bluuebunny/crossref_metadata_2025 huggingface dataset:
Surveillance and control of asymptomatic carriers of drug‐resistant bacteria
Authors: Jamrozik Euzebiusz , Selgelid Michael J.
Published: August 2019

Drug‐resistant bacterial infections constitute a major threat to global public health. Several key bacteria that are becoming increasingly resistant are among those that are ubiquitously carried by human beings and usually cause no symptoms (i.e. individuals are asymptomatic carriers) until and/or unless a precipitating event leads to symptomatic infection (and thus disease). Carriers of drug‐resistant bacteria can also transmit resistant pathogens to others, thus putting the latter at risk of resistant infections. Accumulating evidence suggests that such transmission occurs not only in hospital settings but also in the general community, although considerably more data are needed to assess the extent of this problem. Asymptomatic carriage of drug‐resistant bacteria raises important ethical questions regarding the appropriate public health response, including the degree to which it would be justified to impose burdens on asymptomatic carriers (and others) in order to prevent transmission. In this paper, we (i) summarize current evidence regarding the carriage of key drug‐resistant bacteria, noting important knowledge gaps; and (ii) explore the particular implications of existing public health ethics frameworks for policy‐making regarding asymptomatic carriers. Inter alia, we argue that the relative burdens imposed by public health measures on healthy carriers (as opposed to sick individuals) warrant careful consideration and should be proportionate to the expected public health benefits in terms of risks averted. We conclude that more surveillance and research regarding community transmission will be needed in order to clarify relevant risks and design proportionate policies, although extensive community surveillance itself would also require careful ethical consideration.
Biclustering via sparse clustering
Authors: Helgeson Erika S. , Liu Qian , Chen Guanhua , Kosorok Michael R. , Bair Eric
Published: August 2019

In identifying subgroups of a heterogeneous disease or condition, it is often desirable to identify both the observations and the features which differ between subgroups. For instance, it may be that there is a subgroup of individuals with a certain disease who differ from the rest of the population based on the expression profile for only a subset of genes. Identifying the subgroup of patients and subset of genes could lead to better‐targeted therapy. We can represent the subgroup of individuals and genes as a bicluster, a submatrix, , of a larger data matrix, , such that the features and observations in differ from those not contained in . We present a novel two‐step method, SC‐Biclust, for identifying . In the first step, the observations in the bicluster are identified to maximize the sum of the weighted between‐cluster feature differences. In the second step, features in the bicluster are identified based on their contribution to the clustering of the observations. This versatile method can be used to identify biclusters that differ on the basis of feature means, feature variances, or more general differences. The bicluster identification accuracy of SC‐Biclust is illustrated through several simulated studies. Application of SC‐Biclust to pain research illustrates its ability to identify biologically meaningful subgroups.
M7‐FLIPI is not prognostic in follicular lymphoma patients with first‐line rituximab chemo‐free therapy
Authors: Lockmer Sandra , Ren Weicheng , Brodtkorb Marianne , Østenstad Bjørn , Wahlin Björn E. , Pan‐Hammarström Qiang , Kimby Eva
Published: August 2019

The clinical course of follicular lymphoma (FL) is highly variable. Recently the m7‐FL international prognostic index (FLIPI) integrating performance status, FLIPI score and the mutational status of seven genes, was shown to stratify patients into “low‐risk” and “high‐risk” with respect to 5‐year failure‐free survival after first‐line immunochemotherapy. Our aim was to evaluate the model after rituximab without chemotherapy. The Nordic Lymphoma Group performed two randomized clinical trials on indolent lymphoma patients receiving single rituximab and rituximab with interferon‐α2a. In total, 95 FL patients had sufficient fresh‐frozen diagnostic material for sequencing. A targeted panel for the genes EZH2, ARID1A, MEF2B, EP300, FOXO1, CREBBP and CARD11 was utilized for m7‐FLIPI score calculation. With a median follow‐up of 10·6 years, 76% of patients were alive. No difference in time to treatment failure (TTF), defined as the interval between start of trial therapy and initiation of new therapy or death, nor overall survival (OS) was found between the m7‐FLIPI risk groups (log‐rank P = 0·94 and 0·99, respectively). EZH2 mutations were associated with longer TTF (log‐rank P = 0·04) and in EP300 mutations were associated with shorter TTF (log‐rank P = 0·01). We conclude that the prognostic value of the m7‐FLIPI clinicogenetic model seems dependent on therapeutic regimen.
Age limits for participation in child protection court proceedings in Sweden
Authors: Hultman Elin , Höjer Staffan , Larsson Monica
Published: August 2019

According to the UN Convention on the Rights of the Child and Swedish legislation, children have the right to participate in child protection proceedings. The aim of this paper is to describe and analyse the notion of age and maturity in child protection proceedings in order to elucidate how these aspects could influence children's rights to participate. We focus on the view of three groups of actors involved in child protection proceedings in Sweden—social workers, lawyers, and laypersons in social welfare boards and administrative courts—and on how children's age and maturity should be taken into consideration in decisions on their participation in court. The analysis is based on survey data. The study found that social workers, laypersons, and lawyers have different views on when children are old enough to have the right to litigate in court. Additionally, there is no consensus on how the maturity of the child can be assessed to inform the decision about participation. More discussion is needed about what competences a child needs to participate in court and to what extent this right should be limited by their age. Importantly, courts and decision‐making proceedings can be made more child friendly.
Effect of single‐session transcranial direct current stimulation on cognition in Parkinson's disease
Authors: Lau Chi‐ieong , Liu Mu‐N , Chang Kae‐Chwen , Chang Anna , Bai Chyi‐Huey , Tseng Ching‐Shiang , Walsh Vincent , Wang Han‐Cheng
Published: August 2019

Aims

Nonmotor symptoms (NMS) such as cognitive impairment and impulse‐control disorders in Parkinson's disease (PD) remain a therapeutic challenge. Transcranial direct current stimulation (tDCS) has emerged as a promising alternative, although its immediate effects on NMS have been less well defined. In this randomized, sham‐controlled, crossover study, we aimed to explore the single‐session tDCS effects on cognitive performance in PD.

Methods

Ten nondemented patients with PD completed two sessions in counterbalanced order, receiving 20 minutes of either 2 mA anodal or sham tDCS over the left dorsolateral prefrontal cortex (DLPFC). During stimulation, they performed the visual working memory and go/no‐go tasks. Performance of the tasks was compared between the two conditions.

Results

Single‐session anodal tDCS over the left DLPFC did not significantly improve cognitive tasks in PD compared with sham (P > .05).

Conclusion

Single‐session tDCS is ineffective in improving visual working memory and inhibitory control in PD. Further research may worth exploring alternative tDCS parameters, ideally with repeated sessions and concomitant training.
Making space: Putting landscape‐level mitigation into practice in Mongolia
Authors: Heiner Michael , Galbadrakh Davaa , Batsaikhan Nyamsuren , Bayarjargal Yunden , Oakleaf James , Tsogtsaikhan Battsengel , Evans Jeffrey , Kiesecker Joseph
Published: August 2019

Growing resource demands are driving rapid development to new frontiers in developing countries with important biological diversity. The mitigation hierarchy is a critical tool to manage the impacts of development projects on biodiversity, embedded into numerous government, lender, and corporate policies. However, implementation faces obstacles, in particular deciding when impacts should be avoided. Offset design, the last step, faces difficult questions about location of offsets relative to impacts and how to address uncertainty and conflicts with future development. Planning for conservation and development are typically separate processes, and environmental impact assessments are typically conducted on a project‐by‐project basis that does not consider the landscape context and cumulative impacts of multiple projects. Here we present a mitigation framework for Mongolia with an example from the Mongolian Gobi Desert, a landscape with globally significant biodiversity facing rapid development. This landscape‐level planning approach has been replicated across Mongolia to produce a national level mitigation framework to guide both the government policy commitment to protect 30% of all natural lands and application of the mitigation hierarchy. This has led to protection of 177,000 km2in new national and local protected areas, and development of an offset design mechanism based on the conservation plans.
Discharge frailty following lung transplantation
Authors: Courtwright Andrew M. , Zaleski Derek , Tevald Michael , Adler Joe , Singer Jonathan P. , Cantu Edward E. , A. Bermudez Christian , Diamond Joshua M.
Published: August 2019

Introduction

Frailty at listing for lung transplant has been associated with waitlist and post‐transplant mortality. Frailty trajectories following transplant, however, have been less well characterized, including whether recipient frailty improves. The objective of this study was to identify prevalence and risk factors for frailty at discharge and to evaluate changes in frail recipients enrolled in an outpatient physical therapy program.

Methods

This was a single‐center prospective cohort study of lung transplant recipients. Enrollees completed a short physical performance battery (SPPB) to assess frailty at listing and at initial hospital discharge.

Results

Of the 111 enrolled recipients, none were frail at listing and 18 (16.2%) were prefrail. At discharge, however, 60 (54.1%) patients were frail. Discharge frailty was associated with prefrailty at listing, acute kidney injury post‐transplant, and longer intensive care unit stay. Among the 35 patients who were frail at discharge and who were enrolled in an outpatient PT program, the median improvement in SPPB was 6 points (IQR = 5‐7 points), and 85.7% became not frail over a median of 6 weeks.

Conclusion

Discharge frailty is common following lung transplantation. In most frail patients, an intensive outpatient physical therapy program is associated with improvement in frailty, as assessed by the SPPB.
Tricuspid regurgitation occurring in the early‐diastolic phase in a case of heart failure: Insights from echocardiographic and invasive hemodynamic findings
Authors: Murayama Michito , Iwano Hiroyuki , Tsujinaga Shingo , Sarashina Miwa , Ishizaka Suguru , Chiba Yasuyuki , Nakabachi Masahiro , Yokoyama Shinobu , Nishino Hisao , Okada Kazunori , Kaga Sanae , Shibuya Hitoshi , Nishida Mutsumi , Anzai Toshihisa
Published: August 2019

Although the presence and physiological significance of late‐diastolic tricuspid regurgitation (TR) have been reported, those in TR occurring in early diastole have not been well known. We herein first presented a case of heart failure due to dilated cardiomyopathy showing functional TR occurring in the early‐diastolic phase in whom the mechanism for its genesis could be precisely assessed from echocardiographic findings and intra‐cardiac pressure recordings.
Relating soil salinity, clay content and water vapour sorption isotherms
Authors: Chen Mingyuan , Zeng Wenzhi , Arthur Emmanuel , Gaiser Thomas , Lei Guoqing , Zha Yuanyuan , Ao Chang , Fang Yuanhao , Wu Jingwei , Huang Jiesheng
Published: August 2019

An accurate description of soil water vapour sorption isotherms (WSIs) is significant for modelling numerous soil processes. Soil clay content predictions from WSIs can be cost effective and convenient, although the approach has only been investigated on non‐saline soils. To investigate relationships among the clay content, water vapour sorption characteristics and salinity of soils, the WSIs of 35 soil samples were measured at four salinity levels. The characterization of the isotherms indicated that the double log polynomial (DLP) model was optimal for fitting the WSIs of soils with various salinity levels. Moreover, existing clay content prediction models based on WSIs had poor applicability to saline soils, and soil salinity had a greater influence than the soil clay content on the shape of the WSIs. Therefore, multiple linear regression (MLR) models were established to explain the relationships among the soil clay content, salt content and geometrical characteristics of the WSIs. Specifically, a significant correlation was observed between the soil salt content and the sub‐area at the end interval of the WSIs (relative vapour pressure (RH) = 0.83 to 0.93, coefficient of determination (R2) > 0.9) and the hysteresis sub‐area in the middle of the WSIs (RH = 0.53 to 0.63, R2 > 0.8). Furthermore, a strong linear relationship existed between the clay content and the sub‐areas of desorption and hysteresis at the end interval of the WSIs (RH = 0.73 to 0.83, R2 > 0.9) in the non‐saline soils only. Based on the investigated samples, the geometrical characteristics of WSIs were affected predominantly by the soil clay content when the salt content was low (electrical conductivity (EC) < 4.5 dS m−1), whereas salinity was the main influencing factor for samples that have high salt content (EC ≥ 4.5 dS m−1). Moreover, the WSIs' geometric characteristics had the potential to predict soil salt content and clay content under certain limited conditions. Isotherm models that accurately describe water sorption isotherms of saline soils were identified. Soil clay content and salinity affect water sorption isotherms differently depending on soil salinity level. Robust relationships between the soil salinity, clay content and WSI shape properties were established.

Highlights

Isotherm models that accurately describe water sorption isotherms of saline soils were identified.

Soil clay content and salinity affect water sorption isotherms differently depending on soil salinity level.

Robust relationships between the soil salinity, clay content and WSI shape properties were established.
The underlying etiology of infantile spasms (West syndrome): Information from the International Collaborative Infantile Spasms Study (ICISS)
Authors: Osborne John P. , Edwards Stuart W. , Dietrich Alber Fabienne , Hancock Eleanor , Johnson Anthony L. , Kennedy Colin R. , Likeman Marcus , Lux Andrew L. , Mackay Mark , Mallick Andrew , Newton Richard W. , Nolan Melinda , Pressler Ronit , Rating Dietz , Schmitt Bernhard , Verity Christopher M. , O'Callaghan Finbar J. K. ,   the participating investigators
Published: August 2019

Objective

To determine the underlying etiologies in a contemporary cohort of infants with infantile spasms and to examine response to treatment.

Methods

Identification of the underlying etiology and response to treatment in 377 infants enrolled in a clinical trial of the treatment of infantile spasms between 2007 and 2014 using a systematic review of history, examination, and investigations. They were classified using the pediatric adaptation of International Classification of Diseases, Tenth Revision (ICD‐10).

Results

A total of 219 of 377 (58%) had a proven etiology, of whom 128 (58%) responded, 58 of 108 (54%) were allocated hormonal treatment, and 70 of 111 (63%) had combination therapy. Fourteen of 17 (82%, 95% confidence interval [CI] 59% to 94%) infants with stroke and infarct responded (compared to 114 of 202 for the rest of the proven etiology group (56%, 95% CI 48% to 62%, chi‐square 4.3, P = .037): the better response remains when treatment allocation and lead time are taken into account (odds ratio 5.1, 95% CI 1.1 to 23.6, P = .037). Twenty of 37 (54%, 95% CI 38% to 70%) infants with Down syndrome had cessation of spasms compared to 108 of 182 (59%, 95% CI 52% to 66%, chi‐square 0.35, P = .55) for the rest of the proven etiology group. The lack of a significant difference remains after taking treatment modality and lead‐time into account (odds ratio 0.8, 95% CI 0.4 to 1.7, P = .62). In Down syndrome infants, treatment modality did not appear to affect response: 11 of 20 (55%) allocated hormonal therapy responded, compared to 9 of 17 (53%) allocated combination therapy.

Significance

This classification allows easy comparison with other classifications and with our earlier reports. Stroke and infarct have a better outcome than other etiologies, whereas Down syndrome might not respond to the addition of vigabatrin to hormonal treatment.
Characteristics of KCNQ2 variants causing either benign neonatal epilepsy or developmental and epileptic encephalopathy
Authors: Goto Ayako , Ishii Atsushi , Shibata Mami , Ihara Yukiko , Cooper Edward C. , Hirose Shinichi
Published: August 2019

Objective

Pathogenic variants of KCNQ2, which encode a potassium channel subunit, cause either benign (familial) neonatal epilepsy—B(F)NE)—or KCNQ2 encephalopathy (KCNQ2 DEE). We examined the characteristics of KCNQ2 variants.

Methods

KCNQ2 pathogenic variants were collected from in‐house data and two large disease databases with their clinical phenotypes. Nonpathogenic KCNQ2 variants were collected from the Genome Aggregation Database (gnomAD). Pathogenicity of all variants was reevaluated with clinical information to exclude irrelevant variants. The cumulative distribution plots of B(F)NE, KCNQ2 DEE, and gnomAD KCNQ2 variants were compared. Several algorithms predicting genetic variant pathogenicity were evaluated.

Results

A total of 259 individuals or pedigrees with 216 different pathogenic KCNQ2 variants and 2967 individuals with 247 different nonpathogenic variants were deemed eligible for the study. Compared to the distribution of nonpathogenic variants, B(F)NE and KCNQ2 DEE missense variants occurred in five and three specific KCNQ2 regions, respectively. Comparison between B(F)NE and KCNQ2 DEE sets showed that B(F)NE missense variants frequently localized to the intracellular domain between S2 and S3, whereas those of KCNQ2 DEE were more frequent in S6, and its adjacent pore domain, as well as in the intracellular domain between S6 and helix A. The scores of Protein Variation Effect Analyzer (PROVEAN) and Percent Accepted Mutation (PAM) 30 prediction algorithms were associated with phenotypes of the variant loci.

Significance

Missense variants in the intracellular domain between S2 and S3 are likely to cause B(F)NE, whereas those in S6 and its adjacent regions are more likely to cause KCNQ2 DEE. With such regional specificities of variants, PAM30 is a helpful tool to examine the possibility that a novel KCNQ2 variant is a B(F)NE or KCNQ2 DEE variant in genetic analysis.
Diet and trophic role of octopus on an abalone sea ranch
Authors: Greenwell Claire N. , Loneragan Neil R. , Tweedley James R. , Wall Mark
Published: August 2019

Gastric tract (crop and stomach) and stable isotope analyses (SIA) were used to evaluate the dietary composition of resident, commercially important Octopus aff. O. tetricus Gould, and its importance as a predator of Haliotis laevigata Donovan, on artificial abalone habitats. Taxonomic diversity and resolution of diet were higher in crops (13 taxa) than stomachs (10 taxa), with the latter dominated by unidentifiable material (%Volume = 74%). Crops contained mainly molluscs (~54%, including 31% abalone) and crustaceans (33%), suggesting octopus are important predators of abalone on the sea ranch. Dietary composition of crops did not differ with increasing octopus weight (<300 g, 300–999 g, ≥1,000 g wet weight), paralleling the findings of SIA and reflecting the high stocking densities of abalone that are able to be consumed by octopus of all sizes. The SIA also revealed that octopus occupy a mid‐trophic level, slightly below teleosts and loliginid squids.
Juvenile pheomelanin‐based plumage coloration has evolved more frequently in carnivorous species
Authors: Rodríguez‐Martínez Sol , Galván Ismael
Published: August 2019

Distinctive pheomelanin‐based plumage coloration in juvenile birds has been proposed as a signal of immaturity to avoid aggression by older conspecifics, but recent findings suggest a detoxifying strategy. Pheomelanin synthesis implies the consumption of cysteine, a semi‐essential amino acid that is necessary for the synthesis of the antioxidant glutathione (GSH) but that may be toxic if in excess in the diet. As the nestling stage probably represents a low‐stress period with limited requirement for GSH protection, the synthesis of pheomelanin in developing birds may help to maintain cysteine homeostasis, particularly in species with a high content of protein in the diet (i.e. carnivores). Here we confirm this hypothesis showing that, among 53 species of Western Palaearctic birds, juvenile pheomelanin‐based coloration has evolved more frequently in strictly carnivorous species than in species with other diets.
Predictable shorebird departure patterns from a staging site can inform collision risks and mitigation of wind energy developments
Authors: Howell Jessica E. , McKellar Ann E. , Espie Richard H. M. , Morrissey Christy A.
Published: August 2019

High‐quality staging sites are critical for long‐distance migratory shorebirds to rest and refuel but are under threat from human development, including expansion of wind energy projects. However, predicting migration timing and movements in relation to weather conditions at staging sites can increase our understanding and mitigate effects of wind turbine collisions. Here we assessed northward migration timing and orientation in relation to environmental conditions at an inland staging area in Saskatchewan, Canada, with active and proposed wind energy developments. The area is known to host ~25% of North America's Sanderling Calidris alba population and 16 other Arctic‐breeding migrant shorebird species. We quantified arrival and departure time of day in relation to weather using data from 140 of 237 Sanderlings radiotagged locally and at a southern staging site in the Gulf of Mexico with the Motus Wildlife Tracking System (April–June, 2015–2017). Although Sanderling arrival times were not related to time of day or weather, departures were more likely at sunset in winds blowing towards the northwest at intermediate speeds (<22 km/h). Departure flights were also primarily oriented north‐northwest in the direction of a proposed wind energy development site at a mean ground speed of 21.4 m/s. Based on published climb rates and flight speed data, we estimated that shorebirds needed between 2 and 14 km setback distance to clear maximum turbine heights of 165 m. Given that departure events were predictable in time and space, adaptive mitigation may be useful for planning wind energy developments while reducing risk for staging Arctic‐breeding shorebirds.
Ageing affects the proliferation and mineralization of rat dental pulp stem cells under inflammatory conditions
Authors: Ning T. , Shao J. , Zhang X. , Luo X. , Huang X. , Wu H. , Xu S. , Wu B. , Ma D.
Published: August 2019

Aim

To comparatively evaluate changes in the proliferation and mineralization abilities of dental pulp stem cells (DPSCs) from juvenile and adult rats in a lipopolysaccharide (LPS)‐induced inflammatory microenvironment to provide a theoretical basis for the age‐related differences observed in DPSCs during repair of inflammatory injuries.

Methodology

DPSCs were isolated from juvenile (JDPSCs) and adult rats (ADPSCs), and senescence‐associated β‐galactosidase staining was used to compare senescence between JDPSCs and ADPSCs. Effects of LPS on JDPSCs and ADPSCs proliferation were investigated by cell counting kit‐8 assays and flow cytometry. Alizarin red staining, quantitative reverse transcription polymerase chain reaction and Western blot assay were used to examine the effects of LPS on mineralization‐related genes and proteins in JDPSCs and ADPSCs. Immunohistochemistry was used to compare interleukin‐1β (IL‐1β) and osteocalcin (OCN) expression in the pulpitis model. Unpaired Student's t‐tests and one‐way anova were used for statistical analysis.

Results

DPSCs were isolated from juvenile and adult rat dental pulp tissues. At low concentrations (0.1–1 μg mL−1), LPS significantly promoted the proliferation of JDPSCs (P < 0.01) and ADPSCs (P < 0.01 or P < 0.05), with the effect being stronger in JDPSCs than in ADPSCs. In addition, mineralized nodules and the expression of mineralization‐related genes (OCN, DSPP, ALP, BSP) increased significantly after stimulation with LPS (0.5 μg mL−1) in JDPSCs and ADPSCs (P < 0.01 or P < 0.05), and JDPSCs displayed a more obvious increase than ADPSCs. Western blots revealed OCN and ALP expression levels in JDPSCs treated with LPS were significantly upregulated (P < 0.05); meanwhile, ALP expression in ADPSCs increased slightly but significantly (P < 0.05), and OCN expression was not affected. Finally, IL‐1β expression was significantly higher (P < 0.05) and OCN expression was significantly lower (P < 0.05) in the inflamed dental pulp of adult rats than in juvenile rats.

Conclusions

A certain degree of inflammatory stimulation promoted the proliferation and mineralization of DPSCs; however, this effect declined with age. The DPSCs of adult donors in an inflammatory microenvironment have a weaker repair ability than that of juvenile donors, who are better candidates for tissues damage repair.
Higher vitamin D levels in Nigerian albinos compared with pigmented controls
Authors: Enechukwu Nkechi , Cockburn Myles , Ogun Gabriel , Ezejiofor Ogochukwu I. , George Adekunle , Ogunbiyi Adebola
Published: August 2019

Background

Several studies have suggested that the lower vitamin D levels in blacks is attributable to the effect of increased pigmentation in blocking cutaneous ultraviolet (UV)‐mediated production of vitamin D. Albinos are devoid of melanin and should invariably have higher vitamin D levels when compared with their pigmented counterparts. However, strict photoprotection required in their medical management has been shown to reduce UV‐dependent vitamin D production. Associations between low vitamin D and several diseases suggest that the pattern of vitamin D in the black African albino be investigated.

Objective

To compare the vitamin D levels between albinos and normal pigmented controls in Anambra State, Nigeria, and thus highlight the impact of skin pigmentation and sun protection practices on vitamin D levels.

Methodology

This was a cross‐sectional study of a consecutive series of albinos from the Albino Foundation, Anambra State. The vitamin D levels of 61 albinos and 58 matched pigmented controls were analyzed. The sun exposures of the participants were calculated using validated sun exposure questionnaires.

Results

The albinos had significantly higher vitamin D levels (median 95.9 [50.1–177.4] ng/ml) than the controls (78.2 [12.1–250] ng/ml). None of the albinos had low vitamin D levels. None of the sun protection practices had significant effects on vitamin D levels.

Conclusion

This study contests the claim that black Africans including albinos have low vitamin D levels. Albinos living in South East Nigeria have significantly higher vitamin D levels than their pigmented counterparts.
Nurses' experience of providing home‐based palliative care in the country setting: An integrated literature review
Authors: Rabbetts Lyn , Harrington Ann , Breaden Katrina
Published: August 2019

Aims

The aim of the study is to explore the experiences of nurses providing home‐based palliative care for patients who live in country settings.

Methods

This study is an integrated literature review. Electronic databases, specific journals of interest, and reference lists were searched using key words and Boolean operators. Descriptive thematic analysis was undertaken to identify main themes and subthemes. Critical appraisal of the articles was conducted using the qualitative Critical Appraisal Skills Program guidelines. Primary research articles published in English, in peer‐reviewed journals from 1990 to 2017, were included.

Results

Twelve articles were included in this review. Two main themes emerged including the nature of nursing in country communities and nurses' emotional responses. The first main theme had the subthemes of community connections, geographical distance and isolation, organizational deficits, lack of education, and resources. The second main theme consisted on five subthemes including feeling rewarded, autonomy and professional isolation, hope and hopelessness, frustration, and fear.

Conclusion

Literature is sparse reporting the lived experience of nurses providing palliative care in country areas for patients wanting to die at home. An increase in demand for a home‐based palliative nursing service will require additional funding globally to meet this increase in the future.
Predatory purchasing practices in global apparel supply chains and the employment relations squeeze in the Indian garment export industry
Authors: ANNER Mark
Published: August 2019

While the literature has long acknowledged worker rights abuses in global apparel supply chains, less attention has been paid to the recent worsening of certain decent work deficits and its causes, which this article links to predatory purchasing practices arising from growing power asymmetries. These practices, illustrated here by the garment export industry in India, exert downward pressure on wages and incite non‐standard forms of employment and greater verbal and physical abuse as productivity demands rise. They can be addressed through pricing mechanisms that cover the cost of decent work, appropriate State regulation and worker involvement.
Supporting choice: an innovative model of integrated palliative care funded by a private health insurer
Authors: Cross Jessica , Fischer Amanda , Shotton Donna , Pollicino Christine , May Annabelle , Vora Rohan , Dubrowin Natalie B. , Good Phillip
Published: August 2019

Background

The number of Australians dying each year is predicted to double in the next 25 years and there is an urgent need to establish sustainable models for providing high quality end‐of‐life care. An innovative community care model (Bupa Palliative Care Choices Program or BPCCP) was developed and piloted with the purpose of supporting patients in achieving their choices surrounding end‐of‐life care.

Aims

This study evaluates whether BPCCP patients were more likely to die in their place of choice compared with patients receiving standard care. Additional aims were evaluating patient and carer satisfaction and insurer cost.

Methods

This prospective, comparative cohort study comprises a clinical chart audit and survey of patient and carer experience.

Results

More BPCCP participants preferred to die at home (53% vs 31%). A lower proportion of BPCCP patients died in acute hospitals (10% vs 19%) and more of this cohort died at home (46% vs 26%). In both cohorts, nearly 90% of patients were able to die in their preferred location. Patient and carer satisfaction with the programme was very high in the small cohort who responded to the survey. There was a decrease in average claims spend per patient enrolled in the programme during the first 12‐month period of implementation compared with historical claims spend for inpatients only.

Conclusions

This evaluation of an innovative community palliative care intervention indicates that the extra services available to patients support the choice of dying at home and the ability to do so while generating claims cost efficiencies.
Conceptualizing and determining core clinical competencies in nursing students: a qualitative study
Authors: Moradi Y. , Ahmadi F. , Sadeghi A. , Oshvandi K.
Published: August 2019

Aim

This study aimed to conceptualize and explain the core clinical competencies of nursing students in Iran.

Background/Introduction

Despite the national and international efforts to modify nursing curricula such that the students’ clinical competencies are improved, there is still a widespread concern about this issue, perhaps due to the impact of factors other than the curriculum itself, such as the lack of a clear definition for the concept of clinical competency and its main components in nursing students.

Methods

This qualitative study was conducted using conventional content analysis. The participants were selected through purposive sampling and included 14 senior students of bachelor of nursing, four nurses working in teaching hospitals and six clinical instructors. Individual semi‐structured interviews were used for data collection. After recording and transcribing the interviews, content analysis was used to extract the concepts.

Findings

The main theme of the study was ‘multidimensionality of the concept of clinical competency,’ which had six main categories, namely ‘adoption of and adaptation with the nursing practice,’ ‘nursing knowledge,’ ‘self‐direction in clinical learning,’ ‘patient care skills,’ ‘professional ethics’ and ‘the development of professional behaviours.’

Discussion/Conclusion

Clinical competency and its dimensions among students comprise a multidimensional concept. Having a clear and comprehensive understanding of this concept and focusing on its core axes may be the most important step in improving students’ clinical competency.

Implications for nursing, health and education policy

Policymakers and nursing education authorities can identify the problems existing in the students’ clinical competency and provide them with practical solutions for a standard professional education through a clear understanding of the concept of clinical competency and its dimensions.
Measurement of birth outcomes in analyses of the impact of maternal influenza vaccination
Authors: Rolfes Melissa A. , Vonglokham Phouvanh , Khanthamaly Viengphone , Chitry Bounlap , Pholsena Vathsana , Chitranondh Visith , Mirza Sara A. , Moen Ann , Bresee Joseph S. , Xeuatvongsa Anonh , Olsen Sonja J.
Published: August 2019

Background

The estimated association of maternal influenza vaccination and birth outcomes may be sensitive to methods used to define preterm birth or small‐for‐gestational age (SGA).

Methods

In a cohort of pregnant women in Lao People's Democratic Republic, we estimated gestational age from: (a) date of last menstrual period (LMP), (b) any prenatal ultrasound, (c) first trimester ultrasound, (d) Ballard Score at delivery, and (e) an algorithm combining LMP and ultrasound. Infants were classified as SGA at birth using a Canadian, global, and equation‐based growth reference. We estimated the association of maternal influenza vaccination and birth outcomes, by influenza activity, using multivariable log‐binomial regression and Cox proportional hazards regression with vaccination as a time‐varying exposure.

Results

The frequency of preterm birth in the cohort varied by method to estimate gestational age, from 5% using Ballard Score to 15% using any ultrasound. Using LMP, any ultrasound, or the algorithm, we found statistically significant reductions in preterm birth among vaccinated women during periods of high influenza activity and statistically significant increases in SGA, using a Canadian growth reference. We did not find statistically significant associations with SGA when using global or equation‐based growth references.

Conclusions

The association of maternal influenza vaccination and birth outcomes was most affected by the choice of a growth reference used to define SGA at birth. The association with pre‐term birth was present and consistent across multiple statistical approaches. Future studies of birth outcomes, specifically SGA, should carefully consider the potential for bias introduced by measurement choice.
Outcome predictors for wound healing in patients with a diabetic foot ulcer
Authors: Mohammad Zadeh Maryam , Lingsma Hester , van Neck Johan W. , Vasilic Dalibor , van Dishoeck Anne‐Margreet
Published: August 2019

The aim of this study was to identify diabetic foot ulcer (DFU) patients at risk for the development of a hard‐to‐heal wound. This is a post‐hoc analysis of a prospective cohort study including a total of 208 patients with a DFU. The primary endpoints were time to healing and the development of a hard‐to‐heal‐wound. Univariable and multivariable logistic and Cox regression analysis were used to study the associations of patient characteristics with the primary endpoints. The number of previous DFUs [odds ratio (OR): 1.42, 95% confidence interval (CI): 1.01‐1.99, P = .04], University of Texas (UT) classification grade 2 (OR: 2.93, 95% CI: 1.27‐6.72, P = .01), UT classification grade 3 (OR: 2.80, 95% CI: 1.17‐6.71, P = .02), and a diagnosis of foot stand deformation (OR: 1.54, 95% CI: 0.77‐3.08, P = .05) were significantly associated with the development of a hard‐to‐heal wound. Only UT classification grade 3 (HR: 0.61, 95% CI: 0.41‐0.90, P = .01) was associated with time to healing. The number of previous DFUs, UT classification grade, and a diagnosis of foot deformation are significantly associated with development of a hard‐to‐heal wound in patients with a DFU. The only predictor significantly associated with time to healing was UT classification grade 3. These patient characteristics can be used to identify patients at risk for the development of hard‐to‐heal wounds, who might need an early intervention to prevent wound problems.
Adolescent childbirth, miscarriage, and abortion: associations with changes in alcohol, marijuana, and cigarette use
Authors: Tung Irene , Beardslee Jordan , Pardini Dustin , Chung Tammy , Keenan Kate , Hipwell Alison E.
Published: August 2019

Background

Adolescent girls who become pregnant demonstrate greater risk for substance use than same‐aged peers. However, it remains unclear how risk relates to normative changes in adolescence. Few studies have examined adolescent substance use changes before, during, and after pregnancy and considered how pregnancy outcomes (childbirth, miscarriage, abortion) differentially influence substance use changes. The present study examined associations between different adolescent pregnancy outcomes and within‐person changes in substance use from prepregnancy to postpregnancy.

Methods

Participants included 2,450 girls (52% Black) oversampled from low‐income urban neighborhoods in Pittsburgh, PA. Participants self‐reported pregnancy outcomes and substance use frequency (alcohol, cigarette, marijuana) annually from ages 11–20. Fixed effects regressions focused on first births, first miscarriages, and first abortions occurring from ages 12–19 to test the associations between pregnancy outcomes and within‐individual changes in substance use from prepregnancy to postpregnancy. By design, models controlled for all potential time‐stable confounds, and models included age and subsequent pregnancies as time‐varying covariates.

Results

Consistent with prior studies, girls who became pregnant (20%) reported greater early risk for substance use problems than never‐pregnant adolescents, including earlier age of onset and more regular marijuana and cigarette use. Childbirth predicted a 26%–51% within‐individual reduction in alcohol, marijuana, and cigarette use that remained significantly lower than prepregnancy levels after childbirth. Alcohol and marijuana use decreased (32%–47%) after miscarriage. Abortion was not associated with long‐term changes in substance use; however, marijuana and cigarette use gradually increased (44%–46%) in the years leading up to the year of and after abortion, respectively, before returning to prepregnancy levels.

Conclusions

Findings highlight important differences in adolescent substance use patterns based on pregnancy outcome. For pregnant adolescents with heightened pre‐existing risk for substance use, pregnancy may be a window of opportunity for substance use screening and behavioral intervention.
Prevalence and clinical characteristics of itch in epidemic‐like scenario of dermatophytoses in India: a cross‐sectional study
Authors: Verma S. , Vasani R. , Reszke R. , Matusiak Ł. , Szepietowski J.C.
Published: August 2019

Background

Itch is an integral part of clinical picture of superficial dermatophytoses which constitute a common and growing problem in India.

Objectives

The study aimed to evaluate the prevalence, intensity and clinical characteristics of itch in superficial dermatophytosis.

Methods

The data concerning disease history and clinical type of dermatophytosis were obtained. The presence and various characteristics of itch were documented. Numerical Rating Scale (NRS) was utilized to assess the worst intensity of itch during the last 3 days and during the course of the disease. 4‐Item Itch Questionnaire was utilized to assess itch extent, intensity, frequency and associated sleep impairment, while quality of life (QoL) impairment was assessed via Dermatology Life Quality Index.

Results

Ninety‐nine patients with direct microscopic confirmation of dermatophytosis were included in the study. In 46.5% of subjects, the coexistence of tinea corporis and tinea cruris was noted, followed by tinea cruris (25.2%) and tinea corporis (13.1%). The majority of patients reported itch in the last 3 days (99%) and complained of itch limited to skin lesions (89.9%). According toNRS, the mean intensity of worst itch in the last 3 days was 6.8 ± 1.8 points. Severe and very severe itch was reported by 74.7% of patients. Itch was an isolated sensation in 34.3% of subjects, while 46.9% reported associated burning sensation. Itch was frequently exacerbated by sweating, hot temperature and wearing tight clothes. Difficulties in falling asleep and sleep awakenings were reported by 34.3% and 54.6% of subjects, respectively. Itch negatively influenced the well‐being of patients and its intensity correlated with QoL impairment.

Conclusions

Itch is an important symptom in superficial dermatophytoses and is associated with negative impact on sleep and carries a significant psychosocial burden. Acknowledging its presence is necessary in a holistic approach to these patients.
Different host plant species modifies the susceptibility of Bactericera cockerelli to the entomopathogenic fungus Beauveria bassiana
Authors: Ocampo‐Hernández Jaime A. , Tamayo‐Mejía Fernando , Tamez‐Guerra Patricia , Gao Yulin , Guzmán‐Franco Ariel W.
Published: August 2019

Bactericera cockerelli (Sulc.) is a serious pest of solanaceous crops and a vector of the plant pathogen Candidatus Liberibacter psyllaurous. Entomopathogenic fungi are the most important biological control alternatives for this pest. Host plant species, however, can modify the outcomes of insect–pathogen interactions. We conducted laboratory experiments to quantify the virulence of two isolates of the entomopathogenic fungus Beauveria bassiana (Bals. [Vuill.]), BB40 and BB42, against third instar B. cockerelli nymphs maintained on chilli pepper plants. Owing to the lack of difference in virulence against B. cockerelli nymphs on chilli pepper between the two B. bassiana isolates, only BB42 was used to: compare virulence against nymphs maintained on either chilli pepper, potato or tomato; and in vivo conidia production from nymphs maintained on different host plants. Virulence of the two B. bassiana isolates against B. cockerelli nymphs was similar. Bactericera cockerelli nymphs maintained on tomato were more susceptible to B. bassiana than nymphs maintained on potato or chilli peppers. Infected nymphs maintained on chilli peppers produced the greatest number of conidia followed by infected nymphs maintained on tomato and potato. Host plant affected the susceptibility of B. cockerelli to B. bassiana isolate BB42 and subsequent conidia production. The implications of our results for microbial control of B. cockerelli by B. bassiana are discussed.
Effects of sugar composition on shelf life of hard candy: Optimization study using D‐optimal mixture design of experiments
Authors: Spanemberg Flavio E. M. , Korzenowski André L. , Sellitto Miguel A.
Published: August 2019

The purpose of this study was to determine the sugar formulation that maximizes the shelf life and critical moisture content of hard candy and to verify the relationship between the response variables. The method used was the mixture design of experiments. Experimental points were determined using a D‐optimal mixture design. Industrial‐scale tests were conducted using three commercial sugars commonly found in hard candies. The models were fitted to the experimental results and evaluated via an analysis of variance. There was a maximum point (58.17 d) for the accelerated shelf life model, which was 0.600, 0.200, and 0.200 for the mass fractions of sucrose, 40 DE corn syrup, and 20 DE high‐maltose corn syrup, respectively; the maximum critical moisture content (3.88%) was 0.593, 0.228, and 0.179, respectively. The optimum formulation resulted in a product whose estimated shelf life extended 7 months beyond the expiration date usually used in the industry.

Practical Applications

The results have implications for increasing the shelf life and agility in the development of new products. A practical and low‐cost method for determining the critical moisture content using accelerated tests in the confectionery industry is proposed. This study is a direct application of the mixture design of experiments on an industrial scale and provides significant results not found in the literature.
Effect of contact ultrasonic power on moisture migration during far‐infrared radiation drying of kiwifruit
Authors: Liu Yunhong , Zeng Ya , Hu Runrun , Sun Xue
Published: August 2019

In order to explore the effect of direct contact ultrasound (DCU) on moisture migration during far‐infrared radiation (FIR) drying of kiwifruit, the drying characteristics, microstructure, water status, and moisture change of kiwifruit slices during drying were investigated based on scanning electron microscopy (SEM), low‐field nuclear magnetic resonance (LF‐NMR), and magnetic resonance imaging (MRI). The results showed that the drying time at ultrasonic power of 54 W was 40% shorter than that without DCU application. SEM observation verified that higher ultrasonic power could produce more and larger microcapillaries in the microstructure of kiwifruit slices, which was beneficial for moisture migration. LF‐NMR detection indicated that water mobility and distribution in kiwifruits changed during drying. The relative proportion of free water in kiwifruits decreased from 70 to 0% with the prolongation drying time at different ultrasonic powers, the removal time for free water at ultrasonic power of 54 W was 57% shorter than that without DCU application during FIR drying, and higher ultrasonic power could accelerate the shifting of water in different states. MRI results illustrated that the DCU application at higher ultrasonic power could promote moisture migration and water removal during FIR drying, and then increase drying rate.

Practical applications

Drying is a commonly utilized process method in food and agricultural industry. Far‐infrared radiation (FIR) drying, as one of the modern drying methods, has desirable advantages including high‐energy efficiency and uniform heating. However, it has unsatisfied promoting effect on internal mass transfer. Ultrasound has significant positive effect on moisture diffusion and water removal. In this study, direct contact ultrasound (DCU) was applied in FIR drying of kiwifruit slices. The study verified that the DCU application in FIR drying could promote drying rate, produce loose microstructure, and shorten drying time significantly. The increase in ultrasonic power could accelerate moisture migration and mass transfer to facilitate water removal. Therefore, DCU application with higher ultrasonic power is beneficial to increasing drying rate and reducing drying time of FIR drying, and FIR drying technology combined with DCU is promising in food industry and can be developed for other food products.