bluuebunny/crossref_metadata_2025 huggingface dataset:
Atypical de Winter ECG pattern may be the mirror image of ST elevation
Authors: Wang Jian , Li Jingsen , Diao Shuling , Xu Huipu , Ding Faming
Published: November 2021

Background: The de Winter ECG pattern of ST‐segment depression and tall symmetrical T waves, known as an ST elevation equivalent, accounts for approximately 2% of patients with occlusion of the proximal left anterior descending (LAD) coronary artery. The classic de Winter pattern is restricted to cases without ST elevation. However, mixed cases with different types of ST deviation have been described. Here, we describe an interesting case as an example of an ST elevation myocardial infarction (STEMI) equivalent, showing transient transmural ischemia of the inferolateral myocardium, with ECG changes that mimic the de Winter pattern.
Population‐based study of multisystem inflammatory syndrome associated with COVID‐19 found that 36% of children had persistent symptoms
Authors: Kahn Robin , Berg Stefan , Berntson Lillemor , Berthold Elisabet , Brodin Petter , Bäckström Fredrik , Compagno Michele , Fasth Anders , Lingman Framme Jenny , Horne AnnaCarin , Hätting Josefin , Król Petra , Kukka Antti J , Mossberg Maria , Månsson Bengt , Nordenhäll Charlotta , Idring Nordström Selma , Khammari Nyström Fatine , Palmblad Karin , Rasti Reza , Rudolph André , Rydenman Karin , Sundberg Erik , Säve‐Söderbergh Eva , Altman Maria
Published: November 2021

Aim

Our aim was to describe the outcomes of multisystem inflammatory syndrome in children (MIS‐C) associated with COVID‐19.

Methods

This national, population‐based, longitudinal, multicentre study used Swedish data that were prospectively collected between 1 December 2020 and 31 May 2021. All patients met the World Health Organization criteria for MIS‐C. The outcomes 2 and 8 weeks after diagnosis are presented, and follow‐up protocols are suggested.

Results

We identified 152 cases, and 133 (87%) participated. When followed up 2 weeks after MIS‐C was diagnosed, 43% of the 119 patients had abnormal results, including complete blood cell counts, platelet counts, albumin levels, electrocardiograms and echocardiograms. After 8 weeks, 36% of 89 had an abnormal patient history, but clinical findings were uncommon. Echocardiogram results were abnormal in 5% of 67, and the most common complaint was fatigue. Older children and those who received intensive care were more likely to report symptoms and have abnormal cardiac results.

Conclusion

More than a third (36%) of the patients had persistent symptoms 8 weeks after MIS‐C, and 5% had abnormal echocardiograms. Older age and higher levels of initial care appeared to be risk factors. Structured follow‐up visits are important after MIS‐C.
GELAD chemotherapy with sandwiched radiotherapy for patients with newly diagnosed stage IE/IIE natural killer/T‐cell lymphoma: a prospective multicentre study
Authors: Zhu Yang , Tian Shu , Xu Lan , Ma Yujie , Zhang Wenhao , Wang Lifeng , Jin Lina , Liu Chuanxu , Zhu Chuanying , Li Zhichao , Hao Siguo , Zhong Hua , Ding Hao , Tao Rong
Published: November 2021

Early‐stage natural killer/T‐cell lymphoma (NK/TCL) patients usually receive a combination of chemotherapy and radiotherapy, but the optimal treatment approach has not yet been established. This study aimed to investigate the efficacy and safety profile of a novel chemotherapy regimen and sandwiched radiotherapy in early‐stage NK/TCL. Patients with newly diagnosed stage IE/IIE disease were eligible. Patients were initially treated with two courses of the GELAD regimen (gemcitabine 1·0 g/m2 day 1, etoposide 60 mg/m2 days 1–3, pegaspargase 2000 units/m2 day 4, and dexamethasone 40 mg days 1–4), followed by intensity‐modulated radiotherapy (IMRT; 50–56 Gy in 25–28 fractions) and two additional courses of GELAD chemotherapy. A total of 52 patients were enrolled. The overall response rate and complete response rate per Lugano 2014 criteria were 94·2% and 92·3% respectively. With a median follow‐up of 32 months, the estimated four‐year overall survival rate and progression‐free survival rate were 94·2% [95% confidence interval (CI), 83·2% to 93·1%] and 90·4% (95% CI, 78·4% to 95·9%) respectively. The most common adverse events were related to pegaspargase. Haematological toxicities were mild, with grade 3/4 neutropenia in 15·4% of patients. Our study provides a new approach with high activity and improved safety for the treatment of early‐stage NK/TCL patients. This study was registered at www.clinicaltrials.gov as NCT02733458.
Parents experiences of having an infant with early onset group B streptococcus infection
Authors: McLeod Emma , Mason Celia , Swainston Katherine
Published: November 2021

Objectives

The study explores parents lived experience of having an infant with early onset group B streptococcus (GBS).

Design

The study adopts a qualitative approach and a phenomenological framework with written autobiographical accounts as the method of data collection.

Methods

Twenty‐seven parents wrote first‐hand accounts of their experience of having an infant with early onset GBS. Participants documented their experiences in their own way, reporting their thoughts and feelings, experiences, and events that were meaningful to them.

Results

Four themes were developed from data analysis: ‘bonding’; ‘grief’; ‘communication and information provision’; and ‘future family’.

Conclusions

The study findings demonstrate the complexity of emotions within parent’s experiences and highlight grief and loss as a core component of these experiences. Medical intervention, while acknowledged as being vital and in many cases lifesaving, was viewed as a disruption to early bonding experiences resulting in sadness and guilt. Variation in information provision, communication about this infection, and feeling that their infant’s illness and/or death were preventable added to the sense of loss. Breakdowns in interpersonal communications with partners and family were commonly described and experiences of early onset GBS had implications for decision‐making around future pregnancies.
Insecticide‐contaminated honeydew: risks for beneficial insects
Authors: Calvo‐Agudo Miguel , Tooker John F. , Dicke Marcel , Tena Alejandro
Published: November 2021

Honeydew is the sugar‐rich excretion of phloem‐feeding hemipteran insects such as aphids, mealybugs, whiteflies, and psyllids, and can be a main carbohydrate source for beneficial insects in some ecosystems. Recent research has revealed that water‐soluble, systemic insecticides contaminate honeydew excreted by hemipterans that feed on plants treated with these insecticides. This contaminated honeydew can be toxic to beneficial insects, such as pollinators, parasitic wasps and generalist predators that feed on it. This route of exposure has now been demonstrated in three plant species, for five systemic insecticides and four hemipteran species; therefore, we expect this route to be widely available in some ecosystems. In this perspective paper, we highlight the importance of this route of exposure by exploring: (i) potential pathways through which honeydew might be contaminated with insecticides; (ii) hemipteran families that are more likely to excrete contaminated honeydew; and (iii) systemic insecticides with different modes of action that might contaminate honeydew through the plant. Furthermore, we analyse several model scenarios in Europe and/or the USA where contaminated honeydew could be problematic for beneficial organisms that feed on this ubiquitous carbohydrate source. Finally, we explain why this route of exposure might be important when exotic, invasive, honeydew‐producing species are treated with systemic insecticides. Overall, this review opens a new area of research in the field of ecotoxicology to understand how insecticides can reach non‐target beneficial insects. In addition, we aim to shed light on potential undescribed causes of insect declines in ecosystems where honeydew is an important carbohydrate source for insects, and advocate for this route of exposure to be included in future environmental risk assessments.
Inequality in access to dental services in a market‐based dental care system: A population study from Norway 1975–2018
Authors: Jiang Nan , Grytten Jostein , Kinge Jonas Minet
Published: November 2021

Objective

To examine income‐related inequalities in access to dental services from 1975 to 2018. In Norway, dental care services for adults are privately financed. This may lead to income‐related inequalities in access. In the early 1970s, that is, at the beginning of the study period, there were marked inequalities in access to dental services according to personal income. However, from the beginning of the 1970s, there has been a large increase in gross national income per capita in Norway as a result of the growth of the oil and gas industry. This increase in income also meant that people with a low income in 1975 had a rise in their level of income. According to the law of diminishing utility, an increase in income leads to higher consumption of dental services for people with a low level of income compared to people with a high level of income. The study hypothesis is that the inequalities in access to dental services that existed in 1975 became less over time.

Methods

Statistics Norway collected samples of cross‐sectional health survey data for the following years: 1975, 1985, 1995, 2002, 2008, 2012 and 2018. For each sample, individuals 21 years and older were drawn randomly from the non‐institutionalized adult population using a two‐stage stratified cluster sample technique. Inequalities were measured using the concentration index. The dependent variable was the use of dental services during the last year, and the key independent variable was equivalized household income.

Results

The concentration index for inequalities in use of dental services according to income decreased from 0.10 (95% CI = 0.09, 0.11) in 1975 to 0.04 (95% CI = 0.03, 0.05) in 2018. The decrease was particularly large from 2002 to 2012. This was a period with a large growth in gross national income.

Conclusion

People with a low income had a marked increase in their purchasing power from 1975 to 2018. This coincided with an increase in demand for dental care for this low‐income group.
Erythritol air polishing in the surgical treatment of peri‐implantitis: A randomized controlled trial
Authors: Hentenaar Diederik F.M. , De Waal Yvonne C.M. , Stewart Roy E. , Van Winkelhoff Arie Jan , Meijer Henny J.A. , Raghoebar Gerry M.
Published: November 2021

Objectives

To compare erythritol air polishing with implant surface cleansing using saline during the surgical treatment of peri‐implantitis.

Material and Methods

During a resective surgical intervention, implant surfaces were randomly treated with either air polishing (test group n = 26 patients/53 implants) or saline‐soaked cotton gauzes (control group n = 31 patients/ 40 implants). Primary outcome was change in mean bleeding on probing (BoP) from baseline to 12 months follow‐up. Secondary outcomes were changes in mean suppuration on probing (SoP), plaque score (Plq), probing pocket depth (PPD), marginal bone loss (MBL), periodontal full‐mouth scores (PFMS), and levels of 8 classical periodontal pathogens. Clinical and radiographical parameters were analyzed using multilevel regression analyses. Microbiological outcomes were analyzed using the Mann–Whitney U test.

Results

No differences between the test and control group were found for BoP over 12 months of follow‐up, nor for the secondary parameters Plq, PPD, and MBL. Between both groups, a significant difference was found for the levels of SoP (p = 0.035). No significant effect on microbiological levels was found. A total number of 6 implants were lost in the test group and 10 in the control group. At 1‐year follow‐up, a successful treatment outcome (PPD<5 mm, max 1 out of 6 sites BoP, no suppuration and no progressive bone loss >0.5 mm) was achieved for a total of 18 implants (19.2%).

Conclusions

Erythritol air polishing as implant surface cleansing method was not more effective than saline during resective surgical treatment of peri‐implantitis in terms of clinical, radiographical, and microbiological parameters. Both therapies resulted in low treatment success.

Trial registry: https://www.trialregister.nl/ Identifier: NL8621.
“Good Design is Good Business”: An Empirical Conceptualization of Design Management Using the Balanced Score Card
Authors: Parkman Ian , Malkewitz Keven
Published: November 2021

Despite the increasing attention Design Management has received from academics and practitioners a definitive conceptualization or a widely‐agreed upon empirical measure of the construct does not yet exist. This paper proposes a new measurement of Design Management based on the informational elements captured in product design briefs. Exploratory Factor Analysis results suggest that Design Management is made up of eleven clusters: F1 Customer Insights; F2 Business Model; F3 Aesthetics; F4 Authenticity; F5 Symbolic/Experiential Value; F6 Functional Value; F7 Promotions/Distribution; F8 Sustainability; F9 Production/Development; F10 Project Management; F11 Risk/Safety. Our analysis describes how these factors show differing effects on measures of firm performance at the product project‐ and competitive advantage‐levels (for example, F1, F3, and F9 are strongly and significantly positively related to both sets of measures while F4, F5, and F8 are more important to the competitive advantage of a firm than to any individual product offering). Our findings are organized and discussed using the Balanced Score Card for Design Management tool made up of (1) Customer Perspective (Design as differentiator); (2) Process perspective (Design as coordinator); (3) Learning and Innovation perspective (Design as transformer); and (4) Financial perspective (Design as good business).
Design‐Led Innovation: A Framework for the Design of Enterprise Innovation Systems
Authors: Walls Andrew James
Published: November 2021

Innovation is not business as usual. Many enterprises struggle to build the systems necessary to consistently deliver new and improved sources of value to customers and stakeholders. Through a thematic analysis, expert interviews, systems mapping, and a case study with the $100B Ontario Municipal Employees Retirement System (OMERS), this paper presents a framework for the design of enterprise innovation systems, called the innovation systems design cycle (ISDC). To apply the ISDC, innovators iteratively plan, build, check, and refine innovation systems. The ISDC framework is detailed with new models exploring innovation system mapping and implementation, modes to assess and compare an innovation system’s development, and configurations to support rapid, adaptable design. Together they support innovators of all experience levels in applying the ISDC to design more resource‐efficient innovation systems with a greater capacity to shape an innovation ecosystem and avoid enterprise disruption. The ISDC can be used to build or enhance an innovation system, benchmark performance, frame best practices, quantify value creation potential, demystify innovation systems design, and democratize innovation across not‐for‐profits and other organizations towards a more just, democratic, and sustainable collective future.
A preliminary study of the effects of mindfulness‐based cognitive therapy on structural brain networks in mood‐dysregulated youth with a familial risk for bipolar disorder
Authors: Yang Jing , Lei Du , Suo Xueling , Tallman Maxwell J. , Qin Kun , Li Wenbin , Bruns Kaitlyn M. , Blom Thomas J. , Duran Luis Rodrigo Patino , Cotton Sian , Sweeney John A. , Gong Qiyong , DelBello Melissa P.
Published: November 2021

Background

Mindfulness‐based cognitive therapy for children (MBCT‐C), as a psychotherapeutic intervention, has been shown to be effective for treating mood dysregulation (MD). While previous neuroimaging studies of MD have reported both pre‐treatment structural and functional alterations, the effects of MBCT‐C on brain morphological network organisation has not been investigated.

Methods

We investigated brain morphological network organisation in 10 mood‐dysregulated youth with familial risk for bipolar disorder and 15 matched healthy comparison youth (HC). Effects of 12 weeks of MBCT‐C were examined in the mood‐dysregulated youth. Topological properties of brain networks used for analyses were constructed based on morphological similarities in regional grey matter using a graph‐theory approach using MRI data.

Results

At baseline, compared with the HC group, the mood‐dysregulated group exhibited increased global efficiency (Eglob), decreased path length (Lp), and abnormal nodal properties, mainly in the limbic system. Right temporal pole alterations at baseline predicted change in Child and Adolescent Mindfulness Measure scores after treatment. The mood‐dysregulated group showed significant decreases in both the Eglob and Lp metrics after MBCT‐C, suggesting an improved capacity for optimal information processing. Changes in Lp were correlated with changes in Emotion Regulation Checklist scores. Our results show significant topological alterations in the mood‐dysregulated group as compared to controls at baseline. After MBCT‐C, disrupted topological properties in the mood‐dysregulated group were significantly reduced.

Conclusion

MBCT‐C may facilitate clinically meaningful changes in the brain structural network in mood‐dysregulated individuals.
Vestibular compensation of otolith graviceptive dysfunction in stroke patients
Authors: Baier Bernhard , Cuvenhaus Hannah , Müller Notger , Birklein Frank , Dieterich Marianne
Published: November 2021

Background and purpose

A sensitive and frequent clinical sign of a vestibular tone imbalance is the tilt of the perceived subjective visual vertical (SVV). There are no data yet focusing on lesion location at the cortical level as a factor for predicting compensation from the tilt of the SVV.

Methods

With modern voxelwise lesion behavior mapping analysis, the present study determines whether lesion location in 23 right‐hemispheric cortical stroke patients with an otolith dysfunction could predict the compensation of a vestibular tone imbalance in the chronic stage.

Results

Our statistical anatomical lesion analysis revealed that lesions of the posterior insular cortex are involved in vestibular otolith compensation.

Conclusion

The insular cortex appears to be a critical anatomical region for predicting a tilt of the SVV as a chronic disorder in stroke patients.
Serum neurofilament light as biomarker of seizure‐related neuronal injury in status epilepticus
Authors: Giovannini Giada , Bedin Roberta , Ferraro Diana , Vaudano Anna Elisabetta , Mandrioli Jessica , Meletti Stefano
Published: November 2021

Biomarkers of neuronal damage in status epilepticus (SE) would be of great relevance for clinical and research purposes. In a retrospective cross‐sectional study, serum neurofilament light chain (NfL) levels were measured in patients with SE (30 subjects), patients with drug‐resistant epilepsy (30 subjects), and healthy controls (30 subjects). Serum NfL levels were higher in patients with SE (median = 26.15 pg/ml) compared to both epilepsy patients (median = 7.35 pg/ml) and healthy controls (median = 6.81 pg/ml; p < .001). In patients with SE, serum NfL levels showed a high correlation with cerebrospinal fluid (CSF) NfL (τ = .68, p < .001) as well as with CSF total tau (t‐tau) levels (τ = .627, p < .001); they were higher in SE lasting >24 h (p = .013), in refractory/superrefractory SE (p = .004), and in patients who died within 30 days or who presented a worsening of clinical conditions (p = .001). Values of >28.8 pg/ml predicted 30‐day clinical worsening or death (odds ratio [OR] = 10.83, 95% confidence interval [CI] = 1.96–59.83, p = .006) and SE refractoriness (OR = 9.33, 95% CI = 1.51–57.65, p = .016). In conclusion, serum NfL levels are increased in SE and correlate with SE treatment response, duration, and outcomes, therefore representing a promising biomarker of seizure‐related neuronal damage.
Tolerability and safety of galcanezumab in patients with chronic cluster headache with up to 15 months of galcanezumab treatment
Authors: Láinez Miguel J. A. , Schoenen Jean , Stroud Chad , Bardos Jennifer , Bangs Mark , Kemmer Phebe , Wenzel Richard , Kuruppu Dulanji K. , Martinez James Michael , Oakes Tina M.
Published: November 2021

Objective

The objective of the study was to assess the tolerability and safety of galcanezumab in patients with chronic cluster headache (CH) with up to 15 months of treatment.

Background

Chronic CH is a highly debilitating disease with a substantial and unmet medical need.

Methods

Patients were randomized to receive placebo or galcanezumab (300 mg) monthly for 12 weeks, followed by an optional 52‐week open‐label extension and 16‐week posttreatment follow‐up (washout). This is a secondary analysis and long‐term follow‐up of a previously conducted clinical trial. The safety analysis included patients who received galcanezumab at any time during the study. Outcomes included adverse events (AEs), discontinuations, laboratory values, vital signs, electrocardiograms (ECGs), and suicidality ratings.

Results

A total of 233 patients received at least one galcanezumab dose. The mean exposure was 341 days. Galcanezumab‐treated patients were mostly male (n = 169/233; 72.5%) with a mean age of 44.9 (±10.9) years. Treatment‐emergent adverse events (TEAEs) were reported by 185 patients (n = 185/233; 79.4%), 23 patients (n = 23/233; 9.9%) reported serious adverse events (SAEs), and 18 patients (n = 18/233; 7.7%) discontinued due to AEs. The SAE CH was reported by three patients. The most common TEAEs (>10%) were nasopharyngitis (n = 41/233; 17.6%) and injection site pain (n = 33/233; 14.2%). 27.5% of patients (n = 64/233) had TEAEs related to injection sites. Likely hypersensitivity events, including injection site rash, injection site urticaria, and injection site hypersensitivity were reported (n = 14/233; 6.0%). There were past histories of suicidal ideation (n = 55/237; 23.2%) and suicidal behavior (n = 9/236; 3.8%). During the study, 15 patients (n = 15/230; 6.5%), seven with previous history, reported suicidal ideation. One patient had a nonfatal suicide attempt during the open‐label extension and an aborted attempt during the washout. There were no new safety findings compared with the placebo‐controlled treatment period in laboratory values, vital signs, or ECGs.

Conclusions

Galcanezumab 300 mg monthly had a favorable tolerability and safety profile in patients with chronic CH with up to 15 months of treatment.
Global production of nursing research: A 10‐year survey of subspecialty nursing journals
Authors: Zeng Guohua , Wu Qiong
Published: November 2021

Aim

This study aimed to investigate the characteristics of global productivity of nursing research in subspecialty nursing journals and to provide a general view of global nursing research.

Methods

On 10 January 2020, Web of Science was used for research collection. Publications in subspecialty nursing journals from 2015 to 2019 were analysed.

Results

A total of 34 275 publications were retrieved. The United States (15 155) ranked first, followed by Australia (2439), China (2076), Brazil (1803) and the United Kingdom (1602). High‐income economies produced 82.26% of the total number of publications. Research production was not significantly correlated with the population (p = 0.113, r = 0.412), whereas it was positively correlated with gross domestic product (p = 0.030, r = 0.541). The United States had the highest number of total citations (46 297). The Netherlands ranked highest when analysing mean citations, followed by Finland and Australia. Sweden ranked highest after correcting for gross domestic product, followed by Australia and Finland. Australia was the most productive nation when adjusted by population, followed by Sweden and Norway.

Conclusion

The United States is the leader in nursing research productivity. Countries with large economies tend to make greater contributions to global nursing research. Some European countries and Australia were found to be more prolific when stratified by population size and economic activity.
Conceptualising regional skills ecosystems: Reflections on four African cases
Authors: Wedekind Volker , Russon Jo‐Anna , Ramsarup Presha , Monk David , Metelerkamp Luke , McGrath Simon
Published: November 2021

In this article we address the debate on regional skills formation systems in Africa. We draw on the social ecosystems model (SEM) developed by Hodgson and Spours to analyse data from four case studies that reflect the complexities of African economies, rural and urban, formal and informal. The SEM model helps us focus on the three dimensions of a strong skills ecosystem: collaboration between a range of actors, key institutions and system leaders within the region (the horizontal); top‐down policies, regulations, and funding streams that enable or constrain the regional skills ecosystem (the vertical); and the points where these two interact, often through mediation activities. In the case of the last of these three, our cases point to the importance of nurturing organisations which can provide SEM leadership, particularly in more fragile ecosystems. Yet, in none of the cases, are public vocational institutions playing the strong anchor role envisaged in the model. The significance of the paper lies in three ways it develops the SEM in relation to regional skills ecosystems. First, we problematise the notion of a facilitatory state and place it within wider national and global webs of power. Second, we insist that the local or regional is always embedded in and networked into myriad national and international levels. This requires a more complex understanding of how social skills ecosystems operate. Third, the notion of an anchor institution requires further elaboration. In most social ecosystems these institutions need to be built or strengthened and a clearer understanding is required of the processes of institutionalisation and what mechanisms make it possible to build this capacity and sustain it over time.
Risk factors and early prediction of clinical deterioration and mortality in adult COVID‐19 inpatients: an Australian tertiary hospital experience
Authors: Brook Rowena , Lim Hui Yin , Ho Prahlad , Choy Kay Weng
Published: November 2021

Background

Early recognition of severe COVID‐19 is essential for timely patient triage.

Aims

To report clinical and laboratory findings and patient outcomes at a tertiary hospital in Melbourne, Australia.

Methods

This is a retrospective study of adult inpatients with COVID‐19 admitted to Northern Health from March to September 2020. Data were extracted from electronic medical records.

Results

Key admission data were available for 182 patients (median age 67.0 years (interquartile range, 47.9–83.1); 51.1% female). Fifty‐six (30.8%) were from residential care. One hundred and seventeen (64.3%) patients were assigned Goals of Patient Care (GOPC) A or B and 65 (35.7%) GOPC C or D. Comorbidities were present in 135 patients (74.2%). 63.2% of patients received antibiotics, 6.6% had antivirals, 45.6% received systemic glucocorticoid and 3.3% had tocilizumab. Fifty‐six (30.8%) developed clinical deterioration (24 requiring ventilation, 21 receiving critical care, 34 died). Overall, inhospital clinical deterioration was significantly associated with older age (P < 0.001), history of diabetes (P = 0.038), lower lymphocyte count (P = 0.002) and platelet count (P = 0.004), higher neutrophil‐to‐lymphocyte ratio (P = 0.002), elevated fibrinogen (P = 0.004), higher serum ferritin (P = 0.027) and C‐reactive protein (CRP; P = 0.002). The accuracy of the 4C Deterioration model was moderate, with an area under the curve (AUC) of 0.79 (95% confidence interval (CI), 0.68–0.90) compared with an AUC of 0.77 (95% CI, 0.76–0.78) in the original validation cohort.

Conclusions

In the present study, high neutrophil‐to‐lymphocyte ratio, abnormal d‐dimer, high serum CRP and ferritin appear to be useful prognostic markers.
Early career mental health nurses’ emotional experiences in specialist eating disorder units, Victoria, Australia
Authors: Ryu Hosu , Hamilton Bridget , Tarrant Bronwyn
Published: November 2021

The treatment of consumers with eating disorders requires skilled clinicians due to the psychological and medical complexities of the illness. However, a volume of research shows that clinicians report negative feelings, such as anxiety, frustration and anger when providing care for consumers with eating disorders. Limited research explores mental health nurses’ experiences working in a specialist eating disorder inpatient unit. This study aimed to explore early career mental health nurses’ experiences working in such a unit in Australia. A descriptive qualitative method was used, incorporating a stage of theoretical analysis informed by psychodynamic concepts. A total of six nurses were interviewed. Two key themes emerged: (i) initial tension; (ii) understanding self and others through countertransference. In the first theme, participants commonly reported anxiety and frustration. Frustration often related to the struggle to empathise and feeling powerless to change life‐threatening eating behaviours. The second theme explored the understanding of self and others through countertransference. Participants described the inadequacy, anger and anxiety they felt during the interaction with consumers as the projection of another person’s inner experience. Nurses’ accounts also reflected identification of self to others, in the attempt to understand experiences of consumers. The phenomenon of re‐enactment of pre‐existing relationships was also raised. The study shows that working with consumers with eating disorders can elicit strong emotional experiences, which early career nurses were able to over time to more usefully explore as countertransference. It is recommended that nurses have appropriate opportunities to discuss and reflect on their feelings in order to develop their practice and professional resilience.
First‐principles investigation of solution mechanism of C in TM‐Si‐C matrix as the potential high‐temperature ceramics
Authors: Pu Delin , Pan Yong
Published: November 2021

Although the TM‐Si‐C ternary compounds are promising advanced ceramics, the solution mechanism of C element in TM‐Si matrix is entirely unclear. In particular, the influence of C on the mechanical properties of TM‐Si matrix is no clear. To solve the problem, we apply the first‐principles calculations to study the occupied mechanism of C in TM5Si3 silicides. In addition, the influence of C element on the mechanical properties of TM5Si3 is further studied. Here, two typical TM5Si3 phases: D8l‐Ta5Si3 and D8m‐Mo5Si3 are considered. For C‐doping, six C interstitial sites, Mo5Si3‐C(1), Mo5Si3‐C(2), Mo5Si3‐C(3), Ta5Si3‐C(1), Ta5Si3‐C(2), and Ta5Si3‐C(3), are designed. The calculated results show that six C‐doped TM5Si3 matrices are thermodynamically stable. Among them, the C element prefers to occupy the Mo5Si3‐C(2) and Ta5Si3‐C(3) models. The calculated mechanical properties show that the additive C element weakens the bulk modulus, shear modulus, and Young's modulus of TM5Si3. However, the C element can improve the fracture toughness of Mo5Si3 and Ta5Si3, which are in good agreement with the experimental phenomenon. Naturally, the improvement of fracture toughness is related to the formation of TM‐C bond and Si‐C bond.
Editorial: Do lockdowns scar? Three putative mechanisms through which COVID‐19 mitigation policies could cause long‐term harm to young people's mental health
Authors: Sonuga‐Barke Edmund , Fearon Pasco
Published: November 2021

The use of lockdown to slow the spread of COVID‐19 has been unprecedented in its scale, scope and duration despite early predictions that such a measure would have a negative impact on the mental health and well‐being of many young people and their families. From a developmental psychopathology perspective both direct and indirect effects of lockdown‐related harms to young people’s mental health were predictable: Direct effects, for instance, being due to the negative psychological impact of social isolation and confinement on children; Indirect effects being exerted via negative impacts on family and parent mental health and wellbeing. That these effects would vary from person‐to‐person was also predicted from this perspective; with vulnerable individuals with pre‐existing conditions and those living in high‐risk settings being at particular risk. The presumption has been that such negative effects, if they do occur, would be time limited and that everything would return to normal once lockdowns ended. But this is not necessarily the case. In this editorial we ask whether lockdowns could have long‐term effects on young people's mental health and then briefly outline three putative mechanisms through which such long‐term effects might occur.
Clinical, dermoscopic, and histopathological evaluations of patients with nail disorders
Authors: Abu El‐Hamd Mohammed , Yassin Fatma El‐Zahraa Salah El‐Deen , El‐hamid Nehal Hussein Abd , El‐Sharkawy Reham Ezz El Dawla
Published: November 2021

Objective

This study aimed to assess the possible role of dermoscopy in the diagnosis of different nail disorders compared with the clinical and histopathological diagnosis.

Methods

This study included 104 patients with nail disorders of both sex and any age. All the patients were subjected to a detailed medical history taken, clinical general examination, clinical and dermoscopic examinations of 20 nails. Potassium hydroxide examination was used to examine all patients with suspicious of onychomycosis. Histopathological evaluation was used to examine clinically ambiguous nail disorders.

Results

The most common nail diseases were onychomycosis (54.81%) followed by nail psoriasis (19.2%) and nail lichen planus (3.8%).

Conclusion

Clinical evaluation was important in the diagnosis of different nail diseases. Nail dermoscopy could confirm clinical diagnosis and help in getting an accurate diagnosis of nail diseases and guide in the management of nail diseases by permitting better visualization of nail structure and pathology. The histopathological examination provided the most definitive method in reaching an accurate diagnosis due to it could provide etiologic, diagnostic, and prognostic information. There was a good agreement between clinical, dermoscopic, and histopathological examinations for accurate diagnosis of different nail diseases.
Asian upper blepharoplasty and dual‐plane epicanthoplasty: An integrated four‐step technique
Authors: Li Xin , Wang Jiaqi , Ma Jiguang , Yu Lu , Wang Tailing
Published: November 2021

Introduction

Double‐eyelid blepharoplasty and epicanthoplasty is usually performed concurrently in Asian patients to achieve aesthetically pleasing eye appearance, but the epicanthal area is prone to scarring. This article introduces an integrated four‐step technique that enlarges the eyes with minimal scarring risk.

Methods

One hundred and thirty‐five patients who underwent Asian upper blepharoplasty and dual‐plane epicanthoplasty between January 2019 and September 2020 were retrospectively reviewed. Palpebral fissure distance (PFD), inner canthal distance (ICD), and vertical height of the palpebral fissure (VHPF) were measured based on photographs taken pre‐ and postoperatively, with the diameter of the iris as the reference value, D. Patient‐reported outcome measures (PROMs) were collected to evaluate patient satisfaction and complications.

Results

A total of 129 female and 6 male patients were included. The average follow‐up duration was 12.9 months. The average increasing ratio of PFD/D was 8.1%, whereas the average shortening ratio of ICD/D was 3.5%. The average VHPF/D increased by 10.6%. Statistical analysis was conducted using a paired t‐test which demonstrated statistically significant results. A total of 96 patients responded to our patient‐reported outcome measures (PROMs) at 6 months postoperatively, with an average patient satisfaction score of 62.9 out of 70 (89.8%). Barely visible scarring for the upper eyelid and the inner canthus were reported by 90.6% and 85.4% of patients, respectively. Three (3.1%) patients were not satisfied with the scar in the medial canthal area 6 months after surgery.

Conclusions

The integrated four‐step blepharoplasty and dual‐plane epicanthoplasty is an effective, reliable, and reproducible method with high patient satisfaction and minimal scarring risk.
Assessment of changes in color and size of vitiligo lesions during treatment with narrow band ultraviolet B
Authors: Tawfik Noha Z. , Anbar Mohamed T. , Atwa Mona A.
Published: November 2021

Background

Many treatment modalities have been used to stabilize vitiligo and induce repigmentation. Several methods were used to monitor the color changes inside the treated lesions such as spectroscopes and colorimeters that measure the melanin index inside the lesion.

Objective

To study whether the colorimeter and point counting technique can be used as objective methods in monitoring vitiligo lesions during treatment with Nb‐UVB.

Methods

Twenty randomly chosen patients with non‐segmental vitiligo were enrolled in this interventional study. Vitiligo disease activity score was recorded in each patient. Patients received Nb‐UVB three times per week for 6 months. Two lesions were chosen in each patient, and each lesion was assessed for size using point counting technique and degree of color using the Dermacatch® at the beginning of the treatment and evaluated for changes in color and size every 4 weeks till the end of the treatment.

Results

After 6 months of treatment, regarding the lesion size, 90% of lesions showed variable degrees of repigmentation and 10% showed increase in size, indicating increased activity of the disease, and regarding to color changes. We noticed that after one month of Nb‐UVB treatment, there is marked increase in MI measurements in many lesions before any clinical improvement appeared, while at the end of treatment, inside the lesion; 95% showed an increase in melanin index and 5% showed no elevation. While the color changes outside the lesion showed 75% of lesions increased in melanin index, 15% remained unchanged and 10% of the lesions showed decrease in melanin index.

Conclusion

Colorimeter was able to detect change in color after only one month of treatment before it was clinically apparent which means that it can be used as a prognostic tool.
Triple Hemisection Percutaneous Achilles Tendon Lengthening for Severe Ankle Joint Deformity
Authors: Zhang Chang‐gui , Zhao Xing‐yu , Cao Jin , Lin Yang‐jing , Yang Liu , Duan Xiao‐jun
Published: November 2021

Objective

To investigate the efficacy of modified percutaneous Achilles tendon lengthening for severe ankle joint deformity.

Methods

This retrospective case series study included 33 patients with an average age of 25.2 years who underwent surgery in our hospital from April 1, 2010 to March 1, 2018. Triple hemisection percutaneous Achilles tendon lengthening was performed. One stage surgery, other soft tissue surgery or bone correction surgery could be performed. After surgery, a plaster cast was used to fix the functional position, and rehabilitation training was carried out as planned. Complications during the perioperative period were recorded. Statistical analysis of the patients' visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score before and at the last follow‐up was performed. The recurrence rate of Achilles tendon contracture at the last follow‐up and the patients' satisfaction rate were investigated.

Results

All patients were followed up, with an average follow‐up period of 56.31 months (8–104 months). All achieved good ankle joint function and appearance improvement And there were no infection or skin necrosis complications. In two cases, the incision was poorly healed at non‐Achilles tendon site and was cured by change of dressing. The average VAS score at the last follow‐up was reduced from (2 ± 1.48) points before surgery to (0.26 ± 0.51) points (P = 0.001), and the average AOFAS score was increased from (64.97 ± 13.56) points before surgery to (90.06 ± 10.06) points (P = 0.001). During the follow‐up period, there was no chronic rupture of Achilles tendon. There were two cases of recurrence of foot drop (5.7%), and the patients' satisfaction rate was 93.9%.

Conclusion

In the surgical treatment of severe ankle joint deformity, the application of triple hemisection percutaneous Achilles tendon lengthening for Achilles tendon contracture has the advantages of less trauma, beautiful incision, and reliable efficacy. The satisfaction rate of patients with this treatment is high, and it is worth promoting in the clinic.
Associations of maternal weight status with the risk of offspring atopic dermatitis and wheezing by 1 year of age
Authors: Wei Xueling , Huang Peiyuan , Gao Chang , Shen Songying , Tu Si , Guo Yixin , Zhang Lifang , Lu Min‐Shan , Lu Jinhua , Wang Chi Chiu , He Jian‐Rong , Qiu Xiu
Published: November 2021

Background

Maternal pre‐pregnancy body mass index (BMI) and gestational weight gain (GWG) have been linked to offspring allergic disorders. However, associations observed in previous studies were inconsistent and might be confounded by unmeasured familial factors. We aimed to examine the associations of maternal weight with offspring allergic disorders by using paternal BMI as a negative control exposure.

Methods

We included the data of 10,522 children from the Born in Guangzhou Cohort Study, 2012–2017. Data on maternal weight were obtained from questionnaires and obstetric records, and paternal weight was collected from questionnaires. Atopic dermatitis (AD) and wheezing at the age of 1 year were defined according to parent‐reported physician diagnosis. Risk ratios (RRs) were estimated by log‐binominal regression with mutual adjustment for maternal and paternal weight status.

Results

By the age of 1 year, 16.2% and 7.9% of children were diagnosed with AD and wheezing, respectively. While maternal pre‐pregnancy BMI as a continuous variable was not associated with offspring AD, infants of pre‐pregnancy overweight/obese women had a higher risk of AD than those born to normal weight women; no such associations were observed for paternal BMI. Both maternal pre‐pregnancy BMI and paternal BMI were positively associated with the risk of offspring wheezing. Maternal GWG was not associated with AD or wheezing.

Conclusions

Our findings suggest that maternal pre‐pregnancy overweight/obesity might increase the risk of infant AD via intrauterine mechanisms, whereas the association with wheezing might be confounded by uncontrolled familial factors. These findings may be valuable in early‐life prevention for offspring allergic diseases.
Gender differences in the development of childhood obesity in young teenagers in Murcia, Spain
Authors: Carpena Lucas Pedro J , Jiménez Candel María I , Sánchez‐Cubo Francisco , Ceballos‐Santamaría Guillermo , Vargas Vargas Manuel , Mondéjar Jiménez José
Published: November 2021

Background

The number of overweight children is increasing at an alarming rate. This issue requires effective action plans, as childhood obesity has become a problem in which addressing environmental factors is decisive. Significant differences have also been shown in lifestyle habits that determine overweight based on sex. This study therefore aimed to examine these risk factors according to sex.

Methods

The sample included first‐year high school students from Murcia, Spain. Information was collected through the “Questionnaire on Healthy Habits in Adolescents,” validated for this age range, and the weight, height, and waist circumference of the participants were obtained. Data were analyzed through partial least squares structural equation modeling to determine which modifiable risk factors promoted the appearance of excess weight and in what magnitude.

Results

A total of 421 students participated in the study, and 40.6% of overweight patients were detected according to their body mass index. No differences were found between the sexes and weights. The environment and the use of new technologies that do not involve sitting were significant only in girls (P < 0.05). Conversely, physical activity was significantly higher in boys (P < 0.05). Dietary factors and sedentary activities did not differ according to sex.

Conclusions

The social and school environment, the use of new technologies (for girls), and physical activity (for boys) condition nutritional status. Identifying gender disparities in behaviors that involve health should be a priority for new prevention programs. Targeting young people's health from a gender perspective has considerable potential to reduce overweight problems in adulthood.
Significance of miRNA in enhancement of flavonoid biosynthesis
Authors: Yang K. , Han H. , Li Y. , Ye J. , Xu F.
Published: November 2021

Flavonoid metabolism shows very strong plasticity in plant development and coping with the changing environment. Flavonoid biosynthesis is regulated by many metabolic pathways, including transcriptional regulation, post‐transcriptional control, post‐translational regulationand epigenetic regulation. miRNA is a form of endogenous noncoding single‐strand small molecule RNA that primarily regulates the expression of target genes horizontally after transcription through splicing and translational suppression. It also plays an important role in regulating plant growth and development, secondary metabolism and biotic and abiotic stress. miRNA can regulate the formation of flavonoids by acting on structural genes or indirectly by using an MBW transcription complex comprising MYB‐bHLH‐WD40. This study summarizes the biosynthesis and mechanisms of miRNA, and provides a summary of the mechanisms of miRNAs involved in production of flavonoids, in order to elucidate the biosynthesis pathway and complex regulatory network of plant flavonoids. We aim to provide new insights into improving the content of flavonoid active ingredients in plants.
Altitudinal gradient drives regional and local diversity and composition patterns of epiphyllous bryophytes in ecological refuges
Authors: Araújo F. M. S. , Costa L. E. N. , Souza J. P. S. , Batista W. V. S. M. , Silva M. P. P.
Published: November 2021

‘Brejos de altitude’ is an ecosystem that has been subjected to severe exploitation, leading to an intense reduction in Brazil. Understanding the patterns of bryophyte diversity and composition, particularly of specialized species such as the epiphylls, to anthropic and abiotic variables is crucial for implementing protection measures.

We investigated the relationship between composition and diversity of epiphyllous bryophytes and anthropic (edge effects) and abiotic (altitude) variables at local (within each ‘Brejo’) and regional (set of three ‘Brejos’) scale. Abiotic and anthropic variables were correlated with alpha and beta diversity (decomposed into species replacement and richness differences) using GLM. Their effects on species composition were evaluated using PERMANOVA.

The localities at higher elevations harboured a richer bryoflora and overall beta diversity patterns were associated with altitude and locality, which acted over different scales. Regionally, the contribution of richness differences was limited with increasing altitude. Yet, dissimilarities among localities were associated with richness differences and replacement, denoting the importance of local factors. The composition was explained by local factors interacting with the regional altitudinal gradient. Anthropic activity was significant only when interacting with local factors and altitudinal gradient.

Environmental filtering associated with altitude played a more important role in shaping the diversity and composition of epiphyllous bryophytes, at both regional and local scales. Each ‘Brejo’ acts as an ecological refuge, harbouring part of the whole environmental gradient, and presents a unique floristic composition. Moreover, partitioning beta diversity highlighted the interplay of local and regional forces shaping diversity patterns.