bluuebunny/crossref_metadata_2025 huggingface dataset:
Corticocortical projections to area 1 in squirrel monkeys (Saimiri sciureus)
Authors: Cerkevich Christina M. , Kaas Jon H.
Published: March 2018

Cortical area 1 is a non‐primary somatosensory area in the primate anterior parietal cortex that is critical to tactile discrimination. The corticocortical projections to area 1 in squirrel monkeys were determined by placing multiple injections of anatomical tracers into separate body part representations defined by multiunit microelectrode mapping in area 1. The pattern of labeled cells in the cortex indicated that area 1 has strong intrinsic connections within each body part representation and has inputs from somatotopically matched regions of areas 3b, 3a, 2 and 5. Somatosensory areas in the lateral sulcus, including the second somatosensory area (S2), the parietal ventral area (PV), and the presumptive parietal rostral (PR) and ventral somatosensory (VS) areas, also project to area 1. Topographically organized projections to area 1 also came from the primary motor cortex (M1), the dorsal and ventral premotor areas (PMd and PMv), and the supplementary motor area (SMA). Labeled cells were also found in cingulate motor and sensory areas on the medial wall of the hemisphere. Previous studies revealed a similar pattern of projections to area 1 in Old World macaque monkeys, suggesting a pattern of cortical inputs to area 1 that is common across anthropoid primates.
Family Resilience Among Sojourning Japanese Mothers: Links to Marital Satisfaction and Children's Behavioral Adjustment
Authors: Izumi Mitsuyo , Gullón‐Rivera Angel L.
Published: March 2018

The purpose of this study was to explore sojourning Japanese mothers’ perceived family resilience. The study used Walsh's Framework of Family Resilience in relation to children's behavioral adjustment, perceived stress, and marital satisfaction. Using a quantitative approach, the findings based on responses from 70 mothers revealed the importance of having a strong “belief system” as an adaptive strategy in response to family relocation. The results also indicated that perceived stress, marital satisfaction, and family resilience were significant factors of children's adjustment to the relocation. Implications and recommendations for educators and employers were discussed.
Getting Ready for Community Practice: An Evidence‐Based Preparation Course for Kenyan Practicum Students
Authors: VanLeeuwen Charlene A. , Kathuri‐Ogola Lucy , Weeks Lori E. , Kabaria Muriithi Joan
Published: March 2018

Practicums provide opportunities for students to connect theory with practice through experiential learning and hands‐on work experience. While recommended for students in Kenya, there is little research on the practicum experience. This article describes evidence used to prepare students for practicum experiences. Interviews and focus groups (FGs) were conducted with three stakeholder groups in two phases. Findings informed the development of a practicum preparation course that covers topics including (i) becoming a reflective professional and/or practitioner; (ii) articulating practicum learning goals; (iii) mental preparation for demanding field‐based situations; and (iv) developing confidence in interpersonal communication. Phase two evaluated the initial impact of the course through FGs and follow‐up interviews.
A global comparison of the climatic niches of urban and native tree populations
Authors: Kendal Dave , Dobbs C. , Gallagher R. V. , Beaumont L. J. , Baumann J. , Williams N. S. G. , Livesley S. J.
Published: March 2018

Aim

Urban macroecology studies can provide important insights into the impacts of climate change and human intervention in ecosystems. Current theory predicts that urban trees are constrained by temperature in very cold climates but not in other climates. Here we predict the climatic niche variables of planted urban tree populations from the realized climatic niche of native populations and explore whether niches are constrained across all temperatures.

Location

Global (182 cities across six continents).

Time period

Urban tree data: 1980–2016. Native tree data: 1950–2017.

Major taxa studied

Two hundred and three tree species.

Methods

We used urban tree inventory data and Global Biodiversity Information Facility occurrence data to compare the realized climatic niches of native and urban tree populations. Realized climatic niches are calculated by combining bioclimatic data with native tree and urban tree occurrence data. Regression is used to predict the climatic niche of urban tree populations from the climatic niche of native populations.

Results

The realized climatic niche of native tree populations was a good predictor of the realized climatic niche of urban tree populations, although climatic niches are attenuated in urban populations. Urban tree niches were 38–90% wider than native tree niches, with the mean annual temperature niche breath of urban tree populations 3.3 °C (52%) wider than native tree populations.

Main conclusions

Urban trees are planted in climates that are outside the realized climatic niche of native populations. Temperature remains a strong filter on urban tree populations across the full temperature range. Temperature increases attributable to the combined effect of the urban heat island and global climate change are likely to have a substantial impact on urban tree populations around the globe. This is particularly true for temperate cities, where cold climate trees are planted near the upper limits of their realized temperature niches.
Prevalence of sarcopenia and association with oral health‐related quality of life and oral health status in older dental clinic outpatients
Authors: Takahashi Masaki , Maeda Keisuke , Wakabayashi Hidetaka
Published: March 2018

Aim

The relationship between oral health‐related quality of life (OHRQoL) and sarcopenia is unknown. The purpose of the present study was to clarify the prevalence of sarcopenia in older dental clinic outpatients and its relationship with OHRQoL and oral health status.

Methods

This cross‐sectional study used data from consecutive dental clinic outpatients aged ≥65 years. The Oral Health Impact Profile‐14 was used for the evaluation of OHRQoL, and the Oral Health Assessment Tool was used to assess oral health status. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia criteria. Uni‐ and multivariable analyses were carried out to investigate the relationship between sarcopenia and Oral Health Impact Profile‐14 and Oral Health Assessment Tool scores.

Results

This study involved 279 patients (173 women, 106 men) with a mean age of 76 ± 7.5 years. The sarcopenia prevalence rate was 30.2%, and patients with sarcopenia had significantly poorer OHRQoL and oral health status than did patients without sarcopenia. Furthermore, sarcopenia was independently associated with Oral Health Impact Profile‐14 and Oral Health Assessment Tool scores even after adjusting for confounding factors, such as age, sex, nutritional status, activities of daily living, dysphagia, comorbidities, polypharmacy and clinical dental findings.

Conclusions

Sarcopenia was associated with OHRQoL and oral health status in older dental clinic outpatients. The prevalence of sarcopenia in older outpatients visiting the dental clinic was relatively high. Rehabilitation nutrition together with dental care might be necessary for sarcopenia treatment and prevention. Geriatr Gerontol Int 2018; 18: 915–921
Frailty index and its associations with self‐neglect, social support and sociodemographic characteristics among older adults in rural China
Authors: Li Jie , Zhao Dongdong , Dong Bao , Yu Dandan , Ren Qiongqiong , Chen Jian , Qin Qirong , Bi Peng , Sun Yehuan
Published: March 2018

Aim

The frailty index is used to measure the health status of older individuals. However, its association with self‐neglect, social support and sociodemographic characteristics of older adults is underexplored. The purpose of the present study was to explore such associations among the rural older adults in Anhui Province of China, and to provide scientific evidence for policy‐makers to improve the health and well‐being of older adults in rural China.

Methods

A cross‐sectional survey was undertaken among 3048 older adults in rural China. The frailty index was measured by an accumulation of deficits of 40 items. Ordinal logistic regression models were carried out to explore the associations of self‐neglect, social support and sociodemographic characteristics with the frailty index.

Results

The frailty rate was 15.8% among the participants. Older adults who showed self‐neglect, were female, had a lower education level, had a lower monthly income and did not drink alcohol were more prone to having frailty in the 60–76 years age group, whereas older adults who showed self‐neglect, had poor social support, were female, were not smokers and did not drink alcohol were more likely to have frailty in the ≥77 years age group (P < 0.05). The interaction effect on frailty between self‐neglect and social support was found in the 60–76 years age group.

Conclusions

Age differences were shown in the associations between self‐neglect, social support, sociodemographic characteristics and frailty index, which suggests different measures should be used accordingly for frailty prevention and management. Geriatr Gerontol Int 2018; 18: 987–996
Long‐term clinical and economic outcomes in previously untreated paediatric patients with severe haemophilia A: A nationwide real‐world study with 700 person‐years
Authors: Vepsäläinen K. , Riikonen P. , Lassila R. , Arola M. , Huttunen P. , Lähteenmäki P. , Möttönen M. , Selander T. , Martikainen J.
Published: March 2018

Aim

For previously untreated patients (PUPs) with severe haemophilia A in Finland for the past 2 decades, the standard practice has been to start early primary prophylaxis. We evaluated the long‐term clinical outcomes and costs of treatment with high‐dose prophylaxis in PUPs from birth to adolescence, including immune tolerance induction (ITI).

Methods

From the medical records of all PUPs born between June 1994 and May 2013 in Finland, we retrospectively extracted data on clinical outcomes and healthcare use. Using linear mixed models, we analysed longitudinal clinical outcome data. To analyse skewed cost data, including zero costs, we applied hurdle regression.

Results

All 62 patients received early regular prophylaxis; totally, they have had treatment for nearly 700 patient‐years. The median age of starting home treatment was 1.1 years. The mean (SD) annual treatment costs (€ per kg) were 4391€ (3852). For ages 1‐3, ITI comprised over half of the costs; in other groups, prophylactic FVIII treatment dominated. With these high costs, however, clinical outcomes were desirable; median (IQR) ABR was low at 0.19 (0.07‐0.46) and so was AJBR at 0.06 (0‐0.24). Thirteen (21%) patients developed a clinically significant inhibitor, 10 (16%) with a high titre. All ITIs were successful. The mean costs for ITI were 383 448€ (259 085). The expected ITI payback period was 1.81 (95% CI 0.62‐12.12) years.

Conclusions

Early high‐dose prophylaxis leads to excellent long‐term clinical outcomes, and early childhood ITI therapy seems to turn cost‐neutral generally already in 2 years.
Assessment of HER2 status in breast cancer biopsies is not affected by accelerated tissue processing
Authors: Bulte Joris P , Halilovic Altuna , Kalkman Shona , van Cleef Patricia H J , van Diest Paul J , Strobbe Luc J A , de Wilt Johannes H W , Bult Peter
Published: March 2018

Aims

To establish whether core needle biopsy (CNB) specimens processed with an accelerated processing method with short fixation time can be used to determine accurately the human epidermal growth factor receptor 2 (HER2) status of breast cancer.

Methods and results

A consecutive case–series from two high‐volume breast clinics was created. We compared routine HER2 immunohistochemistry (IHC) assessment between accelerated processing CNB specimens and routinely processed postoperative excision specimens. Additional amplification‐based testing was performed in cases with equivocal results. The formalin fixation time was less than 2 h and between 6 and 72 h, respectively. Fluorescence in‐situ hybridisation and multiplex ligation‐dependent probe amplification were used for amplification testing. One hundred and forty‐four cases were included, 15 of which were HER2‐positive on the routinely processed excision specimens. On the CNB specimens, 44 were equivocal on IHC and required an amplification‐based test. Correlation between the CNB specimens and the corresponding excision specimens was high for final HER2 status, with an accuracy of 97% and a kappa of 0.85.

Conclusions

HER2 status can be determined reliably on CNB specimens with accelerated processing time using standard clinical testing methods. Using this accelerated technology the minimum 6 h of formalin fixation, which current guidelines consider necessary, can be decreased safely. This allows for a complete and expedited histology‐based diagnosis of breast lesions in the setting of a one‐stop‐shop, same‐day breast clinic.
THE ENDOWMENT EFFECT AS BLESSING
Authors: Frenkel Sivan , Heller Yuval , Teper Roee
Published: March 2018

We study the idea that seemingly unrelated behavioral biases can coevolve if they jointly compensate for the errors that any one of them would give rise to in isolation. We suggest that the “endowment effect” and the “winner's curse” could have jointly survived natural selection together. We develop a new family of “hybrid‐replicator” dynamics. Under such dynamics, biases survive in the population for a long period of time even if they only partially compensate for each other and despite the fact that the rational type's payoff is strictly larger than the payoffs of all other types.
The longitudinal relationship between community programmes and policies to prevent childhood obesity and BMI in children: the Healthy Communities Study
Authors: Strauss W. J. , Nagaraja J. , Landgraf A. J. , Arteaga S. S. , Fawcett S. B. , Ritchie L. D. , John L. V. , Gregoriou M. , Frongillo E. A. , Loria C. M. , Weber S. A. , Collie‐Akers V. L. , McIver K. L. , Schultz J. , Sagatov R. D. F. , Leifer E. S. , Webb K. , Pate R. R. ,   on behalf of the Healthy Communities Study Team
Published: March 2018

Background

Although a national epidemic of childhood obesity is apparent, how community‐based programmes and policies (CPPs) affect this outcome is not well understood.

Objectives

This study examined the longitudinal relationship between the intensity of CPPs in 130 communities over 10 years and body mass index (BMI) of resident children. We also examined whether these relationships differ by key family or community characteristics.

Methods

Five thousand one hundred thirty‐eight children in grades K‐8 were recruited through 436 schools located within 130 diverse US communities. Measures of height, weight, nutrition, physical activity and behavioural and demographic family characteristics were obtained during in‐home visits. A subsample of families consented to medical record review; these weight and height measures were used to calculate BMI over time for 3227 children. A total of 9681 CPPs were reported during structured interviews of 1421 community key informants, and used to calculate a time series of CPP intensity scores within each community over the previous decade. Linear mixed effect models were used to assess longitudinal relationships between childhood BMI and CPP intensity.

Results

An average BMI difference of 1.4 kg/m2 (p‐value < 0.01) was observed between communities with the highest and lowest observed CPP intensity scores, after adjusting for community and child level covariates. BMI/CPP relationships differed significantly by child grade, race/ethnicity, family income and parental education; as well as community‐level race/ethnicity.

Conclusions

These results indicate that, over time, more intense CPP interventions are related to lower childhood BMI, and that there are disparities in this association by sociodemographic characteristics of families and communities.
Child neglect and abuse: a global glimpse within the framework of evidence perspective
Authors: Yıldız E. , Tanrıverdi D.
Published: March 2018

Aim

This systematic review was conducted in order to integrate evidence‐based knowledge and experience related to child neglect and abuse into the nursing literature.

Background

The negative and intense effects of neglect and abuse on an individual can last into adulthood. Nurses who are in close contact with such cases have an important role to play in detecting child neglect and abuse and supporting the families involved. When nurses fulfil this role, it is important that evidence‐based information and interventions are known to ensure that the process is a healthy one.

Data sources

Medline/Pubmed and Cochrane Library databases, from 2012 to 2016.

Review methods

The PRISMA guide, a basic search algorithm, was used as a basis for the review.

Results

This systematic research involved 32 articles that met the criteria. When the characteristics of the studies were examined, it was found that one study dealt with physical abuse, seven studies dealt with sexual abuse, 21 studies with neglect and abuse and three studies with all abuse types. It was also found that 16% addressed intervention, 22% addressed the relationship between abuse and other factors, 31% addressed prevention and 31% addressed the defining dimension.

Conclusions

It has been found that, in general, all types of negligence and abuse are studied together and that nurses lack the knowledge and skills needed to assess childhood neglect and abuse.

Implications for nursing and health policies

Nurses have a critical role to play in identifying the dark spots and associated factors in the story of individuals because they are health professionals who are in close contact with patients. It is recommended that guidelines be developed and used in the diagnosis and treatment of abuse and neglect. Thus, in these cases, the standardization of care will be achieved.
Community case management and unplanned hospital admissions in patients with heart failure: A systematic review and qualitative evidence synthesis
Authors: King Anna Jyoti Louise , Johnson Rachel , Cramer Helen , Purdy Sarah , Huntley Alyson Louise
Published: March 2018

Aims

The aim of this study was to describe case management as experienced by patients with heart failure and their health professionals with the aim of understanding why case management might contribute in reducing hospital admissions.

Background

Heart failure is a common cause of unplanned hospital admission. The evidence for case management in patients with heart failure for reducing admissions is promising.

Design

Systematic review and qualitative evidence synthesis.

Data source

Searches were conducted in Medline, Psychinfo, Kings Fund database and Cinahl from inception of each database to 16 February 2017.

Review methods

Robust systematic review methodology was used to identify qualitative studies describing the experiences of patients with heart failure and healthcare providers of case management. Data were synthesized thematically, and analytic themes were developed.

Findings

Five studies (six papers) from which nine descriptive themes were used to determine three analytic themes. This synthesis showed that case management provides positive quality of care for patients, increases perceived access to services and creates more time to ask questions and develop trusted relationships. For health professionals, case management enhanced care by improved relationships with both patients and colleagues although concerns remained around resources, training and inter‐professional conflict.

Conclusions

This synthesis emphasizes the importance of the quality of being cared for as a patient and caring as a health professional. Case management enhances communication between patients and health professionals, supports patient self‐care and self‐management and can be an important contributing factor in reducing unplanned admissions for patients with heart failure.
What distinguishes adolescents with suicidal thoughts from those who have attempted suicide? A population‐based birth cohort study
Authors: Mars Becky , Heron Jon , Klonsky E. David , Moran Paul , O'Connor Rory C. , Tilling Kate , Wilkinson Paul , Gunnell David
Published: March 2018

Background

Only one‐third of young people who experience suicidal ideation attempt suicide. It is important to identify factors which differentiate those who attempt suicide from those who experience suicidal ideation but do not act on these thoughts.

Methods

Participants were 4,772 members of the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population‐based birth cohort. Suicide ideation and attempts were assessed at age 16 years via self‐report questionnaire. Multinomial regression was used to examine associations between factors that differentiated adolescents in three groups: no suicidal ideation or attempts, suicidal ideation only and suicide attempts. Analyses were conducted on an imputed data set based on those with complete outcome data (suicidal thoughts and attempts) at age 16 years (N = 4,772).

Results

The lifetime prevalence of suicidal ideation and attempts in the sample was 9.6% and 6.8% respectively. Compared to adolescents who had experienced suicidal ideation, those who attempted suicide were more likely to report exposure to self‐harm in others (adjusted OR for family member self‐harm: 1.95, for friend self‐harm: 2.61 and for both family and friend self‐harm: 5.26). They were also more likely to have a psychiatric disorder (adjusted OR for depression: 3.63; adjusted OR for anxiety disorder: 2.20; adjusted OR for behavioural disorder: 2.90). Other risk factors included female gender, lower IQ, higher impulsivity, higher intensity seeking, lower conscientiousness, a greater number of life events, body dissatisfaction, hopelessness, smoking and illicit drug use (excluding cannabis).

Conclusions

The extent of exposure to self‐harm in others and the presence of psychiatric disorder most clearly differentiate adolescents who attempt suicide from those who only experience suicidal ideation. Further longitudinal research is needed to explore whether these risk factors predict progression from suicidal ideation to attempts over time.
Investigating Psychometric Isomorphism for Traditional and Performance‐Based Assessment
Authors: Fay Derek M. , Levy Roy , Mehta Vandhana
Published: March 2018

A common practice in educational assessment is to construct multiple forms of an assessment that consists of tasks with similar psychometric properties. This study utilizes a Bayesian multilevel item response model and descriptive graphical representations to evaluate the psychometric similarity of variations of the same task. These approaches for describing the psychometric similarity of task variants were applied to two different types of assessments (one traditional assessment and one performance‐based assessment) with markedly different response formats. Due to the general nature of the multilevel item response model and graphical approaches that were utilized, the methods used for this work can readily be applied to many assessment contexts for the purposes of evaluating the psychometric similarity of tasks.
Detecting Nonadditivity in Single‐Facet Generalizability Theory Applications: Tukey's Test
Authors: Lin Chih‐Kai , Zhang Jinming
Published: March 2018

Under the generalizability‐theory (G‐theory) framework, the estimation precision of variance components (VCs) is of significant importance in that they serve as the foundation of estimating reliability. Zhang and Lin advanced the discussion of nonadditivity in data from a theoretical perspective and showed the adverse effects of nonadditivity on the estimation precision of VCs in 2016. Contributing to this line of research, the current article directs the discussion of nonadditivity from a theoretical perspective to a practical application and highlights the importance of detecting nonadditivity in G‐theory applications. To this end, Tukey's test for nonadditivity is the only method to date that is appropriate for the typical single‐facet G‐theory design, in which a single observation is made per element within a facet. The current article evaluates the Type I and Type II error rates of Tukey's test. Results show that Tukey's test is satisfactory in controlling for falsely detecting nonadditivity when the data are actually additive and that it is generally powerful in detecting nonadditivity when it exists. Finally, the article demonstrates an application of Tukey's test in detecting nonadditivity in a judgmental study of educational standards and shows how Tukey's test results can be used to correct imprecision in the estimated VC in the presence of nonadditivity.
Confidence Intervals for Weighted Composite Scores Under the Compound Binomial Error Model
Authors: Kim Kyung Yong , Lee Won‐Chan
Published: March 2018

Reporting confidence intervals with test scores helps test users make important decisions about examinees by providing information about the precision of test scores. Although a variety of estimation procedures based on the binomial error model are available for computing intervals for test scores, these procedures assume that items are randomly drawn from a undifferentiated universe of items, and therefore might not be suitable for tests developed according to a table of specifications. To address this issue, four interval estimation procedures that use category subscores for the computation of confidence intervals are presented in this article. All four estimation procedures assume that subscores instead of test scores follow a binomial distribution (i.e., compound binomial error model). The relative performance of the four compound binomial–based interval estimation procedures is compared to each other and to the better known normal approximation and Wilson score procedures based on the binomial error model.
What the Trial Judge Needs to Know about the Convention of 23 November 2007 on the International Recovery of Child Support and Other Forms of Family Maintenance
Authors: Keith Robert E.
Published: March 2018

Since the 1950s, there have been several international multi‐lateral treaties for recognition and enforcement of child and spousal support orders. They operated, primarily, in civil law countries where “creditor‐based jurisdiction” allowed establishment of an order in the country of habitual residence of the child or the custodial parent. The United States, requiring “minimum contacts” with the debtor to establish personal jurisdiction, could not be a party to such agreements. For nearly fifty years the U.S., and a few states, sought to fill the need for international reciprocity by negotiating individual country‐to‐country or state‐to‐country arrangements. With ratification of the 2007 Family Maintenance Convention, the United States was finally able to join in a multi‐lateral treaty. The treaty took effect in the United States on January 1, 2017, establishing procedures for international recognition, enforcement and modification of family support orders with 35 other countries already party to the Convention (including the entire European Union). The grand bargain struck during the negotiations between 2003 and 2007 was that the U.S. would honor a foreign order if, under the facts presented, there were sufficient minimum contacts with the debtor that would have supported personal jurisdiction if the order had been entered in any state in the U.S. If unable to recognize a foreign order, the U.S. agreed to take steps to issue a new one. The treaty establishes administrative procedures that, in many respects, are nearly identical to interstate enforcement of domestic support orders in this country. But there are also aspects of the treaty that are entirely new and warrant explanation for family and juvenile court judges. This article focuses on several unique provisions of the treaty that judges and attorneys need to understand.
A 21st Century Developmentally Appropriate Juvenile Probation Approach
Authors: Schwartz Robert G.
Published: March 2018

Principles of adolescent development have accelerated positive changes to the juvenile justice system. These changes have been most pronounced in reducing reliance on incarceration and in approaches to sentencing of youth tried as adults. While juvenile probation has made some developmentally friendly adjustments, it remains an area that is fertile for reform. Many of the principles and goals in this paper have been endorsed by the National Council of Juvenile and Family Court Judges (NCJFCJ), which “supports and is committed to juvenile probation systems that conform to the latest knowledge of adolescent development and adolescent brain science,” and which “recommends that courts cease imposing ‘conditions of probation’ and instead support probation departments’ developing, with families and youth, individualized case plans that set expectations and goals.”

NCJFCJ's July, 2017 resolution in support of developmentally appropriate juvenile probation services built on earlier NCJFCJ policies. From the time NCJFCJ adopted Juvenile Delinquency Guidelines in 2005, those policies have grown increasingly robust.
Experiences of cancer rehabilitation: A cross‐sectional study
Authors: Garmy Pernilla , Jakobsson Liselotte
Published: March 2018

Aims and objectives

To investigate the cancer rehabilitation experiences of working‐age cancer survivors.

Background

Cancer survivors have extremely complex needs, spanning physical, vocational and sexual domains. Although cancer rehabilitation services have been found to eliminate or reduce these strains, these services are often underutilised.

Design

A cross‐sectional study design was employed.

Methods

A survey of persons over the age of 18 with a cancer diagnosis, enrolled in the Social Insurance Agency in a municipality in southern Sweden (n = 168, 68% women), was conducted.

Results

Patients who used the cancer rehabilitation service (57%) were generally satisfied with it. Of participants, 26% reported not having received an offer of rehabilitation. Of those who reported that they received information about cancer rehabilitation services, most also reported that they received this information from a healthcare service professional (69%); for example, from the oncology nurse or the oncologist, whereas 20% claimed they received the information from the administrator of the Swedish Social Insurance Agency. A minority of children and family members of patients received support from the healthcare system.

Conclusions

More efforts should be taken to reach patients in need of cancer rehabilitation. Additionally, more attention should be directed towards family members and young children.

Relevance to clinical practice

More than one in four patients claimed to not have received an offer of cancer rehabilitation, and an even greater number of patients claimed that their spouses and children had never received an offer for this service either. Hence, there is a communication barrier that needs to be overcome. Health providers should be aware that information needs to be repeated several times, and presented both orally and in writing.
Mothers’ experiences of managing their child's pain before and during attendance at the emergency department
Authors: Edmonds Jenny , Twycross Alison
Published: March 2018

Aims and objectives

To explore mothers’ experiences of managing their child's pain before and during attendance at the emergency department.

Background

Pain accounts for 50%–80% of all visits to the emergency department. Historically paediatric pain has been poorly managed in the emergency department and there remains variability in practice. It is mothers who usually bring their child to the emergency department and as such it is important to explore their perspectives of how pain is managed.

Design

Exploratory qualitative study.

Methodology

Semi‐structured interviews were carried out with mothers (n = 10) of children who have attended the emergency department in one hospital in the East of England during April 2015.

Results

Most mothers felt able to assess their child's pain and reported attending the emergency department when their normal pain‐relieving strategies failed following an injury. Several mothers sought advice from elsewhere before bringing their child to the emergency department. The advice received was usually to take their child to the emergency department. Mothers welcomed the professional approach to pain management in the emergency department and valued being kept informed about their child's care. Mothers rated the care provided in the emergency department as good or very good.

Conclusions

Mothers attended the emergency department when their normal pain‐relieving strategies failed. This suggests there is a need to provide additional resources to support parents in this context. Mothers often brought their child to the emergency department rather than their General Practitioner or other primary healthcare providers. The reasons for this need exploring further.

Relevance to clinical practice

The results suggest that mothers need additional resources to enable them to manage their child's pain at home following an injury. The reasons mothers attend the emergency department rather than other healthcare providers need exploring in more depth.
The older patient's experience of the healthcare chain and information when undergoing colorectal cancer surgery according to the enhanced recovery after surgery concept
Authors: Samuelsson Katja Schubert , Egenvall Monika , Klarin Inga , Lökk Johan , Gunnarsson Ulf , Iwarzon Marie
Published: March 2018

Aims and objectives

To describe how older patients experience the healthcare chain and information given before, during and after colorectal cancer surgery.

Background

Most persons with colorectal cancer are older than 70 years and undergo surgery with subsequent enhanced recovery programmes aiming to quickly restore preoperative function. However, adaptation of such programmes to suit the older patient has not been made.

Design

Qualitative descriptive study.

Method

Semi‐structured interviews were conducted on 16 patients undergoing colorectal cancer surgery at a Swedish University Hospital. The inductive content analysis was employed.

Results

During the period of primary investigation and diagnosis, a paucity of information regarding the disease and management, and lack of help in coping with the diagnosis of cancer and its impact on future life, leads to a feeling of vulnerability. During their stay in hospital, the patient's negative perception of the hospital environment, their need for support, and uncertainty and anxiety about the future are evident. After discharge, rehabilitation is perceived as lacking in structure and individual adaptation, leading to disappointment. Persistent difficulty with nutrition delays recovery, and confusion regarding division of responsibility between primary and specialist care leads to increased anxiety and feelings of vulnerability. Information on self‐care is perceived as inadequate. Furthermore, provided information is not always understood and therefore not useful.

Conclusion

Information before and after surgery must be tailored to meet the needs of older persons, considering the patient's knowledge and ability to understand. Furthermore, individual nutritional requirements and preoperative physical activity and status must be taken into account when planning rehabilitation.

Relevance to clinical practice

Patient information must be personalised and made understandable. This can improve self‐preparation and participation in the own recovery. Special needs must be addressed early and followed up.
An updated systematic review and meta‐analysis of early outcomes after left atrial appendage occlusion
Authors: Yerasi Charan , Lazkani Mohamad , Kolluru Prathik , Miryala Varun , Kim Jae , Moole Harsha , Sawant Abhishek C. , Morris Michael , Pershad Ashish
Published: March 2018

Background

Left atrial appendage occlusion (LAAO) is a promising intervention for stroke prevention in patients with non‐valvular atrial fibrillation (NVAF). Early outcomes following LAAO have been published in many studies with variable results.

Objective

This updated meta‐analysis aims to provide a summary of the early outcomes of LAAO.

Methods

Medline/Pubmed, Ovid Journals, Clinical trials, Abstract meetings, Cochrane databases were searched from January 1st, 1999 to November 30th, 2016.

Results

This meta‐analysis included 49 studies involving 12 415 patients. The median age was 73.5 years (IQR 72‐75 years) and 43% were males. Hypertension and diabetes were present in 36% and 15% of the population, respectively. There was a prior history of stroke and congestive heart failure in 14% and 18% of the population, respectively. The median CHADS2 score was 2.9 (IQR 2.6‐3.3) and the median HASBLED score was 3.3 (IQR 3‐4). LAAO implantation was successful in 96.3% of patients (95.40‐97.08, I2 = 76.1%). The pooled proportion of all‐cause mortality was 0.28% (0.19‐0.38, I2 = 0%). The pooled proportion of all‐cause stroke was 0.31% (0.22‐0.42, I2 = 9.4%), major bleeding requiring transfusion was 1.71% (1.13‐2.41, I2 = 73.2%), and pericardial effusion was 3.25% (2.46‐4.14, I2 = 79%). Sub analysis of randomized clinical trials comparing LAAO devices to warfarin showed lower mortality (P = 0.03) with similar bleeding risk (P = 0.20) with LAAO.

Conclusions

This meta‐analysis concludes that LAAO occlusion is a safe and effective stroke prevention strategy in patients with NVAF.
The Association Between Family–Teacher Partnership Satisfaction and Outcomes of Academic Progress and Quality of Life for Children/Youth With Autism
Authors: Goldrich Eskow Karen , Ann Summers Jean , Chasson Gregory S. , Mitchell Renae
Published: March 2018

As the prevalence of Autism Spectrum Disorders (ASD) increases, teachers and special education service providers are experiencing increased contact with not only children with ASD, but also with their parents and families. Partnerships between families and teachers have become more commonplace in the last 20 years in response to mandates related to parent involvement by federal law. The present study examined the relationship between parent–teacher partnership satisfaction and child progress and family quality of life among children (n = 313) receiving autism waiver services (Waiver—Home and Community‐Based Services Waivers (42 U.S.C. SS 1915(b) (c)) and those whose families expressed an interest in receiving waiver services (registry). Results indicated family–teacher partnership satisfaction was associated with parent‐reported improvement in academic progress and family quality of life. These findings were not dependent on group status (waiver vs. registry) and highlight the importance of the quality of service delivery through family–teacher partnerships for children with ASD.
Cardiovascular autonomic dysfunction in insomnia patients with objective short sleep duration
Authors: Jarrin Denise C. , Ivers Hans , Lamy Manon , Chen Ivy Y. , Harvey Allison G. , Morin Charles M.
Published: March 2018

Two phenotypes have been proposed: insomnia with objective near‐normal sleep duration, related to increased psychological symptoms, and insomnia with objective short sleep duration, associated with cardiometabolic morbidity. Reduced heart rate variability has also been implicated in the pathophysiology of cardiometabolic disease; however, there are little data on whether cardiovascular function differs between patients with objective short sleep duration and near‐normal sleep duration. Participants (Mage = 49.9 ± 11.3 years; 62.8% female) were 180 adults with chronic insomnia (Mduration = 15.7 ± 13.6). Objective sleep duration was based on total sleep time averaged across two consecutive nights of polysomnography and subjective sleep duration was based on 2‐week sleep diaries. The sample was divided into two groups, with sleep duration shorter (polysomnography‐total sleep time: n = 46; sleep diary: n = 95) or equal/longer (polysomnography‐total sleep time: n = 134; sleep diary: n = 85) than 6 hr. Electrocardiogram data derived from polysomnography were used to obtain heart rate and heart rate variability during stage 2 (N2) and rapid eye movement sleep. Heart rate variability measures included absolute and normalized high‐frequency component, an index of parasympathetic activation, and the ratio of low‐ to high‐frequency (LF/HF ratio), an index of sympathovagal balance. After controlling for covariates (e.g., co‐morbidity), patients with objective short sleep duration had reduced high‐frequency (p < .05) and elevated low‐frequency/high‐frequency ratio (p = .036) and heart rate (p = .051) compared with patients with near‐normal sleep duration. No differences were observed between phenotypes when subjective sleep duration was used. Insomnia patients with objective short sleep duration showed significantly dampened parasympathetic activation and increased sympathovagal imbalance relative to their counterparts with near‐normal sleep duration. These findings highlight the importance of treating insomnia, as treatment may reduce the risk of cardiovascular disease.
Investigation of sleep spindle activity and morphology as predictors of neurocognitive functioning in medicated patients with schizophrenia
Authors: Baandrup Lone , Christensen Julie A. E. , Fagerlund Birgitte , Jennum Poul
Published: March 2018

Neurocognitive impairment is a trait marker of schizophrenia, but no effective treatment has yet been identified. Sleep spindle deficits have been associated with diminished sleep‐dependent memory learning. We examined whether this link could be extended into various cognitive domains by investigating the association of a neurocognitive test battery (the Brief Assessment of Cognition in Schizophrenia) with sleep spindle activity and morphology. We examined 37 outpatients diagnosed with schizophrenia and medicated with both antipsychotics and benzodiazepines. Participants underwent 1 night polysomnography and test of neurocognitive functioning. We identified and analysed sleep spindles in all non‐rapid eye movement sleep and in non‐rapid eye movement sleep stage 2 in a central electroencephalography channel using an automatic sleep spindle detector previously validated. Slow sleep spindle density was computed from a frontal electroencephalography channel as well. We found no association between cognitive functioning and sleep spindle density or sleep spindle morphology for spindles in non‐rapid eye movement sleep when controlling for gender, age, symptom severity, and daily dose of antipsychotics and benzodiazepines. For spindles in non‐rapid eye movement sleep stage 2, we found that motor speed was associated with frontal slow sleep spindle density. We conclude that frontal slow spindle density might predict motor speed in medicated patients with schizophrenia, but that no other sleep spindle activity or sleep spindle morphology measures were predictors of neurocognitive functioning.
An overview of sleep and circadian dysfunction in Parkinson's disease
Authors: Mantovani Susanna , Smith Simon S. , Gordon Richard , O'Sullivan John D.
Published: March 2018

Sleep and circadian alterations are amongst the very first symptoms experienced in Parkinson's disease, and sleep alterations are present in the majority of patients with overt clinical manifestation of Parkinson's disease. However, the magnitude of sleep and circadian dysfunction in Parkinson's disease, and its influence on the pathophysiology of Parkinson's disease remains often unclear and a matter of debate. In particular, the confounding influences of dopaminergic therapy on sleep and circadian dysfunction are a major challenge, and need to be more carefully addressed in clinical studies. The scope of this narrative review is to summarise the current knowledge around both sleep and circadian alterations in Parkinson's disease. We provide an overview on the frequency of excessive daytime sleepiness, insomnia, restless legs, obstructive apnea and nocturia in Parkinson's disease, as well as addressing sleep structure, rapid eye movement sleep behaviour disorder and circadian features in Parkinson's disease. Sleep and circadian disorders have been linked to pathological conditions that are often co‐morbid in Parkinson's disease, including cognitive decline, memory impairment and neurodegeneration. Therefore, targeting sleep and circadian alterations could be one of the earliest and most promising opportunities to slow disease progression. We hope that this review will contribute to advance the discussion and inform new research efforts to progress our knowledge in this field.
Harrod's long‐range capital outlay as a stabilizer of Harrodian instability
Authors: Franke Reiner
Published: March 2018

Drawing on Harrod, Kalecki and Kaldor, this paper seeks to revive the view that ceteris paribus firms reduce investment if they have already built up high capacities relative to their assessment of the normal potential of their markets. This reaction introduces a fundamental stabilizing mechanism into the economy. The paper adapts the idea to a growth context and applies it to the neo‐Kaleckian baseline model with its Harrodian instability. It demonstrates that, in principle, a sufficiently strong feedback could stabilize the steady state.
Evaluation of a chronic kidney disease risk assessment service in community pharmacies
Authors: Gheewala Pankti A , Peterson Gregory M , Zaidi Syed Tabish R , Jose Matthew D , Castelino Ronald L
Published: March 2018

Aim

Targeted ‘opportunistic’ screening might be a sustainable approach for the early detection of people with undiagnosed chronic kidney disease (CKD). The aim of this study was to implement and evaluate a CKD risk assessment service in the community pharmacy setting.

Methods

Twenty‐four pharmacies in Tasmania, Australia participated in this study. Targeted people were aged between 50 and 74 years, with at least one CKD risk factor. The QKidney risk calculator was used to estimate the participants’ 5‐year percentage risk of developing moderate–severe CKD. Participants identified with ≥3% risk were referred to their general practitioner (GP) and followed‐up after 9 months. Laboratory data was collected from a pathology provider. The main outcome measures were rates of GP referral uptake and of participants who underwent estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) measurement.

Results

We analyzed data for 389 screened participants, of whom 203 (52.1%) had ≥3% 5‐year risk of developing moderate–severe CKD and were referred to their GP. Follow‐up was successful for 126 participants and showed low (27%) GP referral uptake. Analysis of the pathology data revealed suboptimal kidney testing in participants with ≥3% risk, with eGFR and ACR tests performed for only 52.7% and 25.1% of these participants, respectively.

Conclusions

There is significant scope for improving early detection of CKD via implementation of a community pharmacy‐based CKD risk assessment service. However, a healthcare system that encourages inter‐professional collaboration between community pharmacists and GPs, and provides a robust referral pathway is needed to optimize the effectiveness of this service.
Income Inequality and Saving
Authors: Alvarez‐Cuadrado Francisco , El‐Attar Vilalta Mayssun
Published: March 2018

Over the last three decades, the average income for the bottom half of the US distribution increased by 8% while their average saving rate decreased by 8 percentage points. Over the same period, the US experienced a substantial increase in inequality and a continuous decrease in the aggregate saving rate. We propose an explanation based on interpersonal comparisons consistent with these trends. When households care about their consumption relative to others, individual saving rates decrease with reference income while aggregate saving decreases with income inequality. We provide evidence from the PSID and a panel of OECD countries consistent with these predictions.