bluuebunny/crossref_metadata_2025 huggingface dataset:
Mentoring up: A grounded theory of nurse‐to‐nurse mentoring
Authors: Hale Regina L. , Phillips Carolyn A.
Published: August 2018

Aims and objectives

To generate a theoretical explanation of nurse‐to‐nurse mentoring in the clinical setting.

Background

Despite an abundance of mentoring literature, the processes involved between nurses in mentoring relationships have yet to be studied. Nursing literature has focused on mentor attributes and relationship outcomes rather than focusing on theoretical discovery.

Design

Classical grounded theory (CGT).

Methods

CGT procedures (constant comparative method, coding and memoing) were used to analyse interview data exploring fifteen nurse protégés’ experiences of mentoring.

Results

Confidencing, the protégés’ need to become confident in the professional role, emerged as the main concern of study participants. Three dimensions are threaded throughout nurse‐to‐nurse mentoring: earnest intentions, filial bond and trust‐worthiness. Earnest intentions are the sincere attitude that protégés and mentors demonstrate regarding their mentoring relationship. An exclusive, familial‐type connection, filial bond, attends to the affective needs of protégés and mentors. Trust‐worthiness, the explicit feeling of trust between protégés and mentors, strengthens as each demonstrates being worthy of the other's trust. Mentoring Up theory explains five phases of mentoring: seeding, opening, laddering, equalising and reframing. The initial phases are periods of relationship discovery (seeding) and testing (opening). Laddering is an intense period of reciprocal interactions between mentors and protégés. Equalising begins as protégés perceive themselves to be equal to their mentors in terms of their professional capability. Protégés reflect on the meaning of the relationship in the reframing phase.

Conclusions

Mentoring Up is a dense theory that reveals insights, explanations and predictions for initiating, developing and engaging in mentoring relationships. Mentoring Up fills a gap in the existing literature and provides a framework for future mentoring research.

Relevance to clinical practice

The theory has implications for healthcare organisations, nursing education and individual nurses. Mentoring Up expounds on the interpersonal connections and reciprocal interactions vital for successful nurse‐to‐nurse mentoring.
The effects of resilience and turnover intention on nurses’ burnout: Findings from a comparative cross‐sectional study
Authors: Guo Yu‐fang , Plummer Virginia , Lam Louisa , Wang Yan , Cross Wendy , Zhang Jing‐ping
Published: August 2018

Aims and objectives

To investigate burnout among nurses from Australia and China and explore the effects of resilience and turnover intention on nurse burnout between the two countries.

Background

Nursing shortages and burnout have become serious problems worldwide in recent years. In both developed and developing countries, such as Australia and China, nurse burnout levels are high and therefore attract concern from nurse managers, hospital administrators, nurse educators and researchers. However, few studies have been conducted exploring the differences in burnout and its predictors between Australian and Chinese nurses, particularly investigating the differences in the effect sizes of the predictors.

Design

A comparative cross‐sectional design was employed.

Methods

A total of 100 Australian nurses and 197 Chinese nurses participated in the study. Australian participants completed an online questionnaire, while Chinese participants completed a hardcopy questionnaire. Burnout, resilience and turnover intention were measured.

Results

Burnout was worse for Australian participants than Chinese participants. Only having turnover intention significantly predicted burnout in Australian participants, while low resilience, having turnover intention and low level of regular exercise strongly predicted burnout in Chinese participants. The effect size of turnover intention on burnout in the Australian group was almost twice that of the Chinese group.

Conclusion

The findings of this study show that there are differences in burnout between Australian and Chinese nurses. The effects of resilience and turnover intention on burnout between the two groups are also identified.

Relevance to clinical practice

The differences in nurse burnout and the effects of resilience and turnover intention on burnout should be better understood by nurse managers from Australia and China. Moreover, developing effective strategies relevant to their own country to reduce nurse burnout is recommended.
“You'll have to be my eyes and ears”: A conversation analytic study of physical examination on a health helpline
Authors: Lopriore Stefanie , LeCouteur Amanda , Ekberg Katie , Ekberg Stuart
Published: August 2018

Aims and objectives

To explore the accomplishment of physical examination on a health helpline. By focusing on the ways in which callers are asked to examine themselves and report information to nurses, we aim to provide insight into how physical examination at a distance is achieved.

Background

Physical examination is a routine feature of healthcare encounters. In face‐to‐face settings, patients are subject to professional scrutiny through talk, touch and observation. Health professionals working on helplines face challenges in assessing signs of illness when they do not have physical access to patients.

Design and Methods

Conversation analysis was used to explore sequences of interaction between nurses and callers that involved physical examination.

Analysis

Analysis examined how physical examination was routinely accomplished in a helpline environment. Nurses typically guided callers in self‐examination by drawing on gross categorisations that required reporting of large‐scale characteristics of symptoms (e.g., whether a body part looked “normal”). Physical examination was also regularly accomplished by nurses through two‐component speaking turns: a prefacing component that involved instructions about self‐examination; followed by a second component that included an information‐soliciting question. These practices resulted in callers successfully accomplishing physical examination, despite their lack of professional medical knowledge.

Conclusions

This study identifies the communicative practices used by nurses to accomplish physical examination in helpline calls. Such practices involved asking questions that sought general, rather than specific, information and the prefacing of questions with simple instructions on how to undertake self‐examination.

Relevance to clinical practice

Previous research indicates that physical examination in telehealth can be challenging, particularly in environments where clinicians need patients to examine themselves. This study identifies how nurses on a helpline manage this challenge. The findings highlight ways in which nurses can recruit patients to undertake tasks that would typically be undertaken by clinicians in physically co‐present consultations.
Patients’ perspectives on engaging in their healthcare while hospitalised
Authors: Jerofke‐Owen Teresa , Dahlman Jennifer
Published: August 2018

Aims and objectives

To examine patients’ experiences and preferences for engaging in their healthcare while hospitalised.

Background

Promoting patient engagement or involvement in healthcare has become an important component of contemporary, consumer‐oriented approaches to quality care. Previous research on patient engagement highlights that preferences for engagement are not assessed while hospitalised, leading to patient role confusion and frustration.

Methods

Semistructured interviews were conducted with patients from January–March 2017 to examine their experiences and preferences for engaging in their care while hospitalised on medical‐surgical units in the United States. Inductive thematic analysis was used to uncover the themes from the interview transcriptions. The reporting of research findings followed the COREQ checklist.

Results

Seventeen patients, eight male and nine female, aged between 19–83 years old were interviewed. Patients had a difficult time articulating how they participated in their care while hospitalised, with the majority stating there were few decisions to be made. Many patients felt that decisions were made prior to or during hospitalisation for them. Patients described their engagement through the following themes: sharing the subjective, involvement of family, information‐gathering, constraints, “I let them take care of me,” and variability.

Conclusions

Engagement is a dual responsibility of both nurses and patients. Patients’ experiences highlight that engagement preferences and experiences are not universal between patients, speaking to the importance of assessing patient preferences for engagement in health care upon hospital admission.

Relevance to clinical practice

The articulation of what patients actually experience in the hospital setting contributes to improve nursing practice by offering insight into what is important to the patient and how best to engage with them in their care. The constraints that patients reported facing related to their healthcare engagement should be used to inform the delivery of future engagement interventions in the acute care setting.
The self‐care coping process in patients with chronic heart failure: A qualitative study
Authors: Li Chia‐Chien , Chang Shiow‐Ru , Shun Shiow‐Ching
Published: August 2018

Aim

To understand the self‐care coping process among chronic heart failure patients.

Background

Previous studies have been carried out to understand the experience and the challenges of living with chronic heart failure. However, the coping processes that patients use to overcome self‐care challenges are less understood.

Design

A qualitative design with qualitative content analysis of data was employed.

Methods

Purposive sampling was conducted to recruit inpatients with chronic heart failure between March 1, 2014–March 1, 2015, in a teaching hospital in Taiwan. Semi‐structured interviews (N = 27) were completed, and a content analysis was performed using an inductive method to explore the self‐care coping processes in patients with chronic heart failure.

Results

The findings were categorised into three themes: (a) responding to chronic heart failure self‐care (dealing with negative emotions, accepting reality and struggling between a self‐care regime and self preference), (b) finding ways to live with chronic heart failure (enhancing understanding and knowledge about chronic heart failure, maintaining outer and inner self, engaging positively/negatively with others and relying on religious thoughts and seeking consolation) and (c) reinterpreting chronic heart failure and performing meaning‐oriented coping (re‐evaluating the meaning of life, assigning a new perspective for chronic heart failure and discovering a deeper meaning behind it).

Conclusion

Self‐appearance concerns should be given more attention by healthcare professionals. Meaning‐oriented coping was found to be helpful to cope with the challenges of chronic heart failure. Thus, there is a need to develop interventions associated with meaning‐oriented coping to enhance coping strategies for chronic heart failure patients.

Relevance to clinical practice

It is suggested for healthcare professionals to understand an individual's coping process and support people with chronic heart failure who struggle with self‐care coping. Furthermore, specific interventions including meaning‐oriented interventions might benefit people with chronic heart failure to cope more successfully.
Clinical handover practices among healthcare practitioners in acute care services: A qualitative study
Authors: Fealy Gerard , Donnelly Suzanne , Doyle Gerardine , Brenner Maria , Hughes Mary , Mylotte Elaine , Nicholson Emma , Zaki Marina
Published: August 2018

Aims and objectives

To examine clinical handover practices in acute care services in Ireland. Objectives were to examine clinical handover practices between and within teams and between shifts, to identify resources and supports to enhance handover effectiveness and to identify barriers and facilitators of effective handover.

Background

Clinical handover is a high‐risk activity, and ineffective handover practice constitutes a risk to patient safety. Evidence suggests that handover effectiveness is achieved through staff training and standardised handover protocols.

Design

The study design was qualitative‐descriptive using inductive analysis.

Methods

The study involved a series of focus group discussions and interviews among a sample of healthcare practitioners recruited from 12 urban and regional acute hospitals in Ireland. A total of 116 healthcare professionals took part in 28 interviews and 13 focus group discussions. We analysed the data using the directed content analysis method.

Results

Data collection generated rich qualitative data, yielding five categories from which two broad themes emerged: “policy and practice” and “handover effectiveness.” The themes and their associated categories indicate that there is limited organisational‐level policy and limited explicit training in clinical handover, that medical and nursing handovers are separate activities with somewhat different purposes and different modes of execution, and that several factors in the acute care setting, including location, timing and documentation, act as either barriers or enablers to handover effectiveness.

Conclusion

The evidence in the current study suggests that clinical handover merits increased level of prominence in hospital policies or operating procedures. Medical and nursing handover practices represent distinct activities in their content and execution that may be related to cultural and organisational factors.

Relevance to clinical practice

Achieving multidisciplinary team handover requires a change in embedded traditional practices. Several aspects of the clinical handover activities of nursing and medical staff appear to diverge from best‐practice evidence.
“Thrust out of normality”—How adults living with cystic fibrosis experience pulmonary exacerbations: A qualitative study
Authors: Schmid‐Mohler Gabriela , Caress Ann‐Louise , Spirig Rebecca , Benden Christian , Yorke Janelle
Published: August 2018

Aim and objectives

To explore the experience of pulmonary exacerbation from the perspective of adults with cystic fibrosis.

Background

While management of pulmonary exacerbations is a pillar of cystic fibrosis care, little is known of patients’ perspectives. Understanding the patient's experience is essential for developing and evaluating interventions in support of patient self‐management.

Design

Qualitative study with longitudinal study in a subsample.

Methods

The study took place from 2015–2016 in a university hospital. Eighteen patients with cystic fibrosis were included who were ≥18 years of age and had no solid organ transplant. Patients’ experiences were explored through semistructured interviews and analysed using framework analysis. They each participated in one interview, with a subsample (N = 7) being interviewed twice during and once after antibiotic therapy.

Results

Patients (11 men and 7 women; median age 29.5 years, range 19–55 years; median FEV1 45%, range FEV1 23%–105%) experienced pulmonary exacerbations as disruptions of their normality, which led to a substantial increase in their emotional distress. Exacerbations represented a period of threat and domination by CF; that is, symptoms and treatment consumed energy, restricted physical activity and daily life roles. “Noting change,” “waiting until antibiotics help,” “returning to normality” and “establishing a new normality” characterised their descriptions of the pulmonary exacerbation trajectory. Emotional distress was the major driver for patients’ self‐management, and personal goals and illness beliefs influenced also patients’ self‐management decisions.

Conclusion

The experienced degree and source of emotional distress are drivers for self‐management decisions in patients with cystic fibrosis who experience a pulmonary exacerbation.

Relevance to clinical practice

Our data provide new understanding that will be essential to informing clinical practice, future patient‐reported outcomes measures and intervention development.
Unscheduled News and Market Dynamics
Authors: DUGAST JÉRÔME
Published: August 2018

When unscheduled news arrives, investors react with a stochastic delay yet still may exploit new information. In this context, I study the equilibrium dynamics of limit order markets. Continuous idiosyncratic liquidity shocks result in trades on both sides of the order book. News therefore arrives at random times. Following news, order flows become unbalanced and market depth is consumed, leading to positive covariance between price variability, trading volume, and order book unbalances. Holding the unconditional price variability constant, news frequency has a negative effect on both market depth and the variability‐volume covariance.
Equalizing tax bases or tax revenues under tax competition? The role of formula apportionment
Authors: Liesegang Caterina , Runkel Marco
Published: August 2018

This paper contributes to the literature on fiscal equalization and corporate tax competition. The innovation is that we explicitly model multinational enterprises and a corporate tax system that is designed according to formula apportionment. Two main results are obtained. First, in contrast to previous studies we identify cases where tax revenue equalization is better in mitigating detrimental tax competition than tax base equalization. Second, tax base equalization nevertheless has the advantage that it may render tax rates efficient, depending on the shape of the apportionment formula. A pure payroll formula does not ensure efficiency, but a back‐of‐the‐envelope calibration of our model to Canadian provinces suggests that a pure sales formula may be optimal.
Nursing home choice, family bargaining, and optimal policy in a Hotelling economy
Authors: Leroux Marie‐Louise , Ponthiere Gregory
Published: August 2018

We develop a model of family bargaining to study the impact of the distribution of bargaining power within the family on the choice of nursing homes by families, and on the locations and prices chosen by nursing homes in a Hotelling economy. In the baseline (static) model, where the dependent parent cares only about the location of the nursing home, the markup of nursing homes is increasing in the bargaining power of the dependent parent, and nursing homes are located at the extreme periphery. We compare the laissez‐faire with the social optimum (which involves more central locations of nursing homes), and examine its decentralization in first‐best and second‐best settings. We explore the robustness of our results to introducing a bequest motive in a dynamic overlapping generations model, which allows us to study the joint dynamics of wealth accumulation and nursing home prices. If the bequest motive is strong, the markup is decreasing in the bargaining power of the dependent. However, wealth accumulation, by reducing interest rates, raises markup rates and nursing homes prices.
Melatonin and 5‐fluorouracil co‐suppress colon cancer stem cells by regulating cellular prion protein‐Oct4 axis
Authors: Lee Jun Hee , Yun Chul Won , Han Yong‐Seok , Kim SangMin , Jeong Dongjun , Kwon Hyog Young , Kim Hyeongjoo , Baek Moo‐Jun , Lee Sang Hun
Published: August 2018

Melatonin suppresses tumor development. However, the exact relationship between melatonin and cancer stem cells (CSCs) is poorly understood. This study found that melatonin inhibits colon CSCs by regulating the PrPC‐Oct4 axis. In specimens from patients with colorectal cancer, the expressions of cellular prion protein (PrPC) and Oct4 were significantly correlated with metastasis and tumor stages. Co‐treatment with 5‐fluorouracil (5‐FU) and melatonin inhibited the stem cell markers Oct4, Nanog, Sox2, and ALDH1A1 by downregulating PrPC. In this way, tumor growth, proliferation, and tumor‐mediated angiogenesis were suppressed. In colorectal CSCs, PRNP overexpression protects Oct4 against inhibition by 5‐FU and melatonin. In contrast, Nanog, Sox2, and ALDH1A1 have no such protection. These results indicate that PrPC directly regulates Oct4, whereas it indirectly regulates Nanog, Sox2, and ALDH1A1. Taken together, our findings suggest that co‐treatment with anticancer drug and melatonin is a potential therapy for colorectal cancer. Furthermore, PrPC maintains cancer stemness during tumor progression. Therefore, targeting the PrPC‐Oct4 axis may prove instrumental in colorectal cancer therapy.
Dreaming of a learning task is associated with enhanced memory consolidation: Replication in an overnight sleep study
Authors: Wamsley Erin J. , Stickgold Robert
Published: August 2018

Sleep following learning benefits memory. One model attributes this effect to the iterative “reactivation” of memory traces in the sleeping brain, demonstrated in animal models. Although technical limitations prohibit using the same methods to observe memory reactivation in the human brain, the study of mental activity during sleep provides an alternative method of observing memory activation during sleep. In fact, the content of dream experience may reflect the process of memory reactivation and consolidation in the sleeping brain. In line with this hypothesis, we previously reported that dreaming about a spatial learning task during a nap strongly predicts subsequent performance improvements. Here, we replicate this observation in an overnight sleep study, for the first time demonstrating that pre‐sleep training on a virtual maze navigation task is reflected in dreams reported from all phases of sleep, with unambiguous representation of the task in dream content associated with improved next‐morning performance. These observations are consistent with reactivation‐based models of memory consolidation in sleep, confirming our earlier finding that the cognitive‐level activation of recent experience during sleep is associated with subsequent performance gains.
Competitive control of endoglucanase gene engXCA expression in the plant pathogen Xanthomonas campestris by the global transcriptional regulators HpaR1 and Clp
Authors: Liu Guo‐Fang , Su Hui‐Zhao , Sun Han‐Yang , Lu Guang‐Tao , Tang Ji‐Liang
Published: August 2018

Transcriptional regulators are key players in pathways that allow bacteria to alter gene expression in response to environmental conditions. However, work to understand how such transcriptional regulatory networks interact in bacterial plant pathogens is limited. Here, in the phytopathogen Xanthomonas campestris, we demonstrate that the global transcriptional regulator HpaR1 influences many of the same genes as another global regulator Clp, including the engXCA gene that encodes extracellular endoglucanase. We demonstrate that HpaR1 facilitates the binding of RNA polymerase to the engXCA promoter. In addition, we show that HpaR1 binds directly to the engXCA promoter. Furthermore, our in vitro tests characterize two binding sites for Clp within the engXCA promoter. Interestingly, one of these sites overlaps with the HpaR1 binding site. Mobility shift assays reveal that HpaR1 has greater affinity for binding to the engXCA promoter. This observation is supported by promoter activity assays, which show that the engXCA expression level is lower when both HpaR1 and Clp are present together, rather than alone. The data also reveal that HpaR1 and Clp activate engXCA gene expression by binding directly to its promoter. This transcriptional activation is modulated as both regulators compete to bind to overlapping sites on the engXCA promoter. Bioinformatics analysis suggests that this mechanism may be used broadly in Xanthomonas campestris pv. campestris (Xcc) and is probably widespread in Xanthomonads and, potentially, other bacteria. Taken together, these data support a novel mechanism of competitive activation by two global regulators of virulence gene expression in Xcc which is probably widespread in Xanthomonads and, potentially, other bacteria.
The toad fly Lucilia bufonivora: its evolutionary status and molecular identification
Authors: Arias‐Robledo G. , Stark T. , Wall R. L. , Stevens J. R.
Published: August 2018

The blow fly genus Lucilia is composed largely of saprophages and facultative myasis agents, including the economically important species Lucilia cuprina (Wiedemann) (Diptera: Calliphoridae) and Lucilia sericata (Meigen). Only one species is generally recognized as an obligate agent of myiasis, Lucilia bufonivora Moniez, and this is an obligate parasite of toads. Lucilia silvarum (Meigen), a sister species, behaves mainly as a carrion breeder; however, it has also been reported as a facultative parasite of amphibians. Morphologically, these species are almost identical, and historically this has led to misidentification, taxonomic ambiguity and a paucity of studies of L. bufonivora. In this study, dipterous larvae were analysed from toad myiasis cases from the U.K., The Netherlands and Switzerland, together with adult specimens of fly species implicated in amphibian parasitism: L. bufonivora, L. silvarum and Lucilia elongata Shannon (from North America). Partial sequences of two genes, cox1 and ef1α, were amplified. Seven additional blow fly species were analysed as outgroups. Bayesian inference trees of cox1, ef1α and a combined‐gene dataset were constructed. All larvae isolated from toads were identified as L. bufonivora and no specimens of L. silvarum were implicated in amphibian myiasis. This study confirms L. silvarum and L. bufonivora as distinct sister species and provides unambiguous molecular identification of L. bufonivora.
Identification of Mucorales in patients with proven invasive mucormycosis by polymerase chain reaction in tissue samples
Authors: Gholinejad‐Ghadi Nahid , Shokohi Tahereh , Seifi Zahra , Aghili Seyed Reza , Roilides Emmanuel , Nikkhah Mehdi , Pormosa Rostam , Karami Hossein , Larjani Laleh Vahedi , Ghasemi Maryam , Haghani Iman
Published: August 2018

Background

Accurate diagnosis of mucormycosis, a life‐threatening fungal infection, remains a challenge for physicians.

Objectives

To identify the causative Mucorales in fresh clinical samples and formalin‐fixed paraffin‐embedded (FFPE) samples of patients with proven mucormycosis by molecular method.

Patients/Methods

Fresh clinical samples of patients with proven mucormycosis according to the EORTC/MSG criteria admitted between 2015 and 2017 and histopathologically proven FFPE archives collected during 2004‐2007 and 2015‐2017 from Mazandaran University‐affiliated hospitals of northern Iran were included. Seminested PCR targeting the 18S rDNA of Mucorales and ITS region was performed, and PCR products were then sequenced.

Results

While culture was positive only in 5 of 9 (56%) of fresh specimen cases, PCR was positive in all 9 (100%) histologically proven mucormycosis. Ten of 18 (56%) FFPE samples were PCR‐positive. Overall, Mucorales PCR was positive in 19 of 27 (70%) samples. Mucorales species were Rhizopus arrhizus in 16 (84%) cases, R. arrhizus/Amylomyces rouxii in 2 (10.5%) cases and Rhizopus stolonifer in one case (5.5%). Among 27 mucormycosis cases, 25 (93%) cases were rhinocerebral, and 2 (7%) cases were disseminated. Diabetes mellitus (74%) and neutropaenia (63%) were the main risk factors.

Conclusions

Seminested PCR targeting 18S rDNA region of Mucorales is useful for identification of the causative agents of mucormycosis.
Retrospective chart review to assess domains of quality of death (recognition of dying, appropriate limitations, symptom monitoring, anticipatory prescribing) of patients dying in the acute hospital under the care of a nephrology service with renal supportive care support over time
Authors: Urban Agnes K , Foote Celine , Brennan Frank P , Brown Mark , Lee Brendon W H
Published: August 2018

Aim

To explore the quality of deaths in an acute hospital under a nephrology service at two teaching hospitals in Sydney with renal supportive care services over time.

Methods

Retrospective chart review of all deaths in the years 2004, 2009 and 2014 at St George Hospital (SGH) and in 2014 at the Concord Repatriation General Hospital. Domains assessed were recognition of dying, invasive interventions, symptom assessment, anticipatory prescribing, documentation of spiritual needs and bereavement information for families. End‐of‐life care plan (EOLCP) use was also evaluated at SGH.

Results

Over 90% of patients were recognized to be dying in all 3 years at SGH. Rates of interventions in the last week of life were low and did not differ across the 3 years. There was a significant increase in the prescription of anti‐psychotic, anti‐emetic and anti‐cholinergic medication over the years at SGH. Use of EOLCP was significantly higher at SGH, and their use improved several quality domains. Of all deaths, 68% were referred to palliative care at SGH and 33% at Concord Repatriation General Hospital (not significant). Cessation of observations and non‐essential medications and documentation of bereavement information given to families was low across both sites in all years, although this significantly improved when EOLCP were used.

Conclusion

While acute teams are good at recognizing dying, they need support to care for dying patients. The use of EOLCP in acute services can facilitate improvements in caring for the dying. Renal supportive care services need time to become embedded in the culture of the acute hospital.
Bone‐targeted delivery of TGF‐β type 1 receptor inhibitor rescues uncoupled bone remodeling in Camurati–Engelmann disease
Authors: Qin Yunhao , Tang Shibing , Zhen Gehua , Ding Qiang , Ding Sheng , Cao Xu
Published: August 2018

Camurati–Engelmann disease (CED) is a genetic bone‐modeling disorder mainly caused by mutations in the gene that encodes transforming growth factor‐β1 (TGF‐β1). Symptoms of CED include bone pain, fractures, and dysplasia. Currently, effective therapies for bone fracture and dysplasia in CED are urgently needed. We have demonstrated that TGF‐β1 is a coupling factor for bone remodeling and is aberrantly activated in CED. Daily injection of TGF‐β type 1 receptor inhibitor (TβR1I) attenuated CED symptoms, but this systemic administration caused serious side effects. In this study, we created a conjugate linking TβR1I and alendronate, which delivered TβR1I specifically to bone. After weekly injection of the conjugate for 8 weeks, normal bone morphology and remodeling in CED mice was maintained with a minimum effective dose 700 times lower than TβR1I injection. Additionally, we found that the conjugate restored normal bone turnover by reducing the number of osteoblasts and osteoclasts, maintained a regular osteogenic microenvironment by regulating the formation of CD31 and Endomucin double‐positive vessels, and preserved ordinary bone formation via inhibition of the migration of leptin‐receptor‐positive cells. Thus, targeting delivery of TβR1I to bone is a promising therapy for CED and other uncoupled bone remodeling disorders.
How to reduce parental provision of unhealthy foods to 3‐ to 8‐year‐old children in the home environment? A systematic review utilizing the Behaviour Change Wheel framework
Authors: Johnson B. J. , Zarnowiecki D. , Hendrie G. A. , Mauch C. E. , Golley R. K.
Published: August 2018

Background and objective

The effectiveness of obesity prevention interventions to improve children's diet can be enhanced. Deconstructing past interventions can identify components with potential to change behaviour. This systematic review using the Behaviour Change Wheel aimed to examine the behaviour change content of interventions supporting parents of 3‐ to 8‐year olds to reduce provision of unhealthy foods to children.

Methods

Ebscohost, Ovid, Scopus and Web of Science were searched. Eligible studies included controlled interventions with active parent involvement, at least one intervention strategy and outcome measure for unhealthy foods ≥3 months from baseline. Seventeen interventions were included describing 18 intervention arms.

Results

Interventions frequently targeted parents' reflective motivation (n = 17) and psychological capability (n = 15), through education (n = 15) or enablement (n = 15) intervention functions and service provision (n = 18) policy category. Only 24 of the 93 behaviour change techniques were used with an average of five techniques used per intervention.

Conclusions

Existing interventions achieving small reductions in unhealthy food intake are homogenous in approach. There is potential to utilize untapped behaviour change techniques, through comprehensive intervention design and behavioural analysis guided by the Behaviour Change Wheel. Interventions targeting opportunity through persuasion, modelling or environmental restructuring, and using different policy categories are urgently needed to provide an evidence base to inform policy and practice.
The use of an esophageal catheter to check the results of left atrial posterior wall isolation in the treatment of atrial fibrillation
Authors: Furniss Guy , Panagopoulos Dimitrios , Newcomb Dan , Lines Ian , Dalrymple‐Hay Malcolm , Haywood Guy
Published: August 2018

Background

Left atrial posterior wall isolation (LAPWI) via catheter, surgical, and hybrid techniques is a promising treatment for persistent atrial fibrillation (PersAF). We investigated whether confirmation of LAPWI can be achieved using an esophageal pacing and recording electrode.

Methods

Patients undergoing PersAF ablation with the intention to achieve LAPWI were enrolled. Two approaches to LAPWI were tested: (1) ablation using endocardial catheter ablation only, and (2) “Staged Hybrid” ablation with thoracoscopic epicardial ablation, followed by endocardial left atrial electrophysiological study and catheter ablation where necessary. Patients enrolled in the study all required further catheter ablation to achieve LAPWI in this group.

In both the groups, esophageal recording and esophageal pacing was performed at the start of mapping and electrophysiological study and compared with endocardial electrophysiological findings. This was repeated at the end of the procedure.

Results

Twenty patients (16 M, four F) were studied. Endocardial electrophysiological study showed that in none of the cases was the posterior left atrial wall electrically isolated at the start of the study. One patient with Barrett's esophagus failed to sense or pace from the esophagus at any point in the study. In the remaining 19/19, esophageal pacing captured the atrial rhythm at the start of the procedure. LAPWI was then achieved in 17/19 using endocardial catheter ablation; retesting at this point showed sensing and capture of the atrium from the esophagus was abolished. In the remainder sensing and capture persisted.

Conclusions

Esophageal pacing can be used to confirm or refute electrical isolation of the left atrial posterior wall.
Playing it close to the VEST and the clinical guidelines: Clinical guideline compliance in HFrEF patients—Role of WCD
Authors: Mirro Michael J. , Keltner Emily E. , Roebuck Amelia E. , Sears Samuel F.
Published: August 2018

Background

Guideline‐directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) has been challenging to achieve universally. Healthcare providers who seek to achieve optimal medical therapy frequently consider either a wearable cardioverter defibrillator (WCD) or an implantable cardioverter defibrillator (ICD) as indicated. The dynamic process of communication and physician recommendations marks a setting to study the relative interdependence of medical therapies and best practice. The purpose of this study was to examine the long‐term impact of the WCD on GDMT. We hypothesized the WCD serves as a “gateway” therapy, likely impacting other optimal strategies such that successful use of WCD improves GDMT adherence.

Methods

Electronic medical records (EPIC) were manually reviewed to extract data elements in this observational study of 1289 HFrEF patients from 2013‐2015. Data included demographics, comorbidities, and use of GDMT including an ICD use in persistently low ejection fraction (≤36%) patients after 90 days.

Results

WCD use was significantly associated with prescribing adherence to GDMT, χ2 (1, N = 981) = 33.36, P < 0.001. Further, WCD use was significantly associated with recommendations for follow‐up echocardiographic study, χ2 (1, N = 865) = 66.94, P < 0.001 and use of primary prevention ICD, χ2 (1, N = 1093) = 19.00, P < 0.001.

Conclusions

This study demonstrates the use of the WCD correlates with improved clinician use of GDMT, follow‐up echocardiographic studies, and appropriate use of primary prevention ICD. Thus, the potential benefits of the WCD and its care processes may extend beyond prevention of sudden cardiac death to enhanced optimization of GDMT.
Central banks’ communication as reputation management: How the Fed talks under uncertainty
Authors: Moschella Manuela , Pinto Luca
Published: August 2018

This article advances a reputation‐based account to explain the relative salience that different issues assume in central banks’ communication. Based on an innovative dataset consisting of a corpus of speeches by the members of the Board of Governors of the Federal Reserve System of the United States (also known as the Fed) delivered from 2006 to 2016, the analysis shows that the most salient issues in the Fed's communication are shaped by reputational concerns about policy reversals. Specifically, when these concerns are higher, the Fed is more likely to focus on issues related to areas where its reputation is weak or not yet established—that is, issues related to credit easing and systemic financial regulation. In contrast, issues related to activities where the Fed's reputation is established are likely to become less salient—that is, issues related to economic activity and inflation. A similar pattern of issue attention is observed when the Fed addresses political audiences compared to other audiences.
Haematopoietic stem cell transplantation for mucopolysaccharidosis type VII: A case report
Authors: Sisinni Luisa , Pineda Mercedes , Coll Maria Josep , Gort Laura , Turon Eulalia , Torrent Montserrat , Ey Anna , Tobajas Eva , Badell Isabel
Published: August 2018

Mucopolysaccharidosis type VII (MPS VII) is an inherited disease characterized by the cellular accumulation of undegraded GAGs due to the deficiency of the lysosomal enzyme β‐glucuronidase. We describe a case of a 2‐year‐old female affected by a moderate form of MPS VII and submitted twice to HSCT with the aim of stabilizing skeletal problems and preventing neurocognitive alterations. The child underwent a second transplantation due to the rejection of the graft after a reduced‐intensity conditioning in the first transplant. A myeloablative regimen allowed to achieve a stable full donor engraftment and normal enzyme levels during the 6 years of follow‐up. Clinically, we observed stabilization of skeletal deformities and normal neurocognitive development. This is one of the few reports of mucopolysaccharidosis type VII treated with allogeneic HSCT.
High temperatures change the perspective: Integrating hormonal responses in citrus plants under co‐occurring abiotic stress conditions
Authors: Balfagón Damián , Zandalinas Sara I. , Gómez‐Cadenas Aurelio
Published: August 2018

Plants growing in the field are subjected to multiple stress factors acting simultaneously. Abnormally high temperatures are expected to affect wild plants and crops in the next years due to global warming. In this work, we have studied physiological, hormonal and molecular responses of the citrus rootstock, Carrizo citrange (Poncirus trifoliata L. Raf. × Citrus sinensis L. Osb.) subjected to wounding or high salinity occurring individually or in combination with heat stress. According to our results, combination of high salinity and heat stress aggravated the negative effects of salt intoxication in Carrizo. The high transpiration rate caused by high temperatures counteracted physiological responses of plants to salt stress and increased Cl− intake in leaves. In addition, 12‐oxo‐phytodienoic acid accumulated specifically under combination of wounding and heat stress, whereas at low temperatures, wounded plants accumulated jasmonic acid (JA) and JA‐isoleucine (JA‐Ile). Moreover, an antagonism between salicylic acid (SA) and JA was observed, and wounded plants subjected to high temperatures did not accumulate JA nor JA‐Ile whereas SA levels increased (via isochorismate synthase biosynthetic pathway). Wounded plants did not accumulate abscisic acid (ABA) but its catabolite phaseic acid. This could act as a signal for the upregulation of (ABA)‐RESPONSIVE ELEMENT (ABRE)‐BINDING TRANSCRIPTION FACTOR 2 (CsAREB2) and RESPONSIVE TO DISSECATION 22 (CsRD22) in an ABA‐independent way. This work uncovers some mechanisms that explain Carrizo citrange tolerance to high temperatures together with different hormonal signals in response to specific stresses. It is suggested that co‐occurring abiotic stress conditions can modify (either enhance or reduce) the hormonal response to modulate specific responses.
Effects of crowding and water restriction stress on creole goat reproduction in the Oaxacan Sierra Mixteca, Mexico
Authors: Díaz Pacheco Mónica , Vargas Romero Juan , Rojas‐Maya Susana , Retana‐Márquez Socorro
Published: August 2018

Contents

Chronic stress disrupts reproductive efficiency. Yet, the manner in which stress disturbs reproduction in goats is currently unknown. The Oaxacan Mixteca region is one of Mexico's poorest, with high levels of deforestation, high ambient temperatures, and lack of water. Native goats of the Oaxacan Mixteca Region live in these stressful conditions, as well as in overcrowded and water restricted conditions. Therefore, the aim of this study was to evaluate the effects of these very stressful conditions on the reproduction of male and female goats. Control group was uncrowded, with daily water supply; stress group was overcrowded, with water restriction. The study was conducted from September 2015 to February 2016; the expression of reproductive behaviour and variations of cortisol levels were assessed. In females, oestradiol and progesterone were evaluated during the oestrous cycle. In males, testosterone levels were evaluated before and during reproductive activity. Sexual behaviour decreased in stressed goats: approaching, tail swishing, urination, vaginal discharge and flank contraction decreased in stressed females. Anogenital sniffing, licking, Flehmen reflex, bleating, mount attempts and mounts decreased in male goats. Cortisol levels in stressed animals were higher compared with control animals. Oestradiol and Progesterone levels in stressed females were significantly lower during the follicular and luteal phase, respectively, compared with control females. Testosterone levels in stressed males were lower than in control males, both before and during reproduction. These results indicate that even though goats from the Oaxacan Mixteca Region are habituated to their environmental conditions, they are still stressed by them, as shown by a higher activation of the adrenal axis in stressed goats than in control goats. High cortisol levels may induce low oestradiol levels in females and low testosterone levels in males, as well as a disruption in the expression of their reproductive behaviour.
An Investigation into the Acquired Capability for Suicide
Authors: Bauer Brian W. , Martin Rachel L. , Allan Nicholas P. , Fink‐Miller Erin L. , Capron Daniel W.
Published: August 2018

Objective

The acquired capability for suicide (ACS) is one of the most important breakthroughs in suicide research. ACS refers to an individual's increased fearlessness about death over time from experiencing painful and provocative events (PPE) and is based on opponent‐process theory—a habituation model. Few studies have investigated how ACS develops and found that ACS remained relatively stagnant.

Method

This study sought to expand these findings by observing how ACS develops in two cross‐sectional data sets involving high‐risk nonclinical samples of physicians (n = 419) and veterinary students (n = 124). Participants completed online questionnaires assessing both general PPEs (e.g., witnessing abuse) and job‐specific PPEs (e.g., exposure to euthanasia), as well as ACS.

Results

Our results partially replicated prior findings indicating that more PPEs do not significantly affect ACS.

Conclusions

Limitations of this study include the use of cross‐sectional data and self‐report measures. These results, in combination with existing models of habituation, suggest ACS may not progress linearly.
A Matter of Life and Death: Integrating Mattering into the Interpersonal–Psychological Theory of Suicide
Authors: Drabenstott Matt
Published: August 2018

Objective

This paper advocates for a more robust sense of mattering into the interpersonal‐psychological theory of suicide (IPTS) constructs of perceived burdensomeness and thwarted belongingness. According to IPTS, suicide is precipitated in part by the presence of these twin constructs. IPTS theorists rely on mattering, or feeling significant to others, to undergird theoretical constructs. This is not surprising, as mattering theorists herald “significance to others” as essential to one's will to live. However, IPTS theorists solely leverage mattering to explain perceived burdensomeness.

Method

This paper summarizes the existing suicide literature on IPTS and mattering. Further, this paper extensively reviews how mattering has been incorporated into IPTS to date, and possibilities for how mattering could be more fully integrated into the theory.

Results

IPTS theorists rely on select mattering elements to define perceived burdensomeness. Strong theoretical overlap exists between mattering and thwarted belongingness.

Conclusion

Mattering can play central role in understanding both perceived burdensomeness and thwarted belongingness. Implications for future research and use of mattering‐enriched IPTS are discussed.