bluuebunny/crossref_metadata_2025 huggingface dataset:
Public, patient and carers’ views on palliative and end‐of‐life care in India
Authors: Ramasamy Venkatasalu M. , Sirala Jagadeesh N. , Elavally S. , Pappas Y. , Mhlanga F. , Pallipalayam Varatharajan R.
Published: August 2017

Aim

To systematically review the existing evidence on the Indian public, patient and carers’ perspectives on palliative and end‐of‐life care.

Background

With a growing population of terminally ill people across the world, there is also an increasing awareness among international health policy makers of the need to improve the quality of life for terminally ill patients. Understanding service users’ (patients, family and public) perspectives is crucial in developing and sustaining successful community‐centred palliative nursing policies and service models especially in countries like India with diverse population.

Methods

An integrative review was performed on five databases, using hand searches of key journals and reference citation tracking for empirical studies published in English from 1990 to 2015. A thematic analysis framework was used to analyse and identify key themes.

Results

Analysis of the six eligible studies revealed five themes. Themes describe how social, economic, cultural, religious, spiritual and traditional factors influenced the palliative and end‐of‐life care perspectives and experiences among Indians. They also illustrated preferences relating to place of care, as well as benefits and challenges of family caregiving during the last days of life.

Conclusions

Although we found minimal evidence on user perspectives, nurses need to aware of those unique components of context‐specific palliative and end‐of‐life care practices in India – socioeconomic, cultural and religious factors – on their nursing encounters. Nurses need to advocate same in policy development to enable accessibility and utility of palliative and end‐of‐life care services, which are scant in India.

Implications for nursing and health policy

Nurses can be central in gathering the contextual evidence that advocate users’ perspectives to inform further studies and national palliative care policies in India. Emerging policies in nursing education need to focus on integrating family‐centred palliative and end‐of‐life care within curricula, whereas nursing practice may promote nurse‐led community models to address the patchy palliative and end‐of‐life service provision in India.
Modern Likelihood‐Frequentist Inference
Authors: Pierce Donald Alan , Bellio Ruggero
Published: August 2017

We offer an exposition of modern higher order likelihood inference and introduce software to implement this in a quite general setting. The aim is to make more accessible an important development in statistical theory and practice. The software, implemented in anRpackage, requires only that the user provide code to compute the likelihood function and to specify extra‐likelihood aspects of the model, such as stopping rule or censoring model, through a function generating a dataset under the model. The exposition charts a narrow course through the developments, intending thereby to make these more widely accessible. It includes the likelihood ratio approximation to the distribution of the maximum likelihood estimator, that is thep∗formula, and the transformation of this yielding a second‐order approximation to the distribution of the signed likelihood ratio test statistic, based on a modified signed likelihood ratio statisticr∗. This follows developments of Barndorff‐Nielsen and others. The software utilises the approximation to required Jacobians as developed by Skovgaard, which is included in the exposition. Several examples of using the software are provided.
Multiple social media in the workplace: Contradictions and congruencies
Authors: Forsgren Emma , Byström Katriina
Published: August 2017

In this paper, we report an investigation on the use of multiple social media in knowledge work and explore the contribution of activity theory for such a study. As social media are increasingly adopted at work, there is a demand to understand how they are being incorporated. This study focuses on how social media may improve or reduce coherence in work activities, and for this purpose, we use activity theory as an analytical lens to conceptualise social media usage in a Scandinavian software development company. The qualitative data, consisting of interviews and observations, were analysed to capture the mediating role of social media for information sharing within and across work activities. We found social media in general helpful to maintain coherence in terms of sharing work‐related information, improving ambient awareness, as well as for socialising, but they also caused inconsistencies in use and adoption. In addition, we found that social media served different purposes in different activity systems, causing both contradictions and congruencies; what was seen as a benefit for some work activities appeared as a limitation for others (eg, concerning pace and aims of information sharing). In our findings through the lens of activity theory, we observed how objects, although they were shared, were fractionalised in networked activities. Our conclusion is that despite the still unoptimised functionality, social media do bring coherence in work activities in a decentralised work environment.
Non‐adherence to treatment of chronic wounds: patient versus professional perspectives
Authors: Moffatt Christine , Murray Susie , Keeley Vaughan , Aubeeluck Aimee
Published: August 2017

The reasons for the non‐adherence to treatment for wound healing are complex and fall into unintentional and intentional categories. This study explored intentional and unintentional non‐adherence to treatment from patient/carer and health care professional perspectives. Patients with wounds receivingALLEVYNLife dressings (n= 20) and patients not receivingALLEVYNLife dressings who were deemed to be non‐adherent to treatment regimes (n= 6) took part in semi‐structured interviews to explore their experiences of living with a wound, treatment and intentional and unintentional non‐adherence. Three focus groups of health care professionals explored issues surrounding non‐adherence to treatment regimes. Groups included nurses and doctors (n= 25). We found that relationships between participants and health care professionals varied in character across the groups. All participants expressed reasons for both intentional and unintentional adherence. Many reasons for intentional non‐adherence are related to comfort and working the regime around patients' lives. Health care professionals considered the most common form of non‐adherence to be unintentional. However, patients describe the most common form of non‐adherence as being intentional. The relationship between patients and health care professionals varied in character between the groups. Discrepancies between professional and patient perspectives need to be reconciled and addressed to improve adherence to treatment regimes.
Quantum molecular resonance technology in hard‐to‐heal extremity wounds: histological and clinical results
Authors: Fraccalvieri Marco , Salomone Marco , Di Santo Claudia , Ruka Erind , Morozzo Umberto , Bruschi Stefano
Published: August 2017

Chronic wounds are commonly associated with high morbidity rates due to the patient's need of frequent dressing changes and repeated visits to the outpatient wound clinic. Furthermore, chronic wounds are often characterised by severe pain, which can cause significant disability to the patient. New technologies aim to develop an optimal device to reduce discomfort of the patient and to heal wounds. The device Rexon‐age® is introduced for the first time in wound healing, and preliminary data on clinical and histological results are shown.

From April 2014 to April 2015, 11 patients – 7 females and 4 males – were enrolled in the present study. The study was conducted at the Plastic and Reconstructive Institute of the Università degli Studi di Torino, Città della Salute e della Scienza of Torino, Italy. For histological characterisation, pre‐ and post‐treatment biopsies on the wound bed were performed. Data regarding age, gender, weight, height, comorbidity, drug therapy and topical pre‐treatment and dressings of the wound were collected as well. Moreover, local factors regarding the wound data were as follows: aetiology, time of the wound formation until first Rexon‐age treatment, wound dimensions, wound bed, moisture, margins and anatomical region of the wound. A visual analogue scale (VAS) was used to monitor the pain before and after each treatment.

Rexon‐age treatment resulted in improvement in granulation tissue and wound contraction. Moreover, a significant reduction of pain was observed with the reduction of painkillers drug usage. Among these Rexon‐age‐treated patients, three patients displayed 60–80% reduction in pain intensity, and two patients showed complete pain relief. In outpatient follow‐up appointments, we registered long‐term durability of pain relief.

As assessed by histological analyses, post‐treatment biopsies of all nine patients revealed a decreased amount of inflammatory cells and lower expression levels of metalloproteinases (e.g. MMP9). We observed increased capillary thrombosis as well as up‐regulation of vascular endothelial growth factor (VEGF) expression.

The current study presents the first evidence that Rexon‐age‐based therapy can significantly ameliorate and accelerate the healing process of chronic wounds. Although this study analysed only a small number of patients, we could consistently observe positive effects on both the clinical aspect of the lesions, which underwent size reduction and wound reactivation, and the quality of life of our patients due to long‐term pain relief.
Parameters for spray drying ZnO nanopowders as spherical granules
Authors: Yıldız Ömer , Soydan Ali Murat
Published: August 2017

Spray drying is a versatile method to perform atomization, drying, and granulation. Spray dryers enable agglomeration of particles into a spherical granule form with a nano‐meter size and thus very high specific surface areas (SSA). For this, the synthesized Zn(OH)2 precipitate should be concurrently atomized and dried under desired spray drying conditions. The drying process has many complex and critical parameters. In order to obtain ZnO nanopowders in a spherical granule form the inlet temperature and the flow rate of the hot air, the feeding rate and the solid‐liquid ratio of the suspension, need to be optimized for 150°C ≤ ITHA ≤ 180°C, 5 mL/min ≤ FRS ≤ 15 mL/min, 50 g/L ≤ SLRS ≤ 200 g/L, 0.4 m3/min ≤ FRHA ≤ 0.6 m3/min and 60°C ≤ OTDC ≤ 90°C, respectively. The powders synthesized by these modifications have a range of 5‐200 nm (TEM) and high SSA of 21‐114 m2·g−1 (average particle size: 9‐51 nm according to the SSA analyses) depending on the drying process parameters. The ZnO nanopowders have a soft granule structure according to the SSA analyses. Therefore, there is no need to grind the powders. They can be easily processed at all of the mixing and forming steps. In addition, they do not contain any contamination coming from grinding.
Cytotoxicity, chemical stability, and surface properties of ferroelectric ceramics for biomaterials
Authors: Acosta Matias , Detsch Rainer , Grünewald Alina , Rojas Virginia , Schultheiß Jan , Wajda Aleksandra , Stark Robert W. , Narayan Suman , Sitarz Maciej , Koruza Jurij , Boccaccini Aldo R.
Published: August 2017

Surface chemistry and topo‐physical properties determine the interactions of biomaterials with their physiological environment. Ferroelectrics hold great promise as the next generation of scaffolds for tissue repair since they feature tunable surface electrical charges, piezoelectricity, and sensing capabilities. We investigate the topography, wettability, chemical stability, and cytotoxicity in salient ferroelectric systems such as (1−x) (Na1/2Bi1/2)TiO3–xBaTiO3, (1−x)Ba(Zr0.2Ti0.8)O3−x(Ba0.7Ca0.3)TiO3, and Pb(Zr,Ti)O3 to test their suitability as biomaterials. The lead‐free ferroelectrics promote in vitro cell viability and proliferation to a considerably high extent. 0.94 mol % (Na1/2Bi1/2)TiO3–0.06 mol% BaTiO3 showed the greatest potential leading to a cell viability of (149 ± 30)% and DNA synthesis of (299 ± 85)% in comparison to the reference. Lead leaching from Pb(Zr,Ti)O3 negatively affected the cultured cells. Wettability and chemical stability are key factors that determine the cytotoxicity of ferroelectrics. These variables have to be considered in the design of novel electroactive scaffolds based on ferroelectric ceramics.
An assessment of tree availability as a possible cause of population declines in scavenging raptors
Authors: Kendall Corinne J. , Rubenstein Daniel I. , Slater Pamela L. , Monadjem Ara
Published: August 2017

Lack of suitable nesting trees is an increasingly common issue for avian conservation given rampant habitat and tree destruction around the world. In the African savannah, habitat loss and particularly tree damage caused by elephants have been suggested as possible factors in the decline of large bird species. Given the recent declines of vultures and other scavenging raptors, it is critical to understand if nest availability is a limiting factor for these threatened populations. Loss of woodland, partially due to elephant populations, has been reported for the Mara‐Serengeti ecosystem. Data on characteristics of trees used for nesting were collected for white‐backed, lappet‐faced, white‐headed vulture, and tawny eagle nests in Masai Mara National Reserve, Kenya. Nest tree characteristics were compared with the distribution of a random subsample of trees to assess nest preferences and determine suitability of available trees. Nearest neighbor distances were estimated as well as availability of preferred nesting trees to determine if tree availability is a limiting factor for tree‐nesting vultures. Tree availability was found to greatly exceed nesting needs for African vultures and tawny eagles. We thus conclude that on a landscape scale, tree availability is not a limiting factor for any of the species considered here (white‐backed, lappet‐faced, white‐headed vultures and tawny eagles).
Spousal concordance for hypertension: A meta‐analysis of observational studies
Authors: Wang Zhancheng , Ji Wenhui , Song Yanqiu , Li Jin , Shen Yan , Zheng Hongchao , Ding Yueyou
Published: August 2017

The authors performed a meta‐analysis of observational studies to estimate the magnitude of spousal concordance for hypertension and to examine whether the concordance varied by important study methodological aspects. PubMed and Embase were searched up to June 2017 for cross‐sectional, case‐control, and cohort studies that investigated the concordance/association of hypertension between spouse pairs. A meta‐analysis with random‐effects models was performed by pooling adjusted odds ratios. Eight studies with a total number of 81 928 spouse pairs were eligible. The pooled results showed that spouses of individuals with hypertension had 41% (odds ratio, 1.41; 95% confidence interval, 1.21–1.64) increased odds of having hypertension themselves. The association applied to both men and women, and was not significantly different between studies with adjustment for body mass index and those without. The findings highlighted the importance of environmental factors in the development of hypertension.
Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence
Authors: Ferdinand Keith C. , Yadav Kapil , Nasser Samar A. , Clayton‐Jeter Helene D. , Lewin John , Cryer Dennis R. , Senatore Fortunato Fred
Published: August 2017

Blacks are two to three times as likely as whites to die of preventable heart disease and stroke. Declines in mortality from heart disease have not eliminated racial disparities. Control and effective treatment of hypertension, a leading cause of cardiovascular disease, among blacks is less than in whites and remains a challenge. One of the driving forces behind this racial/ethnic disparity is medication nonadherence whose cause is embedded in social determinants. Eight practical approaches to addressing medication adherence with the potential to attenuate disparities were identified and include: (1) patient engagement strategies, (2) consumer‐directed health care, (3) patient portals, (4) smart apps and text messages, (5) digital pillboxes, (6) pharmacist‐led engagement, (7) cardiac rehabilitation, and (8) cognitive‐based behavior. However, while data suggest that these strategies may improve medication adherence, the effect on ameliorating racial/ethnic disparities is not certain. This review describes the relationship between disparities and medication adherence, which likely plays a role in persistent disparities in cardiovascular morbidity and mortality.
Commentary: Lingering questions about the Social Responsiveness Scale short form. A commentary on Sturm et al. (2017)
Authors: Kaat Aaron J. , Farmer Cristan
Published: August 2017

Read the full article at doi: 10.1111/jcpp.12731
Ecological and phylogenetic variability in the spinalis muscle of snakes
Authors: Tingle J. L. , Gartner G. E. A. , Jayne B. C. , Garland T.
Published: August 2017

Understanding the origin and maintenance of functionally important subordinate traits is a major goal of evolutionary physiologists and ecomorphologists. Within the confines of a limbless body plan, snakes are diverse in terms of body size and ecology, but we know little about the functional traits that underlie this diversity. We used a phylogenetically diverse group of 131 snake species to examine associations between habitat use, sidewinding locomotion and constriction behaviour with the number of body vertebrae spanned by a single segment of the spinalis muscle, with total numbers of body vertebrae used as a covariate in statistical analyses. We compared models with combinations of these predictors to determine which best fit the data among all species and for the advanced snakes only (N = 114). We used both ordinary least‐squares models and phylogenetic models in which the residuals were modelled as evolving by the Ornstein–Uhlenbeck process. Snakes with greater numbers of vertebrae tended to have spinalis muscles that spanned more vertebrae. Habitat effects dominated models for analyses of all species and advanced snakes only, with the spinalis length spanning more vertebrae in arboreal species and fewer vertebrae in aquatic and burrowing species. Sidewinding specialists had shorter muscle lengths than nonspecialists. The relationship between prey constriction and spinalis length was less clear. Differences among clades were also strong when considering all species, but not for advanced snakes alone. Overall, these results suggest that muscle morphology may have played a key role in the adaptive radiation of snakes.
An esthetic evaluation of unilateral canine substitution for a missing maxillary lateral incisor
Authors: Thierens Laurent A. M. , Verhoeven Bavo , Temmerman Liesbeth , De Pauw Guy A. M.
Published: August 2017

Objectives

The aim of this study is to determine whether variation in size, morphology, and color of a unilateral substituted maxillary canine has influence on the dentogingival attractiveness perceived by dental professionals and laypeople.

Materials and Methods

A frontal clinical photograph of a patient with unilateral canine substitution was used as standard picture. Five different series were created by modification of following parameters with a raster graphics editor (Photoshop CS 6): (1) width, (2) color, (3) gingival margin height, and (4) crown tip morphology of the substituted canine and (5) the gingival margin height of the neighboring first premolar. For each parameter, the photograph deviating the most from the standard photograph, was combined into a final series. Four groups of examiners (orthodontists, periodontists, dentists, and laypeople) were asked to rank the photographs from most to least attractive.

Results

One hundred seventy‐four examiners ranked the photographs in order of attractiveness. Overall, a darker canine color (mean rank 4.36 ± 1.03) and a more pronounced canine tip morphology (mean rank 3.47 ± 1.11) were significantly ranked as most unattractive (P < .05). The gingival height of the neighboring premolar was ranked as least unattractive by all groups of examiners (mean rank 1.30 ± 0.74).

Conclusions

Darker canine color and a pronounced tip morphology of a substituted canine are rated as the most unattractive by dental professionals and laypeople.

CLINICAL SIGNIFICANCE

The present study showed that the canine color and crown tip morphology are important parameters when considering unilateral canine substitution, both for professionals and laypeople. There is a general preference in favor of canines with a light color and a reduced incisal tip.
Development of a real‐time PCR assay for rapid detection and quantification of Photobacterium damselae subsp. piscicida in fish tissues
Authors: Carraro R , Dalla Rovere G , Ferraresso S , Carraro L , Franch R , Toffan A , Pascoli F , Patarnello T , Bargelloni L
Published: August 2017

The availability of a rapid and accurate method for the diagnosis of Photobacterium damselae subsp. piscicida (Phdp), able to discriminate its strictly correlated subsp. damselae (Phdd), formally known as Vibrio damsela, is essential for managing fish pasteurellosis outbreaks in farmed fish. A single‐step, high‐sensitivity real‐time PCR assay for simultaneous detection and quantification of P. damselae was designed targeting partial of the sequence of the bamB gene and tested for specificity and sensitivity on laboratory‐generated samples as well as on experimentally infected seabream tissue samples. With a limit of detection (LOD) of one copy in pure bacterial DNA, the sensitivity was higher than all methods previously reported. Validation in target and non‐target bacterial species proved the assay was able to discriminate Phdd‐Phdp subspecies from diverse hosts/geographical origins and between non‐target species. In addition, two SNPs in the target amplicon region determine two distinctive qPCR dissociation curves distinguishing between Phdp‐Phdd. This is the first time that a molecular method for P. damselae diagnosis combines detection, quantification and subspecies identification in one step. The assay holds the potential to improve the knowledge of infection dynamics and the development of better strategies to control an important fish disease.
High Symptom Burden and Low Functional Status in the Setting of Multimorbidity
Authors: Portz Jennifer D. , Kutner Jean S. , Blatchford Patrick J. , Ritchie Christine S.
Published: August 2017

Objectives

To enhance understanding of the relationship between multimorbidity, symptom burden, and functional status in individuals with life‐limiting illness.

Design

Secondary analysis of baseline data from a randomized clinical trial conducted in the Palliative Care Research Cooperative Group. Group differences were tested using a t‐test; multivariate regression analysis was used to determine the effect of multiple variables on functional status and symptom burden.

Setting

Fifteen Palliative Care Research Cooperation sites.

Participants

Adults who participated in a parent statin‐discontinuation clinical trial were included in the analysis (N = 381). Inclusion criteria were diagnosis of a life‐limiting illness, statin use for 3 months or longer, life expectancy longer than 1 month, and declining functional status.

Measurements

Cancer diagnosis (solid organ and hematologic malignancies), multimorbidity (Charlson Comorbidity Index (CCI) score), symptom burden (Edmonton Symptom Assessment Scale (ESAS) score, number of symptoms with ESAS severity score >4), functional status (Australia‐modified Karnofsky Performance Scale (AKPS)).

Results

Fifty‐one percent had a primary diagnosis of cancer; mean age 74.1 ± 11.6. Participants had multiple comorbid illnesses (CCI score 4.9 ± 2.8), multiple symptoms (ESAS score 27.2 ± 15.9), and poor functional status (AKPS = 53 ± 13). In univariate and multivariate analyses, multimorbidity was associated with greater symptom burden (4.2 vs 3.1 moderate or severe symptoms (t = −3.2, P = .002), 12% vs 6% with severe symptoms (t = −3.7, P < .001)), but cancer diagnosis was not. In univariate and multivariate analyses, higher symptom burden was associated with poorer functional status (F = 11.6, P < .001), but multimorbidity was not.

Conclusion

Symptoms cannot be attributed solely to a diagnosis of cancer. The association between symptom burden and functional status underscores the importance of clinical attention to symptoms in individuals with multimorbidity.
What impact does nursing care left undone have on patient outcomes? Review of the literature
Authors: Recio‐Saucedo Alejandra , Dall'Ora Chiara , Maruotti Antonello , Ball Jane , Briggs Jim , Meredith Paul , Redfern Oliver C , Kovacs Caroline , Prytherch David , Smith Gary B , Griffiths Peter
Published: August 2017

Aims and objectives

Systematic review of the impact of missed nursing care on outcomes in adults, on acute hospital wards and in nursing homes.

Background

A considerable body of evidence supports the hypothesis that lower levels of registered nurses on duty increase the likelihood of patients dying on hospital wards, and the risk of many aspects of care being either delayed or left undone (missed). However, the direct consequence of missed care remains unclear.

Design

Systematic review.

Methods

We searched Medline (via Ovid), CINAHL (EBSCOhost) and Scopus for studies examining the association of missed nursing care and at least one patient outcome. Studies regarding registered nurses, healthcare assistants/support workers/nurses’ aides were retained. Only adult settings were included. Because of the nature of the review, qualitative studies, editorials, letters and commentaries were excluded. PRISMA guidelines were followed in reporting the review.

Results

Fourteen studies reported associations between missed care and patient outcomes. Some studies were secondary analyses of a large parent study. Most of the studies used nurse or patient reports to capture outcomes, with some using administrative data. Four studies found significantly decreased patient satisfaction associated with missed care. Seven studies reported associations with one or more patient outcomes including medication errors, urinary tract infections, patient falls, pressure ulcers, critical incidents, quality of care and patient readmissions. Three studies investigated whether there was a link between missed care and mortality and from these results no clear associations emerged.

Conclusions

The review shows the modest evidence base of studies exploring missed care and patient outcomes generated mostly from nurse and patient self‐reported data. To support the assertion that nurse staffing levels and skill mix are associated with adverse outcomes as a result of missed care, more research that uses objective staffing and outcome measures is required.

Relevance to clinical practice

Although nurses may exercise judgements in rationing care in the face of pressure, there are nonetheless adverse consequences for patients (ranging from poor experience of care to increased risk of infection, readmissions and complications due to critical incidents from undetected physiological deterioration). Hospitals should pay attention to nurses’ reports of missed care and consider routine monitoring as a quality and safety indicator.
Oral appliances for managing sleep bruxism in adults: a systematic review from 2007 to 2017
Authors: Jokubauskas L. , Baltrušaitytė A. , Pileičikienė G.
Published: August 2017

The review focuses on the last decade of research regarding the use of various oral appliances (OAs) in the management of sleep bruxism (SB) in adults. Sixteen (n = 16) papers of 641 identified citations involving 398 participants were included in the review. Of them, seven were randomised controlled trials (RCTs), seven were uncontrolled before–after studies and two were crossover trials. Analysis of the included articles revealed a high variability of study designs and findings. Generally, the risk of bias was low‐to‐unclear for RCTs and high for crossover studies, whilst the before–after studies exhibited several structural limitations. Nine studies used polysomnography/polygraphy/electromyography for SB diagnosis, whilst others were based on history taking and clinical examination. Most of them featured small samples and were short term. Of the studies using objective SB evaluations, eight showed positive results for almost every type of OA in reducing SB activity, with a higher decrease for devices that are designed to provide a certain extent of mandibular advancement. Among the studies using a subjective SB evaluation, one demonstrated a significant reduction in SB activity, and additional two showed a myorelaxant effect of OA in SB patients. Although many positive studies support the efficiency of OA treatment for SB, accepted evidence is insufficient to support its role in the long‐term reduction of SB activity. Further studies with larger samples and sufficient treatment periods are needed to obtain more acknowledgements for clinical application.
Histology with immunohistochemistry of the fistula region in female anorectal malformation: Can it be used for neo‐anus reconstruction?
Authors: Pandey Anand , Pandey Pinky , Singh Shailendra P , Agarwal Savita , Gupta Vipin , Verma Rajesh
Published: August 2017

Aim

Female anorectal malformation is characterised by communication to the exterior by a fistula. There are conflicting reports of the presence of normal anus in the fistula region. This study was undertaken to assess the histopathology and immunohistochemical correlation of the terminal portion of the fistula in female patients and suitability of fistula incorporation in the reconstruction of the neo‐anus.

Methods

This prospective study included 13 patients of female anorectal malformation. Of these, seven had a vestibular fistula (VF), and the rest had an anterior ectopic anus (AEA). Histopathology of the fistula region was undertaken, along with immunohistochemistry. Various findings were evaluated.

Results

Of seven VF patients, four showed atrophic or disrupted internal sphincter smooth muscle, whereas the remaining three showed hypertropic internal sphincteric smooth muscle. Six patients showed hypertrophic nerve bundle. Five VF patients showed subepithelial fibrosis, and none of them showed ganglion cells. Of six patients of AEA, internal sphincteric smooth muscle was normal in five. It was hypertrophic in one patient. Transitional epithelium was present in four patients. All patients showed hypertrophic nerve bundle and aganglionosis. Subepithelial fibrosis was observed in six patients.

Conclusion

The fistula region in VF and AEA patients appears to be an abnormal structure. Rather than preservation of the terminal fistulous region, resection followed by anoplasty may be a viable option.
Binge drinking as a risk factor for advanced alcoholic liver disease
Authors: Ventura‐Cots Meritxell , Watts Ariel E. , Bataller Ramon
Published: August 2017

See Article on Page 1373
Contradictory Others and the Habitus of Languages: Surveying the L2 Motivation Landscape in the United Kingdom
Authors: LANVERS URSULA
Published: August 2017

Britain's already poor record for language learning might be exacerbated by the Global English phenomenon, in that utilitarian reasons for learning languages other than English are increasingly undermined (Lanvers, 2014; Lo Bianco, 2014). This article offers a state‐of‐the‐art review of UK research on second language (L2) learning motivation and attitude. The introduction is dedicated to a review of language education policy and numerical evidence on the decline in language learning. Part I reviews UK motivational literature under the headings Primary school; Secondary school; University and beyond; Teachers, parents, milieu. The evaluation of the literature reveals some striking lacunae, as well as a misfit between common explanations of the UK's language learning crisis and the social divide between those who choose to learn languages and those who do not. A motivation‐in‐context understanding of UK language learning needs to account for the many contradictory Other influences impacting on learner motivation. Therefore, Part II presents a new motivational model, based on Higgins's Self‐Discrepancy Theory, a model which includes multifaceted Others as well as Own selves, including that of resistance/rebellion against Others.
The Impact of Global English on Motivation to Learn Other Languages: Toward an Ideal Multilingual Self
Authors: USHIODA EMA
Published: August 2017

In 2006, Graddol predicted that numbers of ‘English as a foreign language’ learners would begin to decline through the second decade of this century, as global English achieves basic skill status for children entering education in more societies across the world. As he further noted, having skills in additional languages may thus offer a competitive edge in a global job market where English skills have become commonplace, and where monolingual and even bilingual English speakers may lose out to multilingual competitors. As yet, however, the extent to which the spread of global English may motivate individuals to diversify their language skills beyond English seems limited. Rather, both empirical evidence and commonly held perceptions would seem to endorse the view that global English tends to impact negatively on motivation to learn other languages, despite the growing linguistic and cultural diversity of today's societies. This article critically analyses this impact on motivation from two perspectives. First, from a macro‐sociological perspective, it explores the tensions among language globalization, multiculturalism, and multilingualism in today's changing social world and examines the mixed messages communicated for language education in general and for language learners in particular. In so doing, it considers the socially distributed nature of motivation at the level of societal multilingualism and educational policy and practice, and the impact of the social on the individual. Second, from a theoretical perspective, the article considers whether the impact of global English on motivation to learn other languages might be more positively construed by shifting away from SLA frames of reference (concerned with progression toward proficiency in a particular language) in favour of a ‘linguistic multi‐competence’ framework, defined by Cook (2016) as the overall system of a mind or community that uses more than one language. As the article concludes, an important pedagogical implication would be a focus on multilingual (rather than L2) speakers as the normative model of communication and instruction, and the associated promotion of ideal multilingual selves.
Commentary: Motivation for Learning Languages Other Than English in an English‐Dominant World
Authors: DUFF PATRICIA A.
Published: August 2017

The majority of recent research on language learning motivation has reportedly focused on English as a target language, typically in relatively homogeneous, secondary and postsecondary ‘foreign language’ settings. How applicable, then, are the theories and findings undergirding that research to our understanding of the contemporary challenges and processes involved in the learning of languages other than English (LOTEs) – whether by non‐Anglophones choosing additional or alternative languages, or for Anglophones choosing to learn a different language? And how is motivation theory itself evolving in light of the emerging role of English as a global language and a greater emphasis on sociopolitical, sociocultural, economic, and ideological aspects of language learning in diverse contexts, on the one hand, and a concomitant de‐emphasis of deficit‐oriented notions of learners’ shortcomings or traits in acquiring or using another language, on the other? What research methods are being used? Finally, how is current motivation research taking into account multilingual experiences (i.e., involving three or more languages), rather than just the learning of one additional (foreign) language? In this commentary piece, I address questions such as these by drawing on insights from the nine articles and other related sources and also offer some of my own perspectives drawing from research on Chinese and other languages.
Linear and Linguistic Syntax in Brahms's O Kühler Wald, Op. 72 No. 3
Authors: SNARRENBERG ROBERT
Published: August 2017

This essay explores the interplay between states of syntactic completion and incompletion in the text and music of Brahms's O kühler Wald and how the composer thereby conveys an interpretation of the poetic text to create an experience for the listener that bears a striking resemblance to the experience of the poem's lovelorn persona.
Revealing potential bridge vectors forBTVandSBV: a study onCulicoidesblood feeding preferences in natural ecosystems inSpain
Authors: TALAVERA S. , MUÑOZ‐MUÑOZ F. , VERDÚN M. , PUJOL N. , PAGÈS N.
Published: August 2017

Several species ofCulicoides(Diptera:Ceratopogonidae) are vectors of pathogens, such as the bluetongue (BTV) andSchmallenberg (SBV) viruses, which cause important diseases in domestic and wild ruminants. As wild ruminants can contribute to overwintering and epizootics of both diseases, knowledge of the host‐feeding behaviour ofCulicoidesin natural ecosystems is important to better understand their epidemiology. Blood‐engorgedCulicoidesfemales trapped in natural areas inhabited by different wild ruminant species were genetically analysed to identify host species. The origin of bloodmeals was identified in 114 females of 14 species ofCulicoides. A total of 104 (91.1%)Culicoidesfed on mammals and 10 (8.9%) on birds. The most abundant host identified was red deer (66.7%), followed by humans (13%) and fallow deer (6.1%). Eleven of the 14 species ofCulicoidesfed exclusively on mammalian hosts. Among them, five are mammalophilic species considered to be importantBTVand/orSBVvectors. The results of the present study confirm thatCulicoides imicola,Culicoides obsoletus,Culicoides scoticus,Culicoides pulicarisandCulicoides punctatusfed on wild ruminants, and therefore support the hypothesis that these species can act as bridge vectors by facilitating the circulation of pathogens between wild and domestic ruminant communities.
MRI assessment of the postprandial gastrointestinal motility and peptide response in healthy humans
Authors: Khalaf A. , Hoad C. L. , Menys A. , Nowak A. , Taylor S. A. , Paparo S. , Lingaya M. , Falcone Y. , Singh G. , Spiller R. C. , Gowland P. A. , Marciani L. , Moran G. W.
Published: August 2017

Background

Feeding triggers inter‐related gastrointestinal (GI) motor, peptide and appetite responses. These are rarely studied together due to methodological limitations. Recent MRI advances allow pan‐intestinal, non‐invasive assessment of motility in the undisturbed gut.

This study aimed to develop a methodology to assess pan‐intestinal motility and transit in a single session using MRI and compare imaging findings to GI peptide responses to a test meal and symptoms in a healthy volunteer cohort.

Methods

Fifteen healthy volunteers (29.3±2.7 years and BMI 20.1±1.2 kg m−2) underwent baseline and postprandial MRI scans, symptom questionnaires, and blood sampling (for subsequent GI peptide analysis, Glucagon‐like peptide‐1 [GLP‐1], Polypeptide YY [PYY], Cholecystokinin [CCK]) at intervals for 270 minutes following a 400 g soup meal (204 kcal, Heinz, UK). Gastric volume, gall bladder volume, small bowel water content, small bowel motility, and whole gut transit were measured from the MRI scans.

Key Results

(mean±SEM) Small bowel motility index increased from fasting 39±3 arbitrary units (a.u.) to a maximum of 87±7 a.u. immediately after feeding. PYY increased from fasting 98±10 pg mL−1 to 149±14 pg mL−1 at 30 minutes and GLP‐1 from fasting 15±3 μg mL−1 to 22±4 μg mL−1. CCK increased from fasting 0.40±0.06 pmol mL−1 to 0.94±0.1 pmol mL−1. Gastric volumes declined with a T1/2 of 46±5 minute and the gallbladder contracted from a fasting volume of 19±2 mL−1 to 12±2 mL−1. Small bowel water content increased from 39±2 mL−1 to 51±2 mL−1 postprandial. Fullness VAS score increased from 9±5 mm to 41±6 mm at 30 minutes postprandial.

Conclusions and Inferences

The test meal challenge was effective in inducing a change in MRI motility end‐points which will improve understanding of the pathophysiological postprandial GI response.
Regulation of claudin‐4 via p63 in human epithelial cells
Authors: Kojima Takashi , Kohno Takayuki , Kubo Terufumi , Kaneko Yakuto , Kakuki Takuya , Kakiuchi Akito , Kurose Makoto , Takano Ken‐ichi , Ogasawara Noriko , Obata Kazufumi , Nomura Kazuaki , Miyata Ryo , Konno Takumi , Ichimiya Shingo , Himi Tetsuo
Published: August 2017

P63 is a regulator of cell–cell junction complexes in the epidermis. Claudin‐4 is regulated via various factors in normal epithelial cells and diseases. We found that claudin‐4 was directly regulated via p63 (TAp63 and ΔNp63) in human keratinocytes and nasal epithelial cells. In the epidermis of atopic dermatitis (AD), which contains ΔNp63‐deficient keratinocytes, high expression of claudin‐4 was observed. In primary keratinocytes, downregulation of ΔNp63 by treatment with short interfering RNA (siRNA)‐p63 induced claudin‐4 expression. In nasal epithelial cells in the context of rhinitis or nasal polyps, upregulation of TAp63 and downregulation of claudin‐4 were observed. In primary nasal epithelial cells transfected with the human telomerase reverse transcriptase gene, knockdown of p63 by siRNAs induced claudin‐4 expression. Taken together, these findings indicate that p63 is a negative regulator of claudin‐4 expression. Understanding the regulation of claudin‐4 via p63 in human epithelial cells may be important for developing therapies for allergies and drug delivery systems.
Normal 123I‐MIBG uptake areas may be associated with hyperinnervation and arrhythmia risk in phenol model rabbit hearts
Authors: Amino Mari , Yoshioka Koichiro , Tanaka Sachie , Kawabe Noboru , Kurosawa Hiroyuki , Uchida Keisuke , Oshikiri Shinobu , Hashida Tadashi , Kanda Shigetaka , Inokuchi Sadaki , Ikari Yuji
Published: August 2017

Background

Iodine‐123 metaiodobenzylguanidine (123I‐MIBG) is useful for detecting sympathetic innervation in the heart, and has been closely associated with fatal arrhythmias. However, such imaging is typically calibrated to the area of highest uptake and thus is unable to identify areas of hyperinnervation. We hypothesized that normal 123I‐MIBG uptake regions in the denervated heart would demonstrate nerve sprouting and correlate with the potential for arrhythmogenesis.

Methods

Twenty New Zealand white rabbits treated with phenol or sham were prepared under anesthesia. Sympathetic innervation was quantified using autoradiography and immunostaining 4 weeks after phenol application, and electrophysiological study was performed.

Results

123I‐MIBG revealed maximal local differences in isotope uptake in the border zone between areas with attenuated and abundant MIBG compared with that seen between adjacent regions within the lowest uptake areas. On immunostaining, heterogeneous and decreased expressions of growth‐associated protein 43 signal were observed in the MIBG‐attenuated areas; however, abundant signals were recognized in the MIBG‐abundant areas. Upregulation of the tyrosine hydroxylase signal was observed at the part of the MIBG‐abundant area. In electrophysiological study, the dispersion of activation recovery interval (ARI) was increased in the phenol‐applied areas by norepinephrine infusion. Stellate stimulation exacerbated the ARI dispersion in both the phenol‐applied and nonapplied areas, and was associated with increased inducibility of ventricular tachycardia and ventricular fibrillation.

Conclusions

The presence of hyperinnervation in the nondenervated regions of denervated rabbit hearts suggests that heterogeneous neural remodeling occurs in regions with seemingly normal 123I‐MIBG uptake and contributes to electrical instability.
New crinoids from the Baltic region (Estonia): fossil tip‐dating phylogenetics constrains the origin and Ordovician–Silurian diversification of the Flexibilia (Echinodermata)
Authors: Wright David F. , Toom Ursula
Published: August 2017

This study documents previously unknown taxonomic and morphological diversity among early Palaeozoic crinoids. Based on highly complete, well preserved crown material, we describe two new genera from the Ordovician and Silurian of the Baltic region (Estonia) that provide insight into two major features of the geological history of crinoids: the early evolution of the flexible clade during the Great Ordovician Biodiversification Event (GOBE), and their diversification history surrounding the end‐Ordovician mass extinction. The unexpected occurrence of a highly derived sagenocrinid, Tintinnabulicrinus estoniensis gen. et. sp. nov., from Upper Ordovician (lower Katian) rocks of the Baltic palaeocontinent provides high‐resolution temporal, taxonomic and palaeobiogeographical constraints on the origin and early evolution of the Flexibilia. The Silurian (lower Rhuddanian, Llandovery) Paerticrinus arvosus gen. et sp. nov. is the oldest known Silurian crinoid from Baltica and thus provides the earliest Baltic record of crinoids following the aftermath of the end‐Ordovician mass extinction. A Bayesian ‘fossil tip‐dating’ analysis implementing the fossilized birth–death process and a relaxed morphological clock model suggests that flexibles evolved c. 3 million years prior to their oldest fossil record, potentially involving an ancestor–descendant relationship (via ‘budding’ cladogenesis or anagenesis) with the paraphyletic cladid Cupulocrinus. The sagenocrinid subclade rapidly diverged from ‘taxocrinid’ grade crinoids during the final stages of the GOBE, culminating in maximal diversity among Ordovician crinoid faunas on a global scale. Remarkably, diversification patterns indicate little taxonomic turnover among flexibles across the Late Ordovician mass extinction. However, the elimination of closely related clades may have helped pave the way for their subsequent Silurian diversification and increased ecological role in post‐Ordovician Palaeozoic marine communities. This study highlights the significance of studies reporting faunas from undersampled palaeogeographical regions for clade‐based phylogenetic studies and improving estimates of global biodiversity through geological time.
A novel family of transcription factors conserved in angiosperms is required for ABA signalling
Authors: Tian Hainan , Chen Siyu , Yang Wenting , Wang Tianya , Zheng Kaijie , Wang Yating , Cheng Yuxin , Zhang Na , Liu Shanda , Li Dongqiu , Liu Bao , Wang Shucai
Published: August 2017

The plant hormone abscisic acid (ABA) plays a crucial role in regulating plant responses to environmental stresses. Interplay of several different proteins including the PYR/PYL/RCAR receptors, A‐group PP2C protein phosphatases, SnRK2 protein kinases, and downstream transcription factors regulates ABA signalling. We report here the identification of a family of ABA‐induced transcription repressors (AITRs) that act as feedback regulators in ABA signalling. We found that the expression of all the 6 Arabidopsis AITR genes was induced by exogenously ABA, and their expression levels were decreased in ABA biosynthesis mutant aba1‐5. BLAST searches showed that AITRs are exclusively present in angiosperms. When recruited to the promoter region of a reporter gene by a fused DNA binding domain, all AITRs inhibited reporter gene expression in transfected protoplasts. In Arabidopsis, aitr mutants showed reduced sensitivity to ABA and to stresses such as salt and drought. Quantitative RT‐PCR analysis demonstrated that the ABA‐induced response of PP2C and some PYR/PYL/RCAR genes was reduced in AITR5 transgenic plants but increased in an aitr2 aitr5 aitr6 triple mutant. These results provide important new insights into the regulation of ABA signalling in plants, and such information may lead to the production of plants with enhanced resistance to environmental stresses.