bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraspecific differences in plant defense induction by fall armyworm strains
Authors: Acevedo Flor E. , Peiffer Michelle , Ray Swayamjit , Meagher Robert , Luthe Dawn S. , Felton Gary W.
Published: January 2018

The underlying adaptive mechanisms by which insect strains are associated with specific plants are largely unknown. In this study, we investigated the role of herbivore‐induced defenses in the host plant association of fall armyworm (Spodoptera frugiperda) strains.

We tested the expression of herbivore‐induced defense‐related genes and the activity of plant‐defensive proteins in maize and Bermuda grass upon feeding by fall armyworm strains.

The rice strain caterpillars induced greater accumulation of proteinase inhibitors in maize than the corn strain caterpillars. In Bermuda grass, feeding by the corn strain suppressed induction of trypsin inhibitor activity whereas the rice strain induced greater activity levels. Differences in elicitation of these plant defenses by the two strains seems to be due to differences in the activity levels of the salivary enzyme phospholipase C. The levels of plant defense responses were negatively correlated with caterpillar growth, indicating a fitness effect.

Our results indicate that specific elicitors in the saliva of fall armyworm stains trigger differential levels of plant defense responses that affect caterpillar growth and thus may influence host plant associations in field conditions. The composition and secretion of plant defense elicitors may have a strong influence in the host plant association of insect herbivores.
How leaves of mycoheterotrophic plants evolved – from the view point of a developmental biologist
Authors: Tsukaya Hirokazu
Published: January 2018

How mycoheterotrophs have evolved and how they are sustained are enigmas. Structural analyses of the plastid genome and phylogenetic analyses of mycoheterotrophs have been used to identify mycorrhizal fungi. Molecular genetic studies have also revealed the mechanism for plant–fungi interactions. However, the evolution of the small, scale‐like vegetative leaves of mycoheterotrophs is unknown. As almost all genes determining leaf size affect the floral organ sizes, it is highly implausible that loss‐of‐function mutations in leaf size regulators caused the evolution of smaller foliage leaves in mycoheterotrophs. In this Viewpoint, possible evolutionary scenarios of scale‐like leaves in mycoheterotrophs are discussed from the perspective of developmental genetics of leaves in model plants, including: vegetative phase‐specific changes in expression of leaf size regulator(s); the change from foliage leaves to scale‐like lateral organs; and expression of suppressor(s) involved in organ development. These possibilities can be tested in future studies. This approach will provide a new research field in the developmental biology of plants.
Routine use of Day 6 and Day 7 platelets with rapid testing: two hospitals assess impact 1 year after implementation
Authors: Harm Sarah K. , Szczepiorkowski Zbigniew M. , Dunbar Nancy M.
Published: January 2018

BACKGROUND

In March 2016 the US Food and Drug Administration published a draft guidance to enhance the safety of platelets (PLTs) for transfusion. Options for hospital transfusion services include the use of rapid testing to extend apheresis PLT dating for up to 7 days. This report describes the impact of routine use of Day 6 and Day 7 PLTs at two hospital transfusion services 1 year after implementation of rapid testing for outdate extension.

STUDY DESIGN AND METHODS

PLT transfusion and inventory data were obtained from two hospital‐based transfusion services for 12 months before and 12 months after implementation of rapid testing to extend the outdate of apheresis PLTs to 7 days.

RESULTS

The outdate rate decreased from 5% to 2% (p < 0.0001) at Hospital 1 and 28% to 14% (p < 0.001) at Hospital 2 after implementation of routine use of Day 6 and Day 7 PLTs. The proportion of apheresis PLT units that underwent secondary screening for bacterial contamination before transfusion in the postimplementation period increased from 33% to 54% at Hospital 1 and from 0% to 31% at Hospital 2.

CONCLUSION

A significant decrease in outdate rate was observed after routine use of Day 6 and Day 7 PLTs. Use of rapid testing to extend PLT outdate also resulted in a larger proportion of PLTs that underwent secondary testing for bacterial contamination before transfusion. These observations demonstrate that use of rapid testing to extend apheresis PLT dating up to 7 days enhances the safety of PLTs for transfusion and decreases wastage of a limited resource.
How do I implement a whole blood program for massively bleeding patients?
Authors: Yazer Mark H. , Cap Andrew P. , Spinella Philip C. , Alarcon Louis , Triulzi Darrell J.
Published: January 2018

Building on the successful military experience, interest has been rekindled in transfusing whole blood (WB) early in the resuscitation of traumatically injured civilians, often before their ABO group is known. WB efficiently provides treatment for shock and coagulopathy, as well as platelet hemostatic function, to patients losing large volumes of blood. Unlike group O uncrossmatched red blood cells (RBCs), group O WB contains a substantial amount of plasma, which is incompatible with the RBCs of all non–group O recipients. Thus, when implementing a WB program, it is important to decide how to mitigate the risk of immune‐mediated hemolysis. Other questions that a hospital needs to answer before implementing a WB program include determining which patients will be eligible for this product, how many units eligible patients can receive, for how long it should be stored and under what conditions, and how to monitor for adverse events. The donor center needs to consider if the WB should be leukoreduced, how to comply with the AABB's transfusion‐related acute lung injury risk mitigation standard, and into which storage solution it should be collected. This report describes the multidisciplinary approach taken to implementing a civilian WB program at a multihospital health care system in the United States.
Students’ Housing in Private Universities in Nigeria: Influencing Factors and Effect on Academic Performance
Authors: Adama Joshua Ugbede , Aghimien Douglas Omoregie , Fabunmi Christopher Odunmorayo
Published: January 2018

Student housing plays an essential role in the attainment of quality education. However, there has been significant evidence as regards the inadequacy of this essential facility among public universities in Nigeria. It was further observed that there is a paucity of information as regards this situation within the private institutions in the country. Based on this background this research was conducted to assess the students’ housing in private institutions, by determining the factors influencing students’ choice of residence and its effect on their academic performance. The study adopted a survey approach, with 216 students sampled through a structured questionnaire. Data gathered were analyzed using frequency, mean item score, and Mann-Whitney U-Test. Results revealed that although gender has no relationship with students’ choice of residence, age and academic level does. The major factors influencing students’ choice of residence are: accommodation fee, quality of the environment, need for privacy, influence of friends/desire to be close to friends, and number of students within the building. The study also revealed that students’ on-campus rarely miss classes due to distance of their residence from their lecture halls, unlike their mates staying off-campus. However, they tend to miss classes as a result of inadequacy of needed facilities; a situation that is uncommon among those staying off-campus. As regards students Cumulative Grade Point Average (CGPA) as a measure of their performance, the residence of students does not have any statistical relationship with their academic grades.
Representation of National Identity in Malaysian State Mosque Built Form as a Socio- cultural Product
Authors: Ismail Alice Sabrina
Published: January 2018

The formation of national identity is the essence for a multi-racial country like Malaysia because it can strengthen national solidarity, create a common aspiration, and sustain the continuity of a historical heritage with multiple ethnicity and background. Nevertheless, the characteristics of this national identity is still not fully dealt with from an architectural aspect. Hence, the purpose of this paper is to critically examine the problem of national architectural identity in Malaysia. This is vital to uncover the resulting design principles with national architectural identity characteristics by referencing to three typologies of local state mosque as case study. The finding outlines that there are six architectural principles that influence the formation of national identity. These are the understanding of built form detail elements, materials usage, local style composition and expression, application of organic theory, designing a regionalistic articulation of space and form as well as an understanding of democratic values form to reflect the characteristics of national identity. These established referential guideline design on national identity is of benefit for future designers, builders, developer and related authority to produce built form that symbolizes nation political values as well as responsive to the existing social culture context.
Analysis of Cost of Rework on Time and Cost Performance of Building Construction Projects in Abuja, Nigeria
Authors: Chidiebere Eze Emmanuel , Idiake John Ebhohimen
Published: January 2018

Rework is a menace that leads to undesired and unnecessary loss of efforts, it degrades project cost and schedule performance of construction projects, both at design and construction phases. This study therefore, analyzed the impact of cost of rework on time and cost performance of building construction projects in Nigerian, using selected commercial building project within the country’s capital. A pro forma was adopted for gathering data on rework cost, project cost and time of selected building projects, while structured questionnaire was used to collect information on the likely measures for reducing rework incidences from construction professionals that were involved in the delivery of the identified projects. Regression analysis, relative importance index and Kruskal-Walis test were employed for data analysis. The study revealed a significant relationship between the cost of rework and initial and final project cost of delivering commercial buildings, as an average of 3.53% impact on the initial project cost, 46.60% contribution to cost overrun, and p-value of 0.000 was observed on all assessed projects. For the project delivery time, a significant relationship between the cost of rework and initial and final project duration, as an average of 7.35% impact on the initial delivery time, extra 19 days and p-value of 0.000 was observed on all assessed projects. Team building and education, management commitment, employee involvement, were some of the best possible measures to minimized rework problems.
Factors Responsible for Slow Adoption of Partnering on Construction Projects in Nigeria
Authors: Wasiu Ola-awo Adeniran , Amirudin Roslan , Alumbugu Polycarp Olaku , Abdulrahman Mukaila El-Hussain
Published: January 2018

Partnering procurement method attracted general acceptance due to potential benefits attached globally. Partnering arrangement was embraced in Nigeria, but the level of implementation is low, the stakeholders hold on to the traditional procurement in spite of its harbored problems. A study that investigated the factors responsible for the slow adoption of partnering in construction in Nigeria is rare. This paper examined factors responsible for the slow adoption of partnering in construction projects execution in Nigeria. This study was conducted using quantitative approach via self-administered questionnaires on construction practitioners (clients, contractors, and consultants) that have handled partnering projects before. The analysis was conducted using descriptive statistic, Kruskal-Walis, and factor analysis. The analysis reveals that there is an agreement in the ranking of twenty-five out of the twenty-nine factors identified. The study discovered that attitudinal and behaviors factor; lack of technical know-how; external, economic, and institutional related factor, procurement related factor, ineffective communication; unethical related issues, and lack of commitment are responsible for low level of implementation of partnering in Nigeria. The study findings would assist the practitioners and decision makers on how to achieve best results from their partnering projects. It would also lead to performance improvement which would subsequently lead to the reaping of benefits. The understanding of these factors would assist the decision maker to plan to tackle it.
Relationship between Performance of Quantity Surveying Students in Building Construction and Construction Measurement Courses
Authors: Ayinde Olatunde Nathaniel , Samuel Fawale Tolulope
Published: January 2018

Stakeholders in the educational sector over the century have devoted substantial resources in seeking ways of improving students’ academic performance, yet, the desired improved academic performance has not been achieved. By appraising the relationship between the performance of Quantity Surveying (QS) students in Building Construction and Construction Measurement courses; the study identified a major curriculum drafting deficiency in the QS programmes in Nigeria which if addressed could help achieve the much needed improved students’ academic performance. The specific objectives of the study were to determine the performance of QS students in Building construction and construction Measurement Courses; and to determine whether a relationship exist in the performances of QS students in the two subject areas. Purposive sampling technique was used to select Federal Polytechnic Ede, Osun State for the study. Random sampling technique was used to select 241 students who provide data for the study. Close ended questionnaire was used to collect data for the study and data was analyzed using frequency, percentile and correlation analysis. Finding indicates that 43% of the respondents on the average put up good performances in Building Construction Courses while only 19% of the respondents on the average had good grades in Construction Measurement Courses. Results also showed that a significant relationship exist between the performance of QS students in Building Construction and Construction Measurement courses as 83.3% (five out of six) pair courses shows significant positive linear correlation. The study recommends that a quick curriculum re-adjustment should be initiated so as to enhance improved academic performance by QS Students especially in Construction Measurement courses.
Measuring Transit Oriented Development of Existing Urban Areas around Metro Stations in Faridabad City
Authors: Pal Sat
Published: January 2018

Urban population in Indian cities is encouraging auto reliance and having unsafe economic, social and environmental consequences. Land-use-change patterns are the outcome of the complex relations between the human and the physical surroundings. To address these issues the planners are moving beyond land use planning to a sustainable development. Transit and Land use planning are important components to achieve sustainable future of urban development. TOD is a planning tool to encourage this integration. This paper discusses the land use scenario and opportunity around four Metro transit stations in Faridabad city. Different methods and various sets of indicators are considered to evaluate and measure TOD index in this study. This study will evaluate and measure the Faridabad city in the context of land use around Metro Stations to support TOD. This paper seeks to answer how to promote walkable communities, compact and transit-oriented development (TOD) that incorporates mixed land use development, including neighbourhood schools, retail and business-related space and a mix range of housing types within walkable distance. This paper concludes that the stations area which had a low TOD score needs to have policy for improvement. If planned efficiently, TODs can realize the sustainable development with considerable change in the urban development that focuses on pedestrian based neighbourhood planning.
How to Profit From Declines of Share Prices without Shorting Them
Authors: Zaremba Leszek
Published: January 2018

We present a 1-period model of the Polish financial market from the view point of the largest Polish company KGH, whose share prices declined from 119 PLN on June 1, 2015 to 68 PLN on December 2, 2015. Our goal is to show how KGHM might create portfolios (with practically zero cost), which would (almost) fully compensate these declines without, what is very important, short sale of KGHM’s shares. The presented methodology is equally suitable in any country for all those companies for which options on their shares are also tradable. We employ here a matrix model of a fraction of the Polish financial market and make use of the Black–Scholes formula to valuate 3 portfolios replicating 3 desired by KGHM, but not available on the market, financial instruments. To give more insight to the readers, we distinguish two cases. In one of them, volatility of KGHM’s share prices is 33%, and in the other case it equals 20%.
The implementation of a cystic fibrosis annual review process in a tertiary paediatric hospital
Authors: Armiento Raffaela , Ranganathan Sarath C , Harrison Joanne
Published: January 2018

We evaluated the implementation of a cystic fibrosis annual review process in a tertiary paediatric hospital. After implementation, there was demonstrated improvement in an important outcome measure—the use of inhaled mucolytic agents.
Intimate partner violence and pregnancy spacing: results from a meta-analysis of individual participant time-to-event data from 29 low-and-middle-income countries
Authors: Maxwell Lauren , Nandi Arijit , Benedetti Andrea , Devries Karen , Wagman Jennifer , García-Moreno Claudia
Published: January 2018

Introduction

Inadequately spaced pregnancies, defined as pregnancies fewer than 18 months apart, are linked to maternal, infant, and child morbidity and mortality, and adverse social, educational and economic outcomes in later life for women and children. Quantifying the relation between intimate partner violence (IPV) and women’s ability to space and time their pregnancies is an important part of understanding the burden of disease related to IPV.

Methods

We applied Cox proportional hazards models to monthly data from the Demographic and Health Surveys’ Reproductive Health Calendar to compare interpregnancy intervals for women who experienced physical, sexual and/or emotional IPV in 29 countries. We conducted a one-stage meta-analysis to identify the periods when women who experienced IPV were at the highest risk of unintended and incident pregnancy, and a two-stage meta-analysis to explore cross-country variations in the magnitude of the relation between women’s experience of IPV and pregnancy spacing.

Results

For the one-stage analysis, considering 52 959 incident pregnancies from 90 446 women, which represented 232 394 person-years at risk, women’s experience of IPV was associated with a 51% increase in the risk of pregnancy (95% CI 1.38 to 1.66), although this association decreased over time. When limiting our inference to unintended pregnancies that resulted in live births, women’s experience of IPV was associated with a 30% increase in the risk of unintended pregnancy (95% CI 1.25 to 1.34; n=13 541 pregnancies, 92 848 women, 310 319 person-years at risk). In the two-stage meta-analyses, women’s experience of IPV was associated with a 13% increase in the probability of incident pregnancy (95% CI 1.07 to 1.20) and a 28% increase in the likelihood of unintended pregnancy (95% CI 1.19 to 1.38).

Conclusions

Across countries, women’s experience of IPV is associated with a reduction in time between pregnancies and an increase in the risk of unintended pregnancy; the magnitude of this effect varied by country and over time.
Perceptions of the quality of generic medicines: implications for trust in public services within the local health system in Tumkur, India
Authors: Aivalli Praveen Kumar , Elias Maya Annie , Pati Manoj Kumar , Bhanuprakash Srinath , Munegowda Chikkagollahalli , Shroff Zubin Cyrus , Srinivas Prashanth N
Published: January 2018

Introduction

Generic medicines are an important policy option to reduce out-of-pocket expenditure on medicines. However, negative perceptions of their quality affect utilisation and raise issues of confidence and trust in medicines and health services. The aim of the study was to test the quality of generic and branded medicines and explain negative perceptions towards generic medicines.

Methods

The study was part of a larger study on access to medicines. Information on various quality parameters was collected for branded medicines and branded and unbranded generic versions of the same medicines from government and private pharmacies in Karnataka in Southern India. To assess perceptions related to quality and drivers of preferred point of care (public vs private), focus group discussions were conducted with diabetes and hypertension patients, health workers and private pharmacists. The results of the quality tests were assessed and thematic analysis was conducted on the qualitative data to develop a conceptual framework to explain perceptions of medicine and care quality in the local health system.

Results

The generic and branded variants of the medicines tested were of comparable quality. Contrary to the quality test results, patients’ and health workers’ perceptions of quality were largely in favour of branded medicines. Negative perceptions of medicine quality along with other drivers contribute towards choosing more expensive medicines in the private sector. Trust in the health system emerged as an underlying central theme that explained and drove choice of medicines and providers within the local health system.

Conclusion

Negative perceptions of generic medicines and preferential promotion of branded medicines over generics by pharmaceutical companies could influence prescriber behaviour and affect trust in healthcare provided in public services. To succeed, access to medicines programmes need to systematically invest in information on quality of medicines and develop strategies to build trust in healthcare offered in government health services.
Performance-based financing in low-income and middle-income countries: isn’t it time for a rethink?
Authors: Paul Elisabeth , Albert Lucien , Bisala Badibanga N’Sambuka , Bodson Oriane , Bonnet Emmanuel , Bossyns Paul , Colombo Sandro , De Brouwere Vincent , Dumont Alexandre , Eclou Dieudonné Sèdjro , Gyselinck Karel , Hane Fatoumata , Marchal Bruno , Meloni Remo , Noirhomme Mathieu , Noterman Jean-Pierre , Ooms Gorik , Samb Oumar Mallé , Ssengooba Freddie , Touré Laurence , Turcotte-Tremblay Anne-Marie , Van Belle Sara , Vinard Philippe , Ridde Valéry
Published: January 2018

This paper questions the view that performance-based financing (PBF) in the health sector is an effective, efficient and equitable approach to improving the performance of health systems in low-income and middle-income countries (LMICs). PBF was conceived as an open approach adapted to specific country needs, having the potential to foster system-wide reforms. However, as with many strategies and tools, there is a gap between what was planned and what is actually implemented. This paper argues that PBF as it is currently implemented in many contexts does not satisfy the promises. First, since the start of PBF implementation in LMICs, concerns have been raised on the basis of empirical evidence from different settings and disciplines that indicated the risks, cost and perverse effects. However, PBF implementation was rushed despite insufficient evidence of its effectiveness. Second, there is a lack of domestic ownership of PBF. Considering the amounts of time and money it now absorbs, and the lack of evidence of effectiveness and efficiency, PBF can be characterised as a donor fad. Third, by presenting itself as a comprehensive approach that makes it possible to address all aspects of the health system in any context, PBF monopolises attention and focuses policy dialogue on the short-term results of PBF programmes while diverting attention and resources from broader processes of change and necessary reforms. Too little care is given to system-wide and long-term effects, so that PBF can actually damage health services and systems. This paper ends by proposing entry points for alternative approaches.
Patient pain drawing is a valuable instrument in assessing the causes of exercise-induced leg pain
Authors: Rennerfelt Kajsa , Zhang Qiuxia , Karlsson Jón , Styf Jorma
Published: January 2018

Aim

We validated patientpain drawing (PPD) in establishing the diagnosis of chronic anterior compartment syndrome (CACS) in patients with exercise-induced leg pain.

Methods

The study comprised 477 consecutive patients, all suspected of having CACS. The diagnosis was based on the patient’s history, a thorough clinical examination and measurements of intramuscular pressure (IMP) following an exercise test. Patients completed a PPD before their hospital visit. Two independent orthopaedic surgeons diagnosed the causes of leg pain based only on the PPD at least 1 year after admission. Based on the results of diagnostic tests, the patients were divided into three groups: CACS (n=79), CACS with comorbidity (n=89) and non-CACS (n=306).

Results

The sensitivity of the PPD to identify CACS correctly was 67% (observer 1) and 75% (observer 2). The specificity was 65% and 54%, respectively. The interobserver agreement (n=477) was 80%, and the kappa value was 0.55. The interobserver agreement was 77%, and the kappa value was 0.48 among 168 CACS patients with or without comorbidity. The interobserver agreement was 85%, and the kappa value was 0.56 in 79 CACS, and CACS was correctly diagnosed in 79% (observer 1) and 82% (observer 2). The test–retest showed the same results for the two observers, with an intraobserver agreement of 84%, while the test–retest reliability coefficient was 0.7. Comorbidity was found in 53% of CACS patients.

Conclusion

PPD might be a valuable instrument in diagnosing the causes of exercise-induced leg pain. It is useful in identifying CACS with and without comorbidity.
Severity and pattern of injuries caused by Swiss wrestling (Schwingen): first retrospective study at a level I University Emergency Department in Switzerland
Authors: Maliachovas Nikolaos K , Klukowska-Rötzler Jolanta , Sauter Thomas C , Lehmann Beat , Krummrey Gert , Exadaktylos Aristomenis K
Published: January 2018

Background

This article addresses typical injury patterns related to the traditional Swiss folk wrestling, ‘Schwingen’. This is a fight between two competitors with its own rules, grips and throws. A variety of injuries have been occasionally reported. The aim of this study was to characterise all cases of Schwingen injuries treated in the University Hospital of Bern from January 2006 to July 2016.

Methods

To assess the frequency, type and outcome of Schwingen injuries, database search was performed of all inpatient and outpatient cases related to Schwingen that were admitted to Bern University Hospital from January 2006 to December 2016.

Results

A total of 32 such patients could be identified. Apart from a single woman, all patients were male. 31 of the 32 players were Swiss. One patient was admitted to the intermediate care unit, eight patients underwent surgery, two were hospitalised for further treatment and two were given a plaster. 17 other patients were given medications such as painkillers. One was dismissed without further treatment and another one left the hospital on his own. Typical injury patterns varied from simple lesions to distortions and fractures as well as head injuries and other neurological complications.

Conclusion

The majority of injuries caused by Schwingen are not life threatening. Nevertheless, there is always the potential of head injuries and neurological deficits. Apart from the economic loss due to treatment costs and sick leave, these injuries can be disabling for life. It should therefore be obligatory for all players to evaluate preventive measures.
Effects of an 8-week strength training intervention on tibiofemoral joint loading during landing: a cohort study
Authors: Czasche Maike B , Goodwin Jon E , Bull Anthony M J , Cleather Daniel J
Published: January 2018

Objectives

To use a musculoskeletal model of the lower limb to evaluate the effect of a strength training intervention on the muscle and joint contact forces experienced by untrained women during landing.

Methods

Sixteen untrained women between 18 and 28 years participated in this cohort study, split equally between intervention and control groups. The intervention group trained for 8 weeks targeting improvements in posterior leg strength. The mechanics of bilateral and unilateral drop landings from a 30 cm platform were recorded preintervention and postintervention, as was the isometric strength of the lower limb during a hip extension test. The internal muscle and joint contact forces were calculated using FreeBody, a musculoskeletal model.

Results

The strength of the intervention group increased by an average of 35% (P<0.05; pre: 133±36 n, post: 180±39 n), whereas the control group showed no change (pre: 152±36 n, post: 157±46 n). There were only small changes from pre-test to post-test in the kinematics and ground reaction forces during landing that were not statistically significant. Both groups exhibited a post-test increase in gluteal muscle force during landing and a lateral to medial shift in tibiofemoral joint loading in both landings. However, the magnitude of the increase in gluteal force and lateral to medial shift was significantly greater in the intervention group.

Conclusion

Strength training can promote a lateral to medial shift in tibiofemoral force (mediated by an increase in gluteal force) that is consistent with a reduction in valgus loading. This in turn could help prevent injuries that are due to abnormal knee loading such as anterior cruciate ligament ruptures, patellar dislocation and patellofemoral pain.
Is it necessary to adjust current creatine kinase reference ranges to reflect levels found in professional footballers?
Authors: Mahmutyazicioglu Jamie , Nash Julian , Cleves Andrew , Nokes Len
Published: January 2018

Objective

We aimed to explore the validity of applying current reference ranges of the enzyme creatine kinase (CK) when analysing the medical status of professional footballers and to offer a more functional CK reference range for professional footballers.

Methods

A sample of 27 professional male footballers competing in The Football League Championship was analysed. The single sample Wilcoxon signed-rank test was used to compare the CK distribution of the study group with that of a control group of military personnel reported in the literature.

Results

The median values for study group and the published control group were 284 U/L and 124 U/L, respectively (P<0.001) suggesting that the average CK activity of professional footballers is higher than that of the normal healthy military population.

Conclusion

Ethnicity, sex, age and physical exercise are factors that likely influence CK levels among various populations. From our analysis, we recommend a new 95% reference interval of 64.9 U/L to 1971.7 U/L for professional footballers.
Association between frontal plane knee control and lower extremity injuries: a prospective study on young team sport athletes
Authors: Räisänen Anu M , Pasanen Kati , Krosshaug Tron , Vasankari Tommi , Kannus Pekka , Heinonen Ari , Kujala Urho M , Avela Janne , Perttunen Jarmo , Parkkari Jari
Published: January 2018

Background/aim

Poor frontal plane knee control can manifest as increased dynamic knee valgus during athletic tasks. The purpose of this study was to investigate the association between frontal plane knee control and the risk of acute lower extremity injuries. In addition, we wanted to study if the single-leg squat (SLS) test can be used as a screening tool to identify athletes with an increased injury risk.

Methods

A total of 306 basketball and floorball players participated in the baseline SLS test and a 12-month injury registration follow-up. Acute lower extremity time-loss injuries were registered. Frontal plane knee projection angles (FPKPA) during the SLS were calculated using a two-dimensional video analysis.

Results

Athletes displaying a high FPKPA were 2.7 times more likely to sustain a lower extremity injury (adjusted OR 2.67, 95% CI 1.23 to 5.83) and 2.4 times more likely to sustain an ankle injury (OR 2.37, 95% CI 1.13 to 4.98). There was no statistically significant association between FPKPA and knee injury (OR 1.49, 95% CI 0.56 to 3.98). The receiver operating characteristic curve analyses indicated poor combined sensitivity and specificity when FPKPA was used as a screening test for lower extremity injuries (area under the curve of 0.59) and ankle injuries (area under the curve of 0.58).

Conclusions

Athletes displaying a large FPKPA in the SLS test had an elevated risk of acute lower extremity and ankle injuries. However, the SLS test is not sensitive and specific enough to be used as a screening tool for future injury risk.
Efficacy, tolerability and acceptability of oxycodone for cancer-related pain in adults: an updated Cochrane systematic review
Authors: Schmidt-Hansen Mia , Bennett Michael I , Arnold Stephanie , Bromham Nathan , Hilgart Jennifer S
Published: January 2018

Objectives

To assess the efficacy, tolerability and acceptability of oxycodone for cancer pain in adults

Methods

We searched CENTRAL, MEDLINE, MEDLINE In-Process, Embase, SCI, Conference Proceedings Citation Index-Science, BIOSIS, PsycINFO and four trials registries to November 2016.

Results

We included 23 randomised controlled trials with 2144 patients analysed for efficacy and 2363 for safety. Meta-analyses showed no significant differences between controlled-release (CR) and immediate-release oxycodone in pain intensity or adverse events but did show significantly better pain relief after treatment with CR morphine compared with CR oxycodone. However, sensitivity analysis did not corroborate this result. Meta-analyses of the adverse events showed a significantly lower risk of hallucinations after treatment with CR oxycodone compared with CR morphine, but no other differences. The remaining studies either compared oxycodone in various formulations or compared oxycodone to different alternative opioids. None found any clear superiority or inferiority of oxycodone in pain relief or adverse events. The quality of this evidence base was limited by the high/unclear risk of bias of the studies and the low event rates for many outcomes.

Conclusions

Oxycodone offers similar levels of pain relief and adverse events to other strong opioids. However, hallucinations occurred less with CR oxycodone than with CR morphine, but the quality of this evidence was very low, so this finding should be treated with utmost caution. Our conclusions are consistent with other reviews and suggest that oxycodone can be used first line as an alternative to morphine. However, because it is cheaper, morphine generally remains the first-line opioid of choice.
Changes in the legal environment and enforcement of firearm transfer laws in Pennsylvania and Maryland
Authors: Crifasi Cassandra K , Merrill-Francis Molly , Webster Daniel W , Wintemute Garen J , Vernick Jon S
Published: January 2018

The effectiveness of laws depends on circumstances affecting their enforcement. To assess such circumstances for comprehensive background check (CBC) and straw purchase laws for firearm sales, we examined prosecutions for CBC and straw purchase violations in Pennsylvania and CBC violations in Maryland. We generated pre-post variables and conducted t-tests to assess differences in the mean number of prosecutions filed following changes to the legal environments. The annual number of prosecutions for straw purchase violations increased significantly in Pennsylvania following the passage of a law that strengthened penalties for these violations (difference in means = +1310.86, P=0.003). The annual number of prosecutions for CBC violations decreased significantly in Maryland following a court decision that narrowed the definition of a firearm transfer making enforcement more difficult (difference in means = −20.52, P=0.026). Our findings suggest enforcement is likely influenced by the penalties associated with violating these laws and the interpretation of the language of the laws.
Bibliometric analysis of military trauma publications: 2000–2016
Authors: Vickers Mark L , Coorey C P , Milinovich G J , Eriksson L , Assoum M , Reade M C
Published: January 2018

Introduction

Bibliometric tools can be used to identify the authors, topics and research institutions that have made the greatest impact in a field of medicine. The aim of this research was to analyse military trauma publications over the last 16 years of armed conflict in order to highlight the most important lessons that have translated into civilian practice and military doctrine as well as identify emerging areas of importance.

Methods

A systematic search of research published between January 2000 and December 2016 was conducted using the Thompson Reuters Web of Science database. Both primary evidence and review publications were included. Results were categorised according to relevance and topic and the 30 most cited publications were reviewed in full. The h-index, impact factors, citation counts and citation analysis were used to evaluate results.

Results

A plateau in the number of annual publications on military trauma was found, as was a shift away from publications on wound and mortality epidemiology to publications on traumatic brain injury (TBI), neurosurgery or blast injury to the head. Extensive collaboration networks exist between highly contributing authors and institutions, but less collaboration between authors from different countries. The USA produced the majority of recent publications, followed by the UK, Germany and Israel.

Conclusions

In recent years, the number of publications on TBI, neurosurgery or blast injury to the head has increased. It is likely that the lessons of recent conflicts will continue to influence civilian medical practice, particularly regarding the long-term effects of blast-related TBI.
Construction of an evaluation index system for determining the academic impact of military medical scholars
Authors: Li Xuan , Hao J Y
Published: January 2018

Introduction

Academic papers are an essential manner for describing new ideas and consolidating existing concepts in the field of military medicine. The academic impact of military medical publications reflects the extent and depth of recognition, acceptance and utilisation of the concepts transmitted in these publications. The aim of this research was to construct an evaluation index system suitable for evaluating the academic influence of scholars in the field of military medicine.

Methods

Using the Delphi consensus methodology, 30 experts from the field of military medicine, military medical information and library and information science were asked during three rounds of questioning to score the feasibility and importance of indicators that could be used to determine academic impact. An analytic hierarchy process method was used to calculate the relative weighting of each indicator in determining the final level of academic impact.

Results

Eight evaluation indicators were agreed on to potentially determine academic impact. These comprised: ‘Web of Science documents’, ‘Citation impact’, ‘h-index’, ‘Percentage of international collaborations’, ‘Percentage of the top 10% of the cited frequency’, ‘Category normalised citation impact’, ‘Percentage of documents cited’ and ‘The number of F1000 Recommended papers’.

Conclusions

The evaluation index system determined from this study combines the advantages of both qualitative and quantitative recognised evaluation indicators, which are subsequently weighted according to their importance in the field of military medicine. It is hoped that this framework will provide a manner in the future for comparing the potential academic impact of military medical scholars.
Preliminary programme evaluation of the Scottish Clinical Leadership Fellowship
Authors: Pearson Andrew , Ryan Christina , MacVicar Ronald
Published: January 2018

Background

The Scottish Clinical Leadership Fellowship (SCLF) is a 1-year programme to help medical and dental specialty trainees develop as future clinical leaders for the National Health Service (NHS) in Scotland. This preliminary programme evaluation combines qualitative and quantitative data from the 2016/2017 SCLF cohort. It will lay the foundation for a future more detailed evaluation study.

Methods

Data from written reflections were combined with accounts from a residential day and results of an anonymous survey. The survey considered the various personal development activities of the SCLF and how fellows’ perspectives had changed over the year. Results were thematically analysed.

Results

The 2016/2017 cohort comprised 12 doctors. Fellows were left with highly positive views of the SCLF and their ability to influence their NHS organisation on return to practice. Personal reflections were assessed in six different themes, while the lessons fellows identified felt would shape their future clinical careers centred around personal behaviour, how fellows interacted with teams and their organisation, and improved leadership skills in general.

Conclusion

This preliminary programme evaluation is the first such exercise completed on the SCLF. The highly positive findings have helped shape the programme for the subsequent cohort and will inform a future more detailed evaluation study.
Very delayed lupus nephritis: a report of three cases and literature review
Authors: Alexandre André R , Carreira Pedro L , Isenberg David A
Published: January 2018

Lupus nephritis (LN) affects up to 50% of patients with Systemic Lupus Erythematosus (SLE) and is associated with a worse prognosis. LN usually develops within the first 5 years of the onset of the disease. We report three patients with very delayed LN (DLN) diagnosed after 15 or more years after SLE diagnosis. The three patients were non-Caucasian women with adolescent or adult-onset SLE. Each had antinuclear, anti-dsDNA and anti-Ro antibodies. Hydroxychloroquine was prescribed for each. Their disease courses were characterised by sporadic non-renal flares controlled by steroids and, in two cases, by one cycle of rituximab. Unexpectedly, they developed proteinuria, haematuria and lowering of estimated glomerular filtration rate with clinical signs of renal disease. LN was confirmed by renal biopsy. Reviewing them, each showed serological signs of increasing disease activity (rising levels of anti-dsDNA antibodies and fall in C3) that predated clinical or laboratory signs of LN by 1–3 years. Reviewing the literature, we found a lack of knowledge about DLN starting more than 15 years after SLE diagnosis. With the increasing life expectancy of patients with SLE it is likely that more cases of very DLN will emerge.
Associations between type I interferon and antiphospholipid antibody status differ between ancestral backgrounds
Authors: Iwamoto Taro , Dorschner Jessica , Jolly Meenakshi , Huang Xiangyang , Niewold Timothy B
Published: January 2018

Objective

The type I interferon pathway is activated in many patients with systemic lupus erythematosus (SLE), and anti-double-stranded DNA (dsDNA) and anti-RNA binding protein autoantibodies are correlated with high interferon-α (IFNα) activity. We studied whether antiphospholipid (APL) antibodies, which should not stimulate Toll-like receptors, are also associated with high levels of IFNα activity.

Methods

Serum IFNα activity was measured in patients with SLE using the WISH cell bioassay. IgG APL, anti-RBP and anti-dsDNA antibodies were measured in the clinical laboratory, and standard clinical cut-offs were used to define the positive results.

Results

High IFNα activity was associated with anti-RBP and anti-dsDNA antibodies in all three ancestral backgrounds. Strikingly, African-American subjects with a positive APL antibody test had higher IFNα activity than those without IgG APL antibodies. This was not shared with other ancestral backgrounds. This finding was independent of other autoantibody profiles, and clinical features did not differ between IgG APL antibody positive versus negative African-American patients.

Conclusion

The difference in association between IFNα activity and IgG APL status between ancestral backgrounds supports differences in molecular pathogenesis. This may suggest B cell hyperactivity in the setting of type I IFN in African-Americans and could suggest ways to individualise therapy.
LVIS Blue as a low porosity stent and coil adjuvant
Authors: Koch Matthew J , Stapleton Christopher J , Raymond Scott B , Williams Susan , Leslie-Mazwi Thabele M , Rabinov James David , Patel Aman B
Published: January 2018

Introduction

The LVIS Blue is an FDA-approved stent with 28% metallic coverage that is indicated for use in conjunction with coil embolization for the treatment of intracranial aneurysms. Given a porosity similar to approved flow diverters and higher than currently available intracranial stents, we sought to evaluate the effectiveness of this device for the treatment of intracranial aneurysms.

Methods

We performed an observational single-center study to evaluate initial occlusion and occlusion at 6-month follow-up for patients treated with the LVIS Blue in conjunction with coil embolization at our institution using the modified Raymond–Roy classification (mRRC), where mRRC 1 indicates complete embolization, mRRC 2 persistent opacification of the aneurysm neck, mRRC 3a filling of the aneurysm dome within coil interstices, and mRRC 3b filling of the aneurysm dome.

Results

Sixteen aneurysms were treated with the LVIS Blue device in conjunction with coil embolization with 6-month angiographic follow-up. Aneurysms were treated throughout the intracranial circulation: five proximal internal carotid artery (ICA) (ophthalmic or communicating segments), two superior cerebellar artery, two ICA terminus, two anterior communicating artery, two distal middle cerebral artery, one posterior inferior cerebellar artery, and two basilar tip aneurysms. Post-procedurally, there was one mRRC 1 closure, five mRRC 2 closures, and 10 mRRC 3a or 3b occlusion. At follow-up, all the mRRC 1 and mRRC 3a closures, 85% of the mRRC 3b closures and 75% of the mRRC 2 closures were stable or improved to an mRRC 1 or 2 at follow-up.

Conclusions

The LVIS Blue represents a safe option as a coil adjunct for endovascular embolization within both the proximal and distal anterior and posterior circulation.
Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis
Authors: DiNicolantonio James J , O’Keefe James H , Wilson William
Published: January 2018

Because serum magnesium does not reflect intracellular magnesium, the latter making up more than 99% of total body magnesium, most cases of magnesium deficiency are undiagnosed. Furthermore, because of chronic diseases, medications, decreases in food crop magnesium contents, and the availability of refined and processed foods, the vast majority of people in modern societies are at risk for magnesium deficiency. Certain individuals will need to supplement with magnesium in order to prevent suboptimal magnesium deficiency, especially if trying to obtain an optimal magnesium status to prevent chronic disease. Subclinical magnesium deficiency increases the risk of numerous types of cardiovascular disease, costs nations around the world an incalculable amount of healthcare costs and suffering, and should be considered a public health crisis. That an easy, cost-effective strategy exists to prevent and treat subclinical magnesium deficiency should provide an urgent call to action.