bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ambiguity, bureaucracy and certainty: The ABCs of enabling water self-sufficiency
Authors: Leong Ching , Qian Neng 
Published: May 2016

Abstract
Ambiguity has often been taken as the bete noir of policy implementation, with policy intent stymied by unclear goals and lack of clarity about processes. This paper argues that, given sufficient apparent certainty about strategic intents, ambiguity can actually be an enabling factor that allows for quick adaptations. It goes do in three ways – first, ambiguity allows the creation of faint paths that are overwritten in the light of new decisions; second and relatedly, this enables the bureaucracy to take more risks, in light of the relatively low sunk costs; third, ambiguity allows for experiments with fuzzy parameters of success, which contributes to innovation. In all three, the role of learning is crucial.
This thesis of ambiguity as enabler of learning by bureaucrats is tested in the case of water security in Singapore, which faced economic, technology and security ambiguities. There is a bureaucratic tendency to react to ambiguity with a search for more information and clarity. However because of the ambiguity-enabled learning, Singapore through a very roundabout and messy implementation process, was able to overcome a key strategic vulnerability.
Adaptation Pathways and Real Options Analysis: An approach to deep uncertainty in climate change adaptation policies
Authors: Buurman Joost , Babovic Vladan 
Published: May 2016

Abstract
Governments face the daunting task of developing policies and making investment decisions for climate change adaptation in an environment that consist of complex, interlinked systems with manifold uncertainties. Instead of responding to surprises and making decisions on ad hoc basis, a structured approach to deal with complex systems and uncertainties can provide indispensable support for policy making. This contribution proposes a structured approach for designing climate adaptation policies based on the concepts of Adaptation Pathways, Adaptive Policy Making, and Real Options Analysis. Such an approach results in incorporation of flexibility that allows change over time in response to how the future unfolds, what is learned about the system, and changes in societal preferences. The approach is illustrated by looking at drainage policies and measures to address flooding in Singapore.
Paleotsunamis from the central Kuril Islands segment of the Japan-Kuril-Kamchatka subduction zone
Authors: MacInnes Breanyn , Kravchunovskaya Ekaterina , Pinegina Tatiana , Bourgeois Joanne 
Published: May 2016

AbstractPaleotsunami records from the central Kuril Island segment of the Japan-Kuril-Kamchatka subduction zone indicate that the region has been frequently inundated by tsunamis. As many as 20e22 tsunami deposits are recognized on Matua Island for the past 3300 yr with an average tsunami recurrence interval of ~150 yr, and 34e36 tsunami deposits are evident on Simushir Island for the past 2350 yr with an average recurrence of ~65 yr. These intervals are short, but comparable to other segments of the Japan-Kuril-Kamchatka subduction zone. Results from all survey locations reveal shortening recurrence intervals toward the present, especially for the last 600 yr, indicating a possible preservation bias. On Simushir, tsunamis at least 11 m higher than the modern tsunamis in 2006 and 2007 occurred every ~300 yr on average. On Matua, tsunamis with slightly farther inundation than the 2006 and 2007 tsunamis occurred every ~215 yr while those with at least 100 m farther inland inundation occur every ~750 yr. Our paleotsunami record almost certainly includes tsunamis that are not from great subduction zone earthquakes in the central Kuril segment: we expect the Matua record includes volcanic tsunamis and the Simushir record includes tsunamis from the southern Kuril segment.
Assisted conception and the risk of CHD: a case–control study
Authors: Schofield Susie J. , Doughty Victoria L. , van Stiphout Nicole , Franklin Rodney C. G. , Johnson Mark R. , Daubeney Piers E. F. , Cullinan Paul 
Published: May 2016

AbstractEpidemiological studies suggest a higher prevalence of congenital malformations in children conceived through assisted reproductive technologies. There are a few studies that address CHD specifically and most have examined data from registries. We examined the relationship between CHD and assisted conception using data collected in a specialist paediatric cardiac service in the United Kingdom.Between April, 2010 and July, 2011, the parents of children attending paediatric cardiology clinics at the Royal Brompton Hospital, London, were invited to complete a questionnaire that enquired about the nature of their child’s conception, the route for their original referral, and a number of potential confounding exposures. “Cases” were defined as children diagnosed with one or more carefully defined CHDs and “controls” as those with normal hearts.Of 894 new attendees with complete data, half of them were cases (n=410, 45.9%). The overall prevalence of assisted conception was 5.4% (n=44). Logistic regression analysis demonstrated a non-significant increase in the crude odds for the use of assisted reproduction (odds ratio 1.21, 95% confidence interval 0.66–2.22) in this group. After adjustment for gestation, parity, year of birth, and maternal age, the odds ratio reduced (odds ratio 0.95, 95% confidence interval 0.48–1.88). Increased rates of assisted conception were observed in a number of CHD subgroups, although no significant differences were found.These findings do not suggest an overall association between CHD and assisted reproduction in this population.
NLRP3 Deficiency Reduces Macrophage Interleukin-10 Production and Enhances the Susceptibility to Doxorubicin-induced Cardiotoxicity
Authors: Kobayashi Motoi , Usui Fumitake , Karasawa Tadayoshi , Kawashima Akira , Kimura Hiroaki , Mizushina Yoshiko , Shirasuna Koumei , Mizukami Hiroaki , Kasahara Tadashi , Hasebe Naoyuki , Takahashi Masafumi 
Published: May 2016

AbstractNLRP3 inflammasomes recognize non-microbial danger signals and induce release of proinflammatory cytokine interleukin (IL)-1β, leading to sterile inflammation in cardiovascular disease. Because sterile inflammation is involved in doxorubicin (Dox)-induced cardiotoxicity, we investigated the role of NLRP3 inflammasomes in Dox-induced cardiotoxicity. Cardiac dysfunction and injury were induced by low-dose Dox (15 mg/kg) administration in NLRP3-deficient (NLRP3−/−) mice but not in wild-type (WT) and IL-1β−/− mice, indicating that NLRP3 deficiency enhanced the susceptibility to Dox-induced cardiotoxicity independent of IL-1β. Although the hearts of WT and NLRP3−/− mice showed no significant difference in inflammatory cell infiltration, macrophages were the predominant inflammatory cells in the hearts, and cardiac IL-10 production was decreased in Dox-treated NLRP3−/− mice. Bone marrow transplantation experiments showed that bone marrow-derived cells contributed to the exacerbation of Dox-induced cardiotoxicity in NLRP3−/− mice. In vitro experiments revealed that NLRP3 deficiency decreased IL-10 production in macrophages. Furthermore, adeno-associated virus-mediated IL-10 overexpression restored the exacerbation of cardiotoxicity in the NLRP3−/− mice. These results demonstrated that NLRP3 regulates macrophage IL-10 production and contributes to the pathophysiology of Dox-induced cardiotoxicity, which is independent of IL-1β. Our findings identify a novel role of NLRP3 and provided new insights into the mechanisms underlying Dox-induced cardiotoxicity.
Fragile X Mental Retardation Protein (FMRP) controls diacylglycerol kinase activity in neurons
Authors: Tabet Ricardos , Moutin Enora , Becker Jérôme A. J. , Heintz Dimitri , Fouillen Laetitia , Flatter Eric , Krężel Wojciech , Alunni Violaine , Koebel Pascale , Dembélé Doulaye , Tassone Flora , Bardoni Barbara , Mandel Jean-Louis , Vitale Nicolas , Muller Dominique , Le Merrer Julie , Moine Hervé 
Published: May 2016

Significance
Fragile X syndrome (FXS), the most frequent form of inherited intellectual disability, is caused by the absence of the protein Fragile X Mental Retardation Protein (FMRP) in neurons. In the absence of FMRP, the translation of a high number of mRNAs is increased in glutamatergic synapses, leading to abnormal synaptic function. It is unclear whether FMRP individually controls each of these mRNAs and whether some mRNAs are more important for the pathology. This study shows that FMRP mostly associates with and controls one main mRNA target in neurons, diacylglycerol kinase kappa (Dgkκ), a master regulator that controls two key signaling pathways activating protein synthesis. The deregulation of Dgkκ could account for many of the symptoms associated with FXS and could represent a novel therapeutic target.
Free-energy landscape of a hyperstable RNA tetraloop
Authors: Miner Jacob C. , Chen Alan A. , García Angel E. 
Published: May 2016

Significance
We report a multistate folding free-energy landscape for a hyperstable RNA tetraloop obtained from high-performance molecular dynamic simulations under multiple temperature and pressure conditions. These studies advance previous successes of de novo folding of RNA tetraloops and our understanding of the folded landscape of basic RNA motifs. In addition to the canonical A-RNA conformation, our analysis describes de novo folding of a left-handed Z-RNA conformation and the formation of a purine Triplet, each showing differential stabilization as a function of temperature and pressure. These results provide important insights into the ability of all-atom RNA force fields to describe the conformational heterogeneity of the most basic RNA secondary structures and represent a significant advancement in the utility of RNA molecular dynamics for describing RNA thermodynamics.
Automated pictographic illustration of discharge instructions with Glyph: impact on patient recall and satisfaction
Authors: Hill Brent , Perri-Moore Seneca , Kuang Jinqiu , Bray Bruce E , Ngo Long , Doig Alexa , Zeng-Treitler Qing 
Published: May 2016

AbstractObjectives First, to evaluate the effect of standard vs pictograph-enhanced discharge instructions on patients’ immediate and delayed recall of and satisfaction with their discharge instructions. Second, to evaluate the effect of automated pictograph enhancement on patient satisfaction with their discharge instructions.Materials and Methods Glyph, an automated healthcare informatics system, was used to automatically enhance patient discharge instructions with pictographs. Glyph was developed at the University of Utah by our research team. Patients in a cardiovascular medical unit were randomized to receive pictograph-enhanced or standard discharge instructions. Measures of immediate and delayed recall and satisfaction with discharge instructions were compared between two randomized groups: pictograph (n = 71) and standard (n = 73).Results Study participants who received pictograph-enhanced discharge instructions recalled 35% more of their instructions at discharge than those who received standard discharge instructions. The ratio of instructions at discharge was: standard = 0.04 ± 0.03 and pictograph-enhanced = 0.06 ± 0.03. The ratio of instructions at 1 week post discharge was: standard = 0.04 ± 0.02 and pictograph-enhanced 0.04 ± 0.02. Additionally, study participants who received pictograph-enhanced discharge instructions were more satisfied with the understandability of their instructions at 1 week post-discharge than those who received standard discharge instructions.Discussion Pictograph-enhanced discharge instructions have the potential to increase patient understanding of and satisfaction with discharge instructions.Conclusion It is feasible to automatically illustrate discharge instructions and provide them to patients in a timely manner without interfering with clinical work. Illustrations in discharge instructions were found to improve patients’ short-term recall of discharge instructions and delayed satisfaction (1-week post hospitalization) with the instructions. Therefore, it is likely that patients’ understanding of and interaction with their discharge instructions is improved by the addition of illustrations.
The origin of the α-enhancement of massive galaxies
Authors: Segers Marijke C. , Schaye Joop , Bower Richard G. , Crain Robert A. , Schaller Matthieu , Theuns Tom 
Published: May 2016

Abstract
We study the origin of the stellar α-element-to-iron abundance ratio, [α/Fe]*, of present-day central galaxies, using cosmological, hydrodynamical simulations from the Evolution and Assembly of GaLaxies and their Environments (EAGLE) project. For galaxies with stellar masses of M* &gt; 1010.5 M⊙, [α/Fe]* increases with increasing galaxy stellar mass and age. These trends are in good agreement with observations of early-type galaxies, and are consistent with a ‘downsizing’ galaxy formation scenario: more massive galaxies have formed the bulk of their stars earlier and more rapidly, hence from an interstellar medium that was mostly α-enriched by massive stars. In the absence of feedback from active galactic nuclei (AGNs), however, [α/Fe]* in M* &gt; 1010.5 M⊙ galaxies is roughly constant with stellar mass and decreases with mean stellar age, extending the trends found for lower mass galaxies in both simulations with and without AGN. We conclude that AGN feedback can account for the α-enhancement of massive galaxies, as it suppresses their star formation, quenching more massive galaxies at earlier times, thereby preventing the iron from longer lived intermediate-mass stars (supernova Type Ia) from being incorporated into younger stars.
Reactive School Closure During Increased Influenza-Like Illness (ILI) Activity in Western Kentucky, 2013: A Field Evaluation of Effect on ILI Incidence and Economic and Social Consequences for Families
Authors: Russell Elizabeth S. , Zheteyeva Yenlik , Gao Hongjiang , Shi Jianrong , Rainey Jeanette J. , Thoroughman Douglas , Uzicanin Amra 
Published: May 2016

Abstract
Background.  School closures are an important mitigation strategy during influenza pandemic: if implemented early in a local outbreak, they can slow the disease spread in the surrounding community. During seasonal influenza epidemics, school closures may occur reactively, after the disease is already widespread in the community. Such reactive closures are often too late to reduce influenza transmission. However, they can provide data to determine under which circumstances they might be effective in reducing influenza-like illness (ILI) transmission.
Methods.  We conducted a household survey in a school district in Kentucky. District A closed after high student absenteeism due to influenza-like illness (ILI), whereas adjacent Districts B and C remained open. We collected data on self-reported ILI among household members in these 3 districts 2 weeks before the District A closure, during closure, and 2 weeks after reopening, and we evaluated economic and social consequences of school closure on student households in District A. The difference-in-differences method was applied to compare changes in ILI rates from before to after closure between districts.
Results.  Estimated average daily ILI rate decreased less in District A than in District B or C for the entire sample and when stratified by age groups (0–5 years old, 6–18 years old, and above 18 years old). Twenty-five percent of District A households reported ≥1 closure-related economic or social difficulty.
Conclusions.  Closing schools after a widespread ILI activity in District A did not reduce ILI transmission but caused difficulties for some households.
Objective Metric of Energy Absorbed in Tibial Plateau Fractures Corresponds Well to Clinician Assessment of Fracture Severity
Authors: Kempton Laurence B. , Dibbern Kevin , Anderson Donald D. , Morshed Saam , Higgins Thomas F. , Marsh J. Lawrence , McKinley Todd O. 
Published: May 2016

Objectives:
Determine the agreement between subjective assessments of fracture severity and an objective computed tomography (CT)-based metric of fracture energy in tibial plateau fractures.

Methods:
Six fellowship-trained orthopaedic trauma surgeons independently rank-ordered 20 tibial plateau fractures in terms of severity based on anteroposterior and lateral knee radiographs. A CT-based image analysis methodology was used to quantify the fracture energy, and agreement between the surgeons' severity rankings and the fracture energy metric was tested by computing their concordance, a statistical measure that estimates the probability that any 2 cases would be ranked with the same ordering by 2 different raters or methods.

Results:
Concordance between the 6 orthopaedic surgeons ranged from 82% to 93%, and concordance between surgeon severity rankings and the computed fracture energy ranged from 73% to 78%.

Conclusions:
There is a high level of agreement between experienced surgeons in their assessments of tibial plateau fracture severity, and a slightly lower agreement between the surgeon assessments and an objective CT-based metric of fracture energy. Taken together, these results suggest that experienced surgeons share a similar understanding of what makes a tibial plateau fracture more or less severe, and an objective CT-based metric of fracture energy captures much but not all of that information. Further research is ongoing to characterize the relationship between surgeon assessments of severity, fracture energy, and the eventual clinical outcomes for patients with fractures of the tibial plateau.
Alignment After Intramedullary Nailing of Distal Tibia Fractures Without Fibula Fixation
Authors: De Giacomo Anthony F. , Tornetta Paul 
Published: May 2016

Objective:
To evaluate the efficacy of intramedullary nailing of distal tibia fractures using modern techniques, without fibula fixation, in obtaining and maintaining alignment.

Design:
Retrospective case review.

Setting:
Level-I academic trauma center.

Patients:
One hundred thirty-two consecutive patients with distal tibia fractures.

Intervention:
Intramedullary nail of distal tibia fracture, without fibula fixation, was performed in consecutive patients using modern reduction techniques.

Main Outcome Measures:
Malalignment and malunion were defined as >5 degrees of varus/valgus angulation or anterior/posterior angulation on the initial postoperative or final anteroposterior and lateral x-rays.

Results:
There were 122 consecutive patients (86 men and 36 women) 16–93 years of age (average, 43 years) with 36 (30%) open and 85 (70%) closed fractures with complete follow-up. Mechanism of injury did not predict the presence or level of fibula fracture. Upon presentation, varus/valgus and procurvatum/recurvatum angulation was greatest when the fibula was fractured at the level of the tibia fracture (P = 0.001 and 0.028). The most common intraoperative reduction aids were nailing in relative extension, transfixion external fixation, and clamps at the fracture site. The OTA fracture type or level/presence of fibula fracture did not influence malalignment (P = 0.86 and 0.66), malunion (P = 0.81 and 0.79), or the change in alignment during union, which averaged 0.9 degrees.

Conclusions:
We found an overall low rate of both malalignment (2%) and malunion (3%) after intramedullary nailing of distal tibial shaft fracture without fibula fixation. We conclude that when modern nailing techniques are used, which allow for confirmation of reduction by visualization in fluoroscopy, from nail placement to distal interlocking, fibula fixation is not necessary to obtain or maintain alignment. Furthermore, standard 2 medial to lateral screws distally afford adequate stability to hold the reduction during union with a 0.9-degree difference in the initial postoperative and final united films.

Level of Evidence:
Therapeutic level IV. See Instructions for Authors for a complete description of levels of evidence.
Rim Plating of Posterolateral Fracture Fragments (PLFs) Through a Modified Anterolateral Approach in Tibial Plateau Fractures
Authors: Cho Jae-Woo , Samal Puspak , Jeon Young-Sik , Oh Chang-Wug , Oh Jong-Keon 
Published: May 2016

Summary:
Posterolateral fracture fragments in tibial plateau fractures have proven to be particularly difficult to reduce and adequately repair internally through anterior or anterolateral approaches, although they are safer. Posterior and posterolateral approaches offer a direct approach for the reduction and fixation of plates, but they have several limitations. Here, we have proposed a modified anterolateral approach, which ensures a safe and effective technique for the reduction and fixation of posterolateral fracture fragments, aided by our innovative rim plate.
Surgical Management of Civilian Gunshot-Induced Spinal Cord Injury
Authors: Nwosu Kenneth , Eftekhary Nima , McCoy Eric , Bhalla Amandeep , Fukunaga Dudley , Rolfe Kevin 
Published: May 2016

Study Design.
Retrospective chart review.

Objective.
Assess appropriate utilization of surgery for civilian gunshot-induced spinal cord injuries (CGSWSCI) according to literature standards in a large cohort.

Summary of Background Data.
CGSWSCI are mechanically stable injuries that rarely require surgery. Nonetheless, we continue to see high numbers of these patients undergo surgical treatment. This study compares indications for surgeries performed in a large cohort of CGSWSCI patients to established indications for surgical management of such injuries. The rate of over-utilization of surgical management was calculated.

Methods.
Four hundred eighty-nine CGSWSCI patients transferred for rehabilitation to our institution between 2000 and 2014 were identified. Retrospective chart review was performed to identify patients who underwent initial surgical treatment, the specific surgeries performed, and indications given. We assessed appropriateness of surgery according to literature standards. Patients treated surgically were followed to assess for complications and the need for additional intervention and compared to nonsurgical patients. Secondarily, visual analog scale pain scores (0–10) and patient perceived improvement were compared between surgical and nonsurgical patients after telephone survey of both groups.

Results.
Of 489 patients, 91 (18%) underwent initial surgery. Of 91 surgeries, 69 (75%) were not indicated by literature standards. Five of 91 (5.5%) of initially operated patients required a secondary surgery compared with two of 398 (0.5%) of the nonoperative group (P = 0.003). Over-utilization rate of the entire cohort was 14.1%. No difference was seen for pain scores or patient perceived improvement between operative and nonoperative patients.

Conclusion.
We report a high overutilization rate (14%) of surgery for CGSWSCI in our cohort. Surgical management was associated with higher infection and secondary surgery rates compared to nonsurgical management. Surgery done without a clear, demonstrable benefit poses unnecessary risk to patients and accumulates unwarranted healthcare costs.

Level of Evidence: 3