bluuebunny/crossref_metadata_2025_split huggingface dataset:
Doppler Radar Observations of Horizontal Shearing Instability in Quasi-Linear Convective Systems
Authors: Conrad Dustin M. , Knupp Kevin R. 
Published: February 2019

AbstractDual-Doppler radar observations of two cold-season, wave-propagating quasi-linear convective systems (QLCS), which evolved in high-shear, low-CAPE (HSLC) environments, are analyzed to determine the role that horizontal shearing instability (HSI) plays in the formation of mesovortices. One QLCS occurred on 4 January 2015 and produced two mesovortices within the dual-Doppler region, one of which was associated with an EF-1 tornado with a pathlength of 10 km. The second QLCS occurred on 28 November 2016 and did not produce any mesovortices. Storm characteristics such as the low-level wind speed and wind shift angle are investigated. Rayleigh and Fjørtoft instability criteria, which are required but insufficient for HSI, are also examined. The Rayleigh and Fjørtoft instability criteria are satisfied for the 4 January 2015 QLCS and the 28 November 2016 QLCS, highlighting one of the issues of the “required, but insufficient” characteristic of the criteria. Analysis of the wind shift angle and wind speed agree with previous studies that pronounced wind shifts close to 90° and strong wind speeds were conducive to the formation of mesovortices, while weak wind shift angles and weaker wind speeds were not. It was found that for the 4 January 2015 case, HSI was the likely formation mechanism of the vortices as other features associated with preexisting mesovortexgenesis theories were not observed.
Reconsidering the Role of Design Standards in Developing Effective Safety Labeling: Monolithic Recipes or Collections of Separable Features?
Authors: Kalsher Michael J. , Obenauer William G. , Weiss Christopher F. 
Published: February 2019

Objective This research investigated whether safety labeling design guidelines, such as the American National Standards Institute (ANSI) Z535 series, contribute to better warnings. Background Studies investigating the impact of safety label formatting on warning effectiveness have produced mixed findings. Additionally, research has failed to find a consistent relationship between measures of predicted and actual compliance. One commonality is that all of these studies have investigated the ANSI Z535 guidelines as a binary variable rather than as an integrative system of separable features. Method We measured predicted compliance using both a within-subjects and a between-subjects design, but actual compliance using only a between-subjects design. Data were analyzed using both analysis of variance and linear/probit regressions to test the relationships between warning features recommended in the ANSI Z535 guidelines and measures of behavioral compliance. Results Predicted compliance assessed via a within-subjects design differed greatly from predicted compliance assessed via a between-subjects design. Levels of predicted and actual compliance were most similar when both measures were assessed using a between-subjects design. Consistent with previous research, location had a strong relationship with actual compliance, but surprisingly, presence of an ANSI-style orange warning header had a negative relationship with compliance. Conclusion The choice of experimental design and analytical methods can dramatically influence a study’s results and conclusions drawn. This research identified several aspects of experimental design that should be considered in future research on warning effectiveness. Application Testing features recommended in the ANSI Z535 guidelines under varying conditions can contribute to the development of more effective warnings.
Extranodal NK/T-cell lymphoma in adolescents: imaging findings of a consecutive 7-year case series
Authors: Guan Pujun , Chen Zihang , Chu Lei , Zhen Li , Zhang Li , Pan Ling , Liu Weiping , Liu Rongbo 
Published: February 2019

Objectives Extranodal NK/T-cell lymphoma is reportedly a rare but emerging type of lymphoma in adolescents. The present study was performed to specify its imaging characteristics. Methods Our hospital’s picture archiving and communication systems were searched from January 2009 to December 2016. We identified 13 patients aged <18 years with pathologically confirmed extranodal NK/T-cell lymphoma in the head and neck region. The computed tomography and magnetic resonance images were reviewed to summarize the imaging characteristics of extranodal NK/T-cell lymphoma in adolescents. Results The mean age at onset was 15.2 ± 1.46 years (range, 12–17 years) with a male:female ratio of 1.17:1.00. Most of the patients (n = 10) displayed nasal cavity and/or paranasal involvement. The tumor was homogeneous in both computed tomography and magnetic resonance images and showed slight enhancement. No calcification or liquefactive necrosis was observed. Adjacent structures were usually involved. Conclusion Suggestive imaging characteristics could acquaint specialists with extranodal NK/T-cell lymphoma in adolescents, facilitating improved early recognition of the diagnosis and helping to improve the patient’s outcome.
ACL Repair With Suture Ligament Augmentation Is Associated With a High Failure Rate Among Adolescent Patients
Authors: Gagliardi Alexia G. , Carry Patrick M. , Parikh Harin B. , Traver Jessica L. , Howell David R. , Albright Jay C. 
Published: February 2019

Background: The anterior cruciate ligament (ACL) repair technique avoids graft harvest and therefore the risk of donor site morbidity. However, early failure rates after ACL repair with suture ligament augmentation (SLA) remain high. Purpose: To compare surgical failure, functional outcomes, return to sport, and joint laxity between adolescents who underwent ACL repair with SLA and those who underwent ACL reconstruction with quadriceps tendon–patellar bone autograft (QPA). Study Design: Cohort study; Level of evidence, 3. Methods: Adolescent patients (7-18 years old) underwent ACL repair with SLA or ACL reconstruction with QPA. The authors collected data from those who had postoperative information pertaining to repaired ligament or graft failure, range of motion, complications, and return to sport at a minimum of 6 months after surgery. Participants were contacted after surgery to complete study questionnaires. Results: The cohort included 22 consecutive patients in the SLA group and 157 in the QPA group. The median duration of follow-up was 2.7 years (interquartile range, 2.0-3.6 years) in the QPA group and 3.2 years (2.2-3.4 years) in the SLA group. After adjustment for sex, age, body mass index, and time from injury to surgery, the hazard of graft failure in the SLA group was 10.66 times (95% CI, 3.41-32.92; P < .0001) that of the QPA group. The cumulative incidence of graft failure in the first 3 years after surgery was 48.8% (95% CI, 28.9%-73.1%) in the SLA group, as opposed to 4.7% (2.1%-10.3%) in the QPA group. There was no difference in return to sport between the groups. Among individuals who did not rerupture their ACL, International Knee Documentation Committee and Lysholm scores were comparable between the groups, as well as range of motion. Conclusion: The risk of failure was significantly increased in the SLA group relative to the QPA group. The high risk of failure for the SLA group in this short-term follow-up should be considered when selecting the treatment for adolescent patients with an ACL injury.
Improving End-of-Life Care for Diverse Populations: Communication, Competency, and System Supports
Authors: McCleskey Sara G. , Cain Cindy L. 
Published: February 2019

Background: While disparities in end-of-life care have been well-documented, explanations for the persistence of disparities are less clear. This study sought to examine diverse perceptions of end-of-life care, especially regarding how medical professionals can better serve all populations. Objective: To investigate similarities and differences in end-of-life care preferences, across racial and ethnic groups. Design: This work consists of a qualitative study utilizing in-depth focus group discussions. Setting/Participants: Six community-based focus groups were conducted with a total of 39 participants. Two groups were composed of African American participants, 2 had Latino participants, and 2 groups had white participants. Results: Analysis produced 3 major themes: (1) clear, comprehensive, and culturally relevant provider–patient communication regarding serious illness; (2) provider characteristics and competency; and (3) health system supports and barriers. Although all groups had individuals who expressed a strong preference for direct communication, individuals varied within groups. All groups discussed concerns that the costs of care are high and that financial considerations are given more importance than high-quality care. Groups diverged in their focus on provider characteristics and feelings of marginalization. African American and Latino groups emphasized a desire to match characteristics with providers, and African American groups discussed that their marginalization in the health-care system requires hypervigilance to receive high-quality care. Conclusions: Improvements in care would come from acknowledging diversity within groups, provider demonstration of comfort and competence, more effective care coordination, and recruitment of providers who share similar characteristics with the communities they serve.
Treatment of Renal Artery Stenosis in a Solitary Kidney Using Cutting Balloon Angioplasty in a Paediatric Patient
Authors: Hall Thomas C , Williams Alun , Hussain Farida , O’Neill Richard 
Published: February 2019

Aims: Renovascular hypertension is a rare cause of paediatric hypertension. It is however, a potentially treatable cause particularly when caused by renal artery stenosis (RAS). Materials and Methods: We present the case of an 11-month-old girl presenting with cardiac dysfunction. She was found to be hypertensive with a systolic blood pressure >180mmHg. DMSA demonstrated a small right kidney and a divided renal function of 6% on the right and 94% on the left. Spectral analysis demonstrated abnormal waveforms suggestive of RAS of the left kidney. Results: Angioplasty with a cutting balloon was successful. Blood pressure measurements, renal function and left ventricular function improved. Conclusion: RAS can be successfully treated with cutting balloon angioplasty after failure of convention balloon angioplasty to relieve the narrowing. In our case, there was an immediate successful angiographic result that on mid-term follow-up demonstrated significant improvement in clinical and biochemical outcomes and cessation of all anti-hypertensive medication.
Effects of sarcopenia on functional improvement over the first year after cardiac surgery: a cohort study
Authors: Teng Chiao-Hsin , Chen Ssu-Yuan , Wei Yu-Chung , Hsu Ron-Bin , Chi Nai-Hsin , Wang Shoei-Shen , Chen Yih-Sharng , Chen Cheryl Chia-Hui 
Published: February 2019

Background: Sarcopenia is linked with poor postoperative outcomes. Aims: To evaluate the effects of sarcopenia on first-year functional changes after cardiac surgery. Methods: In this prospective cohort study, functional changes (physical activity levels in metabolic equivalent hours/week, 6-minute walking distance in metres, and grip strength in kg) from preoperative baseline to 1, 3, 6 and 12 months postoperatively were compared in adult patients with and without sarcopenia undergoing cardiac surgery at a tertiary medical centre. Presurgical sarcopenia was defined as low muscle mass plus either low strength or poor physical performance (i.e. reduced gait speed). Secondary outcomes (length of hospital stay and 1-year mortality) were compared between sarcopenia and non-sarcopenia groups. Results: Sarcopenia presented in 27.7% ( n=67) of 242 participants. Participants with sarcopenia were significantly older, predominantly women, and had lower body mass index and higher cardiac surgery risk (measured by the EuroSCORE II) than those without sarcopenia. For both groups, physical activity levels, walking distance and grip strength steadily improved over the year following cardiac surgery. Independent of EuroSCORE II, changes in physical activity levels, walking distance and grip strength did not differ significantly between the sarcopenia and non-sarcopenia groups 1, 3, 6 and 12 months after surgery. Nevertheless, the sarcopenia group had a significantly longer length of hospital stay than the non-sarcopenia group (19.4 vs. 15.3 days; β=2.9, P=0.02) but 1-year mortality (3.4 vs. 3.9% for non-sarcopenia group) was comparable. Conclusions: Despite a longer length of hospital stay for the sarcopenia group, sarcopenia was not a restriction for cardiac surgery given their comparable functional improvement and mortality 1 year following surgery.
Japan's Development Ambitions for Myanmar: The Problem of “Economics before Politics”
Authors: Seekins Donald M. 
Published: February 2019

Myanmar and Japan have had an important shared history since the Pacific War, when Japan occupied the British colony of Burma and established the country's first postcolonial state and army. The period from 1941 to 1945 also witnessed the “militarization” of Myanmar as the country was turned into a battlefield by the Japanese, the Allies and indigenous insurgents. After independence from Britain in 1948, the Union of Burma continued to suffer insurgency and became a deeply conflicted society, especially under the isolationist socialist regime of General Ne Win (1962–1988). However, Japan played a major role in Myanmar's economic development through its allocation of war reparations and official development assistance (ODA), especially yen loans. During the period of martial law from 1988 to 2011, Tokyo exercised some self-restraint in giving aid due to pressure from its major ally, the United States, with its human rights agenda. However, with the transition from junta rule to constitutional government in 2011 came a dramatic increase in Japanese ODA, as Tokyo forgave large amounts of debt and invested in ambitious new special economic zones (SEZ). Japan will no doubt benefit from Myanmar as close ties are expanded: Not only will Japanese companies profit, but Japan will have access to Myanmar's raw materials and gain ability to compete more effectively with an economically expansive China. On Myanmar's side, though, it is unlikely that anyone other than the military and crony capitalist elites will benefit from the flood of new yen loans and infrastructure projects. This paper argues that without a political resolution of Myanmar's many conflicts, including the establishment of genuinely open political institutions, the aid of Japan (and other countries) is likely to make these deep-rooted social and ethnic conflicts even worse.
Adaptive design of a clinical decision support tool: What the impact on utilization rates means for future CDS research
Authors: Mann Devin , Hess Rachel , McGinn Thomas , Mishuris Rebecca , Chokshi Sara , McCullagh Lauren , Smith Paul D. , Palmisano Joseph , Richardson Safiya , Feldstein David A. 
Published: February 2019

OBJECTIVE We employed an agile, user-centered approach to the design of a clinical decision support tool in our prior integrated clinical prediction rule study, which achieved high adoption rates. To understand if applying this user-centered process to adapt clinical decision support tools is effective in improving the use of clinical prediction rules, we examined utilization rates of a clinical decision support tool adapted from the original integrated clinical prediction rule study tool to determine if applying this user-centered process to design yields enhanced utilization rates similar to the integrated clinical prediction rule study. MATERIALS & METHODS: We conducted pre-deployment usability testing and semi-structured group interviews at 6 months post-deployment with 75 providers at 14 intervention clinics across the two sites to collect user feedback. Qualitative data analysis is bifurcated into immediate and delayed stages; we reported on immediate-stage findings from real-time field notes used to generate a set of rapid, pragmatic recommendations for iterative refinement. Monthly utilization rates were calculated and examined over 12 months. RESULTS We hypothesized a well-validated, user-centered clinical decision support tool would lead to relatively high adoption rates. Then 6 months post-deployment, integrated clinical prediction rule study tool utilization rates were substantially lower than anticipated based on the original integrated clinical prediction rule study trial (68%) at 17% (Health System A) and 5% (Health System B). User feedback at 6 months resulted in recommendations for tool refinement, which were incorporated when possible into tool design; however, utilization rates at 12 months post-deployment remained low at 14% and 4% respectively. DISCUSSION Although valuable, findings demonstrate the limitations of a user-centered approach given the complexity of clinical decision support. CONCLUSION Strategies for addressing persistent external factors impacting clinical decision support adoption should be considered in addition to the user-centered design and implementation of clinical decision support.
A virtual reality tool for measuring and shaping trunk compensation for persons with stroke: Design and initial feasibility testing
Authors: Foreman Matthew H , Engsberg Jack R 
Published: February 2019

Background: Compensatory movement, such as flexing the trunk during reaching, may negatively affect motor improvement during task-based practice for persons with stroke. Shaping, or incrementally decreasing, the amount of compensation used during rehabilitation may be a viable strategy with methods using virtual reality. Methods: A virtual reality tool was designed to (1) monitor upper extremity movement kinematics with an off-the-shelf motion sensor (Microsoft Kinect V2), (2) convert movements into control of widely available computer games, and (3) provide real-time feedback to shape trunk compensation. This system was tested for feasibility by a small cohort of participants with chronic stroke ( n = 5) during a 1-h session involving 40 min of virtual reality interaction. Outcomes related to repetitions, compensation, movement kinematics, usability, motivation, and sense of presence were collected. Results: Participants achieved a very high dose of reaching repetitions (461 ± 184), with an average of 81% being successful and 19% involving compensatory trunk flexion. Participants rated the system as highly usable, motivating, engaging, and safe. Conclusions: VRShape is feasible to use as a tool for increasing repetition rates, measuring and shaping compensation, and enhancing motivation for upper extremity therapy. Future research should focus on software improvements and investigation of efficacy during a virtual reality-based motor intervention.
Neurologic Disease Is a Risk Factor for Revision After Lumbar Spine Fusion
Authors: Glassman Steven D. , Carreon Leah Y. , Dimar John R. , Gum Jeffrey L. , Djurasovic Mladen 
Published: February 2019

Study Design: Medicare database analysis. Objective: The purpose of this study was to investigate whether neurologic disorders represent a risk factor for revision after lumbar spine surgery. Methods: Patients who underwent lumbar spine surgery were identified from 5% Medicare Part B claims between 2005 and 2008. Cox regression analysis was used to evaluate risk factors for revision within the 7 years after the index lumbar surgery. Covariates included age, gender, race, census region, Medicare buy-in status, Charlson score, year, prior lumbar fusion within 2 years of index surgery, prior diagnosis of cervical spondylotic myelopathy treated with or without cervical spine surgery, and diagnoses of other neuromuscular conditions. Results: Of 8665 cases who had decompression only, 401 (5%) had a revision within 7 years after the index surgery. Factors predictive of revision were prior lumbar fusion (hazard ratio [HR] = 2.78, confidence interval [CI] = 1.43-5.37, P = .002) and being female (HR = 1.61, CI = 1.31-1.97, P < .001). Of 5501 cases who had a decompression and fusion, 752 (14%) had a revision surgery within 7 years after the index surgery. Factors predictive of revision were the presence of a neurologic disorder (HR = 1.24, CI = 1.05-1.46, P = .010), prior lumbar fusion (HR = 3.09, CI = 2.05-4.63, P < .001), and being female (HR = 1.35, CI = 1.15-1.57, P < .001). Conclusions: An increase in revision rate ( P = 0.01, HR = 1.24) was seen in patients with neurologic disorders undergoing lumbar decompression and fusion, although not for patients undergoing decompression alone. This suggests an opportunity to improve clinical outcome and reduce revision rate through improved surgical decision making or treatment of the neurologic disorder.
Patient Reported Experience in a Pediatric Emergency Department
Authors: Bal Chandan , AlNajjar Mohammad , Thull-Freedman Jennifer , Pols Erin , McFetridge Ashley , Stang Antonia S 
Published: February 2019

Objectives: To describe patient-reported experience in a pediatric emergency department (ED) and determine: ( 1 ) whether there are differences between the experience children report in comparison to their parents; and ( 2 ) whether factors such as time of visit (day, evening, night) and ED census are associated with patient experience. Methods: We conducted a prospective cross-sectional survey of children ≥8 years of age and the parents/guardians of children 0 to 17 years who visited a pediatric ED using a validated patient experience measure. The proportion of respondents for each question indicating that an aspect of their care could have been improved was calculated as problem scores for each survey item. The primary outcome was the overall problem scores for all respondents combined and for children and parents separately. Results: A total of 237 parents and 109 children completed surveys. The areas with the highest problem scores identified by both parents and children were: having enough to do while waiting to be seen (53.5; 95% confidence interval [CI]: 48.1, 58.8) and when to restart usual activities (34.7; 95% CI: 29.7, 40.0). There were meaningful differences in problem scores between children and parents including: doctors and nurses explaining what they were doing (parents: 19; 95% CI: 14.3, 24.7, child 40.4; 95% CI: 31.2, 50.2) and privacy when examined and treated (parents: 17.3; 95% CI: 12.8, 22.9, child: 36.7; 95% CI: 27.8, 46.5). Conclusion: There are differences in reported experience between children and their parents. This highlights the importance of including children when assessing patient experience in a pediatric setting.