bluuebunny/crossref_metadata_2025_split huggingface dataset:
High prevalence of hyperuricaemia and its impact on non-valvular atrial fibrillation: the cross-sectional Guangzhou (China) Heart Study
Authors: Lin Wei-dong , Deng Hai , Guo Pi , Liu Fang-zhou , Chen Ru-yin , Fang Xian-hong , Zhan Xian-zhang , Liao Hong-tao , Huang Wen-xiang , Liu Yang , Wang Feng , Zheng Mu-rui , Liu Hua-zhang , Huang Jun , Wei Wei , Xue Yu-mei , Wu Shu-lin 
Published: May 2019

ObjectivesThere are country and regional variations in the prevalence of hyperuricaemia (HUA). The prevalence of HUA and non-valvular atrial fibrillation (NVAF) in southern China is unknown.DesignA cross-sectional study.Setting and participantsA total of 11 488 permanent residents aged 35 or older from urban and rural areas of Guangzhou, China were enrolled. A questionnaire was used to compile each participant’s demographic information and relevant epidemiological factors for HUA and NVAF. All participants were assessed using a panel of blood tests and single-lead 24-hour ECG.Main outcome measuresHUA was defined as serum uric acid level >420 μmol/L in men and >360 μmol/L in women. NVAF was diagnosed as per guidelines.ResultsThe prevalence of HUA was 39.6% (44.8% in men and 36.7% in women), and 144 residents (1.25%) had NVAF. Prevalence of HUA increased with age in women but remained stably high in men. After adjusting for potential confounders, age, living in urban areas, alcohol consumption, central obesity, elevated fasting plasma glucose level, elevated blood pressure, lower high-density lipoprotein cholesterol level and elevated triglycerides level were associated with increased risk of HUA. Residents with HUA were at higher risk for NVAF. Serum uric acid level had a modest predictive value for NVAF in women but not men.ConclusionsHUA was highly prevalent among citizens of southern China and was a predictor of NVAF among women.
Geographical variation in musculoskeletal surgical care in public hospitals in Ireland: a repeated cross-sectional study
Authors: Walsh Mary E , Boland Fiona , O’Byrne John M , Fahey Tom 
Published: May 2019

ObjectiveTo examine the extent of geographical variation across musculoskeletal surgical procedures and associated factors in Ireland.DesignRepeated cross-sectional study.Setting36 public hospitals in Ireland.ParticipantsAdult admissions for hip fracture, hip and knee replacement, knee arthroscopy and lumbar spine interventions over 5 years (2012–2016).Primary outcome measureStandardised discharge rate (SDR).AnalysisAge and sex SDRs were calculated for 21 geographical areas. Extremal quotients, coefficients of variation and systematic components of variance were calculated. Linear regression analyses were conducted exploring the relationship between SDRs and year, unemployment, % urban population, number of referral hospitals, % on waiting lists>6 months and % with private health insurance for each procedure.ResultsAcross 36 public hospitals, n=102 756 admissions were included. Hip fracture repair showed very low variation. Elective hip and knee procedures showed high variation in particular years, while variation for lumbar interventions was very high. Knee arthroscopy rates decreased over time. Higher unemployment was associated with knee and hip replacement rates and urban areas had lower hip replacement rates. Spinal procedure rates were associated with a lower number of referral hospitals in a region and spinal injection rates were associated with shorter waiting lists. A higher proportion of patients having private health insurance was associated with higher rates of hip and knee replacement and lumbar spinal procedures.ConclusionsVariation and factors associated with SDRs for publicly funded hip and knee procedures are consistent with similar international research in this field. Further research should explore reasons for high rates of spinal injections and the impact of private practice on musculoskeletal procedure variation.
Reducing two-unit red cell transfusions on the oncology ward: a choosing wisely initiative
Authors: Gob Alan , Bhalla Anurag , Aseltine Laura , Chin-Yee Ian 
Published: May 2019

Background/contextDespite Choosing Wisely recommendations for single unit red blood cell transfusion orders, ~50% of orders on the oncology ward at London Health Sciences Centre (LHSC) were for two units. The oncology ward at LHSC is a 60 bed tertiary care unit. In mid 2016, LHSC was 18 months into its implementation of computerised provider order entry (CPOE).Aim/objectivesBy December 2017, increase the proportion of one-unit red cell transfusion orders on the oncology ward from 50% to 80%MeasuresOutcome: % one-unit red cell transfusion orders (aggregated monthly).Improvement/innovation/change ideasOur initial theory was that unawareness of the guidelines (established in 2014) and subscription to the obsolete doctrine of two-unit transfusions were the primary behavioural drivers. Initial change ideas included an educational/awareness blitz including rounds presentations, memos and posters. Failure led us to revisit our hypothesis and carry out a real-time audit, where our team was notified on each two-unit transfusion. This revealed the true root cause: the overwhelming majority of two-unit transfusions could be traced back to standing orders that were entered on an admission order set. After provider engagement, we proceeded to remove all admission order sets containing two-unit transfusions.Impact/lessons learned/resultsAfter order set removal, our one-unit transfusion rate rose to 86% and was sustained for 17 months. We learnt two primary lessons. First that CPOE and poor order set design combined to perpetuate poor ordering practices. Second that revisiting our hypothesis and engaging in thoughtful root cause analysis that included direct observation ultimately led to an effective, sustainable solution.Discussion/spreadOur study underscores the importance of executing root cause analysis on a microsystem level. We would expect the factors driving poor performance to be completely different on a service such as general internal medicine. Our study also highlights the potential pitfalls of CPOE and the importance of regular order set review to ensure adherence to current evidence.
Impact of ‘two-week wait’ referral pathway on the diagnosis, treatment and survival in upper and lower gastrointestinal cancers
Authors: Fallon Matthew , Adil Md Tanveer , Ahmed Kasim , Whitelaw Douglas , Rashid Farhan , Jambulingam Periyathambi 
Published: May 2019

AbstractBackgroundThe ‘two-week wait’(2WW) referral pathway was introduced in the United Kingdom to reduce waiting times for treatment of cancer. There has been a debate regarding the efficacy of 2WW pathway since its implementation.MethodsA singleinstitutional analysis of upper gastrointestinal(UGI) and lower gastrointestinal(LGI) malignancies treated between 1April 2015 and 31March 2017 was undertaken to analyse the impact of 2WWreferral pathway on the diagnosis, treatment and survival.Results2WW referral does not achieve an earlier diagnosis compared with non-2WW routes of referral in UGI (χ2(3)=2.6, p=0.458) and LGI (χ2(3)=0.884, p=0.829) malignancies. 2WW referral does not lead to an improvement in curative treatment in UGI (OR1.48, 95%CI0.68to3.21, p=0.321) and LGI (OR1.59, 95%CI0.97to2.62, p=0.067) malignancies. No improvement in survival is seen in UGI (HR0.99, 95%CI0.56to1.75, p=0.963) and LGI (HR1.10, 95%CI0.60to1.99, p=0.764) malignancies by virtue of 2WW referral. Emergency presentation is the most common presenting route in UGI malignancy(40%) and is associated with poor survival (HR0.55, 95%CI0.30to0.97, p=0.045).Non-emergency route of presentation is associated with higher rates of curative treatment in UGI malignancies (OR3.49, 95%CI1.57to7.76, p=0.002). Lower rate of curative treatment (OR 0.27, 95%CI0.16to0.43, p&lt;0.001) and poor survival (HR0.44, 95%CI0.26to0.76, p=0.003) is also observed in emergency presentation of LGI malignancy(29%) which is the secondmost common route of presentation in this group.Conclusion2WW referral does not achieve early diagnosis nor does it lead to an improvement in the rate of curative treatment in UGI and LGI malignancies. No improvement in short-term survival is seen in UGI malignancies nor in LGI malignancies on multivariate analysis by virtue of 2WW referral.
Financial incentives to Medicaid smokers for engaging tobacco quit line treatment: maximising return on investment
Authors: Mundt Marlon P , Baker Timothy B , Piper Megan E , Smith Stevens S , Fraser David L , Fiore Michael C 
Published: May 2019

BackgroundLow-income smokers experience greater difficulty in quitting smoking than do other smokers. Providing financial incentives for treatment engagement increases smoking cessation success. This study models the cost-effectiveness of varying levels of financial incentives to maximise return on investment (ROI) for engaging low-income Medicaid recipients who smoke to take calls from a tobacco quit line.MethodsParticipants (N=1900) were recruited from May 2013 to June 2015 through quit line-based (n=980), clinic-based (n=444) or community-based referrals (n=476) into the Wisconsin Medicaid Quit Line Incentive project. Incentive (n=948) and control group participants (n=952) received $30 versus $0 per call, respectively, for taking up to five Wisconsin Tobacco Quit Line (WTQL) calls. Cost-effectiveness analyses estimated the incremental cost-effectiveness ratio for alternative financial incentives for engagement with WTQL calls. Probabilistic sensitivity analysis was employed to determine an optimal strategy for financial incentives to minimise the cost per individual who quit smoking.ResultsUsing fixed payments, the incremental cost-effectiveness ratio of $2316 per smoker who quit in the randomised trial decreased to $2150 per smoker who quit when the incentives were modelled at $20 per each of five WTQL calls taken. Using variable payments, the minimal cost per additional smoker who quit was $2125 when incentives for the first four WTQL calls were set at $20, and the financial payment for the fifth WTQL call was set at $70.ConclusionsModelling suggests that financial incentives in the amount of $20 per call for taking the first four quit line calls and $70 for taking a fifth quit line call maximise ROI to engage low-income smokers with evidence-based smoking cessation treatment.
Ban on menthol-flavoured tobacco products predicts cigarette cessation at 1 year: a population cohort study
Authors: Chaiton Michael O , Nicolau Ioana , Schwartz Robert , Cohen Joanna E , Soule Eric , Zhang Bo , Eissenberg Thomas 
Published: May 2019

ObjectivesThe province of Ontario, Canada, banned the use of menthol-flavoured tobacco products as of 1 January 2017. The long-term impact of a menthol ban on smoking behaviour has not been previously evaluated.MethodsPopulation cohort study with baseline survey conducted September–December 2016 and follow-up January–August 2018 among residents of Ontario, Canada, 16 years old and over who reported current smoking (past 30 days) at baseline survey and completed follow-up (n=913) including 187 reporting smoking menthol cigarettes daily, 420 reported smoking menthol cigarettes occasionally, and 306 were non-menthol cigarette smokers. Relative rates of making a quit attempt and being a non-smoker at follow-up were estimated with Poisson regression controlling for smoking and demographic characteristics at baseline.ResultsAt follow-up, 63% of daily menthol smokers reported making a quit attempt since the ban compared with 62% of occasional menthol smokers and 43% of non-menthol smokers (adjusted relative rate (ARR) for daily menthol smokers compared with non-menthol smokers: 1.25; 95% CI 1.03 to 1.50). At follow-up, 24% of daily menthol smokers reported making a quit since the ban compared with 20% of occasional menthol smokers and 14% of non-menthol smokers (ARR for daily menthol smokers compared with non-menthol smokers: 1.62; 95% CI 1.08 to 2.42).ConclusionsThe study found higher rates of quitting among daily and occasional menthol smokers in Ontario 1 year after the implementation of a menthol ban compared with non-menthol smokers. Our findings suggest that restrictions on menthol may lead to substantial improvements in public health.
From Point Cloud Data to Structural Analysis Through a Geometrical hBIM-Oriented Model
Authors: Rolin Raphael , Antaluca Eduard , Batoz Jean-Louis , Lamarque Fabien , Lejeune Mathieu 
Published: May 2019

The assessment of the structural behavior of historic masonry structures like Gothic cathedrals is an important engineering and architectural issue, because of the economic and cultural relevance of such buildings. In this article, we present a complete numerical methodology for point clouds processing, geometrical and parametric 3D modeling, and finite element structural analysis of the spire of the Cathedral of Senlis, France. Our work highlights the particular difficulties linked with digitization and geometrical modeling of highly complex Gothic structures, as well as the need to find compromises between quality and accuracy of extracted data used for geometrical modeling and structural analysis.
The methodology enables the semi-automatic transformation of a three-dimensional points cloud, surveyed through terrestrial laser scanner, into a three-dimensional geometrical historic building information modeling (hBIM)-oriented model, and its use to propose a consistent 3D finite element mesh suitable for advanced structural analysis. A full software chain is integrated in the proposed numerical process, so as to use the most important data contained in the real geometry and accurately transposed in the point clouds. After a successful data processing step with 3DReshaper software that proved to be necessary for enhancement of point clouds, a semi-automated geometrical hBIM-oriented modeling step with Rhinoceros5 software and VisualARQ plugin has allowed the construction of a hybrid model by reverse engineering from the point clouds. This 3D model, containing both geometrical and parametric data of the structure, has been exported to the Hyperworks suite for finite element structural analysis under self-weight. Our computations focused on the estimation of the structure deformation and on the distribution of compression and traction stresses in all components of the complex structure. It is found that the spire is safe. Based on reliable and properly detailed results, our study provides significant information for understanding the behavior of the structure and potential damage monitoring.
Different contributions from lungs and chest wall to respiratory mechanics in mice, rats, and rabbits
Authors: Südy Roberta , Fodor Gergely H. , Dos Santos Rocha André , Schranc Álmos , Tolnai József , Habre Walid , Peták Ferenc 
Published: May 2019

Changes in lung mechanics are frequently inferred from intact-chest measures of total respiratory system mechanics without consideration of the chest wall contribution. The participation of lungs and chest wall in respiratory mechanics has not been evaluated systematically in small animals commonly used in respiratory research. Thus, we compared these contributions in intact-chest mice, rats, and rabbits and further characterized the influence of positive end-expiratory pressure (PEEP). Forced oscillation technique was applied to anesthetized mechanically ventilated healthy animals to obtain total respiratory system impedance (Zrs) at 0, 3, and 6 cmH2O PEEP levels. Esophageal pressure was measured by a catheter-tip micromanometer to separate Zrs into pulmonary (ZL) and chest wall (Zcw) components. A model containing a frequency-independent Newtonian resistance (RN), inertance, and a constant-phase tissue damping (G) and elastance (H) was fitted to Zrs, ZL, and Zcw spectra. The contribution of Zcw to RN was negligible in all species and PEEP levels studied. However, the participation of Zcw in G and H was significant in all species and increased significantly with increasing PEEP and animal size (rabbit > rat > mice). Even in mice, the chest wall contribution to G and H was still considerable, reaching 47.0 ± 4.0(SE)% and 32.9 ± 5.9% for G and H, respectively. These findings demonstrate that airway parameters can be assessed from respiratory system mechanical measurements. However, the contribution from the chest wall should be considered when intact-chest measurements are used to estimate lung parenchymal mechanics in small laboratory models (even in mice), particularly at elevated PEEP levels. NEW & NOTEWORTHY In species commonly used in respiratory research (rabbits, rats, mice), esophageal pressure-based estimates revealed negligible contribution from the chest wall to the Newtonian resistance. Conversely, chest wall participation in the viscoelastic tissue mechanical parameters increased with body size (rabbit > rat > mice) and positive end-expiratory pressure, with contribution varying between 30 and 50%, even in mice. These findings demonstrate the potential biasing effects of the chest wall when lung tissue mechanics are inferred from intact-chest measurements in small laboratory animals.
On the Creation and Evolution of Small-Scale Low-Level Vorticity Anomalies during Tropical Cyclogenesis
Authors: Smith Warren P. , Nicholls Melville E. 
Published: May 2019

Abstract
Recent numerical modeling and observational studies indicate the importance of vortical hot towers (VHTs) in the transformation of a tropical disturbance to a tropical depression. It has recently been recognized that convective-scale downdraft outflows that form within VHTs also preferentially develop positive vertical vorticity around their edges, which is considerably larger in magnitude than ambient values. During a numerical simulation of tropical cyclogenesis it is found that particularly strong low-level convectively induced vorticity anomalies (LCVAs) occasionally form as convection acts on the enhanced vorticity at the edges of cold pools. These features cycle about the larger-scale circulation and are associated with a coincident pressure depression and low-level wind intensification. The LCVAs studied are considerably deeper than the vorticity produced at the edges of VHT cold pool outflows, and their evolution is associated with persistent convection and vortex merger events that act to sustain them. Herein, we highlight the formation and evolution of two representative LCVAs and discuss the environmental parameters that eventually become favorable for one LCVA to reach the center of a larger-scale circulation as tropical cyclogenesis occurs.
Interpretable Deep Learning for Spatial Analysis of Severe Hailstorms
Authors: Gagne II David John , Haupt Sue Ellen , Nychka Douglas W. , Thompson Gregory 
Published: May 2019

AbstractDeep learning models, such as convolutional neural networks, utilize multiple specialized layers to encode spatial patterns at different scales. In this study, deep learning models are compared with standard machine learning approaches on the task of predicting the probability of severe hail based on upper-air dynamic and thermodynamic fields from a convection-allowing numerical weather prediction model. The data for this study come from patches surrounding storms identified in NCAR convection-allowing ensemble runs from 3 May to 3 June 2016. The machine learning models are trained to predict whether the simulated surface hail size from the Thompson hail size diagnostic exceeds 25 mm over the hour following storm detection. A convolutional neural network is compared with logistic regressions using input variables derived from either the spatial means of each field or principal component analysis. The convolutional neural network statistically significantly outperforms all other methods in terms of Brier skill score and area under the receiver operator characteristic curve. Interpretation of the convolutional neural network through feature importance and feature optimization reveals that the network synthesized information about the environment and storm morphology that is consistent with our understanding of hail growth, including large lapse rates and a wind shear profile that favors wide updrafts. Different neurons in the network also record different storm modes, and the magnitude of the output of those neurons is used to analyze the spatiotemporal distributions of different storm modes in the NCAR ensemble.
Acquired Factor VII deficiency – a rare but important consideration
Authors: Zaidi Mehmood Hussain , Stanley Arran , Khan Mohammed 
Published: May 2019

Introduction Isolated acquired Factor VII deficiency is a rare coagulation disorder which is independent of vitamin K deficiency. The exact pathophysiological basis of this condition is unclear. We present a series of cases highlighting different clinical scenarios where this condition was encountered. Case series The first case presented with intra-abdominal sepsis. The second was a patient admitted with acute kidney injury and subsequently diagnosed with myeloma. The final case presented with microangiopathic haemolytic anaemia and was suspected of having atypical Haemolytic Uraemic Syndrome. In each case, there was no family or personal history of a bleeding disorder. Follow-up Factor VII levels after recovery from illness was normal in all three cases. Conclusion Acquired Factor VII deficiency is an uncommon but important finding which should be considered in the general medical setting when an isolated prolonged prothrombin time is detected.
The most perfect natural laboratory in the world: Making and knowing Hawaii National Park
Authors: Shih Ashanti 
Published: May 2019

This article reimagines the meanings of U.S. national parks and so-called ‘natural’ places in our environmental histories and histories of science. Environmental historians have created a compelling narrative about the creation and use of U.S. national parks as places for recreation and natural resource conservation. Although these motivations were undoubtedly significant, I argue that some of the early parks were created and used for a third, often overlooked, reason: to preserve a permanent, state-sanctioned space for scientific knowledge production. Deconstructing the concept of the “natural laboratory,” I show how scientists helped justify and then benefited from the creation of national parks. Hawaii National Park serves as my case study. Advocates of the national park aimed to give settler colonial scientists in the Hawaiian archipelago a permanent place for their research, while tying Hawai‘i’s exotic landscape into the sublime nature of the American West. The park was framed as a perfect laboratory for U.S. experts to study “curious” flora, fauna, and geological processes, becoming a major site of knowledge production in volcanology. Reimagining the parks in this way has ramifications for how we think about issues of access and justice. Environmental historians who have explored the ‘dark side’ of the conservation movement have yet to consider the other half of the story: the parks not only barred certain peoples and their ways of life, but also provided access to scientists – a set of actors whose work was deemed more complementary to conservationist goals than the activities of the Native Hawaiians – and marginalized local and indigenous epistemologies. Thus, the question so often asked in environmental history, “Who is nature for?” might be supplemented by the question, “Who has the power to know nature?”