bluuebunny/crossref_metadata_2025 huggingface dataset:
Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study
Authors: Lea Emma J , Goldberg Lynette R , Price Andrea D , Tierney Laura T , McInerney Fran
Published: September 2017

Aims and objectives

To examine awareness of aged care home staff regarding daily food and fluid care needs of older people with dementia.

Background

Older people in residential care frequently are malnourished, and many have dementia. Staff knowledge of the food and fluid needs of people with dementia is limited. Qualitative research on this topic is scarce but can provide insight into how nutrition and hydration care may be improved.

Design

Qualitative, interview‐based study.

Methods

Eleven staff in a range of positions at one care home were interviewed regarding their perceptions of current and potential food/fluid care practices. Transcripts were coded and analysed thematically.

Results

Key food and fluid issues reported by these staff members were weight loss and malnutrition, chewing and swallowing difficulties (dysphagia), and inadequate hydration. Staff identified a number of current care practices that they felt to be effective in facilitating older people's food and fluid intake, including responsiveness to their needs. Staff suggestions to facilitate food and fluid intake centred on improved composition and timing of meals, enhanced physical and social eating environment, and increased hydration opportunities. Staff commented on factors that may prevent changes to care practices, particularly the part‐time workforce, and proposed changes to overcome such barriers.

Conclusions

Staff were aware of key food and fluid issues experienced by the older people in their care and of a range of beneficial care practices, but lacked knowledge of many promising care practices and/or how to implement such practices.

Relevance to clinical practice

Staff need to be supported to build on their existing knowledge around effective food and fluid care practices. The numerous ideas staff expressed for changing care practices can be leveraged by facilitating staff networking to work and learn together to implement evidence‐based change.
Person‐centred discharge education following coronary artery bypass graft: A critical review
Authors: Rushton Melanie , Howarth Michelle , Grant Maria J , Astin Felicity
Published: September 2017

Aims and objectives

To examine the extent that individualised education helps reduce depression and anxiety and improves self‐care for people who have undergone coronary artery bypass graft surgery.

Background

Individualised discharge planning is increasingly important following cardiac surgery due to recurrent admissions as well as the issue of anxiety and depression, often due to lack of preparation. The hospital to home transition is fundamental in the recovery process. Individualised education and person‐centred care ensure that patients’ educational needs are met. This empowers patients, increasing self‐efficacy or confidence, resulting in autonomy, a smoother discharge process and avoiding postdischarge problems and rehospitalisation.

Design

A critical review of published peer‐reviewed literature was conducted.

Methods

Electronic databases searched included MEDLINE, CINAHL, the Cochrane Library and PsychInfo 2009–2015.

Results

Eight articles were identified for review, and a Critical Appraisal Skills Programme framework was used to determine the quality of the papers, all of the papers focussed on coronary artery bypass graft. The designs were typically experimental or quasi‐experimental with two reviews.

Conclusion

A greater understanding of the patients’ needs allows tailored education to be provided, which promotes self‐care management. This level of patient empowerment increases confidence and ultimately minimise anxiety and depression. Despite the varying teaching and learning methods associated with individualised education, patient‐centred education has the potential to assist cardiac nurses in adequately preparing patients for discharge following their coronary artery bypass graft.

Relevance to clinical practice

Development of individualised education programmes is crucial in preparing patients for discharge. The reduction in readmission to hospital has a significant effect on already stretched resources, and the reduction in postoperative complications during the recovery period linked with depression and anxiety will have a positive effect on the individuals’ ability to self‐care, health and well‐being.
A Radically Orthodox Reformer: J. G. Hamann as a Metacritic of Enlightenment and Secularization
Authors: Betz John
Published: September 2017

The purpose of this article is to shed light on the mysterious figure of J. G. Hamann and to distill his chief contributions to modern theology. To this end it begins with the puzzling question of his style, which, far from being incidental, leads directly into the core concerns of his authorship. Subsequent sections examine his theological aesthetics, which was appropriated by Hans Urs von Balthasar, and his metacritique of secular reason, which has been appropriated in the English‐speaking world most notably by John Milbank and theologians associated with Radical Orthodoxy. It concludes with a brief portrait of Hamann as an ecumenical sign for the times.
Host‐induced gene silencing of an important pathogenicity factor PsCPK1 in Puccinia striiformis f. sp. tritici enhances resistance of wheat to stripe rust
Authors: Qi Tuo , Zhu Xiaoguo , Tan Chenlong , Liu Peng , Guo Jia , Kang Zhensheng , Guo Jun
Published: September 2017

Rust fungi are devastating plant pathogens and cause a large economic impact on wheat production worldwide. To overcome this rapid loss of resistance in varieties, we generated stable transgenic wheat plants expressing short interfering RNAs (siRNAs) targeting potentially vital genes of Puccinia striiformis f. sp. tritici (Pst). Protein kinase A (PKA) has been proved to play important roles in regulating the virulence of phytopathogenic fungi. PsCPK1, a PKA catalytic subunit gene from Pst, is highly induced at the early infection stage of Pst. The instantaneous silencing of PsCPK1 by barley stripe mosaic virus (BSMV)‐mediated host‐induced gene silencing (HIGS) results in a significant reduction in the length of infection hyphae and disease phenotype. These results indicate that PsCPK1 is an important pathogenicity factor by regulating Pst growth and development. Two transgenic lines expressing the RNA interference (RNAi) construct in a normally susceptible wheat cultivar displayed high levels of stable and consistent resistance to Pst throughout the T3 to T4 generations. The presence of the interfering RNAs in transgenic wheat plants was confirmed by northern blotting, and these RNAs were found to efficiently down‐regulate PsCPK1 expression in wheat. This study addresses important aspects for the development of fungal‐derived resistance through the expression of silencing constructs in host plants as a powerful strategy to control cereal rust diseases.
Solvothermal Synthesis of Cs0.33WO3/LDHs Composite as a Novel Visible‐Light‐Driven Photocatalyst
Authors: Zhang Dan , Ji Taotao , Yu Jingang , Jiang Xinyu , Jiao Feipeng
Published: September 2017

A novel Cs0.33WO3/LDHs (CWLDH) composite was synthesized by simple two steps solvothermal method and first investigated as the photocatalyst for tetracycline (TC) and Congo red (CR) degradation under visible light irradiation. The CWLDH heterostructures catalysts were characterized by XRD, UV–Vis, SEM, XPS and BET. The composite CWLDH showed enhanced photocatalytic activity compared with pure Cs0.33WO3 and NiAl‐LDH under identical experimental conditions. The enhanced photocatalytic activity was mainly attributed to the higher visible light‐absorbing ability, efficient electron–hole separation and prolonged lifetimes of photogenerated charges. The photocatalyst presented a high photocatalytic activity (92%) at the optimum of CWLDH‐3 and initial TC concentration of 40 mg L−1. Besides, the degradation efficiency of TC is higher than 75% for reused CWLDH after four cycles, demonstrating that it could be used as a potential catalyst with good photocatalytic activity, stability and reusability. According to the experimental results, a possible photocatalytic mechanism of CWLDH was discussed.
Dynamic Patient Scheduling for Multi‐Appointment Health Care Programs
Authors: Diamant Adam , Milner Joseph , Quereshy Fayez
Published: September 2017

We investigate the scheduling practices of a multidisciplinary, multistage, outpatient health care program. Patients undergo a series of assessments before being eligible for elective surgery. Such systems often suffer from high rates of attrition and appointment no‐shows leading to capacity underutilization and treatment delays. We propose a new scheduling model where the clinic assigns patients to an appointment day but postpones the decision of which assessments patients undergo pending the observation of who arrives. In doing so, the clinic gains flexibility to improve system performance. We formulate the scheduling problem as a Markov decision process and use approximate dynamic programming to solve it. We apply our approach to a dataset collected from a bariatric surgery program at a large tertiary hospital in Toronto, Canada. We examine the quality of our solutions via structural results and compare them with heuristic scheduling practices using a discrete‐event simulation. By allowing multiple assessments, delaying their scheduling, and by optimizing over an appointment book, we show significant improvements in patient throughput, clinic profit, use of overtime, and staff utilization.
Outcomes of Gallstone Disease during Pregnancy: a Population‐based Data Linkage Study
Authors: Ibiebele Ibinabo , Schnitzler Margaret , Nippita Tanya , Ford Jane B.
Published: September 2017

Background

Gallstone disease is a leading indication for non‐obstetric abdominal surgery during pregnancy. There are limited whole population data on maternal and neonatal outcomes. This population‐based study aims to describe the outcomes of gallstone disease during pregnancy in an Australian setting.

Methods

Linked hospital, birth, and mortality data for all women with singleton pregnancies in New South Wales, Australia, 2001–2012 were analysed. Exposure of interest was gallstone disease (acute biliary pancreatitis, gallstones with/without cholecystitis). Outcomes including preterm birth (spontaneous and planned), readmission, morbidity and mortality (maternal and neonatal) were compared between pregnancies with and without gallstone disease. Adjusted risk ratios (aRRs) and 99% confidence intervals were estimated using modified Poisson regression and adjusted for maternal and pregnancy factors.

Results

Among 1 064 089 pregnancies, 1882 (0.18%) had gallstone disease. Of these, 239 (12.7%) had an antepartum cholecystectomy and 1643 (87.3%) were managed conservatively. Of those managed conservatively, 319 (19.0%) had a postpartum cholecystectomy. Gallstone disease was associated with increased risk of preterm birth (aRR 1.3, 99% CI 1.1, 1.6), particularly planned preterm birth (aRR 1.6, 99% CI 1.2, 2.1), maternal morbidity (aRR 1.6, 99% CI 1.1, 2.3), maternal readmission (aRR 4.7, 99% CI 4.2, 5.3), and neonatal morbidity (aRR 1.4, 99% CI 1.1, 1.7). Surgery was associated with decreased risk of maternal readmission (aRR 0.4, 99% CI 0.2, 0.7).

Conclusions

Gallstone disease during pregnancy was associated with adverse maternal and neonatal outcomes. Most women with gallstone disease during pregnancy are managed conservatively. Surgical management was associated with decreased risk of readmission.
Convergence of fMRI and ERP measures of emotional face processing in combat‐exposed U. S. military veterans
Authors: MacNamara Annmarie , Rabinak Christine A. , Kennedy Amy E. , Phan K. Luan
Published: September 2017

The late positive potential (LPP) and fMRI blood‐oxygen‐level dependent (BOLD) activity can provide complementary measures of the processing of affective and social stimuli. Separate lines of research using these measures have often employed the same stimuli, paradigms, and samples; however, there remains relatively little understanding of the way in which individual differences in one of these measures relates to the other, and all prior research has been conducted in psychiatrically healthy samples and using emotional scenes (not faces). Here, 32 combat‐exposed U. S. military veterans with varying levels of posttraumatic stress symptomatology viewed affective social stimuli (angry, fearful, and happy faces) and geometric shapes during separate EEG and fMRI BOLD recordings. Temporospatial principal component analysis was used to quantify the face‐elicited LPP in a data‐driven manner, prior to conducting whole‐brain correlations between resulting positivities and fMRI BOLD elicited by faces. Participants with larger positivities to fearful faces (> shapes) showed increased activation in the amygdala; larger positivities to angry and happy faces (> shapes) were associated with increased BOLD activation in the posterior fusiform gyrus and inferior temporal gyrus, respectively. Across all face types, larger positivities were associated with increased activation in the fusiform “face” area. Correlations using mean area amplitude LPPs showed an association with increased activation in the anterior insula for angry faces (> shapes). LPP‐BOLD associations were not moderated by PTSD. Findings provide the first evidence of correspondence between face‐elicited LPP and BOLD activation across a range of (normal to disordered) psychiatric health.
Startle reflex modulation during threat of shock and “threat” of reward
Authors: Bradley Margaret M. , Zlatar Zvinka Z. , Lang Peter J.
Published: September 2017

During threat of shock, the startle reflex is potentiated, suggesting modulation by defensive mobilization. To determine whether startle potentiation is specific to aversive anticipation, startle reflexes were measured in the context of either aversive or appetitive anticipation in a between‐subject study. Participants wore a device on the wrist that could deliver electrical shock (n = 49), or vibrotactile stimulation indicating monetary reward (n = 48). Cues signaling “threat” or “safe” periods were presented alone, or accompanied by presentation of affective and neutral pictures on half of the trials. Results indicated that the startle reflex was significantly potentiated when anticipating either shock or reward, compared to safe periods, both when no picture was presented, as well as during picture viewing. The difference between threat and safety in both reflex magnitude and skin conductance changes was larger for those anticipating shock, suggesting that the aversive context was more motivationally engaging. The pattern of reflex modulation as a function of picture valence varied under threat and safety, but was identical in the shock and reward groups, consistent with a hypothesis that anticipation of either aversive or appetitive events prompts heightened perceptual vigilance, potentiating the acoustic startle reflex.
Influence of nutrient management on growth and nutrient use efficiency of two plant species for mineland revegetation
Authors: Carvalho João M. , Ramos Silvio J. , Furtini Neto Antonio E. , Gastauer Markus , Caldeira Cecilio F. , Siqueira José O. , Silva Maria L. S.
Published: September 2017

Rehabilitation of degraded areas by mining activities is necessary to achieve sustainable mining. For an effective revegetation, the understanding of plant growth and the nutrient requirements of native plant species, especially those with the potential to be used in the rehabilitation of mined areas such as waste piles or mine pits, is indispensable. In this study, we evaluated the growth performance, nutrient levels, and nutrient use efficiency of an endemic plant (Mimosa acutistipula var. ferrea) and ruderal shrub (Solanum crinitum) that are both found in ferriferous savannas, locally called “canga” in Carajás Mineral Province, Brazil. An experiment was conducted under greenhouse conditions using samples of three different soils (oxisol, canga soil, and iron mining waste) without and with nutrient application; additionally, an omission trial was carried out in canga soils. Fertilization increased the growth of both plant species in all substrates. Macronutrient omission reduced the growth of plants stronger than micronutrient omission, indicating that the lack of N, P, and K may especially impact the rehabilitation of areas. The growth of S. crinitum was higher than M. acutistipula var. ferrea, highlighting its preponderance in mineland rehabilitation, although concerns regarding its role as a ruderal species persist. Therefore, further research is necessary for a risk assessment of the propagation of S. crinitum within mineland restoration projects.
Behavioral Modeling of Adversaries with Multiple Objectives in Counterterrorism
Authors: Mazicioglu Dogucan , Merrick Jason R. W.
Published: September 2017

Attacker/defender models have primarily assumed that each decisionmaker optimizes the cost of the damage inflicted and its economic repercussions from their own perspective. Two streams of recent research have sought to extend such models. One stream suggests that it is more realistic to consider attackers with multiple objectives, but this research has not included the adaption of the terrorist with multiple objectives to defender actions. The other stream builds off experimental studies that show that decisionmakers deviate from optimal rational behavior. In this article, we extend attacker/defender models to incorporate multiple objectives that a terrorist might consider in planning an attack. This includes the tradeoffs that a terrorist might consider and their adaption to defender actions. However, we must also consider experimental evidence of deviations from the rationality assumed in the commonly used expected utility model in determining such adaption. Thus, we model the attacker's behavior using multiattribute prospect theory to account for the attacker's multiple objectives and deviations from rationality. We evaluate our approach by considering an attacker with multiple objectives who wishes to smuggle radioactive material into the United States and a defender who has the option to implement a screening process to hinder the attacker. We discuss the problems with implementing such an approach, but argue that research in this area must continue to avoid misrepresenting terrorist behavior in determining optimal defensive actions.
The content of nurse unit managers’ work: a descriptive study using daily activity diaries
Authors: Sveinsdóttir Herdís , Blöndal Katrín , Jónsdóttir Heiður Hrund , Bragadóttir Helga
Published: September 2017

Background

NUMs’ job description in Icelandic hospitals has been revised and now also includes managerial and financial responsibilities.

Aim

To describe the actual work activities of nurse unit managers (NUMs) in surgical and internal medicine services as self‐documented and reflected in their job description.

Design

Prospective exploratory study.

Method

The study's setting was the largest hospital in Iceland. Data were collected over 7 days from NUMs working on surgical and medical units with an activity diary listing five domains and 41 activities: ‘management and planning’ (seven activities), ‘staff responsibility (seven activities), ‘direct clinical work’ (five activities), ‘service’ (12 activities) and ‘other’ (nine activities).

Results

The managers’ spent most of their time within the ‘other’ domain (32% of their time), then the next significant amount of time on ‘management and planning’ and ‘clinical nursing’ (19%), and the least amount of time on ‘service’ (14%). All reported working on two or more activities simultaneously. NUMs made erroneous estimations approximately half of the time about the domain they spent most of their time in and their satisfaction with their work each day varied greatly.

Conclusion

The work of NUMs is highly diverse, including undefined miscellaneous tasks and clinical work beyond their job description.
Prevalence and causes of musculoskeletal impairment in Fundong District, North‐West Cameroon: results of a population‐based survey
Authors: Smythe Tracey , Mactaggart Islay , Kuper Hannah , Oye Joseph , Sieyen Nana Christopher , Lavy Christopher , Polack Sarah
Published: September 2017

Objectives

Epidemiological data on musculoskeletal conditions such as degenerative joint diseases and bone fractures are lacking in low‐ and middle‐income countries. This survey aimed to estimate the prevalence and causes of musculoskeletal impairment in Fundong Health District, North‐West Cameroon.

Methods

Fifty‐one clusters of 80 people (all ages) were selected using probability proportionate to size sampling. Households within clusters were selected by compact segment sampling. Six screening questions were asked to identify participants likely to have a musculoskeletal impairment (MSI). Participants screening positive to any screening question underwent a standardised examination by a physiotherapist to assess presence, cause, diagnosis and severity of impairment.

Results

In total, 3567 of 4080 individuals enumerated for the survey were screened (87%). The all‐age prevalence of MSI was 11.6% (95% CI: 10.1–13.3). Prevalence increased with age, from 2.9% in children to 41.2% in adults 50 years and above. The majority of MSI cases (70.4%) were classified as mild, 27.2% as moderate and 2.4% as severe. Acquired non‐trauma comprised 67% of the diagnoses. The remainder included trauma (14%), neurological (11%), infection (5%) and congenital (3%). The most common individual diagnosis was degenerative joint disease (43%). Over one‐third (38%) of individuals with MSI had never received medical care or rehabilitation for their condition.

Conclusions

This survey contributes to the epidemiological data on MSI in low‐ and middle‐income countries. Nearly half of adults aged over 50 years had an MSI. There is a need to address the treatment and rehabilitative service gap for people with MSI in Cameroon.
Does globalisation affect the shadow economy?
Authors: Berdiev Aziz N. , Saunoris James W.
Published: September 2017

We investigate the impact of globalisation on the shadow economy using panel data for 119 countries. Our evidence suggests that globalisation matters in mitigating shadow development. More specifically, we find that political globalisation reduces the shadow economy, whereas economic and social globalisations have limited statistical support after controlling for important factors that affect the size of the shadow economy. Overall, these results are robust after accounting for an alternative measure of the shadow economy, outliers, endogeneity and alternative model specifications.
Comparisons between elastographic stiffness scores for benign versus malignant lymph nodes in dogs and cats
Authors: Seiler Gabriela S. , Griffith Emily
Published: September 2017

Lymph node evaluation is an important component of oncology staging in dogs and cats, however diagnosis of malignancy currently requires cytology or histopathology. Elastography is an ultrasound technique that allows estimation of tissue stiffness. In people, it has been shown to increase the sensitivity of sonography in detection of metastatic lymph nodes. The objective of this prospective, cross‐sectional study was to determine if elastographic stiffness differs for malignant versus benign canine and feline lymph nodes that were considered abnormal in gray‐scale ultrasound imaging. Animals scheduled for ultrasound‐guided fine needle aspirates of a lymph node at a single center were prospectively enrolled. Elastography was performed by a board‐certified veterinary radiologist (G.S.) prior to tissue sampling. Softness was scored qualitatively as 1–4 (1 = hard; 4 = soft) on an image depicted by a color scale (blue = hard, red = soft). Quantitative analysis was performed using custom‐made software. Fifty‐one lymph nodes were included in the evaluation, 21 had benign and 30 had neoplastic cytology. Benign lymph nodes were softer (median score of 2.5, range 1–4) than malignant lymph nodes (median = 2, range 1–3), and differences were significant in qualitative and quantitative analyses (P < 0.01). Of the lymph nodes with a score of 2 or below (hard), 19/25 (76%) were malignant, of the lymph nodes with a score over 2 (soft), 24/36 (67%) were benign. Findings indicated that elastographic stiffness scores differed between benign and malignant lymph node groups; however overlapping scores for the two groups limited the use of this technique for routine clinical diagnosis of malignancy.
Influence of hydrogen in silicon nitride films on the surface reactions during hydrofluorocarbon plasma etching
Authors: Kuboi Nobuyuki , Tatsumi Tetsuya , Minari Hideki , Fukasawa Masanaga , Zaizen Yoshifumi , Komachi Jun , Kawamura Takahiro
Published: September 2017

The influence of the amount of hydrogen (H) in hydrogenated silicon nitride films (SixNy:Hz) on the etching properties and etching mechanism are unclear for hydrofluorocarbon plasma etching. Therefore, the authors have investigated the effect of H in SixNy:Hz films on the surface reactions during CH2F2/Ar/O2 plasma etching by experimental and numerical simulation techniques. The experimental etch yield (EY) and polymer layer thickness (TC−F) values for SixNy:Hz films with different H concentrations of 2.6% (low-SiN), 16.8% (mod-SiN), and 21.9% (high-SiN) show different trends with the CH2F2/(CH2F2 + O2) flow rate ratio. To understand the mechanism of the different etching properties, the authors estimated the chemical reaction probabilities of the H outflux between F, O, N, C, and Si dangling bonds using first principles calculations and the results of Fourier transform infrared spectroscopy. Based on the estimated reaction probabilities, the authors modeled the surface reactions of SixNy:Hz films under the assumption that the H outflux mainly scavenges incident F radicals (the main etchant species). The authors also consider that the reaction between H and N from outfluxes decreases the desorption reactions of C2N2 and HCN, resulting in a larger TC−F value. Comparing the simulation results of the trends in the whole flow rate ratio range and the absolute values of EY and TC−F with experimental data, the surface model can successfully explain the mechanism. Furthermore, the authors demonstrated time-dependent etched profile and damage distribution for fin-type field-effect transistor SixNy:Hz side-wall etching using the three-dimensional voxel-slab model with the above surface reactions to obtain knowledge about the effect of H on the etched profile and damage distribution. The results show that the etched profile and damage distribution on the Si fin structure are very different for low-SiN and high-SiN because of the different EY and TC−F values induced by different H outfluxes. These results indicate that it is important to carefully control both the etching process and amount of H in the SixNy:Hz film to achieve high-performance advanced complementary metal oxide semiconductor devices.
Ultrastable atomic copper nanosheets for selective electrochemical reduction of carbon dioxide
Authors: Dai Lei , Qin Qing , Wang Pei , Zhao Xiaojing , Hu Chengyi , Liu Pengxin , Qin Ruixuan , Chen Mei , Ou Daohui , Xu Chaofa , Mo Shiguang , Wu Binghui , Fu Gang , Zhang Peng , Zheng Nanfeng
Published: September 2017

Air-stable atomically thick copper nanosheets are prepared and used for selective electrochemical reduction of CO
2
into CO.
New class of precision antimicrobials redefines role of
Clostridium difficile
S-layer in virulence and viability
Authors: Kirk Joseph A. , Gebhart Dana , Buckley Anthony M. , Lok Stephen , Scholl Dean , Douce Gillian R. , Govoni Gregory R. , Fagan Robert P.
Published: September 2017

Rare
Clostridium difficile
mutants lacking surface-layer protein A escape killing by Avidocin-CDs and display severe phenotypic defects that compromise virulence in animals.
Broadly neutralizing antibodies targeting the HIV-1 envelope V2 apex confer protection against a clade C SHIV challenge
Authors: Julg Boris , Tartaglia Lawrence J. , Keele Brandon F. , Wagh Kshitij , Pegu Amarendra , Sok Devin , Abbink Peter , Schmidt Stephen D. , Wang Keyun , Chen Xuejun , Joyce M. Gordon , Georgiev Ivelin S. , Choe Misook , Kwong Peter D. , Doria-Rose Nicole A. , Le Khoa , Louder Mark K. , Bailer Robert T. , Moore Penny L. , Korber Bette , Seaman Michael S. , Abdool Karim Salim S. , Morris Lynn , Koup Richard A. , Mascola John R. , Burton Dennis R. , Barouch Dan H.
Published: September 2017

Neutralizing antibodies to the HIV-1 envelope V2 apex protect macaques against SHIV challenge at very low serum concentrations.
Evaluation of the Lumipulse G TP-N Chemiluminescent Immunoassay as a Syphilis Screening Test
Authors: Ortiz Daniel A. , Loeffelholz Michael J.
Published: September 2017

A syphilis diagnosis is often aided by the detection of treponemal and nontreponemal antibodies. Automated treponemal antibody detection systems enable high-volume clinical laboratories to perform syphilis screening at a faster pace with lower labor costs. The Lumipulse G TP-N chemiluminescent immunoassay is an automated system that qualitatively detects IgG and IgM antibodies against
Treponema pallidum
antigens in human serum and plasma. To assess performance characteristics and workflow efficiency, the Lumipulse G TP-N assay was compared to the Bioplex 2200 Syphilis IgG multiplex flow immunoassay. Among the 4,134 routine and HIV samples tested by the two automated assays, the percentage of agreement was excellent at 99.0% (95% confidence interval [CI], 98.6% to 99.2%; κ, 0.89), with the Lumipulse G TP-N having a shorter time to first and subsequent results. All specimens with reactive syphilis screening results were further tested by rapid plasma reagin (RPR) and
Treponema pallidum
particle agglutination (TP·PA) testing (
n
= 231). The results from the RPR-reactive samples (
n
= 82) showed complete concordance with the two automated assays, while the TP·PA assay displayed some discrepancies. The positive percent agreement (PPA) and negative percent agreement (NPA) between the TP·PA test and the Lumipulse G TP-N test were 98.9% and 77.3%, respectively. The Bioplex 2200 Syphilis IgG immunoassay displayed a similar PPA (100%) but a substantially lower NPA (15.9%). Patient chart reviews of discrepant results suggested that the Lumipulse G TP-N assay produced 27 fewer falsely reactive results and can reduce the amount of additional confirmatory RPR and TP·PA testing needed. The analogous performance characteristics of the two automated systems indicate that the Lumipulse G TP-N assay is suitable for high-throughput syphilis screening.
Human Herpesvirus 8 Interleukin-6 Interacts with Calnexin Cycle Components and Promotes Protein Folding
Authors: Chen Daming , Xiang Qiwang , Nicholas John
Published: September 2017

Viral interleukin-6 (vIL-6) encoded by human herpesvirus 8 (HHV-8) is believed to contribute via mitogenic, survival, and angiogenic activities to HHV-8-associated Kaposi's sarcoma, primary effusion lymphoma (PEL), and multicentric Castleman's disease through autocrine or paracrine mechanisms during latency or productive replication. There is direct evidence that vIL-6 promotes latently infected PEL cell viability and proliferation and also viral productive replication in PEL and endothelial cells. These activities are mediated largely through endoplasmic reticulum (ER)-localized vIL-6, which can induce signal transduction via the gp130 signaling receptor, activating mitogen-activated protein kinase and signal transducer and activator of transcription signaling, and interactions of vIL-6 with the ER membrane protein vitamin K epoxide reductase complex subunit 1 variant 2 (VKORC1v2). The latter functional axis involves suppression of proapoptotic lysosomal protein cathepsin D by promotion of the ER-associated degradation of ER-transiting, preproteolytically processed procathepsin D. Other interactions of VKORC1v2 and activities of vIL-6 via the receptor have not been reported. We show here that both vIL-6 and VKORC1v2 interact with calnexin cycle proteins UDP-glucose:glycoprotein glucosyltransferase 1 (UGGT1), which catalyzes monoglucosylation of N-glycans, and oppositely acting glucosidase II (GlucII), and that vIL-6 can promote protein folding. This activity was found to require VKORC1v2 and UGGT1, to involve vIL-6 associations with VKORC1v2, UGGT1, and GlucII, and to operate in the context of productively infected cells. These findings document new VKORC1v2-associated interactions and activities of vIL-6, revealing novel mechanisms of vIL-6 function within the ER compartment.

IMPORTANCE
HHV-8 vIL-6 prosurvival (latent) and proreplication functions are mediated from the ER compartment through both gp130 receptor-mediated signal transduction and interaction of vIL-6 with the ER membrane protein VKORC1v2. This report identifies interactions of vIL-6 and VKORC1v2 with calnexin cycle enzymes GlucII and UGGT1, which are involved in glycan processing and nascent protein folding. The presented data show that vIL-6 and VKORC1v2 can cocomplex with GlucII and UGGT1, that vIL-6 promotes protein folding, and that VKORC1v2, UGGT1, and vIL-6 interactions with GlucII and UGGT1 are important for the profolding activity of vIL-6, which can be detected in the context of infected cells. This newly identified ER activity of vIL-6 involving VKORC1v2 may promote viral latency (in PEL cells) and productive replication by limiting the damaging effects of unfolded protein response signaling in addition to enhancing viral protein folding. This is the first report of such a function for a cytokine.
Mechanical Barriers Restrict Invasion of Herpes Simplex Virus 1 into Human Oral Mucosa
Authors: Thier Katharina , Petermann Philipp , Rahn Elena , Rothamel Daniel , Bloch Wilhelm , Knebel-Mörsdorf Dagmar
Published: September 2017

Oral mucosa is one of the main target tissues of the human pathogen herpes simplex virus 1 (HSV-1). How the virus overcomes the protective epithelial barriers and penetrates the tissue to reach its receptors and initiate infection is still unclear. Here, we established an
ex vivo
infection assay with human oral mucosa that allows viral entry studies in a natural target tissue. The focus was on the susceptibility of keratinocytes in the epithelium and the characterization of cellular receptors that mediate viral entry. Upon
ex vivo
infection of gingiva or vestibular mucosa, we observed that intact human mucosa samples were protected from viral invasion. In contrast, the basal layer of the oral epithelium was efficiently invaded once the connective tissue and the basement membrane were removed. Later during infection, HSV-1 spread from basal keratinocytes to upper layers, demonstrating the susceptibility of the stratified squamous epithelium to HSV-1. The analysis of potential receptors revealed nectin-1 on most mucosal keratinocytes, whereas herpesvirus entry mediator (HVEM) was found only on a subpopulation of cells, suggesting that nectin-1 acts as primary receptor for HSV-1 in human oral mucosa. To mimic the supposed entry route of HSV-1 via microlesions
in vivo
, we mechanically wounded the mucosa prior to infection. While we observed a limited number of infected keratinocytes in some wounded mucosa samples, other samples showed no infected cells. Thus, we conclude that mechanical wounding of mucosa is insufficient for the virus to efficiently overcome epithelial barriers and to make entry-mediating receptors accessible.

IMPORTANCE
To invade the target tissue of its human host during primary infection, herpes simplex virus (HSV) must overcome the epithelial barriers of mucosa, skin, or cornea. For most viruses, the mechanisms underlying the invasion into the target tissues of their host organism are still open. Here, we established an
ex vivo
infection model of human oral mucosa to explore how HSV can enter its target tissue. Our results demonstrate that intact mucosa samples and even compromised tissue allow only very limited access of HSV to keratinocytes. Detailed understanding of barrier functions is an essential precondition to unravel how HSV bypasses the barriers and approaches its receptors in tissue and why it is beneficial for the virus to use a cell-cell adhesion molecule, such as nectin-1, as a receptor.
What treatments work for anxiety in children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)? Systematic review
Authors: Stoll Sarah Victoria Ellen , Crawley Esther , Richards Victoria , Lal Nishita , Brigden Amberly , Loades Maria E
Published: September 2017

Objectives

Anxiety is more prevalent in children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) than in the general population. A systematic review was carried out to identify which treatment methods are most effective for children with CFS and anxiety.

Design

Systematic review using search terms entered into the Cochrane library and Ovid to search the databases Medline, Embase and psychINFO.

Participants

Studies were selected if participants were <18 years old, diagnosed with CFS/ME (using US Centers for Disease Control and Prevention, the National Institute for Health and Care Excellence or Oxford criteria) and had a valid assessment of anxiety.

Interventions

We included observational studies and randomised controlled trials.

Comparison

Any or none.

Outcomes

Change in anxiety diagnostic status and/or change in anxiety severity on a validated measure of anxiety from pretreatment to post-treatment.

Results

The review identified nine papers from eight studies that met the inclusion criteria. None of the studies specifically targeted anxiety but six studies tested an intervention and measured anxiety as a secondary outcome. Of these studies, four used a cognitive behavioural therapy (CBT)-type approach to treat CFS/ME, one used a behavioural approach and one compared a drug treatment, gammaglobulin with a placebo. Three of the CBT-type studies described an improvement in anxiety as did the trial of gammaglobulin. As none of the studies stratified outcomes according to anxiety diagnostic status or severity, we were unable to determine whether anxiety changed prognosis or whether treatments were equally effective in those with comorbid anxiety compared with those without.

Conclusion

We do not know what treatment should be offered for children with both anxiety and CFS/ME. Further research is therefore required to answer this question.

Trial registration number

This review was registered on Prospective Register of Systematic Review Protocols (PROSPERO) and the protocol is available fromhttp://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016043488.
Effects of external inspection on sepsis detection and treatment: a study protocol for a quasiexperimental study with a stepped-wedge design
Authors: Hovlid Einar , Frich Jan C , Walshe Kieran , Nilsen Roy M , Flaatten Hans Kristian , Braut Geir Sverre , Helgeland Jon , Teig Inger Lise , Harthug Stig
Published: September 2017

Introduction

Inspections are widely used in health care as a means to improve the health services delivered to patients. Despite their widespread use, there is little evidence of their effect. The mechanisms for how inspections can promote change are poorly understood. In this study, we use a national inspection campaign of sepsis detection and initial treatment in hospitals as case to: (1) Explore how inspections affect the involved organizations. (2) Evaluate what effect external inspections have on the process of delivering care to patients, measured by change in indicators reflecting how sepsis detection and treatment is carried out. (3) Evaluate whether external inspections affect patient outcomes, measured as change in the 30-day mortality rate and length of hospital stay.

Methods and analysis

The intervention that we study is inspections of sepsis detection and treatment in hospitals. The intervention will be rolled out sequentially during 12 months to 24 hospitals. Our effect measures are change on indicators related to the detection and treatment of sepsis, the 30-day mortality rate and length of hospital stay. We collect data from patient records at baseline, before the inspections, and at 8 and 14 months after the inspections. We use logistic regression models and linear regression models to compare the various effect measurements between the intervention and control periods. All the models will include time as a covariate to adjust for potential secular changes in the effect measurements during the study period. We collect qualitative data before and after the inspections, and we will conduct a thematic content analysis to explore how inspections affect the involved organisations.

Ethics and dissemination

The study has obtained ethical approval by the Regional Ethics Committee of Norway Nord and the Norwegian Data Protection Authority. It is registered at www.clinicaltrials.gov (Identifier:NCT02747121). Results will be reported in international peer-reviewed journals.

Trial Registration

NCT02747121; Pre-results.
Qualitative study to develop processes and tools for the assessment and tracking of African institutions’ capacity for operational health research
Authors: Wallis Selina , Cole Donald C , Gaye Oumar , Mmbaga Blandina T , Mwapasa Victor , Tagbor Harry , Bates Imelda
Published: September 2017

Objectives

Research is key to achieving global development goals. Our objectives were to develop and test an evidence-informed process for assessing health research management and support systems (RMSS) in four African universities and for tracking interventions to address capacity gaps.

Setting

Four African universities.

Participants

83 university staff and students from 11 cadres.

Intervention/methods

A literature-informed ‘benchmark’ was developed and used to itemise all components of a university’s health RMSS. Data on all components were collected during site visits to four African universities using interview guides, document reviews and facilities observation guides. Gaps in RMSS capacity were identified against the benchmark and institutional action plans developed to remedy gaps. Progress against indicators was tracked over 15 months and common challenges and successes identified.

Results

Common gaps in operational health research capacity included no accessible research strategy, a lack of research e-tracking capability and inadequate quality checks for proposal submissions and contracts. Feedback indicated that the capacity assessment was comprehensive and generated practical actions, several of which were no-cost. Regular follow-up helped to maintain focus on activities to strengthen health research capacity in the face of challenges.

Conclusions

Identification of each institutions’ strengths and weaknesses against an evidence-informed benchmark enabled them to identify gaps in in their operational health research systems, to develop prioritised action plans, to justify resource requests to fulfil the plans and to track progress in strengthening RMSS. Use of a standard benchmark, approach and tools enabled comparisons across institutions which has accelerated production of evidence about the science of research capacity strengthening. The tools could be used by institutions seeking to understand their strengths and to address gaps in research capacity. Research capacity gaps that were common to several institutions could be a ‘smart’ investment for governments and health research funders.
Influence of hospital volume on nephrectomy mortality and complications: a systematic review and meta-analysis stratified by surgical type
Authors: Hsu Ray C J , Salika Theodosia , Maw Jonathan , Lyratzopoulos Georgios , Gnanapragasam Vincent J , Armitage James N
Published: September 2017

Objectives

The provision of complex surgery is increasingly centralised to high-volume (HV) specialist hospitals. Evidence to support nephrectomy centralisation however has been inconsistent. We conducted a systematic review and meta-analysis to determine the association between hospital case volumes and perioperative outcomes in radical nephrectomy, partial nephrectomy and nephrectomy with venous thrombectomy.

Methods

Medline, Embase and the Cochrane Library were searched for relevant studies published between 1990 and 2016. Pooled effect estimates for nephrectomy mortality and complications were calculated for each nephrectomy type using the DerSimonian and Laird random-effects model. Sensitivity analyses were performed to examine the effects of heterogeneity on the pooled effect estimates by excluding studies with the heaviest weighting, lowest methodological score and most likely to introduce bias from misclassification of standardised hospital volume.

Results

Some 226 372 patients from 16 publications were included in our review and meta-analysis. Considerable between-study heterogeneity was noted and only a few reported volume–outcome relationships specifically in partial nephrectomy or nephrectomy with venous thrombectomy.

HV hospitals were correlated with a 26% and 52% reduction in mortality for radical nephrectomy (OR 0.74, 95% CI 0.61 to 0.90, p<0.01) and nephrectomy with venous thrombectomy (OR 0.48, 95% CI 0.29 to 0.81, p<0.01), respectively. In addition, radical nephrectomy in HV hospitals was associated with an 18% reduction in complications (OR 0.82, 95% CI 0.73 to 0.92, p<0.01). No significant volume–outcome relationship in mortality (OR 0.84, 95% CI 0.31 to 2.26, p=0.73) or complications (OR 0.85, 95% CI 0.55 to 1.30, p=0.44) was observed for partial nephrectomy.

Conclusions

Our findings suggest that patients undergoing radical nephrectomy have improved outcomes when treated by HV hospitals. Evidence of this in partial nephrectomy and nephrectomy with venous thrombectomy is however not yet clear and could be secondary to the low number of studies included and the small patient number in our analyses. Further investigation is warranted to establish the full potential of nephrectomy centralisation particularly as existing evidence is of low quality with significant heterogeneity.
Intake of dietary fibre and lifetime non-steroidal anti-inflammatory drug (NSAID) use and the incidence of colorectal polyps in a population screened for colorectal cancer
Authors: Shaw Eileen , Warkentin Matthew T , McGregor S Elizabeth , Town Susanna , Hilsden Robert J , Brenner Darren R
Published: September 2017

Background

There is suggestive evidence that increased intake of dietary fibre and the use of non-steroidal anti-inflammatory drugs (NSAIDs) are generally associated with decreased colorectal cancer risk. However, the effects on precursors of colorectal cancer, such as adenomatous polyps, are mixed. We present the associations between dietary fibre intake and NSAID use on the presence and type of colorectal polyps in a screening population.

Methods

A cross-sectional study of 2548 individuals undergoing colonoscopy at the Forzani & MacPhail Colon Cancer Screening Centre (Calgary, Canada) was conducted. Dietary fibre intake and NSAID use were assessed using the Diet History Questionnaire I or II and the Health and Lifestyle Questionnaire. Colorectal outcomes were documented as a polyp or high-risk adenomatous polyp (HRAP; villous histology, high-grade dysplasia, ≥10 mm or ≥3 adenomas). Crude and ORs and 95% CIs were estimated using unconditional logistic regression.

Results

There were 1450 negative colonoscopies and 1098 patients with polyps, of which 189 patients had HRAPs. Total dietary fibre intake was associated with a decreased presence of HRAPs (OR=0.50, 95% CI: 0.29 to 0.86) when comparing the highest to lowest quartiles and was observed with both soluble (OR=0.51, 95% CI: 0.30 to 0.88) and insoluble (OR=0.51, 95% CI: 0.30 to 0.86) fibres. Ever use of NSAIDs was also inversely associated with HRAPs (OR=0.65, 95% CI: 0.47 to 0.89), observed with monthly (OR=0.60, 95% CI: 0.37 to 0.95) and daily (OR=0.53, 95% CI: 0.32 to 0.86) use.

Conclusions

Dietary fibre intake and NSAID use were associated with a decreased risk of having a HRAP at screening.