bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Ecosystem Approach and Environmental Justice Nexus in Natural Resource Management
Authors: Alam Shawkat , Mohammad Sheikh Noor 
Published: August 2019

Abstract
The ecosystem approach emerged in the international environmental realm to promote equity and justice for both people and nature. It provides a set of mechanisms, including equitable benefit sharing; conservation and sustainable use; adaptive management; and participatory practices. This article explores how the ecosystem approach that is used in natural resource management shares synergies with notions of environmental justice, including distributional justice, procedural justice and justice-as-recognition. It also explores how the ecosystem approach responds to two additional principles of environmental justice that are specific to environmental disciplines, namely, intergenerational equity and the precautionary principle. The article illustrates the complementarity between the ecosystem approach and environmental justice through practical examples and argues that environmental justice can be promoted by utilizing the ecosystem approach as a vehicle for policy-makers.
Making the Black Box More Transparent: Understanding the Physical Implications of Machine Learning
Authors: McGovern Amy , Lagerquist Ryan , John Gagne David , Jergensen G. Eli , Elmore Kimberly L. , Homeyer Cameron R. , Smith Travis 
Published: August 2019

AbstractThis paper synthesizes multiple methods for machine learning (ML) model interpretation and visualization (MIV) focusing on meteorological applications. ML has recently exploded in popularity in many fields, including meteorology. Although ML has been successful in meteorology, it has not been as widely accepted, primarily due to the perception that ML models are “black boxes,” meaning the ML methods are thought to take inputs and provide outputs but not to yield physically interpretable information to the user. This paper introduces and demonstrates multiple MIV techniques for both traditional ML and deep learning, to enable meteorologists to understand what ML models have learned. We discuss permutation-based predictor importance, forward and backward selection, saliency maps, class-activation maps, backward optimization, and novelty detection. We apply these methods at multiple spatiotemporal scales to tornado, hail, winter precipitation type, and convective-storm mode. By analyzing such a wide variety of applications, we intend for this work to demystify the black box of ML, offer insight in applying MIV techniques, and serve as a MIV toolbox for meteorologists and other physical scientists.
Predictors of help-seeking in unemployed people with mental health problems
Authors: Wigand Moritz E , Oexle Nathalie , Waldmann Tamara , Staiger Tobias , Becker Thomas , Rüsch Nicolas 
Published: August 2019

Background: Unemployment and mental ill health often contribute to each other and lead to social exclusion with negative consequences for individuals and society. Yet, unemployed people with mental health problems often do not seek care. Aims: The aim of this study was to assess predictors of help-seeking among unemployed people with mental health problems. Methods: At baseline, 301 unemployed participants with mental health problems reported potential predictors of help-seeking in terms of mental health literacy, perceived barriers to care, self-concept as having a mental illness and current mental health service use. At 6-month follow-up, 240 participants reported whether or not they had started new mental health treatment since baseline. Results: Adjusted for symptoms, sociodemographic and work-related variables, help-seeking was predicted by previous mental health service use and by fewer non-stigma-related barriers, not by stigma-related barriers. Conclusion: Implications for interventions to increase help-seeking among this vulnerable group are discussed.
Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE
Authors: Krooupa Anna-Maria , Vivat Bella , McKeever Stephen , Marcus Elena , Sawyer Joseph , Stone Paddy 
Published: August 2019

Background: The use of observational measures to assess palliative care patients’ level of consciousness may improve patient care and comfort. However, there is limited knowledge regarding the validity and reliability of these measures in palliative care settings. Aim: To identify and evaluate the psychometric performance of observational level of consciousness measures used in palliative care. Design: Systematic review; PROSPERO registration: CRD42017073080. Data sources: We searched six databases until November 2018, using search terms combining subject headings and free-text terms. Psychometric performance for each identified tool was appraised independently by two reviewers following established criteria for developing and evaluating health outcome measures. Results: We found 35 different levels of consciousness tools used in 65 studies. Only seven studies reported information about psychometric performance of just eight tools. All other studies used either ad hoc measures for which no formal validation had been undertaken ( n = 21) or established tools mainly developed and validated in non-palliative care settings ( n = 37). The Consciousness Scale for Palliative Care and a modified version of the Richmond Agitation–Sedation Scale received the highest ratings in our appraisal, but, since psychometric evidence was limited, no tool could be assessed for all psychometric properties. Conclusion: An increasing number of studies in palliative care are using observational measures of level of consciousness. However, only a few of these tools have been tested for their psychometric performance in that context. Future research in this area should validate and/or refine the existing measures, rather than developing new tools.
Suicides in Young People in Ontario Following the Release of “13 Reasons Why”
Authors: Sinyor Mark , Williams Marissa , Tran Ulrich S. , Schaffer Ayal , Kurdyak Paul , Pirkis Jane , Niederkrotenthaler Thomas 
Published: August 2019

Objective: “13 Reasons Why,” a Netflix series, included a controversial depiction of suicide that has raised fears about possible contagion. Studies of youth suicide in the United States found an increase on the order of 10% following release of the show, but this has not been replicated in other countries. This study aims to begin to address that gap by examining the relationship between the show’s release and youth suicide in Canada’s most populous province. Methods: Suicides in young people (under the age of 30) in the province of Ontario following the show’s release on March 31, 2017, were the outcome of interest. Time-series analyses were performed using data from January 2013 to March 2017 to predict expected deaths from April to December 2017 with a simple seasonal model (stationary R 2 = 0.732, Ljung-Box Q = 15.1, df = 16, P = 0.52, Bayesian information criterion = 3.09) providing the best fit/used for the primary analysis. Results: Modeling predicted 224 suicides; however, 264 were observed corresponding to 40 more deaths or an 18% increase. In the primary analysis, monthly suicides exceeded the 95% confidence limit for 3 of the 9 months (May, July, and October). Conclusion: The statistical strength of the findings here is limited by small numbers; however, the results are in line with what has been observed in the United States and what would be expected if contagion were occurring. Further research in other locations is needed to increase confidence that the associations found here are causal.
Support for Breastfeeding Employees: Assessing Statewide Worksite Lactation Support Recognition Initiatives in the United States
Authors: Reat Amanda , Matthews Krystin J. , Carver Alma E. , Perez Cristell A. , Stagg Julie , Byrd-Williams Courtney E. 
Published: August 2019

Background Although the reasons for discontinued breastfeeding are multifactorial, an unsupportive work environment is consistently reported as a barrier to continued breastfeeding. In the United States, several state breastfeeding advocates have taken a distinctive approach to promote worksite lactation support by developing statewide recognition initiatives aimed at incentivizing employers to support breastfeeding employees by offering public recognition for the worksites’ efforts. Research aim To identify and describe statewide worksite lactation support recognition initiatives in the United States. Methods Between May 2016 and June 2017, semi-structured phone interviews were conducted with breastfeeding experts in each U.S. state ( N = 60 participants) for this cross-sectional study. Experts in states with a recognition initiative were asked about the background, structure, and requirements of the initiative. Results Twenty-six states had a current initiative, and some had requirements for providing a private space ( n = 19; 73%) and time ( n = 18; 69%) for employees to express human milk, as well as a written worksite lactation support policy ( n = 10; 38%). Conclusions This was the first study in which researchers systematically identified ongoing worksite lactation support recognition initiatives in the United States. The results of this work also served to highlight both the similarities and the variety between initiatives. Future researchers should aim to determine the components of an initiative that increase employer support and, in turn, breastfeeding rates.
The characteristics of captopril challenge test–positive patients using various criteria
Authors: Kidoguchi Satoshi , Sugano Naoki , Hayashi-Ishikawa Naomi , Morisawa Norihiko , Tokudome Goro , Yokoo Takashi 
Published: August 2019

Introduction: The captopril challenge test (CCT) is the major confirmatory test for primary aldosteronism (PA), and frequently carried out because of its convenience. However, it presents false-negative results with a certain probability, and as there are many criteria for CCT, it is not concluded yet which criteria to use. Materials and methods: A total of 71 PA patients were evaluated. We compared CCT-positive and CCT-negative patients in the following three criteria: plasma aldosterone/renin ratio (ARR) >200 after the CCT (criterion 1); plasma aldosterone concentration (PAC) >120 pg/ml after the CCT (criterion 2); and PAC suppression <30% of PAC before CCT (criterion 3). Results: The positive rate was 70.4%, 64.8% and 54.9% for criterion 1, criterion 2 and criterion 3, respectively. With criterion 1, the baseline plasma renin activity was lower, thus baseline ARR was higher in CCT-positive patients. With criterion 2, PAC was higher and estimated sodium intake and K were lower in CCT-positive patients. With criterion 3, K and PAC were lower in CCT-positive patients. Although it was not significant, in the patients with high sodium intake, the positive rate of criterion 1 was higher than that of the other criteria. Conclusions: ARR>200 is the valuable criterion for the diagnosis of PA.
Safety and effectiveness of multi-antenna microwave ablation-oriented combined therapy for large hepatocellular carcinoma
Authors: Zhang Tian-qi , Huang Zhi-mei , Shen Jing-xian , Chen Gui-qun , Shen Lu-jun , Ai Fei , Gu Yang-kui , Yao Wang , Zhang Yan-yang , Guo Rong-ping , Chen Min-shan , Huang Jin-hua 
Published: August 2019

Background: In patients with a large, unresectable hepatocellular carcinoma (HCC), the primary recommendation is for transarterial chemoembolization (TACE) but used alone TACE is not typically curative. Combinations of TACE followed in a delayed fashion by single-applicator thermal ablation have also been suboptimal. As an alternative, we investigated the combination of TACE followed within 1–3 days by multi-antenna microwave ablation (MWA) in patients with a large HCC, to determine the feasibility, safety, local control, and short-term survival rates of this approach. Methods: We retrospectively studied 43 patients with a large HCC (mean diameter, 8.8 cm; SD, 2.8 cm) treated between July 2015 and July 2018, who underwent TACE followed within 3 days by multi-antenna simultaneous MWA. We measured the liver and renal function before and after treatment, recorded complications, used three-dimensional software and imaging to calculate tumor necrosis rates at 1 month after therapy, and calculated overall survival (OS) and progression-free survival (PFS) using the Kaplan–Meier method. Results: Mean follow up was 12.2 (range, 3.5–35.6) months. All patients completed the treatment protocol. At 1 month after combined therapy, tumor necrosis was complete in 16 (37.2%), nearly complete in 19 (44.2%), and partial in 8 (18.6%) patients. The 1- and 2-year OS rates were 64.0% and 46.8%, respectively, with a median OS of 23.0 months; and the 1- and 2-year PFS rates were 19.9% and 4.4%, respectively, with a median PFS of 4.2 months. A transient change in liver function occurred 3 days after MWA but resolved within 1 month. Only two patients had major complications, which were treatable and resolved. Conclusion: Multi-antenna MWA-oriented combined therapy is feasible and well tolerated, and it results in satisfactory initial local control and short-term survival in some but not all patients with a large HCC.
Feasibility and safety of the antecubital venous access for right heart catheterization in patients with pulmonary hypertension
Authors: Avriel Avital , Kassirer Michael , Shimony Avi , Tsaban Gal , Bar‐Shai Amir , Merkin Miri , Rosenstein Gabriel , Zahger Doron , Wiesen Jonathan , Cafri Carlos 
Published: August 2019

BackgroundThe diagnosis of pulmonary arterial hypertension requires right heart catheterization (RHC) which is typically performed via proximal venous access (PVA). Antecubital venous access (AVA) is an alternative approach for RHC that can minimize complications, decrease procedural duration and allow for immediate patient recovery. A direct comparison between the two procedures in patients with pulmonary hypertension (PH) is lacking.ObjectivesTo determine the feasibility, safety, and adoption rates of AVA‐RHC as compared with ultrasound‐guided PVA in a subpopulation of patients with PH.MethodsAll patients who underwent RHC for evaluation of PH between December 2014 and March 2017 at a single large academic medical center were included in this study. Demographic, procedural and outcomes data were retrieved from the medical records.ResultsIn total, 159 RHC were included (124 AVA, 35 PVA). The duration of RHC was significantly shorter in the AVA compared with PVA group (53 (IQR 38–70) vs. 80 (IQR 56–95) min, respectively, p < 0.001). 19% of AVA (24/124) procedures were switched to PVA. Failed attempts at AVA were more common in scleroderma (50% failure rate). Success rate of AVA increased from 81.2% to 93.3% from the first to last quartile. Fluoroscopy time was similar in both groups, the difference between the groups in the radiation dose are not statistically significant (54.5 (IQR 25–110) vs. 84.5 (IQR 30–134)).ConclusionAVA‐RHC is a feasible and safe alternative to PVA in patients with PH who are evaluated for pulmonary arterial hypertension diagnosis. Our experience and rapid adoption rate support the use of AVA as the preferred access site for RHC in uncomplicated PH patients.
Blood Lead Levels of Children Using Traditional Indian Medicine and Cosmetics: A Feasibility Study
Authors: Keosaian Julia , Venkatesh Thuppil , D’Amico Salvatore , Gardiner Paula , Saper Robert 
Published: August 2019

Background Traditional Indian cosmetics and Ayurvedic medicines may contain lead. Previous studies have shown a relationship between eye cosmetic use (kohl) in children and elevated blood lead levels (BLLs) > 10 µg/dL. However, an association between Ayurvedic use and elevated BLLs in children is unknown and understudied. Methods We assessed the feasibility of collecting BLLs in children attending Ayurvedic outpatient settings in India. Our pilot study took place over 3 days in the summer of 2010 at a large public Ayurveda hospital and a small pediatric clinic in southern India. Using a trained interpreter, we administered a standardized questionnaire in Malayalam, assessing sociodemographics, Ayurvedic medicine use, kohl use, and other potential risk factors for lead exposure, to parents of pediatric outpatients. We also analyzed BLLs using a portable lead analyzer. Results The study enrolled 29 children (mean age, 3.8 years). The mean BLL was 6.7 µg/dL (SD = 3.5; range, 3.5–20.2). Seventy-two percent of the children used Ayurvedic medicine in the past 2 years and 55% reported kohl use. Mean BLL of Ayurvedic users and nonusers was 6.2 µg/dL and 8.5 µg/dL, respectively ( P = .08). Kohl users had a statistically significant higher BLL than nonusers (8.0 µg/dL vs 5.3 µg/dL, P = .03). Conclusions It is feasible to collect BLLs in pediatric Ayurvedic outpatient clinics in southern India. Collaborative relationships with community members and hospital staff were essential. Further research is needed to investigate Ayurveda and kohl use as risk factors for elevated lead burden among Indian children.
Endoscopic Versus Open Laminectomy for Lumbar Spinal Stenosis: An International, Multi-Institutional Analysis of Outcomes and Adverse Events
Authors: Chiu Ryan G. , Patel Saavan , Zhu Amy , Aguilar Eddy , Mehta Ankit I. 
Published: August 2019

Study Design: Retrospective cohort study and systematic review. Objectives: Endoscopic decompression offers a minimally invasive alternative to traditional, open laminectomy. However, comparison of these surgical techniques has been largely limited to small, single-center studies. In this study, we perform the first international, multicenter comparison of both with regard to their associated rates of mortality, complications, readmissions, and reoperations. Methods: The 2017 American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) database, containing data from over 650 hospitals internationally, was queried to evaluate the effect of endoscopic guidance on adverse events. Operative time, length of stay, readmission and reoperation rates, as well as the incidence of peri- and postoperative complications, were compared between endoscopic and open groups. The PubMed/MEDLINE database was queried for studies comparing the techniques. Results: A total of 10 726 single-level lumbar decompression patients were identified and included in this study, 34 (0.32%) of whom were operated upon endoscopically. Apart from 2 (5.88%) readmissions, among which only 1 was unplanned, there were no reported surgical complications within the endoscopic group. The mean length of stay for these patients was 0.86 ± 1.44 days, with procedures lasting an average of 91.89 ± 46.72 minutes. However, these endpoints did not differ significantly from the open group. On literature review, 16 studies met the inclusion criteria, and largely consisted of single-center, retrospective analyses. Conclusions: Endoscopically guided approaches to single-level lumbar decompression did not reduce the incidence of adverse events, length of stay or operative time, perhaps due to advances among certain nonendoscopic techniques, such as microsurgery.
Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies
Authors: Nguyen Hai , Manolova Gergana , Daskalopoulou Christina , Vitoratou Silia , Prince Martin , Prina A Matthew 
Published: August 2019

Background: With ageing world populations, multimorbidity (presence of two or more chronic diseases in the same individual) becomes a major concern in public health. Although multimorbidity is associated with age, its prevalence varies. This systematic review aimed to summarise and meta-analyse the prevalence of multimorbidity in high, low- and middle-income countries (HICs and LMICs). Methods: Studies were identified by searching electronic databases (Medline, Embase, PsycINFO, Global Health, Web of Science and Cochrane Library). The term ‘multimorbidity’ and its various spellings were used, alongside ‘prevalence’ or ‘epidemiology’. Quality assessment employed the Newcastle-Ottawa scale. Overall and stratified analyses according to multimorbidity operational definitions, HICs/LMICs status, gender and age were performed. A random-effects model for meta-analysis was used. Results: Seventy community-based studies (conducted in 18 HICs and 31 LMICs) were included in the final sample. Sample sizes ranged from 264 to 162,464. The overall pooled prevalence of multimorbidity was 33.1% (95% confidence interval (CI): 30.0–36.3%). There was a considerable difference in the pooled estimates between HICs and LMICs, with prevalence being 37.9% (95% CI: 32.5–43.4%) and 29.7% (26.4–33.0%), respectively. Heterogeneity across studies was high for both overall and stratified analyses ( I 2 > 99%). A sensitivity analysis showed that none of the reviewed studies skewed the overall pooled estimates. Conclusion: A large proportion of the global population, especially those aged 65+, is affected by multimorbidity. To allow accurate estimations of disease burden, and effective disease management and resources distribution, a standardised operationalisation of multimorbidity is needed.
The Effect of Physician Oral Health Services on Dental Use and Expenditures under General Anesthesia
Authors: Meyer B.D. , Wang R. , Steiner M.J. , Preisser J.S. 
Published: August 2019

Background: Despite early evidence touting the effectiveness of physician-provided oral health services (POHS), recent evidence suggests these services might have little impact on caries-related outcomes in children. General anesthesia (GA) is often used to treat early childhood caries and may be considered the most extreme utilization outcome. We sought to assess the impact of POHS utilization on dental GA utilization and expenditures. Methods: We used the Medicaid claims of a birth cohort of children born in 2008 in North Carolina ( N = 32,558) to determine the impact of POHS on dental utilization and expenditures under GA for individual children. Children were followed until their eighth birthday. We analyzed the association of the number of prior POHS visits with visit-specific outcomes of dental treatment under GA using population-averaged models fit with generalized estimating equations with exchangeable working correlation structure. Results: Children with 2 or more previous POHS visits had reduced odds of GA (odds ratio [OR] = 0.93; confidence interval [CI], 0.87–0.99; P = 0.029) and expenditures ($114; CI,−$152.61 to −$75.19; P < 0.001) compared to those without physician-provided oral health visits, adjusting for age, sex, race/ethnicity, and geographic residence. Dental expenditures did not differ between POHS and non-POHS subjects at non-GA visits. Conclusions: POHS decreased the odds of having dental GA treatment and dental expenditures at GA visits. The role of physicians in oral health care can reduce the impact on the most severe outcome—treatment under general anesthesia. Knowledge Transfer Statement: The results of this study have important financial implications for state Medicaid programs and disease management programs trying to mitigate the costs of treating early childhood caries under general anesthesia. Children who receive physician oral health care are less likely to use and more likely to save money on general anesthesia to complete dental treatment.