bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding Long-Term Unmet Needs in Australian Survivors of Stroke
Authors: Andrew Nadine E. , Kilkenny Monique , Naylor Rebecca , Purvis Tara , Lalor Erin , Moloczij Natasha , Cadilhac Dominique A.
Published: July 2014

Background

Limited data exist on the long-term needs of community-dwelling stroke survivors. We aimed to describe factors associated with the extent to which needs were met in Australian survivors of stroke.

Method

Multifaceted strategies were used to obtain a national sample. Adults 12+ months poststroke and living in the community participated. Needs were assessed over the domains of health, everyday living, work, leisure, social support, and finances. Multivariable negative-binomial and logistic regression were used.

Results

Seven hundred sixty-five survivors completed surveys. Most (84%) reported having needs that were not being fully met (median 4 of 20, Q1, Q3: 1, 9). Variations occurred based on age, residential location, time since stroke, and disability level. Multivariable results showed that having fatigue, cognition or emotional problems, decreasing age, and increased disability were associated with increasing numbers of needs not being fully met ( P < 0·001). Factors associated with needs not being fully met were as follows: ( 1 ) greater disability (adjusted odds ratio: 3·4, 95% confidence interval: 1·9, 6·0) and fatigue problems (adjusted odds ratio: 2·0, 95% confidence interval: 1·1, 3·4) (health domain); ( 2 ) greater disability (adjusted odds ratio: 7·0, 95% confidence interval: 3·0, 17·0) and being one to two-years poststroke (adjusted odds ratio: 3·4, 95% confidence interval: 1·5, 7·8) (work domain); and ( 3 ) increased disability (adjusted odds ratio: 3·8, 95% confidence interval: 2·2, 6·5) and memory problems (adjusted odds ratio: 2·1, 95% confidence interval: 1·0, 4·2) (leisure domain).

Conclusion

The extent to which long-term needs were met was influenced by a variety of factors, particularly age, disability levels, and residential location. Changes need to be made to the way and extent to which survivors are supported following stroke.
How to Unfasten the Spanish Stroke Belt? Andalusia Chooses Research
Authors: Montaner J. , Jiménez-Hernández M. D. , López-Barneo J.
Published: July 2014

Andalusia in southern Spain, one of the largest regions in the European Union, has made a profound economic and social transformation that has led to establishment of a modern universal public health care system. However, due to its high stroke mortality rates, Andalusia is still known as the “Spanish Stroke Belt”. To fight these figures, successive initiatives culminated in the launch of the Andalusian Plan for Stroke Care, to be developed during the period of 2011 to 2014. In addition, involved professionals have hypothesized that clinical and experimental research may contribute to improving stroke care in our community. To that end, one of the leading institutes of biomedical research in Andalusia, the Institute of Biomedicine of Seville (IBiS), has selected stroke as a flagship project in the region. Moreover, Seville, the capital of Andalusia, is now conducting a fusion process of its two largest hospitals, with the potential to generate a stroke alliance that will make it one of the main stroke hospitals in Europe (>2000 cases per year). It is anticipated that this will be an excellent platform to facilitate acute-phase clinical trials and speed the translation process from basic research in IBiS laboratories to the clinical setting. Furthermore, the recently created Andalusian Neurovascular Group is ready to develop prospective, collaborative, multicenter research projects that will evaluate interventions in areas of stroke care uncertainty. If we succeed in forging a link between research and health care quality, we may succeed in lowering the incidence of stroke and related mortality in the region in a short period of time.
Prognosis and Treatment of Intracranial Dural Arteriovenous Fistulae: A Systematic Review and Meta-Analysis
Authors: Kobayashi Adam , Salman Rustam Al-Shahi
Published: July 2014

Background

Dural arteriovenous fistulae can cause intracranial hemorrhage, but influences on this are unclear.

Summary of review

We searched Ovid MEDLINE (from 1966), Embase (from 1980), and the Cochrane Library in September 2013 for studies of ≥50 adults with dural arteriovenous fistulae describing death or intracranial hemorrhage. Of 16 studies of retrospective associations between dural arteriovenous fistulae vascular anatomy and prior mode of presentation, fistula location in the cavernous sinus was consistently associated with nonhemorrhagic modes of presentation; in five studies involving 855 patients, fistulae with retrograde leptomeningeal (cortical) venous drainage were associated with prior presentation with intracranial hemorrhage (pooled odds ratio 23·2, 95% CI 13·8 to 39·0; *** I2 = 0%). Future intracranial hemorrhage during untreated clinical course was statistically significantly associated with the presence of venous varix in one study and with presentation with intracranial hemorrhage in patients with retrograde leptomeningeal venous drainage in another. In 19 observational studies of treatment of dural arteriovenous fistulae involving 2329 patients, the pooled risk of death was 1·2% (95% CI 0·6 to 1·8, I2 = 35%), that of nonfatal intracranial haemorrhage was 0·5% (95%CI 0·2 to 0·8, I2 = 9%), and that of nonfatal cerebral infarction was 0·7% (95% CI 0·3 to 1·4, I2 = 52%), for a combined risk of 2·5% (95% CI 1·4 to 3·9, I2 = 69%).

Conclusions

Retrograde leptomeningeal venous drainage seems strongly associated with intracranial hemorrhage at presentation of dural arteriovenous fistula, but its association with subsequent intracranial hemorrhage is less clear. Short-term complications of dural arteriovenous fistula treatment affect 2–3% of patients in published reports.
Equivalent survival and improved preservation of renal function after distal ureterectomy compared with nephroureterectomy in patients with urothelial carcinoma of the distal ureter: A propensity score‐matched multicenter study
Authors: Fukushima Hiroshi , Saito Kazutaka , Ishioka Junichiro , Matsuoka Yoh , Numao Noboru , Koga Fumitaka , Masuda Hitoshi , Fujii Yasuhisa , Sakai Yasuyuki , Arisawa Chizuru , Okuno Tetsuo , Yonese Junji , Kamata Shigeyoshi , Nagahama Katsushi , Noro Akira , Morimoto Shinji , Tsujii Toshihiko , Kitahara Satoshi , Gotoh Shuichi , Higashi Yotsuo , Kihara Kazunori
Published: July 2014

Objectives

To investigate the oncological and functional outcome of distal ureterectomy compared with nephroureterectomy in the management of distal ureteral urothelial carcinoma.

Methods

Using a database including upper urinary tract urothelial carcinoma patients (n = 1329), 282 patients were identified with urothelial carcinoma localized in the distal ureter on clinical evaluation. To adjust for potential baseline differences between groups, 43 patients undergoing distal ureterectomy were matched with 86 patients undergoing nephroureterectomy using propensity scoring. Cox regression models tested the effect of surgery type on recurrence‐free survival and cancer‐specific survival. Estimated glomerular filtration rate was measured before and after surgery.

Results

The median follow‐up period was 50 months. There were no significant differences in 5‐year recurrence‐free survival and cancer‐specific survival rates between the distal ureterectomy and nephroureterectomy groups (P = 0.22 and P = 0.70, respectively). Multivariate analysis showed that surgery type was not associated with recurrence‐free survival and cancer‐specific survival (P = 0.90 and P = 0.28, respectively). In the subanalysis, recurrence‐free survival and cancer‐specific survival in the distal ureterectomy group were equivalent to those of the nephroureterectomy group in both pTa‐1 and pT2‐4 patients. Renal function was better preserved in the distal ureterectomy group than in the nephroureterectomy group (rate of change in estimated glomerular filtration rate 2% vs −20%; P < 0.001).

Conclusions

The oncological outcome of distal ureterectomy is comparable with that of nephroureterectomy in distal ureteral urothelial carcinoma patients, and distal ureterectomy provides better preservation of renal function. Distal ureterectomy would be feasible for carefully selected patients with distal ureteral urothelial carcinoma.
Combined sildenafil with vacuum erection device therapy in the management of diabetic men with erectile dysfunction after failure of first‐line sildenafil monotherapy
Authors: Sun Lu , Peng Fang‐Li , Yu Zhi‐Ling , Liu Cai‐Ling , Chen Jun
Published: July 2014

Objective

To evaluate the efficacy and safety of combination therapy of sildenafil plus vacuum erection devices in men with type 2 diabetes mellitus with moderate to severe erectile dysfunction who are dissatisfied with the results of using sildenafil alone.

Methods

The study included 66 diabetes mellitus patients presenting erectile dysfunction for at least 6 months and dissatisfied with the use of 100 mg sildenafil monotherapy. The patients were randomized in two groups. Those in group A (n = 33) were instructed to use a vacuum erection device only, whereas those in group B (n = 33) were treated with combination therapy, including sildenafil 100 mg and a vacuum erection device. Erectile function was evaluated subjectively using the International Index of Erectile Function, Sexual Encounter Profile questionnaire questions 2 and 3 at visit 1 (baseline; study entry), visit 2 (4 weeks after baseline), and visit 3 (12 weeks after baseline; study end).

Results

There were no significant differences in average patient age, duration of diabetes, duration of erectile dysfunction, baseline International Index of Erectile Function scores, hypertension, blood testosterone, smoking and alcohol consumption between two groups. Mean International Index of Erectile Function scores were significantly higher for group B at the 1‐month (14.86 ± 2.17 vs 12.41 ± 2.63; P < 0.0001) and 3‐months (17.53 ± 2.95 vs 14.29 ± 2.81; P < 0.0001) visits. Men in group B had better successful penetration (73.3% vs 46.6%) and successful intercourse (70% vs 46.6%) at 3 months compared with group A.

Conclusion

Combined use of sildenafil and vacuum erection device therapy significantly enhances erectile function, and it is well tolerated by diabetes mellitus patients not responding to first‐line sildenafil alone.
Challenges to and opportunities for improving mental health services for lesbian, gay, bisexual, and transgender people in Ireland: A narrative account
Authors: McCann Edward , Sharek Danika
Published: July 2014

The views and opinions of people who use mental health services are being increasingly acknowledged in relation to rights‐based, socially‐inclusive, and recovery‐oriented care. However, little is known of the experiences of lesbian, gay, bisexual, and transgender (LGBT) people in this respect. The aim of the present study was to explore the experiences and needs of LGBT people in relation to mental health services. The study was an exploratory design utilizing mixed methods. Both quantitative and qualitative data were collected using a survey instrument (n = 125) and in‐depth semistructured interviews (n = 20) with a sample of people who had completed the survey. This paper will report on the findings from the interview data. The data were thematically analysed, and the main themes that emerged included accessing services, treatment choices, mental health service experiences, and other supports. The findings inform the discussion, and recommendations are made in terms of future mental health practice, education, and research.
Margaret Thatcher, the Thatcherite intellectuals and the fate of Keynes
Authors: Trumpbour John
Published: July 2014

In the early 1970s, major political leaders of the centre‐right such as Richard M. Nixon proudly declared their allegiance to the Keynesian consensus and the welfare state. By the mid‐1970s, this consensus unravelled so rapidly that even the leader of Britain's Labour Party came to regard Keynesian medicine as ineffectual. Seeking to demolish several foundations of the Keynesian welfare state, Thatcherism soon attracted economists and policy pundits eager to defend its achievements, including in North America at such bygone hotbeds of Keynesianism as Harvard University. This essay seeks to probe cherished mythologies of Thatcherism that she restored Britain's economic dynamism, streamlined government and revived plucky entrepreneurship. Her intellectual admirers have largely averted their eyes from law‐and‐order repression and the rewards delivered to politically connected insiders, most dramatically those policies unleashing finance capitalists and extending the tentacles of the Murdoch media empire.
Do unions redistribute income from capital to labour? Union density and wage shares since 1960
Authors: Bengtsson Erik
Published: July 2014

The income distribution between capital and labour is understudied within industrial relations. This article investigates the relationship between union density, taken as an indicator of the bargaining power of unions, and the wage share of national income in 16 advanced capitalist economies since 1960. It is shown that overall there is a positive relationship between union density and the wage share, as one would expect. But the relationship is weak or non‐existent in the Nordic countries, and in some specifications in Germany and Anglo‐Saxon countries, and overall it is weak in the 1980s and early 1990s. The article discusses the differences between countries in relationship to the literature on corporatism and wage moderation, and the decreasing effect over time with reference to increased global competition and conservatism of monetary policy from about 1980 on, increasing unions' incentives for wage moderation policies.
The effectiveness of a twice‐daily skin‐moisturising regimen for reducing the incidence of skin tears
Authors: Carville Keryln , Leslie Gavin , Osseiran‐Moisson Rebecca , Newall Nelly , Lewin Gill
Published: July 2014

A cluster randomised controlled trial was conducted to evaluate the effectiveness of a twice‐daily moisturising regimen as compared to ‘usual’ skin care for reducing skin tear incidence. Aged care residents from 14 Western Australian facilities (980 beds) were invited to participate. The facilities were sorted into pairs and matched in terms of bed numbers and whether they provided high or low care. One facility from each matched pair was randomised to the intervention group. Consenting residents in an intervention facility received a twice‐daily application of a commercially available, standardised pH neutral, perfume‐free moisturiser on their extremities. Residents in the control facilities received ad hoc or no standardised skin‐moisturising regimen. Participant numbers were sufficient to detect a 5% difference in incidence rate between the two groups with 80% power and a significance level of P = 0·05, and the inter‐cluster correlation coefficient was 0·034. Data were collected over 6 months. A total of 1396 skin tears on 424 residents were recorded during the study. In the intervention group, the average monthly incidence rate was 5·76 per 1000 occupied bed days as compared to 10·57 in the control group. The application of moisturiser twice daily reduced the incidence of skin tears by almost 50% in residents living in aged care facilities.
Tumour‐suppressor genes in prostatic oncogenesis: a positional approach
Authors: BOOKSTEIN R. , BOVA G.S. , MacGROGAN D. , LEVY A. , ISAACS W.B.
Published: July 2014

Genetic alterations, such as mutation, methylation and aneuploidy, are thought to underlie the multistep genesis and progression of many human cancers. However, the genetic events occurring in prostatic oncogenesis are still relatively poorly understood. This is especially so in early‐stage tumours, in which mutations of known oncogenes or tumour‐suppressor genes appear to be quite infrequent. Allelic losses of chromosome arms 7q, 8p, 10, 16q and 18q suggest the involvement of novel suppressor loci on these chromosomes; allelic losses of chromosome arm 8p are especially frequent and may be detected even in early‐stage tumours. We have used a positional approach to seek novel genetic targets in prostate cancer, including allelic‐loss mapping of chromosome 8p and physical mapping of chromosome band 8p22 around the MSR gene. A homozygous somatic deletion in one prostatic nodal metastasis was mapped in this region and spanned 730–970 kb. This region was then examined in detail for expressed sequences. One novel gene, called N33, was found to be silenced by a methylation mechanism in most colon cancer cell lines and some primary colorectal tumours. Characterization of additional chromosome 8p22 candidates is in progress.
The palliative therapy of advanced prostate cancer, with particular reference to the results of recent European clinical trials
Authors: NEWLING D.W.W.
Published: July 2014

The palliative therapy of advanced prostate cancer still remains a perplexing problem. If advanced prostate cancer is defined either as a primary advanced‐stage tumour (T3, T4, N0‐N1), or a rising PSA level after primary and hopefully curative therapy, or the traditional patient presenting with small‐ or large‐volume metastases with or without symptoms, then some 60% of all patients have advanced disease when first seen. There is still a need for the continuation of large prospective, randomized studies in all stages of this common illness, to define the role of the different therapeutic options at our disposal. The urological and urooncological worlds must be patient and not jump to too many early conclusions over the benefit of the various therapies until a statistical advantage for both individual and combined therapeutic options has been shown.
Formalized synthesis opportunities for ecology: systematic reviews and meta‐analyses
Authors: Lortie Christopher J.
Published: July 2014

Narrative reviews are dead. Long live systematic reviews (and meta‐analyses). Synthesis in many forms is now a driving force in ecology. Advances in open data for ecology and new tools provide vastly improved capacity for novel, emergent knowledge synthesis in our discipline. Systematic reviews and meta‐analyses are two formal synthesis opportunities for ecologists that are now accepted as traditional publications, but the scope of validated syntheses will continue to expand. To date, systematic reviews are rarely used whilst the rate of meta‐analyses published in ecological journals is increasing exponentially. Systematic reviews provide an overview of the literature landscape for a topic, and meta‐analyses examine the strength of evidence integrated across different studies. Effective synthesis benefits from both approaches, but better data reporting and additional advances in the culture of sharing data, code, analytics, workflows, methods and also ideas will further energize these efforts. At this junction, synthetic efforts that include systematic reviews and meta‐analyses should continue as stand‐alone publications. This is a necessary step in the evolution of synthesis in our discipline. Nonetheless, they are still evolving tools, and meta‐analyses in particular are simply an extended set of statistical tests. Admittedly, understanding the statistics and assumptions influence how we conduct synthesis much as statistical choices often shape experimental design, i.e. ANOVA versus regression‐based experiments, but statistics do not make the paper. Current steps – primary research articles need to more effectively report evidence, sharing scientific products should expand, systematic reviews should be used to identify research gaps/delineate literature landscapes, and meta‐analyses should be used to examine evidence patterns to further predictive ecology.
Identifying the paths leading to variation in geographical range size in western North American monkeyflowers
Authors: Sheth Seema N. , Jiménez Iván , Angert Amy L.
Published: July 2014

Aim

Closely related species can vary tremendously in size of geographical range, yet the causes of such variation are poorly understood. Prominent hypotheses about range size emphasize effects of niche properties and habitat connectivity via the amount and occupancy of suitable habitat, respectively. Previous studies have examined single hypotheses in isolation; however, we assessed the relative importance of these effects along with their potential interactions, using monkeyflower species (genusMimulus) as a study system.

Location

Western North America.

Methods

We used primary occurrence data and climatic layers to estimate climatic niche breadth and position (relative to average regional climate), connectivity of climatically suitable habitat, and geographical range size of 72 monkeyflower species. Using path analysis, we then assessed the relative importance of climatic niche properties and connectivity of climatically suitable habitat in explaining variation in the amount and occupancy of climatically suitable habitat, respectively, and in turn, variation in geographical range size.

Results

We documented strong support for the hypothesized effects of climatic niche breadth, but not niche position and connectivity of climatically suitable habitat. Amount of climatically suitable habitat explained more variation in range size than occupancy of climatically suitable habitat, with amount and occupancy of suitable habitat together explainingc. 83% of the variation in range size.

Main conclusions

To our knowledge, this is the first study to show that climatic niche breadth, via its effects on the amount of climatically suitable habitat, is a strong predictor of geographical range size, thereby improving our understanding of the mechanisms driving species rarity.
Difference in Left Ventricular Mass Index Between Hypertensive Patients With and Without Renal Artery Stenosis by Propensity Score Analysis
Authors: Hoshida Shiro , Shinoda Yukinori , Inui Hirooki , Hosoi Ryoji , Teranishi Fumiko , Asaoka Nobuaki , Sugitani Toshifumi , Hamasaki Toshimitsu
Published: July 2014

This study aimed to define the difference in cardiac hypertrophy between hypertensive patients with and without renal artery stenosis (RAS). When cardiac ultrasonographic examination was performed in 971 consecutive hypertensive outpatients, renal peak systolic velocity (PSV) was examined. Compared with patients without RAS, those with RAS (PSV ≥180 cm/s, 4.1%) were significantly older and included a higher proportion of male patients and had a higher left ventricular mass index (LVMI). A stratified analysis in the selected 120 patients showed that the LVMI was significantly higher in patients with RAS than in those without RAS for each confounding factor such as age and blood pressure. RAS was independently associated with a higher LVMI on propensity score analysis and multivariate analysis. Thus, the difference in LVMI between hypertensive patients with and without RAS was confirmed, irrespective of age and blood pressure, by stratified propensity score analysis and multivariate regression analysis.
The Economy Strikes Back: Support for the EU during the Great Recession
Authors: Gomez Raul
Published: July 2014

This article looks at the role of economic conditions in shaping people's attitudes to the EU during the Great Recession. In contrast with previous research, findings suggest that in this particular instance support for the EU across Member States was affected by economic factors. In particular, both higher unemployment and higher interest rates were strongly associated with lower levels of support. Findings also suggest that young Europeans responded more strongly to adverse economic conditions during the crisis. Even though young citizens tend to have more positive attitudes towards the EU than older people, this difference has been significantly reduced in contexts of higher interest rates.
Assessment of partial‐mouth periodontal examination protocols for periodontitis surveillance
Authors: Tran Duong T. , Gay Isabel , Du Xianglin L. , Fu Yunxin , Bebermeyer Richard D. , Neumann Ana S. , Streckfus Charles , Chan Wenyaw , Walji Muhammad F.
Published: July 2014

Objective

To evaluate bias associated with nine identified partial‐mouth periodontal examination (PMPE) protocols in estimating periodontitis prevalence using the periodontitis case definition given by the Centers of Disease Control and Prevention and American Academy of Periodontology (CDC/AAP).

Material and Methods

Prevalence from full‐mouth examination was determined in a sample of 3667 adults ≥30 years old from the National Health and Nutrition Examination Survey (NHANES) 2009–2010. Prevalence, absolute bias, relative bias, sensitivity and inflation factor were derived for these protocols according to the CDC/AAP definition and half‐reduced CDC/AAP definition as ≤50% of sites were measured.

Results

Bias in moderate and severe periodontitis prevalence ranged between 11.1–52.5% and 27.1–76.3% for full‐mouth mesiobuccal‐distolingual protocol and half‐mouth mesiobuccal protocol respectively; according to the CDC/AAP definition. With half‐reduced CDC/AAP definition, half‐mouth four sites protocol provided small absolute bias (3.2%) and relative bias (9.3%) for the estimates of moderate periodontitis prevalence; corresponding biases for severe periodontitis were −1.2% and −10.2%.

Conclusion

Periodontitis prevalence can be estimated with limited bias when a half‐mouth four sites protocol and a half‐reduced CDC/AAP case definition are used in combination.
Birth weight as an independent predictor of ADHD symptoms: a within‐twin pair analysis
Authors: Pettersson Erik , Sjölander Arvid , Almqvist Catarina , Anckarsäter Henrik , D'Onofrio Brian M. , Lichtenstein Paul , Larsson Henrik
Published: July 2014

Background

Studies have found an association between low birth weight and ADHD, but the nature of this relation is unclear. First, it is uncertain whether birth weight is associated with both of the ADHD dimensions, inattentiveness and hyperactivity‐impulsivity. Second, it remains uncertain whether the association between birth weight and ADHD symptom severity is confounded by familial factors.

Method

Parents of all Swedish 9‐ and 12‐year‐old twins born between 1992 and 2000 were interviewed for DSM‐IV inattentive and hyperactive‐impulsive ADHD symptoms by the Autism – Tics, AD/HD and other Comorbidities (A‐TAC) inventory (N = 21,775 twins). Birth weight was collected prospectively through the Medical Birth Registry. We used a within‐twin pair design to control for genetic and shared environmental factors.

Results

Reduced birth weight was significantly associated with a mean increase in total ADHD (β = −.42; 95% CI: −.53, −.30), inattentive (β = −.26; 95% CI: −.33, −.19), and hyperactive‐impulsive (β = −.16; 95% CI: −.22, −.10) symptom severity. These results imply that a change of one kilogram of birth weight corresponded to parents rating their child nearly one unit higher (going from “no” to “yes, to some extent” on a given symptom) on the total ADHD scale. These associations remained within pairs of MZ and DZ twins, and were also present when restricting the analyses to full term births.

Conclusions

There is an independent association between low birth weight and all forms of ADHD symptoms, even after controlling for all environmental and genetic confounds shared within twin pairs. These results indicate that fetal growth restriction (as reflected in birth weight differences within twin pairs) and/or the environmental factors which influence it is in the casual pathway leading to ADHD.
Teleological care and the last years of life
Authors: Cellarius Victor , Upshur Ross
Published: July 2014

The final years of life present challenges for care. In middle‐/high‐income countries, the percentage of people of advanced age in the population is growing, and the dying process continues to become more complex and protracted. We propose that a new understanding of care, ‘teleological care’, be considered as an important response to the contemporary challenges of the final years of life. Teleological care is a philosophy of care built around the root idea of a telos (i.e. end) in three senses: (1) the end of life as a temporal limit; (2) the ends of life as the individual's purpose and meaning; (3) the end of life as the meaning of life as a whole. In its practice, teleological care adheres to principles of (1) fidelity of practitioner to patient; (2) generalism of practitioners; and (3) coordination of care within existing services. With this philosophy and practice, care is administered by generalist health care professionals arranging for flow between care that attempts to reverse, stop or slow the disease process when appropriate, with care to address symptoms, and with care that responds to the difficulties of dying. Teleological care involves already existing programmes in roughly their present forms, serving as an overarching layer of organization added to the existing systems. Teleological care refocuses the concept of care to the patient's perspective with emotional, spiritual and practical support for facing the end of life, and a space for narrative and reflection within a wider circle of care.
Enterocytozoon bieneusi Genotypes in Yaks (Bos grunniens) and Their Public Health Potential
Authors: Ma Jingbo , Cai Jinzhong , Ma Jiawen , Feng Yaoyu , Xiao Lihua
Published: July 2014

Enterocytozoon bieneusi, the most frequently diagnosed microsporidian species in humans, is also identified in a wide range of animals. To date, few data are available on E. bieneusi in yaks (Bos grunniens). In this study, we examined the occurrence and genotype identity of E. bieneusi in yaks in four counties in Qinghai Province of China. Of 327 fecal specimens examined by nested PCR analysis of the ribosomal internal transcribed spacer, 23 (7.0%) were E. bieneusi‐positive. DNA sequence analysis of the PCR products revealed the presence of five distinct genotypes: three Group 2 genotypes previously reported in cattle as well as humans (BEB4, I and J) and two novel genotypes (CHN11 and CHN12) belonging to the large zoonotic group (Group 1). Data of the study suggest that these animals could be potential reservoirs for human E. bieneusi infection.
Molecular Phylogeny of an Indian Population of Kleinstyla dorsicirrata (Foissner, 1982) Foissner et al., 2002. comb. nov. (Hypotrichia, Oxytrichidae): an Oxytrichid with Incomplete Dorsal Kinety Fragmentation
Authors: Singh Jasbir , Kamra Komal
Published: July 2014

Kleinstyla dorsicirrata (Foissner, 1982) Foissner et al., 2002. comb. nov. (basionym: Gastrostyla dorsicirrata) is a slightly flexible oxytrichid, measuring about 88–115 × 27–46 μm in life and possesses cortical granules. Kleinstyla dorsicirrata is the only oxytrichid known so far with incompletely fragmented dorsal kinety. Morphological and morphogenetic data recognise K. dorsicirrata as nonstylonychine oxytrichid. Molecular phylogeny of an Indian population was inferred using 18S rRNA gene sequences and was examined with respect to oxytrichids exhibiting variation in dorsal kinety fragmentation. Kleinstyla dorsicirrata clusters with Oxytricha lanceolata; this proximity is quite significant as both show deviation from typical oxytrichid fragmentation of dorsal kinety. Molecular phylogeny of Indian population confirms its nonstylonychine oxytrichid status.
Transmission dynamics of the monogeneanGyrodactylus salarisunder seminatural conditions
Authors: Hendrichsen D K , Kristoffersen R , Gjelland K Ø , Knudsen R , Kusterle S , Rikardsen A H , Henriksen E H , Smalås A , Olstad K
Published: July 2014

Tracking individual variation in the dynamics of parasite infections in wild populations is often complicated by lack of knowledge of the epidemiological history of hosts. Whereas the dynamics and development ofGyrodactylus salarisMalmberg, 1957, onAtlantic salmon,Salmo salarL., are known from laboratory studies, knowledge about infection development on individual wild fishes is currently sparse. In this study, the dynamics of an infection ofG. salarison individually markedAtlantic salmon parr was followed in a section of a natural stream. During the 6‐week experiment, the prevalence increased from 3.3 to 60.0%, with an average increase in intensity of 4.1% day−1. Survival analyses showed an initially high probability (93.6%) of staying uninfected byG. salaris, decreasing significantly to 37% after 6 weeks. The results showed that even at subarctic water temperatures and with an initially low risk of infection, the parasite spread rapidly in the Atlantic salmon population, with the capacity to reach 100% prevalence within a short summer season. The study thus track individual infection trajectories ofAtlantic salmon living under near‐natural conditions, providing an integration of key population parameters from controlled experiments with the dynamics of the epizootic observed in free‐living living populations.
Testing the Preservation Activity of Ag‐TiO2‐Fe and TiO2 Composites Included in the Polyethylene during Orange Juice Storage
Authors: Peter Anca , Mihaly‐Cozmuta Leonard , Mihaly‐Cozmuta Anca , Nicula Camelia , Indrea Emil , Barbu‐Tudoran Lucian
Published: July 2014

Orange juice was stored in polyethylene packages containing Ag‐TiO2‐Fe or TiO2 composites to establish the extent to which these composites influence the physical‐chemical, microbiological and organoleptic characteristics of the juice. The composites were characterized in terms of structure (X‐ray diffraction, transmission electron microscopy, Fourier‐transformed infrared) and photoactivity while the packages were profiled in terms of their UV‐vis absorption and water vapor permeability. The acidity and the browning rate of the sample stored in the package with Ag‐TiO2‐Fe decreased after 10 days of storage, as compared with the sample deposited in TiO2 packages and with the reference sample (polyethylene). The microbial population in the orange juice increased after 10 days of storage in all packages, but the increase was smaller in the Ag‐TiO2‐Fe polyethylene package. The organoleptic properties of the fresh orange juice deposited in package with Ag‐TiO2‐Fe were almost identical with those of the freshly prepared sample (0 days), whereas those of the juice deposited in the reference package were unacceptable.

Practical Applications

The study provides evidence that the packages of polyethylene modified with Ag‐TiO2‐Fe can be used to store fresh orange juice for 10 days at room temperature (22.5C).
Improving Medication Management Competency of Clinical Trainees in Geriatrics
Authors: Kostas Tia , Zimmerman Kristin , Salow Marci , Simone Mark , Whitmire Natalie , Rudolph James L. , McMahon Graham T.
Published: July 2014

The authors hypothesized that an interprofessional workshop would improve geriatrics trainees' medication management. The workshop was based on a needs assessment and comprised an interactive session with pharmacists on managing medications in elderly adults. Participants were trainees in their geriatrics rotation at a tertiary care medical center. Trainees completed a medication appropriateness survey for three patients, one of which was their own. After the workshop, trainees reviewed medications of the three patients. Trainees completed online surveys after their rotation and 3 months later. Of 95 trainees rotating through geriatrics, 76 (80%) attended the workshop and completed the worksheet. Trainees' scores on reviewing medication lists improved significantly, from 6.7 ± 2.3 to 7.7 ± 2.0 out of 11 for standardized patient 1 (P < .001) and from 5.7 ± 1.8 to 6.4 ± 1.5 out of 11 for standardized patient 2 (P = .009). Trainees' scores on their own patients' lists also improved significantly, from 5.6 ± 1.5 to 6.6 ± 1.5 out of 10 (P < .001). After the workshop, 95% (71/75) planned to change the medication regimen of the patient they presented, and 93% (68/73) planned to change other patients' medications based on information learned during the workshop. Three months later, 35% (12/34) had made changes to the regimen of the patient they discussed during the workshop, and 71% (15/21) had made changes to other patients' regimens. Seventy‐eight percent (18/23) rated the workshop as the top nonclinical experience of their geriatrics rotation. In conclusion, this interprofessional medication management workshop improved trainees' ability to perform medication reviews accurately and led to change in self‐reported prescribing behavior.
Association Between Hearing Impairment and Lower Levels of Physical Activity in Older Adults
Authors: Gispen Fiona E. , Chen David S. , Genther Dane J. , Lin Frank R.
Published: July 2014

Objectives

To determine whether hearing impairment, highly prevalent in older adults, is associated with activity levels.

Design

Cross‐sectional.

Setting

National Health and Nutritional Examination Survey (2005–06).

Participants

Individuals aged 70 and older who completed audiometric testing and whose physical activity was assessed subjectively using questionnaires and objectively using body‐worn accelerometers (N = 706).

Measurements

Hearing impairment was defined according to the speech‐frequency (0.5–4 kHz) pure‐tone average in the better‐hearing ear (normal <25.0 dB, mild 25.0–39.9 dB, moderate or greater ≥40 dB). Main outcome measures were self‐reported leisure time physical activity and accelerometer‐measured physical activity. Both were quantified using minutes of moderate‐intensity physical activity and categorized as inactive, insufficiently active, or sufficiently active. Ordinal logistic regression analyses were conducted and adjusted for demographic and cardiovascular risk factors.

Results

Individuals with moderate or greater hearing impairment had greater odds than those with normal hearing of being in a lower category of physical activity as measured according to self‐report (OR = 1.59, 95% CI = 1.11–2.28) and accelerometry (OR = 1.70, 95% CI = 0.99–2.91). Mild hearing impairment was not associated with level of physical activity.

Conclusion

Moderate or greater hearing impairment in older adults is associated with lower levels of physical activity independent of demographic and cardiovascular risk factors. Future research is needed to investigate the basis of this association and whether hearing rehabilitative interventions could affect physical activity in older adults.
Weight Change, Body Composition, and Risk of Mobility Disability and Mortality in Older Adults: A Population‐Based Cohort Study
Authors: Murphy Rachel A. , Patel Kushang V. , Kritchevsky Stephen B. , Houston Denise K. , Newman Anne B. , Koster Annemarie , Simonsick Eleanor M. , Tylvasky Frances A. , Cawthon Peggy M. , Harris Tamara B. ,   the Health, Aging, and Body Composition Study
Published: July 2014

Objectives

To examine associations between weight change, body composition, risk of mobility disability, and mortality in older adults.

Design

Prospective, longitudinal, population‐based cohort.

Setting

The Health, Aging, and Body Composition Study.

Participants

Women (n = 1,044) and men (n = 931) aged 70 to 79.

Measurements

Weight and lean and fat mass from dual‐energy X‐ray absorptiometry measured annually over 5 years. Weight was defined as stable (n = 664, reference), loss (n = 662), gain (n = 321), or cycling (gain and loss, n = 328) using change of 5% from year to year or from Year 1 to 6. Mobility disability (two consecutive reports of difficulty walking one‐quarter mile or climbing 10 steps) and mortality were determined for 8 years after the weight change period. Associations were analyzed using Cox proportional hazards regression adjusted for covariates.

Results

During follow‐up, 313 women and 375 men developed mobility disability, and 322 women and 378 men died. There was no risk of mobility disability or mortality with weight gain. Weight loss (hazard ratio (HR) = 1.88, 95% confidence interval (CI) = 1.40–2.53) and weight cycling (HR = 1.59, 95% CI = 1.11–2.29) were associated with mobility disability in women, and weight loss was associated with mobility disability in men (HR = 1.30, 95% CI = 1.01–1.69). Weight loss and weight cycling were associated with mortality risk in women (weight loss: HR = 1.47, 95% CI = 1.07–2.01; weight cycling: HR = 1.62, 95% CI = 1.15–2.30) and in men (weight loss: HR = 1.41, 95% CI = 1.09–1.83; weight cycling: HR = 1.50, 95% CI = 1.08–2.08). Adjustment for lean and fat mass and change in lean and fat mass from Year 1 to 6 attenuated the relationships between weight loss and mobility disability in men and between weight loss and mortality in men and women.

Conclusion

Weight cycling and weight loss predict impending mobility disability and mortality in old age, underscoring the prognostic importance of weight history.
Barriers to Industrial Symbiosis: Insights from the Use of a Maturity Grid
Authors: Golev Artem , Corder Glen D. , Giurco Damien P.
Published: July 2014

The concept of industrial symbiosis (IS) over the last 20 years has become a well‐recognized approach for environmental improvements at the regional level. Many technical solutions for waste and by‐product material, water, and energy reuse between neighboring industries (so‐called synergies) have been discovered and applied in the IS examples from all over the world. However, the potential for uptake of new synergies in the regions is often limited by a range of nontechnical barriers. These barriers include environmental regulation, lack of cooperation and trust between industries in the area, economic barriers, and lack of information sharing. Although several approaches to help identify and overcome some of the nontechnical barriers were examined, no methodology was found that systematically assessed and tracked the barriers to guide the progress of IS development. This article presents a new tool—IS maturity grid—to tackle this issue in the regional IS studies. The tool helps monitor and assess the level of regional industrial collaboration and also indicates a potential path for further improvements and development in an industrial region, depending on where that region currently lies in the grid. The application of the developed tool to the Gladstone industrial region of Queensland, Australia, is presented in the article. It showed that Gladstone is at the third (active) stage of five stages of maturity, with cooperation and trust among industries the strongest characteristic and information barriers the characteristic for greatest improvement.
The Consequences of Early‐Life Adversity: Neurobiological, Behavioural and Epigenetic Adaptations
Authors: Maccari S. , Krugers H. J. , Morley‐Fletcher S. , Szyf M. , Brunton P. J.
Published: July 2014

During the perinatal period, the brain is particularly sensitive to remodelling by environmental factors. Adverse early‐life experiences, such as stress exposure or suboptimal maternal care, can have long‐lasting detrimental consequences for an individual. This phenomenon is often referred to as ‘early‐life programming’ and is associated with an increased risk of disease. Typically, rodents exposed to prenatal stress or postnatal maternal deprivation display enhanced neuroendocrine responses to stress, increased levels of anxiety and depressive‐like behaviours, and cognitive impairments. Some of the phenotypes observed in these models of early‐life adversity are likely to share common neurobiological mechanisms. For example, there is evidence for impaired glucocorticoid negative‐feedback control of the hypothalamic‐pituitary‐adrenal axis, altered glutamate neurotransmission and reduced hippocampal neurogenesis in both prenatally stressed rats and rats that experienced deficient maternal care. The possible mechanisms through which maternal stress during pregnancy may be transmitted to the offspring are reviewed, with special consideration given to altered maternal behaviour postpartum. We also discuss what is known about the neurobiological and epigenetic mechanisms that underpin early‐life programming of the neonatal brain in the first generation and subsequent generations, with a view to abrogating programming effects and potentially identifying new therapeutic targets for the treatment of stress‐related disorders and cognitive impairment.
Hippocampal Plasticity during the Peripartum Period: Influence of Sex Steroids, Stress and Ageing
Authors: Galea L. A. M. , Leuner B. , Slattery D. A.
Published: July 2014

The peripartum period is accompanied by dramatic changes in hormones and a host of new behaviours in response to experience with offspring. Both maternal experience and maternal hormones can have a significant impact upon the brain and behaviour. This review outlines recent studies demonstrating modifications in hippocampal plasticity across the peripartum period, as well as the putative hormonal mechanisms underlying these changes and their modulation by stress. In addition, the impact of reproductive experience upon the ageing hippocampus is discussed. Finally, we consider how these changes in hippocampal structure may play a role in postpartum cognitive function and mood disorders, as well as age‐related cognitive decline.
Sexuality of postinfarction patients: diagnosis, results and nursing intervention
Authors: Santos André Flávia dos , Maria Vera L Regina
Published: July 2014

Aims and objectives

To identify the main nursing diagnosis and to analyse and select the appropriate outcomes and interventions for postinfarction patients.

Background

After a cardiac event, few patients resume their sexual life with the same intensity and frequency they used to have, and some patients do not even do it. Doubtful and insecure reactions are observed in both patients/partners and health professionals. These behaviours are frequently taboos and preconceptions about sexuality which are still taken as real among us.

Design

Exploratory study.

Methods

Integrative literature review with online search on the Virtual Health Library (BVS) and websites. The most relevant diagnosis in the general literature was compared with International Classification for Nursing Practice and North‐American International Nursing Diagnosis Association. The outcomes were selected from Nursing Outcome Classification, and the interventions and activities were based on the general literature and Nursing Intervention Classification.

Results

Sexual dysfunction was the most relevant diagnosis described in the general literature. The characteristics and related factors were specified in patient's/their partner's verbalisation of the physical difficulties in having sexual activity and in their social and emotional reactions to the disease and to the prescribed medicine. The selected priority results were sexuality and knowledge on sexuality. The counselling intervention was chosen as the most appropriate.

Conclusion

It was possible to get to the wide understanding of the sexual dysfunction as a nursing diagnosis expressed in the daily routine of the care to the postinfarction patient. Its identification requires knowledge and abilities to acknowledge its characteristics and related factors, which served as support for selection of outcomes, interventions and nursing activities.

Relevance to clinical practice

Association between diagnosis, outcomes, interventions and nursing activities established for the postinfarction patient is strategic so as to guide the nurses who operate in the cardiovascular area and may contribute towards refinement of the nursing classifications.