bluuebunny/crossref_metadata_2025 huggingface dataset:
An Improvised Dispositif: Invisible Urban Planning in the Refugee Camp
Authors: Oesch Lucas
Published: February 2020

How does a refugee camp urbanize? Up to now, camps have been considered as either urban assemblages made by dwellers’ improvised tactics or spaces governed by disjointed urban planning policies. I demonstrate that there is another side to the urbanism of the refugee camp. A form of coherent institutional urban planning exists as well. It takes the shape of an improvised dispositif (apparatus). One of its main effects is to render the very process of urban planning invisible. I investigate this type of urbanism on the basis of fieldwork conducted in the Al‐Hussein Palestinian refugee camp in Amman, Jordan. I argue that this improvised dispositif of urban planning—of which state and non‐state institutions are part—is the result of a balancing act that ensures the temporary character of the camp, while allowing the implementation of a form of urban development that leads toward a material homogenization between the camp and the surrounding urban space. It does this by rendering its own processes invisible and being officially referred to as ‘improvement’. By emphasizing the key features of heterogeneity, invention and provisionality, I explain that the notion of a dispositif, coined by Foucault (1980), allows us to examine how institutions improvise away from more conventional urban planning. My analysis also complements Jeffrey's examination (2013) of institutional improvisation in the production of space, by showing that improvisation can be a form of strategic elaboration.
Tara gum–bovine sodium caseinate acid gels: Stabilisation of W/W emulsions
Authors: Hidalgo Ma. Eugenia , Ingrassia Romina , Nielsen Nadia Sol , Porfiri Ma. Cecilia , Tapia‐Maruri Daniel , Risso Patricia Hilda
Published: February 2020

Microstructural, rheological, and textural behaviour of tara gum–bovine sodium caseinate aqueous mixtures and their acid gels were evaluated. Acid gels with different microstructures and texture were obtained. These results can be related to a competition between the protein acid gelation process and the segregative phase separation. Depending on the concentration ratio of both biopolymers, a continuous protein gel network or a water‐in‐water emulsion stabilised by acid gelation was observed. These findings may be used to address the development of new food‐grade gels with different textures and also for the obtention of protein microgels to encapsulate hydrophilic compounds.
Modelling the Australian J‐Curve: An ARDL Cointegration Approach
Authors: Ivanovski Kris , Awaworyi Churchill Sefa , Nuhu Ahmed Salim
Published: February 2020

This study tests for the existence of the J‐curve phenomenon in Australia using quarterly data over the period 1970–2016. The autoregressive distributed lag (ARDL) cointegration and error correction methodologies are used to examine the short‐run and long‐run impacts of the real effective exchange rate on Australia's trade balance. Baseline ARDL estimates do not lend support for the J‐curve phenomenon. Sensitivity analyses also support this finding even after controlling for the Global Financial Crisis and asymmetries in exchange rate movements. However, separately investigating the non‐resource trade balance, we find evidence of the J‐curve effect, highlighting the importance of Australia's resource sector for global export activity.
Impact of Physician–Patient Language Concordance on Patient Outcomes and Adherence to Clinical Chest Pain Recommendations
Authors: Altman Danielle E. , Sun Benjamin C. , Lin Bryan , Baecker Aileen , Samuels‐Kalow Margaret , Park Stacy , Shen Ernest , Wu Yi‐Lin , Sharp Adam
Published: February 2020

Objectives

The objective was to evaluate if there is an association between patient–physician language concordance and adverse patient outcomes or physician adherence to clinical recommendations for emergency department (ED) patients with chest pain.

Methods

We conducted a retrospective observational study of adult ED chest pain encounters with a troponin order from May 2016 to September 2017 across 15 community EDs. Outcomes were 30‐day acute myocardial infarction or all‐cause mortality, hospital admission/observation, or noninvasive cardiac testing. To assess patient outcomes, we used the overall cohort. To assess adherence to clinical recommendations, we used a subgroup of patients with a low‐risk HEART score. A mixed‐effects logistic regression model was used to compare the odds of the outcomes between language concordant and discordant patient–physician pairs, controlling for patient characteristics.

Results

Overall, 52,014 ED encounters were included (10,791 low‐risk HEART encounters). Of those 6,452 (12.4%) encounters were language discordant and 1.7% in each group had an adverse outcome. Adjusted models demonstrated no increased risk for language discordant ED encounters when comparing adverse outcomes (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.6 to 1.5) for all patients or recommended care (OR = 1.02, 95% CI = 0.87 to 1.2) for low‐risk patients.

Conclusions

No associations were found between patient–physician language concordance and outcomes or physician adherence to clinical recommendations for ED patients with chest pain. Accessible and effective interpretation services, combined with a decision support tool with standard clinical recommendations, may have contributed to equitable care.
Fetal Alcohol Exposure Alters Mammary Epithelial Cell Subpopulations and Promotes Tumorigenesis
Authors: Saboya Mariana , Jetzt Amanda E. , Datar Ketaki , Cohick Wendie S.
Published: February 2020

Background

Fetal alcohol exposure (FAE) increases the risk of mammary tumorigenesis in adult offspring; however, the underlying mechanism remains unknown. This study tested the hypothesis that FAE shifts the mammary epithelial cell (MEC) composition toward one that promotes tumorigenesis.

Methods

Pregnant Friend Virus B NIH Jackson dams bred to MMTV‐Wnt1 male mice were given ad libitum access to 5% alcohol in 0.2% saccharin solution from GD9‐10 and 10% alcohol in 0.2% saccharin from GD11‐GD19 or 0.2% saccharin solution from GD9‐GD19. Thoracic and inguinal mammary glands from wild‐type (WT) and transgenic (Tg) female offspring were harvested at 5 and 10 weeks of age and dissociated to yield a single cell suspension enriched for MECs for flow cytometry, mammosphere assay, and gene analysis. A subset of Tg offspring was followed for tumor formation.

Results

WT glands of FAE animals exhibited a decreased basal cell population and increased luminal: basal ratio at 10 weeks of age. qRT‐PCR analysis of total MECs found that Hey1 mRNA expression was increased in the WT FAE group at 10 weeks of age. In Tg glands, FAE increased the luminal progenitor cell population at 5 weeks of age but did not alter MEC composition at 10 weeks of age. Tertiary mammosphere‐forming efficiency was greater in the WT glands of FAE animals at 10 weeks of age. Tumor latency was decreased in the FAE group. Flow cytometry analysis indicated that FAE females developed tumors with an increased basal cell population.

Conclusions

These data indicate that FAE can shift MEC subpopulations, increasing the proportion of cells that are potentially vulnerable to transformation and affecting cancer risk.
Drinking risk varies within and between Australian Aboriginal and Torres Strait Islander samples: a meta‐analysis to identify sources of heterogeneity
Authors: Conigrave James H. , Lee K. S. Kylie , Zheng Catherine , Wilson Scott , Perry Jimmy , Chikritzhs Tanya , Slade Tim , Morley Kirsten , Room Robin , Callinan Sarah , Hayman Noel , Conigrave Katherine M.
Published: February 2020

Background and Aims

To reduce health and social inequities, it is important to understand how drinking patterns vary within and between Indigenous peoples. We aimed to assess variability in estimates of Indigenous Australian drinking patterns and to identify demographic and methodological factors associated with this.

Design

A three‐level meta‐analysis of Australian Aboriginal and Torres Strait Islander (‘Indigenous’) drinking patterns [International Prospective Register of Systematic Reviews (PROSPERO) no. CRD42018103209].

Setting

Australia.

Participants

Indigenous Australians.

Measurements

The primary outcomes extracted were drinking status, single‐occasion risk and life‐time risk. Moderation analysis was performed to identify potential sources of heterogeneity. Moderators included gender, age, socio‐economic status, local alcohol restrictions, sample population, remoteness, Australian state or territory, publication year, Indigenous involvement in survey design or delivery and cultural adaptations.

Findings

A systematic review of the literature revealed 41 eligible studies. For all primary outcomes, considerable heterogeneity was identified within (
= 51.39–68.80%) and between (
= 29.27–47.36%) samples. The pooled proportions (P) of current drinkers [P = 0.59, 95% confidence interval (CI) = 0.53–0.65], single‐occasion (P = 0.34, 95% CI = 0.24–0.44) and life‐time (P = 0.21, 95% CI = 0.15–0.29) risk were all moderated by gender, age, remoteness and measurement tool. Reference period moderated proportions of participants at single‐occasion risk.

Conclusions

Indigenous Australian drinking patterns vary within and between communities. Initiatives to reduce high‐risk drinking should take account of this variability.
THE THOMBO TREASURE. COLONIAL POPULATION ADMINISTRATION AS SOURCE FOR THE HISTORICAL DEMOGRAPHY OF EARLY MODERN SRI LANKA
Authors: Kok Jan
Published: February 2020

During their occupation of Sri Lanka (1640–1796) and following Sinhalese and Portuguese practices, the Dutch created an elaborate registration of people, estates, and labour services. The administrative records known as the thombos are incomparable in their level of detail, yet they have hardly been used for the purposes of demographic or economic history. This article describes the challenges involved in ‘decoding’ the thombos, that is, reconstructing the meaning of particular variables in the light of the prevailing legal pluralism in which Sinhalese common law and Roman‐Dutch law co‐existed uncomfortably. It also summarises research findings from a pilot study involving about two hundred small villages in Colombo province. Finally, it sketches research horizons, as the thombo ‘treasure’ holds great prospects for (comparative) studies into family systems and the impact of colonial rule on fertility and mortality.
Predictors of unplanned hospitalisation in the older population: The role of polypharmacy and other medication and chronic disease‐related factors
Authors: Masnoon Nashwa , Shakib Sepehr , Kalisch Ellett Lisa , Caughey Gillian E.
Published: February 2020

Objective

To identify demographic and medication‐related predictors of unplanned hospitalisation and combine them into a hospitalisation risk score.

Methods

Patients aged ≥65 years from an outpatient multimorbidity clinic were included. Hospitalisation predictors within a year of clinic discharge were identified using logistic regression. A risk score was developed. The area under the curve (AUC) was used to assess its predictive ability, compared to that of the medicines count (definition of polypharmacy).

Results

A total of 598 patients were included (median age of 80.0 years). 58.0% (n = 347) were hospitalised within a year of clinic discharge. The AUC for the risk score incorporating age, medicines count, heart failure (HF), atherosclerotic disease and systemic steroids was 0.67 [95% CI 0.62‐0.71], compared to 0.62 [95% CI 0.58‐0.67] for the medicines count.

Conclusion

A hospitalisation risk score incorporating demographics, medicines, namely steroids, and diseases such as HF had increased predictive ability compared to the medicines count, providing guidance for developing future polypharmacy tools.
Repression Technology: Internet Accessibility and State Violence
Authors: Gohdes Anita R.
Published: February 2020

This article offers a first subnational analysis of the relationship between states' dynamic control of Internet access and their use of violent repression. I argue that where governments provide Internet access, surveillance of digital information exchange can provide intelligence that enables the use of more targeted forms of repression, in particular in areas not fully controlled by the regime. Increasing restrictions on Internet accessibility can impede opposition organization, but they limit access to information on precise targets, resulting in an increase in untargeted repression. I present new data on killings in the Syrian conflict that distinguish between targeted and untargeted events, using supervised text classification. I find that higher levels of Internet accessibility are associated with increases in targeted repression, whereas areas with limited access experience more indiscriminate campaigns of violence. The results offer important implications on how governments incorporate the selective access to communication technology into their strategies of coercion.
Systematic review: gastric microbiota in health and disease
Authors: Rajilic‐Stojanovic Mirjana , Figueiredo Ceu , Smet Annemieke , Hansen Richard , Kupcinskas Juozas , Rokkas Theo , Andersen Leif , Machado Jose C. , Ianiro Gianluca , Gasbarrini Antonio , Leja Marcis , Gisbert Javier P. , Hold Georgina L.
Published: February 2020

Background

Helicobacter pylori is the most infamous constituent of the gastric microbiota and its presence is the strongest risk factor for gastric cancer and other gastroduodenal diseases. Although historically the healthy stomach was considered a sterile organ, we now know it is colonised with a complex microbiota. However, its role in health and disease is not well understood.

Aim

To systematically explore the literature on the gastric microbiota in health and disease as well as the gut microbiota after bariatric surgery.

Methods

A systematic search of online bibliographic databases MEDLINE/EMBASE was performed between 1966 and February 2019 with screening in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Randomised controlled trials, cohort studies and observational studies were included if they reported next‐generation sequencing derived microbiota analysis on gastric aspirate/tissue or stool samples (bariatric surgical outcomes).

Results

Sixty‐five papers were eligible for inclusion. With the exception of H pylori‐induced conditions, overarching gastric microbiota signatures of health or disease could not be determined. Gastric carcinogenesis induces a progressively altered microbiota with an enrichment of oral and intestinal taxa as well as significant changes in host gastric mucin expression. Proton pump inhibitors usage increases gastric microbiota richness. Bariatric surgery is associated with an increase in potentially pathogenic proteobacterial species in patient stool samples.

Conclusion

While H pylori remains the single most important risk factor for gastric disease, its capacity to shape the collective gastric microbiota remains to be fully elucidated. Further studies are needed to explore the intricate host/microbial and microbial/microbial interplay.
Relative efficiency of using summary versus individual data in random‐effects meta‐analysis
Authors: Chen Ding‐Geng , Liu Dungang , Min Xiaoyi , Zhang Heping
Published: February 2020

Meta‐analysis is a statistical methodology for combining information from diverse sources so that a more reliable and efficient conclusion can be reached. It can be conducted by either synthesizing study‐level summary statistics or drawing inference from an overarching model for individual participant data (IPD) if available. The latter is often viewed as the “gold standard.” For random‐effects models, however, it remains not fully understood whether the use of IPD indeed gains efficiency over summary statistics. In this paper, we examine the relative efficiency of the two methods under a general likelihood inference setting. We show theoretically and numerically that summary‐statistics‐based analysis is at most as efficient as IPD analysis, provided that the random effects follow the Gaussian distribution, and maximum likelihood estimation is used to obtain summary statistics. More specifically, (i) the two methods are equivalent in an asymptotic sense; and (ii) summary‐statistics‐based inference can incur an appreciable loss of efficiency if the sample sizes are not sufficiently large. Our results are established under the assumption that the between‐study heterogeneity parameter remains constant regardless of the sample sizes, which is different from a previous study. Our findings are confirmed by the analyses of simulated data sets and a real‐world study of alcohol interventions.
Prospects for achieving treatment‐free remission in chronic myeloid leukaemia
Authors: Saglio Giuseppe , Gale Robert P.
Published: February 2020

In addition to the best possible overall survival, discontinuation of the tyrosine kinase‐inhibitor (TKI) treatment [treatment free remission (TFR)] without observing a recurrence of the disease has become a major goal of the therapy of chronic myelogenous leukemia (CML). Many clinical studies have demonstrated that TFR is possible, although for the moment limited to a fraction of the CML patients able to achieve a stable deep molecular response (DMR). The factors associated to the possibility of remaining in TFR or of losing it, have been investigated by a number of controlled and observation clinical trials and although total TKI treatment duration, DMR duration and stability and, more recently, also the depth of the molecular response obtained at the time of discontinuation have been shown to be significant elements, most of the factors associated with a higher possibility of a successful discontinuation still remain elusive and are here reviewed.
“Always trying to walk a bit of a tightrope”: The role of social care staff in supporting adults with intellectual and developmental disabilities to develop and maintain loving relationships
Authors: Bates Claire , McCarthy Michelle , Milne Skillman Karen , Elson Nicola , Forrester‐Jones Rachel , Hunt Siobhan
Published: February 2020

Accessible Summary

Support staff play an important role in helping people with learning disabilities to meet a partner and have a relationship.

Not getting good support can make it difficult for people to have a relationship.

Many support staff want to help people to have a relationship, but are worried about people being abused. This is especially true for those who do not have a lot of staff support.

Support staff do not always get good support themselves to help people with learning disabilities to have relationships, such as training and a policy to follow. This makes it hard for them to know what they are allowed to help with.

Background

People with intellectual and developmental disabilities face challenges in developing and maintaining intimate relationships, frequently requiring support from staff.

Method

Focus groups were conducted with 26 social care staff members to explore the support they provided to people with intellectual and developmental disabilities to find a potential partner and/or develop an existing relationship.

Results

Staff reported that many people with intellectual and developmental disabilities wanted to be in a relationship and that they did what they could to facilitate this, sometimes providing substantial support. Some staff had to address complex issues relating to sexuality, often with no training and with a lack of clear organisational policies.

Conclusion

The need for external inspection and regulatory bodies to prioritise relationship support is emphasised.
Mitochondrial ion channels in pancreatic β‐cells: Novel pharmacological targets for the treatment of Type 2 diabetes
Authors: De Marchi Umberto , Fernandez‐Martinez Silvia , de la Fuente Sergio , Wiederkehr Andreas , Santo‐Domingo Jaime
Published: February 2020

Pancreatic beta‐cells are central regulators of glucose homeostasis. By tightly coupling nutrient sensing and granule exocytosis, beta‐cells adjust the secretion of insulin to the circulating blood glucose levels. Failure of beta‐cells to augment insulin secretion in insulin‐resistant individuals leads progressively to impaired glucose tolerance, Type 2 diabetes, and diabetes‐related diseases. Mitochondria play a crucial role in β‐cells during nutrient stimulation, linking the metabolism of glucose and other secretagogues to the generation of signals that promote insulin secretion. Mitochondria are double‐membrane organelles containing numerous channels allowing the transport of ions across both membranes. These channels regulate mitochondrial energy production, signalling, and cell death. The mitochondria of β‐cells express ion channels whose physio/pathological role is underappreciated. Here, we describe the mitochondrial ion channels identified in pancreatic β‐cells, we further discuss the possibility of targeting specific β‐cell mitochondrial channels for the treatment of Type 2 diabetes, and we finally highlight the evidence from clinical studies.

LINKED ARTICLES

This article is part of a themed issue on Cellular metabolism and diseases. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.10/issuetoc
Taylor‐AMS features and deep convolutional neural network for converting nonaudible murmur to normal speech
Authors: Rajesh Kumar T. , Suresh G. R , Kanaga Subaraja S. , Karthikeyan C.
Published: February 2020

Communication becomes effective when the speech signal arrives with the profound characteristics. This insisted the researchers to develop an automatic system of recognizing the speech signals from the murmurs. Some of the traditional automatic recognition systems are unfit for the silent environments imposing a need for an effective recognition system. Also, the traditional automatic recognition methods, like Neural Networks, render poor performance in the presence of the murmurs. Thus, this article proposes a method for automatic whisper recognition using the Deep Convolutional Neural Network (DCNN). The training of the DCNN is performed using the proposed Stochastic‐Whale Optimization Algorithm (Stochastic‐WOA), which is designed by the integration of Stochastic Gradient Descent algorithm with WOA. The input to the classifier is the features that include pitch chroma, spectral centroid, spectral skewness, and Taylor‐Amplitude Modulation Spectrogram (Taylor‐AMS), which is obtained by combining Taylor series and Amplitude Modulation Spectrogram (AMS) features, of the preprocessed input speech signal. The experimentation of the method is performed using the real database and the analysis proves that the proposed method acquired a maximal accuracy of 0.9723, minimal False Positive Rate of 0.0257, and maximal True Positive Rate of 0.9981, respectively.
Microalbuminuria assessment after thoracic surgery: Early identification of complication risks
Authors: Cagini Lucio , Andolfi Marco , Potenza Rossella , Ceccarelli Silvia , Vannucci Jacopo , Berti Valeria , Reboldi Gianpaolo , Puma Francesco
Published: February 2020

Introduction

Microalbuminuria (MA) is considered a reflection of systemic capillary leak and an early marker of acute stress reaction to the surgical insult, proportional to the severity of the initiating condition and predictive of the individual response to surgical stress.

Objectives

We conducted a prospective study to assess for the variation of MA within 4 days after thoracic surgery. We correlated observed MA levels with both their respective PaO2/FiO2 respiratory ratio and the onset of postoperative complications.

Methods

This single‐centre study enrolled 255 consecutive patients having an American Society of Anaesthesiologists (ASA) score ≤ 3. The mean age was 62 years with 67% male. All patients were scheduled for elective pulmonary resection. MA was measured in urine samples as the albumin‐to‐creatinine ratio (A/C), prior to, at and after extubation up to 96 hours. PaO2/FiO2 was measured at extubation and on the first postoperative day.

Results

Overall, preoperative A/C levels resulted normal, with a significant average increase at extubation which peaked 6 hours later (P < 0.001). Larger postoperative A/C increases were observed in patients who developed postoperative complications, compared to those without these complications (P < 0.019). Moreover, patients undergoing major open pulmonary resections had larger postoperative A/C increases, compared to those undergoing minor video‐assisted thoracic surgery resections (P < 0.006). At the time of extubation, A/C was inversely related to the PaO2/FiO2 ratio (r = −0.25; P = 0.038). Peak A/C > 61 mg/g (P = 0.0003) was associated with postoperative cardio‐pulmonary complications (OR 3.85; P = 0.003).

Conclusion

Within 6 hours after extubation, MA assessment may be a rapid and relatively inexpensive method for better predicting perioperative risk in an ASA score ≤ 3 population.
Exploratory Analysis to Identify Concepts, Skills, Knowledge, and Tools to Educate Business Analytics Practitioners
Authors: Johnson Marina E. , Albizri Abdullah , Jain Rashmi
Published: February 2020

Recent technological advancements in data storage and processing have changed how companies conduct their business. An increasing number of firms have started putting their efforts in extracting information from their databases to improve profitability and reduce costs using quantitative approaches. Thus, the job market has been experiencing a rapidly growing demand for business analytics (BA) practitioners, and universities across the globe are increasingly responding to this newly emerged field by offering both undergraduate and graduate level degrees as well as certificate programs. Thus, this research aims to provide a framework for academic institutions to develop a state‐of‐the‐art master's in business analytics (MSBA) curriculum by identifying concepts, skills, knowledge, and tools (CSKT) that industry seeks in BA practitioners. Our data‐driven methodology utilizes peer institution analysis, indeed.com web scraping, and focus group analysis with mid‐ and senior‐level analytics leaders from major companies. Our contribution to the literature and recommendations to institutions developing MSBA programs are offered at the end.
Geographic variation in the habitat preference of a scarce predatory insect: evolutionary and conservation perspectives
Authors: Sloggett John J. , Zeilstra Ilja
Published: February 2020

1. While there has been considerable focus on prey occurrence as a factor determining the habitat preference of predators, the roles of other factors related to the habitat are less well characterised.

2. In aphidophagous ladybird beetles (Coleoptera: Coccinellidae), a number of species are more restricted in the habitats in which they live than are their prey. A number of such ladybirds appear to show geographic variation in habitat preference.

3. To better understand these phenomena, this study considered geographic variation in habitat preference in one such species, the 5‐spot ladybird Coccinella quinquepunctata. Because of this ladybird's scarcity, a combination of over 20 years' observations, habitat surveys and online data was used to reach the study's conclusions.

4. The data collected indicate that the ladybird is specialised in pioneer habitats close to water, but broadens its range to non‐riverine pioneer habitats in north‐west continental Europe, where it is likely that a damper (micro)climate allows it to do so. Thus, microclimatic factors appear to be important in determining the habitat of this and probably other predators that are not constrained by prey occurrence.

5. Although threatened by river management elsewhere, in north‐western Europe, this species clearly benefits from human activity, which creates many of the disturbed habitats it colonises there. This finding provides further support for the contention that many ladybirds are net beneficiaries of human influence, although they are often characterised as threatened.
Changes in inflammation are related to depression and amount of aerobic exercise in first episode schizophrenia
Authors: Ventura Joseph , McEwen Sarah , Subotnik Kenneth L. , Hellemann Gerhard S. , Ghadiali Manali , Rahimdel Amir , Seo Min Jee , Irwin Michael R. , Nuechterlein Keith H.
Published: February 2020

Introduction

Elevated levels of pro‐inflammatory cytokines have been reported in meta‐analyses of multi‐episode schizophrenia patients when compared to controls. However, little is known about whether these same relationships are present in the early course of schizophrenia.

Objective

To assess first episode schizophrenia patients for depression and to assay blood samples collected at baseline and at 6 months for interleukin‐6 (IL‐6).

Materials and Methods

Trained raters used the Brief Psychiatric Rating Scale to assess depressive symptoms and a standard lab assay kit to assess for IL‐6 levels in plasma.

Conclusions

Decreases in pro‐inflammatory IL‐6 levels were significantly related to decreases in depressive symptoms. Within a subset of patients in a 6‐month aerobic exercise protocol, the number of exercise sessions completed was significantly correlated with the amount of decrease in IL‐6. The reductions observed in IL‐6 with aerobic exercise suggest exercise is a promising intervention to reduce brain inflammation effects in schizophrenia patients.
Tackling the challenge of the impact of continuing education: An evidence synthesis charting a global, cross‐professional shift away from counting hours
Authors: Bullock Alison , Kavadella Argyro , Cowpe Jonathan , Barnes Emma , Quinn Barry , Murphy Denis
Published: February 2020

Introduction

Health professionals worldwide are required to maintain their knowledge and skills through continuing education. However, there is limited evidence that the accumulation of hours of educational activity enhances practice. The aim of this study was to review evidence of the impact of continuing professional development (CPD), best educational practice and new models of CPD requirements.

Methods

We conducted a rapid evidence synthesis, reviewing literature and websites on continuing education for healthcare and non‐healthcare professionals.

Results

We extracted data from 184 publications. Evidence of changed practice and improved patient care is uncommon in studies of CPD. What evidence there is suggests that activities are more likely to have impact if a combination of methods is used and if they are aligned with learning needs. Impact is also affected by the learner and their work environment. In terms of CPD requirements, we identified three models: input‐based; outcomes‐based and mixed models. We found a clear shift from quantitative, time‐serving, input‐models to outcomes‐focused models which emphasise the identification of learning needs, selection of educational activity relevant to practice and reflection on practice improvement. Across a range of professions, recently updated CPD regulations no longer require registrants to accumulate CPD hours/points/credits.

Conclusion

Outcomes‐based models support registrants’ engagement in relevant, meaningful CPD which holds greater potential to positively impact on practice and strengthen patient safety. In funding this study, the UK General Dental Council exemplifies its commitment to reviewing its CPD requirments.
Breaking the deadlock of mistrust? A participative model of the structural reforms in higher education in Poland
Authors: Antonowicz Dominik , Kulczycki Emanuel , Budzanowska Anna
Published: February 2020

Polish higher education provides a particular example of a system that, until very recently, has been largely reform‐resistant as it has a long‐standing tradition of bottom‐up ‘academic self‐governance’ at both the system and the institutional levels. This article explores the process of the structural reforms of the higher education system, commonly known as ‘Law 2.0’ (the original term being ‘Ustawa 2.0’) which proceeded between 2016 and 2018. By doing so, it examines in detail the process of policy formation that has been often advertised as a ‘reform different than others’ due to paying special attention to mechanisms of engaging various stakeholders (mostly internal) and an intellectual contribution from the academic community. This study is conceptual by nature but empirically focused. The paper claims that the major reasons for failure were a radical shift in policy process and a departure from the well‐entrenched patterns of policy formation and the highly politically sensitive nature of the content of the reform.
Human surveillance and phylogeny of highly pathogenic avian influenza A(H5N8) during an outbreak in poultry in South Africa, 2017
Authors: Valley‐Omar Ziyaad , Cloete Alicia , Pieterse Reneé , Walaza Sibongile , Salie‐Bassier Yusrah , Smith Mikhail , Govender Nevashan , Seleka Mpho , Hellferscee Orienka , Mtshali Phillip Senzo , Allam Mushal , Ismail Arshad , Anthony Tasneem , Seutloali Michelle , McCarthy Kerrigan , van Helden Lesley , Cohen Cheryl , Treurnicht Florette Kathleen
Published: February 2020

Background

In June 2017, an outbreak of the highly pathogenic avian influenza A(H5N8) was detected in commercial poultry farms in South Africa, which rapidly spread to all nine South African provinces.

Objectives

We conducted active surveillance for the transmission of influenza A(H5N8) to humans working with infected birds during the South African outbreak.

Methods

Influenza A(H5N8)‐positive veterinary specimens were used to evaluate the ability of real‐time PCR‐based assays to detect contemporary avian influenza A(H5N8) strains. Whole genome sequences were generated from these specimens by next‐generation sequencing for phylogenetic characterization and screening for mammalian‐adaptive mutations.

Results

Human respiratory samples from 74 individuals meeting our case definition, all tested negative for avian influenza A(H5) by real‐time PCR, but 2 (3%) were positive for human influenza A(H3N2). 54% (40/74) reported wearing personal protective equipment including overalls, boots, gloves, masks, and goggles. 94% (59/63) of veterinary specimens positive for H5N8 were detected on an influenza A(H5) assay for human diagnostics. A commercial H5N8 assay detected H5 in only 6% (3/48) and N8 in 92% (44/48). Thirteen (13/25; 52%) A(H5N8) genomes generated from veterinary specimens clustered in a single monophyletic clade. These sequences contained the NS (P42S) and PB2 (L89V) mutations noted as markers of mammalian adaptation.

Conclusions

Diagnostic assays were able to detect and characterize influenza A(H5N8) viruses, but poor performance is reported for a commercial assay. Absence of influenza A(H5N8) in humans with occupational exposure and no clear impression of molecular adaptation for mammalian infection suggest that this avian pathogen continues to be low‐risk human pathogen.
Exploring the prevalence and management of wounds for people with dementia in long‐term care
Authors: Parker Christina N. , Finlayson Kathleen J. , Edwards Helen E. , MacAndrew Margaret
Published: February 2020

The prevalence of wounds and comorbidities such as dementia increase with age. With an ageing population, the likelihood of overlap of these conditions is strong. This study aimed to determine the prevalence of wound types and current management strategies of wound care for people with dementia in long‐term care (LTC). A scoping literature review, a cross‐sectional observational and chart audit study of residents in dementia specific facilities in LTC were conducted. The scoping review indicated that people with dementia/cognitive impairment are often excluded from wound related studies andof the nine studies included in this review, none looked at the prevalence of types of wounds other then pressure injuries. In the skin audit, skin tears were noted as the most common wound type with some evidence‐based practice strategies in place for residents. However, documentation of current wound occurred in less than a third of residents with wounds. This is the first study to note the prevalence of different wound types in people with dementia and current management strategies being used across two dementia‐specific facilities and a lack of research in this area limits evidence in guiding practice.
Predictors of rehospitalization for community‐dwelling older adults with chronic heart failure: A structural equation model
Authors: Ma Chunhua , Zhou Wei
Published: February 2020

Aims

To examine the effects of health literacy, activities of daily living, frailty and self‐care on rehospitalization for older adults with chronic heart failure using a structural equation model.

Design

This was a cross‐sectional study.

Methods

Two hundred and seventy‐one older patients with chronic heart failure were recruited using a convenience sampling method from three community healthcare centres in Guangzhou, Southern China. The data were collected using a questionnaire survey between April 2018 and October 2018 by three research assistants.

Findings

The proposed model revealed a good fit to the data (χ2/d.f. = 2.39, root mean square error of approximation = 0.06, goodness of fit index = 0.93, comparative fit index = 0.91, normed fit index = 0.91). Health literacy (β = 0.21), activities of daily living (β = 0.43), frailty (β = 0.29) and self‐care (β = 0.40) directly affected the rehospitalization of older patients with chronic heart failure. Health literacy (β = 0.19), activities of daily living (β = 0.36) and frailty (β = 0.33) indirectly affected rehospitalization through self‐care. Frailty (β = 0.16) indirectly affected rehospitalization by activities of daily living. Activities of daily living had the highest direct and total effects on rehospitalization; the effect values were 0.43 and 0.57, respectively.

Conclusion

Community‐dwelling older adults with chronic heart failure who had limited health literacy, frailty, declined activities of daily living and lower self‐care were eligible for rehospitalization. Self‐care and activities of daily living were considered mediators between rehospitalization and its predictors. A future longitudinal study is required to validate the results.

Impact

Tailored and targeted measures aiming to enhance self‐care and activities of daily living have been developed for older patients with chronic heart failure because they are not only predictors but also mediators. Assessment of health literacy level of this population is the first step before developing health education. Frailty of patients with chronic heart failure should be reduced to a minimum level.
Role expectations and workplace relations experienced by men in nursing: A qualitative study through an interpretive description lens
Authors: Smith Christopher M. , Lane Susan H. , Brackney Dana E. , Horne Carolyn E.
Published: February 2020

Aims

The aim of this study was to investigate the lived experiences of male nurses in today's healthcare environment to understand the persistently low numbers of men in nursing.

Design

This study used interpretive description methodology, which aligns with nursing's approach to knowledge discovery by acknowledging the evolution and complexity of shared and individual experiences.

Methods

Participants, (N = 11), were recruited through the American Association for Men in Nursing using purposive sampling. Focused interviews were conducted between May 2018 – June 2018. Interviews were semi‐structured, guided by open‐ended questions and video and audio recorded. Data were analysed according to study design with categories and themes extracted using reliability measures.

Results

This study's findings reflected the unique experiences of each participant in a primarily female dominated work environment in clinical and academic settings. Our study identified thematic categories of role expectations and workplace relations for the men in the study. Role expectations were influenced by sociocultural views, professional acceptance and patient/family perceptions. Workplace relations were associated with being male, social cliques and peer support.

Conclusion

Participants shared similar and distinctly individual experiences. Findings from this study indicate there has been progress toward improving male presence in nursing but additional efforts are needed to increase inclusivity. Findings can be used to make recommendations for professional change in nursing, strengthen diversity by refining ways to recruit more men, enhance patients' experiences and improve experiences for future male nurses.

Impact

This study addressed low numbers of men in nursing. Main findings included role expectations and workplace relations and how they are experienced by men in nursing. Findings from this research have a multidisciplinary impact in the workplace, and affect care of patients and their families.
Bullying in nursing evaluated by the Negative Acts Questionnaire‐Revised: A systematic review and meta‐analysis
Authors: Serafin Lena , Sak‐Dankosky Natalia , Czarkowska‐Pączek Bożena
Published: February 2020

Aims

To report a synthesis of the empirical studies that used the Negative Acts Questionnaire‐Revised (NAQ‐R) to assess bullying among nurses based on evaluation of the psychometric properties and use and usability of the instrument and identification of the variables associated with bullying.

Design

Systematic review and meta‐analysis.

Data sources

Four databases were used in the literature search: PubMed, CINAHL, PsycINFO and Scopus. The search was limited to original publications describing results of empirical studies written in English or Polish and published in peer‐reviewed journals between 2002 and 2018.

Review methods

Two reviewers independently assessed eligibility, extracted data and conducted quality assessment. Based on the extracted data, three separate meta‐analyses were conducted.

Results

Thirty‐one articles were included in the review, 13 of which were selected for meta‐analysis. In studies where participants reported bullying (N = 19), its prevalence ranged from 17–94%. Variables most often associated with bullying were age, educational level and years of professional experience. Usability of this instrument in different countries was supported by a high reliability in each study. In two meta‐analyses, which included 12 studies with mean NAQ‐R and item scores, the heterogeneity of data was calculated as high and moderate respectively.

Conclusion

The good quality of the NAQ‐R in determining variables related to bullying is endorsed. Variables related to bullying identified in this review could be used to map out a model of a potential bullying victim for preventative measures.

Impact

The NAQ‐R is a useful and reliable tool for measuring bullying among nurses; however, there remains a strong need to assure that a verified, standardized and updated bullying taxonomy is used in future studies to ensure reliable and comparable data. A model of a potential bullying victim may help nursing directors foster a healthier workplace environment, thereby improving patient outcomes in the long‐term.
Impact of atrial programmed electrical stimulation techniques on unipolar electrogram morphology
Authors: Knops Paul , Schram‐Serban Corina , van der Does Lisette , Croes Marshall , Houben Richard , de Groot Natasja
Published: February 2020

Introduction

Intra‐atrial conduction abnormalities are associated with the development of atrial fibrillation (AF) and cause morphological changes of the unipolar atrial electrogram (U‐AEGM). This study examined the impact of different atrial programmed electrical stimulation (APES) protocols on U‐AEGM morphology to identify the most optimal APES protocol provoking conduction abnormalities.

Methods

APES techniques (14 protocols) were applied in 30 patients referred for an electrophysiology study, consisting of fixed rate, extra, and decremental stimuli at different frequencies. U‐AEGM morphologies including width, amplitude, and fractionation for patients without (control group) and with a history of AF (AF group) were examined during APES. In addition, sinus rhythm (SR) U‐AEGMs preceding different APES protocols were compared to evaluate the morphology stability over time.

Results

U‐AEGM morphologies during SR before the APES protocols were comparable (all P > .396). Atrial refractoriness was longer in the AF group compared to the control group (298 ± 48 vs 255 ± 33 ms; P ≤ .020), but did not differ between AF patients with and without amiodarone therapy (278 ± 48 vs 311 ± 40 ms; P ≥ .126). Compared to the initial SR morphology, U‐AEGM width, amplitude, and fractionation changed significantly during the 14 different APES protocols, particularly in the AF group. In both groups, U‐AEGM changes in morphology were most pronounced during fixed‐rate stimulation with extra stimuli (8S1‐S2 = 400‐250 ms).

Conclusion

APES results in significant changes in U‐AEGM morphology, including width, amplitude, and fractionation. The impact of APES differed between APES sequence and between patients with and without AF. These findings suggest that APES could be useful to identify AF‐related conduction abnormalities in the individual patient.
Illness and two meanings of phenomenology
Authors: Crişan Horaţiu Traian , Copoeru Ion
Published: February 2020

Background

When approaching medicine, phenomenology has at least two meanings that need to be distinguished in order to become relevant in its application to medical practice. Up to now, these two meanings have been overlapped by most of the scholarly literature. Therefore, the purpose of the article is to differentiate between them, thus endorsing their potential use in medical practice.

Methods

The first meaning was instituted by Edmund Husserl and views phenomenology as transcendental, ie, as a transcendental rigorous science based on the unravelling of transcendental subjectivity/intersubjectivity. The second takes it more as a narrative enterprise, ie, as a description of personal subjective experience, thus seeming closer to other approaches to disease which can be found both in philosophy and other fields. Nevertheless, both provide advantages and disadvantages when it comes to approaching illness.

Results

Neither of the two meanings can supersede the other and, consequently, neither of the two analogue forms of phenomenology can impose itself as the phenomenology of medicine.

Conclusion

It is important to clarify the consequences of applying each of the two understandings of phenomenology to medicine in the context of its current development. Our present inquiry concerns not merely the disentanglement of the status of what today's scholarly literature calls phenomenology of medicine in relation to meanings of phenomenology, but also the limits of applying phenomenology to the field of medicine.
The filter‐feeding bivalve Mytilus chilensis capture pelagic stages of Caligus rogercresseyi: A potential controller of the sea lice fish parasites
Authors: Montory Jaime A. , Chaparro Oscar R. , Averbuj Andres , Salas‐Yanquin Luis P. , Büchner‐Miranda Joseline A. , Gebauer Paulina , Cumillaf Juan P. , Cruces Edgardo
Published: February 2020

The copepod Caligus rogercresseyi is an ectoparasite of several salmonid species. The pumping activity of filter‐feeding molluscs could reduce the abundance of copepod dispersive larval stages in the water column. In this research, nauplius II and copepodid larvae of C. rogercresseyi were exposed to filtering mussels (Mytilus chilensis) of different sizes. These mussels were able to filter both larval stages, although they were more efficient in catching nauplius II. The fact that nauplius II were ingested more efficiently could be explained by their smaller size, lower swimming velocity (escape) and longer resting times between movements, when they were exposed to the influx of water around the inhalant area of the mussels. Larger mussels were more effective filtering C. rogercresseyi larvae due to their larger inhalant area and the related water influx. Additionally, the results suggest that larvae captured by the mussels can be incorporated into pseudofaeces or ingested and then released as part of the faeces. Thus, high concentrations of M. chilensis surrounding salmon farms may act as biological barriers, reducing the density of copepod dispersive larval stages and, thus, salmon infestations.