bluuebunny/crossref_metadata_2025 huggingface dataset:
Discussions About Driving Between Older Adults and Primary Care Providers
Authors: Betz Marian E. , Kanani Halinganji , Juarez‐Colunga Elizabeth , Schwartz Robert
Published: June 2016

Objectives

To estimate how many older adults discuss driving with a primary care provider during a calendar year and to describe discussion triggers.

Design

Observational retrospective medical record review.

Setting

Three primary care clinics (geriatric, hospital‐based general internal medicine (GIM), community‐based GIM) affiliated with a tertiary care hospital.

Participants

Random sample of 240 older (aged ≥65) adults with one or more primary care visits in 2014 (January 1 to December 31).

Measurements

Standardized chart abstraction of participant demographic characteristics, medical diagnoses, and presence and context of discussions about driving. Provider factors (obtained from clinic administrators) included sex and average amount worked per week.

Results

Participants who visited the geriatric clinic were oldest, had more medical diagnoses, and had a median of 4 visits in 2014 (vs 3 visits in GIM clinics). Documented discussions about driving occurred with a greater proportion of participants in the geriatric (n = 22, 28%, 95% confidence interval (CI) = 18–39%) and GIM hospital (n = 15, 19%, 95% CI = 11–29%) clinics than the GIM community clinic (n = 6, 7.5%, 95% CI = 2.8–16%). Medical diagnoses that might affect driving were prevalent but not associated with frequency of documented discussions. In multivariable analysis, participants were more likely to have one or more documented driving discussions in 2014 if they went to the geriatric clinic or had a primary care provider younger than 45 or who worked fewer than six half‐day clinics per week.

Conclusion

Over 1 year, a minority of older adults had a documented discussion about driving with a primary care provider, with differences according to clinic and provider characteristics. Strategies to support routine and preparatory conversations about driving should incorporate these findings and might vary among clinic settings.
Comparison of Effect of Two Exercise Programs on Activities of Daily Living in Individuals with Dementia: A 9‐Week Randomized, Controlled Trial
Authors: Bossers Willem J. R. , van der Woude Lucas H. V. , Boersma Froukje , Hortobágyi Tibor , Scherder Erik J. A. , van Heuvelen Marieke J. G.
Published: June 2016

Objectives

To compare the effects of two exercise programs on proxy‐ and performance‐based measures of activities of daily living (ADLs) and to explore potential motor and cognitive mediators underlying ADL improvements in individuals with dementia.

Design

A parallel, three‐group, single‐blind, randomized, controlled trial.

Setting

Psychogeriatric wards.

Participants

Individuals with dementia (mean age 85.6 ± 5.1).

Interventions

Each 9‐week intervention consisted of thirty‐six 30‐minute sessions. A combined group (n = 35) participated in two strength and two walking sessions, an aerobic group (n = 35) participated in four walking sessions, and a social control group (n = 35) participated in four nonexercise social visits per week. The social group was used as a reference for the mediation analysis, which was performed in the combined and aerobic groups.

Measurements

ADLs were assessed using the Katz index (proxy‐reported ADL performance), Erlangen‐ADL test (E‐ADL) (instrumental ADL performance), and 7‐item Physical Performance Test (PPT‐7) (physical ADL performance).

Results

There was a group effect for Katz index (P = .02), E‐ADL (P < .001), and PPT‐7 (P = .003). Differences from baseline to after the intervention were similar in the combined and aerobic groups. Exercise‐induced changes in global cognition mediated changes in Katz index (95% confidence interval (CI) = 0.05–0.41), leg muscle strength mediated changes in E‐ADL (95% CI = 0.03–0.43), and leg muscle strength (95% CI = 0.01–0.36) and walking endurance (95% CI = 0.01–0.43) mediated changes in PPT‐7 only in the combined group.

Conclusion

Physical exercise can improve ADL levels in individuals with dementia, but improvements are small and seem independent of exercise type. Additional analyses suggest that combined aerobic and strength exercise may be more effective than aerobic‐only exercise to effectively target ADL dysfunction in individuals with dementia. Future research is warranted to justify these exercise‐specific findings.
Antipsychotic Drugs and Risk of Hip Fracture in People Aged 60 and Older in Norway
Authors: Bakken Marit S. , Schjøtt Jan , Engeland Anders , Engesæter Lars B. , Ruths Sabine
Published: June 2016

Objectives

To examine associations between exposure to various subgroups of antipsychotic drugs and risk of hip fracture in older adults.

Design

Nationwide cohort study.

Setting

Norway, 2005–2010.

Participants

Everyone living in Norway born before 1945 (N = 906,422).

Measurements

Information was obtained on all prescriptions of antipsychotic drugs dispensed from 2004 to 2010 (Norwegian Prescription Database) and data on all primary hip fractures from 2005 to 2010 (Norwegian Hip Fracture Registry). Incidence rates of hip fracture during person‐time exposed and unexposed to antipsychotic drugs were compared by calculating the standardized incidence ratio (SIR).

Results

Thirty‐nine thousand nine hundred thirty‐eight (4.4%) participants experienced a primary hip fracture. Greater risk of hip fracture was associated with exposure to any antipsychotic (SIR = 2.1, 95% confidence interval (CI) = 1.9–2.1), first‐generation antipsychotics (SIR = 2.0, 95% CI = 1.8–2.2), second‐generation antipsychotics (SIR = 2.2, 95% CI = 1.9–2.4), prolactin‐sparing antipsychotics (SIR = 2.4, 95% CI = 1.8–3.1) and prolactin‐elevating antipsychotics (SIR = 2.0, 95% CI = 1.9–2.2).

Conclusion

In people aged 60 and older in Norway, those who took an antipsychotic drug had twice the risk of sustaining a hip fracture during exposure than during nonexposure. Although confounding by indication, comorbidity, or other drugs used cannot be excluded, this association is relevant for clinical practice because hip fracture and antipsychotic drug use are prevalent in vulnerable older individuals. Clinical studies examining mechanisms or causality of the observed association between antipsychotic drug use and excess risk of hip fracture are needed.
Effects of Disease Burden and Functional Adaptation on Morbidity and Mortality on Older Adults
Authors: Sanders Jason L. , Arnold Alice M. , Hirsch Calvin H. , Thielke Stephen M. , Kim Dae , Mukamal Kenneth J. , Kizer Jorge R. , Ix Joachim H. , Kaplan Robert C. , Kritchevsky Stephen B. , Newman Anne B.
Published: June 2016

Objectives

To ascertain whether older adults with extensive disease but relative vigor (adapters) shorten the period at the end of life in which they live with morbidity (compress morbidity).

Design

Prospective, community‐based cohort study in four U.S. cities.

Setting

Cardiovascular Health Study.

Participants

Individuals aged 65 and older.

Measurements

Participants were categorized into three groups according to extent of disease (assessed noninvasively), vigor, and frailty (expected agers (n = 3,528, extent of disease similar to vigor and frailty—reference group), adapters (n = 882, higher disease but vigorous), and prematurely frail (n = 855, lower disease but frail)) and compared according to years of able life (YAL), years of self‐reported healthy life (YHL), and mortality using multivariable regression and survival analysis.

Results

After adjustment, adapters had 0.97 (95% confidence interval (CI) = 0.60–1.33) more YAL and 0.54 (95% CI = 0.19–0.90) more YHL than expected agers, and those who were prematurely frail had −0.99 (95% CI = −1.36 to −0.62) fewer YAL and −0.53 (95% CI = −0.89 to −0.17) fewer YHL than expected agers. Adapters had 0.9 more and prematurely frail had 1.5 fewer years of total life than expected agers (P < .001). Adapters spent 55% of their remaining life able and healthy, those who were prematurely frail spent 37%, and of expected agers spent 47% (P < .001).

Conclusion

Despite similar levels of disease burden, older adults who were more vigorous appeared to compress morbidity and live longer. Older adults with higher frailty lengthened morbidity and had greater mortality. Adaptive factors may compress morbidity and decrease mortality.
A New Method of Identifying Characteristics of Needing Help to Take Medications in an Older Representative Community‐Dwelling Population: The Older Adults Medication Assist Scale
Authors: Jamerson Brenda D. , Fillenbaum Gerda G. , Sloane Richard , Morey Miriam C.
Published: June 2016

Objectives

To determine the sociodemographic characteristics, health conditions, and cognitive and functional status associated with baseline prevalence and new need for help taking medication 3 years later and to construct a brief scale indicative of need for help taking medications.

Design

Retrospective cross‐sectional and 3‐year longitudinal study.

Setting

Five‐county area in north–central Piedmont, North Carolina.

Participants

Representative community‐dwelling sample of black and white individuals aged 65 and older (N = 4,136).

Measurements

Information was obtained in person in participants' homes using structured questionnaires. Health conditions included sensory impairment and self‐report of physician‐diagnosed conditions. Cognitive status was assessed using the 10‐item Short Portable Mental Status Questionnaire. Functional status was assessed using the three‐item Rosow‐Breslau scale, the five‐item Katz activity of daily living scale, and a modified six‐item Older Americans Resources and Services instrumental activities of daily living scale.

Results

Characteristics associated with need for help taking medications were aged 80 and older, being male, living with others, having four or more chronic conditions, and impaired cognitive or functional status (c‐statistic 0.94, 77.1% sensitivity, 87.9% specificity). Predictors of new need for help with medications 3 years later included aged 75 and older at baseline, being male, and impaired cognitive and functional status (c‐statistic 0.75).

Conclusion

This brief scale can help identify persons needing help with medications and could be useful in assisting clinicians with medication management.
Boys with fragile X syndrome: investigating temperament in early childhood
Authors: Low Kapalu C. M. , Gartstein M. A.
Published: June 2016

Background

Fragile X syndrome (FXS) is an x‐linked genetic disorder that represents the most common hereditary cause of Intellectual Disability (ID). Very specific behavioural features (e.g. attention deficit hyperactivity disorder and stereotyped behaviour) are associated with FXS in adolescents and adults, yet research on temperament and behavioural characteristics in young children with FXS has been more limited and less conclusive.

Method

This study investigated temperament differences in young boys (3–7 years old) with FXS (N = 26) recruited from a national FXS centre and controls (N = 26) matched on age, gender and race.

Results

Compared with controls, boys with FXS exhibited less overall surgency/extraversion and effortful control. Boys with FXS also displayed significantly greater activity and shyness and less attentional focusing, inhibitory control, soothability and high intensity pleasure (tendency to enjoy intense/complex activities), relative to comparison children. A significant interaction between age and diagnosis (FXS or control) was observed for negative affectivity only.

Conclusions

Attention difficulties commonly found in adolescents and adults with FXS appear to also be characteristic of young boys with FXS, as reflected by lower effortful control. Age‐related findings concerning negative affectivity may be particularly significant, leading to improved intervention/preventative efforts.
Oriented inclusions of pyroxene, amphibole and rutile in garnet from the Lüliangshan garnet peridotite massif, North Qaidam UHPM belt, NW China: an electron backscatter diffraction study
Authors: Xu H. J. , Wu Y.
Published: June 2016

Oriented inclusions of clinopyroxene, orthopyroxene, sodic amphibole and rutile have been identified in garnet from the Lüliangshan garnet peridotite massif in the North Qaidam ultrahigh‐pressure metamorphic (UHPM) belt, northern Tibetan Plateau, NW China. Electron backscatter diffraction (EBSD) analyses demonstrate that nearly half of the measured intracrystalline clinopyroxene (8 out of 17) have topotactic crystallographic relationships with host garnet, that is, (100)Cpx//{112}Grt, (010)Cpx//{110}Grt and [001]Cpx//<111>Grt. One‐fifth of the oriented sodic amphibole (23 out of 110) inclusions of have topotactic crystallographic relationships with host garnet, that is, (010)Amp//{112}Grt, (100)Amp//{110}Grt and [001]Amp//<111>Grt. Over a third of rutile (36 out of 99) inclusions also show a close crystallographic orientation relationship with host garnet in that one <103>Rt and one <110>Rt parallel to two <111>Grt while the axes of [001]Rt exhibit small girdles centred the axes of <111>Grt. But, no ‘well‐fit’ crystallographic relationship was observed between orthopyroxene inclusions and host garnet. Considering a very long and complex history for the Lüliangshan garnet peridotite, we suggest that the low fit rates for these oriented minerals may result from several possible assumptions including different generations or multi‐stage formation mechanisms, heterogeneous nucleation and growth under non‐equilibrium conditions, and partial changes of initial crystallographic orientations of some inclusions. However, the residual quantitative ‘well‐fit’ crystallographic information is sufficient to indicate that the nucleation and growth of many pyroxene, amphibole and rutile are controlled by the lattice of the host garnet. The revealed close topotactic relationships accompanied by clear shape orientations provide quantitative microstructural evidence demonstrating a most likely exsolution/precipitate origin for at least some of the oriented phases of pyroxene, sodic amphibole and rutile from former majoritic garnet and support an ultra‐deep (>180 km depth) origin of the Lüliangshan garnet massif.
Comparison between the efficacy and safety of platelet‐rich plasma vs microdermabrasion in the treatment of striae distensae: clinical and histopathological study
Authors: Hersant Barbara , Niddam Jeremy , Meningaud Jean‐Paul
Published: June 2016

The article entitled “Comparison between the efficacy and safety of platelet‐rich plasma vs microdermabrasion in the treatment of striae distensae: clinical and histopathological study” (Zeinab Abd El‐Samad Ibrahim, et al.) is very interesting but the methodology is not robust. Our mains comments concerned the count of the cells, the activation of the PRP and the method of assessment.
The experience of people with dementia and nurses in hospital: an integrative review
Authors: Digby Robin , Lee Susan , Williams Allison
Published: June 2016

Aims and objectives

To identify and examine existing research exploring how people with dementia and nurses view acute hospital care.

Background

Admission to hospital can be traumatic for a person with dementia due to an inability to cope with unfamiliar environments, faces and routines. Adverse behavioural and health outcomes can result. Dementia adds complexity to patient care. Inability to deliver appropriate care is a source of stress and frustration for nurses.

Methods

Integrative review of the literature 2005–2015 reporting the experience of people with dementia and nurses caring for them in an acute hospital setting (n = 24).

Results

Hospitals focus on acute medical care; consequently people with dementia are considered low priority and a disruption to normal routine. Risk management often takes priority over patient dignity. People with dementia are stigmatised. Families have significant roles to play in the care of a person with dementia in hospital but are often excluded. Nurses struggle to complete even basic patient care, and focus on tasks often at the expense of specific patient needs. Support for nurses is lacking. The job satisfaction of nurses caring for people with dementia is poor.

Conclusions

Nurses require improved education and support to care for patients with dementia. Hospitals must focus on genuine caring concurrently with rapid discharge requirements, risk mitigation and fiscal restraint. More research is needed to inform the development of appropriate care for people with dementia in hospitals.

Relevance to clinical practice

Nurses must understand the complex needs of people with dementia in hospital. Nurse education about dementia, practical support, strong clinical leadership and role‐modelling is needed. Empathy for patients regardless of diagnosis must remain a core attribute of nurses. Current hospital culture requires wider system review to mitigate against stigmatisation of patients with dementia.
An integrative review of skin assessment tools used to evaluate skin injury related to external beam radiation therapy
Authors: Baines Carol R , McGuiness William , O'Rourke Geraldine A
Published: June 2016

Aims and objectives

To review literature associated with external beam radiotherapy and skin damage. A focus of the literature search is to highlight and discuss the myriad of skin assessment tools that are available to the clinician when assessing skin injury in patients receiving external beam radiation therapy.

Background

It is apparent that despite considerable work being progressed in the development of individualised skin assessment tools, uptake and use is poor. These tools are designed to assist the clinician in the evaluation of damaged skin and predict the radiation wound development pathway.

Design

An integrated review can be used to address a mature or new and emerging topic through a systematic methodology, which is either theoretical or empirical, gained from research, practice or policy initiatives (Whittemore & Knafl, Journal of Advanced Nursing, 52, 2005, 546). This review is particularly concerned with the employment of skin assessment tools by clinicians in patients with radiation damaged skin. Using the search terms synonyms for radiation, skin and epidermal damage, PubMed/MEDLINE, Medical Complete and Web of Science databases were searched. Consulting professional peers was employed as part of the inclusion and exclusion process.

Conclusion

There is a high level of unpredictability about which patient will have an uncomplicated course of external beam radiotherapy. Variables may include, but are not limited to, an acute reaction, a delayed reaction resulting in actual skin damage or no visible skin disturbance. The skin assessment tools that are readily available are not regularly referenced in clinical practice when attempting to manage the many side effects of radiation therapy. Skin assessment tools require ongoing clinical validation, so they can be used to guide practitioners to undertake further assessment of skin integrity.

Relevance to clinical practice

The current body of knowledge suggests clinicians caring for patients receiving therapeutic radiotherapy should consider integrating a recognised patient assessment skin framework into their daily routine. Such validated tools may add value to postradiotherapy patient care by providing a consistency of management and accordingly refining best practice.
Nurses' experience of caring for people with intellectual disability and dementia
Authors: Cleary Josephine , Doody Owen
Published: June 2016

Aims and objectives

To explore nurses' experiences of caring for older people with intellectual disability and dementia.

Background

Ageing and dementia prevalence is increasing along with the life expectancy of people with intellectual disability. As a population group, people with intellectual disability have a high prevalence of dementia, which is higher within the subpopulation of Down syndrome. People with intellectual disability live in residential care, community or residential settings, and nurses are required to adapt their practices to meet the changed needs of the individual.

Design

A qualitative Husserlian descriptive phenomenological methodology facilitated the researcher to become absorbed in the quintessence of meaning and explore nurses' experience of working with older people with intellectual disability and dementia.

Methods

Ethical approval was obtained, and data were collected utilising semistructured interviews (n = 11). Interviews were transcribed and analysed using Colaizzi's framework for data analysis.

Results

Three key themes were identified: ‘knowledge of dementia’, ‘person‐centred care’ and ‘transitioning within the service’. The study highlights the need for proactive planning, life story books of the patient, and funding to support client and staff.

Conclusions

Overall, the study highlights the importance of knowing the person, supporting the individual and recognising presenting behaviours as outside the control of the individual.

Relevance to clinical practice

This article presents the experiences of nurses caring for the older person with intellectual disability and dementia. Transitions are often very difficult for both the person and their peers, and they experience benefit from the efforts of a multidisciplinary team facilitating a person‐centred approach.
Impact of teamwork on missed care in four Australian hospitals
Authors: Chapman Rose , Rahman Asheq , Courtney Mary , Chalmers Cheyne
Published: June 2016

Aims and objectives

Investigate effects of teamwork on missed nursing care across a healthcare network in Australia.

Background

Missed care is universally used as an indicator of quality nursing care, however, little is known about mitigating effects of teamwork on these events.

Design

A descriptive exploratory study.

Methods

Missed Care and Team Work surveys were completed by 334 nurses. Using Stata software, nursing staff demographic information and components of missed care and teamwork were compared across the healthcare network. Statistical tests were performed to identify predicting factors for missed care.

Results

The most commonly reported components of missed care were as follows: ambulation three times per day (43·3%), turning patient every two hours (29%) and mouth care (27·7%). The commonest reasons mentioned for missed care were as follows: inadequate labour resources (range 69·8–52·7%), followed by material resources (range 59·3–33·3%) and communication (range 39·3–27·2%). There were significant differences in missed care scores across units. Using the mean scores in regression correlation matrix, the negative relationship of missed care and teamwork was supported (r = −0·34, p < 0·001). Controlling for occupation of the staff member and staff characteristics in multiple regression models, teamwork alone accounted for about 9% of missed nursing care.

Conclusion

Similar to previous international research findings, our results showed nursing teamwork significantly impacted on missed nursing care. Teamwork may be a mitigating factor to address missed care and future research is needed.

Relevance to clinical practice

These results may provide administrators, educators and clinicians with information to develop practices and policies to improve patient care internationally.
‘Feeling someone is there for you’ – experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse
Authors: Kobleder Andrea , Mayer Hanna , Senn Beate
Published: June 2016

Aims and objectives

To explore the experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse.

Background

Women with vulvar neoplasia suffer from a high number of symptoms and report a lack of information and support by health care professionals. Further, talking about their disease, which is still a social taboo, is difficult for them. From approaches for other patients, it can be suggested that support from an Advanced Practice Nurse can be helpful. For Advanced Practice Nurse development, implementation and evaluation, it is important to assess patients’ perceptions. But so far, little is known about how patients with vulvar neoplasia experience support of an Advanced Practice Nurse.

Design

A qualitative interview study was chosen to gain understanding of the experience of women with vulvar neoplasia who received care delivered by an Advanced Practice Nurse.

Methods

Narrative interviews were conducted with a purposive sample of 13 women with vulvar neoplasia after they received care from an Advanced Practice Nurse for six months. Thematic analysis was used to analyse the data from the interviews.

Results

Four main themes could be identified: a trusting relationship; accessibility; feeling safe and secure; and feeling someone is there for you. Women felt more secure and less alone in the experience of their illness through having the possibility of contacting an Advanced Practice Nurse and getting sufficient information and psychosocial support.

Conclusions

Women with vulvar neoplasia experienced care delivered by an Advanced Practice Nurse as ‘feeling someone is there for you’. Due to the localisation of the disease and the associated social taboo, psychosocial support from the Advanced Practice Nurse beyond months after surgery was very important for them.

Relevance to clinical practice

Addressing psychosocial needs in caring for women with vulvar neoplasia must be given greater attention in clinical practice. Further, continuous nursing support delivered by an Advanced Practice Nurse beyond the acute treatment phase can be recommended.
Assessment of disease‐related knowledge and possible factors associated with the knowledge level among Chilean patients with inflammatory bowel disease
Authors: Simian Daniela , Flores Lilian , Quera Rodrigo , Kronberg Udo , Ibáñez Patricio , Figueroa Carolina , Lubascher Jaime
Published: June 2016

Aims and objectives

To assess disease‐related knowledge among patients with inflammatory bowel disease and to identify the factors that are possibly associated with the knowledge level.

Background

Disease‐related knowledge can positively influence the acceptance of the disease, increase treatment compliance and improve the quality of life in patients with inflammatory bowel disease.

Design

An observational, cross‐sectional study was conducted and prospectively included patients from the inflammatory bowel disease programme between October 2014–July 2015.

Methods

A Spanish‐translated version of the 24‐item Crohn's and Colitis Knowledge score was used to assess disease‐related knowledge. Patients also completed a demographic and clinical questionnaire.

Results

A total of 203 patients were included, 62% were female, and 66% were diagnosed with ulcerative colitis; the median age was 34 years (range 18–79), and the median disease duration was four years. The median disease‐related knowledge score was 9 (range 1–20). Only 29% of the patients answered more than 50% of the questions correctly. Lower disease‐related knowledge was observed in questions related to pregnancy/fertility and surgery/complications. Patients older than 50 years, with ulcerative colitis, with disease durations less than five years and patients without histories of surgery exhibited lower disease‐related knowledge. There was no association between the knowledge scores and the educational levels.

Conclusions

The patients who attended our inflammatory bowel disease programme exhibited poor disease‐related knowledge that was similar to the knowledge levels that have been observed in developed countries. It is necessary to assess patient knowledge to develop educational strategies and evaluate the influences of these strategies on patient compliance and quality of life.

Relevance to clinical practice

These results will allow the inflammatory bowel disease team to develop educational programmes that account for the disease‐related knowledge of each patient. Inflammatory bowel disease nurses should evaluate their interventions to provide evidence that educating our patients contributes to improving their treatment outcomes and overall health statuses.
An exploration of paediatric nurses’ views of caring for infants who have suffered nonaccidental injury
Authors: Barrett Emma , Denieffe Suzanne , Bergin Michael , Gooney Martina
Published: June 2016

Aims and objectives

To explore paediatric nurses’ views of caring for infants who have suffered nonaccidental injury.

Background

Children less than two years of age are at greater risk of serious abuse than those in any other age group. An infant's physical and mental immaturity makes them especially vulnerable. Abuse in this age group is often caused by a parent who does not report the abuse. The experience of caring for abused children is recognised as being both personally and professionally challenging. However, despite the increased risk of serious or fatal injury, caring for these infants who have suffered abuse is relatively unexplored.

Design

A qualitative research design using purposive sampling was adopted. The setting for this research was a paediatric unit in Ireland.

Method

Semi‐structured interviews were conducted with 10 paediatric nurses and data were analysed using the framework approach.

Results

Paediatric nurses’ views of caring for infants who have suffered a nonaccidental injury were established under four main themes: (1) ‘Personal impact’, (2) ‘Professional roles’, (3) ‘Nurse‐client relationship’ and (4) ‘Resources’.

Conclusion

Findings highlighted that the experience for the nurse is complex. Personal emotions are evoked and the experience influenced reflection on their own lives. Communication with the parents of the infant is often difficult. Professional relationships were sometimes hindered by poor sharing of information. However, nurses strived to maintain their professionalism and to provide nursing care for the infant and their parents that was holistic. Paediatric nurses relied heavily on each other for support and their nursing experience was a valuable resource for managing nonaccidental injuries.

Relevance to clinical practice

The general consensus was that a nurse could never fully be prepared to care for an infant who had suffered a nonaccidental injury. However, recommendations for future practice and education are identified and include frequent and practical education sessions.
From powerlessness to striving for control – experiences of invasive treatment while awake
Authors: Wermström Johanna , Ryrlén Eva , Axelsson Åsa B
Published: June 2016

Aims and objectives

To describe patients’ experiences of being cared for during invasive monitoring and treatment while awake.

Background

Patients with acute heart failure treated in cardiac intensive care are awake during invasive monitoring and treatment and forced to remain in bed rest, sometimes for several days.

Design

Exploratory qualitative design.

Method

Eight patients were interviewed during invasive treatment. Analyses were conducted according to qualitative content analysis.

Results

The participants described their way from a sense of powerlessness and striving to regain control when undergoing invasive monitoring and treatment. Due to their severe illness, they were exposed to the treatment implying a forced loss of empowerment. They surrendered to hospital care. To feel hope and resting from the illness helped the participants to endure the situation. When their condition improved, the need to regain control increased and they wanted to influence their daily care. The participants in present study did not desire to participate in decisions about the medical treatment, but wanted comprehensible information.

Conclusion

This study shows how the patients’ illness forced them to surrender to the staff's knowledge and treatment. As the patients became more aware, it was important that the healthcare staff did not take over decisions and functions the patients could manage themselves. This helped the patients to endure.

Relevance to clinical practice

The result of present study could provide guidance for healthcare staff working with the patients cared for using invasive monitoring and treatment while they are awake. If staff has an increased insight of how the patients’ condition affects their ability to be involved, they have better understanding of the patients’ individual needs. Thus, the staff easier can respond to where the patients are in the process of powerlessness and striving to regain control.
Primary osteosarcoma of the uterine corpus: A case report
Authors: Tsukasaki Nanami , Mori Taisuke , Yasukawa Satoru , Konishi Eiichi , Kokabu Tetsuya , Kitawaki Jo
Published: June 2016

Pure osteosarcoma arising from the uterus is extremely rare. Only 15 cases of this type of cancer have been reported to date. Most patients showed local or lung metastasis early after surgery and died within a year of treatment initiation, regardless of multimodality therapy, indicating that this tumor is aggressive with a poor prognosis. Herein, we report the first clinical experience treated with a combination of docetaxel and gemcitabine for local and lung metastasis from primary osteosarcoma of the uterus. Although the disease was considered stable after three cycles of treatment, new metastatic lesions appeared in the lungs after six cycles. The patient was asymptomatic for 13 months; however, she died two months after symptom recurrence. Our case demonstrates that a combined regimen of docetaxel and gemcitabine may be a sound therapeutic option to control primary osteosarcoma of the uterus.
Diagnosis and classification of idiopathic inflammatory myopathies
Authors: Lundberg I. E. , Miller F. W. , Tjärnlund A. , Bottai M.
Published: June 2016

The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of diseases, collectively termed myositis, sharing symptoms of muscle weakness, fatigue and inflammation. Other organs are frequently involved, supporting the notion that these are systemic inflammatory diseases. The IIMs can be subgrouped into dermatomyositis, polymyositis and inclusion body myositis. The myositis‐specific autoantibodies (MSAs) identify other and often more distinct clinical phenotypes, such as the antisynthetase syndrome with antisynthetase autoantibodies and frequent interstitial lung disease and anti‐SRP and anti‐HMGCR autoantibodies that identify necrotizing myopathy. The MSAs are important both to support myositis diagnosis and to identify subgroups with different patterns of extramuscular organ involvement such as interstitial lung disease. Another cornerstone in the diagnostic procedure is muscle biopsy to identify inflammation and to exclude noninflammatory myopathies. Treatment effect and prognosis vary by subgroup. To develop new and better therapies, validated classification criteria that identify distinct subgroups of myositis are critical. The lack of such criteria was the main rationale for the development of new classification criteria for IIMs, which are summarized in this review; the historical background regarding previous diagnostic and classification criteria is also reviewed. As the IIMs are rare diseases with a prevalence of 10 in 100 000 individuals, an international collaboration was essential, as was the interdisciplinary effort including experts in adult and paediatric rheumatology, neurology, dermatology and epidemiology. The new criteria have been developed based on data from more than 1500 patients from 47 centres worldwide and are based on clinically easily available variables.
Neurolinguistic Relativity: How Language Flexes Human Perception and Cognition
Authors: Thierry Guillaume
Published: June 2016

The time has come, perhaps, to go beyond merely acknowledging that language is a core manifestation of the workings of the human mind and that it relates interactively to all aspects of thinking. The issue, thus, is not to decide whether language and human thought may be ineluctably linked (they just are), but rather to determine what the characteristics of this relationship may be and to understand how language influences—and may be influenced by—nonverbal information processing. In an attempt to demystify linguistic relativity, I review neurolinguistic studies from our research group showing a link between linguistic distinctions and perceptual or conceptual processing. On the basis of empirical evidence showing effects of terminology on perception, language‐idiosyncratic relationships in semantic memory, grammatical skewing of event conceptualization, and unconscious modulation of executive functioning by verbal input, I advocate a neurofunctional approach through which we can systematically explore how languages shape human thought.
Mediator immunity: time for evaluation in England and Wales?
Authors: Brooker Penny
Published: June 2016

In England and Wales, the issue of mediator immunity has not been considered by the courts or via legislation. Mediator immunity is constructed by analogy to that given to judges, but the role of the judiciary is different to that of mediators, who do not determine cases and, it is argued, do not require protection from litigation because the parties are responsible for the final settlement outcome. In Australia and the USA, mediators are usually provided with immunity in mandatory, ‘court-annexed’ programmes, although this varies from an absolute to a qualified level that is constrained by bad faith or dishonesty. In the English jurisdiction, mediation is court-connected and parties are dissuaded from accessing the courts through the risk of costs penalties or automatic referral schemes. Therefore, the time is opportune for a review of many issues involved in mediation development, including immunity. This paper considers the reasoning for extending immunity to mediators, before concluding that the subject should not be determined through legal action until after a comprehensive review of mediation developments and after a consideration of mediator standards and regulation of practice.
Contrasting patterns of population connectivity between regions in a commercially important mollusc Haliotis rubra: integrating population genetics, genomics and marine LiDAR data
Authors: Miller A. D. , van Rooyen A. , Rašić G. , Ierodiaconou D. A. , Gorfine H. K. , Day R. , Wong C. , Hoffmann A. A. , Weeks A. R.
Published: June 2016

Estimating contemporary genetic structure and population connectivity in marine species is challenging, often compromised by genetic markers that lack adequate sensitivity, and unstructured sampling regimes. We show how these limitations can be overcome via the integration of modern genotyping methods and sampling designs guided by LiDAR and SONAR data sets. Here we explore patterns of gene flow and local genetic structure in a commercially harvested abalone species (Haliotis rubra) from southeastern Australia, where the viability of fishing stocks is believed to be dictated by recruitment from local sources. Using a panel of microsatellite and genomewide SNP markers, we compare allele frequencies across a replicated hierarchical sampling area guided by bathymetric LiDAR imagery. Results indicate high levels of gene flow and no significant genetic structure within or between benthic reef habitats across 1400 km of coastline. These findings differ to those reported for other regions of the fishery indicating that larval supply is likely to be spatially variable, with implications for management and long‐term recovery from stock depletion. The study highlights the utility of suitably designed genetic markers and spatially informed sampling strategies for gaining insights into recruitment patterns in benthic marine species, assisting in conservation planning and sustainable management of fisheries.
Quantitative reference value of dopamine transporter single‐photon emission computed tomography in healthy Japanese older adults
Authors: Koh Jinsoo , Yamamoto Kazumi , Sakata Mayumi , Murata Ken‐ya , Ito Hidefumi
Published: June 2016

Background

N‐ω‐fluoropropyl‐2b‐carbomethoxy‐3b‐(4‐123I‐iodophenyl) nortropane (123I‐FP‐CIT) single‐photon emission computed tomography is an effective diagnostic tool for parkinsonism . However, a lack of quantitative reference values of the specific binding ratio of normal Japanese controls is a crucial limitation when we apply this procedure for evaluating Japanese parkinsonian patients.

Aim

In the present study, we aimed to obtain a control database of specific binding ratio in healthy, Japanese older adults.

Methods

We studied 123I‐FP‐CIT single‐photon emission computed tomography in 20 healthy Japanese older adults, and obtained the specific binding ratio with and without attenuation correction.

Results

Clinically and practically relevant data were obtained from 19 participants (10 women, 9 men, age 68.7 ± 8.8 years). The mean specific binding ratio with attenuation correction ± standard deviation was 6.84 ± 1.01, being significantly higher than that of the preceding study of Caucasians by Tossici‐Bolt et al. The mean specific binding ratio without attenuation correction was 5.31 ± 1.04. These were not different between the sexes. The specific binding ratio decreased age‐dependently in the specific binding ratio both with and without attenuation correction. The mean decreasing rate of specific binding ratio with AC was approximately 0.7 per decade. Most of the striatal asymmetry index of specific binding ratio with AC was lower than 8.4%.

Conclusion

We presented the quantitative reference values of Japanese healthy older adults feasible for diagnostic and research use for Japanese parkinsonian patients.
Moral Disagreement and Moral Semantics
Authors: Khoo Justin , Knobe Joshua
Published: June 2016

When speakers utter conflicting moral sentences (“X is wrong”/“X is not wrong”), it seems clear that they disagree. It has often been suggested that the fact that the speakers disagree gives us evidence for a claim about the semantics of the sentences they are uttering. Specifically, it has been suggested that the existence of the disagreement gives us reason to infer that there must be an incompatibility between the contents of these sentences (i.e., that it has to be the case that at least one of them is incorrect). This inference then plays a key role in a now‐standard argument against certain theories in moral semantics. In this paper, we introduce new evidence that bears on this debate. We show that there are moral conflict cases in which people are inclined to say both (a) that the two speakers disagree and (b) that it is not the case at least one of them must be saying something incorrect. We then explore how we might understand such disagreements. As a proof of concept, we sketch an account of the concept of disagreement and an independently motivated theory of moral semantics which, together, explain the possibility of such cases.
Practical Know‐Wh
Authors: Farkas Katalin
Published: June 2016

The central and paradigmatic cases of knowledge discussed in philosophy involve the possession of truth. Is there in addition a distinct type of practical knowledge, which does not aim at the truth? This question is often approached through asking whether states attributed by “know‐how” locutions are distinct from states attributed by “know‐that”. This paper argues that the question of practical knowledge can be raised not only about some cases of “know‐how” attributions, but also about some cases of so‐called “know‐wh” attributions; and that certain features of this practical knowledge‐wh put pressure on the standard analysis of know‐wh.
Evil and God's Toxin Puzzle
Authors: Pittard John
Published: June 2016

I show that Kavka's toxin puzzle raises a problem for the “Responsibility Theodicy,” which holds that the reason God typically does not intervene to stop the evil effects of our actions is that such intervention would undermine the possibility of our being significantly responsible for overcoming and averting evil. This prominent theodicy seems to require that God be able to do what the agent in Kavka's toxin story cannot do: stick by a plan to do some action at a future time even though when that time comes, there will be no good reason for performing that action (and very good reason not to). I assess various approaches to solving this problem. Along the way, I develop an iterated variant of Kavka's toxin case and argue that the case is not adequately handled by standard causal decision theory.
Unravelling the in vivo regulation and metabolic role of the alternative oxidase pathway in C3 species under photoinhibitory conditions
Authors: Florez‐Sarasa Igor , Ribas‐Carbo Miquel , Del‐Saz Néstor Fernández , Schwahn Kevin , Nikoloski Zoran , Fernie Alisdair R. , Flexas Jaume
Published: June 2016

The mitochondrial alternative oxidase pathway (AOP) has been suggested to act as a sink for excess reducing power generated in the chloroplast under high‐light (HL) stress and thus may reduce photoinhibition. The aim of this study was to compare different species to investigate the in vivo regulation and role of AOP under HL stress.

The in vivo activities of AOP (νalt) and the cytochrome oxidase pathway, chlorophyll fluorescence, metabolite profiles, alternative oxidase (AOX) capacity and protein amount were determined in leaves of five C3 species under growth light and after HL treatment.

Differences in respiration and metabolite levels were observed among species under growth light conditions. The HL response of νalt was highly species dependent, correlated with the AOP capacity and independent of AOX protein content. Nevertheless, significant correlations were observed between νalt, levels of key metabolites and photosynthetic parameters.

The results show that the species‐specific response of νalt is caused by the differential post‐translational regulation of AOX. Significant correlations between respiration, metabolites and photosynthetic performance across species suggest that AOP may permit stress‐related amino acid synthesis, whilst maintaining photosynthetic activity under HL stress.
The sun doesn't shine equally on everyone
Authors: Yanovsky Marcelo J. , Mora‐García Santiago
Published: June 2016

This article is a commentary on Kirchenbauer et al., 211: 584–598.
Cytokinins influence root gravitropism via differential regulation of auxin transporter expression and localization in Arabidopsis
Authors: Pernisova Marketa , Prat Tomas , Grones Peter , Harustiakova Danka , Matonohova Martina , Spichal Lukas , Nodzynski Tomasz , Friml Jiri , Hejatko Jan
Published: June 2016

Redirection of intercellular auxin fluxes via relocalization of the PIN‐FORMED 3 (PIN3) and PIN7 auxin efflux carriers has been suggested to be necessary for the root gravitropic response. Cytokinins have also been proposed to play a role in controlling root gravitropism, but conclusive evidence is lacking.

We present a detailed study of the dynamics of root bending early after gravistimulation, which revealed a delayed gravitropic response in transgenic lines with depleted endogenous cytokinins (Pro35S:AtCKX) and cytokinin signaling mutants. Pro35S:AtCKX lines, as well as a cytokinin receptor mutant ahk3, showed aberrations in the auxin response distribution in columella cells consistent with defects in the auxin transport machinery.

Using in vivo real‐time imaging of PIN3‐GFP and PIN7‐GFP in AtCKX3 overexpression and ahk3 backgrounds, we observed wild‐type‐like relocalization of PIN proteins in the columella early after gravistimulation, with gravity‐induced relocalization of PIN7 faster than that of PIN3. Nonetheless, the cellular distribution of PIN3 and PIN7 and expression of PIN7 and the auxin influx carrier AUX1 was affected in AtCKX overexpression lines.

Based on the retained cytokinin sensitivity in pin3 pin4 pin7 mutant, we propose the AUX1‐mediated auxin transport rather than columella‐located PIN proteins as a target of endogenous cytokinins in the control of root gravitropism.