bluuebunny/crossref_metadata_2025_split huggingface dataset:
Slow Gait Speed and Cardiac Rehabilitation Participation in Older Adults After Acute Myocardial Infarction
Authors: Flint Kelsey , Kennedy Kevin , Arnold Suzanne V. , Dodson John A. , Cresci Sharon , Alexander Karen P. 
Published: February 2018

Background

Lack of participation in cardiac rehabilitation (
CR
) and slow gait speed have both been associated with poor long‐term outcomes in older adults after acute myocardial infarction (
AMI
). Whether the effect of
CR
participation on outcomes after
AMI
differs by gait speed is unknown.

Methods and Results

We examined the association between gait speed and
CR
participation at 1 month after discharge after
AMI
, and death and disability at 1 year, in 329 patients aged ≥65 years enrolled in the
TRIUMPH
(Translational Research Investigating Underlying Disparities in Recovery From Acute Myocardial Infarction: Patients' Health Status) registry. Among these patients, 177 (53.7%) had slow gait speed (<0.8 m/s) and 109 (33.1%) participated in
CR
. Patients with slow gait speed were less likely to participate in
CR
compared with patients with normal gait speed (27.1% versus 40.1%;
P
=0.012). In unadjusted analysis,
CR
participants with normal gait speed had the lowest rate of death or disability at 1 year (9.3%), compared with those with slow gait speed and no
CR
participation (43.2%). After adjustment for cardiovascular risk factors and cognitive impairment, both slow gait speed (odds ratio, 2.30; 95% confidence interval, 1.30–4.06) and non‐
CR
participation (odds ratio, 2.34; 95 confidence interval, 1.22–4.48) were independently associated with death or disability at 1 year. The effect of
CR
on the primary outcome did not differ by gait speed (
P
=0.70).

Conclusions

CR
participation is associated with reduced risk for death or disability after
AMI
. The beneficial effect of
CR
participation does not differ by gait speed, suggesting that slow gait speed alone should not preclude referral to
CR
for older adults after
AMI
.
Patient‐Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease‐Specific and a Generic Instrument
Authors: Björkenheim Anna , Brandes Axel , Magnuson Anders , Chemnitz Alexander , Edvardsson Nils , Poçi Dritan 
Published: February 2018

Background
Atrial fibrillation (AF) ablation improves patient‐reported outcomes, irrespective of mode of intermittent rhythm monitoring. We evaluated the use of an AF‐specific and a generic patient‐reported outcomes instrument during continuous rhythm monitoring 2 years after AF ablation.

Methods and Results
Fifty‐four patients completed the generic 36‐Item Short‐Form Health Survey and the AF‐specific AF6 questionnaires before and 6, 12, and 24 months after AF ablation. All patients underwent continuous ECG monitoring via an implantable loop recorder. The generic patient‐reported outcomes scores were compared with those of a Swedish age‐ and sex‐matched population. After ablation, both summary scores reached normative levels at 24 months, while role‐physical and vitality remained lower than norms. Responders to ablation (AF burden <0.5%) reached the norms in all individual 36‐Item Short‐Form Health Survey domains, while nonresponders (AF burden >0.5%) reached norms only in social functioning and mental component summary. All AF6 items and the sum score showed moderate to large improvement in both responders and nonresponders, although responders showed significantly greater improvement in all items except item 1 from before to 24 months after ablation. Higher AF burden was independently associated with poorer physical component summary and AF6 sum score.

Conclusions
The AF‐specific AF6 questionnaire was more sensitive to changes related to AF burden than the generic 36‐Item Short‐Form Health Survey. Patients improved as documented by both instruments, but a higher AF burden after ablation was associated with poorer AF‐specific patient‐reported outcomes and poorer generic physical but not mental health. Our results support the use of an AF‐specific instrument, alone or in combination with a generic instrument, to assess the effect of ablation.

Clinical Trial Registration

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00697359.
Sense of clubhouse community belonging and empowerment
Authors: Tanaka Kimiko , Davidson Larry , Craig Thomas J 
Published: February 2018

Background: While the neighborhood community literature well documents a link between participation in supportive and effective community groups or activities and empowerment, there is as yet little empirical evidence of this relationship in the context of community mental health programs. Aim: The primary purpose of the study was to examine the relationship between sense of community belonging and empowerment among members of mental health clubhouses. Methods: A secondary analysis using a hierarchical regression model was conducted on cross-sectional structured interview data collected through a self-report questionnaire from 102 clubhouse members from six clubhouses in the United States and Finland. Results: The results indicated that members’ sense of clubhouse community belonging positively contributes to their empowerment. Conclusion: Fostering sense of community belonging appears to be a valid approach to catalyze empowerment. Study limitations and future research agendas were discussed.
Nutritional Status and General Immune Competence in Patients with Head and Neck Cancer
Authors: Brookes Gerald B , Clifford Peter 
Published: February 2018

Anergy to 2,4-dinitrochlorobenzene (DNCB) has been reported as a highly significant adverse prognostic immunological factor in several studies of patients with squamous cell carcinomas involving the head and neck. Patients with these tumours often present with concurrent nutritional deficiencies. This paper reports the findings of a prospective study into both the nutritional status and general immune competence of 53 such patients. Analysis of the results has demonstrated a statistically highly significant positive correlation between nutritional status and both the delayed hypersensitivity response to DNCB, and the pretreatment total lymphocyte count levels. It is suggested that nutritional deficit may be a primary adverse prognostic factor in this disease group, with immunoincompetence a secondary phenomenon, and supporting evidence is presented. The consequent probable importance of nutritional status with regard to clinical trials, and the necessity for controlled studies to determine the possible beneficial effect of nutritional support on ‘cure’ rates, are discussed.
Effects of Vibration, Noise and Restraint on Heart Rate, Blood Pressure and Renal Blood Flow in the Pig
Authors: Stephens D B , Rader R D 
Published: February 2018

Pigs and other farm animals are usually transported at least once during their lives; for example, all meat animals are finally taken to the abattoir for slaughter. The vibration, noise and handling associated with such transportation is usually novel to the animals, and therefore constitutes a potential ‘stressor’. Such adverse stimuli may trigger physiological and psychological changes which rapidly produce profound changes in blood flow to peripheral organs, particularly the kidney, whose blood vessels are richly supplied with sympathetic nerve fibres. In the present study, ultrasonic techniques have been used with chronically implanted flow sensors for measuring heart rate (HR) and changes in renal blood flow (RBF) in conscious, freestanding and unanaesthetized pigs to monitor their cardiovascular responses to vibration, noise and various handling procedures. In addition, arterial blood pressure (BP) was measured via a catheter placed in the carotid artery. To ensure that vibration and noise could be accurately reproduced, a transport simulator (TS) was constructed in the laboratory. A small decrease of approximately 5% was observed in RBF during the first few minutes of exposure to vibration and noise, but this returned to the control levels monitored in undisturbed animals within a few minutes. Thereafter, RBF became significantly elevated for the remaining period of exposure to vibration and noise. In contrast, HR remained significantly increased throughout. BP was not significantly changed as a result of the experimental manipulation. Restraint and handling of the animals appeared to cause maximal disturbance. HR and BP were more than doubled compared with the resting value, but there was a concomitant marked decrease in RBF. For example, in one pig, the normal renal blood flow of 5 ml/s was reduced to nearly half during the handling procedure. This, however, returned to normal levels within 4 min of release.
General Practitioner Referral of Patients with Lower Gastrointestinal Symptoms
Authors: Springall R G , Todd I P 
Published: February 2018

Of 500 consecutive patients with symptoms of colorectal disease referred to a specialist hospital for outpatient assessment, 305 were studied. There was a low incidence of examination by the general practitioner; less than half the patients had a rectal examination and 31% had no examination at all. In cases where GPs made a diagnosis, this was correct in half, which both demonstrates the potential for dangerous misdiagnosis and confirms the fact that many anorectal conditions can be identified by the history alone. It is suggested that direct-access clinics in a colorectal unit would minimize delay in accurate diagnosis. The resource implications for such a system would be limited in terms of special investigations and additional clinic facilities.
An Investigation into Factors that May Influence Tonsil Morphology
Authors: Crombie I K , Barr G 
Published: February 2018

To investigate whether tonsillar size was related to human morphology, age or duration of disease, 100 consecutive patients undergoing tonsillectomy for recurrent tonsillitis were investigated. The lengths, widths and volumes of each resected tonsil were measured and compared with patient characteristics ascertained on the day before surgery. The volume of tonsillar tissue was directly related to height (ρ=0.46, P<0.001) and weight (ρ=0.45, P<0.001) and age, but at any age (or body size) there was a wide range of tonsil size. A weak inverse relationship was found with the duration of recurrent tonsillitis. Tonsil size is of no relevance in the assessment of recurrent tonsillitis or adenoid hypertrophy.
Rectal Cancer after Pelvic Irradiation
Authors: Levitt M D , Millar D M , Stewart J O 
Published: February 2018

During a 6 month period in 1988 five women were treated at Colchester General Hospital for carcinoma of the rectum, each more than 10 years after undergoing pelvic irradiation. Although irradiation has not been proven to induce human colorectal cancer, considerable circumstantial and experimental evidence supports this belief. Features suggestive of radiation-induced colorectal cancer are the presence of radiation-damaged bowel adjacent to the carcinoma and a mucus-secreting (‘colloid’) histological pattern. The increasing number of women being exposed to rectal irradiation in the course of treatment of gynaecological malignancy may result in an increase in the incidence of radiation-induced rectal cancer. Awareness of this potential long-term complication is important when planning follow-up of patients subjected to pelvic radiotherapy.
Role of Computed Tomography in the Evaluation of Suspected Sacroiliac Joint Disease
Authors: Fewins H E , Whitehouse G H , Bucknall R C 
Published: February 2018

Computed tomography (CT) was compared with plain radiography in 41 examinations of selected patients with a clinical history suggestive of sacroiliac joint disease. The obliquity of the sacroiliac joints renders radiographic interpretation difficult. In the 41 cases who were examined with standard anteroposterior and posteroanterior radiographs of the sacroiliac joints, four were normal, eight abnormal and 29 were equivocal. Equivocal findings included indistinct and possibly irregular articular margins to the joints and subarticular sclerosis. Of the 29 equivocal studies, nine were normal on CT and 20 were abnormal. CT demonstrated definite changes of sacroiliac joint disease in 29 of the 41 examinations, 16 of which were sacroiliitis and 13 osteoarthritis. With plain radiography four of the eight abnormal studies were consistent with sacroiliitis, and four with osteoarthritis. It is concluded that CT is more sensitive than plain radiography in the evaluation of sacroiliac joint disease, and is especially valuable when there are equivocal plain radiographs.
Endoscopic Insertion of Celestin Tubes in Carcinoma of the Oesophagus
Authors: Beynon J , Winston T , Thompson M H 
Published: February 2018

‘Carcinoma of the oesophagus is by no means uncommon, and few conditions are more distressing. If left to himself the patient has nothing to look forward to but death by slow starvation … The problem of his relief is the purely mechanical one of relieving his obstruction.’ Sir Henry S Souttar 1924
Novel GREM1 Variations in Sub-Saharan African Patients With Cleft Lip and/or Cleft Palate
Authors: Gowans Lord Jephthah Joojo , Oseni Ganiyu , Mossey Peter A. , Adeyemo Wasiu Lanre , Eshete Mekonen A. , Busch Tamara D. , Donkor Peter , Obiri-Yeboah Solomon , Plange-Rhule Gyikua , Oti Alexander A. , Owais Arwa , Olaitan Peter B. , Aregbesola Babatunde S. , Oginni Fadekemi O. , Bello Seidu A. , Audu Rosemary , Onwuamah Chika , Agbenorku Pius , Ogunlewe Mobolanle O. , Abdur-Rahman Lukman O. , Marazita Mary L. , Adeyemo A. A. , Murray Jeffrey C. , Butali Azeez 
Published: February 2018

Objective: Cleft lip and/or cleft palate (CL/P) are congenital anomalies of the face and have multifactorial etiology, with both environmental and genetic risk factors playing crucial roles. Though at least 40 loci have attained genomewide significant association with nonsyndromic CL/P, these loci largely reside in noncoding regions of the human genome, and subsequent resequencing studies of neighboring candidate genes have revealed only a limited number of etiologic coding variants. The present study was conducted to identify etiologic coding variants in GREM1, a locus that has been shown to be largely associated with cleft of both lip and soft palate. Patients and Method: We resequenced DNA from 397 sub-Saharan Africans with CL/P and 192 controls using Sanger sequencing. Following analyses of the sequence data, we observed 2 novel coding variants in GREM1. These variants were not found in the 192 African controls and have never been previously reported in any public genetic variant database that includes more than 5000 combined African and African American controls or from the CL/P literature. Results: The novel variants include p.Pro164Ser in an individual with soft palate cleft only and p.Gly61Asp in an individual with bilateral cleft lip and palate. The proband with the p.Gly61Asp GREM1 variant is a van der Woude (VWS) case who also has an etiologic variant in IRF6 gene. Conclusion: Our study demonstrated that there is low number of etiologic coding variants in GREM1, confirming earlier suggestions that variants in regulatory elements may largely account for the association between this locus and CL/P.
Social work, participation, and poverty
Authors: Boone Katrien , Roets Griet , Roose Rudi 
Published: February 2018

Summary Although participatory social work approaches have been considered as a fruitful strategy, critical questions are raised in relation to the social justice aspirations of participatory social work with people in poverty. Inspired by the work of Nancy Fraser, we provide an in-depth insight in the complexities of supporting participatory parity in ‘Associations where People in Poverty Raise their Voice’. Combining semi-structured interviews and focus groups with practitioners in these organisations, we shed light on the complexities of the ‘how’, the ‘who’, and the ‘what’ of social justice that arise in such participatory practice. Findings Our findings suggest that even in practices that situate the principle of participatory parity at the heart of their fight for social justice, power asymmetries and social inequalities require attention. Exclusionary mechanisms become apparent in how practitioners try to support participatory parity of people in poverty in the different components in the organisation. When practitioners try to overcome these exclusionary effects, a sheer complexity and inescapable power struggles become visible. Moreover, the ambiguity of how practitioners attempt to empower people in poverty and enhance structural change leads to tensions between affirmative and transformative strategies in the fight against poverty. Applications Practitioners should be aware that they will never be able to resolve or escape inherent complexities in their attempts to work on a par with people in poverty. Nevertheless, it remains valuable to make continuous efforts to inform the public debate about the socially unjust nature of poverty and social inequality in our societies.
Evaluating service development in critical care: The impact of establishing a medical high dependency unit on intensive care unit workload, case mix, and mortality
Authors: Amiruddin Nabeel , Prescott Gordon J , Coventry Douglas A , Jansen Jan O 
Published: February 2018

Background Critical care services underpin the delivery of many types of secondary care, and there is increasing focus on how to best deliver such services. The aim of this study was to investigate the impact of establishing a medical high dependency unit, in a tertiary referral center, on the workload, case mix, and mortality of the intensive care unit. Methods Single-center, 11-year retrospective study of patients admitted to the general intensive care unit, before and after the opening of the medical high dependency unit, using interrupted time series methodology. Results Over the duration of the study period, 3209 medical patients were admitted to the intensive care unit. There was a constant rate of medical admissions to the intensive care unit until the opening of the medical high dependency unit, followed by a statistically significant decline thereafter. There was a statistically significant decrease in the average severity of illness of medical patients prior to the opening of the medical high dependency unit, but there was no evidence of a change following the opening of the unit. There was no evidence of a statistically significant change in the estimated mean standardized mortality ratio for either medical or surgical admissions after the intervention. Conclusions The opening of a medical high dependency unit had a minimal impact on the intensive care unit. There was, in all likelihood, an unmet need—of less seriously ill patients, who were previously looked after on a normal ward, but did not require intensive care unit admission—who are now cared for in the new medical high dependency unit. Interrupted time series analysis, although not without limitations, is a useful mean of evaluating changes in service delivery.
Using patient experiences to develop services for chronic pain
Authors: Outlaw Peter , Tripathi Shiva , Baldwin Jacqueline 
Published: February 2018

Purpose: The aim of this study was to improve the overall experience for patients using chronic pain services at a large teaching hospital in England. Experience-based co-design methodology was used to gain a greater understanding of patients’ experiences and to produce a list of priorities for change when improving the patient experience. Method: A total of seven video-recorded patient interviews were conducted to capture a range of patient experiences of using the chronic pain service. The interviews were analysed to identify ‘touchpoints’ which are areas in which patients experienced a heightened emotional response to their interaction with the service or staff. A short trigger film was compiled to illustrate these touchpoints to staff and gain their commitment to improve patients’ experiences when using the service. A patient experience event was held at which patients discussed the touchpoints and identified the most significant areas for change that would improve their experiences of using the chronic pain service. Results: A wide range of touchpoints were identified. The lack of information provided before arriving for a procedure and the need for a short debrief after clinic were prioritised for improvement. Patients valued the development of good relationships with clinic staff and feeling properly listened to for the first time. The patient experience event allowed the key points patients would like to know before a procedure, to be drawn up in a list, which could be passed onto staff. Conclusion: This study featured collaboration between patients and staff to improve patients’ experiences of using chronic pain services. Through patient participation, a comprehensive list of recommendations for service improvement was produced, and possible solutions were identified. The involvement of patients in driving change and re-designing services is shaping a more patient-centred chronic pain clinic and improving the experience for all the patients who use the service.
Antiphospholipid antibodies and recurrent thrombosis after a first unprovoked venous thromboembolism
Authors: Kearon Clive , Parpia Sameer , Spencer Frederick A. , Baglin Trevor , Stevens Scott M. , Bauer Kenneth A. , Lentz Steven R. , Kessler Craig M. , Douketis James D. , Moll Stephan , Kaatz Scott , Schulman Sam , Connors Jean M. , Ginsberg Jeffrey S. , Spadafora Luciana , Bhagirath Vinai , Liaw Patricia C. , Weitz Jeffrey I. , Julian Jim A. 
Published: February 2018

Key Points
The same type of APA on 2 occasions or >1 type of APA on the same or different occasions is associated with recurrent VTE. APA and D-dimer levels seem to be independently associated with recurrence after a first unprovoked VTE.
State of Lunacy in Great Britain and Ireland. 1868
Authors: J. T. D.  
Published: February 2018

The Twenty-third Report of the Commissioners in Lunacy is dated 31st March, 1869. It is a thick volume of 408 pages, of which 107 comprise the report proper, the remainder forming the usual appendices, which consist of—
(A.)The number of insane persons in asylums.(B.)Licences and change of proprietorships.C.D.Average weekly cost of maintenance in asylums and hospitals in 1868.(E.)Entries in visitors' books of county and borough asylums.(F.)The state of the Criminal Asylum, Broadmoor.(G.)Entries in visitors' books in hospitals.(H.)Entries at Fort Pitt and Yarmouth.(I.)Isle of Man Asylum. Report of Superintendent.(J.)Pauper lunatics and idiots not in asylums, &c.(K.)Workhouses.(L.)Statistical tables, with a copy of entry made by Commissioners on a special visit to St. Luke's Hospital, and the reply of the Committee thereto.