bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of lower limb stiffness between male and female dancers and athletes during drop jump landings
Authors: Ward Rachel E. , Fong Yan Alycia , Orishimo Karl F. , Kremenic Ian J. , Hagins Marshall , Liederbach Marijeanne , Hiller Claire E. , Pappas Evangelos
Published: September 2018

Repetition of jumps in dance and sport training poses a potential injury risk; however, non‐contact landing injuries are more common in athletes than dancers. This study aimed to compare the lower limb stiffness characteristics of dancers and athletes during drop landings to investigate possible mechanisms of impact‐related injuries. Kinematics and kinetics were recorded as 39 elite modern and ballet dancers (19 men and 20 women) and 40 college‐level team sport athletes (20 men and 20 women) performed single‐legged drop landings from a 30‐cm platform. Vertical leg stiffness and joint stiffness of the hip, knee, and ankle were calculated using a spring‐mass model. Stiffness data, joint kinematics, and moments were compared with a group‐by‐sex 2‐way analysis of variance. Multiple linear regression was used to assess the relative contribution of hip and knee and ankle joint stiffness to variance in overall vertical leg stiffness for dancers and athletes. Dancers had lower leg (P < 0.001), knee joint (P = 0.034), and ankle joint stiffness (P = 0.043) than athletes. This was facilitated by lower knee joint moments (P = 0.012) and greater knee (P = 0.029) and ankle joint (P = 0.048) range of motion in dancers. Males had higher leg (P < 0.001) and ankle joint stiffness (P < 0.001) than females. This occurred through lower ankle range of motion (P < 0.001) and greater ankle moment (P = 0.022) compared to females. Male and female dancers demonstrated reduced lower limb stiffness compared to athletes, indicating a more pliable landing technique. Dance training techniques could potentially inform approaches to injury prevention in athletes.
Majority Rule, Compromise and the Democratic Legitimacy of Referendums
Authors: Bellamy Richard
Published: September 2018

Cheneval and el‐Wakil () defend referendums as a mechanism that allows a popular majority to express itself in situations where the standard channels of representative democracy fail to include the concerns of certain citizens and end up reflecting the views of a minority. By contrast, this comment argues that the likelihood of exclusion and settlement on a minority preference is much greater when policy choices are made by referendum. The reason lies in the plurality of policy options on many issues, and the fact that the most favoured policy may be a shared second or third best. The tendency for most forms of representative democracy to encourage politicians to build majorities through compromises among different coalitions of minorities is more likely to settle on the majority preference of diverse actors holding a plurality views than a referendum based on a binary choice.
Referendums: Tyranny of the Majority?
Authors: Moeckli Daniel
Published: September 2018

This response piece argues that one should be wary of generalised statements that referendums – or particular types of referendums – are good or bad. Whether a popular vote process has beneficial or damaging effects depends on a myriad of factors, in particular its formal design and the constitutional structure of the state concerned. Similarly, sweeping claims that referendums result in the oppression of minorities should be approached with a good dose of scepticism. A look at actual direct‐democratic practice shows that the danger of a tyranny of the majority is limited to very specific circumstances. Insofar as this danger does exist, damaging effects of referendums for minorities can be prevented through judicial review after the vote and exclusion of certain issues from referendums from the start.
Making Referendums Safe for Democracy: A Call for More and Better Deliberation
Authors: Chambers Simone
Published: September 2018

In this essay I argue that when thinking about the design of referendums we should pay particular attention to the quality, substance, and inclusiveness of the debate and deliberation that precedes the vote. This is especially true for constitutional referendums that affect fundamental laws. I suggest that drawing out the procedure over time and including citizens’ mini‐publics might be helpful additions to our design tools box.
Emerging Research Communities of Practice Versus the Popular Vision of Interdisciplinarity? Insights from Digital Research in the United Kingdom*
Authors: Zhao Yupei , Tsatsou Panayiota
Published: September 2018

Objective

This article shows how social science and humanities researchers in the United Kingdom who make use of digital tools, resources, and services understand and perceive interdisciplinarity and their related experiences and needs.

Methods

The study examined 10 cases of U.K.‐based research, two from each of the following social science and humanities disciplines: business/management, education, history, literature, and politics. Data collection employed a qualitative methodology that consisted of nonparticipant observation and semi‐structured interviews.

Results

The article finds that researchers problematize the meaning and top‐down character of interdisciplinarity and envisage the development of research communities of experience exchange and knowledge sharing that go beyond the imperative of interdisciplinarity.

Conclusion

The article challenges prevalent assumptions that digital research and interdisciplinarity go hand in hand and that one is a prerequisite for and in need of the other, while it invites institutional and funding bodies to consider working jointly with researchers toward developing the alternative of research communities of practice.
Predicting aggregate stability index in ferralsols
Authors: de Melo T. R. , Machado W. , de Oliveira J. F. , Tavares Filho J.
Published: September 2018

Pedotransfer functions are advantageous for predicting attributes in which the analysis or transport is laborious or expensive, such as the aggregate stability index (ASI), which is directly associated with soil use and ecosystem services. The aims of this study were (i) to predict the ASI in Ferralsols based on four soil attributes: clay concentration (Clay), bulk density (Bd), organic matter (OM) and soil pH; and (ii) to evaluate the contribution of these attributes to the ASI in soils with Clay < 350 g/kg, 350 ≤ Clay ≤ 600 g/kg and Clay > 600 g/kg. Samples (n = 405) were collected at the 0.0–0.2 m layer in Ferralsols with different clay concentration and agricultural uses in Paraná, Brazil and used for predicting ASI through multiple linear regression using the least squares method with stepwise to test the persistence of the explanatory attributes in the models. The models were trained using 2/3 of the samples (n = 270), and the remaining samples (n = 135) were used to test the model. The ASI could be predicted with good accuracy ( > 0.77, P < 7.91% and RMSE < 6.74%) using attributes routinely determined in the laboratory (Clay, Bd, OM, and pH), as explanatory attributes in Ferralsols of different clay concentration and under different agricultural uses. The contribution of the explanatory attributes to the ASI is not dependent on the clay concentration group of Ferralsols, and their importance follows the order: Clay > OM = pH = Bd.
PlantFAdb: a resource for exploring hundreds of plant fatty acid structures synthesized by thousands of plants and their phylogenetic relationships
Authors: Ohlrogge John , Thrower Nick , Mhaske Vandana , Stymne Sten , Baxter Melissa , Yang Weili , Liu Jinjie , Shaw Kathleen , Shorrosh Basil , Zhang Meng , Wilkerson Curtis , Matthäus Bertrand
Published: September 2018

Over 450 structurally distinct fatty acids are synthesized by plants. We have developed PlantFAdb.org, an internet‐based database that allows users to search and display fatty acid composition data for over 9000 plants. PlantFAdb includes more than 17 000 data tables from >3000 publications and hundreds of unpublished analyses. This unique feature allows users to easily explore chemotaxonomic relationships between fatty acid structures and plant species by displaying these relationships on dynamic phylogenetic trees. Users can navigate between order, family, genus and species by clicking on nodes in the tree. The weight percentage of a selected fatty acid is indicated on phylogenetic trees and clicking in the graph leads to underlying data tables and publications. The display of chemotaxonomy allows users to quickly explore the diversity of plant species that produce each fatty acid and that can provide insights into the evolution of biosynthetic pathways. Fatty acid compositions and other parameters from each plant species have also been compiled from multiple publications on a single page in graphical form. Links provide simple and intuitive navigation between fatty acid structures, plant species, data tables and the publications that underlie the datasets. In addition to providing an introduction to this resource, this report illustrates examples of insights that can be derived from PlantFAdb. Based on the number of plant families and orders that have not yet been surveyed we estimate that a large number of novel fatty acid structures are still to be discovered in plants.
Canine and feline abdominal arterioportal communications can be classified based on branching patterns in computed tomographic angiography
Authors: Specchi Swan , Rossi Federica , Weisse Chick , Morabito Simona , Petrovitch Nicholas P. , Drees Randi , Thierry Florence , Ricciardi Mario , Penchome Rampaipat , Armenise Andrea , Pey Pascaline , Paek Matthew , Panopoulos Ioannis , Nicoli Stefano , Schwarz Tobias
Published: September 2018

Arterioportal vascular anomalies are communications between the splanchnic arteries and the portal system that represent a rare cause of presinusoidal portal hypertension in small animals. There is little information concerning the imaging findings of arterioportal communications in small animals and no classification could be found for radiologists and surgeons. The aims of this retrospective descriptive multicentric study were to describe the computed tomographic characteristics of arterioportal communications in a group of cats and dogs, and to propose a classification based on computed tomography (CT) angiographic anatomy. Computed tomography databases from multiple veterinary hospitals were searched for cats and dogs with a diagnosis of arterioportal communication. A total of 36 animals (33 dogs, three cats) met the inclusion criteria. There were 32 intrahepatic arterioportal malformations and four extrahepatic fistulae. The intrahepatic arterioportal malformations were classified as right divisional (11/32) and left divisional (21/32), and the left divisional were subclassified as left medial (16/21) and left lateral (4/21). One patient showed multiple intrahepatic arterioportal communications with concomitant left medial and left lateral conformations. Two patients with intrahepatic arteriovenous malformation showed concomitant congenital intrahepatic shunts. The proposed anatomical classification based on CT angiography could allow veterinary radiologists to have a more systematic approach and help improve the radiologist–surgeon communication.
Predominance of hypoechoic tissue changes in nine dogs with malignant prostatic lymphoma
Authors: Di Donato Pamela , Zweifel Raffaela , Koehler Kernt , Golini Lorenzo , Ressel Lorenzo , Kramer Martin , Kiefer Ingmar , Lim Chee Kin , Ondreka Nele
Published: September 2018

Neoplasia of the prostate is relatively uncommon in dogs with adenocarcinoma being the most common type. Non‐epithelial tumors are rare and only individual cases of malignant lymphoma affecting the prostate have been reported. The purpose of this multi‐institutional, retrospective, descriptive study was to characterize the ultrasonographic features of canine prostatic lymphoma. Inclusion criteria were an abdominal ultrasound and cytological/histological diagnosis of malignant prostatic lymphoma. Ultrasonographic features were recorded based on the original ultrasonographic reports and consensus opinion of two readers on the available image sets retrospectively. Nine dogs met the inclusion criteria with a mean age of 6.5 years. Seven dogs were intact and two neutered. Subjective prostatomegaly was noted in all patients however not reproducible by objective measurements. Altered shape with rounded/irregular margins was detected in 78% of the cases. All prostates presented either diffuse (three dogs) or focal/periurethral (four dogs) and/or multifocal areas of hypoechogenicity (three dogs). In one dog, focal and multifocal hypoechoic changes co‐occurred. Prostatic mineralization was not present in any of the cases. Ultrasonographic features of infiltrative disease of multiple organs and/or lymphadenopathy was found in all cases. Even though malignant lymphoma is rare in the prostate, it should be included in the list of differentials in patients with hypoechoic lesions/areas, altered shape, lack of mineralization of the prostatic parenchyma and evidence of multiorgan involvement.
Mechanical analysis of suture attachment methods in toggle suture constructs
Authors: Kraska Kathleen A. , Jackson Joshua
Published: September 2018

Objective

To determine the effect of the method used to attach OrthoFiber #5 to a 1/8‐in Securos toggle rod on the mechanical properties of the resulting construct.

Study design

Prospective bench top mechanical analysis.

Sample population

One hundred twenty‐eight OrthoFiber #5‐toggle rod suture constructs.

Methods

Toggle–suture constructs (groups A‐H) were prepared by using 8 methods to attach OrthoFiber #5 to a 1/8‐in toggle rod (n = 16 constructs/group). A servohydraulic materials‐testing machine was used to test each toggle–suture construct in tension. Mean load to failure, cycles to failure, construct stiffness, and suture elongation under static and cyclic loading were compared among types of constructs.

Results

Mean load to failure was greatest (>500 N) for constructs D (P ≤ .048) and G (P ≤ .048). Mean construct stiffness of D (53.52 N/mm) and E (53.6 N/mm) was greater than that of the 6 other constructs (P ≤ .040). Construct A sustained the most elongation in acute (23.47 mm;P < .001) and cyclic (18.53 mm;P < .003) loading. Cycles to failure was greater for construct C (622 cycles) compared with constructs A, B, and H (P = .008,P = .009, andP = .010, respectively).

Conclusion

The method used to attach OrthoFiber #5 to a 1/8‐in toggle rod influenced the mechanical properties of the construct. No one construct outperformed other groups in all areas of testing, but construct D was superior when mean load to failure and construct stiffness were considered.

Clinical impact

Construct D, with OrthoFiber #5, passed straight through the toggle rod eyelet, may provide superior stability and resistance to fatigue failure to toggle‐in repairs of coxofemoral luxations.
Articular cartilage lesions associated with complete lateral meniscal tears in the dog
Authors: Krier Elizabeth M. , Johnson Tiffany A. , Breiteneicher Adam H. , Peycke Laura E. , Hulse Don A.
Published: September 2018

Objective

To describe articular cartilage (AC) lesions associated with complete lateral meniscal tears in dogs.

Study design

Observational series.

Animals

Seventeen dogs with arthroscopic evidence of a complete lateral meniscal tear and associated AC lesions.

Methods

Medical records of dogs with arthroscopic evidence of complete lateral meniscal tear and associated AC lesions between March 2006 and December 2017 were examined for arthroscopic findings.

Results

The cranial cruciate ligament (CrCL) was intact in 11 of 17 dogs, partially ruptured but competent in 4 of 17 dogs, and completely ruptured in 2 of 17 dogs. All dogs had grossly normal caudal cruciate ligament, medial meniscus, and AC of the medial compartment. In each dog, a complete radial tear of the caudal body of the lateral meniscus was associated with degenerative osteoarthritis (OA) of the lateral compartment of the stifle. The Outerbridge score of the lateral tibial condyle and lateral femoral condyle was 5 of 5 in 15 dogs, 3 of 5 in 1 dog, and 4 of 5 in 1 dog.

Conclusion

Dogs with complete tears of the lateral meniscus developed degenerative OA of the lateral compartment of the stifle leading to AC loss and clinical dysfunction.

Clinical significance

Complete lateral meniscal tears may occur as isolated injuries in dogs with a functional CrCL.
Long‐term postoperative effects of administration of allogeneic blood products in 104 dogs with hemangiosarcoma
Authors: Ciepluch Brittany J. , Wilson‐Robles Heather M. , Pashmakova Medora B. , Budke Christine M. , Ellison Gary W. , Thieman Mankin Kelley M.
Published: September 2018

Objective

To determine the influence of administering allogeneic blood products (ABP) on the progression of hemangiosarcoma in dogs.

Study design

Multi‐institutional, retrospective study.

Sample population

One hundred four dogs with hemangiosarcoma that survived until postoperative discharge from the hospital.

Methods

Medical records of dogs that had been operated on for hemoangiosarcoma were reviewed for signalment, presence of a hemoabdomen, presence of metastatic disease, and whether the dog had received chemotherapy or Yunnan Baiyao. Data that were collected were compared between dogs that received perioperative ABP and those that did not. Disease‐free interval was compared between groups. The Kaplan‐Meier method was used to obtain univariate descriptive statistics for time to clinical decline. A multivariable Cox regression model was used to analyze association or effect of potential predictor variables.

Results

The median disease‐free interval (DFI) was shorter in the 67 dogs that received a blood transfusion (76 days; range, 1‐836) than in the 37 dogs that did not receive a blood transfusion (120 days; range, 38‐916). According to the multivariable Cox regression model, administration of blood products (P = .04) and the presence of gross metastatic disease at the time of surgery (P < .01) shortened the DFI, whereas administration of Yunnan Baiyao (P = .01) prolonged the DFI.

Conclusion

Allogeneic blood product administration was associated with a shorter disease‐free interval in this population. However, we could not demonstrate the association between blood products and shorter DFI because of confounding factors.

Clinical significance

Dogs that receive ABP at the time of surgical therapy for hemangiosarcoma may have accelerated disease progression compared with dogs that do not receive ABP.
ATP in the lateral hypothalamus/perifornical area enhances the CO2 chemoreflex control of breathing
Authors: da Silva Eliandra N. , Horta‐Júnior José de Anchieta C. , Gargaglioni Luciane H. , Dias Mirela B.
Published: September 2018

New Findings

What is the central question of this study?

ATP is known to modulate the chemosensitivity of some brain areas. However, whether the ATP contributes specifically to the mechanism of chemoreception in the lateral hypothalamus/perifornical area (LH/PFA) remains to be determined.

What is the main finding and its importance?

ATP, acting on the LH/PFA, enhances the hypercapnic ventilatory response in rats during wakefulness, in the dark period. Our results highlight the importance of ATP as a modulator of central chemoreception and provide new insight regarding the mechanisms involved in LH/PFA chemosensitivity and the sleep–wake differences in the CO2/H+‐dependent drive to breathe.

The lateral hypothalamus/perifornical area (LH/PFA) is a central chemoreceptor site, which acts in an arousal state‐dependent manner. It has been shown that purinergic signalling through ATP influences the CO2/H+ responsiveness of other chemosensitive regions, but it is unknown whether ATP is also involved in the mechanisms that underlie LH/PFA chemoreception. Here, we studied the effects of microdialysis of a P2X‐receptor agonist [α,β‐methylene ATP (α,β‐meATP), 10 mm] and a non‐selective P2‐receptor antagonist [pyridoxal‐phosphate‐6‐azophenyl‐2′,4′‐disulfonate (PPADS), 1 mm] into the LH/PFA of conscious rats on ventilation in room air and in 7% CO2. In the dark (active) phase, but not in the light, microdialysis of α,β‐meATP caused an augmented hypercapnic ventilatory response during wakefulness, but not during non‐REM sleep (P < 0.001). PPADS caused no change in CO2 ventilatory responses in either the dark period or the light period. Our data suggest that ATP in LH/PFA contributes to the hypercapnic ventilatory response in conscious rats during wakefulness in the dark phase of the diurnal cycle.
NHA2 promotes cyst development in an in vitro model of polycystic kidney disease
Authors: Prasad Hari , Dang Donna K. , Kondapalli Kalyan C. , Natarajan Niranjana , Cebotaru Valeriu , Rao Rajini
Published: September 2018

Key points

Significant and selective up‐regulation of the Na+/H+ exchanger NHA2 (SLC9B2) was observed in cysts of patients with autosomal dominant polycystic kidney disease.

Using the MDCK cell model of cystogenesis, it was found that NHA2 increases cyst size. Silencing or pharmacological inhibition of NHA2 inhibits cyst formation in vitro.

Polycystin‐1 represses NHA2 expression via Ca2+/NFAT signalling whereas the dominant negative membrane‐anchored C‐terminal fragment (PC1‐MAT) increased NHA2 levels.

Drugs (caffeine, theophylline) and hormones (vasopressin, aldosterone) known to exacerbate cysts elicit NHA2 expression.

Taken together, the findings reveal NHA2 as a potential new player in salt and water homeostasis in the kidney and in the pathogenesis of polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) is caused by mutations in PKD1 and PKD2 encoding polycystin‐1 (PC1) and polycystin‐2 (PC2), respectively. The molecular pathways linking polycystins to cyst development in ADPKD are still unclear. Intracystic fluid secretion via ion transporters and channels plays a crucial role in cyst expansion in ADPKD. Unexpectedly, we observed significant and selective up‐regulation of NHA2, a member of the SLC9B family of Na+/H+ exchangers, that correlated with cyst size and disease severity in ADPKD patients. Using three‐dimensional cultures of MDCK cells to model cystogenesis in vitro, we showed that ectopic expression of NHA2 is causal to increased cyst size. Induction of PC1 in MDCK cells inhibited NHA2 expression with concordant inhibition of Ca2+ influx through store‐dependent and ‐independent pathways, whereas reciprocal activation of Ca2+ influx by the dominant negative membrane‐anchored C‐terminal tail fragment of PC1 elevated NHA2. We showed that NHA2 is a target of Ca2+/NFAT signalling and is transcriptionally induced by methylxanthine drugs such as caffeine and theophylline, which are contraindicated in ADPKD patients. Finally, we observed robust induction of NHA2 by vasopressin, which is physiologically consistent with increased levels of circulating vasopressin and up‐regulation of vasopressin V2 receptors in ADPKD. Our findings have mechanistic implications on the emerging use of vasopressin V2 receptor antagonists such as tolvaptan as safe and effective therapy for polycystic kidney disease and reveal a potential new regulator of transepithelial salt and water transport in the kidney.
Commissural communication allows mouse intergeniculate leaflet and ventral lateral geniculate neurons to encode interocular differences in irradiance
Authors: Pienaar A. , Walmsley L. , Hayter E. , Howarth M. , Brown T. M.
Published: September 2018

Key points

Unlike other visual thalamic regions, the intergeniculate leaflet and ventral lateral geniculate nucleus (IGL/vLGN) possess extensive reciprocal commissural connections, the functions of which are unknown.

Using electrophysiological approaches, it is shown that commissural projecting IGL/vLGN cells are primarily activated by light increments to the contralateral eye while cells receiving commissural input typically exhibit antagonistic binocular responses.

Across antagonistic cells, the nature of the commissural input (excitatory or inhibitory) corresponds to the presence of ipsilateral ON or OFF visual responses and in both cases antagonistic responses disappear following inactivation of the contralateral thalamus.

The steady state firing rates of antagonistic cells uniquely encode interocular differences in irradiance.

There is a pivotal role for IGL/vLGN commissural signalling in generating new sensory properties that are potentially useful for the proposed contributions of these nuclei to visuomotor/vestibular and circadian control.

The intergeniculate leaflet and ventral lateral geniculate nucleus (IGL/vLGN) are portions of the visual thalamus implicated in circadian and visuomotor/vestibular control. A defining feature of IGL/vLGN organisation is the presence of extensive reciprocal commissural connections, the functions of which are at present unknown. Here we use a combination of multielectrode recording, electrical microstimulation, thalamic inactivation and a range of visual stimuli in mice to address this deficit. Our data indicate that, like most IGL/vLGN cells, those that project commissurally primarily convey contralateral ON visual signals while most IGL/vLGN neurons that receive this input exhibit antagonistic binocular responses (i.e. excitatory responses driven by one eye and inhibitory responses driven by the other), enabling them to encode interocular differences in irradiance. We also confirm that this property derives from commissural input since, following inactivation of the contralateral visual thalamus, these cells instead display monocular contralateral‐driven ON responses. Our data thereby reveal a fundamental role for commissural signalling in generating new visual response properties at the level of the visual thalamus.
Intrahepatic sarcomatoid cholangiocarcinoma
Authors: Sintra Sara , Costa Rui , Filipe Carlos , Simão Adélia
Published: September 2018

Sarcomatoid carcinoma is a rare tumour composed of intermingled malignant epithelial and mesenchymal cells, and it has been reported in various organs including the liver. Sarcomatoid cholangiocarcinoma (CCC) is an extremely rare liver primary tumour. Here, we report a case of an elderly man who was admitted to our hospital after head trauma. He performed a head CT that diagnosed cerebral metastasis. On abdominal CT, he presented a 10×8×9 cm-sized hypodense liver mass in the VII and VIII segments, with peripheral enhancement. Histological and immunohistochemical examination of the tumour showed a malignant neoplasm with both carcinomatous and sarcomatous components and positive expression of cytokeratin and vimentin antibodies. The patient was diagnosed with intrahepatic sarcomatoid CCC at an advanced stage and died 45 days after the diagnosis. We emphasise the importance of immunohistochemistry which may provide a clue to proper diagnosis.
Rare case of Propionibacterium acnes-related splenic abscess
Authors: Mohammed Subhan , Kollu Vidya S
Published: September 2018

A 64-year-old woman with a medical history of morbid obesity, chronic hepatitis C, essential hypertension, multiple episodes of abdominal cellulitis, diabetes mellitus type 2 on insulin, intravenous and subcutaneous drug abuse presented to the emergency department complaining of left lower chest pain for 6 weeks along with multiple episodes of vomiting. Initial laboratory data revealed leucocytosis of 17 200×103/μL with left shift. She reported multiple episodes of fever spikes. Abdominal and pelvic CT showed a splenic hypodense lesion. Specimens from interventional radiology aspiration and splenectomy grew Propionibacterium acnes. Following splenectomy, patient’s symptoms resolved. To the best of our knowledge, this would represent the fifth reported case of P. acnes splenic abscess.
Strategies to improve the implementation of policies, practices or programmes in sporting organisations targeting poor diet, physical inactivity, obesity, risky alcohol use or tobacco use: a systematic review
Authors: McFadyen Tameka , Chai Li Kheng , Wyse Rebecca , Kingsland Melanie , Yoong Sze Lin , Clinton-McHarg Tara , Bauman Adrian , Wiggers John , Rissel Chris , Williams Christopher Michael , Wolfenden Luke
Published: September 2018

Objectives

The primary aim for this review is to determine the effectiveness of strategies to improve the implementation of policies, practices or programmes in sporting organisations. The secondary aims are to describe the cost or cost-effectiveness and adverse effects of such strategies and to examine the effects of those implementation strategies on individual’s diet, physical activity, obesity, alcohol use or tobacco use.

Methods

We conducted searches of academic databases (eg, MEDLINE, EMBASE and CENTRAL), trial registers and hand searches of selected journals. Studies were included if they were conducted at a sporting venue; described a strategy to improve implementation of policies, practices or programmes focusing on one or more health risks (diet, physical inactivity, obesity, alcohol or tobacco use), and included a parallel control group. Two authors independently screened citations and extracted data. The results of included studies were synthesised narratively.

Results

Of the 5926 citations screened three studies met the inclusion criteria. Two studies were randomised controlled trials. Two studies sought to improve the implementation of nutrition-related policy and practices and one study sought to improve implementation of alcohol-related policy and practices. Each study reported improvement in at least one measure of policy or practice implementation. Two studies reported individual-level outcomes and found a reduction in excessive alcohol consumption and an increase in purchase of fruits and vegetables at the sports club ground. Two studies assessed club revenue as a potential adverse effect, neither reported significant between-group differences on these measures.

Conclusion

There is a sparse evidence base regarding the effectiveness of strategies to improve the implementation of policies, practices or programmes targeting chronic disease risk factors in sporting clubs. While all studies reported some improvements in implementation, for some multistrategic implementation strategies it is difficult to determine the extent to which such effects are generalisable.

PROSPERO registration number

CRD42016039490.
The association between mentoring and training outcomes in junior doctors in medicine: an observational study
Authors: Ong John , Swift Carla , Magill Nicholas , Ong Sharon , Day Anne , Al-Naeeb Yasseen , Shankar Arun
Published: September 2018

Objective

To determine quantitatively if a positive association exists between the mentoring of junior doctors and better training outcomes in postgraduate medical training within the UK.

Design

Observational study.

Participants

117 trainees from the East of England Deanery (non-mentored group) and the recently established Royal College of Physicians (RCP) Mentoring scheme (mentored group) who were core medical trainees (CMTs) between 2015 and 2017 completed an online survey. Trainees who received mentoring at the start of higher specialty training, incomplete responses and trainees who were a part of both the East of England deanery and RCP Mentoring scheme were excluded leaving 85 trainees in the non-mentored arm and 25 trainees in the mentored arm. Responses from a total of 110 trainees were analysed.

Main outcome measures

Pass rates of the various components of the Membership of the Royal College of Physicians (MRCP) (UK) examination (MRCP Part 1, MRCP Part 2 Written and MRCP Part 2 PACES), pass rates at the Annual Review of Competency Progression (ARCP), trainee involvement in significant events, clinical incidents or complaints and trainee feedback on career progression and confidence.

Results

Mentored trainees reported higher pass rates of the MRCP Part 1 exam versus non-mentored trainees (84.0% vs 42.4%, p<0.01). Mentored international medical graduates (IMGs) reported higher pass rates than non-mentored IMGs in the MRCP Part 2 Written exam (71.4% vs 24.0%, p<0.05). ARCP pass rates in mentored trainees were observed to be higher than non-mentored trainees (95.8% vs 69.9%, p<0.05). Rates of involvement in significant events, clinical incidents and complaints in both groups did not show any statistical difference. Mentored trainees reported higher confidence and career progression.

Conclusions

A positive association is observed between the mentoring of CMTs and better training outcomes. Further studies are needed to investigate the causative effects of mentoring in postgraduate medical training within the UK.
Are short-stem prostheses superior to conventional stem prostheses in primary total hip arthroplasty? A systematic review and meta-analysis of randomised controlled trials
Authors: Liang Hao-Dong , Yang Wei-Yi , Pan Jian-Ke , Huang He-Tao , Luo Ming-Hui , Zeng Ling-Feng , Liu Jun
Published: September 2018

Objective

Cementless total hip arthroplasty (THA) is associated with reliable clinical results and high patient satisfaction. Short-stem prostheses (SS) were designed to achieve superior preservation of proximal bone stock and stability compared with those of conventional-stem prostheses (CS). This meta-analysis was conducted to determine the proximal bone remodelling, revision rate, Harris Hip Score, radiolucent line and maximum total point motion values of both SS and CS for primary THA.

Method

Relevant randomised controlled trials (RCTs) involving SS and CS in primary THA were identified from electronic databases, such as EMBASE, PubMed and the Cochrane Library.

Result

Ultimately, 12 RCTs involving 1130 patients (1387 hips) were included. The results showed that compared with CS, SS resulted in less bone mineral density (BMD) changes in Gruen zone 7 at 1 year and 2 years postoperatively (mean difference (MD)=5.11; 95% CI, 1.61, 8.61; P=0.30; and MD=4.90; 95% CI, 1.01, 8.79; P=0.17, respectively). No difference in BMD changes was found for Gruen zone 1 (MD=2.66; 95% CI, −3.31, 8.64; P<0.00001), and no differences were observed for the revision rate (relative risk (RR)=1.52; 95% CI, 0.71, 3.26; P=0.94), Harris Hip Score (MD=−0.38; 95% CI, −1.02, 0.26; P=0.89) or stem migration (MD=0.02; 95% CI, −0.07, 0.11; P=0.04).

Conclusion

Our results suggest that compared with CS, SS may provide superior bone remodelling and similar survival rates and clinical outcomes. However, the short-term follow-up of the included studies was inadequate to determine the long-term performance of SS.
Development of the individualised Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE) trial: a protocol summary of a national cluster-randomised trial of resident duty hour policies in internal medicine
Authors: Shea Judy A , Silber Jeffrey H , Desai Sanjay V , Dinges David F , Bellini Lisa M , Tonascia James , Sternberg Alice L , Small Dylan S , Shade David M , Katz Joel Thorp , Basner Mathias , Chaiyachati Krisda H , Even-Shoshan Orit , Bates David Westfall , Volpp Kevin G , Asch David A
Published: September 2018

Introduction

Medical trainees’ duty hours have received attention globally; restrictions in Europe, New Zealand and some Canadian provinces are much lower than the 80 hours per week enforced in USA. In USA, resident duty hours have been implemented without evidence simultaneously reflecting competing concerns about patient safety and physician education. The objective is to prospectively evaluate the implications of alternative resident duty hour rules for patient safety, trainee education and intern sleep and alertness.

Methods and analysis

63 US internal medicine training programmes were randomly assigned 1:1 to the 2011 Accreditation Council for Graduate Medical Education resident duty hour rules or to rules more flexible in intern shift length and number of hours off between shifts for academic year 2015–2016. The primary outcome is calculated for each programme as the difference in 30-day mortality rate among Medicare beneficiaries with any of several prespecified principal diagnoses in the intervention year minus 30-day mortality in the preintervention year among Medicare beneficiaries with any of several prespecified principal diagnoses. Additional safety outcomes include readmission rates, prolonged length of stay and costs. Measures derived from trainees’ and faculty responses to surveys and from time-motion studies of interns compare the educational experiences of residents. Measures derived from wrist actigraphy, subjective ratings and psychomotor vigilance testing compare the sleep and alertness of interns. Differences between duty hour groups in outcomes will be assessed by intention-to-treat analyses.

Ethics and dissemination

The University of Pennsylvania Institutional Review Board (IRB) approved the protocol and served as the IRB of record for 40 programmes that agreed to sign an Institutional Affiliation Agreement. Twenty-three programmes opted for a local review process.

Trial registration number

NCT02274818; Pre-results.
Physical activity-related injuries among university students: a multicentre cross-sectional study in China
Authors: Gao Yang , Cai Weicong , Gao Lijie , Wang Jingjing , Liang Jiehui , Kwok Heather , Jia Cunxian , Li Liping
Published: September 2018

Objectives

This study aimed to investigate the epidemiological characteristics and preliminarily explore possible risk factors of physical activity-related injury (PARI) occurrences among Chinese university students via a multicentre mixed survey.

Design

Cross-sectional study.

Participants

A total of 4758 undergraduates graded 1–3 in nine universities in three Chinese cities were enrolled via cluster random sampling and completed the self-administered online questionnaires during March and April 2017.

Main outcome measures

PARI in the past 12 months.

Results

Of the 4758 participants, 1081 sustained PARI in the past 12 months, with an overall PARI incidence rate of 22.7% (27.3% (367/1343) in males and 20.9%(714/3415) in females). Around one-quarter of the injured (26.4%) suffered from PARI over at least three episodes. More than half of the injured subjects experienced physical activity (PA) absenteeism and sought medical attention. All PA indicators were significantly and positively associated with PARI, with a frequency of sports and leisure-time vigorous-intensity PA (VPA) participation being the strongest (adjusted OR: 1.079, 95% CI: 1.018 to 1.144). Moreover, males (OR=1.199), Shantou students (OR=4.239), year 1 students (OR=1.287), university and other sports team members (OR=1.717–2.360) and those with insufficient sleep time (OR=1.262–1.333) were also at a higher risk of PARI.

Conclusions

PARI is prevalent among university students in China. The frequency of sports and leisure-time VPA participation was most strongly associated with PARI among all PA indicators. These data can inform future programmes for injury intervention among university students. Safety issues should also be emphasised when promoting PA among the public to reduce PARI.
Hepatitis B virus contact disclosure and testing in Lusaka, Zambia: a mixed-methods study
Authors: Franklin Sarah , Mouliom Amina , Sinkala Edford , Kanunga Annie , Helova Anna , Dionne-Odom Jodie , Turan Janet M , Vinikoor Michael
Published: September 2018

Objectives

The aim of this study was to estimate the frequency of disclosure to and testing of contacts of patients with hepatitis B virus (HBV) in Zambia.

Design

We used a convergent parallel mixed-method research design including a quantitative survey and focus group discussions with patients with HBV.

Setting

A university hospital in Lusaka, Zambia.

Participants

79 hepatitis B surface antigen (HBsAg)-positive, HIV-negative, adults (18+ years) receiving HBV care completed a quantitative survey and 32 also participated in a focus group discussion.

Outcomes and analysis

Contacts of patients with HBV were enumerated and patient-reported disclosure, contact testing and contact HBV test results were used to develop a testing cascade. Using multivariable logistic regression, we identified factors associated with disclosure of HBV status. In focus groups, we explored how index patient knowledge and awareness of their condition shaped perspectives on contact disclosure and testing. Focus groups coding and analysis followed a thematic analysis approach.

Results

Among 79 patients with HBV (median age 35 years; 26.6% women), the majority reported disclosure to ≥1 contact. According to the index patients’ knowledge, of 776 contacts enumerated, 326 (42.1%) were disclosed to, 77 (9.9%) were tested, 67 (8.6%) received results and 8 (11.9%) were HBsAg-positive. Increased stigma score was associated with reduced disclosure. In focus groups, HBV awareness, knowledge and stigma emerged as barriers to disclosure and referral of contacts for testing. Association of HBV with HIV-related stigma was also reported as a strong barrier to contact disclosure and testing and to taking antivirals for HBV monoinfection.

Conclusions

HBV contact disclosure and testing were feasible and yielded new diagnoses in Zambia. A better understanding of barriers to seeking HBV testing and treatment is needed to scale-up this important intervention in Africa.

Trials registration number

NCT03158818.
Implementing delayed cord clamping in premature infants
Authors: Pantoja Alfonso Francisco , Ryan Ann , Feinberg Michelle , DeMarie Mark , Britton John , Liptsen Ellina , Chen Maggie , Crow Jordan
Published: September 2018

The practice of delayed cord clamping (DCC) in premature infants has proven benefit to the neonate. In a community-based perinatal centre, the practice of DCC for more than 60 s for premature infants with gestational age of <35 weeks was identified to occur infrequently at 20% in 2013. The perinatology group in conjunction with nursery, labour and delivery, and obstetric staff sought to improve adherence to the best practice of DCC for premature infants. In an effort to achieve this goal, we developed an evidence-based clinical practice guideline, included key stakeholders in its development and provided timely feedback to delivery providers about DCC performance. The frequency of DCC for this population improved from 19.5% in 2013 to 85% in 2017. The success in improving this best practice is attributed to the involvement of the multidisciplinary team who developed the guideline, and the sustained improvement was encouraged with the continued reaffirmation of DCC goals to delivery providers.
Overall survival in older patients with cancer
Authors: Edwards Beatrice J , Zhang Xiaotao , Sun Ming , Song Juhee , Khalil Peter , Karuturi Meghan Sri , Pang Linda , Geng Yunlong , Dinney Colin P , Valero Vicente , Champlin Richard E , Tripathy Debasish
Published: September 2018

Objectives

A growing number of patients with cancer are older adults. We sought to identify the predictors for overall survival (OS) in older adults with solid tumour and haematological malignancies between January 2013 and December 2016.

Methods

Retrospective cohort study. A comprehensive geriatric assessment was performed, with a median follow-up of 12.8 months. Analysis: univariate and multivariate Cox proportional hazards regression analysis.

Results

In this study, among the 455 patients with last follow-up date or date of death, 152 (33.4%) died during the follow-up. The median follow-up is 12.8 months (range 0.2–51.1 months) and the median OS is 20.5 months (range 0.3–44.5 months). Among all older patients with cancer, predictors of OS included male gender, cancer stage, malnutrition, history of smoking, heavy alcohol use, frailty, weight loss, major depression, low body weight and nursing home residence. Traditional performance scores (Eastern Cooperative Oncology Group (ECOG) and Karnofsky Performance Scale (KPS)) were predictors of OS. Independent predictors included age >85 years and haematological malignancies. Among solid tumours (n=311) in addition to the above predictors, comorbidity, gait speed and vitamin D deficiency were associated with OS.

Conclusions

We identified specific geriatric factors associated with OS in older patients with cancer, and comparable in predictive ability to traditional performance scores such as KPS and ECOG. Prospective studies will be necessary to confirm our findings.
Genome sequencing reveals a deep intronic splicing ACVRL1 mutation hotspot in Hereditary Haemorrhagic Telangiectasia
Authors: Wooderchak-Donahue Whitney L. , McDonald Jamie , Farrell Andrew , Akay Gulsen , Velinder Matt , Johnson Peter , VanSant-Webb Chad , Margraf Rebecca , Briggs Eric , Whitehead Kevin J , Thomson Jennifer , Lin Angela E , Pyeritz Reed E , Marth Gabor , Bayrak-Toydemir Pinar
Published: September 2018

Introduction

Hereditary haemorrhagic telangiectasia (HHT) is a genetically heterogeneous disorder caused by mutations in the genes ENG, ACVRL1, and SMAD4. Yet the genetic cause remains unknown for some families even after exhaustive exome analysis. We hypothesised that non-coding regions of the known HHT genes may harbour variants that disrupt splicing in these cases.

Methods

DNA from 35 individuals with clinical findings of HHT and 2 healthy controls from 13 families underwent whole genome sequencing. Additionally, 87 unrelated cases suspected to have HHT were evaluated using a custom designed next-generation sequencing panel to capture the coding and non-coding regions of ENG, ACVRL1 and SMAD4. Individuals from both groups had tested negative previously for a mutation in the coding region of known HHT genes. Samples were sequenced on a HiSeq2500 instrument and data were analysed to identify novel and rare variants.

Results

Eight cases had a novel non-coding ACVRL1 variant that disrupted splicing. One family had an ACVRL1intron 9:chromosome 3 translocation, the first reported case of a translocation causing HHT. The other seven cases had a variant located within a ~300 bp CT-rich ‘hotspot’ region of ACVRL1intron 9 that disrupted splicing.

Conclusions

Despite the difficulty of interpreting deep intronic variants, our study highlights the importance of non-coding regions in the disease mechanism of HHT, particularly the CT-rich hotspot region of ACVRL1intron 9. The addition of this region to HHT molecular diagnostic testing algorithms will improve clinical sensitivity.
Exploring gendered leadership stereotypes in a shared leadership model in healthcare: a case study
Authors: Idelji-Tehrani Saam , Al-Jawad Muna
Published: September 2018

The existing literature on leadership often describes it within fairly rigid gender roles. Entire models of leadership have been ascribed gendered labels. Shared leadership is, in traditional leadership theory, a feminine model. After observing a National Health Service (NHS) department enacting a shared leadership model, and using ethnography, grounded theory and comics-based research, we decided to explore the relationship between shared leadership and gender stereotypes. We realised our hope was to see a subversion of traditional stereotypes. Our data showed shared leadership overall as a feminine model, with its focus on distribution and compassion. Within the group, a range of gender roles were performed, meaning that the group could represent itself to the outside world as either more masculine or more feminine as required. This was beneficial, as conflict with outsiders was minimised and hence anxiety reduced. However, we noted that within the group, traditional gender roles were not subverted and were probably reinforced. Despite our view that shared leadership has not been an opportunity to resist gender stereotyping within this department, the success of this feminine model may represent a challenge to the prevailing masculine model of leadership within the NHS.