bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Meridional Overturning Circulation in the Indian Ocean and Its Relation to Indian Ocean Dipole
Authors: Wang Weiqiang , Zhu Xiuhua , Wang Chunzai , Köhl Armin 
Published: April 2014

Abstract
This paper uses the 42-yr German Estimating the Circulation and Climate of the Ocean (GECCO) synthesis data to analyze and examine the relationship of the Indian Ocean deep meridional overturning circulation (DMOC) with the Indian Ocean dipole mode (IOD). Contributions of various dynamical processes are assessed by decomposing the DMOC into the Ekman and geostrophic transport, the external mode, and a residual term. The first three terms successfully describe the DMOC with a marginal residual term. The following conclusions are obtained. First, the seasonal cycle of the DMOC is mainly determined by the Ekman component. The exception is during the transitional seasons (March–April and September–October) in the northern Indian Ocean Basin, where the geostrophic component dominates. Second, at the beginning phase of the IOD (May–June), the Ekman component dominates the DMOC structure; at and after the peak phase of the IOD (September–December), the DMOC structure is primarily determined by the geostrophic component in correspondence with the well-developed sea surface temperature anomalies, while the wind (and thus the Ekman component) plays a secondary role south of 10°S and contributes negatively within the zonal band of 10° on both sides of the equator. Therefore, there exists a surface to deep-ocean connection through which IOD-related surface wind and ocean temperature anomalies are transferred down to the deep ocean. Westward-propagating signals are observed even in the deep ocean, suggesting possible roles of Rossby waves in transferring the surface signal to the deep ocean.
Quantifying the Summertime Response of the Austral Jet Stream and Hadley Cell to Stratospheric Ozone and Greenhouse Gases
Authors: Gerber Edwin P. , Son Seok-Woo 
Published: April 2014

Abstract
The impact of anthropogenic forcing on the summertime austral circulation is assessed across three climate model datasets: the Chemistry–Climate Model Validation activity 2 and phases 3 and 5 of the Coupled Model Intercomparison Project. Changes in stratospheric ozone and greenhouse gases impact the Southern Hemisphere in this season, and a simple framework based on temperature trends in the lower polar stratosphere and upper tropical troposphere is developed to separate their effects. It suggests that shifts in the jet stream and Hadley cell are driven by changes in the upper-troposphere–lower-stratosphere temperature gradient. The mean response is comparable in the three datasets; ozone has chiefly caused the poleward shift observed in recent decades, while ozone and greenhouse gases largely offset each other in the future.
The multimodel mean perspective, however, masks considerable spread in individual models’ circulation projections. Spread resulting from differences in temperature trends is separated from differences in the circulation response to a given temperature change; both contribute equally to uncertainty in future circulation trends. Spread in temperature trends is most associated with differences in polar stratospheric temperatures, and could be narrowed by reducing uncertainty in future ozone changes. Differences in tropical temperatures are also important, and arise from both uncertainty in future emissions and differences in models’ climate sensitivity. Differences in climate sensitivity, however, only matter significantly in a high emissions future. Even if temperature trends were known, however, differences in the dynamical response to temperature changes must be addressed to substantially narrow spread in circulation projections.
Retrieval of Atmospheric and Cloud Property Anomalies and Their Trend from Temporally and Spatially Averaged Infrared Spectra Observed from Space
Authors: Kato Seiji , Rose Fred G. , Liu Xu , Wielicki Bruce A. , Mlynczak Martin G. 
Published: April 2014

Abstract
A surface, atmospheric, and cloud (fraction, height, optical thickness, and particle size) property anomaly retrieval from highly averaged longwave spectral radiances is simulated using 28 years of reanalysis. Instantaneous nadir-view spectral radiances observed from an instrument on a 90° inclination polar orbit are computed. Spectral radiance changes caused by surface, atmospheric, and cloud property perturbations are also computed and used for the retrieval. This study’s objectives are 1) to investigate whether or not separating clear sky from cloudy sky reduces the retrieval error and 2) to estimate the error in a trend of retrieved properties. This simulation differs from earlier studies in that annual 10° latitude zonal cloud and atmospheric property anomalies defined as the deviation from 28-yr climatological means are retrieved instead of the difference of these properties from two time periods. The root-mean-square (RMS) difference of temperature and humidity anomalies retrieved from all-sky radiance anomalies is similar to the RMS difference derived from clear-sky radiance anomalies computed by removing clouds. This indicates that the cloud property anomaly retrieval error does not affect the retrieved temperature and humidity anomalies. When retrieval errors are nearly random, the error in the trend of retrieved properties is small. Approximately 30% of 10° latitude zones meet conditions that the true temperature and water vapor amount trends are within a 95% confidence interval of retrieved trends, and that the standard deviation of retrieved anomalies σret is within 20% of the standard deviation of true anomalies σn. If σret/σn − 1 is within ±0.2, 91% of the true trends fall within the 95% confidence interval of the corresponding retrieved trend.
Pan-Arctic and Regional Sea Ice Predictability: Initialization Month Dependence
Authors: Day J. J. , Tietsche S. , Hawkins E. 
Published: April 2014

Abstract
Seasonal-to-interannual predictions of Arctic sea ice may be important for Arctic communities and industries alike. Previous studies have suggested that Arctic sea ice is potentially predictable but that the skill of predictions of the September extent minimum, initialized in early summer, may be low. The authors demonstrate that a melt season “predictability barrier” and two predictability reemergence mechanisms, suggested by a previous study, are robust features of five global climate models. Analysis of idealized predictions with one of these models [Hadley Centre Global Environment Model, version 1.2 (HadGEM1.2)], initialized in January, May and July, demonstrates that this predictability barrier exists in initialized forecasts as well. As a result, the skill of sea ice extent and volume forecasts are strongly start date dependent and those that are initialized in May lose skill much faster than those initialized in January or July. Thus, in an operational setting, initializing predictions of extent and volume in July has strong advantages for the prediction of the September minimum when compared to predictions initialized in May.
Furthermore, a regional analysis of sea ice predictability indicates that extent is predictable for longer in the seasonal ice zones of the North Atlantic and North Pacific than in the regions dominated by perennial ice in the central Arctic and marginal seas. In a number of the Eurasian shelf seas, which are important for Arctic shipping, only the forecasts initialized in July have continuous skill during the first summer. In contrast, predictability of ice volume persists for over 2 yr in the central Arctic but less in other regions.
Confocal Laser Endomicroscopy in the Detection of Head and Neck Precancerous Lesions
Authors: Nathan Cherie‐Ann O. , Kaskas Nadine M. , Ma Xiaohui , Chaudhery Shubnum , Lian Timothy , Moore‐Medlin Tara , Shi Runhua , Mehta Vikas 
Published: April 2014

ObjectiveThis study aimed to determine the feasibility of using probe‐based confocal laser endomicroscopy (pCLE) in the diagnostic differentiation of non‐neoplastic lesions from precancerous and cancerous lesions of head and neck patients.Study DesignDiagnostic test evaluation.SettingLouisiana State University Health Shreveport.Subjects and MethodsIntravenous injection of fluorescein was given to patients with precancerous and cancerous head and neck lesions (n = 21) followed by the use of a 1.8‐mm GastroFlex probe in the oral cavity with subsequent biopsies of selected areas. Probe‐based confocal laser endomicroscopy images were compared to histologic evaluation of visualized sites using sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV).ResultsThe dorsal surface of the tongue was not well visualized. The remaining nonkeratinized subsites, including the buccal mucosa, floor of mouth, and ventral tongue, were well visualized. Diagnoses based on pCLE images correlated well with the gold standard diagnoses based on tissue histology. The overall sensitivity for diagnosis of dysplasia versus nondysplasia was 80.0% (95% confidence interval [CI], 62.0‐98.0), specificity and PPV were 100%, and the NPV was 80.0% (95% CI, 60.0‐100.0). The overall specificity, sensitivity, PPV, and NPV for pCLE diagnosis of carcinoma versus nondysplasia were 100%. The overall sensitivity for diagnosis of carcinoma versus dysplasia was 85.7% (95% CI, 73.0‐99.0), specificity and PPV were 100%, and the NPV was 80.0% (95% CI, 60.0‐100.0).ConclusionThe pCLE is a promising method for differentiating between nondysplastic, precancerous, and cancerous lesions of the head and neck.
Patterns of diagnoses among children and young adults with life-limiting conditions: A secondary analysis of a national dataset
Authors: Fraser Lorna K , Lidstone Victoria , Miller Michael , Aldridge Jan , Norman Paul , McKinney Patricia A , Parslow Roger C 
Published: April 2014

Background: Numbers of children and young people with life-limiting conditions are rising, and increasing lifespans require young adults with life-limiting condition to transit to appropriate adult services. Aim: To describe the prevalence of life-limiting condition in children and young adults by age, sex, diagnostic group, ethnicity and deprivation. Design: A secondary analysis of the English Hospital Episode Statistics dataset was undertaken to calculate prevalence per 10,000 population. Setting/participants: Individuals (0–40 years) with life-limiting conditions were identified within an English Hospital Episode Statistics dataset by applying a customised coding framework of International Classification of Diseases, 10th Edition, disease codes. Results: There were 462,962 inpatient hospital admissions for 92,129 individual patients with a life-limiting condition. Prevalence-by-age group curve is U shaped with the highest overall prevalence in the under 1-year age group (127.3 per 10,000), decreasing until age 21–25 years (21.1 per 10,000) before rising steeply to reach 55.5 per 10,000 in the 36–40 -year age group. The distribution by diagnostic group varies by age: congenital anomalies are most prevalent in children until age 16–20 years with oncology diagnoses then becoming the most prevalent. Conclusion: Non-malignant diagnoses are common in children and young adults, and services that have historically focussed on oncological care will need to widen their remit to serve this population of life-limited patients. The diagnosis determining a patient’s life-limiting condition will strongly influence their palliative care service needs. Therefore, understanding the diagnostic and demographic breakdown of this population of teenagers and young adults is crucial for planning future service provision.
Ketamine infusions for treatment resistant depression: a series of 28 patients treated weekly or twice weekly in an ECT clinic
Authors: Diamond Peter R , Farmery Andrew D , Atkinson Stephanie , Haldar Jag , Williams Nicola , Cowen Phil J , Geddes John R , McShane Rupert 
Published: April 2014

Background: Ketamine has a rapid antidepressant effect in treatment-resistant depression (TRD). The effects on cognitive function of multiple ketamine infusions and of concurrent antidepressant medication on response rate and duration are not known. Method: Twenty-eight patients with uni- or bipolar TRD were treated over three weeks with either three or six ketamine infusions (0.5 mg/kg over 40 minutes) in the recovery room of a routine ECT clinic. Post-treatment memory assessments were conducted on day 21 (4–7 days after the final infusion). Patients were followed up for six months where possible, with severity of depression and side effects monitored throughout. Results: Eight (29%) patients responded of whom four remitted. Only three (11%) patients had responded within six hours after a single infusion, but in all responders, the response had developed before the third infusion. The duration of response from the final infusion was variable (median 70, range 25–168 days). Discontinuations included two (7%) because of acute adverse reactions during the infusion and five (18%) because of failure to benefit and increasing anxiety. Ketamine was not associated with memory impairment. The ECT clinic was rated suitable by patients and offered appropriate levels of monitoring. Conclusion: This small, open label naturalistic study shows that up to six low dose ketamine infusions can safely be given within an existing NHS clinical structure to patients who continue their antidepressants. The response rate was comparable to that found in RCTs of single doses of ketamine in antidepressant-free patients but took slightly longer to develop.
Functional Outcomes and Return to Sports After Acute Repair, Chronic Repair, and Allograft Reconstruction for Proximal Hamstring Ruptures
Authors: Rust David A. , Giveans M. Russell , Stone Rebecca M. , Samuelson Kathryn M. , Larson Christopher M. 
Published: April 2014

Background: There are limited data regarding outcomes and return to sports after surgery for acute versus chronic proximal hamstring ruptures. Hypothesis: Surgery for chronic proximal hamstring ruptures leads to improved outcomes and return to sports but at a lower level than with acute repair. Proximal hamstring reconstruction with an Achilles allograft for chronic ruptures is successful when direct repair is not possible. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2002 and 2012, a total of 72 patients with a traumatic proximal hamstring rupture (51 acute, 21 chronic) underwent either direct tendon repair with suture anchors (n = 58) or Achilles allograft tendon reconstruction (n = 14). Results from the Single Assessment Numeric Evaluation (SANE) for activities of daily living (ADL) and sports-related activities, Short Form–12 (SF-12), visual analog scale (VAS), and a patient satisfaction questionnaire were obtained. Results: The mean time to surgery in the chronic group was 441.4 days versus 17.8 days in the acute group. At a mean follow-up of 45 months, patients with chronic tears had inferior sports activity scores (70.2% vs 80.3%, respectively; P = .026) and a trend for decreased ADL scores (86.5% vs 93.3%, respectively; P = .085) compared with those with acute tears. Patients with chronic tears, however, reported significant improvements postoperatively for both sports activity scores (30.3% to 70.2%; P < .01) and ADL scores (56.1% to 86.5%; P < .01). Greater than 5 to 6 cm of retraction in the chronic group was predictive of the need for allograft reconstruction ( P = .015) and resulted in ADL and sports activity scores equal to those of chronic repair ( P = .507 and P = .904, respectively). There were no significant differences between groups in SF-12, VAS, or patient satisfaction outcomes (mean, 85.2% satisfaction overall). Conclusion: Acute repair was superior to chronic surgery with regard to return to sports. Acute and chronic proximal hamstring repair and allograft reconstruction had favorable results for ADL. For low-demand patients or those with medical comorbidities, delayed repair or reconstruction might be considered with an expected 87% return to normal ADL. For patients who desire to return to sports, acute repair is recommended.
Morphological Characteristics of the Repaired Labrum According to Glenoid Location and Its Clinical Relevance After Arthroscopic Bankart Repair
Authors: Kim Jae-Yoon , Chung Seok Won , Kwak Joo Young 
Published: April 2014

Background: There have been no studies on the postoperative morphological characteristics of the restored labrum at different glenoid locations and its clinical relevance after arthroscopic Bankart repair with suture anchors. Purpose: To analyze the morphological characteristics of the restored labrum at different locations of the glenoid and their relevance to clinical outcomes as well as affecting factors and to trace the inserted suture anchors after arthroscopic Bankart repair using computed tomography arthrography (CTA). Study Design: Case series; Level of evidence, 4. Methods: A total of 46 patients (mean age, 26.5 ± 6.8 years) who underwent arthroscopic Bankart repair with absorbable suture anchors were enrolled in this study. Patients underwent CTA preoperatively and 6 months postoperatively as well as functional outcome evaluation preoperatively and at the last follow-up (>24 months) with the Rowe score and visual analog scale for pain. Labral height and width were measured on conventional axial CTA images at the 3-, 4-, and 5-o’clock positions twice by 2 raters. The postoperative measurements were also compared with those of the healthy anterior labrum, acquired from the same CTA examination of 32 consecutive patients (mean age, 26.5 ± 8.5 years) with superior labral lesions in the same study period. The postoperative difference in the measurements and between clock positions, and the relationship between the measurements and the clinical factors and functional outcomes, were evaluated. In addition, the locations of all suture anchors were traced on each CTA image, and outcomes according to the locations of the most inferior suture anchors were assessed. Results: The interobserver and intraobserver reliabilities of measurements at each location were excellent (Pearson correlation coefficient = 0.773-0.988). Of the 46 patients, 2 (4.35%) had redislocations after surgery. Postoperative labral height and width were significantly increased at all locations (all P < .001) up to a level similar to the healthy anterior labrum, with significantly larger values at the inferior location compared with the superior location (all P < .05). Patients who had a greater frequency of dislocations before surgery showed a lower postoperative labral height at the 5-o’clock position ( P = .012), and this correlated with postoperative instability and poor functional outcomes by the Rowe score ( P = .036). In most patients (41/46; 89.1%), the tips of the lowest suture anchors perforated the far cortex, and these anchors were mostly located below the 5-o’clock position (32/41; 78.0%). However, perforation of the far cortex did not affect functional outcomes. Conclusion: Surgeons should be cautious of restoring labral height at the inferior glenoid location for successful arthroscopic Bankart repair. In addition, attention should be given to inserting the lowest suture anchor regardless of clinical significance.
Social-structural indices and between-nation differences in HIV prevalence
Authors: Tan Judy Y , Earnshaw Valerie A , Pratto Felicia , Rosenthal Lisa , Kalichman Seth 
Published: April 2014

Summary Research emphasises the role that social structures play in shaping national HIV prevalence. This study examined how social, economic, and political contexts that may represent the confluence of individual capabilities and environmental affordances or constraints are associated with national HIV prevalence. Based on social-ecological perspectives, we examined social-structural dimensions in relation to national HIV prevalence. The study identified six publicly available nation-level social, political, and economic indices and examined their associations with national 2009 HIV prevalence across 225 nations. National indices, (a) education expenditures, (b) unemployment rate, (c) homicide rate, (d) freedom of religion, and (e) women's social rights, altogether explained 43% of the variability in national HIV prevalence. Education expenditures, homicide rate, and freedom of religion were significant predictors of national HIV prevalence in the multivariate analysis. The present study identified nation-level factors that capture social, economic, and political contexts to explain between-nation differences in HIV prevalence. Findings extend current literature on the social-structural foundation of HIV-risk and the relationship between human rights and health. National safeguards that afford individuals the power to promote general quality of life and protection from structural violence may be most important to lowering overall rates of HIV transmission.
The IAPT@Flinders Service: adapting the Improving Access to Psychological Therapies model to the emergency department setting in Australia
Authors: Bastiampillai Tarun , Jones Gabrielle M , Furber Gareth , Moreau Michele , Healey David , Watson Julianne , Battersby Malcolm 
Published: April 2014

Objective: To describe the implementation of an Improving Access to Psychological Therapies (IAPT) service at Flinders Medical Centre emergency department (IAPT@Flinders). IAPT, a population-based model of guided self-help for anxiety and depression delivered mainly by phone, was rolled-out nationally in the UK in 2010. There is a growing body of evidence demonstrating its clinical effectiveness and efficiency that can improve treatment adherence, reduce stigma, remove appointment attendance barriers and improve access for hard-to-reach populations. Conclusions: IAPT@Flinders was the test site for the first IAPT in Australia and also the first IAPT service that was integrated with an emergency department (ED). IAPT@Flinders offers rapid access, low-intensity cognitive behavioural therapy, social prescribing and signposting to clients with adjustment disorders, anxiety and/or depressive symptoms. Successful implementation within an Australian crisis setting has demonstrated that many IAPT structures and protocols are applicable to ED settings and the model can be implemented with fidelity. Adaption required consideration of positioning of the service within the Australian mental health framework; staff qualifications; the referral pathways; and exclusion criteria. It is recommended additional test sites and larger scale trials are conducted to provide further evidence of the applicability of large-scale adoption of the UK IAPT model into Australian ED settings.
A case of anorexia nervosa in an elderly man
Authors: Malik Fahd , Wijayatunga Uditha , Bruxner George M 
Published: April 2014

Objective: To explore aspects of anorexia nervosa occurring in older populations, especially men, by reviewing the literature and presenting a case study of an elderly man with unexplained vomiting and weight loss. Method: The literature is reviewed and an illustrative case study of an elderly man with unexplained vomiting and weight loss is described. Conclusions: Anorexia nervosa is an uncommon cause of unexplained weight loss in the elderly, but may be under-recognized and associated with a high level of mortality.