bluuebunny/crossref_metadata_2025_split huggingface dataset:
Have restricted working hours reduced junior doctors’ experience of fatigue? A focus group and telephone interview study
Authors: Morrow Gill , Burford Bryan , Carter Madeline , Illing Jan 
Published: March 2014

ObjectiveTo explore the effects of the UK Working Time Regulations (WTR) on trainee doctors’ experience of fatigue.DesignQualitative study involving focus groups and telephone interviews, conducted in Spring 2012 with doctors purposively selected from Foundation and specialty training. Final compliance with a 48 h/week limit had been required for trainee doctors since August 2009. Framework analysis of data.Setting9 deaneries in all four UK nations; secondary care.Participants82 doctors: 53 Foundation trainees and 29 specialty trainees. 36 participants were male and 46 female. Specialty trainees were from a wide range of medical and surgical specialties, and psychiatry.ResultsImplementation of the WTR, while acknowledged as an improvement to the earlier situation of prolonged excessive hours, has not wholly overcome experience of long working hours and fatigue. Fatigue did not only arise from the hours that were scheduled, but also from an unpredictable mixture of shifts, work intensity (which often resulted in educational tasks being taken home) and inadequate rest. Fatigue was also caused by trainees working beyond their scheduled hours, for reasons such as task completion, accessing additional educational opportunities beyond scheduled hours and staffing shortages. There were also organisational, professional and cultural drivers, such as a sense of responsibility to patients and colleagues and the expectations of seniors. Fatigue was perceived to affect efficiency of skills and judgement, mood and learning capacity.ConclusionsLong-term risks of continued stress and fatigue, for doctors and for the effective delivery of a healthcare service, should not be ignored. Current monitoring processes do not reflect doctors’ true working patterns. The effectiveness of the WTR cannot be considered in isolation from the culture and context of the workplace. On-going attention needs to be paid to broader cultural issues, including the relationship between trainees and seniors.
Pericardial Fat is Associated With Atrial Conduction: The Framingham Heart Study
Authors: Friedman Daniel J. , Wang Na , Meigs James B. , Hoffmann Udo , Massaro Joseph M. , Fox Caroline S. , Magnani Jared W. 
Published: March 2014

Background
Obesity is associated with altered atrial electrophysiology and a prominent risk factor for atrial fibrillation. Body mass index, the most widely used adiposity measure, has been related to atrial electrical remodeling. We tested the hypothesis that pericardial fat is independently associated with electrocardiographic measures of atrial conduction.

Methods and Results

We performed a cross‐sectional analysis of 1946 Framingham Heart Study participants (45% women) to determine the relation between pericardial fat and atrial conduction as measured by P wave indices (
PWI
):
PR
interval, P wave duration (P‐duration), P wave amplitude (P‐amplitude), P wave area (P‐area), and P wave terminal force (P‐terminal). We performed sex‐stratified linear regression analyses adjusted for relevant clinical variables and ectopic fat depots. Each 1‐
SD
increase in pericardial fat was significantly associated with
PR
interval (β=1.7 ms,
P
=0.049), P‐duration (β=2.3 ms,
P
<0.001), and P‐terminal (β=297 μV·ms,
P
<0.001) among women; and P‐duration (β=1.2 ms,
P
=0.002), P‐amplitude (β=−2.5 μV,
P
<0. 001), and P‐terminal (β=160 μV·ms,
P
=0.002) among men. Among both sexes, pericardial fat was significantly associated with P‐duration in analyses additionally adjusting for visceral fat or intrathoracic fat; a similar but non‐significant trend existed with P‐terminal. Among women, pericardial fat was significantly associated with P wave area after adjustment for visceral and intrathoracic fat.

Conclusions

Pericardial fat is associated with atrial conduction as quantified by
PWI
, even with adjustment for extracardiac fat depots. Further studies are warranted to identify the mechanisms through which pericardial fat may modify atrial electrophysiology and promote subsequent risk for arrhythmogenesis.
Mindfulness-based cognitive therapy for recurrent depression: A translational research study with 2-year follow-up
Authors: Meadows Graham N , Shawyer Frances , Enticott Joanne C , Graham Annette L , Judd Fiona , Martin Paul R , Piterman Leon , Segal Zindel 
Published: March 2014

Objective: While mindfulness-based cognitive therapy (MBCT) has demonstrated efficacy in reducing depressive relapse/recurrence over 12–18 months, questions remain around effectiveness, longer-term outcomes, and suitability in combination with medication. The aim of this study was to investigate within a pragmatic study design the effectiveness of MBCT on depressive relapse/recurrence over 2 years of follow-up. Method: This was a prospective, multi-site, single-blind trial based in Melbourne and the regional city of Geelong, Australia. Non-depressed adults with a history of three or more episodes of depression were randomised to MBCT + depression relapse active monitoring (DRAM) ( n=101) or control (DRAM alone) ( n=102). Randomisation was stratified by medication (prescribed antidepressants and/or mood stabilisers: yes/no), site of usual care (primary or specialist), diagnosis (bipolar disorder: yes/no) and sex. Relapse/recurrence of major depression was assessed over 2 years using the Composite International Diagnostic Interview 2.1. Results: The average number of days with major depression was 65 for MBCT participants and 112 for controls, significant with repeated-measures ANOVA ( F(1, 164)=4.56, p=0.03). Proportionally fewer MBCT participants relapsed in both year 1 and year 2 compared to controls (odds ratio 0.45, p<0.05). Kaplan-Meier survival analysis for time to first depressive episode was non-significant, although trends favouring the MBCT group were suggested. Subgroup analyses supported the effectiveness of MBCT for people receiving usual care in a specialist setting and for people taking antidepressant/mood stabiliser medication. Conclusions: This work in a pragmatic design with an active control condition supports the effectiveness of MBCT in something closer to implementation in routine practice than has been studied hitherto. As expected in this translational research design, observed effects were less strong than in some previous efficacy studies but appreciable and significant differences in outcome were detected. MBCT is most clearly demonstrated as effective for people receiving specialist care and seems to work well combined with antidepressants.
Carryover Effects of Highly Automated Convoy Driving on Subsequent Manual Driving Performance
Authors: Skottke Eva-Maria , Debus Günter , Wang Lei , Huestegge Lynn 
Published: March 2014

Objective: In the present study, we tested to what extent highly automated convoy driving involving small spacing (“platooning”) may affect time headway (THW) and standard deviation of lateral position (SDLP) during subsequent manual driving. Background: Although many previous studies have reported beneficial effects of automated driving, some research has also highlighted potential drawbacks, such as increased speed and reduced THW during the activation of semiautomated driving systems. Here, we rather focused on the question of whether switching from automated to manual driving may produce unwanted carryover effects on safety-relevant driving performance. Method: We utilized a pre–post simulator design to measure THW and SDLP after highly automated driving and compared the data with those for a control group (manual driving throughout). Results: Our data revealed that THW was reduced and SDLP increased after leaving the automation mode. A closer inspection of the data suggested that specifically the effect on THW is likely due to sensory and/or cognitive adaptation processes. Conclusion: Behavioral adaptation effects need to be taken into account in future implementations of automated convoy systems. Application: Potential application areas of this research comprise automated freight traffic (truck convoys) and the design of driver assistance systems in general. Potential countermeasures against following at short distance as behavioral adaptation should be considered.
Potentially immunogenic proteins expressed similarly in human embryonic stem cells and induced pluripotent stem cells
Authors: Maynard Kristen M , Arvindam Upasana , Cross Madeline , Firpo Meri T 
Published: March 2014

A major limitation of the use of cellular therapies is the loss of donor-derived cells because of immune incompatibility. While induced pluripotent stem (iPS) cells offer the potential for autologous transplant therapies, questions have been raised using a mouse model that specific antigens mediate the rejection of grafts after syngeneic transplants with iPS, but not embryonic stem (ES) cells. In this study, we examined whether the human homologs of these markers, HORMAD1, ZG16, and Cyp3A, are differentially expressed in human iPS versus ES cells, as well as undifferentiated and in vitro-differentiated cells. Both qRT-PCR and flow cytometric analyses demonstrated similar gene and protein expression profiles for iPS and ES cells regardless of differentiation state. Our data are consistent with a recent study in mice that showed no evidence of rejection of differentiated syngeneic iPS cells. Furthermore, our results suggest that expression of these gene products cannot predict differences in clinical outcomes between human iPS and ES-derived cells.
TAM receptors, Gas6, and protein S: roles in inflammation and hemostasis
Authors: van der Meer Jonathan H. M. , van der Poll Tom , van ‘t Veer Cornelis 
Published: March 2014

AbstractTAM receptors (Tyro3, Axl, and Mer) belong to a family of receptor tyrosine kinases that have important effects on hemostasis and inflammation. Also, they affect cell proliferation, survival, adhesion, and migration. TAM receptors can be activated by the vitamin K–dependent proteins Gas6 and protein S. Protein S is more commonly known as an important cofactor for protein C as well as a direct inhibitor of multiple coagulation factors. To our knowledge, the functions of Gas6 are limited to TAM receptor activation. When activated, the TAM receptors have effects on primary hemostasis and coagulation and display an anti-inflammatory or a proinflammatory effect, depending on cell type. To comprehend the effects that the TAM receptors and their ligands have on hemostasis and inflammation, we compare studies that report the different phenotypes displayed by mice with deficiencies in the genes of this receptor family and its ligands (protein S+/−, Gas6−/−, TAM−/−, and variations of these). In this manner, we aim to display which features are attributable to the different ligands. Because of the effects TAM receptors have on hemostasis, inflammation, and cancer growth, their modulation could make interesting therapeutic targets in thromboembolic disease, atherosclerosis, sepsis, autoimmune disease, and cancer.
Implications of the miR-10 family in chemotherapy response of NPM1-mutated AML
Authors: Havelange Violaine , Ranganathan Parvathi , Geyer Susan , Nicolet Deedra , Huang Xiaomeng , Yu Xueyan , Volinia Stefano , Kornblau Steven M. , Andreeff Michael , Croce Carlo M. , Marcucci Guido , Bloomfield Clara D. , Garzon Ramiro 
Published: March 2014

Key PointsHigh miR-10 family expression levels in AML patients are associated with achieving complete remission to induction chemotherapy. Functional experiments did not show any impact of miR-10a-5p in AML blast growth or survival at baseline conditions or after chemotherapy.
Active transport between home and school assessed with GPS: a cross-sectional study among Dutch elementary school children
Authors: Dessing Dirk , de Vries Sanne I , Graham Jamie MA , Pierik Frank H 
Published: March 2014

Abstract

Background
Active transport to school is associated with higher levels of physical activity in children. Promotion of active transport has therefore gained attention as a potential target to increase children’s physical activity levels. Recent studies have recognized that the distance between home and school is an important predictor for active travel among children. These studies did not yet use the promising global positioning system (GPS) methods to objectively assess active transport. This study aims to explore active transport to school in relation to the distance between home and school among a sample of Dutch elementary school children, using GPS.

Methods
Seventy-nine children, aged 6-11 years, were recruited in six schools that were located in five cities in the Netherlands. All children were asked to wear a GPS receiver for one week. All measurements were conducted between December 2008 and April 2009. Based on GPS recordings, the distance of the trips between home and school were calculated. In addition, the mode of transport (i.e., walking, cycling, motorized transport) was determined using the average and maximum speed of the GPS tracks. Then, proportion of walking and cycling trips to school was determined in relation to the distance between home and school.

Results
Out of all school trips that were recorded (n = 812), 79.2% were classified as active transport. On average, active commuting trips were of a distance of 422 meters with an average speed of 5.2 km/hour. The proportion of walking trips declined significantly at increased school trip distance, whereas the proportion of cycling trips (β = 1.23, p < 0.01) and motorized transport (β = 3.61, p < 0.01) increased. Almost all GPS tracks less than 300 meters were actively commuted, while of the tracks above 900 meters, more than half was passively commuted.

Conclusions
In the current research setting, active transport between home and school was the most frequently used mode of travel. Increasing distance seems to be associated with higher levels of passive transport. These results are relevant for those involved in decisions on where to site schools and residences, as it may affect healthy behavior among children.
Electroacupuncture-like stimulation at Baihui and Dazhui acupoints exerts neuroprotective effects through activation of the brain-derived neurotrophic factor-mediated MEK1/2/ERK1/2/p90RSK/bad signaling pathway in mild transient focal cerebral ischemia in rats
Authors: Cheng Chin Yi , Lin Jaung Geng , Su Shan Yu , Tang Nou Ying , Kao Shung Te , Hsieh Ching Liang 
Published: March 2014

Abstract

Background
This study was designed to evaluate the effects of electroacupuncture-like stimulation at Baihui (GV20) and Dazhui (GV14) acupoints (EA at acupoints) following mild cerebral ischemia-reperfusion (I/R) injury. Furthermore, we investigated whether brain-derived neurotrophic factor (BDNF)-mediated activation of extracellular signal-regulated kinase (ERK)1/2 signaling pathway is involved in the neuroprotection induced by EA at acupoints.

Methods
Rats were subjected to middle cerebral artery occlusion (MCAo) for 15 min followed by reperfusion for 3 d. EA at acupoints was applied 1 d postreperfusion then once daily for 2 consecutive days.

Results
Following the application of EA at acupoints, initiated 1 d postreperfusion, we observed significant reductions in the cerebral infarct area, neurological deficit scores, active caspase-3 protein expression, and apoptosis in the ischemic cortex after 3 d of reperfusion. We also observed markedly upregulated BDNF, phospho-Raf-1 (pRaf-1), phospho-MEK1/2 (pMEK1/2), phospho-ERK1/2 (pERK1/2), phospho-90 kDa ribosomal S6 kinase (pp90RSK), and phospho-Bad (pBad) expression, and restored neuronal nuclear antigen (NeuN) expression. Pretreatment with the MEK1/2 inhibitor U0126 abrogated the effects of EA at acupoints on cerebral infarct size, neurological deficits, active caspase-3 protein, and apoptosis in the ischemic cortex after 3 d of reperfusion. Pretreatment with U0126 also abrogated the effects of EA at acupoints on pMEK1/2, pERK1/2, pp90RSK, pBad, and NeuN expression, but did not influence BDNF and pRaf-1 expression.

Conclusion
Overall, our study results indicated that EA at acupoints, initiated 1 d postreperfusion, upregulates BDNF expression to provide BDNF-mediated neuroprotection against caspase-3-dependent neuronal apoptosis through activation of the Raf-1/MEK1/2/ERK1/2/p90RSK/Bad signaling cascade after 3 d of reperfusion in mild MCAo.
Provision of smoking cessation support for pregnant women in England: results from an online survey of NHS stop smoking services for pregnant women
Authors: Fahy Samantha J , Cooper Sue , Coleman Tim , Naughton Felix , Bauld Linda 
Published: March 2014

Abstract

Background
Smoking during pregnancy is a major public health concern and an NHS priority. In 2010, 26% of UK women smoked immediately before or during their pregnancy and 12% smoked continuously. Smoking cessation support is provided through free at the point of use Stop Smoking Services for Pregnant women (SSSP). However, to date, little is known of how these services provide support across England. The aim of this study was to describe the key elements of support provided through English SSSP.

Methods
SSSP managers were invited to participate in this survey by email. Data were then collected via an online questionnaire; one survey was completed for each SSSP. Up to four reminder emails were sent over a two month period.

Results
86% (121 of 141) of services completed the survey. Responding services were, on average, larger than non-responding services in terms of the number of pregnant women setting quit dates and successfully quitting (p < 0.01). In line with the 2010 NICE guidelines, Stop Smoking in Pregnancy and following Childbirth, one in five SSSP identified pregnant smokers using carbon monoxide (CO) testing and refer via an opt-out pathway. All services offered nicotine replacement therapy (NRT) to pregnant women and 87% of services also offered dual therapy NRT, i.e. combination of a patch and short acting NRT product.. The 2010 NICE guidelines note that services should be flexible and client-centred. Consistent with this, SSSP offer pregnant women a range of support types (median 4) including couple/family, group (open or closed) or one-to-one. These are available in a number of locations (median 5), including in community venues, clinics and women’s homes.

Conclusions
English Stop Smoking Services offer behavioural support and pharmacotherapy to pregnant women motivated to quit smoking. Interventions provided are generally evidence-based and delivered in a variety of both social and health care settings.
Secukinumab treatment in rheumatoid arthritis is associated with incremental benefit in the clinical outcomes and HRQoL improvements that exceed minimally important thresholds
Authors: Strand Vibeke , Kosinski Mark , Gnanasakthy Ari , Mallya Usha , Mpofu Shephard 
Published: March 2014

Abstract

Background
The primary aim of rheumatoid arthritis (RA) treatment is to induce remission, the absence of disease activity. The objective of this study was to explore the association between clinical endpoints used to gauge RA treatment efficacy and patient-reported outcomes of health-related quality of life, fatigue, and physical function in RA patients treated with secukinumab in a phase 2 randomized controlled trial (RCT).

Method
Adult RA patients (n = 237) with incomplete responses to methotrexate were randomized equally to receive monthly s.c. injections of secukinumab 25 mg, 75 mg, 150 mg, 300 mg or placebo. Clinical endpoints used in this study included the ACR response criteria and its components and simplified disease activity score. Patient-reported outcomes (PRO) included Health Assessment Questionnaire-Disability Index (HAQ-DI), Medical Outcomes Study Short Form-36 [SF-36] Survey, and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue). Patients were categorized into mutually exclusive groups according to the magnitude and direction of change from baseline to week 16 in each clinical endpoint. Definitions of minimal important differences [MID] in each clinical endpoint were used to categorize patients, as well as thresholds beyond MID. Mean changes from baseline to week 16 were computed for each PRO and analyses of variance to test the differences in PRO changes observed across groups of patients that differed in each clinical endpoint. Analyses were limited to patients randomized to secukinumab treatment. All dose groups were combined (n = 187).

Results
Mean changes from baseline in each PRO differed significantly across groups of patients in the expected direction. With few exceptions, there was considerable agreement between clinical endpoints and PROs concerning the magnitude of change defined as clinically meaningful. More importantly, results demonstrated that greater improvements in clinical endpoints were associated with incrementally better improvements in HRQoL, fatigue, and physical function.

Conclusion
Results of this study show considerable agreement between minimal thresholds of improvement established for PROs and clinical outcome measures used in RA treatment studies and provide thresholds to be considered in gauging the importance of a treatment effect that goes beyond what is considered as minimally important for PRO measures.
Comparison of the pressure‐relieving properties of various types of forefoot pads in older people with forefoot pain
Authors: Lee Pei Y , Landorf Karl B , Bonanno Daniel R , Menz Hylton B 
Published: March 2014

AbstractBackgroundPlantar forefoot pain is commonly experienced by older people and it is often treated with forefoot pads to offload the painful area. However, studies have found inconsistent effects for different forefoot pads on plantar pressure reduction, and optimum forefoot pad placement is still not clear. The aim of this study was to compare the effects of different forefoot pads on plantar pressure under the forefoot in older people with forefoot pain.MethodsThirty‐seven adults (31 females, 6 males) with a mean age of 73.5 (SD 4.8) participated. Forefoot plantar pressure data were recorded using the pedar®‐X in‐shoe system while participants walked along an 8 m walkway. Five conditions were tested in a standardised shoe: (i) no padding (the control), (ii) a metatarsal dome positioned 10 mm proximal to the metatarsal heads, (iii) a metatarsal dome positioned 5 mm distal to the metatarsal heads, (iv) a metatarsal bar, and (v) a plantar cover.ResultsCompared to the shoe‐only control condition, each of the forefoot pads significantly reduced forefoot peak pressure and maximum force. The metatarsal dome positioned 5 mm distal to the metatarsal heads and the plantar cover were most effective for reducing peak pressure (17%, p < 0.001 and 19%, p < 0.001, respectively).ConclusionsThese findings indicate that forefoot pads are effective for reducing forefoot pressures in older people with forefoot pain, and that the position of the pad relative to the metatarsal heads may be more important than the shape of the pad.
As the Nation Goes, So Goes Maine?
Authors: Kilbreth Elizabeth 
Published: March 2014

Abstract
Historically, Maine has been a state with generous safety net programs and a track record of innovative efforts in health system reform, developed under the leadership of Democratic administrations and with frequent support from moderate Republicans. But the 2010 elections in Maine dramatically changed the political balance of power, anointing both a governor and a legislature ideologically at odds with the state's recent political past. Maine has become a bastion of resistance to the Patient Protection and Affordable Care Act, with a reduced Medicaid program, defunded state access initiative, and no state exchange. In addition, the state has adopted a laissez-faire approach to insurance market dysfunction. Using Maine as a case study of the shifts in national political mood, this article describes in broad brushstrokes Maine's history of health reform efforts and recent shift in political direction, and discusses some of the factors that contributed to the change.