bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in the diet composition of fatty acids and fiber affect the lower gastrointestinal motility but have no impact on cardiovascular parameters: In vivo and in vitro studies
Authors: Mosińska Paula , Martín‐Ruiz Marta , González Antonio , López‐Miranda Visitación , Herradón Esperanza , Uranga José A. , Vera Gema , Sánchez‐Yáñez Adrián , Martín‐Fontelles Mª Isabel , Fichna Jakub , Abalo Raquel
Published: May 2019

Background

Food and diet are central issues for proper functioning of the cardiovascular (CV) system and gastrointestinal (GI) tract. We hypothesize that different types of dietary FAs affect CV parameters as well as GI motor function and visceral sensitivity.

Methods

Male Wistar rats were fed with control diet (CTRL), diet supplemented with 7% soybean oil (SOY), SOY + 3.5% virgin coconut oil (COCO), and SOY + 3.5% evening primrose oil (EP) for 4 weeks. The content of insoluble fiber in CTRL was higher than in SOY, COCO, or EP. Body weight gain and food/water intake were measured. At day 28, biometric, biochemical, CV parameters, GI motor function (X‐ray and colon bead expulsion test), and visceral sensitivity were evaluated. Changes in propulsive colonic activity were determined in vitro. The colon and adipose tissue were histologically studied; the number of mast cells (MCs) in the colon was calculated.

Results

SOY, COCO, and EP had increased body weight gain but decreased food intake vs CTRL. Water consumption, biometric, biochemical, and CV parameters were comparable between groups. SOY increased the sensitivity to colonic distention. All groups maintained regular propulsive neurogenic contractions; EP delayed colonic motility (P < 0.01). SOY, COCO, and EP displayed decreased size of the cecum, lower number and size of fecal pellets, and higher infiltration of MCs to the colon (P < 0.001).

Conclusions and Inferences

Dietary FAs supplementation and lower intake of insoluble fiber can induce changes in the motility of the lower GI tract, in vivo and in vitro, but CV function and visceral sensitivity are not generally affected.
Gender differences in management of patients undergoing catheter ablation of atrioventricular nodal reentry tachycardia
Authors: Musa Thaer , Darrat Yousef , Etaee Farshid , Butt Muhammad , Czarapata Melissa , McMullen Colleen , Mattingly Lynn , Daoud Amro , Coy Kevin , Ogunbayo Gbolahan , Delisle Brian , Elayi Claude S.
Published: May 2019

Background

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common type of supraventricular tachycardia (SVT). Similar to other cardiac tests and interventions, gender bias may influence clinical decision making in providing appropriate care for AVNRT patients. We assessed for gender differences in the diagnosis and management of AVNRT patients who underwent catheter ablation.

Methods

Patients who underwent catheter ablation for AVNRT were included. We explored the gender difference on various clinical parameters such as the time from SVT symptoms, SVT diagnosis, and first electrophysiology consult to time of catheter ablation.

Results

Among 140 patients screened, 116 patients met the inclusion criteria, including 67.2% women. Median time from symptoms onset to SVT diagnosis was 18.5 months (interquartile range [IQR] 4.0‐58.5) in women versus 4.0 months (0.75‐34.7) in men, P = .005. Once SVT was diagnosed, women took a median of 12.5 months (IQR 3.0‐57.0) to proceed with ablation versus 3.0 months (1.0‐7.0) for men, P ≤ .001. It took a longer time from the first electrophysiology consultation to ablation: 54.5 days (20.75‐144.75) for women versus 20.5 days (6.0‐46.25) for men, P = .008. Overall, it took 60.0 months (IQR 12.8‐132.0) for women to have an ablation from initial symptoms onset versus 15 months (IQR 4.6‐48.0) for men, P = .001. Prior to ablation, women had 3.78 ± 3.79 (mean ± SD) emergency department visits for SVT versus men 1.52 ± 1.72 and women tried 1.28 ± 0.82 medications versus men 0.76 ± 0.68, P < .001 and .001, respectively.

Conclusions

This study demonstrates significant and multifactorial gender‐related disparities in AVNRT diagnosis and treatment. Larger studies are needed to confirm these results.
Electrophysiological correlates of hyperoxia during resting‐state EEG in awake human subjects
Authors: Kizuk Sayeed A. D. , Vuong Wesley , MacLean Joanna E. , Dickson Clayton T. , Mathewson Kyle E.
Published: May 2019

Recreational use of concentrated oxygen has increased. Claims have been made that hyperoxic breathing can help reduce fatigue, increase alertness, and improve attentional capacities; however, few systematic studies of these potential benefits exist. Here, we examined the effects of short‐term (15 min) hyperoxia on resting states in awake human subjects by measuring spontaneous EEG activity between normoxic and hyperoxic situations, using a within‐subject design for both eyes‐opened and eyes‐closed conditions. We also measured respiration rate, heart rate, and blood oxygen saturation levels to correlate basic physiological changes due to the hyperoxic challenge with any brain activity changes. Our results show that breathing short‐term 100% oxygen led to increased blood oxygen saturation levels, decreased heart rate, and a slight, but nonsignificant, decrease in breathing rate. Changes of brain activity were apparent, including decreases in low‐alpha (7–10 Hz), high‐alpha (10–14 Hz), beta (14–30 Hz), and gamma (30–50 Hz) frequency ranges during eyes‐opened hyperoxic conditions. During eyes‐closed hyperoxia, increases in the delta (0.5–3.5 Hz) and theta (3.5–7 Hz) frequency range were apparent together with decreases in the beta range. Hyperoxia appeared to accentuate the decrease of low alpha and gamma ranges across the eyes‐opened and eyes‐closed conditions, suggesting that it modulated brain state itself. As decreased alpha during eyes‐opened conditions has been associated with increased attentional processing and selective attention, and increased delta and theta during eyes‐closed condition are typically associated with the initiation of sleep, our results suggest a state‐specific and perhaps opposing influence of short‐term hyperoxia.
Effect of cumulus cell removal and sperm pre‐incubation with progesterone on in vitro fertilization of equine gametes in the presence of oviductal fluid or cells
Authors: Moros‐Nicolás Carla , Douet Cécile , Reigner Fabrice , Goudet Ghylène
Published: May 2019

In spite of many attempts to establish an in vitro fertilization (IVF) technique in the equine, no efficient conventional IVF technique is available. The presence of oviductal fluid or oviductal cells during IVF helps to improve embryo production in vitro but is not sufficient to reach high fertilization rates. Thus, our aim was to perform equine IVF either after sperm pre‐incubation with oviductal fluid or in the presence of oviductal cells, and to evaluate the effect of cumulus removal from the oocyte or sperm pre‐incubation with progesterone. In experiments 1 and 2, IVF was performed in the presence of porcine oviduct epithelial cells. The removal of cumulus cells from equine oocytes after in vitro maturation tended to increase the percentage of fertilization when fresh sperm was used (1/33 vs. 4/31,p > 0.05) but had no effect when frozen sperm was used (1/32 vs. 1/32). Equine sperm pre‐incubation with progesterone did not significantly influence the fertilization rate when fresh or frozen sperm was used (2/14 vs. 2/18 for fresh, 1/29 vs. 1/25 for frozen). In experiments 3 and 4, IVF was performed after pre‐incubation of sperm with porcine oviductal fluid. The removal of cumulus cells tended to increase the percentage of fertilization when fresh sperm was used (1/24 vs. 3/26,p > 0.05). Sperm pre‐incubation with progesterone did not significantly influence the fertilization rate when fresh or frozen sperm was used (2/39 vs. 2/36 for fresh, 2/37 vs. 1/46 for frozen), but two 3–4 cell stage zygotes were obtained with fresh sperm pre‐incubated with progesterone. This is an encouraging result for the setting up of an efficient IVF procedure in equine.
Use of a cervical stent for long‐term treatment of pyometra in the mare: A report of three cases
Authors: Krohn Judith , Ennen Sophia , Hospes Rainer , Nieth Jennifer , Wehrend Axel
Published: May 2019

An effective long‐term treatment is necessary for mares with pyometra, because the condition tends to recur. In many affected animals, several conformational or anatomical anomalies contribute to impaired uterine clearance. Ovariohysterectomy is the surgical procedure of choice. Conservative therapy consists of draining and flushing the uterus, and systemic anti‐inflammatory and antimicrobial treatment. Uterine secretions tend to accumulate again after local treatment, especially in mares with poor vaginal conformation or cervical adhesions. Herein, we describe three cases in which a cervical stent was used in mares after mechanical or manual dilation of the cervix to achieve permanent draining of the uterus. The mares remained symptom‐free for up to 6 years and exhibited good clinical progress and good performance in competitions. Potential complications of the procedure include loss of the stent and obstruction caused by viscous secretion. A cervical stent is a relatively easy and low‐cost option for the long‐term treatment of pyometra in mares, particularly in cases where excessive costs of surgery and risks of a general anaesthesia are to be avoided.
Association between epilepsy and oral maxillofacial trauma: A systematic review and meta‐analysis
Authors: Moreira Falci Saulo Gabriel , Duarte‐Rodrigues Lucas , Primo‐Miranda Ednele Fabyene , Furtado Gonçalves Patrícia , Lanza Galvão Endi
Published: May 2019

A systematic literature search was conducted (through April 2017), using Web of Science, PubMed and Virtual Health Library, manual reference list, and grey literature searches. The quality of the studies was evaluated using the Newcastle‐Ottawa Quality Assessment Scale. The meta‐analysis was performed using R software. A total of 30 studies was included in this review. From a total of 25 studies included in the meta‐analysis, the prevalence of oral and maxillofacial injuries among epileptic subjects was 19%. Among the epileptic patients who suffered some type of injury due to epileptic seizures, 52% had facial soft tissue injuries (95%CI: 28‐75%), 18% suffered dental trauma (95%CI: 11‐29%), and 12% (95%CI: 4‐28%) suffered maxillofacial fractures. Epileptic patients were more likely to have oral and maxillofacial injuries than healthy individuals (OR: 5.22, 95%CI: 2.84‐9.36) and subjects with psychogenic nonepileptic seizures (OR: 2.77, 95%CI: 1.28‐5.99), but not than patients with special needs (OR: 2.45,95%CI: 0.95‐6.31).
Hemocompatibility of different burn wound dressings
Authors: Denzinger Markus , Held Manuel , Scheffler Hanna , Haag Hanna , Nussler Andreas K. , Wendel Hans Peter , Schlensak Christian , Daigeler Adrien , Krajewski Stefanie
Published: May 2019

A variety of wound dressing are available for burns. Furthermore, although their impacts on wound healing have been studied sufficiently, their effects on blood remain unclear. Meanwhile, this aspect is extremely important, since blood interacts with the wound dressing, especially in extensive burn injuries. Therefore, the aim of this study is to evaluate the hemocompatibility and immunogenicity of different burn wound dressings. Accordingly, human whole blood (n= 5) was anticoagulated with heparin, treated with different wound dressings and incubated at 37°C for 30 minutes. Different parameters for coagulation and hemocompatibility were evaluated before and after incubation. Consequently, Jelonet, Xenoderm, and Matriderm showed higher TAT‐III concentrations, Jelonet, Xenoderm, EZ Derm, and Matriderm were higher β‐thromboglobulin; EZ Derm and Burntec showed higher SC5b‐9 concentrations after incubation with whole blood. Our ex vivo study provided initial insights into the hemocompatibility and immunogenicity of different burn wound dressings. Moreover, Xenografts (Xenoderm and EZ Derm), Jelonet and Matriderm showed a hemostyptic effect, while EZ Derm and Burntec activated the complement system. Therefore, further studies must be conducted to analyze the possible effects in vivo.
Reviewer Acknowledgements
Authors: Willianms Ellery
Published: May 2019

Business and Management Studies (BMS) would like to acknowledge the following reviewers for their assistance with peer review of manuscripts for this issue. Many authors, regardless of whether BMS publishes their work, appreciate the helpful feedback provided by the reviewers. Their comments and suggestions were of great help to the authors in improving the quality of their papers. Each of the reviewers listed below returned at least one review for this issue. Reviewers for Volume 5, Number 2 Andrzej Niemiec, Poznań University of Economics and Business, PolandAshford Chea, Benedict College, USAAthina Qendro, Robert Gordon University, UKDalia Susniene, Kaunas University of Technology, LithuaniaDereje Teklemariam Gebremeskel, Gent University, BelgiumFábio Albergaria de Queiroz, Catholic University of Brasília, BrazilFlorin Peci, University of Peja, KosovoFouad Jawab, Universite Sidi Mohamed Ben, MoroccoFuLi Zhou, Zhengzhou University of Light Industry, ChinaGabriela O. Chiciudean, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, RomaniaHung-Che Wu, Nanfang College of Sun Yat-sen University, ChinaIulia Cristina Muresan, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, RomaniaJason Caudill, King University, USAJayalakshmy Ramachandran, Multimedia University, MalaysiaKherchi Ishak, UHBC University, AlgeriaLucie Andreisová, University of Economics in Prague, CzechMarica Ion Dumitrasco, Academy of Sciences of Moldova, MoldovaMichael Okoche, University of South Africa, UgandaMike Rayner, University of Portsmouth, UKMr. Abdul-Kahar Adam, University of Education, Winneba, GhanaMythili Kolluru, College of Banking and Financial Studies, OmanNalina Ganapathi, International Labour Office, SwitzerlandOksana Seroka-Stolka, Technical University of Czestochowa, PolandRaimundo Lima Filho, University of State of Bahia, BrazilRashedul Hasan, International Islamic University Malaysia, MalaysiaRocsana Tonis, Spiru Haret University, RomaniaSammy Kimunguyi, Office of The Auditor-General, KenyaSandeep Kumar , Tecnia Institute of Advanced Studies, Affiliated to GGSIP University Delgi, IndiaZeki Atıl Bulut, Dokuz Eylul University, TurkeyZoran Mastilo, University of East Sarajevo, Bosnia and Herzegovina   Ellery WillianmsEditorial AssistantOn behalf of,The Editorial Board of Business and Management StudiesRedfame Publishing9450 SW Gemini Dr. #99416Beaverton, OR 97008, USAURL: http://bms.redfame.com
Simple zeros of automorphic -functions
Authors: Booker Andrew R. , Cho Peter J. , Kim Myoungil
Published: May 2019

We prove that the complete $L$-function associated to any cuspidal automorphic representation of $\operatorname{GL}_{2}(\mathbb{A}_{\mathbb{Q}})$ has infinitely many simple zeros.
Behavioral economic insights to improve medication adherence in adults with chronic conditions: a scoping review protocol
Authors: Roseleur Jacqueline , Harvey Gillian , Stocks Nigel , Karnon Jonathan
Published: May 2019

Objective:

The objective of this review is to map the evidence on the use of behavioral economic insights to improve medication adherence in adults with chronic conditions.

Introduction:

Medication non-adherence is a barrier to effectively managing chronic conditions, leading to poorer patient outcomes and placing an additional financial burden on healthcare systems. As the population ages and the prevalence of chronic disease increases, new ways to influence patient behavior are needed. Approaches that use insights from behavioral economics may help improve medication adherence, thus reducing morbidity, mortality and financial costs of unmanaged chronic diseases.

Inclusion criteria:

Eligible studies will include adults taking medication for a chronic condition. All interventions relevant to high-income settings using insights from behavioral economics to improve medication adherence in adults will be considered. Contexts may include, but are not limited to, primary health care, corporate wellness programs and health insurance schemes. Any study design published in English will be considered. Studies in facilities where medication is administered to patients will be excluded.

Methods:

PubMed, Embase, Scopus, PsycINFO, EconLit and CINAHL will be searched from database inception to present. Gray literature will be searched using Google Scholar, OpenGrey and the Grey Literature Report. One reviewer will review titles, and then two reviewers will independently review abstracts to identify eligible studies. One reviewer will extract data on study characteristics, study design and study outcomes. A second reviewer will validate 25% of the extracted information. The results of the data extraction will be presented in a table, and a narrative summary will be presented.
Repetitive transcranial magnetic stimulation recovers cortical map plasticity induced by sensory deprivation due to deafferentiation
Authors: Kloosterboer Ellen , Funke Klaus
Published: May 2019

Key points

Partial sensory deprivation (deafferentation) by removing whiskers from the rat snout resulted in a reduced responsiveness of related cortical representations.

Repetitive transcranial magnetic stimulation (three blocks of intermittent theta‐burst) applied for 5 days in combination with sensory exploration restored the normal responsiveness level of the deafferented barrel cortex.

However, intracortical inhibition (lateral and recurrent) appeared to be reduced after repetitive transcranial magnetic stimulation, probably as the cause of improved responsiveness.

Repetitive transcranial magnetic stimulation also reduced the asymmetry of the lateral spread of sensory activity.

Repetitive transcranial magnetic stimulation (rTMS) modulates human cortical excitability. It has the potential to support recovery to normal cortical function when the excitation–inhibition balance is altered (e.g. after a stroke or loss of sensory input). We tested cortical map plasticity on the basis of sensory responses (local field potentials, LFPs) and expression of neuronal activity marker proteins within the barrel cortex of rats receiving either active or sham rTMS after selective unilateral deafferentation by whiskers plucking. Rats received daily rTMS [intermittent theta‐burst (iTBS), active or sham] for 5 days before exploring an enriched environment. Our previous studies indicated a disinhibitory effect of iTBS on cortical activity. Therefore, we also expected disinhibitory effects if deafferentation causes depression of sensory responses. Deafferentation resulted in an acute general reduction of sensory responsiveness and enhanced expression of inhibitory activity markers (GAD67, parvalbumin) in the deafferented hemisphere. Active but not sham‐iTBS‐rTMS normalized these measures. The stronger caudal‐to‐frontal horizontal spread of activity across barrels was reduced after deafferentation but not restored after active iTBS, despite generally increased responses. Fitting the LFP data with a computational model of different strengths and types of excitatory and inhibitory connections further revealed an iTBS‐induced reduction of lateral and recurrent inhibition as the most probable scenario. Whether the disinhibitory effect of iTBS for the restoration of normal cortical function in the acute phase of depression after deafferentiation is also beneficial in humans remains to be demonstrated. As recently discussed, disinhibition appears to be required to open a window for neuronal plasticity.
Effects of Extended Jet Holes to Heat Transfer and Flow Characteristics of the Jet Impingement Cooling
Authors: Tepe Ahmet Ümit , Arslan Kamil , Yetişken Yaşar , Uysal Ünal
Published: May 2019

In this study, effects of extended jet holes to heat transfer and flow characteristics of jet impingement cooling were numerically investigated. Cross-flow in the impinging jet cooling adversely affects the heat transfer on the target surface. The main purpose of this study is to reduce the negative effect of cross-flow on heat transfer by extending jet holes toward the target surface with nozzles. This study has been conducted under turbulent flow condition (15,000 ≤ Re  ≤  45,000). The surface of the turbine blade, which is the target surface, has been modeled as a flat plate. The effect of the ribs, placed on the target surface, on the heat transfer has been also investigated, and the results were compared with the flat surface. The parameters such as average and local Nusselt numbers on the target surface, flow characteristics, and compressor power have been examined in detail. It was obtained from the numerical results that the average Nusselt number increases with decreasing the gap between the target surface and the nozzle. In addition, the higher average Nusselt number was obtained on the flat surface than the ribbed surface. The lowest compressor power was achieved in the 5Dj nozzle gap for the flat surface and in the 4Dj nozzle gap for the ribbed surface.
Trajectory Control and Sensitivity Analysis of Curiosity Rover on Uneven Terrains
Authors: Tashakori Shiva , Kasiri Bidhendi Saleh , Mashadi Behrooz , Marzbanrad Javad
Published: May 2019

In this paper, the six-wheel lunar rover is simulated in Adams/View software environment and then via co-simulation between adams and matlab/simulink with which a path-following controller is designed and implemented on the rocker-bogie mechanism. The proposed algorithm consists of three parts. First, the inverse kinematic equations are used to transform the trajectory into appropriate desired values. Second, a sliding mode controller (SMC) is designed which used the desired values to control the motion of the robot. Moreover, disturbances are taken into consideration to minimize the lateral error. In order to investigate the proposed integrated algorithm, the analysis of rover traversability on the uneven surface of the moon is performed in two different states, namely by considering the motion restrictions of the rocker-bogie mechanisms and by increasing the rover speed, body yaw angle, and also obstacle height in crossing the rough terrain. Investigation of the rover in different states has given insight on the performance of the proposed controller at limits of mobility of the robot. Finally, to reduce the battery energy consumption, input torques proportional to the load on the wheels are produced. The values of the deviations from the desired path and velocity in all the mentioned analyses indicate the effectiveness of the SMC.
Pharyngeal flow simulations during sibilant sound in a patient-specific model with velopharyngeal insufficiency
Authors: Sundström Elias , Oren Liran
Published: May 2019

Dysfunction of the velopharyngeal valve in the human airway causes speech disorders because there is no separation between the oral and nasal cavities during normal oral speech. The speech literature hypothesizes that undesired sound is formed by turbulent flow in the nasal cavity in cases of small velopharyngeal openings. The aim is to determine the flow behavior and the sound-generating mechanism in the vocal tract using computational fluid dynamics in two patient-specific models with small and large velopharyngeal openings and contrast it with cases of complete velopharyngeal closure. The geometry for the models was reconstructed from computed tomography scans that were taken while the patients were sustaining a sibilant sound. The results for the turbulence are correlated with the broadband acoustic models of Proudman and Curle. The models show that turbulence in the vocal tract increases downstream of a constriction and that sound may be generated from it. Furthermore, most of the sound due to turbulence in the nasal cavity is governed by a dipole source where turbulence interacts with the nasal cavity walls. The generated sound power by turbulence itself in the nasal cavity (the quadrupole source) is two orders of magnitude less than the dipole source.
Making Settler Colonialism Visible in Sport Management
Authors: Chen Chen , Mason Daniel S.
Published: May 2019

This study discusses how an epistemological shift—explicitly acknowledging the embedded position of the sport management field in settler colonial societies and its effect on knowledge production therein—is necessary for the field to mobilize social change that problematizes and challenges ongoing settler colonialism. Reviewing previous research examining social change in sport management, the authors then argue that settler colonialism, a condition that underlies some nation-states that produce leading sport management knowledge—the United States, Canada, Australia, and New Zealand—should no longer remain invisible in our research. Drawing upon Indigenous Studies, Settler Colonial Studies, and sport-related work from other social science disciplines, the authors contextualize the position of non-Indigenous scholars and then address three questions that highlight the relevance of settler colonialism to sport management research. They conclude with a discussion on possible ways in which settler colonialism can be visibilized and thus challenged by non-Indigenous scholars.
Jumping gene gave fish a freshwater start
Authors: Weber Jesse N. , Tong Wenfei
Published: May 2019

Fish diversification depended on multiple copies of a metabolic gene
Nonnucleoside Reverse Transcriptase Inhibitor Hypersusceptibility and Resistance by Mutation of Residue 181 in HIV-1 Reverse Transcriptase
Authors: Barnard John P. , Huber Kelly D. , Sluis-Cremer Nicolas
Published: May 2019

Substitutions at residue Y181 in HIV-1 reverse transcriptase (RT), in particular, Y181C, Y181I, and Y181V, are associated with nonnucleoside RT inhibitor (NNRTI) cross-resistance. In this study, we used kinetic and thermodynamic approaches, in addition to molecular modeling, to gain insight into the mechanisms by which these substitutions confer resistance to nevirapine (NVP), efavirenz (EFV), and rilpivirine (RPV).
Unusual presentation of pica in iron-deficiency anaemia associated with primary biliary cholangitis
Authors: Onuorah Nneoma Kate-Joan , Wayde Melinda , Beck Gregory
Published: May 2019

A 50-year-old woman presented with worsening fatigue and shortness of breath. For 2 months, she has been having increased craving for unpeeled lemons and was seen in clinic about a month prior to presentation at the emergency room. At that time, she was asymptomatic except for endorsing craving for lemons. Physical exam findings at presentation noted obesity, sinus tachycardia, pallor, mild scleral jaundice and no other stigmata for chronic liver disease. Her labs suggested iron-deficiency anaemia (IDA), elevated liver enzymes and positive antimitochondrial antibody titre. Abdominal ultrasound and CT scan showed mild scarring. She was diagnosed with primary biliary cholangitis with portal hypertension complicated by oesophageal varices and IDA. Interventions included blood transfusion, oesophageal banding and treatment with ursodeoxycholic acid. Her craving for lemons, shortness of breath and fatigue resolved within 1 week. With ongoing outpatient follow-up and oesophageal variceal surveillance, she continues to do well.
Medical assessment of potential concussion in elite football: video analysis of the 2016 UEFA European championship
Authors: Abraham Karan Joshua , Casey Julia , Subotic Arsenije , Tarzi Christopher , Zhu Alice , Cusimano Michael D
Published: May 2019

Objective

The objective is to determine if suspected concussions in elite football are medically assessed according to the International Conferences on Concussion in Sport consensus statement recommendations.

Setting

Men’s Union of European Football Association (UEFA) Football Championship.

Participants

All professional football players in the UEFA 2016 Championship Tournament.

Design

Observational study.

Outcome measures

Potential concussive events (PCEs) were defined as direct head collision incidents resulting in the athlete being unable to immediately resume play following impact. PCEs identified and description of PCE assessment and outcome were accomplished through direct standardised observation of video footage by trained observers in 51 games played in the Men’s UEFA European Championship (10 June–10 July 2016).

Results

Sixty-nine total PCEs (1.35 per match) were identified in 51 games played during the 2016 Men’s UEFA European Championship. Forty-eight PCEs (69.6%) resulted in two observable signs of concussion, 13 (18.8%) resulted in three signs and 1 (1.4%) resulted in four signs in the injured athletes. Nineteen (27.5%) PCEs were medically assessed by sideline healthcare personnel while 50 (72.5%) were not. Of the 50 PCEs that were not medically assessed, 44 (88%) PCEs resulted in two or more signs of concussion among injured athletes. Of the 19 medically assessed PCEs, 8 resulted in 3 signs of concussion, and 1 resulted in 4 signs; all assessments concluded in the same-game return for the injured athletes.

Conclusions

PCEs were frequent events in the 2016 UEFA Euro championship, but were rarely assessed concordant with the International Conferences on Concussion in Sport consensus statement recommendations. There is an imperative need to improve the assessment and management of players suspected of concussion in elite football.
Effects of yoga on well-being and healthy ageing: study protocol for a randomised controlled trial (FitForAge)
Authors: Östh Josefine , Diwan Vinod , Jirwe Maria , Diwan Vishal , Choudhary Anita , Mahadik Vijay Khanderao , Pascoe Michaela , Hallgren Mats
Published: May 2019

Introduction

Due to ageing populations worldwide, the burden of disability is increasing. It is therefore important to develop interventions that improve healthy ageing, reduce disability onset and enhance life quality. Physical activity can promote healthy ageing and help maintain independence, yet many older adults are inactive. Yoga is a form of physical activity that aims to improve health and may be particularly suitable for older adults. Research indicates positive effects of yoga on several health-related outcomes; however, empirical studies examining the benefits of yoga on well-being among the elderly remain scarce. This study protocol reports the methodology for a 12-week yoga programme aimed to improve health and well-being among physically inactive older adults.

Methods and analysis

Three group parallel, single-blind randomised controlled trial. Two comparison groups are included: aerobic exercise and a non-active wait-list control. In total, 180 participants aged 65–85 years will be recruited. Assessments will be performed at baseline and postintervention (12-week follow-up). The primary outcome is subjective well-being. Secondary outcomes include physical activity/sedentary behaviour, mobility/fall risk, cognition, depression, anxiety, mood, stress, pain, sleep quality, social support and cardiometabolic risk factors. Data will be analysed using intention-to-treat analyses, with mixed linear modelling.

Ethics and dissemination

This study is approved by the Ethical Review Board in Stockholm (2017/1862-31/2). All participants must voluntarily agree to participate and are free to withdraw from the study at any point. Written informed consent will be obtained from each participant prior to inclusion. Results will be available through research articles and conferences. A summary of key results will be publicly available through newspaper articles.

Trial registration number

DRKS00015093, U1111-1217-4248
Comparison of the safety and efficacy between linear stapler and circular stapler in totally laparoscopic total gastrectomy: protocol for a systematic review and meta-analysis
Authors: Liao Tianyou , Deng Leilei , Yao Xueqing , Ouyang Manzhao
Published: May 2019

Introduction

Total gastrectomy is often recommended for upper body gastric cancer, and totally laparoscopic total gastrectomy (TLTG) is deemed to be a promising surgical method with the well-known advantages such as less invasion and fast recovery. However, the anastomosis between oesophagus and jejunum is the difficulty of TLTG. Although staplers have promoted the development of TLTG, the choice of suitable staplers to complete oesophagojejunostomy is controversial and unclear. Therefore, a higher level of research evidence is needed to compare the two types of staplers in terms of safety and efficacy for oesophagojejunostomy in TLTG among patients with gastric cancer.

Methods and analysis

PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Databases will be comprehensively searched from January 1990 to July 2019. All eligible randomised controlled trials (RCTs), non-RCTs or observational studies comparing the two types of staplers will be included. A meta-analysis will be performed using Review Manager V.5.3 software to compare the safety and efficacy of linear and circular staplers for oesophagojejunostomy in TLTG. The primary outcomes are anastomotic leakage, anastomotic stricture, anastomotic haemorrhage. The secondary outcomes include time to first instance of passing gas after surgery, first feeding time, total operation time, reconstruction time, estimated blood loss. The heterogeneity of this study will be assessed by p values and I2statistic. Subgroup analyses and sensitivity analyses will be used to explore and explain the heterogeneity. The risk of bias will be assessed using the Cochrane tool or the Newcastle-Ottawa Quality Assessment Scale.

Ethics and dissemination

Ethical approval will not be required because this proposed systematic review and meta-analysis is based on previously published data, which does not include intervention data on patients. The findings of this study will be submitted to a peer-reviewed journal and will be presented at a relevant congress.

PROSPERO registration number

CRD42018111680.
Initiation and completion rates of isoniazid preventive therapy among people living with HIV in Far-Western Region of Nepal: a retrospective cohort study
Authors: Dhungana Govinda Prasad , Thekkur Pruthu , Chinnakali Palanivel , Bhatta Usha , Pandey Basudev , Zhang Wei-Hong
Published: May 2019

Objectives

Isoniazid preventive therapy (IPT), for people living with HIV (PLHIV) is the proven and recommended intervention to avert tuberculosis (TB). In 2015, Nepal implemented 6 months of IPT for all PLHIV registered for HIV care in antiretroviral therapy (ART) centres. After programmatic implementation, there has been no systematic assessment of IPT initiation and completion rates among PLHIV. We aimed to assess IPT initiation and completion rates in the Far-Western Region (FWR) of Nepal.

Design

We conducted a retrospective cohort study using secondary data extracted from registers maintained at ART centres.

Setting

All 11 ART centres in the FWR of Nepal.

Participants

All PLHIV registered for care between January 2016 and December 2017 in 11 ART centres.

Primary outcome measures

IPT initiation and completion rates were summarised as percentages with 95% CI. Independent association between patient characteristics and non-initiation of IPT was assessed using cluster-adjusted generalised linear model (log binomial regression) and adjusted relative risk (RR) with 95% CI was calculated.

Result

Of the 492 PLHIV included, 477 (97.0%) did not have active TB at registration. Among 477 without active TB, 141 (29.8%, 95% CI 25.7% to 34.1%) had been initiated on IPT and 85 (17.8%) were initiated within 3 months of registration. Of 141 initiated on IPT, 133 (94.3%, 95% CI 89.1% to 97.5%) had completed 6 months of IPT. Being more than 60 years of age (RR-1.3, 95% CI 1.1 to 1.7), migrant worker (RR-1.3, 95% CI 1.1 to 1.4) and not being initiated on ART (RR-1.4, 95% CI 1.1 to 1.8) were significantly associated with IPT initiation.

Conclusions

In FWR of Nepal, three out of 10 eligible PLHIV had received IPT. Among those who have received IPT, the completion rate was good. The HIV care programme needs to explore the potential reasons for this low coverage and take context specific corrective action to fix this gap.
Health costs and efficiencies of patient-specific and single-use instrumentation in total knee arthroplasty: a randomised controlled trial
Authors: Attard Andre , Tawy Gwenllian Fflur , Simons Michiel , Riches Philip , Rowe Philip , Biant Leela C
Published: May 2019

Aim

To investigate whether patient-specific instrumentation (PSI) and single-use instrumentation (SUI) improve operating room efficiency in terms of time and cost to the healthcare provider over conventional/reusable instrumentation (CVR) when performing total knee arthroplasty (TKA).

Patients and methods

Patients requiring TKA were randomised into one of four surgical groups: CVR, CVS (conventional/SUI), PSR (PSI/reusable) and PSS (PSI/SUI). All surgical procedures were video recorded to determine specific surgical time intervals. Other variables reported included the number of instrument trays used, missing equipment, direct instrument costs and the weight of the instruments the staff had to handle. Oxford Knee Score (OKS), estimated blood loss and lengths of hospital stay were also recorded as markers of patient experience.

Results

PSR was significantly quicker in all the recorded time intervals, used less trays, experienced less missing equipment and resulted in lower blood loss and shorter hospital stays. SUI reported significantly slower operating room times and resulted in higher blood loss, but SUI was 88% lighter and 20% cheaper on average when compared with their reusable counterparts. Despite the economic advantages of PSI and SUI, the patients who reported greatest improvements in OKS were those allocated to the CVR group, but no clinically meaningful difference in OKS was found at any time point.

Conclusions

PSI and SUI for TKA have the potential of reducing operating room times over conventional, reusable sets. This reduction will benefit theatre personnel ergonomically, while presenting the healthcare provider with potential cost-saving benefits in terms of reduced sterilisation costs and surgical times.
Disrupting activities in quality improvement initiatives: a qualitative case study of the QuICR Door-To-Needle initiative
Authors: Huq Jo-Louise , Woiceshyn Jaana
Published: May 2019

Background

Healthcare quality improvement (QI) efforts are ongoing but often create modest improvement. While knowledge about factors, tools and processes that encourage QI is growing, research has not attended to the need to disrupt established ways of working to facilitate QI efforts.

Objective

To examine how a QI initiative can disrupt professionals’ established way of working through a study of the Alberta Stroke Quality Improvement and Clinical Research (QuICR) Door-to-Needle Initiative.

Design

A multisite, qualitative case study, with data collected through semistructured interviews and focus groups. Inductive data analysis allowed findings to emerge from the data and supported the generation of new insights.

Findings

In stroke centres where improvements were realised, professionals’ established understanding of the clinical problem and their belief in the adequacy of existing treatment approaches shifted—they no longer believed that their established understanding and treating the clinical problem were appropriate. This shift occurred as participants engaged in specific activities to improve quality. We identify these activities as ones that create urgency, draw professionals away from regular work and encourage questioning about established processes. These activities constituted disrupting action in which both clinical and non-clinical persons were engaged.

Conclusions

Disrupting action is an important yet understudied element of QI. Disrupting action can be used to create gaps in established ways of working and may help encourage professionals’ involvement and support of QI efforts. While non-clinical professionals can be involved in disrupting action, it needs to engage clinical professionals on their own terms.
Periprocedural complications of second-generation flow diverter treatment using Pipeline Flex for unruptured intracranial aneurysms: a systematic review and meta-analysis
Authors: Bhatia Kartik Dev , Kortman Hans , Orru Emanuele , Klostranec Jesse M , Pereira Vitor M , Krings Timo
Published: May 2019

Background

Flow diverters are a breakthrough treatment for large and giant intracranial aneurysms but carry a risk of periprocedural death or major stroke. Pipeline Flex is a second-generation device that is thought to have lower complication rates because of improvements in the delivery system as well as increased operator experience. Our objective was to analyze the risk of periprocedural death or major complications using Pipeline Flex for unruptured intracranial aneurysms.

Methods

A systematic search of three databases was performed for studies of ≥10 treatments using Pipeline Flex for unruptured intracranial aneurysms (2014–2019) using PRISMA guidelines. Random effects meta-analysis was used to pool the rates of periprocedural (<30 days) death, major ischemic stroke, symptomatic intracranial hemorrhage, and minor stroke/transient ischemic attack.

Results

We included eight studies reporting 901 treatments in 879 patients. Periprocedural mortality (<30 days) was 0.8% (5/901; 95% CI 0.4% to 1.5%; I2=0%). Rate of major complications (death, major ischemic stroke, or symptomatic intracranial hemorrhage) was 1.8% (14/901; 95% CI 1.0% to 2.7%; I2=0%). Aneurysm size ≥10 mm was a statistically significant predictor of a major complication (OR 6.4; 95% CI 2.0 to 20.7; p=0.002). Risk of a major complication in aneurysms <10 mm was 0.9% (95% CI 0.3% to 1.7%; I2=0%). The meta-analysis was limited by the predominance of anterior circulation aneurysms.

Conclusion

Treatment of unruptured intracranial aneurysms using the Pipeline Flex flow diverter has a low periprocedural risk of death (0.8%) or major complication (1.8%). The risk of a major complication is significantly higher for large/giant aneurysms (4.4%) and is very low for aneurysms <10 mm (0.9%).
Changes to the littered cigarette pack environment in New York City between 2011 and 2015
Authors: Farley Shannon M , Jasek John P , Sacks Rachel , Schroth Kevin , Davis Kevin
Published: May 2019

Introduction

Imposing policies that increase tobacco prices is a key strategy for reducing smoking prevalence, although it may result in more cigarette trafficking. In 2013, New York City (NYC) passed the Sensible Tobacco Enforcement (STE) law requiring cigarettes be sold for a minimum price of $10.50 per pack. To evaluate whether cigarette price increases changed patterns of behaviour related to cigarette tax evasion, we examined littered pack study data from 2011 and 2015.

Methods

Littered cigarette packs were collected from a random sample of NYC census tracts in 2011 and 2015. The proportions of cigarette packs with proper local, known non-local, foreign or unknown, and no tax stamp were calculated. Changes in volume, source and consumption of domestically trafficked cigarettes over time were estimated.

Results

In 2011, 255 packs with cellophane were collected; in 2015, 226 packs with cellophane were collected. Packs without proper local stamp increased from 60.7% in 2011 to 76.3% in 2015 (p<0.05) and those with foreign or unknown stamp increased from 11.6% in 2011 to 31.4% in 2015 (p<0.05). The percentage of domestically sourced packs attributed to domestic trafficking increased significantly from a range of 47.9% to 52.8% in 2011 to a range of 59.4% to 63.2% in 2015.

Conclusion

While the trafficking rate among domestically sourced cigarettes increased between 2011 and 2015 (before and after the STE minimum price floor on cigarette packs was in place), there was a decline in total consumption of domestically trafficked cigarettes due to a significant increase in consumption of foreign-sourced cigarettes. Jurisdictions considering price measures should bolster monitoring and enforcement efforts to maximise public health impact. Given the interstate nature of cigarette trafficking in the USA, Federal intervention would be optimal.
SPV-Based UPQC with Modified Power Angle Control Scheme for the Enhancement of Power Quality
Authors: Gowrishankar A. , Ramasamy M.
Published: May 2019

Unified Power Quality Conditioner (UPQC) with a modified Power Angle Control (PAC) scheme is presented for effective interconnection of renewable energy system into the grid. The UPQC consists of both shunt and series Active Power Filters (APFs). The shunt and series APF is one of the most effective custom power devices, which provides compensation for current and voltage-based disturbances, respectively. The shunt APF supplies active power to the load from the Distributed Generation (DG) in addition to reactive power demand supplied by it. Because of this functionality, the Volt–Ampere (VA) burden increases along with the rating of the shunt inverter. The PAC scheme aims to effective utilization of series and shunt APFs through sharing of reactive power to reduce VA burden on shunt APF. The PAC scheme is based on Synchronous Reference Frame (SRF) theory, which has simple computations, is robust and uses existing measurements of Solar Photovoltaic (SPV)-integrated UPQC. The performance of the proposed SPV-integrated UPQC is verified with the manifestation of nonlinear loads and reactive burdens with the SPV power generating system. The dynamic performance of the PV-UPQC is verified under the grid disturbances such as voltage sag, swell, varying load and change in solar irradiation. The effectiveness of the proposed control scheme is evaluated through the digital simulation and hardware experimental prototype model.
ANALYSIS AND CHARACTERIZATION OF FORMING BEHAVIOR ON DISSIMILAR JOINTS OF AA5052-O TO AA6061-T6 USING UNDERWATER FRICTION STIR WELDING
Authors: TEJONADHA BABU K. , MUTHUKUMARAN S. , SATHIYA NARAYANAN C. , BHARAT KUMAR C. H.
Published: May 2019

The effects of underwater friction stir welding (UFSW) on mechanical properties, strain hardening behavior, and formability of dissimilar materials of AA5052-O and AA6061-T6 welded joints were investigated. The mechanical properties of the UFSW joints exhibited higher strength and higher joint efficiency than the conventional friction stir welded joints (CFSW). The maximum joint efficiency of 73% has been attained for UFSW joints, which is due to the effect of welding atmosphere. The hardness of the stir zone (SZ) and heat affected zone (HAZ) are also obtained higher for the UFSW joints. Moreover, the hardening capacity, strain hardening exponent and formability of the UFSW joints were greatly improved over the CFSW joints. The improvement in mechanical properties of the UFSW joints is mainly due to faster cooling rate during welding. The microstructural characteristics revealed the formation of fine grains in the UFSW joints compared to the CFSW joints.