bluuebunny/crossref_metadata_2025_split huggingface dataset:
Household’s Choice of Healthcare Provider in Kenya
Authors: Lokina Razack , Musili William 
Published: March 2021

Abstract
People respond in different manners to various injuries or illnesses. Factors that influence response to illness or injuries are usually categorized into enabling factors, predisposing factors and perceived factors. These responses are self-treatment, seeking healthcare services from professional healthcare providers (private, public and mission healthcare facilities), seeking treatment from traditional healers and not seeking treatment at all. Despite an increase in the utilization rate of healthcare facilities, there is still a high prevalence of self-treatment among households in Kenya. This article, therefore, aims to examine the factors that influence household’s choice of the healthcare provider by making use of national household survey data subjected to multinomial probit regression analysis. The article evidences that severity of illness, wealth, health insurance, distance, employment status, education as well as place of residence influences household’s choice of healthcare provider. This implies that government should institute policies aimed at creating employment opportunities, promoting education, construction of additional healthcare facilities and encouraging more households to have health insurance covers.
Disparities of phytochemical constituents and antioxidant activities of some Indigofera species
Authors: Kolar Firdose R. , Kambhar Sidanand V. , Chavan Manjula , Kadam Shruti , Nadaf Peerambi 
Published: March 2021

Abstract
The current study was intended to examine the difference in the phytochemical and antioxidant profile of nine Indigofera species. With this aim, the species were assessed for total phenolic content, flavonoid content, and antioxidant activity using ferric reducing antioxidant power (FRAP), DPPH free radical scavenging, ferrous ion chelating activity, phosphomolybdenum reducing power, deoxyribose degradation, β-carotene bleaching, nitric oxide scavenging, and superoxide radical scavenging assays. The content of total phenolics and flavonoids ranged from 1.33 to 22.5 mg TAE/g plant material and 0.47 to 5.02 mg QE/g plant material respectively in the various species, while the antioxidant activity as tested with different antioxidant test models varied with the species studied as well as with the solvents used for the extraction. Interestingly, all the tested extracts demonstrated considerable free radical scavenging activity, moreover, I. hirsuta, I. glandulosa, I. linnaei, I. hochstetteri, I. linifolia, and I. trita were found to be the most effective among the species studied. The results indicated the significant differences in phytochemical constituents and the antioxidant activity among the species. The Pearson correlation coefficient analysis exhibited a significant correlation of phenolics and flavonoids with the antioxidant activity.
Forecast Skill of the NAO in the Subseasonal to-Seasonal Prediction Models
Authors: Feng Pei-Ning , Lin Hai , Derome Jacques , Merlis Timothy M. 
Published: March 2021

AbstractThe prediction skill of the North Atlantic Oscillation (NAO) in boreal winter is assessed in the operational models of the WCRP/WWRP Subseasonal-to-Seasonal (S2S) prediction project. Model performance in representing the contribution of different processes to the NAO forecast skill is evaluated. The S2S models with relatively higher stratospheric vertical resolutions (high-top models) are in general more skillful in predicting the NAO than those models with relatively lower stratospheric resolutions (low-top models). Comparison of skill is made between different groups of forecasts based on initial condition characteristics: phase and amplitude of the NAO, easterly and westerly phases of the quasi-biennial oscillation (QBO), warm and cold phases of ENSO, and phase and amplitude of the Madden-Julia Oscillation (MJO). The forecasts with a strong NAO in the initial condition are more skillful than with a weak NAO. Those with negative NAO tend to have more skillful predictions than positive NAO. Comparisons of NAO skill between forecasts during easterly and westerly QBO and between warm and cold ENSO show no consistent difference for the S2S models. Forecasts with strong initial MJO tend to be more skillful in the NAO prediction than weak MJO. Among the eight phases of MJO in the initial condition, phases 3-4 and phase 7 have better NAO forecast skills compared with the other phases.The results of this study have implications for improving our understanding of sources of predictability of the NAO. The situation dependence of the NAO prediction skill is likely useful in identifying “ windows of opportunity” for subseasonal to seasonal predictions.
A study of intermediate water circulation in the Strait of Georgia using tracer-based, Eulerian, and Lagrangian methods
Authors: Stevens S. W. , Pawlowicz R. , Allen S. E. 
Published: March 2021

AbstractThe intermediate circulation of the Strait of Georgia, British Columbia, Canada, plays a key role in dispersing contaminants throughout the Salish Sea, yet little is known about its dynamics. Here, we use hydrographic observations and hindcast fields from a regional 3D model to approach the intermediate circulation from three perspectives. Firstly, we derive and model a “seasonality” tracer from temperature observations to age the water, estimate mixing, and infer circulation. Secondly, we analyze modeled velocity fields to create mean current maps and examine the advective and diffusive components of the mean flow field. Lastly, we calculate Lagrangian trajectories to derive Transit Time Distributions and Lagrangian statistics. In combination, these analyses provide an overview of the mean intermediate circulation that can be summarized as follows: subducting water in Haro Strait ventilates the intermediate water primarily via an up-strait boundary current that flows along the eastern shores of the southernmost basin in 1–2 months. This inflowing water is either incorporated into the interior of the basin, recirculated southwards, or transported into the northernmost basin, mixing steadily with adjacent water masses during its transit. A second, shallower ventilating jet emanates southwards from Discovery Passage, locally modifying the Haro Strait inflow signal. Outside of these well-defined advective features, diffusive transport dominates in the majority of the region. The intermediate renewal signal fully ventilates the region in 100–140 days, which serves as a benchmark for contaminant dispersal timescale estimates.
Boundary layer-mediated vorticity generation in currents over sloping bathymetry
Authors: Jagannathan Arjun , Srinivasan Kaushik , McWilliams James C. , Molemaker M. Jeroen , Stewart Andrew L. 
Published: March 2021

AbstractCurrent-topography interactions in the ocean give rise to eddies spanning a wide range of spatial and temporal scales. Latest modeling efforts indicate that coastal and underwater topography are important generation sites for submesoscale coherent vortices (SCVs), characterized by horizontal scales of (0.1 – 10) km. Using idealized, submesoscale and BBL-resolving simulations and adopting an integrated vorticity balance formulation, we quantify precisely the role of bottom boundary layers (BBLs) in the vorticity generation process. In particular, we show that vorticity generation on topographic slopes is attributable primarily to the torque exerted by the vertical divergence of stress at the bottom. We refer to this as the Bottom Stress Divergence Torque (BSDT). BSDT is a fundamentally nonconservative torque that appears as a source term in the integrated vorticity budget and is to be distinguished from the more familiar Bottom Stress Curl (BSC). It is closely connected to the bottom pressure torque (BPT) via the horizontal momentum balance at the bottom and is in fact shown to be the dominant component of BPT in solutions with a well-resolved BBL. This suggests an interpretation of BPT as the sum of a viscous, vorticity generating component (BSDT) and an inviscid, ‘flow-turning ’ component. Companion simulations without bottom drag illustrate that although vorticity generation can still occur through the inviscid mechanisms of vortex stretching and tilting, the wake eddies tend to have weaker circulation, be substantially less energetic, and have smaller spatial scales.
Gender Differences in the Accumulation, Timing, and Duration of Childhood Adverse Experiences and Youth Delinquency in Fragile Families
Authors: Pierce Hayley , Jones Melissa S. 
Published: March 2021

Objective: The purposes of this study are twofold. First, we explore how the accumulation, timing, and duration of ACEs influences youth delinquency. Second, because few studies to date have examined how the effect of ACEs may vary among different groups, we explore how these patterns may vary by gender. Methods: Analyses were based on data from the Fragile Families and Child Wellbeing Study (FFCW), which employs a national sample of urban-born, at-risk youth. Results: The results showed that as the number of early ACEs experienced incrementally increases, the likelihood of youth reporting delinquent behavior also increases, even after adjusting for recent adversity. Moreover, exposure to early ACEs that are high but late, intermittent, or chronically high significantly increase the risk of youth participating in delinquency. Our results also indicate that ACEs are significantly related to delinquency for girls, but not for boys. Conclusions: Prevention and intervention efforts should screen for ACEs—especially in early childhood. Given that the accumulation, timing, and duration of ACE exposure is linked to youth delinquency, interventions that target ACEs early may have greater success at reducing delinquency. Moreover, prevention programs need to consider gender-specific responses to ACEs and gender-specific intervention strategies.
Ethnicity, household composition and COVID-19 mortality: a national linked data study
Authors: Nafilyan Vahé , Islam Nazrul , Ayoubkhani Daniel , Gilles Clare , Katikireddi Srinivasa Vittal , Mathur Rohini , Summerfield Annabel , Tingay Karen , Asaria Miqdad , John Ann , Goldblatt Peter , Banerjee Amitava , Glickman Myer , Khunti Kamlesh 
Published: March 2021

Objective To estimate the proportion of ethnic inequalities explained by living in a multi-generational household. Design Causal mediation analysis. Setting Retrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020). Participants Adults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568). Main outcome measures Hazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health. Results Living in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06–1.30) and 1.21 (95% CI 1.06–1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01–1.13) for elderly men and 1.17 (95% CI 1.07–1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups. Conclusion Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent.
Distal anastomosis support for bypass grafting with coronary endarterectomy for the severe diseased posterior descending artery
Authors: Li Haitao , Wang Liangshan , Liu Changcheng , Gu Chengxiong 
Published: March 2021

Background: The posterior descending artery is the most common vessel chosen for an endarterectomy, while endarterectomy to the posterior descending artery is associated with decreased graft patency. The purpose of this study was to describe a distal anastomosis support (DAS) technique and retrospectively investigate the effect of DAS on the mid-term graft patency. Methods: Between January 2016 and December 2018, 200 patients with a PDA severe lesion who underwent off-pump coronary artery bypass (OPCAB) with CE (OPCAB + CE group, n = 95) and OPCAB + CE with DAS for anastomosis of PDA grafted by saphenous vein (SVG) (OPCAB + CE + DAS group, n = 105) were evaluated retrospectively. All patients came back to follow-up visit 6th, 12th, 24th, and 36th postoperative month. The primary endpoint is the graft failure (FitzGibbon B or O) of SVG-PDA on the follow-up CTA or CAG. Results: There was no significant difference in perioperative outcomes. We found significantly improved cumulative graft patency in OPCAB + CE + DAS group at 36 months after operation (84.6% vs 76.5%, p = 0.02). In multivariate Cox regression analysis, plaque length larger than 2 cm (hazard ratio [HR], 13.108, 95% confidence interval [CI], 2.842–60.457, p = 0.001), and peak TNI ⩾70× ULN within 48 hours of surgery (HR, 3.778, 95% CI, 1.453–9.823, p = 0.006) were independent predictors of graft failure, whereas PDA diameter greater than 1.5 mm (HR, 0.231, 95% CI, 0.081–0.654, p = 0.006), and DAS use (HR, 0.336, 95% CI, 0.139–0.812, p = 0.015) were significant protective factors. Conclusions: Concomitant DAS conferred superior mid-term patency of SVG-PDA. Adding the DAS procedure to OPCAB + CE may be a promising surgical option for patients with a PDA severe lesion, especially when PDA diameter less than 1.5 mm and plaque length greater than 2 cm.
Uncommon site of metastatic neuroblastoma in a 15-year-old girl: case report and description of sonographic and radiographic features
Authors: Avola Emanuele , Giannetta Vincenzo , Depretto Catherine , Scaperrotta Gianfranco P. 
Published: March 2021

Background: Although most breast masses in children are benign, breast cancer must be considered in the differential diagnosis. The majority are represented by sarcomas and secondary lesions. Literature reports only four cases of neuroblastoma breast metastasis, with no emphasis on radiologic features. Our work aims to furnish a description of radiologic and sonographic features of neuroblastoma metastasis in the breast. Case description: A 15-year-old girl had a round nodular mass in the outer upper quadrant of the left breast that had rapidly enlarged over the last month. An ultrasound showed two subcutaneous nodules (3.8 cm and 1.3 cm in maximum diameter), with an irregular shape, heterogeneous echogenicity (isohypoechoic), and hyperechoic foci with a posterior acoustic shadow inside. Overall, the features were highly suspicious of secondary malignant lesions. Computed tomographic scan was performed and found a large retroperitoneal mass and multiple mixed secondary lesions to the spine and hip. A 14G core needle biopsy of breast masses was performed and showed a secondary localization of neuroblastoma. Conclusions: In adolescents, metastases are the most frequent cause of malignant breast masses. Ultrasound examination should be preferred as the first imaging tool. For the differential diagnosis of breast metastasis with benign masses, a rapid enlargement, a heterogeneous echogenicity, and intralesional hyperechogenic foci could be considered features of malignancy.
Critical theory and the question of technology: The Frankfurt School revisited
Authors: Delanty Gerard , Harris Neal 
Published: March 2021

Unlike the first generation of critical theorists, contemporary critical theory has largely ignored technology. This is to the detriment of a critical theory of society – technology is now a central feature of our daily lives and integral to the contemporary form of capitalism. Rather than seek to rescue the first generation’s substantive theory of technology, which has been partly outmoded by historical developments, the approach adopted in this article is to engage with today’s technology through the conceptual apparatus offered by the early Frankfurt School. This rationale is guided by the conviction that the core ideas of critical theory still offer a sound basis for assessing the nature of technology today. Through a reconstruction and engagement with some of the core concepts of first-generation critical theory, as well as the work of Bernard Stiegler and Andrew Feenberg, we can arrive at a more robust theory of technology, capable of critically interrogating the role of technology in contemporary society.
Impact of Low-Dose Fluconazole on Tacrolimus Dosing in Renal Transplant
Authors: Johnston Jackie P. , Cohen Elizabeth A. , Casal Gianna H. , Asch William S. , Reardon David P. 
Published: March 2021

Background: The interaction between azole antifungal therapy and immunosuppressant tacrolimus (TAC) is a barrier to use. Objective: This study quantified the drug interaction between low-dose fluconazole (LDF) and TAC to determine the appropriate TAC dose adjustment when used concurrently in renal transplant recipients. Methods: We conducted a single-center retrospective chart review of renal transplant patients >18 years who received LDF or nystatin (NYS), and TAC. The primary outcome was the difference in tacrolimus total daily dose (TAC TDD) for LDF versus NYS groups. Secondary outcomes included days with supratherapeutic, therapeutic and subtherapeutic tacrolimus levels, time to therapeutic level, incidence of adverse drug reactions and graft rejection. Results: We evaluated 94 patients and included 81. Low-dose fluconazole received a greater TAC TDD prior to post-operative day (POD) 10 (10.5 ± 4.7 mg vs. 7.1 ± 4.5 mg, p < 0.001), but a decreased TAC TDD POD 10 - 30 (8.6 ± 2.2 mg vs. 9.8 ± 0.8 mg, p < 0.001) and following LDF discontinuation (6.9 ± 0.1 mg vs. 9.0 ± 0.4 mg, p < 0.001). Low-dose fluconazole had more patient-days with supratherapeutic (17.9 ± 7.0 vs. 13.9 ± 8.5; p = 0.02) but fewer with subtherapeutic (6.7 ± 5.7 vs. 12.9 ± 7.2; p < 0.01) TAC levels. There was no difference in patient-days with therapeutic TAC levels (15.9 ± 5.8 vs. 14.4 ± 6.6, p = 0.28), meanwhile LDF required less patient-days to therapeutic TAC level (7.1 ± 2.7 vs. 11.5 ± 7.7; p < 0.01). There was no difference in adverse drug reactions between groups and no incidence of graft rejection. Conclusion: A 20% reduction in TAC TDD is warranted in renal transplant patients when used concomitantly with LDF to achieve therapeutic levels.
Determinants of Increased Fibrinogen in COVID-19 Patients With and Without Diabetes and Impaired Fasting Glucose
Authors: Wang Zhenzhou , Du Zhe , Zhao Xiujuan , Guo Fuzheng , Wang Tianbing , Zhu Fengxue 
Published: March 2021

Background: To investigate the factors associated with elevated fibrinogen (Fbg) levels in COVID-19 patients with and without diabetes (DM) and impaired fasting glucose (IFG). Methods: According to whether or not their glucose metabolism was impaired, COVID-19 patients were subdivided into 2 groups: 1) with DM and IFG, 2) control group. Their demographic data, medical history, signs and symptoms, laboratory results, and final clinical results were analyzed retrospectively. Results: 28 patients (16.3%) died during hospitalization, including 21 (29.2%) in group 1 and 7 (7.0%) in group 2 (P < 0.001). Fbg levels in groups 1 and 2 were higher than the normal range, at 5.6 g/L (IQR 4.5–7.2 g/L) and 5.0 g/L (IQR 4.0–6.1 g/L), respectively (P = 0.009). Serum ferritin levels, C-reactive protein (CRP), interleukin-6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α), triglycerides (TG) were significantly increased in group 1 compared to those in the control. TG levels were 1.3 mmol/L in the control, while that in group 1 was 1.8 mmol/L. Multiple linear regression showed that the predicting factors of Fbg in the control group were serum ferritin and CRP, R2 = 0.295; in group 1, serum ferritin, CRP, and TG, R2 = 0.473. Conclusions: Fbg in all COVID-19 patients is related to serum ferritin and CRP involved in inflammation. Furthermore, in COVID-19 patients with insulin resistance, Fbg is linearly positively correlated with TG. This suggests that regulation of TG, insulin resistance, and inflammation may reduce hypercoagulability in COVID-19 patients, especially those with insulin resistance.
Assessing the risk of venous thromboembolism (VTE) in ambulatory patients with cancer: Rationale and implementation of a pharmacist-led VTE risk assessment program in an ambulatory cancer centre
Authors: Pelletier Ryan 
Published: March 2021

Objectives The objectives of this paper were to identify and compare clinical prediction models used to assess the risk of venous thromboembolism (VTE) in ambulatory patients with cancer, as well as review the rationale and implementation of a pharmacist-led VTE screening program using the Khorana Risk Score model in an ambulatory oncology centre in Sault Ste. Marie, Ontario, Canada. Data Sources PubMed was used to identify clinical practice guidelines and review articles discussing risk prediction models used to assess VTE risk in ambulatory patients with cancer. Data Summary Three commonly used VTE risk prediction models in ambulatory patients with cancer: the Khorana Risk Score, Vienna Cancer and Thrombosis Study (CATS) and Protecht Score, were identified via literature review. After considering guideline recommendations, site-specific factors (i.e. laboratory costs, time pharmacists spent calculating VTE risk) and evidence from the CASSINI and AVERT trials, a novel pharmacist-led VTE risk assessment program using the Khorana Risk Score was developed during a fourth-year PharmD clinical rotation at the Algoma District Cancer Program (ADCP) [ambulatory cancer care centre]. ADCP patients with a Khorana Risk Score of [Formula: see text] were referred to the hematologist for a full VTE workup. Considering limitations, inclusion and exclusion criteria of the CASSINI and AVERT trials, the hematologist and pharmacy team decided on appropriate initiation of thromboprophylaxis with a direct oral anticoagulant (DOAC). Conclusions The Khorana Risk Score was the chosen model used for the pharmacist-led VTE risk assessment program due to its user-friendly scoring algorithm, evidence from validation studies and clinical trials, as well as ease of integration into pharmacy workflow. More research is needed to determine if pharmacist-led VTE risk assessment programs will impact patient outcomes, such as morbidity and mortality, secondary to cancer-associated thrombosis.