bluuebunny/crossref_metadata_2025 huggingface dataset:
The association between vaginal parity and hiatal dimensions: a retrospective observational study in a tertiary urogynaecological centre
Authors: Kamisan Atan I , Gerges B , Shek KL , Dietz HP
Published: June 2014

Objective

Vaginal childbirth has a substantial effect on pelvic organ supports, which may be mediated by levator ani (LA) avulsion or hiatal overdistension. Although the impact of a first vaginal delivery on the hiatus has been investigated, little is known about the effect of subsequent births. This study was designed to evaluate the association between vaginal parity and hiatal dimension.

Design

Retrospective observational study.

Setting

A tertiary urogynaecological unit in Australia.

Population

A total of 780 archived data sets of women seen for symptoms of lower urinary tract and pelvic floor dysfunction.

Methods

Standardised in‐house interview and assessment using the International Continence Society (ICS) pelvic organ prolapse quantification (POP‐Q), and four‐dimensional translabial ultrasound. Offline analysis for hiatal dimensions was undertaken blinded to history and clinical examination.

Main outcome measures

Hiatal area on maximum Valsalva.

Results

Of 780 women, 64 were excluded because of missing ultrasound volumes, leaving 716 for analysis: 96% (n = 686) were parous, with a median parity of three (interquartile range, IQR 2–3), and 91.2% (n = 653) were vaginally parous. Levator avulsion was found in 21% (n = 148). The mean hiatal area on Valsalva was 29 cm2 (SD 9.4 cm2). On one‐way anova, vaginal parity was significantly associated with hiatal area (P < 0.001). Most of the effect seems to occur with the first delivery. Subsequent deliveries do not seem to have any significant effect on hiatal dimensions. This remained true after controlling for potential confounding factors using multivariate regression analysis (P = 0.0123).

Conclusions

Vaginal parity was strongly associated with hiatal area on Valsalva. Most of this effect seems to be associated with the first vaginal delivery.
Newborn regional body composition is influenced by maternal obesity, gestational weight gain and the birthweight standard score
Authors: Carlsen EM , Renault KM , Nørgaard K , Nilas L , Jensen JEB , Hyldstrup L , Michaelsen KF , Cortes D , Pryds O
Published: June 2014

Aim

This study investigated whether newborn body composition is influenced by prepregnancy obesity and gestational weight gain (GWG) and explored any associations between body composition and birthweight standard score (z‐score), categorised by size for gestational age.

Methods

We recruited 231 obese and 80 normal weight mothers and their newborn infants and assessed the babies' body composition using dual‐energy X‐ray absorptiometry.

Results

The total and abdominal fat masses of infants born to mother who were obese before pregnancy were 135 g (p < 0.001) and 18 g (p < 0.001) higher than the offspring of normal weight mothers. The infants' fat mass increased by 11 g (p < 0.001) for every kilogram of GWG. There were no associations between prepregnancy obesity and fat‐free mass. The fat percentage was significantly higher in infants who were large for gestational age (15.3%) than small for gestational age (5.2%) and appropriate for gestational age (9.8%) (p < 0.001). Lower birthweight z‐score was associated with a higher proportion of abdominal fat mass (p = 0.009).

Conclusion

Infants born to obese mothers had higher fat mass at birth, with abdominal fat accumulation. Low birthweight was associated with a lower crude abdominal fat mass, but a higher proportion of total fat mass placed abdominally.
Maximum likelihood estimation for model Mt,α for capture–recapture data with misidentification
Authors: Vale R. T. R. , Fewster R. M. , Carroll E. L. , Patenaude N. J.
Published: June 2014

We investigate model for abundance estimation in closed‐population capture–recapture studies, where animals are identified from natural marks such as DNA profiles or photographs of distinctive individual features. Model extends the classical model to accommodate errors in identification, by specifying that each sample identification is correct with probability and false with probability . Information about misidentification is gained from a surplus of capture histories with only one entry, which arise from false identifications. We derive an exact closed‐form expression for the likelihood for model and show that it can be computed efficiently, in contrast to previous studies which have held the likelihood to be computationally intractable. Our fast computation enables us to conduct a thorough investigation of the statistical properties of the maximum likelihood estimates. We find that the indirect approach to error estimation places high demands on data richness, and good statistical properties in terms of precision and bias require high capture probabilities or many capture occasions. When these requirements are not met, abundance is estimated with very low precision and negative bias, and at the extreme better properties can be obtained by the naive approach of ignoring misidentification error. We recommend that model be used with caution and other strategies for handling misidentification error be considered. We illustrate our study with genetic and photographic surveys of the New Zealand population of southern right whale (Eubalaena australis).
Diagnosing attention‐deficit hyperactivity disorder (ADHD) in children involved with child protection services: are current diagnostic guidelines acceptable for vulnerable populations?
Authors: Klein B. , Damiani‐Taraba G. , Koster A. , Campbell J. , Scholz C.
Published: June 2014

Children involved with child protection services (CPS) are diagnosed and treated for attention‐deficit hyperactivity disorder (ADHD) at higher rates than the general population. Children with maltreatment histories are much more likely to have other factors contributing to behavioural and attentional regulation difficulties that may overlap with or mimic ADHD‐like symptoms, including language and learning problems, post‐traumatic stress disorder, attachment difficulties, mood disorders and anxiety disorders. A higher number of children in the child welfare system are diagnosed with ADHD and provided with psychotropic medications under a group care setting compared with family‐based, foster care and kinship care settings. However, children's behavioural trajectories change over time while in care. A reassessment in the approach to ADHD‐like symptoms in children exposed to confirmed (or suspected) maltreatment (e.g. neglect, abuse) is required. Diagnosis should be conducted within a multidisciplinary team and practice guidelines regarding ADHD diagnostic and management practices for children in CPS care are warranted both in the USA and in Canada. Increased education for caregivers, teachers and child welfare staff on the effects of maltreatment and often perplexing relationship with ADHD‐like symptoms and co‐morbid disorders is also necessary. Increased partnerships are needed to ensure the mental well‐being of children with child protection involvement.
Assessment of speech in early‐onset ataxia: a pilot study
Authors: Kuiper Marieke J , Brandsma Rick , Lawerman Tjitske F , Lunsing Roelineke J , Keegstra Anne L , Burger Huibert , De Koning Tom J , Tijssen Marina A J , Sival Deborah A
Published: June 2014

Aim

The aim of the study was to determine whether paediatric ataxia speech subscores are reliably applicable for international early‐onset ataxia (EOA) databases. If so, we reasoned that ataxia speech subscores should be associated with ataxia scores and involve high interobserver agreement, including those for internationally applicable Scale for Assessment and Rating of Ataxia (SARA) syllable repetition tasks (SARASRT).

Method

Three independent paediatric neurologists and a speech therapist scored speech in 52 healthy children (mean age 10y, range 4–16y) and 40 individuals with EOA (mean age 15y, range 5–34y). We compared ataxia speech subscores for the association with age and ataxia scores as well as interobserver reliability.

Results

In healthy children, ataxia speech subscores were moderately associated with age (International Cooperative Ataxia Rating Scale [ICARS]: r=−0.515; SARA: r=−0.321; p<0.05) and with ataxia scores (ICARS: r=0.552; SARA: r=0.336; p<0.05), and revealed slight to moderate interobserver agreement (ICARS‐intraclass correlation coefficient [ICC]: 0.380; SARA‐ICC: 0.185; SARASRT‐ICC: 0.509). In EOA, speech subscores have a strong association with ataxia scores (ICARS: r=0.735; SARA: r=0.730; p<0.001) and revealed substantial to nearly perfect interobserver agreement (ICARS‐ICC: 0.812; SARA‐ICC: 0.854; SARASRT‐ICC: 0.724).

Interpretation

Early‐onset ataxia speech subscores are associated with ataxia and also reveal high interobserver agreement, including those internationally applicable to SARASRT. We conclude that SARASRT appears to be applicable for EOA databases. However, before syllable repetition tasks are included, we would advise to wait for the results published by the international Childhood Ataxia and Cerebellar Group.
3‐D visualisation, printing, and volume determination of the tracheal respiratory system in the adult desert locust, Schistocerca gregaria
Authors: Greco Mark , Bell Duncan , Woolnough Lewis , Laycock Stephen , Corps Nick , Mortimore David , Hudson Diana
Published: June 2014

Here, we describe a single micro‐CT scan with a spatial resolution of 10 μm of a 10‐day‐old adult male Schistocerca gregaria (Forskål) (Orthoptera: Acrididae) and we compare our tracheal volume (VT) determination with published work on the subject. We also illustrate the feasibility of performing non‐invasive ‘virtual dissection’ on insects after performing micro‐CT. These post‐processing steps can be performed using free downloadable 3‐D software. Finally, the values of producing stereo‐lithography (STL) files that can be viewed or used to print out 3‐D models as teaching aids are discussed.
Focal abnormalities in idiopathic generalized epilepsy: A critical review of the literature
Authors: Seneviratne Udaya , Cook Mark , D'Souza Wendyl
Published: June 2014

Conventionally, epilepsy is dichotomized into distinct “focal” and “generalized” categories. However, many studies have reported so‐called focal features among patients with idiopathic generalized epilepsy (IGE) in the domains of semiology, electroencephalography, neuropsychology, neuropathology, and neuroimaging. We sought to review such features and clinical implications. A Web of Science database search was conducted to identify relevant publications. Our search yielded 145 papers describing focal features involving different domains inIGE,with 117 papers analyzed after excluding abstracts and case reports. Focal semiologic features are commonly seen inIGE. There are conflicting data from studies in the domains of electroencephalography, neuroimaging, and neuropathology. Studies on neuropsychology are suggestive of frontal lobe functional deficits in juvenile myoclonic epilepsy. Most advanced neuroimaging studies demonstrate the involvement of both the thalamus and the cortex during generalized spike‐wave discharges (GSWDs). A few electroencephalographic and neuroimaging studies indicate that the cortex precedes the thalamus at the onset ofGSWD. Focal features may contribute to misdiagnosis of IGE as focal epilepsy. However there are methodologic limitations in the studies that affect the results.

A PowerPoint slide summarizing this article is available for download in the Supporting Information sectionhere.
Pharmacokinetics, pulmonary disposition and tolerability of liposomal gentamicin and free gentamicin in foals
Authors: Burton A. J. , Giguère S. , Arnold R. D.
Published: June 2014

Reasons for performing the study

Although gentamicin is highly active againstRhodococcus equi in vitro, its clinical efficacy has been limited presumably due to poor cellular uptake. Encapsulation of drugs in liposomes enhances their cellular uptake.

Objectives

To compare the disposition of liposomal gentamicin (LG) and free gentamicin (FG) in the plasma, pulmonary epithelial lining fluid and bronchoalveolar cells of healthy foals after i.v. administration or by nebulisation, and to assess the tolerability of the drug after repeated i.v. dosing.

Study design

Experimental study.

Methods

Eight healthy foals received a single i.v. or nebulised dose (6.6 mg/kg bwt) ofLGorFGin a balancedLatin square design, with a 14‐day washout period between treatments. Subsequently, 12 healthy foals were given eitherLGorFGat 6.6 mg/kg bwt i.v. q. 24 h for 7 doses and urinary protein, creatinine, γ‐glutamyltransferase and electrolytes were measured on Days 0, 3 and 7 to quantify renal injury. Concentrations of gentamicin were measured using liquid chromatography‐tandem mass spectrometry.

Results

After i.v. administration,LGhad a significantly higher mean (± s.d.) half‐life (16.3 ± 3.5 vs. 6.2 ± 1.8 h) and volume of distribution (2.00 ± 1.03 vs. 0.72 ± 0.32 l/kg bwt) compared withFG. Peak gentamicin concentrations in bronchoalveolar cells were significantly higher forLGcompared withFGafter administration by both the i.v. (5.27 ± 2.67 vs. 2.98 ± 1.67 mg/l) and the nebulised (4.47 ± 2.66 vs. 1.49 ± 0.57 mg/l) routes. Liposomal gentamicin was well tolerated by all foals and indices of renal injury were not significantly different from those of foals administeredFG.

Conclusions

Administration ofLGis well tolerated and results in higher intracellular drug concentrations thanFG. Liposomal gentamicin warrants further investigation for the treatment of infections caused by intracellular pathogens such asRhodococcus equi.
Soil and greenhouse gas responses to biochar additions in a temperate hardwood forest
Authors: Sackett Tara E. , Basiliko Nathan , Noyce Genevieve L. , Winsborough Carolyn , Schurman Jonathan , Ikeda Chihiro , Thomas Sean C.
Published: June 2014

Biochar additions can improve soil fertility and sequester carbon, but biochar effects have been investigated primarily in agricultural systems. Biochar from spruce and maple sawdust feedstocks (with and without inorganic phosphorus in a factorial design) were added to plots in a commercially managed temperate hardwood forest stand in central Ontario, Canada; treatments were applied as a top‐dressing immediately prior to fall leaf abscission in September 2011. Forests in this region have acidic, sandy soils, and due to nitrogen deposition may exhibit phosphorus, calcium, and magnesium limitation. To investigate short‐term impacts of biochar application on soil nutrient supply and greenhouse gas fluxes as compared to phosphorus fertilization, data were collected over the first year after treatment application; linear mixed models were used to analyze data. Two to six weeks after treatment application, there were higher concentrations of potassium in spruce and maple biochar plots, and phosphorus in spruce biochar plots, as compared to the control treatment. There were higher concentrations of calcium, magnesium, and phosphorus in the phosphorus plots. In the following spring and summer (9–12 months after treatment application), there were higher soil calcium concentrations in maple biochar plots, and phosphorus plots still had higher soil phosphorus concentrations than control plots. No treatment effects on fluxes of carbon dioxide, methane, or nitrous oxide were detected in the field; however, laboratory incubations after 12 months showed higher microbial respiration in soils from maple biochar plots as compared to spruce biochar, despite no effect on microbial biomass. The results suggest that the most important short‐term impact of biochar additions in this system is the increased supply of the limiting plant nutrients phosphorus and calcium. We expect that larger changes in mineral soil physical and chemical properties will occur when the surface‐applied biochar becomes incorporated into the soil after a few years.
Extracorporeal shockwave therapy in the treatment of erectile dysfunction: A prospective, randomized, double‐blinded, placebo controlled study
Authors: Yee Chi‐Hang , Chan Eddie SY , Hou Simon See‐Ming , Ng Chi‐Fai
Published: June 2014

Objectives

To investigate the role of low‐intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction.

Methods

This was a double‐blinded, single‐center, prospective, randomized, placebo‐controlled trial. After a 2‐week phosphodiesterase type 5 inhibitor washout period, patients were assessed with Sexual Health Inventory for Men, International Index of Erectile Function‐ED domain scores and Erection Hardness Score. Randomization into either the low‐intensity extracorporeal shockwave therapy group or the sham group took place. After the 9‐week treatment period, patients were followed up 4 weeks later. Follow‐up assessment was in the form of International Index of Erectile Function‐ED domain score and Erection Hardness Score.

Results

A total of 70 patients were recruited into the study, 58 patients completed the study. A total of 28 patients were randomized into the sham therapy arm, and 30 patients were randomized into the low‐intensity extracorporeal shockwave therapy arm. There was no significant difference between these two groups in baseline International Index of Erectile Function‐ED domain score and Erection Hardness Score. The mean International Index of Erectile Function‐ED domain score of the low‐intensity extracorporeal shockwave therapy arm and sham arm in week 13 were 17.8 ± 4.8 and 15.8 ± 6.1, respectively (P = 0.156). The mean Erection Hardness Scores in week 13 were 2.7 ± 0.5 and 2.4 ± 0.9, respectively (P = 0.163). When patients were stratified into different baseline Sexual Health Inventory for Men subgroups, the pre‐intervention and post‐intervention difference in low‐intensity extracorporeal shockwave therapy was found to be significant in the subgroup with severe erectile dysfunction (low‐intensity extracorporeal shockwave therapy International Index of Erectile Function‐ED domain improvement: 10.1 ± 4.1 vs sham therapy International Index of Erectile Function‐ED domain improvement: 3.2 ± 3.3; P = 0.003).

Conclusion

The present trial shows the tolerability and clinical efficacy of low‐intensity extracorporeal shockwave therapy in a subgroup of patients with erectile dysfunction.
Laboratory tests to identify patients at risk of early major adverse events: a prospective pilot study
Authors: Kaufman M. , Bebee B. , Bailey J. , Robbins R. , Hart G. K. , Bellomo R.
Published: June 2014

Background/Aims

To test whether commonly measured laboratory variables can identify surgical patients at risk of major adverse events (death, unplanned intensive care unit (ICU) admission or rapid response team (RRT) activation).

Methods

We conducted a prospective observational study in a surgical ward of a university‐affiliated hospital in a cohort of 834 surgical patients admitted for >24 h. We applied a previously validated multivariable model‐derived risk assessment to each combined set of common laboratory tests to identify patients at risk. We compared the clinical course of such patients with that of control patients from the same ward who had blood tests but were identified as low risk.

Results

We studied 7955 batches and 73 428 individual tests in 834 patients (males 55%; average age 65.8 ± 17.6 years). Among these patients, 66 (7.9%) were identified as ‘high risk’. High‐risk patients were older (75.9 vs 61.8 years of age; P < 0.0001), had much greater early (48 h) mortality (6/66 (9%) vs 4/768 (0.5%); P < 0.0001) and greater overall hospital mortality (11/66 (16.7%) vs 9/768 (1.2%); P < 0.0001). They also had more early (8/66 (12.1%) vs 14/768 (1.8%); P = 0.0001) and overall in‐hospital unplanned ICU admissions (12/66 (18.2%) vs 18/768 (2.3%); P < 0.0001) and more early (26/66 (39.3%) vs 50/768 (6.5%); P < 0.0001) and overall in‐hospital RRT calls (26/66 (39.4%) vs 55/768 (7.2%); P < 0.0001).

Conclusions

Commonly performed laboratory tests identify surgical ward patients at risk of early major adverse events. Further studies are needed to assess whether such identification system can be used to trigger interventions that help improve patient outcomes.
The Goals of Patient Care project: implementing a proactive approach to patient‐centred decision‐making
Authors: Brimblecombe C. , Crosbie D. , Lim W. K. , Hayes B.
Published: June 2014

Background

Patients in the later stages of their lives risk being harmed by futile or unwanted interventions if realistic care goals and patient values are not recognised. Doctors have difficulty discussing and informing patients' healthcare goals.

Aims

To review implementation of a Goals of Patient Care (GOPC) summary in medical inpatients and its applicability in emergency medical response (EMR) situations.

Methods

Single‐centre cross‐sectional study of adult medical inpatients and adult inpatients requiring EMR at a Victorian general hospital. Measures: presence and content of GOPC summary, secondary review of decision‐making and discussion documentation, patient characteristics; EMR precipitants and outcomes.

Results

GOPC were documented for 82 of 101 patients. One had an existing advance directive, and six had records of a patient‐appointed substitute decision‐maker. For patients with GOPC, 80 had life‐prolonging treatment aims, with a varying degree of treatment limitation in 48. Discussion with patient or substitute decision‐maker was evident in 43 cases. GOPC were documented prior to nine of 23 EMR. The EMR triggered a GOPC modification in three instances.

Conclusions

Introduction of a routine GOPC summary encourages consideration of goals of care for most medical inpatients. Few have pre‐existing records of their wishes, and there are opportunities for improvement in this regard. Doctors may still have difficulty determining goals of care, and discussion of GOPC with patients and families may not be clearly documented. Most patients requiring EMR do not have prior GOPC review, and the role of the summary in these situations remains unclear.
Relationship Networks and Earnings Informativeness: Evidence from Corruption Cases
Authors: Fan Joseph P.H. , Guan Feng , Li Zengquan , Yang Yong George
Published: June 2014

The measurement difficulties arising from relationship‐based business transactions can result in accounting opacity. We test this hypothesis by exploiting a natural experiment. Using a sample of firms that were networked with 45 high‐level Chinese bureaucrats involved in corruption scandals between 1996 and 2007, we examine the patterns in the earnings informativeness of these firms before and after the exogenous break of the networks. We predict that the costs and benefits of business‐politics relationships, which are not measurable by the current accounting systems, diminish the ability of accounting earnings to track a firm's economic performance. In turn, a break in a political relationship due to anti‐corruption enforcement reduces the measurement noise and improves the earnings informativeness. We find that, relative to the matched control firms, there is indeed a significant increase in the earnings informativeness of the networked firms following the public exposure of a scandal. Robustness tests fail to show that the documented improvement in the earnings informativeness is primarily due to systematic changes in the firms’ earnings management behavior or disclosure policies.
Waiting list randomized controlled trial within a case‐finding design: methodological considerations
Authors: Ronaldson Sarah , Adamson Joy , Dyson Lisa , Torgerson David
Published: June 2014

Rationale, aims and objectives

Randomized controlled trials (RCTs) are widely used in health care research to provide high‐quality evidence of effectiveness of an intervention. However, sometimes a study does not require an RCT in order to answer its primary objective; a case‐finding design may be more appropriate. The aim of this paper was to introduce a new study design that nests a waiting list RCT within a case‐finding study.

Methods

An example of the new study design is the DOC Study, which primarily aims to determine the diagnostic accuracy of lung function tests for chronic obstructive pulmonary disease. It also investigates the impact of lung function tests on smoking behaviour through use of a waiting list design. The first step of the study design is to obtain participants' consent. Individuals are then randomized to one of two groups; either the ‘intervention now’ group or the ‘intervention later’ group, that is, participants are placed on a waiting list. All participants receive the same intervention; the only difference between the groups is the timing of the intervention.

Results and conclusions

The design addresses patient preference issues and recruitment issues that can arise in other trial designs. Potential limitations include differential attrition between study groups and potential demoralization for the ‘intervention later’ group. The ‘waiting list case‐finding trial’ design is a valuable method that could be applied to case‐finding studies; the design enables the case‐finding component of a study to be maintained while simultaneously exploring additional hypotheses through conducting a trial.
The P450‐type carotene hydroxylase PuCHY1 from Porphyra suggests the evolution of carotenoid metabolism in red algae
Authors: Yang Li‐En , Huang Xing‐Qi , Hang Yu , Deng Yin‐Yin , Lu Qin‐Qin , Lu Shan
Published: June 2014

Carotene hydroxylases catalyze the hydroxylation of α‐ and β‐carotene hydrocarbons into xanthophylls. In red algae, β‐carotene is a ubiquitously distributed carotenoid, and hydroxylated carotenoids such as zeaxanthin and lutein are also found. However, no enzyme with carotene hydroxylase activity had been previously identified in red algae. Here, we report the isolation of a gene encoding a cytochrome P450‐type carotene hydroxylase (PuCHY1) from Porphyra umbilicalis, a red alga with an ancient origin. Sequence comparisons found PuCHY1 belongs to the CYP97B subfamily, which has members from different photosynthetic organisms ranging from red algae to land plants. Functional complementation in Escherichia coli suggested that PuCHY1 catalyzed the conversion from β‐carotene to zeaxanthin. When we overexpressed PuCHY1 in the Arabidopsis thaliana chy2 mutant, pigment analysis showed a significant accumulation of hydroxylated carotenoids, including neoxanthin, violaxanthin, and lutein in the leaves of transgenic plants. These results confirmed a β‐hydroxylation activity of PuCHY1, and also suggested a possible ϵ‐hydroxylation function. The pigment profile and gene expression analyses of the algal thallus under high‐light stress suggested that P. umbilicalis is unlikely to operate a partial xanthophyll cycle for photoprotection.
Biological applications of cryo‐soft X‐ray tomography
Authors: DUKE E. , DENT K. , RAZI M. , COLLINSON L. M.
Published: June 2014

X‐rays are used for imaging many different types of biological specimen, ranging from live organisms to the individual cells and proteins from which they are made. The level of detail achieved as a result of the imaging varies depending on both the sample and the technique used. One of the most recent technical developments in X‐ray imaging is that of the soft X‐ray microscope, designed to allow the internal structure of individual biological cells to be explored. With a field of view of ∼10–20 × ∼10–20 μm, a penetration depth of ∼10 μm and a resolution of ∼40 nm3, the soft X‐ray microscope neatly fits between the imaging capabilities of light and electron microscopes.
Reversed scan direction reduces electron beam damage in EBSD maps
Authors: KIDDER S. , PRIOR D.
Published: June 2014

The deleterious effects of electron beam damage on high‐resolution electron backscatter diffraction (EBSD) maps of undeformed quartz are significantly reduced by scanning in the direction opposite to that dictated by widely used EBSD acquisition software. Higher quality electron backscatter patterns are produced when the electron beam moves progressively down the sample (the apparent ‘up’ direction in the resulting maps) for all step sizes where beam damage affects EBSD map quality (≤ ∼0.4 μm in this study). The relative improvement associated with downward scanning increases as step size is reduced. A comparison of high‐resolution maps made in experimentally deformed quartz demonstrates that downward scanning reduces by a factor of ∼2 the lower limit in step size relative to maps scanned in the conventional direction. The electron beam damages quartz at its point of entry, forming ∼0.1‐μm diameter bumps visible in Scanning electron microscope (SEM) images. Downward scanning produces better results because it minimizes the flux of electrons through these loci of damaged crystal.
The impact of a ‘Critical Moments’ workshop on undergraduate nursing students’ attitudes to caring for patients at the end of life: an evaluation
Authors: Bailey Cara , Hewison Alistair
Published: June 2014

Aims and objectives

To evaluate the impact of an educational workshop on nursing students’ attitudes to caring for dying patients.

Background

The quality of end‐of‐life care education provided in preregistration nursing programmes has been criticised. The lack of attention to the emotional content results in nursing students feeling ill‐prepared to care for the dying and bereaved. This article reports the findings of a study conducted to evaluate the impact of an educational workshop on undergraduate nursing students’ attitudes to caring for patients at the end of life.

Design

A pre‐ and postintervention survey was used to determine nursing students’ attitudes and feelings concerning end‐of‐life care prior to and following their involvement in an educational workshop.

Methods

Third‐year undergraduate nursing students completed two questionnaires incorporating the Frommelt Attitude Toward Care of the Dying Scale, before and after attending a ‘Critical Moments’ workshop.

Results

The data revealed a statistically significant increase in positive attitudes to end‐of‐life care amongst the respondents. Free text responses confirmed the development of positive attitudes and indicated that the workshop was regarded as a valuable learning opportunity.

Conclusions

Workshops that use case studies based on ‘real‐life’ episodes of end‐of‐life care can provide an effective learning opportunity that significantly improves the attitudes of nursing students to caring for the dying.

Relevance to clinical practice

Identifying emotional labour is an important stage in the development of emotionally intelligent nurses. It may reduce the risk of occupational stress, burnout and potential withdrawal from nursing practice in the longer term. Timing, expert facilitation and peer support are important considerations for an educational workshop that aims to enable nurses to remain healthy whilst delivering high‐quality care to patients and their relatives near the end of life.
Prophecy and Progress: Christianity and Dissent in Modern America
Authors: Rossinow Doug
Published: June 2014

The categories of left and right, and the standard interpretive alignments of progressive Christianity with postmillennialism and of right‐wing Protestantism with premillennialist fatalism in US historiography, are far from adequate. Prophetic politics, calling contemporary society to account for its ungodly ways, was widely dispersed among modern American Christians along the whole political spectrum. Moreover, there were many prophetic postmillennialists, who denounced society's iniquity while working to realize God's Kingdom, and there were reform premillennialists, who lamented a fallen world even as, paradoxically, they worked to make it more godly and less satanic.
Long‐term use of occlusal appliance has impact on sleep structure
Authors: Sjoholm T. , Kauko T. , Kemppainen P. , Rauhala E.
Published: June 2014

Acrylic occlusal appliances (OAs) have been used for temporomandibular disorders and sleep bruxism, but the effects of the treatment are still insufficiently evaluated. Two all‐night polysomnographic recordings were made in a sleep laboratory on 14 bruxists (9 females and 5 males with mean age of 27·5 years). The measurement included basic polysomnography with additional masseter muscle electromyogram and movement recording (static charge‐sensitive bed method) using randomisation. The base night recording was followed by the second study night after 8 weeks regular use of OA. The OA was made on the occlusal surface of the teeth of the upper jaw, and it was used at night time during the study period. With the OA, rapid eye movement sleep changed from 23·3% to 19·6% (P = 0·078), and slow wave sleep increased significantly from 10·2% to 14·7% (P = 0·039). Masseter contraction (MC) episodes occurred with similar frequency (9·7 vs. 10·5 episodes per hour, P = 0·272). The intensity of the rhythmic MC bursts within an episode decreased from 5·5 to 4·4 (P = 0·027). The groups were post hoc divided into responders and non‐responders using a 20% change in MC episode per hour as a cut‐off point. The results indicated that 43% of bruxists increased activity (negative responders), while 36% decreased (positive responders), and in 21%, there was no change in the level. It is concluded that OA does not have significant feedback inhibition on masseter muscle motor activity during sleep. However, OA may increase slow wave sleep.
Injury risk among children in motor vehicle crashes: Older versus younger drivers
Authors: Bromfield Samantha G , McGwin Gerald
Published: June 2014

Aim

To explore the relationship between injury risk among child occupants involved in motor vehicle collisions according to the age of the vehicle driver.

Methods

The National Automotive Sampling System Crashworthiness Data System 2000–2009 (n = 10 797) was used to identify demographic, vehicle‐, collision‐ and injury‐related characteristics among motor vehicle collision occupants ≤15 years of age. The association between the age of the driver (older vs. younger, defined as individuals <50 years of age vs. individuals ≥50 years of age, respectively) and injury occurrence was estimated using logistic regression adjusting for the potentially confounding effect of occupant, vehicle and collision characteristics.

Results

Of the child occupants in motor vehicle collisions, 2.9% were driving with an older driver, and approximately 2.9% were injured while driving with a younger driver (odds ratio 1.03; 95% confidence interval 0.55–1.91). After adjusting for child occupant age, gender, restraint use, seat position and vehicle type, there remained no significant association between the age of the driver (older vs. younger) and the risk of injury (odds ratio 0.92; 95% confidence interval 0.49–1.74).

Conclusions

These findings add to the body of literature indicating no difference in injury risk found among children when considering the age of the driver. Research is needed to ascertain the association and further evaluate characteristics more specific to the relationship being explored in this study.
Adolescent chronic fatigue syndrome and somatoform disorders: A prospective clinical study
Authors: Klineberg Emily , Rushworth Alexandra , Bibby Helen , Bennett David , Steinbeck Kate , Towns Susan
Published: June 2014

Aim

To examine and compare the presenting characteristics and the change in the physical and psychosocial functioning of adolescents with chronic fatigue syndrome (CFS) or somatoform disorders who have received an adaptable multidisciplinary intervention over a 12‐month period.

Methods

Fifty adolescents presenting to theComplexAdolescentClinic at TheChildren'sHospital atWestmead,Sydney,Australia were assessed. Their physical and psychosocial functioning was rated by the adolescents and their parents using theChildHealthQuestionnaire. Participants were assessed at baseline, 4 months and 12 months after initiating treatment. Analyses examined whether diagnosis and/or illness precipitants were related to treatment outcome.

Results

Adolescents with bothCFSand somatoform disorders demonstrated improvement in physical and psychosocial functioning over the first 4 months of treatment, sustained at 12‐month follow‐up. A diagnosis ofCFSwas associated with poorer physical functioning over time and a trend towards a longer illness time course compared with somatoform disorder. Adjustment for a physical precipitant reduced the association between diagnosis and physical functioning. Those who had a physical precipitant to their illness had significantly poorer physical functioning over time than those who did not, regardless of diagnostic category. Diagnosis and physical precipitant were not associated with psychosocial functioning.

Conclusions

Improvement in adolescent physical and psychosocial functioning over time suggests that a multidisciplinary treatment model may be effective for varied complex medico‐psychosocial presentations, irrespective of diagnosis and illness precipitant. Illness precipitant may have a greater influence on treatment outcome than diagnostic category.
Ultraviolet radiation exposure and serum vitamin D levels in young children
Authors: Ramankutty Padmaja , de Klerk Nicholas H , Miller Margaret , Fenech Michael , O'Callaghan Nathan , Armstrong Bruce K , Milne Elizabeth
Published: June 2014

Aim

Health benefits of adequate vitamin D levels in the blood include better bone health and a reduced incidence of a range of chronic diseases and infections. Ultraviolet (UV) radiation exposure from the sun is the main source of vitamin D; however, such exposure, especially from a young age, is also a potential risk factor for skin cancer. The current study examined the association of UV exposure with vitamin D production in young children to determine the period of weekly exposure prior to blood testing that affected serum 25‐hydroxyvitamin D (25(OH)D) levels.

Methods

Between 2009 and 2011, healthy children aged 3, 6 and 9 years were recruited from the community for a cross‐sectional study of nutritional factors and DNA damage. Parents of 464 children provided information on the children's average weekly sun exposure and level of sun protection during each of the 16 weeks before blood sample collection by a domiciliary phlebotomist.

Results

Serum 25(OH)D levels were best predicted from UV exposure during the week before blood collection for samples drawn in autumn, summer or spring. For samples drawn in winter, serum 25(OH)D levels were best predicted by UV exposure during the 2 weeks before blood collection.

Conclusions

Consistent weekly sun exposure may be beneficial for young children, especially in winter, to maintain healthy vitamin D levels in the blood. However, confirmation of these results is needed before their public health significance can be fully evaluated.
Epigenetic variation reflects dynamic habitat conditions in a rare floodplain herb
Authors: Schulz Benjamin , Eckstein Rolf Lutz , Durka Walter
Published: June 2014

Variation of DNA methylation is thought to play an important role for rapid adjustments of plant populations to dynamic environmental conditions, thus compensating for the relatively slow response time of genetic adaptations. However, genetic and epigenetic variation of wild plant populations has not yet been directly compared in fast changing environments. Here, we surveyed populations of Viola elatior from two adjacent habitat types along a successional gradient characterized by strong differences in light availability. Using amplified fragment length polymorphisms (AFLP) and methylation‐sensitive amplification polymorphisms (MSAP) analyses, we found relatively low levels of genetic (H′gen = 0.19) and epigenetic (H′epi = 0.23) diversity and high genetic (ϕST = 0.72) and epigenetic (ϕST = 0.51) population differentiation. Diversity and differentiation were significantly correlated, suggesting that epigenetic variation partly depends on the same driving forces as genetic variation. Correlation‐based genome scans detected comparable levels of genetic (17.0%) and epigenetic (14.2%) outlier markers associated with site specific light availability. However, as revealed by separate differentiation‐based genome scans for AFLP, only few genetic markers seemed to be actually under positive selection (0–4.5%). Moreover, principal coordinates analyses and Mantel tests showed that overall epigenetic variation was more closely related to habitat conditions, indicating that environmentally induced methylation changes may lead to convergence of populations experiencing similar habitat conditions and thus may play a major role for the transient and/or heritable adjustment to changing environments. Additionally, using a new MSAP‐scoring approach, we found that mainly the unmethylated (ϕST = 0.60) and CG‐methylated states (ϕST = 0.46) of epiloci contributed to population differentiation and putative habitat‐related adaptation, whereas CHG‐hemimethylated states (ϕST = 0.21) only played a marginal role.
Adaptor bypass mutations of Bacillus subtilis spx suggest a mechanism for YjbH‐enhanced proteolysis of the regulator Spx by ClpXP
Authors: Chan Chio Mui , Hahn Erik , Zuber Peter
Published: June 2014

The global regulator, Spx, is under proteolytic control exerted by the adaptor YjbH and ATP‐dependent protease ClpXP in Bacillus subtilis. While YjbH is observed to bind the Spx C‐terminus, YjbH shows little affinity for ClpXP, indicating adaptor activity that does not operate by tethering. Chimeric proteins derived from B. subtilis AbrB and the Spx C‐terminus showed that a 28‐residue C‐terminal section of Spx (AbrB28), but not the last 12 or 16 residues (AbrB12, AbrB16), was required for YjbH interaction and for ClpXP proteolysis, although the rate of AbrB28 proteolysis was not affected by YjbH addition. The result suggested that the YjbH‐targeted 28 residue segment of the Spx C‐terminus bears a ClpXP‐recognition element(s) that is hidden in the intact Spx protein. Residue substitutions in the conserved helix α6 of the C‐terminal region generated Spx substrates that were degraded by ClpXP at accelerated rates compared to wild‐type Spx, and showed reduced dependency on the YjbH activity. The residue substitutions also weakened the interaction between Spx and YjbH. The results suggest a model in which YjbH, through interaction with residues of helix α6, exposes the C‐terminus of Spx for recognition and proteolysis by ClpXP.
Treatment and outcomes of invasive fusariosis: review of 65 cases from the PATH Alliance® registry
Authors: Horn David L. , Freifeld Alison G. , Schuster Mindy G. , Azie Nkechi E. , Franks Billy , Kauffman Carol A.
Published: June 2014

Invasive Fusarium infections occur in immunosuppressed patients, especially those with haematological malignancies. We conducted a descriptive analysis of data from patients with invasive fusariosis identified in the Prospective Antifungal Therapy Alliance registry, which collected data on invasive fungal infections in the United States and Canada from 2004 to 2008. In this series of 65 patients with proven (83.1%) and probable (16.9%) invasive fusariosis, the most common underlying condition was haematological malignancy, in which neutropenia and corticosteroid usage frequently occurred. Seven patients with invasive Fusarium infections had cross‐reactive galactomannan assay results. The survival rate for all patients at 90 days was 44%, which was an improvement compared with historical data. Disseminated disease occurred frequently (35.4%), and patients with and without disseminated disease had survival rates of 33% and 50%, respectively. Posaconazole and voriconazole were the most frequently employed therapies and may be linked to the improved survival rate observed in this patient series. In summary, patients with invasive Fusarium infections continue to have high fatality rates, especially those with disseminated disease. Fusarium infections should be strongly considered in the absence of Aspergillus isolation in patients at high risk of mould infections with positive galactomannan assay test results.
Cross‐species outlier detection reveals different evolutionary pressures between sister species
Authors: Cullingham Catherine I. , Cooke Janice E. K. , Coltman David W.
Published: June 2014

Lodgepole pine (Pinus contorta var. latifolia) and jack pine (Pinus banksiana) hybridize in western Canada, an area of recent mountain pine beetle range expansion. Given the heterogeneity of the environment, and indications of local adaptation, there are many unknowns regarding the response of these forests to future outbreaks. To better understand this we aim to identify genetic regions that have adaptive potential.

We used data collected on 472 single nucleotide polymorphism (SNP) loci from 576 tree samples collected across 13 lodgepole pine‐dominated sites and four jack pine‐dominated sites. We looked at the relationship of genetic diversity with the environment, and we identified candidate loci using both frequency‐based (arlequin and bayescan) and correlation‐based (matsam and bayenv) methods.

We found contrasting relationships between environmental variation and genetic diversity for the species. While we identified a number of candidate outliers (34 in lodgepole pine, 25 in jack pine, and 43 interspecific loci), we did not find any loci in common between lodgepole and jack pine. Many of the outlier loci identified were correlated with environmental variation.

Using rigorous criteria we have been able to identify potential outlier SNPs. We have also found evidence of contrasting environmental adaptations between lodgepole and jack pine which could have implications for beetle spread risk.
Plasticity in sunflower leaf and cell growth under high salinity
Authors: Céccoli G. , Bustos D. , Ortega L. I. , Senn M. E. , Vegetti A. , Taleisnik E.
Published: June 2014

A group of sunflower lines that exhibit a range of leaf Na+ concentrations under high salinity was used to explore whether the responses to the osmotic and ionic components of salinity can be distinguished in leaf expansion kinetics analysis. It was expected that at the initial stages of the salt treatment, leaf expansion kinetics changes would be dominated by responses to the osmotic component of salinity, and that later on, ion inclusion would impose further kinetics changes. It was also expected that differential leaf Na+ accumulation would be reflected in specific changes in cell division and expansion rates. Plants of four sunflower lines were gradually treated with a relatively high (130 mm NaCl) salt treatment. Leaf expansion kinetics curves were compared in leaves that were formed before, during and after the initiation of the salt treatment. Leaf areas were smaller in salt‐treated plants, but the analysis of growth curves did not reveal differences that could be attributed to differential Na+ accumulation, since similar changes in leaf expansion kinetics were observed in lines with different magnitudes of salt accumulation. Nevertheless, in a high leaf Na+‐including line, cell divisions were affected earlier, resulting in leaves with proportionally fewer cells than in a Na+‐excluding line. A distinct change in leaf epidermal pavement shape caused by salinity is reported for the first time. Mature pavement cells in leaves of control plants exhibited typical lobed, jigsaw‐puzzle shape, whereas in treated plants, they tended to retain closer‐to‐circular shapes and a lower number of lobes.