bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative Caregivers’ Spirituality, Views About Spiritual Care, and Associations With Spiritual Well-Being: A Mixed Methods Study
Authors: O’Callaghan Clare , Seah Davinia , Clayton Josephine M. , Welz Martina , Kissane David , Georgousopoulou Ekavi N. , Michael Natasha 
Published: September 2019

Background:Spiritual care is integral to palliative care. It engenders a sense of purpose, meaning, and connectedness to the sacred or important and may support caregiver well-being.Aim:To examine caregivers’ spirituality, religiosity, spiritual well-being, and views on spiritual/religious support.Design:A mixed-methods study across 4 Australian sites, recruiting caregivers of patients with a life expectancy of under 12 months. The anonymous semistructured questionnaire used included research team developed and adapted questions examining religion/spirituality’s role and support and views on hospitals supporting spiritual/religious requirements. It additionally included the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12).Results:One hundred nine caregivers participated (47.4% responded). Median spiritual well-being was 30.5 on FACIT-Sp-12. Religious affiliation was associated with higher Faith subscores ( P < .001). Spirituality was very important to 24.5%, religiosity to 28.2%, and unimportant to 31.4% and 35.9%, respectively. Caregivers prayed ( P = .005) and meditated ( P = .006) more following patients’ diagnoses, gaining comfort, guidance, and strength. Caregivers whose spiritual/religious needs were met to moderate/full extent by external religious/faith communities (23.8%) reported greater spiritual well-being ( P < .001). Hospitals supported moderate/full caregiver spiritual needs in 19.3%. Pastoral care visits comforted 84.4% of those who received them (n = 32) but elicited discomfort in 15.6%. Caregivers also emphasized the importance of humane staff and organizational tone in supporting spiritual care.Conclusions:Hospital-based spiritual care providers should seek to identify those who seek pastoral or religiously orientated care. Genuine hospitality of showing concern for the other ensures the varied yet inevitably humanist requirements of the caregiver community are met.
Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases
Authors: Akgün Kathleen M. , Krishnan Supriya , Feder Shelli L. , Tate Janet , Kutner Jean S. , Crothers Kristina 
Published: September 2019

Background: Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified by statin discontinuation. Methods: Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using the Edmonton Symptom Assessment System. Results: The mean age of the patients was 73.8 years (standard deviation [SD]: ±11.0) and the mean medication count was 11.6 (SD: ±5.0). We identified 3 dyspnea trajectory groups: none (n = 108), mild (n = 130), and moderate–severe (n = 70). Statins were discontinued in 51.8%, 48.5%, and 42.9% of patients, respectively. In multivariable models adjusting for age, sex, diagnosis, and statin discontinuation, each additional medication was associated with 8% (odds ratio [OR] = 1.08 [1.01-1.14]) and 16% (OR = 1.16 [1.08-1.25]) increased risk for mild and moderate–severe dyspnea, respectively. In stratified models, polypharmacy was associated with dyspnea in the statin continuation group only (mild OR = 1.12 [1.01-1.24], moderate–severe OR = 1.24 [1.11-1.39]) versus statin discontinuation (mild OR = 1.03 [0.95-1.12], and moderate–severe OR = 1.09 [0.98-1.22]). Conclusion: Polypharmacy was strongly associated with dyspnea. Prospective interventions to decrease polypharmacy may impact dyspnea symptoms, especially for statins.
A rare case of endophthalmitis after bleb needle revision for glaucoma Xen® gel stent
Authors: Napoli Luca , Riva Ivano , Oddone Francesco , Michelessi Manuele , Quaranta Luciano 
Published: September 2019

Purpose: To describe the first case of endophthalmitis caused by Sphingobacterium spiritivorum, a glucose non-fermenting Gram-negative rod, in a patient previously implanted with a Xen® gel stent. Case report description: An 83-year-old patient, affected by open-angle glaucoma and with a previous surgery of combined cataract extraction and Xen gel stent implantation, developed endophthalmitis 1 month after bleb needle revision with 5-fluorouracil injection. At presentation, best corrected visual acuity was hand movement, hypopyon was evident into the anterior chamber and a flat bleb with no sign of leakage was present over the Xen gel implant. Outcome: Immediate pars plana vitrectomy was performed, with intravitreal antibiotic administration and silicon oil tamponade. S. spiritivorum was isolated from vitreous bacterial culture. According to the antibiogram, patient was treated with topical fortified ceftazidime eyedrops and appropriate systemic antibiotics (intravenous meropenem, 500 mg every 8 h for 7 days, followed by oral cotrimoxazole, 160 + 800 mg, twice a day for 10 days). After 2 weeks of treatment, ocular inflammation was resolved, best corrected visual acuity was 0.1 (Snellen chart) and intraocular pressure was 18 mm Hg without topical hypotensive therapy. Conclusion: S. spiritivorum was isolated for the first time as a causative agent of endophthalmitis in humans. Bleb needle revision in patients with Xen gel implant is not free of complications, and an attentive follow-up is required.
What is the evidence for the activities of Namaste Care? A rapid assessment review
Authors: Bray Jennifer , Brooker Dawn J , Garabedian Claire 
Published: September 2019

Objectives To assess the quality of research evidence for the different activity components for the psycho-social Namaste Care intervention for care home residents with advanced dementia. Design Namaste Care is a multi-component intervention delivered on a daily basis to people living with advanced dementia or people at end of life with dementia. A significant part of its operationalisation within care homes is the delivery of a number of activities delivered by trained in-house Namaste Care workers to a group of residents with similar high dependency needs. The Namaste Care workers focus on touch, music, nature, sensory experience, aromas and interactions with objects delivered in a way to enhance feelings of enjoyment and wellbeing. This review evaluated the evidence for using these activities with people living with advanced dementia. A systematic search of peer-reviewed research articles was conducted between November 2016 and September 2018 using search terms of activities used in Namaste Care. The quality of each accepted article was rated using the Rapid Evidence Assessment scale. Results The initial literature search returned 1341 results: 127 articles including 42 reviews were included. The majority of activity interventions yielded between 10 and 20 peer-reviewed papers. The use of smells and aromas, interacting with animals and dolls, the use of various forms of music (e.g. background music, singing, personalised music), nature, lighting, various forms of touch/massage and sensory interventions (including Snoezelen) all appear to have proven efficacy with people living with advanced dementia. Conclusions There is generally a limited number of research papers and reviews in this area, but overall there is a good evidence base for including these activities within Namaste Care for people living with advanced dementia.
Emotional instability and expressive suppression are related to paranoia in daily life: An electronic mobile assessment study in nonclinical individuals
Authors: Nittel Clara Marie , Lamster Fabian , Rief Winfried , Kircher Tilo , Soll Daniel , Mehl Stephanie 
Published: September 2019

Although instable negative emotions and problems in emotion regulation (ER) are common in patients with psychosis and are discussed as potential factors involved in the formation and maintenance of paranoia, it is unclear whether they increase the risk of developing paranoia in nonclinical controls. The present study aims to investigate whether the instability of negative emotions leads to paranoia in healthy participants. It should be further analyzed if the application of maladaptive ER strategies enhances subclinical paranoid ideation and if the use of adaptive ER strategies reduces subclinical paranoid ideation. Method: Nonclinical controls ( n = 83) repeatedly reported the presence and instability of negative emotions, paranoia, and the use of maladaptive (expressive suppression, rumination) and adaptive (reappraisal, acceptance) ER strategies in their daily life on six consecutive days using electronic mobile assessment. Results: Hierarchical linear regression analysis revealed that nonclinical controls reporting a pronounced instability of negative emotions showed more pronounced paranoia at a subsequent time point. Moreover, participants who used expressive suppression at a certain time experienced more severe paranoia at the subsequent time point. Conclusion: If these findings are confirmed in high-risk samples, ER processes could be considered as an additional factor in theoretical models of paranoia formation.
Occipitocervical Fixation: General Considerations and Surgical Technique
Authors: Joaquim Andrei Fernandes , Osorio Joseph A. , Riew K. Daniel 
Published: September 2019

Study Design: Narrative literature review. Objective: To review and present details on the occipitocervical fixation (OCF) technique as well as considerations for planning the procedure. Methods: We present the surgical technique of OCF in a step-by-step didactic and practical manner with surgical tips and tricks, including C1 and C2 screw fixation techniques. Additionally, we discuss complications, the extension of fusion, types of OCF, and how to avoid common side effects associated with OCF. Results: The complex and mobile anatomy of the craniocervical junction, when requiring fixation and fusion, warrants rigid instrumentation that can be achieve using a modern screw-plate-rod construct. Indications for OCF are craniocervical instability, and atlantoaxial instability when selective atlantoaxial fusion is not feasible. OCF generally involves occiput-C2 fusion. C1 fixation is generally unnecessary, since it increases the surgical time and is associated with the risk of vascular complications. Selective occiput-C2 fusion is recommended when there is no need for including the cervical subaxial region (eg, when stenosis or fractures coexist in the subaxial spine), and good fixation is achieved at C2. Most instrumentation systems now have occipital plates that are not pre-integrated to rods, making fixation much simpler. Surgical steps, from position to wound closure, are presented in detail, with pearls for practice and discussion of cervical alignment. Conclusions: OCF is a challenging procedure, with potential risk of severe adverse effects. Understanding the surgical indications, as well as the nuances of the surgical technique, is required to improve patient outcomes and avoid complications.
Assessment of Surgical Procedural Time, Pedicle Screw Accuracy, and Clinician Radiation Exposure of a Novel Robotic Navigation System Compared With Conventional Open and Percutaneous Freehand Techniques: A Cadaveric Investigation
Authors: Vaccaro Alexander R. , Harris Jonathan A. , Hussain Mir M. , Wadhwa Rishi , Chang Victor W. , Schroerlucke Samuel R. , Samora Walter P. , Passias Peter G. , Patel Rakesh D. , Panchal Ripul R. , D’Agostino Sabino , Whitney Nathaniel L. , Crawford Neil R. , Bucklen Brandon S. 
Published: September 2019

Study Design: Cadaveric study. Objective: To evaluate accuracy, radiation exposure, and surgical time of a new robotic-assisted navigation (RAN) platform compared with freehand techniques in conventional open and percutaneous procedures. Methods: Ten board-certified surgeons inserted 16 pedicle screws at T10–L5 (n = 40 per technique) in 10 human cadaveric torsos. Pedicle screws were inserted with (1) conventional MIS technique (L2–L5, patient left pedicles), (2) MIS RAN (L2–L5, patient right pedicles), (3) conventional open technique (T10–L1, patient left pedicles), and (4) open RAN (T10–L1, patient right pedicles). Output included (1) operative time, (2) number of fluoroscopic images, and (3) screw accuracy. Results: In the MIS group, compared with the freehand technique, RAN allowed for use of larger screws (diameter: 6.6 ± 0.6 mm vs 6.3 ± 0.5 mm; length: 50.3 ± 4.1 mm vs 46.9 ± 3.5 mm), decreased the number of breaches >2 mm (0 vs 7), fewer fluoroscopic images (0 ± 0 vs 108.3 ± 30.9), and surgical procedure time per screw (3.6 ± 0.4 minutes vs 7.6 ± 2.0 minutes) (all P < .05). Similarly, in the open group, RAN allowed for use of longer screws (46.1 ± 4.1 mm vs 44.0 ± 3.8 mm), decreased the number of breaches >2 mm (0 vs 13), fewer fluoroscopic images (0 ± 0 vs 24.1 ± 25.8) (all P < .05), but increased total surgical procedure time (41.4 ± 8.8 minutes vs 24.7 ± 7.0 minutes, P = .000) while maintaining screw insertion time (3.31.4 minutes vs 3.1 ± 1.0 minutes, P = .650). Conclusion: RAN significantly improved accuracy and decreased radiation exposure in comparison to freehand techniques in both conventional open and percutaneous surgical procedures in cadavers. RAN significantly increased setup time compared with both conventional procedures.
Father communication coaching for children with autism spectrum disorder: A single-subject study
Authors: Flippin Michelle 
Published: September 2019

Background and aims Parent-mediated interventions have been shown to be effective for improving communication skills for children with autism spectrum disorder when implemented by mothers. Little is known about the efficacy of autism spectrum disorder communication interventions implemented by fathers. This study investigated the effects of a 12-week coaching program on a father’s use of responsive strategies. Targeted responsive strategies included follow-in comments, follow-in directives, responsive physical play, and responsive object play. Collateral measures of changes to child communication skills and parental stress levels were also investigated. Methods A single subject, multiple baselines across behaviors experiment was conducted with one dyad (i.e. father and child with autism spectrum disorder). Results Results showed that the participating father was able to quickly learn to use three of the four targeted responsive strategies (i.e. follow-in comments, follow-in directives, responsive physical play). Child’s use of single words increased over baseline level and beginning use of multi-word utterances was documented. Pre–post intervention changes in ratings of stress for the participating father and mother were noted across child and parent domains. Conclusions and implications Findings of this pilot study may have important implications for developing much-needed parent coaching programs to enhance fathers’ use of responsive strategies and increase social communication skills for children with autism spectrum disorder.
Measurable residual disease monitoring in acute myeloid leukemia with t(8;21)(q22;q22.1): results from the AML Study Group
Authors: Rücker Frank G. , Agrawal Mridul , Corbacioglu Andrea , Weber Daniela , Kapp-Schwoerer Silke , Gaidzik Verena I. , Jahn Nikolaus , Schroeder Thomas , Wattad Mohammed , Lübbert Michael , Koller Elisabeth , Kindler Thomas , Götze Katharina , Ringhoffer Mark , Westermann Jörg , Fiedler Walter , Horst Heinz A. , Greil Richard , Schroers Roland , Mayer Karin , Heinicke Thomas , Krauter Jürgen , Schlenk Richard F. , Thol Felicitas , Heuser Michael , Ganser Arnold , Bullinger Lars , Paschka Peter , Döhner Hartmut , Döhner Konstanze 
Published: September 2019

Key Points
MRD assessment in t(8;21) AML allows identification of patients at high relapse risk at defined time points during treatment and follow-up. MRD− after treatment is the most favorable factor for relapse risk and survival, and serial MRD analyses define cutoffs predicting relapse.
Are river protected areas sufficient for fish conservation? Implications from large-scale hydroacoustic surveys in the middle reach of the Yangtze River
Authors: Xie Xiao , Zhang Hui , Wang Chengyou , Wu Jinming , Wei Qiwei , Du Hao , Li Junyi , Ye Huan 
Published: September 2019

AbstractBackgroundThe Yangtze River is the third largest river in the world and suffers from extensive anthropogenic impacts. The fishes in the Yangtze River are essential for the sustainable development of freshwater fisheries and the conservation of aquatic biodiversity in China. However, the fishery resources in the Yangtze River Basin have shown rapid decline due to various human activities. In recent years, nature reserves and germplasm resource reserves have become important means to protect fishes in the Yangtze River. However, nature reserves and germplasm resource reserves that regard freshwater fishes as the main object of protection are not common and have been rarely studied in China. In this paper, a hydroacoustic method and systematic conservation planning tool (Marxan) were combined to evaluate the effectiveness of reserves based on the spatial and temporal patterns of mature fishes in the middle reach of the Yangtze River (MRYR) from 2010 to 2017.ResultsThe hydroacoustic survey results indicated that in the longitudinal direction, low densities of mature fish species were observed in the Jingzhou (S2) and Jianli (S4, S5, S6) sections, whereas high densities of fish were observed in other sections, such as the Yichang (S1), Chenglingji to Huangsangkou (S7–S12), and Hukou (S15) sections. Among the regions preferred by fish, S7, S10 and S12 were non-reserves. No significant difference in mature fish density was observed between the non-reserves and nature reserves, and a similar result was obtained between the non-reserves and germplasm resource reserves. In Marxan, the optimal conservation sites selected for habitat restoration, such as the Chenglingji, Dengjiakou, Zhuankou, Hankou, Yangluo, and Huangsangkou sections, which are located in non-reserves, were identified in the MRYR.ConclusionsThe Chenglingji, Dengjiakou, Zhuankou, Hankou, Yangluo, and Huangsangkou sections, which are located in non-reserves, play equally important roles in the conservation of fish populations in the MRYR. Our results indicated that further optimization is urgently needed for the currently protected areas in this region. These areas should be designated as reserves, and classification protection mechanisms should be adopted to strengthen the effectiveness of fish conservation in the MRYR.
Combining serological and contact data to derive target immunity levels for achieving and maintaining measles elimination
Authors: Funk Sebastian , Knapp Jennifer K. , Lebo Emmaculate , Reef Susan E. , Dabbagh Alya J. , Kretsinger Katrina , Jit Mark , Edmunds W. John , Strebel Peter M. 
Published: September 2019

AbstractBackgroundVaccination has reduced the global incidence of measles to the lowest rates in history. However, local interruption of measles virus transmission requires sustained high levels of population immunity that can be challenging to achieve and maintain. The herd immunity threshold for measles is typically stipulated at 90–95%. This figure does not easily translate into age-specific immunity levels required to interrupt transmission. Previous estimates of such levels were based on speculative contact patterns based on historical data from high-income countries. The aim of this study was to determine age-specific immunity levels that would ensure elimination of measles when taking into account empirically observed contact patterns.MethodsWe combined estimated immunity levels from serological data in 17 countries with studies of age-specific mixing patterns to derive contact-adjusted immunity levels. We then compared these to case data from the 10 years following the seroprevalence studies to establish a contact-adjusted immunity threshold for elimination. We lastly combined a range of hypothetical immunity profiles with contact data from a wide range of socioeconomic and demographic settings to determine whether they would be sufficient for elimination.ResultsWe found that contact-adjusted immunity levels were able to predict whether countries would experience outbreaks in the decade following the serological studies in about 70% of countries. The corresponding threshold level of contact-adjusted immunity was found to be 93%, corresponding to an average basic reproduction number of approximately 14. Testing different scenarios of immunity with this threshold level using contact studies from around the world, we found that 95% immunity would have to be achieved by the age of five and maintained across older age groups to guarantee elimination. This reflects a greater level of immunity required in 5–9-year-olds than established previously.ConclusionsThe immunity levels we found necessary for measles elimination are higher than previous guidance. The importance of achieving high immunity levels in 5–9-year-olds presents both a challenge and an opportunity. While such high levels can be difficult to achieve, school entry provides an opportunity to ensure sufficient vaccination coverage. Combined with observations of contact patterns, further national and sub-national serological studies could serve to highlight key gaps in immunity that need to be filled in order to achieve national and regional measles elimination.
Phasin PhaP1 is involved in polyhydroxybutyrate granules morphology and in controlling early biopolymer accumulation in Azospirillum brasilense Sp7
Authors: Martínez-Martínez María de los Angeles , González-Pedrajo Bertha , Dreyfus Georges , Soto-Urzúa Lucía , Martínez-Morales Luis Javier 
Published: September 2019

Abstract
Phasins are amphiphilic proteins involved in the regulation of the number and size of polyhydroxybutyrate (PHB) granules. The plant growth promoting bacterium Azospirillum brasilense Sp7 accumulates high quantities of bioplastic PHB as carbon and energy source. By analyzing the genome, we identified six genes that code for proteins with a Phasin_2 domain. To understand the role of A. brasilense Sp7 PhaP1 (PhaP1Abs) on PHB synthesis, the phaP1 gene (AMK58_RS17065) was deleted. The morphology of the PHB granules was analyzed by transmission electron microscopy (TEM) and the PHB produced was quantified under three different C:N ratios in cultures subjected to null or low-oxygen transfer. The results showed that PhaP1Abs is involved in PHB granules morphology and in controlling early biopolymer accumulation. Using RT-PCR it was found that phasin genes, except phaP4, are transcribed in accordance with the C:N ratio used for the growth of A. brasilense. phaP1, phaP2 and phaP3 genes were able to respond to the growth conditions tested. This study reports the first analysis of a phasin protein in A. brasilense Sp7.