bluuebunny/crossref_metadata_2025 huggingface dataset:
Electro‐Optic Property of Mg2+/Er3+‐Codoped LiNbO3 Crystal: Mg2+ Concentration Threshold Effect
Authors: Du Wan‐Ying , Zhang Zi‐Bo , Ren Shuai , Wong Wing‐Han , Yu Dao‐Yin , Pun Edwin Yue‐Bun , Zhang De‐Long
Published: October 2016

A series of Mg2+/Er3+‐codoped congruent LiNbO3 crystals were grown by Czochralski method from the growth melts containing 0.5 mol% Er2O3 while varied MgO content from 0.0 to 7.0 mol%. The unclamped electro‐optic coefficients γ13 and γ33 of these crystals were measured by Mach–Zehnder interferometry. Two different voltage‐applying schemes were adopted: one is the DC voltage applied to the crystal via Al films coated onto crystal surfaces and another is via a pair of external Cu slab electrodes. The coefficients measured by the two schemes show similar strong dependence on Mg2+ concentration. The dependence is non‐monotonous, dramatic, and unusual, and reveals the features of two Mg2+ concentration thresholds of optical damage: one in the Mg2+ concentration range of 1.2–2.0 mol% (in crystal) and another in 4.5–5.0 mol%. Around the threshold the electro‐optic coefficient decreases abruptly at first and then recovers quickly, and the coefficient drops by >20% (12%) at the first (second) threshold, which exceeds the error 3% considerably. The dramatic behavior is qualitatively explained on the basis of the EO coefficient model of LiNbO3 and the defect structure model for Mg2+‐doped LiNbO3.
Predictors of physical activity and barriers to exercise in nursing and medical students
Authors: Blake Holly , Stanulewicz Natalia , Mcgill Francesca
Published: October 2016

Aims

To investigate physical activity levels of nursing and medicine students, examine predictors of physical activity level and examine the most influential benefits and barriers to exercise.

Background

Healthcare professionals have low levels of physical activity, which increases their health risk and may influence their health promotion practices with patients.

Design

We surveyed 361 nursing (n = 193) and medicine (n = 168) students studying at a UK medical school.

Methods

Questionnaire survey, active over 12 months in 2014–2015. Measures included physical activity level, benefits and barriers to exercise, social support, perceived stress and self‐efficacy for exercise.

Results

Many nursing and medicine students did not achieve recommended levels of physical activity (nursing 48%; medicine 38%). Perceived benefits of exercise were health related, with medicine students identifying additional benefits for stress relief. Most notable barriers to exercise were as follows: lack of time, facilities having inconvenient schedules and exercise not fitting around study or placement schedules. Nursing students were less active than medicine students; they perceived fewer benefits and more barriers to exercise and reported lower social support for exercise. Physical activity of nursing and medicine students was best predicted by self‐efficacy and social support, explaining 35% of the variance.

Conclusion

Physical activity should be promoted in nursing and medicine students. Interventions should aim to build self‐efficacy for exercise and increase social support. Interventions should be developed that are targeted specifically to shift‐working frontline care staff, to reduce schedule‐related barriers to exercise and to increase accessibility to workplace health and well‐being initiatives.
Skin‐to‐skin contact for procedural pain in neonates: acceptability of novel systematic review synthesis methods and GRADEing of the evidence
Authors: Disher Timothy , Benoit Britney , Johnston Celeste , Campbell‐Yeo Marsha
Published: October 2016

Aims

The aim of this study was to assess the acceptability of methods that increase trial inclusion in meta‐analyses, and the level of evidence for skin‐to‐skin contact for procedural pain in infants.

Background

The current Cochrane review of skin‐to‐skin contact for pain in newborns found it to be an effective intervention, but identified several methodological limitations.

Design

Meta‐re‐analysis

Methods

Trial designs included randomized trials reporting a validated pain assessment tool as a primary outcome including term and pre‐term infants undergoing a tissue‐breaking painful procedure. The search in the original review was conducted to January 2013. Scores of validated tools were scaled to the premature infant pain profile in a fixed‐effect meta‐re‐analysis. The GRADE was used to assess quality of meta‐analysed evidence.

Results

New analysis vs. original found a mean difference: −3·11 in favour of skin‐to‐skin contact vs. −3·21 at 30 seconds; and −2·71 vs. −1·85 at 60 seconds for heel lance. Based on cut‐off scores for the Neonatal Infant Pain Scale, infants receiving skin‐to‐skin contact during IM injection were more likely to display low pain after injection; and during recovery.

Conclusion

Scaling scores to a single outcome can provide additional information in meta‐analyses, simplifies interpretability of pooled scores, and can improve GRADE outcomes. Sensitivity analyses of scaled scores improve confidence in their validity. Risk of bias subgroups simplified the GRADE process, and confidence intervals for heterogeneity statistics assisted in interpretation of sensitivity analyses.
Nurse leaders as managers of ethically sustainable caring cultures
Authors: Salmela Susanne , Koskinen Camilla , Eriksson Katie
Published: October 2016

Aims

The aim of this study was to identify the distinctive foundations of the care culture and how nurse leaders (NL) can manage and strengthen these in a quest for ethically sustainable caring cultures.

Background

Sustainability presupposes an ethical leadership, a management of the good care and a well‐educated staff, but research on NLs as managers of ethically sustainable caring cultures is not available.

Design

The study has a quantitative design with elements of a qualitative research approach.

Method

Data were collected through a web‐based questionnaire sent to staff at eight selected units at a hospital in western Finland during September 2013; the reply rate was 32%. The data material was comprised of opinion questions, the ranking of values and two open‐ended questions on lodestars in care and ethical principles in care work.

Results

NLs manage a care culture that rests on a solid foundation, where staff are co‐creators of an ethically sustainable caring culture that includes good traditions for the praxis of care. NLs as managers are therefore responsible for realizing and passing on ethically sustainable caring cultures and creating prerequisites for staff's growth and development.

Conclusion

The basis of good care, patient safety and sustainability is comprised of ethics with a respectful and dignified care that is evidence‐based and economically stable. Through their management NLs have a responsibility to nurture and protect the core of caring and create contextual, professional and cultural prerequisites to maintain the core and art of caring as well as care staff's ethical and professional competence.
Barriers and facilitators to healthy eating for nurses in the workplace: an integrative review
Authors: Nicholls Rachel , Perry Lin , Duffield Christine , Gallagher Robyn , Pierce Heather
Published: October 2016

Aim

The aim was to conduct an integrative systematic review to identify barriers and facilitators to healthy eating for working nurses.

Background

There is growing recognition of the influence of the workplace environment on the eating habits of the workforce, which in turn may contribute to increased overweight and obesity. Overweight and obesity exact enormous costs in terms of reduced well‐being, worker productivity and increased risk of non‐communicable diseases. The workplace is an ideal place to intervene and support healthy behaviours. This review aimed to identify barriers and facilitators to nurses’ healthy eating in the workplace.

Design

Integrative mixed method review.

Data sources

Five electronic databases were searched: CINAHL, MEDLINE, PROQUEST Health and Medicine, ScienceDirect and PsycINFO. Reference lists were searched. Included papers were published in English between 2000–2016. Of 26 included papers, 21 were qualitative and five quantitative.

Review methods

An integrative literature review was undertaken. Quality appraisal of included studies used standardized checklists. A social‐ecological framework was used to examine workplace facilitators and constraints to healthy eating, derived from the literature. Emergent themes were identified by thematic analysis.

Results

Review participants were Registered, Enrolled and/or Nurse Assistants primarily working in hospitals in middle or high income countries. The majority of studies reported barriers to healthy eating related to adverse work schedules, individual barriers, aspects of the physical workplace environment and social eating practices at work. Few facilitators were reported. Overall, studies found the workplace exerts a considerable negative influence on nurses’ dietary intake.

Conclusion

Reorientation of the workplace to promote healthy eating among nurses is required.
Divergence and gene flow in the globally distributed blue‐winged ducks
Authors: Nelson Joel T. , Wilson Robert E. , McCracken Kevin G. , Cumming Graeme S. , Joseph Leo , Guay Patrick‐Jean , Peters Jeffrey L.
Published: October 2016

The ability to disperse over long distances can result in a high propensity for colonizing new geographic regions, including uninhabited continents, and lead to lineage diversification via allopatric speciation. However, high vagility can also result in gene flow between otherwise allopatric populations, and in some cases, parapatric or divergence‐with‐gene‐flow models might be more applicable to widely distributed lineages. Here, we use five nuclear introns and the mitochondrial control region along with Bayesian models of isolation with migration to examine divergence, gene flow, and phylogenetic relationships within a cosmopolitan lineage comprising six species, the blue‐winged ducks (genus Anas), which inhabit all continents except Antarctica. We found two primary sub‐lineages, the globally‐distributed shoveler group and the New World blue‐winged/cinnamon teal group. The blue‐winged/cinnamon sub‐lineage is composed of sister taxa from North America and South America, and taxa with parapatric distributions are characterized by low to moderate levels of gene flow. In contrast, our data support strict allopatry for most comparisons within the shovelers. However, we found evidence of gene flow from the migratory, Holarctic northern shoveler A. clypeata and the more sedentary, African Cape shoveler A. smithii into the Australasian shoveler A. rhynchotis, although we could not reject strict allopatry. Given the diverse mechanisms of speciation within this complex, the shovelers and blue‐winged/cinnamon teals can serve as an effective model system for examining how the genome diverges under different evolutionary processes and how genetic variation is partitioned among highly dispersive taxa.
Context‐dependent effects of radio transmitter attachment on a small passerine
Authors: Snijders Lysanne , Weme Lydia E. Nieuwe , de Goede Piet , Savage James L. , van Oers Kees , Naguib Marc
Published: October 2016

Biotelemetry devices provide unprecedented insights into the spatial behaviour and ecology of many animals. Quantifying the potential effects of attaching such devices to animals is essential, but certain effects may appear only in specific or particularly stressful contexts. Here we analyse the effects of radio transmitter attachment on great tits Parus major tagged over three environmentally dissimilar years, as part of a project studying social‐ and communication networks. When we radio‐tagged birds before breeding, only those tagged in the coldest spring tended to be less likely to breed than control birds. Breeding probability was independent of relative transmitter weight (between 5 and 8% bodyweight). When we radio‐tagged both parents during nestling provisioning (transmitter weight between 6 and 8%), tagged parents were more likely than control parents to desert their brood in two out of three years, while in the other year no tagged parents deserted. Tagged parents provisioning larger broods were most likely to desert, especially during lower average temperatures. Video analyses did not reveal any transmitter effects on provisioning behaviour of parents in the year with no desertion. We conclude that radio tagging before breeding did not lead to negative effects, regardless of transmitter weight, but that decisions about radio‐tagging both parents during nestling provisioning need to be made with exceptional care, taking both environmental context and transmitter weight into account. Reporting results from long‐term radio‐tracking studies comprising several environmentally variable years is crucial to understand and predict potential transmitter effects and maximise the tremendous potential of biotelemetry.
Evaluating interspecific niche overlaps in environmental and geographic spaces to assess the value of umbrella species
Authors: Fourcade Yoan , Besnard Aurélien G. , Secondi Jean
Published: October 2016

The concept of umbrella species assumes that concentrating resources on the protection of a single species contributes to the conservation of a suite of species and ecological processes belonging to the same ecosystem. The environmental requirements and geographical distribution of the umbrella species should thus overlap those of the group of targeted species. In western France, the conservation of several large grassland floodplains relies on agri‐environmental schemes targeting one single bird species, the corncrake Crex crex. It is considered as an umbrella species but no real assessment of its effectiveness has been carried out so far. We used a two‐step methodology to assess the potential of the corncrake to act as an umbrella species by estimating niche overlap in the environmental and geographic space between the main ground‐nesting species of the bird community in these grasslands, including the corncrake and four passerines. The five species showed substantial differences in their ecological niches so that their distributions did not perfectly overlap. Overlaps in predicted distributions between pairs of species depended on the threshold used to convert suitability to binary maps. Moreover, the number of species that could be protected by a candidate umbrella species was affected by the overlap criterion of success. Although the corncrake may be used as an umbrella species, it would be outperformed by several passerine species. Our study highlights the potential of using niche overlap to select umbrella species. It also reveals the importance of analysing the sensitivity of outputs when changing thresholds and overlap criteria.
Species‐occupancy distribution removes an excessive parameter from species‐area relationship
Authors: Gavish Yoni , Ziv Yaron
Published: October 2016

Aim

Although species‐occupancy distributions (SODs) and species‐area relationships (SARs) arise from the two marginal sums of the same presence/absence matrices, the two biodiversity patterns are usually explored independently. Here, we aim to unify the two patterns for isolate‐based data by constraining the SAR to conserve information from the SOD.

Location

Widespread.

Methods

Focusing on the power‐model SAR, we first developed a constrained form that conserved the total number of occupancies from the SOD. Next, we developed an additive‐constrained SAR that conserves the entire shape of the SOD within the power‐model SAR function, using a single parameter (the slope of the endemics‐area relationship). We then relate this additive‐constrained SAR to multiple‐sites similarity measures, based on a probabilistic view of Sørensen similarity. We extend the constrained and additive‐constrained SAR framework to 23 published SAR functions. We compare the fit of the original and constrained forms of 12 SAR functions using 154 published data sets, covering various spatial scales, taxa and systems.

Main conclusions

In all 23 SAR functions, the constrained form had one parameter less than the original form. In all 154 data sets the model with the highest weight based on the corrected Akaike's information criteria (wAICc) had a constrained form. The constrained form received higher wAICc than the original form in 98.79% of valid pairwise cases, approaching the wAICc expected under identical log‐likelihood. Our work suggests, both theoretically and empirically, that all SAR functions may have one unnecessary parameter, which can be excluded from the function without reduction in goodness‐of‐fit. The more parsimonious constrained forms are also easier to interpret as they reflect the probability of a randomly chosen occupancy to be found in an isolate. The additive‐constrained SARs accounts for two complimentary turn‐over components of occupancies: turnover between species and turnover between sites.
Advanced glycation end‐products are a risk for muscle weakness in Japanese patients with type 1 diabetes
Authors: Mori Hiroyasu , Kuroda Akio , Araki Michiko , Suzuki Reiko , Taniguchi Satoshi , Tamaki Motoyuki , Akehi Yuko , Matsuhisa Munehide
Published: October 2016

Accumulation of advanced glycation end‐products (AGEs) is thought to contribute to muscle weakness in a diabetic animal model. Skin autofluorescence is a proposed marker for accumulation of AGEs in the skin. We aimed to investigate the relationship between AGEs accumulation, sarcopenia and muscle function of Japanese patients with type 1 diabetes. A total of 36 patients with type 1 diabetes participated in the present cross‐sectional study. Sarcopenia parameters (skeletal muscle mass index and knee extension strength) were compared with subcutaneous AGEs accumulation using skin autofluorescence. The prevalence of sarcopenia and impaired knee extension strength was 16.6% (men 0.0%, women 22.2%) and 47.2% (men 22.2%, women 55.6%), respectively. Knee extension strength was negatively correlated with skin autofluorescence (r² = 0.14, P < 0.05), but not with skeletal muscle mass index. In conclusion, the AGEs accumulation might be one of the reasons of impaired lower limb muscle function in Japanese patients with type 1 diabetes.
Design, construction, and performance evaluation of a gari roaster
Authors: Sobowale Sunday Samuel , Adebiyi Janet Adeyinka , Adebo Oluwafemi Ayodeji
Published: October 2016

Traditional roasting of cassava mash into gari continues to be an arduous and intricate unit operation for processors. It is highly labor intensive, tedious, unhygienic, and productivity is often too low to justify labor and investment time. The aim of this study was thus to design and fabricate a gari roaster and evaluate its performance. Cassava mash of different moisture contents (36.21, 39.44, and 43.27%) were roasted at different garifying temperatures (75, 85, and 95°C) and performance characteristics including, roasting time, percentage material loss, functional efficiency, throughput, and machine capacity were evaluated. Results obtained indicated that roasting cassava mash of 39.44% at 85°C yielded the best roasting conditions, as it had the least material loss of 7.8%, best throughput capacity and functional efficiency of 34.66 kg/hr and 92.20%, respectively. The fabricated gari roaster does not require skilled labor and can effectively address the challenges associated with gari roasting.

Practical Application

The fabricated roaster is relevant to the roasting of cassava mash to produce gari. This will practically address the impending challenges associated with gari roasting especially in the rural areas. This roaster will further ensure production of quality gari to its teeming consumers, thereby contributing to food security.
Development of high‐quality weaning food based on maize and chickpea by twin‐screw extrusion process for low‐income populations
Authors: Ali Salim , Singh Baljit , Sharma Savita
Published: October 2016

This study was carried out to produce high‐quality weaning food from locally available and low cost raw materials. Extrudates of maize (Zea mays) and chickpea (Cicer arietinum) were processed by twin‐screw extruder. Experiments were designed using central composite rotatable design (CCRD) with three‐independent variables [feed moisture (14–18%), screw speed (400–550 rpm), barrel temperature (125–175°C)] and five‐dependent variables [specific mechanical energy (SME), bulk density (BD), water absorption index (WAI), water solubility index (WSI), degree of gelatinization (DG)]. Increase in feed moisture reduced SME, WSI, and DG and increased BD and WAI. Increase in screw speed and barrel temperature decreased BD and WAI and increased WSI and DG of the extrudates. Optimum extrusion conditions were 14.13% feed moisture, 534 rpm screw speed, and 167°C barrel temperature. The ratio of ingredients in the optimized weaning mix was 40% maize‐chickpea extrudates, 35% skim milk powder, and 25% sugar (w/w). The nutrient content was in agreement with the standards described by PFA (prevention of food adulteration act and rules, India, 2004) with high protein and starch digestibility.

Practical applications

Development of weaning foods from locally available and low cost raw materials is a constant challenge for developing countries. Weaning foods are generally produced by traditional techniques like milling, roasting, drying, and germination. In the present scenario of convenience and newer products, we explored the possibility of using twin‐screw extruder for preparation of weaning foods from maize and chickpea. Effects of feed moisture, barrel temperature, and screw speed on the quality parameters of extrudates were studied. Extrudates produced at lower feed moisture, higher screw speed, and higher barrel temperature showed good physicochemical properties and higher protein and starch digestibility.
Reduction of lauric acid in coconut copra by supercritical carbon dioxide extraction: Process optimization and design of functional cookies using the lauric acid‐lean copra meal
Authors: Kumar Ghosh Probir , Bhattacharjee Paramita , Poddar‐Sarkar Mousumi
Published: October 2016

Lauric acid, the principal saturated fat in coconut copra, was extracted using supercritical carbon dioxide (SC‐CO2) to obtain “lauric acid‐lean copra meal.” Fatty acid methyl ester gas chromatograph (FAME‐GC) analysis of oil recovered from copra meal by Soxhlet extraction, showed highest reduction in lauric acid (78.16%), post SC‐CO2 extraction of 20 g ground copra (particle size (dp) of 0.42 mm) at 50°C, 40 MPa and 55 min of extraction at a flow rate of 1 L/min of gaseous CO2. At these extraction conditions, the solubility of lauric acid in SC‐CO2 was found to be the highest. A correlated Chrastil equation was also developed for the determination of solubility of lauric acid in SC‐CO2 at different temperature–pressure regimes. Functional cookies designed with lauric acid‐lean copra meal as a replacement of butter, showed high sensory appeal, low oxidation and appreciable antioxidant potency.

Practical applications

Coconut copra although rich in antioxidants, has saturated fatty acids, which are of concern for cardiovascular diseases (CVDs). This study reports on process engineering of coconut copra to reduce its lauric acid content, the principal saturated fatty acid, by supercritical carbon dioxide (SC‐CO2) extraction. Furthermore, a Chrastil equation has been developed for predicting the solubility of lauric acid at different temperature–pressure regimes of SC‐CO2 extraction, to obtain a lauric acid‐rich oil fraction. The data generated from this work could be employed for pilot plant and commercial scale extractions of lauric acid‐rich oil from coconut copra and other oilseed crops. This work has also exhibited a unique application of the lauric acid‐lean copra meal, post SC‐CO2 extraction. The copra meal has been successfully employed in designing functional antioxidant‐rich cookies, without compromising sensory attributes of popular butter cookies. This lauric acid‐lean copra meal is a potential new designer fat for confectionery industries.
Understanding the complications of anti‐tumor necrosis factor therapy in East Asian patients with inflammatory bowel disease
Authors: Cheon Jae Hee
Published: October 2016

Remarkable advances have been made in the treatment of inflammatory bowel disease since the introduction of anti‐tumor necrosis factor‐α agents, especially for patients who are refractory to or cannot tolerate conventional therapies. Currently, infliximab, adalimumab, and golimumab are available in the East Asian medical market, and these agents have been shown to be effective for inducing and maintaining long‐term remission of inflammatory bowel disease. Despite their clinical benefits, anti‐tumor necrosis factor therapy can also lead to increased vulnerability to infections, development of autoimmune diseases and malignancy, and decreased immunogenicity of vaccinations. Because infectious diseases, such as tuberculosis, hepatitis, and influenza, remain major health problems in East Asia, more cautious use of biologics is needed. To further improve treatment efficacy and safety, close monitoring of inflammation, regular surveillance for malignancy, and regularly scheduled vaccinations are needed. Treatment strategies for biologics should be customized to meet the needs of different patients.
Development of a scale to measure diabetes self‐management behaviors among older Koreans with type 2 diabetes, based on the seven domains identified by the American Association of Diabetes Educators
Authors: Seo Kyoungsan , Song Misoon , Choi Suyoung , Kim Se‐an , Chang Sun Ju
Published: October 2016

Aim

The purpose of this study was to develop the Diabetes Self‐Management Behavior for Older Koreans (DSMB‐O). This scale is based on the seven relevant domains that have been identified by the American Association of Diabetes Educators (AADE) and is adjusted for sociocultural and age‐related characteristics.

Methods

Four phases were used to develop of the DSMB‐O as a criterion‐referenced measure. In phases 1 and 2, the DSMB‐O adopted the AADE’s seven domains and established a self‐report questionnaire using a small number of items that are applicable to older Koreans. In phase 3, the DSMB‐O was formulated with 16 preliminary items, including seven subitems. By assessing the content validity, 14 items (including five subitems) were selected. The final phase involved evaluating the DSMB‐O’s psychometric properties, including test–retest reliability, content validity, and criterion‐related validity, using data from 150 older Koreans with type 2 diabetes.

Results

The coefficients of agreement and Cohen's Kappa for the test–retest reliability test ranged from 0.32 to 1.0 and −0.07 to 1.0, respectively. For the content validity, the values of both the item‐ and scale‐level content validity indices were 1.0. The scores from the DSMB‐O were positively correlated with the scores from the Korean version of the Summary of Diabetes Self‐Care Activities Questionnaire.

Conclusion

The DSMB‐O is short and easy for older Koreans to use, as well as having acceptable levels of reliability and validity. Hence, the DSMB‐O can be a useful tool to evaluate diabetes self‐management behaviors in older Koreans with type 2 diabetes.
Enamel biorhythms of humans and great apes: the Havers‐Halberg Oscillation hypothesis reconsidered
Authors: Mahoney Patrick , Miszkiewicz Justyna J. , Pitfield Rosie , Deter Chris , Guatelli‐Steinberg Debbie
Published: October 2016

The Havers‐Halberg Oscillation (HHO) hypothesis links evidence for the timing of a biorhythm retained in permanent tooth enamel (Retzius periodicity) to adult body mass and life history traits across mammals. Potentially, these links provide a way to access life history of fossil species from teeth. Recently we assessed intra‐specific predictions of the HHO on human children. We reported Retzius periodicity (RP) corresponded with enamel thickness, and cusp formation time, when calculated from isolated deciduous teeth. We proposed the biorhythm might not remain constant within an individual. Here, we test our findings. RP is compared between deciduous second and permanent first molars within the maxillae of four human children. Following this, we report the first RPs for deciduous teeth from modern great apes (n = 4), and compare these with new data for permanent teeth (n = 18) from these species, as well as with previously published values. We also explore RP in teeth that retain hypoplastic defects. Results show RP changed within the maxilla of each child, from thinner to thicker enameled molars, and from one side of a hypoplastic defect to the other. When considered alongside correlations between RP and cusp formation time, these observations provide further evidence that RP is associated with enamel growth processes and does not always remain constant within an individual. RP of 5 days for great ape deciduous teeth lay below the lowermost range of those from permanent teeth of modern orangutan and gorilla, and within the lowermost range of RPs from chimpanzee permanent teeth. Our data suggest associations between RP and enamel growth processes of humans might extend to great apes. These findings provide a new framework from which to develop the HHO hypothesis, which can incorporate enamel growth along with other physiological systems. Applications of the HHO to fossil teeth should avoid transferring RP between deciduous and permanent enamel, or including hypoplastic teeth.
Living with breathlessness in chronic heart failure: a qualitative study
Authors: Walthall Helen , Jenkinson Crispin , Boulton Mary
Published: October 2016

Aims and objectives

To explore how patients with Chronic Heart Failure describe their experiences of breathlessness, the pattern of their breathlessness, how daily life is affected and how they adjust to and manage these symptoms.

Background

Chronic Heart Failure is a highly prevalent syndrome often with poor outcomes and in a patient group who are predominately elderly. Breathlessness is the main symptom experienced by patients and often relates to decompensation and hospitalisation, yet subtle changes described by patients are often not discussed with health care professionals.

Design

A descriptive qualitative design.

Methods

Twenty‐five participants with heart failure with reduced ejection fraction (HF‐rEF) from a tertiary referral centre in England were recruited. Each participant took part in a semi‐structured interview exploring the effect of breathlessness had on their lives. Data was analysed through Braun and Clarke's framework for thematic analysis.

Results

All participants reported experiencing breathlessness daily. Four sub‐themes were identified in their accounts: nature of breathlessness, emotional impact of breathlessness, impact of breathlessness on daily life and managing breathlessness.

Conclusion

Participants were able to give vivid descriptions of breathlessness and the way it affected their lives.

Relevance to clinical practice

Health care professionals need to take account of each patient's personal assessment of their own breathlessness and how this is having an effect on their life and ability to undertake activities of daily living. Self‐care management strategies need to be developed so that subtle changes can be assessed by the patient and reviewed by the healthcare professional to avoid hospitalisation and increased mortality risks.
Abdominal ectopic pregnancy with undetectable serum β‐human chorionic gonadotropin 9 days following blastocyst transfer
Authors: Irani Mohamad , Elias Rony T. , Pereira Nigel , Gunnala Vinay , Rosenwaks Zev
Published: October 2016

With the availability of the highly sensitive β‐human chorionic gonadotropin (β‐hCG) assays, all pregnancies, including ectopic pregnancies (EP), are expected to have detectable serum β‐hCG at 4 weeks’ gestation or 9 days following blastocyst transfer. To our knowledge, this is the first report of a woman who underwent in vitro fertilization, had undetectable serum β‐hCG 9 days after blastocyst transfer, and was then diagnosed with a ruptured abdominal EP and intra‐abdominal bleeding 19 days later. This case highlights that the rise in serum β‐hCG might be delayed in abdominal EP compared to intrauterine pregnancy. This delay should raise the suspicion for EP, thus meriting close monitoring. Moreover, in the absence of menstruation, an undetectable serum β‐hCG 9 days post‐blastocyst transfer should prompt β‐hCG measurement in 2–3 days to avoid the misdiagnosis of an EP.
Recommendations for saving mothers' lives in Japan: Report from the Maternal Death Exploratory Committee (2010–2014)
Authors: Hasegawa Junichi , Ikeda Tomoaki , Sekizawa Akihiko , Tanaka Hiroaki , Nakamura Masamitsu , Katsuragi Shinji , Osato Kazuhiro , Tanaka Kayo , Murakoshi Takeshi , Nakata Masahiko , Ishiwata Isamu ,   on behalf of the Maternal Death Exploratory Committee in Japan and the Japan Association of Obstetricians and Gynecologists
Published: October 2016

To make recommendations for saving mothers' lives, issues related to maternal deaths including diseases, causes, treatments, and hospital and regional systems are analyzed by the Maternal Death Exploratory Committee in Japan. In this report, we present ten clinical important recommendations based on the analysis of maternal deaths between 2010 and 2014 in Japan.
Obstetrical management of patients with extra‐anatomic vascular bypass grafts due to Takayasu arteritis
Authors: Miyasaka Naoyuki , Egawa Makiko , Isobe Mitsuaki , Inoue Yoshinori , Kubota Toshiro
Published: October 2016

Little is known about the obstetrical management of patients with Takayasu arteritis (TA) who have undergone extra‐anatomic vascular bypass (EAVB). We describe two cases of EAVB. Case 1 underwent EAVB due to renovascular hypertension associated with stenosis of the abdominal aorta, and Case 2 due to amaurosis fugax episodes associated with stenosis of the brachiocephalic and left common carotid arteries. Pregnancy outcomes were favorable for both cases, though the original symptoms recurred during the third trimester in each case, possibly due to increased blood flow to the pregnant uterus. Neither bypass occlusion nor anastomotic aneurysm formation was observed. Pregnancy outcomes of patients with EAVB due to TA are favorable, although pregnancies of patients with TA who have cardiovascular complications are associated with an increased risk of maternal and fetal morbidity. The obstetrical management of these patients, however, should include monitoring for complications related to the EAVB.
Hypertension and early menopause after the use of assisted reproductive technologies in women aged 43 years or older: Long‐term follow‐up study
Authors: Rosato Elena , Perrone Giuseppina , Capri Oriana , Galoppi Paola , Candelieri Miriam , Marcoccia Eleonora , Schiavi Michele Carlo , Zannini Ilaria , Brunelli Roberto
Published: October 2016

Aim

The aim of this study was to investigate the long‐term consequences to women's health and the onset of menopause in healthy women of advanced reproductive age who conceived by assisted reproductive technologies (ART).

Methods

Healthy women who conceived by ART (72) and controls (80) were selected among 320 women ≥ 43 years, who delivered between January 2010 and December 2011 in the Department of Gynecological and Obstetrical Sciences and Urological Sciences of “Sapienza” University of Rome.

Body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and presence of hypertension and diabetes were analyzed at three days, six months, and three years after delivery. The onset of menopause was analyzed after three years.

Results

In the ART group, SBP, DBP and hypertension were higher at three days, six months, and three years after delivery. Menopausal age was significantly lower.

Conclusion

The impact of ART in healthy women of advanced reproductive age in the years after delivery is not limited to the possible development of cardiovascular risk factors, such as hypertension, but can also influence the age of onset of menopause.
The relationship between proteoglycan inhibition via xylosyltransferase II silencing and the implantation of salivary pleomorphic adenoma
Authors: Liu Huijuan , Wang Jie , Ren Guiyun , Zhang Yanning , Dong Fusheng
Published: October 2016

Objective

To study the relationship between proteoglycan inhibition and the implantation of salivary pleomorphic adenoma (SPA).

Methods

SPA fresh tissue was primitively cultured and identified. The Ad‐shRNA‐XT‐II adenovirus vector was constructed and transfected into SPA cells to silence the XT‐II gene. The expression of the XT‐II gene and protein was detected using real‐time PCR and Western blotting, respectively. The proteoglycan content of the cells was determined 48 h after transfection. The invasion and migration of SPA cells were observed using Matrigel invasion and wound‐healing assays. Fibroblasts from the tumour capsule of the same patient were obtained, cultured and seeded onto an acellular dermal matrix (ADM) scaffold. Tumour cells were seeded onto the scaffold with the fibroblasts and then transferred to BALB/C‐nu nude mice and allowed to grow in vivo for 3 months.

Results

The SPA cells cultures were positive for human calponin, S‐100 protein, α‐SMA and CK. XT‐II gene and protein expression was decreased by 42.72% and 34%, respectively. The proteoglycan content was downregulated by 41.15%. XT‐II gene silencing decreased the invasion and migration abilities of SPA cells. The assessment of SPA growth in nude mice indicated an absence of tumour growth in the SPA‐XT‐II group (in which the XT‐II gene was silenced), whereas SPA growth was observed in the other two groups (in which the XT‐II gene was not silenced), and the tumour tissue was positive for the human S‐100 protein, α‐SMA and CK8&18.

Conclusion

Proteoglycan inhibition induced via XT‐II gene silencing inhibited the implantation of SPA.
Status of Removable Dentures and Relationship with Oral Candida‐Associated Factors in a Geriatric Population in Catalonia
Authors: Martori Elisenda , Ayuso‐Montero Raúl , Willaert Eva , Viñas Miguel , Peraire Maria , Martinez‐Gomis Jordi
Published: October 2016

Purpose

Colonization by Candida is related to wearing a denture. How denture type, status, and maintenance play a role in determining Candida colonization remains unknown. This work evaluated removable denture status in an elderly population and explored the association between denture‐related factors and oral Candida colonization as determined by systemic and local factors.

Materials and Methods

Socio‐demographic, general health, and behavioral data and oral factors were registered by means of a questionnaire. Oral, dental, and denture‐related factors were assessed by clinical examination, and yeasts were isolated from oral and denture specimens. Multiple logistic regression analysis was used to explore the relative relevance of risk factors.

Results

Overall, 52.4% of subjects used complete dentures in both lower and upper arches, and 90% of the prostheses were in good condition. Denture plaque index was high in most cases, and 75% of subjects had yeasts in their oral cavities. Oral Candida colonization was significantly associated with low saliva pH, sugar consumption, and the fault of a denture component; however, only sugar consumption was found to be an independent factor related with oral Candida colonization, showing an odds ratio of 3.04 in a multiple logistic regression model.

Conclusions

Elderly people in this study used a complete denture in good condition, with a median age of 15 years. Daily or weekly sugar consumption was found to be highly associated with oral colonization by Candida.
Impact of an Education Intervention on Missouri K‐12 School Disaster and Biological Event Preparedness
Authors: Rebmann Terri , Elliott Michael B. , Artman Deborah , VanNatta Matthew , Wakefield Mary
Published: October 2016

BACKGROUND

A 2011 nationwide school pandemic preparedness study found schools to be deficient. We examined the impact of a school nurse educational intervention aimed at improving K‐12 school biological event preparedness.

METHODS

Missouri Association of School Nurses (MASN) members were e‐mailed a survey link in fall 2013 (ie, preintervention), links to online education modules (ie, intervention) in late fall, and a postintervention survey link in spring, 2014. School biological event readiness was measured using 35 indicators, for a possible score range of 0‐35. A paired t‐test compared pre‐ to postintervention preparedness scores.

RESULTS

A total of 133 school nurses (33.6% response rate) completed a survey; 35.3% of those (N = 47) completed both pre‐ and postintervention survey that could be matched. Pre‐ and postintervention preparedness scores ranged from 5 to 28.5 ( = 13.3) and 6.5 to 25 ( = 14.8), respectively. Postintervention scores were significantly higher than preintervention scores for those who watched at least 1 module (t = −2.3, p < .05).

CONCLUSION:

The education intervention was effective at improving school preparedness, though the impact was small. The education intervention needs to be reassessed, especially in regard to providing a longer intervention period.
Victims of Bullying and Tobacco Use Behaviors in Adolescents: Differences Between Bullied at School, Electronically, or Both
Authors: Case Kathleen R. , Cooper Maria , Creamer MeLisa , Mantey Dale , Kelder Steven
Published: October 2016

BACKGROUND

Being a victim of bullying is associated with greater risk of youth substance use; however, research specifically examining whether tobacco use behaviors differ among adolescents who were bullied at school only, electronically only, or both at school and electronically is limited.

METHODS

We examined the associations between being a victim of bullying (at school only, electronically only, or both at school and electronically) and use of tobacco products using data from the 2013 national Youth Risk Behavior Survey.

RESULTS

Girls who were bullied both at school and electronically reported the highest odds of all tobacco use behaviors (ever use of cigarettes, current use of cigarettes, and current use of any tobacco product) as compared with girls who were not bullied after adjusting for covariates. Conversely, for boys, only the association between being bullied electronically only and ever use of cigarettes remained significant after adjusting for covariates.

CONCLUSIONS

Results from this study indicate that electronic bullying may differentially influence the odds of tobacco use in high school students as compared with bullying that occurs at school only. Confirmation of these findings could inform interventions to reduce both bullying and tobacco use in high school.
Coding paediatric outpatient data to provide health planners with information on children with chronic conditions and disabilities
Authors: Craig Elizabeth , Kerr Neal , McDonald Gabrielle
Published: October 2016

Aim

In New Zealand, there is a paucity of information on children with chronic conditions and disabilities (CCD). One reason is that many are managed in hospital outpatients where diagnostic coding of health‐care events does not occur. This study explores the feasibility of coding paediatric outpatient data to provide health planners with information on children with CCD.

Methods

Thirty‐seven clinicians from six District Health Boards (DHBs) trialled coding over 12 weeks. In five DHBs, the International Classification of Diseases and Related Health Problems, 10th Edition, Australian Modification (ICD‐10‐AM) and Systematised Nomenclature of Medicine Clinical Terms (SNOMED‐CT) were trialled for 6 weeks each. In one DHB, ICD‐10‐AM was trialled for 12 weeks. A random sample (30%) of ICD‐10‐AM coded events were also coded by clinical coders. A mix of paper and electronic methods were used.

Results

In total 2,604 outpatient events were coded in ICD‐10‐AM and 693 in SNOMED‐CT. Dual coding occurred for 770 (29.6%) ICD‐10‐AM events. Overall, 34% of ICD‐10‐AM and 40% of SNOMED‐CT events were for developmental and behavioural disorders. Chronic medical conditions were also common.

Clinicians were concerned about the workload impacts, particularly for paper‐based methods. Coder's were concerned about clinician's adherence to coding guidelines and the poor quality of documentation in some notes.

Conclusion

Coded outpatient data could provide planners with a rich source of information on children with CCD. However, coding is also resource intensive. Thus its costs need to be weighed against the costs of managing a much larger health budget using very limited information.
Association of peripheral arterial disease with periodontal disease: analysis of inflammatory cytokines and an acute phase protein in gingival crevicular fluid and serum
Authors: Çalapkorur M. Unlu , Alkan B. A. , Tasdemir Z. , Akcali Y. , Saatçi E.
Published: October 2016

Background and Objective

Inflammation is a common feature of both peripheral arterial disease (PAD) and periodontal disease. The aim of this study was to evaluate the relationship between PAD and periodontal disease by examining the levels of inflammatory cytokines (pentraxin 3 and interleukin 1β) and high sensitive C‐reactive protein from gingival crevicular fluid and serum.

Material and Methods

A total of 60 patients were included in this cross‐sectional study. Patients were divided into two groups based on ankle–brachial index values: with PAD (test group) and non‐PAD (control group). Demographic evaluations, clinical periodontal examinations and biochemical analysis for pentraxin 3, interleukin 1β and high sensitive C‐reactive protein were performed to compare the two groups.

Results

There were no significant differences with respect to gender, age, body mass index, or smoking history (duration, amount) between the two groups (p > 0.05). There were no significant differences between the two groups in terms of clinical periodontal parameters (p > 0.05). Neither gingival crevicular fluid nor serum levels of the cytokines showed differences between the two groups. Logistic regression analysis revealed that, after adjusting for confounding factors (age, gender, diabetes, hypertension and body mass index), periodontitis raised the odds ratio for having PAD to 5.842 (95% confidence interval: 1.558–21.909).

Conclusion

Although there were no significant differences with respect to clinical periodontal parameters and biochemical analyses between the study group and control, periodontitis did raise the odds ratio for having PAD. To clarify this possible relationship, future prospective studies are needed.
Hepatic manifestations of inflammatory bowel diseases
Authors: Restellini Sophie , Chazouillères Olivier , Frossard Jean‐Louis
Published: October 2016

Inflammatory bowel diseases are associated with various hepatobiliary disorders, reported both in Crohn's disease and ulcerative colitis. They may occur at any moment in the natural course of the disease. The prevalence of liver dysfunction rises from 3% to 50% accordingly to definitions used in different studies. Fatty liver is considered as the most common hepatobiliary complication in inflammatory bowel diseases while primary sclerosing cholangitis is the most specific one. Less frequently, inflammatory bowel diseases‐associated hepatobiliary disorders include: autoimmune hepatitis/ primary sclerosing cholangitis overlap syndrome, IgG4‐associated cholangiopathy, primary biliary cholangitis, hepatic amyloidosis, granulomatous hepatitis, cholelithiasis, portal vein thrombosis and liver abscess. The spectrum of these manifestations varies according to the type of inflammatory bowel diseases. Treatments of inflammatory bowel diseases may cause liver toxicity, although incidence of serious complications remains low. However, early diagnosis of drug‐induced liver injury is of major importance as it affects future clinical management. When facing abnormal liver tests, clinicians should undertake a full diagnostic work‐up in order to determine whether the hepatic abnormalities are related to the inflammatory bowel diseases or not. Management of hepatic manifestations in inflammatory bowel diseases usually involves both hepatologists and gastroenterologists because of the complexity of some situations.