bluuebunny/crossref_metadata_2025 huggingface dataset:
Biofilm adaptation to iron availability in the presence of biotite and consequences for chemical weathering
Authors: Grant M. R. , Tymon L. S. , Helms G. L. , Thomashow L. S. , Kent Keller C. , Harsh J. B.
Published: July 2016

Bacteria in nature often live within biofilms, exopolymeric matrices that provide a favorable environment that can differ markedly from their surroundings. Biofilms have been found growing on mineral surfaces and are expected to play a role in weathering those surfaces, but a clear understanding of how environmental factors, such as trace‐nutrient limitation, influence this role is lacking. Here, we examine biofilm development byPseudomonas putidain media either deficient or sufficient in Fe during growth on biotite, an Fe rich mineral, or on glass. We hypothesized that the bacteria would respond to Fe deficiency by enhancing biotite dissolution and by the formation of binding sites to inhibit Fe leaching from the system. Glass coupons acted as a no‐Fe control to investigate whether biofilm response depended on the presence of Fe in the supporting solid. Biofilms grown on biotite, as compared to glass, had significantly greater biofilm biomass, specific numbers of viable cells (SNVC), and biofilm cation concentrations of K, Mg, and Fe, and these differences were greater when Fe was deficient in the medium. Scanning electron microscopy (SEM) confirmed that biofilm growth altered the biotite surface, smoothing the rough, jagged edges of channels scratched by hand on the biotite, and dissolving away small, easy‐to‐access particles scattered across the planar surface. High‐resolution magic angle spinning proton nuclear magnetic resonance (HRMAS1HNMR) spectroscopy showed that, in the Fe‐deficient medium, the relative amount of polysaccharide nearly doubled relative to that in biofilms grown in the medium amended with Fe. The results imply that the bacteria responded to the Fe deficiency by obtaining Fe from biotite and used the biofilm matrix to enhance weathering and as a sink for released cation nutrients. These results demonstrate one mechanism by which biofilms may help soil microbes overcome nutrient deficiencies in oligotrophic systems.
Metastatic follicular thyroid carcinoma: a case report
Authors: Sathasivam Hans , Loh Yi M. , Saw Chee L. , Khalid Noraida
Published: July 2016

Objective

A case of oral metastatic follicular thyroid carcinoma is presented.

Background

Metastatic tumours are more frequent in older individuals and can be the only sign/symptom of an undiagnosed primary malignancy.

Case report

A 69‐year‐old lady presented with an enlarging mandibular swelling. Incisional biopsy and imaging studies were suggestive of metastatic follicular thyroid carcinoma.

Conclusion

Metastatic tumours should be considered in the differential diagnosis of mandibular swellings especially in older individuals.
Assessment and validation of a defined fluid restriction protocol in the use of subcutaneous desmopressin for children with inherited bleeding disorders
Authors: Mason J. A. , Robertson J. D. , McCosker J. , Williams B. A. , Brown S. A.
Published: July 2016

Introduction

Despite the availability of subcutaneous desmopressin (1‐deamino‐8‐d‐arginine vasopressin, SC‐DDAVP) as a haemostatic agent for children with mild bleeding disorders, few publications specifically address the safety or efficacy of this mode of administration.

Aim

Our aim was to assess whether a defined fluid restriction protocol was effective in preventing hyponatremia in children receiving perioperative SC‐DDAVP, and to document adequate biological and clinical response in this setting.

Methods

We retrospectively analysed a cohort of children with mild bleeding disorders prescribed SC‐DDAVP over a 5‐year period following institution of a ‘two‐thirds maintenance’ fluid restriction protocol.

Results

Sixty‐nine patients received SC‐DDAVP following this protocol, including 15 with mild haemophilia A, 49 with von Willebrand disease (VWD) and five with platelet storage pool disorder. In patients who underwent formal preoperative assessment a complete or partial response was observed in 28/29 with type 1 VWD and 14/15 with mild haemophilia A. Perioperative SC‐DDAVP provided excellent haemostasis in all patients, with no requirement for factor concentrate or blood products. Mild asymptomatic hyponatremia was detected in seven children who received multiple doses of DDAVP (lowest sodium 129 mmol L−1); however, adherence to the prescribed fluid restriction protocol was questionable in six of these cases. Symptomatic hyponatremia was not observed.

Conclusion

Subcutaneous desmopressin was well‐tolerated, with no serious side‐effects observed, and good biological responses in preoperative trials. A two‐thirds maintenance fluid regimen was effective at preventing symptomatic hyponatremia in our cohort, and is now the standard protocol for fluid restriction post‐DDAVP administration in our centre.
Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study
Authors: Poonnoose P. M. , Hilliard P. , Doria A. S. , Keshava S. N. , Gibikote S. , Kavitha M. L. , Feldman B. M. , Blanchette V. , Srivastava A.
Published: July 2016

Objectives

This study was undertaken to determine the correlation between the radiological changes in haemophilic arthropathy [X‐ray, Ultrasound (US) and MRI] and clinical assessment as determined by the Hemophilia Joint Health Score (HJHS); and to document the US and MRI changes in joints that appear normal on plain X‐ray and clinical evaluation.

Materials and methods

Of 55 study joints (22 knees and 33 ankles) in 51 patients with haemophilia/von Willebrand disease, with a median age of 15 years (range: 5–17) were assessed using X‐rays (Pettersson score) and clinical examination (HJHS) at two centres (Toronto, Canada; Vellore, India). MRI and ultrasonographic scoring was done through a consensus assessment by imagers at both centres using the IPSG MRI and US scores.

Results

The HJHS had a good correlation with the Pettersson score (rs = 0.66). Though the HJHS had moderate correlation with the osteochondral component of the MRI and US scores (rs 0.51, 0.45 respectively), its correlation with the soft tissue component was poor (rs 0.19; 0.26 respectively). Of the 18 joints with a Pettersson score of zero, 88.9% had changes that were detected clinically by the HJHS. Osteochondral abnormalities were identified in 38.9% of these joints by the MRI, while US images of the same joints were deemed abnormal in 83.3% by the current criteria. US identified haemosiderin and other soft tissue changes in all of the joints, while the same changes were noted in 94.4% of these joints on MRI. There were four joints with a HJHS of zero, all of which had soft tissue changes on MRI (score 1–7) and US (score 2–7). Osteochondral changes were detected in three of these joints by US and in 2 by MRI. There were four joints with an MRI score of 0–1 that had significant US scores (3–5) and HJHS scores (0–6).

Conclusion

US and MRI are able to identify pathological changes in joints with normal X‐ray imaging and clinical examination. However, further studies are required to be able to differentiate early abnormalities from normal. Clinical (HJHS) and radiological assessment (US/MRI) provide complimentary information and should be considered conjointly in the assessment of early joint arthropathy.
Age, time living with diagnosed HIV infection, and self‐rated health
Authors: McGowan JA , Sherr L , Rodger AJ , Fisher M , Miners A , Anderson J , Johnson MA , Elford J , Collins S , Hart G , Phillips AN , Speakman A , Lampe FC ,   the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) Study Group
Published: July 2016

Objectives

An increasing proportion of people living with HIV are older adults, who may require specialized care. Adverse physical and psychological effects of HIV infection may be greatest among older people or those who have lived longer with HIV.

Methods

The ASTRA study is a cross‐sectional questionnaire study of 3258 HIV‐diagnosed adults (2248 men who have sex with men, 373 heterosexual men and 637 women) recruited from UK clinics in 2011–2012. Associations of age group with physical symptom distress (significant distress for at least one of 26 symptoms), depression and anxiety symptoms (scores ≥ 10 on PHQ‐9 and GAD‐7, respectively), and health‐related functional problems (problems on at least one of three domains of the Euroqol 5D‐3L)) were assessed, adjusting for time with diagnosed HIV infection, gender/sexual orientation and ethnicity.

Results

The age distribution of participants was: < 30 years, 5%; 30–39 years, 23%; 40–49 years, 43%; 50–59 years, 22%; and ≥ 60 years, 7%. Overall prevalences were: physical symptom distress, 56%; depression symptoms, 27%; anxiety symptoms, 22%; functional problems, 38%. No trend was found in the prevalence of physical symptom distress with age [adjusted odds ratio (OR) for trend across age groups, 0.96; 95% confidence interval (CI) 0.89, 1.04; P = 0.36]. The prevalence of depression and anxiety symptoms decreased with age [adjusted OR 0.86 (95% CI 0.79, 0.94; P = 0.001) and adjusted OR 0.85 (95% CI 0.77, 0.94; P = 0.001), respectively], while that of functional problems increased (adjusted OR 1.28; 95% CI 1.17, 1.39; P < 0.001). In contrast, a longer time with diagnosed HIV infection was strongly and independently associated with a higher prevalence of symptom distress, depression symptoms, anxiety symptoms, and functional problems (P < 0.001 for trends, adjusted analysis).

Conclusions

Among people living with HIV, although health‐related functional problems were more common with older age, physical symptom distress was not, and mental health was more favourable. These results suggest that a longer time with diagnosed HIV infection, rather than age, is the dominating factor contributing to psychological morbidity and lower quality of life.
Internalized Oppression and Its Varied Moral Harms: Self‐Perceptions of Reduced Agency and Criminality
Authors: Liebow Nabina
Published: July 2016

The dominant view in the philosophical literature contends that internalized oppression, especially that experienced in virtue of one's womanhood, reduces one's sense of agency. Here, I extend these arguments and suggest a more nuanced account. In particular, I argue that internalized oppression can cause a person to conceive of herself as a deviant agent as well as a reduced one. This self‐conception is also damaging to one's moral identity and creates challenges that are not captured by merely analyzing a reduced sense of agency. To help illustrate this claim, I consider experiences of people of color who internalize stereotypes regarding criminality and moral deviance. With these examples in mind, I show that internalized prejudices regarding criminality can cause people of color (men and women) to view themselves as outlaws in the moral community, that is, as wrongdoers. This conclusion helps give voice to some of the challenges that women of color who experience multiple sorts of internalized prejudices often face. To conclude, I discuss one strategy for empowerment that women of color have used when confronted with multiple forms of internalized oppression.
Disability as Abject: Kristeva, Disability, and Resistance
Authors: Dohmen Josh
Published: July 2016

In this essay, I develop an account of disability exclusion that, though inspired by Julia Kristeva, diverges from her account in several important ways. I first offer a brief interpretation of Kristeva's essays “Liberty, Equality, Fraternity and … Vulnerability” and “A Tragedy and a Dream: Disability Revisited” and, using this interpretation, I assess certain criticisms of Kristeva's position made by Jan Grue in his “Rhetorics of Difference: Julia Kristeva and Disability.” I then argue that Kristeva's concept ofabjection,especially as developed by Sara Ahmed and Tina Chanter, offers important insights into disability oppression; Ahmed's and Chanter's contributions improve upon Kristeva's account. Understanding disability as abject helps to explain both resistances to interacting with disabled others and ways to resist disability oppression. Finally, I argue that understanding disability as abject is preferable to recent deployments of Lacanian theory in disability studies and that this account is compatible with social models of disability.
The role of heparan sulphate in development: the ectodermal story
Authors: Coulson‐Thomas Vivien Jane
Published: July 2016

Heparan sulphate (HS) is ubiquitously expressed and is formed of repeating glucosamine and glucuronic/iduronic acid units which are generally highly sulphated. HS is found in tissues bound to proteins forming HS proteoglycans (HSPGs) which are present on the cell membrane or in the extracellular matrix. HSPGs influence a variety of biological processes by interacting with physiologically important proteins, such as morphogens, creating storage pools, generating morphogen gradients and directly mediating signalling pathways, thereby playing vital roles during development. This review discusses the vital role HS plays in the development of tissues from the ectodermal lineage. The ectodermal layer differentiates to form the nervous system (including the spine, peripheral nerves and brain), eye, epidermis, skin appendages and tooth enamel.
Point‐of‐care PT and aPTT in patients with suspected deficiencies of coagulation factors
Authors: Niederdöckl J. , Dempfle C.‐E. , Schönherr H.‐R. , Bartsch A. , Miles G. , Laggner A. , Pathil A.
Published: July 2016

Introduction

There are several clinical settings and patient conditions especially in intensive care units, emergency departments, and operating theaters, where the coagulation status of a patient must be known immediately and point‐of‐care (POC) systems are beneficial due to low time to result.

Methods

This noninterventional, single‐blinded, multicenter study with prospectively collected whole blood samples was performed to evaluate the diagnostic accuracy of the CoaguChek PT Test (POC PT) and CoaguChek aPTT Test (POC aPTT) compared to standard laboratory testing in patients with suspected deficiencies of coagulation factors.

Results

In total, 390 subjects were included. Both POC PT and POC aPTT showed concordance with the laboratory PT and aPTT. Lot‐to‐lot variation was below 2% both for POC PT and for POC aPTT. The mean relative difference of capillary blood compared to venous blood was 0.2 % with POC PT and 8.4% with POC aPTT. The coefficients of variation for repeatability of POC PT using whole blood were found to be between 2% and 3.6%.

Conclusion

Our findings suggest reliable quantitative results with this POC system to support on‐site decision‐making for patients with suspected deficiencies of coagulation factors in acute and intensive care.
Psychosocial predictors and moderators of weight management programme outcomes in ethnically diverse obese youth
Authors: Taylor J. H. , Xu Y. , Li F. , Shaw M. , Dziura J. , Caprio S. , Tamborlane W. V. , Nowicka P. , Savoye M.
Published: July 2016

Background

An important area of research in childhood obesity is the identification of factors that predict or moderate the responses to obesity intervention programmes, yet few studies have examined the impact of self‐esteem and family functioning on obesity treatment outcomes.

Objectives

We sought to determine whether baseline self‐esteem and family functioning predicted or moderated childhood obesity intervention outcomes at 6 months.

Methods

From 2009 to 2011, seventy‐five 10–16 year old, racially/ethnically diverse obese youths with abnormal glucose tolerance were randomized to 6 months of an intensive family‐based obesity lifestyle intervention (Bright Bodies) or routine outpatient Clinic Care. We examined youth self‐concept, parent‐rated family functioning and 6‐month outcomes (youths' glucose tolerance, weight, body mass index and percent fat). We set the significance threshold as P ≤ 0.05 for moderator and predictor analyzes.

Results

Having poor family functioning and self‐concept scores indicating high anxiety and low self‐esteem at baseline predicted poor 6‐month outcomes overall (Bright Bodies and Clinic Care groups combined). Additionally, baseline self‐esteem and family functioning moderated treatment effects such that Bright Bodies outperformed Clinic Care in youths with low self‐esteem and poorly functioning families, whereas youths with high self‐esteem and high‐functioning families did similarly well with either intervention.

Discussion

Our findings suggest intensive family‐based lifestyle programmes are particularly beneficial for youth with low self‐esteem and poorly functioning families.
Identification and Characterization of Salt Tolerance of Wheat Germplasm Using a Multivariable Screening Approach
Authors: Oyiga B. C. , Sharma R. C. , Shen J. , Baum M. , Ogbonnaya F. C. , Léon J. , Ballvora A.
Published: July 2016

Salinity is one of the major limitations to wheat production worldwide. This study was designed to evaluate the level of genetic variation among 150 internationally derived wheat genotypes for salinity tolerance at germination, seedling and adult plant stages, with the aim of identifying new genetic resources with desirable adaptation characteristics for breeding programmes and further genetic studies. In all the growth stages, genotype and salt treatment effects were observed. Salt stress caused 33 %, 51 % and 82 % reductions in germination vigor, seedling shoot dry matter and seed grain yield, respectively. The rate of root and shoot water loss due to salt stress exhibited significant negative correlation with shoot K+, but not with shoot Na+ and shoot K+/Na+ ratio. The genotypes showed a wide spectrum of response to salt stress across the growth stages; however, four genotypes, Altay2000, 14IWWYTIR‐19 and UZ‐11CWA‐8 (tolerant) and Bobur (sensitive), exhibited consistent responses to salinity across the three growth stages. The tolerant genotypes possessed better ability to maintain stable osmotic potential, low Na+ accumulation, higher shoot K+ concentrations, higher rates of PSII activity, maximal photochemical efficiency and lower non‐photochemical quenching (NPQ), resulting in the significantly higher dry matter production observed under salt stress. The identified genotypes could be used as parents in breeding for new varieties with improved salt tolerance as well as in further genetic studies to uncover the genetic mechanisms governing salt stress response in wheat.
Molecular genetic, life‐history and morphological variation in a coastal warm‐temperate sciaenid fish: evidence for an upwelling‐driven speciation event
Authors: Henriques Romina , Potts Warren M. , Sauer Warwick H. , Santos Carmen V. , Kruger Jerraleigh , Thomas Jessica A. , Shaw Paul W.
Published: July 2016

Aim

The Benguela Upwelling System (BUS) is a major biogeographical boundary in the south‐eastern Atlantic, but little is known of the effect of historical permeability of the barrier on species distributed across the region. We used phylogenetic, life‐history and morphological analyses to test the influence of regional oceanographic features on genetic divergence, evolutionary history and ecological divergence in a warm‐temperate fish, Atractoscion aequidens.

Location

Benguela Current, south‐eastern Atlantic Ocean.

Methods

Individual At. aequidens were analysed for molecular (N = 35), biological (N = 81) and morphological (N = 282) differentiation across the BUS region. To compare patterns of genetic divergence, we also included analyses of individuals sampled from three related Argyrosomus species occurring in the area.

Results

Atractoscion aequidens comprises two deeply divergent lineages (average mtDNA genetic distance p = 0.049), which are separated by the boundary between the northern and southern Benguela subsystems. Divergence time was estimated at 2–3 Myr. Life‐history traits, such as maximum size, growth rate and size and age at maturity, differed significantly between the two lineages, but morphological features did not. Divergent life‐history traits appear to be associated with the evolution of migratory behaviour in the southern population, and thus ecological diversification across the Benguela region.

Main conclusions

The oceanographic features of the BUS constitute an impermeable barrier to the dispersal of At. aequidens across the region. The estimated time since most recent common ancestor (TMRCA) points to the strengthening of the upwelling system in the last 2 Myr as the most likely mechanism driving isolation. However, the BUS is known to have periodic disruptions, which have mediated dispersal in multiple taxa. Therefore, the depth of genetic divergence and the presence of different life‐history traits between the two lineages suggest that ecological divergence may have played a role in maintaining the observed isolation. Based on genealogical, geographical and ecological concordance, we suggest that At. aequidens is composed of two sibling species in the Benguela region and a full taxonomic revision of the genus is required.
Danshensu alleviates cardiac ischaemia/reperfusion injury by inhibiting autophagy and apoptosis via activation of mTOR signalling
Authors: Fan Guanwei , Yu Jiahui , Asare Patrick Fordjour , Wang Lingyan , Zhang Han , Zhang Boli , Zhu Yan , Gao Xiumei
Published: July 2016

The traditional Chinese medicine Danshensu (DSS) has a protective effect on cardiac ischaemia/reperfusion (I/R) injury. However, the molecular mechanisms underlying the DSS action remain undefined. We investigated the potential role of DSS in autophagy and apoptosis using cardiac I/R injury models of cardiomyocytes and isolated rat hearts. Cultured neonatal rat cardiomyocytes were subjected to 6 hrs of hypoxia followed by 18 hrs of reoxygenation to induce cell damage. The isolated rat hearts were used to perform global ischaemia for 30 min., followed by 60 min. reperfusion. Ischaemia/reperfusion injury decreased the haemodynamic parameters on cardiac function, damaged cardiomyocytes or even caused cell death. Pre‐treatment of DSS significantly improved cell survival and protected against I/R‐induced deterioration of cardiac function. The improved cell survival upon DSS treatment was associated with activation of mammalian target of rapamycin (mTOR) (as manifested by increased phosphorylation of S6K and S6), which was accompanied with attenuated autophagy flux and decreased expression of autophagy‐ and apoptosis‐related proteins (including p62, LC3‐II, Beclin‐1, Bax, and Caspase‐3) at both protein and mRNA levels. These results suggest that alleviation of cardiac I/R injury by pre‐treatment with DSS may be attributable to inhibiting excessive autophagy and apoptosis through mTOR activation.
Duration of diabetes and types of diabetes therapy in Japanese patients with type 2 diabetes: The Japan Diabetes Complication and its Prevention prospective study 3 (JDCP study 3)
Authors: Hayashino Yasuaki , Izumi Kazuo , Okamura Shintaro , Nishimura Rimei , Origasa Hideki , Tajima Naoko ,   the JDCP study group
Published: July 2016

Aims/Introduction

To analyze the association between the duration of diabetes and selection of diabetes therapy in a large database of Japanese patients with type 2 diabetes.

Materials and Methods

We used the data of 5,844 patients with type 2 diabetes to evaluate the association between the duration of diabetes and types of diabetes therapy. The logistic regression model was used to analyze the association between duration of diabetes and selection of diabetes therapy, and restricted cubic spline curves were used to represent the schematic association.

Results

Overall, clinical characteristics of the patients were women, 39.9%; mean age, 61.4 years; median duration of diabetes, 9 years; mean glycated hemoglobin, 7.4% (57.0 mmol/mol); and mean body mass index, 24.5 kg/m2. Compared with the first quartile of diabetes duration, the multivariable‐adjusted odds of any antidiabetic therapy (oral hypoglycemic agents or insulin) for the second, third and fourth quartiles were 2.17 (95% confidence interval [CI] 1.68–2.80; 3.39, 95% CI 2.53–4.54; 4.99, 95% CI 3.64–6.84), respectively (P for trend <0.001), and these associations were attenuated after adjusting possible confounders. Furthermore, those of insulin therapy were 1.48 (95% CI 1.20–1.84; 2.16, 95% CI 1.77–2.64; 4.94, 95% CI 4.04–6.04), respectively (P for trend <0.001). Schematic representation of restricted cubic spline curves analysis showed that a longer duration of diabetes was linearly associated with the odds of insulin therapy.

Conclusions

Obtained data showed that a longer duration of diabetes required complex diabetes drug regimens to be introduced to patients with type 2 diabetes.
Interprofessional Collaboration to Improve Discharge from Skilled Nursing Facility to Home: Preliminary Data on Postdischarge Hospitalizations and Emergency Department Visits
Authors: Reidt Shannon L. , Holtan Haley S. , Larson Tom A. , Thompson Bruce , Kerzner Lawrence J. , Salvatore Toni M. , Adam Terrence J.
Published: July 2016

An interprofessional collaborative practice model was established at Hennepin County Medical Center to improve discharge management from the transitional care unit of the skilled nursing facility (SNF) to home. The practice model involves a geriatrician, nurse practitioner, and pharmacist who care for individuals at a community‐based SNF. Before SNF discharge, the pharmacist conducts a chart and in‐person medication review and collaborates with the nurse practitioner to determine the discharge medication regimen. The pharmacist's review focuses on assessing the indication, safety, effectiveness, and convenience of medications. The pharmacist provides follow‐up in‐home or over the telephone 1 week after SNF discharge, focusing on reviewing medications and assessing adherence. Hospitalizations and emergency department (ED) visits 30 days after SNF discharge of individuals who received care from this model was compared with those of individuals who received usual care from a nurse practitioner and geriatrician. From October 2012 through December 2013, the intervention was delivered to 87 individuals, with 189 individuals serving as the control group. After adjusting for age, sex, race, and payor, those receiving the intervention had a lower risk of ED visits (odds ratio (OR) = 0.46, 95% confidence interval (CI) = 0.22–0.97), although there was no significant difference in hospitalizations (OR = 0.47, 95% CI = 0.21–1.08). The study suggests that an interprofessional approach involving a pharmacist may be beneficial in reducing ED visits 30 days after SNF discharge.
Evaluation of a self‐efficacy enhancement program to prevent pressure ulcers in patients with a spinal cord injury
Authors: Kim Jung Yoon , Cho Eunhee
Published: July 2016

Aim

This study developed a self‐efficacy enhancement program and evaluated its effects on the self‐care behaviors, self‐care knowledge, and self‐efficacy regarding pressure ulcer prevention in patients with a spinal cord injury.

Methods

This was a multicenter randomized controlled trial. Six hospitals were invited to recruit patients with a spinal cord injury who were undergoing rehabilitation after receiving acute treatment. These hospitals were randomly allocated into experimental (three hospitals) or control (three hospitals) groups and 47 patients participated (24 in the experimental group and 23 in the control group). The experimental group was given an 8 week self‐efficacy enhancement program for pressure ulcer prevention. The self‐efficacy enhancement program consisted of small‐group face‐to‐face intervention (education and skills training), education with computer animation, phone counseling, face‐to‐face counseling, and self‐management records. The control group only received a pressure ulcer prevention information booklet. Self‐care knowledge, self‐efficacy, self‐care behaviors, and pressure ulcer incidence were measured at baseline and after the 8 week self‐efficacy enhancement program.

Results

The experimental group showed a significantly greater improvement in self‐care knowledge, self‐efficacy, and self‐care behaviors for pressure ulcer prevention than did the control group. One participant in the control group developed a pressure ulcer, while none of the participants in the experimental group developed a pressure ulcer; this difference was not statistically significant.

Conclusions

The self‐efficacy enhancement program enabled patients with a spinal cord injury to engage in continued self‐care behaviors and helped them to improve their knowledge and self‐efficacy concerning pressure ulcer prevention.
Activities of daily living and rehabilitation needs for older adults with a stroke: A comparison of home care and nursing home care
Authors: Lee Kyongeun , Cho Eunhee
Published: July 2016

Aim

To compare the changes in benefit levels of activities of daily living (ADLs), rehabilitation, and long‐term care services (LTCS) in older adults with a stroke in different modalities of LTCS, which include home care and nursing home care.

Methods

This study analyzed national data regarding LTCS from 2008 to 2009 in South Korea. The data about 7668 older adults with a stroke were extracted from a pool of 182,535 total beneficiaries. In order to control for the baseline differences between older adults who received home care and those who received nursing home care, propensity score matching (PSM) was carried out and there were 1099 matched pairs of participants (
n
 = 2198). After the PSM, the changes in ADLs and rehabilitation between the two groups were analyzed by using a paired t‐test and the changes in LTCS benefit levels were compared by using the χ2‐test.

Results

The ADLs and rehabilitation needs of the older adults who received home care improved, while the older adults who received nursing home care experienced deterioration. After 1 year, the LTCS benefit levels were significantly different between the home care and the nursing home care groups

Conclusion

All of the ADLs, rehabilitation needs, and LTCS benefit levels for 1 year had improved in the home care patients, while they worsened in those who received nursing home care. This finding provides evidence to direct the policy of LTCS and offers information to guide older adults with a stroke and their family when deciding between the modalities of LTCS.
Being in togetherness: meanings of encounters within primary healtcare setting for patients living with long‐term illness
Authors: Nygren Zotterman Anna , Skär Lisa , Olsson Malin , Söderberg Siv
Published: July 2016

Aims and objectives

The aim of this study was to elucidate meanings of encounters for patients with long‐term illness within the primary healthcare setting.

Background

Good encounters can be crucial for patients in terms of how they view their quality of care. Therefore, it is important to understand meanings of interactions between patients and healthcare personnel.

Design

A phenomenological hermeneutic method was used to analyse the interviews.

Methods

Narrative interviews with ten patients with long‐term illness were performed, with a focus on their encounters with healthcare personnel within the primary healthcare setting. A phenomenological hermeneutical approach was used to interpret the interview texts.

Results

The results demonstrated that patients felt well when they were seen as an important person and felt welcomed by healthcare personnel. Information and follow‐ups regarding the need for care were essential. Continuity with the healthcare personnel was one way to establish a relationship, which contributed to patients' feelings of being seen and understood. Good encounters were important for patients' feelings of health and well‐being. Being met with mistrust, ignorance and nonchalance had negative effects on patients' perceived health and well‐being and led to feelings of lower confidence regarding the care received.

Conclusions

Patients described a great need to be confirmed and met with respect by healthcare personnel, which contributed to their sense of togetherness. Having a sense of togetherness strengthened patient well‐being.

Relevance to clinical practice

By listening and responding to patients' needs and engaging in meetings with patients in a respectful manner, healthcare personnel can empower patients' feelings of health and well‐being. Healthcare personnel need to be aware of the significance of these actions because they can make patients experience feelings of togetherness, even if patients meet with different care personnel at each visit.
Gender differences in feelings and knowledge about stroke
Authors: Itzhaki Michal , Melnikov Semyon , Koton Silvia
Published: July 2016

Aims and objectives

To examine gender differences in knowledge and feelings about stroke among ≥40 years old population.

Background

Knowledge of stroke is consistently found to be poor among both genders in general populations, however, it has been reported to be better among women than men. Gender differences in feelings about stroke in the general population have not been examined.

Design and methods

Data were collected from a convenience sample using semi‐structured personal interviews. Participants were representative of Israeli sub‐populations aged ≥40 with no history of stroke. Knowledge of stroke was studied with quantitative methods while constant comparative analysis was used for the qualitative data analysis of feelings evoked by stroke.

Results

One hundred and seventy‐seven participants were interviewed, 79/177 (44·6%) men and 98/177 (55·4%) women. Rates of self‐reported hypertension [33/79 (41·8%) men, 25/98 (25·5%) women] and current smoking [29/79 (36·7%) men, 18/98 (18·4%) women] were significantly higher in men than women. Over 50% men and women mentioned one‐side sudden weakness or paralysis as a stroke symptom, however, other stroke symptoms were not recognised by most participants. Education was associated with the number of identified stroke signs. Knowledge of stroke‐warning signs was better in women. The main feelings expressed by both genders were fear of dying and disability, self‐concern about survival, blaming fate and self‐accusation.

Conclusion

Stroke knowledge is poor among men and women. Higher level of education is a predictor of stroke knowledge among both genders. Gender‐specific differences in stroke risk factors and feelings about stroke in different sub‐populations should be taken into account to improve prevention of stroke through education programmes.

Relevance to clinical practice

Health education on stroke prevention should be tailored to population groups differing in level of education. Health promotion recommendations should be provided by nurses with regard to beliefs of both men and women regarding prevention of stroke.
Making sense of negligence
Authors: Hedley Steve
Published: July 2016

What is negligence? Our answers to this are frequently misleading, because we turn all our attention on to what doctrine says rather than asking how it is actually used. So we routinely talk of personal liability, even though we know very well that individuals (as opposed to organisations, typically insurers) do not pay damages. We think of negligence doctrine as if it were applied automatically and without bias, when in fact the complex insurance arrangements involved have rather decided biases. And we treat the development of the law purely as a matter of evolving judicial thought, when in fact legislatures and insurers also routinely modify the system in response to new realities. The result is that fundamental change has occurred under the very noses of theorists, who still tell us that negligence holds individual defendants responsible for their wrongdoing (it does not) or that the economic effect of tort rules is to deter defendants (there is not much reason to think this is so). Why are the leading theoretical justifications of negligence – corrective justice, responsibility theory and economic theory – so dependent on myths? Is it because the myths do not matter? Or is it that, in fact, we have no good justification for the system as it works in practice at all – we have no good theory of why negligence makes sense because it does not, in reality, make sense?
Privatization and Entry with Switching Costs
Authors: Dong Quan , Bàrcena‐Ruiz Juan Carlos
Published: July 2016

Although many papers consider the effect of switching costs on entry when the incumbent firm is privately‐owned, the effect when the incumbent firm is publicly‐owned has not been analyzed. We seek to fill that gap here and show that, unlike the case of a private incumbent where entry may decrease welfare, with a public incumbent entry always raises welfare. We also study whether the government privatizes the public incumbent firm and whether it deters entry. We find that switching costs reduce the range of values of the parameters for which privatization is chosen. Moreover, the government may prefer a private monopoly to a public monopoly or even a mixed duopoly. Finally, there is more privatization and less entry if the government decides on both privatization and entry than if it decides only on privatization.
Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review
Authors: Campbell J. A. , Venn A. , Neil A. , Hensher M. , Sharman M. , Palmer A. J.
Published: July 2016

Background

Health economic evaluations inform healthcare resource allocation decisions for treatment options for obesity including bariatric/metabolic surgery. As an important advance on existing systematic reviews, we aimed to capture, summarize and synthesize a diverse range of economic evaluations on bariatric surgery.

Methods

Studies were identified by electronic screening of all major biomedical/economic databases. Studies included if they reported any quantified health economic cost and/or consequence with a measure of effect for any type of bariatric surgery from 1995 to September 2015. Study screening, data extraction and synthesis followed international guidelines for systematic reviews.

Results

Six thousand one hundred eighty‐seven studies were initially identified. After two levels of screening, 77 studies representing 17 countries (56% USA) were included. Despite study heterogeneity, common themes emerged, and important gaps were identified. Most studies adopted the healthcare system/third‐party payer perspective; reported costs were generally healthcare resource use (inpatient/shorter‐term outpatient). Out‐of‐pocket costs to individuals, family members (travel time, caregiving) and indirect costs due to lost productivity were largely ignored. Costs due to reoperations/complications were not included in one‐third of studies. Body‐contouring surgery included in only 14%. One study evaluated long‐term waitlisted patients. Surgery was cost‐effective/cost‐saving for severely obese with type 2 diabetes mellitus. Study quality was inconsistent.

Discussion

There is a need for studies that assume a broader societal perspective (including out‐of‐pocket costs, costs to family and productivity losses) and longer‐term costs (capture reoperations/complications, waiting, body contouring), and consequences (health‐related quality‐of‐life). Full economic evaluation underpinned by reporting standards should inform prioritization of patients (e.g. type 2 diabetes mellitus with body mass index 30 to 34.9 kg/m2or long‐term waitlisted) for surgery. © 2016 World Obesity
En Bloc Resection of Primary Malignant Bone Tumor in the Cervical Spine Based on 3‐Dimensional Printing Technology
Authors: Xiao Jian‐ru , Huang Wen‐ding , Yang Xing‐hai , Yan Wang‐jun , Song Dian‐wen , Wei Hai‐feng , Liu Tie‐long , Wu Zhi‐peng , Yang Cheng
Published: July 2016

Objective

To investigate the feasibility and safety of en bloc resection of cervical primary malignant bone tumors by a combined anterior and posterior approach based on a three‐dimensional (3‐D) printing model.

Methods

Five patients with primary malignant bone tumors of the cervical spine underwent en bloc resection via a one‐stage combined anteroposterior approach in our hospital from March 2013 to June 2014. They comprised three men and two women of mean age 47.2 years (range, 26–67 years). Three of the tumors were chondrosarcomas and two chordomas. Preoperative 3‐D printing models were created by 3‐D printing technology. Sagittal en bloc resections were planned based on these models and successfully performed. A 360° reconstruction was performed by spinal instrumentation in all cases. Surgical margins, perioperative complications, local control rate and survival rate were assessed.

Results

All patients underwent en bloc excision via a combined posterior and anterior approach in one stage. Mean operative time and estimated blood loss were 465 minutes and 1290 mL, respectively. Mean follow‐up was 21 months. Wide surgical margins were achieved in two patients and marginal resection in three; these three patients underwent postoperative adjuvant radiation therapy. One vertebral artery was ligated and sacrificed in each of three patients. Nerve root involved by tumor was sacrificed in three patients with preoperative upper extremity weakness. One patient (Case 3) had significant transient radiculopathy with paresis postoperatively. Another (Case 4) with C
4 and C
5 chordoma had respiratory difficulties and pneumonia after surgery postoperatively. He recovered completely after 2 weeks’ management with a tracheotomy tube and antibiotics in the intensive care unit. No cerebrovascular complications and wound infection were observed. No local recurrence or instrumentation failure were detected during follow‐up.

Conclusion

Though technically challenging, it is feasible and safe to perform en bloc resection of cervical primary bone tumors. This is the most effective means of managing cervical spine tumors. Preoperative 3‐D printing modelling enables better anatomical understanding of the relationship between the tumor and cervical spine and can assist in planning the surgical procedure.
Intervertebral Fusion with Mobile Microendoscopic Discectomy for Lumbar Degenerative Disc Disease
Authors: Xu Bao‐shan , Liu Yue , Xu Hai‐wei , Yang Qiang , Ma Xin‐long , Hu Yong‐cheng
Published: July 2016

The aim of this article is to introduce a technique for lumbar intervertebral fusion that incorporates mobile microendoscopic discectomy (MMED) for lumbar degenerative disc disease. Minimally invasive transforaminal lumbar interbody fusion is frequently performed to treat degenerative diseases of the lumbar spine; however, the scope of such surgery and vision is limited by what the naked eye can see through the expanding channel system. To expand the visual scope and reduce trauma, we perform lumbar intervertebral fusion with the aid of a MMED system that provides a wide field through freely tilting the surgical instrument and canals. We believe that this technique is a good option for treating lumbar degenerative disc disease that requires lumbar intervertebral fusion.
Limb Salvage by Distraction Osteogenesis for Distal Tibial Osteosarcoma in a Young Child: A Case Report
Authors: He Xin , Zhang Hui‐lin , Hu Yong‐cheng
Published: July 2016

Under the effective chemotherapy protocol, physeal distraction could be used as an effective limb salvage in the growing children with lower‐limb malignant metaphyseal bone tumours and could actively prevent leg length discrepancy or malalignment that profoundly affects function. In this paper, we report a 7‐year‐old boy with right distal tibial osteosarcoma but not yet invaded the epiphysis, which underwent surgical treatment after effective chemotherapy. The surgical procedure included two phases: epiphysiolysis (physeal distraction) and en‐bloc resection of tumor and distraction osteogenesis. In the first phase, after osteotomy of the proximal fibula was performed, two Ilizarov rings were attached to the proximal tibia and one Ilizarov ring was applied to the distal tibia. At same time, U‐shape ring as an important external fixator was been used in the axis of rotation of the ankle joint in order to balance the stress from the surrounding tissues, increase distracting stabilization and prevent the deformity or contracture of ankle joint. In the second phase, the tumor bone (5.7 cm) was en bloc resected by diaphyseal osteotomy. Distraction osteogenesis was commenced 1 week postoperatively at a rate of 1 mm twice a day. The patient was reviewed by X‐ray intermittently. The new bone was formed and the entire bone defect was covered in four months after the operation. Doxorubicin and cisplatin as the neoadjuvant chemotherapy protocol are effective to osteosarcoma and chemotherapy process did not adversely affect the union. Through this technique, the right distal tibial epiphysis was reserved successfully. At the last follow‐up, there are no local recurrence or metastasis and we achieve to prevent leg length discrepancy or malalignment that profoundly affects function.
Clinical and Radiographic Results of Reconstruction with Fibular Autograft for Distal Radius Giant Cell Tumor
Authors: Qi Dian‐wen , Wang Peng , Ye Zhao‐ming , Yu Xiu‐chun , Hu Yong‐cheng , Zhang Guo‐chuan , Yan Xiao‐bo , Zheng Kai , Zhao Li‐ming , Zhang Hui‐lin
Published: July 2016

Objective

To evaluate the result of en bloc resection and reconstruction of the distal radius with a non‐vascularized fibular autograft for giant cell tumor (GCT) of bone.

Methods

Between 2005 and 2015, 12 eligible patients (seven males, five females, mean age 31.3 years) with grade III GCT of the distal radius were treated by en bloc resection and reconstruction with non‐vascularized proximal fibular autografts in four Chinese institutions (members of Giant Cell Tumor Team of China). The patients had a clinical and radiographic review every 6 months for the first 2 years then annually thereafter. The functional, oncologic and radiological outcomes of the patients were analyzed.

Results

The mean duration of follow‐up was 39.6 months. Bony union was achieved in all cases. None of the patients were dissatisfied with the shape and appearance of the wrist. The mean MSTS score was 25.23 ± 2.38 (range, 22–29). The mean DASH score was 13.0 (range, 6.7–33.3). The average range of motion of the wrist was: 35.8° ± 14.5° of extension, 14.0° ± 8.4° of flexion, 15.5° ± 6.7° of radial deviation, 19.4° ± 10.1° of ulnar deviation, 57.2° ±18.9° of pronation and 44.0° ± 24.8° of supination. The average percentage of grip strength was 55.2% ± 29.0% compared with that of the contralateral side. One localized soft tissue recurrence occurred; it was successfully managed by excision. Lung metastases developed postoperatively in one case and were treated by gamma knife radiotherapy. There was radiographic evidence of radiocarpal arthritis in eleven patients, bone resorption in ten, distal radioulnar joint diastasis in six, ulnar deviation of the wrist in seven, subluxation of the carpal bone in three and dislocation of the carpal bone in one patient.

Conclusions

Reconstruction with a non‐vascularized proximal fibular autograft is a reasonable option after en bloc resection of the distal radius for giant cell tumor of bone.
Application of Piezosurgery in Anterior Cervical Corpectomy and Fusion
Authors: Pan Sheng‐fa , Sun Yu
Published: July 2016

Anterior cervical corpectomy and fusion (ACCF) is frequently used to decompress the cervical spine; however, this procedure is risky when dealing with a hard disc or ossification of the posterior longitudinal ligament (OPLL). Piezosurgery offers a useful tool for performing this procedure. In this article, we present a 50 years old man who had cervical spondylotic myelopathy with OPLL at the C
6 level and segmental stenosis of the cervical spinal canal. When removing the posterior wall of his C
6 vertebral body and OPLL, piezosurgery was used to selectively cut hard structures piece by piece without injuring delicate soft tissues like the nerve roots and spinal cord. Because there is no bleeding from the bone surface with piezosurgery, it provides a clean operative field.