bluuebunny/crossref_metadata_2025 huggingface dataset:
MAXIMA: software to determine local maxima from gridded data
Authors: Dumont R , Bardossy Z , Miles W
Published: August 2015

MAXIMA is a Geosoft GX implementation of a method of identifying local maxima from gridded data described by Blakely and Simpson (1986). The routine determines local maxima in 1, 2, 3, or 4 directions. The position of the local maximum value is calculated from
9 local grid cells and is an improvement on methods using grid cell centres as the position of the maxima. Local maxima can be discriminated by a user supplied minimum input grid value. The output maxima are written to a Geosoft GDB file.
Retention preferences and the relationship between total rewards, perceived organisational support and perceived supervisor support
Authors: Smit Wilmien , Stanz Karel , Bussin Mark
Published: August 2015

Orientation: Currently there is much debate whether modifying traditional reward packages to focus on the preferences of multi-generations would be essential in attracting, motivating and retaining talent. Total reward factors, perceived organisational support and perceived supervisor support are distinct but related concepts, all of which appear to influence an employee’s decision to stay at an organisation.Research purpose: The objective of this study was to identify the different total reward components that multi-generations prefer as most important for retention. In essence, the study aims to establish possible relationships between multi-generations’ total reward components, perceived organisational support, and perceived supervisor support.Motivation for the study: This study is useful as it conducts a contemporary retention exploration that considers both the emerging demographic workforce shift and the new paradigm shift towards talent management.Research methodology: A quantitative, cross-sectional research design was applied to gather data from employees (N = 303) from different industry sectors in South African organisations.Main findings: The results showed that performance management and remuneration are considered to be the most important retention factors amongst multi-generation groups. Differences between total reward preferences and demographical variables, which include age, gender, race, industry and job level, were found.Practical/managerial implications: Organisations should design their reward packages by taking employees preferences into account. More specifically, organisations should focus on remuneration, performance management and development opportunities in order to retain scarce skills.Contribution/value additions: The results of the study can assist managers to design effective retention strategies, whilst also providing crucial information for the retention and motivation of employees.
Machine Learning Techniques for Prediction of Early Childhood Obesity
Authors: Mukhopadhyay S. , Carroll A. , Downs S. , Dugan T. M.
Published: August 2015

Objectives: This paper aims to predict childhood obesity after age two, using only data collected prior to the second birthday by a clinical decision support system called CHICA.

Methods: Analyses of six different machine learning methods: RandomTree, RandomForest, J48, ID3, Naïve Bayes, and Bayes trained on CHICA data show that an accurate, sensitive model can be created.

Results: Of the methods analyzed, the ID3 model trained on the CHICA dataset proved the best overall performance with accuracy of 85% and sensitivity of 89%. Additionally, the ID3 model had a positive predictive value of 84% and a negative predictive value of 88%. The structure of the tree also gives insight into the strongest predictors of future obesity in children. Many of the strongest predictors seen in the ID3 modeling of the CHICA dataset have been independently validated in the literature as correlated with obesity, thereby supporting the validity of the model.

Conclusions: This study demonstrated that data from a production clinical decision support system can be used to build an accurate machine learning model to predict obesity in children after age two.

Citation: Dugan TM, Mukhopadhyay S, Carroll AE, Downs SM. Machine learning techniques for prediction of early childhood obesity. Appl Clin Inform 2015; 6: 506–520

http://dx.doi.org/10.4338/ACI-2015-03-RA-0036
Ozone and carbon monoxide over India during the summer monsoon: regional emissions and transport
Authors: Ojha N. , Pozzer A. , Rauthe-Schöch A. , Baker A. K. , Yoon J. , Brenninkmeijer C. A. M. , Lelieveld J.
Published: August 2015

Abstract. We compare in situ measurements of ozone (O3) and carbon monoxide (CO) profiles from the CARIBIC program with the results from the regional chemistry transport model (WRF-Chem) to investigate the role of local/regional emissions and long-range transport over southern India during the summer monsoon of 2008. WRF-Chem successfully reproduces the general features of O3 and CO distributions over the South Asian region. However, the absolute CO concentrations in lower troposphere are typically underestimated. Here we investigate the influence of local relative to remote emissions through sensitivity simulations. The influence of 50 % enhanced CO emissions over South Asia is found to be 33 % increase in surface CO during June. The influence of enhanced local emissions is found to be smaller (5 %) in the free troposphere, except during September. Local to regional emissions are therefore suggested to play a minor role in the underestimation of CO by WRF-Chem during June–August. In the lower troposphere, ahigh pollution (O3: 146.4 ± 12.8 nmol mol−1, CO: 136.4 ± 12.2 nmol mol−1) event (15 July 2008), not reproduced by the model, is shown to be due to transport of photochemically processed air masses from the boundary layer into southern India. Sensitivity simulation combined with backward trajectories indicates that long-range transport of CO to southern India is significantly underestimated, particularly in air masses from the west, i.e. from Central Africa. This study highlights the need for more aircraft-based measurements over India and adjacent regions and the improvement of emission inventories.
Simultaneous high C fixation and high C emissions in Sphagnum mires
Authors: Harpenslager S. F. , van Dijk G. , Kosten S. , Roelofs J. G. M. , Smolders A. J. P. , Lamers L. P. M.
Published: August 2015

Abstract. Peatlands play an important role in the global carbon (C) cycle due to their large C storage potential. Their C sequestration rates, however, highly vary depending on climatic and geohydrological conditions. Transitional mires are often characterised by floating peat with infiltration of buffered groundwater or surface water. Sphagnum mosses grow on top, producing recalcitrant organic matter and fuelling large C stocks. As Sphagnum species strongly differ in their tolerance to the higher pH in these mires, their species composition can be expected to influence C dynamics in transitional mires. We therefore experimentally determined growth and net C sequestration rates for four different Sphagnum species (Sphagnum squarrosum, S. palustre, S. fallax and S. magellanicum) in aquaria, with floating peat influenced by the infiltration of buffered water. Surprisingly, even though the first three species increased their biomass, the moss-covered peat still showed a net efflux of CO2 that was up to 3 times higher than that of bare peat. This species-dependent C release could be explained by Sphagnum's active lowering of the pH, which triggers the chemical release of CO2 from bicarbonate. Our results clearly illustrate that high Sphagnum biomass production may still coincide with high C emission. These counterintuitive C dynamics in mire succession seem to be the result of both species- and biomass-dependent acidification and buffered water infiltration. Together, these processes can explain part of the large variation in C fluxes (ranging from C sequestration to C release) reported for pristine mires in the literature.
Projected climate change impacts on North Sea and Baltic Sea: CMIP3 and CMIP5 model based scenarios
Authors: Pushpadas D. , Schrum C. , Daewel U.
Published: August 2015

Abstract. Climate change impacts on the marine biogeochemistry and lower trophic level dynamics in the North Sea and Baltic Sea have been assessed using regional downscaling in a number of recent studies. However, most of these where only forced by physical conditions from Global Climate Models (GCMs) and regional downscaling considering the climate change impact on oceanic nutrient conditions from Global Earth System Models (ESMs) are rare and so far solely based on CMIP3-generation climate models. The few studies published show a large range in projected future primary production and hydrodynamic condition. With the addition of CMIP5 models and scenarios, the demand to explore the uncertainty in regional climate change projections increased. Moreover, the question arises how projections based on CMIP5-generation models compare to earlier projections and multi-model ensembles comprising both AR4 and AR5 generation forcing models. Here, we investigated the potential future climate change impacts to the North Sea and the Baltic Sea ecosystem using a coherent regional downscaling strategy based on the regional coupled bio-physical model ECOSMO. ECOSMO was forced by output from different ESMs from both CMIP3 and CMIP5 models. Multi-model ensembles using CMIP3/A1B and CMIP5/RCP4.5 scenarios are examined, where the selected CMIP5 models are the successors of the chosen CMIP3 models. Comparing projected changes with the present day reference condition, all these simulations predicted an increase in Sea Surface Temperature (SST) in both North Sea and Baltic Sea, reduction in sea ice in the Baltic, decrease in primary production in the North Sea and an increase in primary production in the Baltic Sea. Despite these largely consistent results on the direction of the projected changes, our results revealed a broad range in the amplitude of projected climate change impacts. Our study strengthens the claim that the choice of the ESM is a major factor for regional climate projections. The change in oceanic nutrient input appeared to be the major driver for the projected changes in North Sea primary production. Assessing the spread in ensemble groups, we found that there is for the North Sea a significant reduction in the spread of projected changes among CMIP5 forced model simulations compared to those forced by CMIP3 ESMs, except for salinity. The latter was due to an unexpected salinification observed in one of the CMIP5 model while all other models exhibit freshening in the future. However, for the Baltic Sea substantial differences in inter-model variability in projected climate change impact to primary production is lacking.
Diagnosing the seasonal land–atmosphere correspondence over northern Australia: dependence on soil moisture state and correspondence strength definition
Authors: Decker M. , Pitman A. , Evans J.
Published: August 2015

Abstract. The similarity of the temporal variations of land and atmospheric states during the onset (September) through to the peak (February) of the wet season over northern Australia is statistically diagnosed using ensembles of offline land surface model simulations that produce a range of different background soil moisture states. We derive the temporal correspondence between variations in the soil moisture and the planetary boundary layer via a statistical measure of rank correlation. The simulated evaporative fraction and the boundary layer are shown to be strongly correlated during both SON (September–October–November) and DJF (December–January–February) despite the differing background soil moisture states between the two seasons and among the ensemble members. The sign and magnitude of the boundary layer–surface layer soil moisture association during the onset of the wet season (SON) differs from the correlation between the evaporative fraction and boundary layer from the same season, and from the correlation between the surface soil moisture and boundary layer association during DJF. The patterns and magnitude of the surface flux–boundary layer correspondence are not captured when the relationship is diagnosed using the surface layer soil moisture alone. The conflicting results arise because the surface layer soil moisture lacks strong correlation with the atmosphere during the monsoon onset because the evapotranspiration is dominated by transpiration. Our results indicate that accurately diagnosing the correspondence and therefore coupling strength in seasonally dry regions, such as northern Australia, requires root zone soil moisture to be included.
The representation of location by a regional climate model in complex terrain
Authors: Maraun D. , Widmann M.
Published: August 2015

Abstract. To assess potential impacts of climate change for a specific location, one typically employs climate model simulations at the grid box corresponding to the same geographical location. For most of Europe, this choice is well justified. But, based on regional climate simulations, we show that simulated climate might be systematically displaced compared to observations. In particular in the rain shadow of mountain ranges, a local grid box is therefore often not representative of observed climate: the simulated windward weather does not flow far enough across the mountains; local grid boxes experience the wrong air masses and atmospheric circulation. In some cases, also the local climate change signal is deteriorated. Classical bias correction methods fail to correct these location errors. Often, however, a distant simulated time series is representative of the considered observed precipitation, such that a non-local bias correction is possible. These findings also clarify limitations of bias correcting global model errors, and of bias correction against station data.
Predicting parameters of degradation succession processes of Tibetan Kobresia grasslands
Authors: Lin L. , Li Y. K. , Xu X. L. , Zhang F. W. , Du Y. G. , Liu S. L. , Guo X. W. , Cao G. M.
Published: August 2015

Abstract. In the past two decades, increasing human activity (i.e., overgrazing) in the Tibetan Plateau has strongly influenced plant succession processes, resulting in the degradation of alpine grasslands. Therefore, it is necessary to diagnose the degree of degradation to enable implementation of appropriate management for sustainable exploitation and protection of alpine grasslands. Here, we investigated environmental factors and plant functional group quantity factors (PFGs) during the alpine grassland succession processes. Principal component analysis (PCA) was used to identify the parameters indicative of degradation. We divided the entire degradation process into six stages. PFG types shifted from rhizome bunch grasses to rhizome plexus and dense plexus grasses during the degradation process. Leguminosae and Gramineae plants were replaced by Sedges during the advanced stages of degradation. The PFGs were classified into two reaction groups: the grazing-sensitive group, containing Kobresia humilis Mey, and Gramineae and Leguminosae plants, and the grazing-insensitive group, containing Kobresia pygmaea Clarke. The first group was correlated with live root biomass in the surface soil (0–10 cm), whereas the second group was strongly correlated with mattic epipedon thickness and K. pygmaea characteristics. The degree of degradation of alpine meadows may be delineated by development of mattic epipedon and PFG composition. Thus, meadows could be easily graded and their use adjusted based on our scaling system, which would help prevent irreversible degradation of important grasslands. Because relatively few environmental factors are investigated, this approach can save time and labor to formulate a conservation management plan for degraded alpine meadows.
Fram Strait spring ice export and September Arctic sea ice
Authors: Halvorsen M. H. , Smedsrud L. H. , Zhang R. , Kloster K.
Published: August 2015

Abstract. The Arctic Basin exports ~ 10 % of the sea ice area southwards annually through Fram Strait. A larger than normal export decreases the remaining mean thickness and ice area. A new updated timeseries from 1979–2013 of Fram Strait sea ice area export shows an overall increase until today, and that more than 1 million km2 has been exported annually in recent years. The new timeseries has been constructed from high resolution radar satellite imagery of sea ice drift across 79° N from 2004–2013, regressed on the observed cross-strait surface pressure difference, and shows an increasing trend of 7 % per decade. The trend is caused by higher southward ice drift speeds due to stronger southward geostrophic winds, largely explained by increasing surface pressure on Greenland. Spring and summer area export increases more (~ 14 % per decade) than in autumn and winter, and these export anomalies have a large influence on the following September mean ice extent.
Assessment of 5-year system-wide type 2 diabetes control measures in a Southeast Asian metropolis
Authors: Jiamjarasrangsi Wiroj , Attavorrarat Suwapiccha , Navicharern Rungrawee , Aekplakorn Wichai , Keesukphan Prasit
Published: August 2015

Background: Sparse information exists regarding the progress of the chronic care model (CCM) implementation for type 2 diabetes, at system-wide level for developing countries including Thailand.

Objective: We assessed the extent to which type 2 diabetes patients in Bangkok, Thailand report having received CCM-based services by using the Patient Assessment of Chronic Illness Care (PACIC).

Methods: One thousand type 2 diabetes patients from 64 healthcare facilities throughout Bangkok were randomly selected, data about the extent they have received CCM-based services, their dietary, physical activity, medication-taking behaviors, body mass index (BMI), and blood sugar control status were collected by a set of structured questionnaires and medical record abstraction.

Results: PACIC and self-management scores for patients receiving care from public hospitals and health centers were significantly higher than those from private hospitals. Being the primary care unit (PCU)-where the CCM implementation has been enforced since 2008 was significantly associated with higher PACIC scores for public hospitals. This was not the case for private hospitals. PCU status was significantly associated with better selfmanagement scores for patients in both public and private hospitals. However, variations in PACIC and selfmanagement scores did not reflect to BMI or glycemic control outcomes of the patients.

Conclusion: There is encouraging evidence of progress of CCM implementation for type 2 diabetes patients in Bangkok, Thailand. This had also resulted in improved self-management, but not physiological or metabolic outcomes.
Adiponectin response to supervised aerobic training in type II diabetic patients
Authors: Aly Farag A. , Alghadir Ahmad H. , Gabr Sami A.
Published: August 2015

Background: Cross-sectional studies have linked decreased adiponectin levels with several metabolic traits, including insulin resistance, dyslipidemia, and metabolic syndrome. Previous studies conducted to investigate the effects of acute or chronic exercise on the serum adiponectin have produced conflicting and controversial results.

Objective: To investigate the effect of supervised aerobic training of moderate intensity on the total serum levels of adiponectin and its relationship to insulin resistance and body weight in subjects with type 2 diabetes (DM2).

Methods: Thirty-five patient participants diagnosed as having DM2 mellitus for more than 5 years with normal or near normal body weight took part in this study. The diagnosis of DM was based on the American Diabetes Association criteria for type 2 diabetes mellitus. Serum levels of blood glucose, insulin, total adiponectin, high molecular weight adiponectin, and insulin resistance were determined before and after a 12-week program of supervised moderate intensity aerobic training.

Results: Twelve weeks of supervised moderate intensity aerobic training produced a significant reduction of fasting blood sugar, fasting insulin, glycosylated hemoglobin, and insulin resistance in male subjects with DM2. By contrast, a significant increase in the total serum adiponectin and high molecular weight adiponectin has been reported. There was no significant correlation between the reduction of the body mass index, insulin resistance, and the increase of the total serum adiponectin or high molecular weight adiponectin.

Conclusion: Prolonged exercise training of at least moderate intensity improves levels of adiponectin and insulin sensitivity in men with type 2 diabetes.
Prognostic value of the Marshall computed tomography classification for traumatic subarachnoid hemorrhage
Authors: Wang Fang , Huang Xin , Wen Liang , Gong Jiang-biao , Wang Hao , Li Gu , Zhan Ren-ya , Yang Xiao-feng
Published: August 2015

Background: The Marshall computed tomography (CT) system for classification of traumatic brain injury (TBI) includes the most important independent prognostic variables except for traumatic subarachnoid hemorrhage (tSAH).

Objectives: To evaluate the prognostic effect of tSAH on different injury types based on the Marshall CT system.

Methods: We performed a retrospective study. All patients with severe closed head injury admitted from February 2011 to July 2012 were included. Their scans were classified into two groups: localized injury and diffuse injury using the Marshall classification. Outcomes were compared between patients with tSAH and those without tSAH among the two groups.

Results: Ninety-six patients were included in this study. Seventy-two (75%) were found to have tSAH, and outcomes significantly negatively correlated with tSAH in both localized injury and diffused injury groups.

Conclusions: tSAH had an important effect on the patients’ outcome. Although the Marshall classification includes important independent prognostic variables, tSAH should also be added.
Potential of bone scaffolds containing vancomycin and bone morphogenetic protein-2 in a rat model of osteomyelitis
Authors: Thanyaphoo Suphannee , Kaewsrichan Jasadee
Published: August 2015

Background: Infected bone is often intractable. An ideal approach is to simultaneously eradicate infection and repair the bone defect. The development of osteoinductive bone graft composites to control antibiotic drug release would be useful for the treatment of intractable bone infections.

Objectives: To develop a rat model of osteomyelitis for assessing osteoinductive bone graft scaffolds containing antibiotics and a bone morphogenetic protein.

Methods: Si-imprinted calcium phosphate is a new hydroxyapatite derivative used in fabricating bone scaffolds. Vancomycin and bone morphogenetic protein-2 (BMP-2) were loaded onto scaffolds of Si-imprinted calcium phosphate using an established method. The efficiency of the scaffold as a drug carrier system was assessed in vivo. Osteomyelitis was induced in rats by infection of the tibial epiphysis with Staphylococcus aureus (BAA 1680). The success of inducing disease was checked after 4 weeks using bacterial culture and radiography. A 10 mm metaphysis bone was surgically removed and replaced with a drug-loaded scaffold. Histology and X-ray imaging were used to evaluate the implants at 8 weeks post implantation.

Results: We successfully established a rat model of osteomyelitis. The causative bacteria were effectively eradicated by vancomycin released from the implants. Enhanced bone formation was observed for the implant samples containing vancomycin and BMP-2 compared with those containing either vancomycin or BMP2 alone.

Conclusions: The newly developed bone scaffold has potential as a vehicle for therapeutic agents to treat bone diseases.
Brief communication (Original). Trefoil factor expression by immunohistochemistry in patients with oral lichen planus
Authors: Chaiyarit Ponlatham , Klanrit Poramaporn , Phothipakdee Pensri , Subarnbhesaj Ajiravudh , Thongprasom Kobkan , Giraud Andrew S.
Published: August 2015

Background: Oral lichen planus (OLP) is a chronic immune-mediated inflammatory disease that usually causes oral mucosal damage. OLP has been considered to be a potentially malignant disorder associated with an increased risk for oral cancer. Trefoil factors (TFFs) are mainly synthesized by mucin-producing epithelial cells. Expression of TFFs in oral epithelia is thought to be an essential factor in protection against oral mucosal damage. However, very little is known about the connection between tissue damage of oral mucosa in OLP patients and expression of TFFs.

Objectives: To determine levels of TFF expression in oral mucosa from patients with OLP.

Methods: Tissue samples were collected from 35 patients with normal oral mucosa (controls) and 35 patients with OLP. An immunohistochemical method was used to determine the expression of the 3 TFFs (TFF1, 2, and 3) in mucosal tissues of the oral cavity.

Results:TFF2 and TFF3 expression in oral epithelia were significantly decreased in OLP patients (Mann- Whitney U test; P = 0.006, and P = 0.002, respectively). There were no significant differences in TFF1 expression between OLP patients and control subjects.

Conclusion: The present study demonstrated reduced expression of TFF2 and TFF3 in oral epithelia of OLP patients. These outcomes support our previous observations that chronic inflammation may play a major role in downregulation of TFF expression, which may be associated with oral mucosal damage in OLP patients.
Brief communication (Original). National survey of helminthiasis in Thailand
Authors: Wongsaroj Thitima , Nithikathkul Choosak , Rojkitikul Wichit , Nakai Worayut , Royal Louis , Rammasut Pongroma
Published: August 2015

Background: Helminth infections continue to pose serious health problems in Thailand. The infections of greatest concern are opisthorchiasis and hookworm.

Objectives: We evaluated the prevalence of these infections. The Thai Ministry of Health established a national health plan in 1995 to coordinate health plans for the provincial public health sectors.

Methods: A national survey based on probability sampling, interviews, and stool examinations was conducted in 2009 to gather prevalence information of the helminth infections.

Results: We found an overall prevalence of helminthiasis among 15,555 Thai people of 18.1%. The highest prevalence was found in the northeastern regions of Thailand. By comparison with previous surveys conducted over the past 5 decades, the prevalence rates have decreased. However, pockets of high infection remain, particularly in the north and northeast of Thailand.

Conclusions: Targeted intervention by means of educational programs and public health intervention, and continuing surveillance are indicated.
Clinical report. Acral melanoma in Cambodia: challenges associated with a rare and aggressive disease encountered in a developing country setting
Authors: Kim Yong-June , Waller Karen , Keo Vanna , Soum Ratha , Gollogly James G.
Published: August 2015

Background: Melanoma is a highly malignant skin cancer. Acral lentiginous melanoma (ALM) is most common among Asians. The prevalence of ALM among melanoma cases in Cambodian is not known.

Objective: To describe the prevalence of ALM among cases of melanoma and the stage of disease at presentation to the health facilities and health providers.

Method: Electronic clinical records were obtained from Children’s Surgical Centre (CSC) database between January 2002 and April 2014. Types and stages melanoma at presentation were documented.

Result: A total of 10 out of 26 melanoma patients had ALM. Their average age at diagnosis was 65.3 years. Most primary lesions were located on the plantar or lateral surfaces of the foot. Most histopathological descriptions were consistent with ALM. Seventy percent had lymph node metastases.

Conclusion: A high proportion of ALM was found associated with trauma as a potential risk factor. Most frequency presented at a late stage of disease. Providers must be made aware of the disease and render appropriate management early for good outcome.
Surgical treatments of cystic neoplasms of the pancreas: an Asian university hospital experience
Authors: Sriussadaporn Suvit , Sriussadaporn Sukanya , Pak-art Rattaplee , Kritayakirana Kritaya , Prichayudh Supparerk , Samorn Pasurachate
Published: August 2015

Background

Premalignant and malignant cystic neoplasms of the pancreas are relatively rare, but absolute indications for surgical resection. Modern imaging modalities have increased recognition of asymptomatic cysts resulting in therapeutic dilemmas of whether surgery or observation is appropriate.

Objectives

To examine our surgical experience with cystic neoplasms of the pancreas.

Methods

A retrospective study of patients who had cystic neoplasms of the pancreas and underwent surgical resections from June 2000 to April 2013. Presenting symptoms, surgical procedures, pathological diagnoses, and postoperative complications were analyzed.

Results

Data from 16 patients were examined. Two patients had asymptomatic cystic neoplasms. Fourteen had symptoms ranging from 2 days to 6 years before diagnosis and surgery. Six patients underwent pylorus preserving pancreaticoduodenectomy, 4 underwent distal pancreatectomy with splenectomy, 2 underwent splenic preserving distal pancreatectomy, and 1 each underwent a classical Whipple operation, total pancreatectomy, distal pancreatectomy with splenectomy with partial resection of the posterior gastric wall, and distal pancreatectomy with splenectomy with left colectomy. The operative time ranged from 150 to 450 minutes. Operative blood transfusion ranged from 0 to 5 units. Four patients had mucinous cystadenoma, 4 had intraductal papillary mucinous neoplasia with varying degree of dysplasia and carcinomatous changes, 6 had other malignancies, and 2 had other benign cysts. Postoperative complications occurred in 3 patients. There was no perioperative mortality.

Conclusion

Any suspicion of malignant changes in asymptomatic cysts should have them considered for surgical resection. Meticulous surgical techniques are important for pancreatic resection to minimize the occurrence of postoperative complications.
Redaktøren har ordet/Nytt fra nett
Authors: Nrugham Latha , Amundsen Kirsti
Published: August 2015

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Anesthesiologists and the Risk for Suicidal Behaviour: a Note of Concern
Authors: Gurunathan Usha
Published: August 2015

Although physicians seem to have healthy lifestyles, they can be susceptible to the stress of the profession, resulting in substance abuse and depression that may culminate in suicide. Amongst the medical fields, anesthesiology has been considered as a stressful specialty due to the huge responsibility involved in safe care of patients through any surgery as well as the production pressure and time constraints in the work atmosphere. This burden, along with the advanced clinical skills and ready accessibility to potent drugs, increases the risk of addiction and suicide. This article summarises the results from various studies done so far on the factors contributing to the risk of suicide in physicians, in particular anesthesiologists, and discusses the issues associated with detection of the extent of the problem along with strategies to prevent further increase in the problem. It is intended to raise public awareness about this occupational hazard amongst trainees and consultants in this profession. Leger med en tilsynelatende sunn livsførsel, kan være sårbare for profesjonsstresset, noe som kan resultere i stoffmisbruk og depresjon – ov videre føre til selvmordsatferd. Blant spesialistgrenene har anestesi blitt betraktet som spesielt stressende, grunnet det store ansvaret som forsvarlig pasientpleie ved enhver kirurgi krever, samt produksjonspress og tidsføringer i jobbsituasjonen. Denne byrden, i tillegg til de avanserte tekniske ferdighetene denne gruppen besitter og tilgjengeligheten av potente legemidler, øker risikoen for avhengighet og selvmord. Denne artikkelen oppsummerer resultatene fra ulike studier som har undersøkt de risikofaktorer som medvirker til legers selvmordsrisiko, særlig hos anestesileger. Artikkelen diskuterer hvorfor det er vanskelig å oppdage problemet og hvor utbredt det er, samt forbyggingsstrategiene. Artikkelen er ment som et innlegg for å mane til offentlig oppmerksomhet rundt de yrkesrisiko som omgir turnuskandidater og spesialister i denne profesjonen.
Refugee and Asylum Seeker Self Harm with Implications for
Transition to Employment Participation – a Review
Authors: Procter Nicholas , Williamson Penny , Gordon Andrea , McDonoughs Deborah
Published: August 2015

This article is a review of the literature investigating
self-harm in refugees and asylum seekers and the influence that this may have on
employment. High rates of physical and mental health issues among refugees and
asylum seekers can lead to self-harm and suicide attempts. This can have a
lasting impact on refugee or asylum seekers in terms of employability and how
they can cope within a working environment. Employers are encouraged to seek a
better understanding of the underlying mental health issues of current and
future employees from a refugee background. This can be achieved by mental
health and human service workers sharing their understanding of refugees and
asylum seekers. A broader vision of treatment and care for previous and current
mental health distress can improve the social inclusion framework. Further
research is justified and necessary on self-harm such as lip-stitching and
employment opportunities for asylum seekers and refugees.

Denne artikkelen er en gjennomgang av litteratur som utforsker
selvskade hos flyktninger og asylsøkere, og den innflytelse dette kan ha på
tilknytningen til arbeidslivet. De høye ratene på fysisk og psykisk
helse-problematikk blant flyktninger og asylsøkere kan slå ut i selvskade og
selvmordsforsøk. Dette kan ha en varig effekt på flyktninger og asylsøkere med
hensyn til sysselsettingsevne og hvordan de fungerer i et arbeidsmiljø.
Arbeidsgivere oppfordres til å søke en bedre forståelse av den underliggende
psykisk helse-problematikk fra nåværende og framtidige arbeidstakere med
flyktningbakgrunn. Dette kan oppnås ved at kompetanse innenfor psykisk helse og
sosialarbeidere deler sin erfaring og kompetanse om flyktninger og asylsøkere.
En bredere visjon for behandling og omsorg av tidligere og nåværende psykiske
belastninger, kan forbedre rammene for sosial inkludering. Videre forskning på
selvskading, som for eksempel lip-stitching, og på asylsøkeres og flyktningers
arbeidsmuligheter, er nødvendig og berettiget.
Overdoser som selvmord: en fenomenologisk case studie
Authors: Biong Stian
Published: August 2015

Forskningslitteraturen dokumenterer at noen overdosedødsfall kan være selvmord. Denne studien baserer seg på data fra en gjennomgang av alle registrerte overdosedødsfall i Oslo i perioden 2006–2008. Med utgangspunkt i et case bestående av to av disse dødsfallene som ble vurdert å være selvmord enten på bakgrunn av spesifikke uttalelser eller avskjedsbrev, beskriver den hvordan pårørende og fagfolk erfarte de avdødes livsomstendigheter siste året de levde. Fenomenet overdoser som selvmord belyses også med erfaringer fra andre deltakere i Oslo-gjennomgangen. Gjennom en kvalitativ analyse fremkom fem forhold av betydning for overdoser som selvmord. Forholdene drøftes i lys av to av prinsippene fra Ottawa-erklæringen om å fremme helse. Konklusjonen antyder viktigheten av å innta en deltakerposisjon i forhold til personenes livsomstendigheter og betydningen av å skape håp. In the research literature there is documentation that some overdose deaths may be suicide. This study is based on data from a review of all fatal overdoses in Oslo during the period 2006-2008. Based on a case comprising two of these deaths that were assumed to be suicide, either based on specific statements or suicide notes, we describe how relatives and professionals experienced the deceased persons' life situation during the last year they lived. The phenomenon of overdose as suicide is also illustrated using the experiences of other participants in the Oslo study group. Using qualitative analysis, we found five important elements for overdose as suicide. These are discussed in the light of two of the principles for health promotion in the Ottawa declaration. We suggest the importance of taking on a participant-position in relation to the persons' life contexts and the meaning of creating hope.
Amresh Shivastava, Megan Kimbrell og David Lester (red.): Suicide from a global perspective. Psychiatric approaches.
Authors: Larsen Kim
Published: August 2015

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Sorg og sykmelding
Authors: Rekdal Kari Wille , Herrestad Henning
Published: August 2015

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Erfaringar med dialektisk åtferdsterapi i Molde
Authors: Bjørnerem Heidi , Jonsbu Egil
Published: August 2015

Det er ei stor utfordring å gi pasientar med kjenslemessig ustabilitet og sjølvdestruktiv åtferd eit godt behandlingstilbod. Dialektisk åtferdsterapi (DBT) er ein poliklinisk behandlingsmodell som har gitt gode resultat. DBT-poliklinikken i Molde er den første i sitt slag i Noreg. Vi ønskjer i dette arbeidet å evaluere våre pasientar i høve til komorbiditet, karakteristika for dei som deltok og dei som fall ut av behandlinga, endringar under behandling, samt å samanlikne pasientar med kort og lang behandlingstid. Pasientane blir evaluert i høve til alder, kjønn, diagnosar og psykometriske variablar. Av 128 pasientar evaluert for DBT, starta 60 opp i programmet. Pasientane vart diagnostisert med MINI og SCID-II, i tillegg til eigenvurderingar og terapeutvurderingar av psykometriske variablar. Det var høg grad av komorbiditet, og dei fleste hadde personlegdomsdiagnosar (80 %). Fråfallprosent var låg (20 %). Dei som fall frå skilte seg lite frå behandlingsgruppa ved oppstart av behandlinga. Behandlingsgruppa viste signifikant positiv endring for håpløyse, depresjon, livskvalitet, psykisk helse, skår for personlegdomsforstyrring og terapeutvurdert funksjons- og symptomskår. Dei med kort behandlingstid var yngre og hadde mindre eteforstyrringar. DBT-poliklinikk i Distrikts-Noreg synest å vere eit hensiktsmessig og godt behandlingstilbod for pasientar med kjenslemessig dysregulering og sjølvdestruktiv åtferd. Offering proper treatment to people with emotional instability and self-destructive behaviour is a challenge. Dialectical Behavior Therapy (DBT) is an outpatient treatment that has proven effective. The DBT-outpatient clinic in Molde is the first of its kind in Norway. In this study we want to evaluate patients according to comorbidity, characteristics of those who attended and those who dropped out of treatment, changes during treatment, and differences by length of treatment. Of 128 patients evaluated for DBT, 60 attended the programme. The patients were diagnosed by MINI and SCID II, in addition to self-evaluations and therapist assessments of psychiatric variables. The degree of comorbidity was high and most of the patients had personality disorders (80%). Dropout was low (20 %). The dropouts showed little difference at the beginning of treatment from those who completed the treatment. The treatment group showed significant positive changes in hopelessness, depression, mental health, quality of life, personality disorder scores and therapist-assessed scores for symptoms and function. The patients who attended for a short time were younger and had lower prevalence of eating disorder The DBT outpatient clinic seems to offer suitable and positive treatment for patients with emotional dysregulation and self-destructive behaviour in rural parts of Norway.
Screening for selvskading i barne- og ungdomspsykiatriske poliklinikker – erfaringer fra rekruttering til en randomisert kontrollert studie
Authors: Grøholt Berit , Haga Egil , Tørmoen Anita Johanna , Ramberg Maria , Mehlum Lars
Published: August 2015

I forbindelse med en randomisert kontrollert behandlingsstudie ble 5 poliklinikker involvert i screening av unge over 12 år for selvskading. Av 1999 henviste unge ble 25 inkludert i behandlingsstudien. Vi ønsket å studere screeningsprosessen. 47 % ble stilt det aktuelle screeningspørsmålet om de hadde skadet seg selv. Av disse 987 svarte 241 ja (24,4 %). Mange tilfredsstilte ikke inklusjonskriterier eller ønsket ikke å være med, og 85 ble henvist til prosjektet. Av disse gjennomgikk 36 en grundig vurdering. Det var mange likheter mellom de 241 og de 25 som til slutt ble inkludert: Det som skilte dem var henvisning for selvskade, antall selvskader, antall henvisningsgrunner. Tross tett oppfølging fra prosjektet var screeningen langt fra komplett. Noen av poliklinikkene screenet flere enn de andre, men andel som ble fanget opp av prosjektet varierte lite mellom poliklinikkene. Klinisk skjønn ble trolig brukt med hell, men med over 24 % som selv-skader bør alle få screeningsspørsmål. Konklusjon: Implementering av rutiner er ikke enkelt. De som til slutt ble inkludert, skilte seg lite fra andre som selvskader. Det som skiller dem ut er et høyt lidelsestrykk, uttrykt ved mange selvskadinger, mange grunner for henvisning, og oftest henvisning for internaliserende lidelser. Five outpatient clinics were engaged in screening referred patients 13-17 year of age, for deliberate self-harm, to a randomized controlled treatment study. Of 1999 patients referred, 25 were finally included. We wanted to study the screening process. The screening included 987 (47 %). Self-harm was confirmed by 241 (24.4 %). Of these inclusion criteria seemed fulfilled and inclusion accepted for 86. Of these 36 were thoroughly evaluated. Compared to the 241, the 25 had selfharmed more often and were more often referred for self-harm and for more than one reason. In spite of close monitoring from the project, the screening was far from complete. The clinics included from 34 % to 77 % of referrals, but the percentage of referred patients reporting selfharm differed insignificantly between clinics. Clinical judgment was probably used with some success, but with more than 24 % confirming self-harm, every patient above 12 year should be asked about self-harm. Conclusion: Implementation of new routines is not easy. Those who were included did not differ much from those confirming self-harm. The included patients seemed to have a high level of distress, as they had self-harmed more often, more reasons for referral were given, and they were more often referred for internalizing problems.
Økonomisk evaluering av behandling for ungdom med villet egenskade – hvorfor og hvordan?
Authors: Haga Egil , Grøholt Berit , Tørmoen Anita Johanna , Aas Eline , Mehlum Lars
Published: August 2015

I studier av kostnadseffektivitet evaluerer man om behandlingskostnader står i et rimelig forhold til effekten. Gitt begrensede ressurser er slike studier viktige som beslutningsgrunnlag vedrørende implementering av nye behandlingsformer. I forbindelse med en intervensjonsstudie for ungdommer med repetert villet egenskade, der dialektisk atferdsterapi for ungdom (DBT-A) sammenlignes med standard behandling, planlegges det å gjøre en økonomisk evaluering. Formålet med denne artikkelen er å gjøre rede for metoden for evaluering av kostnadseffektivitet, samt belyse rasjonalet for en slik evaluering. Eksisterende forskning peker i retning av at ungdommer med repetert selvskading har et stort forbruk av helsetjenester, men at det er lite kunnskap om hvorvidt behandlingen som tilbys er kostnadseffektiv. Nylig publiserte resultater fra den nevnte intervensjonsstudien viste at DBTA var mer effektiv enn standard behandling etter en behandlingsperiode på 19 uker (Mehlum et al., 2014), samtidig som DBT-A medførte mer omfattende bruk av ressurser. I lys av dette synes det særlig relevant for beslutningstagere at DBT-A evalueres med henblikk på kostnadseffektivitet. Den endelige økonomiske evalueringen vil gjøres over en periode på til sammen 71 uker (behandlings- og oppfølgingsperiode) og vil basere seg på gjennomsnittlig totalkostnad per pasient (DBT-A vs. standard behandling) og effektanalyser. The aim of cost-effectiveness studies is to evaluate whether the costs of a new treatment are reasonable in relation to treatment effects. Given limited resources such studies are important for decision-makers when making priorities with respect to implementation of new treatments. Following an intervention study for adolescents with repeated deliberate self-harm, comparing dialectical behavior therapy for adolescents (DBT-A) with standard treatment, the costeffectiveness of DBT-A will be evaluated. The objective of this paper is to outline the method for evaluation of cost-effectiveness, as well as discussing the rationale for conducting a costeffectiveness study of DBT-A. Research indicates that adolescents with selfharm is a patient group with extensive use of health services, however, that the knowledge of cost-effectiveness of treatment is sparse. The intervention study showed that DBT-A was more effective than standard treatment after a treatment period of 19 weeks (Mehlum et al., 2014), but that DBT-A also lead to more use of outpatient resources. Thus, it appears highly relevant to evaluate the cost-effectiveness of DBT-A. The evaluation will be conducted over a period of 71 weeks (treatment and follow-up), and will be based on average total costs per patient (DBT-A vs standard treatment) and analyses of treatment effects.
Rapport fra skolebesøk i Miami
Authors: Møllen Ingrid Sæbø
Published: August 2015

I september 2013 dro seks norske rådgivere på besøk til Miami Dade skoledistrikt i Florida. Å forebygge selvmord er definert som en viktig del av arbeidet med å utvikle en trygg skole i dette skoledistriktet. Dette omfatter ulike programmer med fokus på ferdighetstrening som kommunikasjon, problemløsning, mestring, relasjoner, stresshåndtering, kunnskap om helse og ressurser. Skolene har også gruppetilbud i forhold til sinnemestring, sorg, seksuelle minoriteter og andre tema. Elever i akutt selvmordsfare og elever som mister en medelev i selvmord som ellers har behov for det, kan få psykologisk oppfølging på skolen. In September 2013 six Norwegian advisors visited the Miami Dade school district in Florida. In this school district preventing suicide is defined as an important part in developing A safe school. This includes various programs focusing on skills training such as communication, problem solving, coping, relationships, stress management, health knowledge and resources. School also offers group sessions with different topics, such as anger, grief, sexual minorities. The school offers psychological help to pupils at risk of suicide and postvention care to students who lose a fellow student in suicide.
Samhällets lidandeproduktion och behov av resiliens
Authors: Beskow Jan
Published: August 2015

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Lamprey VLRB response to influenza virus supports universal rules of immunogenicity and antigenicity
Authors: Altman Meghan O , Bennink Jack R , Yewdell Jonathan W , Herrin Brantley R
Published: August 2015

Immunoglobulins (Igs) are a crown jewel of jawed vertebrate evolution. Through recombination and mutation of small numbers of genes, Igs can specifically recognize a vast variety of natural and man-made organic molecules. Jawless vertebrates evolved a parallel system of humoral immunity, which recognizes antigens not with Ig, but with a structurally unrelated receptor called the variable lymphocyte receptor B (VLRB). We exploited the convergent evolution of Ig and VLRB antibodies (Abs) to investigate if intrinsic chemical features of foreign proteins determine their antigenicity and immunogenicity. Surprisingly, we find lamprey VLRB and mouse Ig responses to influenza A virus are extremely similar. Each focuses ∼80% of the response on hemagglutinin (HA), mainly through recognition of the major antigenic sites in the HA globular head domain. Our findings predict basic conservation of Ab responses to protein antigens, strongly supporting the use of animal models for understanding human Ab responses to viruses and protein immunogens.