bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of radiofrequency ablation alone & in combination with percutaneous ethanol injection for management of hepatocellular carcinoma
Authors: Kalra Naveen , Kang Mandeep , Duseja Ajay K. , Bhatia Anmol , Singh Virendra , Dhiman Radha K. , Rajwanshi Arvind , Chawla Yogesh K. , Khandelwal Niranjan 
Published: March 2018

Background & objective:
It has been shown that the combined use of alcohol before radiofrequency ablation (RFA) helps to augment the therapeutic advantage of RFA. The present study was conducted to compare the outcome of treatment with RFA alone and RFA with alcohol as ablative technique in patients with small hepatocellular carcinomas (HCCs), who were not candidates for surgery.

Methods:
Fifty patients with chronic liver disease and concurrent HCC were enrolled in this prospective study. The patients were treated with either RFA alone (n=25) or RFA combined with alcohol (n=25). Patient outcome was evaluated, and the tumour recurrence and survival of the patients were assessed in the two groups.

Results:
The survival rates at six months in patients who completed at least six months of follow up were 84 and 80 per cent in patients treated with RFA alone and combination therapy, respectively. During the follow up period, 11 and four patients treated with RFA alone showed local and distant intrahepatic tumour recurrence, respectively. All local recurrences were at one to 18 months of the follow up period. The distant recurrences occurred at 6-36 months of the follow up period. During the follow up period, eight and six patients treated with combination therapy showed local and distant intrahepatic tumour recurrence, respectively. All local recurrences were at 1.5-15 months during the follow up period. The distant intrahepatic recurrences occurred at 6-72 months during the follow up period.

Interpretation & conclusions:
No significant difference was seen between the survival time of the patients treated with RFA alone and RFA with alcohol as well as in the local recurrences and distant intrahepatic recurrences in RFA compared to RFA and alcohol group patients. Combined use of RFA and alcohol did not improve the local tumour control and survival in patients with HCC compared to RFA alone.
Quantitative Data Analysis of Perceived Barriers and Motivators to Physical Activity in Stroke Survivors
Authors: Nicholson SL , Greig CA , Sniehotta F , Johnston M , Lewis SJ , McMurdo MET , Johnston D , Scopes J , Mead GE 
Published: March 2018

Background Levels of physical activity after stroke are low, despite multiple health benefits. We explored stroke survivors’ perceived barriers, motivators, self-efficacy and intention to physical activity. Methods Fifty independently mobile stroke survivors were recruited prior to hospital discharge. Participants rated nine possible motivators and four possible barriers based on the Mutrie Scale, as having ‘no influence', ‘some influence’ or ‘a major influence’ on physical activity. Participants also rated their self-efficacy and intention to increasing walking. Results The most common motivator was ‘physical activity is good for health’ [34 (68%)]. The most common barrier was ‘feeling too tired’ [24 (48%)]. Intention and self-efficacy were high. Self-efficacy was graded as either 4 or 5 (highly confident) on a five-point scale by [34 (68%)] participants, while 42 (84%) ‘strongly agreed’ or ‘agreed’ that they intended to increase their walking. Conclusion Participants felt capable of increasing physical activity but fatigue was often perceived as a barrier to physical activity. This needs to be considered when encouraging stroke survivors to be more active.
New insights into the use of stable water isotopes at the northern Antarctic Peninsula as a tool for regional climate studies
Authors: Fernandoy Francisco , Tetzner Dieter , Meyer Hanno , Gacitúa Guisella , Hoffmann Kirstin , Falk Ulrike , Lambert Fabrice , MacDonell Shelley 
Published: March 2018

Abstract. Due to recent atmospheric and oceanic warming, the Antarctic Peninsula is one of the most challenging regions of Antarctica to understand in terms of both local- and regional-scale climate signals. Steep topography and a lack of long-term and in situ meteorological observations complicate the extrapolation of existing climate models to the sub-regional scale. Therefore, new techniques must be developed to better understand processes operating in the region. Isotope signals are traditionally related mainly to atmospheric conditions, but a detailed analysis of individual components can give new insight into oceanic and atmospheric processes. This paper aims to use new isotopic records collected from snow and firn cores in conjunction with existing meteorological and oceanic datasets to determine changes at the climatic scale in the northern extent of the Antarctic Peninsula. In particular, a discernible effect of sea ice cover on local temperatures and the expression of climatic modes, especially the Southern Annular Mode (SAM), is demonstrated. In years with a large sea ice extension in winter (negative SAM anomaly), an inversion layer in the lower troposphere develops at the coastal zone. Therefore, an isotope–temperature relationship (δ–T) valid for all periods cannot be obtained, and instead the δ–T depends on the seasonal variability of oceanic conditions. Comparatively, transitional seasons (autumn and spring) have a consistent isotope–temperature gradient of +0.69 ‰ °C−1. As shown by firn core analysis, the near-surface temperature in the northern-most portion of the Antarctic Peninsula shows a decreasing trend (−0.33 °C year−1) between 2008 and 2014. In addition, the deuterium excess (dexcess) is demonstrated to be a reliable indicator of seasonal oceanic conditions, and therefore suitable to improve a firn age model based on seasonal dexcess variability. The annual accumulation rate in this region is highly variable, ranging between 1060 and 2470 kg m−2 year−1 from 2008 to 2014. The combination of isotopic and meteorological data in areas where data exist is key to reconstruct climatic conditions with a high temporal resolution in polar regions where no direct observations exist.
The effect of a state health care consent law on patient care in hospitals: A survey of physicians
Authors: Comer Amber R. , Gaffney Margaret , Stone Cynthia , Torke Alexia 
Published: March 2018

Objective: When a patient cannot make medical decisions for him or herself, and has not appointed a healthcare representative, default state healthcare consent laws determine who is able to make healthcare decisions for the patient. The narrow construction of some state laws leaves many patients in situations where the closest person to the patient does not qualify as a representative under the law, or where the patient has too many representatives and a consensus cannot be reached on the patient’s medical care.Methods: In order to determine how state healthcare consent laws affect patient care in hospitals, a survey of 412 Indiana physicians was conducted.Results: The data shows 53.8% of physicians experienced a delay in patient care because they were unable to identify a legally appropriate health care representative. Almost half (46.01%) of physicians experienced delay of patient care due to the inability to identify a final decision maker when disputes arose between multiple legal representatives.Conclusions: The results of this study have important implications for hospital administrators as a delay in patient care can be costly and unnecessarily utilizes hospital resources. Additionally, the results of this study have important implications for the status of state surrogate decision making laws. Amending state laws to include more potential surrogates, has the potential to minimize delays in patient care and ensure that appropriate surrogates are making medical care decisions for patients without the undue burden of court intervention.
Applications of Pell Polynomials in Rings
Authors: TASYURDU Yasemin , ÇiFÇi Devran , DEVECi Ömür 
Published: March 2018

In this paper, we study the Pell polynomials according to modulo mwhere $X^2=2x+1$ and various properties of these sequences are obtained. Also, Pell polynomials to the ring of complex numbers was defined. We define the Pell Polynomial-type orbits $P_（α,β){^R}(x)={X_i}$ where R be a 2-generator ring and (α,β) is a generating pair of the ring. Furthermore, we obtain the periods of the Pell Polynomial-type orbits P_（α,β){^R}(x) in finite 2-generator rings of order P{^2}.
Feasibility of the estimation of octanol-water distribution coefficients of acidic drugs by microemulsion electrokinetic chromatography
Authors: Fernández-Pumarega Alejandro , Amézqueta Susana , Fuguet Elisabet , Rosés Martí 
Published: March 2018

Previous studies have shown that a microemulsion electrokinetic chromatography (MEEKC) system can estimate the logarithm of the octanol-water partition coefficient (log P<sub>o/w</sub>) of neutral solutes. In the present work, the applicability of the method to partially and fully ionized acids has been evaluated. Naproxen, a monoprotic acid, has been used as test solute. The retention factor (k) of this compound has been measured in MEEKC at several values of pH and the retention factor-pH profile has been established. As log P<sub>o/w</sub> correlates with log k<sub>MEEKC</sub> for neutral compounds, this correlation has been used to estimate the logarithm of the octanol-water partition coefficient of the neutral (log P<sub>o/w(HA)</sub>), and the fully ionized (log P <sub>o/w(A-)</sub>) forms of naproxen. Then, the logarithm of the octanol-water distribution coefficient (log D<sub>o/w</sub>) of the partially ionized form of the acid has been estimated. The comparison of the estimated values with the ones obtained experimentally using the classical procedures, such as the shake-flask method, shows differences under 0.4 log D<sub>o/w</sub> units either if the acid is partially ionized or in its neutral form in the most part of the pH range. However, the method overestimates the log D<sub>o/w </sub>of the highly (&gt;99.5 %) or fully ionized form of naproxen.
Educational Intervention in a Medically Underserved Area
Authors: Atance Joel , Mickalis Morgan , Kincade Brianna 
Published: March 2018

Abstract

Context
Medical students from rural and medically underserved areas (MUAs) are more likely than their peers to practice medicine in rural areas and MUAs. However, students from MUAs are also more likely to face socioeconomic barriers to a career in medicine.

Objective
To determine whether a week-long summer enrichment experience (SEE) at Edward Via College of Osteopathic Medicine-Carolinas could successfully teach high school students from MUAs basic biomedical concepts and foster an interest in medicine and the health sciences.

Methods
The SEE program is open to high school students in the Spartanburg, South Carolina, area. The program includes interactive lectures, laboratories, demonstrations on gross anatomy prosections, demonstrations on medical simulation models, tours of emergency vehicles, an introduction to osteopathic manipulative medicine, and student-led research projects. Participants were asked to complete a 15-question quiz that assessed their knowledge of basic biomedical concepts and a 10-question survey that assessed their attitudes toward careers in medicine and health sciences. Both the quiz and the survey were completed on both the first and final days of the program. The data were analyzed using paired t tests.

Results
Participant knowledge of basic biomedical concepts, as determined by the quiz scores, increased after completion of the program (9.1 average correct answers vs 12.6 average correct answers) (P<.001). Participant attitude toward medicine and the health sciences improved in 9 of the 10 items surveyed after completion of the program (P<.05).

Conclusions
Participant knowledge of basic biomedical concepts and their knowledge of and interest in careers in the health sciences improved after completing the SEE program. These findings suggest that educational interventions for high school students could help to develop primary care physicians for rural areas and MUAs and that there is a role for osteopathic medical schools to nurture these students as early as possible.
Y‐Mars: An Astrobiological Analogue of Martian Mudstone
Authors: Stevens Adam H. , Steer Elizabeth , McDonald Alison , Amador Elena S. , Cockell Charles S. 
Published: March 2018

AbstractNASA's Mars Science Laboratory mission has collected evidence of a long‐lasting habitable environment in the Sheepbed sediments of Gale Crater on Mars. The geochemistry of this mudstone suggests that the lake filling the crater in Mars' past had a neutral pH and low salinity and contained elements and redox couples required by life. We produced a geochemical analogue to the Sheepbed mudstone by mixing a collection of its primary minerals to match the X‐Ray diffraction data from Mars Science Laboratory. Here we describe the production of the Y‐Mars (Yellowknife‐Mars) analogue and characterize its properties, including the presence of background carbon, nitrogen, and sulfur. We highlight some of the unavoidable issues involved in making analogues, especially for astrobiological applications. The Y‐Mars analogue has a number of applications for astrobiological research, but more analogues are required to properly represent the diversity of Martian sedimentary contexts.
Spatiotemporal Variations in Rainfall and Temperature in Ghana Over the Twentieth Century, 1900–2014
Authors: Abbam Tawia , Johnson Fiifi Amoako , Dash Jadu , Padmadas Sabu S. 
Published: March 2018

AbstractClimate‐dependent subsistence agriculture remains the main livelihood for most populations in Ghana. The spatiotemporal variations in rainfall and temperature have influence particularly in poorly‐developed agrarian regions with limited or no irrigation infrastructure. Therefore, a systematic understanding of climate patterns across space and time is important for mitigating against food insecurity and household poverty. Using over a century of high‐spatial resolution data, this study examines the spatiotemporal variations in rainfall and temperature across Ghana to identify climate‐stressed locations with potential effect on the production of major staple crops. The data for the analysis were drawn from the University of Delaware's Gridded Precipitation and Temperature Monthly Climatology version 4.01. The analysis was restricted to the main crop‐growing periods (March to December). The Mann‐Kendall nonparametric regression test was used to examine significant changes in rainfall variability and temperature at the district level. The results show that Ghana's climate has become progressively drier over the last century and prone to drought conditions. The most climate‐stressed districts are clustered within the three northern regions (Upper West, Upper East, and Northern) and the Western region. The most recent census in Ghana shows that the three northern regions also have the highest prevalence of subsistence agriculture. The findings from this study have implications for targeted interventions such as the Ghanaian government's recent policy initiative aimed at alleviating rural poverty by encouraging youth participation in agriculture along with efforts to intensifying crop production using modern farming techniques.
Estimating Solar Irradiance Since 850 CE
Authors: Lean J. L. 
Published: March 2018

AbstractSolar total and spectral irradiance are estimated from 850 to 1610 by regressing cosmogenic irradiance indices against the National Oceanic and Atmospheric Administration Solar Irradiance Climate Data Record after 1610. The new estimates differ from those recommended for use in the Paleoclimate Model Intercomparison Project (PMIP4) in the magnitude of multidecadal irradiance changes, spectral distribution of the changes, and amplitude and phasing of the 11‐year activity cycle. The new estimates suggest that total solar irradiance increased 0.036 ± 0.009% from the Maunder Minimum (1645–1715) to the Medieval Maximum (1100 to 1250), compared with 0.068% from the Maunder Minimum to the Modern Maximum (1950–2009). PMIP4's corresponding increases are 0.026% and 0.055%, respectively. Multidecadal irradiance changes in the new estimates are comparable in magnitude to the PMIP4 recommendations in the ultraviolet spectrum (100–400 nm) but somewhat larger at visible (400–700 nm) and near‐infrared (700–1,000 nm) wavelengths; the new estimates suggest increases from the Maunder Minimum to the Medieval Maximum of 0.17 ± 0.04%, 0.030 ± 0.008%, and 0.036 ± 0.009% in the ultraviolet, visible, and near‐infrared spectral regions, respectively, compared with PMIP4 increases of 0.17%, 0.021%, and 0.016%. The uncertainties are 1σ estimates accruing from the statistical procedures that reconstruct irradiance in the Medieval Maximum relative to the Modern Maximum, not from the specification of Modern Maximum irradiances per se. In the new estimates, solar irradiance cycle amplitudes in the Medieval Maximum are comparable to those in the Modern Maximum, whereas in the PMIP4 reconstruction they are at times almost a factor of 2 larger at some wavelengths and differ also in phase.
Sea Level Rise Impacts on Wastewater Treatment Systems Along the U.S. Coasts
Authors: Hummel Michelle A. , Berry Matthew S. , Stacey Mark T. 
Published: March 2018

AbstractAs sea levels rise, coastal communities will experience more frequent and persistent nuisance flooding, and some low‐lying areas may be permanently inundated. Critical components of lifeline infrastructure networks in these areas are also at risk of flooding, which could cause significant service disruptions that extend beyond the flooded zone. Thus, identifying critical infrastructure components that are exposed to sea level rise is an important first step in developing targeted investment in protective actions and enhancing the overall resilience of coastal communities. Wastewater treatment plants are typically located at low elevations near the coastline to minimize the cost of collecting consumed water and discharging treated effluent, which makes them particularly susceptible to coastal flooding. For this analysis, we used geographic information systems to assess the exposure of wastewater infrastructure to various sea level rise projections at the national level. We then estimated the number of people who would lose wastewater services, which could be more than five times as high as previous predictions of the number of people at risk of direct flooding due to sea level rise. We also performed a regional comparison of wastewater exposure to marine and groundwater flooding in the San Francisco Bay Area. Overall, this analysis highlights the widespread exposure of wastewater infrastructure in the United States and demonstrates that local disruptions to infrastructure networks may have far‐ranging impacts on areas that do not experience direct flooding.
Phosphorus Loadings to the World's Largest Lakes: Sources and Trends
Authors: Fink Gabriel , Alcamo Joseph , Flörke Martina , Reder Klara 
Published: March 2018

AbstractEutrophication is a major water quality issue in lakes worldwide and is principally caused by the loadings of phosphorus from catchment areas. It follows that to develop strategies to mitigate eutrophication, we must have a good understanding of the amount, sources, and trends of phosphorus pollution. This paper provides the first consistent and harmonious estimates of current phosphorus loadings to the world's largest 100 lakes, along with the sources of these loadings and their trends. These estimates provide a perspective on the extent of lake eutrophication worldwide, as well as potential input to the evaluation and management of eutrophication in these lakes. We take a modeling approach and apply the WorldQual model for these estimates. The advantage of this approach is that it allows us to fill in large gaps in observational data. From the analysis, we find that about 66 of the 100 lakes are located in developing countries and their catchments have a much larger average phosphorus yield than the lake catchments in developed countries (11.1 versus 0.7 kg TP km−2 year−1). Second, the main source of phosphorus to the examined lakes is inorganic fertilizer (47% of total). Third, between 2005–2010 and 1990–1994, phosphorus pollution increased at 50 out of 100 lakes. Sixty percent of lakes with increasing pollution are in developing countries. P pollution changed primarily due to changing P fertilizer use. In conclusion, we show that the risk of P‐stimulated eutrophication is higher in developing countries.
Tuffaceous Mud is a Volumetrically Important Volcaniclastic Facies of Submarine Arc Volcanism and Record of Climate Change
Authors: Gill J. B. , Bongiolo E. M. , Miyazaki T. , Hamelin C. , Jutzeler M. , DeBari S. , Jonas A‐S. , Vaglarov B. S. , Nascimento L. S. , Yakavonis M. 
Published: March 2018

AbstractThe inorganic portion of tuffaceous mud and mudstone in an oceanic island arc can be mostly volcanic in origin. Consequently, a large volume of submarine volcaniclastic material is as extremely fine‐grained as products of subaerial eruptions (<100 µm). Using results of IODP Expedition 350 in the Izu rear arc, we show that such material can accumulate at high rates (12–20 cm/k.y.) within 13 km of the nearest seamount summit and scores of km behind the volcanic front. The geochemistry of bulk, acid‐leached mud, and its discrete vitriclasts, shows that >75% of the mud is volcanic, and that most of it was derived from proximal rear arc volcanic sources. It faithfully preserves integrated igneous geochemical information about arc evolution in much the same way that terrigenous shales track the evolution of continental crust. In addition, their high sedimentation rate enables high resolution study of climate cycles, including the effects of Pleistocene glaciation on the behavior of the Kuroshio Current in the Shikoku Basin south of Japan.
Coupled SKR Emissions in Saturn's Northern and Southern Ionospheres
Authors: Kivelson Margaret G. , Jia Xianzhe 
Published: March 2018

AbstractKilometric radiation (SKR) emitted above Saturn's auroral ionosphere is modulated in intensity at periods close to the planetary rotation period; SKR periods differ slightly for sources in the north and in the south. Although there is good evidence that the signals are generated independently in the two hemispheres, it is also well established that during southern summer power emitted from the northern hemisphere is modulated in intensity not only at the northern period but also at the southern period, an observation that requires an explanation. We examine the idea that the signal in the north at the southern period is a secondary effect of the strong field‐aligned current system centered at 270° that drives the southern signal. Basing our analysis on studies of field‐aligned current systems in the terrestrial and Jovian magnetospheres, we argue that the parallel electric fields that drive electrons into the southern auroral ionosphere and generate SKR are, at least in part, bidirectional and thus capable of accelerating electrons toward the opposite hemisphere where the secondary signal is detected with intensity lower than that of the locally generated signal. This interpretation implies that the atmospheric process that modulates the periodic responses can operate independently in each hemisphere.