bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midlatitude–Equatorial Dynamics of a Grounded Deep Western Boundary Current. Part I: Midlatitude Flow and the Transition to the Equatorial Region
Authors: Swaters Gordon E. 
Published: July 2015

AbstractA comprehensive theoretical study of the nonlinear hemispheric-scale midlatitude and cross-equatorial steady-state dynamics of a grounded deep western boundary current is given. The domain considered is an idealized differentially rotating, meridionally aligned basin with zonally varying parabolic bottom topography so that the model ocean shallows on both the western and eastern sides of the basin. Away from the equator, the flow is governed by nonlinear planetary geostrophic dynamics on sloping topography in which the potential vorticity equation can be explicitly solved. As the flow enters the equatorial region, it speeds up and becomes increasingly nonlinear and passes through two distinguished inertial layers referred to as the “intermediate” and “inner” inertial equatorial boundary layers, respectively. The flow in the intermediate equatorial region is shown to accelerate and turn eastward, forming a narrow equatorial jet. The qualitative properties of the solution presented are consistent with the known dynamical characteristics of the deep western boundary currents as they flow from the midlatitudes into the tropics. The predominately zonal flow across the ocean basin in the inner equatorial region (and its exit from the equatorial region) is determined in Part II of this study.
The Political Economy of Brazil-China Trade Relations, 2000–2010
Authors: de Melo Maria Cristina Pereira , do Amaral Filho Jair 
Published: July 2015

Sino-Brazilian trade reached record levels in 2010. At the core of this phenomenon was the return to a primary production structure reinforced by the difficulty of diversifying exports of Brazilian manufactures of higher value added and technological content. Brazilian imports have revolved around the acquisition of manufactures similar to the ones produced in Brazil and with a sophisticated technological profile. The results of this trade tie are related to differences in the development agendas of the two countries, especially their industrial policies. Em 2010, o volume do comércio sino-brasileiro ultrapassou níveis anteriormente re-gistrados. O cerne desse fenômeno foi um retorno à estrutura de produção calçada no setor primário. Ademais, esse retorno foi reforçado pela dificuldade em diversificar as exportaçãoes dos manufaturados brasileiros de alto valor agregado e conteúdo tecnológico. As importações brasileiras estão centradas na aquisição de manufaturas similares às produzidas no Brasil e que apresentam um perfil tecnológico sofisticado. Os resultados desses laços comerciais correspondem às diferenças nas agendas de desenvolvimento dos dois países, especialmente suas respectivas políticas industriais.
Multicentre investigation of pathogenic bacteria and antibiotic resistance genes in Chinese patients with acute exacerbation of chronic obstructive pulmonary disease
Authors: Ma Xiuqing , Cui Junchang , Wang Jing , Chang Yan , Fang Qiuhong , Bai Changqing , Zhou Xiumei , Zhou Hong , Feng Huasong , Wang Ying , Zhao Weiguo , Wen Zhongguang , Wang Ping , Liu Yi , Yu Ling , Li Chunsun , Chen Liangan 
Published: July 2015

Objective A prospective observational study to investigate the distribution and antimicrobial resistance of pathogenic bacteria in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing, China. Methods Patients with AECOPD were recruited from 11 general hospitals. Sputum specimens were cultured and bacteria identified. Antibiotic susceptibility was determined for each isolate, and presence of antibiotic resistance genes was evaluated using polymerase chain reaction. Results Pathogenic bacteria were isolated from 109/318 patients (34.28%); 124 isolates of 22 pathogenic bacterial species were identified, including Klebsiella pneumoniae (16.94%), Pseudomonas aeruginosa (16.94%), Acinetobacter baumannii (11.29%), Streptococcus pneumoniae (8.87%), and Staphylococcus aureus (7.26%). S. aureus was sensitive to tigecycline, teicoplanin, vancomycin and linezolid but resistant to penicillin and levofloxacin. K.pneumoniae, P. aeruginosa, A. baumannii and E. coli were susceptible to amikacin and cefoperazone. Conclusions K. pneumoniae and P. aeruginosa are the most common pathogenic bacteria in AECOPD cases in Beijing, China. Our antibiotic resistance findings may be helpful in selecting antibiotic therapy.
Occupational therapists as change agents in multidisciplinary teams
Authors: Brian Helen , Cook Sarah , Taylor Deborah , Freeman Lara , Mundy Tim , Killaspy Helen 
Published: July 2015

Introduction This qualitative study explored the experiences of occupational therapists attempting to implement change within multidisciplinary teams via a 5-week training intervention. This encouraged ward staff in inpatient mental health rehabilitation units to facilitate service user engagement in activities. This study is supplementary to a randomised control trial (RCT). Method Daily diaries and training reflections completed by two therapists (P1 and P2) during the training were subjected to Framework analysis. The indexing stage of this process was completed in collaboration with the participants. Findings When implementing change, the occupational therapists encountered a number of barriers such as emotional responses and attitudes towards service users. Facilitators of change included openness, sharing knowledge and skills, and reported change. The analysis revealed a change process moving from ‘assessing the context’, to ‘building relationships’ and ‘addressing issues’ that was aided by the therapists’ high-level skills and capacity for social and self-awareness. Conclusion The process of change aligned well with the chosen three-stage model of change as well as occupational therapy philosophy. When acting as change agents, the therapists adapted and applied their clinical skills to the organisational context in accord with their core values and capacity for social and self-awareness.
The experience of sleep for women with borderline personality disorder: An occupational perspective
Authors: Wood Anna , Brooks Rob , Beynon-Pindar Catherine 
Published: July 2015

Introduction Sleep difficulties are prevalent in borderline personality disorder; however, the experience of sleep for individuals with a diagnosis of borderline personality disorder has not been considered from an occupational therapy perspective. Method This study adopted a qualitative methodology. Semi-structured interviews were utilised to explore how sleep is experienced by four women with a diagnosis of borderline personality disorder, in an inpatient setting. Interviews were recorded and transcribed verbatim. Findings Through thematic analysis four themes were identified: ‘there isn’t a proper pattern or structure to my sleeps’, ‘sleep is getting away for me’, ‘before I came in [to the unit] my life–work balance was all chaotic’ and ‘I know the routine, but it doesn’t really seem to affect me’. These findings described the variety of problems experienced by participants with regard to sleep and the implications of sleep difficulties on occupational performance and participation. Conclusion Women with borderline personality disorder on an inpatient unit experienced a variety of sleep difficulties that impact on their ability to engage in occupations. Sleep and sleep difficulties should be explicitly addressed by occupational therapists and sleep interventions should be individually tailored; further research is required to examine occupational therapy interventions for sleep.
Beyond the Frame of Practical Reason: The Indian Evidence Act and Its Performative Life
Authors: Samaddar Ranabir 
Published: July 2015

AbstractThis article is about the Indian Evidence Act. It explains how evidence is the script that carries law's unconscious. One one hand, evidence is the site of reason, and on the other hand it is the performative site of the unconscious. The operation of the Evidence Act requires a court, arguments, ways of producing evidence, counter-arguments, scrutiny of the nature of the evidence submitted, and finally the disputation around what constitutes an evidence – and then the judgement. This article argues, through a brief presentation of the history of the Act, how law in this way combines the normative and the performative – science of inquiry and the unpredictable script of the outcome, procedure and the spectacle built around elements such as live deposition and the hermeneutic power of the image, rational considerations and emotion, virtuality and the event, serious business in the court and the element of drama. The article suggests (with a bit of irony) the injunction that to see what law is and how it functions we can go to the cinema, and to see what cinema is we can go to the court.
Estimating negative likelihood ratio confidence when test sensitivity is 100%: A bootstrapping approach
Authors: Marill Keith A , Chang Yuchiao , Wong Kim F , Friedman Ari B 
Published: July 2015

Objectives Assessing high-sensitivity tests for mortal illness is crucial in emergency and critical care medicine. Estimating the 95% confidence interval (CI) of the likelihood ratio (LR) can be challenging when sample sensitivity is 100%. We aimed to develop, compare, and automate a bootstrapping method to estimate the negative LR CI when sample sensitivity is 100%. Methods The lowest population sensitivity that is most likely to yield sample sensitivity 100% is located using the binomial distribution. Random binomial samples generated using this population sensitivity are then used in the LR bootstrap. A free R program, “bootLR,” automates the process. Extensive simulations were performed to determine how often the LR bootstrap and comparator method 95% CIs cover the true population negative LR value. Finally, the 95% CI was compared for theoretical sample sizes and sensitivities approaching and including 100% using: (1) a technique of individual extremes, (2) SAS software based on the technique of Gart and Nam, (3) the Score CI (as implemented in the StatXact, SAS, and R PropCI package), and (4) the bootstrapping technique. Results The bootstrapping approach demonstrates appropriate coverage of the nominal 95% CI over a spectrum of populations and sample sizes. Considering a study of sample size 200 with 100 patients with disease, and specificity 60%, the lowest population sensitivity with median sample sensitivity 100% is 99.31%. When all 100 patients with disease test positive, the negative LR 95% CIs are: individual extremes technique (0,0.073), StatXact (0,0.064), SAS Score method (0,0.057), R PropCI (0,0.062), and bootstrap (0,0.048). Similar trends were observed for other sample sizes. Conclusions When study samples demonstrate 100% sensitivity, available methods may yield inappropriately wide negative LR CIs. An alternative bootstrapping approach and accompanying free open-source R package were developed to yield realistic estimates easily. This methodology and implementation are applicable to other binomial proportions with homogeneous responses.
Role of a Limited Transarticular Release in Severe Hallux Valgus Correction
Authors: Wagner Emilio , Ortiz Cristian , Figueroa Francisco , Vela Omar , Wagner Pablo , Gould John S. 
Published: July 2015

Background: Hallux valgus (HV) treatment is continuously evolving, and no definitive treatment can be recommended. Osteotomies are the main surgical choice for these deformities, but no clear role for soft tissue procedures is available. Objective: To perform a retrospective comparison of the radiographic and clinical outcomes of 2 groups of patients with severe HV operated with the same osteotomy technique but differing on the type of lateral release. Methods: Two groups of patients with symptomatic moderate to severe HV deformities were operated with the same proximal metatarsal osteotomy, which differed on the type of lateral release: group 1 had limited transarticular lateral capsule release (n = 62), and group 2 complete lateral release, including capsule, adductor tendon, and intermetatarsal (IM) ligament (n = 57). We recorded the American Orthopaedic Foot & Ankle Society (AOFAS) score, HV and IM angles, first metatarsal shortening, concomitant metatarsal shortening osteotomies (Weil), Akin osteotomies, and complications. Results: The postoperative AOFAS score in group 1 was similar to that of group 2. The HV and IM angles improved in both groups with no significant difference. The multivariate analysis showed no influence of any variable analyzed on HV or IM angle improvement. Regarding AOFAS score improvement, a limited lateral release was associated with a higher increase in AOFAS score ( P = .019). Conclusion: No studies are available to identify which soft tissue structures are involved in HV deformities nor which have to be released, if any. A limited transarticular release can provide similar clinical and radiologic outcomes when compared with a classic open lateral release. Level of Evidence: Level IV, case series.
Why does increasing public access to medicines differ between countries? Qualitative comparison of nine countries
Authors: Gauld Natalie , Bryant Linda , Emmerton Lynne , Kelly Fiona , Kurosawa Nahoko , Buetow Stephen 
Published: July 2015

Objective To identify factors associated with differences between developed countries in reclassifying (switching) medicines from prescription to non-prescription availability. Methods Cross-national qualitative research using a heuristic approach in the US, UK, Japan, Australia and New Zealand, supplemented by data from Canada, Denmark, the Netherlands and Singapore. In-depth interviews with 80 key informants (65 interviews) explored and compared factors in terms of barriers and enablers to reclassification of medicines in each country. Document analysis supplemented interview data. Results Each country had a unique mix of enablers and barriers to reclassification. Enablers included government policy (particularly in UK), pharmacist-only scheduling (particularly in Australia and New Zealand) and large market size (particularly in the US and Europe). Local barriers included limited market potential in small countries, the cost of a reclassification (particularly in the US), competition from distributors of generic medicines, committee inconsistency and consumer behavior. UK had more enablers than barriers, whereas in Australia the opposite was true. Conclusions Different factors limit or enable reclassification, affecting consumer access to medicines in different countries. For countries attempting to reduce barriers to reclassification, solutions may include garnering government support for reclassification, support and flexibility from the medicines regulator, having a pharmacy-only and/or pharmacist-only category, providing market exclusivity, ensuring best practice in pharmacy, and minimizing the cost and delays of reclassification.
Preliminary Results of Mismatch Repair Deficiency Screening via Immunohistochemical Staining in Young Asian Colorectal Cancers
Authors: Koh Poh-Koon , Chew Min-Hoe , Tan Yan-Sheng , Lim Kiat-Hon , Loi Carol , Tang Choong-Leong , Eu Kong-Weng 
Published: July 2015

Background: The incidence of mismatch repair (MMR) deficiency in young colorectal cancers (CRC) remains unknown in Asians. This preliminary study assessed the clinicopathological features and efficacy of screening for MMR protein deficiency in young Asian CRC patients. Methods: From January 2006 to October 2009, patients under the age of 50 with immunohistochemical (IHC) staining for MMR proteins in resected CRC specimens were retrieved from a prospective computerised database. Results: Eighty unrelated patients comprising predominantly 80% Chinese (n = 64), with median age of diagnosis at 41 years (range 22–50 years) had IHC performed. Twenty-three per cent (n=18) of the patients had abnormal IHC staining. Loss of staining for MLH1, MSH2 and MSH6 proteins were observed in 18%, 2% and 6% of tumours respectively. Of the 15 patients who had abnormal staining of MLH1, three had concomitant equivocal staining for MSH6. One tumour specimen had abnormal staining in all 3 proteins. Multivariate analysis revealed that family history was the only significant predictive factor for defective MMR detection (OR 8.06, 95% CI 1.69–38.35, p=0.002). However if Amsterdam criteria alone were to be used, 72% (n=12) of the cohort would have not been detected for MMR gene defects. Conclusion: The overall burden of germline MMR deficiency in the Singapore population may be as high as 23%. Amsterdam criteria alone are insufficient to detect hereditary non-polyposis colorectal cancer (HNPCC) related patients. The use of IHC staining of at least 3 MMR proteins is a useful screening strategy for HNPCC diagnosis and routine screening of mismatch repair deficiency may be recommended for all young Asian CRC patients.
Cross-Sectional and Longitudinal Validity of the Hughston Clinic Knee Questionnaire in Arthroscopic Meniscal Repair
Authors: Pua Yong Hao , Lim Cheng Kuan 
Published: July 2015

Aim: To examine the cross-sectional and longitudinal convergent and discriminant validity and the sensitivity to change of the Hughston Clinic Knee Questionnaire (HCQ) in young adults with meniscal repair. Method: Seventeen young adults completed the HCQ and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at 1 week and at 6 weeks after an arthroscopic meniscal repair. Convergent validity was assessed by evaluating the correlation between the HCQ and the SF-36 physical function subscale. Discriminant validity from pain measure was assessed by examining the HCQ with the physical function and bodily pain subscales of the SF-36. Sensitivity to change was assessed using standardised response means. Spearman correlation coefficients were also calculated. Results: The HCQ showed moderate to strong cross-sectional and longitudinal convergent validity with the SF-36 physical function subscale; however, discriminant validity was not evident for the HCQ. The HCQ showed a larger standardised response mean than did the SF-36 physical function subscale. Conclusion: Cross-sectional and longitudinal convergent — but not discriminant — validity was established for the HCQ. Although the HCQ was more adept in detecting change scores than did the SF-36 physical function subscale, the reason for this finding was unclear.
Herbal/Health Supplements Intake by Polyclinic Patients on Warfarin
Authors: Goh Bandy Qiuling , Tan Swee Keng , Tay Siew Cheng Sarah , Goh Chin Chin , Lo Pauline Fei Ling , Tang Woh Peng , Khoo Shu Yuen Rachel 
Published: July 2015

Aims: It is well documented that many herbal/health supplements (collectively referred as supplements) interact with warfarin. This research aimed to study the prevalence and intake of supplements by SingHealth Polyclinics patients on warfarin, and their knowledge of and perception towards potential supplements-warfarin interactions. Methods: One hundred SingHealth Polyclinics patients who were on warfarin were recruited from 4 polyclinics. Each patient was interviewed in person and completed a 6-part survey. The results of the survey were statistically analysed. Results: In this 3-month study, a significant 42% of the patients took supplements concurrently with warfarin. Traditional Chinese Medicines, glucosamine and omega-3 fatty acids were the 3 most common supplements consumed. Eighty-nine per cent of the patients were unable to verbalise the supplements that could interact with warfarin. Out of the 42 patients who were on supplements, 74% (31 out of 42) felt that it was important to inform their healthcare professionals with regards to their supplements use. However, 45% (14 out of 31) of them did not inform their healthcare professionals. The correlation between the importance attached by patients to inform healthcare professionals about their supplements intake and their actual decision to inform their healthcare professionals was significant (p=0.0122). Doctors, pharmacists and family members were their top 3 sources of information when they needed advice before their intake of supplements. Conclusion: Patients' concurrent intake of supplements without informing their healthcare professionals poses potential risk to their health. Healthcare professionals can play a significant role in advancing medication safety by educating these patients on the possibility of supplements-warfarin interactions and the risk of interference with anticoagulation therapy. This study also highlighted supplements on which further research could be done to determine their potential for interactions with warfarin.
A Randomised Controlled Trial Evaluating the Efficacy of a Nurse Controlled Analgesia (NCA) Protocol in Post Anaesthesia Care Unit (PACU)
Authors: Tan Michelle , Tan Boon Suan , Wee Choo Neo , Yang Jumei , Gao Fei , Ho Kok-Yuen , Ong Sharon 
Published: July 2015

Introduction: The purpose of this trial was to determine the efficacy of a Nurse Controlled Analgesia (NCA) protocol in reducing the time taken to achieve a satisfactory postoperative pain score. The safety aspects of the NCA protocol were also evaluated. Method: 120 patients undergoing major surgery were randomised into 2 groups – NCA group and the doctor administered analgesia group (DRA). Nurses in the Post Anaesthestic Care Area (PACU) administered analgesia based on a protocol whereas analgesia was titrated at the discretion of the doctor in the DRA group. Effective pain control was measured by the time taken to obtain first dose of analgesia and the time taken to achieve either a pain score of less than 4/10 or if the patient refused further analgesia. Results: Patients received their first dose of morphine faster in the NCA group compared to DRA group, 6.7 minutes versus 9.5 minutes respectively (p= 0.037). Time taken to achieve a pain score of less than 4 was shorter in the doctor group although this was not significant. Complication rates were not different in both groups. Conclusion: Nurse administered analgesia based on a protocol can provide pain relief for patients in the postoperative period as effectively and safely as doctor administered analgesia.