bluuebunny/crossref_metadata_2025 huggingface dataset:
“Tell Me How That Makes You Feel”: Philosophy's Reason/Emotion Divide and Epistemic Pushback in Philosophy Classrooms
Authors: Wolf Allison B.
Published: October 2017

Alison Bailey has recently explored the nature of what she calls privilege‐evasive epistemic pushback or “the variety of willful ignorance that many members of dominant groups engage in when they are asked to consider both the lived experience and structural injustices that members of marginalized groups experience daily.” In this article, I want to use Bailey's argument to demonstrate how privilege‐evasive epistemic pushback is facilitated and obscured by the disciplinary tools of traditional Western philosophy. Specifically, through exploring philosophical cultures of justification and case studies, this work will reveal how students engage in privilege‐evasive epistemic pushback by deploying the reason/emotion divide and various philosophical norms and practices it underlies to protect their epistemic home turf. Then, I offer three emotion‐enhancing critical philosophical practices aimed at disrupting the ignorance‐promoting moves of privilege‐evasive epistemic pushback and, instead, engage emotion as epistemically significant.
The relationship between entanglement concentration and physicochemical properties of potato and sweet potato starch dispersions
Authors: Guo Li , Cui Bo
Published: October 2017

Entanglement concentration (ce) is defined as the onset of overlap and interpenetration of random‐coil chains in a polymer solution and is important in determining rheological, dynamic and fracture properties. However, few studies have reported in detail how ce influences physicochemical properties of starch dispersions. So, the effects of ce on the physicochemical properties of the potato and sweet potato starch dilute and semi‐dilute dispersions were investigated. The results showed that for the two starch dispersions with concentrations ≥ce, the gelatinisation temperature increased more significantly with increasing concentrations, and storage modulus increased faster than loss modulus with increasing frequency. The potato starch dispersion with concentrations ≥ce possessed higher entanglement density of the chain segments. The two starch dispersions with concentrations >ce exhibited shear thinning with increasing frequency. The two starches could only form film at concentrations ≥ce. So, ce will be a suitable concentration for regulating the concentration of starch dispersions to obtain the expected physicochemical properties.
A challenging case of calcific myonecrosis of tibialis anterior and hallucis longus muscles with a chronic discharging wound
Authors: Tan Alethea MY , Loh Charles Yuen Yung , Nizamoglu Metin , Tare Makarand
Published: October 2017

The occurrence of calcific myonecrosis of the anterior compartment of the leg is rare. Common risk factors include a history of trauma, although little is known about the exact pathophysiology, latency period or triggering factors resulting in disease progression. Macroscopically, it begins with a single muscle being replaced by a fusiform calcified mass, which progresses peripherally.

We present a rare case of a 7‐year history of chronic discharging sinus overlying the site with protruding calcified muscle and discuss the senior author's wound management strategy and surgical considerations.

The initial approach used dressing applications to reduce wound exudate while obtaining repeated imaging for disease progression comparison. Repeated CT scans showed significant disease progression from a single solitary amorphous soft tissue calcification to disseminated scattered calcified myonecrosis. In planning such surgeries, extensive debridement and temporary wound coverage is the first stage. Subsequent definitive coverage includes skin grafting of the remaining defect.
A novel model of humanised keloid scarring in mice
Authors: Shang Tao , Yao Bin , Gao Dongyun , Xie Jiangfan , Fu Xiaobing , Huang Sha
Published: October 2017

Treatments for keloid scarring are a major challenge to scientists and physicians for their unknown aetiology. Although several models, including monolayer cell culture to tissue‐engineered models, were developed, further research on keloid has more or less been hindered by the lack of appropriate animal models. Because these aberrant scars are specific to humans, we obtained human normal and keloid skin tissues and isolated dermal fibroblasts from them. Cell morphology, growth and immunohistochemical staining of myofibroblastmarker α‐SMA were examined, and the cell medium of 2‐hour culture and 24‐hour culture was implanted on the back of nude mice. The cell medium of 2‐hour culture and 24‐hour culture was also analysed by a protein array for the detection of distinction in inflammatory factors. We showed that keloid fibroblasts had similar morphology and growth compared to normal skin fibroblasts, but the α‐SMA expression was obviously up‐regulated. After 6 weeks, mice of the 2‐hour keloid‐derived culture medium group exhibited keloid‐like hypertrophic nodules macroscopically, while mice of 24‐hour keloid‐derived culture medium group were similar to normal skin. Histological findings confirmed that the reconstituted skin tissues had the typical features of human keloids. The protein array data revealed that RANTES were involved in humanised fibrotic occurrence in mice, also suggesting they were important modulators of this inflammatory event. This novel model might help to understand the key events that result in the formation of these abnormal scars and provide new therapeutic options.
Gα12 regulates osteoclastogenesis by modulating NFATc1 expression
Authors: Song Min‐Kyoung , Park Cheolkyu , Lee Yong Deok , Kim Haemin , Kim Min Kyung , Kwon Jun‐Oh , Koo Ja Hyun , Joo Min Sung , Kim Sang Geon , Kim Hong‐Hee
Published: October 2017

The G12 family of G protein alpha subunits has been shown to participate in the regulation of various physiological processes. However, the role of Gα12 in bone physiology has not been well described. Here, by micro‐CT analysis, we discovered that Gα12‐knockout mice have an osteopetrotic phenotype. Histological examination showed lower osteoclast number in femoral tissue of Gα12‐knockout mice compared to wild‐type mice. Additionally, in vitro osteoclastic differentiation of precursor cells with receptor activator of nuclear factor‐κB ligand (RANKL) showed that Gα12 deficiency decreased the number of osteoclast generated and the bone resorption activity. The induction of nuclear factor of activated T‐cell c1 (NFATc1), the key transcription factor of osteoclastogenesis, and the activation of RhoA by RANKL was also significantly suppressed by Gα12 deficiency. We further found that the RANKL induction of NFATc1 was not dependent on RhoA signalling, while osteoclast precursor migration and bone resorption required RhoA in the Gα12‐mediated regulation of osteoclasts. Therefore, Gα12 plays a role in differentiation through NFATc1 and in cell migration and resorption activity through RhoA during osteoclastogenesis.
Factors associated with pain and analgesic consumption following non‐surgical periodontal therapy under local anaesthesia and carried out by dental students
Authors: Schirmer Caroline , dos Santos Gabriela Otero , Rost Júlia Franciele , Ferreira Maria Beatriz Cardoso , Weidlich Patrícia
Published: October 2017

Aim

Evaluate factors associated with pain and analgesic consumption following non‐surgical periodontal therapy.

Materials and methods

The sample consisted of 218 patients with chronic periodontitis, submitted to non‐surgical scaling and root planing under local anaesthesia at a public dental service in southern Brazil. The data collection instruments included a demographic questionnaire, as well as State‐Trait Anxiety Inventory, Corahʼs Dental Anxiety Scale, Visual Analogue Scale, Numerical Rating Scale and Verbal Rating Scale. The presence and intensity of pain were evaluated at 2, 6, 12, 24 and 48 hr after scaling and root planing.

Results

A total of 52.3% of the patients reported mild intensity pain at some point during the 48 hr after scaling and root planing with local anaesthesia. Smoking (PR = 1.47; 95% CI = 1.16–1.65), severe periodontal inflammation (PR = 1.31; 95% CI = 1.09–1.58) and dental anxiety (PR = 1.24; 95% CI = 1.03–1.49) were associated with postoperative pain after adjusting for age, gender and state and trait anxiety scores. Moreover, 46.8% of the subjects used analgesics at some time during the 48‐hr follow‐up period and dental anxiety was the only factor associated with postoperative analgesic use.

Conclusions

Smoking, severe periodontal inflammation and dental anxiety were identified as factors associated with pain after non‐surgical scaling and root planing with local anaesthesia. Dental anxiety was also a factor associated with postoperative analgesic use.
What does physicians' clinical expertise contribute to oncologic decision‐making? A qualitative interview study
Authors: Salloch Sabine , Otte Ina , Reinacher‐Schick Anke , Vollmann Jochen
Published: October 2017

Background

Physicians' clinical expertise forms an exclusive body of competences, which helps them to find the appropriate diagnostics and treatment for each individual patient. Empirical evidence, however, suggests that there is an inverse relationship between the number of years in practice and the quality of care provided by a physician. Knowledge and adherence to professional standards (such as clinical guidelines) are often used as indicators in previous research.

Methods

Semistructured interviews and the Q method were used for an explorative study on oncologists' views on the interplay between their own clinical expertise, intuition, and the external evidence incorporated in clinical guidelines. The interviews were audio recorded, transcribed ad verbatim, and analysed using qualitative content analysis.

Results

Data analysis shows the complex character of clinical expertise with respect to experience, professional development, and intuition. An irreplaceable role is attributed to personal and bodily experience during the providing of care for a patient. Professional experience becomes important, particularly in those situations that lie out of the focus of “guideline medicine.” Intuition is regarded as having a strong emotional component and helps for deciding which therapeutic option the patient can deal with.

Conclusions

Using measurable knowledge and adherence to standards as indicators does not account for the complexity of clinical expertise. Other factors, such as the importance of bodily experience and physicians' intuitive knowledge, must be considered, also with respect to the occurrence of treatment biases.
Astrocytes with previous chronic exposure to amyloid β‐peptide fragment 1–40 suppress excitatory synaptic transmission
Authors: Kawano Hiroyuki , Oyabu Kohei , Yamamoto Hideaki , Eto Kei , Adaniya Yuna , Kubota Kaori , Watanabe Takuya , Hirano‐Iwata Ayumi , Nabekura Junichi , Katsurabayashi Shutaro , Iwasaki Katsunori
Published: October 2017

Synaptic dysfunction and neuronal death are responsible for cognitive and behavioral deficits in Alzheimer's disease (AD). It is well known that such neurological abnormalities are preceded by long‐term exposure of amyloid β‐peptide (Aβ) and/or hyperphosphorylated tau prior. In addition to the neurological deficit, astrocytes as a major glial cell type in the brain, significantly participate in the neuropathogenic mechanisms underlying synaptic modulation. Although astrocytes play a significant key role in modulating synaptic transmission, little is known on whether astrocyte dysfunction caused by such long‐term Aβ exposure affects synapse formation and function. Here, we show that synapse formation and synaptic transmission are attenuated in hippocampal‐naïve neurons co‐cultured with astrocytes that have previously experienced chronic Aβ1‐40 exposure. In this abnormal astrocytic condition, hippocampal neurons exhibit decrements of evoked excitatory post‐synaptic currents (EPSCs) and miniature EPSC frequency. Furthermore, size of readily releasable synaptic pools and number of excitatory synapses were also significantly decreased. Contrary to these negative effects, release probability at individual synapses was significantly increased in the same astrocytic condition. Taken together, our data indicate that lower synaptic transmission caused by astrocytes previously, and chronically, exposed to Aβ1–40 is attributable to a small number of synapses with higher release probability.

image
Registered nurses’ own experience of using a nurse‐initiated pain protocol based on their working experience
Authors: Sturesson Lars , Falk Ann‐Charlotte , Ulfvarson Johanna , Lindström Veronica
Published: October 2017

Aims and objectives

To explore registered nurses’ (RNs) own experience of using the nurse‐initiated pain protocol (NIPP) in the emergency department (ED) based on their working experience.

Background

Pain is known to be one of the most common symptoms among adult patients seeking care at the ED. Several strategies aiming to improve pain management have been developed. Despite some improvements in pain management using NIPP, a large number of patients continue to have inadequate pain treatment when cared for in EDs.

Design and method

A cross‐sectional study design based on a questionnaire was used. The variable working experience was based on a theory that experience will make a change in RNs’ knowledge. Descriptive statistics and Pearson's chi‐square tests were used for analysing quantative data. Qualitative data were analysed by summative content analysis.

Results

Seventy RNs answered the questionnaire (response rate 42%) and 61% considered the NIPP adequate to relieve patients’ acute pain at the ED. No significant difference was found on how the RNs used the NIPP. However, qualitative data showed that more experienced RNs adapt the NIPP according to the patients’ needs in a higher extent.

Conclusion

A majority of the RNs consider the NIPP to be adequate to relieve patients’ acute pain in the ED. An increase in working experience showed an impact on how the NIPP was used, with an increase in pain management that is personalised depending on individual patients’ needs. The RNs used several alternatives to both dosage and type of medication when the ED becomes crowded.

Relevance to clinical practice

Registered nurses’ working experience should be considered when planning nursing schedules to be better able to meet patients’ needs. Guidelines should be developed and evaluated by both healthcare professionals and patients.
Variation in nurse self‐reported practice of managing chest tubes: A cross‐sectional study
Authors: Lu Cui , Jin Ying‐hui , Gao Weijie , Shi Yue‐xian , Xia Xinhua , Sun Wen‐xi , Tang Qi , Wang Yunyun , Li Ge , Si Jinhua
Published: October 2017

Aims and objectives

To reveal nurses’ self‐reported practice of managing chest tubes and to define decision‐makers for these practices.

Background

No consensus exists regarding ideal chest‐tube management strategy, and there are wide variations of practice based on local policies and individual preferences, rather than standardised evidence‐based protocols.

Design

This article describes a cross‐sectional study.

Methods

Questionnaires were emailed to 31 hospitals in Tianjin, and the sample consisted of 296 clinical nurses whose work included nursing management of chest drains. The questionnaire, which was prepared by the authors of this research, consisted of three sections, including a total of 22 questions that asked for demographic information, answers regarding nursing management that reflected the practice they actually performed and who the decision‐makers were regarding eight chest‐drain management procedures. McNemar's test was used to analyse the data.

Results

The results indicated that most respondents thought that it was necessary to manipulate chest tubes to remove clots impeding unobstructed drainage (91.2%). Most respondents indicated that dressings would be changed when the dressing was dysfunctional. At the same time, more than half of respondents approved of changing dressings routinely, and the frequency of changing dressings varied. When drainage was employed for pleural effusion and for a pneumothorax, 64.6% and 94.5% of respondents, respectively, considered that underwater seal‐drainage bottles should be changed routinely, and the frequency of changing bottles both varied. The results indicated that nurses were the primary decision‐makers in the replacement of chest tubes, manipulation of chest tubes and monitoring of drainage fluid.

Conclusions

There was considerable variation in respondents’ self‐reported clinical nursing practice regarding management of chest drains. The rationale on which respondents’ practices were based also varied greatly. This study indicated that nurses were the primary decision‐makers for three of eight procedures regarding management of chest drains, which reflects that clinical nurses’ decision‐making power regarding management of chest drains was weak.

Relevance to clinical practice

This study describes the nurse‐reported practices of Chinese nurses from Tianjin, including changing and selecting dressing types, manipulating chest tubes, clamping drains and replacing drainage bottles, and the study defines who the decision‐makers were for these interventions. By focusing on nurses’ self‐report of behaviours in managing chest drains (actual nursing practice vs. nursing knowledge), this article also relates the literature to the research findings and denotes the gaps in knowledge for future research.
Effects of home‐based lower limb resistance training on muscle strength and functional status in stable Chronic obstructive pulmonary disease patients
Authors: Chen Yi , Niu Mei'e , Zhang Xiuqin , Qian Hongying , Xie Anwei , Wang Xiya
Published: October 2017

Aims and objectives

This study aimed to determine the effect of home‐based lower limb resistance training (LLRT) in patients with stable COPD.

Background

Pulmonary rehabilitation (PR) in COPD patients has been substantially investigated, but the rehabilitation components differ among studies. Few works have focused on home‐based LLRT. Furthermore, few studies have assessed muscle strength and functional status by isokinetic/isometric extensor muscle peak torque (PT) and five‐repetition sit‐to‐stand test (FTSST), respectively.

Design

A randomised controlled design was adopted.

Methods

(i) The home‐based LLRT consisted of six sets of lower limb training cycles by self‐gravity resistance and Thera‐band resistance at 8–12RM, 20–30 min/session and 3 sessions/week for 12 weeks. (ii) The intervention group (n = 25) received routine PR guidance and home‐based LLRT, whereas the control group (n = 22) received routine PR guidance only. The muscle strengths, FTSST durations, 6‐min walking distances (6MWDs) and COPD assessment test results at enrolment and week 12 were compared.

Results

Relative to the baseline findings, all the indexes of muscle strength (isometric extensor muscle PT, isometric extensor muscle PT to body weight ratio [PT/BW], isokinetic extensor muscle PT and isokinetic extensor muscle PT/BW) did not significantly change in the intervention group. Meanwhile, no significant intragroup difference was noted among the indexes of muscle strength (except for isometric extensor muscle PT) in the control group. The FTSST decrease was significant between and within groups. By contrast, the 6MWD significantly increased within both groups, but not between the groups. The COPD assessment tool score decreased significantly within the intervention group.

Conclusions

Compared with routine PR guidance, home‐based LLRT can improve not only the muscle strength and exercise endurance but also the lower limb functional status.

Relevance to clinical practice

Our developed home‐based LLRT intervention is simple, safe and feasible in stable COPD patients and could hence be promoted in clinical practice.
The effect on pain of three different nonpharmacological methods in peripheral intravenous catheterisation in adults
Authors: Yılmaz Dilek , Güneş Ülkü Yapucu
Published: October 2017

Aims and objectives

To compare the effectiveness in reducing pain during peripheral intravenous catheterisation of coughing, blowing into a spirometer and squeezing a stress ball.

Background

Peripheral intravenous catheterisation is widely performed by nurses; it causes pain and discomfort to patients.

Design

This was a single‐blind randomized controlled study.

Methods

The sample of the study consisted of 120 males who came to donate blood. Before the peripheral intravenous catheterisation, the individuals were divided by a simple randomisation method into four groups: a coughing group, a blowing into a spirometer group, a stress ball squeezing group and a control group. During the procedure, the pain levels felt by the individuals were assessed using the visual analog scale by a nurse who was blinded to the procedure.

Findings

The mean pain of the individuals in the coughing group was found to be 19.5 mm (SD: 13.6), that of the spirometer group was 28.3 mm (SD: 20.2), that of the stress ball group was 32.1 mm (SD: 23.8) and that of the control group was 45.5 mm (SD: 19.5). Statistical analysis showed a significant difference between the mean pain scores of individuals in the control group and those of individuals in the coughing, spirometer and stress ball groups.

Conclusion

The techniques of squeezing a stress ball, blowing into a spirometer and in particular coughing, depending on the potential mechanism of the Valsalva manoeuvre and diverting attention, are effective techniques in reducing the pain of peripheral catheterisation procedures.

Relevance to clinical practice

It is important that nurses should be aware of pain and stress experienced by patients during invasive procedures. For this reason, nurses should have knowledge of proven nonpharmacological methods which can reduce pain to a minimum.
Medication administration and interruptions in nursing homes: A qualitative observational study
Authors: Odberg Kristian Ringsby , Hansen Britt Sætre , Aase Karina , Wangensteen Sigrid
Published: October 2017

Aims and objectives

To contribute in‐depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized?

Background

Medication administration is a vital process across healthcare settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety.

Design

A qualitative observational study design was applied.

Methods

Data were collected using partial participant observations. An inductive content analysis was performed.

Results

Factors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation and staff's apparent freedom as to how and where to perform medication‐related activities. Interruptions during medication administration are prevalent and can be characterised as passive (e.g., alarm and background noises), active (e.g., discussions) or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes.

Conclusions

A process of normalisation has taken place whereby staff put up with second‐rate technological solutions, noise and interruptions when they are performing medication‐related tasks. Before seeking to minimise interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach.

Relevance to clinical practice

Staff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence.
Evaluation of a nurse‐led intervention to improve adherence to recommended guidelines for prevention of venous thromboembolism for hip and knee arthroplasty patients: A quasi‐experimental study
Authors: Lockwood Rosemarie , Kable Ashley , Hunter Sharyn
Published: October 2017

Aims and objectives

To measure adherence to a nurse‐led evidence‐based venous thromboembolism prevention programme (intervention) compared to usual care in hip and knee arthroplasty patients and associated clinical outcomes.

Background

Venous thromboembolism morbidity and mortality of hospitalised patients is a major concern for health professionals. Venous thromboembolism prevention guidelines have been developed; however, adherence to guidelines is variable.

Participants

There were 410 potential participants who were adult patients that were booked for elective hip or knee arthroplasty at the two study sites during a 2‐year period (2011–2013). Of these, 27 did not meet the inclusion criteria, and the remainder were eligible for inclusion in the study (intervention siten = 196 and control siten = 187, total populationn = 383).

Methods

This study adopted a quasi‐experimental design, using an intervention and control study site, conducted in two private hospitals in a regional area in Australia.

Results

The intervention group had a mean compliance score of 11.09, higher than the control group score of 7.19. This is equivalent to a compliance rate of 85% and 55%, respectively, and indicates that adherence at the study site was significantly higher. Patient adherence and outcomes in the postdischarge period were not significantly different between the study sites.

Conclusion

This study demonstrated a nurse‐led intervention achieved high adherence with translating evidence‐based guidelines into routine patient care for hip and knee arthroplasty patients. Nurses can be critical to implementing clinical practice guidelines and adopting preventive programmes in acute care to improve patient outcomes and reduce postoperative venous thromboembolism in arthroplasty patients.

Relevance to clinical practice

This research demonstrates the capacity of nurses to lead the translation of evidence‐based practice guidelines for prevention of venous thromboembolism into routine patient care.
The meaning of rituals after a stillbirth: A qualitative study of mothers with a stillborn baby
Authors: Tseng Ying‐Fen , Hsu Min‐Tao , Hsieh Yueh‐Tzu , Cheng Hsiu‐Rong
Published: October 2017

Aims and objectives

To explore the meaning of rituals that women and their families perform after a stillbirth.

Background

A cultural taboo in Taiwan prohibits discussing death; thus, parents of stillborn babies have no established public mourning or burial ceremonies to perform for their stillborn children. Stillbirths are often treated as if they had never happened.

Design

Qualitative descriptive study.

Methods

In‐depth interviews, which were transcribed and content analysed, were conducted with a purposive sample of 16 women discharged from two teaching hospitals in Taiwan after they had a stillbirth.

Results

Families engaged in rituals for two underlying reasons: to benefit the deceased child and the immediate family. The meanings of the rituals for the child are presented through three themes: (i) sending the baby's spirit to a safe place, (ii) protecting it from suffering and (iii) preparing it for a better reincarnation. The meanings of rituals for the families are presented through four themes: (i) releasing parental guilt by doing their best for the deceased child, (ii) cutting bonds with the child, (iii) avoiding additional misfortune should they mishandle the funeral and (iv) praying for a successful subsequent pregnancy.

Conclusions

Death‐related rituals are highly culturally diverse. This study fills a gap about Asian cultures. Participating in rituals permits a mother to do something for her deceased child, helps relieve her guilt and lets her cope with the stillbirth. Rituals after a stillbirth can help a woman recover from grieving and allow her to hope for a successful subsequent pregnancy.

Relevance to clinical practice

Health professionals should discuss with bereaved parents what rituals they would like to perform and then respect their decisions. A continuum of care and support that exists from the prenatal diagnosis through the stillbirth and beyond is recommended for parents and families during this difficult time.
Hospital discharge processes involving older adults living with dementia: An integrated literature review
Authors: Stockwell‐Smith Gillian , Moyle Wendy , Marshall Andrea P , Argo Alison , Brown Laura , Howe Shelley , Layton Keith , Naidoo Ornissa , Santoso Yuwati , Soleil‐Moudiky‐Joh Elizabeth , Grealish Laurie
Published: October 2017

Aims and objectives

To identify barriers and facilitators to engagement of people with dementia and family carers in planning for discharge from hospital.

Background

Hospital discharge can be particularly challenging for older people with dementia. To assist in the development of bespoke discharge processes that address the unique needs of older people with dementia, an integrated review of the literature was undertaken.

Design and methods

A four‐stage integrative review framework guided the review. Three search strategies were employed: a computerised database search, a hand search of reference lists and forward citation searching. Paired members of the research team reviewed eligible full‐text papers. The methodological quality of each paper was assessed using the Mixed‐Methods Assessment Tool, followed by data extraction and completion of summary tables. Within and across study analysis and synthesis of study findings was undertaken using thematic synthesis.

Results

Fifteen papers were included in the review. Most identified barriers to collaborative discharge processes related to distributed responsibility for discharge, risk averse approaches to discharge, limited family carer confidence, and limited validation of assumptions about family competency to manage at home. Facilitators included supported clinician and family carer engagement, and maintaining independence for activities of daily living.

Relevance to clinical practice

Reflective analysis of discharge decisions, focused on risk and possible risk aversion, can assist teams to evaluate the quality of their discharge decisions. The use of formal communication strategies such as a patient/family‐held journal of the hospital experience and a structured family meeting early in the hospital admission can enhance family engagement in discharge planning. Prevention of functional and cognitive decline is emerging as critical to improving hospital discharge outcomes.
Oral health matters for the nutritional status of older persons—A population‐based study
Authors: Lindmark Ulrika , Jansson Henrik , Lannering Christina , Johansson Linda
Published: October 2017

Aims and objectives

To explore the association between oral health and nutritional status in the context of daily care for older people.

Background

Oral problems often increase with age and affect a person's ability to chew and swallow. They might also influence the ability to maintain a satisfactory nutritional status. Oral health awareness is therefore of great importance in nursing care for older people.

Design

A retrospective cross‐sectional study.

Methods

Data from the Swedish quality register, Senior Alert, were used, including structured assessments of both oral and nutritional status using the Revised Oral Assessment Guide—Jönköping and the Mini Nutritional Assessment. In total, 1,156 persons (mean age: 82.8 ± 7.9) had both oral and nutritional assessments registered by the nursing staff in daily care.

Results

Approximately 29% of participants had moderate oral health problems. Another 12% had severe problems. Over 60% of the persons were considered at risk of malnutrition or were malnourished. There was a weak correlation between poor nutritional status and poor oral health, and approximately one‐third of the persons who were at risk or malnourished had simultaneous oral problems. A multivariate logistic regression revealed that when problems involving voice and swallowing were present, there was also a greater possibility of being assessed as at risk of malnourishment or being malnourished.

Conclusion

There is a relationship between oral health problems and nutritional status, indicating the importance of evaluating oral health status in older persons with nutritional problems.

Relevance to clinical practice

Nursing staff involved in care for older people should be aware of the importance of including regular oral health check‐ups in their work. There is also a need for nursing staff members and oral health professionals to exchange knowledge.
Proton‐Pump Inhibitor use and the risk of Ischaemic Stroke
Authors: Dai C. , Jiang M. , Cao Q.
Published: October 2017

Click here to view the Letter to the Editor by Dr. Sehested et al.
Long‐Term Magnetization Transfer Ratio Evolution in Multiple Sclerosis White Matter Lesions
Authors: Zheng Yufan , Lee Jar‐Chi , Rudick Richard , Fisher Elizabeth
Published: October 2017

BACKGROUND AND PURPOSE

Magnetization transfer ratio (MTR), a magnetic resonance imaging technique used to assess tissue integrity, correlates with demyelination and axonal loss in multiple sclerosis (MS) lesions. In acute white matter lesions, short‐term MTR changes mainly reflect demyelination and remyelination, in addition to edema and axonal and glial changes. Long‐term MTR changes in MS lesions have not been studied extensively.

METHODS

A new quantitative image analysis method was developed to measure long‐term MTR changes in MS lesions. The method was applied to a group of 59 patients and 14 healthy control subjects followed for 4 years. MTR changes in white matter lesions were analyzed, where lesion voxels were classified into six categories based on starting MTR and change over time. For each patient, the proportion of lesion voxels in each MTR‐change category was calculated. Correlations between long‐term MTR evolution, disability progression, and brain atrophy were investigated.

RESULTS

The proportion of lesion voxels in the high stable category correlated with less atrophy progression, while the proportion with low and increasing MTR correlated with increased atrophy. The proportion of lesion voxels in the high and stable MTR lesion category was significantly different between MS disease subgroups. The group with disability progression had a higher proportion of lesion voxels with low and increasing MTR.

CONCLUSIONS

These results suggest that long‐term changes in MTR in white matter lesions can be used to distinguish lesion subtypes associated with MS disease progression and improve understanding of the temporal evolution of MS pathology.
Does EU cohesion policy work? Theory and evidence
Authors: Fiaschi Davide , Lavezzi Andrea Mario , Parenti Angela
Published: October 2017

This paper evaluates the effectiveness of European Cohesion Policy in the regions of 12 EU countries in the period 1991–2008, on the basis of a spatial growth model, which allows for the identification of both direct and indirect effects of EU funds on GDP per worker growth. We find that “Objective 1” funds are characterized by strong spatial externalities and a positive and concave effect on the growth of GDP per worker, which reaches a peak at the ratio funds/GDP of approximately 3 percent and becomes non‐significant after 4 percent. “Objective 2” and “Cohesion” funds have nonsignificant effects, while all the other funds exert a positive and significant effect, but their size is very limited. EU Cohesion Policy, moreover, appears to have increased its effectiveness over time. In the period 2000–2006 Objective 1 funds are estimated to have a median multiplier equal to 1.52, and to have added 0.37 percent to the GDP per worker growth. Overall, in the period 1991–2008, funds are estimated to have added 1.4 percent to the median annual growth, and to have reduced regional disparities of 8 basis points in terms of the Gini index.
Human capital sorting: The “when” and “who” of the sorting of educated workers to urban regions
Authors: Ahlin Lina , Andersson Martin , Thulin Per
Published: October 2017

The sorting of high‐ability workers is often advanced as one source of spatial disparities in economic outcomes. There are still few papers that analyze when human capital sorting occurs and whom it involves. Using data on 16 cohorts of university graduates in Sweden, we demonstrate significant sorting to urban regions on high school grades and education levels of parents, i.e., two attributes typically associated with latent abilities that are valued in the labor market. A large part of this sorting has already occurred in deciding where to study, because the top universities in Sweden are predominantly located in urban regions. The largest part of directed sorting on ability indicators occurs in the decision of where to study. Even after controlling for sorting prior to labor market entry, the “best and brightest” are still more likely to start working in urban regions. However, this effect appears to be driven by Sweden's main metropolitan region, Stockholm. We find no influence of our ability indicators on the probability of starting to work in urban regions after graduation when Stockholm is excluded. Studies of human capital sorting need to account for selection processes to and from universities, because neglecting mobility prior to labor market entry is likely to lead to an underestimation of the extent of the sorting to urban regions.
Organization of plastid genomes in the freshwater red algal order Batrachospermales (Rhodophyta)
Authors: Paiano Monica Orlandi , Del Cortona Andrea , Costa Joana F. , Liu Shao‐Lun , Verbruggen Heroen , De Clerck Olivier , Necchi Orlando
Published: October 2017

Little is known about genome organization in members of the order Batrachospermales, and the infra‐ordinal relationship remains unresolved. Plastid (cp) genomes of seven members of the freshwater red algal order Batrachospermales were sequenced, with the following aims: (i) to describe the characteristics of cp genomes and compare these with other red algal groups; (ii) to infer the phylogenetic relationships among these members to better understand the infra‐ordinal classification. Cp genomes of Batrachospermales are large, with several cases of gene loss, they are gene‐dense (high gene content for the genome size and short intergenic regions) and have highly conserved gene order. Phylogenetic analyses based on concatenated nucleotide genome data roughly supports the current taxonomic system for the order. Comparative analyses confirm data for members of the class Florideophyceae that cp genomes in Batrachospermales is highly conserved, with little variation in gene composition. However, relevant new features were revealed in our study: genome sizes in members of Batrachospermales are close to the lowest values reported for Florideophyceae; differences in cp genome size within the order are large in comparison with other orders (Ceramiales, Gelidiales, Gracilariales, Hildenbrandiales, and Nemaliales); and members of Batrachospermales have the lowest number of protein‐coding genes among the Florideophyceae. In terms of gene loss, apcF, which encodes the allophycocyanin beta subunit, is absent in all sequenced taxa of Batrachospermales. We reinforce that the interordinal relationships between the freshwater orders Batrachospermales and Thoreales within the Nemaliophycidae is not well resolved due to limited taxon sampling.
Type‐III secretion pore formed by flagellar protein FliP
Authors: Ward Elizabeth , Renault Thibaud T. , Kim Eun A , Erhardt Marc , Hughes Kelly T. , Blair David F.
Published: October 2017

During assembly of the bacterial flagellum, protein subunits that form the exterior structures are exported through a specialized secretion apparatus energized by the proton gradient. This category of protein transport, together with the similar process that occurs in the injectisomes of gram‐negative pathogens, is termed type‐III secretion. The membrane‐embedded part of the flagellar export apparatus contains five essential proteins: FlhA, FlhB, FliP, FliQ and FliR. Here, we have undertaken a variety of experiments that together support the proposal that the protein‐conducting conduit is formed primarily, and possibly entirely, by FliP. Chemical modification experiments demonstrate that positions near the center of certain FliP trans‐membrane (TM) segments are accessible to polar reagents. FliP expression sensitizes cells to a number of chemical agents, and mutations at predicted channel‐facing positions modulate this effect. Multiple assays are used to show that FliP suffices to form a channel that can conduct a variety of medium‐sized, polar molecules. Conductance properties are strongly modulated by mutations in a methionine‐rich loop that is predicted to lie at the inner mouth of the channel, which might form a gasket around cargo molecules undergoing export. The results are discussed in the framework of an hypothesis for the architecture and action of the cargo‐conducting part of the type‐III secretion apparatus.
A cerato‐platanin protein SsCP1 targets plant PR1 and contributes to virulence of Sclerotinia sclerotiorum
Authors: Yang Guogen , Tang Liguang , Gong Yingdi , Xie Jiatao , Fu Yanping , Jiang Daohong , Li Guoqing , Collinge David B. , Chen Weidong , Cheng Jiasen
Published: October 2017

Cerato‐platanin proteins (CPs), which are secreted by filamentous fungi, are phytotoxic to host plants, but their functions have not been well defined to date.

Here we characterized a CP (SsCP1) from the necrotrophic phytopathogen Sclerotinia sclerotiorum. Sscp1 transcripts accumulated during plant infection, and deletion of Sscp1 significantly reduced virulence. SsCP1 could induce significant cell death when expressed in Nicotiana benthamiana.

Using yeast two‐hybrid, GST pull‐down, co‐immunoprecipitation and bimolecular florescence complementation, we found that SsCP1 interacts with PR1 in the apoplast to facilitate infection by S. sclerotiorum. Overexpressing PR1 enhanced resistance to the wild‐type strain, but not to the Sscp1 knockout strain of S. sclerotiorum. Sscp1‐expressing transgenic plants showed increased concentrations of salicylic acid (SA) and higher levels of resistance to several plant pathogens (namely Botrytis cinerea, Alternaria brassicicola and Golovinomyces orontii).

Our results suggest that SsCP1 is important for virulence of S. sclerotiorum and that it can be recognized by plants to trigger plant defense responses. Our results also suggest that the SA signaling pathway is involved in CP‐mediated plant defense .
WRKY70 prevents axenic activation of plant immunity by direct repression of SARD1
Authors: Zhou Man , Lu You , Bethke Gerit , Harrison Brian T. , Hatsugai Noriyuki , Katagiri Fumiaki , Glazebrook Jane
Published: October 2017

SARD1 is an activator of plant immunity that promotes production of the hormone salicylic acid (SA) and activation of defense gene expression. SARD1 itself is strongly inducible by infection. Here, we investigated the transcriptional control of SARD1.

We used yeast one‐hybrid assays to identify WRKY70. The WRKY70 binding site was defined using electrophoretic mobility shift assays, and its importance was investigated using an Arabidopsis thaliana protoplast system. The effect of wrky70 mutations was studied by measurements of pathogen growth, SA concentrations, and gene expression by RNA‐seq.

WRKY70 binds to a GACTTTT motif in the SARD1 promoter in yeast and Arabidopsis protoplasts. Plants with wrky70 mutations have elevated expression of SARD1 in the absence of pathogens, but not when infected. Expression profiling revealed that WRKY70 represses many pathogen‐inducible genes in the absence of pathogens, yet is required for activation of many other pathogen‐inducible genes in infected plants. The GACTTTT motif is enriched in the promoters of both these gene sets, and conserved in SARD1 orthologs within the Brassicaceae.

WRKY70 represses SARD1 by binding the motif GACTTTT in the absence of pathogens. Conservation of the WRKY70 binding among the Brassicaceae suggests that WRKY70 repression of SARD1 is important for fitness.
Migrant Networks and the Spread of Information
Authors: Elsner Benjamin , Narciso Gaia , Thijssen Jacco
Published: October 2017

Diaspora networks provide information to future migrants, which affects their success in the host country. While the existing literature explains the effect of networks on the outcomes of migrants through the size of the migrant community, we show that the quality of the network is an equally important determinant. We argue that networks that are more integrated in the society of the host country can provide more accurate information to future migrants about job prospects. In a decision model with imperfect signalling, we show that migrants with access to a better network are more likely to make the right decision, that is, they migrate only if they gain. We test these predictions empirically using data on recent Mexican migrants to the United States. To instrument for the quality of networks, we exploit the settlement of immigrants who came during the Bracero program in the 1950s. The results are consistent with the model predictions, providing evidence that connections to a better integrated network lead to better outcomes after migration.
Informed consent in pediatric anesthesiology
Authors: Gentry Katherine R. , Lepere Katherine , Opel Douglas J.
Published: October 2017

Background

Informed consent for pediatric anesthesia is unique because it is (1) obtained from surrogates (ie, parents) rather than from the patient and (2) sought after parents have authorized the surgical intervention. There are limited data on how pediatric anesthesia informed and consent discussions are conducted. The purpose of this study was to characterize the content of preanesthesia informed consent discussions and assess their impact on parent recall and understanding.

Methods

We conducted a cross‐sectional observational study at a tertiary pediatric hospital. We audio‐recorded and transcribed preanesthesia consent discussions between pediatric anesthesia providers and parents of children undergoing elective surgery. Parents were recruited on the day of surgery and completed a survey postdiscussion to assess their recall and perceived understanding. We used directed content analysis to identify 7 informed consent elements: (i) description of the plan; mention of (ii) alternatives, (iii) risks, and (iv) benefits; (v) discussion of uncertainties; (vi) assessment of comprehension; and (vii) solicitation of a decision. We used multivariable logistic regression to explore the association between discussions that included 3 informed consent elements (description of plan, mention of risks, and mention of benefits) and parent recall and understanding of these elements.

Results

We analyzed 97 discussions involving 41 different anesthesia providers. The element most frequently included in preanesthesia discussions was a description of the plan (100%); the least frequently included was decision solicitation (18%). Seventy‐one percent of discussions included ≥5 informed consent elements and 70% included a description of the plan, mention of risks, and mention of benefits. Parental recall of these 3 informed consent elements was associated with their inclusion in the preanesthesia discussion (75% vs 34%), and more parents understood all 3 elements if they had reported (vs not reported) recall of all 3 elements (97% vs 53%).

Conclusion

Most pediatric preanesthesia discussions include ≥5 informed consent elements and describe the plan, mention risks, and mention benefits. Inclusion of these latter 3 consent elements was associated with parental recall of these elements but not understanding.