bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examining Potential Psychosocial Mediators in a Physical Activity Intervention for Older Adults
Authors: McMahon Siobhan K , Lewis Beth , Oakes J Michael , Wyman Jean F , Guan Weihua , Rothman Alexander J 
Published: August 2019

The purpose of this study was to examine psychosocial constructs targeted as potential mediators in a prior physical activity (PA) intervention study. This secondary analysis used data from 102 older adults randomized to one of four conditions—within a 2 (Interpersonal Strategies: yes, no) x 2 (Intrapersonal Strategies: yes, no) factorial design. We tested intervention effects on social support, self-efficacy, self-regulation, and goal attainment, and whether these constructs mediated intervention effects on PA. Participants who received interventions with interpersonal strategies, compared to those who did not, increased their readiness (post-intervention), the self-regulation subscale of self-assessment, and goal attainment (post-intervention, 6-months). Participants who received interventions with intrapersonal strategies, compared to those who did not, increased their social support from family (post-intervention). There was no statistically significant mediation. To understand mechanisms through which interventions increase older adults’ PA and to improve intervention effectiveness, researchers should continue to examine potential psychosocial mediators. Clinical Trial Registry: NCT02433249.
Visualizing social support in home pediatric palliative care using network maps
Authors: Lindemann Daniela , Borasio Gian Domenico , Führer Monika , Wasner Maria 
Published: August 2019

Background: Home care of children with life-limiting diseases is extremely challenging for parents/family caregivers and their social environment. In order to gain new insights into the perspective of family caregivers, we employed digital Network Maps for the first time in the field of pediatric palliative care. Aim: To examine whether the use of Network Maps helps to identify and visualize significant members of the social support system and the quality of the relationship, as well as the main areas of life that are experienced as being supportive by each individual. Design: The design was an integrated mixed methods study. Creation of Network Maps was assessed in conjunction with qualitative interviews. In addition, participants gave an oral feedback on the Network Maps themselves. Setting/participants: Parents of patients supported by a Specialized Home Pediatric Palliative Care team were eligible for inclusion. Forty-five parents were enrolled in the study. Results: All mothers and fathers were able to generate their individual Network Map without problems. The composition of the support systems differed greatly, even between members of the same family. Parents named on average 11 supporting actors, mainly family members and health care professionals. Some relationships were perceived as helpful and stressful at the same time. Conclusion: Network Maps appear to be an appropriate tool for the collection, reconstruction, and assessment of the current support situation of parents of dying children. Further studies should examine the usefulness of Network Maps for the understanding of the caregivers’ support needs and for the development of psychosocial interventional strategies by pediatric palliative care teams.
Uptake of cancer screening among adults with disabilities in Flanders (Belgium)
Authors: Kellen Eliane , Nuyens Charlotte , Molleman Catherine , Hoeck Sarah 
Published: August 2019

Objective To explore the association between disability and participation in breast, cervical, and colorectal cancer screening in Flanders (Belgium). Methods Data from the Centre for Cancer Detection were linked to data of the Flemish Agency for disabled persons by the Crossroads Bank for Social Security, using National Social Security Numbers. Results The study population consisted of 92,334 invited individuals registered as disabled in 2013–2015. For breast cancer screening (including both opportunistic screening and participation in the screening program), 51.7% of disabled women had undergone mammography in the last two years, compared with the Flemish uptake of 61.8%. In cervical screening, 45% of the women with a disability had undergone a PAP smear in the last three years (overall Flemish uptake was 60.7%). For colorectal cancer screening, 40.7% of individuals with a disability had undergone a fecal immunochemical test in the last two years (overall Flemish uptake was 51.5%). Participation in breast and colorectal cancer screening among persons with a disability was 10% points less than the Flemish average during the same period. In the cervical cancer screening program, the difference between the participation of disabled women and the Flemish average was 10% points. Persons with any type of disability had a lower uptake of cancer screening than the Flemish average, except for individuals with a hearing impairment. Conclusions Participation disparities in the Flemish cancer screening programs between persons with and without disabilities require specific efforts to increase cancer screening among people with a disability.
Concepts of health in long-term home care: An empirical-ethical exploration
Authors: Seidlein Anna-Henrikje , Buchholz Ines , Buchholz Maresa , Salloch Sabine 
Published: August 2019

Background Concepts of health have been widely discussed in the philosophy and ethics of medicine. Parallel to these theoretical debates, numerous empirical research projects have focused on subjective concepts of health and shown their significance for individuals and society at various levels. Only a few studies have so far investigated the concepts of health of non-professionals and professionals involved in long-term home care and discussed these empirical perspectives regarding moral responsibilities. Objectives To identify the subjective concepts of the health of non-professionals (care recipients, informal caregivers) and professionals (registered nurses) involved in long-term home care and to discuss them against the background of existing normative guidelines addressing non-professionals and professionals’ responsibilities and rights concerning health. Research design A qualitative design was chosen to explore subjective concepts of health. Data were collected by semi-structured interviews; content analysis was applied according to Mayring. Participants and research context Twenty-eight interviews were conducted with non-professionals and professionals in long-term home care arrangements in Northern Germany. Ethical considerations Ethics approval was obtained from the Institutional Review Board at the University Medicine Greifswald (BB123/16). Findings Non-professionals and professionals consider health as a capability that enables them to participate in social activities and live their own lives according to their preferences. The former regard health particularly as a feeling and an attitude, the latter as the absence of disease with a focus on mental and emotional well-being. Both groups highlight the unsurpassable value of health and the personal responsibility for it. Discussion Normative guidelines applicable to practice in long-term home care discuss responsibilities and rights unevenly and raise several problems regarding non-professionals and professionals’ subjective concepts of health. Conclusion Individuals’ concepts of health are relevant for the subsequent interpretation of rights and responsibilities and should, thus, be reflected upon to address health-related needs effectively.
The shared stories that written words tell when no one is reading: exploring modality in typographic landscapes as an ecosocial semiotic system
Authors: Pescatore Frisk Ryan , Pauwels Luc 
Published: August 2019

In this article, the authors argue that typography at times functions as a primary semiotic resource when compared to the semantic meaning of text. The central inquiry further claims that this phenomenon is not an exception but, instead, a fundamental characteristic of systematic relationships in the broader semiotic network and may be understood from this perspective. The study explores typographic meaning as an ecosocial semiotic network to research how local ideologies are influenced by trajectories of semiotic potential across scales of time and space. The exploration takes up the task (however lightly or implicitly) of connecting ideas of distinct features of typography (serifs, proportions, construction, organization, cohesion, etc.) to a network of semiotic potential that is materialized within social practices of local communities. It develops an approach to understanding recurring characteristics in the semiotic system of typography through material/semiotic biases or material couplings, namely how material processes, human physiology and culture influence (and continuously reinforce) meaning in written words. Building on the assumption that aspects of material origin and social practice interact to produce variation in typographic artifacts, ecosocial semiotic theory is incorporated as a conceptual framework as well as an evaluation criteria to test the central argument. It evaluates an approach to connecting broadly distributed, large-scale cultural patterns to emplaced social practices through the idea of modality. Two prominent strands of modality are surveyed, connecting findings from the initial case study to a broader ecosocial semiotic network. Through the idea of modality, the authors present a clear argument for why typography, as a semiotic resource, is fundamentally different from images and may be seen as a direct manifestation of social difference within everyday practices.
δ-Aminolevulinate induces fetal hemoglobin expression by enhancing cellular heme biosynthesis
Authors: Liu Li , Zhu Xingguo , Yu Alexander , Ward Christina M , Pace Betty S 
Published: August 2019

Sickle cell disease (SCD) and β-thalassemia are inherited blood disorders caused by genetic defects in the β-globin gene on chromosome 11, producing severe disease in people worldwide. Induction of fetal hemoglobin consisting of two α-globin and two γ-globin chains ameliorates the clinical symptoms of both disorders. In the present study, we investigated the ability of δ-aminolevulinate (ALA), the heme precursor, to activate γ-globin gene expression as well as its effects on cellular functions in erythroid cell systems. We demonstrated that ALA induced γ-globin expression at both the transcriptional and protein levels in the KU812 erythroid cell line. Using inhibitors targeting two enzymes in the heme biosynthesis pathway, we showed that cellular heme biosynthesis was involved in ALA-mediated γ-globin activation. Moreover, the transcription factor NRF2 (nuclear factor [erythroid-derived 2]-like 2), a critical regulator of the cellular antioxidant response, was activated by ALA and contributed to mechanisms of γ-globin activation; ALA did not affect cell proliferation and was not toxic to cells. Subsequent studies demonstrated ALA-induced γ-globin activation in erythroid progenitors generated from normal human CD34+ stem cells. These data support future study to explore the potential of stimulating intracellular heme biosynthesis by ALA or similar compounds as a novel therapeutic strategy for treating SCD and β-thalassemia. Impact statement Inherited mutations in the β-globin-like genes result in the most common forms of genetic blood disease including sickle cell disease (SCD) and β-thalassemia worldwide. Therefore, effective inexpensive therapies that can be distributed widely are highly desirable. Currently, drug-mediated fetal hemoglobin (HbF) induction can ameliorate clinical symptoms of SCD and β-thalassemia and is the most effective strategy for developing new therapeutic options. In the current study, we confirmed that δ-Aminolevulinate (ALA), the precursor of heme, induces γ-globin expression at both the transcriptional and translational levels in primary human erythroid progenitors. Moreover, the results indicate activation of the transcription factor NRF2 (nuclear factor (erythroid-derived 2)-like 2) by ALA to enhance HbF expression. These data support future study to explore the potential of stimulating intracellular heme biosynthesis by ALA or similar compounds as a novel therapeutic strategy for treating SCD and β-thalassemia.
The road from intermittently scanned continuous glucose monitoring to hybrid closed-loop systems. Part B: results from randomized controlled trials
Authors: De Ridder Francesca , den Brinker Marieke , De Block Christophe 
Published: August 2019

Background: Advances in diabetes technology have been exponential in the last few decades. With evolution in continuous glucose monitoring (CGM) systems and its progressive automation in control of insulin delivery, these advances have changed type 1 diabetes mellitus (T1DM) management. These novel technologies have the potential to improve glycated haemoglobin (HbA1c), reduce hypoglycaemic events, increase time spent in range and improve quality of life (QoL). Our aim was to evaluate the sustained effects in free-living unsupervised conditions of CGM systems (intermittently scanned and real time) and insulin delivery [from multiple daily injections, via sensor-augmented pump therapy and (predictive) low-glucose insulin suspension to hybrid closed-loop systems] on glucose control and QoL in adults and children with T1DM. Methods: We performed a systematic review of randomized controlled trials (RCTs), using PubMed and the Cochrane library up to 30 May 2019. Inclusion of RCTs was based on type of intervention (comparing glucose-monitoring devices and insulin-delivery devices), population (nonpregnant adults and children with T1DM), follow-up (outpatient setting for at least 8 weeks) and relevant outcomes [HbA1c, time in range (TIR), time in target, time in hypoglycaemia and QoL]. Exclusion of RCTs was based on intervention (exercise, only overnight use). The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were used to score the quality of the papers and for the final selection of the articles. Results: Our search resulted in 214 articles, of which 19 were eligible. Studies on advanced use in adults and children with T1DM reported increased TIR (all 9 studies); decreased time in hypoglycaemia (13 out of 15 studies); lowered HbA1c levels (5 out of 15 studies); improved QoL (10 of 16 studies) and treatment satisfaction (7 studies). Conclusions: Recent technologies have dramatically changed the course of T1DM. They are proving useful in controlling glycaemia in patients with T1DM, without increasing the treatment burden.
Effects of autologous adipose-derived regenerative stem cells administered at the time of anterior cruciate ligament reconstruction on knee function and graft healing
Authors: Alentorn-Geli Eduard , Seijas Roberto , Martínez-De la Torre Adrián , Cuscó Xavier , Steinbacher Gilbert , Álvarez-Díaz Pedro , Barastegui David , Navarro Jordi , Serra-Renom José Maria , Nishishinya Betina , Català Jordi , Laiz Patricia , García-Balletbó Montserrat , Cugat Ramón 
Published: August 2019

Purpose: To compare the healing and clinical outcomes of anterior cruciate ligament (ACL) reconstruction between patients with or without intraoperative administration of adipose-derived regenerative stem cells (ADRC). Methods: Between 2013 and 2014, the outcomes of 20 soccer players undergoing ACL reconstruction using bone–patellar tendon–bone autograft infiltrated with ADRC at the end of the procedure were compared to a historical, matched cohort of 19 soccer players undergoing the same procedure without ADRC. Outcomes were obtained at baseline, and 6 and 12 months postop for IKDC (International Knee Documentation Committee), Lysholm, and Lequesne, and at 2, 4, 6, and 12 months postop for VAS (visual analogue scale) for pain and graft maturation to evaluate the ligamentization process (magnetic resonance imaging (MRI)-based). Results: Both groups significantly improved the IKDC ( p < 0.001 in both groups), Lysholm ( p < 0.001 in both groups), Lequesne index ( p < 0.001 in both groups), VAS for pain ( p = 0.002 for the ADRC and p < 0.001 for the control group), and MRI scores ( p < 0.001 in both groups) in the 12 months postop compared to baseline scores. However, there were no significant differences in the improvement of the outcomes between groups across time ( p > 0.05). All patients returned to sports after surgery, but 8 (40%) patients in the ADRC and 13 (68.4%) patients in the control group had lower Tegner activity score at 12 months postop. Conclusions: Patients receiving ADRC at the time of ACL reconstruction significantly improved knee function and healing/maturation of the graft at 12 months. However, this improvement was not statistically significant compared to a control group undergoing ACL reconstruction alone.
Tranexamic acid or epsilon-aminocaproic acid in total joint arthroplasty? A randomized controlled trial
Authors: Bradley Kendall E. , Ryan Sean P. , Penrose Colin T. , Grant Stuart A. , Wellman Samuel S. , Attarian David E. , Green Cynthia L. , Risoli Thomas , Bolognesi Michael P. 
Published: August 2019

Aims Antifibrinolytic agents, including tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA), have been shown to be safe and effective for decreasing perioperative blood loss and transfusion following total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, there are few prospective studies that directly compare these agents. The purpose of this study was to compare the benefits of intraoperative intravenous TXA with EACA. Patients and Methods A total of 235 patients (90 THA and 145 TKA) were enrolled in this prospective, randomized controlled trial at a single tertiary-care referral centre. In the THA cohort, 53.3% of the patients were female with a median age of 59.8 years (interquartile range (IQR) 53.3 to 68.1). In the TKA cohort, 63.4% of the patients were female with a median age of 65.1 years (IQR 59.4 to 69.5). Patients received either TXA (n = 119) or EACA (n = 116) in two doses intraoperatively. The primary outcome measures included change in haemoglobin level and blood volume, postoperative drainage, and rate of transfusion. Secondary outcome measures included postoperative complications, cost, and length of stay (LOS). Results TKA patients who received EACA had greater drainage (median 320 ml (IQR 185 to 420) vs 158 ml (IQR 110 to 238); p < 0.001), increased loss of blood volume (891 ml (IQR 612 to 1203) vs 661 ml (IQR 514 to 980); p = 0.014), and increased haemoglobin change from the preoperative level (2.1 ml (IQR 1.7 to 2.8) vs 1.9 ml (IQR 1.2 to 2.4); p = 0.016) compared with patients who received TXA. For the THA cohort, no statistically significant differences were observed in any haematological outcome measure. One patient in the EACA group required transfusion. No patient in the TXA group required transfusion. There were no statistically significant differences in number or type of postoperative complications or LOS for either THA or TKA patients regardless of whether they received TXA or EACA. Conclusion For hip and knee arthroplasty procedures, EACA is associated with increased perioperative blood loss compared with TXA. However, there is no significant difference in transfusion rate. While further prospective studies are needed to compare the efficacy of each agent, we currently recommend orthopaedic surgeons to select their antifibrinolytic based on cost and regional availability. Cite this article: Bone Joint J 2019;101-B:1093–1099.
Tibial nailing using a suprapatellar rather than an infrapatellar approach significantly reduces anterior knee pain postoperatively: a multicentre clinical trial
Authors: MacDonald D. R. W. , Caba-Doussoux P. , Carnegie C. A. , Escriba I. , Forward D. P. , Graf M. , Johnstone A. J. 
Published: August 2019

AimsThe aim of this study was to compare the incidence of anterior knee pain after antegrade tibial nailing using suprapatellar and infrapatellar surgical approachesPatients and MethodsA total of 95 patients with a tibial fracture requiring an intramedullary nail were randomized to treatment using a supra- or infrapatellar approach. Anterior knee pain was assessed at four and six months, and one year postoperatively, using the Aberdeen Weightbearing Test – Knee (AWT-K) score and a visual analogue scale (VAS) score for pain. The AWT-K is an objective patient-reported outcome measure that uses weight transmitted through the knee when kneeling as a surrogate for anterior knee pain.ResultsA total of 53 patients were randomized to a suprapatellar approach and 42 to an infrapatellar approach. AWT-K results showed a greater mean proportion of weight transmitted through the injured leg compared with the uninjured leg when kneeling in the suprapatellar group compared with the infrapatellar group at all timepoints at all follow-up visits. This reached significance at four months for all timepoints except 30 seconds. It also reached significance at six months at 0 seconds, and for one year at 60 seconds.ConclusionThe suprapatellar surgical approach for antegrade tibial nailing is associated with less anterior knee pain postoperatively compared with the infrapatellar approach Cite this article: Bone Joint J 2019;101-B:1138–1143
Physeal-preserving endoprosthetic replacement with short segment fixation in children with bone sarcomas
Authors: Tsuda Y. , Fujiwara T. , Sree D. , Stevenson J. D. , Evans S. , Abudu A. 
Published: August 2019

AimsThe aim of this study was to report the results of custom-made endoprostheses with extracortical plates plus or minus a short, intramedullary stem aimed at preserving the physis after resection of bone sarcomas in children.Patients and MethodsBetween 2007 and 2017, 18 children aged less than 16 years old who underwent resection of bone sarcomas, leaving ≤ 5 cm of bone from the physis, and reconstruction with a custom-made endoprosthesis were reviewed. Median follow-up was 67 months (interquartile range 45 to 91). The tumours were located in the femur in 11 patients, proximal humerus in six, and proximal tibia in one.ResultsThe five-year overall survival rate was 78%. No patient developed local recurrence. The five-year implant survival rate was 79%. In all, 11 patients (61%) developed a complication. Seven patients (39%) required further surgery to treat the complications. Implant failures occurred in three patients (17%) including one patient with aseptic loosening and two patients with implant or periprosthetic fracture. The preserved physis continued to grow at mean 3.3 cm (0 to 14). The mean Musculoskeletal Society score was 88% (67% to 97%).ConclusionCustom-made endoprostheses that aim to preserve the physis are a safe and effective option for preserving physeal growth, limb length, and joint function with an acceptable rate of complications. Cite this article: Bone Joint J 2019;101-B:1144–1150