bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biological v. psychosocial treatments: a myth about pharmacotherapy v. psychotherapy
Authors: Prosser Aaron , Helfer Bartosz , Leucht Stefan 
Published: April 2016

SummaryDespite evidence for their comparable efficacy, psychotherapy faces a dramatic decline relative to pharmacotherapy in psychiatry. A deep ideological reason for this decline centres on the belief that psychotherapy is a psychosocial treatment whereas pharmacotherapy is a biological treatment. Modern cognitive neuroscience demonstrates that this distinction is a myth.
Sampling in epidemiological research: issues, hazards and pitfalls
Authors: Tyrer Stephen , Heyman Bob 
Published: April 2016

SummarySurveys of people's opinions are fraught with difficulties. It is easier to obtain information from those who respond to text messages or to emails than to attempt to obtain a representative sample. Samples of the population that are selected non-randomly in this way are termed convenience samples as they are easy to recruit. This introduces a sampling bias. Such non-probability samples have merit in many situations, but an epidemiological enquiry is of little value unless a random sample is obtained. If a sufficient number of those selected actually complete a survey, the results are likely to be representative of the population. This editorial describes probability and non-probability sampling methods and illustrates the difficulties and suggested solutions in performing accurate epidemiological research.
Faith, ethics and Section 63 of the Mental Health Act 1983
Authors: Curtice Martin , James Louisa 
Published: April 2016

SummarySection 63 of the Mental Health Act 1983 states that an approved clinician can provide medical treatment irrespective of whether or not a detained patient has capacity to refuse such treatment. Case law has established that a range of acts ancillary to the core mental disorder treatment are allowed under Section 63. This article analyses a unique court judgment involving a detained Jehovah's Witness patient who had made an advance decision refusing blood transfusions but who self-inflicted lacerations resulting in blood loss. Core issues within the case involved capacity to consent to treatment and the ethics of treating or not treating patients in such cases.
First-generation antipsychotics: not gone but forgotten
Authors: Dibben Claire R. M. , Khandaker Golam M. , Underwood Benjamin R. , O'Loughlin Christopher , Keep Catherine , Mann Louisa , Jones Peter B. 
Published: April 2016

Aims and methodTo identify training needs of the next generation of psychiatrists and barriers in prescribing first-generation antipsychotics (FGAs). We have surveyed psychiatry trainees in East Anglia with regard to their training experience, knowledge and attitudes to the use of oral FGAs as regular medication.ResultsTwo-thirds of trainees were aware that first- and second-generation antipsychotics (SGAs) have similar efficacy, and a similar proportion perceived the older drugs to have more or ‘stronger’ side-effects. Lack of training experience was noted as the second leading concern for prescribing FGAs. A quarter of trainees received no training exposure to the older drugs and two-thirds had never initiated these drugs themselves. Although nearly 90% of trainees felt confident about initiating an oral SGA as a regular medication, only about 40% felt confident with FGAs (P<0.001).Clinical implicationsThe survey highlights worrying gaps in training. FGAs can be used effectively, minimising side-effects, by careful dose titration, avoiding antipsychotic polypharmacy, high-dose, and high-potency drugs, thus ensuring they are not lost to future generations of psychiatrists.
Cardiac-Specific Disruption of GH Receptor Alters Glucose Homeostasis While Maintaining Normal Cardiac Performance in Adult Male Mice
Authors: Jara Adam , Liu Xingbo , Sim Don , Benner Chance M. , Duran-Ortiz Silvana , Qian Yanrong , List Edward O. , Berryman Darlene E. , Kim Jason K. , Kopchick John J. 
Published: April 2016

Abstract
GH is considered necessary for the proper development and maintenance of several tissues, including the heart. Studies conducted in both GH receptor null and bovine GH transgenic mice have demonstrated specific cardiac structural and functional changes. In each of these mouse lines, however, GH-induced signaling is altered systemically, being decreased in GH receptor null mice and increased in bovine GH transgenic mice. Therefore, to clarify the direct effects GH has on cardiac tissue, we developed a tamoxifen-inducible, cardiac-specific GHR disrupted (iC-GHRKO) mouse line. Cardiac GH receptor was disrupted in 4-month-old iC-GHRKO mice to avoid developmental effects due to perinatal GHR gene disruption. Surprisingly, iC-GHRKO mice showed no difference vs controls in baseline or postdobutamine stress test echocardiography measurements, nor did iC-GHRKO mice show differences in longitudinal systolic blood pressure measurements. Interestingly, iC-GHRKO mice had decreased fat mass and improved insulin sensitivity at 6.5 months of age. By 12.5 months of age, however, iC-GHRKO mice no longer had significant decreases in fat mass and had developed glucose intolerance and insulin resistance. Furthermore, investigation via immunoblot analysis demonstrated that iC-GHRKO mice had appreciably decreased insulin stimulated Akt phosphorylation, specifically in heart and liver, but not in epididymal white adipose tissue. These changes were accompanied by a decrease in circulating IGF-1 levels in 12.5-month-old iC-GHRKO mice. These data indicate that whereas the disruption of cardiomyocyte GH-induced signaling in adult mice does not affect cardiac function, it does play a role in systemic glucose homeostasis, in part through modulation of circulating IGF-1.
Going Back to Their Roots: Comanche Trade and Diet Revisited
Authors: Mitchell Peter 
Published: April 2016

Abstract
Recent studies of eighteenth- and nineteenth-century Comanches have argued that their dependence on bison posed a serious nutritional challenge in the form of a dangerously imbalanced high-protein diet. They contend that this specialization required Comanches to obtain carbohydrates in the form of maize from Spanish-ruled New Mexico and Texas or Native American horticulturalists. This in turn is claimed to have been crucial in structuring Comanche economic and political ties with their neighbors. This article argues instead that the documentary evidence used to support a trade in foodstuffs is weak and that Comanches employed alternative nutritional strategies, including consuming and storing a wide range of wild plants. Prestige and utilitarian goods such as metal tools and weapons, firearms, and items of personal adornment—not food—were the primary motivation for Comanche trade with Europeans.
Indigenous State Making on the Frontier: Arhuaco Politics in the Sierra Nevada de Santa Marta, Colombia, 1900–1920
Authors: Muñoz Catalina 
Published: April 2016

Abstract
This article examines the ways in which, during the early decades of the twentieth century, Arhuaco leaders of the southern slopes of the Sierra Nevada de Santa Marta in Colombia turned to the state to legitimize and move forward their claims. By so doing, they made the state a real presence in an area that has been thought of as a frontier characterized by the state’s absence. I explore Arhuaco interactions with the government and nonindigenous inhabitants of the area in local archives and argue that, far from resting at its margins, the Arhuaco brought the state into being. This case study contributes to the literature about popular and in particular indigenous politics by considering an instance of state formation in a frontier region where the institutional presence of the central administration was sparse. Without external provocation, some Arhuacos invited the state into their lives in selective and strategic ways.
The inner workings of stress fibers − from contractile machinery to focal adhesions and back
Authors: Livne Ariel , Geiger Benjamin 
Published: April 2016

ABSTRACT
Ventral stress fibers and focal adhesions are physically coupled structures that play key roles in cellular mechanics and force sensing. The tight functional interdependence between the two is manifested not only by their apparent proximity but also by the fact that ventral stress fibers and focal adhesions are simultaneously diminished upon actomyosin relaxation, and grow when subjected to external stretching. However, whereas the apparent co-regulation of the two structures is well-documented, the underlying mechanisms remains poorly understood. In this Commentary, we discuss some of the fundamental, yet still open questions regarding ventral stress fiber structure, its force-dependent assembly, as well as its capacity to generate force. We also challenge the common approach – i.e. ventral stress fibers are variants of the well-studied striated or smooth muscle machinery – by presenting and critically discussing alternative venues. By highlighting some of the less-explored aspects of the interplay between stress fibers and focal adhesions, we hope that this Commentary will encourage further investigation in this field.
A mutation abolishing the ZMPSTE24 cleavage site in prelamin A causes a progeroid disorder
Authors: Wang Yuexia , Lichter-Konecki Uta , Anyane-Yeboa Kwame , Shaw Jessica E. , Lu Jonathan T. , Östlund Cecilia , Shin Ji-Yeon , Clark Lorraine N. , Gundersen Gregg G. , Nagy Peter L. , Worman Howard J. 
Published: April 2016

ABSTRACT
In 1994 in the Journal of Cell Science, Hennekes and Nigg reported that changing valine to arginine at the endoproteolytic cleavage site in chicken prelamin A abolishes its conversion to lamin A. The consequences of this mutation in an organism have remained unknown. We now report that the corresponding mutation in a human subject leads to accumulation of prelamin A and causes a progeroid disorder. Next generation sequencing of the subject and her parents' exomes identified a de novo mutation in the lamin A/C gene (LMNA) that resulted in a leucine to arginine amino acid substitution at residue 647 in prelamin A. The subject's fibroblasts accumulated prelamin A, a farnesylated protein, which led to an increased percentage of cultured cells with morphologically abnormal nuclei. Treatment with a protein farnesyltransferase inhibitor improved abnormal nuclear morphology. This case demonstrates that accumulation of prelamin A, independent of the loss of function of ZMPSTE24 metallopeptidase that catalyzes processing of prelamin A, can cause a progeroid disorder and that a cell biology assay could be used in precision medicine to identify a potential therapy.
Exchange nailing for nonunion of diaphyseal fractures of the tibia
Authors: Tsang S. T. J. , Mills L. A. , Frantzias J. , Baren J. P. , Keating J. F. , Simpson A. H. R. W. 
Published: April 2016

Aims The aim of this study was to identify risk factors for the failure of exchange nailing in nonunion of tibial diaphyseal fractures. Patients and Methods A cohort of 102 tibial diaphyseal nonunions in 101 patients with a mean age of 36.9 years (15 to 74) were treated between January 1992 and December 2012 by exchange nailing. Of which 33 (32%) were initially open injuries. The median time from primary fixation to exchange nailing was 6.5 months (interquartile range (IQR) 4.3 to 9.8 months). The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to union. Univariate analysis and multiple regression were used to identify risk factors for failure to achieve union. Results Multiple causes for the primary nonunion were found for 28 (27%) tibiae, with infection present in 32 (31%). Six patients were lost to follow-up. Further surgical procedures were required in 35 (36%) nonunions. Other fixation modalities were required in five fractures. A single nail exchange procedure achieved union in 60/96 (63%) of all nonunions. Only 11 out of 31 infected nonunions (35.4%) healed after one exchange nail procedure. Up to five repeated exchange nailings, with or without bone grafting, ultimately achieved union in 89 (93%) fractures. The median time to union after exchange nailing was 8.7 months (IQR 5.7 to 14.0 months). Univariate analysis confirmed that an oligotrophic/atrophic pattern of nonunion (p = 0.002), a bone gap of 5 mm or more (p = 0.04) and infection (p < 0.001), were predictive for failure of exchange nailing Multiple regression analysis found that infection was the strongest predictor of failure (p < 0.001). Conclusion Exchange nailing is an effective treatment for aseptic tibial diaphyseal nonunion. However, in the presence of severe infection with a highly resistant organism, or extensive sclerosis of the bone, other fixation modalities, such as Ilizarov treatment, should be considered. Take home message: Exchange nailing is an effective treatment for aseptic tibial diaphyseal nonunion. Cite this article: Bone Joint J 2016;98-B:534–41.
A single blind randomised controlled trial of the impact on patient-reported pain of arm elevation versus exsanguination prior to tourniquet inflation
Authors: Lees D. A. , Penny J. B. , Baker P. 
Published: April 2016

Aims The aim of this study was to compare the pain caused by the application of a tourniquet after exsanguination of the upper limb with that occurring after simple elevation. Patients and Methods We used 26 healthy volunteers (52 arms), each of whom acted as their own matched control. The primary outcome measure was the total pain experienced by each volunteer while the tourniquet was inflated for 20 minutes. This was calculated as the area under the pain curve for each individual subject. Secondary outcomes were pain at each time point; the total pain experienced during the recovery phase; the ability to tolerate the tourniquet and the time for full recovery after deflation of the tourniquet. Results There was a significant difference in the area under the pain curves in favour of exsanguination (mean difference 8.4; 95% confidence interval (CI) 3.0 to 13.7, p = 0.004). There was no difference between the dominant and non-dominant arms (mean difference -0.2; 95% CI -23.2 to 22.8, p = 0.99). The area under both recovery curves were similar (mean difference 0.7; 95% CI -6.0 to 4.6, p = 0.78). There was no statistical difference in recovery time, the actual mean difference being 30 seconds longer in the elevation group (p = 0.06). Conclusion Many orthopaedic and plastic surgery procedures are done under local anaesthetic or regional block where a bloodless field and a motionless patient are essential. Optimising patient comfort during surgery with the tourniquet inflated is thus a priority. This study is useful in that it compares two common methods of preparation of the upper limb prior to tourniquet inflation and which have not previously been compared in this context. Following on the results of this study, we can confidently conclude that exsanguinating the upper limb before inflating a tourniquet is more comfortable than simply elevating the arm for patients undergoing a procedure under local or regional block, both during the procedure and in the recovery phase. Take home message: Exsanguination rather than elevation is recommended in order to minimise patient discomfort and optimise the surgical field. Cite this article: Bone Joint J 2016;98-B:519–25.
Enhanced recovery programmes after total hip arthroplasty can result in reduced length of hospital stay without compromising functional outcome
Authors: Maempel J. F. , Clement N. D. , Ballantyne J. A. , Dunstan E. 
Published: April 2016

Aims The primary aim of this study was to investigate the effect of an enhanced recovery program (ERP) on the short-term functional outcome after total hip arthroplasty (THA). Secondary outcomes included its effect on rates of dislocation and mortality. Patients and Methods Data were gathered on 1161 patients undergoing primary THA which included 611 patients treated with traditional rehabilitation and 550 treated with an ERP. Results The ERP was shown to be a significant independent factor which shortened length of stay (LOS) by a mean of 1.5 days (95% confidence interval (CI) 1.3 to 1.8, p < 0.001) after adjusting for confounding variables. The rates of dislocation (traditional 1.03% vs ERP 0.91%, p = 0.84) and mortality (1.5% vs 0.6%, p = 0.14) one year post-operatively were not significantly different. Both groups showed significant improvement in Harris Hip Score (42.8 vs 41.5) at 12 to 18 months post-operatively and there was no significant difference in the magnitude of improvement on univariate (p = 0.09) and multivariate analysis (p = 0.35). There was no significant difference in any of the eight domain scores of the Short-Form - 36 general health surveys post-operatively (p > 0.38). Conclusion We conclude that an ERP after THA shortens LOS by a mean of 1.5 days and does not increase the rate of complications post-operatively. It gives equivalent functional outcomes to a traditional rehabilitation pathway. Take home message: ERP reduces LOS after THA in comparison to traditional rehabilitation, without adversely affecting functional outcomes, dislocation rates or mortality. Cite this article: Bone Joint J 2016;98-B:475–82.
Histological evaluation of two designs of shoulder surface replacement implants
Authors: Ajami S. , Blunn G. W. , Lambert S. , Alexander S. , Foxall Smith M. , Coathup M. J. 
Published: April 2016

Aims To assess the extent of osteointegration in two designs of shoulder resurfacing implants. Bony integration to the Copeland cylindrical central stem design and the Epoca RH conical-crown design were compared. Patients and Methods Implants retrieved from six patients in each group were pair-matched. Mean time to revision surgery of Copeland implants was 37 months (standard deviation (sd) 23; 14 to 72) and Epoca RH 38 months (sd 28; 12 to 84). The mean age of patients investigated was 66 years (sd 4; 59 to 71) and 58 years (sd 17; 31 to 73) in the Copeland and Epoca RH groups respectively. None of these implants were revised for loosening. Results Increased osteointegration was measured under the cup in the Copeland implant group with limited bone seen in direct contact with the central stem. Bone adjacent to the Epoca RH implants was more uniform. Conclusion This difference in the distribution of bone-implant contact and bone formation was attributed to the Epoca implant’s conical crown, which is positioned in more dense peripheral bone. The use of a central stem may not be necessary provided there is adequate peripheral fixation within good quality humeral bone. Take home message: Poor osteointegration of cementless surface replacement shoulder prosthesis may be improved by implant design. Cite this article: Bone Joint J 2016;98-B:504–11.
Coccygectomy for patients with chronic coccydynia
Authors: Hanley E. N. , Ode G. , Jackson III J. B. , Seymour R. 
Published: April 2016

AimsThe purpose of this prospective study was to evaluate the outcomes of coccygectomy for patients with chronic coccydynia.Patients and MethodsBetween 2007 and 2011, 98 patients underwent coccygectomy for chronic coccydynia. The patients were aged > 18 years, had coccygeal pain, local tenderness and a radiological abnormality, and had failed conservative management. Outcome measures were the Short Form 36 (SF-36), the Oswestry Disability Index (ODI) and a visual analogue scale (VAS) for pain. Secondary analysis compared the pre-operative features and the outcomes of patients with successful and failed treatment, two years post-operatively. The threshold for success was based on a minimum clinically important difference (MCID) on the ODI of 20 points. All other patients, including those lost to follow-up, were classified as failures.ResultsThere was significant improvement in all ten components of the SF-36 (p < 0.05), the ODI (23 points) and VAS (39 points) (p < 0.0001). A total of 69 patients (70.4%) met the designated MCID threshold for a successful outcome. The failure group consisted of 25 patients (25.5%) who did not reach the MCID and four (4.1%) who were lost to follow-up. Six patients (6.1%) in the failure group had ODI scores that were no better or worse than that pre-operatively. The patients in whom treatment failed had significantly worse pre-operative scores for the ODI (p = 0.04), VAS (p = 0.02) and on five of ten SF-36 components (p < 0.04). They also had a higher incidence of psychiatric disorders, pre-operative opiate use and more than three comorbidities. Take home message: Coccygectomy for chronic coccydynia results in significant improvement in patient-reported outcomes at two years. Failure is associated with certain pre-operative characteristics such as psychiatric illness, poor quality of life features, higher levels of pain, and use of opiates. Cite this article: Bone Joint J 2016;98-B:526–33.
Corticosteroid injection for Morton’s neuroma with or without ultrasound guidance
Authors: Mahadevan D. , Attwal M. , Bhatt R. , Bhatia M. 
Published: April 2016

Aims The objective of this double-blind randomised controlled trial was to assess whether ultrasound guidance improved the efficacy of corticosteroid injections for Morton’s neuroma (MN). Patients and Methods In all, 50 feet (40 patients) were recruited for this study but five feet were excluded due to the patients declining further participation. The mean age of the remaining 36 patients (45 feet) was 57.8 years (standard deviation (sd) 12.9) with a female preponderance (33F:12M). All patients were followed-up for 12 months. Treatment was randomised to an ultrasound guided (Group A) or non-ultrasound guided (Group B) injection of 40 mg triamcinolone acetonide and 2 ml 1% lignocaine, following ultrasound confirmation of the diagnosis. Results The mean visual analogue score for pain improved significantly in both groups (Group A – from 64 mm, sd 25 mm to 29 mm, sd 27; Group B – from 69 mm, sd 23 mm to 37 mm, sd 25) with no statistical difference between them at all time-points. The failure rate within 12 months of treatment was 11/23 (48%) and 12/22 (55%) in Groups A and B, respectively (p = 0.458). The improvement in Manchester Oxford Foot Questionnaire Index and patient satisfaction favoured Group A in the short-term (three months) that almost reached statistical significance (p = 0.059 and 0.066 respectively). However, this difference was not observed beyond three months. Conclusion This study has shown that ultrasound guidance did not demonstrably improve the efficacy of corticosteroid injections in patients with MN. Take home message: In the presence of a clear diagnosis of MN, a trained clinician who understands the forefoot anatomy may perform an injection without ultrasound guidance with good and safe results. Cite this article: Bone Joint J 2016;98-B:498–503.
Clinical oral microbiology: A view of the road ahead
Authors: Lockhart Deborah EA , Pankhurst Caroline , Richardson Riina , Seoudi Noha , Smith Andrew , Wilson Melanie 
Published: April 2016

‘There’s none so blind as those that will not see.’ With almost daily headlines describing novel and re-emerging challenges in healthcare related to infection prevention and antimicrobial resistance, it is quite extraordinary that there are currently only four clinical oral microbiologists in UK consultant posts, and no trainees. Given the backdrop of increasing antimicrobial resistance, and a drive towards optimal diagnosis, surveillance and management of infection in all others areas of healthcare, how has this situation arisen? More importantly, can it be remedied? If so, how?