bluuebunny/crossref_metadata_2025 huggingface dataset:
Controlled randomized trial of walking exercise with positive education on cardiovascular fitness and happiness in retired older adults
Authors: Lee Tony Szu‐Hsien , Hung Chia‐Chun , Lin Chao‐Kuang , Chiang Hui‐Hsun
Published: July 2019

Aim

Regular walking exercise (RWE) is associated with increased cardiovascular fitness and might elevate subjective psychological well‐being. Positive education links positive psychology concepts with self‐efficacy through the curriculum, which helps foster well‐being. This study examines if regular walking exercise with positive education has better effects on cardiovascular fitness and happiness than RWE alone in retired older adults.

Methods

Three arms of experimental design were used: pedometer walking exercise training (PWET); positive education and pedometer walking exercise training (PEPWET); and pedometer walking exercise (PWE). Trained walking exercise was provided to the PWET and PEPWET groups by a walking exercise coach three times per week, for 45 min per session for 12 weeks. Positive education was designed and led by a licensed PhD psychologist every other week. Of 150 participants, 60, 60 and 30 were randomly assigned to PWET, PEPWET and PWE, respectively. Demographic information, Chinese Happiness Inventory, RWE, and 6‐min walking distance were assessed before and after the intervention.

Results

The percentage of participants who practiced RWE after 12 weeks was significantly higher in the PEPWET group (96.7%), followed by the PWET (75%) and PWE groups (40%). Cardiovascular fitness in the PWET and PEPWET groups was significantly better than in the PWE group. Chinese Happiness Inventory scores in the PWET and PEPWET groups were significantly higher than in the PWE group, and the PEPWET group also showed significantly higher Chinese Happiness Inventory scores than the PWET group.

Conclusions

In addition to RWE, the study findings show that positive education can be beneficial to promote older adults’ RWE, cardiovascular fitness and happiness. Geriatr Gerontol Int 2019; 19: 879–884.
A questionnaire‐based study of attitudes to spirituality in mental health practitioners and the relevance of the concept of spiritually competent care
Authors: Rogers Melanie , Wattis John , Stephenson John , Khan Wajid , Curran Stephen
Published: July 2019

In the light of the increasing recognition of the relevance of spirituality in person‐centred, holistic care, this study examines the attitudes of a convenience sample of mental health practitioners, including nurses, to the concepts of spirituality in general and in clinical practice. A series of 5‐point Likert‐style items assessed two key domains of spirituality in everyday life (SEDL) and spirituality in practice (SIP). The questionnaire was derived from one previously used with healthcare educators (including nurses). Each item was scored from 1 point (strongly disagree) to 5 points (strongly agree). Additional information about how far practitioners believed spirituality had been integrated in their education and how much they believed that spirituality related to religion was also ascertained. Three further items, not part of the main questionnaire, dealt with respondents’ views of spirituality competent practice, in the light of a description provided as part of the questionnaire. Data were collected from 104 respondents. Standard statistical procedures, including reliability analyses, were applied to the data. Respondents who viewed spirituality to be distinct from religion, or a place of worship, were likely to place a higher value on spirituality in everyday life, while respondents who experienced the integration of spirituality within their preregistration training and/or clinical education were likely to place a higher value on the place of spirituality in practice. The possible reasons for these associations are discussed in the light of the importance of spiritual care as a part of person‐centred, holistic practice.
MicroRNA‐351 eases insulin resistance and liver gluconeogenesis via the PI3K/AKT pathway by inhibiting FLOT2 in mice of gestational diabetes mellitus
Authors: Chen Shu‐Hong , Liu Xiao‐Nan , Peng Yan
Published: July 2019

Gestational diabetes mellitus (GDM) is known as different degree glucose intolerance that is initially identified during pregnancy. MicroRNAs (miRs) may be a potential candidate for treatment of GDM. Herein, we suggested that miR‐351 could be an inhibitor in the progression of GDM via the phosphoinositide 3‐kinase/protein kinase B (PI3K/AKT) pathway. Microarray analysis was used to identify differentially expressed genes and predict miRs regulating flotillin 2 (FLOT2). Target relationship between miR‐351 and FLOT2 was verified. Gestational diabetes mellitus mice were treated with a series of mimic, inhibitor and small interfering RNA to explore the effect of miR‐351 on insulin resistance (IR), cell apoptosis in pancreatic tissues and liver gluconeogenesis through evaluating GDM‐related biochemical indexes, as well as expression of miR‐351, FLOT2, PI3K/AKT pathway‐, IR‐ and liver gluconeogenesis‐related genes. MiR‐351 and FLOT2 were reported to be involved in GDM. FLOT2 was the target gene of miR‐351. Gestational diabetes mellitus mice exhibited IR and liver gluconeogenesis, up‐regulated FLOT2, activated PI3K/AKT pathway and down‐regulated miR‐351 in liver tissues. Additionally, miR‐351 overexpression and FLOT2 silencing decreased the levels of FLOT2, phosphoenolpyruvate carboxykinase, glucose‐6‐phosphatase, fasting blood glucose, fasting insulin, total cholesterol, triglyceride, glyeosylated haemoglobin and homeostasis model of assessment for IR index (HOMA‐IR), extent of PI3K and AKT phosphorylation, yet increased the levels of HOMA for islet β‐cell function, HOMA for insulin sensitivity index and glucose transporter 2 expression, indicating reduced cell apoptosis in pancreatic tissues and alleviated IR and liver gluconeogenesis. Our results reveal that up‐regulation of miR‐351 protects against IR and liver gluconeogenesis by repressing the PI3K/AKT pathway through regulating FLOT2 in GDM mice, which identifies miR‐351 as a potential therapeutic target for the clinical management of GDM.
Response to IL‐17A inhibitors secukinumab and ixekizumab cannot be explained by genetic variation in the protein‐coding and untranslated regions of the IL‐17A gene: results from a multicentre study of four European psoriasis cohorts
Authors: van Vugt L.J. , van den Reek J.M.P.A. , Meulewaeter E. , Hakobjan M. , Heddes N. , Traks T. , Kingo K. , Galluzzo M. , Talamonti M. , Lambert J. , Coenen M.J.H. , de Jong E.M.G.J.
Published: July 2019

Background

Genetic predictors for treatment response could optimize allocation of biological treatment in patients with psoriasis. There is minimal knowledge about pharmacogenetics of anti‐IL‐17 agents.

Objectives

To assess whether genetic variants in the protein‐coding region or untranslated regions of the IL‐17A gene are associated with response to IL‐17A inhibitors in patients with psoriasis.

Methods

This was a multicenter European cohort study investigating pharmacogenetics of IL‐17A inhibitors in patients with psoriasis. Patients with plaque psoriasis treated with secukinumab or ixekizumab in daily practice were included. For all participants, the protein‐coding region and untranslated regions of the IL‐17A gene were analysed using Sanger sequencing. Identified genetic variants were tested for association with response to secukinumab/ixekizumab, measured as ∆PASI, after 12 weeks (primary outcome) and after 24 weeks (secondary outcome). Association was tested using a linear regression model with correction for baseline PASI as a fixed covariate and for biological naivety and body mass index as additional covariates.

Results

In total, 134 patients treated with secukinumab or ixekizumab were included. Genotyping of the cohort identified genetic variants present in untranslated regions and intronic DNA, but not in the protein‐coding region of the IL‐17A gene. Five genetic variants in non‐coding DNA with a known or suspected functional effect on IL‐17A expression were selected for association analyses: rs2275913, rs8193037, rs3819025, rs7747909 and rs3748067. After 12 weeks, 62% of patients achieved PASI75 and 39% achieved PASI90. At week 24, PASI75 and PASI90 response rates were 72% and 62%, respectively. No associations were found between the five genetic variants and ∆PASI, PASI75 or PASI90 after 12 and 24 weeks of anti‐IL‐17A treatment.

Conclusions

Response to IL‐17A inhibitors secukinumab and ixekizumab cannot be explained by genetic variation in the protein‐coding and untranslated regions of the IL‐17A gene. Pharmacogenetics of IL‐17A inhibitors in the treatment of psoriasis requires further exploration.
Culture and Sanity at the End of Life
Authors: Matlock Daniel D. , Fischer Stacy M.
Published: July 2019

This editorial comments on the article by Bynum et al.
Optimizing Clock Drawing Scoring Criteria: Development of the West Haven–Yale Clock Drawing Test
Authors: Gromisch Elizabeth S. , Beauvais John , Iannone Lynne P. , Marottoli Richard A.
Published: July 2019

BACKGROUND/OBJECTIVES

The Clock Drawing Test (CDT) is a widely used measure, which has been included as a recommended cognitive screen for driving evaluations. This study aimed to develop an optimized scoring method—the West Haven–Yale CDT (WHY‐CDT)—based on the scoring methods of Freund and Royall's CLOX, the latter of which is significantly associated with executive control functions.

DESIGN

Retrospective cohort study.

SETTING

Greater New Haven, Connecticut, area.

PARTICIPANTS

A total of 237 adults, aged 70 years and older, who had a current driver's license and drove at least once a month.

MEASUREMENTS

Clock drawings were independently scored using both scoring systems, as well as a qualitative‐based 5‐point gestalt score. Interrater reliability was calculated using Light's κ for dichotomous variables and intraclass correlations for continuous variables. A categorical principal component analysis was conducted to determine which items from the Freund and Royall scoring systems should be retained in the modified system, with the Kuder‐Richardson test used to assess internal consistency (reliability).

RESULTS

The majority of the quantitative scoring items had moderate to almost perfect interrater reliability, with excellent interrater reliability for the qualitative gestalt score. The final scoring method retained seven items from the Freund and Royall versions, of which over 85% were from the latter. Internal consistency was fair to acceptable for the WHY‐CDT's two dichotomously scored subscales, but poor for both the Freund and Royall scoring methods.

CONCLUSIONS

The WHY‐CDT is a simple scoring method that combines elements of the Freund and Royall methods, as well as an overall gestalt score, and has strong interrater reliability. Future directions for use of this modified system are discussed. J Am Geriatr Soc 67:2129–2133, 2019
Nursing students’ career identity, satisfaction with major, and career stress by career decision type
Authors: Jung Young‐Mi
Published: July 2019

Aim

This study aimed to understand the career decision types of nursing college students and accordingly identify their career identity, satisfaction with major, and career stress.

Methods

Convenience sampling was used to recruit nursing students (N = 220) attending the same college in Korea. Data were collected from May 1 to May 30, 2017. General characteristics included sex, grade, religion, extracurricular activities, and motive for their nursing major choice. The instruments included career decision type, career identity, satisfaction with major, and career stress.

Results

Total cases of clusters showed 79 (39.5%) individuals in the undecided‐uncomfortable type, 75 (37.5%) in decided‐comfortable, 32 (16.0%) in undecided‐comfortable, and 14 (7.0%) in decided‐uncomfortable. The results indicated statistically significant differences in grade (P = .001), religion (P = .040), nursing major selection motive (P = .030), career identity (P < .001), satisfaction with major (P < .001), and career stress (P < .001) by career decision type.

Conclusions

Customized career education programs should be provided to nursing students to improve their career identity and satisfaction with major, while lowering career stress, considering career decision‐comfort and decidedness, along with the reasons why some students find career decisions emotionally uncomfortable.
Early postpartum resting‐state functional connectivity for mothers receiving buprenorphine treatment for opioid use disorder: A pilot study
Authors: Swain James E. , Ho S. Shaun
Published: July 2019

Between 1999 and 2014, the prevalence of opioid use disorder (OUD) among pregnant women quadrupled in the USA. The standard treatment for peripartum women withOUDis buprenorphine. However, the maternal behavior neurocircuit that regulates maternal behavior and mother‐infant bonding has not been previously studied for human mothers receiving buprenorphine treatment forOUD(BT). Rodent research shows opioid effects on reciprocal inhibition between maternal care and defence maternal brain subsystems: the hypothalamus and periaqueductal gray, respectively. We conducted a longitudinal functional magnetic resonance imaging (fMRI) pilot study in humans to specifically examine resting‐state functional connectivity (rs‐FC) between the periaqueductal gray and hypothalamus, as well as to explore associations with maternal bonding forBT. We studied 32 mothers who completedfMRIscans at 1 month (T1) and 4 months postpartum (T2), including seven mothers receiving buprenorphine forOUDand 25 non‐OUDmothers as a comparison group (CG). The participants underwent a 6‐minute resting‐statefMRIscan at each time point. We measured potential bonding impairments using the Postpartum Bonding Questionnaire to explore how rs‐FCwith periaqueductal gray is associated with bonding impairments. Compared toCG,BTmothers differed in periaqueductal gray‐dependent rs‐FCwith the hypothalamus, amygdala, insular cortex and other brain regions at T1, with many of these differences disappearing at T2, suggesting potential therapeutic effects of continuing buprenorphine treatment. In contrast, the “rejection and pathological anger” subscale of the Postpartum Bonding Questionnaire at T1 and T2 was associated with the T1‐to‐T2 increases in periaqueductal gray‐dependent rs‐FCwith the hypothalamus and amygdala. Preliminary evidence links maternal bonding problems for mothers withOUDearly in the postpartum to connectivity between specific care and defence maternal brain circuits, which may be mitigated by buprenorphine treatment. This exploratory study supports a potential mechanism for investigating both the therapeutic benefits and risks of opioids for maternal care and bonding with infants.
Pregnancy rate after emergency contraception with single‐dose oral levonorgestrel in Japanese women
Authors: Sakurai Shigeru
Published: July 2019

Aim

To evaluate the pregnancy rate in Japanese women treated with levonorgestrel for emergency contraception.

Methods

This retrospective record‐based medical study included 1000 women who visited our clinic for emergency contraceptive treatment with 1.5 mg single‐dose oral levonorgestrel, followed by 50 μg hormonal oral contraceptive from May 2011 to December 2017. The outcomes of the emergency contraceptive treatment were recorded at a follow‐up visit, and descriptive statistics were obtained.

Results

The number of women treated with levonorgestrel at the clinic increased from 2011 to 2015, but there was no subsequent increase thereafter. Most women were in their 20s (57.4%), followed by their 30s (19.3%) and teens (18.3%). Of the 1000 women treated with levonorgestrel, 659 were followed up. Among the 659 women with follow‐up data, 16 were pregnant (2.4%), of whom 11 underwent abortions, three had miscarriages, and two delivered at term. The timing of unprotected sexual intercourse relative to the estimated ovulation date among the pregnant women ranged from −3 to 23 days. The most commonly used contraceptive method before the emergency contraceptive visit was condoms (89.3%, 887/993). No new safety concerns were identified throughout the study period.

Conclusion

The pregnancy rate after levonorgestrel treatment in Japanese women was low, and similar to that reported in previous studies. Information on contraceptive methods and emergency contraception with levonorgestrel needs to be better disseminated among women of childbearing age.
Phenotyping obstructive sleep apnoea—Bringing precision to oral appliance therapy
Authors: Cistulli Peter A. , Sutherland Kate
Published: July 2019

Obstructive Sleep Apnoea (OSA) is a highly prevalent disorder across the world and is characterised by repeated obstruction of the pharyngeal airway during sleep, resulting in oxygen desaturation (intermittent hypoxia) and sleep fragmentation. As awareness of the disorder has risen over the last few decades, there is growing recognition that OSA is a highly heterogeneous disorder, and that application of a precision medicine framework to its treatment could significantly enhance patient outcomes by allowing prediction of who has OSA, who needs it treated, who is susceptible to symptoms and comorbidities, which treatment should be used and who will respond to therapy. To achieve this, there is a need to develop an understanding of intermediate OSA phenotypes in terms of their contribution to disease pathogenesis, clinical and physiological expression and treatment responses. Recently, there have been an increasing number of studies using unsupervised (cluster) analytical approaches that have generated new insights, demonstrating the viability of a precision medicine approach in sleep medicine. These advances will undoubtedly influence the emerging field of dental sleep medicine, and dentists need to be aware of these developments.
Glucose, cholesterol and blood pressure in type II diabetes: A longitudinal observational study comparing patients with and without severe mental illness
Authors: Smith Robert , Han Lu , Ali Shehzad , Prady Stephanie L. , Taylor Joanne , Hughes Tom , Ajjan Ramzi A. , Siddiqi Najma , Doran Tim
Published: July 2019

Accessible Summary

What is known on the subject?

People with severe mental illness (SMI) have a life expectancy of 15–20 years less than the general population, partly due to increased risk of physical disease, including type II diabetes (T2DM) and cardiovascular disease.

Little is known about changes in cardiovascular risk factors over time in people with both T2DM and SMI compared to those with T2DM and no SMI.

What this paper adds to existing knowledge?

We investigated whether levels of cardiovascular risk factors, cholesterol, HbA1c, systolic and diastolic blood pressure associated with adverse clinical outcomes are different in T2DM patients with and without SMI. We found significant differences in systolic blood pressure and HbA1c between the two groups.

Fifty‐five percent and twenty‐nine percent of T2DM patients with comorbid SMI are at increased risk of adverse clinical outcomes due to sub‐optimal HbA1c and systolic blood pressure levels, respectively.

What are the implications for practice?

Many patients with T2DM and SMI have higher levels of cardiovascular risk compared to patients with T2DM only, and good management of risk factors is therefore particularly important in patients with both conditions.

Achieving better control of HbA1c levels is likely to be central to addressing inequalities in outcomes for patients with both SMI and T2DM.

Introduction

Patients with both severe mental illness (SMI) and type II diabetes (T2DM) have lower life expectancy than patients with T2DM alone, partly due to poor control of cardiovascular risk factors in comorbid patients.

Aim

To compare levels of cholesterol, HbA1c and blood pressure in T2DM patients with and without SMI.

Method

We analysed longitudinal clinical records of 30,353 people with T2DM (657 with SMI; 29,696 controls without SMI) between 2001 and 2013 using the Clinical Practice Research Datalink (CPRD). We used mixed‐effects regression models to compare cardiovascular risk factors between SMI and controls.

Results

Patients with SMI had lower mean systolic blood pressure (SBP; β: −2.49; SE = .45 p = <.01) and were more likely to have extreme (high and low) values of HbA1c and SBP (OR: 1.38, 95% CI: 1.16, 1.64 and 1.76:1.40, 2.21, respectively).

Discussion

People with T2DM and SMI have similar average values of cardiovascular risk factors to people with T2DM alone but are more likely to have values of HbA1c and SBP indicating increased risk of adverse clinical outcomes.

Implications for Practice

Improved management of cardiovascular risk factors in general, glycaemic control in particular, is central to addressing the increased risk of adverse outcomes in people with both SMI and T2DM.
A taxonomic revision of Tectaria (Tectariaceae) from New Caledonia
Authors: Dong Shi‐Yong
Published: July 2019

A taxonomic revision of Tectaria from New Caledonia is presented here based on a thorough study of herbarium specimens from New Caledonia and adjacent Pacific islands. Six species of Tectaria are presently recognized in New Caledonia. Tectaria kouniensis and T. pseudosinuata are reduced to synonyms of T. dissecta and T. sinuata, respectively. The morphological limit between T. seemannii and T. sinuata and the confused specimen citations in previous accounts are clarified. Apart from T. dissecta, the other five species, i.e. T. lifuensis, T. moorei, T. seemannii, T. sinuata and T. vieillardii, are mainly distributed in New Caledonia, with only T. seemannii and T. sinuata recently reported also from Vanuatu. A key to species, typification of accepted names and relevant synonyms, and brief comments on the relationships of species are provided.
Dynamic thiol/disulphide homeostasis and pathogenesis of Kawasaki disease
Authors: Kaman Ayşe , Aydın Teke Türkan , Gayretli Aydın Zeynep Gökçe , Karacan Küçükali Gülin , Neşelioğlu Salim , Erel Özcan , Tanır Gönül
Published: July 2019

Background

Kawasaki disease (KD) is an acute, self‐limited, systemic vasculitis of unknown etiology. In the present study, we investigated whether there is a relationship between KD and dynamic thiol/disulphide homeostasis.

Methods

This case–control study involved KD patients and healthy controls. Plasma total, native and disulphide thiol and the disulphide/native, disulphide/total and native thiol/total thiol ratios of all patients and the control group were analyzed simultaneously.

Results

A total of 20 patients with KD (male/female, 12/8) and 25 age‐ and gender‐matched healthy controls (male/female, 12/13) were evaluated. Native, total thiol and native thiol/total thiol ratio were significantly lower in KD patients than in the control group (P < 0.001). In contrast, disulphide thiol, disulphide/native thiol and disulphide/total thiol ratios were significantly higher in KD patients than control subjects (P < 0.001). In KD patients with coronary artery lesion (CAL), the native thiol and total thiol were significantly lower than in KD patients without CAL. In KD patients with CAL, the ratios of disulphide/total thiol and disulphide/native thiol were significantly higher than in those without CAL (P = 0.02 and P = 0.02, respectively), whereas the ratio of native/total thiol was significantly lower (P = 0.02).

Conclusion

The KD patients had lower plasma thiol (native and total) and higher disulphide thiol than controls, indicating that dynamic thiol/disulphide homeostasis might be an important indicator of inflammation in KD. Alteration and shifting of thiol/disulphide homeostasis to the oxidized side are correlated with the pathogenesis of KD and CAL.
Trauma informed public health nursing visits to parents and children
Authors: Ballard Julianne , George Liz , Zazueta‐Lara Eva , Turner Laura , Aguado Jesús , Law Jennifer , Alger Renée
Published: July 2019

Adverse Childhood Experiences (ACEs) research has demonstrated a strong correlation between a traumatic childhood and poor health and social status in adulthood. Maternal/child Public Health Nursing (PHN) home visiting teams frequently encounter families experiencing trauma, thus offering a unique opportunity to assist parents in recognizing the potential harm such stress may have for their child. The Sonoma County Field Nursing team developed a trauma‐informed model utilizing ACEs education in a self‐reflective approach with parents to increase family resilience and reduce the risk for future childhood trauma. This paper presents the supporting research used to develop the trauma‐informed approach and describes the execution of the model by the Sonoma County Field Nursing team.
University‐industry collaboration and front‐end success: the moderating effects of innovativeness and parallel cross‐firm collaboration
Authors: Gretsch Oliver , Salzmann Edmund Christian , Kock Alexander
Published: July 2019

Collaboration with science‐based and/or market‐based partners is a promising means for firms’ R&D groups to leverage complementary expertise and resources to generate innovative results. However, R&D managers face the dilemma which partner type to choose in different innovative contexts and whether to focus on one partner type or to integrate both types in early stage R&D. Using survey data from 166 heads of R&D groups, this study investigates university–industry collaboration’s impact on front‐end success depending on the degree of innovativeness and the interaction with other industry partners. The results confirm an overall positive relationship between university–industry collaboration and front‐end success. However, innovativeness increases complexity in this relationship. Parallel collaboration with firms and universities can have a mixed impact on front‐end success depending on the degree of innovativeness. This simultaneous collaboration with firms and universities strengthens front‐end success for more radical innovations, while parallel collaboration activities for more incremental innovations do not necessarily strengthen front‐end success. These findings imply that both collaboration types should be used simultaneously in the front end of radical innovation and that firms could reduce complexity by focusing on either firms or universities as partners for incremental innovations.
The contribution of the International Organization for Standardization to ocean governance
Authors: Seta Makoto
Published: July 2019

Private standard setting by non‐State actors has gained increasing attention and has expanded to regulating various activities. Maritime activities are no exception. The International Organization for Standardization (ISO) sets private standards to govern maritime activities in cooperation with the International Maritime Organization. These ISO standards are incorporated in the United Nations Convention on the Law of the Sea system and will likely play a more important role in the future. However, the relationship between these standards and the law of the sea has not yet been analysed. This article therefore examines the contribution of private standards, especially those set by the ISO, to ocean governance and evaluates this contribution from a global administrative law perspective. Since the ISO is the largest entity that sets private standards, it can serve as a model for other non‐State actors that set private standards to govern maritime activities.
Management of palpitations and cardiac arrhythmias in pregnancy
Authors: Roberts Anna , Mechery Joseph , Mechery Anthony , Clarke Bernard , Vause Sarah
Published: July 2019

Key content

Palpitations are common in pregnancy; while they are frequently benign, some will represent a significant arrhythmia.

Pregnant women presenting with palpitations require a careful assessment to determine whether their symptoms can be attributed to normal physiology or require further investigation for pathology.

Management of pre‐existing arrhythmias in pregnancy requires a multidisciplinary team approach.

Most anti‐arrhythmic treatments are safe in pregnancy, and prompt, effective treatment of pathological arrhythmias should be instigated without delay.

Learning objectives

To identify which women presenting with palpitations require further investigation.

To understand normal changes in the electrocardiogram in pregnancy and be able to identify common arrhythmias.

To understand the principles of management of common cardiac arrhythmias during pregnancy.

To know the risks and benefits of common anti‐arrhythmic drugs in pregnancy and breastfeeding.
Effects of needle gauge and syringe size on small intestinal leakage at injection sites
Authors: Brand Kenneth J. , Hess Emily , Risselada Marije
Published: July 2019

Objective

To determine the influence of needle gauge, syringe volume, and syringe size on needle tract leakage after injection in porcine jejunum.

Study design

Ex vivo experiment.

Sample population

Three hundred sixty jejunal segments from 20 feedlot pigs.

Methods

Fresh porcine intestines were divided into 5‐cm or 10‐cm segments and randomly assigned to the one of nine treatment groups: 25‐gauge, 22‐gauge, and 20‐gauge needles attached to full 12‐mL, half‐full 20‐mL, and full 20‐mL syringes (n = 20/group). The jejunal segments were occluded with Rochester‐Carmalt forceps prior to injection of diluted India ink. Injection time and leakage were noted by a blinded observer. Multivariate analysis was used with segment size, needle gauge, volume infused, time to inject per milliliter, and syringe size as variables.

Results

Leakage occurred in 36% of 5‐cm and 15% of 10‐cm segments and was immediate without palpation in 33.8% and 11% of segments, respectively. Protective effects were seen for 22‐gauge needles in both 5‐cm (P = .002) and 10‐cm (P = .001) segments, whereas injection of 20 mL had a higher odds ratio of leakage compared with injection of 10 mL and 12 mL in 5‐cm segments (P = .003).

Conclusion

Injections with 22‐gauge needles reduced the frequency of leakage, while 20 mL instilled in 5‐cm segments increased the frequency of leakage in intact segments of porcine jejunum.

Clinical significance

Injection with a smaller syringe size attached to a 22‐gauge needle through a 10‐cm segment of small intestine may lower the frequency of leakage from the injection site, but influence on the detection of surgical site leakage remains unknown.
Towards a Kachru Institute
Authors: Crystal David
Published: July 2019

In September 1984, Braj Kachru suggested that an institutional archive for research on the English language across cultures should be set up. In Kachru's view, this project would include six strands of activity, including empirical sociolinguistic studies, pedagogical studies, resource materials, special registers, functional domains and formal studies. Over the succeeding decades, however, no such institute came into existence. This current paper therefore seeks to revive the plan to create such an institute, which, of course, should be appropriately named as ‘The Kachru Institute’.
Becoming a world Englishes scholar
Authors: Friedrich Patricia
Published: July 2019

In this insightful and reflective article, Professor Friedrich describes her journey as a student of the English language, the impact of Kachruvian linguistics on her thinking about the English language and linguistics, as well as her own relationship with the language, and her personal development as a leading scholar in the field of world Englishes.
Professor Braj B. Kachru and intelligibility
Authors: Nelson Cecil L.
Published: July 2019

Professor Braj Kachru instituted the school of world Englishes in his forthright examinations of the bases of the criteria that could reasonably be argued to constitute ‘good English’ and to define ‘an English speaker’. One specific stream of those investigations is that of intelligibility in terms of the features which English users need to take into account when they are making sense of others’ productions and composing their own.
Elaborating on the Expanding Circle
Authors: Proshina Zoya G.
Published: July 2019

While the Inner and Outer Circle varieties are recognized by all linguists and educationists, the status of any Expanding Circle English as a variety per se is still a subject of incessant discussions. This article, based on Russian English as a typical variety of the Expanding Circle, focuses on the reasons for misconceptions and inaccuracies. The author discusses the parameters for singling out varieties and their application to the Expanding Circle, highlights Kachru's definition of a performance variety, and concludes that the specifics of exonormative Englishes result in a greater variability of norms as compared with endonormative varieties. Distinctive features of an Expanding Circle variety are not unique but their set makes the variety distinctive. The difference of varieties is majorly due to diversity of cultures that underpin a variety. Therefore, legitimacy of Expanding Circle Englishes is in their ability to serve the cultures and to express linguacultural identity of their users.
The Kachruvian connection and English language teaching in the Philippines
Authors: Velasco Yvonne Pedria
Published: July 2019

The non‐native speakers as teachers of English hold a key role in teaching a language which is the world's most taught, learned and used second or foreign language. With this current global context of English, Philippine ELT has to reflect on the ‘curricula of teacher training programs, in the methodology of teaching, in understanding the sociolinguistic profile of the language, and in cross‐cultural awareness’ the implications of the internationalization of English (Kachru, 1992, p. 355). This paper argues that while Professor Kachru sounded the call for the modification of ELT practices decades ago, ELT practitioners in the Philippines have yet to fully come to terms to a shift in the teaching paradigm of English that necessitates a change in the way non‐standard features of the language are perceived and how teaching methods should be modified to match the current reality of English as an international language.
The L-type amino acid transporter LAT1 inhibits osteoclastogenesis and maintains bone homeostasis through the mTORC1 pathway
Authors: Ozaki Kakeru , Yamada Takanori , Horie Tetsuhiro , Ishizaki Atsushi , Hiraiwa Manami , Iezaki Takashi , Park Gyujin , Fukasawa Kazuya , Kamada Hikari , Tokumura Kazuya , Motono Mei , Kaneda Katsuyuki , Ogawa Kazuma , Ochi Hiroki , Sato Shingo , Kobayashi Yasuhiro , Shi Yun-Bo , Taylor Peter M. , Hinoi Eiichi
Published: July 2019

Amino acid uptake through the transporter LAT1 maintains bone homeostasis by stimulating mTORC1 signaling.
Spheroplast-Mediated Carbapenem Tolerance in Gram-Negative Pathogens
Authors: Cross Trevor , Ransegnola Brett , Shin Jung-Ho , Weaver Anna , Fauntleroy Kathy , VanNieuwenhze Michael S. , Westblade Lars F. , Dörr Tobias
Published: July 2019

Antibiotic tolerance, the ability to temporarily sustain viability in the presence of bactericidal antibiotics, constitutes an understudied and yet potentially widespread cause of antibiotic treatment failure. We have previously shown that the Gram-negative pathogen
Vibrio cholerae
can tolerate exposure to the typically bactericidal β-lactam antibiotics by assuming a spherical morphotype devoid of detectable cell wall material. However, it is unclear how widespread β-lactam tolerance is.
Exposure to UV-B Radiation Leads to Increased Deposition of Cell Wall-Associated Xerocomic Acid in Cultures of
Serpula himantioides
Authors: Torres Solange , González-Ramírez Mariela , Gavilán Javiera , Paz Cristian , Palfner Goetz , Arnold Norbert , Fuentealba Jorge , Becerra José , Pérez Claudia , Cabrera-Pardo Jaime R.
Published: July 2019

Our study shows the morphological and chemical responses of
S. himantioides
to controlled doses of UV-B radiation under
in vitro
culture conditions. We found that increased biosynthesis of xerocomic acid was the main strategy adopted by
S. himantioides
against UV-B radiation. Xerocomic acid showed strong antioxidant and photoprotective abilities, which has not previously been reported. Our results indicate that upon UV-B exposure,
S. himantioides
decreases its hyphal growth rate and uses this energy instead to increase the biosynthesis of xerocomic acid, which is allocated near the cell wall. This metabolic switch likely allows xerocomic acid to efficiently defend
S. himantioides
from UV radiation through its antioxidant and photoprotective properties. The findings further suggest that xerocomic acid is a promising candidate for development as a cosmetic ingredient to protect against UV radiation and should therefore be investigated in depth in the near future both
in vitro
and
in vivo
.
Графы задач для репликаторных уравнений и "трагедия исчерпания общего ресурса"
Authors: Волосова Наталья Константиновна , Volosova Natal'ya Konstantinovna , Волосова Александра Константиновна , Volosova Aleksandra Konstantinovna , Волосов Константин Александрович , Volosov Konstantin Aleksandrovich , Вакуленко Сергей Петрович , Vakulenko Sergei Petrovich
Published: July 2019

Появились активные пользователи, которым необходимо решение обратных задач на графе в условиях неопределeнности для моделирования процессов в экономической сфере. Такие задачи ранее математиками не рассматривались. В данной работе найдена аналогия с математическими моделями, которые описываются репликаторной системой (РС) уравнений, связанной с темой «трагедии исчерпания общего ресурса» (ТИОР). Построены точные и асимптотические решения в случае «жeстких» РС. Обнаружены эффекты «apriori» вымирающего клона и эффект пограничного слоя, которые наблюдаются при численных расчeтах. Проведена аналогия с некоторыми похожими по свойствам объектами, реально существующими в экономике. Описан эффект существования «теневых, невидимых» сверхпотребителей.
Diplopia and proptosis due to isolated lateral rectus plasmacytoma in a patient with multiple myeloma
Authors: Saffra Norman , Gorgani Farzan , Panasci David , Kirsch David
Published: July 2019

Orbital involvement of multiple myeloma (MM) is uncommon, with most of those reported cases occurring at the time of initial diagnosis of MM. We present a case of an extramedullary plasmacytoma involving only the right lateral rectus of a patient who had been in disease remission. The patient presented with new-onset diplopia and an abduction deficit of the right eye, with mild proptosis. In light of her past medical history of MM, an orbital MRI was obtained. The MRI demonstrated an isolated finding of eccentric enlargement of the right lateral rectus muscle limited to the muscle belly with sparing of the tendinous insertions, leading to diagnosis of plasmacytoma. Patching of the involved eye to alleviate the symptoms of diplopia was instituted. Chemotherapy was initiated, followed by orbital radiation and stem-cell transplantation for coexisting systemic disease. The orbital symptoms of proptosis and diplopia resolved within 1 month of treatment.
Osteomalacia in subtropical Auckland
Authors: Narang Ravi K , Reid Ian
Published: July 2019

A 56-year-old man was referred with left-sided hip pain. MRI scans demonstrated an undisplaced stress fracture in the femoral neck and subchondral oedema within the femoral head. Bone densitometry showed T-scores of −2.0 at the spine, −3.5 at the femoral neck and −2.4 for the total hip. Laboratory tests revealed 25-hydroxyvitamin D <10 nmol/L. He was prescribed a 10-day course of calciferol 1.25 mg (50 000 IU)/day and started on calcium carbonate 1.25 g twice daily. Following the correction of vitamin D deficiency, his symptoms resolved. A striking feature of this patient was the complete reversal of ‘osteoporosis’ within 14 months with vitamin D and calcium supplementation. Bone mineral densities (BMDs) increased by 19.5% and 33.4% at the spine and hip, respectively. Such changes are never seen with conventional pharmacological management of osteoporosis. Vitamin D deficiency should be considered as a cause for reduced BMD in people with risk factors.
Malignant deciduoid mesothelioma: a rare variant of epithelioid mesothelioma
Authors: Taylor Leah , Cooper David , Aujayeb Avinash
Published: July 2019

We describe a case of a deciduoid mesothelioma, a rare variant of epithelioid mesothelioma, which is associated with a very poor prognosis. A review of the relevant literature is also included. The patient was a man with probable asbestos exposure and presented with classic features of pleural malignancy. Diagnosis was reached with close correlation between clinical, radiological and pathological findings.
Gestational diabetes mellitus, pre-gestational BMI and offspring BMI z-score during infancy and childhood: 2004 Pelotas Birth Cohort
Authors: Buffarini Romina , Barros Aluisio J D , Matijasevich Alicia , Loret de Mola Christian , Santos Ina S
Published: July 2019

Objective

Gestational diabetes mellitus (GDM) affects a significant number of women. Evidence regarding the association between GDM and offspring body mass index (BMI) is unclear due to small samples and lack of adequate confounding control. The objective of this study was to investigate the association between GDM and offspring BMI z-scores from birth to early adolescence and to examine the role of maternal pre-gestational BMI in this relationship.

Design

Prospective study.

Setting

Pelotas 2004 Birth Cohort, Brazil.

Participants

Cohort participants that were followed-up from birth up to early adolescence (~3500) and their mothers.

Primary outcome measures

BMI z-scores at birth, 3, 12, 24, 48 months and 6 and 11 years of age, calculated according to the WHO growth charts.

Results

Unadjusted and adjusted linear regressions were performed and interaction terms between maternal pre-gestational BMI and GDM were included. Prevalence of self-reported GDM was 2.6% (95% CI 2.1% to 3.1%). The offspring BMI z-scores (SD) at birth, 3, 12, 24, 48 months and at 6 and 11 years were 0.10 (1.12), –0.47 (1.10), 0.59 (1.10), 0.59 (1.08), 0.78 (1.32), 0.70 (1.43) and 0.75 (1.41), respectively. Unadjusted regression models showed positive associations between GDM and offspring BMI z-scores at birth, 6 and 11 years. After adjustment, the associations attenuated towards the null. Statistical evidence of effect modification between maternal pre-gestational BMI and GDM was observed at birth (p=0.007), with the association between GDM and offspring BMI z-score being apparent only in those children born to overweight or obese mothers (β=0.72, 95% CI 0.30 to 1.14 and β=0.61, 95% CI 0.20 to 1.01, respectively).

Conclusions

We observed that in the association between GDM and offspring BMI z-scores, there is a predominant role for maternal nutritional status before pregnancy and that the association between GDM and newborn’s BMI is apparent only among those born to overweight or obese mothers.
Development and validation of the Social Capital Assessment Tool in pregnancy for Maternal Health in Low and middle income countries (LSCAT-MH)
Authors: Agampodi Thilini C , Agampodi Suneth B , Glozier Nick , Lelwala T A , Sirisena K D P S , Siribaddana Sisira
Published: July 2019

Objectives

Social capital which implies ‘features of social organisation, such as trust, norms and networks that can improve the efficiency of society by facilitating coordinated actions’ is rarely assessed in relation to maternal health in low/middle-income countries (LMICs). A main reason for this research gap could be the unavailability of a specific tool to measure social capital in pregnancy. The study developed and validated an instrument to measure social capital among pregnant women.

Setting

We developed the tool based on World Bank Social Capital Assessment Tool and its adaptations identified as applicable to LMIC from an initial systematic review. The study was conducted in Anuradhapura district in the North Central Province of Sri Lanka. Validation process was conducted in urban, rural and resettled communities.

Participants

Study participants of the cognitive validation included pregnant women from the three communities, and an expert panel including a social scientist, methodological expert, subject expert, public health officers. The psychometric validation was performed on 439 pregnant women permanently residing in the three communities.

Results

The 24-item Low and middle income countries Social Capital Assessment Tool for Maternal Health (LSCAT-MH) demonstrated high internal consistency (Cronbach’s α=0.94). Factor analytical methods suggested a four-factor model of (1) neighbourhood networks (structural bonding), (2) domestic and neighbourhood cohesion (cognitive bonding), (3) social contribution and (4) social participation (structural bridging). Concurrent validity with antenatal mental ill health was confirmed through a negative correlation with the Edinburgh Postpartum Depression Scale. Test–retest reliability was high with intraclass correlation of 0.71 and a Pearson correlation of 0.83.

Conclusion

The LSCAT-MH is a psychometrically valid and reliable tool to measure social capital in pregnancy. Predictive validity was not tested as the study was not a longitudinal follow-up.
Botulinum toxin for chronic pelvic pain in women with endometriosis: a cohort study of a pain-focused treatment
Authors: Tandon Hannah K , Stratton Pamela , Sinaii Ninet , Shah Jay , Karp Barbara I
Published: July 2019

Background and objectives

Many women with endometriosis continue to have pelvic pain despite optimal surgical and hormonal treatment; some also have palpable pelvic floor muscle spasm. We describe changes in pain, spasm, and disability after pelvic muscle onabotulinumtoxinA injection in women with endometriosis-associated pelvic pain, a specific population not addressed in prior pelvic pain studies on botulinum toxin.

Methods

We present an open-label proof-of-concept case series of women with surgically diagnosed endometriosis. Under conscious sedation and with topical anesthetic, 100 units of onabotulinumtoxinA was injected transvaginally into pelvic floor muscle spasm areas under electromyography guidance. Changes in pain intensity, muscle spasm, disability, and pain medication use were assessed at periodic visits for up to 1 year after injection.

Results

Thirteen women underwent botulinum toxin injection and were followed for at least 4 months. Before injection, 11 of the 13 women had spasm in >4/6 assessed pelvic muscles and reported moderate pain (median visual analog scale (VAS): 5/10; range: 2–7). By 4–8 weeks after injection, spasm was absent/less widespread (≤3 muscles) in all (p=0.0005). Eleven rated their postinjection pain as absent/mild (median VAS: 2; range: 0–5; p<0.0001); 7/13 reduced pain medication. Disability decreased in 6/8 women with at least moderate preinjection disability (p=0.0033). Relief lasted 5–11 months in 7 of the 11 patients followed for up to 1 year. Adverse events were mild and transient.

Conclusions

These findings suggest pelvic floor spasm may be a major contributor to endometriosis-associated pelvic pain. Botulinum toxin injection may provide meaningful relief of pain and associated disability.

Trial registration number

NCT01553201