bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and evaluation of the population pharmacokinetic models for FVIII and FIX concentrates of the WAPPS‐Hemo project
Authors: Hajducek Dagmar M. , Chelle Pierre , Hermans Cedric , Iorio Alfonso , McEneny‐King Alanna , Yu Jacky , Edginton Andrea
Published: April 2020

Background

The Web‐Accessible Population Pharmacokinetic Service (WAPPS) project generates individually predicted pharmacokinetic (PK) profiles and tailored prophylactic treatment regimens for haemophilic patients, which rely on a set of population PK (PopPK) models providing concentrate‐specific priors for the Bayesian forecasting methodology.

Aim

To describe the predictive performance of the WAPPS PopPK models in use on the WAPPS‐Hemo platform.

Methods

Data for modelling include dense PK data obtained from industry sponsored and independent PK studies, and dense and sparse data accumulated through WAPPS‐Hemo. WAPPS PopPK models were developed via non‐linear mixed‐effect modelling taking into account the effects of covariates and between‐individual—and sometimes between‐occasion—variability. Model evaluation consisted of (a) prediction‐corrected Visual Predictive Check (pcVPC), (b) Limited Sampling Analysis (LSA) and (c) repeated hold‐out cross‐validation.

Results

Thirty‐three WAPPS PopPK models built on data from 3188 patients (ages 1‐78 years) under treatment by factor VIII or IX products (FVIII, FIX) were evaluated. Overall, models exhibit excellent performance characteristics. The pcVPC shows that the observed PK data fall within acceptable 90% interpercentile predictive bands. A slight overprediction beyond the expected half‐life, an anticipated result of using sparse data, occurs for some models. The LSA results in lower than 3% of relative error for FVIII and FIX products and 16% for engineered FIX products. Cross‐Validation analysis yields relative errors lower than 1.5% and 1.4% in estimates of half‐life and time to 0.02 IU/mL, respectively.

Conclusion

The WAPPS‐Hemo models consistently showed excellent performance characteristics for the intended use for Bayesian forecasting of individual PK profiles.
Adapting epicutaneous patch testing protocols to assess immediate‐type skin reactions
Authors: Mehling A. , Benard S. , Braun N. , Degwert J. , Duttine M. , Jassoy C. , Merk H. , Rossow U. , Welzel J. , Wigger‐Alberti W. , Wilhelm K.P. , Ennen J.
Published: April 2020

Objective

During the development of cosmetic formulations, in vitro and in vivo methods are essential tools used to reliably assess the skin irritation potential of a product or ingredient. Epicutaneous patch testing (single and/or multiple application protocols) has long been used as an initial in vivo method to screen for possible skin irritation properties of a substance or formulation. To confirm the mildness and dermatological and/or consumer acceptance of a product, use tests are often subsequently conducted. A study was therefore initiated to see how well patch test results correlate with use tests with respect to irritation elicited by skincare (leave‐on) products.

Methods/results

A number of different cosmetic formulations were assessed in both tests. Although the patch test results did not indicate substantial irritation potentials, immediate‐type reactions (stinging and redness) were observed in some volunteers which disappeared within approx. 1 h. Although transient, these reactions suggested that consumer acceptance would probably be low and the studies were discontinued. Immediate‐type reactions are rare but have been described for some substances used in cosmetics. These unexpected results were nevertheless intriguing and prompted the start of a journey to see if patch test protocols could be modified to assess these reactions. An occlusive short‐term patch test protocol with an application period of 20 min was developed. Successful identification of the spontaneous reactions became possible. Furthermore, there was a correlation between the intensity of reactions observed in the short‐term patch test and those observed in the controlled in‐use studies. Short‐term patch testing using the developed protocol can therefore reliably be used as a screening method, for example in the development and optimization of cosmetic formulations containing ingredients that could cause spontaneous reactions, for instance of non‐immunological contact urticaria type.

Conclusion

The lessons learned from this studies indicate that simple modifications of existing test protocols can lead to important insights into skin reactions. These modifications can then be used to create further building blocks in the development and optimization of test strategies for cosmetic formulations which offer reliable study designs for possible reactions product developers may encounter.
Optimization of electrical conductivity in the Na2O‐P2O5‐AlF3‐SO3 glass system
Authors: Le Quyen H. , Calahoo Courtney , Xia Yang , Buchheim Johannes , Bragatto Caio B. , Wondraczek Lothar
Published: April 2020

We report on the individual roles of charge carrier density and network modification in sodium ion conducting glasses from the Na2O‐P2O5‐SO3‐AlF3 (NAPFS) system. For this, a broad range of glass compositions was considered across the series of 44Na2O/(56 – x − y)P2O5/xAlF3/ySO3, 47Na2O/(53 − x − y)P2O5/xAlF3/ySO3, and 50Na2O/(50 − x − y)P2O5/xAlF3/ySO3, with x = 8, 12, 16, 20 and y = 0, 5, 7, 10, 12. Impedance spectroscopy was conducted on these glasses at frequencies from 10−2 to 106 Hz and over temperatures from 50 to 250°C, and complemented by structural analyses using Raman spectroscopy and nuclear magnetic resonance data. While the trends in dc conductivity and activation energy follow that of Na2O content (increasing from 44 to 50 mol%), substantial enhancement of conductivity (by about two orders of magnitude) and correspondingly lower activation energy were also found for constant Na2O concentration when adjusting SO3 or AlF3 within specific limits of glass structure.
Nurses' role in delivering discharge education to general surgical patients: A qualitative study
Authors: Kang Evelyn , Tobiano Georgia A. , Chaboyer Wendy , Gillespie Brigid M.
Published: April 2020

Aims

To explore nurses' perceived role and experience in providing discharge education to general surgical patients.

Design

Qualitative, using focus groups and face‐to‐face individual interviews.

Methods

Purposive sampling with maximum variation was used to recruit nurses from the general surgical wards in a tertiary hospital in Queensland, Australia. Semi‐structured interviews (three focus groups and four individual interviews) were conducted with 21 nurses involved in delivering postoperative discharge education from August 2018 ‐ July 2019. Interview data were analysed using inductive content analysis.

Results

Four themes emerged: assuming responsibility for patient education in the absence of discharge communication; supporting patients to participate in self‐management after hospitalization; variability in the resources, content and delivery of discharge education; and meeting operational demands compromises the quality of patients' discharge education.

Conclusion

This study highlights the importance of nurses' role and the challenges encountered in delivering effective discharge education. These findings can be used to identify strategies to enhance discharge communication among health professionals and standardize the delivery of education to improve surgical patients' postoperative outcomes.

Impact

Ineffective discharge education contributes to patients' poor management of their postdischarge recovery. Developing an understanding of nurses' role in discharge education can inform policies and nursing practice to improve patients' well‐being and reduce the potential for unplanned and emergency care.
The effectiveness of web‐based mobile health interventions in paediatric outpatient surgery: A systematic review and meta‐analysis of randomized controlled trials
Authors: Rantala Arja , Pikkarainen Minna , Miettunen Jouko , He Hong‐Gu , Pölkki Tarja
Published: April 2020

Aims

To evaluate the effectiveness of web‐based mobile health interventions on paediatric patients and their parents in the day surgery context, where the primary outcome was children's pre‐operative anxiety and secondary outcomes were postoperative pain and parents’ anxiety and satisfaction with entire course of the day surgery.

Design

A systematic review and meta‐analysis of randomized controlled trials.

Data Sources

CENTRAL, CINAHL, Scopus, Ovid MEDLINE, and Web of Science were systematically searched without time limits (up to December 2018).

Review Methods

Studies were appraised using the Cochrane risk of bias tool. A random effect meta‐analysis of children's pre‐operative anxiety was performed.

Results

Eight studies with a total of 722 patients were included in the analysis. The effectiveness of web‐based mobile health interventions, including age‐appropriate videos, web‐based game apps, and educational preparation games made for the hospital environment, was examined in pre‐operative settings. A meta‐analysis (N = 560 children) based on six studies found a statistically significant reduction in pre‐operative anxiety measured by the Modified Yale Pre‐operative Anxiety Scale with a moderate effect size. Three studies reported parental satisfaction.

Conclusion

Web‐based mobile health interventions can reduce children's pre‐operative anxiety and increase parental satisfaction. Web‐based mobile health interventions could be considered as non‐pharmacological distraction tools for children in nursing. There is not enough evidence regarding the effectiveness of reducing children's postoperative pain and parental anxiety using similar interventions.

Impact

Web‐based mobile health interventions reduce children´s pre‐operative anxiety and could therefore be considered as non‐pharmacological distraction tools for children in nursing.
Depression and self‐care in older adults with multiple chronic conditions: A multivariate analysis
Authors: Iovino Paolo , De Maria Maddalena , Matarese Maria , Vellone Ercole , Ausili Davide , Riegel Barbara
Published: April 2020

Aims

To investigate the relationship between depression and self‐care behaviours in older individuals with multimorbidity.

Design

Cross‐sectional study. Data were collected between April 2017 – June 2019.

Methods

Patients were enrolled from community and outpatient settings and included if they were ≥65 years, affected by heart failure, diabetes mellitus or chronic obstructive pulmonary disease and at least another chronic condition. They were excluded if they had dementia and/or cancer. Patient Health Questionnaire‐9 was used to measure depression and Self‐Care of Chronic Illness Inventory was used to measure self‐care maintenance, monitoring, and management. The relationship between depression and self‐care was evaluated by performing two sets of univariate analyses, followed by multivariate and step‐down analyses. The second set was performed to control for the number of chronic conditions, age, and cognitive function.

Results

The sample (N = 366) was mostly female (54.2%), with a mean age of 76.4 years. Most participants (65.6%) had mild to very severe depressive symptoms. Preliminary analysis indicated a significant negative association between depression and self‐care maintenance and monitoring and a significant negative association between depression and multivariate self‐care. Step‐down analysis showed that self‐care maintenance was the only dimension negatively associated with depression, even after controlling for the number of chronic conditions, age, and cognitive function.

Conclusion

In multimorbid populations, depression is more likely to be associated with self‐care maintenance than the other self‐care dimensions. Therefore, self‐care maintenance behaviours (e.g., physical activity and medication adherence) should be prioritized in assessment and focused on when developing interventions targeting depressed older adults with multimorbidity.

Impact

The results of this study may help guide clinical practice. In patients with depressive symptoms, self‐care maintenance behaviours should be assessed first, as a potential first indicator of poor self‐care.
Longitudinal changes in frailty prevalence and related factors in older adults living in long‐term care facilities
Authors: Oh Eunmi , Moon SeolHwa , Hong Gwi‐Ryung S.
Published: April 2020

Aims

To investigate longitudinal changes in the prevalence of frailty and related factors in older adults residing in long‐term care facilities (LTCFs) in Korea.

Design

A longitudinal cohort study design.

Methods

Three hundred and fifty adults (aged 65 and older) residing in 10 LTCFs between January 2014 and January 2016 in Korea were initially investigated. Among these, 182 participants were included in the final analysis. Fried's Cardiovascular Health Study index was used to assess frailty based on Freiheit and colleagues. Data analysed included descriptive statistics and repeated‐measures multivariate analysis of variance.

Results

The prevalence of frailty was 25.8%, 33.5% and 35.2% in 2014, 2015 and 2016, respectively. Differences in dependence of activities of daily living, number of chronic diseases, nutritional status and depression were statistically significant among the normal, pre‐frail and frail groups at each year. Overall, from 2014–2016, the percentage of older adults decreased from 9.4–6.0% in the normal group and from 64.8%–58.8% in the pre‐frail group, while increasing in the frail group from 25.8%–35.2%.

Conclusion

The prevalence rate of frailty among older adults living in LTCFs was high and the rate of frail older adults gradually increased over time.

Impact

Frailty is a comprehensive health condition and a dynamic, changeable state. This longitudinal study showed a high rate of frailty and dynamic change in frailty level over time among residents. Because frailty is dynamic in every older adult over time, management should be tailored according to the individual's state of frailty to prevent functional decline. Development of a comprehensive frailty assessment tool that can easily measure not only physical frailty but also the comprehensive aspects of frailty would be useful for older adults in LTCFs.
A systematic mixed studies review of health behaviour change interventions in colorectal cancer survivors
Authors: Sweeney‐Magee Molly , Moustaqim‐Barrette Amina , Gotay Carolyn , Dummer Trevor
Published: April 2020

Aims

To explore available health behaviour change interventions in improving key health behaviours in colorectal cancer survivors and patient perspectives about these interventions.

Design

A systematic mixed studies review was conducted.

Data Sources

Databases searched included Ovid Medline, Ovid Embase, EBSCO PsychoInfo and EBSCO CINAHL. A grey literature search was also completed using Google Scholar and the TRIP database. Identified studies were published between 2003 – 2018.

Review methods

A parallel‐results convergent synthesis design using narrative syntheses was used. Data analysis was conducted following a process of constant comparison. Quality appraisal was conducted using recognized tools appropriate to different study designs.

Results

Sixteen unique studies were identified from an initial search of 354 records. There was a pattern of successful physical activity and dietary change associated with behaviour change interventions of varying intensity, modality and length, but sparse description of intervention content was common. Participants preferred clear explanations of health behaviour importance and for interventions to be administered in sessions either with, or led by, other patients.

Conclusion

The available evidence tentatively suggests that behaviour change interventions can improve the health behaviours of colorectal cancer survivors. However, more research focused on identifying key intervention elements is needed. Patients indicated clear preferences for specific intervention content and delivery, but further research is needed to allow for the appropriate incorporation of patient preferences into the design of such interventions.

Impact

This review highlights the potential for interventions to improve health behaviours evidenced to influence short and long‐term health outcomes in colorectal cancer survivors. However, the examination of the impact of these interventions and patient perspectives indicated a paucity of research. This is an important finding in demonstrating additional research is necessary to improve the support available to a growing group of patients with complex health needs.
The geography of speciation in dasyurid marsupials
Authors: García‐Navas Vicente , Kear Benjamin P. , Westerman Michael
Published: April 2020

Aim

To determine the effects of competition and divergence time on morphological dissimilarity and geographical range overlap between dasyurid species at both regional and local scales. Our hypothesis is that speciation in this group has been largely allopatric at regional scale, but involved morphological divergence at local scale through sympatric character displacement.

Location

Australia, New Guinea and surrounding islands.

Taxon

Dasyurid (Dasyuridae) marsupials, 67 species.

Methods

Geographical range overlap was quantified using polygons representing the outer limits of species distributions. Local‐scale range overlap was quantified as the degree of co‐occurrence of two taxa across a set of ecological survey plots representing 83 sampled communities. Phylogenies were generated using a novel DNA dataset, with divergence times estimated via total‐evidence dating incorporating fossils. Morphological divergence was determined using body mass and lower molar row length as proxy traits for reconstructing niche exploitation.

Results

Sister species pairs were found to be sympatric in 52% (11/21) of cases. Range overlap tended to increase with node age, which supports the hypothesis that mammalian speciation is routinely allopatric. We detected no evidence of character displacement with increasing range overlap between sister species pairs. However, a negative relationship was observed between morphological divergence in body mass and range overlap across all sampled taxa, suggesting that selection in sympatry is convergent, while divergent selection occurs in allopatry. Local‐scale co‐occurrences revealed no trace of species aversion, indicating that competition has not impacted on the spatial distribution of dasyurids.

Main conclusions

Despite moderate levels of sympatry through time, our results evince low rates of spatial co‐occurrence between dasyurid species. Although this may be indicative competitive exclusion, the lack of character displacement suggests that biotic interactions have likely not acted as a dominant driver of phenotypic evolution in this radiation. We alternatively posit that abiotic factors including aridity and geographical connectivity have more feasibly propagated character convergence, and led to both niche conservatism and speciation in this ubiquitous australidelphian clade.
Osteoidosis leads to altered differentiation and function of osteoclasts
Authors: Grünherz Lisanne , Prein Carina , Winkler Thomas , Kirsch Manuela , Hopfner Ursula , Streichert Thomas , Clausen‐Schaumann Hauke , Zustin Jozef , Kirchhof Kristin , Morlock Michael M. , Machens Hans‐Günter , Schilling Arndt Friedrich
Published: April 2020

In patients with osteomalacia, a defect in bone mineralization leads to changed characteristics of the bone surface. Considering that the properties of the surrounding matrix influence function and differentiation of cells, we aimed to investigate the effect of osteoidosis on differentiation and function of osteoclasts. Based on osteomalacic bone biopsies, a model for osteoidosis in vitro (OIV) was established. Peripheral blood mononuclear cells were differentiated to osteoclasts on mineralized surfaces (MS) as internal control and on OIV. We observed a significantly reduced number of osteoclasts and surface resorption on OIV. Atomic force microscopy revealed a significant effect of the altered degree of mineralization on surface mechanics and an unmasking of collagen fibres on the surface. Indeed, coating of MS with RGD peptides mimicked the resorption phenotype observed in OIV, suggesting that the altered differentiation of osteoclasts on OIV might be associated with an interaction of the cells with amino acid sequences of unmasked extracellular matrix proteins containing RGD sequences. Transcriptome analysis uncovered a strong significant up‐regulation of transmembrane glycoprotein TROP2 in osteoclastic cultures on OIV. TROP2 expression on OIV was also confirmed on the protein level and found on the bone surface of patients with osteomalacia. Taken together, our results show a direct influence of the mineralization state of the extracellular matrix surface on differentiation and function of osteoclasts on this surface which may be important for the pathophysiology of osteomalacia and other bone disorders with changed ratio of osteoid to bone.
Characterization of the prognostic values and response to immunotherapy/chemotherapy of Krüppel‐like factors in prostate cancer
Authors: Meng Jialin , Lu Xiaofan , Zhou Yujie , Zhang Meng , Gao Lei , Gao Shenglin , Yan Fangrong , Liang Chaozhao
Published: April 2020

At present, the overall genetic and epigenetic effects of Krüppel‐like factors (KLFs) on prostate cancer (PCa) remain unclear. Therefore, we systematically investigated the molecular differences in KLFs of transcription expression, promoter methylation and genetic alteration. Univariate and multivariate Cox proportional hazard regression was used to analyse the effect on RFS and establish the prognostic signature in the TCGA cohort, MSKCC and GSE116918 cohorts employed to validate the signature. Biological pathway enrichment and the potential response to immunotherapy and chemotherapy were inferred. The transcription levels of most KLFs are associated with the clinical outcome of PCa. Gleason score (P = .009), pathology T stage (P = .006), KLF3 (P = .034), KLF5 (P = .002) and KLF7 (P = .035) were independent prognostic factors. A prognostic signature was established in the TCGA cohort (P < .001) and validated in the MSKCC (P < .001) and GSE116918 cohorts (P = .006). Demethylation of KLF5 by 5‐azacytidine led to increased protein levels, whereas knockdown of KLF5 promoted cell proliferation. Patients in KLF‐F were more likely to respond to immunotherapy (P < .001) and bicalutamide (P < .001). In summary, we found that the KLFs and clinical feature‐based signatures may improve prognosis prediction in PCa and further promote patient stratification and disease management.
Characteristics and outcomes of patients treated with apremilast in the real world: results from the APPRECIATE study
Authors: Augustin M. , Kleyn C.E. , Conrad C. , Sator P.G. , Ståhle M. , Eyerich K. , Radtke M.A. , Bundy C. , Mellars L. , Greggio C. , Cordey M. , Koscielny V. , Griffiths C.E.M.
Published: April 2020

Background

APPRECIATE is a multinational, observational, retrospective, cross‐sectional study in patients treated for psoriasis with apremilast, an oral phosphodiesterase 4 inhibitor.

Objectives

To describe the characteristics of patients with psoriasis treated with apremilast in the clinical setting, to evaluate real‐world outcomes of psoriasis treatment with apremilast and to better understand the perspectives of patients and physicians on treatment outcomes.

Methods

In six European countries, patients with chronic plaque psoriasis treated in clinical practice who could be contacted 6 (±1) months after apremilast initiation were enrolled. Patient characteristics, Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI) were obtained from medical records when available. Outcomes were evaluated using patient/physician questionnaires.

Results

In 480 patients at treatment initiation, mean [median; 95% confidence interval (CI)] PASI and DLQI scores were 12.5 (10.7; 11.6–13.4) and 13.4 (13.0; 11.4–14.2), respectively. At 6 (±1) months, 72.3% of patients (n = 347) continued apremilast treatment [discontinuations: lack of efficacy (13.5%), safety (11.7%), other (2.5%)]. In patients continuing treatment, 48.6% achieved a ≥75% reduction in PASI score; mean (95% CI) DLQI score was 5.7 (4.5–6.9), and mean (SD) Patient Benefit Index score was 2.8 (1.2). Physicians perceived clinical improvement in 75.6% of patients. Physicians’ perspective on overall success of apremilast in meeting expectations correlated with patients’ perception of treatment benefit (r = 0.691). Most commonly reported adverse events (>5% of patients) were diarrhoea, nausea and headache.

Conclusions

Patients in APPRECIATE reported high disease burden despite more moderate skin involvement than those who enrolled in clinical trials of apremilast. Findings from APPRECIATE demonstrate the real‐world value of apremilast for psoriasis treatment, as 7 of 10 patients continued therapy and showed notable improvement in disease severity and quality of life 6 (±1) months after apremilast initiation.
No evidence for divergence in male harmfulness or female resistance in response to changes in the opportunity for dispersal
Authors: Lymbery Samuel J. , Wyber Blake , Tomkins Joseph L. , Simmons Leigh W.
Published: April 2020

The outcome of sexual conflict can depend on the social environment, as males respond to changes in the inclusive fitness payoffs of harmfulness and harm females less when they compete with familiar relatives. Theoretical models also predict that if limited male dispersal predictably enhances local relatedness while maintaining global competition, kin selection can produce evolutionary divergences in male harmfulness among populations. Experimental tests of these predictions, however, are rare. We assessed rates of dispersal in female and male seed beetles Callosobruchus maculatus, a model species for studies of sexual conflict, in an experimental setting. Females dispersed significantly more often than males, but dispersing males travelled just as far as dispersing females. Next, we used experimental evolution to test whether limiting dispersal allowed the action of kin selection to affect divergence in male harmfulness and female resistance. Populations of C. maculatus were evolved for 20 and 25 generations under one of three dispersal regimens: completely free dispersal, limited dispersal and no dispersal. There was no divergence among treatments in female reproductive tract scarring, ejaculate size, mating behaviour, fitness of experimental females mated to stock males or fitness of stock females mated to experimental males. We suggest that this is likely due to insufficient strength of kin selection rather than a lack of genetic variation or time for selection. Limited dispersal alone is therefore not sufficient for kin selection to reduce male harmfulness in this species, consistent with general predictions that limited dispersal will only allow kin selection if local relatedness is independent of the intensity of competition among kin.
Floodplain evaluation matrix FEM: A multiparameter assessment methodology
Authors: Habersack Helmut , Schober Bernhard
Published: April 2020

River floodplains allow for higher levels of conveyance and a greater capacity for floodwater, often improving the flood situation locally and regionally in hydrological and hydraulic terms. The European Floods Directive aims to protect existing and to restore potential floodplains to make use of their beneficial functions within an integrated plan of flood risk management. However, river floodplains are confronted with many other demands such as development of settlements, industry, and commerce and its supporting infrastructure. With such developments flood protection measures such as dykes and walls often follow restricting the floodplain's natural boundaries. To limit the loss of floodplains it is necessary to evaluate the importance of floodplains for flood risk management and to develop ultimately support tools for legal and spatial planning. This paper presents a method for evaluating and ranking river floodplains according to hydrological and hydraulic parameters and demonstrates its application at two very different Austrian river reaches. The results show which parameters and associated thresholds prove to be of greatest applicability to support future spatial planning strategies.
Use of the Veggie Meter® as a tool to objectively approximate fruit and vegetable intake among youth for evaluation of preschool and school‐based interventions
Authors: May K. , Jilcott Pitts S. , Stage V. C. , Kelley C. J. , Burkholder S. , Fang X. , Zeng A. , Lazorick S.
Published: April 2020

Background

Reflection spectroscopy is an emerging, non‐invasive objective measure used to approximate fruit and vegetable intake. The present study aimed to use a reflection spectroscopy device (the Veggie Meter®, Longevity Link Corporation, Salt Lake City, UT, USA) to assess skin carotenoid status in preschool, middle‐ and high‐school students and to examine associations between skin carotenoids and self‐reported dietary intake.

Methods

In Autumn 2018, we used the Veggie Meter® to assess skin carotenoids and age‐appropriate validated dietary assessment measures to approximate fruit and vegetable (FV) intake. Preschool participants completed a previously validated pictorial liking tool using an iPad (Apple Inc., Cupertino, CA, USA). Middle‐school participants completed selected questions from the validated School Physical Activity and Nutrition (SPAN) (Michael & Susan Dell Center for Healthy Living, University of Texas, Austin, TX, USA) questionnaire regarding frequency of their FV and beverage intake on the previous day, with additional questions about physical activity. High‐school participants’ FV intake was assessed using the Fruit and Vegetable Screener (National Cancer Institute, Bethesda, MD, USA). Spearman correlation coefficients were used to determine bivariate associations between measures of dietary intake and Veggie Meter®‐assessed skin carotenoid levels.

Results

Mean (SD) Veggie Meter® readings were 266 (82.9), 219 (68.1) and 216 (67.2) among preschool, middle‐ and high‐school students. There was an inverse association between soda intake and Veggie Meter® readings (r = −0.22, P = 0.03) among middle‐school students; and a positive association between daily fruit intake and Veggie Meter® readings (r = 0.25, P = 0.06) among high‐school students.

Conclusions

The Veggie Meter® comprises a promising evaluation tool for preschool and school‐based nutrition interventions.
A model of the multidimensional nature of experienced dietitian clinical decision‐making in the acute care setting
Authors: Vo R. , Smith M. , Patton N.
Published: April 2020

Background

Clinical decision‐making (CDM) is an essential component of dietetic practice that can significantly affect the quality of patient care. Research around CDM in clinical dietetics is scarce, with research in other healthcare professions offering limited insight into dietitian CDM in the specific setting of the acute care hospitals. The aim of this qualitative research was to deepen our understanding of the nature of the CDM of experienced dietitians in the acute care setting.

Methods

The present study employed philosophical hermeneutics to guide methods situated within the interpretative paradigm. This study invited dietitians currently practising in adult acute care hospitals with at least 3 years of experience to be involved two in‐depth semi‐structured interviews using the principles of hermeneutics. A reference focus group session was then used to provide rigour and further interpretation of the findings.

Results

Ten dietitians participated in the interviews and five of these same participants in the reference focus group. The findings have informed the development ofA Model of the Multidimensional Nature of Dietitian CDM in the Acute Care Setting, which reflects the nature of making decisions for patient care through the synergistic relationship between five key dimensions: (i) tasks; (ii) interactions; (iii) reasoning; (iv) practitioner factors; and (v) context, all of which are managed and monitored by the higher‐

order reasoning process of the dietitian’s clinical judgement.

Conclusions

Because there is scarcity of research on the CDM of dietitians in acute care settings, the present study can provide training and professional development insights to managers, educators and supervisors.
Burden of living with multiple concurrent symptoms in patients with end‐stage renal disease
Authors: Ng Marques Shek Nam , Wong Cho Lee , Ho Eva Hau Sim , Hui Yun Ho , Miaskowski Christine , So Winnie Kwok Wei
Published: April 2020

Aims and objectives

To explore the experience of multiple concurrent symptoms over time and their impact on daily living in patients with end‐stage renal disease undergoing dialysis.

Background

Patients undergoing dialysis experienced multiple concurrent symptoms because of the disease and treatment. Evidence suggests that these symptoms cluster around and have a significant impact on quality of life. However, the experience of this impact remained not clear.

Design

A longitudinal descriptive qualitative study.

Methods

Ten patients were purposely selected from the cohort of a longitudinal quantitative study in Hong Kong. A total of 28 face‐to‐face semi‐structured interviews were conducted between July 2017 and July 2018. Interviews were audiotaped, transcribed and analysed using a thematic analysis approach. Findings were reported following the COREQ checklist.

Results

Four themes emerged from the data. The first theme “complex symptom experience” described a dynamic pattern of symptoms among patients. Although patients were unaware of the relationships among symptoms, a cluster of tiredness, breathlessness, dizziness and sleep disturbance was identified in the narratives of individual symptoms. The report of symptom experience and its change revealed a unique pattern of symptom perception. The three other themes illustrated the impact of multiple concurrent symptoms on daily living, namely “decreased physical functioning,” “changes in social functioning” and “diet and fluid restrictions.”

Conclusions

Patients perceived dynamic and complex symptom experiences. This perception appears to be modulated by a number of factors. In addition, these experiences had negative and positive effects on patients' daily living.

Relevance to clinical practice

Patients perceived unique impact of symptoms on daily living. Therefore, a nurse‐led person‐centred approach of care is warranted. In addition to routine symptom assessment, nurses need to capture the specific impact of symptoms on day‐to‐day life. Based on this assessment, symptom management interventions (e.g. health education, referral) can be tailor‐made and prioritised.
Effects of organisational justice, work engagement and nurses' perception of care quality on turnover intention among newly licensed registered nurses: A structural equation modelling approach
Authors: Cao Ting , Huang Xiuxiu , Wang Limin , Li Bei , Dong Xu , Lu Han , Wan Qiaoqin , Shang Shaomei
Published: April 2020

Aims and objectives

To investigate turnover intention among newly licensed registered nurses and to clarify the impact pathways of organisational justice, work engagement and nurses’ perception of care quality on turnover intention.

Background

Nurse shortage is an ongoing and urgent issue worldwide, in which nurse turnover could exacerbate the situation. Newly licensed registered nurses will become the main nursing workforce in the future; however, previous studies have not revealed the specific reasons underlying their turnover intentions.

Design

A descriptive cross‐sectional design.

Methods

A total of 569 newly licensed registered nurses undertaking direct care were recruited from thirteen hospitals from October to November 2018 across Beijing, China. Based on the job demands–resources model, we advanced a hypothetical model, linking the paths between organisational justice, work engagement, nurses’ perception of care quality and turnover intention. Structural equation modelling was used to examine the hypothetical model. The study adhered to the STROBE statement for observational studies.

Results

In total, 22.3% of newly licensed registered nurses had a high turnover intention. The final model had an acceptable fit and could explain 58% of the variance in turnover intention. The organisational justice was directly related to high work engagement, great nurses’ perception of care quality and low turnover intention. Additionally, organisational justice also had indirect effects on great nurses’ perception of care quality and low turnover intention, which were partially mediated by work engagement. However, the effect of nurses’ perception of care quality on turnover intention was not significant.

Conclusion

The improvement of organisational justice could enhance work engagement, and nurses’ perception of care quality, and reduce turnover intention, which is crucial to improving care quality and addressing the shortage of nurses.

Relevance to clinical practice

This study provides evidence for policymakers and hospital administrators to take targeted measures to enhance work engagement, foster high‐quality care and create better defences against losing nurses.
Performance competence of pregraduate nursing students and hospital nurses: A comparison study
Authors: Liou Shwu‐Ru , Liu Hsiu‐Chen , Tsai Shu‐Ling , Chu Tsui‐Ping , Cheng Ching‐Yu
Published: April 2020

Aims and objectives

To compare and contrast the competence in clinical performance between pregraduate nursing students and hospital nurses. The study also explored the most difficult technical skills for the participants to perform.

Background

Assessment, communication and critical thinking are competencies that help in providing safe and appropriate care for patients. Yet, self‐perceived competence was mostly measured while performance competence that reflected nurses’ performance in real cases has seldom been explored in literature.

Design

A cross‐sectional design was applied. The study adhered to the STROBE guidelines to improve reporting quality.

Method

Fifty‐two nurses and 50 nursing students completed the Computerized Model of Performance‐Based Measurement system, which measures performance competence including the steps of critical thinking, conflict resolutions and common clinical technical problems. Six case scenarios containing 107 test questions were completed.

Results

Only 53.85% of nurses and 20.0% of students achieved a satisfactory level of performance competence. They showed low scores on the steps of critical thinking: “collecting data from on‐site physical assessment,” “processing information,” “recognising/prioritising problems” and “arranging a course of action for patient care,” as well as solving common technical problems and conflicts. The three most difficult skills to perform were CPR, reading EKGs and venipuncture/starting intravenous lines.

Conclusions

The study captured the participants’ weaknesses in the critical thinking process and the nursing skills that were difficult to perform. These skills are imperative to nursing care and need to be strengthened in school and in‐service education. The academic curriculum and course design for students as well as training programmes for nurses need to be reviewed to address the challenges to be faced in a clinical setting.

Relevance to clinical practice

Teaching‐learning strategies that focus on enhancing critical thinking and performing difficult skills need to be designed and implemented both in practice and in school.
Comparison of the transcriptional profile in the decidua of early‐onset and late‐onset pre‐eclampsia
Authors: Tong Jing , Niu Yichao , Chen Zi‐Jiang , Zhang Cong
Published: April 2020

Aim

To compare early‐onset pre‐eclampsia (EOPE) and late‐onset pre‐eclampsia (LOPE) and provide insight into the pathophysiology of pre‐eclampsia (PE).

Methods

Our recent work compared the transcriptomics in decidua of EOPE, LOPE and normal pregnancies (NP).

Results

We found there are a significant number of genes uniquely expressed in the decidua of EOPE and LOPE comparing with NP. Moreover, EOPE and LOPE have their distinct profiles. Unique EOPE‐associated genes were mainly involved in apoptosis related pathways such as ‘apoptosis’ and ‘Ras signaling pathway’. PIK3CB and BCL‐2 are the core regulatory genes in EOPE decidua, their abnormal expression caused decidual abnormal apoptosis which is relevant to the pathogenesis of EOPE. Whereas, LOPE is a more complicated entity which has more special LOPE‐associated genes involved in decidua differentiation, especially in ‘gap junction pathway’, ‘vascular smooth muscle contraction’ and ‘long‐term depression’. PIK3CB, FLT1, CBLC and ITGA7 are the core regulatory genes differentially expressed in EOPE decidua comparing with LOPE.

Conclusion

In brief, the different decidual transcriptomics of EOPE and LOPE may correlate with their different etiology. These findings highlight the complex pathophysiology of PE and provide potential targets for a new treatment strategy in patients with PE.
Decision aids available for parents making end‐of‐life or palliative care decisions for children: A scoping review
Authors: Medeiros Christina , Buckley Laura , Metcalfe Kelly , Narayanan Unni G , Widger Kimberley
Published: April 2020

Aim

To identify and assess the quality of decision aids that align the decision, values and information provided for parents making end‐of‐life or palliative care decisions for children with life‐threatening conditions.

Methods

Six databases and the grey literature were searched in December 2018. Two reviewers independently reviewed database citations, and one reviewed grey literature citations. Citation chaining via Scopus was conducted. Quality was assessed using IPDAS Collaboration Criteria.

Results

After reviewing 18 671 database citations and 10 988 grey literature citations, 18 citations describing 11 decision aids remained. Decision aids targeted premature infants, children requiring airway management, children with cancer and children with scoliosis. Three aids underwent testing beyond initial development. Quality scores averaged 27 of 50 points.

Conclusions

There are few high‐quality decision aids available for use and a lack evidence of widespread clinical use. Additional research is needed to support systematic development and the use of decision aids with families.
Urinary excretion of advanced glycation end products in dogs and cats
Authors: Palaseweenun Pornsucha , Hagen‐Plantinga Esther A. , Schonewille J. Thomas , Koop Gerrit , Butre Claire , Jonathan Melliana , Wierenga Peter A. , Hendriks Wouter H.
Published: April 2020

The present study was conducted with privately owned dogs and cats to investigate whether a relationship exists between the dietary AGEs and the urinary excretion of AGEs, as indication of possible effective absorption of those compounds in the intestinal tract of pet carnivores. For this purpose, data were collected from both raw fed and dry processed food (DPF) fed to dogs and cats, through spot urine sampling and questionnaires. Raw pet food (RF, low in AGE diets) was fed as a primary food source to 29 dogs and DPF to 28 dogs. Cats were categorized into 3 groups, which were RF (n = 15), DPF (n = 14) and dry and wet processed pet food (DWF, n = 25). Urinary‐free carboxymethyllysine (CML), carboxyethyllysine (CEL) and lysinoalanine (LAL) were analysed using ultrahigh‐performance liquid chromatography (UHPLC)—mass spectrometry, and were standardized for variable urine concentration by expressing the AGE concentrations as a ratio to urine creatinine (Ucr) concentration (µg/µmol Ucr). Urinary excretion of CML, CEL and LAL in dogs fed with DPF was 2.03, 2.14 and 3 times higher compared to dogs fed with RF (p < .005). Similar to the dogs, a significant difference in CML:Ucr, CEL:Ucr and LAL:Ucr between the three diet groups was observed in cats (p‐overall < 0.005, ANOVA), in which the RF fed group excreted less AGEs than the other groups. Linear regression coefficients and SE of CML:Ucr, CEL:Ucr and LAL:Ucr showed that body weight and neuter status were significantly correlated with CML and CEL excretion, but not to LAL excretion. Our results revealed a significant correlation between dietary AGEs and urinary excretion of free CML, CEL and LAL, and also showed that endogenous formation of these AGEs occurs in both dogs and cats under physiological conditions.
Efficacy of some feed additives to attenuate the hepato‐renal damage induced by aflatoxin B1 in rabbits
Authors: Ismail Ismail E. , Farag Mayada R. , Alagawany Mahmoud , Mahmoud Hemat K. , Reda Fayiz M.
Published: April 2020

The present trial was conducted to evaluate the beneficial role of some feed additives (potassium sorbate; Sor, hydrated sodium calcium almuniosilicate; Hsc and l‐methionine; L‐M) in attenuating the hepatic and renal toxicity of aflatoxin B1 (AFB1) in rabbits. A total number of 72 NZW growing rabbits (5 week‐old) were divided into six experimental groups (four replicates with three rabbits each) as follows: control group, AFB1 group (supplemented with AFB1 0.3 mg/kg diet), AFB1 + Sor group (AFB1 0.3 mg/kg diet + Sor 2 g/kg diet), AFB1 + Hsc group (AFB1 0.3 mg/kg diet + Hsc 5 g/kg diet), AFB1 + L‐M group (AFB1 0.3 mg/kg diet + L‐M 8 g/kg diet) and AFB1 + Mix group (AFB1 0.3 mg/kg diet + 2 Sor + 5 Hsc + 8 L‐M g/kg diet). Serum levels of total protein, albumin and globulin were significantly reduced by AF. AF increased the serum activity of aspartate aminotransferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALP) enzymes. While, they were reduced in AF + Sor and AF + Mix groups compared with AF group. AF increased the level of cystatin C and Beta‐2 microglobulin (BMG). All other supplements significantly reduced the level of cystatin C than AF; however, this reduction was more pronounced in AF‐L‐M group. AF + Sor, AF + L‐M and AF + Mix equally reduced the BMG level than AF and AF + HSc, however, still higher than control. AF elevated the total cholesterol (TC) and LDL‐cholesterol levels. A significant reduction in HDL cholesterol was seen in AF group. Additionally, AF induced pathological alterations in the liver and kidney of exposed rabbits on the other hands, the three additives separately or in mix attenuated the Af‐induced alterations. In conclusion, the dietary supplementation of Sor, L‐M, Hsc or their mixture was effective in ameliorating the negative effects of AFB1 on liver and kidney function and structure in rabbits with more better improvement obtained by Sor or L‐M separately.
Trace elements homeostasis in brain exposed to 900 MHz RFW emitted from a BTS‐antenna model and the protective role of vitamin E
Authors: Azimzadeh Mansour , Jelodar Gholamali
Published: April 2020

Advances in telecommunication and their broad usage in the community have become a great concern from the health aspect. The object of the present study was to examine the effects of exposure to 900 MHz RFW on brain Iron (Fe), Copper (Cu), Zinc (Zn) and Manganese (Mn) concentration, and the protective role of pre‐treatment of vitamin E on mentioned elements homoeostasis. Twenty adult male Sprague–Dawley rats (200 ± 20 g) randomly were divided into four groups. Control group (without any exposure, received distilled water), treatment control group (orally received 250 mg/kg BW/d vitamin E), treatment group (received 250 mg/kg BW/d vitamin E and exposed to 900 MHz RFW) and sham‐exposed group (exposed to 900 MHz RFW). Animals (with freely moving in the cage) were exposed to RFW for 30 consecutive days (4 hr/day). The levels of the above mentioned elements in the brain tissue were determined on the last day using atomic absorption spectrophotometry. Exposure to 900 MHz RFW induced a significant increase in the Fe, Cu, Mn levels and Cu/Zn ratio accompanied by a significant decrease in Zn level in the sham‐exposed group compare to control group. Vitamin E pre‐treatment improved the level of Fe, Cu, Mn and Cu/Zn ratio, except in the Zn concentration. Exposure to 900 MHz RFW caused disrupted trace elements homoeostasis in the brain tissue and administration of vitamin E as an antioxidant and neuroprotective agent improved the situation.