bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital uni‐leaflet mitral valve with severe stenosis: A case report with literature review
Authors: Zhang Weixin , Wang Yonghuai , Ma Chunyan , Zhang Zhiwei , Yang Jun
Published: February 2017

Numerical abnormalities of mitral leaflets is a special entity in congenital mitral malformations. Previously reported cases of uni‐leaflet mitral valve were primarily related to absence or dysplasia of certain leaflets. We present a case here with mitral leaflets that were not divided into anterior and posterior as usual, but developed as an integral structure instead, which is different from previously documented cases of uni‐leaflet mitral valves. Real time three‐dimensional echocardiography (RT3DE) provides a visual presentation of the abnormal mitral structure which was confirmed by surgical operation. To the best of our knowledge, this unusual form of uni‐leaflet mitral valve has not been reported yet.
Benign mitochondrial myopathy with exercise intolerance in a large multigeneration family due to a homoplasmic m.3250T>C mutation in MTTL1
Authors: Darin N. , Hedberg‐Oldfors C. , Kroksmark A.‐K. , Moslemi A.‐R. , Kollberg G. , Oldfors A.
Published: February 2017

Background and purpose

Most mitochondrial disorders with onset in early childhood are progressive and involve multiple organs. The m.3250T>C mutation in MTTL1 has previously been described in a few individuals with a possibly riboflavin‐responsive myopathy and an association with sudden infant death syndrome was suspected. We describe a large family with this mutation and evaluate the effect of riboflavin treatment.

Methods

Medical data were collected with the help of a standardized data collection form. Sanger sequencing was used to screen for variants in mitochondrial DNA and the proportion of the mutation was analyzed in different tissues. Biochemical and muscle morphological investigations of muscle tissue were performed in two individuals. The effect of riboflavin treatment was evaluated in two individuals.

Results

Thirteen family members experienced exercise intolerance with fatigue and weakness. Inheritance was maternal with 100% penetrance. The course was either static or showed improvement over time. There was no evidence of other organ involvement except for a possible mild transient cardiac enlargement in one child. Muscle investigations showed isolated complex I deficiency and mitochondrial proliferation. The level of m.3250T>C was apparently 100%, i.e. homoplasmic, in all examined tissues. Riboflavin treatment showed no effect in any treated family member and there have been no cases of sudden infant death in this family.

Conclusions

This study illustrates the importance of considering mitochondrial disorders in the work‐up of individuals with exercise intolerance and provides a better understanding of the phenotype associated with the m.3250T>C mutation in MTTL1.
People with epilepsy obtain added value from education in groups: results of a qualitative study
Authors: Ridsdale L. , Philpott S. J. , Krooupa A.‐M. , Morgan M.
Published: February 2017

Background and purpose

Having epilepsy requires individuals to learn about self‐management. So far, trials of self‐management courses have not included in‐depth qualitative evaluations of how the learning method influences participants’ perceptions and behaviour. We aimed to interview participants who had attended a course, as part of a randomized controlled trial, to examine: (i) their perceptions of what they valued and negative aspects of the intervention, and (ii) whether and in what ways they continued to make use of the training.

Methods

Twenty participants were selected within 6 months of undertaking a course from the larger randomized controlled trial conducted in England. Semi‐structured interviews were based on a topic guide.

Results

Participants’ characteristics were representative of the clinical and demographic characteristics of the trial group. Their mean age was 44 years, half were male, and three‐quarters had had epilepsy for over 10 years and had experienced one or more seizures in the previous month. Participants valued the opportunity to meet ‘people like them’. Structured learning methods encouraged them to share and compare feelings and experience. Specific benefits included: overcoming the sense of ‘being alone’ and improving self‐acceptance through meeting people with similar experience. Over half reported that this, and comparison of attitudes and experience, helped them to improve their confidence to talk openly, and make changes in health behaviours.

Conclusions

People feel socially isolated in long‐term poorly controlled epilepsy. They gain confidence and self‐acceptance from interactive groups. Expert‐facilitated courses that encourage experiential learning can help people learn from each other, and this may enhance self‐efficacy and behaviour change.
Evaluation of observer‐ and industry‐based catch data in a recreational charter fishery
Authors: Gray C. A. , Kennelly S. J.
Published: February 2017

There is international recognition for greater inclusion of recreational fisheries catch data in species, fisheries and ecosystem assessments. Recreational charter fisheries provide important social services and contribute to total species catches. This study compares and validates industry logbook catch and effort data (1,357 trips) against observer data (154 trips) across six ports in a recreational charter fishery in eastern Australia. The mean numbers of clients and fishing effort (hours) per trip varied inconsistently between data sources and among ports. Logbooks did not adequately report released catches, and the mean number of species retained per trip was consistently underestimated in logbooks compared to observer data. For both data sources, catch rates of total individuals and key species displayed similar trends across different units of effort; catch per hour, client, client/hour and trip. The mean catch rates of total individuals and most key species, except those retained for bait, were similar across data sources, as were estimates of total fleet harvests. The length compositions of retained catches of some key species displayed truncation of larger organisms in the observer data whereas other species did not. Despite the shortcomings of the logbook data, future fishery and species monitoring strategies could include industry and observer data sources.
Cost‐effectiveness analysis of late prophylaxis vs. on‐demand treatment for severe haemophilia A in Italy
Authors: Coppola A. , D'Ausilio A. , Aiello A. , Amoresano S. , Toumi M. , Mathew P. , Tagliaferri A. ,   the Potter Study Group
Published: February 2017

Introduction

Long‐term regular administrations of factor VIII (FVIII) concentrate (prophylaxis) initiated at an early age prevents bleeding in patients with severe haemophilia A (HA). The 5‐year prospective Italian POTTER study provided evidence of benefits in adolescents and adults of late prophylaxis (LP) vs. on‐demand therapy (OD) in reducing bleeding episodes and joint morbidity and improving quality of life; however, costs were increased.

Aim

The aim of this study was to determine the cost‐effectiveness of LP vs. OD with sucrose‐formulated recombinant FVIII in adolescents and adults with severe HA in Italy.

Methods

A Markov model evaluated lifetime cost‐effectiveness of LP vs. OD in patients with severe HA in Italy, from both the healthcare and societal perspectives. Clinical input parameters were taken from the POTTER study and published literature. Health utility values were assigned to each health state as measured by the joint disease severity Pettersson score. Costs were expressed in Euro (€) 2014, including drug and other medical costs. Sensitivity analyses were performed considering societal perspective (including productivity lost) and varying relative risk of bleeding episodes between regimens. Clinical outcomes and costs were discounted at 6% according to previous studies.

Results

Lifetime incremental discounted quality‐adjusted life‐years (QALYs) were +4.26, whereas incremental discounted costs were +€229,694 from a healthcare perspective, with estimated incremental cost‐effectiveness ratios (ICERs) equal to €53,978/QALY. Sensitivity analyses confirmed the base‐case results showing lower ICERs with the societal perspective.

Conclusion

Late prophylaxis vs. on‐demand therapy results in a cost‐effective approach with ICERs falling below the threshold considered acceptable in Italy.
No evidence of a role for mitochondrial complex I in Helicobacter pylori pathogenesis
Authors: Ng Garrett Z. , Ke Bi‐Xia , Laskowski Adrienne , Thorburn David R. , Sutton Philip
Published: February 2017

Background

Complex I is the first enzyme complex in the mitochondrial respiratory chain, responsible for generating a large fraction of energy during oxidative phosphorylation. Recently, it has been identified that complex I deficiency can result in increased inflammation due to the generation of reactive oxygen species by innate immune cells. As a reduction in complex I activity has been demonstrated in human stomachs with atrophic gastritis, we investigated whether complex I deficiency could influence Helicobacter pylori pathogenesis.

Materials and Methods

Ndufs6gt/gt mice have a partial complex I deficiency. Complex I activity was quantified in the stomachs and immune cells of Ndufs6gt/gt mice by spectrophotometric assays. Ndufs6gt/gt mice were infected with H. pylori and bacterial colonization assessed by colony‐forming assay, gastritis assessed histologically, and H. pylori ‐specific humoral response quantified by ELISA.

Results

The immune cells and stomachs of Ndufs6gt/gt mice were found to have significantly decreased complex I activity, validating the model for assessing the effects of complex I deficiency in H. pylori infection. However, there was no observable effect of complex I deficiency on either H. pylori colonization, the resulting gastritis, or the humoral response.

Conclusions

Although complex I activity is described to suppress innate immune responses and is decreased during atrophic gastritis in humans, our data suggest it does not affect H. pylori pathogenesis.
Losing Hope: Injustice and Moral Bitterness
Authors: Stockdale Katie
Published: February 2017

In this article, I defend a conception of bitterness as a moral emotion and offer an evaluative framework for assessing when instances of bitterness are morally justified. I argue that bitterness is a form of unresolved anger involving a loss of hope that an injustice or other moral wrong will be sufficiently acknowledged and addressed. Orienting the discussion around instances of bitterness in response to social and political injustices, I argue that bitterness is sometimes morally justified even if it is ultimately undesirable to bear. I then suggest that focusing only on the harms and risks of bitterness can distract from its positive role as a moral reminder about a past or persistent injustice, indicating that there is still moral and often political work left to do. Finally, I address the concern that bearing bitterness may lead to despair and inaction. I respond by arguing that moral agents can and do persist in their moral and political struggles with bitterness, and without hope that their efforts will be successful.
Epistemic Injustice and Resistance in the Chiapas Highlands: The Zapatista Case
Authors: Gallegos Sergio , Quinn Carol
Published: February 2017

Though Indigenous women in Mexico have traditionally exhibited some of the highest levels of maternal mortality in the country—a fact that some authors have argued was an important reason to explain the EZLN uprising in 1994—there is some evidence that the rate of maternal mortality has fallen in Zapatista communities in the Chiapas Highlands in the last two decades, and that other health indicators have improved. In this article, we offer an account of the modest success that Zapatista communities have achieved in improving their health levels. In particular, we argue that Zapatista women have implicitly used a form of feminist standpoint theory to diagnose the epistemic (and economic) injustice to which they have been traditionally subjected and to develop an epistemology of resistance that is manifested in actions such as becoming health promoters in their communities. We also argue that this epistemology of resistance is partially responsible for the improvement of health levels in their communities. Finally, on the basis of our discussion of the Zapatista case, we suggest that standpoint theory could play an important role in other healthcare settings involving oppressed minorities.
Personal Autonomy, Social Identity, and Oppressive Social Contexts
Authors: Johnston Rebekah
Published: February 2017

Attempts to articulate the ways in which membership in socially subordinated social identities can impede one's autonomy have largely unfolded as part of the debate between different types of internalist theories in relation to the problem of internalized oppression. The different internalist positions, however, employ a damage model for understanding the role of social subordination in limiting autonomy. I argue that we need an externalist condition in order to capture the ways in which membership in a socially subordinated identity can constrain one's autonomy, even if one is undamaged in one's autonomy competencies and self‐reflexive attitudes. I argue that living among those practically empowered to harass, to engage in racial profiling, and to treat as expendable is incompatible with a freedom‐condition required for unconstrained global self‐determination.
Thyrotropin receptor gene expression in the association between chronic spontaneous urticaria and Hashimoto's thyroiditis
Authors: Silvares Maria R. C. , Fortes Maria R. P. , Nascimento Renata de A. M. L. , Padovani Carlos R. , Miot Hélio A. , Nogueira Célia R. , Mazeto Gláucia M. F. da S.
Published: February 2017

Background

Chronic spontaneous urticaria (CSU) may be associated with autoimmune thyroid diseases, and the Autologous Serum Skin Test (ASST) is an autoreactivity marker. The thyrotropin (TSH) and TSH receptor (TSHR) could play a role in the pathogenesis of CSU. The aim of this study was to evaluate ASST positivity and TSHR gene expression in healthy skin and ASST wheals in euthyroid women with CSU, with (14 patients) and without (15 patients) Hashimoto's thyroiditis (HT).

Methods

ASST was performed and TSHR gene expression studied in wheals induced by ASST and in healthy skin.

Results

ASST presented greater positivity (86% × 40%) and larger diameter (10.8 × 9.6 mm) in the HT group (P < 0.05). TSHR gene expression was higher in the ASST area and healthy skin of HT group (P < 0.01). Positive correlation of antibodies levels with ASST wheal measurements and TSHR gene expression was seen.

Conclusions

Women with CSU and HT presented greater positivity and larger measurements for ASST and higher TSHR expression in the skin, suggesting association between CSU, thyroid autoimmunity, and TSHR.
Opening new horizons in regenerative dermatology using platelet‐based autologous therapies
Authors: Anitua Eduardo , Pino Ander , Orive Gorka
Published: February 2017

Biological therapeutic therapies are gaining the attention of scientists and medical doctors. Accumulating evidence suggests that blood‐derived autologous therapies are safe and effective treatments for skin repair and wound healing. The fibrin network formed after plasmatic activation and the autologous growth factors released when platelets degranulate constitute a real biological medicine that has been shown to promote cell recruitment, stimulate new blood vessel formation, reduce inflammation as well as protect from local infections. This perspective highlights recent basic and clinical results published on blood‐derived autologous therapies in the field of regenerative dermatology and discusses potential challenges and future prospects.
A functional variant of miRNA‐149 confers risk for allergic rhinitis and comorbid asthma in Chinese children
Authors: Hu D. , Zhang Z. , Ke X. , Kang H. , Hong S.
Published: February 2017

The prevalence of allergic rhinitis (AR) and asthma has been increasing, and the comorbidity rates of these diseases are very high. Here, 176 AR patients, 124 patients with comorbid AR and asthma (AR‐A) and 206 healthy Chinese children as controls were included in a case–control study. Six single‐nucleotide polymorphisms (SNPs), miR‐146a (rs2910164, rs57095329 and rs6864584), miR‐196a2 (rs11614913), miR‐499 (rs3746444) and miR‐149 (rs2292832), were genotyped. The prevalence of homozygous miR‐149 (rs2292832) CC genotype and C allele were considerably increased in AR and AR‐A patients, compared with the controls. AR‐A group showed higher frequencies of CC genotype and C allele of rs2292832 than AR group. No significant difference in the genotypic and allelic frequencies of other miRNA SNPs was found between the groups. MiR‐149 levels in peripheral blood mononuclear cells (PBMCs) were significantly lower in CC (variant type) cases compared with TT (wild‐type) cases. In further experiments, PBMCs obtained from the healthy controls with CC, CT and TT genotypes were stimulated by house dust mite extracts, which led to a significant decrease in the levels of miR‐149 in PBMCs obtained from CC and TT individuals. This decrease was more pronounced in CC compared with TT cases. Our results demonstrate that miR‐149 rs2292832 variant is not only strongly associated with AR and AR‐A, but it may lead to an increase in the susceptibility to allergies following the stimulation with an allergen, through the changes in miR149 expression. Additionally, AR patients with CC genotypes were shown to be more susceptible to asthma.
Information supply chain optimization with bandwidth limitations
Authors: Hirsch Michael J. , Ortiz‐Peña Héctor
Published: February 2017

Workflow management systems allow for visibility, control, and automation of many business processes. Recently, nonbusiness domains have taken an interest in the management of workflows, and the optimal assignment and scheduling of workflow tasks to users across a network. This research aims at developing a rigorous mathematical programming formulation of the workflow optimization problem. The resulting formulation is nonlinear, but a linearized version is produced. Three heuristics are developed to find solutions efficiently. Computational experiments are presented and analyzed, comparing solutions to the original linearized formulation with the three heuristics.
Natural Duties of Justice in a World of States
Authors: Meckled‐García Saladin
Published: February 2017

The agency objection to applying distributive justice globally is that principles of distributive justice need to apply to the behaviour of a special kind of institutional agent of distributive justice because of the special powers of that agent. No such agent exists capable of configuring cooperative arrangements between all persons globally, and so distributive justice does not apply globally. One response to institutional views of this kind is that they do not rule out Natural Duties of Justice that fall on all of us to bring about institutional agencies capable of global distributive justice. In this article I argue that this move presupposes a particular, teleological, conception of justice whilst institutional accounts most plausibly rest on a non‐teleological one. I provide an argument for favouring the non‐teleological conception. I also show why alternative ways of arguing for global Natural Duties of Justice do not get around this controversy. The debate is at the level of presuppositions about justice, and relying on a partisan conception is question begging.
Significant Discrepancy Between Estimated and Actual Longevity in St. Jude Medical Implantable Cardioverter‐Defibrillators
Authors: DOPPALAPUDI HARISH , BARRIOS JAMES , CUELLAR JOSE , GANNON MELANIE , YAMADA TAKUMI , KUMAR VINEET , MADDOX WILLIAM R. , PLUMB VANCE J. , BROWN TODD M. , MCELDERRY H TOM
Published: February 2017

Discrepancy in Longevity Estimation in SJM ICDs

Background

Real‐time estimated longevity has been reported in pacemakers for several years, and was recently introduced in implantable cardioverter‐defibrillators (ICDs).

Objective

We sought to evaluate the accuracy of this longevity estimate in St. Jude Medical (SJM) ICDs, especially as the device battery approaches depletion.

Methods

Among patients with SJM ICDs who underwent generator replacements due to reaching elective replacement indicator (ERI) at our institution, we identified those with devices that provided longevity estimates and reviewed their device interrogations in the 18 months prior to ERI. Significant discrepancy was defined as a difference of more than 12 months between estimated and actual longevity at any point during this period.

Results

Forty‐six patients with Current/Promote devices formed the study group (40 cardiac resynchronization therapy [CRT] and 6 single/dual chamber). Of these, 34 (74%) had significant discrepancy between estimated and actual longevity (28 CRT and all single/dual). Longevity was significantly overestimated by the device algorithm (mean maximum discrepancy of 18.8 months), more in single/dual than CRT devices (30.5 vs. 17.1 months). Marked discrepancy was seen at voltages ≥2.57 volts, with maximum discrepancy at 2.57 volts (23 months). The overall longevity was higher in the discrepant group of CRT devices than in the nondiscrepant group (67 vs. 61 months, log‐rank P = 0.03).

Conclusions

There was significant overestimation of longevity in nearly three‐fourths of Current/Promote SJM ICDs in the last 18 months prior to ERI. Longevity estimates of SJM ICDs may not be reliable for making clinical decisions on frequency of follow‐up, as the battery approaches depletion.
Sestrin 1 ameliorates cardiac hypertrophy via autophagy activation
Authors: Xue Ruicong , Zeng Junyi , Chen Yili , Chen Cong , Tan Weiping , Zhao Jingjing , Dong Bin , Sun Yu , Dong Yugang , Liu Chen
Published: February 2017

Cardiac hypertrophy is one of the major risk factors of cardiovascular morbidity and mortality. Autophagy is acknowledged to be an important mechanism regulating cardiac hypertrophy. Sestrin 1, a downstream target gene of p53, has been proven to regulate autophagy. However, the role of Sestrin 1 in cardiac hypertrophy remains unknown. Our study showed that Sestrin 1 mRNA and protein expression declined in pressure overload cardiac hypertrophy and phenylephrine (PE)‐induced cardiac hypertrophy. Knockdown of Sestrin 1 by RNAi deteriorated PE‐induced cardiac hypertrophy, whereas the overexpression of Sestrin 1 by adenovirus transfection blunted hypertrophy. We discovered that knockdown of Sestrin 1 resulted in impaired autophagy while overexpression of Sestrin 1 resulted in increased autophagy without affecting lysosomal function. In addition, the antihypertrophic effect of Sestrin 1 overexpression was eliminated by autophagy blockade. Importantly, Sestrin 1 targets at the AMPK/mTORC1/autophagy pathway to inhibit cardiac hypertrophy by interaction with AMPK which is responsible for autophagy regulation. Taken together, our data indicate that Sestrin 1 regulates AMPK/mTORC1/autophagy axis to attenuate cardiac hypertrophy.
Long‐term Metformin Therapy and Monitoring for Vitamin B12 Deficiency Among Older Veterans
Authors: Kancherla Vijaya , Elliott John L. , Patel Birju B. , Holland N. Wilson , Johnson Theodore M. , Khakharia Anjali , Phillips Lawrence S. , Oakley Godfrey P. , Vaughan Camille P.
Published: February 2017

Objective

To examine the association between long‐term metformin therapy and serum vitamin B12 monitoring.

Design

Retrospective cohort study.

Setting

A single Veterans Affairs Medical Center (VAMC), 2002–2012.

Participants

Veterans 50 years or older with either type 2 diabetes and long‐term metformin therapy (n = 3,687) or without diabetes and no prescription for metformin (n = 13,258).

Measurements

We determined diabetes status from outpatient visits, and defined long‐term metformin therapy as a prescription ≥500 mg/d for at least six consecutive months. We estimated the proportion of participants who received a serum B12 test and used multivariable logistic regression, stratified by age, to evaluate the association between metformin use and serum B12 testing.

Results

Only 37% of older adults with diabetes receiving metformin were tested for vitamin B12 status after long‐term metformin prescription. The mean B12 concentration was significantly lower in the metformin‐exposed group (439.2 pg/dL) compared to those without diabetes (522.4 pg/dL) (P = .0015). About 7% of persons with diabetes receiving metformin were vitamin B12 deficient (<170 pg/dL) compared to 3% of persons without diabetes or metformin use (P = .0001). Depending on their age, metformin users were two to three times more likely not to receive vitamin B12 testing compared to those without metformin exposure, after adjusting for sex, race and ethnicity, body mass index, and number of years treated at the VAMC.

Conclusion

Long‐term metformin therapy is significantly associated with lower serum vitamin B12 concentration, yet those at risk are often not monitored for B12 deficiency. Because metformin is first line therapy for type 2 diabetes, clinical decision support should be considered to promote serum B12 monitoring among long‐term metformin users for timely identification of the potential need for B12 replacement.
Enhanced high‐energy protocol using a fractional bipolar radiofrequency device combined with bipolar radiofrequency and infrared light for improving facial skin appearance and wrinkles
Authors: Gold Michael H. , Biesman Brian S. , Taylor Mark
Published: February 2017

Background

Fractional bipolar radiofrequency treatment and treatment with bipolar radiofrequency combined with infrared light have been shown in previous trials to safely and effectively improve the appearance of facial wrinkles.

Aims

To evaluate a high‐energy protocol with combined bipolar radiofrequency and infrared light energies for improvement in photoaged facial skin.

Patients/Methods

Seventy‐two patients presenting with mild to moderate facial wrinkles underwent a single full‐face treatment (n=54) or two treatments (n=18) at 6‐week intervals. Independent blinded assessment and investigator assessment were performed, using the Fitzpatrick Wrinkle and Elastosis Scale (0‐9) and the Global Aesthetic Improvement scale. Patients also completed a self‐assessment questionnaire concerning satisfaction with the treatment.

Results

All patients achieved some degree of improvement in their wrinkles and skin appearance, following a single treatment or two treatments with the enhanced‐energy protocol. Blinded evaluation demonstrated 71% and 70% of the patients showing improvement of one unit or greater on the Fitzpatrick Scale, at the 12‐week and 24‐week follow‐ups post‐treatment, respectively. Similar results were reported by investigators. Under the Global Aesthetic Improvement Scale, investigators observed 87%, 91% and 81% of patients showing improvement at the 6‐, 12‐, and 24‐week post‐treatment end, respectively. Patients tolerated the treatments well and were satisfied with the clinical results.

Conclusion

The enhanced‐energy treatment protocol, with fractional bipolar radiofrequency treatment and treatment with bipolar radiofrequency combined with infrared light applications, yields significant improvement of skin texture, wrinkling, and overall appearance following a single treatment. The results appear gradually over time and are maintained for at least 6 months' post‐treatment.
They know it's safe – they know what to expect from that face: perceptions towards a cognitive‐behavioural counselling programme among caregivers of children with cystic fibrosis
Authors: Moola Fiona J , Henry Lauren AV , Huynh Elizabeth , Stacey Jenna A , Faulkner Guy EJ
Published: February 2017

Aims and objectives

To explore the experiences of eight caregivers who provide care to children with cystic fibrosis in an eight‐week cognitive‐behavioural counselling programme at a children's hospital in Winnipeg, Canada.

Background

Youth with cystic fibrosis experience significant behavioural and psychosocial challenges, such as depression, anxiety and poor treatment adherence. Caregivers are critical to the provision of care and treatment to young people living with cystic fibrosis. Caregivers of youth with cystic fibrosis experience psychosocial morbidity. Thus, the development of counselling interventions is required to enhance psychosocial well‐being among the caregivers of youth with cystic fibrosis.

Design and methods

This study was informed by the thematic analytic qualitative research tradition. In‐depth, semistructured interviews were conducted with eight caregivers who participated in our programme. The audiotaped interviews were then subject to thematic analysis.

Results

The counselling sessions were experienced as ‘distinctly different’ from routine appointments at the hospital and were characterised by a sense of listening and bidirectional communication. In addition to acquiring a sense of trust and accountability through the programme, counselling appeared to enhance caregivers’ perception of their time use, leading to greater temporal agency.

Conclusion and relevance to clinical practice

From this evidence‐based cognitive‐behavioural counselling programme, insights about the complex psychosocial lives of the cystic fibrosis community are discussed within the context of the literature. Integrating cognitive‐behavioural counselling into routine clinical CF care should be considered as a method to enhance caregiving capacity in the CF community and should be championed by nurses.
Newly graduated nurses’ use of knowledge sources in clinical decision‐making: an ethnographic study
Authors: Voldbjerg Siri Lygum , Grønkjær Mette , Wiechula Rick , Sørensen Erik Elgaard
Published: February 2017

Aims and objectives

To explore which knowledge sources newly graduated nurses’ use in clinical decision‐making and why and how they are used.

Background

In spite of an increased educational focus on skills and competencies within evidence‐based practice, newly graduated nurses’ ability to use components within evidence‐based practice with a conscious and reflective use of research evidence has been described as being poor. To understand why, it is relevant to explore which other knowledge sources are used. This may shed light on why research evidence is sparsely used and ultimately inform approaches to strengthen the knowledgebase used in clinical decision‐making.

Design and methods

Ethnographic study using participant‐observation and individual semistructured interviews of nine Danish newly graduated nurses in medical and surgical hospital settings.

Results

Newly graduates use of knowledge sources was described within three main structures: ‘other’, ‘oneself’ and ‘gut feeling’. Educational preparation, transition into clinical practice and the culture of the setting influenced the knowledge sources used. The sources ranged from overt easily articulated knowledge sources to covert sources that were difficult to articulate. The limited articulation of certain sources inhibited the critical reflection on the reasoning behind decisions. Reflection is a prerequisite for an evidence‐based practice where decisions should be transparent in order to consider if other evidentiary sources could be used.

Conclusion and relevance to clinical practice

Although there is a complexity and variety to knowledge sources used, there is an imbalance with the experienced nurse playing a key role, functioning both as predominant source and a role model as to which sources are valued and used in clinical decision‐making. If newly graduates are to be supported in an articulate and reflective use of a variety of sources, they have to be allocated to experienced nurses who model a reflective, articulate and balanced use of knowledge sources.
Work‐related fear and the threats of fear among emergency department nursing staff and physicians in Finland
Authors: Mikkola Riitta , Huhtala Heini , Paavilainen Eija
Published: February 2017

Aims and objectives

To describe fear, the threats causing fear and the occurrence of fear among emergency department nursing staff and physicians.

Background

The emergency department is a challenging workplace where the staff is often confronted by factors that cause fear.

Design

A cross‐sectional study.

Methods

A survey was conducted in 16 hospitals (n = 544). Nurses, practical nurses, orderlies and physicians from those hospitals participated in the survey. The survey questionnaire was based on the analysis of interviews of 30 nurses from one university hospital and one central hospital. The results of the interviews were analysed using the inductive content analysis method. The analysis of the survey was performed using statistical methods, such as frequencies, cross‐tabulation and principal component analysis.

Results

The results showed that nearly all of the emergency department personnel had experienced work‐related fear. Generally, the fear had been momentary. According to the survey results, fear was most often caused by medication errors, the resuscitation of a child, a catastrophic accident, urgent or violent situations or patients armed with weapons. Threats that caused fear included insecurity, danger in the work environment, threat of loss of one's health and threat of the consequences of one's mistakes and actions.

Conclusion

The staff of emergency departments often encountered factors or situations that caused fear. The main threats causing fear that were raised by the respondents were insecurity and danger in the work environment.

Relevance to clinical practice

The data obtained from this study can be utilised in identifying and describing work‐related fear and threats of fear among emergency department nursing staff and physicians. Based on the information herein, it will be possible to develop methods to prevent situations that cause fear in emergency departments.
Dietary niche differentiation facilitates coexistence of two large carnivores
Authors: du Preez B. , Purdon J. , Trethowan P. , Macdonald D. W. , Loveridge A. J.
Published: February 2017

An animal's diet is an important attribute of its niche, and affects the role that it plays in the ecosystem. Comparing the diets of sympatric species reveals the level of dietary niche overlap between them, which can be used to gauge the potential for competition, as well as each species’ vulnerability to competitive exclusion. Because of a morphology adapted to predation, sympatric carnivores can have particularly aggressive and dangerous competitive interactions; the intensity of which may be directly related to the amount of overlap in prey species consumed. Using predator scat analysis and prey survey techniques, we analyze and compare the underlying mechanisms of prey selection – prey body size and group size – between sympatric populations of leopard Panthera pardus and lion Panthera leo, to test for possible means of competitive avoidance between them. Because leopard and lion differ in both size and social structure, we controlled for the differing prey handling ability of each species, and found that there was still a significant difference in mean prey body size preference between the two carnivores (P = 0.050), despite a relatively high level of dietary niche overlap (0.717). Both species avoid prey in larger groups, but the tendency is more pronounced for leopards. Where intraguild competitors overlap spatiotemporally, dietary niche segregation such as this may be a mechanism through which competition is avoided and, in the case of carnivores, could reduce the frequency of potentially costly interactions.
Annual variability in dentin δ15N and δ13C reveal sex differences in weaning age and feeding habits in Risso's dolphins (Grampus griseus)
Authors: Evacitas Florence Chan , Kao Wen‐Yuan , Worthy Graham A. J. , Chou Lien‐Siang
Published: February 2017

Teeth of odontocetes accumulate annual dentinal growth layer groups (GLGs) that record isotope ratios, which reflect the time of their synthesis. Collectively, they provide lifetime records of individual feeding patterns from which life history traits can be inferred. We subsampled the prenatal dentin and postnatal GLGs in Risso's dolphins (Grampus griseus) (n = 65) that stranded or were collected as bycatch in Taiwan (1994–2014) and analyzed them for δ15N and δ13C. Age‐specific δ15N and δ13C values were corrected for effects of calendar year, stranding site, C/N, and sex. δ15N values were higher in prenatal layers (14.94‰ ± 0.74‰) than in adult female GLGs (12.58‰ ± 0.20‰), suggesting fetal enrichment during gestation. Decreasing δ15N values in early GLGs suggested changes in dietary protein sources during transition to complete weaning. Weaning age was earlier in males (1.09 yr) than in females (1.81 yr). Significant differences in δ15N values between weaned males and females suggest potential sexual segregation in feeding habits. δ13C values increased from the prenatal to the 4th GLG by ~1.0‰, indicative of a diet shift from 13C‐depleted milk to prey items. Our results provide novel insights into the sex‐specific ontogenetic changes in feeding patterns and some life history traits of Risso's dolphins.
The MIXED framework: A novel approach to evaluating mixed‐methods rigor
Authors: Eckhardt Ann L. , DeVon Holli A.
Published: February 2017

Evaluation of rigor in mixed‐methods (MM) research is a persistent challenge due to the combination of inconsistent philosophical paradigms, the use of multiple research methods which require different skill sets, and the need to combine research at different points in the research process. Researchers have proposed a variety of ways to thoroughly evaluate MM research, but each method fails to provide a framework that is useful for the consumer of research. In contrast, the MIXED framework is meant to bridge the gap between an academic exercise and practical assessment of a published work. The MIXED framework (methods, inference, expertise, evaluation, and design) borrows from previously published frameworks to create a useful tool for the evaluation of a published study. The MIXED framework uses an experimental eight‐item scale that allows for comprehensive integrated assessment of MM rigor in published manuscripts. Mixed methods are becoming increasingly prevalent in nursing and healthcare research requiring researchers and consumers to address issues unique to MM such as evaluation of rigor.
Youth and mobility in working holidays: Imagined freedoms and lived constraints in lives of Taiwanese working holidaymakers in New Zealand
Authors: Tsai Lisa Lee , Collins Francis L.
Published: February 2017

Mobility for work and travel is often aligned with conceptions of youth and possibilities that movement entails for cultural capital accumulation and self‐development. This article reflects on this connection by investigating the experiences of Taiwanese working holidaymakers in New Zealand. Our discussion reveals contrasting notions of youth expressed through working holidays and highlights how imaginative freedoms associated with the figure of the working holidaymaker are articulated through societal expectations, social infrastructures and temporal limits. The findings call for further research on the imbrication of working holidays with mutating notions of youth and their implications for the lived experience of mobility.
Quality of healthcare information on the Internet: the case of Apicectomies
Authors: Parvizi M. , Talai N.N. , Parvizi Z.
Published: February 2017

Background

Patients often have misconceptions about the appropriateness of an Apiceptomy, partly due to poor quality information on the Internet. Clinical consequences include a patient's false expectations of preserving a tooth that is of a poor prognosis or conversely the loss of a tooth that had the potential to be saved.

Aim

To assess the quality of information available for patients on Apicectomy.

Materials and methods

We conducted a quality assessment of online information relating to Apicectomies using the DISCERN instrument.

Results

Fifteen websites met the inclusion criteria, of which one had ‘good’ quality, seven were of ‘fair’ quality, and seven had ‘poor’ quality. Furthermore, no websites were of ‘excellent’ or ‘very poor’ quality.

Conclusions

Our results are in line with the literature demonstrating poor quality online health information. Furthermore, we find that websites authored by dentists do not have a superior quality to those with unspecified authors. We propose that practitioners can adopt a proactive role. For example, Wikipedia was the first search result, yet was of ‘poor quality’. Due to Wikipedia being a user‐generated website, practitioners can revise its content to enhance the quality of information. Such action may lead to better‐informed patients, more dynamic doctor–patient relationship, and reduction in the gap between the expectations of patients and realities of Apicectomy outcomes.
European Commissioner cabinet advisers: Policy managers, bodyguards, stakeholder mobilizers
Authors: Gouglas Athanassios , Brans Marleen , Jaspers Sylke
Published: February 2017

The article investigates the substantive and dimensional aspect of advisers’ policy work in the cabinets of European Commissioners. Advisers’ roles are mapped using Connaughton's (2010a) typology of four adviser types and Maley's (2015) framework of three arenas. Using data collected via a survey and follow‐up face‐to‐face interviews with European Commissioner cabinet advisers in the Juncker Commission in 2015, it is shown that the majority of those agents perform policy coordination and political bodyguard functions. They are both policy managers who steer policy and political bodyguards who mind the Commissioner. It is also their core work responsibility to be highly active across three arenas: orientate and mobilize officials in the Directorate Generals, coordinate policy across Commissioner cabinets, and build political support through consulting and bargaining with external stakeholders. European Commissioner cabinet advisers are individual agents active within a variant of the ministerial cabinet system tradition.
Faunal response to sea‐level and climate change in a short‐lived seaway: Jurassic of the Western Interior, USA
Authors: Danise Silvia , Holland Steven M.
Published: February 2017

Understanding how regional ecosystems respond to sea‐level and environmental perturbations is a main challenge in palaeoecology. Here we use quantitative abundance estimates, integrated within a sequence stratigraphic and environmental framework, to reconstruct benthic community changes through the 13 myr history of the Jurassic Sundance Seaway in the western United States. Sundance Seaway communities are notable for their low richness and high dominance relative to most areas globally in the Jurassic, and this probably reflects steep temperature and salinity gradients along the 2000 km length of the Seaway that hindered colonization of species from the open ocean. Ordination of samples shows a main turnover event at the Middle–Upper Jurassic transition, which coincided with a shift from carbonate to siliciclastic depositional systems in the Seaway, probably initiated by northward drift from subtropical latitudes to more humid temperate latitudes, and possibly global cooling. Turnover was not uniform across the onshore–offshore gradient, but was higher in offshore environments. The higher resilience of onshore communities to third‐order sea‐level fluctuations and to the change from a carbonate to a siliciclastic system was driven by a few abundant eurytopic species that persisted from the opening to the closing of the Seaway. Lower stability in offshore facies was instead controlled by the presence of more volatile stenotopic species. Such increased onshore stability in community composition contrasts with the well‐documented onshore increase in taxonomic turnover rates, and this study underscores how ecological analyses of relative abundance may contrast with taxonomically based analyses. We also demonstrate the importance of a stratigraphic palaeobiological approach to reconstructing the links between environmental and faunal gradients, and how their evolution through time produces local stratigraphic changes in community composition.
Comparison of caudal ropivacaine‐morphine and paravertebral catheter for major upper abdominal surgery in infants
Authors: Sato Makoto , Iida Takafumi , Kikuchi Chika , Sasakawa Tomoki , Kunisawa Takayuki
Published: February 2017

Background

The caudal epidural block is one of the most commonly used regional anesthetic techniques in children. Administration of morphine via caudal injection enables analgesia, even for upper abdominal surgery. The thoracic paravertebral block has also been successfully used to treat perioperative pain during upper abdominal procedures in pediatric patients.

Aim

In the current study, we compared the two regional techniques for upper abdominal surgery in infants to determine whether one of them was preferable to the other.

Methods

Consecutive patients under 12 months of age who underwent upper abdominal surgery were retrospectively divided according to the chosen postoperative analgesia: Group C, caudal ropivacaine‐morphine; Group P, paravertebral catheter. We analyzed the following outcomes: requirement for additional analgesics, pain scores, need for mechanical ventilation and oxygen dosage, postoperative blood pressure and heart rate, time to pass first stool, time until first full meal, and complications.

Results

Twenty‐one consecutive patients were included: 10 in Group C and 11 in Group P. Median age at surgery was 80 (47.5−270.0) and 84.5 (34.3−287.5) days, respectively. No difference was found between the two groups in requirement for additional analgesics at 24 h after surgery (median 1 in Group C vs 1 in Group P, P = 0.288, 95% CI: −2 to 1). BOPS pain scores were only lower in Group P when compared to Group C at 24 h after surgery (median 1 vs 2, P = 0.041, 95% CI: −2 to 0). None of the patients had perioperative complications.

Conclusions

In this small series, there was no significant difference between caudal ropivacaine‐morphine and paravertebral catheter for postoperative care in infants undergoing upper abdominal surgery. Further prospective studies are needed to compare the efficacy and incidence of complications of caudal block and paravertebral catheter for postoperative analgesia.
Risks of Preterm Delivery and Small for Gestational Age Infants: Effects of Nondaily and Low‐Intensity Daily Smoking During Pregnancy
Authors: Tong Van T. , England Lucinda J. , Rockhill Karilynn M. , D'Angelo Denise V.
Published: February 2017

Background

Few studies have examined the effects of nondaily smoking or low‐intensity daily smoking and infant outcomes. We examined the associations between preterm delivery and small for gestational age (SGA) infants in relation to both nondaily and daily smoking.

Methods

We used population‐based data on women who delivered live singleton infants using the 2009–11 Pregnancy Risk Assessment Monitoring System. Women's smoking status in the last 3 months of pregnancy was categorised as nonsmokers, quitters, nondaily smokers (<1 cigarette/day), and daily smokers. Controlling for maternal age, maternal race/ethnicity, education, marital status, prepregnancy body mass index (BMI), trimester of prenatal care entry, parity, and alcohol use, we estimated adjusted prevalence ratios (PR) for the outcomes of preterm delivery (<37 weeks’ gestation) and SGA.

Results

Of the 88 933 women, 13.1%, 1.7%, and 9.6% of the sample were quitters, nondaily smokers, and daily smokers, respectively, in the last 3 months of pregnancy. While nondaily smoking was not associated with preterm delivery, daily smoking was. However, we found no dose–response relationship with the number of cigarettes smoked per day. Risk of delivering a SGA infant was increased for both nondaily and daily smokers (PR 1.4, 95% CI 1.1, 1.8 and PR 2.0, 95% CI 1.9, 2.2 respectively).

Conclusions

Nondaily smoking in the last 3 months of pregnancy was associated with an increased risk of delivering a SGA infant. Pregnant women should be counselled that smoking, including nondaily and daily smoking, can adversely affect birth outcomes.