bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental Life Cycle Costing and Sustainability: Insights from Pollution Abatement and Resource Recovery in Wastewater Treatment
Authors: Hall Murray R. , Priestley Anthony , Muster Tim H.
Published: August 2017

The relationship between environmental life cycle costing (ELCC) and sustainability was explored using two detailed wastewater case studies. The case studies were selected to increase the tension between existing market values and values for sustainability; the first case study considered incremental change to an existing plant and the second considered a paradigm shift in wastewater treatment. Pollution control provided the greatest cost savings for the first case study and provided a “win‐win” result—meeting existing standards and saving money. However, benefits for pollution control beyond current standards were not captured, which emphasized the role of standards to internalize as well as limit the values considered in ELCC. In the second case study, the value of water had the potential to change the focus of wastewater design from pollution abatement to resource recovery. However, social acceptance of recovered water and market access for resources created large risk for investment. The ELCC was also sensitive to the discount rate which limited longer‐term considerations. Other sustainability values such as scarcity and ecological thresholds were not captured. The ELCC code of practice suggests including such costs if likely in the foreseeable future; defining these values may also clarify the role of ELCC to evaluate sustainability over the life cycle.
The impact of ageing, fasting and high‐fat diet on central and peripheral glucose tolerance and glucose‐sensing neural networks in the arcuate nucleus
Authors: van den Top M. , Zhao F.‐Y. , Viriyapong R. , Michael N. J. , Munder A. C. , Pryor J. T. , Renaud L. P. , Spanswick D.
Published: August 2017

Obesity and ageing are risk factors for diabetes. In the present study, we investigated the effects of ageing, obesity and fasting on central and peripheral glucose tolerance and on glucose‐sensing neuronal function in the arcuate nucleus of rats, with a view to providing insight into the central mechanisms regulating glucose homeostasis and how they change or are subject to dysfunction with ageing and obesity. We show that, following a glucose load, central glucose tolerance at the level of the cerebrospinal fluid (CSF) and plasma is significantly reduced in rats maintained on a high‐fat diet (HFD). With ageing, up to 2 years, central glucose tolerance was impaired in an age‐dependent manner, whereas peripheral glucose tolerance remained unaffected. Ageing‐induced peripheral glucose intolerance was improved by a 24‐hour fast, whereas central glucose tolerance was not corrected. Pre‐wean, immature animals have elevated basal plasma glucose levels and a delayed increase in central glucose levels following peripheral glucose injection compared to mature animals. Electrophysiological recording techniques revealed an energy‐status‐dependent role for glucose‐excited, inhibited and adapting neurones, along with glucose‐induced changes in synaptic transmission. We conclude that ageing affects central glucose tolerance, whereas HFD profoundly affects central and peripheral glucose tolerance and, in addition, glucose‐sensing neurones adapt function in an energy‐status‐dependent manner.
Differential response patterns of kisspeptin and RFamide‐related peptide to photoperiod and sex steroid feedback in the Djungarian hamster (Phodopus sungorus)
Authors: Rasri‐Klosen K. , Simonneaux V. , Klosen P.
Published: August 2017

Many animals synchronise their reproductive activity with the seasons to optimise the survival of their offspring. This synchronisation involves switching on and off their gonadotrophic axis. Ever since their discovery as key regulators of gonadotrophin‐releasing hormone (GnRH) neurones, the hypothalamic RF‐amide peptides kisspeptin and RFamide‐related peptide (RFRP) have been a major focus of research on the seasonal regulation of the gonadotrophic axis. In the present study, we investigated the regulation of both neuropeptides in the Djungarian hamster, a major animal model for the study of seasonal reproduction. During the long‐day breeding period, kisspeptin neurones in the anteroventral periventricular area are solely controlled by a positive sex steroid feedback and, in the arcuate nucleus, they are subject to a very strong negative sex steroid feedback associated with a minor photoperiodic effect. During short‐day sexual quiescence, the disappearance of this hormonal feedback leads to high levels of kisspeptin in arcuate neurones. Notably, chronic central administration of kisspeptin is able to over‐ride the photoperiodic inhibition of the gonadotrophic axis and reactivate the reproductive function. Therefore, our data suggest that kisspeptin secretion by arcuate neurones during sexual quiescence is inhibited by mechanisms upstream of kisspeptin neurones. RFRP expression is solely controlled by photoperiod, being strongly reduced in short days independently of the sex steroid feedback. Thus, kisspeptin and RFRP display contrasting patterns of expression and regulation. Upstream mechanisms controlling these neurones should be the focus of further studies on the roles of these RFamide neuropeptides in the seasonal control of reproduction.
Prevalence of malnutrition among older people in medical and surgical wards in hospital and quality of nutritional care: A multicenter, cross‐sectional study
Authors: Bonetti Loris , Terzoni Stefano , Lusignani Maura , Negri Marina , Froldi Marco , Destrebecq Anne
Published: August 2017

Aims and objectives

To determine and compare the prevalence of malnutrition in medical and surgical hospital units; to assess quality of nutritional care and patients’ perception about quality of food and nutritional care.

Background

Hospital malnutrition in older people leads to increased mortality, length of stay, risk of infections and pressure ulcers. Several studies show that malnutrition is often caused by hospitalisation and related to poor nutritional care. Few studies report data on surgical older patients.

Design

A cross‐sectional, multicenter study was conducted in 12 hospitals in northern Italy.

Methods

Malnutrition prevalence was determined according to the Mini Nutritional Assessment full‐version. Head nurses were interviewed in 80 units, through a validated questionnaire regarding quality of nutritional care. Semi‐structured interviews were administered to a sample of patients, to investigate their perception about quality of food and nutritional care.

Results

Two hundred twenty‐eight patients of 1,066 were malnourished (21.4%). Medical patients were at higher risk, so were women, patients aged 85 or more, with impaired autonomy, pressure ulcers or taking more than three drugs. The lack of personnel impacts on quality of care: in 55% of the units, no nutritional screening is performed; nutritional history is investigated in 48% only. No protocols for nutritional problems exist in 70% of the wards; hardly ever the intake is measured. Patients are mostly satisfied, even though they report that food has no taste and is not well presented. They remark the need for more personnel.

Conclusion

Prevalence was high, as found in other studies. Medical patients were at higher risk. Nutritional care was inadequate, and often no measures were adopted to prevent malnutrition. Staffing should be increased during meals.

Relevance to clinical practice

These findings will provide indications on the strategies needed to overcome such barriers.
Application of an enhanced device to transluminal retrieval of malappositioned coronary stents: An experimental study
Authors: Mori Masayuki , Sakata Kenji , Yokawa Junichiro , Nakanishi Chiaki , Okada Hirofumi , Shimojima Masaya , Yoshida Shohei , Yoshimuta Tsuyoshi , Hayashi Kenshi , Yamagishi Masakazu , Kawashiri Masa‐aki
Published: August 2017

Objectives

This study investigated the application of a novel enhanced device to retrieval of deployed stents in a porcine coronary model.

Background

Recurrence of in‐stent restenosis and stent thrombosis still remains to be resolved. Under these conditions, it is sometimes necessary to retrieve malfunctional stents responsible for thrombosis. However, few data exist regarding the feasibility and safety of retrieval device use in previously deployed coronary stents.

Methods

We have developed an enhanced device consisting of an asymmetric forceps, conducting shaft (1.6 mm diameter, 150 cm length), and control handle. Bare‐metal stents (3 mm diameter) were implanted in four pigs to create a malapposition model. Coronary artery injury was evaluated by intravascular ultrasound (IVUS) and histological imaging on the first and 14th days.

Results

The device was delivered to the coronary artery using the existing catheter (7 Fr). After opening the forceps, the blade was forced into the space between the vessel wall and the stent, and the stent struts were then grasped with the forceps. This was then pulled back into the catheter, still grasping the stent struts with the forceps. All stents were successfully retrieved by this method (n = 4). On the first day, no apparent vessel wall injury was detectable by IVUS, although histological findings revealed damage to endothelial monolayer on retrieval of deployed stent. On the 14th day, mild intimal thickening was observed by IVUS and histology.

Conclusions

These results demonstrate that the present device can be applied to transluminal retrieval of acquired malappositioned coronary stents.
Coronary revascularization for acute myocardial infarction in the HIV population
Authors: Singh Vikas , Mendirichaga Rodrigo , Savani Ghanshyambhai T. , Rodriguez Alexis P. , Dabas Nitika , Munagala Anish , Alfonso Carlos E. , Cohen Mauricio G. , Elmariah Sammy , Palacios Igor F.
Published: August 2017

Objective

To analyze trends in management and outcomes of patients infected with the human immunodeficiency virus (HIV) undergoing percutaneous coronary intervention (PCI) for an acute myocardial infarction (AMI) in the United States.

Background

Infection with HIV is an independent risk factor for accelerated atherosclerosis associated with higher rates of AMI. Current trends and outcomes of HIV‐infected individuals presenting with AMI in the United States remain unknown.

Methods

Using the Healthcare Cost and Utilization Project National Inpatient Sample database we identified HIV‐infected individuals who underwent PCI for an AMI from 2002 to 2013. Multivariable logistic regression and propensity‐score matching were performed to analyze outcomes.

Results

We identified a total of 59 194 patients of which 7841 underwent PCI during index hospitalization (13.3%). Most patients were men (71%), ≥50 years of age (82%), and white (74%). ST‐elevation myocardial infarction was present in 21% of cases. Charlson comorbidity index (CCI) was 5.67 ± 0.4. Predictors of post‐procedural complications included female sex, black race, higher CCI, and placement of a bare metal stent, whereas predictors of mortality included occurrence of a complication, ST‐elevation myocardial infarction, age ≥70 years, and higher CCI. Conversely, placement of a drug‐eluting stent was associated with a reduced risk of complications and mortality. After propensity‐score matching, HIV‐infected individuals were less likely to undergo PCI and receive a drug‐eluting stent, while having longer length of stay, higher hospitalization costs, and higher in‐hospital mortality when compared to non‐infected individuals.

Conclusion

Significant disparities continue to affect HIV‐infected individuals undergoing PCI for AMI in the United States.
Multivariate Almost Stochastic Dominance
Authors: Tsetlin Ilia , Winkler Robert L.
Published: August 2017

Almost stochastic dominance allows small violations of stochastic dominance rules to avoid situations where most decision makers prefer one alternative to another but stochastic dominance cannot rank them. We present the concepts of multivariate almost stochastic dominance and multivariate almost nth‐degree risk and their connections with a preference for combining good with bad. Then, we show how a preference for combining good with bad can be applied to obtain various comparative statics results, and we extend our approach to risk‐prone (convex) stochastic dominance, which relates to the opposite preference, for combining good with good and bad with bad.
Melatonin improves the fertilization capacity and developmental ability of bovine oocytes by regulating cytoplasmic maturation events
Authors: Zhao Xue‐Ming , Wang Na , Hao Hai‐Sheng , Li Chong‐Yang , Zhao Ya‐Han , Yan Chang‐Liang , Wang Hao‐Yu , Du Wei‐Hua , Wang Dong , Liu Yan , Pang Yun‐Wei , Zhu Hua‐Bin
Published: August 2017

Melatonin is a well‐characterized antioxidant that has been successfully used to protect oocytes from reactive oxygen species during in vitro maturation (IVM), resulting in improved fertilization capacity and development ability. However, the mechanism via which melatonin improves oocyte fertilization capacity and development ability remains to be determined. Here, we studied the effects of melatonin on cytoplasmic maturation of bovine oocytes. In the present study, bovine oocytes were cultured in IVM medium supplemented with 0, 10–7, 10–9, and 10−11 mol/L melatonin, and the cytoplasmic maturation parameters of MII oocytes after IVM were investigated, including redistribution of organelles (mitochondria, cortical granules [CGs], and endoplasmic reticulum [ER]), intracellular glutathione (GSH) and ATP levels, expression of endogenous antioxidant genes (Cat, Sod1, and GPx), and fertilization‐related events (IP3R1 distribution and expression of CD9 and Juno). Our results showed that melatonin significantly improved the cytoplasmic maturation of bovine oocytes by improving the normal distribution of organelles, increasing intracellular GSH and ATP levels, enhancing antioxidant gene expression levels, and modulating fertilization‐related events, all of which resulted in increased fertilization capacity and developmental ability. Meanwhile, melatonin also increased the mRNA and protein expression levels of the Tet1 gene and decreased the Dnmt1 gene mRNA and protein levels in bovine oocytes, indicating that melatonin regulates the expression of the detected genes via demethylation. These findings shed insights into the potential mechanisms by which melatonin improves oocyte quality during IVM.
Factors Associated with Colostrum Quality and Effects on Serum Gamma Globulin Concentrations of Calves in Swiss Dairy Herds
Authors: Reschke C. , Schelling E. , Michel A. , Remy‐Wohlfender F. , Meylan M.
Published: August 2017

Background

Previous studies have shown a high prevalence of failure of passive transfer of immunity (FPT) in Swiss dairy calves.

Objectives

To investigate risk factors associated with poor colostrum quality andFPTon Swiss dairy farms.

Animals

Colostrum and serum samples from 373 dam‐calf pairs at 141 farms.

Methods

The gamma globulin (Gg) concentrations of the dams’ colostrum and the calves’ serum samples were determined by electrophoresis. Potential risk factors were assessed by logistic regression of questionnaire data.

Results

Prevalence values of 15.5% (95% confidence interval [CI], 12.0–19.6%) for low‐quality colostrum (<50 g Gg/L) in cows and 43.5% (95%CI, 38.4–48.8%) forFPT(serum Gg < 10 g/L) in calves were estimated. The main factors associated with low colostrum quality included colostrum leakage before or during parturition and a time lag > 6 hours between parturition and first milking. The results confirm that the occurrence ofFPTin calves primarily was influenced by the quality of colostrum, the amount of ingested colostrum, and the time between birth and first feeding.

Conclusions and Clinical Importance

These results confirm a large potential for improvement in colostrum harvesting and colostrum feeding procedures in the study herds. Control for colostrum leaking intra‐partum, early colostrum milking, and ensuring that the calves ingest a sufficient volume of colostrum within the first hours of life are measures that can be readily implemented by farmers to decrease the incidence ofFPTwithout additional workload.
Climate signals in tree‐ring δ18O and δ13C from southeastern Tibet: insights from observations and forward modelling of intra‐ to interdecadal variability
Authors: Zeng Xiaomin , Liu Xiaohong , Treydte Kerstin , Evans Michael N. , Wang Wenzhi , An Wenling , Sun Weizhen , Xu Guobao , Wu Guoju , Zhang Xuanwen
Published: August 2017

Stable isotopes in tree rings are increasingly used as proxies for climatic and ecophysiological changes. However, uncertainties remain about the strength and consistency of their response to environmental variation at different temporal (i.e. seasonal to inter‐decadal) scales.

We developed 5 yr of intra‐seasonal and 62 yr of early‐ and late‐wood δ13C and δ18O series of Smith fir (Abies georgei var. smithii) on the southeastern Tibetan Plateau, and used a process‐based forward model to examine the relative importance of environmental and physiological controls on the isotopic data.

In this temperate high‐altitude region, the response, both δ18O and δ13C, is primarily to variations in relative humidity, but by different processes. In δ18O, the response is via source water δ18O but also arises from leaf water 18O enrichment. In δ13C, the response is via changes in stomatal conductance but is modified by carry‐over effects from prior periods.

We conclude that tree‐ring δ18O may be a more robust climate proxy than δ13C, and δ13C may be more suited to studies of site‐related physiological responses to the local environment.
Does water availability regulate biomass partitioning between trunk and branches?
Authors: Magnin A. , Torres C. D. , Villalba R. , Puntieri J. G.
Published: August 2017

The extent to which a vertical trunk is differentiated from its branches is a key trait for the architecture of trees and may affect interspecific relationships.

In this study, we analysed the effect of soil water availability on biomass partitioning for Nothofagus pumilio by means of a nursery experiment. Juvenile trees were subject to three irrigation conditions: no irrigation, intermediate irrigation and high irrigation. Irrigation conditions emulated the mean precipitation of the most representative environments inhabited by N. pumilio.

Changes in soil water availability modified the biomass partitioning patterns of trees. In comparison to the other two conditions, high irrigation caused: (i) a higher ratio of biomass partitioning to stems than roots; (ii) more trunk growth in relation to its branches; and (iii) more photosynthetic organs relative to the aboveground biomass. Trunk size relative to that of its most recent branches was not increased by water availability.

Water availability may play a significant role in the capacity of N. pumilio for space occupation due to the effects on axis differentiation.
Pollen and stigma size changes during the transition from tristyly to distyly inOxalis alpina(Oxalidaceae)
Authors: Baena‐Díaz F. , Fornoni J. , Sosenski P. , Weller S. G. , Domínguez C. A.
Published: August 2017

Pollen and stigma size have the potential to influence male fitness of hermaphroditic plants, particularly in species presenting floral polymorphisms characterised by marked differences in these traits among floral morphs. In this study, we take advantage of the evolutionary transition from tristyly to distyly experienced byOxalis alpina(Oxalidaceae), and examined whether modifications in the ancillary traits (pollen and stigma size) respond to allometric changes in other floral traits. Also, we tested whether these modifications are in accordance with what would be expected under the hypothesis that novel competitive scenarios (as in distylous‐derived reproductive system) exert morph‐ and whorl‐specific selective pressures to match the available stigmas.

We measure pollen and stigma size in five populations ofO. alpinarepresenting the tristyly–distyly transition.

A general reduction in pollen and stigma size occurred along the tristyly–distyly transition, and pollen size from the two anther levels within each morph converged to a similar size that was characterised by whorl‐specific changes (increases or decreases) in pollen size of different anthers in each floral type.

Overall, results from this study show that the evolution of distyly in this species is characterised not only by changes in sexual organ position and flower size, but also by morph‐specific changes in pollen and stigma size. This evidence supports the importance of selection on pollen and stigma size, which increase fitness of remaining morphs following the evolution of distyly, and raises questions to explore on the functional value of pollen size in heterostylous systems under pollen competition.
Pythium yorkensis sp. nov., a potential soybean pathogen from southeastern Pennsylvania, USA
Authors: Veterano S. T. , Coffua L. S. , Mena‐Ali J. I. , Blair J. E.
Published: August 2017

Biodiversity surveys of natural as well as agricultural ecosystems commonly reveal novel isolates. A new species, Pythium yorkensis sp. nov., is reported here, isolated from field soil during a survey of oomycete diversity in symptomless soybean across southeastern Pennsylvania. Molecular data from both mitochondrial and nuclear loci support a unique phylogenetic position for the isolates collected, and morphological features distinguish this new species from close relatives in Pythium clade J. Pathogenicity assays suggest that this new species may be a potential agricultural pathogen, as isolates were mildly aggressive on soybean. This study highlights the continued need for culture‐based surveys in collaboration with high‐throughput sequence‐based approaches for environmental sampling.
Passive restoration following ungulate removal in a highly disturbed tropical wet forest devoid of native seed dispersers
Authors: Nafus Melia G. , Savidge Julie A. , Yackel Adams Amy A. , Christy Michelle T. , Reed Robert N.
Published: August 2017

Overabundant ungulate populations can alter forests. Concurrently, global declines of seed dispersers may threaten native forest structure and function. On an island largely devoid of native vertebrate seed dispersers, we monitored forest succession for 7 years following ungulate exclusion from a 5‐ha area and adjacent plots with ungulates still present. We observed succession from open scrub to forest and understory cover by non‐native plants declined. Two trees, native Hibiscus tiliaceus and non‐native Leucaena leucocephala, accounted for most forest regeneration, with the latter dominant. Neither species is dependent on animal dispersers nor was there strong evidence that plants dependent on dispersers migrated into the 5‐ha study area. Passive restoration following ungulate removal may facilitate restoration, but did not show promise for fully restoring native forest on Guam. Restoration of native forest plants in bird depopulated areas will likely require active outplanting of native seedlings, control of factors resulting in bird loss, and reintroduction of seed dispersers.
Renewal ecology: conservation for the Anthropocene
Authors: Bowman David M. J. S. , Garnett Stephen T. , Barlow Snow , Bekessy Sarah A. , Bellairs Sean M. , Bishop Melanie J. , Bradstock Ross A. , Jones Darryl N. , Maxwell Sean L. , Pittock Jamie , Toral‐Granda Maria V. , Watson James E. M. , Wilson Tom , Zander Kerstin K. , Hughes Lesley
Published: August 2017

The global scale and rapidity of environmental change is challenging ecologists to reimagine their theoretical principles and management practices. Increasingly, historical ecological conditions are inadequate targets for restoration ecology, geographically circumscribed nature reserves are incapable of protecting all biodiversity, and the precautionary principle applied to management interventions no longer ensures avoidance of ecological harm. In addition, human responses to global environmental changes, such as migration, building of protective infrastructures, and land use change, are having their own negative environmental impacts. We use examples from wildlands, urban, and degraded environments, as well as marine and freshwater ecosystems, to show that human adaptation responses to rapid ecological change can be explicitly designed to benefit biodiversity. This approach, which we call “renewal ecology,” is based on acceptance that environmental change will have transformative effects on coupled human and natural systems and recognizes the need to harmonize biodiversity with human infrastructure, for the benefit of both.
Low‐cost agricultural waste accelerates tropical forest regeneration
Authors: Treuer Timothy L. H. , Choi Jonathan J. , Janzen Daniel H. , Hallwachs Winnie , Peréz‐Aviles Daniel , Dobson Andrew P. , Powers Jennifer S. , Shanks Laura C. , Werden Leland K. , Wilcove David S.
Published: August 2017

Lower‐cost tropical forest restoration methods, particularly those framed as win–win business‐protected area partnerships, could dramatically increase the scale of tropical forest restoration activities, thereby providing a variety of societal and ecosystem benefits, including slowing both global biodiversity loss and climate change. Here we describe the long‐term regenerative effects of a direct application of agricultural waste on tropical dry forest. In 1998, as part of an innovative agricultural waste disposal service contract, an estimated 12,000 Mg of processed orange peels and pulp were applied to a 3 ha portion of a former cattle pasture with compacted, rocky, nutrient‐poor soils characteristic of prolonged fire‐based land management and overgrazing in Área de Conservación Guanacaste, northwestern Costa Rica. After 16 years, the experimental plot showed a threefold increase in woody plant species richness, a tripling of tree species evenness (Shannon Index), and a 176% increase in aboveground woody biomass over an adjacent control plot. Hemispheric photography showed significant increases in canopy closure in the area where orange waste was applied relative to control. Orange waste deposition significantly elevated levels of soil macronutrients and important micronutrients in samples taken 2 and 16 years after initial orange waste application. Our results point to promising opportunities for valuable synergisms between agricultural waste disposal and tropical forest restoration and carbon sequestration.
The validity and reliability of the type 2 diabetes and health promotion scale Turkish version: a methodological study
Authors: Yildiz Esra , Kavuran Esin
Published: August 2017

Objective

A healthy promotion is important for maintaining health and preventing complications in patients with type 2 diabetes.

Aim

The aim of the present study was to examine the psychometrics of a recently developed tool that can be used to screen for a health‐promoting lifestyle in patients with type 2 diabetes.

Method

Data were collected from outpatients attending diabetes clinics. The Type 2 Diabetes and Health Promotion Scale (T2DHPS) and a demographic questionnaire were administered to 295 participants. Forward–backward translation of the original English version was used to develop a Turkish version. Internal consistency of the scale was assessed by Cronbach's alpha. An explanatory factor analysis and confirmatory factor analysis used validity of the Type 2 Diabetes and Health Promotion Scale – Turkish version.

Results

Kaiser‐Meyer‐Olkin (KMO) and Bartlett's sphericity tests showed that the sample met the criteria required for factor analysis. The reliability coefficient for the total scale was 0.84, and alpha coefficients for the subscales ranged from 0.57 to 0.92. A six‐factor solution was obtained that explained 59.3% of the total variance. The ratio of chi‐square statistics to degrees of freedom (χ2/df) 3.30 (χ2 = 1157.48/SD = 350); error of root mean square approximation (RMSEA) 0.061; GFI value of 0.91 and comparative fit index (CFI) value was obtained as 0.91.

Conclusions

Turkish version of The T2DHPS is a valid and reliable tool that can be used to assess patients’ health‐promoting lifestyle behaviours. Validity and reliability studies in different cultures and regions are recommended.
Conflicting rationales: leader's experienced ethical challenges in community health care for older people
Authors: Slettebø Åshild , Skaar Ragnhild , Brodtkorb Kari , Skisland Anne
Published: August 2017

Background

Ethical challenges arise in all types of care, and leaders need to be aware of how to resolve these challenges. Healthcare systems tend to be organised around medical conditions, and the patient is often faced with a series of uncoordinated visits to multiple specialties. Ideally, care should be organised around the patient's needs.

Aim

The purpose of this article was to highlight some ethical challenges perceived by leaders with responsibility for management and service distribution, finance and ensuring quality of community health services for older people.

Method

This study had a qualitative design with a qualitative content analysis of one focus group with six leaders that met four times in total. Leaders from the community healthcare sector in one Norwegian municipality were included, representing both nursing homes and home‐based health care. The study followed the intentions of the Declaration of Helsinki and standard ethical principles. The Norwegian Social Science Data Services approved the study. All participants voluntarily gave written informed consent.

Findings

The main theme that emerged from this study was the ethical challenge leaders felt in the form of an inherent conflict between a caring rationale versus economic or technological rationales. Four categories emerged: (i) Management: quality versus economy; (ii) Prioritisation: fair distribution of healthcare services; (iii) Responsibility: considering individuals' needs versus the needs of the whole community; and (iv) Welfare technology: possibilities and challenges.

Conclusion

Leaders' responsibilities in community health care for older people need to strike a balance between ethical principles in the management of limited resources.
Attitudes of mental health professionals towards service user involvement
Authors: Kortteisto Tiina , Laitila Minna , Pitkänen Anneli
Published: August 2017

Patient‐centred care and user involvement in healthcare services are much emphasised globally. This study was the first step in a multicentre research project in Finland to improve service users' and carers' opportunities to be more involved in mental health services. The aim of the study was to assess attitudes of professionals towards service user involvement. The data were collected via an online questionnaire from 1069 mental health professionals in four hospital districts. Altogether, 351 professionals responded. Data were analysed using appropriate statistical methods. According to the results, attitudes of healthcare professionals were more positive towards service users' involvement in their own treatment than in other levels of services. There were also differences in gender, age groups, working places and experiences in the attitudes of professionals concerning service users' involvement in their own treatment. These should be taken into account in the future when planning education for mental health professionals. In spite of governmental guidance on service user involvement and the growing body of knowledge of the benefits associated with it, change in attitudes towards user involvement is slow. Special attention should be paid to the attitudes of professionals working in inpatient care and of those with less working experience.
Attitudes towards care robots among Finnish home care personnel – a comparison of two approaches
Authors: Rantanen Teemu , Lehto Paula , Vuorinen Pertti , Coco Kirsi
Published: August 2017

Study's rationale

The significance of care robotics has been highlighted in recent years.

Aims and objective

The article examines the adoption of care robots in home care settings, and in particular Finnish home care personnel's attitudes towards robots. The study compares the importance of the Negative Attitudes towards Robots Scale advanced by Nomura and specific positive attitudes related to the usefulness of care robots for different tasks in the home care.

Methodological design

A cross‐sectional study conducted by questionnaire. The research data were gathered from a survey of Finnish home care personnel (n = 200).

Research methods

Exploratory factor analysis, Pearson's correlation coefficient and linear regression analysis.

Measures

The Negative Attitudes towards Robots Scale (NARS), by Nomura, with a specific behavioural intention scale based on Ajzen's theory of planned behaviour, and a measure of positive attitudes towards the usefulness of care robots for different tasks in home care and the promotion of independent living of older persons.

Results

The study shows that NARS helps to explain psychological resistance related to the introduction of care robots, although the scale is susceptible to cultural differences. Care personnel's behavioural intentions related to the introduction of robot applications are influenced also by the perception of the usefulness of care robots.

Study limitations

The study is based only on a Finnish sample, and the response rate of the study was relatively small (18.2%), which limits the generalisability of the results.

Conclusions

The study shows that the examination of home care personnel's attitudes towards robots is not justified to focus only on one aspect, but a better explanation is achieved by combining the perspectives of societal attitudes, attitudes related to psychological reactions and the practical care and promotion of the independent living of older people.
An ethnographic investigation of healthcare providers' approaches to facilitating person‐centredness in group‐based diabetes education
Authors: Stenov Vibeke , Hempler Nana Folmann , Reventlow Susanne , Wind Gitte
Published: August 2017

Aim

To investigate approaches among healthcare providers (HCPs) that support or hinder person‐centredness in group‐based diabetes education programmes targeting persons with type 2 diabetes.

Methods

Ethnographic fieldwork in a municipal and a hospital setting in Denmark. The two programmes included 21 participants and 10 HCPs and were observed over 5 weeks. Additionally, 10 in‐depth semi‐structured interviews were conducted with patients (n = 7) and HCPs (n = 3). Data were analysed using systematic text condensation.

Results

Hindering approaches included a teacher‐centred focus on delivering disease‐specific information. Communication was dialog based, but HCPs primarily asked closed‐ended questions with one correct answer. Additional hindering approaches included ignoring participants with suboptimal health behaviours and a tendency to moralize that resulted in feelings of guilt among participants. Supporting approaches included letting participants set the agenda using broad, open‐ended questions.

Discussion

Healthcare providers are often socialized into a biomedical approach and trained to be experts. However, person‐centredness involves redefined roles and responsibilities. Applying person‐centredness in practice requires continuous training and supervision, but HCPs often have minimum support for developing person‐centred communication skills. Techniques based on motivational communication, psychosocial methods and facilitating group processes are effective person‐centred approaches in a group context.

Conclusion

Teacher‐centredness undermined person‐centredness because HCPs primarily delivered disease‐specific recommendations, leading to biomedical information overload for participants.
User participation in a Municipal Acute Ward in Norway: dilemmas in the interface between policy ideals and work conditions
Authors: Johannessen Anne‐Kari , Tveiten Sidsel , Werner Anne
Published: August 2017

User participation has become an increasingly important principle in health care over the last few decades. Healthcare professionals are expected to involve patients in treatment decisions. Clear guidance as to what this should entail for professionals in clinical work is not accounted for in legislation. In this study, we explore how healthcare professionals in a Municipal Acute Ward perceived, experienced and performed user participation. The ward represents a new short‐time service model for emergency assistance in Norway. We focused on the challenges the professionals faced in clinical work and how they dealt with these. Data were drawn from qualitative interviews with 11 healthcare professionals and from 10 observations in relation to previsits and physician's rounds in the ward. Transcripts of interviews and observations were analysed using a method for systematic text condensation. In the analysis, we applied Lipsky's perspective on dilemmas of street‐level bureaucrats. The results show that that the professionals perceived user participation as an important and natural part of their work. They experienced difficulties related to collaboration with patients, caregivers, and professionals in other services, and with framework conditions that caused conflicting expectations, responsibility, and priorities. The professionals seemed to take a pragmatic approach to user participation, managing it within narrow perspectives. Our study indicates that the participants dealt with the dilemmas at the cost of user participation. The results demonstrate that there is a gap between the outlined health policy and the professionals' opportunities to fulfil this policy in clinical work regarding user participation. The policy decision‐makers should recognise the balancing work required of healthcare professionals to deal with difficulties in clinical work. The knowledge that professionals possess as performers of services and the need for valuing in policy processes should be acknowledged.
Patient experience with early discharge after total knee arthroplasty: a focus group study
Authors: Høvik Lise Husby , Aglen Bjørg , Husby Vigdis Schnell
Published: August 2017

Background

Total knee arthroplasty is experienced as a painful procedure, and pain after surgery seems to be the most limiting factor for early mobilisation. Physical exercise is of utter importance for avoiding complications such as persistent pain and functional limitations. A fast‐track pathway aims at improving patient outcome, and patients are now discharged 2–3 days after surgery. Little is known about how the patients cope with pain, exercise or daily activities at home.

Aim

To explore the experience of patients undergoing total knee arthroplasty in a fast‐track pathway during the first 2 weeks after surgery.

Design

Qualitative design.

Methods

Three focus group interviews, including 13 patients from two different units of an orthopaedic department in central Norway, were conducted from May to June 2015. The interviews were analysed using Malteruds` method of systematic text condensation.

Findings

The main finding was the patients' determination and ability to cope at home. The fast‐track pathway seemed to enable patients to take an active role in own self‐care. The patient's coping capacity was strengthened by education, knowledge and predictability. Four main areas related to coping emerged after discharge. First, the majority of patients expressed that it was good to come home and take responsibility for their own rehabilitation. Second, prerequisites for feeling secure after returning home were highlighted. Third, the patients seemed empowered by sharing experiences with others. Fourth, postoperative pain was prevalent in many patients after discharge, but the patients seemed prepared by information provided in the fast‐track pathway.

Conclusion

The fast‐track pathway released coping skills and resources among the patients. The expectation of, and preparation for early discharge made the patients feel confident when discharged few days after surgery. The patients expected to take great responsibility for their own rehabilitation process.
Aggregate Fluctuations and International Migration
Authors: Beine Michel , Bourgeon Pauline , Bricongne Jean‐Charles
Published: August 2017

In this paper, we study the role of short‐run factors such as business cycles or changes in employment rates in explaining international migration flows. First, we derive a model of optimal migration choice predicting that short‐run economic fluctuations trigger migration flows on top of the impact exerted by long‐run factors. Second, we empirically test the magnitude of the effect of these short‐run factors on migration flows. Our results indicate that both aggregate fluctuations and employment rates affect migration flows. Third, we provide evidence that the Schengen Agreement and the euro significantly increased the international mobility of workers between the member countries.uuuü
Relationship of personality with integration and confrontation in internal dialogues
Authors: Puchalska‐Wasyl Małgorzata M.
Published: August 2017

Interest in confrontational and integrative internal dialogues (IDs) has been growing, as they perform numerous important functions. This study aimed to identify the personality‐related determinants of integration and confrontation processes in ID that simulates social relationships. The test group comprised 125 students (62 men). Participants were given a description of a fictional problem facing a young married couple and they were to imagine a dialogue between the characters. Additionally three instruments were administered: the NEO Five Factor Inventory, the Experiences in Close Relationships – Revised Questionnaire and the Integration‐Confrontation Questionnaire. Using canonical correlation analysis it was found that intense neuroticism and anxious or avoidant attachments, combined with low openness, conscientiousness and agreeableness, are conducive to confrontational attitude in the author of a dialogue, whereas the opposite combination of personality characteristics is associated with integrative attitudes in both parties to the dialogue.
Youth Suicide Deaths: Investigation of Clinical Predictors in a Statewide Sample
Authors: Keeshin Brooks R. , Gray Doug , Zhang Chong , Presson Angela P. , Coon Hilary
Published: August 2017

Death by suicide is a significant cause of mortality among youth. However, there is limited information on the demographic and clinical factors associated with youth suicide deaths. The objective of this study was to link large statewide databases to describe demographic, clinical, and cause of death characteristics among youth who died by suicide. We examined 1,218 decedents under age 26 who died by suicie between 2000 and 2014. Eighteen died before age 12, 53 died between ages 12 and 14, 292 died between ages 15 and 18, and 855 died between ages 19 and 25. Most were male (83%), and firearm was most common cause of death; 28% previously attempted suicide, 31% had a mental health diagnosis, and 17% were prescribed psychotropic medication. Younger children died by hanging/smothering (89% of all 7‐ to 11‐year olds), and overdose/poisoning increased progressively with age. Adolescents had a higher proportion of females than young adults (23% vs. 14%, p = .002). Combining data from the medical examiner and large hospital systems allows examination of youth suicide from a developmental perspective. Differences between age groups included gender, method, diagnosed mental illness, and diagnosis of attention deficit hyperactivity disorder. These data point to missed opportunities for effective interventions for specific developmental stages.
Cold water immersion: kill or cure?
Authors: Tipton M. J. , Collier N. , Massey H. , Corbett J. , Harper M.
Published: August 2017

New Findings

What is the topic of this review?

This is the first review to look across the broad field of ‘cold water immersion’ and to determine the threats and benefits associated with it as both a hazard and a treatment.

What advances does it highlight?

The level of evidence supporting each of the areas reviewed is assessed.

Like other environmental constituents, such as pressure, heat and oxygen, cold water can be either good or bad, threat or treatment, depending on circumstance. Given the current increase in the popularly of open cold water swimming, it is timely to review the various human responses to cold water immersion (CWI) and consider the strength of the claims made for the effects of CWI. As a consequence, in this review we look at the history of CWI and examine CWI as a precursor to drowning, cardiac arrest and hypothermia. We also assess its role in prolonged survival underwater, extending exercise time in the heat and treating hyperthermic casualties. More recent uses, such as in the prevention of inflammation and treatment of inflammation‐related conditions, are also considered. It is concluded that the evidence base for the different claims made for CWI are varied, and although in most instances there seems to be a credible rationale for the benefits or otherwise of CWI, in some instances the supporting data remain at the level of anecdotal speculation. Clear directions and requirements for future research are indicated by this review.
Central angiotensin‐(1–7) increases osmotic thirst
Authors: dos‐Santos Raoni Conceição , Monteiro Lívia da Rocha Natalino , Paes‐Leme Bruno , Lustrino Danilo , Antunes‐Rodrigues José , Mecawi André Souza , Reis Luís Carlos
Published: August 2017

New Findings

What is the central question of this study?

The central goal of this study was to understand the effects of central angiotensin‐(1–7) on basal and osmotically stimulated water intake in rats.

What is the main finding and its importance?

This study demonstrated that central administration of angiotensin‐(1–7) did not induce thirst in basal conditions but increased water intake after osmotic stimulation, such as water deprivation and salt loading. These results indicate a new function for this peptide, which, in turn, allows for future research on the mechanisms through which angiotensin‐(1–7) influences osmotic thirst.

Angiotensin‐(1–7) [Ang‐(1–7)] is generated by type 2 angiotensin‐converting enzyme (ACE2) and binds to the MAS receptor. Although it is well known that Ang‐(1–7) functionally antagonizes the effects of the classical renin–angiotensin system in several situations, the role of Ang‐(1–7) in hydromineral homeostasis is not clear. The aim of this study was to assess the role of Ang‐(1–7) on neuroendocrine responses to hyperosmolality in rats. Male Wistar rats were divided into the following three groups: control; 24 h of water deprivation (WD); and 24 h of salt loading (SL; 1.8% NaCl). Intracerebroventricular (i.c.v.) injections of Ang‐(1–7) or vehicle were given to assess water intake and plasma concentration of vasopressin. Additionally, the brains from control and WD groups were collected to evaluate gene expression in the subfornical organ (SFO), paraventricular nucleus (PVN) and supraoptic nucleus (SON). It was found that i.c.v. Ang‐(1–7) did not change water and salt intake in control rats; however, Ang‐(1–7) increased water intake after WD and SL, with no change in salt intake. Plasma vasopressin was not changed by i.c.v. Ang‐(1–7) in control or WD rats. Moreover, WD increased Mas gene expression in the SON and PVN, with no changes in Ace2 mRNA levels. In conclusion, Ang‐(1–7) increases thirst after osmotic stimuli, indicating that a previous sensitization to its action is necessary. This finding is consistent with the increased Mas gene expression in the PVN and SON after water deprivation.