bluuebunny/crossref_metadata_2025 huggingface dataset:
Oxidation Products of 5-Methylcytosine are Decreased in Senescent Cells and Tissues of Progeroid Mice
Authors: Zarakowska Ewelina , Czerwinska Jolanta , Tupalska Agnieszka , Yousefzadeh Matt J , Gregg Siobhán Q , Croix Claudette M St , Niedernhofer Laura J , Foksinski Marek , Gackowski Daniel , Szpila Anna , Starczak Marta , Tudek Barbara , Olinski Ryszard
Published: February 2018

5-Hydroxymethylcytosine and 5-formylcytosine are stable DNA base modifications generated from 5-methylcytosine by the ten-eleven translocation protein family that function as epigenetic markers. 5-Hydroxymethyluracil may also be generated from thymine by ten-eleven translocation enzymes. Here, we asked if these epigenetic changes accumulate in senescent cells, since they are thought to be inversely correlated with proliferation. Testing this in ERCC1-XPF-deficient cells and mice also enabled discovery if these DNA base changes are repaired by nucleotide excision repair. Epigenetic marks were measured in proliferating, quiescent and senescent wild-type (WT) and Ercc1−/− primary mouse embryonic fibroblasts. The pattern of epigenetic marks depended more on the proliferation status of the cells than their DNA repair capacity. The cytosine modifications were all decreased in senescent cells compared to quiescent or proliferating cells, whereas 5-(hydroxymethyl)-2′-deoxyuridine was increased. In vivo, both 5-(hydroxymethyl)-2′-deoxyuridine and 5-(hydroxymethyl)-2′-deoxycytidine were significantly increased in liver tissues of aged WT mice compared to young adult WT mice. Livers of Ercc1-deficient mice with premature senescence and aging had reduced level of 5-(hydroxymethyl)-2′-deoxycytidine and 5-formyl-2′-deoxycytidine compared to aged-matched WT controls. Taken together, we demonstrate for the first time, that 5-(hydroxymethyl)-2′-deoxycytidine is significantly reduced in senescent cells and tissue, potentially yielding a novel marker of senescence.
Evaluating implementation of the Ebola response in Margibi County, Liberia
Authors: Sepers Charles E , Fawcett Stephen B , Hassaballa Ithar , DiGennaro Reed Florence , Schultz Jerry , Munodawafa Davison , Phori Peter Malekele , Chiriseri Ephraim
Published: February 2018

Implementation of the Ebola response was credited with reducing incidence of Ebola virus disease (EVD) in West Africa; however little is known about the amount and kind of Ebola response activities that were ultimately successful in addressing the 2014 outbreak. We collaboratively monitored Ebola response activities and associated effects in Margibi County, Liberia, a rural county in Liberia deeply affected by the outbreak. We used a participatory monitoring and evaluation system, including key informant interviews and document review, to systematically document activities, code them, characterize their contextual features, and discover and communicate patterns in Ebola response activities to essential stakeholders. We also measured incidence of EVD over time. Results showed a distinct pattern in Ebola response activities and key events, which corresponded with subsequent decreased EVD incidence. These data are suggestive of the role of Ebola response activities played in reducing the incidence of EVD within Margibi County, which included implementing safe burials, social mobilization and community engagement and case management. Systematic monitoring and evaluation of response activities to control disease outbreaks holds lessons for implementing and evaluating similar comprehensive and multi-sectoral community health efforts.
Identification-Robust Inference on Risk Premia of Mimicking Portfolios of Non-traded Factors
Authors: Kleibergen Frank , Zhan Zhaoguo
Published: February 2018

Mimicking portfolios of economic (non-traded) factors are commonly constructed by projecting the factors on a set of base assets. When these factors are associated with small betas, the beta-estimator using their mimicking portfolios has non-standard limit behavior. This jeopardizes inference on risk premia in the commonly used Fama and MacBeth (1973) two-pass procedure. Using sorting or the average excess returns on the mimicking portfolios to estimate the risk premia leads to similar non-standard behavior. We therefore propose a novel test for the risk premia on mimicking portfolios. Its validity does not depend on the magnitude of the betas. Simulation evidence suggests that it performs well in terms of size and power. We use it to analyze the risk premium on the leverage factor of Adrian, Etula, and Muir (2014). Our results indicate that the leverage factor is a weak factor which leads to substantially different results for its risk premium.
Four‐year follow‐up of an internet‐based brief intervention for unhealthy alcohol use in young men
Authors: Bertholet Nicolas , Studer Joseph , Cunningham John A. , Gmel Gerhard , Burnand Bernard , Daeppen Jean‐Bernard
Published: February 2018

Aim

To estimate the long‐term efficacy of an internet‐based brief intervention (IBI) in decreasing alcohol use among men on (1) number of drinks/week and (2) monthly or more binge drinking prevalence. In addition, overall changes in alcohol use were assessed.

Design

Participants in a cohort study were recruited in a two parallel‐group randomized controlled trial of an IBI versus no‐intervention control condition, showing a positive intervention effect at 6 months. As part of the regular cohort assessments, participants were re‐assessed 47 months after the initial trial, offering an opportunity to determine long‐term efficacy.

Setting

Young Swiss men from the general population.

Participants

Of 737 randomized trial participants with unhealthy alcohol use (> 14 drinks/week or ≥ 6 drinks/occasion at least monthly, or Alcohol Use Disorders Identification Test (AUDIT) ≥ 8), 626 completed a cohort assessment at mean ± standard deviation (SD) = 47.4 ± 2.6) months after their randomized trial baseline assessment.

Intervention

IBI included normative and personalized feedback on alcohol use, risk indicators, information about alcohol and health and recommendations; controls: assessment only.

Measurements

Self‐reported number of drinks/week and monthly or more binge drinking prevalence.

Findings

Comparisons at follow‐up were adjusted for baseline drinking. Missing values were replaced with the last observation carried forward. There was no evidence of differences between the IBI and control group on either the number of drinks/week [IBI: 10.8 (14.2); control: 10.7 (14.1), P = 0.8] or monthly or more binge drinking prevalence (IBI: 65.1%; control: 63.5%, P = 0.5). Although there was no evidence of overall change from baseline in number of drinks/week [9.8 (7.9) at baseline, 10.8 (14.1) at 47 months, P = 0.051], there was evidence that monthly or more binge drinking prevalence had decreased during the follow‐up time (84.9% at baseline, 64.3% at 47 months, P < 0.001).

Conclusions

An internet‐based brief intervention directed at unhealthy alcohol use among young men does not appear to reduce drinking over the long‐term.
The relationship between methamphetamine use and heterosexual behaviour: evidence from a prospective longitudinal study
Authors: McKetin Rebecca , Lubman Dan I. , Baker Amanda , Dawe Sharon , Ross Joanne , Mattick Richard P. , Degenhardt Louisa
Published: February 2018

Aims

To estimate the extent to which specific sexual behaviours (being sexually active, having multiple sex partners, casual sex, condomless casual sex, anal sex and condomless anal sex) change during periods of methamphetamine use.

Design

Within‐person estimates for the relationship between methamphetamine use and sexual behaviour were derived from longitudinal panel data from the Methamphetamine Treatment Evaluation Study (MATES) cohort (2006–10).

Setting

Sydney and Brisbane, Australia.

Participants

Participants (n = 319) were recruited through treatment and other health services, self‐identified as heterosexual, were aged 17–51 years, 74% were male and all were dependent on methamphetamine on study entry.

Measurements

Days of methamphetamine use in the past month and sexual behaviour in the past month were both assessed using the Opiate Treatment Index.

Findings

When using methamphetamine, participants had double the odds of being sexually active compared with when they were not using, after adjustment for demographics and other substance use [adjusted odds ratio (aOR) = 1.9, P = 0.010]. When participants were sexually active, they were more likely to have multiple sex partners (aOR = 3.3, P = 0.001), casual sex partners (aOR = 3.9, P < 0.001) and condomless casual sex (aOR = 2.6, P = 0.012) when using methamphetamine than when they were not using. During months when participants had a casual sex partner, there was no significant reduction in their likelihood of condom use when they were using methamphetamine. There was no significant change in the likelihood of having anal sex or condomless anal sex during months of methamphetamine use.

Conclusions

Methamphetamine use is associated with an increase in being sexually active, having multiple sex partners and casual sex partners and having condomless sex with casual partners, but it is not associated with a change in condom use per se.
Range size and drivers of African elephant (Loxodonta africana) space use on Karongwe Private Game Reserve, South Africa
Authors: Orrick Katherine D.
Published: February 2018

Mathematical models can identify different drivers and/or habitat preferences depending on the size and area of the analysis. Important criteria for survival, such as water access, may be seen at various spatial ranges while features such as human disturbance may only impact wildlife at a coarse scale. This study analyses the impact of roads surrounding Karongwe Private Game Reserve, South Africa, on a herd of African elephants (Loxodonta africana) over 6 years at three separate spatial ranges—coarse (the entire available area), home (95% isopleth) and core (50% isopleth). The purpose was to determine which anthropogenic (eastern and western public roads) and natural features (rivers, dams and vegetation) elephants avoided and preferred within each range. Coarse‐scale analysis indicates a clear avoidance by elephants for all public roads. Home and core range analyses showed a seasonal avoidance of roads by the breeding herd but not by bulls. Results indicate the importance in interpreting data at various ranges to improve identifying wildlife movement drivers.
Disappearance rate of chimpanzee scats: Implications for census work on Pan troglodytes
Authors: Phillips Caroline A. , Woolley Christopher , Mann Darren , McGrew William C.
Published: February 2018

Scat (faeces) decay rate estimates are used to calculate animal species abundance and density. For African great apes, this has been measured only for Gorilla; chimpanzee scats are assumed to decay at a faster rate due to lower fibre content. We provide the first systematic measure of scat decay rate duration for Pan troglodytes schweinfurthii, in Kanyawara, Kibale National Park, Uganda. We used two methods: (1) multiple visits to obtain prospective decay rates (PDR) (N = 96 scats) and (2) a novel approach of time‐lapse photography (TLP) (N = 17 scats). Most of the visited scats (67%) decayed in ≤24 hr, and median decay rate duration from photographic documentation was 18 hr. Using regression analyses, we tested 11 covariables to determine predictors for decay rate duration. Greater volume of scat and reduced levels of diurnal dung beetle activity were positively associated with longer decay rate duration. Given a high prevalence of dung beetle activity (88% of scats), particularly within 3 hr post‐defaecation, we suggest the use of the alternative term, disappearance rate of scats. With a rapid disappearance rate, scat count surveys of unhabituated chimpanzees are challenging; further work is then needed for Pan spp. to determine spatial and temporal differences at intra‐ and inter‐species level.
Effects of early antiplatelet therapy after splenectomy with gastro‐oesophageal devascularization
Authors: Zhou Jin‐Bao , Luo Bao‐Yang , Liu Chi‐Wen , Zhu Feng
Published: February 2018

Background

This study aimed to explore the effects of early antiplatelet therapy (APT) for portal vein thrombosis (PVT) in patients with cirrhotic portal hypertension after splenectomy with gastro‐oesophageal devascularization.

Methods

We retrospectively analysed 139 patients who underwent splenectomy with gastro‐oesophageal devascularization for portal hypertension due to cirrhosis between April 2010 and December 2016. Based on the post‐operative platelet values, we used two different APT regimens: APT was started when platelet counts were increased to 200 × 109/L or above (group A, n = 64) or 300 × 109/L or above (group B, n = 75). We took note of the patients’ clinical symptoms, operative factors and biochemical indicators.

Results

Platelet count, mean platelet volume, D‐dimer and pancreatic fistula were closely related to the development of PVT. Early APT was an independent protective factor for PVT. The incidence of post‐operative PVT was 15.1% (21/139) overall, 4.7% (3/64) in group A and 24% (18/75) in group B; there was a significant difference between groups A and B (χ2 = 10.042, P = 0.002).

Conclusion

Platelet count, mean platelet volume, D‐dimer and pancreatic fistula were independent risk factors for the development of PVT after splenectomy with gastro‐oesophageal devascularization. Selection of the appropriate timing for early APT according to the post‐operative platelet count was feasible. Moreover, the use of aspirin combined with dipyridamole was safe and effective for early prevention of PVT.
Aging‐related tau astrogliopathy (ARTAG): not only tau phosphorylation in astrocytes
Authors: Ferrer Isidro , García Meritxell Aguiló , González Irene López , Lucena Daniela Diaz , Villalonga Aina Roig , Tech Margarita Carmona , Llorens Franc , Garcia‐Esparcia Paula , Martinez‐Maldonado Alejandra , Mendez Margalida Frau , Escribano Benjamín Torrejón , Bech‐Serra Joan Josep , Sabido Eduard , de la Torre Gómez Carolina , del Rio José Antonio
Published: February 2018

Aging‐related tau astrogliopathy (ARTAG) is defined by the presence of two types of tau‐bearing astrocytes: thorn‐shaped astrocytes (TSAs) and granular/fuzzy astrocytes in the brain of old‐aged individuals. The present study is focused on TSAs in rare forms of ARTAG with no neuronal tau pathology or restricted to entorhinal and transentorhinal cortices, to avoid bias from associated tauopathies. TSAs show 4Rtau phosphorylation at several specific sites and abnormal tau conformation, but they lack ubiquitin and they are not immunostained with tau‐C3 antibodies which recognize truncated tau at Asp421. Astrocytes in ARTAG have atrophic processes, reduced glial fibrillary acidic protein (GFAP) and increased superoxide dismutase 2 (SOD2) immunoreactivity. Gel electrophoresis and western blotting of sarkosyl‐insoluble fractions reveal a pattern of phospho‐tau in ARTAG characterized by two bands of 68 and 64 kDa, and several middle bands between 35 and 50 kDa which differ from what is seen in AD. Phosphoproteomics of dissected vulnerable regions identifies an increase of phosphorylation marks in a large number of proteins in ARTAG compared with controls. GFAP, aquaporin 4, several serine‐threonine kinases, microtubule associated proteins and other neuronal proteins are among the differentially phosphorylated proteins in ARTAG thus suggesting a hyper‐phosphorylation background that affects several molecules, including many kinases and proteins from several cell compartments and various cell types. Finally, present results show for the first time that tau seeding is produced in neurons of the hippocampal complex, astrocytes, oligodendroglia and along fibers of the corpus callosum, fimbria and fornix following inoculation into the hippocampus of wild type mice of sarkosyl‐insoluble fractions enriched in hyper‐phosphorylated tau from selected ARTAG cases. These findings show astrocytes as crucial players of tau seeding in tauopathies.
The current state of GPCR‐based drug discovery to treat metabolic disease
Authors: Sloop Kyle W , Emmerson Paul J , Statnick Michael A , Willard Francis S
Published: February 2018

One approach of modern drug discovery is to identify agents that enhance or diminish signal transduction cascades in various cell types and tissues by modulating the activity of GPCRs. This strategy has resulted in the development of new medicines to treat many conditions, including cardiovascular disease, psychiatric disorders, HIV/AIDS, certain forms of cancer and Type 2 diabetes mellitus (T2DM). These successes justify further pursuit of GPCRs as disease targets and provide key learning that should help guide identifying future therapeutic agents. This report reviews the current landscape of GPCR drug discovery with emphasis on efforts aimed at developing new molecules for treating T2DM and obesity. We analyse historical efforts to generate GPCR‐based drugs to treat metabolic disease in terms of causal factors leading to success and failure in this endeavour.

Linked Articles

This article is part of a themed section on Molecular Pharmacology of GPCRs. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.21/issuetoc
Deciphering the mechanism and spectrum of chronic inflammatory demyelinating polyneuropathy using morphology
Authors: Koike Haruki , Katsuno Masahisa , Sobue Gen
Published: February 2018

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a form of chronic neuropathy characterized by demyelination due to immune‐mediated processes. In addition to the typical form of CIDP, several atypical forms, such as multifocal acquired demyelinating sensory and motor, distal acquired demyelinating symmetric (DADS), pure sensory, pure motor, and focal types, have also been included as subtypes of CIDP, indicating the heterogeneity of pathogenesis. The degradation of the myelin sheath by macrophages has been reported in CIDP and is considered to play an important role in the pathogenesis of this disease. By contrast, recent studies have suggested the association of autoantibodies directed against paranodal junction proteins, such as anti‐neurofascin 155 and anti‐contactin 1 antibodies, with subpopulations of CIDP patients. Although patients with these antibodies tend to manifest typical CIDP or DADS symptoms, such patients show unique clinical characteristics, such as a younger age at onset, sensory ataxia, tremor and poor response to intravenous immunoglobulin treatment. Classical macrophage‐induced demyelination is not observed in patients with these antibodies, whereas paranodal dissection resulting from attachment of immunoglobulin G4 antibodies to paranodal junctions plays a pivotal role in the mechanisms of neuropathy. Therefore, two distinct mechanisms exist that lead to nerve conduction abnormalities from a pathological viewpoint in CIDP. Advances in the search for autoantibodies in CIDP might make it necessary to reconsider the classification of this disease from the viewpoint of antibody recognition sites.
Comparison between characteristics of severe and very severe aortic stenosis
Authors: Tanaka Hidekazu , Kim Yong‐Jin , Park Seung‐Ji , Park Seung Woo , Hozumi Takeshi , Izumi Chisato , Ling Lieng His , Yu Cheuk‐Man , Fukuda Shota , Otsuji Yutaka , Song Jae‐Kwan , Sohn Dae‐Won
Published: February 2018

Objectives

Patients with very severe aortic stenosis (AS) have extremely poor clinical outcomes even if they are asymptomatic compared to those with severe AS, but the clinical and echocardiographic characteristics of patients with very severe AS remain unclear.

Methods

The Asian Valve Registry is a prospective, multicenter, multinational registry for the study and identification of the incidence, natural course, clinical outcomes, and prognostic factors for patients with significant AS at 9 centers in Asian countries. Severe AS was observed in 367 of 1066 patients with AS, and 212 were classified as very severe AS, defined as a peak aortic valve velocity ≥5.0 m/s or a mean aortic valve gradient ≥60 mm Hg.

Results

The prevalence of NYHA functional class II–IV among patients with very severe AS was significantly higher than that among patients with severe AS (67.9% vs 51.5%, P < .001). As for echocardiographic parameters, it was noteworthy that left ventricular mass index (LVMI) and left atrial volume index (LAVI) for patients with very severe AS were significantly larger than those for patients with severe AS (LVMI: 145.1 ± 36.4 g/m2 vs 119.2 ± 32.1 g/m2, P < .0001; LAVI: 56.1 ± 24.6 mL/m2 vs 49.8 ± 22.6 mL/m2, P = .002). Moreover, multivariate logistic regression analysis showed that LVMI was the only independently associated with NYHA functional class II–IV in patients with very severe AS.

Conclusions

Our findings may well have clinical implications for better management of patients with AS and lead to better understanding of poor outcomes for patients with very severe AS.
Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis
Authors: Taha N. A. , Abdelkhader S. Z.
Published: February 2018

Aim

To assess the outcome of full pulpotomy using Biodentine in permanent teeth with carious exposures and symptoms indicative of irreversible pulpitis.

Methodology

Sixty‐four permanent molar teeth with symptomatic vital pulps in 52 patients aged 19–69 years were included. Preoperative pulpal and periapical diagnosis was established. After informed consent, the tooth was anaesthetized, isolated using rubber dam and disinfected with 5% NaOCl before caries excavation; subsequently, the pulp was amputated to the level of the canal orifices. Haemostasis was achieved, and a 3‐mm layer of Biodentine (Septodont, Saint‐Maur‐des‐Fosses, France) was placed as the pulpotomy agent. Resin‐modified glass–ionomer liner was placed and the tooth restored with either resin composite or amalgam, and a postoperative periapical radiograph exposed. Clinical and radiographic evaluation was completed at 6 months and 1 year postoperatively. Pain levels were scored preoperatively and 2 days post‐treatment.

Results

Clinical signs and symptoms indicative of irreversible pulpitis were established in all teeth, and periapical rarefaction was present in nine teeth. After 2 days, 93.8% reported complete relief of pain. At 6 months, 63 of 64 attended recall with 98.4% clinical and radiographic success. At 1 year, 59 of 63 attended recall, with 100% clinical and 98.4 radiographic success. Seven of eight cases with periapical rarefaction who attended recall had improvement in the periapical index (PAI) score. A hard tissue barrier was detected radiographically in four cases.

Conclusion

Full pulpotomy using Biodentine was a successful treatment option for cariously exposed pulps in mature permanent molar teeth with clinical signs and symptoms indicative of irreversible pulpitis, up to 1 year.
PORTFOLIO REBALANCING AND ASSET PRICING WITH HETEROGENEOUS INATTENTION
Authors: Rachedi Omar
Published: February 2018

Can households' inattention to the stock market quantitatively account for the inertia in portfolio rebalancing? I address this question by introducing an observation cost into a production economy with heterogeneous agents. In this environment, inattention changes endogenously over time and across agents. I find that inattention explains the inertia in portfolio rebalancing and its heterogeneity across households. Inattention also rationalizes the limited stock market participation observed in the data and improves the asset pricing performance of the model. Finally, I present a novel testable implication linking the effects of inattention on portfolio choices and asset prices to households' funding liquidity.
ON THE TAXATION OF DURABLE GOODS
Authors: Koehne Sebastian
Published: February 2018

This article proposes a dynamic Mirrleesian theory of commodity taxation in the presence of durable goods. A uniform taxation across all goods is suboptimal even when the consumption preferences are separable from labor. If the consumption utility function is strictly concave and durable stocks are adjustable without friction, durable investment should be taxed at a higher rate than the purchase of nondurable goods. With adjustment frictions, the wedge on durable investment depends on substitution effects between durable and nondurable consumption and can be positive or negative. An application suggests that housing investment should face higher tax rates than regular consumption.
Interactions between the Newly Described Small‐ and Fast‐Swimming Mixotrophic Dinoflagellate Yihiella yeosuensis and Common Heterotrophic Protists
Authors: Jeong Hae Jin , Kang Hee Chang , You Ji Hyun , Jang Se Hyeon
Published: February 2018

The mixotroph Yihiella yeosuensis is a small‐ and fast‐swimming dinoflagellate. To investigate its protistan predators, interactions between Y. yeosuensis and 11 heterotrophic protists were explored. No potential predators were able to feed on actively swimming Y. yeosuensis cells, which escaped via rapid jumps, whereas Aduncodinium glandula, Oxyrrhis marina, and Strombidinopsis sp. (approximately 150 μm in cell length) were able to feed on weakly swimming cells that could not jump. Furthermore, Gyrodinium dominans, Luciella masanensis, and Pfiesteria piscicida were able to feed on heat‐killed Yihiella cells, whereas Gyrodinium moestrupii, Noctiluca scintillans, Oblea rotunda, Polykrikos kofoidii, and Strombidium sp. (20 μm) did not feed on them. Thus, the jumping behavior of Y. yeosuensis might be primarily responsible for the observed lack of predation. With increasing Yihiella concentration, the growth rate of O. marina decreased, whereas that of Strombidinopsis did not change. However, with increasing Yihiella concentration (up to 530 ng C/ml), the ingestion rate of Strombidinopsis on Yihiella increased linearly. The highest ingestion rate was 24.1 ng C per predator per d. The low daily carbon acquisition from Yihiella relative to the body carbon content of Strombidinopsis might be responsible for its negligible growth. Thus, Y. yeosuensis might have an advantage over its competitors due to its low mortality rate.
“It's about fitting in with the organisation”: A qualitative study of employers of nurse practitioners
Authors: Leidel Stacy , Hauck Yvonne , McGough Shirley
Published: February 2018

Aims and objectives

To explore the views of employers about the value nurse practitioners (NPs) add to health services, enablers and barriers to employing NPs, and intentions to employ NPs or expand NP services in the future.

Background

Research on Australian NPs has focused on NPs’ experiences or patient‐related factors like waiting times. Few studies have explored NP roles from the perspective of employers. Australian NPs employed by the private sector are eligible for reimbursement by the national health insurance scheme (Medicare Australia), potentially generating revenue for employers and broadening their career opportunities. We aimed to explore private sector employers’ views on the barriers and facilitators to employing NPs and to identify factors affecting NP employability.

Design

A qualitative descriptive exploratory study.

Method

Employers of NPs from 23 private and nonprofit health services in Western Australia were interviewed. Inductive content analysis was used to explore the data.

Results

Enablers to employing an NP included enhanced customer service and improved health outcomes. Barriers to employing an NP included lack of financial benefit and inadequate experience or qualifications. Employers also identified future directions for NP employability, such as filling a gap that added value to the health service.

Conclusions

Employers wanted NPs to work towards a shared vision of patient care that aligned with organisational needs.

Relevance to clinical practice

Findings can inform NP education and workforce planning to optimally meet employer and patient health needs.
Trajectories of change in cognitive function in people with chronic obstructive pulmonary disease
Authors: Park Soo Kyung
Published: February 2018

Aims and objectives

To describe changes in cognitive function, as measured by the trail making test; to identify distinct patterns of change in cognitive function; and to examine predictors of change in cognitive function in people with severe chronic obstructive pulmonary disease.

Background

How cognitive function changes in people with chronic obstructive pulmonary disease and what factors influence those changes over time is not well known, despite the fact that it declines rapidly in this population and significantly impacts functional decline in healthy older adults.

Design

A secondary analysis and longitudinal study with a follow‐up period of 3 years.

Methods

A data set from the National Emphysema Treatment Trial provided participant data. Patients with severe chronic obstructive pulmonary disease (n = 307) were recruited at a clinical site. Several demographic and clinical measures were assessed at baseline. Trail making test scores were measured at baseline, 1, 2 and 3 years.

Results

Cognitive function was stable for 3 years in people with chronic obstructive pulmonary disease. However, four distinct patterns of change in cognitive function were identified. Age, education, 6‐min walk distance and cognitive impairment scores at baseline on the trail making test Part B were significant predictors of worsening cognitive function and below‐average cognitive function over 3 years.

Conclusions

These findings suggest that increasing exercise capacity improves cognitive function and delays deterioration of cognitive function in people with COPD.

Relevance to clinical practice

Understanding the trajectories of change in cognitive function and predictors of change in cognitive function over 3 years may enable health care providers to identify patients at greatest risk of developing mental deterioration and those who might benefit from interventions to improve cognitive function. Health care providers should periodically assess and frequently screen people with COPD for cognitive function.
Trapped like a butterfly in a spider's web: Experiences of female spousal caregivers in the care of husbands with severe mental illness
Authors: Rahmani Farnaz , Ebrahimi Hossein , Seyedfatemi Naeimeh , Namdar Areshtanab Hossein , Ranjbar Fatemeh , Whitehead Bill
Published: February 2018

Aims and objectives

To explore the experiences of female spousal caregivers in the care of husbands with severe mental illness.

Background

Family involvement in the care of patients with chronic illness is essential to provide a backbone of support for them. However, little is known about how female spousal caregivers are confronted with challenges while taking care of their husbands with severe mental illness.

Design

An exploratory qualitative study.

Methods

Fourteen female spousal caregivers of people with severe mental illness (defined here as schizophrenia, schizoaffective disorders and bipolar affective disorders) were recruited using purposive sampling and were interviewed using a semistructured in‐depth interview method. Data were analysed by conventional content analysis until data saturation was achieved.

Results

Care of a husband with severe mental illness had a disruptive influence on the emotional relationships of the family and resulted in emotional detachment over time. Despite the caregivers’ struggle to protect their families, the lack of supportive resources caused emotional exhaustion. Caregiving tasks interfering with their many other responsibilities, along with being a reference for family matters, led to loss of self. Consequently, they experienced psychological distress because of the transition to a caregiver role without any supportive resources.

Conclusion

Constant caring, without supportive resources, forced them to do various roles and manage other issues within the family. Being unprepared for a caregiving role led to the psychological distress of female spousal caregivers. Therefore, adequate information, education and supportive resources must be provided for spouses to facilitate their transition to caregiving roles.

Relevance to clinical practice

It is necessary to pay close attention to the spousal caregivers’ own mental health problems while they care for their mentally ill husbands. Mental health professionals should adopt a new approach to the prioritisation and planning of policies that support both family caregivers and patients.
Inertia in nursing care of hospitalised patients with urinary incontinence
Authors: Artero‐López Consuelo , Márquez‐Hernández Verónica V. , Estevez‐Morales María Teresa , Granados‐Gámez Genoveva
Published: February 2018

Aims and objectives

To assess the existence of therapeutic inertia in the nursing care of patients with urinary incontinence during the patient's time in hospital, together with the sociodemographic and professional variables involved.

Background

Inertia in care is a problem which appears in the nursing care process. Actions related to inertia can be attributed to not adhering to protocols, clinical guidelines and the lack of prevention measures which have undesirable effects on the efficiency of care.

Design

This was a prospective observational study.

Methods

A total of 132 nursing professionals participated over two consecutive months. Data were collected randomly through the method of systematic, nonparticipative observation of medical practice units and patients’ medical records.

Results

The results showed a pattern of severely compromised action in the assessment of the pattern of urinary elimination, in actions related to urinary continence, in therapeutic behaviour and in patient satisfaction and were found to be consistent with professional experience (p < .05). In the 600 records analysed, no statistically significant differences were found between gender and the use of records. In 50% (n = 301), the use of a rating scale was not reflected. In over 90% (n = 560) of cases, the type of incontinence was not recorded. In no continuity of care report were recommendations regarding incontinence included, nor was the type of continence products recommended indicated.

Conclusion

It is clear that inertia exists in nursing care in the hospital environment while the patient is hospitalised, in prevention care, in the treatment of urinary incontinence and in the management of records.

Relevance to clinical practice

Contributing to the understanding of the existence of inertia in nursing care raises questions regarding its causes and interventions to predict or monitor it.
Recognition and assessment of resident’ deterioration in the nursing home setting: A critical ethnography
Authors: Laging Bridget , Kenny Amanda , Bauer Michael , Nay Rhonda
Published: February 2018

Aims and objectives

To explore the recognition and assessment of resident deterioration in the nursing home setting.

Background

There is a dearth of research exploring how nurses and personal‐care‐assistants manage a deteriorating nursing home resident.

Design

Critical ethnography.

Methods

Observation and semi‐structured interviews with 66 participants (general medical practitioners, nurses, personal‐care‐assistants, residents and family members) in two Australian nursing homes. The study has been reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.

Results

The value of nursing assessment is poorly recognised in the nursing home setting. A lack of clarity regarding the importance of nursing assessments associated with resident care has contributed to a decreasing presence of registered nurses and an increasing reliance on personal‐care‐assistants who had inadequate skills and knowledge to recognise signs of deterioration. Registered nurses experienced limited organisational support for autonomous decision‐making and were often expected to undertake protocol‐driven decisions that contributed to potentially avoidable hospital transfers.

Conclusions

Nurses need to demonstrate the importance of assessment, in association with day‐to‐day resident care and demand standardised, regulated, educational preparation of an appropriate workforce who are competent in undertaking this role. Workforce structures that enhance familiarity between nursing home staff and residents could result in improved resident outcomes. The value of nursing assessment, in guiding decisions at the point of resident deterioration, warrants further consideration.
“Dignity”: A central construct in nursing home staff understandings of quality continence care
Authors: Ostaszkiewicz Joan , Tomlinson Emily , Hutchinson Alison M
Published: February 2018

Aims and objectives

To explore nursing home staff members’ beliefs and expectations about what constitutes “quality continence care” for people living in nursing homes.

Background

Most nursing home residents require assistance to maintain continence or manage incontinence. Best practice guidelines promote active investigation of incontinence, treatment of underlying potentially reversible causes, and initial conservative interventions to prevent, minimise and/or treat incontinence. Despite research showing the positive benefits of implementing active interventions, translating the findings of research into practice in nursing homes has been modest. Understanding the perspectives of individuals who provide continence care may help bridge the gap between evidence and practice.

Design

A qualitative exploratory descriptive design.

Methods

Qualitative interviews were conducted with 19 nursing home staff: eight registered nurses, four enrolled nurses and seven personal care workers working in a nursing home in Australia between 2014–2015. Data were analysed inductively to identify themes and subthemes that described and explained staff beliefs about quality continence care in nursing homes.

Findings

Participants’ understanding and expectations about quality continence care were linked to beliefs about incontinence being an intractable and undignified condition in nursing homes. The key theme to emerge was “protecting residents’ dignity” which was supported by the following six subthemes: (i) using pads, ii) providing privacy, (iii) knowing how to “manage” incontinence, (iv) providing timely continence care, (v) considering residents’ continence care preferences and (vi) communicating sensitively.

Conclusion

The findings provide new insight into the basis for continence care practices in nursing homes. Education about continence care should challenge beliefs that limit continence care practice to cleaning, containing and concealing incontinence. There is a need for a multidimensional framework that is informed by social, psychological and biomedical research about incontinence, research about the fundamental elements of care, care‐dependent individuals’ expectations about care, and values about dignity and care.

Relevance to clinical practice

The in‐depth exploration led to an understanding of the basis for continence care practices that centre on cleaning, containing and concealing residents’ incontinence in some nursing homes. There is a need to review the quality of education for the aged care workforce about incontinence to ensure it equips them with a broad understanding of the fundamentals of care and how to enact dignity in continence care through a resident‐centred approach.
Risk of hepatitis B virus reactivation in hepatitis B virus + hepatitis C virus‐co‐infected patients with compensated liver cirrhosis treated with ombitasvir, paritaprevir/r + dasabuvir + ribavirin
Authors: Preda C. M. , Popescu C. P. , Baicus C. , Constantinescu I. , Oproiu A. , Voiosu T. , Diculescu M. , Negreanu L. , Gheorghe L. , Sporea I. , Trifan A. , Ceausu E. , Proca D. , Manuc M.
Published: February 2018

Hepatitis B virus may reactivate in patients with chronic hepatitis C treated with direct‐acting antivirals. The aim of this study was to investigate the risk of hepatitis B virus (HBV) reactivation in HBV + hepatitis C virus (HCV)‐co‐infected patients with compensated liver cirrhosis treated with paritaprevir/ombitasvir/ritonavir, dasabuvir with ribavirin. We reviewed prospectively gathered data from a national cohort of 2070 hepatitis C virus patients with compensated liver cirrhosis who received reimbursed paritaprevir/ombitasvir/r, dasabuvir with ribavirin for 12 weeks from the Romanian National Health Agency during 2015‐2016. Twenty‐five patients in this cohort were HBs antigen positive (1.2%); 15 untreated with nucleotide analogues agreed to enter the study. These patients were followed up: ALT monthly, serology for HBV and DNA viral load at baseline, EOT and SVR at 12 weeks. Hepatitis B virus (HBV)‐co‐infected patients were all genotype 1b and 52% females, with a median age of 60 years (51 ÷ 74); 76% were pretreated with peginterferon + ribavirin; 72% were with severe necroinflammatory activity on FibroMax assessment; 40% presented comorbidities; and all were HBe antigen negative. Hepatitis C virus (HCV) SVR response rate was 100%. Hepatitis B virus (HBV)‐DNA viral load was undetectable in 7/15 (47%) before therapy, and for the other 8 patients, it varied between below 20 and 867 IU/mL. Five patients (33%) presented virological reactivation (>2 log increase in HBV‐DNA levels) during therapy. One patient presented with hepatitis associated with HBV reactivation, and two started anti‐HBV therapy with entecavir. Hepatitis B virus (HBV) virological reactivation was present in 33% in our patients. Generally, HBV‐DNA elevations were mild (<20 000 IU/mL); however, we report one case of hepatitis associated with HBV reactivation.
Does introgression of crop alleles into wild and weedy living populations create cryptic in situ germplasm banks?
Authors: Ellstrand Norman C.
Published: February 2018

Natural gene flow often delivers alleles from cultivated species into unmanaged populations of weedy or wild relatives. Unmanaged populations with introgressed crop alleles may become the unintended repositories of crop alleles that are no longer available to breeders. Descriptive studies have confirmed the introgression of alleles from 17 crop species into free‐living populations. Multigeneration experimental studies allowing hybrid‐derived individuals to evolve under natural conditions are informative, but remain few. A study in this issue of Molecular Ecology (Molecular Ecology, 26, 2017) documents genomewide crop allele evolution in experimental populations of crop‐wild hybrid‐derived sunflowers. Approximately, three‐quarters of the wild alleles increased in frequency;—however, 5% of the crop alleles in each of the two sites increased (Molecular Ecology, 26, 2017; Figure ). The remainder behaved as if they were neutral. This study's results plus those of prior studies demonstrate that introgressed populations of crop‐wild relatives contain a mixture of wild and crop alleles and thereby can be valued as a distinct kind of in situ germplasm resource relative to nonintrogressed populations.

A lone wild sunflower in the foreground. A field of thousands of cultivated sunflowers in the background

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Epidemiology, treatment, disposition and outcome of patients with acute exacerbation of COPD presenting to emergency departments in Australia and South East Asia: An AANZDEM study
Authors: Kelly Anne Maree , Holdgate Anna , Keijzers Gerben , Klim Sharon , Graham Colin A. , Craig Simon , Kuan Win Sen , Jones Peter , Lawoko Charles , Laribi Said
Published: February 2018

Background and objective

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a common presentation to emergency departments (ED) but data regarding its epidemiology and outcomes are scarce. We describe the epidemiology, clinical features, treatment and outcome of patients treated for AECOPD in ED.

Methods

This was a planned sub‐study of patients with an ED diagnosis of AECOPD identified in the Asia, Australia and New Zealand Dyspnoea in Emergency Departments (AANZDEM) study. The AANZDEM was a prospective, interrupted time series cohort study conducted in 46 ED in Australia, New Zealand, Singapore, Hong Kong and Malaysia over three 72‐h periods in May, August and October 2014. Primary outcomes were patient epidemiology, clinical features, treatment and outcomes (hospital length of stay (LOS) and mortality).

Results

Forty‐six ED participated. There were 415 patients with an ED primary diagnosis of AECOPD (13.6% of the overall cohort; 95% CI: 12.5–14.9%). Median age was 73 years, 60% males and 65% arrived by ambulance. Ninety‐one percent had an existing COPD diagnosis. Eighty percent of patients received inhaled bronchodilators, 66% received systemic corticosteroids and 57% of those with pH < 7.30 were treated with non‐invasive ventilation (NIV). Seventy‐eight percent of patients were admitted to hospital, 7% to an intensive care unit. In‐hospital mortality was 4% and median LOS was 4 days (95% CI: 2–7).

Conclusion

Patients treated in ED for AECOPD commonly arrive by ambulance, have a high admission rate and significant in‐hospital mortality. Compliance with evidence‐based treatments in ED is suboptimal affording an opportunity to improve care and potentially outcomes.
The effects of flexibility training on exercise‐induced muscle damage in young men with limited hamstrings flexibility
Authors: Brusco C. M. , Blazevich A. J. , Radaelli R. , Botton C. E. , Cadore E. L. , Baroni B. M. , Trajano G. S. , Pinto R. S.
Published: February 2018

Adaptations to 6 weeks of supervised hamstring stretching training and its potential impact on symptoms of eccentric exercise‐induced muscle damage (EIMD) were studied in 10 young, untrained men with limited hamstrings flexibility. Participants performed unilateral flexibility training (experimental leg; EL) on an isokinetic dynamometer, while the contralateral limb acted as control (CL). Hip range of motion (ROM), passive, isometric, and concentric torques, active optimum angle, and biceps femoris and semitendinosus muscle thickness and ultrasound echo intensity were assessed both before and after the training. Additionally, muscle soreness was assessed before and after an acute eccentric exercise bout in both legs (EL and CL) at post‐training only. Hip ROM increased (P < .001) only in EL after the training (EL = 10.6° vs CL = 1.6°), but no changes (P > .05) in other criterion measurements were observed. After a bout of eccentric exercise at the end of the program, isometric and dynamic peak torques and muscle soreness ratings were significantly altered at all time points equally in EL and CL. Also, active optimum angle was reduced immediately, 48 and 72 hours post‐exercise, and hip ROM was reduced at 48 and 72 hours equally in EL and CL. Finally, biceps femoris muscle thickness was significantly increased at all time points, and semitendinosus thickness and echo intensity significantly increased at 72 hours, with no significant differences between legs. The stretching training protocol significantly increased hip ROM; however, it did not induce a protective effect on EIMD in men with tight hamstrings.