bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geology of the Flint Hills, Kansas: Sea-level and climate changes in the Permian
Authors: Goldberg* Karin , Miller* Keith B. 
Published: July 2019

ABSTRACT
The Midcontinent Permian succession in Kansas shows a long-term trend from a monsoonal to semi-arid climate (early Permian) to an increasingly arid and evaporitic climate (late Permian), superimposed by higher-frequency variations that resulted in the alternating deposition of marine carbonates, shales, and paleosols. Within the high-frequency cycles, at least three different orders of subcycles can be recognized: (1) the cyclothems, interpreted as representing glacio-eustatic sea-level fluctuations driven by Milankovitch orbital modulations; (2) the carbonate-to-clastic facies patterns, interpreted as climate change from arid to monsoonal; and (3) the calcic to vertic paleosol profiles, possibly a reflection of increasing precipitation within a monsoonal regime, controlled by weak versus strong monsoons. This field trip focuses on the Lower Permian (Wolfcampian) succession exposed in the Manhattan area, Riley County, Kansas. Nearly continuous exposures display numerous cycles of sea-level change (“cyclothems”). Stacked paleosol horizons that are part of the Wolfcampian cyclothems also record climate changes, from arid/semi-arid to sub-humid/seasonal climates.
Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study
Authors: Sun Xiaohui , Gulliford Martin C 
Published: July 2019

ObjectiveTo analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017.MethodsData were analysed for 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink (CPRD) from 2014 to 2017. Prescriptions for all ABs and for broad-spectrum β-lactam ABs were evaluated. Relative rate reductions (RRR) were estimated from a random-effects Poisson model, adjusting for age, gender, and general practice.ResultsTotal AB prescribing declined from 608 prescriptions per 1000 person-years in 2014 to 489 per 1000 person-years in 2017; RRR 6.9% (95% CI 6.6% to 7.1%) per year. Broad-spectrum β-lactam AB prescribing decreased from 221 per 1000 person-years in 2014 to 163 per 1000 person-years in 2017; RRR 9.3% (9.0% to 9.6%) per year. Declines in AB prescribing were similar for men and women but the rate of decline was lower over the age of 55 years than for younger patients. All AB prescribing declined by 9.8% (9.6% to 10.1%) per year for respiratory infections, 5.7% (5.2% to 6.2%) for genitourinary infections, but by 3.8% (3.1% to 4.5%) for no recorded indication. Overall, 38.8% of AB prescriptions were associated with codes that did not suggest specific clinical conditions, and 15.3% of AB prescriptions had no medical codes recorded.ConclusionAntibiotic prescribing has reduced and become more selective but substantial unnecessary AB use may persist. Improving the quality of diagnostic coding for AB use will help to support antimicrobial stewardship efforts.
Hospital use in survivors of transient ischaemic attack compared with survivors of stroke in central China: a nested case–control study
Authors: Li Sangsang , Tian Qingfeng , Fan Junxing , Shi Zhan , Guo Bingxin , Chen Huanan , Li Yapeng , Shi Songhe 
Published: July 2019

ObjectivesThere is a lack of knowledge regarding post-discharge hospitalisation utilisation after transient ischaemic attack (TIA) in China. The aim of this study is to quantify rehospitalisation use in survivors of TIA compared with their own previous hospital use and matched survivors of stroke.DesignNested case–control study of electronic medical records datasets.Setting958 hospitals in Henan, China, from July 2012 to December 2015.ParticipantsIn total, 4823 survivors of stroke were matched to the TIA cohort (average age: 64.5 years; proportion of men: 48.4%) at a 1:1 ratio. All subjects with an onset of stroke/TIA were recorded with a 1-year look-back and follow-up.Outcome measuresAdjusted difference-in-differences (DID) values in 1-year hospital lengths of stay (LOSs) and readmission within 7, 30 and 90 days.ResultsThere was an increase in hospital admissions in survivors of TIA in the year after the index hospitalisation compared with the prior year. Of the 2449 rehospitalisation events that occurred during the first year after TIA, stroke (20.6%) was the most common reason for rehospitalisation. There was no difference in the stroke-specific readmission rates between the TIA and stroke cohorts (p=0.198). The TIA cohort had fewer readmissions within 30 days and 90 days after all-cause discharge compared with the controls. The corresponding covariate-adjusted DID values were −3.5 percentage points (95% CI −5.3 to −1.8) and −4.5 (95% CI −6.5 to −2.4), respectively. A similar trend was observed in the 1-year LOS. In the stratified analysis, the DID reductions were not significant in patients with more comorbidities or in rural patients.ConclusionsCompared with survivors of stroke, survivors of TIA use fewer hospital resources up to 1 year post-discharge. Greater attention to TIAs among patients with more comorbidities and rural patients may provide an opportunity to reduce hospital use.
Sleepiness of day workers and watchkeepers on board at high seas: a cross-sectional study
Authors: Oldenburg Marcus , Jensen Hans-Joachim 
Published: July 2019

ObjectivesTo estimate the prevalence of sleepiness on duty among day workers and watchkeepers on board.DesignCross-sectional survey in a maritime field study.Setting10 shipping companies with container vessels under German management.ParticipantsThe whole crew (75 day workers and 123 watchkeepers) during 18 voyages on 18 different container ships.Outcome measuresSleepiness on duty and efficiency of sleep using pupillometry (in a cross-shift design) and the SenseWear armband activity monitor.ResultsThe watchkeepers showed significantly shorter sleep periods than day workers (5.5 hours vs 5.8 hours). The average efficiency of sleep was 69.6% and significantly lower among watchkeepers (OR 0.48; 95% CI 0.26 to 0.88). 396 pupillometric examinations were carried out and revealed 88 study members (22.2%) with a pupillary unrest index (rPUI) in a range characterised as ‘unfit for duty’ and 110 seafarers (27.8%) categorised as ‘particular attention required’. The average rPUI was similar between day workers and watchkeepers. The Epworth Sleepiness Scale revealed recent daytime sleepiness in 70 seafarers, which was similarly often stated by day workers and watchkeepers. Based on the Stanford Sleepiness Scale (SSS), a measurable cross-shift increase in the SSS value during the examined shift was observed, especially among watchkeepers. The amount of time already spent on the vessel at the time of the present examination was significantly associated with the rPUI (p=0.009).ConclusionSleep periods of both the day workers and the watchkeepers aboard vessels were alarmingly short and sleep efficiency was low. Sleepiness on duty is similarly prevalent among day workers and watchkeepers and seems to depend partly on the cumulative working period on the vessels. Preventive measures need to be taken by the shipping industry to counteract fatigue (eg, by enabling sufficient rest and sleep times).
Validation of an algorithm using inpatient electronic health records to determine the presence and severity of cirrhosis in patients with hepatocellular carcinoma in England: an observational study
Authors: Driver Robert J , Balachandrakumar Vinay , Burton Anya , Shearer Jessica , Downing Amy , Cross Tim , Morris Eva , Rowe Ian A 
Published: July 2019

ObjectivesOutcomes in hepatocellular carcinoma (HCC) are determined by both cancer characteristics and liver disease severity. This study aims to validate the use of inpatient electronic health records to determine liver disease severity from treatment and procedure codes.DesignRetrospective observational study.SettingTwo National Health Service (NHS) cancer centres in England.Participants339 patients with a new diagnosis of HCC between 2007 and 2016.Main outcomeUsing inpatient electronic health records, we have developed an optimised algorithm to identify cirrhosis and determine liver disease severity in a population with HCC. The diagnostic accuracy of the algorithm was optimised using clinical records from one NHS Trust and it was externally validated using anonymised data from another centre.ResultsThe optimised algorithm has a positive predictive value (PPV) of 99% for identifying cirrhosis in the derivation cohort, with a sensitivity of 86% (95% CI 82% to 90%) and a specificity of 98% (95% CI 96% to 100%). The sensitivity for detecting advanced stage cirrhosis is 80% (95% CI 75% to 87%) and specificity is 98% (95% CI 96% to 100%), with a PPV of 89%.ConclusionsOur optimised algorithm, based on inpatient electronic health records, reliably identifies and stages cirrhosis in patients with HCC. This highlights the potential of routine health data in population studies to stratify patients with HCC according to liver disease severity.
Duration of second victim symptoms in the aftermath of a patient safety incident and association with the level of patient harm: a cross-sectional study in the Netherlands
Authors: Vanhaecht Kris , Seys Deborah , Schouten Loes , Bruyneel Luk , Coeckelberghs Ellen , Panella Massimiliano , Zeeman Gerda 
Published: July 2019

ObjectivesTo describe healthcare providers’ symptoms evoked by patient safety incidents (PSIs), the duration of these symptoms and the association with the degree of patient harm caused by the incident.DesignCross-sectional survey.Setting32 Dutch hospitals that participate in the ‘Peer Support Collaborative’.Participants4369 healthcare providers (1619 doctors and 2750 nurses) involved in a PSI at any time during their career.InterventionsAll doctors and nurses working in direct patient care in the 32 participating hospitals were invited via email to participate in an online survey.Primary and secondary outcome measuresPrevalence of symptoms, symptom duration and its relationship with the degree of patient harm.ResultsIn total 4369 respondents were involved in a PSI and completely filled in the questionnaire. Of these, 462 reported having been involved in a PSI with permanent harm or death during the last 6 months. This had a personal, professional impact as well as impact on effective teamwork requirements. The impact of a PSI increased when the degree of patient harm was more severe. The most common symptom was hypervigilance (53.0%). The three most common symptoms related to teamwork were having doubts about knowledge and skill (27.0%), feeling unable to provide quality care (15.6%) and feeling uncomfortable within the team (15.5%). PSI with permanent harm or death was related to eightfold higher likelihood of provider-related symptoms lasting for more than 1 month and ninefold lasting longer than 6 months compared with symptoms reported when the PSI caused no harm.ConclusionThe impact of PSI remains an underestimated problem. The higher the degree of harm, the longer the symptoms last. Future studies should evaluate how these data can be integrated in evidence-based support systems.
Impact of e-cigarette health warnings on motivation to vape and smoke
Authors: Brewer Noel T , Jeong Michelle , Hall Marissa G , Baig Sabeeh A , Mendel Jennifer R , Lazard Allison J , Noar Seth M , Kameny Madeline R , Ribisl Kurt M 
Published: July 2019

BackgroundA prevailing hypothesis is that health warnings for electronic cigarettes (e-cigarettes) could drive people away from vaping and towards smoking cigarettes. We consider an alternative hypothesis that e-cigarette warnings discourage both vaping and smoking.MethodsParticipants were a national convenience sample of 2218 US adults who used e-cigarettes, cigarettes or both. In August 2018, we randomised participants to one of three warningtypes(control text about littering, text-only e-cigarette warning or pictorial e-cigarette warning). We further randomised participants viewing e-cigarette warnings to one of threetopics(nicotine addiction, health hazards of use, or both health hazards and harms of use). The preregistered primary outcome was intentions to quit vaping among e-cigarette users. Secondary outcomes included interest in smoking and Tobacco Warnings Model constructs: attention, negative affect, anticipated social interactions and cognitive elaboration.ResultsText warnings elicited higher intentions to quit vaping than control among e-cigarette users (d=0.44, p<0.001), and pictorial warnings elicited still higher intentions to quit vaping than text (d=0.12, p<0.05). Text warnings elicited lower interest in smoking compared with control among smokers (p<0.05); warnings had no other effects on interest in smoking among smokers or non-smokers. Text warnings about health hazards elicited higher intentions to quit vaping than nicotine addiction warnings. E-cigarette warnings also increased Tobacco Warnings Model constructs.DiscussionE-cigarette health warnings may motivate users to quit vaping and discourage smoking. The most promising warnings include health hazards (other than nicotine addiction) and imagery. We found no support for the hypothesis that e-cigarette warnings could encourage smoking cigarettes.
WudStay and the Houseboat Sector in India
Authors: Gupta Rakesh , Narayan Kirthivasan Sathya , Sharma Sowmya , Sunny Roshni 
Published: July 2019

This case deals with the challenges and dilemma faced by WudStay, a start-up engaged in the aggregation of different accommodation options in India. The company wants to evaluate the attractiveness and the challenges facing the houseboat sector and decide whether to enter this sector. The case illustrates the present state of the houseboat sector and captures the direction it is heading. Since its inception, the sector has remained unorganized, resulting in unsatisfactory customer service standards. The short-sighted approach of houseboat owners to maximize profits and refusal to adopt technological solutions has put doubts on the long-term health of this sector with many tourists looking for better alternatives. The sector is concentrated in two states in India: Jammu and Kashmir (J&K) and Kerala. The differences in the external-macro environment has taken the sector in these two states to completely different directions. In Kashmir, the deteriorating security situation has a negative impact on tourist inflows, thus reducing the demand for houseboats. In Kerala, the sector is on an upswing, with the government playing a catalytic role in promoting tourism and incentivizing houseboats through subsidies. In this background, WudStay wants to evaluate its long-term attractiveness and the opportunity of creating a sustainable value proposition in this sector.
Association between semen quality among men with different occupational exposures and risk of recurrent spontaneous abortion in island residents
Authors: Cao Wenli , Pan Xinyao , Ye Feijun , Zhou Jing , Huang Zengshu , Li Chuyu , Zhang Yanpu , Fang Jianwei , Jiang Yan , Lian Hongyu , Fu Zhongxing , Du Yan , Wang Ling 
Published: July 2019

Objective: This study aimed to evaluate the semen quality of male adults whose spouses suffer from recurrent spontaneous abortion (RSA) in the island area, and to explore the association between RSA and occupational exposures. Methods: A total of 131 male patients were recruited and divided into two groups: spouse with recurrent spontaneous abortion group (RSA group, [Formula: see text]) and the normal fertility group (control group, [Formula: see text]). Information such as height, weight and occupational exposure history of 131 men were obtained. Semen samples were collected and analyzed. Differences in semen parameters and DNA fragmentation index (DFI) between the two groups were compared. Odds ratios (ORs) and their corresponding 95% confidence intervals were calculated to evaluate the association between occupational exposures and RSA status. Results: Overall, no significant difference was found in sperm concentration, progressive motility and normal morphology rate between RSA and control groups. Only DFI was observed to be significantly higher in the RSA group. Evaluation of the receiver operating characteristic (ROC) curve showed DFI (AUC: 0.623, [Formula: see text]) could discriminate between males from the couples with RSA and without RSA. Conclusion: The analysis of conventional semen parameters could not directly reflect their influence on embryonic development, and test of integrity of the sperm DNA is of paramount importance to fully understand male fertility. It is crucial to conduct studies regarding occupational exposures and pregnancy loss and/or RSA risk, since it will provide population-level data to aid in the identification of important risk factors that warrant further mechanistic investigation, and eventually lead to effective prevention and treatment strategies.
TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial)
Authors: Pang Peter S. , Fermann Gregory J. , Hunter Benton R. , Levy Phillip D. , Lane Kathleen A. , Li Xiaochun , Cole Mette , Collins Sean P. 
Published: July 2019

Background:
Identifying low-risk acute heart failure patients safe for discharge from the emergency department is a major unmet need.

Methods AND RESULTS:

A prospective, observational, multicenter pilot study targeting lower risk acute heart failure patients to determine whether hsTnT (high-sensitivity troponin T) identifies emergency department acute heart failure patients at low risk for rehospitalization and mortality. hsTnT was drawn at baseline and 3 hours. Phone follow-up occurred at 30 and 90 days. The primary end point composite of all-cause mortality, rehospitalization, and emergency department visits at 90 days (changed from 30 days because of lack of mortality events), analyzed using logistic regression. Secondary end points: 30- and 90-day all-cause mortality. hsTnT values less than the 99th percentile were defined as low hsTnT. Out of 527 enrolled patients, 499 comprised the initial analysis set. Of these, 332 had both 0- and 3-hour hsTnT drawn, of whom 319 completed 30 day follow-up. The average age was 62, 60% male, and 57% black. Median hsTnT was 26.4 ng/L (interquartile range, 15.1–44.3). There were 99 (21%) 30-day composite events, 13 (2.7%) deaths at 30 days, and 25 deaths (8.2%) at 90 days. Serial hsTnT values below the 99th percentile were not associated with a lower risk for the 90-day primary composite end point (odds ratio, 0.79; 95% CI, 0.42–1.50;
P
=0.4736). However, no deaths occurred in the low hsTnT group at 30 days with 1 death at 90 days.

Conclusions:
hsTnT did not identify patients at low risk for the primary outcome of rehospitalization, emergency department visits, and mortality at 90 days.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02592135.
Race/Ethnicity and Neighborhood Characteristics Are Associated With Bystander Cardiopulmonary Resuscitation in Pediatric Out‐of‐Hospital Cardiac Arrest in the United States: A Study From CARES
Authors: Naim Maryam Y. , Griffis Heather M. , Burke Rita V. , McNally Bryan F. , Song Lihai , Berg Robert A. , Nadkarni Vinay M. , Vellano Kimberly , Markenson David , Bradley Richard N. , Rossano Joseph W. 
Published: July 2019

Background

Whether racial and neighborhood characteristics are associated with bystander cardiopulmonary resuscitation (
BCPR
) in pediatric out‐of‐hospital cardiac arrest (
OHCA
) is unknown.

Methods and Results

An analysis was conducted of CARES (Cardiac Arrest Registry to Enhance Survival) for pediatric nontraumatic
OHCA
s from 2013 to 2017. An index (range, 0–4) was created for each arrest based on neighborhood characteristics associated with low
BCPR
(>80% black; >10% unemployment; <80% high school; median income, <$50 000). The primary outcome was
BCPR
.
BCPR
occurred in 3399 of 7086
OHCA
s (48%). Compared with white children,
BCPR
was less likely in other races/ethnicities (black: adjusted odds ratio [
aOR
], 0.59; 95%
CI
, 0.52–0.68; Hispanic:
aOR
, 0.78; 95%
CI
, 0.66–0.94; and other:
aOR
, 0.54; 95%
CI
, 0.40–0.72). Compared with arrests in neighborhoods with an index score of 0,
BCPR
occurred less commonly for arrests with an index score of 1 (
aOR
, 0.80; 95%
CI
, 0.70–0.91), 2 (
aOR
, 0.75; 95%
CI
, 0.65–0.86), 3 (
aOR
, 0.52; 95%
CI
, 0.45–0.61), and 4 (
aOR
, 0.46; 95%
CI
, 0.36–0.59). Black children had an incrementally lower likelihood of
BCPR
with increasing index score while white children had an overall similar likelihood at most scores. Black children with an index of 4 were approximately half as likely to receive
BCPR
compared with white children with a score of 0.

Conclusions

Racial and neighborhood characteristics are associated with
BCPR
in pediatric
OHCA
. Targeted
CPR
training for nonwhite, low‐education, and low‐income neighborhoods may increase
BCPR
and improve pediatric
OHCA
outcomes.
Prediction of Aneurysm Stability Using a Machine Learning Model Based on PyRadiomics-Derived Morphological Features
Authors: Liu QingLin , Jiang Peng , Jiang YuHua , Ge HuiJian , Li ShaoLin , Jin HengWei , Li YouXiang 
Published: July 2019

Background and Purpose—
Discrimination of the stability of intracranial aneurysms is critical for determining the treatment strategy, especially in small aneurysms. This study aims to evaluate the feasibility of applying machine learning for predicting aneurysm stability with radiomics-derived morphological features.

Methods—
Morphological features of 719 aneurysms were extracted from PyRadiomics, of which 420 aneurysms with Maximum3DDiameter ranging from 4 mm to 8 mm were enrolled for analysis. The stability of these aneurysms and other clinical characteristics were reviewed from the medical records. Based on the morphologies with/without clinical features, machine learning models were constructed and compared to define the morphological determinants and screen the optimal model for predicting aneurysm stability. The effect of clinical characteristics on the morphology of unstable aneurysms was analyzed.

Results—

Twelve morphological features were automatically extracted from PyRadiomics implemented in Python for each aneurysm. Lasso regression defined Flatness as the most important morphological feature to predict aneurysm stability, followed by SphericalDisproportion, Maximum2DDiameterSlice, and SurfaceArea. SurfaceArea (odds ratio [OR], 0.697; 95% CI, 0.476–0.998), SphericalDisproportion (OR, 1.730; 95% CI, 1.143–2.658), Flatness (OR, 0.584; 95% CI, 0.374–0.894), Hyperlipemia (OR, 2.410; 95% CI, 1.029–5.721), Multiplicity (OR, 0.182; 95% CI, 0.082–0.380), Location at middle cerebral artery (OR, 0.359; 95% CI, 0.134–0.902), and internal carotid artery (OR, 0.087; 95% CI, 0.030–0.211) were enrolled into the final prediction model. In terms of performance, the area under curve of the model reached 0.853 (95% CI, 0.767–0.940). For unstable aneurysms, Compactness1 (
P
=0.035), Compactness2 (
P
=0.036), Sphericity (
P
=0.035), and Flatness (
P
=0.010) were low, whereas SphericalDisproportion (
P
=0.034) was higher in patients with hypertension.

Conclusions—
Morphological features extracted from PyRadiomics can be used for aneurysm stratification. Flatness is the most important morphological determinant to predict aneurysm stability. Our model can be used to predict aneurysm stability. Unstable aneurysm is more irregular in patients with hypertension.