bluuebunny/crossref_metadata_2025 huggingface dataset:
Stent‐induced tracheal stenosis can be predicted by IL‐8 expression in rabbits
Authors: Arellano‐Orden Elena , Serrano Carolina , Montes‐Worboys Ana , Sánchez‐López Verónica , Laborda Alicia , Lostalé Fernando , Lahuerta Celia , Rodríguez‐Panadero Francisco , de Gregorio Miguel Ángel
Published: November 2016

Background

Bare metal stents may cause complications like fibrous encapsulation, granulation and tracheal stenosis. We investigated the behaviour of three commercially available stents in vivo (rabbits) and in vitro (coculture of those stents with epithelial and fibroblast cell lines). Also, we investigated whether development of tracheal stenosis could be predicted by any biological marker.

Materials and methods

The tracheae of 30 rabbits were implanted with either nitinol stents, with or without paclitaxel elution, or a cobalt‐based stent. An additional ten rabbits underwent mock implantation (controls). Serial peripheral venous blood samples were taken throughout the study, and several cytokines measured. Animals were euthanized on day 90, with immediate tracheal endoscopy and lavage performed, then necropsy.

Results

Rabbits with cobalt‐based stent exhibited more inflammation and the highest stenosis incidence, with reduced survival. Both in vivo and in vitro, this stent induced higher IL‐8 levels than nitinol stents. Most important, the presence of stent‐induced tracheal stenosis was closely associated to increase in IL‐8 expression in blood just 1 day after tracheal stent implantation: a 1·19‐fold increase vs. baseline had 83% sensitivity, 83% specificity, 77% positive predictive value, 88% negative predictive value and 83% accuracy to predict development of stenosis.

Conclusions

The cobalt‐based stent had the highest incidence of tracheal inflammation and stenosis. On the other hand, the paclitaxel‐eluting nitinol stent did not prevent those complications and provoked a marked reaction compared with the bare nitinol stent. Early increase in IL‐8 expression in blood after stent implantation could predict development of tracheal stenosis in rabbits.
Temporal scaling in analysis of animal activity
Authors: McCann Nicholas P. , Zollner Patrick A. , Gilbert Jonathan H.
Published: November 2016

Activity is a fundamental aspect of animal behavior, but whether different factors influence activity at different temporal scales is poorly understood as ecologically‐relevant multi‐temporal‐scale (MTS) activity analysis frameworks have not been developed. The hierarchy of limiting factors hypothesis postulates that the scale of resource selection reflects its importance for escaping limiting factors, but the hypothesis has not been tested by studies that examine activity across multiple temporal scales. We hypothesized that a MTS analysis framework would reveal that different factors influence activity at different temporal scales. We studied American martens Martes americana fitted with sensors that measured activity during winter at high temporal resolution. Using a MTS analysis framework, we showed that different factors influenced marten activity across three different biologically based, hierarchically‐ordered temporal scales (day, bout, and decision). Mortality risk influenced marten activity at the broader scales examined (day and bout), but not at the finest scale (decision), which is consistent with the hierarchy of limiting factors hypothesis. We also found evidence of cross scale consistency and support of multiple hypotheses at bout and decision scales, suggesting some factors operate across multiple scales and trade‐offs occur for some factors (e.g. risk for forage). Prey activity and thermal conservation influenced activity at the finer scales examined, but not at the day‐scale, and competition influenced activity only at the bout scale. Marten activity was polyphasic and occurred across the 24‐h period, which is probably due to digestive and metabolic constraints. Results from this and other studies indicate that activity is sensitive to temporal scale for a wide range of species. MTS frameworks should lead to a more comprehensive understanding of how different mechanisms influence animal activity, and ultimately, biological fitness.
Incorporating evolutionary adaptation in species distribution modelling reduces projected vulnerability to climate change
Authors: Bush Alex , Mokany Karel , Catullo Renee , Hoffmann Ary , Kellermann Vanessa , Sgrò Carla , McEvey Shane , Ferrier Simon
Published: November 2016

Based on the sensitivity of species to ongoing climate change, and numerous challenges they face tracking suitable conditions, there is growing interest in species' capacity to adapt to climatic stress. Here, we develop and apply a new generic modelling approach (AdaptR) that incorporates adaptive capacity through physiological limits, phenotypic plasticity, evolutionary adaptation and dispersal into a species distribution modelling framework. Using AdaptR to predict change in the distribution of 17 species of Australian fruit flies (Drosophilidae), we show that accounting for adaptive capacity reduces projected range losses by up to 33% by 2105. We identify where local adaptation is likely to occur and apply sensitivity analyses to identify the critical factors of interest when parameters are uncertain. Our study suggests some species could be less vulnerable than previously thought, and indicates that spatiotemporal adaptive models could help improve management interventions that support increased species' resilience to climate change.
Current velocity shapes co‐existence patterns among invasive Dikerogammarus species
Authors: Borza Péter , Huber Thomas , Leitner Patrick , Remund Nadine , Graf Wolfram
Published: November 2016

Facilitative interactions among co‐evolved representatives of the endemic Ponto‐Caspian fauna are regarded as a major factor of their invasion success. Nevertheless, the most renowned examples represent interactions between different trophic levels or functional groups, while ecologically similar species can be expected to show competition‐based niche partitioning.

Here, we test for differences in the realized niche of three invasive Dikerogammarus species (Crustacea: Gammaridae) in their co‐occurring range. We sampled multiple habitats within sites distributed along the River Danube to test whether some environmental variables could reveal spatial niche differentiation among the three species of Dikerogammarus, and if so, to test a predictive model outside the zone of co‐occurrence.

Spatial niche differentiation was present among the species, primarily determined by current velocity (and associated substrate preference), likely reflecting a stress tolerance–competitive ability trade‐off. Suspended matter concentration was also relevant, suggesting food resources (through filter feeding) might represent another important niche axis, somewhat loosening the terms of co‐existence between D. haemobaphes and the other two species.

Environmental variables could effectively explain the absence of D. bispinosus in the Lower Danube, implying that the co‐existence of the three species is possible only along a sufficiently wide current velocity gradient, and the observed turnovers are the result of niche expansion in the absence of the stronger competitor.

Hence, differences in invasion success may be attributed to a stress tolerance–competitive ability trade‐off. Our results suggest the advantage of D. villosus is attributable to its competitive dominance, allowing it to monopolize lentic and/or structured habitats, which represents a fortunate pre‐adaptation to anthropogenic alterations of aquatic ecosystems. The presence of D. villosus does not greatly affect the expansion of D. haemobaphes; however, the exclusion of D. bispinosus from lentic habitats by D. villosus probably strongly limits its potential to spread by active dispersal.
Assessing long‐term effects of multiple, potentially confounded drivers in ecosystems from species traits
Authors: Floury Mathieu , Usseglio‐Polatera Philippe , Delattre Cecile , Souchon Yves
Published: November 2016

Although species traits have the potential to disentangle long‐term effects of multiple, potentially confounded drivers in ecosystems, this issue has received very little attention in the literature. We aimed at filling this gap by assessing the relative effects of hydroclimatic and water quality factors on the trait composition of invertebrate assemblages over 30 years in the Middle Loire River (France). Usinga prioripredictions on the long‐term variation of trait‐based adaptations over the three decades, we evaluated the ability of invertebrate traits to indicate the effects of warming, discharge reduction and water quality improvement. Hydroclimatic and water quality factors contributed to up to 65% of the variation in trait composition. More than 70% of the initial trait response predictions made according to observed long‐term hydroclimatic changes were confirmed. They supported a general climate‐induced trend involving adapted resistance and resilience strategies. A partial confounding effect of water quality improvement acting on trophic processes was also highlighted, indicating that improved water quality management can significantly help to reduce some adverse effects of climate change. This trait‐based approach can have wider implications for investigating long‐term changes driven by multiple, potentially confounded factors, as frequently encountered in the context of global change.
Asunaprevir/daclatasvir and sofosbuvir/ledipasvir for recurrent hepatitis C following living donor liver transplantation
Authors: Omichi Kiyohiko , Akamatsu Nobuhisa , Mori Kazuhiro , Togashi Junichi , Arita Junichi , Kaneko Junichi , Hasegawa Kiyoshi , Sakamoto Yoshihiro , Kokudo Norihiro
Published: November 2016

Aim

This study aimed to clarify the efficacy and safety of interferon‐free therapy using asunaprevir and daclatasvir, or sofosbuvir and ledipasvir for post living donor liver transplantation (LDLT) recipients with hepatitis C virus (HCV).

Methods

A retrospective cohort study of LDLT recipients with HCV genotype 1b treated with asunaprevir (100 mg twice daily) and daclatasvir (60 mg once daily), or sofosbuvir (400 mg/day) and ledipasvir (90 mg/day) was carried out.

Results

Ten patients without mutations in the area of L31 and Y93 completed the treatment with asunaprevir and daclatasvir. Five of them had end‐stage chronic kidney disease, including three hemodialysis patients. Of the 10 patients, nine completed the protocol of 24 weeks; one stopped the treatment due to the development of aortic valve stenosis. All nine patients who completed the 24‐week treatment protocol achieved end of treatment response. Nineteen patients received treatment with sofosbuvir and ledipasvir. Of the 19 patients, 18 completed the protocol of 12 weeks; one stopped treatment due to severe interstitial pneumonia. All 18 patients who completed the 12‐week treatment protocol achieved end of treatment response. All patients in both treatment groups who completed the regimen and reached 3 months after the end of treatment achieved sustained virological response at 12 weeks after treatment. Liver functions were significantly improved at the end of treatment, and no adverse events were observed.

Conclusions

Interferon‐free therapy using asunaprevir and daclatasvir, or sofosbuvir and ledipasvir, is highly effective for post‐LDLT recipients with HCV genotype 1b.
Factors predictive of the efficacy of bezafibrate therapy in patients with primary sclerosing cholangitis
Authors: Mizuno Suguru , Isayama Hiroyuki , Hirano Kenji , Watanabe Takeo , Takahara Naminatsu , Kogure Hirofumi , Matsubara Saburo , Nakai Yousuke , Tada Minoru , Koike Kazuhiko
Published: November 2016

Aim

Primary sclerosing cholangitis (PSC) is a rare cholestatic disease. We previously reported the effects of bezafibrate on elevated hepatobiliary enzyme levels in patients with this disease both retrospectively and prospectively. In this study, we assessed factors predictive of bezafibrate efficacy.

Methods

Twenty‐five patients with PSC, who underwent bezafibrate therapy (400 mg per day) from November 2006 to June 2015, were evaluated. Treatment was judged as being effective if the levels of all of the hepatobiliary enzymes decreased after 12 weeks. We investigated the patients’ characteristics, disease history, concomitant medications, liver function, and liver stiffness.

Results

The efficacy rate of bezafibrate was 60% (15/25 patients). The efficacy rate in patients graded as Child–Pugh class A was significantly higher (75% [15/20]) than that in patients graded as class B (0% [0/5], P < 0.01). Non‐responders had higher liver stiffness values (18.0 vs. 8.8 kPa, P = 0.19), and concomitantly used ursodeoxycholic acid more frequently (100% vs. 73%, P = 0.12) than responders.

Conclusions

We could not elucidate the factors predictive for bezafibrate efficacy for the treatment of PSC. However, bezafibrate was more effective for patients with preserved liver function (Child–Pugh class A) when it was prescribed before progression of liver fibrosis and failure of ursodeoxycholic acid therapy.
Spiritual Citizenship: Immigrant Religious Participation and the Management of Deportability1
Authors: Guzman Garcia Melissa
Published: November 2016

This article advances the concept of spiritual citizenship to examine how some religiously active migrants employ religion to see themselves as, and to try to become, less deportable. Drawing from ethnographic observations and interviews with Central American and Mexican immigrants in the United States, I find that undocumented migrants use religion to redefine their own sense of self and to position themselves as spiritual citizens of “good moral character.” This research examines how the priorities of religious organizations can operate in relation to and through a neoliberal context. While religion supports migrants as they endure criminalization, my discussion of spiritual citizenship shows how the benefits of religious participation can also depend on migrants’ willingness to become deserving neoliberal citizens.
Contextual constraints and the relevance discovery process: challenges facing knowledge gatekeepers in emerging economies
Authors: Kuznetsov Andrei , Kuznetsova Olga
Published: November 2016

This paper explores conceptually the process of relevance discovery prompted by a major alteration in the institutional settings that has caused a radical change in the existing management knowledge paradigm, as new, mostly “imported”, knowledge replaces the “old” knowledge base. This situation puts significant pressure on a particular group of experts designated in the literature as “knowledge gatekeepers”. Their role is particularly important when external information requires contextual interpretation in order to be considered useful by other members of the social group. The paper focuses on recontextualisation as a critical element of relevance discovery and the transformation of “imported” knowledge from irrelevant to relevant and analyses the factors that influence the ability of knowledge gatekeepers to cope with the task of contextualisation. An account of two field studies of post‐communist marketisation is used to illustrate the challenges of contextualisation.
Prevalence of periodontal diseases in a multicenter cohort of perinatally HIV‐infected and HIV‐exposed and uninfected youth
Authors: Ryder Mark I. , Yao Tzy‐Jyun , Russell Jonathan S. , Moscicki Anna‐Barbara , Shiboski Caroline H. ,   the Pediatric HIV/AIDS Cohort Study
Published: November 2016

Aims

To compare the prevalence and severity of periodontal diseases between 180 perinatally HIV‐infected (PHIV) and 118 perinatally HIV‐exposed and uninfected (PHEU) youth in a cross‐sectional study conducted at 11 clinical sites in the United States and Puerto Rico from the Adolescent Master Protocol study of the Pediatric HIV/AIDS cohort study (PHACS) network.

Methods

Several analyses were conducted, employing the current CDC/AAP classification for periodontitis and incorporating a definition of gingivitis based on a bleeding on probing (BOP) threshold, and analyses based on more detailed whole‐mouth, intra‐oral regionally, site‐based and tooth‐based criteria of BOP, plaque levels, pockets depths and clinical attachment levels.

Results

After adjusting for plaque control habits and behavioural and sociodemographic factors, there were no significant differences in periodontal diseases between the PHIV and PHEU youth using any of these criteria. For PHIV youth, there was no significant association between parameters of periodontal disease and current HIV status.

Conclusions

Although no significant differences in periodontal parameters were noted between the PHIV and PHEU youth, the influence of antiretroviral therapy merits further exploration in this cohort in a longitudinal study.
AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults
Authors: Farrell Timothy W. , Widera Eric , Rosenberg Lisa , Rubin Craig D. , Naik Aanand D. , Braun Ursula , Torke Alexia , Li Ina , Vitale Caroline , Shega Joseph ,   the Ethics, Clinical Practice and Models of Care, and Public Policy Committees of the American Geriatrics Society
Published: November 2016

In this position statement, we define unbefriended older adults as patients who: (1) lack decisional capacity to provide informed consent to the medical treatment at hand; (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so; and (3) lack family, friends or a legally authorized surrogate to assist in the medical decision‐making process. Given the vulnerable nature of this population, clinicians, health care teams, ethics committees and other stakeholders working with unbefriended older adults must be diligent when formulating treatment decisions on their behalf. The process of arriving at a treatment decision for an unbefriended older adult should be conducted according to standards of procedural fairness and include capacity assessment, a search for potentially unidentified surrogate decision makers (including non‐traditional surrogates) and a team‐based effort to ascertain the unbefriended older adult's preferences by synthesizing all available evidence. A concerted national effort is needed to help reduce the significant state‐to‐state variability in legal approaches to unbefriended patients. Proactive efforts are also needed to identify older adults, including “adult orphans,” at risk for becoming unbefriended and to develop alternative approaches to medical decision making for unbefriended older adults. This document updates the 1996 AGS position statement on unbefriended older adults.
Etidronate rescues cognitive deficits through improving synaptic transmission and suppressing apoptosis in 2‐vessel occlusion model rats
Authors: Li Wen , Yuan Huijuan , Yu Yao , Cheong Yuen‐Ki , Ren Guogang , Yang Zhuo
Published: November 2016

Vascular dementia is a neurodegenerative disorder caused by the reduction of cerebral blood flow. It shows a progressive cognitive impairment. In our previous study, we found that etidronate (ET) showed neuroprotective effects against glutamate‐injured PC12 cells. Thus, in this study, we aimed to observe the effects of ET on learning and memory impairment and the related mechanism in 2‐vessel occlusion (2VO) model rats. Rats were administered a permanent bilateral common carotid artery occlusion to induce vascular dementia model. Two weeks later, 2VO model rats were treated with ET (20 mg/kg/day i.p.) for 1 week. Results showed that ET improved the spatial learning and memory function in 2VO rats detected by Morris water maze experiment. A reduced long‐term potentiation was also rescued by ET treatment in 2VO rats. Moreover, the long‐term potentiation‐related proteins, calcium/calmodulin‐dependent protein kinase II (CaMKII), NMDAR 2B and PSD95 were up‐regulated after treatment with ET. By testing the levels of malondialdehyde and superoxide dismutase in 2VO rats, we discovered that ET lowered oxidative stress. Furthermore, ET displayed a better anti‐apoptosis ability through detecting the levels of Bcl‐2 and Bax protein and terminal deoxynucleotidyl transferase dUTP nick‐end labeling‐positive cells. In conclusion, ET shows neuroprotective effects on 2VO rats through rescuing spatial working memory deficits, and a possible mechanism may be related to the increased synaptic transmission and the inhibition of oxidative stress and apoptosis.

image
Physical health monitoring in mental health settings: a study exploring mental health nurses’ views of their role
Authors: Mwebe Herbert
Published: November 2016

Aims and objectives

To explore nurses’ views of their role in the screening and monitoring of the physical care needs of people with serious mental illness in a mental health service provider.

Background

There is increasing awareness through research that people with serious mental illness disproportionately experience and die early from physical health conditions. Mental health nurses are best placed as front‐line workers to offer screening, monitoring and interventions; however, their views on physical care interventions are not studied often.

Design

Qualitative exploratory study.

Methods

The study was carried out in a mental health inpatient centre in England. Volunteer sampling was adopted for the study with a total target sample of (n = 20) nurses from three inpatient wards. Semistructured interviews were conducted with (n = 10) registered mental health nurses who had consented to take part in the study. Inductive data analysis and theme development were guided by a thematic analytic framework.

Results

Participants shared a clear commitment regarding their role regarding physical health screening and monitoring in mental health settings. Four themes emerged as follows: features of current practice and physical health monitoring; perceived barriers to physical health monitoring; education and training needs; and strategies to improve physical health monitoring.

Conclusions

Nurses were unequivocal in their resolve to ensure good standard physical health monitoring and screening interventions in practice. However, identified obstacles have to be addressed to ensure that physical health screening and monitoring is integrated adequately in everyday clinical activities. Achieving this would require improvements in nurses’ training, and an integrated multiservice and team‐working approach.

Relevance to clinical practice

Attending to the physical health needs of people with serious mental illness has been associated with multiple improvements in both mental and physical health; nurses have a vital role to play in identifying and addressing causes of poor physical health to improve physical health outcomes in people with serious mental illness.
Risk factors of post‐traumatic stress symptoms in patients with cancer
Authors: Lin Yu‐Hua , Kao Chia‐Chan , Wu Shu‐Fen , Hung Shu‐Ling , Yang Hsing‐Yu , Tung Hong‐Yi
Published: November 2016

Aims and objectives

To determine the level of post‐traumatic stress symptoms and to identify demographics, disease history and clinical symptoms that were associated with post‐traumatic stress symptoms among patients with gynaecological, breast or colorectal cancer in Taiwan.

Background

Literature indicated that 7·3–35·2% of patients with cancer had experienced level of post‐traumatic stress symptoms. However, the post‐traumatic stress symptoms among patients with cancer in Taiwan was not documented.

Design

A cross‐sectional study.

Methods

A total of 347 participants recruited from two general hospitals in southern Taiwan. They completed the Chinese version of Davidson Trauma Scale and a profile describing their demographics and clinical symptoms. Disease history was collected from medical records.

Results

Approximately 21·6% of participants reported higher score on Chinese version of Davidson Trauma Scale (Mean ± SD = 22·85 ± 24·12). The top four scores on Chinese version of Davidson Trauma Scale were painful memories, insomnia, shortened lifespan and flashbacks. The risk factors of post‐traumatic stress symptoms were suicidal intention (OR = 2·29, 95% CI = 1·86–2·82), chemotherapy (OR = 2·13, 1·18–3·84), metastasis (OR = 2·07, 1·29–3·34), cancer‐specific symptoms (OR = 1·21, 1·15–1·27) and high education (OR = 1·75, 1·10–2·78).

Conclusion

To prevent post‐traumatic stress symptoms, patients with cancer should be routinely screened by psychiatrists for post‐traumatic stress symptoms, for ongoing symptom control and suicidal intention. Patients with cancer who are at risk of suicidal behaviour should be enrolled in suicide prevention programmes.

Relevance to clinical practice

Nurses need to assess post‐traumatic stress symptoms of patients with cancer, particularly those who with high education, suffered from complications of chemotherapy, metastasis and cancer‐specific symptoms and suicidal intention.
Gum chewing combined with oral intake of a semi‐liquid diet in the postoperative care of patients after gynaecologic laparoscopic surgery
Authors: Pan Yuping , Chen Li , Zhong Xiaorong , Feng Suwen
Published: November 2016

Aim and objectives

To evaluate the effects of gum chewing combined with a semi‐liquid diet on patients after gynaecologic laparoscopic surgery.

Background

Previous studies suggested that chewing gum before traditional postoperative care promotes the postoperative recovery of bowel motility and function after open and laparoscopic surgery. However, gum chewing combined with a semi‐liquid diet has not been reported in postoperative care of patients following gynaecologic laparoscopic surgery.

Design

A prospective randomised study.

Methods

Total 234 patients were randomly assigned after elective gynaecologic laparoscopic surgery to a gum chewing and semi‐liquid diet group, a semi‐liquid only diet group or a liquid diet group. The gum chewing and semi‐liquid diet group chewed sugar‐free gum with an oral intake of a semi‐liquid diet six hours postoperatively. The semi‐liquid only diet and liquid diet groups received a semi‐liquid diet or a liquid diet, respectively. The time to first bowel sounds, time to first regular postoperative bowel sounds, time to first passage of flatus, time to first defecation, serum gastrin and incidences of hunger, nausea, vomiting and abdominal distension were recorded. Hunger and gastrointestinal sensations were assessed using a four‐point scale. Serum gastrin was assayed pre‐ and postoperatively using a gastrin radioimmunoassay kit.

Results

The gum chewing and semi‐liquid diet group had first bowel sounds, first regular bowel sounds, first passage of flatus and first defecation earlier than the semi‐liquid only and liquid groups. Increased serum gastrin was observed in the gum chewing and semi‐liquid diet group. Incidences of nausea, vomiting and abdominal distention were not significantly different between these groups.

Conclusion

Chewing gum combined with an oral intake of a semi‐liquid diet is safe and accelerates the postoperative recovery of bowel function. It might be recommended as a better postoperative care regimen for patients after gynaecologic laparoscopic surgery.

Relevance to clinical practice

This study developed a new postoperative diet regimen to improve the postoperative care of patients undergoing laparoscopic gynecologic surgery.
Changes in self‐efficacy, collective efficacy and patient outcome following interprofessional simulation training on postpartum haemorrhage
Authors: Egenberg Signe , Øian Pål , Eggebø Torbjørn Moe , Arsenovic Mirjana Grujic , Bru Lars Edvin
Published: November 2016

Aims and objectives

To examine whether interprofessional simulation training on management of postpartum haemorrhage enhances self‐efficacy and collective efficacy and reduces the blood transfusion rate after birth.

Background

Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide, although it is preventable in most cases. Interprofessional simulation training might help improve the competence of health professionals dealing with postpartum haemorrhage, and more information is needed to determine its potential.

Design

Multimethod, quasi‐experimental, pre–post intervention design.

Methods

Interprofessional simulation training on postpartum haemorrhage was implemented for midwives, obstetricians and auxiliary nurses in a university hospital. Training included realistic scenarios and debriefing, and a measurement scale for perceived postpartum haemorrhage‐specific self‐efficacy, and collective efficacy was developed and implemented. Red blood cell transfusion was used as the dependent variable for improved patient outcome pre–post intervention.

Results

Self‐efficacy and collective efficacy levels were significantly increased after training. The overall red blood cell transfusion rate did not change, but there was a significant reduction in the use of ≥5 units of blood products related to severe bleeding after birth.

Conclusion

The study contributes to new knowledge on how simulation training through mastery and vicarious experiences, verbal persuasion and psychophysiological state might enhance postpartum haemorrhage‐specific self‐efficacy and collective efficacy levels and thereby predict team performance. The significant reduction in severe postpartum haemorrhage after training, indicated by reduction in ≥5 units of blood transfusions, corresponds well with the improvement in collective efficacy, and might reflect the emphasis on collective efforts to counteract severe cases of postpartum haemorrhage.

Relevance to clinical practice

Interprofessional simulation training in teams may contribute to enhanced prevention and management of postpartum haemorrhage, shown by a significant increase in perceived efficacy levels combined with an indicated reduction of severe postpartum haemorrhage after training.
The mental healthcare needs of undocumented migrants: an exploratory analysis of psychological distress and living conditions among undocumented migrants in Norway
Authors: Myhrvold Trine , Småstuen Milada Cvancarova
Published: November 2016

Aims and objectives

To explore undocumented migrants’ mental healthcare needs and more specifically to explore how undocumented adults living in Norway perceive psychological distress, to gather insight on their living conditions and to explore associated living condition risk factors.

Background

Undocumented migrants are defined both nationally and internationally as an especially vulnerable group with regard to their health status, living conditions and barriers to access to health care and social welfare.

Design

An exploratory mixed‐methods design using primarily quantitative data with a qualitative component was implemented.

Methods

Socio‐demographic data on 90 undocumented migrants were obtained, and self‐report questionnaire on psychological distress was completed, supplemented by qualitative data obtained through interviews.

Results

The level of psychological distress was extremely high in our group of undocumented migrants. Leaving their home country because of war or persecution, economic strain, homelessness, hunger and having experienced abuse was significantly positively associated with psychological distress. Contrary to what was predicted, having family and work was not significantly associated with the reduction of psychological distress. Additional qualitative data indicate that having family entails great responsibilities and work implies exploitation to such an extent that any potential positive influence this has on mental health, such as a sense of belonging and a reasonable standard of living, is outweighed.

Conclusions

The high level of psychological distress indicates a need of additional diagnostic evaluation and mental health care. The living conditions were so marginal that their day‐to‐day existence was threatened.

Relevance to clinical practice

We recognised a need for an interdisciplinary and dynamic approach to mental health care. Undocumented migrants are in need of a minimum of psychological and material support assuring basic needs such as shelter and appropriate food and access to health care and social welfare.
Implant Treatment in the Predoctoral Clinic: A Retrospective Database Study of 1091 Patients
Authors: Prasad Soni , Hambrook Christopher , Reigle Eric , Sherman Katherine , Bansal Naveen , Hefti Arthur
Published: November 2016

Purpose

This retrospective study was conducted at the Marquette University School of Dentistry to (1) characterize the implant patient population in a predoctoral clinic, (2) describe the implants inserted, and (3) provide information on implant failures.

Materials and Methods

The study cohort included 1091 patients who received 1918 dental implants between 2004 and 2012, and had their implants restored by a crown or a fixed dental prosthesis. Data were collected from patient records, entered in a database, and summarized in tables and figures. Contingency tables were prepared and analyzed by a chi‐squared test. The cumulative survival probability of implants was described using a Kaplan‐Meier survival curve. Univariate and multivariate frailty Cox regression models for clustered observations were computed to identify factors associated with implant failure.

Results

Mean patient age (±1 SD) at implantation was 59.7 ± 15.3 years; 53.9% of patients were females, 73.5% were Caucasians. Noble Biocare was the most frequently used implant brand (65.0%). Most implants had a regular‐size diameter (59.3%). More implants were inserted in posterior (79.0%) than in anterior jaw regions. Mandibular posterior was the most frequently restored site (43%); 87.8% of implants were restored using single implant crowns. The overall implant‐based cumulative survival rate was 96.4%. The patient‐based implant survival rate was 94.6%. Implant failure risk was greater among patients than within patients (p < 0.05). Age (>65 years; hazard ratio [HR] = 3.2, p = 0.02), implant staging (two‐stage; HR = 4.0, p < 0.001), and implant diameter (wide; HR = 0.4, p = 0.04) were statistically associated with implant failure.

Conclusions

Treatment with dental implants in a supervised predoctoral clinic environment resulted in survival rates similar to published results obtained in private practice or research clinics. Older age and implant staging increased failure risk, while the selection of a wide implant diameter was associated with a lower failure risk.
Increased novel single nucleotide polymorphisms in weedy rice populations associated with the change of farming styles: Implications in adaptive mutation and evolution
Authors: Song Dong‐Yuan , Wang Zhe , Song Zhuo‐Jun , Zhou Cheng‐Chuan , Xu Peng‐Hao , Yang Jie , Yang Ji , Lu Bao‐Rong
Published: November 2016

Substantial genetic variation is found in weedy rice (Oryza sativa f. spontanea Roshev.) populations from different rice‐planting regions with the change of farming styles. To determine the association of such genetic variation with rice farming changes is critical for understanding the adaptive evolution of weedy rice. We studied weedy‐rice specific novel single nucleotide polymorphisms (SNPs) by genome‐wide comparison between DNA sequences of weedy and cultivated rice, in addition to polymerase chain reaction fingerprinting at 22 selected novel SNP loci in weedy rice populations. A great number of novel SNPs were identified across the weedy rice genome. High frequencies of the novel SNPs were determined at the 22 selected loci, although with considerable variation among weedy rice populations in different rice‐planting regions. The highest frequency (∼57%) of novel SNPs was identified in weedy rice populations from Jiangsu that experienced the most dramatic changes in rice farming styles, including the shift from transplanting to direct seeding, and from indica to japonica varieties. The lowest frequency (∼29%) was detected in weedy rice populations from Northeast China, where rice farming has undergone relatively less change. The association between frequencies of novel SNPs in weedy rice populations and the extent of changes in rice farming styles suggests the critical role of adaptive mutation and accumulation of the mutation influenced by human activities in the rapid evolution of weedy rice.
Exploring the pteridophyte flora of the Eastern Afromontane biodiversity hotspot
Authors: Liu Hong‐Mei , Zhang Shou‐Zhou , Wan Tao , Kamau Peris W. , Wang Zheng‐Wei , Grall Aurelie , Hemp Andreas , Schneider Harald
Published: November 2016

In this review, we explore our current understanding of the fern and lycophyte diversity occurring in the Eastern Afromontane Biodiversity Hotspot (EABH). The review explores the species diversity of this region in the context of the Afromadagascan pteridophyte diversity based on an exhaustive species list assembled in the synopsis of Afromadagascan pteridophytes published by Roux in 2009. The list was updated by incorporating recent progress in our understanding of the taxonomy and phylogeny of these plants. Evidence for a distinct pteridophyte flora occurring in the East African mountain region was discovered using ordination and clustering analyses. This EABH floras shares links to other Afromadagascan pteridophyte floras such as the one in the tropical lowland forests of central and western Africa. These floras share the dominance of species that preferably occur in humid climates whereas other African pteridophyte floras tend to contain a higher proportion of xeric adapted ferns. The phylogenetic composition of the EABH pteridophyte flora was assessed by comparing global versus local proportion of orders, families, and genera. This analysis revealed distinct patterns that are partly caused by the radiation of Blotiella and Triplophyllum besides selective colonization of species pre‐adapted to Afromadagascan climates. In situ speciation in the East African tropical mountains may have contributed to the global diversity of widespread genera such as Asplenium and Pteris. In summary, this is the first comprehensive attempt to assess the pteridophyte diversity of the East African mountains providing the framework for future studies on their conservation, ecology, and evolution.
Assessment of the Fecal Microbiota in Beef Calves
Authors: Weese J.S. , Jelinski M.
Published: November 2016

Background

There is increasing interest in the fecal microbiota, but study in calves has been limited.

Hypothesis/Objectives

To evaluate the fecal microbiota of beef calves and cows on different farms, and to preliminarily explore the impact of antimicrobial exposure.

Animals

A total of 172 animals, 156 (91%) calves and 16 (9.3%) cows, were enrolled from 5 cow‐calf farms.

Methods

The fecal bacterial microbiota was assessed through sequencing of 16S rRNA gene (V4 region) amplicons.

Results

There were significant differences in the relative abundances of numerous phyla between calves on different farms. Farms could be separated into 2 groups: 1 (farms B and C) dominated by Firmicutes and 1 (farms A, D, and E) with predominance of Proteobacteria and Actinobacteria. Richness (median 2,974 versus 1,477, P = .008), diversity (51.4 versus 29.1, P = .0029), and evenness (0.73 versus 0.68, P = .006) were higher in cows. Over‐represented operational taxonomic units (OTUs) in cows tended to be from the classes Bacilli and Bacteroidia, whereas Clostridia and Actinobacteria were most prominently over‐represented in calves. There were differences in community membership (P = .028) and structure (P = .029) in calves that had a history of antimicrobial exposure compared those that did not. Eight (89%) over‐represented OTUs in the untreated group were Firmicutes (7 from the order Clostridiales), compared to only 3 (38%) (2 Clostridiales) in the untreated group.

Conclusions and Clinical Importance

Interfarm variation should be investigated to determine the causes and potential implications for health and production. Antimicrobial exposure may have an impact on the fecal microbiota at individual and farm levels.
Class Jurisprudes: Free Labor Ideology and For-Profit Penal Labor in Gilded Age Courts
Authors: Hall Aaron R.
Published: November 2016

For-profit penal servitude flourished in Gilded Age America. Prisoners produced consumer goods inside factory-penitentiaries for private enterprise. Regulations protecting free labor encountered litigation by businesses invested in carceral capitalism. Judges who defended “liberty of contract,” maintained “state neutrality,” and condemned “class legislation” exhibited a different approach when evaluating labeling laws. Such statutes were seemingly consonant with the free labor ideology that dominated appellate benches—they remediated markets distorted by state-created privileges. Yet courts routinely struck them down. This article argues that judges were motivated by a class-infused framework structuring interpretation of facts and aliening lower-class Americans. Judges perceived workingmen who sought remedial assistance as seeking class legislation; they saw prison inmates and products as ordinary workers and goods, not as captive manpower and state-subsidized wares. Jurisprudence bent and bowed from judges’ values and associations. This article thus reintroduces the explanatory power of class to the Lochner era through judicial subjectivity.
The clinic is my woodshed: a new paradigm for learning and refining communication skills
Authors: Haidet Paul , Picchioni Michael
Published: November 2016

Jazz cats use the term ‘woodshedding’ to denote a period of intense practice during which they aim to take their playing up a few notches. Developing expertise, whether we are speaking musically or talking about communicating with patients, requires a lifelong commitment to such practice. For physicians, the woodshed is not a practice room or an isolated space. No: clinical environments are the woodsheds; they are the only places in which one can hone communication skills. The idea of ‘shedding’ in the setting of routine practice challenges prevailing notions about communication skills training and has implications for how such skills should be learned, nurtured and assessed. In this essay, we use stories of woodshedding from jazz music history to discuss concepts related to deliberative practice, formal education and learning communities.
Where do physicians start and end?
Authors: H Ellaway Rachel , Topps David , Topps Maureen
Published: November 2016

Medical education is primarily about training physicians and maintaining their capabilities over time. Given that physicians are the primary focus of the field, there is a need for a clear idea of what physicians are or could be. This paper seeks to explore this issue by posing the simple question: ?Where do physicians start and end?’ In doing so, the authors explore a series of different conceptual frames, including those of a physician’s physical dimensions, their cellular boundaries, personal intentions and beliefs, professional identity, regulation, entrustability, professional performance, extended cognition, and disability. This existential look at the concept of a physician demonstrates the plurality of medical education scholarship and the implications of the many intersecting points of view in the field.
A fresh look at Miller's pyramid: assessment at the ‘Is’ and ‘Do’ levels
Authors: Al‐Eraky Mohamed , Marei Hesham
Published: November 2016

In its silver jubilee, we celebrate the ground‐breaking pyramid of George Miller by submitting a fresh look at it. We discuss two questions. (i) Does the classical pyramidal structure perfectly portray the relationships of the four levels that were described by Miller? (ii) Can the model of Miller fulfill the unmet needs of assessors to measure evolving essential constructs and accommodate the increasingly sophisticated practice of assessment of health professionals? In response to the first question, Miller's pyramid is revisited in view of two assumptions for pyramidal structures, namely: hierarchy and tapering. Then we suggest different configurations for the same classical four levels and indicate when to use each one. With regard to the second question, we provide a rationale for amending the pyramid with two further dimensions to assess personal qualities of students at the ‘Is’ level and their performance in teams at the ‘Do’ (together) level. At the end of the article, we yearn to think outside the pyramid and suggest the Assessment Orbits framework to assess students as individuals and in teams. The five Assessment Orbits alert educators to assess the emerging cognitive and non‐cognitive constructs, without implying features such as hierarchy or tapering that are ingrained in pyramidal structures. The ‘Is’ orbit attends to the personal qualities of graduates ‘who’ we may (or may not) trust to be our physicians. Assessment of teams at the ‘Do’ level (together) offers a paradigm shift in assessment from competitive ranking (storming) among students toward norming and performing as teams.
The stringent response plays a key role in Bacillus subtilis survival of fatty acid starvation
Authors: Pulschen André A. , Sastre Diego E. , Machinandiarena Federico , Crotta Asis Agostina , Albanesi Daniela , de Mendoza Diego , Gueiros‐Filho Frederico J.
Published: November 2016

The stringent response is a universal adaptive mechanism to protect bacteria from nutritional and environmental stresses. The role of the stringent response during lipid starvation has been studied only in Gram‐negative bacteria. Here, we report that the stringent response also plays a crucial role in the adaptation of the model Gram‐positive Bacillus subtilis to fatty acid starvation. B. subtilis lacking all three (p)ppGpp‐synthetases (RelBs, RelP and RelQ) or bearing a RelBs variant that no longer synthesizes (p)ppGpp suffer extreme loss of viability on lipid starvation. Loss of viability is paralleled by perturbation of membrane integrity and function, with collapse of membrane potential as the likely cause of death. Although no increment of (p)ppGpp could be detected in lipid starved B. subtilis, we observed a substantial increase in the GTP/ATP ratio of strains incapable of synthesizing (p)ppGpp. Artificially lowering GTP with decoyinine rescued viability of such strains, confirming observations that low intracellular GTP is important for survival of nutritional stresses. Altogether, our results show that activation of the stringent response by lipid starvation is a broadly conserved response of bacteria and that a key role of (p)ppGpp is to couple biosynthetic processes that become detrimental if uncoordinated.
Multiple transporters are involved in natamycin efflux in Streptomyces chattanoogensis L10
Authors: Wang Tan‐Jun , Shan Yi‐Ming , Li Han , Dou Wei‐Wang , Jiang Xin‐Hang , Mao Xu‐Ming , Liu Shui‐Ping , Guan Wen‐Jun , Li Yong‐Quan
Published: November 2016

Antibiotic‐producing microorganisms have evolved several self‐resistance mechanisms to prevent auto‐toxicity. Overexpression of specific transporters to improve the efflux of toxic antibiotics has been found one of the most important and intrinsic resistance strategies used by many Streptomyces strains. In this work, two ATP‐binding cassette (ABC) transporter‐encoding genes located in the natamycin biosynthetic gene cluster, scnA and scnB, were identified as the primary exporter genes for natamycin efflux in Streptomyces chattanoogensis L10. Two other transporters located outside the cluster, a major facilitator superfamily transporter Mfs1 and an ABC transporter NepI/II were found to play a complementary role in natamycin efflux. ScnA/ScnB and Mfs1 also participate in exporting the immediate precursor of natamycin, 4,5‐de‐epoxynatamycin, which is more toxic to S. chattanoogensis L10 than natamycin. As the major complementary exporter for natamycin efflux, Mfs1 is up‐regulated in response to intracellular accumulation of natamycin and 4,5‐de‐epoxynatamycin, suggesting a key role in the stress response for self‐resistance. This article discusses a novel antibiotic‐related efflux and response system in Streptomyces, as well as a self‐resistance mechanism in antibiotic‐producing strains.