bluuebunny/crossref_metadata_2025 huggingface dataset:
Does long‐term care insurance reduce the burden of medical costs? A retrospective elderly cohort study
Authors: Choi Jae Woo , Park Eun‐Cheol , Lee Sang Gyu , Park Sohee , Ryu Hwang‐Gun , Kim Tae Hyun
Published: October 2018

Aim

To examine whether long‐term care insurance (LTCI) reduces medical utilization and the burden of medical costs of beneficiaries.

Methods

The elderly cohort database of the National Health Insurance Service during 2005–2013 was used. The participants were 3029 beneficiaries who received consecutive LTCI services. We carried out a 1:3 case–control match on the propensity score to select a comparison group, and the final participants were 12 116 people, including 9087 who formed the control group. The dependent variables were semi‐annually measured medical utilizations (inpatient, outpatient and drug prescription) and the burden of medical costs at the individual level. This study applied the method of generalized estimating equations to the data.

Results

The present study showed that the number of hospitalizations of beneficiaries significantly decreased compared with non‐beneficiaries (ratio 0.95, 95% CI 0.95–0.96). Similarly, the length of stay of beneficiaries also showed a significant reduction compared with non‐beneficiaries (ratio 0.76, 95% CI 0.73–0.79). The number of outpatient visits and receipt of drug prescriptions of beneficiaries and non‐beneficiaries increased marginally. The burden of medical costs of beneficiaries reduced considerably compared with non‐beneficiaries (ratio 0.80, 95% CI 0.77–0.83).

Conclusions

The study results show that the burden of medical costs for LTCI beneficiaries were significantly reduced compared with non‐beneficiaries, despite the rise in medical costs among older adults. The positive effect of LTCI supports continuous implementation and expansion of the LTCI service for non‐beneficiaries who require care assistance. Geriatr Gerontol Int 2018; 18: 1641–1646.
Prevalence and predictors of inappropriate prescribing according to the Screening Tool of Older People's Prescriptions and Screening Tool to Alert to Right Treatment version 2 criteria in older patients discharged from geriatric and internal medicine wards: A prospective observational multicenter study
Authors: Bo Mario , Gibello Maddalena , Brunetti Enrico , Boietti Edoardo , Sappa Matteo , Falcone Yolanda , Aurucci Maria Luigia , Iacovino Marina , Fonte Gianfranco , Cappa Giorgetta
Published: October 2018

Aim

To evaluate the prevalence and predictors of potentially inappropriate medications (PIM) and potential prescribing omissions (PPO) in hospital‐discharged older patients, according to the recently updated Screening Tool of Older People's Prescriptions and Screening Tool to Alert to Right Treatment version 2 criteria.

Methods

This was a multicenter prospective observational study of patients aged ≥65 years consecutively discharged from geriatric and internal medicine wards. Each patient underwent a comprehensive geriatric assessment, and PIM and PPO at discharge were determined according to the Screening Tool of Older People's Prescriptions and Screening Tool to Alert to Right Treatment version 2 criteria. A multivariate logistic regression was carried out to identify variables independently associated with PIM and PPO.

Results

Among 726 participants (mean age 81.5 years, 47.8% women), the prevalence of PIM and PPO were 54.4% and 44.5%, respectively. Benzodiazepines and proton‐pump inhibitors were the drugs most frequently involved with PIM, whereas PPO were often related to 5‐alpha reductase inhibitors, angiotensin‐converting enzyme inhibitors, statins and drugs for osteoporosis. The number of medications (OR 1.22, 95% CI 1.15–1.28) and discharge from geriatric units (OR 0.55, 95% CI 0.40–0.75) were associated with PIM, whereas PPO were independently associated with discharge from geriatric wards (OR 0.44, 95% CI 0.31–0.62), age (OR 1.04, 95% CI 1.02–1.07), comorbidities (OR 1.17, 95% CI 1.04–1.30) and the number of drugs (OR 1.12, 95% CI 1.05–1.18).

Conclusions

Inappropriate prescribing is highly prevalent among hospital‐discharged older patients, and is associated with polypharmacy and discharge from internal medicine departments. Geriatr Gerontol Int 2019; 19: 5–11.
Prevalence and risk factors of delirium and subsyndromal delirium in Chinese older adults
Authors: Yam Ka‐Keung , Shea Yat‐Fung , Chan Tuen‐Ching , Chiu Ka‐Chun , Luk James Ka‐Hei , Chu Leung‐Wing , Chan Felix Hon‐Wai
Published: October 2018

Aim

To study the prevalence and risk factors of delirium and subsyndromal delirium (SSD) in Chinese older adults with acute medical illnesses.

Methods

A prospective cohort study was carried out in acute general medical wards in a university‐affiliated hospital in Hong Kong. Patients were assessed by the confusion assessment method by geriatricians within 6 h after admission and classified into three mutually exclusive groups, namely delirium, SSD and those without both conditions. Predisposing factors and precipitating factors of delirium and SSD were retrieved from collateral information, clinical charts and electronic clinical records.

Results

A total of 575 patients with mean age of 80.8 years were recruited. A total of 73% of the patients did not have delirium, 15.8% of patients had delirium and 11.3% of patients had SSD. On multivariate analysis, patients with delirium or SSD were more likely to be current users of psychotropic medications, had hearing and visual impairment, had a major neurocognitive disorder as defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, and with a lower Barthel Index 20 points version than those without both conditions. Significant predisposing and precipitating factors of delirium included psychotropic medications, acute stroke and other causes of organic brain syndromes. Predisposing and precipitating factors of delirium and SSD were almost identical.

Conclusions

Delirium and SSD are common among Chinese older adults with acute medical illnesses, with a combined prevalence of delirium and SSD of 27%. Important precipitating and predisposing factors include psychotropic medications, acute ischemic stroke and other causes of organic brain syndromes. Geriatr Gerontol Int 2018; 18: 1625–1628.
Developments in Survey Research over the Past 60 Years: A Personal Perspective
Authors: Kalton Graham
Published: October 2018

Many developments have occurred in the practice of survey sampling and survey methodology in the past 60 years or so. These developments have been partly driven by the emergence of computers and the continuous growth in computer power over the years and partly by the increasingly sophisticated demands from the users of survey data. The paper reviews these developments with a main emphasis on survey sampling issues for the design and analysis of social surveys. Design‐based inference based on probability samples was the predominant approach in the early years, but over time, that predominance has been eroded by the need to employ model‐dependent methods to deal with missing data and to satisfy analysts' demands for survey estimates that cannot be met with design‐based methods. With the continuous decline in response rates that has occurred in recent years, much current research has focused on the use of non‐probability samples and data collected from administrative records and web surveys.
Process assessment in dynamic testing using electronic tangibles
Authors: Veerbeek Jochanan , Vogelaar Bart , Verhaegh Janneke , Resing Wilma C.M.
Published: October 2018

Task solving processes and changes in these processes have long been expected to provide valuable information about children's performance in school. This article used electronic tangibles (concrete materials that can be physically manipulated) and a dynamic testing format (pretest, training, and posttest) to investigate children's task solving processes and changes in these processes as a result of training. We also evaluated the value of process information for the prediction of school results. Participants were N = 253 children with a mean age of 7.8 years. Half of them received a graduated prompts training; the other half received repeated practice only. Three process measures were used: grouping behaviour, verbalized strategies, and completion time. Different measures showed different effects of training, with verbalized strategies showing the largest difference on the posttest between trained and untrained children. Although process measures were related to performance on our dynamic task and to math and reading performance in school, the amount of help provided during training provided the most predictive value to school results. We concluded that children's task solving processes provide valuable information, but the interpretation requires more research.
Weak and inconsistent associations between melanic darkness and fitness‐related traits in an insect
Authors: Sandre Siiri‐Lii , Kaart Tanel , Morehouse Nathan , Tammaru Toomas
Published: October 2018

The idea that the fitness value of body coloration may be affected by biochemically mediated trade‐offs has received much research attention. For example, melanization is believed to interact with other fitness‐related traits via competition for substrates, costs associated with the synthesis of melanin or pleiotropic effects of the involved genes. However, genetic correlations between coloration and fitness‐related traits remain poorly understood. Here, we present a quantitative‐genetic study of a coloration trait correlated to melanin‐based cuticular darkness (‘darkness’, hereafter) in a geometrid moth, Ematurga atomaria. This species has considerable variation in larval appearance. We focus on correlations between larval darkness and fitness‐related growth performance traits. Both a half‐sib analysis and an ‘animal model’ approach revealed moderately high heritabilities of larval darkness and indices of growth performance. Heritability estimates of darkness derived from the animal model were, however, considerably higher than those based on the half‐sib model suggesting that the determination of coloration includes genetic interactions and epigenetic effects. Importantly, on the host plant with the largest sample size, we found no evidence for either genetic or environmental correlations between darkness and growth parameters. On an alternative host plant, there was some indication of positive genetic and negative environmental correlation between these traits. This shows that respective relationships are environment‐specific. Nevertheless, the overall pattern of weak and inconsistent correlations between larval coloration and growth parameters does not support universal trade‐offs between these traits and suggests that physiological costs of producing colour patterns do not necessarily interfere with adaptive evolution of coloration.
Ear, nose, and throat surgical access for remote living Indigenous children: What is the least costly model?
Authors: Jacups Susan P. , Kinchin Irina , McConnon Kate M.
Published: October 2018

Rationale, aims, and objectives

This costing evaluation compares three service delivery models for ear, nose, and throat (ENT) surgery for remote living Indigenous children to improve their hearing outcomes, with the aim to identify the least costly model.

Methods

The main outcome measure presented was the incremental cost difference between the base case (Model 1) and two alternative models (Model 2, 3). The costs in 2017 Australian dollars are assessed from two viewpoints: (1) health system perspective, and (2) patients and their families including travel out‐of‐pocket expenses, presented separately according to the funding source.

Results

Findings indicate that the least costly model offered low‐risk ENT surgery from a state funded hospital in a remote setting, with high use of videoconference technology: TeleHealth (Model 3) could save $3626 to $5067 per patient, compared with patients travelling to a regional centre public hospital (Model 1). A federally funded scheme which allowed groups of patients to access a direct flight charter transfer to the private hospital in regional centre (Model 2) reduced the cost by $2178 to $2711 per patient when compared with standard care (Model 1). From a societal perspective, Model 1 required out‐of‐pocket patient expenses, with greater time away from home, and hence appears the least preferred option.

Conclusions

The sensitivity analyses also demonstrate that Model 3 would be the more economical model for providing ENT surgery for remote living children. By proving an accurate assessment of the true costs of delivering these important ear and hearing health services, strategic health service planners may be better informed and sufficient budgets can be allocated to provide improved service delivery. The benefits of Model 3, over Models 1 or 2, would also incorporate improvements to patient safety as a result of reducing patient travel, which should in‐turn, reduce failure‐to‐attend rates.
Methodology for the analysis and comparison of protocols for glycaemic control in intensive care
Authors: Fernández‐Méndez Rocío , Rodríguez‐Villar Sancho , Méndez Pablo F. , Windle Richard , Adams Gary George
Published: October 2018

Rationale, aims, and objectives

The practice of glycaemic control of critically ill patients admitted to intensive care units (ICUs) is guided by clinical management protocols, designed locally by the ICUs. These protocols differ significantly in their aims and methods. The aim of this study was to develop a standardized methodology for the systematic and objective analysis and comparison of protocols for glycaemic control implemented in any ICU.

Method

The protocols for glycaemic control implemented in seven ICUs of a UK‐based ICU network were analysed using techniques of inductive content analysis, through an open coding process and the framework method. This involved the identification and classification of protocol instructions for glycaemic control, as well as of the processes and decisions pertaining to each of these instructions. These were used to develop a framework for the structured and systematic description and comparison of the protocols' contents, and to develop a technique for the protocols' graphic visualization.

Results

The following elements were identified or developed: (1) 35 quantifiable variables and 11 non‐quantifiable subjects that could be present in an ICU protocol for glycaemic control, to be used as a framework for the description and comparison of contents; (2) a technique for condensing a protocol into a single, comprehensive flowchart; (3) using these flowcharts, a method for assessing the complexity and comprehensiveness of the protocols.

Conclusions

The methodology developed in this study will allow for any future work analysing the contents of glycaemic control protocols to be carried out in a structured and standardized way. This may be done either as a standalone study, or as the essential first step in any investigation on the impact of new protocols. In turn, the methodology will facilitate the performance of regional, national, and international comparisons, demonstrating the usefulness of this study at a global scale.
Pathogenicity of Pasteurella sp. in lumpsuckers (Cyclopterus lumpus L.)
Authors: Ellul Rebecca Marie , Walde Cecilie , Haugland Gyri Teien , Wergeland Heidrun , Rønneseth Anita
Published: October 2018

The incidence of disease caused by Pasteurella sp. in farmed lumpsuckers in Norway has been steadily increasing in recent years, causing significant economic losses and fish welfare issues. The disease affects all life stages, both in hatcheries and after release into salmon cages. Therefore, it is important to establish robust challenge models, to be used for vaccine development. Exposure experiments via intramuscular and intraperitoneal injection underlined the high virulence of the bacteria, whereas the cohabitation and bath models allowed the chronic symptoms of the disease to be studied more accurately. Skin lesions and haemorrhage at the base of fins were observed in the more acute cases of the disease. Symptoms including white spots over the skin, especially around the eyes, characterized the chronic cases. The latter were most prominent from the bath challenge model. Histopathology indicated a systemic pattern of disease, whereas qPCR analysis from head kidney showed that bacteria may be present in survivor fish at the end of the challenges. In all the challenge models investigated, Pasteurella sp. was re‐isolated from the fish, thus fulfilling Koch's postulates. These findings highlight the importance of screening of lumpsuckers prior to transfer to minimize the risks of carrying over asymptomatic carriers.
Street food research worldwide: a scoping review
Authors: Abrahale K. , Sousa S. , Albuquerque G. , Padrão P. , Lunet N.
Published: October 2018

Background

Street foods vary with respect to their nutritional value and safety characteristics and contribute to a sizable proportion of food intake in many populations worldwide. Therefore, the present study aimed to describe the coverage in the scientific literature of different health‐related and socio‐economic aspects of street food consumption and trading.

Methods

Three electronic databases (searched from inception to 16 October 2017), a hand‐search of relevant journals and backward citation tracking were used to identify eligible scientific articles with a main objective of investigating or reporting specific results on health‐related or socio‐economic aspects of street food. Papers published in English, Portuguese, French, Spanish or Italian, as well as English abstracts of papers published in other languages, were assessed. The selected articles were evaluated by two independent researchers and described according to year of publication, geographical distribution, definition of street food, main topics addressed and target population.

Results

In total, 441 papers were selected. The number of publications has increased in recent years, almost half of them being published after 2012. Almost three‐quarter of the articles were from Africa or Asia. Most studies addressed food safety (85.5%), whereas street food availability and consumption were much less frequently investigated (30.3%). The focus of the studies was usually the food (mostly its microbiological contamination) and the vendors (mostly their food handling), whereas consumers and vending sites were seldom evaluated. More than half of the studies did not specify a definition for street food.

Conclusions

Efforts are needed for a more widespread and comprehensive assessment of different issues related to street food availability and consumption in different settings, especially regarding street food offer, nutritional composition, and patterns of purchase and consumption by the population.
REE partitioning between monazite and garnet: Implications for petrochronology
Authors: Hacker Bradley , Kylander‐Clark Andrew , Holder Robert
Published: October 2018

Rare‐earth element and Y partitioning between garnet and monazite was measured in metamorphic rocks from western Norway to provide more confidence in tying monazite U/Th–Pb dates to P–T conditions recorded in garnet. A subset of samples has low‐Y garnet mantles and low‐Y monazite cores that gave Y‐partitioning temperatures similar to independently determined metamorphic temperatures. In combination with previously published data, these monazite–garnet pairs have temperature‐dependent partitioning of the HREE from Dy to Lu, and nonsystematic partitioning of the LREE from La–Gd. The temperature‐dependent partitioning must be considered when using HREE to assess which portions of garnet and monazite might have coexisted, but experiments are needed to place the dependence on a firm footing.
High‐fat diet and type 2 diabetes induced disruption of the oestrous cycle and alteration of hormonal profiles, but did not affect subpopulations of KNDy neurones in female rats
Authors: Ziarniak Kamil , Kołodziejski Paweł A. , Pruszyńska‐Oszmałek Ewa , Kallό Imre , Śliwowska Joanna H.
Published: October 2018

Apart from the primary metabolic symptoms of obesity and/or diabetes, there are numerous secondary problems, including disruptions of the reproductive system. The KNDy neurones, which express kisspeptin, neurokinin B and dynorphin A and are located in the arcuate nucleus of the hypothalamus (ARC), are important regulators of reproduction. Their functions are highly influenced by metabolic and hormonal status. We have previously shown that, in male rats with experimentally‐induced diabetes type 2 (but not with high‐fat diet‐induced obesity), there are alterations in the number of these cells. In the present study, we hypothesised that a high‐fat diet (HFD) and/or diabetes type 2 (DM2) in female rats affect the oestrous cycle, hormonal profiles and the number of kisspeptin‐immunoreactive, neurokinin B‐immunoreactive and/or dynorphin A‐immunoreactive neurones in the ARC. Rats were assigned to one of three groups: a control group fed a regular chow diet, a high‐fat diet group (HFD) and a diabetic group (DM2), with both of the latter two groups receiving a high calorie diet (50% of energy from lard). The third group was additionally treated with streptozotocin to induce DM2. Their oestrous cycles was monitored and their metabolic and hormonal status were assessed. We found that HFD and DM2 female rats, despite having significant alterations in their metabolic and hormonal profiles, as well as disruptions of the oestrous cycle, showed no changes in the number of the kisspeptin‐immunoreactive, neurokinin B‐immunoreactive and/or dynorphin A‐immunoreactive neurones in the ARC. However, slight differences in the rostrocaudal distribution of these neurones among groups were reported. In conclusion, the data from the present study, together with our previously published results in males, indicate sex differences in the response of KNDy neurones to DM2 but not to HFD conditions.
Differential effects of chronic 17β‐oestradiol treatment on rat behaviours relevant to depression
Authors: Gogos Andrea , McCarthy Madeleine , Walker Adam J. , Udawela Madhara , Gibbons Andrew , Dean Brian , Kusljic Snezana
Published: October 2018

Sex differences are a prominent feature of the pathophysiology of psychiatric disorders, such as major depressive disorder, which affects women at a higher incidence than men. Research suggests that the most potent endogenous oestrogen, 17β‐oestradiol, may have therapeutic potential in treating depression. However, preclinical studies have produced mixed results, likely as a result of various methodological factors such as treatment duration. The present study aimed to investigate the effects of ovariectomy and chronic 17β‐oestradiol treatment via a s.c. silastic implant on behaviours relevant to depression in adult female Sprague‐Dawley rats. Rats were assessed in the forced swim test, saccharin preference test and novel object recognition memory test, as well as for possible confounding behaviours, including locomotion and anxiety (open field test) and motivation and anxiety (novelty suppressed feeding test). Treatment effects were verified using body and uterus weight, as well as serum concentrations of 17β‐oestradiol, progesterone and testosterone. Compared to ovariectomised rats, chronic 17β‐oestradiol treatment enhanced saccharin preference and novel object recognition performance. There were no group differences in passive or active coping behaviour when assayed using the forced swim test. Taken together, these results support an antidepressant‐like action of oestrogens but highlight that the beneficial effects of chronic 17β‐oestradiol treatment may be related to specific depression‐related symptoms, particularly anhedonia and memory.
The association between a mixing ability test and patient reported chewing ability in patients treated for oral malignancies
Authors: de Groot Reilly J. , Rosenberg Antoine J. W. P. , van der Bilt Andries , Aalto Daniel , Merkx Matthias A. W. , Speksnijder Caroline M.
Published: October 2018

Introduction

Mastication has been assessed in several ways in the past. Both patients reported and objective assessment methods have been developed. The University Medical Center (UMC) Utrecht has developed a mixing ability test (MAT) using a two‐coloured wax tablet. The present study investigates the association between the mixing ability test and a chewing related questionnaire in patients treated for oral malignancies.

Patients and methods

In a cohort study, patients treated for oral malignancies were assessed 4‐6 weeks before and 4‐6 weeks after treatment, as well as 6 months, 1 year and 5 years after treatment. The mixing ability test was assessed using 10 and 20 chewing strokes and was compared to seven questions about several aspects of mastication. Regression analysis was performed and density plots were drawn for statistical analysis.

Results

One hundred and twenty‐three patients were included in this study. The questionnaire was less predictive for the 10‐chewing stroke test and the test was less discriminatory for different food types than the 20‐chewing stroke mixing ability test. Three questions about the ability to chew solid, soft and thickened liquid food types were found to be significantly predictive for the 20‐chewing stroke test. Threshold values on the mixing ability index were around 20 for the ability to chew solid food types and 24 for soft food types.

Conclusion

The 10‐chewing stroke mixing ability test is less suitable than 20‐chewing strokes for patients with and treated for oral cancer. The 20‐chewing stroke mixing ability test has a fair association with self‐reported outcomes.
Preparation Techniques Used to Make Single‐Unit Crowns: Findings from The National Dental Practice‐Based Research Network
Authors: Minyé Helena M. , Gilbert Gregg H. , Litaker Mark S. , Mungia Rahma , Meyerowitz Cyril , Louis David R. , Slootsky Alan , Gordan Valeria V. , McCracken Michael S. ,   National Dental PBRN Collaborative Group
Published: October 2018

Purpose

To: (1) determine which preparation techniques clinicians use in routine clinical practice for single‐unit crown restorations; (2) test whether certain practice, dentist, and patient characteristics are significantly associated with these techniques.

Materials and Methods

Dentists in the National Dental Practice‐Based Research Network participated in a questionnaire regarding preparation techniques, dental equipment used for single‐unit crown preparations, scheduled chair time, occlusal clearance determination, location of finish lines, magnification during preparation, supplemental lighting, shade selection, use of intraoral photographs, and trimming dies. Survey responses were compared by dentist and practice characteristics using ANOVA.

Results

Of the 2132 eligible dentists, 1777 (83%) responded to the survey. The top two margin configuration choices for single‐unit crown preparation for posterior crowns were chamfer/heavy chamfer (65%) and shoulder (23%). For anterior crowns, the most prevalent choices were the chamfer (54%) and the shoulder (37%) configurations. Regarding shade selection, a combination of dentist, assistant, and patient input was used to select anterior shades 59% of the time. Photographs are used to communicate shade selection with the laboratory in about half of esthetically demanding cases. The ideal finish line was located at the crest of gingival tissue for 49% of respondents; 29% preferred 1 mm below the crest; and 22% preferred the finish line above the crest of tissue. Average chair time scheduled for a crown preparation appointment was 76 ± 21 minutes. Practice and dentist characteristics were significantly associated with margin choice including practice type (p < 0.001), region (p < 0.001), and years since graduation (p < 0.001).

Conclusions

Network dentists prefer chamfer/heavy chamfer margin designs, followed by shoulder preparations. These choices were related to practice and dentist characteristics.
Closure of the anterior and posterior fontanelle in the New Zealand population: A computed tomography study
Authors: Kirkpatrick Joshua , Bowie Sarah , Mirjalili Seyed A
Published: October 2018

Aim

Significant ethnic variation has been demonstrated in the closure of the anterior fontanelle (AF); however, to date, this has not been investigated in the Māori/Pasifika population.

Methods

The computed tomography scans of 163 individuals (116 Māori/Pasifika and 47 New Zealand (NZ) European) aged between birth and 4 years were retrospectively analysed to investigate the surface area (SA) and time of closure of the anterior and posterior fontanelles in New Zealand.

Results

The Māori/Pasifika group showed clinical AF closure (SA < 114 mm2) rates of 25% at 4–6 months, increasing to 47% at 10–12 months and 80% at 13–18 months. The posterior fontanelle was clinically unfused in 17% of the Māori/Pasifika group aged <1 month and in 7% of the 1–3‐month‐old group. No cases of posterior fontanelle non‐fusion were identified in the NZ European population.

Conclusion

This study establishes normal values for AF size and closure frequency for the first time in the paediatric Māori/Pasifika population.
Pass the parcel: Service provider views on bridging gaps for youth with dual diagnosis of intellectual disability and mental health disorders in regional areas
Authors: Son Jane , Debono Deborah , Leitner Robert , Lenroot Rhoshel , Johnson Julie
Published: October 2018

Aim

Youth with both intellectual disability (ID) and mental health (MH) disorders (dual diagnosis) have complex physical and MH needs that can make providing integrated care for this complex group challenging. We conducted a mixed methods needs assessment to identify gaps and challenges in care delivery, identify bridges for these and identify what works well in existing services.

Methods

Our research team recruited service providers (n = 126) caring for youth aged 14–24 years with a dual diagnosis in the Illawarra Shoalhaven region of New South Wales, Australia, to participate in focus group interviews. Data were transcribed and analysed thematically.

Results

We identified six themes related to caring for youth with dual diagnosis in regional areas: access to services and information about services, communication between service providers and with clients and carers, the divide between MH and ID, early intervention and health promotion, capacity building of service providers and capacity building of clients and carers. Across these themes, service providers highlighted the transition from child to adult services as a particularly challenging time for clients, families and carers.

Conclusions

Our data suggest several approaches to break down silos and to facilitate collaboration between current services for youth with a dual diagnosis, including increasing specialised ID/MH services and building the capacity of current disability and MH service providers. Our results provide important information to provide quality and integrated care for youth with complex health needs.
An informational role of supermajority rules in monitoring the majority party's activities
Authors: Kishishita Daiki
Published: October 2018

There often exists a supermajority rule that enables the minority party to delay or prevent a vote on a bill. I construct a two‐period model consisting of a representative voter, self‐interested parties, and a media outlet. In the model, the majority party has an incentive to misrepresent the voter's optimal policy. I show that the minority party's attempt to block a vote (e.g., a filibuster) can signal this misrepresentation. Interestingly, the key is that the minority party and the mass media are complementary in creating the signal. Overall, the results suggest that supermajority rules could be beneficial even for the majority of voters.
The Role of Market and Technical Information Generation in New Product Development
Authors: Cui Anna Shaojie , Xiao Yazhen
Published: October 2018

Firms are investing an increasing amount of time and resources to gather information about market and technology in new product development (NPD). Yet there is a lack of consistent understanding of whether such costly information generation activities can improve product outcomes. More importantly, it is unclear how the benefit of market information and technical information generation may differ and how they may jointly impact new product performance. This study examines the role of market and technical information generation in NPD in three ways: (1) It contrasts the effects of market and technical information generation on product outcomes; (2) it identifies conditions that moderate the effects of market and technical information generation and further investigates how the moderating effects differ for these two types of activities; and (3) it examines the joint effect of market and technical information generation to understand potential synergies between them. Using survey data at the NPD project level, we find that market information generation has an inverted U‐shaped effect on new product advantage, whereas the effect of technical information generation follows a U‐shape. Furthermore, these effects are moderated differently by two conditions: a firm’s R&D intensity that influences NPD projects’ need for different types of information, and the use of multidisciplinary teams that affects the degree to which information can be shared and utilized to improve product design. The findings provide important implications for organizational learning and shed light on how to manage information generation activities to achieve NPD success.
NREM sleep EEG slow waves in autistic and typically developing children: Morphological characteristics and scalp distribution
Authors: Lehoux Thomas , Carrier Julie , Godbout Roger
Published: October 2018

Autism is a developmental disorder with a neurobiological aetiology. Studies of the autistic brain identified atypical developmental trajectories that may lead to an impaired capacity to modulate electroencephalogram activity during sleep. We assessed the topography and characteristics of non‐rapid eye movement sleep electroencephalogram slow waves in 26 boys aged between 6 and 13 years old: 13 with an autism spectrum disorder and 13 typically developing. None of the participants was medicated, intellectually disabled, reported poor sleep, or suffered from medical co‐morbidities. Results are derived from a second consecutive night of polysomnography in a sleep laboratory. Slow waves (0.3–4.0 Hz; >75 µV) were automatically detected on artefact‐free sections of non‐rapid eye movement sleep along the anteroposterior axis in frontal, central, parietal and occipital derivations. Slow wave density (number per minute), amplitude (µV), slope (µV s−1) and duration (s) were computed for the first four non‐rapid eye movement periods. Slow wave characteristics comparisons between groups, derivations and non‐rapid eye movement periods were assessed with three‐way mixed ANOVAs. Slow wave density, amplitude, slope and duration were higher in anterior compared with most posterior derivations in both groups. Children with autism spectrum disorder showed lower differences in slow waves between recording sites along the anteroposterior axis than typically developing children. These group differences in the topography of slow wave characteristics were stable across the night. We propose that slow waves during non‐rapid eye movement sleep could be an electrophysiological marker of the deviant cortical maturation in autism linked to an atypical functioning of thalamo‐cortical networks.
The roles of competition and climate in tree growth variation in northern boreal old‐growth forests
Authors: Aakala Tuomas , Berninger Frank , Starr Mike
Published: October 2018

Questions

How have tree growth and growth trends varied in structurally complex old‐growth forests? What determines this variation and how this differs among species?

Location

Natural boreal old‐growth forests, northern Finland.

Methods

We sampled trees over 10‐cm diameter on 48 randomly located 0.1‐ha plots in three landscapes and compiled a data set of 1,565 trees including all three main species, and a full range of sizes and competitive states in northern boreal old‐growth forests. We extracted tree ring samples from every tree and used ring widths to reconstruct tree sizes and their neighbourhood for the past 50 years for Pinus sylvestris and Picea abies, and 30 years for Betula pubescens. We used mixed‐effects models to study variation in tree growth. In the models, we used annually varying environmental variables, forest and tree structural variables and site variables as predictors. We also measured soil hydraulic properties for a water balance model to specifically include soil moisture deficits as predictors.

Results

Tree growth rates had increased during the analysis period for all three species, with the highest increases for P. sylvestris and B. pubescens. All three species grew well during warm summers, but P. sylvestris and P. abies growth was also negatively influenced by soil moisture deficits. Competition in these sparse forests had a small influence on growth. However, its influence increased over time.

Conclusions

The trees showed positive growth trends, but the increasing competition means that such strong positive trends are unlikely to continue over the long term. For year‐to‐year variability, negative influence of droughts implied that increasing temperatures are not only beneficial to tree growth even in these high‐latitude forests. Overall, the findings demonstrate the site‐ and species‐dependent complexity in tree responses to environmental and structural changes we may expect in the future.
Evaluating treatment outcomes for young people participating in a high‐intensity therapeutic violence intervention in the English Youth Custody Service
Authors: Derbyshire Jonathan M. , Tarrant Emily , Fitter Ruby , Gibson Rachel A.
Published: October 2018

Purpose

A specialized unit for long‐term sentenced male young people sought to provide additional support to those convicted of the gravest violent offences, who had the highest risk of further offending. One key element was the introduction of a violence reduction intervention, Life Minus Violence‐Enhanced (LMV‐E). The present study evaluated LMV‐E.

Methods

Participants (N = 21, starting age = 16–17 years) were convicted of a violent offence and had a history of custodial and or community violence. Pre‐ and post‐intervention comparisons were of risk for future violence as measured by the Structured Assessment of Violence Risk in Youth (SAVRY; Borum et al., , Structured Assessment of Violence Risk in Youth (SAVRY). Psychological Assessment Resources Inc.) and treatment‐related change on self‐report questionnaires. Sanctions for further aggression in custody or following release were recorded at 12 and 24 months post‐intervention.

Results

SAVRY identified statistically significant reductions in individual–clinical and social–contextual scales, with large effect sizes. Statistically significant changes, with moderate effect sizes, were noted in self‐report questionnaires. Reductions were in rumination, physical and verbal aggression, and anger. Improvements were in emotional awareness, emotion regulation, and impulsivity. Follow‐up showed favourable rates of aggression within the community and custody.

Conclusions

Risk reduction findings are important, pointing towards a generalized reduction in aggression risk following this intervention. Significantly, participants also demonstrated improvement in empathy, a direct treatment target. Treatment‐related change was multidomain, across several areas addressed by the intervention. This study therefore found good evidence for the utility of LMV‐E in addressing risk of aggression for young people.
Potential mechanisms linking gut microbiota and portal hypertension
Authors: Baffy Gyorgy
Published: October 2018

Gut microbiota is the largest collection of commensal micro‐organisms in the human body, engaged in reciprocal cellular and molecular interactions with the liver. This mutually beneficial relationship may break down and result in dysbiosis, associated with disease phenotypes. Altered composition and function of gut microbiota has been implicated in the pathobiology of nonalcoholic fatty liver disease (NAFLD), a prevalent condition linked to obesity, insulin resistance and endothelial dysfunction. NAFLD may progress to cirrhosis and portal hypertension, which is the result of increased intrahepatic vascular resistance and altered splanchnic circulation. Gut microbiota may contribute to rising portal pressure from the earliest stages of NAFLD, although the significance of these changes remains unclear. NAFLD has been linked to lower microbial diversity and weakened intestinal barrier, exposing the host to bacterial components and stimulating pathways of immune defence and inflammation. Moreover, disrupted host‐microbial metabolic interplay alters bile acid signalling and the release of vasoregulatory gasotransmitters. These perturbations become prominent in cirrhosis, increasing the risk of clinically significant portal hypertension and leading to bacterial translocation, sepsis and acute‐on‐chronic liver failure. Better understanding of the gut‐liver axis and identification of novel microbial molecular targets may yield specific strategies in the prevention and management of portal hypertension.
The impact of HCV eradication by direct‐acting antivirals on the transition of precancerous hepatic nodules to HCC: A prospective observational study
Authors: Toyoda Hidenori , Kumada Takashi , Tada Toshifumi , Mizuno Kazuyuki , Sone Yasuhiro , Akita Tomoyuki , Tanaka Junko , Johnson Philip J.
Published: October 2018

Background & Aims

It remains controversial whether the eradication of hepatitis C virus (HCV) by interferon (IFN)‐free anti‐HCV therapy using direct‐acting antivirals (DAAs) suppresses or promotes hepatocellular carcinoma (HCC) development. We investigated the influence of HCV eradication by DAA therapy on HCC development, by observing changes of non‐hypervascular hypointense nodules (NHHNs) by gadolinium‐ethoxybenzyl‐diethylenetriamine pentaacetic acid‐enhanced magnetic resonance imaging (EOB‐MRI).

Methods

A total of 401 patients treated with DAA therapy who did not have a history of HCC were enrolled in this prospective cohort study. All patients underwent EOB‐MRI prior to the start of DAA therapy and were followed up periodically after therapy. The progression of NHHNs detected at baseline to typical HCC, as indicated by hypervascularization and the incidence of newly emergent NHHNs, was analyzed.

Results

In comparison of patients who achieved sustained virologic response (SVR) with propensity score‐matched patients with persistent HCV infection, there was no difference in the incidence of hypervascularization of NHHNs to typical HCC among patients who had NHHNs at baseline. Among patients who did not have NHHNs at baseline, the incidence of the new emergence of NHHNs did not differ between study patients and propensity score–matched patients with persistent HCV infection.

Conclusions

During a 2‐year observation period after SVR, the eradication of HCV by IFN‐free DAA therapy did not suppress or enhance HCC development. (UMIN000017020).
Persisting subacute infarct pattern as early MRI feature of brain intravascular lymphoma
Authors: Kobayashi Zen , Ishihara Shoichiro , Tomimitsu Hiroyuki , Ogawa Shinichi , Numasawa Yoshiyuki , Kobayashi Daisuke , Shintani Shuzo
Published: October 2018

A 67‐year‐old man was admitted to our hospital for gait disturbance due to muscle weakness of the right lower limb lasting for 2 months. Brain MRI demonstrated multiple small cerebral white matter lesions showing a subacute infarct pattern (approximately 10–21 days after ischemic stroke onset), characterized by both hyperintensities on diffusion‐weighted images and intermediate apparent diffusion coefficient (ADC) values. The ADC values of the lesions remained almost unchanged 4 months after onset and decreased in some lesions 8 months after onset. Random skin biopsy established a diagnosis of intravascular lymphoma (IVL). Brain lesions showing a persistent subacute infarct pattern on MRI may be an early feature of brain IVL.
Qualitative exploration of fear of childbirth and preferences for mode of birth among Japanese primiparas
Authors: Takegata Mizuki , Haruna Megumi , Morikawa Miharu , Yonezawa Kaori , Komada Mariko , Severinsson Elisabeth
Published: October 2018

Antenatal fear of childbirth (FOC) is associated with negative effects, such as postnatal traumatic symptoms. As the birth‐related culture of East Asian countries differs from that in Western countries, the aim of the present qualitative, descriptive study was to explore FOC, perceptions for Caesarean section (CS), and obstetric analgesia (OA) among Japanese primiparas. The qualitative, descriptive study included focus group interviews with 11 primiparous women, which were conducted in a birth house and a maternity hospital in a metropolitan area of Japan in 2013. As a result, seven categories emerged from the analysis: Maternal and child risk, pain, losing control, uncertainty, prolonged labor, poor family support and loneliness before hospitalization. All participants denied having a preference for CS birth due to fear. Opposing values of OA were identified in women who chose OA and those who did not.

In conclusion, it is necessary to increase clinical awareness that the objects of fear are diverse. Furthermore, diverse values regarding OA should be understood and equally respected by health‐care professionals.
Vestured pits and scalariform perforation plate morphology modify the relationships between angiosperm vessel diameter, climate and maximum plant height
Authors: Medeiros Juliana S. , Lens Frederic , Maherali Hafiz , Jansen Steven
Published: October 2018

Shared ancestry among species and correlation between vessel diameter and plant height can obscure the mechanisms linking vessel diameter to current climate distributions of angiosperms. Because wood is complex, various traits may interact to influence vessel function. Specifically, pit vesturing (lignified cell wall protuberances associated with bordered pits) and perforation plate morphology could alter the relationships between vessel diameter, climate and plant height.

Using phylogenetically informed analyses, we tested for associations between vessel diameter, climate and maximum plant height across angiosperm species with different pit vesturing (presence/absence) and perforation plate morphology (simple/scalariform and quantitative variation).

We show significantly larger changes in vessel diameter and maximum plant height across climates for species with vestures and simple perforation plates, compared to nonvestured species and those with scalariform plates. We also found a significantly greater increase in height for a given increase in vessel diameter with lower percentage of scalariform plates.

Our study provides novel insights into the evolution of angiosperm xylem by showing that vessel pit vesturing and perforation plate morphologies can modify relationships among xylem vessels, climate and height. Our findings highlight the complexity of xylem adaptations to climate, substantiating an integrative view of xylem function in the study of wood evolution.