bluuebunny/crossref_metadata_2025_split huggingface dataset:
Supraspinatus detachment causes musculotendinous degeneration and a reduction in bone mineral density at the enthesis in a rat model of chronic rotator cuff degeneration
Authors: Thangarajah Tanujan , Henshaw Frederick , Sanghani-Kerai Anita , Lambert Simon M. , Pendegrass Catherine J. , Blunn Gordon W. 
Published: March 2017

Background To evaluate biological strategies that enhance tendon–bone healing in humans, it is imperative that suitable animal models accurately reproduce the pathological changes observed in the clinical setting following a tear. The purpose of the present study was to investigate rotator cuff degeneration in a rat, as well as assess the development of osteopenia at the enthesis following tendon detachment. Methods Eighteen female Wistar rats underwent unilateral detachment of the supraspinatus tendon. Specimens were retrieved at 4 weeks ( n = 6), 6 weeks ( n = 6) and 9 weeks ( n = 6) postoperatively for histological analysis and peripheral quantitative computer tomography. Results Three weeks following tendon detachment, there was a significant increase in the modified Movin score, characterized by a loss of muscle mass, fatty infiltration, an increase in musculotendinous cellularity, loss of normal collagen fibre structure/arrangement, rounded tenocyte nuclei and an increase in the number of vascular bundles. This was accompanied by a reduction in bone mineral density at the tendon insertion site. After 3 weeks however, these changes were less prominent. Conclusions The rotator cuff tendon-muscle-bone unit in a rat model 3 weeks after detachment of supraspinatus represents a valid model for investigating rotator cuff degeneration.
Antipsychotic prescription patterns in the management of delirium symptoms in hospitalized elderly patients
Authors: Nguyen Patrick Viet-Quoc , Malachane Alice , Minh Thien Tuong Vu 
Published: March 2017

Objective: The objective of this study was to study the pharmacological management of delirium in elderly hospitalized patients in acute geriatric medical wards. Method: We conducted a one-year retrospective cross-sectional study in patients 65 years of age or older who were admitted to an acute geriatric unit care at a teaching hospital with a delirium diagnosis. Results: A total of 133 subjects were included in the study. Delirium was prevalent in 78% of patients. The average length of delirium was 13 days. Antipsychotics were prescribed to 74% of patients with delirium. Patients with hyperactive, mixed and hypoactive delirium received antipsychotics regularly in a proportion of 68%, 54%, and 34% respectively. The length of antipsychotic prescription was of 11 days. Risperidone was the most commonly prescribed agent given on a regular basis while haloperidol was chosen for the as required prescriptions. Fifty-five percent of demented patients received a daily prescription of antipsychotics compared to 46% in the non-demented population. A shorter length of delirium episodes in subjects with acetylcholinesterase inhibitors was also observed. A higher mortality rate was observed in the group of subjects receiving benzodiazepine during the delirium episode. Conclusion: This study shows that antipsychotic treatment is widely, but not systematically prescribed in demented and non-demented patients in all types of delirium including hypoactive. Efforts should be made to increase appropriate antipsychotic prescription in this vulnerable population.
Social Rights and Market Freedom in the European Constitution: A Re-Appraisal
Authors: Giubboni Stefano 
Published: March 2017

Building a common market while preserving the legitimate concerns for different social models at national level has always been one of the main challenges of the European project. The aim of this article is to verify how the normative criteria, which preside over such a delicate balance between constructing a common market and preserving legitimate differences in the national welfare systems, have changed over time. It is submitted that these criteria have in fact significantly changed, with a progressive shift from the upward harmonization paradigm to regulatory competition between systems. The decline of harmonization, as the main tool for governing the differences between national social systems, has in fact gradually left its place to a mix of new regulatory techniques, which were enriched during the 1990s and lastly rationalized by the Lisbon Treaty. Moreover, in the latest phase that follows the 2004 enlargement, the regulatory competition – conveyed by means of a very liberal interpretation of the freedom to provide services – has come to occupy some of the most protected areas of national labour law. These trends are likely to generate difficult tensions between the legitimate demands of preservation of national social models and the demands of enlarging and deepening European integration. A reinforced coordination, via hard law, is needed, and possibly a further re-shaping and re-launching of differentiated harmonization techniques, along with a solid framework of fundamental social rights and principles enshrined in the body of the new Treaties. It is submitted that if we want to avoid the risk of crisis of the European integration process this way of coping with the challenges of diversity has to go forward to looking for a virtuous balance between market freedom and social rights in the European Constitution.
The Implementation of the Directive on Temporary Agency Work in the UK: A Missed Opportunity
Authors: Davies Anne 
Published: March 2017

Agency work is more prevalent in the UK than in most other European countries. Agency workers make up around 5% of the total UK workforce, compared to 2.5% in the Netherlands, just over 2% in France, and less than 0.5% in Denmark.1 This may, in part at least, reflect the fact that the UK has not traditionally regulated the use of agency work to any great extent. The Directive on Temporary Agency Work requires the UK to offer a greater degree of protection to agency workers, but as this article will seek to demonstrate, agency workers will remain vulnerable in certain important respects even after the Directive has been implemented.2 This article will give a brief account of the emergence of the Directive and of English law's current position on agency work, before exploring in some detail a selection of key issues arising out of the Agency Workers Regulations 2010, the UK's implementation measure.3
EU Limits for the Personal Scope of Employment Law
Authors: Van Peijpe Taco 
Published: March 2017

EU Member States are obliged to protect all labourers who fall within the scope of EU labour law. The Member States are free, in principle, to extend the scope of protection by applying a worker concept which includes the economically dependent self-employed. EU free movement principles restrict this freedom of the Member States to apply their own worker concepts. The ECJ makes this freedom almost illusory through a strict application of the subordination criterion for the definition of the concept of ‘worker’, as laid down in its Lawrie-Blum case law. If the ECJ would develop a positive and narrow definition of the concept of self-employed persons, then the Member States would retain the freedom which is necessary to extend adequate protection to the economically dependent self-employed, and to combat bogus self-employment. A few judgments of the ECJ contain materials for the development of such a definition of self-employed persons.
The Dark Side of Fundamental Rights Adjudication?
Authors: Papa Veronica 
Published: March 2017

The aim of the article is to deal with the case law of the European Court of Justice in the field of fundamental social rights, with particular regard to the application of the Charter of fundamental rights. The analysis starts from an evaluation – in the first part – of the judgment delivered by the CJEU in the case Association de médiation sociale (AMS). Then, the second part of the article explores the legal reasoning of the CJEU in other paradigmatic cases, from which is possible to infer the asymmetric interpretation of the Charter of fundamental rights, mentioned in the title. Finally, some brief reflections on the role of the CJEU in the social architecture of the European Union are proposed.
Crisis and Labour Law
Authors: Ribeiro Ana Teresa 
Published: March 2017

The present study exposes the main features of the recent changes introduced in Portuguese labour law, following the severe crisis the country went through and the external financial aid it required. It addresses separately the alterations implemented in individual labour law and collective labour law, pinpointing the main developments verified in these areas and the driving forces behind them. Aside from an explanatory perspective (that covers the previous and the currents traits of the labour regime), this article also provides a critical point of view, regarding the consequences of these changes and the reactions they provoked amongst Portuguese society and its social partners.
“There are days I wish it wasn’t there, and there’s days I realize I’m lucky”: A qualitative study of psychological sequelae to the implantable cardioverter defibrillator as a treatment for the prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy
Authors: Etchegary Holly , Pullman Daryl , Connors Sean P , Simmonds Charlene , Young Terry-Lynn , Hodgkinson Kathy A 
Published: March 2017

Objectives Arrhythmogenic right ventricular cardiomyopathy caused by a TMEM43 p.S358L mutation is a fully penetrant autosomal dominant cause of sudden cardiac death where prophylactic implantable cardioverter defibrillator therapy significantly reduces mortality by returning lethal cardiac rhythms to normal. This qualitative study assessed the psychological ramifications of the implantable cardioverter defibrillator on recipients, their spouses and their mutation negative siblings. Design Qualitative interview study. Participants Twenty-one individuals (nine mutation positive, eight mutation negative and four spouses) from 15 families completed semi-structured interviews. Results No theoretical assumptions about the data were made: inductive sub-coding was accomplished with the constant comparison method and cohesive themes across all respondent interviews were determined. All interviewees had a family history of sudden cardiac death and appropriate implantable cardioverter defibrillator therapy in themselves or family members. Average length of time with an implantable cardioverter defibrillator was 10 years. Major themes included: (1) acceptance and gratitude, (2) grudging acceptance, (3) psychological effects (on emotional and psychological well-being; functioning of the broader family unit; and relationships), and (4) practical concerns (on clothes, travel, loss of driving licence and the effects of an implantable cardioverter defibrillator discharge). These affected all family members, regardless of mutation status. Conclusions Despite the survival advantage of implantable cardioverter defibrillator therapy, the intervention carries psychological and practical burdens for family members from kindreds manifesting p.S358L TMEM43 ARVC that does not appear to dissipate with time. A move towards integrating psychology services with the cardiac genetics clinic for the extended family may provide benefit.
Prescription patterns of long-acting somatostatin analogues
Authors: Machado-Alba Jorge Enrique , Machado-Duque Manuel Enrique 
Published: March 2017

Background: Acromegaly and endocrine tumors are uncommon morbidities that are currently treated with different drugs. Objective: To determine the prescription patterns of somatostatin analogues in patients affiliated with the Health System of Colombia. Methods: Retrospective cohort study of patients of any age and sex treated with octreotide or lanreotide between January 2011 and August 2015. Socio-demographic, clinical (indications) and pharmacological (comedications) variables were considered. Multivariate analysis was performed with SPSS 23.0. Results: We identified 289 patients, with a mean age of 56.6 ± 14.0 years and female predominance (59.5%), who underwent treatment during the 56 months of monitoring. Octreotide was used in 56.1% of cases, followed by lanreotide (43.9%), both at approved doses. We found that 4.5% of subjects changed from one drug to another over the course of therapy, which was associated with being diabetic and receiving insulin (odds ratio: 4.27; 95% confidence interval: 1.23–14.84; p = 0.014). The most common indications were acromegaly (52.2% of cases) followed by neuroendocrine tumors (15.9%). The most common comorbidities were hypertension (39.4% of cases), depression (27.3%), dyslipidemia (23.3%), diabetes mellitus (23.5%) and hypothyroidism (23.5%). Being male (odds ratio: 0.57; 95% confidence interval: 0.35–0.94; p = 0.029) and belonging to the age group between 45 and 65 years (odds ratio: 0.44; 95% confidence interval: 0.21–0.90; p = 0.024) were significantly associated with a lower risk of receiving comedications. Conclusion: Somatostatin analogues are being used at recommended doses, especially in patients with acromegaly and neuroendocrine tumors. Variables associated with change in therapy were identified.
Experiences of supportive care when waiting for a lung re-transplantation
Authors: Ivarsson Bodil , Ingemansson Richard , Sjöberg Trygve 
Published: March 2017

Objectives: Lung transplant patients and their next of kin share the experiences of illness but little is known in the face of a lung re-transplantation. To describe patients’ and next of kin’s experiences of supportive care while awaiting lung re-transplantation and the objective was to highlight a small group with special circumstances and needs. Methods: Using qualitative content analysis, seven adult patients and seven next of kin were consecutively selected from a regional lung transplantation centre and individually interviewed shortly after decision about lung re-transplantation. Results: The experiences of supportive care were captured in one main category: ‘once again haunted by death’ and three sub-categories: ‘when life turns and death once again snorts down your neck’, ‘the importance of information’, and ‘perceptions of support’. A complex interaction between the experience of waiting, and communication patterns, emotional states, and social support was shown. Conclusion: This study provides insights into the complex interaction between the experience of waiting for a second lung transplant and communication patterns, emotional states, social support and social roles between patients, next of kin, healthcare professionals, and the health and social welfare system. There is a need for developing supportive care programme to achieve the best possible care.
How Comprehensive and Efficient Are Patient-Reported Outcomes for Rotator Cuff Tears?
Authors: Makhni Eric C. , Hamamoto Jason T. , Higgins John D. , Patterson Taylor , Griffin Justin W. , Romeo Anthony A. , Verma Nikhil N. 
Published: March 2017

Background: Increasing emphasis is placed on patient-reported outcomes (PROs) after common orthopaedic procedures as a measure of quality. When considering PRO utilization in patients with rotator cuff tears, several different PROs exist with varying levels of accuracy and utilization. Hypothesis/Purpose: Understanding which disease-specific PRO may be most efficiently administered in patients after rotator cuff repair may assist in promoting increased patient and physician adoption of these useful scores. Using a novel assessment criterion, this study assessed all commonly used rotator cuff PROs. We hypothesize that surveys with fewer numbers of questions may remain comparable (with regard to comprehensiveness) to longer surveys. Study Design: Systematic review. Methods: Commonly utilized rotator cuff PROs were analyzed with regard to number of survey components, comprehensiveness, and efficiency. Comprehensiveness (maximum score, 11) was scored as the total number of pain (at rest/baseline, night/sleep, activities of daily living [ADLs], sport, and work) and functional (strength, motion/stiffness, and ability to perform ADLs, sport, and work) metrics included, along with inclusion of quality of life/satisfaction metrics. Efficiency was calculated as comprehensiveness divided by the number of survey components. Results: Sixteen different PROs were studied. Number of components ranged from 5 (University of California at Los Angeles score [UCLA]) to 36 (Short Form–36 [SF-36], Japanese Orthopaedic Association score [JOA]). The Quality of Life Outcome Measure for Rotator Cuff Disease (RC-QoL) included all 5 pain components, while 7 PROs contained all 5 functional components. Ten PROs included a quality of life/satisfaction component. The most comprehensive scores were the RC-QoL (score, 11) and Penn (score, 10), and the least comprehensive score was the Marx (score, 3). The most efficient PROs were the UCLA, the Quick Disabilities of the Arm, Shoulder, and Hand score (QuickDASH), and Constant scores. The least efficient scores were the JOA and SF-36 scores. Conclusion: Many commonly utilized PROs for rotator cuff tears are lacking in comprehensiveness and efficiency. Continued critical assessment of PRO quality may help practitioners identify the most comprehensive and efficient PRO to incorporate into daily clinical practice.
Eliciting the Functional Processes of Apologizing for Errors in Health Care
Authors: Prothero Marie M. , Morse Janice M. 
Published: March 2017

This article has been awarded GQNR’s Best Paper Award for the 2017 Volume The purpose of this article was to analyze the concept development of apology in the context of errors in health care, the administrative response, policy and format/process of the subsequent apology. Using pragmatic utility and a systematic review of the literature, 29 articles and one book provided attributes involved in apologizing. Analytic questions were developed to guide the data synthesis and types of apologies used in different circumstances identified. The antecedents of apologizing, and the attributes and outcomes were identified. A model was constructed illustrating the components of a complete apology, other types of apologies, and ramifications/outcomes of each. Clinical implications of developing formal policies for correcting medical errors through apologies are recommended. Defining the essential elements of apology is the first step in establishing a just culture in health care. Respect for patient-centered care reduces the retaliate consequences following an error, and may even restore the physician patient relationship.
How I manage the toxicities of myeloma drugs
Authors: Delforge Michel , Ludwig Heinz 
Published: March 2017

AbstractThe treatment of multiple myeloma is considered a continuously evolving paradigm as a result of the growing availability of new and highly effective drugs, including first- and second-generation proteasome inhibitors, immunomodulatory agents, and monoclonal antibodies. Clinical trials advocate long-term rather than short-term treatment schedules with combinations of these new anti–myeloma drug classes. Although the overall toxicity profile of the recommended regimens can be considered favorable, their increasing complexity and prolonged use warrant a heightened vigilance for early and late side effects, a priori because real-life patients can be more frail or present with 1 or more comorbidities. The treatment decision process, at diagnosis and at relapse, therefore requires myeloma physicians to carefully balance efficacy and toxicity profiles for each individual patient. Early and/or unnecessary tapering or treatment discontinuation for drug-related adverse events may not only reduce patients’ quality of life, but also negatively impact their outcome. Accurate knowledge in recognizing and managing the potential side effects of present-day treatment regimens is therefore a cornerstone in myeloma care. Using 5 case vignettes, we discuss how to prevent and manage the most common nonhematological adverse events of anti–myeloma treatment regimens containing proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies.
Human bronchial epithelium orchestrates dendritic cell activation in severe asthma
Authors: Gras Delphine , Martinez-Anton Asuncion , Bourdin Arnaud , Garulli Celine , de Senneville Laure , Vachier Isabelle , Vitte Joana , Chanez Pascal 
Published: March 2017

The innate immune response is impaired in asthma, with increased epithelial release of C-X-C motif chemokine ligand (CXCL)8, interleukin (IL)-33 and thymic stromal lymphopoietin (TSLP). We hypothesised that dendritic cells might modulate the hyperresponsive epithelium in severe asthma.For this purpose, we investigated epithelial–dendritic crosstalk in normal and diseased conditions, and because ultrafine particulate matter may affect asthmatic airways, we investigated its impact on this crosstalk. Air–liquid interface cultures of human bronchial epithelial cells (HBEC) of control subjects (cHBEC) or severe asthma patients (saHBEC) were co-cultured with monocyte-derived dendritic cells (moDC).Increased release of CXCL8, TSLP and IL-33 from saHBEC contrasted with cHBEC producing CXCL10 and CCL2. Regarding moDC activation, saHBEC co-cultures induced only upregulation of CD86 expression, while cHBEC yielded full moDC maturation with HLA-DR, CD80, CD86 and CD40 upregulation. Particulate matter stimulation of HBEC had no effect on cHBEC but stimulated CXCL8 and IL-33 release in saHBEC. Particulate matter impaired epithelium signalling (TSLP, IL-33 and CXCL8) in saHBEC co-cultures despite C-C chemokine ligand 2 induction.Crosstalk between HBEC and moDC can be establishedin vitro, driving a T1-type response with cHBEC and a T2-type response with saHBEC. Normal or asthmatic status of HBEC differentially shapes the epithelial–dendritic responses. We conclude that control moDC cannot rescue the hyperresponsive airway epithelium of severe asthmatics.