bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sensitivity of Arctic Climate Variability to Mean State: Insights from the Cretaceous
Authors: Poulsen Christopher J. , Zhou Jing 
Published: March 2013

Abstract
This study investigates Arctic climate variability during a period of extreme warmth using the Community Climate System Model, version 3 (CCSM3) coupled ocean–atmosphere general circulation model. Four mid-Cretaceous simulations were completed with different CO2 levels (1, 10, and 16 times preindustrial levels with dynamic vegetation) and vegetation treatments (10 times with specified uniform bare ground). The magnitude and frequency of Arctic temperature variability is highly sensitive to the mean state and high-latitude upper-ocean static stability. As stability increases with a rise in CO2 levels from 1 to 10 times preindustrial levels, the frequency of temperature variability increases from decades (1x) to centuries (10x with bare ground) and longer (10x) and the peak-to-peak magnitude increases from ~1° (for 1x) to ~2°C (for 10x). In the 16x simulation with a highly stratified ocean, Arctic temperature variability is low with peak-to-peak magnitudes &lt;0.5°C. Under low CO2, Arctic climate variability is tied to sensible heat release from the ocean during movement of the sea ice margin. In absence of substantial sea ice, variability is driven by mass transport and upper-ocean salinity advection into the Arctic. In both cases, destruction of low-level clouds acts as an important feedback on low-level warming. The authors also report a link between unforced Arctic climate variability and North Pacific meridional overturning with warming events leading intensification. These results suggest that the nature of Arctic climate variability was likely much different in past climates and is likely to be so in the future.
The evolution of Public Service Bargains of Australian senior public servants
Authors: Halligan John 
Published: March 2013

The agreements between the Australian senior public service and the political executive have undergone several shifts during the reform era of the last thirty years. These have involved fundamental redefinitions of the role, responsibilities, identity and autonomy of the senior public servant.There has been a succession of challenges to the relationship focusing on the role and status of the public service on the one hand and the behaviour and resources of the political executive on the other. Over time the trend has been towards strengthening the political executive, but punctuated by debates about issues that slowed the rate of change and contained political pressures on the public service. This process has produced clarifications of central aspects of the relationship and a clearer articulation of the range of roles provided by departmental secretaries. The article examines the evolution of public service bargains centred on the changing roles of the secretaries of departments of state, and analyses the implications of the changing relationship for the role and functioning of the public service in governance and public policy. Points for practitioners The article addresses how the roles of departmental secretaries in Australia have varied in significance during the reform era. A new arrangement has now emerged which clearly articulates the roles and codifies them. One of the roles, stewardship, recognizes that secretaries have a part to play independently of ministers.
New Public Management, Public Service Bargains and the challenges of interdepartmental coordination: a comparative analysis of top civil servants in state administration
Authors: Hansen Morten Balle , Steen Trui , Jong Marsha de 
Published: March 2013

In this article we are interested in how the coordinating role of top civil servants is related to the argument that country-level differences in the adoption of New Public Management significantly alter the Public Service Bargains of top civil servants and consequently their capacity to accomplish interdepartmental coordination. A managerial PSB limits top civil servants’ role in interdepartmental coordination, as their focus will be on achieving goals set for their specific departments, rather than for the central government as a collective. We test our argument with empirical insights from a comparative analysis of five countries: Belgium, Canada, Denmark, the Netherlands and the United Kingdom. We find that our argument is only partly valid and discuss the theoretical and empirical implications of the analysis. Points for practitioners Alongside the introduction of New Public Management, the relationships between ministers and their top civil servants in state administration have evolved. At the same time, societal issues are getting more complex and demand a holistic, cross-sector approach. The concept of a managerial Public Service Bargain is used to analyze changes in top civil servants’ role and the impact of reforms on the capacity of top civil servants to accomplish interdepartmental coordination. Practitioners can learn more about the close link between challenges for interdepartmental coordination and changes in the role and functioning of top civil servants.
Neck Strength Imbalance Correlates With Increased Head Acceleration in Soccer Heading
Authors: Dezman Zachary D.W. , Ledet Eric H. , Kerr Hamish A. 
Published: March 2013

Background: Soccer heading is using the head to directly contact the ball, often to advance the ball down the field or score. It is a skill fundamental to the game, yet it has come under scrutiny. Repeated subclinical effects of heading may compound over time, resulting in neurologic deficits. Greater head accelerations are linked to brain injury. Developing an understanding of how the neck muscles help stabilize and reduce head acceleration during impact may help prevent brain injury. Hypothesis: Neck strength imbalance correlates to increasing head acceleration during impact while heading a soccer ball. Study Design: Observational laboratory investigation. Methods: Sixteen Division I and II collegiate soccer players headed a ball in a controlled indoor laboratory setting while player motions were recorded by a 14-camera Vicon MX motion capture system. Neck flexor and extensor strength of each player was measured using a spring-type clinical dynamometer. Results: Players were served soccer balls by hand at a mean velocity of 4.29 m/s (±0.74 m/s). Players returned the ball to the server using a heading maneuver at a mean velocity of 5.48 m/s (±1.18 m/s). Mean neck strength difference was positively correlated with angular head acceleration (rho = 0.497; P = 0.05), with a trend toward significance for linear head acceleration (rho = 0.485; P = 0.057). Conclusion: This study suggests that symmetrical strength in neck flexors and extensors reduces head acceleration experienced during low-velocity heading in experienced collegiate players. Clinical Relevance: Balanced neck strength may reduce head acceleration cumulative subclinical injury. Since neck strength is a measureable and amenable strength training intervention, this may represent a modifiable intrinsic risk factor for injury.
AAV-mediated expression of an ADAMTS13 variant prevents shigatoxin-induced thrombotic thrombocytopenic purpura
Authors: Jin Sheng-Yu , Xiao Juan , Bao Jialing , Zhou Shangzhen , Wright J. Fraser , Zheng X. Long 
Published: March 2013

Key PointsAdministration of AAV8-hAAT-mdtcs vector results in sustained expression of plasma ADAMTS13 activity and antigen. The AAV8-mediated expression of ADAMTS13 variant is a safe and efficacious approach for treatment of a murine model of TTP.
Use of tiotropium Respimat Soft Mist InhalerversusHandiHaler and mortality in patients with COPD
Authors: Verhamme Katia M.C. , Afonso Ana , Romio Silvana , Stricker Bruno C. , Brusselle Guy G.O. , Sturkenboom Miriam C.J.M. 
Published: March 2013

Tiotropium, a long-acting anticholinergic, is deliveredviaHandiHaler orviaRespimat. Randomised controlled trials suggest that use of tiotropium Respimat increases the risk of dying. We compared the risk of mortality between tiotropium RespimatversusHandiHaler.Within the Integrated Primary Care Information database, we defined a source population of patients, aged ≥40 years, with ≥1 year of follow-up. Based on prescription data, we defined episodes of tiotropium use (Respimat or HandiHaler). The risk of mortality, within these episodes, was calculated using a Cox proportional hazard regression analysis.From the source population, 11 287 patients provided 24 522 episodes of tiotropium use. 496 patients died while being exposed to HandiHaler or Respimat. Use of Respimat was associated with almost 30% increased risk of dying (adjusted HR 1.27, 95% CI 1.03–1.57) with the highest risk for cardiovascular/cerebrovascular death (adjusted HR 1.56, 95% CI 1.08–2.25). The risk was higher in patients with co-existing cardiovascular disease (adjusted HR 1.36, 95% CI 1.07–1.73) than in patients without (adjusted HR 1.02, 95% CI 0.61–1.71).Use of tiotropium Respimat was associated with an almost 30% increase of mortality compared with HandiHaler and the association was the strongest for cardiovascular/cerebrovascular death. It is unclear whether this association is causal or due to residual confounding by chronic obstructive pulmonary disease severity.
Relevance of an extensive follow-up after surgery for nonsmall cell lung cancer
Authors: Gourcerol Delphine , Scherpereel Arnaud , Debeugny Stephane , Porte Henri , Cortot Alexis B. , Lafitte Jean-Jacques 
Published: March 2013

There are no international guidelines for an appropriate and cost-effective follow-up for resected nonsmall cell lung cancer (NSCLC).We retrospectively reviewed the outcome of NSCLC patients after curative surgery. Follow-up included physical examination and chest radiography every 3 months, and chest computed tomography (CT) scan, bronchoscopy, abdominal ultrasound, brain CT scan and bone scan every 6 months for 3 years, then every year over the following 2 years. Prognostic factors and costs were analysed.Median overall survival following surgery for NSCLC in 162 patients was 38.5 months. Recurrence occurred in 85 (52.5%) patients including 41 (48%) symptomatic subjects. Disease-free survival was similar between patients with asymptomatic recurrenceversussymptomatic patients (11.4versus12 months; p=0.41). Recurrence was detected by physical examination or chest radiography in 47 (55.3%) patients. Curative-intent therapy was provided in 18 (41%) out of 44 patients with asymptomatic recurrence and in four (10%) out of 41 symptomatic cases (p=0.001). Median overall survival from time of recurrence was higher in asymptomatic patients than in symptomatic patients (15.5versus7.2 months; p=0.001). The cost per year of life gained was USD32 700 (€22 397).An extensive follow-up, with acceptable cost, may improve the outcome of patients with resected NSCLC through detection of asymptomatic recurrences; however, validation by prospective studies is required.
Simple functional performance tests and mortality in COPD
Authors: Puhan Milo A. , Siebeling Lara , Zoller Marco , Muggensturm Patrick , ter Riet Gerben 
Published: March 2013

Exercise tests are important to characterise chronic obstructive pulmonary disease patients and predict their prognosis, but are often not available outside of rehabilitation or research settings. Our aim was to assess the predictive performance of the sit-to-stand and handgrip strength tests.The prospective cohort study in Dutch and Swiss primary care settings included a broad spectrum of patients (n=409) with Global Initiative for Chronic Obstructive Lung Disease stages II to IV. To assess the association of the tests with outcomes, we used Cox proportional hazards (mortality), negative binomial (centrally adjudicated exacerbations) and mixed linear regression models (longitudinal health-related quality of life) while adjusting for age, sex and severity of disease.The sit-to-stand test was strongly (adjusted hazard ratio per five more repetitions of 0.58, 95% CI 0.40–0.85; p=0.004) and the handgrip strength test moderately strongly (0.84, 95% CI 0.72–1.00; p=0.04) associated with mortality. Both tests were also significantly associated with health-related quality of life but not with exacerbations. The sit-to-stand test alone was a stronger predictor of 2-year mortality (area under curve 0.78) than body mass index (0.52), forced expiratory volume in 1 s (0.61), dyspnoea (0.63) and handgrip strength (0.62).The sit-to-stand test may close an important gap in the evaluation of exercise capacity and prognosis of chronic obstructive pulmonary disease patients across practice settings.
CFTR dysfunction induces vascular endothelial growth factor synthesis in airway epithelium
Authors: Martin Clémence , Coolen Nathalie , Wu Yongzheng , Thévenot Guiti , Touqui Lhousseine , Prulière-Escabasse Virginie , Papon Jean-François , Coste André , Escudier Estelle , Dusser Daniel J. , Fajac Isabelle , Burgel Pierre-Régis 
Published: March 2013

Peribronchial angiogenesis may occur in cystic fibrosis and vascular endothelial growth factor (VEGF)-A regulates angiogenesis in airways.Peribronchial vascularity and VEGF-A expression were examined using immunocytochemistry and morphometric analysis in lung sections obtained in 10 cystic fibrosis patients at transplantationversus10 control nonsmokers, and in two strains of Cftr-deficient mice versus wild-type littermates. Airway epithelial NCI-H292 cells and primary cultures of noncystic fibrosis human airway epithelial cells were treated with cystic fibrosis transmembrane conductance regulator (CFTR) inhibitors (CFTR-inh172or PPQ-102) or transfected with a CFTR small interfering (si)RNA with or without a selective epidermal growth factor receptor tyrosine kinase inhibitor. Concentrations of VEGF-A and phosphorylated epidermal growth factor receptor were measured by ELISA.Peribronchial vascularity was increased in cystic fibrosis patients, but not inCftr-deficient mice. VEGF-A immunostaining was localised to airway epithelium and was increased in cystic fibrosis patients and inCftr-deficient mice. In cultured airway epithelial cells, treatment with CFTR inhibitors or transfection with CFTR siRNA induced a twofold increase in VEGF-A production. CFTR inhibitors triggered epidermal growth factor receptor phosphorylation that was required for VEGF-A synthesis.Cystic fibrosis airways at transplantation showed increased peribronchial vascularity and epithelial VEGF-A expression. CFTR dysfunction triggered epithelial synthesis of VEGF-A, which may contribute to vascular remodelling.
Sputum induction to aid diagnosis of smear-negative or sputum-scarce tuberculosis in adults in HIV-endemic settings
Authors: Peter Jonathan G. , Theron Grant , Singh Nevanda , Singh Avani , Dheda Keertan 
Published: March 2013

Sputum induction can aid tuberculosis (TB) diagnosis, but adult data from HIV-endemic environments are limited, and it is unclear how performance varies depending on the clinical context (in-patientversusoutpatient), HIV status and whether patients are smear-negative or sputum-scarce.696 adults with suspected smear-negative or sputum-scarce TB from Cape Town (South Africa) were referred for routine sputum induction. Liquid culture forMycobacterium tuberculosisserved as the reference standard.82% (573 out of 696) of patients provided a specimen ≥1 mL, 83% (231 out of 278) of which were of adequate quality. 15% (96 out of 652) of sputum induction specimens were culture-positive, and this yield was higher among inpatientsversusoutpatients (17% (71 out of 408)versus10% (25 out of 244), p=0.01) and HIV-infectedversusuninfected patients (17% (51 out of 294)versus9% (16 out of 173), p=0.02), but similar for CD4 (>200versus≤200 cells·μL−1) and patient (smear-negativeversussputum-scarce) subcategories. Overall sensitivity (95% CI) of smear-microscopy was 49% (39–59%), higher among in-patientsversusoutpatients (55% (43–67%)versus32% (14–50%), p=0.05), but unaffected by HIV co-infection, CD4 count or patient type. 29% (203 out of 696) of patients commenced anti-TB treatment and sputum induction offered microbiological confirmation and susceptibility testing in only 47% (96 out of 203).Under programmatic conditions in an HIV-endemic environment although the yield of culture was approximately two-fold higher amongst HIV-infected patients and inpatients, a fifth of all patients were unable to provide a specimen following sputum induction. Same-day microbiological diagnosis was only possible in ∼50% of patients.
Clostridium difficile infection in Italian urban hospitals: data from 2006 through 2011
Authors: Di Bella Stefano , Musso Maria , Cataldo Maria A , Meledandri Marcello , Bordi Eugenio , Capozzi Daniela , Cava Maria C , Chiaradonna Patrizia , Prignano Grazia , Petrosillo Nicola 
Published: March 2013

Abstract

Background
In developed countries, Clostridium difficile infection (CDI) represents an emerging threat in terms of morbidity and mortality rates. In our country limited CDI epidemiological data can be found.
We have conducted a 6-year retrospective study to evaluate the incidence of CDI in Italian urban hospitals.

Methods
Stool samples tested for C. difficile toxins from January 2006 to December 2011 in 5 large hospitals in Rome, Italy, were considered in the analysis. Repeated samples taken ≤ 2 months after a positive result were excluded.

Results
A total of 402 CDI episodes were identified. The incidence of CDI episodes progressively increased from 0.3 in 2006 to 2.3 per 10,000 patient-days in 2011. CDI episodes mostly occurred in patients > 60 years of age (77%). The >80 year-old age class reported the highest percentage of CDI episodes on tested samples (16%). Eighty percent (80%) of CDI episodes occurred in medical wards followed by surgery (10.2%) and intensive care units (9.8%).

Conclusions
A significant increasing incidence of CDI episodes over the study period was observed during the years (p<.001), particularly in the older age groups. Medical wards experienced the highest number of CDI episodes as compared to intensive care and surgical wards. The increasing rate of CDI episodes over the last six years in our country, is alarming; urgent improvements in the surveillance systems and control programs are advisable.
The Fit for School health outcome study - a longitudinal survey to assess health impacts of an integrated school health programme in the Philippines
Authors: Monse Bella , Benzian Habib , Naliponguit Ella , Belizario Vincente , Schratz Alexander , van Palenstein Helderman Wim 
Published: March 2013

AbstractBackgroundChild health in many low- and middle-income countries lags behind international goals and affects children’s education, well-being, and general development. Large-scale school health programmes can be effective in reducing preventable diseases through cost-effective interventions. This paper outlines the baseline and 1-year results of a longitudinal health study assessing the impact of the Fit for School Programme in the Philippines.MethodsA longitudinal 4-year cohort study was conducted in the province of Camiguin, Mindanao (experimental group); an external concurrent control group was studied in Gingoog, Mindanao. The study has three experimental groups: group 1—daily handwashing with soap, daily brushing with fluoride toothpaste, biannual deworming with 400 mg albendazole (Essential Health Care Program [EHCP]); group 2—EHCP plus twice-a-year access to school-based Oral Urgent Treatment; group 3—EHCP plus weekly toothbrushing with high-fluoride concentration gel. A non-concurrent internal control group was also included. Baseline data on anthropometric indicators to calculate body mass index (BMI), soil-transmitted helminths (STH) infection in stool samples, and dental caries were collected in August 2009 and August 2010. Data were analysed to assess validity of the control group design, baseline, and 1-year results.ResultsIn the cohort study, 412 children were examined at baseline and 341 1 year after intervention. The baseline results were in line with national averages for STH infection, BMI, and dental caries in group 1 and the control groups. Children lost to follow-up had similar baseline characteristics in the experimental and control groups. After 1 year, group 1 showed a significantly higher increase in mean BMI and lower prevalence of moderate to heavy STH infection than the external concurrent control group. The increases in caries and dental infections were reduced but not statistically significant. The results for groups 2 and 3 will be reported separately.ConclusionsDespite the short 1-year observation period, the study found a reduction in the prevalence of moderate to heavy STH infections, a rise in mean BMI, and a (statistically non-significant) reduction in dental caries and infections. The study design proved functional in actual field conditions. Critical aspects affecting the validity of cohort studies are analysed and discussed.Trial registrationDRKS00003431 WHO Universal Trial NumberU1111-1126-0718
Determinants of health literacy and health behavior regarding infectious respiratory diseases: a pathway model
Authors: Sun Xinying , Shi Yuhui , Zeng Qingqi , Wang Yanling , Du Weijing , Wei Nanfang , Xie Ruiqian , Chang Chun 
Published: March 2013

Abstract

Background
Health literacy has been defined as the degree to which individuals have the capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions. Currently, few studies have validated the causal pathways of determinants of health literacy through the use of statistical modeling. The purpose of the present study was to develop and validate a health literacy model at an individual level that could best explain the determinants of health literacy and the associations between health literacy and health behaviors even health status.

Methods
Skill-based health literacy test and a self-administrated questionnaire survey were conducted among 3222 Chinese adult residents. Path analysis was applied to validate the model.

Results
The model explained 38.6% of variance for health literacy, 11.7% for health behavior and 2.3% for health status: (GFI = 0.9990; RMR = 0.0521; χ2 = 10.2151, P = 0.1159). Education has positive and direct effect on prior knowledge (β = 0.324) and health literacy (β = 0.346). Health literacy is also affected by prior knowledge (β = 0.245) and age (β = -0.361). Health literacy is a direct influencing factor of health behavior (β = 0.101). The most important factor of health status is age (β = 0.107). Health behavior and health status have a positive interaction effect.

Conclusion
This model explains the determinants of health literacy and the associations between health literacy and health behaviors well. It could be applied to develop intervention strategies to increase individual health literacy, and then to promote health behavior and health status.