bluuebunny/crossref_metadata_2025_split huggingface dataset:
Triglyceride Paradox Is Related to Lipoprotein Size, Visceral Adiposity and Stearoyl-CoA Desaturase Activity in Black Versus White Women
Authors: Chung Stephanie T. , Cravalho Celeste K.L. , Meyers Abby G. , Courville Amber B. , Yang Shanna , Matthan Nirupa Rachel , Mabundo Lilian , Sampson Maureen , Ouwerkerk Ronald , Gharib Ahmed M. , Lichtenstein Alice H. , Remaley Alan T. , Sumner Anne E. 
Published: October 2019

Rationale:
In black women, triglycerides are paradoxically normal in the presence of insulin resistance. This relationship may be explained by race-related differences in central adiposity and SCD (stearoyl-CoA desaturase)-1 enzyme activity index.

Objective:
In a cross-sectional study, to compare fasting and postprandial triglyceride-rich lipoprotein particle (TRLP) concentrations and size in black compared with white pre- and postmenopausal women and determine the relationship between TRLP subfractions and whole-body insulin sensitivity, hepatic and visceral fat, and SCD-1 levels.

Methods and Results:

In 122 federally employed women without diabetes mellitus, 73 black (58 African American and 15 African immigrant) and 49 white; age, 44±10 (mean±SD) years; body mass index, 30.0±5.6 kg/m
2
, we measured lipoprotein subfractions using nuclear magnetic resonance. Hepatic fat was measured by proton magnetic resonance spectroscopy, insulin sensitivity index calculated by minimal modeling from a frequently sampled intravenous glucose test, and red blood cell fatty acid profiles were measured by gas chromatography and were used to estimate SCD-1 indices. Hepatic fat, insulin sensitivity index, and SCD-1 were similar in black women and lower than in whites, regardless of menopausal status. Fasting and postprandial large, medium, and small TRLPs, but not very small TRLPs, were lower in black women. Fasting large, medium, and very small TRLPs negatively correlated with insulin sensitivity index and positively correlated with visceral and hepatic fat and SCD-1 activity in both groups. In multivariate models, visceral fat and SCD-1 were associated with total fasting TRLP concentrations (adjR2, 0.39;
P
=0.001). Black women had smaller postprandial changes in large (
P
=0.005) and medium TRLPs (
P
=0.007).

Conclusions:
Lower visceral fat and SCD-1 activity may contribute to the paradoxical association of lower fasting and postprandial TRLP subfractions despite insulin resistance in black compared with white pre- and postmenopausal women. Similar concentrations of very small TRLPs are related to insulin resistance and could be important mediators of cardiometabolic disease risk in women.

Clinical Trial Registration:

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01809288.
Sixteen‐Week Physical Activity Intervention in Subjects With Increased Cardiometabolic Risk Shifts Innate Immune Function Towards a Less Proinflammatory State
Authors: Noz Marlies P. , Hartman Yvonne A. W. , Hopman Maria T. E. , Willems Peter H. G. M. , Tack Cees J. , Joosten Leo A. B. , Netea Mihai G. , Thijssen Dick H. J. , Riksen Niels P. 
Published: October 2019

Background
Low‐grade inflammation, largely mediated by monocyte‐derived macrophages, contributes to atherosclerosis. Sedentary behavior is associated with atherosclerosis and cardiovascular diseases (CVD). We examined whether reducing sedentary behavior and improving walking time improves monocyte inflammatory phenotype in subjects with increased cardiovascular risk.

Methods and Results

Across 2 waves, 16 individuals with increased
cardiovascular
risk performed a 16‐week intervention study (age 64±6 years, body mass index 29.9±4.3 kg/m
2
), using a device with vibration feedback to promote physical activity. Before and after intervention, we objectively examined physical activity (Activ
PAL
), cytokine production capacity after ex vivo stimulation in peripheral blood mononuclear cells, metabolism of peripheral blood mononuclear cells, circulating cytokine concentrations, and monocyte immunophenotype. Overall, no significant increase in walking time was found (1.9±0.7 to 2.2±1.2 h/day,
P
=0.07). However, strong, inverse correlations were observed between the change in walking time and the change in production of interleukin (
IL
)‐1β,
IL
‐6,
IL
‐8, and
IL
‐10 after lipopolysaccharide stimulation (
r
s
=−0.655, −0.844, −0.672, and −0.781, respectively, all
P
<0.05). After intervention optimization based on feedback from wave 1, participants in wave 2 (n=8) showed an increase in walking time (2.2±0.8 to 3.0±1.3 h/day,
P
=0.001) and attenuated cytokine production of
IL
‐6,
IL
‐8, and
IL
‐10 (all
P
<0.05). Glycolysis (
P
=0.08) and maximal
OXPHOS
(
P
=0.04) of peripheral blood mononuclear cells decreased after intervention. Lower
IL
‐6 concentrations (
P
=0.06) and monocyte percentages (
P
<0.05), but no changes in monocyte subsets were found.

Conclusions

Successfully improving walking time shifts innate immune function towards a less proinflammatory state, characterized by a lower capacity to produce inflammatory cytokines, in individuals with increased
cardiovascular
risk.

Clinical Trial Registration Information

URL:
http://www.trialregister.nl
. Unique identifier:
NTR
6387.
Metabolic Syndrome and Risk of Ischemic Stroke in Atrial Fibrillation
Authors: Decker Joseph J. , Norby Faye L. , Rooney Mary R. , Soliman Elsayed Z. , Lutsey Pamela L. , Pankow James S. , Alonso Alvaro , Chen Lin Y. 
Published: October 2019

Background and Purpose—

Metabolic syndrome (MetS), a prothrombotic state, is associated with an increased risk of atrial fibrillation (AF) and stroke. The CHA
2
DS
2
-VASc score does not account for the MetS components of prehypertension, prediabetes mellitus, abdominal obesity, elevated triglycerides, and low HDL (high-density lipoprotein). Data are limited on the association of MetS with stroke in AF, independent of CHA
2
DS
2
-VASc variables. Our aim was to identify MetS components associated with ischemic stroke in participants with AF in the ARIC study (Atherosclerosis Risk in Communities).

Methods—
We included 1172 participants with incident AF within 5 years of measurement of MetS components. MetS was defined by ATP criteria and International Diabetes Federation criteria. Incident ischemic stroke was physician adjudicated. Multivariable Cox proportional hazards regression was used to assess the association of MetS components with stroke.

Results—

After a median follow-up of 14.8 years, there were 113 ischemic stroke cases. Of the individual MetS components, low HDL was borderline associated with increased stroke risk (hazard ratio, 1.48 [95% CI, 0.99–2.21]) after adjustment for CHA
2
DS
2
-VASc variables while the remaining MetS variables were not associated with stroke risk. The presence of ≥3 components of MetS was not significantly associated with ischemic stroke after adjustment for CHA
2
DS
2
-VASc variables (hazard ratio, 1.38 [95% CI, 0.91–2.11]). The risk of stroke increased by 13% for each additional component of MetS; however, this association was borderline significant (hazard ratio, 1.13 [95% CI, 0.99–1.28]).

Conclusions—

The presence of MetS was not significantly associated with ischemic stroke after adjustment for CHA
2
DS
2
-VASc variables. Consideration of MetS is unlikely to improve stroke prediction in AF.
Training for Walking Efficiency With a Wearable Hip-Assist Robot in Patients With Stroke
Authors: Lee Hwang-Jae , Lee Su-Hyun , Seo Keehong , Lee Minhyung , Chang Won Hyuk , Choi Byung-Ok , Ryu Gyu-Ha , Kim Yun-Hee 
Published: October 2019

Background and Purpose—
The purpose of this study was to investigate the effects of gait training with a newly developed wearable hip-assist robot on locomotor function and efficiency in patients with chronic stroke.

Methods—
Twenty-eight patients with stroke with hemiparesis were initially enrolled, and 26 patients completed the randomized controlled trial (14 in the experimental and 12 in the control groups). The experimental group participated in a gait training program over a total of 10 sessions, including 5 treadmill sessions and 5 over-ground gait training sessions while wearing a hip-assist robot, the Gait Enhancing and Motivating System (GEMS, Samsung Advanced Institute of Technology, Suwon, Republic of Korea). The control group received gait training without Gait Enhancing and Motivating System. Primary outcome measured locomotor function and cardiopulmonary metabolic energy efficiency. Also, secondary outcome measured motor function and balance parameter.

Results—

Compared with the control group, the experimental group had significantly greater improvement in spatiotemporal gait parameters and muscle efforts after the training intervention (
P
<0.05). The net cardiopulmonary metabolic energy cost (mL·kg
−1
·min
−
1
) was also reduced by 14.71% in the experimental group after the intervention (
P
<0.01). Significant group×time interactions were observed for all parameters (
P
<0.05). Cardiopulmonary metabolic efficiency was strongly correlated with gait symmetry ratio in the experimental group (
P
<0.01).

Conclusions—
Gait training with Gait Enhancing and Motivating System was effective for improving locomotor function and cardiopulmonary metabolic energy efficiency during walking in patients with stroke. These findings suggest that robotic locomotor training can be adopted for rehabilitation of patients with stroke with gait disorders.

Clinical Trial Registration—

URL:
https://clinicaltrials.gov
. Unique identifier: NCT02843828.
South Africa’s Proposed Exit from the Rome Statute: Alternative Perspectives
Authors: Wabwile Michael Nyongesa 
Published: October 2019

AbstractIn the aftermath of the Omar al Bashir case, South Africa’s engagement with the International Criminal Court (hereafter the ICC) is at an anti-climax. Conventional perspectives from the decisions of the ICC assert the sanctity of treaty obligations. However, alternative perspectives can be explored. There is a need to address continuing dissatisfaction with and limitations of the Rome Statute. Dissent by States parties may signal need for review of the treaty and introduction of new procedures for conducting consultations with States to improve compliance. The Rome Statute does not deal with resolving on-going armed conflicts and should be complemented by alternative processes for addressing such threats to peace and security. Withdrawal from treaties is a normal fact of life in the international legal system. States exit from treaties when changed circumstances, shifting domestic priorities, or dissatisfaction with treaty-based institutions create tensions between national interests and international commitments. This would not necessarily be regarded as retrogressive. Exit by a significant number of important states may be the catalyst required for reform of contentious aspects of the treaty system. Therefore, South Africa’s proposed exit from the Rome Statute can be a potentially positive development.
Towards Effective Implementation of the African Charter on the Rights and Welfare of the Child in Egypt
Authors: Gyan Nyarko Michael 
Published: October 2019

AbstractThe adoption of the Convention on the Rights of the Child (CRC) in 1989 marked an important step towards the ‘legal recognition and protection of the rights of children’. The inadequacies of the CRC regarding some issues peculiar to the African child, however, led to the adoption of the African Charter on the Rights and Welfare of the Child (ACRWC or African Children’s Charter) in 1990, to complement the CRC and provide protection to children in peculiar African realities. The desired effects of the Charter will, however, only be achieved if its provisions are diligently implemented. Based on desk research and semi-structured interviews, this article discusses the implementation of the ACRWC in Egypt, highlighting the legislative and other measures adopted by Egypt to implement the provisions of the ACRWC. It also considers the role of the African Committee of Experts on the Rights and Welfare of the Child (African Children’s Committee) in ensuring implementation of the ACRWC in Egypt through the state reporting and complaint mechanisms and considers the measures adopted by Egypt towards the implementation of concluding observations of the African Children’s Committee. It concludes with recommendations on how Egypt can better implement the provisions of the ACRWC.
Is unemployment less important than expected for suicide attempted in developing regions? Occupational profile of suicide attempts in Jujuy, north westernmost Argentina
Authors: López Steinmetz Lorena Cecilia , López Steinmetz Romina Lucrecia , Godoy Juan Carlos 
Published: October 2019

Background: Mental health practices consider unemployment as a suicide main risk factor, based on models built for populations of developed countries. Aim: This study assesses the association between the occupational risk factor and suicidal behaviors, by considering sex, age and temporal distribution, in a Latin American Andean population from north westernmost Argentina. Methods: Data include 481 suicide attempt cases assisted by emergency service psychologists at a head hospital in the Jujuy Province, northern Argentina, during two biennials. General categories and specific types of occupational situation, sex, age and temporal distribution were analyzed. Results: 83.58% of cases corresponded to the with occupation category, but without occupation characterized male cases ( p-value = .01). The type no referred occupation (19.15%) mainly contributed to this association ( p-value = .02). Unemployed only represented 1.6%. These features revealed independent from the biennial period of assistance ( p-value = .96 (general), p-value = .86 (specific)). Associations by age ranges did not seem to be specific of suicidal attempts. Conclusion: The present contribution provides an occupational characterization of suicide attempts in an Andean population from north westernmost Argentina. Unemployment is not associated with suicidal behavior in this population, suggesting that dissimilar patterns underlie suicidal behavior of populations from developed and developing regions.
Validation of a method to measure three-dimensional hip joint kinematics in subjects with femoroacetabular impingement
Authors: Ward Thomas R , Hussain Mafruha M , Pickering Mark , Perriman Diana , Burns Al , Scarvell Jennie , Smith Paul N 
Published: October 2019

Introduction: A kinematic measurement method combining dynamic motion and imaging, which captures the behaviour of the hip at terminal motion, may offer improved diagnostic accuracy and enhance our understanding of the mechanics of femoroacetabular impingement (FAI). Methods: 3 embalmed cadaveric hip/pelvis specimens with implanted Roentgen Stereophotogrammetric Analysis (RSA) beads were mounted on a custom rig and imaged with a fluoroscope in four poses to simulate a clinical impingement examination: in hip extension and in three positions: near impingement, early impingement and late impingement while simulating a flexion/adduction/internal rotation manoeuvre. Hip joint kinematics were measured using 2 methods and compared: RSA (gold standard) and a custom 3-dimensional to 2-dimensional (3D–2D) image registration method which matches 3D models developed from CT to 2D fluoroscopic images. Results: Using RSA as the gold standard, bias and precision of hip joint rotations measured using 3D–2D registration demonstrated maximums of 1.64° and 3.96°, respectively. However, if the single outlier was removed, bias and precision were 0.55° and 1.38°. Bias and precision of translations had maximums of 0.51 mm and 0.77 mm, respectively. Conclusions: This 3D to 2D registration method may offer a clinically useful solution for dynamic assessment of hip impingement. If 5-mm translation and 10° of rotation represent a clinically significant difference in hip kinematics, the method’s accuracy of approximately 1 mm displacement and 1° rotation should enable detection of significant clinical differences.
The relationship between living with a spouse and mental health in the elderly population: Moderated mediation effects of loneliness and perceived problems
Authors: Soh Lin Ken , Pang Joyce S. 
Published: October 2019

Objectives: Study 1 investigated if the elderly’s perception of experiencing life problems moderates the effect of spousal living arrangements on their mental health, while study 2 first assessed loneliness as a mediator on the spousal living arrangements and mental health relationship, and then tested 2 moderated-mediation models whereby perceived problems moderates the mediation. Methods: Study 1 involved 135 participants aged 60 years and above (mean = 70.96; SD = 6.16); Study 2 involved 122 participants aged 65 years and above (mean = 74.85; SD = 6.91). Results: This study found simple moderation and mediation effects of perceived problems and loneliness, respectively, on the spousal living arrangements and mental health relationship. Furthermore, results showed that perceived problems moderate the loneliness and mental health link in a moderated-mediation model. Discussion: Findings inform potential interventions for elderly mental health. Interventions could focus on reducing loneliness and problems faced by the elderly, especially those with nonspousal living arrangements.
Sensitivity and specificity of an algorithm based on medico-administrative data to identify hospitalized patients with major bleeding presenting to an emergency department
Authors: Oger Emmanuel , Botrel Marie-Anne , Juchault Catherine , Bouget Jacques 
Published: October 2019

Abstract

Background
Validation studies on an ICD-10-based algorithm to identify major bleeding events are scarce, and mostly focused on positive predictive values.

Objective
To evaluate the sensitivity and specificity of an ICD-10-based algorithm in adult patients referred to hospital.

Methods
This was a cross-sectional, retrospective analysis. Among all hospital stays of adult patients referred to Rennes University Hospital, France, through the emergency ward in 2014, we identified major bleeding events according to an index test based on a list of ICD-10 diagnoses. As a reference, a two-step process was applied: firstly, a computerized request for electronic health records from the emergency ward, using several hemorrhage-related diagnostic codes and specific emergency therapies so as to discard stays with a very low probability of bleeding; secondly, a chart review of selected records was conducted by a medical expert blinded to the index test results and each hospital stay was classified into one of two exclusive categories: major bleeding or no major bleeding, according to pre-specified criteria.

Results
Out of 16,012 hospital stays, the reference identified 736 major bleeding events and left 15,276 stays considered as without the target condition. The index test identified 637 bleeding events: 293 intracranial hemorrhages, 197 gastrointestinal hemorrhages and 147 other bleeding events. Overall, sensitivity was 65% (95%CI, 62 to 69), and specificity was 99.0%. We observed differential sensitivity and specificity across bleeding types, with the highest values for intracranial hemorrhage. Positive predictive values ranged from 59% for “other” bleeding events, to 71% (95%CI, 65 to 78) for gastrointestinal hemorrhage, and 96% for intracranial hemorrhage.

Conclusions
Low sensitivity and differential measures of accuracy across bleeding types support the need for specific data collection and medical validation rather than using an ICD-10-based algorithm for assessing the incidence of major bleeding.
Association between the use of free-of-charge intrauterine devices and a history of induced abortion: a retrospective study
Authors: Ulbricht Sabina , Beyer Angelika , John Ulrich 
Published: October 2019

Abstract

Background
To determine whether use of intrauterine device (IUD) is influenced by a history of induced abortion and the type of contraceptives used until costs are covered.

Methods
We analyzed data from 301 female residents in Mecklenburg-West Pomerania, an economically challenged community. The women, aged between 20 and 35 years, were entitled to receive unemployment benefits, and had access to free-of-charge oral contraceptives, ring or IUD. Cross-sectional data were analyzed using logistic regression.

Results
There were 112 (37.2%) women with a history of induced abortion, and 46 (15.3%) reported exclusively using less effective contraceptives (e.g. condoms). In a univariate logistic regression, use of an IUD was associated with a history of having had an induced abortion. Furthermore, uptake of an IUD was associated with women who had, until costs were covered, exclusively choice to use less effective contraceptives (OR = 3.281, 95% CI: 1.717; 6.273). Both associations remained significant in a multivariate model.

Conclusions
Free contraceptives provided to women receiving unemployment benefits may increase the use of IUDs, especially among those with a history of an induced abortion and those using less effective contraceptives.
Insights into student assessment outcomes in rural clinical campuses
Authors: Shulruf Boaz , Velan Gary , Forster Lesley , O’Sullivan Anthony , Harris Peter , Taylor Silas 
Published: October 2019

Abstract

Background
There is an ongoing debate about the impact of studying medicine in rural vs. metropolitan campuses on student assessment outcomes. The UNSW Medicine Rural Clinical School has five main campuses; Albury-Wodonga, Coffs Harbour, Griffith, Port Macquarie and Wagga Wagga. Historical data of student assessment outcomes at these campuses raised concerns regarding potential biases in assessment undertaken, as well as the availability and quality of learning resources. The current study aims to identify the extent to which the location of examination (rural versus metropolitan) has an impact on student marks in OSCEs.

Methods
Assessment data was employed for this study from 275 medical students who sat their final examinations in Years 3 and 6 of the undergraduate Medicine program at UNSW in 2018. The data consists of matched student assessment results from the Year 3 (Y3) MCQ examination and OSCE, and from the Year 6 (Y6) MCQ, OSCE and management viva examinations. The analysis used Univariate Analysis of Variance and linear regression models to identify the impact of site of learning and site of examination on assessment outcomes.

Results
The results demonstrate that neither site of learning nor site of examination had any significant impact on OSCE or Management Viva assessment outcomes while potential confounders are controlled.

Conclusion
It is suggested that some of the supposed disadvantages inherent at rural campuses are effectively mitigated by perceived advantages; more intensive interaction with patients, the general and medical communities at those sites, as well as effective e-learning resources and moderation of assessment grades.