bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implication of Blood Rheology and Pulmonary Hemodynamics on Exercise-Induced Hypoxemia at Sea Level and Altitude in Athletes
Authors: Raberin Antoine , Nader Elie , Lopez Ayerbe Jorge , Mucci Patrick , Pialoux Vincent , Meric Henri , Connes Philippe , Durand Fabienne 
Published: July 2021

This study aimed to investigate the changes in blood viscosity, pulmonary hemodynamics, nitric oxide (NO) production, and maximal oxygen uptake () during a maximal incremental test conducted in normoxia and during exposure to moderate altitude (2,400 m) in athletes exhibiting exercise-induced hypoxemia at sea level (EIH). Nine endurance athletes with EIH and eight without EIH (NEIH) performed a maximal incremental test under three conditions: sea level, 1 day after arrival in hypoxia, and 5 days after arrival in hypoxia (H5) at 2,400 m. Gas exchange and oxygen peripheral saturation (SpO2) were continuously monitored. Cardiac output, pulmonary arterial pressure, and total pulmonary vascular resistance were assessed by echocardiography. Venous blood was sampled before and 3 min after exercise cessation to analyze blood viscosity and NO end-products. At sea level, athletes with EIH exhibited an increase in blood viscosity and NO levels during exercise while NEIH athletes showed no change. Pulmonary hemodynamics and aerobic performance were not different between the two groups. No between-group differences in blood viscosity, pulmonary hemodynamics, and were found at 1 day after arrival in hypoxia. At H5, lower total pulmonary vascular resistance and greater NO concentration were reported in response to exercise in EIH compared with NEIH athletes. EIH athletes had greater cardiac output and lower SpO2 at maximal exercise in H5, but no between-group differences occurred regarding blood viscosity and . The pulmonary vascular response observed at H5 in EIH athletes may be involved in the greater cardiac output of EIH group and counterbalanced the drop in SpO2 in order to achieve similar than NEIH athletes.
Examination of a Composite Walking Measure on Cognitive Functioning Among Participants in the Chicago Health and Aging Project
Authors: Desai Pankaja , Halloway Shannon , Dhana Klodian , Zhang Yanyu , Holland Thomas , Agarwal Puja , Ford Christopher N. , Mendes de Leon Carlos , Evans Denis A. , Morris Martha C. 
Published: July 2021

This study examined the relationship between walking and cognitive function among Chicago Health and Aging Project participants. Data collection occurred during six 3-year cycles, of which Cycles 4–6 were used for this specific analysis. Information was obtained regarding walking frequency and duration, demographics, chronic conditions, cognitive activities, apolipoprotein E4, physical function, and cognitive function (global and domains). A composite walking measure was developed and categorized as follows: no walking, ≤105 min/week, and >105 min/week. Mixed-effects regression analyses tested associations between walking and global cognitive function, episodic memory, and perceptual speed. The sample consisted of 4,320 participants (African American/Black: 65%; female: 65%; mean education: 13 years; mean age: 75 years). Composite or total walking had a statistically significant association with global cognitive function and perceptual speed, after adjustments were made.
Hip-Focused Neuromuscular Exercise Provides Immediate Benefits in Foot Pronation and Dynamic Balance: A Sham-Controlled Cross-Over Study
Authors: Turgut Elif , Yagci Gozde , Bayrakci Tunay Volga 
Published: July 2021

Context: Knowledge on how to utilize a kinetic chain approach in foot and ankle rehabilitation is important. Objective: The aim of this study was to investigate the immediate effects of hip-focused neuromuscular exercise on foot pronation and single-leg neuromuscular control. Design: Cross-over study. Setting: University laboratory. Participants: This cross-over study included 44 asymptomatic volunteers with foot pronation. Interventions: All participants performed (1) a hip-focused neuromuscular exercise and (2) a sham exercise in randomized order. Main Outcome Measures: Foot pronation was assessed by the navicular drop test, and lower-extremity neuromuscular control was assessed by the Modified Star Excursion Balance Test and frontal plane projection angle during single-leg squat before and after the experiments. Results: Navicular drop test scores were significantly lower after the hip-focused neuromuscular exercise than after the sham exercise (mean difference [95% CI] = 2.84 [−1.08 to 6.77], P = .003). Modified Star Excursion Balance Test scores in the anterior (P = .008), posteromedial (P = .04), and posterolateral (P < .001) directions were significantly increased after hip-focused neuromuscular exercise. No statistically significant condition × time interaction was found for the frontal plane projection angle (P > .05). However, a main effect of time (P = .003) indicated that less dynamic knee valgus occurred during single-leg squat after both experiments. Conclusions: Hip-focused neuromuscular exercise produced immediate alterations in foot pronation and dynamic balance. Thus, the hip-focused neuromuscular exercise may be used to control foot posture in foot rehabilitation integrated with a kinetic chain approach and could be an effective prevention and treatment strategy.
Shoulder Range of Motion, Rotator Strength, and Upper-Extremity Functional Performance in Junior Tennis Players
Authors: Busra Cigercioglu Nazli-Busra , Guney-Deniz Hande , Unuvar Ezgi , Colakoglu Filiz , Baltaci Gul 
Published: July 2021

Purpose: Repetitive and asymmetric movements in tennis can result in biomechanical adaptation in shoulder joint. The aim of this study was to investigate the differences in shoulder range of motion (ROM), strength, and functional performance tests between the dominant and nondominant shoulders, as well as to identify gender differences in junior tennis players. Methods: Forty-two junior tennis players (age mean: 11.3 [1.2] y, body mass index 18.3 [2.4] kg/m2) were included in the study. Shoulder internal rotation (IR), external rotation (ER) ROM, and total ROM, IR and ER isokinetic strength and closed kinetic chain upper-extremity stability, seated medicine ball throw used, grip hold tests were applied bilaterally. Paired sample t test and Student t test were used to compare the differences. Results: ER ROM was greater, while IR ROM and total ROM were lower on the dominant shoulder (all P values < .05). Nineteen players had glenohumeral IR deficit (IR ROM difference >13°). The players had a greater ER strength on the dominant side and similar IR strength between shoulders. There was significant difference in seated medicine ball throw results between the dominant and nondominant sides (P < .001). The mean distance for bilateral seated medicine ball throw was 377.02 (85.70) m, and closed kinetic chain upper-extremity stability results were calculated as a mean of 15.85 (1.72) touches. Differences between the genders: total ROM of the dominant shoulder was higher in female players (P = .045), the IR PT/BW at 60°/s angular speed was higher in male players’ dominant shoulder (P = .030), and closed kinetic chain upper-extremity stability performance was higher in male players (P = .019). Conclusions: Adolescent tennis players demonstrated differences in strength, ROM, and functional performance results between the dominant and nondominant shoulders. Gender differences were also seen in the aforementioned parameters in junior tennis players. Determining these differences may improve our understanding of sport-specific shoulder joint adaptations in tennis.
Evaluation of Left Ventricular Outflow Gradients During Staged Exercise Stress Echocardiography Helps Differentiate Pediatric Patients With Hypertrophic Cardiomyopathy From Athletes and Normal Subjects
Authors: Gaitonde Mansi , Jones Shannon , McCracken Courtney , Ferguson Matthew E. , Michelfelder Erik , Sachdeva Ritu , Border William 
Published: July 2021

Background: Elevated left ventricular outflow tract (LVOT) gradients during exercise can occur in patients with hypertrophic cardiomyopathy (HCM) as well as in athletes and normal controls. The authors’ staged exercise protocol calls for imaging at rest and during each stage of exercise to evaluate the mechanism of LVOT obstruction at each stage. They investigated whether this staged approach helps differentiate HCM from athletes and normal controls. Methods: They reviewed pediatric exercise stress echocardiograms completed between January 2009 and October 2017 at their center and identified those with gene-positive HCM, athlete’s heart, and normal controls. Children with inducible obstruction (those with no LVOT gradient at rest who developed a LVOT peak gradient > 25 mm Hg during exercise) were included. LVOT peak gradient, velocity time integral, acceleration time, and deceleration time were measured at rest, submaximal stages, and peak exercise. Results: Compared with athletes, HCM patients had significantly higher LVOT peak gradients at rest (P = .019), stage 1 of exercise (P = .002), and peak exercise (P = .051), as well as a significantly higher change in LVOT peak gradient from rest to stage 1 (P = .016) and from rest to peak (P = .038). The acceleration time/deceleration time ratio of the LVOT Doppler was significantly lower in HCM patients compared with normal controls at peak exercise. Conclusions: The HCM patients who develop elevated LVOT gradients at peak exercise typically manifest early obstruction in the submaximal stages of exercise, which helps to differentiate them from athletes and normal controls.
Development of National Cancer Database for Cost and Quality of Life (CaDCQoL) in India: a protocol
Authors: Prinja Shankar , Dixit Jyoti , Gupta Nidhi , Mehra Nikita , Singh Ashish , Krishnamurthy Manjunath Nookala , Gupta Dharna , Rajsekar Kavitha , Kalaiyarasi Jayachandran Perumal , Roy Partha Sarathi , Malik Prabhat Singh , Mathew Anisha , Pandey Awadhesh , Malhotra Pankaj , Gupta Sudeep , Kumar Lalit , Kataki Amal , Singh Gurpreet 
Published: July 2021

IntroductionThe rising economic burden of cancer on healthcare system and patients in India has led to the increased demand for evidence in order to inform policy decisions such as drug price regulation, setting reimbursement package rates under publicly financed health insurance schemes and prioritising available resources to maximise value of investments in health. Economic evaluations are an integral component of this important evidence. Lack of existing evidence on healthcare costs and health-related quality of life (HRQOL) makes conducting economic evaluations a very challenging task. Therefore, it is imperative to develop a national database for health expenditure and HRQOL for cancer.Methods and analysisThe present study proposes to develop a National Cancer Database for Cost and Quality of Life (CaDCQoL) in India. The healthcare costs will be estimated using a patient perspective. A cross-sectional study will be conducted to assess the direct out-of-pocket expenditure (OOPE), indirect cost and HRQOL among cancer patients who will be recruited at seven leading cancer centres from six states in India. Mean OOPE and HRQOL scores will be estimated by cancer site, stage of disease and type of treatment. Economic impact of cancer care on household financial risk protection will be assessed by estimating prevalence of catastrophic health expenditures and impoverishment. The national database would serve as a unique open access data repository to derive estimates of cancer-related OOPE and HRQOL. These estimates would be useful in conducting future cost-effectiveness analyses of management strategies for value-based cancer care.Ethics and disseminationApproval was granted by Institutional Ethics Committee vide letter no. PGI/IEC-03/2020-1565 of Post Graduate Institute of Medical Education and Research, Chandigarh, India. The study results will be published in peer-reviewed journals and presented to the policymakers at national level.
Impact of aspirin use on clinical outcomes in patients with vasospastic angina: a systematic review and meta-analysis
Authors: Lin Yaowang , Chen Yang , Yuan Jie , Qin Haiyan , Dong Shaohong , Chen Qiuling 
Published: July 2021

ObjectivesThe use of aspirin to prevent cardiovascular disease in vasospastic angina (VSA) patients without significant stenosis has yet to be investigated. This study aimed to investigate the efficacy of aspirin use among VSA patients.DesignSystematic review and meta-analysis.Data sourcesPubMed, Web of Science and Cochrane Central Register of Controlled Trials were searched for relevant information prior to October 2020.Eligibility criteria for selecting studiesAspirin use versus no aspirin use (placebo or no treatment) among VSA patients without significant stenosis.Data extraction and synthesisTwo investigators extracted the study data. ORs and 95% CIs were calculated and graphed as forest plots. The Newcastle-Ottawa Quality Assessment Scale tool and Begg’s funnel plot were used to assess risk of bias.ResultsFour propensity-matched cohorts, one retrospective analysis and one prospective multicentre cohort, in total comprising 3661 patients (aspirin use group, n=1695; no aspirin use group, n=1966) were included in this meta-analysis. Aspirin use and the incidence of major cardiovascular adverse events with follow-up of 1–5 years were not significantly correlated (combined OR=0.90, 95% CI: 0.55 to 1.68, p=0.829, I2=82.2%; subgroup analysis: OR=1.09, 95% CI: 0.81 to 1.47, I2=0%). No significant difference was found between aspirin use and the incidence of myocardial infarction (OR=0.62, 95% CI: 0.09 to 4.36, p=0.615, I2=73.8%) or cardiac death (OR=1.73, 95% CI: 0.61 to 4.94, p=0.444, I2=0%) during follow-up.ConclusionAspirin use may not reduce the risk of future cardiovascular events in VSA patients without significant stenosis.PROSPERO registration numberCRD42020214891.
Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic: an observational study in 16 European countries
Authors: van der Velden Alike W , Bax Eva A , Bongard Emily , Munck Aabenhus Rune , Anastasaki Marilena , Anthierens Sibyl , Balan Anca , Böhmer Femke , Bruno Pascale , Chlabicz Slawomir , Coenen Samuel , Colliers Annelies , Emmerich Susanne , Garcia-Sangenis Ana , Ghazaryan Hrachuhi , van der Linde Sanne R , Malania Lile , Pauer József , Tomacinschii Angela , Tonkin-Crine Sarah , Vellinga Akke , Zastavnyy Ihor , Verheij Theo , Goossens Herman , Butler Christopher C 
Published: July 2021

ObjectiveTo describe primary health care (consultation characteristics and management) for patients contacting their general practitioner (GP) with a respiratory tract infection (RTI) early on in the COVID-19 pandemic in contrasting European countries, with comparison to prepandemic findings.SettingPrimary care in 16 countries (79 practices), when no routine SARS-CoV-2 testing was generally available.Design and participantsBefore (n=4376) and early in the pandemic (n=3301), patients with RTI symptoms were registered in this prospective audit study.Outcome measuresConsultation characteristics (type of contact and use of PPE) and management characteristics (clinical assessments, diagnostic testing, prescribing, advice and referral) were registered. Differences in these characteristics between countries and between pandemic and prepandemic care are described.ResultsCare for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. GPs provided frequent and varied COVID-related advice and more frequently scheduled a follow-up contact (50%, 95% CI 48% to 52%). GPs reported a slightly higher degree of confidence in the likely effectiveness of their management in face-to-face (73% (very) confident, 95% CI 71% to 76%) than in virtual consultations (69%, 95% CI 67% to 71%).ConclusionsDespite between-country variation in consultation characteristics, access to SARS-CoV-2 laboratory testing and medication prescribing, GPs reported a high degree of confidence in managing their patients with RTIs in the emerging pandemic. Insight in the highly variable pandemic responses, as measured in this multicountry audit, can aid in fine-tuning national action and in coordinating a pan-European response during future pandemic threats.
Medical students’ experience of the hidden curriculum around primary care careers: a qualitative exploration of reflective diaries
Authors: Parekh Ravi , Jones Melvyn Mark , Singh Surinder , Yuan Jack Shi Jie , Chan See Chai Carol , Mediratta Saniya , Smith Rhys , Gunning Elinor , Gajria Camille , Kumar Sonia , Park Sophie 
Published: July 2021

ObjectivesPrimary healthcare internationally is facing a workforce crisis with fewer junior doctors choosing general practice (GP) as a career. In the UK, a national report on GP careers highlighted adverse influences during medical school on students’ career choices. The authors explored these influences in two urban UK medical schools, both with relatively low numbers of students entering GP training.DesignUsing a phenomenological approach, the authors thematically analysed the reflective diaries of four medical students who were recruited as ‘participant researchers’ over a period of 10 months. These students made regular reflexive notes about their experiences related to GP career perceptions in their academic and personal environments, aiming to capture both positive and negative perceptions of GP careers. The research team discussed emerging data and iteratively explored and developed themes.SettingTwo UK medical schoolsParticipantsUndergraduate medical studentsResultsSeven key themes were identified: the lack of visibility and physicality of GP work, the lack of aspirational GP role models, students’ perceptions of a GP career as default, the performativity of student career choice with the perceptions of success linked to specialism, societal perceptions of GP careers, gender stereotyping of career choices and the student perception of life as a GP.ConclusionsStudents overwhelmingly reflected on negative cues to GP careers, particularly through their experience of the hidden curriculum. Three recommendations are made: the need for increased representation of GP role models in clinical curricula content delivery and senior leadership; ensuring GP clerkships involve an active and authentic student role with patients, enabling students to experience GP’s ‘work’ including managing complexity, uncertainty and risk. Finally, institutions need to consider students’ experiences of the hidden curriculum and the effect this can have on students’ perception of careers, alongside the challenges of rankings and perceived hierarchical positioning of disciplines.
Psychological factors for the onset of depression: a meta-analysis of prospective studies
Authors: Fu Zhongfang , Brouwer Marlies , Kennis Mitzy , Williams Alishia , Cuijpers Pim , Bockting Claudi 
Published: July 2021

ObjectivesA comprehensive overview of the evidence for factors derived from leading psychological theories of the onset of major depressive disorder (MDD) that underpin psychological interventions is scarce . We aimed to systematically investigate the prospective evidence for factors derived from the behavioural, cognitive, diathesis–stress, psychodynamic and personality-based theories for the first onset of MDD.DesignSystematic review and meta-analysis.MethodsDatabases PubMed, PsycINFO, Cochrane and Embase and published articles were systematically searched from inception up to August 2019. Prospective, longitudinal studies that investigated theory-derived factors before the first onset of MDD, established by a clinical interview, were included. Screening, selection and data extraction of articles were conducted by two screeners. The Grading of Recommendations Assessment, Development and Evaluation criteria were used to estimate level of confidence and risk of bias. Meta-analysis was conducted using random-effects models and mixed-method subgroup analyses.Primary and secondary outcome measuresEffect size of a factor predicting the onset of MDD (OR, risk ratio or HR).ResultsFrom 42 133 original records published to August 2019, 26 studies met the inclusion criteria. Data were only available for the cognitive (n=6585) and personality-based (n=14 394) theories. Factors derived from cognitive theories and personality-based theories were related to increased odds of MDD onset (pooled OR=2.12, 95% CI: 1.12 to 4.00; pooled OR=2.43, 95% CI: 1.41 to 4.19). Publication bias and considerable heterogeneity were observed.ConclusionThere is some evidence that factors derived from cognitive and personality-based theories indeed predict the onset of MDD (ie, dysfunctional attitudes and negative emotionality). There were no studies that prospectively studied factors derived from psychodynamic theories and not enough studies to examine the robust evidence for behavioural and diathesis–stress theories. Overall, the prospective evidence for psychological factors of MDD is limited, and more research on the leading psychological theories is needed.PROSPERO registration numberCRD42017073975.
Gravitating Meron-like topological solitons in massive Yang–Mills theory and the Einstein–Skyrme model
Authors: Ipinza Marcelo , Salgado-Rebolledo Patricio 
Published: July 2021

AbstractWe show that Merons in D-dimensional Einstein–Massive–Yang–Mills theory can be mapped to solutions of the Einstein–Skyrme model. The identification of the solutions relies on the fact that, when considering the Meron ansatz for the gauge connection $$A=\lambda U^{-1}dU$$

A
=
λ

U

-
1

d
U

, the massive Yang–Mills equations reduce to the Skyrme equations for the corresponding group element U. In the same way, the energy–momentum tensors of both theories can be identified and therefore lead to the same Einstein equations. Subsequently, we focus on the SU(2) case and show that introducing a mass for the Yang–Mills field restricts Merons to live on geometries given by the direct product of $$S^3$$

S
3

(or $$S^2$$

S
2

) and Lorentzian manifolds with constant Ricci scalar. We construct explicit examples for $$D=4$$

D
=
4

and $$D=5$$

D
=
5

. Finally, we comment on possible generalisations.