bluuebunny/crossref_metadata_2025_split huggingface dataset:
SERVICE USER PERSPECTIVES ON PATIENT SAFETY IN THE AMBULANCE SERVICE
Authors: O'Hara Rachel , Hirst Enid , Johnson Maxine , Newman Chris , Shaw Deborah , Turner Janette 
Published: May 2015

BackgroundThe contribution of service users to identifying and prioritising research issues is vital to make practice and policy more relevant to their needs. Their experiences and knowledge can complement those of clinicians, health professionals and researchers. The aim of this research was to explore service-user perceptions of ambulance service care and patient safety.MethodsThree service-users focus groups (n=23) were conducted in three different Ambulance Service Trust regions and enabled participants to discuss their respective perceptions, experiences and concerns. Discussions were audio-recorded, transcribed and thematically analysed.FindingsService-users identified a number of concerns. The skills of call handlers in managing two-way communication at the initial call stage was perceived as critical to informing appropriate triage decisions; the risk at this stage was considered to be higher where callers have communication difficulties. Participants emphasised the importance of patient involvement in decisions made at-scene, and carers/advocates where appropriate; however, different levels of understanding in relation to their rights were apparent. Awareness of new ambulance service roles and alternatives to ED conveyance also varied. Non-conveyance was viewed as an acceptable option and even preferable where appropriate, and where alternative care options are assured. Participants were aware of the demands facing front-line staff and the impact of 24/7 accessibility, while other services were perceived as more difficult to access, in part due to limited awareness. Risk aversion amongst the public and health professionals was also perceived as a potential contributor to the increased demand for emergency care.ConclusionsDespite the relatively small number of participants, the findings provide useful service-user perspectives relevant to pre-hospital emergency care policy and practice, as well as the wider urgent and emergency care context. It is important that such views can be represented through public/patient involvement in decision making at organisational and service commissioning level.
Migration, urbanisation and mortality: 5-year longitudinal analysis of the PERU MIGRANT study
Authors: Burroughs Pena Melissa S , Bernabé-Ortiz Antonio , Carrillo-Larco Rodrigo M , Sánchez Juan F , Quispe Renato , Pillay Timesh D , Málaga Germán , Gilman Robert H , Smeeth Liam , Miranda J Jaime 
Published: May 2015

ObjectiveTo compare all-cause and cause-specific mortality among 3 distinct groups: within-country, rural-to-urban migrants, and rural and urban dwellers in a longitudinal cohort in Peru.MethodsThe PERU MIGRANT Study, a longitudinal cohort study, used an age-stratified and sex-stratified random sample of urban dwellers in a shanty town community in the capital city of Peru, rural dwellers in the Andes, and migrants from the Andes to the shanty town community. Participants underwent a questionnaire and anthropomorphic measurements at a baseline evaluation in 2007–2008 and at a follow-up visit in 2012–2013. Mortality was determined by death certificate or family interview.ResultsOf the 989 participants evaluated at baseline, 928 (94%) were evaluated at follow-up (mean age 48 years; 53% female). The mean follow-up time was 5.1 years, totalling 4732.8 person-years. In a multivariable survival model, and relative to urban dwellers, migrant participants had lower all cause mortality (HR=0.30; 95% CI 0.12−0.78), and both the migrant (HR=0.07; 95% CI 0.01−0.41) and rural (HR=0.06; 95% CI 0.01−0.62) groups had lower cardiovascular mortality.ConclusionsCardiovascular mortality of migrants remains similar to that of the rural group, suggesting that rural-to-urban migrants do not appear to catch up with urban mortality in spite of having a more urban cardiovascular risk factor profile.
The impact of smoke-free legislation on educational differences in birth outcomes
Authors: McKinnon Britt , Auger Nathalie , Kaufman Jay S 
Published: May 2015

BackgroundSmoke-free legislation may have positive effects on birth outcomes. Given that smoking and secondhand smoke during pregnancy vary with socioeconomic position, legislation may have greater effects in some socioeconomic groups. For this study, we evaluated the impact of a 2006 ban on smoking in public places in the Canadian province of Quebec on preterm birth, small-for-gestational-age birth and birth weight, and on educational differences in these birth outcomes.MethodsWe analysed data on singleton births in Quebec between 2003 and 2010. Logistic regression was used to model the association of smoke-free legislation with preterm birth (<37 weeks), very preterm birth (<34 weeks), small-for-gestational-age birth (<10th centile for gestational age and sex), low birth weight (<2500 g) and mean birth weight, adjusting for secular trends before and after legislation. Interaction terms were included to assess differential effects by level of maternal education.ResultsSmoke-free legislation was associated with average reductions of 3.1 preterm births (95% CI 0.1 to 6.0), 2.3 very preterm births (95% CI 0.9 to 3.7), 5.9 small-for-gestational-age births (95% CI 2.6 to 9.3) and 1.0 low birthweight infants (95% CI 0.4 to 1.6) per 1000 live births, as well as a 17.1 g increase in mean birth weight (95% CI 10.7 to 23.6). Legislation was associated with improved birth outcomes in all categories of maternal education.ConclusionsSmoke-free legislation in Quebec was associated with reductions in preterm and small-for-gestational-age births, and an increase in birth weight. There was no compelling evidence that legislation impacted educational gradients in birth outcomes.
Proteolytic activity of extracellular products from Arthrobotrys musiformis and their effect in vitro against Haemonchus contortus infective larvae
Authors: Acevedo‐Ramírez Perla María del Carmen , Figueroa‐Castillo Juan Antonio , Ulloa‐Arvizú Raúl , Martínez‐García Luz Gisela , Guevara‐Flores Alberto , Rendón Juan Luis , Valero‐Coss Rosa Ofelia , Mendoza‐de Gives Pedro , Quiroz‐Romero Héctor 
Published: May 2015

Arthrobotrys musiformis is a nematophagous fungus with potential for the biological control of Haemonchus contortus larvae. This study aimed to identify and demonstrate the proteolytic activity of extracellular products from A musiformis cultured in a liquid medium against H contortus infective larvae. A musiformis was cultured on a solid medium and further grown in a liquid medium, which was then processed through ion exchange and hydrophobic interaction chromatography. The proteolytic activity of the purified fraction was assayed with either gelatin or bovine serum albumin as substrate. Optimum proteolytic activity was observed at pH 8 and a temperature of 37°C. Results obtained with specific inhibitors suggest the enzyme belongs to the serine‐dependent protease family. The purified fraction concentrate from A musiformis was tested against H contortus infective larvae. A time‐dependent effect was observed with 77 per cent immobility after 48 hours incubation, with alteration of the sheath. It is concluded that A musiformis is a potential candidate for biological control because of its resistant structures and also because of its excretion of extracellular products such as proteases. The present study contributes to the identification of one of the in vitro mechanisms of action of Amusiformis, namely the extracellular production of proteases against H contortus infective larvae. More investigations should be undertaken into how these products could be used to decrease the nematode population in sheep flocks under field conditions, thereby improving animal health while simultaneously diminishing the human and environmental impact of chemical‐based drugs.
Cancer-Directed Therapy and Hospice Care for Metastatic Cancer in American Indians and Alaska Natives
Authors: Shiovitz Stacey , Bansal Aasthaa , Burnett-Hartman Andrea N. , Karnopp Andrew , Adams Scott V. , Warren-Mears Victoria , Ramsey Scott D. 
Published: May 2015

Abstract
Background: Little has been reported regarding patterns of oncologic care in American Indian/Alaska Natives (AI/AN). Observed worse survival has been attributed to later-stage presentation. We aimed to evaluate racial differences in cancer-directed therapy and hospice care utilization in AI/ANs and non-Hispanic whites (NHW) with metastatic cancer.
Methods: The linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims database was accessed for AI/AN and NHW metastatic-cancer cases diagnosed between 2001 and 2007. Utilization of cancer-directed therapy (surgery, radiation, and/or chemotherapy) and/or hospice services was compared between AI/ANs and NHWs. Minimally adjusted (age, sex, diagnosis year) and fully-adjusted (also Klabunde comorbidity score, sociodemographic factors) regression models were used to estimate odds (OR) and hazard ratios (HR) for receipt of care.
Results: AI/ANs were younger, more likely to reside in the West, be unmarried, have lower income, and live in a nonurban setting than NHWs. Fewer AI/ANs received any cancer-directed therapy (57% vs. 61% NHWs) within 3 months of diagnosis; sociodemographic factors accounted for much of this difference [fully-adjusted HR, 0.94; 95% confidence interval (CI), 0.83–1.08]. We noted differences in hospice utilization between AI/ANs (52%) and NHWs (61%). A significant difference in hospice utilization remained after adjustment for sociodemographics (OR, 0.78; 95% CI, 0.61–0.99).
Conclusion: Observed absolute differences in care for AI/ANs and NHWs with metastatic cancer were largely accounted for by adjusting for socioeconomics, comorbidities, and demographic factors. A significant association between race and hospice utilization was noted.
Impact: Efforts to improve metastatic-cancer care should focus on socioeconomic barriers and investigate the observed disparity in receipt of hospice services. Cancer Epidemiol Biomarkers Prev; 24(7); 1138–43. ©2015 AACR.
Smad3 Signaling Promotes Fibrosis While Preserving Cardiac and Aortic Geometry in Obese Diabetic Mice
Authors: Biernacka Anna , Cavalera Michele , Wang Junhong , Russo Ilaria , Shinde Arti , Kong Ping , Gonzalez-Quesada Carlos , Rai Vikrant , Dobaczewski Marcin , Lee Dong-Wook , Wang Xiao-Fan , Frangogiannis Nikolaos G. 
Published: May 2015

Background—
Heart failure in diabetics is associated with cardiac hypertrophy, fibrosis and diastolic dysfunction. Activation of transforming growth factor-β/Smad3 signaling in the diabetic myocardium may mediate fibrosis and diastolic heart failure, while preserving matrix homeostasis. We hypothesized that Smad3 may play a key role in the pathogenesis of cardiovascular remodeling associated with diabetes mellitus and obesity.

Methods and Results—
We generated leptin-resistant db/db Smad3 null mice and db/db Smad3+/− animals. Smad3 haploinsufficiency did not affect metabolic function in db/db mice, but protected from myocardial diastolic dysfunction, while causing left ventricular chamber dilation. Improved cardiac compliance and chamber dilation in db/db Smad3+/− animals were associated with decreased cardiomyocyte hypertrophy, reduced collagen deposition, and accentuated matrix metalloproteinase activity. Attenuation of hypertrophy and fibrosis in db/db Smad3+/− hearts was associated with reduced myocardial oxidative and nitrosative stress. db/db Smad3 null mice had reduced weight gain and decreased adiposity associated with attenuated insulin resistance, but also exhibited high early mortality, in part, because of spontaneous rupture of the ascending aorta. Ultrasound studies showed that both lean and obese Smad3 null animals had significant aortic dilation. Aortic dilation in db/db Smad3 null mice occurred despite reduced hypertension and was associated with perturbed matrix balance in the vascular wall.

Conclusions—
Smad3 mediates diabetic cardiac hypertrophy, fibrosis, and diastolic dysfunction, while preserving normal cardiac geometry and maintaining the integrity of the vascular wall.
Kansas City Cardiomyopathy Questionnaire Score Is Associated With Incident Heart Failure Hospitalization in Patients With Chronic Kidney Disease Without Previously Diagnosed Heart Failure
Authors: Mishra Rakesh K. , Yang Wei , Roy Jason , Anderson Amanda H. , Bansal Nisha , Chen Jing , DeFilippi Christopher , Delafontaine Patrice , Feldman Harold I. , Kallem Radhakrishna , Kusek John W. , Lora Claudia M. , Rosas Sylvia E. , Go Alan S. , Shlipak Michael G. 
Published: May 2015

Background—
Chronic kidney disease is a risk factor for heart failure (HF). Patients with chronic kidney disease without diagnosed HF have an increased burden of symptoms characteristic of HF. It is not known whether these symptoms are associated with occurrence of new onset HF.

Methods and Results—

We studied the association of a modified Kansas City Cardiomyopathy Questionnaire with newly identified cases of hospitalized HF among 3093 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study who did not report HF at baseline. The annually updated Kansas City Cardiomyopathy Questionnaire score was categorized into quartiles (Q1–4) with the lower scores representing the worse symptoms. Multivariable-adjusted repeated measure logistic regression models were adjusted for demographic characteristics, clinical risk factors for HF, N-terminal probrain natriuretic peptide level and left ventricular hypertrophy, left ventricular systolic and diastolic dysfunction. Over a mean (±SD) follow-up period of 4.3±1.6 years, there were 211 new cases of HF hospitalizations. The risk of HF hospitalization increased with increasing symptom quartiles; 2.62, 1.85, 1.14, and 0.74 events per 100 person-years, respectively. The median number of annual Kansas City Cardiomyopathy Questionnaire assessments per participant was 5 (interquartile range, 3–6). The annually updated Kansas City Cardiomyopathy Questionnaire score was independently associated with higher risk of incident HF hospitalization in multivariable-adjusted models (odds ratio, 3.30 [1.66–6.52];
P
=0.001 for Q1 compared with Q4).

Conclusions—
Symptoms characteristic of HF are common in patients with chronic kidney disease and are associated with higher short-term risk for new hospitalization for HF, independent of level of kidney function, and other known HF risk factors.
Effect of Surface Fluxes versus Radiative Heating on Tropical Deep Convection
Authors: Anber Usama , Wang Shuguang , Sobel Adam 
Published: May 2015

Abstract
The effects of turbulent surface fluxes and radiative heating on tropical deep convection are compared in a series of idealized cloud-system-resolving simulations with parameterized large-scale dynamics. Two methods of parameterizing the large-scale dynamics are used: the weak temperature gradient (WTG) approximation and the damped gravity wave (DGW) method. Both surface fluxes and radiative heating are specified, with radiative heating taken as constant in the vertical in the troposphere. All simulations are run to statistical equilibrium.
In the precipitating equilibria, which result from sufficiently moist initial conditions, an increment in surface fluxes produces more precipitation than an equal increment of column-integrated radiative heating. This is straightforwardly understood in terms of the column-integrated moist static energy budget with constant normalized gross moist stability. Under both large-scale parameterizations, the gross moist stability does in fact remain close to constant over a wide range of forcings, and the small variations that occur are similar for equal increments of surface flux and radiative heating.
With completely dry initial conditions, the WTG simulations exhibit hysteresis, maintaining a dry state with no precipitation for a wide range of net energy inputs to the atmospheric column. The same boundary conditions and forcings admit a rainy state also (for moist initial conditions), and thus multiple equilibria exist under WTG. When the net forcing (surface fluxes minus radiative heating) is increased enough that simulations that begin dry eventually develop precipitation, the dry state persists longer after initialization when the surface fluxes are increased than when radiative heating is increased. The DGW method, however, shows no multiple equilibria in any of the simulations.
Origin and Flow History of Air Parcels in Orographic Banner Clouds
Authors: Schappert Sebastian , Wirth Volkmar 
Published: May 2015

Abstract
Banner clouds are clouds in the lee of steep mountains or sharp ridges. Previous work suggests that the main formation mechanism is vertical uplift in the lee of the mountain. On the other hand, little is known about the Lagrangian behavior of air parcels as they pass the mountain, which motivates the current investigation. Three different diagnostics are applied in the framework of large-eddy simulations of airflow past an isolated pyramid-shaped obstacle: Eulerian tracers indicating the initial positions of the parcels, streamlines along the time-averaged wind field, and online trajectories computed from the instantaneous wind field.
All three methods diagnose a plume of large vertical uplift in the immediate lee of the mountain. According to the time-mean Eulerian tracers, the cloudy parcels originated within a fairly small coherent area at the inflow boundary. In contrast, the time-mean streamlines indicate a bifurcation into two distinct classes of air parcels with very different characteristics. The parcels in the first class originate at intermediate altitudes, pass the obstacle close to its summit, and proceed directly into the cloud. By contrast, the parcels in the second class start at low altitude and take a fairly long time before they reach the cloud on a spiraling path. A humidity tracer quantifies mixing, revealing partial moistening for the first class of parcels and drying for the second class of parcels. For the online trajectories, the originating location of parcels is more scattered, but the results are still consistent with the basic features revealed by the other two diagnostics.
Constraints on Cumulus Parameterization from Simulations of Observed MJO Events
Authors: Del Genio Anthony D. , Wu Jingbo , Wolf Audrey B. , Chen Yonghua , Yao Mao-Sung , Kim Daehyun 
Published: May 2015

Abstract
Two recent activities offer an opportunity to test general circulation model (GCM) convection and its interaction with large-scale dynamics for observed Madden–Julian oscillation (MJO) events. This study evaluates the sensitivity of the Goddard Institute for Space Studies (GISS) GCM to entrainment, rain evaporation, downdrafts, and cold pools. Single Column Model versions that restrict weakly entraining convection produce the most realistic dependence of convection depth on column water vapor (CWV) during the Atmospheric Radiation Measurement MJO Investigation Experiment at Gan Island. Differences among models are primarily at intermediate CWV where the transition from shallow to deeper convection occurs. GCM 20-day hindcasts during the Year of Tropical Convection that best capture the shallow–deep transition also produce strong MJOs, with significant predictability compared to Tropical Rainfall Measuring Mission data. The dry anomaly east of the disturbance on hindcast day 1 is a good predictor of MJO onset and evolution. Initial CWV there is near the shallow–deep transition point, implicating premature onset of deep convection as a predictor of a poor MJO simulation. Convection weakly moistens the dry region in good MJO simulations in the first week; weakening of large-scale subsidence over this time may also affect MJO onset. Longwave radiation anomalies are weakest in the worst model version, consistent with previous analyses of cloud/moisture greenhouse enhancement as the primary MJO energy source. The authors’ results suggest that both cloud-/moisture-radiative interactions and convection–moisture sensitivity are required to produce a successful MJO simulation.
The Positive North Atlantic Oscillation with Downstream Blocking and Middle East Snowstorms: The Large-Scale Environment
Authors: Luo Dehai , Yao Yao , Dai Aiguo , Feldstein Steven B. 
Published: May 2015

Abstract
In this study, the atmospheric conditions for the December 2013 Middle East snowstorm are examined from a case study perspective and by performing a composite analysis of extreme winter events from 1950 to 2013 using reanalysis data. It is revealed that this snowstorm arises from the occurrence of an omega (Ω)-type European blocking (EB) with a strong downstream trough that is associated with a southward-displaced positive-phase North Atlantic Oscillation (NAO+) event. In the anomaly field, the EB exhibits a northeast–southwest (NE–SW)-tilted dipole structure. The Ω-type EB transports cold air into the Middle East and produces snowfall within the trough over the Middle East.
The composite analysis shows that the location of cold temperatures depends strongly on the tilting direction and strength of the EB dipole anomaly. The NE–SW [northwest–southeast (NW–SE)]-tilted EB dipole occurs with a southward (northward)-displaced NAO+ event. The NE–SW-tilted EB dipole anomaly is associated with an arching-type low-frequency wave train that spans the North Atlantic, Europe, and the Middle East. This tilting has the most favorable structure for cold air outbreaks over the Middle East and southeastern Europe because this tilting leads to an intense downstream trough over this region. In contrast, a NW–SE-tilted EB dipole anomaly leads to cold temperatures over northwestern Africa and southwestern Europe. The analyses herein also suggest that a strong jet over the North Atlantic may be a precursor for a southward-displaced NAO+ event that is usually associated with an Ω-type EB with a NE–SW-tilted dipole in the anomaly height field that favors a cold air outbreak over the Middle East.
Estimates of Ocean Macroturbulence: Structure Function and Spectral Slope from Argo Profiling Floats
Authors: McCaffrey Katherine , Fox-Kemper Baylor , Forget Gael 
Published: May 2015

AbstractThe Argo profiling float network has repeatedly sampled much of the World Ocean. This study uses Argo temperature and salinity data to form the tracer structure function of ocean variability at the macroscale (10–1000 km, mesoscale and above). Here, second-order temperature and salinity structure functions over horizontal separations are calculated along either pressure or potential density surfaces, which allows analysis of both active and passive tracer structure functions. Using Argo data, a map of global variance is created from the climatological average and each datum. When turbulence is homogeneous, the structure function slope from Argo can be related to the wavenumber spectrum slope in ocean temperature or salinity variability. This first application of structure function techniques to Argo data gives physically meaningful results based on bootstrapped confidence intervals, showing geographical dependence of the structure functions with slopes near ⅔ on average, independent of depth.