bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Method for Data Processing to Obtain High-Quality XCTD Data
Authors: Uchida Hiroshi , Shimada Koji , Kawano Takeshi 
Published: April 2011

Abstract
A data processing method to obtain high-quality data from an expendable conductivity–temperature–depth (XCTD) profiler is proposed. By adjusting the mismatch of the response time of the temperature and conductivity sensors, systematic error (on the order of −0.05) in XCTD salinity data can be eliminated from regions having a strong vertical temperature gradient (&gt;0.2°C m−1), such as the main thermocline of the nearshore side of the Kuroshio axis and the seasonal thermocline of the subarctic North Pacific. The systematic errors in XCTD depth and temperature data from two cruises were evaluated by comparing the CTD and XCTD data taken simultaneously during each cruise. The XCTD depths were in good agreement with the CTD depths from one cruise, but depth-dependent depth errors from the other cruise were found. The cause of the depth error is unknown but may have occurred because the terminal velocity for the XCTD probes was much less (−0.0428 m s−1) than that provided by the manufacturer for the later cruise. The results suggest that XCTD and expendable bathythermograph (XBT) observations may have a similar depth error because XBT and XCTD do not have pressure sensors, and therefore depth is inferred from the fall rate of the probe. Systematic positive biases (0.018°C on average) were found in XCTD temperature data. The viscous heating effect may contribute to the thermal bias because flow past the XCTD temperature probe is relatively fast (&gt;3 m s−1). Evaluation of XBT/XCTD data by using simultaneous CTD observations data is valuable for validation of statistical corrections of the global XBT/XCTD dataset.
Cycles and Propagation of Deep Convection over Equatorial Africa
Authors: Laing Arlene G. , Carbone Richard E. , Levizzani Vincenzo 
Published: April 2011

Long-term statistics of organized convection are vital to improved understanding of the hydrologic cycle at various scales. Satellite observations are used to understand the timing, duration, and frequency of deep convection in equatorial Africa, a region with some of the most intense thunderstorms. Yet little has been published about the propagation characteristics of mesoscale convection in that region. Diurnal, subseasonal, and seasonal cycles of cold cloud (proxy for convective precipitation) are examined on a continental scale. Organized deep convection consists of coherent structures that are characteristic of systems propagating under a broad range of atmospheric conditions. Convection is triggered by heating of elevated terrain, sea/land breezes, and lake breezes. Coherent episodes of convection result from regeneration of convection through multiple diurnal cycles while propagating westward. They have an average 17.6-h duration and 673-km span; most have zonal phase speeds of 8–16 m s−1. Propagating convection occurs in the presence of moderate low-level shear that is associated with the southwesterly monsoonal flow and midlevel easterly jets. Convection is also modulated by eastward-moving equatorially trapped Kelvin waves, which have phase speeds of 12–22 m s−1 over equatorial Africa. Westward propagation of mesoscale convection is interrupted by the dry phase of convectively coupled Kelvin waves. During the wet phase, daily initiation and westward propagation continues within the Kelvin wave and the cold cloud shields are larger. Mesoscale convection is more widespread during the active phase of the Madden–Julian oscillation (MJO) but with limited westward propagation. The study highlights multiscale interaction as a major source of variability in convective precipitation during the critical rainy seasons in equatorial Africa.
Comments on “Conditional Exceedance Probabilities”
Authors: Bröcker Jochen , Siegert Stefan , Kantz Holger 
Published: April 2011

Abstract
In a recent paper, Mason et al. propose a reliability test of ensemble forecasts for a continuous, scalar verification. As noted in the paper, the test relies on a very specific interpretation of ensembles, namely, that the ensemble members represent quantiles of some underlying distribution. This quantile interpretation is not the only interpretation of ensembles, another popular one being the Monte Carlo interpretation. Mason et al. suggest estimating the quantiles in this situation; however, this approach is fundamentally flawed. Errors in the quantile estimates are not independent of the exceedance events, and consequently the conditional exceedance probabilities (CEP) curves are not constant, which is a fundamental assumption of the test. The test would reject reliable forecasts with probability much higher than the test size.
The acute effects of smokeless tobacco on central aortic blood pressure and wave reflection characteristics
Authors: Martin Jeffrey S , Beck Darren T , Gurovich Alvaro N , Braith Randy W 
Published: April 2011

The main objectives of this study were to examine the acute effect of a single dose of smokeless tobacco (ST) on central aortic blood pressure and wave reflection characteristics. Fifteen apparently healthy male subjects (aged 30.6 ± 6.2 y) were given a 2.5 g oral dose of ST after baseline measurements were recorded. Pulse wave analysis using radial artery applanation tonometry was performed in triplicate at baseline (0 min) and at 10-min intervals during (10, 20 and 30 min) and after (40, 50 and 60 min) ST use. An acute dose of ST was associated with a significant increase in heart rate (HR), central aortic systolic and diastolic blood pressure, peripheral brachial systolic and diastolic blood pressure, and aortic augmentation index normalized to a fixed heart rate of 75 bpm (AIx@75). Furthermore, ejection duration and round trip travel time of the reflected pressure wave (Δ tp) were significantly decreased as a result of one time ST use. As a result of changes in aortic pressure wave reflection characteristics, there was a significant increase in wasted left ventricular pressure energy (LVEw) and the tension–time index (TTI) as a result of ST use. In conclusion, one time use of ST elicits significant transient increases in HR, central aortic pressures, AIx@75, the TTI and LVEw. Chronic users subjected to decades of elevated central pressures and left ventricular work may have an increased cardiovascular risk as central aortic pressures are even more strongly related to cardiovascular outcomes than peripheral blood pressures.
Establishment of self-sequential longitudinal reference intervals of maternal thyroid function during pregnancy
Authors: Yu Bin , Wang Qiu-Wei , Huang Rui-Ping , Cao Fang , Zhu Zi-Qiang , Sun Da-Cheng , Zhou Hong , Zhang Yi-Ming 
Published: April 2011

The objective of this study is to establish self-sequential longitudinal reference intervals of thyroid function in normal pregnant women. According to the selection criteria, 301 cases were taken as the normal pregnant population to establish a normal reference range. Meanwhile, 150 healthy women were selected as the normal non-pregnant control group. To establish their own self-sequential longitudinal reference intervals, we collected samples five times in every case throughout the gestation (including first trimester, second trimester, third trimester, prenatal and postpartum), and detected the levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibodies (TPO-Ab), and then established the self-sequential longitudinal reference intervals. The levels of TSH, FT4 and TPO-Ab were quantified by electrochemistry immunoassay (ECL) and statistically analyzed using SPSS 13.0 software. Serum TSH of normal pregnant women was at a low level in the first trimester ( P < 0.05) and began to rise continuously. Not until prenatal phase was it restored to the non-pregnant state ( P > 0.05). During pregnancy, serum FT4 of normal pregnant women were consistently lower than non-pregnant levels ( P < 0.05) and kept at low levels. Serum TPO-Ab increased significantly in the third trimester and prenatal phase ( P < 0.05). Of normal pregnant women, 6.5% were TPO-Ab positive. In conclusion, the reference intervals in our case will reflect the changes of thyroid function in pregnant women more realistically, resulting in a more accurate value for clinical diagnosis and therapy.
Minor surgery activity in primary care
Authors: Serra Marta , Arévalo Antonio , Ortega Cristina , Ripoll Ana , Giménez Nuria 
Published: April 2011

Objective The aim of this study was to describe the activity in our Outpatient Minor Surgery unit during its first five-year period. Design Retrospective descriptive study. Methods It was carried out in two centres of a Basic Health Area with a catchment area of 73,000 inhabitants. Participants Patients who underwent surgery from January 2002 to December 2007 were included in the research. Main outcome measures Information on the sociodemographic data of the patients, characteristics of the lesions, risk factors, treatment and its complications was gathered. Results A total of 2317 surgical procedures was performed on 1520 patients. The mean was 46 years old and 52% were men. The concordance between clinical and anatomopathological diagnosis was 81%. There were complications in 5% of them. The main pathologies were: epidermoid cysts (22%), nevus (20%) and fibromas (18%). They were mainly located in the back (24%), superior extremities (14%) and head (11%). In 73% mepivicaine was used as anaesthetic. The most current techniques used were: incision (36%), curettage (33%) and fusiform excision (28%). Less than 1% had malignant lesions, 50% of which were not diagnosed clinically. The mean waiting time was 30 days. Ninety-two percent had the informed consent. Conclusions Minor surgery in primary care is feasible and has a good clinicopathological concordance and minimum complications, but some malignant lesions are overlooked in the diagnosis based exclusively on clinical criteria.
Achieving 18-week waiting times in elective hand surgery
Authors: Chuo Cb , Wright Tc , Breuning E , Mendonca D 
Published: April 2011

Summary Objective The Department of Health proposed an 18-week referral-to-treatment time (RTT) as a measure of high quality healthcare, to be achieved by December 2008. In 2007, referrals for elective hand surgery, to the Plastic Surgery Hand Service, were either direct or indirect. Direct referrals were from the general practitioner (GP). Indirect referrals were from other specialties, to which patients had been initially referred. We audited the RTT in elective hand surgery patients to see if 18-week waiting times could be achieved. Design The RTT for 152 patients who had elective hand surgery in 2007 were audited prospectively and retrospectively. After the initial audit, managers responsible for the ‘Choose & Book‘ (CAB) GP referral system, managers responsible for ‘Action on Orthopaedics‘ and colleagues who referred, were contacted, to explain the difficulties in meeting the 18-week wait target. The audit cycle was repeated prospectively in 2008 with the audit of a further 94 patients. Setting This audit took place in a district general hospital, in the United Kingdom. Main outcome measure The main outcome measure was referral-to-treatment time. Results The mean RTT for direct referrals decreased from 15 to 12 weeks and that for indirect referrals decreased from 43 to 24 weeks (p < 0.0001). The difference in the average RTT for direct and indirect referrals remained statistically significant (p < 0.0001), in both audit cycles. Conclusions The attempts to reduce the RTT, in both groups of patients, did not decrease the average RTT for indirect referrals, to within government targets. Increase in GP awareness of the limitations of the CAB system and availability of local hand surgery services, may help to reduce inappropriate referrals. However we are aware that a multispecialty approach is required to ensure that hand surgery referrals are passed on to plastic surgery as soon as possible.
The World Health Organization's ‘Surgical Safety Checklist’: should evidence-based initiatives be enforced in hospital policy?
Authors: Sivathasan Niroshan , Rakowski Krzysztof R M , Robertson Bernard F M , Vijayarajan Lavnya 
Published: April 2011

Summary Objectives To assess the awareness and voluntary usage of the World Health Organization's Surgical Safety Checklist (WHO SSC), just prior to its mandatory implementation. Design Questionnaire-based, prospective, telephone survey. Setting Patients are exposed to systematic risks and principles of surgical safety are inconsistently applied even in sophisticated settings. The evidence-based WHO SSC addresses shortfalls to promote patient safety. It was formally introduced in the United Kingdomin January 2009andbecame a mandatory preoperative requirement in all hospitals from February 2010. Participants Two hundred and thirty-eight hospitals, both private and government-run, in the UK. Main outcome measures Appreciation among senior theatre personnel as to the existence, implementation and usage of the WHO SSC concept. Results Almost all had heard of the SSC, but in only two-thirds of hospitals was its use mandatory. Where the SSC was not compulsory, 80% were using it informally or sporadically. One-quarter of senior theatre personnel in hospitals without compulsory use indicated they did not know or that their department did not plan on using the checklist in the next six months, despite the deadline for implementation. Conclusions If the SSC is to optimize safety, then greater education and awareness is required.
The role of education in the promotion of red reflex assessments
Authors: Muen Wj , Hindocha M , Reddy Ma 
Published: April 2011

Summary Objectives To assess the impact of an information poster on rate and accuracy of referrals of abnormal red reflex from general practioners (GP) and hospital doctors involved in the care of children. Design A retrospective audit of all referrals for abnormal red reflex received between the periods September 2005 to September 2006 was carried out. Posters were sent to 200 GP practices in East London as well as our local hospital. Pathways for referrals were given, and a prospective re-audit was conducted from October 2006 to March 2008. Setting The Royal London Hospital and practices serving the East End of London. Participants GPs serving the East End of London and hospital doctors involved in child care. Main outcome measures (1) Increase in the referral rate for abnormal red reflex finding; and (2) accuracy of referral for abnormal red reflex. Results Prior to posters being sent, there were no referrals of abnormal red reflexes to our department. Following the posters being sent, 21 abnormal red reflex referrals were made over a period of 18 months; 18 from GPs and three from neonatologists. Thirteen were detected at 6 weeks of age (routine screening). Three patients had a positive finding (two with bilateral cataracts and one with hypermetropic astigmatism). Conclusions Although an increase in referrals suggests that the assessment of the red reflex is being performed and public awareness has increased, the sensitivity of this test remains low. Management strategies need to be in place to deal with an influx of patients who may have normal assessments and a strategy in East London will be discussed.
Planned implementations of ePrescribing systems in NHS hospitals in England: a questionnaire study
Authors: Crowe Sarah , Cresswell Kathrin , Avery Anthony J , Slee Ann , Coleman Jamie J , Sheikh Aziz 
Published: April 2011

Objectives To describe the plans of English NHS hospitals to implement ePrescribing systems. Design and setting Questionnaire-based survey of attendees of the National ePrescribing Forum. Participants A piloted questionnaire was distributed to all NHS and non-NHS hospital-based attendees. The questionnaire enquired about any completed or planned implementation of ePrescribing systems, the specific systems of interest, and functionality they offered. Main outcome measures Estimate of the number of NHS Trusts planning to implement ePrescribing systems. Results Ninety-one of the 166 questionnaires distributed to NHS hospital-based staff were completed and returned. Of those, six were incomplete, resulting in a total usable response rate of 51% ( n = 85). Eighty-two percent ( n = 46) of the 56 Trusts represented at the Forum were either ‘thinking of implementing’ or ‘currently implementing’ an ePrescribing system, such as Ascribe (13%, n = 7) and JAC (20%, n = 11). Forty percent ( n = 22) of respondents specified other systems, including those procured by NHS Connecting for Health e.g. RiO, Lorenzo and Cerner. Knowledge support, decision support and computerized links to other elements of patients’ individual care records were the functionalities of greatest interest. Conclusion There is considerable reported interest and activity in implementing ePrescribing systems in hospitals across England. Whether such developments have the desired impact on improving the safety of prescribing is however, yet to be determined.
Psychiatric misdiagnoses in patients with chronic fatigue syndrome
Authors: Lawn Tara , Kumar Praveen , Knight Bernice , Sharpe Michael , White Peter D 
Published: April 2011

Objectives The aim of this study was to examine the accuracy of doctors at diagnosing co-morbid psychiatric disorders in patients with chronic fatigue syndrome (CFS). Design Case series comparing clinical diagnoses with a standardized structured psychiatric interview. Setting Secondary care specialist chronic fatigue syndrome clinic. Participants One hundred and thirty-five participants of a randomized controlled trial of non-pharmacological treatments at one centre in the PACE trial. Main outcome measures Current psychiatric diagnoses made by CFS specialist doctors, compared with current psychiatric diagnoses made independently using a structured psychiatric interview. Results Clinicians identified 59 (44%, 95% CI 39-56%) of patients as suffering from a co-morbid psychiatric disorder compared to 76 (56%, CI 53-69%) by structured interview. Depressive and anxiety disorders were most common. Clinicians were twice as likely to miss diagnoses (30 patients, 22%) than misdiagnose them (13, 10%). Psychiatrists were less likely to miss diagnoses than other clinicians, but were as likely to misdiagnose them. Conclusions Doctors assessing patients in a chronic fatigue syndrome clinic miss psychiatric diagnoses more often than misdiagnosing them. Missed diagnoses are common. CFS clinic doctors should be trained to diagnose psychiatric disorders.
In what circumstances is telemedicine appropriate in the developing world?
Authors: Wootton Richard , Bonnardot Laurent 
Published: April 2011

Summary Objectives To review papers reporting actual experience with telemedicine in developing countries and to summarize their findings, including the strength of the evidence. Design A retrospective review was conducted. Study quality was assessed. Setting Four commonly-used electronic databases. Main outcome measures Study quality scores. Results From a total of 202 potential articles, 38 relevant papers were identified. Thirty-four articles (89%) reported clinical experience and 14 articles (37%) reported the use of telemedicine for educational purposes. The quality of the reports was rather weak (median quality-score 3, on a scale 0-9); only one study, rated at 7, fell into the high quality score band. The fact that almost all studies reported positively in favour of telemedicine suggests a publication bias. Of the 38 articles, 15 (39%) reported the use of real-time telemedicine and 25 (66%) reported the use of asynchronous, or store-and-forward, telemedicine. Email was the most commonly reported modality (half of all studies). Conclusion Some of the longer established telemedicine operations have developed into substantial networks. The review suggests that great potential exists for telemedicine in the developing world. However, some caution is required in future telemedicine work if telemedicine exemplars are to be produced which can be widely copied.
Differential prognostic utility of NTproBNP and Cystatin C in patients with acute exacerbation of chronic pulmonary disease
Authors: Pérez-Calvo Juan I , Sánchez-Marteles Marta , Ruiz-Ruiz Francisco-José , Morales-Rull José-Luis , Nieto-Rodríguez José-Antonio 
Published: April 2011

Summary Objectives To determine whether serum Cystatin C (CysC) and NTproBNP have prognostic value among patients with long-standing chronic lung disease. Design Prospective, observational, non-interventional study. Setting CysC and NTproBNP are prognostic markers in several cardiac conditions. In addition, CysC acts as an antiprotease following Cathepsin activation, which has been involved in the pathogenesis of chronic obstructive pulmonary disease. Participants Patients with a basal functional status of II-IV (NYHA), admitted for an acute exacerbation of chronic pulmonary diseases and no previous history of symptoms related to pulmonary hypertension or heart failure. Main outcome measures NTproBNP and CysC were determined at admission in 107 patients with acute exacerbation of chronic lung disease. During 12-month follow-up, mortality, new hospital admissions and prescription of diuretics were recorded. Results During follow-up there were eight patient deaths (7.5%). Mean NTproBNP among the deceased was 1510.20 pg/mL (95% CI 498.44-4628.55) vs 502.70 pg/mL (95% CI 395.44-645.48) among survivors (p= 0.01). Twenty-seven patients (25%) were prescribed loop diuretics. Mean concentration of CysC was 1.45 mg/dL (95% CI 1.21-1.69 mg/dL) vs 1.17 mg/dL (95% IC 1.09-1.25 mg/dL) in those not prescribed (p = 0.004). NTproBNP concentration was 837.14 pg/mL (95% CI 555.57-1274.10 pg/mL) in patients prescribed diuretics vs 473.42 pg/mL (95% CI 357.80-632.70 pg/mL) in those not prescribed (p = 0.03). Kaplan-Meier analysis revealed a significant difference between death and diuretic prescription during follow-up when cut-off value for NTproBNP was 550 pg/mL (p = 0.03 and p= 0.02, respectively). For 1.16mg/dL of CsysC, a significant difference was only observed in diuretic prescription (p = 0.007). Conclusions In patients with chronic respiratory diseases NTproBNP has predictive value in terms of mortality whereas CysC does not. However, it is still possible that both can contribute to the early identification of patients at risk of developing clinical ventricular dysfunction.