bluuebunny/crossref_metadata_2025_split huggingface dataset:
What Is the Predictability Limit of Midlatitude Weather?
Authors: Zhang Fuqing , Sun Y. Qiang , Magnusson Linus , Buizza Roberto , Lin Shian-Jiann , Chen Jan-Huey , Emanuel Kerry 
Published: January 2019

Abstract
Understanding the predictability limit of day-to-day weather phenomena such as midlatitude winter storms and summer monsoonal rainstorms is crucial to numerical weather prediction (NWP). This predictability limit is studied using unprecedented high-resolution global models with ensemble experiments of the European Centre for Medium-Range Weather Forecasts (ECMWF; 9-km operational model) and identical-twin experiments of the U.S. Next-Generation Global Prediction System (NGGPS; 3 km). Results suggest that the predictability limit for midlatitude weather may indeed exist and is intrinsic to the underlying dynamical system and instabilities even if the forecast model and the initial conditions are nearly perfect. Currently, a skillful forecast lead time of midlatitude instantaneous weather is around 10 days, which serves as the practical predictability limit. Reducing the current-day initial-condition uncertainty by an order of magnitude extends the deterministic forecast lead times of day-to-day weather by up to 5 days, with much less scope for improving prediction of small-scale phenomena like thunderstorms. Achieving this additional predictability limit can have enormous socioeconomic benefits but requires coordinated efforts by the entire community to design better numerical weather models, to improve observations, and to make better use of observations with advanced data assimilation and computing techniques.
The impact of control strategies on space heating system efficiency in low-energy buildings
Authors: Brembilla Christian , Renman Ronny , Soleimani-Mohseni Mohsen , Östin Ronny , Olofsson Thomas 
Published: January 2019

In this study efficiency factors measure the thermal energy performance for space heating. This study deals with the influence of control strategies on the efficiency factors of space heating and its distribution system. An adaptive control is developed and applied to two types of heating curves (linear and non-linear) for a low-energy building equipped with renewable energy sources. The building is modelled with a hybrid approach (law-driven + data-driven model). The model of the floor heating is calibrated and validated by assessing the uncertainty bands for flow temperatures and mass flow rate. Benefits and drawbacks of linear and non-linear heating curves are highlighted to illustrate their impact on space heating thermodynamic behaviour and on the efficiency factors of the space heating system. Practical application: The study reveals that applying commercial building energy simulation software is worthwhile to determine reliable energy performance predictions. Massless building models are not capable of simulating the thermodynamic response of a building subjected to different control strategies. In particular, the application of different heating curves (linear and non-linear) to massless building models leaves the amount of mass flow rate delivered to the space heating unchanged when the building is subjected to sharp variations of the outdoor temperature.
p16 Influence on Laryngeal Squamous Cell Carcinoma Relapse and Survival
Authors: Sánchez Barrueco Alvaro , González Galán Fernando , Villacampa Aubá José Miguel , Díaz Tapia Gonzalo , Fernández Hernández Sofía , Martín‐Arriscado Arroba Cristina , Cenjor Español Carlos , Almodóvar Álvarez Carlos 
Published: January 2019

Objective(1) To identify p16 protein in laryngeal squamous cell carcinoma (LSCC) specimens and to correlate it with the presence of human papillomavirus (HPV) found in these specimens from a previous study. (2) To analyze p16 impact on 10‐year overall and disease‐free survival.Study DesignRetrospective case series with oncologic database chart review.SettingAcademic tertiary care hospital.SubjectsA total of 123 samples of LSCC (taken from the glottis only) from patients treated with primary surgical resection between 1977 and 2005.Methodsp16 protein expression was analyzed through immunohistochemistry and compared with the presence of HPV established in our previous studies. Results were compared with histologic, clinicopathologic, and survival parameters, with a 10‐year follow‐up.ResultsOf the samples, 39.02% were positive for p16, but only 11.38% were positive for both p16 and HPV. The p16+ cohort showed a significant improvement in disease‐free survival (P =. 0022); statistical significance was not achieved for overall survival. p16+ cases had fewer relapses over time, with no relapses after a 2‐year follow‐up. Age at the time of diagnosis and tobacco consumption were the only epidemiologic factors that influenced overall survival.ConclusionThe expression of p16 protein was a beneficial prognostic factor for disease‐free survival among patients with LSCC of the glottis, with no relapses after a 2‐year follow‐up.
Occupational Burnout among Otolaryngology–Head and Neck Surgery Trainees in Australia
Authors: Raftopulos Marco , Wong Eugene H. , Stewart Thomas E. , Boustred R. Niell , Harvey Richard J. , Sacks Raymond 
Published: January 2019

ObjectivesSurgical trainee burnout has gained attention recently as a significant factor leading to poorer quality of patient care, decreased productivity, and personal dysfunction. As a result, we aimed to determine the prevalence and associated risk factors for burnout among otolaryngology–head and neck surgery (OHNS) trainees in Australia.Study DesignCross‐sectional survey.SettingNational cohort of accredited OHNS trainees in Australia.Subjects and MethodsParticipants completed the Maslach Burnout Inventory (MBI). Trainee burnout was defined if any threshold of the 3 MBI domains—emotional exhaustion, depersonalization, or personal accomplishment—reached an established high threshold. Demographic data on potential predictors of burnout, such as stressors, workload, satisfaction, and support systems, were collected from survey responses. Predictors were compared with the burnout status.ResultsOf 67 OHNS trainees, 60 responded (66.7% men). Burnout was common among respondents, with 73.3% suffering from burnout in at least 1 of the 3 MBI domains (70.0%, emotional exhaustion; 46.7%, depersonalization; 18.3%, personal accomplishment). Trainee burnout was significantly influenced by training location (chi‐square, P =. 05), living geographically apart from social supports (odds ratio [OR], 3.49; chi‐square, P =. 007), number of years trained rurally or away from social supports (Kendall's tau‐B, P =. 03), difficulty balancing work and nonwork commitments (OR, 10.0; chi‐square, P =. 03), training negatively affecting their partner or family (OR, 14.30; chi‐square, P =. 05), and feeling uncomfortable approaching a supervisor (OR, 2.50; chi‐square, P <. 0001).ConclusionBurnout was found to be very common among OHNS trainees in Australia. The statistically significant predictors identified should be addressed to minimize trainee burnout.
Unsolicited Patient Complaints among Otolaryngologists
Authors: Nassiri Ashley M. , Pichert James W. , Domenico Henry J. , Galloway Mitchell B. , Cooper William O. , Bennett Marc L. 
Published: January 2019

ObjectivesTo analyze unsolicited patient complaints (UPCs) among otolaryngologists, identify risk factors for UPCs, and determine the impact of physician feedback on subsequent UPCs.MethodsThis retrospective study reviewed UPCs associated with US otolaryngologists from 140 medical practices from 2014 to 2017. A subset of otolaryngologists with high UPCs received peer‐comparative feedback and was monitored for changes.ResultsThe study included 29,778 physicians, of whom 548 were otolaryngologists. UPCs described concerns with treatment (45%), communication (19%), accessibility (18%), concern for patients and families (10%), and billing (8%). Twenty‐nine (5.3%) otolaryngologists were associated with 848 of 3659 (23.2%) total UPCs. Male sex and graduation from a US medical school were statistically significantly associated with an increased number of UPCs (P =. 0070 and P =. 0036, respectively). Twenty‐nine otolaryngologists with UPCs at or above the 95th percentile received peer‐comparative feedback. The intervention led to an overall decrease in the number of UPCs following intervention (P =. 049). Twenty otolaryngologists (69%) categorized as “responders” reduced the number of complaints an average of 45% in the first 2 years following intervention.DiscussionPhysician demographic data can be used to identify otolaryngologists with a greater number of UPCs. Most commonly, UPCs expressed concern regarding treatment. Peer‐delivered, comparative feedback can be effective in reducing UPCs in high‐risk otolaryngologists.Implications for PracticeSystematic monitoring and respectful sharing of peer‐comparative patient complaint data offers an intervention associated with UPCs and concomitant malpractice risk reduction. Collegial feedback over time increases the response rate, but a small proportion of physicians will require directive interventions.
Predischarge home visits after hip fracture: a randomized controlled trial
Authors: Lockwood Kylee J , Harding Katherine E , Boyd Jude N , Taylor Nicholas F 
Published: January 2019

Objective: The objective of this study is to investigate whether home assessment visits prior to hospital discharge for patients recovering from hip fracture reduce falls and prevent hospital readmissions, within the first 30 days and six months after discharge home. Design: A randomized controlled trial was conducted. Setting: The study setting included hospital wards and the community. Participants: The study included adults 50 years and over recovering from hip fracture ( n = 77). Intervention: Both groups received inpatient rehabilitation and hospital-based discharge planning. In addition, the intervention group received a home assessment visit by an occupational therapist prior to discharge from hospital. Main measures: Primary outcomes were falls and hospital readmissions. Secondary outcome measures included Functional Independence Measure, Functional Autonomy Measurement Scale, Nottingham Extended Activities of Daily Living Scale, EuroQol five dimension scale questionnaire and Falls Efficacy Scale-International. Results: The intervention group had fewer hospital readmissions in the first 30 days compared to the control group (intervention n = 1, control n = 10; odds ratio (OR) 12.9, 95% confidence interval (CI) 1.5 to 99.2). The intervention group was observed to have fewer falls than controls in the 30 days after discharge (intervention n = 6, control n = 14; incidence rate ratio (IRR) = 0.41, 95% CI 0.15 to 1.11). Between-group differences favoured the intervention group for functional independence at six months (11.2 units, 95% CI 4.2 to 18.2). There were no other between-group differences. Conclusion: Home assessment visits by occupational therapists prior to hospital discharge for patients recovering from hip fracture reduced the number of readmissions to hospital, increased functional independence at six months and may have reduced the risk of falls in the first 30 days after discharge.
Dopamine manipulations drive changes in information sampling in healthy volunteers
Authors: Vicario-Feliciano Raquel , Wigton Rebekah L , White Thomas P , Shergill Sukhi S , Averbeck Bruno B 
Published: January 2019

Background: Information sampling is the cognitive process of accumulating information before committing to a decision. Patients across numerous disorders show decreased information sampling relative to controls. Aims: Here, we used the Beads and the Best Choice Tasks to study the role of dopamine signaling in information sampling. Methods: Participants were given placebo, amisulpride, or ropinirole in each session, in a double-blind cross-over design. Results: We found that ropinirole (agonist) increased the number of beads drawn in the Beads Task specifically when participants faced a loss, and decreased the rank of the chosen option in the Best Choice Task. Conclusions: These effects are likely driven by a combination of effects at presynaptic D2 receptors, which affect dopamine release, and post-synaptic D2 receptors. Increased D2 relative to D1 receptor activation in the striatum leads to increased sampling in the loss condition in the Beads Task. It also leads to choice of a poorer ranked option in the Best Choice Task. Decreased D2 relative to D1 receptor activation leads to decreased sampling in the Beads Task in the loss condition.
Post-Marketing Surveillance in Pharmaceuticals: Reactions
Authors: Murray J. Alex 
Published: January 2019

Numerous recent deaths have been linked to government-approved prescription medicines which revealed no toxic effects during pre-market tests. Governments want to mandate a legal post-marketing surveillance program which would monitor and scrutinize individual drugs over their life cycle. The industry is divided in its response. Some executives refer to the proposed action as “overkill” while others simply anticipate more government regulations. A third group endorses the efforts of government as a positive step in mitigating public fears before they become epidemic. This paper focuses on this struggle within the industry and between the industry and government. Research was undertaken to examine industry reaction to government surveillance systems and to analyze the results within a framework of coping behavior. In addition, relationships are drawn between market structure and corporate response, and between government-mandated responsibility to consumer concerns and industry's numerous stakeholders.
Parents’ Experiences of Information and Decision Making in the Care of Their Child With Severe Spinal Muscular Atrophy: A Population Survey
Authors: Beernaert Kim , Lövgren Malin , Jeppesen Jørgen , Werlauff Ulla , Rahbek Jes , Sejersen Thomas , Kreicbergs Ulrika 
Published: January 2019

Objective: This study aims to assess the experiences and wishes of parents of children with severe spinal muscular atrophy regarding information and decision-making throughout the course of the illness. Study Design: A full population survey, conducted in 2015, among parents of children with severe spinal muscular atrophy who were born in Denmark between January 1, 2003, and December 31, 2013. We used a study-specific questionnaire with items about experiences and wishes concerning the provision of information about diagnosis, treatment, and end-of-life care. Results: Among the 47 parents that were identified, 34 parents of 21 children participated. Eleven of them were nonbereaved and 23 were bereaved parents. All parents stated that health care staff did not take any decisions without informing them. A proportion of parents indicated that they were not informed about what spinal muscular atrophy entails (32%), possible treatment options (18%), or the fact that their child would have a short life (26%) or that death was imminent (57%). Most of the bereaved parents who had wishes concerning how and where their child would pass away had their wishes fulfilled. Conclusions: The study showed that health care staff did not take treatment decisions without parents being informed. However, there is room for improvement concerning information about what spinal muscular atrophy entails, treatment options, and prognosis. Possibilities of palliative care and advance care planning should be investigated for these parents, their child, and health care staff.
High prevalence of exercise-induced ischemia in the asymptomatic limb of patients with apparently strictly unilateral symptoms and unilateral peripheral artery disease
Authors: Henni Samir , Bauer Pascal , Le Meliner Tanguy , Hersant Jeanne , Papon Xavier , Daligault Mickael , Chretien Jean-Marie , Ammi Myriam , Picquet Jean , Abraham Pierre 
Published: January 2019

Background: The prevalence of exercise-induced ischemia in the asymptomatic limb of patients with unilateral claudication based on history and treadmill evaluation, and with unilateral ipsilateral peripheral artery disease (i.e ankle-to-brachial systolic pressure index <0.90) is unknown. Methods: We detected exercise-induced ischemia in the asymptomatic limb of patients with apparently unilateral claudication. Among 6059 exercise-oximetry tests performed in 3407 nondiabetic and 961 diabetic patients. We estimated the intensity of ischemia in the both limb (buttocks and calves) using the lowest minimum value of the decrease from rest of oxygen pressure (DROP; limb changes minus chest changes from rest), with significant ischemia defined as DROP lower than −15 mmHg. Results: We found 152 tests performed in 142 nondiabetic patients and 40 tests performed in 38 diabetic patients. The asymptomatic limb showed significant ischemia in 46.7% and 37.5% of the tests. Strictly unilateral exercise-induced claudication with apparently unilateral peripheral artery disease was rare (<4% of all tests). However, among these highly selected tests, significant ischemia was found in the asymptomatic limb in more than one-third of cases. Conclusion: The asymptomatic limb of patients with peripheral artery disease should not be considered a normal limb.
Strengthening the Health Workforce through the ECHO Stages of Participation: Participants’ Perspectives on Key Facilitators and Barriers
Authors: Shimasaki Suzuho , Bishop Erin , Guthrie Michelle , Thomas John F (Fred) 
Published: January 2019

Introduction: Project Extension for Community Health Outcomes (ECHO) was originally developed by the University of New Mexico’s Health Science Center (UNMHSC) to build the capacities of primary-care providers and to increase specialty-care access to rural and underserved populations. ECHO Colorado, a replication site at the University of Colorado Anschutz Medical Campus (CUAMC), was developed with the same purpose and to help build the health workforce of Colorado. The CUAMC and its community-based partners recognized that by reducing unnecessary referrals to the medical campus and building primary-care capacity in communities, both would increase their scope and expand overall capacity. This study examines the key factors that influence participant engagement, how participants value the ECHO experience, and the utility of the ECHO Colorado experience according to participants. Methods: This study used a mixed-methods approach including 42 interviews and 34 completed surveys. Transcribed interview recordings were coded in NVivo 11, and codes were queried in NVivo and Excel to identify key themes. Survey responses were analyzed in SPSS. Data were examined between and across four attendance groups and triangulated to assess the reliability of the data and validity of overall findings. Findings: Key factors increasing registrant engagement included relevant and practical curriculum content; strong and supportive relationships among learners, ECHO faculty, and workplace colleagues; and innovative learning approaches that included opportunities for active, virtual participation through technology, participant management activities, and ECHO’s unique curriculum design. Conclusion: Findings from this study validated many of the important elements of ECHO Colorado that make it unique from other iterations of the model being implemented nationally and internationally and identified participant-driven strategies for further amplifying its impact.
The von Willebrand factor D′D3 assembly and structural principles for factor VIII binding and concatemer biogenesis
Authors: Dong Xianchi , Leksa Nina C. , Chhabra Ekta Seth , Arndt Joseph W. , Lu Qi , Knockenhauer Kevin E. , Peters Robert T. , Springer Timothy A. 
Published: January 2019

AbstractD assemblies make up half of the von Willebrand factor (VWF), yet are of unknown structure. D1 and D2 in the prodomain and D′D3 in mature VWF at Golgi pH form helical VWF tubules in Weibel Palade bodies and template dimerization of D3 through disulfides to form ultralong VWF concatemers. D′D3 forms the binding site for factor VIII. The crystal structure of monomeric D′D3 with cysteine residues required for dimerization mutated to alanine was determined at an endoplasmic reticulum (ER)-like pH. The smaller C8-3, TIL3 (trypsin inhibitor-like 3), and E3 modules pack through specific interfaces as they wind around the larger, N-terminal, Ca2+-binding von Willebrand D domain (VWD) 3 module to form a wedge shape. D′ with its TIL′ and E′ modules projects away from D3. The 2 mutated cysteines implicated in D3 dimerization are buried, providing a mechanism for protecting them against premature disulfide linkage in the ER, where intrachain disulfide linkages are formed. D3 dimerization requires co-association with D1 and D2, Ca2+, and Golgi-like acidic pH. Associated structural rearrangements in the C8-3 and TIL3 modules are required to expose cysteine residues for disulfide linkage. Our structure provides insight into many von Willebrand disease mutations, including those that diminish factor VIII binding, which suggest that factor VIII binds not only to the N-terminal TIL′ domain of D′ distal from D3 but also extends across 1 side of D3. The organizing principle for the D3 assembly has implications for other D assemblies and the construction of higher-order, disulfide-linked assemblies in the Golgi in both VWF and mucins.
The podiatric surgery theatre environment in the UK; is it conducive to learning? A quantitative study using the surgical theatre educational environment measure (STEEM)
Authors: Austen Thomas , Otter Simon 
Published: January 2019

AbstractBackgroundIn 2015 the Health and Care Professions Council (HCPC) reported that annotation of the register for podiatric surgery would improve the way in which risks are currently managed. The academic institutions provide the teaching environment for the ‘learnt’ Diploma in principles of podiatric surgery however the podiatric surgery departments facilitate the production of the next generation of podiatric surgeons. This research aimed to identify the major elements that contribute to the educational environment, and find and utilise a valid assessment tool which could identify discrete areas to be targeted for improvement as well as being used for monitoring of the environment.MethodsA quantitative study using the Surgical Theatre Educational Environment Measure (STEEM) via an online tool was utilised for podiatrists working within podiatric surgery, podiatric surgical trainees and podiatric surgeons working towards the Certificate of Completion of Podiatric Surgery Training (CCPST) with a view to assessing the educational environment within the podiatric surgical theatre in the UK.Results16/33 responses with a response rate of 48.4% the overall STEEM mean score was 122/160. Four subscales included teaching and training, learning opportunities, atmosphere, and workload/supervision/support were measured. The overall mean score of 76.73% suggests the learning environment may be considered satisfactory; however, areas for potential improvement are identifiable. Results reveal strengths such as a non‐discriminatory surgical theatre atmosphere on racial grounds.ConclusionsPerception was of a very satisfactory ‘Atmosphere’ within the theatre environment and a very satisfactory ‘opportunity to assist’ within the podiatric surgery theatre environment. The STEEM has potential to be applied further as a quality assessment tool whose results could be used to demonstrate part of the HCPC standards.