bluuebunny/crossref_metadata_2025 huggingface dataset:
Extended‐release naltrexone (XR‐NTX) for opioid use disorder in clinical practice: Vivitrol's Cost and Treatment Outcomes Registry
Authors: Saxon Andrew J. , Akerman Sarah C. , Liu Chih‐Chin , Sullivan Maria A. , Silverman Bernard L. , Vocci Frank J.
Published: March 2018

Background and Aims

Extended‐release naltrexone (XR‐NTX), a μ‐opioid receptor antagonist for prevention of relapse to opioid dependence, has demonstrated efficacy compared with placebo and comparative effectiveness with buprenorphine–naloxone. We report outcomes for XR‐NTX in Vivitrol's Cost and Treatment Outcomes Registry.

Design

Observational, open‐label, single‐arm, multi‐center registry assessing baseline characteristics and clinical and health‐related quality‐of‐life outcomes associated with XR‐NTX treatment in clinical practice.

Setting

32 US treatment centers from 2011 to 2013.

Participants

Patients with opioid dependence who were prescribed XR‐NTX treatment and then enrolled into the registry.

Measurements

Monthly visits were evaluated for the full population and for patient ubgroups retrospectively, defined by injection number, focusing on the period between baseline and month 6 (1‐, 2/3‐ or 6‐XR‐NTX).

Findings

Of 403 enrolled patients, 395 were analyzed. Most patients (n = 349) received out‐patient care. On average, patients received five injections (median = 3; range = 1–25). The median number of injections administered within 6 months was higher in patients who at baseline were employed (three versus two unemployed, P = 0.02) or had private insurance (five versus two self‐payment, P = 0.005; versus two state‐funded, P < 0.001). The 1‐, 2/3‐ and 6‐XR‐NTX groups had 132, 152 and 111 patients, respectively. At baseline, the 6‐XR‐NTX patients were more likely to meet normal/minimal mental illness criteria and attend school and less likely to report recent drug use. Within 6 months, the 6‐XR‐NTX group demonstrated improvements in employment, mental health and psychosocial functioning, and decreases in opioid craving, drug use and drug‐related behavior.

Conclusions

Among opioid‐dependent people receiving XR‐NTX treatment, better mental health, higher education and lower recent drug use at baseline are associated with greater treatment duration; in turn, longer treatment duration is associated with lower relapse rates and improved outcomes generally.
Radiological and osteological study of the pelvic limbs in free‐ranging capybaras (Hydrochoerus hydrochaeris)
Authors: Brombini G. C. , Rahal S. C. , Schimming B. C. , Santos I. F. C. , Tsunemi M. H. , Mamprim M. J. , Alves L. S. , Filadelpho A. L. , Teixeira C. R.
Published: March 2018

This study aimed to describe the radiographic anatomy and osteology and to evaluate angular radiographic measurements—Norberg angle, inclination angle and anteversion angle—of the pelvic limbs in free‐ranging capybaras. Twenty cadavers of free‐ranging capybaras (Hydrochoerus hydrochaeris), including five adults and 15 subadults, were studied. Ventrodorsal, craniocaudal, dorsoplantar and mediolateral radiographic views of the pelvic limbs were obtained. The radiographic features were described together with bone samples. The hip bone (os coxae), shaped like an isosceles trapezoid, was elongated and narrow with the presence of an oblong obturator foramen, sagittal ilial wing and rectilinear ilial body. The femoral shaft was relatively straight, while the greater trochanter was projected above the femoral head. No sesamoid bones of the gastrocnemius and popliteus muscles were observed radiographically or for those animals used in gross macroscopy. The fibula was located lateral and parallel to the tibia. Eight tarsal bones, four metatarsal bones and three digits were identified. The mean radiographic measurements included Norberg angle of 125.9°; respective angles of femoral inclination by the Hauptman B and Tomlinson methods of 139.9 and 141°; anteversion angle of the femoral head and neck of 29.80°. The bones of the pelvic limbs in capybaras have several anatomical characters and radiological features that are shared with members of the caviomorph superfamily Cavioidea. The radiographic angles measured in this study help characterize the functional morphology of this species.
DOES GLOBAL SHAPES OF UTILITY FUNCTIONS MATTER FOR INVESTMENT DECISIONS?
Authors: Ranganathan Kavitha
Published: March 2018

The study investigates relation between global shapes of utility functions and investor preferences towards particular asset classes for investment decisions. Global shapes that emerge are fully concave, fully convex, Reverse‐S and S‐shaped utility functions, using the certainty equivalence method for eliciting risk preferences. Investor clusters show existence of two types of investors, preference towards financial assets (bank deposits, insurance, pension and provident fund, shares and mutual funds) vs traditional assets (chit funds, gold and precious metals, real estate, postal savings, and government bonds). Investors with reverse‐S and S‐shaped utility functions prefer investment in financial assets, while investors with fully concave and fully convex utility functions prefer traditional assets. Prior studies suggest reverse‐S and S‐shaped category of investors perceive risk in terms of gains and losses, and financial assets with ready price quotes facilitate such buying and selling. In contrast, fully concave and fully convex utility functions prefer investment in traditional assets that requires long term horizon and stable risk preferences. Among demographics, males with reverse‐S shaped utility function are more likely to invest in financial assets, and increase in dependents reduces the possibility to invest in financial assets.
Prognostic significance of grade 3/4 neutropenia in Japanese prostate cancer patients treated with cabazitaxel
Authors: Kosaka Takeo , Shinojima Toshiaki , Morita Shinya , Oya Mototsugu
Published: March 2018

The present study aimed to evaluate the efficacy of cabazitaxel in Japanese patients affected by metastatic castration‐resistant prostate cancer (mCRPC) previously treated with a docetaxel‐containing regimen. In this retrospective study, 41 patients with mCRPC treated with cabazitaxel at Keio University Hospital were retrospectively reviewed. Cabazitaxel at a dose of 20‐25 mg/m² was administered every 3 or 4 weeks. Clinicopathological factors and laboratory data were collected to assess the prognostic factors for overall survival (OS) and progression‐free survival (PFS). An upfront dose‐reduction was required in 52.5% of patients due to their reduced general condition or advanced age. Prophylactic G‐CSF was prescribed to all the patients. Grade ≥3 neutropenia and febrile neutropenia occurred in 21 patients (53.6%) and 3 patients (6.8%), respectively. Treatment was generally well tolerated, with a median of 5 cycles (range 1‐17). Median PFS and OS from the start of cabazitaxel treatment were 4.4 and 15.0 months (95% CI 8.9‐21.2), respectively. Waterfall plot analysis revealed that a prostate‐specific antigen (PSA) decline >50% was noticed in n = 11 patients receiving cabazitaxel (26.8%). Univariate analysis revealed that poor performance status, PSA ≥100 ng/mL prior to cabazitaxel treatment, visceral metastasis, absence of grade 3/4 neutropenia during cabazitaxel therapy and neutrophil‐lymphocyte ratio were significantly associated with shorter overall survival. Multivariate analysis revealed that poor performance status, visceral metastasis, and the absence of grade 3/4 neutropenia during cabazitaxel therapy were the independent prognostic indicators for OS. The practical implication of our results might be to tailor cabazitaxel dosing on the basis of its hematological effects.
Serum IGFBP‐2 levels are associated with reduced insulin sensitivity in obese children
Authors: Yau S. W. , Harcourt B. E. , Kao K.‐T. , Alexander E. J. , Russo V. C. , Werther G. A. , Sabin M. A.
Published: March 2018

Insulin‐like growth factor binding protein 2 (IGFBP‐2) may represent a critical link between body composition and insulin sensitivity. We investigated the relationship between circulating IGFBP‐2 levels, body composition, insulin sensitivity, energy intake and physical activity in children with obesity. Children were recruited via the Weight Management Service at the Royal Children's Hospital, Melbourne, as part of the Childhood Overweight BioRepository of Australia (COBRA). Comprehensive anthropometric, biochemical and environmental data were collected and compared to serum IGFBP‐2 levels (measured by enzyme‐linked immunosorbent assay). Multiple regression modelling was used to assess the influence of circulating IGFBP‐2 levels on anthropometric and biochemical measures. One hundred and ninety‐four children were included in this study (46% male). Circulating IGFBP‐2 negatively correlated with age, anthropometric measures, blood pressure and insulin concentration. Positive associations were observed between insulin sensitivity index‐homeostasis model assessment (ISI‐HOMA) and serum IGFBP‐2. In multiple regression modelling, IGFBP‐2 significantly contributes to variance in systolic blood pressure (−19%, P < 0.05), circulating triglycerides (−16%, P < 0.05) and ISI‐HOMA (18%, P < 0.05). No associations were observed between dietary energy intake or physical activity and IGFBP‐2 levels. Circulating IGFBP‐2 levels in children with obesity correlate inversely with body mass and markers of metabolic dysfunction, and positively with insulin sensitivity. These findings suggest that reduced levels of IGFBP‐2 may play an important role in the pathogenesis of obesity complications in early life.
Reach and messages of the world's largest ivory burn
Authors: Braczkowski Alexander , Holden Matthew H. , O'Bryan Christopher , Choi Chi‐Yeung , Gan Xiaojing , Beesley Nicholas , Gao Yufang , Allan James , Tyrrell Peter , Stiles Daniel , Brehony Peadar , Meney Revocatus , Brink Henry , Takashina Nao , Lin Ming‐Ching , Lin Hsien‐Yung , Rust Niki , Salmo Severino G. , Watson James E.M. , Kahumbu Paula , Maron Martine , Possingham Hugh P. , Biggs Duan
Published: March 2018

Recent increases in ivory poaching have depressed African elephant populations. Successful enforcement has led to ivory stockpiling. Stockpile destruction is becoming increasingly popular, and most destruction has occurred in the last 5 years. Ivory destruction is intended to send a strong message against ivory consumption, both in promoting a taboo on ivory use and catalyzing policy change. However, there has been no effort to establish the distribution and extent of media reporting on ivory destruction events globally. We analyzed media coverage of the largest ivory destruction event in history (Kenya, 30 April 2016) across 11 nation states connected to ivory trade. We used an online‐media crawling tool to search online media outlets and subjected 5 of the largest print newspapers (by circulation) in 5 nations of interest to content analysis. Most online news on the ivory burn came from the United States (81% of 1944 articles), whereas most of the print news articles came from Kenya (61% of 157 articles). Eighty‐six to 97% of all online articles reported the burn as a positive conservation action, whereas 4–50% discussed ivory burning as having a negative impact on elephant conservation. Most articles discussed law enforcement and trade bans as effective for elephant conservation. There was more relative search interest globally in the 2016 Kenyan ivory burn than any other burn in 5 years. Ours is the first attempt to track the reach of media coverage relative to an ivory burn and provides a case study in tracking the effects of a conservation‐marketing event.
What are the predictive factors of caecal perforation in patients with obstructing distal colon cancer?
Authors: Sabbagh C. , Siembida N. , Yzet T. , Robert B. , Chivot C. , Browet F. , Mauvais F. , Regimbeau J. M.
Published: March 2018

Aim

In the presence of large bowel obstruction, the choice of treatment is determined by the patient's general status, the tumour characteristics and the perceived risk of caecal perforation. This study was designed to evaluate the predictive factors of impending caecal perforation, and also investigated the use of caecal volumetry.

Method

From January 2011 to June 2016, patients with obstructive distal colon cancer undergoing emergency laparotomy, for whom a pretreatment CT scan was available, were included in this retrospective, case–control, two‐centre study. Two patient groups were defined: patients with and without impending caecal perforation. The primary end‐point of the study was a determination of predictive factors for caecal perforation.

Results

A total of 72 patients (45 men, 62.5%) were included. Univariate analysis revealed that the presence of pericaecal fluid (P < 0.0001), caecal pneumatosis (P < 0.0001), mean maximum caecal diameter (P = 0.001), mean caecal diameter at the ileocaecal junction (P = 0.0001) and mean caecal volume (P = 0.001) were associated with caecal perforation. Receiver operating characteristic curve analysis revealed that a caecal volume greater than 400 cm3 (P < 0.0001), a maximum caecal diameter > 9 cm (P = 0.002) and a caecal diameter at the ileocaecal junction > 7.5 cm (P = 0.001) were associated with impending caecal perforation. In multivariate analysis, only caecal volume > 400 cm3 (P = 0.001) was correlated with the risk of impending caecal perforation.

Conclusion

Caecal volumetry is an easy and useful tool to predict impending caecal perforation in patients with large bowel obstruction.
Overcoming resistance to mitochondrial apoptosis by BZML‐induced mitotic catastrophe is enhanced by inhibition of autophagy in A549/Taxol cells
Authors: Bai Zhaoshi , Gao Meiqi , Xu Xiaobo , Zhang Huijuan , Xu Jingwen , Guan Qi , Wang Qing , Du Jianan , Li Zhengqiang , Zuo Daiying , Zhang Weige , Wu Yingliang
Published: March 2018

Objectives

Our previous in vitro study showed that 5‐(3, 4, 5‐trimethoxybenzoyl)‐4‐methyl‐2‐(p‐tolyl) imidazol (BZML) is a novel colchicine binding site inhibitor with potent anti‐cancer activity against apoptosis resistance in A549/Taxol cells through mitotic catastrophe (MC). However, the mechanisms underlying apoptosis resistance in A549/Taxol cells remain unknown. To clarify these mechanisms, in the present study, we investigated the molecular mechanisms of apoptosis and autophagy, which are closely associated with MC in BZML‐treated A549 and A549/Taxol cells.

Methods

Xenograft NSCLC models induced by A549 and A549/Taxol cells were used to evaluate the efficacy of BZML in vivo. The activation of the mitochondrial apoptotic pathway was assessed using JC‐1 staining, Annexin V‐FITC/PI double‐staining, a caspase‐9 fluorescence metric assay kit and western blot. The different functional forms of autophagy were distinguished by determining the impact of autophagy inhibition on drug sensitivity.

Results

Our data showed that BZML also exhibited desirable anti‐cancer activity against drug‐resistant NSCLC in vivo. Moreover, BZML caused ROS generation and MMP loss followed by the release of cytochrome c from mitochondria to cytosol in both A549 and A549/Taxol cells. However, the ROS‐mediated apoptotic pathway involving the mitochondria that is induced by BZML was only fully activated in A549 cells but not in A549/Taxol cells. Importantly, we found that autophagy acted as a non‐protective type of autophagy during BZML‐induced apoptosis in A549 cells, whereas it acted as a type of cytoprotective autophagy against BZML‐induced MC in A549/Taxol cells.

Conclusions

Our data suggest that the anti‐apoptosis property of A549/Taxol cells originates from a defect in activation of the mitochondrial apoptotic pathway, and autophagy inhibitors can potentiate BZML‐induced MC to overcome resistance to mitochondrial apoptosis.
National Association of Medical Examiners position paper: Recommendations for the investigation and certification of deaths in people with epilepsy
Authors: Middleton Owen , Atherton Daniel , Bundock Elizabeth , Donner Elizabeth , Friedman Daniel , Hesdorffer Dale , Jarrell Heather , McCrillis Aileen , Mena Othon J. , Morey Mitchel , Thurman David , Tian Niu , Tomson Torbjörn , Tseng Zian , White Steven , Wright Cyndi , Devinsky Orrin
Published: March 2018

Sudden unexpected death of an individual with epilepsy can pose a challenge to death investigators, as most deaths are unwitnessed, and the individual is commonly found dead in bed. Anatomic findings (eg, tongue/lip bite) are commonly absent and of varying specificity, thereby limiting the evidence to implicate epilepsy as a cause of or contributor to death. Thus it is likely that death certificates significantly underrepresent the true number of deaths in which epilepsy was a factor. To address this, members of the National Association of Medical Examiners, North American SUDEP Registry, Epilepsy Foundation SUDEP Institute, American Epilepsy Society, and the Centers for Disease Control and Prevention constituted an expert panel to generate evidence‐based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of autopsy and toxicology findings, and death certification to improve the precision of death certificate data available for public health surveillance of epilepsy‐related deaths. The recommendations provided in this paper are intended to assist medical examiners, coroners, and death investigators when a sudden unexpected death in a person with epilepsy is encountered.
A Taste of Good Health: Evaluation of a School‐Based, Healthy Lifestyles Program for Parents in Latino Communities
Authors: Besnilian Annette , Johnson Peggy , Plunkett Scott W.
Published: March 2018

The purpose of this study was to evaluate a school‐based, parent education program to promote health behaviors and knowledge in Latino families in five schools in Los Angeles, California. An evaluation was conducted during and after the program. The sample consisted of 91 Latino parents. Pretest (baseline), post‐test (4th week), and follow‐up (12th week) quantitative data were collected from paper surveys. In addition, qualitative data regarding strengths and suggestions for improvements of the program were collected at post‐test (4th week) and follow‐up (12th week). The quantitative data indicated participants had significant increases in nutrition/cooking knowledge, nutrition/cooking behaviors, physical activity knowledge, and physical activity behaviors. The results from the qualitative data indicated that participants used the knowledge gained in the classes to create healthier home environments for their children and families. The primary suggestion by participants was to continue having classes in exercise, nutrition, and cooking.
Source of Information and Projected Household Investment Portfolio Performance
Authors: Yao Rui , Lei Shan
Published: March 2018

Using modern information economics as the conceptual framework and data from the 2013 Survey of Consumer Finances, this study adopts a decomposition technique to explore the relationship between the primary information source used by U.S. investors and their household investment portfolio performance. The sample includes households with investable assets and those whose primary information source is a financial planner or self‐directed sources. Households that received large amounts of inheritance or gifts within the past year are excluded from this study due to the necessity of additional planning and the associated time commitment to accomplish it. The findings reveal that investors who consult with financial planners have a higher probability of achieving better household investment portfolio performance than self‐directed investors. Results also show that household income and investor's gender mediated the effect of information source on investment portfolio performance. This study is one of the first to provide empirical evidence of a positive relationship between the service that U.S. financial planners provide and their clients' financial outcome.
TAYLOR PROJECTION: A NEW SOLUTION METHOD FOR DYNAMIC GENERAL EQUILIBRIUM MODELS
Authors: Levintal Oren
Published: March 2018

This article presents a new solution method for dynamic equilibrium models. The solution is approximated by polynomials that zero the residual function and its derivatives at a given point x0. The algorithm is essentially a type of projection but is significantly faster, since the problem is highly sparse and can be easily solved by a Newton solver. The obtained solution is accurate locally in the neighborhood of x0. Importantly, a local solution can be obtained at any point of the state space. This makes it possible to solve models at points that are further away from the steady state.
Immune responses in stroke: how the immune system contributes to damage and healing after stroke and how this knowledge could be translated to better cures?
Authors: Rayasam Aditya , Hsu Martin , Kijak Julie A. , Kissel Lee , Hernandez Gianna , Sandor Matyas , Fabry Zsuzsanna
Published: March 2018

Stroke is one of the leading causes of death and disability worldwide. The long‐standing dogma that stroke is exclusively a vascular disease has been questioned by extensive clinical findings of immune factors that are associated mostly with inflammation after stroke. These have been confirmed in preclinical studies using experimental animal models. It is now accepted that inflammation and immune mediators are critical in acute and long‐term neuronal tissue damage and healing following thrombotic and ischaemic stroke. Despite mounting information delineating the role of the immune system in stroke, the mechanisms of how inflammatory cells and their mediators are involved in stroke‐induced neuroinflammation are still not fully understood. Currently, there is no available treatment for targeting the acute immune response that develops in the brain during cerebral ischaemia. No new treatment has been introduced to stroke therapy since the discovery of tissue plasminogen activator therapy in 1996. Here, we review current knowledge of the immunity of stroke and identify critical gaps that hinder current therapies. We will discuss advances in the understanding of the complex innate and adaptive immune responses in stroke; mechanisms of immune cell‐mediated and factor‐mediated vascular and tissue injury; immunity‐induced tissue repair; and the importance of modulating immunity in stroke.
The interstitiality ofITrisk: An inquiry into information systems development practices
Authors: Öbrand Lars , Augustsson Nils‐Petter , Mathiassen Lars , Holmström Jonny
Published: March 2018

Information systems development (ISD) has been part of the core of information systems for over 40 years. Throughout its history, the issue of risk has been closely related to ISD projects, and significant efforts have been made by researchers and practitioners to improve their quality. While important headway has been made in assessing and resolving ISD risk, the literature shows that new and salient risks emerge outside the scope of extant risk management regimes. As a consequence, organizations still struggle with leveraging new technology as projects continue to fail at almost the same rate, albeit for different reasons. Understood as the distinction between reality and possibility, risk is inherently intertwined with practice and rooted in the knowledge, goals, power, and values of specific actors in particular contexts. Hence, to understand how risks emerge, we present a longitudinal case study in which we trace the origin and locus of risks in contemporary ISD practices. We draw on these insights to theorize information technology risk as increasingly interstitial, originating from sources positioned in between established practices and therefore outside the scope of conventional risk analyses. In conclusion, we discuss interstitial risks as an important form of emergent risk with implications for both research and practice.
An integer programming column generation principle for heuristic search methods
Authors: Zhao Yixin , Larsson Torbjörn , Rönnberg Elina
Published: March 2018

There is an increasing interest in integrating column generation and heuristic approaches to efficiently solve large‐scale discrete optimisation problems. We contribute in this direction. Based on the insights from Lagrangian duality theory, we present an auxiliary problem that can be used for finding near‐optimal solutions to a discrete column‐oriented model. The structure of this auxiliary problem makes it suitable for being addressed with a heuristic search method involving column generation. To this end, we suggest a large neighbourhood search strategy where the repair step is to solve a column generation type subproblem. The suggested search strategy and mathematical models involved need to be tailored to the problem structure. To illustrate important design options and computational behaviour, four applications are studied: bin packing, generalised assignment, a resource allocation problem and the fixed‐charge transportation problem.
Epoxy‐based gelcasting of machinable hydroxyapatite foams for medical applications
Authors: Stastny Premysl , Chlup Zdenek , Kalasova Dominika , Zikmund Tomas , Kaiser Jozef , Trunec Martin
Published: March 2018

Machinable hydroxyapatite foams for subtractive manufacturing of customized bone scaffolds have been developed. The foams were prepared by direct foaming of water‐based hydroxyapatite suspension with dissolved epoxy resin. The foams were consolidated by gelation of the epoxy‐based suspension in air atmosphere. The effect of processing conditions on the foam structure was investigated. The foams had a cellular‐like structure with interconnected pores. The sintered foam with 78% open porosity, the most frequent pore size 430 μm, and the most frequent interconnecting pore window size 150 μm, has been chosen as the foam with the optimal structure from the viewpoint of an application in bone regeneration. The compressive strength of this sintered foam reached 3.3 MPa. The machinability of the optimal foam was investigated using computer numerical controlled (CNC) milling of a test pattern. The milling tests were carried out with the foam at different processing stages and after impregnation with paraffin wax. The best milling result was obtained for a dried foam impregnated with paraffin. The applicability of the whole processing chain was demonstrated and a customized scaffold was manufactured.
Nurses’ attitudes and behaviour towards patients’ use of complementary therapies: A mixed methods study
Authors: Hall Helen , Brosnan Caragh , Cant Robyn , Collins Melissa , Leach Matthew
Published: March 2018

Aim

To explore Registered Nurses’ attitudes and behaviour towards patients’ use of complementary therapies.

Background

Despite high rates of use of complementary therapies by the general population, little is known of how nurses respond to patients’ use of these therapies.

Design

A two‐phase sequential exploratory mixed methods design.

Methods

Nineteen Registered Nurses working in Australia participated in a semi‐structured interview in 2015–2016 and emerging themes informed the development of a quantitative survey instrument administered online nationwide in 2016.

Findings

Emerging key themes “Promoting safe care”; “Seeking complementary therapies knowledge”;” Supporting holistic health care”; and “Integrating complementary therapies in practice” were reflected in survey results. Survey responses (N = 614) revealed >90% agreement that complementary therapies align with a holistic view of health and that patients have the right to use them. Most nurses (77.5%) discussed complementary therapies with patients and 91.8% believed nurses should have some understanding of the area. One‐third did not recommend complementary therapies and there was a lack of overall consensus as to whether these therapies should be integrated into nursing practice. Nurses with training in complementary therapies held more positive views than those without.

Conclusion

Nurses were generally supportive of patients’ interest in complementary therapies, although their primary concern was safety of the patient. Despite broad acceptance that nurses should have a basic understanding of complementary therapies, there was a lack of consensus about recommendation, integration into nursing practice and referral. Further research should explore how nurses can maintain safe, patient‐centred care in the evolving pluralistic healthcare system.
Systematic review and narrative summary: Treatments for and risk factors associated with respiratory tract secretions (death rattle) in the dying adult
Authors: Kolb Hildegard , Snowden Austyn , Stevens Elaine
Published: March 2018

Aim

To identify effective treatments and risk factors associated with death rattle in adults at the end of life.

Background

The presence of noisy, pooled respiratory tract secretions is among the most common symptoms in dying patients around the world. It is unknown if “death rattle” distresses patients, but it can distress relatives and clinicians. Treatments appear unsatisfactory, so prophylaxis would be ideal if possible.

Design

Quantitative systematic review and narrative summary following Cochrane Collaboration guidelines.

Data sources

CINAHL, MEDLINE, Health Source Nursing and Web of Science were searched for international literature in any language published from 1993 ‐ 2016 using MeSH headings and iterative interchangeable terms for “death rattle”.

Review methods

Randomized controlled trials were appraised using the Cochrane Collaboration's tool for assessing risk of bias. Non‐randomized studies were assessed using ROBINS‐I tool for assessing risk of bias in non‐randomized studies of interventions. Instances of treatment and risk were extracted and relevant key findings extracted in line with Cochrane methods.

RESULTS

Five randomized trials and 23 non‐randomized studies were analysed. No pharmacological or non‐pharmacological treatment was found superior to placebo. There was a weak association between lung or brain metastases and presence of death rattle, but otherwise inconsistent empirical support for a range of potential risk factors.

Conclusions

Clinicians have no clear evidence to follow in either treating death rattle or preventing it occurring. However, several risk factors look promising candidates for prospective analysis, so this review concludes with clear recommendations for further research.
Space–time patterns of body size variation in island bovids: The key role of predatory release
Authors: Rozzi Roberto
Published: March 2018

Aim

I provide the first comprehensive study on body size evolution of extinct and living insular bovids, exploring the causal biotic and abiotic selective factors for observed patterns.

Location

Islands worldwide.

Methods

I assembled data on the geographic characteristics of 13 focal islands (area, isolation, latitude, net primary productivity) and on the ecological and morphological characteristics of 32 insular bovid taxa (number of predators and competitors, richness of large mammals, body mass of mainland relatives). I used linear regressions and machine learning methods (regression trees and random forest analyses) to examine the hypothesized contextual importance of these factors in explaining variation in the body size of island bovids. I also calculated evolutionary rates of body size divergence of focal taxa in order to assess whether this phenomenon is influenced by time in isolation.

Results

The results of regression, regression tree and random forest analyses were in agreement with predictions based on a hypothesis of ecological release (more pronounced body size divergence on islands with the fewest competitors and predators). Only limited support for a resource limitation hypothesis (more pronounced body size divergence for the larger taxa on smaller islands) was found.

Main conclusions

The majority of insular bovids, as large mammals, do follow the main prediction of the island rule, exhibiting body size reduction, and predator diversity is the main factor influencing body size evolution of these taxa. Results obtained highlighted the crucial role of time in isolation, with body size reduction becoming more pronounced for bovids with longer residence times on the islands.
Aggregating Polytomous DIF Results Over Multiple Test Administrations
Authors: Zwick Rebecca , Ye Lei , Isham Steven
Published: March 2018

In typical differential item functioning (DIF) assessments, an item's DIF status is not influenced by its status in previous test administrations. An item that has shown DIF at multiple administrations may be treated the same way as an item that has shown DIF in only the most recent administration. Therefore, much useful information about the item's functioning is ignored. In earlier work, we developed the Bayesian updating (BU) DIF procedure for dichotomous items and showed how it could be used to formally aggregate DIF results over administrations. More recently, we extended the BU method to the case of polytomously scored items. We conducted an extensive simulation study that included four “administrations” of a test. For the single‐administration case, we compared the Bayesian approach to an existing polytomous‐DIF procedure. For the multiple‐administration case, we compared BU to two non‐Bayesian methods of aggregating the polytomous‐DIF results over administrations. We concluded that both the BU approach and a simple non‐Bayesian method show promise as methods of aggregating polytomous DIF results over administrations.
Assessing ecological and molecular divergence between the closely related species Hydrolagus pallidus and H. affinis (Chimaeridae)
Authors: Violi B. , Gaither M. R. , Burns F. , Rus Hoelzel A. , Neat F.
Published: March 2018

This study investigated taxonomic validity of the pale ghost shark Hydrolagus pallidus Hardy & Stehmann, 1990, which was described as a species distinct from the smalleyed rabbitfish H. affinis (de Brito Capello 1868). While few morphological characters distinguish the two taxa, a striking difference in sex ratio and fixed differences (1·1–1·6% divergence) in the cytochrome oxidase subunit I barcoding gene support the recognition of both species.
Integrated genetic and morphological data support eco‐evolutionary divergence of Angolan and South African populations of Diplodus hottentotus
Authors: Gwilliam M. P. , Winkler A. C. , Potts W. M. , Santos C. V. , Sauer W. H. H. , Shaw P. W. , McKeown N. J.
Published: March 2018

The genus Diplodus presents multiple cases of taxonomic conjecture. Among these the D. cervinus complex was previously described as comprising three subspecies that are now regarded as separate species: Diplodus cervinus, Diplodus hottentotus and Diplodus omanensis. Diplodus hottentotus exhibits a clear break in its distribution around the Benguela Current system, prompting speculation that Angolan and South African populations flanking this area may be isolated and warrant formal taxonomic distinction. This study reports the first integrated genetic [mitochondrial (mt)DNA and nuclear microsatellite] and morphological (morphometric, meristic and colouration) study to assess patterns of divergence between populations in the two regions. High levels of cytonuclear divergence between the populations support a prolonged period of genetic isolation, with the sharing of only one mtDNA haplotype (12 haplotypes were fully sorted between regions) attributed to retention of ancestral polymorphism. Fish from the two regions were significantly differentiated at a number of morphometric (69·5%) and meristic (46%) characters. In addition, Angolan and South African fish exhibited reciprocally diagnostic colouration patterns that were more similar to Mediterranean and Indian Ocean congeners, respectively. Based on the congruent genetic and phenotypic diversity we suggest that the use of hottentotus, whether for full species or subspecies status, should be restricted to South African D. cervinus to reflect their status as a distinct species‐like unit, while the relationship between Angolan and Atlantic–Mediterranean D. cervinus will require further demo‐genetic analysis. This study highlights the utility of integrated genetic and morphological approaches to assess taxonomic diversity within the biogeographically dynamic Benguela Current region.
Ambiguous loss and post‐traumatic growth: Experiences of mothers whose school‐aged children were born extremely prematurely
Authors: Wilson Caroline , Cook Catherine
Published: March 2018

Aims and objectives

To develop insight into the experiences of mothers whose school‐aged children were born extremely prematurely.

Background

Extreme prematurity, where infants are born at 28 weeks or earlier, has significant initial maternal impact in terms of distress, uncertainty and disruption to maternal identity. However, little is known about the experiences of these mothers beyond their child's infancy.

Design

A qualitative study was undertaken using thematic analysis, drawing on a cluster of social constructionist theories that have been applied to studies investigating mothers’ early preterm or childhood disability experiences.

Methods

The study involved face‐to‐face interviews with nine mothers whose children were born prior to 28 weeks and were now aged between 4‐to‐7 years old.

Results

Participants described a prolonged period of anxiety, and relative isolation due to infection fears and complex care regimes. Although they grieved their different mothering trajectory, they celebrated their children's successes and noted their own resilience. The following themes were identified: traumatic beginnings; dialectics and the horror‐miracle contradiction; labour‐intensive parenting and managing the multidisciplinary team; stigma and storying the meaning of premature birth; and impact on relationships.

Conclusions

Women's vulnerability and resilience are evident long after the birth of an extremely prematurely born infant. Women value connection with similar mothers, and yet finding community is often daunting due to their children's early complex needs. Generalist healthcare providers may be unaware of the experiences these mothers have endured, and need to enquire about their well‐being.

Relevance to clinical practice

The lives of mothers of extremely preterm infants may take years to merge with the world of those mothers who parent healthy, term infants. Neonatal nurses and those in primary health care are well placed to notice signs of isolation, depression and anxiety, and to support and refer women appropriately.
Delirium in ICU patients following cardiac surgery: An observational study
Authors: Simeone Silvio , Pucciarelli Gianluca , Perrone Marco , Teresa Rea , Gargiulo Gianpaolo , Guillari Assunta , Castellano Gaetano , Tommaso Luigi Di , Niola Massimo , Iannelli Gabriele
Published: March 2018

Aims and objectives

To observe the clinical and structural factors that can be associated with the post‐operative onset of delirium in patients who have undergone heart surgery.

Background

Several risk factors could contribute to the development of delirium, such as the use of some sedative drugs and a patient's history with certain types of acute chronic disease. However, in the literature, there is little knowledge about the association between delirium in patients who have undergone cardiac surgical intervention and their clinical and environmental predictors.

Design

We used an observational design.

Methods

We enrolled 89 hospitalised patients in the ICU. Patients were first evaluated using the Richmond Agitation Sedation Scale and subsequently using the Confusion Assessment Method for the ICU. A linear model of regression was used to identify the predictors of delirium in patients.

Results

The patients had an average age of 89 years (SD = 6.9), were predominantly male (84.3%) and were mostly married (79.8%). The majority of patients had been subjected to bypass (80.9%), while 19.1% had undergone the intervention of endoprosthesis. The logistic regression model showed that patient age, the duration of mechanically assisted ventilation, continuous exposure to artificial light and the presence of sleep disorders were predictors of the onset of delirium.

Conclusion

This study further confirms that clinical aspects such as insomnia and one's circadian rhythm as well as structural elements such as exposure to artificial light are variables that should be monitored in order to prevent and treat the onset of severe post‐operative delirium.

Relevance to clinical practice

Identifying the possible factors that predispose a patient to the onset of delirium during intensive therapy following cardiac surgery, it is fundamental to implement interventions to prevent this syndrome.
Knowing how to get things done: Nurse consultants as clinical leaders
Authors: Giles Michelle , Parker Vicki , Conway Jane , Mitchell Rebecca
Published: March 2018

Background

Clinical leaders drive healthcare performance in the provision of safe, high‐quality patient care by influencing others and augmenting change. Clinical leadership features strongly in nurse consultant roles and holds potential to strengthen the nurse consultant's place in healthcare teams, making their contribution as clinical leaders more recognisable. This study explores how clinical leadership is enacted through the nurse consultant role, providing understanding of the elements that influence their effectiveness as clinical leaders.

Design

This study presents qualitative findings from a larger sequential mixed‐method study conducted in a large Local Health District in New South Wales, Australia.

Methods

Focus groups were held with nurse consultants, managers and other stakeholders from a variety of context including acute, primary and community care settings across metropolitan and rural locations. An online discussion forum was provided for nurse consultants unable to attend focus groups. Transcript data were analysed using iterative theming techniques.

Results

A total of 26 nurse consultants, 20 managers and 16 other stakeholders participated in focus groups and 22 nurse consultants contributed to the discussion forum. The role of the nurse consultant as clinical leader was a dominant feature, manifested through the following four themes: knowing and being known, being a collaborator, being a utility player and working across and within.

Conclusions

Nurse consultants are cogent clinical leaders, recognised and valued for their contribution to interprofessional teams and service delivery. The nurse consultant role is seen as having a broad sphere of influence and is able to action change through clinical leadership.

Relevance to clinical practice

Findings give organisational leaders and other healthcare professional's greater understanding of nurse consultants as clinical leaders. This informs how nurse consultants are appointed and positioned and how they can be supported in fulfilling their clinical leadership potential.
Nurses' role in recognising and responding to clinical deterioration in surgical patients
Authors: Mohammmed Iddrisu Suad , Hutchinson Ana F , Sungkar Yasmin , Considine Julie
Published: March 2018

Aim and objectives

To explore nurse’ role in recognising and responding to deteriorating post‐operative patients.

Background

Clinical deterioration is a significant problem in acute care settings. Nurses play a vital role in post‐operative patient monitoring; however, there is limited understanding of the nurses’ role in recognising and responding to clinical deterioration in surgical patients.

Methods

This qualitative exploratory study was conducted at a metropolitan teaching hospital in Melbourne, Australia. Data were collected through focus groups from 1 September to 31 October 2014. Four focus groups of 2–5 surgical nurses (n = 14) were conducted to explore the nurses’ perception of their role in managing deterioration over the first 72 hr postoperatively. Qualitative data were recorded, transcribed and key themes identified.

Results

Nurses demonstrated a high level of awareness of their role in recognising and responding to early signs of deterioration. The themes that arose from the focus group interviews were “struggling with blood pressure,” and “we know our patient is sick.” The nurses were confident about the clinical indicators of deterioration and the appropriate channels to use to escalate care. Using track and trigger observation charts enabled nurses to identify deteriorating patients prior to the patient fulfilling rapid response system escalation criteria.

Conclusions

These findings highlight the importance of a collective team approach to preventing, recognising and responding to clinical deterioration across the whole patient journey. Initiatives to ensure accurate written and verbal communication between medical and nursing staff warrants further assessment.

Relevance to clinical practice

Nurses working in acute surgical wards are highly engaged in the process of recognising and responding to clinical deterioration in post‐operative patients. Many nurses reported being able to anticipate deterioration occurring but are required by current organisational frameworks to escalate care to rapid response systems. How nurses anticipate and manage deterioration prior to the patient fulfilling rapid response system criteria warrants further investigation.
Growth and protein‐rich food intake in infancy is associated with fat‐free mass index at 2–3 years of age
Authors: Smith‐Brown Paula , Morrison Mark , Krause Lutz , Newby Ruth , Davies Peter SW
Published: March 2018

Aim

The reduction of infant protein intake and associated growth velocity is a recommended public health strategy for reducing the risk of childhood obesity. This study tests the hypothesis that infants’ growth and protein‐rich food (dairy, meat, fish and egg) intake influences childhood body size and composition at 2–3 years of age.

Methods

Thirty‐six children were studied from the Feeding Queensland Babies Study Cohort, which prospectively collected data on infant growth and diet. Body composition was estimated using the deuterium oxide dilution technique at 2–3 years of age.

Results

Fat‐free mass index Z score at 2–3 years of age was positively associated with animal protein food (dairy, meat, fish and egg) intake at 12 months of age (r = 0.58, P = 0.002, false discovery rate corrected P value = 0.008) and negatively associated with weight‐for‐length growth velocity from 6 to 12 months of age (r = −0.75, P = 0.019, false discovery rate corrected P value = 0.038), which in turn was negatively associated with growth velocity from 0 to 6 months of age (r = −0.790, P = 0.007).

Conclusion

This study suggests that strategies to reduce protein intake and growth velocity in early life may limit fat‐free mass growth, potentially predisposing to increased adiposity in later life.
The enhanced effect of tetrahydrocurcumin on radiosensitivity of glioma cells
Authors: Zhang Xingzhen , Peng Lei , Liu Anchang , Ji Jianbo , Zhao Lixia , Zhai Guangxi
Published: March 2018

Objectives

To evaluate the effects of tetrahydrocurcumin (THC) on the radiosensitivity of glioma cells and the possible molecular mechanism.

Methods

MTT assay, colony forming and wound healing assays were performed to detect the proliferation, radiosensitivity and migration of cells with various treatments. Cell apoptosis, cell cycle and GHS level were determined for exploring potent sensitization mechanism of THC. Meanwhile, protein expressions of cyclin D1 and PCNA were also measured. Furthermore, both orthotopic C6 mouse models and C6 subcutaneously grafted mouse models were established to test the tumour inhibitory effects of combined treatment in vivo.

Key findings

Cells treated with combined THC and radiation demonstrated lower cell viability and higher apoptosis rate as compared to radiation group. Moreover, the intracellular GSH was also decreased in the THC co-treated C6 cells. More importantly, combinatorial treatment group significantly induced G0/G1 cell cycle arrest and a decrease in the S phase cell through the down-regulation of cyclin D1 and PCNA. The in-vivo therapeutic efficacy assay indicated that the growth of tumour was greatly inhibited in combinatorial group.

Conclusions

Tetrahydrocurcumin can synergistically enhance the radiosensitivity of glioma cells by inhibiting the expressions of cyclin D1 and PCNA.