bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review of the Local Organizing Committee (LOC) medical services during the 12th FINA World Swimming Championships (25 m) in Doha, Qatar
Authors: Dijkstra H Paul , Geertsema Liesel , Benzarti Nejib , van Dorssen Elsbeth A L , van den Hoogenband Cees-Rein , Mountjoy Margo 
Published: March 2016

BackgroundOne of the primary roles of Fédération Internationale de Natation (FINA) is to promote athlete health. The planning and delivery of major international event medical services is carried out in collaboration with the Local Organizing Committee Medical Commission (LOCMC). Aspetar Orthopaedic and Sports Medicine Hospital provided the medical services to the 12th FINA World Swimming Championships (25 m) creating a unique opportunity for collaboration with FINA.AimThe purpose of this paper is to review the planning and delivery of medical services and athlete health promotion projects during the 12th FINA World Swimming Championships (25 m) to facilitate the planning of future sporting events of this size and scope.MethodsThe 12th FINA World Swimming Championships (25 m) hosted 974 athletes from 166 countries. The LOC medical team recorded all medical encounters—newly incurred (or acute exacerbations of chronic) injuries and illnesses as well as follow-up consultations.ResultsMore than 90% of teams did not travel with a team physician and relied on the LOCMC for diagnosis and treatment of injuries and illnesses in athletes and accredited team officials. The LOC medical team had a total of 554 medical encounters: 385 therapy, 34 athlete injury, 65 athlete illness and 70 non-athlete encounters.ConclusionsThe LOCMC in collaboration with FINA delivered comprehensive medical services to athletes, officials and spectators attending the 12th FINA World Swimming Championships (25 m). This review paper provides information relevant to the planning and delivery of LOCMC medical services for future international swimming events contributing to the FINA objective of promoting athlete health.
Incidence and aetiology of acute injuries during competitive road cycling
Authors: Decock Mathieu , De Wilde Lieven , Vanden Bossche Luc , Steyaert Adelheid , Van Tongel Alexander 
Published: March 2016

IntroductionDespite the ever-increasing popularity of bicycle racing, the high perceived risk of acute injuries and the recent media attention, studies of acute injuries in road cyclists are rather scarce. The goal of this study is to evaluate the incidence, aetiology and patterns of acute injuries in non-professional competitive road cyclists during cycling races in Flanders.Material and methodsAll acute injuries that occurred during competition in Flanders in 2002 and 2012, collected in the injury registry, were analysed. The incidence, injury rate, diagnosis, circumstances and level of performance were evaluated.ResultsA total of 777 documented reports of accidents (1230 injuries) were retrieved for the years 2002 and 2012. There was no significant difference between incidence and injury rate between 2002 and 2012. There was a strong significant difference in the incidence between the different levels of performance in both seasons. Severe injuries were seen in 29.5% in 2002 and in 30.1% in 2012. The most common location of a severe injury was the hand. Collision with another rider was the most common cause of injury.ConclusionsAlmost 1 out of 6 non-professional competitive road cyclists had an accident during cycling races in 2002 and 2012 in Flanders and collision with other riders was the most important cause of a crash. The most common lesion was abrasion, but almost one out of three riders had a severe injury.
The effects of shifting tasks from pharmacy to non-pharmacy personnel for providing antiretroviral therapy to people living with HIV: a systematic review protocol
Authors: Mbeye Nyanyiwe M , Kredo Tamara , Wiysonge Charles S 
Published: March 2016

IntroductionShifting selected antiretroviral therapy (ART) tasks from specialised healthcare workers to those with shorter or less formal training has been implemented in resource-limited settings to alleviate critical shortages of human resources for health. However, the specifics of shifting ART dispensing from pharmacy to non-pharmacy personnel have not been addressed in a systematic review, although this can potentially increase access to ART. We will assess the effects of shifting dispensing and distribution of ART and adherence assessment from pharmacy to non-pharmacy personnel in low and middle-income countries.Methods and analysisWe will search PubMed, CENTRAL, EMBASE, WHO Global Health Library and relevant grey literature for eligible controlled trials. Two authors will screen the search output, select eligible studies, assess risk of bias and extract data from included studies, resolving discrepancies by discussion and consensus. We will perform meta-analysis using both fixed and random effects models, investigate clinical and statistical heterogeneity, and assess our confidence in the overall evidence using standard Cochrane methods, including GRADE.Ethics and disseminationOnly secondary data will be included in this review and ethics approval is not required. We will disseminate the review findings in various scientific fora, including peer-reviewed journals. The findings may help to inform policy makers in defining the scope of work of healthcare workers, and global recommendations for shifting the dispensing and distribution of ART from pharmacy to non-pharmacy personnel.Trial registration numberCRD42015017034.
Role of students’ context in predicting academic performance at a medical school: a retrospective cohort study
Authors: Thiele Tamara , Pope Daniel , Singleton A , Stanistreet D 
Published: March 2016

ObjectivesThis study examines associations between medical students’ background characteristics (postcode-based measures of disadvantage, high school attended, sociodemographic characteristics), and academic achievement at a Russell Group University.DesignRetrospective cohort analysis.SettingApplicants accepted at the University of Liverpool medical school between 2004 and 2006, finalising their studies between 2010 and 2011.Participants571 students (with an English home postcode) registered on the full-time Medicine and Surgery programme, who successfully completed their medical degree.Main outcome measuresFinal average at year 4 of the medical programme (represented as a percentage).ResultsEntry grades were positively associated with final attainment (p<0.001). Students from high-performing schools entered university with higher qualifications than students from low-performing schools (p<0.001), though these differences did not persist at university. Comprehensive school students entered university with higher grades than independent school students (p<0.01), and attained higher averages at university, though differences were not significant after controlling for multiple effects. Associations between school type and achievement differed between sexes. Females attained higher averages than males at university. Significant academic differences were observed between ethnic groups at entry level and university. Neither of the postcode-based measures of disadvantage predicted significant differences in attainment at school or university.ConclusionsThe findings of this study suggest that educational attainment at school is a good, albeit imperfect, predictor of academic attainment at medical school. Most attainment differences observed between students either decreased or disappeared during university. Unlike previous studies, independent school students did not enter university with the highest grades, but achieved the lowest attainment at university. Such variations depict how patterns may differ between subjects and higher-education institutions. Findings advocate for further evidence to help guide the implementation of changes in admissions processes and widen participation at medical schools fairly.
Measurement of Exercise Tolerance before Surgery (METS) study: a protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery
Authors: Wijeysundera Duminda N , Pearse Rupert M , Shulman Mark A , Abbott Tom E F , Torres Elizabeth , Croal Bernard L , Granton John T , Thorpe Kevin E , Grocott Michael P W , Farrington Catherine , Myles Paul S , Cuthbertson Brian H 
Published: March 2016

IntroductionPreoperative functional capacity is considered an important risk factor for cardiovascular and other complications of major non-cardiac surgery. Nonetheless, the usual approach for estimating preoperative functional capacity, namely doctors’ subjective assessment, may not accurately predict postoperative morbidity or mortality. 3 possible alternatives are cardiopulmonary exercise testing; the Duke Activity Status Index, a standardised questionnaire for estimating functional capacity; and the serum concentration ofN-terminal pro-B-type natriuretic peptide (NT pro-BNP), a biomarker for heart failure and cardiac ischaemia.Methods and analysisThe Measurement of Exercise Tolerance before Surgery (METS) Study is a multicentre prospective cohort study of patients undergoing major elective non-cardiac surgery at 25 participating study sites in Australia, Canada, New Zealand and the UK. We aim to recruit 1723 participants. Prior to surgery, participants undergo symptom-limited cardiopulmonary exercise testing on a cycle ergometer, complete the Duke Activity Status Index questionnaire, undergo blood sampling to measure serum NT pro-BNP concentration and have their functional capacity subjectively assessed by their responsible doctors. Participants are followed for 1 year after surgery to assess vital status, postoperative complications and general health utilities. The primary outcome is all-cause death or non-fatal myocardial infarction within 30 days after surgery, and the secondary outcome is all-cause death within 1 year after surgery. Both receiver-operating-characteristic curve methods and risk reclassification table methods will be used to compare the prognostic accuracy of preoperative subjective assessment, peak oxygen consumption during cardiopulmonary exercise testing, Duke Activity Status Index scores and serum NT pro-BNP concentration.Ethics and disseminationThe METS Study has received research ethics board approval at all sites. Participant recruitment began in March 2013, and 1-year follow-up is expected to finish in 2016. Publication of the results of the METS Study is anticipated to occur in 2017.
Associations of cigarette smoking, betel quid chewing and alcohol consumption with high-sensitivity C-reactive protein in early radiographic knee osteoarthritis: a cross-sectional study
Authors: Zhang Yi , Zeng Chao , Wei Jie , Li Hui , Yang Tuo , Yang Ye , Deng Zhen-han , Ding Xiang , Lei Guanghua 
Published: March 2016

ObjectivesHigh-sensitivity C-reactive protein (hsCRP) is possibly related to osteoarthritis (OA) progression and a variety of OA-related symptoms. This study aimed to examine associations between cigarette smoking, betel quid chewing and alcohol consumption and hsCRP in early radiographic knee OA.DesignCross-sectional health examination survey.SettingThis primary study was conducted in a health examination centre in China.Participants936 (656 men and 280 women) patients with early radiographic knee OA were included in this cross-sectional study.Primary and secondary outcome measuresSmoking status was classified into four levels based on daily smoking habit: 0/day, 1–10/day, 11–20/day and >20/day. Betel quid chewing and alcohol consumption status was divided into ‘Yes’ or ‘No’. Early radiographic knee OA was defined as Kellgren Lawrence (K-L) grade 1 or 2 in at least one leg, and elevated hsCRP was assessed as ≥3.0 mg/L.ResultsAfter adjustment for a number of potential confounding factors, a significant positive association between cigarette smoking and hsCRP was observed in the multivariable model. The multivariable-adjusted ORs (95% CI) of elevated hsCRP (≥3.0 mg/L) in the second (1–10/day, n=133), third (11–20/day, n=59) and highest (>20/day, n=104) cigarette smoking categories were 1.54 (95% CI 0.91 to 2.61), 1.27 (95% CI 0.57 to 2.79) and 2.09 (95% CI 1.20 to 3.64), respectively, compared with the non-smoker category (n=640). In addition, there was a positive dose–response relationship between cigarette smoking and elevated hsCRP (p for trend=0.01). No significant associations between betel quid chewing and alcohol consumption and hsCRP were observed in the multivariable model.ConclusionsThis study indicated that cigarette smoking was positively associated with serum hsCRP level in patients with early radiographic knee OA. However, in view of the nature of cross-sectional designs, the results need to be confirmed by further prospective studies.
Is the peripapillary retinal perfusion related to myopia in healthy eyes? A prospective comparative study
Authors: Wang Xiaolei , Kong Xiangmei , Jiang Chunhui , Li Mengwei , Yu Jian , Sun Xinghuai 
Published: March 2016

ObjectivesThe aim of this study was to evaluate the peripapillary and parafoveal perfusion of young, healthy myopic subjects with spectral domain optical coherence tomography (OCT) angiography.DesignA prospective comparative study was conducted from December 2014 to January 2015.SettingParticipants recruited from a population-based study performed by the Eye, Ear, Nose and Throat Hospital of Fudan University in Shanghai.ParticipantsA total of 78 Chinese normal subjects (78 eyes) with different refraction were included. Myopia was divided into 4 groups on the basis of the refractive status: 20 eyes with emmetropia (mean spherical equivalent (MSE) 0.50D to −0.50D), 20 eyes with mild myopia (MSE −0.75D to −2.75D), 20 eyes with moderate myopia (MSE −3.00D to −5.75D), and 18 eyes with high myopia (MSE≤−6.00D).Main outcome measuresPeripapillary and parafoveal retinal and choroidal perfusion parameters and their relationships with axial length (AL) and retinal nerve fibre layer (RNFL) thickness were analysed.ResultsSignificant differences were found for the retinal flow index and vessel density in the peripapillary area among the 4 groups, but not in the parafoveal area. The high myopia group had the lowest peripapillary retinal flow index and vessel density. In addition, there was a negative correlation (β=−0.002, p=0.047) between the AL and peripapillary retinal flow index and a positive correlation between RNFL thickness and the peripapillary retinal perfusion parameters (flow index: β=0.001, p=0.006; vessel density: β=0.350, p=0.002) even after adjustment for other variables.ConclusionsHighly myopic eyes have a decreased peripapillary retinal perfusion compared with emmetropic eyes. Such vascular features might increase the susceptibility to vascular-related eye diseases.
The expression of arginase-1, keratin (K) 8 and K18 in combined hepatocellular-cholangiocarcinoma, subtypes with stem-cell features, intermediate-cell type
Authors: Akiba Jun , Nakashima Osamu , Hattori Satoshi , Naito Yoshiki , Kusano Hironori , Kondo Reiichiro , Nakayama Masamichi , Tanikawa Ken , Todoroki Keita , Umeno Yumi , Nakamura Ken , Sanada Sakiko , Yamaguchi Rin , Ogasawara Sachiko , Yano Hirohisa 
Published: March 2016

AimsThe WHO classification describes that combined hepatocellular-cholangiocarcinoma, subtypes with stem-cell features, intermediate-cell subtype (CHC-INT) is composed of tumour cells with features intermediate between hepatocytes and cholangiocytes. However, we previously reported that CHC-INT showed a high positive rate of biliary markers, but the expression of hepatocyte paraffin (HepPar)-1 was low. In this study, we examined the expression of other hepatocyte markers, such as arginase-1 (Arg-1), keratin (K) 8 and K18 in CHC-INT in order to examine the utility of pathological diagnosis in CHC-INT.MethodsWe performed immunohistochemistry (IHC) of Arg-1, K8 and K18 using 32 previously diagnosed as CHC-INT. Immunoreactivity was evaluated with grading from 0 to 4 according to the distribution area of positive cells. The obtained findings of Arg-1, K8 and K18 were compared with those of K7, K19 and HepPar-1.ResultsOut of the 32 cases, 22 (68.8%) cases were positive for Arg-1. Twenty-five (78.1%) were positive for K8. The IHC scores of Arg-1 and K8 were significantly higher than those of HepPar-1, but significantly lower than those of K7 and K19. The K18 expression was widely observed in all cases (100%). The IHC score of Arg-1 and K8 in CHC-INT was intermediate between hepatocellular carcinoma and cholangiocarcinoma.ConclusionsArg-1 and K8 were good markers to identify intermediate cells between hepatocytes and cholangiocytes. These can be useful markers for pathological diagnosis of CHC-INT, which usually has wide histological diversities, in combination with other hepatocytic and/or cholangiocytic markers.
Left ventricular assist device: a bridge to transplant or destination therapy?
Authors: Patel Swati , Nicholson Louise , Cassidy Christopher J , Wong Kenneth Y-K 
Published: March 2016

AbstractHeart failure is a major problem worldwide; it is the leading cause of hospitalisation and is posing a huge financial burden. Advances in healthcare have contributed to increased life expectancy, with a resultant increase in the number of patients with chronic heart failure. For many patients who are still severely symptomatic despite optimal medical therapy and cardiac resynchronisation therapy, cardiac transplantation would be the preferred treatment option. However, hopes are cut short with a limited donor pool of hearts for the increasing number of patients requiring cardiac transplantation. One uprising method to fill this treatment void for patients with advanced end-stage heart failure (ESHF) is the Left Ventricular Assist Device (LVAD). Although traditionally used as a bridge to transplantation, owing to limitation of suitable donors, evidence suggests increasing potential for the use of LVAD as destination therapy (DT), that is, lifelong permanent support. Exploration of DT is a promising avenue to many patients suffering with ESHF who may never be fortunate enough to receive a heart transplant, but not without reservations of its efficacy, safety, effects on quality-adjusted life years and cost-effectiveness, especially in comparison to heart transplantation.
Chronic Pain in Canada ‐ Prevalence, Treatment, Impact and the Role of Opioid Analgesia
Authors: Moulin Dwight E , Clark Alexander J , Speechley Mark , Morley-Forster Patricia K 
Published: March 2016

OBJECTIVE: To assess the prevalence, treatment and impact of chronic pain in Canada.METHODS: A stratified random sample of 2012 adult Canadians (weighted by sex, age and region according to 1996 census data) was surveyed by telephone in 2001 to determine the prevalence of chronic pain, defined as continuous or intermittent pain for at least six months. A second sample of 340 chronic pain sufferers who were taking prescription medication for their pain was studied in detail to determine current therapeutic approaches and to assess the social and economic impact of chronic pain.RESULTS: Chronic noncancer pain was reported by 29% of the respondents, with increased frequency in women and older age groups. The average duration of pain was 10.7 years and the average intensity was 6.3 (on a scale from 1 to 10), with 80% reporting moderate or severe pain. Anti‐inflammatory agents were prescribed for 49% of respondents and opioid analgesics were prescribed for 22% (two‐thirds of these were codeine). Almost 70% were worried about addiction potential, and one‐third felt that strong analgesics should be reserved for terminal illnesses. Almost one‐half were unable to attend social and family events, and the mean number of days absent from work in the past year due to chronic pain was 9.3.INTERPRETATION: Chronic noncancer pain is common in Canadian adults and has a major social and economic impact. Despite growing evidence supporting the efficacy and safety of major opioid analgesics for chronic noncancer pain, less than 10% of chronic pain patients taking prescription medication were treated with a major opioid. Chronic pain is undertreated in Canada, and major opioid analgesics are probably underutilized in the management of moderate to severe pain as part of a multidisciplinary treatment program.
Evidence of a Relationship between Adult Attachment Variables and Appraisals of Chronic Pain
Authors: Meredith Pamela J , Strong Jenny , Feeney Judith A 
Published: March 2016

OBJECTIVE: Although threat and challenge appraisals of pain have been linked to both the acute and laboratory‐induced pain experience, these appraisals have not yet been explored in relation to chronic pain. In addition, although attachment theory has been separately linked to the chronic pain experience and to responses to perceived threat, it has not been explored in the context of threat and challenge appraisals of chronic pain. The present paper addresses these two main goals.METHODS: A sample of 141 participants reporting noncancer pain longer than two months in duration completed a battery of assessments before commencing treatment in one of two multidisciplinary rehabilitation programs.RESULTS: Analysis of the pain appraisal inventory produced two factors (threat and challenge), replicating earlier findings. Reliability coefficients for the two extracted scales were 0.87 and 0.86, respectively. Links between the two pain appraisal scales and adult attachment variables proved to be significant. In particular, comfort with closeness was strongly related to challenge appraisal, while anxiety over relationships was strongly associated with threat appraisal. As expected, both appraisals and attachment variables were also related to catastrophizing and emotional distress.CONCLUSIONS: Results support use of the pain appraisal inventory as an evaluation tool for those with chronic pain. Findings further suggest a substantial association between adult attachment and pain appraisal, supporting the need for more in‐depth analysis and consideration of implications for treatment.
Treatment Persistence and Compliance with Medications for Chronic Obstructive Pulmonary Disease
Authors: Cramer Joyce A , Bradley-Kennedy Carole , Scalera Alissa 
Published: March 2016

BACKGROUND AND OBJECTIVE: Inhaled beta‐agonist, anticholinergic and glucocorticoid medications are used to treat asthma and chronic obstructive pulmonary disease (COPD). The present study assessed the patterns of persistence with the above mentioned inhaled medications.METHODS: Prescription claims data from the Ontario Drug Benefit Program were analyzed to assess persistence (time to discontinuation) and compliance (percentage of days with doses available divided by days to last refill) of patients prescribed inhaled medications. Patients were grouped as naive (no inhaled medication in the previous year) or experienced (previous or current treatment), and by age (18 to 65 years of age and older than 65 years of age). Medications included ipratropium, ipratropium plus salbutamol, formoterol, formoterol plus budesonide, salmeterol, salmeterol plus fluticasone, and tiotropium.RESULTS: The database included 31,368 patients (4888 naive and 26,480 experienced) who were prescribed at least one of these medications. Fifteen per cent to 63% of patients continued on the index drug for more than six months, which decreased to 7% to 53% at 12 months, and 5% to 47% at 18 months. At 12 months, patients taking tiotropium had significantly longer persistence compared with other therapies (53% versus 7% to 30%; all P<0.0001), and fewer switches to alternative medications. Most naive patients had significantly shorter treatment persistence than experienced patients for all drugs (all P<0.0001), including tiotropium (27% versus 55%, P<0.0001). Compliance rates were similar for all drugs (ie, 76% to 94%) but were highest for tiotropium.CONCLUSIONS: These data demonstrated that persistence with inhaled treatment was low overall, but patients treated with tiotropium remained on therapy significantly longer than when treated with other medications, and patients naive to inhaled treatment had shorter treatment persistence than experienced patients.