bluuebunny/crossref_metadata_2025 huggingface dataset:
Nurses’ perceptions regarding providing psychological care for older residents in long‐term care facilities: A qualitative study
Authors: Kuo Chien‐Lin , Wang Shou‐Yu , Tsai Chuan‐Hsiu , Pan Yu‐Fan , Chuang Yeu‐Hui
Published: May 2019

Aims and objectives

To explore nurses' perceptions regarding providing psychological health care for older residents in long‐term care facilities (LTCFs).

Background

Loneliness and depressive symptoms are commonly observed among older residents living in LTCFs. Nurses are expected to provide holistic care including physical, psychological and social care for older residents in LTCFs to fulfil their needs. Therefore, understanding nurses' feelings and thoughts regarding providing care for older residents who feel lonely, sad, unhappy or depressed is important for delivering better care.

Design

A qualitative research design was employed. The Standards for Reporting Qualitative Research (SRQR) was used to enhance for reporting quality.

Methods

Purposive sampling and snowball sampling were applied in Northern Taiwan. One‐to‐one in‐depth interviews were conducted using a semi‐structured interview guide. Twenty‐one nurses with a mean age of 38.4 years were interviewed. Content analysis was performed for data analysis.

Findings

Four themes were generated from the data: “insufficient psychological healthcare competency,” “having a willing heart but not adequate support,” “families playing an essential role in residents’ mood” and “physical‐oriented care model.”

Conclusions

Long‐term care facilitie nurses felt that they were not adequately prepared for taking care of older adults' psychological problems before their nursing career or during their practice. Unreasonable nurse‐to‐resident ratios and an absence of care consensus among healthcare providers can make nurses feel that they have a willing heart but not adequate support. Family members are essential in older residents' emotional status within the Taiwanese cultural context. Physical care evaluation indicators emphasised by LTCF accreditation resulted in the current care practice model.

Implications for practice

This study provides valuable information for LTCF nurses, managers and directors to develop appropriate strategies to assist nurses in providing better psychological health care for older residents. Evaluation indicators required by LTCF accreditation in Taiwan must be re‐examined at the earliest stage.
A novel approach for predicting the probability of ignition of palaeofires using fossil leaf assemblages
Authors: Boulton Chris A. , Belcher Claire M.
Published: May 2019

Many metrics are used to predict and manage wildfires today but it is difficult to directly apply these to past wildfires histories. Developing an approach that enables estimation of these fire metrics in the past would provide significant power in our ability to compare past fire risk with that of the modern day. We use the Climate Leaf Analysis Multivariate Program (CLAMP) to estimate warm month mean temperature and annual mean relative humidity for a modern day leaf dataset and establish a novel methodology by which we can generate ‘pseudo‐daily’ meteorological parameters to calculate the probability of ignition (p(I)), an aspect of the North American Fire Danger Rating System. We test this methodology on Tortonian aged fossil leaves (11.62–7.25 Ma) from five sites across California, which reveal that the Tortonian was cooler and considerably more humid and that p(I) was lower during this time than in the region today.
Transparency About Painkillers: A Remedy for the Evaluativist's Headache
Authors: Simon Jonathan A.
Published: May 2019

The paradox of pain is that pain is in some ways like a bodily state and in other ways like a mental state. You can have a pain in your shin, but there is no denying that you are in pain if it feels like you are. How can a state be both in your shin and in your mind? Evaluativism is a promising answer. According to evaluativism, an experience of pain in your shin represents that there is a disturbance in your shin, and that it is bad that this disturbance is there. Thus, the experience brings you to tend to your shin by telling you something about the state of your shin. But the paradox of pain still confronts evaluativism in the form of the killing the messenger objection: The evaluativist has a nice story about our body‐directed responses to pain, like tending to wounds, but this story does not explain responses to pain, like taking painkillers, that seem to be experience‐directed. Evaluativists have offered accounts of experience‐directed responses to pain, but I will argue that these accounts conflict with the Transparency thesis—the claim that we can only access our experiences inferentially. Evaluativism and Transparency are natural bedfellows, so this is a problem for evaluativists. Having argued as much, I will go on to develop a new evaluativist account of taking painkillers, which does not conflict with Transparency. I call it naïve evaluativism. According to naïve evaluativism, we experience painkillers as making tissue damage or disruption less bad, and absent further reflection, that is, why we take them.
Trichomegaly induced by topical tacrolimus for the treatment of periorbital vitiligo: A brief report of a new adverse effect
Authors: Molés‐Poveda Paula , Cowen Edward W.
Published: May 2019

Trichomegaly is a known adverse effect of systemic administration of cyclosporine but is less commonly associated with systemic tacrolimus or with topical calcineruin inhibitors. In this report, we describe the first case, to our knowledge, of trichomegaly due to long‐term use of topical tacrolimus for periocular vitiligo.
Moderating effect of cognitive reserve on the association between grey matter atrophy and memory varies with age in older adults
Authors: Kwak Seyul , Shin Minyoung , Kim Hoyoung , Cho Belong , Ha Jung‐Hwa , Han Gyounghae , Kim Hongsoo , Koo Yangmi , Kwon Soonman , Lee Chulhee , Lee Hyeon Jung , Park Keong‐Suk , Chey Jeanyung
Published: May 2019

Background

Educational attainment and verbal intelligence, which indirectly reflect an individual's cognitive reserve (CR), is suggested to buffer the effect of late‐life brain degradation on cognitive performance outcome. We aimed to explore how the relationship between whole grey matter volume (GMV) and episodic memory function is altered by CR proxy as well as age in healthy older adults.

Methods

Elderly Verbal Learning Test (EVLT) and structural magnetic resonance imaging were administered to 110 community‐residing older adults. Moderated moderation model tested whether the association between whole GMV and episodic memory was moderated by both CR and chronological age.

Results

The results showed that the moderating effect of CR on Immediate Recall, Short‐delay Recall, and Recognition scores of EVLT differed across age groups. The elderly with higher CR showed steeper GMV effect on EVLT at the Age‐Younger condition, while such moderating effect was reversed in the Age‐Older condition, suggesting an alleviated brain atrophy effect in higher CR elderly.

Conclusion

These findings suggest that although higher CR elderly may exhibit earlier GMV‐related memory decline, the buffering effect of CR on the cognitive decline due to brain atrophy would become more evident in old‐old elderly people who are likely to have accumulated more neuropathological changes. This study underscores chronological age as an important moderating factor in examining the moderating role of CR in late‐life memory function.
Event‐related potentials in response to feedback following risk‐taking in the hot version of the Columbia Card Task
Authors: de Groot Kristel , van Strien Jan W.
Published: May 2019

Given the importance of risk‐taking in individuals’ personal and professional life, several behavioral tasks for measuring the construct have been developed. Recently, a new task was introduced, the Columbia Card Task (CCT). This task measures participants’ risk levels and establishes how sensitive participants are to gains, losses, and probabilities when taking risk. So far, the CCT has been examined in behavioral studies and in combination with several (neuro)biological techniques. However, no electroencephalography (EEG) research has been done on the task. The present study fills this gap and helps to validate this relatively new experimental task. To this end, n = 126 students were asked to complete self‐reports (reward responsiveness, impulsiveness, and sensation‐seeking) and to perform the CCT (and other risk tasks) in an EEG setup. The results show that feedback appraisal after risky decision‐making in the CCT was accompanied by a feedback‐related negativity (FRN) and a P300, which were stronger in response to negative than positive feedback. Correlations between the FRN and P300 difference wave on the one hand and risk‐related self‐reports and behavior on the other were nonsignificant and small, but were mostly in the expected direction. This pattern did not change after excluding participants with psychiatric/neurological disorders and outliers. Excluding participants with reversed (positive > negative) difference waves strengthened FRN correlations. The impact such individuals can have on the data should be taken into account in future studies. Regarding the CCT in particular, future studies should also address its oddball structure and its masking of true values (censoring).
Do Interactions Between Environmental Chemicals and the Human Microbiome Need to Be Considered in Risk Assessments?
Authors: Rodricks Joseph , Huang Yvonne , Mantus Ellen , Shubat Pamela
Published: May 2019

One of the most dynamic and fruitful areas of current health‐related research concerns the various roles of the human microbiome in disease. Evidence is accumulating that interactions between substances in the environment and the microbiome can affect risks of disease, in both beneficial and adverse ways. Although most of the research has concerned the roles of diet and certain pharmaceutical agents, there is increasing interest in the possible roles of environmental chemicals. Chemical risk assessment has, to date, not included consideration of the influence of the microbiome. We suggest that failure to consider the possible roles of the microbiome could lead to significant error in risk assessment results. Our purpose in this commentary is to summarize some of the evidence supporting our hypothesis and to urge the risk assessment community to begin considering and influencing how results from microbiome‐related research could be incorporated into chemical risk assessments. An additional emphasis in our commentary concerns the distinct possibility that research on chemical–microbiome interactions will also reduce some of the significant uncertainties that accompany current risk assessments. Of particular interest is evidence suggesting that the microbiome has an influence on variability in disease risk across populations and (of particular interest to chemical risk) in animal and human responses to chemical exposure. The possible explanatory power of the microbiome regarding sources of variability could reduce what might be the most significant source of uncertainty in chemical risk assessment.
Similar yet unique: the victim's journey after acute sexual assault and the importance of continuity of care
Authors: Hutschemaekers Giel J. M. , Zijlstra Elza , de Bree Chrissy , Lo Fo Wong Sylvie , Lagro‐Janssen Antoine
Published: May 2019

Objective

To examen the short‐term and long‐term responses of sexual assault victims who attended a sexual assault centre.

Methods

Semi‐structured interviews were held with twelve victims of sexual assault who received help from a sexual assault centre. Analyses were done in Atlas.ti. via a process of open, axial and selective coding.

Results

Shortly after assault, the victims’ response was to strike a balance between denial and acknowledgement that the violence was real and not their fault. In the ling term most victims experienced a dynamic recovery process with fluctuating responses. Their social support network played a crucial role in reaching out for professional care.

Conclusion

Shortly after assault sexual violence victims need the violence to be acknowledged by skilful, empathic care providers. In the long term, victims experience vitims experience a dynamic recovery process with fluctuating responses in which continuity of care is of the utmost importance.
Cash for long‐term care: Policy debates, visions, and designs on the move
Authors: Da Roit Barbara , Le Bihan Blanche
Published: May 2019

Cash‐for‐care (CfC) schemes have introduced a key transformation in long‐term care policies across Europe since the 1990s. The article explores the extent to which CfC policies have changed over time and into which directions, the ways in which change (if any) has occurred and the forces underlying it. By combining the literature on institutional change with ideational approaches, the article focuses on policy theories and policy designs, on modes of change and factors pushing for change within the CfC policy, and in the long‐term care and neighbouring policy fields. In doing so, we aim to contribute to understanding institutional change and the transformation of an increasingly important sector of the welfare state.
High‐frequency ultrasonography a new quantitative method in evaluation of skin lymphomas—First comparative study in relation to histopathology
Authors: Polańska Adriana , Bowszyc‐Dmochowska Monika , Olek‐Hrab Karolina , Adamski Zygmunt , Żaba Ryszard , Dańczak‐Pazdrowska Aleksandra
Published: May 2019

Introduction

High‐frequency ultrasonography (HF‐USG) is a noninvasive method used in evaluation of depth and width of skin neoplasms. Recent data suggest that this method may also supplement objective clinical assessment in skin lymphomas, especially in mycosis fungoides, where subepidermal low echogenic band (SLEB) can be observed. The aim of the study was to present characteristic ultrasonic picture of MF in relation to histopathologic findings.

Materials and methods

Ten patients diagnosed as MF were included in the study. The USG examination was performed with the use of 20 MHz transducer within representative plaque. From the scanning lesion, the skin biopsy was taken. The relationship between histopathologic infiltrate with clonal T cells and USG image was investigated.

Results

In all analyzed sonograms obtained from lesional skin of early‐stage MF, we could detect the presence of subepidermal low echogenic band (SLEB). We detected strong correlations between SLEB thickness and the thickness of subepidermal infiltration (0.994,P < 0.05).

Conclusions

Subepidermal low echogenic band is a typical sign of infiltrative stage of MF, and its thickness may depend on the type of skin lesion. HF‐USG may be a reliable noninvasive method of quantitive assessments in MF, which corresponds to the thickness on T‐cell infiltration in histopathology.
The novel KIR2DL4*038 allele identified by sequencing‐based typing in a Chinese Naxi individual
Authors: Su Pincan , Wang Jue , Yao Fuzhu , Siqi Cai , Deng Zhi‐Hui
Published: May 2019

The novel KIR2DL4*038 allele differs from the closest allele KIR2DL4*00102 by a single missense mutation.
Comparison of 2 canine celiotomy closure models for training novice veterinary students
Authors: Williamson Julie A. , Brisson Brigitte A. , Anderson Stacy L. , Farrell Robin M. , Spangler Dawn
Published: May 2019

Objective

To compare a low‐fidelity foam and fabric (FF) model to a high fidelity silicone (SI) model for teaching canine celiotomy closure.

Study design

Prospective blinded comparison of learning outcomes.

Sample population

Second‐year veterinary students who had never performed surgery as a primary surgeon (n = 46) and veterinarians experienced in performing canine celiotomy (n = 10).

Methods

Veterinary students performed a digitally recorded celiotomy closure on a canine cadaver before and after participation in 4 facilitated laboratory training sessions on their randomly assigned model. Recordings were scored by masked, trained educators with an 8‐item task‐specific rubric. Students completed surveys evaluating the models. Experienced veterinarians tested the models and provided feedback on their features.

Results

Completed pretest and posttest recordings were available for 38 of 46 students. Students' performance improved regardless of the model used to practice (P = .04). The magnitude of improvement did not differ between the 2 groups (P = .10). All students (n = 46) described their models favorably. Ninety percent of veterinarians thought both models were helpful for training students and gave similar ratings on all measures except for realism, which was rated higher for the SI model's skin (median, agree) compared with the FF model (median, neutral, P = .02).

Conclusion

Model‐based training was effective at improving students' surgical skills. Less experienced learners achieved similar skill gains after practicing with FF or SI models.

Clinical significance

The acquisition of surgical skills required to perform celiotomy closure in companion animals occurs similarly well on models made of foam and fabric or of silicone, providing flexibility in model selection.
Can a dire ecological warning lead to action?
Authors: Stokstad Erik
Published: May 2019

Having documented the decline of nature, expert group calls for transformative change.
Genomics breeds new legal questions
Authors: Couzin-Frankel Jennifer
Published: May 2019

Experts try to bring laws, regulations in line with genetic testing as its use surges.
Adult-born hippocampal neurons bidirectionally modulate entorhinal inputs into the dentate gyrus
Authors: Luna Victor M. , Anacker Christoph , Burghardt Nesha S. , Khandaker Hameda , Andreu Valentine , Millette Amira , Leary Paige , Ravenelle Rebecca , Jimenez Jessica C. , Mastrodonato Alessia , Denny Christine A. , Fenton Andre A. , Scharfman Helen E. , Hen Rene
Published: May 2019

Afferents modulate newborn neurons

What is the role of adult neurogenesis in learning, memory, and mood? Luna
et al.
found that adult-born neurons either inhibited or excited the dentate gyrus, depending on whether synaptic inputs originated from the lateral or the medial entorhinal cortex (see the Perspective by Llorens-Martín). These opposing mechanisms were driven by extrasynaptic transmission from adult-born neurons directly onto mature granule cells via metabotropic glutamate receptors or
N
-methyl-
D
-aspartate receptors, respectively. The balance between these mechanisms could explain the differences in dentate gyrus activity during two versions of an active place-avoidance task. The action of adult-born neurons thus depended entirely on the demands of the environment, which can be defined by the activity of cortical and subcortical regions sending inputs to the dentate gyrus.

Science
, this issue p.
578
; see also p.
530
LMBR1L regulates lymphopoiesis through Wnt/β-catenin signaling
Authors: Choi Jin Huk , Zhong Xue , McAlpine William , Liao Tzu-Chieh , Zhang Duanwu , Fang Beibei , Russell Jamie , Ludwig Sara , Nair-Gill Evan , Zhang Zhao , Wang Kuan-wen , Misawa Takuma , Zhan Xiaoming , Choi Mihwa , Wang Tao , Li Xiaohong , Tang Miao , Sun Qihua , Yu Liyang , Murray Anne R. , Moresco Eva Marie Y. , Beutler Bruce
Published: May 2019

Wnt signaling out on a limb

The Wnt/β-catenin signaling pathway is central to hematopoietic stem cell (HSC) survival, renewal, and differentiation. Both excessive and insufficient β-catenin can have adverse consequences, so “destruction complexes” ensure its precise regulation. Using a mouse forward genetic screen, Choi
et al.
identified a mutation in the gene limb region 1–like (
Lmbr1l
) that severely impaired lymphocyte development and function. LMBR1L interacted with multiple members of the Wnt/β-catenin signaling pathway. The authors found that LMBR1L works with an endoplasmic reticulum–localized ubiquitin ligase to serve as a second brake on this system in lymphocytes. Deleting β-catenin decreased apoptosis and restored proliferative capacity in an
Lmbr1l
-deficient mouse T cell line.

Science
, this issue p.
eaau0812
Measles and the canonical path to elimination
Authors: Graham Matthew , Winter Amy K. , Ferrari Matthew , Grenfell Bryan , Moss William J. , Azman Andrew S. , Metcalf C. Jessica E. , Lessler Justin
Published: May 2019

The path to elimination

Measles is highly infectious and can be dangerous. The classic 1968 vaccine is highly effective, and it should be possible to eliminate measles. Graham
et al.
found that measles transmission changes as vaccination coverage and birth rates (that is, the rate of arrival of susceptible individuals into the population) change in a country in response to socioeconomic variables. As a result, measles everywhere follows the canonical mode of decline in response to vaccination campaigns. Incidence is initially high, and variability is low. As incidence declines, variability increases, and as incidence drops toward elimination, so does variability. It is possible to identify countries that are deviating from this expectation and to adapt their vaccination programs to regain the path to elimination.

Science
, this issue p.
584
A specialized metabolic network selectively modulates
Arabidopsis
root microbiota
Authors: Huang Ancheng C. , Jiang Ting , Liu Yong-Xin , Bai Yue-Chen , Reed James , Qu Baoyuan , Goossens Alain , Nützmann Hans-Wilhelm , Bai Yang , Osbourn Anne
Published: May 2019

Mix of metabolites tunes root microbiota

Uncharacterized biosynthetic genes in plant genomes suggest that plants make a plethora of specialized metabolites. Huang
et al.
reconstructed three biosynthetic networks from the small mustard plant
Arabidopsis thaliana
. Promiscuous acyltransferases and dehydrogenases contributed to metabolite diversification. The plant may use these specialized metabolites to modulate the microbiota surrounding its roots. Disruption of the pathways and intervention with purified compounds caused changes in the root microbiota.

Science
, this issue p.
eaau6389
Structures of the M1 and M2 muscarinic acetylcholine receptor/G-protein complexes
Authors: Maeda Shoji , Qu Qianhui , Robertson Michael J. , Skiniotis Georgios , Kobilka Brian K.
Published: May 2019

Choosing a partner

G protein–coupled receptors (GPCRs) bind ligands outside the cell and trigger events inside the cell by selectively binding and activating specific G proteins. The selectivity occurs even among highly related GPCRs. For example, five subtypes of muscarinic acetylcholine receptors (M1R to M5R) play different roles in the nervous system by binding to different G proteins. Maeda
et al.
determined cryo–electron microscopy structures of M1R and M2R bound to their respective G proteins. A side-by-side comparison provided a molecular understanding of G protein–coupling selectivity.

Science
, this issue p.
552
Overcoming quantum decoherence with plasmonics
Authors: Bogdanov Simeon I. , Boltasseva Alexandra , Shalaev Vladimir M.
Published: May 2019

The use of nanoscale plasmonic metamaterials can optimize photon-matter interactions
Comparative Activities of Ceftazidime-Avibactam and Ceftolozane-Tazobactam against Enterobacteriaceae Isolates Producing Extended-Spectrum β-Lactamases from U.S. Hospitals
Authors: Castanheira Mariana , Doyle Timothy B. , Mendes Rodrigo E. , Sader Helio S.
Published: May 2019

The activities of ceftazidime-avibactam, ceftolozane-tazobactam, and comparators were evaluated for 733 isolates displaying resistance to broad-spectrum cephalosporins and carrying extended-spectrum β-lactamase (ESBL) genes detected by whole-genome sequencing analysis. Isolates were collected during 2017 in U.S.
Salmonella enterica Serovar Typhimurium Interacts with CD209 Receptors To Promote Host Dissemination and Infection
Authors: Ye Chenglin , Li Qiao , Li Xinyi , Park Chae Gyu , He Yingxia , Zhang Yingmiao , Wu Bicong , Xue Ying , Yang Kun , Lv Yin , Ying Xiao-Ling , Ding Hong-Hui , Cai Huahua , Alkraiem Ayman Ahmad , Njiri Olivia , Tembo John , Huang Hong-Ping , Li An-Yi , Gong Jianping , Qin Jichao , Cheng Bing , Wei Xiang , Sun Ziyong , Zhang Shu-Sheng , Zhang Pei , Zheng Guo-Xing , Li Wei , Kan Biao , Yan Meiying , Xiding Xiamu , Huo Xixiang , Zeng Yingchun , Peng Hua , Fu Yangxin , Klena John D. , Skurnik Mikael , Jiang Ling-Yu , Chen Tie
Published: May 2019

Salmonella enterica
serovar Typhimurium, a Gram-negative bacterium, can cause infectious diseases ranging from gastroenteritis to systemic dissemination and infection. However, the molecular mechanisms underlying this bacterial dissemination have yet to be elucidated. A study indicated that using the lipopolysaccharide (LPS) core as a ligand,
S
.
How to use perianal examination in children
Authors: Colvin David , Mallett Peter , McMahon Naomi , Bourke Thomas , Thompson Andrew , McCallion William
Published: May 2019

No examination of a child’s abdomen or gastrointestinal system is complete without an examination of the ’backside" or perineum, however there is often reluctance among paediatricians to perform this examination routinely. This article aims to describe how to use perineal examination in infants and children. It discusses the indications and stepwise approach to performing a per-rectal examination and interpretation of the findings one could expect to encounter. We include four cases encompassing the major conditions, both congenital and acquired, that paediatricians should be aware of and how they were managed in our institution.
Should I stay or should I go? A retrospective propensity score-matched analysis using administrative data of hospital-at-home for older people in Scotland
Authors: Tsiachristas Apostolos , Ellis Graham , Buchanan Scott , Langhorne Peter , Stott David J , Shepperd Sasha
Published: May 2019

Objectives

To compare the characteristics of populations admitted to hospital-at-home services with the population admitted to hospital and assess the association of these services with healthcare costs and mortality.

Design

In a retrospective observational cohort study of linked patient level data, we used propensity score matching in combination with regression analysis.

Participants

Patients aged 65 years and older admitted to hospital-at-home or hospital.

Interventions

Three geriatrician-led admission avoidance hospital-at-home services in Scotland.

Outcome measures

Healthcare costs and mortality.

Results

Patients in hospital-at-home were older and more socioeconomically disadvantaged, had higher rates of previous hospitalisation and there was a greater proportion of women and people with several chronic conditions compared with the population admitted to hospital. The cost of providing hospital-at-home varied between the three sites from £628 to £2928 per admission. Hospital-at-home was associated with 18% lower costs during the follow-up period in site 1 (ratio of means 0.82; 95% CI: 0.76 to 0.89). Limiting the analysis to costs during the 6 months following index discharge, patients in the hospital-at-home cohorts had 27% higher costs (ratio of means 1.27; 95% CI: 1.14 to 1.41) in site 1, 9% (ratio of means 1.09; 95% CI: 0.95 to 1.24) in site 2 and 70% in site 3 (ratio of means 1.70; 95% CI: 1.40 to 2.07) compared with patients in the control cohorts. Admission to hospital-at-home was associated with an increased risk of death during the follow-up period in all three sites (1.09, 95% CI: 1.00 to 1.19 site 1; 1.29, 95% CI: 1.15 to 1.44 site 2; 1.27, 95% CI: 1.06 to 1.54 site 3).

Conclusions

Our findings indicate that in these three cohorts, the populations admitted to hospital-at-home and hospital differ. We cannot rule out the risk of residual confounding, as our analysis relied on an administrative data set and we lacked data on disease severity and type of hospitalised care received in the control cohorts.
Developmental factors associated with decline in grip strength from midlife to old age: a British birth cohort study
Authors: Kuh Diana , Hardy Rebecca , Blodgett Joanna M , Cooper Rachel
Published: May 2019

Objectives

To test whether developmental factors are associated with grip strength trajectories between 53 and 69 years, and operate independently or on the same pathway/s as adult factors.

Design

British birth cohort study.

Setting

England, Scotland and Wales.

Participants

3058 men and women.

Main outcome measures

Grip strength (kg) at ages 53, 60–64 and 69 were analysed using multilevel models to estimate associations with developmental factors (birth weight, growth parameters, motor and cognitive development) and father’s social class, and investigate adult factors that could explain observed associations, testing for age and sex interactions.

Results

In men, heavier birth weight, beginning to walk ‘on time’, later puberty and greater weight 0–26 years and in women, heavier birth weight and earlier age at first standing were independently associated with stronger grip but not with its decline. The slower decline in grip strength (by 0.07 kg/year, 95% CI 0.02 to 0.11 per 1 SD, p=0.003) in men of higher cognitive ability was attenuated by adjusting for adult verbal memory.

Conclusions

Patterns of growth and motor development have persisting associations with grip strength between midlife and old age. The strengthening associations with cognition suggest that, at older ages, grip strength increasingly reflects neural ageing processes. Interventions across life that promote muscle development or maintain muscle strength should increase the chance of an independent old age.
One-minute and five-minute Apgar scores and child developmental health at 5 years of age: a population-based cohort study in British Columbia, Canada
Authors: Razaz Neda , Cnattingius Sven , Persson Martina , Tedroff Kristina , Lisonkova Sarka , Joseph K S
Published: May 2019

Objectives

We investigated the associations between Apgar scores at 1 and 5 min, across the entire range of score values, and child developmental health at 5 years of age.

Setting

British Columbia, Canada

Participants

All singleton term infants without major congenital anomalies born between 1993 and 2009, who had a developmental assessment in kindergarten between 1999 and 2014.

Main outcomes and measures

Developmental vulnerability on one or more domains of the Early Development Instrument and special needs requirements. Adjusted rate ratios (aRRs) and 95% CIs were estimated using log-linear regression.

Results

Of the 150 081 children in the study, 45 334 (30.2%) were developmentally vulnerable and 3644 (2.5%) had special needs. There was an increasing trend in developmental vulnerability and special needs with decreasing 1 min and 5 min Apgar scores. Compared with children with an Apgar score of 10 at 5 min, the aRR for developmental vulnerability increased steadily with decreasing Apgar score from 1.02 (95% CI 1.00 to 1.04) for an Apgar score of 9 to 1.57 (95% CI 1.03 to 2.39) for an Apgar score of 2. Among children with 1 min Apgar scores in the 7–10 range, changes in Apgar scores between 1 and 5 min were associated with significant differences in developmental vulnerability. Compared with children who had an Apgar score of 9 at 1 min and 10 at 5 min, children with an Apgar score of 9 at both 1 and 5 min had higher rates of developmental vulnerability (aRR 1.03, 95% CI 1.01 to 1.05). Compared with infants with an Apgar of 10 at both 1 and 5 min, infants with a 1 min score of 10 and a 5 min score of <10 had higher rates of developmental vulnerability (aRR 1.53, 95% CI 1.08 to 2.17).

Conclusion

Risks of adverse developmental health and having special needs at 5 years of age are inversely associated with 1 min and 5 min Apgar scores across their entire range.
Experiences using the poststroke checklist in Sweden with a focus on feasibility and relevance: a mixed-method design
Authors: Kjörk Emma K , Carlsson Gunnel , Sunnerhagen Katharina S , Lundgren-Nilsson Åsa
Published: May 2019

Objective

The wide range of outcomes after stroke emphasises the need for comprehensive long-term follow-up. The aim was to evaluate how people with stroke and health professionals (HPs) perceive the use of the poststroke checklist (PSC), with a focus on feasibility and relevance.

Design

An exploratory design with a mix of qualitative and quantitative methods.

Setting

Outpatient care at a university hospital and primary care centres in western Sweden.

Participants

Forty-six consecutive patients (median age, 70; range, 41–85; 13 women) and 10 health professionals (median age 46; range, 35–63; 7 women).

Results

Most patients (87%) had one or more problems identified by the PSC. The most common problem areas were life after stroke (61%), cognition (56%), mood (41%) and activities of daily living (39%). Three organisational themes emerged from the focus group discussions. The perception ofthe content and relevance ofthe PSC was that common poststroke problems were covered but that unmet needs still could be missed. Identifying needs was facilitated when using thePSC as a tool for dialogue.The dialogue between the patient and HP as well as HPs stroke expertise was perceived as important. The PSC was seen asa systematic routine and a base for egalitarian follow-up, but participants stressed consideration given to each individual. Addressing identified needs and meeting patient expectations were described as challenging given available healthcare services.

Conclusions

The PSC is a feasible and relevant tool to support egalitarian follow-up and identify patients who could benefit from targeted poststroke interventions. Stroke expertise, room for dialogue and caring for identified needs emerged as important issues to consider when using the PSC. Nutrition, sexuality and fatigue were areas mentioned that might need to be addressed within the discussions. The PSC can facilitate patients in expressing their needs, enhancing their ability to participate in decision-making.
Hypotonic and isotonic intravenous maintenance fluids in hospitalised paediatric patients: a randomised controlled trial
Authors: Torres Silvio Fabio , Iolster Thomas , Schnitzler Eduardo Julio , Siaba Serrate Alejandro Javier , Sticco Nicolás A , Rocca Rivarola Manuel
Published: May 2019

Objective

To compare the changes in serum sodium and acid/base status in patients receiving hypotonic and isotonic solutions.

Design

A randomised, controlled and double-blind clinical trial.

Setting

Department of Paediatrics in a tertiary general hospital (Hospital Universitario Austral) in Buenos Aires, Argentina.

Patients

Children between 29 days and 15 years of age who were hospitalised in the paediatric intensive care unit and general hospital between 12 January 2010 and 30 November 2016, and who required exclusively parenteral maintenance solutions for at least 24 hours.

Interventions

A hypotonic solution with 77 mEq/L sodium chloride (0.45% in 5% dextrose) and isotonic solution with 150 mEq/L (0.9% in 5% dextrose) were infused for 48 hours and were labelled.

Main outcome measure

The main outcome was to evaluate the incidence of hyponatraemia between patients treated with parenteral hydration with hypotonic or isotonic fluids. The secondary outcome was to estimate the incidence of metabolic acidosis induced by each of the solutions.

Results

The 299 patients in the present study were randomised to groups that received the hypotonic solution (n=154) or isotonic solution (n=145). The mean serum sodium concentration measurements at 12 hours were 136.3±3.9 mEq/L and 140.1±2.3 mEq/L in the hypotonic and isotonic groups, respectively, with a hyponatraemia incidence of 8.27% (n=12) and 18.8% (n=29) (p<0.001). At 24 hours, 12.4% (n=18) of the isotonic group had developed hyponatraemia compared with 46.1% (n=71) of the hypotonic group (p<0.001). The mean serum sodium concentration measurements were 134.4±5.6 and 139.3±3.1, respectively. No patient developed hypernatraemia (serum sodium concentrations >150 mEq/L) or other adverse outcomes. The relative risk in the hypotonic group was 3.7 (95% CI 2.3 to 5.9), almost four times the risk of developing hyponatraemia than those who received isotonic fluids. There were also no significant differences between the groups with regard to the development of metabolic acidosis. Hypotonic solution, age <12 months and postoperative abdominal surgery were risk factors associated with hyponatraemia.

Conclusions

The incidence of iatrogenic hyponatraemia was greater with the administration of hypotonic fluids compared with that of isotonic fluids. There were no significant differences in the incidence of metabolic acidosis between the groups.
Association between rectal douching and HIV and other sexually transmitted infections among men who have sex with men: a systematic review and meta-analysis
Authors: Li Peiyang , Yuan Tanwei , Fitzpatrick Thomas , Smith Kumi , Zhao Jin , Wu Guohui , Ouyang Lin , Wang Ying , Zhang Kechun , Zhou Yiguo , Li Meijuan , Chen Dahui , Li Linghua , Cai Weiping , Cai Yong , Zou Huachun
Published: May 2019

Background

Men who have sex with men (MSM) are disproportionately affected by HIV and other STIs worldwide. Rectal douching, which is commonly used by MSM in preparation for anal sex, may increase the risk of HIV and other STIs by injuring the rectal mucosa. Results from individual studies reporting associations between rectal douching and HIV and other STIs among MSM are inconsistent. We performed a systematic review and meta-analysis to estimate the association between rectal douching and HIV and other STIs among MSM.

Methods

We searched PubMed, Embase, Scopus and Web of Science for studies published from January 1970 to November 2018. Studies that reported ORs and 95% CIs of associations between rectal douching and infection with HIV/STIs, or reported enough data to calculate these estimates, were included. We assessed risk of bias using the Newcastle-Ottawa Scale. ORs were pooled using a random effects model.

Results

Twenty-eight eligible studies were identified in our review, of which 24 (20 398 participants) were included in the meta-analysis. Rectal douching was associated with increased odds of infection with HIV (OR 2.80, 95% CI 2.32 to 3.39), and any STI other than HIV (including hepatitis B virus (HBV), hepatitis C virus (HCV), chlamydia, gonorrhoea, syphilis and human papillomavirus) (OR 2.46, 95% CI 1.95 to 3.11) among MSM. For specific STIs, douching was associated with increased odds of viral hepatitis (HBV, HCV) (OR 3.29, 95% CI 2.79 to 3.87), and chlamydia or gonorrhoea (OR 3.25, 95% CI 2.02 to 5.23). These associations remained significant in studies that adjusted for potential confounders.

Conclusion

Rectal douching may put MSM at increased risk for infection with HIV and other STIs. Longitudinal studies are needed to clarify this association, and health education materials should inform men of the potential for increased risk of infection with rectal douching.
Economic burden of lung cancer attributable to smoking in China in 2015
Authors: Shi Ju-Fang , Liu Cheng-Cheng , Ren Jian-Song , Parascandola Mark , Zheng Rong , Tang Wei , Huang Hui-Yao , Li Fang , Wang Le , Su Kai , Li Ni , Zhang Kai , Chen Wan-Qing , Wu Ning , Zou Xiao-Nong , Liu Guo-Xiang , Dai Min
Published: May 2019

Background

Lung cancer is substantially attributable to smoking, but detailed related estimates on smoking-attributable expenditure (SAE) in China are not available yet, which could inform tobacco control and cancer prevention initiatives.

Methods

A prevalence-based approach was adopted to estimate the total SAE, including direct expenditure (medical and non-medical) and indirect cost (disability and premature death). Detailed per-patient data on direct expenditure and work-loss days were acquired from a unique multicentre survey in China. Other parameters were from literatures and official reports.

Results

The total estimated SAE of lung cancer was US$5249 million in China in 2015 (0.05 % of gross domestic product for China). The estimated direct SAE was US$1937 million (36.9 % of the total SAE), accounting for 0.29 % of total healthcare expenditure for China. The medical and non-medical direct expenditures were US$1749 million and US$188 million, respectively. The estimated indirect cost was US$3312 million (63.1 % of the total SAE), including US$377 million due to disability and US$2935 million due to premature death. The SAE increased with age, peaking at 60–64 years (US$1004 million), and was higher among men, in urban areas and in eastern China. If smoking prevalence was reduced to 20%, as is the goal of Healthy China 2030, the total SAE would be decreased by 4.9 %.

Conclusions

Smoking-attributable economic burden caused by lung cancer was substantial in China in 2015, and will continue increasing given current trends in lung cancer. However, future economic burden can be prevented with implementation of effective tobacco control and other interventions.
Who do you think you are?
Authors: Barker Penny
Published: May 2019

Ever found yourself convinced you're a fraud, on the brink of being exposed as having fluked your way through your veterinary career? Imposter syndrome is far from a rare phenomenon but, as Penny Barker explains, there are ways to fight back.
Mitochondrial dysfunction regulates the JAK–STAT pathway via LKB1-mediated AMPK activation ER-stress-independent manner
Authors: Kim Dong-Yeon , Lim Su-Geun , Suk Kyoungho , Lee Won-Ha
Published: May 2019

Mitochondria affect cellular functions alone or in cooperation with other cellular organelles. Recent research has demonstrated the close relationship of mitochondria with the endoplasmic reticulum (ER), both at the physical and the functional level. In an effort to define the combined effect of mitochondrial dysfunction (MD) and ER stress in the proinflammatory activities of macrophages, the human macrophage-like monocytic leukemia cell line THP-1 was treated with mitochondrial electron transport chain (ETC) blockers, and changes in the cellular responses upon stimulation by interferon (IFN)-γ were analyzed. Inducing mitochondrial dysfunction (MD) with ETC blockers resulted in suppression of IFN-induced activation of JAK1 and STAT1/3, as well as the expression of STAT1-regulated genes. In addition, experiments utilizing pharmacological modulators of adenosine 5′-monophosphate (AMP)-activated protein kinase (AMPK) and liver kinase B1 (LKB1)-deficient HeLa cells demonstrated that these suppressive effects are mediated by the LKB1–AMPK pathway. Treatment with pharmacological inhibitors of ER stress sensors failed to affect these processes, thus indicating that involvement of ER stress is not required. These results indicate that MD, induced by blocking the ETC, affects IFN-induced activation of JAK–STAT and associated inflammatory changes in THP-1 cells through the LKB1–AMPK pathway independently of ER stress.
Upper-bound limit analysis of soils with a nonlinear failure criterion
Authors: Zhang R. , Smith C.C.
Published: May 2019

Limit analysis is a widely used technique for the analysis of geotechnical collapse states and there exists a significant body of literature covering its application to soils with a linear failure criterion. However, such a failure criterion is often an idealization of an actual nonlinear response for which available analytical techniques are limited. This paper presents a new fully general solution procedure for generating multi-wedge rigid-block upper-bound mechanisms for a soil with a nonlinear failure criterion, utilizing a curved interface that obeys the nonlinear yield function flow rule along its full length. This work extends the long-established kinematic sliding-wedge approach for linear soils and is illustrated through application to active and passive retaining wall and anchor–trapdoor problems. Through additional consideration of the lower-bound solution, close bounds on the retaining wall problem to within ∼1% are established. The ability of the nonlinear upper bound solution to predict the shear and normal stress at every point along the failure surface is discussed.
Drivers of ecosystem metabolism in restored and natural prairie wetlands
Authors: Bortolotti Lauren E. , St. Louis Vincent L. , Vinebrooke Rolf D.
Published: May 2019

Elucidating drivers of aquatic ecosystem metabolism is key to forecasting how inland waters will respond to anthropogenic changes. We quantified gross primary production (GPP), respiration (ER), and net ecosystem production (NEP) in a natural and two restored prairie wetlands (one “older” and one “recently” restored) and identified drivers of temporal variation. GPP and ER were highest in the older restored wetland, followed by the natural and recently restored sites. The natural wetland was the only net autotrophic site. Metabolic differences could not be definitively tied to restoration history, but were consistent with previous studies of restored wetlands. Wetlands showed similar metabolic responses to abiotic variables (photosynthetically active radiation, wind speed, temperature), but differed in the direct and interactive influences of biotic factors (submersed aquatic vegetation, phytoplankton). Drivers and patterns of metabolism suggested the importance of light over nutrient limitation and the dominance of autochthonous production. Such similarity in ecosystem metabolism between prairie wetlands and shallow lakes highlights the need for a unifying metabolic theory for small and productive aquatic ecosystems.
The first assessment of social organisation of the Indian Ocean humpback dolphin (Sousa plumbea) along the south coast of South Africa
Authors: Bouveroux Thibaut , Kirkman Stephen P. , Conry Danielle , Vargas-Fonseca O. Alejandra , Pistorius Pierre A.
Published: May 2019

The Indian Ocean humpback dolphin (Sousa plumbea (G. Cuvier, 1829)) is the most endangered marine mammal species in South Africa, and the overall decline of its abundance and group size may affect the social organisation of the species, potentially accentuating its vulnerability. Understanding the social organisation is therefore particularly relevant to conservation efforts. From photo-identification surveys along the south coast of South Africa from March 2014 to June 2015, we quantified association patterns and investigated the social organisation of Indian Ocean humpback dolphins using the half-weight index, social cluster, and network analyses. During the 101 surveys conducted and 553 h of survey effort, 98 sightings of dolphins were recorded and 65 individuals identified. Using individuals seen at least three times, this study reveals that the social network is well differentiated, as strong social divisions exist between individuals that seem to be split into four distinctive social clusters. Network strength was low; approximately half of the associations were low to moderate, whereas some individuals were strongly associated, especially between four pairs of individuals. Although this study is based on a limited number of individuals, our study nevertheless suggests that the atypical strong social bonds recorded here could result from behavioural responses following the decline in group size and abundance.