bluuebunny/crossref_metadata_2025_split huggingface dataset:
Injuries in Collegiate Ladies Gaelic Footballers: A 2-Season Prospective Cohort Study
Authors: O’Connor Siobhán , Bruce Conor , Teahan Calvin , McDermott Elaine , Whyte Enda 
Published: May 2020

Context: Although Ladies Gaelic football is one of the most popular female sports in Ireland, just 2 previous injury surveillance studies have been completed, and both were retrospective in nature. Objective: To prospectively examine the injury incidence and injury profile in collegiate Ladies Gaelic football over 2 seasons. Design: Prospective cohort study. Setting: College. Patients (or Other Participants): Adult Ladies Gaelic footballers from one collegiate institution (season 1: n = 50, season 2: n = 82). Intervention(s): All time-loss injuries that occurred were recorded by certified athletic therapists and student-athletic therapists and trainers over 2 seasons. Main Outcome Measures: A standardized injury report form was used to record the injury onset, mechanism, location, nature, and outcome. Injury incidence proportion, repeat incidence proportion and total, match and training injury rates, and their 95% confidence intervals were calculated. The frequencies and proportions were also calculated. Results: The match and training injury rates were 42.48 and 7.93 injuries per 1000 hours, respectively. A low repeat incidence proportion per season was noted (11.7% and 0.0%). The injuries were predominantly acute (74.68%) and noncontact (66.25%), with hamstring injuries (21.52%) and strains (36.71%) the most frequent location and nature of injuries noted. Strains (104.92 d absent per 1000 h) and knee injuries (106.46 d absent per 1000 h) led to the greatest injury burden. Further investigations were not frequently required, with an X-ray and magnetic resonance imaging ordered in 8.00% and 6.67% of the cases, respectively. Surgery was completed following one injury. Conclusions: This is the first study to provide prospective injury data on Ladies Gaelic football. Priority needs to be given to preventing hamstring and knee injuries due to their occurrence and negative impact on player availability to play. Collegiate Ladies Gaelic football teams should be encouraged to implement an injury-prevention warm-up, such as the GAA15+, at training and matches.
Reliability of a Novel Semiautomated Ultrasound Segmentation Technique for Assessing Average Regional Femoral Articular Cartilage Thickness
Authors: Lisee Caroline , McGrath Melanie L. , Kuenze Christopher , Zhang Ming , Salzler Matt , Driban Jeffrey B. , Harkey Matthew S. 
Published: May 2020

Context: Ultrasound imaging is a clinically feasible tool to assess femoral articular cartilage and may have utility in tracking early knee osteoarthritis development. Traditional assessment techniques focus on measurements at a single location, which can be challenging to adopt for novice raters. Objective: To introduce a novel semiautomated ultrasound segmentation technique and determine the intrarater and interrater reliability of average regional femoral articular cartilage thickness and echo intensity of a novice and expert rater. Design: Descriptive observational study. Setting: Orthopedic clinic. Patients or Other Participants: Fifteen participants (mean [SD]; age 23.5 [4.6] y, height = 172.6 [9.3] cm, mass = 79.8 [15.7] kg) with a unilateral history of anterior cruciate ligament reconstruction participated. Intervention: None. Main Outcome Measures: One rater captured anterior femoral cartilage images of the participants’ contralateral knees using a transverse suprapatellar ultrasound assessment. The total femoral cartilage cross-sectional area of each image was segmented by a novice and expert rater. A novel custom program automatically separated the cartilage segmentations into medial, lateral, and intercondylar regions to determine the cross-sectional area and cartilage length. The average cartilage thickness in each region was calculated by dividing the cross-sectional area by the cartilage length. Echo intensity was calculated as the average gray-scale pixel value of each region. Two-way random effect intraclass correlations coefficient (ICC) for absolute agreement were used to determine the interrater reliability between a novice and expert rater, as well as the intrarater reliability of the novice rater. Results: The novice rater demonstrated excellent intrarater (ICC [2,k] range = .993–.997) and interrater (ICC [2,k] range = .944–.991) reliability with the expert rater of all femoral articular cartilage average thickness and echo intensity regions. Conclusions: The novel semiautomated average cartilage thickness and echo-intensity assessment is efficient, systematic, and reliable between an expert and novice rater with minimal training.
Understanding efficiency and the effect of pay-for-performance across health facilities in Tanzania
Authors: Binyaruka Peter , Anselmi Laura 
Published: May 2020

BackgroundEnsuring efficient use and allocation of limited resources is crucial to achieving the UHC goal. Performance-based financing that provides financial incentives for health providers reaching predefined targets would be expected to enhance technical efficiency across facilities by promoting an output-oriented payment system. However, there is no study which has systematically assessed efficiency scores across facilities before and after the introduction of pay-for-performance (P4P). This paper seeks to fill this knowledge gap.MethodsWe used data of P4P evaluation related to healthcare inputs (staff, equipment, medicines) and outputs (outpatient consultations and institutional deliveries) from 75 health facilities implementing P4P in Pwani region, and 75 from comparison districts in Tanzania. We measured technical efficiency using Data Envelopment Analysis and obtained efficiency scores across facilities before and after P4P scheme. We analysed which factors influence technical efficiency by regressing the efficiency scores over a number of contextual factors. We also tested the impact of P4P on efficiency through a difference-in-differences regression analysis.ResultsThe overall technical efficiency scores ranged between 0.40 and 0.65 for hospitals and health centres, and around 0.20 for dispensaries. Only 21% of hospitals and health centres were efficient when outpatient consultations and deliveries were considered as output, and <3% out of all facilities were efficient when outpatient consultations only were considered as outputs. Higher efficiency scores were significantly associated with the level of care (hospital and health centre) and wealthier catchment populations. Despite no evidence of P4P effect on efficiency on average, P4P might have improved efficiency marginally among public facilities.ConclusionMost facilities were not operating at their full capacity indicating potential for improving resource usage. A better understanding of the production process at the facility level and of how different healthcare financing reforms affects efficiency is needed. Effective reforms should improve inputs, outputs but also efficiency.
Managing mental health on a prolonged deployment: UK military exercise SAIF SAREEA 3
Authors: Sawford H J , Smith M B 
Published: May 2020

IntroductionThis paper presents the burden of mental health cases throughout UK military exercise SAIF SAREEA 3 (SS3), a low-tempo armoured brigade exercise in Oman from June to November 2018, and aims to discuss ways that mental health may be better managed on future large exercises.MethodsA retrospective review of all attendances at army medical facilities and relevant computerised medical records was undertaken.Results14 mental health cases were identified, which required 51 follow-up presentations throughout the duration of SS3. This represented 1.2% of all first patient presentations, and 6.3% of all follow-up work. 64% had diagnoses which predated deployment and could all be classified within 10th revision of International Statistical Classification of Diseases and Related Health Problems as either F30–F39 mood (affective) disorders, or F40–F48 neurotic, stress-related and somatoform disorders; all new diagnoses made while deployed were adjustment disorders. The medical officer spent an average of 147 min total clinical care time per patient. Six patients were aeromedically evacuated (AE), which represented 26% of all AE cases from SS3.ConclusionsPresentations were low, but time consuming and with poor disposal outcomes. Most conditions predated the exercise, and could have been predicted to worsen through the deployment. Given the disproportionate burden that mental health cases afforded during SS3, future brigade-sized deployments should include deployed mental health professionals in order to offer evidence-based therapy which should lead to improved disposal outcomes and a reduced AE burden.
Microscopic and macroscopic comparisons of 0.223 soft point and full metal jacket ammunition with bos taurus scapulae as a proxy to human flat bones
Authors: Taylor Seth C , Kieser D C , Hammer N , Pullen A , Hooper G 
Published: May 2020

BackgroundThe prevalence of civilian 0.223 ammunition is widespread. Due to low costs and the same dimensions as a 5.56×45 mm North Atlantic Treaty Organization, this round is exceptionally popular. However, recent mass shootings have employed soft point (SP) expanding ammunition to cause grievous wounds compared with military full metal jacket (FMJ) rounds that do not rapidly expand on impact.MethodsThe aim of this given study is to compare FMJ and SP rounds to determine if there are diagnostic differences between the bullet types in the wounds inflicted to flat bones.Bos taurusscapulae were used for 25 m simulated cranial gunshot injuries. Scanning electron microscopy was employed to assess the difference in wound morphology and elemental analysis between SP and FMJ rounds.ResultsEntrance and exit wound morphology change significantly between the two different types of ammunition as seen with circumferential delamination which is indicative of FMJ rounds and is not seen with the softer SP hunting rounds. Lead staining of the entrance wound is visible on only the SP rounds.ConclusionGunshot flat bone wound morphology is distinctively different between SP and FMJ rounds. Circumferential delamination is only seen with FMJ due to the hardness of the round. Lead staining is only seen with SP rounds due to bullet composition.
Has the introduction of direct oral anticoagulants (DOACs) in England increased emergency admissions for bleeding conditions? A longitudinal ecological study
Authors: Alfirevic Ana , Downing Jennifer , Daras Konstantinos , Comerford Terence , Pirmohamed Munir , Barr Ben 
Published: May 2020

ObjectiveThere is concern about long-term safety of direct oral coagulants (DOACs) in clinical practice. Our aim was to investigate whether the introduction of DOACs compared with vitamin-K antagonists in England was associated with a change in admissions for bleeding or thromboembolic complications.Setting5508 General practitioner (GP) practices in England between 2011 and 2016.ParticipantsAll GP practices in England with a registered population size of greater than 1000 that had data for all 6 years.Main outcome measureThe rate of emergency admissions to hospital for bleeding or thromboembolism, per 100 000 population for each GP practice in England.Main exposure measureThe annual number of DOAC items prescribed for each GP practice population as a proportion of all anticoagulant items prescribed.DesignThis longitudinal ecological study used panel regression models to investigate the association between trends in DOAC prescribing within GP practice populations and trends in emergency admission rates for bleeding and thromboembolic conditions, while controlling for confounders.ResultsFor each additional 10% of DOACs prescribed as a proportion of all anticoagulants, there was a 0.9% increase in bleeding complications (rate ratio 1.008 95% CI 1.003 to 1.013). The introduction of DOACs between 2011 and 2016 was associated with additional 4929 (95% CI 2489 to 7370) emergency admissions for bleeding complications. Increased DOAC prescribing was associated with a slight decline in admission for thromboembolic conditions.ConclusionOur data show that the rapid increase in prescribing of DOACs after changes in National Institute for Health and Care Excellence guidelines in 2014 may have been associated with a higher rate of emergency admissions for bleeding conditions. These consequences need to be considered in assessing the benefits and costs of the widespread use of DOACs.
Historical database cohort study addressing the clinical patterns prior to idiopathic pulmonary fibrosis (IPF) diagnosis in UK primary care
Authors: Thickett David , Voorham Jaco , Ryan Ronan , Jones Rupert , Coker Robina , Wilson Andrew M , Yang Sen , Ow Mandy YL , Raju Priyanka , Chaudhry Isha , Hardjojo Antony , Carter Victoria , Price David B 
Published: May 2020

ObjectiveTo explore the clinical pathways, including signs and symptoms, and symptom progression patterns preceding idiopathic pulmonary fibrosis (IPF) diagnosis.Design and settingA historical cohort study was conducted using primary care patient records from the Optimum Patient Care Research Database.ParticipantsPatients included were at least 30 years, had IPF diagnosis, identified via clinical-coding and free-text records and had a consultation with a chest specialist prior to IPF diagnosis.Outcome measuresThe signs and symptoms in the year prior to IPF diagnosis from clinical codes and free-text in primary care electronic records included: cough, dyspnoea, dry cough, weight loss, fatigue/malaise, loss of appetite, crackles and clubbed fingers. The time course of presentations of clinical features and investigations in the years prior to IPF diagnosis were mapped.ResultsWithin 462 patients identified, the majority (77.9%) had a respiratory consultation within 365 days prior to the chest specialist visit preceding the IPF diagnosis recorded in their primary care records. The most common symptoms recorded in the 1 year prior to IPF diagnosis were dyspnoea (48.7%) and cough (40.9%); other signs and symptoms were rarely recorded (<5%). The majority of patients with cough (58.0%) and dyspnoea (55.0%) in the 1 year before IPF diagnosis had multiple recordings of the respective symptoms. Both cough and dyspnoea were recorded in 23.4% of patients in the year prior to diagnosis. Consultation rates for cough, dyspnoea and both, but not other signs or symptoms, began to increase 4 to 5 years prior diagnosis, with the sharpest increase in the last year. Cough and dyspnoea were often preceded by a reduction in measured weight over 5 years leading to IPF diagnosis.ConclusionProlonged cough and/or progressive dyspnoea, especially if accompanied with weight loss, should signal for a referral to specialist assessment at the earliest opportunity.
Characteristics and interpretation of subgroup analyses based on tumour characteristics in randomised trials testing target-specific anticancer drugs: design of a systematic survey
Authors: Schandelmaier Stefan , Schmitt Andreas M , Herbrand Amanda K , Glinz Dominik , Ewald Hannah , Briel Matthias , Guyatt Gordon H , Hemkens Lars G , Kasenda Benjamin 
Published: May 2020

BackgroundTarget-specific anticancer drugs are under rapid development. Little is known, however, about the risk of administering target-specific drugs to patients who have tumours with molecular alterations or other characteristics that can make the drug ineffective or even harmful. An increasing number of randomised clinical trials (RCTs) investigating target-specific anticancer drugs include subgroup analyses based on tumour characteristics. Such subgroup analyses have the potential to be more credible and influential than subgroup analyses based on traditional factors such as sex or tumour stage. In addition, they may more frequently lead to qualitative subgroup effects, that is, show benefit in one but harm in another subgroup of patients (eg, if the tumour characteristic makes the drug ineffective or even enhance tumour growth). If so, subgroup analyses based on tumour characteristics would be highly relevant for patient safety. The aim of this study is to systematically assess the frequency and characteristics of subgroup analyses based on tumour characteristics, the frequency of qualitative subgroup effects, their credibility, and the interpretations that investigators and guidelines developers report.Methods and analysisWe will perform a systematic survey of 433 RCTs testing the effect of target-specific anticancer drugs. Teams of methodologically trained investigators and oncologists will identify eligible studies, extract relevant data and assess the credibility of putative subgroup effects using a recently developed formal instrument. We will systematically assess how trial investigators interpret apparent subgroup effects based on tumour characteristics and the extent to which they influence subsequent practice guidelines. Our results will provide empirical data characterising an increasingly used type of subgroup analysis in cancer trials and its potential impact on precision medicine to predict benefit or harm.Ethics and disseminationFormal ethical approval is not required for this study. We will disseminate the findings in a peer-reviewed and open-access journal publication.
Study protocol to examine the relationship between environmental exposure to lead and blood lead levels among children from day-care centres in Ekurhuleni Metropolitan Municipality
Authors: Cindi Mbalenhle Desiree , Mbonane Thokozani Patrick , Naicker Nisha 
Published: May 2020

IntroductionLead exposure is toxic to all humans and is very harmful to young children, especially 5-year-olds. Elevated blood lead levels (BLLs) in children have been associated with their daily surrounding environment. This protocol seeks to evaluate the association between environmental lead exposure and BLLs among children in day-care centres, including household and other risk factors.Methods and analysisTo achieve the objectives of the study, we adopted a cross-sectional analytical design. A portable X-ray fluorescence analyser was used for environmental sampling, and BLLs were determined using the LeadCare II machine among preschool children. Household and other risk factors were assessed using a questionnaire. Random sampling was employed to select day-care centres in the municipality and children in each day-care centre. Data will be analysed using SPSS V. 26.Ethics and disseminationEthical approval and permission were obtained prior to commencement of the study. The researcher intends to publish the results in peer-reviewed journals and also to present a paper at a scientific conference. The study will generate information on environmental lead exposure among vulnerable children (2–5 years), and it will promote public health action to prevent long-term exposure in day-care centres.
Data-sharing recommendations in biomedical journals and randomised controlled trials: an audit of journals following the ICMJE recommendations
Authors: Siebert Maximilian , Gaba Jeanne Fabiola , Caquelin Laura , Gouraud Henri , Dupuy Alain , Moher David , Naudet Florian 
Published: May 2020

ObjectiveTo explore the implementation of the International Committee of Medical Journal Editors (ICMJE) data-sharing policy which came into force on 1 July 2018 by ICMJE-member journals and by ICMJE-affiliated journals declaring they follow the ICMJE recommendations.DesignA cross-sectional survey of data-sharing policies in 2018 on journal websites and in data-sharing statements in randomised controlled trials (RCTs).SettingICMJE website; PubMed/Medline.Eligibility criteriaICMJE-member journals and 489 ICMJE-affiliated journals that published an RCT in 2018, had an accessible online website and were not considered as predatory journals according to Beall’s list. One hundred RCTs for member journals and 100 RCTs for affiliated journals with a data-sharing policy, submitted after 1 July 2018.Main outcome measuresThe primary outcome for the policies was the existence of a data-sharing policy (explicit data-sharing policy, no data-sharing policy, policy merely referring to ICMJE recommendations) as reported on the journal website, especially in the instructions for authors. For RCTs, our primary outcome was the intention to share individual participant data set out in the data-sharing statement.ResultsEight (out of 14; 57%) member journals had an explicit data-sharing policy on their website (three were more stringent than the ICMJE requirements, one was less demanding and four were compliant), five (35%) additional journals stated that they followed the ICMJE requirements, and one (8%) had no policy online. In RCTs published in these journals, there were data-sharing statements in 98 out of 100, with expressed intention to share individual patient data reaching 77 out of 100 (77%; 95% CI 67% to 85%). One hundred and forty-five (out of 489) ICMJE-affiliated journals (30%; 26% to 34%) had an explicit data-sharing policy on their website (11 were more stringent than the ICMJE requirements, 85 were less demanding and 49 were compliant) and 276 (56%; 52% to 61%) merely referred to the ICMJE requirements. In RCTs published in affiliated journals with an explicit data-sharing policy, data-sharing statements were rare (25%), and expressed intentions to share data were found in 22% (15% to 32%).ConclusionThe implementation of ICMJE data-sharing requirements in online journal policies was suboptimal for ICMJE-member journals and poor for ICMJE-affiliated journals. The implementation of the policy was good in member journals and of concern for affiliated journals. We suggest the conduct of continuous audits of medical journal data-sharing policies in the future.RegistrationThe protocol was registered before the start of the research on the Open Science Framework (https://osf.io/n6whd/).
Remarkably high prevalence of overuse-related knee complaints and MRI abnormalities in youth competitive alpine skiers: a descriptive investigation in 108 athletes aged 13–15 years
Authors: Fröhlich Stefan , Peterhans Loris , Stern Christoph , Frey Walter O , Sutter Reto , Spörri Jörg 
Published: May 2020

Background/aimCompetitive alpine skiing is known to be associated with a high risk of traumatic knee injuries. However, little is known about the exact prevalence of knee overuse injuries and their associations with structural changes, particularly in youth skiers. Accordingly, the aim of the present study was to describe the overuse-related knee complaints and MRI abnormalities in a cohort of youth skiers around the growth spurt.Methods108 youth competitive alpine skiers aged 13–15 years were examined using an MRI of both knees, an interview on existing knee complaints and a physical examination. As a common baseline for these assessments, skiers were prospectively monitored by the use of the Oslo Sports Trauma Research Centre questionnaire on health problems over a period of 12 months preceding the major investigations.Results88.0% of the youth skiers showed at least one MRI abnormality in the knees. The most frequent findings were distal femoral cortical irregularities (63%), focal periphyseal oedema (FOPE) zones (25.0%) and cartilage lesions (18.5%). 47.2% of all skiers suffered from at least one overuse-related knee complaint during the 12 months preceding the MRI examination, mostly at the distal and proximal patellar tendon. However, despite a certain association with corresponding MRI abnormalities, the sensitivity of an MRI-based detection of such complaints was strongly limited.ConclusionYouth competitive alpine skiers suffer from a remarkably large number of knee overuse injuries. Accordingly, an effective prevention strategy should include a systematic screening of clinical complaints, ideally already starting around the growth spurt.