper Mekong River to understand fish response processes and the underlying mechanisms. Optimal hydroenvironmental conditions for key reproduction stages (e.g., pre‐spawning, hatching and post‐hatching) were reconstructed using daily increment analysis of larval otoliths and hydroenvironmental data.

The flow regime was substantially disrupted by the dam, and water temperature was only slightly changed. The disappearance of young of the year from downstream after dam operation indicates that the changed hydroenvironment caused recruitment failure in S. lissolabiatus. By matching optimal hydroenvironmental conditions for S. lissolabiatus reproduction with the monitored hydroenvironmental data series before and after dam operation, we found that changes in thermal regime alone caused narrowing of the reproduction window by an average of 41%, whereas flow‐regime change alone narrowed it by 96% and it was narrowed by 98% for thermal and flow changes combined.

This study shows that the altered flow regime, but not the thermal regime, was the primary driver of the recruitment failure of S. lissolabiatus. The findings highlight the importance of prioritising flow‐regime management to improve recruitment success for S. lissolabiatus and to favour the persistence of other imperilled Schizothoracinae fishes and native species in dammed rivers.
Uranium Isotope Ratios of Twenty‐nine Geological Rock Reference Materials Measured by MC‐ICP‐MS
Authors: Wang Xuefeng , Wang Xiangli , Wang Lisheng , Wu Shitou , Xue Dingshuai , Duan Wuhui , Ma Zhibang , Xiao Jule , Li Xianhua
Published: May 2023

Uranium isotope ratios are reported for twenty‐nine geological reference materials (RMs) including igneous, metamorphic and sedimentary rocks, as well as sediments. Measurements were conducted on a multi‐collector inductively coupled plasma‐mass spectrometer (MC‐ICP‐MS) using the 233U‐236U double spike technique. These RMs possess a wide range of matrices with U mass fractions ranging from 0.11 μg g‐1 to 18.7 μg g‐1. The δ234/238U values (relative to the n(234U)/n(238U) ratio at secular equilibrium) show minor fluctuations around the secular equilibrium value except for two Pleistocene speleothem RMs. The δ238/235U values (relative to the value for NBL CRM 112a (NBS SRM 960)) of igneous rocks and metamorphic rocks are within the range of the continental crust value (‐0.29 ± 0.03‰, 95% CI). The δ238/235U value for sedimentary rock and sediment RMs spans a wide range of 0.98‰, suggesting significant 238U/235U isotopic fractionation in low temperature environments. The range of δ238/235U RMs reported in this study (‐0.63‰ to 0.35‰) exceeds that of previous RMs (‐0.61‰ to 0.17‰), allowing inter‐laboratory calibration of wider ranges of geological and environmental samples.
Finite element simulation and experimental analysis of B4C‐TiB2‐SiC ceramic cutting tools
Authors: Yang Guangyuan , Zhang Zhixiao , Li Weixing , Guo Xu , Liu Chunyue , Shi Yingjie , Wang Yanming , Wang Aiyang , Zhang Xiaoliang , Zhang Xiaorong
Published: May 2023

Here, cutting properties and wear mechanism of the home‐made B4C‐TiB2‐SiC ceramic cutting tools in turning of AISI 4340 steel workpieces were studied through a combination of finite element simulation using Deform‐3D software and turning experiments. Simulation results show that cutting parameters have significant effects on the main cutting force and tool temperature of the B4C‐TiB2‐SiC cutting tool. The optimal cutting parameters for the ceramic cutting tool are cutting speed of 300 m/min, depth of cut of .3 mm, and feed rate of .1 mm/r. Experimental results show the cutting length of the B4C‐TiB2‐SiC cutting tool is about 101 m, which is 21.0% and 32.9% larger than that of the home‐made B4C‐TiB2 ceramic cutting tool and commercially available tungsten carbide tool, indicating that the B4C‐TiB2‐SiC cutting tool has a desired service life. The surface roughness of the workpieces processed by the B4C‐TiB2‐SiC cutting tool is 2.43 µm, which is 29.4% lower than that of the workpieces processed by the B4C‐TiB2 cutting tool, indicating that the B4C‐TiB2‐SiC cutting tool has a satisfying machining accuracy. Wear forms of the B4C‐TiB2‐SiC ceramic cutting tool involve craters, chipping, and flank wear, and the main wear mechanisms are abrasive, adhesive, oxidative, and diffusion wear.
Mechanical properties of ZrB2 ceramics determined by two laboratories
Authors: Swab Jeffrey J. , Jarman Jecee , Fahrenholtz William , Watts Jeremy
Published: May 2023

The mechanical properties for zirconium diboride (ZrB2) were measured at two laboratories and compared. Two billets of ZrB2 were prepared by hot‐pressing commercial powder. The relative densities of the billets were >99% and with an average grain size of 5.9 ± 4.5 µm. Both laboratories prepared American Society for Testing and Materials (ASTM) C1161 B‐bars for strength and ASTM C1421 bars with notch configuration A for fracture toughness. Specimens were machined by diamond grinding at the Army Research Laboratory (ARL) and electrical discharge machining (EDM) at Missouri S&T. Strength bars tested at Missouri S&T were polished to a .25 μm finish while the bars were tested as‐ground at ARL. Strengths were 473 ± 79 MPa for the Missouri S&T bars and 438 ± 68 for the ARL bars while the fracture toughness values were 3.9 ± .7 MPa•m1/2 for the Missouri S&T bars and 4.4 ± .6 MPa•m1/2 for the ARL bars. Vickers hardness was measured by both laboratories over a range of indentation loads. The resulting hardness values were on the low end of previously reported values and were quite different from each other especially at indentation loads ≤20N. The study demonstrated that the properties of materials tested to ASTM standards at different laboratories can be compared directly. In addition, strength and fracture toughness were nearly identical for bars prepared by conventional diamond grinding or EDM.
A novel corporoplasty technique with a urethral plate flap in hypospadias repair
Authors: Ru Wei , Feng Ciyuan , Tian Hongjuan , Wu Dehua , Tang Daxing , Tao Chang
Published: May 2023

Objectives

To report a novel corporoplasty technique with a urethral plate flap in hypospadias repair and evaluate its safety and efficacy for ventral lengthening.

Methods

Data were retrospectively collected from consecutive patients with hypospadias who underwent urethral plate flap corporoplasty between July 2021 and March 2022. All patients underwent hypospadias repair using the Duckett technique. The corporoplasty procedure involved the following key steps: the half‐spongiosum of the urethral plate was harvested as a flap (with a pedicle attached to the corpus cavernosum); a transverse incision of the tunica albuginea was made adjacent to the pedicle; and the flap was patched onto the corporal defect.

Results

The study included 10 patients, with a median age of 20 months. The initial meatal location was penile in two patients, penoscrotal in four patients, and scrotal in four patients. The median ventral curvature was 45° after degloving and urethral plate transection. The median ventral lengthening distance proportional to penis length was 0.21. During the median follow‐up of 13.8 months, complications occurred in three cases, including two cases of fistula and one case of urethral stricture with secondary diverticulum. No cases of recurrent ventral curvature, meatal stenosis, or urethral dehiscence were noted. Postoperative ultrasonography showed a good continuation of the tunica albuginea and integrity of the stratum spongiosum at the corporoplasty site.

Conclusions

Urethral plate flap corporoplasty is a simple and effective ventral lengthening procedure. The novel corporoplasty technique allows for anatomical and architectural repair of corporal disproportion.
The microRNA pathway core genes are indispensable for development and reproduction in the brown planthopper, Nilaparvata lugens
Authors: Wang Ni , Chen Min , Zhou Ying , Zhou Wen‐Wu , Zhu Zeng‐Rong
Published: May 2023

MicroRNAs (miRNAs) are small single‐stranded non‐coding RNAs involved in a variety of cellular events by regulating gene expression at the post‐transcriptional level. Several core genes in miRNA biogenesis have been reported to participate in a wide range of physiological events, in some insect species. However, the functional significance of miRNA pathway core genes in Nilaparvata lugens remains unknown. In the present study, we conducted a systematic characterisation of five core genes involved in miRNA biogenesis. We first performed spatiotemporal expression analysis and found that miRNA core genes exhibited similar expression patterns, with high expression levels in eggs and relatively high transcriptional levels in the ovaries and fat bodies of females. RNA interference experiments showed that injecting third‐instar nymphs with dsRNAs targeting the miRNA core genes, NlAgo1, NlDicer1, and NlDrosha resulted in high mortality rates and various degrees of body melanism, moulting defects, and wing deformities. Further investigations revealed that the suppression of miRNA core genes severely impaired ovarian development and oocyte maturation, resulting in significantly reduced fecundity and disruption of intercellular spaces between follicle cells. Moreover, the expression profiles of miR‐34‐5p, miR‐275‐3p, miR‐317‐3p, miR‐14, Let‐7‐1, and miR‐2a‐3p were significantly altered in response to the knockdown of miRNA core genes mixture, suggesting that they play essential roles in regulating miRNA‐mediated gene expression. Therefore, our results provide a solid theoretical basis for the miRNA pathway in N. lugens and suggest that the NlAgo1, NlDicer1, and NlDrosha‐dependent miRNA core genes are essential for the development and reproduction of this agricultural pest.
Chemical inhibition of DNA‐PKcs impairs the activation and cytotoxicity of CD4+ helper and CD8+ effector T cells
Authors: Azevedo‐Pouly Ana C , Appell Lauren E , Burdine Lyle , Rogers Lora J , Morehead Lauren C , Fil Daniel , Barker Melanie , Rainwater Randall R , Waldrip Zachary J , Koss Brian , Burdine Marie Schluterman
Published: May 2023

Modulation of T cell activity is an effective strategy for the treatment of autoimmune diseases, immune‐related disorders and cancer. This highlights a critical need for the identification of proteins that regulate T cell function. The kinase DNA‐dependent protein kinase catalytic subunit (DNA‐PKcs) is emerging as a potent regulator of the immune system, spurring interest in its use as a therapeutic target. In murine models of immune‐related diseases including asthma and rheumatoid arthritis, treatment with small‐molecule DNA‐PKcs inhibitors decreased the disease severity. Additionally, DNA‐PKcs inhibitors reduced T cell‐mediated graft rejection in a murine allogenic skin graft model. These in vivo studies suggest the use of DNA‐PKcs inhibitors as immunotherapy for autoimmune and T cell‐mediated disorders. In this study, we sought to characterize further the effects of DNA‐PKcs inhibitors on T cells to better understand their clinical potential. We determined that inhibition of DNA‐PKcs using inhibitor NU7441 and the inhibitors currently in clinical trials for cancer therapy, M3184 and AZD7648, abrogated the activation of murine and human CD4+ and CD8+ T cells as evidenced by the reduced expression of the activation markers CD69 and CD25. Furthermore, inhibition of DNA‐PKcs impeded metabolic pathways and the proliferation of activated T cells. This reduced the ability of OTI‐CD8+ T cells to kill cancer cells and the expression of IFNγ and cytotoxic genes. These results highlight a critical role for DNA‐PKcs in T cells and validate future studies using DNA‐PKcs inhibitors as immune modulation therapy for the treatment of immune‐related diseases.
Effect of slag basicity on Turing pattern corrosion of alumina refractory ceramics in the presence of free radicals
Authors: Peng Yuefang , Li Shenghao , Huang Ao , Gu Huazhi , Zou Yongshun , Fu Lvping
Published: May 2023

Turing pattern corrosion causes serious damage to alumina ceramics. Therefore, the quaternary slag corrosion of alumina refractory ceramics was studied with different slag basicity by adjusting relative content of MgO and Al2O3. The results show that reactive oxygen species (ROS) like singlet oxygen and superoxide radicals are generated in the slags. The height of corrosion peak is determined by both the original superoxide radical and the amount of non‐bridging oxygen (NBO) of the slags under the change of basicity. Moreover the influence of free radicals on the corrosion peak is greater than that of NBOs. A free‐radical reaction was proposed as the formation mechanism of the Turing pattern corrosion peaks based on ROS.
Predictors and outcomes of tricuspid regurgitation improvement after radiofrequency catheter ablation for persistent atrial fibrillation
Authors: Ukita Kohei , Egami Yasuyuki , Nohara Hiroaki , Kawanami Shodai , Sugae Hiroki , Kawamura Akito , Nakamura Hitoshi , Yasumoto Koji , Tsuda Masaki , Okamoto Naotaka , Matsunaga‐Lee Yasuharu , Yano Masamichi , Nishino Masami , Tanouchi Jun
Published: May 2023

Introduction

Little has been reported on the predictors and outcomes of improvement of tricuspid regurgitation (TR) after radiofrequency catheter ablation (RFCA) for persistent atrial fibrillation (AF).

Methods

We enrolled 141 patients with persistent AF and moderate or severe TR assessed by transthoracic echocardiography (TTE) who underwent an initial RFCA between February 2015 and August 2021. These patients underwent follow‐up TTE at 12 months after the RFCA, and were categorized into two groups based on the improvement (defined as at least one‐grade improvement of TR) and non‐improvement of TR: IM group and Non‐IM group, respectively. We compared the patient characteristics, ablation procedures, and recurrences after the RFCA between the two groups. In addition, we examined the major event (defined as admission for heart failure or all‐cause death) more than 12 months after the RFCA.

Results

IM group consisted of 90 patients (64%). A multivariate analysis revealed that age <71 years old and absence of late recurrence (LR, defined as recurrence of atrial tachyarrhythmia between 3 and 12 months after the RFCA) were independently associated with the improvement of TR after the RFCA. Furthermore, IM group had the higher incidence of major event‐free survival than Non‐IM group.

Conclusions

Relatively young age and absence of LR were good predictors of improvement of TR after the RFCA for persistent AF. In addition, the improvement of TR was related to better clinical outcomes.
Comprehensive effects of lifestyle reform, adherence, and related factors on hypertension control: A review
Authors: Ojangba Theodora , Boamah Solomon , Miao Yudong , Guo Xinghong , Fen Yifei , Agboyibor Clement , Yuan Jingjing , Dong Wenyong
Published: May 2023

Despite the effectiveness of currently available antihypertensive medications, there is still a need for new treatment strategies that are more effective in certain groups of hypertensive and for additional resources to combat hypertension. However, medication non‐adherence was previously recognized as a major problem in the treatment of hypertension. The mechanisms behind the positive impacts of lifestyle changes might occur in different ways. In comparison with other studies, the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials. However, in this review, the attitudinal lifestyle modifications and barriers to blood pressure control were elaborated on. An effective method for reducing blood pressure (BP) and preventing cardiovascular events with antihypertensive medications has been outlined. Maintaining healthy lifestyle factors (body mass index, diet, smoking, alcohol consumption, sodium excretion, and sedentary behavior) could lower systolic blood pressure BP by 3.5 mm Hg and reduce the risk of cardiovascular disease (CVD) by about 30%, regardless of genetic susceptibility to hypertension. Conducting a lifestyle intervention using health education could improve lifestyle factors, such as reducing salt, sodium, and fat intake, changing eating habits to include more fruits and vegetables, not smoking, consuming less alcohol, exercising regularly, maintaining healthy body weight, and minimizing stressful conditions. Each behavior could affect BP by modulating visceral fat accumulation, insulin resistance, the renin‐angiotensin‐aldosterone system, vascular endothelial function, oxidative stress, inflammation, and autonomic function. Evidence of the joint effect of antihypertensive medications and lifestyle reforms suggests a pathway to reduce hypertension.
Academic motivation decreases across adolescence for youth with and without attention‐deficit/hyperactivity disorder: Effects of motivation on academic success
Authors: Smith Zoe R. , Flax Marcus , Becker Stephen P. , Langberg Joshua
Published: May 2023

Background

This longitudinal study examined growth trajectories of academic motivation in youth with and without attention‐deficit/hyperactivity disorder (ADHD) across the important developmental transition from middle school to high school, and associations with academic success. Consistent with self‐determination theory (SDT) of motivation, trajectories of amotivation, extrinsic motivation, and intrinsic motivation were modeled.

Methods

The study included a robust multi‐method, multi‐source assessment of academic outcomes, including homework performance ratings; reading and mathematics standardized test scores; and grade point average (GPA) obtained from school records. Participants included 302 adolescents (ages 12–14; Mage = 13.20) in eighth grade who were specifically recruited so that approximately half (n = 162) were diagnosed with ADHD and 140 adolescents comprising a comparison sample without ADHD. The sample was predominantly White (81.80%), with 7.90% identifying as bi/multiracial, 5.30% identifying as Black/African American, 4.60% identifying as Asian, and 0.30% identifying as Indigenous/Alaskan.

Results

Adolescents with ADHD had worse academic motivation at all timepoints. Growth curve analyses indicated the academic motivation of adolescents without ADHD decreased at faster rates across the transition to high school compared to adolescents with ADHD. However, for adolescents with ADHD, amotivation, extrinsic motivation, and intrinsic motivation each predicted GPA, with higher extrinsic and intrinsic motivation also predicting better homework performance and different aspects of math performance, whereas for youth without ADHD, only amotivation and extrinsic motivation predicted GPA.

Conclusions

Intervention and school policy implications are discussed, including the importance of fostering autonomy and internal motivation, and consideration of whether current ADHD interventions primarily foster extrinsic motivation.
Maxillary occlusal device designed with an anterior platform for guiding the occlusal adjustments during the delivery appointment: A dental protocol
Authors: Kois John C. , Kois Dean E. , Zeitler Jonathan M. , Revilla‐León Marta
Published: May 2023

Objective

To describe a technique for fabricating an additively manufactured maxillary occlusal device using a complete digital workflow.

Clinical Considerations

The maxillary occlusal device design may include an anterior platform to guide the positioning of the mandible in a reproducible position for facilitating the delivery procedure.

Conclusions

The described technique provides a more efficient and less time‐consuming method for designing and manufacturing a printed occlusal device, when compared with conventional fabrication techniques.

Clinical Significance

The additively manufactured occlusal device designed with an anterior platform guides the positioning of the mandible in a reproducible position, facilitates the delivery procedures, and produces a more efficient and less time‐consuming method when compared with conventional methods.
Leucism in sharks: a histological examination
Authors: Wargat Bryanna N. , Adams Douglas H. , Habegger Maria Laura
Published: May 2023

Isolated cases of skin pigment disorders, including leucism, in sharks and rays have been reported for multiple species. Nonetheless, the morphological basis behind these chromatic anomalies has not been examined histologically. In this study, the authors quantified and compared the presence of melanin in multiple tissue samples of leucistic and fully pigmented blacktip sharks Carcharhinus limbatus. The authors’ results support lack of melanin to be responsible for leucistic colouration. The histological differences responsible were evaluated.
The salt‐activated CBF1/CBF2/CBF3‐GALS1 module fine‐tunes galactan‐induced salt hypersensitivity in Arabidopsis
Authors: Yan Jingwei , Liu Ya , Yan Jiawen , Liu Zhihui , Lou Heqiang , Wu Jiasheng
Published: May 2023

Plant growth and development are significantly hampered in saline environments, limiting agricultural productivity. Thus, it is crucial to unravel the mechanism underlying plant responses to salt stress. β‐1,4‐Galactan (galactan), which forms the side chains of pectic rhamnogalacturonan I, enhances plant sensitivity to high‐salt stress. Galactan is synthesized by GALACTAN SYNTHASE1 (GALS1). We previously showed that NaCl relieves the direct suppression of GALS1 transcription by the transcription factors BPC1 and BPC2 to induce the excess accumulation of galactan in Arabidopsis (Arabidopsis thaliana). However, how plants adapt to this unfavorable environment remains unclear. Here, we determined that the transcription factors CBF1, CBF2, and CBF3 directly interact with the GALS1 promoter and repress its expression, leading to reduced galactan accumulation and enhanced salt tolerance. Salt stress enhances the binding of CBF1/CBF2/CBF3 to the GALS1 promoter by inducing CBF1/CBF2/CBF3 transcription and accumulation. Genetic analysis suggested that CBF1/CBF2/CBF3 function upstream of GALS1 to modulate salt‐induced galactan biosynthesis and the salt response. CBF1/CBF2/CBF3 and BPC1/BPC2 function in parallel to regulate GALS1 expression, thereby modulating the salt response. Our results reveal a mechanism in which salt‐activated CBF1/CBF2/CBF3 inhibit BPC1/BPC2‐regulated GALS1 expression to alleviate galactan‐induced salt hypersensitivity, providing an activation/deactivation fine‐tune mechanism for dynamic regulation of GALS1 expression under salt stress in Arabidopsis.
Promoting self‐determination of persons with severe or profound intellectual disabilities: a systematic review and meta‐analysis
Authors: Kuld P. B. , Frielink N. , Zijlmans M. , Schuengel C. , Embregts P. J. C. M.
Published: May 2023

People with severe or profound intellectual disabilities (IDs) are believed to experience low levels of self‐determination, which negatively affects their quality of life. This systematic review describes existing interventions aimed to support self‐determination or components thereof and synthesises evidence on the interventions' effects. Eight databases were searched, turning in 76 articles for the final inclusion. The studies included 631 people with severe or profound IDs of whom 81% had multiple disabilities. The studies had quantitative (k = 63), qualitative (k = 7) and mixed study designs (k = 6). Sample sizes ranged from 1 to 95 and a study quality index ranged from 40% to 100%. While many studies included several self‐determination components and intervention elements, overall, 53 studies focused on the self‐determination components choice making, independence and problem solving. Other studies included increased assistance (k = 14); engagement in meaningful activities and relationships (k = 10); community and societal participation (k = 5); supporting the basic psychological needs autonomy, competence and relatedness (k = 4); individuality and dignity (k = 3); supportive decision‐making (k = 2); self‐advocacy (k = 2); and motivation (k = 1). Intervention elements included technology (k = 33); multiple‐component training packages, goal setting, empowerment tactics and applied behaviour principles (k = 17); training of caretakers (k = 17); changes in policies and living arrangements (k = 9); supporter responsiveness (k = 1); drama therapy and storytelling (k = 1); electrical wheelchair training (k = 1); joint painting procedure (k = 1); youth advocacy project (k = 1); and multiliteracies training (k = 1). Reflecting the heterogeneity of the field, only four studies tested a similar intervention for this population and were eligible for the meta‐analysis, which combined showed a small effect size of 2.69. Further research is needed to explore relationships between individuals with severe or profound IDs and their relatives and health care professionals and create supportive environments that meet their basic psychological needs.
Real‐time quaking‐induced conversion assay using a small‐scale substrate production workflow for the diagnosis of Creutzfeldt‐Jakob disease
Authors: Thanapornsangsuth Poosanu , Chongsuksantikul Adipa , Saraya Abhinbhen W. , Hiransuthikul Akarin , Hemachudha Thiravat
Published: May 2023

The lack of a dedicated surveillance program for prion disease, particularly in low‐ and middle‐income countries (LMICs), has hindered the global effort to address this public health threat. Although cerebrospinal fluid (CSF) Real‐time quaking‐induced conversion (RT‐QuIC) is considered the most reliable test for sporadic Creutzfeldt‐Jakob disease (sCJD), its availability in LMICs is limited because of its cost and technical difficulty in generating the recombinant prion protein substrate (recPrP). This study aimed to evaluate the performance of RT‐QuIC with recPrP produced in‐house through a small‐scale method—that is, the application of reusable prepacked chromatography columns and subsequent dialysis. Here, CSF specimens from patients suspected of having prion disease were consecutively collected and stored between October 2015 and January 2023. Electronic medical record data were reviewed to clinically classify participants as probable sCJD or non‐sCJD. CSF RT‐QuIC was performed using in‐house recPrP. Its specificity and sensitivity for diagnosing probable sCJD were reported, along with details of other clinical data and investigations. We found that among 39 eligible participants, with a median (interquartile range) age of 64 (56–70) years and 16 (41%) female, 13 had probable sCJD and the remaining 26 unequivocally suffered from nonprion disorders. Magnetic resonance imaging and electroencephalogram were suggestive of sCJD in 100% (13/13) and 46.2% (6/13) of sCJD participants, respectively. RT‐QuIC was positive in 12/13 sCJD participants (sensitivity 0.92, 95% confidence interval [CI] 0.67–0.99) and negative in all non‐sCJD participants (specificity 1.00, 95% CI 0.87–1.00). CSF tau/p‐tau ratio showed sensitivity and specificity of 0.62–1.0 and 0.85–1.0, respectively. In summary, RT‐QuIC using recPrP generated through a small‐scale workflow demonstrated great performance in detecting sCJD. Given its performance results along with its low cost, this technique could feasibly be implemented in LMICs and potentially be the first step toward establishing local prion disease surveillance programs.

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Radiofrequency and microwave ablation controls hepatic oligoprogression of advanced gastroenteropancreatic neuroendocrine tumors
Authors: Matrood Sami , Gress Thomas Mathias , Rinke Anja , Mahnken Andreas Horst
Published: May 2023

In progression of multifocal liver metastases of gastroenteropancreatic neuroendocrine tumors (GEP‐NET) escalation of systemic therapy is indicated. The aim of this retrospective study was to investigate the potential of local thermal ablation in hepatic oligoprogression and otherwise stable disease in GEP‐NET. Patients with hepatic oligoprogression and otherwise stable disease, who underwent radiofrequency ablation (RFA) or microwave ablation (MWA) for local control, were included in the study. Thermal ablation was performed while maintaining the ongoing systemic therapy or without addition of a systemic therapy. The effectiveness of this therapeutic approach was evaluated by determination of local treatment success, improvement of progression‐free survival (PFS) and the safety. Seventeen thermal ablation procedures were performed in 13 patients with well differentiated NET including seven ileum NET, four pancreatic NET, one appendix NET and one rectum NET. RFA and MWA of liver metastases were well tolerated without major complications. Thermal ablation resulted in an estimated median PFS of 62.6 weeks (mean 50.5 weeks; range 10.1–78.9 weeks) per procedure. In four patients, two ablation procedures were performed throughout the course of their disease resulting in an estimated median PFS of 69.1 weeks (mean 71.6 weeks; range 10.1–123.1 weeks) per patient. Start or change of systemic therapy could be delayed up to 123.1 weeks by using thermal ablations for isolated progression of single liver metastases. 88% of thermal ablations prolonged PFS. Thermal ablation of liver metastases in a non‐curative intent has the potential to provide focal growth control and to prolong PFS in GEP‐NET patients with hepatic oligoprogression.
A scoping review of registered nurses' delegating care and support to unlicenced care and support workers
Authors: Wilson Nathan J. , Pracilio Amy , Morphet Julia , Kersten Michelle , Buckley Thomas , Trollor Julian N. , Cashin Andrew
Published: May 2023

Aim

To scope the international literature about registered nurses delegated models of care to unlicenced workers, identify gaps and reflect upon how the evidence relates to nursing in multiple contexts.

Design

Scoping review of the peer reviewed literature from the year 2000 onwards, using the PRISMA‐ScR checklist.

Methods

The study searched the following databases in February 2022: CINAHL, Medline, ProQuest, and SCOPUS, and included keywords, Boolean operators and subject headings relevant to registered nurses delegating the provision of care to unlicenced workers.

Results

A total of 49 articles met the eligibility criteria for this study, and relevant data were extractedThree models of delegation were highlighted within the literature: direct, indirect and a mixture of both. The data highlighted that direct delegation mainly occurred in acute contexts, with delegation decreasing with increasing patient acuity and/or complexity but the threshold of when this would occur was not clear. There was one intervention study that measured patient outcomes which could aid in the determination of what is effective delegation. For studies that did report on it (n = 6), there were few examples of better patient outcomes in cases where care was delegated from registered nurses to unlicenced workers.

Conclusions

The scoping review highlighted heterogeneity in practice areas and methods of delegation practice. A key gap in literature is the absence of studies focusing on patient outcomes, with a clear baseline to measure and identify effective delegation practices. Additionally, the legal and logistical implications presented in both direct and indirect delegation practices is not evident in the literature.

Implications for the Profession

Decisions related to delegation are often made at the service level and prescribed to those who work within the service, suggesting that models of indirect delegation are in fact not delegation at all, rather a re‐distribution of nurses' work.

Relevance to clinical practice

Delegation is a vital component of the scope of practice of registered nurses. This review has highlighted unique differences in delegation by practice context, where the proliferation of unlicensed workers in certain contexts places a vastly different professional and legal burden on the registered nurse.
Nursing students' experience of workplace violence in clinical practice: A qualitative systematic review
Authors: Dafny Hila Ariela , McCloud Christine , Pearson Vincent , Brown Shannon , Phillips Craig , Waheed Nasreena , Freeling Michelle , Parry Yvonne Karen , Champion Stephanie
Published: May 2023

Aims

To systematically identify, appraise and synthesise qualitative studies investigating Registered Nurse students' (RNS) experiences of workplace violence (WPV) while on clinical placement. It is expected that the literature review findings will guide the development of targeted programs and policies to address WPV against RNS.

Background

WPV affects RNS during clinical placements as they are vulnerable to violence due to their limited experience and skills to challenge abusive behaviour. In this review, RNS are students enrolled in a Bachelor of Nursing program to become registered nurses and exclude students who are enrolled in nursing program that does not lead to registration as a registered nurse. For example, enrolled in nursing programs and postgraduate nursing programs. RNS are chosen for their scope of practice and the training requirements. RNS reported experiencing WPV mainly from colleagues, staff, teachers, doctors and supervisors, which resulted in leaving nursing practice, impacting students' progression and healthcare systems. This review examines all types of violence RNS face irrespective of the abuser.

Methods

A qualitative systematic review of existing literature was conducted through a comprehensive database search of eight databases MEDLINE, CINAHL, Web of Science, Scopus, Embase, Cochrane Central and ProQuest. Furthermore, reference lists of included studies were searched to identify further research. English language qualitative primary studies of any study design were searched from inception to 6th June 2022 and included if they met the inclusion criteria. Double review process utilised from screening until data synthesis reported according to PRISMA. JBI critical appraisal tools were used to assess the studies, and data extraction utilised JBI QARI tool and screened for credibility and confidence in findings.

Results

A total of 18 studies met the inclusion criteria, and the studies were conducted in nine countries. Five main themes relating to RNS experiences of WPV while on clinical placement were identified, including: ‘Types of workplace violence’, ‘Perpetrators’, ‘Causes’, ‘Consequences’ and ‘Management of workplace violence’.

Conclusions

This qualitative systematic review provides new and significant knowledge in understanding the phenomenon of WPV experienced by RNS while on clinical placement.

Relative to clinical practice

This review highlights the unwillingness of RNS to reach out to instructors or clinical placement leaders in many situations and identifies avenues of support and awareness that are crucial to empower and enabling students to seek support.