bluuebunny/crossref_metadata_2025 huggingface dataset:
The expression and prognostic significance of bcl‐2‐associated transcription factor 1 in rectal cancer following neoadjuvant therapy
Authors: Brown Gordon T , Cash Beatriz , Alnabulsi Ayham , Samuel Leslie M , Murray Graeme I
Published: July 2015

Aims

bcl‐2‐associated transcription factor 1 (BCLAF1) is a nuclear protein that binds to bcl‐related proteins and can induce apoptosis and autophagy. The aim of this study was to investigate the expression of BCLAF1 in a series of rectal cancers following neoadjuvant therapy.

Methods and results

Immunohistochemistry was performed on a post‐neoadjuvant therapy rectal cancer tissue microarray. It contained rectal cancers (n = 248), lymph node metastases (n = 76), and non‐neoplastic rectal mucosal samples (n = 73). A monoclonal antibody against BCLAF1 that we have developed was used. Non‐neoplastic rectal epithelium showed nuclear localization of BCLAF1 in both crypt and surface epithelial cells, whereas rectal cancers showed both nuclear and cytoplasmic BCLAF1 expression. Most rectal cancers showed moderate or strong nuclear immunoreactivity, but showed weak cytoplasmic immunoreactivity. Cytoplasmic BCLAF1 expression was increased in primary rectal cancers as compared with non‐neoplastic rectal mucosa (P = 0.008). Negative and weak nuclear BCLAF1 expression was associated with a poor prognosis [hazard ratio (HR) 0.502, 95% confidence interval (CI) 0.269–0.939, χ2 = 4.876, P = 0.027]. Nuclear BCLAF1 expression was independently prognostic in a multivariate model (HR 0.431, 95% CI 0.221–0.840, P = 0.013).

Conclusions

This study has shown that both cytoplasmic BCLAF1 expression and nuclear BCLAF1 expression are increased in post‐neoadjuvant therapy rectal cancer, and that negative and weak nuclear BCLAF1 expression are independently associated with a poor prognosis.
Vitamin D, osteoprotegerin/receptor activator of nuclear factor‐kappaB ligand (OPG/RANKL) and inflammation with alendronate treatment in HIV‐infected patients with reduced bone mineral density
Authors: Natsag J , Kendall MA , Sellmeyer DE , McComsey GA , Brown TT
Published: July 2015

Objectives

The aim of the study was to determine the effect of alendronate (ALN) on inflammatory markers and osteoprotegerin (OPG)/receptor activator of nuclear factor‐kappaB ligand (RANKL), and to explore the associations of baseline systemic inflammation and vitamin D status on the bone mineral density (BMD) response to ALN.

Methods

Eighty‐two HIV‐positive patients with lumbar spine T‐score ≤ −1.5 were randomized to ALN 70 mg weekly or placebo for 48 weeks; all received calcium carbonate 500 mg/vitamin D3 200 IU twice daily. Serum C‐telopeptide (CTx) and BMD were assessed at baseline and week 48. Stored plasma samples in 70 subjects were assayed for levels of 25‐hydroxyvitamin D (25(OH)D), OPG, RANKL, interleukin (IL)‐6 and soluble receptors for tumour necrosis factor (TNF)‐α 1 and 2 (sTNFR 1 and 2).

Results

ALN increased BMD more than placebo at both the lumbar spine (difference ALN − placebo 2.64%; P = 0.011) and the total hip (difference 2.27%; P = 0.016). No within‐ or between‐arm differences in OPG, RANKL or inflammatory markers were observed over 48 weeks. High baseline CTx and sTNFR2 were associated with a more robust BMD response to ALN over 48 weeks at the lumbar spine [difference 5.66%; 95% confidence interval (CI) 3.50, 7.82; P < 0.0001] and total hip (difference 4.99%; 95% CI 2.40, 7.57; P = 0.0002), respectively. Baseline 25(OH)D < 32 ng/mL was associated with larger increases in total hip BMD over 48 weeks, independent of ALN treatment (P = 0.014).

Conclusions

Among HIV‐positive patients, higher baseline bone resorption and TNF‐α activity were associated with an increased BMD response to ALN. The greater BMD response in those with lower vitamin D reinforces the importance of vitamin D supplementation with bisphosphonate treatment.
Managing a nosocomial outbreak of carbapenem‐resistant Klebsiella pneumoniae: an early Australian hospital experience
Authors: Chang L. W. K. , Buising K. L. , Jeremiah C. J. , Cronin K. , Poy Lorenzo Y. S. , Howden B. P. , Kwong J. , Cocks J. , Blood A. , Greenough J. , Waters M. J.
Published: July 2015

Background

Carbapenems are traditionally reserved as the last line of defence for treatment of serious infections with multiresistant Gram‐negative bacilli. Reports of Klebsiella pneumoniae carbapenemase (KPC)‐producing organisms have been emerging globally, but rare in Australasia to date. We describe an outbreak of KPC‐2 producing K. pneumoniae at an Australian hospital.

Methods

After initial detection in October 2012, a retrospective review of patients with meropenem‐resistant K. pneumoniae to June 2012, and ongoing prospective surveillance, was undertaken. Included patients were admitted to the hospital after June 2012 and had meropenem‐resistant K. pneumoniae isolated from any site. Available isolates underwent detection of the KPC‐2 gene by polymerase chain reaction and molecular typing was performed to determine genetic relatedness between isolates. Point‐prevalence screening was performed on selected wards to detect asymptomatic carriage. Infection control procedures were implemented to contain the outbreak.

Results

Ten cases were identified in the initial cluster. Eight were localised to a single inpatient ward. Point‐prevalence screening revealed one extra case. After temporary containment, re‐emergence of KPC‐producing isolates was observed post October 2013 with 18 further cases identified. Four K. pneumoniae isolates in the 2012 cluster and 16 from the 2013–2014 cluster were referred for further testing. All carried the KPC‐2 beta‐lactamase gene. The 2012 isolates were genetically similar to the 2014 isolates.

Conclusion

KPC‐2 mediated resistance is an emerging threat in Australia. The re‐emergence of KPC despite initial containment emphasises the need for constant vigilance in the microbiology laboratory and ongoing maintenance of infection control and antimicrobial stewardship activity.
Comparing visual and objective skin assessment with pressure injury risk
Authors: Borzdynski Caroline J , McGuiness William , Miller Charne
Published: July 2015

Contemporary approaches to pressure injury (PI) risk identification rely on the use of risk assessment tools and visual skin assessment. Objective biophysical measures that assess skin hydration, melanin, erythema and lipids have not been traditionally used in PI risk; however, these may prove useful as a risk assessment tool. The relationship between subjective visual assessments of skin condition, biophysical measures and PI risk warrants investigation. This study used a descriptive correlational design to examine the relationship between measures of skin hydration, colour (melanin and erythema) and lipids at PI‐prone areas amongst geriatric persons (n = 38), obtained using biophysical skin measures and visual skin assessment. Twice daily measures of epidermal hydration, colour and lipids were assessed using the SD202 Skin Diagnostic (Courage + Khazaka GmBH, Cologne, Germany) over pressure‐prone areas of the body of study participants over seven consecutive days. Concurrent visual assessment of skin hydration and colour was performed. Results obtained using the SD202 Skin Diagnostic were compared with results gathered from visual assessment and examined for their association with participants' PI risk based on scores of the Norton Risk Assessment Scale. While epidermal hydration and skin colour reading scores did not vary significantly over the data collection period, lipid readings could not be registered on any occasion. With the exception of skin dryness, skin parameters via both objective and subjective means had significant, positive correlations. Statistically significant correlations emerged between visual assessment of skin wetness at the sacrum (r = −0·441, P < 0·01) and ischia (r = −0·468, P < 0·01) and Norton Risk Assessment Scale scores. It was found that the objective assessment of epidermal hydration (skin wetness) was also significantly associated with PI risk at the sacrum (r = −0·528, P < 0·01), as well as the right ischia (r = −0·410, P < 0·05) and left ischia (r = −0·407, P < 0·05). Erythema, when assessed objectively, was significantly correlated with PI risk at the sacrum (r = −0·322, P < 0·05). Such findings indicating that the finer measures afforded by the SD202 Skin Diagnostic in the assessment of the subtle red hues displayed in erythematous skin may provide an additional advantage over traditional, clinician assessment.
The effect of catch‐and‐release angling at high water temperatures on behaviour and survival of Atlantic salmon Salmo salar during spawning migration
Authors: Havn T. B. , Uglem I. , Solem Ø. , Cooke S. J. , Whoriskey F. G. , Thorstad E. B.
Published: July 2015

In this study, behaviour and survival following catch‐and‐release (C&R) angling was investigated in wild Atlantic salmon Salmo salar (n = 75) angled on sport fishing gear in the River Otra in southern Norway at water temperatures of 16·3–21·1° C. Salmo salar were tagged externally with radio transmitters and immediately released back into the river to simulate a realistic C&R situation. The majority of S. salar (91%) survived C&R. Most S. salar that were present in the River Otra during the spawning period 3–4 months later were located at known spawning grounds. Downstream movements (median furthest position: 0·5 km, range: 0·1–11·0 km) during the first 4 days after release were recorded for 72% of S. salar, presumably stress‐induced fallback associated with C&R. Individuals that fell back spent a median of 15 days before commencing their first upstream movement after release, and 34 days before they returned to or were located above their release site. Mortality appeared to be somewhat elevated at the higher end of the temperature range (14% at 18–21° C), although sample sizes were low. In conclusion, C&R at water temperatures up to 18° C had small behavioural consequences and was associated with low mortality (7%). Nevertheless, low levels of mortality occur due to C&R angling and these losses should be accounted for by management authorities in rivers where C&R is practised. Refinement of best practices for C&R may help to reduce mortality, particularly at warmer temperatures.
Microsatellite loci confirm a lack of population connectivity among globally distributed populations of the tope shark Galeorhinus galeus (Triakidae)
Authors: Chabot C. L.
Published: July 2015

This study used 11 polymorphic nuclear microsatellite loci to determine the population connectivity of five geographically isolated populations of tope shark Galeorhinus galeus (Africa, Australia, North America, South America and western Europe). Genetic analyses revealed significant structure among all populations indicating a lack of population connectivity. These findings indicate that globally distributed populations of G. galeus are isolated and should be managed as distinct, independent stocks.
Spatial ecology of coastal Atlantic cod Gadus morhua associated with parasite load
Authors: Aalvik I. M. , Moland E. , Olsen E. M. , Stenseth N. C.
Published: July 2015

Acoustic tags and receivers were used to investigate the spatial ecology of coastal Atlantic cod Gadus morhua (n = 32, mean fork length: 50 cm, range: 33–80 cm) on the Norwegian Skagerrak coast in 2012. Monthly home ranges (HR), swimming activity and depth use varied considerably among individuals and through the months of June, July and August. HR sizes for the period ranged from 0·25 to 5·20 km2 (mean = 2·30 km2). Two thirds of the tagged G. morhua were infected with black spot disease Cryptocotyle lingua parasites; these fish had larger HRs and occupied deeper water compared with non‐infected fish. The infected fish also tended to be more active in terms of horizontal swimming. From an ecological and evolutionary perspective, any environmental change that modifies G. morhua behaviour may therefore also alter the parasite load of the population, and its conservation and fishery status.
Temporal fossa defects: techniques for injecting hyaluronic acid filler and complications after hyaluronic acid filler injection
Authors: Juhász Margit Lai Wun , Marmur Ellen S
Published: July 2015

Facial changes with aging include thinning of the epidermis, loss of skin elasticity, atrophy of muscle, and subcutaneous fat and bony changes, all which result in a loss of volume. As temporal bones become more concave, and the temporalis atrophies and the temporal fat pad decreases, volume loss leads to an undesirable, gaunt appearance. By altering the temporal fossa and upper face with hyaluronic acid filler, those whose specialty is injecting filler can achieve a balanced and more youthful facial structure. Many techniques have been described to inject filler into the fossa including a “fanned” pattern of injections, highly diluted filler injection, and the method we describe using a three‐injection approach. Complications of filler in the temporal fossa include bruising, tenderness, swelling, Tyndall effect, overcorrection, and chewing discomfort. Although rare, more serious complications include infection, foreign body granuloma, intravascular necrosis, and blindness due to embolization into the ophthalmic artery. Using reversible hyaluronic acid fillers, hyaluronidase can be used to relieve any discomfort felt by the patient. Injectors must be aware of the complications that may occur and provide treatment readily to avoid morbidities associated with filler injection into this sensitive area.
Factors associated with rushed and missed resident care in western Canadian nursing homes: a cross‐sectional survey of health care aides
Authors: Knopp‐Sihota Jennifer A , Niehaus Linda , Squires Janet E , Norton Peter G , Estabrooks Carole A
Published: July 2015

Aims and objectives

To describe the nature, frequency and factors associated with care that was rushed or missed by health care aides in western Canadian nursing homes.

Background

The growing number of nursing home residents with dementia has created job strain for frontline health care providers, the majority of whom are health care aides. Due to the associated complexity of care, health care aides are challenged to complete more care tasks in less time. Rushed or missed resident care are associated with adverse resident outcomes (e.g. falls) and poorer quality of staff work life (e.g. burnout) making this an important quality of care concern.

Design

Cross‐sectional survey of health care aides (n = 583) working in a representative sample of nursing homes (30 urban, six rural) in western Canada.

Methods

Data were collected in 2010 as part of the Translating Research in Elder Care study. We collected data on individual health care aides (demographic characteristics, job and vocational satisfaction, physical and mental health, burnout), unit level characteristics associated with organisational context, facility characteristics (location, size, owner/operator model), and the outcome variables of rushed and missed resident care.

Results

Most health care aides (86%) reported being rushed. Due to lack of time, 75% left at least one care task missed during their previous shift. Tasks most frequently missed were talking with residents (52% of health care aides) and assisting with mobility (51%). Health care aides working on units with higher organisational context scores were less likely to report rushed and missed care.

Conclusion

Health care aides frequently report care that is rushed and tasks omitted due to lack of time.

Relevance to clinical practice

Considering the resident population in nursing homes today—many with advanced dementia and all with complex care needs—health care aides having enough time to provide physical and psychosocial care of high quality is a critical concern.
Medication communication during handover interactions in specialty practice settings
Authors: Braaf Sandra , Rixon Sascha , Williams Allison , Liew Danny , Manias Elizabeth
Published: July 2015

Aims and objectives

To investigate what and how medication information is communicated during handover interactions in specialty hospital settings.

Background

Effective communication about patients’ medications between health professionals and nurses at handover is vital for the delivery of safe continuity of care.

Design

An exploratory qualitative design and observational study.

Methods

Participant observation was undertaken at a metropolitan Australian public hospital in four specialty settings: cardiothoracic care, intensive care, emergency care and oncology care. A medication communication model was applied to the data and thematic analysis was performed.

Results

Over 130 hours of observational data were collected. In total, 185 (predominately nursing) handovers were observed across the four specialty settings involving 37 nurse participants. Health professionals communicated partial details of patients’ medication regimens, by focusing on auditing the medication administration record, and through the handover approach employed. Gaps in medication information at handover were evident as shown by lack of communication about detailed and specific medication content. Incoming nurses rarely posed questions about medications at handover.

Conclusions

Handover interactions contained restricted and incomplete medication information. Improving the transparency, completeness and accuracy of medication communication is vital for optimising patient safety and quality of care in specialty practice settings.

Relevance to clinical practice

For nurses to make informed and rapid decisions regarding appropriate patient care, information about all types of prescribed medications is essential, which is communicated in an explicit and clear way. Jargon and assumptions related to medication details should be minimised to reduce the risk of misunderstandings. Disclosure of structured medication information supports nurses to perform accurate patient assessments, make knowledgeable decisions about the appropriateness of medications and their doses, and anticipate possible adverse events associated with medications. In addition, benefits of patient and family member contributions in communicating about medications at handover should also be considered.
Nurses' attitudes towards professional containment methods used in psychiatric wards and perceptions of aggression in Turkey
Authors: Keser Özcan Neslihan , Bilgin Hülya , Akın Münevver , Badırgalı Boyacıoğlu Nur Elçin
Published: July 2015

Aims and objective

The aim of this study was to determine nurses' attitudes towards professional containment methods and to explore the relationship between those attitudes and nurses' perception of aggression.

Background

Different containment methods are used in psychiatric wards when patients behave aggressively towards others or exhibit self‐harm. It is known that in addition to patient‐specific and environmental influences, many factors related to the staff influence the choice of containment method. One of these factors is the perception of aggression.

Design

A cross‐sectional descriptive design was used and the sample consisted of 144 nurses who are employed in a psychiatric hospital in Istanbul and who volunteered to participate in the study.

Method

Data were collected using a questionnaire addressing the socio‐demographic and professional features of nurses and using the attitudes to professional containment methods and Perception of Aggression Scale.

Results

While pro re nata medication was used commonly, time‐out was infrequently used in the wards. Intermittent observation, pro re nata medication and containment in the psychiatric intensive care unit were the most approved methods. The use of net beds was the least approved method. Nurses who perceive aggression as dysfunctional/undesirable are more likely to approve compulsory intramuscular medication and mechanical restraint.

Conclusion

These results showed that nurses' perception of aggression is an important factor influencing the choice of a professional containment method.

Relevance to clinical practice

This study might lead to closer critiquing of psychiatric ward nurses' attitudes towards professional containment methods, leading to a decrease in the usage of these methods.
A multidisciplinary approach to reducing spurious hyperkalemia in hospital outpatient clinics
Authors: Loh Tze Ping , Sethi Sunil K
Published: July 2015

Aims and objectives

To describe a multidisciplinary effort to investigate and reduce the occurence of outpatient spurious hyperkalaemia.

Background

Spurious hyperkalemia is a falsely elevated serum potassium result that does not reflect the in vivo condition of a person. A common practice of fist clenching/pumping during phlebotomy to improve vein visualisation is an under‐appreciated cause of spurious hyperkalemia.

Design

Pre‐ and postinterventional study.

Method

Objective evidence of spurious hyperkalaemia was sought by reviewing archived laboratory results. A literature review was undertaken to summarise known causes of spurious hyperkalaemia and develop a best practice in phlebotomy. Subsequently, nurses from the Urology Clinic were interviewed, observed and surveyed to understand their phlebotomy workflow and identify potential areas of improvement by comparing to the best practice in phlebotomy. Unexplained (potentially spurious) hyperkalaemia was defined as a serum potassium of >5·0 mmol/l in a patient without stage 5 chronic kidney disease or haemolysed blood sample.

Results and conclusion

Nurses from the Urology Clinic showed significant knowledge gap regarding causes of spurious hyperkalaemia when compared to the literature review. Direct observation revealed patients were routinely asked to clench their fists, which may cause spurious hyperkalaemia. Following these observations, several educational initiatives were administered to address the knowledge gap and stop fist clenching. The rate of unexplained hyperkalaemia at the Urology clinic reduced from a baseline of 16·0–3·8%, 58 weeks after intervention. Similar education intervention was propagated to all 18 other specialist outpatient clinic locations, which saw their rate of unexplained hyperkalaemia decrease from 5·4 to 3·7%. To ensure sustainability of the improvements, the existing phlebotomy standard operating protocol, educational and competency testing materials at variance with the best practice were revised.

Relevance to clinical practice

A simple intervention of avoiding fist clenching/pumping during phlebotomy produced significant reduction in the rate of spurious hyperkalemia.
Imaging in Endovascular Stroke Trials
Authors: Malhotra Konark , Liebeskind David S.
Published: July 2015

Ischemic stroke remains a leading cause of death and disability worldwide. Various endovascular trials have addressed clinical outcomes without elucidating the impact of imaging studies in patient selection. The success of recent endovascular trials was bolstered by the use of advanced imaging techniques for optimal selection of reperfusion candidates. This seminal juncture in the history of stroke trials warrants further consideration on the use of imaging to guide future refinements in the treatment of acute stroke. In this article, we systematically review the imaging methodology and key facets used in all published endovascular stroke trials to date, discuss the success of recent trials using latest advanced imaging techniques and focus on the importance of imaging studies for future patient selection.
MANAGING FINANCIALLY DISTRESSED PENSION PLANSINTHE INTERESTOF BENEFICIARIES
Authors: Inkmann Joachim , Blake David , Shi Zhen
Published: July 2015

The beneficiaries of a corporate defined benefit pension plan in financial distress care about the security of their promised pensions. We propose to value the pension obligations of a corporate defined benefit plan using a discount rate that reflects the funding ability of the pension plan and its sponsoring company, and therefore depends, in part, on the chosen asset allocation. An optimal valuation is determined by a strategic asset allocation that is optimal given the risk premium a representative pension plan member demands for being exposed to funding risk. We provide an empirical application using the General Motors pension plan.
Melatonin induces the transcripts of CBF/DREB1s and their involvement in both abiotic and biotic stresses in Arabidopsis
Authors: Shi Haitao , Qian Yongqiang , Tan Dun‐Xian , Reiter Russel J. , He Chaozu
Published: July 2015

Melatonin (N‐acetyl‐5‐methoxytryptamine) is a naturally occurring small molecule that acts as an important secondary messenger in plant stress responses. However, the mechanism underlying the melatonin‐mediated signaling pathway in plant stress responses has not been established. C‐repeat‐binding factors (CBFs)/Drought response element Binding 1 factors (DREB1s) encode transcription factors that play important roles in plant stress responses. This study has determined that endogenous melatonin and transcripts level of CBFs (AtCBF1, AtCBF2, and AtCBF3) in Arabidopsis leaves were significantly induced by salt, drought, and cold stresses and by pathogen Pseudomonas syringe pv. tomato (Pst) DC3000 infection. Moreover, both exogenous melatonin treatment and overexpression of CBFs conferred enhanced resistance to both abiotic and biotic stresses in Arabidopsis. Notably, AtCBFs and exogenous melatonin treatment positively regulated the mRNA expression of several stress‐responsive genes (COR15A, RD22, and KIN1) and accumulation of soluble sugars content such as sucrose in Arabidopsis under control and stress conditions. Additionally, exogenous sucrose also conferred improved resistance to both abiotic and biotic stresses in Arabidopsis. Taken together, this study indicates that AtCBFs confer enhanced resistance to both abiotic and biotic stresses, and AtCBF‐mediated signaling pathway and sugar accumulation may be involved in melatonin‐mediated stress response in Arabidopsis, at least partially.
Computational Models of Reading: A Primer
Authors: Reichle Erik D.
Published: July 2015

This article briefly reviews four computational models of reading and the types of empirical findings that they are designed to explain: (1) theDual‐Route modelof word identification (Coltheart et al., 2001); (2) theSimple‐Recurrent Network modelof sentence processing (Elman, 1990); (3) theConstruction–Integration modelof discourse representation (Kintsch, 1988); and (4) theE‐Z Reader modelof eye‐movement control in reading (Reichle et al., 2012). These particular models are reviewed because they provide comprehensive accounts of a large number of empirical findings in each of their respective domains, and because they have advanced our understanding of the cognitive processes involved in reading by motivating new empirical studies. Future models of reading will build upon the success of their predecessors by integrating models from two or more of the aforementioned domains, thereby providing a means to examine the compatibility of their theoretical assumptions and more comprehensive accounts of the cognitive processes involved in reading.
In Physics Education, Perception Matters
Authors: Sattizahn Jason R. , Lyons Daniel J. , Kontra Carly , Fischer Susan M. , Beilock Sian L.
Published: July 2015

Student difficulties in science learning are frequently attributed to misconceptions about scientific concepts. We argue that domain‐general perceptual processes may also influence students' ability to learn and demonstrate mastery of difficult science concepts. Using the concept of center of gravity (CoG), we show how student difficulty in applying CoG to an object such as a baseball bat can be accounted for, at least in part, by general principles of perception (i.e., not exclusively physics‐based) that make perceiving the CoG of some objects more difficult than others. In particular, it is perceptually difficult to locate the CoG of objects with asymmetric‐extended properties. The basic perceptual features of objects must be taken into account when assessing students' classroom performance and developing effective science, technology, engineering, and mathematics (STEM) teaching methods.
What are the factors that influence the delivery of smoking cessation advice in critical care?
Authors: Lang Markus , Waterworth Susan , O'Brien Anthony
Published: July 2015

Background

The world's leading cause of preventable deaths, diseases and disabilities is smoking. Hospitalization can provide an opportunity for smokers to quit. Previous research found that smokers make up a high percentage of patients admitted to intensive care. Health care professionals working in critical care environments can make a valuable contribution to this public health issue by providing smoking cessation advice.

Aim

To identify factors that inhibit and facilitate the delivery of smoking cessation advice by nurses and doctors in critical care settings.

Design

Quantitative design using an online survey.

Methods

This research was a single centre study carried out in a large tertiary hospital. Study sites were two adult critical care departments including a 14‐bed general intensive care and a 16‐bed cardiovascular intensive care unit. The target population for this research was the nursing and medical staff working in adult critical care environments.

Results

The data suggests that doctors and nurses have a good understanding of the complications related to tobacco use and also have education on smoking cessation. Additionally the data suggest that doctors and nurses at the study sites generally have positive attitudes towards smoking cessation. Patient acuity and competence were concerns raised in relation to the delivery and effectiveness of smoking cessation advice in critical care environments.

Conclusions

The recovery phase following critical illness might be an opportunity to provide cessation advice. This could include focusing cessation advice efforts on awake, orientated and extubated patients. Further research might be required to confirm this.

Relevance to clinical practice

The provision of smoking cessation advice is an on‐going World Health Organization and New Zealand Government priority and all parts of the health sector need to provide responses. However, responses need to be adapted to the specific context such as the unique challenges of critical care.
Demographic and Clinical Characteristics to Predict Paroxysmal Atrial Fibrillation: Insights from an Implantable Loop Recorder Population
Authors: FRONTERA ANTONIO , CARPENTER ALEXANDER , AHMED NAUMAN , FASIOLO MATTEO , NELSON MARTIN , DIAB IHAB , CRIPPS TIM , THOMAS GLYN , DUNCAN EDWARD
Published: July 2015

Background

There is growing interest in detecting paroxysmal atrial fibrillation (PAF) to identify patients at high risk of thromboembolic stroke. The implantable loop recorder (ILR) is emerging as a powerful new tool in the diagnosis of PAF. Widespread implantation has significant cost implications and their use must be targeted at those patients at most risk.

Methods

We retrospectively studied a population of 200 adult patients who underwent ILR implantation for the investigation of syncope or palpitations. Clinical data, baseline electrocardiogram (ECG) characteristics, and echocardiographic data were collected. All ECGs and electrograms (EGMs) were scrutinized by two blinded investigators. PAF incidence was defined as episodes lasting >30 seconds on EGMs recorded in ILR memory.

Results

Our ILR population consists of 200 patients, 111 (56%) male, with a mean age of 61.4 years (range 19–95). PAF was detected in 42 patients. The following factors were significant predictors of PAF by multivariate logistic regression analysis: cigarette smoking (odds ratio [OR] = 3.73, 95% confidence interval [CI] = 1.40–10.24, P = 0.009) and incomplete right bundle branch block (IRBBB; OR = 9.04, 95% CI = 2.51–34.64, P = 0.00088). Significant differences included incidence of IRBBB (P = 0.012), cigarette smoking (P = 0.026), hypercholesterolemia (P = 0.015), age (P = 0.002), estimated glomerular filtration rate (P = 0.031), left atrial volume (P = 0.019), and PR interval (P = 0.031). The PAF group had significantly higher CHA2DS2‐VASc scores (P = 0.01).

Conclusions

Our study reports predictive factors for PAF in an ILR population. We suggest that cigarette smoking and IRBBB are independently associated with paroxysmal AF in patients presenting with palpitations or syncope.
Validity and Reliability of Turkish Translation of Neuropathic Pain Impact on Quality‐of‐Life (NePIQoL) Questionnaire
Authors: Acar Betul , Turkel Yakup , Kocak Orhan M. , Kemal Erdemoglu A.
Published: July 2015

Objectives

The aim of this study was to adapt the “Neuropathic Pain Impact on Quality‐of‐Life Questionnaire” (NePIQoL) into Turkish and to test its validity and reliability in neuropathic pain patients.

Methods

We enrolled 200 chronic pain patients who admitted to the Neurology Department of Kirikkale University, Faculty of Medicine, in our study. Patients were diagnosed with neuropathic or nociceptive pain based on medical history, physical examination, electromyography and nerve conduction studies, laboratory examinations, and imaging techniques. Discriminant analysis was used to diagnose the neuropathic pain regarding sensitivity and specificity. The original version of the NePIQoL was translated into Turkish by standard procedures.

Results

Total NePIQoL scores were statistically different between neuropathic and nociceptive pain patients in both the first and second NePIQoL applications (P < 0.001). Cronbach's alpha coefficient of total 12 items of the first and second applications was 0.95. These results suggest a high validity level for the Turkish version of the NePIQoL.

Conclusions

The Turkish version of NePIQoL appears to be reliable and valid for neuropathic pain impact on quality of life in patients with neuropathic pain.
The role of thioredoxin reductase 1 in melanoma metabolism and metastasis
Authors: Cassidy Pamela B. , Honeggar Matthew , Poerschke Robyn L. , White Karen , Florell Scott R. , Andtbacka Robert H. I. , Tross Joycelyn , Anderson Madeleine , Leachman Sancy A. , Moos Philip J.
Published: July 2015

Although significant progress has been made in targeted and immunologic therapeutics for melanoma, many tumors fail to respond, and most eventually progress when treated with the most efficacious targeted combination therapies thus far identified. Therefore, alternative approaches that exploit distinct melanoma phenotypes are necessary to develop new approaches for therapeutic intervention. Tissue microarrays containing human nevi and melanomas were used to evaluate levels of the antioxidant protein thioredoxin reductase 1 (TR1), which was found to increase as a function of disease progression. Melanoma cell lines revealed metabolic differences that correlated with TR1 levels. We used this new insight to design a model treatment strategy that creates a synthetic lethal interaction wherein targeting TR1 sensitizes melanoma to inhibition of glycolytic metabolism, resulting in a decrease in metastases in vivo. This approach holds the promise of a new clinical therapeutic strategy, distinct from oncoprotein inhibition.
Socioeconomic Disparities in Adverse Birth Outcomes in Urban and Rural Contexts: a French Mother–Child Cohort
Authors: Bertin Mélanie , Viel Jean‐François , Monfort Christine , Cordier Sylvaine , Chevrier Cécile
Published: July 2015

Background

Although adverse birth outcomes have been associated with neighbourhood deprivation in urban areas, few studies have addressed this issue in rural zones. This study examines whether associations between neighbourhood deprivation and adverse birth outcomes differ in urban and rural contexts, while taking individual characteristics and spatial accessibility of prenatal care (SAPC) into account.

Methods

Pregnant women from a French mother–child cohort were recruited from 2002 to 2006 in Brittany. Their residential addresses were geocoded into their census blocks (the finest geographical resolution available). Deprivation was assessed at the same neighbourhood level. Models to assess the associations of deprivation, stratified by urban/rural status, with preterm delivery (PTD), with small for gestational age birth weight (SGA) and with small for gestational age head circumference at birth (SHC), estimated odds ratios (ORs), adjusted for maternal socioeconomic characteristics and SAPC.

Results

This study considered 2929 liveborn singleton pregnancies from 780 census blocks. Neighbourhood deprivation was associated with increased risks of SGA and SHC (P trend < 0.01 and 0.03 respectively), only among mothers residing in rural areas. Neighbourhood deprivation had statistically significantly heterogeneous effects on SGA and SHC according to the urban/rural status of maternal residence.

Conclusion

These findings suggest that neighbourhood deprivation affects fetal growth differentially in urban and rural areas and that SAPC does not seem to be responsible for this difference. Comparison of these findings with the literature requires caution in the conceptualisation of urban and rural settings.
Increased dosage of donepezil for the management of behavioural and psychological symptoms of dementia in dementia with Lewy bodies
Authors: Manabe Yuta , Ino Teruo , Yamanaka Katsuo , Kosaka Kenji
Published: July 2015

Background

As with other types of dementia, the behavioral and psychological symptoms of dementia (BPSD) can make caregiving difficult for patients with dementia with Lewy bodies (DLB). We hypothesized that administration of donepezil at an increased dose of 10 mg/day might dose‐dependently improve BPSD in DLB patients with relapse, after their symptoms had been controlled initially by donepezil therapy at the standard dose.

Methods

The present study was as an open‐label trial. We enrolled 24 patients with DLB (diagnosed according to the Consortium on Dementia with Lewy Bodies Guideline‐Revised) who experienced a relapse of BPSD despite treatment with donepezil at the standard dose (5 mg/day). The donepezil dose for these patients was increased to 10 mg/day, and we evaluated the efficacy and safety of this dose escalation strategy.

Results

The Neuropsychiatric Inventory (NPI) scores for BPSD showed statistically significant improvements as a result of the increased dosage, except those for anxiety and euphoria, disinhibition, irritability/lability. High‐dose donepezil therapy caused gastrointestinal symptoms in 4 patients, but there were no life‐threatening adverse events, such as arrhythmias, or no exacerbation of parkinsonian symptoms.

Conclusions

We found that donepezil dose‐dependently improved relapsing BPSD in these patients. Therefore, increasing the dosage of donepezil is a safe and effective treatment for patients with DLB who experience a relapse of BPSD.
A comparative study of caregiver burden in late‐onset depression and Alzheimer's disease
Authors: Kazhungil Firoz , Velayudhan Rajmohan , Kumar Manoj , Thazhe Mangool Raghuram
Published: July 2015

Background

Alzheimer's disease (AD) and major depressive disorder are the two most common psychogeriatric disorders. Late‐onset depression (LOD) is the most common cause of emotional suffering in the elderly and is associated with a poor quality of life in caregivers. Although the burden on caregivers of individuals suffering from AD has been well studied, there is a paucity of comparative studies on caregiver burden between AD and LOD. The objectives of this study were to compare the caregiver burden in LOD and AD and to identify factors associated with caregiver burden in LOD.

Methods

The study included two groups of 25 patients and their caregivers. Group 1 consisted of LOD patients diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision, with onset after age 60, and their caregivers. Group 2 consisted of AD patients and their caregivers. Caregiver burden was assessed by the Zarit Caregiver Burden Interview. Sociodemographic and clinical correlates of caregiver burden in LOD and AD were analyzed.

Results

There was no significant difference in caregiver burden between LOD and AD (P = 0.27). In LOD, the factors positively associated with caregiver burden included the patient's education and the caregiver being a woman, married, unmarried, and a student. Factors negatively associated with caregiver burden included being the son of the patient and high income status. Multivariate stepwise regression analysis showed that caregiver burden in AD is predicted by the Behavioural Pathology in Alzheimer's Disease Scale score, income, presence of diabetes, and in‐laws as caregivers (adjusted R2 = 0.847, P < 0.001). In LOD, caregiver burden is predicted by income, the patient's education, and whether the caregiver is a student or spouse (adjusted R2 = 0.388, P < 0.001).

Conclusion

This study highlights the finding that caregiver burden in LOD is comparable to that in AD and requires interventions to reduce the caregiver strain.
In Vitro Measures for Assessing Boar Semen Fertility
Authors: Jung M , Rüdiger K , Schulze M
Published: July 2015

Contents

Optimization of artificial insemination (AI) for pig production and evaluation of the fertilizing capacity of boar semen are highly related. Field studies have demonstrated significant variation in semen quality and fertility. The semen quality of boars is primarily affected by breed and season. AI centres routinely examine boar semen to predict male fertility. Overall, the evaluation of classical parameters, such as sperm morphology, sperm motility, sperm concentration and ejaculate volume, allows the identification of ejaculates corresponding to poor fertility but not high‐efficiency prediction of field fertility. The development of new sperm tests for measuring certain sperm functions has attempted to solve this problem. Fluorescence staining can categorize live and dead spermatozoa in the ejaculate and identify spermatozoa with active mitochondria. Computer‐assisted semen analysis (CASA) provides an objective assessment of multiple kinetic sperm parameters. However, sperm tests usually assess only single factors involved in the fertilization process. Thus, basing prediction of fertilizing capacity on a selective collection of sperm tests leads to greater accuracy than using single tests. In the present brief review, recent diagnostic laboratory methods that directly relate to AI performance as well as the development of a new boar fertility in vitro index are discussed.
Development Policy Implications for Growth and Regional Inequality in a Small Open Economy: The Indian Case
Authors: Barua Alokesh , Sawhney Aparna
Published: July 2015

Inclusive economic development has become a pressing goal of government policy in India in the face of rising regional inequality. This paper examines the role of targeted development policy action in inducing economic growth and also in reducing regional income inequality during the last two decades (since the beginning of the 1990s)—a period marked by increasing trade openness. In our disaggregated analysis of the states, we find that while the government capital expenditure policy has had significant positive impact on output growth of the poorer states, it failed to break the trend of escalating regional inequality. The policy has been significantly more effective in enhancing manufacturing sector output in the poorer states compared with the richer states. On the trade front, while the poorer states gained somewhat in income growth from greater openness, the gains were not large enough to offset the increasing regional disparity.
Migration, Transfers and Child Labor
Authors: Dimova Ralitza , Epstein Gil S. , Gang Ira N.
Published: July 2015

We examine agricultural child labor in the context of emigration, transfers and the ability to hire outside labor. We start by developing a theoretical background and show how hiring labor from outside the household and transfers to the household might induce a reduction in children's working hours. Analysis using Living Standards Measurement Survey (LSMS) data on the Kagera region in Tanzania lend support to the hypothesis that both emigration and remittances reduce child labor.
Reserve Requirements and Real Exchange Rate Misalignments in Emerging Market Economies
Authors: Loeffler Axel
Published: July 2015

A popular policy target in emerging markets is the real exchange rate as an undervalued real exchange rate is seen to enhance international competitiveness. Within an augmented Dornbusch model it is shown that the implicit tax of low remunerated reserve requirements represents an efficient tool to depreciate the real exchange rate. The model is empirically tested for a panel of Latin American, East Asian and Eastern European countries. Controlling for the impact of fiscal policies and direct capital controls, the reserve requirement tax significantly explains real exchange rate misalignments.
Capital Flows and Exchange Rate Volatility in India: How Crucial Are Reserves?
Authors: Kohli Renu
Published: July 2015

This paper tests if the adequacy of reserves helps reduce exchange rate volatility in an environment of financial globalization, market‐determined exchange rate and macroeconomic imbalances. It exploits the difference in the period after 2010 when India did not accumulate reserves but faced higher capital flow pressures, relative to a previous managed‐float period marked by significant absorption of surplus capital flows. Along with other determinants, the sensitivity of rupee volatility is examined. The paper finds that adequate reserve holdings significantly reduce exchange rate volatility irrespective of the exchange rate regime; the effect is more through influence upon market sentiment and confidence than actual intervention. It contributes to existing evidence on the role of reserves in mitigating exchange rate volatility amid capital flow swings and offers insights into the policy environment depicted in the trilemma.
Emotional regulation, attachment to possessions and hoarding symptoms
Authors: Phung Philip J. , Moulding Richard , Taylor Jasmine K. , Nedeljkovic Maja
Published: July 2015

This study aimed to test which particular facets of emotion regulation (ER) are most linked to symptoms of hoarding disorder, and whether beliefs about emotional attachment to possessions (EA) mediate this relationship. A non‐clinical sample of 150 participants (108 females) completed questionnaires of emotional tolerance (distress tolerance, anxiety sensitivity, negative urgency – impulsivity when experiencing negative emotions), depressed mood, hoarding, and beliefs about emotional attachment to possessions. While all emotional tolerance measures related to hoarding, when considered together and controlling for depression and age, anxiety sensitivity and urgency were the significant predictors. Anxiety sensitivity was fully mediated, and urgency partially mediated, via beliefs regarding emotional attachment to possessions. These findings provide further support for (1) the importance of anxiety sensitivity and negative urgency for hoarding symptoms, and (2) the view that individuals with HD symptoms may rely on items for emotion regulation, leading to stronger beliefs that items are integral to emotional wellbeing.
Rethinking the Crisis in Social Psychology: A Dialectical Perspective
Authors: Dafermos Manolis
Published: July 2015

This paper examines the crisis in social psychology as a multifaceted process. The epistemological, theoretical, and methodological tensions and controversies that arise in the extensive, reflexive debate on the crisis in social psychology are considered in their interconnections with psychological practice. The paper argues that despite the dominant tendency to return to “business as usual”, the increasing disunity and fragmentation of social psychology only indicate that its crisis has deepened. The paper offers a critical account of the main strategies for the resolution of the crisis in social psychology and suggests a dialectical perspective as a tool for a critical reflection on important theoretical and methodological issues of psychology as a discipline (the relationship between theory and practice, relationship between individual and society, empiricism, etc.)