bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of ARDS on Survival: Do Patients Die From ARDS or With ARDS?
Authors: Fuchs Lior , Feng Mengling , Novack Victor , Lee Joon , Taylor Jonathan , Scott Daniel , Howell Michael , Celi Leo , Talmor Daniel 
Published: July 2017

Objective: To investigate the contribution of acute respiratory distress syndrome (ARDS) in of itself to mortality among ventilated patients. Design and Setting: A longitudinal retrospective study of ventilated intensive care unit (ICU) patients. Patients: The analysis included patients ventilated for more than 48 hours. Patients were classified as having ARDS on admission (early-onset ARDS), late-onset ARDS (ARDS not present during the first 24 hours of admission), or no ARDS. Primary outcomes were mortality at 28 days, and secondary outcomes were 2-year mortality rate from ICU admission. Results: A total of 1411 ventilated patients were enrolled: 41% had ARDS on admission, 28.5% developed ARDS during their ICU stay, and 30.5% did not meet the ARDS criteria prior to ICU discharge or death. The non-ARDS group was used as the control. We also divided the cohort based on the severity of ARDS. After adjusting for covariates, mortality risk at 28 days was not significantly different among the different groups. Both early- and late-onset ARDS as well as the severity of ARDS were found to be significant risk factors for 2 years from ICU survival. Conclusion: Among patients who were ventilated on ICU admission, neither the presence, the severity, or the timing of ARDS contribute independently to the short-term mortality risk. However, acute respiratory distress syndrome does contribute significantly to 2-year mortality risk. This suggests that patients may not die acutely from ARDS itself but rather from the primary disease, and during the acute phase of ARDS, clinicians should focus on improving treatment strategies for the diseases that led to ARDS.
Socioeconomic and Racial/Ethnic Disparities in Physical Activity Environments in Georgia Elementary Schools
Authors: Van Dyke Miriam E. , Cheung Patricia C. , Franks Padra , Gazmararian Julie A. 
Published: July 2017

Purpose: This study aimed to characterize physical activity (PA) environments in Georgia public elementary schools and to identify socioeconomic status (SES) and racial/ethnic disparities in PA environments. Design: A school setting PA survey was launched in 2013 to 2014 as a cross-sectional online survey assessing PA environment factors, including facility access and school PA practices, staff PA opportunities, parental involvement in school PA, and out-of-school PA opportunities. Setting: All 1333 Georgia public elementary schools were recruited. Participants: A total of 1083 schools (81.2%) responded. Survey respondents included school administrators, physical education (PE) teachers, and grade-level chairs. Measures: Physical activity environment factors were assessed via an online questionnaire adapted from school PA surveys and articles. Analysis: The chi-square and Fisher exact analyses were conducted to examine the reporting of PA environment factors overall and by school SES, as measured by free/reduced lunch rate, and/or racial/ethnic composition. Results: Overall, many PA environment factors were widely prevalent (ie, gym [99%] or field [79%] access), although some factors such as some PA-related programs (ie, a structured walk/bike program [11%]) were less widely reported. Disparities in school PA environment factors were largely patterned by SES, though they varied for some factors by racial/ethnic composition and across SES within racial/ethnic composition categories. For example, lower SES schools were less likely to report access to blacktops and tracks ( p-value < .0001), and higher SES schools were less likely to report access to playgrounds ( p-value = .0076). Lower SES schools were also less likely to report “always/often” giving access to PE/PA equipment during recess ( p-value < .01). Lower SES and majority nonwhite schools were less likely to report having joint use agreements with community agencies ( p-value < .0001). Conclusion: This study highlights SES and racial/ethnic disparities in PA environments in Georgia public elementary schools.
Applying a Social–Ecological Framework to Factors Related to Nicotine Replacement Therapy for Adolescent Smoking Cessation
Authors: King Jessica L. , Merten Julie W. , Wong Tzu-Jung , Pomeranz Jamie L. 
Published: July 2017

Objective: This systematic review synthesizes factors related to nicotine replacement therapy (NRT) use among adolescents seeking to quit smoking, using the social–ecological model as a guiding framework. Data Source: Searches of PubMED, ProQuest, EBSCOhost, and ERIC were conducted in July 2016. Study Inclusion and Exclusion Criteria: Original studies of cigarette smokers younger than 18 years that discussed NRT were included. Data Extraction: Two reviewers individually extracted study purpose, sample, design, and results. Data Synthesis: Factors were categorized by social–ecological model level and summarized. Results: A total of 103 907 articles were identified during initial search. After narrowing to peer-reviewed articles in English and eliminating reviews and adult-only studies, we reviewed 51 articles. These 51 articles identified factors from studies at each level of the social–ecological model: intrapersonal ( k = 20), interpersonal ( k = 2), organizational ( k = 7), community ( k = 11), and public policy ( k = 14). Conclusion: Findings provide insight into the applicability of NRT for adolescent smoking cessation, and factors by social–ecological model level highlight areas for additional research. Future adolescent NRT studies should assess factors at the interpersonal, organizational, and community levels, as well as the interactions between levels.
Examining How Neighborhood Socioeconomic Status, Geographic Accessibility, and Informational Accessibility Influence the Uptake of a Free Population-Level Physical Activity Intervention for Children
Authors: Clark Andrew F. , Wilk Piotr , Mitchell Christine A. , Smith Christine , Archer Josh , Gilliland Jason A. 
Published: July 2017

Purpose: To evaluate the uptake of ACT-i-Pass (G5AP), a physical activity (PA) intervention that provides free access to PA opportunities, and to understand the extent to which the intervention provides equitable access to children. Design: This study evaluates the differences in uptake (ie, enrollment) by comparing postal codes of registrants with the postal codes of all eligible children. Setting: Children were provided the opportunity to register for the G5AP during the 2014 to 2015 school year in London, Canada. Participants: The population of grade 5 students in London who registered for the G5AP (n = 1484) and did not register (n = 1589). Intervention: The G5AP offered grade 5 students free access to select PA facilities/programs during 2014 to 2015 school year. Measures: Measures included G5AP registration status, method of recruitment, distance between home and the nearest facility, and neighborhood socioeconomic status. Analysis: Getis-Ord Gi* and multilevel logistic regression were used to analyze these data. Results: There were significant differences in the uptake of the G5AP: residing in neighborhoods of high income (odds ratio [OR] = 1.062, P = .029) and high proportion of recent immigrants (OR = 1.036, P = .001) increased the likelihood of G5AP registration. Children who were recruited actively were significantly more likely to register for the G5AP (OR = 2.444, P < .001). Conclusion: To increase the uptake of a PA intervention, children need to be actively recruited. Interactive presentations provide children with increased access to information about both the program and its nuances that cannot be communicated as effectively through passive methods.
India: Non Alignment: India and the future By M.S. Rajan, University of Mysore. 1970. 117 P. Rs. 7.50.
Authors: Rana A. P. 
Published: July 2017

Foreign Policy and its Planning By K.P. Misra. Asia, Bombay. 1970. 88 p. Rs. 15. Aspects of India's Foreign Policy By A.G. Noorani, Jaico Publishing House, 1970. 400 p. Rs 10.
Epidemiology training for primary health care: the use of computer-assisted distance learning
Authors: Macfarlane Sarah B. , Cuevas Luis E. , Moody John B. , Russell Wanda B. , Schlecht Bernard J. 
Published: July 2017

The Liverpool Epidemiology Programme, based in the Liverpool School of Tropical Medicine, has designed a series of computer-based modules for use in distance learning. The purpose of this paper is to highlight the role of computers in training health workers in epidemiology in developing countries. The aim of the modules is to provide health workers with solutions to problems which they face in their everyday work. The modules are written in hypertext software for IBM compatible machines and interact with the epidemiological software Epi Info. Four modules are described: LEP-Nut which deals with nutritional surveillance, LEP-Ref which looks at the role of epidemiology within a refugee health care programme, LEP-Surv dealing with health surveillance and LEP-Rap which introduces the concept of rapid appraisal. They are also easily distributed, particularly with the development of the Internet. The modules are carefully evaluated before and after distribution. Issues related to their evaluation and subsequent revision are discussed, in particular is the content important, adequate, communicated and useful? A major advantage of computer-based learning materials is that they can be easily updated with new advancements of knowledge and experience from the field.
Clinical determinants of clopidogrel responsiveness in a heterogeneous cohort of Puerto Rican Hispanics
Authors: Hernandez-Suarez Dagmar F. , Scott Stuart A. , Tomey Matthew I. , Melin Kyle , Lopez-Candales Angel , Buckley Charlotte E. , Duconge Jorge 
Published: July 2017

Background: Clopidogrel is by far the most prescribed platelet adenosine diphosphate (ADP) antagonist in Puerto Rico despite the advent of newer agents (prasugrel and ticagrelor). Given the paucity of data on clopidogrel responsiveness in Hispanics, we sought to determine the association between clinical characteristics and platelet reactivity in Puerto Rican patients on clopidogrel therapy. Study population: A total of 100 Puerto Rican patients on clopidogrel therapy were enrolled and allocated into two groups: Group I, without high on-treatment platelet reactivity (HTPR); and Group II, with HTPR. Platelet function was measured ex vivo using the VerifyNow® P2Y12 assay. Results: The cohort was comprised of Hispanic patients with coronary artery disease (57%), peripheral artery disease (32%), carotid artery stenosis (7%), cerebral artery aneurysm (2%), and stroke (2%). Mean platelet reactivity was 200 ± 61 P2Y12 reaction units (PRUs) (range: 8–324), and 35% of patients had HTPR (PRUs ⩾ 230). Multivariable logistic regression analysis determined that diabetes mellitus (DM) [odds ratio (OR) = 3.27; 95% confidence interval (CI): 1.20–8.96], use of proton-pump inhibitors (PPIs) (OR = 3.60; 95% CI: 1.09–11.82), and calcium channel blockers (CCBs) (OR = 3.10; 95% CI: 1.09–8.83) were independent predictors of HTPR ( p < 0.05) after adjusting for other clinical variables. Conclusions: In a sample of 100 Puerto Rican Hispanic patients on clopidogrel, 35% had HTPR. Furthermore, DM, PPIs and CCBs predicted HTPR. Clinical outcome data are needed to identify appropriate PRU thresholds for risk prediction in the Puerto Rican population.
Complications associated with the use of oral anticoagulation in patients with pulmonary arterial hypertension from two referral centers
Authors: Roldan Tamara , Rios Juan J , Villamañan Elena , Waxman Aaron B. 
Published: July 2017

Anticoagulants are widely used in patients with pulmonary arterial hypertension (PAH) to prolong survival. However, there is a lack of robust evidence demonstrating the benefits of anticoagulants in PAH patients and very little is known about the complications of their use in this population. The objective of this study is to compare the safety of routine administration of oral anticoagulants between PAH patients who were and were not treated with oral anticoagulants. This observational, retrospective cohort study included consecutive patients with confirmed PAH from two centers: Brigham and Women’s Hospital in Boston and Hospital Universitario La Paz in Madrid from January 2009 to August 2015. The study group comprised patients who received therapeutic anticoagulation; patients who had never received anticoagulants were placed in the control group. Of the 201 included patients, 60.2% were treated with oral anticoagulants and 39.8% were not treated. The hazard ratio for major bleeding was 2.7 (95% confidence interval [CI] = 1.1–6.8; P = 0.036). The incidence rate for the anticoagulation group was 4.7 per 100 patient‐years (95% CI = 2.5–8.0). The most frequent major hemorrhage was gastrointestinal bleeding with 24 cases (72.7%). Prior bleeding, poor anticoagulation, HAS‐BLED score ≥3, diabetes, and number of medications were factors that increased the risk of major bleeding in patients using anticoagulants. The harmful effects of anticoagulants could outweigh the benefits in PAH patients. Therefore, anticoagulants should be prescribed on a case‐by‐case basis and should not be systematically recommended.
Unemployment and HIV mortality in the countries of the Organisation for Economic Co-operation and Development: 1981–2009
Authors: Maruthappu Mahiben , Zhou Charlie , Williams Callum , Zeltner Thomas , Atun Rifat 
Published: July 2017

Objectives To determine an association between unemployment rates and human immunodeficiency virus (HIV) mortality in the Organisation for Economic Co-operation and Development (OECD). Design Multivariate regression analysis. Participants OECD member states. Setting OECD. Main outcome measures World Health Organization HIV mortality. Results Between 1981 and 2009, a 1% increase in unemployment was associated with an increase in HIV mortality in the OECD (coefficient for men 0.711, 0.334–1.089, p = 0.0003; coefficient for women 0.166, 0.071–0.260, p = 0.0007). Time lag analysis showed a significant increase in HIV mortality for up to two years after rises in unemployment: p = 0.0008 for men and p = 0.0030 for women in year 1, p = 0.0067 for men and p = 0.0403 for women in year 2. Conclusions Rises in unemployment are associated with increased HIV mortality. Economic fiscal policy may impact upon population health. Policy discussions should take into consideration potential health outcomes.
Current practice in the management of Rockwood type III acromioclavicular joint dislocations—National survey
Authors: Domos Peter , Sim Frank , Dunne Mike , White Andrew 
Published: July 2017

Purpose: Our aim was to conduct this survey among consultant shoulder surgeons in the United Kingdom to document the current management of Rockwood type III acromioclavicular joint (ACJ) injuries. Methods: British Elbow and Shoulder Society Research Committee-approved online survey was used and 137 responses were collected within 3 months. Results: One hundred percent of responders would treat type III injuries conservatively initially. Routine physiotherapy would be offered by 86% of surgeons. The patient’s factors that influence the decision to consider surgery are pre-injury functional demand, current functional deficit, pain and patient request for surgery. Across all groups the mean time to surgical intervention from injury was 3.8 months. About 45% of all consultants would use the same technique for all cases and there were differences between the varieties of techniques used by surgeons, depending on their degree of experience. LockDown was the most widely used technique in all groups of patients. This was followed by Ligament Augmentation & Reconstruction System (LARS), hook plate and Arthroscopic TightRope/DogBone technique for acute injuries. LARS, modified Weaver–Dunn and ACJ resection were used most commonly after LockDown for delayed cases. Conclusion: Our survey revealed the current trends in clinical practice to treat symptomatic Rockwood type III ACJ injuries, but it also confirmed the controversial and complex management differences, which vary among shoulder surgeons in the United Kingdom.
Total hip arthroplasty after failed osteosynthesis of proximal femoral fractures: Revision and mortality of 80 patients
Authors: Müller Franz , Galler Michael , Zellner Michael , Bäuml Christian , Füchtmeier Bernd 
Published: July 2017

Purpose: Total hip arthroplasty (THA) after failed osteosynthesis for proximal femoral fractures is associated with higher revision rates, particularly for dislocation. The purpose of this study was to report our results with THA after failed osteosynthesis within a treatment period of 10 years. Methods: A retrospective cohort study including 80 consecutive patients was conducted. After a minimum follow-up of 1 year, we evaluated revision for any cause including dislocation, outcome, and mortality. Results: We performed 48 THAs with standard components only and 32 THAs with revision implants. Routinely, a 36-mm femoral head was used, and trochanteric fixation was performed in one-third of the cases. Total revision rate for any cause was 21%, which included six infections, six periprosthetic fractures, and five hematomas. One hip dislocation was also treated. Treatment with uncemented revision stem revealed significantly higher number of revisions—compared to standard cemented or uncemented stem. The mortality rate after 1 year was 9%, and the mean Parker score at follow-up was 6.6 (range: 0−9). Conclusions: THA was associated with an increased surgical revision rate, but hip dislocation was documented only once. In most cases, a standard implant with a large 36-mm femoral head size was sufficient. Uncemented revision stem revealed significantly higher number of revisions—compared to standard cemented or uncemented stem. One-year mortality was lower than expected.
Concomitant SLAP repair does not influence the surgical outcome for arthroscopic Bankart repair of traumatic shoulder dislocations
Authors: Aydin Nuri , Unal Mehmet Bekir , Asansu Mustafa , Tok Okan 
Published: July 2017

Background: Prior studies revealed the presence of superior labrum anterior-to-posterior (SLAP) injury together with Bankart lesions in some patients. The purpose of the study is to compare the clinical results of isolated Bankart repairs with the clinical results of Bankart repairs when performed with concomitant SLAP repairs. Methods: The patients who underwent arthroscopic surgery for treatment of anterior glenohumeral instability were evaluated retrospectively. Group 1 consisted of 19 patients who had arthroscopic SLAP repair together with Bankart repair. The mean age of the patients was 23. Group 2 consisted of 38 patients who underwent isolated Bankart repair. The mean age was 24. Knotless anchors were used in both groups. Results: The mean follow-up was 34 months (range: 26–72). In group 1, the mean preoperative Constant score was 84 (range: 74–90, standard deviation (SD): 5.91) and Rowe score was 64.1 (range: 40–70, SD: 8.14). In group 2, the preoperative Constant score was 84.4 (range: 70–96, SD: 5.88) and Rowe score was 60 (range: 45–70, SD: 7.95). In group 1, the postoperative mean Constant score raised to 96.8 (range: 88–100, SD: 2.91) and the mean Rowe score raised to 92.3 (range: 85–100, SD: 5.17). In group 2, the postoperative mean Constant score was 94.9 (range: 88–100, SD: 3.70) and the mean Rowe score was 94.2 (range: 80–100, SD: 4.71). The difference between the scores of two groups was insignificant ( p > 0.05). When the numbers of redislocations and range of motion were compared, no significant difference was found ( p > 0.05). Conclusion: Accompanying SLAP repair in surgical treatment with Bankart repair for shoulder instability does not affect the results negatively. Properly repaired labral tears extending from anterior inferior to the posterior superior of the glenoid in instability treatment have the same outcome in overall results as repaired isolated Bankart lesions.
The reliability of measuring acetabular component position on radiographs using everyday diagnostic imaging software
Authors: Lahy Jack , Stevens Jarrad , McKenzie Dean , de Steiger Richard 
Published: July 2017

Background: It is standard practice for total hip arthroplasty (THA) patients to have post-operative imaging, and one of the reasons is to assess the adequacy of acetabular component position. Correct positioning of the acetabular component is important for successful outcome in THA. Acetabular component position can be measured from either computed tomography (CT) or plain radiographs. While CT is the gold standard for accurately measuring acetabular component position, radiographs are routinely used for post-operative evaluation. However, measurement of acetabular component position from plain radiographs is not straightforward and numerous methods have been proposed. As most imaging is now digital, the aim of this study was to investigate the reliability of one method to measure acetabular component position using a basic diagnostic imaging software program that is readily available to orthopaedic surgeons. Methods: We investigated the reliability Lewinnek’s method using a basic Picture Archiving and Communication System program, InteleViewer ™ . We measured 69 post-operative anteroposterior (AP) radiographs of patients who underwent primary THA. Intra-observer and inter-observer reliability for Lewinnek’s method was calculated using the intraclass correlation coefficient. Results: Our results showed excellent intra- and inter-observer reliability for both inclination (0.99, 95% confidence interval (CI): 0.99–1.0; and 0.97, 95% CI: 0.95–0.99) and anteversion (0.99, 95% CI: 0.98–0.99; and 0.93, 95% CI: 0.89–0.96) measurements. Conclusion: This study has shown that using Lewinnek’s method, acetabular component position can be reliably measured on post-operative AP digital radiographs using readily available software tools.