bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and incidence of diabetes mellitus: a nationwide population‐based pharmaco‐epidemiological study in Sweden
Authors: Jansson S. P. O. , Fall K. , Brus O. , Magnuson A. , Wändell P. , Östgren C. J. , Rolandsson O.
Published: February 2015

Aim

To investigate the changes in prevalence and incidence of pharmacologically and non‐pharmacologically treated diabetes in Sweden during 2005 to 2013.

Methods

We obtained data on gender, date of birth and pharmacologically and non‐pharmacologically treated diabetes from national registers for all Swedish residents.

Results

During the study period a total of 240 871 new cases of pharmacologically treated diabetes was found. The age‐standardized incidence during the follow‐up was 4.34 and 3.16 per 1000 individuals in men and women, respectively. A decreasing time trend in incidence for men of 0.6% per year (0.994, 95% CI 0.989–0.999) and for women of 0.7% per year (0.993, 95% CI 0.986–0.999) was observed. The age‐standardized prevalence increased from 41.9 and 29.9 per 1000 in 2005/2006 to 50.8 and 34.6 in 2012/2013 in men and women, respectively. This corresponds to an annually increasing time trend for both men (1.024, 95% CI 1.022–1.027) and women (1.019, 95% CI 1.016–1.021). The total age‐standardized prevalence of pharmacologically and non‐pharmacologically treated diabetes (2012) was 46.9 per 1000 (55.6 for men and 38.8 for women). This corresponds to an annually increasing time trend (2010–2012) for both men (1.017, 95% CI 1.013–1.021) and women (1.012, 95% CI 1.008–1.016).

Conclusions

The prevalence of pharmacologically treated diabetes increased moderately during 8 years of follow‐up, while the incidence decreased modestly. This is in contrast to the results reported by most other studies. The total prevalence of diabetes (both pharmacologically and non‐pharmacologically treated) in Sweden is relatively low, from a global viewpoint.
Glomerular haemodynamic profile of patients with Type 1 diabetes compared with healthy control subjects
Authors: Škrtić M. , Lytvyn Y. , Yang G. K. , Yip P. , Lai V. , Silverman M. , Cherney D. Z. I.
Published: February 2015

Aims

To evaluate the glomerular haemodynamic profile of patients with Type 1 diabetes with either renal hyperfiltration (GFR ≥ 135 ml/min/1.73 m2) or renal normofiltration (GFR 90–134 ml/min/1.73 m2) during euglycaemic and hyperglycaemic conditions, and to compare this profile with that of a similar group of healthy control subjects.

Methods

Gomez's equations were used to derive afferent and efferent arteriolar resistances, glomerular hydrostatic pressure and filtration pressure.

Results

At baseline, during clamped euglycaemia, patients with Type 1 diabetes and hyperfiltration had lower mean ± sd afferent arteriolar resistance than both those with Type 1 diabetes and normofiltration (914 ± 494 vs. 2065 ± 597 dyne/s/cm5; P < 0.001) and healthy control subjects (1676 ± 707 dyne/s/cm5; p < 0.001). By contrast, efferent arteriolar resistance was similar in the three groups. Patients with Type 1 diabetes and hyperfiltration also had higher mean ± sd glomerular hydrostatic pressure than both healthy control subjects and patients with Type 1 diabetes and normofiltration (66 ± 6 vs. 60 ± 3 vs. 55 ± 3 mmHg; P < 0.05). Similar findings for afferent arteriolar resistance, efferent arteriolar resistance, glomerular hydrostatic pressure and filtration pressure were observed during clamped hyperglycaemia.

Conclusion

Hyperfiltration in Type 1 diabetes is primarily driven by alterations in afferent arteriolar resistance rather than efferent arteriolar resistance. Renal protective therapies should focus on afferent renal arteriolar mechanisms through the use of pharmacological agents that target tubuloglomerular feedback, including sodium‐glucose cotransporter 2 inhibitors and incretins.
Community‐based peer support significantly improves metabolic control in people with Type 2 diabetes in Yaoundé, Cameroon
Authors: Assah F. K. , Atanga E. N. , Enoru S. , Sobngwi E. , Mbanya J. C.
Published: February 2015

Aims

To examine the effectiveness of a community‐based multilevel peer support intervention in addition to usual diabetes care on improving glycaemic levels, blood pressure and lipids in patients with Type 2 diabetes in Yaoundé, Cameroon.

Methods

A total of 96 subjects with poorly controlled Type 2 diabetes (intervention group) and 96 age‐ and sex‐matched controls were recruited and followed up over 6 months. The intervention subjects underwent a peer support intervention through peer‐led group meetings, personal encounters and telephone calls. Both intervention subjects and controls continued their usual clinical care. HbA1c, blood pressure, blood lipids and self‐care behaviours were measured at 0 and 6 months.

Results

There was significant reduction in HbA1c in the intervention group [–33 mmol/mol (–3.0%)] compared with controls [–14 mmol/mol (–1.3%)]; P < 0.001. Peer support also led to significant reductions in fasting blood sugar (–0.83 g/l P < 0.001), cholesterol (–0.54 g/l P < 0.001), HDL (–0.09 g/l, P < 0.001), BMI (–2.71 kg/m² P < 0.001) and diastolic pressure (–6.77 mmHg, P < 0.001) over the 6‐month period. Also, diabetes self‐care behaviours in the intervention group improved significantly over the 6 months of peer support.

Conclusion

Community‐based peer support, in addition to usual care, significantly improved metabolic control in patients with uncontrolled Type 2 diabetes in Yaoundé, Cameroon. This could provide a model for optimizing diabetes care and control in other settings with limited healthcare and financial resources.
Major bleeding risk prediction using Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease equations in acute coronary syndrome
Authors: Flores‐Blanco Pedro J. , López‐Cuenca Ángel , Januzzi James L. , Marín Francisco , Sánchez‐Martínez Marianela , Quintana‐Giner Miriam , Romero‐Aniorte Ana I. , Valdés Mariano , Manzano‐Fernández Sergio
Published: February 2015

Background

Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) equations estimate glomerular filtration rate more accurately than the Modification of Diet in Renal Disease (MDRD) Study equation. Our aim was to evaluate whether CKD‐EPI equations based on serum creatinine and/or cystatin C (CysC) predict risk for major bleeding (MB) more accurately than the MDRD Study equation in patients with non‐ST‐segment elevation acute coronary syndromes (ACS).

Materials and methods

Three hundred and fifty consecutive subjects with non‐ST‐segment elevation ACS (68 ± 12 years, 70% male) were studied. Glomerular filtration rate was estimated using the CKD‐EPI and MDRD Study equations. The primary endpoint was the occurrence of MB during the follow‐up, which was defined according to the Bleeding Academic Research Consortium Definition criteria as bleeding types 3–5.

Results

During the median follow‐up of 589 days (interquartile range, 390–986), 27 patients had MB (0·04% events per person year). Patients with MB had worse kidney function parameters, regardless of the estimating equation used (P < 0·001). After multivariate Cox regression adjustment, both CysC‐based CKD‐EPI equations were independent predictors of MB (CKD‐EPIcreatinine‐cystatin C per mL/min/1·73 m2, HR = 0·973 (95%CI 0·955–0·991; P = 0·003) and CKD‐EPIcystatin C per mL/min/1·73 m2, HR = 0·976 (95%CI 0·976–0·992; P = 0·003), while the CKD‐EPIcreatinine and MDRD equations did not achieve statistical significance. Both CKD‐EPIcreatine‐cystatin C and CKD‐EPIcystatin C were associated with a significant improvement in MB risk reclassification.

Conclusions

In this cohort of non‐ST‐segment elevation ACS patients with relatively preserved renal function, both CysC‐based CKD‐EPI equations improved ability to predict risk for MB and were superior to other equations for this application.
Saccadic foraging: reduced reaction time to informative targets
Authors: Bray T. J. P. , Carpenter R. H. S.
Published: February 2015

The study of saccadic reaction times has revealed a great deal about the neural mechanisms underlying neural decision, in terms ofBayesian factors such as prior probability and information supply. In addition, recent work has shown that saccades are faster to visual targets associated with conventional monetary or food rewards. However, because the purpose of saccades is to acquire information, it could be argued that this is an unnatural situation: the most natural and fundamental reward is the amount of information supplied by a target. Here, we report the results of a study investigating the hypothesis that a saccade to a target whose colour provides information about the location of a subsequent target is faster than to one that does not. We show that the latencies of saccades to a location that provides reliable information about the location of a future target are indeed shorter, their distributions being shifted in a way that implies that the rate of rise of the underlying decision signal is increased. In a race between alternative targets, this means that expected information will be an important factor in deciding where to look, so that ‘foraging’ saccades are more likely to be made to useful targets.
Zinc: indications in brain disorders
Authors: Prakash Atish , Bharti Kanchan , Majeed Abu Bakar A.
Published: February 2015

Zinc is the authoritative metal which is present in our body, and reactive zinc metal is crucial for neuronal signaling and is largely distributed within presynaptic vesicles. Zinc also plays an important role in synaptic function. At cellular level, zinc is a modulator of synaptic activity and neuronal plasticity in both development and adulthood. Different importers and transporters are involved in zinc homeostasis. ZnT‐3 is a main transporter involved in zinc homeostasis in the brain. It has been found that alterations in brain zinc status have been implicated in a wide range of neurological disorders including impaired brain development and many neurodegenerative disorders such as Alzheimer's disease, and mood disorders including depression, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, and prion disease. Furthermore, zinc has also been implicated in neuronal damage associated with traumatic brain injury, stroke, and seizure. Understanding the mechanisms that control brain zinc homeostasis is thus critical to the development of preventive and treatment strategies for these and other neurological disorders.
Effects of grassland intensification on Whinchats Saxicola rubetra and implications for conservation in upland habitats
Authors: Strebel Gavino , Jacot Alain , Horch Petra , Spaar Reto
Published: February 2015

Modern, intensive grassland management has led to strong declines in ground‐nesting grassland birds, and is now increasingly threatening the last remaining strongholds of the Whinchat Saxicola rubetra in the Central European uplands. In this study, we assess key threats to Whinchat populations in these uplands in order to suggest appropriate conservation measures. We compared the direct threat of early mowing as well as the indirect threat resulting from a deteriorating arthropod food source in an inner‐alpine valley. Five of our seven study sites were mown too early with respect to the chicks' fledging date. Such early mowing was particularly evident on the more intensively farmed, earlier mown valley bottoms than on the valley slopes. Arthropod abundance and biomass did not differ between valley bottoms and slopes. However, valley bottoms had a greater amount of unprofitable prey items such as flies. Breeding bird density was mainly determined by the degree of overlap between the mowing schedule and breeding phenology. These findings suggest that in upland grasslands at an early stage of intensification, early mowing is of greater importance for populations than possible negative effects of a reduced food source. We suggest that mowing is delayed until a sufficient proportion of nestlings are safely fledged.
Opioid receptor delta as a global modulator of skin differentiation and barrier function repair
Authors: Chajra H. , Amstutz B. , Schweikert K. , Auriol D. , Redziniak G. , Lefèvre F.
Published: February 2015

Synopsis

Objectives

The aims of this study were to confirm the properties of selective agonist peptide (Rubixyl) contained in the spinach towards opioid receptor delta. In fact, agonist properties of both spinach peptides (Rubiscolin‐5 and Rubixyl) towards opioid receptor delta were demonstrated by Zang et al., but their effects on the other opioid receptors were not studied [1]. We also studied the expression of opioid receptor delta in epidermis under normal and stress condition (inflammatory) and its role in epidermis homeostasis under stress condition in vitro and in vivo.

Methods

Agonist properties studies were performed using functional agonist cellular model containing human opioid receptors.

Opioid receptor delta expression and epidermis homeostasis were studied on human reconstructed epidermis under normal and stress conditions (inflammatory stress) using gene expression (RT‐qPCR) and protein expression analysis (immunohistological analysis).

Skin repair properties of opioid receptor delta agonist were based on the following parameters TEWL (trans epidermal water loss, hydration and wrinkle depth at periocular and perilabial area) on human volunteers having either intrinsic ageing (more than 40 years old and non‐smoker group) and both intrinsic ageing and extrinsic ageing (more than 40 years old and smoker group).

Results

We have demonstrated that the Rubixyl peptide is a specific agonist of opioid receptor delta. We have demonstrated that opioid receptor delta expression is modulated under inflammatory condition. The agonist Rubixyl was able to block the depletion of opioid receptor delta seen under inflammatory condition in reconstructed human epidermis.

Inflammatory conditions lead to the unbalanced gene and protein expressions of markers involved in epidermis integrity and barrier function properties. The treatment of human reconstructed epidermis with the agonist Rubixyl leads to the normalization of unbalanced gene and protein expressions. In vivo study has confirmed the efficiency of the agonist Rubixyl to repair damaged skin by decreasing TEWL, increasing hydration and decreasing wrinkle depth at the periocular and perilabial area.

Conclusion

In this research, we have demonstrated in vitro (on inflamed reconstructed human epidermis, RHE) and in vivo (on human aged volunteers) that activation by natural agonist peptide of opioid receptor delta reduces the skin inflammation thus leading to improvement in epidermis differentiation and skin barrier properties.
Comparison of in vivo dental pulp responses to capping with iRoot BP Plus and mineral trioxide aggregate
Authors: Shi S. , Bao Z. F. , Liu Y. , Zhang D. D. , Chen X. , Jiang L. M. , Zhong M.
Published: February 2015

Aim

To compare dental pulp responses to capping with iRoot BP Plus and mineral trioxide aggregate (MTA) in dogs.

Methodology

Pulps in 36 incisors of three 8‐month‐old beagle dogs were mechanically exposed and assigned to two experimental groups (iRoot BP Plus group and MTA group, n = 15 per group) and one control group (n = 6). Direct pulp capping was performed using either iRoot BP Plus or MTA. The animals were sacrificed 3 months later. Histological sections were stained with haematoxylin and eosin and categorized using a histologic scoring system. Statistical analysis was performed using the Mann–Whitney U‐test, with the significance set at 0.05.

Results

The majority of specimens in both experimental groups were associated with complete calcified bridge formation and the absence of pulpal inflammation. There was no significant difference in pulp response to iRoot BP Plus or MTA after 3 months (P > 0.05).

Conclusion

iRoot BP Plus and MTA had similar favourable results when used as pulp‐capping agents.
No evidence for MHC class I‐based disassortative mating in a wild population of great tits
Authors: Sepil I. , Radersma R. , Santure A. W. , De Cauwer I. , Slate J. , Sheldon B. C.
Published: February 2015

Genes of the major histocompatibility complex (MHC) are regarded as a potentially important target of mate choice due to the fitness benefits that may be conferred to the offspring. According to the complementary genes hypothesis, females mate with MHC dissimilar males to enhance the immunocompetence of their offspring or to avoid inbreeding depression. Here, we investigate whether selection favours a preference for maximally dissimilar or optimally dissimilar MHC class I types, based on MHC genotypes, average amino acid distances and the functional properties of the antigen‐binding sites (MHC supertypes); and whether MHC type dissimilarity predicts relatedness between mates in a wild great tit population. In particular, we explore the role that MHC class I plays in female mate choice decisions while controlling for relatedness and spatial population structure, and examine the reproductive fitness consequences of MHC compatibility between mates. We find no evidence for the hypotheses that females select mates on the basis of either maximal or optimal MHC class I dissimilarity. A weak correlation between MHC supertype sharing and relatedness suggests that MHC dissimilarity at functional variants may not provide an effective index of relatedness. Moreover, the reproductive success of pairs did not vary with MHC dissimilarity. Our results provide no support for the suggestion that selection favours, or that mate choice realizes, a preference for complimentary MHC types.
Distribution, structure and biosynthetic gene families of (1,3;1,4)‐β‐glucan in Sorghum bicolor
Authors: Ermawar Riksfardini A. , Collins Helen M. , Byrt Caitlin S. , Betts Natalie S. , Henderson Marilyn , Shirley Neil J. , Schwerdt Julian , Lahnstein Jelle , Fincher Geoffrey B. , Burton Rachel A.
Published: February 2015

In cereals, the presence of soluble polysaccharides including (1,3;1,4)‐β‐glucan has downstream implications for human health, animal feed and biofuel applications. Sorghum bicolor (L.) Moench is a versatile crop, but there are limited reports regarding the content of such soluble polysaccharides. Here, the amount of (1,3;1,4)‐β‐glucan present in sorghum tissues was measured using a Megazyme assay. Very low amounts were present in the grain, ranging from 0.16%–0.27% (w/w), while there was a greater quantity in vegetative tissues at 0.12–1.71% (w/w). The fine structure of (1,3;1,4)‐β‐glucan, as denoted by the ratio of cellotriosyl and cellotetraosyl residues, was assessed by high performance liquid chromatography (HPLC) and ranged from 2.6–3:1 in the grain, while ratios in vegetative tissues were lower at 2.1–2.6:1. The distribution of (1,3;1,4)‐β‐glucan was examined using a specific antibody and observed with fluorescence and transmission electron microscopy. Micrographs showed a variable distribution of (1,3;1,4)‐β‐glucan influenced by temporal and spatial factors. The sorghum orthologs of genes implicated in the synthesis of (1,3;1,4)‐β‐glucan in other cereals, such as the Cellulose synthase‐like (Csl) F and H gene families were defined. Transcript profiling of these genes across sorghum tissues was carried out using real‐time quantitative polymerase chain reaction, indicating that, as in other cereals, CslF6 transcripts dominated.
Chronic Oestradiol Reduces the Dendritic Spine Density of KNDy (Kisspeptin/Neurokinin B/Dynorphin) Neurones in the Arcuate Nucleus of Ovariectomised Tac2‐Enhanced Green Fluorescent Protein Transgenic Mice
Authors: Cholanian M. , Krajewski‐Hall S. J. , McMullen N. T. , Rance N. E.
Published: February 2015

Neurones in the arcuate nucleus that express neurokinin B (NKB), kisspeptin and dynorphin (KNDy) play an important role in the reproductive axis. Oestradiol modulates the gene expression and somatic size of these neurones, although there is limited information available about whether their dendritic structure, a correlate of cellular plasticity, is altered by oestrogens. In the present study, we investigated the morphology of KNDy neurones by filling fluorescent neurones in the arcuate nucleus of Tac2‐enhanced green fluorescent protein (EGFP) transgenic mice with biocytin. Filled neurones from ovariectomised (OVX) or OVX plus 17β‐oestradiol (E2)‐treated mice were visualised with anti‐biotin immunohistochemistry and reconstructed in three dimensions with computer‐assisted microscopy. KNDy neurones exhibited two primary dendrites, each with a few branches confined to the arcuate nucleus. Quantitative analysis revealed that E2 treatment of OVX mice decreased the cell size and dendritic spine density of KNDy neurones. The axons of KNDy neurones originated from the cell body or proximal dendrite and gave rise to local branches that appeared to terminate within the arcuate nucleus. Numerous terminal boutons were also visualised within the ependymal layer of the third ventricle adjacent to the arcuate nucleus. Axonal branches also projected to the adjacent median eminence and exited the arcuate nucleus. Confocal microscopy revealed close apposition of EGFP and gonadotrophin‐releasing hormone‐immunoreactive fibres within the median eminence and confirmed the presence of KNDy axon terminals in the ependymal layer of the third ventricle. The axonal branching pattern of KNDy neurones suggests that a single KNDy neurone could influence multiple arcuate neurones, tanycytes in the wall of the third ventricle, axon terminals in the median eminence and numerous areas outside of the arcuate nucleus. In parallel with its inhibitory effects on electrical excitability, E2 treatment of OVX Tac2‐EGFP mice induces structural changes in the somata and dendrites of KNDy neurones.
Effects of Reproductive Experience on Central Expression of Progesterone, Oestrogen α, Oxytocin and Vasopressin Receptor mRNA in Male California Mice (Peromyscus californicus)
Authors: Perea‐Rodriguez J. P. , Takahashi E. Y. , Amador T. M. , Hao R. C. , Saltzman W. , Trainor B. C.
Published: February 2015

Fatherhood in biparental mammals is accompanied by distinct neuroendocrine changes in males, involving some of the same hormones involved in maternal care. In the monogamous, biparental California mouse (Peromyscus californicus), paternal care has been linked to changes in the central and/or peripheral availability of oestrogen, progesterone, vasopressin and oxytocin, although it is not known whether these endocrine fluctuations are associated with changes in receptor availability in the brain. Thus, we compared mRNA expression of oestrogen receptor (ER)α, progesterone receptor (PR), vasopressin receptor (V1a) and oxytocin receptor (OTR) in brain regions implicated in paternal care [i.e. medial preoptic area (MPOA)], fear [i.e. medial amygdala (MeA)] and anxiety [i.e. bed nucleus of the stria terminalis (BNST)] between first‐time fathers (n = 8) and age‐matched virgin males (n = 7). Males from both reproductive conditions behaved paternally towards unrelated pups, whereas fathers showed significantly shorter latencies to behave paternally and less time investigating pups. Furthermore, fathers showed significantly lower PR, OTR and V1a receptor mRNA expression in the BNST compared to virgins. Fathers also showed a marginally significant (P = 0.07) reduction in progesterone receptor mRNA expression in the MPOA, although fatherhood was not associated with any other changes in receptor mRNA in the MPOA or MeA. The results of the present study indicate that behavioural and endocrine changes associated with the onset of fatherhood, and/or with cohabitation with a (breeding) female, are accompanied by changes in mRNA expression of hormone and neuropeptide receptors in the brain.
Coping with melanoma‐related worry: a qualitative study of the experiences and support needs of patients with malignant melanoma
Authors: Bird Joanne , Coleman Patricia , Danson Sarah
Published: February 2015

Aims and objectives

To explore the patients' experience of having malignant melanoma, their related support needs and the processes that lead to these needs being met.

Background

The number of patients attending surveillance clinics after a diagnosis of malignant melanoma is increasing. In the UK specialist nurses provide support to patients, but little evidence exists about the nature of patients' support needs or their experience of having melanoma. Melanoma has often been researched within general cancer studies, yet the support needs of melanoma patients may be different from those of patients with other skin cancers or tumour types.

Design

A Grounded Theory Approach was used to guide sampling, data collection and analysis.

Methods

In‐depth interviews were conducted with eleven patients who where purposively sampled. Transcripts were read several times, coded and categorised using the constant comparative method. Emergent categories were discussed with participants.

Results

Three emergent categories related to a core category of melanoma‐related worry which formed a substantive theory about the strategies patients use to control this. Participants reported needing to have their concerns believed by others prior to and after diagnosis. They discussed discerning whom to share their concerns with depending upon who they felt would not perceive assisting them as being burdensome. They also sought ways to reassure themselves.

Conclusions

Patients need to have their fear and worries acknowledged by others. This includes nurses, healthcare professionals and family members. Patients will also use self‐examination and the absence of symptoms to reassure themselves.

Relevance to clinical practice

Nurses play key roles throughout the patient's care; therefore they need to be sensitive to the fact that patients may consider them a primary source of support. When teaching self‐examination it is important that nurses discuss that this may ease worry and aid coping.
‘Good ethics and moral standing’: a qualitative study of aesthetic leadership in clinical nursing practice
Authors: Mannix Judy , Wilkes Lesley , Daly John
Published: February 2015

Aims and objectives

To explore how aesthetic leadership is embodied by clinical leaders in the nursing workplace.

Background

A number of different leadership styles have been developed, theorised and applied to the nursing workforce over the years. Many of these styles lack an explicit moral dimension in their identified leader attributes, due to a shift in theorising of leadership to focus on the impact of leader traits on followers. It is timely to look at aesthetic leadership, with its explicit moral dimension, as a way of improving outcomes for nurses, patients and health care organisations.

Design

Qualitative design, using conversation‐style interviews with experienced registered nurses in designated clinical leadership roles.

Methods

Twelve experienced registered nurses who worked in designated clinical leadership roles participated in an individual, digitally recorded, semi‐structured conversation‐style interview. Narrative data were transcribed and subject to thematic analysis.

Findings

Three main themes emerged: ‘True to their beliefs’: embodying principled practice; ‘Not all policies fit every patient’: ethical leadership in ambiguous situations; and ‘Being open to people's concerns’: providing fair and just solutions. A strong moral compass shaped and guided participants' day‐to‐day clinical leadership activities.

Conclusions

Participants provided a rich narrative on how aesthetic leadership is embodied in the clinical nursing setting. It was evident that their clinical leadership is shaped and guided by a strong moral compass. By incorporating into their practice an aesthetic world‐view with its strong moral purpose, participants in this study have shown how aesthetic leadership can enhance the clinical nursing workplace.

Relevance to clinical practice

Nurses in the clinical setting value clinical leaders who embrace and operate with a strong moral compass. Aesthetic leadership, with its explicit strong moral purpose, offers a way of incorporating morality into clinical leadership in the nursing workplace.
Supporting staff to respond effectively to informal complaints: findings from an action research study
Authors: Allan Helen T , Odelius Ann Christine , Hunter Billie J , Bryan Karen , Knibb Wendy , Shawe Jill , Gallagher Ann
Published: February 2015

Aim and objective

To understand how nurses and midwives manage informal complaints at ward level.

Background

The provision of high quality, compassionate clinical nursing and midwifery is a global priority. Complaints management systems have been established within the National Health Service in the UK to improve patient experience yet little is known about effective responses to informal complaints in clinical practice by nurses and midwives.

Design

Collaborative action research.

Methods

Four phases of data collection and analysis relating to primarily one National Health Service trust during 2011–2014 including: scoping of complaints data, interviews with five service users and six key stakeholders and eight reflective discussion groups with six midwives over a period of nine months, two sessions of communications training with separate groups of midwives and one focus group with four nurses in the collaborating trust.

Results

Three key themes emerged from these data: multiple and domino complaints; ward staff need support; and unclear complaints systems.

Conclusions

Current research does not capture the complexities of complaints and the nursing and midwifery response to informal complaints.

Relevance to clinical practice

Robust systems are required to support clinical staff to improve their response to informal complaints and thereby improve the patient experience.
Similarities and differences in the experience of fatigue among people living with fibromyalgia, multiple sclerosis, ankylosing spondylitis and stroke
Authors: Eilertsen Grethe , Ormstad Heidi , Kirkevold Marit , Mengshoel Anne M , Söderberg Siv , Olsson Malin
Published: February 2015

Aims and objectives

To elucidate the experience of fatigue across several long‐term illnesses, focusing on the similarities and differences.

Background

Fatigue is common to many long‐term illnesses, but it has been studied mainly within the context of a single illness; qualitative studies comparing the experience and its impact on daily life across different long‐term illnesses are lacking.

Design

Qualitative design.

Methods

A secondary analysis was conducted of five original interview studies involving 95 persons with ankylosing spondylitis, fibromyalgia, multiple sclerosis or stroke.

Results

Similarities and differences concerning experiences of fatigue were found across the studied long‐term illnesses. All patients expressed the perception of having an unfamiliar body. Fatigue was also commonly expressed as unpredictable, uncontrollable and invisible to others. Differences were related to a constant versus a varying condition, a sudden and an uncontrollable sleepiness, a mutual reinforcement with pain and increased stress sensitivity. A lack of energy and a need for sleep and rest were common experiences, as was the impact on social relationships. There were also similarities regarding how the patients managed their daily life. The search for practical solutions and attitude adjustment differed with the fatigue characteristics. All patients felt a lack of understanding and disbelief from others.

Conclusion and relevance to clinical practice

Fatigue is commonly expressed by patients with long‐term illnesses. Variations in experience are related to the type of diagnosis. The disparity between experiences influences how patients managed and adjusted to the conditions of everyday life. The illness‐specific characteristics of fatigue warrant increased clinical awareness and may allow professionals to offer adequate information and establish effective methods of managing the condition. The feeling of invisibility and difficulty describing the experience of fatigue in particular highlights this need.
High sensitivity detection of salivary 8‐hydroxy deoxyguanosine levels in patients with chronic periodontitis
Authors: Kurgan Ş. , Önder C. , Altıngöz S. M. , Bağış N. , Uyanık M. , Serdar M. A. , Kantarcı A.
Published: February 2015

Background

Inflammation is associated with hydroxyl radical damage to DNA as a result of oxidative stress. 8‐Hydroxy deoxyguanosine (8‐OHdG) is a marker of this process and its levels in saliva could be linked to the severity of periodontal inflammation. The aim of this study was to test the sensitivity of liquid chromatography with tandem mass spectrometry (LC‐MS/MS) in comparison to enzyme‐linked immune sorbent assay (ELISA) for the detection of 8‐OHdG in saliva in patients with chronic periodontitis before and after periodontal treatment.

Methods

Saliva samples were collected from 23 patients (eight females and 15 males; 46.1 ± 5.1 years of age) with generalized chronic periodontitis and 25 (15 females and 10 males; 44.9 ± 6.8 years of age) periodontally healthy individuals. Patients received initial periodontal treatment consisting of scaling and root planing and were evaluated at baseline and after 6 wk of completion of non‐surgical therapy. Salivary 8‐OHdG levels were measured using ELISA and LC‐MS/MS before and after the treatment. Clinically, plaque index, gingival index, clinical attachment level, bleeding on probing, gingival recession and probing pocket depth were measured at baseline and after 6 wk.

Results

Salivary levels of 8‐OHdG decreased significantly after the non‐surgical periodontal treatment (p < 0.001). Statistically significant positive correlations were observed between plaque index, gingival index, probing pocket depth, clinical attachment level, bleeding on probing values and LC‐MS/MS and ELISA levels of 8‐OHdG (p < 0.001).

Conclusion

LC‐MS/MS is a reliable and sensitive method for evaluating salivary 8‐OHdG levels to monitor the treatment response of periodontitis.
Molecular and morphological evidence for a new grass genus, Dupontiopsis (Poaceae tribe Poeae subtribe Poinae s.l.), endemic to alpine Japan, and implications for the reticulate origin of Dupontia and Arctophila within Poinae s.l.
Authors: SORENG Robert J. , GILLESPIE Lynn J. , KOBA Hidehisa , BOUDKO Ekaterina , BULL Roger D.
Published: February 2015

Phylogenetic analyses within Poaceae tribe Poeae subtribes Puccinellinae (=Coleanthinae), Phleinae, Poinae s.l. (including Alopecurinae), and Miliinae (PPAM clade), revealed that one species formerly placed in Poa represents a new monotypic genus belonging to subtribe Poinae s.l., Dupontiopsis gen. nov., D. hayachinensis comb. nov. (based on Poa hayachinensis), endemic to wet, gravelly, serpentine, alpine habitats in northern Japan. This genus forms a strongly supported clade (DAD) with two circumarctic Poinae genera, Arctophila and Dupontia, in phylogenetic analyses of plastid and nuclear ribosomal DNA sequence data. Both morphology and DNA sequence analyses provide support for D. hayachinensis as a lineage distinct from either Arctophila or Dupontia, with moderate DNA support for a position as sister to these two genera. Dupontiopsis resembles these other monotypic genera in its several‐flowered spikelets, lemmas usually 3‐nerved, with frequently awned attenuate scarious apices (as in Dupontia) and calluses with a crown of hairs around the base of the lemma, but differs in its keeled lemmas, scabrous palea keels, glumes shorter than the first lemma. Our investigation suggests that the most recent shared ancestor of the DAD clade evolved from a single hybridization event, as a hexaploid, probably in western Beringia. The probable parentage of the ancestor is considered to be within the Poinae–Alopecurinae clade excluding Poa. We provide evidence for possible secondary hybridization and introgression of duodecaploid Dupontia fisheri with Puccinellia. A key to perennial genera of PPAM with hairy calluses, and a supplemental table of morphological characters in the genera accepted in PPAM are provided.
Angiotensin and Neurovascular Coupling: Beyond Hypertension
Authors: Bloch Sherri , Obari Dima , Girouard Hélène
Published: February 2015

Brain homeostasis is dependent upon the constant perfusion of oxygen and nutrients through CBF. The mechanism responsible to couple CBF to neuronal activity is termed NVC. Ang II, a key player in hypertension, impairs NVC and has been found to be of significant importance in neurodegenerative diseases, such as AD. The presence of Ang II and its metabolites, as well as their receptors have been detected in many areas of the brain. Findings indicate that disruption of NVC by Ang II is mediated by its AT1R and NADPH oxidase (NOX)‐dependent ROS production independently of its effect on blood pressure. Although the process causing ROS to interfere with NVC has yet to be elucidated, data label peroxynitrite as the leading ROS to do so. The same common pathway is involved in NVC impairment in AD experimental models. This review investigates recent data concerning the effects of Ang II on NVC with the intent of exploring new treatment perspectives for neurodegenerative diseases such as AD.
Osteonecrosis of the mandible in a patient with lung adenocarcinoma undergoing anti‐angiogenic therapy with bevacizumab
Authors: Tzermpos F. , Ismail A. , Pavli M. , Tosios K.I.
Published: February 2015

Bevacizumab is a recombinant monoclonal humanised antibody, designed to inhibit the binding ability of vascular endothelial growth factor to its receptor. Recently bevacizumab has been implemented in the treatment protocols against certain types of cancer. A 63‐year‐old Caucasian male patient with lung adenocarcinoma, presented in the OMFS clinic with a non‐healing lesion of the mucosa at the region of tooth 17 including areas of exposed bone and presence of pus along with paraesthesia, distributed to the left side of the lower lip. The patient had undergone two chemotherapy cycles including IV bevacizumab which was administered once every 3 weeks in a dose of 15 mg/kg. The radiographic examination (Orthopantomogram, ConeBeamComputedTomography) revealed cortical erosion of the lingual plate on the posterior left mandibular region with involvement of the inferior alveolar nerve. A diagnosis of stage II osteonecrosis was established that was later confirmed by the histopathological evaluation and ruled out possible bone metastases. After 2 weeks of treatment with an empiric antibiotic regimen, the necrotic lesion was removed with surgical debridement and without complications. In the 6 months follow‐up the diseased area was fully healed and the paraesthesia was improved.
Comparative study of trichloroacetic acid vs. photodynamic therapy with topical 5‐aminolevulinic acid for actinic keratosis of the scalp
Authors: Di Nuzzo Sergio , Cortelazzi Chiara , Boccaletti Valeria , Zucchi Alfredo , Conti Maria Luisa , Montanari Paola , Feliciani Claudio , Fabrizi Giuseppe , Pagliarello Calogero
Published: February 2015

Background

Photodynamic therapy with 5‐methyl‐aminolevulinate and photodynamic therapy with trichloroacetic acid 50% are the two techniques utilized in the management of actinic keratosis. This study was planned to compare the efficacy, adverse effects, recurrence and cosmetic outcome of these option therapies in patients with multiple actinic keratosis of the scalp.

Methods

Thirteen patients with multiple actinic keratosis were treated with one of the two treatments on half of the scalp at baseline, while the other treatment was performed on the other half 15 days apart, randomly. Efficacy, adverse effects, cosmetic outcome and recurrence were recorded at follow‐up visit at 1, 3, 6 and 12 months.

Results

Photodynamic therapy with 5 methyl‐aminolevulinate was more effective than trichloroacetic acid although less tolerated by patients as it was more painful. Early adverse effects were almost the same even if trichloroacetic acid leads also to crust formation and to a worse cosmetic outcome characterized by hypopigmentation. Recurrence was lower in the area treated with photodynamic therapy.

Conclusion

Trichloroacetic acid 50% is less effective than photodynamic therapy with 5 methyl‐aminolevulinate in the treatment of multiple actinic keratosis of the scalp although better tolerated by patients. As this technique is less painful and less expensive than photodynamic therapy, we hypothesize and suggest that more sequential treatments could lead to better results.
Usefulness of in vivo photodiagnosis for the identification of tumor margins in recurrent basal cell carcinoma of the face
Authors: Borroni Riccardo G. , Barruscotti Stefania , Carugno Andrea , Barbaccia Vincenzo , Arbustini Eloisa , Brazzelli Valeria
Published: February 2015

Background

Basal cell carcinoma (BCC) is the most frequent malignant tumor of the skin. The high prevalence of BCC, the risk of local recurrence, and the difficult clinical identification of the excision margins emphasize the importance of studying new approaches, ensuring complete surgical excision that allows preservation of normal tissue, especially for BCCs located on cosmetically important areas such as the mid face. Photodiagnosis (PD) is a pre‐operative technique that allows a more accurate distinction of neoplastic lesions from surrounding healthy skin in vivo.

Purpose

The aim of this study is to assess the usefulness of PD for the evaluation of tumor margins in 10 patients with recurrent BCC of the face.

Methods

We study the red fluorescence emitted by neoplastic tissue under a Wood's lamp irradiation, after accumulation of methyl amino levulinate (MAL) cream in 10 patients with recurrent BCC.

Results

Our histologic analysis of perilesional skin by PD allowed to delineate more precise tumor margins, thus achieving radical excision in 90% of patients.

Conclusion

PD represents a diagnostic method that helps to distinguish between tumor tissue and surrounding healthy tissue especially in case of recurrent BCC of the face when the clinical delimitation is not clear.
Meta‐community theory and stream restoration: evidence that spatial position constrains stream invertebrate communities in a mine impacted landscape
Authors: Kitto Justin A.J. , Gray Duncan P. , Greig Hamish S. , Niyogi Dev K. , Harding Jon S.
Published: February 2015

Mining activities, particularly acid mine drainage, often result in adverse effects on stream diversity and ecosystem functioning, and increased concern about these effects has generated a focus on restoration of mine‐impacted waterways. However, many stream restoration projects have not led to increased stream diversity and ecological recovery. One reason for this failure may be that restoration practitioners focus on local environmental conditions and fail to consider the importance of dispersal as a driver of stream invertebrate composition. To test this hypothesis, we used a meta‐community analysis to compare the influence of the local stream conditions with the regional supply of colonists. Invertebrate communities and physico‐chemical conditions were sampled in 37 streams across a mine‐impact gradient on the Stockton Plateau, West Coast of New Zealand's South Island. We found that pH, temperature, dissolved metals, and sediment significantly influenced invertebrate community composition. Furthermore, the spatial location of streams was a good predictor of stream diversity and invertebrate communities, independent of local environmental conditions. This result indicates an important role for regional dispersal barriers in determining stream invertebrate communities. Consequently, consideration of both the locations and strategic preservation of future colonist source streams and potential dispersal barriers during mine planning would enhance post‐mining restoration.
Fulminant endocarditis and disseminated infection caused by carbapenem‐resistant Acinetobacter baumannii in a renal‐pancreas transplant recipient
Authors: Patel G. , Perez F. , Hujer A.M. , Rudin S.D. , Augustine J.J. , Jacobs G.H. , Jacobs M.R. , Bonomo R.A.
Published: February 2015

Acinetobacter baumannii is an important cause of healthcare‐associated infections, and is particularly problematic among patients who undergo organ transplantation. We describe a case of fulminant sepsis caused by carbapenem‐resistant A. baumannii harboring the blaOXA‐23 carbapenemase gene and belonging to international clone II. This isolate led to the death of a patient 6 days after simultaneous kidney‐pancreas transplantation. Autopsy findings revealed acute mitral valve endocarditis, myocarditis, splenic and renal emboli, peritonitis, and pneumonia. This case highlights the severe nature of certain A. baumannii infections and the vulnerability of transplanted patients to the increasingly intractable “high‐risk” clones of multidrug‐resistant organisms.
Metabolism of acyl‐lipids in Chlamydomonas reinhardtii
Authors: Li‐Beisson Yonghua , Beisson Fred , Riekhof Wayne
Published: February 2015

Microalgae are emerging platforms for production of a suite of compounds targeting several markets, including food, nutraceuticals, green chemicals, and biofuels. Many of these products, such as biodiesel or polyunsaturated fatty acids (PUFAs), derive from lipid metabolism. A general picture of lipid metabolism in microalgae has been deduced from well characterized pathways of fungi and land plants, but recent advances in molecular and genetic analyses of microalgae have uncovered unique features, pointing out the necessity to study lipid metabolism in microalgae themselves. In the past 10 years, in addition to its traditional role as a model for photosynthetic and flagellar motility processes, Chlamydomonas reinhardtii has emerged as a model organism to study lipid metabolism in green microalgae. Here, after summarizing data on total fatty acid composition, distribution of acyl‐lipid classes, and major acyl‐lipid molecular species found in C. reinhardtii, we review the current knowledge on the known or putative steps for fatty acid synthesis, glycerolipid desaturation and assembly, membrane lipid turnover, and oil remobilization. A list of characterized or putative enzymes for the major steps of acyl‐lipid metabolism in C. reinhardtii is included, and subcellular localizations and phenotypes of associated mutants are discussed. Biogenesis and composition of Chlamydomonas lipid droplets and the potential importance of lipolytic processes in increasing cellular oil content are also highlighted.
Microsatellite DNA variation within and among invasive populations of Ambrosia artemisiifolia from the southern Pannonian Plain
Authors: Kočiš Tubić N , Djan M , Veličković N , Anačkov G , Obreht D
Published: February 2015

Although the Pannonian Plain presents one of the areas in Europe most highly infested by Ambrosia artemisiifolia, previously reported population genetic studies of the invasive species have included only a few populations from this region. Our goal was to determine the level of genetic diversity and genetic structure of A. artemisiifolia populations from the southern Pannonian Plain using microsatellite DNA markers. We documented a high level of genetic diversity within the Pannonian populations, as compared with the genetic diversity parameters previously published for the other invasive populations of A. artemisiifolia in Europe. The mean number of alleles per locus (NA) ranged between 6.8 and 9.4, allelic richness (r) between 6.59 and 8.53 and mean number of rare alleles per locus (NR) ranged between 3.4 and 6.4 per analysed population. A low level of among‐population differentiation was detected, with percentage of variation between populations of 3.3%, generally low pairwise FST values (ranged from −0.007 to 0.152) and also according to principal coordinate analysis. A Bayesian approach revealed that most individuals did not strongly associate with any single genetic cluster, confirming a lack of genetic structuring in the analysed region. Together with the results of quantification of the level of gene flow (Nm = 5.671), these observations indicated a presence of extensive gene exchange and admixture between the populations. Therefore, A. artemisiifolia in the Pannonian Plain region has the potential for rapid expansion.