bluuebunny/crossref_metadata_2025 huggingface dataset:
Translation, cultural adaptation, validation, and reliability study of the Quick‐EBP‐VIK instrument: Chinese version
Authors: Zhou Chunlan , Wang Yanfang , Wang Siqi , Ou Jiexia , Wu Yanni
Published: November 2018

Rationale, aims, and objectives

Valid and reliable instruments for measuring are needed. To add knowledge to the subject of tools of evidence‐based practice (EBP) evaluation in mainland China, the present study aims to translate the Quick‐EBP‐VIK into Chinese, which is an instrument for the assessment of nurses' value, knowledge, and implementation of EBP, and to evaluate the metric characteristics of the Chinese version.

Methods

In this methodological study, a total sample of 402 nurses from mainland China was applied. Construct validity was evaluated by using factor analysis and further supported through known‐group validity. A panel of experts examined the content validity. Internal consistency was determined using composite reliability and Cronbach alpha. The intraclass correlation coefficient (ICC) was calculated to assess test‐retest reliability.

Results

The exploratory factor analysis revealed a three‐factor structure model same to the original instrument. The confirmatory factor analysis showed a good fit model with a comparative fit index of 0.957 and a root mean square error of approximation of 0.065. Significant differences were found in the item means of the tool between nurses who received EBP training and those who had not, which supported the known‐group validity. The Cronbach alpha and composite reliability for the three subscales were all higher than 0.70. The ICC ranged from 0.569 to 0.928 for the three subscales and from 0.494 to 0.903 for the items included in the instrument.

Conclusion

The Chinese version of the Quick‐EBP‐VIK has evidence of acceptable reliability and validity and can be used to measure value, knowledge, and implementation of EBP for Chinese nurses.
Effect of different dry‐polishing regimens on the intrapulpal temperature assessed with pulpal blood microcirculation model
Authors: Ertugrul Ihsan Furkan , Orhan Ekim Onur , Yazkan Basak
Published: November 2018

Objective

The aim of the study was to evaluate the effect of different dry‐polishing regimens on the intrapulpal temperature assessed using a pulpal blood microcirculation model.

Materials and Methods

Eighty extracted human mandibular premolar teeth were used. Standardized class V cavity preparations were performed and were then restored. Teeth were divided into four main groups (n = 20): Fine polishing disc (SSF; 3M Sof‐Lex, 3M ESPE, Minnesota); Super‐fine polishing disc (SSS; 3M Sof‐Lex); Spiral finishing wheel (SSW; 3M Sof‐Lex); Enhance PoGo—One step diamond micro‐polisher cup (EPO; Dentsply Sirona, Inc, Delaware). The main groups were divided: the low‐load pressure (0.4N) and the high‐load pressure (0.8N). The average change in intrachamber temperatures (Δt), from initial to highest, were measured.

Results

The highest temperature increase was recorded in SSF08 (9.55°C). The lowest value was recorded in EPO04 (1.9°C). SSS08, SSW08, and EPO08 demonstrated significantly higher Δt values than the low‐load mode in SSS04, SSW04, and EPO04, respectively (P < .0001).

Conclusions

Temperature was the least affected by the diamond cup in both pressure modes, and it was also less affected by the spiral finishing wheel in the low‐load mode than in the high‐load mode. Fine and super‐fine discs had the greatest effect on intrachamber temperatures.

Clinical Significance

The present study suggests intrachamber temperature can rise among different dry‐polishing regimes. Dental practitioners should pay attention to dry‐polishing regimens and pressures for reducing heat‐related dental problems.
Management of Acute Changes in Condition in Skilled Nursing Facilities
Authors: Ouslander Joseph G. , Engstrom Gabriella , Reyes Bernardo , Tappen Ruth , Rojido Carolina , Gray‐Miceli Deanna
Published: November 2018

OBJECTIVES

To describe the presentation and management of acute changes in condition in skilled nursing facilities (SNFs) during implementation of a program designed to reduce unnecessary emergency department visits and hospitalizations.

DESIGN

Secondary analysis of data from a randomized controlled trial involving 264 SNFs.

PARTICIPANTS

One hundred thirty‐three of the 264 participating SNFs that provided data on acute changes in condition: 55 in the intervention group, 78 in the control group.

INTERVENTIONS

During a 12‐month period, intervention SNFs received training and support for implementation of the Interventions to Reduce Acute Care Transfers program. Control SNFs were offered training and implementation support after the end of the 12‐month trial.

MEASURES

Project champions used a structured online tool to describe acute changes in condition that did not result in a hospital transfer within 72 hours of the change.

RESULTS

Most of the 7,689 episodes of acute change in condition reported involved multiple changes that were not disease specific. Ten percent resulted in hospital transfer between 72 hours and 7 days after the change. Five acute changes had odds ratios for transfer greater than 2 (mental status change, abnormal vital signs, bleeding, shortness of breath, and unresponsiveness). Most transfers were for reasons other than the initial change in condition.

CONCLUSIONS

A wide variety of acute changes in condition can be managed in SNFs without hospital transfer. Most of these changes are nonspecific and multiple, and when they are associated with hospital transfer, the reasons for the transfer are most often different from the initial acute change in condition. These data highlight the multifactorial nature of acute changes in condition in the SNF population and suggest that disease‐specific protocols and assessment tools may not be the most appropriate approach to managing acute changes in condition in the SNF setting. J Am Geriatr Soc 66:2259–2266, 2018.
Strategies for Managing the Aging Tsunami in China: Weifang Model
Authors: Tu Wen‐Jun , Slevin Mark , Zeng Xianwei
Published: November 2018

See the Reply by Leng et al.
Reply to: Comments on the Aging Tsunami and Senior Healthcare Development in China
Authors: Li Xin , Fan Li , Leng Sean X.
Published: November 2018

This letter comments on the letters by Manfred Gogol and Tu et al.
Multifactorial Examination of Caregiver Burden in a National Sample of Family and Unpaid Caregivers
Authors: Riffin Catherine , Van Ness Peter H. , Wolff Jennifer L. , Fried Terri
Published: November 2018

OBJECTIVES

To examine factors associated with caregiver burden from a multifactorial perspective by examining caregiver and care recipient characteristics and a full range of caregiving tasks.

DESIGN

Nationally representative surveys of community‐dwelling older adults and their family caregivers residing in the United States.

SETTING

2011 National Health and Aging Trends Study and National Study of Caregiving.

PARTICIPANTS

Community‐dwelling older adults and their family caregivers.

MEASUREMENTS

Caregiver burden, comprising emotional, physical, and financial difficulties associated with caregiving.

RESULTS

An estimated 14.9 million caregivers assisted 7.6 million care recipients. More than half of caregivers reported burden related to caregiving. In a multivariable regression model, caregivers who assisted with more activities of daily living and instrumental activities of daily living, health management tasks, and health system logistics were more likely to experience burden, as were female caregivers, adult child caregivers, caregivers in poor health, caregivers with anxiety symptoms, and those using respite care. Dementia was the only care recipient characteristic associated with burden.

CONCLUSION

Caregiver characteristics and provision of caregiving tasks determine caregiver burden more than care recipient characteristics. Absence of an association between type of a care recipient's chronic conditions and burden, except for dementia, suggests that the tasks that caregivers who assist older adults with a variety of health conditions undertake shape the experience of caregiving. J Am Geriatr Soc 67:277–283, 2019.
The 8–Hour Challenge: Incentivizing Sleep during End–of–Term Assessments
Authors: King Elise , Mobley Christine , Scullin Michael K.
Published: November 2018

Sleep is critical to physical health, mental well–being, attention, and creativity. During the week of final exams, however, fewer than 10% of undergraduate students maintain the recommended average of 8 hours/night (or even the recommended minimum of 7 hours/night). For students completing multifaceted projects in studio–based majors (e.g., interior design, architecture, graphic design, studio art), anecdotal and questionnaire data suggest that the end–of–semester reduction in sleep duration may be even worse. One potential solution is to offer students an incentive to maintain healthy sleep durations. We offered interior design students, who were enrolled in a freshman–level graphics studio course, an optional extra credit incentive to maintain optimal sleep durations for five nights leading up to the due date of their final project. If participants maintained an average sleep duration of ≥8.0 hours for five nights, they would earn extra credit. By contrast, if they slept an average of 7.0–7.9 hours, there would be no grade change, and if they slept an average of ≤6.9 hours, they were instructed that they would lose points (no points were actually deducted). Of the 27 students enrolled in the course, 22 students attempted the challenge (81.5%), and we monitored their sleep duration objectively using wristband actigraphy devices. We compared their sleep duration to that of a group of 22 nonincentivized students enrolled in the same program. In the nonincentivized comparison group, very few students averaged 8 hours (9%) or even 7 hours (14%) of sleep per night. In dramatic contrast, the 8–hour challenge increased the percentage of 8– and 7–hour sleepers to 59% and 86%, respectively. Participants who took the 8–hour challenge slept an average of 98 minutes more each night than nonincentivized students and 82 minutes more than they self–reported to sleeping during the semester. The substantial increase in nightly sleep duration did not come at a cost to project performance. Individuals who opted in to the sleep challenge performed as well on the final project as students who did not opt in, and students who showed more consistent sleep (i.e., fewer nights of poor sleep followed by rebound sleep) performed better than students who showed inconsistent sleep. Thus, even during highly stressful “deadline” weeks, students can maintain healthy sleeping patterns without exacting a cost on their project performance.
Assessment of microRNA‐144‐5p and its putative targets in inflamed gingiva from chronic periodontitis patients
Authors: Li Jianjia , Wang Runting , Ge Yihong , Chen Danhong , Wu Buling , Fang Fuchun
Published: November 2018

Background and Objective

This study aimed to discover the distinctive MicroRNAs (miRNA) functioning in the pathogenesis of periodontal inflammation, which might be potential therapy targets of chronic periodontitis.

Material and Methods

miRNA profiles of human inflamed gingival tissue from three previous microarrays were re‐analysed. Gingival tissues were collected for the validation of overlapping miRNAs, and a network was constructed to show regulatory connection between overlapping miRNAs and periodontitis‐associated target genes. Potential miRNAs were screened based on their expression levels and predicted target genes. Correlation analysis and binding site prediction were conducted to reveal the relationship between the potential miRNAs and their target genes.

Results

miR‐144‐5p, found to be upregulated in all three studies, showed the greatest upregulation (P < 0.0001). Another 16 miRNAs (10 upregulated and six downregulated) overlapped between any two of the three studies. All overlapping miRNAs had expected expression levels except for miR‐203 during validation. Ten miRNAs (six upregulated and four downregulated) were found to have periodontal inflammation‐associated targets. Cyclooxygenase 2 (COX2) and interleukin‐17F (IL17F), predicted target genes of upregulated miR‐144‐5p, showed significant decreases and were negatively correlated with miR‐144‐5p in the periodontitis group (r = −0.742 for COX2, r = −0.615 for IL17F).

Conclusion

This re‐analysis of miRNA signatures has implied the potential regulatory mechanism of miR‐144‐5p and its potential for exploring alternative therapeutic approaches, especially those that use miRNA delivery systems to treat chronic periodontitis. Nevertheless, further study based on larger sample size and homogenous cells is needed to reveal the exact roles of miRNAs in chronic periodontitis.
Dynamic changes in innate immune responses during direct‐acting antiviral therapy for HCV infection
Authors: Holmes Jacinta A. , Carlton‐Smith Charles , Kim Arthur Y. , Dumas Emily O. , Brown Joelle , Gustafson Jenna L. , Lauer Georg M. , Silva Sakuni T. , Robidoux Maxwell , Kvistad Daniel , Alatrakchi Nadia , Tonnerre Pierre , Cohen Daniel E. , Zhang Hongtao , Shulman Nancy S. , Chung Raymond T.
Published: November 2018

The role of the endogenous interferon (IFN) system has been well characterized during IFN‐based therapy for chronic hepatitis C virus (HCV) infection; less is known for direct‐acting antivirals (DAAs). In this phase 3b open‐label study, we assessed changes in IFN‐stimulated genes (ISGs) in non‐cirrhotic treatment‐naïve or pegIFN/RBV‐experienced HCV‐GT1a‐infected patients receiving paritaprevir/ritonavir/ombitasvir + dasabuvir + ribavirin (PrOD + R) for 12 weeks. ISG expression was quantified from peripheral blood mononuclear cells at baseline, treatment weeks (TW)2, TW4, TW8, end of treatment (EOT) and at post‐treatment week 12. Paired sera were used to assess IFN‐α/IFN‐related chemokines/cytokines. Twenty‐five patients were enrolled. Overall sustained virologic response (SVR)12 was 92% (no virologic failure [VF]) and 100% for those completing the study protocol. Two patients were excluded from the ISG analysis due to lack of post‐treatment samples. The majority of ISGs were downregulated at TW2‐TW4 (nadir TW4); however, a relative increase was observed at TW8‐EOT, although levels were lower than baseline. This downregulation was accompanied by increases in IFN‐α/IFN‐related chemokines, a finding not observed with TH1/2‐related cytokines. Following SVR, ISG expression returned to TW2 levels. In conclusion, PrOD + R for 12 weeks was well‐tolerated with no VF. Our data demonstrate dynamic alterations in innate immune profiles during highly potent IFN‐free DAA therapy. The downregulation of ISG post‐therapy suggests reversal of the “exhausted” ISG phenotype following SVR, and the rise in ISGs and IFN‐α/IFN‐responsive chemokines late during therapy suggests resetting of IFN responsiveness that may be relevant in determining duration of or immunological sequelae from DAA therapy, including HBV reactivation.
Experimental hydrothermal alteration of basaltic glass with relevance to Mars
Authors: Sætre C. , Hellevang H. , Riu L. , Dypvik H. , Pilorget C. , Poulet F. , Werner S. C.
Published: November 2018

Phyllosilicates, carbonates, zeolites, and sulfates on Mars give clues about the planet's past environmental conditions, but little is known about the specific conditions in which these minerals formed within the crust and at the surface. The aim of the present study was to gain increased understanding on the formation of secondary phases by hydrothermal alteration of basaltic glass. The reaction processes were studied under varying conditions (temperature, pCO2, water:rock ratio, and fluid composition) with relevance to aqueous hydrothermal alteration in fully and partly saturated Martian basalt deposits. Analyses made on reaction products using X‐ray diffraction (XRD) and scanning electron microscope (SEM) were compared with near infrared spectroscopy (NIR) to establish relative detectability and spectral signatures. This study demonstrates that comparable alteration minerals (phyllosilicates, carbonates, zeolites) form from vapor condensing on mineral surfaces in unsaturated sediments and not only in fully water‐saturated sediments. In certain environments where water vapor might be present, it can alter the basaltic bedrock to a suite of authigenic phases similar to those observed on the Martian surface. For the detection of the secondary phases, XRD and SEM‐EDS were found to be superior to NIR for detecting and characterizing zeolites. The discrepancy in detectability of zeolites between NIR and XRD/SEM‐EDS might indicate that zeolites on Mars are more abundant than previously thought.
Gene flow, divergent selection and resistance to introgression in two species of morning glories (Ipomoea)
Authors: Rifkin Joanna L. , Castillo Allan S. , Liao Irene T. , Rausher Mark D.
Published: November 2018

Gene flow is thought to impede genetic divergence and speciation by homogenizing genomes. Recent theory and research suggest that sufficiently strong divergent selection can overpower gene flow, leading to loci that are highly differentiated compared to others. However, there are also alternative explanations for this pattern. Independent evidence that loci in highly differentiated regions are under divergent selection would allow these explanations to be distinguished, but such evidence is scarce. Here, we present multiple lines of evidence that many of the highly divergentSNPs in a pair of sister morning glory species,Ipomoea cordatotrilobaandI. lacunosa, are the result of divergent selection in the face of gene flow. We analysed aSNPdata set across the genome to assess the amount of gene flow, resistance to introgression and patterns of selection on loci resistant to introgression. We show that differentiation between the two species is much lower in sympatry than in allopatry, consistent with interspecific gene flow in sympatry. Gene flow appears to be substantially greater fromI. lacunosatoI. cordatotrilobathan in the reverse direction, resulting in sympatric and allopatricI. cordatotrilobabeing substantially more different than sympatric and allopatricI. lacunosa. ManySNPs highly differentiated in allopatry have experienced divergent selection, and, despite gene flow in sympatry, resist homogenization in sympatry. Finally, five out of eight floral and inflorescence characteristics measured exhibit asymmetric convergence in sympatry. Consistent with the pattern of gene flow,I. cordatotrilobatraits become much more like those ofI. lacunosathan the reverse. Our investigation reveals the complex interplay between selection and gene flow that can occur during the early stages of speciation.
Genome‐wide signals of drift and local adaptation during rapid lineage divergence in a songbird
Authors: Friis Guillermo , Fandos Guillermo , Zellmer Amanda J. , McCormack John E. , Faircloth Brant C. , Milá Borja
Published: November 2018

The formation of independent evolutionary lineages involves neutral and selective factors, and understanding their relative roles in population divergence is a fundamental goal of speciation research. Correlations between allele frequencies and environmental variability can reveal the role of selection, yet the relative contribution of drift can be difficult to establish. Recently diversified taxa like the Oregon junco (Aves, Passerellidae,Junco hyemalis oreganus) of western North America provide ideal scenarios to apply genetic‐environment association analyses (GEA) while controlling for population structure. Analysis of genome‐wide SNP loci revealed marked genetic structure consisting of differentiated populations in isolated, dry southern mountain ranges, and less divergent, recently expanded populations in humid northern latitudes. We used correlations between genomic and environmental variance to test for three specific modes of evolutionary divergence: (a) drift in geographic isolation, (b) differentiation along continuous selective gradients and (c) isolation‐by‐adaptation. We found evidence of strong drift in southern mountains, but also signals of local adaptation driven by temperature, precipitation, elevation and vegetation, especially when controlling for population history. We identified numerous variants under selection scattered across the genome, suggesting that local adaptation can promote rapid differentiation when acting over multiple independent loci.
Simulation of the entanglement of a North Atlantic right whale (Eubalaena glacialis) with fixed fishing gear
Authors: Howle Laurens E. , Kraus Scott D. , Werner Timothy B. , Nowacek Douglas P.
Published: November 2018

Population estimates of the critically endangered North Atlantic right whale (Eubalaena glacialis) put the number of individuals at 458 with the actual number likely being lower due to a recent unusual mortality event. Entanglement with fixed fishing gear is the most significant cause of mortality of North Atlantic right whales. There remains little documentation of how North Atlantic right whales become enwrapped during an encounter with fixed fishing gear. In order to gain a better understanding of how entanglements might occur, an interactive simulator was developed that allows the user to swim a virtual whale model using a standard game controller through a gear field in an attempt to re‐create an entanglement. The morphologically accurate right whale model produces realistic swimming motions and is capable of pectoral fin motions in response to user input. Using the simulator, gear entanglements involving the pectoral flippers including ropes wrapping around the body and entanglements involving the tailstock were re‐created. Entanglements involving the pectoral flippers with body wraps were more easily generated than entanglements involving the tailstock only. The simulator should aid scientists, fisheries experts, fishing gear designers, and bycatch reduction scientists in understanding entanglement dynamics and testing potential new gear configurations.
The Age Structure of Human Capital and Economic Growth
Authors: Castelló‐Climent Amparo
Published: November 2018

This paper shows that the age structure of human capital is a relevant characteristic to take into account when analysing the role of human capital in economic growth. The effect of an increase in the education of the population aged 40–49 years is found to be an order of magnitude larger than an increase in the education attained by any other age cohort. The results are unlikely to be driven by the age structure of the population, as we find that the effects on growth of the age structure of education and the age structure of population are distinct. The findings are robust across specifications and remain unchanged when we control for long‐delayed effects in human capital or for the experience of the workforce.
Beyond Early Warning Indicators: High School Dropout and Machine Learning
Authors: Sansone Dario
Published: November 2018

This paper combines machine learning with economic theory in order to analyse high school dropout. It provides an algorithm to predict which students are going to drop out of high school by relying only on information from 9th grade. This analysis emphasizes that using a parsimonious early warning system – as implemented in many schools – leads to poor results. It shows that schools can obtain more precise predictions by exploiting the available high‐dimensional data jointly with machine learning tools such as Support Vector Machine, Boosted Regression and Post‐LASSO. Goodness‐of‐fit criteria are selected based on the context and the underlying theoretical framework: model parameters are calibrated by taking into account the policy goal – minimizing the expected dropout rate ‐ and the school budget constraint. Finally, this study verifies the existence of heterogeneity through unsupervised machine learning by dividing students at risk of dropping out into different clusters.
The influence of high‐intensity interval training on anthropometric variables of adults with overweight or obesity: a systematic review and network meta‐analysis
Authors: Andreato L. V. , Esteves J. V. , Coimbra D. R. , Moraes A. J. P. , de Carvalho T.
Published: November 2018

Objective

The goal of this study was to evaluate the influence of high‐intensity interval training (HIIT) on anthropometric variables in adults afflicted with overweight or obesity and to compare the effects with those of moderate‐intensity continuous training.

Methods

A computer literature search was performed for HIIT intervention studies that evaluated anthropometric variables in adults afflicted with overweight or obesity.

Results

Of the 857 articles retrieved in the electronic search, 48 met the inclusion criteria. The analyses demonstrated that HIIT was effective in decreasing body mass (−1.45 kg [95% CI: −1.85 to −1.05 kg]), body mass index (−0.44 kg m−2 [95% CI: −0.59 to −0.30 kg m−2]), waist circumference (−2.3 cm [95% CI: −3.1 to −1.4 cm]), waist/hip ratio (−0.01 [95% CI: −0.02 to −0.00]), body fat percentage (−1.29% [95% CI: −1.70% to −0.87%]) and abdominal visceral fat area (−6.83 cm2 [95% CI: −11.95 to −1.71 cm2]). When considering equalization between the two methods (energy expenditure or workload matched), no differences were found in any measure except body mass (for which HIIT was superior).

Conclusions

High‐intensity interval training and moderate‐intensity continuous training results were similar, particularly when equalization between the two methods was considered. Thus, HIIT can be used as a secondary method for the treatment of obesity in adults.
Phylogeny, ecology and deep time: 2D outline analysis of anuran skulls from the Early Cretaceous to the Recent
Authors: Bardua Carla , Evans Susan E. , Goswami Anjali
Published: November 2018

Anurans have a long fossil record, spanning from the Early Jurassic to the Recent. However, specimens are often severely flattened, limiting their inclusion in quantitative analyses of morphological evolution. We perform a two‐dimensional morphometric analysis of anuran skull outlines, incorporating 42 Early Cretaceous to Miocene species, as well as 93 extant species in 32 families. Outlines were traced in tpsDig2 and analysed with elliptical Fourier analysis. Fourier coefficients were used in MANOVAs, phylogenetic MANOVAs (as significant phylogenetic signal was found) and disparity analyses across multiple ecological and life history groupings. The Neotropical realm showed higher disparity than the Australian, Palaearctic and Oriental realms (p = 0.007, 0.013, 0.038, respectively) suggesting concordance of disparity and diversity. Developmental strategy had a weak effect on skull shape (R2 = 0.02, p = 0.039) and disparity was similar in metamorphosing and direct developing frogs. Ecological niche was a significant discriminator of skull shape (F = 1.43, p = 0.004) but not after phylogenetic correction. Evolutionary allometry had a small but significant influence on the cranial outlines of the combined extant and fossil dataset (R2 = 0.05, p = 0.004). Finally, morphospace occupation appears to have changed over time (F = 1.59, p = 5 × 10−10). However, as with ecological signal, this shift appears to be largely driven by phylogeny and was not significant after phylogenetic correction (R2 = 0.26, p = 0.22). This study thus suggests that frog skull evolution is shaped more by phylogenetic constraints than by ecology.
Perioperative management of tracheocutaneous fistula closure in children: A review of 96 cases
Authors: Ferns Janis M. , Khan Mehnaz , Gupta Sanjeev , Smith Jonathan H.
Published: November 2018

Background

A tracheocutaneous fistula is a known complication following tracheostomy decannulation. Although surgical techniques for its repair are well described, there is no consensus about perioperative management and this procedure may generate significant airway and respiratory complications intraoperatively, and in the early postoperative period. We aimed to describe variations in perioperative management in tracheocutaneous fistula closure, estimate the incidence of early airway and respiratory complications, and identify any predisposing factors.

Methods

The otorhinolaryngology surgical database identified 118 tracheocutaneous fistula closures from August 1994 to September 2015. Ninety‐seven case notes were located generating 96 procedures for retrospective review. The data collected included demographics, comorbidities, anesthetic, and surgical technique, and complications up to 24 hours postoperatively.

Results

The median age at surgery was 5 years 10 months (range 1 year 8 months to 19 years 6 months). Preoperatively, 72% of patients had a “mini” sleep study (where the tracheocutaneous fistula is covered and saturations measured overnight). Ninety percent had an inhalational induction and 96% a tracheal intubation. Intraoperatively, laryngospasm occurred in 2% and there was difficulty ventilating in another 2%. A “leak test” to check fistula repair airtightness was recorded in 35%. Postoperatively 24% had one or more episodes of oxygen desaturation. Major complications occurred in five patients (incidence 5%, 95% CI 0.8‐9.7); four patients had pneumothoraxes with two needing postoperative mechanical ventilation and one patient developed life‐threatening subcutaneous emphysema.

Conclusion

Perioperative care for children undergoing tracheocutaneous fistula closure was not standardized. Advocated tests such as preoperative “mini” sleep studies and “leak test” intraoperatively were not consistently performed. Intraoperative anesthetic complications were uncommon; however, major postoperative respiratory complications were 5%.
Which Patients With Chronic Pain Are More Likely to Improve Pain Biology Knowledge Following Education?
Authors: Pate Joshua W. , Veage Stephanie , Lee Susan , Hancock Mark J. , Hush Julia M. , Pacey Verity
Published: November 2018

Background

Pain education is an important part of multidisciplinary management of chronic pain. The characteristics of people likely to have more improvement in pain biology knowledge following pain education are unknown.

Objective

To identify the baseline factors predicting changes in pain biology knowledge in adults with chronic pain following a 2‐hour multidisciplinary pain education session.

Methods

Fifty‐five adults with chronic pain attended a 2‐hour pain education session prior to a multidisciplinary assessment at a pain clinic. Patients completed the 12‐item revised Neurophysiology of Pain Questionnaire (rNPQ, score/12) before and after the pain education session. The primary outcome was change in pain biology knowledge, evaluated with the change in rNPQ score. Ten preselected predictors were investigated using univariate models followed by multivariable models with a manual forwards‐building process.

Results

Education level and age were significantly associated with change in rNPQ score in the univariate models. Participants with higher levels of education had, on average, 1.96 (0.68 to 3.23) points more improvement in rNPQ score than those with lower levels of education. For every 10 years older a participant was, his or her rNPQ score changed on average by 0.5 (0.1 to 0.8) points less. In the multivariable model, only the education level remained significant, explaining 17% of the variance (R2 = 0.17). The clinical variables that were assessed (pain severity, pain interference, pain self‐efficacy, depression, anxiety, and pain catastrophizing) did not predict any knowledge change.

Conclusion

This study suggests that, of those patients with chronic pain who choose to attend pain education, more educated patients are more likely to improve their pain biology knowledge after a pain education session.
Living liver donation improves patient and graft survival in the pediatric population
Authors: Montenovo Martin I. , Bambha Kiran , Reyes Jorge , Dick Andre , Perkins James , Healey Patrick
Published: November 2018

Background

The utilization of living donor grafts resulted in an increased availability of liver for pediatric recipients, and accordingly, this was associated with a significantly decreased waiting time before liver transplantation as well as reduced pre‐transplant mortality. We hypothesized that the use of living donors in pediatric LT may lead to improved graft and patient survival, when compared to LT using deceased donors.

Methods

Retrospective cohort analysis of pediatric recipients (aged <18 years) registered in the UNOS database who received a primary liver transplant between February 2002 and December 2016. Covariates predictive of survival by multivariable analyses were included in the Cox proportional hazards regression models to determine predictors of patient and graft survival.

Results

A total of 6312 children received a primary LT from a LD (n = 800) or a deceased donor (n = 5517; partial graft n = 1784 and whole graft n = 3733). Vascular and biliary complications were similar. Kaplan‐Meier graft and patient survival rates were superior in LD recipients compared with recipients of deceased whole and reduced graft (Figures 1 and 2). In the multivariable analysis, LD were an independent predictor of improved patient and graft survival.

Conclusion

The use of LD in children is associated with improved patient and graft survival. The option of LD should be introduced early on in the evaluation of every pediatric patient being evaluated for liver transplant.
Epstein‐Barr virus (EBV)‐positive diffuse large B‐cell lymphoma arising in patient with a history of EBV‐positive mucocutaneous ulcer and EBV‐positive nodal polymorphous B‐lymphoproliferative disorder
Authors: Daroontum Teerada , Kohno Kei , Inaguma Yoko , Okamoto Akinao , Okamoto Masataka , Kimura Yoshihiro , Nagahama Masato , Sakakibara Ayako , Satou Akira , Nakamura Shigeo
Published: November 2018

Elderly patients with Epstein‐Barr virus (EBV) infection are at increased risk for developing B‐cell lymphoproliferative disorder (B‐LPD) due to immunosenescence. Here, we describe a case of a 75‐year‐old man who developed an EBV‐positive (EBV+) mucocutaneous ulcer (EBVMCU) in the gingiva with spontaneous regression. Eighteen months after regression, he had a cervical lymph node enlargement that was diagnosed as EBV+ nodal polymorphous B‐LPD, Ann Arbor stage IA. Clinicians decided to observe his clinical course without any treatment. Fourteen months later, the patient developed EBV‐positive diffuse large B‐cell lymphoma (DLBCL), Ann Arbor stage IIA, and received six courses of age‐adjusted dose chemotherapy and achieved a complete remission. No evidence of a clonal relationship was found among these three lesions by standard polymerase chain reaction (PCR) analysis for immunoglobulin heavy chain. However, they all had expression of PD‐L1 in the EBV+ large B‐cells and Hodgkin Reed‐Sternberg‐like cells. This is the first case report of a PD‐L1‐positive (PD‐L1+) EBVMCU and the development of multiple EBV‐driven B‐LPDs in the setting of immunosenescence within a 32‐month period.
The relationship between innovation culture and innovation outcomes: exploring the effects of sustainability orientation and firm size
Authors: Jin Zhongqi , Navare Jyoti , Lynch Richard
Published: November 2018

Being sustainability‐oriented has become a key strategy for many firms. Equally, innovation culture and innovation outcomes have long been recognized as important contributors to the growth of firms. However, the literature on sustainability and innovation provides limited understanding of the important relationship between sustainability orientation, innovation culture and innovation outcomes. Given that large firms and small firms differ in building and employing their strategic assets, firm size matters in understanding the relationship. Through the lens of resource‐based view, we develop a theoretical model embedding the four components and test it using data from a global survey: the 2012 Comparative Performance Assessment Study. Our research contributes to sustainability literature and innovation theory by providing an integrated framework to explicate the mechanism through which the innovation culture of the firm impacts on innovative performance through the sustainability orientation of the firm. The findings advance our understanding of the extent to which sustainable orientation can explain the relationship between innovation culture and innovation outcomes. Our evidence shows that the innovation culture of a firm facilitates the sustainability orientation of the firm and that the converse also applies. The research also contributes to our knowledge of the differences between large and small firms in leveraging their strategic assets in terms of innovation culture and sustainability orientation to facilitate superior innovation outcomes. Although firm size moderates the relationship between innovation culture and innovation outcomes, the research shows that this no longer holds when sustainability orientation is included in the relationship. A strong sustainability orientation can be a competitive advantage for firms in the R&D Management delivery of superior innovation outcomes.
Identifying and analysing the drivers of heterogeneity among ecosystem builder accelerators
Authors: Prexl Katja‐Maria , Hubert Marco , Beck Susanne , Heiden Christian , Prügl Reinhard
Published: November 2018

In response to convergent and dynamic market developments, established firms use corporate accelerators to open their innovation processes to start‐ups. Among different accelerator themes, the ecosystem builder theme introduced by recent research plays a crucial role in furthering our understanding of the heterogeneity of accelerators due to its broad objectives. By interviewing 20 leading experts from 16 German corporate accelerators, we first identify heterogeneity among different ecosystem builder accelerators based on the differences in the process of selection, business support, and graduation. Second, we further structure the observed heterogeneity by depicting five different ecosystem builder accelerator types instead of a single ecosystem builder theme. These ecosystem builder accelerator types show important differences and similarities in terms of strategies, design elements, and processes within each of the process steps. Our findings hold meaningful research and managerial implications by providing (1) a consistent and systematic conceptual understanding about ecosystem builder accelerators, their strategies, design elements, and processes and (2) guidance to design and position ecosystem builder accelerators with regard to a long‐term corporate strategy.
Towards an improved international framework to govern the life cycle of plastics
Authors: Raubenheimer Karen , McIlgorm Alistair , Oral Nilüfer
Published: November 2018

Current international and regional frameworks provide a fragmented approach to the global governance of the life cycle of plastics. Three options to address marine litter have recently been published and presented at the third meeting of the United Nations Environment Assembly. This article outlines two options for a new international architecture, leaving to the side the third option of maintaining the status quo. The first suggests a global voluntary agreement that supplements the appropriate revisions and strengthening of relevant existing instruments. The second option provides for a global agreement that combines binding and voluntary measures. Whether the approach is binding or voluntary, strong integration with industry must be a primary outcome for either to be effective. The article discusses the merits of these options and considers where the authority for a new international instrument could come from.
An EU ban on microplastics in cosmetic products and the right to regulate
Authors: Kentin Esther , Kaarto Heidi
Published: November 2018

In January 2018, the European Commission initiated a restriction procedure on microplastics in cosmetic products. This article deals with the legal implications of a European Union (EU) restriction under the Regulation on the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) in relation to the right to regulate in the EU and in the context of the World Trade Organization (WTO). The article argues that in the aftermath of harmonization, the legal scope for EU Member States is dependent on the definition that will be adopted as regards microplastics under REACH: the wider the scope of the restriction, the more probable it is that Member States’ action is restrained. In the context of WTO rules, similar considerations apply as regards the scope of the definition: the wider the scope of an EU ban, the more demanding it will be to satisfy the requirements under the Agreement on Technical Barriers to Trade. Providing scientific evidence is instrumental, as there is little room for the precautionary principle in both regimes.
Addressing Climate Change as an Emerging Risk to Infrastructure Systems
Authors: Shortridge Julie , Camp Janey Smith
Published: November 2018

The consequences that climate change could have on infrastructure systems are potentially severe but highly uncertain. This should make risk analysis a natural framework for climate adaptation in infrastructure systems. However, many aspects of climate change, such as weak background knowledge and societal controversy, make it an emerging risk where traditional approaches for risk assessment and management cannot be confidently employed. A number of research developments aimed at addressing these issues have emerged in recent years, such as the development of probabilistic climate projections, climate services, and robust decision frameworks. However, additional research is needed to improve the suitability of these methods for infrastructure planning. In this perspective, we outline some of the challenges in addressing climate change risks to infrastructure and summarize new developments aimed at meeting these challenges. We end by highlighting needs for future research, many of which could be well‐served by expertise within the risk analysis community.
T11TS immunotherapy augments microglial and lymphocyte protective immune responses against Cryptococcus neoformans in the brain
Authors: Hazra Iman , SK Md Omar Faruk , Datta Ankur , Mondal Somnath , Moitra Saibal , Singh Manoj Kumar , Chaudhuri Suhnrita , Das Prasanta Kumar , Basu Anjan Kumar , Dhar Indranil , Basu Nandita , Chaudhuri Swapna
Published: November 2018

Cryptococcus neoformans, the encapsulated yeast acquired through inhalation, remains localized in lungs, but harbours the CNS in immunocompromised individuals. Several treatment regimes have failed combating this disease totally, but long‐term usage of drugs leads to organ damage. As T11‐target structure (T11TS) has documented profound immune potentiation, we aimed to investigate the role of microglia, pivotal immune cells of brain in ameliorating cryptococcosis, with T11TS immunotherapy. Murine model with C neoformans infection was prepared by intraperitoneal injection and the brains of rats examined 7 days post‐infections for histopathology by PAS and Alcian blue staining corroborated with organ fungal burden evidencing restorative T11TS action on Cryptococcal meningitis. Immunotherapy with three doses of T11TS, a CD2 ligand, in C neoformans infected rats, upregulates toll‐like receptors 2, −4 and −9 of microglia, indicating increased phagocytosis of the fungus. Flowcytometric analysis revealed increased numbers of T11TS treated brain infiltrating CD4+ and CD8+ T‐lymphocytes along with increased MHC I and MHC II on microglia, activating the infiltrating lymphocytes aiding the killing mechanism. Present study also indicated that T11TS increased production of Th1 inflammatory cytokines conducive to fungal elimination while the inhibitory Th2 cytokines were dampened. This preclinical study is first of its kind to show that T11TS effected profound immune stimulation of microglial activity of C neoformans infected rats eradicating residual fungal burden from the brain and can be a useful therapeutic strategy in fighting against this deadly disease.
Mood, Dimensional Personality, and Suicidality in a Longitudinal Sample of Patients with Bipolar Disorder and Controls
Authors: Kamali Masoud , Saunders Erika F. H. , Assari Shervin , Ryan Kelly A. , Marshall David F. , McInnis Melvin G.
Published: November 2018

Objective

To evaluate the effects of mood and anxiety symptoms in relation to personality dimensions and clinical features such as trauma and substance use on suicidal behaviors in a longitudinal sample of individuals with bipolar illness (BP) and healthy controls (HC).

Methods

Mood, personality, and clinical features were assessed in 151 individuals with BP I and 119 HC. Clinical data were collected at baseline and at 2‐year follow‐up. Personality traits were measured using the NEO PI‐R.

Results

In bivariate analyses, personality measures were significantly different between BP and HC, and between BP based on suicide attempt history. However, in regression analyses, baseline measures of depression, mania, anxiety, trauma, education, and age of BP onset correlated with personality domains, while a history of suicide attempts did not. Logistic regressions showed that prospective depression or mania, and a pattern of mixed mood features and chronicity of illness, along with two Neuroticism facet scores (N4—Self‐Consciousness and N6—Vulnerability) were predictive of suicide ideation (SI) in the 2‐year follow‐up period.

Conclusions

While dimensions of personality, trauma, and substance use clearly correlated with suicidal behaviors in BP, in multivariate models emerging mood symptoms were the most robust predictors of suicidality. These results reinforce the importance and attributable role of mood and anxiety symptoms in evaluating suicidal risk.
Relationship Status and Suicidal Behavior in Gay Men: The Role of Thwarted Belongingness and Hope
Authors: Riley Kym , McLaren Suzanne
Published: November 2018

Objective

Levels of suicidal behavior among gay men are a significant concern. The Interpersonal Theory of Suicide proposes that being unpartnered is a risk factor for suicidal behavior due to thwarted belongingness; however, this has yet to be tested empirically. Recent studies also indicate that the two components of hope, agency and pathways, may be protective against suicidal behavior. The first aim of the current study was to investigate whether thwarted belongingness mediates the relationship between relationship status and suicidal behavior in gay men. The study also examined whether agency and pathways weaken the association between relationship status and thwarted belongingness, and whether agency weakens the relation between thwarted belongingness and suicidal behavior.

Method

A sample of 370 self‐identified gay men aged from 18 to 66 years old (M = 26.13, SD = 8.02) completed the Suicidal Behaviors Questionnaire—Revised, the Interpersonal Needs Questionnaire—Revised, and the Adult Dispositional Hope Scale.

Results

Results showed that thwarted belongingness mediated the relationship between relationship status and suicidal behavior. The hypothesized moderated‐mediation models were not supported.

Conclusions

These findings have implications for the development of interventions that aim to reduce suicidal behaviors in gay men.