bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modulation of the Agulhas Current Retroflection and Leakage by Oceanic Current Interaction with the Atmosphere in Coupled Simulations
Authors: Renault Lionel , McWilliams James C. , Penven Pierrick 
Published: June 2017

AbstractCoupled ocean–atmosphere simulations are carried out for the Mozambique Channel, the Agulhas Current system, and the Benguela upwelling system to assess the ocean surface current feedback to the atmosphere and its impact on the Agulhas Current (AC) retroflection and leakage. Consistent with previous studies, the authors show that the current feedback slows down the oceanic mean circulation and acts as an oceanic eddy killer by modulating the energy transfer between the atmosphere and the ocean, reducing by 25% the mesoscale energy and inducing a pathway of energy transfer from the ocean to the atmosphere. The current feedback, by dampening the eddy kinetic energy (EKE), shifts westward the distribution of the AC retroflection location, reducing the presence of eastern retroflections in the simulations and improving the realism of the AC simulation. By modulating the EKE, the AC retroflection and the Good Hope jet intensity, the current feedback allows a larger AC leakage (by 21%), altering the water masses of the Benguela system. Additionally, the eddy shedding is shifted northward and the Agulhas rings propagate less far north in the Atlantic. The current–wind coupling coefficient sw is not spatially constant: a deeper marine boundary layer induces a weaker sw. Finally the results indicate that the submesoscale currents may also be weakened by the current feedback.
The Influence of Subinertial Internal Tides on Near-Topographic Turbulence at the Mendocino Ridge: Observations and Modeling
Authors: Musgrave R. C. , MacKinnon J. A. , Pinkel R. , Waterhouse A. F. , Nash J. , Kelly S. M. 
Published: June 2017

AbstractShipboard measurements of velocity and density were obtained in the vicinity of a small channel in the Mendocino Ridge, where flows were predominantly tidal. Measured daily inequalities in transport are much greater than those predicted by a barotropic tide model, with the strongest transport associated with full depth flows and the weakest with shallow, surface-confined flows. A regional numerical model of the area finds that the subinertial K1 (diurnal) tidal constituent generates topographically trapped waves that propagate anticyclonically around the ridge and are associated with enhanced near-topographic K1 transports. The interaction of the baroclinic trapped waves with the surface tide produces a tidal flow whose northward transports alternate between being surface confined and full depth. Full depth flows are associated with the generation of a large-amplitude tidal lee wave on the northward face of the ridge, while surface-confined flows are largely nonturbulent. The regional model demonstrates that, consistent with field observations, near-topographic dissipation over the entire ridge is diurnally modulated, despite the semidiurnal tidal constituent having larger barotropic velocities. It is concluded that at this location it is the bottom-trapped subinertial internal tide that governs near-topographic dissipation and mixing. The effect of the trapped wave on regional energetics is to increase the fraction of converted barotropic–baroclinic tidal energy that dissipates locally.
An innovative school-based intervention to promote healthy lifestyles
Authors: Piana Natalia , Ranucci Claudia , Buratta Livia , Foglia Elena , Fabi Marta , Novelli Francesca , Casucci Simone , Reginato Elisa , Pippi Roberto , Aiello Cristina , Leonardi Alessia , Romani Giannermete , De Feo Pierpaolo , Mazzeschi Claudia 
Published: June 2017

Objective: To describe an innovative school-based intervention to promote healthy lifestyles. To evaluate its effects on children’s food habits and to highlight the key components which contribute most to the beneficial effects obtained from children’s, teachers’ and parents’ perspectives. Design: An educational tool to improve personal awareness, promote healthy food choices and increase children’s levels of physical activity was developed and evaluated. The tool used a community-based approach and included family members, schools, university, families, sports societies, farms, mass media and municipalities. Setting: A total of 11 primary school classes in five schools in Spoleto, Umbria. Methods: The tool dealt with healthy food choices, lifestyle and physical activities and is structured in four phases (4 months). The Kidmed test (a validated index based on principles sustaining Mediterranean dietary patterns as well as those that undermine them) and open-ended questionnaires (to highlight the key components which contributed most to the beneficial effects) were used to assess the effectiveness of the intervention. Kidmed scores were evaluated both before and after intervention (T0–T1) and the written answers collected (from teachers, parents and children) were subjected to content analysis using a form of grounded theory. Results: Data point to a significant before/after increase on Kidmed scores ( t = −3.88; p = .000), revealing an increase in children’s adherence to the Mediterranean Diet, healthy habit changes, greater parental awareness of their educational responsibilities regarding food choices as well as physical activity, and a new school-family alliance as a result of the educational intervention. Conclusion: Project findings reveal positive effects on children’s food habits and highlight key components necessary to enhance the effectiveness of a school-based educational intervention.
Assessment of Selected Overdose Poisoning Indicators in Health Care Administrative Data in 4 States, 2012
Authors: Hume Beth , Gabella Barbara , Hathaway Jeanne , Proescholdbell Scott , Sneddon Cristy , Brutsch Elizabeth , Hedin Riley , Drucker Christopher J. 
Published: June 2017

Objectives: In 2012, a consensus document was developed on drug overdose poisoning definitions. We took the opportunity to apply these new definitions to health care administrative data in 4 states. Our objective was to calculate and compare drug (particularly opioid) poisoning rates in these 4 states for 4 selected Injury Surveillance Workgroup 7 (ISW7) drug poisoning indicators, using 2 ISW7 surveillance definitions, Option A and Option B. We also identified factors related to the health care administrative data used by each state that might contribute to poisoning rate variations. Methods: We used state-level hospital and emergency department (ED) discharge data to calculate age-adjusted rates for 4 drug poisoning indicators (acute drug poisonings, acute opioid poisonings, acute opioid analgesic poisonings, and acute or chronic opioid poisonings) using just the principal diagnosis or first-listed external cause-of-injury fields (Option A) or using all diagnosis or external cause-of-injury fields (Option B). We also calculated the high-to-low poisoning rate ratios to measure rate variations. Results: The average poisoning rates per 100 000 population for the 4 ISW7 poisoning indicators ranged from 11.2 to 216.4 (ED) and from 14.2 to 212.8 (hospital). For each indicator, ED rates were usually higher than were hospital rates. High-to-low rate ratios between states were lowest for the acute drug poisoning indicator (range, 1.5-1.6). Factors potentially contributing to rate variations included administrative data structure, accessibility, and submission regulations. Conclusions: The ISW7 Option B surveillance definition is needed to fully capture the state burden of opioid poisonings. Efforts to control for factors related to administrative data, standardize data sources on a national level, and improve data source accessibility for state health departments would improve the accuracy of drug poisoning surveillance.
Noninvasive Quantitative Assessment of Hepatic Steatosis by Proton Magnetic Resonance Spectroscopy Among Adult Patients Receiving Home Parenteral Nutrition
Authors: Huijbers Angelique , Wanten Geert , Dekker Helena Maria , van der Graaf Marinette 
Published: June 2017

AbstractBackground: Intestinal failure–associated liver disease is a frequent complication in patients with chronic intestinal failure (CIF), with steatosis as a dominant feature in adults. Proton magnetic resonance spectroscopy (1H‐MRS) is a noninvasive method to quantify liver fat content (LFC). In this study, LFC was assessed with 1H‐MRS, taking into account the possible accumulation of paramagnetic components of home parenteral nutrition (HPN) that may disturb these measurements. Methods: LFC was measured in 15 adult CIF patients who had been receiving HPN for >6 months. 1H‐MR spectra were obtained with a 3 Tesla magnetic resonance (MR) system, with a method correcting for the presence of paramagnetic ions. Patients with low (<5%) versus high (≥5%, steatosis) LFC were compared with nonparametric statistical tests. Results: 1H‐MRS analysis revealed steatosis in 5 patients (median, 10.3%), while 10 patients had normal LFC (median, 0.9%). In all patients, the 1H‐MRS results indicated the presence of various amounts of paramagnetic constituents in the liver. Patients with steatosis had higher alanine aminotransferase values than patients without steatosis (median, 60 vs 28 U/L). Unexpectedly, in the steatosis group, the frequency of HPN use was lower, with significant lower total HPN and carbohydrate calories. In 1 patient, MR spectra were of inferior quality, with broadened resonances after infusion with a ferric compound. Conclusion: 1H‐MRS enables reliable noninvasive assessment of LFC in patients receiving long‐term HPN, if correcting for possible accumulation of paramagnetic components in the liver. However, LFC determination by 1H‐MRS is not recommended after a recent ferric compound infusion.
Comparing the effect of Cawthorne–Cooksey and Frenkel exercises on balance in patients with multiple sclerosis: a randomized controlled trial
Authors: Afrasiabifar Ardashir , Karami Fatemeh , Najafi Doulatabad Shahla 
Published: June 2017

Objective: To evaluate the effect of Cawthorne–Cooksey and Frenkel exercises on balance in patients with multiple sclerosis. Design: It was a three-arm parallel randomized controlled trial study. Setting: Outpatient clinic. Subjects: Patients with multiple sclerosis. Interventions: Subjects in the intervention groups completed a 12-week program consisted of Cawthorne–Cooksey or Frenkel exercises. The control group only received routine care. Main measures: The outcome measure was the Berg Balance Scale. Results: Seventy-two patients completed the study. At the end of the intervention, there was a statistically significant improvement in Berg Balance Scale in the Cawthorne–Cooksey group ( n = 24) in comparison with the other two groups ( P = 0.001). In the Frenkel group ( n = 23), the improvement was statistically greater than the changes in the control group ( n = 25), but it did not appear to be clinically significant. The Berg Balance Scale score increased to 8.9 in the Cawthorne–Cooksey group and 2.3 in the Frenkel group, while it decreased to 1.2 in the control group. When comparing inter-group changes, Berg Balance Scale showed significant improvements in favor of the Cawthorne–Cooksey group after the intervention ( P < 0.05). Conclusion: This study demonstrated that in comparison with Frenkel and the control groups, a program of Cawthorne–Cooksey exercise is more effective in improving balance in patients with multiple sclerosis.
A randomized controlled trial of a modified wheelchair arm-support to reduce shoulder pain in stroke patients
Authors: Pan Ruihuan , Zhou Mingchao , Cai Hao , Guo Youhua , Zhan Lechang , Li Mei , Yang Zhijing , Zhu Leying , Zhan Jie , Chen Hongxia 
Published: June 2017

Objective: To evaluate the effect of modified wheelchair arm-support to mitigate hemiplegic shoulder pain and reduce pain frequency in stroke patients. Design: A single-blind randomized controlled trial using computer-generated simple randomization. Setting: Participants recruited from inpatients at the Guangdong Provincial Hospital of Chinese Medicine. Subjects: A total of 120 patients with stroke were divided into two groups. Interventions: All subjects underwent basic rehabilitation training and wheelchair assistance with eight weeks follow-up period. Patients in the treatment group additionally received modified wheelchair arm-support for at least 60 minutes a day, six days a week, for four weeks. Outcome measures: Primary outcome was measured by the Visual Analogue Pain Scale or Numeric Pain Rating Scale. Secondary outcome was measured using the Upper Extremity Fugl-Meyer Assessment scale, Modified Barthel Index and Quality of Life Index. Measurements were made at 4 weeks and 12 weeks, following the intervention. Results: Patients age from 21 to 83 years (mean ± SD = 62.41 ± 12.26). The average duration of disease was 1.9 ± 1.3 months. At four weeks, the median of pain intensity was higher in the control group (median, interquartile range = 3, 5.75 vs. 2, 3.75; P = 0.059). At 12 weeks, the median of pain intensity was higher in the control group (median, interquartile range = 3, 5.00 vs. 0, 1.00; P < 0.001). At 12 weeks, patients with shoulder pain were higher in the control group (6 vs. 1; P < 0.05). Conclusion: Using the modified wheelchair arm-support could lead to the mitigation of hemiplegic shoulder pain and reduction in pain incidence in stroke patients. It may also improve the patients’ quality of life.
Use of buccal morphine in the management of pain in children with life-limiting conditions: Results of a laboratory study
Authors: McCulloch Renée , Sattar Mohammed , Henderson Ellen M , Lane Majella E , Bluebond-Langner Myra 
Published: June 2017

Background: Children and infants with impaired swallow or compromised enteral absorption require alternative routes for administration of analgesia. Recent clinical guidance and practice for paediatric palliative care teams, who often treat such children, supports buccal morphine sulphate as a fast acting, effective and easily administered agent for pain relief. However, a consideration of the physicochemical properties and potency of morphine would suggest that it is not a suitable candidate for delivery via the transmucosal route, raising questions about its use in children and infants. Aim: To explore the permeability of buccal morphine sulphate in an established ex vivo porcine buccal mucosa as a necessary step in examining efficacy for use in children with life-limiting conditions and life-threatening illnesses. Design: A permeation study conducted with morphine sulphate in an ex vivo porcine buccal tissue model. Flux values and pharmacokinetic data were used to calculate the plasma values of morphine that would result following buccal administration in a 20kg child. Results: Results show that the estimated steady state plasma values of morphine sulphate following buccal administration in this model do not achieve minimum therapeutic concentration. Conclusion: These data strongly suggest that morphine sulphate is not suitable for buccal administration and that further research is needed to establish its efficacy in relief of pain in children with life-limiting conditions and life-threatening illnesses.
Interleukin 1 Receptor Antagonist Anakinra, Intravenous Immunoglobulin, and Corticosteroids in the Management of Critically Ill Adult Patients With Hemophagocytic Lymphohistiocytosis
Authors: Wohlfarth Philipp , Agis Hermine , Gualdoni Guido A. , Weber Johannes , Staudinger Thomas , Schellongowski Peter , Robak Oliver 
Published: June 2017

Background: Hemophagocytic lymphohistiocytosis (HLH) causes multiple organ dysfunction frequently leading to intensive care unit (ICU) referral and/or death. We report on a series of critically ill adult patients treated with a non-etoposide-based regimen including interleukin 1 antagonist anakinra, intravenous immunoglobulin (IVIG), and/or corticosteroids (CS) for HLH. Methods: Eight adult (≥18 years) ICU patients having received treatment with anakinra ± IVIG ± CS for HLH between March 2014 and March 2016 at a large tertiary care university hospital (Medical University of Vienna, Vienna, Austria) were retrospectively analyzed. Results: Eight patients (median age: 38 years; range: 20-58 years; 4 males and 4 females) received anakinra together with IVIG (n = 7) and/or high-dose CS (n = 5) for suspected reactive HLH (median H-score: 214; range: 171-288). Seven (88%) patients required vasopressors and invasive mechanical ventilation and 6 (75%) patients required renal replacement therapy (median Sequential Organ Failure Assessment [SOFA] score at HLH diagnosis: 9.5; range: 6-14). Six patients showed a significant decline in the SOFA score at 1 and 2 weeks following treatment initiation ( P = .03), and the remainder 2 patients experienced early death. Five patients survived to ICU discharge, 4 of them could further be discharged from hospital (hospital survival rate: 50%). No overt treatment-related toxicity was noted. Conclusion: Anakinra in combination with IVIG and/or CS resulted in a hospital survival rate of 50% in 8 critically ill adult patients with HLH despite a vast degree of organ dysfunction and the need for aggressive ICU treatment. Further research on non-etoposide-based treatment strategies for HLH in critically ill adults is warranted.
Measuring Sleep in the Intensive Care Unit: A Critical Appraisal of the Use of Subjective Methods
Authors: Jeffs Emma L. , Darbyshire Julie L. 
Published: June 2017

Objectives: To collate and appraise the use of subjective measures to assess sleep in the intensive care unit (ICU). Design: A systematic search and critical review of the published literature. Data Sources: Medline, Scopus, and Cumulative Index to Nursing and Allied Health Literature were searched using combinations of the key words “Sleep,” “Critical Care,” “Intensive Care,” and “Sleep Disorders,” and this was complemented by hand searching the most recent systematic reviews on related topics. Study Eligibility Criteria: Papers were limited to non-gray English-language studies of the adult population, published in the last 10 years. Outcome Measures: Primary outcomes were the number and categorization of quantitative studies reporting measures of sleep, the number of participants for each data collection method, and a synthesis of related material to appraise the use of survey tools commonly used for sleep measurement in the ICU. Results: Thirty-eight papers reported quantitative empirical data collection on sleep, 17 of which used a primary method of subjective assessment of sleep by the patient or nurse. Thirteen methods of subjective sleep assessment were identified. Many of these tools lacked validity and reliability testing. Conclusions: Research using questionnaires to assess sleep is commonplace in light of practical barriers to polysomnography or other measures of sleep. A methodologically sound approach to tool development and testing is crucial to gather meaningful data, and this robust approach was lacking in many cases. Further research measuring sleep subjectively in ICU should use the Richards Campbell Sleep Questionnaire, and researchers should maintain a commitment to transparency in describing methods.
Study of composite vascular scaffold combining with differentiated VSMC- and VEC-like cells in vitro and in vivo
Authors: Liu Xuqian , Wang Jie , Dong Fusheng , Song Peng , Li Hexiang , Hou Yali 
Published: June 2017

Although research into the tissue engineering of vessels has proceeded at a tremendous pace, many deficiencies still need to be resolved. A well-adopted constructed vessel requires both functional and structural properties to stimulate the native vessel and resist stress and tension in vivo. In the present study, we developed a novel three-layer composite vascular scaffold consisting of differentiated vascular smooth muscle cell-, vascular endothelial cell-like cells, and a rabbit acellular vascular matrix (ACVM)-0.25% HLC-I scaffold. HE staining, immunohistochemical assays, immunofluorescence assays (IFAs), and scanning electron microscopy were performed to monitor the growth status of cells on the scaffold material in vitro. After the vascular endothelial cell -vascular smooth muscle cell-scaffold was implanted into nude mice for three, six, and nine weeks, samples were harvested from the implanted mice and observed visually or by HE staining and IFAs for cell viability and morphology. Additionally, burst pressure resistance experiments were used to assess the maximal pressure that the engineered vessel could resist. We found that the engineered vascular endothelial cell-vascular smooth muscle cell-scaffold vessel possessed favorable biocompatibility and considerable strength, matching native vessels in vivo and in vitro, and may be significant in the future clinical implantation of tissue-engineered vasculature.
Sustainability in care through an ethical practice model
Authors: Nyholm Linda , Salmela Susanne , Nyström Lisbet , Koskinen Camilla 
Published: June 2017

Background: While sustainability is a key concept in many different domains today, it has not yet been sufficiently emphasized in the healthcare sector. Earlier research shows that ethical values and evidence-based care models create sustainability in care practice. Objective: The aim of this study was to gain further understanding of the ethical values central to the realization of sustainability in care and to create an ethical practice model whereby these basic values can be made perceptible and active in care practice. Research design: Part of the ongoing “Ethical Sustainable Caring Cultures” research project, a hermeneutical application research design was employed in this study. Participants: Dialogues were used, where scientific researchers and co-researchers were given the opportunity to reflect on ethical values in relation to sustainability in care. Findings: An ethical practice model with ethos as its core was created from the results of the dialogues. In the model, ethos is encircled by the ethical values central to sustainability: dignity, responsibility, respect, invitation, and vows. Discussion: The model can be used as a starting point for ethical conversations that support carers’ reflections on the ethical issues seen in day-to-day care work and the work community, allowing ethical values to become visible throughout the entire care culture. Conclusion: It is intended as a tool whereby carers can more deeply understand an organization’s common basic values and what they entail in regard to sustainability in care.