bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of prehospital triage and five-level triage system at the emergency department
Authors: Tsai Li-Heng , Huang Chien-Hsiung , Su Yi-Chia , Weng Yi-Ming , Chaou Chung-Hsien , Li Wen-Cheng , Kuo Chan-Wei , Ng Chip-Jin 
Published: July 2017

ObjectiveThere is lack of scientific evidence regarding the effectiveness of prehospital triage systems. This study compared the two-level Taiwan Prehospital Triage System (TPTS) with the five-level Taiwan Triage and Acuity Scale (TTAS) at ED arrival regarding the prediction of patient outcomes and the utilisation of medical resources.DesignThis was a retrospective cohort study. Adult patients transported via the emergency medical service (EMS), who arrived at the ED of a medical centre in northern Taiwan during the study period were enrolled. TTAS acuity levels 1–2 were considered comparable to the designation of ‘emergent’ by the prehospital TPTS system. The outcomes were analysed by comparing TPTS and TTAS by acuity levels.ResultsAmong 4430 enrolled patients, 25.2% and 74.8% were classified as emergent and non-emergent by TPTS; 44.1% and 55.9% were classified as levels 1–2 and levels 3–5 by TTAS. Of the TPTS emergent patients, 15.2% were classified as TTAS levels 3–5, whereas 30.4% of TPTS non-emergent transports were classified as TTAS levels 1–2 at the ED. TTAS levels 1–2 showed better predictability than TPTS emergent level for hospitalisation rate with a sensitivity of 70.3% (95% CI 68.3% to 72.2%) versus 41.1% (95% CI 39.0% to 43.2%), and a negative predictive value of 74.8% (95% CI 73.4% to 76.0%) versus 62.6% (95% CI 61.7% to 63.5%).ConclusionThe current prehospital triage system is insufficient and inappropriate in classifying patients transported to the ED. The present study offers supporting evidence for the introduction of a five-level triage system to prehospital EMS systems.
Ticagrelor Versus Aspirin in Acute Embolic Stroke of Undetermined Source
Authors: Amarenco Pierre , Albers Gregory W. , Denison Hans , Easton J. Donald , Evans Scott R. , Held Peter , Hill Michael D. , Jonasson Jenny , Kasner Scott E. , Ladenvall Per , Minematsu Kazuo , Molina Carlos A. , Wang Yongjun , Wong K.S. Lawrence , Johnston S. Claiborne 
Published: July 2017

Background and Purpose—
Ticagrelor is an effective antiplatelet therapy among patients with atherosclerotic disease and, therefore, could be more effective than aspirin in preventing recurrent stroke and cardiovascular events among patients with embolic stroke of unknown source (ESUS), which includes patients with ipsilateral stenosis <50% and aortic arch atherosclerosis.

Methods—
We randomized 13 199 patients with a noncardioembolic, nonsevere ischemic stroke or high-risk transient ischemic attack to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2–90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2–90) within 24 hours of symptom onset. In all patients, investigators informed on the presence of ipsilateral stenosis ≥50%, small deep infarct <15 mm, and on cardiac source of embolism detected after enrollment or rare causes, which allowed to construct an ESUS category in all other patients with documented brain infarction. The primary end point was the time to the occurrence of stroke, myocardial infarction, or death within 90 days.

Results—

ESUS was identified in 4329 (32.8%) patients. There was no treatment-by-ESUS category interaction (
P
=0.83). Hazard ratio in ESUS patients was 0.87 (95% confidence interval, 0.68–1.10;
P
=0.24). However, hazard ratio was 0.51 (95% confidence interval, 0.29–0.90;
P
=0.02) in ESUS patients with ipsilateral stenosis <50% or aortic arch atherosclerosis (n=961) and 0.98 (95% confidence interval, 0.76–1.27;
P
=0.89) in the remaining ESUS patients (n=3368;
P
for heterogeneity =0.04).

Conclusions—
In this post hoc, exploratory analysis, we found no treatment-by-ESUS category interaction. ESUS subgroups have heterogeneous response to treatment (Funded by AstraZeneca).

Clinical Trial Registration—

URL:
http://www.c
linicalt
rials.gov
. Unique identifier: NCT01994720.
Extended Reconstructed Sea Surface Temperature, Version 5 (ERSSTv5): Upgrades, Validations, and Intercomparisons
Authors: Huang Boyin , Thorne Peter W. , Banzon Viva F. , Boyer Tim , Chepurin Gennady , Lawrimore Jay H. , Menne Matthew J. , Smith Thomas M. , Vose Russell S. , Zhang Huai-Min 
Published: July 2017

Abstract
The monthly global 2° × 2° Extended Reconstructed Sea Surface Temperature (ERSST) has been revised and updated from version 4 to version 5. This update incorporates a new release of ICOADS release 3.0 (R3.0), a decade of near-surface data from Argo floats, and a new estimate of centennial sea ice from HadISST2. A number of choices in aspects of quality control, bias adjustment, and interpolation have been substantively revised. The resulting ERSST estimates have more realistic spatiotemporal variations, better representation of high-latitude SSTs, and ship SST biases are now calculated relative to more accurate buoy measurements, while the global long-term trend remains about the same. Progressive experiments have been undertaken to highlight the effects of each change in data source and analysis technique upon the final product. The reconstructed SST is systematically decreased by 0.077°C, as the reference data source is switched from ship SST in ERSSTv4 to modern buoy SST in ERSSTv5. Furthermore, high-latitude SSTs are decreased by 0.1°–0.2°C by using sea ice concentration from HadISST2 over HadISST1. Changes arising from remaining innovations are mostly important at small space and time scales, primarily having an impact where and when input observations are sparse. Cross validations and verifications with independent modern observations show that the updates incorporated in ERSSTv5 have improved the representation of spatial variability over the global oceans, the magnitude of El Niño and La Niña events, and the decadal nature of SST changes over 1930s–40s when observation instruments changed rapidly. Both long- (1900–2015) and short-term (2000–15) SST trends in ERSSTv5 remain significant as in ERSSTv4.
Age-related macular degeneration: what do patients find on the internet?
Authors: Rennie Christina A , Hannan Shabeeba , Maycock Nick , Kang Chee 
Published: July 2017

Objective To assess the quality of information and readability of the top internet sites for age-related macular degeneration (AMD). Design An examination of the technical information provision, quality and readability of websites found during an internet search for ‘age-related macular degeneration’. Setting Six internet search engines were used to find 26 unique sites on AMD. Main outcome measures Technical information and quality were assessed using a simple grading system. Readability was assessed using a Simple Measure Of Gobbledygook (SMOG) rating. Results Twelve organizational, seven academic and seven commercial sites were identified. The average technical scores were 82.3%, 67.9% and 65.2% for each type of site, respectively ( P=0.097, one way ANOVA). The average quality scores were 62.2%, 62.6%, and 49.5% for each type of site, respectively ( P=0.356, one-way ANOVA). The average SMOG ratings were 16.3, 16.1, and 16.2 for each type of site, respectively ( P=0.983, one-way ANOVA). Fifteen of the sites provided details of new and emerging treatments, with seven providing a detailed discussion. Conclusions Many websites are now meeting the challenge of providing comprehensive information about AMD and its new treatments. Quality scores were disappointing, with sites needing to provide more evidence of authorship and attribution of information. The majority of sites had SMOG scores above 10, making them difficult for the average person to understand. As physicians we need to help design and direct patients to sites that provide high quality, current information.
Pneumococcal meningitis post‐cochlear implantation: Potential routes of infection and pathophysiology
Authors: Wei Benjamin P.C. , Shepherd Robert K. , Robins‐Browne Roy M. , Clark Graeme M. , O'Leary Stephen J. 
Published: July 2017

ObjectiveThis review describes the current concept of pneumococcal meningitis in cochlear implant recipients based on recent laboratory studies. It examines possible routes of Streptococcus pneumoniae infection to the meninges in cochlear implant recipients. It also provides insights into fundamental questions concerning the pathophysiology of pneumococcal meningitis in implant recipients.Data SourcesMedline/PubMed database; English articles after 1960. Search terms: cochlear implants, meningitis, pneumococcus, streptococcus pneumonia.Review MethodsNarrative review. All articles relating to post‐implant meningitis without any restriction in study designs were assessed and information extracted.ResultsThe incidence of pneumococcal meningitis in cochlear implant recipients is greater than that of an age‐matched cohort in the general population. Based on the current clinical literature, it is difficult to determine whether cochlear implantation per se increases the risk of meningitis in subjects with no existing risk factors for acquiring the disease. As this question cannot be answered in humans, the study of implant‐related infection must involve the use of laboratory animals in order for the research findings to be applicable to a clinical situation. The laboratory research demonstrated the routes of infection and the effects of the cochlear implant in lowering the threshold for pneumococcal meningitis.ConclusionThe laboratory data complement the existing clinical data on the risk of pneumococcal meningitis post‐cochlear implantation.
The Holistic Approach to Development Research
Authors: Amini Amin 
Published: July 2017

While recognising the contribution of the traditional approaches and the vital role of the economic components of development, this article is an attempt to explore the need for a radical shift from partial understanding of development, as purely economic phenomena, to a comprehensive and integrated appreciation of development as a multidimensional socio-economic process. In an integrated system nothing can be clearly understood and analysed in isolation. Although components of the interconnected system have separate functions, their compositions, cooperative collectiveness, interrelations and interdependencies, that represent the characteristics of the whole, may not be studied and analysed in isolation and require a multidisciplinary or holistic approach. This paper will discuss a paradigm which considers the economic system as a subsystem of the complex social system. It will emphasise that development research must adopt a holistic approach which considers the political, social, cultural, environmental, religious, geographical, educational and economic dimensions of ecologically sustainable development. It will also argue that the present global conditions necessitate a paradigm shift to include social and moral in addition to economic dimension in development research and studies.
Meanings of Ownership of the Firm
Authors: Learmount Simon , Roberts John 
Published: July 2017

The notion of ‘ownership of the firm’ is central to conventional treatments of corporate governance, yet there is very little discussion about what this means in practice. In this paper we briefly draw attention to some of the debates around the notion of ownership in various disciplinary fields, and then recount and discuss some of the meanings associated with ownership of the firm that we have found in two empirical studies carried out in the UK and Japan. Our aim is to illuminate and disturb some of the commonly taken for granted notions of what it means to ‘own’ a firm. JEL Codes: G34, L20, L00
Ten Questions for Legal Scholars
Authors: Hsiung Bingyuan 
Published: July 2017

By raising and discussing ten questions, this paper attempts to continue the dialogue between economists and legal scholars. The questions examine the nature of causal relationship, the benchmarks used in economics and legal studies, the meanings of morality, the strengths and weaknesses of doctrinal analysis, and the generality of legal theories. The paper concludes with a summary of the implications of the economic approach to legal scholars. JEL classification: B41, K10.
Price Reduction Strategy for a Multi-Category Retailer
Authors: Kuo Chris 
Published: July 2017

Multi-category businesses often reduce the price of one category to generate purchases for other categories. The extra profit from related purchases will hopefully justify the sacrificed margin in the promoted category, and eventually lead to overall profit increase. The author develops a model incorporating three critical factors that determine the magnitude of the price promotion effect: the profit margins, the sales volumes, and the own- and cross-category price elasticities. The model shows that only in certain conditions can a price cut lead to net profit increase. Retailers reduce the prices of the target category as well as the complementary categories to create the maximal price-cut image. This strategy often results in the loss of total store margin, though the sales increases. The reason for the profit loss is because the retailer has given away the margins of the target category as well as that of the complementary categories. The author suggests a managerial procedure for a storewide pricing decision. The first step is to identify categories into complementary groups according to the cross-category elasticity estimates. The second step then selects carefully a target category for each complementary group. This implementation can maximize the profit increase, increase the sales and still maintain a storewide price reduction image.
On the (Mis)Measurement of Transport Costs in Econometric Modelling
Authors: Chasomeris Mihalis 
Published: July 2017

Several world institutions and researchers use import cif/fob ratios to measure a country’s international transport costs. The purpose of this paper is to investigate the (mis)measurement of transport costs in econometric modelling. The paper discusses the econometric assumptions that are used to justify the (mis)use of country cif/fob ratios to measure international transport costs. Several econometric studies use a country’s cif/fob ratios as exogenous explanatory variables, whereas this study shows that the ratio may indeed be an endogenous variable, hence generating spurious empirical results. In this paper, the relationship between annual cif/fob ratios and compositions of imports are examined via correlation analysis. The findings show that where the quality of the data is reliable, a country’s composition of imports has a significant effect on that country’s cif/fob ratios; hence researchers cannot use the ratio as a dependable measure of direct shipping costs. Researchers should be wary of substituting country cif/fob ratios for direct measures of transport costs. JEL Code: F10
Currency Markets, Performance, and Mutual Fund Cash Flows
Authors: Adams John C. , Hartsfield F. Reid 
Published: July 2017

We analyze cash flows in and out of US based domestic and international mutual funds. Our results suggest that currency market changes are important considerations when investors decide to purchase or redeem mutual fund shares. Specifically, we find that increased foreign currency values are positively related to fund flows. While exchange rates are important considerations for investor cash flows in and out of domestic and international funds, we find that foreign fund flows are more sensitive to exchange rates. Furthermore, the increased flows into international funds over the 1998–2007 sample period are not exclusively due to superior risk adjusted performance relative to domestic funds. JEL Classification: G23, F31
Damages in German Labor Law – Amending the AGG
Authors: Frenzel Hartmut H. , Thöni Magdalena 
Published: July 2017

The European legislature has enacted European anti-discrimination laws (Race Equality Directive – 2000/43/EC, Employment Equality Directive – 2000/78/EC, Directives on equal treatment for men and women – 2002/73/EC) with the task of all member states of converting them into national laws. The German legislature has decided to enact in the General Act on Equal Treatment ( Allgemeines Gleichbehandlungsgesetz – abbreviated AGG) by means of civil law with damage-compensation and compensation for non-economic-loss. The focus of this work at hand is to assess whether the existing form of the AGG is efficient from the perspective of law and economics. Firstly, we will assess the legality of damage-compensation and compensation for non-economic-loss as well as the role of the legislator and legal application. Secondly, we will analyse the perspective of Law and economics in examining civil law sanctions such as efficient alternatives for amending the AGG.
Histologic Evaluation of the Shoulder Capsule in Normal Shoulders, Unstable Shoulders, and after Failed Thermal Capsulorrhaphy
Authors: McFarland Edward G. , Kim Tae Kyun , Banchasuek Prachan , McCarthy Edward F. 
Published: July 2017

Background: Attenuation of the shoulder capsule has been noted during revision surgery for failed thermal capsulorrhaphy. Hypothesis: The attenuated capsule seen in patients who have undergone failed thermal capsulorrhaphy will show histologic characteristics distinguishing it from the capsule of normal shoulders and dislocating shoulders. Study Design: Case control study. Methods: The shoulder capsules were studied in 12 patients with traumatic anterior instability and in 7 patients who experienced recurrent instability after a thermal capsulorrhaphy. The capsules of six fresh-frozen cadavers with no shoulder lesions were used as controls. Results: Among patients who had a history of traumatic instability, a denuded synovial layer was present in 58%, subsynovial edema in 58%, increased cellularity in 25%, and increased vascularity in 83%. At the time of surgery, five of seven shoulders in the failed thermal capsulorrhaphy group (71%) were subjectively felt to be thin and attenuated. Denuded synovium was found in 100% of these patients, subsynovial edema in 43%, and changes in the collagen layer in 100%. Changes in the collagen layer in these patients included a “hyalinization” appearance in five cases (71%), increased collagen fibrosis in two cases (29%), and increased cellularity in two cases (29%). Conclusions: There was no one characteristic observable on histologic evaluation that would explain the attenuation of the capsule in cases of failed thermal treatment. Morphologic collagen structure can be histologically abnormal for up to 16 months after thermal capsulorrhaphy.
Biomechanical Analysis of an Anatomic Anterior Cruciate Ligament Reconstruction
Authors: Yagi Masayoshi , Wong Eric K. , Kanamori Akihiro , Debski Richard E. , Fu Freddie H. , Woo Savio L-Y. 
Published: July 2017

Background: The focus of most anterior cruciate ligament reconstructions has been on replacing the anteromedial bundle and not the posterolateral bundle. Hypothesis: Anatomic two-bundle reconstruction restores knee kinematics more closely to normal than does single-bundle reconstruction. Study Design: Controlled laboratory study. Methods: Ten cadaveric knees were subjected to external loading conditions: 1) a 134-N anterior tibial load and 2) a combined rotatory load of 5-N·m internal tibial torque and 10-N·m valgus torque. Resulting knee kinematics and in situ force in the anterior cruciate ligament or replacement graft were determined by using a robotic/universal force-moment sensor testing system for 1) intact, 2) anterior cruciate ligament deficient, 3) single-bundle reconstructed, and 4) anatomically reconstructed knees. Results: Anterior tibial translation for the anatomic reconstruction was significantly closer to that of the intact knee than was the single-bundle reconstruction. The in situ force normalized to the intact anterior cruciate ligament for the anatomic reconstruction was 97% ± 9%, whereas the single-bundle reconstruction was only 89% ± 13%. With a combined rotatory load, the normalized in situ force for the single-bundle and anatomic reconstructions at 30° of flexion was 66% ± 40% and 91% ± 35%, respectively. Conclusions: Anatomic reconstruction may produce a better biomechanical outcome, especially during rotatory loads. Clinical Relevance: Results may lead to the use of a two-bundle technique.
Lavage Solution Temperature Influences Depth of Chondrocyte Death and Surface Contouring during Thermal Chondroplasty with Temperature-Controlled Monopolar Radiofrequency Energy
Authors: Lu Yan , Edwards Ryland B. , Nho Shane , Cole Brian J. , Markel Mark D. 
Published: July 2017

Background: Although radiofrequency energy can smooth and contour cartilage surface, it has deleterious effects on chondrocyte viability. Hypothesis: Monopolar thermal chondroplasty in a 37°C lavage solution, as compared with a 22° lavage solution, will reduce chondrocyte death and result in greater smoothing of the articular cartilage surface. Study Design: Controlled laboratory study. Methods: Sixteen chondromalacic samples from patients undergoing total knee arthroplasty were divided into two groups: 22°C and 37°C lavage solution. Each sample was divided into two equal parts and half of each group was treated for 10 seconds and the other half for 15 seconds. Results: Confocal laser microscopy demonstrated that the depth of chondrocyte death in the 37°C lavage solution group was significantly less (range, 200 to 340 μm) than that in the 22°C solution group for both 10- and 15-second treatment times. Scanning electron microscopy demonstrated that the cartilage surface in the 37°C lavage solution group was smoother than that in the 22°C solution group for the 10-second treatment time. Energy delivery power in the 37°C lavage solution group was significantly lower than in the 22°C solution group for both treatment times. Conclusions: Thermal chondroplasty with 37°C lavage solution resulted in less depth of chondrocyte death and produced smoother surfaces than with 22°C solution for 10 seconds of treatment. Clinical Relevance: Less chondrocyte death would permit increased use of thermal chondroplasty.
Back Pain in Intercollegiate Rowers
Authors: Teitz Carol C. , O'Kane John , Lind Bonnie K. , Hannafin Jo A. 
Published: July 2017

Background: Back pain is prevalent among intercollegiate rowers. Purpose: We conducted a large-scale study to determine the rate of and the potential etiologic factors for clearly defined back pain that developed during intercollegiate rowing. Study Design: Survey. Methods: Surveys from 1632 former intercollegiate rowing athletes were analyzed. These surveys concerned training methods and back pain before and during intercollegiate rowing. Back pain was defined as pain that lasted at least 1 week. Results: Five hundred twenty-six subjects reported that back pain developed during intercollegiate rowing. Factors significantly associated with the development of back pain included age at the time of the survey; history of rowing before age 16; use of a hatchet oar blade; training with free weights, weight machines, and an ergometer; midline ergometer cable position; and ergometer training sessions longer than 30 minutes. Back pain while in college also was associated with higher mean college weight and height. Conclusions: Intercollegiate rowers in the last 10 years covered by this study were larger, started rowing at an earlier age, trained more intensely, and developed more back pain during college than their predecessors.