bluuebunny/crossref_metadata_2025 huggingface dataset:
Printing with mechanically interlocked extrudates using a custom bi-extruder for fused deposition modelling
Authors: Khondoker Mohammad Abu Hasan , Asad Asad , Sameoto Dan
Published: July 2018

Purpose

This paper aims to target to print functionally gradient materials (FGM) devices made of immiscible polymers in multi-material fused deposition modelling (FDM) systems. The design is intended to improve adhesion of dissimilar thermoplastics without the need for chemical compatibilization so that filaments from many different sources can be used effectively. Therefore, there is a need to invent an alternative solution for printing multiple immiscible polymers in an FDM system with the desired adhesion.

Design/methodology/approach

In this study, the authors have developed a bi-extruder for FDM systems which can print two thermoplastics through a single nozzle with a static intermixer to enhance bonding between input materials. The system can also change the composition of extrudates continuously.

Findings

The uniqueness of this extruder is in its easy access to the internal channel so that a static intermixer can be inserted, enabling deposition of mechanically interlocked extrudates composed of two immiscible polymers. Without this intermixer, the bi-extruder extrudes with simple side-by-side co-extrusion having no mechanical interlocking. The bi-extruder was characterized by printing objects using pairs of materials including polylactic acid, acrylonitrile butadiene styrene and high impact polystyrene. Microscope images of the cross-sections of the extrudates confirm the ability of this bi-extruder to control the composition as desired. It was also found that the mechanically interlocked extrudates composed of two immiscible polymers substantially reduces adhesion failures within and between filaments.

Originality/value

In this study, the first-ever FDM extruder with a mechanical blending feature next to the nozzle has been designed and used to successfully print FGM objects with improved mechanical properties.
Referring Hospital Characteristics Associated With Potentially Avoidable Emergency Department Transfers
Authors: Ray Kristin N. , Marin Jennifer R. , Li Joyce , Davis Billie S. , Kahn Jeremy M.
Published: July 2018

Objective

Many emergency department (ED) transfers of children may be avoidable. Identifying hospital‐level variables associated with avoidable transfers may guide system‐level interventions to improve pediatric emergency care. We sought to examine hospital characteristics associated with ED transfers deemed “probably avoidable” in a large state Medicaid program.

Methods

We performed a retrospective cohort study using 2009 to 2013 claims data for Pennsylvania Medicaid beneficiaries. We categorized all ED transfers of children < 17 years old as “probably avoidable,” “possibly avoidable”, or “unavoidable” based on ultimate disposition and procedures (including subspecialty consultations) at the receiving ED. Using descriptive statistics and multivariable regression, we examined hospital characteristics associated with probably avoidable transfers.

Results

Among 2,839,379 pediatric visits to EDs across 158 Pennsylvania hospitals, 20,304 resulted in transfer. Among these, 3,764 (18.5%) were categorized as probably avoidable and 6,091 (30.0%) as possibly avoidable transfers. In adjusted analysis, compared to hospitals with no pediatric‐specific capabilities, probably avoidable transfers were less likely from referring hospitals with pediatric‐specific EDs and no other pediatric‐specific capabilities (adjusted odds ratio [aOR] = 0.38, 95% confidence interval [CI] = 0.21–0.71) and from referring hospitals with pediatric‐specific EDs and inpatient capabilities (aOR = 0.36, 95% CI = 0.20–0.64). Probably avoidable transfers were more likely from referring hospitals in large metropolitan areas (aOR = 2.64, 95% CI = 1.46–4.80) compared to those in rural areas.

Conclusions

Among pediatric emergency transfers in a large state Medicaid program with a nearly 20% probably avoidable transfer rate, there was significant hospital‐level variation in the proportion of probably avoidable transfers. Transfers from hospitals in large metropolitan areas and transfers from hospitals without pediatric‐specific capabilities had increased odds of being probably avoidable transfers, such that these hospitals may represent targets for interventions to reduce these transfers.
Disease, invasions and conservation: no evidence of squirrelpox virus in grey squirrels introduced to Italy
Authors: Romeo C. , McInnes C. J. , Dale T. D. , Shuttleworth C. , Bertolino S. , Wauters L. A. , Ferrari N.
Published: July 2018

Native red squirrels Sciurus vulgaris in Great Britain and Ireland are threatened by alien grey squirrels S. carolinensis through exploitation competition and spillover of squirrelpox virus (SQPV). By accelerating the replacement of red squirrels by the invader, SQPV represents a fundamental factor to consider when planning management and conservation strategies. In mainland Europe, grey squirrels introduced to Italy threaten the survival of the whole continental red squirrel population, but no extensive surveys for SQPV presence have been carried out in the region. We therefore investigated SQPV infection in north Italian grey squirrel populations through a combination of serological and molecular methods. Firstly, we analysed sera from 285 individuals through an enzyme‐linked immunosorbent assay (ELISA) to detect antibodies against SQPV. Secondly, a PCR designed to amplify a segment of the G8R SQPV gene was carried out on DNA extracted from swabs and skin tissue samples from a second set of 66 grey squirrels. ELISA tests identified four reactors (1.4%), but the subsequent PCR survey did not detect any SQPV DNA. Based on the low prevalence observed and on PCR results, we believe that the four suspected positives were the result of an ELISA cross‐reaction following exposure to another pox virus. Considering sample size and performances of the two methods, confidence of freedom from SQPV resulted above 99.9%. However, because of the severe impact of SQPV on red squirrels, we recommend the implementation of a passive surveillance plan for the early detection of an SQPV emergence in continental Europe.
Global, regional, and country‐level estimates of hepatitis C infection among people who have recently injected drugs
Authors: Grebely Jason , Larney Sarah , Peacock Amy , Colledge Samantha , Leung Janni , Hickman Matthew , Vickerman Peter , Blach Sarah , Cunningham Evan B. , Dumchev Kostyantyn , Lynskey Michael , Stone Jack , Trickey Adam , Razavi Homie , Mattick Richard P. , Farrell Michael , Dore Gregory J. , Degenhardt Louisa
Published: July 2018

Background and Aims

People who have recently injected drugs are a priority population in efforts to achieve hepatitis C virus (HCV) elimination. This study estimated the prevalence and number of people with recent injecting drug use living with HCV, and the proportion of people with recent injecting drug use among all people living with HCV infection at global, regional and country‐levels.

Methods

Data from a global systematic review of injecting drug use and HCV antibody prevalence among people with recent (previous year) injecting drug use were used to estimate the prevalence and number of people with recent injecting drug use living with HCV. These data were combined with a systematic review of global HCV prevalence to estimate the proportion of people with recent injecting drug use among all people living with HCV.

Results

There are an estimated 6.1 million [95% uncertainty interval (UI) = 3.4–9.2] people with recent injecting drug use aged 15–64 years living with HCV globally (39.2% viraemic prevalence; UI = 31.6–47.0), with the greatest numbers in East and Southeast Asia (1.5 million, UI = 1.0–2.1), eastern Europe (1.5 million, UI = 0.7–2.4) and North America (1.0 million, UI = 0.4–1.7). People with recent injecting drug use comprise an estimated 8.5% (UI = 4.6–13.1) of all HCV infections globally, with the greatest proportions in North America (30.5%, UI = 11.7–56.7), Latin America (22.0%, UI = 15.3–30.4) and eastern Europe (17.9%, UI = 8.2–30.9).

Conclusions

Although, globally, 39.2% of people with recent injecting drug use are living with hepatitis C virus (HCV) and 8.5% of all HCV infections occur globally among people with recent injecting drug use, there is wide variation among countries and regions.
Anatomical variations in the circle of Willis in canines
Authors: Tanaka Toshiyuki , Akiyoshi Hideo , Mie Keiichiro
Published: July 2018

The circle of Willis (CW) supplies blood to the brain. In humans, anatomical variations in the CW are an important risk factor for transient ischaemic attack and stroke. In canines, anatomical variations in the CW have not been reported. The aim of this study was to determine anatomical variations in the CW in dogs by magnetic resonance angiography. Normal configuration of the CW was observed in 82%, aplasia of the precommunicating segment of the rostral cerebral artery was observed in 14%, and aplasia of the rostral communicating artery was observed in 4% of dogs included in the study.
Egg allergen specific IgE diversity predicts resolution of egg allergy in the population cohort HealthNuts
Authors: Dang Thanh D. , Peters Rachel L. , Koplin Jennifer J. , Dharmage Shyamali C. , Gurrin Lyle C. , Ponsonby Anne‐Louise , Martino David J. , Neeland Melanie , Tang Mimi L. K. , Allen Katrina J. ,   the HealthNuts study
Published: July 2018

Background

IgE‐mediated egg allergy presents as one of the most common food allergies in children. Measurement of egg white specific IgE (sIgE) levels in serum or skin prick test has been shown to be a poor predictor of clinical allergy to raw egg white, and also to baked or cooked egg. Recent developments in component resolved diagnostic (CRD) technology have enabled us to improve the way in which we diagnose and predict peanut allergy by examining IgE specificity to individual peptides.

Objectives

We aimed to investigate whether egg CRD could improve current methods to diagnose various egg allergy phenotypes as well as predict the development of tolerance to egg.

Methods

Using the HealthNuts cohort of food challenge‐proven egg allergic and egg‐sensitized and egg‐tolerant, age‐matched 12‐month infants with longitudinal follow‐up at 2 and 4 years (n = 451), we measured serum egg white, Gal d 1, 2, 3 and 5 sIgE using ImmunoCAP.

Results

Gal d 1 sensitization increased the risk of persistent egg allergy by 2.5‐fold. The production of sIgE to all four egg allergens (Gal d 1, 2, 3 or 5) increased the risk of having persistent raw egg allergy fourfold (OR 4.19 (95% CI: 1.25‐14.07). We did not find any improvements of using Gal d 1, 2, 3 or 5 to diagnose current egg allergy compared to egg white sIgE.

Conclusion

Sensitization to multiple egg allergens Gal d 1, 2, 3 or 5 may be a prognostic marker that could be useful for patient management and identifying individuals at risk of developing persistent egg allergy.
Management of patients with advanced prostate cancer in the Asia Pacific region: ‘real‐world’ consideration of results from the Advanced Prostate Cancer Consensus Conference (APCCC) 2017
Authors: Chiong Edmund , Murphy Declan G. , Akaza Hideyuki , Buchan Nicholas C. , Chung Byung Ha , Kanesvaran Ravindran , Khochikar Makarand , Letran Jason , Lojanapiwat Bannakij , Ng Chi‐fai , Ong Teng , Pu Yeong‐Shiau , Saad Marniza , Schubach Kathryn , Türkeri Levent , Umbas Rainy , Le Chuyen Vu , Williams Scott , Ye Ding‐Wei ,   ANZUP Cancer Trials Group, Davis Ian D.
Published: July 2018

Objective

The Asia Pacific Advanced Prostate Cancer Consensus Conference (APAC APCCC 2018) brought together 20 experts from 15 APAC countries to discuss the real‐world application of consensus statements from the second APCCC held in St Gallen in 2017 (APCCC 2017).

Findings

Differences in genetics, environment, lifestyle, diet and culture are all likely to influence the management of advanced prostate cancer in the APAC region when compared with the rest of the world. When considering the strong APCCC 2017 recommendation for the use of upfront docetaxel in metastatic castration‐naïve prostate cancer, the panel noted possible increased toxicity in Asian men receiving docetaxel, which would affect this recommendation in the APAC region. Although androgen receptor‐targeting agents appear to be well tolerated in Asian men with metastatic castration‐resistant prostate cancer, access to these drugs is very limited for financial reasons across the region. The meeting highlighted that cost and access to contemporary treatments and technologies are key factors influencing therapeutic decision‐making in the APAC region. Whilst lower cost/older treatments and technologies may be an option, issues of culture and patient or physician preference mean, these may not always be acceptable. Although generic products can reduce cost in some countries, costs may still be prohibitive for lower‐income patients or communities. The panellists noted the opportunity for a coordinated approach across the APAC region to address issues of access and cost. Developments in technologies and treatments are presenting new opportunities for the diagnosis and treatment of advanced prostate cancer. Differences in genetics and epidemiology affect the side‐effect profiles of some drugs and influence prescribing.

Conclusions

As the field continues to evolve, collaboration across the APAC region will be important to facilitate relevant research and collection and appraisal of data relevant to APAC populations. In the meantime, the APAC APCCC 2018 meeting highlighted the critical importance of a multidisciplinary team‐based approach to treatment planning and care, delivery of best‐practice care by clinicians with appropriate expertise, and the importance of patient information and support for informed patient choice.
Determinants of parent‐delivered therapy interventions in children with cerebral palsy: A qualitative synthesis and checklist
Authors: Lord Clarissa , Rapley Tim , Marcroft Claire , Pearse Janice , Basu Anna
Published: July 2018

Introduction

Parent‐delivered therapy interventions for children with cerebral palsy can help achieve a sufficient therapy dose, improve parental mental well‐being, and facilitate parent–child relationships creating a more relaxed familial environment. However, parent‐delivered interventions may also lead to increased parental stress, guilt if the therapy is not delivered, and time constraints. The primary aim of this review was to gain a deeper understanding of the determinants of effective parent‐delivered therapy interventions.

Method

Searches were conducted in the following databases: Medline, PubMed, Scopus, Embase, CINAHL, and Cochrane. Studies had to meet the following inclusion criteria: descriptions of parent/health care professional/child experiences of parent‐delivered therapy interventions for children and young people age 0–18 years with cerebral palsy, published in the English language between January 1989 and May 2017, with qualitative or mixed methods research design. The articles were critically appraised, then synthesized using a meta‐ethnographic approach.

Results

A literature search identified 17 articles, which met the inclusion criteria. Three main themes were identified: (a) building trusting relationships, (b) enabling the parents to cope, and (c) for parents and health care professionals to see the intervention as a priority. Further synthesis presented three concepts identifying the important aspects of the interventions: empowerment, motivation, and relationships.

Conclusions

The themes and concepts emerging from this qualitative synthesis can be addressed by specific points of action to support parent‐delivered therapy interventions. We have summarized these in a checklist for use by intervention developers, health care professionals, and parents.
Independent association of serum vitamin D with anti‐Mullerian hormone levels in women with polycystic ovary syndrome
Authors: Wong Ho Yan Queenie , Li Hang Wun Raymond , Lam Karen Siu Ling , Tam Sidney , Shek Chi Chung , Lee Chi Yan Vivian , Yeung William Shu Biu , Ho Pak Chung , Ng Ernest Hung Yu
Published: July 2018

Objective

This study aimed at investigating the association of serum vitamin D (25(OH)D) and anti‐Mullerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS) as well as non‐PCOS healthy ovulatory women and the possible confounding effects of adiposity and androgen.

Method

This was a cross‐sectional study conducted on serum samples collected from 451 women diagnosed with PCOS as well as 244 age‐matched healthy ovulatory women in a tertiary gynaecology out‐patient clinic and a family planning clinic.

Results

Serum 25(OH)D level was significantly higher in women recruited during summer and autumn than those recruited in winter and spring. Both serum 25(OH)D and AMH levels peaked during summer in women with PCOS. In ovulatory women, only serum 25(OH)D but not AMH level showed such seasonal variation. Serum 25(OH)D level in women with PCOS significantly correlated positively with AMH, AMH/antral follicle count (AFC) ratio, serum total testosterone, sex‐hormone‐binding globulin and quantitative insulin‐sensitivity check index and inversely with body mass index (BMI), insulin, triglycerides and homeostatic model assessment of insulin resistance. After controlling for BMI, 25(OH)D level remained significantly correlated positively with serum AMH, AMH/AFC and total testosterone, and inversely with triglycerides. 25(OH)D level was an independent predictor of serum AMH level after controlling for age, BMI and free androgen index in women with PCOS.

Conclusion

Serum 25(OH)D level is an independent factor significantly associated with AMH level in women with PCOS but not in ovulatory women.
Interleukin‐8 produced by T cells is under the control of dopamine signaling
Authors: Matsuyama Toshiyuki , Kawano Masaaki , Takagi Rie , Nakagome Kazuyuki , Chikamatsu Kazuaki , Matsushita Sho
Published: July 2018

Objective

Interleukin (IL)‐17 produced by T helper (Th)17 cells is considered to be accepted by the IL‐17 receptor expressed by the airway epithelium, thereby influencing the migration of neutrophils by inducing the production of IL‐8, a neutrophil migration chemokine. However, it was recently reported that Th17 cells show marked production of IL‐8. Our previous studies showed that Th17 cell differentiation is governed by dopamine signals. We therefore analyzed the role of dopamine signals in IL‐8 production.

Methods

We cocultured dopamine D2‐like receptor agonists and an antagonist with peripheral blood mononuclear cells isolated from the peripheral blood of healthy human volunteers, as well as cloned Th cells established from peripheral blood mononuclear cells. We then determined the levels of IL‐8.

Results

Cloned Th1 and Th17 cells, but not Th2 cells, showed marked production of IL‐8. Interferon‐γ and IL‐17 levels, but not those of IL‐5, showed a positive correlation with IL‐8 levels. The IL‐8 production of activated T cells was augmented by a dopamine D2‐like receptor antagonist and suppressed by dopamine D2‐like receptor agonists.

Conclusions

The dopamine signal is not only a differentiation induction factor of Th17, but is also involved in IL‐8 production from activated T cells. It is suppressed by dopamine D2‐like receptor agonists, which are known to ameliorate Parkinson's disease.
Auditory motion does not modulate spiking activity in the middle temporal and medial superior temporal visual areas
Authors: Chaplin Tristan A. , Allitt Benjamin J. , Hagan Maureen A. , Rosa Marcello G. P. , Rajan Ramesh , Lui Leo L.
Published: July 2018

The integration of multiple sensory modalities is a key aspect of brain function, allowing animals to take advantage of concurrent sources of information to make more accurate perceptual judgments. For many years, multisensory integration in the cerebral cortex was deemed to occur only in high‐level “polysensory” association areas. However, more recent studies have suggested that cross‐modal stimulation can also influence neural activity in areas traditionally considered to be unimodal. In particular, several human neuroimaging studies have reported that extrastriate areas involved in visual motion perception are also activated by auditory motion, and may integrate audiovisual motion cues. However, the exact nature and extent of the effects of auditory motion on the visual cortex have not been studied at the single neuron level. We recorded the spiking activity of neurons in the middle temporal (MT) and medial superior temporal (MST) areas of anesthetized marmoset monkeys upon presentation of unimodal stimuli (moving auditory or visual patterns), as well as bimodal stimuli (concurrent audiovisual motion). Despite robust, direction selective responses to visual motion, none of the sampled neurons responded to auditory motion stimuli. Moreover, concurrent moving auditory stimuli had no significant effect on the ability of single MT and MST neurons, or populations of simultaneously recorded neurons, to discriminate the direction of motion of visual stimuli (moving random dot patterns with varying levels of motion noise). Our findings do not support the hypothesis that direct interactions between MT, MST and areas low in the hierarchy of auditory areas underlie audiovisual motion integration.
Improving the quality of systematic reviews of neurological conditions: an assessment of current practice and the development and validation of six new search strategies
Authors: Bui K.‐T. A. , Abdaem J. , Muccilli A. , Gore G. C. , Keezer M. R.
Published: July 2018

Background and purpose

Our aim was to study the quality of the literature search strategies used in recent systematic reviews and to develop and assess the diagnostic accuracy of six new search strategies (i.e. hedges).

Methods

Six neurological conditions were studied: migraine, stroke, dementia, epileptic seizures, Parkinson's disease and multiple sclerosis. Two reviewers independently assessed the quality of the search strategies used in systematic reviews published in 2015–2016. Complex hedges pertaining to the six conditions for use in Ovid MEDLINE were developed. Their diagnostic accuracy was compared to simple, single‐term keyword searches.

Results

Almost 60% of quality criteria for the overall literature search strategy used in 182 systematic reviews were not respected. Over 30% of search strategies relied on a single keyword to identify the neurological condition. The sensitivities of our complex hedges amongst 10 311 articles were between 83% and 95%, significantly higher than the simple keyword searches (as low as 48%). The specificities were greater than 97%.

Conclusions

There is great room for improvement in the search strategies used in systematic reviews of neurological conditions. Complex hedges were developed and validated to improve the accuracy of such searches. It is expected that this will lead to higher quality systematic reviews and meta‐analyses.
Board structure and role of outside directors in private firms
Authors: Gao Huasheng , He Zhongda
Published: July 2018

We examine the board composition and the role of outside directors in US private firms. We find that compared with public firms, private firms have a higher proportion of outside directors on the boards and select their outside directors in a more responsive way to their advisory and monitoring needs. We also find that private firms’ CEO turnover–performance sensitivity, earnings quality, going‐public likelihood, and IPO value increase with the proportion of outside directors. These results are consistent with the view that lack of external governance in private firms leads to a greater demand for board monitoring for private firms.
Murine type VII collagen distorts outcome in human skin graft mouse model for dystrophic epidermolysis bullosa
Authors: Bremer Jeroen , Kramer Duco , Eichhorn Daryll S. , Gostyński Antoni , Diercks Gilles F. H. , Jonkman Marcel F. , van den Akker Peter C. , Pasmooij Anna M. G.
Published: July 2018

Human skin graft mouse models are widely used to investigate and develop therapeutic strategies for the severe generalized form of recessive dystrophic epidermolysis bullosa (RDEB), which is caused by biallelic null mutations in COL7A1 and the complete absence of type VII collagen (C7). Most therapeutic approaches are focused on reintroducing C7. Therefore, C7 and anchoring fibrils are widely used as readouts in therapeutic research with skin graft models. In this study, we investigated the expression pattern of human and murine C7 in a grafting model, in which human skin is reconstituted out of in vitro cultured keratinocytes and fibroblasts. The model revealed that murine C7 was deposited in both human healthy control and RDEB skin grafts. Moreover, we found that murine C7 is able to form anchoring fibrils in human grafts. Therefore, we advocate the use of human‐specific antibodies when assessing the reintroduction of C7 using RDEB skin graft mouse models.
Ca2+‐induced orientation of tandem collagen binding domains from clostridial collagenase ColG permits two opposing functions of collagen fibril formation and retardation
Authors: Caviness Perry , Bauer Ryan , Tanaka Keisuke , Janowska Katarzyna , Roeser Jeffrey Randall , Harter Dawn , Sanders Jes , Ruth Christopher , Matsushita Osamu , Sakon Joshua
Published: July 2018

To penetrate host tissues, histotoxic clostridia secrete virulence factors including enzymes to hydrolyze extracellular matrix.Clostridium histolyticum, recently renamed asHathewaya histolytica, produces two classes of collagenase (ColG and ColH). The high‐speedAFMstudy showed that ColG collagenase moves unidirectionally to plane collagen fibril and rebundles fibril when stalled. The structural explanation of the roles for the tandem collagen‐binding segment (CBDs) is illuminated by its calcium‐bound crystal structure at 1.9 Å resolution (Rwork= 15.0%;Rfree= 19.6%). Activation may involve calcium‐dependent domain rearrangement supported by both small‐angle X‐ray scattering and size exclusion chromatography. AtpCa ≥ 5 (pCa = −log[Ca2+]), the tandemCBDadopts an extended conformation that may facilitate secretion from the bacterium. AtpCa ≤ 4, the compact structure seen in the crystal structure is adopted. This arrangement positions the two binding surfaces ~ 55 Å apart, and possibly ushers ColG along tropocollagen molecules that allow for unidirectional movement. A sequential binding mode where tighter bindingCBD2 binds first could aid in processivity as well. Switch from processive collagenolysis to fibril rearrangement could be concentration dependent. Collagen fibril formation is retarded at 1 : 1 molar ratio of tandemCBDto collagen. TandemCBDmay help isolate a tropocollagen molecule from a fibril at this ratio. At 0.1 : 1 to 0.5 : 1 molar ratios fibril self‐assembly was accelerated. Gain of function as a result of gene duplication ofCBDfor the M9B enzymes is speculated. The binding and activation modes described here will aid in drug delivery design.

Accession codes

The full atomic coordinates of the tandemCBDand its corresponding structure factor amplitudes have been deposited in the Protein Data Bank (PDBaccession code5IKU). Small‐angle X‐ray scattering data and correspondingab initiomodels have been submitted to the Small Angle Scattering Biological Data Bank (SASBDB). Accession codesCL2, collagenase module 2,CN2,CP2 are assigned to envelopes for tandemCBDat −log[Ca2+] (pCa) 3, 4, 5, and 6, respectively. Accession codeDC64 was assigned to the complex of polycystic kidney disease‐CBD1‐CBD2 with mini‐collagen.
Signals of local adaptation across an environmental gradient among highly connected populations of the Dead Sea Sparrow Passer moabiticus in Israel
Authors: Magory Cohen Tali , Haran Ron , Dor Roi
Published: July 2018

Populations found at the edge of a species range often have decreased genetic diversity, which together with high gene flow may reduce the ability of a species to adapt to local environmental conditions. The Dead Sea Sparrow Passer moabiticus occupies a disjointed range, where the Israeli populations are considered peripheral and fragmented. The species is also thought to have undergone a recent range expansion. We aimed to describe the genetic and morphological variation of the Israeli populations and to determine the extent of gene flow among them. We expected that because of the small latitudinal gradient across Israel and the recent range expansion of the species that Dead Sea Sparrow populations would show no significant morphological adaptation to local environmental conditions, and that considerable gene flow would be taking place among populations. Our findings indicate the existence of gene flow, suggesting high connectivity among populations, but recovered no support for a recent range expansion, possibly due to insufficient time since expansion for mutations to have accumulated. However, despite recurrent gene flow among populations, latitudinal variation in wing length (male and female) and body mass (male) was indicative of local adaptation across Israel, in accordance with Bergmann's rule.
Value addition of red beet (Beta vulgaris L.) by‐products: Emulsion formation and stability
Authors: Ralla Theo , Salminen Hanna , Wolfangel Timo , Edelmann Matthias , Dawid Corinna , Hofmann Thomas , Weiss Jochen
Published: July 2018

Replacement of synthetically derived food additives and increase of sustainability are two major trends within the food industry, and usage of by‐products may represent a potential solution. We characterised an extract obtained from red beet that could also be obtained from red beet peels, that are typical industrial by‐products, and examined its interfacial and emulsion forming properties. Results showed that red beet extract contained considerable amounts of surface‐active saponins. The smallest negatively charged droplets (~1.36 μm, −40 mV) were obtained at low emulsifier‐to‐oil ratio and were fairly stable over a wide range of environmental stresses such as a wide pH range and temperature (<50 °C) despite some oiling‐off. Emulsions showed flocculation at low pH, as well as coalescence at high temperature (≥50 °C) and phase separation after a freeze–thaw cycle. Overall, our results indicate red beet extract may be employed as new naturally derived emulsifier for food and beverage products.
Nontechnical skills of the operating theatre circulating nurse: An ethnographic study
Authors: Redaelli Ilaria
Published: July 2018

Aim

This paper aims to uncover circulating nurses’ nontechnical skills—namely, the cognitive and social skills that floor nurses need to deliver patient care in the operating room.

Background

Previous studies have shown that nontechnical skills play a key role in the safe execution of high‐risk health practices, such as anaesthesia, resuscitation, and surgery. Regarding the surgical team, research has thus far focused on the nontechnical skills of anaesthesiologists, surgeons, and scrub nurses, leaving unexplained the cognitive and social skills that circulating nurses need to acquire and use.

Design

Ethnographic study.

Methods

Empirical materials were collected in the operating department of a hospital located in northern Italy, drawing on direct observation, document analysis and informal interviews with the circulating nurses. Data collection lasted 3 months, from May ‐ July 2017.

Results

Nontechnical skills of circulating nurses can be described using five categories: leadership, situation awareness, task management, communication, and teamwork.

Conclusion

This paper explicitly addresses circulating nontechnical skills needed to support the design of educational and training pathways for nurses.
Development and validation of the Moral Distress in Dementia Care Survey instrument
Authors: Awosoga Olu , Pijl Em M. , Hagen Brad , Hall Barry , Sajobi Tolulope , Spenceley Shannon
Published: July 2018

Aims

To report on the development and validation of the Moral Distress in Dementia Care Survey instrument.

Background

Despite growing awareness of moral distress among nurses, little is known about the moral distress experiences of nursing staff in dementia care settings. To address this gap, our research team developed a tool for measuring the frequency, severity and effects of moral distress in nursing staff working in dementia care.

Design

The research team employed an exploratory sequential mixed method design to generate items for the moral distress questionnaire. Data were collected between January 2013 – June 2014. In this paper, we report on the development and validation of the Moral Distress in Dementia Care Survey instrument.

Methods

The Moral Distress in Dementia Care Survey instrument was piloted with a portion of the target population prior to a broader implementation. Appropriate statistical analyses and psychometric testing were completed.

Results

The team collected 389 completed surveys from registered nurses, licensed practical nurses and healthcare aides, representing a 43.6% response rate across 23 sites. The Moral Distress in Dementia Care Survey emerged as a reliable and valid instrument to measure the frequency, severity and effects of moral distress for nursing staff in dementia care settings. The relative value of the Moral Distress in Dementia Care Survey as a measurement instrument was superseded by its clinical relevance for dementia care staff.

Conclusion

The Moral Distress in Dementia Care Survey is a potentially useful tool for estimating the frequency, severity and effects of moral distress in nursing staff working in dementia care settings and for the evaluation of measures taken to mitigate moral distress.
Interacting grassland species under threat of multiple global change drivers
Authors: De Kort Hanne , Prunier Jerome G. , Tessier Marc , Turlure Camille , Baguette Michel , Stevens Virginie M.
Published: July 2018

Aims

Multiple environmental changes simultaneously altering the biotic and abiotic context of species are threatening communities and ecosystems worldwide. Exploration and mitigation of the eco‐evolutionary impacts of global change threats correspondingly are major components of conservation research, yet joint global change impacts remain poorly studied. Moreover, changes in the biotic context of species are rarely considered when assessing global change‐induced range shifts. We aim to unravel the contributions of habitat fragmentation, climate warming, genetic variation and biotic interactions to the past, current and future distribution of a rare grassland butterfly.

Location

French Pyrenees.

Taxon

Phengaris (Maculinea) alcon, Gentiana pneumonanthe.

Methods

We examined the combined effects of habitat fragmentation and climate warming on the expected distribution of a specialized grassland butterfly and its host plant species using ecological niche modelling and genetic analysis. More specifically, circuit theory and maximum entropy modelling were used to assess changes in connectivity and habitat suitability under various land use and climate warming scenarios. Complementary, we used pooled RAD sequencing to assess relations between genetic diversity on the one hand, and connectivity, habitat suitability and altitude on the other hand.

Results

We show that both habitat fragmentation and climate warming reduce the amount of suitable and reachable habitat. Complete abandonment of mild grazing practices would drastically reshuffle the distribution of suitable habitat and would render most of the remaining suitable patches poorly reachable. Moreover, serial genetic founder effects observed in high‐altitudinal populations of both species suggest that their dispersal rates lag behind environmental change.

Main conclusions

Together, these findings corroborate the notion that habitat fragmentation, through abandonment of mild grazing practices and agricultural intensification, is the most eminent threat to the highly biodiverse semi‐natural grassland ecosystems across Europe. Fighting habitat fragmentation would increase the genetic and ecological resilience of communities towards other global environmental threats.
Patterns and drivers of species diversity in the Indo‐Pacific red seaweed Portieria
Authors: Leliaert Frederik , Payo Dioli Ann , Gurgel Carlos Frederico D. , Schils Tom , Draisma Stefano G. A. , Saunders Gary W. , Kamiya Mitsunobu , Sherwood Alison R. , Lin Showe‐Mei , Huisman John M. , Le Gall Line , Anderson Robert J. , Bolton John J. , Mattio Lydiane , Zubia Mayalen , Spokes Tracey , Vieira Christophe , Payri Claude E. , Coppejans Eric , D'hondt Sofie , Verbruggen Heroen , De Clerck Olivier
Published: July 2018

Aim

Biogeographical processes underlying Indo‐Pacific biodiversity patterns have been relatively well studied in marine shallow water invertebrates and fishes, but have been explored much less extensively in seaweeds, despite these organisms often displaying markedly different patterns. Using the marine red alga Portieria as a model, we aim to gain understanding of the evolutionary processes generating seaweed biogeographical patterns. Our results will be evaluated and compared with known patterns and processes in animals.

Location

Indo‐Pacific marine region.

Methods

Species diversity estimates were inferred using DNA‐based species delimitation methods. Historical biogeographical patterns were inferred based on a six‐gene time‐calibrated phylogeny, distribution data of 802 specimens, and probabilistic modelling of geographical range evolution. The importance of geographical isolation for speciation was further evaluated by population genetic analyses at the intraspecific level.

Results

We delimited 92 candidate species, most with restricted distributions, suggesting low dispersal capacity. Highest species diversity was found in the Indo‐Malay Archipelago (IMA). Our phylogeny indicates that Portieria originated during the late Cretaceous in the area that is now the Central Indo‐Pacific. The biogeographical history of Portieria includes repeated dispersal events to peripheral regions, followed by long‐term persistence and diversification of lineages within those regions, and limited dispersal back to the IMA.

Main conclusions

Our results suggest that the long geological history of the IMA played an important role in shaping Portieria diversity. High species richness in the IMA resulted from a combination of speciation at small spatial scales, possibly as a result of increased regional habitat diversity from the Eocene onwards, and species accumulation via dispersal and/or island integration through tectonic movement. Our results are consistent with the biodiversity feedback model, in which biodiversity hotspots act as both “centres of origin” and “centres of accumulation,” and corroborate previous findings for invertebrates and fish that there is no single unifying model explaining the biological diversity within the IMA.
Multicomponent Interventions Reduce High‐Risk Medications for Delirium in Hospitalized Older Adults
Authors: Adeola Mobolaji , Azad Rejena , Kassie Gizat M. , Shirkey Beverly , Taffet George , Liebl Michael , Agarwal Kathryn
Published: July 2018

Delirium threatens the functional independence and cognitive capacity of patients. Medications, especially those with strong anticholinergic effects, have been implicated as a preventable cause of delirium. We evaluated the effect of multicomponent interventions aimed at reducing the use of 9 target medications in hospitalized older adults at risk of delirium. This continuous quality improvement program was undertaken at a tertiary care facility and 4 community hospitals in a hospital system. We included 21, 541 hospital admissions with patients aged 70 and older on acute care medical or surgical units from the preintervention (2012) period, and 27,764 from the postintervention (2015) period. Implemented interventions include formulary and policy changes, technology‐assisted medication review, age‐conditional order set modifications, best practice alerts, and education. The proportion of hospital admissions with individual's receiving at least 1 target medication declined from 45.6% to 31.3% (relative reduction (RR)=31.4%) from before to after the intervention, meaning that target medication exposure was avoided in approximately 4,000 older adults. The greatest effect was observed for zolpidem (11.2% to 5.3%, RR=52.6%) and diphenhydramine (12.9% to 7.1%, RR=45%). Furthermore, the mean number of doses administered during all hospital admissions was reduced for 7 of 9 medications. Multicomponent interventions implemented in our hospital system were effective at reducing exposure to target medications in hospitalized older adults at risk of delirium. These systematic changes applied throughout the medication use process are sustained today.
Who's challenging who training for staff empathy towards adults with challenging behaviour: cluster randomised controlled trial
Authors: Hastings R. P. , Gillespie D. , Flynn S. , McNamara R. , Taylor Z. , Knight R. , Randell E. , Richards L. , Moody G. , Mitchell A. , Przybylak P. , Williams B. , Hunt P. H.
Published: July 2018

Background

One in five adults with intellectual disabilities (ID) known to services display challenging behaviours (CBs), and these individuals are at risk for restrictive practices and poor care. Staff attitudes may contribute to the development and/or maintenance of CBs. We investigated the effectiveness of co‐produced Who's Challenging Who? training delivered by people with ID to staff.

Method

This study involved a cluster randomised controlled trial (RCT) of Who's Challenging Who? training with follow‐up at six and 20 weeks post‐randomisation. Participants: two staff from each of 118 residential care settings for adults with ID at least one of whom displayed aggressive CB. Primary outcome: Self‐reported Staff Empathy for people with Challenging Behaviour Questionnaire. Analysis: intention to treat of all randomised settings. ISCRTN registration: ISRCTN53763600.

Results

118 residential settings (including 236 staff) were randomised to either receive training (59 settings) or to receive training after a delay (59 settings). The primary analysis included data from 121 staff in 76 settings (51% of staff, 64% of settings). The adjusted mean difference on the transformed (cubed) Staff Empathy for people with Challenging Behaviour Questionnaire score at the primary end point was 1073.2 (95% CI: ‐938.1 to 3084.5, P = 0.296) in favour of the intervention group (effect size Cohen's d = .19).

Conclusions

This is the first large‐scale RCT of a co‐produced training course delivered by people with ID. Findings indicated a small positive (but statistically non‐significant) effect on increased staff empathy at 20 weeks, and small to moderate effects for staff reported secondary outcomes in favour of the intervention group.
Snoring and Blood Pressure in Third‐Trimester Normotensive Pregnant Women
Authors: Tsai Shao‐Yu , Lee Pei‐Lin , Lee Chien‐Nan
Published: July 2018

Purpose

To examine the association between snoring, sleep quality, quantity, and blood pressure in third‐trimester normotensive pregnant women.

Design

This study was a cross‐sectional analysis of two cohorts of healthy pregnant women recruited from a prenatal clinic in a medical center in Northern Taiwan.

Methods

A total of 322 women reported sociodemographic and health characteristics in a structured interview and wore a wrist actigraph on their nondominant wrist for 7 consecutive days to assess objective sleep patterns. The women's resting blood pressures were measured while seated in the clinic by trained personnel using an electronic sphygmomanometer.

Findings

One hundred thirty‐three (41.3%) women reported snoring. Ninety‐three women (28.9%) had <6 hr of nighttime sleep, with only 95 (29.5%) women averaging 7 or more hours of nighttime sleep. In the univariate analyses, snoring was positively associated with systolic and diastolic blood pressure as well as mean arterial pressure levels (p < .05). In the multivariate analyses, snoring remained as a significant predictor of higher diastolic blood pressure (β = 2.07, p < .05) and mean arterial pressure levels (β = 2.00, p < .05), after adjustment for age, parity, gestational age, body mass index before pregnancy, and sleep quantity and quality by actigraphy.

Conclusions

Snoring is a highly prevalent condition experienced by healthy third‐trimester pregnant women and is associated with elevated blood pressure.

Clinical Relevance

Clinical assessment and screening of snoring are of utmost importance in obstetric nursing practice to potentially prevent or reduce the associated adverse cardiovascular consequences in women during pregnancy.
Neuroanatomy and inner ear labyrinths of the narwhal, Monodon monoceros, and beluga, Delphinapterus leucas (Cetacea: Monodontidae)
Authors: Racicot Rachel A. , Darroch Simon A. F. , Kohno Naoki
Published: July 2018

Narwhals (Monodon monoceros) and belugas (Delphinapterus leucas) are the only extant members of the Monodontidae, and are charismatic Arctic‐endemic cetaceans that are at risk from global change. Investigating the anatomy and sensory apparatuses of these animals is essential to understanding their ecology and evolution, and informs efforts for their conservation. Here, we use X‐ray CT scans to compare aspects of the endocranial and inner ear labyrinth anatomy of extant monodontids and use the overall morphology to draw larger inferences about the relationship between morphology and ecology. We show that differences in the shape of the brain, vasculature, and neural canals of both species may relate to differences in diving and other behaviors. The cochleae are similar in morphology in the two species, signifying similar hearing ranges and a close evolutionary relationship. Lastly, we compare two different methods for calculating 90var – a calculation independent of body size that is increasingly being used as a proxy for habitat preference. We show that a ‘direct’ angular measurement method shows significant differences between Arctic and other habitat preferences, but angle measurements based on planes through the semicircular canals do not, emphasizing the need for more detailed study and standardization of this measurement. This work represents the first comparative internal anatomical study of the endocranium and inner ear labyrinths of this small clade of toothed whales.
Association of fish and long‐chain omega‐3 fatty acids intakes with total and cause‐specific mortality: prospective analysis of 421 309 individuals
Authors: Zhang Y. , Zhuang P. , He W. , Chen J. N. , Wang W. Q. , Freedman N. D. , Abnet C. C. , Wang J. B. , Jiao J. J.
Published: July 2018

Background

Prevailing dietary guidelines recommend regular fish consumption. However, the associations of fish and long‐chain omega‐3 polyunsaturated fatty acids (LCn‐3 PUFAs) intakes with mortality remain unclear.

Objectives

To examine the associations of fish and LCn‐3 PUFAs intakes with total and cause‐specific mortality.

Methods

A total of 240 729 men and 180 580 women from NIH‐AARP Diet and Health Study were prospectively followed‐up for 16 years. Dietary intakes were assessed using a validated NIH Diet History Questionnaire.

Results

A total of 54 230 men and 30 882 women died during 6.07 million person‐years of follow‐up. Higher fish and LCn‐3 PUFAs intakes were significantly associated with lower total mortality (P < 0.0001). Comparing the highest with lowest quintiles of fish intake, men had 9% (95% confidence interval, 6–11%) lower total mortality, 10% (6–15%) lower cardiovascular disease (CVD) mortality, 6% (1–10%) lower cancer mortality, 20% (11–28%) lower respiratory disease mortality and 37% (17–53%) lower chronic liver disease mortality, while women had 8% (5–12%) lower total mortality, 10% (3–17%) lower CVD mortality and 38% (20–52%) lower Alzheimer's disease mortality. Fried fish consumption was not related to mortality in men whereas positively associated with mortality from all causes (P = 0.011), CVD and respiratory disease in women. LCn‐3 PUFAs intake was associated with 15% and 18% lower CVD mortality in men and women across extreme quintiles, respectively.

Conclusion

Consumption of fish and LCn‐3 PUFAs was robustly associated with lower mortality from major causes. Our findings support current guidelines for fish consumption while advice on non‐frying preparation methods is needed.