bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethnic Differences in Bony Hip Morphology in a Cohort of 445 Professional Male Soccer Players
Authors: Mosler Andrea B. , Crossley Kay M. , Waarsing Jan H. , Jomaah Nabil , Weir Adam , Hölmich Per , Agricola Rintje
Published: August 2016

Background:

Participation in high-impact athletic activities has recently been associated with a higher prevalence of cam deformity. Bony hip morphology has also emerged as an important factor in the development of hip osteoarthritis. However, it is unknown whether bony morphology differs between ethnicities in athletes participating in high-impact sports.

Purpose:

To investigate whether the prevalence of specific bony hip morphological abnormalities differed between professional male soccer players of diverse ethnic backgrounds.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Professional male soccer players from an entire league attending preparticipation screening were invited to participate in this study. Ethnicity was registered, and standardized radiographs of anteroposterior pelvic and Dunn views were obtained. Cam and pincer deformity, and acetabular dysplasia were quantified using the alpha angle, triangular index, and lateral center-edge angle (LCEA). Regression analyses with generalized estimating equations were used to determine prevalence differences in bony hip morphology.

Results:

A total of 445 male soccer players (890 hips; mean age ± SD, 25 ± 4.9 years) participated in the study, representing the following ethnic groups: Arabic (59%), black (24%), Persian (7%), white (6%), East Asian (2%), and other (2%). The prevalence of cam deformity (alpha angle >60°) ranged from 57.5% to 71.7% across 4 of the groups, but East Asians had a significantly lower prevalence (18.8%; P ≤ .032). A large cam deformity (alpha angle >78°) was more prevalent in white (33.3%) compared with black soccer players (17.8%; P = .041) and was absent in East Asian players. Pincer deformity (LCEA >40°) was uncommon (3%) in all ethnicities. The prevalence of acetabular dysplasia (LCEA <20°) ranged from 8.0% to 16.7%, apart from the white group, in which prevalence was only 1.9% ( P = .03).

Conclusion:

The prevalence of a cam deformity and acetabular dysplasia differed between ethnicities in this cohort of professional male soccer players. These findings suggest that there may be ethnic differences in both acetabular morphology and femoral bony response to athletic load.
Twenty-Year Outcome of a Longitudinal Prospective Evaluation of Isolated Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon or Hamstring Autograft
Authors: Thompson Simon Michael , Salmon Lucy J. , Waller Alison , Linklater James , Roe Justin P. , Pinczewski Leo A.
Published: August 2016

Background:

Long-term prospective studies of isolated endoscopic anterior cruciate ligament (ACL) reconstruction are limited and may include confounding factors.

Purpose:

This study aimed to compare the outcomes of isolated ACL reconstruction using the patellar tendon (PT) autograft and the hamstring (HT) autograft in 180 patients over 20 years.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A total of 180 participants undergoing isolated ACL reconstruction between 1993 and 1994 were prospectively recruited. Evaluation was performed at 1, 2, 5, 7, 10, 15, and 20 years after surgery and included the International Knee Documentation Committee (IKDC) knee ligament evaluation with radiographic evaluation, KT-1000 arthrometer side-to-side difference, and subjective scores.

Results:

Over 20 years, there were 16 patients (18%) and 9 patients (10%) with an ACL graft rupture in the HT and PT groups, respectively ( P = .13). ACL graft rupture was associated with male sex (odds ratio [OR], 3.9; P = .007), nonideal tunnel position (OR, 3.6; P = .019), and age <18 years at the time of surgery (OR, 4.6; P = .003). The odds of a contralateral ACL rupture were increased in patients with the PT graft compared with patients with the HT graft (OR, 2.2; P = .02) and those aged <18 years at the time of surgery (OR, 3.4; P = .001). The mean IKDC scores at 20-year follow-up were 86 and 89 for the PT and HT groups, respectively ( P = .18). At 20 years, 53% and 57% of the PT and HT groups participated in strenuous or very strenuous activities ( P = .55), kneeling pain was present in 63% and 20% of the PT and HT groups ( P = .018), and radiographic osteoarthritic change was found in 61% and 41% of the PT and HT groups ( P = .008), respectively.

Conclusion:

Compared with patients who received the HT graft, patients who received the PT graft had significantly worse outcomes with regard to radiologically detectable osteoarthritis, kneeling pain, and contralateral ACL injury. At 20-year follow-up, both HT and PT autografts continued to provide good subjective outcomes and objective stability. However, further ACL injury is common, particularly in male individuals, younger patients, and those with tunnel malposition.
Acute Precipitants of Physical Elder Abuse: Qualitative Analysis of Legal Records From Highly Adjudicated Cases
Authors: Rosen Tony , Bloemen Elizabeth M. , LoFaso Veronica M. , Clark Sunday , Flomenbaum Neal E. , Breckman Risa , Markarian Arlene , Riffin Catherine , Lachs Mark S. , Pillemer Karl
Published: August 2016

Elder abuse is a common phenomenon with potentially devastating consequences for older adults. Although researchers have begun to identify predisposing risk factors for elder abuse victims and abusers, little is known about the acute precipitants that lead to escalation to physical violence. We analyzed legal records from highly adjudicated cases to describe these acute precipitants for physical elder abuse. In collaboration with a large, urban district attorney’s office, we qualitatively evaluated legal records from 87 successfully prosecuted physical elder abuse cases from 2003 to 2015. We transcribed and analyzed narratives of the events surrounding physical abuse within victim statements, police reports, and prosecutor records. We identified major themes using content analysis. We identified 10 categories of acute precipitants that commonly triggered physical elder abuse, including victim attempting to prevent the abuser from entering or demanding that he or she leave, victim threatening or attempting to leave/escape, threat or perception that the victim would involve the authorities, conflict about a romantic relationship, presence during/intervention in ongoing family violence, issues in multi-generational child rearing, conflict about the abuser’s substance abuse, confrontation about financial exploitation, dispute over theft/destruction of property, and disputes over minor household issues. Common acute precipitants of physical elder abuse may be identified. Improved understanding of these acute precipitants for escalation to physical violence and their contribution to elder abuse may assist in the development of prevention and management strategies.
Breastfeeding Support in Spanish Neonatal Intensive Care Units and the Baby-Friendly Hospital Initiative
Authors: Alonso-Díaz Clara , Utrera-Torres Isabel , de Alba-Romero Concepción , Flores-Antón Beatriz , Lora-Pablos David , Pallás-Alonso Carmen Rosa
Published: August 2016

Background:

The Baby-Friendly Hospital Initiative (BFHI) has a positive effect on breastfeeding in maternity wards; however, few studies have examined to what degree it affects care in neonatal intensive care units (NICUs). Recently, the BFHI has been adapted to the NICUs (Neo-BFHI).

Objective:

This study aimed to compare breastfeeding support in Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited (group 1) with NICUs in hospitals that have not yet begun this initiative (group 2).

Methods:

A validated questionnaire on breastfeeding support was distributed to level II and III NICUs in Spanish public hospitals. A univariate analysis and an analysis adjusted for the number of beds in NICUs were conducted. The results of the analysis of 36 breastfeeding support measures are presented in accordance with the Ten Steps to Successful Breastfeeding adapted to NICUs.

Results:

Of the 141 participating NICUs, 129 (91%) responded to the questionnaire: 38 NICUs from group 1 and 91 NICUs from group 2. Group 1 had implemented a higher number of breastfeeding support measures than group 2. There were significant differences in 18 measures related to steps 2, 4, 5, 7, and 8 of the Neo-BFHI. In addition, a comparison of NICUs in hospitals with full accreditation (7 of 129) with those in group 2 revealed significant differences in 7 measures pertaining to steps 2, 5, 8, and 9.

Conclusion:

The Spanish NICUs in hospitals with BFHI accreditation or in the process of being accredited have better implementation of practices to promote and support breastfeeding.
Crisis Neoliberalism and Regimes of Permanent Exception
Authors: Davidson Neil
Published: August 2016

Since the world system emerged in the mid-19th century, the stages of capitalist development have all been initiated by economic crises. But unlike the crises of 1873, 1929 or 1973, that of 2007 did not signal the end of the neoliberal stage, but rather its continuation in more extreme forms. This break in the previous pattern requires us to periodize neoliberalism itself and understand how the cumulative effect of the policies implemented during the ‘vanguard’ and ‘social’ periods prepared the way for the current ‘crisis’ period, by restricting the options available to political and state managerial representatives of capital. By reorganizing political economy in such a way that states respond to short-term demands by key sectors of capital rather than the needs of the system as a whole, neoliberalism has inadvertently undermined the accumulation process, producing permanent ‘states of exception’ as the only means of containing the resulting social crisis.
Cooperative Dynamics During the Financial Crisis: Evidence From Basque and Breton Case Studies
Authors: Narvaiza Lorea , Aragon-Amonarriz Cristina , Iturrioz-Landart Cristina , Bayle-Cordier Julie , Stervinou Sandrine
Published: August 2016

In the recent financial crisis period, when traditional economic organizations were not able to meet stakeholders’ expectations, not-for profit organizations such as cooperatives became an optimal solution as they are expected to serve social and economic performance simultaneously. This theoretical assumption is questioned based on the downturn pressures that may weaken cooperatives’ social performance in favor of economic performance. This degeneration process is countered by some traditional cooperatives that have developed regeneration dynamics. The aim of our study is to explore how small and medium cooperatives face degeneration and develop regeneration dynamics in periods of crisis. To fulfill the objective of the article, four small and medium Basque and Breton cooperatives are studied in depth.
X. Functionalism, Darwinism, and intersectionality: Using an intersectional perspective to reveal the appropriation of science to support the status quo
Authors: Shields Stephanie A
Published: August 2016

Why should anyone care about long-dead 19th-century scientists’ thoughts about the differences between women and men? And what does such a paper have to say to our contemporary concerns? I believe that knowledge of this history is invaluable to the health and progress of feminist psychology. This history, when viewed through an intersectional lens, can give us insight into the complex way in which values can constrict research questions and methods, can narrow and oversimplify what counts as “data,” and can be used as a regressive instrument to shore up the sociocultural status quo. In this paper I first briefly review the context in which “Functionalism, Darwinism, and the Psychology of Women” (hereinafter Functionalism/Darwinism) was written. Then I examine what the addition of an intersectionality perspective to that work adds to our understanding of the history of the psychology of women and gender. I focus on the intersection of gender and race (and briefly touch on social class) because these were critical to 19th-century scientific justifications for existing status and power relations.
Auto-brewery syndrome: Ethanol pseudo-toxicity in diabetic and hepatic patients
Authors: Hafez EM , Hamad MA , Fouad M , Abdel-Lateff A
Published: August 2016

Endogenous alcohol has been applied for spontaneous ethanol production via different metabolic pathways of the human body. Auto-brewery syndrome describes the patients with alcohol intoxication after ingesting carbohydrate-rich meals. The main objective of this study is to investigate the effect of diabetes mellitus (DM), liver cirrhosis (LC) and presence of both (DM and LC) on blood alcohol concentration (BAC) especially after carbohydrate ingestion. BAC has been measured by headspace gas chromatography-mass spectrometry in three groups of humans namely control, DM, LC and both (DM and LC) groups. The results showed that BAC in control group was 0.01–.3 mg/dL with mean 0.3 ± 0.41 mg/dL. In patients with DM, BAC is significantly higher than that of control group 4.85 ± 3.96 mg/dL. In patients with LC, BAC was 3.45 ± 2.65 mg/dL. In patients with both DM and LC, BAC increases to reach 10.88 ± 5.36 mg/dL. Endogenous ethanol production appears to increase in DM and LC. Also, it increased much more in patients with both diseases, but it did not reach toxic levels. On comparing BAC and blood glucose level in each group, all groups show insignificant correlations ( p > 0.05).
Neural correlates of absolute pitch: A review
Authors: Hou Jiancheng , Chen Andrew CN , Song Bei , Sun Changan , Beauchaine Theodore P.
Published: August 2016

Absolute pitch (AP) is the ability to identify and/or produce specific music notes without a reference tone from the Western tonal system. Functional imaging studies show that AP is subserved by a network of interconnected neural structures including the left posterior dorsolateral frontal cortex (DLFC), the bilateral planum temporale (PT), and other brain regions. Neurophysiological studies show that AP possessors do not always require context updating during pitch identification due to possible “tonal templates”, and that AP appears to emerge at a late processing stage that is associated with multiple cognitive strategies and is facilitated by music training at early ages. Morphometry studies show decreased cortical thickness and gray matter concentration among those with AP, which may reflect increased efficiency of AP skill. Graph theoretical analyses of cortical thickness covariations show involvement of higher-order auditory processing, working memory, and semantic memory processes. Diffusion tensor imaging studies provide evidence for a neural pathway between the left posterior DLFC and the left PT, which establishes retrieval and manipulation of verbal-tonal associations. Compared to AP musicians, quasi-AP (QAP) musicians have an extensive right hemisphere network implicated in auditory working memory and show the bilateral structural characteristics of PT morphometry. Future research should confirm the definition of PT boundary and the role of (bi)lateralization of PT in AP ability, develop a standard AP test, identify genetic bases of AP, and describe relations between AP, tonal languages, and associated neural functions and structures among non-musicians with AP ability.
Testing a Social Cognitive Model of Workplace Sexual Identity Management
Authors: Tatum Alexander K. , Formica Louis J. , Brown Steven D.
Published: August 2016

Lent and Brown proposed a social cognitive career self-management process model that extended prior social cognitive career theory (SCCT) content models to explain the conditions under which people will engage in career management behaviors (e.g., career exploration). We tested the SCCT self-management model in the context of workplace sexual identity management. The model hypothesizes that engagement in sexual identity management strategies in the workplace is facilitated by strong sexual identity management self-efficacy beliefs and positive outcome expectations for engaging in sexual identity management behaviors. The model also posits that additional person and contextual variables will influence engagement in sexual identity management behaviors directly as well as indirectly via self-efficacy beliefs and outcome expectations. Using a sample of 152 sexual minority participants drawn from community Internet mailing lists, partial and full mediation models of workplace sexual identity disclosure were tested using theoretically relevant person input (i.e., concealment motivation) and contextual (i.e., workplace climate) variables. Results supported a partially mediated model suggesting that concealment motivation and workplace climate influence workplace disclosure directly as well as indirectly through self-efficacy and positive outcome expectations. Policy and social justice implications for the results are discussed and future research directions are considered.
Cognitive Benefits for Senders
Authors: Yoo Sung Woo , Kim Ji Won , Gil de Zúñiga Homero
Published: August 2016

Using panel data, this article examines the democratic benefit of expressing political messages on social media, by looking into the sender effect of information processing. Results suggest people who post textual and visual content tend to elaborate upon information themselves. The effect is different depending upon types of discussion motivations for discussion. Civic intentions such as persuasive discussion motivation led to elaboration about the information, while social discussion motivation did not. The relationship was mediated by news-seeking behaviors. Combining findings, this study proposes a theoretical model that implies a virtuous cycle of information flow on the social media sphere.
Ethics, Methods, and Measures in Intimate Partner Violence Research: The Current State of the Field
Authors: Bender Annah K.
Published: August 2016

Although intimate partner violence (IPV) is a well-studied topic, surprisingly little consensus among researchers has been reached with regard to the definition and measurement of its major typologies and constructs. The rigorous development and testing of prevention and intervention strategies on a large scale are hampered by many of these methodological difficulties as well as ethical considerations that make conducting IPV research difficult. The author presents a review of the current state of IPV research in these three areas (ethics, methods, and measurement) with suggestions for innovative research possibilities building from this status quo. Moving the field of IPV research forward is necessary to establish a broader evidence base for the prevention and treatment of abuse and to improve outcomes for survivors of IPV.
Between philosophy and cultural psychology: Pragmatist and semiotic reflections on the thresholds of sense
Authors: Innis Robert E
Published: August 2016

Cultural psychology has multiple points of intersection with some of the central themes and issues of philosophy, especially a philosophy that is not self-absorbed with problems purely of its own making or over which it claims exclusive rights even if they clearly need multiple analytical approaches. The “problems of philosophy” should be, and are, our problems, vitally important issues embedded in what John Dewey called “problematic situations” that bear upon what for the pragmatist tradition are the defining matrices for “the conduct of life.” Like such a pragmatist philosophy and other traditions that look outward over the broad landscape of life, cultural psychology is concerned with the manifold “ways of knowing and acting” that mark the intentional bonds and webs of transactions between us and what we call “the world.” It recognizes a plurality of forms of apprehension and patterns of meaningful action especially in their social contexts and conditions. It further recognizes, in line with the semiotic turn in philosophy, that the defining feature of human beings is rooted in (a) differentiated processes of the production and interpretation of signs, a meaning-making power unmatched in nature that unfolds at both the upper and lower thresholds of sense-giving and sense-reading and (b) the systematic production and use of material tools, instruments, and objects to modify the environment and the producers themselves and which embody or exemplify existential stances, values, and ends-in-view.
Out with the old, in with the new? Perceptions of social (and other) media by local and regional Norwegian politicians
Authors: Larsson Anders Olof , Skogerbø Eli
Published: August 2016

The role of social media has been studied extensively within a series of national political contexts. However, only few studies have focused on the uses of social media by local or regional politicians. This exploratory study presents results from a survey regarding the professional communication habits of Norwegian local and regional politicians. The main results indicate that while services like Facebook and Twitter have gained considerable popularity among politicians, the bulk of respondents find traditional channels of communication more important. Moreover, while the respondents largely acknowledge the interactive potential of novel services, considerable differences concerning use and adoption can be found among the politicians.
Modeling relevance of mobile communication services by social setting dimensions
Authors: Menichelli Elena , Ling Richard
Published: August 2016

There is little research examining the confluence of what communication channel is used for which purpose with which person. This study examines the “setting” for communication that includes what is communicated (e.g. positive or negative messages), the nature of the relationship (close versus distant), and the information channel. The respondents to a web-based questionnaire ( n = 627) were Norwegian smartphone users aged 16–35 years. Respondents evaluated mobile communication services that they used in specific social settings by “checking off” all that apply. Two methods of analysis are used to examine the material. First, a Principal Component Regression validated the main method, namely a mixed model for the Analysis of Variance. Results show the probability of using a mobile communication service is based on the effects of social group, communication purpose, communication channel, and their interaction. The relationship to the interlocutor was found to have the strongest effect on channel choice.
Finite element analysis and experimental study of plastic lattice structures manufactured by selective laser sintering
Authors: Niu Jie , Choo Hui Leng , Sun Wei
Published: August 2016

The availability of additive manufacturing technologies in particular the selective laser sintering process has enabled the fabrication of high strength, lightweight and complex cellular lattice structures. In this study, the effective mechanical properties of selective laser sintering produced periodic lattice structures were investigated. Three different types of lattice structures were designed by repeating three types of open-form unit cells consisting of triangular prism, square prism and hexagonal prism. A novel approach of creating the complex and conformable lattice structures using traditional modelling software such as Creo® proposed by the authors was used. Based on the predesigned lattice structures, finite element analysis was carried out to evaluate the mechanical properties of these structures. For the experimental study, nylon samples were printed using a plastic selective laser sintering system and tested using a universal testing machine. Finite element analysis results show that lattice structures with triangular prism perform better than the other two prisms in terms of Young’s modulus to relative density ratio. Tensile tests results show good conformance with the results obtained from finite element analysis.
Incidental Dose to Pelvic Nodal Regions in Prostate-Only Radiotherapy
Authors: Murthy Vedang , Lewis Shirley , Sawant Mayur , Paul Siji N. , Mahantshetty Umesh , Shrivastava Shyam Kishore
Published: August 2016

Objectives:

Pelvic lymph nodal regions receive an incidental dose from conformal treatment of the prostate. This study was conducted to investigate the doses received by the different pelvic nodal regions with varying techniques used for prostate radiotherapy.

Methods and Materials:

Twenty patients of high-risk node-negative prostate cancer treated with intensity-modulated radiotherapy to the prostate alone were studied. Replanning was done for intensity-modulated radiotherapy, 3-dimensional conformal treatment, and 2-dimensional conventional radiotherapy with additional delineation of the pelvic nodal regions, namely, common iliac (upper and lower), presacral, internal iliac, obturator, and external iliac. Dose–volume parameters such as Dmean, D100%, D66%, D33%, V40, and V50 to each of the nodal regions were estimated for all patients.

Results:

The obturator nodes received the highest dose among all nodal regions. The mean dose received by obturator nodal region was 44, 29, and 22 Gy from 2-dimensional conventional radiotherapy, 3-dimensional conformal treatment, and intensity-modulated radiotherapy, respectively. The mean dose was significantly higher when compared between 2-dimensional conventional radiotherapy and 3-dimensional conformal treatment ( P < .001), 2-dimensional conventional radiotherapy and intensity-modulated radiotherapy ( P < .001), and 3-dimensional conformal treatment and intensity-modulated radiotherapy ( P < .001). The D33% of the obturator region was 64, 39, and 37 Gy from 2-dimensional conventional radiotherapy, 3-dimensional conformal treatment, and intensity-modulated radiotherapy, respectively. The dose received by all other pelvic nodal regions was low and not clinically relevant.

Conclusion:

The incidental dose received by obturator regions is significant especially with 2-dimensional conventional radiotherapy and 3-dimensional conformal treatment techniques as used in the trials studying elective pelvic nodal irradiation. However, with intensity-modulated radiotherapy, this dose is lower, making elective pelvic irradiation more relevant.

Advances in Knowledge:

This study highlights that incidental dose received by obturator regions is significant especially with 2-dimensional conventional radiotherapy and 3-dimensional conformal treatment techniques.
A narrative approach to studying symbolic boundaries among drug users: A qualitative meta-synthesis
Authors: Copes Heith
Published: August 2016

The narrative study of identity promotes the idea that people develop social identities by telling stories about themselves and others. Through these stories, people associate with desired groups and create social boundaries separating them from the less desirable. While all people engage in boundary work, it is especially important for those who are physically or socially near members of stigmatized groups (e.g. drug users). My aim here is to examine how drug users narratively create symbolic boundaries to differentiate types of users (i.e. functional vs. dysfunctional). To elaborate on the general characteristics of these symbolic boundaries, I rely on qualitative meta-synthesis of research on boundary work among drug users and insights from my own research with people who use drugs. I draw from narrative identity theory to locate the places from which they derive their stories when creating symbolic boundaries and the content of the symbolic boundaries. I discuss the role of symbolic boundaries in facilitating drug use and inhibiting recovery and conclude by discussing the theoretical importance of using narrative criminology for understanding boundary development, boundary maintenance, and the content of boundaries.
Impact of the implementation of an evidence-based guideline on diagnostic testing, management, and clinical outcomes for infants with bronchiolitis
Authors: Henao-Villada Ricardo , Sossa-Briceño Monica P. , Rodríguez-Martínez Carlos E.
Published: August 2016

Background:

Although bronchiolitis poses a significant health problem in low- and middle-income countries (LMICs), to the best of our knowledge, to date it has not been determined whether evidence-based bronchiolitis clinical practice guidelines (CPGs) complemented by standardized educational strategies reduce the use of unnecessary diagnostic tests and medications and improve clinically important outcomes in LMICs.

Methods:

In an uncontrolled before and after study, we assessed the impact of the implementation of an evidence-based bronchiolitis CPG on physician behavior and the care of infants with bronchiolitis by comparing pre-guideline (March to August 2014) and post-guideline (March to August 2015) use of diagnostic tests and medications through an electronic medical record review in a children’s hospital in Bogota, Colombia. We also sought to assess the impact of the implementation of the CPG on clinically important outcomes such as lengths of stay, hospital admissions, intensive care admissions, and hospital readmissions.

Results:

Data from 662 cases of bronchiolitis (pre-guideline period) were compared with the data from 703 cases (post-guideline period). On comparing the pre- and post-guideline periods, it was seen that there was a significant increase in the proportion of patients with an appropriate diagnosis and treatment of bronchiolitis (36.4% versus 44.5%, p = 0.003), and there were statistically significant decreases in the use of a hemogram (33.2% versus 26.6%, p=0.010), procalcitonin (3.9% versus 1.6%, p=0.018), nebulized beta-2 agonists (45.6% versus 3.4%, p < 0.001), nebulized anticholinergics (3.3% versus 1.4%, p= 0.029), and nebulized epinephrine (16.2% versus 7.8%, p < 0.001). Likewise, a significant increase in the use of nebulized hypertonic saline was seen (79.6% versus 91.7%, p < 0.001). However, implementation of the CPG for bronchiolitis was not associated with significant changes in clinically important outcomes.

Conclusions:

The development and implementation of a good quality bronchiolitis CPG is associated with a significant increase in the proportion of cases with an appropriate diagnosis and treatment of the disease in the context of a university-based hospital located in the capital of an LMIC. However, we could not demonstrate an improvement in clinically important outcomes such as any of the bronchiolitis severity parameters.
Efficacy and tolerability of dimethyl fumarate in White-, African- and Hispanic- Americans with multiple sclerosis
Authors: Zhovtis Ryerson Lana , Green Rivka , Confident Gladyne , Pandey Krupa , Richter Benjamin , Bacon Tamar , Sammarco Carrie , Laing Lisa , Kalina Jennifer , Kister Ilya
Published: August 2016

Background:

Dimethyl fumarate (DMF) was approved by the US Food and Drug Administration (FDA) for treatment of relapsing–remitting multiple sclerosis (RRMS) based on two phase III randomized clinical trials (RCTs). There were not enough non-White patients enrolled in these RCTs to allow for subgroup analysis based on race. Efficacy and tolerability of DMF therapy across various racial groups is unknown.

Methods:

Retrospective chart review was performed on all patients with RRMS who were started on DMF in two tertiary multiple sclerosis (MS) clinics. Efficacy and tolerability of DMF was compared across three self-identified racial groups: White-American (WA), African-American (AA) and Hispanic-American (HA).

Results:

A total of 390 RRMS patients were included in the study: 261 (66.9%) WA, 69 (17.7%) AA and 52 (13.3%) HA. When comparing ‘pre-DMF’ (1 year) and ‘on DMF’ (mean follow up of 14 months) periods, statistically significant reduction in rates of annualized relapses (WA from 0.44 to 0.19, AA from 0.39 to 0.15, and HA from 0.39 to 0.14; no differences between groups), new T2 lesions (WA from 45% to 23%, AA from 39% to 23%, HA from 52% to 26%; no difference between groups), and Gd+ lesions (WA from 25% to 13%, AA from 24% to 7%, HA from 23% to 12%; no difference between groups) were seen. DMF was relatively well tolerated across all groups, with an overall discontinuation rate of 20% (no difference between the three groups).

Conclusion:

Efficacy of DMF in our clinic population did not differ across three major ethnic groups, WA, AA and HA, and was comparable with results observed in the pivotal studies. These ‘real-life’ data suggest that race is not a factor that needs to be taken into account when initiating DMF.
Environmental Variables That Influence Patient Satisfaction
Authors: MacAllister Lorissa , Zimring Craig , Ryherd Erica
Published: August 2016

Patient’s perception of care—referred to as patient satisfaction—is of great interest in the healthcare industry, as it becomes more directly tied to the revenue of the health system providers. The perception of care has now become important in addition to the actual health outcome of the patient. The known influencers for the patient perception of care are the patient’s own characteristics as well as the quality of service received. In patient surveys, the physical environment is noted as important for being clean and quiet but is not considered a critical part of patient satisfaction or other health outcomes. Patient perception of care is currently measured as patient satisfaction, a systematic collection of perceptions of social interactions from an individual person as well as their interaction with the environment. This exploration of the literature intends to explore the rigorous, statistically tested research conducted that has a spatial predictor variable and a health or behavior outcome, with the intent to begin to further test the relationships of these variables in the future studies. This literature review uses the patient satisfaction framework of components of influence and identifies at least 10 known spatial environmental variables that have been shown to have a direct connection to the health and behavior outcome of a patient. The results show that there are certain features of the spatial layout and environmental design in hospital or work settings that influence outcomes and should be noted in the future research.
Burden of upper gastrointestinal symptoms in patients prescribed dabigatran for stroke prevention
Authors: Chan Pak-Hei , Hai Jo-Jo , Huang Duo , Ho Mei-Han , Chan Esther W , Cheung Bernard Man-Yung , Chan Annie On-On , Wong Ian Chi-Kei , Tse Hung-Fat , Hung Ivan Fan-Ngai , Siu Chung-Wah
Published: August 2016

Background:

Dabigatran, a non-vitamin K antagonist oral anticoagulant, has been shown to prevent stroke in patients with non-valvular atrial fibrillation. Nonetheless, studies show that 10%–30% of those prescribed dabigatran experience dyspepsia that may eventually lead to discontinuation of therapy and loss of clinical benefit.

Aim:

To evaluate the gastrointestinal tolerability of dabigatran utilizing a validated questionnaire, as well as determining subsequent non-compliance and drug discontinuation.

Method:

This is an observational study. All patients were assessed by a validated questionnaire, Hong Kong dyspepsia index, prior to drug prescription and again 4 weeks later.

Results:

In this study, 115 patients with non-valvular atrial fibrillation (mean age: 74.6 ± 11.4 years; mean CHA2DS2-VASc score was 3.39 ± 1.59) were prescribed dabigatran. At baseline, the mean Hong Kong dyspepsia index was 12.9 ± 1.6 and nine patients had significant dyspepsia (Hong Kong dyspepsia index ⩾ 16). After 4 weeks, the mean Hong Kong dyspepsia index was similar at 12.6 ± 1.9 ( p = 0.23). There was no change in Hong Kong dyspepsia index after initiation of dabigatran in 59 (51.3%) patients, and improvement in 37 (32.2%). Only 19 (16.5%) patients had worsening of Hong Kong dyspepsia index, and among these 19 patients, only 1 patient (0.9%) discontinued dabigatran due to significant dyspepsia.

Conclusion:

Worsening of dyspepsia with dabigatran 110 mg twice daily was uncommon with correct drug administration and clear instructions provided. Systematic assessment of dyspeptic symptoms using a validated questionnaire (i.e. Hong Kong dyspepsia index) before and after treatment initiation allows a more objective comparison of dyspeptic symptoms.
Janata Party (1974–77): Creation of an All-India Opposition
Authors: Ankit Rakesh
Published: August 2016

This article focuses on the interactions among four parties during 1974–77 that led to their combining to form the Janata Party, which represented a united opposition to the then Prime Minister Mrs Indira Gandhi and her Congress government in January 1977. These inter-party exchanges remain an overlooked episode in the works on the Janata Party, when compared to its much written about the failure in government (1977–79). Forty years on, Janata Party’s formation continues to be understood as a natural and inevitable response to the imposition of emergency by Mrs Gandhi in June 1975. This article, instead, focuses on the engagements among the leaders of the Bharatiya Lok Dal (BLD), Congress (O), Bharatiya Jana Sangh (BJS) and the Socialist Party (SP) before, during and after the emergency and contends that Janata’s creation was neither a foregone conclusion nor a straightforward process. Second, this coming together of disparate individuals owed more to the possibility of gaining power and personal inclinations than any political principles or policy impulses. Third, while Jayaprakash Narayan (JP) is rightly celebrated as the rival protagonist in oppositional politics to Mrs Gandhi, this article argues that there were limits to his leadership in forging the new party and there was no automatic evolution of the latter from the former. This article is based on the papers of JP and his secretary Brahmanand and, supplemented by other relevant material, shows an unheralded facet of an attempt, which might have come to power on hyperbole but its formation was hard work.
Factors Influencing Adherence to Antiretroviral Therapy among People Living with HIV in Coastal South India
Authors: Banagi Yathiraj Arjun , Unnikrishnan Bhaskaran , Ramapuram John T. , Kumar Nithin , Mithra Prasanna , Kulkarni Vaman , Holla Ramesh , Darshan B. , Thapar Rekha
Published: August 2016

Background:

Antiretroviral Therapy (ART) has transformed life threatening HIV/AIDS scenario into chronic manageable disease.

Methodology:

In this cross-sectional, 409 People Living with Human Immunodeficiency Virus (PLHIV) aged ≥ 18 years, who were on ART, were assessed regarding the adherence to ART and factors affecting adherence using semi-structured questionnaire. The association between factors affecting adherence and the level of adherence were analyzed using multiple logistic regression model and odds ratio (OR) with 95% confidence intervals (CI) were reported.

Results:

Among 409 PLHIV, 70.4% showed adherence to ART (≥95%). Univariate analysis yielded many factor associated with adherence ( P < 0.05). However, on multivariate analysis, PLHIV who do not forget to take ART and not consuming alcohol were the factors consistent with adherence to ART ( P < 0.05).

Conclusion:

Regular patient education and counseling regarding the usage of memory aids and abstinence from alcohol could be useful for adherence and long term success of ART among PLHIV.
Abnormal orthostatic blood pressure control among subjects with lacunar infarction
Authors: Ryan Daniel J , Kenny Rose Anne , Finucane Ciaran , Meaney James F , Collins Daniel R , Walsh Suzanne , Harbison Joseph A
Published: August 2016

Introduction

Hypertension is a recognised risk factor for lacunar stroke. However, their association has been evaluated using static blood pressure (BP) assessment in supine or sitting position alone. We hypothesised that impaired dynamic (orthostatic) BP control may associate with lacunar strokes.

Patients and methods

Consecutive subjects with mitral regurgitation (MR) confirmed, lacunar strokes were compared with two control groups. Firstly “normal”, age and sex matched, population controls (1:3 ratio) and then ‘at risk’ controls matched for age, sex, hypertension history and antihypertensive medication (1:2 ratio). Orthostatic BP control was assessed by active stand tests with continuous, phasic, beat-to-beat BP measurement.

Findings

Thirty-six subjects (mean 69.9 years) were compared with 108 controls in group 1 and 72 in group 2. Prevalence of syncope was higher among those with lacunar stroke (cases: 44.4%, group 1: 17.6%, p = 0.003, group 2: 12.5%, p = 0.0004, Fisher’s exact). Mean baseline systolic BP (SBP) was significantly higher in cases (cases: 150 mm Hg, group 1: 140 mm Hg, p = 0.03, group 2: 143 mm Hg, p = 0.1). Ten seconds after standing, SBP dropped significantly less in cases (cases: −14.1 mm Hg, group 1: −31.4 mm Hg, p < 0.0005, group 2: −27.3 mm Hg, p = 0.001, t test). Diastolic BP also fell significantly less in cases. Cases’ SBP and DBP recovered to, then persistently overshot baseline levels.

Discussion and conclusion

Subjects with MR-defined lacunar stroke, of likely small vessel aetiology, exhibit orthostatic hypertension compared with population norms.
Mechanisms of exertional dyspnoea in symptomatic smokers without COPD
Authors: Elbehairy Amany F. , Guenette Jordan A. , Faisal Azmy , Ciavaglia Casey E. , Webb Katherine A. , Jensen Dennis , Ramsook Andrew H. , Neder J. Alberto , O'Donnell Denis E.
Published: August 2016

Dyspnoea and activity limitation can occur in smokers who do not meet spirometric criteria for chronic obstructive pulmonary disease (COPD) but the underlying mechanisms are unknown.

Detailed pulmonary function tests and sensory–mechanical relationships during incremental exercise with respiratory pressure measurements and diaphragmatic electromyography (EMGdi) were compared in 20 smokers without spirometric COPD and 20 age-matched healthy controls.

Smokers (mean±sdpost-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity 75±4%, mean±sdFEV1104±14% predicted) had greater activity-related dyspnoea, poorer health status and lower physical activity than controls. Smokers had peripheral airway dysfunction: higher phase-III nitrogen slopes (3.8±1.8versus2.6±1.1%·L−1) and airway resistance (difference between airway resistance measured at 5 Hz and 20 Hz 19±11versus12±7% at 5 Hz) than controls (p<0.05). Smokers had significantly (p<0.05) lower peak oxygen uptake (78±40versus107±45% predicted) and ventilation (61±26versus97±29 L·min−1). Exercise ventilatory requirements, operating lung volumes and cardio-circulatory responses were similar. However, submaximal dyspnoea ratings, resistive and total work of breathing were increased in smokers compared with controls (p<0.05); diaphragmatic effort (transdiaphragmatic pressure/maximumal transdiaphragmatic pressure) and fractional inspiratory neural drive to the diaphragm (EMGdi/maximal EMGdi) were also increased (p<0.05) mainly reflecting the reduced denominator.

Symptomatic smokers at risk for COPD had greater exertional dyspnoea and lower exercise tolerance compared with healthy controls in association with greater airways resistance, contractile diaphragmatic effort and fractional inspiratory neural drive to the diaphragm.
Predictors of functional independence, quality of life, and return to work in patients with burn injuries in mainland China
Authors: Tang Dan , Li-Tsang Cecilia W. P. , Au Ricky K. C. , Shen Xia , Li Kui-cheng , Yi Xian-feng , Liao Lin-rong , Cao Hai-yan , Feng Ya-nan , Liu Chuan-shun
Published: August 2016

Background

Burn injury may be associated with long-term rehabilitation and disability, while research studies on the functional performance after injuries, quality of life (QOL), and abilities to return to work of burn patients are limited. These outcomes are related not just to the degree and nature of injuries, but also to the socio-economical background of the society. This study aimed to identify the factors which might affect burn patients’ abilities to reintegrate back to the society based on a sample in mainland China.

Methods

A retrospective study was conducted to collect data of demographic characteristics, medical data about burn injuries, physical and psychological status, and self-perceived QOL at the initial phase and upon discharge from a rehabilitation hospital, timing of rehabilitation, and duration of rehabilitation intervention. Four hundred fifteen patients with burn injuries were recruited in the study. Multiple linear regression and logistic regression were used to obtain a model to predict the functional abilities and the perceived QOL at discharge and their changes during rehabilitation, as well as the post-injury work status within 6 months after discharge.

Results

The functional performance at discharge and its change were significantly predicted by the functional abilities and QOL at the admission, duration of treatment, timing of rehabilitation, payer source, and total body surface area burned. The perceived QOL at discharge and its change were significantly predicted by the baseline QOL at admission and duration of treatment. The significant predictors of work status within 6 months post-discharge included age, education, payer source, total body surface area burned, perceived QOL, and bodily pain at admission.

Conclusions

The present study identified a number of factors affecting the rehabilitation outcomes of people with burn injuries. Identification of these predictors may help clinicians assess the rehabilitation potential of burn survivors and assist in resource allocation. Policy makers should ensure that resources are adequate to improve the outcomes based on these factors.
Socioeconomics and quality of life of Irish patients undergoing cardiac surgery Cork, Ireland
Authors: Flynn Angela , Doherty Cathal , Byrne Margaret
Published: August 2016

Aim:

This article examines the social and demographic characteristics and quality of life (QoL) of a sample of patients undergoing cardiac surgery and rehabilitation in an Irish hospital.

Background:

Sociodemographic factors influence the risks of developing diseases as well as the outcomes of treatments. Risk factors for cardiovascular disease (CVD) have been thoroughly researched and are clearly identifiable. Evidence also exists demonstrating that individuals from some sociodemographic groups have higher risks of developing CVD than others.

Methods:

A prospective study of 127 Irish preoperative cardiac surgical patients was carried out using a widely recognised quality of life self-report instrument (the SF-36) and a detailed demographics questionnaire.

Results:

QoL was found to relate to demographic variables including private health insurance cover.

Conclusions:

The results of this study provide a unique examination of the backgrounds of Irish cardiac patients allowing consideration of sociodemographic factors that warrant consideration when planning tailored, equally accessible health care intended to improve QoL.