bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unveiling the mysteries of SST evolutions in the equatorial Pacific at the onset of El Niño events
Authors: Zou Youjia , Xi Xiangying 
Published: May 2021

AbstractIt is generally accepted that the El Niño-Southern Oscillation (ENSO) dominates interannual climate variability. Yet its genesis and maintenance mechanisms are still under intense debate with no scientific consensus. Some authors argued that the westerly winds originating over the equatorial Indian Ocean significantly enhanced and extended eastward in the western and central equatorial Pacific during El Niño events, thus advecting the warm pool eastward along the equator and causing SST anomalies. However, this assertion is unlikely to be quantitatively supported by observational data. Here we present detailed observational data and modeling evidence to demonstrate that the westerly winds remained little changein intensity in the western equatorial Pacific, with a wider zonal extent only during most El Niño events, and with a slight increase even if in the most pronounced 1997 El Niño. Instead, an eastward equatorial current near the equator has been observed and considered to play a significant role in shifting the eastern edge of the warm pool eastward, elevating SSTs in the central and eastern equatorial Pacific and giving rise to El Niño, with the interactions between the eastward warm pool and the upwelling in the eastern cold tongue ascertaining the amplitudes of SST anomalies.
The Effects of Language Barriers and Time Constraints on Online Learning Performance: An Eye-Tracking Study
Authors: Jónsdóttir Auður Anna , Kang Ziho , Sun Tianchen , Mandal Saptarshi , Kim Ji-Eun 
Published: May 2021

Objective The goal of this study is to model the effect of language use and time pressure on English as a first language (EFL) and English as a second language (ESL) students by measuring their eye movements in an on-screen, self-directed learning environment. Background Online learning is becoming integrated into learners’ daily lives due to the flexibility in scheduling and location that it offers. However, in many cases, the online learners often have no interaction with one another or their instructors, making it difficult to determine how the learners are reading the materials and whether they are learning effectively. Furthermore, online learning may pose challenges to those who face language barriers or are under time pressure. Method The effects of two factors, language use (EFL vs. ESL) and time constraints (high vs. low time pressure), were investigated during the presentation of online materials. The effects were analyzed based on eye movement measures (eye fixation rate—the total number of eye fixations divided by the task duration and gaze entropy) and behavioral measures (correct rate and task completion time). Results The results show that the ESL students had higher eye fixation rates and longer task completion times than the EFL students. Moreover, high time pressure resulted in high fixation rates, short task completion time, low correct rates, and high gaze entropy. Conclusion and Application The results suggest the possibility of using unobtrusive eye movement measures to develop ways to better assist those who struggle with learning in the online environment.
Effect of Handrail Height and Age on Trunk and Shoulder Kinematics Following Perturbation-Evoked Grasping Reactions During Gait
Authors: Komisar Vicki , Novak Alison C. 
Published: May 2021

Objective To characterize the effect of handrail height and age on trunk and shoulder kinematics, and concomitant handrail forces, on balance recovery reactions during gait. Background Falls are the leading cause of unintentional injury in adults in North America. Handrails can significantly enhance balance recovery and help individuals to avoid falls, provided that their design allows users across the lifespan to reach and grasp the rail after balance loss, and control their trunk by applying hand-contact forces to the rail. However, the effect of handrail height and age on trunk and shoulder kinematics when recovering from perturbations during gait is unknown. Method Fourteen younger and 13 older adults experienced balance loss (sudden platform translations) while walking beside a height-adjustable handrail. Handrail height was varied from 30 to 44 inches (76 to 112 cm). Trunk and shoulder kinematics were measured via 3D motion capture; applied handrail forces were collected from load cells mounted to the rail. Results As handrail height increased (up to 42 inches/107 cm), peak trunk angular displacement and velocity generally decreased, while shoulder elevation angles during reaching and peak handrail forces did not differ significantly between 36 and 42 inches (91 and 107 cm). Age was associated with reduced peak trunk angular displacements, but did not affect applied handrail forces. Conclusion Higher handrails (up to 42 inches) may be advantageous for trunk control when recovering from destabilizations during gait. Application Our results can inform building codes, workplace safety standards, and accessibility standards, for safer handrail design.
Association of dietary fiber and risk of hip fracture in men from the Framingham Osteoporosis Study and the Concord Health and Ageing in Men Project
Authors: Dai Zhaoli , Hirani Vasant , Sahni Shivani , Felson David T. , Naganathan Vasi , Blyth Fiona , Le Couteur David , Handelsman David , Seibel Markus J , Waite Louise , Kiel Douglas P , Cumming Robert 
Published: May 2021

Background: Data in the Offspring Framingham Osteoporosis Study (FOS) suggested that higher intake of dietary fiber was modestly protective against loss of bone mineral density at the femoral neck in men but not in women. Aim: To examine the relationship of fiber intake with risk of hip fractures in men. Methods: We included 367 men from the FOS Original cohort, 1730 men from the FOS Offspring cohort, and 782 men from the Concord Health and Ageing in Men Project (CHAMP) in the analysis. Incident fractures were defined as medically confirmed first occurrence of osteoporotic fractures at the proximal femur. Fiber intake was estimated via a validated food frequency questionnaire (FFQ) or diet history. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). A random-effects model was used to estimate the pooled relative risk in meta-analysis. Results: Seventy-two incident hip fractures were identified, of which 24 occurred in the FOS Original cohort [mean (SD): age 75.3 (5.1) years; follow-up time: 8.5 (6.2) years; dietary fiber: 19 (8) (g/d)], 19 in the FOS Offspring cohort [58.8 (9.8) years; 11.0 (5.9) years; 19 (8) (g/d)], and 29 in CHAMP [81.4 (4.5) years; 5.2 (1.5) years; 28 (10) (g/d)]. We did not find significant associations within each cohort between fiber intake and risk of hip fractures. The pooled HR (95% CI) was 0.80 (0.39, 1.66) comparing energy-adjusted dietary fiber at tertile 3 vs. tertile 1 (I2 = 0, p = 0.56). Conclusion: These data suggested that dietary fiber was not associated with risk of incident hip fractures in men.
Role of the norepinephrine transporter polymorphisms in atomoxetine treatment: From response to side effects in children with ADHD
Authors: Gul Melike Kevser , Sener Elif Funda , Onal Muge Gulcihan , Demirci Esra 
Published: May 2021

Objective: Atomoxetine (ATX), one of the most commonly used drugs after stimulants in attention deficit hyperactivity disorder (ADHD) treatment, is an inhibitor of the norepinephrine transporter ( NET/SLC6A2), which is also associated with the etiology of ADHD. In this study, we aimed to investigate the effect of NET gene polymorphisms on response to ATX treatment and to find the answers to the questions about whether there is a relationship between the severity of the disorder and the observed side effects in children with ADHD. Method: About 100 children with ADHD and 80 healthy controls (HCs) were included in this study. The dose of ATX was started at 0.5 mg/kg/day and titrated at 1.2 mg/kg/day. Response to treatment of 78 patients was evaluated 2 months after the beginning of the treatment. After whole blood samples were obtained, DNAs were isolated, and samples were stored at −80°C. Two single-nucleotide polymorphisms (SNPs) (rs12708954 and rs3785143) were analyzed by real-time quantitative PCR (qRT-PCR). Results: The patients with both rs12708954 and rs3785143 heterozygous genotype had better treatment response and more side effects than patients with wild type. There was not found any association between any of the investigated NET polymorphisms and ADHD severity. Conclusion: It was, however, found that the NET rs12708954 and rs3785143 genotypes affect the treatment response to ATX in our study; thus, further studies with a large population are needed to understand the effects of NET polymorphisms on treatment, side effects, and also the severity of ADHD.
Diagnostic values of MMP-7, MMP-9, MMP-11, TIMP-1, TIMP-2, CEA, and CA19-9 in patients with colorectal cancer
Authors: Huang Xiwen , Lan Yongquan , Li En , Li Jiaquan , Deng Qiaoting , Deng Xunwei 
Published: May 2021

Objective Colorectal cancer (CRC) is one of the most common and lethal malignancies. The identification of precise and noninvasive biomarkers is urgently needed to aid the early diagnosis and clinical management of CRC. Methods A total of 112 patients with CRC and 115 healthy control subjects were included in this study. Serum levels of matrix metalloproteinase (MMP)-7, MMP-9, MMP-11, tissue inhibitor of metalloproteinase (TIMP)-1, and TIMP-2 were analyzed by enzyme-linked immunosorbent assay, and carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 levels were measured using an automatic immunoassay analyzer. Results MMP-7, MMP-9, MMP-11, TIMP-1, TIMP-2, CEA, and CA19-9 levels were all significantly higher in CRC patients compared with healthy controls. MMP-7, TIMP-1, and CEA levels were also closely related to clinicopathologic features in patients with CRC. The combination of serum CEA, MMP-7, and TIMP-1 significantly improved the diagnostic value compared with any single marker (area under the curve 0.858–0.890). Furthermore, a combined detection model including MMP-7, TIMP-1, and CEA improved both the specificity and sensitivity for detecting CRC. Conclusions The results showed that combined detection of CEA, MMP-7, and TIMP-1 in serum could provide a specific and sensitive biomarker for the diagnosis of CRC.
Occupational therapy and psychosis: POINTER feasibility study for a pragmatic clinical trial
Authors: Inman Joanne , Bannigan Katrina , Akhurst Jacqueline 
Published: May 2021

Introduction The dearth of clinical trials of individualised occupational therapy with people with a diagnosis of psychosis limits the evidence base globally for occupational therapy practice. This study evaluated the feasibility of conducting a pragmatic clinical trial. Method Mixed methods design using a pragmatic perspective; two-centre, one-group pretest-posttest study, at six months. POINTER Occupational Intervention Specification captured routine individualised occupational therapy. Process evaluation included recruitment, retention, intervention delivery, fidelity, adherence and outcome measurement. The primary outcome was participation in activities of everyday life, measured by Time Use Survey, Participation Scale and Utrecht Scale for Evaluation of Rehabilitation-Participation. The Canadian Occupational Performance Measure measured self-reported experience of and satisfaction with occupational performance. The Short Form-36v2 Health Survey measured health-related quality of life, a secondary outcome. Participants’ experiences were explored using a questionnaire. Intervention providers’ perspectives were investigated via the POINTER occupational intervention log and focus groups. Results Recruitment was (20/36) and drop-out 20% (4/20). Fidelity was 77%, and adherence was good; POINTER had validity and utility. Outcome measurement was acceptable to participants, indicating increased participation in activities of everyday life. Conclusion A larger clinical trial is merited; recruitment processes need further exploration, and outcome measurement needs refining.
Determination of the optimal cutoff values and validity of the Purdue Pegboard Test
Authors: Sigirtmac Ilkem Ceren , Oksuz Cigdem 
Published: May 2021

Introduction The Purdue Pegboard Test (PPT) is crucial for assessing fine dexterity of patients with hand injury. Determining the PPT cutoff value is needed to distinguish patients with impaired hand dexterity from those with unimpaired hand dexterity. The aim of this article is to examine the construct validity of PPT and to determine its cutoff values for patients with hand injuries. Method The PPT and Disabilities of Arm Shoulder and Hand Questionnaire Turkish version (DASH-T) were used to measure hand dexterity. To examine construct validity, we measured the correlation between PPT and DASH-T. The cutoff values were determined using the receiver operating characteristic (ROC) curve generated with sensitivity and 1-specificity. We recruited 101 patients with hand injury and 162 healthy participants. Results Correlation between all subtests of PPT and DASH-T were weak ( r = −0.282; −0.473: p<0.05). The cutoff value for the assembly subtest of PPT was 24.5. The range of area under the curve (AUC) values for PPT subtests was good to excellent (AUC: 0.82–0.92). Conclusion The current study demonstrates that PPT is a valid instrument for measuring hand dexterity in patients with hand injury. Results also suggest that PPT distinguished the patients with impaired hand function from those with unimpaired hand dexterity.
Effects of a nurse–occupational therapist meeting on function and motivation in hospitalized elderly patients: A pilot randomized control trial
Authors: Kondo Ken , Noguchi Naoto , Teshima Ryoto , Tanaka Koji , Lee Bumsuk 
Published: May 2021

Introduction This pilot randomized controlled trial assessed the effectiveness of a nurse–occupational therapist meeting on improving motor and social-cognitive functions, as well as motivation, in a subacute hospital setting. Methods Participants were randomized to a weekly multidisciplinary team meeting group (‘control’, n = 20) or a nurse–occupational therapist meeting group (‘intervention’, n = 18). Medical care plans in both groups were discussed in the weekly meeting. In addition, the details of daily life problems for the intervention patients were discussed in the nurse–occupational therapist meeting. Outcome measures included motor and social-cognitive functions assessed by the Functional Independence Measure and motivation assessed by the Vitality Index. Assessment time points were at admission and discharge. Results In the intervention group, additional improvements were found in the Functional Independence Measure cognitive ( p = 0.048, r = 0.32) and the Vitality Index ( p = 0.027, r = 0.36), whereas the Functional Independence Measure motor was improved in both groups ( p ≤ 0.018, r ≥ 0.52). Conclusion We found significant improvement in motor function in both groups and additional improvements in social-cognitive function and motivation in the intervention group. These observations suggest that collaborative practice between nurses and occupational therapists could improve functions underlying independent daily life in hospitalized elderly patients.
The relationship between cognitive function and performance in instrumental activities of daily living in older adults
Authors: Toth Cheryl , Tulliani Nikki , Bissett Michelle , Liu Karen PY 
Published: May 2021

Introduction Deficits in cognition have been found to be associated with problems in performing daily activities; however, it is unknown what specific domains of cognition are related to each daily activity. Method Thirty-six occupational therapists identified the 20 most important instrumental activities of daily living for older adults and the cognitive demands required. Thirty-two older adults rated the perceived mental effort when performing these activities. They were assessed on their cognitive functions. Descriptive statistics were used to report the results. The Pearson correlation coefficient was used to identify relationships between cognitive functions and perceived mental effort. Results Activities relating to ‘communication’, ‘financial management’, ‘health management’ and ‘safety and emergency management’ require more cognitive demands. Results from the older adults showed the highest significant correlations in immediate memory and ‘paying bills’ ( r = 0.54), delayed memory and ‘following emergency procedures’ and ‘paying bills’ ( rs = 0.52), and executive functioning and ‘making and keeping medical appointments’ ( r = −0.49). Conclusion Findings contribute to the emerging understanding of specific cognitive domains related to the instrumental activities of daily living. The results can be used to reframe and improve intervention strategies for individuals with cognitive decline to maintain or improve performance in daily activities.
Prothrombin Complex Concentrate Use in Intracranial Hemorrhage Patients With Cirrhosis Not on Prior Anticoagulation
Authors: Small Clay , Attridge Rebecca L. , Franco-Martinez Crystal , Donnelly Jonathan , Barthol Colleen 
Published: May 2021

Background/Objective: Patients with intracranial hemorrhage (ICH) have a 30-day mortality rate up to 52%, and the risk of mortality is increased in patients with disease-induced coagulopathy such as cirrhosis. The objective of this study was to evaluate whether 4F-PCC administration mitigates hematoma expansion in ICH patients with cirrhosis not currently receiving anticoagulation therapy compared to standard of care therapies. Methods: This was a single-center, retrospective study comparing adult patients with ICH and history of cirrhosis who received 4F-PCC versus standard of care therapies. The primary outcome was rate of ICH expansion within 24 hours after admission. Results: A total of 58 patients were included with 21 who received 4FPCC vs 37 who received standard of care therapies. The 4F-PCC group had a significantly higher number of patients with Child Pugh Class C cirrhosis (85.7% vs. 48.6%, P = 0.006), higher baseline INR (1.7 vs. 1.4, P = 0.001) and more patients with a spontaneous cause of hemorrhage (61.9% vs. 29.7%, P = 0.01). Stable follow-up head CT was achieved in 68.4% of patients who received 4F-PCC versus 72.7% of patients treated with standard of care therapies ( P = 0.11). Patients who received 4F-PCC had a significantly greater change in INR within 24 hours (-0.2 vs. 0, P = 0.02) and higher rate of mortality (61.9% vs. 18.9%, P = 0.001). Baseline INR > 2 and surgical evacuation for ICH were associated with decreased odds of stable follow-up head CT in the multivariate logistic regression model. Conclusions: A single dose of 4F-PCC did not significantly improve the rate of stable head CT at 24 hours in patients with ICH and cirrhosis. Randomized clinical trials with larger patient populations are warranted to fully determine the role of 4F-PCC in this unique population.
Multivariate Meta-Analysis of the Mortality Effect of Prone Positioning in the Acute Respiratory Distress Syndrome
Authors: Moran John L. , Graham Petra L. 
Published: May 2021

Background: The efficacy of prone positioning (PP) as therapy of the acute respiratory distress syndrome (ARDS) has varied in recent meta-analyses. The efficacy question was reviewed using a cohesive multivariate meta-analysis model incorporating all available common time-point data. Methods: Data from a core group of 8 randomized controlled trials (2001-2013) utilized in 8 current meta-analyses (2014-2017) was extracted for common time points. Multivariate meta-analysis and meta-regression models for prone-hours per day, mechanical ventilation tidal-volume and baseline patient PaO2/FiO2, considered as continuous and categorical predictors, determined the pooled relative risk (RR) of mortality for prone versus supine positioning. Results: Mortality RR at 28-30 days, 2-3 months and 6-months was not significant overall ( P > 0.05). Meta-regression of categorical predictors indicated significant mortality reduction ( P ≤ 0.001) for ≥ 12 prone-hours (versus < 12), lung protective ventilation (versus none) and moderate-severe ARDS (versus all ARDS). Meta-regressions of continuous predictors were also significant ( P ≤ 0.021) and yielded treatment inflection points of efficacious therapy for ≥ 12 prone-hours per day, ≤ 8.5 mL/kg tidal volume and ≤ PaO2/FiO2 ratio of 130. Conclusions: The mortality treatment effect of PP in ARDS, was not demonstrated in the unadjusted meta-analysis model. Moderator effects indicated consistent significant benefit of prone positioning. In the absence of individual patient data, multivariate models provide more decisive conclusions than individual time point analyses.
Nurses’ challenges, concerns and unfair requirements during the COVID-19 outbreak
Authors: Sperling Daniel 
Published: May 2021

Background During disease outbreaks, nurses express concerns regarding the organizational and social support required to manage role conflicts. Objectives The study examined concerns, threats, and attitudes relating to care provision during the COVID-19 outbreak among nurses in Israel. Design A 53-item questionnaire was designed for this research, including four open-ended questions. The article used a qualitative research to analyze the responses to the open-ended questions and their association with responses to the close-ended ones. Participants and research context In all, 231 registered nurses and fourth-year nursing students throughout the whole country. The questionnaire was delivered in nursing Facebook and WhatsApp groups and through snowball sampling. Ethical considerations The research was pre-approved by the Ethics Committee at the researchers’ university. Results Nurses mostly referred to personal risk, followed by dilemmas regarding care provision. On average, 38.6% of quotations stated that during the pandemic, nurses are not asked to perform unfair duties. Nurses discussed activities and requirements that impact their personal and familial safety, their relationship with employer, organization or the state, and their duty to providing care. Other than fear of contraction, respondents’ most frequent themes of concerns were related to work condition and patients’ interests, inter-collegiate relationships, and uncertainty and worries about the future. Respondents’ ethical dilemmas mostly referred to clinical questions, providing care without adequate equipment or managerial support, and in conditions of uncertainty and increased risk. Discussion Nurses raise important issues concerning their relationships with employers and family members, and significant insights regarding the pandemic and their revised responsibilities and definition of work. They raise serious concerns regarding their rights at work and their standing for them. Conclusions Health managers should find ways to enhance the ethical climate and institutional support to enable a better work-life balance in times of pandemic and support nurses’ working needs and labor rights.