bluuebunny/crossref_metadata_2025_split huggingface dataset:
Human adaptive immune receptor repertoire analysis—Past, present, and future
Authors: Nielsen Sandra C. A. , Boyd Scott D. 
Published: June 2018

SummaryThe genes encoding adaptive immune antigen receptors, namely the immunoglobulins expressed in membrane‐bound or secreted forms by B cells, and the cell surface T cell receptors, are unique in human biology because they are generated by combinatorial rearrangement of the genomic DNA. The diversity of receptors so generated in populations of lymphocytes enables the human immune system to recognize antigens expressed by pathogens, but also underlies the pathological specificity of autoimmune diseases and the mistargeted immunity in allergies. Several recent technological developments, foremost among them the invention of high‐throughput DNA sequencing instruments, have enabled much deeper and thorough evaluation of clones of human B cells and T cells and the antigen receptors they express during physiological and pathogenic immune responses. The evolutionary struggles between host adaptive immune responses and populations of pathogens are now open to greater scrutiny, elucidation of the underlying reasons for successful or failed immunity, and potential predictive modeling, than ever before. Here we give an overview of the foundations, recent progress, and future prospects in this dynamic area of research.
Bohemian T cell receptors: sketching the repertoires of unconventional lymphocytes
Authors: Schattgen Stefan A. , Thomas Paul G. 
Published: June 2018

SummaryOver the last several decades, novel populations of unconventional T cells have been identified; defined by an invariant (or nearly invariant) T cell receptor (TCR) with a fixed specificity to non‐canonical antigens and major histocompatibility (MHC) molecules, they form large, functionally monoclonal populations tasked with surveying for their specific antigens. With residence in both lymphoid and non‐lymphoid tissues coupled with their ability to rapidly produce a spectrum of cytokines and effector molecules, the unconventional T cells are poised as some of the first responders to infection/damage and are thought to provide critical coverage before more focused, conventional T cell responses are mobilized. However, new technologies for the measurement and characterization of TCR repertoires have identified an underappreciated amount of TCR diversity in the unconventional T cells. In many cases, the specificities of these diverse TCRs converge on the same or similar antigens as their invariant counterparts, while others have yet to be defined. Here, we will review the current knowledge of the TCR repertoires of unconventional T cells and discuss how repertoires might be used as a framework for their organization, and further our understanding of their role not only during an immune response, but also their contribution in maintaining homeostasis.
The sequences encoded by immunoglobulin diversity (DH) gene segments play key roles in controlling B‐cell development, antigen‐binding site diversity, and antibody production
Authors: Khass Mohamed , Vale Andre M. , Burrows Peter D. , Schroeder Harry W. 
Published: June 2018

SummaryAlthough at first glance the diversity of the immunoglobulin repertoire appears random, there are a number of mechanisms that act to constrain diversity. For example, key mechanisms controlling the diversity of the third complementarity determining region of the immunoglobulin heavy chain (CDR‐H3) include natural selection of germline diversity (DH) gene segment sequence and somatic selection upon passage through successive B‐cell developmental checkpoints. To test the role of DH gene segment sequence, we generated a panel of mice limited to the use of a single germline or frameshifted DH gene segment. Specific individual amino acids within core DH gene segment sequence heavily influenced the absolute numbers of developing and mature B‐cell subsets, antibody production, epitope recognition, protection against pathogen challenge, and susceptibility to the production of autoreactive antibodies. At the tip of the antigen‐binding loop (PDB position 101) in CDR‐H3, both natural (germline) and somatic selection favored tyrosine while disfavoring the presence of hydrophobic amino acids. Enrichment for arginine in CDR‐H3 appeared to broaden recognition of epitopes of varying hydrophobicity, but led to diminished binding intensity and an increased likelihood of generating potentially pathogenic dsDNA‐binding autoreactive antibodies. The phenotype of altering the sequence of the DH was recessive for T‐independent antibody production, but dominant for T‐cell‐dependent responses. Our work suggests that the antibody repertoire is structured, with the sequence of individual DH selected by evolution to preferentially generate an apparently preferred category of antigen‐binding sites. The result of this structured approach appears to be a repertoire that has been adapted, or optimized, to produce protective antibodies for a wide range of pathogen epitopes while reducing the likelihood of generating autoreactive specificities.
A bundled phosphate control intervention (4Ds) for adults with end‐stage kidney disease receiving haemodialysis: A cluster randomized controlled trial protocol
Authors: Milazi Molly , Douglas Clint , Bonner Ann 
Published: June 2018

AbstractAimTo evaluate the effectiveness of a bundled self‐management intervention (Taking control of your phosphate with the 4Ds) to improve phosphate control among adults receiving haemodialysis.BackgroundHyperphosphataemia occurs in end‐stage kidney disease and is associated with increased morbidity and mortality. While hyperphosphataemia can be managed through four methods (food, drinks, drugs and dialysis) adherence to these methods is challenging for patients. Studies also tend to focus on one method of phosphate control rather than bundling all methods together into a theoretically driven intervention.DesignA multisite cluster randomized controlled trial with repeated measures.MethodsAdults receiving haemodialysis with high serum phosphate levels (>1.6 millimoles per litre for at least 3 months) will be cluster randomized to standard care or intervention according to haemodialysis treatment shift. Informed by social cognitive theory, the intervention focuses on improving self‐efficacy and incorporates the “teach‐back” method of patient education. The intervention brings together essential phosphate control strategies of diet, drinks, drugs (phosphate binders) and dialysis prescription in a 12‐week self‐management education programme. The primary outcome is serum phosphate level. Secondary outcomes are knowledge of and adherence to phosphate control strategies and self‐efficacy for managing kidney disease.DiscussionEfforts to improve phosphate control have been undertaken although the optimal approach remains unclear. This study will make an important contribution to building an evidence base of phosphate control nursing intervention that can be delivered during routine haemodialysis.Trial registration: Australian and New Zealand Clinical Trials Registry Number ACTRN12617000703303
Development and initial testing of the self‐care of chronic illness inventory
Authors: Riegel Barbara , Barbaranelli Claudio , Sethares Kristen A. , Daus Marguerite , Moser Debra K. , Miller Jennifer L. , Haedtke Christine A. , Feinberg Jodi L. , Lee Solim , Stromberg Anna , Jaarsma Tiny 
Published: June 2018

AbstractAimThe aim was to develop and psychometrically test the self‐care of chronic illness Inventory, a generic measure of self‐care.BackgroundExisting measures of self‐care are disease‐specific or behaviour‐specific; no generic measure of self‐care exists.DesignCross‐sectional survey.MethodsWe developed a 20‐item self‐report instrument based on the Middle Range Theory of Self‐Care of Chronic Illness, with three separate scales measuring Self‐Care Maintenance, Self‐Care Monitoring, and Self‐Care Management. Each of the three scales is scored separately and standardized 0–100 with higher scores indicating better self‐care. After demonstrating content validity, psychometric testing was conducted in a convenience sample of 407 adults (enrolled from inpatient and outpatient settings at five sites in the United States and ResearchMatch.org). Dimensionality testing with confirmatory factor analysis preceded reliability testing.ResultsThe Self‐Care Maintenance scale (eight items, two dimensions: illness‐related and health‐promoting behaviour) fit well when tested with a two‐factor confirmatory model. The Self‐Care Monitoring scale (five items, single factor) fitted well. The Self‐Care Management scale (seven items, two factors: autonomous and consulting behaviour), when tested with a two‐factor confirmatory model, fitted adequately. A simultaneous confirmatory factor analysis on the combined set of items supported the more general model.ConclusionThe self‐care of chronic illness inventory is adequate in reliability and validity. We suggest further testing in diverse populations of patients with chronic illnesses.
The impact of burnout on self‐efficacy, outcome expectations, career interest and nurse turnover
Authors: Chang Hao‐Yuan , Friesner Daniel , Chu Tsung‐Lan , Huang Tzu‐Ling , Liao Yen‐Ni , Teng Ching‐I 
Published: June 2018

AbstractAimsTo examine the impact of burnout on self‐efficacy, outcome expectations, career interest and on nurses’ intentions to leave the profession and to leave the organization.BackgroundBurnout is associated with nurse turnover. Research clarifying the underlying mechanism may provide a novel means to mitigate the impact of burnout on nurse turnover.DesignThis study uses a cross‐sectional design and proportionate stratified sampling.MethodsData were collected from a sample of nurses in one medical centre in northern Taiwan during February ‐ March 2017. This study included nurses employed full‐time at the medical centre. Burnout was measured using Maslach Burnout Inventory—Human Service Survey. Self‐efficacy, outcome expectations and career interest were measured using the scale of Cunningham et al. Intentions to leave were measured using the scales of Teng et al. Structural equation modelling was used to assess the proposed framework.ResultsBurnout was negatively related to self‐efficacy and outcome expectations. Self‐efficacy was positively related to outcome expectations. Outcome expectations were also positively related to career interest. However, self‐efficacy was not related to career interest. Career interest was negatively related to the intention to leave the organization, which was further related to the intention to leave the profession. The model fitted the data acceptably.ConclusionsWhen nurses leave the profession, patient outcomes may be affected. Policy makers should evaluate whether the healthcare system can instil expectations for satisfaction, power and adequate compensation in the profession and thus retain nurses.
Refining nursing assessment and management with a new postanaesthetic care discharge tool to minimize surgical patient risk
Authors: Street Maryann , Phillips Nicole M. , Haesler Emily , Kent Bridie 
Published: June 2018

AbstractAimsTo evaluate use of an evidence‐based discharge tool, the Post‐Anaesthetic Care Tool and its impact on nursing assessment, communication, and management of patients in the postanaesthetic care unit.BackgroundPostanaesthetic care unit nurses manage patients immediately after surgery and make clinical decisions on discharge readiness. There is a lack of evidence‐based guidance on assessing, documenting, and communicating the patient's postoperative experience. The Post‐Anaesthetic Care Tool, which includes instructions for assessing discharge readiness and incorporates theISOBARacronym, was developed following a comprehensive systematic review and expert consultation.Design and MethodsThis quasiexperimental, multicentre, nonrandomized study was conducted in three postanaesthetic care units in Australia. Participants were nurses providing care to adults postgeneral anaesthesia. Episodes of care were observed before (N = 723) and after (N = 694) introduction of the evidence‐based tool. Statistical methods (Chi‐Square and Mann–WhitneyU‐Tests) were undertaken to analyse nursing assessment, communication, and management outcomes before and after implementation of the Post‐Anaesthetic Care Tool.ResultsThe Post‐Anaesthetic Care Tool was associated with statistically significant improvements in the frequency of nursing assessment and responsiveness to complications including pain, nausea/vomiting and hypothermia. After the tool's introduction, nurses requested more medical reviews. This was associated with increased recognition of clinical deterioration and significant improvements in clarity of handover from the postanaesthetic care unit to the ward.ConclusionsThe structured discharge tool, Post‐Anaesthetic Care Tool, was associated with improved nursing management of patients in the postanaesthetic care unit and enabled early identification and response to clinical concerns.
Adherence, knowledge, and perception about oral anticoagulants in patients with atrial fibrillation at high risk for thromboembolic events after radiofrequency ablation
Authors: Smet Lily , Heggermont Ward A. , Goossens Eva , Eeckloo Kristof , Vander Stichele Robert , De Potter Tom , De Backer Tine 
Published: June 2018

AbstractAimsThis study aimed to: (a) determine adherence rates to oral anticoagulants in atrial fibrillation patients with a high risk for thromboembolic events postradiofrequency ablation; (b) evaluate patients’ knowledge and perceptions towards oral anticoagulants; and (c) explore the impact of patients’ knowledge and perceptions on treatment adherence.BackgroundAtrial fibrillation is a common arrhythmia associated with an increased risk of developing thromboembolic events such as stroke. Although adherence to oral anticoagulants is crucial to prevent such complications, the relationship between adherence, knowledge and patient perceptions is poorly understood in patients with atrial fibrillation at high risk for thromboembolic events after radiofrequency ablation.DesignA cross‐sectional observational survey study was performed in a single centre.MethodsThe levels of adherence, knowledge, and perception towards oral anticoagulants were assessed using the 8‐item Morisky Medication Adherence Scale, Knowledge of Oral Anticoagulation Tool, Perception of Anticoagulant Treatment Questionnaire and Benefit‐Risk Perception Tool, respectively. Results from these self‐reported tools were analysed descriptively. A multivariable binary logistic regression model was used to identify factors associated with levels of adequate adherence.ResultsAdequate treatment adherence was found in three‐quarters of patients. The total mean knowledge score was low. Participants expressed high ease of use and low burden of treatment. Higher total knowledge and satisfaction scores were significant factors associated with higher levels of adherence.ConclusionThere remains a huge unmet need to follow‐up and educate patients with atrial fibrillation, focusing on good knowledge and correct perception of the advantages and disadvantages of oral anticoagulants. Our results suggest that increased knowledge and satisfaction rates might have a positive impact on adherence to oral anticoagulants.
Divergent parasite infections in sympatric cichlid species in Lake Victoria
Authors: Karvonen Anssi , Wagner Catherine E. , Selz Oliver M. , Seehausen Ole 
Published: June 2018

AbstractParasitism has been proposed as a factor in host speciation, as an agent affecting coexistence of host species in species‐rich communities and as a driver of post‐speciation diversification. Young adaptive radiations of closely related host species of varying ecological and genomic differentiation provide interesting opportunities to explore interactions between patterns of parasitism, divergence and coexistence of sympatric host species. Here, we explored patterns in ectoparasitism in a community of 16 fully sympatric cichlid species at Makobe Island in Lake Victoria, a model system of vertebrate adaptive radiation. We asked whether host niche, host abundance or host genetic differentiation explains variation in infection patterns. We found significant differences in infections, the magnitude of which was weakly correlated with the extent of genomic divergence between the host species, but more strongly with the main ecological gradient, water depth. These effects were most evident with infections of Cichlidogyrus monogeneans, whereas the only host species with a strictly crevice‐dwelling niche, Pundamilia pundamilia, deviated from the general negative relationship between depth and parasitism. In accordance with the Janzen–Connell hypothesis, we also found that host abundance tended to be positively associated with infections in some parasite taxa. Data on the Pundamilia sister species pairs from three other islands with variable degrees of habitat (crevice) specialization suggested that the lower parasite abundance of P. pundamilia at Makobe could result from both habitat specialization and the evolution of specific resistance. Our results support influences of host genetic differentiation and host ecology in determining infections in this diverse community of sympatric cichlid species.
The challenge of acquiring a satisfactory EBSD result of CWSR Zircaloy‐4 cladding tube
Authors: LAN K.‐C. , ZHONG W. , MOUCHE P.A. , TUNG H.‐M. , LEE H. , HEUSER B.J. , STUBBINS J.F. 
Published: June 2018

SummaryThis work presents a methodology combining SEM, EDS, conventional EBSD, and transmission‐EBSD to analyse a recrystallised Zircaloy‐4 sheet and cold‐worked stress‐relieved (CWSR) Zircaloy‐4 cladding in unprecedented detail. Second‐phase precipitates (SPPs) in Zircaloy‐4 specimens were revealed after chemical polishing using a solution containing hydrofluoric acid (HF). Pitting corrosion of Zircaloy‐4 specimens was revealed after electropolishing using an electrolyte containing HClO4. A zirconium coupon without SPPs was used to confirm the chemical response of SPPs on surface morphology. Intrinsic features of cold‐worked Zircaloy‐4 such as relatively small grain sizes, high dislocation density, and complex microstructure make it significantly more difficult to collect excellent EBSD results compared to recrystallised Zircaloy‐4. The fine hydride structure of as‐hydrided CWSR Zircaloy‐4 cladding further increases the level of challenge on EBSD analysis.Lay descriptionWe present a methodology combining multiple microscopic methods to analyse a recrystallised Zircaloy‐4 sheet and cold‐worked stress‐relieved (CWSR) Zircaloy‐4 cladding, important alloys of structural materials widely used in nuclear application, and emphasis on the challenge of acquiring a satisfactory electron backscatter diffraction (EBSD) result of CWSR Zircaloy‐4 cladding material in great details. EBSD is a powerful technique to characterise the crystallographic distribution and lattice type of conductive crystalline materials, especially for a highly textured material like CWSR Zircaloy‐4 alloy. However, zirconium alloys are known to be one of the most difficult materials to prepare for EBSD characterisation. We point out that the configuration of the microstructure of the specimen cause the challenge in the EBSD sample preparations. Moreover, the occurrence of tiny zirconium hydride precipitates in Zircaloy‐4 increases the difficulty. We believe that the information of the EBSD sample preparation related results in this paper can provide researchers and scientists in this community a useful reference to speed up the EBSD sample preparation of CWSR Zircaloy‐4 cladding material and to expect the corresponding EBSD results.
Using vignettes to understand heart failure self‐care
Authors: Xu Jiayun , Arruda Sofia , Gallo Joseph J , Wenzel Jennifer , Nolan Marie T , Flowers Deirdre , Szanton Sarah L , Dennison Himmelfarb Cheryl , Han Hae‐Ra 
Published: June 2018

AbstractAims and objectivesTo explore hospitalised heart failure (HF) patients' self‐care decisions.BackgroundHeart failure self‐care is integral to maintain and manage health, and may prevent unnecessary HF hospitalisations. Nevertheless, self‐care remains challenging for patients, and using vignettes offer a new perspective to understand patient HF self‐care decision‐making.DesignThis qualitative descriptive analysis was conducted as part of a mixed methods study.MethodsWe conducted semi‐structured interviews (N = 20) to elicit patient decisions about self‐care in responses to three vignettes, which varied in symptom severity. Content analysis was used to extract quotes describing participant responses.ResultsParticipants were on average 60 years old, primarily male, African American, unemployed and highly symptomatic (NYHA Class III or IV). Overall, participants were able to identify when symptoms required a decision to seek urgent medical attention, but had difficulty identifying the appropriate decision to make in response to less acute symptoms such as swelling.ConclusionsSymptoms other than shortness of breath were challenging for patients to interpret and manage appropriately. Understanding how to apply HF knowledge to alleviate symptoms was also difficult.Relevance to clinical practiceVignettes may be a helpful tool to prompt patient–healthcare provider communication about self‐care management and prompt discussions about appropriate self‐care decisions in response to varying levels of symptom severity.
Occurrence of oral health problems and planned measures in dependent older people in nursing care
Authors: Rantzow Veronica , Andersson Pia , Lindmark Ulrika 
Published: June 2018

AbstractAims and objectiveTo describe oral health problems and planned measures in older people receiving nursing care.BackgroundPoor oral health conditions have a negative impact on the quality of life of older people. Therefore, oral care is an important task in daily nursing activities.MethodsData were obtained from the web‐based Swedish national quality register Senior Alert. Data regarding oral health status and planned measures in individuals ≥65 years from one county in Sweden between July 2014–June 2015 were included. The Revised Oral Assessment Guide—the Jönköping (ROAG‐J) was used routinely by nursing staff in nursing care facilities to measure oral health status.ResultsOral assessments were made on 2,567 individuals (65.7% women). The most common oral health problem was related to “Teeth” (43.0%), which indicates deficient oral hygiene and/or broken teeth. At least one measure was planned in all the participants. The most common planned measures were “Moistening of the mouth” (16.6%), followed by “Brushing – assistance or complete help” (13.5%).ConclusionOral health problems were common, and planned measures did not seem to be sufficient to address the identified problems. The results indicate that greater priority should be given to the oral health care of older people in nursing care.Relevance to clinical practiceThe study highlights the importance of not only identifying oral health problems but also having knowledge and strategies for oral health care. Collaboration is needed to support nurses in caring for the oral health care of older people in nursing homes.