bluuebunny/crossref_metadata_2025 huggingface dataset:
Midwives in India: a delayed cord clamping intervention using simulation
Authors: Faucher M.A. , Riley C. , Prater L. , Reddy M.P.
Published: March 2016

Background

Iron deficiency is a prevalent health problem in India affecting women and newborns. Delayed umbilical cord clamping at birth is a safe and effective means for increasing serum iron levels in newborns up to 6 months of age.

Aim

The study aim was to increase the utilization of delayed cord clamping in a group of midwives working in Hyderabad, India.

Methods

A single group pre‐ and post‐test design was used to evaluate knowledge, beliefs and practice before and after a delayed cord clamping intervention including follow‐up at 10 months after the original intervention. The intervention included lectures and simulation.

Results

Results show significant increases in knowledge and positive beliefs about the practice of delayed cord clamping. Simulation was effective for eliciting important feedback related to learning.

Limitations

Results represent a small group of midwives working with a non‐profit foundation in Southern India. Language discordancy and cultural norms in this group of midwives may have influenced results.

Conclusions

Knowledge, beliefs and practice related to delayed cord clamping were all significantly improved after the intervention. The Knowledge to Action framework using simulation is an effective cross‐cultural method for implementing education about evidence‐based practice. Midwives are invested in learning practices that promote public health.

Implications for nursing and health policy

Changing institutional policy may have limitations without first considering normative practice. Using simulation combined with institutional health policy appears to result in significant uptake of practice change. Qualitative studies exploring the interconnections between cultural norms and decision making may be informative about promoting practice change particularly in this setting. Upscaling midwifery has been recommended to improve maternal and child health in India.
Enhancing the provision of health and social care in Europe through eHealth
Authors: De Raeve P. , Gomez S. , Hughes P. , Lyngholm T. , Sipilä M. , Kilanska D. , Hussey P. , Xyrichis A. ,   the ENS4Care project
Published: March 2016

Aim

To report on the outcomes of the European project ENS4Care, which delivered evidence‐based guidelines enabling implementation of eHealth services in nursing and social care.

Background

Within a policy context of efficiency, safety and quality in health care, this project brought together a diverse group of stakeholders from academia, industry, patient and professional organizations to lead the development of five eHealth guidelines in the areas of prevention, clinical practice, integrated care, advanced roles and nurse ePrescribing.

Sources of evidence

Data were collected through a cross‐sectional, online, questionnaire survey of health professionals from 21 countries. Quantitative data were analysed using descriptive and summary statistics, while comments to open questions underwent a process of content analysis.

Discussion

Representing an evidence‐based consensus statement, the five guidelines outline key steps and considerations for the deployment of eHealth services at different levels of enablement. Through analysis of the data, and sharing of best practices, common deployment processes and implementation lessons were identified.

Conclusion

Findings reveal the richness, diversity and potential that eHealth holds for enabling the delivery of safer, more efficient and patient‐centred health care. Nurses and social care workers as the main proprietors of such practices hold the key to a healthier future for citizens across Europe.

Implications for nursing and health policy

The preparation, agreement and dissemination of the ENS4Care guidelines will enable European Union leaders to diagnose the organizational changes needed and prescribe the development of new skills and roles in the workforce to meet the challenge of eHealth. Nurses and social care workers, with the right knowledge and skills will add considerable value and form an important link between technological innovation, health promotion and disease prevention.
Service encounter thinklets: how to empower service agents to put value co‐creation into practice
Authors: Giesbrecht Tobias , Schwabe Gerhard , Schenk Birgit
Published: March 2016

The concept of value co‐creation and the service encounter as locus of this value co‐creation gained much academic interest, notably in marketing research and service sciences. While the current research discourse mainly follows conceptual perspectives, there has been little research on the practical implications on service agents' enabling co‐creation of value in the information technology (IT)‐supported service encounters with clients. In this paper, we seek to bridge this gap and first use the example of IT‐supported citizen advisory services to show the fundamental deficiencies in current service agents regarding the implementation of value co‐creation work practices. We introduce the concept of service encounter thinklets, adapted from collaboration engineering, to overcome these deficiencies and to empower service agents to put value co‐creation into practice. We show how service encounter thinklets can complement existing advisory support measures to enable service agents to transform the IT‐supported customer service encounter into a collaborative work environment, bringing together themselves, customers and supporting information systems to co‐create the advisory's value. A test with employees in a public administration's front office has provided first evidence that service encounter thinklets can effectively empower service agents on the job to adapt their work practices and to bring value co‐creation into practice.
The clinical experience for treating post‐burn depigmentation with tiny epidermal particles graft
Authors: Chen Baoguo , Xu Minghuo , Li Bingyuan
Published: March 2016

The critical problem of post‐burn depigmentation is the lacking normal melanocytes. Auto‐skin grafting and autologous non‐cultured epidermal cell suspension have been used to improve the appearance. However, a large amount of skin graft is required of donor sites in the former method, while the latter method is thought to be complicated and costly. This study is designed to generalise the experience of tiny epidermal particles graft (TEPG) for treating post‐burn depigmentation. From 2012 to 2013, 30 consecutive patients with depigmentation caused by burn injuries were divided into I and II group. I group: 15 cases (11 males and 4 females) were treated by the TEPG. II group: 15 patients (10 males and 5 females) were treated by suction blister epidermal skin graft (SBEG). Imagine‐Pro Plus software was used to evaluate the size of repigmentation (RP) 12 months post‐surgery. SPSS software 13.0 was used to evaluate the data. The optimum rate of RP was defined as more than 75% (RP > 75%) when excellent RP was defined as more than 90% (>90%). All patients were followed up for 12 months. The mean size of RP in two groups demonstrated that there were statistically significant differences in pigmentation between the two groups (P = 0·002), while there was no significant difference in the other factors (gender, site and age). No infection occurred in the recipient site. Pathological result showed that melanocytes existed at the basal layer of resurfacing skin. Optimum RP (RP > 75%) was seen in 12 patients in I group and 9 patients in II group. Excellent RP was achieved in 14 cases in I group and 10 patients in II group. Excellent RP can be obtained by the abovementioned two surgical techniques. In contrast to SBEG, TEPG is less traumatic, and definite effects can be guaranteed. It is a preferred treatment, especially for those patients who suffer from large depigmented lesions.
Povidone‐iodine ointment demonstrates in vitro efficacy against biofilm formation
Authors: Hoekstra Matthias J , Westgate Samantha J , Mueller Stefan
Published: March 2016

Anti‐infectives used to treat chronic exuding wounds are diluted by wound exudates, absorbed into dressings, metabolised by proteases and destroyed by pH. In order to mimic such effects of exudates, the efficacy of six topical wound agents was assessed undiluted and at 10% concentrations, including povidone‐iodine ointment and a silver‐impregnated wound dressing, to remove biofilms of Pseudomonas aeruginosa, multi‐species biofilms of Candida albicans and methicillin‐resistant Staphylococcus aureus (MRSA) in vitro in a Centers for Disease Control and Prevention (CDC) reactor. Povidone‐iodine was also diluted to 3·3% and 33·3% of the commercial concentrations. Viable microorganisms in each preparation were quantified by colony count. No viable P. aeruginosa biofilm material was recovered after 4 and 24 hours of treatment with povidone‐iodine ointment at the 100% and 10% concentrations. No C. albicans/MRSA biofilm material was recovered after 4 and 24 hours of treatment with povidone‐iodine ointment at the 100% concentration. In general, following dilution, povidone‐iodine ointment appeared to exhibit greater biofilm removal than the other agents tested. Further research involving different microorganisms in vitro and in vivo over a longer period of time will help elucidate the full potential of povidone‐iodine ointment and liposomal hydrogel.
What should be the antibiotic prescription protocol for burn patients admitted in the department of burns, plastic and reconstructive surgery
Authors: Mir Mohd Altaf , Khurram Mohammad Fahud , Khan Arshad Hafiz
Published: March 2016

This is a prospective study with the aim to determine specific patterns of burn wound bacterial colonisation and antimicrobial resistance profiles. There is a high incidence of infections and septicaemia in post‐burn patients, which, in turn, are associated with high morbidity and mortality, a fact that compelled us to undertake this study. The study was conducted over a period 11 months, from 1 August 2014 to 30 June 2015, in 50 burn patients admitted in our burn unit. Wound cultures were taken after 72 hours of admission from all the patients, and then, empirical systemic antibiotics were administered. For wound cultures; 1 cubic cm tissue was taken and placed in aerobic and anaerobic culture vials and transported to the microbiology lab under all aseptic precautions as soon as possible. At the time of fever any time after 72 hours of admission, 16 ml of blood was drawn under all aseptic precautions. Both aerobic and anaerobic blood culture vials were filled with 8 ml of blood each and transported to the microbiology lab. The results of culture and sensitivity reports of 50 patients were recorded. The data obtained was analysed using appropriate statistical analytical tests. The most common organism responsible for bacteraemia is Pseudomonas (43%). Most of the strains of organisms isolated were resistant to commonly used antibiotics in the hospital; Pseudomonas was found 100% resistant to a combination of ampicillin + sulbactum, ceftriaxone and was most often sensitive to imipenem, amikacin and vancomycin. Methicillin‐resistant Staphylococcus aureus (MRSA) was also found resistant to commonly used antibiotics like ceftriaxone, ampicillin + sulbactum and ceftazidime + calvulanic acid. Linzolid and vancomycin were effective in 83% and 100% cases, respectively. We conclude that similar institution‐specific studies should be conducted, and such studies will be helpful in providing useful guidelines for choosing effective empirical therapy that will have a great impact on the prevention of infection and its complications in burn patients because of bacteraemia.
Objectified Body Consciousness, Physical Activity, and Dietary Intake in Women
Authors: Faries Mark D. , Espie Elizabeth
Published: March 2016

Using a cross‐sectional survey from a relatively large sample of adult women, we examined the relationships of objectified body consciousness (OBC) to physical activity levels, dietary intake, and self‐efficacy to control one's weight through exercise or healthy eating. OBC accounted for a small, statistically significant amount of variation in moderate and vigorous physical activity. Self‐efficacy partially mediated the weak relationship between control beliefs and vigorous physical activity. Differences in OBC between weight control motivation groups (those trying to lose weight vs. maintain weight) and body mass index levels were found. Findings indicate a complex interaction of OBC with health behavior, having associations with restrained and disordered eating, but little to no relationship with physical activity and dietary food choices.
Magnetism and Transport Properties of Sr2Ru1−xCoxO4 with x ≤ 0.25
Authors: Gu Xiaomin , Zhou Guotai , Gao Kaige , Peng Jin , Wang Wei , Zhang Fengming , Wu Xiaoshan
Published: March 2016

Single‐phase polycrystalline Sr2Ru1−xCoxO4 are successfully synthesized by conventional solid‐state method with doping content up to x = 0.25. Ferrimagnetism develops among the incommensurate antiferromagnetic fluctuations in the doped compounds. An abnormal coercivity–temperature relation at a high doping level (x > 0.10), in which the samples have smaller coercive field at low temperature than that at high temperature, i.e., HC(5 K) < HC(50 K), is observed. The Curie–Weiss temperature shows the negative value for all samples, and the susceptibility increases with Co doping content x. The exchange bias effect is detected in magnetic hysteresis loops. A three‐dimensional transport property has been derived based on the variable rang hopping theory, indicating a thermally assisted hopping of electrons between the localized states.
SHS/QP Synthesis and Characterization of Ce‐Bearing Zirconolite‐Rich Waste Forms Using MoO3 as the Oxidant
Authors: Zhang Kuibao , Wen Guanjun , Yin Dan , Zhang Haibin
Published: March 2016

In this study, zirconolite (CaZrTi2O7)/Mo composite was rapidly synthesized by self‐propagating high‐temperature plus quick pressing (SHS/QP) technique using MoO3 as the oxidant. As the surrogate of tetravalent actinide nuclides, up to 50 at.% CeO2 (about 17.5 wt% of the raw material) was introduced to substitute the Zr site of zirconolite. Perovskite (CaTiO3) and rutile TiO2 were inevitably produced after the incorporation of CeO2. The raw CeO2 was partially reduced to trivalent state, which promotes the substitution of Ce into the Ca sites of perovskite and zirconolite. The aqueous durability of Ce‐bearing waste form was investigated with normalized leaching rates (42 d) of Ce in moderate value of about 10−2 g m−2 d−1.
Synthesis, Structure, and Performance of Efficient Red Phosphor LiNaGe4O9:Mn4+ and Its Application in Warm WLEDs
Authors: Li Pengfei , Tan Linling , Wang Liping , Zheng Jiayu , Peng Mingying , Wang Yuefei
Published: March 2016

For phosphor‐converted warm white light‐emitting diodes (WLEDs), it is essential to find highly efficient red oxide phosphors, which are better chemically stable and benign to environment and can be prepared in a much milder condition. Here, we report a red phosphor LiNaGe4O9:Mn4+ with a quantum yield up to 78% after systematic optimization in synthesis temperature, dopant concentration of Mn4+, and sintering time. Best performance of the phosphor can be reached when it is synthesized in a mild reaction condition, that is, at 850°C for 3 h in air. The integrated emission intensity is more than four times stronger than commercial red phosphor 3.5MgO·0.5MgF2·GeO2:Mn4+ (MFG:Mn4+) under a blue light excitation at 470 nm. Crystal structural analysis reveals that the high efficiency Mn4+ exhibits in the compound is mainly due to the well separation of GeO6 groups from each other by GeO4 tetrahedra in the neighborhood and the ideal substitution of octahedral Ge4+ site by Mn4+ in view of both size and charge matches. The high performance of the phosphor encourages us to apply the blue absorbing red phosphor to WLED, which is based on combination of a blue LED chip and YAG:Ce3+, and the warm perception WLED is therefore achieved with a color temperature of 3353 K.
How do pregnant women justify smoking? A qualitative study with implications for nurses’ and midwives’ anti‐tobacco interventions
Authors: Goszczyńska Eliza , Knol‐Michałowska Kamila , Petrykowska Alicja
Published: March 2016

Aim

To research the subjective lay justifications expressed by smoking pregnant women to explain why they use cigarettes during pregnancy and to determine a typology for these justifications.

Background

Smoking pregnant mothers’ awareness of the detrimental effects of smoking on foetal health frequently is a source of stress and cognitive dissonance (stemming from the contrast between viewing themselves as responsible mothers and smokers). One possible way to reduce these unpleasant feelings is acceptance or creation of beliefs allowing them to explain rationally why they continue this behaviour during pregnancy.

Design

Qualitative design.

Methods

Thematic analysis of the content of posts from the three largest Polish parenting on‐line forums written between the time they were founded and 12 November 2012. The data were collected between September ‐ October 2012. During the analysis of the selected 73 posts, each of which included subjective explanations of smoking during pregnancy, 151 fragments, each containing one lay justification, were identified and analysed.

Findings

Thirty‐five subthemes of lay justifications assigned to two main themes were developed. The first main theme includes convictions that undermine the need to break the nicotine addiction and the positive aspects resulting from quitting. The second main theme comprises beliefs that question the possibility to abstain from smoking and exaggerate the barriers in the process of quitting.

Conclusions

The creation of a typology of lay justifications might help nurses and midwives perform more effective anti‐tobacco interventions geared specifically towards the thought patterns typical of pregnant women.
Substitution of general practitioners by nurse practitioners in out‐of‐hours primary care: a quasi‐experimental study
Authors: van der Biezen Mieke , Schoonhoven Lisette , Wijers Nancy , van der Burgt Regi , Wensing Michel , Laurant Miranda
Published: March 2016

Aim

To provide insight into the impact of substituting general practitioners with nurse practitioners in out‐of‐hours services on: (1) the number of patients; and (2) general practitioners’ caseload (patient characteristics, urgency levels, types of complaints).

Background

General practitioners’ workload during out‐of‐hours care is high, and the number of hours they work out‐of‐hours has increased, which raises concerns about maintaining quality of care. One response to these challenges is shifting care to nurse practitioners.

Design

Quasi‐experimental study comparing differences between and within out‐of‐hours teams: experimental, one nurse practitioner and four general practitioners; control, five general practitioners.

Methods

Data of 12,092 patients from one general practitioners cooperative were extracted from medical records between April 2011 and July 2012.

Results

The number of patients was similar in the two study arms. In the experimental arm, the nurse practitioner saw on average 16·3% of the patients and each general practitioner on average 20·9% of the patients. General practitioners treated more older patients; higher urgency levels; and digestive, cardiovascular and neurological complaints. Nurse practitioners treated more patients with skin and respiratory complaints. Substitution did not lead to a meaningful increase of general practitioners’ caseload.

Conclusion

The results show that nurse practitioners can make a valuable contribution to patient care during out‐of‐hours. The patients managed and care provided by them is roughly the same as general practitioners. In areas with a shortage of general practitioners, administrators could consider employing nurses who are competent to independently treat patients with a broad range of complaints to offer timely care to patients with acute problems.
Re‐evaluating the distribution of cooperative breeding in birds: is it tightly linked with altriciality?
Authors: Wang Ning , Kimball Rebecca T.
Published: March 2016

The evolution of cooperative breeding (CB) in birds has aroused intensive interest for decades, largely due to the paradox that some adults forgo independent breeding to help others. While much effort has been directed at understanding the adaptive significance of CB behavior, much less effort has been spent on understanding its origin. Ligon and Burt argued that the evolution of altriciality played a key role in the origin of CB since CB occurs more frequently in altricial lineages than expected if developmental mode and CB evolved independently and that both traits arose early in the avian tree of life. We mapped presence or absence of CB, and precocial or altricial development on a recent phylogeny of all birds to re‐evaluate their conclusions. Our results suggest altriciality may be more recently derived than previously thought, and that CB species clustered in a derived land bird clade (especially within Passeriformes) where we reconstructed many gains and losses. We did find a link between cooperative breeding and altriciality. However, since CB also occurs in precocial species, has not evolved in many altricial clades, and may have evolved prior to altriciality (based on some classifications of which species have CB), it is not clear whether altriciality is linked to other factors, such as benefits to group living, that are necessary for the acquisition of CB behavior, or whether altriciality may have been a driving force in the evolution of CB itself. The relative importance of these other factors versus altriciality for the origin of CB needs to be considered.
Age‐dependence and individual heterogeneity in reproductive success of greater sage‐grouse
Authors: Caudill Danny , Guttery Michael R. , Leone Erin , Caudill Gretchen , Messmer Terry A.
Published: March 2016

Research on iteroparous species has shown that reproductive success may increase with age until the onset of senescence. However, from the population perspective, increased reproductive success with age could be a consequence of within‐individual variation (e.g. ageing, breeding experience, foraging ability hypotheses), between‐individual variation (e.g. individual heterogeneity, frailty, selection, delayed breeding hypotheses), or a combination thereof. We evaluated within‐ and between‐individual variation in reproductive success of greater sage‐grouse (Centrocercus urophasianus; sage‐grouse), a galliforme of conservation concern throughout western North America. We monitored female reproductive activity from 1998–2010 and used generalized linear mixed models incorporating within‐subject centering to evaluate and separate within‐ and between‐individual effects. We detected positive effects of within‐individual variation on nest initiation and success where ageing increased the likelihood of both parameters, which appears to support the breeding experience and/or foraging ability hypotheses. However, nest initiation was also affected by between‐individual variation whereby the likelihood of initiation was higher for individuals with higher mean age (i.e. survived longer), as is predicted by the frailty and selection hypotheses. Our results indicate both within‐ and between‐individual variation affect reproductive output of sage‐grouse, but the effects of each varied by measure of reproductive output. Our results corroborate previous findings that suggest population age parameters (i.e. cross‐sectional) should be interpreted with caution due to potential entanglement of within‐ and between‐individual processes. Moreover, the relative role and strength of within‐ and between‐individual processes appeared to vary by measure of reproductive output in our results, which further emphasizes the need for longitudinal analysis of age effects, even in relatively short‐lived iteroparous animals, to adequately interpret biological processes.
Genetic parameters for milk fatty acids, milk yield and quality traits of a Holstein cattle population reared under tropical conditions
Authors: Petrini J. , Iung L.H.S. , Rodriguez M.A.P. , Salvian M. , Pértille F. , Rovadoscki G.A. , Cassoli L.D. , Coutinho L.L. , Machado P.F. , Wiggans G.R. , Mourão G.B.
Published: March 2016

Information about genetic parameters is essential for selection decisions and genetic evaluation. These estimates are population specific; however, there are few studies with dairy cattle populations reared under tropical and sub‐tropical conditions. Thus, the aim was to obtain estimates of heritability and genetic correlations for milk yield and quality traits using pedigree and genomic information from a Holstein population maintained in a tropical environment. Phenotypic records (n = 36 457) of 4203 cows as well as the genotypes for 57 368 single nucleotide polymorphisms from 755 of these cows were used. Covariance components were estimated using the restricted maximum likelihood method under a mixed animal model, considering a pedigree‐based relationship matrix or a combined pedigree‐genomic matrix. High heritabilities (around 0.30) were estimated for lactose and protein content in milk whereas moderate values (between 0.19 and 0.26) were obtained for percentages of fat, saturated fatty acids and palmitic acid in milk. Genetic correlations ranging from −0.38 to −0.13 were determined between milk yield and composition traits. The smaller estimates compared to other similar studies can be due to poor environmental conditions, which may reduce genetic variability. These results highlight the importance in using genetic parameters estimated in the population under evaluation for selection decisions.
Safety and Long‐Term Outcomes of Catheter Ablation of Atrial Fibrillation Using Magnetic Navigation versus Manual Conventional Ablation: A Propensity‐Score Analysis
Authors: ADRAGÃO PEDRO PULIDO , CAVACO DIOGO , FERREIRA ANTÓNIO MIGUEL , COSTA FRANCISCO MOSCOSO , PARREIRA LEONOR , CARMO PEDRO , MORGADO FRANCISCO BELLO , SANTOS KATYA REIS , SANTOS PEDRO GALVÃO , CARVALHO MARIA SALOMÉ , DURAZZO ANAI , MARQUES HUGO , GONÇALVES PEDRO ARAÚJO , RAPOSO LUÍS , MENDES MIGUEL
Published: March 2016

Magnetic versus Manual Ablation of Atrial Fibrillation

Introduction

Whether or not the potential advantages of using a magnetic navigation system (MNS) translate into improved outcomes in patients undergoing atrial fibrillation (AF) ablation is a question that remains unanswered.

Methods and Results

In this observational registry study, we used propensity‐score matching to compare the outcomes of patients with symptomatic drug‐refractory AF who underwent catheter ablation using MNS with the outcomes of those who underwent catheter ablation using conventional manual navigation. Among 1,035 eligible patients, 287 patients in each group had similar propensity scores and were included in the analysis. The primary efficacy outcome was the rate of AF relapse after a 3‐month blanking period. At a mean follow‐up of 2.6 ± 1.5 years, AF ablation with MNS was associated with a similar risk of AF relapse as compared with manual navigation (18.4% per year and 22.3% per year, respectively; hazard ratio 0.81, 95% CI 0.63–1.05; P = 0.108). Major complications occurred in two patients (0.7%) using MNS, and in six patients (2.1%) undergoing manually navigated ablation (P = 0.286). Fluoroscopy times were 21 ± 10 minutes in the manual navigation group, and 12 ± 9 minutes in the MNS group (P < 0.001), whereas total procedure times were 152 ± 52 minutes and 213 ± 58 minutes, respectively (P < 0.001).

Conclusions

In this propensity‐score matched comparison, magnetic navigation and conventional manual AF ablations seem to have similar relapse rates and a similar risk of complications. AF ablations with magnetic navigation take longer to perform but expose patients to significantly shorter fluoroscopy times.
A Comparison of Remote Magnetic Irrigated Tip Ablation versus Manual Catheter Irrigated Tip Catheter Ablation With and Without Force Sensing Feedback
Authors: WEISS J. PETER , MAY HEIDI T. , BAIR TAMI L. , CRANDALL BRIAN G. , CUTLER MICHAEL J. , DAY JOHN D. , OSBORN JEFFREY S. , MALLENDER CHARLES , BUNCH T. JARED
Published: March 2016

Comparison of Remote Magnetic Irrigated Tip

Background

Remote magnetic navigation (RMN) and contact force (CF) sensing technologies have been utilized in an effort to improve safety and efficacy of catheter ablation. A comparative analysis of the relative short‐ and long‐term outcomes of AF patients has not been performed. As such, we comparatively evaluated the safety and efficacy of these technologies.

Methods

A total of 627 patients who underwent catheter ablation with either a manual irrigated tip catheter: (312, 49.8%) or by RMN: (315, 50.2%) were included in this single‐center cohort study. Patients treated with CF (59) were analyzed separately as well. One‐ and 3‐year endpoints included death, HF hospitalization, stroke, TIA, and atrial flutter or AF recurrence.

Results

Age averaged 65.1 ± 10.7 years and 64.1% male. One‐ and 3‐year endpoints of death, HF hospitalization, stroke, TIA, and atrial flutter or AF recurrence were statistically similar between manual and RMN treated groups. Fluoroscopy times were significantly lower in the RMN group compared to the manual ablation group (8.47 ± 0.45 vs. 9.63 ± 4.06 minutes, P < 0.0001). CF guided patients had 1‐year recurrence rate of AF/atrial flutter statistically identical to patients treated with RMN (36.8% vs. 38.6%; P = 1.00).

Conclusion

RMN results in outcomes similar to manual navigation. The addition of CF sensing catheters did not improve relative procedural outcome or safety profile in comparison to RMN guided ablation in this large observational study of AF ablation.
Catheter Ablation of Ischemic Ventricular Tachycardia With Remote Magnetic Navigation: STOP‐VT Multicenter Trial
Authors: SKODA JAN , ARYA ARASH , GARCIA FERMIN , GERSTENFELD EDWARD , MARCHLINSKI FRANCIS , HINDRICKS GERHARD , MILLER JOHN , PETRU JAN , SEDIVA LUCIE , SHA QUN , JANOTKA MAREK , CHOVANEC MILAN , WALDAUF PETR , NEUZIL PETR , REDDY VIVEK Y.
Published: March 2016

Study to Obliterate Persistent Ventricular Tachycardia

Introduction

Catheter ablation is an effective treatment of scar‐related ventricular tachycardia (VT), but the overall complexity of the procedure has precluded its widespread use. Remote magnetic navigation (RMN) has been shown to facilitate cardiac mapping and ablation of VT in a retrospective series. STOP‐VT is the first multicenter, prospective, single‐arm and single‐procedure study evaluating RMN‐based mapping and ablation of post‐infarction VT.

Methods

Patients with documented VT and prior MI, in whom an ICD was implanted either for primary or secondary prevention, were recruited from four EU and US centers. Either a transseptal (48 patients) or transaortic (5 patients) approach was employed to gain access for ventricular endocardial mapping/ablation during VT (entrainment mapping, activation mapping) and/or substrate mapping in sinus rhythm (elimination of fractionated/late potentials, variable extent of substrate modification) with RMN and irrigated RF ablation. The primary endpoints were as follows: (i) non‐inducibility of the target VT or any other sustained VT; (ii) elimination of sustained VT/VF during ICD follow‐up of up to 12 months.

Results

The cohort included 53 consecutive patients (median age 67 years, 49 men, median LVEF 31%). One hemodynamically unstable patient was excluded at the onset of mapping. Inducibility of sustained VT was achieved an average of 2.2 times per patient (1–8), with mean tachycardia cycle length (TCL) 374 milliseconds (179–510). Mean total procedure and fluoroscopy times were 223 minutes and 8.7 minutes, respectively; mean cumulative fluoroscopy time during mapping and ablation was 0.95 minutes; maximum power averaged 42.3 W with nominal saline 30 cc/min irrigation; mean cumulative RF time was 38 minutes. Non‐inducibility of the target VT was achieved in 49/52 patients (94.2%) and non‐inducibility of any VT was achieved in 38/52 patients (73.1%). A combination of RMN and manual ablation was performed in two patients, rendering one non‐inducible. During the 12‐month ICD follow‐up period, freedom from any sustained VT/VF was observed in 30 patients (62%), of which 19 (63%) were off antiarrhythmic medications. Five patients expired during follow‐up: one presented with a VT storm, but for the others, death was not related to VT/VF (MI‐cardiogenic shock, pulmonary embolism, bronchogenic carcinoma, end stage heart failure). No procedural complications were reported.

Conclusions

This first prospective, single‐procedure, multicenter study indicates that remote magnetic navigation is a safe and effective method for catheter ablation of post‐infarction VT.
Efficacy and Safety of Atrial Fibrillation Ablation Using Remote Magnetic Navigation: Experience from 1,006 Procedures
Authors: JIN QI , PEHRSON STEEN , JACOBSEN PETER KARL , CHEN XU
Published: March 2016

RMN‐Guided Ablation for AF

Background

The objective of this study was to assess the procedural outcomes of catheter ablation guided by remote magnetic navigation (RMN) in a large cohort of patients with paroxysmal atrial fibrillation (PAF) and persistent AF (PerAF).

Methods

A total of 726 patients (547 male, age: 58.5 ± 10.3 years) with symptomatic AF (61% PAF) were analyzed from a prospective ablation registry. Procedural parameters including pulmonary venous (PV) anatomy, left atrial (LA) volume, procedural time, ablation time, fluoroscopy time, total X‐ray dose, and complications were assessed.

Results

One thousand and six ablation procedures were analyzed. One‐third of the patients (240/726) were ablated on more than one occasion, resulting in a mean of 1.3 ± 0.6 times for the entire group. When analyzing all procedures, the mean procedural time and ablation time was 134 ± 35 minutes and 2,130 ± 1,025 seconds, respectively. The mean fluoroscopy time was 5.4 ± 3.7 minutes. Compared to PAF patients, procedural time and ablation time were significantly increased in patients with PerAF by 10% (P < 0.001) and 19% (P < 0.001), respectively. However, fluoroscopy time was not increased (5.3 ± 3.5 minutes, PAF vs. 5.6 ± 4.0 minutes, PerAF, P = 0.17). The overall complication rate was 0.6%. One PAF patient experienced cardiac tamponade. AF repeat ablations by RMN significantly reduced the procedural and ablation times when compared with their first ablation times.

Conclusions

AF ablation guided by RMN is safe as evidenced by a low complication rate. Fluoroscopy time was relatively short for both PAF and PerAF ablation.
Remote Magnetic Navigation: A Focus on Catheter Ablation of Ventricular Arrhythmias
Authors: AAGAARD PHILIP , NATALE ANDREA , BRICENO DAVID , NAKAGAWA HIROSHI , MOHANTY SANGHAMITRA , GIANNI CAROLA , BURKHARDT J. DAVID , DI BIASE LUIGI
Published: March 2016

A Focus on Catheter Ablation of Ventricular Arrhythmias

VT ablation is based on percutaneous catheter insertion under fluoroscopic guidance to selectively destroy (i.e., ablate) myocardial tissue regions responsible for the initiation or propagation of ventricular arrhythmias. Although the last decade has witnessed a rapid evolution of ablation equipment and techniques, the control over catheter movement during manual ablation has remained largely unchanged. Moreover, the procedures are long, and require ergonomically unfavorable positions, which can lead to operator fatigue. In an attempt to overcome these constraints, several technical advancements, including remote magnetic navigation (RMN), have been developed. RMN utilizes a magnetic field to remotely manipulate specially designed soft‐tip ablation catheters anywhere in the x, y, or z plane inside the patient's chest. RMN also facilitates titration of the contact force between the catheter and the myocardial tissue, which may reduce the risk of complications while ensuring adequate lesion formation. There are several non‐randomized studies showing that RMN has similar efficacy to manual ablation, while complication rates and total radiation exposure appears to be lower. Although these data are promising, larger randomized studies are needed to prove that RMN is superior to manual ablation of VT.
Commentary: How can family‐based quasi‐experimental designs and national registers be used to address confounding in risk factor studies of psychopathology? A reflection on Obel et al. (2016)
Authors: Larsson Henrik
Published: March 2016

Standard observational studies have reported a robust correlation between maternal smoking during pregnancy and risk of ADHD in offspring. In the accompanying article, Obel et al. used sibling‐comparisons to explore the extent to which unmeasured familial confounding explains this association. This commentary highlights three important implications of the study. At a general level, Obel et al. illustrates how (1) family‐based quasi‐experimental designs and (2) national registers can be used to address confounding in risk factor studies of psychopathology. At a more specific level, the study suggests that maternal smoking during pregnancy is probably not a causal risk factor for ADHD.
Commentary: Conduct disorder and perceiving harm to others – a reflection on Michalska et al. (2016)
Authors: L. Lockwood Patricia , Viding Essi
Published: March 2016

The study by Michalska et al. () reported in this issue of JCPP focused on how children with conduct disorder (CD) process harm to other people. Many children with CD lack empathy for their victims and this behavioural profile has encouraged the investigation of potential underpinnings of atypical empathy in this group. Michalska et al. () administered an fMRI task depicting harm to other people to a large sample of children with CD and typically developing peers. The authors found that CD symptom severity and degree of callousness were negatively associated with right posterior insula response to other people experiencing harm. Furthermore, CD and callousness ratings were negatively associated with anterior insula, anterior midcingulate cortex and posterior superior temporal sulcus response to intentional harm. Reactive aggression scores, in contrast, were associated with increased positive insula reactivity when processing harm to others. Finally, the authors reported a sex difference in the engagement of brain areas associated with computations of intentionality when children processed intentional harm. In females (but not males) with CD, higher CD symptomatology was associated with lower activity in pSTS and middle frontal gyrus (MFG). This study is novel in focusing on a preadolescent sample of children and testing for sex differences in the neural underpinnings of conduct disorder (CD) symptomatology. We look forward to further work in this area and are certain that the important study by Michalska et al. () will motivate a host of new investigations that help us uncover the neural underpinnings of CD.
Executive functioning – a key construct for understanding developmental psychopathology or a ‘catch‐all’ term in need of some rethinking?
Authors: Halperin Jeffrey M.
Published: March 2016

For the past few decades, the role of executive functions in developmental psychopathology has been the focus of considerable research and a feature of conceptual models for a range of conditions including, but not limited to, ADHD, autism, schizophrenia, bipolar disorder, learning disorders, and aggression/conduct problems. Consistent with its prominence throughout the field, executive functioning plays a central role in approximately a third of the papers in this issue of JCPP, and notably, with foci largely on different conditions. These papers, all of which make valuable contributions to the field, propose or test the possibility of a causal role for executive functions in the emergence of psychopathology.
Match‐Fixing in a Monopoly Betting Market
Authors: Bag Parimal Kanti , Saha Bibhas
Published: March 2016

A monopolist bookmaker may set betting odds on a fairly even contest to induce match‐fixing by an influential corrupt punter. His loss to the corrupt punter is more than made up for by enticing enough ordinary punters to bet on the losing team. This result is in sharp contrast to competitive bookmaking, where even contests have been shown to be immune to fixing. The analysis also reveals a surprising result that the incidence of match‐fixing can dramatically fall when match‐fixing opportunities rise. This is shown by comparing two scenarios—when only one team is corruptible and when both are corruptible. For both teams corruptible, the bookmaker is uncertain about to which team the influential punter will have access, so carefully maneuvering the odds to induce match‐fixing is too costly.
Determination of the optimal parasitoid‐to‐host ratio for efficient mass‐rearing of the parasitoid, Sclerodermus pupariae (Hymenoptera: Bethylidae)
Authors: Wei K. , Gao S. K. , Tang Y. L. , Wang X. Y. , Yang Z. Q.
Published: March 2016

Sclerodermus pupariae Yang et Yao (Hymenoptera: Bethylidae) is used as a potential biocontrol agent for several buprestid and cerambycid larvae. This study aimed to enhance the efficiency of mass‐rearing of this parasitoid by investigating the fitness gain of this bethylid wasp, including the proportion of successful parasitism and development, brood size, sex ratio, proportion of winged female offspring, body size and longevity of female offspring, under eight different maternal parasitoid density treatments using Thyestilla gebleri Faldermann as host in the laboratory. The results indicated that the foundress densities did not affect the parasitism or emergence rate of this parasitoid. Brood size of the parasitoids increased significantly when the number of maternal wasps ranged from one to four. However, further increases in foundress number did not affect the parasitoid brood size. The sex ratios of S. pupariae were always female‐biased. The proportions of male in the progeny colonies were <10% throughout all experimental treatments. The percentage of winged female progeny was not significantly influenced by the density of adult maternal parasitoids. Body sizes of parasitoids significantly declined with increasing maternal parasitoid densities. Although the parasitoid body size reduced when maternal wasp number was higher, it could be compromised by the relatively higher number of female offspring produced. Further, more than 70% of the parasitoids remained alive when they were stored at 12°C for four months throughout the experiments. These findings suggest that exposure of four female wasps to a single host larva would result in the highest fitness of S. pupariae. Our findings might provide a new approach to enhance the efficiency of mass‐rearing of this bethylid wasp.
Challenges to clinical pharmacy practice in Nigerian hospitals: a qualitative exploration of stakeholders' views
Authors: Auta Asa , Strickland‐Hodge Barry , Maz Julia
Published: March 2016

Rationale, aims and objectives

In Nigeria, a shift from the traditional pharmacists' role of dispensing and compounding of medications began in the 1980s with the introduction of drug information services and unit dose‐dispensing systems in some hospitals. More than three decades after this, clinical pharmacy practice is still underdeveloped. This study was conducted to explore stakeholders' views on the barriers to the development of clinical pharmacy practice in Nigerian hospitals.

Methods

Qualitative, semi‐structured interviews were conducted with 44 purposefully sampled Nigerian stakeholders including pharmacists, pharmacy technicians, doctors, policymakers and patient group representatives. Transcribed interviews were entered into the QSR (Burlington, MA, USA) NVivo 10 software and analysed thematically.

Results

Three major themes emerged from the study: pharmacists' professional identity, the structure of pharmacy practice and external barriers. The results revealed an ongoing struggle by Nigerian hospital pharmacists to establish their clinical identities as many non‐pharmacy stakeholders viewed pharmacists' roles to be mainly supply based. Barriers to the development of clinical pharmacy practice identified included pharmacists' lack of confidence, shortage of pharmacy staff, underutilisation of pharmacy technicians, lack of specialisation and clinical career structure, medical dominance and opposition and lack of policies that support clinical pharmacy practice.

Conclusion

Several years after its introduction, clinical pharmacy practice is yet to be fully developed in Nigerian hospitals. The barriers identified in this study need to be addressed in order for clinical pharmacy practice to flourish.
Degumming and Neutralization of Rice Bran Oil
Authors: Engelmann jênifer Inês , Ramos Lucas Pedroso , Crexi Valéria Terra , Morais Marcilio Machado
Published: March 2016

The present study aimed to perform degumming and neutralization steps of crude oil from rice bran. The degumming was studied through a central composite rotational design where the study variables were the amount of water added and temperature and the response variable was phosphorus content. In the neutralization study, a complete experimental design was used, with the study variables being temperature and amount of NaOH solution added, while the response variables were acidity and γ‐oryzanol content. The best working region for degumming was in the condition of 5% water and a temperature of 58C, under this condition the oil showed a phosphorus contentof 4.10 mg/100 g. In the neutralization step, the best condition was 60C and an addition of 20% excess soda, where an acidity of 0.41% oleic acid and γ‐oryzanol content of 1.10% was obtained.

Practical Applications

Water degumming proves to be advantageous compared to acid degumming, commonly carried out in oil refining industries since the phospholipids obtained in this step can be dried to yield lecithin without the need of purification. The lecithin obtained from the degumming process has commercial value, especially for its emulsifying action and can be used in food industries, in products such as ice cream, milk powder and chocolates. In its composition, rice bran oil has the γ‐oryzanol compound, a natural antioxidant that is extracted during the refining process of rice bran oil, especially during the neutralization step.

The refining difficulties presented by the rice bran oil reflect the high cost of the final product compared to other oils. Thus, the study of the degumming step for the use of lecithin is justified, since the lecithin obtained from water degumming can be used as a byproduct of the oil industry, generating profit. The study of neutralization to preserve the maximum γ‐oryzanol content in the rice bran oil is justified by the benefits that this can bring to the health of consumers, such as lower total plasma cholesterol and increased HDL cholesterol levels. Furthermore, the maintenance of this compound improves oil quality, since the γ‐oryzanol increases the oxidative stability of the oil occasioned for factors such as the amount of water, oxygen, process and storage temperature and time.