bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous vaginal birth varies significantly across US hospitals
Authors: Clark Rebecca R. S. , Lake Eileen T.
Published: November 2020

Background

Birth is the most common reason for hospitalization in the United States. Hospital variation in maternal outcomes is an important indicator of health care quality. Spontaneous vaginal birth (SVB) is the most optimal birth outcome for the majority of mothers and newborns. The purpose of this study was to examine hospital‐level variation in SVB overall and among low‐risk women in a four‐state sample representing 25% of births in the United States in 2016.

Methods

Women giving birth in California, Pennsylvania, New Jersey, and Florida were identified in 2016 state discharge abstracts. Patient data were merged with hospital data from the American Hospital Association's (AHA) 2016 Annual Survey. Overall and low‐risk SVB rates were calculated for each hospital in the sample and stratified by bed size, teaching status, rurality, birth volume, and state.

Results

Our final sample included 869 681 women who gave birth in 494 hospitals. The mean overall SVB rate in the sample was 61.1%, ranging from 16.8% to 79.9%. The mean low‐risk SVB rate was 78% and ranged from 34.6% to 93.3%. Variation in SVB rates cut across all the hospital structural characteristic strata.

Discussion

The wide variation in SVB rates indicates significant room for improvement in this maternal quality metric. Our finding, that hospitals of all types and locations had both low and high SVB rates, suggests that excellent maternal outcomes are possible in all hospital settings. The variation in SVB rates across hospitals warrants research into modifiable hospital factors that may be influencing SVB rates.
Patterns and trends in eczema management in UK primary care (2009–2018): A population‐based cohort study
Authors: de Lusignan Simon , Alexander Helen , Broderick Conor , Dennis John , McGovern Andrew , Feeney Clarie , Flohr Carsten
Published: November 2020

Background

Despite the high disease burden of eczema, a contemporary overview of the patterns and trends in primary care healthcare utilization and treatment is lacking.

Objective

To quantify primary care consultations, specialist referrals, prescribing, and treatment escalation, in children and adults with eczema in England.

Methods

A large primary care research database was used to examine healthcare and treatment utilization in people with active eczema (n = 411,931). Management trends and variations by age, sex, socioeconomic status, and ethnicity were described from 2009 to 2018 inclusive.

Results

Primary care consultation rates increased from 87.8 (95% confidence interval [95% CI] 87.3–88.3) to 112.0 (95% CI 111.5–112.6) per 100 person‐years over 2009 to 2018. Specialist referral rates also increased from 3.8 (95% CI 3.7–3.9) to 5.0 (95% CI 4.9–5.1) per 100 person‐years over the same period. Consultation rates were highest in infants. Specialist referrals were greatest in the over 50s and lowest in people of lower socioeconomic status, despite a higher rate of primary care consultations. There were small changes in prescribing over time; emollients increased (prescribed to 48.5% of people with active eczema in 2009 compared to 51.4% in 2018) and topical corticosteroids decreased (57.3%–52.0%). Prescribing disparities were observed, including less prescribing of potent and very potent topical corticosteroids in non‐white ethnicities and people of lower socioeconomic status. Treatment escalation was more common with increasing age and in children of non‐white ethnicity.

Conclusion and clinical relevance

The management of eczema varies by sociodemographic status in England, with lower rates of specialist referral in people from more‐deprived backgrounds. There are different patterns of healthcare utilization, treatment, and treatment escalation in people of non‐white ethnicity and of more‐deprived backgrounds.
Validation study of a new chemiluminescent singleplex IgE assay in a set of Italian allergic rhinitis patients
Authors: Potapova Ekaterina , Bauersachs Daniel , Villella Valeria , Meneguzzi Giorgia , Scala Enrico , Sfika Ifigenia , Tripodi Salvatore , Panetta Valentina , Dramburg Stephanie , Skevaki Chrysanthi , Matricardi Paolo Maria
Published: November 2020

Background

The measurement of specific IgE to allergenic extracts and molecules in patients with allergic rhinitis (AR) is crucial for a precise diagnosis and further immunotherapy. Companies providing in vitro diagnostic methods in allergology continuously strive for the optimization and modernization of such methods. A new generation of automated allergy tests based on chemiluminescence detection and paramagnetic microparticles is now available, with possible advantages in sample volume, cost‐effectiveness and avoidance of sample‐related interference.

Objectives

To test whether sIgE antibody levels obtained with a new singleplex chemiluminescent method have a good agreement with the corresponding results obtained with a “gold standard” test.

Methods

We tested sera from 368 AR patients. Specific IgE sera levels (kU/L) to a comprehensive panel of 15 allergen extracts and 6 molecules were tested with ImmunoCAP® (Thermo Fisher Scientific Inc, Phadia AB, Uppsala, Sweden) and NOVEOS™ (HYCOR® Biomedical, Garden Grove, CA, USA). We evaluated the qualitative and quantitative performance of the new NOVEOS system in matching the outcome of ImmunoCAP to each of the examined allergens.

Results

In relation to ImmunoCAP, the overall diagnostic sensitivity and specificity of sIgE tests with NOVEOS were 90.8% (95% CI = 88.6–92.7) and 96.2% (95% CI = 93.9–97.8), respectively. These values were higher when only molecules were considered (sensitivity = 98.7% [95% CI = 96.4%–99.7%]; specificity = 94.2% [95% CI = 88.4%–97.6%]) and lower when only extracts were considered (sensitivity = 87.6% [95% CI = 84.7%–90.2%]; specificity = 97% [95% CI = 94.4%–98.6%]). Spearman's correlation between the data set of both methods for a ≥ 0.1 kU/L cut‐off was 0.84 (p < .001).

Conclusions

The new singleplex NOVEOS system presented good results for qualitative and quantitative comparisons when testing specific serum IgE antibodies against a range of 21 allergens. This novel immunoassay system using only 4 µl of sample per test appears to be robust and reliable and can, therefore, be used as an aid in allergy diagnosis.
Evidence for increasing human‐wildlife conflict despite a financial compensation scheme on the edge of a Ugandan National Park
Authors: Braczkowski Alexander , Fattebert Julien , Schenk Ralph , O'Bryan Christopher , Biggs Duan , Maron Martine
Published: November 2020

The conflict of large carnivores and agro‐pastoral communities is a key driver of carnivore decline globally. The East African state of Uganda relies heavily on tourism as a GDP contributor and large carnivores are important for generating visitor revenue in its national parks. African leopards, spotted hyenas and African lions are three species that draw significant tourist attention but also cause damage to the livestock of human communities living on Ugandan national park edges. A private safari lodge in the Lake Mburo National Park has been using a financial compensation scheme in an attempt to stem conflict between these species and human communities living in the region since 2009. Financial compensations have produced mixed results with some studies reporting successes in reducing carnivore deaths, while others warn against their use, citing moral hazard, financial unsustainability and weakened protection of livestock by farmers. We sought to assess the characteristics of this compensation scheme and the patterns of conflict between Bahima pastoralist communities and carnivores that the scheme aims to mitigate. Using a dataset of 1,102 leopard and hyena depredation events (January 2009–December 2018) we found that spotted hyenas were responsible for the overwhelming majority of livestock depredation (69%) around Lake Mburo. Depredations occurred mostly at night (97% and 89% of all depredation for spotted hyenas and leopards respectively) and inside livestock protective pens (bomas). Depredation was more likely to occur in rugged areas, closer to human settlements, and the national park border, and further away from water. We could find no evidence of seasonality in depredation events. Our most important, albeit worrying result was that conflict had increased dramatically over time and the number of depredation claims had tripled in the period from 2014–2018 when compared to 2009–2013, risking financial unsustainability of the scheme. Our results are important for future conservation stakeholders attempting to implement financial compensation in the broader Ugandan landscape. They suggest that careful thought needs to be placed into fund sustainability, increasing claims over time and the development of clear rules that underpin compensation claims.
Urgent desensitization in patients bridged to heart transplantation under extracorporeal membrane oxygenation support: A preliminary experience
Authors: Guihaire Julien , D'Avino Serena , Stephan Francois , Kloeckner Martin , To Ngoc Tram , Potier Agathe , Gaillard Maïra , Ramadan Ramzi , Taupin Jean‐Luc , Le Pavec Jerome , Deleuze Philippe
Published: November 2020

Antihuman leukocyte antigen (HLA) antibodies restrict the access to cardiac allografts. Desensitization therapy is a major challenge in patients with cardiogenic shock waiting for urgent heart transplantation (HT). We retrospectively reviewed six patients (mean age of 37.5 years [16–70]) who underwent plasmapheresis (PP) under extracorporeal membrane oxygenation (ECMO) before transplant between January 2017 and September 2018. The average duration of follow‐up was 25 months [20–32]. Mean fluorescence intensity (MFI) of HLA‐specific antibodies was reported as follows: score 4 for MFI < 1000, score 6 for 1000 < MFI < 3000 and score 8 for MFI > 3000. The mean duration of ECMO support was 29 days [1–74] and 6.8 [1–29] PP sessions were performed per patient before transplant. The mean number of HLA‐specific antibodies before HT was 9.6 for score 6 [4–13] and 5.8 for score 8 [1–12]. Four patients had major complications after transplantation (2 hemorrhagic shocks, 5 infectious events). Mean MFI reduction rate was 94% [79–100] for Class I and 44.2% for Class II [0–83]. Hospital survival was 100%, and early antibody‐mediated rejection was diagnosed in one patient at 7 days after HT. Plasmapheresis under ECMO support was associated with favorable early outcomes in highly sensitized candidates for urgent heart transplantation.
Impaired left atrial stiffness in patients with corrected congenital left ventricular outflow obstructions
Authors: Labombarda Fabien , Mulet Benoit , Maragnes Pascale , Beygui Farzin
Published: November 2020

Objective

We examined the left atrial stiffness index (LA Stiff) on echocardiography and its determinants in adults and adolescents with repaired congenital left ventricular outflow obstructions (c‐LVOOs), including isolated subaortic stenosis (SAS), stenotic bicuspid aortic valve (BAV), and aortic coarctation (CoA).

Methods

Seventy‐two patients (43 males, age: 31 ± 15 years) with repaired c‐LVOOs (SAS: n = 12; BAV: n = 27; CoA: n = 33) were compared to 72 age‐ and sex‐matched controls. 2D strain imaging was performed to assess left ventricular (LV) and LA function, including peak positive longitudinal LA strain (LAS), late diastolic LA strain (LDS), and LV global longitudinal strain (GLS). The (E/Ea)/LAS ratio was used to calculate LA Stiff.

Results

LA Stiff was significantly higher in the c‐LVOO group than in the control group. Among the c‐LVOO patients, the CoA group had the lowest GLS and the highest LA Stiff; no significant differences were found with respect to sex, hypertension history, smoking status, or repeated repair among c‐LVOO subtypes. Multivariable regression analysis with the variables “BMI” and “c‐LVOO subtype” revealed that BMI and c‐LVOO subtypes were independently associated with LA Stiff (b = 0.290, P = .009 and b = 0.353, P = .002, respectively).

Conclusions

We documented abnormal LA Stiff values in adults and adolescents after c‐LVOO repair. Patients with CoA demonstrated the most impaired LA Stiff values. Overweight may contribute to worse LA Stiff values. Further studies are required to determine the prognostic implications of LA Stiff in patients with repaired c‐LVOOs.
The Amazon river is a suture zone for a polyphyletic group of co‐mimetic heliconiine butterflies
Authors: Rosser Neil , Shirai Leila T. , Dasmahapatra Kanchon K. , Mallet James , Freitas André V. L.
Published: November 2020

The Amazon basin contains few obvious geographic barriers, yet it is the most biodiverse region on Earth. One hypothesis to explain its diversity is that the very large rivers promote allopatric divergence. Consistent with this, maps of heliconiine butterflies made from museum specimens show high subspecies richness close to the Amazon river, suggesting that it may produce or maintain intra‐specific phenotypic variability. However, museum data are subject to strong spatial biases (the ‘Wallacean shortfall' of distribution data), raising the possibility that this pattern is a sampling artefact. To test this, we systematically collected along a ~900 km north–south transect running through central Amazonia. We found a significant association between phenotypic diversity and major rivers, with distance from the Amazon river explaining 61% of the variance in the mean polymorphism of 25 species. This association is partly because many species exhibit different phenotypes on either side of the river. Nonetheless, we also find sites with high polymorphism close to the river, indicating continual cross‐river dispersal. Our results strongly suggest the presence of a suture zone (a region where multiple species have hybrid zones) near the city of Manaus. However, the effect of the river on spatial patterns of intra‐specific phenotypic diversity depends on a species' mimetic phenotype. Rather than being absolute barriers, our results support the idea that rivers can act as partial barriers that trap moving hybrid zones, resulting in a suture zone. As such, the wide Amazonian rivers help generate and maintain colour pattern diversity, but to date there is no evidence that they lead to speciation in our study group.
Dispersal evolution in currents: spatial sorting promotes philopatry in upstream patches
Authors: Allgayer R. L. , Scarpa A. , Fernandes P. G. , Wright P. J. , Lancaster L. , Bocedi G. , Travis J. M. J.
Published: November 2020

Substantial literature is devoted to understanding dispersal evolution, but we lack theory on how dispersal evolves when populations inhabit currents. Such theory is required for understanding connectivity in freshwater and marine environments; moreover, many animals, fungi and plants rely on wind‐based dispersal, but the effects of currents on dispersal evolution in these organisms is unknown. We develop an individual‐based model for evolution of dispersal probability along a linear environment with a unidirectional current. Even a slight current substantially reduces overall emigration probability compared to no current. Under stronger currents, emigration can be drastically reduced, especially in the upstream patches. When introducing rare long‐distance dispersal that is not subject to the current, higher emigration probabilities evolve and the spatial variability in emigration propensity along the stream is reduced. Our results provide an alternative solution to the long debated ‘drift paradox' concerning the loss of individuals from upstream populations due to advective forces. A combination of natural selection and spatial sorting generates and maintains downstream gradients in dispersal propensity, where individuals from upstream populations tend to be substantially more philopatric. This is likely to have major implications for ecological and genetic connectivity that will impact effective management strategies for populations inhabiting currents.
Altered ioflupane single‐photon emission computed tomography in anti‐IgLON5 disease: A new case mimicking probable progressive supranuclear palsy and review of the literature
Authors: González‐Ávila Carmen , Casado Laura , Muro García Inés , Villacieros‐Álvarez Javier , Vivancos José , Quintas Sonia
Published: November 2020

Background and purpose

Anti‐IgLON5 disease is a rare disorder characterized by a heterogeneous myriad of symptoms that may include sleep disorders, bulbar dysfunction, gait problems, movement disorders, cognitive impairment, oculomotor abnormalities, and nervous system hyperexcitability. Its physiopathology remains unknown, with a combination of both autoimmune and neurodegenerative findings.

Methods

We describe clinical, cerebrospinal fluid (CSF), and ioflupane single‐photon emission computed tomography (SPECT) findings of a positive case of anti‐IgLON5 disease mimicking probable progressive supranuclear palsy (PSP). We performed a literature review of previous publications reporting on anti‐IgLON5 disease and ioflupane SPECT.

Results

We report the case of a 66‐year‐old male who met clinical criteria for probable PSP, in whom ioflupane SPECT showed an alteration of the left presynaptic dopaminergic pathway. However, the presence of atypical neurological symptoms for PSP led to further complementary tests, and IgLON5 antibodies were detected in CSF. According to our literature review, ioflupane SPECT findings have been previously described in only three other patients with anti‐IgLON5 disease, with a reduced uptake in the striatum in two of them.

Conclusions

Ioflupane SPECT abnormalities, though scarcely described, are not uncommon in anti‐IgLON5 disease. They could be related to nigrostriatal dopaminergic degeneration in the context of the tauopathy component of the disease, but further case descriptions are necessary.
Meta‐analysis of genotype and phenotype studies to confirm the predictive role of the RNF213 p.R4810K variant for moyamoya disease
Authors: Wang Yue , Yang Luping , Wang Xiaotong , Zeng Fanxin , Zhang Kaili , Zhang Qian , Liu Mengwei , Liu Shan , Shang Mengke , Li Qian , Yang Yuetian , Liang Man , Liu Wanyang
Published: November 2020

Background and Purpose

The aim of this meta‐analysis study was to assess the predictive effects of RNF213 p.R4810K on phenotype in moyamoya disease (MMD).

Methods

Electronic databases (e.g., Pubmed and EMBASE) were searched, and relevant articles published up to August 2020 were retrieved. Review Manager 5.3 and Stata 12.0 were used for all statistical analyses. Pooled odds ratios, with 95% confidence intervals, and three comparison models were evaluated to analyze the association between RNF213 pR4810K variant and clinical characteristics of MMD patients using a fixed‐effects model.

Results

A total of 2798 patients with MMD were selected and the effects of the heterozygous or homozygous RNF213 p.R4810K variant on 18 clinical features were identified. There were more patients aged <15 years in the GA and AA groups (AA vs GA: p = 0.009; AA vs GG: p = 0.003; GA vs GG: p = 0.001). Among homozygous patients, the majority experienced MMD onset before the age of 4 years (AA vs. GA: p < 0.00001; AA vs GG: p < 0.00001). The frequency of infarctions and transient ischemic attack was significantly higher in homozygotes and heterozygotes，respectively. However, the frequency of intracerebral/intraventricular hemorrhage was lower in patients with the GA than the GG genotype. More MMD patients with AA and GA genotypes had a family history of the disease (p = 0.003, p < 0.00001, respectively). Posterior cerebral artery involvement was more common in patients with the GA genotype (p < 0.00001).

Conclusion

The homozygous or heterozygous RNF213 variant may be an efficient biomarker with which to classify different clinical phenotypes of MMD.
Prognostic significance of uric acid change in acute ischemic stroke patients with reperfusion therapy
Authors: Wang Changyi , Cui Ting , Wang Lu , Zhu Qiange , Wang Anmo , Yuan Ye , Hao Zilong , Wu Bo
Published: November 2020

Background

Uric acid (UA) is an important endogenous free radical scavenger that has been found to have a neuroprotective effect. However, there is uncertainty about the relationship between UA change and outcome in acute ischemic stroke (AIS) patients with reperfusion therapy.

Methods

We consecutively enrolled AIS patients with reperfusion therapy. UA was measured upon admission and during hospitalization. The change in UA levels (ΔUA) was determined by calculating the difference between admission UA and the lowest UA among all follow‐up measurements, with a positive ΔUA suggesting a decrease in UA levels. Functional outcome was assessed by modified Rankin Scale (mRS) at 3 months. Poor outcome was defined as mRS >2.

Results

A total of 361 patients were included (mean age 68.7 ± 13.9 years, 54.3% males). The mean UA on admission was 355 ± 96.1 μmol/L. The median ΔUA was 121 μmol/L (IQR 50–192 μmol/L) and 18 (5%) patients had increased UA levels. UA on admission was positively associated with good outcome (p for trend = 0.017). When patients were classified into quartiles by ΔUA, patients with the largest decrease in UA (Q4: 199–434 μmol/L) had a higher risk of poor outcome at 3 months compared to patients with the least decrease in UA (Q1: 0–57 μmol/L) (OR 2.55, 95% CI 1.09–5.98, p = 0.031). The risk of poor outcome increased with ΔUA (p for trend = 0.048).

Conclusions

In patients with reperfusion therapy, high UA on admission was associated with a good 3‐month outcome, while a greater decrease in UA was associated with poor outcome.
Low prevalence of radiographic hip osteoarthritis and its discordance with hip pain: A nationwide study in Korea
Authors: Park Jae Hyeon , Lee Jung Soo , Lee Soong Joon , Kim Yeo Hyung
Published: November 2020

Aim

This study aimed to evaluate the prevalence and associated factors of radiographic hip osteoarthritis (OA) in the Korean community‐dwelling population.

Methods

This study included 11 814 individuals (5025 men and 6789 women) ≥50 years of age from the Korea National Health and Nutrition Examination Surveys. Radiographic hip OA was defined as having a Kellgren–Lawrence grading scale score ≥2. Painful hip OA was defined as radiographic hip OA with the presence of hip pain. The prevalence of radiographic hip OA was evaluated with respect to age group, sex and presence of hip pain. The associations of sociodemographic and clinical variables with hip OA and hip pain were assessed using multivariable logistic regression analyses.

Results

The weighted prevalence of radiographic hip OA and painful hip OA was 1.1% and 0.2%, respectively, in Korea. Older age (≥75 years) and male sex were independently associated with radiographic hip OA and painless hip OA. Comorbid musculoskeletal pain (knee pain) was independently associated with painful hip OA. The difference between painful and painless hip OA was the presence of comorbid musculoskeletal pain (knee pain and low back pain). Although hip pain was more common in women than in men, it was associated with the severity of hip OA only in men.

Conclusions

Radiographic hip OA is rare in Korean middle‐aged and elderly people. Furthermore, hip pain is infrequent in radiographic hip OA. Geriatr Gerontol Int 2021; 21: 20–26.
Widespread underfilling of the potential ranges of North American trees
Authors: Seliger Benjamin J. , McGill Brian J. , Svenning Jens‐Christian , Gill Jacquelyn L.
Published: November 2020

Aim

Climatic equilibrium is a foundational principle in ecological theory and models used in conservation, but has been challenged by growing evidence of disequilibrium, particularly for long‐lived, sessile organisms like trees. Here, we calculated range filling for North American trees to detect the degree to which trees are filling their potential climatic niches, and to assess climatic and non‐climatic drivers of underfilling.

Location

North America (22°N–72°N).

Taxon

Trees and shrubs.

Methods

We modelled the potential ranges of 447 North American tree and shrub species with species distribution models using bioclimatic variables, and calculated the occupied proportion of each potential range. Results were compared to a null model using simulated ranges generated by a spreading‐dye algorithm. We further used range shape ratios (latitude/longitude) to detect the drivers of disequilibrium.

Results

The potential ranges of North American trees and shrubs are broadly underfilled (mean = 48%). Furthermore, range filling is positively correlated with geographic range size. Large‐ranged species have higher range filling than the null model, and shape ratios indicative of climatic restrictions. Small‐ranged species showed a stronger influence of dispersal limitation.

Main conclusions

Climate explains only about half of tree species' ranges, and the signal of climatic equilibrium increases with range size. Small‐range species show high levels of climatic disequilibrium, which is likely be driven by combinations of dispersal lags, and undetected environmental factors or biotic interactions. These results highlight the importance of conserving small‐ranged species and the difficulty of forecasting how their distributions will shift in the coming centuries.
HNF1B inhibits cell proliferation via repression of SMAD6 expression in prostate cancer
Authors: Lu Wei , Sun Jian , Zhou Huihui , Wang Fei , Zhao Chunchun , Li Kai , Fan Caibin , Ding Guanxiong , Wang Jianqing
Published: November 2020

Prostate cancer is the most common malignancy in men in developed countries. In previous study, we identified HNF1B (Hepatocyte Nuclear Factor 1β) as a downstream effector of Enhancer of zeste homolog 2 (EZH2). HNF1B suppresses EZH2‐mediated migration of two prostate cancer cell lines via represses the EMT process by inhibiting SLUG expression. Besides, HNF1B expression inhibits cell proliferation through unknown mechanisms. Here, we demonstrated that HNF1B inhibited the proliferation rate of prostate cancer cells. Overexpression of HNF1B in prostate cancer cells led to the arrest of G1 cell cycle and decreased Cyclin D1 expression. In addition, we re‐explored data from ChIP‐sequencing (ChIP‐seq) and RNA‐sequencing (RNA‐seq), and demonstrated that HNF1B repressed Cyclin D1 via direct suppression of SMAD6 expression. We also identified CDKN2A as a HNF1B‐interacting protein that would contribute to HNF1B‐mediated repression of SMAD6 expression. In summary, we provide the novel mechanisms and evidence in support HNF1B as a tumour suppressor gene for prostate cancer.
Clinical, inflammatory and microbiological outcomes of full‐mouth scaling with adjunctive glycine powder air‐polishing: A randomized trial
Authors: Zhang Wenyi , Wang Wei , Chu Cunchao , Jing Jin , Yao Nengliang (Aaron) , Sun Qinfeng , Li Shu
Published: November 2020

Aim

To determine the effects of glycine powder air‐polishing (GPAP) as an adjunct to full‐mouth scaling and root planing (SRP) on clinical, inflammatory and microbiological outcomes in patients with untreated periodontitis.

Materials and Methods

Forty‐one patients were randomly assigned to the control group A (SRP) and test groups B1 (subgingival GPAP right after SRP) and B2 (subgingival GPAP right before SRP). Clinical examinations and sample collections (saliva, subgingival plaque, serum and gingival crevicular fluid) were performed at assessment visits and before therapies at clinical visits of baseline, 6‐week and 3‐month. C‐reactive protein, IL‐6 and TNF‐α were assessed in serum and gingival crevicular fluid, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum were measured in saliva and subgingival plaque.

Results

Patients in control and test groups did not significantly differ by age, sex and disease severity at baseline. Participants in control and intervention groups had similar improvements in clinical parameters (PD, BOP, PLI and BI). All groups had a similar percentage of sites showing PD reduction of ≥2 mm between baseline and follow‐up visits, with a few exceptions. Reduced C‐reactive protein, IL‐6 and TNF‐α in serum were found after treatments.

Conclusion

Full‐mouth SRP with and without GPAP resulted in largely similar clinical, inflammatory and microbiological outcomes in the care of untreated periodontitis.
Comparison of marginal and internal fit of pressed lithium disilicate veneers fabricated via a manual waxing technique versus a 3D printed technique
Authors: Guachetá Lizeth , Stevens Clinton D. , Tamayo Cardona Julián A. , Murgueitio Rafael
Published: November 2020

Objective

The purpose of this in vitro study was to compare the marginal and internal fit of pressed lithium disilicate veneers fabricated from a 3D printed castable wax resin versus a manual waxing technique.

Materials and Methods

A typodont model central incisor was prepared for a porcelain veneer. Following stone model fabrication from a polyvinyl siloxane impression, the model was digitized using a laboratory scanner. Group 1 veneers were designed digitally and 3D printed with a castable wax resin, then pressed. Group 2 veneers were fabricated using a manual wax and press approach. Veneers from both groups were bonded to printed dies. Following measurements of marginal adaptation under a stereo microscope, the dies were sectioned and measurements were made for internal adaption. Statistical analysis included a Kolmogorov test and a Mann–Whitney U test.

Results

Average marginal gap (μm) for Group 1 was 40.37 ± 11.75 and 50.63 ± 16.99 for Group 2 (p = 0.51). Average internal gap (μm) for Group 1 was 61.21 ± 18.20 and 68.03 ± 14.07 for Group 2 (p = 0.178).

Conclusion

There was no difference in marginal fit or internal fit between pressed lithium disilicate veneers fabricated with a 3D printed castable resin and those fabricated with a manual waxing technique. The use of digital technologies and 3D printing provide significant advantages in the fabrication of pressed glass ceramic veneers, with marginal and internal adaptation comparable to manual wax and press techniques.
Feasibility of the constipation point‐of‐care ultrasound educational program in observing fecal retention in the colorectum: A descriptive study
Authors: Matsumoto Masaru , Yoshida Mikako , Miura Yuka , Sato Naoko , Okawa Yohei , Yamada Masako , Otaki Junji , Nakagami Gojiro , Sugama Junko , Okada Shingo , Ohta Hideki , Sanada Hiromi
Published: November 2020

Aim

Nurses have difficulty assessing the type of constipation by ordinal assessment methods and may therefore struggle to select an appropriate defecation care. Although previous studies described the safety and effectiveness of defecation care based on ultrasonographic observations in the colorectum, no standardized educational program has been established. This study aimed to determine the feasibility of the constipation point‐of‐care ultrasound (POCUS) educational program regarding the use of ultrasonography as an assessment tool to determine different types of constipation.

Methods

This descriptive study was conducted for visiting nurses working in Japan. The constipation POCUS educational program that nurses can learn in as short as 7 days comprised four elements: E‐learning, a hands‐on seminar, self‐learning, and objective structured clinical examinations (OSCEs). The nurses were asked to complete a questionnaire regarding the education materials. OSCEs were used to assess the participants' skills in assessing patients based on the use of ultrasound observation in the colorectum.

Results

Of the 44 participants who enrolled, 40 were able to complete the program. All the 40 participants (100.0%) who took the OSCEs were able to pass at the first attempt. Moreover, 94.9% of the trainees indicated that this program was able to cover the content necessary to use ultrasonography in home care settings.

Conclusions

The results of this study suggest that the 7‐day constipation POCUS educational program provided trainees with a foundational knowledge and skills to observe fecal retention in the colorectum. Thus, further educational program enhancements and clinical skill evaluations are needed to maximize the program's effectiveness in the future.
The use of the community of inquiry survey in blended learning pedagogy for a clinical skill‐based module
Authors: Siah Chiew‐Jiat , Lim Fui‐Ping , Lau Siew‐Tiang , Tam Wilson
Published: November 2020

Aim and Objectives

The primary aim of this study was to examine the effectiveness of the blended learning pedagogy in a clinical skill‐based module using the Community of Inquiry (CoI) framework. The secondary objectives were to assess the effectiveness of blended learning in improving the nursing knowledge, and students' satisfaction with this approach.

Background

Blended learning is increasingly adopted in education as more online resources are made available for tutors to use for the benefit of their students. That implied a reduction in the face‐to‐face contact time in replacement for online teaching, which therefore warrants a need to examine the effectiveness of blended learning approach. The application of CoI framework could evaluate the blended learning approach to assist teaching faculty with evidence‐based practices on online teaching.

Design

This study used the quasi‐experimental, pretest–posttest design, and results were presented according to the Transparent Reporting of Evaluations with Nonrandomised Designs (TREND) guidelines.

Methods

This study was conducted in a university and recruited 219 Year 1 nursing students who completed a clinical‐based module.

Results

The results of the CoI survey found that teaching presence scored the highest mean, followed by cognitive and social presence. The design of the blended learning was effective in enhancing students' knowledge but they only expressed a moderate level of satisfaction.

Conclusions

Blended learning is a feasible pedagogical strategy for a clinical skill‐based module. However, further investigation is required to explore the factors and strategies which could improve students' satisfaction.

Relevance to clinical practice

Blended learning has become one of the contemporary trends in education. Refining teaching strategies may meet the learning needs of today's generation and improve students' learning outcomes.
Mapping diversity and demographic‐based changes to a pediatric population attending a specialist tertiary hospital: a retrospective review
Authors: Sheppard‐Law Suzanne , Cruickshank Marilyn , Debono Deborah
Published: November 2020

Aims

This study aimed to describe the demographic characteristics and to measure annual changes in composition of the paediatric population attending a specialist tertiary hospital in Sydney, Australia, between 2015 and 2017.

Background

Australia has experienced steady growth in the number of people born overseas in the last fifty years thereby building a culturally and linguistically rich country. Such dynamic population changes pose a challenge to the nursing workforce, in particular how the needs of migrant families from non‐English‐speaking countries are accommodated.

Design

Retrospective review of medical records.

Methods

De‐identified paediatric inpatient data were imported from a hospital database into Statistical Package for the Social Sciences (version 21) database for cleaning and analysis. Strengthening the reporting of observational studies in epidemiology checklist was completed.

Results

Paediatric inpatients born in a country other than Australia (8762, 5.7%) emigrated from 155 countries or were “born at Sea” (n = 13, 0.1%) and spoke an array of primary languages (n = 139), other than English. Whilst inpatient health service rates remained constant during the study period, an increased rate of service utilisation was reported for children born in Asia (IRR 1.3, p ≤ 0.001, 95% CI: 1.2–1.4) and in the Middle East (IRR 1.4, p ≤ 0.001, 95% CI: 1.2–1.6). Families who reported that they preferred to speak Chinese Languages, Middle Eastern languages (not Arabic) and languages of India reported increased rates.

Conclusion

Significant annual changes in composition of the paediatric population were reported. Regular analysis of local inpatient data will inform health care that is responsive to change and addresses the unique needs of diverse families.

Relevance to clinical practice

Diversity poses a potential challenge to the nursing workforce on a daily basis and more broadly. To meet the changing needs of diverse inpatient populations, nurses will need to plan, implement and evaluate cultural competency, linguistic access, workforce diversity and the quality of care to diverse populations.
Understandings of and experiences with evidence‐based practice in practice among nurses in a surgical department: A constructivist approach
Authors: Halberg Nina , Assafi Lone , Nørholm Vibeke
Published: November 2020

Aim and objectives

To explore nurses’ constructions of the concept of evidence‐based practice through their understandings of and experiences with evidence‐based practice in a clinical care setting.

Background

The primary purpose of evidence‐based practice is high‐quality patient outcomes. However, the adoption of evidence‐based practice is described as a complex process, and research shows that evidence‐based practice is not translated into practice. Research often explores facilitators and barriers of implementing and adopting evidence‐based practice. Yet there is limited knowledge on how nurses construct the concept in practice.

Design

This study has a constructivist approach and follows COREQ guidelines.

Method

Ten semi‐structured interviews with 26 nurses were conducted in 2019. Data were analysed with an emic and inductive approach.

Results

Three key constructions emerged. Understandings of evidence‐based practice were based on the original concept of evidence‐based medicine. This included the hierarchy of evidence which was perceived as an inflexible concept not encompassing the nursing care. However, while not using the term evidence‐based practice, the nurses were doing evidence‐based practice portrayed through outcomes from management‐supported nursing‐based projects and incorporated reflections and discussions into weekly meetings. A discrepancy between a theoretical understanding and a practical doing of evidence‐based practice appeared and was especially evident when the nurses’ primary evidence sources consisted of the immediate options, for example asking colleagues or following accessible guidelines. Searching for evidence was central in their theoretical understanding but not an incorporated part of their daily work tasks.

Conclusion

The nurses’ constructions of evidence‐based practice indicate a discrepancy between the theoretical understanding of evidence‐based practice and the practical doing of evidence‐based practice, which hinders the basis of working according to the concept.

Relevance to clinical practice

Theoretical discussions of evidence‐based practice within the nursing field remain academic, as nurses in practice construct the concept on standards from evidence‐based medicine.
THE (NON‐)SIGNIFICANCE OF REPORTING ERRORS IN ECONOMICS: EVIDENCE FROM THREE TOP JOURNALS
Authors: Pütz Peter , Bruns Stephan B.
Published: November 2020

We investigate the prevalence and sources of reporting errors in 30,993 hypothesis tests from 370 articles in three top economics journals. We define reporting errors as inconsistencies between reported significance levels by means of eye‐catchers and calculated‐values based on reported statistical values, such as coefficients and standard errors. While 35.8% of the articles contain at least one reporting error, only 1.3% of the investigated hypothesis tests are afflicted by reporting errors. For strong reporting errors for which either the eye‐catcher or the calculated‐value signals statistical significance but the respective other one does not, the error rate is 0.5% for the investigated hypothesis tests corresponding to 21.6% of the articles having at least one strong reporting error. Our analysis suggests a bias in favor of errors for which eye‐catchers signal statistical significance but calculated‐values do not. Survey responses from the respective authors, replications, and exploratory regression analyses indicate some solutions to mitigate the prevalence of reporting errors in future research.
Pregnancy complicated by refractory severe hypercholanaemia from sodium taurocholate co‐transporting polypeptide deficiency
Authors: Wu Christine , Smet Maria‐Elisabeth , Heath Susan , Curnow Jennifer , Lin Ming‐Wei , George Jacob , Alahakoon Thushari I.
Published: November 2020

Sodium taurocholate co‐transporting polypeptide deficiency is a rare metabolic autosomal recessive condition resulting in critically elevated plasma bile acid levels. Hypercholanaemia in similar conditions such as intrahepatic cholestasis of pregnancy has been associated with an increased risk of adverse obstetric outcomes including stillbirth. We present the first case of Sodium taurocholate co‐transporting polypeptide deficiency in a current pregnancy in a patient with one previous stillbirth in the context of severe hypercholanaemia, where conventional treatments for cholestasis including ursodeoxycholic acid, rifampicin and cholestyramine were ineffective. Therapeutic plasma exchange and novel treatment with elobixibat were trialed with mixed results. The pregnancy resulted in an iatrogenic preterm delivery of a live infant at 32 weeks gestation.
Laparoscopic adenomyomectomy combined with levonorgestrel‐releasing intrauterine system in the treatment of adenomyosis: Feasibility and effectiveness
Authors: Sun Feng , Zhang Ye , You Min , Yang YePing , Yu YingYing , Xu Hong
Published: November 2020

Aim

To evaluate the clinical efficacy and safety of laparoscopic adenomyomectomy combined with intraoperative replacement of levonorgestrel‐releasing intrauterine system (LNG‐IUS) in the treatment of symptomatic adenomyosis.

Methods

This is a case‐series study in a university medical center. A total of 52 patients with symptomatic adenomyosis were treated by laparoscopic adenomyomectomy combined with intraoperative replacement of LNG‐IUS from January 2015 to July 2018. Visual analog scale, menstrual flow and uterine volume were compared before and after the surgery (3, 12 and 24 months). Meanwhile, LNG‐IUS‐induced adverse reactions (e.g. irregular vaginal bleeding, amenorrhea, expulsion, and perforation) were also recorded.

Results

All operations were successfully completed via laparoscopy without conversion to laparotomy. No severe complications were noted during the surgical procedure or follow‐up period. The mean postoperative visual analog scale and menstrual flow scores and the volume of the uterus were significantly decreased (all P < 0.001) at 3, 12, and 24 months postoperatively, compared with preoperative scores. The clinical effective rates among the patients with dysmenorrhea were 98%, 96% and 96% at 3, 12 and 24 months after the operation, respectively. And the clinical effectiveness rate of menorrhagia was 97.6%, 95.2% and 95.2% at 3, 12 and 24 months after treatment, respectively. Among all related adverse reactions, amenorrhea was the most common (n = 12, 23.1%). There was one case of LNG‐IUS perforation (1.9%) and two cases of expulsion (3.8%).

Conclusion

Laparoscopic adenomyomectomy combined with intraoperative replacement of LNG‐IUS is a novel and effective conservative surgical procedure for symptomatic adenomyosis treatment.
Forging a Pure Military Identity: The Rise of Jurchen Heritage in Northeast Asia (15th–17th Century)
Authors: Ru Sung Hee
Published: November 2020

Prominent studies of the Qing dynasty's military evolution in the field of comparative military history, which is heavily dependent on the binary conception of “West–China,” have failed to present the early military heritage of the dynasty. Unlike previous studies, this paper aims to find a new voice for the early Qing military inheritance, as a reflection of past West–China comparative studies that have continued to discriminate between Western and Chinese military merits and demerits and to ignore the early Qing military approach. By presenting the economic and military interconnections between the Manchu (the Jianzhou Jurchens, the Jianzhou confederation, and Nurhaci), Ming, and Chosŏn, this article reveals that early economic and military development through border trade, tributary trade, and predatory behaviors enabled the Manchus to establish the Later Jin and Qing states. Understanding early Manchu military history helps us put forward an important but less studied military heritage of Qing.
Rheology and tribology of starch + κ‐carrageenan mixtures
Authors: You Kwan‐Mo , Murray Brent S. , Sarkar Anwesha
Published: November 2020

In this study, we investigated the rheological and tribological properties of biopolymer mixtures of gelatinized corn starches (0.5 – 10.0 wt%) and κ‐carrageenan (κC) (0.05 – 1.0 wt%). Two different starch samples were used. The first starch (CS1), despite extensive heating and shearing contained “ghost” granules, while the second starch (CS2) had no visible ghost granules after the same gelatinization process as CS1. Apparent viscosity measurements demonstrated that κC + CS1 mixtures were shear thinning liquids, with viscosity values being lower than the corresponding weight average of the values of the individual equilibrium phases at shear rates < 50 s−1. Tribological results revealed that κC ≥ 0.5 wt% was required to observe any decrease in friction coefficients in the mixed lubrication regime. Starch (CS1) showed an unusual behavior at ≥ 5 wt%, where the friction coefficient decreased not only in the mixed regime but also in the boundary regime, probably due to the presence of the “ghost” granules, as the latter became entrained in the contact region. The CS1 + κC mixtures showed significantly lower friction coefficients than that of pure CS1 and κC in the mixed regime. However, the CS2 + κC mixture (i.e., containing no ghost granules) showed similar behavior to pure κC in the mixed regime, while lower friction coefficients than that of the pure CS2 and κC in the boundary regime. These findings illustrate new opportunities for designing biopolymer mixtures with tunable lubrication performance, via optimizing the concentrations of the individual biopolymers and the gelatinization state of the starch.
Interventive Care: Uncertainty, Distributed Agency, and Cesarean Section in a Zika Virus Epidemic
Authors: Williamson K. Eliza
Published: November 2020

Beginning in 2015, Brazil witnessed the births of thousands of children with neurological abnormalities linked to the Zika virus. Drawing on ethnographic fieldwork conducted between 2016 and 2018 with parents of children with congenital Zika syndrome in Salvador da Bahia, this article attends to how one of Brazil's most overused obstetric technologies—cesarean section—was mobilized to mitigate the uncertainties of Zika's reproductive consequences. I argue that during the epidemic, C‐section constituted a form of what I call interventive care, in which others interceded on behalf of pregnant women to secure surgical delivery. In dialogue with scholarship problematizing autonomy in reproductive decision making, I show how my Bahian interlocutors understood such intercessions, and the C‐sections themselves, as forms of appropriate, concerned care. I suggest, furthermore, that interventive care highlights the ways in which reproductive decisions are distributed among people rather than autonomous, particularly in contexts of heightened uncertainty.