bluuebunny/crossref_metadata_2025 huggingface dataset:
Farewell to the requirement for character independence: phylogenetic methods to incorporate different types of dependence between characters
Authors: Goloboff Pablo A. , De Laet Jan
Published: November 2023

This paper discusses methods to take into account interactions between characters, in the context of parsimony analysis. These interactions can be in the form of some characters becoming inapplicable given certain states of other, primary characters; in the form of only certain states being allowed in some characters when a given state or set of states occurs for other characters; or in the form of transformation costs in some character being higher or lower when other characters have certain states or transformations between states. Character–state reconstructions and evaluation of trees under the assumption of independence may easily lead to ancestral assignments that violate elementary rules of biomechanics, well‐established theories relating form and function or ideas about character co‐variation. An obvious example is reconstructing an ancestral bird as wingless and flying at the same time; another is reconstructing a protein‐coding gene as having a stop codon in some ancestors. If the characters are optimized independently, such chimeric ancestral reconstructions can occur even when no terminal displays the impossible combination of states. A set of conventions (implemented via new TNT commands and options) allows the definition of complex rules of interaction. By recoding groups of characters with proper step–matrix costs (and excluding impossible combinations from the set of permissible states), it is possible to find the ancestral reconstructions that maximize homology (and thus the degree to which similarities can be explained by common ancestry), within the constraints imposed by the rules specified by the user. We expect that considerations of biomechanics, functional morphology and natural history will be a source of many theories on possible character dependences, and that the present implementation will encourage users to take the possibility of character dependences into account in their phylogenetic analyses.
Complications of acute mastoiditis in a paediatric population at a UK Tertiary Centre: A retrospective review
Authors: Heywood Emily G. , Stubington Thomas , Chandarana Karishma , Bowerman Kathryn , Baruah Paramita
Published: November 2023

Objectives

Acute mastoiditis (AM) and its associated intra and extracranial complications are rare complications of acute otitis media. However, they are associated with a high morbidity. The management of AM with complications carries significant variations in approach. We aimed to evaluate the presentation of children with AM with complications to a tertiary referral centre in the United Kingdom and describe evolution of the treatment approaches.

Methods

We undertook a retrospective chart review of all children admitted with AM to the University Hospitals of Leicester between 2013 and 2022.

Results

Twenty‐seven children were included in this study: 7 patients had sigmoid sinus thrombosis (SST), 4 had an intracranial collection, 3 had cranial nerve palsy and 16 had a subperiosteal abscess (SPA); some patients had more than 1 complication. In this study, treatment of SPA with incision and drainage (I&D) and grommet insertion was effective, as all patients treated with grommet insertion and I&D recovered well and did not require a subsequent cortical mastoidectomy. All patients with SST received anticoagulation and intravenous (IV) antibiotics; surgical input consisted of grommet insertion alone and cortical mastoidectomy was not routinely performed in these patients.

Conclusion

In our series, management of SPA with grommet insertion and drainage had good outcomes. SST management mainly consisted of IV antibiotics, anticoagulation and grommet insertion with good recovery. The evidence to guide the management of complications of mastoiditis is of poor quality and further research is needed to clarify the optimal management of these complications.
Impact of a cuff‐based device calibration method on the agreement between invasive and noninvasive aortic and brachial pressure
Authors: Bia Daniel , Salazar Federico , Cinca Luis , Gutierrez Marcos , Facta Álvaro , Diaz Alejandro , Zócalo Yanina
Published: November 2023

Introduction

Brachial cuff‐based methods are increasingly used to estimate aortic systolic blood pressure (aoSBP). However, there are several unresolved issues.

Aims

to determine to what extent the scheme used to calibrate brachial records (1) can affect noninvasive obtained aoSBP levels, and consequently, the level of agreement with the aoSBP recorded invasively, and (2) how different ways of calibrating ultimately impact the relationship between aoSBP and cardiac properties.

Methods

brachial and aortic blood pressure (BP) was simultaneously obtained by invasive (catheterisation) and noninvasive (brachial oscillometric‐device) methods (89 subjects). aoSBP was noninvasive obtained using three calibration schemes: ‘SD’: diastolic and systolic brachial BP, ‘C’: diastolic and calculated brachial mean BP (bMBP), ‘Osc’: diastolic and oscillometry‐derived bMBP. Agreement between invasive and noninvasive aoSBP, and associations between BP and echocardiographic‐derived parameters were analysed.

Conclusions

‘C’ and ‘SD’ schemes generated aoSBP levels lower than those recorded invasively (mean errors: 6.9 and 10.1 mmHg); the opposite was found when considering ‘Osc’(mean error: −11.4 mmHg). As individuals had higher invasive aoSBP, the three calibration schemes increasingly underestimated aoSBP levels; and viceversa. The ‘range’ of invasive aoSBP in which the calibration schemes reach the lowest error level (−5–5 mmHg) is different: ‘C’: 103–131 mmHg; ‘Osc’: 159–201 mmHg; ‘SD’:101‐124 mmHg. The calibration methods allowed reaching levels of association between aoSBP and cardiac characteristics, somewhat lower, but very similar to those obtained when considering invasive aoSBP. There is no evidence of a clear superiority of one calibration method over another when considering the association between aoSBP and cardiac characteristics.
Understanding the research capacity of alcohol and other drugs services in New South Wales, Australia
Authors: Stirling Robert , Hudson Suzie , Ross Joanne , Deans Emily , Tibbetts Joel , Day Carolyn , Deacon Rachel , Dunlop Adrian , Lintzeris Nicholas
Published: November 2023

Introduction

Enhancing health system research capacity can support improved quality care. This study assessed the research capacity of public local health district (LHD) and non‐government organisation (NGO) alcohol and other drug (AOD) services, at the organisational, team and individual level. Research barriers and motivators were also examined.

Methods

Staff from LHD and NGO AOD treatment services in New South Wales completed an online survey using the Research Capacity and Culture (RCC) tool. Overall median research capacity scores are presented for the RCC subscales (organisational, team and individual). Comparisons were conducted by service type (LHD/NGO), geographical location (metropolitan/rural) and affiliation with a research network (yes/no). Qualitative questions explored barriers and motivators to research at individual and team levels.

Results

Of 242 participants, 55% were LHD‐based and 45% NGO‐based. Overall RCC scores indicated moderate research capacity at all levels. Organisational capacity (Med = 6.50, interquartile range [IQR] = 3.50) scored significantly higher than the team (Med = 5.00, IQR = 6.00) and individual level (Med = 5.00, IQR = 4.25). No differences in RCC scores existed between NGOs and LHDs. Metropolitan AOD services scored higher research capacity at the organisational level (Med = 7.00, IQR = 3.00) than rural services (Med = 5.00, IQR = 5.00). LHDs affiliated with a research network scored significantly higher at the organisational, team and individual level than non‐affiliated LHD services. Key research barriers were inadequate time and funding. Motivators included skill development and problem‐identification requiring change.

Discussions and Conclusions

AOD services in New South Wales have moderate research capacity. Identified barriers and motivators can be used to target responses that enhance capacity and improve treatment outcomes.
Management practices influence biocontrol potential of generalist predators in maize cropping systems
Authors: Puliga Giovanni Antonio , Sprangers Timo , Huiting Hilfred , Dauber Jens
Published: November 2023

Intensification of conventional agriculture is a leading cause of negative environmental impact, loss of biodiversity, and reduced delivery of ecosystem services in agroecosystems. Maize, due to its growth habits and cultivation management, provides a poor habitat for beneficial arthropods. Several strategies are available to make maize cropping systems more sustainable and to promote biodiversity at field level. The present study evaluates the effects of various maize cropping systems – precisely, maize continuous monoculture, maize multiple cropping, and three mixed cropping systems (maize‐runner bean, maize‐sorghum, and maize‐flower strips) – on generalist predators and their biological control potential. Overall, we found that the reference system with maize continuous monoculture and conventional crop management had the lowest activity of generalist predators compared in particular to the low‐input mixed cropping systems. Higher activity density and biocontrol potential were found in the systems that provided a dense and permanent vegetation cover of the ground (i.e., maize/sorghum, maize/flower strip). Although these effects were not consistent for all the parameters investigated and for every sampling date, we conclude that generalist predators can benefit from more conservative management practices in maize systems, thereby enhancing their biological pest control potential. Furthermore, spatial intercropping may represent a valid alternative to the conventional monocultural crop system to support the delivery of biodiversity‐mediated ecosystem services towards a more sustainable system.
Prevalence and clinical profile of comorbid anxiety in young adult patients with first‐episode and drug‐naive major depressive disorder
Authors: Luo Rui‐Chen‐Xi , Wang Dongmei , Zhou Huixia , Lang Xiao E , Zhang Xiang‐Yang
Published: November 2023

Aim

Patients with major depressive disorder (MDD) frequently have coexisting anxiety disorders. However, few studies have focused on the prevalence and risk factors of comorbid anxiety symptoms in young adult first‐episode and drug‐naive (FEDN) MDD patients.

Methods

We recruited 520 FEDN MDD patients and collected their demographic and clinical data. The Hamilton Depression Rating Scale (HAMD), the Hamilton Anxiety Rating Scale (HAMA) and the positive scale of the Positive and Negative Syndrome Scale (PANSS) were used to measure depressive symptoms, anxiety symptoms and psychotic symptoms, respectively.

Results

Anxiety symptoms were found in 79.6% of young adult patients. Besides, anxiety group patients had a higher prevalence of psychotic symptoms than the non‐anxiety group. Anxiety symptoms were substantially related to suicide attempts in young adult patients. Logistic analysis shows that suicide attempts and total HAMD scores were significantly associated with anxiety symptoms.

Conclusions

The findings show that anxiety symptoms are common in Chinese young adult MDD patients. The anxiety group was more likely to have psychotic symptoms, suicide attempts, and more severe depressive symptoms than the non‐anxiety group. Suicide attempts were associated with anxiety symptoms in young adult MDD patients, suggesting the importance of reducing anxiety symptoms in this population to prevent suicides.
Influence of feeding and other factors on adrenocorticotropin concentration and thyrotropin‐releasing hormone stimulation test in horses and ponies
Authors: Drozdzewska Karolina , Winter Judith , Barton Ann Kristin , Merle Roswitha , Gehlen Heidrun
Published: November 2023

Background

The basal (bACTH) and post‐thyrotropin‐releasing hormone stimulation concentration of adrenocorticotropin (pACTH) are recommended for diagnosis of pituitary pars intermedia dysfunction (PPID). Many factors influence bACTH (e.g., disease, age, month) and some affect the results only in autumn (e.g., breed, colour, sex). There are discrepancies about the impact of feeding on b/pACTH.

Objectives

To determine whether feeding, month, age, breed, colour, sex and body condition score affect b/pACTH.

Study design

Prospective crossover.

Methods

Sixty‐one animals were divided into groups: healthy, PPID, treated‐PPID. The b/pACTH was measured three times (1 mg protirelin; blood collection after 10 min; mid‐November to mid‐July) after different feedings: fasting, hay, hay + grain. Friedman's test was applied to evaluate the influence of feeding on b/pACTH and linear mixed model to evaluate impact of further factors.

Results

The b/pACTH was not significantly affected by feeding (p = 0.7/0.5). The bACTH was lowest in healthy (29.3 pg/mL, CI 9–49.5 pg/mL) and highest in PPID‐group (58.9 pg/mL, CI 39.7–78.1 pg/mL). The pACTH was significantly lower in healthy (396.7 pg/mL, CI 283.2–510.1 pg/mL) compared to PPID (588.4 pg/mL, CI 480.7–696.2 pg/mL) and treated‐PPID group (683.1 pg/mL, CI 585.9–780.4 pg/mL), highest in July (881.2 pg/mL, CI 626.3–1136.3 pg/mL) and higher in grey (723.5 pg/mL, CI 577.5–869.4 pg/mL) than other colours (338.7 pg/mL, CI 324.8–452.5 pg/mL). The size of effect for those variables was >0.5.

Main limitations

Small number of animals, subsequent bACTH measurements were significantly lower in each horse.

Conclusions

There was no evidence that feeding influences the b/pACTH. There was evidence that pergolide affects the bACTH but it had little effect on pACTH. Further investigation of the impact of month and coat colour on b/pACTH is warranted to better interpret the results.
Prospective pilot study evaluating a vitamin D3 loading dose in critically ill children with vitamin D deficiency
Authors: Covington Elizabeth W. , Jasper‐Trotter Shaneese L. , Arnold Robert D. , Amin Raj , Egbert Susan , Chung Allison
Published: November 2023

Background

Vitamin D deficiency is a common finding in critically ill children. However, the optimal supplementation strategy in this patient population is unknown. The objective of this study was to evaluate the effects of high‐dose (10 000 IU/kg, max. 400 000 IU) vitamin D supplementation on 25‐hydroxyvitamin D3 (25[OH]D3) levels in pediatric intensive care unit (PICU) patients with baseline vitamin D deficiency.

Methods

This was a prospective, institutional review board‐approved pilot research study performed at the University of South Alabama Women's and Children's Hospital in Mobile, AL. The study sample consisted of patients less than 18 years old admitted to the PICU with baseline 25‐hydroxyvitamin D (25[OH]D) level less than 30 ng/ml. Included patients received a one‐time dose of vitamin D3 orally or via gastric tube (10 000 IU/kg, max. 400 000 IU).

Results

A total of 17 patients were screened with 11 included in the study. Blood analysis revealed a significant increase in 25(OH)D3 level from baseline to 12‐h post dose (21.6 [4.5] ng/ml vs. 46.7 [15.5] ng/ml, P < 0.001). At the 12‐h post‐dose time point, 10/11 patients (91%) had 25(OH)D3 levels that were greater than 30 ng/ml. No adverse effects were observed.

Conclusion

Vitamin D3 supplementation at a dose of 10 000 IU/kg (max. 400 000 IU) significantly increased 25(OH)D3 levels in critically ill pediatric patients.
Development of a decision‐support framework to support professionals and promote comfort among older hospital inpatients living with dementia
Authors: Davies Nathan , West Emily , Smith Ellen M. , Vickerstaff Victoria , Manthorpe Jill , Shah Malvi , Rait Greta , Wilcock Jane , Ward Jane , Sampson Elizabeth L.
Published: November 2023

Background

Acute hospital wards can be difficult places for many people living with dementia. Promoting comfort and wellbeing can be challenging in this environment. There is little evidence‐based support for professionals working on acute care wards on how to respond to distress and maximise comfort and wellbeing among patients living with dementia.

Objectives

Our overall aim was to codesign an evidence‐based easy‐to‐use heuristic decision‐support framework, which was acceptable and practical but acknowledges the complex and acute nature of caring for patients with dementia in the hospital. This paper presents the development process and resulting framework.

Methods

A codesign study was informed by data from (1) a literature review of the care and management of people living with dementia in acute hospitals; (2) a cohort study of comfort and discomfort in people with dementia in acute hospitals; and (3) interviews with family carers and health care professionals. We synthesised evidence from these data sources and presented to key stakeholders through codesign meetings and workshops to produce our decision‐support framework.

Results

The framework consists of a series of flowcharts and operates using a three‐stage process of: (1) assess comfort/discomfort; (2) consider causes of discomfort; and (3) address patient needs to manage the discomfort.

Conclusion

Working with key stakeholders, synthesising diverse quantitative and qualitative evidence to build a clinical framework is a feasible approach to help address the needs of patients living with dementia in an acute hospital setting. The result is a framework which is now ready for evaluation and implementation.

Patient and Public Contribution

We worked closely with people living with dementia and family carers throughout this study, including the development of the study protocol with input on study development and design, through to inclusion in stakeholder workshops and codesign of the decision support framework.
Tumour 63 protein (p63) in breast pathology: biology, immunohistochemistry, diagnostic applications, and pitfalls
Authors: Alkhayyat Rabab , Abbas Areeg , Quinn Cecily M , Rakha Emad A
Published: November 2023

Tumour protein 63 (p63) is a transcription factor of the p53 gene family, encoded by the TP63 gene located at chromosome 3q28, which regulates the activity of genes involved in growth and development of the ectoderm and derived tissues. p63 protein is normally expressed in the nuclei of the basal cell layer of glandular organs, including breast, in squamous epithelium and in urothelium. p63 immunohistochemical (IHC) staining has several applications in diagnostic breast pathology. It is commonly used to demonstrate myoepithelial cells at the epithelial stromal interface to differentiate benign and in situ lesions from invasive carcinoma and to characterize and classify papillary lesions including the distinction of breast intraduct papilloma from skin hidradenoma. p63 IHC is also used to identify and profile lesions showing myoepithelial cell and/or squamous differentiation, e.g. adenomyoepithelioma, salivary gland‐like tumours including adenoid cystic carcinoma, and metaplastic breast carcinoma including low‐grade adenosquamous carcinoma. This article reviews the applications of p63 IHC in diagnostic breast pathology and outlines a practical approach to the diagnosis and characterization of breast lesions through the identification of normal and abnormal p63 protein expression. The biology of p63, the range of available antibodies with emphasis on staining specificity and sensitivity, and pitfalls in interpretation are also discussed. The TP63 gene in humans, which shows a specific genomic structure, resulting in either TAp63 (p63) isoform or ΔNp63 (p40) isoform. As illustrated in the figure, both isoforms contain a DNA‐binding domain (Orange box) and an oligomerization domain (Grey box). TAp63 contains an N‐terminal transactivation (TA) domain (Green box), while ΔNp63 has an alternative terminus (Yellow box). Antibodies against conventional pan‐p63 (TP63) bind to the DNA binding domain common to both isoforms (TAp63 and p40) and does not distinguish between them. Antibodies against TAp63 bind to the N‐terminal TA domain, while antibodies specific to ΔNp63 (p40) bind to the alternative terminus. Each isoform has variant isotypes (α, β, γ, δ, and ε).
Antioxidant properties of wheat bran FOs prepared by Bacillus amyloliquefaciensIT‐45 fermentation
Authors: Yu Xiaohong , Mao Wanjie , Gao Wenbo , Liu Jinbin , Wang Bingqian , Zhang Xiaoyang , Liu Xiaochen , Wang Dujun , Lyu Yongmei
Published: November 2023

As functional oligosaccharides, feruloyl oligosaccharides (FOs) exhibit the physiological activities of both ferulic acid and oligosaccharides. In this study, FOs were prepared by fermenting wheat bran with the generally recognised as safe (GRAS) bacterium Bacillus amyloliquefaciens IT‐45. On the fourth day of fermentation, the activities of xylanase and cellulase reached 447.67 and 33.41 U/mL, respectively. UV, FTIR, and HPLC were used to characterise the structure properties of wheat bran FOs from B. amyloliquefaciens IT‐45 fermentation. The monosaccharide compositions of FOs were mainly composed of xylose and arabinose. Under the optimal conditions of fermentation time of 4 days, fermentation temperature of 25 °C, initial pH of 6.5 and inoculation amount of 11% (v/v), the maximum yield of FOs in the broth was 0.6397 mM. In vitro antioxidant activity analysis showed that FOs prepared by B. amyloliquefaciens fermentation had good scavenging ability against ABTS, DPPH and hydroxyl radicals, demonstrating the application potential. The results provided a relatively environmentally friendly and food‐safety way to prepare feruloyl oligosaccharides.
Investigation of cell wall characteristics of copigmented and coated whole blueberry fruit for improving anthocyanin stability under high hydrostatic pressure process and refrigerated storage
Authors: Lin Chieh‐Yi , Jung Jooyeoun , Zhao Yanyun
Published: November 2023

The combined copigmentation and layer‐by‐layer (LBL) hydrophobic coating technique was developed to preserve anthocyanins in thermally processed (TP) whole blueberry fruit in our previous study. This study investigated the impact of the developed technique on the cell wall composition and structure, anthocyanin stability and fruit firmness in non‐thermally (high hydrostatic pressure (HHP)) processed whole blueberry fruit during the refrigerated storage at 4 °C ~ 7 °C. Meanwhile, the wet‐milling process was utilised to treat cellulose nanofiber (CNF) based first layer coating for enhancing adhesion and improving the appearance of LBL coating on the fruit. The developed anthocyanin preservation technique retained significantly (P < 0.05) higher chelator‐soluble pectin in both thermally and HHP processed fruit (102.8 ± 7.0 and 100.8 ± 5.1 mg g−1 dry fruit skin, respectively). The technique also enhanced fruit anthocyanin stability reflected by the bathochromic and hyperchromic effect on fruit skin extract. In addition, it significantly (P < 0.05) enhanced the firmness of HHP (551.2 ± 80.7 g) or TP (579.8 ± 90.9 g) processed fruit during the refrigerated or ambient storage compared with control (488.9 ± 75.8 g). The wet‐milling process was able to fibrillate aggregated cellulosic fibres in the coating suspension, thus improved the adhesion and appearance of LBL coating onto the fruit surface. This study demonstrated that the combined copigmentation and LBL coating, along with wet milling treatment of CNF‐based coating, can effectively preserve anthocyanins in HHP processed whole blueberry fruit during extended refrigeration storage owning to the modification of fruit surface cell wall composition and structure.
Effect of retort processing, containers and motion types on digestibility of black beans (Phaseolus vulgaris L.) starch
Authors: Punia Bangar Sneh , Whiteside Scott
Published: November 2023

With the growing demand for convenient and shelf‐stable canned beans, understanding the changes in starch digestibility due to retort processing is crucial for optimising nutritional quality and enhancing consumer health. The present study investigated the impact of retort processing, specifically container type and agitation, on the digestibility of black bean starch. Retort pouches exhibited a more rapid heat transfer rate to the enclosed product than cans, which reduced the overall processing duration. Also, the processing time to achieve a Fo = 6 of Clostridium botulinum was almost 2.5 min (pouches) and 3.2 min (cans) faster for the oscillating than the static mode. The in vitro digestibility data revealed that the retort processing of black beans led to an increase in rapidly digestible starch (RDS) from 10.51% to 32.11%. However, slowly digestible starch (SDS) decreased from 15.67% to 7.89%, and resistant starch (RS) decreased from 47.91% to 11.86%, regardless of the container type and motion involved. Processing enhanced starch digestibility in all the combinations of container and motions; nevertheless, black beans in pouches with oscillatory motion still contain a relatively significant amount of SDS and RS than the other combinations. These findings have important implications for the food industry in optimising processing techniques and packaging strategies to preserve the nutritional value of black beans. The findings of this study can have practical implications for food producers engaged in the retort processing of foods contained in pouches and cans. The investigation will provide insights into how the process of retort sterilisation affects digestibility, including slowly digestible starch and resistant starch of different types of starch.
Common variable immunodeficiency, cross currents, and prevailing winds
Authors: Romberg Neil , Le Coz Carole
Published: November 2023

Common variable immunodeficiency (CVID) is a heterogenous disease category created to distinguish late‐onset antibody deficiencies from early‐onset diseases like agammaglobulinemia or more expansively dysfunctional combined immunodeficiencies. Opinions vary on which affected patients should receive a CVID diagnosis which confuses clinicians and erects reproducibility barriers for researchers. Most experts agree that CVID's most indeliable feature is defective germinal center (GC) production of isotype‐switched, affinity‐maturated antibodies. Here, we review the biological factors contributing to CVID‐associated GC dysfunction including genetic, epigenetic, tolerogenic, microbiome, and regulatory abnormalities. We also discuss the consequences of these biological phenomena to the development of non‐infectious disease complications. Finally, we opine on topics and lines of investigation we think hold promise for expanding our mechanistic understanding of this protean condition and for improving the lives of affected patients.
I have not come here because I have nothing better to do: The lived experience of presenting to the emergency department for people with a psychosocial disability and an NDIS plan—A qualitative study
Authors: McIntyre Heather , Loughhead Mark , Hayes Laura , Allen Caroline , Barton‐Smith Dean , Bickley Brooke , Vega Louis , Smith Jewels , Wharton Ursula , Procter Nicholas
Published: November 2023

Almost 60 000 people have a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan. As PSD can be a fluctuating condition, people with a PSD and an NDIS plan, at times, may require crisis care and present to the emergency department (ED). This national study explored the experiences of people with a PSD and an NDIS plan when presenting to the ED. To understand the unique lived experience of people with a PSD and an NDIS plan, semi‐structured interviews were conducted with 24 people between March and November 2022 and were analysed thematically. A lived experience advisory group was engaged as part of the research team. Participants were asked about their experiences in the ED including barriers to therapeutic care and what worked well. Participants reported emotional distress caused by receiving a biomedical rather than a person‐centred mental health response. A previous mental health history overshadowed diagnostic decisions and most participants interviewed stated they would not choose to return to the ED. Half of the participants spoke of one presentation only where needs were met. Four main themes emerged from the data: (a) Diagnostic overshadowing; (b) Judgement and stigma; (c) Waiting without hope; and (d) If things went well. This study provides evidence of the unique lived experience of people with a PSD and an NDIS plan when presenting to the ED. The results highlight the need for clinicians in the ED to understand the complexity and nuances of supporting people with a PSD. Recommendations for a person‐centred care approach are provided. Alternative support options for this group of people need to be explored.
Predictive model for temporomandibular disorder in adolescents: Decision tree
Authors: Waked Jorge Pontual , de Aguiar Camilla Siqueira , Aroucha João Marcílio Coelho Neto Lins , Godoy Gustavo Pina , de Melo Ricardo Eugenio Varela Ayres , Caldas Arnaldo
Published: November 2023

Background

Temporomandibular disorders (TMD) do not only occur in adults but also in adolescents, with negative impacts on their development.

Aim

To propose a predictive model for TMD in adolescents using a decision tree (DT) analysis and to identify groups at high and low risk of developing TMD in the city of Recife, PE, Brazil.

Design

This cross‐sectional study was conducted in Recife on 1342 schoolchildren of both sexes aged 10–17 years. The analyses were performed using Pearson's chi‐squared test and Fisher's exact test, as well as the CHAID algorithm for the construction of the DT. The SPSS statistical program was used.

Results

The prevalence of TMD was 33.2%. Statistically significant associations were observed between TMD and sex, depression, self‐reported orofacial pain, and orofacial pain on clinical examination. The DT consisted of self‐reported orofacial pain, orofacial pain on physical examination, and depression, with an overall predictive power of 73.0%.

Conclusion

The proposed tree has a good predictive capacity and permits to identify groups at high risk of developing TMD among adolescents, such as those with self‐reported orofacial pain or orofacial pain on examination associated with depression.
Association between psychological factors and molar–incisor hypomineralization: A cross‐sectional study
Authors: Mafla Ana Cristina , Orozco‐Tovar Ana Elizabeth , Ortiz‐Gómez Floralba , Ortiz‐Pizán Álvaro Javier , González‐Ruano Andrea Viviana , Schwendicke Falk
Published: November 2023

Background

Molar–incisor hypomineralization (MIH) is a developmental enamel defect characterized by opacities from white to brownish color. A suspected multifactorial etiology has been suggested, whereas psychological factors during pregnancy have only been limitedly analyzed.

Aim

We assessed the association between stress, depression, and anxiety in pregnancy and the presence of MIH in children at a later age.

Design

Using a cross‐sectional Web‐based questionnaire, we included 384 mothers who had children aged 6 and 12 years from Pasto, Colombia. Data were collected between October 2021 and March 2022. Sociodemographic variables; maternal and child factors related to prenatal, natal, or postnatal problems; and psychological factors such as stress and symptoms of anxiety and depression in pregnancy were inquired. Utilizing photographs depicting MIH lesions, mothers assessed their child's MIH status. A directed acyclic graph (DAG) analysis was performed to create causal assumptions, and logistic regression models were estimated to evaluate these assumptions. p‐value was set at p < .05.

Results

The prevalence of MIH was 33.3%; 12.8% of the participants exhibited hypomineralization in both molars and incisors. DAG analysis and logistic regression models determined that MIH (present or not) was associated with symptoms of maternal depression (ORadj = 3.26, 95% CI: 1.92–5.52, p < .001), and MIH (both molars and incisors) was associated with symptoms of maternal anxiety (ORadj = 3.49, 95% CI: 1.80–6.76, p < .001).

Conclusion

Psychological factors, among others, were significantly associated with the presence of MIH.
Influence of environmental risk factors on the development of wounds associated with squamous cell carcinoma
Authors: Jia Yulei , Chen Fengchao , Yan Tongtong , Zhang Siya , Salem Mohamed M. , Singh Soumya , Salem‐Bekhit Mounir M. , Kumar Sanjay Kirshan , Ali Muhammad Mehr
Published: November 2023

The incidence of squamous cell carcinoma (SCC) is on the rise, making it a significant global health concern. Environmental risk factors are crucial to the development of SCC. This study sought to examine comprehensively the impact of these factors on the onset of SCC. We conducted a cross‐sectional study involving 480 participants at Beijing tertiary care hospital. Utilizing structured questionnaires, data on demographics, environmental exposures, medical history and clinical characteristics were collected. The cohort was composed of 272 men (56.67%) and 208 women (43.33%). The majority (44.38%) were between ages of 41 and 60, and Type III skin predominated (34.79%). Most of the participants belonged to the middle socioeconomic class (60.83%). ‘Vegetarian’ dietary habits (46.67%) were prevalent, as was the ‘Sedentary’ lifestyle (49.79%). Regarding environmental exposures, moderate sun exposure of 3 to 5 h per day (54.58%) and UV protective eyewear (30.83%) were prevalent. The majority (69.58%) of respondents indicated ‘Never’ exposure to carcinogens. A variety of wound characteristics were observed, with ‘non‐smokers’ (64.17%) dominating. Most SCC lesions were located on the extremities (40.21%), lasted less than 6 months (44.38%) and measured 1–3 cm (39.79%). The majority (54.58%) did not have a history of cutaneous injuries. Our research uncovered substantial relationships between SCC and numerous environmental variables, gender, Fitzpatrick skin type, occupation, duration of sun exposure, exposure to carcinogens, dietary practices, history of skin wounds, wound location, duration, size and depth were significantly associated with the onset of SCC. These results highlighted the complexity of SCC aetiology and need for individualized prevention and treatment strategies.
Experiences and needs of adult informal carers of adults at risk of suicide: A systematic review with mixed methods analysis
Authors: Lascelles Karen Moya , Davey Zoe , Jackson Debra , Aveyard Helen
Published: November 2023

Aim

To systematically review and synthesize primary research on experiences and needs of adult informal caregivers of adults at risk of suicide.

Design

Systematic review with a data‐based convergent synthesis.

Data Sources

MEDLINE, PsychINFO and CINAHL were searched in April 2022 and February 2023. English language research focusing on experiences of adult carers of adults was included.

Methods

Articles were screened by title (n = 9077) and abstract (n = 132) with additional articles (n = 6) obtained via citation and hand searching. Thirty‐one included studies were quality assessed using the Mixed Methods Appraisal Tool and study data were systematically extracted prior to thematic synthesis.

Results

Five interconnected themes resulted: transitions; living with fear and uncertainty; changing relationships; interface with healthcare professionals and services; what carers need and want. Caring impacts mental, physical and social wellbeing. Relationships are affected in ways which might not be evident when caring for a minor. Repeated suicidal behaviour is particularly challenging with ongoing hypervigilance contributing to burden, burnout and interpersonal strain. Poor carer support exacerbates negative effects; carers need to feel informed, educated, involved and holistically supported.

Conclusion

Timely support for carers is essential. Interventions should address emotional responses, relational changes and effective care recipient support. Longitudinal research is required to understand effects of ongoing caring where there are multiple suicide attempts.

Implications

Nurses can provide carers with early support and information and longer term psychosocial interventions. If carers are adequately equipped and supported patient safety and wellbeing will be improved.

Impact

Findings of this systematic review include relational changes due to carer hypervigilance reducing autonomy and living with the possibility of suicide. Clinician awareness of the potential for relational shifts will help them prepare and support carers.

Patient or Public Contribution

There was no patient or public contribution.
Role of health literacy profiles in fluid management of individuals receiving haemodialysis: A cross‐sectional study
Authors: Chen Chen , Zheng Jing , Liu Xu , Liu Jiali , You Liming
Published: November 2023

Aims

To identify health literacy profiles in individuals receiving haemodialysis and to explore how these profiles interact with individuals' self‐efficacy, engagement with traditional dietary habits, self‐reported fluid restriction and relative‐interdialytic weight gain.

Design

A cross‐sectional study engaging nephrology departments from four hospitals in Guangdong Province, China.

Methods

A sample of 433 individuals receiving haemodialysis participated between December 2018 and July 2019. We assessed health literacy, self‐efficacy and self‐reported fluid restriction using the Health Literacy Questionnaire, the Fluid Self‐efficacy Scale and the Fluid Adherence Subscale, respectively. Traditional dietary habits, including daily tea drinking, soup drinking and preserved food consumption, were measured using three yes/no questions. Relative‐interdialytic weight gain was calculated by dividing the mean interdialytic weight gain (from three recent intervals) by dry weight. Latent profile analysis and structural equation modelling were performed.

Results

Three health literacy profiles were identified: low, moderate and high. Compared to those in the low health literacy profile, individuals in high and moderate health literacy profiles demonstrated an indirect association with reduced relative‐interdialytic weight gain. This reduction can be attributed to their higher self‐efficacy levels, decreased reliance on dietary habits and higher self‐reported fluid restrictions.

Conclusions

Most participants exhibited either low or moderate levels of health literacy. Improving health literacy has the potential to promote self‐efficacy and foster effective fluid restriction, ultimately leading to a reduction in relative‐interdialytic weight gain in individuals receiving haemodialysis.

Impact

This study reveals heterogeneity in health literacy levels among individuals receiving haemodialysis and illuminates the connections between an individual's entire spectrum of health literacy and fluid management. These findings provide valuable insights for developing person‐centred fluid management interventions, especially for individuals with diverse cultural dietary backgrounds within the haemodialysis population.

Reporting Method

We adhered to the STROBE guideline.

Patient or Public Contribution

Patients were included only for collecting their data.
The impact of COVID‐19 on nursing students' lives and online learning: A cross‐sectional survey
Authors: Griscti Odette , Sammut Roberta , Camilleri Liberato , Phee‐Donovan Erica
Published: November 2023

Aims

To explore the impact of COVID‐19 on students' lives and their online learning experience.

Design

A cross‐sectional survey design was used in this study.

Methods

A total of 44 nursing students who were enrolled in an undergraduate programme at a Canadian University participated in the study. The students were asked to fill out a 35‐item survey that was developed by the European Students' Union and that was circulated across Europe in April 2020.

Results

The COVID‐19 pandemic and subsequent lockdown affected students mentally, and emotionally. Findings also revealed that whilst most students had the privilege to study from home, many students did not have a desk, or a quiet place to study in their home and some had problems with Internet connectivity. Online lectures were delivered according to students' preferences; however, students were dissatisfied with the way their practice was organized.

Conclusion

The similarities between this study and the European study provide common grounds for academics around the world to connect, collaborate and work on the challenges in providing nurse education in emergencies such as national disasters or pandemics to ensure preparedness for such future events.

Patient or Public Contribution

No Patient or Public Contribution.

Impact

The commonalities experienced in nursing education across the globe should act as an impetus for globalized nursing action. Educators need to prepare and reinvent a role for students in the clinical area in the event of future disasters/pandemics. Policy makers and administrators need to ensure when switching to online education no student is underprivileged or marginalized in the process.
Left atrial strain is a good predictor of atrio‐ventricular synchrony in leadless pacemaker pacing
Authors: Troisi Federica , Caccavo Vincenzo P. , Santobuono Vincenzo E. , Sgarra Luca , Carella Maria C. , Basile Paolo , Guaricci Andrea I. , Grimaldi Massimo
Published: November 2023

Introduction

The importance of atrio‐ventricular synchrony pacing in sinus rhythm patients is known. To identify patients in whom leadless pacemakers are able to guarantee this atrio‐ventricular synchrony, we explored correlations among echocardiographic measures of left atrial (LA) size and function (doppler parameter and strain) with A4 amplitude in patients implanted with new generation Micra‐AV device.

Methods

After implantation with Micra‐AV system, patients underwent device interrogation to evaluate AV synchrony based on the sensing of atrial mechanics and echocardiographic exam to assess LA morphology and LA function.

Results

In the 21 studied patients (14 males, 72 ± 13 years), the A4 wave amplitude values inversely correlated with LA antero‐posterior diameter, LA volume, LA contraction strain and LA conduit strain, while they were positively related with LA reservoir strain.

Discussion

Our results indicate a statistically significant relationship between morphological echocardiographic LA parameters and atrial contraction signal (A4), detected by leadless pacemakers and used to synchronize ventricular pacing with the atrium. Instantaneous LA function assessment obtained with LA strain provides incremental information over morphological parameters. LA strain evaluates atrial myocardial deformation during the whole cardiac cycle. We found higher value of A4 in patients that have grater absolute value of LAsr, LAscd and LAsct, that are simple and measurable parameters of LA functional capacity.

Conclusion

Preimplant echocardiographic evaluation of the atrial contractility may be useful in predicting adequate A4 sensing and consequently a good atrio‐ventricular synchrony pacing. Echocardiography LA strain study seems promising in Micra‐AV patient selection.
Dynamic expression analysis of peripheral blood derived small extracellular vesicle miRNAs in sepsis progression
Authors: Liu Xinyan , Yu Dapeng , Li Tiantian , Zhu Kehan , Bi Yang , Wang Chaofan , Wang Chunting , Song Xuan
Published: November 2023

Immune disorders caused by sepsis have recently drawn much attention. We sought to dynamically monitor the expression of small extracellular vesicle (sEV) miRNAs in peripheral blood during sepsis to explore these miRNAs as potential biomarkers for monitoring immune function in sepsis patients. This study included patients with sepsis. Blood samples were obtained from 10 patients on the first through 10th days, the 12th day and the 14th day since sepsis onset, resulting in 120 collected samples. Serum sEVs were extracted from peripheral venous blood, and levels of MIR497HG, miR‐195, miR‐497, and PD‐L1 in serum sEVs were detected by qPCR, and clinical information was recorded. Our study revealed that the levels of MIR497HG, miR‐195, miR‐497 and PD‐L1 in serum sEVs showed periodic changes; the time from peak to trough was approximately 4–5 days. The levels of sEV MIR497HG and miR‐195 had a positive linear relationship with SOFA score (r values were −0.181 and −0.189; p values were 0.048 and 0.039, respectively). The recorded quantities of sEV MIR497HG, miR‐195 and PD‐L1 showed a substantial correlation with ARDS. ROC curve analysis revealed that sEV MIR497HG, miR‐195 and miR‐497 could predict the 28‐day mortality of sepsis patients with an AUC of 0.66, 0.68 and 0.72, respectively. Levels of sEVs MIR497HG, miR‐195, miR‐497 and PD‐L1 showed periodic changes with the immune status of sepsis, which provides a new exploration direction for immune function biomarkers and immunotherapy timing in sepsis patients.
Phototherapy for atopic dermatitis: A survey of European practice
Authors: Steyn M. , Gerbens L. A. A. , Spuls P. I. , Mashayekhi S. , Deleuran M. , Barbarot S. , Wollenberg A. , Ferguson J. , Ibbotson S. , Flohr C.
Published: November 2023

Background

Phototherapy is used to treat atopic dermatitis (AD). Evidence for its efficacy, impact on quality of life, cost‐effectiveness and short‐ and long‐term safety with real‐life usage is weak.

Objectives

We established a taskforce to examine how phototherapy is currently being used as a treatment for AD across the United Kingdom and Europe to inform our understanding and guide future research into management of patients with AD using UV‐based phototherapies.

Methods

An anonymous electronic multiple‐response survey exploring phototherapy prescribing practices and experience of phototherapy modalities was developed by the study authors and sent to members of phototherapy networks from the United Kingdom and Europe. Responses were received between February and July 2021.

Results

About 144 respondents from 27 European countries completed the survey. NBUVB was the most widely used [n = 138 (96%)]. Home‐based NBUVB was available in 8/27 countries (25/144 respondents, 17%). Oral psoralen‐UVA (PUVA) was more widely available than bath PUVA (n = 106, 74% vs. n = 60, 42%) and used mainly in adult patients. 49/144 (34%) of respondents had access to UVA1. Phototherapy would be considered instead of systemic treatment in 96% of adults and 82% of children for NBUVB, versus 40% of adults and 3% of children for PUVA. Starting doses, standard dosing increments, length of treatment courses, lifetime limits for treatments and thresholds for performing annual skin assessments varied between responders.

Conclusions

NBUVB was the most widely used phototherapy for AD in adult and paediatric patients, while PUVA and UVA1 were less used. Prescribing practices varied considerably, highlighting the lack of consensus practice in many different aspects of phototherapy for the treatment of AD in children and adults. This indicates that further studies are required to determine optimal phototherapeutic regimens for AD and informs our understanding of parameters that should be included in future high‐quality randomized controlled trials (RCT) of phototherapy.