bluuebunny/crossref_metadata_2025 huggingface dataset:
Global and local sensitivity analysis of the Emission Dispersion Model input parameters
Authors: Chettouh Samia
Published: May 2021

Purpose

The objectives of this paper are the application of sensitivity analysis (SA) methods in atmospheric dispersion modeling to the emission dispersion model (EDM) to study the prediction of atmospheric dispersion of NO2 generated by an industrial fire, whose results are useful for fire safety applications. The EDM is used to predict the level concentration of nitrogen dioxide (NO2) emitted by an industrial fire in a plant located in an industrial region site in Algeria.

Design/methodology/approach

The SA was defined for the following input parameters: wind speed, NO2 emission rate and viscosity and diffusivity coefficients by simulating the air quality impacts of fire on an industrial area. Two SA methods are used: a local SA by using a one at a time technique and a global SA, for which correlation analysis was conducted on the EDM using the standardized regression coefficient.

Findings

The study demonstrates that, under ordinary weather conditions and for the fields near to the fire, the NO2 initial concentration has the most influence on the predicted NO2 levels than any other model input. Whereas, for the far field, the initial concentration and the wind speed have the most impact on the NO2 concentration estimation.

Originality/value

The study shows that an effective decision-making process should not be only based on the mean values, but it should, in particular, consider the upper bound plume concentration.
Case of pemphigoid vegetans with autoantibodies against the BP180 C‐terminal domain and BP230 antigen
Authors: Doi Chiaki , Shiraishi Ken , Koga Hiroshi , Ishii Norito , Sayama Koji
Published: May 2021

Pemphigoid vegetans is a rare variant of bullous pemphigoid characterized by vegetative and purulent lesions of the groin, axillae, thighs, hands, eyelids, and perioral regions. The clinical features and histological findings of pemphigus vegetans and immunohistochemical characteristics of bullous pemphigoid are shown. An 86‐year‐old woman presented with vegetative lesions in the vulva and groin, and blisters on the head, neck, axillae, and thighs. Although clinically suspected as pemphigus vegetans, skin biopsy showed subepidermal clefts with eosinophil infiltration and eosinophilic pustules in the epidermis. Direct immunofluorescence analysis showed linear deposition of immunoglobulin (Ig)G along the basement membrane zone. Indirect immunofluorescence using 1 mol/L NaCl salt‐split skin showed linear deposition of IgG on the epidermal side. Chemiluminescent enzyme immunoassay and enzyme‐linked immunosorbent assay were positive for BP180 and BP230. Immunoblotting of recombinant protein of the BP180 C‐terminal domain showed positive reactivity. Pemphigoid vegetans was diagnosed and treated successfully with oral corticosteroids. This is the first case of pemphigoid vegetans reported to date with detection of autoantibodies against both BP180 C‐terminal domain and BP230.
‘Not a good time’: Assessing the economic impact of COVID‐19 in Africa using a macro‐micro simulation approach
Authors: Morsy Hanan , Balma Lacina , Mukasa Adamon N.
Published: May 2021

The paper studies the effects of the coronavirus disease 2019 (COVID‐19) pandemic on African economies and household welfare using a top‐down sequential macro‐micro simulation approach. The pandemic is modeled as a supply shock that disrupts economic activities of African countries and then affects households’ consumption behavior, the level of their welfare, and businesses’ investment decisions. The macroeconomic dynamic general equilibrium model is calibrated to account for informality, a key feature of African economies. We find that COVID‐19 could diminish employment in the formal and informal sectors and contract consumption of non‐savers and, especially, savers. These contractions would lead to an economic recession in Africa and widen both fiscal and current account deficits. Extreme poverty is expected to increase further in Africa, in particular if the welfare of the poorest households grows at lower rates. We also use the macroeconomic model to analyze the effects of different fiscal policy responses to the COVID‐19 pandemic.
The Politics of Levelling Up
Authors: Jennings Will , McKay Lawrence , Stoker Gerry
Published: May 2021

‘Levelling up’ is an expression of a realignment in British politics with the Conservatives presenting themselves as the new party of redistribution. This is not primarily concerned with redistribution between social classes, or even between regions, but rather targets communities that feel they have lost their centrality and standing. This seemingly surprising manoeuvre is facilitated by voters’ distrust of politics, a geography of discontent that reflects uneven patterns of social and economic development, and the Conservative Party's capacity for pragmatic shifts in ideological direction. Yet, the sustainability of this project is uncertain. Levelling up creates opportunities for high‐profile initiatives and symbols of change through which the government can craft a narrative of success. It may also help the Conservatives appeal to voters that lean one way on economics but another on social issues by targeting attention and interventions in specific places—in a way that speaks to some voters’ feelings of having been neglected over many decades and having lost status to other groups in society. The tensions in delivering levelling up reflect the complexity of the changes wrought by globalisation and technological change, but the challenge for progressive forces is to develop a better alternative—a far from easy task.
Return to school after acquired brain injury in the UK – the educators' perspectives
Authors: Bate Catherine , Turner Kim , Fricke Silke
Published: May 2021

Childhood acquired brain injury (ABI) is associated with poorer life outcomes. Increasing numbers of children and young people are surviving severe brain injury and returning to mainstream schools with multiple impairments. It is widely acknowledged that for these children, their school becomes by default their rehabilitation centre. International studies of this transition and a recent UK government report criticize educators' inconsistent implementation of support strategies, lack of educator training and poor communication between clinicians, educators, child and family. The educators' perspectives of the return‐to‐school are, however, not well represented in the literature. This study therefore explored the experiences of educators in the UK (N = 10) who had recently facilitated a return‐to‐school of a child with ABI aged 8–12 (N = 5) using semi‐structured interviews analysed by data‐driven thematic analysis. The findings highlight common experiences: a continuum of intensive problem‐solving with heavy reliance on the Special Educational Needs Coordinator; educators valuing collaboration with clinical specialists in context over general ‘training’; uncertainty over the validity of implementing support strategies from prior teaching experience; uncertainty about how to support the child's emotional needs; and frustration with UK statutory processes for Special Educational Needs and Disabilities. Recommendations are made for changes to practice and future research.
AcrAB, the major RND‐type efflux pump of Photorhabdus laumondii, confers intrinsic multidrug‐resistance and contributes to virulence in insects
Authors: Hadchity Linda , Lanois Anne , Kiwan Paloma , Nassar Fida , Givaudan Alain , Khattar Ziad Abi
Published: May 2021

The resistance‐nodulation‐division (RND)‐type efflux pumps AcrAB and MdtABC contribute to multidrug‐resistance (MDR) in Gram‐negative bacteria. Photorhabdus is a symbiotic bacterium of soil nematodes that also produces virulence factors killing insects by septicaemia. We previously showed that mdtA deletion in Photorhabdus laumondii TT01 resulted in no detrimental phenotypes. Here, we investigated the roles of the last two putative RND transporters in TT01 genome, AcrAB and AcrAB‐like (Plu0759‐Plu0758). Only ΔacrA and ΔmdtAΔacrA mutants were multidrug sensitive, even to triphenyltetrazolium chloride and bromothymol blue used for Photorhabdus isolation from nematodes on the nutrient bromothymol blue‐triphenyltetrazolium chloride agar (NBTA) medium. Both mutants also displayed slightly attenuated virulence after injection into Spodoptera littoralis. Transcriptional analysis revealed intermediate levels of acrAB expression in vitro, in vivo and post‐mortem, whereas its putative transcriptional repressor acrR was weakly expressed. Yet, plasmid‐mediated acrR overexpression did not decrease acrAB transcript levels neither MDR in TT01 WT. While no pertinent mutations were detected in acrR of the same P. laumondii strain grown either on NBTA or nutrient agar, we suggest that AcrR‐mediated repression of acrAB is not physiologically required under conditions tested. Finally, we propose that AcrAB is the primary RND‐efflux pump, which is essential for MDR in Photorhabdus and may confer adaptive advantages during insect infection.
Detection of a pinhole‐sized bronchoesophageal fistula under bronchoscopic autofluorescence imaging
Authors: Morikawa Kei , Izawa Naoki , Kida Hirotaka , Handa Hiroshi , Inoue Takeo , Mineshita Masamichi
Published: May 2021

Autofluorescence imaging (AFI) is a technique for detecting early‐stage lung cancer by amplifying the difference in autofluorescence of the bronchial mucosa. However, there are few reports detailing its other applications. Here, we report the case of a 54‐year‐old woman with stage IVa esophageal cancer who completed chemoradiation therapy, but developed a bronchoesophageal fistula at the left main bronchus and underwent fasting treatment. Computed tomography confirmed that the fistula had closed; however, she subsequently developed aspiration pneumonia and underwent bronchoscopy for confirmation. Although it was difficult to identify the site of the pinhole bronchoesophageal fistula under white light, AFI could easily identify the fistula and digestive mucus in light magenta. AFI may therefore be worth considering for the detection of pinhole bronchoesophageal fistulas.
Evaluation of interventions in people with digestive stoma through the Nursing Interventions Classification
Authors: Capilla‐Díaz Concepción , Moya‐Muñoz Noelia , Matas‐Terrón José Manuel , Pérez‐Morente María Ángeles , Álvarez‐Serrano María Adelaida , Montoya‐Juárez Rafael , Hueso‐Montoro César
Published: May 2021

Purpose

To determine which nursing interventions are used in individuals with a digestive stoma and the relationships between nursing interventions used and sociodemographic and clinical variables.

Methods

The present study is an observational, cross‐sectional, descriptive. Data from 102 individuals in the general surgery unit of a first‐level hospital (University Hospital Complex of Granada, Spain) were analyzed. Data on the use of nursing interventions and sociodemographic and clinical variables were collected. Univariate, bivariate, and multivariate data analyses were conducted.

Findings

Interventions: Decision‐Making Support (5250) and Ostomy Care (0480) were the most prevalent interventions in the sample. The period of care (postoperative and follow‐up) was the most common significant variable (p < 0.05) among the interventions observed. Anxiety Reduction (5820), Nutritional Counseling (5246), Self‐Esteem Enhancement (5400), and Body Image Enhancement (5220) were also relevant findings.

Conclusions

The present study contributes to determining which nursing interventions are used in individuals with a digestive stoma.

Implications for nursing practice

This study could be useful in planning nursing interventions in individuals with a digestive stoma.
Solidarity Economy and social inclusion: The Immigrant Fair in Florianópolis, Brazil
Authors: Annoni Danielle , de Souza Silva Karine , Martini dos Santos Gabriela
Published: May 2021

Motivation

The Solidarity Economy movement emerged in Latin America in the 1970s and 1980s as an alternative mode of production led by mutual principles, such as co‐operative work, self‐management, and consensual distribution of economic gains. Much has been developed on its potential to include groups marginalized by capitalism in new development schemes, but to date there has been no work regarding immigrants’ participation specifically. This research aims to fill this gap.

Purpose

The article investigates the importance of the partnership between institutions in the host country and immigrants to their insertion in the Solidarity Economy Fairs in Florianópolis. It questions to what extent it has furthered income generation, the formation of social identity, and the construction of community ties.

Methods and approach

The approach is anchored in intervention–research, proposing a socio‐analytical intervention (Aguiar & Rocha, 2007). To pursue qualitative research, an online form was distributed to participants at the Immigrant Fair. The form comprised semi‐structured interviews, with the possibility of giving free answers.

Findings

The data analysis reveals the nuances of the life trajectory of recent immigrants in Brazil: people, mostly of Latin American origin, over 30 years of age, seeking economic insertion in another country. For them, the Solidarity Economy has offered a possibility for social and economic insertion in Brazil. The opportunity for marginalized populations to engage with the Solidarity Economy offers an effective tool against systemic competition. The Fair operates as an alternative to the insertion into the capitalist market for outsider groups, enabling new ways to conduct economic life within the capitalist economy.

Policy implications

Our findings suggest that the Fair has provided immigrants both the means to obtain a weekly (although unstable) financial income and their social integration—it requires interaction with other immigrants, state agents, tourists, and the local community. The social isolation resulting from the COVID‐19 pandemic has jeopardized both outcomes. In order to consolidate solidarity ventures and immigrants’ enterprises, there is an urgent need to implement a public policy regarding immigrants’ social and economic rights in Santa Catarina State.
A behavioral logic underlying aggression in an African cichlid fish
Authors: Alward Beau A. , Cathers Phillip H. , Blakkan Danielle M. , Hoadley Andrew P. , Fernald Russell D.
Published: May 2021

Social rank in a hierarchy determines which individuals have access to important resources such as food, shelter, and mates. In the African cichlid fish Astatotilapia burtoni, rank is under social control, such that larger males are more likely than smaller males to be dominant in rank. Although it is well known that the relative size of A. burtoni males is critical in controlling social rank, the specific behaviors underlying responses to males of different sizes are not well understood. In many other fish species, when size asymmetries between competing males are small, physical aggression is likely to be used to settle territorial disputes. Our goal was to characterize these responses in male A. burtoni by performing resident‐intruder assays, in which aggressive behaviors were measured in territorial males in response to the introduction of unfamiliar males that differed in relative standard length (SL). We found that the relative SL of intruders played an important role in determining behavioral performance. Resident males that were smaller than the intruder (resident >5% smaller in SL) or matched (resident between 0 and 5% smaller or larger in SL) in size to the intruder performed more lateral displays, a type of non‐physical aggression, than resident males that were larger than the intruder (resident >5% larger in SL). However, physical aggression, such as chases and bites, did not differ as a function of relative SL. Thus, contrary to what was expected based on work in other species, our results demonstrate that dominant resident A. burtoni increase non‐physical aggression to settle territorial disputes when non‐dominant intruders are closer in size. This behavioral strategy may aid in readily settling conflicts when size asymmetries are small.
Isotopic analyses of Ordovician–Silurian siliceous skeletons indicate silica‐depleted Paleozoic oceans
Authors: Trower Elizabeth J. , Strauss Justin V. , Sperling Erik A. , Fischer Woodward W.
Published: May 2021

The Phanerozoic Eon marked a major transition from marine silica deposition exclusively via abiotic pathways to a system dominated by biogenic silica sedimentation. For decades, prevailing ideas predicted this abiotic‐to‐biogenic transition were marked by a significant decrease in the concentration of dissolved silica in seawater; however, due to the lower perceived abundance and uptake affinity of sponges and radiolarians relative to diatoms, marine dissolved silica is thought to have remained elevated above modern values until the Cenozoic radiation of diatoms. Studies of modern marine silica biomineralizers demonstrated that the Si isotope ratios (δ30Si) of sponge spicules and planktonic silica biominerals produced by diatoms or radiolarians can be applied as quantitative proxies for past seawater dissolved silica concentrations due to differences in Si isotope fractionations among these organisms. We undertook 446 ion microprobe analyses of δ30Si and δ18O of sponge spicules and radiolarians from Ordovician–Silurian chert deposits of the Mount Hare Formation in Yukon, Canada. These isotopic data showed that sponges living in marine slope and basinal environments displayed small Si isotope fractionations relative to coeval radiolarians. By constructing a mathematical model of the major fluxes and reservoirs in the marine silica cycle and the physiology of silica biomineralization, we found that the concentration of dissolved silica in seawater was less than ~150 μM during early Paleozoic time—a value that is significantly lower than previous estimates. We posit that the topology of the early Paleozoic marine silica cycle resembled that of modern oceans much more closely than previously assumed.
Prospective physical fitness status and development of cardiometabolic risk in children according to body fat and lifestyle behaviours: The IDEFICS study
Authors: Santaliestra‐Pasías Alba M. , Moreno Luis A. , Gracia‐Marco Luis , Buck Christoph , Ahrens Wolfgang , De Henauw Stefaan , Hebestreit Antje , Kourides Yiannis , Lauria Fabio , Lissner Lauren , Molnar Denes , Veidebaum Toomas , González‐Gil Esther M. ,   on behalf the IDEFICS consortium
Published: May 2021

Background

Elevated cardiometabolic risk (CMR) is an important factor for cardiovascular diseases later in life while physical fitness seems to decrease CMR.

Objective

Thus, the aim of the present study is to assess the association between muscular fitness (MF) and cardiorespiratory fitness (CRF) on CMR in European children, both cross‐sectional and longitudinally.

Methods

A total of 289 children (49.5% males) from eight European countries, aged 6 to 9, with longitudinal information on blood pressure, triglycerides, total cholesterol, HDL‐cholesterol, homoeostasis model assessment, body mass index, data on fitness level, objectively measured physical activity (PA), diet quality, and total screen time were included. A CMR score was calculated and dichotomized. MF and CRF were also dichotomized. Cross‐sectional and longitudinal multilevel logistic regressions adjusting for lifestyle behaviours were performed.

Results

Reaching a high level of MF during childhood as well as remaining in that level over‐time were associated with an 82% and 62% lower probability of high CMR at follow‐up, respectively. Also, children who became top CRF over time, showed a 77% lower probability (P < 0.05) of being in the highest CMR quartile at follow‐up, independently of sociodemographic and lifestyle indicators.

Conclusions

A high MF at early childhood and during childhood reduces the odds of having CMR. Same occurs with the improvement of CRF during childhood. These findings highlight the importance of enhancing fitness to avoid CMR already in children.
Effects of the COVID‐19 pandemic on acute stress disorder and career planning among healthcare students
Authors: Zhang Luping , Qi Hongbo , Wang Longqiong , Wang Fulan , Huang Jin , Li Feifei , Zhang Zhiwei
Published: May 2021

This study aimed to investigate the effects of COVID‐19 on the prevalence of acute stress disorder and subsequent effects on career planning among healthcare students. A cross‐sectional survey was conducted among 1158 healthcare students across five medical universities in February 2020. Acute stress disorder was assessed using the Stanford Acute Stress Response Questionnaire. Further data regarding COVID‐19 knowledge, individual behaviours, occupational choices, and career planning were collected. Based on the results of the Stanford Acute Stress Response Questionnaire, the students were divided into high‐risk and low‐risk groups for acute stress disorder. The correlation between acute stress disorder and the impact on career planning was analysed. The high‐risk group comprised 143 (12.3%) participants, while 1015 (87.7%) participants were in the low‐risk group. Two factors increased the risk of acute stress disorder in the students, including ‘I think the pandemic is far away from me’ (B: 1.27, 95%CI: 1.60–7.87) and ‘Physical contact with confirmed or suspected cases’ (B: 2.49, 95%CI: 3.42–42.44). Those who obtained pandemic information from official media sources indicated a lower risk of acute stress disorder (B: −0.24, 95%CI: 0.49–1.26). The high‐risk group was more likely to quit the medical profession after graduation. The COVID‐19 pandemic may cause acute stress disorder among healthcare students and affect their career planning. Universities and relevant departments should provide more information and moral support for these students.
COVID‐19 impact on nurses in Spain: a considered opinion survey
Authors: Pérez‐Raya F. , Cobos‐Serrano J.L. , Ayuso‐Murillo D. , Fernández‐Fernández P. , Rodríguez‐Gómez J.A. , Almeida Souza A.
Published: May 2021

Aim

To survey nurses' opinions about their work conditions at the onset of the COVID‐19 pandemic in Spain.

Background

For the Spanish General Council of Nursing (the Consejo General de Enfermería de España), it was essential to have information on nursing workforce conditions and nurses' preparedness to wear protective measures at the pandemic's onset. The coronavirus outbreak was believed to have started in China and rapidly spread as a global pandemic requiring policies and actions for planning emergency healthcare delivery.

Methods

A cross‐sectional survey was conducted online. Data were collected during April 2020 and covered social demography, working conditions, training, availability of personal protective equipment, and nurses' health conditions, including the impact of COVID‐19.

Findings

From all national territories in Spain, 11 560 registered nurses from different services completed the questionnaire. Findings indicated that the lack of personal protective equipment was a crucial issue, as well as service planning and organization, and 80.2% reported high or very high psychological impact of COVID‐19. Alarmingly, 29.5% of the nurses reported COVID‐19 symptoms. Of these 23.3% had been tested, and 30.2% were confirmed as being positive to the virus. The nurses deemed proper preparedness for emergencies and disasters as a significant concern.

Conclusion

Nurses’ responses showed evidence of health services deficiencies as a source of damage to their capacity to provide safe patient care and protect themselves and their families' health. The working conditions of the nurses are at critical levels and are unacceptable. The study results provide evidence regarding the necessity of suitable planning and actions being taken to enable safe patient care and safety for nurses.

Implications for Nursing and Health Policy

Our survey gathered nurses' views at the pandemic's onset. The evidence gathered is being used to advise policymakers and nursing organizations to take actions to control public health risks to populations. It is necessary that more investment in growing nursing workforce expertise and health infrastructure for pandemic and epidemic emergencies is provided.
Crop lodging, pod fertility and yield formation in canola under varying degrees of short‐term heat stress during flowering
Authors: Wu Wei , Duncan Robert W. , Ma Bao‐Luo
Published: May 2021

There has been little research on crop lodging and yield determination in response to varying degrees of heat stress in canola. This research aimed to examine root morphology, pod fertility, seed yield and crop lodging of two canola genotypes subjected to normal temperature (23/17°C, light/dark, as CK), and three elevated temperature regimes imposed at flowering for a short term (10 days), namely CK+2 (25.0/22.0°C, light/dark), CK+4 (27.0/24.0°C) and CK+6 (29.0/26.0°C), in a controlled growth facility. Elevated temperature treatment, CK+4 and CK+6, displayed a significant adverse effect on seed yield and stem lodging. Compared to the CK, a significant yield loss of 35.6% and 48.7% in CK+4 and CK+6, respectively, was mainly due to poor pod fertility. This was evident from the smaller number of total filled pods (−21% in the CK+4 and −25% in the CK+6), low success ratio of pod developed (−25%, CK+4 and −29%, CK+6) and poor pollen viability (−36%, CK+4 and −50%, CK+6), averaged across both genotypes. Lateral root development was sensitive to the elevated temperature treatment, showing significant reductions in the lateral root morphology (8.0%–28.5%), while the taproot was relatively tolerant to the elevated temperature stress. A strong relationship between root electrical capacitance and lateral root morphology (R2 > .74**) indicates that electrical measurements could be used as a non‐destructive method for evaluating root parameters under elevated temperatures. Higher risk of stem lodging (21.4% lower stem safety factor) compared to the CK was evident under severe elevated temperature stress, as ascribed from the reduced stem bending strength that was caused by the deteriorating stem mechanical properties such as decreased flexural rigidity and weakened vascular bundle size (i.e. stunted fibre cell, and thinned size of fibre wall, deteriorated secondary xylem and smaller secondary phloem). These results were further verified by the principal component analysis and structural equation model. The root lodging risk was not influenced by the elevated temperature regime, primarily due to the unaffected anchorage strength and height of the centre of gravity. This information will be useful in improving lodging resistance and alleviating the related impact of heat stress in canola.
How Do I Know What I See Until I Hear What I Say?
Authors: Reichertz Mathew , Christie John , Maycock Bryan , Wong Jack , Klein Raymond M.
Published: May 2021

Whereas we acknowledge that drawing as process and product within the visual arts is complex and wide ranging, this study concentrates on testing the effectiveness of different pedagogical strategies for enhancing accuracy as a learning objective in drawing from observation. Based on our collective experience teaching observational drawing, we hypothesised that describing a scene verbally in advance of drawing it would encourage a more sophisticated appraisal of the scene and result in a more accurate representation. To test this hypothesis, drawings were made under three conditions: beginning to draw immediately, waiting before drawing, and describing the scene verbally before drawing. The drawings were then rated for accuracy by expert and non‐expert raters. Interestingly, the ‘wait’ condition had the greatest average benefit to drawing accuracy; however, the comprehensiveness of the description in the ‘describe’ condition also had a positive effect on drawing accuracy. As the number of words used in the description increased, the drawing accuracy increased such that the better descriptions result in drawings superior to the average in the ‘wait’ condition. This finding recommends that when drawing accuracy is important one should generate as rich a description as possible before beginning to draw.
Towards a unifying caring life‐course theory for better self‐care and caring solutions: A discussion paper
Authors: Kitson Alison , Feo Rebecca , Lawless Michael , Arciuli Joanne , Clark Robyn , Golley Rebecca , Lange Belinda , Ratcliffe Julie , Robinson Sally
Published: May 2021

Aim

To present the first iteration of the caring life‐course theory.

Background

Despite requiring care from birth to death, a person's universal or fundamental care needs and the subsequent care provision, either by self or others, has yet to be presented within a life‐course perspective. Accurately describing the care people require across their lifespan enables us to identify who, what type, how and where this care should be provided. This novel perspective can help to legitimise a person's care needs and the support they require from wider care systems and contexts.

Design

Discussion paper outlines theory development. We adopted an inductive approach to theory development, drawing upon existing literature and the team's diverse experiences. Our theoretical insights were refined through a series of collaborative meetings to define the theory's constructs, until theoretical saturation was reached.

Discussion

Fourteen constructs are identified as essential to the theory. We propose it is possible, using these constructs, to generate caring life‐course trajectories and predict divergences in these trajectories. The novel contribution of the theory is the interplay between understanding a person's care needs and provision within the context of their lifespan and personal histories, termed their care biography, and understanding a person's care needs and provision at specific points in time within a given care network and socio‐political context.

Impact for Nursing

The caring life‐course theory can provide a roadmap to inform nursing and other care industry sectors, providing opportunities to integrate and deliver care from the perspective of the person and their care history, trajectories and networks, with those of professional care teams. It can help to shape health, social and economic policy and involve individuals, families and communities in more constructive ways of talking about the importance of care for improved quality of life and healthy societies.
Reproductive performance of Angus, Hereford, Salers and Nellore crossbred females: Additive and non‐additive effects
Authors: Martinez‐Boggio Guillermo , Lema Mario , Aguilar Ignacio , Gimeno Diego , Ravagnolo Olga
Published: May 2021

Reproductive traits in breeding herds can be improved through crossbreeding, which results in breed differences, heterosis and breed complementarity. The aim of this study was to estimate group additive genetic and dominance effects for three reproductive traits; probability of artificial insemination (AIP); calving success (CS); and days to calving (DC) for Hereford (H), Angus (A), Nellore (N) and Salers (S) breeds under grazing conditions. Data were obtained from an experiment carried out during 1992–2002 by the Faculty of Agronomy, Universidad de la Republica (UdelaR), Uruguay and Caja Notarial de Seguridad Social. The data set contained reproductive information of 1,164 females from 11 different genetic groups (GG) consisting of crosses between H, N, S and A. AIP, CS and DC were examined in first‐calf heifers, while CS and DC were examined in second‐calf and 3‐ to 7‐year‐old cows. Least square means for each GG and group additive genetic and dominance effects were estimated for each trait. F1 crossbreed females performed better for artificial insemination probability than purebred females. Crossbred A/H heifers had the highest AIPs and CS rates, while crossbred N/H 3‐ to 7‐year‐old cows recorded the highest averages for CS and DC. Estimates of group additive genetic effects did not differ amongst A, S, N and H; however, dominance increased the AIP and CS of the heifers.
Phellodendrine promotes autophagy by regulating the AMPK/mTOR pathway and treats ulcerative colitis
Authors: Su Shuai , Wang Xin , Xi Xiaonan , Zhu Lanping , Chen Qiuyu , Zhang Hongxia , Qin Yuan , Yang Boli , Che Na , Cao Hailong , Zhong Weilong , Wang Bangmao
Published: May 2021

To investigate the therapeutic effects of phellodendrine in ulcerative colitis (UC) through the AMPK/mTOR pathway. Volunteers were recruited to observe the therapeutic effects of Compound Cortex Phellodendri Liquid (Huangbai liniment). The main components of Compound Cortex Phellodendri Liquid were analysed via network pharmacology. The target of phellodendrine was further analysed. Caco‐2 cells were cultured, and H2O2 was used to stimulate in vitro cell model. Expression levels of LC3, AMPK, p‐AMPK, mTOR and p‐mTOR were detected via Western blotting and through immunofluorescence experiments. The therapeutic effects of phellodendrine were analysed via expression spectrum chip sequencing. The sequencing of intestinal flora further elucidated the therapeutic effects of phellodendrine. Compared with the control group, Compound Cortex Phellodendri Liquid could substantially improve the healing of intestinal mucosa. Network pharmacology analysis revealed that phellodendrine is the main component of Compound Cortex Phellodendri Liquid. Moreover, this alkaloid targets the AMPK signalling pathway. Results of animal experiments showed that phellodendrine could reduce the intestinal damage of UC compared with the model group. Findings of cell experiments indicated that phellodendrine treatment could activate the p‐AMPK /mTOR signalling pathway, as well as autophagy. Expression spectrum chip sequencing showed that treatment with phellodendrine could promote mucosal healing and reduce inflammatory responses. Results of intestinal flora detection demonstrated that treatment with phellodendrine could increase the abundance of flora and the content of beneficial bacteria. Phellodendrine may promote autophagy by regulating the AMPK‐mTOR signalling pathway, thereby reducing intestinal injury due to UC.
Guided tooth autotransplantation in edentulous areas post‐orthodontic treatment
Authors: Abella Sans Francesc , Ribas Ferran , Doria Guillermo , Roig Miguel , Durán‐Sindreu Fernando
Published: May 2021

Objective

Tooth autotransplantation with a complete root formation to replace one or more lost teeth is indicated as a cost‐effective alternative to implants. The aim of this case report was to describe a successfully guided autotransplantation of a maxillary third molar with fully formed roots into a surgically created socket after orthodontic space opening.

Clinical considerations

A guided autotransplantation of the maxillary left third molar into the missing maxillary left first molar site was chosen. After virtually orientating donor tooth to confirm its optimum fit, it was deemed necessary to open 4 mm the mesiodistal space. Following the orthodontic movement, a 3‐dimensional (3D)‐guiding template and a milled surgical guide were manufactured to allow the donor tooth to be transplanted exactly in the planned position. The 2‐year follow‐up periapical radiograph showed a continuous periodontal space with no signs of apical periodontitis or root resorption.

Conclusions

Virtual planning and 3D‐printed tooth replica combined with guided surgery can simplify the autotransplantation technique for both the clinician and the patient, particularly when the socket has been completely created during surgery.

Clinical significance

Virtual digital planning, which can accurately calculate the exact space to open orthodontically before an autotransplantation, could prove essential to enhancing the precision of 3D placement of the donor tooth in the recipient site.
Clinical approach to chronic wound management in older adults
Authors: Alam Wahila , Hasson Jonathan , Reed May
Published: May 2021

Older adults are at high risk of developing chronic wounds due to numerous changes that occur with aging. It is reasonable to consider chronic wounds as a geriatric syndrome—highly prevalent, multifactorial, and associated with substantial morbidity and mortality. Due to the morbidity and cost associated with chronic wounds, prevention, early diagnosis, and treatment are important. The most common chronic wounds presenting in older adults are pressure and vascular wounds, including those associated with diabetes. Atypical wounds are also common and should raise the suspicion for skin malignancy. Diagnosis is primarily clinical and assessment should include documentation of wound characteristics, such as location, size and depth, presence of slough, drainage, odor, and infection. The mainstay of treatment is based on the TIME principle: Tissue debridement, Infection control, Moisture balance, and optimal wound Edges. The use of protein supplements has been shown to improve wound healing in subsets of older adults. In addition to wound care and optimizing nutrition, disease‐specific wound therapy forms an integral part of wound management. Pressure reduction for pressure injury, compression therapy for venous wounds, evaluation of arterial circulation with ABI or arterial Doppler and iCC for diabetic ulcers form the mainstays of therapy. Atypical wounds may present as chronic ulcers and should be biopsied. The goals of treatment should be realistic and for some older adults, palliative wound management may be more appropriate.
How should advance care planning be done when a surrogate is making decisions?
Authors: Cohen Andrew B. , DeMartino Erin S.
Published: May 2021

This editorial comments on the article by in der Schmitten et al. in this issue.
Hypothalamic neuropeptides and neurocircuitries in Prader Willi syndrome
Authors: Correa‐da‐Silva Felipe , Fliers Eric , Swaab Dick F. , Yi Chun‐Xia
Published: May 2021

Prader‐Willi Syndrome (PWS) is a rare and incurable congenital neurodevelopmental disorder, resulting from the absence of expression of a group of genes on the paternally acquired chromosome 15q11‐q13. Phenotypical characteristics of PWS include infantile hypotonia, short stature, incomplete pubertal development, hyperphagia and morbid obesity. Hypothalamic dysfunction in controlling body weight and food intake is a hallmark of PWS. Neuroimaging studies have demonstrated that PWS subjects have abnormal neurocircuitry engaged in the hedonic and physiological control of feeding behavior. This is translated into diminished production of hypothalamic effector peptides which are responsible for the coordination of energy homeostasis and satiety. So far, studies with animal models for PWS and with human post‐mortem hypothalamic specimens demonstrated changes particularly in the infundibular and the paraventricular nuclei of the hypothalamus, both in orexigenic and anorexigenic neural populations. Moreover, many PWS patients have a severe endocrine dysfunction, e.g. central hypogonadism and/or growth hormone deficiency, which may contribute to the development of increased fat mass, especially if left untreated. Additionally, the role of non‐neuronal cells, such as astrocytes and microglia in the hypothalamic dysregulation in PWS is yet to be determined. Notably, microglial activation is persistently present in non‐genetic obesity. To what extent microglia, and other glial cells, are affected in PWS is poorly understood. The elucidation of the hypothalamic dysfunction in PWS could prove to be a key feature of rational therapeutic management in this syndrome. This review aims to examine the evidence for hypothalamic dysfunction, both at the neuropeptidergic and circuitry levels, and its correlation with the pathophysiology of PWS.
Uptake of interferon‐free DAA therapy among HCV‐infected decompensated cirrhosis patients and evidence for decreased mortality
Authors: McDonald Scott A. , Barclay Stephen T. , Innes Hamish A. , Fraser Andrew , Hayes Peter C. , Bathgate Andrew , Dillon John F. , Went April , Goldberg David J. , Hutchinson Sharon J.
Published: May 2021

Interferon‐free DAA therapies have recently been licensed for patients infected with hepatitis C virus (HCV) who have decompensated cirrhosis (DC). Our aim was to describe factors associated with uptake of IFN‐free DAAs in DC patients and to compare mortality risk and hospital admission rates between pre‐DAA and DAA eras. This observational study used record‐linkage between Scotland's HCV Clinical Database and national inpatient hospitalization and mortality registers. For the DAA uptake analysis, the study population (n = 297) was restricted to patients alive on 1 November 2014, and Cox regression was used to estimate uptake associated with various covariates. For the Cox regression of mortality comparing pre‐DAA and DAA eras, the study population (n = 624) comprised those diagnosed with DC in 2005–2018; follow‐up was censored at two years. DAA uptake was 63% overall and was significantly higher for treatment‐experienced patients (adjusted hazard ratio (aHR) = 1.64, 95% CI:1.14–2.34), genotype 1 vs. other genotypes (aHR = 1.55. 95% CI:1.15–2.10) and lower for persons diagnosed with DC pre‐2014 (0.47, 95% CI:0.33–0.68) and in Greater Glasgow (0.64, 95% CI:0.47–0.88). The intention‐to‐treat SVR rate was 89% (95% CI:83–93%). All‐cause and liver‐related mortality risk were significantly reduced among patients diagnosed with DC in the DAA era (November 2014–December 2018) compared with the pre‐DAA era (2005–October 2014) (aHRs of 0.68, 95% CI:0.49–0.93; 0.69, 95% CI:0.50–0.95, respectively); in contrast, hospital admission rates were higher in the DAA era (aRR = 1.14, 95% CI:1.04–1.26). The majority of HCV‐infected DC patients engaged with specialist services can be treated with IFN‐free DAAs. Improved survival among patients diagnosed with DC in the DAA era supports the beneficial impact of IFN‐free therapies among those with advanced liver disease.
Only partial improvement in health‐related quality of life after treatment of chronic hepatitis C virus infection with direct acting antivirals in a real‐world setting—results from the German Hepatitis C‐Registry (DHC‐R)
Authors: Ohlendorf Valerie , Schäfer Arne , Christensen Stefan , Heyne Renate , Naumann Uwe , Link Ralph , Herold Christoph , Schiffelholz Willibold , Günther Rainer , Cornberg Markus , Serfert Yvonne , Maasoumy Benjamin , Wedemeyer Heiner , Kraus Michael R.
Published: May 2021

Improvement of health‐related quality of life (HRQoL) is frequently reported as a benefit when treating hepatitis C virus infection (HCV) with direct acting antivirals (DAA). As most of the available data were obtained from clinical trials, limited generalizability to the real‐world population might exist. This study aimed to investigate the impact of DAA therapy on changes in HRQoL in a real‐world setting. HRQoL of 1180 participants of the German Hepatitis C‐Registry was assessed by Short‐Form 36 (SF‐36) questionnaires. Scores at post‐treatment weeks 12–24 (FU12/24) were compared to baseline (BL). Changes of ≥2.5 in mental and physical component summary scores (MCS and PCS) were defined as a minimal clinical important difference (MCID). Potential predictors of HRQoL changes were analysed. Overall, a statistically significant increase in HRQoL after DAA therapy was observed, that was robust among various subgroups. However, roughly half of all patients failed to achieve a clinically important improvement in MCS and PCS. Low MCS (p < .001, OR = 0.925) and PCS (p < .001, OR = 0.899) BL levels were identified as predictors for achieving a clinically important improvement. In contrast, presence of fatigue (p = .023, OR = 1.518), increased GPT levels (p = .005, OR = 0.626) and RBV containing therapy regimens (p = .001, OR = 1.692) were associated with a clinically important decline in HRQoL after DAA therapy. In conclusion, DAA treatment is associated with an overall increase of HRQoL in HCV‐infected patients. Nevertheless, roughly half of the patients fail to achieve a clinically important improvement. Especially patients with a low HRQoL seem to benefit most from the modern therapeutic options.
Scrutinizing the Monotonicity Assumption in IV and fuzzy RD designs*
Authors: Fiorini Mario , Stevens Katrien
Published: May 2021

Whenever treatment effects are heterogeneous, and there is sorting into treatment based on the gain, monotonicity is a condition that both instrumental variable (IV) and fuzzy regression discontinuity (RD) designs must satisfy for their estimate to be interpretable as a local average treatment effect. However, applied economic work often omits a discussion of this important assumption. A possible explanation for this missing step is the lack of a clear framework to think about monotonicity in practice. In this paper, we use an extended Roy model to provide insights into the interpretation of IV and fuzzy RD estimates under various degrees of treatment effect heterogeneity, sorting on gain and violation of monotonicity. We then extend our analysis to two applied settings to illustrate how monotonicity can be investigated using a mix of economic insights, data patterns and formal tests. For both settings, we use a Roy model to interpret the estimate even in the absence of monotonicity. We conclude with a set of recommendations for the applied researcher.
Impact of once‐daily ER‐Tac on trough concentration variability in a stable AYA renal transplant recipient cohort
Authors: Chandran Mary Moss , Blanchette Eliza , Goebel Jens , Bock Margret
Published: May 2021

Background

Successful renal transplantation requires complex medication regimens that rely on strict adherence to be effective. Variability in immunosuppression exposure, specifically tacrolimus, is associated with poor allograft outcomes. Wide intra‐patient variability of tacrolimus trough concentrations (Vtac) is likely, in part, attributable to regimen complexity and poor medication adherence. Once‐daily tacrolimus formulations create opportunity to simplify therapeutic regimens, and this study aims to evaluate their impact on Vtac and ultimately transplant outcomes.

Methods

This retrospective cohort study investigated stable (AYA) renal transplant recipients converted from (IR‐Tac) to (ER‐Tac). Subjects served as their own controls. Vtac was assessed by measuring the (SD) of serial tacrolimus trough concentrations prior to and at four time points post‐conversion to ER‐Tac over 24‐month follow‐up. Secondary outcome measures included graft function, infection rates, and effect on modifiable treatment‐related factors.

Results

Twenty‐eight AYA subjects were converted from IR‐Tac to ER‐Tac. Vtac significantly improved following conversion and was sustained for 24 months (Vtac0 2.32 vs. Vtac24 1.11, p .017). Renal function remained stable, and (BPAR) rates were modest (14%). Mean pill burden was reduced by 15%, and 42.9% of subjects achieved a once‐daily medication regimen.

Conclusions

Conversion from IR‐Tac to ER‐Tac in this AYA population significantly improved Vtac with sustained effect over 2 years. This effect is likely attributable in part to simplification of the medication regimen and presumably improved medication adherence. Such conversion does not appear to compromise graft function for at least 2 years post‐conversion.