bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychological impact of electrocardiogram screening in National Collegiate Athletic Association athletes
Authors: Asif Irfan M , Annett Scott , Ewing Joseph A , Abdelfattah Ramy , Sutphin Brittan , Conley Kyle , Rothmier Justin , Harmon Kimberly G , Drezner Jonathan A 
Published: October 2017

PurposeDetermine the psychological impact of false-positive ECG screening in National Collegiate Athletic Association (NCAA) athletes.MethodsAthletes representing seven NCAA institutions received a standardised history, physical examination and ECG interpreted using the 2013 Seattle Criteria. Assessments of health attitudes, anxiety and impact of screening on sport were conducted using validated prescreen and postscreen measurements.Results1192 student-athletes participated (55.4% male, median age 19 years, 80.4% Caucasian). 96.8% of athletes had a normal cardiovascular screen, 2.9% had a false-positive ECG and 0.3% were diagnosed with a serious cardiac condition. Prior to screening, 4.5% worried about potentially harbouring cardiac disease and 70.1% preferred knowing about an underlying condition, rather than play sports without this knowledge. There was no difference in anxiety described by athletes with a normal versus false-positive screen (p=0.369). Reported anxiety levels during screening also did not differ when analysed by different gender, race, division of play or sport. Athletes with normal and false-positive screens had similar levels of satisfaction (p=0.714) and would recommend ECG screening to other athletes at similar rates (p=0.322). Compared with athletes with a normal screen, athletes with false-positive results also reported feeling safer during competition (p>0.01). In contrast, athletes with false-positive screens were more concerned about the possibility of sports disqualification (p<0.001) and the potential for developing a future cardiac condition (p<0.001).ConclusionsAthletes with a false-positive ECG do not experience more anxiety than athletes with a normal screen but do express increased concern regarding sports disqualification and the development of a cardiac disorder. These findings do not justify avoiding advanced cardiovascular screening protocols. Further understanding of athlete experiences could better prepare the practising physician to counsel athletes with an abnormal ECG.
Factor analyses of the Chinese Zarit Burden Interview among caregivers of patients with schizophrenia in a rural Chinese community
Authors: Tang Bingwei , Yu Yu , Liu Ziwei , Lin Meijuan , Chen Yumei , Zhao Mei , Xiao Shuiyuan 
Published: October 2017

ObjectiveThis study aimed to evaluate the factor structure of the Chinese version of the 22-item Zarit Burden Interview (ZBI) among family caregivers of patients with schizophrenia in China.MethodsUsing one-stage cluster-sampling design, 324 primary caregivers of patients with schizophrenia in Ningxiang County, Hunan Province, China, completed the Zarit Burden Interview face-to-face. Confirmatory factor analysis (CFA) was first performed based on existing models to check model fit. Owing to an unsatisfactory result of CFA, exploratory factor analysis (EFA) was then conducted to explore a new factor structure, and a subsequent CFA was run to examine its model fit.ResultsThe CFA results showed that none of the existing models fit the data reasonably well. The EFA results suggested five dimensions: negative emotion (10 items), interpersonal relationship (4 items), time demand (3 items), patient’s dependence (2 items) and self-accusation and guilt (2 items). The following CFA confirmed the five-factor solution in this study, and the goodness-of-fit for this model fell within the acceptable range. The overall internal consistency (Cronbach’s alpha) was 0.88, and the internal consistency coefficients of individual dimensions were 0.68 to 0.84.ConclusionThis study supported a 22-item ZBI scale, with a five-factor structure when applied to Chinese caregivers of patients with schizophrenia.
A cross-sectional examination of the profile of chiropractors recruited to the Australian Chiropractic Research Network (ACORN): a sustainable resource for future chiropractic research
Authors: Adams Jon , Peng Wenbo , Steel Amie , Lauche Romy , Moore Craig , Amorin-Woods Lyndon , Sibbritt David 
Published: October 2017

ObjectivesThe Australian Chiropractic Research Network (ACORN) practice-based research network (PBRN) cohort was established to provide sustainable infrastructure necessary to address lack of rigorous investigation and to bridge the research–practice gap focused on chiropractic care for future years. This paper presents the profile of chiropractors recruited to the ACORN PBRN, a nationally representative sample of chiropractors working in Australia.DesignCross-sectional analysis of baseline data from a cohort study of chiropractors in Australia.SettingAll registered chiropractors in Australia were invited to participate in the ACORN study and those who completed a practitioner questionnaire and consent form were included in the PBRN cohort.ParticipantsA total of 1680 chiropractors (36%) were recruited to the cohort database. The average age of the PBRN participants is 41.9 years and 63% are male. The vast majority of the PBRN participants hold a university degree.ResultsGeneral practitioners were identified as the most popular referral source for chiropractic care and low back pain and neck pain were the most common conditions ‘often’ treated by the PBRN chiropractors. The chiropractors in this PBRN cohort rated high velocity, low amplitude adjustment/manipulation/mobilisation as the most commonly used technique/method and soft tissue therapy as the most frequently employed musculoskeletal intervention in their patient management.ConclusionsThe ACORN PBRN cohort constitutes the largest coverage of any single healthcare profession via a national voluntary PBRN providing a sustainable resource for future follow-up. The ACORN cohort provides opportunities for further nested substudies related to chiropractic care, chiropractors, their patients and a vast range of broader healthcare issues with a view to helping build a diverse but coordinated research programme and further research capacity building around Australian chiropractic.
Effect of weekend admission on process of care and clinical outcomes for the management of acute coronary syndromes: a retrospective analysis of three UK centres
Authors: Martin Glen P , Kinnaird Tim , Sperrin Matthew , Anderson Richard , Gamal Amr , Jabbar Avais , Kwok Chun Shing , Barker Diane , Heatlie Grant , Zaman Azfar G , Mamas Mamas A 
Published: October 2017

ObjectivesThe effect of weekend versus weekday admission following acute coronary syndrome (ACS) on process of care and mortality remains controversial. This study aimed to investigate the ‘weekend-effect’ on outcomes using a multicentre dataset of patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction/unstable angina (NSTEMI/UA).DesignThis retrospective observational study used propensity score (PS) stratification to adjust estimates of weekend effect for observed confounding. Logistic regression was used to estimate odds ratios (ORs) for binary outcomes and time-to-event endpoints were modelled using Cox proportional hazards to estimate hazard ratios (HRs).SettingThree tertiary cardiac centres in England and Wales that contribute to the Myocardial Ischaemia National Audit Project.ParticipantsBetween January 2010 and March 2016, 17 705 admissions met the study inclusion criteria, 4327 of which were at a weekend.Primary and secondary outcomesAssociations were studied between weekend admissions and the following primary outcome measures: in-hospital mortality, 30-day mortality and long-term survival; secondary outcomes included several processes of care indicators, such as time to coronary angiography.ResultsAfter PS stratification adjustment, mortality outcomes were similar between weekend and weekday admission across patients with STEMI and NSTEMI/UA. Weekend admissions were less likely to be discharged within 1 day (HR 0.72, 95% CI 0.66 to 0.78), but after 4 days the length of stay was similar (HR 0.97, 95% CI 0.90 to 1.04). Fewer patients with NSTEMI/UA received angiography between 0 and 24 hours at a weekend (HR 0.71, 95% CI 0.65 to 0.77). Weekend patients with STEMI were less likely to undergo an angiogram within 1 hour, but there was no significant difference after this time point.ConclusionPatients with ACS had similar mortality and processes of care when admitted on a weekend compared with a weekday. There was evidence of a delay to angiography for patients with NSTEMI/UA admitted at the weekend.
Does laryngeal reinnervation or type I thyroplasty give better voice results for patients with unilateral vocal fold paralysis (VOCALIST): study protocol for a feasibility randomised controlled trial
Authors: Blackshaw Helen , Carding Paul , Jepson Marcus , Mat Baki Marina , Ambler Gareth , Schilder Anne , Morris Stephen , Degun Aneeka , Yu Rosamund , Husbands Samantha , Knowles Helen , Walton Chloe , Karagama Yakubu , Heathcote Kate , Birchall Martin 
Published: October 2017

IntroductionA functioning voice is essential for normal human communication. A good voice requires two moving vocal folds; if one fold is paralysed (unilateral vocal fold paralysis (UVFP)) people suffer from a breathy, weak voice that tires easily and is unable to function normally. UVFP can also result in choking and breathlessness. Current treatment for adults with UVFP is speech therapy to stimulate recovery of vocal fold (VF) motion or function and/or injection of the paralysed VF with a material to move it into a more favourable position for the functioning VF to close against. When these therapies are unsuccessful, or only provide temporary relief, surgery is offered. Two available surgical techniques are: (1) surgical medialisation; placing an implant near the paralysed VF to move it to the middle (thyroplasty) and/or repositioning the cartilage (arytenoid adduction) or (2) restoring the nerve supply to the VF (laryngeal reinnervation). Currently there is limited evidence to determine which surgery should be offered to adults with UVFP.Methods and analysisA feasibility study to test the practicality of running a multicentre, randomised clinical trial of surgery for UVFP, including: (1) a qualitative study to understand the recruitment process and how it operates in clinical centres and (2) a small randomised trial of 30 participants recruited at 3 UK sites comparing non-selective laryngeal reinnervation to type I thyroplasty. Participants will be followed up for 12 months. The primary outcome focuses on recruitment and retention, with secondary outcomes covering voice, swallowing and quality of life.Ethics and disseminationEthical approval was received from National Research Ethics Service—Committee Bromley (reference 11/LO/0583). In addition to dissemination of results through presentation and publication of peer-reviewed articles, results will be shared with key clinician and patient groups required to develop the future large-scale randomised controlled trial.Trial registration numberISRCTN90201732; 16 December 2015.
Risk factors and barriers to case management of neonatal pneumonia: protocol for a pan-India qualitative study of stakeholder perceptions
Authors: Nair N Sreekumaran , Lewis Leslie Edward , Lakiang Theophilus , Godinho Myron Anthony , Murthy Shruti , Venkatesh Bhumika T 
Published: October 2017

IntroductionIndia accounted for more neonatal deaths (estimated at 696 000) than any other country, as of 2015. Of these , most neonatal deaths due to infections can be attributed to pneumonia which accounts for 16% of all neonatal mortalities (2010). Despite simple, inexpensive case management strategies being available, pneumonia continues to cause significant mortality and morbidity among neonates. Understanding the perceptions and experiences of stakeholders of neonatal care can help find solutions to barriers to care and design tailored strategies for controlling neonatal pneumonia.Methods and analysisA pan-India qualitative study will be conducted. Participants include healthcare providers, programme officers, academicians, representatives of non-governmental organisations/bilateral agencies and policy makers. They will be recruited purposively from rural and urban, public and private, and facility and community healthcare settings across six Indian regions. Within each region, a minimum of one state will be selected. Districts will be based on neonatal mortality indicators, and will be subject to feasibility at the time of conducting the study. We plan to conduct in-depth interviews (IDI) and focus group discussions focusing on (a) burden, (b) risk factors, (c) case management, (d) treatment guidelines, (e) barriers to case management, (f) recommendations. The number of interviews will depend on the information saturation. Interviews will be audio-recorded with prior written consent and transcribed verbatim. Principles of thematic analysis will be applied for qualitative data analysis using R package for Qualitative Data Analysis (RQDA).Ethics and disseminationThe protocol has been approved by the Health Ministry Screening Committee, Government of India and the Institutional Ethics Committee at the host institution. Confidentiality and privacy of the participants will be maintained. The findings of the study will be shared with all stakeholders of this research including the participants. Knowledge dissemination workshops will be conducted to ultimately transfer the evidence tailored to the stakeholders' need.
Evolution of pain at 3 months by oral resveratrol in knee osteoarthritis (ARTHROL): protocol for a multicentre randomised double-blind placebo-controlled trial
Authors: Nguyen Christelle , Boutron Isabelle , Baron Gabriel , Coudeyre Emmanuel , Berenbaum Francis , Poiraudeau Serge , Rannou François 
Published: October 2017

IntroductionOsteoarthritis (OA) pathophysiology is driven in part by joint inflammation. Resveratrol has in vitro anti-inflammatory properties. We aim to assess the efficacy of oral resveratrol for knee pain at 3 months in people with knee OA.Methods and analysisWe will conduct a randomised double-blind placebo-controlled trial. Overall, 164 individuals with knee OA fulfilling 1986 American College of Rheumatology criteria will be recruited in three tertiary care centres in France and randomised to receive oral resveratrol, 40 mg (two caplets) two times per day for 1 week, then 20 mg (one caplet) two times per day or a matching placebo for a total of 6 months. Randomisation will be centralised and stratified by centre. The allocation ratio of assignments will be 1:1. The primary outcome will be the mean change from baseline in knee pain on a self-administered 11-point pain Numeric Rating Scale at 3 months. Secondary outcomes will be the mean change in knee pain at 6 months, the function subscore of the Western Ontario and McMaster Universities Arthritis Index score, patient global assessment, proportion of responders according to the Osteoarthritis Research Society International–Outcome Measures in Rheumatology criteria at 3 and 6 months, and self-reported number of intra-articular injections of corticosteroids or hyaluronic acid and consumption of analgesics and non-steroidal anti-inflammatory drugs since the last contact. Other interventions will be allowed and self-reported. Adherence will be monitored by capsule counts and a booklet and adverse events recorded at 3 and 6 months. Statisticians, treating physicians and participants will be blinded to the allocated treatment.Ethics and disseminationThe oral resveratrol in knee osteoarthritis (ARTHROL) trial has been authorised by theAgenceNationale de Sécurité du Médicament et des Produits de Santéand ethics were approved by theComité deProtection des Personnes Île-de-FranceIII. The findings of the study will be published in a peer-reviewed journal and disseminated at conferences. The design of ARTHROL will warrant the translation of its findings into clinical practice.Trial registration numberClinicalTrials.gov identifier:NCT02905799. Pre-results. First received: 14 September 2016. Last updated: 16 September 2016. Status: not yet recruiting.
Permanent work disability before and after ischaemic heart disease or stroke event: a nationwide population-based cohort study in Sweden
Authors: Ervasti Jenni , Virtanen Marianna , Lallukka Tea , Friberg Emilie , Mittendorfer-Rutz Ellenor , Lundström Erik , Alexanderson Kristina 
Published: October 2017

ObjectivesWe examined the risk of disability pension before and after ischaemic heart disease (IHD) or stroke event, the burden of stroke compared with IHD and which factors predicted disability pension after either event.DesignA population-based cohort study with follow-up 5 years before and after the event. Register data were analysed with general linear modelling with binary and Poisson distributions including interaction tests for event type (IHD/stroke).Setting and participantsAll people living in Sweden, aged 25‒60 years at the first event year, who had been living in Sweden for 5 years before the event and had no indication of IHD or stroke prior to the index event in 2006‒2008 were included, except for cases in which death occurred within 30 days of the event. People with both IHD and stroke were excluded, resulting in 18 480 cases of IHD (65%) and 9750 stroke cases (35%).Primary outcome measuresDisability pension.ResultsOf those going to suffer IHD or stroke event, 25% were already on disability pension a year before the event. The adjusted OR for disability pension at first postevent year was 2.64-fold (95% CI 2.25 to 3.11) for people with stroke compared with IHD. Economic inactivity predicted disability pension regardless of event type (OR=3.40; 95% CI 2.85 to 4.04). Comorbid mental disorder was associated with the greatest risk (OR=3.60; 95% CI 2.69 to 4.83) after an IHD event. Regarding stroke, medical procedure, a proxy for event severity, was the largest contributor (OR=2.27, 95% CI 1.43 to 3.60).ConclusionsWhile IHD event was more common, stroke involved more permanent work disability. Demographic, socioeconomic and comorbidity-related factors were associated with disability pension both before and after the event. The results help occupational and other healthcare professionals to identify vulnerable groups at risk for permanent labour market exclusion after such an event.
Effect of adherence to the first-generation injectable immunomodulatory drugs on disability accumulation in multiple sclerosis: a longitudinal cohort study
Authors: Zhang Tingting , Kingwell Elaine , Zhu Feng , Petkau John , Kastrukoff Lorne F , Marrie Ruth Ann , Tremlett Helen , Evans Charity 
Published: October 2017

ObjectiveTo examine the association between optimal adherence to the first-generation injectable immunomodulatory drugs (IMDs) for multiple sclerosis (MS) and subsequent disability accumulation.MethodsWe accessed prospectively collected linked clinical and administrative health data from British Columbia, Canada. Subjects with MS treated with a first-generation injectable IMD at an MS clinic (1996–2004) were followed until their last clinic visit before 2009. Adherence was estimated using the proportion of days covered (PDC). The primary outcome was disability accumulation, defined as an increase in the Expanded Disability Status Scale (EDSS) score as recorded during each year of follow-up. Generalised estimating equation models, adjusted for baseline sex, age, EDSS and time between scores, were used to measure associations between optimal adherence (≥80% PDC) during the first year of treatment and subsequent disability accumulation. The relationship between early IMD adherence and the secondary outcome, time to sustained EDSS 6, was examined using Cox proportional hazards regression.ResultsAmong 801 subjects, 598 (74.7%) had optimal adherence over the first year of IMD treatment and 487 (39.0%) demonstrated one or more instances of disability accumulation. Early optimal adherence was not associated with disability accumulation (adjusted OR 0.94; 95% CI 0.78 to 1.15), nor with time to sustained EDSS 6 (adjusted HR 0.91; 95% CI 0.57 to 1.44).ConclusionAlmost three-quarters of subjects with MS had optimal early adherence to their first-line injectable IMD. There was no evidence that this was associated with disability accumulation in the following years.
Incorporation of relative cerebral blood flow into CT perfusion maps reduces false ’at risk' penumbra
Authors: Peretz Shlomi , Orion David , Last David , Mardor Yael , Kimmel Yotam , Yehezkely Shelly , Lotan Eyal , Itsekson-Hayosh Ze’ev , Koton Sylvia , Guez David , Tanne David 
Published: October 2017

PurposeThe region defined as ‘at risk’ penumbra by current CT perfusion (CTP) maps is largely overestimated. We aimed to quantitate the portion of true ‘at risk’ tissue within CTP penumbra and to determine the parameter and threshold that would optimally distinguish it from false ‘at risk’ tissue, that is, benign oligaemia.MethodsAmong acute stroke patients evaluated by multimodal CT (NCCT/CTA/CTP) we identified those that had not undergone endovascular/thrombolytic treatment and had follow-up NCCT. Maps of absolute and relative CBF, CBV, MTT, TTP and Tmax as well as summary maps depicting infarcted and penumbral regions were generated using the Intellispace Portal (Philips Healthcare, Best, Netherlands). Follow-up CT was automatically co-registered to the CTP scan and the final infarct region was manually outlined. Perfusion parameters were systematically analysed – the parameter that resulted in the highest true-negative-rate (ie, proportion of benign oligaemia correctly identified) at a fixed, clinically relevant false-negative-rate (ie, proportion of ‘missed’ infarct) of 15%, was chosen as optimal. It was then re-applied to the CTP data to produce corrected perfusion maps.ResultsForty seven acute stroke patients met selection criteria. Average portion of infarcted tissue within CTP penumbra was 15%±2.2%. Relative CBF at a threshold of 0.65 yielded the highest average true-negative-rate (48%), enabling reduction of the false ‘at risk’ penumbral region by ~half.ConclusionsApplying a relative CBF threshold on relative MTT-based CTP maps can significantly reduce false ‘at risk’ penumbra. This step may help to avoid unnecessary endovascular interventions.