bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed
Authors: Andersson Stig Haugsboe , Bahr Roald , Clarsen Benjamin , Myklebust Grethe 
Published: August 2017

BackgroundShoulder injuries are common among handball players and predominantly characterised by overuse characteristics. Reduced total glenohumeral rotation, external rotation weakness and scapular dyskinesis have been identified as risk factors among elite male handball players.AimTo assess whether previously identified risk factors are associated with overuse shoulder injuries in a large cohort of elite male and female handball players.Methods329 players (168 male, 161 female) from the two upper divisions in Norway were included and tested prior to the 2014–2015 season. Measures included glenohumeral internal and external rotation range of motion, isometric internal and external rotation strength, and assessment of scapular dyskinesis. Players were followed prospectively for one competitive season, with prevalence and severity of shoulder problems registered monthly using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A severity score based on players’ questionnaire responses was used as the outcome measure in multivariable logistic regression to investigate associations between candidate risk factors and overuse shoulder injury.ResultsNo significant associations were found between total rotation (OR 1.05 per 5° change, 95% CI 0.98 to 1.13), external rotation strength (OR 1.05 per 10 N change, 95% CI 0.92 to 1.20) or obvious scapular dyskinesis (OR 1.23, 95% CI 0.25 to 5.99) and overuse shoulder injury. A significant positive association was found between greater internal rotation (OR 1.16 per 5° change, 95% CI 1.00 to 1.34) and overuse shoulder injury.ConclusionNone of the previously identified risk factors were associated with overuse shoulder injuries in a mixed-sex cohort of elite handball players.
Haemoglobin Fontainebleau (HBA2: c. 64G>C) in Oman: molecular and haematological characteristics and interaction with various haemoglobinopathies
Authors: Daar Shahina , Al Zadjali Shoaib , Alkindi Salam , Wali Yasser , Al-Rawas Abdulhakeem , Al-Haddabi Humood , Al-Riyami Arwa Z 
Published: August 2017

ObjectivesTo describe the laboratory features of haemoglobin Fontainebleau (Hb FB) and its interactions with various α and β globin gene mutations in the Omani population.MethodsOver a period of 10 years, a total of 94 blood samples were suspected to have an α variant on HPLC at the Sultan Qaboos University Hospital, Muscat, Oman. Molecular testing was performed using PCR based techniques to define the variant and to analyse other interacting mutations in either α or β globin genes.ResultsOf 94 subjects, molecular analysis confirmed the Hb FB variant in 55 samples (38 non-cord and 17 cord blood). A total of 36/38 non-cord samples were heterozygous for the variant, while all 17 cord blood samples were heterozygotes. A total of 43/55 individuals had a concomitant α and/or β globin gene mutation.ConclusionsHb FB is the the most common α variant in the Omani population. We report the different HPLC profiles of this variant that we observed, with and without other haemoglobinopathies in non-cord and cord blood samples. This is the first report describing the HPLC profiles of this α globin chain variant on 1 year follow-up testing of cord blood samples. With careful analysis by HPLC, it is possible not only to identify Hb FB but also to predict any concomitant α and/or β globin gene mutations.
Advice given by NHS Direct in Wales: do deprived patients get more urgent decisions? Study of routine data
Authors: Peconi Julie , Macey Steven , Rodgers Sarah , Russell Ian , Snooks Helen , Watkins Alan 
Published: August 2017

BackgroundIn the UK, National Health Service Direct Wales (NHSDW) uses computerised decision support software to advise patients on appropriate care. However, the effect of deprivation on the advice given is not known. We aimed to estimate the effect of deprivation on advice given by nurses in NHSDW adjusting for confounding variables.MethodsWe included 400 000 calls to NHSDW between January 2002 and June 2004. We used logistic regression to model the effect of deprivation on advice given by nurses in response to calls seeking advice or information. We analysed two outcomes: receiving advice to phone 999 emergency care rather than to seek other care and receiving advice to seek care face to face rather than self-care.ResultsAfter adjustment for covariates, an increase in deprivation from one-fifth of the distribution to the next fifth increased by 13% the probability that those calling for advice rather than information received advice to phone 999 (OR 1.127; 95% CI from 1.113 to 1.143). Deprivation increased the corresponding probability of being advised to seek care face to face rather than self-care by 5% (OR 1.049; 95% CI from 1.041 to 1.058) within advice calls and by 3% (OR 1.034; 95% CI from 1.022 to 1.047) within information calls.ConclusionsDeprivation increased the chance of receiving more urgent advice, particularly advice to call 999. While our dataset may underestimate the ‘need’ of deprived patients, it yields no evidence of major inequity in advice given to these patients.
Mortality and causes of death among homeless in Finland: a 10-year follow-up study
Authors: Stenius-Ayoade Agnes , Haaramo Peija , Kautiainen Hannu , Gissler Mika , Wahlbeck Kristian , Eriksson Johan G 
Published: August 2017

BackgroundHomelessness is associated with increased mortality, and some predictors of mortality have been previously identified. We examined the overall and cause-specific mortality among homeless men in Helsinki and the associations of social background and health service use with mortality.MethodsTo assess cause-specific mortality in a competing risks framework, we performed a register-based, case–control study of 617 homeless men and an age-matched control group of 1240 men from the general population that were followed for 10 years between 2004 and 2014. Cox proportional hazards model was used to calculate HR for death and a competing risks model to calculate sub-HRs (sHR) for cause-specific death.ResultsDuring the follow-up, 45.0% of the homeless died compared with 10.5% of controls (HR 5.38, 95% CI 4.39 to 6.59). The risk of death was particularly elevated for the homeless aged ≤50 years (HR 10.3, 95% CI 7.0 to 15.2). External causes caused 34% of the deaths (sHR 11.2, 95% CI 6.8 to 18.2), but also deaths from medical causes were common (sHR 3.6, 95% CI 2.9 to 4.6). Age and somatic hospitalisation were significant predictors of death both among homeless and controls. Educational attainment, marital status, employment and psychiatric hospitalisation were significant predictors of mortality among the controls, but not among the homeless.ConclusionsHomelessness is associated with a fivefold mortality compared with the controls, and especially homeless aged ≤50 years have an increased risk of death. Being homeless eliminates the protective effects of marriage, employment and education on mortality risk.
Genetic transmission networks reveal the transmission patterns of HIV-1 CRF01_AE in China
Authors: Li Xiaoshan , Gao Rong , Zhu Kexin , Wei Feiran , Fang Kun , Li Wei , Song Yue , Ge You , Ji Yu , Zhong Ping , Wei Pingmin 
Published: August 2017

ObjectivesThe epidemic of HIV-1 CRF01_AE has become a major public health issue in China. This study aimed to characterise the transmission patterns of genetic networks for CRF01_AE nationwide and elucidate possible opportunities for prevention.MethodsWe isolated and conducted genetic transmission network analysis of all available CRF01_AE pol sequences (n=4704) from China in the Los Alamos HIV sequence database.ResultsA total of 1391 (29.6%) sequences were identified as belonging to 400 separate networks. Of men who have sex with men (MSM) in the networks, 93.8% were linked to other MSM and only 2.4% were linked to heterosexual women. However, 11.8% heterosexual women in the networks were linked to MSM. Lineages composed mainly of MSM had higher transmission than those that were mostly heterosexuals. Of the 1391 individuals in networks, 513 (36.9%) were linked to cases diagnosed in different provinces. The proportion of individuals involved in inter-province links was interrelated with the number of migrant people (Spearman’s r=0.738, p=0.001).ConclusionsThe outcome of this study could help improve our ability to understand HIV transmission among various regions and risk groups in China, and highlighted the importance of targeting MSM and migrants by prevention and intervention efforts.
Glucose Homeostasis, Pancreatic Endocrine Function, and Outcomes in Advanced Heart Failure
Authors: Melenovsky Vojtech , Benes Jan , Franekova Janka , Kovar Jan , Borlaug Barry A. , Segetova Marketa , Tura Andrea , Pelikanova Tereza 
Published: August 2017

Background

The mechanisms and relevance of impaired glucose homeostasis in advanced heart failure (
HF
) are poorly understood. The study goals were to examine glucose regulation, pancreatic endocrine function, and metabolic factors related to prognosis in patients with nondiabetic advanced HF.

Methods and Results

In total, 140 advanced
HF
patients without known diabetes mellitus and 21 sex‐, age‐, and body mass index–matched controls underwent body composition assessment, oral glucose tolerance testing, and measurement of glucose‐regulating hormones to model pancreatic β‐cell secretory response. Compared with controls,
HF
patients had similar fasting glucose and insulin levels but higher levels after oral glucose tolerance testing. Insulin secretion was not impaired, but with increasing
HF
severity, there was a reduction in glucose, insulin, and insulin/glucagon ratio—a signature of starvation. The insulin/C‐peptide ratio was decreased in
HF
, indicating enhanced insulin clearance, and this was correlated with lower cardiac output, hepatic insufficiency, right ventricular dysfunction, and body wasting. After a median of 449 days, 41% of patients experienced an adverse event (death, urgent transplant, or assist device). Increased glucagon and, paradoxically, low fasting plasma glucose displayed the strongest relations to outcome (
P
=0.01). Patients in the lowest quartile of fasting plasma glucose (3.8–5.1 mmol·L
−1
, 68–101 mg·dL
−1
) had 3‐times higher event risk than in the top quartile (6.0–7.9 mmol·L
−1
, 108–142 mg·dL
−1
; relative risk: 3.05 [95% confidence interval, 1.46–6.77];
P
=0.002).

Conclusions

Low fasting plasma glucose and increased glucagon are robust metabolic predictors of adverse events in advanced
HF
. Pancreatic insulin secretion is preserved in advanced
HF
, but levels decrease with increasing
HF
severity due to enhanced insulin clearance that is coupled with right heart failure and cardiac cachexia.
Novel Urinary Peptidomic Classifier Predicts Incident Heart Failure
Authors: Zhang Zhen‐Yu , Ravassa Susana , Nkuipou‐Kenfack Esther , Yang Wen‐Yi , Kerr Shona M. , Koeck Thomas , Campbell Archie , Kuznetsova Tatiana , Mischak Harald , Padmanabhan Sandosh , Dominiczak Anna F. , Delles Christian , Staessen Jan A. 
Published: August 2017

Background

Detection of preclinical cardiac dysfunction and prognosis of left ventricular heart failure (
HF
) would allow targeted intervention, and appears to be the most promising approach in its management. Novel biomarker panels may support this approach and provide new insights into the pathophysiology.

Methods and Results

A retrospective comparison of urinary proteomic profiles generated by mass spectrometric analysis from 49
HF
patients, 36 patients who progressed to
HF
within 2.6±1.6 years, and 192 sex‐ and age‐matched controls who did not progress to
HF
enabled identification of 96 potentially
HF
‐specific peptide biomarkers. Based on these 96 peptides, the classifier called Heart Failure Predictor (
HFP
) was established by support vector machine modeling. The incremental prognostic value of
HFP
was subsequently evaluated in urine samples from 175 individuals with asymptomatic diastolic dysfunction from an independent population cohort. Within 4.8 years, 17 of these individuals progressed to overt
HF
. The area under receiver‐operating characteristic curve was 0.70 (95%
CI
, 0.56–0.82);
P
=0.0047 for
HFP
and 0.57 (0.42–0.72;
P
=0.62) for N‐terminal pro b‐type natriuretic peptide. Hazard ratios were 1.63 (
CI
, 1.04–2.55;
P
=0.032) per 1‐
SD
increment in
HFP
and 0.70 (
CI
, 0.35–1.41;
P
=0.32) for a doubling of the logarithmically transformed N‐terminal pro b‐type natriuretic peptide.

Conclusions

HFP
is a novel biomarker derived from the urinary proteome and might serve as a sensitive tool to improve risk stratification, patient management, and understanding of the pathophysiology of
HF
.
The Ukraine Crisis as an Unintended Consequence of the EU’s Public Diplomacy: Reception of the EU’s Narratives in Ukraine
Authors: Krasnodębska Molly 
Published: August 2017

Summary
International relations (IR) scholars studying public diplomacy expect that if a foreign public accepts and responds favourably to the narrative disseminated by a public diplomacy actor, this actor is more likely to achieve its desired policy objectives in the country. So how can we explain that pro-European elites in Ukraine employed the European Union’s narratives during the Maidan protests, leading to regime change in Ukraine and a separatist war involving Russia — situations the European Union had wanted to avoid? Drawing on Gadamer’s theory on the transformation of meaning in communication processes, this article seeks to explain how local activists pick up, transform and employ narratives disseminated by an international actor. Arguing that public diplomacy narratives can be reinterpreted by the receptor, thus leading to unintended effects, the article calls for further attention on the role of narratives and their reception by local actors in the study of IR.
US Food and Drug Administration Clearance of Moderate‐Risk Otolaryngologic Devices via the 510(k) Process, 1997‐2016
Authors: Rathi Vinay K. , Gadkaree Shekhar K. , Ross Joseph S. , Kozin Elliott D. , Sethi Rosh K. , Naunheim Matthew R. , Puram Sidharth V. , Gray Stacey T. 
Published: August 2017

ObjectiveThe US Food and Drug Administration (FDA) clears moderate‐risk devices via the 510(k) process based on substantial equivalence to previously cleared devices; evidence of safety and effectiveness is not required. We characterized the premarket evidence supporting FDA clearance of otolaryngologic devices.Study DesignRetrospective cross‐sectional analysis.SettingPublicly available FDA documents.Subjects and MethodsRecently cleared (1997‐2016) moderate‐risk otolaryngologic devices were categorized by type (diagnostic/therapeutic), subspecialty, implantable designation (yes/no), and recall history (yes/no). Supporting evidence was categorized by type (clinical/nonclinical/none; nonclinical and clinical mutually inclusive) and public availability of nonclinical and clinical performance data (available/not provided/not applicable).ResultsBetween 1997 and 2016, the FDA cleared 377 moderate‐risk otolaryngologic devices. The majority were therapeutic (n = 240/377 [63.7%]) and otologic (n = 311/377 [82.5%]); roughly one‐third (n = 121/377 [32.1%]) were implantable. Few (n = 10/377 [2.7%]) devices were subject to recall. FDA documents summarizing premarket evidence were accessible for two‐thirds (n = 247/377 [65.5%]) of devices. Among these devices, one‐quarter (n = 66/247 [26.7%]) were supported by clinical evidence. The majority (n = 177/247 [71.7%]) were supported by nonclinical evidence, although nearly one‐quarter (n = 58/247 [23.5%]) were cleared without supporting evidence. Therapeutic devices were more often cleared without supporting evidence (therapeutic: n = 53/170 [31.2%]; diagnostic: n = 5/77 [6.5%]; P <. 0001). Nonclinical and clinical performance data were rarely available (nonclinical: n = 49/247 [19.8%]; clinical: n = 32/247 [13.0%]) within public summaries.ConclusionThe FDA cleared most moderate‐risk otolaryngologic devices for marketing via the 510(k) process without clinical evidence of safety and effectiveness. Otolaryngologists should be aware of limitations in premarket evidence when considering the adoption of new devices into clinical practice.
Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial
Authors: Brazil Kevin , Carter Gillian , Cardwell Chris , Clarke Mike , Hudson Peter , Froggatt Katherine , McLaughlin Dorry , Passmore Peter , Kernohan W George 
Published: August 2017

Background: In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor. Aim: To evaluate the effectiveness of advance care planning with family carers in dementia care homes. Design: Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff. Setting/participants: A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions. Results: The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (−10.5, 95% confidence interval: −16.4 to −4.7; p < 0.001). Conclusion: Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.
Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review
Authors: Fasano S , Margiotta D P , Navarini L , Pierro L , Pantano I , Riccardi A , Afeltra A , Valentini G 
Published: August 2017

Background Systemic lupus erythematosus is associated with an increased risk of cardiovascular disease. Low-dose aspirin, hydroxychloroquine and statins have been suggested to play a prophylactic role of cardiovascular events. This study is devoted to reviewing the literature on the topic and assessing the effects of these drugs in preventing a first cardiovascular event in a two-centre Italian series. Methods A PubMed search on cardiovascular prevention in systemic lupus erythematosus was performed. Moreover, systemic lupus erythematosus patients admitted to two centres from 2000–2015, who at admission had not experienced any cardiovascular event, were investigated. Aspirin, hydroxychloroquine and statin use, and the occurrence of any cardiovascular event, were recorded at each visit. Kaplan-Meier and Cox regression analyses were performed to evaluate the role of traditional, disease-related cardiovascular risk factors and of each of the three drugs in the occurrence of new cardiovascular events. Results The literature search produced conflicting results. Two hundred and ninety-one systemic lupus erythematosus patients were included in the study and followed for a median of eight years. During follow-up, 16 cardiovascular events occurred. At multivariate analysis, taking aspirin (hazard ratio: 0.24) and hydroxychloroquine for more than five years (hazard ratio: 0.27) reduced, while antiphospholipid antibody positivity (hazard ratio: 4.32) increased, the risk of a first cardiovascular event. No effect of statins emerged. Conclusion Our study confirms an additive role of aspirin and hydroxychloroquine in the primary prophylaxis of cardiovascular events in Italian patients with systemic lupus erythematosus. The lack of any detected effect in previous reports may depend on the design of studies and their short follow-up period.
A hermeneutical rapprochement framework for clinical ethics practice
Authors: Carnevale Franco A 
Published: August 2017

Background: A growing number of frameworks for the practice of clinical ethics are described in the literature. Among these, hermeneutical frameworks have helped highlight the interpretive and contextual nature of clinical ethics practice. Objectives: The aim of this article is to further advance this body of work by drawing on the ideas of Charles Taylor, a leading hermeneutical philosopher. Design/Findings: A Hermeneutical Rapprochement Framework is presented for clinical ethics practice, based on Taylor’s hermeneutical “retrieval” and “rapprochement.” This builds on existing hermeneutical approaches for the practice of clinical ethics by articulating a framework with interpretive and reconciliatory scope that extends beyond the presenting “local” context. A Hermeneutical Rapprochement Framework considers broader socio-historical horizons and imaginaries grounded on Taylor’s expansive work in epistemological, ontological, political, and moral philosophy. Discussion: The framework is discussed in terms of how it can be operationalized for clinical practice as well as normative development. Implications for the educational preparation of clinical ethicists are also discussed. Although this work is directly relevant for clinical ethicists, it can also help inform the ethical practice of all clinicians.
Techniques and survival incidence for revascularization of degloved fingers
Authors: Kayalar Murat , Güntürk Özgün Barış , Kaplan İbrahim , Sügün Tahir Sadık , Ademoğlu Yalçın 
Published: August 2017

We report techniques and survival incidence of three subtotally and nine completely degloved fingers in seven patients. We performed end-to-end arterial repairs in seven fingers, vein graft repairs for arteries in two fingers, arteriovenous anastomoses in three fingers. End-to-end vein anastomosis was performed in all fingers. One finger requred re-exploration. Soft tissues in the eight degloved fingers survived completely, two failed completely, and two were partially necrotic. We conclude from our results that following revascularization, the skin from a completely degloved finger skin will survive in approximately two cases out of three. Level of evidence: IV