bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility of exercise for adolescents with persisting symptoms following a sport-related concussion: a randomized controlled trial
Authors: Chan Catherine , Silverberg Noah , Purtzki Jacqueline , Wong Kathy , Iverson Grant , Gagnon Isabelle 
Published: November 2017

ObjectiveTo describe the feasibility and safety of a randomised controlled trial (RCT) comparing active rehabilitation (AR) to treatment as usual (TAU) in adolescents with persistent symptoms following a sport-related concussion.DesignPartially blinded, pilot RCT.SettingOutpatient Rehabilitation Hospital.Participants13 adolescents enrolled and completed the study (10 girls, 3 boys). All were between the ages of 12–18 and were symptomatic for greater than 4 weeks. Participants were excluded if they had more than 1 concussion in the last year, any active mental health disorder, or if their concussion occurred more than 1 year from enrolment.InterventionParticipants were randomly allocated to TAU (occupational therapy and school recommendations) or AR. AR included aerobic exercise, positive visualisation techniques, and sport-specific exercises. AR sessions were supervised by a physiotherapist, and a blinded assessor monitored all participants weekly.Outcome measuresInvestigators monitored symptoms using the Post-Concussion Symptom Inventory. Secondary outcome measures included activity level, balance, mood, fatigue, and return to school.Main results125 individuals were screened over a 1.25 year period. Of the 22% of individuals deemed eligible, 15 declined to participate. Most commonly, individuals were excluded due to being unreachable, uninterested, or having more than one concussion. No drop outs occurred. An external committee reviewed two adverse events in TAU and 1 adverse event in the AR group. All adverse events were unrelated to the intervention and study procedures.ConclusionsBased on this small pilot study, exercise appeared safe in this sample of youth with persistent symptoms.Competing interestsNone.
The effect of persistent post-concussive symptoms on cognitive performance after sport concussion
Authors: Su Zhangjie , Davies David , Bhavsar Amar , Hammond Douglas , Hacker David , Evans Shaun , Grey Michael , Belli Antonio 
Published: November 2017

ObjectiveWe aim to study the effect of persistent post-concussive symptoms on cognitive performance of elite athletes, based on the hypothesis that persistent symptoms could impair athletes’ cognitive performances and functional outcomes.DesignProspective observational and longitudinal case control study.SettingUniversity research centre, single centre.Participants7 athletes with persistent symptoms (>2 weeks, assessed at median 31 days post-concussion), 10 athletes with brief symptoms (<3 days, assessed within a week, median 3.5 days), and 9 age-matched healthy volunteers. Inclusion criteria: male/female athletes (aged 18–40) in contact sports who sustained concussion(s) recently, being symptomatic with normal neuro-radiological findings at enrolment.InterventionIndependent variables: post-concussive symptom scores and duration of symptoms.Outcome measuresMulti-dimensional scores from Sport Concussion Assessment Tool III, Immediate Post-concussion Assessment and Cognitive Testing, WAIS symbol search and digit span backward tests.Main resultsPatients with persistent symptoms scored less in the symbol search test than those with brief symptoms and the healthy volunteers (grouping effect p=0.006; post hoc tests p=0.039 and 0.004, respectively). In all 17 patients, symptom scores correlated with reaction time (ρ=−0.61, p=0.009), and visual motor speed correlated with symbol search scores (ρ=0.59, p=0.013). 6 patients who completed follow-up assessments when symptom-free showed improvement in their symbol search scores (p=0.042) and visual memory (p=0.028).ConclusionsConcussed athletes with persistent symptoms performed poorly in visual perception/analysis and information processing. Persistent post-concussive symptoms could affect athletes’ visual memory, perception/analysis, reaction time and information processing speed, thus precipitating them to further injuries should they return to play prematurely.Competing interestsNone.
Acute sport-related concussion suppresses heart rate variability beyond clinical recovery
Authors: Wright Alexander D , Smirl Jonathan D. , Grewal Harjas S. , Bryk Kelsey , van Donkelaar Paul 
Published: November 2017

ObjectiveTo examine the effect of acute sport-related concussion on heart rate variability (HRV) in contact-sport athletes over 1 month post-injury.DesignProspective Cohort.SettingLaboratory.Participants136 male contact-sport athletes (19.1±1.4 years) were recruited and a subset of 14 athletes sustained concussions (19±1.4 years) and were included in the current analyses.InterventionParticipants completed baseline (T0) and post-injury testing at 72-hours (T1), 2-weeks (T2), and 1-month (T3). A three-lead electrocardiogram was recorded to assess HRV during 5-minutes of quiet stance and while actively squatting at 0.10 Hz (6 squats per minute). Recordings were analysed using Kubios software (Kuopio, Finland). Independent variables included condition (resting versus active) and time (4).Outcome measuresTime-Domain: square root of mean squared differences of successive R-R intervals (RMSSD), percentage of successive R-R intervals that differ by more than 50 milliseconds (pNN50). Non-linear: approximate entropy (ApEn).Main resultsRM-ANOVA revealed a significant main effect of time for ApEn only (p=0.016). ApEn was reduced at T2 (−0.126, 95% CI: 0.029–0.222, p=0.015) and T3 (−0.068, 95% CI: 0.009–0.128, p=0.027) compared to T0. Median return-to-play duration was 14.5 days.ConclusionsAcute sport-related concussions induce a delayed reduction in heart rate variability that does not manifest until near-clinical recovery, and persists until at least 1-month post-injury. This is an important finding, indicating that concussions impair regulation of the autonomic nervous system for a duration persisting well beyond clinical recovery.Competing interestsNone.
Muscle injury rate in professional football is higher in matches played within 5 days since the previous match: a 14-year prospective study with more than 130 000 match observations
Authors: Bengtsson Håkan , Ekstrand Jan , Waldén Markus , Hägglund Martin 
Published: November 2017

BackgroundThe association between match congestion and injury rates in professional football has yielded conflicting results.AimTo analyse associations between match congestion on an individual player level and injury rates during professional football matches.MethodsData from a prospective cohort study of professional football with 133 170 match observations were analysed with Poisson regressions. Associations between short-term match congestion, defined as number of days between two match exposures (≤3, 4, 5, 6 and 7–10 days) and injury rates were analysed. To analyse the influence of long-term match congestion, defined as individual match exposure hours in the 30 days preceding a match, observations were categorised into three groups (low, ≤4.5; medium, >4.5 to ≤7.5; and high, >7.5 hours).ResultsNo differences in total match injury rates were found between the reference category (≤3 days) and the other categories of short-term congestion. Muscle injury rates were significantly lower in matches preceded by 6 (rate ratio (RR) 0.79; 95% CI 0.65 to 0.95) or 7–10 days (RR 0.81; 95% CI 0.71 to 0.93) compared with ≤3 days since the last match exposure. No differences in total and muscle injury rates between the three long-term match congestion groups were found.ConclusionsIn this study of male professional football players, there were no match congestion-related differences in total match injury rates, but muscle injury rates during matches were lower when players were given at least 6 days between their match exposures.
Incidence of patient safety events and process-related human failures during intra-hospital transportation of patients: retrospective exploration from the institutional incident reporting system
Authors: Yang Shu-Hui , Jerng Jih-Shuin , Chen Li-Chin , Li Yu-Tsu , Huang Hsiao-Fang , Wu Chao-Ling , Chan Jing-Yuan , Huang Szu-Fen , Liang Huey-Wen , Sun Jui-Sheng 
Published: November 2017

BackgroundIntra-hospital transportation (IHT) might compromise patient safety because of different care settings and higher demand on the human operation. Reports regarding the incidence of IHT-related patient safety events and human failures remain limited.ObjectiveTo perform a retrospective analysis of IHT-related events, human failures and unsafe acts.SettingA hospital-wide process for the IHT and database from the incident reporting system in a medical centre in Taiwan.ParticipantsAll eligible IHT-related patient safety events between January 2010 to December 2015 were included.Main outcome measuresIncidence rate of IHT-related patient safety events, human failure modes, and types of unsafe acts.ResultsThere were 206 patient safety events in 2 009 013 IHT sessions (102.5 per 1 000 000 sessions). Most events (n=148, 71.8%) did not involve patient harm, and process events (n=146, 70.9%) were most common. Events at the location of arrival (n=101, 49.0%) were most frequent; this location accounted for 61.0% and 44.2% of events with patient harm and those without harm, respectively (p<0.001). Of the events with human failures (n=186), the most common related process step was the preparation of the transportation team (n=91, 48.9%). Contributing unsafe acts included perceptual errors (n=14, 7.5%), decision errors (n=56, 30.1%), skill-based errors (n=48, 25.8%), and non-compliance (n=68, 36.6%). Multivariate analysis showed that human failure found in the arrival and hand-off sub-process (OR 4.84, p<0.001) was associated with increased patient harm, whereas the presence of omission (OR 0.12, p<0.001) was associated with less patient harm.ConclusionsThis study shows a need to reduce human failures to prevent patient harm during intra-hospital transportation. We suggest that the transportation team pay specific attention to the sub-process at the location of arrival and prevent errors other than omissions. Long-term monitoring of IHT-related events is also warranted.
Mortality of hospitalised internal medicine patients bedspaced to non-internal medicine inpatient units: retrospective cohort study
Authors: Bai Anthony D , Srivastava Siddhartha , Tomlinson George A , Smith Christopher A , Bell Chaim M , Gill Sudeep S 
Published: November 2017

ObjectiveTo compare inhospital mortality of general internal medicine (GIM) patients bedspaced to off-service wards with GIM inpatients admitted to assigned GIM wards.MethodA retrospective cohort study of consecutive GIM admissions between 1 January 2015 and 1 January 2016 was conducted at a large tertiary care hospital in Canada.Inhospital mortality was compared between patients admitted to off-service wards (bedspaced) and assigned GIM wards using a Cox proportional hazards model and a competing risk model. Sensitivity analyses included propensity score and pair matching based on GIM service team, workload, demographics, time of admission, reasons for admission and comorbidities.ResultsAmong 3243 consecutive GIM admissions, more than a third (1125, 35%) were bedspaced to off-service wards with the rest (2118, 65%) admitted to assigned GIM wards. In hospital, 176 (5%) patients died: 88/1125 (8%) bedspaced patients and 88/2118 (4%) assigned GIM ward patients. Compared with assigned GIM wards patients, bedspaced patients had an HR of 3.42 (95% CI 2.23 to 5.26; P<0.0001) for inhospital mortality at admission, which then decreased by HR of 0.97 (95% CI 0.94 to 0.99; P=0.0133) per day in hospital. Competing risk models and sensitivity analyses using propensity scores and pair matching yielded similar results.ConclusionsBedspaced patients had significantly higher inhospital mortality than patients admitted to assigned GIM wards. The risk was highest at admission and subsequently declined. The results of this single centre study may not be generalisable to other hospitals and may be influenced by residual confounding. Despite these limitations, the relationship between bedspacing and patient outcomes requires investigation at other institutions to determine if this common practice represents a modifiable patient safety indicator.
Butyrate reduces appetite and activates brown adipose tissue via the gut-brain neural circuit
Authors: Li Zhuang , Yi Chun-Xia , Katiraei Saeed , Kooijman Sander , Zhou Enchen , Chung Chih Kit , Gao Yuanqing , van den Heuvel José K , Meijer Onno C , Berbée Jimmy F P , Heijink Marieke , Giera Martin , Willems van Dijk Ko , Groen Albert K , Rensen Patrick C N , Wang Yanan 
Published: November 2017

ObjectiveButyrate exerts metabolic benefits in mice and humans, the underlying mechanisms being still unclear. We aimed to investigate the effect of butyrate on appetite and energy expenditure, and to what extent these two components contribute to the beneficial metabolic effects of butyrate.DesignAcute effects of butyrate on appetite and its method of action were investigated in mice following an intragastric gavage or intravenous injection of butyrate. To study the contribution of satiety to the metabolic benefits of butyrate, mice were fed a high-fat diet with butyrate, and an additional pair-fed group was included. Mechanistic involvement of the gut-brain neural circuit was investigated in vagotomised mice.ResultsAcute oral, but not intravenous, butyrate administration decreased food intake, suppressed the activity of orexigenic neurons that express neuropeptide Y in the hypothalamus, and decreased neuronal activity within the nucleus tractus solitarius and dorsal vagal complex in the brainstem. Chronic butyrate supplementation prevented diet-induced obesity, hyperinsulinaemia, hypertriglyceridaemia and hepatic steatosis, largely attributed to a reduction in food intake. Butyrate also modestly promoted fat oxidation and activated brown adipose tissue (BAT), evident from increased utilisation of plasma triglyceride-derived fatty acids. This effect was not due to the reduced food intake, but explained by an increased sympathetic outflow to BAT. Subdiaphragmatic vagotomy abolished the effects of butyrate on food intake as well as the stimulation of metabolic activity in BAT.ConclusionButyrate acts on the gut-brain neural circuit to improve energy metabolism via reducing energy intake and enhancing fat oxidation by activating BAT.
Genome-wide DNA methylation analysis reveals a prognostic classifier for non-metastatic colorectal cancer (ProMCol classifier)
Authors: Gündert Melanie , Edelmann Dominic , Benner Axel , Jansen Lina , Jia Min , Walter Viola , Knebel Phillip , Herpel Esther , Chang-Claude Jenny , Hoffmeister Michael , Brenner Hermann , Burwinkel Barbara 
Published: November 2017

ObjectivePathological staging used for the prediction of patient survival in colorectal cancer (CRC) provides only limited information.DesignHere, a genome-wide study of DNA methylation was conducted for two cohorts of patients with non-metastatic CRC (screening cohort (n=572) and validation cohort (n=274)). A variable screening for prognostic CpG sites was performed in the screening cohort using marginal testing based on a Cox model and subsequent adjustment of the p-values via independent hypothesis weighting using the methylation difference between 34 pairs of tumour and normal mucosa tissue as auxiliary covariate. From the 1000 CpG sites with the smallest adjusted p-value, 20 CpG sites with the smallest Brier score for overall survival (OS) were selected. Applying principal component analysis, we derived a prognostic methylation-based classifier for patients with non-metastatic CRC (ProMCol classifier).ResultsThis classifier was associated with OS in the screening (HR 0.51, 95% CI 0.41 to 0.63, p=6.2E−10) and the validation cohort (HR 0.61, 95% CI 0.45 to 0.82, p=0.001). The independent validation of the ProMCol classifier revealed a reduction of the prediction error for 3-year OS from 0.127, calculated only with standard clinical variables, to 0.120 combining the clinical variables with the classifier and for 4-year OS from 0.153 to 0.140. All results were confirmed for disease-specific survival.ConclusionThe ProMCol classifier could improve the prognostic accuracy for patients with non-metastatic CRC.
Increased coronary heart disease and stroke hospitalisations from ambient temperatures in Ontario
Authors: Bai Li , Li Qiongsi , Wang Jun , Lavigne Eric , Gasparrini Antonio , Copes Ray , Yagouti Abderrahmane , Burnett Richard T , Goldberg Mark S , Cakmak Sabit , Chen Hong 
Published: November 2017

ObjectiveTo assess the associations between ambient temperatures and hospitalisations for coronary heart disease (CHD) and stroke.MethodsOur study comprised all residents living in Ontario, Canada, 1996–2013. For each of 14 health regions, we fitted a distributed lag non-linear model to estimate the cold and heat effects on hospitalisations from CHD, acute myocardial infarction (AMI), stroke and ischaemic stroke, respectively. These effects were pooled using a multivariate meta-analysis. We computed attributable hospitalisations for cold and heat, defined as temperatures above and below the optimum temperature (corresponding to the temperature of minimum morbidity) and for moderate and extreme temperatures, defined using cut-offs at the 2.5th and 97.5th temperature percentiles.ResultsBetween 1996 and 2013, we identified 1.4 million hospitalisations from CHD and 355 837 from stroke across Ontario. On cold days with temperature corresponding to the 1st percentile of temperature distribution, we found a 9% increase in daily hospitalisations for CHD (95% CI 1% to 16%), 29% increase for AMI (95% CI 15% to 45%) and 11% increase for stroke (95% CI 1% to 22%) relative to days with an optimal temperature. High temperatures (the 99th percentile) also increased CHD hospitalisations by 6% (95% CI 1% to 11%) relative to the optimal temperature. These estimates translate into 2.49% of CHD hospitalisations attributable to cold and 1.20% from heat. Additionally, 1.71% of stroke hospitalisations were attributable to cold. Importantly, moderate temperatures, rather than extreme temperatures, yielded the most of the cardiovascular burdens from temperatures.ConclusionsAmbient temperatures, especially in moderate ranges, may be an important risk factor for cardiovascular-related hospitalisations.
Biomarkers of cardiovascular stress and fibrosis in preclinical hypertrophic cardiomyopathy
Authors: Ho Jennifer E , Shi Ling , Day Sharlene M , Colan Steven D , Russell Mark W , Towbin Jeffrey A , Sherrid Mark V , Canter Charles E , Jefferies John Lynn , Murphy Anne , Taylor Matthew , Mestroni Luisa , Cirino Allison L , Sleeper Lynn A , Jarolim Peter , Lopez Begoña , Gonzalez Arantxa , Diez Javier , Orav E John , Ho Carolyn Y 
Published: November 2017

ObjectiveSarcomeric gene mutation carriers without overt left ventricular hypertrophy (G+/LVH−) can harbour subclinical changes in cardiovascular structure and function that precede the development of hypertrophic cardiomyopathy (HCM). We sought to investigate if circulating biomarkers of cardiovascular stress and collagen metabolism among G+/LVH− individuals, measured at rest and following exercise provocation, yield further insights into the underlying biology of HCM.MethodsWe studied 76 individuals with overt HCM, 50 G+/LVH− individuals and 41 genotype-negative related controls enrolled in a cross-sectional, multicentre observational study (HCMNet). Biomarkers of cardiac stress (N-terminal pro-B-type natriuretic peptide, NT-proBNP; high-sensitivity troponin I, hsTnI; soluble ST2) and fibrosis (carboxy-terminal propeptide of procollagen type I; C-terminal telopeptide of type I collagen; galectin-3; periostin) were measured.ResultsIndividuals with overt HCM had elevated NT-proBNP and hsTnI compared with G+/LVH− subjects and controls at rest, along with an exaggerated increase in NT-proBNP and hsTnI in response to exercise. We found no detectable differences in resting or exercise-provoked biomarker profiles of cardiovascular stress and fibrosis among G+/LVH− individuals compared with healthy controls despite subtle echocardiographic differences in cardiac structure and function.ConclusionDynamic exercise testing exaggerated resting differences in natriuretic peptides and troponin elevations among individuals with overt HCM. In contrast, we found no differences in biomarker profiles of cardiovascular stress and fibrosis among G+/LVH− individuals compared with controls even after maximal exercise provocation. Our findings highlight the need for continued investigation into early phenotypes of sarcomeric gene mutations and the evolution of HCM.
Discrete duality for De Morgan Algebras with operators
Authors: Gregori Verónica 
Published: November 2017

A discrete duality is a relationship between classes of algebras and classes of relational systems (frames). In this paper, discrete dualities are presented for De Morgan algebras with various kind of unary operators. To do this, we will extend the discrete duality given in [W. Dzik, E. Orłowska and C. van Alten, Relational representation theorems for general lattices with negations, in Relations and Kleene Algebra in Computer Science, Lecture Notes in Computer Science, Vol. 4136 (Springer, Berlin, 2006), pp. 162–176], for De Morgan algebras.
Differential Expression of Homing Receptor Ligands on Tumor-Associated Vasculature that Control CD8 Effector T-cell Entry
Authors: Woods Amber N. , Wilson Ashley L. , Srivinisan Nithya , Zeng Jianhao , Dutta Arun B. , Peske J. David , Tewalt Eric F. , Gregg Randal K. , Ferguson Andrew R. , Engelhard Victor H. 
Published: November 2017

AbstractAlthough CD8+ T cells are critical for controlling tumors, how they are recruited and home to primary and metastatic lesions is incompletely understood. We characterized the homing receptor (HR) ligands on tumor vasculature to determine what drives their expression and their role in T-cell entry. The anatomic location of B16-OVA tumors affected the expression of E-selectin, MadCAM-1, and VCAM-1, whereas the HR ligands CXCL9 and ICAM-1 were expressed on the vasculature regardless of location. VCAM-1 and CXCL9 expression was induced by IFNγ-secreting adaptive immune cells. VCAM-1 and CXCL9/10 enabled CD8+ T-cell effectors expressing α4β1 integrin and CXCR3 to enter both subcutaneous and peritoneal tumors, whereas E-selectin enabled E-selectin ligand+ effectors to enter subcutaneous tumors. However, MadCAM-1 did not mediate α4β7+ effector entry into peritoneal tumors due to an unexpected lack of luminal expression. These data establish the relative importance of certain HRs expressed on activated effectors and certain HR ligands expressed on tumor vasculature in the effective immune control of tumors. Cancer Immunol Res; 5(12); 1062–73. ©2017 AACR.