bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased care demand and medical costs after falls in nursing homes: A Delphi study
Authors: Sterke Carolyn Shanty , Panneman Martien J , Erasmus Vicki , Polinder Suzanne , van Beeck Ed F 
Published: April 2018

Aims and objectiveTo estimate the increased care demand and medical costs caused by falls in nursing homes.BackgroundThere is compelling evidence that falls in nursing homes are preventable. However, proper implementation of evidence‐based guidelines to prevent falls is often hindered by insufficient management support, staff time and funding.DesignA three‐round Delphi study.MethodsA panel of 41 experts, all working in nursing homes in the Netherlands, received three online questionnaires to estimate the extra hours of care needed during the first year after the fall. This was estimated for ten falls categories with different levels of injury severity, in three scenarios, that is a best‐case, a typical‐case and a worst‐case scenario. We calculated the costs of falls by multiplying the mean amount of extra hours that the participants spent on the care for a resident after a fall with their hourly wages.ResultsIn case of a noninjurious fall, the extra time spent on the faller is on average almost 5 hr, expressed in euros that add to € 193. The extra staff time and costs of falls increased with increasing severity of injury. In the case of a fracture of the lower limb, the extra staff time increased to 132 hr, expressed in euros that is € 4,604. In the worst‐case scenario of a fracture of the lower limb, the extra staff time increased to 284 hr, expressed in euros that is € 10,170.ConclusionsFalls in nursing homes result in a great deal of extra staff time spent on care, with extra costs varying between € 193 for a noninjurious fall and € 10,170 for serious falls.Relevance to clinical practiceThis study could aid decision‐making on investing in appropriate implementation of falls prevention interventions in nursing homes.
Nature and scope of certified nurse‐midwifery practice: A workforce study
Authors: Hastings‐Tolsma Marie , Foster Sarah Wilcox , Brucker Mary C. , Nodine Priscilla , Burpo Rebecca , Camune Barbara , Griggs Jackie , Callahan Tiffany J. 
Published: April 2018

Aims and ObjectivesTo describe the nature and scope of nurse‐midwifery practice in Texas and to determine legislative priorities and practice barriers.BackgroundAcross the globe, midwives are the largest group of maternity care providers despite little known about midwifery practice. With a looming shortage of midwives, there is a pressing need to understand midwives’ work environment and scope of practice.DesignMixed methods research utilising prospective descriptive survey and interview.MethodsAn online survey was administered to nurse‐midwives practicing in the state of Texas (N = 449) with a subset (n = 10) telephone interviewed. Descriptive and inferential statistics and content analysis was performed.ResultsThe survey was completed by 141 midwives with eight interviewed. Most were older, Caucasian and held a master's degree. A majority worked full‐time, were in clinical practice in larger urban areas and were employed by a hospital or physician group. Care was most commonly provided for Hispanic and White women; approximately a quarter could care for greater numbers of patients. Most did not clinically teach midwifery students. Physician practice agreements were believed unnecessary and prescriptive authority requirements restrictive. Legislative issues were typically followed through the professional organisation or social media sites; most felt a lack of competence to influence health policy decisions. While most were satisfied with current clinical practice, a majority planned a change in the next 3 to 5 years.ConclusionsAn ageing midwifery workforce, not representative of the race/ethnicity of the populations served, is underutilised with practice requirements that limit provision of services. Health policy changes are needed to ensure unrestricted practice.Relevance to clinical practiceRobust midwifery workforce data are needed as well as a midwifery board which tracks availability and accessibility of midwives. Educators should consider training models promoting long‐term service in underserved areas, and development of skills crucial for impacting health policy change.
Development of tools to measure dignity for older people in acute hospitals
Authors: Tauber‐Gilmore Marcelle , Norton Christine , Procter Sue , Murrells Trevor , Addis Gulen , Baillie Lesley , Velasco Pauline , Athwal Preet , Kayani Saeema , Zahran Zainab 
Published: April 2018

BackgroundDignity is a concept that applies to all patients. Older patients can be particularly vulnerable to experiencing a loss of dignity in hospital. Previous tools developed to measure dignity have been aimed at palliative and end‐of‐life care. No tools for measuring dignity in acute hospital care have been reported.ObjectivesTo develop tools for measuring patient dignity in acute hospitals.SettingA large UK acute hospital. We purposively selected 17 wards where at least 50% of patients are 65 years or above.MethodsThree methods of capturing data related to dignity were developed: an electronic patient dignity survey (possible score range 6–24); a format for nonparticipant observations; and individual face‐to‐face semi‐structured patient and staff interviews (reported elsewhere).ResultsA total of 5,693 surveys were completed. Mean score increased from 22.00 pre‐intervention to 23.03 after intervention (p < 0.001). Staff–patient interactions (581) were recorded. Overall 41% of interactions (239) were positive, 39% (228) were neutral, and 20% (114) were negative. The positive interactions ranged from 17%–59% between wards. Quality of interaction was highest for allied health professionals (76% positive), lowest for domestic staff (22% positive) and pharmacists (29% positive), and intermediate for doctors, nurses, healthcare assistants and student nurses (40%–48% positive). A positive interaction was more likely with increased length of interaction from 25% (brief)–63% (longer interactions) (F[2, 557] = 28.67, p < 0.001).ConclusionsWe have developed a simple format for a dignity survey and observations. Overall, most patients reported electronically that they received dignified care in hospital. However, observations identified a high percentage of interactions categorised as neutral/basic care, which, while not actively diminishing dignity, will not enhance dignity. There is an opportunity to make these interactions more positive.
The use of a logistic regression model to develop a risk assessment of intraoperatively acquired pressure ulcer
Authors: Gao Ling , Yang Lina , Li Xiaoqin , Chen Jin , Du Juan , Bai Xiaoxia , Yang Xianjun 
Published: April 2018

Aims and objectivesTo screen the factors of intraoperatively acquired pressure ulcer and establish a new risk assessment model of intraoperatively acquired pressure ulcer.DesignThis is a prospective study.MethodsA total of 1,963 patients who received neurosurgery, orthopaedics, paediatric surgery and cardiac surgery therapy in Sichuan Academy of Medical Science and Provincial People's Hospital in China from October 2015–October 2016 were enrolled in the study, and their clinical parameters were collected. Multivariable logistic regression analysis and decision tree analysis were used to analyse and screen the factors of intraoperatively acquired pressure ulcer and establish the risk assessment model of intraoperatively acquired pressure ulcer.ResultsThe risk factors for intraoperatively acquired pressure ulcer included the application of external force during operation (β = 1.10, OR = 3.20), lean body mass (β = 1.08, OR = 2.95), time of operation ≥6 hr (β = 2.66, OR = 14.30), prone position operation (β = 1.13, OR = 3.10), cardiopulmonary bypass during operation (β = 1.72, OR = 5.59) and intraoperative blood loss (β = 0.67, OR = 1.95). The new risk assessment model showed that the AUC of ROC curve was 0.897 (p < .001). According to the maximum principle of Youden's index, the sensitivity, specificity and Youden's index J of the model were 0.81, 0.88 and 0.69, respectively, when the cut‐off point was set at π = 0.025.ConclusionsA new and relatively reliable assessment model for intraoperatively acquired pressure ulcer is established.Relevance to clinical practicePressure ulcers remain a challenge in clinical nursing. A new risk assessment model of pressure ulcers that is applicable to surgical patients is highly recommended.
Exploring the meaning of home and its implications for the care of older people
Authors: Board Michele , McCormack Brendan 
Published: April 2018

Aims and objectivesTo explore the meaning of home for six baby boomers and consider how this insight can be used when caring for older people in hospital or residential settings.BackgroundFeeling at home is important to help retain a sense of autonomy, security and well‐being, but home is a complex concept to understand. The baby boomers are a large cohort entering later life and understanding their sense of home is not only an example of anticipatory gerontology but it could also provide the tools to explore home with the current older population, who may be in a variety of care settings.Design and methodsA qualitative hermeneutic approach was adopted to explore the meaning of home of six baby boomers. The participants were asked to take photographs showing what home meant to them and interpret these in a recorded photo‐elicitation interview. Small teams then reviewed the images to provide further insight. Finally, all the data were reviewed to provide an overall analysis of the revealed meaning of home.ResultsHaving possessions or stuff was important for the meaning of home; being familiar with the local environment was also “homely,” as well as certain textures and familiar sounds and smells; relationships with others and the ability to have choice in where and how the participants live were also significant for their meaning of home.ConclusionsThe meaning of home is complex. Nevertheless, in this study, an evocative sense of home was revealed and these insights could be used in discussions with older people in care settings to help increase their sense of autonomy, security and well‐being. Furthermore, these insights could also be used to develop a framework to help nursing staff guide these discussions.Relevance to clinical practiceBy considering the multisensory nature of the meaning of home, nurses can create a sense of home for patients. Feeling at home can improve the well‐being and a sense of autonomy for patients. Enabling patients to feel more autonomous recognises the importance of a person‐centred approach to care.
Prosthetic rehabilitation of patients with hypohidrotic ectodermal dysplasia: A systematic review
Authors: Schnabl D. , Grunert I. , Schmuth M. , Kapferer‐Seebacher I. 
Published: April 2018

SummaryHypohidrotic ectodermal dysplasia (HED) comprises a large group of inherited disorders of ectodermal structures, characterised by hypo‐ or anhidrosis, hypotrichosis and hypo‐ or oligo‐ or anodontia. We aimed to systematically assess the spectrum of prosthodontic approaches with regard to the patients' age and to provide clinical implications for practicing dentists. An electronic and manual search was conducted in four databases (Medline, LIVIVO, Cochrane Library, Web of Science Core Collection). Publications of multiple study designs written in English or German without data restrictions, reporting on prosthodontic treatment of patients diagnosed with HED and afflicted with oligo‐ or anodontia, were included. In total, 75 articles on 146 patients were analysed according to the patients′ age. In children aged 2‐17 years, removable full or partial (over)dentures represented standard treatment. In the mandible, implant‐supported removable dentures on two interforaminal implants presented an alternative, already in young childhood. In cases with more than six teeth per jaw, also fixed (resin) bridges were used, frequently after orthodontic treatment. In adults, fixed or removable reconstructions with the help of up to eight implants per jaw, usually placed after bone augmentation procedures, were standard. Ten case reports/series with long‐term follow‐up illustrated the need for consistent maintenance including denture renewals. Prosthodontic rehabilitation should start in early childhood and needs to be revised in accordance with the patients' growth. Treatment should be carried out by a multidisciplinary team addressing variable demands in different age groups.
Informal housing, spatial structure, and city compactness
Authors: Posada Héctor M. 
Published: April 2018

AbstractThis paper develops a monocentric city model with a formal and an informal sector in the housing industry. While formal developers build houses renting land from landowners, informal developers use land for free. However, informal developers must incur defensive expenditures to avoid government intervention. In equilibrium, at any distance of the central business district (CBD), informal developers use land until the value of the marginal productivity of land equals the defensive expenditures per unit of land. The model shows the land allocated to produce short informal (tall formal) buildings increases (decreases) with distance to the CBD. Thus, the model introduces a new source of spatial variation of building height. The model also shows that a higher level of informal housing increases the spatial size of a city and reduces the height of its buildings.
State‐owned firms and private debt
Authors: Picard Pierre M. , Rusli Ridwan D. 
Published: April 2018

AbstractWe study the role of private debt financing in reducing government transfers and information costs in a state‐owned firm. We show that debt contracts allow the government to reduce socially costly subsidies by letting underperforming state‐owned firms default. When the firm has private information, the government uses debt to reduce the firm's information rents. The option of default and privatization allows the government to stop subsidizing the firm. We identify the conditions under which information costs outweigh privatization costs and a positive debt level benefits governments.
What's the damage? Environmental regulation with policy‐motivated bureaucrats
Authors: Voss Achim , Lingens Jörg 
Published: April 2018

AbstractIn choosing environmental policy, governments rely on information provided by bureaucrats, who may have a political motivation of their own. We analyze the ensuing principal–agent relationship and derive the government's optimal contract. We find that a regulatory agent who is more environmentalist than the government is rewarded for truthfully stating that the environmental impact of the regulated economic activity is low (and vice versa). The bureaucrat has a stronger influence on policy if there is greater uncertainty about the environmental impact, or if the policy choice has a strong weight in his utility function. For some impact values, the bureaucrat is permitted to set his own preferred policy, which is a form of optimal delegation.
Weight suppression as a predictor variable in the treatment of eating disorders: A systematic review
Authors: Jenkins P. E. , Lebow J. , Rienecke R. D. 
Published: April 2018

Accessible summaryWhat is known on the subject?

Weight suppression (WS) has been suggested to predict outcome following psychological treatment for an eating disorder (ED).

Some findings are contradictory and have not been considered systematically.

What the paper adds to existing knowledge?

The review suggests that weight gain at post‐treatment is reliably predicted by pretreatment WS, but findings regarding other outcomes (e.g., treatment dropout) are less consistent.

Approximate effect sizes for observed relationships are identified, alongside support for biobehavioural theories of metabolic adaptation to weight loss.

What are the implications for practice?

Degree of WS at pretreatment is associated with weight gain and is important for clinicians to consider before offering treatment to patients with EDs.

Patients high in WS might benefit from further support (e.g., psychoeducation) prior to beginning treatment.

AbstractIntroductionWeight suppression (WS—the difference between highest body weight and current body weight) has been proposed as a predictor of treatment outcome within eating disorders (EDs), although this hypothesis has not been consistently supported.Aim/QuestionReview the association between pretreatment WS and outcome following psychological treatment for EDs.MethodA comprehensive electronic database search for published and unpublished literature from 1979 to 2017. Reference lists were also inspected. Eligibility criteria were determined according to relevant guidelines and a quality appraisal was conducted.ResultsTwelve studies met inclusion criteria (one was subsequently excluded based on insufficient data). Greater WS was generally associated with weight gain at post‐treatment although not with other treatment outcomes.DiscussionThe existing evidence, with data from 1,566 participants, is summarized according to three main post‐treatment outcomes: weight change; treatment completion; and symptom abstinence. Patients with disordered eating and greater WS may need to gain more weight than others during treatment to achieve good outcomes. Recommendations for future studies are provided.Implications for practiceEvidence‐based treatments for EDs may benefit from considering WS when planning treatment, such as further psychoeducation on weight changes. Societal interventions regarding promotion of healthy eating may also draw on these findings.
Phylogenetic analysis of Dunaliella (Chlorophyta) emphasizing new benthic and supralittoral isolates from Great Salt Lake
Authors: Henley William J. , Cobbs Michael , Novoveská Lucie , Buchheim Mark A. 
Published: April 2018

Dunaliella, a commercially important chlorophyte, is globally distributed in saline habitats. Morphological species have not been definitively reconciled with phylogenetic analyses. Considerable genetic diversity continues to be discovered in new isolates, especially from soil and benthic habitats. Twenty‐nine new isolates from Great Salt Lake, Utah, many from benthic or supralittoral habitats, were phylogenetically analyzed using ITS1+5.8S+ITS2 in comparison to a broad sampling of available sequences. A few new isolates align in one branch of a bifurcated monophyletic Dunaliella salina clade and several cluster within monophyletic D. viridis. Several others align with relatively few unnamed strains from other locations, comprising a diverse clade that may represent two or more new species. The overall Dunaliella clade is relatively robust, but the nearest outgroups are ambiguously placed with extremely long branches. About half of the isolates, all from benthic or supralittoral habitats, have been persistently sarcinoid in liquid media since isolation. This trait is spread across the Dunaliella phylogeny. The morphology of two sarcinoid strains was documented with light microscopy, revealing an extensive glycocalyx. Clumping behavior of unicellular and sarcinoid strains was unaffected by presence or absence of Mg2+ or Ca2+, addition of lectin‐inhibiting monosaccharides, or water‐soluble factors from morphologically opposite strains. Results from this investigation have significantly expanded our current understanding of Dunaliella diversity, but it seems likely that much remains to be discovered with additional sampling.
Role of climate and herbivory on native and alien conifer seedling recruitment at and above the Fennoscandian tree line
Authors: Bognounou Fidele , Hulme Philip E. , Oksanen Lauri , Suominen Otso , Olofsson Johan 
Published: April 2018

AbstractQuestionsWe investigated the importance of climate and herbivory on native and alien conifer colonization of the birch‐dominated Fennoscandian tree line by addressing the following questions: (a) are tree line and tundra habitats similarly suitable for conifer seedling recruitment; (b) do ungulate and rodent herbivores differentially impact seedling recruitment; and (c) how does the role of habitat and herbivory on seedling recruitment vary across a marked climate gradient?LocationNorthern Fennoscandia, Sweden (Vassijaure and Paddus), and Norway (Joatka and Seiland).MethodsWe conducted an experiment to assess the emergence rate, survival probability and height development of Norway spruce (Picea abies), Scots pine (Pinus sylvestris) and Siberian larch (Larix sibirica) seedlings. Three experimental plots (i.e., open control, reindeer exclosure and complete vertebrate exclosure) were established in both tree line and tundra habitats at each of the four locations. Seeds of the three conifer species were sown in each plot in June 1999 during three consecutive years. The surviving seedlings were counted in August to September 1999, 2000, 2001, 2002 and 2007. The height of all seedlings was measured in 2007.ResultsOur study reveals that Norway spruce, Scots pine and Siberian larch can regenerate from seed at and above the current tree line in northern Fennoscandia. Their performance was generally higher above tree line in tundra than at tree line, but depended on species identity, climate aridity and mammal herbivory, particularly by rodents. These results suggest that the species composition and latitudinal limit of the tree line in the future might depend not only on direct effects of the future climate on the current tree line species, but also on the intensity of alien and native conifer introductions, as well as changes in herbivore populations.ConclusionIf sufficient seeds of Norway spruce, Scots pine and Siberian larch should reach the current tree line, their performances will increase with a warmer and wetter climate, and this effect will be markedly modulated by herbivores (particularly rodents). Further work is required to extend these results to determine the ability of these conifers to become tree line‐forming species in the future.
Insights into the post‐translational modifications of archaeal Sis10b (Alba): lysine‐16 is methylated, not acetylated, and this does not regulate transcription or growth
Authors: Cao Jingjing , Wang Qian , Liu Tao , Peng Nan , Huang Li 
Published: April 2018

SummaryNucleic acid‐binding proteins of the Sac10b family, also referred to as Alba (for acetylation lowers binding affinity), are highly conserved in Archaea. It was reported that Sso10b, a Sac10b homologue from Sulfolobus solfataricus, was acetylated at the ɛ‐amino group of K16 and the α‐amino group of the N‐terminal residue. Notably, acetylation of K16 reduced the affinity of Sso10b for DNA and de‐repressed transcription in vitro. Here, we show that Sis10b, a Sac10b homologue from Sulfolobus islandicus, underwent a range of post‐translational modifications (PTMs). K16 in Sis10b as well as Sso10b was not acetylated. Substitution of K16 for R16, which resulted in the loss of the PTMs at the site, showed little effect on the growth of the cell and resulted in only a slight change in the expression of a very small fraction of the genes. The N‐terminus of Sis10b was nearly completely Nα‐acetylated. The reduction or loss of the terminal acetylation led to a significant increase in the cellular concentration of Sis10b, suggesting the involvement of the modification in the control of the turnover of the protein. These results have clarified the PTMs of Sac10b homologues and shed light on the proposed roles of acetylation of the protein.