bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence ofTrichomonas vaginalisinfection and protozoan load in South African women: a cross-sectional study
Authors: de Waaij Dewi J , Dubbink Jan Henk , Ouburg Sander , Peters Remco P H , Morré Servaas A 
Published: October 2017

ObjectivesTrichomonas vaginalisis thought to be the most common non-viral sexually transmitted infection worldwide. We investigated the prevalence, risk factors and protozoan load ofT. vaginalisinfection in South African women.MethodsA cross-sectional study of 604 women was conducted at 25 primary healthcare facilities in rural South Africa (Mopani district).T. vaginalisDNA was detected in vaginal and rectal swabs. In univariate and multivariate analyses, theT. vaginalisinfection was investigated in relation to demographic characteristics, medical history and behavioural factors. TheT. vaginalisload was determined as the logarithm of DNA copies per microlitre sample solution.ResultsCollected vaginal and rectal swabs were tested forT. vaginalisDNA. Prevalence of vaginalT. vaginaliswas 20% (95% CI 17.0% to 23.4%) and rectal 1.2% (95% CI 0.6% to 2.4%). Most women (66%) with a vaginal infection were asymptomatic. Factors associated withT. vaginalisinfection were a relationship status of single (OR 2.4; 95% CI 1.5 to 4.0; p<0.001) and HIV positive infection (OR 1.6; 95% CI 1.0 to 2.6; p=0.041). Women with vaginalT. vaginalisinfection were more likely to have concurrentChlamydia trachomatisrectal infection than those without vaginal infection (12%vs3%; p<0.001; OR 4.1). A higher medianT. vaginalisload was observed among women with observed vaginal discharge compared with those without vaginal discharge (p=0.025).ConclusionsVaginal trichomoniasis is highly prevalent in rural South Africa, especially among single women and those with HIV infection, and often presents without symptoms.
Patterns and correlates of active commuting in adults with type 2 diabetes: cross-sectional evidence from UK Biobank
Authors: Falconer Catherine L , Cooper Ashley R , Flint Ellen 
Published: October 2017

ObjectivesTo describe the active commuting (AC) patterns of adults with type 2 diabetes and how these relate to physical activity and sedentary behaviour in UK Biobank. Social and environmental correlates of AC will also be explored.DesignCross-sectional analysis of a cohort study.SettingsThis is a population cohort of over 500 000 people recruited from 22 centres across the UK. Participants aged between 37 and 73 years were recruited between 2006 and 2010.Participants6896 participants with a self-reported type 2 diabetes diagnosis who reported commuting to work and had complete covariate data were included in the analysis.Exposure measuresExposure measures were AC to work, measured as usual mode of transport.Outcome measuresOutcome measures were weekly minutes of moderate to vigorous physical activity (MVPA), hours/day of sedentary time and participation in active travel.ResultsAC (reporting walking or cycling to work only) was reported by 5.5% of participants, with the great majority using the car to commute (80%). AC was associated with an additional 73 (95% CI 10.8 to 134.9) and 105 (95% CI 41.7 to 167.2) weekly minutes of MVPA for men and women, respectively. AC was associated with reduced sedentary time (β −1.1, 95% CI −1.6 to –0.7 hours/day for men; and β −0.8, 95% CI −1.2 to –0.3 hours/day for women). Deprivation and distance from home to work were identified as correlates of AC behaviour.ConclusionsRates of AC are very low in adults with type 2 diabetes. However, AC offers a potentially sustainable solution to increasing physical activity and reducing sedentary behaviour. Therefore, strategies to improve the environment and encourage AC may help to increase population levels of physical activity and reduce the disease burden associated with type 2 diabetes.
Single-centre retrospective analysis of growth hormone supplementation in IVF patients classified as poor-prognosis
Authors: Keane Kevin N , Yovich John L , Hamidi Anahita , Hinchliffe Peter M , Dhaliwal Satvinder S 
Published: October 2017

BackgroundPatients undergoing in vitro fertilisation (IVF) receive various adjuvant therapies in order to enhance success rates, but the true benefit is actively debated. Growth hormone (GH) supplementation was assessed in poor-prognosis women undergoing fresh IVF transfer cycles.MethodsData were retrospectively analysed from 400 IVF cycles, where 161 women received GH and 239 did not.ResultsClinical pregnancy, live birth rates and corresponding ORs and CIs were significantly greater with GH, despite patients being significantly older with lower ovarian reserve. Patient’s age, quality of transferred embryo and GH were the only significant independent predictors of clinical pregnancy (OR: 0.90, 5.00 and 2.49, p<0.002, respectively) and live birth chance (OR: 0.91, 3.90 and 4.75, p<0.014, respectively). GH increased clinical pregnancy chance by 3.42-fold (95% CI 1.82 to 6.44, p<0.0005) and live birth chance by 6.16-fold (95% CI 2.83 to 13.39, p<0.0005) after adjustment for maternal age, antral follicle count and transferred embryo quality.ConclusionThese data provided further evidence to indicate that GH may support more live births, particularly in younger women. It also appears that embryos generated under GH have a better implantation potential, but whether the biological mechanism is embryo-mediated or endometrium-mediated is unclear.
The first prospective injury audit of League of Ireland footballers
Authors: Fitzharris Nigel , Jones Gareth , Jones Ashley , Francis Peter 
Published: October 2017

ObjectivesFootball has the highest sports participation (10.6%) in Ireland ahead of its Gaelic counterpart (3.9%). Research into injury incidence and patterns in Irish football is non-existent. The aim of this study was to conduct a prospective injury audit of League of Ireland (semiprofessional) footballers during the 2014 season (8 months, 28 games).MethodsA total of 140 semiprofessional League of Ireland footballers were prospectively followed between March and November 2014. Data were collected in accordance with the international consensus on football injury epidemiology.ResultsThe injury rate was 9.2/1000 hour exposure to football (95% CI 6.2 to 12.9, p<0.05). Players were at a higher risk of injury during a match compared with training (23.1 (95% CI 15.2 to 31.3) vs 4.8 (95% CI 2.2 to 7.7)/1000 hours, p<0.05). Injuries were most common during non-contact activity (54.6%), mainly running (30.9%), and occurred almost three times more often in the second half (56% vs 21%, p<05). Strains (50.1%) and sprains (20.3%) were the most common injury types, and the thigh region was injured most often (28.3%).ConclusionsThe prevalence of injury in League of Ireland football is similar to that of European professional football, although the incidence of injury is higher. The incidence of injury is in line with that of Dutch amateur football.
Cracking the code for maintaining quality training in Olympic distance triathlon: lessons learnt from a squad of elite Scandinavian athletes
Authors: Myburgh Corrie , Hansen Tobias , Holm Beck Anders , Boyle Eleanor 
Published: October 2017

ObjectiveHigh-quality training is a key determinant of performance in the Olympic distance triathlon and is potentially influenced by a unique array of context-specific biopsychosocial factors. Our objective was to explore and describe these factors among squad members of a university-based, elite Olympic distance triathlete developmental programme.MethodA qualitative investigation using a visual communication tool-assisted focus group and longitudinal semistructured individual interviews was conducted. Responses were solicited from the University of Southern Denmark’s elite triathlon team (n=8), and inductive coding from the focus group formed the basis of questions for the two rounds of individual interviews 11 months apart. All interviews were transcribed verbatim and then analysed thematically.ResultsSeventeen context-relevant factors were identified and 10 themes emerged, these being ‘the cold weather ritual’, ‘digestive system conditioning’, ‘the curse of the night owl’, ‘the strings attached to sponsorship’, ‘my coach—my rock’, ‘mood maintenance’, ‘the asynchronous training rhythm’, ‘psychological slavery’, ‘the legacy of the asphalt tattoo’ and ‘the tension of family and friends’.ConclusionsBy reflecting on their personal training vortex, elite triathletes were able to provide context-relevant insights into the maintenance of training quality over the course of a competitive season. Further research is required to elucidate whether and how biopsycholosocial factors can be modified to optimise the achievement of training goals.
Patient-family agreement on values and preferences for life-sustaining treatment: results of a multicentre observational study
Authors: Abdul-Razzak Amane , Heyland Daren K , Simon Jessica , Ghosh Sunita , Day Andrew G , You John J 
Published: October 2017

ObjectivesTo quantify agreement between patients and their family members on their own values and preferences for use or non-use of life-sustaining treatments for the patient.MethodsHospitalised patients aged 55 years or older with advanced pulmonary, cardiac, liver disease or metastatic cancer or aged 80 years or older from medical wards at 16 Canadian hospitals and their family members completed a questionnaire including eight items about values related to life-sustaining treatment and a question about preferences for life-sustaining treatments.ResultsWe recruited a total of 313 patient-family member dyads. Crude agreement between patients and family members about values related to life-sustaining treatment was 42% across all eight items but varied widely: 20% when asking how important it was for the patient to respect the wishes of family members regarding their care; 72% when asking how important it was for the patient to be kept comfortable and suffer as little as possible. Crude agreement on preferences for life-sustaining treatment was 91% (kappa 0.60; 95%CI 0.45 to 0.75) when looking at preferences for cardiopulmonary resuscitation (CPR) versus no CPR but fell to 56% when including all five response options with varying degrees of resuscitative, medical or comfort options (kappa 0.39; 95%CI 0.31 to 0.47).ConclusionsThere is appreciable disagreement between seriously ill hospitalised patients and family members in their values and preferences for life-sustaining treatment. Strategies are needed to improve the quality of advance care planning, so that surrogates are better able to honour patient’s wishes at the end of life.
Sequential simulation used as a novel educational tool aimed at healthcare managers: a patient-centred approach
Authors: Weldon Sharon Marie , Kelay Tanika , Ako Emmanuel , Cox Benita , Bello Fernando , Kneebone Roger 
Published: October 2017

BackgroundA new challenge for healthcare managers is to improve the patient experience. Simulation is often used for clinical assessment and rarely for those operating outside of direct clinical care. Sequential simulation (SqS) is a form of simulation that re-creates care pathways, widening its potential use.Local problemNumbers, outcome measures and system profiling are used to inform healthcare decisions. However, none of these captures the personal subtleties of a patient’s experience.Intervention56 students attended a teaching module using SqS and facilitated workshops as part of their induction week on an MSc International Health Management course. The workshop was voluntary and was offered as an opportunity for the students to gain an insight into the UK health system through the medium of simulation.MethodsAn evaluation survey incorporating quantitative and qualitative student feedback was conducted. Descriptive statistics were generated from the quantitative data, and thematic analysis was undertaken for the qualitative data.ResultsThere was strong agreement for the acceptability of the workshop approach in relation to the aims and objectives. Likert scale (1–-5) mean total=4.49. Participants responded enthusiastically (revealed through the qualitative data) with ideas related to perspectives sharing, understanding healthcare management and processes and the consideration of feasibility and practicalities. They also suggested other applications that SqS could be used for.ConclusionThe SqS approach has demonstrated that simulation has a wider potential than for clinical assessment alone. Further studies are required to determine its potential uses and affordances beyond its current format.
A qualitative evaluation of the role of simulation in policy development for service improvement
Authors: Blanks Thomas , Woodier Nicholas , Baxendale Bryn , Fores Mark , Fullerton Lynn 
Published: October 2017

ObjectiveTo evaluate the efficacy of simulation-based techniques to prospectively assess developing polices prior to implementation.MethodsA self-selected sample of nursing staff from a local, acute hospital reviewed a draft intravenous drug administration policy before simulating drug administration of either an infusion or direct injection. The participants completed a postsimulation questionnaire regarding the new policy and simulation, took part in a semistructured interview and were observed during the simulation with their consent.Results10 staff attended the simulation. The emergent themes identified a wide range of factors relating to the everyday usability and practicalities of the policy. There were issues surrounding inconsistent language between different clinical teams and training requirements for the new policy.ConclusionSimulation, using simple scenarios, allows the safe evaluation of new policies before publication to ensure they are appropriate for front-line use. It engages staff in user-centred design in their own healthcare system.
Uterine perforation by intrauterine devices: a 16-year review
Authors: O’Brien Paul A , Pillai Sarah 
Published: October 2017

IntroductionOne of the major concerns with the insertion of intrauterine devices is uterine perforation. Though uncommon, it can be debilitating and result in failure of the device. In this article we review uterine perforation with intrauterine contraception (IUC) in a community clinic in the UK over a 16-year period.MethodsWe prospectively collected data on uterine perforations for the years 2000–2015, reviewed associated factors and calculated the annual rate of perforation, estimating if this lay within the expected range of normal variation using statistical process control (SPC) analysis. We analysed the rates of perforation in relation to the time from delivery and to breastfeeding.ResultsWe identified 30 uterine perforations in 22 795 IUC insertions over the 16 years of observation, with an annual rate ranging from 0 to 4.3 per 1000 insertions, and a mean annual rate of 1.3 per 1000 insertions (95% CI 0.9 to 1.9), which remain within the SPC limits. Twenty-eight of the perforations were in parous women, 87% of whom were within 18 weeks of delivery, peaking at 13 weeks postpartum. Twenty of these were in breastfeeding women. In 3/28 cases for which we have outcome data the device was adherent to or had perforated either the bladder or bowel.ConclusionOur perforation rate is consistent with other studies. Most of our perforations were within 18 weeks of childbirth, earlier than in a recent major study. We cannot tell from our data if there is a true peak in perforations 3 months postpartum as that may be a time when a high proportion of insertions are done.
Association of Life's Simple 7 and presence of cardiovascular disease in general Australians
Authors: Peng Yang , Wang Zhiqiang 
Published: October 2017

ObjectiveThe American Heart Association developed Life’s Simple 7 to define and monitor cardiovascular health (CVH), but their contributions to cardiovascular disease (CVD) in general Australians are still unclear. Our study aimed to evaluate the separate and combined effects of Life’s Simple 7 on CVD among Australians.MethodsWe performed a cross-sectional study based on 7499 adults (≥18 years) who have been tested for total cholesterol and fasting plasma glucose as part of the 2011–2012 Australian Health Survey. Poisson regression analyses were used to estimate the incidence rate ratios and population attributable fractions of those metrics to CVD prevalence. Participants were classified into three CVH status groups based on the number of ideal metrics: inadequate (0–2), average (3–4) and optimal (5–7). Logistic regression analyses were performed to illustrate the relationships between overall CVH and CVD prevalence.Results2100 (21.0%) participants were having CVD. Smoking, elevated body mass index, blood pressure, total cholesterol, fasting plasma glucose and physical inactivity were observed as significant indicators of CVD. Compared with the inadequate category, participants in the optimal and average category have a 66% (adjusted OR, 0.34; 95% CI 0.22 to 0.54) and a 33% (adjusted OR, 0.67; 95% CI 0.56 to 0.81) lower CVD risk. One more ideal metric was associated with a 21% reduced CVD risk (adjusted OR, 0.79; 95% CI 0.73 to 0.84).ConclusionsWe have identified several modifiable risk factors and contributors of CVD in general Australians. The improvement of overall CVH may also reduce CVD risk.
Lung function response and side effects to rapamycin for lymphangioleiomyomatosis: a prospective national cohort study
Authors: Bee Janet , Fuller Sharon , Miller Suzanne , Johnson Simon R 
Published: October 2017

RationaleMechanistic target of rapamycin inhibitors reduce loss of lung function in lymphangioleiomyomatosis (LAM), although their benefit varies between individuals. We examined lung function response and side effects to rapamycin in a national cohort.MethodsSubjects were receiving rapamycin for progressive lung disease. Clinical evaluation, detailed phenotyping, serial lung function, rapamycin and safety monitoring were performed according to a clinical protocol. Lung function change, measured as FEV1 slope (ΔFEV1), was reported for those treated for 1 year or longer.ResultsRapamycin was associated with improved ΔFEV1 in 21 individuals where pretreatment data were available (p<0.0001). In 47 treated for a mean duration of 35.8 months, mean ΔFEV1 was +11 (SD 75) mL/year, although it varied from +254 to −148 mL/year. The quartile with the highest positive ΔFEV1 had greater pretreatment FEV1 (p=0.02) and shorter disease durations (p=0.02) than the lowest quartile. Serum rapamycin level was positively associated with side effects (p=0.02) but not ΔFEV1 over 1 year. Within the first month of therapy, apthous ulcers, nausea and diarrhoea were associated with higher rapamycin levels. Acne, oedema and menstrual irregularities tended to increase over the first year of therapy. At the end of observation, the prevalence of side effects was 5% or less.ConclusionsRapamycin reduces lung function loss in LAM, although in some, ΔFEV1 continues to fall at an accelerated rate. Poor response to rapamycin was associated with lower pretreatment lung function and longer disease duration but not serum level. Early intervention with low-dose rapamycin may preserve lung function and reduce side effects.
Tobacco price boards as a promotional strategy—a longitudinal observational study in Australian retailers
Authors: Bayly Megan , Scollo Michelle , White Sarah , Lindorff Kylie , Wakefield Melanie 
Published: October 2017

BackgroundPrice boards in tobacco retailers are one of the few forms of tobacco promotion remaining in Australia. This study aimed to examine how these boards were used to promote products over a period of rapidly rising taxes.MethodsObservations were made in a panel of 350 stores in Melbourne, Australia, in November of 2013 (just before) and in 2014 and 2015 (after 12.5% increases in tobacco duty). Fieldworkers unobtrusively noted the presence and characteristics of price boards, and the brand name, size and price of the product at the top of each board.ResultsPrice boards were common in all store types apart from newsagent/lottery agents. The characteristics of the top-listed product changed notably over time: premium brands accounted for 66% of top-listed products in 2013, significantly declining to 43% in 2015, while packs of 20 cigarettes increased in prominence from 32% to 45%. The prevalence of packs of 20 cigarettes in budget market segments tripled from 2013 (13%) and 2014 (11%) to 32% in 2015, with no change in the proportion of packs that were under $A20 from 2014 (37%) to 2015 (36%). The rate of increase in the average price of the top-listed pack correspondingly flattened from 2014 to 2015 compared with 2013–2014.ConclusionsPrice boards promote tobacco products in ways that undermine the effectiveness of tax policy as a means of discouraging consumption. Communication to consumers about prices should be restricted to information sheets provided to adult smokers on request at the point of sale.
The geological history of the Istria ‘Depression’, Romanian Black Sea shelf: tectonic controls on second-/third-order sequence architecture
Authors: Boote David R. D. 
Published: October 2017

Abstract
The Istria ‘Depression’ or sub-basin of offshore Romania lies at the intersection of the trans-European Tornquist–Teisseyre ‘Zone’ and the Black Sea back-arc basin, just outboard of the East Carpathian orogenic welt. Its Late Mesozoic–Cenozoic succession records an extraordinary polyphase history of subsidence and sedimentation, interrupted by several quite spectacular second-/third-order erosional unconformities, reflecting the interplay between these tectonic domains. The unconformities divide the succession into a number of stratigraphic sequences.
The sub-basin first developed as a transtensional rift in the Triassic–Early Jurassic, evolving into a narrow oceanized trough in the later Jurassic. This was tilted west during the Early Cretaceous, and the residual Late Jurassic topography was filled and buried by a west-facing clastic–evaporite wedge. Following Late Aptian–Albian(?) rifting, post-rift subsidence and spreading in the Western Black Sea imposed a strong easterly tilt, encouraging the partial evacuation of its Early Cretaceous sedimentary fill by gravity-driven mass wastage. The incised valley topography was subsequently infilled and buried during the later Cretaceous and Early Cenozoic. During the mid-Late Cenozoic, the Black Sea Basin experienced intermittent periods of partial to complete isolation from the world ocean and significant base-level drawdown. The first major sea-level fall occurred in the Eocene when the Istria ‘Depression’ was deeply incised, to be healed by Oligocene shales during the subsequent rise. Yet another period of drawdown and exposure occurred in the mid-Miocene, with extensive shelf-margin mass wastage and erosion, followed by re-flooding and deposition of a transgressive backstepping sequence in the middle-late Miocene. Messinian drawdown in the Mediterranean caused a further period of isolation and falling base level. The shelf margin was again exposed, and experienced widespread mass wastage and slumping. Rising sea level eroded the earlier slumped sequence and the margin was healed by a lowstand prograding wedge in the late Miocene–early Pliocene. This was followed by shelf sedimentation in the Plio-Pleistocene periodically interrupted by canyon-incision events, testifying to continued climatically or tectonically imposed base-level fluctuations.
Several direct and indirect tectonic factors were responsible for valley/canyon incision within the Istria Depression and erosion of the Romanian Black Sea shelf margin. These include: (1) the local structural framework; (2) direct tectonic uplift and tilting; and (3) more indirect tectonically imposed isolation encouraging significant base-level falls.