bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Range Transport of Mineral Dust to the Northeast Indian Ocean: Regional versus Remote Sources and the Implications
Authors: Banerjee Priyanka , Satheesh S. K. , Moorthy K. Krishna , Nanjundiah Ravi S. , Nair Vijayakumar S. 
Published: January 2019

Abstract
Synergizing satellite remote sensing data with vertical profiles of atmospheric thermodynamics and regional climate model simulations, we investigate the relative importance, transport pathways, and seasonality of contribution of dust from regional (Thar Desert and adjoining arid regions) and remote (southwest Asia and northeast Africa) sources over the northeast Indian Ocean [i.e., the Bay of Bengal (BOB)]. We show that while over the northern BOB dust from the regional sources contribute more than 50% to the total dust load during the southwest monsoon period (June–September), interestingly; the remote dust sources dominate rest of the year. On the other hand, over the southern BOB, dust transported from the remote-source regions dominate throughout the year. During June, the dry elevated layer (at altitudes between 850 and 700 hPa) of dust, transported across the Indo-Gangetic Plain to the northern BOB, arises primarily from the Thar Desert. Dust from remote sources in the far west reaches the southern BOB after traversing over and around the southern Indian Peninsula. Since dust from these distinct source regions have different mineral composition (hence optical properties) and undergo distinct changes during atmospheric transport, it is important to understand source-specific dust contribution and transport pathways to address dust–climate feedback.
Moisture Source Changes Contributed to Different Precipitation Changes over the Northern and Southern Tibetan Plateau
Authors: Zhang Chi , Tang Qiuhong , Chen Deliang , van der Ent Ruud J. , Liu Xingcai , Li Wenhong , Haile Gebremedhin Gebremeskel 
Published: January 2019

Abstract
Precipitation on the Tibetan Plateau (TP) showed different spatial changes during 1979–2016, with an increasing trend over the northern Tibetan Plateau (NTP) and a slightly negative trend over the southern Tibetan Plateau (STP). The changes in precipitation moisture sources over the NTP and STP are investigated using the improved Water Accounting Model with an atmospheric reanalysis as well as observational precipitation and evaporation data. The results show the region in the northwest (region NW), ranging from the TP to Europe dominated by the westerlies, provides 38.9% of precipitation moisture for the NTP, and the region in the southeast (region SE), ranging from the TP to the Indian Ocean and Indochina dominated by the Asian monsoons, provides 51.4% of precipitation moisture for the STP. For the precipitation increase over the NTP, the SE and TP are the main contributors, contributing around 35.8% and 51.7% of the increase, respectively. The contributions from the SE and TP to the STP are, however, minor and insignificant. Meanwhile, the NW shows a negative trend of −4.2 ± 2.9 mm yr−1 decade−1 (significant at the 0.01 level), which contributes to the negative precipitation trend over the STP. Results during the wet season indicate that moisture sources from the areas dominated by the Asian monsoons have contributed more precipitated moisture for the NTP, but not for the STP. Further analysis reveals that precipitated moisture originating from the Indian subcontinent has increased for the NTP while it has decreased for the STP during 1979–2016.
Ergothérapie et intégration communautaire : examen de la portée en neurologie adulte
Authors: Turcotte Samuel , Vallée Catherine , Vincent Claude 
Published: January 2019

Description. Bien que l’intégration communautaire (IC) constitue l’ultime but en réadaptation, elle s’actualise rarement en clinique. But. Le but de cette étude était de (a) synthétiser l’état des connaissances ergothérapiques liées à l’IC auprès de personnes atteintes d’un trouble neurologique et (b) dresser un portrait de l’opérationnalisation du concept d’IC au sein de ces écrits. Méthodologie. Un examen de la portée fut réalisé en double sélection pour ultimement retenir 47 écrits, touchant quatre populations sélectionnées. Les thématiques propres à l’ensemble des clientèles ont été dégagées par analyse de contenu et les constats touchant l’évolution des connaissances ont fait l’objet de synthèses itératives. Résultats. Les écrits retenus concernent le traumatisme craniocérébral ( n = 21, 9 devis expérimentaux [EXP]), les blessures médullaires ( n = 11, 4 EXP), l’accident vasculaire cérébral ( n = 9, 4 EXP) et la sclérose en plaques ( n = 4, 1 EXP). L’IC est employée de façon interchangeable avec la participation sociale: 51 % des écrits définissent l’IC uniquement à partir d’un outil de mesure et 10 % n’offrent aucune définition de l’IC. La dimension physique de l’IC est plus étudiée que les dimensions sociale et psychologique. Conséquences. Les pratiques innovantes doivent viser l’affiliation et l’exercice d’une pleine citoyenneté afin de soutenir une habilitation durable.
The Potential Role of Context-Related Exposure in Explaining Differences in Water Safety Cue Utilization
Authors: Wiggins Mark W. , Griffin Barbara , Brouwers Sue 
Published: January 2019

Objective: To examine whether differences in water safety–related cue utilization might be associated with differences in exposure to water-related recreational contexts. Background: A disproportionate number of incidents of drowning were attributable to recent visitors to New South Wales in the 2016–2017 summer swimming season. This was due to their assumed lack of exposure to the water-related recreational settings in which Australians engage and therefore, the absence of cues that are associated with danger. Method: In Study 1, the water safety cue utilization of 101 Australian residents and 328 recent visitors to the country was compared using the Expert Intensive Skills Evaluation (EXPERTise 2.0) program. Accounting for differences between the samples, Australian residents demonstrated significantly superior water safety cue utilization. In Study 2, the water safety cue utilization of a sample of 219 Australian residents was examined, the outcomes of which indicated that those participants who learned to swim before the age of 11 years demonstrated superior water safety cue utilization to participants who learned to swim at a later age. Results: Overall, the results suggest that there are individual differences in water safety cue utilization that are explained, in part, by differences in country of residence and the age at which participants first learned to swim. Conclusion: Water safety cue utilization is likely to be dependent upon exposure to water-related activities. Identifying individual differences enables the development of more targeted, drowning-prevention strategies.
A content analysis of documentation on communication disability in hospital progress notes: diagnosis, function, and patient safety
Authors: Steel Joanne , Georgiou Andrew , Balandin Susan , Hill Sophie , Worrall Linda , Hemsley Bronwyn 
Published: January 2019

Objective: To examine the content, quantity, and quality of multidisciplinary team documentation of ‘communication’ in hospital progress notes of patients with communication disability, and to explore the relationship of this documentation to patient safety. Design: Retrospective chart review involving a descriptive analysis and a qualitative content analysis of the progress notes. Setting: Acute medical and rehabilitation wards in two regional hospitals in one health district in Australia. Participants: Eight patients with communication disability who had experienced documented patient safety incidents in hospital. Methods: In total, 906 progress note entries about communication during 38 hospital admissions were extracted from eight patient’s charts; written by staff in 11 different health disciplines. Data were analysed descriptively according to quantity, and qualitatively according to the content. Results: Four content categories of meaning in progress note entries relating to communication were (1) use of communication diagnostic and impairment terms; (2) notes on the patient’s communicative function; (3) reports of the topic or content of the patient’s communication attempts; and (4) references to third parties communicating for the patient. Communication-related information was often brief, unclear, and/or inaccurate. Descriptions of communicative function and recommended strategies for successful communication were often lacking. Conclusion: The suboptimal documentation of patient communication in progress notes may contribute to the higher risk of patient safety incidents for hospital patients with communication disability. Increased accuracy in documenting communication disability and function in progress notes might assist staff in communicating with these patients and improve the quality and safety of their care.
Comorbidity Patterns of Psychiatric Conditions in Canadian Armed Forces Personnel
Authors: Richardson J. Don , Thompson Amanda , King Lisa , Ketcheson Felicia , Shnaider Philippe , Armour Cherie , St. Cyr Kate , Sareen Jitender , Elhai Jon D. , Zamorski Mark A. 
Published: January 2019

Objective: Posttraumatic stress disorder (PTSD) is often accompanied by other mental health conditions, including major depressive disorder (MDD), substance misuse disorders, and anxiety disorders. The objective of the current study is to delineate classes of comorbidity and investigate predictors of comorbidity classes amongst a sample of Canadian Armed Forces (CAF) Regular Force personnel. Methods: Latent class analyses (LCAs) were applied to cross-sectional data obtained between April and August 2013 from a nationally representative random sample of 6700 CAF Regular Force personnel who deployed to the mission in Afghanistan. Results: MDD was the most common diagnosis (8.0%), followed by PTSD (5.3%) and generalized anxiety disorder (4.7%). Of those with a mental health condition, LCA revealed 3 classes of comorbidity: a highly comorbid class (8.3%), a depressed-only class (4.6%), and an alcohol use–only class (3.1%). Multinomial logit regression showed that women (adjusted relative risk ratio [ARRR] = 2.77; 95% CI, 2.13 to 3.60; P < 0.01) and personnel reporting higher trauma exposure (ARRR = 4.18; 95% CI, 3.13 to 5.57; P < 0.01) were at increased risk of membership in the comorbid class compared to those without a mental health condition. When compared to those with no mental health condition, experiencing childhood abuse increased the risk of being in any comorbidity class. Conclusions: Results provide further evidence to support screening for and treatment of comorbid mental health conditions. The role of sex, childhood abuse, and combat deployment in determining class membership may also prove valuable for clinicians treating military-related mental health conditions.
Learning Through Action: Creating and Implementing a Strategy Game to Foster Innovative Thinking in Higher Education
Authors: Franco Paul F. , DeLuca Deborah A. 
Published: January 2019

Background. Interactive hands-on learning is effective for learners of all ages and professional backgrounds. A shift from traditional didactic classroom models to the adoption of an active learning approach through constructivism in the classroom, specifically, in higher education, is shown to encourage critical thinking and problem solving in learners based on learned experiences. Aim. This article focuses on detailing a game used for healthcare leadership doctoral students that is adaptable and applicable for students in any program focused on teaching strategies in management and leadership and/or in critical thinking. Method. Based on the Escape Room video games and social activity phenomenon, teams compete to solve content-specific challenges to attain puzzle piece clues which lead to the next challenge or obstacle set forth by the instructors (representing hurdles in management/leadership and/or an academic program). Traditional quiz-type exercises, pictograms, cryptograms and crossword puzzles are coupled with modern technological components (e.g. social media and smartphone apps). The first team to obtain all puzzle pieces is deemed most strategic winner. Depending on allotted class time, gameplay can range from 2 to 4 hours. Results and Conclusion. This game mimics interdisciplinary team work environments. Participating in interactive collaborative learning environments enhances the overall learning experience, allowing learners to apply knowledge through gameplay, rather than just memorize concepts without context, which is characteristic of traditional didactic learning environments.
Flaws in Anticoagulation Strategies in Patients With Atrial Fibrillation at Hospital Discharge
Authors: Kartas Anastasios , Samaras Athanasios , Vasdeki Dimitra , Dividis George , Fotos George , Paschou Eleni , Forozidou Evropi , Tsoukra Paraskevi , Kotsi Eleni , Goulas Ioannis , Efthimiadis George , Karvounis Haralambos , Tzikas Apostolos , Giannakoulas George 
Published: January 2019

Background: Proper anticoagulation is a crucial therapeutic regimen in atrial fibrillation (AF). Objectives: To evaluate the real-life anticoagulation prescriptions of AF patients upon hospital discharge. Methods: We studied 768 patients with comorbid AF who were discharged from the cardiology ward of a tertiary hospital. We assessed the appropriateness of oral anticoagulation (OAC) regimens at discharge based on stroke risk (CHA2DS2-Vasc score), SAMe-TT2R2 (sex, age, medical history, treatment, tobacco, race) score for vitamin K antagonists (VKA), and European labeling for nonvitamin K oral anticoagulant (NOAC) dosing. Logistic regression identified factors associated with suboptimal OAC use. Results: Of 734 patients at significant (moderate or high) stroke risk, 107 (14.6%) were not prescribed OAC, which was administered to 23 (67.6%) of 34 patients at low risk. Nonprescribing of OAC to high-risk patients was associated with paroxysmal AF (adjusted odds ratio [OR]: 2.42, 95% confidence interval [CI]: 1.47-3.99, P < .001), history of major bleeding (adjusted OR: 1.89, 95% CI: 1.03-3.47, P = .039), and concomitant antiplatelet use (adjusted OR: 5.78, 95% CI: 3.51-9.51, P < .001). Anticoagulation control was inadequate (SAMe-TT2R2 score > 2) in 102 (50.2%) VKA-treated patients. Off-label dosing was evident in 118 (28.9%) NOAC-treated patients and was associated with a prior stroke/transient ischemic attack (adjusted OR: 2.06, 95% CI: 1.10-3.85, P = .023). Both outcomes were independently associated with low creatinine clearance. Conclusions: One of 6 patients with AF newly discharged from the hospital was treated discordantly for the corresponding risk of stroke. Suboptimal OAC use was evident in half of VKA regimens, twice as common compared to NOACs, and could be predicted by several clinical parameters.
Placental Chorionic Cyst Fluid Has Prothrombotic Properties and Differs From Amniotic Fluid
Authors: Stolla Moritz , Refaai Majed A , Conley Grace , Spinelli Sherry , Casey Ann , Katerji Hani , McRae Hannah L , Blumberg Neil , Phipps Richard , Metlay Leon A , Katzman Philip J 
Published: January 2019

Introduction Chorionic cysts of the chorion laeve, fetal chorionic plate, septum, and free membranes have been associated with placental hypoxia, but they have no clear clinical significance. Although immunohistochemistry has identified fibronectin and collagen IV in cyst fluid, the contents have yet to be fully characterized. Methods Placental chorionic cysts (N = 10) were sampled by fluid extraction and hemotoxylin and eosin-stained sections. Amniotic fluid samples (N = 8) were obtained from pregnant women who had cytogenetic evaluation. The content of the cysts was tested for thrombogenicity using thromboelastography. The cyst content was tested by Luminex multiplex and ELISA assays and for known prothrombotic and proinflammatory factors. Results We identified cysts, especially those in the chorionic plate, adjacent to intervillous thrombi with apparent cyst rupture. Thromboelastography revealed a significantly shorter R time compared to whole blood control samples. Concentration of creatinine, α-fetoprotein, and surfactant D in the cyst fluid differed significantly from amniotic fluid. Cyst fluids had a significantly higher expression of all prothrombotic and some proinflammatory factors. Discussion Our data provide the first evidence that chorionic cyst fluid is prothrombotic and different from amniotic fluid. The association of ruptured cysts with adjacent thrombi and the prothrombotic properties of cyst fluid suggest a causal relationship; however, further studies are needed.
Factors associated with more frequent diagnostic tests and procedures in patients with irritable bowel syndrome
Authors: Lacy Brian , Ayyagari Rajeev , Guerin Annie , Lopez Andrea , Shi Sherry , Luo Michelle 
Published: January 2019

Background: Irritable bowel syndrome (IBS) reduces quality of life and burdens healthcare systems. This study identified factors associated with frequent use of IBS diagnostic tests and procedures. Methods: Using a United States claims database (2001–2012), tests and procedures in IBS patients occurring in the 2-year study period (12 months before/following the first IBS diagnosis) were analyzed: endoscopy, GI transit testing, anorectal procedures, and radiologic imaging. Patients were classified based on test/procedure frequency (3+, 1–2, or 0). Multivariate logistic regression identified factors associated with more frequent tests/procedures. Results: Among 201,322 IBS patients, 41.7% had 3+ tests/procedures, 35.1% had 1–2, and 23.3% had 0. Patients with more tests/procedures were older [mean age 50.6 (3+ group), more likely to be female and had more comorbidities, including anxiety, depressive disorders, and somatization. Dyspepsia [odds ratio (95% confidence interval): 1.80 (1.72–1.87)], interstitial cystitis [1.60 (1.45–1.77)], gastroesophageal reflux disease [1.59 (1.55–1.63)], constipation [1.50 (1.45–1.54)], and dyspareunia [1.38 (1.25–1.52)] were significantly associated with more tests/procedures (3+ versus 1–2), while anxiety, depressive disorders, and somatization were not. Patients with more frequent specialist visits [emergency department (ED; 1.10 (1.09–1.11)) and gastroenterologists (1.26 (1.26–1.27))] or at least one GI-related ED visit or inpatient admission [1.95 (1.86–2.04) and 3.67 (3.48–3.87), respectively] were more likely to have more tests/procedures (all p < 0.05). Conclusions: Test frequency in patients with IBS is strongly associated with demographic and clinical characteristics, especially comorbid conditions related to IBS. Presence of common overlapping comorbid conditions should increase clinicians’ confidence in making the diagnosis of IBS, thus curtailing redundant testing and reducing healthcare costs.
Predicting mortality and adverse events in patients with advanced pancreatic cancer treated with palliative gemcitabine-based chemotherapy in a multicentre phase III randomized clinical trial: the APC-SAKK risk scores
Authors: Gargiulo Piera , Dietrich Daniel , Herrmann Richard , Bodoky György , Ruhstaller Thomas , Scheithauer Werner , Glimelius Bengt , Berardi Simona , Pignata Sandro , Brauchli Peter 
Published: January 2019

Background: The prognosis of advanced pancreatic cancer (APC) is poor and differs considerably among patients. Therefore, it is clinically relevant to identify patients with APC who are more likely to benefit from palliative chemotherapy with reduced risk of toxicity. To date, there is no prognostic score universally recommended to help clinicians in planning the therapeutic management. Methods: Using individual patient data from 319 cases of APC treated with gemcitabine-based chemotherapy and enrolled in the SAKK 44/00-CECOG/PAN.1.3.001 randomized trial, several baseline variables, including inflammatory markers, were analysed post hoc as predictors of mortality and/or grade 3 or 4 chemotherapy-related toxicity and separate risk scores were developed. Results: Median survival of the study patients was 7.9 months (interquartile range 3.7–13.3 months). Independent predictors of mortality included increased Aspartate transaminase (ASAT), low performance status, increased derived neutrophil to lymphocyte ratio, increased Carbohydrate Antigen 19-9 (CA 19-9), low haemoglobin, presence of pain, presence of metastasis and increased alkaline phosphatase (ALP). During the study, 117 patients experienced at least one grade 3 or 4 adverse event. Independent predictors of toxicity included white blood cells, ALP, renal function and bilirubin levels at baseline. Both models displayed moderate levels of discrimination (C-statistic 0.68 and 0.64 for mortality and toxicity, respectively) and adequate calibration. Conclusions: We developed simple-to-use prognostic scores for mortality and severe toxicity for patients with APC. These scores can be useful in daily practice to identify patients with increased risk of death or toxicity and to plan the most appropriate therapeutic strategy to improve survival and quality of life. Further prospective studies to validate such scores are needed.
Non-critical healthcare tools as a potential source of healthcare-acquired bacterial infections in eastern Ethiopia: A hospital-based cross-sectional study
Authors: Weldegebreal Fitsum , Admassu Desalegn , Meaza Dereje , Asfaw Mulatu 
Published: January 2019

Background: Outbreaks of healthcare-acquired infections have been linked to contaminated medical devices such as electronic thermometers, sphygmomanometers, stethoscopes, latex gloves, masks, neckties, white coats and other. Objective: The aim of this study was to assess non-critical healthcare tools as a potential source of healthcare-acquired bacterial infections and associated factors in public health hospitals of Harar, eastern Ethiopia from March 2016 to February 2017. Methods: A hospital-based cross-sectional study was conducted on 212 non-critical healthcare tools owned by different health professionals. The data were collected from each owner using self-administered questionnaire. Swab specimens were collected from 187 stethoscopes and 25 sphygmomanometers using sterile cotton tips. Bacterial investigation and antimicrobial susceptibility tests were performed using standard culture tests. The data were double entered into EPI-Data version 3.1 and exported into the Statistical Package for Social Sciences version 16 for analysis. Result: The overall prevalence of non-critical healthcare tool contamination was 53.8%. A total of 137 bacterial strains were isolated. Staphylococcus aureus was the most frequent isolate (35%). Resistance to two or more different classes of antimicrobial was found to be 19.3%. The proportion of stethoscopes or sphygmomanometers contamination owned by the health professionals who were not cleaned regularly before and after examining each patient was found to be high (77%). The majority of non-critical healthcare tools used by health professionals working in the intensive care unit were contaminated (75%) followed by medical wards (73.5%). Conclusion: This study confirmed that the majority of the stethoscopes and sphygmomanometers were contaminated with pathogenic bacteria known to be associated with healthcare-acquired infections. Most of the healthcare workers did not practice stethoscope and sphygmomanometers disinfection. Strict and careful decontamination of stethoscopes and sphygmomanometers need to be in place before use.