bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptation of an in‐house PCR for the detection of Helicobacter pylori and the mutations associated with macrolide resistance into ready‐to‐use PCR microwell strips
Authors: Bénéjat Lucie , Ducournau Astrid , Domingues‐Martins Chloé , Lecoeur Mélanie , Blosse Alice , Mégraud Francis , Bessède Emilie , Lehours Philippe
Published: October 2021

Background and Objectives

The present study describes the successful adaptation of an in‐house Polymerase Chain Reaction (PCR) for Helicobacter pylori detection coupled with the main mutations associated with resistance to clarithromycin in ready‐to‐use PCR microwell strips.

Materials and Methods

These microwell strips can be used on LightCycler® 480, and are delivered with nine microliters of the reaction mixture dispensed into 8‐well microwell strips. An extraction control PCR targeting the β‐globin household gene is amplified in the same run as H pylori detection.

Results and Conclusion

These microwell strips can be stored at −20°C for 1 year and left at room temperature and in the light for up to 4 h with no impact on the PCR results. Microwell strips can also undergo a thaw and refreeze cycle without impacting the PCR results. These PCR microwell strips are available for purchase from Eurogentec.
Identifying local barriers to access to healthcare services in Chile using a communitarian approach
Authors: Núñez Alicia , Manzano Carlos A.
Published: October 2021

Introduction

Previous research has used proxy variables or a unique construct to quantify healthcare access. However, there is a need for a different model that can handle this multivariable problem. This study seeks to develop a way to measure access to the local healthcare system with higher local resolution.

Methods

A new survey was developed based on communitarian claims, following a behavioural model and an ontological framework. The survey was used to identify local barriers to healthcare services and the local preferences for priority settings. The results were analysed using multiattribute utility functions and individual weights were assigned by a panel of experts. National and regional indexes of access to healthcare were developed.

Results

The survey contained seven modules and 104 questions. It was conducted on 1885 participants at 42 rural and 231 urban locations in three regions of Chile. The total disutility of the identified barriers to healthcare access at the national level was low (0.1448; values ranged between 0 and 1, with 1 representing a higher barrier) and was higher in the northern region (0.1467). The barriers associated with the health‐policy component showed the highest disutility value, and specific barriers for each community were identified.

Conclusions

These results have the potential to improve health decision‐making in Chile and can be used to assess the impacts of new health policy reforms. Although this model was tested in Chile, it can be adapted for use in any other country.

Patient or Public Contribution

Participants contributed to this study by completing a survey, participating in general talks and receiving brochures with the results obtained from this study.
Framing gender in Mughal South Asia
Authors: Kalb Emma
Published: October 2021

Research on gender in Mughal South Asia has tended to focus either on the nature of the harem and elite female seclusion or, alternately, on constructions of elite masculinity. The first body of literature centers on debates as to the degree to which the harem functioned to limit (elite) women and constrain their political, economic, and social roles. The second analyzes how normative masculinity took shape during different reigns, according to both the preferences of the emperor and his advisors as well as the broader socio‐political context. Taken as a whole, this body of work provides nuanced, contextualized accounts of how gender functioned to shape the lives and/or representations of elite men and women, even as it echoes archival sources in focusing on Mughal elites and tends to be framed primarily in terms of the Persianate or Islamicate world. Recent research suggests not only the value of examining questions of gender in relation to non‐elites, but also the relevance of the household and the family, the influence of the Indic, the relationship of notions of gender to understandings of the body itself, and alternatives to a narrowly defined gender binary.
Diagnostic value of white blood cell parameters for COVID‐19: Is there a role for HFLC and IG?
Authors: Myari Alexandra , Papapetrou Evangelia , Tsaousi Christina
Published: October 2021

Introduction

As the Coronavirus disease 2019 (COVID‐19) pandemic is still ongoing with patients overwhelming healthcare facilities, we aimed to investigate the ability of white blood cell count (WBC) and their subsets, high fluorescence lymphocyte cells (HFLC), immature granulocyte count (IG), and C‐reactive protein (CRP) to aid diagnosis of COVID‐19 during the triage process and as indicators of disease progression to serious and critical condition.

Methods

We collected clinical and laboratory data of patients, suspected COVID‐19 cases, admitted at the emergency department of University General Hospital of Ioannina (Ioannina, Greece). We selected 197 negative and 368 positive cases, confirmed by polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2. COVID‐19 cases were classified into mild, serious, and critical disease. Receiver operating characteristic curve and binary logistic regression analysis were utilized for assessing the diagnosing ability of biomarkers.

Results

WBC, neutrophil count (NEUT), and HFLC can discriminate efficiently negative cases from mild and serious COVID‐19, whereas eosinopenia and basopenia are early indicators of the disease. The combined WBC‐HFLC marker is the best diagnostic marker for both mild (sensitivity: 90.6% and specificity: 64.1%) and serious (sensitivity: 90.3% and specificity: 73.4%) disease. CRP and Lymphocyte count are early indicators of progression to serious disease whereas WBC, NEUT, IG, and neutrophil‐to‐lymphocyte ratio are the best indicators of critical disease.

Conclusion

Lymphopenia is not useful in screening patients with COVID‐19. HFLC is a good diagnostic marker for mild and serious disease either as a single marker or combined with WBC whereas IG is a good indicator of progression to critical disease.
Where Does the Holy Spirit Proceed To?
Authors: Lombardo Nicholas E.
Published: October 2021

Following suggestions from Karl Rahner and Gilles Emery, this article looks to the economy for answers about where, within the immanent Trinity, the Holy Spirit proceeds to. After discussing the theological legitimacy of the question and drawing some initial conclusions – namely, that the Spirit proceeds from the Father to the Son, and then through the Son back to the Father – it discusses indications in the economy that conflict with these initial conclusions, and then proposes a resolution. It proposes that, by holding the Holy Spirit to be identical with the Spirit's very act of proceeding, and by understanding the Spirit's act of proceeding to be a circular movement from Father to Son and then back to the Father, the conflicting indications of the economy can be resolved.
Long‐term effect of extracorporeal magnetic innervation for post‐prostatectomy urinary incontinence: 1‐year follow‐up
Authors: Terzoni Stefano , Ferrara Paolo , Mora Cristina , Destrebecq Anne
Published: October 2021

Urinary incontinence after radical prostatectomy is a common and bothersome problem. Pelvic floor muscle training (PFMT) is supported by strong recommendations in the European guidelines as the first‐choice rehabilitation method. Extracorporeal magnetic innervation (ExMI) has been studied in a previous pilot investigation by our team and seemed useful for shortening the duration of the rehabilitation programme, although patients still need to perform maintenance PFMT regardless of the method chosen for rehabilitation. Very few data exist in literature about its long‐term effects on men; the need for additional evidence therefore remains. To investigate the long‐term effects of ExMI associated with maintenance PFMT, compared to PFMT alone, in maintaining continence after the end of a rehabilitation programme. Follow‐up study on 83 rehabilitated patients (67 PFMT, 16 ExMI). All patients were instructed by a nurse specialist to perform the same maintenance PFMT exercises, based on the literature. Pad‐test was performed by all patients after 3, 6 and 12 months from the end of the rehabilitation programme. As in previously published studies, rehabilitation was defined as leakages <10 g/day based on a literature definition. A mixed effects linear model was used to assess differences between residual leakages over time. Both PFMT and ExMI gave clinically satisfactory results during the whole follow‐up period, without statistically significant differences in the leakages. However, the correlation coefficients suggest that the results are more stable in the PFMT group over time, with less variations in the residual leakages. ExMI can be used during rehabilitation to speed up recovery, but PFMT are still needed for maintenance and provide better results in the long run, even though ExMI also provides satisfactory continence outcomes at follow‐up. Studies on larger samples are needed to confirm these findings.
Using video observation in the family context: The association between camera‐related behaviors and parental sensitivity
Authors: Flameling L. Jacob , Mesman Judi
Published: October 2021

Research on parental sensitivity often relies on video observation of parent–infant dyads. However, to date, no study has assessed both infants’ and parents’ interactions with the camera, and how this relates to parental sensitivity levels. This exploratory study micro‐coded camera‐related behaviors (CRB) by 4‐month olds and their mothers and fathers on a 1‐s time base, and examined the associations between those behaviors and parental sensitivity in 75 Dutch families. While parents’ CRB made up only 0.8% of total interaction time, infants’ made up 12%. Multi‐level time‐series analyses showed that infants’ CRB predicted mothers’. Infants’ CRB predicted fathers’ CRB, and vice versa. Maternal sensitivity was significantly lower when children looked at the camera for over one‐third of total interaction time (Cohen's d = 1.26). These findings indicate further research is required to better understand how video observation might threaten ecological validity.
Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe—A longitudinal study
Authors: Kaihlanen Anu‐Marja , Gluschkoff Kia , Koskinen Sanna , Salminen Leena , Strandell‐Laine Camilla , Fuster Linares Pilar , Sveinsdóttir Herdís , Fatkulina Natalja , Ní Chianáin Linda , Stubner Juliane , Leino‐Kilpi Helena ,   the ProCompNurse Consortium
Published: October 2021

Aims

The aim of the study was to examine the association between the characteristics of a nursing student’s final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries.

Design

A longitudinal design with two data collections points (pre‐ and post‐graduate).

Methods

The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence.

Results

Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found.

Conclusion

Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession.

Impact

This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses.
Designing a nurse‐led assessment and care planning intervention to support frail older people in primary care: An e‐Delphi study
Authors: Lyndon Helen , Latour Jos M. , Marsden Jonathan , Kent Bridie
Published: October 2021

Aim

To identify and establish expert consensus on important and feasible components of a nurse‐led, comprehensive geriatric assessment (CGA)‐based intervention for community‐dwelling older people who live with frailty.

Design

A three‐round modified e‐Delphi survey.

Methods

An expert panel of 33 UK specialist older people's, primary and community care nurses participated in the three‐round e‐Delphi survey over a 12‐month period in 2017–2018. Data from round 1 were analysed using content analysis. Descriptive statistics were used in the subsequent two rounds to demonstrate convergence of panel opinion and consensus.

Results

In round 1, experts proposed 30 CGA components that were combined with six additional components from a literature review and clustered into six domains. In round 2, components were rated for importance and feasibility. Rating scores for importance were high across all domains, with lower scores for feasibility. Round 3 revealed that 36 components achieved consensus on importance and 11 out of 36 components reached consensus on feasibility.

Conclusion

Based on expert panel opinion, the content of a nurse‐led CGA‐based intervention was established, with the aim of future feasibility testing in a randomized controlled trial.

Impact

This study provides feasible components of a CGA‐based intervention that can be implemented in clinical practice by nurses in partnership with older people who live with frailty. Following further testing and evaluation, the components have the potential to improve clinical outcomes, maximize independence and improve the quality of life for community‐dwelling frail older people.
GPX7 Facilitates BMSCs Osteoblastogenesis via ER Stress and mTOR Pathway
Authors: Hu Xuchen , Li Boer , Wu Fanzi , Liu Xiaoyu , Liu Mengyu , Wang Chenglin , Shi Yu , Ye Ling
Published: October 2021

Emerging evidence indicates extensive oxidative stress is a consequence of obesity which impairs bone formation. Glutathione peroxidase 7 (GPX7) is a conserved endoplasmic reticulum (ER) retention protein, lacking of which causes accumulation of reactive oxygen species (ROS) and promotes adipogenesis. Since the imbalance between osteogenic and adipogenic differentiation of bone marrow mesenchymal stem cell (BMSC) leads to severe bone diseases such as osteoporosis, it is critical to investigate the potential protective role of Gpx7 in osteogenesis. Here, we provide evidence that deficiency of Gpx7 reduces osteogenesis, but increases adipogenesis in both human BMSCs (hBMSCs) and mouse mesenchymal stem cell line. Interestingly, further studies indicate this defect can be alleviated by the ER stress antagonist, but not the ROS inhibitor, unveiling an unexpected finding that, unlike adipogenesis, lacking of Gpx7 inhibits osteogenesis mediating by induced ER stress instead of enhanced ROS. Furthermore, the mTOR signalling pathway is found down‐regulation during osteogenic differentiation in Gpx7‐deficient condition, which can be rescued by relief of ER stress. Taken together, for the first time we identify a novel function of Gpx7 in BMSCs’ osteogenic differentiation and indicate that Gpx7 may protect against osteoporotic deficits in humans through ER stress and mTOR pathway interplay.
A pooled analysis of randomized, controlled, phase 3 trials investigating the efficacy and safety of a novel, fixed dose calcipotriene and betamethasone dipropionate cream for the topical treatment of plaque psoriasis
Authors: Pinter A. , Green L.J. , Selmer J. , Praestegaard M. , Gold L.S. , Augustin M. ,   the trial investigator group
Published: October 2021

Background

Plaque psoriasis is a common, chronic and relapsing inflammatory skin disease clinically characterized by erythema and scaling desquamation. As over 90% of psoriasis patients benefit from topical therapies, local treatments continue to play an eminent role in management strategies. One such topical treatment is the fixed dose combination of calcipotriol (CAL) and betamethasone dipropionate (BDP).

Objectives

Pooled analysis of two different phase 3 clinical trails to compare superiority regarding efficacy, safety and quality of life (QoL) between CAL/BDP PAD‐cream and CAL/BDP TS.

Methods

The data from two phase 3, multicentre, randomized, investigator‐blind, active and vehicle‐controlled trials enrolling patients with psoriasis were pooled and analysed. Investigational products included a CAL/BDP cream based on PAD™ Technology (PAD‐cream) designed for high skin penetration and increased patient preference, an active control (marketed CAL/BDP topical suspension/gel, in the following abbreviated as CAL/BDP TS) and cream vehicle, which were applied once daily for 8 weeks.

Results

Efficacy and safety of the novel CAL/BDP PAD‐cream formulation for the topical treatment of psoriasis demonstrated superiority for all efficacy end points after 8 weeks of treatment. PGA treatment success for CAL/BDP PAD‐cream (43.2%) was greater than CAL/BDP TS (31.9%; P < 0.0001), the mean per cent reduction in mPASI for CAL/BDP PAD‐cream was 64.6% compared to 56.4% for CAL/BDP TS (P < 0.0001) and DLQI 0/1 was obtained by 43.8% in the CAL/BDP PAD‐cream group versus 34.2% in the CAL/BDP TS group (P = 0.0005). There was no adverse drug reaction reported with a frequency of >1%, associated with the CAL/BDP PAD‐cream.

Conclusions

The novel fixed dose combination CAL/BDP PAD‐cream offers greater efficacy, superior patient QoL and equivalent favourable safety for the topical treatment of psoriasis, in comparison to the currently available topical suspension/gel.
Montgomery's legal and practical impact: A systematic review at 6 years
Authors: Le Gallez Isabelle , Skopek Jeffrey , Liddell Kathleen , Kuhn Isla , Sagar Andrew , Fritz Zoë
Published: October 2021

Rationale, Aims and Objectives

Six years ago, the Supreme Court judgement in Montgomery v Lanarkshire changed medical law. It introduced a new patient‐based standard of care for the communication of treatment risks and alternatives, rejecting the doctor‐based standard that had long governed all aspects of medical negligence. This is the first systematic review to analyse the literature on Montgomery. Our aim is to appraise and synthesize the literature on Montgomery's impact on medicine and the law and to identify areas for further academic enquiry and implications for professional guidance and training.

Methods

Searches were run in Medline, Embase, PsycINFO, Web of Science, Scopus, Westlaw UK, HeinOnline, and LexisNexis. Two reviewers screened papers. Extracted data was analysed and discussed by an interdisciplinary team. PRISMA guidelines were followed.

Results

Of the 1134 papers identified, 100 met the inclusion criteria. These papers revealed significant disagreement on four core sets of issues, focusing on Montgomery's impact on: (1) legal and professional duties; (2) medical practice; (3) the patient experience; and (4) litigation. The first set addresses whether the case actually changed doctors' legal and professional duties, the relationship between GMC guidance and medical law, and the boundaries of Montgomery. The second explores whether the decision has incentivized defensive medicine, its resource implications, and doctors' knowledge of it. The third concerns whether and how the decision has promoted patient autonomy and involvement in their own care. The fourth focuses on whether the case has caused an increase in litigation.

Conclusions

Despite the abundance of legal and medical literature on Montgomery, many issues remain unresolved. Empirical research is required for many of the questions. Doctrinal analysis informed by medical knowledge is also required to assess whether Montgomery may have unrecognized ramifications—for example, whether it will require the disclosure of risks associated with diagnostic uncertainty, where doctors advise patients without performing procedures.
Enamel wear against monolithic zirconia restorations: A meta‐analysis and systematic review of in vitro studies
Authors: Aljomard Yasamin R. M. , Altunok Elif Çiğdem , Kara Haluk Barış
Published: October 2021

Objective

An assessment was performed to identify and evaluate dental enamel wear caused by monolithic zirconia restoration. Literature searches were conducted in PubMed, Science Direct, Cochrane Evidence, and the Cochrane Library up to May 2020.

Material and methods

Studies were selected for systematic review according to the inclusion (articles conducted on the wear of enamel samples opposing monolithic zirconia) and exclusion (case reports, non‐English articles, and monolithic zirconia samples facing other materials rather than human enamel) criteria. Of those, articles on polished and glazed monolithic zirconia subjected to a 50 N vertical load with a range of 240,000–250,000 cycles, equivalent to 1 year of in vivo mastication, were included in the meta‐analysis.

Results

In total, 3968 articles were pooled. Twenty‐five articles met the inclusion criteria for the systematic review. Three studies were included in the meta‐analysis. The results showed that the enamel wear against monolithic zirconia was within the statistically accepted level. Moreover, the polished monolithic zirconia surface caused less enamel wear than the glazed surface.

Conclusion

This review indicates that monolithic zirconia restorations cause acceptable antagonist enamel wear. Moreover, the meta‐analysis results agreed that the final restoration's surface texture plays an essential role in the wear process.

Clinical significance

Monolithic zirconia restorations have been widely used in dental practice because they eliminate the chipping problems resulting from using veneered restorations. With recent technology development, monolithic zirconia has obtained more esthetic features and a more natural look. However, due to the high strength and surface roughness of monolithic zirconia, wear on the antagonist's teeth was detected. The results showed that this wear amount was statistically acceptable and lower than other ceramics such as feldspathic porcelain and enamel. Furthermore, surface treatment methods must be applied to minimize tooth wear, as polished or glazed surfaces interfere with enamel loss.
The influence of the renewal or the single application of the peroxide gel on the efficacy and tooth sensitivity outcomes of in‐office bleaching—A systematic review and meta‐analysis
Authors: Kury Matheus , Lins Rodrigo Barros Esteves , Resende Bruna de Almeida , Picolo Mayara Zaghi Dal , André Carolina Bosso , Cavalli Vanessa
Published: October 2021

Objective

To answer the question: “Does the peroxide gel application regimen (single application vs. renewal) influence the efficacy and the tooth sensitivity outcomes of in‐office tooth bleaching?”

Methods

The search was done in Pubmed, Cochrane, LILACS, Scopus, Web of Science, and EMBASE in February 2021 (updated in July 2021). Randomized clinical trials (RCT) comparing the single application vs. the renewal protocols of HP were included. The meta‐analyses were performed for the objective (ΔEab), subjective (ΔSGU) color changes, and absolute risk of tooth sensitivity (TS). Heterogeneity was evaluated using Q test (I2). Cochrane Collaboration tool assessed the risk of bias (RoB). The GRADE evaluated the certainty of evidence.

Results

Five RCT studies remained. Two studies showed high RoB, and three presented some concerns. No significant differences were observed between the protocols in terms of the ΔEab, ΔSGU, and TS. ΔEab exhibited substantial heterogeneity (I2 = 87%), while ΔSGU (I2 = 60%) and the TS (I2 = 62%) presented a moderate one. The certainty of evidence was considered low or very low, depending on the variable response and the evaluation time.

Conclusion

The application regimen (single vs. renewal of HP) did not impact color change or the absolute risk of TS.

Clinical significance

The renewal of bleaching gel during the in‐office appointment may not be necessary. However, there is at least a low certainty of evidence. Because of this, further randomized clinical trials with appropriate methodology on this topic are encouraged.
Association of coffee, green tea, and caffeine with the risk of dementia in older Japanese people
Authors: Matsushita Nana , Nakanishi Yuta , Watanabe Yumi , Kitamura Kaori , Kabasawa Keiko , Takahashi Akemi , Saito Toshiko , Kobayashi Ryosaku , Takachi Ribeka , Oshiki Rieko , Tsugane Shoichiro , Iki Masayuki , Sasaki Ayako , Yamazaki Osamu , Watanabe Kei , Nakamura Kazutoshi
Published: October 2021

Objectives

Coffee, green tea, and caffeine are potential preventive factors for dementia, but the underlying evidence is insufficient. This study aimed to examine associations between the consumption of coffee, green tea, and caffeine and dementia risk in middle‐aged and older people.

Methods

This was a cohort study with an 8.0‐year follow‐up. Participants were community‐dwelling individuals (n = 13,757) aged 40–74 years. A self‐administered questionnaire survey was conducted in 2011–2013. Predictors were the consumption of coffee/green tea, from which caffeine consumption was estimated. The outcome was incident dementia obtained from the long‐term care insurance database. Covariates were demographic factors, body mass index, physical activity, energy, smoking, drinking, and disease history. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. HRs were also calculated using a Cox model with delayed entry.

Results

The number of dementia cases during the study period was 309. Participants with higher coffee consumption had lower HRs (adjusted p for trend = 0.0014), with the fifth quintile (≥326 ml/day) having a significantly lower HR (0.49, 95% confidence interval [CI]: 0.30–0.79) than the first quintile (<26 ml/day, reference). Similarly, participants with higher caffeine consumption had a significantly lower HR (adjusted p for trend = 0.0004) than the reference. The Cox model with delayed entry yielded similar results. These associations were significant in men, but not in women. Moreover, participants who consumed 2–2.9 cups/day and ≥3 cups/day of coffee had lower HRs (0.69, 95% CI: 0.48–0.98 and 0.53, 95% CI: 0.31–0.89, respectively) than those who consumed 0 cup/day. The association between green tea consumption and reduced dementia risk was significant (adjusted p for trend = 0.0146) only in the 60–69 years age subgroup.

Conclusions

High levels of coffee and caffeine consumption were significantly associated with a reduced dementia risk in a dose‐dependent manner, especially in men. Moreover, coffee consumption of ≥3 cups/day was associated with a 50% reduction in dementia risk.
Predicting 1 year mortality after traumatic injury using the Clinical Frailty Scale
Authors: Braude Philip , Carter Ben , Parry Frances , Ibitoye Sarah , Rickard Frances , Walton Ben , Short Roxanna , Thompson Julian , Shipway David
Published: October 2021

Background

Frailty is known to affect how people admitted with traumatic injuries recover during their inpatient stay and shortly after discharge. However, few studies have examined the effect of frailty on long‐term mortality when adjusted for significant factors including age. We aimed to determine the effect of frailty on 1‐year morality in older adults admitted with traumatic injuries.

Methods

We undertook an observational study at the Severn Major Trauma Network's major trauma centre based in South West England. Patients ≥65 years old admitted between November 2018 and September 2019 with traumatic injuries were included. Isolated hip fractures and inpatient injuries were excluded. A geriatrician assessed all patients for frailty using the Clinical Frailty Scale. Follow‐up occurred at 1 year. A multivariable Cox proportional baseline hazards model assessed the effect of frailty on time‐to‐mortality. The adjusted model included age, sex, multimorbidity, surgery, most injured site, injury severity, postinjury complications, and geriatrician review.

Results

Five hundred and eighty‐five patients were included. Median age was 81 years old (IQR 74–88), and median injury severity score was 13 (IQR 9–25). At 1 year 147 (25.1%) patients had died. Living with frailty was associated with mortality. The risk of dying increased with frailty severity. Compared to CFS 1–3: CFS 4 aHR = 1.73 (95% CI 0.89–3.36, p = 0.11); CFS 5 aHR = 3.82 (95% CI 2.11–6.93, p < 0.001); CFS 6 aHR = 4·05 (95% CI 2.21–7.45, p < 0.001); CFS 7–8 aHR = 6.57 (95% CI 3.43–12.59, p < 0.001).

Conclusion

This study is the first to demonstrate a consistent effect of frailty, at all levels of severity and independent of age, on older peoples' survival 1 year after traumatic injury. These data support performing an admission frailty assessment to aid long‐term management decisions and provide opportunity to modify frailty to improve outcomes.
The ethical implications of paradoxical lucidity in persons with dementia
Authors: Ney David B. , Peterson Andrew , Karlawish Jason
Published: October 2021

This case report describes the ethical implications of paradoxical lucidity in persons with severe stage dementia. Paradoxical lucidity describes an episode of unexpected communication or connectedness in a person who is believed to be noncommunicative due to a progressive and pathological process that causes dementia. A caregiver who witnesses an event of paradoxical lucidity may experience it as ethically and emotionally transformative. We provide an ethical framework for addressing this event in clinical practice. The framework addresses clinician interactions with the patient, caregiver, and family to improve understanding of paradoxical lucidity and to enhance patient care, caregiver well‐being, and decision‐making. Participants for this case study consented to having the case published. Participant names are changed to protect confidentiality.
Local complications of insulin administration sites and effect on diabetes management
Authors: Demir Günay , Er Eren , Atik Altınok Yasemin , Özen Samim , Darcan Şükran , Gökşen Damla
Published: October 2021

Background

Administration of insulin may be associated with substantial cutaneous adverse effects, such as lipoatrophy and lipohypertrophy (LH), which can cause glycemic excursions above and below the target levels for blood glucose. Our aim was to evaluate the effect on compliance with the use of insulin administration site, dermatological complications and diabetes management in children with type 1 diabetes (T1D).

Methods

Patients aged 021 years who were followed up with the diagnosis of T1D for at least one year were included. A 14‐question survey including demographic characteristics and a subjective opinion of skin‐related complications of insulin administration was given. Data were obtained from the medical records to evaluate the effect of dermatological complications on diabetes management. This study was checked with the STROBE checklist.

Results

Two hundred and fifty‐four patients were included and 53% of these were female. The mean age was 14.9 ± 4.7 years and the duration of T1D was 7.3 ± 4.1 years. The mean HbA1c level was 8 ± 1.4% and the mean total insulin dose was 0.84 ± 0.25 units/kg/day. More than half of the individuals (57%) were receiving multiple daily injections (MDI) and 43% were on insulin pump therapy (IPT). Of the participants, 11.8% reported LH, 7.5% wound, 21.7% allergy, 55.5% bleeding, 41.3% bruising and 47.2% pain. LH rates varied significantly by regimen, 17.1% in MDI and 4.6% with IPT (p = .001). Those with LH were using higher median doses of insulin (0.97 U/kg/day) than those who did not (0.78 U/kg/day; p = .016). LH was reported more frequently (18.3%) in patients with frequent hypoglycemia (p = .007). Positive correlation between BMI‐SDS and LH in patients aged <18 years was found (p = .043). LH rates by site were: right arm 20.8%, left arm 26.4%, right abdomen 26.4%, left abdomen 22.6% and 1% in the right and left leg.

Conclusions

Local complications of insulin therapy are common in young patients with T1D. The complication with the most impact on metabolic control was LH, present in nearly 12% of patients. Users of IPT have a significantly lower risk of LH. The results emphasise the importance of individualised education for young T1D patients and their families about injection site preference and rotation techniques.

Relevance to clinical practice

The diabetes team should check the insulin administration sites of children with type 1 diabetes at each visit and provide repeated education about the dermatological complications of insulin.
Effect of steroid hormone receptor gene variants PROGINS (Alu insertion) and PGR C/T (rs1042839) as a risk factor for recurrent pregnancy loss in Kashmiri population (North India)
Authors: Khan Nebela , Zargar Mahrukh Hameed , Ahmed Rehana , Godha Meena , Ahmad Abida , Afroze Dil , Masoodi Shariq R.
Published: October 2021

Aim

To unveil and evaluate the association and analyze the incidence and pattern of PGR gene polymorphisms (PROGINS insertion and PGR exon 5‐C/T polymorphism) in recurrent pregnancy loss (RPL) couples of Kashmir.

Methods

In this study, analyses of PGR gene polymorphisms in RPL couples were genotyped by amplification‐refractory mutation system polymerase chain reaction (PCR) and PCR‐restriction fragment length polymorphism.

Results

Molecular analysis of PGR gene polymorphisms indicated that the genotypic and allelic frequencies of PROGINS insertion and PGR exon 5 C/T polymorphisms of female group in cases and controls to be significantly different and poses risk in predisposition to RPL. Moreover, haplotype analysis in female group revealed that P1P2/CC and P1P2/CT genotype are significantly associated with RPL.

Conclusion

Our data indicate that the PROGINS insertion and exon 5‐C/T polymorphism can act as useful genetic markers in the female group, but needs to be replicated in further studies including various other single nucleotide polymorphisms of PGR gene relevant to pregnancy loss which may contribute to novel therapeutic targets with improved conclusions.
Understanding Strengths in Adolescent–Parent Relationships: A Qualitative Analysis of Adolescent Speech Samples
Authors: McKenna Sarah , Olsen Anna , Pasalich Dave
Published: October 2021

Although adolescents’ perspective on the parent‐adolescent relationship uniquely predicts their mental health and wellbeing, there is limited research using qualitative methodologies to explore rich descriptions of adolescents’ expectations, attitudes, and beliefs towards parents. The current study qualitatively analyzed adolescent narratives regarding their relationships with their parents. Seventy‐two adolescents (68% female; M age = 16.56) provided three‐minute speech samples that were examined using thematic analysis to understand key themes in adolescent–parent relationships from adolescents’ perspectives. Overall, adolescents valued positive relationships with parents (involving emotional support and companionship), respected their authority, and looked to parents to role‐model–valued traits. Mentions of negative interactions were mostly absent or justified as normal. Thus, normative adolescent–parent relationships are largely positive and valued by adolescents.
“WHAT CAN I CALL THAT HURT?”
Authors: Wiinikka‐Lydon Joseph
Published: October 2021

Moral injury is a term coined both to reflect the moral dimension of wartime experience and to critique overly clinical approaches to psychological harms originating in wartime. Originally defined not only with the tools of the behavioral sciences but also literature and philosophy, clinical approaches have come to dominate moral injury discourse over the past decade. This article argues for a return to interdisciplinarity by engaging metaphysics and ethics, and in particular Iris Murdoch’s post‐Christian notions of the Good and void, to help better account for the experiences of veterans who claim that they hurt not only physically but also morally as a result of their wartime experience.
Dietary protein sources and their effects on faecal odour and the composition of volatile organic compounds in faeces of French Bulldogs
Authors: Urrego Maria Isabel Gonzalez , Pedreira Raquel Silveira , Santos Karine de Melo , Ernandes Mariane Ceschin , Santos João Paulo Fernandes , Vendramini Thiago Henrique Annibale , Eberlin Marcos Nogueira , Balieiro Julio Cesar de Carvalho , Pontieri Cristiana Ferreira Fonseca , Brunetto Marcio Antonio
Published: October 2021

The strong odour of faeces and excessive production of gases in some dog breeds have long been a concern of owners. The pet food industry uses nutritional alternatives, such as high‐quality ingredients and additives, to improve the odour of faeces. However, there are still some dog breeds, such as the French Bulldog, that present this problem due to the presence into the large intestine of indigested protein. Therefore, a deeper understanding of the volatile compounds that influence the odour of dog faeces is important. This study aimed to identify changes of faecal odour compounds that are most prevalent in French Bulldogs based on food containing different high‐quality protein sources and their effect in sensory analysis. Four maintenance foods with different protein sources were formulated: P, poultry meal food; W, wheat gluten food; PW, poultry meal and wheat gluten food; and PWH, poultry meal, wheat gluten, and hydrolysed protein food. Eight adult French Bulldogs were arranged in a 4x4 Latin square design and adapted to foods for 28 days. Fresh faeces were collected for analysis of volatile organic compounds (VOCs) and sensory analysis. The means were compared by SAS, and statistical significance was indicated by p ≤ 0.05. No adverse effects were observed in the animals regarding VOCs, and a significant difference was observed in two of the 68 compounds identified. The animals fed a P food had higher concentrations of phenol in the faeces, whereas the indole compound was present at higher concentrations in animals fed the W food. P food was associated with higher odour perception during sensory evaluation. In summary, the source of protein in the foods had little impact on the composition of VOCs, and a greater perception of the odour was determined by sensory analysis when foods containing animal protein were administered.
Effects of thermal energy on extrusion characteristics, digestibility and palatability of a dry pet food for cats
Authors: Baller Mayara Aline , Pacheco Peterson Dante Gavasso , Vitta‐Takahashi Amanda , Putarov Thaila Cristina , Vasconcellos Ricardo Souza , Carciofi Aulus Cavalieri
Published: October 2021

The influence of specific thermal energy (STE) applications on extruder preconditioner was evaluated in a dry food for cats. In the first study, six STE applications were tested with mass temperatures of 45°C, 55°C, 65°C, 75°C, 85°C and 95°C. The extrusion parameters, starch gelatinization and kibble formation were evaluated. Diets were given to cats to evaluate digestibility, faecal characteristics and palatability. In the second experiment, three treatments were compared: low STE—a preconditioner temperature of 45°C (LSTE); high STE—a preconditioner temperature of 95°C (HSTE); high STE (preconditioner temperature of 95°C) combined with an increase in the mass flow rate to obtain a motor amperage similar to that of the LSTE (HSTEflow). Data were analysed by polynomial contrasts (Experiment 1) or Tukey's test (Experiment 2; p < 0.05). An increase in STE reduced motor amperage, mass pressure and specific mechanical energy (SME) implementation (p < 0.001) and increased total specific energy (TSE) and mass temperature (p < 0.01). The increase in STE induced greater kibble expansion and starch gelatinization (p < 0.001). No changes in apparent nutrient digestibility or faeces characteristics were observed (p > 0.05). Lower STE and starch gelatinization induced higher butyrate and total volatile fatty acid (VFA) contents in faeces (p < 0.01). Cats showed greatest preference for the formulation with the highest STE (p < 0.01). In the second experiment, when the motor amperage was increased in the HSTEflow treatment to a value similar to that of the LSTE, the mass flow rate increased 40%, and the electric energy consumption remained unchanged (p < 0.001), with gains observed for efficiency and cost. In conclusion, STE application is important for sufficient TSE implementation, enhancing kibble expansion, starch gelatinization, cat preferences for food, extruder productivity and reducing SME application. Foods with lower starch gelatinization lead to increased VFA in faeces, with possible implications for gut health.
Exploring the Narrative of an Early Childhood Education and Care Teacher from the Perspective of Polyphonic Time1
Authors: Katsuura Mahito , Ueda Harutomo , Fujii Maki
Published: October 2021

This is a case study of an early childhood education and care (ECEC) teacher from the perspective of her polyphonic time spent with young children. The purpose of the study was to reconstruct a teacher's understanding of play based on her own narrative. In particular, the E‐series time created through play between the ECEC teacher and the children is discussed. The study is based on an interview with the ECEC teacher, Haruka, who was involved in a “slide and mud play” activity while working with the children as a classroom teacher at Day Care Center A. The five narratives pertaining to slide and mud play were analyzed qualitatively from the perspective of a teacher's polyphonic sense of time. It can be perceived from the results that an ECEC teacher's narratives, which include aspects of polyphonic time, reveal not only their own professionalism, but also their experience of intersubjective relationships through play activities shared with children. This is what makes an ECEC teacher's narrative unique, and it is an indispensable point of view when telling the story of childcare.
Liberal sexual morality, religion, and attitudes toward abortion in Turkey
Authors: Fidan Ahmet , Alagoz Rezzan , Karaman Nuray
Published: October 2021

The present study examines the association between sexual morality, religion, and attitudes toward the practice of abortion in Turkey. Drawing upon data from the 2008–2010 European Value Survey in the case of Turkey, several hypotheses were tested concerning the role of liberal sexual relations and many aspects of religion on abortion attitudes. Findings reveal that support of liberal sexual relations demonstrates the strongest justification for abortion. As a religious determinant, prayer practice indicates the most robust opposition to the practice of abortion. Additional religious factors, personal religious identity, and personal faith were also found to be significantly associated with antiabortion attitudes. The findings are discussed and have implications for future research on attitudes toward abortion.
Regularized estimation of high‐dimensional vector autoregressions with weakly dependent innovations
Authors: Masini Ricardo P. , Medeiros Marcelo C. , Mendes Eduardo F.
Published: October 2021

There has been considerable advance in understanding the properties of sparse regularization procedures in high‐dimensional models. In time series context, it is mostly restricted to Gaussian autoregressions or mixing sequences. We study oracle properties of LASSO estimation of weakly sparse vector‐autoregressive models with heavy tailed, weakly dependent innovations. In contrast to current literature, our innovation process satisfy an L1 mixingale type condition on the centered conditional covariance matrices. This condition covers L1‐NED sequences and strong (‐) mixing sequences as particular examples.
Vertical locomotion in the arboreal salamander Aneides vagrans
Authors: Aretz J. M. , Brown C. E. , Deban S. M.
Published: October 2021

Salamanders are often used as a model of early tetrapod locomotion, due to their generalized tetrapod body plan. We imaged five individuals of wandering salamander, Aneides vagrans, during horizontal and vertical locomotion and compared kinematic and gait adjustments made to compensate for each condition. We used ImageJ to calculate duty factor, stride length, stride frequency, contralateral foot spread, heading of climbing, and forward velocity. Like other terrestrial salamanders, A. vagrans use a diagonal couplet, lateral sequence walk on horizontal surfaces. When walking vertically, however, they use a single‐foot gait, taking smaller steps and extending the duty factor compared with level walking. Salamanders adjusted their limbs to have a wider contralateral foot spread between fore‐ and hindfeet when walking downward as compared to walking upward or horizontally. These gait adjustments may minimize the risk of slipping or falling by increasing the number of contact points during the stride cycle, and by bringing their center of mass closer to the surface. We found that salamanders moved at a significantly faster velocity when traveling horizontally compared to vertically. Furthermore, we found no significant difference between upward and downward velocity, despite greater stride lengths in upward locomotion; this was explained by a higher stride frequency in downward locomotion. We estimate travel time up or down an old‐growth redwood tree to be on the scale of hours, a significant time investment that may encourage alternatives when available. These results suggest that, in an ecological context, while salamanders are capable of traveling straight down a redwood tree, they may simply tend to jump.
Subnational mapping for targeting anaemia prevention in women of reproductive age in Ethiopia: A coverage‐equity paradox
Authors: Hailu Bayuh Asmamaw , Laillou Arnaud , Chitekwe Stanley , Beyene Joseph , Baye Kaleab
Published: October 2021

Anaemia in women of reproductive age (WRA) can be effectively addressed if supported by a better understanding of the spatial variations, magnitude, severity and distribution of anaemia. This study aimed to map the subnational spatial distribution of anaemia (any, moderate and severe forms) among WRA in Ethiopia. We identified and mapped (any, moderate and severe) anaemia hotspots in WRA (n = 14,923) at the subnational level and identified risk factors using multilevel logistic regression. Kulldorff scan statistics were used to identify hotspot regions. Ordinary kringing was used to predict the anaemia prevalence in unmeasured areas. The overall anaemia prevalence increased from 16.6% in 2011 to 23.6% in 2016, a rise that was mostly related to the widening of existing hotspot areas. The primary clusters of (any) anaemia were in Somali and Afar regions. The horn of the Somali region represented a cluster of 330 km where 10% of WRA were severely anaemic. The Oromia–Somali border represented a significant cluster covering 247 km, with 9% severe anaemia. Population‐dense areas with low anaemia prevalence had high absolute number of cases. Women education, taking iron‐folic‐acid tablets during pregnancy and birth‐delivery in health facilities reduced the risk of any anaemia (P < 0.05). The local‐level mapping of anaemia helped identify clusters that require attention but also highlighted the urgent need to study the aetiology of anaemia to improve the effectiveness and safety of interventions. Both relative and absolute anaemia estimates are critical to determine where additional attention is needed.