bluuebunny/crossref_metadata_2025 huggingface dataset:
Complement 5a‐mediated trophoblasts dysfunction is involved in the development of pre‐eclampsia
Authors: Ma Yu , Kong Ling‐Ran , Ge Qian , Lu Yuan‐Yuan , Hong Mo‐Na , Zhang Yu , Ruan Cheng‐Chao , Gao Ping‐Jin
Published: November 2017

Pre‐eclampsia (PE) is a life‐threatening multisystem disorder leading to maternal and neonatal mortality and morbidity. Emerging evidence showed that activation of the complement system is implicated in the pathological processes of PE. However, little is known about the detailed cellular and molecular mechanism of complement activation in the development of PE. In this study, we reported that complement 5a (C5a) plays a pivotal role in aberrant placentation, which is essential for the onset of PE. We detected an elevated C5a deposition in macrophages and C5a receptor (C5aR) expression in trophoblasts of pre‐eclamptic placentas. Further study showed that C5a stimulated trophoblasts towards an anti‐angiogenic phenotype by mediating the imbalance of angiogenic factors such as soluble fms‐like tyrosine kinase 1 (sFlt1) and placental growth factor (PIGF). Additionally, C5a inhibited the migration and tube formation of trophoblasts, while, C5aR knockdown with siRNA rescued migration and tube formation abilities. We also found that maternal C5a serum level was increased in women with PE and was positively correlated with maternal blood pressure and arterial stiffness. These results demonstrated that the placental C5a/C5aR pathway contributed to the development of PE by regulating placental trophoblasts dysfunctions, suggesting that C5a may be a novel therapeutic possibility for the disease.
The impact of membrane pretreatment on the enzymatic production of whey‐derived galacto‐oligosaccharides
Authors: Pázmándi Melinda , Maráz Anna , Ladányi Márta , Kovács Zoltán
Published: November 2017

This study presents a multistep process for the valorization of whey that involves membrane filtration techniques to fractionate whey compounds and the subsequent enzymatic conversion of lactose into galacto‐oligosaccharides with a degree of polymerization (DP) of 3–5. Partially demineralized whey was first concentrated and diafiltered by ultrafiltration (UF) to obtain whey protein isolates. Over 97% of the initial amount of lactose was recovered into the permeate which was then concentrated by nanofiltration (NF) up to 330 g L−1. Finally, a systematic study was performed to investigate the hydrolytic and transgalactosylation activity of Biolacta N5, a Bacillus circulans‐derived β‐galactosidase, on whey‐derived substrates consisting of lactose in various concentrations. Hydrolysis was especially pronounced for UF permeates with low lactose concentrations (< 50 g L−1), whereas transgalactosylation was dominant for streams concentrated by NF, obtaining comparable yields of the DP3‐5 fractions (∼ 35%) for moderate and high NF concentration factors.

Practical applications

The market for functional foods and dairy‐based functional beverages represents a growing segment of the global food industry. This article describes a technique for the valorization of whey that is based on the fractionation of whey constituents and the subsequent bioconversion of lactose into GOS. GOS are prebiotic substances with favorable technological properties such as low viscosity and good pH and temperature stability. These low‐calorie sweeteners can be added to a wide range of foods to increase product functionality. The here proposed multiproduct process has potential applications in whey management practice. The reported experimental data on the performance of the processing steps and the proposed approaches to the synchronization of the individual operations is useful for the design of whey valorization processes with reduced waste and energy consumption.
The effect of combined AC electric field and ultrasound on the chemical compositions and Escherichia coli content of spearmint aromatic water
Authors: Behruzian Ava , Hosseinzadeh Samani Bahram , Rostami Sajad , Lorigooini Zahra , Behruzian Mehrsa
Published: November 2017

The aromatic waters are one of the forms of the use of medicinal plants, mostly for edible or medicinal uses. They are required to control the microbial load. Common methods of pasteurization by reason of applying high temperatures cause the undesirable changes in taste, odor, medicinal properties, nutritional quality, and reduction in essential oil. Therefore, novel methods of pasteurization have been widely used recently. In order to determine the microbial inactivation by pulsed electric field and ultrasound, Escherichia coli at a concentration of 7 × 106/mL was inoculated to spearmint aromatic water. The field intensities of 5, 7.5, and 10 kV/cm with time durations of 5, 20, and 35 s and ultrasound powers of 100, 150, and 200 W with time durations of 3, 4, and 5 min were applied. The data obtained from the experiments were analyzed using response surface methods. The results showed that the effect of the four variables listed on the inactivation of microorganisms and energy consumption per cycle of microbial reduction are significant. At the end, the process was optimized. The optimum values for the electric field intensity, time of applying the field, the ultrasound power, and sonication time were 10 kV/cm, 35 μs, 185.90 W, and 4.47 min, respectively. It should be noted that the proposed method had minimal changes in the chemical composition of the raw spearmint aromatic water and was superior to conventional heating methods.

Practical applications

The mint aromatic water is used in food, pharmaceutical, and personal care industries; it is necessary to microbiological control of its content. Because of conventional pasteurization methods cause undesirable changes in taste, smell, and nutritional quality with a reduction in the amount of essential oil. For this purpose, researchers are looking for solutions that by combining new thermal and nonthermal approaches, the damaging effects of conventional pasteurization be removed. However, the main challenge facing the nonthermal technologies in food processing is the inactivation of pathogenic microorganisms and food spoilage agents, which can be achieved by various methods. The aim of the present research was examined the simultaneous effect of the ultrasonic and the electric field to remove microorganism and save quality and benefit chemical compositions of medicinal aromatic water. This research introduces an innovative and combined method for aromatic water pasteurization and this method can benefit to the food industry.
Production of pomegranate fruit leather (pestil) using different hydrocolloid mixtures: An optimization study by mixture design
Authors: Tontul Ismail , Topuz Ayhan
Published: November 2017

Pestil (a kind of fruit leather) is a traditional Turkish product generally made from mulberry, grape, and apricot. It is a good alternative for unhealthy candies made from corn syrup and artificial colorant. However, in the traditional processing of pestil, fruit juice (which has 10–14°Bx) and other ingredients (honey, milk, etc.) are boiled in the open vessel to concentrate (40–50°Bx) and starch (approximately 10%) is added to form a gel structure while the concentrate still boiling. As explained, this process is not standardized, and some toxic compounds can be formed during heat treatment. Therefore, this study was conducted to produce a pomegranate pestil from commercial pomegranate juice using xanthan gum (0–4%), locust bean gum (0–10%), and pregelatinized starch (0–10%). D‐optimal mixture design was used for the optimization of the pestil formulation. The pestil produced according to experimental design was tested for their water activity, moisture content, color properties, browning index, HMF content, total monomeric anthocyanin, total phenolics, total flavonoids, total proanthocyanidin, antioxidant activity, extensibility, and sensorial properties. According to formulation optimization, the optimum hydrocolloid formula was calculated as 7.5% locust bean gum and 2.5% pregelatinized starch. The pestil produced with optimum formulation had improved properties than traditional pestil.

Practical applications

Pestil is a stable fruit product, which is consumed throughout the year. It is produced by boiling of fruit pulp or juice added with starch or flour. Process induced toxic compounds can be formed during pestil production since the process is heat involved. Therefore, we optimized formulation using cold gelling hydrocolloids to eliminate heat treatment in pestil production. Healthier product in terms of both phenolics and toxic compounds was produced using optimized formulation.
PSO‐based BP‐ANN predictive model of S. Typhimurium in processing of surimi with citric acid
Authors: Qin Tian , Liu Shaowei , Mao Yizheng , Liu Xue , Tang Xiaozhi , Li Ran , Cai Wanjing
Published: November 2017

Foodborne pathogenic contamination is a major problem of surimi production. In this study, the effect of variables, namely citric acid concentration (0.5, 1, and 2%), process temperature (4 and 25 °C) and time (1–15 min) on the inactivation of Salmonella Typhimurium (S. Typhimurium) were investigated. The results indicated that citric acid had a significant effect on the survival of S. Typhimurium. To describe the kinetics of S. Typhimurium, both back‐propagation artificial neural network (BP‐ANN) and particle swarm optimization‐based back‐propagation artificial neural network (PSO BP‐ANN) were used to develop models for simulating the dynamic population of S. Typhimurium. The novelty of this work consisted in the application of combining PSO and BP‐ANN together as an optimization strategy to enhance its predictive ability. The results of the new model with PSO algorithm suggested a more accurate prediction model. With the optimal ANN–PSO model, the coefficient of determination (R2) were 0.9786 and 0.9985; mean squared error (MSE) values were 0.0499 and 0.0049 for the training and testing data set, respectively.

Practical applications

Surimi is an important intermediate product in Asia, while fresh surimi may be contaminated with Salmonella Typhimurium during processing, transportation, and storage. In this study, Citric acid has been used to control microbial growth, and extend food shelf‐life. PSO‐based BP‐ANN model were selected to predict the population of Salmonella Typhimurium in processing of surimi with citric acid as a more accurate prediction model. As surimi is constantly consumed, predicting and monitoring the harmful pathogenic bacteria is vital to ensure the food safety.
Prevalence of Frailty and Associated Factors in the Community‐Dwelling Population of China
Authors: Ma Lina , Tang Zhe , Zhang Li , Sun Fei , Li Yun , Chan Piu
Published: November 2017

Background/Objectives

Frailty in older adults predicts dependence and mortality and is a major challenge for healthcare systems in countries with rapidly aging populations. Little is known about frailty in China. We investigated the prevalence and associated risk factors of frailty in older adults in China.

Design

Cross‐sectional.

Setting

Data were obtained from the China Comprehensive Geriatric Assessment Study, conducted in 2011–12, which was the first uniform comprehensive assessment system adopted in China.

Participants

Older adults from 7 cities were selected based on well‐established cluster, stratification, and random selection statistical sampling techniques (N = 5,844).

Measurements

The Comprehensive Geriatric Assessment‐Frailty Index was measured based on demographic characteristics, physical health, physical function, living behavior and social function, mental health, and cognitive function.

Results

The overall weighted prevalence of frailty was 9.9%: 12.7% in southwestern China, 11.0% in northern China, 5.9% in northwestern China, 5.0% in south‐central China, 2.5% in eastern China, and 2.3% in northeastern China. The prevalence of frailty increased with age and was significantly higher in women and those living in rural areas. After adjusting for sex, age, area, region, and education, activity of daily living impairment was the strongest risk factor for frailty. Chronic diseases, depression, poor lifestyle, and geriatric syndromes were also independent risk factors.

Conclusion

Our study provides epidemiological characteristics and the risk factors of frailty in China; the findings indicate greater regional disparities. Efforts to promote physical, psychological, and social health in older adults are a core objective of health policy, especially in women and those living in rural areas.
Changes in intraepidermal nerve fiber and Langerhans cell densities in the plantar skin of rats after mercuric chloride exposure
Authors: Sun Binbin , Fan Shuangyi , Yao Kai , Li Yifan , Huang Xusheng
Published: November 2017

Mercury and its compounds possess strong neurotoxicity and patients with mercury poisoning often report pain and numbness in the distal extremities that conform to the “stocking–glove” pattern. However, no study has investigated whether damage to small nerve fibers is associated with mercury poisoning. The aims of the present study were to evaluate the effects of different doses of mercury chloride (HgCl2) on intraepidermal nerve fibers density (IENFD) and Langerhans cells (LCs) in the plantar skin of rats and to assess the possible relationship between changes in IENFD and sensory testing. Male Sprague–Dawley rats were divided into three experimental groups and administered HgCl2 solutions via gavage at three different doses (4.25, 8.5, and 17 mg/kg/day) for 21 days. Subsequently, behavioral tests and pathological changes in IENFD and LCs were assessed at three different time points (1, 2, and 3 weeks). Rats in all three HgCl2 groups exhibited varying degrees of weight and hair loss. Thermal hypersensitivity was evident in all the HgCl2 groups (for middle‐2w subgroup, p < 0.05). Mechanical sensitivity tests revealed hyposensitivity in all the HgCl2 groups except the high‐1w subgroup. Significant decreases in IENFD (for the high‐1w, middle‐1w, low‐2w, and low‐3w subgroups, p < 0.05) and significant increases in the density of LCs (except for the low‐1w and high‐2w subgroups, all p < 0.05) were found in all groups after HgCl2 exposure. An association analysis revealed a significant correlation between the decrease in IENFD and the increase in LCs densities (r = −0.573, p < 0.01). The present study demonstrated a decrease in IENFD and an increase in LCs density in the plantar skin of rats after HgCl2 poisoning, indicating that damage of the small nerve fibers occurs after mercury poisoning.
Impact of active cancer disease on the outcome of patients undergoing transcatheter aortic valve replacement
Authors: Mangner Norman , Woitek Felix J. , Haussig Stephan , Holzhey David , Stachel Georg , Schlotter Florian , Höllriegel Robert , Mohr Friedrich W. , Schuler Gerhard , Linke Axel
Published: November 2017

Background

Patients undergoing transcatheter aortic valve replacement (TAVR) are often characterized by risk factors not reflected in conventional risk scores. In this context, little is known about the outcome of patients suffering from an active cancer disease (ACD). The objective was to determine the prevalence, clinical characteristics, perioperative outcomes, and mortality of patients with ACD undergoing TAVR compared to those with a history of cancer (HCD) and controls without known tumor disease.

Methods

TAVR patients between 02/2006 and 09/2014 were stratified according to the presence of ACD, HCD, and control. All‐cause‐mortality at 1‐year was the primary end point. All end point definitions were subject to the Valve Academic Research Consortium II definitions.

Results

Overall, 1821 patients were included: 99 patients (5.4%) suffered from ACD and 251 patients (13.8%) had HCD. ACD was related to a solid organ or hematological source in 72.7% and 27.3%, respectively. Patients with ACD were more often male (P = 0.004) and had a lower logisticEuroScore I (P = 0.033). Overall rates of VARC‐II defined periprocedural myocardial infarction, stroke, bleeding, access‐site complications, and acute kidney injury were not different between groups. Thirty‐day mortality did not differ between patients with ACD, HCD, and controls (6.1% vs 4.4% vs 7.6%, P = 0.176). All‐cause 1‐year mortality was higher in patients with ACD compared HCD and controls (37.4% vs 16.4% vs 20.8%, P < 0.001). ACD was an independent predictor of all‐cause 1‐year mortality (HR 2.10, 95%‐CI 1.41‐3.13, P < 0.001).

Conclusion

The presence of ACD in patients undergoing TAVR is associated with significantly higher 1‐year mortality.
In‐hospital outcomes in invasively managed acute myocardial infarction patients who receive morphine
Authors: McCarthy Cian P. , Bhambhani Vijeta , Pomerantsev Eugene , Wasfy Jason H.
Published: November 2017

Objective

We aimed to analyze the association between morphine and in‐hospital outcomes in invasively managed ST elevation myocardial infarction (STEMI) and non‐ST elevation acute coronary syndrome (NSTE‐ACS) patients.

Background

Morphine is commonly used for analgesia in the setting of acute coronary syndromes (ACS); however, recently its utility in ACS has come under closer scrutiny.

Methods

We identified all STEMI and NSTE‐ACS patients undergoing coronary angiogram +/− percutaneous intervention between January 2009 and July 2016 in our center and recorded patient characteristics and inpatient outcomes.

Results

Overall, 3027 patients were examined. Overall, STEMI patients who received morphine had no difference in in‐hospital mortality [4.18% vs. 7.54%, odds ratio (OR): 0.36, P = 0.19], infarct size (mean troponin level 0.75 ng/mL vs. 1.29 ng/mL, P = 0.32) or length of hospital stay (P = 0.61). The NSTE‐ACS patients who received morphine had a longer hospital stay (mean 6.58 days vs. 4.78 days, P < 0.0001) and larger infarct size (mean troponin 1.16 ng/mL vs. 0.90 ng/mL, P = 0.02). Comparing matched patients, the use of morphine was associated with larger infarct size (mean troponin 1.14 ± 1.92 ng/mL vs. 0.83 ± 1.49 ng/mL, P = 0.01), longer hospital stay (6.5 ± 6.82 days vs. 4.89 ± 5.36 days, P = 0.004) and a trend towards increased mortality (5% vs. 2%, OR: 2.55, P = 0.06) in NSTE‐ACS patients but morphine did not affect outcomes in the propensity matched STEMI patients.

Conclusion

In a large retrospective study, morphine was associated with larger infarct size, a longer hospital stay and a trend towards increased mortality in invasively managed NSTE‐ACS patients even after adjustment for clinical characteristics.
Airport delays and metropolitan employment
Authors: Lakew Paulos Ashebir , Bilotkach Volodymyr
Published: November 2017

This study provides the first empirical assessment of the impact airline delays have on urban employment. While previous works have suggested that road congestion can slow down regional development, the influence of air traffic delays on metro‐level jobs has not been examined comprehensively. The present study uses a nine‐year panel of quarterly data, which covers passenger airline traffic and delays at airports across urban areas in the United States. The panel also includes data on total and industry‐specific employment at the metropolitan‐area level. Our empirical estimates of the impact of air traffic on total employment are comparable to previously reported measures in the literature. However, we find that service‐sector employment is less sensitive to air traffic than other studies suggested. We provide new evidence confirming that delays have a negative effect on employment, a finding that is robust to various specifications of our empirical model. Our results indicate that a 10 percent increase in the number of delayed flights leads to up to a 0.15 percent decrease in total and service‐sector employment, a 0.47 percent decline in leisure and hospitality employment, and a 0.7 percent reduction in the employment level of goods‐producing jobs.
Can a child and family health service improve early childhood health outcomes in an urban Aboriginal community?
Authors: Freeman Jessica , Murphy Elisabeth , Woolfenden Susan , Waters Edward , Winters Jennifer , Callaghan Lola , Zwi Karen
Published: November 2017

Aims

To describe the engagement of a cohort of urban Aboriginal families with an Early Childhood Health Service, and to assess any association of engagement with the service with screening by the Edinburgh Post‐Natal Depression Scale (EPDS), full breastfeeding rates and post‐natal smoking status.

Methods

Routine electronic medical record data collected by a Child and Family Health Nurse between 2011 and 2014 was analysed retrospectively. Associations between use of the service and acceptance of EPDS, breastfeeding rates and post‐natal smoking status were determined using binary and multinomial multiple logistic regression analyses.

Results

There were 424 Aboriginal babies and 215 mothers included in the study. Each occasion of service increased the odds of accepting screening with the EPDS (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.00–1.03, P = 0.04) and complete breastfeeding (OR 1.11, CI 1.01–1.23, P = 0.04), but not of quitting smoking (OR 0.99, CI 0.96–1.02, P = 0.34). Despite accounting for engagement with the service, overall uptake of the EPDS remained low; of 267 offers for EPDS screening, only 115 were accepted (43%).

Conclusion

The service was accessed in increasing numbers during the study period. Mothers who utilised the service more frequently were more likely to accept EPDS screening and exclusively breastfeed; however, acceptance of EPDS screening remained low overall. Further research is recommended to investigate the low acceptance of EPDS in this Aboriginal population and whether those results are transferable to other communities.
Using preceding hospital admissions to identify children at risk of developing acute rheumatic fever
Authors: Oliver Jane , Foster Tim , Williamson Deborah A , Pierse Nevil , Baker Michael G
Published: November 2017

Aims

New Zealand (NZ) Māori and Pacific children have high rates of acute rheumatic fever (ARF). Around 150 new cases arise each year. As part of the national ARF prevention programme, funding is available to improve housing. To obtain maximum benefit from interventions, an effective tool is needed for targeting high‐risk children. This study aimed to assess the effectiveness of using hospitalisations for identifying children at risk of subsequent ARF.

Methods

Three potentially avoidable hospitalisation (PAH) groups were investigated, including diseases thought to be influenced by housing. All were developed using expert opinion or systematic reviews. These were: (i) the PAH conditions associated with the housing environment (PAHHE) group; (ii) the Crowding group; and (iii) the Ministry of Health (MoH) group. We analysed NZ public hospital discharge data (2000–2014). The prevalence of ARF among patients hospitalised in each group was calculated to estimate sensitivity and potential effectiveness. The number needed to screen (NNS) to identify one ARF case was estimated as a measure of efficiency.

Results

Nearly one‐third of ARF patients experienced a PAH as children (before developing ARF). Sensitivity for detecting future ARF ranged from <5% (MoH group) to 27% (PAHHE group). NNS ranged from 502.4 (PAHHE) to 707.5 (MoH).

Conclusions

Because ARF is relatively rare, observing hospitalisations is not particularly efficient for targeting prevention activities for this condition alone. However, housing interventions are likely to improve multiple outcomes; thus, the hospital setting is still useful for identifying at‐risk children who could benefit from such programmes.
Bothriospermum longistylum sp. nov. (Boraginaceae) from north China
Authors: Lin Qin‐Wen , Le Chi‐Toan , Njenga Dennis Mwithukia , Hao Yun‐Qing , Liu Bing , Yu Wen‐Tao , Chen Zhi‐Duan
Published: November 2017

Based on field investigations as well as morphological and molecular systematic studies we found a new species of Bothriospermum which can be easily distinguished from all other known congeneric species by its unlobed faucal appendages and very long styles. We conducted molecular phylogenetic analyses based on a combined dataset from nrITS, plastid rps16, trnL‐trnF and trnG‐trnS regions. The results indicated that the new species indeed belongs in Bothriospermum and that it is well separated from other congeneric clusters, but that the genus Bothriospermum is paraphyletic with Nihon and Thyrocarpus clusetered within it. As a result, Bothriospermum longistylum sp. nov. is described and illustrated here. A revised key to species of Bothriospermum and a distributional map are also presented.
N‐terminomics reveals control of Arabidopsis seed storage proteins and proteases by the Arg/N‐end rule pathway
Authors: Zhang Hongtao , Gannon Lucy , Hassall Kirsty L. , Deery Michael J. , Gibbs Daniel J. , Holdsworth Michael J. , van der Hoorn Renier A. L. , Lilley Kathryn S. , Theodoulou Frederica L.
Published: November 2017

The N‐end rule pathway of targeted protein degradation is an important regulator of diverse processes in plants but detailed knowledge regarding its influence on the proteome is lacking.

To investigate the impact of the Arg/N‐end rule pathway on the proteome of etiolated seedlings, we used terminal amine isotopic labelling of substrates with tandem mass tags (TMT‐TAILS) for relative quantification of N‐terminal peptides in prt6, an Arabidopsis thaliana N‐end rule mutant lacking the E3 ligase PROTEOLYSIS6 (PRT6).

TMT‐TAILS identified over 4000 unique N‐terminal peptides representing c. 2000 protein groups. Forty‐five protein groups exhibited significantly increased N‐terminal peptide abundance in prt6 seedlings, including cruciferins, major seed storage proteins, which were regulated by Group VII Ethylene Response Factor (ERFVII) transcription factors, known substrates of PRT6. Mobilisation of endosperm α‐cruciferin was delayed in prt6 seedlings. N‐termini of several proteases were downregulated in prt6, including RD21A. RD21A transcript, protein and activity levels were downregulated in a largely ERFVII‐dependent manner. By contrast, cathepsin B3 protein and activity were upregulated by ERFVIIs independent of transcript.

We propose that the PRT6 branch of the pathway regulates protease activities in a complex manner and optimises storage reserve mobilisation in the transition from seed to seedling via control of ERFVII action.
Seed‐dispersal networks respond differently to resource effects in open and forest habitats
Authors: Vollstädt Maximilian G. R. , Ferger Stefan W. , Hemp Andreas , Howell Kim M. , Böhning‐Gaese Katrin , Schleuning Matthias
Published: November 2017

While patterns in species diversity have been well studied across large‐scale environmental gradients, little is known about how species’ interaction networks change in response to abiotic and biotic factors across such gradients. Here we studied seed‐dispersal networks on 50 study plots distributed over ten different habitat types on the southern slopes of Mt Kilimanjaro, Tanzania, to disentangle the effects of climate, habitat structure, fruit diversity and fruit availability on different measures of interaction diversity. We used direct observations to record the interactions of frugivorous birds and mammals with fleshy‐fruited plants and recorded climatic conditions, habitat structure, fruit diversity and availability. We found that Shannon interaction diversity (H) increased with fruit diversity and availability, whereas interaction evenness (EH) and network specialization (H2) responded differently to changes in fruit availability depending on habitat structure. The direction of the effects of fruit availability on EH and H2 differed between open habitats at the mountain base and structurally complex habitats in the forest belt. Our findings illustrate that interaction networks react differently to changes in environmental conditions in different ecosystems. Hence, our findings demonstrate that future projections of network structure and associated ecosystem functions need to account for habitat differences among ecosystems.
Optimising residential respite care in nursing homes: Current problems and solutions for a better future
Authors: Willoughby Melissa , Ibrahim Joseph Elias , Ferrah Noha , Bugeja Lyndal
Published: November 2017

Aim

To examine whether residential respite care increases the risk of harm to older people and suggest directions for future research and policy.

Background

Respite care is a vital part of the aged care system that supports dependent older people and their caregivers to continue residing in the community. There is little research determining whether an older person experiences harm from residential respite.

Methods

This commentary considered conceptual research and existing empirical evidence to determine whether the risk of death was greater during residential respite care for older people.

Results

Evidence on the mortality in contemporary respite care is extremely limited with the majority of studies published almost 20 years ago and focussing on planned respite admissions. The evidence available has limitations in design and lacks comparison groups and key variables relevant to outcome and risk stratification. Nonetheless, it provides a theoretical basis supporting that the potential for harm and mortality may be increased during a residential respite care admission.

Conclusions

The question of whether residential respite care presents significant risks to older people remains unanswered. Substantial changes in practice since the last century make the existing empirical evidence redundant. However, there is much to learn by reflecting on omissions of important details from these studies.

Implications for practice

A full and objective understanding of the harm associated with residential respite care for older people requires reopening and re‐examining this area with robust research. Informed professional nursing practice and policy requires an empirical evidence basis to residential respite care.
Seeing it differently: self‐reported description of vision loss in dry age‐related macular degeneration
Authors: Taylor Deanna J. , Edwards Laura A. , Binns Alison M. , Crabb David P.
Published: November 2017

Purpose

A realistic description of visual symptoms associated with dry age‐related macular degeneration (AMD) is important for raising awareness of the condition and educating patients. This study aimed to develop a set of descriptors for dry AMD and examine the realism of images currently and frequently used to show visual symptoms of the condition.

Methods

Volunteers with dry AMD with a range of disease severity were given an eye examination and were asked to describe visual symptoms of their condition in a conversational interview. Participants were also asked to comment on a photograph typically used to portray the visual symptoms of AMD. Interviews were audio recorded, transcribed and subjected to content analysis.

Results

Twenty‐nine participants were interviewed. Median (interquartile range [IQR]) age was 75 (70, 79) years. Median (IQR) binocular visual acuity (VA) and Pelli‐Robson contrast sensitivity (CS) was 0.2 (0.18, 0.36) logMAR and 1.65 (1.50, 1.95) log CS respectively. Three, 17 and nine patients had early, intermediate and late (geographic atrophy, GA) AMD, respectively. The most frequently reported descriptor group was blur (n = 13) followed by missing (n = 10) and distortion (n = 7). We chose the most popular image used to portray the visual symptoms of dry AMD based on an internet search and showed this to 21 participants. Sixteen participants (76% [95% confidence interval 53–92%]), including three out of the seven people with geographic atrophy, unequivocally rejected the realism of the image.

Conclusions

People with dry AMD use a wide range of descriptors for their visual experience. Visual symptoms of dry AMD as portrayed by commonly shown images were not the experience of most people in this study.
Retinal putative glial alterations: implication for glaucoma care
Authors: Ashimatey Bright S. , King Brett J. , Swanson William H.
Published: November 2017

Purpose

Gliosis‐like retinal alterations, presumed to be activated retinal astrocytes and Müller cells (ARAM), have been reported to occur frequently in patients with glaucoma but rarely in controls. We investigated the association between glaucomatous abnormality and the presence, the extent of retinal region, and the spatial distribution, of hyperreflective retinal alterations on optical coherence tomography (OCT) en‐face images, presumed to be ARAM.

Methods

Findings of hyperreflective structures, presumed to be ARAM, in the central retinal ±24 degrees of OCT en‐face images (acquired with the SPECTRALIS® OCT) were compared between 35 younger controls, 42 older controls and 38 patients with glaucoma. Presumed ARAM was defined as reflective structures on the en‐face images other than retinal vasculature and retinal nerve fibre bundles. Chi‐square tests were used to compare the proportion of younger controls vs older controls with presumed ARAM to investigate the effect of ageing, and the proportion of patients vs age‐similar older controls with presumed ARAM to investigate the effect of disease. We also investigated the effect of glaucoma on the retinal area with presumed ARAM when it was present; we used an analysis of covariance (ancova) to compare the retinal area with hyperreflectivity in patients vs controls, adjusting for the effects of age and axial length.

Results

The mean (S.D.) age of the younger controls, older controls, and patients with glaucoma was 26 (3), 62 (10) and 69 (8) years, respectively. The median (25th quartile, 75th quartile) of the retinal region with the hyperreflective structures, presumed to be ARAM, was zero (0,0), 1 (0,6), and 11 (0,43) degrees square in the younger controls, older controls and patients with glaucoma respectively. The chi‐square test investigating the effect of ageing found χ2(1, N = 77) = 24.8, p < 0.001, and that investigating the effect of disease found χ2(1, N = 80) = 2.3, p = 0.1. The ancova found F(1, 46) = 10.32, P = 0.02.

Conclusions

There was an effect of ageing on the presence of the hyperreflective structures, presumed to be ARAM, on OCT images. Compared to the presence of hyperreflective structures, the extent of retinal region with the hyperreflective structures has a greater potential of being an indicator of glaucomatous degeneration. Further study is needed to investigate the nature of the relation between glaucomatous abnormality and the extent of the retina with the hyperreflective structures, presumed to be ARAM.
Introducing the 6‐4‐0 fasting regimen and the incidence of prolonged preoperative fasting in children
Authors: Andersson Hanna , Hellström Per M. , Frykholm Peter
Published: November 2017

Background

Children often starve for longer than recommended by current preoperative fasting guidelines.

Aims

We studied the effects of implementing a more lenient fasting regimen on the duration of clear fluid fasting, as well as the incidence of extended fasting in children.

Methods

Preoperative duration of clear fluid fasting was recorded for patients scheduled for procedures in a unit applying the standard 6‐4‐2 fasting regimen. This group was compared with a cohort in the same unit 1 year after transitioning to a 6‐4‐0 fasting regimen. The latter includes no limitations on clear fluid intake until the child is called to theater. A third cohort from a unit in which the 6‐4‐0 fasting regimen has been implemented for over a decade was also studied for comparison.

Results

Patients fasting according to the 6‐4‐2 fasting regimen (n = 66) had a median fasting time for clear fluids of 4.0 h and a 33.3% incidence of fasting more than 6 h. After transitioning to the 6‐4‐0 fasting regimen (n = 64), median duration of fasting for clear fluids decreased to 1.0 h, and the incidence of fasting more than 6 h decreased to 6.3%. In the second unit (n = 73), median fasting time was 2.2 h and the proportion of patients fasting more than 6 h was 21.9%.

Conclusion

The introduction and implementation of the 6‐4‐0 fasting regimen reduces median fluid fasting duration and the number of children subjected to extended fasting.
Association of Preoperative Serum Total Cholesterol Level with Postoperative Pain Outcomes after Laparoscopic Surgery for Gastric Cancer
Authors: Oh Tak Kyu , Kim Hyung‐Ho , Park Do Joong , Ahn Sang‐Hoon , Do Sang‐Hwan , Hwang Jung‐Won , Kim Jin Hee , Oh Ah‐Young , Jeon Young‐Tae , Song In‐Ae
Published: November 2017

Background

Opioid usage is reportedly increased in patients with advanced cancer and low total cholesterol (TC). The aim of this study was to determine the effects of preoperative serum TC levels on postoperative opioid usage in patients undergoing laparoscopic gastric cancer surgery.

Methods

We retrospectively analyzed the medical records of patients with gastric cancer who underwent laparoscopic gastrectomy at our institution between January 1, 2011 and July 31, 2017. We investigated the correlation between TC levels in the month before surgery and numeric rating scale (NRS) scores and opioid consumption on postoperative days (PODs) 0 to 3. The patients were stratified according to preoperative TC level (< 160 mg/dL, low; 160 to 199 mg/dL, medium; ≥ 200 mg/dL, high).

Results

TC and NRS scores (PODs 0, 1) for 1,919 eligible patients showed weak but significant positive coefficients (0.074 and 0.098 on POD 0 and POD 1, respectively, P < 0.01). After adjusting for confounders, there were no significant differences in postoperative NRS scores on PODs 0, 1, 2, or 3 or in oral morphine equivalents on PODs 0 to 3 according to TC level.

Conclusion

Preoperative serum TC levels have no effect on pain outcomes in the 3 days following laparoscopic gastric surgery.
Family members’ expectations regarding nurses’ competence in care homes: a qualitative interview study
Authors: Kiljunen Outi , Kankkunen Päivi , Partanen Pirjo , Välimäki Tarja
Published: November 2017

Background

Structural and cultural changes in the care of older people have influenced nursing practice, creating a need to identify current competency requirements for nurses working in care homes. Family members have an important role in ensuring the well‐being of older people living in care homes, and family members’ can provide valuable information about competence requirements.

Aim

To explore the expectations of the care home residents’ family members regarding the competence of nurses in care homes for older people.

Methods

A qualitative descriptive design was used. Semi‐structured interviews were conducted with 18 care home residents’ family members between March and September 2016. Participants were recruited with help from regional associations and member associations of The Central Association of Carers in Finland and from regional associations of The Alzheimer's Society of Finland. The snowball technique was also used. The data were analysed using inductive content analysis.

Ethics

Ethics committee approval was obtained from the university committee on research ethics, and written informed consent was obtained from participants.

Findings

The care home residents’ family members expected that nurses would be able to interact with and treat people respectfully. Reflective collaboration between the nurse and a family member was also emphasised. Family members expected nurses to provide high‐quality basic care and nursing and support residents’ well‐being individually and holistically.

Conclusions

Family members’ expectations reflect the need for ethical and interactional competence in the care home. In addition, evidence‐based practice competencies are required to provide high‐quality care. Nurses’ ability to provide person‐centred, individual and holistic care is vital to ensure care home residents’ well‐being.
Factors associated with medication administration errors and why nurses fail to report them
Authors: Hammoudi Baraa M. , Ismaile Samantha , Abu Yahya Omar
Published: November 2017

Background

Patient safety is a significant challenge facing healthcare systems. The administration of medication is pivotal to patient safety, and errors in drug administration are associated with mortality and morbidity. In this study, we assessed the factors contributing to the occurrence and reporting of medication errors from the nurse's perspective.

Methods

In this descriptive cross‐sectional study, we distributed a validated questionnaire to 367 nurses at a large public hospital and obtained a response rate of 73.4%. The questionnaire comprised 65 questions, including 29 on the causes of medication errors, 16 on the reasons why medication errors are not reported and 20 that estimated the percentages of the different medication errors actually reported. Informed consent was obtained from all participants, and the anonymity and confidentiality of participants’ information were preserved throughout the process. This study received institutional review board approval. Descriptive statistics were used for data analysis.

Results

The main factors associated with medication errors by nurses were related to medication packaging, nurse–physician communication, pharmacy processes, nurse staffing and transcribing issues. The main barriers to the reporting of errors by nurses were related to the administrative response, fear of reporting and disagreements regarding the definitions of errors.

Conclusion

Medication errors by nurses are related to medication packaging, poor communication, unclear medication orders, workload and staff rotation. To prevent medication errors, teamwork must be improved. All healthcare settings should emphasise awareness of the culture of safety, provide support and guidance to nurses and improve communication skills. We also recommend the use of integrated health informatics, including computerised drug administration systems. The limitations of this study include the potential for nonresponse bias associated with the sampling method. Further research is required to explore the complex and multidimensional causes of medication errors and review the responses of nurses regarding the errors reported.
Shifting frames: Collective action framing from a dialogic and relational perspective
Authors: Lindstedt Nathan
Published: November 2017

This article discusses (a) sustained critiques of framing theory and of collective action frames, (b) the development and implications of a dialogic and relational alternative, and (c) suggestions for how to pursue this alternative approach using mental models. Proponents of framing theory have advocated that a dialogic and relational alternative could prove fruitful in advancing sociological understanding of the variety of contexts in which social movement discourse takes place. Drawing insights from the work of several scholars, I propose what this alternative entails in terms of both theory and research. Parallel to the development of relational sociology, academics have developed discourse mapping techniques that blend network analysis with cultural analysis. I suggest that one way researchers can integrate a dialogic and relational approach into their analyses of framing is through the use of mental models.
Intergroup conflict and barriers to common ground: A self‐affirmation perspective
Authors: Sherman David K. , Brookfield Jacob , Ortosky Lauren
Published: November 2017

Psychological barriers to conflict resolution stem, in part, from defensive responses to feelings of self‐threat. Self‐affirmation theory proposes that affirmations of global self‐worth—often achieved by writing or reflecting on core values—can broaden individuals' perspectives and potentially reduce biases in their intergroup judgments. In this paper, we review the extant literature on the use of self‐affirmation to potentially reduce intergroup biases in order to shed light on the role of self‐threat in perpetuating conflict. Self‐affirmation has been shown to impact 3 key aspects of intergroup conflict: (a) the strength with which conflict‐supporting beliefs are held, (b) the biased processing of conflict‐relevant information, and (c) the resistance to seeing common ground in negotiations. Discussion centers on the limits as well as the potential of self‐affirmation to promote openness and conflict resolution.
Evolution of lacewings and allied orders using anchored phylogenomics (Neuroptera, Megaloptera, Raphidioptera)
Authors: WINTERTON SHAUN L. , LEMMON ALAN R. , GILLUNG JESSICA P. , GARZON IVONNE J. , BADANO DAVIDE , BAKKES DEON K. , BREITKREUZ LAURA C.V. , ENGEL MICHAEL S. , LEMMON EMILY MORIARTY , LIU XINGYUE , MACHADO RENATO J.P. , SKEVINGTON JEFFREY H. , OSWALD JOHN D.
Published: November 2017

Analysis of anchored hybrid enrichment (AHE) data under a variety of analytical parameters for a broadly representative sample of taxa (136 species representing all extant families) recovered a well‐resolved and strongly supported tree for the higher phylogeny of Neuropterida that is highly concordant with previous estimates based on DNA sequence data. Important conclusions include: Megaloptera is sister to Neuroptera; Coniopterygidae is sister to all other lacewings; Osmylidae, Nevrorthidae and Sisyridae are recovered as a monophyletic Osmyloidea, and Rhachiberothidae and Berothidae were recovered within a paraphyletic Mantispidae. Contrary to previous studies, Chrysopidae and Hemerobiidae were not recovered as sister families and morphological similarities between larvae of both families supporting this assumption are reinterpreted as symplesiomorphies. Relationships among myrmeleontoid families are similar to recent studies except Ithonidae are placed as sister to Nymphidae. Notably, Ascalaphidae render Myrmeleontidae paraphyletic, again calling into question the status of Ascalaphidae as a separate family. Using statistical binning of partitioned loci based on a branch‐length proxy, we found that the diversity of phylogenetic signal across partitions was minimal from the slowest to the fastest evolving loci and varied little over time. Ancestral character‐state reconstruction of the sclerotization of the gular region in the larval head found that although it is present in Coleoptera, Raphidioptera and Megaloptera, it is lost early in lacewing evolution and then regained twice as a nonhomologous gula‐like sclerite in distantly related clades. Reconstruction of the ancestral larval habitat also indicates that the ancestral neuropteridan larva was aquatic, regardless of the assumed condition (i.e., aquatic or terrestrial) of the outgroup (Coleopterida).