bluuebunny/crossref_metadata_2025_split huggingface dataset:
100-Year Lower Mississippi Floods in a Global Climate Model: Characteristics and Future Changes
Authors: van der Wiel Karin , Kapnick Sarah B. , Vecchi Gabriel A. , Smith James A. , Milly P. C. D. , Jia Liwei 
Published: August 2018

AbstractFloods in the Mississippi basin can have large negative societal, natural, and economic impacts. Understanding the drivers of floods, now and in the future, is relevant for risk management and infrastructure-planning purposes. We investigate the drivers of 100-yr-return lower Mississippi River floods using a global coupled climate model with an integrated surface water module. The model provides 3400 years of physically consistent data from a static climate, in contrast to available observational data (relatively short records, incomplete land surface data, transient climate). In the months preceding the model’s 100-yr floods, as indicated by extreme monthly discharge, above-average rain and snowfall lead to moist subsurface conditions and the buildup of snowpack, making the river system prone to these major flooding events. The meltwater from snowpack in the northern Missouri and upper Mississippi catchments primes the river system, sensitizing it to subsequent above-average precipitation in the Ohio and Tennessee catchments. An ensemble of transient forcing experiments is used to investigate the impacts of past and projected anthropogenic climate change on extreme floods. There is no statistically significant projected trend in the occurrence of 100-yr floods in the model ensemble, despite significant increases in extreme precipitation, significant decreases in extreme snowmelt, and significant decreases in less extreme floods. The results emphasize the importance of considering the fully coupled land–atmosphere system for extreme floods. This initial analysis provides avenues for further investigation, including comparison to characteristics of less extreme floods, the sensitivity to model configuration, the role of human water management, and implications for future flood-risk management.
Shahbag Stolen? Third Force Dynamics and Electoral Politics in Bangladesh
Authors: Roy Anupam Debashis 
Published: August 2018

The Shahbag Movement, demanding capital punishment for war criminals of the 1971 liberation war in Bangladesh, emerged in February 2013 in Dhaka. This youth-led grassroots movement erupted in response to infuriating establishment party politics as a populist third force, wanting closure to the painful memories of Bangladesh’s freedom struggle by seeking justice for the atrocities of 1971. However, perceived as siding with secular forces, Shahbag became instantly embroiled in adversarial party politics and appears to have been hijacked, as is argued here, by both major political parties of Bangladesh.  Evaluating Shahbag as a case study for the framing tasks theory of social movements, the article supports its analysis through detailed empirical findings. Viewed historically, Shahbag may be treated as an initially powerful grassroots youth movement, akin to ‘Arab Spring’ phenomena, later stolen from the people of Bangladesh. However, a deeper analysis of Shahbag’s dynamics, accounting for the impact of the controversial national elections of January 2014, yields crucial insights about the continuing scope for a ‘third force’ in the forthcoming elections scheduled for December 2018.
Are the effects of internal focus instructions different from external focus instructions given during balance training in stroke patients? A double-blind randomized controlled trial
Authors: Kal Elmar , Houdijk Han , van der Kamp John , Verhoef Manon , Prosée Rens , Groet Erny , Winters Marinus , van Bennekom Coen , Scherder Erik 
Published: August 2018

Objective: This study aimed to assess if external focus instructions result in greater improvements in motor skill and automaticity compared to internal focus instructions in stroke patients. Design: Double-blind randomized controlled trial. Setting: Inpatient stroke rehabilitation unit. Subjects: A total of 63 stroke patients (Meanage = 59.6 ± 10.7 years; Meandays since stroke = 28.5 ± 16.6; MedianFunctional Ambulation Categories = 4). Interventions: Patients were randomly assigned to an internal ( N = 31) or external ( N = 32) focus instruction group. Both groups practiced a balance board stabilization task, three times per week, for three weeks. Balance performance was assessed at baseline, and after one and three weeks of practice. Main measures: Primary outcome was the threshold stiffness (Nm/rad) at which patients could stay balanced. Secondary outcomes were patients’ sway (root-mean-square error in degrees) at the baseline threshold stiffness under single- and dual-task conditions, and their performance on the Timed Up and Go Test and Utrecht Scale for Evaluation of Rehabilitation. Results: Both groups achieved similar improvements in threshold stiffness (∆= 27.1 ± 21.1 Nm/rad), and single- (∆= 1.8 ± 2.3° root-mean-square error) and dual-task sway (∆= 1.7 ± 2.1° root-mean-square error) after three weeks of practice. No differences were found in improvements in clinical tests of balance and mobility. Patients with comparatively good balance and sensory function, and low attention capacity showed greatest improvements with external focus instructions. Conclusion: External focus instructions did not result in greater improvement in balance skill in stroke patients compared to internal focus instructions. Results suggest that tailoring instructions to the individual stroke patient may result in optimal improvements in motor skill.
Emerging From the Haze: A Pilot Study Evaluating Feasibility of a Psychoeducational Intervention to Improve Cancer-Related Cognitive Impairment in Gynecologic Cancer Survivors
Authors: Liang Margaret I. , Erich Bryce , Bailey Charlotte , Jo Mi-Yeoung , Walsh Christine S. , Asher Arash 
Published: August 2018

Purpose: The objective of this pilot study is to evaluate the (1) applicability of a 15-hour attending-taught psychoeducational intervention in a retrospective cohort and (2) feasibility of a trainee-taught intervention in a prospective cohort of patients with gynecologic cancer to help manage cancer-related cognitive impairment (CRCI). Methods: Adults with any stage gynecologic cancer who completed chemotherapy and reported cognitive complaints were eligible. Additionally, the screening criteria of Functional Assessment of Cancer Therapy–Cognition (FACT-Cog) perceived cognitive impairment (PCI) subscale score <59 was used in the prospective cohort. Validated patient-reported outcomes including FACT-Cog and Patient-Reported Outcomes Measurement Information System (PROMIS) Applied Cognition Abilities and General Concerns were measured before and after the intervention. Results: Twelve patients underwent an attending-taught intervention between 2011 and 2014. Significant improvements in mean FACT-Cog PCI (+6.1, P < .048), quality of life (+2.4, P = .04), and total score (+9.8, P = .03) were demonstrated, while there was no significant change in mean FACT-Cog perceived cognitive abilities. Ten patients underwent a trainee-taught intervention in 2017. No significant changes in mean FACT-Cog subscale or total scores were seen. Significant improvements in PROMIS Applied Cognition Abilities (+8.2, P = .01) and PROMIS Applied Cognition General Concerns were demonstrated (−8.0, P < .01). Conclusions: Our psychoeducational intervention demonstrates applicability to patients with gynecologic cancer reporting CRCI and supports the feasibility of more widespread training based on improvements in validated patient-reported outcomes related to cognition.
Do Electronic Medical Records Improve Advance Directive Documentation? A Systematic Review
Authors: Lemon Christopher , De Ridder Michael , Khadra Mohamed 
Published: August 2018

Background: Documentation rates of advance directives (ADs) remain low. Using electronic medical records (EMRs) could help, but a synthesis of evidence is currently lacking. Objectives: To evaluate the evidence for using EMRs in documenting ADs and its implications for overcoming challenges associated with their use. Design: Systematic review of articles in English, published from inception of databases to December 2017. Data Sources: PubMed, PsycINFO, EMBASE, and CINAHL. Methods/Measurements: Four databases were searched from inception to December 2017. Randomized and nonrandomized quantitative studies examining the effects of EMRs on creation, storage, or use of ADs were included. All featured an advance care planning process. Evidence was evaluated using the Cochrane Collaboration’s risk assessment tool. Results: Fifteen studies were included: 1 randomized controlled trial, 1 randomized pilot, 4 pre–post studies, 4 cross-sectional studies, 1 retrospective cohort study, 1 historical control study, 1 retrospective observational study, 1 retrospective review, and 1 evaluation of an EMR feature. Seven studies showed that EMR-based reminders, AD templates, and decision aids can improve AD documentation rates. Three demonstrated that EMR search functions, decision aids, and automatic identification software can help identify patients who have or need ADs according to certain criteria. Five showed EMRs can create documentation challenges, including locating ADs, and making some patients more likely than others to have an AD. Most studies had an unclear or high risk of bias. Conclusions: Limited evidence suggests EMRs could be used to help address AD documentation challenges but may also create additional problems. Stronger evidence is needed to more conclusively determine how EMR may assist in population approaches to improving AD documentation.
Ceramic bearings for total hip arthroplasty are associated with a reduced risk of revision for infection
Authors: Madanat Rami , Laaksonen Inari , Graves Stephen E , Lorimer Michelle , Muratoglu Orhun , Malchau Henrik 
Published: August 2018

Introduction: Periprosthetic joint infection (PJI) is a serious complication after total hip arthroplasty (THA) and bearing material’s associations to PJI prevalence is largely unknown. The main purposes of this study were to determine if revision for infection varied depending on the type of bearing surface used in primary THA and to study whether patient or implant related factors had an effect on this variation. Methods: A total of 177,237 primary THA procedures from the Australian Registry (AOANJRR) were analysed. 3 bearing surfaces were compared. Metal-on-highly cross-linked polyethylene (MoXP) bearing had been used in 95,129 hips, ceramic-on-highly cross-linked polyethylene (CoXP) in 24,269 hips, and ceramic-on-ceramic (CoC) in 57,839 hips. Revision rates for infection were compared between the 3 groups. Results: Both MoXP and CoXP had a higher revision rate for infection compared to CoC hips (hazard ratio [HR] 1.46 (1.25, 1.72), p < 0.001) and HR 1.42 (1.15, 1.75), p = 0.001 respectively). Patients aged 70 years or less had a lower revision rate for infection when a CoC bearing was used. This difference was independent of sex, and prostheses selection. No difference was evident if the femoral component was cemented or a head size of 28 mm was used. Discussion: In this registry-based material, use of a CoC bearing was associated with a lower risk of revision for infection in patients younger than 70 years when cementless femoral components were used. Further studies are needed to verify this finding.
Tasks of activities of daily living (ADL) are more valuable than the classical neurological examination to assess upper extremity function and mobility in multiple sclerosis
Authors: van Munster Caspar EP , D’Souza Marcus , Steinheimer Saskia , Kamm Christian P , Burggraaff Jessica , Diederich Manuela , Kravalis Kristina , Dorn Jonas , Walsh Lorcan , Dahlke Frank , Kappos Ludwig , Uitdehaag Bernard MJ 
Published: August 2018

Background: Accurate clinical assessment in multiple sclerosis (MS) is challenging. The Assess MS system is being developed to automatically quantify motor dysfunction in MS, including upper extremity function (UEF) and mobility. Objective: To determine to what extent combinations of standardized movements included in the Assess MS system explain accepted measures of UEF and mobility. Methods: MS patients were recruited at four European MS centres. Eight movements were selected, including tasks of activities of daily living (ADL) and classical neurological tests. Movements were recorded on video and rated by experienced neurologists ( n = 5). Subsequently, multivariate linear regression models were performed to explain the variance of the Nine-Hole Peg Test (9HPT), Arm Function in Multiple Sclerosis Questionnaire (AMSQ) and Timed-25 Foot Walk test (T25WT). Results: In total, 257 patients were included. The movements explained 62.9% to 80.1% of the variance of the 9HPT models, 43.3% and 44.3% of the AMSQ models and 70.8% of the T25WT. In all models, tasks of ADL contributed most to the variance. Conclusion: Combinations of movements are valuable to assess UEF and mobility. Incorporating ADL tasks into daily clinical practice and clinical trials may be more valuable than the classical neurological examination of UEF and mobility.
Manner of Death Certification After Significant Emotional Stress
Authors: Lesnikova Iana , Leone Lisa , Gilliland MGF 
Published: August 2018

Not commonly seen, the risk of sudden death after significant emotional stress has been reported since antiquity and incorporated into folk wisdom, reflected by phrases such as “scared to death” and “broken heart.” A typical “victim” suffers from significant and often life-threatening natural diseases, making determination of the manner of death complicated, and at times controversial. The present study is designed to assess inter-rater variability and nonuniformity and controversy seen in manner of death certification in certain cases of death with significant stress involved in the circumstances of death. Members of the National Association of Medical Examiner (NAME) were surveyed to assess differences in manner of death certification for eight sudden unexpected death scenarios in middle-aged men and women with underlying cardiac disease after significant stressful events including: being chased down a lonely road followed by a verbal confrontation, a roll-over motor vehicle collision (MVC) without injuries, a fall from a wheelchair in a MVC, an alleged armed robbery, an involuntary commitment, an arrest by police, sexual intercourse, and a severe panic attack with breathing problems. In all cases, the autopsy examination revealed hypertensive and arteriosclerotic cardiovascular disease. In all cases, natural diseases were identified as significant contributing condtions, including emphysema in six cases and diabetes mellitus in three. Eighty-six responses were collected. The results show wide inter-rater variability, ranging from very good to poor (Kappa ranges from 0.16 to 0.94). One hundred fifty-five comments were collected. Most of the comments addressed more than one topic and were followed by discussions, open questions, and responders’ experiences with previous cases and legal proceedings. Our data show that cases of sudden death after significant stress have almost complete agreement in four cases and very high inter-rater variability in the other four. We propose that a detailed analysis of each case and an algorithmic approach could improve the predictability of the outcomes of death investigations for the legal system and for families.
Incentive-Based Game for Allaying Preoperative Anxiety in Children: A Prospective, Randomized Trial
Authors: Chaurasia Bijay , Jain Divya , Mehta Swati , Gandhi Komal , Mathew Preethy J. 
Published: August 2018

BACKGROUND:
Induction of anesthesia can be distressing both for children and their parents. Nonpharmacological behavioral interventions can reduce the anxiety of children without significant adverse effects as seen with sedative medications. We hypothesized that the use of incentive-based game therapy in conjunction with parental involvement would be a simple and cost-effective intervention in reducing the preoperative anxiety in children.

METHODS:
Eighty children between the age group of 4 and 8 years scheduled to undergo surgery were randomly assigned to a control group (n = 40) and intervention group (n = 40). Children in the intervention group participated in an incentive-based game in the preoperative room. Anesthesia was induced with parental presence in both the groups. The modified Yale Preoperative Anxiety Scale (mYPAS) score to measure the anxiety of the children during induction was taken as the primary outcome. Induction Compliance Checklist score and parental satisfaction were assessed as secondary outcomes.

RESULTS:
The mYPAS score of children in the intervention group was significantly less than the control group during anesthesia induction. The mean difference (95% confidence interval [CI]) of the mYPAS at induction between the 2 groups was 20 (95% CI, 16–24; P < .001). Fourteen (35%) children in the intervention group and 2 (5%) children in control group displayed no anxiety (mYPAS score <30) (difference of −30%; 95% CI, −11% to −49%; P < .001). Children in the intervention group were more compliant with mask induction and had a significantly less Induction Compliance Checklist score compared to the control (P < .001). Thirty (75%) parents in the intervention group were satisfied at the end of surgery compared to 6 (15%) in the control group (difference of −60%; 95% CI, −39% to −73%; P < .001).

CONCLUSIONS:
The use of incentive-based game therapy reduces the anxiety scores during induction of anesthesia and improves the compliance to facemask induction in children undergoing surgery. It can form a simple, cost-effective, and easy-to-administer technique that can be easily applied in low-income settings.
Reversal of Deep Pipecuronium-Induced Neuromuscular Block With Moderate Versus Standard Dose of Sugammadex: A Randomized, Double-Blind, Noninferiority Trial
Authors: Tassonyi Edömér , Asztalos László , Szabó-Maák Zoltán , Nemes Réka , Pongrácz Adrienn , Lengyel Szabolcs , Fülesdi Béla 
Published: August 2018

BACKGROUND:
Certain surgical interventions may require a deep neuromuscular block (NMB). Reversal of such a block before tracheal extubation is challenging. Because anticholinesterases are ineffective in deep block, sugammadex 4 mg/kg has been recommended for the reversal of rocuronium- or vecuronium-induced deep NMB. However, this recommendation requires opening 2 vials of 200 mg sugammadex, which results in an increase in drug costs. Therefore, we sought a less expensive solution for the induction and reversal of deep NMB. Although the optimal dose of sugammadex for antagonism of deep block from pipecuronium has not been established, data pertaining to moderate block are available. Accordingly, we hypothesized that sugammadex 2 mg/kg would be a proper dose to reverse deep pipecuronium block, enabling us to avoid cost increases. In the present study, we compared sugammadex 2 mg/kg with the standard dose of 4 mg/kg for reversal of deep block from pipecuronium.

METHODS:
This single-center, randomized, double-blind, 2 parallel-arms, noninferiority study comprised 50 patients undergoing general anesthesia with propofol, sevoflurane, fentanyl, and pipecuronium. Neuromuscular monitoring was performed with acceleromyography (TOF-Watch SX). Noninferiority margin was specified beforehand as an increase in reversal time of no >10% (corresponding to 1 minute for the primary outcome). When the block spontaneously recovered to posttetanic count 1, the patients randomly received sugammadex 2 or 4 mg/kg, and the time from the injection to the train-of-four (TOF) ratio of 1.0 was measured. Primary outcome was the time to achieve the normalized TOF ratio of 0.9 in a particular patient. Residual or recurrent postoperative NMB was additional end point.

RESULTS:
Each patient recovered to the normalized TOF ratio of 0.9. In the 2 mg/kg group, reversal time was 1.73 ± 1.03 minutes (95% confidence interval [CI], 1.33–2.13; n = 25), and in the 4 mg/kg group, reversal time was 1.42 ± 0.63 minutes (mean ± standard deviation) (95% CI, 1.17–1.67; n = 25). The mean difference in reversal times between the 2 groups was 0.31 minutes (95% CI, −0.18 to 0.8), and the upper limit of CI was below the noninferiority margin of 1 minute. Postoperative block did not occur.

CONCLUSIONS:
The effect of sugammadex 2 mg/kg was noninferior to that of 4 mg/kg in reversing posttetanic count-1 degree pipecuronium block. Sugammadex reversal of deep pipecuronium block appears to be effective.
Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache: A Randomized Controlled Trial
Authors: Abdelaal Ahmed Mahmoud Ahmed , Mansour Amr Zaki , Yassin Hany Mahmoud , Hussein Hazem Abdelwahab , Kamal Ahmed Moustafa , Elayashy Mohamed , Elemady Mohamed Farid , Elkady Hany W. , Mahmoud Hatem Elmoutaz , Cusack Barbara , Hosny Hisham , Abdelhaq Mohamed 
Published: August 2018

BACKGROUND:
Postdural puncture headache (PDPH) lacks a standard evidence-based treatment. A patient treated with neostigmine for severe PDPH prompted this study.

METHODS:
This randomized, controlled, double-blind study compared neostigmine and atropine (n = 41) versus a saline placebo (n = 44) for treating PDPH in addition to conservative management of 85 patients with hydration and analgesics. The primary outcome was a visual analog scale score of ≤3 at 6, 12, 24, 36, 48, and 72 hours after intervention. Secondary outcomes were the need for an epidural blood patch, neck stiffness, nausea, and vomiting. Patients received either neostigmine 20 μg/kg and atropine 10 μg/kg or an equal volume of saline.

RESULTS:
Visual analog scale scores were significantly better (P< .001) with neostigmine/atropine than with saline treatment at all time intervals after intervention. No patients in the neostigmine/atropine group needed epidural blood patch compared with 7 (15.9%) in the placebo group (P< .001). Patients required no >2 doses of neostigmine/atropine. There were no between-group differences in neck stiffness, nausea, or vomiting. Complications including abdominal cramps, muscle twitches, and urinary bladder hyperactivity occurred only in the neostigmine/atropine group (P< .001).

CONCLUSIONS:
Neostigmine/atropine was effective in treating PDPH after only 2 doses. Neostigmine can pass the choroid plexus but not the blood–brain barrier. The central effects of both drugs influence both cerebrospinal fluid secretion and cerebral vascular tone, which are the primary pathophysiological changes in PDPH. The results are consistent with previous studies and clinical reports of neostigmine activity.