bluuebunny/crossref_metadata_2025 huggingface dataset:
Significant improvements in SEIzure interVAL (time between seizure clusters) across time in patients treated with diazepam nasal spray as intermittent rescue therapy for seizure clusters
Authors: Misra Sunita N. , Sperling Michael R. , Rao Vikram R. , Peters Jurriaan M. , Davis Charles , Carrazana Enrique , Rabinowicz Adrian L.
Published: August 2022

Objective

Intermittent rescue therapy may be used for seizure clusters, which are clinical emergencies that may persist ≥24 h and increase risk of status epilepticus, emergency room visits, and reduced quality of life for patients with epilepsy. Beyond effectiveness for aborting seizure clusters, no data exist on how intermittent rescue therapy may impact the long‐term natural course of seizure clusters. This novel analysis explores SEIzure interVAL (SEIVAL; time between seizure clusters) in patients from a long‐term safety study of diazepam nasal spray (Valtoco) to assess SEIVAL changes with intermittent rescue therapy across time.

Methods

Patients were aged 6–65 years. Age‐ and weight‐based doses of diazepam nasal spray were administered during a 12‐month treatment period with an optional follow‐up period. SEIVAL was evaluated in patients receiving two or more doses of diazepam nasal spray using 90‐day periods.

Results

Of 163 treated patients, 151 had one or more SEIVALs. One hundred twenty had SEIVALs in Period 1 and one or more other periods. An increase in SEIVAL was noted from Period 1 compared with all subsequent periods (p ≤ .001). A consistent cohort (n = 76) had one or more SEIVALs in each of Periods 1–4 (360 days); mean SEIVALs increased significantly (p < .01) from 12.2 days (Period 1) to 25.7 days (Period 4). Similar SEIVAL patterns occurred when repeat doses within a seizure cluster were eliminated and irrespective of age group, treatment duration, and change to concomitant medications. In adults, Quality of Life in Epilepsy scores were maintained with increased SEIVALs.

Significance

Across 12 months, increases in SEIVAL were demonstrated in patients using diazepam nasal spray for seizure cluster treatment in a phase 3 safety study. Increased time between seizure clusters may reflect a previously unrecognized beneficial effect of intermittent rescue therapy. These results generate a range of biological and behavioral hypotheses and warrant exploration of the impact of intermittent rescue therapy.
Influence of fish attractant on hooking location of Lutjanus carponotatus and Epinephelus quoyanus caught with soft plastic and hard‐bodied lures
Authors: Diggles Ben K. , Ernst Ingo , Wesche Stephen , Scutt Katie
Published: August 2022

Recreational fishing gear continues to evolve, and factors such as anatomical hooking location may change over time due to technology creep. We revisited studies conducted in 1996 by re‐examining hooking location in experiments where hard‐bodied and soft plastic lures were presented to stripey (Lutjanus carponotatus) and wire netting cod (Epinephelus quoyanus) either with or without application of a synthetic fish attractant. These data were compared to those of fish hooked on organic bait using circle or J‐style hooks. Lure type and application of attractant both significantly affected hooking location. Addition of attractant to hard‐bodied lures reduced foul hooking of both species. For L. carponotatus, soft plastic lures both with and without attractant tended to be taken deeper than hard‐bodied lures. For E. quoyanus captured on soft plastic lures coated with attractant, hooking locations were similar to those using organic baits on circle hooks. However, deepest hooking of both species occurred using organic bait on J‐style hooks. The use of soft plastic lures with an effective fish attractant may result in deeper hooking, which could potentially influence post‐release survival and increase fishing power.
Influences of multiple anthropogenic disturbances coupled with a tailings dam rupture on spatiotemporal variation in fish assemblages of a tropical river
Authors: Salvador Gilberto N. , Montag Luciano F. A. , Hughes Robert M. , Almeida Sara M. , Prudente Bruno S. , Pessali Tiago C. , Barroso Tobias A. , Cianciaruso Marcus V. , Ligeiro Raphael , Juen Leandro , Carlucci Marcos B.
Published: August 2022

The Mariana disaster, resulting from the rupture of the Fundão tailings storage facility (TSF) in 2015, was a large‐scale environmental disaster that drastically affected the entire channel of the Rio Doce, southeastern Brazil. The disaster produced substantial channel siltation, increased turbidity, riparian damage and a massive fish kill. However, the Rio Doce basin has a long history of environmental degradation, including hydroelectric dams. The latter are major threats to the ichthyofauna because they affect flow regimes, trap sediments and large wood, select generalist species, impair fish migrations and favour non‐native invasive species. In this study, we analysed the effects of the rupture as well as impacts from the construction of a run‐of‐the‐river hydroelectric dam on native and non‐native fish abundances, and species richness and composition in the middle Rio Doce.

To do this, we examined fish survey data collected before and after each disturbance upriver of the reservoir, in the reservoir area and downriver of the dam. The data were separated into three temporal intervals: free‐flowing river, post‐filling reservoir and post‐TSF disaster. To assess temporal changes in native and non‐native fish species richness, we used a rarefaction method and tested it with two‐way ANOVA, which also was used to compare fish abundances. To test temporal changes in fish assemblage composition we used a PERMANOVA test.

We observed no significant differences in total native or non‐native species richness as a result of the dam or the disaster. However, we did observe increased non‐native individual abundances after the TSF rupture as well as native individual abundances, depending on the location studied. The assemblage composition also changed after dam construction and the TSF rupture, except for the upriver reach after dam construction.

We conclude that both the dam and the TSF rupture affected fish assemblages, favouring increased non‐native abundances, and also changed fish assemblage composition.

Our results suggest that a century of landscape and riverscape pressures had extirpated the sensitive fishes from the Rio Doce before the TSF rupture. We conclude that multiple long‐term chronic disturbances can be as harmful to aquatic biota as the acute effects of a major environmental disaster.
Varieties of connections, varieties of corruption: Evidence from bureaucrats in five countries
Authors: Harris Adam S. , Meyer‐Sahling Jan‐Hinrik , Mikkelsen Kim Sass , Schuster Christian , Seim Brigitte , Sigman Rachel
Published: August 2022

Why do some bureaucrats engage in corruption for personal gain, yet others for political gain? We show that these forms of corruption frequently do not coincide and offer an explanation: bureaucrats hired based on political and personal connections have different identities and incentives which compel them to engage in corruption for political and personal gain respectively. List experiments with a unique sample of 6400 bureaucrats in five countries in Africa and Asia support our argument. As theoretically expected, effects are strongest for bureaucrats whose political patrons remain in power (for corruption for political gain) and who do not need corruption gains to sustain their households (for corruption for personal gain). We also find that personal connections matter more than political connections for bureaucratic recruitment across surveyed countries. Our findings underscore the importance of studying varieties of bureaucratic corruption and of supplementing the politicization literature with studies of personal connections in bureaucracy.
Prevalence of fatty liver and advanced fibrosis by ultrasonography and FibroScan in a general population random sample
Authors: Nagaoki Yuko , Sugiyama Aya , Mino Megumi , Kodama Hiroomi , Abe Kanon , Imada Hirohito , Ouoba Serge , E Bunthen , Ko Ko , Akita Tomoyuki , Sako Toru , Kumada Takashi , Chayama Kazuaki , Tanaka Junko
Published: August 2022

Aim

Fatty liver is the most common liver disease. This study examined fatty liver and advanced fibrosis prevalence in a random sample of the Japanese general population.

Methods

A total of 6000 people randomly selected from two cities in Hiroshima Prefecture were invited to participate in this cross‐sectional study originally carried out for hepatitis virus screening. Ultrasonography and FibroScan (controlled attenuation parameter [CAP] and liver stiffness measurement [LSM]) were provided as additional tests.

Results

Of 6000 invited individuals, 1043 participated in hepatitis virus screening, of which 488 randomly selected individuals (median age, 56 years; interquartile range, 45–68 years; male participants, 49.8%) underwent ultrasonography, CAP, and LSM. Ultrasonography showed fatty liver in 24.6% and mild fatty liver in 32.8%. Controlled attenuation parameter showed severe steatosis in 27.5%, moderate steatosis in 12.5%, and mild steatosis in 11.1%. Overall, 62.1% were diagnosed with fatty liver based on ultrasonography or CAP. Nonalcoholic fatty liver disease (NAFLD) prevalence was 50.6%. Liver stiffness measurement found cirrhosis in 1.0% and severe fibrosis in 1.8%. Multivariate analysis of risk factors associated with ≥F2 or higher liver fibrosis showed that age ≥60 years and above (adjusted odds ratio [AOR], 3.2; 95% confidence interval [CI], 1.5–6.9; p = 0.0031), hepatitis C virus antibody positivity (AOR, 8.4; 95% CI, 1.0–68.4; p = 0.0467), and fatty liver (AOR, 2.3; 95% CI, 1.1–6.2; p = 0.0317) are independent risk factors.

Conclusions

In the general population, 62.1% had fatty liver, and NAFLD prevalence was twice as high as previously reported. Screening that is noninvasive, low‐cost, and does not require special techniques or equipment is needed to detect advanced liver fibrosis.
Elucidation of the signalling pathways for enhanced exosome release from Mycobacterium‐infected macrophages and subsequent induction of differentiation
Authors: Singh Arpana , Das Kaushik , Banerjee Sampali , Sen Prosenjit
Published: August 2022

Exosomes are extracellular vesicles released by all cell types; perform several important functions such as cell‐to‐cell communication, growth, differentiation and so on. Exosomes elicit several signalling mechanisms as they carry information in the form of DNA, RNA or protein docked on them. We show that exosomes released from Mycobacterium tuberculosis (Mtb)‐infected macrophages not only induce differentiation of naïve monocytes but also generate functionally active macrophages via MAPK‐dependent signalling mechanism through MK‐2 and NF‐κβ activation which is completely different from the differentiation induced by exosomes from uninfected macrophages. Further, we elucidate unequivocally the signalling mechanism behind the enhanced release of exosome generation from infected macrophages driven by AKT phosphorylation involving Rab7a and Rab11a. Genes of both ESCRT‐dependent and ‐independent pathways are found to be involved in enhanced exosomes release and are modulated by AKT. However, interestingly, the genes of the ESCRT‐independent pathway are dependent on NF‐κβ activation while the genes of the dependent pathway are not, suggesting two parallel signalling cascades operating in tandem.
Microstructure and conductivity of blacklight‐sintered TiO2, YSZ, and Li0.33La0.57TiO3
Authors: Porz Lukas , Scherer Michael , Muhammad Qaisar Khushi , Higuchi Kimitaka , Li Yan , Koga Shuhei , Nakamura Atsutomo , Rheinheimer Wolfgang , Frömling Till
Published: August 2022

Rapid densification of ceramics has been realized and its merits were demonstrated through multiple approaches out of which UHS and flash sintering attract recent attention. So far, however, scalability remains difficult. A rise in throughput and scalability is enabled by the introduction of blacklight sintering powered by novel light source technology. Intense illumination with photon energy above the bandgap (blacklight) allows high absorption efficiency and, hence, very rapid, contactless heating for all ceramics. While heating the ceramic directly with light without any furnace promises scalability, it simultaneously offers highly accurate process control. For the technology transfer to industry, attainable material quality needs to be assured. Here, we demonstrate the excellent microstructure quality of blacklight‐sintered ceramics observed with ultrahigh voltage electron microscopy revealing an option to tune nanoporosity. Moreover, we confirm that electronic, electron, oxygen, and lithium‐ion conductivities are equal to conventionally sintered ceramics. This gives the prospect of transmitting the merits of rapid densification to the scale of industrial kilns.
The dual role of bismuth in Li2O–Bi2O3–B2O3 glasses along the orthoborate join
Authors: Topper Brian , Tsekrekas Elizabeth M. , Greiner Lucas , Youngman Randall E. , Kamitsos Efstratios I. , Möncke Doris
Published: August 2022

The structures of glasses in the lithium–bismuth orthoborate composition range deviate significantly from the short‐range order structure of the two crystalline end‐members. Although binary Li3BO3 and BiBO3 are solely of comprised trigonal orthoborate anions, all glasses formed by their combination contain four‐coordinated borate tetrahedra. We analyze the structure of (75−1.5x)Li2O–xBi2O3–(25+0.5x)B2O3 glasses in increments of x = 5, with 11B magic‐angle spinning nuclear magnetic resonance (NMR), infrared (IR), and Raman spectroscopy. For the full series, the oxygen‐to‐boron ratio remains constant at O/B = 3:1. NMR quantifies an increase in the fraction of tetrahedral boron with increasing bismuth oxide content. Evolution of the mid‐IR profile suggests multiple types of tetrahedral boron sites. Raman spectroscopy reveals that Bi2O3 tends to cluster within the lithium borate matrix when initially introduced and that this behavior transforms into a bismuthate network with increasing bismuth oxide content. In all cases, mixed Bi–O–B linkages are observed. The dual role of bismuth as network modifier and network former is likewise observed in the far IR. The glass transition temperature continuously increases with bismuth oxide content; however, the glass stability displays a maximum in the multicomponent glass of x = 40.
Parents with intellectual disability reporting on factors affecting their caregiving in the wake of the COVID‐19 pandemic: A qualitative study
Authors: Forslund Tommie , Fernqvist Stina , Tegler Helena
Published: August 2022

Background

Parents with intellectual disability are vulnerable to parenting stress and overwhelming life events. The COVID‐19 pandemic constitutes a potentially overwhelming event, but there is little knowledge concerning the effects on parents' caregiving. The present study aimed to fill this gap.

Method

Semi‐structured interviews with 10 Swedish parents with intellectual disability were analysed using thematic analysis.

Results

One broad caregiving‐related theme: increased caregiving demands and reduced resources for coping resulting in strained parent–child interactions and relationships. Four subthemes highlighted influential factors: pandemic information, professional support, social relationships and informal support, and children's school activities. Strained parent–child interactions were particularly common in the absence of adapted pandemic information, if professional and informal support were compromised, and if the parents had dealt with school‐related changes.

Conclusions

Findings support contextual models of caregiving and a stress‐resources perspective, and emphasise the importance of adapted information and support to parents with intellectual disability during crises.
The use of social media among high school students and its relationship with the perception of loneliness: A pilot study
Authors: Kitiş Yeter , Dağci Büşra , Köse Neslihan , Geniş Çiğdem
Published: August 2022

Background

Physical, psychological, and social impairments are becoming more common in the world due to internet use and excessive use.

Purpose

This study was conducted to determine the relationship between social media addiction (SMA) and the perception of loneliness in the high school period when peer influence is important.

Methodology

This cross‐sectional study was conducted with a total of 988 students studying at four high schools in Ankara, the capital city of Turkey, in the fall semester of 2019‐2020. The research data were collected using Introductory Information Form, Social Media Addiction Scale (SMAS), and UCLA Loneliness Scale.

Results

According to the findings, 67.2% of the students had different degrees of SMA. It was found that 7.8% of the students had a high or very high degree of addiction. Loneliness levels of the students were found to be high (UCLA mean 62.78). A strong negative correlation (p < 0.01) was found between loneliness and all the subscales of the SMAS except the busyness subscale.

Conclusions

The findings demonstrate the social media addiction and the perception of loneliness in high school students are related at a level that cannot be ignored. Future research should evaluate social media addiction and loneliness together with other psychological markers.
Bateman gradients reflect variation in sexual selection in a species with dynamic sex roles
Authors: Hare Robin M. , Simmons Leigh W.
Published: August 2022

Bateman gradients, the slope of the regression of reproductive success on mating success, are among the most commonly reported measures of sexual selection. They are particularly insightful in species with reversed sex roles, where females are expected to be under sexual selection. We measured Bateman gradients in replicate experimental populations of the spermatophore gift‐giving bushcricket Kawanaphila nartee (Orthoptera: Tettigoniidae). In this species, the operational sex ratio (OSR) and thus the sex competing for mates varies depending on the availability of pollen food resources: under pollen‐limited regimens females are more competitive, whereas under pollen‐rich regimens males are more competitive. We maintained populations in enclosures with either limited or supplemented pollen and calculated Bateman gradients for males and females under both conditions. Bateman gradients were significantly positive in males, and the slope was steeper in pollen‐supplemented populations where the OSR was more male‐biased. Bateman gradients for females were shallow and nonsignificant regardless of pollen availability. Our results show that the strength of sexual selection on males can depend on environmental context. The lack of significant gradients among females may reflect experimental limitations on our ability to estimate Bateman gradients in female K nartee.
Screening naturally mildewed maize kernels based on Raman hyperspectral imaging coupled with machine learning classifiers
Authors: Long Yuan , Wang Qingyan , Tian Xi , Zhang Bin , Huang Wenqian
Published: August 2022

Mildewed maize kernels were common in nature and they were harmful to humans and livestocks. Therefore, it is essential to screen the mildewed maize kernels and improve food security. In this study, Raman hyperspectral imaging technique was used to screen the mildewed maize kernels. Hyperspectral imaging of both embryo‐up and embryo‐down side were taken into consideration and the effect of their weight ratio on the screening accuracy was compared. Pixel‐wise approach and object‐wise approach were both analyzed and different variables selection methods were applied to optimize the input variables. Six machine learning classifiers including random forest (RF), support vector machine (SVM), linear discriminant analysis (LDA), extreme learning machine (ELM), partial least squares discriminant analysis (PLSDA), and naive Bayes classifier (NBC) were used to establish the screening models. The results exhibited 19 variables selected by competitive adaptive reweighted sampling (CARS) method from the weight ratio of 3:7 based on object‐wise approach were the most suitable for establishment of screening model with accuracy of 90.63% in the testing set. The microscopic mechanism of mildewed maize kernels was illustrated by micro‐fluorescence imaging. The study showed that Raman hyperspectral imaging combined with both embryo‐up and embryo‐down sides of maize kernels could be used as effective methods to improve the accuracy of screening mildewed maize kernels.

Practical Applications

This study provides a comprehensive analysis about the pixels and both sides of maize kernels and gives a nondestructive screening method based on both sides of maize kernels for the mildewed detection. According the mildew of maize kernels, enterprises can effectively improve the storage efficiency of maize kernels to reduce economic losses.
Effect of the STRIDE fall injury prevention intervention on falls, fall injuries, and health‐related quality of life
Authors: Ganz David A. , Yuan Anita H. , Greene Erich J. , Latham Nancy K. , Araujo Katy , Siu Albert L. , Magaziner Jay , Gurwitz Jerry H. , Wu Albert W. , Alexander Neil B. , Wallace Robert B. , Greenspan Susan L. , Rich Jeremy , Volpi Elena , Waring Stephen C. , Dykes Patricia C. , Ko Fred , Resnick Neil M. , McMahon Siobhan K. , Basaria Shehzad , Wang Rixin , Lu Charles , Esserman Denise , Dziura James , Miller Michael E. , Travison Thomas G. , Peduzzi Peter , Bhasin Shalender , Reuben David B. , Gill Thomas M.
Published: August 2022

Background

Falls are common in older adults and can lead to severe injuries. The Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) trial cluster‐randomized 86 primary care practices across 10 health systems to a multifactorial intervention to prevent fall injuries, delivered by registered nurses trained as falls care managers, or enhanced usual care. STRIDE enrolled 5451 community‐dwelling older adults age ≥70 at increased fall injury risk.

Methods

We assessed fall‐related outcomes via telephone interviews of participants (or proxies) every 4 months. At baseline, 12 and 24 months, we assessed health‐related quality of life (HRQOL) using the EQ‐5D‐5L and EQ‐VAS. We used Poisson models to assess intervention effects on falls, fall‐related fractures, fall injuries leading to hospital admission, and fall injuries leading to medical attention. We used hierarchical longitudinal linear models to assess HRQOL.

Results

For recurrent event models, intervention versus control incidence rate ratios were 0.97 (95% confidence interval [CI], 0.93–1.00; p = 0.048) for falls, 0.93 (95% CI, 0.80–1.08; p = 0.337) for self‐reported fractures, 0.89 (95% CI, 0.73–1.07; p = 0.205) for adjudicated fractures, 0.91 (95% CI, 0.77–1.07; p = 0.263) for falls leading to hospital admission, and 0.97 (95% CI, 0.89–1.06; p = 0.477) for falls leading to medical attention. Similar effect sizes (non‐significant) were obtained for dichotomous outcomes (e.g., participants with ≥1 events). The difference in least square mean change over time in EQ‐5D‐5L (intervention minus control) was 0.009 (95% CI, −0.002 to 0.019; p = 0.106) at 12 months and 0.005 (95% CI, −0.006 to 0.015; p = 0.384) at 24 months.

Conclusions

Across a standard set of outcomes typically reported in fall prevention studies, we observed modest improvements, one of which was statistically significant. Future work should focus on patient‐, practice‐, and organization‐level operational strategies to increase the real‐world effectiveness of interventions, and improving the ability to detect small but potentially meaningful clinical effects.

Clinicaltrials.gov identifier: NCT02475850.
The association of a frailty index from laboratory tests and vital signs with clinical outcomes in hospitalized older adults
Authors: Ysea‐Hill Otoniel , Gomez Christian J. , Mansour Natalie , Wahab Kamal , Hoang Mihn , Labrada Mabel , Ruiz Jorge G.
Published: August 2022

Background

Frailty, a state of vulnerability to stressors resulting from loss of physiological reserve due to multisystemic dysfunction, is common among hospitalized older adults. Hospital clinicians need objective and practical instruments that identify older adults with frailty. The FI‐LAB is based on laboratory values and vital signs and may capture biological changes of frailty that predispose hospitalized older adults to complications. The study's aim was to assess the association of the FI‐LAB versus VA‐FI with hospital and post‐hospital clinical outcomes in older adults.

Methods

Retrospective cohort study was conducted on Veterans aged ≥60 admitted to a VA hospital. We identified acute hospitalizations January 2011‐December‐2014 with 1‐year follow‐up. A 31‐item FI‐LAB was created from blood laboratory tests and vital signs collected within the first 48 h of admission and scores were categorized as low (<0.25), moderate (0.25–0.40), and high (>0.40). For each FI‐LAB group, we obtained odds ratio (OR) and confidence intervals (CI) for hospital and post‐hospital outcomes using multivariate binomial logistic regression. Additionally, we calculated hazard ratios (HR) and CI for all‐cause in‐hospital mortality comparing the high and moderate FI‐LAB group with the low group.

Results

Patients were 1407 Veterans, mean age 72.7 (SD = 9.0), 67.8% Caucasian, 96.1% males, 47.0% (n = 661), 41.0% (n = 577), and 12.0% (n = 169) were in the low, moderate, and high FI‐LAB groups, respectively. Moderate and high scores were associated with prolonged LOS, OR:1.62 (95% CI:1.29–2.03); and 3.36 (95% CI:2.27–4.99), ICU admission, OR:1.40 (95% CI:1.03–1.90); and OR:2.00 (95% CI:1.33–3.02), nursing home placement OR:2.36 (95% CI:1.26–4.44); and 5.99 (95% CI:2.83–12.70), 30‐day readmissions OR:1.74 (95% CI:1.20–2.52); and 2.20 (95% CI:1.30–3.74), 30‐day mortality OR: 2.51 (95% CI:1.01–6.23); and 8.97 (95% CI:3.42–23.53), 6‐month mortality OR:3.00 (95% CI:1.90–4.74); and 6.16 (95% CI:3.55–10.71), and 1‐year mortality OR: 2.66 (95% CI:1.87–3.79); and 4.76 (95% CI:3.00–7.54) respectively. The high FI‐LAB group showed higher risk of in‐hospital mortality, HR:18.17 (95% CI:4.01–80.52) with an area‐under‐the‐curve of 0.843 (95% CI:0.75–0.93).

Conclusions

High and moderate FI‐LAB scores were associated with worse in‐hospital and post‐hospital outcomes. The FI‐LAB may identify hospitalized older patients with frailty at higher risk and assist clinicians in implementing strategies to improve outcomes.
Incidence and characteristics of hospital‐acquired mucous membrane pressure injury: A five‐year analysis
Authors: Fulbrook Paul , Lovegrove Josephine , Butterworth Jacob
Published: August 2022

Background

Pressure injuries on mucous membranes are caused by pressure from medical devices at the site of injury and differ to those on the skin. Intensive care patients, who have multiple devices in situ, are particularly vulnerable. There is a significant knowledge gap regarding mucous membrane pressure injury (MMPI) incidence in acute hospital settings.

Aim

To analyse MMPI incidence and characteristics in a tertiary acute general hospital.

Methods

A secondary data analysis of hospital clinical incident reports was conducted. The sample included all adults with MMPIs between 2015 and 2019. The STROBE reporting guideline was followed.

Results

There were 414 reports of MMPI. Most (91.5%, n = 379) were hospital‐acquired with the majority found in intensive care patients (74.4%, n = 282). Hospital‐acquired MMPI incidence was 0.1% (11 MMPI per 10,000 hospital episodes). In intensive care, the incidence was 2.4% (235 MMPI per 10,000 intensive care episodes). The median time from device insertion until reporting of an MMPI was 3 days. The most common sites of mucosal injury were the lips (35.6%) and mouth (28.8%). In all cases except one, MMPI was associated with medical device use at the site of injury. Five device types were identified (oral endotracheal tube‐related 70.3%; urinary catheter 15.5%; gastric tube 8.3%; nasal prongs 3.5%; tracheostomy tube 2.4%). In intensive care, oral endotracheal tube‐related devices were most often associated with MMPI (84.8%), whereas in non‐intensive care MMPI it was the urinary catheter (51.4%).

Conclusions

While hospital‐acquired MMPI incidence is relatively low, it is considerably higher in intensive care patients compared to those in non‐intensive care settings. The most common sites are the lips and mouth.

Relevance to clinical practice

Mucous membrane pressure injuries represent a significant proportion of all hospital‐acquired pressure injuries.

Patient or public contribution

Neither patients nor the public were directly involved in this project.
Engaging in narrative relations in everyday work on a geriatric ward: A qualitative study with healthcare professionals
Authors: Herulf Scholander Lisa , Boström Anne‐Marie , Josephsson Staffan , Vikström Sofia
Published: August 2022

Aims and objectives

To explore healthcare professionals' experiences and reflections about narration in their everyday work.

Background

The need for integrated and people‐centred healthcare for older adults has highlighted the relevance of narration in healthcare practice. Although theoretical foundations vary, different frameworks building on narration have been proposed for translating person‐centredness philosophies into practice. However, to understand how theoretical knowledge on narration can be adopted into clinical work, we need to learn how healthcare staff understand narration from their experiential knowledge and practice.

Design

The research process followed guidelines from Constructivist Grounded Theory as described by Charmaz. The study adheres to the COREQ guidelines.

Methods

Data collection entailed interprofessional focus groups discussions with healthcare staff (n = 31). Vignettes depicting realistic scenarios were used to encourage participants to reflect on clinical practice. Data were analysed via a constant comparative method.

Results

One core theme arose from the analysis. The core theme showed how narration was a relational process that people engaged in to pursue and uphold several foundational qualities in healthcare practice presented in the following subthemes: preventing simplistic understandings of people and situations; supporting trustful relations; supporting continuity and coherence; and learning from coworkers. However, a minor theme raised awareness of narrative relations as a double‐edged sword.

Conclusions

By acknowledging the mutual and multifacetted nature of narration in everyday practice, this study shows how healthcare professionals' engagement in narrative relations may contribute to upholding several foundational qualities which resonate with philosophies of person‐centredness in everyday healthcare practice.

Relevance to clinical practice

Recognition of both the advantages and possible risks embedded in narrative relations in healthcare practice emphasises the obligation to collectively reflect on the repercussions of narrative relations in any local context.

Patient or public contribution

Healthcare professionals contributed by sharing their experiential knowledge and reflections on narration in practice.
Excessive mechanical stress induced temporomandibular joint osteoarthritis via osteoclasts‐mediated osteogenic differentiation of BMSCs
Authors: Wang Lingzhi , Tian Yihong , Liu Meixi , He Zijing , Yan Xiao , Yuan Xiao , Zhang Qiang
Published: August 2022

Background

Bone homeostasis is a dynamic process maintained by osteoblasts and osteoclasts, which may be regulated by excessive mechanical stress (EMS).

Objectives

Our study aimed to explore the relationship between osteogenic differentiation of BMSCs and EMS‐activated osteoclast differentiation of RAW 264.7 cells in order to optimise orthodontic treatment.

Methods

We established the model of EMS in vivo and in vitro. In vivo, HE, Safranin‐O staining, micro‐CT, and immunofluorescence double‐labelling were utilised to assess the changes in condylar, the distributions of osteoblasts, osteoclasts and MAPKs. In vitro, the effects of EMS‐activated osteoclast differentiation exerting on osteogenic differentiation of BMSCs were observed by Western Blot, qRT‐PCR and Alizarin Red staining. Furthermore, the role of MAPKs in this progress was explored by using inhibitors of MAPKs and co‐culture supernatants.

Results

In vivo, EMS led to the degradation of condylar cartilage and destruction of subchondral bone, diagnosed as temporomandibular joint osteoarthritis (TMJ OA). Osteoclasts and osteoblasts were both enriched in subchondral bone, but osteoclast predominated. The expressions of p‐JNK, p‐ERK1/2, and p‐p38 were all activated in vitro and in vivo, which were localised mainly in the Trap+ area in subchondral bone. Interestingly, only the inactivation of p‐ERK1/2 in osteoclasts significantly inhibited the osteogenic differentiation of BMSCs in vitro. This revealed that p‐ERK1/2 played a key role in the osteoclasts‐induced osteogenic differentiation of BMSCs.

Conclusion

Our results proved that EMS led to TMJ OA, in which upregulated p‐ERK1/2 in osteoclasts was mechanosensitive and facilitated the osteogenic differentiation of BMSCs.
The experience of transitioning into life‐sustaining treatment: A systematic literature review
Authors: Sedin Annica , Isaksson Johan , Patel Harshida
Published: August 2022

Background

Being informed about treatment options for kidney failure and included in the related decision‐making process can facilitate a smooth transition. Among patients with kidney failure the initiation of kidney failure replacement therapy is considered a traumatic event, causing physical and emotional distress and disrupting several aspects of one's social life. In order to ease the transition, health care personnel must ensure that the patient understands the parameters of each treatment option. It is imperative to increase the knowledge of patients' lived experiences around initiating kidney failure replacement therapy.

Objectives

To explore how adults with kidney failure describe the lived experience of transitioning into life‐sustaining kidney failure replacement therapy.

Design

A systematic review of qualitative literature.

Methods

Primary qualitative studies published in English between 2010 and 2020 from CINAHL, PubMed and PsycINFO were included. Content analysis summarised the patients' lived experience.

Findings

From 959 records screened, 17 studies were eligible for inclusion. A total of 5 themes that described the patients' lived experience were identified: an existential transformative feeling, a change in quality of life, limitation, safety, and ambivalence.

Conclusion

Being prepared and receiving emotional, physical, and social support can ease the transition for the patient. Among all available treatment options, dialysis and transplantation, the transition into kidney failure replacement therapy is experienced as a life‐changing event. With this knowledge, it is imperative to clarify the importance of providing a patient with adequate support during the transition.
The Impact of a High School‐Based Positive Youth Development Program on Sexual Health Outcomes: Results from a Randomized Controlled Trial
Authors: Walsh Sarah , Jenner Eric , Qaragholi Noor , Henley Catherine , Demby Hilary , Leger Rebekah , Burgess Kelly
Published: August 2022

BACKGROUND

Although positive youth development (PYD) programs have demonstrated effectiveness in improving adolescent reproductive health outcomes, there is a lack of evidence on effective school‐based interventions designed especially for high school settings. This study examined the efficacy of Peer Group Connection (PGC‐HS), a school‐based PYD program, in improving sexual health outcomes for high school participants.

METHODS

A total of 1523 ninth‐grade students at 18 schools were randomly assigned to be offered PGC‐HS or a classes‐as‐usual control condition during 2016 to 2017 and 2017 to 2018 school years. Impacts were assessed on three confirmatory and 6 exploratory outcomes via self‐reported participant questionnaire data collected at the beginning of 10th grade.

RESULTS

Although the offer of PGC‐HS had no statistically detectable effect on confirmatory behavioral outcomes (sexual initiation, frequency of sex, and number of sexual partners) at 10th grade follow‐up, causal impact estimates indicate that PGC‐HS participants were less likely than control participants to ever have had vaginal sex. PGC‐HS participants also scored higher on decision‐making skills and perceived connection to peer connectedness.

CONCLUSIONS

Results suggest that by building social and emotional skills and helping students form supportive peer relationships, PGC‐HS may encourage students to make healthier choices and avoid risky behaviors during a critical period in high school, thus, reducing the risk of pregnancy.
Impact of panelist's age on the ease of swallow and sensory perception of texture‐modified broccoli purees
Authors: Mihnea Mihaela , Tobin Aarti B. , Lopez‐Sanchez Patricia , Garrido‐Bañuelos Gonzalo
Published: August 2022

Swallowing disorders affect approximately 8% of the global population. It is more prevalent in the elderly, leading to malnutrition and dehydration. Different strategies have been investigated to design new texture‐modified food products that would reduce or mitigate the suffering from these swallowing disorders. Despite the recent interest and research in this area, there are, however, still a lot of unknowns regarding the specific sensory insights by this targeted group. The aim of this work was to understand if the ease of swallow and related sensory characteristics are perceived differently by “young” and “elderly” healthy individuals. Broccoli purees with different textural properties were created by changing the fluid component (water or xanthan solution) or processing conditions. Samples were evaluated by an elderly panel (n = 19, average age = 68.9 years) and a young panel (n = 16, average age = 25.4 years). Multivariate data analysis strategies were used to understand the intrapanel sample discrimination and to compare between panels. Results showed a similar overall discrimination between samples between young and elderly panels. The use of xanthan improved the ease of swallow in both age groups. In the absence of xanthan gum, processing conditions determined the ease of swallow, which was related to the particle size distribution. Nevertheless, small differences were found between panels. For example, the elderly panel was more sensitive when discriminating samples based on the ease of swallow (p = .005). Therefore, panelist age seems to be relevant when designing tailored foods enhancing the ease of swallow for the elderly populations.

Practical Applications

The present study highlights new insights on the relevance of age and sensory capabilities when designing new texture‐modified food products. It also provides new insights regarding the key sensory attributes to consider and how these are affected by the type of food processing.
Post‐operative steroids in boys with histologically proven balanitis xerotica obliterans reduce the need for subsequent meatal dilatation
Authors: ElAgami Hesham , Naqvi Sheryer , Murphy Feilim
Published: August 2022

Aim

Post‐circumcision topical steroids may reduce the number of patients with balanitis xerotica obliterans (BXO) who require subsequent meatal dilatation. However, their use has only been investigated in the presence of an abnormal urethral meatus. The aim of this study is to determine if post‐operative topical steroids reduce the need for subsequent meatal dilatation in patients with histologically proven BXO independent of the appearance of the urethral meatus. To determine if post‐operative topical steroids reduce the need for subsequent meatal procedures in patients with histologically proven BXO. To determine if the appearance of the meatus at circumcision affects the need for subsequent meatal procedure.

Methods

We performed a retrospective review of all paediatric patients with histologically confirmed BXO post circumcision. We excluded all those with ‘chronic inflammation’ or ‘early BXO’. Patients were divided into groups based on whether post‐operative topical steroids were prescribed. The appearance of the urethral meatus at circumcision was recorded. Primary outcome was progression to subsequent meatal dilatation. Statistical significance was calculated using Fisher's exact test. A P value < 0.05 was considered significant.

Results

One hundred and seventeen patients with histologically confirmed BXO were identified between October 2012 and December 2017. Fifty‐nine patients were prescribed post‐operative topical steroids (50%). Nine patients required subsequent meatal dilatation procedure (8%) and only one of these had been prescribed post‐operative topical steroids (P = 0.0165).

Abnormal meatus was noted in 24 (21%) patients. Three patients in this group required subsequent meatal dilatation compared with 6 in the group with a normal meatal appearance (P = 0.385).

Conclusions

Post‐operative topical steroids can reduce the need for subsequent meatal dilatation in boys with BXO. The appearance of the urethral meatus at circumcision does not predict the need for subsequent meatal dilatation.
Extracorporeal membrane oxygenation in children: A brief review
Authors: Sakurai Ken , Singhal Nitesh
Published: August 2022

With the advancement in technology and increasing familiarity, the use of extracorporeal membrane oxygenation (ECMO) has expanded in the past decade. Although ECMO can be lifesaving for critically ill children, it is an invasive therapy associated with complications that may necessitate rehabilitation and long‐term follow‐up. Paediatric clinicians play an essential role in managing these children, especially after the acute phase of their illness. This review provides an overview of ECMO and will provide a basic understanding of ECMO and its principles.
Relationship between hearing, cognitive function, and quality of life in aging companion dogs
Authors: Fefer Gilad , Khan Michael Z. , Panek Wojciech K. , Case Beth , Gruen Margaret E. , Olby Natasha J.
Published: August 2022

Background

Elderly people with presbycusis are at higher risk for dementia and depression than the general population. There is no information regarding consequences of presbycusis in dogs.

Objective

Evaluate the relationship between cognitive function, quality of life, and hearing loss in aging companion dogs.

Animals

Thirty‐nine elderly companion dogs.

Methods

Prospective study. Hearing was evaluated using brainstem auditory evoked response (BAER) testing. Dogs were grouped by hearing ability. Owners completed the canine dementia scale (CADES) and canine owner‐reported quality of life (CORQ) questionnaire. Cognitive testing was performed, and cognitive testing outcomes, CADES and CORQ scores and age were compared between hearing groups.

Results

Nineteen dogs could hear at 50 dB, 12 at 70 dB, and 8 at 90 dB with mean ages (months) of 141 ± 14, 160 ± 16, and 172 ± 15 for each group respectively (P = .0002). Vitality and companionship CORQ scores were significantly lower as hearing deteriorated (6.6‐5.4, 50‐90 dB group,P = .03 and 6.9‐6.2, 50‐90 dB group,P = .02, respectively). Cognitive classification by CADES was abnormal in all 90 dB group dogs and normal in 3/12 70 dB group and 11/19 50 dB group dogs (P = .0004). Performance on inhibitory control, detour and sustained gaze tasks decreased significantly with hearing loss (P = .001,P = .008,P = .002, respectively). In multivariate analysis, higher CADES score was associated with worse hearing (P = .01).

Conclusions and Clinical Importance

Presbycusis negatively alters owner‐pet interactions and is associated with poor executive performance and owner‐assessed dementia severity.
Efficacy and safety of desmopressin orally disintegrating tablets 25 and 50 μg in male patients with nocturia: A Japanese real‐world multicenter clinical study
Authors: Kyoda Yuki , Kimura Makoto , Shimizu Takashi , Miyao Noriomi , Ogasawara Takuto , Shimizu Toshiaki , Iwasawa Akihiko , Yorozuya Wakako , Hashimoto Jiro , Ichihara Koji , Takei Fumiyasu , Uchida Kosuke , Kouzen Nodoka , Suzuki Noriyoshi , Tachikawa Kimihito , Shibuya Akihiko , Muranaka Ippei , Okada Manabu , Igarashi Manabu , Shibamori Kosuke , Nofuji Seisuke , Fujino Keiko , Toyota Tomohiro , Ito Yu , Shinkai Nobuo , Hashimoto Kohei , Kobayashi Ko , Tanaka Toshiaki , Masumori Naoya
Published: August 2022

Objectives

To clarify Japanese real‐world clinical data on the use of desmopressin 25 and 50 μg orally disintegrating tablets (ODT) for male patients with nocturia and evaluate the predictive factors to improve nighttime frequency.

Methods

We retrospectively accumulated real‐world clinical data from 27 institutions in Japan. Male patients with two or more episodes of nocturia who received desmopressin ODT for nocturnal polyuria (NP) from 2019 through 2021 were included. The primary endpoint was the change of nighttime frequency until 3 months after desmopressin administration. The secondary endpoints were to clarify the persistence rate, adverse events, and predictive factors of decreasing nighttime frequency.

Results

A total of 118 patients were eligible to participate in this study. The persistence rate of desmopressin on the Kaplan‐Meier curve at week 12 was 51.3. The reason for discontinuation was mainly the occurrence of adverse events in 67 patients (56.8%), particularly hyponatremia in 7 patients (5.9%). Nighttime frequencies at baseline, ‐ 1 month and 1 ‐ 3 months after desmopressin administration were 4.1 ± 1.3, 2.9 ± 1.4 (P < .01), and 2.6 ± 1.3 (P < .01), respectively. The mean nighttime urine volume voided at baseline was significantly larger in patients whose nighttime frequency decreased by two or more times than in those with a decrease of less than two times.

Conclusions

Desmopressin 25 and 50 μg ODT treatments are feasible for male patients with NP in Japanese real‐world clinical practice. Patients with higher voided volumes, particularly in the nighttime, may have great benefit from desmopressin.
Roles of RodZ and class A PBP1b in the assembly and regulation of the peripheral peptidoglycan elongasome in ovoid‐shaped cells of Streptococcus pneumoniaeD39
Authors: Lamanna Melissa M. , Manzoor Irfan , Joseph Merrin , Ye Ziyun A. , Benedet Mattia , Zanardi Alessia , Ren Zhongqing , Wang Xindan , Massidda Orietta , Tsui Ho‐Ching T. , Winkler Malcolm E.
Published: August 2022

RodZ of rod‐shaped bacteria functions to link MreB filaments to the Rod peptidoglycan (PG) synthase complex that moves circumferentially perpendicular to the long cell axis, creating hoop‐like sidewall PG. Ovoid‐shaped bacteria, such as Streptococcus pneumoniae (pneumococcus; Spn) that lack MreB, use a different modality for peripheral PG elongation that emanates from the midcell of dividing cells. Yet, S. pneumoniae encodes a RodZ homolog similar to RodZ in rod‐shaped bacteria. We show here that the helix‐turn‐helix and transmembrane domains of RodZ(Spn) are essential for growth at 37°C. ΔrodZ mutations are suppressed by Δpbp1a, mpgA(Y488D), and ΔkhpA mutations that suppress ΔmreC, but not ΔcozE. Consistent with a role in PG elongation, RodZ(Spn) co‐localizes with MreC and aPBP1a throughout the cell cycle and forms complexes and interacts with PG elongasome proteins and regulators. Depletion of RodZ(Spn) results in aberrantly shaped, non‐growing cells and mislocalization of elongasome proteins MreC, PBP2b, and RodA. Moreover, Tn‐seq reveals that RodZ(Spn), but not MreCD(Spn), displays a specific synthetic‐viable genetic relationship with aPBP1b, whose function is unknown. We conclude that RodZ(Spn) acts as a scaffolding protein required for elongasome assembly and function and that aPBP1b, like aPBP1a, plays a role in elongasome regulation and possibly peripheral PG synthesis.