bluuebunny/crossref_metadata_2025_split huggingface dataset:
From strategy to action: a qualitative study on salient factors influencing knowledge transfer in project-based experiential learning in healthcare organisations in Kenya
Authors: Chelagat Tecla , Onyango Joseph , Kokwaro Gilbert , Rice Jim 
Published: October 2019

ObjectivesKnowledge transfer is recognised as a key determinant of organisational competitiveness. Existing literature on the transfer of knowledge and skills imply diminutive return on investment in training and development due to the low application of learnt knowledge. Following devolution of health services provision to new counties in Kenya in 2013, Strathmore Business School designed an experiential facility improvement project-based leadership training programme for healthcare managers in the new counties. Selected healthcare management teams participated in the leadership training to improve health systems performance in the devolved counties in Kenya. Despite similar training, the projects implementation contexts were different, leading to different implementation completion rates. The aim of this study was to investigate the reasons for this disparity and then recommend solutions.DesignA qualitative study using semi-structured interviews. A thematic framework approach was used in data analysis.Setting and participantsThirty-nine projects teams constituting; 33 successful and 6 unsuccessful project teams, were purposively selected based on their project implementation success rates at the end of the leadership training. The managers had undertaken a team-based institutional improvement project. The prioritised projects were housed within; 23 public, 10 faith-based and 6 private health facilities in 19 counties in Kenya.ResultsOur findings indicate projects completion rates were influenced by (training design, work environment climate, trainee characteristics, team-based coaching and leveraging on occurring opportunities). Transfer barriers were (inadequate management support, inadequate team and staff support, high staff turnover, misalignment of board’s verses manager’s priorities, missing technical expertise, endemic strikes, negative politics and poor communication). Recommendations were (need-driven curriculum, effective allocation and efficient utilisation of resources, proper prioritisation, effective communication, longitudinal coaching and work-teams recruitment).ConclusionThe findings reveal that unless training interventions are informed by a need-driven curriculum customised to real-world work teams, the potential knowledge and skill transfer can be thwarted.
Transformational change in the field of diffuse optics: From going bananas to going nuts
Authors: Fantini Sergio , Blaney Giles , Sassaroli Angelo 
Published: September 2019

The concept of region of sensitivity is central to the field of diffuse optics and is closely related to the Jacobian matrix used to solve the inverse problem in imaging. It is well known that, in diffuse reflectance, the region of sensitivity associated with a given source–detector pair is shaped as a banana, and features maximal sensitivity to the portions of the sample that are closest to the source and the detector. We have recently introduced a dual-slope (DS) method based on a special arrangement of two sources and two detectors, which results in deeper and more localized regions of sensitivity, resembling the shapes of different kinds of nuts. Here, we report the regions of sensitivity associated with a variety of source–detector arrangements for DS measurements of intensity and phase with frequency-domain spectroscopy (modulation frequency: 140[Formula: see text]MHz) in a medium with absorption and reduced scattering coefficients of 0.1 and 12 cm[Formula: see text], respectively. The main result is that the depth of maximum sensitivity, considering only cases that use source-detector separations of 25 and 35 mm, progressively increases as we consider single-distance intensity (2.0[Formula: see text]mm), DS intensity (4.6[Formula: see text]mm), single-distance phase (7.5[Formula: see text]mm), and DS phase (10.9[Formula: see text]mm). These results indicate the importance of DS measurements, and even more so of phase measurements, when it is desirable to selectively probe deeper portions of a sample with diffuse optics. This is certainly the case in non-invasive optical studies of brain, muscle, and breast tissue, which are located underneath the superficial tissue at variable depths.
Unexpected Early Oncologic Mortality after Open Radical Cystectomy for Bladder Cancer: Who Is to Be Blamed?
Authors: Hautmann Richard E. , Bolenz Christian , Volkmer Björn 
Published: September 2019

Purpose: To investigate prevalence and variables associated with early oncologic mortality (EOM; within ≥30 to ≤90 days) of open radical cystectomy (RC) for bladder cancer. The unexpected rapidity of tumour recurrence and the huge metastatic burden of these patients drew us to analyse this cohort. Methods: We reviewed our RC database. All 1,487 patients were treated with curative intent between January 1986 and December 2008. Imaging for staging was done by CT (chest) and CT or MRI (abdomen). Clinical and histopathological variables were recorded until death to determine whether disease- or treatment-related factors were associated with mortality. Results: There were 93 deaths within 90 days of surgery. Twenty-four patients died from early progression to high volume disseminated metastatic disease. Group 1: unresectable tumours, which were never free of disease. Group 2: resectable tumours, considered tumour-free after RC. Group 1 is characterized by local tumour spread and a low distant failure rate. Group 2 has a low local and a high distant failure rate. Conclusions: Disease related (advanced tumour stage, positive soft tissue surgical margins (+STSM), non urothelial histology, unresectable tumours, atypical occult metastasis), rather than technical factors, had the leading role in EOM. Understaging was universal.
Mortality Assessment of Paclitaxel-Coated Balloons
Authors: Gray William A. , Jaff Michael R. , Parikh Sahil A. , Ansel Gary M. , Brodmann Marianne , Krishnan Prakash , Razavi Mahmood K. , Vermassen Frank , Zeller Thomas , White Roseann , Ouriel Kenneth , Adelman Mark A. , Lyden Sean P. 
Published: September 2019

Background:
A recent summary-level meta-analysis comprising randomized, controlled trials (RCTs) of femoropopliteal paclitaxel-coated balloon and stent intervention identified excess late mortality in the paclitaxel-treated patients.

Methods:
We evaluated the safety of the Stellarex drug-coated balloon (DCB) for femoropopliteal artery disease with an independently performed meta-analysis of patient-level data from all patients in the Stellarex femoropopliteal clinical program. To compare mortality after DCB or uncoated percutaneous transluminal angioplasty (PTA), we aggregated data from 2 RCTs comprising 419 patients treated with DCB and 170 patients treated with PTA. In an additional analysis, data were aggregated from 6 poolable Stellarex DCB studies (2 RCTs, 3 single-arm studies, and 1 registry). All serious adverse events including deaths were adjudicated by a blinded, third-party, independent Clinical Events Committee. Kaplan–Meier estimates in the RCTs were compared with restricted mean survival time. Predictors of death were assessed with hazard ratios (HRs) and Cox proportional hazards modeling.

Results:

Baseline characteristics were similar in the patients treated with DCB and PTA in the pooled RCT analysis, with the exception that the DCB cohort was younger (67.4±9.7 versus 69.4±9.4 years,
P
=0.02), smoked more frequently (86.6% versus 78.8%,
P
=0.02), and were less often treated for recurrent lesions (8.8% versus 14.7%,
P
=0.04). In the RCTs, patients treated with DCB had all-cause mortality rates that were not different from those of patients treated with PTA (Kaplan–Meier estimates 1.8±0.7% versus 1.3±0.9%, 6.5±1.2% versus 5.9±1.9%, and 9.3±1.5% versus 9.9±2.4% at 1, 2, and 3 years, respectively,
P
=0.86). All-cause mortality rates were similar in a 1906-patient pooled nonrandomized DCB data set (Kaplan–Meier estimates of 2.1%, 4.9%, and 7.0% at 1, 2, and 3 years, respectively). Clinical Events Committee–adjudicated causes of death were balanced between the DCB and PTA cohorts. Multivariable Cox modeling identified age (HR, 1.06; 95% CI, 1.04–1.08;
P
<0.001), diabetes mellitus (HR, 1.42; 95% CI, 1.01–2.00;
P
=0.04), congestive heart failure (HR, 1.88; 95% CI, 1.12–3.16;
P
=0.02), and renal insufficiency (HR, 2.00; 95% CI, 1.33–3.01;
P
<0.001) as predictors of mortality. Paclitaxel exposure was unrelated to mortality (HR, 1.04; 95% CI, 0.98–1.10;
P
=0.23).

Conclusions:
The mortality rates for patients treated with the DCB and uncoated PTA were indistinguishable over 3-year follow-up. Additional patient-level, adequately powered meta-analyses with larger RCT data sets will be needed to confirm the generalizability of these findings.

Clinical Trial Registration:

URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT02110524, NCT01858363, NCT01858428, NCT03421561, NCT01912937, NCT01927068, and NCT02769273.
Association of Adverse Pregnancy Outcomes With Hypertension 2 to 7 Years Postpartum
Authors: Haas David M. , Parker Corette B. , Marsh Derek J. , Grobman William A. , Ehrenthal Deborah B. , Greenland Philip , Bairey Merz C. Noel , Pemberton Victoria L. , Silver Robert M. , Barnes Shannon , McNeil Rebecca B. , Cleary Kirsten , Reddy Uma M. , Chung Judith H. , Parry Samuel , Theilen Lauren H. , Blumenthal Elizabeth A. , Levine Lisa D. , Mercer Brian M. , Simhan Hyagriv , Polito LuAnn , Wapner Ronald J. , Catov Janet , Chen Ida , Saade George R. ,   for the NHLBI nuMoM2b Heart Health Study
Published: September 2019

Background
Identifying pregnancy‐associated risk factors before the development of major cardiovascular disease events could provide opportunities for prevention. The objective of this study was to determine the association between outcomes in first pregnancies and subsequent cardiovascular health.

Methods and Results

The Nulliparous Pregnancy Outcomes Study Monitoring Mothers‐to‐be Heart Health Study is a prospective observational cohort that followed 4484 women 2 to 7 years (mean 3.2 years) after their first pregnancy. Adverse pregnancy outcomes (defined as hypertensive disorders of pregnancy, small‐for‐gestational‐age birth, preterm birth, and stillbirth) were identified prospectively in 1017 of the women (22.7%) during this pregnancy. The primary outcome was incident hypertension (
HTN
). Women without adverse pregnancy outcomes served as controls. Risk ratios (
RR
) and 95%
CI
s were adjusted for age, smoking, body mass index, insurance type, and race/ethnicity at enrollment during pregnancy. The overall incidence of
HTN
was 5.4% (95%
CI
4.7% to 6.1%). Women with adverse pregnancy outcomes had higher adjusted risk of
HTN
at follow‐up compared with controls (
RR
2.4, 95%
CI
1.8‐3.1). The association held for individual adverse pregnancy outcomes: any hypertensive disorders of pregnancy (
RR
2.7, 95%
CI
2.0‐3.6), preeclampsia (
RR
2.8, 95%
CI
2.0‐4.0), and preterm birth (
RR
2.7, 95%
CI
1.9‐3.8). Women who had an indicated preterm birth and hypertensive disorders of pregnancy had the highest risk of
HTN
(
RR
4.3, 95%
CI
2.7‐6.7).

Conclusions

Several pregnancy complications in the first pregnancy are associated with development of
HTN
2 to 7 years later. Preventive care for women should include a detailed pregnancy history to aid in counseling about
HTN
risk.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
Unique identifier:
NCT
02231398.
Marine Omega‐3 Supplementation and Cardiovascular Disease: An Updated Meta‐Analysis of 13 Randomized Controlled Trials Involving 127 477 Participants
Authors: Hu Yang , Hu Frank B. , Manson JoAnn E. 
Published: September 2019

Background
Whether marine omega‐3 supplementation is associated with reduction in risk of cardiovascular disease (CVD) remains controversial.

Methods and Results

This meta‐analysis included study‐level data from 13 trials. The outcomes of interest included myocardial infarction, coronary heart disease (CHD) death, total CHD, total stroke, CVD death, total CVD, and major vascular events. The unadjusted rate ratios were calculated using a fixed‐effect meta‐analysis. A meta‐regression was conducted to estimate the dose–response relationship between marine omega‐3 dosage and risk of each prespecified outcome. During a mean treatment duration of 5.0 years, 3838 myocardial infarctions, 3008 CHD deaths, 8435 total CHD events, 2683 strokes, 5017 CVD deaths, 15 759 total CVD events, and 16 478 major vascular events were documented. In the analysis excluding REDUCE‐IT (Reduction of Cardiovascular Events with Icosapent Ethyl‐Intervention Trial), marine omega‐3 supplementation was associated with significantly lower risk of myocardial infarction (rate ratio [RR] [95% CI]: 0.92 [0.86, 0.99];
P
=0.020), CHD death (RR [95% CI]: 0.92 [0.86, 0.98];
P
=0.014), total CHD (RR [95% CI]: 0.95 [0.91, 0.99];
P
=0.008), CVD death (RR [95% CI]: 0.93 [0.88, 0.99];
P
=0.013), and total CVD (RR [95% CI]: 0.97 [0.94, 0.99];
P
=0.015). Inverse associations for all outcomes were strengthened after including REDUCE‐IT while introducing statistically significant heterogeneity. Statistically significant linear dose–response relationships were found for total CVD and major vascular events in the analyses with and without including REDUCE‐IT.

Conclusions
Marine omega‐3 supplementation lowers risk for myocardial infarction, CHD death, total CHD, CVD death, and total CVD, even after exclusion of REDUCE‐IT. Risk reductions appeared to be linearly related to marine omega‐3 dose.
The Shape and Density Evolution of Snow Aggregates
Authors: Dunnavan Edwin L. , Jiang Zhiyuan , Harrington Jerry Y. , Verlinde Johannes , Fitch Kyle , Garrett Timothy J. 
Published: September 2019

Abstract
Snow aggregates evolve into a variety of observed shapes and densities. Despite this diversity, models and observational studies employ fractal or Euclidean geometric measures that are assumed universal for all aggregates. This work therefore seeks to improve understanding and representation of snow aggregate geometry and its evolution by characterizing distributions of both observed and Monte Carlo–generated aggregates. Two separate datasets of best-fit ellipsoid estimates derived from Multi-Angle Snowflake Camera (MASC) observations suggest the use of a bivariate beta distribution model for capturing aggregate shapes. Product moments of this model capture shape effects to within 4% of observations. This mathematical model is used along with Monte Carlo simulated aggregates to study how combinations of monomer properties affect aggregate shape evolution. Plate aggregates of any aspect ratio produce a consistent ellipsoid shape evolution whereas thin column aggregates evolve to become more spherical. Thin column aggregates yield fractal dimensions much less than the often-assumed value of 2.0. Ellipsoid densities and fractal analogs of density (lacunarity) are much more variable depending on combinations of monomer size and shape. Simple mathematical scaling relationships can explain the persistent triaxial ellipsoid shapes that appear in both observed and modeled aggregates. Overall, both simulations and observations prove aggregates are rarely oblate. Therefore, the use of the proposed bivariate ellipsoid distribution in models will allow for similar-sized aggregates to exhibit a realistic dispersion of masses and fall speeds.
Mechanisms of Future Changes in Equatorial Upwelling: CMIP5 Intermodel Analysis
Authors: Terada Mio , Minobe Shoshiro , Deutsch Curtis 
Published: September 2019

AbstractThe future change in equatorial upwelling between 1971–2000 and 2071–2100 is investigated using data from 24 coupled climate models. The multimodel ensemble (MME) mean exhibits substantial equatorial upwelling decrease in the eastern Pacific and weaker decrease in the western Atlantic Ocean. The MME mean of upwelling change and intermodel variation of that are decomposed into distinct isopycnal and diapycnal components. In the Pacific, the diapycnal upwelling decreases near the surface, associated with a weakened Ekman pumping. The isopycnal upwelling decreases at depths of 75–200 m around the core of the Equatorial Undercurrent (EUC) due to flattening of the density layer in which it flows. Both the weakened Ekman pumping and the EUC flattening are induced by the locally weakened trade wind over the eastern Pacific basin. In the equatorial Atlantic, both the change in MME mean and the intermodel variation of upwellings are significantly related to the weakened trade wind and enhanced stratification, although these drivers are not independent. The results for the Pacific Ocean imply that future reduction in upwelling may have impacts at different depths by different mechanisms. In particular, the rapid warming of sea surface temperature in the eastern Pacific basin may be mainly caused by the near-surface diapycnal upwelling reduction rather than isopycnal upwelling reduction associated EUC flattening, which is important at deeper levels.
Interaction of the Westerlies with the Tibetan Plateau in Determining the Mei-Yu Termination
Authors: Kong Wenwen , Chiang John C. H. 
Published: September 2019

AbstractThis study explores how the termination of the mei-yu is dynamically linked to the westerlies impinging on the Tibetan Plateau. It is found that the mei-yu stage terminates when the maximum upper-tropospheric westerlies shift beyond the northern edge of the plateau, around 40°N. This termination is accompanied by the disappearance of tropospheric northerlies over northeastern China. The link between the transit of the jet axis across the northern edge of the plateau, the disappearance of northerlies, and termination of the mei-yu holds on a range of time scales from interannual through seasonal and pentad. Diagnostic analysis indicates that the weakening of the meridional moisture contrast and meridional wind convergence, mainly resulting from the disappearance of northerlies, causes the demise of the mei-yu front. The authors propose that the westerlies migrating north of the plateau and consequent weakening of the extratropical northerlies triggers the mei-yu termination. Model simulations are employed to test the causality between the jet and the orographic downstream northerlies by repositioning the northern edge of the plateau. As the plateau edge extends northward, orographic forcing on the westerlies strengthens, leading to persistent strong downstream northerlies and a prolonged mei-yu. Idealized simulations with a dry dynamical core further demonstrate the dynamical link between the weakening of orographically forced downstream northerlies with the positioning of the jet from south to north of the plateau. Changes in the magnitude of orographically forced stationary waves are proposed to explain why the downstream northerlies disappear when the jet axis migrates beyond the northern edge of the plateau.
Anatomy teaching stuck in time? A 10-year follow-up of anatomy education in Australian and New Zealand medical schools
Authors: Trautman Jodie , McAndrew Darryl , Craig Steven J 
Published: September 2019

Objectives To detail how human anatomy is currently being taught and assessed in Australian and New Zealand medical schools. Methods Medical schools in Australia and New Zealand were invited to respond to an online survey of their teaching and assessment of human anatomy in the 2018 academic year. The results are compared with 2008 data. Changes in curricula and teaching methods are reported. Results Despite robust media and academic discussion over the last decade, very little has changed in the amount of anatomy teaching or assessment of anatomy in Australasian medical schools. One exception is that most universities have invested in new technology for teaching; however, the use of new technologies is irregular. Conclusions Australian and New Zealand medical schools should actively and cohesively respond to the changing requirements for anatomy education, or risk being left behind our international counterparts in the provision of anatomy education, to the detriment of doctors’ training and the healthcare system.
Effect of economic crisis on suicide cases: An ARDL bounds testing approach
Authors: Demirci Şenol , Konca Murat , Yetim Birol , İlgün Gülnur 
Published: October 2019

Background: Suicide events observed in various groups, community or countries, especially in the periods of economic recession. It is thought that suicide cases increase when people’s income decreases dramatically and they lose their jobs. Aim/Objective: In this study, it was aimed to investigate whether the 2008 economic crisis had any effect on suicides in the United States. Methods: Autoregressive distributed lag method was used. For the purpose of the study, the number of suicide-related deaths was taken as the dependent variable, while unemployment rates and 2008 economic crisis were taken as independent variables. Findings: The short-term and long-term relationships obtained within the scope of the study indicated that the 2008 economic crisis had a statistically significant effect on suicide cases in the United States. Results and Conclusion: It can be said that the results of this study are consistent with the information which emphasizes that economic crises increase suicide cases in the literature.
MR volumetry in predicting the aggressiveness of endometrioid adenocarcinoma: correlation with final pathological results
Authors: Cai Shulei , Zhang He , Chen Xiaojun , Wang Tianping , Lu Jiaqi , Liu Xuefen , Zhang Guofu 
Published: September 2019

Background Magnetic resonance (MR) has been widely used in predicting the aggressiveness of endometrioid adenocarcinoma. However, the diagnostic value of the MR volume of the lesion has been controversial. Purpose To determine whether the whole-lesion MR volume measurement could be used as a better predictor for evaluating the aggressiveness of endometrioid adenocarcinoma. Material and Methods In this retrospective study, we include 357 patients with pathologically demonstrated endometrioid adenocarcinoma at our institution between 1 January 2013 and 31 December 2018. Whole-lesion MR volume was calculated on sagittal T2-weighted images with ITK-SNAP software on a personal computer. Results According to the receiver operating characteristics curve analysis, whole-lesion MR volume has the competitive advantage in evaluating deep myometrial invasion compared with the frozen results, generating area under the curve (AUC) values of 0.751 vs. 0.834 ( P = 0.0629, Z = 1.860). The AUC of tumor maximum diameter, simple tumor volume, and whole-lesion MR volume in predicting deep myometrial invasion was 63.8%, 67.6%, and 75.1%, respectively. Conclusion Whole-lesion MR volume is a good diagnostic tool for prediction of deep myometrial invasion, lymph node metastasis, and lymphovascular invasion. MR volumetry could reflect the aggressiveness of endometrioid adenocarcinoma more accurately than traditional lesion measurements.