bluuebunny/crossref_metadata_2025_split huggingface dataset:
A unified multi-level model approach to assessing patient responsiveness including; return to normal, minimally important differences and minimal clinically important improvement for patient reported outcome measures
Authors: Sayers Adrian , Wylde Vikki , Lenguerrand Erik , Gooberman-Hill Rachael , Dawson Jill , Beard David , Price Andrew , Blom Ashley W 
Published: July 2017

ObjectiveThis article reviews and compares four commonly used approaches to assess patient responsiveness with a treatment or therapy (return to normal (RTN), minimal important difference (MID), minimal clinically important improvement (MCII), OMERACT-OARSI [Outcome Measures in Rheumatology—Osteoarthris Reseach Society International] (OO)) and demonstrates how each of the methods can be formulated in a multilevel modelling (MLM) framework.DesignCohort study.SettingA cohort of patients undergoing total hip and knee replacement were recruited from a single UK National Health Service hospital.Population400 patients from the Arthroplasty Pain Experience cohort study undergoing total hip (n=210) and knee (n=190) replacement who completed the Intermittent and Constant Osteoarthritis Pain questionnaire prior to surgery and then at 3, 6 and 12 months after surgery.Primary outcomesThe primary outcome was defined as a response to treatment following total hip or knee replacement. We compared baseline scores, change scores and proportion of individuals defined as ‘responders’ using traditional and MLM approaches with patient responsiveness.ResultsUsing existing approaches, baseline and change scores are underestimated, and the variance of baseline and change scores overestimated in comparison with MLM approaches. MLM increases the proportion of individuals defined as responding in RTN, MID and OO criteria compared with existing approaches. Using MLM with the MCII criteria reduces the number of individuals identified as responders.ConclusionMLM improves the estimation of the SD of baseline and change scores by explicitly incorporating measurement error into the model and avoiding regression to the mean when making individual predictions. Using refined definitions of responsiveness may lead to a reduction in misclassification when attempting to predict who does and does not respond to an intervention and clarifies the similarities between existing methods.
Exploring the relationship between frequent internet use and health and social care resource use in a community-based cohort of older adults: an observational study in primary care
Authors: Clarke Caroline S , Round Jeff , Morris Stephen , Kharicha Kalpa , Ford John , Manthorpe Jill , Iliffe Steve , Goodman Claire , Walters Kate 
Published: July 2017

ObjectivesGiven many countries’ ageing populations, policymakers must consider how to mitigate or reduce health problems associated with old age, within budgetary constraints. Evidence of use of digital technology in delaying the onset of illness and reducing healthcare service use is mixed, with no clear consensus as yet. Our aim was to investigate the relationship between frequent internet use and patterns of health or social care resource use in primary care attendees who took part in a study seeking to improve the health of older adults.MethodsParticipants recruited from primary care, aged >65 and living in semirural or urban areas in the south of England, were followed up at 3 and 6 months after completing a comprehensive questionnaire with personalised feedback on their health and well-being. We performed logistic regression analyses to investigate relationships between frequent internet use and patterns of service use, controlling for confounding factors, and clustering by general practitioner practice. Four categories of service use data were gathered: use of primary National Health Service (NHS) care; secondary NHS care; other community health and social care services; and assistance with washing, shopping and meals.ResultsOur results show, in this relatively healthy population, a positive relationship (OR 1.72, 95% CI 1.33 to 2.23) between frequent internet use and use of any other community-based health services (physiotherapist, osteopath/chiropractor, dentist, optician/optometrist, counselling service, smoking cessation service, chiropodist/podiatrist, emergency services, other non-specific health services) and no relationship with the other types of care. No causal relationship can be postulated due to the study’s design.ConclusionsNo observed relationship between frequent internet use and primary or secondary care use was found, suggesting that older adults without internet access are not disadvantaged regarding healthcare use. Further research should explore how older people use the internet to access healthcare and the impact on health.
A 3D navigation template for guiding a unilateral lumbar pedicle screw with contralateral translaminar facet screw fixation: a study protocol for multicentre randomised controlled trials
Authors: Shao Zhen-Xuan , He Wei , He Shao-Qi , Lin Sheng-Lei , Huang Zhe-Yu , Tang Hong-Chao , Ni Wen-Fei , Wang Xiang-Yang , Wu Ai-Min 
Published: July 2017

IntroductionThe incidence of lumbar disc degeneration disease has increased in recent years. Lumbar interbody fusion using two unilateral pedicle screws and a translaminar facet screw fixation has advantages of minimal invasiveness and lower costs compared with the traditional methods. Moreover, a method guided by a three-dimensional (3D) navigation template may help us improve the surgical accuracy and the success rate. This is the first randomised study using a 3D navigation template to guide a unilateral lumbar pedicle screw with contralateral translaminar facet screw fixation.Methods and analysisPatients who meet the criteria of the surgery will be randomly divided into experimental groups and control groups by a computer-generated randomisation schedule. We will preoperatively design an individual 3D navigation template using CATIA software and MeditoolCreate. The following primary outcomes will be collected: screw angles compared with the optimal screw trajectories in 3D digital images, length of the wound incision, operative time, intraoperative blood loss and complications. The following secondary outcomes will be collected: visual analogue scale (VAS) for back pain, VAS for leg pain and the Oswestry Disability Index. These parameters will be evaluated on day 1 and then 3, 6, 12 and 24 months postoperatively.Ethics and disseminationThe study has been reviewed and approved by the institutional ethics review board of the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University. The results will be presented at scientific communities and peer-reviewed journals.Trial registration numberChiCTR-IDR-17010466
Influences on university students’ intention to receive recommended vaccines: a cross-sectional survey
Authors: Landowska Kate , Waller Jo , Bedford Helen , Rockliffe Lauren , Forster Alice S 
Published: July 2017

ObjectivesTo explore predictors of university students’ intention to receive a recommended vaccine and the main sources of vaccine-related information accessed by university students.SettingParticipants were recruited from University College London (UK) in summer 2015.Participants177 university students participated. The majority of participants were female (58%), White (68%) and had no religion (58%). Participants were aged 18 to 42 (mean age=23.6).Primary and secondary outcome measuresPrimary outcome measures included vaccine attitude, perceived subjective norm, perceived behavioural control, perceived self-efficacy, past receipt of recommended childhood vaccines, perceived adverse reaction to past vaccination and needle fear. As a secondary outcome sources of vaccine-related information were assessed.ResultsStudents classified as high intenders were more likely to have received all recommended childhood vaccines (OR 3.57; 95% CI 1.21 to 10.59; p=0.022), be less afraid of needles (OR 2.44; 95% CI 1.12 to 5.36; p=0.026) and to have lived in the UK until at least the age of 4 compared with those not living in the UK until at least the age of 4 (OR 0.39; 95% CI 0.18 to 0.83; p=0.015) and those who lived both in the UK and elsewhere (OR 0.42; 95% CI 0.04 to 4.06; p=0.424). The multivariable model explained 25.5% of variance in intention to receive a recommended vaccine. The internet was the most commonly reported source of vaccination information.ConclusionsFindings provide an indication of the factors that may need to be addressed by interventions aiming to increase uptake of recommended vaccines in a university population. Future research is recommended using a prospective cohort design.
Impact of the Diurnal Radiation Cycle on Secondary Eyewall Formation
Authors: Tang Xiaodong , Tan Zhe-Min , Fang Juan , Sun Y. Qiang , Zhang Fuqing 
Published: July 2017

AbstractThe sensitivity of the secondary eyewall formation (SEF) of Hurricane Edouard (2014) to the diurnal solar insolation cycle is examined with convection-permitting simulations. A control run with a real diurnal radiation cycle and a sensitivity experiment without solar insolation are conducted. In the control run, there is an area of relatively weak convection between the outer rainbands and the primary eyewall, that is, a moat region. This area is highly sensitive to solar shortwave radiative heating, mostly in the mid- to upper levels in the daytime, which leads to a net stabilization effect and suppresses convective development. Moreover, the heated surface air weakens the wind-induced surface heat exchange (WISHE) feedback between the surface fluxes (that promote convection) and convective heating (that feeds into the secondary circulation and then the tangential wind). Consequently, a typical SEF with a clear moat follows. In the sensitivity experiment, in contrast, net radiative cooling leads to persistent active inner rainbands between the primary eyewall and outer rainbands, and these, along with the absence of the rapid filamentation zone, are detrimental to moat formation and thus to SEF. Sawyer–Eliassen diagnoses further suggest that the radiation-induced difference in diabatic heating is more important than the vortex wind structure for moat formation and SEF. These results suggest that the SEF is highly sensitive to solar insolation.
Understanding the Time Scales of the Tropospheric Circulation Response to Abrupt CO2 Forcing in the Southern Hemisphere: Seasonality and the Role of the Stratosphere
Authors: Grise Kevin M. , Polvani Lorenzo M. 
Published: July 2017

This study examines the time scales of the Southern Hemisphere (SH) tropospheric circulation response to increasing atmospheric CO2 concentrations in models from phase 5 of the Coupled Model Intercomparison Project (CMIP5). In response to an abrupt quadrupling of atmospheric CO2, the midlatitude jet stream and poleward edge of the Hadley circulation shift poleward on the time scale of the rising global-mean surface temperature during the summer and fall seasons but on a much more rapid time scale during the winter and spring seasons. The seasonally varying time scales of the SH circulation response are closely tied to the meridional temperature gradient in the upper troposphere–lower stratosphere and, in particular, to temperatures in the SH polar lower stratosphere. During summer and fall, SH polar lower-stratospheric temperatures cool on the time scale of warming global surface temperatures, as the lifting of the tropopause height with tropospheric warming is associated with cooling at lower-stratospheric levels. However, during winter and spring, SH polar lower-stratospheric temperatures cool primarily from fast time-scale radiative processes, contributing to the faster time-scale circulation response during these seasons. The poleward edge of the SH subtropical dry zone shifts poleward on the time scale of the rising global-mean surface temperature during all seasons in response to an abrupt quadrupling of atmospheric CO2. The dry zone edge initially follows the poleward shift in the Hadley cell edge but is then augmented by the action of eddy moisture fluxes in a warming climate. Consequently, with increasing atmospheric CO2 concentrations, key features of the tropospheric circulation response could emerge sooner than features more closely tied to rising global temperatures.
Large-Scale Forcing of the Amundsen Sea Low and Its Influence on Sea Ice and West Antarctic Temperature
Authors: Clem Kyle R. , Renwick James A. , McGregor James 
Published: July 2017

Abstract
Using empirical orthogonal function (EOF) analysis and atmospheric reanalyses, the principal patterns of seasonal West Antarctic surface air temperature (SAT) and their connection to sea ice and the Amundsen Sea low (ASL) are examined. During austral summer, the leading EOF (EOF1) explains 35% of West Antarctic SAT variability and consists of a widespread SAT anomaly over the continent linked to persistent sea ice concentration anomalies over the Ross and Amundsen Seas from the previous spring. Outside of summer, EOF1 (explaining ~40%–50% of the variability) consists of an east–west dipole over the continent with SAT anomalies over the Antarctic Peninsula opposite those over western West Antarctica. The dipole is tied to variability in the southern annular mode (SAM) and in-phase El Niño–Southern Oscillation (ENSO)/SAM combinations that influence the depth of the ASL over the central Amundsen Sea (near 105°W). The second EOF (EOF2) during autumn, winter, and spring (explaining ~15%–20% of the variability) consists of a dipole shifted approximately 30° west of EOF1 with a widespread SAT anomaly over the continent. During winter and spring, EOF2 is closely tied to variability in ENSO and a tropically forced wave train that influences the ASL in the western Amundsen/eastern Ross Seas (near 135°W) with an opposite-sign circulation anomaly over the Weddell Sea; the ENSO-related circulation brings anomalous thermal advection deep onto the continent. The authors conclude that the ENSO-only circulation pattern is associated with SAT variability across interior West Antarctica, especially during winter and spring, whereas the SAM circulation pattern is associated with an SAT dipole over the continent.
Appropriateness of Tympanostomy Tubes in the Boston Metropolitan Area: Are the AAO‐HNSF Guidelines Being Met?
Authors: Hughes Amy L. , Roberson David , Bannos Cassandra , Trudell Emily K. , Vernacchio Louis 
Published: July 2017

IntroductionOtitis media (OM) is the most common reason children receive general anesthesia, with bilateral tympanostomy tube (TT) insertion the second most common surgery in children. Prior research suggests overuse of TT. As part of a project designed to improve appropriateness of OM referrals, we evaluated appropriateness of TT insertion in a patient cohort.MethodsPatients younger than 9 years with initial otolaryngology (ORL) visits in academic and private office settings for OM from January 1, 2012, to August 31, 2013, were identified through claims database. A detailed retrospective chart review of patients undergoing TT insertion was performed to determine appropriateness of TT insertion per the 2013 American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO‐HNSF) guidelines.ResultsA total of 120 patients undergoing TT insertion were randomly chosen for detailed chart review; 32 patients were excluded. Sixty‐six (75%) of 88 patients available for analysis met AAO‐HNSF guidelines for TT. Recurrent acute OM with middle ear effusion was the most common indication (56%). Other indications included chronic OME and TT in at‐risk patients with speech, learning, or behavioral delays. Of the 22 patients undergoing TT insertion not meeting AAO‐HNSF guidelines, 11(50%) had abnormal exams, but were 1 to 2 infections short of meeting guidelines; 7 (33%) had normal exams but met criteria for number of infections.DiscussionContrary to prior publications, 75% of patients undergoing TT insertion had an appropriate indication per AAO‐HNSF guidelines. In only 5% was TT insertion a substantial departure from guidelines.Implications for PracticeThe study outcomes suggest appropriate clinical decision making, improved guideline adherence, and better guideline applicability from the previously published 1994 and 2004 guidelines.
Psychiatric Hospital Workers’ Exposure to Disturbing Patient Behavior and Its Relation to Post-Traumatic Stress Disorder Symptoms
Authors: Hilton N. Zoe , Ham Elke , Dretzkat Alecia 
Published: July 2017

Background About 10% of health-care workers experience post-traumatic stress disorder (PTSD); the rate is higher among workers exposed to aggression. Objective We extended this research by examining PTSD and exposure to violence and other disturbing patient behaviors, among nursing and other staff on inpatient psychiatric units (forensic and nonforensic). Method Surveys were completed online or in person by 219 respondents (30% response rate). Participants indicated which disturbing behaviors they had been exposed to and ranked the worst three behaviors in each of three categories: most unpleasant to work with, most disruptive to patient care, and most upsetting. Most ( n = 192) also completed the PTSD Checklist (PCL). Results All but two participants reported exposure to at least one disturbing behavior and ranked violence, feces smearing, and screaming constantly as the worst experiences overall. On the PCL, 24% scored above the cut off for probable PTSD. Nursing staff had the highest scores, with no difference between nursing staff on forensic versus nonforensic units. PCL score showed a small positive correlation with the number of disturbing behaviors experienced. Conclusion PTSD symptoms are common among psychiatric hospital workers, not only nursing staff. Future research using clinical assessment, longitudinal designs, and measurement of nonviolent disturbing behaviors is recommended.
Bioabsorbable Versus Metal Screw in the Fixation of Tibial Tubercle Transfer: A Cadaveric Biomechanical Study
Authors: Nurmi Janne T. , Itälä Ari , Sihvonen Raine , Sillanpää Petri , Kannus Pekka , Sievänen Harri , Järvinen Teppo L.N. 
Published: July 2017

Background: In tibial tubercle transfer (TTT) procedures, the osteotomized and transferred tibial tubercle is usually fixed into the host bone using metal screws. Purpose: To compare the strength of fixation provided by a single bioabsorbable screw versus a metal screw for TTT. Study Design: Controlled laboratory study. Methods: Twenty-two pairs of human cadaveric tibiae were used to compare the fixation strength of a single 4.5-mm bicortical bioabsorbable or metal screw for TTT. In our 2-phase biomechanical testing protocol, the specimens were first subjected to a cyclic-loading test (1500 loading cycles between 50 and 300 N at 0.5 Hz frequency), after which they were loaded to failure (single-cycle load-to-failure test). To control for possible differences in bone quality, volumetric bone mineral density was determined using peripheral quantitative computed tomography. Results: No significant displacement differences were observed between the 2 groups for the cyclic-loading test. In the subsequent single-cycle load-to-failure test, the mean yield load was 566 ± 234 N in the bioabsorbable screw group and 984 ± 630 N in the metal screw group ( P = .002). The failure mode of bioabsorbable screws was breakage and/or bending, and that of metal screws was bending and/or pull-out. Bone density was similar in the 2 groups. Conclusion: A metal screw seems to provide greater fixation strength than a biodegradable screw in the TTT of a human cadaveric knee. However, considering the maximum quadriceps pull in vivo, the strength of fixation provided by a biodegradable screw seems clinically sufficient. Clinical Relevance: Bioabsorbable screws, particularly if used in duplicate, could provide a viable option for metal screws in TTT fixation.
Development of a Prediction Model for Stress Fracture During an Intensive Physical Training Program: The Royal Marines Commandos
Authors: Sanchez-Santos Maria T. , Davey Trish , Leyland Kirsten M. , Allsopp Adrian J. , Lanham-New Susan A. , Judge Andrew , Arden Nigel K. , Fallowfield Joanne L. 
Published: July 2017

Background: Stress fractures (SFs) are one of the more severe overuse injuries in military training, and therefore, knowledge of potential risk factors is needed to assist in developing mitigating strategies. Purpose: To develop a prediction model for risk of SF in Royal Marines (RM) recruits during an arduous military training program. Study Design: Case-control study; Level of evidence, 3. Methods: RM recruits (N = 1082; age range, 16-33 years) who enrolled between September 2009 and July 2010 were prospectively followed through the 32-week RM training program. SF diagnosis was confirmed from a positive radiograph or magnetic resonance imaging scan. Potential risk factors assessed at week 1 included recruit characteristics, anthropometric assessment, dietary supplement use, lifestyle habits, fitness assessment, blood samples, 25(OH)D, bone strength as measured by heel broadband ultrasound attention, history of physical activity, and previous and current food intake. A logistic least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation was used to select potential predictors among 47 candidate variables. Model performance was assessed using measures of discrimination (c-index) and calibration. Bootstrapping was used for internal validation of the developed model and to quantify optimism. Results: A total of 86 (8%) volunteer recruits presented at least 1 SF during training. Twelve variables were identified as the most important risk factors of SF. Variables strongly associated with SF were age, body weight, pretraining weightbearing exercise, pretraining cycling, and childhood intake of milk and milk products. The c-index for the prediction model, which represents the model performance in future volunteers, was 0.73 (optimism-corrected c-index, 0.68). Although 25(OH)D and VO2max had only a borderline statistically significant association with SF, the inclusion of these factors improved the performance of the model. Conclusion: These findings will assist in identifying recruits at greater risk of SF during training and will support interventions to mitigate this injury risk. However, external validation of the model is still required.