bluuebunny/crossref_metadata_2025 huggingface dataset:
Editorial: What is depression?
Authors: Stringaris Argyris
Published: November 2017

‘Depression is a common, debilitating, and potentially lethal disorder.’ This is a standard opening to many a scientific paper on depression. And it is often followed by some very grim statistics. Over 300 million people in the world are estimated to live with depression, and the disorder is ranked by WHO as the single largest contributor to global disability. Most worryingly, adolescents with major depressive disorder are up to 30 times more likely to commit suicide.

Yet, what exactly is depression? Do all 300 million depressed people in the world suffer from the same thing, with the same aetiology? Is depression one disorder that comes in different shades of severity or is it best thought of as heterogeneous mix of problems that we have given one common name to? And, more practically, should we be treating all depression in similar ways?
Natural occurrence of the entomopathogenic genus Pandora on spittlebug pests of crops and pastures in Argentina
Authors: Foieri A. , Pedrini N. , Toledo A.
Published: November 2017

The natural occurrence of entomophathogenic fungi infecting spittlebugs (Hemiptera: Cercopidae) considered serious pests to pasture grasses and crops in Argentina was investigated during summer˗autumn (December to May) from 2013 to 2016. Adults and nymphs of spittlebugs were collected from Sorghum halepense and Setaria parviflora var. parviflora in San Miguel de Tucumán, Tucumán province. The entomopathogenic fungal species were characterized on the basis of morphological keys and molecular techniques. Microscopic characters were described from material mounted in lactophenol/aceto‐orcein (1% w/v), and the amplification of the fungal SSU rDNA was carried out using the universal primers nu‐SSU‐0021‐5′ and nu‐SSU‐1780‐3′. Summarized information about occurrence of fungal infections on spittlebugs populations is provided. This study reports for the first time the occurrence of the genus Pandora infecting adults of the economically important spittlebugs Deois (Deois) mourei, D. (D.) knoblauchii, Isozulia christenseni christenseni and Notozulia entreriana from Argentina expanding the host range and geographical distribution of entomophthoralean fungi.
Growth performance, fatty‐acid composition, lipid deposition and hepatic‐lipid metabolism‐related gene expression in juvenile pond loach Misgurnus anguillicaudatus fed diets with different dietary soybean oil levels
Authors: Li Y. , Jia Z. , Liang X. , Matulic D. , Hussein M. , Gao J.
Published: November 2017

A 10 week feeding trial was conducted to evaluate the effects of different dietary soybean oil (SO) levels on growth performance, fatty‐acid composition and lipid deposition in viscera, histology and histochemistry of liver, intestine and hepatic‐lipid metabolism‐related gene expressions in pond loach Misgurnus anguillicaudatus juveniles. Misgurnus anguillicaudatus (mean ± s.d. mass 0·40 ± 0·01 g) were fed five experimental diets containing SO at different concentrations: 0, 20, 32, 56 and 100% SO and a diet containing 100% fish oil (100% FO). The mass gains and specific growth rates of M. anguillicaudatus fed 20% SO and 100% FO diets were significantly higher than those of the other groups (P < 0·05). The lipid content of viscera and the amount of cytoplasmic vacuolation in the liver increased with incremental dietary SO level. Meanwhile, increasing dietary SO levels up‐regulated the messenger (m)RNA levels of lipogenic genes (such as Δ6fad, scd, pparγ, fas and srebp‐1) and down‐regulated the mRNA levels of the lipolytic genes (such as pparα, cpt1, atgl and hsl) in the liver. The percentage of 20:4n‐6 significantly (P < 0·05) increased with increasing dietary SO level, which might be correlated with the up‐regulation of the mRNA level of Δ6fad. The highest levels of dietary SO, however, had a negative effect on growth performance, lipid deposition of viscera and histology and histochemstry of liver and intestine. The increased lipid accumulation induced by incremental dietary SO level probably occurred through different strategies for lipid metabolism as a result of competition between lipolysis and lipogenesis and between export and import of lipids in this species.
Statistical modelling of sea lice count data from salmon farms in the Faroe Islands
Authors: Gislason H
Published: November 2017

Fiskaaling regularly counts the number of sea lice in the attached development stages (chalimus, mobiles and adult) for the salmon farms in the Faroe Islands. A statistical model of the data is developed. In the model, the sea‐lice infection is represented by the chalimus (or mobile) lice developing into adult lice and is used to simulate past and current levels of adult lice—including treatments—as well as to predict the adult sea lice level 1–2 months into the future. Time series of the chalimus and adult lice show cross‐correlations that shift in time and grow in size with temperature. This implies in situ the temperature‐dependent development times of about 56 down to 42 days and the inverted development times (growth rates) of 0.018 up to 0.024 lice/day at 8–10°C. The temperature dependence is approximated by days at the mean temperature 8.5°C—similar to days from EWOS data. The observed development times at four sites for a year (2010–11) were 49, 50, 51 and 52 days, respectively. Finally, we estimate the sea lice production from fish farms to discuss approaches to control the sea lice epidemics—preferably by natural means. This study is useful for understanding sea lice levels and treatments, and for in situ analysis of the sea‐lice development times and growth rates.
Study of the hooking behaviour of Lepeophtheirus salmonis (Krøyer, 1837) copepodids on Atlantic salmon, Salmo salar L., using a novel in vivo test system
Authors: Delfosse C , Lafont‐Lecuelle C , Barthélémy H , Chabaud C , Teruel E , Bienboire‐Frosini C , Pageat P
Published: November 2017

The screening of putative semiochemicals involved in the interaction between Lepeophtheirus salmonis copepodid and the Atlantic salmon could be used to develop methods to prevent infestation. A bioassay was designed to evaluate the attractiveness of Atlantic salmon for L. salmonis copepodids by counting the number of hooked parasites. A salmon was bathed in a tank with 60 copepodids during 45 min. The salmon was humanely killed and its body was scrubbed above a plastic bag. The content of the bag was filtered to count the number of hooked parasites. This procedure was tested at different water temperatures and for different body mass. The temperature significantly influenced the number of hooked copepodids (p < .05). Smolts presented significantly more hooked copepodids at a higher water temperature (24.6 at 13.8°C) compared to smolts at a lower temperature (18.6 at 6.1°C; p = .011). No correlation was found between the body mass and the number of hooked parasites (p = .65). This bioassay was used to successfully measure the attractiveness of Atlantic salmon for L. salmonis copepodids, making it an interesting tool to screen putative semiochemicals designed to prevent the infestation.
Fish stock losses due to extreme floods – findings from pond‐based aquaculture in the Czech Republic
Authors: Rutkayová J. , Vácha F. , Maršálek M. , Beneš K. , Civišová H. , Horká P. , Petrášková E. , Rost M. , Šulista M.
Published: November 2017

Global climate changes exhibit increasingly severe weather effects throughout Europe, which can affect agriculture by extreme flood events. Those events are related to pond‐based aquaculture damages, which lead to losses of fish stock. The objective was to examine the loss of fish in pond‐based aquaculture during extreme floods in 2002, 2006, 2009, and 2013 in the Czech Republic. The total assessed loss of fish in pond aquacultures caused by recent extreme flood events was 54.2%. The most numerous losses of fish were not achieved in 2002 of extreme events in contrast to logical assumption. Based on the statistical evaluation, carp is significantly (P < 0.001) less vulnerable (or susceptible to losses) than tench, grass carp, pike, and perch. The study revealed differences between the reactions of diverse fish species to flooding and different susceptibilities to flooding within groups of juvenile and adult fish when considering fish species and their age category. This study summarizes the knowledge about the losses of fish stock in pond‐based aquaculture and exposes pilot findings about the species sensitivity and loss rate during flood events. The outcomes also evaluate flood impacts on different aquaculture companies at the same time, and help them to deal with flood risk management.
New Hope for Sarcopenia
Authors: Kim Kwang‐Il
Published: November 2017

See the Reply by Rooks et al.
Phase equilibria modelling constraints on P–T conditions during fluid catalysed conversion of granulite to eclogite in the Bergen Arcs, Norway
Authors: Bhowany K. , Hand M. , Clark C. , Kelsey D. E. , Reddy S. M. , Pearce M. A. , Tucker N. M. , Morrissey L. J.
Published: November 2017

Exhumed eclogitic crust is rare and exposures that preserve both protoliths and altered domains are limited around the world. Nominally anhydrous Neoproterozoic anorthositic granulites exposed on the island of Holsnøy, in the Bergen Arcs in western Norway, preserve different stages of progressive prograde deformation, together with the corresponding fluid‐assisted metamorphism, which record the conversion to eclogite during the Ordovician–Silurian Caledonian Orogeny. Four stages of deformation can be identified: (1) brittle deformation resulting in the formation of fractures and the generation of pseudotachylites in the granulite; (2) development of mesoscale shear zones associated with increased fluid–rock interaction; (3) the complete large‐scale replacement of granulite by hydrous eclogite with blocks of granulite sitting in an eclogitic “matrix”; and (4) the break‐up of completely eclogitized granulite by continued fluid influx, resulting in the formation of coarse‐grained phengite‐dominated mineral assemblages. P–T constraints derived from phase equilibria forward modelling of mineral assemblages of the early and later stages of the conversion to eclogite document burial and partial exhumation path with peak metamorphic conditions of ~21–22 kbar and 670–690°C. The P–T models, in combination with existing T–t constraints, imply that the Lindås Nappe underwent extremely rapid retrogressive pressure change. Fluid infiltration began on the prograde burial path and continued throughout the recorded P–T evolution, implying a fluid source that underwent progressive dehydration during subduction of the granulites. However, in places limited fluid availability on the prograde path resulted in assemblages largely consuming the available fluid, essentially freezing in snapshots of the prograde evolution. These were carried metastably deeper into the mantle with strain and metamorphic recrystallization partitioned into areas where ongoing fluid infiltration was concentrated.
Comparative anatomy of zebrafish paired and median fin muscles: basis for functional, developmental, and macroevolutionary studies
Authors: Siomava Natalia , Diogo Rui
Published: November 2017

In the last decades, Danio rerio became one of the most used model organisms in various evo‐devo studies devoted to the fin skeletal anatomy and fin‐limb transition. Surprisingly, there is not even a single paper about the detailed anatomy of the adult muscles of the five fin types of this species. To facilitate more integrative developmental, functional, genetic, and evolutionary studies of the appendicular musculoskeletal system of the zebrafish and to provide a basis for further comparisons with other fishes and tetrapods, we describe here the identity, overall configuration, and attachments of appendicular muscles in a way that can be easily understood and implemented by non‐anatomist researchers. We show that the muscle pattern of the caudal fin is very different from patterns seen in other fins but is very consistent within teleosts. Our observations support the idea of the developmental and evolutionary distinction of the caudal fin and point out that the musculature of the adult zebrafish pectoral and pelvic fins is in general very similar. Both paired fins have superficial and deep layers of abductors and adductors going to all/most rays plus the dorsal and ventral arrectors going only to the first ray. Nevertheless, we noted three major differences between the pelvic and pectoral fins of adult zebrafishes: (i) the pectoral girdle lacks a retractor muscle, which is present in the pelvic girdle – the retractor ischii; (ii) the protractor of the pelvic girdle is an appendicular/trunk muscle, while that of the pectoral girdle is a branchiomeric muscle; (iii) the first ray of the pectoral fin is moved by an additional arrector‐3. The anal and dorsal fins consist of serially repeated units, each of which comprises one half‐ray and three appendicular muscles (one erector, depressor, and inclinator) on each side of the body. The outermost rays are attachment points for the longitudinal protractor and retractor. Based on our results, we discuss whether the pectoral appendage might evolutionarily be closer to the head than to the pelvic appendage and whether the pelvic appendage might have been derived from the trunk/median fins. We discuss a hypothesis of paired fin origin that is a hybrid of the fin‐fold and Gegenbaur's theories. Lastly, our data indicate that D. rerio is indeed an appropriate model organism for the appendicular musculature of teleosts in particular and, at least in the case of the paired fins, also of actinopterygians as a whole.
3D analysis of sexual dimorphism in size, shape and breathing kinematics of human lungs
Authors: Torres‐Tamayo Nicole , García‐Martínez Daniel , Lois Zlolniski Stephanie , Torres‐Sánchez Isabel , García‐Río Francisco , Bastir Markus
Published: November 2017

Sexual dimorphism in the human respiratory system has been previously reported at the skeletal (cranial and thoracic) level, but also at the pulmonary level. Regarding lungs, foregoing studies have yielded sex‐related differences in pulmonary size as well as lung shape details, but different methodological approaches have led to discrepant results on differences in respiratory patterns between males and females. The purpose of this study is to analyse sexual dimorphism in human lungs during forced respiration using 3D geometric morphometrics. Eighty computed tomographies (19 males and 21 females) were taken in maximal forced inspiration (FI) and expiration (FE), and 415 (semi)landmarks were digitized on 80 virtual lung models for the 3D quantification of pulmonary size, shape and kinematic differences. We found that males showed larger lungs than females (P < 0.05), and significantly greater size and shape differences between FI and FE. Morphologically, males have pyramidal lung geometry, with greater lower lung width when comparing with the apices, in contrast to the prismatic lung shape and similar widths at upper and lower lungs of females. Multivariate regression analyses confirmed the effect of sex on lung size (36.26%; P < 0.05) and on lung shape (7.23%; P < 0.05), and yielded two kinematic vectors with a small but statistically significant angle between them (13.22°; P < 0.05) that confirms sex‐related differences in the respiratory patterns. Our 3D approach shows sexual dimorphism in human lungs likely due to a greater diaphragmatic action in males and a predominant intercostal muscle action in females during breathing. These size and shape differences would lead to different respiratory patterns between sexes, whose physiological implications need to be studied in future research.
The endocranial shape of Australopithecus africanus: surface analysis of the endocasts of Sts 5 and Sts 60
Authors: Beaudet Amélie , Dumoncel Jean , de Beer Frikkie , Durrleman Stanley , Gilissen Emmanuel , Oettlé Anna , Subsol Gérard , Thackeray John Francis , Braga José
Published: November 2017

Assessment of global endocranial morphology and regional neuroanatomical changes in early hominins is critical for the reconstruction of evolutionary trajectories of cerebral regions in the human lineage. Early evidence of cortical reorganization in specific local areas (e.g. visual cortex, inferior frontal gyrus) is perceptible in the non‐human South African hominin fossil record. However, to date, little information is available regarding potential global changes in the early hominin brain. The introduction of non‐invasive imaging techniques opens up new perspectives for the study of hominin brain evolution. In this context, our primary aim in this study is to explore the organization of the Australopithecus africanus endocasts, and highlight the nature and extent of the differences distinguishing A. africanus from the extant hominids at both local and global scales. By means of X‐ray‐based imaging techniques, we investigate two A. africanus specimens from Sterkfontein Member 4, catalogued as Sts 5 and Sts 60, respectively a complete cranium and a partial cranial endocast. Endocrania were virtually reconstructed and compared by using a landmark‐free registration method based on smooth and invertible surface deformation. Both local and global information provided by our deformation‐based approach are used to perform statistical analyses and topological mapping of inter‐specific variation. Statistical analyses indicate that the endocranial shape of Sts 5 and Sts 60 approximates the Pan condition. Furthermore, our study reveals substantial differences with respect to the extant human condition, particularly in the parietal regions. Compared with Pan, the endocranial shape of the fossil specimens differs in the anterior part of the frontal gyri.
Ipsilateral shoulder pain in patients following lung resection in the decubitus position
Authors: Bando Takae , Kondo Kazuya , Onishi Chiemi , Kajiura Koichiro , Takizawa Hiromitsu , Yamada Kazuyo , Sato Hiromi , Imai Yoshie
Published: November 2017

Aims and objectives

To examine the frequency, influencing factors and clinical course of shoulder pain in patients following lung resection.

Background

Thoracoscopes have been introduced in the surgical treatment of lung cancer and allow for less invasive surgery with a minimal incision. However, decubitus position‐related shoulder pain on the operated side has not yet been investigated.

Design

A longitudinal descriptive study.

Methods

Patients who underwent lung resection in the decubitus position. Patients were interviewed 2 days before surgery and once daily for 5 days after surgery. Interview items included background data, the concomitant use of epidural anaesthesia, operative duration, the presence of preoperative shoulder stiffness (excluding shoulder pain), type of surgery and site of operation. The intensity of pain was approximately 5 on an 11‐point numerical rating scale. Descriptive statistics on patient backgrounds were obtained using SPSS Statistics 22 for Windows.

Results

Of the 74 patients who underwent lung resection in a decubitus position, 30 (40.5%) developed shoulder pain on the operated side. The highest rating occurred 1 day after surgery and decreased over time. The following two factors were found to influence shoulder pain on the operated side: operative duration (Z = −2.63; p = .01) and the presence of preoperative shoulder stiffness (excluding shoulder pain) (χ2 = 4.16; p = .04).

Conclusions

This study demonstrated that approximately 40% of patients who underwent lung resection in the decubitus position developed shoulder pain.

Relevance to clinical practice

The presence of postoperative shoulder pain was related to both the duration of the operation and to the presence of preoperative shoulder stiffness. Although the shoulder pain resolves within 4 days, it causes the patient additional discomfort and distress. Therefore, further research is needed on positioning for thoracotomy in order to investigate ways to reduce or eliminate this complication of lung surgery.
Understanding the factors which promote registered nurses’ intent to stay in emergency and critical care areas
Authors: Van Osch Mary , Scarborough Kathy , Crowe Sarah , Wolff Angela C. , Reimer‐Kirkham Sheryl
Published: November 2017

Aims and Objective

To explore the influential factors and strategies that promote an experienced nurse's intent to stay in their emergency or critical care area.

Background

Turnover among registered nurses (herein referred to as nurses) working in specialty areas of practice can result in a range of negative outcomes. The retention of specialty nurses at the unit level has important implications for hospital and health systems. These implications include lost knowledge and experience which may in turn impact staff performance levels, patient outcomes, hiring, orientating, development of clinical competence and other aspects of organizational performance.

Design

This qualitative study used an interpretive descriptive design to understand nurses’ perceptions of the current factors and strategies that promote them staying in emergency or critical care settings for two or more years.

Methods

Focus groups were conducted with 13 emergency and critical care nurses. Data analysis involved thematic analysis that evolved from codes to categories to themes.

Results

Four themes were identified: leadership, interprofessional relationships, job fit and practice environment. In addition, the ideas of feeling valued, respected and acknowledged were woven throughout.

Conclusions

Factors often associated with nurse attrition such as burnout and job stresses were not emphasised by the respondents in our study as critical to their intent to stay in their area of practice. This study has highlighted positive aspects that motivate nurses to stay in their specialty areas.

Relevance to clinical practice

To ensure quality care for patients, retention of experienced emergency and critical care nurses is essential to maintaining specialty expertise in these practice settings.
A multi‐institutional study of the perceived barriers and facilitators to implementing evidence‐based practice
Authors: Duncombe Daphne C
Published: November 2017

Aims and objectives

To examine perceived barriers and facilitators to implementing evidence‐based practice among nurses working in psychiatric, geriatric, hospital and community settings in The Bahamas.

Background

It is evident from previous studies that a number of factors exist which either obstruct or promote the utilisation of research evidence in nursing practice. Identifying these factors is vital to the successful uptake of evidence‐based practice in nursing.

Design

Descriptive, comparative study.

Method

Data were collected using self‐administered questionnaires. A stratified random sample (n = 100) of registered nurses participated; 5‐point Likert‐like scales were used to examine nurses’ perceptions of barriers and facilitators of evidence‐based practice. Descriptive statistics were used to describe demographic characteristics and to compare responses of nurses.

Results

Participants were predominantly female (98.4%), in the 25 to <35 years age group (45.9%). Of nurses surveyed, 72.1% had never tried to implement evidence‐based practice previously. The greatest barriers identified were as follows: “Inadequate resources for implementing research findings” (85.2%; n = 52) and “Inadequate training in research methods” (83.6%; n = 51). The top facilitators identified were as follows: “Training in research methods” (88.5%; n = 54) and “Organisational policies and protocols that are evidence‐based” (86.9%; n = 53).

Conclusions

Nurses generally expressed that they required additional training in research and evidence‐based practice concepts. Although some nurses had a desire to implement evidence‐based practice to provide quality care and improve patient outcomes, many expressed that they lacked the required resources. The study draws attention to the need for prioritisation of evidence‐based practice both at institutional and governmental levels.

Relevance to clinical practice

Successful adoption of evidence‐based practice implies combined efforts of nurses, healthcare providers and policymakers. Further research is needed to determine the best method for successfully incorporating evidence‐based practice into nursing practice in The Bahamas.
Exploring communication during the journey from noticing bodily changes to a diagnosis of endometrial cancer
Authors: Cook Catherine , Brunton Margaret , Pukepuke Tepora , Tan Ai Ling
Published: November 2017

Aims and objectives

To understand women's perspectives about the trajectory from first bodily changes to diagnosis.

Background

With endometrial cancer, as with all gynaecological cancers, early diagnosis is key to successful outcomes. However, women do not always seek clinical advice early. Previously, this gap has been referred to as a “delay,” blamed on fear or refusal to acknowledge symptoms.

Methods

A qualitative research project which involved face‐to‐face interviews with 16 women who had presented with symptoms of endometrial cancer. The paucity of research in the trajectory of women who experience a diagnosis of endometrial cancer required an exploratory overview of the data. Accordingly, an inductive thematic analysis was conducted using the framework of Braun and Clarke (Qualitative Research in Psychology, 3, 2006, 77).

Results

Women and health professionals both resorted to satisficing, using heuristics to make decisions about the importance of symptoms depending on their severity and duration. Most women initially determined that the bodily changes were within the realms of normal. Time to diagnosis was also affected by the following: women's long‐standing assumptions; communication with health professionals; liminality—women oscillating between their self‐assessment that these changes were something significant or nothing important; and gaps in health literacy.

Conclusions

The journey from noticing bodily changes to diagnosis was a nonlinear trajectory. Women worked to make sense of what was happening to them, informed by their sociocultural environment. In particular, confusion about the purpose of cervical screening led a number of participants who had regular smears to assume they were “safe” from cancer worries.

Relevance to clinical practice

Women and some health professionals may be unfamiliar with symptoms potentially indicative of endometrial cancer. There may be structural and communication barriers for women navigating healthcare systems. It is vital that nurses take time both to listen to women and to provide them with resources to enhance their health literacy.
Factors influencing the quality of vital sign data in electronic health records: A qualitative study
Authors: Stevenson Jean E , Israelsson Johan , Petersson Goran , Bath Peter A
Published: November 2017

Aims and objectives

To investigate reasons for inadequate documentation of vital signs in an electronic health record.

Background

Monitoring vital signs is crucial to detecting and responding to patient deterioration. The ways in which vital signs are documented in electronic health records have received limited attention in the research literature. A previous study revealed that vital signs in an electronic health record were incomplete and inconsistent.

Design

Qualitative study.

Methods

Qualitative study. Data were collected by observing (68 hr) and interviewing nurses (n = 11) and doctors (n = 3), and analysed by thematic analysis to examine processes for measuring, documenting and retrieving vital signs in four clinical settings in a 353‐bed hospital.

Results

We identified two central reasons for inadequate vital sign documentation. First, there was an absence of firm guidelines for observing patients’ vital signs, resulting in inconsistencies in the ways vital signs were recorded. Second, there was a lack of adequate facilities in the electronic health record for recording vital signs. This led to poor presentation of vital signs in the electronic health record and to staff creating paper “workarounds.”

Conclusions

This study demonstrated inadequate routines and poor facilities for vital sign documentation in an electronic health record, and makes an important contribution to knowledge by identifying problems and barriers that may occur. Further, it has demonstrated the need for improved facilities for electronic documentation of vital signs.

Relevance to clinical practice

Patient safety may have been compromised because of poor presentation of vital signs. Thus, our results emphasised the need for standardised routines for monitoring patients. In addition, designers should consult the clinical end‐users to optimise facilities for electronic documentation of vital signs. This could have a positive impact on clinical practice and thus improve patient safety.
Compassion in practice—Evaluating the awareness, involvement and perceived impact of a national nursing and midwifery strategy amongst healthcare professionals in NHS Trusts in England
Authors: O'Driscoll Mike , Allan Helen , Liu Liang , Corbett Kevin , Serrant Laura
Published: November 2017

Aims and objectives

To report the findings from an evaluation of the impact of the Compassion in Practice Vision and Strategy (National Health Service England (NHSE), 2012) on nursing, midwifery and care staff.

Background

The Compassion in Practice Vision and Strategy was a programme of work to highlight the importance of compassionate care following the Francis Report in 2013 into the deficits in care in an NHS Hospital Trust. It was launched by NHS England in 2012 at a time when fiscal cuts were introduced by the Department of Health in England.

Design and setting

Mixed methods.

Results

Inferential statistics were used to test whether there were significant differences between staff at different levels of seniority with regard to awareness and involvement in Compassion in Practice Vision and Strategy and their attitudes to it. Awareness and involvement of staff in Compassion in Practice Vision and Strategy were high amongst middle and senior management but limited at ward level. Staff involvement in Compassion in Practice Vision and Strategy was limited due to a lack of awareness. Ward level staff who were aware and involved, perceived a lack of support and communication from senior leadership to deliver the Compassion in Practice Vision and Strategy.

Discussion

Results reveal professional anger, distress and resistance to the Compassion in Practice Vision and Strategy and a view of the programme as a top‐down initiative which did not sufficiently recognise structural constraints on nurses’ ability to deliver compassionate care. We discuss the implications of our findings for global nursing.

Conclusion

Participants emphasised that compassion for patients is only sustainable where there is compassion for staff and many participants felt that they were not being treated with compassion.

Relevance for clinical practice

National Health Service England should strongly affirm that nurses and midwives in general provide compassionate care. Trust leadership should provide support for ward level staff who deliver compassionate care in difficult circumstances.
Perceptions of adults with overweight/obesity and chronic musculoskeletal pain: An interpretative phenomenological analysis
Authors: Cooper Lesley , Ells Louisa , Ryan Cormac , Martin Denis
Published: November 2017

Aims and objectives

To gain insight into the lived experience of adults with overweight/obesity and chronic musculoskeletal pain. Knowledge gained will inform healthcare professionals about the complexity of the weight–pain relationship and enable more effective engagement with this population.

Background

Quantitative studies show links between weight and pain. Adults with overweight/obesity are more likely to experience comorbidity; however, qualitative research describing the complexities of the relationship is limited.

Methods

A purposive sample of adults with overweight/obesity and chronic musculoskeletal pain participated in face‐to‐face interviews. Interviews were audio‐recorded, transcribed verbatim and analysed using interpretive phenomenological analysis.

Results

Eighteen adults (16 female) aged 29–71, body mass index ≥25–46, participated in this study. Three superordinate themes emerged: “pain as a motivator and barrier to weight loss”; “fear of weight causing more damage”; and “activity is positive.” Pain motivates some individuals to lose weight while simultaneously inhibiting weight loss efforts. Participants' perception that extra pressure caused by their weight further damaged joints contributed to fear and catastrophising. Fear is often exacerbated by healthcare professionals' descriptions of musculoskeletal damage, or participants' perception of healthcare professionals' attitude towards people with overweight/obesity. Conversely, individuals acknowledged the benefits of increased activity.

Conclusion

Adults with overweight/obesity and chronic musculoskeletal pain in this study identified a bidirectional relationship between their weight and pain that challenged their weight loss efforts. Overweight/obesity contributed to fear and catastrophising, which resulted in avoidance of exercise that would have assisted their weight loss.

Relevance to clinical practice

Healthcare professionals need to understand the complex relationship between weight and pain, and their patients' understanding of that relationship. Healthcare professionals should use therapeutic communication to reduce the fear of weight causing damage, and thus promote physical activities that will contribute to weight loss. It is also important to ensure that the language used with this patient group does not stigmatise individuals, or cause or exacerbate fear of normal movement.
Nurses’ professional stigma and attitudes towards postpartum women with severe mental illness
Authors: Ordan Revital , Shor Ron , Liebergall‐Wischnitzer Michal , Noble Lawrence , Noble Anita
Published: November 2017

Aims and objectives

To examine professional stigma and attitudes of parenthood towards postpartum women with severe mental illness and the association between postpartum nurses’ attitudes and nursing interventions that promote motherhood.

Background

Stigma and attitudes towards parenthood of women with severe mental illness may influence nurses’ clinical practices.

Design

Cross‐sectional, mixed methods.

Methods

The Stigma among Health Professionals towards People with Severe Mental Illness, Attitudes towards Parenthood among People with Severe Mental Illness and Nursing Interventions that Promote Becoming a Mother Questionnaires were used in the study, as well as qualitative analysis.

Results

Sixty‐one postpartum nurses participated in the study. Increased stigma was associated with an increase in negative attitudes towards parenthood among people with severe mental illness, in general, and towards their parenthood skills, in particular. Postpartum nurses reported a decrease in nursing interventions and a therapeutic nurse–client relationship that fosters mother's empowerment. Themes that emerged from the qualitative analysis were postpartum nurse's perceptions of inadequacy, difficulty of postpartum nurses taking responsibility for managing women with severe mental illness and a paternalistic approach to these women, rather than empowerment, regarding infant care.

Conclusion

Nurses providing care to postpartum women with severe mental illness and their infants may provide fewer routine postpartum interventions due to professional stigma and negative attitudes concerning parenting skills. Nurses should provide individualised, tailored care that allows women with severe mental illness to become a mother to the best of her ability.

Relevance to clinical practice

Not all women with severe mental illness are capable of caring for themselves and/or their baby. Nurses should provide individualised, tailored care that allows the women with severe mental illness to become a mother to the best of her ability.
Esthetic Evaluation of Implant‐Supported Single Crowns: The Implant Restoration Esthetic Index and Patient Perception
Authors: Li Xiachen , Wu Bilin , Cheng Xiaohui , Li Yiming , Xie Xin , Deng Feilong
Published: November 2017

Purpose

To test the validity and reliability of a newly developed Implant Restoration Esthetic Index (IREI) and to compare esthetic outcomes reported by patients and professionals.

Materials and Methods

Ten graduate students and 10 prosthodontists assessed esthetic outcomes of 27 single‐tooth implants with the IREI. Six peri‐implant soft tissue parameters were measured using visual analog scales: mesial papilla presence, distal papilla presence, gingival trigone, soft tissue curvature, alveolar process deficiency, and soft tissue color and texture, as well as the six crown parameters: crown contour, crown position, crown labial convexity, crown characterization, crown color and translucency, and abutment visibility. The validity was tested based on Pearson's correlation. The internal consistency reliability was analyzed by Cronbach's alpha. Interclass correlation coefficients (ICC) were calculated to express the test‐retest reliability and the inter‐rater reliability. The correlations between patient and professional evaluations were analyzed by Pearson's correlation.

Results

The IREI demonstrated significant correlation (p < 0.05) to the pink esthetic score and white esthetic score (PES/WES). The internal consistency reliability showed a Cronbach's Alpha of 0.830. The test‐retest reliability was excellent in both the graduate student group and the prosthodontist group, with ICCs of 0.961 and 0.952, respectively (p < 0.05). The inter‐rater reliability was acceptable, with ICCs of 0.649 and 0.667, respectively (p < 0.05). Low correlation coefficients were found between patient and professional evaluations.

Conclusions

The results of this study indicated that the IREI was considered a valid and reliable index involving sufficient parameters for professional esthetic evaluation of single‐tooth implant restorations. The patient‐reported esthetic outcomes had poor or no significant correlation to professional‐reported outcomes.
Beyond Kuznets: Inequality and the size and distribution of cities
Authors: Castells‐Quintana David
Published: November 2017

As countries develop the percentage of population living in urban areas tends to increase. As this happens, inequality is expected first to increase and then to decline in what is known as the Kuznets inverted‐U. But the literature has not paid much attention to differences in the absolute size of cities potentially affecting economy‐wide inequality. Building on insights from the urban economics literature, this paper studies the relationship between the size and distribution of cities and income inequality at country level. Results show that beyond Kuznets’ hypothesis there is a U‐shaped relationship between average city size and inequality; inequality first falls and then increases with average city size. This result is robust to a long list of controls, different estimation techniques, and identification strategies.
Current perspectives on the role of tonsillectomy
Authors: Greig Samuel R
Published: November 2017

Tonsillectomy is one of the most common paediatric surgical procedures performed in Australasia. The aim of this paper is to provide an up‐to‐date review of the indications for the procedure (and the evidence base for each of these indications), as well as describe the surgical technique and perioperative management and risks for a non‐surgical audience. The primary indications for tonsillectomy are obstructive sleep apnoea (OSA) (where it is most commonly performed in association with adenoidectomy) and recurrent pharyngotonsillitis. There is now high‐quality evidence that tonsillectomy improves objective measures of OSA on sleep studies, as well as quality of life and child behaviour. The impact of surgery on cognitive function is less well delineated. For recurrent pharyngotonsillitis, tonsillectomy has a modest impact on recurrent sore throat symptoms – clinicians should ensure an appropriate pre‐operative observation period and adequately discuss the potential benefits with parents prior to surgery. Traditional approaches to tonsillectomy involve surgically dissecting the entire tonsil from the underlying pharyngeal muscle. Subtotal tonsillectomy (intracapsular tonsillectomy or tonsillotomy) is described for OSA and may reduce perioperative morbidity. Children younger than 3 years and those with moderate to severe OSA or significant comorbidities should be admitted for overnight observation. Simple analgesia is adequate for most patients postoperatively. Codeine is contraindicated due to reports of postoperative death due to respiratory suppression. Overall, tonsillectomy is a well‐tolerated procedure, with pain and postoperative haemorrhage (2–4%) being the most common complications. Haemorrhage can be life threatening; however, the mortality rate remains very small at approximately 1:30 000.
Lateral neck lumps: A systematic approach for the general paediatrician
Authors: King Sebastian K
Published: November 2017

Lateral neck lumps are very common in children, and are largely benign in nature. The majority of lumps may be diagnosed on history and clinical examination alone, and further investigations are often not required. The most common pathologies in young children include reactive lymphadenopathy, lymphadenitis and atypical mycobacterial infections. A lateral neck lump is an uncommon presentation for malignancy and is largely restricted to older children and adolescents. The paediatric surgeon plays an important role in the assessment and management of lateral neck lumps, often in the form of reassurance to the patients and their carers.
Umbilicus and its extensive clinical repertoire
Authors: Beasley Spencer W
Published: November 2017

The umbilicus is involved in a wide range of abnormalities in infants and children. The most severe are evident at birth and include exomphalos (omphalocele) and gastroschisis, both of which can be life‐threatening but are easy to diagnose. Exomphalos is often associated with other congenital abnormalities, whereas the associated problems in gastroschisis are largely confined to the gut. Infection of the umbilicus in the neonate presents as omphalitis. The causes of a moist umbilicus following separation of the umbilical stump are multiple, from the relatively minor umbilical granuloma or ectopic bowel mucosa to the more significant patent urachus that leaks urine. Patency of the entire vitello‐intestinal (omphalomesenteric) tract allows air and faecal fluid to drain through the umbilicus. The clinical manifestations of persistence of the vitello‐intestinal tract vary markedly according to which part remains: clinical presentations include melaena and anaemia, closed‐loop bowel obstruction and Meckel diverticulitis. An umbilical hernia occurs when the umbilical cicatrix fails to close. On the other hand, the umbilicus has its uses, which range from being a route for intravenous access in the neonate to being a convenient point of access in laparoscopic surgery.
Melatonin alleviates adipose inflammation through elevating α‐ketoglutarate and diverting adipose‐derived exosomes to macrophages in mice
Authors: Liu Zhenjiang , Gan Lu , Zhang Tiantian , Ren Qian , Sun Chao
Published: November 2017

Obesity is associated with macrophage infiltration and metabolic inflammation, both of which promote metabolic disease progression. Melatonin is reported to possess anti‐inflammatory properties by inhibiting inflammatory response of adipocytes and macrophages activation. However, the effects of melatonin on the communication between adipocytes and macrophages during adipose inflammation remain elusive. Here, we demonstrated melatonin alleviated inflammation and elevated α‐ketoglutarate (αKG) level in adipose tissue of obese mice. Mitochondrial isocitrate dehydrogenase 2 (Idh2) mRNA level was also elevated by melatonin in adipocytes leading to increase αKG level. Further analysis revealed αKG was the target for melatonin inhibition of adipose inflammation. Moreover, sirtuin 1 (Sirt1) physically interacted with IDH2 and formed a complex to increase the circadian amplitude of Idh2 and αKG content in melatonin‐inhibited adipose inflammation. Notably, melatonin promoted exosomes secretion from adipocyte and increased adipose‐derived exosomal αKG level. Our results also confirmed that melatonin alleviated adipocyte inflammation and increased ratio of M2 to M1 macrophages by transporting of exosomal αKG to macrophages and promoting TET‐mediated DNA demethylation. Furthermore, exosomal αKG attenuated signal transducers and activators of transduction‐3 (STAT3)/NF‐κB signal by its receptor oxoglutarate receptor 1 (OXGR1) in adipocytes. Melatonin also attenuated adipose inflammation and deceased macrophage number in chronic jet‐lag mice. In summary, our results demonstrate melatonin alleviates metabolic inflammation by increasing cellular and exosomal αKG level in adipose tissue. Our data reveal a novel function of melatonin on adipocytes and macrophages communication, suggesting a new potential therapy for melatonin to prevent and treat obesity caused systemic inflammatory disease.
Neuroprotective effects of melatonin on amphetamine‐induced dopaminergic fiber degeneration in the hippocampus of postnatal rats
Authors: Leeboonngam Tanawan , Pramong Ratchadaporn , Sae‐ung Kwankanit , Govitrapong Piyarat , Phansuwan‐Pujito Pansiri
Published: November 2017

Chronic amphetamine (AMPH) abuse leads to damage of the hippocampus, the brain area associated with learning and memory process. Previous results have shown that AMPH‐induced dopamine neurotransmitter release, reactive oxygen species formation, and degenerative protein aggregation lead to neuronal death. Melatonin, a powerful antioxidant, plays a role as a neuroprotective agent. The objective of this study was to investigate whether the protective effect of melatonin on AMPH‐induced hippocampal damage in the postnatal rat acts through the dopaminergic pathway. Four‐day‐old postnatal rats were subcutaneously injected with 5‐10 mg/kg AMPH and pretreated with 10 mg/kg melatonin prior to AMPH exposure for seven days. The results showed that melatonin decreased the AMPH‐induced hippocampal neuronal degeneration in the dentate gyrus, CA1, and CA3. Melatonin attenuated the reduction in the expression of hippocampal synaptophysin, PSD‐95, α‐synuclein, and N‐methyl‐D‐aspartate (NMDA) receptor protein and mRNA caused by AMPH. Melatonin attenuated the AMPH‐induced reduction in dopamine transporter (DAT) protein expression in the hippocampus and the reduction in mRNA expression in the ventral tegmental area (VTA). Immunofluorescence demonstrated that melatonin not only prevented the AMPH‐induced loss of DAT and NMDA receptor but also prevented AMPH‐induced α‐synuclein overexpression in the dentate gyrus, CA1, and CA3. Melatonin decreased the AMPH‐induced reduction in the protein and mRNA of the NMDA receptor downstream signaling molecule, calcium/calmodulin‐dependent protein kinase II (CaMKII), and the melatonin receptors (MT1 and MT2). This study showed that melatonin prevented AMPH‐induced toxicity in the hippocampus of postnatal rats possibly via its antioxidative effect and mitochondrial protection.