bluuebunny/crossref_metadata_2025 huggingface dataset:
The Nursing Diagnosis of “Death Anxiety”: Content Validation by Experts
Authors: Fernández‐Donaire Lidia , Romero‐Sánchez José Manuel , Paloma‐Castro Olga , Boixader‐Estévez Francesc , Porcel‐Gálvez Ana María
Published: November 2018

PURPOSE

To validate the content of the NANDA‐I diagnosis “death anxiety” (00147).

METHODS

Descriptive study using the Fehring model with 202 Spanish nurses who were expert in end‐of‐life care to explore the adequacy of the components of the NANDA‐I diagnosis “death anxiety” (00147) in the Spanish edition.

FINDINGS

None of the diagnosis definitions were considered as representative. Furthermore, 5 of the 56 defining characteristics and 5 of the 26 related factors were validated as major.

CONCLUSIONS

In general, the components of the diagnosis “death anxiety” (00147) in the Spanish edition are not representative according to experts.

IMPLICATIONS FOR NURSING PRACTICE

The results support the need to either exclude the diagnosis from the taxonomy or adjust its content.
What defines a clinically meaningful outcome in the treatment of substance use disorders: ‘Getting your life back’
Authors: Ray Lara A. , Lim Aaron C. , Shoptaw Steven
Published: November 2018

Commentary to: What defines a clinically meaningful outcome in the treatment of substance use disorders: reductions in direct consequences of drug use or improvement in overall functioning?
Atlantic salmon (Salmo salar L.) genetics in the 21st century: taking leaps forward in aquaculture and biological understanding
Authors: Houston R. D. , Macqueen D. J.
Published: November 2018

Atlantic salmon (Salmo salar L.) is among the most iconic and economically important fish species and was the first member of Salmonidae to have a high‐quality reference genome assembly published. Advances in genomics have become increasingly central to the genetic improvement of farmed Atlantic salmon as well as conservation of wild salmon stocks. The salmon genome has also been pivotal in shaping our understanding of the evolutionary and functional consequences arising from an ancestral whole‐genome duplication event characterising all Salmonidae members. Here, we provide a review of the current status of Atlantic salmon genetics and genomics, focussed on progress made from genome‐wide research aimed at improving aquaculture production and enhancing understanding of salmonid ecology, physiology and evolution. We present our views on the future direction of salmon genomics, including the role of emerging technologies (e.g. genome editing) in elucidating genetic features that underpin functional variation in traits of commercial and evolutionary importance.
A nationwide population‐based study of social demographic factors, associated diseases and mortality of keratoconus patients in Denmark from 1977 to 2015
Authors: Bak‐Nielsen Sashia , Ramlau‐Hansen Cecilia H. , Ivarsen Anders , Plana‐Ripoll Oleguer , Hjortdal Jesper
Published: November 2018

Purpose

To study sociodemographic factors, associated diseases and survival of Danish keratoconus patients.

Methods

All patients diagnosed with keratoconus 1977–2015 (n = 2679) were matched to 10 persons who had not been diagnosed with keratoconus (n = 26 790). Conditional logistic regression assessed whether sociodemographic factors and specific systemic diseases were associated with the odds of keratoconus. Mortality was assessed with time‐to‐event analysis.

Results

After adjustment, non‐Europeans had more than threefold higher odds of keratoconus compared to Europeans (OR, 3.34; 96% CI 2.94–3.80). Single persons had 27% higher odds (OR, 1.27; 95% CI 1.13–1.43), and divorced persons had 18% lower odds (OR 0.82; 95% CI 0.68–0.97) of keratoconus compared with persons in a relationship. Persons living in cities with <500 and 500–4999 inhabitants had 40% (OR, 0.60; 95% CI 0.51–0.71) and 30% (OR, 0.70; 95% CI 0.61–0.81) lower odds of keratoconus, respectively, compared with those living in the capital (>1 000 000 inhabitants). Persons receiving government substitution had 68% higher odds of keratoconus (OR, 1.68; 95% CI 1.30–2.17) compared to self‐employed. Keratoconus patients had more than twofold higher odds of asthma (OR, 2.21; 95% CI 1.91–2.55), more than threefold higher odds of allergic rhinitis (OR, 3.44; 95% CI 2.75–4.30), more than sevenfold higher odds of atopic dermatitis (OR, 7.97; 95% CI, 6.21–10.21) and 69% higher odds of depression (OR, 1.69; 95% CI 1.18–2.43). Mortality rates were similar among keratoconus patients and controls (HR, 1.02; 95% CI 0.90–1.16).

Conclusion

Danish keratoconus patients differ from controls on several sociodemographic factors and have higher risk of allergic rhinitis, asthma, atopic dermatitis and depression. They do not have excess mortality compared to controls.
Changes of computed tomography‐based body composition after adrenalectomy in patients with endogenous hypercortisolism
Authors: Hong Namki , Lee Jooyeon , Ku Cheol Ryong , Han Kichang , Lee Cho Rok , Kang Sang Wook , Rhee Yumie
Published: November 2018

Context

Data on longitudinal changes of computed tomography (CT)‐determined visceral fat area (VFA), skeletal muscle area (SMA) and skeletal muscle radiodensity (SMD) after adrenalectomy are limited in patients with hypercortisolism.

Objective

To examine the association of severity of cortisol excess and improvement of CT‐based muscle and fat parameters after adrenalectomy.

Design

Retrospective observational cohort study.

Patients

One hundred thirty‐four patients with overt Cushing's syndrome (CS; n = 39), mild autonomous cortisol excess (MACE; n = 57), or nonfunctioning adrenal tumour (NFAT; n = 38) at a tertiary endocrinology institution between 2006 and 2017 were included.

Measurements

Changes in CT‐determined VFA, visceral‐to‐subcutaneous fat ratio (VSR), SMA, skeletal muscle index (SMI), and SMD measured at the third lumbar vertebra (L3).

Results

At baseline, CS patients had higher VFA, lower SMA, SMI and SMD values, compared to NFAT or MACE patients. Compared to NFAT, significant decreases in VFA and increases in SMA, SMI and SMD was observed in CS 1 year after adrenalectomy. In MACE, adjusted mean changes of SMD but not VFA, SMA or SMI differ significantly compared to NFAT (+8.9% vs −3.4%, P = 0.032). In a multivariate linear regression model, the increase by 1 μg/dL of post‐dexamethasone serum cortisol at baseline was independently associated with greater reduction of VFA (−3.95%), VSR (−3.07%), and increase in SMD (+0.92%, P < 0.05 for all) after adrenalectomy.

Conclusions

The severity of cortisol excess was associated with greater improvement of L3 VFA, VSR and SMD 1 year after adrenalectomy. These CT‐based markers may allow more objective assessment of treatment benefit at earlier stage.
Primary vs myocutaneous flap closure of perineal defects following abdominoperineal resection for colorectal disease: a systematic review and meta‐analysis
Authors: Yang XY. , Wei MT. , Yang XT. , He YZ. , Hao Y. , Zhang XB. , Deng XB. , Wang ZQ. , Zhou ZQ.
Published: November 2018

Aim

Perineal wound complications after abdominoperineal resection (APR) have become a major clinical challenge. Myocutaneous flap closure has been proposed in place of primary closure to improve wound healing. We conducted this comprehensive meta‐analysis to evaluate the current scientific evidence of primary closure vs myocutaneous flap closure of perineal defects following APR for colorectal disease.

Methods

We systematically searched the MEDLINE, Embase, PubMed, Web of Science and Cochrane Library databases to identify all relevant studies. After data extraction from the included studies, meta‐analysis was performed to compare perioperative outcomes of primary closure and myocutaneous flap closure.

Results

Eighteen studies with a total of 17 913 patients (16 346 primary closure vs 1567 myocutaneous flap closure) were included. We found that primary closure was significantly associated with higher total perineal wound complications (P = 0.007), major perineal wound complications (P < 0.001) and perineal wound infection (P = 0.001). On the other hand, myocutaneous flap closure takes more operation time (P < 0.001) and increases the risk of perineal wound dehiscence (P = 0.01), deep surgical site infection (P < 0.001), enterocutaneous fistulas (P = 0.03) and return to the operating room (P = 0.0005). There were no significant differences between the two groups for other outcomes.

Conclusions

This is the first systematic review with meta‐analysis comparing primary closure with myocutaneous flap closure of perineal defects after APR for colorectal disease. Although taking more operation time and an increased risk of specific complications, the pooled results have validated the use of myocutaneous flaps for reducing total/major perineal wound complications. More investigations are needed to draw definitive conclusions on this dilemma.
Assessing surgical difficulty in locally advanced mid–low rectal cancer: the accuracy of two MRI‐based predictive scores
Authors: de'Angelis N. , Pigneur F. , Martínez‐Pérez A. , Vitali G. C. , Landi F. , Gómez‐Abril S. A. , Assalino M. , Espin E. , Ris F. , Luciani A. , Brunetti F. ,   the EuMaRCS Study Group
Published: November 2018

Aim

Predicting surgical difficulty is a critical factor in the management of locally advanced rectal cancer (LARC). This study evaluates the accuracy and external validity of a recently published morphometric score to predict surgical difficulty and additionally proposes a new score to identify preoperatively LARC patients with a high risk of having a difficult surgery.

Methods

This is a retrospective study based on the European MRI and Rectal Cancer Surgery (EuMaRCS) database, including patients with mid/low LARC who were treated with neoadjuvant chemoradiation therapy and laparoscopic total mesorectal excision (L‐TME) with primary anastomosis. For all patients, pretreatment and restaging MRI were available. Surgical difficulty was graded as high and low based upon a composite outcome, including operative (e.g. duration of surgery) and postoperative variables (e.g. hospital stay). Score accuracy was assessed by estimating sensitivity, specificity and area under the receiver operating characteristic curve (AROC).

Results

In a total of 136 LARC patients, 17 (12.5%) were graded as high surgical difficulty. The previously published score (calculated on body mass index, intertuberous distance, mesorectal fat area, type of anastomosis) showed low predictive value (sensitivity 11.8%; specificity 92.4%; AROC 0.612). The new EuMaRCS score was developed using the following significant predictors of surgical difficulty: body mass index > 30, interspinous distance < 96.4 mm, ymrT stage ≥ T3b and male sex. It demonstrated high accuracy (AROC 0.802).

Conclusion

The EuMaRCS score was found to be more sensitive and specific than the previous score in predicting surgical difficulty in LARC patients who are candidates for L‐TME. However, this score has yet to be externally validated.
Effect of glycaemic control on cardiovascular disease in individuals with type 2 diabetes with pre‐existing cardiovascular disease: A systematic review and meta‐analysis
Authors: Barer Yael , Cohen Ohad , Cukierman‐Yaffe Tali
Published: November 2018

The role of intensive glucose control in people with type 2 diabetes and pre‐existing cardiovascular disease (CVD) is controversial. The aim of this systematic review and meta‐analysis was to determine in a subset of people with type 2 diabetes and pre‐existing CVD, the CV effect of intensive glucose control versus standard of care. We searched Medline, the Cochrane library, EMBASE and the National Institutes of Health Trial registration database for randomized controlled trials that evaluated the effect of intensive glucose control versus standard glucose control in people with type 2 diabetes on incident CVD. Data were extracted using a structured form. When data were not available in the publications, authors were contacted. Eight trials involving 8339 participants were included. Among adults with type 2 diabetes and pre‐existing CVD, there was no difference in the risk of CV events in those allocated to intensive glucose control compared with those in the standard care arm (relative risk 0.98, 95% confidence interval 0.87‐1.09). In conclusion, in people with diabetes and pre‐existing CVD, intensive glucose control versus standard care had a neutral effect on incident CV events.
Corpus callosum low‐frequency stimulation suppresses seizures in an acute rat model of focal cortical seizures
Authors: Couturier Nicholas H. , Durand Dominique M.
Published: November 2018

Objective

Low‐frequency fiber‐tract stimulation has been shown to be effective in treating mesial temporal lobe epilepsies through activation of the hippocampal commissure in rodents and human patients. The corpus callosum is a major pathway connecting the two hemispheres of the brain; however, few experiments have documented corpus callosum stimulation. The objective is to determine the efficacy of corpus callosum stimulation at low frequencies to suppress cortical seizures.

Methods

4‐Aminopyridine was injected in the primary motor cortex of 24 rats under anesthesia. Recording electrodes were placed in the contralateral motor cortex and hippocampus. Three pairs of stimulating electrodes were inserted into the corpus callosum along its longitudinal axis. Local field potentials were recorded 1 hour before, during, and after stimulation to determine the effect of stimulation on seizure duration. Stimulation was delivered from each pair of electrodes independently in separate experiments. Furthermore, electrical stimulation was applied to the region of the corpus callosum with the highest degree of innervation of the seizure focus to compare the efficacy of different stimulation frequencies (1‐30 Hz) on seizure suppression.

Results

Corpus callosum stimulation was effective at suppressing seizures at 10 Hz by 76% (P < 0.05, n = 5) and at 20 Hz by 95% (P < 0.0001, n = 14). Stimulation at frequencies of 1 and 30 Hz did not have a significant effect on reducing the total time spent seizing (P > 0.9999, n = 5). Furthermore, stimulation was only effective at suppressing seizures when the pair of electrodes was placed within the section of corpus callosum containing fibers innervating the seizure focus. Secondarily generalized seizures in the hippocampus were eliminated when seizures in the cortical focus were suppressed.

Significance

Low‐frequency fiber‐tract stimulation of the corpus callosum suppresses both cortical and cortically induced hippocampal seizures in an acute model of focal cortical seizures. The stimulation paradigm is selective, as it is only effective when targeted to specific regions of the corpus callosum that project maximally to cortical regions generating the seizure activity. Selective placement of stimulation electrodes along the corpus callosum could be used as a patient‐specific treatment for cortical epilepsies.
Health‐related quality of life in paediatric haemophilia B patients treated with rIX‐FP
Authors: von Mackensen Sylvia , Shah Jinesh , Seifert Wilfried , Kenet Gili
Published: November 2018

Introduction

Frequent infusions and bleeds can impact on the health‐related quality of life (HRQoL) of paediatric haemophilia B patients. rIX‐FP (IDELVION®) is a fusion protein linking recombinant factor IX with recombinant albumin, and is associated with low bleeding rates with a weekly regimen, which could improve HRQoL.

Aims

To measure the effect of rIX‐FP prophylaxis on the HRQoL of paediatric patients and treatment satisfaction in their caregivers using the Haemo‐QoL and Hemo‐SATP questionnaires, respectively.

Methods

At baseline and end‐of‐study (EOS), patients 4‐11 years old participating in the PROLONG‐9FP program answered the Haemo‐QoL questionnaire and gave information on their socio‐demographic data and physical activity. Caregivers completed the Hemo‐SatP. Minimal important differences (MID) (|Cohen's d| > 0.5) between baseline and EOS and the number of responders (patients with meaningful subject‐level improvements over time) at EOS were calculated.

Results

Twenty patients (age group I: 4‐7 years old [n = 12]; age group II: 8‐12 years old [n = 8]) completed the Haemo‐QoL questionnaire at baseline. MIDs were found in age group I representing improvement for “physical health” (d = −0.547) domain; 60% of patients were responders for “physical health.” In age group II, MIDs were seen in most domains; 71.4% patients were responders in “total score.” In caregivers, improvements were seen for most domains of the Hemo‐SatP with a small effect size. Fewer patients missed school when treated with rIX‐FP and 94.1% patients maintained their physical activity level.

Conclusion

Prophylaxis with rIX‐FP led to substantial improvements in HRQoL in paediatric patients and treatment satisfaction in caregivers.
Sports participation and physical activity in patients with von Willebrand disease
Authors: Atiq Ferdows , Mauser‐Bunschoten Eveline P. , Eikenboom Jeroen , van Galen Karin P. M. , Meijer Karina , de Meris Joke , Cnossen Marjon H. , Beckers Erick A. M. , Laros‐van Gorkom Britta A. P. , Nieuwenhuizen Laurens , van der Bom Johanna G. , Fijnvandraat Karin , Leebeek Frank W. G. ,   the WiN study group
Published: November 2018

Introduction

Patients with bleeding disorders may experience limitations in sports participation and physical activity. Several studies on sports participation have been performed in haemophilia patients, but studies in patients with von Willebrand disease (VWD) are lacking.

Aim

We assessed the sports participation and physical activity of a large cohort of VWD patients.

Methods

Patients were included from the “WiN study.” All patients completed a questionnaire on sports participation, physical activity, quality of life and bleeding symptoms (Tosetto bleeding score).

Results

From the 798 included patients, 474 had type 1, 301 type 2 and 23 type 3 VWD. The mean age was 39 ± 20 (standard deviation) years. Five hundred and fifty‐two patients (69.3%) participated in various types of sports. Type 3 VWD patients more often did not participate in sports due to fear of bleeding and physical impairment, respectively, OR = 13.24 (95% CI: 2.45‐71.53) and OR = 5.90 (95% CI: 1.77‐19.72). Patients who did not participate in sports due to physical impairment had a higher bleeding score item for joint bleeds 1.0 (±1.6) vs 0.5 (± 1.1) (P = 0.036). Patients with type 3 VWD and patients with a higher bleeding score frequently had severe limitations during daily activities, respectively, OR = 9.84 (95% CI: 2.83‐34.24) and OR = 1.08 (95% CI: 1.04‐1.12).

Conclusion

The majority of VWD patients participated in sports. Patients with type 3 VWD, a history of joint bleeds and a more severe bleeding phenotype frequently experienced limitations in sports participation and physical activities during daily life.
The traditional care culture and the Western nursing culture in Cameroon
Authors: Chance Emmanuel Aoudi , Ågotnes Gudmund , Petersen Karin Anna
Published: November 2018

Aim

This study explored the relationship between the traditional care culture and the Western nursing culture.

Background

Cameroonians are highly dependent on seeking medical aid from traditional healers and medicines, despite the emergence of contemporary health practices that are provided by Western nursing care.

Methods

This study was conducted based on Bourdieu's praxeological approach using observational and descriptional research, and interviews.

Results

While the traditional care culture and the Western nursing culture practices coexist, there are also conflicts and challenges. The people of Cameroon prefer the availability of both health care forms because they are provided with options in terms of the care they are offered and can afford.

Conclusion

Traditional care culture practices can be combined with the contemporary practices of Western nursing care. Both health care forms have advantages, and when integrated, they can contribute to providing more effective health care practices that can improve health care services in Cameroon.
Transnationalization of a Recruitment Regime: Skilled Migration to Japan
Authors: Conrad Harald , Meyer‐Ohle Hendrik
Published: November 2018

Japan, facing a demographic decline and challenges by companies and universities to internationalize, has opened its doors to skilled migration. Focussing initially on a two‐step student migration model, Japanese companies are now recruiting young graduates from overseas universities, mainly in Asia. We argue that, with the help of brokers, the domestic recruitment regime (a set of particular employment practices) has been transnationalized. Based on interviews with stakeholders and discussing international recruitment fairs as the site of engagement, we present first evidence that the activities of brokers have the potential to change attitudes towards employability among overseas universities and their students. We also find that this development compromises the original diversity objectives of Japanese employers and point to a lack of rules of engagement for brokers operating across national borders.
Serum urate levels and therapy in adults treated with long‐term dialysis: a retrospective cross‐sectional study
Authors: Yeo Estella , Palmer Suetonia C. , Chapman Peter T. , Frampton Christopher , Stamp Lisa K.
Published: November 2018

Background

The management of gout in chronic kidney disease and end‐stage renal disease is challenging and remains controversial. There are limited data on the use of urate‐lowering therapy in people receiving dialysis.

Aim

To estimate the point prevalence of gout, gout treatment and achievement of target serum urate (SU) among adults treated with long‐term dialysis.

Methods

Three secular cohorts of adults receiving dialysis for at least 90 days on 1 February 2017, 1 January 2016 and 1 January 2015 were identified. Medical records were reviewed for SU concentrations. Results were compared between haemodialysis (HD) and peritoneal dialysis (PD), and participants prescribed and not prescribed urate‐lowering therapy. The percentage reduction in SU 24‐ and 48‐h post‐HD was estimated based on data from a previous study. SU concentrations were then used to estimate the percentage time the SU was <0.36 mmol/L using linear interpolation.

Results

Of 216 dialysis patients, 61 (point prevalence 28.2%, 95% confidence interval 22.35–34.8%) had a diagnosis of gout. The mean (SD) age among those with gout was 61 years (14.4), 46 (75.4%) were men and 18 (31.1%) identified as Māori or Pacific Island. Forty‐two (68.9%) were prescribed allopurinol (mean (SD) dose 116.0 ± 66.9 mg/day). 46% had a predialysis SU ≤0.36 mmol/L on less than 25% of occasions and 23% were below target on 76–100% of occasions. SU was below target 41% of time, with no statistically significant difference in those on HD or PD (P = 0.39), and those prescribed or not prescribed allopurinol (P = 0.55).

Conclusions

Gout is experienced by approximately one in four adults treated with dialysis and two‐thirds are prescribed allopurinol. A minority have SU at a target sufficient to prevent gout despite allopurinol and HD. A treat to target SU should be considered in those with SU above target.
Inhibiting the urokinase‐type plasminogen activator receptor system recovers STZ‐induced diabetic nephropathy
Authors: Dal Monte Massimo , Cammalleri Maurizio , Pecci Valeria , Carmosino Monica , Procino Giuseppe , Pini Alessandro , De Rosa Mario , Pavone Vincenzo , Svelto Maria , Bagnoli Paola
Published: November 2018

The urokinase‐type plasminogen activator (uPA) receptor (uPAR) participates to the mechanisms causing renal damage in response to hyperglycaemia. The main function of uPAR in podocytes (as well as soluble uPAR ‐(s)uPAR‐ from circulation) is to regulate podocyte function through αvβ3 integrin/Rac‐1. We addressed the question of whether blocking the uPAR pathway with the small peptide UPARANT, which inhibits uPAR binding to the formyl peptide receptors (FPRs) can improve kidney lesions in a rat model of streptozotocin (STZ)‐induced diabetes. The concentration of systemically administered UPARANT was measured in the plasma, in kidney and liver extracts and UPARANT effects on dysregulated uPAR pathway, αvβ3 integrin/Rac‐1 activity, renal fibrosis and kidney morphology were determined. UPARANT was found to revert STZ‐induced up‐regulation of uPA levels and activity, while uPAR on podocytes and (s)uPAR were unaffected. In glomeruli, UPARANT inhibited FPR2 expression suggesting that the drug may act downstream uPAR, and recovered the increased activity of the αvβ3 integrin/Rac‐1 pathway indicating a major role of uPAR in regulating podocyte function. At the functional level, UPARANT was shown to ameliorate: (a) the standard renal parameters, (b) the vascular permeability, (c) the renal inflammation, (d) the renal fibrosis including dysregulated plasminogen‐plasmin system, extracellular matrix accumulation and glomerular fibrotic areas and (e) morphological alterations of the glomerulus including diseased filtration barrier. These results provide the first demonstration that blocking the uPAR pathway can improve diabetic kidney lesion in the STZ model, thus suggesting the uPA/uPAR system as a promising target for the development of novel uPAR‐targeting approaches.
Substance use screening and brief intervention: Evaluation of patient and implementation differences between primary care and emergency department settings
Authors: O'Grady Megan A. , Kapoor Sandeep , Kwon Nancy , Morley Jeanne , Auerbach Mark , Neighbors Charles J. , Conigliaro Joseph , Morgenstern Jon
Published: November 2018

Rationale, aims, and objectives

There are well‐documented barriers that have limited widespread, sustained adoption of screening and brief intervention for risky substance use in health care settings. In order to better inform implementation efforts, this study evaluates whether patient characteristics, screening results, and implementation success indicators differed between two clinical setting types: primary care and emergency.

Methods

Patients presenting to an emergency or primary care setting were screened for risky substance use (n = 41 567). Patients with a positive screen were further assessed for psychosocial, health, and substance use problems (n = 1604). Differences in patient characteristics between primary care and emergency settings were examined using chi‐square and t tests. Multilevel logistic regression was used to examine whether setting type predicted screening results. Site‐level indicators of implementation success were calculated (percentage prescreens completed, percentage full screens completed, and percentage refused services) for all patient visits (n = 78 656).

Results

As compared with primary care patients, emergency patients had more severe substance use patterns and screening scores, were more likely to use a variety of illicit drugs, and reported more psychosocial issues. In logistic regression models, setting type did not predict whether patients screened positive; however, it did predict screening into a higher vs lower risk category such that emergency patients were more likely to be in a higher risk category. Emergency settings had lower indicators of implementation success (eg, 14% lower prescreen completion rate) as compared with primary care settings on some implementation measures.

Conclusions

This evaluation found important differences in patient characteristics and screening and implementation results between primary care and emergency settings. Health care organizations and administrators implementing screening and brief intervention should attend to setting differences that could affect implementation and clinical care.
Length of stay by uncomplicated diabetes bariatric surgery patients: A laparoscopic adjustable banding versus laparoscopic sleeve gastrectomy
Authors: Baffoe Seth K.A. , Rohrer James E. , Goes James
Published: November 2018

Rationale, aims, and objective

Bariatric surgery is an effective procedure for morbidly obese patients when all else fails. The purpose of this study was to compare the hospital length of stay (LOS) for two surgical procedures, laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG).

Methods

This study was a retrospective cross‐sectional analysis of the Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who received bariatric surgery as indicated by International Classification of Diseases, Ninth Revision (ICD‐9) procedure codes were selected (N = 4001). Cases were limited to uncomplicated diabetic patients. Differences in the odds of long vs short (2< and ≥2) stay for a patient receiving LSG were compared with LAGB while adjusting for hospital volume, hospital size, patient age, gender, ethnicity, season, and year using logistic regression analysis.

Results

The odds for LSG (odds ratio [OR] = 0.100, 0.066‐0.150, P < 0.001) patients for long LOS are lower when compared with LAGB. In the stratified logistic regression model, both male (OR = 0.157, 0.074‐0.333, P < 0.001) and female (OR = 0.077, 0.046‐0.127, P < 0.001) had reduced odds of extended LOS for LSG. Discharged patients in the year 2012 (OR = 0.660, 0.536‐0.813, P < 0.001) had decreased odds of having a longer LOS when compared with the year 2014.

Both government, nonfederal (OR = 0.452, 0.251‐0.816, P = 0.008), and private investor‐owned (OR = 0.421, 0.244‐0.726, P < 0.001) patients had similar odds for long duration of stay when compared with government or private. Urban non‐teaching (OR = 1.954, 1.653‐2.310, P < 0.001) patients had higher odds for long LOS in comparison with urban teaching. New England patients' (OR = 0.365, 0.232‐0.576, P < 0.001) odds for extended LOS were lower when compared with pacific. Both patients who received care in low (OR = 1.330, 1.109‐1.595, P = 0.002) and medium (OR = 1.639, 1.130‐2.377, P = 0.009) volume hospital had increased odds for long duration of stay. Female patients in the stratified logistic regression model with high (OR = 1.330, 1.109‐1.595, P < 0.002) volume had elevated odds of extended LOS when compared with very low volume hospital.

Conclusion

Among the uncomplicated diabetic patients, LSG provides a substantially low odds of extended LOS after adjusting for covariates when compared with LAGB. The finding of the relative reduction in LOS for LSG suggests opportunities for improvement both for cost reduction for third party insurance payers and greater efficacy and outcomes for patients.
Adherence to the Mediterranean diet was positively associated with micronutrient adequacy and negatively associated with dietary energy density among adolescents
Authors: Peng W. , Berry E. M. , Goldsmith R.
Published: November 2018

Background

The possible associations between adherence to the Mediterranean diet and micronutrient and energy intakes are unknown among Israeli adolescents.

Methods

A cross‐sectional, nationally representative, school‐based study was conducted in Israeli adolescents. Schoolchildren (n = 5005), aged 11–18 years, who completed a food frequency questionnaire and had complete data to compose a 14‐item modified KIDMED score were included.

Results

The nutrient intakes for all the micronutrients showed a significant monotonic increase in the poor, average and good KIDMED groups (all P < 0.001). The same monotonic increasing was also shown in nutrient densities for most micronutrients (for calcium, magnesium, potassium, copper, vitamin A, vitamin E, vitamin C, thiamin, riboflavin, vitamin B6, folate in both genders, additionally for phosphorus in girls) (all P < 0.05). A positive association was shown between the percentages of students with adequate intakes (AIs) or recommended dietary allowances (RDAs) in micronutrients and modified KIDMED scores. The positive association also existed between the number of micronutrients with AIs or RDAs and modified KIDMED scores (r = 0.495 and 0.501, P < 0.001) for boys and girls, respectively. By contrast, dietary energy density (calibrated by 1000 kcal) was negatively linearly associated with modified KIDMED scores, and a significant monotonic decrease in energy density was shown among the poor, average and good KIDMED groups (all P < 0.001).

Conclusions

The modified KIDMED score was positively associated with better micronutrient profile and negatively associated with dietary energy density in Israeli adolescents, indicating that the KIDMED index is a useful tool for combating the malnutrition of micronutrient deficiency and overweight/obesity.
Bands of Fontana are caused exclusively by the sinusoidal path of axons in peripheral nerves and predict axon path; evidence from rodent nerves and physical models
Authors: Alvey Luke M. , Jones James F. X. , Tobin‐O'Brien Cathal , Pickering Mark
Published: November 2018

The precise cause of the bands of Fontana, striations on peripheral nerves visible to the naked eye, has been the subject of debate for hundreds of years. Some researchers have described them as reflecting the sinuous course of nerve fibres passing through nerves, and others have proposed that endoneurial collagen and sheaths surrounding nerves play a role in their appearance. We hypothesised that the bands are caused exclusively by reflection of light from the surfaces of nerve fibres travelling in phase in sinusoidal waveforms through peripheral nerves. We aligned images of obliquely illuminated nerves with confocal images of axons in those nerves, and the numbers and positions of the bands precisely matched the axonal waves. We also developed three‐dimensional models of nerves with representations of the sinusoidal path of axons at their surface. We observed patterns resembling the bands of Fontana when these models were obliquely illuminated. This provides evidence that the bands of Fontana can be caused by light reflected sinusoidal path of axons alone. We subsequently describe a mechanism of band production based on our observations of both nerves and models. We report that smaller diameter nerves such as phrenic nerves and distal branches of sciatic nerves have shorter band intervals than larger nerves, such as proximal trunks of sciatic nerves, and that shorter band intervals correlate with longer axons per unit length of nerve, which suggests a greater tolerance to stretch. Inspection of banding patterns on peripheral nerves may permit prediction of axon length within nerves, and assist in the interpretation of nerve conduction data, especially in diseases where axon path has become altered.
Scheduled care—As a way of caring: A phenomenological study of being cared for when suffering from alcohol use disorders
Authors: Bové Hanne Morkenborg , Lisby Marianne , Norlyk Annelise
Published: November 2018

Aims and objectives

To elucidate the lived experience of how patients with alcohol use disorders experience being cared for when admitted to acute medical units.

Background

Alcohol use is health damaging and is identified as one of the major avoidable risk factors, and alcohol use disorder is classified among the most harmful, debilitating disease categories. Patients suffering from alcohol use disorders are characterised by complex problems and health pictures spawned by chaotic lifestyles. However, the experience of the hospitalisation from patients’ perspective is poorly documented.

Design

The present study has a qualitative research design and is anchored in phenomenological and hermeneutical methodology, as described in reflective lifeworld research.

Methods

The data set consists of 15 in‐depth interviews with patients suffering from alcohol use disorders admitted to an acute medical unit. A purposive sampling strategy was used, and the interviews were conducted as open dialogues. The study was reported in accordance with the consolidated criteria for reporting qualitative research.

Results

Being cared for when hospitalised was experienced as a two‐stage process that changed throughout the hospitalisation from an experience of scheduled care experienced as caring to an experience of scheduled care experienced as non‐caring. Four constituents further described the variable experiences: being in a safe haven, sharing a tacit but mutual goal, being in a chaotic space and being on your own.

Conclusions

The study showed that being met in an authentic presence by nurses was a powerful tool that helped ease the hospitalisation. Patients suffering from alcohol use disorders call for an intentional and distinctive attentiveness and authentic presence from the nurses throughout their hospitalisation.

Relevance to clinical practice

Our findings highlight that patients suffering from alcohol use disorders call for an intentional and distinct attentiveness from nurses throughout the hospitalisation, where a possible transfer of attention is noticed and responded to in the care provided.
The protective effects of Δ9-tetrahydrocannabinol against inflammation and oxidative stress in rat liver with fructose-induced hyperinsulinemia
Authors: Beydogan Alisa Bahar , Coskun Zeynep Mine , Bolkent Sema
Published: November 2018

Objectives

A large amount of fructose is metabolized in the liver and causes hepatic functional damage. Δ9-tetrahydrocannabinol (THC) is known as a therapeutic agent for clinical and experimental applications. The study aims to investigate the effects of THC treatment on inflammation, lipid profiles and oxidative stress in rat liver with hyperinsulinemia.

Methods

Sprague-Dawley rats were divided into groups: control, fructose (10% fructose in drinking water for 12 weeks), THC (1.5 mg/kg/day for the last 4 weeks, intraperitoneally) and fructose+THC groups. Biochemical parameters were measured spectrophotometrically. ELISA method was used for insulin measurement. Apoptosis and inflammation markers were detected by the streptavidin-biotin peroxidase method.

Key findings

The consumptions of food and fluid are inversely proportional to fructose and non-fructose groups. Insulin levels were the highest in fructose group. The reduced glutathione-S-transferase level significantly increased in fructose + THC group compared with fructose group. Total cholesterol level in the fructose + THC group was higher than the fructose group. Caspase-3 and NF-κβ immunopositive cell numbers increased in fructose + THC rats compared with fructose group. The number of IL-6 immunopositive cell decreased in fructose + THC group compared with fructose group.

Conclusions

According to the result, long-term and low-dose THC administration may reduce hyperinsulinemia and inflammation in rats to some extent.
Bioaccumulation of trace elements in Arthrospira fusiformis algal blooms in Lakes Bogoria and Sonachi, Kenya: Evaluation and verification of toxicokinetic models
Authors: Muohi Anne W. , Zauke Gerd‐Peter , Brumsack Hans‐Jurgen , Mavuti Kenneth M.
Published: November 2018

The bioaccumulation of cadmium (Cd), copper (Cu), lead (Pb) and zinc (Zn) was examined in Arthrospira fusiformis algal blooms. The present study was designed to provide information on accumulation strategies of the test organism and to verify two‐compartment toxicokinetic models as predictive tools. Heavy metal accumulation in the organisms did occur, and it was possible to estimate significant model parameters of two‐compartment models. The nominal exposure was a metal mixture of 0.005, 0.03, 0.02 and 0.06 μg/g of Cd, Cu, Pb and Zn, respectively, being doubled and tripled in subsequent experiments. The experiment design was a semi‐static system comprising five hours for uptake and a similar duration for clearance. The design comprised two replicates and a control. Cd and Cu produced better models (R2 > 0.5), compared to Pb and Zn. Concurrent uptake rate constants (k1) were higher than the elimination rate constants (k2), leading to net accumulation. The t‐values for parameter estimates were ≥2, indicating the estimates were statistically different from zero. Kinetic bioconcentration factors (BCFs) at theoretical equilibrium increased with increased exposure doses, especially for Cu. Time‐dependent model parameters were verified with independent experimental data to assess reproducibility. Cd and Cu models were verifiable, especially when the experiments were for the same environmental medium/lake. Time‐dependent model parameters were verified with data from concentration‐dependent exposures, indicating the models were verifiable, exhibiting better agreement when the model parameters and test data were from the same lake. Specific trace elements accumulation strategies for the test organism, Arthrospira fusiformis, the main food organism for flamingos in the studied lakes, can be useful in interpreting trophic transfers, noting flamingos in those lakes must be conserved because they are a tourist attraction, thereby being of significant economic benefit to the citizens and government of Kenya.
Use of monitoring data to improve implementation of a home fortification program in Bihar, India
Authors: Mehta Rukshan , Martorell Reynaldo , Chaudhuri Indrajit , Girard Amy Webb , Ramakrishnan Usha , Verma Pankaj , Kekre Priya , Srikantiah Sridhar , Young Melissa F.
Published: November 2018

This paper describes the use of program‐monitoring data to track program performance and inform activities. Monitoring data were collected as part of an effectiveness trial of multiple micronutrient powders (MNPs) for children 6–18 months in Bihar, India. Communities (n = 70; reaching over 10,000 children) were randomized to receive either counselling on infant and young child feeding or both counselling and MNPs. Government frontline health workers (FLWs) implemented and monitored program activities with support from CARE India and university partners. Monitoring data were collected over the duration of the entire program to assess program impact pathways using various checklists, which captured information about (a) attendance and training of FLWs at health subcentre meetings, (b) distribution of MNPs, (c) receipt and use of MNPs at the household level, and (d) midline mixed methods survey. At the beginning of the program, 72% of households reported receiving and 53% reported currently consuming MNPs. These numbers fell to 40% and 43% at midline, respectively. The main barrier to use by household was a lack of MNPs, due in part to infrequent FLW distribution. However, FLWs rarely reported MNP shortages at Anganwadi centres. Side effects also emerged as a barrier and were addressed through revised recommendations for MNP use. Qualitative data indicated high community acceptance of MNPs and a good understanding of the program by FLWs. The use of real‐time program data allowed for recognition of key program issues and decision‐making to enhance program implementation.
Elevational patterns and hierarchical determinants of biodiversity across microbial taxonomic scales
Authors: Yeh Chih‐Fu , Soininen Janne , Teittinen Anette , Wang Jianjun
Published: November 2018

Microbial biogeography is gaining increasing attention due to recent molecular methodological advance. However, the diversity patterns and their environmental determinants across taxonomic scales are still poorly studied. By sampling along an extensive elevational gradient in subarctic ponds of Finland and Norway, we examined the diversity patterns of aquatic bacteria and fungi from whole community to individual taxa across taxonomic coverage and taxonomic resolutions. We further quantified cross‐phylum congruence in multiple biodiversity metrics and evaluated the relative importance of climate, catchment and local pond variables as the hierarchical drivers of biodiversity across taxonomic scales. Bacterial community showed significantly decreasing elevational patterns in species richness and evenness, and U‐shaped patterns in local contribution to beta diversity (LCBD). Conversely, no significant species richness and evenness patterns were found for fungal community. Elevational patterns in species richness and LCBD, but not in evenness, were congruent across bacterial phyla. When narrowing down the taxonomic scope towards higher resolutions, bacterial diversity showed weaker and more complex elevational patterns. Taxonomic downscaling also indicated a notable change in the relative importance of biodiversity determinants with stronger local environmental filtering, but decreased importance of climatic variables. This suggested that niche conservatism of temperature preference was phylogenetically deeper than that of water chemistry variables. Our results provide novel perspectives for microbial biogeography and highlight the importance of taxonomic scale dependency and hierarchical drivers when modelling biodiversity and species distribution responses to future climatic scenarios.
The cap‐snatching reaction of yeast L‐A double‐stranded RNA virus is reversible and the catalytic sites on both Gag and the Gag domain of Gag‐Pol are active
Authors: Fujimura Tsutomu , Esteban Rosa
Published: November 2018

The yeast L‐A double‐stranded RNA virus synthesizes capped transcripts by a unique cap‐snatching mechanism in which the m7Gp moiety of host mRNA (donor) is transferred to the diphosphorylated 5′ end of the viral transcript (acceptor). This reaction is activated by viral transcription. Here, we show that cap snatching can be reversible. Because only m7Gp is transferred during the reaction, the resulting decapped donor, as expected, retained diphosphates at the 5′ end. We also found that the 5′ terminal nucleotide of the acceptor needs to be G but not A. Interestingly, the A‐initiated molecule when equipped with a cap structure (m7GpppA…) could work as cap donor. Because the majority of host mRNAs in yeast have A after the cap structures at the 5′ ends, this finding implies that cap‐snatching in vivo is virtually a one‐way reaction, in favor of furnishing the viral transcript with a cap. The cap‐snatching sites are located on the coat protein Gag and also the Gag domain of Gag‐Pol. Here, we demonstrate that both sites are functional, indicating that activation of cap snatching by transcription is not transmitted through the peptide bonding between the Gag and Pol domains of Gag‐Pol.
Should they stay or should they go? Nitric oxide and the clash of regulators governing Vibrio fischeri biofilm formation
Authors: Stabb Eric V.
Published: November 2018

A key regulatory decision for many bacteria is the switch between biofilm formation and motile dispersal, and this dynamic is well illustrated in the light‐organ symbiosis between the bioluminescent bacterium Vibrio fischeri and the Hawaiian bobtail squid. Biofilm formation mediated by the syp gene cluster helps V. fischeri transition from a dispersed planktonic lifestyle to a robust aggregate on the surface of the nascent symbiotic organ. However, the bacteria must then swim to pores and down into the deeper crypt tissues that they ultimately colonize. A number of positive and negative regulators control syp expression and biofilm formation, but until recently the environmental inputs controlling this clash between opposing regulatory mechanisms have been unclear. Thompson et al. have now shown that Syp‐mediated biofilms can be repressed by a well‐known host‐derived molecule: nitric oxide. This regulation is accomplished by the NO sensor HnoX exerting control over the biofilm regulator HahK. The discoveries reported here by Thompson et al. cast new light on a critical early stage of symbiotic initiation in the V. fischeri‐squid model symbiosis, and more broadly it adds to a growing understanding of the role(s) that NO and HnoX play in biofilm regulation by many bacteria.