bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Internal Variability due to Anthropogenic Forcing: A New Field Significance Test
Authors: LaJoie Emerson , DelSole Timothy 
Published: April 2016

Abstract
Changes in internal variability of seasonal and annual mean 2-m temperature in response to anthropogenic forcing are quantified for a global domain using climate models driven by a twenty-first-century high-emissions scenario. While changes in variance have been quantified previously in a univariate sense, the field significance of such changes has remained unclear. This paper proposes a new field significance test for changes in variance that accounts for spatial and temporal relationships within the domain. The test proposed here uses an optimization technique based on discriminant analysis, yielding results that are invariant to linear transformations of the data and therefore independent of normalization procedures. Multiple significance tests are employed because spatial fields can differ in many ways in a multivariate space. All climate models investigated here predict significant changes in internal variability of temperature in response to anthropogenic forcing. The models consistently predict decreases to temperature variance in regions of seasonal sea ice formation and across the Southern Ocean by the end of the twenty-first century. While more than half the models also predict significant changes in variance over ENSO regions and the North Atlantic Ocean, the direction of this change is model dependent. Seasonal mean changes are remarkably similar to annual mean changes, but there are model-dependent exceptions. Some models predict future variability that is more than double their preindustrial control variability, raising questions about the adequacy of doubling uncertainty estimates to test robustness in detection and attribution studies.
Clinical relevance of trace element measurement in patients on initiation of parenteral nutrition
Authors: Salota Rashim , Omar Sohail , Sherwood Roy A , Raja Kishor , Vincent Royce P 
Published: April 2016

Background and Aims Serum zinc, copper and selenium are measured in patients prior to commencing on parenteral nutrition; however, their interpretation can be difficult due to acute phase reactions. We assessed (i) the relationship of raised C-reactive protein with trace elements and albumin (ii) benefits of measuring trace elements when C-reactive protein is raised in patients requiring short-term parenteral nutrition. Methods Samples were collected for zinc, copper, selenium and albumin at baseline and then every two weeks and correlated with C-reactive protein results in patients on parenteral nutrition. Results were categorized into four groups based on the C-reactive protein concentrations: (i) <20 mg/L, (ii) 20–39 mg/L, (iii) 40–79 mg/L and (iv) ≥80 mg/L. Results In 166 patients, zinc, selenium and albumin correlated (Spearman’s) negatively with C-reactive protein; r = −0.26, P < 0.001 (95% CI −0.40 to −0.11), r = −0.44, P < 0.001 (−0.56 to −0.29) and r = −0.22 P = 0.005 (−0.36 to −0.07), respectively. Copper did not correlate with C-reactive protein (r = 0.09, P = 0.25 [−0.07 to 0.25]). Comparison of trace elements between the four groups showed no difference in zinc and copper (both P > 0.05), whereas selenium and albumin were lower in the group with C-reactive protein > 40 mg/L ( P < 0.05). Conclusion In patients on short-term parenteral nutrition, measurement of C-reactive protein is essential when interpreting zinc and selenium but not copper results. Routine measurement of trace elements prior to commencing parenteral nutrition has to be considered on an individual basis in patients with inflammation.
External Hand Forces Exerted by Long-Term Care Staff to Push Floor-Based Lifts
Authors: Lachance Chantelle C. , Korall Alexandra M. B. , Russell Colin M. , Feldman Fabio , Robinovitch Stephen N. , Mackey Dawn C. 
Published: April 2016

Objective: The aim of this study was to investigate the effects of flooring type and resident weight on external hand forces required to push floor-based lifts in long-term care (LTC). Background: Novel compliant flooring is designed to reduce fall-related injuries among LTC residents but may increase forces required for staff to perform pushing tasks. A motorized lift may offset the effect of flooring on push forces. Method: Fourteen female LTC staff performed straight-line pushes with two floor-based lifts (conventional, motor driven) loaded with passengers of average and 90th-percentile resident weights over four flooring systems (concrete+vinyl, compliant+vinyl, concrete+carpet, compliant+carpet). Initial and sustained push forces were measured by a handlebar-mounted triaxial load cell and compared to participant-specific tolerance limits. Participants rated pushing difficulty. Results: Novel compliant flooring increased initial and sustained push forces and subjective ratings compared to concrete flooring. Compared to the conventional lift, the motor-driven lift substantially reduced initial and sustained push forces and perceived difficulty of pushing for all four floors and both resident weights. Participants exerted forces above published tolerance limits only when using the conventional lift on the carpet conditions (concrete+carpet, compliant+carpet). With the motor-driven lift only, resident weight did not affect push forces. Conclusion: Novel compliant flooring increased linear push forces generated by LTC staff using floor-based lifts, but forces did not exceed tolerance limits when pushing over compliant+vinyl. The motor-driven lift substantially reduced push forces compared to the conventional lift. Application: Results may help to address risk of work-related musculoskeletal injury, especially in locations with novel compliant flooring.
Feasibility of Parent-to-Parent Support in Recently Diagnosed Childhood Diabetes
Authors: Channon Sue , Lowes Lesley , Gregory John W. , Grey Laura , Sullivan-Bolyai Susan 
Published: April 2016

Purpose The purpose of this study was to develop and test the feasibility of a parent-to-parent support intervention for parents whose child has recently been diagnosed with type 1 diabetes in the United Kingdom. Methods The research team conducted a formative evaluation, working with parents to design an individual-level parent-to-parent support intervention. Issues of recruitment, uptake, attrition, pattern of contact, and intervention acceptability were assessed. Results A US program was adapted in collaboration with a parents’ advisory group. Of 19 parents nominated as potential mentors by their pediatric diabetes specialist nurses, 12 (63%) volunteered and 11 continued for the 12-month intervention period. Thirty-three children were diagnosed with diabetes in the study period, with 25 families eligible to participate as recipients of the intervention; 9 parents from 7 of those families participated, representing 28% of those eligible. Feedback from parents and clinic staff identified peer support as a welcome service. Lessons were learned about the nature of the supporting relationship (eg, proximity, connectedness, and managing endings) that will enhance the design of future peer support programs. Conclusions Parent-to-parent support in the context of newly diagnosed childhood diabetes in the United Kingdom is feasible to deliver, with good engagement of mentors and clinic staff. The program was acceptable to parents who chose to participate, although uptake by parents whose child had been recently diagnosed was lower than expected. The results merit further investigation, including exploration of parent preference in relation to peer support.
Benign Cervical Cystic Teratoma
Authors: Woods Robert D. , Pearson Bruce W. , Weiland Louis H. 
Published: April 2016

Teratomas of the neck are rare in adults. Nine adult patients have been previously reported on in the world literature; six had malignant and three had benign lesions. Most of the lesions were seen as a mass in the neck, but teratoma is rarely considered in the differential diagnosis of neck lesions.A tenth patient, whose case we are presenting, had a supraclavicular sinus mass that was diagnosed at surgical exploration. The tumor was successfully resected and proved to be benign.
The in vivo and in vitro effect of phenylephrine (neo synephrine) on nasal ciliary beat frequency and mucociliary transport
Authors: Phillips P. Perry , McCaffrey Thomas V. , Kern Eugene B. 
Published: April 2016

Twenty volunteers with normal noses were studied to determine the effect of phenylephrine on nasal ciliary function. In vivo study of this drug was performed in 15 patients and revealed a significant increase in their ciliary beat frequency from a control of 11 Hz to 12.03 Hz (p = 0.001). Mucociliary transit times in these volunteers were also studied, revealing a mean of 9.9 minutes prestimulation and 10.2 minutes poststimulation, which was not statistically significant (p = 0.77). Five additional subjects donated ciliated mucosal samples for in vitro analysis of varying concentrations of this agent that showed a significant ciliostimulatory effect at lower concentrations (0.01%), with a progressive cilioinhibitory effect at higher concentrations (0.25%, 0.5%). The 0.05% concentration showed no significant change in ciliary activity compared to control measurements. These data demonstrate that phenylephrine has a ciliostimulatory effect in vivo, as well as in appropriate concentrations in vitro, and should be safe and relatively nontoxic to the mucociliary apparatus for short‐term use.3
Blood flow and capillary surface area of rat posterior canal ampulla
Authors: Wanamaker H.H. , Lyon M.J. 
Published: April 2016

Vascular disorders have often been proposed to explain disorders of the inner ear, in both the cochlear and vestibular systems. While the cochlea has been extensively studied, little work has been done on vestibular blood flow. Existing studies have reported only total vestibular blood flow, using microspheres. By combining the physiologic technique of microsphere injection with new developments in morphologic stereology studies, data on end‐organ blood flow (excluding nerve; 0.074 ± 0.027 μl/min; 5.99 μl/min/mm3), capillary surface area (10.87 mm2/mm3), mean capillary diameter (9.64 μm), and end‐organ volume (0.013 mm3) was determined for the posterior canal ampulla of young Fischer 344 rats. Results indicate an anatomic basis for increases in blood flow with CO2 breathing, and provide an assessment of appropriate microsphere size for vestibular blood flow studies. By allowing comparison of blood flow and capillary parameters related to surface area and volume, this new method of blood flow study will allow more meaningful data to be collected on the vestibular system.
Factors associated with changes in hospitalisation in patients prescribed clozapine
Authors: Gee Siobhan H , Shergill Sukhwinder S , Taylor David M 
Published: April 2016

Objective: The objective of this study was to examine whether delays in clozapine treatment affect outcomes once clozapine is started and identify factors that affect these outcomes. Method: Patients starting clozapine in a four year period at South London and the Maudsley NHS Foundation Trust were included. Clinical details were gathered from clinical notes. Primary outcome was net change in inpatient admissions comparing the periods before and after clozapine was started. Results: There was no significant association between the length of clozapine delay (mean clozapine delay = 3.93 years) and number or length of inpatient admissions once clozapine had been started (mean net change in days of admission = 16.74 days), F value = 0.901, p = 0.345. Clozapine reduced the total number of bed days per year, but only if treatment was continued – stopping resulted in inpatient admissions returning to pre-clozapine levels. Younger patients had a greater reduction in bed days when taking clozapine ( p = 0.027). Conclusion: Clozapine reduces the number of inpatient days, regardless of the chronicity of the illness at the time clozapine was started. Continued compliance with clozapine is necessary to maintain this benefit. Reduction in bed days is greater in younger patients, suggesting early initiation of clozapine may be beneficial.
Evaluation issues in the Swedish Two-County Trial of breast cancer screening: An historical review
Authors: Tabar Laszlo , Chen Tony Hsiu-Hsi , Hsu Chen-Yang , Wu Wendy Yi-Ying , Yen Amy Ming-Fang , Chen Sam Li-Sheng , Chiu Sherry Yueh-Hsia , Fann Jean Ching-Yuan , Beckmann Kerri , Smith Robert A , Duffy Stephen W 
Published: April 2016

Objectives To summarize debate and research in the Swedish Two-County Trial of mammographic screening on key issues of trial design, endpoint evaluation, and overdiagnosis, and from these to infer promising directions for the future. Methods A cluster-randomized controlled trial of the offer of breast cancer screening in Sweden, with a single screen of the control group at the end of the screening phase forms the setting for a historical review of investigations and debate on issues of design, analysis, and interpretation of results of the trial. Results There has been considerable commentary on the closure screen of the control group, ascertainment of cause of death, and cluster randomization. The issues raised were researched in detail and the main questions answered in publications between 1989 and 2003. Overdiagnosis issues still remain, but methods of estimation taking full account of lead time and of non-screening influences on incidence (taking place mainly before 2005) suggest that it is a minor phenomenon. Conclusion Despite resolution of issues relating to this trial in peer-reviewed publications dating from years, or even decades ago, issues that already have been addressed continue to be raised. We suggest that it would be more profitable to concentrate efforts on current research issues in breast cancer diagnosis, treatment, and prevention.
Concept analysis of moral courage in nursing: A hybrid model
Authors: Sadooghiasl Afsaneh , Parvizy Soroor , Ebadi Abbas 
Published: April 2016

Background: Moral courage is one of the most fundamental virtues in the nursing profession, however, little attention has been paid to it. As a result, no exact and clear definition of moral courage has ever been accessible. Objective: This study is carried out for the purposes of defining and clarifying its concept in the nursing profession. Methods: This study used a hybrid model of concept analysis comprising three phases, namely, a theoretical phase, field work phase, and a final analysis phase. To find relevant literature, electronic search of valid databases was utilized using keywords related to the concept of courage. Field work data were collected over an 11 months’ time period from 2013 to 2014. In the field work phase, in-depth interviews were performed with 10 nurses. The conventional content analysis was used in two theoretical and field work phases using Graneheim and Lundman stages, and the results were combined in the final analysis phase. Ethical consideration: Permission for this study was obtained from the ethics committee of Tehran University of Medical Sciences. Oral and written informed consent was received from the participants. Results: From the sum of 750 gained titles in theoretical phase, 26 texts were analyzed. The analysis resulted in 494 codes in text analysis and 226 codes in interview analysis. The literature review in the theoretical phase revealed two features of inherent–transcendental characteristics, two of which possessed a difficult nature. Working in the field phase added moral self-actualization characteristic, rationalism, spiritual beliefs, and scientific–professional qualifications to the feature of the concept. Conclusion: Moral courage is a pure and prominent characteristic of human beings. The antecedents of moral courage include model orientation, model acceptance, rationalism, individual excellence, acquiring academic and professional qualification, spiritual beliefs, organizational support, organizational repression, and internal and external personal barriers. Professional excellence resulting from moral courage can be crystallized in the form of provision of professional care, creating peace of mind, and the nurse’s decision making and proper functioning.
Resiliency and women exiting sex trade industry work
Authors: Hickle Kristine E 
Published: April 2016

Summary A qualitative approach was used to explore the experience of exiting sex trade industry work from the perspective of 19 adults formerly involved in the sex trade industry. A narrative approach to data collection was used to explore the participants’ experiences of successful exiting and phenomenological analysis was employed to identify themes that reflected the ways in which participants developed resiliency throughout the exiting process. Findings Themes include connection (including subthemes: survivor presence, children and spirituality), resources (including subthemes: networks, structure and safety) and personal growth. Significance These themes represent women with diverse experiences in the sex trade industry, including a majority who were victimised by (internal) sex trafficking. The findings demonstrate opportunities for social work practice to address the diverse needs of individuals exiting the sex trade industry, specifically for those who experienced sex trafficking and sexual exploitation.
The Historical Origins and Contemporary Dynamics of Conservatism in the United States: Anticommunism, the New Class Critique, and the Environment
Authors: Howison Jeffrey D 
Published: April 2016

This review article offers a critical assessment of three recent books on postwar conservatism in the United States. The broad themes of these works – anticommunism, the new class critique, and opposition to environmentalism – are used as a basis to review the extant literature and to analyse the historical trajectory of the conservative movement. Although American conservatism is generally a unified political force, important ideological divisions remain both among and between libertarians and social conservatives. These divisions are imperative for understanding the movement today and offer promising lines of future scholarship. Doody C (2013) Detroit’s Cold War: The Origins of Postwar Conservatism. Urbana, IL: University of Illinois Press. Horowitz RB (2013) America’s Right: Anti-Establishment Conservatism from Goldwater to the Tea Party. Cambridge: Polity Press. Layzer JA (2012) Open for Business: Conservatives’ Opposition to Environmental Regulation. Cambridge, MA: The MIT Press.
Enhancing clinical evidence by proactively building quality into clinical trials
Authors: Meeker-O’Connell Ann , Glessner Coleen , Behm Mark , Mulinde Jean , Roach Nancy , Sweeney Fergus , Tenaerts Pamela , Landray Martin J 
Published: April 2016

Background: Stakeholders across the clinical trial enterprise have expressed concern that the current clinical trial enterprise is unsustainable. The cost and complexity of trials have continued to increase, threatening our ability to generate reliable evidence essential for making appropriate decisions concerning the benefits and harms associated with clinical interventions. Overcoming this inefficiency rests on improving protocol design, trial planning, and quality oversight. Methods: The Clinical Trials Transformation Initiative convened a project to evaluate methods to prospectively build quality into the scientific and operational design of clinical trials (“quality-by-design”), such that trials are feasible to conduct and important errors are prevented rather than remediated. A working group evaluated aspects of trial design and oversight and developed the Clinical Trials Transformation Initiative quality-by-design principles document, outlining a series of factors generally relevant to the reliability of trial conclusions and to patient safety. These principles were then applied and further refined during a series of hands-on workshops to evaluate their utility in facilitating proactive, cross-functional dialogue, and decision-making about trial design and planning. Following these workshops, independent qualitative interviews were conducted with 19 workshop attendees to explore the potential challenges for implementing a quality-by-design approach to clinical trials. The Clinical Trials Transformation Initiative project team subsequently developed recommendations and an online resource guide to support implementation of this approach. Conclusion: The Clinical Trials Transformation Initiative quality-by-design principles provide a framework for assuring that clinical trials adequately safeguard participants and provide reliable information on which to make decisions on the effects of treatments. The quality-by-design workshops highlighted the value of active discussions incorporating the different perspectives within and external to an organization (e.g. clinical investigators, research site staff, and trial participants) in improving trial design. Workshop participants also recognized the value of focusing oversight on those aspects of the trial where errors would have a major impact on participant safety and reliability of results. Applying the Clinical Trials Transformation Initiative quality-by-design recommendations and principles should enable organizations to prioritize the most critical determinants of a trial’s quality, identify non-essential activities that can be eliminated to streamline trial conduct and oversight, and formulate appropriate plans to define, avoid, mitigate, monitor, and address important errors.
Brand versus generic medications: A disease state approach to identify patients’ perceptions and concerns
Authors: Smith Lillian , Mosley Juan , Ford Megan , Courtney Jonathan , Stefanelli Chase 
Published: April 2016

Background Medication cost does not solely dictate patient preference of brand name or generic medications. However, few studies have been completed to assess the influence of other factors, such as demographics and chronic diseases. Methods Responses were collected from 347 English speaking adults in the United States, age 18 and older, pertaining to demographics, diagnosed conditions, preference and knowledge of brand and generic medications. Results Participants with COPD, epilepsy, and high cholesterol felt that their condition influenced their preference of brand or generic medication more as compared with participants diagnosed with other conditions. If cost was not an issue, then 46% of respondents would prefer the brand name product, while 18% of participants felt their preference depended on the condition that the medication was intended to treat. Roughly one-third of the participants did not fully understand why there are both brand name and generic medications, and education level did not impact comprehension significantly. Conclusion The incentive for generic preference over brand name is primarily due to cost differences. However, improvement of education pertaining to brand/generic equivalency is needed, as some patients still believe brand name medications are superior to generic alternatives for certain disease states.