bluuebunny/crossref_metadata_2025_split huggingface dataset:
Why Eddy Momentum Fluxes are Concentrated in the Upper Troposphere
Authors: Ait-Chaalal Farid , Schneider Tapio 
Published: December 2014

Abstract
The extratropical eddy momentum flux (EMF) is controlled by generation, propagation, and dissipation of large-scale eddies and is concentrated in Earth’s upper troposphere. An idealized GCM is used to investigate how this EMF structure arises. In simulations in which the poles are heated more strongly than the equator, EMF is concentrated near the surface, demonstrating that surface drag generally is not responsible for the upper-tropospheric EMF concentration. Although Earth’s upper troposphere favors linear wave propagation, quasi-linear simulations in which nonlinear eddy–eddy interactions are suppressed demonstrate that this is likewise not primarily responsible for the upper-tropospheric EMF concentration. The quasi-linear simulations reveal the essential role of nonlinear eddy–eddy interactions in the surf zone in the upper troposphere, where wave activity absorption away from the baroclinic generation regions occurs through the nonlinear generation of small scales. In Earth-like atmospheres, wave activity that is generated in the lower troposphere propagates upward and then turns meridionally, eventually being absorbed nonlinearly in the upper troposphere. The level at which the wave activity begins to propagate meridionally appears to be set by the typical height reached by baroclinic eddies. This can coincide with the tropopause height but also can lie below it if convection controls the tropopause height. In the latter case, EMF is maximal well below the tropopause. The simulations suggest that EMF is concentrated in Earth’s upper troposphere because typical baroclinic eddies reach the tropopause.
Long-Term Mortality Rates in Acute De Novo Versus Acute-on-Chronic Heart Failure
Authors: AlHabib Khalid F. , Kashour Tarek , Elasfar Abdelfatah A. , Alfaleh Hussam , Hersi Ahmad , Alshamiri Mostafa , Alshaer Fayez , Mimish Layth , Almasood Ali , AlHabeeb Waleed , AlGhamdi Saleh , Ghabashi Abdullah , Asfina KaziNur , Altaradi Hani , Alnobani Omar , Alkamel Nour , Thalib Lukman 
Published: December 2014

Aim: The heart function assessment registry trial in Saudi Arabia (HEARTS) is a national multicenter project that compared de novo versus acute-on-chronic heart failure (ACHF). Methods and Results: This is a prospective registry in 18 hospitals in Saudi Arabia between October 2009 and December 2010. The study enrolled 2610 patients: 940 (36%) de novo and 1670 (64%) ACHF. Patients with ACHF were significantly older (62.2 vs 60 years), less likely to be males (64% vs 69%) or smokers (31.6% vs 36.7%), and more likely to have history of diabetes mellitus (65.7% vs 61.3%), hypertension (74% vs 65%), and severe left ventricular dysfunction (52% vs 40%). The ACHF group had a higher adjusted 3-year mortality rate (hazard ratio, 1.6; 95% confidence interval [CI] 1.3-2.0; P < .001). Conclusion: Patients with ACHF had significantly higher long-term mortality rates than those with de novo acute heart failure (HF). Multidisciplinary HF disease management programs are highly needed for such high-risk populations.
Voice Quality in Laryngotracheal Stenosis
Authors: Hillel Alexander T. , Karatayli-Ozgursoy Selmin , Benke James R. , Best Simon , Pacheco-Lopez Paulette , Teets Kristine , Starmer Heather , Akst Lee M. 
Published: December 2014

Objective: To assess the impact of suspension microlaryngoscopy with balloon dilation on voice-related quality of life (V-RQOL) in laryngotracheal stenosis (LTS). Methods: Retrospective chart review of LTS patients dilated at a tertiary-care academic hospital from 2010 to 2013. Data were obtained and then analyzed. LTS was stratified by (1) subglottic or tracheal stenosis and (2) multilevel stenosis (MLS; glottic and subglottic/tracheal). Pre- and postoperative V-RQOL and grade, roughness, breathiness, asthenia, strain (GRBAS) scores were compared. The number and frequency of balloon dilation procedures over the lifetime were secondary outcome variables. Results: Thirty-eight patients were identified: 26 subglottic/tracheal and 12 multilevel. Of these, 71.4% required multiple dilations, with greatest dilations/patient for multilevel stenosis (4.8). V-RQOL improved in the 27 patients with completed pre- and postoperative scores from a mean of 70.4 to 80 ( P = .025). Pre/postoperative V-RQOLs for tracheal/subglottic (mean, 82.8/93.8) were significantly higher ( P = .0001/.0001) than multilevel stenosis (48/55.3). Voice quality-of-life improvement was significant for the subglottic/tracheal cohort ( P = .036) but not for the MLS group. GRBAS was performed pre- and postoperatively in 10 patients with improvement in all domains except breathiness. Conclusion: Laryngotracheal stenosis is associated with dysphonia. Patients with glottic involvement have significantly worse voice quality of life than those with tracheal/subglottic stenosis. Endoscopic balloon dilation improves V-RQOL in patients with subglottic/tracheal stenosis.
Stimulant use disorders in people with psychosis: A meta-analysis of rate and factors affecting variation
Authors: Sara Grant E , Large Matthew M , Matheson Sandra L , Burgess Philip M , Malhi Gin S , Whiteford Harvey A , Hall Wayne D 
Published: December 2014

Objective: Stimulant abuse and dependence often complicate the care of people with psychotic disorders. This study systematically reviews the prevalence estimates reported for stimulant abuse and dependence in people with psychotic disorders, and examines personal, clinical, regional and methodological factors which explain variation in these rates. Methods: PsychINFO, EMBASE and MEDLINE (1946–2013) were searched systematically for studies reporting on stimulant drug use disorders in representative samples of people with psychotic disorders. Random effects models estimated the pooled rate of a stimulant use disorder, defined to include stimulant abuse and stimulant dependence. Study characteristics associated with heterogeneity in rates of stimulant use disorder were examined by subgroup analyses for categorical variables, by meta-regression for continuous independent variables and by multiple meta-regression. Results: Sixty-four studies provided 68 estimates of lifetime or recent stimulant use disorders in 22,500 people with psychosis. The pooled rate of stimulant use disorder was 8.9% (95% CI 7.4%, 10.5%). Higher rates of stimulant use disorders were reported in studies of affective psychosis, studies from inpatient settings, studies from the USA and Australia, and studies with higher rates of cannabis disorder; in multiple meta-regression analysis these factors explained 68% of between-study variance. Rates of stimulant use disorder were stable over time, and unrelated to age, sex, stage of psychosis, type of stimulant drug or study methodology factors. Conclusions: Reported rates of stimulant use disorder in people with psychosis are much higher than in the general population but vary widely and are associated with regional, service setting and clinical differences between studies. It is likely that stimulants contribute to the overall burden of psychosis, and that social and environmental factors combine with drug and illness-related factors to influence stimulant use in psychosis.
Bargaining and informal interactions in the national budget: a game theory analysis of the Israeli case
Authors: Cohen Nissim 
Published: December 2014

This article suggests a game theory analysis of the interaction between Israeli politicians and bureaucrats regarding the national budget process since the 1980s. During the 1970s and 1980s new structural conditions created new formal and informal rules that weakened Israeli politicians’ bargaining position vis-à-vis the Ministry of Finance (MOF). The 1985 Israeli Economic Stabilization Plan not only changed the formal political institutions, but also created new informal institutions. Under the new circumstances, Israeli politicians can rarely challenge the MOF in the political bargaining process. Given that the MOF officials are aware of Israel’s internal processes and public opinion, attempts by Israeli politicians to create the impression that they are willing to challenge the MOF officials are unlikely. We demonstrate that this situation may ultimately lead to a sub-optimal equilibrium for Israel’s social welfare because the balance of power between the players favors one dominant side – the MOF officials. Points for practitioners This article provides insights into how institutional change and various formal and informal political strategies are played out in budgetary decision-making. When structural conditions create new formal and informal rules that weaken politicians’ bargaining position vis-à-vis the Ministry of Finance, politicians may find it very hard to challenge the Ministry of Finance officials. The results may include the creation of a significant gap between public opinion and the socioeconomic policy in practice. The key for preventing such scenarios is making sure, via strong institutions, that the balance of power between the players will not favor one dominant side.
Development of a novel indirect-expansion solar-assisted multifunctional heat pump with four heat exchangers
Authors: Wang Q , Ren B , Zeng ZY , He W , Liu YQ , Xiangguo Xu , Chen GM 
Published: December 2014

A novel indirect-expansion solar-assisted multifunctional heat pump with four heat exchangers was proposed in this paper, which integrates a heat pump air conditioner, a solar water heater and a heat pump water heater. In addition to these three basic operation modes, it also provided five energy-saving operation modes, which resulted in a higher utilization ratio of the solar energy and lower operational cost. Experiments of the solar-assisted space heating mode, air source heat pump water heating mode and solar-assisted heat pump water heating mode have been investigated in detail at different outdoor temperatures and different water temperatures. The novel indirect-expansion solar-assisted multifunctional heat pump is especially suitable for the regions abundant in solar radiation where the space heating, space cooling and water heating are required all the year round. Practical applications: The novel IX-SAMHP can provide space cooling, space heating, hot water by one system. The space used for those appliances can be reduced effectively. Solar energy was used to assist the space heating and water heating and defrost process and it can save the energy consumption efficiently.
Severity of Childhood Obstructive Sleep Apnea and Hypertension Improved after Adenotonsillectomy
Authors: Lee Li‐Ang , Li Hsueh‐Yu , Lin Yu‐Sheng , Fang Tuan‐Jen , Huang Yu‐Shu , Hsu Jen‐Fu , Wu Che‐Ming , Huang Chung‐Guei 
Published: December 2014

ObjectiveTo report improvements in childhood obstructive sleep apnea (OSA) and hypertension after adenotonsillectomy.Study DesignCase series with planned data collection.SettingTertiary referral center.Subjects and MethodsFifty consecutive patients (36 boys and 14 girls; median age, 7.0 years) who underwent plasma knife–assisted total tonsillectomy and adenoidectomy for OSA between January 2010 and March 2013 were assessed with the body mass index z score, apnea‐hypopnea index (AHI), systolic blood pressure (BP), and diastolic BP at baseline and at ≥6 months postoperatively. Changes in these parameters were statistically analyzed using nonparametric tests with the bootstrap approach.ResultsThe median follow‐up period was 9.6 months. Postoperatively, the median AHI significantly reduced from 9.8 to 1.6 (P <. 001). Although the median systolic BP and diastolic BP insignificantly changed in the overall group, both were significantly reduced in children with preoperative hypertension (systolic: from 119.0 to 113.0 [P =. 038]; diastolic: from 79.0 to 68.0 [P =. 005]). Accordingly, the hypertension rate significantly reduced from 34% to 14% (P =. 006). However, the change in OSA severity was not well correlated with the change in hypertension severity. In multiple logistic regression analysis with forward selection, a combination of preoperative hypertension and severe OSA was a significant predictor of postoperative hypertension (relative risk, 15.4; 95% confidence interval, 3.7‐64.3; P <. 001).ConclusionThe decreased hypertension rate indicates that a reduction of the AHI is not all that matters after adenotonsillectomy in childhood OSA. However, patients with preoperative severe OSA and hypertension need careful management of their elevated BP despite surgical treatment.
Routine Computed Tomography in the Evaluation of Vocal Fold Movement Impairment without an Apparent Cause
Authors: Chen Diane W. , Young Alex , Donovan Donald T. , Ongkasuwan Julina 
Published: December 2014

ObjectiveRoutine computed tomography (CT) for vocal fold movement impairment (VFMI) without an apparent cause is common. However, given increased cancer risk associated with ionizing radiation exposure, our purpose is to evaluate the utility of routine scans for these patients.Study DesignRetrospective case series.SettingHouston, Texas.Subjects and MethodsA 5‐year review of patients with VFMI diagnosed at an academic institution was conducted. For patients without an apparent cause (eg, recent head, neck, or cardiothoracic surgery or known malignancy), CT head/neck and chest was performed to evaluate the recurrent laryngeal nerve course. Data included demographics, symptoms, radiography, and interventions. Statistical analyses were performed via χ2 analysis.ResultsOf 406 patients with VFMI, 47 (11%) patients had no apparent cause clinically. Routine CT revealed abnormalities in 10 (21%) patients, of which only 3 (6%) could account for VFMI: benign thyroid adenoma (1), papillary thyroid cancer (1), and an esophageal mass (1). The most common lesion detected involved the thyroid. Demographic data and symptom type were not significantly associated with detection of a VFMI‐attributable lesion on CT. Overall, routine CT did not identify a focal etiology in 94% patients with VFMI without an apparent cause.ConclusionRoutine pan‐CT evaluation failed to reveal an etiology in 94% of patients with VFMI without an apparent cause. Patients may be subjected to health risks associated with radiation exposure without significant diagnostic benefit. Further studies should consider more judicious use of CT in the context of risk factors and safer imaging modalities as the initial diagnostic step.
Doctors’ and nurses’ views and experience of transferring patients from critical care home to die: A qualitative exploratory study
Authors: Coombs Maureen , Long-Sutehall Tracy , Darlington Anne-Sophie , Richardson Alison 
Published: December 2014

Background: Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. Aim: To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. Design: Exploratory two-stage qualitative study Setting/participants: Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. Findings: The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. Conclusion: There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting.
Inviting parents to take part in paediatric palliative care research: A mixed-methods examination of selection bias
Authors: Crocker Joanna C , Beecham Emma , Kelly Paula , Dinsdale Andrew P , Hemsley June , Jones Louise , Bluebond-Langner Myra 
Published: December 2014

Background: Recruitment to paediatric palliative care research is challenging, with high rates of non-invitation of eligible families by clinicians. The impact on sample characteristics is unknown. Aim: To investigate, using mixed methods, non-invitation of eligible families and ensuing selection bias in an interview study about parents’ experiences of advance care planning (ACP). Design: We examined differences between eligible families invited and not invited to participate by clinicians using (1) field notes of discussions with clinicians during the invitation phase and (2) anonymised information from the service’s clinical database. Setting: Families were eligible for the ACP study if their child was receiving care from a UK-based tertiary palliative care service (Group A; N = 519) or had died 6–10 months previously having received care from the service (Group B; N = 73). Results: Rates of non-invitation to the ACP study were high. A total of 28 (5.4%) Group A families and 21 (28.8%) Group B families ( p < 0.0005) were invited. Family–clinician relationship appeared to be a key factor associated qualitatively with invitation in both groups. In Group A, out-of-hours contact with family was statistically associated with invitation (adjusted odds ratio 5.46 (95% confidence interval 2.13–14.00); p < 0.0005). Qualitative findings also indicated that clinicians’ perceptions of families’ wellbeing, circumstances, characteristics, engagement with clinicians and anticipated reaction to invitation influenced invitation. Conclusion: We found evidence of selective invitation practices that could bias research findings. Non-invitation and selection bias should be considered, assessed and reported in palliative care studies.
Sleep Disturbance and Neurocognitive Function During the Recovery From a Sport-Related Concussion in Adolescents
Authors: Kostyun Regina O. , Milewski Matthew D. , Hafeez Imran 
Published: December 2014

Background: Sleep disturbances are a hallmark sign after a sport-related concussion (SRC). Poor sleep has been shown to adversely affect baseline neurocognitive test scores, but it is not comprehensively understood how neurocognitive function is affected by disrupted sleep during recovery from a concussion. Purpose: To identify the correlation between adolescent athletes’ neurocognitive function and their self-reported sleep quantity and sleep disturbance symptoms during recovery from SRC. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Immediate Post-Concussion Assessment and Cognition Testing (ImPACT) data were retrospectively collected for 545 adolescent athletes treated for SRC at a sports medicine concussion clinic. Patients were stratified into groups based on 2 criteria: self-reported sleep duration and self-reported sleep disturbance symptoms during postinjury ImPACT testing. Sleep duration was classified as short (<7 hours), intermediate (7-9 hours), and long (>9 hours). Sleep disturbance symptoms were self-reported as part of the Post-Concussion Symptom Scale (PCSS) as either sleeping less than normal, sleeping more than normal, or having trouble falling asleep. One-way analyses of variance were conducted to examine the effects that sleep duration as well as self-reported sleep disturbance symptoms had on composite scores. A total of 1067 ImPACT tests were analyzed: test 1, 545; test 2, 380; and test 3, 142. Results: Sleeping fewer than 7 hours the night before testing correlated with higher PCSS scores ( P < .001), whereas sleeping longer than 9 hours correlated with worse visual memory ( P = .01), visual motor speed ( P <.001), and reaction time ( P = .04) composite scores. With regard to self-reported sleep disturbance symptoms, patients demonstrated worse composite scores during ImPACT testing when they self-reported sleeping more than normal (ImPACT test 1: verbal memory, P < .001; visual motor speed, P = .05; reaction time, P = .01; ImPACT test 2: verbal memory, P < .001; visual memory, P < .001; visual motor speed, P < .001; reaction time, P = .01). Adolescent patients recovering from SRC demonstrated higher (worse) PCSS scores ( P < .001) when they sensed that their sleep had been disrupted. Conclusion: Adolescent patients who perceive that their sleep is somehow disrupted after SRC may report a greater number of concussion symptoms during their recovery. In addition, the study results suggest that sleeping more than normal may identify an individual who continues to be actively recovering from concussion, given the correlation between lower neurocognitive function and this self-reported symptom.
Anterior Cruciate Ligament Reconstruction With Contralateral Autogenous Patellar Tendon Graft
Authors: Shelbourne K. Donald , Beck Matthew B. , Gray Tinker 
Published: December 2014

Background: Few surgeons use a contralateral patellar tendon autograft for primary anterior cruciate ligament (ACL) reconstruction because of concern for donor site morbidity. Hypothesis: There will be no difference in quadriceps muscle strength or International Knee Documentation Committee (IKDC) subjective scores in patients with contralateral grafts compared with patients with ipsilateral grafts. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2007 and 2009, a total of 279 patients who underwent primary ACL reconstruction with autogenous patellar tendon graft from the contralateral knee met the inclusion criteria of unilateral knee involvement, no arthritic changes preoperatively, and minimum 2-year follow-up objective and subjective evaluations. A control group was obtained of 58 patients who had the same inclusion criteria and were of the same age but who underwent surgery with ipsilateral graft. Patients underwent a goal-directed and sequential postoperative rehabilitation program that first emphasized controlling a hemarthrosis and obtaining full knee range of motion immediately after surgery, followed by increasing leg strength and performing functional activities. The rehabilitation for the contralateral donor site emphasized high-repetition/low-resistance exercises beginning the day after surgery. The IKDC subjective data were compared between surgery groups. Quadriceps muscle strength was evaluated in both knees compared with the preoperative values obtained in the noninvolved knee and between knees at 2 years postoperatively. Results: Quadriceps muscle strength compared with the preoperative normal value (mean ± SD) was 105% ± 29% in the ipsilateral ACL-reconstructed knee versus 114% ± 28.4% in the contralateral donor knee ( P < .01) and 116% ± 25% in the contralateral ACL-reconstructed knee ( P = .0339). Mean side-to-side strength (ACL-reconstructed knee/opposite knee) was 98.4% ± 13.6% in the contralateral group versus 92.9% ± 13.0% in the ipsilateral group ( P < .01). The mean total IKDC score was 92.4 ± 9.6 for the contralateral donor knee. The mean IKDC total score for the ACL-reconstructed knee was 88.8 ± 12.3 in the contralateral group and 88.9 ± 11.2 in the ipsilateral group ( P = .626). Conclusion: After ACL reconstruction with contralateral patellar tendon graft, patients can achieve strength symmetry between legs after surgery without experiencing adverse subjective symptoms after graft harvest. Furthermore, strength return can be superior with a contralateral graft than with an ipsilateral graft.