bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of demographic factors on newborn TSH levels and congenital hypothyroidism screening
Authors: Heather Natasha L. , Derraik José G. B. , Webster Dianne , Hofman Paul L.
Published: June 2019

Context

Optimal newborn screening thyroid‐stimulating hormone (TSH) cut‐offs are contentious. Analysis of demographic factors that impact screen TSH levels may help explain international variance and provide guidance to screening programmes.

Objective

To determine the influence of demographic factors on newborn screening TSH levels and screening performance parameters.

Design and Setting

National, retrospective population study using blood spot TSH cards from the New Zealand newborn screening programme in 2010‐2015.

Patients

325 685 blood spot cards.

Main Outcome Measures

Likelihood of exceeding specific TSH thresholds (TSH ≥5, ≥10 and ≥15 mIU/L) and group‐specific screening performance parameters.

Results

The likelihood of high TSH levels differed between ethnic groups. Pacific Island infants were more than twice as likely to have high‐normal TSH levels (≥5 and ≥10 mIU/L) and nearly twice as likely to have a positive screen (≥15 mIU/L) as New Zealand Europeans. Māori or Chinese ethnicity, male sex, younger gestational age and greater socio‐economic deprivation scores were also associated with high‐normal TSH levels. At a TSH threshold ≥15 mIU/L, screening sensitivity was lowest (88.89% vs 95.83% overall) and PPV greatest (88.89% vs 62.84%) amongst Asian infants. Early samples were more than three times as likely to reach the screen‐positive threshold and more likely to yield a false‐positive result (PPV 20.00% vs 68.87%, P = 0.004).

Conclusions

Newborn TSH levels are impacted by a number of demographic variables, particularly ethnicity and age at sample collection. Screening performance may be improved through the use of targeted thresholds.
Varicella zoster virus in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
Authors: Pergam Steven A. , Limaye Ajit P. ,   the AST Infectious Diseases Community of Practice
Published: June 2019

These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the diagnosis, prevention, and management of varicella zoster virus (VZV) in the pre‐ and post‐transplant period. Primary varicella is an uncommon complication post‐solid‐organ transplant (SOT), except among pediatric transplant patients and those seronegative for VZV. As the majority of SOT recipients are seropositive for VZV, herpes zoster (HZ) occurs frequently following SOT, particularly among recipients who are older (≥65 years of age) and those receiving more intensive immunosuppression. Transplant providers should aware of the increased risk for HZ‐related complications such as dissemination, organ‐specific involvement, and post‐herpetic neuralgia. Treatment for localized zoster is primarily given as oral regimens, but those with more complicated presentations or those at risk for dissemination should be treated initially with IV therapy. Available antiviral prophylaxis regimens and vaccination strategies for varicella and HZ among these immunosuppressed patients remain a mainstay for prevention in the pre‐and post‐transplant periods. Finally, we discuss important approaches to addressing post‐exposure prophylaxis and infection control practices for those SOT patients with documented VZV infections.
Outcomes of DCD kidneys recovered for transplantation with versus without pre‐mortem heparin administration
Authors: Narvaez J. Reinier F. , Noyes Katia , Nie Jing , Kayler Liise K.
Published: June 2019

Background

Pre‐mortem heparin administration during donation after circulatory death (DCD) organ recovery may be particularly important to improve perfusion and prevent graft thrombosis. However, pre‐mortem heparin administration is not universally practiced in the US and scarce data exist regarding its efficacy.

Methods

Using a national transplant registry data, we identified DCD kidneys recovered for transplantation from January 1, 2003, to March 10, 2017, and examined discard and outcomes after transplantation using bivariate and multivariable analyses. Organs with unknown or missing donor heparin status (n = 193), seropositive HIV (n = 10), HTLV (n = 33), hepatitis B (n = 26), or hepatitis C (n = 648) were excluded.

Results

Of 24 861 DCD kidneys recovered with (n = 22 557) or without pre‐mortem heparin administration (n = 2304), discard occurred in 19.1% and 20.8%, respectively (P = 0.05). On multivariate analysis, heparin use was not associated with discard (aOR 1.02, 95% CI 0.89‐1.17, P = 0.820). Overall graft survival of no‐heparin (n = 1791) vs heparin groups (n = 17 968) was similar on univariate and multivariate analysis (aHR 0.98, 95% CI 0.87‐1.09, P = 0.640).

Conclusion

DCD kidneys from donors that have not received pre‐mortem heparin administration have acceptable transplant outcomes and are not associated with discard.
Local niche differences predict genotype associations in sister taxa of desert tortoise
Authors: Inman Richard , Fotheringham A. Stewart , Franklin Janet , Esque Todd , Edwards Taylor , Nussear Kenneth
Published: June 2019

Aims

To investigate spatial congruence between ecological niches and genotype in two allopatric species of desert tortoise that are species of conservation concern.

Location

Mojave and Sonoran Desert ecoregions; California, Nevada, Arizona, Utah, USA.

Methods

We compare ecological niches ofGopherus agassiziiandGopherus morafkaiusing species distribution modelling (SDM) and then calibrate a pooled‐taxa distribution model to explore local differences in species–environment relationships based on the spatial residuals of the pooled‐taxa model. We use multiscale geographically weighted regression (MGWR) applied to those residuals to estimate local species–environment relationships that can vary across the landscape. We identify multivariate clusters in these local species–environment relationships and compare them against models of (a) a geographically based taxonomic designation for two sister species and (b) an environmental ecoregion designation, with respect to their ability to predict a genotype association index for these two species.

Results

We find non‐identical niches for these species, with differences that span physiographic and vegetation niche dimensions. We find evidence for two distinct clusters of local species–environment relationships that when mapped, predict an index of genotype association for the two sister taxa better than did either the geographically based taxonomic designation or an environmental ecoregion designation.

Main conclusions

Exploring local species–environment relationships by coupling SDM and MGWR can benefit studies of biogeography and conservation. We find that niche separation in habitat selection conforms to genotypic differences between sister taxa of tortoise in a recent secondary contact zone. This result may inform decision making by agencies with regulatory or land management authority for the two sister taxa addressed here.
Incorporating habitat suitability into community projections: Ant responses to climate change in the Australian Wet Tropics
Authors: Nowrouzi Somayeh , Bush Alex , Harwood Tom , Staunton Kyran M. , Robson Simon K. A. , Andersen Alan N.
Published: June 2019

Aim

Studies of climate change impacts on animal distributions typically consider only the direct impacts of a changing climate, under the assumption that future areas of suitable climate will otherwise remain ecologically suitable. Here we assess both the direct and indirect impacts of climate change on rain forest ant communities, where substantial shifts are projected to occur for both climate and habitat types.

Location

Australian Wet Tropics (AWT).

Methods

Generalized Dissimilarity Modelling was used to model turnover in the composition of ~300 rain forest ant species sampled at 150 sites across six mountains spanning five degrees of latitude. Ants were sampled within the leaf litter, on the litter surface and on tree trunks. By modelling the rate of turnover among sites, we determined the current effective area of similar ecological environments (SEE) for ant communities and consequently the expected change in species persistence when habitat shifts under two climate projections for the years 2035, 2055 and 2085. We compared results when SEE considered only the direct effects of a changing climate, with those when changes in habitat were also included.

Results

The rain forest ant communities modelled will lose a substantial proportion of SEE under both climate change scenarios. Under combined direct (changes in climate) and indirect (changes in rain forest habitat) impacts of climate change, >90% of the communities in the region were predicted to lose up to half their similar habitats compared with 50%–60% when only considering direct climate change impacts. The highest risk of reduction in area of SEE is projected in drier inland areas of the AWT, where profound compositional turnover is linked to dramatic changes in rain forest vegetation, including extensive conversion into savanna.

Main conclusions

Our findings emphasize the importance of incorporating habitat suitability into future projections of species turnover under a changing climate, particularly for habitats where vegetation structure is projected to undergo profound change.
Improving the Patient Experience With Migraine Camp, a One‐Day Group Intervention for Adolescents With Chronic Headache and Their Parents
Authors: Hall Amanda L. , Karvounides Dina , Gelfand Amy A. , Mankin Haley , Kessel Shirley , Corroo Janet , Malavolta Carrie P. , Pezzuto Tara , Chadehumbe Madeline , Szperka Christina L.
Published: June 2019

Though chronic migraine is actually common in adolescents, living with constant headache can be isolating for both patients and their families. As an outgrowth of clinical care, we developed the Miles for Migraine Youth Camp, a recurring 1‐day event for adolescents with chronic headache and their parents. Migraine Camp was developed to provide expanded headache education, teach coping strategies for living with chronic pain, and encourage development of a supportive community for adolescents living with chronic headache disorders and their families. The creation and curriculum of the Camps at the University of California San Francisco and Children's Hospital of Philadelphia are described in this manuscript, along with patient and caregiver feedback. Overall, feedback was positive. Teens reported feeling less isolated and more prepared to cope with headaches using new strategies. Both patients and caregivers consistently described benefit from connecting with others who experience similar challenges. The Migraine Camp teams at both institutions found it feasible to conduct the Camps 1‐2 times per year using existing resources, but noted that to scale it to a more regular event additional administrative and/or volunteer support would be needed. In summary, the experience has been positive for patients, caregivers, and staff, and we hope that this manuscript can serve as a “how to” model for similar events at other institutions.
U‐shaped association of vigorous physical activity with risk of metabolic syndrome in men with low lean mass, and no interaction of physical activity and serum 25‐hydroxyvitamin D with metabolic syndrome risk
Authors: Yeap Bu B. , Dedic Deila , Budgeon Charley A. , Murray Kevin , Knuiman Matthew W. , Hunter Michael , Zhu Kun , Cooke Brian R. , Lim Ee M. , Mulrennan Siobhain , Walsh John P. , Green Daniel J.
Published: June 2019

Background

There is uncertainty over how lean mass, physical activity (PA) and 25‐hydroxyvitamin D (25‐OH‐D) status interact on metabolic syndrome (MetS) risk in adults.

Aims

To test the hypothesis that these factors additively influence MetS risk.

Methods

Four thousand eight hundred and fifty‐eight adults (54.6% female) mean ± SD age 58.0 ± 5.8 years, body mass index 28.1 ± 4.8 kg/m2, resident in Busselton, Western Australia. PA assessed by questionnaire (all/total and vigorous), lean mass using dual energy X‐ray absorptiometry (% total body mass), serum 25‐OH‐D via immunoassay, analysed using multivariable logistic regression.

Results

In men, lower total PA was associated with MetS (no vs >24 h/week odds ratio (OR) = 3.1; ≤8 vs >24 h/week OR = 1.8, both P < 0.001), as was lower lean mass (low vs high OR = 20.4; medium vs high OR = 7.4, both P < 0.001). Men with low lean mass exhibited a U‐shaped relationship of vigorous PA with MetS risk (covariate‐adjusted: 0 vs 4–8 h/week OR = 2.1, P = 0.037; >12 vs 4–8 h/week OR = 4.3, P = 0.002; interaction P = 0.039). In women, low PA (0 vs >24 h/week OR = 2.1, P = 0.003) and lean mass (low vs high OR = 13.1; medium vs high OR = 7.2, both P < 0.001) were associated with MetS risk. Low 25‐OH‐D status was associated with MetS in men (low vs high OR = 4.1; medium vs high OR = 2.3, both P < 0.001) and women (OR = 3.5 and 2.1 respectively, both P < 0.001) with no PA interaction.

Conclusions

Men and women with high lean mass have low risk of MetS regardless of PA. Low lean mass identifies men who may benefit most from increasing PA, with an optimal level associated with lowest risk. 25‐OH‐D and PA do not interact on MetS risk.
Synthesis of molybdenum carbide nanoparticles using pulsed wire discharge in mixed atmosphere of kerosene and argon
Authors: Chu Ngo Minh , Hieu Nguyen Duy , Do Dung Thi Mai , Sarathi Ramanujam , Nakayama Tadachika , Suematsu Hisayuki
Published: June 2019

Pulsed wire discharge was used to prepare nanoparticles of molybdenum and its carbides from Mo wires in a gas mixture of argon and kerosene at pressures of 100, 50, and 25 kPa. The different pressures affected the carburization process and particle formation. The most effective pressure was 25 kPa, where the volume fraction of MoC was identified by Rietveld refinement of X‐ray diffraction data to be 98.4%. The particle size distribution was also obtained from transmission electron microscopy measurements, and the smallest geometric mean diameter was determined tobe 24.3 nm for the sample prepared at 25 kPa.
Organizational learning in hospitals: A realist review
Authors: Lyman Bret , Jacobs Jonathan D. , Hammond Emily L. , Gunn Margaret M.
Published: June 2019

Aim

To establish a middle‐range theory of organizational learning in hospitals.

Design

A realist review of the literature, conducted according to established standards for realist and meta‐narrative evidence syntheses. Middle‐range theory development was performed according to Smith and Liehr's recommendations.

Data sources

Two comprehensive scientific databases and six discipline‐focused databases spanning health care, life sciences, business, sociology, and psychology were searched from inception to 12 May 2016.

Review methods

Citations meeting the inclusion criteria were appraised using the Mixed Methods Appraisal Tool. Data extraction was guided by a focus on the contextual factors, mechanisms, and outcomes associated with organizational learning.

Results

The initial search yielded 2,332 citations, 147 of which were ultimately included in the review. The included citations were generally of high quality. Reviewed evidence indicates certain aspects of organizational context can be conducive to mechanisms of organizational learning, leading to a range of positive organizational outcomes.

Conclusion

This review updates and expands on a previous review of the literature on organizational learning in hospitals, refines the concept of organizational learning in hospitals, and provides a middle‐range theory of organizational learning in hospitals.

Impact

This updated review provides a strong evidence base for future work on the topic of organizational learning in hospitals. The refined concept of organizational learning makes it possible to develop reliable, valid research instruments that better reflect of the full scope of organizational learning. Finally, the middle‐range theory guides researchers and clinical leaders as they advance the science and practice of organizational learning.
Pathogenesis of fulminant type 1 diabetes: Genes, viruses and the immune mechanism, and usefulness of patient‐derived induced pluripotent stem cells for future research
Authors: Hosokawa Yoshiya , Hanafusa Toshiaki , Imagawa Akihisa
Published: June 2019

We reviewed fulminant type 1 diabetes, a recently established subtype of type 1 diabetes, from the aspects of genes, viruses, immune mechanism and usefulness of patient‐derived induced pluripotent stem cells (iPSCs). In an analysis of the pancreas of patients with fulminant type 1 diabetes, viral antigens and viral receptors were expressed in β‐cells, as well as macrophages and T lymphocytes surrounding the β‐cells. These findings suggest that the β‐cells of patients with fulminant type 1 diabetes are destroyed during an immune response against viral infection of the pancreas. Recently, fulminant type 1 diabetes was induced by treatment with anti‐programmed cell death 1 antibodies, suggesting that immune regulatory mechanisms are also involved in the onset of this disease. We generated iPSCs from patients with fulminant type 1 diabetes for the first time. We also successfully differentiated patient‐derived iPSCs into insulin‐producing cells in vitro, and produced a disease model. The proportion of cytokine‐induced apoptotic cells among insulin‐positive cells was higher in the iPSCs from patients with fulminant type 1 diabetes than in iPSCs from healthy control participants. We carried out ribonucleic acid sequencing in insulin‐producing cells differentiated from patient‐derived iPSCs, and are now attempting to identify new biomarkers for the disease.
Comparison of methods to estimate the affected body surface area and the dosage of topical treatments in psoriasis and atopic dermatitis: the advantage of a picture‐based tool
Authors: Speeckaert R. , Hoorens I. , Corthals S. , Delbaere L. , Lambert J. , Lesseliers T. , Mylle S. , Ongenae K. , De Schepper S. , De Smet L. , Speeckaert M. , van Geel N.
Published: June 2019

Background

The accurate determination of the dosage of topical treatments is important given its repercussions on patient adherence and therapeutic efficacy. Up till now, the fingertip unit calculated by the rule of hands is considered the gold standard, although its use is associated with several drawbacks.

Objective

To compare different methods to estimate the affected body surface area (BSA) and dosage of topical treatments in atopic dermatitis and psoriasis and investigate its reliability, user‐friendliness and timing.

Methods

In this study, we compared the reliability of three different methods: (i) the fingertip unit calculated by the 1% hand rule; (ii) a picture‐based tool [termed Cutaneous Inflammatory Disease Extent Score (CIDES)]; and (iii) a digital drawing tool. Eleven observers scored 40 patients with psoriasis and eczema to assess the inter‐rater and intrarater reliability. Timing was automatically recorded, and user‐friendliness was investigated by a questionnaire.

Results

An excellent intraclass correlation (ICC) was found for both inter‐rater agreement and intrarater agreement for the picture‐based tool (ICC = 0.92 and ICC = 0.96, respectively). The ICCs for drawing the area of involvement on a silhouette were 0.89 and 0.93, respectively. Finally, the rule of hands was associated with an increased inter‐rater variability although an excellent intrarater agreement was found (ICC = 0.79 and 0.95, respectively). Automated calculation of the amount of topical treatment improved reliability, and CIDES was associated with the least variation. CIDES was considered the preferred method by all observers and was fast to perform (median: 30 s).

Conclusion

A picture‐based method offered the most advantages (in terms of reliability, speed and user‐friendliness) to estimate the affected BSA and calculate the dosage of topical treatments.
The effects of heterospecific mating frequency on the strength of cryptic reproductive barriers
Authors: Larson Erica L. , Brassil Margaret M. , Maslan Jonathan , Juárez Danielle , Lilagan Flordeliza , Tipton Hallie , Schweitzer Andrew , Skillman Joe , Monsen‐Collar Kirsten J. , Peterson Merrill A.
Published: June 2019

Heterospecific mating frequency is critical to hybrid zone dynamics and can directly impact the strength of reproductive barriers and patterns of introgression. The effectiveness of post‐mating prezygotic (PMPZ) reproductive barriers, which include reduced fecundity via heterospecific matings and conspecific sperm precedence, may depend on the number, identity and order of mates. Studies ofPMPZbarriers suggest that they may be important in many systems, but whether these barriers are effective at realistic heterospecific mating frequencies has not been tested. Here, we evaluate the strength of cryptic reproductive isolation in two leaf beetles (Chrysochus auratusandC. cobaltinus) in the context of a range of heterospecific mating frequencies observed in natural populations. We found both species benefited from multiple matings, but the benefits were greater inC. cobaltinusand extended to heterospecific matings. We found thatPMPZbarriers greatly limited hybrid production byC. auratusfemales with moderate heterospecific mating frequencies, but that their effectiveness diminished at higher heterospecific mating frequencies. In contrast, there was no evidence forPMPZbarriers inC. cobaltinusfemales at any heterospecific mating frequency. We show that integrating realistic estimates of cryptic isolation with information on relative abundance and heterospecific mating frequency in the field substantially improves our understanding of the strong directional bias in F1 production previously documented in theChrysochushybrid zone. Our results demonstrate that heterospecific mating frequency is critical to understanding the impact of cryptic post‐copulatory barriers on hybrid zone structure and dynamics, and that future studies of such barriers should incorporate field‐relevant heterospecific mating frequencies.
Risk factors for a difficult intravenous access: A multicentre study comparing nurses' beliefs to evidence
Authors: Piredda Michela , Fiorini Jacopo , Facchinetti Gabriella , Biagioli Valentina , Marchetti Anna , Conti Fabio , Iacorossi Laura , Giannarelli Diana , Matarese Maria , De Marinis Maria Grazia
Published: June 2019

Aims and objectives

To summarise the evidence about patient‐related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence.

Background

Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%–40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence.

Design

The study included a literature review of the evidence on patient‐related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross‐sectional multicentre survey on clinical nurses.

Methods

The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed.

Results

Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research.

Conclusions

An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research.

Relevance to clinical practice

Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care.
Knowledge, Attitudes and Practices related to standard precautions among nurses: A comparative study
Authors: Zhu Siyue , Kahsay Kibrom Mehari , Gui Li
Published: June 2019

Aim and objective

To describe and compare the Knowledge, Attitudes and Practices (KAP) pertaining to standard precautions (SPs) among nurses in China and Ethiopia.

Background

SPs are guidelines for reducing the risk of transmission of blood‐borne and other pathogens in hospital settings. SPs have been widely promoted to protect healthcare workers (HCW); however, these are not fully practised worldwide, especially in resource‐constrained countries like China and Ethiopia.

Design

A descriptive, cross‐sectional, comparative study was performed between February–April 2018. The study followed the “Strengthening the Reporting of Observational Studies in Epidemiology” (STROBE) guideline.

Methods

Self‐administered questionnaire survey of a convenience sample of 357 nurses (237 Chinese and 120 Ethiopian nurses) from one teaching hospital each in China and Ethiopia. KAP pertaining to SPs were measured.

Results

Nurses of both countries were found to have a good understanding of the concept of SPs; however, the acceptance to organisation of policies for prevention of hospital‐acquired infections (HAI) was lower in Ethiopia. Fewer medical resources in Ethiopia resulted in poorer adherence to use of personal protective equipment (PPE). The usage rate of PPE (except apron and goggles) among Ethiopian nurses was significantly lower than that among Chinese nurses.

Conclusions

Both Ethiopian and Chinese nurses showed favourable attitudes towards SPs; however, Chinese nurses reported better knowledge and practices. The organisation should strengthen formal and on‐the‐job training, implement targeted infection prevention strategies and provide adequate medical supplies to improve infection control in Ethiopia.

Relevance to clinical practice

Our findings highlight some of the reasons for low compliance to SPs in both countries and potentially other similar settings. The information provided here can help develop infection prevention and control strategies for resource‐constrained countries.
Nurse‐led postdischarge telephone follow‐up calls: A mixed study systematic review
Authors: Woods Cindy E. , Jones Rikki , O’Shea Eilish , Grist Elizabeth , Wiggers John , Usher Kim
Published: June 2019

Aims and objectives

To explore the quantitative and qualitative literature on the impact of nurse‐led postdischarge telephone follow‐up (TFU) call interventions on patient outcomes.

Background

Adverse patient outcomes such as postdischarge problems, premature contact with health systems, inability to self‐manage conditions and hospital readmissions all have an impact on the health and well‐being, and satisfaction of patients as well as a financial impact on healthcare systems.

Design

A mixed‐study systematic review.

Review methods

A systematic search of CINAHL, Ebsco, PubMed, Quest and Cinch‐Health databases was undertaken using the key terms “nurs*,” “nurse‐led,” “nurse initiated,” “discharge,” “hospital,” “telephone,” “follow‐up” and “telephone follow‐up” to identify relevant original peer‐reviewed studies published between 2010–2016. Ten articles were selected for inclusion. The selected papers were critically appraised. A sequential explanatory approach with a convergent synthesis was used to report findings following PRISMA guidelines.

Results

The findings demonstrate that nurse‐led TFU interventions have the potential to improve patient outcomes. The studies suggest patient satisfaction with TFU is one of the strongest positive outcomes from the interventions. However, the results do not support improvement in patient readmission or mortality.

Conclusions

Of the 10 studies reviewed, only two were methodologically strong limiting the conclusions that can be drawn from the current research on this topic. Telephone follow‐up interventions improve patient satisfaction and have the potential to meet patient information and communication needs, improve self‐management and follow‐up appointment attendance and reduce postdischarge problems. Further research is required to explore patients’ perceptions of the most useful content of TFU calls, the efficacy of TFU calls and nurses’ perceptions and experiences of conducting TFU interventions.

Relevance to clinical practice

When conducted by a nurse, these interventions have the potential to enhance postdischarge care to patients and meet care needs. Patients perceive TFU as acceptable and are satisfied with this form of postdischarge care.
MiR‐455‐3p, miR‐150 and miR‐375 are aberrantly expressed in salivary gland adenoid cystic carcinoma and polymorphous adenocarcinoma
Authors: Brown Amy L. , Al‐Samadi Ahmed , Sperandio Marcelo , Soares Andresa Borges , Teixeira Lucas Novaes , Martinez Elizabeth F. , Demasi Ana Paula Dias , Araújo Vera Cavalcanti , Leivo Ilmo , Salo Tuula , Passador‐Santos Fabricio
Published: June 2019

Background

Adenoid cystic carcinoma (AdCC) and polymorphous adenocarcinoma (PAC) are included among the most common salivary gland cancers. They share clinical and histological characteristics, making their diagnosis challenging in specific cases. MicroRNAs (miRNA) are short, non‐coding RNA sequences of 19‐25 nucleotides in length that are involved in post‐transcriptional protein expression. They have been shown to play important roles in neoplastic and non‐neoplastic processes and have been suggested as diagnostic and prognostic markers.

Methods

This study, using quantitative RT‐PCR, investigated miR‐150, miR‐455‐3p and miR‐375 expression, in order to identify a possible molecular distinction between AdCC and PAC.

Results

miRNA‐150 and miRNA‐375 expression was significantly decreased in AdCC and PAC compared with salivary gland tissue controls, whilst miRNA‐455‐3p showed significantly increased expression in AdCC when compared to PAC, (P < 0.05). miR‐150, miR‐357 and miR‐455‐3p expression in AdCC, PAC and control was not associated with age, gender nor with anatomic site (major and minor salivary glands) (P > 0.05).

Conclusion

MiR‐455‐3p could be used as a complimentary tool in the diagnosis of challenging AdCC cases.
Gender differences in clinical, laboratory and polysomnographic features of restless legs syndrome
Authors: Holzknecht Evi , Hochleitner Margarethe , Wenning Gregor K. , Högl Birgit , Stefani Ambra
Published: June 2019

Summary

Restless legs syndrome is a common neurological disorder with a clear female predominance. This study aims to evaluate gender differences in clinical, laboratory and polysomnographic features in patients with restless legs syndrome. For this retrospective analysis, 42 women and 42 men from the Innsbruck RLS database matched by age and therapy were included. Demographic data as well as different severity scales (IRLS, RLS‐6 and CGI) were evaluated. Laboratory parameters included several indicators of serum iron status. In all patients, polysomnography was performed according to the AASM guidelines, and periodic leg movements during sleep were scored according to the AASM criteria. IRLS, RLS‐6 and CGI revealed more severe symptoms in women (IRLS median [range]: 17.5 [0–35] versus 13.5 [0–32], p = 0.028; RLS‐6 median [range]: 18 [0–39] versus 12 [1–42], p = 0.014). Women had lower serum ferritin levels than men (median [range] in μg L−1: 74 [9–346] versus 167 [15–389], p < 0.001). Twenty‐two women and eight men (53.7% versus 22.2%, p = 0.003) had ferritin values below 75 μg L−1. Periodic leg movements during sleep indices were significantly lower in women than in men (median [range] in number per hr: 11.4 [0–62.5] versus 40 [0–154], p = 0.004, and 12.6 [0–58.5] versus 40 [0.5–208], p = 0.002, for night I and night II, respectively). Restless legs syndrome severity as measured by validated scales was worse in women, while periodic leg movements during sleep indices were higher in men. These results suggest a possible gender difference in phenotypical presentation of restless legs syndrome, manifesting with predominantly sensory symptoms in women and predominantly motor symptoms in men.
Additional fibrate treatment in UDCA‐refractory PBC patients
Authors: Chung Sung Won , Lee Jeong‐Hoon , Kim Minseok Albert , Leem Galam , Kim Sun Woong , Chang Young , Lee Hyo Young , Yoon Jun Sik , Park Jun Yong , Lee Yun Bin , Cho Eun Ju , Yu Su Jong , Kim Yoon Jun , Yoon Jung‐Hwan
Published: June 2019

Background & Aims

There is no proven treatment for ursodeoxycholic acid (UDCA)‐refractory primary biliary cholangitis (PBC) other than obeticholic acid. Although fibrates have been reported to improve biochemical parameters, the long‐term effects remain unclear. This study evaluated the effect of fibrate on clinical outcomes of UDCA‐refractory PBC.

Methods

Patients whose alkaline phosphatase (ALP) was not normalized with at least 13 mg/kg of UDCA treatment for >1 year were included from two tertiary referral centres. The primary outcome was ALP normalization. Secondary outcomes included the development of cirrhosis and hepatic deterioration. Immortal time bias was adjusted using the Mantel‐Byar method.

Results

A total of 100 UDCA‐refractory PBC patients were included: 71 patients received UDCA alone (the UDCA group) and 29 patients received UDCA plus additional fibrate treatment of 160 mg/d fenofibrate or 400 mg/d bezafibrate (the fibrate/UDCA group). During the follow‐up period, the probability of ALP normalization was significantly higher in the fibrate/UDCA group (hazard ratio [HR] = 5.00, 95% confidence interval = 2.87‐8.27, P < 0.001). Among 58 non‐cirrhotic patients (43 in the UDCA group and 15 in the fibrate/UDCA group), 19 patients (44.1%) in the UDCA group and none in the fibrate/UDCA group developed cirrhosis (HR = 0.12, P = 0.04). Hepatic deterioration (Child‐Pugh score increase or signs of decompensated cirrhosis) occurred in 17 patients (23.9%) of the UDCA group and none in the fibrate/UDCA group in which the difference was significant (HR = 0.12, P = 0.04).

Conclusions

In patients with UDCA‐refractory PBC, additional fibrate treatment is associated with a higher probability of ALP normalization and a lower risk of cirrhosis development and hepatic deterioration.
Protection and skills: Does trade policy favor low‐skill workers?
Authors: Bradford Scott
Published: June 2019

Many believe that international trade barriers in rich nations help low‐skill workers. Also, the empirical endogenous protection literature strongly implies that protection decreases with skill levels. This paper presents evidence against this conventional wisdom. Regressions based on a political economy model with search frictions and unemployment imply that protection and skill levels actually have a mound‐shaped relationship: industries with skills in the middle range get more protection than industries at either end of the distribution. Apparently, the politics of trade policy trump social concerns, rendering protection less “progressive” than is commonly believed.
Nonparametric geometric outlier detection
Authors: Heikkilä Matias
Published: June 2019

Outlier detection is a major topic in robust statistics due to the high practical significance of anomalous observations. Many existing methods, however, either are parametric or cease to perform well when the data are far from linearly structured. In this paper, we propose a quantity, Delaunay outlyingness, that is a nonparametric outlyingness score applicable to data with complicated structure. The approach is based on a well‐known triangulation of the sample, which seems to reflect the sparsity of the pointset to different directions in a useful way. We derive results on the asymptotic behavior of Delaunay outlyingness in case of a sufficiently simple set of observations. Simulations and an application to empirical data are also discussed.
Perceived Coercion During Admission Into Psychiatric Hospitalization Increases Risk of Suicide Attempts After Discharge
Authors: Jordan Joshua T. , McNiel Dale E.
Published: June 2019

Objective

There is an elevated risk for suicide in the year following psychiatric hospitalization. The present study examined whether perceived coercion during admission into psychiatric hospitalization increases risk for postdischarge suicide attempts.

Methods

Participants were 905 psychiatric inpatients from the MacArthur Violence Risk Assessment Study that were assessed every 10 weeks during the year following discharge. Perceived coercion during admission was assessed while hospitalized, and suicide attempts were assessed following discharge. Analyses adjusted for nonrandom assignment of groups via propensity score weighting and for established correlates of postdischarge suicidal behavior.

Results

Of 905 participants, 67% endorsed perception of coercion into psychiatric hospitalization, and 168 (19%) made a postdischarge suicide attempt. Patients who perceived coercion during hospitalization admission were more likely to make a suicide attempt after discharge than those who did not, even after adjusting for established covariates (OR = 1.29, |z| = 2.87,p = .004, 95% CI = 1.08, 1.54). There was no interaction between recent self‐harm or suicidal ideation at time of admission and perceived coercion on postdischarge suicide attempts.

Conclusions

Patients’ perception of the context in which they were hospitalized is associated with a small but significant increase in their likelihood of postdischarge suicide attempts.
The turn to optional familialism through the market: Long‐term care, cash‐for‐care, and caregiving policies in Europe
Authors: Le Bihan Blanche , Da Roit Barbara , Sopadzhiyan Alis
Published: June 2019

Cash‐for‐care (CfC) schemes are monetary transfers to people in need of care who can use them to organize their own care arrangements. Mostly introduced in the 1990s, these schemes combine different policy objectives, as they can aim at (implicitly or explicitly) supporting informal caregivers as well as increasing user choice in long‐term care or even foster the formalization of care relations and the creation of care markets. This article explores from a comparative perspective, how CfC schemes, within broader long‐term care policies, envision, frame, and aim to condition informal care, if different models of relationships between CfC and informal care exist and how these have persisted or changed over time and into which directions. Building on the scholarly debate on familialization vs. defamilialization policies, the paper proposes an analytical framework to investigate the trajectories of seven European countries over a period of 20 years. The results show that, far from being simply instruments of supported familialism, CfC schemes have contributed to a turn towards “optional familialism through the market,” according to which families are encouraged to provide family care and are (directly or indirectly) given alternatives through the provision of market care.
Genome‐wide association study identified novel candidate loci affecting wood formation in Norway spruce
Authors: Baison John , Vidalis Amaryllis , Zhou Linghua , Chen Zhi‐Qiang , Li Zitong , Sillanpää Mikko J. , Bernhardsson Carolina , Scofield Douglas , Forsberg Nils , Grahn Thomas , Olsson Lars , Karlsson Bo , Wu Harry , Ingvarsson Pär K. , Lundqvist Sven‐Olof , Niittylä Totte , García‐Gil M Rosario
Published: June 2019

Norway spruce is a boreal forest tree species of significant ecological and economic importance. Hence there is a strong imperative to dissect the genetics underlying important wood quality traits in the species. We performed a functional genome‐wide association study (GWAS) of 17 wood traits in Norway spruce using 178 101 single nucleotide polymorphisms (SNPs) generated from exome genotyping of 517 mother trees. The wood traits were defined using functional modelling of wood properties across annual growth rings. We applied aLeast Absolute Shrinkage and Selection Operator (LASSO‐based) association mapping method using a functional multilocus mapping approach that utilizes latent traits, with a stability selection probability method as the hypothesis testing approach to determine a significant quantitative trait locus. The analysis provided 52 significantSNPs from 39 candidate genes, including genes previously implicated in wood formation and tree growth in spruce and other species. Our study represents a multilocusGWASfor complex wood traits in Norway spruce. The results advance our understanding of the genetics influencing wood traits and identifies candidate genes for future functional studies.
Outpatient transfusions: time to study what matters to patients
Authors: Lin Yulia , Buckstein Rena
Published: June 2019

See article on page 1934–1943, in this issue
Morphological variations of the infraorbital canal during CT has limited association with headshaking in horses
Authors: Edwards Ralph A. , Hermans Hanneke , Veraa Stefanie
Published: June 2019

Headshaking is a common problem in horses. The etiology is unknown but thought to involve sensory input from branches of the trigeminal nerve, some of which are within the infraorbital canal. The objective of this retrospective cross‐sectional study was to describe the CT anatomy and variations of the infraorbital canal in horses with local disease processes and normal horses, and to examine associations between those findings and headshaking. Computed tomography scans were reviewed and morphological changes of the infraorbital canal were described. Presence of changes was then tested for association with headshaking prevalence, presence of disease processes in the region of the infraorbital canal, age, and sex. Nonparametric tests were used and a P‐value of .05 was considered significant. A total of 218 horses were included, 9% of which had headshaking and 45% had CT lesions in the region of the infraorbital canal. Morphological changes to the bone of the infraorbital canal were found in 121 horses (56%) and included the following: increased mineralization 39 (18%), decreased mineralization 89 (41%), deformed shape 51 (23%), displaced position 43 (20%), and disruption 11 (5%). All changes of the infraorbital canal significantly increased in frequency with the presence of adjacent disease. Increased mineralization and disruption of the infraorbital canal were significantly associated with headshaking in horses with adjacent disease; the latter only reached significance after exclusion of dentally immature horses. No other changes were significantly associated with the presence of headshaking. No association was found between headshaking and the age or sex of the horse.
Endorsement and Validation of the Essential Evidence‐Based Practice Competencies for Practicing Nurses in Finland: An Argument Delphi Study
Authors: Saunders Hannele , Gallagher‐Ford Lynn , Vehviläinen‐Julkunen Katri
Published: June 2019

Objectives

To explore nurses’ views and establish consensus on the key content of the essential evidence‐based practice (EBP) competencies developed by Melnyk et al. (2014, Worldviews on Evidence‐Based Nursing, 11, 5) for practicing registered nurses (RNs) and advanced practice nurses (APNs) among Finnish nurse panelists.

Background

Broad‐based integration of best evidence into daily practice is central to effectively improving care quality and patient outcomes. EBP competencies allow healthcare professionals and organizations to clarify performance expectations regarding EBP and succinctly outline the expected competencies for successful application of best evidence to daily care.

Design

A modified Policy Delphi study design.

Methods

The Delphi panel was conducted in late 2017 among 14 Finnish nurse clinicians, educators, and leaders with a special interest in EBP. The data were collected using an eDelphi Internet application and the Argument Delphi method, highlighting the panelists’ different perspectives. Standardized guidelines and descriptive statistics were used to translate the essential EBP competencies into Finnish and analyze the data.

Results

The Finnish Delphi panel endorsed and validated the essential EBP competencies for practicing RNs and APNs with a few minor modifications. Of the 13 essential EBP competencies for practicing RNs, consensus was established among the Delphi panelists over two rounds on all but one of the EBP competencies. Of the 11 additional essential EBP competencies for practicing APNs, consensus was established over two Delphi rounds on all the EBP competencies for APNs.

Linking Evidence to Action

As EBP is a shared competency and the key principles and steps of EBP implementation are universal, the international endorsement and validation of national consensus‐based, clinical practice‐oriented EBP competency sets establish an international quality standard for nurses to aspire to and attain on EBP and provide guidance for nurses in integrating best evidence into their daily practice, facilitating broad‐based, consistent implementation of EBP worldwide.
Investigation of the Impact of Unsteady Turbulence Effects on the Aeroelastic Analysis of a Low-Pressure Turbine Rotor Blade
Authors: Heners Jan Philipp , Vogt Damian M. , Frey Christian , Ashcroft Graham
Published: June 2019

The impact of the unsteadiness in the considered turbulence quantities on the numerical prediction of the aeroelastic behavior of a low-pressure turbine (LPT) rotor blade is evaluated by means of a numerical study. In this context, one of the main objectives of this work is to compare different nonlinear harmonic balance (HB) approaches—one neglecting and one considering the unsteadiness in the employed turbulence models—with a conventional nonlinear solver of the unsteady Reynolds-averaged Navier–Stokes (URANS) equations in the time domain. In order to avoid unphysical oscillations in the turbulence quantities caused by the Gibbs phenomenon in the chosen HB approach, a filter method based on the Lanczos filter is developed. The developed filter method is applied in the course of the HB simulations considering the unsteadiness in the underlying turbulence model. Furthermore, the impact of its application on the solution of the flow field and on the unsteady surface pressure of the rotor blade, in particular, is discussed in the context of this work.
An Experimental Investigation of Rotor–Box Aerodynamic Interaction1
Authors: Shukla Dhwanil , Komerath Narayanan
Published: June 2019

Multirotor unmanned aerial vehicles (UAVs) are a promising means of package delivery. Such applications generally involve carrying bulky payloads under the vehicle. Understanding the aerodynamic interaction effects of payloads on the vehicle is the key to design such systems, in the low Reynolds number regime of small UAVs. High-speed particle image velocimetry (PIV), force, and torque measurements have been used with a rotor and a cubic box to investigate the rotor–box interactions and configurations typical of multirotor UAVs. The observed rotor and vehicle performance trends are explained by the mean flow field captured through PIV. Conditions similar to ground-effect operation are developed for the rotor at a high level of rotor-box overlap. A slight improvement in the vehicle performance is observed at conditions where the box is just out of the rotor wake. Some basic instantaneous flow phenomena due to rotor–box interaction have been identified. The interactions have been classified into three distinct modes based on observations at a range of box positions relative to the rotor. An empirical tip vortex trajectory model for isolated rotors is found to be instrumental in predicting the interaction mode at a given box position.