bluuebunny/crossref_metadata_2025 huggingface dataset:
Retracted: Cytosolic glyceraldehyde‐3‐phosphate dehydrogenase 2/5/6 increase drought tolerance via stomatal movement and reactive oxygen species scavenging in wheat
Authors: Zhang Lin , Lei Daili , Deng Xia , Li Fangfang , Ji Haikun , Yang Shushen
Published: December 2019

Drought is a major threat to wheat growth and crop productivity. However, there has been only limited success in developing drought‐hardy cultivars. This lack of progress is due, at least in part, to a lack of understanding of the molecular mechanisms of drought tolerance in wheat. Here, we evaluated the potential role of three cytosolic glyceraldehyde‐3‐phosphate dehydrogenases (TaGAPC2/5/6) under drought stress in wheat and Arabidopsis. We found that TaGAPC2/5/6 all positively responded to drought stress via reactive oxygen species (ROS) scavenging and stomatal movement. The results of yeast co‐transformation and electrophoretic mobility shift assay showed that TaWRKY33 acted as a direct regulator ofTaGAPC2/5/6genes. The dual luciferase reporter assay indicated that TaWRKY33 positively activated the expression ofTaGAPC2/5/6. The results of bimolecular fluorescence complementation and yeast two‐hybrid system demonstrated that TaGAPC2/5/6 interacted with phospholipase Dδ (PLDδ). We then demonstrated that TaGAPC2/5/6 positively promoted the activity of TaPLDδ in vitro and in vivo. Furthermore, lower PLDδ activity in RNAi wheat could lead to less PA accumulation, causing higher stomatal aperture sizes under drought stress. In summary, our results establish a new positive regulatory mechanism ofTaGAPCswhich helps wheat fine‐tune their drought responses.
Shade avoidance and reproductive strategies of an early successional species Penthorum chinense in relation to shade treatments
Authors: Yang Y. Y. , Kim J. G.
Published: December 2019

Shade avoidance is expected to be favoured under moderate light. However, in previous studies, shade avoidance was highest in the deepest shade, despite the fact that the plants incur the costs of shade avoidance without the benefits of being exposed to increased light.

We performed shading experiments under different light intensities to understand: (i) how shade avoidance traits of Penthorum chinense could peak in moderate light, and (ii) if there was a trade‐off between plant height and allocation of seeds along the light gradients.

Penthorum chinense increased shade avoidance traits such as height per total dry mass as the amount of light decreased. Side stem number per total dry mass of P. chinense decreased as shade became deeper, from full light to low light. Regressions on seed mass fraction and height were significant with a linear model (y = −0.0006x + 0.1338). There were more resources allocated to seeds under low light than under moderate light.

Penthorum chinense increased shade avoidance traits with the decrease in light amount, as found in previously studied species. There was a trade‐off between height and production of more seeds. The reproductive strategy of P. chinense was to increase seed mass fraction under low light more than under moderate light. This species might be able to expand established populations by both rhizomes and seeds under low light environments.
Estimation and Inference in Mixed Effect Regression Models Using Shape Constraints, with Application to Tree Height Estimation
Authors: Liao Xiyue , Meyer Mary C.
Published: December 2019

Estimation of tree height given diameter is an important part of the forest inventory analysis of the US Forest Service. Existing methods use parametric models to estimate the curve. We propose a semiparametric model in which log (height) is a smooth, increasing and concave function of diameter, with a random-plot component and fixed effect covariates. Large sample properties and inference methods that work well in practice are derived. Proposed inference methods use approximate normal distributions for the fixed effects and a likelihood ratio test for the significance of the random effect. A closed form approximate prediction method is provided and overall it outperformed competitors for both a simulation and a real data application. The methods are implemented by the cgamm routine in the R package cgam and can be used for a wide range of mixed model applications.
Meso–Cenozoic cooling and exhumation history of the Orlica‐Śnieżnik Dome (Sudetes, NE Bohemian Massif, Central Europe): Insights from apatite fission‐track thermochronometry
Authors: Sobczyk Artur , Sobel Edward R. , Georgieva Viktoria
Published: December 2019

This study presents the first suite of apatite fission‐track (AFT) ages from the SE part of the Western Sudetes. AFT cooling ages from the Orlica‐Śnieżnik Dome and the Upper Nysa Kłodzka Graben range from Late Cretaceous (84 Ma) to Early Palaeocene–Middle Eocene (64–45 Ma). The first stage of basin evolution (~100–90 Ma) was marked by the formation of a local extensional depocentre and disruption of the Mesozoic planation surface. Subsequent far‐field convergence of European microplates resulted in Coniacian–Santonian (~89–83 Ma) thrust faulting. AFT data from both metamorphic basement and Mesozoic sedimentary cover indicate homogenous Late Cretaceous burial of the entire Western Sudetes. Thermal history modeling suggests that the onset of cooling could be constrained between 89 and 63 Ma with a climax during the Palaeocene–Middle Eocene basin inversion phase.
Ectopic expression of a rice plasma membrane intrinsic protein (OsPIP1;3) promotes plant growth and water uptake
Authors: Liu Siyu , Fukumoto Tatsuya , Gena Patrizia , Feng Peng , Sun Qi , Li Qiang , Matsumoto Tadashi , Kaneko Toshiyuki , Zhang Hang , Zhang Yao , Zhong Shihua , Zeng Weizhong , Katsuhara Maki , Kitagawa Yoshichika , Wang Aoxue , Calamita Giuseppe , Ding Xiaodong
Published: December 2019

Plasma membrane intrinsic proteins (PIPs) are known to be major facilitators of the movement of a number of substrates across cell membranes. From a drought‐resistant cultivar of Oryza sativa (rice), we isolated an OsPIP1;3 gene single‐nucleotide polymorphism (SNP) that is mostly expressed in rice roots and is strongly responsive to drought stress. Immunocytochemistry showed that OsPIP1;3 majorly accumulated on the proximal end of the endodermis and the cell surface around the xylem. Expression of GFP‐OsPIP1;3 alone in Xenopus oocytes or rice protoplasts showed OsPIP1;3 mislocalization in the endoplasmic reticulum (ER)‐like neighborhood, whereas co‐expression of OsPIP2;2 recruited OsPIP1;3 to the plasma membrane and led to a significant enhancement of water permeability in oocytes. Moreover, reconstitution of 10×His‐OsPIP1;3 in liposomes demonstrated water channel activity, as revealed by stopped‐flow light scattering. Intriguingly, by patch‐clamp technique, we detected significant NO3− conductance of OsPIP1;3 in mammalian cells. To investigate the physiological functions of OsPIP1;3, we ectopically expressed the OsPIP1;3 gene in Nicotiana benthamiana (tobacco). The transgenic tobacco plants exhibited higher photosynthesis rates, root hydraulic conductivity (Lpr) and water‐use efficiency, resulting in a greater biomass and a higher resistance to water deficit than the wild‐type did. Further experiments suggested that heterologous expression of OsPIP1;3 in cyanobacterium altered bacterial growth under different conditions of CO2 gas supply. Overall, besides shedding light on the multiple functions played by OsPIP1;3, this work provides insights into the translational value of plant AQPs.
Safety and efficacy of topically administered netarsudil (Rhopressa™) in normal and glaucomatous dogs withADAMTS10‐open‐angle glaucoma (ADAMTS10‐OAG)
Authors: Leary Kelly A. , Lin Kuan‐Ting , Steibel Juan P. , Harman Christine D. , Komáromy András M.
Published: December 2019

Objective

To evaluate safety and efficacy of topically administered 0.02% netarsudil ophthalmic solution (Rhopressa™; Aerie Pharmaceutical) in normal and glaucomatous dogs withADAMTS10‐open‐angle glaucoma (ADAMTS10‐OAG).

Animals studied

Five normal and 5 glaucomatous Beagle dogs withADAMTS10‐OAG.

Procedures

In each dog, left or right eye was randomly selected for netarsudil treatment. Contralateral eyes were sham‐treated with balanced salt solution (BSS). Following a 1‐week baseline period, dogs were treated once daily (q24h) during week 2, and twice daily (q12h) during week 3; week 4 served as washout period. Efficacy was measured by diurnal intraocular pressure (IOP) and pupil diameter. Safety was assessed by routine ophthalmic examination, gonioscopy, and pachymetry. Differences in least square means of quantitative outcome measures were compared between netarsudil and BSS sham‐treated eyes by linear Gaussian model.

Results

Baseline IOPs were 18.5 ± 0.5 mm Hg (mean ± SEM) in normal and 27.8 ± 1.0 mm Hg in OAG dogs. Even though mean IOPs were lower in netarsudil‐ vs sham‐treated eyes, the overall differences were neither significant nor clinically relevant, regardless of treatment frequency (q24h‐normal: sham 16.4 ± 1.1 mm Hg vs treatment 15.6 ± 1.0 mm Hg; q24hr‐OAG: sham 25.8 ± 2.3 mm Hg vs. treatment 25.7 ± 2.4 mm Hg; q12hr‐normal: sham 15.4 ± 0.8 mm Hg vs. treatment 14.4 ± 0.8 mm Hg; q12hr‐OAG: sham 26.3 ± 1.7 mm Hg vs. treatment 25.4 ± 1.8 mm Hg). Netarsudil administration was well tolerated but resulted in significant, moderate‐to‐severe conjunctival hyperemia (P < .001).

Conclusions

Once or twice daily administration of netarsudil resulted in marginal and clinically irrelevant IOP decreases in normal and OAG‐affected dogs. Except for conjunctival hyperemia, the drug was well tolerated.
Tourism in Neuroscience Framework/Cultural Neuroscience, Mirror Neurons, Neuroethics
Authors: Njegovanović Ana
Published: December 2019

Tourism is a dynamic and competitive industry that requires the ability to constantly adapt to the changing needs and wishes of customers in the uncertain financial global environment posing the problem of attracting tourists. The aim of the paper is to research the involvement of neuroscience through cultural neuroscience, mirror neurons, neuroethics as a new approach to different aspects of tourism. We present the most important research in the field of tourism through existing literature, discuss the limitations of this approach and propose guidelines for future research. In a theoretical approach, given the specific tourist experiences, mirror neurons can contribute to explaining some important aspects of tourism. Investigations lead to a neurological context, where many modes are associated, the language utilizes a multimodal sensory motor system that includes the brain area (concept of empathy, characterization of the traditional anthropological relationship between the host and host of the Istrian region).Research on cultural neuroscience examines how cultural and genetic diversity shape the human mind, brain, and behavior in multiple time scales: state, ontogenesis, and phylogeny.We particularly emphasize the importance of medical tourism by including empirical research from different disciplines and ethical issues involving individual and population perspectives.
Short Women’s Prayers in Spoken Ladino During three Times of Crisis
Authors: Dori Nitsa
Published: December 2019

This article discusses a limited number of ritual incantations or short prayers, used by Ladino-speaking women during crises – birth, war, or drought. These prayers, transmitted from one woman to another, were chosen because they are absent from the two major recent books on women’s prayers – Aliza Lavie’s A Jewish Woman’s Prayer Book (2008), which includes women’s prayers from different ethnic communities, some in Ladino, and Ora (Rodrigue) Schwarzwald’s Seder Nashim (2012), prayers from a sixteenth century Ladino prayer book. This article seeks to document those short prayers before they are lost. They are quoted directly from Ladino-speaking informers, and discuss their life experiences, cultural norms, and individual discomforts.
Changes in systemic and subcutaneous adipose tissue inflammation and oxidative stress in response to exercise training in obese black African women
Authors: Nono Nankam Pamela A. , Mendham Amy E. , De Smidt Melony F. , Keswell Dheshnie , Olsson Tommy , Blüher Matthias , Goedecke Julia H.
Published: December 2019

Key points

Inflammation and oxidative stress are interrelated during obesity and contribute to the development of insulin resistance; and exercise training represents a key component in the management of these conditions.

Black African women, despite high gluteal subcutaneous adipose tissue (SAT) and less visceral fat, are less insulin sensitive than their white counterparts.

Exercise training improved systemic oxidative stress in obese black women, which was related to gynoid fat reduction and not insulin sensitivity.

Inflammatory markers changed depot‐specifically in response to exercise training, increasing in gluteal SAT without changing in abdominal SAT.

The increase of inflammatory state in gluteal SAT after exercise training is suggested to result from tissue remodelling consecutive to the reduction of gynoid fat but does not contribute to the improvement of whole‐body insulin sensitivity in obese black South African women.

Inflammation and oxidative stress are interrelated during obesity and contribute to the development of insulin resistance. Exercise training represents a key component in the management of obesity. We evaluated the effects of 12 weeks’ combined resistance and aerobic exercise training on systemic and abdominal vs. gluteal subcutaneous adipose tissue (SAT) inflammatory and oxidative status in obese black South African women. Before and after the intervention, body composition (dual energy X‐ray absorptiometry), cardio‐respiratory fitness (), serum and SAT inflammatory and oxidative stress markers were measured from 15 (control group) and 20 (exercise group) women and insulin sensitivity (SI; frequently sampled intravenous glucose tolerance test) was estimated. Following the intervention, (9.8%), body fat composition (1–3%) and SI (9%) improved, serum thiobarbituric acid reactive substances (TBARS) decreased (6.5%), and catalase activity increased (23%) in the exercise compared to the control group (P < 0.05), without changes in circulating inflammatory markers. The mRNA content of interleukin‐10, tumour necrosis factor α, nuclear factor κB and macrophage migration inhibitory factor increased in the gluteal SAT exercise compared to the control group P < 0.05), with no changes in abdominal SAT. These changes of inflammatory profile in gluteal SAT, in addition to the reduction of circulating TBARS, correlated with the reduction of gynoid fat, but not with the improvement of SI. The changes in systemic oxidative stress markers and gluteal SAT inflammatory genes correlated with the reduction in gynoid fat but were not directly associated with the exercise‐induced improvements in SI.
O Jogo Social dos atores na Gestão Federativa em Saúde
Authors: Gimenez de Carvalho Brígida , Stefano Nicoletto Sônia Cristina , Polo de Almeida Nunes Elisabete De Fátima
Published: December 2019

O espaço da gestão federativa é a Comissão Intergestores Regional, onde atores discutem, negociam e pactuam ações de saúde. Com objetivo de compreender a gestão federativa produzida em regiões de saúde do Paraná - Brasil, realizou-se estudo qualitativo. Participaram 40 gestores municipais em cinco grupos focais e cinco representantes da gestão estadual, entrevistados. Os resultados foram analisados por meio da hermenêutica-dialética, à luz da Teoria do Jogo Social. Nas discussões dos gestores predominaram demandas das esferas nacional e estadual e a rotatividade de alguns e o despreparo de outros dificultam a construção de um coletivo coeso. O poder teve destaque, fazendo com que a vontade de uns prevalecesse e o consenso fosse alcançado à custa de apatia. Constatou-se interferência de outros jogos sociais, com destaque para o político, econômico e da comunicação. Considera-se que a gestão federativa necessita posicionamento dos atores diferente do encontrado.
Comparison of distortion-product otoacoustic emission and stimulus-frequency otoacoustic emission two-tone suppression in humans
Authors: Rasetshwane Daniel M. , Bosen Emily C. , Kopun Judy G. , Neely Stephen T.
Published: December 2019

Distortion-product otoacoustic emission (DPOAE) and stimulus-frequency otoacoustic emission (SFOAE) are two types of acoustic signals emitted by the inner ear in response to tonal stimuli. The levels of both emission types may be reduced by the inclusion of additional (suppressor) tones with the stimulus. Comparison of two-tone suppression properties across emission type addresses a clinically relevant question of whether these two types of emission provide similar information about cochlear status. The purpose of this study was to compare DPOAE suppression to SFOAE suppression from the same ear in a group of participants with normal hearing. Probe frequency was approximately 1000 Hz, and the suppressor frequency varied from −1.5 to 0.5 octaves relative to the probe frequency. DPOAE and SFOAE suppression were compared in terms of (1) suppression growth rate (SGR), (2) superimposed suppression tuning curves (STCs), and (3) STC-derived metrics, such as high-frequency slope, cochlear amplifier gain, and QERB (ERB, equivalent rectangular bandwidth). Below the probe frequency, the SGR was slightly greater than one for SFOAEs and slightly less than two for DPOAEs. There were no differences in STC metrics across emission types. These observations may provide useful constraints on physiology-based models of otoacoustic emission suppression.
Engineering a CRISPR Interference System To Repress a Class 1 Integron in Escherichia coli
Authors: Li Qingyang , Zhao Peng , Li Lili , Zhao Haifeng , Shi Lei , Tian Pingfang
Published: December 2019

Microbial multidrug resistance (MDR) poses a huge threat to human health. Bacterial acquisition of MDR relies primarily on class 1 integron-involved horizontal gene transfer (HGT) of antibiotic resistance genes (ARGs). To date, no strategies other than the use of antibiotics can efficiently cope with MDR. Here, we report that an engineered CRISPR interference (CRISPRi) system can markedly reduce MDR by blocking a class 1 integron in
Escherichia coli
. Using CRISPRi to block plasmid R388 class 1 integron,
E. coli
recombinants showed halted growth upon exposure to relevant antibiotics.
In Vivo
Imaging of the Buccal Mucosa Shows Loss of the Endothelial Glycocalyx and Perivascular Hemorrhages in Pediatric Plasmodium falciparum Malaria
Authors: Lyimo Eric , Haslund Lars Emil , Ramsing Thomas , Wang Christian William , Efunshile Akinwale Michael , Manjurano Alphaxard , Makene Victor , Lusingu John , Theander Thor Grundtvig , Kurtzhals Jørgen Anders Lindholm , Paulsen Rasmus , Hempel Casper
Published: December 2019

Severe malaria is mostly caused by
Plasmodium falciparum,
resulting in considerable, systemic inflammation and pronounced endothelial activation. The endothelium forms an interface between blood and tissue, and vasculopathy has previously been linked with malaria severity. We studied the extent to which the endothelial glycocalyx that normally maintains endothelial function is involved in falciparum malaria pathogenesis by using incident dark-field imaging in the buccal mucosa.
Contribution of Laccase Expression to Immune Response against Cryptococcus gattii Infection
Authors: Hansakon Adithap , Ngamskulrungroj Popchai , Angkasekwinai Pornpimon
Published: December 2019

Cryptococcosis is an infectious disease caused by two fungal species,
Cryptococcus neoformans
and
Cryptococcus gattii
. While
C. neoformans
affects mainly immunocompromised patients,
C. gattii
infects both immunocompetent and immunocompromised individuals. Laccase is an important virulence factor that contributes to the virulence of
C. neoformans
by promoting pulmonary growth and dissemination to the brain. The presence of laccase in
C. neoformans
can shift the host immune response toward a nonprotective Th2-type response.
A Screen for Antibiotic Resistance Determinants Reveals a Fitness Cost of the Flagellum in Pseudomonas aeruginosa
Authors: Rundell E. A. , Commodore N. , Goodman A. L. , Kazmierczak B. I.
Published: December 2019

The cell envelopes of Gram-negative bacteria render them intrinsically resistant to many classes of antibiotics. We used insertion sequencing to identify genes whose disruption altered the fitness of a highly antibiotic-resistant pathogen,
Pseudomonas aeruginosa
, in the presence of antibiotics usually excluded by the cell envelope. This screen identified gene products involved in outer membrane biogenesis and homeostasis, respiration, and efflux as important contributors to fitness. An unanticipated fitness cost of flagellar assembly and function in the presence of the glycopeptide antibiotic vancomycin was further characterized. These findings have clinical relevance for individuals with cystic fibrosis who are infected with
P. aeruginosa
and undergo treatment with vancomycin for a concurrent
Staphylococcus aureus
infection.
Disruption of
l
-Rhamnose Biosynthesis Results in Severe Growth Defects in Streptococcus mutans
Authors: Bischer Andrew P. , Kovacs Christopher J. , Faustoferri Roberta C. , Quivey Robert G.
Published: December 2019

Streptococcus mutans
is a pathogenic bacterium that is the primary etiologic agent of dental caries, a disease that affects billions yearly. Rhamnose biosynthesis is conserved not only in streptococcal species but in other Gram-positive, as well as Gram-negative, organisms. This study highlights the importance of rhamnose biosynthesis in RGP production for protection of the organism against acid and oxidative stresses, the two major stressors that the organism encounters in the oral cavity. Loss of RGP also severely impacts biofilm formation, the first step in the onset of dental caries. The high conservation of the rhamnose synthesis enzymes, as well as their importance in
S. mutans
and other organisms, makes them favorable antibiotic targets for the treatment of disease.
Complex regional pain syndrome after transradial cerebral intervention
Authors: Walker Melanie , Levitt Michael R
Published: December 2019

Access site complications from transradial approaches for endovascular interventions are uncommon and many are preventable. Complications described in the literature include hematoma, radial artery occlusion, vasospasm, and even compartment syndrome. Mild post-procedure discomfort reported by patients is typically self-limited and managed symptomatically with oral analgesics. Pain that has no obvious structural correlate and is unresponsive to intravenous narcotics is very unusual. We describe the diagnosis and management of a case of complex regional pain syndrome of the upper extremity after transradial stent-assisted coil embolization of a cerebral aneurysm.
Unique mishap following transfacial pin fixated midface distraction and successful management using nasal endoscopy
Authors: Jayakumar Naveenkumar , Saravanamuthu Thirunavukarasu , Balasubramaniam Chidambaram , Singaravelu Ramesh
Published: December 2019

A 2-year-old female child with craniosynostosis was referred to our unit for definitive management. She presented with a turricephalic head, hypoplastic midface and obstructive sleep apnoea. Routine preoperative workup included radiographs, CT and polysomnography. She was provisionally planned for calvarial remodelling and midface advancement using transfacial pin fixated distractor (TPF). This involves insertion of a K-wire from one zygoma to the other, a few millimetres below the orbits, traversing across maxilla and nasal cavity. The ends of K-wire are then connected to the distractor anchored firmly to the temporal bone. During insertion, the K-wire transected the nasogastric tube. This technical disaster was circumvented by endoscopic-guided disengagement prior to recovery. The purpose of this paper is to discuss the probable causes that lead to such untoward instances and strategies to avoid and manage the same.
Traumatic brachial plexus injury rehabilitation using neuromuscular electrical muscle stimulation in a polytrauma patient
Authors: Rich Jessica Anne , Newell Abraham , Williams Timothy
Published: December 2019

We report a 28-year-old man admitted postmotorcycle versus car in September 2017. The patient sustained multiple injuries in both the upper and lower limbs. He sustained a complex brachial plexus injury on his left side and was transferred immediately to Stanmore Hospital to undergo specialist surgery (supraclavicular brachial plexus exploration and neurolysis) to repair his brachial plexus injury. The patient was transferred back to the specialist trauma ward for additional surgeries for his subsequent injuries. Due to the complexity of the injury and surgery the patient was not able to start rehabilitation until six weeks post operation, at which point he was referred to outpatient physiotherapy. Prior to this his left upper limb was in a sling but was instructed to move it as able. The patient commenced his comprehensive physiotherapy programme in January 2018.
Transscleral cyclophotocoagulation as primary management in a nanophthalmic eye with anterior uveitis and secondary mixed mechanism glaucoma
Authors: Bromeo Albert John , Bartilad Kathrin
Published: December 2019

A 36-year-old woman presented with eye pain and blurring of vision in her right eye. On eye examination, it was noted that there were angle-closure glaucoma and anterior uveitis in both eyes. Ocular ultrasound showed short axial lengths as well as a choroidal thickening in both eyes, confirming the diagnosis of nanophthalmos. Nanophthalmos is a condition where the eye is abnormally short, resulting in axial hyperopia and predisposing it to angle-closure glaucoma. The patient was initially managed medically, but the glaucoma was intractable. The patient underwent repeated sessions of transscleral cyclophotocoagulation which eventually lowered the intraocular pressure. The management of nanophthalmic eyes can be quite challenging due to the risk of inciting uveal effusion syndrome with any form of intraocular surgery. Controlled and repeated sessions of transscleral cyclophotocoagulation may be considered as a viable management option in these cases.
Pregnancy decisions after fetal or perinatal death: systematic review of qualitative research
Authors: Dyer Eleanor , Bell Ruth , Graham Ruth , Rankin Judith
Published: December 2019

Objectives

To synthesise the findings of qualitative research exploring parents’ experiences, views and decisions about becoming pregnant following a perinatal death or fetal loss.

Design

Systematic review and meta-synthesis of qualitative research.

Data sources

Medline, Web of Science, CINAHL, PsycINFO, ASSIA, Embase, PUBMED, Scopus and Google Scholar.

Eligibility criteria

Nine electronic databases were searched using predefined search terms. Articles published in English, in peer-reviewed journals, using qualitative methods to explore the experiences and attitudes of bereaved parents following perinatal or fetal loss, were included.

Data extraction and synthesis

Qualitative data relating to first-order and second-order constructs were extracted and synthesised across studies using a thematic analysis.

Results

15 studies were included. Four descriptive themes and 10 subthemes were identified. The descriptive themes were: deciding about subsequent pregnancy, diversity of reactions to the event, social network influences, and planning or timing of subsequent pregnancy. The decision to become pregnant after death is complex and varies between individuals and sometimes within couples. Decisions are often made quickly, in the immediate aftermath of a pregnancy loss, but may evolve over time. Bereaved parents may feel isolated from social networks.

Conclusions

There is an opportunity to support parents to prepare for a pregnancy after a fetal or perinatal loss, and conversations may be welcomed at an early stage. Health professionals may play an important role providing support lacking from usual social networks.

PROSPERO registration number

CRD42018112839
Patient safety in inpatient mental health settings: a systematic review
Authors: Thibaut Bethan , Dewa Lindsay Helen , Ramtale Sonny Christian , D'Lima Danielle , Adam Sheila , Ashrafian Hutan , Darzi Ara , Archer Stephanie
Published: December 2019

Objectives

Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology.

Design

Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to ‘mental health’, ‘patient safety’, ‘inpatient setting’ and ‘research’. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model.

Results

Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control.

Conclusions

Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice.

PROSPERO registration number

CRD42016034057.
Development and evaluation of an intervention based on the provision of patient feedback to improve patient safety in Spanish primary healthcare centres: study protocol
Authors: Serrano-Ripoll Maria J , Ripoll Joana , Llobera Joan , Valderas Jose Maria , Pastor-Moreno Guadalupe , Olry de Labry Lima Antonio , Ricci-Cabello Ignacio
Published: December 2019

Introduction

Despite the enormous potential for adverse events in primary healthcare (PHC), the knowledge about how to improve patient safety in this context is still sparse. We describe the methods for the development and evaluation of an intervention targeted at PHC professionals to improve patient safety in Spanish PHC centres.

Methods and analysis

The intervention will consist in using the patient reported experiences and outcomes of safety in primary care (PREOS-PC) survey to gather patient-reported experiences and outcomes concerning the safety of the healthcare patients receive in their PHC centres, and feed that information back to the PHC professionals to help them identify opportunities for safer healthcare provision. The study will involve three stages. Stage 1 (developing the intervention) will involve: (i) qualitative study with 40 PHC providers to optimise the acceptability and perceived utility of the proposed intervention; (ii) Spanish translation, cross-cultural adaptation and validation of the PREOS-PC survey; (iii) developing the intervention components; and (iv) developing an online tool to electronically administrate PREOS-PC and automatically generate feedback reports to PHC centres. Stage 2 (piloting the intervention) will involve a 3-month feasibility (one group pre-post) study in 10 PHC centres (500 patients, 260 providers). Stage 3 (evaluating the intervention) will involve: (i) a 12-month, two-arm, two-level cluster randomised controlled trial (1248 PHC professionals within 48 PHC centres; with randomisation at the centre level in a 1:1 ratio) to evaluate the impact of the intervention on patient safety culture (primary outcome), patient-reported safety experiences and outcomes (using the PREOS-PC survey), and avoidable hospitalisations; (ii) qualitative study with 20 PHC providers to evaluate the acceptability and perceived utility of the intervention and identify implementation barriers.

Ethics and dissemination

The study was approved by the Ethics Committee of the Balearic Islands (CEI IB: 3686/18) with the 1964 Helsinki Declaration and its later amendments. The results will be disseminated in peer-reviewed publications and national and international conferences.

Trial registration number

NCT03837912; pre-results.
Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting
Authors: Ashworth Mark , Durbaba Stevo , Whitney David , Crompton James , Wright Michael , Dodhia Hiten
Published: December 2019

Objective

To study the social determinants and cardiovascular risk factors for multimorbidity and the acquisition sequence of multimorbidity.

Design

Longitudinal study based on anonymised primary care data.

Setting

General practices in an urban multiethnic borough in London, UK.

Participants

332 353 patients aged ≥18 years.

Main outcome measures

Clinical and sociodemographic characteristics of patients with multimorbidity, defined as ≥3 of 12 long-term conditions (LTCs) selected according to high predicted healthcare use. Multilevel logistic regression was used to model social determinants and cardiovascular risk factors. Alluvial plots were constructed to illustrate multimorbidity acquisition sequences according to age, ethnicity and social deprivation.

Results

5597 (1.7%) patients had ≥3 selected LTCs, the ‘multimorbidity cohort’. The the most common LTCs were diabetes (63.0%) and chronic pain (CP) (42.8%). Social deprivation and ethnicity were independent determinants of multimorbidity: most compared with the least deprived quintile (adjusted OR (AOR) 1.56 (95% CI 1.41 to 1.72)); South Asian compared with white ethnicity (AOR 1.44 (95% CI 1.29 to 1.61)); and black compared with white ethnicity (AOR 0.86 (95% CI 0.80 to 0.92)). The included cardiovascular risk factors were relatively strong determinants of multimorbidity: hypertension (AOR 5.05 (95% CI 4.69 to 5.44)), moderate obesity (AOR 3.41 (95% CI 3.21 to 3.63)) and smoking (AOR 2.30 (95% CI 2.16 to 2.45)). The most common initial onset conditions were diabetes and depression; diabetes particularly in older and black ethnic groups; and depression particularly in younger, more deprived and white ethnicity groups. CP was less common as an initial condition.

Conclusion

Our findings confirm the importance of age, social deprivation and ethnicity as determinants of multimorbidity. Smoking, obesity and hypertension as cardiovascular risk factors were stronger determinants of multimorbidity than deprivation or ethnicity. The acquisition sequence of multimorbidity is patterned by sociodemographic determinants. Understanding onset conditions of multimorbidity and cardiovascular cardiovascular risk factors may lead to the development of interventions to slow the progression of multimorbidity.
Non-pharmacological interventions for improving quality of life of long-term care residents with dementia: a scoping review protocol
Authors: Akintola Abimbola A , Achterberg Wilco P , Caljouw Monique A A
Published: December 2019

Introduction

Evidence concerning the effectiveness of non-pharmacological interventions that are applied to people with dementia living in long-term care facilities is inconsistent. The purpose of this protocol is to describe the methodological considerations that will guide the completion of a scoping review that will inventorise and assess the effectiveness of the various non-pharmacological interventions that are documented in literature for improving quality of life of people with dementia living in long-term care.

Methods and analysis

This scoping review will combine the methodology outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews and Guidance for conducting systematic scoping reviews by Peterset al. PubMed; MEDLINE; CINAHL; Embase; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; Emcare; Sociological Abstracts and PsycINFO databases will be searched. Grey literature databases will also be explored. A two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of studies. Studies, irrespective of design, will be included that quantitatively assess quality of life of long-term care residents who receive non-pharmacological interventions for dementia. A pair of reviewers will independently assess all articles for eligibility, and all eligible articles will be abstracted and charted using a standardised form. The extracted data will undergo a ‘narrative review’ or a descriptive analysis of the contextual or process-oriented data and quantitative analysis reflecting the objectives of this scoping review.

Ethics and dissemination

Research ethics approval is not required for this scoping review. This review started off in October 2018, anticipated end date is June 2020. We plan to disseminate this research through publications, presentations at relevant national and international conferences and meetings with relevant stakeholders. This scoping review protocol has been registered at Open Science Framework (https://osf.io/tupbv).
Multimorbidity patterns in patients with heart failure: an observational Spanish study based on electronic health records
Authors: Gimeno-Miguel Antonio , Gracia Gutiérrez Anyuli , Poblador-Plou Beatriz , Coscollar-Santaliestra Carlos , Pérez-Calvo J Ignacio , Divo Miguel J , Calderón-Larrañaga Amaia , Prados-Torres Alexandra , Ruiz-Laiglesia Fernando J
Published: December 2019

Objectives

To characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the impact of such patterns on the risk of hospitalisation and mortality.

Design

Observational retrospective population study based on electronic health records.

Setting

EpiChron Cohort (Aragón, Spain).

Participants

All the primary and hospital care patients of the EpiChron Cohort with a diagnosis of HF on 1 January 2011 (ie, 8488 women and 6182 men). We analysed all the chronic diseases registered in patients’ electronic health records until 31 December 2011.

Primary outcome

We performed an exploratory factor analysis to identify the multimorbidity patterns in men and women, and logistic and Cox proportional-hazards regressions to investigate the association between the patterns and the risk of hospitalisation in 2012, and of 3-year mortality.

Results

Almost all HF patients (98%) had multimorbidity, with an average of 7.8 chronic diseases per patient. We identified six different multimorbidity patterns, named cardiovascular, neurovascular, coronary, metabolic, degenerative and respiratory. The most prevalent were the degenerative (64.0%) and cardiovascular (29.9%) patterns in women, and the metabolic (49.3%) and cardiovascular (43.2%) patterns in men. Every pattern was associated with higher hospitalisation risks; and the cardiovascular, neurovascular and respiratory patterns significantly increased the likelihood of 3-year mortality.

Conclusions

Multimorbidity is the norm rather than the exception in patients with heart failure, whose comorbidities tend to cluster together beyond simple chance in the form of multimorbidity patterns that have different impact on health outcomes. This knowledge could be useful to better understand common pathophysiological pathways underlying this condition and its comorbidities, and the factors influencing the prognosis of men and women with HF. Further large scale longitudinal studies are encouraged to confirm the existence of these patterns as well as their differential impact on health outcomes.
Supporting surgeons in patient-centred complex decision-making: a qualitative analysis of the impact of a perioperative physician clinic
Authors: Pham Clarabelle T , Gibb Catherine L , Fitridge Robert A , Karnon Jon , Hoon Elizabeth
Published: December 2019

Objective

Patients with comorbidities can be referred to a physician-led high-risk clinic for medical optimisation prior to elective surgery at the discretion of the surgical consultant, but the factors that influence this referral are not well understood. The aims of this study were to understand the factors that influence a surgeon’s decision to refer a patient to the clinic, and how the clinic impacts on the management of complex patients.

Design

Qualitative study using theoretical thematic analysis to analyse transcribed semi-structured interviews.

Setting

Interviews were held in either the surgical consultant’s private office or a quiet office/room in the hospital ward.

Participants

Seven surgical consultants who were eligible to refer patients to the clinic.

Results

When discussing the factors that influence a referral to the clinic, all participants initially described the optimisation of comorbidities and would then discuss with examples the challenges with managing complex patients and communicating the risks involved with having surgery. When discussing the role of the clinic, two related subthemes were dominant and focused on the management of risk in complex patients. The participants valued the involvement of the clinic in the decision-making and communication of risks to the patient.

Conclusions

The integration of the high-risk clinic in this study appears to offer additional value in supporting the decision-making process for the surgical team and patient beyond the clinical outcomes. The factors that influence a surgeon’s decision to refer a patient to the clinic appear to be driven by the aim to manage the uncertainty and risk to the patient regarding surgery and it was seen as a strategy for managing difficult and complex cases.
Efficacy of a computer-tailored web-based physical activity intervention using Fitbits for older adults: a randomised controlled trial protocol
Authors: Alley Stephanie , van Uffelen Jannique GZ , Schoeppe Stephanie , Parkinson Lynne , Hunt Susan , Power Deborah , Duncan Mitch J , Schneiders AG , Vandelanotte Corneel
Published: December 2019

Introduction

Physical activity is an integral part of healthy ageing, yet the majority of older adults 65+ years are not sufficiently active. Web-based physical activity interventions hold much promise to reach older adults. Preliminary evidence suggests that web-based interventions with tailored advice and Fitbits may be well suited for older adults.

Methods and analysis

This study aims to test the effectiveness of ‘Active for Life’, a 12-week computer-tailored web-based physical activity intervention using Fitbits for older adults. We will recruit 300 participants who will be randomly assigned to one of three trial arms: (1) web-based physical activity intervention with tailored advice only, (2) web-based physical activity intervention with tailored advice and Fitbit or (3) a wait-list control. The primary outcome, objective moderate to vigorous physical activity (MVPA) and secondary outcomes of objective sedentary behaviour, objective sleep, quality of life, social support, physical function and satisfaction with life will be assessed at baseline and week 12. The secondary outcomes of self-reported physical activity, sitting time and sleep will be assessed at baseline, week 6, 12 and 24. Website usability and participant satisfaction will be assessed at week 12 and website usage and intervention fidelity will be assessed from week 1 to 24. Intention-to-treat linear mixed model analyses will be used to test for group (tailoring only, tailoring +Fitbit, control) differences on changes in the main outcome, MVPA and secondary outcomes. Generalised linear models will be used to compare intervention groups (tailoring only, tailoring +Fitbit) on website usability, participant satisfaction, website usage and intervention fidelity.

Ethics and dissemination

The study has received ethics approval from the Central Queensland University Human Research Ethics Committee (H16/12-321). Study outcomes will be disseminated through peer-reviewed publications and academic conferences and used to inform improvements and dissemination of a tailored, web-based physical activity intervention for adults 65+ years.

Trial registration number

Australian and New Zealand Clinical Trials Registry Number: ACTRN12618000646246
What factors contribute to uncontrolled gout and hospital admission? A qualitative study of inpatients and their primary care practitioners
Authors: Kong Darren Chyi Hsiang , Sturgiss Elizabeth Ann , Dorai Raj Annamma Kochummen , Fallon Kieran
Published: December 2019

Objective

To provide deeper insight into why patients are admitted to hospital with gout and discover potential targets for better disease control.

Design

Data from semi-structured interviews were analysed using a thematic analysis approach.

Participants and setting

Eleven inpatients from a tertiary institution in the Australian Capital Territory of Australia and their respective general practitioners (GPs) were invited to participate in the semi-structured interviews.

Results

Despite significant pain and disability that accompanied acute flares, patients continue to experience shame in seeking treatment and regarded gout as being not particularly important. Other barriers included patients’ poor continuity of care with and lack of confidence in GPs, suboptimal management in outpatient and inpatient settings, poor understanding of disease and treatment, and misconceptions held by both patients and physicians leading to uncontrolled disease activity.

Conclusions

Barriers to optimal gout management including patient and health practitioner factors have produced a complex effect which has led to a cycle of treatment avoidance behaviours and recurrent hospitalisations for severe acute gout flares. These barriers could be addressed using a multipronged approach guided by the chronic care model which has been applied in a variety of other chronic diseases with improved patient and professional-level outcomes. Managing gout according to best practice for chronic disease is more likely to prevent recurrent hospitalisations and improve health outcomes in patients with gout.