bluuebunny/crossref_metadata_2025 huggingface dataset:
A conditional directional distance function approach for measuring tax collection efficiency: evidence from Spanish regional offices
Authors: Cordero Jose Manuel , Díaz‐Caro Carlos , Pedraja‐Chaparro Francisco , Tzeremes Nickolaos G.
Published: June 2018

This paper analyzes the evolution of the technical efficiency of Spanish regional tax offices with respect to the main devolved taxes for the period 2005–2014. We apply the conditional directional distance function methodology, which allows us to incorporate undesirable outputs into the production function, represented by administrative complaints lodged by taxpayers as an (inverse) measure of the quality of service provision, and account for the influence of the socioeconomic context in which these offices operate. This methodology has been adapted for application in a dynamic context in order to analyze how the performance of these units has evolved over a period that includes different stages of the economic cycle. The main results show that efficiency levels have fallen over the period, especially since the start of the economic recession. Likewise, we identify that the influence of incomes and fiscal capacity are especially significant explanatory factors of this evolution.
The effect of preparation strategies, qualification and professional background on clinical nurse educator confidence
Authors: Nguyen Van N.B. , Forbes Helen , Mohebbi Mohammadreza , Duke Maxine
Published: June 2018

Aims

To describe how clinical nurse educators (CliNEs) in Vietnam are prepared for their role; to identify which preparation strategies assist development of confidence in clinical teaching; and to measure the effect of educational qualifications and professional background on perceived confidence levels.

Background

The quality of clinical teaching can directly affect the quality of the student learning experience. The role of the clinical educator is complex and dynamic and requires a period of adjustment for successful role transition to occur. Planned orientation and specific preparation programmes assist transition and reduce anxiety for new CliNEs. There is, however, a lack of clear evidence to identify the form this preparation should take or which strategies are likely to facilitate the development of role confidence.

Design

Descriptive survey study.

Methods

Cross‐sectional surveys were used to collect data from 334 CliNEs during January–March 2015.

Results

Eight preparation methods commonly used in Vietnam were identified. There was a small yet significant association between preparation and CliNEs’ perceived confidence. Formal preparation methods, and postgraduate qualifications and years of clinical teaching experience were linked to increased confidence in clinical teaching. Conversely, informal mentorship was found to hinder confidence development.

Conclusions

This study identifies several preparation strategies that significantly enhance clinical educator confidence and readiness for their complex role. These preparation strategies drawn from the Vietnamese context, provide important examples for the wider nursing community to consider.
Relationships of health literacy to self‐care behaviors in people with diabetes aged 60 and above: Empowerment as a mediator
Authors: Shin Kyung Suk , Lee Eun‐Hyun
Published: June 2018

Aim

To examine the relationships of health literacy to diabetes self‐care behaviors (diet, physical exercise, foot care and blood glucose monitoring) through empowerment controlling for diabetes education.

Background

Potential mechanisms of how health literacy links to health outcomes have not clearly elucidated.

Design

A cross‐sectional study design was used.

Methods

Participants were recruited from three community health centers in South Korea from September 2016 to April 2017 using a convenience sampling method. A total of 136 people with diabetes aged 60 and above were participated in this study. The main study variables of health literacy, empowerment and diabetes self‐care activities were assessed using self‐reported questionnaires. This study applied a simple mediation analysis with a single covariate using the PROCESS macro, with health literacy entered as an antecedent variable, empowerment as a mediator, diabetes self‐care behaviors as outcome variables and diabetes education as a covariate.

Results

After controlling for diabetes education, the indirect effects of health literacy to self‐care behaviors through empowerment were significant when the self‐care behaviors were particularly diet and physical exercise. Whereas, the indirect effects were not significant when the self‐care behaviors were foot care and blood glucose monitoring.

Conclusions

This study indicates that the people with higher health literacy were more empowered and those with higher empowerment were more likely to eat healthy foods and exercise. In the light of these findings, a health literacy‐tailored empowerment enhancing program may be important targets for interventions promoting diabetes self‐care behaviors of diet and physical exercise.
The NURSING‐Positive Recruitment Arabic Model (NURS‐P.R.A.M.): A mixed methods study
Authors: Tawash Eman , Cowman Seamus
Published: June 2018

Aim

To identify factors influencing high school students’ choice of nursing and explore strategic interventions to promote nursing as a career in the Arab region.

Background

This study forms part of a PhD thesis, conducted in Bahrain, in a healthcare environment with a high dependence on expatriate nurses to maintain nursing services. However, in attracting local candidates to study nursing, the public image of nursing in the Middle East must be improved by implementing strategies that are sensitive to the Arabic culture.

Design

A mixed methods approach incorporating quantitative and qualitative dimensions.

Methods

Data were collected between 2012 ‐ 2015 using self‐administered questionnaires, semi‐structured interviews, focus groups, and written narratives. The study sample included high school students, parents, career guidance counsellors, and nursing students. A one‐group pre‐test posttest design was used to introduce a nursing recruitment intervention to high school students.spsswas used to analyse quantitative data. Colaizzi's () and Krueger's () frameworks were applied to analyse the qualitative data.

Findings

It is proposed that the public perceptions of Arab people about nursing may be grounded in strong cultural influences and any efforts to improve the enrolment and retention of local nurses should consider enhancing the social values of the nursing profession. The NURSING‐Positive Recruitment Arabic Model incorporates essential elements which will guide nursing recruitment in the Arabic cultures.

Conclusion

The study findings reflect certain issues similar to the core international literature on nursing recruitment, however there are fundamental issues particular to the Arab region, which must be included in the development of a nursing recruitment strategy for Arabic nursing.
Supplemental food alters nest defence and incubation behaviour of an open‐nesting wetland songbird
Authors: Vafidis Jim O. , Facey Richard J. , Leech David , Thomas Robert J.
Published: June 2018

Climate‐driven increases in spring temperatures are expected to result in higher prey availability earlier in the breeding season for insectivorous birds breeding in wetland habitats. Predation during the incubation phase is a major cause of nesting failure in open‐nesting altricial birds such as the Eurasian reed warbler. The nest predation rate in this species has recently been shown to be substantially reduced under conditions of experimentally elevated invertebrate prey availability. Food availability near the nest may be an important determinant of adult incubation and nest defence behaviours during the incubation period. We used two experimental studies to compare incubation behaviour and nest defence in food‐supplemented and unsupplemented adult Eurasian reed warblers during the incubation phase. In the first study we measured nest defence behavioural responses to a taxidermic mount of a native predator (stoat Mustela erminea). In the second study we used temperature loggers installed in nests to measure breaks in incubation as a measure of nest vulnerability. Food‐supplemented birds responded aggressively to the presence of a predator more quickly than those in the unsupplemented group, suggesting they are closer to their nest and can more quickly detect a predator in the vicinity. Food‐supplemented birds also had shorter breaks in incubation (both in terms of maximum and mean off‐bout durations), presumably because they were foraging for shorter periods or over shorter distances from the nest. This study therefore identifies the behavioural mechanisms by which changes in food availability may lead to changes in nest survival and thus breeding productivity, in open‐nesting insectivorous birds.
Females mate with males with diminished pheomelanin‐based coloration in the Eurasian nuthatch Sitta europaea
Authors: Galván Ismael , Rodríguez‐Martínez Sol
Published: June 2018

Sexual selection can drive the evolution of phenotypic traits because of female preferences for exaggerated trait expression in males. Sexual selection can also lead to the evolutionary loss of traits, a process to which female preferences for diminished male trait expression are hypothesized to contribute. However, empirical evidence of female preferences for diminished male traits is virtually lacking. Eurasian nuthatches Sitta europaea provide an opportunity to test this possibility, as a chestnut flank patch produced by the pigment pheomelanin is present since the first plumage of these birds and its color is more intense in nestlings in poor condition in our study population. It has been proposed that developing birds in poor condition may increase their production of pheomelanin as a detoxifying strategy. Female nuthatches may thus prefer mating with males showing flank feathers of diminished color, as this could indicate that males experienced good conditions early in development, which can positively affect the fitness of future generations. Here we show results according with this prediction in a wild population of Eurasian nuthatches, as adult males with lighter chestnut feathers paired earlier in the season, while chestnut coloration had no effect on female mating success. Chestnut color expression was not affected by the body condition of birds, suggesting that females obtain information on the body condition in early life of their potential mates and not on their current body condition. This constitutes one of the few examples of females mating with males showing diminished traits and provides the only explanation so far by which this process can occur.
Joint interaction effect of metabolic syndrome and obstructive sleep apnea on hypertension
Authors: Zhao Xiaolong , Xu Huajun , Zou Jianyin , Qian Yingjun , Yi Hongliang , Guan Jian , Yin Shankai
Published: June 2018

Numerous studies have observed a relationship between obstructive sleep apnea and hypertension, but the effects of metabolic syndrome on hypertension, and their interaction with obstructive sleep apnea, remain unclear. For this study, a total of 2972 patients were recruited from the Shanghai Sleep Health Study. Data from overnight polysomnography parameters, serum lipids, fasting blood glucose, blood pressure, and anthropometric measurements were collected. The authors then explored the independent associations and multiplicative and additive interactions of predictors of metabolic syndrome with hypertension. A positive dose–response relationship was observed between systolic blood pressure and diastolic blood pressure and quartiles of fasting glucose, triglyceride, low‐density lipoprotein cholesterol, body mass index, and apnea–hypopnea index. Furthermore, logistic regression analysis showed that, in men, a high triglyceride level, hyperglycemia, and overweight status (and their interaction effect on obstructive sleep apnea) were associated with hypertension. Being overweight and hyperglycemic may markedly augment the adverse effect of obstructive sleep apnea on hypertension in men. Therefore, hypertension therapy should be individualized based on the specific comorbidities of each patient.
miR‐200b ameliorates myofibroblast transdifferentiation in precancerous oral submucous fibrosis through targeting ZEB2
Authors: Liao Yi‐Wen , Yu Cheng‐Chia , Hsieh Pei‐Ling , Chang Yu‐Chao
Published: June 2018

Oral submucous fibrosis (OSF) is a progressive scarring disease. MicroRNA‐200b (miR‐200b) has been reported as a tumour suppressor, but its role in the precancerous OSF remains unknown. In this study, we investigated the impact of miR‐200b on myofibroblastic differentiation activity. Arecoline is a major areca nut alkaloid and has been employed to induce the elevated myofibroblast activity in human buccal mucosal fibroblasts (BMFs). Treatment of arecoline in BMFs dose‐dependently reduced gene expression of miR‐200b, which corresponded with the decreased expression of miR‐200b in fBMFs. The arecoline‐induced myofibroblast activities were abolished by overexpression of miR‐200b in BMFs, and the same results were observed in fBMFs. In addition, α‐SMA was inhibited by an increase in miR‐200b. We further demonstrated that miR‐200b‐mediated decrease in ZEB2 led to down‐regulation of α‐SMA, vimentin. Loss of miR‐200b resulted in enhanced collagen contraction and migration capabilities, and knockdown of ZEB2 reversed these phenomena. Lastly, we showed the expression of miR‐200b was significantly less and ZEB2 was markedly higher in OSF tissues. These results suggested that down‐regulation of miR‐200b may contribute to the pathogenesis of areca quid‐associated OSF through the regulation of ZEB2 and myofibroblast hallmarks.
Exosomes, the message transporters in vascular calcification
Authors: Zhang Chao , Zhang Kun , Huang Feifei , Feng Weijing , Chen Jie , Zhang Huanji , Wang Jingfeng , Luo Pei , Huang Hui
Published: June 2018

Vascular calcification (VC) is caused by hydroxyapatite deposition in the intimal and medial layers of the vascular wall, leading to severe cardiovascular events in patients with hypertension, chronic kidney disease and diabetes mellitus. VC occurrences involve complicated mechanism networks, such as matrix vesicles or exosomes production, osteogenic differentiation, reduced cell viability, aging and so on. However, with present therapeutic methods targeting at VC ineffectively, novel targets for VC treatment are demanded. Exosomes are proven to participate in VC and function as initializers for mineral deposition. Secreted exosomes loaded with microRNAs are also demonstrated to modulate VC procession in recipient vascular smooth muscle cells. In this review, we targeted at the roles of exosomes during VC, especially at their effects on transporting biological information among cells. Moreover, we will discuss the potential mechanisms of exosomes in VC.
CIP2A facilitates the G1/S cell cycle transition via B‐Myb in human papillomavirus 16 oncoprotein E6‐expressing cells
Authors: Tian Yonghao , Chen Hanxiang , Qiao Lijun , Zhang Wenhao , Zheng Jingyi , Zhao Weiming , Chen Jason. J. , Zhang Weifang
Published: June 2018

Infection with high‐risk human papillomaviruses (HR‐HPVs, including HPV‐16, HPV‐18, HPV‐31) plays a central aetiologic role in the development of cervical carcinoma. The transforming properties of HR‐HPVs mainly reside in viral oncoproteins E6 and E7. E6 protein degrades the tumour suppressor p53 and abrogates cell cycle checkpoints. Cancerous inhibitor of protein phosphatase 2A (CIP2A) is an oncoprotein that is involved in the carcinogenesis of many human malignancies. Our previous data showed that CIP2A was overexpressed in cervical cancer. However, the regulation of CIP2A by HPV‐16E6 remains to be elucidated. In this study, we demonstrated that HPV‐16E6 significantly up‐regulated CIP2A mRNA and protein expression in a p53‐degradation‐dependent manner. Knockdown of CIP2A by siRNA inhibited viability and DNA synthesis and caused G1 cell cycle arrest of 16E6‐expressing cells. Knockdown of CIP2A resulted in a significant reduction in the expression of cyclin‐dependent kinase 1 (Cdk1) and Cdk2. Although CIP2A has been reported to stabilize c‐Myc by inhibiting PP2A‐mediated dephosphorylation of c‐Myc, we have presented evidence that the regulation of Cdk1 and Cdk2 by CIP2A is dependent on transcription factor B‐Myb rather than c‐Myc. Taken together, our study reveals the role of CIP2A in abrogating the G1 checkpoint in HPV‐16E6‐expressing cells and helps in understanding the molecular basis of HPV‐induced oncogenesis.
Characterisation of Cutibacterium acnes phylotypes in acne and in vivo exploratory evaluation of Myrtacine®
Authors: Pécastaings S. , Roques C. , Nocera Th. , Peraud C. , Mengeaud V. , Khammari A. , Dréno B.
Published: June 2018

Objective

Our main objective was to compare Cutibacterium acnes (C. acnes) skin colonisation in patients with mild to moderate acne versus healthy controls and secondly, to evaluate a Myrtacine®‐based cream on C. acnes total population and antibioresistant Cutibacteria in patients with acne.

Methods

In 60 acne patients (Global Acne Severity Scale, GEA grades 2–3), of mean age 20 [15–30] years and in 24 age‐ and sex‐ matched healthy controls, forehead strips samplings were performed for microbiological analysis of comedones by colony forming unit (CFU) counts of global C. acnes and erythromycin (EryR) or clindamycin‐resistant (ClnR) populations of Cutibacterium and determination of phylotypes by MALTI‐TOF. Clinical evaluations of acne patients (GEA, lesion count, porphyrin fluorescence) were performed at baseline and after 56 days of twice‐daily application of a Myrtacine®‐based cream.

Results

We first showed (i) high and similar levels of C. acnes colonisation in superficial pilosebaceous follicles and detection of EryR and ClnR strains in both acne and control groups; (ii) different repartition of phylotypes in acne patients versus healthy control, with a predominance of phylotype IA in acne patients and a link between phylotype IA and erythromycin resistance. Besides, after treatment with the Myrtacine®‐based cream in acne patients, there was no change in C. acnes total load, but a significant decrease of EryR Cutibacteria, reduced porphyrin production by C. acnes, a decrease in acne severity (GEA), associated with reduced retentional and inflammatory lesions.

Conclusion

Cutibacterium acnes colonisation was not significantly different in acne versus control groups. Phylotype IA was predominant in acne patient and in EryR C. acnes. A Myrtacine®‐based cream significantly reduced the level of EryR Cutibacteria in vivo and improved acne lesions.
In situ nail unit melanoma: epidemiological and clinic‐pathologic features with conservative treatment and long‐term follow‐up
Authors: Goettmann S. , Moulonguet I. , Zaraa I.
Published: June 2018

Background

Nail unit melanoma (NUM) is a rare melanoma variant, usually associated with a poor prognosis because of a delayed diagnosis. Few data are available concerning the management and long‐term outcome of in situ NUM.

Objective

To use a large cohort to provide comprehensive patient data and long‐term follow‐up information. This will serve to investigate distinctive epidemiological, clinical and histological features of in situ NUM. To report treatment modalities, assess conservative surgery and evaluate its long‐term safety.

Methods

Patients with confirmed diagnosis of in situ NUM were retrospectively reviewed. Demographics, clinical presentation, therapeutic data and follow‐up were analysed.

Results

Sixty‐three cases of in situ NUM were identified as follows: 44 were women (70%), with a mean age of 51 years. The mean duration of symptoms prior to consultation was 4.3 years [range 3 months–28 years]. Clinically, with 58 cases, i.e. (92%) longitudinal melanonychia was the most common clinical presentation. The thumb was the most affected digit, being afflicted in 28 cases: 44%. Medical history found a widening and/or recent darkening of the melanonychia in 46 cases (82%). The treatment consisted of, respectively, 56 En bloc excisions of the nail apparatus 89% of the patients we studied, and seven amputations of the distal phalanx. During the follow‐up period (mean: 10 years), two patients presented in situ recurrences.

Conclusion

The recognition of a NUM at an in situ stage allows early treatment and curing of this tumour. At this early stage, a ‘functional surgery’ is a rational approach with an excellent oncologic safety.
Influence of native catfish mucus on Flavobacterium columnare growth and proteolytic activity
Authors: Shoemaker Craig A. , LaFrentz Benjamin R. , Peatman Eric , Beck Benjamin H.
Published: June 2018

Flavobacterium columnare causes columnaris disease of farmed and wild freshwater fish. Skin mucus is an important factor in early stages of columnaris pathogenesis, albeit little studied. Our objectives were to (a) characterize the terminal glycosylation pattern (TGP) of catfish mucus, (b) determine the growth of F. columnare in formulated water (FW)‐containing channel catfish (Ictalurus punctatus) or hybrid catfish (Ictalurus punctatus X Ictalurus furcatus) mucus and (c) examine extracellular protease activity of two F. columnare isolates differing in virulence. The TGP of catfish mucus by lectin binding was as follows: alpha‐D‐mannose/alpha‐D‐glucose >N‐acetyl‐beta‐D‐glucosamine >N‐acetyl‐beta‐D‐glucosamine/N‐acetylneuraminic acid >N‐acetyl‐D‐galactosamine >alpha‐D‐galactose/N‐acetyl‐alpha‐D‐galactosamine >beta‐D‐galactose = alpha‐L‐fucose. Virulence studies demonstrated isolate AL‐02‐36 was highly virulent in channel catfish fry (0.1 g) with cumulative mortality of 90%‐100% versus 60% for isolate ALG‐00‐530 at equivalent doses (~3 × 106 CFU/ml); a similar result was observed in larger (0.7 g) catfish. In multiple experiments, F. columnare replicated (2‐3 logs) and survived (28 days) in formulated water‐containing catfish mucus. Highly virulent isolate AL‐02‐36 possessed at least 2.5‐ to fivefold higher protease activity following growth in mucus than the less virulent ALG‐00‐530. Flavobacterium columnare utilized catfish mucus as a nutrient source and mucus presence modulated extracellular protease production.
Comparison of the clinical, radiographic, and histological effects of titanium‐prepared platelet rich fibrin to allograft materials in sinus‐lifting procedures
Authors: Olgun Ebru , Ozkan Serdar Y. , Atmaca Hasan T. , Yalim Mehmet , Hendek Meltem Karsiyaka
Published: June 2018

Aim

In the present study, we evaluated the clinical, radiographic, and histological comparisons of completely autologous titanium‐prepared platelet rich fibrin (T‐PRF) or allograft in sinus‐lifting procedures.

Methods

Eighteen posterior maxilla requiring sinus‐lifting procedures using the balloon‐lifting technique for implant placement were selected. Ten sinuses were randomly assigned to T‐PRF as the test group and eight to allografts as the control group. After 4 and 6 months in the test and control groups, respectively, computed tomography was done, and bone samples were received during implant surgery. Three months after the second surgery, implant stability was measured.

Results

Radiological results showed that the allograft group had better results (62% in volume, 53% in density, and 69% in height) than the T‐PRF group. Histomorphometric results showed that newly‐formed bone ratios were 17.28 ± 2.53 and 16.58 ± 1.05 in the allograft group and T‐PRF groups, respectively. There was no significant difference between the test and control groups (P = .611) for implant stability values.

Conclusions

The use of T‐PRF alone in sinus‐lifting operations has successful clinical and histomorphometric results. Bone formation in the T‐PRF group was accelerated to 4 months compared to allografts according to the histological results.
The panniculus carnosus muscle: an evolutionary enigma at the intersection of distinct research fields
Authors: Naldaiz‐Gastesi Neia , Bahri Ola A. , López de Munain Adolfo , McCullagh Karl J. A. , Izeta Ander
Published: June 2018

The panniculus carnosus is a thin striated muscular layer intimately attached to the skin and fascia of most mammals, where it provides skin twitching and contraction functions. In humans, the panniculus carnosus is conserved at sparse anatomical locations with high interindividual variability, and it is considered of no functional significance (most possibly being a remnant of evolution). Diverse research fields (such as anatomy, dermatology, myology, neuroscience, surgery, veterinary science) use this unique muscle as a model, but several unknowns and misconceptions remain in the literature. In this article, we review what is currently known about panniculus carnosus structure, development, anatomical location, response to environmental stimuli and potential function(s), with the aim of putting together the evidence arising from the different research communities and raising interest in this unique muscle, which we postulate as an ideal model for both vascular and muscular research.
How home health nurses plan their work schedules: A qualitative descriptive study
Authors: Irani Elliane , Hirschman Karen B , Cacchione Pamela Z , Bowles Kathryn H
Published: June 2018

Aims and objectives

To describe how home health nurses plan their daily work schedules and what challenges they face during the planning process.

Background

Home health nurses are viewed as independent providers and value the nature of their work because of the flexibility and autonomy they hold in developing their work schedules. However, there is limited empirical evidence about how home health nurses plan their work schedules, including the factors they consider during the process and the challenges they face within the dynamic home health setting.

Design

Qualitative descriptive design.

Methods

Semi‐structured interviews were conducted with 20 registered nurses who had >2 years of experience in home health and were employed by one of the three participating home health agencies in the mid‐Atlantic region of the United States. Data were analysed using conventional content analysis.

Results

Four themes emerged about planning work schedules and daily itineraries: identifying patient needs to prioritise visits accordingly, partnering with patients to accommodate their preferences, coordinating visit timing with other providers to avoid overwhelming patients, and working within agency standards to meet productivity requirements. Scheduling challenges included readjusting the schedule based on patient needs and staffing availability, anticipating longer visits, and maintaining continuity of care with patients.

Conclusion

Home health nurses make autonomous decisions regarding their work schedules while considering specific patient and agency factors, and overcome challenges related to the unpredictable nature of providing care in a home health setting. Future research is needed to further explore nurse productivity in home health and improve home health work environments.

Relevance to clinical practice

Home health nurses plan their work schedules to provide high quality care that is patient‐centered and timely. The findings also highlight organisational priorities to facilitate continuity of care and support nurses while alleviating the burnout associated with high productivity requirements.
Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers
Authors: Fealy Gerard M , Casey Mary , O'Leary Denise F , McNamara Martin S , O'Brien Denise , O'Connor Laserina , Smith Rita , Stokes Diarmuid
Published: June 2018

Aims and objectives

To collate, synthesise and discuss published evidence and expert professional opinion on enablers and barriers to the development and sustainability of specialist and advanced practice roles in nursing and midwifery.

Background

Expanded practice is a response to population health needs, healthcare costs and practitioners’ willingness to expand their scope of practice through enhanced responsibility, accountability and professional autonomy.

Design

This discursive paper is based on a rapid review of literature on enablers and barriers to the development and sustainability of specialist and advanced practice roles and is part of a wider policy analysis.

Methods

We analysed and synthesised of 36 research articles, reviews and discussion papers on enablers and barriers in the development and sustainability of expanded practice roles.

Results

Several factors enable role expansion, including: role clarity; credentialing and endorsement; availability of education for expanded roles; individual practitioners’ dispositions towards role expansion; support from peers, other professionals and the work organisation; and costs. Where limited or absent, these same factors can constrain role expansion.

Conclusions

Enabling nurses and midwives to practice to their full scope of education and expertise is a global challenge for disciplinary leadership, a national challenge for professional regulation and a local challenge for employers and individual clinicians. These challenges need to be addressed through multistakeholder coordinated efforts at these four levels.

Relevance to clinical practice

This discursive paper synthesises empirical evidence and expert professional opinion on the factors that enable or hinder the development and sustainability of specialist and advanced practice roles. Providing a critical appraisal of current knowledge, it provides a reference source for disciplinary debate and policy development regarding the nursing and midwifery resource and informs clinicians of the myriad issues that can impact on their capacity to expand their scope of practice.
Low‐salt diet adherence in African Americans with hypertension
Authors: Bolin Linda P , Horne Carolyn E , Crane Patricia B , Powell James R
Published: June 2018

Aims and objectives

To identify health and physiological measures, depressive symptoms and locus of control (LOC) in adherence to a low salt (1,500 mg sodium), diet in African American (AA) adults with hypertension (HTN).

Background

Adherence determinants to self‐management behaviours among AA adults with HTN is essential in prevention of outcomes such as stroke. A low‐salt diet is one key factor in the successful management of HTN.

Design

A cross‐sectional correlational design.

Methods

Systolic blood pressure, co‐morbidities, serum creatinine, potassium, education, depression, LOC and social support were examined in relationship to self‐reported adherence to a low‐salt diet in a sample of AA adults (N = 77) aged 55–84. Demographic and physiologic data were collected in addition to diet adherence on a 100 mm visual analog scale. Standardised tools included Multidimensional Health LOC scale and the Patient Health Question‐9 Depression Instrument.

Results

Lower adherence to a low‐salt diet was more prevalent in females (n = 27; 73%). A moderate negative correlation (r = −0.294; p < 0.01) was found with low‐salt diet adherence in the PHQ‐9 (r = −0.294; p < 0.01). Both multiple regression, models significantly influenced adherence to low salt diet, with both models explaining 24% of the variance; internal LOC (F = 2.599 [8, 68]; p = 0.02) and external LOC (F = 2.667 [8, 68]; p = 0.013).

Conclusion

Increasing awareness of factors affecting adherence to a low‐salt diet is important for clinicians for effective management of HTN in AA adults.

Relevance to clinical practice

Nurses are encouraged to adopt a comprehensive assessment of those with HTN to identify psychosocial needs, in particular depressive symptoms, as a potential secondary prevention measure.
The perspective of allied health staff on the role of nurses in subacute care
Authors: Digby Robin , Bolster Danielle , Perta Andrew , Bucknall Tracey K
Published: June 2018

Aims and objectives

To explore allied health staff perceptions on the role of nurses in subacute care wards.

Background

A consequence of earlier discharge from acute hospitals is higher acuity of patients in subacute care. The impact on nurses’ roles and required skill mix remains unknown. In the same way, nurses’ integration into the rehabilitation team is ambiguous.

Design

Descriptive qualitative inquiry.

Methods

Semistructured interviews conducted with 14 allied health staff from one subacute care facility in Melbourne, Australia. Interviews were audio‐recorded and transcribed verbatim. Analysis using the framework approach.

Results

Three main themes were evident: (a) the changing context of care: patient acuity, rapid patient discharge and out‐dated buildings influenced care; (b) generalist as opposed to specialist rehabilitation nurses: a divide between traditional nursing roles of clinical and personal care and a specialist rehabilitation role; and (c) interdisciplinary relations and communication demonstrated lack of respect for nurses and integrating holistic care into everyday routines.

Conclusions

Allied health staff had limited understanding of nurses’ role in subacute care, and expectations varied. Power relationships appeared to hamper teamwork. Failure to include nurses in team discussions and decision‐making could hinder patient outcomes. Progressing patients to levels of independence involves both integrating rehabilitation into activities of daily living with nurses and therapy‐based sessions. Promotion of the incorporation of nursing input into patient rehabilitation is needed with both nurses and allied health staff.

Relevance to clinical practice

Lack of understanding of the nurses’ role contributes to lack of respect for the nursing contribution to rehabilitation.

Nurses have a key role in rehabilitation sometimes impeded by poor teamwork with allied health staff.

Processes in subacute care wards need examination to facilitate more effective team practices inclusive of nurses.

Progressing patients’ independence in rehabilitation units involves activities of daily living with nurses as much as therapy‐based sessions.
Patient autonomy in a high‐tech care context—A theoretical framework
Authors: Lindberg Catharina , Fagerström Cecilia , Willman Ania
Published: June 2018

Aims and objectives

To synthesise and interpret previous findings with the aim of developing a theoretical framework for patient autonomy in a high‐tech care context.

Background

Putting the somewhat abstract concept of patient autonomy into practice can prove difficult as when it is highlighted in healthcare literature, the patient perspective is often invisible. Autonomy presumes that a person has experience, education, self‐discipline and decision‐making capacity. Reference to autonomy in relation to patients in high‐tech care environments could therefore be considered paradoxical, as in most cases, these persons are vulnerable, with impaired physical and/or metacognitive capacity, thus making extended knowledge of patient autonomy for these persons even more important.

Design

Theory development.

Methods

The basic approaches in theory development by Walker and Avant were used to create a theoretical framework through an amalgamation of the results from three qualitative studies conducted previously by the same research group.

Results

A theoretical framework—the control‐partnership‐transition framework—was delineated disclosing different parts cocreating the prerequisites for patient autonomy in high‐tech care environments. Assumptions and propositional statements that guide theory development were also outlined, as were guiding principles for use in day‐to‐day nursing care. Four strategies used by patients were revealed as follows: the strategy of control, the strategy of partnership, the strategy of trust and the strategy of transition.

Conclusions

An extended knowledge base, founded on theoretical reasoning about patient autonomy, could facilitate nursing care that would allow people to remain/become autonomous in the role of patient in high‐tech care environments.

Relevance to clinical practice

The control‐partnership‐transition framework would be of help in supporting and defending patient autonomy when caring for individual patients, as it provides an understanding of the strategies employed by patients to achieve autonomy in high‐tech care contexts. The guiding principles for patient autonomy presented could be used in nursing guidelines.
Stroke survivors’ experiences transitioning from hospital to home
Authors: Connolly Teresa , Mahoney Ellen
Published: June 2018

Aims and objectives

To investigate the experiences of ischaemic stroke survivors during the transitional period from the hospital through the first 4 weeks after discharge home.

Background

Ischaemic stroke survivors describe the transition from hospital to home as an important time in their recovery and describe various physical and cognitive concerns early within the recovery period. Adequate transitional care interventions should be informed by such experiences.

Design

This is a qualitative descriptive study.

Method

This study used semistructured telephone interviews and an inductive approach to enable thematic analysis of information from 31 persons experiencing an ischaemic stroke.

Results

Five major themes emerged: (a) the shock of a stroke interrupting a normal day; (b) transition to an unfamiliar home; (c) uncertainty; (d) understanding a new sense of self; and (e) adjusting to a new sense of self. All participants articulated a need to cope with uncertainty and adjusting to a new sense of self. Ischaemic stroke survivors who experienced less uncertainty described that return to their prior daily routine, preventing another stroke, depended on a helpful support system including frequent follow‐up and communication with healthcare professionals.

Conclusion

All ischaemic stroke survivors are at risk for complications during recovery, regardless of stroke severity. This study found that, even after experiencing minimal physical or cognitive symptoms, ischaemic stroke survivors can have difficulty adjusting to life after discharge.

Relevance to clinical practice

Adjusting to life after a stroke during the first 4 weeks after discharge home is an in individualised experience. For the complex psychosocial and physical needs of ischaemic stroke survivors, nurses can play an important role beyond symptom management by fostering a dynamic relationship through individualised transitional care based on ischaemic stroke survivors experiences.
Social adjustment experiences of adolescents with Tourette syndrome
Authors: Lee Mei‐Yin , Wang Huei‐Shyong , Chen Chen‐Jung , Lee Mei‐Hua
Published: June 2018

Aims and objectives

To explore and describe the experience of social adjustment of adolescents with Tourette syndrome in Taiwan.

Background

Although Tourette syndrome is a non‐life‐threatening disease, the inherent difficulties in controlling tics and comorbidities can cause long‐term physical and psychological issues, as well as social maladjustment among adolescents. Good social adjustment can promote mental health among adolescents. Currently, it is not clear how adolescents with Tourette syndrome can self‐adjust and maintain harmonious social interaction with others.

Design

Descriptive phenomenological approach was used in this study. Four criteria were applied to establish the trustworthiness or methodological rigour.

Methods

Sixteen adolescents with Tourette syndrome were recruited by purposive sampling from a medical centre in Northern Taiwan. Semistructured one‐on‐one interviews were performed from March 2014–April 2015 for data collection. Every participant was interviewed once or twice, and each interview lasted for duration of around 60–90 min. Data were analysed with Giorgi's phenomenological method for data analysis.

Results

Three themes were identified from the adolescent’ interviews. The themes were included visible and invisible destitution, moulding a socially acceptable self and coexisting friends and foes.

Conclusions

Adolescents with Tourette syndrome experienced that tics are often not understood nor accepted during social interactions with others. However, with age and autonomy of adolescents, they were able to adjust and develop a socially acceptable body image and maintain amicable social interactions with others. Accompanied by positive thinking, support from friends and families, the adolescents could achieve good social adjustments for living with Tourette syndrome.

Relevance to clinical practice

The experiences and feelings highlighted in this study can bring awareness to nurses and healthcare professionals for developing interventions that promote healthy social adjustment and mental health for adolescents with Tourette syndrome.
Yakovlev's Basolateral Limbic Circuit in Multiple Sclerosis Related Cognitive Impairment
Authors: Keser Zafer , Kamali Arash , Younes Kyan , Schulz Paul E. , Nelson Flavia M. , Hasan Khader M.
Published: June 2018

BACKGROUND AND PURPOSE

In 1948, Paul Yakovlev described an additional limbic circuit located basolateral to James Papez's circuit (1937) and included orbitofrontal cortex, amygdala, and dorsomedial nucleus of thalamus. This circuit is shown to be an important component of subcortical cognitive abilities. We aimed to demonstrate this circuit in a multiple sclerosis (MS) cohort using diffusion tensor imaging (DTI) and evaluate its role in MS‐related cognitive impairment (CI).

METHODS

We enrolled cognitively intact (n = 10) and impaired (n = 36) MS patients who underwent a comprehensive cognitive assessment; the minimal assessment of cognitive function in MS (MACFIMS) and structural magnetic resonance imaging. Correlation analyses between volumetric and DTI‐derived values of the orbitofrontothalamic (OFT), amygdalothalamic tracts (ATTs), and dorsomedial nucleus of thalamus and CI index derived from MACFIMS were computed after adjustment for age, education, and lesion load.

RESULTS

We observed a consistent trend between CI index and bilateral dorsomedial nucleus’ mean diffusivity (MD) (r = .316; P = .02), left OFT Fractional anisotropy (FA) (r = −.302; P = .02), MD (r = .380; .006), and radial diffusivities (RDs) (r = .432; P = .002), also with right ATT FA (r = −.475; P = .0006) and left ATT FA ( = −.487; P = .0005). After Bonferroni correction, correlations of left OFT RD and right and left ATT FA with CI were found to be significant.

CONCLUSIONS

Our study provides in vivo DTI delineation of Yakovlev's historical basolateral limbic circuit and establishes a role in MS‐related CI. These findings may potentially pave the way for future clinical studies using targeted invasive and noninvasive neurostimulation modalities for CI in MS.
Pharmacokinetics of low‐dose methotrexate in healthy beagle dogs
Authors: Rostang Antoine , Mosca Marion , Jeannin Morgan , Luissiez Coralie , Berny Philippe , Fourel Isabelle , Pin Didier , Prouillac Caroline
Published: June 2018

Methotrexate may be an alternative to ciclosporin in the treatment of canine atopic dermatitis (cAD) as suggested by recent data. The aim of the study was to investigate both the tolerance and the pharmacokinetic behavior of methotrexate (MTX) in plasma, following intravenous (i.v.), subcutaneous (s.c.) or oral (OR) administration over several weeks. Six healthy dogs were given oral MTX once a week, respectively, per dog at 2.5 mg/1 week, 5 mg/4 weeks, 7.5 mg/3 weeks, 10 mg/6 weeks and 12.5 mg/5 weeks. No clinically relevant abnormalities of laboratory parameters were noticed. A high inter‐individual variation of MTX plasma concentration was observed with a suspicion of saturation phenomenon in absorption. To compare with other routes of administration, six healthy beagle dogs followed a crossover design study at 7.5 mg per dog MTX. The absolute bioavailability was 93% for SC injection and 30% for the oral route. The inter‐individual variability was quite low following SC administration compared to oral route. Just as in human, given the substantial variability of oral absorption, clinicians cannot assume consistent oral bioavailability of MTX. Therefore, they may consider switching dogs to the SC route in case of absence of clinical response with a weekly oral dose.
Staphylococcus pseudintermedius biofilms secrete factors that induce inflammatory reactions in vitro
Authors: Arima S. , Ochi H. , Mitsuhashi M. , Kibe R. , Takahashi K. , Kataoka Y.
Published: June 2018

Biofilms, composed of bacterial cells embedded in a secreted polysaccharide and protein matrix, often cause problems such as chronic and refractory infections. Staphylococcus pseudintermedius, which is an important pathogen in veterinary medicine, has a high rate of biofilm production. Although it is considered that S. pseudintermedius biofilms are associated with prolonged inflammatory disorders, there are no reports that S. pseudintermedius biofilm directly regulates inflammatory reactions. In this study, we focused on the metabolites derived from biofilm cultures of S. pseudintermedius and evaluated their inflammatory effects in vitro. Expression levels of interleukin-1 beta and interleukin-6 mRNA significantly increased in RAW264.7 cells that were cultured with biofilm-conditioned medium (BCM). The secreted proteins in BCM were heat resistance and activated a Toll-like receptor (TLR) signalling pathway. Moreover, based on SDS-PAGE analysis, isolates with stronger biofilm-forming capabilities induced more inflammatory reactions and had specific banding patterns compared with those of weak biofilm producers. Collectively, our results suggest that the proteins derived from S. pseudintermedius biofilm induce a host inflammatory response via a TLR pathway. Furthermore, the severity of inflammation depends on the biofilm formation capacity of the S. pseudintermedius strain.

Significance and Impact of the Study

Staphylococcus pseudintermedius is a biofilm-forming bacterium. We identified some biofilm secreted heat-resistant proteins that induce inflammatory reactions through Toll-like receptor signalling. The expression of the secreted protein varied depending on the potency of biofilm production. Our data suggest that these proteins may be the factors causing biofilm-related inflammation during S. pseudintermedius infections. Identification of these proteins may lead to the development of novel medications to prevent the exacerbation of infections caused by S. pseudintermedius.
Doubling Down: Inequality in Responsiveness and the Policy Preferences of Elected Officials
Authors: Mendez Matthew S. , Grose Christian R.
Published: June 2018

Is bias in responsiveness to constituents conditional on the policy preferences of elected officials? The scholarly conventional wisdom is that constituency groups who do not receive policy representation still obtain some level of responsiveness by legislators outside of the policy realm. In contrast, we present a theory of preference‐induced responsiveness bias where constituency responsiveness by legislators is associated with legislator policy preferences. Elected officials who favor laws that could disproportionately impact minority groups are also less likely to engage in nonpolicy responsiveness to minority groups. We conducted a field experiment in 28 US legislative chambers. Legislators were randomly assigned to receive messages from Latino and white constituents. If legislators supported voter identification laws, Latino constituents were less likely to receive constituency communications from their legislators. There are significant implications regarding fairness in the democratic process when elected officials fail to represent disadvantaged constituency groups in both policy and nonpolicy realms.