bluuebunny/crossref_metadata_2025 huggingface dataset:
Competing for seed dispersal: evidence for the role of avian seed hoarders in mediating apparent predation among oaks
Authors: Pesendorfer Mario B. , Koenig Walter D.
Published: September 2016

In communities of large‐seeded tree species, generalist seed hoarders often link the temporally variable dynamics of various species in ways that can result in indirect ecological interactions. A special case of such interactions is ‘apparent predation’ – when variation in seed production of one tree species changes the outcome of the interaction between seed hoarders and another tree species from seed dispersal mutualism to predation.

We investigated how two species of avian hoarders responded to differences in acorn availability among individual valley oaks (Quercus lobata) and across a landscape dominated by blue oaks (Q. douglasii) to determine whether seed dispersal and predation dynamics result in apparent predation between these oak species.

California scrub‐jays (Aphelocoma californica), high‐quality seed dispersers with large spatial scales of resource perception, showed strong numerical and functional responses to individually large Q. lobata acorn crops when landscape‐level acorn crops were low, but the numerical response was not observed when Q. douglasii produced a good acorn crop the subsequent year. In contrast, acorn woodpeckers (Melanerpes formicivorus), which are significant acorn predators, exhibited a consistent functional response to individual Q. lobata acorn crops independent of landscape‐wide availability. Consequently, Q. lobata experienced increased predation and a near absence of high‐quality seed dispersal when Q. douglasii acorns were abundant.

Our results suggest that apparent predation among oak species can arise from contrasting responses of generalist seed predators and dispersers to acorn availability on different spatial scales. Thus, the spatial scale of resource perception, which can differ greatly among generalist seed hoarders, may provide a proximate mechanism underlying indirect, temporally variable ecological affects such as apparent predation among sympatric species of large‐seeded trees.

A lay summary is available for this article.
Learning management by self‐employed occupational therapists in private practice
Authors: Millsteed Jeannine , Redmond Janice , Walker Elizabeth
Published: September 2016

Background/aim

This study explored how occupational therapists in private practice developed the business skills needed to operate a successful private practice. The literature shows that many small‐business owner‐managers have poorly developed business skills, and some experience high rates of failure. This indicates that to be successful in private practice, occupational therapists need to gain mastery of management competencies in addition to their professional clinical competencies.

Methods

A qualitative study, using in‐depth interviews, collected data from twenty‐six self‐employed occupational therapists on their experiences of becoming a small‐business owner‐manager. A narrative analysis built an understanding about how these therapists developed their business competencies.

Results

Analysis revealed the factors affecting the development of business competencies were interactions between the initial motivations for start‐up, growth aspirations and engagement with external business environments. Business competencies developed through a combination of formal learning prior to starting their businesses, and informal learning once their businesses were in operation. Lower level learning occurred in the routine and operational processes, with higher level learning through discontinuous events resulting in a transformation in the therapists’ understanding about themselves as business owner‐managers.

Conclusions

Findings led to a proposition that occupational therapists make the transition to becoming successful small‐business owner‐manager through management learning that includes elements of self‐reflection, identifying environmental opportunities and risks, developing capabilities, and strategic planning for growth and development. It provides insights on what occupational therapists need to consider to become successful small‐business owner‐managers.
Does anybody notice? How policy positions of coalition parties are perceived by voters
Authors: SPOON JAE‐JAE , KLÜVER HEIKE
Published: September 2016

Does governing in coalitions affect how coalition parties’ policy positions are perceived by voters? In this article, the authors seek to understand the relationship between parties’ participation in coalition governments and their perception by voters. Policy positions are an important instrument through which parties compete for the support of voters. However, it is unclear to what extent voters can correctly perceive the positions of parties when they govern together with other coalition partners. It is argued here that because of the blurred lines of responsibility in multiparty cabinets, it is difficult for voters to correctly perceive the positions of coalition parties. What is more, it is expected that the internal functioning of coalition cabinets affects the extent to which coalition parties struggle to get their message out to voters. It is hypothesized in the article that intra‐cabinet conflict is negatively related to misperception. To test their theoretical expectations, the authors combine data on the left‐right policy positions of political parties from the Comparative Manifestos Project with data on how these positions are perceived by voters gathered from the Comparative Study of Electoral Systems from 1996 to 2011. The findings shed light on the relationship between party competition and coalition governments, and its implications for political representation.
Recent Developments in Methods and Techniques for Rapid Monitoring of Sugar Metabolism in Fruits
Authors: Hu Weihong , Sun Da‐Wen , Pu Hongbin , Pan Tingtiao
Published: September 2016

The major sugars in fruits, including glucose, fructose, and sucrose, play a critical role in fruit quality control and maturity evaluation. Many novel methods and techniques such as enzymatic and nonenzymatic biosensors, nuclear magnetic resonance, and near‐infrared spectroscopy have been developed to provide the rapid estimation of sugar inversion under different storage conditions. This review provides a description of recent advancements in these technologies for the determination of sugar contents in fruits. The prospects of emerging spectroscopic technologies such as Raman spectroscopy, hyperspectral imaging, and terahertz imaging, for assessing sugars in intact fruits are discussed. The challenges for further developments of these methods and technologies to meet the increasing demand for rapid and on‐line quality control are also presented.
The Emergency Medicine Events Register: An analysis of the first 150 incidents entered into a novel, online incident reporting registry
Authors: Hansen Kim , Schultz Timothy , Crock Carmel , Deakin Anita , Runciman William , Gosbell Andrew
Published: September 2016

Objective

Incident reporting systems are critical to understanding adverse events, in order to create preventative and corrective strategies. There are very few systems dedicated to Emergency Medicine with published results. All EDs in Australia and New Zealand were contacted to encourage the use of an Emergency Medicine – specific online reporting system called the Emergency Medicine Events Register (EMER).

Methods

We conducted an analysis of the first 150 incidents entered into EMER. EMER captures Emergency‐medicine‐specific details including triage score, clinical presentation, outcome, contributing factors, mitigating factors, other specialities involved and patient journey stage. These details were analysed by an expert panel.

Results

Over the first 26 months, 150 incidents were reported into EMER. The most common categories reported, in order, were diagnostic error, procedural complication and investigation errors. Most incidents contained more than one category of error. The most common stage of the patient's journey in which an incident was detected was after discharge from the ED.

Conclusion

A focus on correct diagnosis, procedure performance and investigation interpretation may reduce errors in the ED. The ability to learn from incidents and make system changes to enhance patient safety in healthcare organisations is an inherent part of providing a proactive, quality culture.
Review article: Diagnostic accuracy of risk stratification tools for patients with chest pain in the rural emergency department: A systematic review
Authors: Roche Tina , Jennings Natasha , Clifford Stuart , O'connell Jane , Lutze Matthew , Gosden Edward , Hadden N Fionna , Gardner Glenn
Published: September 2016

Risk stratification tools for patients presenting to rural EDs with undifferentiated chest pain enable early definitive treatment in high‐risk patients. This systematic review compares the most commonly used risk stratification tools used to predict the risk of major adverse cardiac event (MACE) for patients presenting to rural EDs with chest pain. A comprehensive search of MEDLINE and Embase for studies published between January 2011 and January 2015 was undertaken. Study quality was assessed using QUADAS‐2 criteria and the PRISMA guidelines.Eleven studies using eight risk stratification tools met the inclusion criteria. The percentage of MACE in the patients stratified as suitable for discharge, and the percentage of patients whose scores would have recommended admission that did not experience a MACE event were used as comparisons. Using the findings of a survey of emergency physicians that found a 1% MACE rate acceptable in discharged patients, the EDACS‐ADP was considered the best performer. EDACS‐ADP had one of the lowest rates of MACE in those discharged (3/1148, 0.3%) and discharged one of the highest percentage of patients (44.5%). Only the GRACE tool discharged more patients (69% – all patients with scores <100) but had a MACE rate of 0.3% in discharged patients. The HFA/CSANZ guidelines achieved zero cases of MACE but discharged only 1.3% of patients.EDACS‐ADP can potentially increase diagnostic efficiency of patients presenting at ED with chest pain. Further assessment of tool in a rural context is recommended.
Impact of population ageing on growing demand for emergency transportation to emergency departments in Western Australia, 2005–2020
Authors: Aboagye‐Sarfo Patrick , Mai Qun , Sanfilippo Frank M , Fatovich Daniel M
Published: September 2016

Objective

The aim of the present paper is to quantify the impact of population ageing on demand for emergency transportation (ET) to EDs in Western Australia (WA).

Methods

A population‐based longitudinal study using the statewide ED presentation data from 2005–2014 was used to predict ET demand in 2020, stratified by age group and sex.

Results

From 2005 to 2014, 14.9% of all ED presentations arrived by ET. The number rose from 94 369 (13.9%) in 2005 to 153 374 (15.5%) in 2014, a compound annual growth of 5.5%. Of those presentations, 55.2% resulted in hospital admission. The proportion was higher in older age groups (64.5% in 65–74 years, 67.1% in 75–84 years and 68.4% in ≥85 years). Of ED presentations arriving by ET in age group ≥65 years, 70.9% were Australasian Triage Scale category 1, 2 or 3. The rate of ET per 1000 population increased in all age groups and sex. The highest growth was in the older age groups: from 86.6, 187.0 and 512.1 in ages 65–74 years, 75–84 years and ≥85 years, respectively, in 2005 to 102.5, 226.7 and 613.6 in 2014, and are expected to increase to 115.1, 264.3 and 707.7 by 2020. The ET demands in these age groups were projected to increase annually by 5.0%, 3.6% and 4.9%, respectively, in the next 6 years, comparing to less than 4.5% in the younger age groups.

Conclusion

There has been a continuous rise in ET demand in WA, particularly in older people who have a higher urgency and requirement for admission.
Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre
Authors: Buckland Aaron J , Bressan Silvia , Jowett Helen , Johnson Michael B , Teague Warwick J
Published: September 2016

Objective

Evidence‐based decision‐making tools are widely used to guide cervical spine assessment in adult trauma patients. Similar tools validated for use in injured children are lacking. A paediatric‐specific approach is appropriate given important differences in cervical spine anatomy, mechanism of spinal injury and concerns over ionising radiation in children. The present study aims to survey physicians' knowledge and application of cervical spine assessment in injured children.

Methods

A cross‐sectional survey of physicians actively engaged in trauma care within a paediatric trauma centre was undertaken. Participation was voluntary and responses de‐idenitified. The survey comprised 20 questions regarding initial assessment, imaging, immobilisation and perioperative management. Physicians' responses were compared with available current evidence.

Results

Sixty‐seven physicians (28% registrars, 17% fellows and 55.2% consultants) participated. Physicians rated altered mental state, intoxication and distracting injury as the most important contraindications to cervical spine clearance in children. Fifty‐four per cent considered adequate plain imaging to be 3‐view cervical spine radiographs (anterior–posterior, lateral and odontoid), whereas 30% considered CT the most sensitive modality for detecting unstable cervical spine injuries. Physicians' responses reflected marked heterogeneity regarding semi‐rigid cervical collars and what constitutes cervical spine ‘clearance’. Greater consensus existed for perioperative precautions in this setting.

Conclusions

Physicians actively engaged in paediatric trauma care demonstrate marked heterogeneity in their knowledge and application of cervical spine assessment. This is compounded by a lack of paediatric‐specific evidence and definitions, involvement of multiple specialties and staff turnover within busy departments. A validated decision‐making tool for cervical spine assessment will represent an important advance in paediatric trauma.
Pea and Broad Bean Pods as a Natural Source of Dietary Fiber: The Impact on Texture and Sensory Properties of Cake
Authors: Belghith‐Fendri Lilia , Chaari Fatma , Kallel Fatma , Zouari‐Ellouzi Soumaya , Ghorbel Raoudha , Besbes Souhail , Ellouz‐Chaabouni Semia , Ghribi‐Aydi Dhouha
Published: September 2016

Attention has focused on bakery products such as cake which is one of the most common bakery products consumed by people in the world. Legume by‐products, pea pods (PPs) (Pisum sativum L.) and broad bean pods (BBPs) (Vicia faba L.) mediterranean (Tunisian), has been studied for its high dietary fiber content (PP: 43.87 g/100 g; BBP: 53.01 g/100 g). Protein content was also a considerable component for both by‐products. We investigated the effect of substituted of 5%, 10%, 15%, 20%, 25%, and 30% of PP and BBP flours on the sensory and technological properties in cake. Cakes hardness increased whereas L* and a* color values decreased. The overall acceptability rate showed that a maximum of 15% of PP and BBP flours can be added to prepare acceptable quality cakes.
Is the daily use of vacuum erection device for a month before penile prosthesis implantation beneficial? a randomized controlled trial
Authors: Canguven O. , Talib R. A. , Campbell J. , De Young L. , El Ansari W. , Al‐Ansari A.
Published: September 2016

Patient concerns about penile length after penile prosthesis (PP) implantation for erectile dysfunction (ED) have significant impact on patients and their partners. In addition, corporal fibrosis is associated with difficult PP implantation. The preoperative use of vacuum erectile devices (VED) is an uncommon physical treatment for such concerns. Therefore, the current randomized controlled study assessed two outcomes: whether pre‐operative VED use for a month before surgery would significantly increase flaccid stretched penile length (SPL) on the day of surgery, and facilitate easier corporal dilatation intraoperatively. Fifty‐one patients scheduled for PP implantation for ED were randomized to either intervention group (pre‐operative VED use; 10–15 min/day for ≥30 days; Group A; n = 25), or control group (no intervention; Group B; n = 26). A research assistant (blinded to the treatment assignments) recorded SPL at baseline (initial consultation) and on day of surgery. The surgeons performing the PP implantation (also blinded to the treatment assignments) provided subjective assessments of the ease of corporal dilatation. Baseline patient characteristics, demographics, and comorbidities were the same in both groups. Baseline measurements (SPL‐1) were 10.71 ± 1.28 and 10.87 ± 1.26 cm in Group A and Group B, respectively; and the day of surgery measurements (SPL‐2) were 11.50 ± 1.33 and 11.06 ± 1.34 cm in Group A and Group B, respectively. In terms of outcomes: mean SPL increase in Group A was significantly more by a mean of 0.80 ± 0.38 cm (p < 0.05) compared to Group B; and surgeons’ subjective report of surgical ease indicated smoother corporal dilatation for Group A compared to Group B. VED use (10–15 min/day during the month prior to PP implantation) was associated with significantly increased SPL on day of surgery, and facilitated easier corporal dilatation intraoperatively. Future studies should examine the long‐term outcomes of penile prosthesis implantation after pre‐operative use of vacuum erectile devices.
Treatment of Chilaiditi syndrome using laparoscopic surgery
Authors: Takahashi Kodai , Ito Hideto , Katsube Toshio , Tsuboi Ayaka , Hashimoto Masatoshi , Ota Emi , Mita Kazuhito , Asakawa Hideki , Hayashi Takashi , Fujino Keiichi
Published: September 2016

Chilaiditi syndrome is defined as the interposition of the bowel between the liver and right diaphragm. It is a rare disease and may be difficult to diagnose and manage. Treatment for asymptomatic patients with Chilaiditi is usually conservative and does not require surgical intervention, but surgery may be necessary if conservative treatment fails. This report describes a rare case of Chilaiditi syndrome causing small bowel obstruction and corrected using laparoscopic surgery.
A population‐based study of the comparative effectiveness of second‐generation antipsychotics vs older antimanic agents in bipolar disorder
Authors: Bauer Mark S , Miller Christopher J , Li Mingfei , Bajor Laura A , Lee Austin
Published: September 2016

Objectives

Numerous antimanic treatments have been introduced over the past two decades, particularly second‐generation antipsychotics (SGAs). However, it is not clear whether such newer agents provide any advantage over older treatments.

Methods

A historical cohort design investigated the nationwide population of outpatients with bipolar disorder treated in the Department of Veterans Affairs who were newly initiated on an antimanic agent between 2003 and 2010 (N=27 727). The primary outcome was likelihood of all‐cause hospitalization during the year after initiation, controlling for numerous demographic, clinical, and treatment characteristics. Potential correlates of effect were explored by investigating time to initiation of a second antimanic agent or antidepressant.

Results

After control for covariates, those initiated on lithium or valproate monotherapy, compared to those beginning SGA monotherapy, were significantly less likely to be hospitalized, had a longer time to hospitalization, and had fewer hospitalizations in the subsequent year. Those on combination treatment had a significantly higher likelihood of hospitalization, although they also had a longer time to addition of an additional antimanic agent or antidepressant.

Conclusions

The present analysis of a large and unselected nationwide population provides important complementary data to that from controlled trials. Although various mechanisms may be responsible for the results, the data support the utilization of lithium or valproate, rather than SGAs, as the initial antimanic treatment in bipolar disorder. A large‐scale, prospective, randomized, pragmatic clinical trial comparing the initiation of SGA monotherapy to that of lithium or valproate monotherapy is a logical next step.
Quality of life results from a phase 3 study of brentuximab vedotin consolidation following autologous haematopoietic stem cell transplant for persons with Hodgkin lymphoma
Authors: Ramsey Scott D. , Nademanee Auayporn , Masszi Tamas , Holowiecki Jerzy , Abidi Muneer , Chen Andy , Stiff Patrick , Viviani Simonetta , Sweetenham John W. , Radford John , Zhu Yanyan , Bonthapally Vijayveer , Thomas Elizabeth , Richhariya Akshara , Hunder Naomi N. , Walewski Jan , Moskowitz Craig H.
Published: September 2016

Brentuximab vedotin (BV) significantly improved progression‐free survival in a phase 3 study in patients with relapsed or refractory Hodgkin lymphoma (RR‐HL) post‐autologous‐haematopoietic stem cell transplant (auto‐HSCT); we report the impact of BV on quality of life (QOL) from this trial. The European Quality of Life five dimensions questionnaire was administered at the beginning of each cycle, end of treatment, and every 3 months during follow‐up; index value scores were calculated using the time trade‐off (TTO) method for UK‐weighted value sets. Questionnaire adherence during the trial was 87·5% (N = 329). In an intent‐to‐treat analysis, compared with placebo, TTO scores in the BV arm did not exceed the minimally important difference (MID) of 0·08 except at month 15 (−0·084; 95% confidence interval, −0·143 to −0·025). On‐treatment index scores were similar between arms and did not reach the MID at any time point; mixed‐effect modelling showed that BV treatment effect was not significant (P = 0·2127). BV‐associated peripheral neuropathy did not meaningfully impact QOL. Utility scores for patients who progressed declined compared with those who did not; TTO scores between these patients exceeded the MID beginning at month 15. In conclusion, QOL decreased modestly with BV consolidation treatment in patients with RR‐HL at high risk of relapse after auto‐HSCT.
Total daily fluoride intake and fractional urinary fluoride excretion in 4‐ to 6‐year‐old children living in a fluoridated area: weekly variation?
Authors: Omid Narges , Maguire Anne , O'Hare William T. , Zohoori Fatemeh V.
Published: September 2016

Objectives

Risk of development of dental fluorosis may increase with even a short‐term increase in fluoride (F) intake during tooth formation. Considering the wide variations in F concentrations of different food and drinks, it is important to assess short‐term differences in F intake and consequently fractional urinary F excretion (FUFE) in children, which provide an indication of F body burden. Therefore, the aim of this study was to investigate weekly variation in total daily F intake (TDFI) and its sources and fractional urinary F excretion (FUFE) in 4‐ to 6‐year‐olds living in a fluoridated area in the UK.

Methods

Sixty‐one children were surveyed twice with a 1‐week gap between surveys. Dietary F intake was assessed by ‘food‐diary’ and ‘duplicate‐plate collection’. Toothbrushing expectorate (saliva/toothpaste) was collected to estimate F intake from toothpaste ingestion. TDFI was calculated from dietary F intake and toothpaste ingestion. Daily urinary F excretion (DUFE) was estimated by collecting 24‐h urine samples and FUFE was calculated from DUFE and TDFI [FUFE = (DUFE/TDFI) × 100].

Results

The overall mean TDFI, DUFE and FUFE for all children were 0.056 (SD 0.036) mg/kgbw/day, 0.018 (SD 0.007) mg/kgbw/day and 39 (SD 20)%, respectively. The mean (95% CI) difference between the 2 weeks studied was 0.004 (−0.004, 0.011) mg/kgbw/day for TDFI, 0.002 (−0.001, 0.004) mg/kgbw/day for DUFE and 1 (−6, 8)% for FUFE.

Conclusions

Mean TDFI and FUFE did not vary statistically significantly with week and therefore one set of data collection from a group of children living in a temperate climate could be sufficient to monitor F exposure and F body burden in community prevention programmes for oral health.
A 17‐year experience in perioperative anaphylaxis 1998–2015: harmonizing optimal detection of mast cell mediator release
Authors: Egner W. , Sargur R. , Shrimpton A. , York M. , Green K.
Published: September 2016

Background

Sheffield NARCOS (National Adverse Reactions Advisory Service) investigates suspected perioperative anaesthetic reactions using serial tryptase, urinary methylhistamine (UMH) and clinical information. Further recommendations for additional allergy clinic assessment are provided.

Objective

To establish a robustly measurable protocol for identifying mast cell mediator (MMR) release in this cohort. To compare these thresholds with previously suggested thresholds and algorithms.

Method

A review of 3455 NARCOS cases referred with a suspected perioperative allergic reaction. Tryptase, UMH and clinical details were analysed. A total of 1746 cases were graded using the Ring and Messmer scale. Reaction grade, tryptase and UMH changes were compared with statistical and graphical presentations appropriate to non‐normally distributed measurements using Analyse‐IT software.

Results

Sensitive strategies such as 3 μg/L or 20% are measurable and translatable and would substantially increase detection of potentially relevant changes in tryptases. Adequate quality assurance for low‐level measurement is needed. An incremental threshold of 20% would identify potential MMR in an additional 14% of cases with peak tryptase (Tp) between 5 and 14 μg/L and a further 15% with Tp below 5 μg/L. Further work is required to establish the diagnostic performance characteristics of this more sensitive approach. UMH also identified up to 120 further cases of potential MMR in the absence of tryptase increments.

Conclusions and Clinical Relevance

Future studies should establish and compare the predictive performance characteristics of each strategy against clinical phenotypes. A single agreed definition of positive serial tryptases is needed to enable robust evaluation of diagnostic strategies. This could serve as a harmonized standard for comparative studies of case series from different centres.
On Taxonomy and Evaluation of Feature Selection‐Based Learning Classifier System Ensemble Approaches for Data Mining Problems
Authors: Debie Essam , Shafi Kamran , Merrick Kathryn , Lokan Chris
Published: September 2016

Ensemble methods aim at combining multiple learning machines to improve the efficacy in a learning task in terms of prediction accuracy, scalability, and other measures. These methods have been applied to evolutionary machine learning techniques including learning classifier systems (LCSs). In this article, we first propose a conceptual framework that allows us to appropriately categorize ensemble‐based methods for fair comparison and highlights the gaps in the corresponding literature. The framework is generic and consists of three sequential stages: a pre‐gate stage concerned with data preparation; the member stage to account for the types of learning machines used to build the ensemble; and a post‐gate stage concerned with the methods to combine ensemble output. A taxonomy of LCSs‐based ensembles is then presented using this framework. The article then focuses on comparing LCS ensembles that use feature selection in the pre‐gate stage. An evaluation methodology is proposed to systematically analyze the performance of these methods. Specifically, random feature sampling and rough set feature selection‐based LCS ensemble methods are compared. Experimental results show that the rough set‐based approach performs significantly better than the random subspace method in terms of classification accuracy in problems with high numbers of irrelevant features. The performance of the two approaches are comparable in problems with high numbers of redundant features.
The learning curves in living donor hemiliver graft procurement using small upper midline incision
Authors: Ikegami Toru , Harimoto Norifumi , Shimokawa Masahiro , Yoshizumi Tomoharu , Uchiyama Hideaki , Itoh Shinji , Okabe Norihisa , Sakata Kazuhito , Nagatsu Akihisa , Soejima Yuji , Maehara Yoshihiko
Published: September 2016

The learning curve for performing living donor hemiliver procurement (LDHP) via small upper midline incision (UMI) has not been determined. Living donors (n=101) who underwent LDHP via UMI were included to investigate the learning curve using cumulative sum analysis. The cumulative sum analysis showed that nine cases for right lobe (case #23) and 19 cases for left lobe (case #32 in the whole series) are needed for stable and acceptable surgical outcomes in LDHP via UMI. The established phase (n=69, since case #33) had a significantly shorter operative time, a smaller incision size, and less blood loss than the previous learning phase (n=32, serial case number up to the last 19th left lobe case). Multivariate analysis showed that the learning phase, high body mass index ≥25 kg/m2, and left lobe graft procurement are the factors associated with surgical events including operative blood loss ≥400 mL, operative time ≥300 minutes, or surgical complications ≥Clavien‐Dindo grade II. There is an obvious learning curve in performing LDHP via UMI, and 32 cases including both 19 cases for left lobe and nine cases for right lobe are needed for having stable and acceptable surgical outcomes.
Preformed donor‐specific HLA antibodies are associated with increased risk of early mortality after liver transplantation
Authors: McCaughan Jennifer A. , Robertson Victoria , Falconer Stuart J. , Cryer Claire , Turner David M. , Oniscu Gabriel C.
Published: September 2016

There is limited evidence for a negative impact of preformed, donor‐specific HLA antibodies (DSA) identified by cross‐matching on outcomes after liver transplantation. Three recent studies have suggested an association between preformed DSA detected by Luminex and reduced graft or recipient survival in liver transplant cohorts with a high prevalence of hepatitis C. This study investigated the impact of preformed DSA identified by Luminex in the Scottish liver transplant population. All recipients of liver transplants in Scotland between 2007 and 2015 with samples available for day of transplant antibody testing and donor HLA typing were included (n=459); 96% of the cohort were white and 19% had a primary diagnosis of hepatitis C. The median follow‐up time was 36 months. Preformed DSA were detected in 88 recipients. In multivariate analysis, preformed DSA with a median fluorescent intensity ≥10 000 were associated with recipient mortality at 1 year. There was no association between DSA and overall graft or recipient survival. This study adds to the growing body of evidence supporting a detrimental impact of preformed, high‐level DSA in a subset of liver transplant recipients by identifying an association in an ethnically and demographically distinct liver transplant population.
Immunohistochemical markers for hepatocellular carcinoma prognosis after liver resection and liver transplantation
Authors: Lee Soo‐Ho , Lee Jun‐Suh , Na Gun‐Hyung , You Young‐Kyoung , Kim Dong‐Goo
Published: September 2016

Aim

There were differences in progression and prognosis of hepatocellular carcinoma (HCC) after surgery between liver resection (LR) and liver transplantation (LT). In this study, immunohistochemical (IHC) markers associated with the prognosis of HCC were assessed.

Methods

Data were collected from 167 patients who underwent LT (n=41) or LR (n=126) for HCC. IHC markers including alpha‐fetoprotein (AFP), p53, Ki‐67, cytokeratin 7 (CK7), and cytokeratin 19 (CK19) were compared between the treatment methods in tumor tissue.

Results

AFP‐ and p53‐negative patients had a significantly higher survival rate than AFP‐ and p53‐positive patients (AFP: disease‐free survival [DFS] P=.006, overall survival [OS] P=.016; p53: DFS P=.005, OS P=.038) in the LR group. CK19 was related to DFS (P=.005), while CK7 (P=.014) and CK19 (P=.06) were related to OS in the LT group. When we combined factors that were significant in both groups (LR: AFP and p53, LT: CK7 and CK19), all‐negative patients had a higher survival rate (LR: DFS P=.025, OS P=.043, LT: DFS P=.034, OS P=.008).

Conclusion

p53 and AFP were predictors for poor prognosis of HCC after LR; CK7 and CK19 could be predictors for poor prognosis of patients with HCC after LT.
Is universal antifungal prophylaxis mandatory in adults after lung transplantation? A review and meta‐analysis of observational studies
Authors: Pilarczyk Kevin , Haake Nils , Heckmann Jens , Carstens Henning , Haneya Assad , Cremer Jochen , Jakob Heinz , Pizanis Nikolaus , Kamler Markus
Published: September 2016

Background

Lung transplant (LTX) recipients are at high risk of invasive Aspergillus infections (IAI). However, no randomized‐controlled trials (RCT) or international guidelines on antifungal prophylaxis (AFP) in the LTX population exist.

Methods

A meta‐analysis was performed to determine whether AFP reduces the rate of IAI after LTX. A total of six eligible observational studies (five with no prophylaxis, one with targeted prophylaxis, three studies including heart/lung transplantation) with a total of 748 patients were included.

Results

The pooled odds ratio (OR) for IAI (62 IFI in the intervention arm and 82 in the control group) was 0.234 (95% confidence interval [CI] 0.097‐0.564, P=0.001, z=−3.237). Pooled studies were characterized by substantial heterogeneity (I2=66.64%); number needed to treat was 6.8. A subgroup analyses with exclusion of heart transplant recipients also showed a statistically significant reduction in IAI with AFP (OR 0.183, 95% CI 0.0449‐0.744, P=0.018).

Conclusion

This study suggests that universal antifungal prophylaxes reduces incidence of IAI after LTX. However, included studies are limited by small sample size, single‐center structure without randomization, mixed population (including heart/heart‐lung transplant), and heterogeneity due to variations in immunosuppression, type, and duration of AFP. Therefore, there is a clear need for an adequately powered RCT.
The ‘Morph'ology of cytotechnology education
Authors: Donnelly A.
Published: September 2016

‘Morph’ means to change gradually and completely from one thing into another usually in a way that is surprising or seems magical. How can cytotechnology education be morphed into an expanded curriculum to teach new skills for advanced practice? The challenges cytotechnology programmes are facing today are many. The biggest of these challenges is the decreasing volume of Pap tests. Pap tests have been our ‘bread and butter’ throughout history; however, advances in health care and technology are inevitable, thus requiring changes in our educational practices. While these challenges seem insurmountable, we have the ability to expand the field of cytotechnology by taking advantage of existing opportunities. One example of these opportunities is performing rapid on site evaluation (ROSE) for specimen adequacy and perhaps taking it one step further by giving a preliminary diagnosis as a billable procedure. Now is the time to take gradual steps towards change in the current practice of cytotechnology. Let's join together and make the journey surprising and magical.
Guidance on liquid‐based cytology system conversion training: a secondary publication
Authors: Wilson A.
Published: September 2016

National cervical screening programmes are considering a move to HPV primary screening. HPV testing requires the cervical sample to be placed in liquid based cytology (LBC) media and the triage cytology test will be carried out using LBC preparations. The resources required for conversion training from conventional smears to LBC should not be underestimated as errors can be made without the use of a structured training plan and monitoring of performance. In the UK, many labs have converted between the two main LBC technologies, Thinprep and Surepath. The same logic apples: all staff including primary screeners and cytopathologists must undergo a structured conversion course with clear and measurable outcomes to ensure the competence of all staff before going “live” with the new technology. It is expected that conversion training will take approximately 39 hrs and a minimum of 95% high grade sensitivity and 70% specificity must be achieved.
Usefulness of bubble study in echocardiographic diagnosis of contained rupture of hydatid cyst in the right ventricular outflow tract
Authors: Singh Amitoj , Sharma Ravindra , Garg Ashok , Nanda Navin C. , Elsayed Mahmoud , Taher Ahmed , Bulur Serkan
Published: September 2016

We describe an adult female presenting with dyspnea in whom both transthoracic and transesophageal echocardiography detected a mobile sac‐like structure in the right ventricular outflow tract (RVOT) containing a heterogenous echogenic mass. This sac‐like structure markedly changed its shape and size during the cardiac cycle. These findings and the fact that the patient lived in a rural area raised the possibility that this was a hydatid cyst. A bubble study using normal saline was useful in detecting a contained rupture of the cyst. Bubble echoes were noted within the sac‐like structure but did not penetrate the inner wall of the cyst which contained echogenic material, indicating that the rupture was confined only to the outer layers. At surgery, a 0.5 cm communication was noted between the cyst and the RVOT and pathology confirmed the diagnosis of hydatid cyst.
Mating disruption method against the vine mealybug, Planococcus ficus: effect of sequential treatment on infested vines
Authors: Sharon Rakefet , Zahavi Tirtza , Sokolsky Tamar , Sofer‐Arad Carmit , Tomer Maor , Kedoshim Rika , Harari Ally R.
Published: September 2016

The vine mealybug, Planococcus ficus (Signoret) (Hemiptera: Pseudococcidae), is a major pest of vineyards. Here, we tested the efficacy of the mating disruption method against the pest when applied during one or two successive years in high and low infestation levels. Following 1 year of treatment, at low initial infestation levels a shutdown of pheromone traps was observed, along with a significant reduction in infested vines. With initially high infestation levels, a gradual reduction in infested vines was observed, with a trap shutdown seen only after the second year of pheromone application. We discuss the implications of the male mating disruption method for this pest in which the wingless females are aggregated with limited movement among vines, offering multiple mating opportunities for the flying male.
Does the host's developmental stage affect host preference following an ovipositioning experience in Heterospilus prosopidis?
Authors: Sasakawa Kôji , Abe Masato S. , Shimada Masakazu
Published: September 2016

Many parasitoid wasps exhibit ‘oviposition learning,’ whereby females associate host‐related cues with oviposition and use them in subsequent searches for hosts. This is affected by various factors that have yet to be fully elucidated. We examined the effects of host developmental stage on oviposition learning in parasitoid wasps that utilize both larval and pupal hosts using Heterospilus prosopidis Viereck (Hymenoptera: Braconidae), an ectoparasitoid of Bruchinae beetles (Coleoptera: Chrysomelidae), as a model. First, we examined whether the induction of host species preference differs between oviposition on larval and pupal hosts. Oviposition choice experiments were performed for both larval and pupal hosts using two equally preferred host species – Callosobruchus chinensis (L.) and Callosobruchus maculatus (Fabricius) – and wasps that were conditioned by an oviposition experience on either of the two host species. We found an induction of host species preference in wasps conditioned with pupal hosts but not in wasps conditioned with larval hosts. Next, we examined whether the induced preference was host‐stage‐specific. Oviposition experiments with pupal‐host‐conditioned wasps and larval hosts as choice hosts indicated that learned cues were not used when searching for larval hosts. Similar results were obtained for larval‐host‐conditioned wasps. We compared oviposition behavior on larval and pupal hosts but found no behavioral differences that could contribute to the observed difference in host preference induction. Our results indicate that larval and pupal hosts have different effects on host preference following an oviposition experience in H. prosopidis, although the detailed mechanisms remain unclear. These findings are notable because in parasitoid wasps that utilize both larval and pupal hosts, host developmental stages have attracted little attention as factors affecting oviposition learning.
From Hard to Soft Governance in Multi‐level Education Systems
Authors: Wilkoszewski Harald , Sundby Eli
Published: September 2016

Decision‐making in educations systems has become more complex: while decentralisation has moved the locus of power to lower governance levels, the central level still is held responsible for the quality of outcomes. As a consequence, new steering strategies have emerged that tend to apply softer modes of governance as opposed to harder ones in the past. This article aims at shedding empirical and conceptual light on these new developments. It compares two national examples for soft modes of governance with a supra‐national one (the EU's Open Method of Co‐ordination OMC) and argues that OMC might be both a useful analytical lens to categorise new steering mechanisms and a possibly promising policy strategy at the national level.
Introduction bias affects relationships between the characteristics of ornamental alien plants and their naturalization success
Authors: Maurel Noëlie , Hanspach Jan , Kühn Ingolf , Pyšek Petr , van Kleunen Mark
Published: September 2016

Aim

Alien plants with certain characteristics may have been introduced earlier and more frequently than others. Such introduction bias may cause spurious associations between plant characteristics and naturalization (the establishment of self‐sustaining populations in the wild). We aimed to disentangle direct and indirect (i.e. mediated by introduction history) effects of species characteristics on the naturalization success of alien plants introduced for horticulture.

Location

Germany (non‐native range); rest of the world (native range).

Methods

We compiled a dataset of 435 alien plant species introduced in cultivation in Germany, including data on their year of introduction, the number of botanical gardens where they are planted, native range, biological traits and naturalization success. We used path analysis to estimate the direct effects of geographical origin and biological traits on naturalization, and their indirect effects mediated by year and/or frequency of introduction.

Results

We found significant direct positive effects of native range size and winter hardiness on naturalization. Alien species native to other parts of Europe and species with a large native range were brought to the country earlier than other species. In addition, woody species, winter‐hardy species and tall species were planted more frequently than others. Because the number of botanical gardens where a species is planted increased naturalization success directly, and residence time did so indirectly through a significant positive association with the number of botanical gardens, most of the species characteristics had indirect effects on naturalization.

Main conclusions

Our approach allowed us to show that apparent effects of species characteristics on naturalization success can be at least partly indirect, due to introduction biases. This indicates that failure to recognize such introduction biases could impair our ability to explain the success of alien plant species.
Low‐literate consumers' use of clothing labels amidst personal and product related challenges
Authors: van Staden Hanlie , van der Merwe Daleen , van Aardt Annette , Ellis Susanna
Published: September 2016

Low‐literate consumers experience various challenges in the marketplace. This quantitative study focused on low‐literate female consumers' use of clothing labels amidst personal and product‐related challenges in the marketplace. An interviewer‐administered questionnaire was used among black African female consumers (n = 450) with literacy levels ranging from Grades 5 to 8 (on average, 11–14 years old), residing in the Emfuleni Local Municipality area, Gauteng, South Africa. Personal challenges experienced involved reading and numeracy skills, as well as concrete and pictographic thinking. Although respondents indicated that they read and understand clothing labels, results revealed problems experienced when attempting to use the information provided. Their numeracy skills were average and related abstract thinking skills were fair. Product‐related challenges were related to the format of labels, care‐label knowledge and evaluation of clothing quality. Respondents' preference for symbolic and graphic presentation of size format provided evidence of pictographic thinking. Care label understanding was poor, and clothing products were evaluated concretely. Some of the older respondents were inclined to follow the peripheral route of elaboration when reading clothing‐label information. We conclude that low‐literate consumers' use of clothing label information can improve if provided in a format that they can read and understand.
Egg utilization and consumer acceptability of egg dishes prepared with commercial egg powder in rural Mkhambathini, South Africa
Authors: Ntila Sithandiwe , Kolanisi Unathi , Siwela Muthulisi
Published: September 2016

Eggs have a potential to alleviate protein‐energy malnutrition among rural communities. Unfortunately, eggs are perishable and most rural communities in South Africa have very limited access to effective food storage and preservation facilities. Utilization of eggs by rural households could increase if they were available in the form of egg powder, which is convenient and shelf‐stable. However, rural communities in South Africa are not familiar with egg powder and therefore it is not known whether it would be acceptable to them. The aim of the current study was to explore the utilization of eggs by rural households of Mkhambathini, South Africa, and assess the potential for using egg powder in popular egg dishes. A total of 110 household representatives completed a survey questionnaire, 50 participated in focus group discussions and 51 in sensory evaluation of egg dishes (sandwich and relish) prepared with commercial egg powder. The households perceived eggs as an important, nutritious food, but cultural beliefs, ineffective storage facilities, and limited market access restricted their utilization. Results of sensory evaluation showed that the acceptability of the egg powder dishes was similar to that of their fresh egg counterparts. Overall, the study demonstrates that there is a great potential for rural households to replace fresh egg dishes with egg powder dishes.