bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serum Lactate Albumin Ratio as a Predictor of Mortality in Severe Sepsis and Septic Shock at Tribhuwan University Teaching Hospital, Kathmandu
Authors: Thapa Sameer , Prasad PN , Shakya YM 
Published: November 2017

IntroductionSevere sepsis and septic shock, is a common cause of emergency room admission and is associated with high morbidity and mortality worldwide. This study inspects the prediction of mortality in severe sepsis and septic shock with increased lactate/albumin ratio.Objective The objective of the study was to predict the serum lactate albumin ratio as an indicator of mortality in severe sepsis and septic shock.MethodologyIt was a hospital based cross sectional study done at Tribhuvan University Teaching Hospital, Kathmandu from November 2015 to October 2016. The consent was taken from patients. Acute Physiology and Chronic Health Evaluation II score, serum lactate and serum albumin levels on first day of arrival in emergency room were calculated. Patients were classified as severe sepsis and septic shock and treated according to Surviving Sepsis Campaign 2012 guideline. The patient were follow up at 28 day, The associations of 28-day outcome with Acute Physiology and Chronic Health Evaluation II score, serum lactate value, serum albumin value and serum lactate albumin ratio value were derived.ResultsOut of total 240 severe sepsis and septic shock patients it is found that increased serum lactate/albumin ratio was an independent predictor of the mortality with cut off value of 0.07. Furthermore serum lactate albumin ratio shows strong correlation with APACHE 2 score in predicting mortality in severe sepsis and septic shock.ConclusionIncreased lactate/albumin ratio predicts mortality in patients with severe sepsis and septic shock. Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 191-195
Internal and external hazards inside the containment in case of an emergency situation
Authors: Abdelhady A. 
Published: November 2017

Abstract
The objective of this paper is to estimating radionuclide concentrations in air and radiological dose consequences to indoor workers in a containment of MTR open pool type reactor during emergency situations. A postulated core degradation accident causes fission products to release and the ventilation system will be converted automatically from the normal situation into emergency situation in order to purify the contaminated air by forcing it to pass through a group of filters. The study computes internal and external worker doses from inhalation and submersion in a finite cloud of contaminated air during the emergency mode. A radiological toolbox version 2 was used to evaluate the radiation dose levels inside the containment.
Recent fluctuations of the Dry Valleys glaciers, McMurdo Sound, Antarctica
Authors: Chinn T.J. 
Published: November 2017

The state of equilibrium of the frontal positions of the glaciers of the Dry Valleys area of McMurdo Sound, Antarctica, has heen a subject of speculation since the) were fu si seen. A programme to measure the changes in frontal positions of 12 ice-cliffed glaciers has been maintained since 1982-83, with a 30 year record for Mcscrve Glacier. Simple taped distances from fixed points to the fronts of the glaciers have demonstrated that, in proportion to their flow and ablation regimes which are two orders of magnitude slower than those of temperate glaciers, the glaciers are fluctuating as dynamically as do temperate glaciers. Maximum advance or recession rates have been found to be near ±1 m a−1, changes which are almost undetectable in comparative photographs. Recession was found to be the dominant change trend, with yearly variations reflecting changes in annual ablation.The total height of the ice cliff gives a ready estimation of glacier equilibrium, with cliff heights being greatest on advancing glaciers. The division between advancing and receding glaciers was found to be at a cliff height of about 25 m.
Modelling the long-term response of the Antarctic ice sheet to global
warming
Authors: Warner Roland C. , Budd W.Κ. 
Published: November 2017

The primary effects of global warming on the Antarctic ice sheet can involve
increases in surface melt for limited areas at lower elevations, increases in net
accumulation, and increased basal melting under floating ice. For moderate global
wanning, resulting in ocean temperature increases of a few °C, the
large- increase in basal melting can become the dominant factor in
the long-term response of the ice sheet. The results from
ice-sheet modelling show that the increased basal melt rates lead to a reduction
of the ice shelves, increased strain rates and flow at the grounding lines, then
thinning and floating of the marine ice sheets, with consequential further basal
melting.
The mass loss from basal melting is counteracted to some extent by the
increased accumulation, but in the long term the area of ice cover decreases,
particularly in West Antarctica, and the mass loss can dominate. The ice-sheet
ice-shelf model of Budd and others (1994) with 20 km resolution has been modified
and used to carry out a number of sensitivity studies of the long-term response of
the ice sheet to prescribed amounts of global warming. The changes in the ice
sheet are computed out to near-equilibrium, but most of the changes take place
with in the first lew thousand years. For a global mean temperature increase of
3°C with an ice-shelf basal melt rate of 5 m a−1 the ice
shelves disappear with in the first few hundred years, and the marine-based parts
of the ice sheet thin and retreat. By 2000 years the West Antarctic region is
reduced to a number of small, isolated ice caps based on the bedrock regions which
are near or above sea level. This allows the warmer surface ocean water to
circulate through the archipelago in summer, causing a large change to the local
climate of the region.
Preliminary investigation of palaeoclimate signals recorded in the ice core
from Dome Fuji station, east Dronning Maud Land, Antarctica
Authors:   Dome-F Ice Core Research
                  Group
Published: November 2017

ABSTRACT
An ice core to 2503.52 m depth was drilled during 1995 and 1996 at
77°19′01″S, 39°42′12″ E (3810 m a.s.l.), at the summit of Dome Fuji, East
Antarctica. Climatic and environmental conditions were observed at the coring site
throughout the 2 years of wintering operation. Meteorological and glaciological
observations made clear the present surface processes of mass balance. The
chemistry of the surface snow layers was observed for investigation of the
atmospheric environment reflected in snow deposits.
Core analyses have been carried out in Japan. Permeability and density
measurements show that air bubbles are completely closed off by densification
processes at about 98 m depth. The vertical profile of
δ
18O suggests that the core covers two warm stages and one
cold stage from the surface down to 1800 m depth. The transition from the cold to
the warm period affects the vertical distribution of ice-crystal size. The
chemical constituents in the ice core show large differences between warm and cold
periods. A depth–age relationship is presented and a study made of palaeoclimatic
and core signals.
Chemical and isotopic profiles from snow pits and shallow firn cores on
Campbell Glacier, northern Victoria Land, Antarctica
Authors: Gragnani R. , Smiraglia C. , Stenni B. , Torcini S. 
Published: November 2017

The chemical (Na+, K+,
Mg2+, Ca2+,
CH3SO3
− (MSA), Cl− , NO3
− , SO4
2-) and isotopic (δl8O) composition of
snow and firn samples from Campbell Glacier, northern Victoria Land, Antarctica,
was studied to evaluate the accumulation rate of snow and to investigate the
chemical contribution from some emission sources (marine biogenic activity, sea
and crust). During the 1994-95 Italian Antarctic Expedition, snow and firn were
collected from snow pits and from cores obtained from drilling at three sites (A:
74°41'S, 164°30' E; B: 74°15' S, 164° '04' E; C: 73°45' S, 163°20' E), located ai
50 m (on the floating glacier tongue), 800 m and 1580 m a.s.l.,
respectively.
The mean concentration of sea salt decreased with increasing distance from
the coast and with altitude. Generally, the
Na+/K+ and
Na+/Ca2+ ratios were much lower than
the bulk sea-water ratios at sites B and C. The MSA showed mean concentrations
(0.27 and 0.17 ¿teq 1 at sites B and C, respectively) consistent with data
obtained from other Antarctic sites. The mean concentrations of
NO3 ranged from 2.1 μeq 1−1 (site A)
to 0.97 μeq1 1 (site C).The mean nss (non-sea-salt)
SO4
2-/SO4
2- ratio was -0.055,0.54 and 0.42 at sites A, B and C,
respectively. Moreover, the relationship between a2+,
nssCa2+, SO4
2- and nssSO4 was quite different at
sites B and C. in order to expla in the relationships between the elements and
compounds studied at these sites, chemical fractionation and/or reactions inside
air masses and différent origin of the air masses at the two sites should be
considered.
A comparison of the isotopic and chemical profiles was carried out in order
to provide a more reliable chronological scale. The chemical and
δ18O seasonal variations recorded along the firn cores
from the upper site of Campbell Glacier seem to be fairly homogeneous. This made
it possible to identify many annual cycles (14-18 years for the 7 m firn core).
Using the measured density values, the accumulation rale was also calculated for
lower and upper Campbell Glacier. It did not appear to differ between the two
sites (150-170 kg m −2a−1 at site B and
140-180 kg m−2a−1at site C) and is in
keeping with rates calculated previously for the same area.
On the improvement of sea-ice models for climate simulations:
the Sea Ice Model Intercomparison Project
Authors: Lemke Peter , Hibler W.D. , Flato G. , Harder M. , Kreyscher M. 
Published: November 2017

Experiments with dynamic thermodynamic sea-ice models indicate a strong
dependence of the net freezing rate, sea-ice transport and variability on
dynamic model parameters. Although current dynamic—thermodynamic sea-ice
models show relatively good agreement with observations, an optimization
seems to be necessary, especially for the parameterizations of dynamic
processes.Presently, only a few coupled climate models use dynamic-thermodynamic
sea-ice models. In order to promote, by means of coordinated numerical
experiments, the development of an optimal sea-ice model for climate
research, the Sea Ice Ocean Modelling Panel of the Arctic Climate System
Study (ACSYS, a project of the World Climate Research Programme has
initiated the Sea Ice Model Intercomparison Project (SIMIP). The first
results from this model hierarchy approach are presented.
Determination of a melt-onset date for Arctic sea-ice regions
using passive-microwave data
Authors: Anderson Mark R. 
Published: November 2017

Although the formation and melt of sea ice are primarily functions of the
annual radiation cycle, atmospheric sensible-heat forcing does serve to
delay or advance the timing of such events. Additionally, if atmospheric
conditions in the Arctic were to vary due to climate change it may have
significant influence on ice conditions. Therefore, this paper investigates
a methodology to determine melt-onset dale distribution, both spatially and
temporally, in the Arctic Ocean and surrounding sea-ice covered regions.Melt determination is made by a threshold technique using the spectral
signatures of the horizontal brightness temperatures (19 GHz horizontal
channel minus the 37 GHz horizontal channel) obtained from the Special
Sensor Microwave Imager (SSM/I) passive-microwave sensor. Passive-microwave
observations are used to identify melt because of the large increase in
emissivity that occurs when liquid water is present. Emissivity variations
are observed in the brightness temperatures due to the different scattering,
absorption and penetration depths of the snowpack from the available
satellite channels during melt. Monitoring the variations in the brightness
temperatures allows the determination of melt-onset dates.Analysis of daily brightness temperature data allows spatial variations in
the date of the snow inch onset for sea ice to be detected. Since the data
are gridded on a daily basis, a climatology of daily melt-onset dates can be
produced for the Arctic region. From this climatology, progression of melt
can be obtained and compared inter-annually.
On the potential use of glacier and permafrost observations for
verification of climate models
Authors: Beniston Martin , Haeberli Wilfried , Hoelzle Martin , Taylor Alan 
Published: November 2017

While the capability of global and regional climate models in reproducing
current climate has significantly improved over the past few years, the
confidence in model results for remote regions, or those where complex
orography is a dominant feature, is still relatively low. This is, in part,
linked to the lack of observational data for model verification and
intercomparison purposes.Glacier and permafrost observations are directly related to past and present
energy flux patterns at the Earth-atmosphere interface and could be used as
a proxy for air temperature and precipitation, particularly of value in
remote mountain regions and boreal and Arctic zones where instrumental
climate records are sparse or non-existent. It is particularly important to
verify climate-model performance in these regions, as this is where most
general circulation models (GCMs) predict the greatest changes in air
temperatures in a warmer global climate.Existing datasets from glacier and permafrost monitoring sites in remote and
high altitudes are described in this paper; the data could be used in
model-verification studies, as a means to improving model performance in
these regions.
Effects of Amerindian Genetic Ancestry on Clinical Variables and Therapy in Patients with Rheumatoid Arthritis
Authors: Sánchez Elena , García de la Torre Ignacio , Sacnún Mónica , Goñi Mario , Berbotto Guillermo , Paira Sergio , Musuruana Jorge Luis , Graf César , Alvarellos Alejandro , Messina Osvaldo D. , Babini Alejandra , Strusberg Ingrid , Marcos Juan Carlos , Scherbarth Hugo , Spindler Alberto , Quinteros Ana , Toloza Sergio , Moreno José Luis C. , Catoggio Luis J. , Tate Guillermo , Eimon Alicia , Citera Gustavo , Pellet Antonio Catalán , Nasswetter Gustavo , Cardiel Mario H. , Miranda Pedro , Ballesteros Francisco , Esquivel-Valerio Jorge A. , Maradiaga-Ceceña Marco A. , Acevedo-Vásquez Eduardo M. , García Conrado García , Tusié-Luna Teresa , Pons-Estel Bernardo A. , Alarcón-Riquelme Marta E. ,   the GENAR Study
Published: November 2017

Objective.To define whether Amerindian genetic ancestry correlates with clinical and therapeutic variables in admixed individuals with rheumatoid arthritis (RA) from Latin America.Methods.Patients with RA (n = 1347) and healthy controls (n = 1012) from Argentina, Mexico, Chile, and Peru were included. Samples were genotyped for the Immunochip v1 using the Illumina platform. Clinical data were obtained through interviews or the clinical history.Results.Percentage of Amerindian ancestry was comparable between cases and controls. Morning stiffness (p < 0.0001, OR 0.05), rheumatoid factor (RF; p < 0.0001, OR 0.22), radiographic changes (p < 0.0001, OR 0.05), and higher number of criteria were associated with lower Amerindian ancestry after Bonferroni correction. Higher Amerindian ancestry correlated only with weight loss (pBonferroni < 0.0001, OR 2.85). Increased Amerindian ancestry correlated with higher doses of azathioprine (p < 0.0001, OR 163.6) and sulfasalazine (p < 0.0001, OR 48.6), and inversely with methotrexate (p = 0.001, OR 0.35), leflunomide (p = 0.001, OR 0.16), and nonsteroidal antiinflammatory drugs (pBonferroni = 0.001, OR 0.37). Only the presence of RF and weight loss were modified after confounders adjustment.Conclusion.Amerindian ancestry protects against most major clinical criteria of RA, but regarding the association of RF with increased European ancestry, age, sex, and smoking are modifiers. Ancestry also correlates with the therapeutic profiles.
Limited Exercise Capacity in Patients with Systemic Sclerosis: Identifying Contributing Factors with Cardiopulmonary Exercise Testing
Authors: Martis Nihal , Queyrel-Moranne Viviane , Launay David , Neviere Rémi , Fuzibet Jean-Gabriel , Marquette Charles-Hugo , Leroy Sylvie 
Published: November 2017

Objective.Exercise limitation in patients with systemic sclerosis (SSc) is often multifactorial and related to complications such as interstitial lung disease (ILD), pulmonary vasculopathy (PV), left ventricular dysfunction (LVD), and/or peripheral/muscular limitation (PML). We hypothesized that cardiopulmonary exercise testing (CPET) could not only suggest and rank competing etiologies, but also highlight peripheral impairment.Methods.Clinical, resting pulmonary function testing, and CPET data from patients with SSc referred for exercise limitation between October 2009 and November 2015 were retrospectively analyzed in this bi-center study. Patients were categorized as having ILD, PV, LVD, and/or PML based on CPET response patterns and the diagnoses were matched with results from the reference investigations. The latter consisted of transthoracic echocardiography, chest computed tomography scan, and right heart catheterization (RHC).Results.Twenty-seven patients presented with CPET profiles consistent with ILD (n = 16), PV (n = 15), LVD (n = 5), and PML (n = 19). None of the subjects had a normal CPET profile. There was a statistically significant negative correlation between resting DLCO, on the one hand, and dead space to tidal volume ratio and alveolar–arterial gradient [P(Ai-a)O2] on the other (p < 0.005). CPET identified 90% of patients with a mean pulmonary arterial pressure at rest ≥ 21 mmHg measured by RHC (n = 10). Peak P(Ai-a)O2, taken independently from other variables, was crucial in distinguishing subjects with ILD from those without ILD (p < 0.05).Conclusion.CPET is useful for the characterization of multifactorial exercise limitation in patients with SSc and in identifying SSc-related complications such as ILD and PV. This study also identifies PML as an underestimated cause of exercise limitation.
Improving Access to Rheumatologists: Use and Benefits of an Electronic Consultation Service
Authors: Rostom Krista , Smith C. Douglas , Liddy Clare , Afkham Amir , Keely Erin 
Published: November 2017

Objective.To describe the use and benefits of an innovative eConsult service to improve access to rheumatologists.Methods.There were 225 eConsults directed to rheumatology that were categorized by type of question and effect on face-to-face referral rates.Results.The median response time by the rheumatologists was 1.9 days. Clinical questions included drug treatment (34%), diagnosis (26%), or management (14%). Osteoporosis was the most common diagnosis (22%), followed by pain in multiple joints (11%), and polyarthritis (10%). A face-to-face referral was avoided in 38% of cases.Conclusion.There are clinical questions that can be answered quickly by an eConsult, improving access to rheumatologists.
Nodular Regenerative Hyperplasia of the Liver: A Rare Vascular Complication in Systemic Sclerosis
Authors: Graf Laura , Dobrota Rucsandra , Jordan Suzana , Wildi Lukas Martin , Distler Oliver , Maurer Britta 
Published: November 2017

Objective.To investigate nodular regenerative hyperplasia (NRH) as a vascular complication of systemic sclerosis (SSc) with microvasculopathy as a common denominator.Methods.Cases of SSc-NRH were identified by systematic literature review and by screening the Zurich cohort. NRH had to be diagnosed by liver biopsy.Results.Literature review retrieved 22 cases. In our cohort, 1.4% of patients with SSc were diagnosed with NRH. Most had vasculopathy, were positive for anticentromere antibodies, had elevated alkaline phosphatase and gamma-glutamyl transferase levels, normal liver morphology on ultrasound yet increased stiffness on ultrasound elastography, and had portal hypertension.Conclusion.NRH might represent a rare yet potentially life-threatening vascular complication in SSc.
Is Facebook a Suitable Tool in Modern World Technology for Active Learning in as Regards 21st Century Learning?
Authors: Thinnukool Orawit , Kongchouy Noodchanath 
Published: November 2017

The style of learning nowadays has been changed especially for students of Generation Z. The suitable technique for teaching courses needs to be adopted to improve the learning effectiveness of students. Technology in modern world affects student learning abilities especially in 21st century learning, which require students to learn by doing.
Tools and environment are aspects that can encourage students to have high learning efficiency. A powerful tool Facebook was used as a tool to support students’ learning. This study aims to research and test learning efficiency and student satisfaction in the course of rapid application development by setting two environments in the classroom. The experiment found that two environments had two different outcomes, which can suggest that setting up active learning environment in the classroom proves to be beneficial. Interesting results and implication for research are discussed.
Nur77 Is Upregulated in B-1a Cells by Chronic Self-Antigen Stimulation and Limits Generation of Natural IgM Plasma Cells
Authors: Huizar John , Tan Corey , Noviski Mark , Mueller James L , Zikherman Julie 
Published: November 2017

Abstract
B-1a cells are a unique population of innate-like B cells with a highly restricted and self-reactive BCR repertoire. Preimmune “natural” IgM produced by B-1a–derived plasma cells is essential for homeostatic clearance of cellular debris and forms a primary layer of protection against infection. In this study, we take advantage of a fluorescent reporter of BCR signaling to show that expression of the orphan nuclear hormone receptor Nur77 is upregulated under steady-state conditions in self-reactive B-1a cells in response to chronic Ag stimulation. Nur77-deficient mice exhibit elevated natural serum IgM (but not IgG) and marked expansion of IgM plasma cells of B-1a origin. Moreover, we show that Nur77 restrains the turnover of B-1a cells and the accumulation of immature IgM plasma cells. Thus, we identify a new critical negative-regulatory pathway that serves to maintain B-1a cells in a quiescent state in the face of chronic endogenous Ag stimulation.
Anthroposophic Therapy for Anxiety Disorders: A Two-year Prospective Cohort Study in Routine Outpatient Settings
Authors: Hamre Harald J. , Witt Claudia M. , Kienle Gunver S. , Glockmann Anja , Ziegler Renatus , Willich Stefan N. , Kiene Helmut 
Published: November 2017

Background and Methods Anthroposophic treatment for anxiety disorders includes special artistic and physical therapies and special medications. We conducted a prospective cohort study of 64 consecutive adult outpatients starting anthroposophic treatment for anxiety disorders under routine conditions. Main outcomes were Anxiety Severity (physician and patient ratings 0–10), Self-rating Anxiety Scale (0–100), Center for Epidemiological Studies Depression Scale, German version (CES-D, 0–60), and SF-36 Mental Component Summary. Results Mean age was 42.3 years. Most frequent diagnoses were generalized anxiety disorder (44% of patients, n = 28/64) and panic disorder (39%). Median disease duration was 4.5 years. The anthroposophic treatment modalities used were medications (56% of patients), eurythmy therapy (41%), art therapy (30%), and rhythmical massage therapy (3%). Median number of eurythmy/art/massage sessions was 12, median therapy duration was 120 days. From baseline to six-month follow-up, all outcomes improved significantly; average improvements were: Physician-rated Anxiety Severity 3.60 points (95% confidence interval 2.97–4.22, p < 0.001), patient-rated Anxiety Severity 3.50 (2.88–4.12, p < 0.001), Self-rating Anxiety Scale 11.88 (7.70–16.05, p < 0.001), CES-D 8.79 (5.61–11.98, p < 0.001), and SF-36 Mental Component 9.53 (5.98–13.08, p < 0.001). All improvements were maintained until last follow-up after 24 months. Conclusions Patients with anxiety disorders under anthroposophic treatment had long-term improvements of symptoms and quality of life.