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CONCLUSIONS The novel stratification of MM regions was predictive of challenging mLND by MIS. Surgeons should have a low threshold for conversion for MMs in proximal regions. © 2020 Wiley Periodicals, Inc.AIM To describe a theory on intercultural caring in maternity care and its development. METHODOLOGY The theory has been developed qualitatively using hermeneutics. MATERIAL Previous studies have been interpreted. FINDINGS Five meaningful interpretation patterns emerged. These are that the experience of caring is related to power; the family is always present; childbearing and migration - a multiple vulnerability; the intercultural encounter changes the mother and the midwife; and conflicts may cause change. These themes are implicit in the theory. The theory consists of the caring relationship between the midwife and the mother. Intercultural caring has four dimensions universal, cultural, contextual and unique caring. Intercultural caring relieves suffering and promotes health and well-being. selleck compound Outer circumstances on three levels influence the maternity care. The five patterns and the theory are merged together. CONCLUSION The theory can be used in nursing education to awaken awareness in students of cultural aspects and caring in the maternity care of immigrants. Midwives can apply the theory to maternity care to enable a positive experience of childbearing by immigrant and minority mothers, which in turn can influence the well-being and indirectly the health outcome. The theory connects caring, culture, intercultural and maternity care in a new way, which is important in the care of childbearing immigrant and minority women. It also adds the intercultural and maternity care contexts to the theory of caritative caring. © 2020 Nordic College of Caring Science.OBJECTIVES To create a replacement nasolacrimal system, using the puncta and canaliculi, with prolonged implant retention and minimal use of Elizabethan collars or other restraint devices. MATERIALS AND METHODS The method was used in 11 dogs and two cats. Silicone tubing was placed through both canaliculi and, via a drill hole, into the nasal cavity. Distally, the tubing ends were tied in a subcutaneous pocket lateral to the premaxilla. Tubing retention time was 4 to 7 months. Elizabethan collars were used only until skin suture removal at 2 weeks. RESULTS In all animals, a functional nasolacrimal system was re-created and remained patent over prolonged follow-up periods. Adverse effects and complications were mild. CLINICAL SIGNIFICANCE The described method is relatively straightforward, thereby making relief of tear outflow problems widely accessible. © 2020 British Small Animal Veterinary Association.BACKGROUND AND OBJECTIVES Marking positive lymph nodes (LNs) before neoadjuvant chemotherapy (NAC) may improve the accuracy of sentinel lymph node biopsy (SLNB). The aim of this study was to determine the feasibility of marking LNs with 4% carbon microparticle suspension (CMS) before NAC and to evaluate if this technique would improve the SLNB identification rate. METHODS A prospective study of patients with cT1-T4, cN1-N2 breast cancer who underwent US-guided fine-needle aspiration biopsy (FNAB) of suspected LNs and concomitant marking with 4% CMS was performed. After NAC, LNs marked with 4% CMS and those marked with Patent Blue V dye (PBV) were identified and resected. RESULTS Of the 123 patients included, 74 (60.1%) had positive LNs at FNAB. link2 During axillary surgery, 4% CMS was identified in 121 of 123 patients (98.3%) and blue sentinel LNs in 91% (112 of 123 patients) (P = .0103). Comparing isolated results of PBV and 4%CMS + PBV, the association was better in identifying positive LNs (72.2% vs 97.7%) (P = .02). CONCLUSION The association of 4% CMS and PBV is feasible and significantly increased the identification rate of positive LNs. 4% CMS may play an important role as a complementary technique in patients submitted to NAC. © 2020 Wiley Periodicals, Inc.INTRODUCTION The development of bedside methods to assess muscularity is an essential critical care nutrition research priority. We aimed to compare ultrasound-derived muscle thickness at 5 landmarks with computed tomography (CT) muscle area at intensive care unit (ICU) admission. Secondary aims were to (1) combine muscle thicknesses and baseline covariates to evaluate correlation with CT muscle area and (2) assess the ability of the best-performing ultrasound model to identify patients with low CT muscle area. METHODS Adult patients who underwent CT scanning at the third lumbar area less then 72 hours after ICU admission were prospectively recruited. Muscle thickness was measured at mid-upper arm, forearm, abdomen, and thighs. Low CT muscle area was determined using published cutoffs. Pearson correlation compared ultrasound-derived muscle thickness and CT muscle area. Linear regression was used to develop ultrasound prediction models. Bland-Altman analyses compared ultrasound-predicted and CT-measured muscle area. RESULTS Fifty ICU patients were enrolled, aged 52 ± 20 years. Ultrasound-derived muscle thickness at each landmark correlated with CT muscle area (P less then .001). The sum of muscle thickness at mid-upper arm and bilateral thighs, including age, sex, and the Charlson Comorbidity Index, improved the correlation with CT muscle area (r = 0.85; P less then .001). Mean difference between ultrasound-predicted and CT-measured muscle area was -2 cm2 (95% limits of agreement, -40 cm2 to +36 cm2 ). The best-performing ultrasound model demonstrated good ability to identify 14 patients with low CT muscle area (area under curve = 0.79). CONCLUSION Ultrasound shows potential for assessing muscularity at ICU admission (Clinicaltrials.gov NCT03019913). © 2020 American Society for Parenteral and Enteral Nutrition.BACKGROUND Increment of compound muscle action potential amplitude is a diagnostic hallmark of Lambert-Eaton myasthenic syndrome (LEMS). Making a diagnosis can be challenging, therefore, a proper cutoff for abnormal increment is highly relevant for improved recognition of this rare disease. METHODS We determined the sensitivity and specificity of 60% and 100% cutoff values in all consecutive patients who underwent increment testing in our hospital from 1999 to 2016. RESULTS We included 156 patients, 63 with LEMS and 93 without LEMS. Sensitivity of a 60% cutoff for increment testing was 77.8% (95% confidence interval 65.5%-87.3%) and 58.7% (45.6%-71.0%) for 100%. Specificity was 98.9% (94.2%-100%) and 100% (96.1%-100%) using a threshold of 60% and 100%, respectively. CONCLUSIONS Lowering the cutoff value for abnormal increment to 60% greatly increases sensitivity to diagnose LEMS without an overt loss in specificity. © 2020 The Authors. link3 Muscle & Nerve published by Wiley Periodicals, Inc.Understanding the effects of invasive alien species (IAS) on native host-parasite relationships is of importance for enhancing ecological theory and IAS management. When IAS and their parasite(s) invade a guild, the effects of interspecific resource competition and/or parasite-mediated competition can alter existing native host-parasite relationships and the dependent biological traits such as native species' behaviour. We used a natural experiment of populations of native red squirrels Sciurus vulgaris that were colonized by the alien grey squirrel Sciurus carolinensis, comparing repeated measurements of red squirrel parasite infection and personality with those taken in sites where only the native species occurred. We explored two alternative hypotheses (a) individual differences in personality traits (activity and/or sociability) of native red squirrel positively affect the probability of macroparasite spillover and thus the likelihood to acquire the alien's parasitic helminth Strongyloides robustus; (b) t© 2020 British Ecological Society.BACKGROUND How best to target intrapartum antibiotic prophylaxis (IAP) to minimise both Early-Onset Group B Streptococcus (EOGBS) neonatal infection and maternal/fetal antibiotic exposure is uncertain, with both routine-screening and risk-factor approaches available. AIMS This retrospective cohort study was undertaken to examine the outcomes of a hybrid risk-and-screen approach to EOGBS prevention using GBS polymerase chain reaction (PCR). The target population was women with term prelabour rupture of membranes (TermPROM) having the risk factor of prolonged rupture of membranes (ROM) ≥18 h. MATERIALS AND METHODS Non-labouring TermPROM women had rapid GBS PCR testing at presentation. GBS screen-positive women proceeded to induction of labour and received IAP. GBS screen-negative women were allowed home to await spontaneous labour and not given IAP regardless of duration of ROM, unless other risk factors developed. For all other women, the risk-factor approach was followed. RESULTS From 2009 to 2018, there were 20 cases of culture-positive EOGBS, a rate of 0.36/1000 live births (95% CI 0.22-0.56/1000), comparable to other recent reports. Over 2010-2018 when laboratory data were available, 1120 TermPROM women with ROM ≥18 h avoided antibiotics because they were GBS PCR-negative (2.3% of all births, 3.6% of vaginal births) while 338 TermPROM women with ROM less then 18 h received targeted antibiotics for being GBS-positive. No cases of EOGBS occurred in TermPROM women, those with ROM ≥18 h, or due to protocol-compliance failure. CONCLUSIONS A hybrid approach involving risk-factor-based IAP and intrapartum GBS PCR screening of non-labouring TermPROM women delivers acceptably low rates of EOGBS while minimising and better targeting antibiotic exposure. © 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.Examining the multitude of influences on the development of adolescent stress responses, especially among low-income families, is a critical and understudied topic in the field. The current study examined cortisol attunement between adolescent girls and parents (mostly mothers) from predominantly low-income, single parent, ethnic minority families before and after an in-laboratory disagreement discussion task. The sample consisted of 118 adolescents (Mage  = 13.79 years, 76.3% ethnic minorities, 23.7% European Americans) and primary caregivers (Mage  = 40.62 years; Mdn yearly income = $24,000; 43.2% single parents; 50% living below poverty line). We investigated oxytocin receptor (OXTR rs53576) gene variations as a potential contributor to attunement within the dyad. Results showed that parents and adolescents showed stress system attunement across the disagreement task, but that parent and adolescent oxytocin receptor genotype did not impact attunement. Future studies should detail biological factors that contribute to the calibration of stress response systems of adolescents across a variety of samples, particularly those experiencing a combination of stressors. © 2020 Wiley Periodicals, Inc.BACKGROUND In patients with hepatitis C virus (HCV) and compensated advanced chronic liver disease (cACLD) there is evidence that sustained virological response (SVR) to direct-acting antivirals (DAA) may ameliorate portal hypertension, although both the course of oesophageal varices and the performance of their non-invasive predictors following DAA-induced SVR are less defined. In this study, our aim was to assess the variation in oesophageal varices status in HCV patients with cACLD who obtained an SVR to DAAs, and to evaluate the diagnostic performance of non-invasive predictors of varices after HCV cure. MATERIAL AND METHODS Sixty-three HCV patients with cACLD and SVR to DAAs were prospectively followed up, and oesophageal varices surveillance was carried out according to the Baveno VI indications. Appearance and disappearance of varices, accuracy performance of their non-invasive predictors (Baveno/expanded Baveno VI criteria, platelet count/spleen diameter ratio), and number of endoscopies spared with their application were calculated.