bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Road to Mental Readiness for First Responders: A Meta-Analysis of Program Outcomes
Authors: Szeto Andrew , Dobson Keith S. , Knaak Stephanie 
Published: April 2019

Objectives:First-responder mental health, especially in Canada, has been a topic of increasing interest given the high incidence of poor mental health, mental illness, and suicide among this cohort. Although research generally suggests that resiliency and stigma reduction programs can directly and indirectly affect mental health, little research has examined this type of training in first responders. The current paper examines the efficacy of the Road to Mental Readiness for First Responders program (R2MR), a resiliency and anti-stigma program.Methods:The program was tested using a pre-post design with a 3-month follow-up in 5 first-responder groups across 16 sites.Results:A meta-analytic approach was used to estimate the overall effects of the program on resiliency and stigma reduction. Our results indicate that R2MR was effective at increasing participants’ perceptions of resiliency and decreasing stigmatizing attitudes at the pre-post review, which was mostly maintained at the 3-month follow-up.Conclusions:Both quantitative and qualitative data suggest that the program helped to shift workplace culture and increase support for others.
Photodynamic Therapy for Genital Warts Causes Activation of Local Immunity
Authors: Xie Fang , Yu Haisheng S. , Wang Rui , Wang Dong , Li Yanming M. , Wen Haiying Y. , Du Jiangbo B. , Ba Wei , Meng Xianfu F. , Yang Jie , Lin Biwen W. , Li Hengjin J. , Li Chengxin X. , Zhang Liguo G. , Fang Xiangdong D. , Zhao Hua 
Published: April 2019

Background: 5-aminolevulinic acid photodynamic therapy (PDT) for genital warts is effective, safe, and can prevent recurrence. It is believed that PDT can induce immune responses, but the mechanism is not completely understood. Objectives: The objectives of this article are to confirm the effect of PDT for genital warts on local immunity and to investigate the recruitment and significance of immune cells in tissues. Methods: Local immune changes in T lymphocytes (CD3+, CD4+, CD8+), plasmacytoid dendritic cells (pDCs) (CD123+), and myeloid dendritic cells (CD1a+) after PDT in patients were evaluated by immunohistochemistry staining. Changes in mRNA levels of IFN-γ, IFN-α, IFN-ß, interferon-stimulated gene 15 kDa (ISG-15), Mx2, Toll-like receptor 9 (TLR9), and interferon regulatory factor 7 (IRF7) were analyzed by real-time quantitative polymerase chain reaction. Results: At 4 hours after PDT, CD4+ increased, accompanied by increased levels of mRNA expression of IFN-γ, but CD4+ and mRNA expression levels of IFN-γ were decreased at 24 hours after PDT. CD123+ pDCs showed an increasing trend. CD1a+ LCs in the epidermis gradually decreased, and DCs in the epidermis gradually increased. CD3+ infiltrated and migrated to the superficial dermis, but CD8+ did not change significantly after PDT. The mRNA expression levels of IFN-α, IFN-ß, ISG-15, Mx2, TLR9, and IRF7 showed an increasing trend after PDT. As compared with the patients without significantly increased IFN-α and IFN-ß after PDT sessions, patients with significant increases needed fewer sessions of PDT for remission. Conclusions: PDT for genital warts can activate T lymphocyte-mediated, DC-related, and pDC-related immunity. The clinical efficacy of PDT for genital warts may be related to the increased levels of IFN-α and IFN-ß after treatment.
Development of an evidence-based e-health readiness assessment framework for Uganda
Authors: Kiberu Vincent M , Mars Maurice , Scott Richard E 
Published: April 2019

Background: While e-health readiness assessment is vital to the successful implementation of e-health innovations, there is little published guidance (i.e. e-health readiness assessment frameworks (eHRAFs)) for institutions and countries. Objective: To develop an evidence-based and locally relevant eHRAF for Uganda. Method: A list of possible e-health readiness domains and constructs was developed through a structured review of the e-health literature. This list was first refined using author experience, insight and reflection. Based on this refined list, an eHRAF questionnaire was developed, which was initially pilot tested for face and content validity. Thereafter, it was distributed to 13 purposively selected study participants who were Ugandan e-health experts from the fields of health, information and communications technology (ICT) and academia. The questionnaire was discussed in a focus group setting for consensus input, where study participants confirmed, rejected or revised proposed domains and constructs suitable to guide e-health readiness assessment at either the national or site-specific level within Uganda. Results: Of 148 identified literature resources, 13 met inclusion criteria. A subjective review highlighted 11 frequently used e-health domains. Further reflection reduced these to nine domains, which were shared with study participants by means of the questionnaire. Based upon prior use of, and familiarity with, a management tool (PESTEL), participants’ consensus on factors essential for readiness assessment in Uganda was aligned with PESTEL’s six domains: political, economic, sociocultural, technological, environmental, and legal and regulatory. The participants considered engagement, and core and societal readiness as optional domains. Based on this input, the authors developed a proposed eHRAF suitable for Uganda, comprised of domains, sub-domains and constructs. Conclusion: The eHRAF developed in this research is an evidence-based framework (literature and cross-sectoral expert opinion) and consists of primary domains, sub-domains and constructs suitable for assessing e-health readiness in Uganda, either nationally or locally, prior to implementation of any e-health system. The process and principles may have utility in other countries. Implications: A national, culturally relevant, context-specific Ugandan eHRAF could facilitate efficient and effective planning and implementation of new e-health programmes across the country and assist policymakers and legislators to develop consistent and reliable guidelines and regulations.
Interdisciplinary User Groups and the Design of Healthcare Facilities
Authors: Carthey Jane 
Published: April 2019

Aim: This Australian research explores how “user group” participants from diverse professional discipline backgrounds understand, define, perform their roles, and assess the outcomes of the healthcare design process. Background: Part of the design process in Australia and New Zealand, the purpose of interdisciplinary user group consultation is to design the best healthcare facilities possible within the parameters set by project clients and funding bodies. Method: An online survey was used to explore how user group participants viewed the process, including how well informed they felt they were about their role/s in it, its success in achieving specific outcomes for their project, and how they felt their project client, owner, or funding body assessed these same issues. It included both closed and open-ended questions, and data were then analyzed using an interpretative methodology by an architect researcher based in practice. Results: Emergent issues identified include governance of the process, knowledge asymmetries between participants, missed opportunities for innovation, composition and workloads of user groups, and the quality of resources available to guide the process. Conclusions: The interdisciplinary user group process could be improved, and future research will look at how drawing on participatory design methods used in sectors such as urban planning may support the development of new techniques for conducting user groups.
Efficacy of Abdominal Control Feedback and Scapula Stabilization Exercises in Participants With Forward Head, Round Shoulder Postures and Neck Movement Impairment
Authors: Shiravi Shirin , Letafatkar Amir , Bertozzi Lucia , Pillastrini Paolo , Khaleghi Tazji Mehdi 
Published: April 2019

Background: Signs and symptoms of impaired function of the musculoskeletal system may be targeted by treating dysfunction located elsewhere. Hypothesis: Abdominal control feedback and scapular stabilization exercise interventions would result in positive changes in pain intensity, strength, electromyography, and flexion-relaxation phenomena in women with forward head and round shoulder postures and neck movement impairment. Study Design: Pretest-posttest intervention. Level of Evidence: Level 1. Methods: A total of 135 women (aged 27.23 ± 1.9 years) with forward head and round shoulder postures were randomized to 3 groups. Group 1 received 6-week scapular stabilization exercises with abdominal control feedback (n = 45), group 2 received 6-week scapular stabilization exercises without abdominal control feedback (n = 45), and group 3 received active self-exercise as a control group (n = 45). Posture, pain, proprioception, strength, and electromyography were assessed before and after the interventions. Results: There were significant between-group differences in pain, proprioception, strength, and electromyography favoring group 1. There were significant within-group changes in posture, pain, proprioception, strength, and electromyography in both groups 1 and 2. No significant change was observed for muscle strength. Conclusion: The addition of abdominal control feedback to the scapular stabilization exercises was shown to be superior to the scapular stabilization exercises alone for decreasing neck pain and restoring proper proprioception, strength, and electromyography in females with forward head and round shoulder postures and neck movement impairment. Clinical Relevance: The addition of abdominal control feedback to scapular stabilization exercises is superior to scapular stabilization exercises alone on the neck for improving electromyography, strength, and function in females with forward head and round shoulder postures and neck movement impairment.
Hip and Groin Injuries in Professional Basketball Players: Impact on Playing Career and Quality of Life After Retirement
Authors: Ekhtiari Seper , Khan Moin , Burrus Tyrrell , Madden Kim , Gagnier Joel , Rogowski Joseph P. , Maerz Tristan , Bedi Asheesh 
Published: April 2019

Background: Professional basketball players are at increased risk of hip and groin pain. Epidemiologic data exist on the prevalence of hip and groin issues among players in the National Basketball Association (NBA), but little is known about how these injuries affect athletes after retirement. Hypothesis: A high proportion of retired NBA athletes would have hip and/or groin pain. Study Design: Cross-sectional survey. Level of Evidence: Level 4. Methods: A survey was developed through an interdisciplinary focus group. The survey was developed to capture data regarding demographics, collegiate and professional athletic injuries, and current quality of life and musculoskeletal health. The questionnaire was electronically distributed to all members of the National Basketball Players Association using SurveyMonkey (N = 900). Results: A total of 108 (12%) retired NBA players completed the survey. More than one-third (36.3%) of athletes report currently experiencing hip and/or groin pain, and 17.6% had received injections for hip or groin conditions since retiring from the NBA. Since retiring, 14.7% of respondents had undergone total hip arthroplasty. The median Tegner activity level scale was 3 out of 10. Nearly one-third (32.4%) of athletes report moderate to severe problems with mobility, and close to half (48%) had moderate to extreme pain/discomfort. Conclusion: Hip and groin injuries are common among NBA athletes, affecting players throughout their careers and into retirement. A subset of athletes may exist in whom intra-articular hip pathology is not appropriately identified and treated while playing in the NBA. Clinical Relevance: Retired NBA athletes are at high risk of hip and groin pain after retirement and are more likely to require total hip arthroplasty compared with the general population.
Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis
Authors: Sahin Cigdem , Courtney Karen L , Naylor PJ , E Rhodes Ryan 
Published: April 2019

Objectives This study aimed to identify, assess and summarize available scientiﬁc evidence on tailored text messaging interventions focused on type 2 diabetes self-management. The systematic review concentrated on message design and delivery features, and tailoring strategies. The meta-analysis assessed the moderators of the effectiveness of tailored text messaging interventions. Methods A comprehensive search strategy included major electronic databases, key journal searches and reference list searching for related studies. PRISMA and Cochrane Collaboration's guidelines and recommended tools for data extraction, quality appraisal and data analysis were followed. Data were extracted on participant characteristics (age, gender, ethnicity), and interventional and methodological characteristics (study design, study setting, study length, choice of modality, comparison group, message type, format, content, use of interactivity, message frequency, message timing, message delivery, tailoring strategies and theory use). Outcome measures included diet, physical activity, medication adherence and glycated hemoglobin data (HbA1C). Where possible, a random effects meta-analysis was performed to pool data on the effectiveness of the tailored text messaging interventions and moderator variables. Results The search returned 13 eligible trials for the systematic review and 11 eligible trials for the meta-analysis. The majority of the studies were randomized controlled trials, conducted in high-income settings, used multi-modalities, and mostly delivered informative, educational messages through an automated message delivery system. Tailored text messaging interventions produced a substantial effect ( g = 0.54, 95% CI = 0.08–0.99, p < 0.001) on HbA1C values for a total of 949 patients. Subgroup analyses revealed the importance of some moderators such as message delivery ( QB = 18.72, df = 1, p = 0.001), message direction ( QB = 5.26, df = 1, p = 0.022), message frequency ( QB = 18.72, df = 1, p = 0.000) and using multi-modalities ( QB = 6.18, df = 1, p = 0.013). Conclusions Tailored mobile text messaging interventions can improve glycemic control in type 2 diabetes patients. However, more rigorous interventions with larger samples and longer follow-ups are required to confirm these findings and explore the effects of tailored text messaging on other self-management outcomes.
Regional Variation in Nonoperative Therapy Utilization for Symptomatic Lumbar Stenosis and Spondylolisthesis: A 2-Year Costs Analysis
Authors: Davison Mark A. , Lilly Daniel T. , Moreno Jessica , Cheng Joseph , Bagley Carlos , Adogwa Owoicho 
Published: April 2019

Study Design: Retrospective cohort study. Objectives: To characterize regional variations in maximal nonoperative therapy (MNT) costs in patients suffering from lumbar stenosis or spondylolisthesis. Methods: Medical records from patients with symptomatic lumbar stenosis or spondylolisthesis undergoing primary ≤3-level lumbar decompression and fusion procedures from 2007 to 2016 were gathered from a large insurance database. Geographic regions (Midwest, Northeast, South, and West) reflected the US Census Bureau definitions. Records were searchable by International Classification of Diseases diagnosis/procedure codes, Current Procedural Terminology codes, and insurance-specific generic drug codes. Utilization of MNT, defined as cost billed, prescriptions written, and number of units disbursed, within 2-years prior to index surgery was assessed. Results: A total of 27 877 patients underwent 1-, 2-, or 3-level lumbar decompression and fusion surgery. Regional breakdown of the study cohort was as follows: South 62.3%, Midwest 25.2%, West 10.4%, Northeast 2.1%. Regional variations in the number of patients using nonsteroidal anti-inflammatory drugs (NSAIDs) ( P < .0001), opioids ( P < .0001), muscle relaxants ( P < .0001), and lumbar steroid injections ( P < .0001) were detected. A significant difference was identified in the regional MNT failure rates ( P < .0001). The total cost associated with MNT prior to index surgery was $48 411 125 ($1736.60/patient), with the Midwest ($1943.83/patient) responsible for the greatest average spending. Despite comprising 62.3% of the cohort, the South was accountable for 67.5% of NSAID prescriptions, 64.6% of opioid prescriptions, and 71.2% of muscle relaxant prescriptions. Conclusions: Regional differences exist in the costs of MNT in patients with lumbar stenosis and spondylolisthesis prior to surgery. Future studies should focus on identifying patients likely to fail prolonged nonoperative management.
A Comparison of Borrowing and Default Behaviour Between Men and Women
Authors: Koride Padmavathi , Gurtoo Anjula 
Published: April 2019

Micro-credit started out as an intervention designed to address credit scarcity of women, purportedly because women are disenfranchised from property rights and adhere to repayment norms. Men, in contrast, were known for misusing the loans and defaulting on them. This paper, based on a sample of 490 men and 349 women drawn from four districts in erstwhile Andhra Pradesh, compares the borrowing and default drivers of men and women using systematic sampling techniques and rigorous statistical tests. Results show women’s disenfranchisement from family income and property, and hence their dependence on SHG membership for borrowing. Furthermore, men borrow from banks and planned repayments even in conditions of distress, where both genders are cost rationed. The findings also point to men co-opting with women for financing agriculture. A comparison of default drivers points to debt traps and lower or inadequate income driving defaults and underscores the asymmetry of information and asymmetry of power between lender–principals and borrower–agents, where the principals have an advantage over the agents in both the cases ( Saam, 2007 ). The paper, therefore, questions the blanket assumptions of compliant repayments by women and wilful defaults by men. JEL codes: D63, D82, J16, Z13, C51
Sternoclavicular Joint Reconstruction Fracture Risk Is Reduced With Straight Drill Tunnels and Optimized With Tendon Graft Suture Augmentation
Authors: Martetschläger Frank , Reifenschneider Franziska , Fischer Nicole , Wijdicks Coen A. , Millett Peter J. , Imhoff Andreas B. , Braun Sepp 
Published: April 2019

Background: Despite the rare entity of sternoclavicular joint (SCJ) instability, a variety of different reconstruction techniques for SCJ dislocations have been described. A technique with oblique drilling has been proposed to reduce intraoperative risks. Purpose: To biomechanically investigate different cerclage reconstruction techniques and the benefit of additional reinforcement using suture tape. Study Design: Controlled laboratory study. Methods: Reconstructed artificial bone specimens were mounted on a mechanical testing machine. They were subjected to anterior and posterior translation, analyzing ultimate strength, displacement, stiffness, and elongation. For stage 1, different angulations of the drill tunnels through the sternum and clavicle were compared. Straight drill tunnels from anterior to posterior were compared with 45° oblique drill tunnels. For stage 2, three different materials for cerclage reconstruction were compared: (1) suture tape alone (FT group), (2) tendon graft alone (tendon group), and (3) tendon graft with suture tape augmentation (tendon+FT group). Results: For the FT group, in the anterior and posterior directions, straight drill holes resulted in a significantly higher load to failure (936.9 ± 122.5 N) compared with oblique ones (434.5 ± 20.2 N) ( P < .0001). During cyclic testing, all specimens with straight drill holes survived the 5- to 550-N step, while all specimens with oblique ones failed during the 5- to 450-N step. Analyzing the graft material choice, the mean load to failure was 556.6 ± 174.3 N for the tendon group, 936.9 ± 122.5 N for the FT group, and 767.0 ± 110.7 N for the tendon+FT group ( P = .089). The stiffness of the tendon+FT group was significantly lower than that of the FT group and significantly higher than that of the tendon group. Conclusion: Oblique tunnel placement during SCJ reconstruction, while reducing the intraoperative risk, results in decreased primary stability of the construct. Tendon graft reconstruction with suture tape augmentation leads to enhanced stability and optimizes biomechanical properties of the construct. Clinical Relevance: The surgical technique with straight drill holes has superior initial biomechanical properties and may likewise produce superior clinical outcomes in the treatment of SCJ instability. Suture tape augmentation can provide additional stability to reconstruction procedures.
Patient Safety Morning Report: Innovation in Teaching Core Patient Safety Principles to Third-Year Medical Students
Authors: Beekman Michele , Emani Vamsi K , Wolford Robert , Hanson Keith , Wickham Gerald , Aiyer Meenakshy 
Published: April 2019

Introduction: Patient safety (PS) is one of the most important priorities in modern healthcare systems. Unfortunately, PS education is limited in many medical school curricula. Our objective was to implement an innovative curriculum to introduce third-year medical students on their pediatric clerkship to PS concepts and domains, and to provide a safe environment to discuss lapses in PS that they identified while caring for patients. Methods: At the start of the pediatric clerkship, students were introduced to the curriculum, instructed to identify a lapse of PS, and to submit a description and analysis of the lapse using the SAFE framework (S = Safety concern, A = Action taken, F = Failure, linked to safety domains, E = Effects on patient outcome). Two sessions, 90-mins each, were conducted every clerkship during which there was a brief didactic presentation, each student presented their case, and the case discussed by students and faculty. Results: Over 19 months, 75 students participated. The most common PS themes identified were Communication (57% of cases), Human factors (39%), and System issues (37%). Anonymous written feedback was obtained; learners reported improved knowledge and ability to identify lapses in PS and to propose potential solutions to prevent similar future events. They expressed a desire for additional PS and quality improvement education. Discussion: Our results show that third-year medical students are able to identify lapses in PS and able to propose solutions. This aligns with the Association of American Medical Colleges (AAMC) goals of entrustable professional activities (EPA) 13. We intend to expand the curriculum to other third-year core clerkships.