bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of life among Malaysian mothers with a child with Down syndrome
Authors: Geok Chan Kim , Abdullah Khatijah Lim , Kee Ling How
Published: May 2013

The purpose of this paper is to examine the quality of life (QOL) among mothers with a child with Down syndrome using The World Health Organization Quality of Life scale instrument. A convenience sample of 161 mothers was accessed through the various institutions which provide interventional or educational programmes to children with disabilities within two of the regions of the Borneo State of Malaysia (Sarawak). Nearly half of the group of mothers perceived their QOL as neither poor nor good (n = 73). An overall QOL score of 14.0 ± 1.84 was obtained. The highest and lowest domain scores were found for social relationship domain (Mean = 14.9 ± 2.1) and environmental support domain (Mean = 13.3 ± 2.1) respectively. Correlation analysis of selected background variables (i.e. locality, education, income and marital status) and overall QOL indicated rho (161) = 0.22–0.28 (P < 0.01). Inverse correlation between maternal age and overall QOL score was indicated, with rho (161) = −0.17 (P < 0.05). Linear regression analysis indicated that the combination of these few variables together accounted for 14.5% of the QOL variability in the sample. Findings point to implications for priorities of care provisions by policy‐makers and care professionals in their practice.
Disclosure challenges among people living with HIV in Thailand
Authors: Lee Sung‐Jae , Li Li , Iamsirithaworn Sopon , Khumtong Siwaporn
Published: May 2013

One of the main challenges facing people living with HIV (PLH) in Thailand is HIV disclosure. The goal of this study was to examine HIV disclosure barriers and motivators in Northeastern Thailand. Focus groups were conducted with 40 PLH to explore the barriers and motivators. To confirm the themes identified in the focus groups, face‐face interviews were conducted with 50 PLH. Focus group findings revealed barriers to HIV disclosure in three domains: perceived stigma, shame and fear of rejection. Motivators to HIV disclosure consisted of the following: coping with illness, seeking help and common experiences. Findings from the face‐to‐face interviews included the following barriers: fear of privacy breach, fear of rejection and communication difficulties. The motivators to HIV disclosure included seeking supportive relationship, duty to inform and catharsis. Based on these findings, we are currently developing family‐focused HIV disclosure intervention in Northeastern Thailand.
Anthropometric indicators of obesity as screening tools for high blood pressure in the elderly
Authors: Leal Neto João de Souza , Coqueiro Raildo da Silva , Freitas Roberta Souza , Fernandes Marcos Henrique , Oliveira Daniela Sousa , Barbosa Aline Rodrigues
Published: May 2013

The study objectives were to investigate the indicators of obesity most associated with high blood pressure in community‐dwelling elderly and identify among these which one best discriminates high blood pressure. This is an epidemiological, population, cross‐sectional and home‐based study of elderly people (≥ 60 years, n = 316) residing in northeastern Brazil. The results showed that the body mass index and the body adiposity index were the indicators more closely associated with high blood pressure in both sexes. Both in female and male genders, body mass index showed high values of specificity and low sensitivity values for discriminating high blood pressure, whereas the body adiposity index showed high sensitivity and moderate specificity values. In clinical practice and health surveillance, it is suggested that both indicators be used as screening tools for hypertension in the elderly.
The double embarrassment: Understanding the actions of nursing staff in an unexpected situation
Authors: Sandvoll Anne Marie , Kristoffersen Kjell , Hauge Solveig
Published: May 2013

A nursing home is a complex multifactorial environment that influences the decisions and actions of nursing staff. Many of the actions performed by nursing staff appear to be straightforward or simple because they are repetitive, encompassing everyday activities such as helping a resident to get up in the morning, shower or get dressed. These daily activities are usually performed smoothly as part of normal care. This article draws on ethnographic data from a study of caring practices in a nursing home with the aim of investigating how a seemingly ordinary, but unexpected, event can develop into a chaotic situation. Staff appeared to have difficulty managing the situation, and they seemed to be disorganized in the application of their skills. First, we describe the situation in detail before investigating and discussing the situation to provide a deeper understanding of the complexity of nursing home practice.
Evaluation and validation of the Core Lower Urinary Tract Symptom Score as an outcome assessment tool for the treatment of benign prostatic hyperplasia: Effects of the α1‐adrenoreceptor antagonist silodosin
Authors: Ito Hiroki , Sano Futoshi , Ogawa Takehiko , Yao Masahiro
Published: May 2013

We investigated the Core Lower Urinary Tract Symptom Score as an outcome assessment tool for the treatment of lower urinary tract symptoms using silodosin. In addition, the ability of the Core Lower Urinary Tract Symptom Score to detect overactive bladder in male patients with lower urinary tract symptoms was examined. The present study included 241 males with benign prostatic hyperplasia treated at 31 medical facilities between June 2009 and December 2010. All patients were given silodosin, and the effects of silodosin intake were measured using four questionnaires: the Core Lower Urinary Tract Symptom Score, International Prostate Symptom Score, Overactive Bladder Symptom Score and Quality‐of‐Life index. The efficacy of silodosin for treating lower urinary tract symptoms was validated according to the total scores of all four questionnaires weighted equally (P < 0.05). Spearman's ρ among the Core Lower Urinary Tract Symptom Score, International Prostate Symptom Score and Overactive Bladder Symptom Score showed a mild‐high correlation. However, the correlation between the baseline values of the Core Lower Urinary Tract Symptom Score and Quality‐of‐Life index was low in the groups with benign prostatic hyperplasia (ρ = 0.314) and benign prostatic hyperplasia/overactive bladder (ρ = 0.244). Our findings showed the Core Lower Urinary Tract Symptom Score, both its total score and each subscore, is able to show the efficacy of silodosin, similar to other questionnaires. The Core Lower Urinary Tract Symptom Score is also useful for identifying overactive bladder symptoms in patients with benign prostatic hyperplasia. As the Core Lower Urinary Tract Symptom Score does not correlate well with the Quality‐of‐Life index, these two questionnaires might be better used in combination to assess treatment outcomes.
Acute infection of mice with Clostridium difficile leads to eIF2α phosphorylation and pro‐survival signalling as part of the mucosal inflammatory response
Authors: Sadighi Akha Amir A. , Theriot Casey M. , Erb‐Downward John R. , McDermott Andrew J. , Falkowski Nicole R. , Tyra Heather M. , Rutkowski D. Thomas , Young Vincent B. , Huffnagle Gary B.
Published: May 2013

The current study sought to delineate the gene expression profile of the host response in the caecum and colon during acute infection with Clostridium difficile in a mouse model of infection, and to investigate the nature of the unfolded protein response in this process. The infected mice displayed a significant up‐regulation in the expression of chemokines (Cxcl1, Cxcl2 and Ccl2), numerous pro‐inflammatory cytokines (Ifng, Il1b, Il6, and Il17f), as well as Il22 and a number of anti‐microbial peptides (Defa1, Defa28, Defb1, Slpi and Reg3g) at the site(s) of infection. This was accompanied by a significant influx of neutrophils, dendritic cells, cells of the monocyte/macrophage lineage and all major subsets of lymphocytes to these site(s). However, CD4 T cells of the untreated and C. difficile‐infected mice expressed similar levels of CD69 and CD25. Neither tissue had up‐regulated levels of Tbx21, Gata3 or Rorc. The caeca and colons of the infected mice showed a significant increase in eukaryotic initiation factor 2α (eIF2α) phosphorylation, but neither the splicing of Xbp1 nor the up‐regulation of endoplasmic reticulum chaperones, casting doubt on the full‐fledged induction of the unfolded protein response by C. difficile. They also displayed significantly higher phosphorylation of AKT and signal transducer and activator of transcription 3 (STAT3), an indication of pro‐survival signalling. These data underscore the local, innate, pro‐inflammatory nature of the response to C. difficile and highlight eIF2α phosphorylation and the interleukin‐22–pSTAT3–RegIIIγ axis as two of the pathways that could be used to contain and counteract the damage inflicted on the intestinal epithelium.
Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents
Authors: Blomqvist Ylva Thernström , Frölund Lovisa , Rubertsson Christine , Nyqvist Kerstin Hedberg
Published: May 2013

Scand J Caring Sci; 2013; 27; 345–353

Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents

Background:  Kangaroo Mother Care (KMC) supports parents’ role at the neonatal intensive care unit (NICU). To enhance parents’ provision of KMC, it is essential to obtain knowledge of what parents perceive as supportive factors and barriers regarding their opportunities to perform KMC.

Aim:  To identify factors that parents of preterm infants perceived as supportive factors or barriers for their performance of KMC and to explore the timing of and reasons for parents’ discontinuation of KMC.

Methods:  A descriptive study performed at two NICUs in Sweden with 76 mothers and 74 fathers of preterm infants born at gestational ages ranging from 28 to 33 weeks. Data on infant characteristics were obtained from the infants’ medical records. A questionnaire, based on scientific literature and the researchers’ clinical experience, was completed by the mothers and the fathers separately, shortly after the infant’s discharge from the hospital. The data were analyzed with qualitative content analysis and descriptive statistic.

Results:  Four categories were identified in parents’ responses regarding support and barriers for their performance of KMC: Parent related factors, Time, Infants related factors and The NICU and home environment. The hospital staff and environment were described by the parents as both supportive and barriers for their application of KMC. Some mothers described the infants’ feeding process as an obstacle to KMC. Sleeping with the infant skin‐to‐skin in the same position throughout the night could be difficult, as an uncomfortable sleeping position caused insufficient sleep. A majority of both mothers and fathers continued providing their infant with KMC to some extent after discharge.

Conclusion:  Interventions for enhancing parents’ opportunities for performing KMC should address both hospital staff attitudes and practices and the NICU environment.
Nanocomposites of Surface‐Modified BaTiO3 Nanoparticles Filled Ferroelectric Polymer with Enhanced Energy Density
Authors: Yu Ke , Niu Yujuan , Zhou Yongcun , Bai Yuanyuan , Wang Hong
Published: May 2013

We report nanocomposites of increased dielectric permittivity, enhanced electric breakdown strength and high‐energy density based on surface‐modified BaTiO3 (BT) nanoparticles filled poly(vinylidene fluoride) polymer. Polyvinylprrolidone (PVP) is used as the surface modification agent and homogeneous nanocomposite films have been prepared by solution casting processing. The dielectric permittivity of the nanocomposite with treated BT is higher than those with untreated BT and reaches the maximum value of 77 (1 kHz) at BT concentration of 55 vol%. The electric breakdown strength of the nanocomposite is greatly enhanced to 336 MV/m at BT concentration of 10 vol% and the calculated energy density is 6.8 J/cm3. The results indicate that using PVP as surface modification agent can greatly enhance the dielectric permittivity and electric breakdown strength of the ceramic–polymer nanocomposite and achieve high‐energy density for energy storage and power capacitor applications.
Multi‐Decadal Remote‐Sensing Analysis of Irrigated Areas in the Lower Rio Grande Valley, New Mexico
Authors: Jordan David L. , Barroll Peggy
Published: May 2013

A time series of estimates of irrigated area was developed for the Lower Rio Grande valley (LRG) in New Mexico from the 1970s to present day. The objective of the project was to develop an independent, accurate, and scientifically justifiable evaluation of irrigated area in the region for the period spanning from the mid‐1970s to the present. These area estimates were used in support of groundwater modeling of the LRG region, as well as for other analyses. This study used a remote‐sensing‐based methodology to evaluate overall irrigated area within the LRG. We applied a methodology that involved the normalization of vegetation indices derived from satellite imagery to get a more accurate estimation of irrigated area across multiple time periods and multiple Landsat platforms. The normalization allows more accurate evaluation of vegetation index data that span several decades. An accuracy assessment of the methodology and results from this study was performed using field‐collected crop data from the 2008 growing season. The comparisons with field data indicate that the accuracy of the remote‐sensing‐based estimates of historical irrigated area is very good, with rates of false positives (areas identified as irrigated that are not truly irrigated) of only about 4%, and rates of false negatives (areas identified as not irrigated that are truly irrigated) in the range of 0.6‐2.0%.
Assessing Calibration Uncertainty and Automation for Estimating Evapotranspiration from Agricultural Areas Using METRIC
Authors: Morton Charles G. , Huntington Justin L. , Pohll Greg M. , Allen Richard G. , McGwire Kenneth C. , Bassett Scott D.
Published: May 2013

Agricultural irrigation accounts for a large fraction of the total water use in the western United States. The Mapping Evapotranspiration at high Resolution with Internalized Calibration (METRIC) remote sensing energy balance model is being used to estimate historical agricultural water use in western Nevada to evaluate basin‐wide water budgets. Each METRIC evapotranspiration (ET) estimate must be calibrated by a trained user, which requires some iterative time investment and results in variation in ET estimates between users. An automated calibration algorithm for the METRIC model was designed to generate ET estimates comparable to those from trained users by mimicking the manual calibration process. Automated calibration allows for rapid generation of METRIC ET estimates with minimal manual intervention, as well as uncertainty and sensitivity analysis of the model. The variation in ET estimates generated by the automated calibration algorithm was found to be similar to the variation in manual ET estimates. Results indicate that uncertainty was highest for fields with low ET levels and lowest for fields with high ET levels, with a seasonal mean uncertainty of approximately 5% for all fields. In addition, in a blind comparison, automated daily and seasonal ET estimates compared well with flux tower measurement ET data at multiple sites. Automated methods can generate first‐order ET estimates that are similar to time intensive manual efforts with less time investment.
Operational Evapotranspiration Mapping Using Remote Sensing and Weather Datasets: A New Parameterization for the SSEB Approach
Authors: Senay Gabriel B. , Bohms Stefanie , Singh Ramesh K. , Gowda Prasanna H. , Velpuri Naga M. , Alemu Henok , Verdin James P.
Published: May 2013

The increasing availability of multi‐scale remotely sensed data and global weather datasets is allowing the estimation of evapotranspiration (ET) at multiple scales. We present a simple but robust method that uses remotely sensed thermal data and model‐assimilated weather fields to produce ET for the contiguous United States (CONUS) at monthly and seasonal time scales. The method is based on the Simplified Surface Energy Balance (SSEB) model, which is now parameterized for operational applications, renamed as SSEBop. The innovative aspect of the SSEBop is that it uses predefined boundary conditions that are unique to each pixel for the “hot” and “cold” reference conditions. The SSEBop model was used for computing ET for 12 years (2000‐2011) using the MODIS and Global Data Assimilation System (GDAS) data streams. SSEBop ET results compared reasonably well with monthly eddy covariance ET data explaining 64% of the observed variability across diverse ecosystems in the CONUS during 2005. Twelve annual ET anomalies (2000‐2011) depicted the spatial extent and severity of the commonly known drought years in the CONUS. More research is required to improve the representation of the predefined boundary conditions in complex terrain at small spatial scales. SSEBop model was found to be a promising approach to conduct water use studies in the CONUS, with a similar opportunity in other parts of the world. The approach can also be applied with other thermal sensors such as Landsat.
Collaborative Modeling for Decision Support in Water Resources: Principles and Best Practices
Authors: Langsdale Stacy , Beall Allyson , Bourget Elizabeth , Hagen Erik , Kudlas Scott , Palmer Richard , Tate Diane , Werick William
Published: May 2013

Collaborative Modeling for Decision Support integrates collaborative modeling with participatory processes to inform natural resources decisions. Practitioners and advocates claim that the approach will lead to better water management, balancing interests more effectively and reducing the likelihood of costly legal delays. These claims are easy to make, but the benefits will only be realized if the process is conducted effectively. To provide guidance for how to conduct an effective collaborative modeling process, a task committee cosponsored by the Environmental Water Resources Institute (EWRI) of the American Society of Civil Engineers and by the U.S. Army Corps of Engineers' Institute for Water Resources developed a set of Principles and Best Practices for anyone who might convene or conduct collaborative modeling processes. The guidance is intended for both conflict resolution professionals and modelers, and our goal is to integrate these two fields in a way that will improve water resources planning and decision making. Here, the set of eight principles is presented along with a selection of associated best practices, illustrated by two different case examples. The complete document is available at: http://www.computeraideddisputeresolution.us/bestpractices/.
Identifying individual psychosocial and adherence support needs in patients with psoriasis: a multinational two‐stage qualitative and quantitative study
Authors: Bewley A. , Burrage D. M. , Ersser S. J. , Hansen M. , Ward C.
Published: May 2013

Background

Psoriasis has a serious impact on patients' lives. However, adherence to medications is often poor, potentially compounding the burden of disease. Identifying patients who need support with psychosocial problems, or issues with adherence, can be complex.

Objectives

We aimed to develop statements that could assist the consultation process, identifying the relative importance of factors related to effective management of psoriasis for patients.

Methods

A two‐stage study design was used to comprehensively identify, and assess validity of, statements describing psoriasis impact and management issues. Both components were conducted in Canada, France, Germany, Italy, Spain, the United Kingdom and the United States. Findings from patient observation and interviews were analysed for pattern strength, and were then used to inform the development of statements that were quantitatively assessed using a survey. The association of drivers towards agreement with ‘my psoriasis dictates how I lead my life’ was assessed using anova.

Results

Fifty‐six patients participated in the qualitative component, and 1,884 patients using prescription medications completed the survey. Two thematic categories were identified; disappointment with treatments, and confusion regarding psoriasis associated with a lack of direction. When assessed quantitatively, key statements associated with a strong burden of psoriasis on patients' lives were related to isolation, social stigma, visible symptoms, impact on activities and feelings of hopelessness. A mixture of patient‐, doctor‐ and treatment‐related factors were among the most common reasons for non‐adherence.

Conclusion

Questioning using the statements most associated with psychosocial impact and non‐adherence could help identify patients with additional support needs, and assist in overcoming adherence issues.
A one‐locus model of androdioecy with two homomorphic self‐incompatibility groups: expected vs. observed male frequencies
Authors: Husse L. , Billiard S. , Lepart J. , Vernet P. , Saumitou‐Laprade P.
Published: May 2013

Androdioecy, the occurrence of males and hermaphrodites in a single population, is a rare breeding system because the conditions for maintenance of males are restrictive. In the androdioecious shrub Phillyrea angustifolia, high male frequencies are observed in some populations. The species has a sporophytic self‐incompatibility (SI) system with two self‐incompatibility groups, which ensures that two groups of hermaphrodites can each mate only with the other group, whereas males can fertilize hermaphrodites of both groups. Here, we analyse a population genetic model to investigate the dynamics of such an androdioecious species, assuming that self‐incompatibility and sex phenotypes are determined by a single locus. Our model confirms a previous prediction that a slight reproductive advantage of males relative to hermaphrodites allows the maintenance of males at high equilibrium frequencies. The model predicts different equilibria between hermaphrodites of the two SI groups and males, depending on the male advantage, the initial composition of the population and the population size, whose effect is studied through stochastic simulations. Although the model can generate high male frequencies, observed frequencies are considerably higher than the model predicts. We finally discuss how this model may help explain the large male frequency variation observed in other androdioecious species of Oleaceae: some species show only androdioecious populations, as P. angustifolia, whereas others show populations either completely hermaphrodite or androdioecious.
Why care? Inferring the evolution of complex social behaviour
Authors: Székely T. , Remeš V. , Freckleton R. P. , Liker A.
Published: May 2013

Phylogenetic comparative analyses of complex traits often reduce the traits of interests into a single (or a few) component variables. Here, we show that this may be an over‐simplification, because components of a complex trait may evolve independently from each other. Using eight components of parental care in 400 bird species from 89 avian families that represent the relative contribution of male vs. female to a particular type of care, we show that some components evolve in a highly correlated manner, whereas others exhibit low (or no) phylogenetic correlation. Correlations were stronger within types of parental activity (brooding, feeding, guarding) than within stages of the breeding cycle (incubation, prefledging care, post‐fledging care). A phylogenetically corrected cluster analysis identified two groups of parental care components that evolved in a correlated fashion: one group included incubation and brooding, whereas the other group comprised of the remaining components. The two groups of components provide working hypotheses for follow‐up studies to test the underlying genetic, developmental and ecological co‐evolutionary mechanism between male and female care. Furthermore, the components within each group are expected to respond consistently to different ambient and social environments.
Identification of a uniquely southern African clade of coastal pipefishes Syngnathus spp
Authors: Mwale M. , Kaiser H. , Barker N. P. , Wilson A. B. , Teske P. R.
Published: May 2013

The taxonomic status of two southern African coastal pipefish species, Syngnathus temminckii and Syngnathus watermeyeri, was investigated using a combination of morphological and genetic data. Morphological data showed that S. temminckii is distinct from the broadly distributed European pipefish Syngnathus acus, and a molecular phylogeny reconstructed using mitochondrial DNA recovered S. temminckii and S. watermeyeri as sister taxa. The southern African species share an evolutionary origin with north‐eastern Atlantic Ocean and Mediterranean Sea species, including S. acus. These data support the existence of a distinct southern African clade of Syngnathus pipefishes that has diverged in situ to form the two species present in the region today.
Vertical and horizontal distributions of coral‐reef fish larvae in open water immediately prior to reef colonization
Authors: Lecchini D. , Waqalevu V. P. , Holles S. , Lerohellec M. , Brie C. , Simpson S. D.
Published: May 2013

To explore the vertical and horizontal distributions of fish larvae near the end of their pelagic period, six light traps were set up over four lunar months at different depths (sub‐surface, midwater and bottom) and different habitat types (reef slope: 50 m horizontal distance from the reef crest; frontier zone: 110 m horizontal distance; sandy zone: 200 m horizontal distance) on the outer reef slope of Moorea Island, French Polynesia. The highest captures were in sub‐surface traps on the reef slope and the frontier zone, and in bottom traps on the sandy zone and the frontier zone. It is hypothesized that fish larvae move towards the surface near the reef slope to avoid reef‐based planktivores and to get into a favourable position for surfing over the reef crest.
Effects of sampling techniques on population assessment of invasive round goby Neogobiusmelanostomus
Authors: Brandner J. , Pander J. , Mueller M. , Cerwenka A. F. , Geist J.
Published: May 2013

In this study, a comparison of point abundance sampling (PAS) electrofishing, angling with two different hook sizes and trap‐based fishing was performed in a non‐wadeable river to analyse their effects on catch per unit effort (CPUE) and population characteristics of invasive round goby Neogobius melanostomus. PAS electrofishing was identified as the most effective (mean ± s.e. CPUE = 57 ± 4 N. melanostomus min−1) and least selective method in terms of size, feeding status and species composition. Angling had the second highest CPUE, but was more size selective and resulted in a higher proportion of males compared to electrofishing [overall sex ratio angling (female:male) = 1:0·92, electrofishing 1:0·65]. Owing to low CPUE (0·012 ± 0·004) and low frequency of occurrence, minnow traps were least suitable for N. melanostomus population assessment. The results of this study suggest that a higher degree of standardization and inter‐calibration is useful to achieve better comparability of population data of invasive N. melanostomus and other benthic fish species.
Aggregate Risk and the Choice between Cash and Lines of Credit
Authors: ACHARYA VIRAL V. , ALMEIDA HEITOR , CAMPELLO MURILLO
Published: May 2013

Banks can create liquidity for firms by pooling their idiosyncratic risks. As a result, bank lines of credit to firms with greater aggregate risk should be costlier and such firms opt for cash in spite of the incurred liquidity premium. We find empirical support for this novel theoretical insight. Firms with higher beta have a higher ratio of cash to credit lines and face greater costs on their lines. In times of heightened aggregate volatility, banks exposed to undrawn credit lines become riskier; bank credit lines feature fewer initiations, higher spreads, and shorter maturity; and, firms’ cash reserves rise.
Central granular cell odontogenic tumor: a systematic review
Authors: Sarode Sachin C. , Sarode Gargi S. , Vaidya Kedar
Published: May 2013

Central granular cell odontogenic tumor (CGCOT) is a rare benign odontogenic neoplasm reported with various terms and is not included in the 2005 WHO classification of odontogenic tumors. It shows a predilection for middle‐aged women, usually presenting as an asymptomatic swelling of the mandibular premolar–molar region. Radiographic manifestations include unilocular or multilocular radiolucent lesion, but mixed density lesions can also occur. Histopathology shows sheets and lobules of round to polygonal cells with abundant eosinophilic, granular cytoplasm and eccentrically placed nuclei. Immunohistochemical and ultrastructural features suggest the histiocytic origin of granular cells. The neoplasm does not exhibit an aggressive biological behavior and hence enucleation or curettage ensuring complete removal remains the treatment of choice. We present a systematic review on clinical, radiological, histopathological, immunohistochemical and treatment aspect of CGCOT. Published articles were identified through a literature search using online databases (PubMed, MEDLINE, Scopus) and cross‐references for papers published from the year 1950 to March 2013. From a total of 37 papers, 26 (38 cases) were extracted from the database for systematic review.
The ex utero intrapartum treatment (EXIT) procedure: Application of a new therapeutic paradigm
Authors: Taghavi Kiarash , Beasley Spencer
Published: May 2013

The ex utero intrapartum treatment (EXIT) procedure is a term given to a technique that can transform a potentially fatal neonatal emergency to a controlled intervention with an improved outcome. It has revolutionised the care of prenatally diagnosed congenital malformations in which severe upper airway obstruction is anticipated. An extended period of utero‐placental circulation can be utilised to avoid profound cardiopulmonary compromise. Its therapeutic applications have been broadened to include fetuses with congenital diaphragmatic hernia after tracheal plugging, high‐risk intrathoracic masses, severe cardiac malformations and conjoined twins. It requires the co‐ordination of a highly skilled and experienced multidisciplinary team. The recent enthusiasm for the EXIT procedure needs to be balanced against maternal morbidity. Specific indications and guidelines are likely to be refined as a consequence of ongoing advances in fetal intervention and antenatal imaging.
Prophylactic anticoagulation for venous thromboembolism in hospitalized cirrhosis patients is not associated with high rates of gastrointestinal bleeding
Authors: Intagliata Nicolas M. , Henry Zachary H. , Shah Neeral , Lisman Ton , Caldwell Stephen H. , Northup Patrick G.
Published: May 2013

Background

Hospitalized patients with cirrhosis are at risk to develop venous thromboembolism. Although current guidelines support the routine administration of thromboprophylaxis to hospitalized patients, there is limited data regarding the safety or efficacy of this practice in hospitalized cirrhosis patients.

Aims

We aimed to determine if administration of thromboprophylaxis was associated with increased complication rates for hospitalized cirrhosis patients.

Methods

Data were collected on patients admitted to the University of Virginia between 2007 and 2010. Study personnel systematically collected data on complications, including gastrointestinal bleed, venous thromboembolism and death directly from the medical record.

Results

A total of 235 patients (accounting for 355 discrete hospitalizations in which thromboprophylaxis was administered) met inclusion criteria accounting for 1660 person‐days of thromboprophylaxis administered to patients. The mean age at admission was 58 (95% CI 57.1–59.2) years and 217 (61%) were male patients. The mean admission model for end‐stage liver disease (MELD) score was 16.2 (95% CI 15.5–16.9). The mean hospital length of stay was 6.5 (95% CI 5.9–7.4) days. In patients who received thromboprophylaxis, the mean treatment length was 4.7 days (95% CI 4.2–5.2). There were nine gastrointestinal bleeding events (2.5% of admissions), five venous thromboembolisms (1.4% of admissions), two cases of heparin‐induced thrombocytopenia (0.5% of admissions) and 14 deaths overall (3.9% of admissions).

Conclusions

The use of thromboprophylaxis in hospitalized cirrhosis patients is not associated with high rates of gastrointestinal bleeding or death.
Metacognitions, worry and attentional control in predicting OSCE performance test anxiety
Authors: O’Carroll Pierce J , Fisher Peter
Published: May 2013

Objectives  This study investigated the applicability of the self‐regulatory executive functioning (S‐REF) model to performance test anxiety (PTA) in objective structured clinical examinations (OSCEs). Specifically, it examined the relative contributions of metacognitive beliefs, trait worry and attentional control to PTA.

Methods  A cross‐sectional design was used. Immediately prior to their formative Communication for Clinical Practice OSCE, 240 Year 1 medical students completed the following self‐report questionnaires: the Metacognitions Questionnaire‐30 (MCQ‐30); the Penn State Worry Questionnaire (PSWQ); the Attentional Control Scale (ACS), and the Performance Test Anxiety questionnaire (PTA).

Results  Univariate analysis indicated that female students scored significantly more highly than male students on the MCQ‐30 subscale for negative beliefs about the uncontrollability and danger of worry, the MCQ‐30 subscale for cognitive confidence and the PSWQ subscale for trait worry. Partial correlations (controlling for gender) showed that metacognitions, worry and attentional control were significantly correlated with PTA. Multiple regression analyses showed that worry and negative beliefs about the uncontrollability and danger of worry were independent predictors of PTA in both male and female students, whereas attention focus was an independent predictor only in male students.

Conclusions  The findings support predictions derived from the S‐REF model that metacognitive beliefs, trait worry and attentional control processes underlie the onset and maintenance of PTA.
The availability of purine nucleotides regulates natural competence by controlling translation of the competence activator Sxy
Authors: Sinha Sunita , Mell Joshua , Redfield Rosemary
Published: May 2013

Many bacteria are naturally competent, able to bind and take up DNA from their extracellular environment. This DNA can serve as a significant source of nutrients, in addition to providing genetic material for recombination. The regulation of competence in several model organisms highlights the importance of this nutritional function, although it has often been overlooked. Natural competence is induced by starvation in Haemophilus influenzae, the model for competence regulation in the gamma‐proteobacteria. This induction depends on the activation of the global metabolic regulator CRP, which occurs upon depletion of phosphotransferase sugars. In this work, we show that the depletion of purine nucleotides under competence‐inducing conditions activates the CRP‐dependent competence‐specific regulator Sxy. Depletion of extra‐ or intra‐cellular purine nucleotides activates Sxy translation, while high levels inhibit it. This is modulated by the stem structure formed by sxy mRNA. The exact mechanism by which the nucleotide depletion signal is transduced is unclear, but it does not involve direct binding of purine intermediates to the sxy stem, and does not require Hfq or competence proteins. Similar regulation occurs in the relatives of H. influenzae, Actinobacillus pneumoniae and A. suis, confirming the importance of processes enabling competent bacteria to exploit the abundant DNA in their environments.
Compassion fatigue and satisfaction: A cross‐sectional survey among US healthcare workers
Authors: Smart Denise , English Ashley , James Jennifer , Wilson Marian , Daratha Kenn B. , Childers Belinda , Magera Chris
Published: May 2013

Professional quality of life among healthcare providers can impact the quality and safety of patient care. The purpose of this research was to investigate compassion satisfaction and compassion fatigue levels as measured by the Professional Quality of Life Scale self‐report instrument in a community hospital in the United States. A cross‐sectional survey study examined differences among 139 RNs, physicians, and nursing assistants. Relationships among individual and organizational variables were explored. Caregivers for critical patients scored significantly lower on the Professional Quality of Life subscale of burnout when compared with those working in a noncritical care unit. Linear regression results indicate that high sleep levels and employment in critical care areas are associated with less burnout. Identification of predictors can be used to design interventions that address modifiable risks.
Harnessing the beneficial properties of adipogenic microbes for improving human health
Authors: Dhurandhar N. V. , Geurts L. , Atkinson R. L. , Casteilla L. , Clement K. , Gerard P. , Vijay‐Kumar M. , Nam J. H. , Nieuwdorp M. , Trovato G. , Sørensen T. I. A. , Vidal‐Puig A. , Cani P. D.
Published: May 2013

Obesity is associated with numerous metabolic comorbidities. Weight loss is an effective measure for alleviating many of these metabolic abnormalities. However, considering the limited success of most medical weight‐management approaches in producing a sustained weight loss, approaches that improve obesity‐related metabolic abnormalities independent of weight loss would be extremely attractive and of practical benefit. Metabolically healthy obesity supports the notion that a better metabolic profile is possible despite obesity. Moreover, adequate expansion of adipose tissue appears to confer protection from obesity‐induced metabolic comorbidities. To this end, the 10th Stock conference examined new approaches to improve metabolic comorbidities independent of weight loss. In particular, human adenovirus 36 (Ad36) and specific gut microbes were examined for their potential to influence lipid and glucose homeostasis in animals and humans. While these microbes possess some undesirable properties, research has identified attributes of adenovirus Ad36 and gut microbes that may be selectively harnessed to improve metabolic profile without the obligatory weight loss. Furthermore, identifying the host signalling pathways that these microbes recruit to improve the metabolic profile may offer new templates and targets, which may facilitate the development of novel treatment strategies for obesity‐related metabolic conditions.
Myopia and international educational performance
Authors: Morgan Ian G , Rose Kathryn A
Published: May 2013

Purpose

To analyse the relationship between myopia, educational performance and engagement in after‐school tutorial classes.

Methods

Educational performance data and data on engagement in after‐school tutorial classes were taken from the results of theOrganisation forEconomicCooperation andDevelopment (OECD)Program inSecondaryAssessment (PISA) reports for 2009, which tested educational outcomes in representative samples of 15 year‐old school children from 65 jurisdictions. High prevalence of myopia (>70%) and low prevalence of myopia (<40%) locations were identified by systematic literature search.

Results

Six locations with a high prevalence of myopia were identified from among the participants inPISA2009 –Shanghai‐China,HongKong‐China,Taiwan,Singapore,Japan andSouthKorea. All were ranked in the top quartile on educational performance. Other participants in the top educational performance quartile were identified as locations with a low prevalence of myopia, includingAustralia andFinland. The locations with a high prevalence of myopia combined high educational performance and high engagement in after‐school tutorials, whereas the locations with a low prevalence of myopia combined high educational performance with little engagement in tutorials.

Discussion

These results show that it is possible to achieve high educational outcomes without extensive engagement in after‐school tutorials, and that the combination of high educational outcomes with extensive use of tutorials is associated with high prevalence rates of myopia. We suggest that extensive use of after‐school tutorials may be a marker of educational environments which impose high educational loads. Further quantification of educational loads to include after‐ school educational activities, such as homework, tutorials and other after‐school classes, as well as formal school classes, is desirable. Policy initiatives to decrease these loads may contribute to the prevention of myopia, perhaps, at least in part, by enabling children to spend more time outdoors.
The role of luminance and chromatic cues in emmetropisation
Authors: Rucker Frances J
Published: May 2013

Purpose

At birth most, but not all eyes, are hyperopic. Over the course of the first few years of life the refraction gradually becomes close to zero through a process called emmetropisation. This process is not thought to require accommodation, though a lag of accommodation has been implicated in myopia development, suggesting that the accuracy of accommodation is an important factor. This review will cover research on accommodation and emmetropisation that relates to the ability of the eye to use colour and luminance cues to guide the responses.

Recent Findings

There are three ways in which changes in luminance and colour contrast could provide cues: (1) The eye could maximize luminance contrast. Monochromatic light experiments have shown that the human eye can accommodate and animal eyes can emmetropise using changes in luminance contrast alone. However, by reducing the effectiveness of luminance cues in monochromatic and white light by introducing astigmatism, or by reducing light intensity, investigators have revealed that the eye also uses colour cues in emmetropisation. (2) The eye could compare relative cone contrast to derive the sign of defocus information from colour cues. Experiments involving simulations of the retinal image with defocus have shown that relative cone contrast can provide colour cues for defocus in accommodation and emmetropisation. In the myopic simulation the contrast of the red component of a sinusoidal grating was higher than that of the green and blue component and this caused relaxation of accommodation and reduced eye growth. In the hyperopic simulation the contrast of the blue component was higher than that of the green and red components and this caused increased accommodation and increased eye growth. (3) The eye could compare the change in luminance and colour contrast as the eye changes focus. An experiment has shown that changes in colour or luminance contrast can provide cues for defocus in emmetropisation. When the eye is exposed to colour flicker the eye grows almost twice as much, and becomes more myopic, compared to when the eye is exposed to luminance flicker.

Neural responses of the luminance and colour mechanisms direct accommodation and emmetropisation mechanisms to different focal planes. Therefore, it is likely that the set point of refraction and accommodation is dependent on the sensitivity of the eye to changes in spatial and temporal, colour and luminance contrast.
Effects of muscarinic agents on chick choroids in intact eyes and eyecups: evidence for a muscarinic mechanism in choroidal thinning
Authors: Nickla Debora L , Zhu Xiaoying , Wallman Josh
Published: May 2013

Purpose

In chicks, ocular growth inhibition is associated with choroidal thickening and growth stimulation with choroidal thinning, suggesting a mechanistic link between the two responses. Because muscarinic antagonists inhibit the development of myopia in animal models by a non‐accommodative mechanism, we tested the hypothesis that agonists would stimulate eye growth and thin the choroid. We also hypothesized that the effective growth‐inhibiting antagonists would thicken the choroid.

Methods

Chicks, age 12–16 days, were used. In vivo: Agonists: Single intravitreal injections (20 μL) of oxotremorine (oxo), pilocarpine (pilo), carbachol (carb), or arecaidine (arec) were given to otherwise untreated eyes. A‐scan ultrasonography was done prior to injections, and at 3, 24, 48 and 72 h. Antagonists: −10D lenses were worn on one eye for 4 days. Atropine (atro), pirenzepine (pirz), oxyphenonium (oxy) or dicyclomine (dicy) were injected (20 μL) daily into lens‐wearing eyes; saline injections were done as controls. Ultrasonography was done on d1 and on d4; on d4 measurements were done before and 3 h after injections. In vitro: Paired eyecups of retinal pigment epithelium (RPE), choroid and sclera were made from 1‐week old chicks. All drugs except atropine were tested on one eyecup, its pair in plain medium. Choroidal thickness was measured at various times over 48 h.

Results

Agonists: In vivo, oxotremorine caused an increase in the rate of axial elongation (drug vs saline: 24–72 h: 338 μm vs 250 μm; p < 0.001). All except pilocarpine caused choroidal thinning by 24 h (oxo, carb and arec vs saline: −25, −35 and −46 μm vs 3 μm). In vitro, all agonists thinned choroids by 24 h (oxo: −6 vs 111 μm; pilo: 45 vs 212 μm; carb: −58 vs 65 μm; arec: 47 vs 139 μm; p < 0.05). Antagonists: Atropine, pirenzepine and oxyphenonium inhibited the development of myopia in negative lens‐wearing eyes, and also caused choroidal thickening (drug vs saline: 42, 80, 88 vs 10 μm per 3 h). In vitro, pirenzepine thickened choroids by 3 h (77 vs 2 μm, p < 0.01).

Conclusions

Muscarinic agonists caused choroidal thinning in intact eyes and eyecups, supporting a role for acetylcholine in the choroidal response to hyperopic defocus or form deprivation. Only oxotremorine stimulated eye growth, which is inconsistent with a muscarinic receptor mechanism for antagonist‐induced eye growth inhibition. The dissociation between choroidal thinning and ocular growth stimulation for the other agonists in vivo suggest separate pathways for the two.