bluuebunny/crossref_metadata_2025 huggingface dataset:
Reversal of albuminuria by combined AM6545 and perindopril therapy in experimental diabetic nephropathy
Authors: Barutta F , Bellini S , Mastrocola R , Gambino R , Piscitelli F , di Marzo V , Corbetta B , Vemuri VK , Makriyannis A , Annaratone L , Bruno G , Gruden G
Published: September 2018

Background and Purpose

The endocannabinoid (EC) system has been implicated in the pathogenesis of diabetic nephropathy (DN). We investigated the effects of peripheral blockade of the cannabinoid CB1 receptor as an add‐on treatment to ACE‐inhibition in type 1 diabetic mice (DM) with established albuminuria.

Experimental Approach

Renal functional parameters (albumin excretion rate, creatinine clearance), tubular injury, renal structure, both EC and CB receptor levels and markers of podocyte dysfunction, fibrosis and inflammation were studied in streptozotocin‐induced DM treated for 14 weeks with vehicle, the ACE‐inhibitor perindopril (2 mg·kg−1·day−1), peripherally‐restricted CB1 receptor antagonist AM6545 (10 mg·kg−1·day−1) or both. Treatments began at 8 weeks after diabetes onset, when early DN is established.

Key Results

CB1 receptors were overexpressed in DM and neither perindopril nor AM6545 altered this effect, while both drugs abolished diabetes‐induced overexpression of angiotensin AT1 receptors. Single treatment with either AM6545 or perindopril significantly reduced progression of albuminuria, down‐regulation of nephrin and podocin, inflammation and expression of markers of fibrosis. However, reversal of albuminuria was only observed in mice administered both treatments. The ability of the combination therapy to completely abolish slit diaphragm protein loss, monocyte infiltration, overexpression of inflammatory markers and favour macrophage polarization towards an M2 phenotype may explain this greater efficacy. In vitro experiments confirmed that CB1 receptor activation directly inhibits retinoic acid‐induced nephrin expression in podocytes and IL‐4‐induced M2 polarization in macrophages.

Conclusion and Implications

Peripheral CB1 receptor blockade used as add‐on treatment to ACE‐inhibition reverses albuminuria, nephrin loss and inflammation in DM.
Farm management fragmentation in Nova Scotia does not affect farm habitat provision
Authors: Sherren Kate , Greenland‐Smith Simon
Published: September 2018

Farmland comprises an important opportunity for biodiversity conservation worldwide. The likelihood of a farmer fostering habitat for biodiversity has been studied from the perspective of personal or economic drivers. Beyond farm area, the geographic characteristics of the farmland itself—such as parcel sizes, numbers, and distribution—are rarely considered. This paper uses a landholder survey (n = 350, 37% response rate) to explore the variety of farmland management fragmentation and its implications for habitat on farms, specifically ponds, wetlands, and woodlands. This exploratory research was implemented in Nova Scotia, a relatively long‐settled province of Canada, which is subject to inheritance, farmland abandonment, and farm expansion. An index and a typology of management fragmentation were developed, based on geographical impacts (increased distance to travel and edge per unit area), drawing on hypotheses about how geography may affect farmer decision making about habitat. Results suggest that farm size matters more than fragmentation, but also that perceptions of ecosystem services from each ecosystem may have an impact. Suggestions for further research are provided, including alternative methods that could be used and testing these insights in more homogenous agricultural landscapes.
Neonatal TSH levels in Northern Ireland from 2003 to 2014 as a measure of population iodine status
Authors: Mullan Karen , Patterson Chris , Doolan Katy , Cundick Jennifer , Hamill Lesley , McKeeman Gareth , McMullan Paul , Smyth Peter , Young Ian , Woodside Jayne V.
Published: September 2018

Objective

The re‐emergence of iodine deficiency in the UK has recently been reported in a large cohort of teenage girls including from Northern Ireland (NI) using the gold standard spot urinary iodine concentration. We wished to explore and confirm this by analysing neonatal thyroid‐stimulating hormone (nTSH) levels in the NI population.

Design

We analysed the nTSH heel prick tests results from the NI national screening database between 2003 and 2014. The WHO proposes a definition for population iodine sufficiency at <3% of the population with nTSH results >5 mIU/L.

Methods

Anonymized results from 288 491 nTSH tests were retrieved, and prevalence rates of results at increasing cut‐offs including >2 mIU/L and >5 mIU/L calculated. We also assessed for possible seasonal variation in nTSH results.

Results

An overall population prevalence of 0.49% with TSH >5 mIU/L was found, indicating population iodine sufficiency with no year attaining a prevalence >3%. The prevalence of nTSH >2 mIU/L decreased to 4.1% in 2007 and subsequently increased to 9.8% in 2014. Modest seasonal variation was also detected, with higher levels among April/May births.

Conclusions

The neonatal TSH database suggests iodine sufficiency in the NI population. However, the rising frequency of results >2 mIU/L may indicate an emerging mild iodine deficiency. This is one of the largest and longest studies of its kind in the UK and the first carried out in NI. The summer months may be a time of increased risk of iodine deficiency in our pregnant women whose requirements are increased and who are not currently targeted by any iodine fortification programme in the UK.
Sensitization to, and allergic contact dermatitis caused by, colophonium in north‐eastern Italy in 1996 to 2016 with a focus on occupational exposures
Authors: Mauro Marcella , Fortina Anna Belloni , Corradin Teresa , Marino Alessandro , Bovenzi Massimo , Filon Francesca Larese
Published: September 2018

Background

Colophonium is a natural substance derived from Pineaceae trees. It is used in a wide range of consumer and occupational products because of its tackiness, and is a known sensitizer.

Objectives

To analyse the temporal trend of contact allergy to colophonium in north‐eastern Italy, and to evaluate the associations with occupations in our geographical area.

Methodology

From 1996 to 2016, 27 381 patients with suspected allergic contact dermatitis were patch tested in north‐eastern Italy. Individual characteristics were documented by use of a standardized questionnaire in 6 departments of dermatology or occupational medicine.

Results

The overall prevalence of colophonium sensitization was 1.67%; the prevalence was significantly higher in women (1.75%) than in men (1.49%). No significant differences among departments were observed. We found significant associations between colophonium sensitization and being a student (odds ratio [OR] 4.64; 95% confidence interval [CI]: 1.04‐20.6), being a farmer or fishermen (OR 3.63; 95%CI: 1.21‐10.84), being a housekeeper (OR 2.02; 95%CI: 1.08‐3.77), and being retired (OR 2.06; 95%CI: 1.08‐3.92).

Conclusion

Our study showed that contact allergy to colophonium is still relevant in north‐eastern Italy. The frequency of sensitization has dropped significantly over a period of 10 years, but students and farmers/fishermen still have sensitization prevalences above 3.5%. Our results are in line with European data.
Connectivity increases trophic subsidies in fragmented landscapes
Authors: Hawn Christine L. , Herrmann John D. , Griffin Sean R. , Haddad Nick M.
Published: September 2018

Landscape corridors mitigate the negative effects of habitat fragmentation by increasing dispersal. Corridors also increase biodiversity in connected habitat fragments, suggestive of metacommunity dynamics. What is unknown in this case is the mechanisms through which metacommunity dynamics act. Working in a large‐scale fragmentation experiment, we tested the effect of corridors on the movement of prey species and subsequent effects on predator nutrition (which we call trophic subsidies). We enriched plants of central patches with 15N, then measured δ15N in green lynx spiders, the most abundant insect predator, in patches that were either connected to or isolated from the enriched patch. We found that corridors increased prey movement, as they increased spider δ15N by 40% in connected patches. Corridors also improved spider body condition, increasing nitrogen relative to carbon. We suggest a novel mechanism, trophic subsidies, through which corridors may increase the stability or size of populations in connected landscapes.
Lack of response to quinidine in KCNT1‐related neonatal epilepsy
Authors: Numis Adam L. , Nair Umesh , Datta Anita N. , Sands Tristan T. , Oldham Michael S. , Patel Akash , Li Melody , Gazina Elena , Petrou Steven , Cilio Maria Roberta
Published: September 2018

Objective

To evaluate the clinical efficacy and safety of quinidine in patients with KCNT1‐related epilepsy of infancy with migrating focal seizures (EIMFS) in the infantile period and to compare with the effect of quinidine on mutant channels in vitro.

Methods

We identified 4 patients with EIMFS with onset in the neonatal period, pathogenic variants in the KCNT1 gene, and lack of response to AEDs. Patients were prospectively enrolled, treated with quinidine, and monitored according to a predefined protocol. Electroclinical, neuroimaging, and genetic data were reviewed. Two patients had novel variants in the KCNT1 gene that were modeled in Xenopus oocytes with channel properties characterized using electrophysiology recordings.

Results

Three of four patients were treated with quinidine early in their disease course, prior to 6 months of age. No significant side effects were noted with quinidine therapy. In addition, there were no significant changes in electroencephalography (EEG)–confirmed seizure burden during therapy, and patients had near hourly seizures before, during, and after treatment. Two patients had previously reported gain‐of‐function mutations, which demonstrated sensitivity to high levels of quinidine in the oocyte assay. Two patients with novel variants, showed characteristic gain‐of‐function and were thus predicted to be pathogenic. Of interest, these variants were essentially insensitive to high levels of quinidine.

Significance

Patients had no reported benefit to quinidine therapy despite age at treatment initiation. Pharmacogenetic results in oocytes were consistent with clinical treatment failure in 2 patients, suggesting that single‐dose pharmacologic assessment may be helpful in predicting which patients are exceedingly unlikely to achieve benefit with quinidine. In the 2 patients who had a lack of therapeutic benefit despite sensitivity to high concentrations of quinidine with in vitro oocyte assay, it is likely that the achievable exposure levels in the brain were too low to cause significant in vivo channel blockade.
Mind, Body, Brain, and the Conditions of Meaning
Authors: Seligman Rebecca
Published: September 2018

This article explores the relationship between meaning and the body, and the role of mind and brain in mediating this relationship. Drawing on research on “grounded cognition” in cognitive neuropsychology, I consider the mechanisms through which meanings become embodied. I illustrate my argument using examples of the ways in which meaning conditions experiences of illness and health. Focusing especially on the example of religious healing through spirit possession, I explore how the state of one's body can be “conditioned” by meaning, and in turn, how the condition of one's body may affect cognitive processes of meaning making. In doing so, this article aims not only to inform anthropological understandings of embodiment, but also the way we think about cognition, knowledge, and meaning. [Embodiment, brain, grounded cognition, spirit possession, religious healing]
Anticipation and reaction to going‐concern modified audit opinions by sophisticated investors
Authors: Geiger Marshall A. , Kumas Abdullah
Published: September 2018

The purpose of this paper is to examine whether institutional investors (i) anticipate a distressed firm's receipt of a first‐time going‐concern modified audit opinion, and (ii) react to a first‐time going‐concern modified opinion by engaging in abnormal net selling of firm shares. Using a proprietary database of US institutional investor trades, we find that institutional investors are net sellers of first‐time going‐concern opinion firms beginning 6 months before the release of the report and remain net sellers through the subsequent 3 months. We also find that the severity of the reasons auditors modify their opinions is associated with increased trading activity, but only after the opinion is publicly available. Our results support the position that an auditor's going‐concern modified opinion is influential in the marketplace by documenting that institutional investors anticipate this price‐relevant information and react through increased selling. The finding of increased net selling of firms with more severe reasons for report modifications provides evidence of the incremental informational value of the wording in the modified opinion.
The impact of auditor brand name on auditor remuneration in a large private client segment
Authors: Ratzinger‐Sakel Nicole V.S. , Schönberger Martin W.
Published: September 2018

The purpose of this study is to investigate the impact of auditor reputation and nonaudit services on audit pricing in the context of large private audit clients. Focusing on German large private clients, we use a low litigious audit environment that allows us to investigate the role of auditor reputation as proxied by auditor type for three auditor tiers. We find evidence for a Big 4 audit fee premium, suggesting the pronounced role of auditor reputation even in a private client segment. However, this premium is subject to the Big 4 auditor's role in the national audit market. Audit pricing is also affected by nonaudit services, which add value to the audit engagement for the client. Nonaudit fees further incentivize pricing strategies for audits of private audit clients, particularly for Big 4 auditors, which indicates a joint effect of nonaudit fees and auditor type on audit fees.
Screening of hereditary spherocytosis and pyruvate kinase deficiency by automated blood count using erythrocytic and reticulocytic parameters
Authors: Bobée Victor , Daliphard Sylvie , Schrapp Aurélien , Lahary Agnès
Published: September 2018

Introduction

Development of additional parameters for complete blood count has emerged in recent hematology analyzers, leading to many publications. However, few studies have been conducted on advanced RBC parameters and hemolytic anemias. We investigated the interest of Sysmex unique parameters, MicroR and HypoHe, as well as the immature fraction of reticulocytes (IRF) in combination with complete blood and reticulocyte count, for screening hereditary spherocytosis (HS) and pyruvate kinase deficiency.

Methods

We analyzed 182 samples using Sysmex XE‐5000 analyzers from a cohort of red cell disorder patients from the Rouen University Hospital. These included 47 HS, 17 pyruvate kinase deficiencies, sickle cell diseases and trait, β‐thalassemia minor, iron deficiencies, and 489 samples from a routine group.

Results

Combining five parameters (hemoglobin level, reticulocyte count, IRF, MicroR, and %HypoHe), we developed a specific screening tool for HS allowing a sensitivity of 100% and a specificity of 92.1% and a specific screening tool for pyruvate kinase deficiencies allowing a sensitivity of 100% and a specificity of 96.5%. These parameters were also found accurate in infants and in HS without anemia.

Conclusion

We propose a costless, easy‐to‐use, and efficient approach to detect HS and pyruvate kinase deficiencies using Sysmex analyzers. These screening tools may help diagnosis of these disorders, help prevent complications, and result in a better management of these patients.
The importance of commutability in material used for quality control purposes
Authors: Jennings Ian , Kitchen Dianne , Kitchen Steve , Woods Timothy , Walker Isobel
Published: September 2018

External Quality Assessment (EQA) is an important part of laboratory quality assurance. Spiking of normal plasma is sometimes employed to mimic clinical samples. It is important that spiked material gives similar results to clinical samples (ie, is commutable) to ensure appropriate conclusions can be drawn from EQA exercises. We describe here data from UK National External Quality Assessment Scheme for Blood Coagulation (NEQAS BC) exercises where spiked samples were tested alongside samples from patients to explore commutability of artificial material. Normal plasma was spiked with unfractionated heparin (UFH), low molecular weight heparin (LMWH), Dabigatran or Rivaroxaban. Factor VIII (FVIII) deficient plasma was spiked with FVIII concentrate. Spiked samples and ex vivo patient material were sent to laboratories for testing. For LMWH, good agreement was seen between results for samples from patient plasma and plasma spiked with heparin. For UFH, APTT ratios differed between spiked and patient samples for the same drug concentration, with no correlation in ranking of reagents. Precision for patient and spiked material for Rivaroxaban and Dabigatran assays was comparable. However, the pattern of results for some Dabigatran assay kits differed between spiked and patient samples. For FVIII assays, results obtained with spiked and postinfusion samples gave comparable results. Spiked material is suitable for EQA if commutability is demonstrated. Our data show commutability for plasma spiked with Rivaroxaban, LWMH and some FVIII concentrates. For some tests, notably APTT for UFH, marked differences between patient and spiked samples indicate not all tests can be evaluated using artificial samples.
Fournier gangrene: an historical reappraisal
Authors: Short Bruce
Published: September 2018

Perineal gangrene (synergistic gangrene), an age‐old severe infectious disorder, was more completely described by Dr Robert Robertson (1742–1829) in 1777, providing much needed data on the clinical features well before Dr Jean Alfred Fournier's (1832–1914) account in 1883. Robertson’s historically overlooked and detailed narrative is presented with implications, in part, refuting some conclusions made by Fournier 100 years later.
On the Viability of Fixing Leaky Supply Chains for the Poor Through Benefit Transfers: A Call for Joint Distribution
Authors: Rao Shashank , Nilakantan Rahul , Iyengar Deepak , Lee Kang Bok
Published: September 2018

Supply chain managers have yet to solve the conundrum of profitably distributing and selling to the poorest consumers. Most prevailing methods of addressing this problem take one of two contrasting approaches—that is, (1) price subsidization or (2) benefits/cash transfers. The former has been heavily studied in the literature with the consensus being that it is highly inefficient and prone to leaks. We investigate the viability of the latter by focusing on how branching out to reach the poorest customers impacts the performance of banks. Results indicate that the impacts of this approach are deleterious, thereby questioning its commercial scalability. Therefore, we argue that this approach may also have only limited potential in terms of being an effective, large‐scale solution to the problem of access for the poor. Instead, a third approach to achieve scalable Bottom of the Pyramid growth and development needs to be considered—cultivating partnerships through joint distribution.
Genome‐wide identification of loci affecting seed glucosinolate contents in Brassica napus L.
Authors: Wei Dayong , Cui Yixin , Mei Jiaqin , Qian Lunwen , Lu Kun , Wang Zhi‐Min , Li Jiana , Tang Qinglin , Qian Wei
Published: September 2018

Glucosinolates are amino acid‐derived secondary metabolites that act as chemical defense agents against pests. However, the presence of high levels of glucosinolates severely diminishes the nutritional value of seed meals made from rapeseed (Brassica napus L.). To identify the loci affecting seed glucosinolate content (SGC), we conducted genome‐wide resequencing in a population of 307 diverse B. napus accessions from the three B. napus ecotype groups, namely, spring, winter, and semi‐winter. These resequencing data were used for a genome‐wide association study (GWAS) to identify the loci affecting SGC. In the three ecotype groups, four common and four ecotype‐specific haplotype blocks (HBs) were significantly associated with SGC. To identify candidate genes controlling SGC, transcriptome analysis was carried out in 36 accessions showing extreme SGC values. Analyses of haplotypes, genomic variation, and candidate gene expression pointed to five and three candidate genes in the common and spring group‐specific HBs, respectively. Our expression analyses demonstrated that additive effects of the three candidate genes in the spring group‐specific HB play important roles in the SGC of B. napus.
The effectiveness of a structured nursing intervention program on maternal stress and ability among mothers of premature infants in a neonatal intensive care unit
Authors: Ong Swee Leong , Abdullah Khatijah Lim , Danaee Mahmoud , Soh Kim Lam , Soh Kim Geok , Lee Daphne Siew Kee , Hussin Emni Omar Daw
Published: September 2018

Aims and objectives

To investigate the effectiveness of a structured nursing intervention program on maternal stress and NICU‐related maternal ability after the admission of premature infants to a neonatal intensive care unit (NICU).

Background

Mothers of premature infants may face stress having premature infants, and their infants may be admitted to the NICU for a few weeks or months. The mothers’ experience of stress would be worse if they have low knowledge and poor NICU‐related maternal ability. Mothers of infants admitted to the NICU require well‐planned interventions to cope with psychological matters arising after an infant hospitalisation.

Design

Quasi‐experimental design.

Methods

A total of 216 mothers were consecutively assigned to control and intervention groups. Each group consisted of 108 mothers. The mothers in both groups received questionnaire concerning maternal stress and NICU‐related ability during their first visit to NICU (within 48 hr of admission). A structured nursing intervention was implemented for 10 days on mothers in the intervention group. The control group continued to receive existing practice nursing care. Mothers of both groups were again given the questionnaire on maternal stress and NICU‐related ability after 14 days of admission.

Results

In the intervention group, the difference between the mean total score of maternal stress and parental role and relationship subscale decreased significantly, compared to the control group (p = 0.04; p = 0.01) respectively. Maternal ability improved significantly in mothers in the intervention group 2 weeks postintervention, p < 0.001.

Conclusion

A structured nursing intervention for mothers could significantly reduce maternal stress and promote maternal NICU‐related abilities.

Relevance to clinical practice

The results of the study could help neonatal nurses to develop an appropriate nursing intervention for parents with premature infants in the NICU.
Ethical issues in the care of patients with stroke: A scoping review
Authors: Rannikko Sunna , Stolt Minna , Suhonen Riitta , Leino‐Kilpi Helena
Published: September 2018

Aims and objectives

The aim was to identify and analyse the ethical issues in the care of patients with stroke (PwS). The goal was to understand the nature of the existing knowledge on the topic and to identify whether there are ethical issues specific to the care of PwS.

Background

Stroke is a disease with possible multiple effects on the patient's overall condition and experienced ethical issues in the care. Additionally, stroke impacts the life of the significant other. For health professionals, the care of PwS is challenging at different stages of the care process. The care of stroke includes several ethically sensitive situations from the perspectives of all participants.

Design

Scoping review.

Methods

The review was conducted following the five‐stage methodological framework of Arksey and O'Malley (2005). The literature search was conducted in several electronic databases and complemented with a manual search, resulting in 15 reviewed articles. The analysis was conducted by charting descriptive numerical data and by content analysis of the narrative representations.

Results

The studies focused on hospital or rehabilitation contexts and a high number of studies had a qualitative approach. Three main themes were identifiable: “decision‐making as an ethically challenging act,” “care process‐specific ethical issues” and “environmental ethical issues.”

Conclusions

Ethical issues occur at different stages of the care process of PwS and from the viewpoints of all those involved. However, not all the recognised ethical issues were stroke specific. As the number of the reviewed articles was limited, more research is needed for a comprehensive understanding of the topic.

Relevance to clinical practice

Individual health professionals may use the results in observing their own action from an ethical perspective and to deepen the ethical understanding of the care of PwS. In health care organisations, the results may be used in developing the ethical quality of care.
Postoperative patient handovers—Variability in perceptions of quality: A qualitative focus group study
Authors: Reine Elizabeth , Rustøen Tone , Ræder Johan , Aase Karina
Published: September 2018

Aims and objectives

(a) To explore the factors affecting quality in postoperative handovers as perceived by the different professional groups of clinicians involved. (b) To explore possible differences in perceptions of postoperative handover quality across professional groups and level of experience.

Background

High quality patient handovers after surgery and anaesthesia are important to ensure patient safety. There is a paucity of research describing contextual factors related to handover quality and the perspectives of different professional groups involved.

Design

A qualitative exploratory design was applied.

Method

A total of eight focus group interviews with 37 participants (29 nurses, eight doctors) were conducted. Anaesthesiologists, resident anaesthesiologists, nurse anaesthetists, postoperative care nurses and operating room nurses participated in the study. The interviews were conducted according to profession with two groups per profession: one with experienced clinicians and one with less experienced clinicians. The data were analysed using thematic analysis. The study adheres to the COREQ guidelines.

Results

The data analysis identified the following factors affecting postoperative handover quality: “timing and concurrency conflicts,” “handover structure,” “patient conditions,” “individual characteristics of clinicians involved” and “team composition.” Differences across professional groups and level of experience were related to responsibility, structure and adaptation.

Conclusion

The professional groups involved describe the postoperative patient handover as a complex and variable process that needs to be carefully planned and executed according to the influencing factors. Variability exists across professional groups and level of experience.

Relevance to clinical practice

Health care providers need to be aware that postoperative handovers are affected by a set of factors related to internal (patient conditions, individual characteristics of clinicians involved and team composition) and external (timing and concurrency conflicts, handover structure) characteristics. These issues need to be acknowledged when procedures and routines for handover quality are designed, implemented and used.
Endovascular therapy after acute ischaemic stroke—Experiences and needs of relatives
Authors: Sørensen Kristina Eiskjær , Dreyer Pia , Rasmussen Mads , Simonsen Claus Z. , Andersen Grethe
Published: September 2018

Aims and objectives

To explore the experiences and needs of relatives being part of the endovascular therapy (EVT) pathway.

Background

Ischaemic stroke is the third leading cause of death and the most common cause of acquired disability among adults in the Western world. The most recently approved treatment for major stroke is EVT. Removing the arterial occlusion has proven to be the best predictor of outcome. While patients are treated, relatives are left waiting. Facing the massive shock of their loved ones having a stroke may cause emotional turmoil and leave relatives with various needs. No previous studies have explored experiences and needs of relatives who are part of an EVT pathway.

Design

A qualitative design using a phenomenological–hermeneutic approach.

Methods

Semi‐structured interviews and participant observations were carried out. Data were collected from April 2016–January 2017. Data were analysed using Ricoeur's theory of interpretation, capturing meaning and ensuring comprehensive understanding.

Results

Four themes emerged are as follows: (a) The first phase—shock, chaos and feeling paralysed; (b) the all‐important information—sharing is pivotal; (c) professional loving care—being seen and heard by caring health professionals; and (d) adjusting to new roles. One essential finding that emerged across all themes was relatives’ constant need for care, for support and for health professionals to “be there.”

Conclusion

Relatives need support and care during the entire EVT pathway. They tend to be modest and ignore their own needs. Relatives who experience chaos, fear and worry need to be met by professionals with real presence.

Relevance to clinical practice

These findings will be used as a foundation for development of local structures and policies that should provide knowledge and ensure a consistent and proactive approach to meet the needs of the relatives in a timely and efficient manner.
Social support network of family members of abused children and adolescents: Perspectives and possibilities
Authors: Carlos Diene Monique , Silva Lygia Maria Pereira , Beserra Maria Aparecida , Aragão Ailton de Souza , Gregory Alison , Ferriani Maria das Graças Carvalho
Published: September 2018

Aims and objectives

To analyse the network of care and social support from the perspectives of family members of children and adolescents who have been abused.

Background

The theoretical–methodological background of the ecological model for understanding violence and the Paradigm of Complexity provide a broad perspective of violence. The paradigm considers all aspects that constitute a phenomenon as well as particular features.

Design

Qualitative research based on the Paradigm of Complexity, developed by Edgar Morin, the primary philosopher. We have adhered to the COREQ Checklist guidelines for qualitative research.

Methods

Data were collected through Minimal Maps of Personal Social Networks, and semi‐structured interviews were held with 15 families who were assisted by a nongovernmental organisation in a Brazilian city. The notions of comprehension and contextualisation guided the data analysis.

Results

Two categories emerged from the data analyses: “Social isolation” and “Affective relationships needs.” The maps revealed a weakened and limited network with low‐density, homogeneous bonds and few significant bonds. Therefore, the network provided predominantly instrumental and material social support with few important effective relationships. The participants disclosed some strategies to empower their lives.

Conclusions

We conclude that it is urgent to develop strategies in a broad manner to promote family empowerment, especially on education and employment dimension, and to construct supportive and respectful relationships between services and families as well.

Relevance to clinical practice

The present study contributes to international clinical nursing, especially in low‐ and middle‐income countries, by discussing (a) looking at and caring for family members of children and adolescents who have been abused in a contextualised manner; (b) family empowerment, which enables them to have access to healthier environments and to educational/employment opportunities; and (c) broad comprehension of health care among the family members, which provides perspectives not only for looking at violence but also for strengthening supportive social relationships.
A narrative analysis of the stories of mothers who have parented a child with Hodgkin lymphoma who is currently in early survivorship
Authors: Darcy Jennifer
Published: September 2018

Aims and Objectives

To explore the lived experience of mothers of children who have survived Hodgkin lymphoma, from diagnosis, through treatment and recovery as she has lived it and in her own words and to discuss the self‐reported experiences in the context of the theoretical propositions of Attachment Theory and birth order as it applies to the mother–child dyad with this life experience.

Background

While much has been written about childhood cancer survivors and their parents independently, there are unique struggles that a mother and a childhood cancer survivor face as a dyad. Examining the dyadic relationship over time offers a unique perspective to understanding the parenting experience with a child whose fate is uncertain.

Design and Method

Narrative Inquiry was utilised to explore the bonds the mother has with her child before he or she is diagnosed with cancer, the relationship during treatment and the subsequent relationship when the child has entered survivorship. Most specifically, the research explored the attachment of the mother to her child as it relates to the Caregiving System. A purposive sample of 13 mothers of children diagnosed with Hodgkin lymphoma representing children from each birth order category (youngest child, middle child, oldest child and only child) was chosen. The interviews were analysed through thematic analysis with final themes identified.

Results

Several core themes emerged from the narratives regardless of birth order. The most significant was the “need to protect.” Additional themes were “things will never be the same,” “unique bond,” “shifting priorities” and “lost innocence.”

Conclusions and relevance to practice

The research shows activation of the Caregiving Behavioral Response System as it relates as a reciprocal to Attachment Theory.
Current status and influencing factors of barriers to enteral feeding of critically ill patients: A multicenter study
Authors: Huang Jingying , Yang Lili , Zhuang Yiyu , Qi Haiou , Chen Xiangpin , Lv Kai
Published: September 2018

Aims and objectives

To investigate the barriers in administering enteral feeding to critically ill patients from the nursing perspective. Our objectives are to provide tailored interventions for addressing identified barriers and propose an optimal enteral nutrition (EN) practice in intensive care unit (ICU).

Background

Despite the availability of numerous verified clinical practice guidelines focusing on enteral feeding of critically ill patients, a wide gap remains between the guideline recommendations and actual nutrition performances. Underfeeding is also a global problem. Therefore, to further understand the reasons of the systemic iatrogenic underfeeding in ICUs, several potential issues are investigated.

Design

This research is a cross‐sectional descriptive study.

Methods

A total of 808 nurses were recruited from 10 comprehensive hospitals from different districts in China. The nursing staff demographic, the unit's EN management information and the Chinese version of barriers to enteral feeding critically ill patients questionnaire were the parameters used to collect data via WeChat app. Moreover, the collected data were analysed by descriptive and correlative statistical analysis methods.

Results

Results obtained by multiple linear regression showed that frequency of EN‐related training, full‐time ICU nutritionist, hospital level, specific protocols for enteral feeding and position were significantly influencing the enteral feeding of ICU patients.

Conclusions

Enteral feeding barriers of ICU patients are at a moderate level and are influenced by multiple aspects. Hence, hospital departments should strengthen standardisation and systematic EN training, provide ICU full‐time nutritionists and distribute medical resources and personnel rationally. Moreover, construction of a localised feeding process and exerting subjective initiative of clinical nurses from an evidence‐based guideline are important. Multifaceted tailored interventions should be implemented to address these barriers.

Relevance to clinical practice

The findings of this study can be used to inform future intervention and guidelines aimed at addressing these barriers systematically and improving adherence to critical care nutrition guidelines for the provision of enteral nutrition.
Determining the impact of a bowel management protocol on patients and clinicians' compliance in cardiac intensive care: A mixed‐methods approach
Authors: Warren Dawn , Kent Bridie
Published: September 2018

Background

Bowel management protocols standardise care and, potentially, improve the incidence of diarrhoea and constipation in intensive care. However, little research exists reporting compliance with such protocols in intensive care throughout patients' stay. Furthermore, there is a limited exploration of the barriers and enablers to bowel management protocols following their implementation, an important aspect of improving compliance.

Aim and objective

To investigate the impact of a bowel management protocol on the incidence of constipation and diarrhoea, levels of compliance, and to explore the enablers and barriers associated with its use in intensive care.

Methods

A mixed‐methods study was conducted in cardiac intensive care using two phases: (a) a retrospective case review of patients' hospital notes, before and after the protocol implementation, establishing the levels of diarrhoea and constipation and levels of compliance; (b) focus groups involving users of the protocol, 6 months following its implementation, exploring the barriers and enablers in practice.

Results and findings

Fifty‐one patients' notes were reviewed during phase one: 30 pre‐implementation and 21 post‐implementation. Following the protocol implementation, there was a tendency for a higher incidence of constipation and less severe cases of diarrhoea. Overall compliance with the protocol was low (2.3%). However, there was evidence of behavioural change following protocol implementation, including less variation in aperients given and a shorter, less varied time period between starting enteral feed and administering aperients. Several themes emerged from the focus groups: barriers and enablers to the protocol characteristics and dissemination; barriers to bowel assessment; nurse as a barrier; medical involvement and protocol outcomes.

Conclusions

The bowel management protocol implementation generated some positive outcomes to bowel care practices. However, compliance was low and until there is improvement, through overcoming the barriers identified, the impact of such protocols in practice will remain largely unknown.
Factors associated with the increased bleeding in the postoperative period of cardiac surgery: A cohort study
Authors: Pereira Kárla M. F. S. M. , de Assis Caroline S. , Cintra Haulcionne N. W. L. , Ferretti‐Rebustini Renata Eloah L. , Püschel Vilanice A. A. , Santana‐Santos Eduesley , Rodrigues Adriano Rogério B. , de Oliveira Larissa B.
Published: September 2018

Aims and objectives

To identify factors associated with the increased bleeding in patients during the postoperative period after cardiac surgery.

Background

Bleeding is among the most frequent complications that occur in the postoperative period after cardiac surgery, representing one of the major factors in morbidity and mortality. Understanding the factors associated with the increased bleeding may allow nurses to anticipate and prioritise care, thus reducing the mortality associated with this complication.

Design

Prospective cohort study.

Methods

Adult patients in a cardiac hospital who were in the postoperative period following cardiac surgery were included. Factors associated with the increased bleeding were investigated by means of linear regression, considering time intervals of 6 and 12 hr.

Results

The sample comprised 391 participants. The factors associated with the increased bleeding in the first 6 hr were male sex, body mass index, cardiopulmonary bypass duration, anoxia duration, metabolic acidosis, higher heart rate, platelets and the activated partial thromboplastin time in the postoperative period. Predictors in the first 12 hr were body mass index, cardiopulmonary bypass duration, metabolic acidosis, higher heart rate, platelets and the activated partial thromboplastin time in the postoperative.

Conclusions

This study identified factors associated with the increased postoperative bleeding from cardiac surgery that have not been reported in previous studies. The nurse is important in the vigilance, evaluation and registry of chest tube drainage and modifiable factors associated with the increased bleeding, such as metabolic acidosis and postoperative heart rate, and in discussions with the multiprofessional team.

Relevance to clinical practice

Knowledge of the factors associated with the increased bleeding is critical for nurses so they can provide prophylactic interventions and early postoperative treatment when needed.
Vaccine‐preventable disease following allogeneic haematopoietic stem cell transplant in Western Australia
Authors: Ryan Anne L , Kerr Fiona , Gough Hazel , Carter Tina L , Kotecha Rishi S
Published: September 2018

Aim

Infection is an important and frequent cause of mortality and morbidity following allogeneic haematopoietic stem cell transplantation (HSCT). This study was conducted to determine the epidemiology and clinical phenotype of vaccine‐preventable disease in children who have undergone HSCT following the implementation of a standard revaccination programme.

Methods

Children receiving first allogeneic HSCT in Western Australia between January 2005 and December 2014 were eligible for recruitment. Patients received standard antimicrobial prophylaxis and were vaccinated according to the West Australian post‐HSCT immunisation schedule, commencing 6 months following HSCT. Children who developed any illness post‐HSCT were reviewed, and investigations for infectious disease were undertaken as clinically indicated. Positive identification of vaccine‐preventable disease was documented with the clinical course of the illness.

Results

A total of 71 patients were enrolled in the study. The overall incidence of vaccine‐preventable disease following HSCT was 19.7%; influenza accounted for 50% of all cases, herpes zoster for 42.9%. All episodes occurred late, beyond day 100 post‐HSCT. Overall survival for matched‐sibling donor transplants was 83.3 and 75.0% at 1 and 5 years, respectively, and was 72.3 and 63.3% for alternative donor transplants. Mortality due to vaccine‐preventable disease was low, with one death from disseminated herpes zoster.

Conclusions

There is a high incidence of vaccine‐preventable morbidity post‐allogeneic HSCT in West Australian children. Viral aetiology constitutes the main burden, namely, influenza infection and varicella zoster virus reactivation. Further efforts are required to identify the most appropriate preventative strategies.
Brood‐tending males in a biparental fish suffer high paternity losses but rarely cuckold
Authors: Bose Aneesh P. H. , Zimmermann Holger , Henshaw Jonathan M. , Fritzsche Karoline , Sefc Kristina M.
Published: September 2018

Extra‐pair paternity within socially monogamous mating systems is well studied in birds and mammals but rather neglected in other animal taxa. In fishes, social monogamy has evolved several times but few studies have investigated the extent to which pair‐bonded male fish lose fertilizations to cuckolders and gain extra‐pair fertilizations themselves. We address this gap and present genetic paternity data collected from a wild population of Variabilichromis moorii, a socially monogamous African cichlid with biparental care of offspring. We show that brood‐tending, pair‐bonded males suffer exceptionally high paternity losses, siring only 63% of the offspring produced by their female partners on average. The number of cuckolders per brood ranged up to nine and yet, surprisingly, brood‐tending males in the population were rarely the culprits. Brood‐tending males sired very few extra‐pair offspring, despite breeding in close proximity to one another. While unpaired males were largely responsible for the cuckoldry, pair‐bonded males still enjoyed higher fertilization success than individual unpaired males. We discuss these results in the context of ecological and phenotypic constraints on cuckoldry and the fitness payoffs of alternative male tactics. Our study provides new insights into how pair‐bonded males handle the trade‐off between securing within‐pair and extra‐pair reproduction.
Fluconazole resistance is not a predictor of poor outcome in patients with cryptococcosis
Authors: Vena Antonio , Muñoz Patricia , Guinea Jesús , Escribano Pilar , Peláez Teresa , Valerio Maricela , Bonache Francisco , Gago Sara , Álvarez‐Uría Ana , Bouza Emilio
Published: September 2018

Background

Cryptococcus isolates with high MICs to fluconazole are increasingly reported, and a potential clinical impact has been advocated. However, there are different methods to evaluate fluconazole MICs and comparative analysis among such techniques and their comprehensive correlation with clinical outcome are not available.

Methods

Over a 13‐year period (2000‐2013), fluconazole MICs were determined for 62 cryptococcal isolates recovered from 22 patients with cryptococcosis using CLSI M27‐A3, EUCAST, E test and Sensititre YeastOne, simultaneously. The relationship between the fluconazole MICs and the clinical outcome at week 10 was assessed in patients who received fluconazole as induction or maintenance therapy (n = 16).

Results

The percentage of cryptococcal strains with MIC values ≥16 μg/mL according to different methods was CLSI 1.6%, EUCAST 16.1%, E test 31.6% and Sensititre YeastOne 53.2%. Among the 16 patients treated with fluconazole, no correlation between clinical outcome and any MIC value obtained with either method was observed. The only variable independently associated with a poor outcome was having a disseminated disease.

Conclusions

There is a weak correlation between fluconazole MICs against Cryptococcus spp. as determined by CLSI, EUCAST, E test and Sensititre YeastOne. Neither procedure could predict the clinical outcome of patients with cryptococcosis receiving fluconazole‐based therapy. With present methods, fluconazole resistance in Cryptococcus may be clinically misleading.
Constrained or creative? Changes in financial condition and entrepreneurial orientation in public organizations
Authors: Singla Akheil , Stritch Justin M. , Feeney Mary K.
Published: September 2018

Public managers and organizations are often encouraged to take a proactive role in finding solutions to the challenges that face their communities. These challenges require meeting increasingly high expectations for public service provision with ever reducing resources. This research investigates the relationship between change in resource constraints—as measured by longer and shorter term financial condition—and the entrepreneurial orientation of US local governments. Theoretically, it remains unclear whether resource constraints foster or impede entrepreneurial actions (i.e., risk taking, proactivity, and innovation) in public organizations. While entrepreneurial actions may be related to increased organizational financial capacity, a decline in an organization's financial condition might motivate proactivity, innovation, and risk taking as problem‐solving mechanisms and a means to continue service provision. We explore this relationship using two sources of data: a 2012 national survey of managers in 500 cities and financial data from Comprehensive Annual Financial Reports. Our findings suggest that resource constraints are associated with increased entrepreneurial activity in US local governments.