bluuebunny/crossref_metadata_2025_split huggingface dataset:
Personal, professional and workplace factors that contribute to burnout in Australian midwives
Authors: Fenwick Jennifer , Lubomski Anna , Creedy Debra K , Sidebotham Mary 
Published: November 2017

AbstractAimThis study aimed to identify personal, professional and workplace factors that contribute to burnout in midwives.BackgroundBurnout is prevalent in the midwifery workforce. Burnout adversely affects the well‐being of midwives, diminishes the quality of care they provide and can shorten career duration.DesignSelf‐administered online survey. The survey included the Copenhagen Burnout Inventory and personal and professional variables related to age, children, years of experience, role, model of care and satisfaction with work life. Midwives were invited to participate via an email sent from the Australian College of Midwives and through professional networks between June and July 2014. Variables associated with burnout were entered in a multinomial logistic regression.ResultsA total of 1,037 responses were received and 990 analysed. The prevalence of moderate to severe personal (N = 643; 64.9%) and work‐related burnout (N = 428; 43.8%) were high. Having children, providing caseload midwifery care and working in a regional area were associated with low burnout. However, midwives registered for 5–10 years were more likely to report work and client‐related burnout. Similarly, midwives reporting a lack of satisfaction with work–life balance were also more likely to report personal and work‐related burnout.ConclusionsFamily‐friendly work environments that facilitate work–life balance can help to reduce the personal and organizational costs of burnout. Similarly, providing continuity of midwifery care in a caseload model can facilitate work–life balance and provide significant mental health benefits to participating midwives.
Unpacking action research and implementation science: Implications for nursing
Authors: Casey Mary , O' Leary Denise , Coghlan David 
Published: November 2017

AbstractAimThe aim of this study was to unpack the key concepts of action research and implementation science thereby enabling appropriate use of these methods in nursing.BackgroundA key issue in action research is not so much the methodology employed to gather data/evidence but who decides the research agenda and who benefits from it. Implementation science is a way to ensure that evidence is translated into practice. The question arises as to how action research and implementation may be understood in relation to one another in nursing.DesignDiscussion PaperData sourcesThis discussion paper is based on our own experiences and offers an exploration of action research and implementation science with the aim of clarifying what each involves and what synergies, if any, exist between them.Implications for NursingUsing action research to secure the voice of patients in their own care is essential to delivering quality nursing care. Using implementation science frameworks to get research evidence into practice is effective. Familiarity with both these concepts may enable their improved use and have a positive impact on quality of care.ConclusionThere is a tension between action researchers and the protagonists of implementation science related to perceived “trade offs” between what constitutes “science” and the necessity of community participation. Nevertheless, the use of an implementation science framework in an action research approach can reduce the research practice time lag and action research provides sound theoretical and philosophical underpinnings that can be used by those in the implementation science field.
Effect of human amniotic epithelial cells on pro‐fibrogenic resident hepatic cells in a rat model of liver fibrosis
Authors: Cargnoni Anna , Farigu Serafina , Cotti Piccinelli Ester , Bonassi Signoroni Patrizia , Romele Pietro , Vanosi Graziella , Toschi Ivan , Cesari Valentina , Barros Sant'Anna Luciana , Magatti Marta , Silini Antonietta R. , Parolini Ornella 
Published: November 2017

AbstractMyofibroblasts are key fibrogenic cells responsible for excessive extracellular matrix synthesis characterizing the fibrotic lesion. In liver fibrosis, myofibroblasts derive either from activation of hepatic stellate cells (HSC) and portal fibroblasts (PF), or from the activation of fibroblasts that originate from ductular epithelial cells undergoing epithelial–mesenchymal transition. Ductular cells can also indirectly promote myofibroblast generation by activating TGF‐β, the main fibrogenic growth factor, through αvβ6 integrin. In addition, after liver injury, liver sinusoidal cells can lose their ability to maintain HSC quiescence, thus favouring HSC differentiation towards myofibroblasts. The amniotic membrane and epithelial cells (hAEC) derived thereof have been shown to decrease hepatic myofibroblast levels in rodents with liver fibrosis. In this study, in a rat model of liver fibrosis, we investigated the effects of hAEC on resident hepatic cells contributing to myofibroblast generation. Our data show that hAEC reduce myofibroblast numbers with a consequent reduction in fibronectin and collagen deposition. Interestingly, we show that hAEC strongly act on specific myofibroblast precursors. Specifically, hAEC reduce the activation of PF rather than HSC. In addition, hAEC target reactive ductular cells by inhibiting their proliferation and αvβ6 integrin expression, with a consequent decrease in TGF‐β activation. Moreover, hAEC counteract the transition of ductular cells towards fibroblasts, while it does not affect injury‐induced and fibrosis‐promoting sinusoidal alterations. In conclusion, among the emerging therapeutic applications of hAEC in liver diseases, their specific action on PF and ductular cells strongly suggests their application in liver injuries involving the expansion and activation of the portal compartment.
A twin study exploring the association between childhood emotional and behaviour problems and specific psychotic experiences in a community sample of adolescents
Authors: Shakoor Sania , McGuire Philip , Cardno Alastair G. , Freeman Daniel , Ronald Angelica 
Published: November 2017

BackgroundChildhood emotional and behaviour problems are antecedents for later psychopathology. This study investigated genetic and environmental influences shaping the longitudinal association between childhood emotional and behaviour problems and specific PEs.MethodIn a community‐based twin sample, parents reported on emotional and behaviour problems when twins were ages 7 and 12 years. At age 16 years, specific PEs were measured using self‐reports and parent reports. Structural equation model‐fitting was conducted.ResultsChildhood emotional and behaviour problems were significantly associated with paranoia, cognitive disorganisation and parent‐rated negative symptoms in adolescence (mean r = .15–.38), and to a lesser extent with hallucinations, grandiosity and anhedonia (mean r = .04‐.12). Genetic influences on childhood emotional and behaviour problems explained significant proportions of variance in adolescent paranoia (4%), cognitive disorganisation (8%) and parent‐rated negative symptoms (3%). Unique environmental influences on childhood emotional and behaviour problems explained ≤1% of variance in PEs. Common environmental influences were only relevant for the relationship between childhood emotional and behaviour problems and parent‐rated negative symptoms (explaining 28% of variance) and are partly due to correlated rater effects.ConclusionsChildhood emotional and behaviour problems are significantly, if weakly, associated with adolescent PEs. These associations are driven in part by common genetic influences underlying both emotional and behaviour problems and PEs. However, psychotic experiences in adolescence are largely influenced by genetic and environmental factors that are independent of general childhood emotional and behaviour problems, suggesting they are not merely an extension of childhood emotional and behaviour problems.
Scientism, conflicts of interest, and the marginalization of ethics in medical education
Authors: Mayes Christopher , Williams Jane , Kerridge Ian , Lipworth Wendy 
Published: November 2017

AbstractAimThis paper reports on the findings from 6 focus groups conducted with Australian medical students. The focus groups sought students' perspectives on how the influence of commercial interests on medical practice and education could be managed.MethodWe conducted 6 focus groups with medical students in New South Wales, Australia. Participants were recruited via student‐run medical society and faculty e‐mail lists. Forty‐nine students from 6 medical schools in New South Wales participated. The research team reflected on the extent to which students uncritically appealed to science in the abstract as a management solution for conflicts of interest. Data analysis was largely inductive, looking for uses of scientific terminology, EBM, and appeals to “science” in the management of COI and applied theoretical analyses of scientism.ResultsThe students in our study suggested that science and evidence‐based medicine, rather than ethics or professionalism, were the best tools to deal with undue influence and bias. This paper uses philosophy of science literature to critically examine these scientistic appeals to science and EBM as a means of managing the influence of pharmaceutical reps and commercial interests. We argue that a scientistic style of reasoning is reinforced through medical curricula and that students need to be made aware of the epistemological assumptions that underpin science, medicine, and EBM to address the ethical challenges associated with commercialised health care.ConclusionMore work is needed to structure medical curricula to reflect the complexities of practice and realities of science. However, curricula change alone will not sufficiently address issues associated with commercial interests in medicine. For real change to occur, there needs to be a broader social and professional debate about the ways in which medicine and industry interact, and structural changes that restrict or mitigate commercial influences in educational, research, and policy settings.
Reducing the risk of healthcare‐associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy)
Authors: Improta Giovanni , Cesarelli Mario , Montuori Paolo , Santillo Liberatina Carmela , Triassi Maria 
Published: November 2017

AbstractRationale, aims, and objectivesLean Six Sigma (LSS) has been recognized as an effective management tool for improving healthcare performance. Here, LSS was adopted to reduce the risk of healthcare‐associated infections (HAIs), a critical quality parameter in the healthcare sector.MethodsLean Six Sigma was applied to the areas of clinical medicine (including general medicine, pulmonology, oncology, nephrology, cardiology, neurology, gastroenterology, rheumatology, and diabetology), and data regarding HAIs were collected for 28,000 patients hospitalized between January 2011 and December 2016. Following the LSS define, measure, analyse, improve, and control cycle, the factors influencing the risk of HAI were identified by using typical LSS tools (statistical analyses, brainstorming sessions, and cause‐effect diagrams). Finally, corrective measures to prevent HAIs were implemented and monitored for 1 year after implementation.ResultsLean Six Sigma proved to be a useful tool for identifying variables affecting the risk of HAIs and implementing corrective actions to improve the performance of the care process. A reduction in the number of patients colonized by sentinel bacteria was achieved after the improvement phase.ConclusionsThe implementation of an LSS approach could significantly decrease the percentage of patients with HAIs.
Identifying causal mechanisms in health care interventions using classification tree analysis
Authors: Linden Ariel , Yarnold Paul R. 
Published: November 2017

AbstractRationale, aims, and objectivesMediation analysis identifies causal pathways by testing the relationships between the treatment, the outcome, and an intermediate variable that mediates the relationship between the treatment and outcome. This paper introduces classification tree analysis (CTA), a machine‐learning procedure, as an alternative to conventional methods for analysing mediation effects.MethodUsing data from the JOBS II study, we compare CTA to structural equation models (SEMs) by assessing their consistency in revealing mediation effects on 2 outcomes; reemployment (a binary variable) and depressive symptoms (a continuous variable). Because study participants were not randomized sequentially to both treatment and mediator, an additional model was generated including baseline covariates to strengthen the validity of some key identifying assumptions required of all mediation analyses.ResultsUsing SEM, no statistically significant treatment or mediated effects were found for either outcome. In contrast, CTA found a significant treatment effect for reemployment (P = .047) and a mediated pathway for individuals in the treatment group (P = .014). No CTA model could be generated for the reemployment outcome. When covariates were added to the model, CTA found numerous interactions, while SEM found no effects.ConclusionsCTA may uncover mediation effects where conventional approaches do not, because CTA does not require any assumptions about the distribution of variables nor of the functional form of the model, and CTA will systematically identify all statistically viable interactions. The versatility of CTA enables the investigator to explore the theorized underlying causal mechanism of an intervention in a much more comprehensive manner than conventional mediation analytic approaches.
Thickness evaluation of articulating papers and foils
Authors: Malta Barbosa João , Urtula Adolf Brian , Hirata Ronaldo , Caramês João 
Published: November 2017

AbstractArticulation and occlusion test materials are tools used in daily prosthodontic and restorative procedures that aid the clinicians in the evaluation of adjacent and opposing natural and/or artificial tooth contacts. A precision micrometer (Series 293, Mitutoyo, Japan) with a resolution of 0.001 mm was used to measure the thickness of five articulating papers and six articulation foils. Four of the articulating foils tested presented thicknesses inferior or equal to 21 μm, confirming their adequacy for the evaluation of natural dentitions. Clinicians and researchers should be aware that some labeled and actual papers/foils thicknesses are not in accordance.Clinical SignificanceThe thickness of articulating papers and foils reported by some manufacturers is not accurate. The information provided in this article may aid clinicians and researchers to better select the most appropriate materials for the evaluation of static and dynamic occlusion.
Glutathione reductase mediates drug resistance in glioblastoma cells by regulating redox homeostasis
Authors: Zhu Zhongling , Du Shuangshuang , Du Yibo , Ren Jing , Ying Guoguang , Yan Zhao 
Published: November 2017

AbstractGlutathione (GSH) and GSH‐related enzymes constitute the most important defense system that protects cells from free radical, radiotherapy, and chemotherapy attacks. In this study, we aim to explore the potential role and regulatory mechanism of the GSH redox cycle in drug resistance in glioblastoma multiforme (GBM) cells. We found that temozolomide (TMZ)‐resistant glioma cells displayed lower levels of endogenous reactive oxygen species and higher levels of total antioxidant capacity and GSH than sensitive cells. Moreover, the expression of glutathione reductase (GSR), the key enzyme of the GSH redox cycle, was higher in TMZ‐resistant cells than in sensitive cells. Furthermore, silencing GSR in drug‐resistant cells improved the sensitivity of cells to TMZ or cisplatin. Conversely, the over‐expression of GSR in sensitive cells resulted in resistance to chemotherapy. In addition, the GSR enzyme partially prevented the oxidative stress caused by pro‐oxidant L‐buthionine ‐sulfoximine. The modulation of redox state by GSH or L‐buthionine –sulfoximine regulated GSR‐mediated drug resistance, suggesting that the action of GSR in drug resistance is associated with the modulation of redox homeostasis. Intriguingly, a trend toward shorter progress‐free survival was observed among GBM patients with high GSR expression. These results indicated that GSR is involved in mediating drug resistance and is a potential target for improving GBM treatment.
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Comparative hindlimb myology of foot‐propelled swimming birds
Authors: Clifton Glenna T. , Carr Jennifer A. , Biewener Andrew A. 
Published: November 2017

AbstractSeveral groups of birds have convergently evolved the ability to swim using their feet despite facing trade‐offs with walking. However, swimming relative to terrestrial performance varies across these groups. Highly specialized divers, such as loons and grebes, excel at swimming underwater but struggle to stand on land, whereas species that primarily swim on the water surface, such as Mallards, retain the ability to move terrestrially. The identification of skeletal features associated with a swimming style and conserved across independent groups suggests that the hindlimb of foot‐propelled swimming birds has adapted to suit the physical challenges of producing propulsive forces underwater. But in addition to skeletal features, how do hindlimb muscles reflect swimming ability and mode? This paper presents the first comparative myology analysis associated with foot‐based swimming. Our detailed dissections of 35 specimens representing eight species reveal trends in hindlimb muscle size and attachment location across four independent lineages of extant swimming birds. We expand upon our dissections by compiling data from historical texts and provide a key to any outdated muscle nomenclature used in these sources. Our results show that highly diving birds tuck the femur and proximal tibiotarsus next to the ribcage and under the skin covering the abdomen, streamlining the body. Several hindlimb muscles exhibit dramatic anatomical variation in diving birds, including theflexor cruris lateralis(FCL) andiliofibularis(IF), which reduce in size and shift distally along the tibiotarsus. Thefemorotibialis medius(FTM) extends along an expanded cnemial crest. The resulting increased moment arms of these muscles likely help stabilize the hip and knee while paddling. Additionally, distal ankle plantarflexors, including thegastrocnemiusand digital flexors, are exceptionally large in diving birds in order to power foot propulsion. These patterns exist within distantly related lineages of diving birds and, to a lesser extent, in surface swimmers. Together, our findings verify conserved muscular adaptations to a foot‐propelled swimming lifestyle. The association of muscle anatomy with skeletal features and biomechanical movement demands can inform functional interpretation of fossil birds and reveal selective pressures underlying avian diversification.
Decision‐making in nursing practice: An integrative literature review
Authors: Nibbelink Christine W. , Brewer Barbara B. 
Published: November 2017

Aims and objectivesTo identify and summarise factors and processes related to registered nurses’ patient care decision‐making in medical–surgical environments. A secondary goal of this literature review was to determine whether medical–surgical decision‐making literature included factors that appeared to be similar to concepts and factors in naturalistic decision making (NDM).BackgroundDecision‐making in acute care nursing requires an evaluation of many complex factors. While decision‐making research in acute care nursing is prevalent, errors in decision‐making continue to lead to poor patient outcomes. Naturalistic decision making may provide a framework for further exploring decision‐making in acute care nursing practice. A better understanding of the literature is needed to guide future research to more effectively support acute care nurse decision‐making.DesignPubMed and CINAHL databases were searched, and research meeting criteria was included. Data were identified from all included articles, and themes were developed based on these data.ResultsKey findings in this review include nursing experience and associated factors; organisation and unit culture influences on decision‐making; education; understanding patient status; situation awareness; and autonomy.ConclusionsAcute care nurses employ a variety of decision‐making factors and processes and informally identify experienced nurses to be important resources for decision‐making. Incorporation of evidence into acute care nursing practice continues to be a struggle for acute care nurses. This review indicates that naturalistic decision making may be applicable to decision‐making nursing research.Relevance to clinical practiceExperienced nurses bring a broad range of previous patient encounters to their practice influencing their intuitive, unconscious processes which facilitates decision‐making. Using naturalistic decision making as a conceptual framework to guide research may help with understanding how to better support less experienced nurses’ decision‐making for enhanced patient outcomes.
Describing the healthcare experiences and strategies of women survivors of violence
Authors: Reeves Elizabeth A. , Humphreys Janice C. 
Published: November 2017

Aim and ObjectiveThe purpose of this study was to develop knowledge on women survivors' healthcare experiences and strategies.BackgroundSurvivors of traumatic life events are at an increased risk for an array of negative health consequences, which can be complicated when distressing healthcare experiences act as a barrier to accessing needed care. Implications for trauma‐informed and sensitive practice are well established, but evidence to date on survivors' healthcare experiences and patient engagement is limited.DesignThis study utilized individual interviews and qualitative description methods.MethodsFourteen participants completed a demographic questionnaire and one semistructured interview focused on their exposure to violence, healthcare experiences and strategies for navigating health care. Thematic analysis in alignment with qualitative description methods was used to analyse interview transcripts and identify themes.ResultsParticipants in this study reported a variety of traumatic life experiences, ranging from childhood sexual abuse and intimate partner violence to severe car accidents. Experiencing a multiplicity of trauma sometimes complicated participants' later healthcare experiences. Although participants described ways in which providers helped them attain positive care experiences, they also acknowledged that limitations of the healthcare system could make trauma‐informed practices difficult to implement. Participants described strategies they use to prepare for, navigate and recover after healthcare encounters including selecting providers, bringing support persons to appointments and engaging in relaxing activities after appointments.ConclusionsParticipants emphasised the importance of trusting and equitable provider–patient relationships and described several ways they prepare for, cope with and care for themselves after difficult healthcare experiences. Descriptive data on the patient engagement behaviours of survivors of violence is a unique contribution of this study to existing research.Relevance to clinical practiceFindings from this study indicate the importance of comprehensive trauma history screening during health assessments, development of trusting and mutually respectful provider–patient relationships and provider training programmes focused on trauma‐informed care practices.