bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ocean–Atmosphere Feedback during Extreme Rainfall Events in Eastern Northeast Brazil
Authors: Luiz do Vale Silva Thiago , Veleda Doris , Araujo Moacyr , Tyaquiçã Pedro 
Published: March 2018

AbstractThe coupled ocean–atmosphere–wave–sediment transport model and the Weather Research and Forecasting (WRF) atmospheric model were used to simulate extreme rainfall events from 10 to 25 June 2010 in eastern Northeast Brazil (ENEB). The simulations aimed at investigating the improvements from using a coupled ocean–atmospheric model of meteorological systems as the ocean–atmosphere interactions intensified during the period when flood events occurred in ENEB. In June 2010, the sea surface temperature (SST) was warmer than 28.5°C in the western tropical South Atlantic Ocean with anomalies above 1°C, which are characteristics of a warm pool. The sensible and latent heat fluxes acted to moisten the lower troposphere and affected the height of the trade winds inversion layer (TWIL). The meteorological system that occurred at the low–midlevels during the period favored the weakening and even the breakdown of the TWIL. These atmospheric disturbances were associated with convergence, cyclonic vorticity, and upward water vapor motion to the midtroposphere levels. When the disturbances reached the coast of ENEB, they favored convection and intense rainfall over the region. Both coupled and uncoupled modeling experiments were performed with the same physical parameterizations and validated with in situ atmospheric and oceanic measurements. The results highlight that the predictions of extreme rainfall events were greatly improved with the coupled model.
Initiation of Convective Storms at Low-Level Mesoscale Boundaries in Southwestern Ontario
Authors: Alexander Lisa S. , Sills David M. L. , Taylor Peter A. 
Published: March 2018

Abstract
The relationship between low-level mesoscale boundaries and convective storm initiation was investigated in southwestern Ontario, Canada. The influence of lake-breeze fronts, a type of boundary that frequently affects this region of the Great Lakes watershed in summer, presented a particular interest.
Radar data were processed using thunderstorm cell identification and tracking algorithms. The distances between the locations of storm cells reaching an intensity of 40 dBZ and the closest low-level mesoscale boundary were measured. Considering only days not influenced by a warm front, more than 75% of cells developed within 30 km of a low-level mesoscale boundary. Further examination by boundary type showed that cell initiations associated with moving boundaries and storm gust fronts occurred most often 0–5 km behind the boundaries. However, cell initiations associated with lake-breeze fronts most often occurred 0–5 km ahead of the boundaries. The analysis also suggested that lake-breeze fronts would often initiate the first storms of the day, which in turn generated gust fronts that could initiate subsequent storms.
Overall, the results were similar to a previous study investigating storm initiation in the vicinity of low-level mesoscale boundaries in eastern Colorado and include some new findings in relation to lake-breeze fronts. The findings can be used by forecasters as well as automated nowcasting algorithms in order to improve predictions of storm initiation.
In vitro and in vivo evaluation of polylactic acid-based composite with tricalcium phosphate microsphere for enhanced biodegradability and osseointegration
Authors: Shin Da Yong , Kang Min-Ho , Kang In-Gu , Kim Hyoun-Ee , Jeong Seol-Ha 
Published: March 2018

A biodegradable polylactic acid composite containing tricalcium phosphate microsphere was fabricated. The composite exhibited enhanced biocompatibility and a well-interconnected porous structure that enabled tissue ingrowth after degradation. The tricalcium phosphate microspheres had an average size of 106 ± 43 μm and were incorporated into the polylactic acid matrix using a high-shear mixer. The resulting bioactivity and hydrophilicity were enhanced to levels comparable to those of a polylactic acid composite containing tricalcium phosphate powder, which is a well-known material used in the medical field. An accelerated 30-day degradation test in HCl revealed successful generation of an open porous structure with ∼98% interconnectivity in the polylactic acid–tricalcium phosphate microsphere composite, demonstrating the potential of this material to induce enhanced osseointegration in the later stage of bone regeneration. The early stage osseointegration was also evaluated by implanting the composite in vivo using a rabbit femoral defect model. After 16 weeks of implantation, the bone-to-implant contact ratio of the polylactic acid–tricalcium phosphate microsphere composite was enhanced owing to tissue ingrowth through the generated pores near the surface.
Models for governing relationships in healthcare organizations: Some empirical evidence
Authors: Romiti Anna , Del Vecchio Mario , Grazzini Maddalena 
Published: March 2018

Recently, most European countries have undergone integration processes through mergers and strategic alliances between healthcare organizations. The present paper examined three cases within the Italian National Health Service in order to determine how different organizations, within differing institutional contexts, govern an healthcare integration process. Furthermore, we explored the possibility that the governance mode, usually seen as alternatives (i.e., merger or alliance), could be considered as a separate step in the development of a more suitable integration process. Multiple case studies were used to compare different integration approaches. Specifically, three cases were considered, of which two were characterized by collaborative processes and the other by a merger. Semi-structured interviews were conducted with managers involved in the processes. Each case presents different governing modes, structures, and mechanisms for achieving integration. The role played by the institutional context also led to different results with unique advantages and disadvantages. Three main conclusions are discussed: (a) Alliances and mergers can be interpreted as different steps in a path leading to a better integration; (b) The alignment between institutional/political time horizon and the time needed for the organizations to achieve an integration process lead to a better integration; (c) Trust plays an important role in integration process operating at different levels that of institutional and organizational level and that built between people.
Improving the quality of care and patient experience of care during the diagnosis of lupus: a qualitative study of primary care
Authors: Amsden L B , Davidson P T , Fevrier H B , Goldfien R , Herrinton L J 
Published: March 2018

Purpose To better understand diagnostic delay and doctor–patient communication during the diagnosis of systemic lupus erythematous in patients without malar rash, we conducted a qualitative study of primary care providers’ perceptions. Methods We conducted in-depth interviews with a purposive sample of eight primary care physicians in Kaiser Permanente Northern California. Telephone interviews were recorded, transcribed, reviewed, and coded for domains and themes. Results We identified five domains related to diagnosis: initial assessment and tests, initial diagnosis and empiric treatment, timeliness of diagnosis, communicating with the patient, and opportunities for improvement. In the absence of malar rash, the lupus manifestations are common while the disease is rare. Once the primary care provider believes that the disease may be autoimmune, they work with a rheumatologist, but this could take months. Initially, the physician assesses whether the condition is self-limiting or responds to empiric treatments. Over time, as empiric treatments fail or additional lupus manifestations emerge, the primary care provider makes a referral. Doctor–patient communication is critical to help the physician make sense of the symptoms, maintain trust, and assure the patient that he or she is receiving appropriate care. Patient persistence and communication are critically important. Continuing education was deemed essential by each physician. Conclusion In the absence of malar rash, a lupus diagnosis can be difficult. Enhanced doctor–patient communication, patient persistence, physician access to rheumatology and continuing education of primary care might improve time to diagnosis and the patient’s experience with primary care. This knowledge is transferable to other rare, complex diseases.
The ratio of erythrocyte sedimentation rate to C-reactive protein is useful in distinguishing infection from flare in systemic lupus erythematosus patients presenting with fever
Authors: Littlejohn E , Marder W , Lewis E , Francis S , Jackish J , McCune W J , Somers E C 
Published: March 2018

Background Both C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can be elevated in systemic lupus erythematosus (SLE) flare and infection, and are therefore of limited utility for distinguishing between the two conditions in febrile SLE patients. Methods A medical records review of hospitalizations (1997–2006) of SLE patients in the Michigan Lupus Cohort was performed. Eligible hospitalizations were those in which patients presented with a temperature of >100.3°F or with subjective fevers as a presenting complaint at admission. Detailed demographic, clinical, and laboratory data were collected. Multivariable logistic regression was used to examine the associations between ESR and CRP and the outcome of flare vs infection, adjusted for confounders. Results Among 557 SLE patients screened, there were 53 eligible hospitalizations (28 flares and 25 infections). Each unit increase in the ratio of ESR:CRP was associated with a 17% increase in the odds of fever being attributable to SLE flare compared to infection (OR 1.17, 95% CI 1.04, 1.31; p = 0.009), when adjusted for white blood cell count, SLE duration, sex, race, and age. ESR and CRP were not individually associated with flare vs infection when modeled with their ratio. Conclusions The ratio of ESR:CRP may provide diagnostic value beyond individual ESR and CRP levels in distinguishing flare vs infection in SLE patients presenting with fever.
Association of vitamin D receptor gene TaqI, FokI and ApaI variants with arteriovenous fistula failure in hemodialysis patients
Authors: Huzmeli Can , Bagci Gokhan , Candan Ferhan , Bagci Binnur , Akkaya Lale , Kayatas Mansur 
Published: March 2018

Purpose: We investigated the influence of the vitamin D receptor gene TaqI (rs731236), ApaI (rs7975232), and FokI (rs2228570) polymorphisms in arteriovenous fistula failure in hemodialysis patients. Methods: This study was carried out with 54 patients who experienced two or more fistula failures in the late period after arteriovenous fistula operation and 58 control patients with no history of arteriovenous fistula failure in 3 years or longer. The polymerase chain reaction–restriction fragment length polymorphism method was used to determine the vitamin D receptor TaqI, FokI, and ApaI polymorphisms. Results: For vitamin D receptor gene TaqI and Fok1 polymorphisms, no significant association was found between the two groups ( p > 0.05). However, a statistically significant association was determined for ApaI polymorphism between the two groups ( p = 0.02). In patients, ApaI AA, AC, and CC genotype frequencies were found as 21 (38.9%), 32 (59.3%), and 1 (1.8%), respectively. However, genotype frequencies of AA, AC, and CC in the control group were 29 (50%), 22 (37.9%), and 7 (12.1%), respectively. In all three polymorphisms, no significant difference was found between the two groups in terms of allele frequencies ( p > 0.05). Conclusion: Vitamin D receptor ApaI AC genotype may be a possible cardiovascular risk factor for the development of arteriovenous fistula failure.
The incidence of symptomatic upper limb venous thrombosis associated with midline catheter: Prospective observation
Authors: Lisova Katerina , Hromadkova Jaroslava , Pavelková Katerina , Zauška Vladimir , Havlin Jan , Charvat Jiri 
Published: March 2018

Aim: The evaluation of the incidence of symptomatic upper limb venous thrombosis (ULVT) associated with midline catheters in patients admitted to the hospital. Methods: The frequency of symptomatic ULVT diagnosed in a group of patients with midline catheters confirmed by sonographic examination in hospitalised patients at Faculty Hospital over the period of 1 year. Results: Four hundred thirty-nine midline catheters were inserted in 430 patients (250 women and 180 men) during year 2015. Nine patients had two midline catheters. The average age of the patient was 68 years (range: 19–96 years). The median time of midline catheter introduction into a vein was 10 days (range: 1–112 days). Symptomatic thrombosis was diagnosed in 20 patients (4.5%), 3.3/1000 catheter days. It was associated with gender (male) and midline insertion in the cephalic vein. Conclusion: The risk of upper limb symptomatic thrombosis associated with midline catheters during a stay in the hospital should be taken into consideration when indicating optimal venous access.
Decrease of muscle strength in vascular access hand due to silent ischaemia
Authors: Kmentova Tereza , Valerianova Anna , Kovarova Lucie , Lachmanova Jana , Hladinova Zuzana , Malik Jan 
Published: March 2018

Background: Creation of vascular access leads to considerable local haemodynamic changes with decreased hand perfusion. Distal limb tissues then represent a model of hand ischaemia effect on muscles. The aim of our study was to investigate how the presence of vascular access influences the hand muscle strength in end-stage renal disease patients. Methods: We included 52 chronically haemodialysed patients with upper limb access without clinical signs of hand ischaemia. Muscle strength was evaluated by dynamometry. Finger pressure was measured on the second and fourth fingers and averaged for further analysis. Thenar tissue oxygenation (rSO2) was analysed using near-infrared spectroscopy. All examinations were performed in both the hands. Basic laboratory analysis was added. Data were processed with unpaired t-test and correlation analysis. Results: Hands with dialysis access had lower values of handgrip strength (54.2 ± 29.1 lbs vs 48.6 ± 23.4 lbs, p = 0.0006), systolic finger pressure (127.1 ± 32.0 mmHg vs 101.4 ± 31.6 mmHg, p < 10−8) and of thenar rSO2 (45.8% ± 12.9% vs 42.5% ± 13.3%, p = 0.002). Muscle strength (handgrip) was directly related to the thenar oxygenation ( r = 0.36; p = 0.014) and to the finger systolic pressure ( r = 0.38; p = 0.007) on the access extremity. On the extremity without dialysis access, handgrip strength was inversely related to patient’s age ( r = −0.41, p = 0.003), dialysis vintage ( r = −0.32, p = 0.02) and red cell distribution width ( r = −0.37, p = 0.01). Conclusion: The presence of dialysis access leads to the decrease of finger pressure, oxygenation, and also muscle strength even in the absence of clinically overt hand ischaemia. All these parameters are interrelated. This study underlines the consequences of inadequate muscle perfusion.
Free functioning gracilis transfer for reanimation of elbow and hand in total traumatic brachial plexopathy in children
Authors: Madura Tomas , Doi Kazuteru , Hattori Yasunori , Sakamoto Sotetsu , Shimoe Takashi 
Published: March 2018

The purpose of this study was to evaluate long-term outcomes of the free functioning gracilis transfer in children with traumatic total brachial plexus palsy. We used the free functioning gracilis transfer to reconstruct elbow flexion and prehension in 17 children with a mean age of 13.4 years (range 3–17) who were followed-up over a mean period of 6 years (range 2–16). The transferred gracilis delivered a stable elbow flexion with a useful power, as well as reconstructed active finger motion. In 3–11-year-old patients we noted a tendency towards developing a progressive flexion contracture of the elbow. The limb length discrepancy observed in our patients was not different from the brachial plexus palsy patients treated without the free functioning gracilis transfer. In conclusion, the free functioning gracilis transfer is a reliable reconstructive technique for reanimating upper extremity in children of all ages capable of delivering stable function over a long period of time. Level of evidence: IV
Tissue Motion Annular Displacement Predicts Mortality/Transplant After the Bidirectional Glenn
Authors: Penk Jamie S. , Zaidi S. Javed H. , Lefaiver Cheryl A. , Muangmingsuk Supitcha , Cui Vivian W. , Roberson David A. 
Published: March 2018

Background: Quantifying right ventricular function in patients with a systemic right ventricle (RV) is difficult but important for prognosis. Tissue motion annular displacement tracks displacement of the tricuspid annulus toward the apex. We evaluated this measure alongside fractional area change (FAC) on patients with single, RV prior to the bidirectional Glenn procedure. We tested both measures for correlation with outcomes. Methods: Retrospective measurement of tissue motion annular displacement and FAC was performed on echocardiographic clips obtained prior to the bidirectional Glenn. A chart review included postoperative outcomes and midterm mortality/transplant. Bivariate correlations and Cox proportional hazards models were used for analyses. Results: Fifty-one patients with dominant RV underwent the bidirectional Glenn procedure and all had image quality that allowed analysis. The age ranged from 3 to 11 months (median 4 months). Neither tissue motion annular displacement nor FAC correlated with short-term postoperative outcomes. Tissue motion annular displacement was independently predictive of mortality/transplant ( P = .03) in the Cox hazard model. The mean for survivors was 12.4% and for nonsurvivors/transplants was 10.0%. Tissue motion annular displacement intra-observer variability was 2.8% (1.2%-3.5%). Interobserver mean variability was 6.1% (3.3%-8.1%). Fractional area change was not predictive of mortality/transplant. Conclusion: Tissue motion annular displacement is an independent predictor of midterm mortality/transplant after the bidirectional Glenn procedure in patients with single, RV, in this study. It may outperform FAC in this regard and has good reproducibility. Tissue motion annular displacement may be a useful measure in identifying high-risk children in this population.
A Randomized Trial Comparing Cardiac Rehabilitation to Standard of Care for Adults With Congenital Heart Disease
Authors: Opotowsky Alexander R. , Rhodes Jonathan , Landzberg Michael J. , Bhatt Ami B. , Shafer Keri M. , Yeh Doreen DeFaria , Crouter Scott E. , Ubeda Tikkanen Ana 
Published: March 2018

Background: Cardiac rehabilitation (CR) improves exercise capacity and quality of life while reducing mortality in adults with acquired heart disease. Cardiac rehabilitation has not been extensively studied in adults with congenital heart disease (CHD). Methods: We performed a prospective, randomized controlled trial (NCT01822769) of a 12-week clinical CR program compared with standard of care (SOC). Participants were ≥16 years old, had moderate or severe CHD, had O2 saturation ≥92%, and had peak O2 consumption ([Formula: see text]) < 80% predicted. We assessed exercise capacity, physical activity, quality of life, self-reported health status, and other variables at baseline and after 12 weeks. The prespecified primary end point was change in [Formula: see text]. Results: We analyzed data on 28 participants (aged 41.1 ± 12.1 years, 50% male), 13 randomized to CR and 15 to SOC. [Formula: see text] averaged 16.8 ± 3.8 mL/kg/min, peak work rate = 95 ± 28 W, and median Minnesota Living with Heart Failure Questionnaire (MLHFQ) score = 27 (interquartile range: 11-44). Cardiac rehabilitation participants were older (48 ± 9 years vs 36 ± 12 years; P = .01), but there were no significant between-group differences in other variables. There were no adverse events related to CR. [Formula: see text] increased in the CR group compared with SOC (+2.2 mL/kg/min, 95% confidence interval: 0.7-3.7; P = .002, age-adjusted +2.7 mL/kg/min; P = .004); there was a nonsignificant improvement in work rate (+8.1 W; P = .13). Among the 25 participants with baseline MLHFQ > 5, there was a clinically important >5-point improvement in 72.7% and 28.6% of CR and SOC participants, respectively ( P = .047). Cardiac rehabilitation was also associated with improved self-assessment of overall health ( P < .04). Conclusions: Cardiac rehabilitation is safe and is associated with improvement in aerobic capacity and self-reported health status compared with SOC in adults with CHD.
Clinical spectrum of pyruvate kinase deficiency: data from the Pyruvate Kinase Deficiency Natural History Study
Authors: Grace Rachael F. , Bianchi Paola , van Beers Eduard J. , Eber Stefan W. , Glader Bertil , Yaish Hassan M. , Despotovic Jenny M. , Rothman Jennifer A. , Sharma Mukta , McNaull Melissa M. , Fermo Elisa , Lezon-Geyda Kimberly , Morton D. Holmes , Neufeld Ellis J. , Chonat Satheesh , Kollmar Nina , Knoll Christine M. , Kuo Kevin , Kwiatkowski Janet L. , Pospíšilová Dagmar , Pastore Yves D. , Thompson Alexis A. , Newburger Peter E. , Ravindranath Yaddanapudi , Wang Winfred C. , Wlodarski Marcin W. , Wang Heng , Holzhauer Susanne , Breakey Vicky R. , Kunz Joachim , Sheth Sujit , Rose Melissa J. , Bradeen Heather A. , Neu Nolan , Guo Dongjing , Al-Sayegh Hasan , London Wendy B. , Gallagher Patrick G. , Zanella Alberto , Barcellini Wilma 
Published: March 2018

Key Points
PK deficiency manifests a broad spectrum in anemia severity that moderately improves after splenectomy. Close attention to monitoring for iron overload, gallstones, and other complications is recommended in all patients with PK deficiency.
Microseismic velocity model inversion and source location: The use of neighborhood algorithm and master station method
Authors: Tan Yuyang , He Chuan , Mao Zhonghua 
Published: March 2018

The accuracy of the velocity model strongly affects the accuracy of microseismic source location and hence the reliability of fracture imaging. We have developed a systematic methodology for microseismic velocity model inversion and source location. A new misfit function is used for both problems, which yields more reliable result than the conventional ones. Using the same measure of misfit, the location errors resulting from the use of different misfit functions are eliminated. The neighborhood algorithm and master station method (MSM) are adopted for calculating the velocity model and source location, respectively. The reason for using the neighborhood algorithm is that it has fewer tuning parameters and is easy to be tuned, whereas the advantage of the MSM is that it can automatically remove the mispicks. The performance of the proposed methods is illustrated using the ball-hit events with known locations, and the validity of the inversion results is verified by the relocations of these events. We also used the inverted velocity models to locate the microseismic events detected from the monitoring data. The location result indicates that the fractures have an average half-length of 280 m and height of 55 m and the fracture azimuth is approximately N77°W.