bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical failure factors for continuous improvement methodologies in the Irish MedTech industry
Authors: McDermott Olivia , Antony Jiju , Sony Michael , Healy Tom
Published: March 2022

Purpose

The main objective of this study is to investigate what are the critical success factors that exist for continuous improvement (CI) methodology deployment in the Irish medical technology (MedTech) industry. The research will, in particular, seek to establish if the highly regulated nature of the global MedTech industry is an additional critical failure factor (CFF) for the deployment of CI methodology. The study involves the analysis of the benefits, challenges, CFFs and tools most utilised for the application to the deployment of CI methodologies in the Irish medical device (MD) industry.

Design/methodology/approach

A quantitative survey was utilised in this study. The main participants were made up of senior quality professionals working in operational excellence, quality consultants, quality directors, quality engineers, quality managers and quality supervisors working in both manufacturing and service sectors from Irish MD companies. A total of 94 participants from the Irish MedTech industry responded to the survey.

Findings

The main finding of this study is that 42% of participants perceived that a highly regulated environment was a CFF to CI, whilst 79% of respondents utilised Lean Six Sigma in their organisations, and productivity and financial factors were found to be the highest reasons for CI deployment amongst the Irish MedTech industry. The top CFFs highlighted for CI in regulated industries were fear of extra validation activity, compliance versus quality culture and a regulatory culture of being “safe”. Another relevant finding presented in this paper is that just over 48% of participants felt that CI tools are very strongly integrated into the industries quality management systems (QMSs) such as the corrective and preventative action system, non-conformance and audit systems.

Research limitations/implications

All data collected in the survey came from professionals working for Irish indigenous and multinational MedTech companies. It is important to highlight that n = 94 is a low sample size, which is enough for a preliminary survey but reinforcing the limitation in terms of generalisation of the results. A further study on a wider European and global scale as well as a comparison with the highly regulated pharma industry would be informative.

Originality/value

The authors understand that this is the very first research focussed on the CFFs for CI in the MedTech/MD manufacturing industry with a specific focus on the highly regulated nature of the industry as a potential CFF. The results of this study represent an important first step towards a full understanding of the applicability and use of CI in the medical-device-manufacturing industries on a global scale.
Effect of plastic aggregates addition on accelerated carbonation of sand concrete
Authors: Boucedra Aissa , Bederina Madani
Published: March 2022

Purpose

This study aims to the framework of the development of a new sand concrete, essentially manufactured with river/dune sand and recycled plastic aggregates (PAs; 0/3.15 mm). This new concrete may have a great interest, as it can enable us to achieve the best economical, technical and ecological solutions for local construction problems. Given the high abundance of dune sand (DS) and the large quantities of plastic waste, plastic–mineral sand concrete can be a good alternative to the ordinary building materials available on the local market.

Design/methodology/approach

A replacement of sand by PAs is made by volume substitution. The plastic percentages laid down are 0%, 25%, 50% and 100%. Indeed, after a general experimental characterization of the studied composites, the investigation mainly concentrated on the study of the effect of the addition of plastic particles on the accelerated carbonation of river sand (RS) concrete and DS concrete, separately.

Findings

The density of the composites and consequently their compressive strength are slightly reduced; but their thermal insulation is significantly improved. Their structure seems to be homogeneous, the plastic grains are well distributed in the matrix and the adhesion “plastic–matrix” is good. At small plastic contents, the RS concrete is slightly better. As regards the carbonation results, the PAs significantly contribute to the improvement of the resistance of the composite against carbonation effect. It can be observed that increasing the proportion of plastic particles in sand concrete considerably decreases the thickness of the carbonated concrete.

Originality/value

The studies led on the behavior of plastic concrete, particularly in arid zones, are very limited. Moreover, for sand concrete, there are no similar studies. Therefore, the characterization of such materials is necessary. In addition of thermo-mechanical characterization, this work aims at studying the durability of the material, especially its resistance to carbonation. On the other hand, this work has a significant positive impact on both environment and economy, since it focuses on the recycling of industrial waste, and the valorization of DS, which is available in great quantities in south of Algeria.
MCTS1 promotes laryngeal squamous cell carcinoma cell growth via enhancing LARP7 stability
Authors: Yang Mengsheng , Ma Binjuan , Liu Xiangyi
Published: March 2022

MCTS1 Re‐Initiation and Release Factor (MCTS1) has been characterised as an oncoprotein in some cancers. In this study, we explored the expression of MCTS1 in laryngeal squamous cell carcinoma (LSCC) and its regulatory effects on the proliferation and cell‐cycle progression of tumour cells, as well as the underlying mechanisms. The data from the Cancer Genome Atlas was used to analyse MCTS1 expression and its correlation with survival outcomes in LSCC patients. Subsequent in vitro cellular and molecular studies were performed based on representative LSCC cell lines. Results showed that the upregulation of MCTS1 in LSCC is linked to poor progression‐free survival (PFS) and disease‐specific survival (DSS). In TU177 and AMC‐HN‐8 cells, MCTS1 exerted positive regulations on cell viability, colony formation, cell cycle progression, and the expression of CDK1, CDK2, cyclin A2, and cyclin B1. Co‐IP assay confirmed mutual interaction between MCTS1 and LARP7, mainly in the cytoplasm. Cycloheximide (CHX) chase and co‐IP assay of ubiquitination showed that MCTS1 could increase LARP7 protein half‐life and reduce its poly‐ubiquitination. LARP7 overexpression enhanced the viability and colony formation of LSCC cells and also elevated the expression of CDK1, CDK2, cyclin A2, and cyclin B1. In addition, its overexpression partly reversed the negative influence of MCTS1 knockdown. In summary, this study confirmed that the expression of MCTS1 might be an indicator of unfavourable prognosis for patients with LSCC. Mechanically, it promotes LSCC cell viability and proliferation via interacting with LARP7 and reducing its proteasomal‐mediated degradation.
Training in systems theory using a contextual pedagogical approach during the October revolution in Lebanon: Reflections from a clinical psychology program
Authors: Bosqui Tania , Hanna Estefania
Published: March 2022

The October 2019thawra(revolution) in Lebanon saw unprecedented mass protests across the country in response to governmental corruption, mismanagement and a looming economic disaster. Students learning family systems theory as part of the Clinical Psychology Program at the American University of Beirut faced, at this time, a disconnect between applying systems theory at the individual family level, and their overwhelming experiences at the collective national level. A contextual pedagogical approach was used to apply systems theory to observations of societal level processes during the revolution. Students reported positive feedback about the approach, particularly for being responsive and flexible to student needs, and demonstrating the relevance of systems theory at the community level and not just the family level. Lessons learned, such as sensitivity to both divided and multiple perspectives on national events, are also presented.
‘Something extra’: In defence of an uncanny humanism
Authors: Cohen Josh
Published: March 2022

This article proposes literature and psychoanalysis as forms of critical education, putting in urgent question the market-driven, instrumental models of learning that currently dominate higher education policy. In psychoanalytic terms, it argues, the primary mechanism at work in such a policy is what psychoanalysis calls splitting, which involves above all a kind of banishment of doubt and a rigid assurance in the rightness of the status quo that precludes meaningful change or transformation in the self and the world. The article goes on to identify in psychoanalysis and literature more ‘unsplit’ modes of thinking that refuse the reduction of the human being to a purely functional value. It ends with a reading of Kazuo Ishiguro's Never Let Me Go as a critical meditation on this reductive tendency.
An algorithm using administrative data to measure adverse childhood experiences (ADM‐ACE)
Authors: Henkhaus Laura E. , Gonzales Gilbert , Buntin Melinda B.
Published: March 2022

Objective

To develop an algorithm using administrative data to measure adverse childhood experiences (ADM‐ACE) within routinely collected health insurance claims and enrollment data.

Data Sources

We used claims and enrollment data from Tennessee's Medicaid program (TennCare) in 2018.

Study Design

We studied five types of ACEs: maltreatment and peer violence, foster care and family disruption, maternal mental illness, maternal substance use disorder, and abuse of the mother. We used diagnosis and procedure codes, prescription drug fills, and enrollment files to develop the ADM‐ACE, which we applied to measure the prevalence of ACEs and to examine prevalence by demographic characteristics among our sample of children in TennCare. We compared ADM‐ACE prevalence to child welfare records and survey results from Tennessee.

Data Collection/Extraction Methods

Our study sample included children aged 0–17 years who were linked to their mothers if also enrolled in TennCare in 2018 (N = 763,836 children).

Principal Findings

Approximately 19.2% of children in TennCare had indicators for ADM‐ACEs. The prevalence of ACEs was higher among children who were younger (p < 0.001), non‐Hispanic white or black (compared to Hispanic) (p < 0.001), and children residing in rural versus urban counties (p < 0.001). The prevalence of maltreatment identified through the ADM‐ACE (1.6%) falls between the percent of children in Tennessee who were reported to child welfare authorities and the percent for whom reports of maltreatment were substantiated. Comparison with survey reports from Tennessee parents suggests an advantage in measuring maternal mental illness with the ADM‐ACE using health insurance claims data.

Conclusions

The ADM‐ACE can be applied to health encounter data to study and monitor the prevalence of certain ACEs, their association with health conditions, and the effects of policies on reducing exposure to ACEs or improving health outcomes for children with ACEs.
Significance of two different ranking methods for studying fish fauna: a case study on the fish fauna from upper and middle portions from Mekong River
Authors: ZHOU Wei , LI Xu
Published: March 2022

Studies on fish fauna should not only focus on fish composition and the comparison of fish composition among the study region and adjacent regions, but should also explore the origin and uniqueness of different taxa as well as the substitution of genera and species. In this study, the value of floristic presence method was modified and renamed the value of fish fauna presence (VFFP) method. The specific steps of the VFFP method and the traditional fish fauna analysis (TFFA) method were refined and standardized. Then, the VFFP and TFFA methods were applied to study the fish fauna of the upper and middle portions of the Mekong River basin. The results indicate that the TFFA method reflects the families (subfamilies) and genera that constitute the main body of fish in the studied river basin. The results of the VFFP method show which families (subfamilies) and genera are representative for the basin. Therefore, combining the TFFA and VFFP methods to analyze the composition of fish fauna can reflect the characteristics of fish fauna from different perspectives. The case study shows that the fish fauna of the Mekong River is a part of the fish fauna of Southeast Asia. Although it shows some similarities to the composition of South Asian fish fauna, it does not belong to the South Asian fish fauna as a whole, and is essentially different from the East Asian fish fauna. This study provides an objective, quantitative, and verifiable method for studying fish fauna.
Polycyclic aromatic hydrocarbons in cachaças packed in bottles of polyethylene terephthalate
Authors: Souza Rafaella H. Z. , Cardoso Maria das Graças , Machado Ana Maria R. , Santiago Wilder D. , Pedroso Márcio P. , Brandão Rafaela M. , Oliveira Renan E. S. , Barbosa Richard B. , Alvarenga Gabriela F. , Caetano Alex R. S. , Nelson David L.
Published: March 2022

Cachaça is a beverage of great cultural and economic importance for Brazil. It is made up of several substances that are responsible for the flavor of the beverage. Countless substances of a toxic nature can also be present, such as polycyclic aromatic hydrocarbons (PAHs). These contaminants are commonly found in beverages and food. They have been studied because their toxicity is related to their mutagenic and carcinogenic properties, and they pose a risk to human health. The PAHs can be formed in cachaça during different stages of processing. In this work, the presence of PAHs (naphthalene, acenaphene, fluorene, phenanthrene, anthracene, fluoranthene, pyrene, benzo[a]anthracene, acephenylene, and benzo[a]pyrene) was investigated during the storage of the beverage in plastic containers. Thus, samples from five producers of cachaça in the state of Minas Gerais were stored for up to 8 months in polyethylene terephthalate (PET) packaging from three different manufacturers. Samples stored for 4 and 8 months were analyzed by high‐performance liquid chromatography, and 10 PAHs (naphthalene, acenaphene, fluorene, phenanthrene, anthracene, fluoranthene, pyrene, benzo[a]anthracene, acephenylene, and benzo[a]pyrene) were identified and quantified. An increase in PAH concentration in cachaça samples with the storage time in plastic containers was observed. The three different packages contributed to the contamination of the cachaça samples with different PAHs. The highest concentration (approximately 11.0 µg L–1) of fluorene was observed in sample A from the three packages and during the two storage times. Thus, it can be inferred that the storage of cachaça in bottles of PET is inadequate for maintaining the quality of the beverage.

Practical Application

Therefore, it can be inferred from the results of the analysis that PET packages are sources of PAHs, and the storage time in these packages contributed to the increase in the concentration of these contaminants in the beverage. These results suggest that a review of the legislation regarding the use of PET packaging for beverage storage is necessary, as these compounds are carcinogenic.
Effects of acidified blanching water and pectinase enzyme pretreatments on physicochemical properties and antioxidant capacity of Carica papaya juice
Authors: Siti Rashima R. , Ong W. L. , Aina Nadiah Z. , Maizura M.
Published: March 2022

The high pectin content in papaya (Carica papaya) causes the juice extraction to be difficult and results in a low yield. This study aims to determine the effect of acidified blanching water and pectinase enzyme pretreatments on the yield, physicochemical properties, and antioxidant activities of the papaya juice. For acidified blanching treatment, papaya cubes (3 cm3) were blanched in water containing 0%, 0.5%, 1.5%, and 2.5% w/v citric acid at 95℃ for 2 min. For enzyme treatment, a pectinase enzyme (10, 20, and 30 ppm) was added to the homogenous papaya puree and incubated at 45℃ (200 rpm) for 60 min. The enzyme reaction was stopped by pasteurization at 74℃ for 2 min. The puree was filtered, and the juice was pasteurized at 74℃ for 7 min. All pretreated papaya juice were analyzed for physicochemical properties (color, clarity, viscosity, pH, total soluble solids [TSSs], total carotenoid content, total phenolic content [TPC], and total flavonoid content [TFC]), and antioxidant activities (2,2‐diphenyl‐1‐picrylhydrazyl [DPPH] and ferric reducing antioxidant power [FRAP] assay). Both pretreatments improved the clarity of papaya juice, and was significantly greater after pretreatment with pectinase enzyme. The TPC and antioxidant activities of papaya juice were conserved and maintained by acidified blanching at 1.5% (w/v) citric acid. Increased concentrations of pectinase enzyme significantly reduced the TPC and total carotenoid content. Pretreatment with pectinase enzyme up to 20 ppm does not significantly reduce the TFC and antioxidant activities. Acidified blanching and pectinase enzyme pretreatments have an impact on extraction of papaya fruit juice while retaining the nutritional composition of the juice.

Practical Application

Papaya (Carica papaya) is a fruit with great nutritional values but is highly perishable and prone to postharvest loss. Juice has become a more cost‐effective and convenient option for preserving the fruit. However, since papaya is a pectin‐rich fruit, the extraction of juice using mechanical pressing is difficult due to the bonding of juice to the pulp in the form of a jellied mass, which results in juice with low yield. Using acidified blanching and pectinase enzyme to clarify the juice not only increases the yield but also retains the nutrient composition of the juice.
The effect of exercise training programs with aerobic components on C‐reactive protein, erythrocyte sedimentation rate and self‐assessed disease activity in people with ankylosing spondylitis: A systematic review and meta‐analysis
Authors: Harpham Conrad , Harpham Quillon K. , Barker Alan R.
Published: March 2022

Aim

To examine the effect of exercise training programs with aerobic components on C‐reactive protein, erythrocyte sedimentation rate and self‐assessed disease activity in people with ankylosing spondylitis compared to non‐aerobic rehabilitation.

Methods

A systematic review was undertaken of PubMED, Cochrane Library, Embase and Web of Science databases. Articles evaluating the effect of exercise training programs with aerobic components on C‐reactive protein, erythrocyte sedimentation rate or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in adults (>17 years) with ankylosing spondylitis were included. Control groups were defined as non‐aerobic rehabilitation, including usual care or physiotherapy.

Results

Thirteen articles met inclusion criteria for qualitative and meta‐analysis, involving 366 participants undertaking exercise and 361 controls. Exercise programs included modalities such as running, aerobic walking and swimming, and were between 3 weeks and 3 months in duration. Exercise programs significantly reduced C‐reactive protein (weighted mean difference [WMD]: −1.09; 95% CI: −2.08 to −0.10; P = .03; n = 5) and BASDAI (WMD: −0.78; 95% CI: −0.98 to −0.58; P < .001; n = 13) compared to non‐aerobic rehabilitation. BASDAI subgroup analysis revealed greater improvements compared to usual care than structured physiotherapy. Exercise programs did not reduce erythrocyte sedimentation rate (WMD: 0.16; 95% CI: −2.15 to 2.47; P = .89; n = 4).

Conclusion

Exercise training programs with aerobic components reduced C‐reactive protein and improved self‐assessed disease activity in people with ankylosing spondylitis. Further research is required to investigate the effects of differing aerobic exercise modes, intensities and durations.
Afghanistan, regional powers and non‐traditional security threats and challenges
Authors: Verma Raj
Published: March 2022

In February 2020, the United States (US) and the Taliban signed a peace deal in Doha, Qatar which stipulated US troop withdrawal from Afghanistan by 1 May 2021. The Biden administration extended the deadline to 11 September 2021. The Doha agreement does not augur peace and stability in Afghanistan with the country predicted to suffer from protracted violence and even a civil war. The instability in Afghanistan will also cascade into the neighbourhood and beyond and lead to non‐traditional threats/challenges. In the new millennium, while Russia, Iran and some Central Asian countries have borne the brunt of the narcotics trade emanating from Afghanistan, these countries along with India, China and Pakistan have also suffered from increase in terrorist attacks due to an unstable Afghanistan. Human migration has also negatively impacted the socio‐economic and political milieu of Pakistan and Iran. This special section assesses the non‐traditional security challenges/threats such as transnational Islamic fundamentalist terrorism, drugs/narcotics trade and human migration in the region and beyond posed by increasing instability and protracted violence in Afghanistan as a consequence of US withdrawal, and discusses the role (or the lack) of international and regional organizations and country initiatives in providing solutions to overcome or mitigate these problems.
Comparative morphology of the paw pad of the main arboreal Xenarthras from Amazon
Authors: Freire Elisa Carla Barra , Mesquita Ellen Yasmin Eguchi , Giese Elane Guerreiro , Branco Érika , de Lima Ana Rita
Published: March 2022

Paw pads are specializations of the integument and important shock absorbers of the locomotor system, as well as pressure, pain, temperature, storage and excretion sensors. Aiming to describe the paw pad morphology of the main arboreal xenarthras species in the Amazon, 16 animals were studied, Bradypus variegatus (6), Choloepus didactylus (5), Tamandua tetradactyla (3) and Cyclopes didactylus (2) that after death were donated to the Animal Morphological Research Laboratory (LaPMA / Ufra). The corpses were thawed and fixed with 10% aqueous formalin solution. The paw pads were measured, photographed and removed by skin incision dorsally to them. Fragments were used for routine histological processing, using two staining techniques: Hematoxylin‐Eosin (HE) and Gomori's Trichrome, in sections of 6 to 8 µm. Choloepus didactylus, Tamandua tetradactyla and Cyclopes didactylus have digital paw pads, one in each digit, and one palm, as well as a plantar, whose shapes and colours are distinct from each other. Bradypus variegatus, however, has only one palmar and one plantar pad. Histologically, they have keratinized stratified squamous epithelium, supported by a large amount of collagen fibres and fibroblast cords in the dermis and hypodermis. Groups of eccrine sweat glands were observed in the reticular dermis of C. didactylus, B. variegatus, T. tetradactyla and only in the hypodermis of Cyclopes didactylus.
The perceptions of obstetric care providers about cervical length screening for preterm birth prevention
Authors: Pedretti Michelle K. , Doherty Dorota A. , Dickinson Jan E.
Published: March 2022

Background

Routine cervical length (CL) measurement at the mid‐pregnancy ultrasound is a central recommendation of the Western Australian Preterm Birth Prevention Initiative (Initiative).

Aim

To evaluate the perceptions and changes in practice of Western Australian obstetric care providers regarding routine CL screening for preterm birth (PTB) prevention following the Initiative introduction.

Methods

Two self‐administered questionnaires were completed by providers from a range of practices. The first was during site visits with the Initiative Outreach team in 2015–2016. The questionnaire was re‐issued in 2021 via online dissemination. Participant demographic data and opinions on CL screening for PTB prevention were collected.

Results

Two hundred and fourteen providers participated in 2015–2016 and 109 in 2021. In both surveys, providers were more likely to discuss transvaginal CL screening with high‐risk women (48.1%, 76.1%; P < 0.001) compared with low‐risk (7.5%, 18.3%; P = 0.002) and the importance of CL screening (13.5%, 40.4%; P < 0.001), in 2015–2016 and 2021, respectively. Responses relating to CL screening, including what constitutes a short cervix on ultrasound were varied. A transabdominal CL <35 mm was classified as short by 46.2% and 37.6% and <25 mm on transvaginal ultrasound by 49.1% and 64.2%, in the respective surveys. Most providers ceased progesterone (68.6%, 75.2%) at >28 weeks gestation.

Conclusions

Providers focused on women with overt PTB risk factors, rather than a universal CL screening approach. Although there was improvement between the surveys, the definition of what constitutes a short cervix on ultrasound and how to treat and monitor women with a short CL remained varied.
Transcriptomics of rhinovirus persistence reveals sustained expression of RIG‐I and interferon‐stimulated genes in nasal epithelial cells in vitro
Authors: Ong Hsiao Hui , Andiappan Anand Kumar , Duan Kaibo , Lum Josephine , Liu Jing , Tan Kai Sen , Howland Shanshan , Lee Bernett , Ong Yew Kwang , Thong Mark , Chow Vincent T. , Wang De‐Yun
Published: March 2022

Background

Human rhinoviruses (HRVs) are frequently associated with asthma exacerbations, and have been found in the airways of asthmatic patients. While HRV‐induced acute infection is well‐documented, it is less clear whether the nasal epithelium sustains prolonged HRV infections along with the associated activation of host immune responses.

Objective

To investigate sustainably regulated host responses of human nasal epithelial cells (hNECs) during HRV persistence.

Methods

Using a time‐course study, HRV16 persistence and viral replication dynamics were established using an in vitro infection model of hNECs. RNA sequencing was performed on hNECs in the early and late stages of infection at 3 and 14 days post‐infection (dpi), respectively. The functional enrichment of differentially expressed genes (DEGs) was evaluated using gene ontology (GO) and Ingenuity pathway analysis.

Results

HRV RNA and protein expression persisted throughout prolonged infections, even after decreased production of infectious virus progeny. GO analysis of unique DEGs indicated altered regulation of pathways related to ciliary function and airway remodeling at 3 dpi and serine‐type endopeptidase activity at 14 dpi. The functional enrichment of shared DEGs between the two time‐points was related to interferon (IFN) and cytoplasmic pattern recognition receptor (PRR) signaling pathways. Validation of the sustained regulation of candidate genes confirmed the persistent expression of RIG‐I and revealed its close co‐regulation with interferon‐stimulated genes (ISGs) during HRV persistence.

Conclusions

The persistence of HRV RNA does not necessarily indicate an active infection during prolonged infection. The sustained expression of RIG‐I and ISGs in response to viral RNA persistence highlights the importance of assessing how immune‐activating host factors can change during active HRV infection and the immune regulation that persists thereafter.
How Does Couple Psychotherapy Allow for and Respond to the Individual?
Authors: McCann Damian
Published: March 2022

Those undertaking therapy with couples will undoubtedly at some point during their work encounter the technically challenging question of deciding how best to proceed when the couple therapist's designated patient, that is the couple, fails to attend and instead the therapist is confronted with the presence of only one of the partners. Equally, couple therapists must also consider under what circumstances, if any, it is advisable to see and work with only one of the partners. This paper is therefore concerned with exploring the complexity involved in undertaking couple therapy in the presence of only one of the partners and the implications of this for the therapy as a whole. Given the importance of this topic for couple therapists, it seems surprising that there is such a paucity of literature on the matter, and so this paper is attempting to address a gap in thinking and practice for those undertaking couple therapy.
‘If only I were a boy …’: Psychotherapeutic Explorations of Transgender in Children and Adolescents
Authors: Evans Marcus
Published: March 2022

This paper is based on the author’s experience of working with a particular group of female/male trans children and young people who present a similar clinical profile: a fragile ego prone to fragmentation and concrete thinking. Often, there is evidence of a grievance over the failed ideal object, which is internalized, projected into the body, and then attacked. Faced with the developmental challenge of sexuality at puberty, young adults withdraw to a psychic retreat designed to halt development. This paper focuses on the development of a trans identity in defence against an underlying fear of depressive anxieties and psychic collapse. It describes the ongoing assessment of Joanne, a 19‐year‐old biological female who wanted to be known as Luke in therapy and wished to transition in the belief that this was the only way she could have a life. The concrete nature of Joanne’s thinking created problems in the therapy, as thoughts were often experienced as physical actions. This paper describes the function of the phantasy that transitioning performs in creating a psychic retreat from the demands of psychological development.
Unilaterally disrupted structural and functional connectivity of the fronto‐limbic system in idiopathic hypogonadotropic hypogonadism
Authors: Cao Jibin , Yin Zhiyang , Chen Boyu , Chang Miao , Li Chao , Fan Guoguang , Cui Lingling
Published: March 2022

Objective

Idiopathic hypogonadotropic hypogonadism (IHH) is rare and can either be associated with normal or defective olfactory sensation, classified as normosmic IHH (nIHH) or Kallmann syndrome (KS). We do not yet understand the central processing pathways in the olfactory system. We aimed to compare the resting‐state structural and functional connectivity (FC) of olfactory neural pathways in patients with IHH. We hypotheses that alterations of structural connectivity and FC may exist in the olfactory cortex pathways in IHH patients.

Design: Structural and functional connectivity data results between two groups were analyzed

Patients: Twenty‐five IHH patients (13 nIHH patients and 12 KS patients) were recruited from the Department of Endocrinology and were assessed. A total of 25 age‐matched healthy male controls were recruited from the community.Measurements: All subjects underwent diffusion tensor imaging and functional magnetic resonance imaging (fMRI) scans. Structural and functional connectivity data analyses were then performed. Pearson's correlation analyses were performed to investigate the correlations between the fractional anisotropy (FA) value and FC strength, showing significant differences among the three groups separately.

Results

Compared with the HC group, FA value in the right uncinate fasciculus (UF) decreased significantly in the IHH group. The olfactory cortex FC values of the right gyrus rectus, orbitofrontal cortex (OFC) and right middle temporal gyrus in the IHH group were decreased compared with those in the HC group. Moreover, there were significant negative correlations between right UF FA and olfactory cortex‐FC to both the gyrus rectus and OFC within the HC group (p < .05).

Conclusion

Our findings suggest that alterations of structural and FC support the presence of neurobiological disruptions in IHH patients, particularly a specific structural‐functional asymmetry disruption may exist in the olfactory cortex pathways in IHH patients.
Clonidine suppression test for a reliable diagnosis of pheochromocytoma: When to use
Authors: Tsiomidou Spyridoula , Pamporaki Christina , Geroula Aikaterini , Van Baal Lukas , Weber Frank , Dralle Henning , Schmid Kurt W. , Führer Dagmar , Unger Nicole
Published: March 2022

Objective

In clinical practice, false‐positive results in biochemical testing for suspected pheochromocytoma/paraganglioma (PPGL) are not infrequent and may lead to unnecessary examinations. We aimed to evaluate the role of the clonidine suppression test (CST) in the era of analyses of plasma‐free metanephrines for the diagnosis or exclusion of PPGL in patients with adrenal tumours and/or arterial hypertension.

Design and Methods

This single‐centre, prospective trial investigated the use of CST in 60 patients with suspected PPGL associated with out‐patient elevations of plasma normetanephrine (NMN) and/or metanephrine (MN), in most cases accompanied with hypertension or an adrenal mass. Measurements of plasma catecholamines and free metanephrines were performed by liquid chromatography with electrochemical detection and tandem mass spectrometry, respectively.

Results

Forty‐six patients entered final analysis (n = 20 with PPGL and n = 26 with a nonfunctional adrenal mass and/or hypertension). CST reliably excluded false‐positive baseline NMN results with a specificity of 100%. The sensitivity of CST improved from 85% to 94% when tumours with isolated MN increase (n = 3) were not considered. In patients with elevated baseline NMN (n = 24), CST correctly identified all patients without PPGL. Patients with falsely elevated baseline NMN results (n = 7, 26.9%) exhibited increases of baseline NMN up to 1.7‐fold above the upper reference limit.

Conclusion

CST qualifies as a useful diagnostic tool for differential diagnosis of borderline elevated plasma‐free NMN in patients with suspected PPGL. In this context, CST helps to correctly identify all false‐positive NMN screening results.
Effectiveness of soft tissue augmentation procedures for coverage of buccal soft tissue dehiscence around dental implants: A systematic review
Authors: Soetebeer Maren , Jennes Marie‐Elise , Antonoglou Georgios N. , Al‐Nawas Bilal , Beuer Florian
Published: March 2022

Objective

This systematic review evaluated the effectiveness of soft tissue augmentation procedures for complete coverage and mean coverage of buccal soft tissue dehiscence (BSTD) in patients with implant‐supported restorations.

Methods

Three databases were surveyed for randomized (RCTs), non‐randomized controlled clinical trials (CCTs), cohort studies, case–control studies, and case series with a minimum of five patients per control or test group. Studies dealing with soft tissue augmentation procedures to cover BSTD—occurring during implant function and not due to the result of peri‐implantitis—were included. Risk of bias was evaluated with RoB 2 or the National Institutes of Health's Quality Assessment. Whenever possible, exploratory meta‐analyses were performed to evaluate weighted mean effects (WME) for the different outcomes. The primary outcomes were the percentage of complete coverage and mean coverage of BSTD.

Results

Seven articles were included. Only one study was a RCT, with a high risk of bias. Meta‐analyses showed that after 1 year (2 studies, n = 36 patients; WME = 70; 95% confidence interval [CI] = 50; 90; p = .23) as well as after 5 years (3 studies, n = 54 patients; WME = 70; 95%; CI = 60; 80; p = .44), complete coverage of BSTD could be achieved in 70% of the cases.

Conclusion

Based on limited evidence, it can be concluded that BSTD can be substantially reduced with the use of soft tissue augmentation procedures. Further research with comparative trials using larger samples and longer follow‐up periods is needed to study the stability of soft tissues in the long term.
Effective thermoforming method for maintaining mouthguard thickness with a circular sheet using a circular frame
Authors: Takahashi Mutsumi , Bando Yogetsu
Published: March 2022

Background/Aim

Mouthguard thickness is important to prevent oral and facial trauma during sports. The aim of this study was to establish an effective thermoforming method for maintaining mouthguard thickness with a circular sheet using a circular frame.

Materials and Methods

Mouthguards were thermoformed using 4.0‐mm‐thick ethylene vinyl acetate sheets and a vacuum forming machine. Each sheet was pinched at the top and bottom and stabilized by a circular frame. Two heating conditions were compared: (1) condition N, where the sheet was formed when it sagged 10 mm below the level of the sheet frame at the top of the post, and (2) condition L, where the sheet frame was lowered 50 mm below the ordinary level and heated, and the sheet was formed when it sagged 10 mm. In each heating method, two forming conditions were compared: (1) when the sheet softened, the sheet frame was lowered and formed (condition C; N‐C, L‐C), and (2) after the sheet frame was lowered, the model was moved forward 20 mm and then formed (condition MP; N‐MP, L‐MP). Six mouthguards were fabricated for each condition. Thickness differences due to heating conditions and forming conditions were analyzed by the two‐way ANOVA and Bonferroni's multiple comparison test.

Results

At the incisal edge and at the labial and buccal surfaces, significant differences were observed among all conditions, and the thicknesses were in the order N‐C < L‐C < N‐MP <L‐MP. At the cusp, significant differences were not observed depending on the heating conditions.

Conclusions

The thermoforming method with a circular sheet using a circular frame did not maintain a sufficient thickness only by the method of moving the model position just before formation. However, the results suggest that a single‐layer mouthguard with a labial thickness of 3 mm or more could be fabricated by applying the method of lowering the sheet frame and heating the sheet.
Phylogenetic and functional clustering illustrate the roles of adaptive radiation and dispersal filtering in jointly shaping late‐Quaternary mammal assemblages on oceanic islands
Authors: Si Xingfeng , Cadotte Marc W. , Davies T. Jonathan , Antonelli Alexandre , Ding Ping , Svenning Jens‐Christian , Faurby Søren
Published: March 2022

Islands frequently harbour unique assemblages of species, yet their ecological roles and differences are largely ignored in island biogeography studies. Here, we examine eco‐evolutionary processes structuring mammal assemblages on oceanic islands worldwide, including all extant and extinct late‐Quaternary mammal species. We find island mammal assemblages tend to be phylogenetically clustered (share more recent evolutionary histories), with clustering increasing with island area and isolation. We also observe that mammal assemblages often tend to be functionally clustered (share similar traits), but the strength of clustering is weak and generally independent from island area or isolation. These findings indicate the important roles of in situ speciation and dispersal filtering in shaping island mammal assemblages under pre‐anthropogenic conditions, notably through adaptive radiation of a few clades (e.g. bats, with generally high dispersal abilities). Our study demonstrates that considering the functional and phylogenetic axes of diversity can better reveal the eco‐evolutionary processes of island community assembly.
Gregory’s forgotten rebel: the portrayal of Basina by Gregory of Tours and its implications
Authors: Singer Rachel
Published: March 2022

Scholars of Gregory of Tours have paid little regard to the specific role of Basina in the nuns’ rebellion at Sainte‐Croix abbey in Poitiers. Their inattention mirrors Gregory’s narrative of the ‘scandal’, which presents Basina as Clotild’s more passive and reluctant sidekick, whereas the judgement of the bishops’ tribunal that tried the rebellion’s leaders characterizes them as equally blameworthy. This article examines Basina’s role in the ‘scandal’ in detail and argues that she was a more active participant than Gregory chose to suggest. It then seeks to explain why Gregory minimized Basina’s involvement and examines what his portrayal of her contributes to our understanding of his manipulation of historical events.
Remote hearings in family courts in England and Wales during Covid‐19: Insights and lessons
Authors: Harker Lisa , Ryan Mary
Published: March 2022

The introduction of social distancing measures during the COVID‐19 pandemic resulted in family court hearings in England and Wales being conducted remotely, by video or telephone. Over a 15 months period, the Nuffield Family Justice Observatory undertook three rapid consultations to identify how remote proceedings were working, according to families and to a wide range of professionals who work in and around the family court. The consultations revealed the value of working remotely in certain circumstances, but also highlighted significant questions of fairness and justice. These insights should inform how courts operate in the future.
The role of climate in past forest loss in an ecologically important region of South Asia
Authors: Haughan Alice E. , Pettorelli Nathalie , Potts Simon G. , Senapathi Deepa
Published: March 2022

Tropical forests in India have declined at an alarming rate over the past century, with extensive literature focusing on the high contributions of agricultural expansions to deforestation, while the effects of climate change have largely been overlooked. Climate change effects, such as increasing temperatures, drought and flooding, have already occurred, and are projected to worsen. Climate velocity, a metric that accounts for spatial heterogeneity in climate, can help identify contiguous areas under greater climate stress and potential climate refuges in addition to traditional temporal trends. Here, we examined the relative contribution of climate changes to forest loss within an area of India, Jammu, Kashmir, and Ladakh during the period 2001–2018, at two spatial (regional and study area) and two temporal (seasonal and annual) scales. This includes, for the first time, a characterization of climate velocity in the area. Our findings show that annual forest loss increased substantially over the 17‐year period examined (2001–2018), with the majority of forest loss occurring in the Northeast region. Decreases in temporal trends of temperature and precipitation were most associated with forest losses, but there was large spatial and seasonal variation in the relationship. In every region except the Northeast, forest losses were correlated with faster velocities of at least one climate variable but overlapping areas of high velocities were rare. Our findings indicate that climate changes have played an important role in past forest loss within the study area but likely remain secondary to other factors at present. We stress concern for climates velocities recorded reaching 97 km year−1, and highlight that understanding the different regional and seasonal relationships between climatic conditions and forest distributions will be key to effective protection of the area's remaining forests as climate change accelerates.
The effectiveness of auscultatory, colorimetric capnometry and pH measurement methods to confirm placement of nasogastric tubes: A methodological study
Authors: Taskiran Nihal , Sari Dilek
Published: March 2022

Aim

To determine the effectiveness of auscultatory, colorimetric capnometry and pH measurement methods for confirmation of correct nasogastric tube placement in critically ill patients.

Background

Incorrect nasogastric tube placement causes serious complications.

Design

This was a methodological and comparative study.

Methods

The study sample consisted of 88 new insertions of nasogastric feeding tubes between April 2018–2019. Results from the ‘auscultatory’, ‘pH’ and ‘colorimetric capnometry’ methods were compared with the location of the nasogastric tube as determined through radiography. Descriptive statistics, Eta analysis and the Cohen kappa compliance test as well as sensitivity and specificity were conducted.

Results

There was a weak agreement (26.3%) between the auscultation and radiological evaluation for confirming nasogastric tube placement. The pH measurement and colorimetric capnometry methods were not correlated with radiological evaluation. Stomach pH increased as patient age increased and use of the colorimetric capnometry method failed to confirm the oesophageal and duodenal location. The specificity of the auscultation was low, and both the specificity and sensitivity pH methods were low.

Conclusion

It was determined that auscultation, measuring pH and colorimetric capnometry were unreliable methods for confirming placement of nasogastric tubes. It is recommended to confirm initial placement of the nasogastric tube with radiography and to develop effective and reliable non‐radiological measurement methods that can be performed at the bedside.
Barriers and enablers to embedding fundamental nursing care for older patients—Implications of a mixed methods study for nursing leadership
Authors: Grealish Laurie , Ranse Kristen , Todd Jo‐Anne , Armit Lyn , Billett Stephen , Collier Leigh , Bail Kasia , Moyle Wendy
Published: March 2022

Aims

To understand the enablers and barriers for delivering fundamental care to hospitalized older patients.

Design

Explanatory sequential mixed methods design, with qualitative data used to elaborate quantitative results.

Methods

Set in one medical and one surgical unit of a tertiary hospital in southeast Queensland, Australia. Observations of nursing practice using the Work Sampling Technique were conducted over two 2‐week periods in 2019. Data were analyzed and presented to groups of nurses who appraised the findings of the observations.

Results

There were 1176 and 1278 observations of care in the medical unit over two time periods and 1380 and 1398 observations over the same period in the surgical unit. Fundamental care activities were recorded in approximately 26% (i.e. medical) and 22% (i.e. surgical) of all observations. Indirect care was highest, recorded in 41% (i.e. medical) and 43% (i.e. surgical) of observations. Nurses prioritized the completion of reportable activities, which is perceived as a potential enabler of fundamental care. Potential barriers to fundamental care included frequent delays in indirect care and difficulty balancing care requirements across a group of patients when patients have high fundamental care needs.

Conclusion

The cultural acceptance of missed nursing care has the potential to erode public confidence in health systems, where assistance with fundamental care is expected. Relational styles of nurse leadership should focus on: (1) making fundamental care important work in the nurses’ scope thereby offering an opportunity for organizational change, (2) promoting education, demonstrating the serious implications of missed fundamental care for older patients and (3) investigating work interruptions.

Impact

Fundamental care is necessary to arrest the risk of functional decline and associated hospital‐acquired complications in older patients. However, nurses commonly report fundamental care as missed or omitted care. Understanding the challenges of implementing fundamental care can assist in the development of nurse leadership strategies to improve older patients’ care. Fundamental care was observed between 22% (i.e. surgical) and 26% (i.e. medical) of all observations. Nurses explained that they were focused on prioritizing and completing reported activities, experienced frequent delays when delivering indirect care and found balancing care requirements across groups of patients more challenging when patients had fundamental care needs. Clinical nurses working in acute health services with increasing populations of older patients can lead improvements to fundamental care provision through relational leadership styles to demonstrate how this work is in nurses’ scope of practice, promote education about the serious implications of missed fundamental care and investigate the root cause of work interruptions.