bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examination of intensive care unit patients' oral health
Authors: Celik Gul Gunes , Eser Ismet 
Published: September 2017

AbstractBackgroundOral health problems are common complications that most intensive care unit patients experience. There are many factors that affect oral health negatively and nurses have important responsibilities in this regard.AimThe aim of this study was assessment of the intensive care unit patients' oral health and risk factors.MethodsThis study was planned as a descriptive study and conducted between December 2015 and June 2016, with 202 patients in 20 intensive care units of 6 hospitals in Turkey. Data were collected via Data Collection Form and Bedside Oral Exam guide. Oral health assessment of patients was made using a source of light and a tongue depressor.ResultsWe observed a significant difference in score of the Bedside Oral Exam guide by age, consciousness, type of respiration and feeding, the frequency of oral health, the total number of drugs, and technique of oral care (P < 0.05). None of the intensive care units were using the oral assessment guide.ConclusionThe result of this study shows that there are various risk factors that adversely affect the oral health of intensive care unit patients. Nurses should undertake assessments on the basis of oral care protocols for patients at risk and carry out evidence‐based individualized oral care applications.
The contribution of a directional preference of stiffness to the efficacy of prophylactic sacral dressings in protecting healthy and diabetic tissues from pressure injury: computational modelling studies
Authors: Levy Ayelet , Schwartz Dafna , Gefen Amit 
Published: September 2017

AbstractThe sacral region is the most common site for pressure injuries (PIs) associated with lying in bed, and such sacral PIs often commence as deep tissue injuries (DTIs) that later present as open wounds. In complex patients, diabetes is common. Because, among other factors, diabetes affects connective tissue stiffness properties, making these tissues less able to dissipate mechanical loads through physiological deformations, diabetes is an additional biomechanical risk factor for PIs and DTIs. A preventive measure with established successful clinical outcomes is the use of sacral prophylactic dressings. The objective of this study has been to expand our previous work regarding the modes of action and biomechanical efficacy of prophylactic dressings in protecting the soft tissues adjacent to the sacrum by specifically examining the role of a directional stiffness preference (anisotropy) of the dressing while further accounting for diabetic tissue conditions. Multiple three‐dimensional anatomically detailed finite element (FE) model variants representing diabetic tissue conditions were used, and tissue loading state data were compared with healthy tissue simulations. We specifically compared soft tissue exposures to elevated internal shear stresses and strain energy densities (SED) near the sacrum during supine weight bearing on a standard (foam) hospital mattress without a dressing, with a prophylactic dressing lacking directional stiffness preferences and with an anisotropic dressing. Our results have clearly shown that an anisotropic dressing design reduces the peak tissue stresses and exposure to sustained tissue deformations in both healthy and diabetic cases. The present study provides additional important insights regarding the optimal structural and material design of prophylactic dressings, which in turn, informs clinicians and decision makers regarding beneficial features.
A systematic review of qualitative research into people's experiences of living with venous leg ulcers
Authors: Phillips Patrick , Lumley Elizabeth , Duncan Rosie , Aber Ahmed , Woods Helen Buckley , Jones Georgina L. , Michaels Jonathan 
Published: September 2017

AbstractAimTo systematically identify, evaluate and synthesize qualitative research that examined the symptoms and health‐related quality of life themes that are important from the perspective of patients with venous leg ulceration.BackgroundVenous leg ulceration is a common chronic condition; the symptoms and associated treatments have a negative effect on health‐related quality of life. Qualitative research methods can provide insight into the personal experiences of patients with venous leg ulceration.DesignQualitative evidence synthesis (using framework synthesis).Data SourcesMultiple electronic databases including MEDLINE, EMBASE, PsycINFO and CINAHL were comprehensively searched from inception to November 2015.Review MethodsSystematic identification, quality assessment and synthesis of existing qualitative research were performed; framework synthesis was conducted on included studies. An inductive approach was used and emergent themes were identified. The final stage in the synthesis involved the development of new interpretations.ResultsThirteen studies met the inclusion criteria; the overall quality of the included studies was good. Four overarching themes were identified; physical impact, psychological impact, social impact and treatment and, in these, further subthemes were identified. Ulcer and treatment‐related pain, as well as odour and exudate appeared to have significant and direct negative effects on quality of life, with additional and cumulative effects on sleep, mobility and mood.ConclusionThe themes identified in this review should be considered by professionals providing services, care and treatment for venous leg ulcer patients and in the selection, or development, of patient‐reported outcome measures for use with this population.
Do adults with Down syndrome do the same amount of physical activity as adults without disability? A proof of principle study
Authors: Shields Nora , Plant Samantha , Warren Catherine , Wollersheim Dennis , Peiris Casey 
Published: September 2017

BackgroundThis study compared levels of physical activity completed by adults with and without Down syndrome.MethodFifteen adults with and 15 adults without Down syndrome matched for age and gender, took part. The intensity and duration of physical activity were measured using RT3 accelerometers worn for seven days.ResultsOnly, 12 participants with Down syndrome had complete physical activity data, and these participants and their matched controls (total: six females, 18 males; aged 25.8 ± 9.7) were included in the analyses. There were significantly lower levels of moderate and vigorous physical activity per day for people with Down syndrome (median = 27 min) compared to those without (median = 101 min) (p < .001). Participants without disability were twice more likely to achieve recommended levels of physical activity than people with Down syndrome.ConclusionsAdults with Down syndrome appear to participate in lower levels of physical activity than adults without Down syndrome. Further research should validate these estimates.
Use of reflectance confocal microscopy to evaluate 5‐fluorouracil 0.5%/salicylic acid 10% in the field‐directed treatment of subclinical lesions of actinic keratosis: subanalysis of a Phase III, randomized, double‐blind, vehicle‐controlled trial
Authors: Ulrich M. , Reinhold U. , Falqués M. , Rodriguez Azeredo R. , Stockfleth E. 
Published: September 2017

AbstractBackgroundActinic keratosis (AK) is a common skin disorder that can progress to invasive squamous‐cell carcinoma. AK can present as clinical (visible) or subclinical (invisible) lesions within areas of chronic sun damage. The importance of treating subclinical AK is gaining support. We present a subanalysis of a previously published Phase III, double‐blind, vehicle‐controlled study (NCT02289768), to assess 5‐fluorouracil (5‐FU) 0.5%/salicylic acid 10% treatment of subclinical AK lesions, based on reflectance confocal microscopy (RCM).ObjectiveTo determine the efficacy of 5‐FU 0.5%/salicylic acid 10% as field‐directed treatment for subclinical AK lesions using RCM.MethodsFor inclusion in this subanalysis, patients had to have at least three subclinical AK lesions within a 25 cm2 area of skin. Subclinical AK lesions were diagnosed according to the presence of three key RCM criteria: architectural disarray; keratinocyte atypia and pleomorphism at the basal, spinous and granular layer. Subclinical AK lesions were evaluated by RCM at baseline, after 4, 6 and 12 weeks of 5‐FU 0.5%/salicylic acid 10% treatment or vehicle, and 8 weeks following the end of treatment.ResultsTwenty‐seven patients were included: 17 [mean age = 72.2 years, standard deviation (SD) = 6.3] received 5‐FU 0.5%/salicylic acid 10% treatment and 10 (mean age = 76.4 years, SD = 3.9) received vehicle. Eight weeks following the end of treatment, the mean number of subclinical lesions declined (from 3.0 at baseline) to 0.3 (95% confidence interval [CI] 0.06–0.57) for the 5‐FU 0.5%/salicylic acid 10% group and 1.6 (95% CI 0.52–2.68) in the vehicle group (reductions of 90% [95% CI 72.1–107.1] vs. 47% [95% CI 24.8–69.5], respectively; P = 0.005). The proportion of patients receiving 5‐FU 0.5%/salicylic acid 10% showing complete clearance of three preselected subclinical AK lesions was numerically greater than in the vehicle group (69% vs. 40%, respectively; P = 0.183).ConclusionTo the best of our knowledge, this is the first randomized, vehicle‐controlled study investigating 5‐FU 0.5%/salicylic acid 10% treatment for subclinical AK lesions. The present data suggest some treatment efficacy for subclinical AK lesions detected using RCM. However, this subanalysis was not sufficiently powered and should be reproduced in a larger, subsequent cohort.
Risk of Fracture in Women with Sarcopenia, Low Bone Mass, or Both
Authors: Harris Rebekah , Chang Yuefang , Beavers Kristen , Laddu‐Patel Deepika , Bea Jennifer , Johnson Karen , LeBoff Meryl , Womack Catherine , Wallace Robert , Li Wenjun , Crandall Carolyn , Cauley Jane 
Published: September 2017

ObjectivesTo determine whether women with sarcopenia and low bone mineral density (BMD) are at greater risk of clinical fractures than those with sarcopenia or low BMD alone.DesignWomen's Health Initiative (WHI) Observational and Clinical trials.SettingThree U.S. clinical centers (Pittsburgh, PA; Birmingham, AL; Phoenix/Tucson, AZ).ParticipantsWomen (mean age 63.3 ± 0.07) with BMD measurements (N = 10,937).MeasurementsSarcopenia was defined as appendicular lean mass values corrected for height and fat mass. Low BMD was defined as a femoral neck T‐score less than −1.0 based on the Third National Health and Nutrition Examination Survey reference database for white women. Cox proportional hazards analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). We followed women for incident fractures over a median of 15.9 years.ResultsParticipants were classified into mutually exclusive groups based on BMD and sarcopenia status: normal BMD and no sarcopenia (n = 3,857, 35%), sarcopenia alone (n = 774, 7%), low BMD alone (n = 4,907, 45%), and low BMD and sarcopenia (n = 1,399, 13%). Women with low BMD, with (HR = 1.72, 95% CI = 1.44–2.06) or without sarcopenia (HR = 1.58, 95% CI = 1.37–1.83), had greater risk of fracture than women with normal BMD; the difference remained statistically significant after adjustment for important covariates. Women with low BMD, with (HR = 2.78, 95% CI = 1.78–4.30 and without (HR = 2.42, 95% CI = 1.63–3.59) sarcopenia had higher risk of hip fractures. Women with sarcopenia alone had similar HRs to women with normal BMD.ConclusionCompared to women with normal BMD.
Birthweight, HIV exposure and infant feeding as predictors of malnutrition in Botswanan infants
Authors: Chalashika P. , Essex C. , Mellor D. , Swift J. A. , Langley‐Evans S. 
Published: September 2017

AbstractBackgroundA better understanding of the nutritional status of infants who are HIV‐Exposed‐Uninfected (HEU) and HIV‐Unexposed‐Uninfected (HUU) during their first 1000 days is key to improving population health, particularly in sub‐Saharan Africa.MethodsA cross‐sectional study compared the nutritional status, feeding practices and determinants of nutritional status of HEU and HUU infants residing in representative selected districts in Botswana during their first 1000 days of life. Four hundred and thirteen infants (37.3% HIV‐exposed), aged 6–24 months, attending routine child health clinics, were recruited. Anthropometric, 24‐h dietary intake and socio‐demographic data was collected. Anthropometric Z‐scores were calculated using 2006 World Health Organization growth standards. Modelling of the determinants of malnutrition was undertaken using logistic regression.ResultsOverall, the prevalences of stunting, wasting and being underweight were 10.4%, 11.9% and 10.2%, respectively. HEU infants were more likely to be underweight (15.6% versus 6.9%), (P < 0.01) and stunted (15.6% versus 7.3%), (P < 0.05) but not wasted (P = 0.14) than HUU infants. HEU infants tended to be formula fed (82.5%), whereas HUU infants tended to breastfeed (94%) for the first 6 months (P < 0.001). Significant predictors of nutritional status were HIV exposure, birthweight, birth length, APGAR (appearance, pulse, grimace, activity and respiration) score and mother/caregiver's education with little influence of socio‐economic status.ConclusionsHEU infants aged 6–24 months had worse nutritional status compared to HUU infants. Low birthweight was the main predictor of undernutrition in this population. Optimisation of infant nutritional status should focus on improving birthweight. In addition, specific interventions should target HEU infants aiming to eliminate growth disparity between HEU and HUU infants.
Comparative morphology of snake (Squamata) endocasts: evidence of phylogenetic and ecological signals
Authors: Allemand Rémi , Boistel Renaud , Daghfous Gheylen , Blanchet Zoé , Cornette Raphaël , Bardet Nathalie , Vincent Peggy , Houssaye Alexandra 
Published: September 2017

AbstractBrain endocasts obtained from computed tomography (CT) are now widely used in the field of comparative neuroanatomy. They provide an overview of the morphology of the brain and associated tissues located in the cranial cavity. Through anatomical comparisons between species, insights on the senses, the behavior, and the lifestyle can be gained. Although there are many studies dealing with mammal and bird endocasts, those performed on the brain endocasts of squamates are comparatively rare, thus limiting our understanding of their morphological variability and interpretations. Here, we provide the first comparative study of snake brain endocasts in order to bring new information about the morphology of these structures. Additionally, we test if the snake brain endocast encompasses a phylogenetic and/or an ecological signal. For this purpose, the digital endocasts of 45 snake specimens, including a wide diversity in terms of phylogeny and ecology, were digitized using CT, and compared both qualitatively and quantitatively. Snake endocasts exhibit a great variability. The different methods performed from descriptive characters, linear measurements and the outline curves provided complementary information. All these methods have shown that the shape of the snake brain endocast contains, as in mammals and birds, a phylogenetic signal but also an ecological one. Although phylogenetically related taxa share several similarities between each other, the brain endocast morphology reflects some notable ecological trends: e.g. (i) fossorial species possess both reduced optic tectum and pituitary gland; (ii) both fossorial and marine species have cerebral hemispheres poorly developed laterally; (iii) cerebral hemispheres and optic tectum are more developed in arboreal and terrestrial species.
Earliest depiction of vitiligo in “Venus at a Mirror” (1615) by Peter Paul Rubens (1577–1640)
Authors: Ashrafian Hutan 
Published: September 2017

SummaryThe 1615 painting of Venus at a Mirror by Peter Paul Rubens is considered a powerful example of the Flemish Baroque movement. Recently it has been identified that the Venus character in the image has a goitre, however on studying the image further, I note dermato‐pathology in another of the painting's main characters; the dark‐skinned female typically described as the Venus’ maidservant who clearly demonstrates patches of skin pigment loss on her face and neck with a concurrent streak of white hair. Together these suggest the underlying diagnosis of vitiligo. There is also a goitre in this individual suggesting thyroid disease. This new finding may offer additional insight into the historical epidemiology of disease in northern Europe but also offers further understanding of the method, origin, and pathological associations of this prominent painting from a genius artist.
The experiences of being a registered nurse prescriber within an acute service setting
Authors: Lennon Roisin , Fallon Anne 
Published: September 2017

Aims and objectivesTo explore the experiences of nurse prescribers in an acute service setting.DesignA descriptive phenomenological design underpinned by Husserl's philosophy was used as the guiding framework.MethodsData were collected using semistructured interviews and purposive sampling of 11 current registered nurse prescribers from two acute hospitals. Colaizzi's seven steps were employed to analyse the data and develop themes which reflected the participants' experiences of prescribing.ResultsThe study identified three themes: Enhanced Patient Care, Impact on the Nurse as a Prescriber and the Challenges of Nurse Prescribing. The nurses interviewed were proud to be prescribers and perceived their prescribing practice as safe. This was a unique finding, not described by other research. Increased job satisfaction was also important to those interviewed as identified in previous studies pertaining to prescriptive authority. Ongoing challenges affecting prescribers included staff shortages, extra workload arising from prescribing and the need to educate colleagues about nurse prescribing. Those interviewed also suggested standardising both the prescribing course and local Drugs and Therapeutics Committees nationally, to overcome identified issues.ConclusionsFurther research into the safety of nurse prescribing is recommended to ascertain if what was described locally applies nationally. A larger study into the experiences of nurse and midwife prescribers is also required, to promote and maintain this practice and to ensure future prescribers embrace this extended scope of practice.Relevance to clinical practiceInsight into how nurse prescribers feel about prescriptive authority. Highlights the advantages and disadvantages of this extended scope of practice. RNPs describe how to overcome some of the barriers they have encountered with useful suggestions being made for practice development and further research.
Psychosocial stress and major cardiovascular events in patients with stable coronary heart disease
Authors: Hagström E. , Norlund F. , Stebbins A. , Armstrong P. W. , Chiswell K. , Granger C. B. , López‐Sendón J. , Pella D. , Soffer J. , Sy R. , Wallentin L. , White H. D. , Stewart R. A. H. , Held C. 
Published: September 2017

AbstractObjectivesAssess the risk of ischaemic events associated with psychosocial stress in patients with stable coronary heart disease (CHD).MethodsPsychosocial stress was assessed by a questionnaire in 14 577 patients (median age 65.0, IQR 59, 71; 81.6% males) with stable CHD on optimal secondary preventive therapy in the prospective randomized STABILITY clinical trial. Adjusted Cox regression models were used to assess associations between individual stressors, baseline cardiovascular risk factors and outcomes.ResultsAfter 3.7 years of follow‐up, depressive symptoms, loss of interest and financial stress were associated with increased risk (hazard ratio, 95% confidence interval) of CV death (1.21, 1.09–1.34; 1.15, 1.05–1.27; and 1.19, 1.08–1.30, respectively) and the primary composite end‐point of CV death, nonfatal MI or nonfatal stroke (1.21, 1.13–1.30; 1.19, 1.11–1.27; and 1.17, 1.10–1.24, respectively). Living alone was related to higher risk of CV death (1.68, 1.38–2.05) and the primary composite end‐point (1.28, 1.11–1.48), whereas being married as compared with being widowed, was associated with lower risk of CV death (0.64, 0.49–0.82) and the primary composite end‐point (0.81, 0.67–0.97).ConclusionsPsychosocial stress, such as depressive symptoms, loss of interest, living alone and financial stress, were associated with increased CV mortality in patients with stable CHD despite optimal medical secondary prevention treatment. Secondary prevention of CHD should therefore focus also on psychosocial issues both in clinical management and in future clinical trials.
Three‐dimensional reconstruction with serial whole‐mount sections of oral tongue squamous cell carcinoma: A preliminary study
Authors: Wang Yujia , Chen Sheng , Ni Yanhong , Magee Derek , Pu Yumei , Zhou Qian , Wang Zhiyong , Zhang Lei , Huang Xiaofeng , Hu Qingang 
Published: September 2017

ObjectivesMargin status and invasion pattern are prognostic factors for oral tongue squamous cell carcinoma (OTSCC). Current methods to identify these factors are limited to 2D observation; it is necessary to explore 3D reconstruction with whole‐mount sample to improve the accuracy of analysis. This study aimed to study the tissue preparation, section generation, and 3D reconstruction with whole‐mount OTSCC specimen.Study designTwo OTSCC samples were retrieved from Nanjing Stomatological Hospital, Medical School of Nanjing University. One sample was sliced into 3 equal‐sized pieces and subjected to different processing schedules to determine the best method. The second sample was processed accordingly. Serial whole‐mount sections of the second sample were generated, stained with HE/anticytokine antibody in intersection manner, and scanned into digital images. Digital images were aligned and reconstructed into 3D images with Hetero Genius Medical Image Manager 3D Pathology Add‐On [HGMIM3D].ResultsSuccessful serial whole‐mount sections of comparable quality to traditional sections were generated. Three‐dimensional images with serial whole‐mount sections were successfully generated.ConclusionsWhole‐mount histopathological 3D reconstruction of OTSCC was successfully generated, providing a solid foundation for comprehensive margin and invasion analysis. Although future study and improvement were needed, whole‐mount histopathological 3D reconstruction proved to be a promising method in OTSCC study.