bluuebunny/crossref_metadata_2025 huggingface dataset:
The association betweencatechol o-methyltransferase (comt) rs4680 polymorphism, harm avoidance scores, and concussion history in rugby union players
Authors: Fie Sarah MC , Abrahams Shameemah , Patricios Jon , Suter Jason , Posthumus Michael , September Alison V
Published: November 2017

Objective

To investigate the relationship between personality traits andCatechol O-methyltransferase (COMT)rs4680 genotypewith concussion history in rugby players.

Design

Case-control study.

Setting

High school, amateur, and professional rugby teams in South Africa.

Participants

Participants were excluded if they reported a previous brain-related medical condition or a non rugby-related concussion, or were not of European ancestry. Three hundred and one participants were included in the study. Based on self-reported concussion history (30 suspected concussion cases were excluded), participants were grouped into the control (non-concussed, n=140) or case group (one or more diagnosed concussions, n=131).

Assessment of risk factors

Participants completed a concussion history questionnaire, Cloninger’s Tridimensional Personality Questionnaire (TPQ) and all DNA samples were genotyped forCOMTrs4680. Logistic regression, co-varying for age, was used to determine differences in genotype frequencies. A one-way analysis of variance was used to compare TPQ dimension (novelty seeking, harm avoidance, and reward dependence) scores.

Outcome measures

COMTrs4680 genotype frequencies and TPQ scores.

Main results

TheCOMTrs4680 VV genotype was overrepresented in the controlgroup when all participants were combined (p=0.030, OR: 1.89, 95% CI: 1.05 – 3.45; control: 31%, cases: 18%) and whenonly school participants were analysed (p=0.009, OR: 3.23, 95% CI: 1.27 – 8.33; control:37%, cases:15%). Furthermore, the schoolcontrol group had higher harm avoidance scores compared to cases (p=0.004), andthe VV genotype was associated with increased harm avoidance subscale 1 scores (p=0.023).

Conclusions

This study provides preliminary indication that personality traits, and associated genetic variants, can influence concussion in rugby.

Competing interests

None.
White matter integrity and its relationship to cognitive-motor integration in females with post-concussion syndrome
Authors: Hurtubise Johanna , Gorbet Diana , Hughes Cindy , Macpherson Alison , Sergio Lauren
Published: November 2017

Objective

Cognitive-motor integration (CMI) is required in sport when performing movements where a rule is used to align the required motor output and the guiding visual information. Previous research has shown CMI declines in young athletes with a concussion history, deemed recovered at the time of evaluation. The purpose of this study was to characterise differences in symptoms, CMI, and white matter integrity (fractional anisotropy, FA) in those with post-concussion syndrome (PCS) and healthy controls. We hypothesised that those with PCS would have decreased FA and CMI performance, with increased symptom scores.

Participants

Twelve females were included; 6 with PCS for 6 months or more, and 6 age-matched healthy controls with no concussion history.

Methods

Participants were administered the SCAT3, four visuomotor CMI tasks, and diffusion weighted images were acquired. Participants displaced a cursor from a central target to peripheral targets by sliding their finger on a horizontally placed tablet either directly to the viewed target or with decoupled eye-hand coordination (targets viewed on a vertical monitor, 180° feedback rotation, or both).

Results

We observed worse symptom scores and impaired performance in CMI tasks, as well as decreased mean FA in bilateral corticospinal tracts beneath the premotor and primary motor cortices and in the white matter underlying the right superior parietal lobule, in those with PCS compared to healthy controls.

Conclusions

CMI decline may be related to decreased FA within the frontal-parietal-subcortical network. Measuring CMI, a skill crucial to athletes, provides an effective behavioural means for detection of brain alterations associated with concussion.

Competing interests

None.
Can cognitive recovery time be estimated by clinical recovery time in concussion suffered by soccer athletes?
Authors: Silva Neto Moacir , Teixeira Paulo , Collins Michael
Published: November 2017

Objective

Determine if there is a correlation between the Clinical Recovery Time (CRT) and the Time from CRT to Cognitive Recovery (CGRT).

Design

A non-concurrent cohort study.

Setting

Chart review of Soccer Athletes who suffered concussion and were followed in the Concussion Management Program of the University of Pittsburgh Medical Centre.

Participants

92 charts were reviewed. Average Age was 16.2 (SD=2.7), 62% were females. Both CRT and CGRT were retrieved for 42 athletes.

Outcome measures

CRT was determined by the days that were necessary for a list of rated concussion symptoms to be considered normal. Cognitive Recovery Time (CGRT) was determined when the computerised cognitive test used on follow-ups was considered to be back to normal by trained neuropsychologists.

Main results

CRT: Median time=23 days. Mean time=42 (SD=53) days (Minimum=1 day and Maximum 231 days). Time from CRT to CGRT: Median time=10 days. Mean time=17.7 (SD=27) days (Minimum=−7 days and Maximum of 157 days). Bivariate correlation of CRT to Time from CRT to CGRT was 0.195 (p=0.216).

Conclusions

Both CRT ad CGRT vary a lot among soccer players who suffer concussion. Time from CRT to CGRT didn’t correlate with CRT and can’t be estimated based on CRT. Both CRT and CGRT should be evaluated independently during rehabilitation of concussed soccer athletes.

Competing interests

None.

Share holder of ImPACT Applications, Inc.
Compliance with and effectiveness of return-to-activity progressions following concussion: a systematic review of the literature
Authors: Valovich McLeod Tamara C , Lewis Joy H , Whelihan Kate , Welch Bacon Cailee E
Published: November 2017

Objective

To systematically review the literature regarding healthcare provider compliance with and the effectiveness of the graded return-to-activity progression.

Design

Systematic Review.

Search strategy

An electronic search was conducted in 6 databases. Search terms included: brain concussion AND-rest; concuss*AND-sports-AND-rest, -sports-AND-return-to-play; mild traumatic brain injury AND-return-to-activity, -return-to-play; recurrent concussion-AND-sport. Hand searches were also performed.

Study selection

After removal of duplicates, initial screen of titles and abstracts was completed by 3 authors, followed by full text review. Articles were included if they were in English and original studies related to the clinical questions. Reviews, editorials, commentaries, and animal research were excluded.

Data extraction

The initial search yielded 2851 articles, with 1239 undergoing title/abstract screen, 143 undergoing full-text review, and 21 included in the review. Study design, patient/participant, instrumentation/interventions utilised, outcome measures, main results, and conclusions were extracted. Strength of recommendation (SOR) as outlined by the Oxford Centre for Evidence-Based Medicine was assigned to the body of literature.

Data synthesis

Articles were categorised based on their ability to answer one of the clinical questions of interest and the conclusions were summarised using a qualitative synthesis of the findings. Data were not appropriate for meta-analysis due to the observational nature of many included studies and heterogeneity of the patients, participants, interventions and outcomes.

Conclusions

The review identified that significant variability in the use of assessment tools and compliance with recommended return-to-activity guidelines exists (SOR=B) and there is little evidence to support the effectiveness of the graded return-to-activity progression (SOR=D).

Competing interests

None.
What is the definition of sports-related concussion: a systematic review
Authors: McCrory Paul , Feddermann-Demont Nina , Dvořák Jiří , Cassidy J David , McIntosh Andrew , Vos Pieter E , Echemendia Ruben J , Meeuwisse Willem , Tarnutzer Alexander A
Published: November 2017

Objectives

Various definitions for concussion have been proposed, each having its strengths and weaknesses. We reviewed and compared current definitions and identified criteria necessary for an operational definition of sports-related concussion (SRC) in preparation of the 5th Concussion Consensus Conference (Berlin, Germany). We also assessed the role of biomechanical studies in informing an operational definition of SRC.

Design

This is a systematic literature review.

Data sources

Data sources include MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Clinical Trials and SPORT Discus (accessed 14 September 2016).

Eligibility criteria for selecting studies

Eligibility criteria were studies reporting (clinical) criteria for diagnosing SRC and studies containing SRC impact data.

Results

Out of 1601 articles screened, 36 studies were included (2.2%), 14 reported on criteria for SRC definitions and 22 on biomechanical aspects of concussions. Six different operational definitions focusing on clinical findings and their dynamics were identified. Biomechanical studies were obtained almost exclusively on American football players. Angular and linear head accelerations linked to clinically confirmed concussions demonstrated considerable individual variation.

Summary/conclusions

SRC is a traumatic brain injury that is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces with several common features that help define its nature. Limitations identified include that the current criteria for diagnosing SRC are clinically oriented and that there is no gold/standard to assess their diagnostic properties. A future, more valid definition of SRC would better identify concussed players by demonstrating high predictive positive/negative values. Currently, the use of helmet-based systems to study the biomechanics of SRC is limited to few collision sports. New approaches need to be developed to provide objective markers for SRC.
Dissemination of 2014 dual antiplatelet therapy (DAPT) trial results: a systematic review of scholarly and media attention over 7 months
Authors: Sharp Melissa K , Haneef Romana , Ravaud Philippe , Boutron Isabelle
Published: November 2017

Objective

To explore how the results from the 2014 dual antiplatelet therapy (DAPT) trial were disseminated to the scientific community and online media.

Design

A a systematic review of scholarly and public attention surrounding the DAPT study.

Settings

Data were collected from the ISI Web of Knowledge, Google Scholar, PubMed Commons, EurekAlert, the DAPT study website (www.daptstudy.org) and theNew England Journal of Medicinewebsite (for scholarly attention) and Altmetric Explorer, Snap Bird, YouTube (for public attention) citing DAPT study results appearing from 16 November 2014 to 10 June 2015.

Participants

No participants were involved in this study.

Main outcome measure

Proportion of contents highlighting the increased risk of mortality and critical to the author’s interpretation of the results.

Results

We identified 425 items reported by seven sources; 164 (39%) disseminated the authors’ interpretation via an electronic link or a reference, with no additional text. Among 81 items (19 %), the message favoured prolonged treatment and consequently overstated the article conclusions. Among 119 items (28 %), the text was uncertain about the benefit of prolonged treatment but was reported with no or inappropriate mention of increased risk of mortality. Only 34 items (8 %) were uncertain about the benefit of prolonged treatment and mentioned increased risk of mortality. In all, 27 items (6 %) did not favour prolonged treatment, and only 12 of these (3 %) clearly raised some concerns about the reporting of increased risk of death.

Conclusion

Dissemination of the DAPT study results to the scientific community and on different media sources rarely criticised the interpretation of the study results.
Effectiveness of community health worker training programmes for cardiovascular disease management in low-income and middle-income countries: a systematic review
Authors: Abdel-All Marwa , Putica Barbara , Praveen Deversetty , Abimbola Seye , Joshi Rohina
Published: November 2017

Introduction

Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs.

Methods

A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project’s Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers.

Results

The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before–after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention.

Conclusion

The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.
Collective leadership and safety cultures (Co-Lead): protocol for a mixed-methods pilot evaluation of the impact of a co-designed collective leadership intervention on team performance and safety culture in a hospital group in Ireland
Authors: McAuliffe Eilish , De Brún Aoife , Ward Marie , O’Shea Marie , Cunningham Una , O’Donovan Róisín , McGinley Sinead , Fitzsimons John , Corrigan Siobhán , McDonald Nick
Published: November 2017

Introduction

There is accumulating evidence implicating the role of leadership in system failures that have resulted in a range of errors in healthcare, from misdiagnoses to failures to recognise and respond to patient deterioration. This has led to concerns about traditional hierarchical leadership structures and created an interest in the development of collective ways of working that distribute leadership roles and responsibilities across team members. Such collective leadership approaches have been associated with improved team performance and staff engagement. This research seeks to improve our understanding of collective leadership by addressing two specific issues: (1) Does collective leadership emerge organically (and in what forms) in a newly networked structure? and (2) Is it possible to design and implement collective leadership interventions that enable teams to collectively improve team performance and patient safety?

Methods and analysis

The first phase will include a social network analysis, using an online survey and semistructured interviews at three time points over 12 months, to document the frequency of contact and collaboration between senior hospital management staff in a recently configured hospital group. This study will explore how the network of 11 hospitals is operating and will assess whether collective leadership emerges organically. Second, collective leadership interventions will be co-designed during a series of workshops with healthcare staff, researchers and patient representatives, and then implemented and evaluated with four healthcare teams within the hospital network. A mixed-methods evaluation will explore the impact of the intervention on team effectiveness and team performance indicators to assess whether the intervention is suitable for wider roll-out and evaluation across the hospital group.

Ethics and dissemination

Favourable ethical opinion has been received from the University College Dublin Research Ethics Committee (HREC-LS-16–116397/LS-16-20). Results will be disseminated via publication in peer-reviewed journals, national and international conferences, and to relevant stakeholders and interest groups.
Public views towards community health and hospital-based outpatient services and their utilisation in Zhejiang, China: a mixed methods study
Authors: Wu Dan , Lam Tai Pong , Lam Kwok Fai , Zhou Xu Dong , Sun Kai Sing
Published: November 2017

Objective

China is engaged in promoting community health services (CHS) nationwide. This study examines the public’s views towards CHS and their utilisation of community-based and hospital-based outpatient services.

Design

A mixed methods study using qualitative interviews and a cross-sectional survey.

Study setting and participants

The study was conducted among the public between September 2014 and September 2015 in Zhejiang province, China. Six focus groups and 13 individuals were interviewed. The questionnaire was completed by 1248 respondents (response rate: 83%).

Primary outcome measures

Utilisation of community-based and hospital-based outpatient services.

Results

Functions of CHS perceived by the public included provision of minor illness management, coordination, drug dispensing, follow-up care and patient education. However, many also showed a distrust in primary care providers’ (PCPs) competence for confirming the initial diagnosis and management plan. As coordinators, PCPs’ integrity was challenged, and PCPs were thought to be potential ‘tuo er’ (cunning agents who tried to lead patients to some notorious hospitals to make money). Survey results showed that 800 (64.1%) respondents visited hospital-based clinics and 688 (55.1%) visited CHS at least once in the past year. Compared with the uninsured group, those covered by Urban Resident Medical Insurance (adjusted OR (AOR)=1.95, 95% CI 1.24 to 3.07) and Urban Employee Medical Insurance (AOR=2.59, 95% CI 1.59 to 4.24) were more likely to use hospital-based services. Respondents who had a chronic condition were more likely than their counterparts to use both hospital-based services (AOR=1.72, 95% CI 1.18 to 2.49) and CHS (AOR=1.66, 95% CI 1.19 to 2.32). Income levels were positively associated with the likelihood of visiting hospital-based clinics (AOR=1.67, 95% CI 1.15 to 2.42) but negatively associated with the likelihood of using CHS (AOR=0.68, 95% CI 0.48 to 0.96).

Conclusions

Demand of hospital-based outpatient services is much higher than the community-based outpatient services. Policy reformers need to take further actions to address the public distrust in PCPs to facilitate their gatekeeping role.
Post-operative patient-related risk factors for chronic pain after total knee replacement: a systematic review
Authors: Wylde Vikki , Beswick Andrew D , Dennis Jane , Gooberman-Hill Rachael
Published: November 2017

Objective

To identify postoperative patient-related risk factors for chronic pain after total knee replacement (TKR).

Design

The systematic review protocol was registered on the International Prospective Register of Systematic Reviews (CRD42016041374). MEDLINE, Embase and PsycINFO were searched from inception to October 2016 with no language restrictions. Key articles were also tracked in the Institute for Scientific Information (ISI) Web of Science. Cohort studies evaluating the association between patient-related factors in the first 3 months postoperatively and pain at 6 months or longer after primary TKR surgery were included. Screening, data extraction and assessment of methodological quality were undertaken by two reviewers. The primary outcome was pain severity in the replaced knee measured with a patient-reported outcome measure at 6 months or longer after TKR. Secondary outcomes included adverse events and other aspects of pain recommended by the core outcome set for chronic pain after TKR.

Results

After removal of duplicates, 16 430 articles were screened, of which 805 were considered potentially relevant. After detailed evaluation of full-text articles, 14 studies with data from 1168 participants were included. Postoperative patient-related factors included acute pain (eight studies), function (five studies) and psychosocial factors (four studies). The included studies had diverse methods for assessment of potential risk factors and outcomes, and therefore narrative synthesis was conducted. For all postoperative factors, there was insufficient evidence to draw firm conclusions about the association with chronic pain after TKR. Selection bias was a potential risk for all studies, as none were reported to be conducted at multiple centres.

Conclusion

This systematic review found insufficient evidence to draw firm conclusions about the association between any postoperative patient-related factors and chronic pain after TKR. Further high-quality research is required to provide a robust evidence base on postoperative risk factors, and inform the development and evaluation of targeted interventions to optimise patients’ outcomes after TKR.
Effect of cardiologist care on 6-month outcomes in patients discharged with heart failure: results from an observational study based on administrative data
Authors: Avaldi Vera Maria , Lenzi Jacopo , Urbinati Stefano , Molinazzi Dario , Descovich Carlo , Campagna Anselmo , Taglioni Martina , Fioritti Angelo , Fantini Maria Pia
Published: November 2017

Objectives

To evaluate the effect of cardiologist care on adherence to evidence-based secondary prevention medications, mortality and readmission within 6 months of discharge in patients with heart failure (HF).

Design

Retrospective observational study based on administrative data.

Setting

Local Healthcare Authority (LHA) of Bologna, one of the largest LHAs of Italy with ~870 000 inhabitants.

Participants

All patients residing in the LHA of Bologna discharged from hospital with a diagnosis of HF between 1 January 2015 and 31 December 2015.

Primary and secondary outcome measures

Multivariable regression analysis was used to assess the association of inpatient and outpatient cardiologist care with adherence to evidence-based medications, all-cause mortality and hospital readmission (including emergency room visits) within 6 months of discharge.

Results

The study population included 2650 patients (mean age 82.3 years). 340 (12.8%) patients were discharged from cardiology wards, while 635 (24.0%) were seen by a cardiologist during follow-up. Inpatient and outpatient cardiologist care was associated with an increased likelihood of adherence to ACE inhibitors/angiotensin receptor blockers (ACEIs/ARBs), β-blockers and aldosterone antagonists after discharge. The risk of mortality was significantly lower among patients adherent to ACEIs/ARBs and/or β-blockers (–53% and –28%, respectively); the risk of hospital readmission was significantly lower among patients adherent to ACEIs/ARBs (–28%).

Conclusions

Compared with non-specialist care, cardiologist care improves patient adherence to evidence-based medications and might thus favourably affect mortality and readmission following HF.
Protocol for the HAPPY Hearts study: cardiovascular screening for the early detection of future adverse cardiovascular outcomes in middle-aged and older women: a prospective, observational cohort study
Authors: Boreskie Kevin F , Kehler D Scott , Costa Eduardo C , Cortez Pedro C , Berkowitz Ivan , Hamm Naomi C , Moffatt Teri L , Stammers Andrew N , Kimber Dustin E , Hiebert Brett M , Kent David E , Cornish Denise E , Blewett Heather , Nguyen Thang , Arora Rakesh C , Strachan Shaelyn M , Semenchuk Brittany N , Hay Jacqueline L , Cohn Jay N , Duhamel Todd A
Published: November 2017

Introduction

Efforts to identify individuals at a higher risk for adverse cardiovascular outcomes focus on traditional risk factors, such as age, sex, smoking status, blood pressure and and cholesterol; however, this approach does not directly assess cardiovascular function and may underestimate the risk of experiencing adverse cardiovascular outcomes in women. This prospective, observational cohort study will examine the ability of the Heart Attack Prevention Program for You (HAPPY) Hearts screening protocol, a series of non-invasive procedures to identify middle-aged and older women who are at an elevated risk for experiencing an adverse cardiovascular event in the 5-year period after screening. The predictive value of the HAPPY Hearts protocol will also be compared with the Framingham Risk Score to determine the sensitivity for estimating risk for an adverse cardiovascular outcome.

Methods and analysis

One thousand women 55 years of age or older will be recruited to be screened by the HAPPY Hearts protocol. This involves the cardiovascular assessment of resting blood pressure, blood pressure response to 3 min of moderate intensity exercise and large and small arterial elasticity. The participants will be classified into risk categories based on these measures. The incidence of the following adverse cardiovascular outcomes will be assessed in the 5-year period after screening in both groups: ischaemic heart disease, acute myocardial infarction, stroke, percutaneous coronary intervention, coronary bypass surgery, congestive heart failure and new hypertension.

Ethics and dissemination

Information gathered in this research will be published in peer-reviewed journals and presented in a programme evaluation report to inform Manitoba Health and key stakeholders about the outcomes of the study. The University of Manitoba Health Research Ethics Board has approved the study protocol V.2.0, dated 29 September 2014 (H2014:224).

Trial registration number

NCT02863211.
Quantifying the role of modifiable risk factors in the differences in cardiovascular disease mortality rates between metropolitan and rural populations in Australia: a macrosimulation modelling study
Authors: Alston Laura , Peterson Karen Louise , Jacobs Jane P , Allender Steven , Nichols Melanie
Published: November 2017

Objectives

The study aimed (1) to quantify differences in modifiable risk factors between urban and rural populations, and (2) to determine the number of rural cardiovascular disease (CVD) and ischaemic heart disease (IHD) deaths that could be averted or delayed if risk factor levels in rural areas were equivalent to metropolitan areas.

Setting

National population estimates, risk factor prevalence, CVD and IHD deaths data were analysed by rurality using a macrosimulation Preventable Risk Integrated Model for chronic disease risk. Uncertainty analysis was conducted using a Monte Carlo simulation of 10 000 iterations to calculate 95% credible intervals (CIs).

Participants

National data sets of men and women over the age of 18 years living in urban and rural Australia.

Results

If people living in rural Australia had the same levels of risk factors as those in metropolitan areas, approximately 1461 (95% CI 1107 to 1791) deaths could be delayed from CVD annually. Of these CVD deaths, 793 (95% CI 506 to 1065) would be from IHD. The IHD mortality gap between metropolitan and rural populations would be reduced by 38.2% (95% CI 24.4% to 50.6%).

Conclusions

A significant portion of deaths from CVD and IHD could be averted with improvements in risk factors; more than one-third of the excess IHD deaths in rural Australia were attributed to differences in risk factors. As much as two-thirds of the increased IHD mortality rate in rural areas could not be accounted for by modifiable risk factors, however, and this requires further investigation.
Players’ and coaches’ knowledge and awareness of the BokSmartSafe Sixinjury prevention programme: an ecological cross-sectional questionnaire study
Authors: Sewry Nicola , Verhagen Evert , Lambert Mike , van Mechelen Willem , Brown James
Published: November 2017

Objectives

Rugby has a high injury incidence and therefore BokSmart introduced theSafe Sixinjury prevention programme in 2014 in an attempt to decrease this incidence. In 2015, BokSmart used a ‘targeted marketing approach’ to increase the awareness and knowledge of theSafe Six. Therefore, the aim of this study was to determine the change in the knowledge of coaches and players of theSafe Sixprogramme, compared with the launch year, following a ‘targeted marketing approach’.

Design

Ecological cross-sectional questionnaire study

Setting

The 2014–2016 South African rugby union youth week tournaments.

Participants

Questionnaires were completed by 4502 players and coaches who attended any of the four youth week tournaments during 2014–2016.

Outcome measures

Logistic regression (adjusted OR, 95% CI) was performed in comparison to year prior to targeted marketing, separately for coaches and players, for changes in awareness and knowledge.

Results

The awareness of theSafe Sixincreased significantly for players in 2015 (1.74 times (95% CI 1.49 to 2.04)) and in 2016 (1.54 times (95% CI 1.29 to 1.84)). Similarly for coaches, there was a 3.55 times (95% CI 1.23 to 9.99) increase in 2015 and a 10.11 times (95% CI 2.43 to 42.08) increase in 2016 compared with 2014. Furthermore, a player was significantly more likely to be aware of theSafe Sixif his coach was aware of the programme (p<0.05).

Conclusions

The knowledge and awareness of the BokSmartSafe Sixof both players and coaches increased in 2015 and 2016 (compared with 2014) since the launch of the programme. Coaches, the Unions/the South African Rugby Union and social media were the largest contributors to knowledge in coaches and players. While the ‘targeted marketing approach’ was associated with an increase in awareness, future studies should determine if this translates into behavioural change.
Laser scanning in vivo confocal microscopy (IVCM) for evaluating human corneal sub-basal nerve plexus parameters: protocol for a systematic review
Authors: De Silva Manikkuwadura Eranda Harshan , Zhang Alexis Ceecee , Karahalios Amalia , Chinnery Holly Rose , Downie Laura Elizabeth
Published: November 2017

Introduction

Laser scanning in vivo confocal microscopy (IVCM) enables non-invasive, high-resolution imaging of the cornea. In recent years, there has been a vast increase in researchers using laser scanning IVCM to image and quantify corneal nerve parameters. However, a range of methodological approaches have been adopted. The primary aim of this systematic review is to critically appraise the reported method(s) of primary research studies that have used laser scanning IVCM to quantify corneal sub-basal nerve plexus (SBNP) parameters in humans, and to examine corneal nerve parameters in healthy individuals.

Methods and analysis

A systematic review of primary studies that have used laser scanning IVCM to quantify SBNP parameters in humans will be conducted. Comprehensive electronic searches will be performed in Ovid MedLine, Embase and the Cochrane Library. Two reviewers will independently assess titles and abstracts, and exclude studies not meeting the inclusion criteria. For studies judged eligible or potentially eligible, full texts will be independently assessed by two reviewers to determine eligibility. A third reviewer will resolve any discrepancies in judgement. Risk of bias will be assessed using a custom tool, covering five methodological domains: participant selection, method of image capture, method of image analysis, data reporting and other sources of bias. A systematic narrative synthesis of findings will be provided. A multilevel random-effects meta-analysis will be performed for corneal nerve parameters derived from healthy participants. This review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Ethics and dissemination

As this review considers published data, ethical approval is not required. We foresee that this synthesis will serve as a reference for future studies, and can be used to inform best practice standards for using IVCM in clinical research. A manuscript reporting the results of the review will be published and may also be presented at scientific conferences.
Long-Term Conditions Questionnaire (LTCQ): initial validation survey among primary care patients and social care recipients in England
Authors: Potter Caroline M , Batchelder Laurie , A’Court Christine , Geneen Louise , Kelly Laura , Fox Diane , Baker Matthew , Bostock Jennifer , Coulter Angela , Fitzpatrick Ray , Forder Julien E , Gibbons Elizabeth , Jenkinson Crispin , Jones Karen , Peters Michele
Published: November 2017

Objective

The aim of this study was to validate a new generic patient-reported outcome measure, the Long-Term Conditions Questionnaire (LTCQ), among a diverse sample of health and social care users in England.

Design

Cross-sectional validation survey. Data were collected through postal surveys (February 2016–January 2017). The sample included a healthcare cohort of patients recruited through primary care practices, and a social care cohort recruited through local government bodies that provide social care services.

Participants

1211 participants (24% confirmed social care recipients) took part in the study. Healthcare participants were recruited on the basis of having one of 11 specified long-term conditions (LTCs), and social care participants were recruited on the basis of receiving social care support for at least one LTC. The sample exhibited high multimorbidity, with 93% reporting two or more LTCs and 43% reporting a mental health condition.

Outcome measures

The LTCQ’s construct validity was tested with reference to the EQ-5D (5-level version), the Self-Efficacy for Managing Chronic Disease scale, an Activities of Daily Living scale and the Bayliss burden of morbidity scale.

Results

Low levels of missing data for each item indicate acceptability of the LTCQ across the sample. The LTCQ exhibits high internal consistency (Cronbach’s α=0.95) across the scale’s 20 items and excellent test–retest reliability (intraclass correlation coefficient=0.94, 95% CI 0.93 to 0.95). Associations between the LTCQ and all reference measures were moderate to strong and in the expected directions, indicating convergent construct validity.

Conclusions

This study provides evidence for the reliability and validity of the LTCQ, which has potential for use in both health and social care settings. The LTCQ could meet a need for holistic outcome measurement that goes beyond symptoms and physical function, complementing existing measures to capture fully what it means to live well with LTCs.
Long-term performance of colorectal cancer screening programmes based on the faecal immunochemical test
Authors: Zorzi Manuel , Hassan Cesare , Capodaglio Giulia , Fedato Chiara , Montaguti Adriana , Turrin Anna , Rosano Alberto , Monetti Daniele , Stocco Carmen , Baracco Susanna , Russo Francesca , Repici Alessandro , Rugge Massimo
Published: November 2017

Background

The long-term performance of colorectal cancer (CRC) screening programmes based on a 2-year faecal immunochemical test (FIT) is still unclear.

Methods

In a sample of 50 to 69-year-olds repeatedly screened with the FIT (OC-Hemodia latex agglutination test; cut-off: 20 µg haemoglobin/g faeces), we examined: (1) the FIT positivity rate, the CRC and advanced adenoma detection rate and the FIT’s positive predictive value (PPV) for advanced neoplasia, at each round of screening and (2) the cumulative CRC and advanced adenoma detection rate after five rounds of FIT.

Results

Over 12 years (2002–2014), 123 347 individuals were administered the FIT up to six times, and 781 CRCs and 4713 advanced adenomas were diagnosed. The CRC and advanced adenoma detection rates declined substantially from the first to the third (rate ratio (RR) 0.25, 95% CI 0.20 to 0.32) and second (RR 0.51, 95% CI 0.47 to 0.56) rounds, respectively, and then remained stable. The PPV for advanced neoplasia dropped by 18% in the second round (RR 0.82, 95% CI 0.77 to 0.89), with no further reduction thereafter due to a concomitant decline in the FIT positivity rate (RR first to sixth rounds: 0.56, 95% CI 0.53 to 0.60).

The cumulative CRC and advanced adenoma detection rates over five consecutive rounds were 8.5‰ (95% CI 7.8 to 9.2), and 58.9‰ (95% CI 56.9 to 61.0), respectively.

Conclusions

Repeated FIT significantly reduces the burden of colorectal disease while facilitating an efficient use of colonoscopy resources. The cumulative detection rate after five rounds of FIT is similar to primary screening with colonoscopy, supporting the need to account for the cumulative sensitivity of repeated FITs when evaluating the test’s efficacy.
Genetic mannose binding lectin deficiency is associated with airway microbiota diversity and reduced exacerbation frequency in COPD
Authors: Dicker Alison J , Crichton Megan L , Cassidy Andrew J , Brady Gill , Hapca Adrian , Tavendale Roger , Einarsson Gisli G , Furrie Elizabeth , Elborn J Stuart , Schembri Stuart , Marshall Sara E , Palmer Colin N A , Chalmers James D
Published: November 2017

Background

In cystic fibrosis and bronchiectasis, genetic mannose binding lectin (MBL) deficiency is associated with increased exacerbations and earlier mortality; associations in COPD are less clear. Preclinical data suggest MBL interferes with phagocytosis of Haemophilus influenzae, a key COPD pathogen. We investigated whether MBL deficiency impacted on clinical outcomes or microbiota composition in COPD.

Methods

Patients with COPD (n=1796) underwent MBL genotyping; linkage to health records identified exacerbations, lung function decline and mortality. A nested subcohort of 141 patients, followed for up to 6 months, was studied to test if MBL deficiency was associated with altered sputum microbiota, through 16S rRNA PCR and sequencing, or airway inflammation during stable and exacerbated COPD.

Findings

Patients with MBL deficiency with COPD were significantly less likely to have severe exacerbations (incidence rate ratio (IRR) 0.66, 95% CI 0.48 to 0.90, p=0.009), or to have moderate or severe exacerbations (IRR 0.77, 95% CI 0.60 to 0.99, p=0.047). MBL deficiency did not affect rate of FEV1 decline or mortality. In the subcohort, patients with MBL deficiency had a more diverse lung microbiota (p=0.008), and were less likely to be colonised with Haemophilus spp. There were lower levels of airway inflammation in patients with MBL deficiency.

Interpretation

Patients with MBL deficient genotype with COPD have a lower risk of exacerbations and a more diverse lung microbiota. This is the first study to identify a genetic association with the lung microbiota in COPD.
Complications and outcomes associated with 13 cases of triceps tendon disruption in dogs and cats (2003–2014)
Authors: Earley Naomi Frances , Ellse Gemma , Wallace Adrian M , Parsons Kevin J , Voss Katja , Pugliese Lauren C , Moores Andy P , Whitelock Richard , Stork Christoph , Langley‐Hobbs Sorrel J , Radke Heidi
Published: November 2017

This study reports data from a larger number of cases of triceps tendon disruption. Records from 10 veterinary referral hospitals between 2003 and 2014 were searched for canine and feline cases diagnosed with triceps tendon disruption, based on orthopaedic examination confirmed during surgery. Long‐term follow‐up and owner satisfaction were assessed using a questionnaire. There were 13 cases of triceps tendon disruption diagnosed across seven hospitals (nine dogs, four cats). Trauma, history or presence of a wound, surgery in the region of tendon attachment or corticosteroid treatment preceded triceps tendon disruption. Radiographic signs or histopathology suggestive of a chronic tendinopathy was common. All cases underwent surgical repair involving a tendon suture pattern, 12 of which were secured through bone tunnels. Immobilisation was used in all cases in the form of transarticular external skeletal fixation (TAESF) (8/9 dogs) or spica splint (four cats, two dogs; in one dog a TAESF was applied after complications associated with the spica splint). Complications occurred in 11 cases (17 total complications), frequently associated with the immobilisation method. One case had traumatic tendon rerupture two years following surgery. A wound at presentation was associated with the development of multiple complications. Nine cases had long‐term follow‐up; five achieved normal function, four achieved acceptable function. Despite the complications, overall return to subjective normal or acceptable function, as assessed by the owners, was achieved in the majority of cases.
Evaluation of ground loss ratio with moving trajectories induced in double-O-tube (DOT) tunnelling
Authors: Ren Dong-Jie , Shen Shui-Long , Arulrajah Arul , Wu Huai-Na
Published: November 2017

This paper investigates the influence of moving trajectories on ground loss ratio (GRL) due to the double-O-tube (DOT) tunnelling method. DOT tunnelling has three moving trajectories: pitching, yawing, and rolling, which have different behaviours during tunnel construction compared with those from single circular shield tunnelling. These moving trajectories cause overexcavation during tunnelling. The calculation method of gap area between the DOT shield machine and linings is evaluated in this research. Based on the superposition concept, the modification equation of GLR is proposed, which takes both moving trajectory and grouting volume into consideration. A field DOT tunnelling case is analysed to determine the correlation between moving trajectories and ground settlement. The influence of tail grouting is discussed by adjusting the grouting volume in different periods. The finite element method is also employed by setting the modified ground loss ratio (GLR′) as the contraction increment of linings. Results from both the measured and simulated settlements verify the reasonability of the proposed equation and the effect of moving trajectories on ground loss.
Kantowski–Sachs modified holographic Ricci dark energy model in Saez–Ballester theory of gravitation
Authors: Bhaskar Rao M.P.V.V. , Reddy D.R.K. , Sobhan Babu K.
Published: November 2017

We have considered Kantowski–Sachs space–time in the presence of matter and anisotropic modified holographic Ricci dark energy components in the scalar–tensor theory of gravitation formulated by Saez and Ballester (Phys. Lett. A, 113, 467, 1986) and derived the field equations of the theory. We have used (i) hybrid expansion law proposed by Akarsu et al. (JCAP, 022, 2014), (ii) a relation between metric potentials, and (iii) modified holographic Ricci dark energy density given by Chen and Jing (Phys. Lett. B, 679, 144, 2009) to obtain an exact solution of the field equations that describes a Kantowski–Sachs holographic modified Ricci dark energy universe in this theory. Physical and kinematical parameters are also computed and their physical behavior is discussed.
SINGAPORE’S LIFE PROGRAM: ACTUARIAL FRAMEWORK, LONGEVITY RISK AND IMPACT OF ANNUITY FUND RETURN
Authors: KWONG KOON-SHING , TSE YIU-KUEN , CHAN WAI-SUM
Published: November 2017

The Central Provident Fund (CPF) is a defined-contribution savings plan forming the key pillar of the pension system in Singapore. The CPF Lifelong Income For the Elderly (LIFE) program, which provides lifetime income for retirees, is a mandatory pension scheme for all Singapore residents. In this paper we construct an actuarial framework to analyze the LIFE program. We use this framework to study the plan payout outcomes with respect to changes in mortality and annuity fund return assumptions. We also examine the effects of some possible changes in the program on the payouts and bequests.
Colored HOMFLY-PT polynomials that distinguish mutant knots
Authors: Nawata Satoshi , Ramadevi P. , Singh Vivek Kumar
Published: November 2017

We illustrate from the viewpoint of braiding operations on WZNW conformal blocks how colored HOMFLY-PT polynomials with multiplicity structure can detect mutations. As an example, we explicitly evaluate the [Formula: see text]-colored HOMFLY-PT polynomials that distinguish a famous mutant pair, Kinoshita–Terasaka and Conway knot.
Dark matter (energy) may be indistinguishable from modified gravity (MOND)
Authors: Sivaram C.
Published: November 2017

For Newtonian dynamics to hold over galactic scales, large amounts of dark matter (DM) are required which would dominate cosmic structures. Accounting for the strong observational evidence that the universe is accelerating requires the presence of an unknown dark energy (DE) component constituting about 70% of the matter. Several ingenious ongoing experiments to detect the DM particles have so far led to negative results. Moreover, the comparable proportions of the DM and DE at the present epoch appear unnatural and not predicted by any theory. For these reasons, alternative ideas like MOND and modification of gravity or general relativity over cosmic scales have been proposed. It is shown in this paper that these alternate ideas may not be easily distinguishable from the usual DM or DE hypotheses. Specific examples are given to illustrate this point that the modified theories are special cases of a generalized DM paradigm.
The Hilbert space of quantum gravity is locally finite-dimensional
Authors: Bao Ning , Carroll Sean M. , Singh Ashmeet
Published: November 2017

We argue in a model-independent way that the Hilbert space of quantum gravity is locally finite-dimensional. In other words, the density operator describing the state corresponding to a small region of space, when such a notion makes sense, is defined on a finite-dimensional factor of a larger Hilbert space. Because quantum gravity potentially describes superpositions of different geometries, it is crucial that we associate Hilbert-space factors with spatial regions only on individual decohered branches of the universal wave function. We discuss some implications of this claim, including the fact that quantum-field theory cannot be a fundamental description of nature.
A new length scale for quantum gravity: A resolution of the black hole information loss paradox
Authors: Singh Tejinder P.
Published: November 2017

We show why and how Compton wavelength and Schwarzschild radius should be combined into one single new length scale, which we call the Compton–Schwarzschild length. Doing so offers a resolution of the black hole information loss paradox, and suggests Planck mass remnant black holes as candidates for dark matter. It also compels us to introduce torsion, and identify the Dirac field with a complex torsion field. Dirac equation and Einstein equations, are shown to be mutually dual limiting cases of an underlying gravitation theory which involves the Compton–Schwarzschild length scale, and includes a complex torsion field.
Universally stable black holes
Authors: Bueno Pablo , Cano Pablo A.
Published: November 2017

We argue that, when certain higher-curvature corrections are added to the four-dimensional Einstein–Hilbert action, black holes become stable below certain mass. We show this to be the case for an infinite family of ghost-free theories involving terms of arbitrarily high order in curvature. The thermodynamic behavior of the new black holes is universal for arbitrary values of the couplings, with the only exception of the Schwarzschild solution itself, which is recovered when all the couplings are set to zero. For this class of theories, the issue of non-unitary evolution is inexistent, as black holes never evaporate completely.