bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and safety of saxagliptin in combination with metformin as initial therapy in Chinese patients with type 2 diabetes: Results from the START study, a multicentre, randomized, double‐blind, active‐controlled, phase 3 trial
Authors: Dou Jingtao , Ma Jianhua , Liu Jun , Wang Changjiang , Johnsson Eva , Yao Hui , Zhao June , Pan Changyu
Published: September 2017

Aim

To assess the efficacy and safety of saxagliptin plus metformin over 24 weeks in pharmacotherapy‐naïve Chinese patients with type 2 diabetes mellitus and inadequate glycaemic control (HbA1c, 8.0%‐12.0%).

Research Design and Methods

In this multicentre, double‐blind, active‐controlled study (The START study: NCT02273050, clinicaltrials.gov), patients were randomized (1:1:1) to saxagliptin 5 mg plus metformin, saxagliptin 5 mg plus placebo or metformin plus placebo. Saxagliptin was taken once daily; metformin was taken once/twice daily and was titrated from 500 mg to a maximum of 2000 mg/d over 8 weeks. The primary end point was change in HbA1c from baseline to Week 24.

Results

Data from 630 patients (66.5% men; mean age, 50.1 years; mean body mass index, 26.6 kg/m2; mean HbA1c, 9.4%; mean diabetes duration, 0.81 years) were analysed. Mean reduction in HbA1c was greater with saxagliptin plus metformin (−3.0%) than with saxagliptin plus placebo (−2.1%; P < .001) or metformin plus placebo (−2.8%; P = .034). Changes in mean fasting plasma glucose, 120‐minute postprandial glucose, and 180‐minute postprandial glucose area under the curve were greater, and more patients achieved a therapeutic glycaemic response, with saxagliptin plus metformin than with either monotherapy. Hypoglycaemic events were infrequent (<2%). Incidence of adverse events was similar among groups; upper respiratory tract infection and diarrhoea were most common.

Conclusions

Saxagliptin 5 mg plus metformin significantly improved glycaemic control compared with either monotherapy in treatment‐naïve Chinese patients with type 2 diabetes, and was well tolerated.
The ontogeny of developmental buffering in lizard head shape
Authors: Lazić Marko M. , Rödder Dennis , Kaliontzopoulou Antigoni
Published: September 2017

Canalization and developmental stability (DS) are important organismal properties involved in determining the level of phenotypic variation. Ontogenetic patterns of phenotypic variance components can shed light on the mechanistic basis of developmental buffering (DB). Here, we analyze how individual FA and among‐individual variation in head shape change in ontogenetic series of three lizard species raised in laboratory. The degree of asymmetry increased slightly with size, suggesting that developmental mechanisms hypothesized to correct for deviations either do not exist, or that their efficiency is truncated with increasing size. Alternatively, they may need the disturbance as a trigger. The relationship between asymmetry and age was complex, with asymmetry being stable across the age range in two species but increased with age in the third. Lack of congruence in ontogenetic patterns of asymmetry might be due to intrinsic differences in buffering mechanisms or a result of species‐specific growth patterns. Head shape was shown to be equally canalized across both size and age range in all species, probably as a result of a balance between the buffering mechanisms and mechanisms generating variance. The patterns of symmetric and asymmetric head shape variation were highly correlated across species meaning that DS and canalization may rely on similar mechanisms.
Characterization of TP53 mutations in low‐grade myelodysplastic syndromes and myelodysplastic syndromes with a non‐complex karyotype
Authors: Wang Wei , Routbort Mark J. , Tang Zhenya , Ok Chi Young , Patel Keyur P. , Daver Naval , Garcia‐Manero Guillermo , Medeiros L. Jeffrey , Wang Sa A.
Published: September 2017

Objectives

Although commonly associated with high‐grade myelodysplastic syndrome (MDS) and MDS with a complex karyotype, TP53 mutations also occur in low‐grade MDS and MDS with a non‐complex karyotype. In latter cases, their clinicopathological features and the characteristics of TP53 mutations remain poorly characterized.

Methods

176 MDS cases with TP53 mutations were stratified and characterized based on their karyotype and histologic subtype.

Results

Among 176 cases, 17% had a non‐complex karyotype and 24% were low‐grade MDS. TP53 mutations often occurred in DNA‐binding domains and the majority of cases had only one mutation, irrespective of their karyotype and MDS subtype. The variant allele frequency (VAF), however, was associated with karyotype complexity and the types of MDS with a lower VAF found in cases with a non‐complex karyotype and low‐grade MDS. A low (<20%) VAF was associated with a better survival, as well as low‐grade subtype.

Conclusions

In low‐grade MDS and MDS with a non‐complex karyotype, TP53 mutations showed a lower VAF. Patients with a lower VAF had a better survival. TP53 mutations are not the only prognostic factor in MDS patients with TP53 mutations as the VAF, blast counts and history of prior therapy also play important roles in prognosis.
Brain functional connectome abnormalities in amyotrophic lateral sclerosis are associated with disability and cortical hyperexcitability
Authors: Geevasinga N. , Korgaonkar M. S. , Menon P. , Van den Bos M. , Gomes L. , Foster S. , Kiernan M. C. , Vucic S.
Published: September 2017

Background and purpose

The present study utilized a multimodal approach encompassing connectome networks combined with brain volume analysis, and assessment of cortical excitability to provide novel insights into amyotrophic lateral sclerosis (ALS) pathogenesis.

Methods

Magnetic resonance images were acquired using a 3.0‐Tesla Signa HDx scanner (GE Healthcare, Milwaukee, WI, USA), using an eight‐channel head coil. Magnetic resonance images for the resting‐state scan were acquired using an echo‐planar imaging magnetic resonance sequence, acquiring 40 contiguous axial/oblique slices. Structural magnetic resonance imaging three‐dimensional T1‐weighted images were acquired in the sagittal plane using three‐dimensional spoiled gradient echo sequences. For structural imaging, a T1‐weighted high‐resolution (3.0‐Tesla) magnetic resonance imaging scan was used. Cortical excitability was assessed by using the threshold‐tracking transcranial magnetic stimulation paradigm. Network‐based statistics and whole‐brain functional topology (using graph theoretical approaches) assessed functional connectivity.

Results

Using a global network‐based statistical analysis approach, functional connectivity was increased in 12 network edges connecting 14 nodes (P < 0.05) within the frontal, temporal, parietal and subcortical regions. Analysis of local connectedness disclosed dichotomous effects with reduced connectivity in frontal regions and increased connectivity in occipital regions in ALS. Cortical hyperexcitability was evident in patients with ALS, negatively correlated with functional connectivity changes in the pre‐central gyrus (P < 0.01). Connectivity changes in the frontal regions were negatively associated with functional disability (P < 0.05).

Conclusions

Multimodal assessment of cortical function in patients with ALS identified deficits in functional connectivity associated with cortical hyperexcitability that correlated with patient disability. Novel integration of functional brain assessment further contributes to the understanding of disease pathogenesis in ALS.
Evaluation of a palliative and hospice care telephone hotline for patients severely affected by multiple sclerosis and their caregivers
Authors: Strupp J. , Groebe B. , Knies A. , Mai M. , Voltz R. , Golla H.
Published: September 2017

Background and purpose

Palliative and hospice care (PHC) still mainly focuses on patients with cancer. In order to connect patients severely affected by multiple sclerosis (MS) and caregivers to PHC, a nationwide hotline was implemented to facilitate access to PHC.

Methods

The hotline was designed in cooperation with the German Multiple Sclerosis Society. Self‐disclosed information given by callers was documented using case‐report forms supplemented by personal notes. Data were analysed descriptively.

Results

A total of 222 calls were documented in 27 months. The patients' mean age was 51.12 years (range 27–84 years) and mean illness duration was 18 years (range 1 month to 50 years). Inquiries included information on PHC (28.8%) and access to PHC (due to previous refusal of PHC, 5.4%), general care for MS (36.1%), adequate housing (9.0%) and emotional support in crisis (4.5%). A total of 31.1% of callers reported ‘typical’ palliative symptoms (e.g. pain, 88.4%), 50.5% reported symptoms evolving from MS and 35.6% reported psychosocial problems. For 67 callers (30.2%), PHC services were recommended as indicated.

Conclusions

The hotline provided insight into the needs and problems of patients severely affected by MS and their caregivers, some of which may be met by PHC. Future follow‐up calls will demonstrate if the hotline helped to improve access to PHC beyond providing information. Overall, the hotline seemed to be easily accessible for patients severely affected by MS whose mobility is limited.
Tsunamis from submarine landslides
Authors: Tappin David R.
Published: September 2017

Most tsunamis are generated by earthquakes, with secondary, less frequent, mechanisms including subaerial and submarine landslides, volcanic eruptions and (extra‐terrestrial) bolide impacts. Different mechanisms generate tsunamis with different magnitudes, travel distances and impacts. Submarine landslides had been mapped and studied for decades but records suggested that only a few had generated tsunamis, and that these were minor. It was not until 1998, when a slump on the seabed offshore of northern Papua New Guinea caused a tsunami wave up to 15 m high that killed over 2200 people, was the significance of submarine landslides in tsunami generation realised. A combination of new (multibeam) seabed mapping technology and the development of improved numerical tsunami models for tsunami generation led to the recognition of the landslide tsunami mechanism of the PNG event. As a result the hazard from submarine landslides in tsunami generation is now recognized and better understood. Extensive mapping of ocean margins reveals that submarine landslides are common. Although many of these probably generated tsunamis, few have been identified, so their hazard remains uncertain. This article describes how the hazard from submarine landslide tsunamis was first recognized, how submarine landslides generate tsunamis, why they were previously discounted as a major hazard, and their potential hazards. An important aspect of the recognition of the tsunami hazard from submarine landslides has been the significance of geology, which has contributed to a subject previously dominated by seismologists.
Electronic‐Diary for Recording Headaches, Triggers, and Medication Use: Development and Evaluation
Authors: Bandarian‐Balooch Siavash , Martin Paul R. , McNally Brenton , Brunelli Arissa , Mackenzie Sharon
Published: September 2017

Objective

To evaluate an e‐diary developed for measuring headaches, triggers, and medication consumption, in terms of reliability and validity, and variables such as ease of use and participant compliance.

Background

For many decades, behavioral treatment of headaches has been evaluated via participants completing paper diaries recording their headaches and associated phenomena. There is some limited evidence supporting the reliability and validity of paper diaries, and criticisms have been offered such as the large amount of effort involved for both participants and researchers. This study evaluates a new e‐diary that will operate on virtually any device that can connect to the internet, and yields 5 of the recommended outcome measures.

Methods

One hundred and eighty‐one participants (146 females, 35 males) were allocated to 2 groups, e‐diaries vs paper diaries, via a disproportionate stratified allocation process. The e‐diary group included 4 subgroups based on the technology available to the participant, and the paper diary group included 2 subgroups, one parallel to the e‐dairies (short paper), and one representative of traditional paper diaries (long paper). The study commenced with individuals who had self‐identified as headache and migraine sufferers attending a screening session that included headache diagnosis. Participants who met selection criteria then completed the Headache Disability Inventory and a measure of quality of life (SF‐36) to assess the convergent validity of the diaries, and the Depression Anxiety Stress Scales to assess the discriminant validity of the diaries. They also completed a Measure of Acceptance Questionnaire. Participants then completed the headache diaries over the next 30 days. Finally, participants completed for a second time the questionnaires completed previously.

Results

The 5 outcome measures – headache frequency, peak intensity, average intensity, duration, and medication usage – were found to have strong test–retest reliability (r, 0.68‐0.79), for all 3 types of diary. These 5 measures for the e‐diaries were shown to have good convergent validity via comparison with scores on the Headache Disability Inventory (r, 0.46‐0.55) and SF‐36 (r, −0.35 to −0.49), and divergent validity via comparison with scores on the Depression Anxiety and Stress Scale (r, 0.10‐0.25). The long‐paper diaries had significantly higher missing data scores (M = 15.20, SD = 14.84) and more errors in data completion (M = 5.47, SD = 3.28) than the e‐diaries and short‐paper diaries (P < .05). In addition, the long‐paper diaries were evaluated by the participants as more burdensome and significantly less easy to use than the e‐diaries and short‐paper diaries.

Conclusions

The e‐diaries evaluated in this research would prove a useful tool in clinical trials of behavioral treatment for headaches.
Quantitative Analysis of Mouse Dural Afferent Neurons Expressing TRPM8, VGLUT3, and NF200
Authors: Ren Lynn , Chang Michelle Jaehee , Zhang Zhiyu , Dhaka Ajay , Guo Zhaohua , Cao Yu‐Qing
Published: September 2017

Objective

To quantify the abundance of dural afferent neurons expressing transient receptor potential channel melastatin 8 (TRPM8), vesicular glutamate transporter 3 (VGLUT3), and neurofilament 200 (NF200) in adult mice.

Background

With the increasing use of mice as a model system to study headache mechanisms, it is important to understand the composition of dural afferent neurons in mice. In a previous study, we have measured the abundance of mouse dural afferent neurons that express neuropeptide calcitonin gene‐related peptide as well as two TRP channels TRPV1 and TRPA1, respectively. Here, we conducted quantitative analysis of three other dural afferent subpopulations in adult mice.

Methods

We used the fluorescent tracer Fluoro‐Gold to retrogradely label dural afferent neurons in adult mice expressing enhanced green fluorescent protein in discrete subpopulations of trigeminal ganglion (TG) neurons. Mechanoreceptors with myelinated fibers were identified by NF200 immunoreactivity. We also conducted Ca2+‐imaging experiments to test the overlap between TRPM8 and VGLUT3 expression in mouse primary afferent neurons (PANs).

Results

The abundance of TRPM8‐expressing neurons in dural afferent neurons was significantly lower than that in total TG neurons. The percentages of dural afferent neurons expressing VGLUT3 and NF200 were comparable to those of total TG neurons, respectively. TRPM8 agonist menthol evoked Ca2+ influx in less than 7% VGLUT3‐expressing PANs in adult mice.

Conclusions

TG neurons expressing TRPM8, VGLUT3, and NF200 all innervate adult mouse dura. TRPM8 and VGLUT3 are expressed in distinct subpopulations of PANs in adult mice. These results provide an anatomical basis to investigate headache mechanisms in mouse models.
Laugh‐Induced Headache: Clinical Features and Literature Review
Authors: Ran Ye , Liu Huanxian , Zhang Meichen , Dong Zhao , Yu Shengyuan
Published: September 2017

Background

Laughing is a rare precipitating factor for headaches, and the pathogenesis underlying laugh‐induced headache (LH) remains unclear.

Methods

Two cases of headache triggered predominantly by laughing were presented in this article. We also reviewed the published English literature regarding LH, summarized the clinical characteristics of LH, and discussed the probable pathophysiological mechanisms.

Results

In the first patient, magnetic resonance imaging of the brain revealed cerebellar tonsillar herniation through the foramen magnum. In the second patient, we did not find any evidence of intracranial disease. The literature review showed that LH is a mild to severe, non‐pulsating headache. In most cases, the duration of each attack was limited to a few minutes. The headache usually bursts after laughing and reaches its peak almost immediately. In some cases, the headache can only be induced by mirthful laughing rather than by fake laughing.

Conclusion

LH can be categorized as primary LH and secondary LH. Changes in the spatial structure in the posterior cranial fossa and cerebrospinal fluid circulation may contribute to the development of secondary LH. Primary LH, primary cough headache, and primary exercise headache may share some common pathogenesis. And we speculate that the regions of the brain associated with the expression of mirth might be associated with LH.
Pitted keratolysis – a study of various clinical manifestations
Authors: Makhecha Meena , Dass Shreya , Singh Tishya , Gandhi Riddhi , Yadav Tulika , Rathod Dipali
Published: September 2017

Background

Pitted keratolysis (PK) is a common bacterial infection of skin characterized by noninflammatory superficial pits. Very few studies have focused on variations in clinical manifestations of PK. We conducted this study so that diagnosis of this treatable condition is not missed when it presents in an uncommonly perceived way.

Aims and objectives

Assessment of PK patients for various sites and morphologies.

Materials and methods

A total of 30 patients with PK were assessed for various sites and morphologies. Bacterial and fungal cultures along with histopathology were performed.

Results

Of 30 patients, 24 were females. Hyperhidrosis and malodour were the most common symptoms. Interdigital interface skin of the toes was the first site affected in most patients. Plantar skin was affected in all patients with involvement of interface skin of the toes in 29 patients. Other sites affected were palms, finger web spaces, nonglabrous skin, paronychium, and nail. Other than classical pits, scaly crusted inflammatory lesions with post‐inflammatory hyperpigmentation (PIH) were noted. Associated keratoderma was also reported in some patients.

Discussion

The presence of hyperhidrosis, malodour, and plantar lesions is consistent with previous studies. Interface skin between toes as the first site affected, involvement of toe web spaces, and associated keratoderma have been reported rarely. However, female preponderance, involvement of finger web spaces, nonglabrous skin, paronychium, nail changes, the presence of inflammation with crusting, and PIH have never been reported previously.

Conclusion

PK can involve web spaces, nonglabrous skin, and paronychium, and can cause nail changes. The lesions can be inflammatory with crusting and PIH.
Assessment of counselling for acute diarrhoea in German pharmacies: a simulated patient study†
Authors: Langer Bernhard , Bull Elisa , Burgsthaler Tina , Glawe Julia , Schwobeda Monique , Simon Karen
Published: September 2017

Objectives

The aim of this study was to assess the quality of counselling provided for acute diarrhoea and to evaluate the role of the patient's approach and different user groups in determining the outcome of counselling.

Methods

The simulated patient methodology was used in all 21 community pharmacies in a north-eastern German city. Four different scenarios related to self-medication of acute diarrhoea were developed and used in all the pharmacies (a total of 84 visits). The assessment form, completed immediately postvisit by the simulated patient, included 9 objective items scored using dichotomous scales to produce a scale from 0 to 9. After evaluating the data, every pharmacy received individual performance feedback to encourage behavioural changes and improve the quality of the counselling provided.

Key findings

Overall, the quality of counselling was poor (mean score of 3.3/9 (37%)). The most common information provided was about dosage (87% of interactions), while the least common information given was about side effects (4% of interactions). The main effect was seen when comparing the product and symptom requests (F(1,60) = 24.748, P < 0.001, ωp2 = 0.277). There was no effect resulting from different user groups (F(1,28) = 0.237, P = 0.630, ωp2 = −0.026) and no interaction between the type of request and different user groups (F(1,28) = 3.395, P = 0.076, ωp2 = 0.073).

Conclusions

This study highlighted the current deficits in appropriate counselling provided by community pharmacies in Germany.
We Face, I Tweet: How Different Social Media Influence Political Participation through Collective and Internal Efficacy
Authors: Halpern Daniel , Valenzuela Sebastián , Katz James E.
Published: September 2017

This study advances a theoretical model centered on collective and internal efficacy to explain the separate pathways through which political sharing on Facebook and Twitter may influence individuals to engage in political activities. We test the model with data from a 2-wave panel survey conducted with an adult population in 2013 in Chile. We found that frequent usage of Facebook and Twitter for sharing political information is conducive to higher levels of participation through different efficacy measures. Facebook has a significant effect on collective—not internal—efficacy, whereas Twitter's effect is on internal—not collective—efficacy. Results are discussed in light of the diverse affordances and strengths of network ties of Facebook and Twitter.
Multidisciplinary full‐mouth rehabilitation with soft tissue regeneration in the esthetic zone
Authors: Liebermann Anja , Frei Stefan , Pinheiro Dias Engler Madalena Lucia , Zuhr Otto , Prandtner Otto , Edelhoff Daniel , Saeidi Pour Reza
Published: September 2017

Objective

Oral rehabilitation often requires a multidisciplinary approach including restorative dentistry, prosthodontics, and periodontology to fulfill high esthetic and functional demands, frequently combined with changes in the vertical dimension. The presence of gingival recessions can be associated with numerous factors, such as brushing or preparation trauma and persistent inflammation of the gingiva due to inadequate marginal fit of restorations. Because gingival recessions can cause major esthetic and functional problems, obtaining stability of the gingival tissue around prosthetic restorations is of essential concern. Modifications of the occlusal vertical dimension require sufficient experience of the whole dental team. Especially in patients with functional problems and craniomandibular dysfunction, a newly defined occlusal position should be adequately tested and possibly adjusted.

Clinical considerations

This case report presents a complete prosthetic rehabilitation combined with a periodontal surgical approach for a patient with gingival recessions and functional/esthetic related problems. The vertical dimension was carefully defined through long‐term polymethyl methacrylate provisionals as a communication tool between all parts involved. All‐ceramic crowns were inserted after periodontal healing as definitive rehabilitation.

Conclusions

Complex rehabilitation in patients with high esthetic demands including soft tissue corrections requires a multidisciplinary team approach that consists of periodontal surgeon, dentist and dental technician.
Sharing morphospaces: early ontogenetic shape changes in two clingfish larvae (Pisces: Gobiesocidae) from the south‐east Pacific Ocean
Authors: Bernal‐Durán V. , Jahnsen‐Guzmán N. , Landaeta M. F.
Published: September 2017

Larval body shape changes and developmental timing were examined in two clingfish species from the south‐east Pacific Ocean, Gobiesox marmoratus and Sicyases sanguineus. Ontogenetic allometry showed no interspecific variation and <7 mm standard length (LS) larvae of both species occupied similar morphospace, but larger G. marmoratus showed increased body depth while larvae of S. sanguineus developed a flattened head and maintained a hydrodynamic body. Estimated developmental timing suggests that larval body shape changes were faster in G. marmoratus than in S. sanguineus prior to settlement.
Self‐Reported Function More Informative than Frailty Phenotype in Predicting Adverse Postoperative Course in Older Adults
Authors: Kapoor Alok , Matheos Theofilos , Walz Matthias , McDonough Christine , Maheswaran Abiramy , Ruppell Evan , Mohamud Deeqo , Shaffer Nicholas , Zhou Yanhua , Kaur Shubjeet , Heard Stephen , Crawford Sybil , Cabral Howard , White Daniel K. , Santry Heena , Jette Alan , Fielding Roger , Silliman Rebecca A. , Gurwitz Jerry
Published: September 2017

Background/Objective

Current preoperative assessment tools such as the American College of Surgeons Surgical Risk Calculator (ACS Calculator) are suboptimal for evaluating older adults. The objective was to evaluate and compare the performance of the ACS Calculator for predicting risk of serious postoperative complications with the addition of self‐reported physical function versus a frailty score.

Design

Prospective cohort.

Setting

Two tertiary care academic medical centers in Massachusetts.

Participants

Individuals aged 65 and older undergoing any surgery with a risk of serious complication of 5% or greater (N = 403).

Measurements

We measured self‐reported physical function using the Late‐Life Function and Disability Instrument (LLFDI FUNCTION) and frailty phenotype (FP), which has a score ranging from 0 to 5 based on slow gait speed, weak handgrip, exhaustion, weight loss, or low activity. Using c‐statistic and net classification improvement (NRI), we then analyzed capability of LLFDI‐FUNCTION versus FP to improve the ACS Calculator for predicting an adverse postoperative course (serious complication, discharge to nursing home, readmission, death within 30 days of surgery). Increase in c‐statistic and net reclassification improvement (NRI) for LLFDI‐FUNCTION versus FP in addition to the ACS Calculator for predicting an adverse postoperative course (serious complication, discharge to nursing home, readmission, death within 30 days of surgery)

Results

Over 30 days, 26% of participants developed an adverse postoperative course. The increase in c‐statistic for the ACS Calculator (baseline value 0.645) was slightly greater with LLFDI‐FUNCTION (0.076) than with FP (0.058), with a bootstrapped difference in c‐statistic of 0.005 (95% confidence interval = 0.002–0.007). NRI was also better with LLFDI‐FUNCTION.

Conclusion

The LLFDI‐FUNCTION predicted postoperative complications slightly better than the FP. Further studies are needed to confirm these findings and validate the use of the LLFDI‐FUNCTION with the ACS Calculator for preoperative assessments of older adults.
The Effects of Placental Transfusion on Placental Residual Blood Volume and 24 to 48‐hour Hemoglobin and Serum Bilirubin in Term Newborns: A Randomized Controlled Trial
Authors: Erickson‐Owens Debra , Mercer Judith
Published: September 2017

Purpose

To determine if newborns who receive a full placental transfusion at birth differ in placental residual blood volume (PRBV) and 24 to 48‐hour hemoglobin (Hb) and total serum bilirubin (TSB) levels compared to newborns who receive no placental transfusion.

Research Question

Will newborns who receive a full placental transfusion have less PRBV, a higher 24 to 48‐hour Hb, and no difference in peak TSB compared to newborns who receive no placental transfusion?

Significance

The usual maternity care practice in the United States is to immediately clamp the umbilical cord (immediate cord clamping [ICC]) at the time of birth. When ICC occurs, 20% to 40% of the fetal‐placental blood volume (containing iron‐rich red blood cells) is left behind in the placenta, potentially leading to lower iron stores in infancy.

Methods

A prospective randomized controlled trial was conducted. Seventy‐three healthy term pregnant women with singleton fetuses were enrolled. At birth, they were randomized to either ICC (<20 seconds; n = 36) or delayed cord clamping (DCC) (≥5 minutes; n = 37) and then placed skin‐to‐skin. The primary endpoints were PRBV in mL/kg, Hb (g/dL), and peak TSB at 24 to 48 hours of age. Primary analyses were conducted by intention‐to‐treat and secondary analyses by actual treatment.

Results

Maternal and newborn demographics were not significantly different between groups. Mean (standard deviation [SD]) cord clamping time was 303 (121) seconds (DCC) versus 10 (6) (ICC) seconds (P = .001). Eleven newborns received cord milking as a proxy for DCC at the time of cesarean birth or when resuscitation measures were indicated. There were 9 protocol violations. Newborns randomized to DCC left behind less PRBV (20.0 vs 30.8 mL/kg, P < .001). At 24 to 48 hours of age, newborns exposed to DCC had significantly higher Hb levels (19.5 vs 17.7 g/dL, P = .002) without a difference in peak TSB levels (DCC = 8.5 vs ICC = 9.0 mg/dL, P = .45) compared to infants with ICC. Two newborns in each group had phototherapy.

Discussion

Newborns with ICC left behind more PRBV and had lower Hb levels at 24 to 48 hours. There was no difference between the groups on peak TSB levels or other indicators of hyperbilirubinemia. The results support the early hematological advantage of DCC while demonstrating no association with an increase in hyperbilirubinemia.
The fibular meniscus of the kangaroo as an adaptation against external tibial rotation during saltatorial locomotion
Authors: Miller Adrian C. , Cake Martin A. , Warburton Natalie M.
Published: September 2017

The kangaroo knee is, as in other species, a complex diarthrodial joint dependent on interacting osseous, cartilaginous and ligamentous components for its stability. While principal load bearing occurs through the femorotibial articulation, additional lateral articulations involving the fibula and lateral fabella also contribute to the functional arrangement. Several fibrocartilage and ligamentous structures in this joint remain unexplained or have been misunderstood in previous studies. In this study, we review the existing literature on the structure of the kangaroo ‘knee’ before providing a new description of the gross anatomical and histological structures. In particular, we present strong evidence that the previously described ‘femorofibular disc’ is best described as a fibular meniscus on the basis of its gross and histological anatomy. Further, we found it to be joined by a distinct tendinous tract connecting one belly of the m. gastrocnemius with the lateral meniscus, via a hyaline cartilage cornu of the enlarged lateral fabella. The complex of ligaments connecting the fibular meniscus to the surrounding connective tissues and muscles appears to provide a strong resistance to external rotation of the tibia, via the restriction of independent movement of the proximal fibula. We suggest this may be an adaptation to resist the rotational torque applied across the joint during bipedal saltatory locomotion in kangaroos.
Nurses’ clinical reasoning practices that support safe medication administration: An integrative review of the literature
Authors: Rohde Emily , Domm Elizabeth
Published: September 2017

Aims and objectives

To review the current literature about nurses’ clinical reasoning practices that support safe medication administration.

Background

The literature about medication administration frequently focuses on avoiding medication errors. Nurses’ clinical reasoning used during medication administration to maintain medication safety receives less attention in the literature. As healthcare professionals, nurses work closely with patients, assessing and intervening to promote mediation safety prior to, during and after medication administration. They also provide discharge teaching about using medication safely. Nurses’ clinical reasoning and practices that support medication safety are often invisible when the focus is medication errors avoidance.

Design

An integrative literature review was guided by Whittemore and Knafl's (Journal of Advanced Nursing, 5, 2005 and 546) five‐stage review of the 11 articles that met review criteria. This review is modelled after Gaffney et al.'s (Journal of Clinical Nursing, 25, 2016 and 906) integrative review on medical error recovery.

Methods

Health databases were accessed and systematically searched for research reporting nurses’ clinical reasoning practices that supported safe medication administration. The level and quality of evidence of the included research articles were assessed using The Johns Hopkins Nursing Evidence‐Based Practice Rating Scale©.

Results

Nurses have a central role in safe medication administration, including but not limited to risk awareness about the potential for medication errors. Nurses assess patients and their medication and use knowledge and clinical reasoning to administer medication safely. Results indicated nurses’ use of clinical reasoning to maintain safe medication administration was inadequately articulated in 10 of 11 studies reviewed.

Conclusion

Nurses are primarily responsible for safe medication administration. Nurses draw from their foundational knowledge of patient conditions and organisational processes and use clinical reasoning that supports safe medication practice. There was minimal evidence clearly articulating nurses’ clinical reasoning used to support medication safety.

Relevance to clinical practice

This review focused on finding evidence of nurses’ clinical reasoning that supported safe medication administration.
Facilitation of child health research in hospital settings: The views of nurses
Authors: Brown Julie , Barr Owen , Lindsay Mary , Ennis Edel , O'Neill Siobhan
Published: September 2017

Aims and objectives

To explore the views of nurses towards child health research and to identify factors influencing their willingness to facilitate it in practice.

Background

Child health research in clinical practice is increasing throughout the UK. Nurses and midwives facilitate access to patients, enact research study protocols and have a critical role in parental decisions to enrol children into research studies. Little is known about their perception of this process.

Design

This study was a descriptive study design.

Methods

A newly designed questionnaire was completed in 2013 by 105 nurses in three neonatal and two children's units in two discrete acute hospital sites.

Results

Overwhelming support for clinical research was reported. Participants were motivated to facilitate research in order to improve patient care and contribute to the evidence base, but discouraged by external organisational factors and ethical concerns. Training, education and a dedicated team to support research were considered important. Misconceptions regarding consent and the allocation of treatment were reported. Participants raised particular concerns about trials of investigational medicinal product.

Conclusion

Negative views of nurses towards research, combined with a lack of knowledge of research processes, governance and ethics, have the potential to threaten the success of clinical research studies.

Relevance to clinical practice

Focus on three main areas: staff education, improved communication and the demonstration of managerial commitment to clinical research.
Adult plasticity in African cichlids: Rapid changes in opsin expression in response to environmental light differences
Authors: Nandamuri Sri Pratima , Yourick Miranda R. , Carleton Karen L.
Published: September 2017

Phenotypic plasticity allows organisms to adapt quickly to local environmental conditions and could facilitate adaptive radiations. Cichlids have recently undergone an adaptive radiation in Lake Malawi where they inhabit diverse light environments and tune their visual sensitivity through differences in cone opsin expression. While cichlid opsin expression is known to be plastic over development, whether adults remain plastic is unknown. Adult plasticity in visual tuning could play a role in cichlid radiations by enabling survival in changing environments and facilitating invasion into novel environments. Here we examine the existence of and temporal changes in adult visual plasticity of two closely related species. In complementary experiments, wild adult Metriaclima mbenji from Lake Malawi were moved to the lab under UV‐deficient fluorescent lighting; while lab raised M. benetos were placed under UV‐rich lighting designed to mimic light conditions in the wild. Surprisingly, adult cichlids in both experiments showed significant changes in the expression of the UV‐sensitive single cone opsin, SWS1, in only 3 days. Modeling quantum catches in the light environments revealed a possible link between the light available to the SWS1 visual pigment and SWS1 expression. We conclude that adult cichlids can undergo rapid and significant changes in opsin expression in response to environmental light shifts that are relevant to their habitat and evolutionary history in Lake Malawi. This could have contributed to the rapid divergence characteristic of these fantastic fishes.
Retinal vessel morphology in rheumatoid arthritis: Association with systemic inflammation, subclinical atherosclerosis, and cardiovascular risk
Authors: Anyfanti Panagiota , Triantafyllou Areti , Gkaliagkousi Eugenia , Koletsos Nikolaos , Athanasopoulos Georgios , Zabulis Xenophon , Galanopoulou Vasiliki , Aslanidis Spyros , Douma Stella
Published: September 2017

Objective

Quantification of retinal vessel morphology has emerged as a marker of cardiovascular health. We examined retinal microvascular diameters in RA, particularly in regard to systemic inflammation, subclinical atherosclerosis, and cardiovascular risk.

Methods

Retinal images from RA patients and controls were processed using computerized software, to obtain CRAE and CRVE and AVR. Subclinical atherosclerosis was assessed with cIMT, and 10‐year risk of general cardiovascular disease was calculated.

Results

Both CRAE (78.8 ± 8.9 vs 90.2 ± 9.9 μm, P < .001) and AVR (0.69 ± 0.09 vs 0.81 ± 0.09, P < .001) were decreased in RA patients (n = 87) compared to controls (n = 46), whereas CRVE did not differ. Among RA patients, CRAE and AVR were inversely associated with both cIMT and CRP, whereas CRVE positively correlated with CRP (P < .05 for all). CRAE additionally correlated with cardiovascular risk score (r = −.396, P = .001). In the multivariate analysis, cardiovascular risk was associated with CRAE; age with CRVE, while CRP independently predicted AVR.

Conclusions

Our study shows altered retinal microvascular morphology in RA patients. Inflammation appears as the biological link for the observed association between retinal microvascular abnormalities and subclinical atherosclerosis. Retinal arteriolar narrowing might play its own role in cardiovascular risk prediction in RA.
SUB1 has photoreceptor dependent and independent functions in sexual development and secondary metabolism in Trichoderma reesei
Authors: Bazafkan Hoda , Beier Sabrina , Stappler Eva , Böhmdorfer Stefan , Oberlerchner Josua T. , Sulyok Michael , Schmoll Monika
Published: September 2017

Light dependent processes are involved in the regulation of growth, development and enzyme production in Trichoderma reesei. The photoreceptors BLR1, BLR2 and ENV1 exert crucial functions in these processes. We analyzed the involvement of the transcription factor SUB1 in sexual development as well as secondary metabolism and its position in the light signaling cascade. SUB1 influences growth and in contrast to its homologue in N. crassa, SUB1 is not essential for fruiting body formation and male fertility in T. reesei, but required for female fertility. Accordingly, SUB1 is involved in the regulation of the pheromone system of T. reesei. Female sterility of mutants lacking env1 is rescued in triple mutants of blr1, blr2 and env1, but not in double mutants of these genes. Confrontation of strains lacking sub1 results in growth arrest prior to contact of the potential mating partners. This effect is at least in part due to altered secondary metabolite production. Additionally, together with BLR1 and BLR2, SUB1 is essential for spore pigmentation and transcription of pks4, and secondary metabolism is regulated by SUB1 in a light‐ and nutrient dependent manner. Our results hence indicate rewiring of several pathways targeted by SUB1 in T. reesei.
Lectotypification of species names in Jacquemontia (Convolvulaceae)
Authors: Buril Maria Teresa , Staples George
Published: September 2017

During the preparation of a revision of Brazilian species of Jacquemontia, we detected 17 names which were not clearly typified and thus lectotypifications and one neotypification were required. The choice of lectotypes and the neotype is explained and comments on the taxonomic circumscription of the species and the correct application of the names are provided.
Why Take Painkillers?
Authors: Bain David
Published: September 2017

Accounts of the nature of unpleasant pain have proliferated over the past decade, but there has been little systematic investigation of which of them can accommodate its badness. This paper is such a study. In its sights are two targets: those who deny the non‐instrumental disvalue of pain's unpleasantness; and those who allow it but deny that it can be accommodated by the view—advanced by me and others—that unpleasant pains are interoceptive experiences with evaluative content. Against the former, I argue that pain's unpleasantness does indeed have noninstrumental disvalue; against the latter I argue both that my critics’ own desire‐theoretic accounts of pain's unpleasantness cannot accommodate such disvalue, and that my evaluativist view can—either by appealing to “anti‐unpleasantness” desires or by exploiting pain's perceptuality.
Childhood obesity and school absenteeism: a systematic review and meta‐analysis
Authors: An R. , Yan H. , Shi X. , Yang Y.
Published: September 2017

Regular school attendance is a key determinant of student's academic achievement and psychosocial development. Obesity may affect children's school attendance through its detrimental impact on their physical and mental health. A literature search was conducted in the PubMed, Web of Science and Cochrane Library for articles published until April 2017 that examined the relationship between unhealthy body weight and school absenteeism among children and adolescents. Thirteen studies total (10 cross‐sectional and three longitudinal) conducted in seven countries were identified. The mean and median sample sizes were 24,861 and 3,113, respectively. Ten studies objectively measured children's height and weight, and three were based on parents' self‐report. Four studies measured absenteeism using school administrative data, and nine administered questionnaires on children's parents. Among them, 11 reported a statistically significant positive association between childhood overweight/obesity and school absence, whereas two reported null effect. The meta‐analysis found that the odds of being absent from school was 27% and 54% higher among children with overweight and obesity than among their normal weight counterparts, respectively. Future studies should adopt an experimental study design and accurate measures on school attendance and delineate the underlining pathways linking childhood obesity to school absenteeism through obesity‐related illnesses and psychosocial problems.
Dissection of additive, epistatic and QTL × environment effects involved in oil content variations in rapeseed
Authors: Huang Jixiang , Chen Fei , Zhang Haozhong , Ni Xiyuan , Wang Yilong , Liu Han , Yao Xiangtan , Xu Haiming , Wang Hao , Meng Jinling , Zhao Jianyi
Published: September 2017

In this study, we observed variation of rapeseed oil content in SG population across 11 environments. A joint mapping was conducted to detect the quantitative trait loci (QTL) involved in oil content variation. We examined additive main (a), epistatic effects (aa) and their interactions with environments (QE). Apart from a of 12 QTL (collectively to 6.74% of oil content), aa of 18 locus pairs contributed to 5.36% difference, explaining 45.3% of phenotypic variation in the population. Moreover, 28 QE interactions contributed to a change of 1.55% in oil content in each environment, accounting for 13.3% phenotypic variation. Two environmentally sensitive QTL (OilC2 and OilC8‐1) exhibited a small a (0.17) but strong ae (0.41 and 0.32 averagely). These two QTL were also frequently involved in epistatic interactions. However, two major QTL (OilA7 and OilC8‐2) showed few QE and uninvolved in epistasis. In conclusion, a and aa were the dominant contributors to oil content in rapeseed, while QE accounted for 10‐15% of variation. The results suggest OilA7 and OilC8‐2 are potential candidates for breeding utilization and gene cloning.
In situ temperature relationships of biochemical and stomatal controls of photosynthesis in four lowland tropical tree species
Authors: Slot Martijn , Winter Klaus
Published: September 2017

Net photosynthetic carbon uptake of Panamanian lowland tropical forest species is typically optimal at 30–32 °C. The processes responsible for the decrease in photosynthesis at higher temperatures are not fully understood for tropical trees. We determined temperature responses of maximum rates of RuBP‐carboxylation (VCMax) and RuBP‐regeneration (JMax), stomatal conductance (Gs), and respiration in the light (RLight) in situ for 4 lowland tropical tree species in Panama. Gs had the lowest temperature optimum (TOpt), similar to that of net photosynthesis, and photosynthesis became increasingly limited by stomatal conductance as temperature increased. JMax peaked at 34–37 °C and VCMax ~2 °C above that, except in the late‐successional species Calophyllum longifolium, in which both peaked at ~33 °C. RLight significantly increased with increasing temperature, but simulations with a photosynthesis model indicated that this had only a small effect on net photosynthesis. We found no evidence for Rubisco‐activase limitation of photosynthesis. TOpt of VCMax and JMax fell within the observed in situ leaf temperature range, but our study nonetheless suggests that net photosynthesis of tropical trees is more strongly influenced by the indirect effects of high temperature—for example, through elevated vapour pressure deficit and resulting decreases in stomatal conductance—than by direct temperature effects on photosynthetic biochemistry and respiration.