bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quitting patient care and career break intentions among general practitioners in South West England: findings of a census survey of general practitioners
Authors: Fletcher Emily , Abel Gary A , Anderson Rob , Richards Suzanne H , Salisbury Chris , Dean Sarah Gerard , Sansom Anna , Warren Fiona C , Campbell John L 
Published: April 2017

ObjectiveGiven recent concerns regarding general practitioner (GP) workforce capacity, we aimed to describe GPs’ career intentions, especially those which might impact on GP workforce availability over the next 5 years.DesignCensus survey, conducted between April and June 2016 using postal and online responses , of all GPs on the National Health Service performers list and eligible to practise in primary care. Two reminders were used as necessary.SettingSouth West England (population 3.5  million), a region with low overall socioeconomic deprivation.ParticipantsEligible GPs were 2248 out of 3370 (67 % response rate).Main outcome measuresReported likelihood of permanently leaving or reducing hours spent in direct patient care or of taking a career break within the next 5 years and present morale weighted for non-response.ResultsResponders included 217 7 GPs engaged in patient care. Of these, 863 (37% weighted, 95%  CI 35 % to 39 %) reported a high likelihood of quitting direct patient care within the next 5 years. Overall, 1535 (70% weighted, 95%  CI 68 % to 72 %) respondents reported a career intention that would negatively impact GP workforce capacity over the next 5 years, through permanently leaving or reducing hours spent in direct patient care, or through taking a career break. GP age was an important predictor of career intentions; sharp increases in the proportion of GPs intending to quit patient care were evident from 52 years. Only 305 (14% weighted, 95%  CI 13 % to 16 %) reported high morale, while 1195 ( 54 % weighted, 95%  CI 52 % to 56 %) reported low morale. Low morale was particularly common among GP partners. Current morale strongly predicted GPs’ career intentions; those with very low morale were particularly likely to report intentions to quit patient care or to take a career break.ConclusionsA substantial majority of GPs in South West England report low morale. Many are considering career intentions which, if implemented, would adversely impact GP workforce capacity within a short time period.Study registrationNIHR HS&DR - 14/196/02, UKCRN ID 20700.
The diagnostic value of hyperammonaemia induced by the non-ischaemic forearm exercise test
Authors: Hogrel Jean-Yves , Janssen Jorien B E , Ledoux Isabelle , Ollivier Gwenn , Béhin Anthony , Stojkovic Tanya , Eymard Bruno , Voermans Nicol C , Laforet Pascal 
Published: April 2017

AimsThe non-ischaemic forearm exercise test (NIFET) is used as a diagnostic tool for the screening of patients with exercise intolerance and for the diagnosis of various metabolic muscle disorders. The production of lactate and ammonia are generally analysed to guide the diagnosis. The aim of this retrospective study was to determine the level of ammonia rise, which can be suggestive of a muscle disease.MethodsThis retrospective study involved 1440 patients who underwent NIFET. The clinical files of the patients with hyperammonaemia were methodically studied. Normal values were derived from 60 healthy controls.Results110 patients with hyperammonaemia were detected. They were classified as either having mild (between 94 and 141 µmol/L) or severe (more than 141 µmol/L) hyperammonaemia. Their diagnosis was studied with respect to the increase in lactate induced by the NIFET.ConclusionsSevere postexercise hyperammonaemia, even in the presence of a normal lactate response, is strongly suggestive of a muscle glycogen storage disease. Mild hyperammonaemia in the absence of other abnormalities is most likely non-specific and not indicative of a muscle disease.
Utilisation of radiology rotations in ACGME-accredited general surgery programmes
Authors: Eid Joseph J , Macedo Francisco Igor , Mittal Vijay K 
Published: April 2017

ABSTRACTBackgroundGeneral surgery (GS) residents are often required to provide immediate preliminary interpretations of radiological images, especially in critical situations. It is unclear whether residents in Accreditation Council for Graduate Medical Education-accredited GS programmes receive sufficient radiological training to deliver adequate patient care.ObjectivesDetermine the utilisation of radiology rotations (RR) during GS residency.MethodsBetween February and March 2015, a pilot voluntary 19-item survey was electronically distributed to GS programme directors (PDs) regarding the availability and value of a RR during GS training.ResultsA total of 234 PDs received the questionnaire and the response rate was 36.8% (n=86). Sixty-five (77.4%) PDs expected their trainees to interpret imaging studies in the acute setting; however, only 8.3% of programmes had a dedicated RR. RRs are more prevalent among community-based than university-based programmes (71.4% vs 27.9% p=0.003). The implementation of a RR may be limited due to insufficient number of GS residents in the department (p=0.002). 75.4% of PDs expect GS residents to confirm their findings with a radiologist. In those programmes with RR, most PDs (85.7%) believed that a dedicated rotation improved GS residents’ understanding of radiological imaging.ConclusionThe majority of PDs are currently not confident that GS residents are capable of interpreting radiological imaging independently; however, the implementation of a mandatory RR in GS residency curriculum yet seems to be controversial. Given the expectation of PDs and the continued need to improve patient care, the integration of a dedicated RR in GS training should be encouraged.
A Hybrid Approach for Personalized News Recommendation in a Mobility Scenario Using Long-Short User Interest
Authors: Viana Paula , Soares Márcio 
Published: April 2017

Access to information has been made easier in different domains that range from multimedia content, books, music, news, etc. To deal with the huge amount of alternatives, recommendation systems have been often used as a solution to filter the options and provide suggestions of items that might be of interest to an user. The news domain introduces additional challenges due not only to the large amount of new items produced daily but also due to their ephemeral timelife. In this paper, a news recommendation system which combines content-based and georeferenced techniques in a mobility scenario, is proposed. Taking into account the volatility of the information, short-term and long-term user profiles are considered and implicitly built. Besides tracking users’ clicks, the system infers different levels of interest an article has by tracking and weighting each action in the system and in social networks. Impact of the different fields that make up a news is also taken into account by following the inverted pyramid model that assumes different levels of importance to each paragraph of the article. The solution was tested with a population of volunteers and results indicate that the quality of the recommendation approach is acknowledged by the users.
Implications of plan-based generalization in sensorimotor adaptation
Authors: McDougle Samuel D. , Bond Krista M. , Taylor Jordan A. 
Published: April 2017

Generalization is a fundamental aspect of behavior, allowing for the transfer of knowledge from one context to another. The details of this transfer are thought to reveal how the brain represents what it learns. Generalization has been a central focus in studies of sensorimotor adaptation, and its pattern has been well characterized: Learning of new dynamic and kinematic transformations in one region of space tapers off in a Gaussian-like fashion to neighboring untrained regions, echoing tuned population codes in the brain. In contrast to common allusions to generalization in cognitive science, generalization in visually guided reaching is usually framed as a passive consequence of neural tuning functions rather than a cognitive feature of learning. While previous research has presumed that maximum generalization occurs at the instructed task goal or the actual movement direction, recent work suggests that maximum generalization may occur at the location of an explicitly accessible movement plan. Here we provide further support for plan-based generalization, formalize this theory in an updated model of adaptation, and test several unexpected implications of the model. First, we employ a generalization paradigm to parameterize the generalization function and ascertain its maximum point. We then apply the derived generalization function to our model and successfully simulate and fit the time course of implicit adaptation across three behavioral experiments. We find that dynamics predicted by plan-based generalization are borne out in the data, are contrary to what traditional models predict, and lead to surprising implications for the behavioral, computational, and neural characteristics of sensorimotor adaptation. NEW & NOTEWORTHY The pattern of generalization is thought to reveal how the motor system represents learned actions. Recent work has made the intriguing suggestion that maximum generalization in sensorimotor adaptation tasks occurs at the location of the learned movement plan. Here we support this interpretation, develop a novel model of motor adaptation that incorporates plan-based generalization, and use the model to successfully predict surprising dynamics in the time course of adaptation across several conditions.
Suppression of Lymphocyte Functions by Plasma Exosomes Correlates with Disease Activity in Patients with Head and Neck Cancer
Authors: Ludwig Sonja , Floros Theofanis , Theodoraki Marie-Nicole , Hong Chang-Sook , Jackson Edwin K. , Lang Stephan , Whiteside Theresa L. 
Published: April 2017

AbstractPurpose: Head and neck cancers (HNCs) often induce profound immunosuppression, which contributes to disease progression and interferes with immune-based therapies. Body fluids of patients with HNC are enriched in exosomes potentially engaged in negative regulation of antitumor immune responses. The presence and content of exosomes derived from plasma of patients with HNC are evaluated for the ability to induce immune dysfunction and influence disease activity.Experimental Design: Exosomes were isolated by size-exclusion chromatography from plasma of 38 patients with HNC and 14 healthy donors. Morphology, size, numbers, and protein and molecular contents of the recovered exosomes were determined. Coculture assays were performed to measure exosome-mediated effects on functions of normal human lymphocyte subsets and natural killer (NK) cells. The results were correlated with disease stage and activity.Results: The presence, quantity, and molecular content of isolated, plasma-derived exosomes discriminated patients with HNC with active disease (AD) from those with no evident disease (NED) after oncologic therapies. Exosomes of patients with AD were significantly more effective than exosomes of patients with NED in inducing apoptosis of CD8+ T cells, suppression of CD4+ T-cell proliferation, and upregulation of regulatory T-cell (Treg) suppressor functions (all at P &lt; 0.05). Exosomes of patients with AD also downregulated NKG2D expression levels in NK cells.Conclusions: Exosomes in plasma of patients with HNC carry immunosuppressive molecules and interfere with functions of immune cells. Exosome-induced immune suppression correlates with disease activity in HNC, suggesting that plasma exosomes could be useful as biomarkers of HNC progression. Clin Cancer Res; 23(16); 4843–54. ©2017 AACR.
A Gene Signature for Selecting Benefit from Hypoxia Modification of Radiotherapy for High-Risk Bladder Cancer Patients
Authors: Yang Lingjian , Taylor Janet , Eustace Amanda , Irlam Joely J. , Denley Helen , Hoskin Peter J. , Alsner Jan , Buffa Francesca M. , Harris Adrian L. , Choudhury Ananya , West Catharine M.L. 
Published: April 2017

Abstract
Purpose: Hypoxia modification improves overall survival in muscle-invasive bladder cancer patients who undergo radiotherapy. There is evidence that hypoxic tumors benefit most from hypoxia modification. The study aimed to identify or derive a hypoxia gene signature that predicts benefit from hypoxia-modifying treatment in bladder cancer.
Experimental Design: Published hypoxia signatures were tested and a new one derived by analyzing bladder cancer transcriptomic data from public databases. Tumor samples were available from the BCON phase III randomized trial of radiotherapy alone or with carbogen and nicotinamide (CON). Gene expression data were generated for 151 tumors using Affymetrix Human 1.0 Exon ST arrays and used for independent validation.
Results: A 24-gene signature was derived, which was prognostic in four of six independent surgical cohorts (n = 679; meta HR, 2.32; 95% CI, 1.73–3.12; P &lt; 0.0001). The signature was also prognostic in BCON patients receiving radiotherapy alone (n = 75; HR for local relapse-free survival, 2.37; 95% CI, 1.26–4.47; P = 0.0076). The signature predicted benefit from CON (n = 76; HR, 0.47; 95% CI, 0.26–0.86; P = 0.015). Prognostic significance (P = 0.017) and predictive significance (P = 0.058) remained after adjusting for clinicopathologic variables. A test for interaction between hypoxia status and treatment arms was significant (P = 0.0094).
Conclusions: A 24-gene hypoxia signature has strong and independent prognostic and predictive value for muscle-invasive bladder cancer patients. The signature can aid identification of patients likely to benefit from the addition of carbogen and nicotinamide to radiotherapy. Clin Cancer Res; 23(16); 4761–8. ©2017 AACR.
Health Literacy and Awareness of Atrial Fibrillation
Authors: Reading Stephanie R. , Go Alan S. , Fang Margaret C. , Singer Daniel E. , Liu In‐Lu Amy , Black Mary Helen , Udaltsova Natalia , Reynolds Kristi ,   the Anticoagulation and Risk Factors in Atrial Fibrillation–Cardiovascular Research Network (ATRIA‐CVRN) Investigators
Published: April 2017

Background

Atrial fibrillation (
AF
) is the most common clinically significant arrhythmia in adults and a major risk factor for ischemic stroke. Nonetheless, previous research suggests that many individuals diagnosed with
AF
lack awareness about their diagnosis and inadequate health literacy may be an important contributing factor to this finding.

Methods and Results

We examined the association between health literacy and awareness of an
AF
diagnosis in a large, ethnically diverse cohort of Kaiser Permanente Northern and Southern California adults diagnosed with
AF
between January 1, 2006 and June 30, 2009. Using self‐reported questionnaire data completed between May 1, 2010 and September 30, 2010, awareness of an
AF
diagnosis was evaluated using the question “Have you ever been told by a doctor or other health professional that you have a heart rhythm problem called atrial fibrillation or atrial flutter?” and health literacy was assessed using a validated 3‐item instrument examining problems because of reading, understanding, and filling out medical forms. Of the 12 517 patients diagnosed with
AF
, 14.5% were not aware of their
AF
diagnosis and 20.4% had inadequate health literacy. Patients with inadequate health literacy were less likely to be aware of their
AF
diagnosis compared with patients with adequate health literacy (prevalence ratio=0.96; 95%
CI
[0.94, 0.98]), adjusting for sociodemographics, health behaviors, and clinical characteristics.

Conclusions

Lower health literacy is independently associated with less awareness of
AF
diagnosis. Strategies designed to increase patient awareness of
AF
and its complications are warranted among individuals with limited health literacy.
Predicting Ice Shape Evolution in a Bulk Microphysics Model
Authors: Jensen Anders A. , Harrington Jerry Y. , Morrison Hugh , Milbrandt Jason A. 
Published: April 2017

Abstract
A novel bulk microphysics scheme that predicts the evolution of ice properties, including aspect ratio (shape), mass, number, size, and density is described, tested, and demonstrated. The scheme is named the Ice-Spheroids Habit Model with Aspect-Ratio Evolution (ISHMAEL). Ice is modeled as spheroids and is nucleated as one of two species depending on nucleation temperature. Microphysical process rates determine how shape and other ice properties evolve. A third aggregate species is also employed, diversifying ice properties in the model. Tests of ice shape evolution during vapor growth and riming are verified against wind tunnel data, revealing that the model captures habit-dependent riming and its effect on fall speed. Lagrangian parcel studies demonstrate that the bulk model captures ice property evolution during riming and melting compared with a bin model. Finally, the capabilities of ISHMAEL are shown in a 2D kinematic framework with a simple updraft. A direct result of predicting ice shape evolution is that various states of ice from unrimed to lightly rimed to densely rimed can be modeled without converting ice mass between predefined ice categories (e.g., snow and graupel). This leads to a different spatial precipitation distribution compared with the traditional method of separating snow and graupel and converting between the two categories, because ice in ISHMAEL sorts in physical space based on the amount of rime, which controls the thickness and therefore fall speed. Predicting these various states of rimed ice leads to a reduction in vapor growth rate and an increase in riming rate in a simple updraft compared with the traditional approach.
The Role of Shallow Convection over the Tibetan Plateau
Authors: Li Yunying , Zhang Minghua 
Published: April 2017

AbstractCumulus (Cu) from shallow convection is one of the dominant cloud types over the Tibetan Plateau (TP) in the summer according to CloudSat–CALIPSO observations. Its thermodynamic effects on the atmospheric environment and impacts on the large-scale atmospheric circulation are studied in this paper using the Community Atmospheric Model, version 5.3 (CAM5.3). It is found that the model can reasonably simulate the unique distribution of diabatic heating and Cu over the TP. Shallow convection provides the dominant diabatic heating and drying to the lower and middle atmosphere over the TP. A sensitivity experiment indicates that without Cu over the TP, large-scale condensation and stratiform clouds would increase dramatically, which induces enhanced low-level wind and moisture convergence toward the TP, resulting in significantly enhanced monsoon circulation with remote impact on the areas far beyond the TP. Cu therefore acts as a safety valve to modulate the atmospheric environment that prevents the formation of superclusters of stratiform clouds and precipitation over the TP.
A Moist Static Energy Budget–Based Analysis of the Sahel Rainfall Response to Uniform Oceanic Warming
Authors: Hill Spencer A. , Ming Yi , Held Isaac M. , Zhao Ming 
Published: April 2017

AbstractClimate models generate a wide range of precipitation responses to global warming in the African Sahel, but all that use the NOAA Geophysical Fluid Dynamics Laboratory AM2.1 model as their atmospheric component dry the region sharply. This study compares the Sahel’s wet season response to uniform 2-K SST warming in AM2.1 using either its default convective parameterization, relaxed Arakawa–Schubert (RAS), or an alternate, the University of Washington (UW) parameterization, using the moist static energy (MSE) budget to diagnose the relevant mechanisms.UW generates a drier, cooler control Sahel climate than does RAS and a modest rainfall increase with SST warming rather than a sharp decrease. Horizontal advection of dry, low-MSE air from the Sahara Desert—a leading-order term in the control MSE budget with either parameterization—is enhanced with oceanic warming, driven by enhanced meridional MSE and moisture gradients spanning the Sahel. With RAS, this occurs throughout the free troposphere and is balanced by anomalous MSE import through anomalous subsidence, which must be especially large in the midtroposphere where the moist static stability is small. With UW, the strengthening of the meridional MSE gradient is mostly confined to the lower troposphere, due in part to comparatively shallow prevailing convection. This necessitates less subsidence, enabling convective and total precipitation to increase with UW, although both large-scale precipitation and precipitation minus evaporation decrease. This broad set of hydrological and energetic responses persists in simulations with SSTs varied over a wide range.
ACC Meanders, Energy Transfer, and Mixed Barotropic–Baroclinic Instability
Authors: Youngs Madeleine K. , Thompson Andrew F. , Lazar Ayah , Richards Kelvin J. 
Published: April 2017

AbstractAlong-stream variations in the dynamics of the Antarctic Circumpolar Current (ACC) impact heat and tracer transport, regulate interbasin exchange, and influence closure of the overturning circulation. Topography is primarily responsible for generating deviations from zonal-mean properties, mainly through standing meanders associated with regions of high eddy kinetic energy. Here, an idealized channel model is used to explore the spatial distribution of energy exchange and its relationship to eddy geometry, as characterized by both eddy momentum and eddy buoyancy fluxes. Variations in energy exchange properties occur not only between standing meander and quasi-zonal jet regions, but throughout the meander itself. Both barotropic and baroclinic stability properties, as well as the magnitude of energy exchange terms, undergo abrupt changes along the path of the ACC. These transitions are captured by diagnosing eddy fluxes of energy and by adopting the eddy geometry framework. The latter, typically applied to barotropic stability properties, is applied here in the depth–along-stream plane to include information about both barotropic and baroclinic stability properties of the flow. These simulations reveal that eddy momentum fluxes, and thus barotropic instability, play a leading role in the energy budget within a standing meander. This result suggests that baroclinic instability alone cannot capture the dynamics of ACC standing meanders, a challenge for models where eddy fluxes are parameterized.
Acoustic Waveform Inversion for Ocean Turbulence
Authors: Minakov Alexander , Keers Henk , Kolyukhin Dmitriy , Tengesdal Hans Christian 
Published: April 2017

AbstractThe seismic oceanography method is based on extracting and stacking the low-frequency acoustic energy scattered by the ocean heterogeneity. However, a good understanding on how this acoustic wavefield is affected by physical processes in the ocean is still lacking. In this work an acoustic waveform modeling and inversion method is developed and applied to both synthetic and real data. In the synthetic example, the temperature field is simulated as a homogeneous Gaussian isotropic random field with the Kolmogorov–Obukhov spectrum superimposed on a background stratified ocean structure. The presented full waveform inversion method is based on the ray-Born approximation. The synthetic seismograms computed using the ray-Born scattering method closely match the seismograms produced with a more computationally expensive finite-difference method. The efficient solution to the inverse problem is provided by the multiscale nonlinear inversion approach that is specifically stable with respect to noise. Full waveform inversion tests are performed using both the stationary and time-dependent sound speed models. These tests show that the method provides a reliable reconstruction of both the spatial sound speed variation and the theoretical spectrum due to fully developed turbulence. Finally, the inversion approach is applied to real seismic reflection data to determine the heterogeneous sound speed structure at the west Barents Sea continental margin in the northeast Atlantic. The obtained model illustrates in more detail the processes of diapycnal mixing near the continental slope.