Fostering Collaborative Teamwork-A Comprehensive Approach to Vascular Graft Infection Following Arterial Reconstructive Surgery

Vascular graft infection (VGI) is one of the most serious complications following arterial reconstructive surgery. VGI has received increasing attention over the past decade, but many questions remain regarding its diagnosis and management. In this review, we describe our approach to VGI through multidisciplinary collaboration and discuss decision making for challenging presentations. This review will concentrate on VGI that impacts both aneurysms and pseudoaneurysms excluding the ascending thoracic aorta.

Integrated phylogenomic analyses unveil reticulate evolution in Parthenocissus (Vitaceae), highlighting speciation dynamics in the Himalayan-Hengduan Mountains

Hybridization caused by frequent environmental changes can lead both to species diversification (speciation) and to speciation reversal (despeciation), but the latter has rarely been demonstrated. Parthenocissus, a genus with its trifoliolate lineage in the Himalayan-Hengduan Mountains (HHM) region showing perplexing phylogenetic relationships, provides an opportunity for investigating speciation dynamics based on integrated evidence. We investigated phylogenetic discordance and reticulate evolution in Parthenocissus based on rigorous analyses of plastome and transcriptome data. We focused on reticulations in the trifoliolate lineage in the HHM region using a population-level genome resequencing dataset, incorporating evidence from morphology, distribution, and elevation. Comprehensive analyses confirmed multiple introgressions within Parthenocissus in a robust temporal-spatial framework. Around the HHM region, at least three hybridization hot spots were identified, one of which showed evidence of ongoing speciation reversal. We present a solid case study using an integrative methodological approach to investigate reticulate evolutionary history and its underlying mechanisms in plants. It demonstrates an example of speciation reversal through frequent hybridizations in the HHM region, which provides new perspectives on speciation dynamics in mountainous areas with strong topographic and environmental heterogeneity.

Integrated phylogenomic analyses unveil reticulate evolution in Parthenocissus (Vitaceae), highlighting speciation dynamics in the Himalayan-Hengduan Mountains

Hybridization caused by frequent environmental changes can lead both to species diversification (speciation) and to speciation reversal (despeciation), but the latter has rarely been demonstrated. Parthenocissus, a genus with its trifoliolate lineage in the Himalayan-Hengduan Mountains (HHM) region showing perplexing phylogenetic relationships, provides an opportunity for investigating speciation dynamics based on integrated evidence. We investigated phylogenetic discordance and reticulate evolution in Parthenocissus based on rigorous analyses of plastome and transcriptome data. We focused on reticulations in the trifoliolate lineage in the HHM region using a population-level genome resequencing dataset, incorporating evidence from morphology, distribution, and elevation. Comprehensive analyses confirmed multiple introgressions within Parthenocissus in a robust temporal-spatial framework. Around the HHM region, at least three hybridization hot spots were identified, one of which showed evidence of ongoing speciation reversal. We present a solid case study using an integrative methodological approach to investigate reticulate evolutionary history and its underlying mechanisms in plants. It demonstrates an example of speciation reversal through frequent hybridizations in the HHM region, which provides new perspectives on speciation dynamics in mountainous areas with strong topographic and environmental heterogeneity.

A descriptive analysis of assessment measures on the effectiveness of a comprehensive stuttering intervention approach: A single case study

BACKGROUND

For effective client outcomes, stuttering assessment and intervention approaches need to be aligned. This encompasses using assessment and intervention approaches that address the three multidimensional constructs of stuttering, namely core behaviours, secondary behaviours and negative feelings and attitudes.

OBJECTIVE

The study aimed to explore whether multiple assessment measures could be used to describe the effectiveness of a comprehensive stuttering intervention approach, undergirded by the International Classification of Functioning, Disability and Health (ICF) framework.

METHOD

A single-subject case design was employed with one male adult who stutters. Data was collected by administering the Stuttering Severity Instrument-Fourth Edition (SSI-4) and Overall Assessment of the Speaker's Experience of Stuttering-Adults (OASES-A) at three testing periods (pre-intervention, immediately post-intervention and 7 months post-intervention), and a semi-structured interview schedule immediately post-intervention. Descriptive statistics was used to analyse the SSI-4 and OASES-A, and thematic analysis was conducted to evaluate the participant's interview schedule responses.

RESULTS

The participant's total scores, impact scores and severity ratings of both the SSI-4 and OASES decreased across the three testing periods. The main theme of effectiveness of the comprehensive stuttering intervention to reduce aspects of disability emerged from the participant's responses.

CONCLUSION

Evaluation of the results from the assessment measures revealed that the comprehensive stuttering intervention approach was effective in reducing the participant's core behaviours, secondary behaviours and negative feelings and attitudes. Assessment and management of fluency disorders should promote a client-specific multidimensional approach that extends beyond the core behaviours and secondary behaviours, by addressing the underlying social and emotional facets of fluency disorders.

Using Smart Sensors to Monitor Physical Activity and Technical-Tactical Actions in Junior Tennis Players

The use of smart devices to obtain real-time data has notably increased in the context of training. These technological tools provide data which monitor the external load and technical–tactical actions related to psychological and physical health in junior tennis players. The purpose of this paper is to monitor technical–tactical actions and physical activity during a current tennis competition in the Green stage using a Zepp Tennis Smart Sensor 2. The participants were 20 junior tennis players (under 10 years of age), with an average age of 9.46 years. The total number of strokes (n= 21,477) during 75 matches was analyzed. The study variables were the following aspects: (a) number of strokes, (b) ball impact in the sweet spot; (c) racket speed; (d) ball spin; (e) calories burned; and (f) match time. The current system of competition, based on knockout, does not meet the World Health Organization’s recommendations for daily physical activity time. Players mainly used flat forehands with a lack of variability in technical–tactical actions which did not meet the current learning opportunity criteria of comprehensive methodologies. The competition system in under-11 tennis should be adapted to the players’ characteristics by improving the variability and quantity of practice.

A qualitative study on barriers in the prevention of anaemia during pregnancy in public health centres: perceptions of Indonesian nurse-midwives

BACKGROUND

Anemia in pregnancy remains a major problem in Indonesia over the past decade. Early detection of anaemia in pregnancy is one of the components which is unsuccessfully implemented by nurse-midwives. This study aims to explore nurse-midwives' experiences in managing pregnant women with anaemia in Public Health Centres.

METHODS

We conducted a qualitative study with semi-structured face to face interviews from November 2011 to February 2012 with 23 nurse-midwives in five districts in Yogyakarta Special Province. Data analysis was thematic, using the constant comparison method, making comparison between participants and supported by ATLAS.ti software.

RESULTS

Twelve nurse-midwives included in the interviews had less than or equal to 10 years' working experience (junior nurse-midwives) and 11 nurse-midwives had more than 10 years' working experience (senior nurse-midwives) in Public Health Centres. The senior nurse-midwives mostly worked as coordinators in Public Health Centres. Three main themes emerged: 1) the lack of competence and clinical skill; 2) cultural beliefs and low participation of family in antenatal care programme; 3) insufficient facilities and skilled support staff in Public Health Centres. The nurse-midwives realized that they need to improve their communication and clinical skills to manage pregnant women with anaemia. The husband and family involvement in antenatal care was constrained by the strength of cultural beliefs and lack of health information. Moreover, unfavourable work environment of the Public Health Centres made it difficult to apply antenatal care the pregnant womens' need.

CONCLUSIONS

The availability of facilities and skilled staffs in Public Health Centre as well as pregnant women's husbands or family members contribute to the success of managing anaemia in pregnancy. Nurse-midwives and pregnant women need to be empowered to achieve the optimum result of anaemia management. We recommend a more comprehensive approach in managing pregnant women with anaemia, which synergizes the available resources and empowers nurse-midwives and pregnant women.