bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterogeneity in subcellular muscle glycogen utilisation during exercise impacts endurance capacity in men
Authors: Jensen Rasmus , Ørtenblad Niels , Stausholm Marie‐Louise Holleufer , Skjærbæk Mette Carina , Larsen Daniel Nykvist , Hansen Mette , Holmberg Hans‐Christer , Plomgaard Peter , Nielsen Joachim 
Published: July 2020

Key points
When muscle biopsies first began to be used routinely in research on exercise physiology five decades ago, it soon become clear that the muscle content of glycogen is an important determinant of exercise performance.
Glycogen particles are stored in distinct pools within the muscles, but the role of each pool during exercise and how this is affected by diet is unknown.
Here, the effects of diet and exercise on these pools, as well as their relation to endurance during prolonged cycling were examined.
We demonstrate here that an improved endurance capacity with high carbohydrate loading is associated with a temporal shift in the utilisation of the distinct stores of glycogen pools and is closely linked to the content of the glycogen pool closest to actin and myosin (intramyofibrillar glycogen).
These findings highlight the functional importance of distinguishing between different subcellular microcompartments of glycogen in individual muscle fibres.
AbstractIn muscle cells, glycogen is stored in three distinct subcellular pools: between or within myofibrils (inter‐ and intramyofibrillar glycogen, respectively) or beneath the sarcolemma (subsarcolemmal glycogen) and these pools may well have different functions. Here, we investigated the effect of diet and exercise on the content of these distinct pools and their relation to endurance capacity in type 1 and 2 muscle fibres. Following consumption of three different diets (normal, mixed diet = MIX, high in carbohydrate = HIGH, or low in carbohydrate = LOW) for 72 h, 11 men cycled at 75% of max until exhaustion. The volumetric content of the glycogen pools in muscle biopsies obtained before, during, and after exercise were quantified by transmission electron micrographs. The mean (SD) time to exhaustion was 150 (30), 112 (22), and 69 (18) minutes in the HIGH, MIX and LOW trials, respectively (P < 0.001). As shown by multiple regression analyses, the intramyofibrillar glycogen content in type 1 fibres, particularly after 60 min of exercise, correlated most strongly with time to exhaustion. In the HIGH trial, intramyofibrillar glycogen was spared during the initial 60 min of exercise, which was associated with levels and utilisation of subsarcolemmal glycogen above normal. In all trials, utilisation of subsarcolemmal and intramyofibrillar glycogen was more pronounced than that of intermyofibrillar glycogen in relative terms. In conclusion, the muscle pool of intramyofibrillar glycogen appears to be the most important for endurance capacity in humans. In addition, a local abundance of subsarcolemmal glycogen reduces the utilisation of intramyofibrillar glycogen during exercise.
Variations in Constitutive Properties of the Fluid Elicit Divergent Vibrational and Pressure Response Under Shock Wave Loading
Authors: Alay Eren , Skotak Maciej , Chandrasekeran Subhalakshmi , Ziner Jonathan , Chandra Namas 
Published: July 2020

Abstract
We performed a characterization of the shock wave loading on the response of the specimen representing a simplified head model. A polycarbonate cylinder (2-in. outer diameter, wall thickness: 0.06 or 0.12 in.) was filled with two fluids: pure de-ionized water and 40% glycerol in water, which differ only slightly in their constitutive material properties. These two fluids were selected to represent the cerebrospinal fluid and cerebral blood, using their high strain rate viscosity as a primary selection criterion. The model specimen was exposed to a single shock wave with two nominal intensities: 70 and 130 kPa overpressure. The response of the model was measured using three strain gauges and three pressure sensors, one mounted on the front face of the cylinder and two embedded in the cylinder to measure the pressure inside of the fluid. We noted several discriminant characteristics in the collected data, which indicate that the type of fluid is strongly influencing the response. The vibrations of the cylinder walls are strongly correlated with the fluid kind. The similarity analysis via the Pearson coefficient indicated that the pressure waveforms in the fluid are only moderately correlated, and these results were further corroborated by Euclidean distance analysis. Continuous wavelet transform of pressure waveforms revealed that the frequency response is strongly correlated with the properties of the fluid. The observed differences in strain and pressure modalities stem from relatively small differences in the properties of the fluids used in this study.
Placebos in chronic pain: evidence, theory, ethics, and use in clinical practice
Authors: Kaptchuk Ted J , Hemond Christopher C , Miller Franklin G 
Published: July 2020

ABSTRACTDespite their ubiquitous presence, placebos and placebo effects retain an ambiguous and unsettling presence in biomedicine. Specifically focused on chronic pain, this review examines the effect of placebo treatment under three distinct frameworks: double blind, deception, and open label honestly prescribed. These specific conditions do not necessarily differentially modify placebo outcomes. Psychological, clinical, and neurological theories of placebo effects are scrutinized. In chronic pain, conscious expectation does not reliably predict placebo effects. A supportive patient-physician relationship may enhance placebo effects. This review highlights “predictive coding” and “bayesian brain” as emerging models derived from computational neurobiology that offer a unified framework to explain the heterogeneous evidence on placebos. These models invert the dogma of the brain as a stimulus driven organ to one in which perception relies heavily on learnt, top down, cortical predictions to infer the source of incoming sensory data. In predictive coding/bayesian brain, both chronic pain (significantly modulated by central sensitization) and its alleviation with placebo treatment are explicated as centrally encoded, mostly non-conscious, bayesian biases. The review then evaluates seven ways in which placebos are used in clinical practice and research and their bioethical implications. In this way, it shows that placebo effects are evidence based, clinically relevant, and potentially ethical tools for relieving chronic pain.
Women’s experience of episiotomy: a qualitative study from China
Authors: He Siyuan , Jiang Hong , Qian Xu , Garner Paul 
Published: July 2020

ObjectiveTo describe women’s experience of episiotomy in urban China.DesignThis is a semistructured, indepth interview with women after episiotomy. We analysed transcriptions using thematic analysis in Chinese. Emerging themes were debated in English to finalise interpretation.SettingTwo community health centres and four hospitals in Shanghai, China.ParticipantsPurposive sampling of 30 postpartum women who had experienced episiotomy; 25 were primiparous and 4 had deliveries by forceps. We interviewed health providers to complement the data.ResultsWe identified four main themes: (1) women’s views of the procedure vary considerably; (2) pain interferes with daily life for weeks; (3) long-term anxiety is a consequence for some, described as a ‘psychological shadow’; and (4) societal norms assume women will not complain.ConclusionWomen receive little information in advance about episiotomy, yet the procedure has a wide range of physical and psychological consequences. This includes long-term anxiety about the damage done to them as women.
Behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement (PEP-TALK): study protocol for a pragmatic randomised controlled trial
Authors: Smith Toby O , Parsons Scott , Fordham Beth , Ooms Alexander , Dutton Susan , Hing Caroline , Barber Vicki S , Png May Ee , Lamb Sarah 
Published: July 2020

IntroductionWhile total hip replacement (THR) and total knee replacement (TKR) successfully reduce pain associated with chronic joint pathology, this infrequently translates into increased physical activity. This is a challenge given that over 50% of individuals who undergo these operations are physically inactive and have medical comorbidities such as hypertension, heart disease, diabetes and depression. The impact of these diseases can be reduced with physical activity. This trial aims to investigate the effectiveness of a behaviour change physiotherapy intervention to increase physical activity compared with usual rehabilitation after THR or TKR.Methods and analysisThe PEP-TALK trial is a multicentre, open-labelled, pragmatic randomised controlled trial. 260 adults who are scheduled to undergo a primary unilateral THR or TKR and are moderately inactive or inactive, with comorbidities, will be recruited across eight sites in England. They will be randomised post-surgery, prior to hospital discharge, to either six, 30 min weekly group-based exercise sessions (control), or the same six weekly, group-based, exercise sessions each preceded by a 30 min cognitive behaviour approach discussion group. Participants will be followed-up to 12 months by postal questionnaire. The primary outcome is the University of California, Los Angeles (UCLA) Physical Activity Score at 12 months. Secondary outcomes include: physical function, disability, health-related quality of life, kinesiophobia, perceived pain, self-efficacy and health resource utilisation.Ethics and disseminationResearch ethics committee approval was granted by the NRES Committee South Central (Oxford B - 18/SC/0423). Dissemination of results will be through peer-reviewed, scientific journals and conference presentations.Trial registration numberISRCTN29770908.
Community-based online survey on seeking care and information for lower limb pain and injury in Australia: an observational study
Authors: Bowden Jocelyn L , Lamberts Rod , Hunter David J , Melo Luciano Ricardo , Mills Kathryn 
Published: July 2020

ObjectivesMusculoskeletal pain is a leading cause of disability globally. In geographically and socioeconomically diverse countries, such as Australia, care seeking when someone experiences musculoskeletal pain is varied and potentially influenced by their individual characteristics, access to practitioners or perceived trustworthiness of information. This study explored how consumers currently access healthcare, how well it is trusted and if sociodemographic factors influenced healthcare utilisation.DesignAnonymous online observational survey.SettingAustralia.ParticipantsA convenience sample of 831 community-based individuals (18+ years).Outcome measuresDescriptive analyses and generalised estimating equations were used to quantify healthcare-seeking behaviours, sources and trust of health information for (A) first-contact practitioners, (B) medical practitioners, and (C) other sources of information.ResultsOf the 761 respondents, 73% were females, 54% resided in capital cities. 68% of respondents had experienced pain or injury in more than one lower limb joint. Despite this, more than 30% of respondents only sought help when there had not been natural resolution of their pain. Physiotherapists had the highest odds of being seen, asked and trusted for healthcare information. The odds of seeking care from general practitioners were no higher than seeking information from an expert website. Older individuals and women exhibited higher odds of seeking, asking and trusting health information.ConclusionIntelligible and trustworthy information must be available for consumers experiencing lower limb pain. Individuals, particularly younger people, are seeking information from multiple, unregulated sources. This suggests that healthcare professionals may need to invest time and resources into improving the trustworthiness and availability of healthcare information to improve healthcare quality.
Differences in regional distribution and inequality in health-resource allocation at hospital and primary health centre levels: a longitudinal study in Shanghai, China
Authors: Dong Enhong , Liu Shipeng , Chen Minjie , Wang Hongmei , Chen Li-Wu , Xu Ting , Wang Tao , Zhang Lufa 
Published: July 2020

ObjectivesTo analyse differences in regional distribution and inequality in health-resource allocation at the hospital and primary health centre (PHC) levels in Shanghai over 7 years.DesignA longitudinal survey using 2010–2016 data, which were collected for analysis.SettingThe study was conducted at the hospital and PHC levels in Shanghai, China.Outcome measuresTen health-resource indicators were used to measure health-resource distribution at the hospital and PHC levels. In addition, the Theil Index was calculated to measure inequality in health-resource allocation.ResultsAll quantities of healthcare resources per 1000 people in hospitals and PHCs increased across Shanghai districts from 2010 to 2016. Relative to suburban districts, the central districts had higher ratios, both in terms of doctors and equipment, and had faster growth in the doctor indicator and slower growth in the equipment indicator in hospitals and PHCs. The Theil Indices of all health-resource allocation in hospitals had higher values compared with those in PHCs every year from 2010 to 2016; furthermore, the Theil Indices of the indicators, except for technicians and doctors in hospitals, all exhibited downward time trends in hospitals and PHCs.ConclusionsIncreased healthcare resources and reduced inequality of health-resource allocation in Shanghai during the 7 years indicated that measures taken by the Shanghai government to deepen the new round of healthcare reform in China since 2009 had been successful. Meanwhile there still existed regional difference between urban and rural areas and inequality across different medical institutions. To solve these problems, we prescribe increased wages, improved working conditions, and more open access to career development for doctors and nurses; reduced investments in redundant equipment in hospitals; and other incentives for balancing the health workforce between hospitals and PHCs.
Empathy variation of undergraduate medical students after early clinical contact: a cross-sectional study in China
Authors: Ye Xiong , Guo Haiying , Xu Zhou , Xiao Hui 
Published: July 2020

ObjectivesEmpathy education is very important for medical students. There is little research on the influence of early clinical practice on the development of empathy and other aspects of professionalism in medical students. The aim of this study was to compare the self-reported empathy levels of first-year and second-year undergraduate medical students before and after their early clinical contact curriculum.SettingThe study was conducted at the Shanghai University of Medicine & Health Sciences, Shanghai, China.ParticipantsA total of 257 undergraduate medical students participated in the study. The 154 first-year students were studying in 10 community-based teaching hospitals, and the 103 second-year students were studying in 3 university-affiliated hospitals.Primary and secondary outcome measuresPrimary measures: the Jefferson Scale of Empathy—Student version (JSE-S) was compared between students of different sexes and in different academic years before their early clinical contact course. Secondary measures: comparisons were made after they finished the curriculum 3 weeks later.ResultsA total of 219 of 257 students responded (85.21% response rate), and 214 answers could be analysed (135 first-year and 79 second-year students; 120 female and 94 male individuals). No significant differences in the empathy scores before early clinical contact were observed between students of different sexes and in different academic years. After early clinical contact, the mean JSE-S score of the participants was significantly higher than the mean score at the beginning of the curriculum.ConclusionsEmpathy-focused training during early clinical contact can improve the empathetic capacity of undergraduate medical students. Fostering empathetic attitudes among undergraduate medical students is necessary for the early stage of their medical education. Further research is needed on the long-term effects of empathy-focused education in entry-level medical students.
Can changes in spending on health and social care explain the recent mortality trends in Scotland? A protocol for an observational study
Authors: Wraw Christina , Minton Jon , Mitchell Rory , Wyper Grant M A , Campbell Clare , McCartney Gerry 
Published: July 2020

IntroductionThere have been steady reductions in mortality rates in the majority of high-income countries, including Scotland, since 1945. However, reductions in mortality rates have slowed down since 2012–2014 in these nations; and have reversed in some cases. Deaths among those aged 55+ explain a large amount of these changing mortality trends in Scotland. Increased pressures on health and social care services have been suggested as one factor explaining these changes. This paper outlines a protocol for the approach to testing the extent to which health and social care pressures can explain recent mortality trends in Scotland. Although a slower rate of mortality improvements have affected people of all ages, certain ages have been more negatively affected than the others. The current analyses will be run by age-band to test if the service pressure-mortality link varies across age-group.Methods and analysisThis will be an observational ecological study based on the Scottish population. The exposures of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in real terms per capita spending on social and healthcare services between 2011 and 2017. The outcome of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in age-standardised mortality rate between 2012 and 2018 for men and women separately. The units of analysis will be the 32 local authorities and the 14 territorial health boards. The analyses will be run for both all age-groups combined and for the following age bands: <1, 1–15, 16–44, 45–64, 65–74, 75–84 and 85+.A series of descriptive analyses will summarise the distribution of health and social care expenditure and mortality trends between 2011 and 2018. Linear regression analysis will be used to investigate the direct association between health care spending and mortality rates.Ethics and disseminationThe data used in this study will be publicly available and aggregated and will not be individually identifiable; therefore, ethical committee approval is not needed. This work will not result in the creation of a new data set. On completion, the study will be stored within the National Health Service research governance system. All of the results will be published once they have been shared with partner agencies.
Effectiveness of psychological interventions on mental health, quality of life and relationship satisfaction for individuals and/or couples undergoing fertility treatment: a systematic review and meta-analysis protocol
Authors: Bright Katherine , Dube Loveness , Hayden K Alix , Gordon Jennifer L 
Published: July 2020

IntroductionInfertility is a global public health problem affecting men, women and couples worldwide. The medical implications of infertility are often of primary focus in healthcare settings, but the experience of infertility also has a considerable social, emotional and psychological impact. Interventions aimed at alleviating psychological symptoms in individual and/or couples undergoing fertility treatment requires a systematic and comprehensive review of the literature to determine the efficacy of psychological interventions. The objective of this review is to evaluate the effectiveness, feasibility and acceptability of psychological interventions for individuals and/or couples seeking fertility to treat anxiety, depression, distress, quality of life and relationship satisfaction, as well as improve pregnancy rates.Methods and analysisThe search strategy will involve 11 databases, including MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (OVID), The Cumulative Index to Nursing and Allied Health Literature (CINAHL) with Full Text (EBSCO), Social Work Abstracts (EBSCO), SocINDEX with Full Text (EBSCO), Academic Search Complete (EBSCO), Family & Society Studies Worldwide (EBSCO), Family Studies Abstracts (EBSCO) and Scopus. These databases will be searched from their inception to September 2019. Independent reviewers will search peer-reviewed published studies through electronic databases and additional sources, will extract the data and assess the methodological quality. Random-effects meta-analysis will be carried out by calculating effect sizes as Cohen’s d indices. Heterogeneity will be examined by the I2 and the Q statistics.Ethics and disseminationThe current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals.PROSPERO registration numberCRD42019133757.
What is the evidence for the impact of gardens and gardening on health and well-being: a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription
Authors: Howarth Michelle , Brettle Alison , Hardman Michael , Maden Michelle 
Published: July 2020

ObjectiveTo systematically identify and describe studies that have evaluated the impact of gardens and gardening on health and well-being. A secondary objective was to use this evidence to build evidence-based logic models to guide health strategy decision making about gardens and gardening as a non-medical, social prescription.DesignScoping review of the impact of gardens and gardening on health and well-being. Gardens include private spaces and those open to the public or part of hospitals, care homes, hospices or third sector organisations.Data sourcesA range of biomedical and health management journals was searched including Medline, CINAHL, Psychinfo, Web of Knowledge, ASSIA, Cochrane, Joanna Briggs, Greenfile, Environment Complete and a number of indicative websites were searched to locate context-specific data and grey literature. We searched from 1990 to November 2019.Eligibility criteriaWe included research studies (including systematic reviews) that assessed the effect, value or impact of any garden that met the gardening definition.Data extraction and synthesisThree reviewers jointly screened 50 records by titles and abstracts to ensure calibration. Each record title was screened independently by 2 out of 3 members of the project team and each abstract was screened by 1 member of a team of 3. Random checks on abstract and full-text screening were conducted by a fourth member of the team and any discrepancies were resolved through double-checking and discussion.ResultsFrom the 8896 papers located, a total of 77* studies was included. Over 35 validated health, well-being and functional biometric outcome measures were reported. Interventions ranged from viewing gardens, taking part in gardening or undertaking therapeutic activities. The findings demonstrated links between gardens and improved mental well-being, increased physical activity and a reduction in social isolation enabling the development of 2 logic models.ConclusionsGardens and gardening can improve the health and well-being for people with a range of health and social needs. The benefits of gardens and gardening could be used as a ‘social prescription’ globally, for people with long-term conditions (LTCs). Our logic models provide an evidence-based illustration that can guide health strategy decision making about the referral of people with LTCs to socially prescribed, non-medical interventions involving gardens and gardening.