bluuebunny/crossref_metadata_2025_split huggingface dataset:
Generation of Upwelling Circulation under Downwelling-Favorable Wind within Bottom-Attached, Buoyant Coastal Currents
Authors: Chen Sih-Yu , Chen Shih-Nan 
Published: August 2017

AbstractA two-dimensional modeling study by Moffat and Lentz recently reported that downwelling-favorable wind can induce cross-shore upwelling circulation within a bottom-attached, buoyant coastal current. Here, we extend the problem to three dimensions. The driving mechanism and the sensitivity for the upwelling circulation are studied, using a primitive equation ocean model and an analytical model. After the initial downwelling adjustment that steepens the isopycnals and compresses the coastal current, the cross-shore flow can switch to steady upwelling circulation. This reverse circulation coincides with a vertically well-mixed water column and persists until interrupted by the arrival of river plume bulge from upstream. During the upwelling phase, the ageostrophic cross-shore flow follows the Ekman balance. The sense of cross-shore circulation is governed by a dimensionless parameter, the shear ratio, which measures the relative size of geostrophic shear and velocity shear supported by the wind in the shallow-water limit. Upwelling circulation occurs when the shear ratio is greater than one. This condition represents that, near the surface, the wind-intensified pressure gradient exceeds the maximum possible Coriolis force associated with the wind-forced, alongshore flow. The resulting upwelling circulation acts to slump the isopycnals to restore the geostrophic balance. Therefore, within a coastal current, decreasing wind stress in fact strengthens the upwelling circulation, as a weaker wind produces a weaker shear and thus increases the imbalance. This inverse relation holds until the wind is too weak to mix the water column. Based on the analytical model, a regime classification for the cross-shore circulation under downwelling-favorable wind is proposed. An observational example is given.
Assessing energy performance of smart cities
Authors: Causone Francesco , Sangalli Andrea , Pagliano Lorenzo , Carlucci Salvatore 
Published: August 2017

The massive urbanization process registered since 1950s and projected to continue for the coming decades is posing a crucial issue for the management of existing cities and the planning of future ones. Smart cities are often envisioned as ideal urban environments where the different dimensions of a city, such as economy, education, energy, environment, finance, etc., are managed in an effective and proactive way. Nevertheless, in order to reach this remarkable and challenging objective, analysis tools are required to create scenarios that are able to inform policy makers’ decisions. Focusing on energy, this paper proposes an analysis method, based on exergy, to support smart city planning. It may help the decision makers to assess the energy-smartness of different scenarios, and to address urban energy policies. Possibilities and limitations of the analysis method are discussed via the application to the cities of London, Milan, and Lisbon that committed to become smart cities. Practical application: The paper summarizes a study on the possibilities and limitations of adopting an assessment technique, based on exergy, in order to evaluate the energy-smartness of policies in existing and future smart cities. As highlighted in the paper, building’s energy uses have a huge share of many cities’ energy breakdown. Thus, professionals in the building industry will be interested in the paper not only because it refers to smart cities, but because the built environment plays a pivotal role in them. Professionals may also refer to this study to perform a similar analysis in other urban environments to support decision makers.
Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures
Authors: Gao Chang , Zong Min , Wang Wen-tao , Xu Lei , Cao Da , Zou Yue-fen 
Published: August 2017

Background Percutaneous kyphoplasty (PKP) is a common treatment modality for painful osteoporotic vertebral compression fractures (OVCFs). Pre- and postoperative identification of risk factors for cement leakage and follow-up complications would therefore be helpful but has not been systematically investigated. Purpose To evaluate pre- and postoperative risk factors for the occurrence of short-term cement leakages and long-term complications after PKP for OVCFs. Material and Methods A total of 283 vertebrae with PKP in 239 patients were investigated. Possible risk factors causing cement leakage and complications during follow-up periods were retrospectively assessed using multivariate analysis. Cement leakage in general, three fundamental leakage types, and complications during follow-up period were directly identified through postoperative computed tomography (CT). Results Generally, the presence of cortical disruption ( P = 0.001), large volume of cement ( P = 0.012), and low bone mineral density (BMD) ( P = 0.002) were three strong predictors for cement leakage. While the presence of intravertebral cleft and Schmorl nodes ( P = 0.045 and 0.025, respectively) were respectively identified as additional risk factors for paravertebral and intradiscal subtype of cortical (C-type) leakages. In terms of follow-up complications, occurrence of cortical leakage was a strong risk factor both for new VCFs ( P = 0.043) and for recompression ( P = 0.004). Conclusion The presence of cortical disruption, large volume of cement, and low BMD of treated level are general but strong predictors for cement leakage. The presence of intravertebral cleft and Schmorl nodes are additional risk factors for cortical leakage. During follow-up, the occurrence of C-type leakage is a strong risk factor, for both new VCFs and recompression.
Novel occupational therapy intervention in the early rehabilitation of patients with brain tumours
Authors: Hansen Anders , Boll Mette , Minet Lisbeth , Søgaard Karen , Kristensen Hanne 
Published: August 2017

Statement of context The Danish Health Authority recommends that patients with brain tumours should have their rehabilitation needs evaluated prior to hospital discharge. Critical reflection on practice To our knowledge, no specific recommendations for specialised occupational therapy intervention in patients with glioma have been published. We rationalise how occupational therapy practices founded on shared decision-making and common goal-setting are implicated to patients with brain tumours and elaborate on how an occupation-centred approach with occupation-focused and based intervention has the potential to impact a patient’s performance ability and satisfaction in performing occupations established by the Canadian Occupational Performance Measure. This practice was embedded in a randomised controlled trial investigating the effectiveness of intensive rehabilitation efforts and involving occupational therapy compared with standard care in patients with glioma (ClinicalTrials.gov Identifier NCT02221986). Implications for practice Occupational therapy makes an important contribution in neurorehabilitation, which may also apply to patients with brain tumours.
Heel-Rise Height Deficit 1 Year After Achilles Tendon Rupture Relates to Changes in Ankle Biomechanics 6 Years After Injury
Authors: Brorsson Annelie , Willy Richard W. , Tranberg Roy , Grävare Silbernagel Karin 
Published: August 2017

Background:It is unknown whether the height of a heel-rise performed in the single-leg standing heel-rise test 1 year after an Achilles tendon rupture (ATR) correlates with ankle biomechanics during walking, jogging, and jumping in the long-term.Purpose:To explore the differences in ankle biomechanics, tendon length, calf muscle recovery, and patient-reported outcomes at a mean of 6 years after ATR between 2 groups that, at 1-year follow-up, had less than 15% versus greater than 30% differences in heel-rise height.Study Design:Cohort study; Level of evidence, 3.Methods:Seventeen patients with less than 15% (<15% group) and 17 patients with greater than 30% (>30% group) side-to-side difference in heel-rise height at 1 year after ATR were evaluated at a mean (SD) 6.1 (2.0) years after their ATR. Ankle kinematics and kinetics were sampled via standard motion capture procedures during walking, jogging, and jumping. Patient-reported outcome was evaluated with Achilles tendon Total Rupture Score (ATRS), Physical Activity Scale (PAS), and Foot and Ankle Outcome Score (FAOS). Tendon length was evaluated by ultrasonography. The Limb Symmetry Index (LSI = [Injured Side ÷ Healthy Side] × 100) was calculated for side differences.Results:The >30% group had significantly more deficits in ankle kinetics during all activities compared with patients in the <15% group at a mean of 6 years after ATR (LSI, 70%-149% and 84%-106%, respectively; P = .010-.024). The >30% group, compared with the <15% group, also had significantly lower values in heel-rise height (LSI, 72% and 95%, respectively; P < .001) and heel-rise work (LSI, 58% and 91%, respectively; P < .001) and significantly larger side-to-side difference in tendon length (114% and 106%, respectively; P = .012). Achilles tendon length correlated with ankle kinematic variables ( r = 0.38-0.44; P = .015-.027) whereas heel-rise work correlated with kinetic variables ( r = −0.57 to 0.56; P = .001-.047). LSI tendon length correlated negatively with LSI heel-rise height ( r = −0.41; P = .018). No differences were found between groups in patient-reported outcome ( P = .143-.852).Conclusion:Height obtained during the single-leg standing heel-rise test performed 1 year after ATR related to the long-term ability to regain normal ankle biomechanics. Minimizing tendon elongation and regaining heel-rise height may be important for the long-term recovery of ankle biomechanics, particularly during more demanding activities such as jumping.
Donor Milk or Formula: A Qualitative Study of Postpartum Mothers of Healthy Newborns
Authors: Kair Laura R. , Flaherman Valerie J. 
Published: August 2017

Background: Many breastfed infants receive supplemental feeds during the birth hospitalization, either by maternal request or due to medical indications. Donor milk from a certified milk bank has become increasingly available and is now used in some settings for term and late preterm infants. No studies have explored maternal opinions about donor milk and formula as options for supplementary feedings. Research aim: This study aimed to explore maternal perceptions about donor milk and formula supplementation and implications for continued breastfeeding. Methods: The authors conducted semistructured interviews with 30 postpartum mothers of healthy newborns who breastfed and gave supplementary feedings with pasteurized donor milk and/or formula during the birth hospitalization. They analyzed transcripts using the constant comparative method and identified four major themes. Results: Identified themes included the following: (a) Donor milk is seen as temporary whereas formula is seen as an ongoing plan, (b) formula is viewed as familiar whereas donor milk is viewed as unfamiliar, (c) donor milk is costly and challenging logistically, and (d) donor milk is “healthier.” Conclusion: For mothers who view donor milk as temporary and formula as permanent, the provision of donor milk rather than formula when supplementation is medically indicated may have the potential to promote the return to exclusive maternal breastfeeding. Barriers to the use of donor milk include cost and lack of familiarity and access.
Spillover improved survival in non-invited patients of the colorectal cancer screening programme
Authors: Miettinen Joonas , Malila Nea , Hakama Matti , Pitkäniemi Janne 
Published: August 2017

Objectives In colorectal cancer screening, randomized clinical trials have shown a 16% mean reduction in colorectal cancer mortality, but the Finnish randomized health services study showed no effect. We quantified spillover (the total indirect effect caused by the programme on the non-invited) and corrected the effectiveness estimate of the Finnish programme. Methods We retrieved from the Finnish Cancer Registry data on all non-invited colorectal cancer patients diagnosed in 1999–2013 in municipalities that adopted screening ( n = 18,948). Patients were stratified by three 5-year diagnostic periods and two calendar periods of programme adoption in the municipality of residence. Follow-up ended on 31 December 2013. We measured the spillover effect in patient survival, based on differences of adjusted estimates of the colorectal cancer-related hazard of death between pairs of consecutive diagnostic periods. Results The spillover effect was estimated as 9 percentage points (95% confidence interval: −1 to 19 percentage points). It was 13 percentage points in men (−1 to 26 percentage points) and 5 percentage points in women (−9 to 20 percentage points). The corrected effect estimate of implementing screening in Finland was 5 percentage points. Conclusions The corrected Finnish effectiveness estimate was consistent with estimates from randomized trials. Indirect effects (spillover) bias the invitee–control contrast. In this case, spillover was an inherent benefit of the Finnish programme.
Regulating work in the gig economy: What are the options?
Authors: Stewart Andrew , Stanford Jim 
Published: August 2017

AbstractPaid work associated with digital platform businesses (in taxi, delivery, maintenance and other functions) embodies features which complicate the application of traditional labour regulations and employment standards. This article reviews the extent of this type of work in Australia, and its main characteristics. It then considers the applicability of existing employment regulations to these ‘gig’ jobs, citing both Australian and international legislation and case law. There is considerable uncertainty regarding the scope of traditional regulations, minimum standards and remedies in the realm of irregular digitally mediated work. Regulators and policymakers should consider how to strengthen and expand the regulatory framework governing gig work. The article notes five major options in this regard: enforcement of existing laws; clarifying or expanding definitions of ‘employment’; creating a new category of ‘independent worker’; creating rights for ‘workers’, not employees; and reconsidering the concept of an ‘employer’. We review the pros and cons of these approaches and urge regulators to be creative and ambitious in better protecting the minimum standards and conditions of workers in these situations.
Making moves: Transitioning R-EPOCH to the ambulatory setting
Authors: Martin Allison L , Frank Joel P , Waggoner Mindy L 
Published: August 2017

Purpose Ambulatory administration of chemotherapy provides benefit to patients and institutions alike. We hypothesized that transitioning rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (R-EPOCH) from an inpatient to ambulatory setting would reduce inpatient bed days and overall healthcare costs. The purpose of this effort was to create a guideline that would transition R-EPOCH to the ambulatory setting. To assess institutional benefit, we assessed inpatient bed days saved and financial impact. Methods A single center, retrospective analysis of inpatient R-EPOCH administration from January 2013 to December 2015 defined the need for medication use guidelines for ambulatory R-EPOCH administration. While this guideline targeted a reduction in inpatient bed days, it also created desired staff-and-patient education on R-EPOCH. Multidisciplinary collaboration enabled this comprehensive approach to outpatient chemotherapy administration. Results The 42 patients included received 147 cycles of R-EPOCH. Administration was primarily inpatient, amounting to 107 cycles and 799 inpatient days. Concurrently, 40 cycles of R-EPOCH were administered to 11 patients in the ambulatory setting. Only two patients received all cycles as outpatient; the other nine patients received chemotherapy in both settings. Financial analysis showed a 53% reduction in drug acquisition cost and 30% reduction in direct costs with ambulatory R-EPOCH administration. Based on our projection, after guideline implementation, 12 patients will be eligible for ambulatory R-EPOCH annually, resulting in a savings of 360 bed days and approximately $650,000 per year. Conclusion Transitioning R-EPOCH is a viable option to significantly decrease inpatient bed days and overall healthcare costs. Multidisciplinary collaboration is vital to successfully transitioning regimens to the ambulatory setting and to establishing consistent support for ambulatory administration.
The impact of adverse childhood experiences on health service use across the life course using a retrospective cohort study
Authors: Bellis Mark , Hughes Karen , Hardcastle Katie , Ashton Kathryn , Ford Kat , Quigg Zara , Davies Alisha 
Published: August 2017

Objectives The lifelong health impacts of adverse childhood experiences are increasingly being identified, including earlier and more frequent development of non-communicable disease. Our aim was to examine whether adverse childhood experiences are related to increased use of primary, emergency and in-patient care and at what ages such impact is apparent. Methods Household surveys were undertaken in 2015 with 7414 adults resident in Wales and England using random probability stratified sampling (age range 18–69 years). Nine adverse childhood experiences (covering childhood abuse and household stressors) and three types of health care use in the last 12 months were assessed: number of general practice (GP) visits, emergency department (ED) attendances and nights spent in hospital. Results Levels of use increased with increasing numbers of adverse childhood experiences experienced. Compared to those with no adverse childhood experiences, odds (±95% CIs) of frequent GP use (≥6 visits), any ED attendance or any overnight hospital stay were 2.34 (1.88–2.92), 2.32 (1.90–2.83) and 2.67 (2.06–3.47) in those with ≥ 4 adverse childhood experiences. Differences were independent of socio-economic measures of deprivation and other demographics. Higher health care use in those with ≥ 4 adverse childhood experiences (compared with no adverse childhood experiences) was evident at 18–29 years of age and continued through to 50–59 years. Demographically adjusted means for ED attendance rose from 12.2% of 18-29 year olds with no adverse childhood experiences to 28.8% of those with ≥ 4 adverse childhood experiences. At 60–69 years, only overnight hospital stay was significant (9.8% vs. 25.0%). Conclusions Along with the acute impacts of adverse childhood experiences on child health, a life course perspective provides a compelling case for investing in safe and nurturing childhoods. Disproportionate health expenditure in later life might be reduced through childhood interventions to prevent adverse childhood experiences.
Identifying potential predictive indicators of massive transfusion in pediatric trauma
Authors: Hwu Ruth S , Keller Martin S , Spinella Philip C , Baker David , Shi Junxin , Leonard Julie C 
Published: August 2017

Objective Predictive scores were developed in adults to identify patients at risk for traumatic hemorrhage but have not been studied in children. Our objective was to identify clinical predictors of massive transfusion (≥40 ml/kg red blood cells or ≥80 ml/kg total blood product at 24 h) in injured children. Methods We conducted a retrospective case–control study of children <18 years old who presented from 2005 to 2014 for trauma care. Cases were children who received massive transfusion. Two control groups were identified: (1) ‘random’ and (2) matched for age and injury severity score (matched). Variables included vital signs, injury mechanism, active bleeding, and laboratory values. Multivariate logistic regression models to predict massive transfusion were developed using only clinical findings (‘pre-arrival’ model) and then also including laboratory values (emergency department model). Results Of 11,995 injured children, 44 received massive transfusion. We selected 132 random and 127 matched controls. Using random controls, the pre-arrival model included heart rate, Glasgow Coma Scale, temperature, and penetrating injury mechanism (AUC = 0.965). With matched controls, the pre-arrival model included Glasgow Coma Scale, penetrating injury, and active bleeding resulted (AUC = 0.812). The ED model using random controls included Glasgow Coma Scale, hemoglobin, and penetrating injury (AUC = 0.987). The emergency department model using matched controls included hemoglobin, temperature, prolonged partial thromboplastin time, and active bleeding on arrival (AUC = 0.734). Conclusions We identified predictive models for children who receive massive transfusion that rely on only clinical findings pre-arrival to the emergency department and then incorporate laboratory tests for those in the emergency department.
Beyond equality: Providing equitable care for persons with disabilities
Authors: Wakeham Scott , Heung Sally , Lee Janet , Sadowski Cheryl A. 
Published: August 2017

Background: Almost 14% of Canadians have a disability, and older adults are most commonly affected. People living with disabilities have challenges accessing health care services, including medications and other services provided in pharmacies. Methods: A literature review was conducted regarding disability and pharmacy services. Resources regarding accessibility were also incorporated. Results: A number of organizations provide guidance on caring for those with disabilities. A primary concern for these vulnerable individuals relates to being invisible or overlooked by the health care system. There are also the stresses of physical, communication and attitudinal barriers. Pharmacists may be unaware of these barriers and may actually be contributing to them. To understand their patients’ accessibility needs, pharmacists can consider physical and nonphysical barriers and engage in education, advocacy and communications training to improve their patient-centred care for individuals with disabilities. Discussion and Conclusion: Pharmacists can improve the care of individuals with disabilities by learning more about accessibility. Within the community pharmacy environment, there are physical and nonphysical interventions that pharmacists can implement to ensure that patient-centred care is prioritized.