bluuebunny/crossref_metadata_2025 huggingface dataset:
Determination of Human Chorionic Gonadotropin in Postmortem Samples in Ectopic Pregnancies
Authors: Palmiere Cristian , Lesta Maria del Mar , Fanton Laurent , Ventura Francesco , Bonsignore Alessandro , Reggiani Bonetti Luca
Published: August 2015

Increased human chorionic gonadotropin levels (HCG) can be detected in femoral blood, bile, and vitreous humor collected during autopsy of pregnant women using a standard kit designed for living patients. In the study herein, the concentrations of HCG were measured in postmortem serum, vitreous, bile, cerebrospinal, and pericardial fluids in 4 cases of fatal ectopic pregnancy and 40 controls using a quantitative electrochemiluminescence immunoassay designed for living patients. No false‐negative cases were identified in any of the analyzed samples in any of the ectopic pregnancy cases. No correlations were found between total HCG levels in postmortem serum and the other tested specimens. The results of this study would suggest that higher HCG in bile, vitreous, pericardial, and cerebrospinal fluids may confirm the existence of ectopic pregnancy and therefore identify other situations in which this hormone is increased, although gestational age cannot be reliably estimated using these values.
Metabolic syndrome in first‐time hospitalized patients with depression: a 1‐year follow‐up study
Authors: Nyboe L. , Vestergaard C. H. , Lund H. , Møller M. K. , Videbech P.
Published: August 2015

Objective

Studies on metabolic syndrome (MetS) in younger patients with depression are few. We examined the prevalence and progression of MetS in first‐time hospitalized patients with depression during 1 year of follow‐up. Furthermore, we explored putative risk factors of MetS.

Method

We evaluated MetS and its components in first‐time hospitalized patients with depression (N = 52) and healthy controls (N = 50) (18–45 years). Physical activity, aerobic fitness, sleeping disturbances, smoking and dietary habits, and psychopharmacological treatment were recorded at baseline for all participants and after 1 year for the patients.

Results

Patients had significantly higher waist circumference (WC) and lower high‐density lipoproteins compared with healthy controls (P < 0.05). Patients had higher prevalence of MetS, but this was not significant when adjusted for age. Patients had significant increase in WC and triglycerides and a non‐significant increase in the prevalence of MetS. Antipsychotic medication (OR 10.5, 95% CI 1.18–94.14) and low aerobic fitness (OR 0.79, 95% CI 0.68–0.93) were significantly correlated with MetS (P < 0.05).

Conclusion

Metabolic syndrome is highly prevalent in younger, severely depressed patients and the incidence increases during 1 year of follow‐up. Low aerobic fitness and use of atypical antipsychotics are strongly correlated with MetS.
Improvement of liver function parameters in advanced HCV‐associated liver cirrhosis by IFN‐free antiviral therapies
Authors: Deterding K. , Höner zu Siederdissen C. , Port K. , Solbach P. , Sollik L. , Kirschner J. , Mix C. , Cornberg J. , Worzala D. , Mix H. , Manns M. P. , Cornberg M. , Wedemeyer H.
Published: August 2015

Background

Successful antiviral treatment of decompensated hepatitis B with HBV polymerase inhibitors is associated with improvement of liver function. To what extent liver function also improves in cirrhotic patients with chronic hepatitis C receiving novel interferon‐free (IFN‐free) therapies is unknown.

Aim

To study liver function in cirrhotic HCV patients receiving IFN‐free therapies.

Methods

We here studied 80 consecutive patients with advanced HCV associated liver cirrhosis including 34 patients (43%) with Child B/C cirrhosis and 42 patients (53%) with platelet counts of <90.000/μL receiving different combinations of direct acting antivirals without interferon [sofosbuvir/ribavirin (n = 56), sofosbuvir/simeprevir ± ribavirin (n = 15) and sofosbuvir/daclatasvir ± ribavirin (n = 9)]. The majority of patients was infected with HCV genotype 1 (n = 50); HCV genotypes 2, 3 and 4 were present in 4, 24 and 2 patients, respectively.

Results

Liver function parameters including albumin, bilirubin, cholinesterase and prothrombin time all improved in the majority of patients during antiviral therapy irrespectively of the underlying HCV genotype, however, with different kinetics. MELD scores improved until post‐treatment week 12 in 44% of the patients but worsened in 15%. A sustained virological response was achieved in 63% of the patients. HCV RNA relapse led to moderate ALT increases in 15/23 patients but was not associated with hepatic decompensations.

Conclusion

This real‐world single centre study showed that interferon‐free treatment of hepatitis C patients with advanced liver cirrhosis restores liver function, and may thereby reduce the need for liver transplantations.
Preincubation with green tea polyphenol extract is beneficial for attenuating sperm injury caused by freezing‐thawing in swine
Authors: Kitaji Hideki , Ookutsu Shoji , Sato Masahiro , Miyoshi Kazuchika
Published: August 2015

Polyphenols (PFs) extracted from green tea, known to be potent anti‐oxidants, have been reported to be effective in increasing the motility and viability of mammalian sperm, preserved in a liquid form. Therefore, we tested whether PFs might also be effective for maintaining the integrity of frozen‐thawed boar spermatozoa. Ejaculates, collected from Clawn miniature pigs, were diluted in a semen extender containing various amounts of PFs (0, 0.01, 0.05, 0.1 and 0.2% w/v) and then stored at 15°C overnight. The semen samples were processed, using the straw freezing procedure, and then frozen in liquid nitrogen. After rapid thawing at 40°C, the spermatozoa were subjected to several assays to evaluate semen quality. Spermatozoa frozen in a medium containing 0.01% w/v PFs exhibited significantly (P < 0.05) higher degrees of post‐thawed viability and acrosomal integrity than those stored in the absence of PFs. However, no change in the mitochondrial activity was noted between the two groups. The inclusion of 0.01% PFs in the semen extender was significantly (P < 0.05) effective in increasing both the rates of monospermic oocyte formation and of blastocyst formation. These findings indicate that preincubation with the semen extender, containing 0.01% PFs prior to freezing, exerts a protective effect on boar sperm by preventing injuries associated with freezing‐thawing.
A phase II study of bortezomib added to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone in patients with previously untreated indolent non‐Hodgkin's lymphoma
Authors: Cohen Jonathon B. , Switchenko Jeffrey M. , Koff Jean L. , Sinha Rajni , Kaufman Jonathan L. , Khoury H. Jean , Bumpers Nassoma , Colbert Amanda , Hutchison‐Rzepka Amanda , Nastoupil Loretta J. , Heffner Leonard T. , Langston Amelia A. , Lechowicz Mary Jo , Lonial Sagar , Flowers Christopher R.
Published: August 2015

Bortezomib‐containing combinations are active in non‐Hodgkin lymphoma (NHL) although peripheral neuropathy can limit their dose intensity. Based on our phase I findings, we conducted a phase II trial of bortezomib in combination with R‐CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) with a modified dose of vincristine. Patients with untreated indolent NHL received bortezomib (1·6 mg/m2) on days 1 and 8 of a 21‐day cycle for up to 8 cycles and R‐CHOP with a 1·5 mg cap of vincristine. Patients achieving a complete response (CR) received maintenance rituximab, and remaining patients received maintenance rituximab and bortezomib. The primary endpoint was CR rate; secondary survival analyses were evaluated using the Kaplan–Meier method. Among 29 eligible patients, NHL morphologies included follicular (n = 20), marginal zone (n = 5) and small lymphocytic lymphoma (n = 4). Nineteen patients had CR (66%) and 10 had partial response (34%), yielding a 100% overall response rate. With a median follow‐up of 48·7 months, the 4‐year progression‐free and overall survivals were 83% and 93%. Twenty‐two patients experienced peripheral neuropathy of any grade, and two had grade 3 neuropathy. The combination of bortezomib with R‐CHOP is effective for indolent NHL, and we plan to evaluate therapies incorporating novel proteasome inhibitors in future studies in NHL.
Perceived moral responsibility for attitude‐based discrimination
Authors: Redford Liz , Ratliff Kate A.
Published: August 2015

This research investigated judgements of moral responsibility for attitude‐based discrimination, testing whether a wrongdoer's mental states – awareness and foresight – are central determinants of culpability. Participants read about and judged a target person who was described as consciously egalitarian, but harbouring negative attitudes that lead him to treat African Americans unfairly. Two studies showed that participants ascribed greater moral responsibility for discrimination when the target was aware of having negative attitudes than when he was unaware. Surprisingly, moral judgements were equally harsh towards a target who was explicitly aware that his bias could influence his behaviour as a target who was not. To explain this result, a second study showed that the path from awareness to moral responsibility was mediated by perceptions that the target had an obligation to foresee his discriminatory behaviour, but not by perceptions of the target's actual foresight. These results suggest that bias awareness influences moral judgements of those who engage in attitude‐based discrimination because it obligates them to foresee harmful consequences. The current findings demonstrate that moral judges consider not just descriptive facts, but also normative standards regarding a wrongdoer's mental states.
Kin Recognition and Inbreeding Avoidance in a Butterfly
Authors: Fischer Klaus , Karl Isabell , Heuskin Stéphanie , Janowitz Susann , Dötterl Stefan
Published: August 2015

Owing to the risk of inbreeding depression, the evolution of inbreeding avoidance by means of kin recognition is expected for many biological systems. Nevertheless, an ability to distinguish among relatives and non‐relatives has been only rarely demonstrated, especially so in non‐social organisms. We here show that, in the non‐social tropical butterfly Bicyclus anynana, females discriminate against relatives by preferentially mating with non‐relatives. Inbreeding avoidance was more pronounced in inbred as compared with outbred butterflies, suggesting that it is partly condition dependent. We argue that, in our system, the evolution of inbreeding avoidance is related to carrying a high genetic load and thus to being particularly sensitive to inbreeding depression. We suggest that kin recognition might be more widespread than currently thought and that future studies may possibly benefit from considering condition dependence, especially by paying attention to and/or manipulating population history, genetic load, and the risk of inbreeding depression. We further suggest that kin recognition in B. anynana might be based on cuticular hydrocarbons used for self‐referencing.
Is drift the primary process promoting the resilience of river invertebrate communities? A manipulative field experiment in an intermittent alluvial river
Authors: Vander Vorste Ross , Malard Florian , Datry Thibault
Published: August 2015

In river systems, aquatic invertebrate communities are surprisingly persistent over time and generally recover quickly from disturbances. Drift has long been viewed as the primary process promoting this resilience, and it plays a important role in predictive models of community composition and concepts in lotic ecology. More recently, other processes such as vertical migration from the hyporheic zone, aerial oviposition from distant refuges and the use of resistance forms (e.g. diapause) have received greater recognition and support for their importance.

In this study, the view that drift is the primary process promoting invertebrate community resilience was challenged in an intermittent alluvial river using reach‐scale flow manipulations. First, six treatment channels were completely dried for 1 week, while three others were left flowing to be used as controls. Second, flow was re‐established in channels and drift was either allowed or blocked for a 4‐week period. Third, during this period the resilience of community structure, composition and function was compared between treatments, and the potential for colonisation from the drift, hyporheic zone, aerial oviposition and resistance forms was measured.

Communities recovered after only 2 weeks in all of the previously dried channels, and contrary to our hypotheses, invertebrate community structure, composition and functional trait composition were not altered by blocking drift, indicating it was not the primary process promoting resilience in this river.

Three lines of evidence suggested colonisation from the hyporheic zone and not aerial oviposition nor resistance forms promoted resilience following rewetting including the following: (i) finding all common benthic taxa in the hyporheic zone during the drying event, (ii) a distinct decrease in invertebrate size upon rewetting in all treatment channels and (iii) a negative correlation between resilience and water table depth.

This experiment highlighted the potential importance of the hyporheic zone as a key source of colonisation in alluvial rivers and emphasises the need for a three‐dimensional perspective when considering community resilience in rivers. Adaptive management approaches are needed to direct attention to sources (e.g. hyporheic zone) that are essential to promoting community resilience in rivers facing increased pressures due to climate change, water abstraction and flow regime alteration.
The effect of two contrasting concentrate allocation strategies on the performance of grazing dairy cows
Authors: Dale A. J. , McGettrick S. , Gordon A. W. , Ferris C. P.
Published: August 2015

The objective of this study was to examine the performance of grazing Holstein–Friesian dairy cows when equal quantities of concentrates were offered using either a flat‐rate or a feed‐to‐yield allocation strategy. The study involved fifty‐six cows (twenty primiparous and thirty‐six multiparous) and continued for 122 d, with concentrate feed levels adjusted on five occasions during the study (every four weeks approximately). Total concentrate intake over the duration of the study was 463 and 525 kg cow−1 (3·8 and 4·3 kg cow−1 d−1) for multiparous and primiparous animals respectively. Concentrate allocation strategy had no effect on average daily milk yield, milk fat or protein content, milk‐fat‐plus‐protein yield or end‐of‐study live weight and body condition score (P > 0·05). In conclusion, concentrate allocation strategy had minimal impact on the overall performance of these mid/late lactation cows when concentrate feed levels were modest and grass availability was high.
Updated analysis: central venous access device infection rates in an expanded cohort of paediatric patients with severe haemophilia receiving prophylactic recombinant tissue plasminogen activator
Authors: McCarthy C. E. , O'Brien M. , Andrews J. , Zoland J. M. , Macasiray E. , Wong W. , Lo C. , Glader B. , Tamaresis J. , Jeng M.
Published: August 2015

Introduction

Central venous access devices (CVADs) are used in the care of paediatric haemophilic patients with difficult peripheral access, but their use is limited by complications such as infection. We previously published our experience with monthly recombinant tissue plasminogen activator (r‐tPA) administration to CVADs of haemophilic patients as an intervention for infection prophylaxis, which suggested a 10‐fold decrease in infection rate compared to published rates without r‐tPA.

Aim

This study was conducted to assess the CVAD infection rate in an expanded haemophilia cohort receiving r‐tPA over an extended period.

Methods

A retrospective review was performed on patients with haemophilia who received monthly r‐tPA to CVADs, with data collected from January 1, 2008 to December 31, 2012. The data were merged with the previously reported data set (collected from June 1, 1998 to December 31, 2007).

Results

Over the entire observation period, there were 46 350 CVAD days among 32 patients [26 severe factor VIII (FVIII) deficiency, six severe FIX deficiency]. Eight patients received immune tolerance therapy for inhibitors and 24 patients received prophylactic factor administration. No patients were HIV positive. Three infections were observed, with an overall infection rate of 0.06 infections per 1000 CVAD days.

Conclusions

A low CVAD infection rate, similar to that observed in our previous study (0.04 per 1000 CVAD days), was observed in this expanded haemophilia cohort treated with prophylactic r‐tPA, supporting the use of monthly r‐tPA as CVAD infection prophylaxis in haemophilia patients.
Sex-rated Statistics
Authors: Spiegelhalter David
Published: August 2015

David Spiegelhalter's new book explores human sexual activity through numbers. But there is nothing salacious about this extract. Instead, Spiegelhalter shows us how to sort quality stats from tawdry factoids, using a simple classification system

David Spiegelhalter's new book explores human sexual activity through numbers. He explains how to sort quality stats from tawdry factoids, using a simple classification system
Ab initio Molecular Dynamics Simulations of the Hydroxylation of Nanoporous Silica
Authors: Rimsza J.M. , Du Jincheng
Published: August 2015

Accurate information on the interactions between water and silica is critical to the understanding of its properties including mechanical strength under stress and long‐term chemical durability of silica and silicate glasses. In this study, interactions between water and nanoporous amorphous silica models were investigated using density functional theory (DFT) based ab initio molecular dynamics (AIMD) simulations which accurately describe bond breakage and formation as well as chemical reactions. AIMD simulations up to 30 ps were performed for systems containing water and nanoporous silica with a wide range of porosities (31%–67%). Partial removal of defects, such as two‐membered rings, was observed during the AIMD runs whereas more reactive coordination defects were removed during the initial geometry optimization. The limited two‐membered ring removal can be attributed to restricted water‐defect movement or the increased stability of rings located on concave surfaces. Two‐membered ring removal mechanisms included the formation of an overcoordinated silicon (Si5) intermediate defect from the dynamic simulations. Si5 defects continued to develop throughout the simulations, indicating a thermodynamic drive for two‐membered ring removal which is kinetically limited. Changes in the electronic structures, such as atomic charges, and bond length‐bond angle correlation functions were monitored during the hydroxylation process.
Atrioventricular Nodal Reentrant Tachycardia in Implantable Cardioverter Defibrillators: Diagnosis and Troubleshooting
Authors: ENRIQUEZ ANDRES , ELLENBOGEN KENNETH A. , BOLES USAMA , BARANCHUK ADRIAN
Published: August 2015

AVNRT in ICDs

Inappropriate therapies are frequent in patients with implantable cardioverter defibrillators (ICDs) and are associated with adverse outcomes, including increased mortality. Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common reentrant supraventricular tachycardia (SVT) and a cause of inappropriate therapies in these patients. In the present article we review the problem of AVNRT in ICD patients with a focus on diagnosis and the available algorithms to improve arrhythmia discrimination and prevent inappropriate shocks.
Observations on Attenuation of Local Electrogram Amplitude and Circuit Impedance During Atrial Radiofrequency Ablation: An In vivo Investigation Using a Novel Direct Endocardial Visualization Catheter
Authors: BHASKARAN ABHISHEK , CHIK WILLIAM , NALLIAH CHRISHAN , POULIOPOULOS JIM , BARRY TONY , NGUYEN DOAN TRANG , MIDEKIN CHRISTINE , SAMANTA RAHUL , FARRAHA MELAD , THOMAS STUART , KOVOOR PRAMESH , THIAGALINGAM ARAVINDA
Published: August 2015

Radiofrequency Ablation with Visual Ablation Catheter

Aims

To define the temporal characteristics of atrial lesion growth (lesion surface area), local electrogram amplitude attenuation, and circuit impedance decrement during in vivo radiofrequency (RF) ablation with direct endocardial visualization (DEV).

Methods and Results

A direct endocardial visualization catheter was used for real‐time endoscopic visualization of atrial endocardial surface during RF ablation. Videos of lesion growth (surface area), circuit impedance, and local electrogram amplitude were recorded during ablation in 11 ovine. Fifty‐two atrial ablations at 12 W, 14 W, and 16 W power for 30 seconds were analyzed. During 30‐second RF ablation, the lesion matured (90% of final lesion dimension) in the first 23.0 ± 5.8 seconds. The local electrogram amplitude attenuation (80% decrement) and circuit impedance attenuation (20% decrement from initial) occurred 13.8 ± 8.2 seconds and 13.1 ± 7.9 seconds, respectively, before lesion maturity in a significant proportion of 30 second atrial ablations.

Conclusion

The DEV observations suggest that in smooth atrial surface ablations with significant local electrogram and impedance decrement in the first 10 seconds, further extension of ablation for 10–15 seconds could deliver optimal surface dimensions; however, real‐time measurement of depth was not possible.
Closed Claims Analysis of Medical Malpractice Lawsuits Involving Midwives: Lessons Learned Regarding Safe Practices and the Avoidance of Litigation
Authors: McCool William F. , Guidera Mamie , Griffinger Ellie , Sacan Dulcy
Published: August 2015

Introduction

The risk of litigation remains of concern to midwives, their practice partners, employers, and malpractice insurance providers. Closed claims analysis is a method of examining risk patterns and behaviors in lawsuits, including those involving health care practices. The purpose of this investigation was to evaluate claims brought against midwives, with the intent of developing strategies to decrease the incidence of litigation.

Methods

Data were collected in joint meetings with members of the American College of Nurse‐Midwives (ACNM); the American Association of Birth Centers; the American International Group (AIG), a major malpractice insurer for certified nurse‐midwives/certified midwives (CNMs/CMs); and Contemporary Insurance Services, an independent insurance agency that has worked with AIG to facilitate the writing of malpractice insurance policies for CNMs/CMs. The purpose of the meetings was to review 162 litigation cases that involved midwives insured by AIG and had been closed between the years 2002 and 2011. Follow‐up analyses of data and reporting of results were performed by the authors, who are members of the Professional Liability Section of the ACNM Division of Standards and Practice.

Results

Findings reflected 7 major categories of liability risk ranging from the most prevalent (ie, fetal/newborn complications or death) to the least prevalent (ie, attending a vaginal birth after cesarean). Data also were examined regarding the highest amounts incurred in court decisions or pretrial settlements because they were related to types of adverse outcomes that occurred.

Discussion

Recommendations for improving clinical practice and avoiding litigation based on findings from the closed claims analysis include, but are not limited to, the need for thorough and accurate documentation in practice, appropriate and timely consultation and collaboration, and the presence of practitioners whose clinical skills match the level of care assessed to be necessary for each woman for whom care is offered.
Analysis of the volumetric relationship among human ocular, orbital and fronto‐occipital cortical morphology
Authors: Masters Michael , Bruner Emiliano , Queer Sarah , Traynor Sarah , Senjem Jess
Published: August 2015

Recent research on the visual system has focused on investigating the relationship among eye (ocular), orbital, and visual cortical anatomy in humans. This issue is relevant in evolutionary and medical fields. In terms of evolution, only in modern humans and Neandertals are the orbits positioned beneath the frontal lobes, with consequent structural constraints. In terms of medicine, such constraints can be associated with minor deformation of the eye, vision defects, and patterns of integration among these features, and in association with the frontal lobes, are important to consider in reconstructive surgery. Further study is therefore necessary to establish how these variables are related, and to what extent ocular size is associated with orbital and cerebral cortical volumes. Relationships among these anatomical components were investigated using magnetic resonance images from a large sample of 83 individuals, which also included each subject's body height, age, sex, and uncorrected visual acuity score. Occipital and frontal gyri volumes were calculated using two different cortical parcellation tools in order to provide a better understanding of how the eye and orbit vary in relation to visual cortical gyri, and frontal cortical gyri which are not directly related to visual processing. Results indicated that ocular and orbital volumes were weakly correlated, and that eye volume explains only a small proportion of the variance in orbital volume. Ocular and orbital volumes were also found to be equally and, in most cases, more highly correlated with five frontal lobe gyri than with occipital lobe gyri associated with V1, V2, and V3 of the visual cortex. Additionally, after accounting for age and sex variation, the relationship between ocular and total visual cortical volume was no longer statistically significant, but remained significantly related to total frontal lobe volume. The relationship between orbital and visual cortical volumes remained significant for a number of occipital lobe gyri even after accounting for these cofactors, but was again found to be more highly correlated with the frontal cortex than with the occipital cortex. These results indicate that eye volume explains only a small amount of variation in orbital and visual cortical volume, and that the eye and orbit are generally more structurally associated with the frontal lobes than they are functionally associated with the visual cortex of the occipital lobes. Results also demonstrate that these components of the visual system are highly complex and influenced by a multitude of factors in humans.
Perceptions of needs related to the practice of self‐care for minor illness
Authors: Gustafsson Silje , Vikman Irene , Sävenstedt Stefan , Martinsson Jesper
Published: August 2015

Aims and objectives

The aim of this study was to describe people's perceptions of needs to feel confident in self‐care for minor illnesses as well as their perceptions about supporting and obstructing factors in the practice of self‐care.

Background

Minor illness constitutes a large part of primary care, and patients' attendance to doctors' appointments for minor illness has been seen to increase future attendance for the same condition. Almost half of the consultations with telenurses result in the provision of self‐care advice.

Design

A cross‐sectional survey.

Method

Primary data were collected using a questionnaire, and the study participants (n = 315) were randomly selected from the national Swedish address register.

Results

Having knowledge and receiving health care advice and reliable information were perceived to be needs in order for participants to feel confident in self‐care. Having family or friends to consult with was perceived to be a positive factor influencing confidence in self‐care, especially for persons under the age of 35. Health care services were perceived to support self‐care practice by offering easy access to care, giving information about self‐care, and offering increased follow‐up after consultations. Lack of knowledge, along with difficulties being away from work, were obstructing factors in the practice of self‐care.

Conclusions

Young age was the factor influencing people's perceptions of needs and supporting factors the most. Young age and low knowledge scores about minor illnesses were the two factors that had the most influence on perceived obstructing factors.

Relevance to clinical practice

Nurses play a major role in the promotion of self‐care and in the dissemination of self‐care advice. If health care services fail to meet the needs of care‐seekers with minor illnesses, patients might turn to out‐of‐hours clinics and emergency departments for help.
Emergency nurses' perceptions of sedation management practices for critically ill intubated patients: a qualitative study
Authors: Varndell Wayne , Fry Margaret , Elliott Doug
Published: August 2015

Aims and objectives

The aim of this study was to explore factors influencing practices in assessing, titrating and managing sedation for the critically ill intubated patients, from the perspective of emergency nurses.

Background

The number of critically ill patients presenting to Australian public Emergency Departments has increased by over 30% since 1980. Emergency nurses are increasingly relied upon to manage sedation of critically ill intubated patients. There is little evidence within international literature relating to how emergency nurses accomplish this.

Design

Descriptive qualitative study.

Method

A purposive sample of 15 experienced emergency nurses participated in semi‐structured face‐to‐face interviews. Transcribed data were analysed using thematic analysis.

Results

The qualitative analysis yielded five themes: becoming the resuscitation nurse; becoming confident as the resuscitation nurse; communicating about sedation; visual cues and the vanishing act. The safety and quality of sedation experienced by critically ill intubated patients in ED was the responsibility of emergency nurses, yet uncertainties and barriers were evident.

Conclusion

Patient continuity of care, including optimisation of comfort relies upon the knowledge, skills and expertise of the emergency nurse allocated to the resuscitation area. For most nurses transitioning into the resuscitation nurse role, it represents the first time they will have had contact with patients with highly complex needs and sedation. The use of self‐directed clinical workbooks and supervised clinical practice alone may be insufficient to adequately prepare nurses for the spectrum of critically ill sedated patients managed in the resuscitation area; a situation made worse in the presence of poor team communication.

Relevance to clinical practice

The findings of this study should assist in the development of policy and formal education of emergency nurses transitioning into the resuscitation area and the management of continuous intravenous sedation to critically ill mechanically ventilated patients is required.
Excessive bleeding predictors after cardiac surgery in adults: integrative review
Authors: Lopes Camila Takao , dos Santos Talita Raquel , Brunori Evelise Helena Fadini Reis , Moorhead Sue A , Lopes Juliana de Lima , Barros Alba Lucia Bottura Leite de
Published: August 2015

Aims and objectives

To integrate literature data on the predictors of excessive bleeding after cardiac surgery in adults.

Background

Perioperative nursing care requires awareness of the risk factors for excessive bleeding after cardiac surgery to assure vigilance prioritising and early correction of those that are modifiable.

Design

Integrative literature review.

Methods

Articles were searched in seven databases. Seventeen studies investigating predictive factors for excessive bleeding after open‐heart surgery from 2004–2014 were included.

Results

Predictors of excessive bleeding after cardiac surgery were: Patient‐related: male gender, higher preoperative haemoglobin levels, lower body mass index, diabetes mellitus, impaired left ventricular function, lower amount of prebypass thrombin generation, lower preoperative platelet counts, decreased preoperative platelet aggregation, preoperative platelet inhibition level >20%, preoperative thrombocytopenia and lower preoperative fibrinogen concentration. Procedure‐related: the operating surgeon, coronary artery bypass surgery with three or more bypasses, use of the internal mammary artery, duration of surgery, increased cross‐clamp time, increased cardiopulmonary bypass time, lower intraoperative core body temperature and bypass‐induced haemostatic disorders. Postoperative: fibrinogen levels and metabolic acidosis.

Conclusions

Patient‐related, procedure‐related and postoperative predictors of excessive bleeding after cardiac surgery were identified.

Relevance to clinical practice

The predictors summarised in this review can be used for risk stratification of excessive bleeding after cardiac surgery. Assessment, documentation and case reporting can be guided by awareness of these factors, so that postoperative vigilance can be prioritised. Timely identification and correction of the modifiable factors can be facilitated.
Role of the Lebanese family caregivers in cardiac self‐care: a collective approach
Authors: Dumit Nuhad Y , Abboud Sarah , Massouh Angela , Magilvy Joan K
Published: August 2015

Aims and objectives

The purpose of this study was to explore perceptions of cardiac self‐care among Lebanese family caregivers of cardiac patients. The specific aims were to describe the cultural context of cardiac care‐giving in Lebanon and to explore the roles of family caregivers in enhancing self‐care practices in patients with cardiac diseases.

Background

The role of family caregivers in Lebanon, a country in the Middle East, is assumed to extend beyond care‐giving to making decisions on behalf of the patient and assuming responsibility for patient care. To date, there has been no study done to empirically validate this impression.

Design

The design of the study is qualitative descriptive that used semi‐structured individual interviews with family caregivers of Lebanese cardiac patients.

Method

Thirteen family caregivers of cardiac patients were recruited from a referral medical centre in Lebanon. The participants were designated by their patients and interviewed in a place of their choice.

Results

One overarching and three themes emerged from data analysis describing roles of family care givers in cardiac self‐care. The overarching theme was: Family caregivers of Lebanese cardiac patients were unfamiliar with the term, concept and meaning of Self‐Care. The moral and emotional duty to care for the family member stemmed from obligation and responsibility towards patients (theme I). Interdependent care (theme II) between cardiac patients and their families emerged as a significant cultural role. Family members play multiple supportive roles in care‐giving namely emotional, informational and instrumental role (theme III).

Conclusion

In this study, family caregiver role is shown to be based in the sense of obligation and duty towards the sick family member who collectively provide different types of supportive care.

Relevance to clinical practice

Nurses have to give significant importance to the family caregiver role as an integral part of any culturally sensitive patient/family intervention.
Mode of delivery and birthweight among teenage and adult primigravida Saudi women: A retrospective comparative study
Authors: Mohamed Abdelrahim Awadelkarim Abdelrahman , Almalaq Abdulrahman Ahmed Abdullah , Almansour Raed Dawood Mohammed , Alanazi Haitham Samer Abdulaziz , Al‐Khamali Mohammad Mosa , Shommo Sohair Ali Mohammed
Published: August 2015

Aim

The aim of this study was to determine the mode of delivery and birthweight among teenagers in comparison to adult pregnant Saudi women.

Material and Methods

This was a retrospective comparative study. We included all primigravid teenage girls aged 19 years or younger and adult women aged 20–29 years with singleton term normal pregnancies who delivered at Hail Maternity Hospital during 1 January–31 December 2013.

Results

Incidence of vaginal delivery among teenagers was higher than that in adults, at 105 (80.2%) and 588 (70.5%), respectively. There was a lower incidence of vacuum extraction and cesarean section among the teenage group compared to the adult group (1 [0.8%] vs 25 [3.0%], and 25 [19.1%] vs 221 [26.5%], respectively [P > 0.05]). Incidence of low birthweight among the teenage group was higher than that in adults (28 [21.4%] and 84 [10.1%], respectively [P < 0.05]).

Conclusion

Our study concluded that teenage pregnancy is associated with a high risk of low birthweight (P < 0.05). Adult mothers experienced more cesarean section and vacuum extraction deliveries (P > 0.05). Adequate antenatal care, community education and raising awareness might decrease the number of teenage pregnancies, which was 13.6% in our study.
The effect of evidence type, identification accuracy, line‐up presentation, and line‐up administration on observers' perceptions of eyewitnesses
Authors: Beaudry Jennifer L. , Lindsay Roderick C. L. , Leach Amy‐May , Mansour Jamal K. , Bertrand Michelle I. , Kalmet Natalie
Published: August 2015

Purpose

People tend to believe eyewitness testimony and have difficulty assessing the accuracy of eyewitness identifications. This study examines observers' perceptions of eyewitness identifications made under various line‐up presentation and administration conditions. We also investigate whether observers' ability to discriminate between accurate and inaccurate identifications is enhanced by viewing video‐recorded identification decisions rather than eyewitness testimony.

Methods

Each participant (N = 432) viewed a video of an accurate or inaccurate eyewitness providing testimony and/or making an identification decision. Identifications were obtained from simultaneous or sequential line‐ups conducted under double‐blind, single‐blind, or post‐identification feedback administration conditions.

Results

Exposure to eyewitness testimony was associated with a bias to believe the evidence; exposure to the identification decision eliminated the response bias, however, it did not improve observer sensitivity to identification accuracy. Viewing the identification decision resulted in greater belief of accurate than inaccurate identifications when eyewitnesses chose from simultaneous – but not sequential – line‐ups. Regardless of evidence type or identification accuracy, observers were more likely to believe eyewitnesses who received confirmatory post‐identification feedback compared to the non‐feedback conditions.

Conclusions

Presenting a video record of the identification decision neither improved observers' ability to discriminate between accurate and inaccurate eyewitness identifications nor reduced belief of identifications obtained from suggestive procedures. Further research is warranted before presenting video‐recorded identification procedures in court.
Unusual strains of Microsporum audouinii causing tinea in Europe
Authors: Brasch J. , Müller S. , Gräser Y.
Published: August 2015

We comment on an unusual strain of Microsporum (M.) audouinii. It was isolated from tinea corporis of a boy who lived in Germany and most likely had acquired his infection during a stay on a farm with animal husbandry in Poland. The strain showed features of M. canis (plenty of markedly rough‐walled macroconidia, growth on rice, positive hair perforation) as well as of M. audouinii (white thallus, long macroconidia with central constriction) and in vitro it degraded hair of various mammals. Because its ribosomal internal transcribed spacer region showed 99.9% homology to a M. audouinii reference strain it was finally identified as M. audouinii. We relate these findings with recent observations of M. audouinii causing tinea in Europe. This appraisal suggests that irrespective of an identical ribosomal ITS region distinct M. audouinii strains can display a spectrum of morphological and physiological features that is broader than currently outlined in mycological textbooks. Certain unusual characteristics like an enhanced capacity to utilise keratins may even be associated with unexpected transmission routes. Above all sporadic M. audouinii infections in Europe that bear no relation to an endemic area should be analysed from this perspective.
The effect of temperature on the male and female recombination landscape of barley
Authors: Phillips Dylan , Jenkins Glyn , Macaulay Malcolm , Nibau Candida , Wnetrzak Joanna , Fallding Derek , Colas Isabelle , Oakey Helena , Waugh Robbie , Ramsay Luke
Published: August 2015

Barley (Hordeum vulgare) is a crop of global significance. However, a third of the genes of barley are largely inaccessible to conventional breeding programmes as crossovers are localised to the ends of the chromosomes. This work examines whether crossovers can be shifted to more proximal regions simply by elevating growth temperature.

We utilised a genome‐wide marker set for linkage analysis combined with cytological mapping of crossover events to examine the recombination landscape of plants grown at different temperatures.

We found that barley shows heterochiasmy, that is, differences between female and male recombination frequencies. In addition, we found that elevated temperature significantly changes patterns of recombination in male meiosis only, with a repositioning of Class I crossovers determined by cytological mapping of HvMLH3 foci. We show that the length of synaptonemal complexes in male meiocytes increases in response to temperature.

The results demonstrate that the distribution of crossover events are malleable and can be shifted to proximal regions by altering the growth temperature. The shift in recombination is the result of altering the distribution of Class I crossovers, but the higher recombination at elevated temperatures is potentially not the result of an increase in Class I events.
Growth characteristics underlying the lack of a chin in pigs: a histomorphometric study
Authors: Price J. , Tee B. C. , Vig K. , Shanker S. , Kennedy K. , Sun Z.
Published: August 2015

Structured Abstract

Objectives

Despite similar mandibular growth to that of humans, pigs lack a chin projection as shown in most humans. To understand whether this divergence is contributed to differences in local symphyseal growth, this project characterized bone modeling activities at the symphyseal surfaces of juvenile pigs.

Material and Methods

Symphyseal specimens from two age groups (4‐ and 6‐month‐old, n = 10) were processed into histological sections with and without decalcification, which were assessed for surface mineral apposition and bone resorption, respectively. In a blinded fashion, measurements of four parameters (MAR: mineral apposition rate, MAZ: mineral apposition zone, ES/BS: eroded surface and OC.N/BS: osteoclast number) were obtained and tested by a multivariate two‐way mixed‐model analyses of variance (manova) for the differences between symphyseal regions and ages.

Results

Qualitatively, pig symphyseal labial and lingual surfaces were horizontally oriented and characterized by mineral apposition and bone resorption, respectively. Quantitatively, labial mineral apposition tended to be greater rostrally than caudally at 4 months, which became greater caudally than rostrally at 6 months (region/age interactions: p = 0.127 for MAR, p = 0.012 for MAZ). Lingual bone resorption tended to be greater caudally than rostrally, but only ES/BS measurements were significant (p = 0.039) regardless of age, while OC.N/BS measurements varied with ages and regions (age/region interaction, p = 0.087).

Conclusions

Insufficient differential in symphyseal surface modeling between the labial–caudal and labial–rostral regions contributes to the lack of chin projection in the pig.
T‐ and B‐cell subsets in periodontitis
Authors: Gonzales José R.
Published: August 2015

A large amount of information is available, in the medical literature, on the molecular and immunological mechanisms in which T‐ and B‐cells are involved in the pathogenesis of inflammatory diseases. This review attempts to describe the most important features of the T‐cell subsets and their cytokine networks in periodontitis, including the interaction of pathogens with different cell subsets and their gene‐expression profiles. Additionally, the known interactions of T‐ and B‐cell subsets in periodontitis are described. The purpose of this article was to provide an overview of the cell interactions and cytokine networks specifically involved in the pathogenesis of periodontitis, and models and paradigms from recent research in this area are presented. However, the review of the literature also revealed that relatively little is known about the genetic or structural factors that confer cross‐reactivity of natural and/or autoreactive antibodies in the immunopathogenesis of periodontitis. Pathogens, in turn, are continuously evolving and creating mechanisms to evade immunological reactions controlled and modulated by T‐ and B‐cells.
Dendritic cells: microbial clearance via autophagy and potential immunobiological consequences for periodontal disease
Authors: El‐Awady Ahmed R. , Arce Roger M. , Cutler Christopher W.
Published: August 2015

Dendritic cells are potent antigen‐capture and antigen‐presenting cells that play a key role in the initiation and regulation of the adaptive immune response. This process of immune homeostasis, as maintained by dendritic cells, is susceptible to dysregulation by certain pathogens during chronic infections. Such dysregulation may lead to disease perpetuation with potentially severe systemic consequences. Here we discuss in detail how intracellular pathogens exploit dendritic cells and escape degradation by altering or evading autophagy. This novel mechanism explains, in part, the chronic, persistent nature observed in several immuno‐inflammatory diseases, including periodontal disease. We also propose a hypothetical model of the plausible role of autophagy in the context of periodontal disease. Promotion of autophagy may open new therapeutic strategies in the search of a ‘cure’ for periodontal disease in humans.
Foreign service special care opportunity in SCDA
Authors: Hicks Jeff , Schaffer Rebecca , Frances Denise , Usher Sarah , Barnes Jeff , Sabbah Ahmed
Published: August 2015

A foreign service clinic in Guatemala caring for patients with special needs was initiated by joining SCDA efforts with the Open Wide Foundation. The trip included five SCDA members: two AEGD residents and three support staff. Open Wide participants included the Executive Director, the Clinical Director in Guatemala, as well as two dentists, dental support staff, and Guatemalan dental students. Two physician anesthesiologists provided general anesthesia. Care adjuncts included general anesthesia, oral sedation, and medical stabilization. Lessons learned: (1) Conducting a dental clinic for patients with special needs is possible and relatively easy to accomplish, given a partnership with a foundation that agrees with and facilitates this service; (2) advance planning is required to maximize the service provided; (3) committed and flexible team members can accomplish a significant amount of care in a short period of time; and (4) limited but invaluable training of in‐country healthcare providers is possible.

The Special Care Dentistry Association is long known for service and care delivery to patients with special needs by its members, and for its advocacy and organizational support for these activities. A foreign service opportunity in Guatemala, Central America, was sought out by members of the SCDA to further the outreach efforts of the organization, give members clinical experience in a foreign setting, and train in‐country providers to deliver care to patients with special needs. This was the first effort by SCDA members to host a clinic to deliver care specifically to patients with special needs outside of North America.