bluuebunny/crossref_metadata_2025 huggingface dataset:
Gait parameters in children with bilateral spastic cerebral palsy: a systematic review of randomized controlled trials
Authors: Gómez‐Pérez Cristina , Font‐Llagunes Josep M , Martori Joan Carles , Vidal Samsó Joan
Published: November 2018

Aim

To identify the gait parameters used to assess gait disorders in children with bilateral spastic cerebral palsy (CP) and evaluate their responsiveness to treatments.

Method

A systematic search within PubMed, Web of Science, and Scopus (in English, 2000–2016) for randomized controlled trials of children with bilateral spastic CP who were assessed by instrumented gait analysis (IGA) was performed. Data related to participants and study characteristics, risk of bias, and outcome measures were collected. A list of gait parameters responsive to clinical interventions was obtained.

Results

Twenty‐one articles met the inclusion criteria. Eighty‐nine gait parameters were identified, 56 of which showed responsiveness to treatments. Spatiotemporal and kinematic parameters were widely used compared to kinetic and surface electromyography data. The majority of responsive gait parameters were joint angles at the sagittal plane (flexion–extension).

Interpretation

The IGA yields responsive outcome measures for the gait assessment of children with bilateral spastic CP. Spatiotemporal and kinematic (at sagittal plane) parameters are the gait parameters used most frequently. Further research is needed to establish the relevant gait parameters for each clinical problem.

What this paper adds

Fifty‐six responsive gait parameters for children with bilateral spastic cerebral palsy were identified.

Most responsive gait parameters belong to joint angles time‐series at sagittal plane.

Spatiotemporal and kinematic parameters are widely used compared to kinetic and surface electromyography parameters.
Two for one? Effects of a couples intervention on partners of persons with Type 2 diabetes: a randomized controlled trial
Authors: Trief P. M. , Fisher L. , Sandberg J. , Hessler D. M. , Cibula D. A. , Weinstock R. S.
Published: November 2018

Aims

To compare the outcomes of partners who participated in a telephone couples behavioural intervention to improve glycaemic control in persons with Type 2 diabetes with those of untreated partners of participants in an individual intervention or education; to explore ‘ripple effects’, i.e. positive behaviour changes seen in untreated partners.

Methods

The Diabetes Support Project was a three‐arm randomized telephone intervention trial comparing outcomes of couples calls (CC), individual calls (IC) and diabetes education calls (DE). Couples included one partner with Type 2 diabetes and HbA1c ≥ 58 mmol/mol (7.5%). All arms received self‐management education (two calls). CC and IC arms participated in 10 additional behaviour change calls. CC included partners, emphasizing partner communication, collaboration and support. Blinded assessments were performed at 4, 8 and 12 months. Partner outcomes were psychosocial (diabetes distress, relationship satisfaction, depressive symptoms), medical (BMI, blood pressure) and behavioural (fat intake, activity).

Results

Partners’ (N = 268) mean age was 55.8 years, 64.6% were female and 29.9% were from minority ethnic groups. CC (vs. IC and DE) partners had greater reductions in diabetes distress, greater increases in marital satisfaction (4 and 8 months), and some improvements in diastolic BP. There were no consistent differences among arms in other outcomes. There was no evidence of a dietary or activity behaviour ripple effect on untreated partners, i.e. comparing partners in the IC and DE arms.

Conclusions

A collaborative couples intervention resulted in significant improvements in partner diabetes distress and relationship satisfaction. There were no consistent effects on behavioural or medical partner outcomes, and no evidence of diet or activity behaviour ripple effects, suggesting that partners should be targeted directly to achieve these changes. (Clinical Trial Registry No: NCT01017523)
Severe conduct problems in adolescence and risk of schizophrenia in early adulthood
Authors: Manninen Marko , Latvala Reetta , Torniainen‐Holm Minna , Suvisaari Jaana , Lindgren Maija
Published: November 2018

Aim

Reform school (RS) is a foster care institution for adolescents with severe conduct problems. Both instability of early rearing environment and severe conduct problems in adolescence may associate with later psychotic disorders. We studied whether the risk of schizophrenia in adulthood is elevated in RS adolescents, and whether it is related to the age at first foster care placement or placement instability.

Methods

Adult age schizophrenia spectrum disorder data from RS subjects (N = 1099) were compared to a comparison group matched by age, sex, and place of birth (N = 5437) in a register based follow‐up study, with up to 23 years follow‐up time. Schizophrenia was also predicted with chosen placement factors. Cox proportional regression model was used in the analysis.

Results

RS subjects had an 8‐fold (HR = 7.82, 95% CI 5.63‐10.87) risk of schizophrenia compared to the comparison group. RS subjects also had an earlier age of schizophrenia onset. RS cohort, gender, placement instability, or age during the first out‐of‐home placement did not predict later schizophrenia.

Conclusions

Adolescents with severe conduct problems are a specific high‐risk group for later schizophrenia. The risk manifests early, which compromises the pathway to the adult well‐being. Specialized screening procedures for psychosis risk should be implemented in the standard clinical procedures when working with adolescents with severe behaviour problems, and early intervention programs should be available.
Crack growth evaluation by XFEM for nuclear pipes considering thermal aging embrittlement effect
Authors: Sim Jae Min , Chang Yoon‐Suk
Published: November 2018

Since thermal aging embrittlement (TE) causes loss of fracture toughness and may lead to failure, it is one of structural integrity issues to be assessed in nuclear industry. In this study, crack growth simulation by using extended finite element method (XFEM) was carried out for CF8M base metal and ER316L weld metal, which are typical vulnerable materials. First, user subroutines were constructed to incorporate variation of mechanical properties of two materials due to the TE. In particular, with regard to ER316L, weld residual stress (WRS) distribution was considered. Second, validity of the subroutines and XFEM was confirmed by comparing with analytical and experimental data. Finally, crack growth analyses for nuclear pipes were performed by applying the verified methodology. Thereby, differences of the crack growth amounts and paths as the presence or absence of the TE and WRS were quantified and discussed.
Experimental island biogeography demonstrates the importance of island size and dispersal for the adaptation to novel habitats
Authors: Alzate Adriana , Etienne Rampal S. , Bonte Dries
Published: November 2018

Aim

Island biogeography theory describes how island size and isolation determine population colonization success. Large islands sustain larger populations than small ones and experience less demographic stochasticity, thus a lower extinction risk. Nearby islands are more likely to be colonized than distant ones, because they receive more immigrants from the mainland. However, local conditions on islands are often different from those on the mainland; therefore, populations on recently colonized islands also need to adapt. Island size and isolation are known to impact the build‐up of genetic variation necessary for adaptation; hence, we integrated island biogeography with evolution experimentally to gain a better understanding of the roles of island size and isolation in biodiversity patterns.

Location

Laboratory, Ghent University, Belgium.

Time period

October 2013 to June 2014.

Major taxa studied

Two‐spotted spider mite (Tetranychus urticae).

Methods

Using experimental evolution, we studied the effects of island size and isolation on colonization, extinction and adaptation of the two‐spotted spider mite to new islands. The mainland population consisted of bean plants and the islands of tomato plants (a known challenging condition). Islands differed in their size (number of plants) and in the number of immigrants (females, the dispersive stage) they received from the mainland.

Results

Island size and dispersal decreased extinction risk and increased colonization success and adaptation. Populations on small islands, which are most affected by extinction, were rescued demographically by an increase in dispersal. However, they were never able to adapt.

Main conclusions

Evolutionary rescue via dispersal is possible only when populations are sufficiently large; small populations cannot adapt, because they lack the genetic variation necessary for local adaptation. Hence, in addition to the effects of island size and dispersal on the ecological processes of colonization and extinction, our results show that island size and dispersal can jointly affect the evolutionary process of adaptation to novel habitats.
Combining multiple visual surveys to model the habitat of deep‐diving cetaceans at the basin scale
Authors: Virgili Auriane , Authier Matthieu , Boisseau Oliver , Cañadas Ana , Claridge Diane , Cole Tim , Corkeron Peter , Dorémus Ghislain , David Léa , Di‐Méglio Nathalie , Dunn Charlotte , Dunn Tim E. , García‐Barón Isabel , Laran Sophie , Lauriano Giancarlo , Lewis Mark , Louzao Maite , Mannocci Laura , Martínez‐Cedeira José , Palka Debra , Panigada Simone , Pettex Emeline , Roberts Jason J. , Ruiz Leire , Saavedra Camilo , Santos M. Begoña , Van Canneyt Olivier , Vázquez Bonales José Antonio , Monestiez Pascal , Ridoux Vincent
Published: November 2018

Aim

Deep‐diving cetaceans are oceanic species exposed to multiple anthropogenic pressures including high intensity underwater noise, and knowledge of their distribution is crucial to manage their conservation. Due to intrinsic low densities, wide distribution ranges and limited presence at the sea surface, these species are rarely sighted. Pooling data from multiple visual surveys sharing a common line‐transect methodology can increase sightings but requires accounting for heterogeneity in protocols and platforms.

Location

North Atlantic Ocean and Mediterranean Sea.

Time period

1998 to 2015.

Major taxa

Ziphiidae; Physeteriidae; Kogiidae.

Methods

About 1,240,000 km of pooled effort provided 630 sightings of ziphiids, 836 of physeteriids and 106 of kogiids. For each taxon, we built a hierarchical model to estimate the effective strip width depending on observation conditions and survey types. We then modelled relative densities in a generalized additive modelling framework. Geographical predictions were limited to interpolations identified with a gap analysis of environmental space coverage.

Results

Deeper areas of the North Atlantic gyre were mostly environmental extrapolation in the predictions, thereby highlighting gaps in sampling across the different surveys. For the three species groups, the highest relative densities were predicted along continental slopes, particularly in the western North Atlantic Ocean where the Gulf Stream creates dynamic frontal zones and eddies.

Main conclusions

Pooling a large number of surveys provided the first basin‐wide models of distribution for deep‐diving cetaceans, including several data‐deficient taxa, across the North Atlantic Ocean and the Mediterranean Sea. These models can help the conservation of elusive and poorly known marine megafauna.
Non‐Pharmacological Treatment for Primary Headaches Prevention and Lifestyle Changes in a Low‐Income Community of Brazil: A Randomized Clinical Trial
Authors: Fernando Prieto Peres Mario , Prieto Peres Mercante Juliane , Belitardo de Oliveira Arão
Published: November 2018

Background

Primary headaches can be reduced by lifestyle changes, such as stress management and physical activity. However, access to programs focused on behavioral interventions is limited in underserved, poor communities.

Objectives

We performed a randomized open‐label clinical trial to test the therapeutic and behavioral effects of aerobic exercise, relaxation, or the combination of both, in individuals with primary headaches of a small, low‐income community of the Brazilian Amazon.

Methods

Participants were screened from the riverine/rural population, and individuals with primary headache were included. We assessed clinical characteristics and physical activity levels. Interventions were delivery 3 times/week for 6 months. The primary outcome variable was changes in days with headache, while changes in duration of attacks, pain intensity, and physical activity levels were secondary outcomes variables.

Results

Seven hundred and ninety individuals were screened (15.3% of rural/riverine population). Seventy‐four participants were randomly assigned to relaxation (n = 25), physical activity orientation program (n = 25), or both (n = 24) interventions. Intention to treat analyses showed all interventions as effective to reduce days with headaches and duration of attacks (both P < .01). Pain intensity was reduced only in relaxation and relaxation + physical activity groups (both P < .01). Physical activity levels increased only in the relaxation + physical activity group (P < .05).

Conclusions

Non‐pharmacological interventions such as physical activity and relaxation are effective for reducing headaches, while combining such interventions promote health behavior toward higher physical activity levels in low‐income populations with primary headaches.

Clinical Trial Registration number: SGPP 1544.
Is the sum of positive neuroendocrine immunohistochemical stains useful for diagnosis of large cell neuroendocrine carcinoma (LCNEC) on biopsy specimens?
Authors: Derks Jules L , Dingemans Anne‐Marie C , van Suylen Robert‐Jan , den Bakker Michael A , Damhuis Ronald A M , van den Broek Esther C , Speel Ernst‐Jan , Thunnissen Erik
Published: November 2018

Aims

Pulmonary large cell neuroendocrine carcinoma (LCNEC) is underdiagnosed on biopsy specimens. We evaluated if routine neuroendocrine immunohistochemical (IHC) stains are helpful in the diagnosis of LCNEC on biopsy specimens.

Methods and results

Using the Dutch pathology registry (PALGA), surgically resected LCNEC with matching pre‐operative biopsy specimens were identified and haematoxylin and IHC slides (CD56, chromogranin‐A, synaptophysin) requested. Subsequently, three pathologists assigned (1) the presence or absence of the WHO 2015 criteria and (2) cumulative size of all (biopsy) specimens. For validation, a tissue microarray (TMA) of non‐small‐cell lung cancer (NSCLC) (n = 77) and LCNEC (n = 19) was used. LCNEC was confirmed on the resection specimens in 32 of 48 re‐reviewed cases. In 47% (n = 15 of 32) LCNEC was also confirmed in the paired biopsy specimens. Neuroendocrine morphology was absent in 53% (n = 17 of 32) of paired biopsy specimens, more often when smaller amounts of tissue were available for evaluation [29% < 5 mm (n = 14) versus 67% ≥5 mm (n = 18) P = 0.04]. Combined with current WHO criteria, positive staining for greater than or equal to two of three neuroendocrine IHC markers increased the sensitivity for LCNEC from 47% to 93% on paired biopsy specimens, and further validated using an independent TMA of LCNEC and NSCLC with sensitivity and specificity of 80% and 99%, respectively.

Conclusions

LCNEC is difficult to diagnose because neuroendocrine morphology is frequently absent in biopsy specimens. In NSCLC devoid of obvious morphological squamous or adenocarcinoma features, positive staining in greater than or equal to two of three neuroendocrine IHC stains supports the diagnosis of LCNEC.
Attitudes toward Christian church retailing: A study in Cape Town, South Africa
Authors: Bundwini Nqobile , Lappeman James
Published: November 2018

The temporal and eternal often cross paths in economic and financial transactions, with the blending of religion and commerce producing divergent views. Nevertheless, churches increasingly use commercial methods such as marketing and retailing for, inter alia, fundraising, connecting with congregations and keeping abreast of social, technological and economic changes. As with most businesses, churches may investigate their target consumers in order to align their efforts to meet the needs of consumers. The peculiar nature of religious consumption has both short‐term, product‐based needs and long‐term spiritual influences. This study investigated the attitudes of church members toward church retailing and various types of church retail products. A series of 26 in‐depth interviews were conducted for this study, resulting in antithetical attitudes toward the broad concept of church retailing, and with more distinct positive and negative attitudes toward particular product types. Generally, attitudes were more positive toward products perceived to be more authentic with regard to the religious mission of the church, and more negative toward products perceived as straying from it. Furthermore, attitudes in relation to church retailing were influenced by who the ultimate beneficiaries would be.
Civic Arithmetic
Authors: Lewis Michael Anthony
Published: November 2018

Michael Anthony Lewis explores the link between mathematics and politics through the hot-button issues of apportionment, citizenship and the US census
Dealing with Confusion over Death “Counts”
Authors: Spagat Michael , Jewell Britta , Jewell Nicholas
Published: November 2018

President Trump is not alone in mistaking death “estimates” for death “counts”, write Michael Spagat, Britta Jewell and Nicholas Jewell
Did a Roulette System “Break the Bank”?
Authors: Kendall Graham
Published: November 2018

In the book Thirteen Against the Bank, Norman Leigh claims to have achieved the impossible and devised a system to consistently return a profit from playing roulette. It sounds too good to be true, and maybe it is. Graham Kendall uses computer simulation to sort fact from fiction
One method to establish Epstein‐Barr virus‐associated NK/T cell lymphoma mouse models
Authors: Xue Weili , Li Weiming , Shang Yufeng , Zhang Yanjie , Lan Xuan , Wang Guannan , Li Zhaoming , Zhang Xudong , Song Yue , Wu Baopeng , Dong Meng , Wang Xinhua , Zhang Mingzhi
Published: November 2018

Novel nude mice model of human NK/T cell lymphoma were established by subcutaneously injecting two NK/T cell lymphoma cell lines into the right axillary region of mice and successful passages were completed by injecting cell suspension which was obtained through a 70‐μm cell strainer. These mice models and corresponding cell clones have been successfully developed for more than 8 generations. The survival rates of both resuscitation and transplantation in NKYS and YT models were 90% and 70% correspondingly. Pathologically, the tumour cells in all passages of the lymphoma‐bearing mice and cell lines obtained from tumours were parallel to initial cell lines. Immunologically, the tumour cells expressed the characteristics of the primary and essential NK/T lymphomas. The novel mice models maintained the essential features of human NK/T cell lymphoma, and they would be ideal tools in vivo for further research of human NK/T cell lymphoma.
Behavioural mechanisms of sexual isolation involving multiple modalities and their inheritance
Authors: Moran Peter A. , Hunt John , Mitchell Christopher , Ritchie Michael G. , Bailey Nathan W.
Published: November 2018

Speciation research dissects the genetics and evolution of reproductive barriers between parental species. Hybrids are the “gatekeepers” of gene flow, so it is also important to understand the behavioural mechanisms and genetics of any potential isolation from their parental species. We tested the role of multiple behavioural barriers in reproductive isolation among closely related field crickets and their hybrids (Teleogryllus oceanicus and Teleogryllus commodus). These species hybridize in the laboratory, but the behaviour of hybrids is unusual and there is little evidence for gene flow in the wild. We found that heterospecific pairs exhibited reduced rates of courtship behaviour due to discrimination by both sexes, and that this behavioural isolation was symmetrical. However, hybrids were not sexually selected against and exhibited high rates of courtship behaviour even though hybrid females are sterile. Using reciprocal hybrid crosses, we characterized patterns of interspecific divergence and inheritance in key sexual traits that might underlie the mating patterns we found: calling song, courtship song and cuticular hydrocarbons (CHCs). Song traits exhibited both sex linkage and transgressive segregation, whereas CHCs exhibited only the latter. Calculations of the strength of isolation exerted by these sexual traits suggest that close‐range signals are as important as long‐distance signals in contributing to interspecific sexual isolation. The surprisingly weak mating barriers observed between hybrids and parental species highlight the need to examine reproductive isolating mechanisms and their genetic bases across different potential stages of introgressive hybridization.
Reduction of routine radiographs in the follow‐up of distal radius and ankle fractures: Barriers and facilitators perceived by orthopaedic trauma surgeons
Authors: van Gerven Pieter , van Bodegom‐Vos Leti , Weil Nikki L. , van den Berg Jasper , Rubinstein Sidney M. , Termaat Marco F. , Krijnen Pieta , van Tulder Maurits W. , Schipper Inger B.
Published: November 2018

Rationale, aims, and objectives

Studies suggest that routine radiographs during follow‐up of distal radius and ankle fractures result in increased radiation exposure and health care costs, without influencing treatment strategies. Encouraging clinicians to omit these routine radiographs is challenging, and little is known about barriers and facilitators that influence this omission. Therefore, this study aims to identify barriers and facilitators among orthopaedic trauma surgeons that might prove valuable towards the design of a deimplementation strategy.

Methods

A mixed‐method approach was used. First, interviews were conducted with orthopaedic trauma surgeons and patients (n = 16). Subsequently, a questionnaire was developed. This questionnaire was presented to 228 orthopaedic trauma surgeons in the Netherlands. Regression analyses were performed in order to identify which variables were independently associated to the decision to stop performing routine radiographs 6 and 12 weeks after trauma if proven not effective in a large randomized controlled trial.

Results

In total, 130 (57%) respondents completed the questionnaire. Of these, 71% indicated they would stop ordering routine radiographs if they were proven not effective. Three facilitators were independent predictors for the intention to omit routine radiographs: This will “lead to lower health care costs” (Odds Ratio [OR]: 5.38 and 4.38), the need for “incorporation in the regional protocol” (OR: 3.66 and 2.66), and this will “result in time savings for the patient” (OR: 4.84).

Conclusions

We identified three facilitators that could provide backing for a deimplementation strategy aimed at a reduction of routine radiographs for patients with distal radius and ankle fractures.
National estimates of case‐mix, mortality, and economic outcomes among inpatient HIV/AIDS mono‐infection and hepatitis C co‐infection cases in the US
Authors: Pham Timothy , Rathbun R. Chris , Keast Shellie , Nesser Nancy , Farmer Kevin , Skrepnek Grant
Published: November 2018

Rationale, aims, and objectives

To assess inpatient clinical and economic outcomes for AIDS/HIV and Hepatitis C (HCV) co‐infection in the United States from 2003 to 2014.

Method

This historical cohort study utilized nationally representative hospital discharge data to investigate inpatient mortality, length of stay (LoS), and inflation‐adjusted charges among adults (≥18 years). Outcomes were analysed via multivariable generalized linear models according to demographics, hospital and clinical characteristics, and AIDS/HIV or HCV sequelae.

Results

Overall, 17.8% of the 2.75 million estimated AIDS/HIV inpatient cases involved HCV from 2003 to 2014, averaging 48.5 ± 9.0 years of age and 68.0% being male. Advanced sequalae of AIDS and HCV incurred a LoS of 10.3 ± 11.9 days, charges of $88 789 ± 131 787, and a 16.9% mortality. Many cases involved noncompliance, tobacco use disorders, and substance abuse. Although mortality decreased over time, multivariable analyses indicated that poorer outcomes were generally associated with more advanced clinical conditions and AIDS‐associated sequalae, although mixed results were observed for specific manifestations of HCV. Rural residence was independently associated with a 3.26 times higher adjusted odds of mortality from 2009 to 2014 for HIV/HCV co‐infection (P < 0.001), although not for AIDS/HCV (OR = 1.38, P = 0.166).

Conclusion

Given the systemic nature and modifiable risks inherent within coinfection, more proactive screening and intervention appear warranted, particularly within rural areas.
Ten Things Every Geriatrician Should Know About House Calls
Authors: Yang Mia , Thomas Jantira , Zimmer Rachel , Cleveland Maryjo , Hayashi Jennifer L. , Colburn Jessica L.
Published: November 2018

Home‐based primary care (HBPC) is experiencing a reemergence to meet the needs of homebound older adults. This brief review based on existing literature and expert opinion discusses 10 key facts about HBPC that every geriatrician should know: (1) the team‐based nature of HBPC is key to its success; (2) preparations and after‐hour access for house calls are required; (3) home safety for the clinician and patient must be considered; (4) being homebound is an independent mortality risk factor with a high symptom burden; (5) home care medicine presents unique benefits and challenges; (6) a systems‐based approach to care is essential; (7) HBPC is a sustainable model within value‐based care proven by the Department of Veterans Affairs and the Independence at Home Medicare Demonstration Project; (8) HBPC has an educational mission; (9) national organizations for HBPC include American Academy of Home Care Medicine and Home Centered Care Institute; and (10) practicing HBPC is a privilege. HBPC is a dynamic and unique practice model that will continue to grow in the future. J Am Geriatr Soc 67:139–144, 2019.
Hospitalisation of adults with Down syndrome: lesson from a 10‐year experience from a community hospital
Authors: Chenbhanich J. , Wu A. , Phupitakphol T. , Atsawarungruangkit A. , Treadwell T.
Published: November 2018

Background

Life expectancy of individuals with Down syndrome (DS) has improved significantly over the past decades. However, there are sparse data documenting the co‐morbidities and hospitalisation of adult patients with DS in the literature. The aim of this study was to characterise the co‐morbidities and pattern of hospitalisation in adult patients with DS during a 10‐year period at the community hospital as well as to compare hospitalisation parameters with the general adult population during the same years.

Method

We reviewed the medical records of 81 hospitalisations from 37 patients with DS aged 21 to 68 years at Metrowest Medical Center during a 10‐year period and compared with those of the general adult population during the same time. Co‐morbidities were also described.

Results

Adults with DS had a mean age at admission of 48.6 ± 8.8 years with the median length of stay of 3 days (interquartile range 4 days). Male patients were hospitalised longer than female patients (mean 5.0 vs. 2.8 days; P < 0.05), and patients who lived at home were admitted at earlier ages than those who came from residential healthcare facility (mean 41.5 vs. 52.2 years; P < 0.001). The most common cause of hospitalisation was pneumonia/aspiration syndrome (29.6%), and the most common co‐morbidity was gastroesophageal reflux disease (GERD)/dysphagia (70.3%). Presence of GERD/dysphagia or seizure disorder was significantly associated with multiple admission and readmission within 1 month (P < 0.05). The mortality rate was 4.9%, and the rate of intensive care unit admission was 8.6%.

Conclusions

Our cohort did not show statistically significant different hospitalisation parameters such as inpatient mortality and average length of stay when compared with general adult population hospitalised at the same years. The care of adult patients with DS presents challenges in internal medicine due to its unique co‐morbid profile and signifies the importance of multidisciplinary approach. In order to improve the care of this patient population, their co‐morbidities, particularly GERD/dysphagia and seizure disorder, should be optimally managed and comprehensively addressed when patients are hospitalised.
Do SMEs Benefit from Unconventional Monetary Policy and How? Microevidence from the Eurozone
Authors: FERRANDO ANNALISA , POPOV ALEXANDER , UDELL GREGORY F.
Published: November 2018

We study the impact of the announcement of the European Central Bank's (ECB's) Outright Monetary Transactions Program on small firms’ access to finance using a matched firm‐bank data set from eight Eurozone countries. We find that following the announcement, credit access improved relatively more for firms borrowing from banks with high balance sheet exposures to impaired sovereign debt, with such firms less likely to be refused a loan or to be price rationed. Loan terms also improved as manifested by lengthening of loan maturities. Unconventional monetary policy has a positive impact on firms’ investment and profitability, while its effect on firm innovation is weaker.
Embodying compassion: A systematic review of the views of nurses and patients
Authors: Durkin Joanne , Usher Kim , Jackson Debra
Published: November 2018

Aims and objectives

To provide a review of empirical research investigating how compassion is expressed by nurses and received by patients in hospital settings.

Background

Compassion is viewed as an important and fundamental part of a health professional practice. Universally, reports from both media and government agencies have addressed perceived deficits of compassion in healthcare with nurses accused of a lack of compassion. Research into compassion to date has largely focused on the problematic nature of compassion such as burnout, fatigue and other negative personal and work‐related outcomes.

Design

A systematic literature review of empirical research guided by a meta‐ethnographic approach supported the systematic comparison and translation of the included studies. Six online databases were searched from January 2006–December 2016.

Methods

This review was carried out according to the PRISMA‐P reporting guidelines. How compassion in healthcare was defined was extracted alongside findings on how compassion was expressed by nurses and received by patients. Synthesis of the research was completed resulting in new interpretations.

Results

Eleven papers met the inclusion criteria and were included in the review. Multiple differing definitions of compassion in healthcare were applied. Nurses embody and enact compassion through behaviours such as spending time with patients and communicating effectively with patients. Patients experience compassion through a sense of togetherness with nurses.

Conclusion

Existing research demonstrated dissonance between the expression of compassion by nurses and how compassion is experienced by patients. The themes identified in this review should be considered by health professionals providing patient care.

Relevance to clinical practice

Health providers should acknowledge and account for the time that nurses need with patients to demonstrate compassion in practice. Nursing education relating to the expression of compassion should articulate both the subjectivity and ambiguity of the term and examine the relationship between compassion and suffering.
Use of quantitative descriptive analysis (QDA) coupled with multivariate statistical methods to detection and discrimination of adulterated fresh cheeses
Authors: Juárez‐Barrientos José M. , de Montserrat Tejeda‐Paz Marisol , de Jesús Ramírez‐Rivera Emmanuel , Aguirre‐Cruz Andrés , Rodríguez‐Miranda Jesús , Martínez‐Sánchez Cecilia E. , Herman‐Lara Erasmo
Published: November 2018

The most recurrent adulteration of cheeses consists of adding vegetable fat of lower cost than milk fat. Several analytical techniques are used to detect adulteration of cheeses but do not offer sensory perception information. The objective of this study was to detect and discriminate fresh cheeses adulterated with known concentrations of vegetable fat using sensory analysis coupled with multivariate techniques. The panel generated eight attributes through Quantitative Descriptive Analysis. The results showed that the power of discrimination was high (p < .05) in each panelist and panel level in all attributes evaluated. Principal Components Analysis explained the use of average value of the attributes, about 85% of the variability of the cheeses in two main components. Using dendrogram and confidence ellipses, the adulterated cheeses with a concentration of 15 g/L or higher of vegetable fat were identified. The discrimination of adulterated cheeses by this method was 92.5%.

Practical applications

The findings demonstrated the high sensitivity of the sensory panel, which aligned well with analytical statistical techniques for the differentiation and detection of cheeses, which may be applied well to other adulterated food products. The proposed methodology could be implemented in companies, research centers, and associations of producers with economic restrictions that do not allow for sophisticated analytical equipment for the determination of adulterated food products.
Everything is awesome: Don't forget the Lego
Authors: Tagg Andrew , Roland Damian , Leo Grace SY , Knight Katie , Goldstein Henry , Davis Tessa ,   on behalf of Don't Forget The Bubbles
Published: November 2018

Aim

Children frequently ingest coins (generally with minimal reported side effects); however, the ingestion of other items has been subject to less academic study. Parental concern regarding ingestion applies across a range of materials. In this study, we aimed to determine typical transit times for another commonly swallowed object: a Lego figurine head.

Methods

Six paediatric health‐care professionals were recruited to swallow a Lego head. Previous gastrointestinal surgery, inability to ingest foreign objects and aversion to searching through faecal matter were all exclusion criteria. Pre‐ingestion bowel habit was standardised by the Stool Hardness and Transit (SHAT) score. Participants ingested a Lego head, and the time taken for the object to be found in the participants stool was recorded. The primary outcome was the Found and Retrieved Time (FART) score.

Results

The FART score averaged 1.71 days. There was some evidence that females may be more accomplished at searching through their stools than males, but this could not be statistically validated.

Conclusions

A toy object quickly passes through adult subjects with no complications. This will reassure parents, and the authors advocate that no parent should be expected to search through their child's faeces to prove object retrieval.
Effects of Bacillus subtilis C‐3102 on production, hatching performance, egg quality, serum antioxidant capacity and immune response of laying breeders
Authors: Liu Xu , Peng Canyang , Qu Xiangyong , Guo Songchang , Chen Ji Fa , He Changqing , Zhou Xuebin , Zhu Shiwei
Published: November 2018

To investigate the supplemental effects of Bacillus subtilis C‐3102 on the production, hatching performance, egg quality, serum antioxidant capacity and immune response of laying breeders, a total of 480 Xuefeng black‐bone (25‐week‐old) hens were randomly assigned into four treatment groups: Hens fed the basal diets with 0 (CON), 3.0 × 105 (BS‐1), 6.0 × 105 cfu/g (BS‐2) and 9.0 × 105 (BS‐3) cfu/g of B. subtilis C‐3102. As the B. subtilis C‐3102 level increased, egg weight (linear, p < 0.01; quadratic, p = 0.003), fertility (linear, p = 0.021; quadratic, p = 0.059), hatchability (linear, p = 0.038; quadratic, p = 0.119) and yolk colour (linear, p = 0.006; quadratic, p = 0.021) increased in a linear or quadratic manner. Yolk index increased quadratically (linear, p = 0.054; quadratic, p = 0.017), and eggshell thickness (linear, p = 0.036; quadratic, p = 0.128), the activity of GSH‐Px (linear, p = 0.024; quadratic, p = 0.078), the concentration of IgM (linear, p = 0.016; quadratic, p = 0.056) and the level of AIV‐Ab (linear, p = 0.034; quadratic, p = 0.103) in the serum increased linearly as dietary supplementation of B. subtilis C‐3102 increased. The results showed that dietary treatments did not affect egg production, feed conversion ratio, egg mass, hatchability of fertile eggs, eggshell‐breaking strength, egg‐shape index, yolk percentage, Haugh unit, T‐SOD, T‐AOC, MDA, IgA and IgG concentrations and the level of NDV‐Ab in the serum. In conclusion, dietary supplementation of 9.0 × 105 cfu/g B. subtilis C‐3102 in laying breeders diets may be a feasible means of effectively increasing egg weight, fertility and hatchability, and improving egg quality such as eggshell thickness, yolk index and yolk colour. Besides, B. subtilis C‐3102 can enhance the activity of GSH‐Px, the concentration of IgM and the level of AIV‐Ab in the serum.
Total nutrient digestibility and small intestine starch digestion in Nellore and Angus young bulls fed a whole shelled corn diet
Authors: Carvalho José Rodolfo R. , Schoonmaker Jon P. , Chizzotti Mario L. , Teixeira Priscilla D. , Dias Julio Cesar O. , Gionbelli Tathyane R. S. , Rodrigues Aline C. , Costa Suely F. , Ladeira Marcio M.
Published: November 2018

Eighteen Nellore and 18 Angus young bulls with BW of 381 ± 12 kg were randomly assigned into two feeding groups (whole shelled corn [WSC] or ground corn with silage [GC]) to evaluate the interaction of breed and diet on total nutrient digestibility, pancreatic α‐amylase, and maltase activity and SLC5A1expression in the small intestine. Experimental diets (DM basis) included (a) a diet containing 30% corn silage and 70% GC and soya bean meal‐based concentrate and (b) a diet containing 85% WSC and 15% of a soya bean meal‐ and mineral‐based pelleted supplement. The treatments were Nellore fed GC diet; Nellore fed WSC diet; Angus fed GC diet; and Angus fed WSC diet. Total faecal collection for the digestibility trial occurred from day 48 until day 50 of the experimental period. Feeding the WSC diet reduced DM and NDF intake (p < 0.01). Angus had greater DM and nutrient intake in kg/day (p < 0.01). However, there was no breed effect on DM and nutrient intakes based on percentage of BW (p > 0.19). Angus had greater starch digestibility (p = 0.03) than Nellore. Cattle fed the WSC diet had greater DM, NDF and starch digestibility (p < 0.01) compared with those fed the GC diet. The activity of pancreatic α‐amylase (U/g of protein) was greater in Nellore (p < 0.01) and was not affected by diet (p = 0.52). In duodenum, maltase activity (U/g of protein) was greater in bulls fed GC diet (p = 0.02). Expression of the gene SLC5A1was not affected by breed or diet (p > 0.05). In conclusion, Nellore had less capacity to digest starch. However, they did not have less pancreatic α‐amylase and duodenal maltase activity compared to Angus. The use of the WSC diet increases DM and total nutrient digestibility.
Microanatomical changes and biomolecular expression at the PDL‐entheses during experimental tooth movement
Authors: Yang Lynn , Kang Misun , He Rui , Meng Bo , Pal Arvin , Chen Ling , Jheon Andrew H. , Ho Sunita P.
Published: November 2018

The novel aspect of this study was to contextualize the co‐localization of biomolecular expression in widened and narrowed periodontal ligament (PDL)‐space within a mechanically activated periodontal complex. The PDL is unique as it is the only ligament with both innervation and vascularization. Maxillary molars in 6‐week‐old male C57BL/6 mice (N = 5) were experimentally translated for 2 weeks using an elastic spacer. Contralateral teeth were used as controls. Mechanical testing of the periodontal complex of a mouse in situ and imaging using X‐ray micro‐computed tomography (micro‐XCT) illustrated deformations within blood vessels (BV) of the PDL. PDL‐bone and PDL‐cementum entheses at the widened and narrowed PDL‐spaces following experimental tooth movement (ETM) illustrated osterix (OSX), bone sialoprotein (BSP), cluster of differentiation 146 (CD146), and protein gene product 9.5 (PGP9.5), indicating active remodeling at these sites. PGP9.5 positive nerve bundles (NBs) were co‐localized with multinucleated cells (MCs), Howship's resorption lacunae, and CD146 positive BVs. Association between nerves and MC was complemented by visualizing the proximity of osmium tetroxide stained NBs with the ultrastructure of MCs by performing scanning transmission electron microscopy. Spatial association of NB with BV, and NB with MC, provided insights into the plausible co‐activation of NBs to initiate osteoclastic activity. Resorption of mineral occurred as an attempt to restore PDL‐space of the load‐bearing complex, specifically at the PDL‐entheses. Mapping of anatomy‐specific structural elements and their association with regenerative molecules by correlating light and electron micrographs provided insights into the use of these extracellular matrix molecules as plausible targets for pharmacological interventions related to tooth movement. Within the realm of tissue regeneration, modulation of load can reverse naturally occurring mineral formation to experimentally induced resorption, and naturally occurring mineral resorption to experimentally induced formation at the enthesial sites to permit tooth translation.
Impact of work hours and sleep on well‐being and burnout for physicians‐in‐training: the Resident Activity Tracker Evaluation Study
Authors: Mendelsohn Daniel , Despot Ivan , Gooderham Peter A , Singhal Ashtush , Redekop Gary J , Toyota Brian D
Published: November 2018

Objective

The Resident Activity Tracker Evaluation (RATE) is a prospective observational study evaluating the impact of work hours, sleep and physical activity on resident well‐being, burnout and job satisfaction.

Background

Physician burnout is common and its incidence is increasing. The impact of work hours and sleep on resident well‐being and burnout remains elusive. Activity trackers are an innovative tool for measuring sleep and physical activity.

Methods

Residents were recruited from (i) general surgery and orthopaedics (SURG), (ii) internal medicine and neurology (MED) and (iii) anaesthesia and radiology (RCD). Groups 1 and 2 do not enforce restrictions on the duration of being on‐call, and group 3 had restricted the duration of being on‐call to 12 hours. Participants wore FitBit trackers for 14 days. Total hours worked, daily sleep, sleep on‐call and daily steps were recorded. Participants completed validated surveys assessing self‐reported well‐being (Short‐Form Health Survey), burnout (Maslach Burnout Inventory), and satisfaction with medicine.

Results

Surgical residents worked the most hours per week, followed by medical and RCD residents (SURG, 84.3 hours, 95% CI, 80.2–88.5; MED, 69.2 hours, 95% CI, 65.3–73.2; RCD, 52.2 hours, 95% CI, 48.2–56.1; p < 0.001). Surgical residents obtained fewer hours of sleep per day (SURG, 5.9 hours, 95% CI, 5.5–6.3; MED, 6.9 hours, 95% CI, 6.5–7.3; RCD, 6.8 hours, 95% CI, 5.6–7.2; p < 0.001). Nearly two‐thirds of participants (61%) scored high burnout on the Maslach depersonalisation subscore. Total steps per day and well‐being, burnout and job satisfaction were comparable between groups. Total hours worked, daily sleep and steps per day did not predict burnout or well‐being.

Conclusions

Work hours and average daily sleep did not affect burnout. Physical activity did not prevent burnout. Work hour restrictions may lead to increased sleep but may not affect resident burnout or well‐being.
Organization and architecture of AggR‐dependent promoters from enteroaggregative Escherichia coli
Authors: Yasir Muhammad , Icke Christopher , Abdelwahab Radwa , Haycocks James R. , Godfrey Rita E. , Sazinas Pavelas , Pallen Mark J. , Henderson Ian R. , Busby Stephen J. W. , Browning Douglas F.
Published: November 2018

Enteroaggregative Escherichia coli (EAEC), is a diarrhoeagenic human pathogen commonly isolated from patients in both developing and industrialized countries. Pathogenic EAEC strains possess many virulence determinants, which are thought to be involved in causing disease, though, the exact mechanism by which EAEC causes diarrhoea is unclear. Typical EAEC strains possess the transcriptional regulator, AggR, which controls the expression of many virulence determinants, including the attachment adherence fimbriae (AAF) that are necessary for adherence to human gut epithelial cells. Here, using RNA‐sequencing, we have investigated the AggR regulon from EAEC strain 042 and show that AggR regulates the transcription of genes on both the bacterial chromosome and the large virulence plasmid, pAA2. Due to the importance of fimbriae, we focused on the two AAF/II fimbrial gene clusters in EAEC 042 (afaB‐aafCB and aafDA) and identified the promoter elements and AggR‐binding sites required for fimbrial expression. In addition, we examined the organization of the fimbrial operon promoters from other important EAEC strains to understand the rules of AggR‐dependent activation. Finally, we generated a series of semi‐synthetic promoters to define the minimal sequence required for AggR‐mediated activation and show that the correct positioning of a single AggR‐binding site is sufficient to confer AggR‐dependence.
Sequential regiospecific gem‐diprenylation of tetrahydroxyxanthone by prenyltransferases from Hypericum sp.
Authors: Nagia Mohamed , Gaid Mariam , Biedermann Eline , Fiesel Tobias , El‐Awaad Islam , Hänsch Robert , Wittstock Ute , Beerhues Ludger
Published: November 2018

Polyprenylated acylphloroglucinol derivatives, such as xanthones, are natural plant products with interesting pharmacological properties. They are difficult to synthesize chemically. Biotechnological production is desirable but it requires an understanding of the biosynthetic pathways.

cDNAs encoding membrane‐bound aromatic prenyltransferase (aPT) enzymes from Hypericum sampsonii seedlings (HsPT8px and HsPTpat) and Hypericum calycinum cell cultures (HcPT8px and HcPTpat) were cloned and expressed in Saccharomyces cerevisiae and Nicotiana benthamiana, respectively. Microsomes and chloroplasts were used for functional analysis.

The enzymes catalyzed the prenylation of 1,3,6,7‐tetrahydroxyxanthone (1367THX) and/or 1,3,6,7‐tetrahydroxy‐8‐prenylxanthone (8PX) and discriminated nine additionally tested acylphloroglucinol derivatives. The transient expression of the two aPT genes preceded the accumulation of the products in elicitor‐treated H. calycinum cell cultures. C‐terminal yellow fluorescent protein fusions of the two enzymes were localized to the envelope of chloroplasts in N. benthamiana leaves.

Based on the kinetic properties of HsPT8px and HsPTpat, the enzymes catalyze sequential rather than parallel addition of two prenyl groups to the carbon atom 8 of 1367THX, yielding gem‐diprenylated patulone under loss of aromaticity of the gem‐dialkylated ring. Coexpression in yeast significantly increased product formation. The patulone biosynthetic pathway involves multiple subcellular compartments. The aPTs studied here and related enzymes may be promising tools for plant/microbe metabolic pathway engineering.