bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved Prediction of Cold-Air Pools in the Weather Research and Forecasting Model Using a Truly Horizontal Diffusion Scheme for Potential Temperature
Authors: Arthur Robert S. , Lundquist Katherine A. , Olson Joseph B. 
Published: November 2020

AbstractThe terrain-following vertical coordinate system used by many atmospheric models, including the Weather Research and Forecasting (WRF) Model, is prone to errors in regions of complex terrain. These errors stem, in part, from the calculation of horizontal gradients within the diffusion term of the momentum or scalar evolution equations. In WRF, such gradients can be calculated along coordinate surfaces, or using metric terms that help account for grid skewness. However, neither of these options ensures a truly horizontal gradient calculation, especially if a grid cell is skewed enough that the heights of the neighboring grid points used in the calculation fall outside the vertical range of the cell. In this work, an improved scheme that uses Taylor series approximations to vertically interpolate variables to the level necessary for a truly horizontal gradient calculation is implemented in WRF for the diffusion of potential temperature. The scheme is validated using an atmosphere-at-rest configuration, in which spurious flows develop only as a result of numerical errors and can thus be used as a proxy for model performance. Following validation, the method is applied to the simulation of cold-air pools (CAPs), which occur in regions of complex terrain and are characterized by strong near-surface temperature gradients. Using the truly horizontal scheme, idealized simulations demonstrate reduced numerical mixing in a quiescent CAP, and a realistic case study in the Columbia River basin shows a reduction in positive wind speed bias by up to roughly 20% compared to observations from the Second Wind Forecast Improvement Project.
Prescribing Pattern of Oral Anticoagulants in Patients With Obesity
Authors: Falk Kristina , McComb Meghan N. , Shapiro Nancy L. , Uppuluri Ellen M. 
Published: November 2020

Introduction: There is limited efficacy and safety data for direct oral anticoagulants (DOACs) in patients with obesity, and it has been suggested to avoid DOACs in this patient population. Objective: Describe the prescribing pattern of oral anticoagulants in obese patients in an urban university setting and assess efficacy, safety, and adherence. Methods: Retrospective, cohort study in patients ≥18 years with a history of VTE and/or atrial fibrillation. Patients with a BMI >40 kg/m2 and/or weight >120 kilograms and a prescription for warfarin or a DOAC from August 25, 2014 until August 25, 2017 are included. The primary outcome is the number of warfarin or DOAC prescriptions. Secondary outcomes include thromboembolism and bleeding events. Patient adherence was evaluated using time in therapeutic range (TTR), adherence rate to clinic appointments, and medication possession ratio (MPR). Results: Of the 276 patients who met eligibility criteria, 158 (57.2%) were prescribed warfarin and 118 (42.8%) were prescribed a DOAC. There was no difference in the rate of stroke or recurrent VTE between groups (3.2% vs. 3.4%, p = 0.944). There was also no difference in the rate of bleeding between groups (16.1% vs. 17.8%, p = 0.707). The TTR for the warfarin group was 44.8 ± 23%, and appointment adherence was 78.6 ± 20%. The MPR for the DOAC group was 0.93 ± 0.24. Conclusions: Despite limited data in obese patients, DOACs are prescribed in this population. Results suggest no difference in safety and efficacy compared to warfarin, but barriers to quality anticoagulation may exist in this population.
A Pilot Study to Explore Novice Debriefers’ Post-Simulation Debriefing Experiences
Authors: Ng Grace , Lugassy Daniel M. 
Published: November 2020

Introduction. Effective debriefing of simulation-based experiences is critical for learning. Approximately 33% of health professions instructors are debriefing novices. However, specific faculty development needs of novice debriefers has not been studied. This study examines how health professions instructors approach debriefing when they are new to debriefing simulation-based experiences. Methods. This pilot qualitative study used a thematic analysis approach to explore novice debriefers’ experiences in conducting post-simulation debriefings. Eligible participants engaged in one-hour semi-structured interviews. Recruitment continued until data saturation was reached. We reviewed verbatim interview transcripts, hand-coded the data, and formed codes into themes. Results. Nine novice debriefers participated. The overarching theme “I’m on my own…and they’re on their own,” reflects debriefers’ view that they are on their own, without resources. Debriefers also believe learners should identifying their own errors. Three main themes emerged: “Deep divide between me and the learners” portrays a separation between debriefers and learners in terms of expectations, roles, and responsibilities. “Winging it” depicts debriefers’ making-up their own debriefing approaches. “Debriefing quality: missing pieces of the puzzle” portrays novice debriefers unaware of criteria for effective debriefing. Conclusions. Novice debriefers in this study perceived that they were on their own, having little to no debriefing training and mentorship. Study participants expressed debriefing struggles in several areas including discussing errors, facilitating learner participation, and assessing debriefing quality. Our findings shed light on simulation as a growing specialty by health profession educators and it is critical that resources are devoted to faculty development for debriefing skill acquisition. These findings can serve as a basis for future studies on debriefer skill acquisition.
Treatment Experiences in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom
Authors: Ardouin Kenny , Drake David , Popat Sandip , Stock Nicola Marie 
Published: November 2020

Objectives: Adults with cleft lip and/or palate (CL/P) may report dissatisfaction with aesthetic and/or functional outcomes and express desire for further treatment. Although medical intervention can improve quality of life, surgical procedures require complex decision-making and can invoke psychological distress. The aim of this study was to gain a better understanding of ongoing treatment-related support needs by examining self-reported treatment experiences of a sample of adults born with CL/P. Design: An online, mixed-methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics. Results: Although participants were satisfied with surgical and dental/orthodontic outcomes overall, many reported ongoing difficulties. Some stated they would seek further treatment while others felt conflicted about risks and benefits. Some had refused treatment, citing treatment fatigue, anxiety, and/or concerns that treatment would be unsuccessful. More than 40% of participants were unaware of their entitlement to cleft-related treatment provided by the National Health Service, and many others had experienced difficulties accessing care. Conclusions: Although advances in health care may offer opportunities for adults to improve their quality of life, treatment decisions should be weighed with the support of a clinical psychologist where available. Guidance for young adults considering future treatment is also recommended. Finally, training and resources for local practitioners may improve general awareness of CL/P services and increase access to specialist care for adults with ongoing CL/P-related concerns.
Diagnostic and Prognostic Value of TAT, PIC, TM, and t-PAIC in Malignant Tumor Patients With Venous Thrombosis
Authors: Zhou Kun , Zhang Jun , Zheng Zun-Rong , Zhou Yu-Zhen , Zhou Xun , Wang Li-Da , Suo Bing , Jiang Xiao-Feng , Liu Pei-Jia , Wang Dong-Hua 
Published: November 2020

Background: Venous thromboembolism (VTE) is an important complication in patients with malignant tumors. Its exact diagnosis and treatment are still lacking. We used a high-sensitive chemiluminescence method to detect thrombin–antithrombin III complex (TAT), plasmin-α2-plasmininhibitor complex (PIC), thrombomodulin (TM), and tissue plasminogen activator–inhibitor complex(t-PAIC) in combination with D-dimer and fibrin degradation product (FDP) to analyze their diagnostic and prognostic value in patients with malignant tumors. Methods: In total, 870 patients with confirmed malignant tumors were included, 82 of whom had diagnosed VTE; 200 healthy individuals were classified as the control group. The TAT, PIC, TM, and t-PAIC were detected using Sysmex HISCL5000 automated analyzers, whereas FDP and D-dimer were detected using Sysmex CS5100 coagulation analyzer. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficiency. Survival probabilities were determined using Kaplan–Meier analysis, and multivariate analyses were performed using a Cox regression model. Results: Compared with healthy controls, patients with malignant tumors showed significantly elevated TAT, PIC, TM, t-PAIC, D-dimer, and FDP. Similarly, compared with patients in the non-thrombosis group, those in the thrombosis group showed significantly elevated levels of the above mentioned markers. Logistic regression analysis showed that TAT, PIC, TM, t-PAIC, D-Dimer, and FDP were all associated with VTE. ROC analysis showed that “TAT+PIC+TM+t-PAIC+D-dimer+FDP”showed the highest sensitivity and specificity. Patients with elevated TAT, PIC, TM, and t-PAIC had a significantly shorter survival. Multivariate Cox survival analysis showed that TM and t-PAIC were significantly associated with poor prognosis. In addition, the incidence of VTE was significantly lower in patients with malignant tumors who were treated with low-molecular-weight heparin (LMWH), and their survival period was significantly longer than that of patients with malignant tumors who were not treated with LMWH. Conclusion: TAT, PIC, TM, and t-PAIC combined with D-dimer and FDP were better than the application of a single marker in the diagnosis of VTE in patients with malignant tumors. TAT and PIC can be used as sensitive markers in the diagnosis of VTE but not as prognostic markers. TM and t-PAIC might be independent prognostic indicators in patients with malignant tumors, regardless of the state of thrombus.
Subcutaneous administration of triamcinolone as part of the management of feline eosinophilic keratoconjunctivitis
Authors: Lucyshyn Danica R , Good Kathryn L , Knickelbein Kelly E , Chang Maggie W , Strøm Ann R , Hollingsworth Steven R , Thomasy Sara M , Leonard Brian C , Sebbag Lionel , Wiggans K Tomo , Maggs David J 
Published: November 2020

Objectives The aim of this retrospective case-control study was to report the efficacy of subcutaneous triamcinolone as part of a regimen for feline eosinophilic keratoconjunctivitis (FEK). Methods Records and clinical photographs were reviewed and lesions semiquantitatively graded for cats with cytologically confirmed FEK. Clinical data were compared between a study population of nine cats (11 eyes) treated with, and a reference population of seven cats (eight eyes) treated without, a median of 0.11 mg/kg (range 0.10–0.20 mg/kg) of triamcinolone acetonide subcutaneously. Results Breed, sex, age and prevalence of corneal ulceration at presentation; corneal disease severity before and at the initiation of immunomodulation; and duration of antiviral treatment before immunomodulation did not differ significantly between populations ( P ⩾0.059). Corneal plaques resolved in five cats each from the study and reference populations ( P = 0.366). Median (range) time from immunomodulation to corneal plaque resolution did not significantly differ ( P = 0.246) between the study (median 14 days; range 8–38 days) and reference (median 28 days, range 14–46 days) populations. No adverse reactions were attributed to triamcinolone administration, and all corneal ulcers in the study population re-epithelialized within 14 days (range 8–38 days) following triamcinolone injection. Time to corneal ulcer re-epithelialization following triamcinolone injection varied minimally in those receiving antivirals prior to (8 or 30 days until re-epithelialization), simultaneously with (38 days) or after (14 or 24 days) triamcinolone. Conclusions and relevance In otherwise healthy cats with FEK, subcutaneous administration of triamcinolone appears to be well tolerated and as efficacious as conventional topical immunomodulatory therapies. It may be especially useful in ulcerated eyes where topical immunomodulation is contraindicated.
Is clinical expertise a conflict of interest in research?
Authors: Neill Sara , Martin Lisa , Harris Lisa 
Published: November 2020

Purpose: Doctors who research and provide abortion care have had their work characterized as a conflict of interest. We investigated whether surgeons who perform medical procedures other than abortion also routinely conduct research on that procedure and whether they disclose this as a relevant “conflict of interest.” Method: We conducted a two-step literature review of five medical procedures—abortion, rhinoplasty, Mohs micrographic surgery, transurethral resection of the prostate, and laminectomy. We identified articles published between June 2011 and May 2012, and we calculated the proportion of articles authored by clinicians who also perform that procedure as well as the percentage that reported clinical care as a conflict of interest. We then screened conflict of interest statements on publications on said procedures from the same journals between 2012 and 2019 and calculated the proportion of publications that reported clinical work as a conflict of interest. Results: We identified 135 publications that met inclusion criteria. We calculated that 100% of publications on rhinoplasty, transurethral resection of the prostate, and Mohs included a clinician who performs that procedure. Seventy-five percent of publications on laminectomy and 78% of publications on abortion included a clinician. None of the reviewed research articles included a disclosure that the authors also performed the procedure. From 2012 to 2019, there were 1,903 published articles on these procedures. None included a conflict of interest that disclosed clinical work as a conflict of interest. Conclusion: Although abortion providers publish as clinician-researchers at rates similar to surgeons in other areas of medicine, they alone face accusations that their clinical expertise is a potential conflict of interest. This stigmatizing practice could have wide-ranging consequences including delegitimization of the scientific method and peer review process broadly.
Addressing inactivity after stroke: The Collaborative Rehabilitation in Acute Stroke (CREATE) study
Authors: Jones Fiona , Gombert- Karolina , Honey Stephanie , Cloud Geoffrey , Harris Ruth , Macdonald Alastair , McKevitt Christopher , Robert Glenn , Clarke David 
Published: November 2020

Background Stroke patients are often inactive outside of structured therapy sessions – an enduring international challenge despite large scale organizational changes, national guidelines and performance targets. We examined whether experienced-based co-design (EBCD) – an improvement methodology – could address inactivity in stroke units. Aims To evaluate the feasibility and impact of patients, carers, and staff co-designing and implementing improvements to increase supervised and independent therapeutic patient activity in stroke units and to compare use of full and accelerated EBCD cycles. Methods Mixed-methods case comparison in four stroke units in England. Results Interviews were held with 156 patients, staff, and carers in total; ethnographic observations for 364 hours, behavioral mapping of 68 patients, and self-report surveys from 179 patients, pre- and post-implementation of EBCD improvement cycles. Three priority areas emerged: (1) ‘Space’ (environment); (2) ‘Activity opportunities’ and (3) ‘Communication’. More than 40 improvements were co-designed and implemented to address these priorities across participating units. Post-implementation interview and ethnographic observational data confirmed use of new social spaces and increased activity opportunities. However, staff interactions remained largely task-driven with limited focus on enabling patient activity. Behavioral mapping indicated some increases in social, cognitive, and physical activity post-implementation, but was variable across sites. Survey responses rates were low at 12–38% and inconclusive. Conclusion It was feasible to implement EBCD in stroke units. This resulted in multiple improvements in stroke unit environments and increased activity opportunities but minimal change in recorded activity levels. There was no discernible difference in experience or outcome between full and accelerated EBCD; this methodology could be used across hospital stroke units to assist staff and other stakeholders to co-design and implement improvement plans.
The nuclear receptor 4A family members: mediators in human disease and autophagy
Authors: Chen Liqun , Fan Fengtian , Wu Lingjuan , Zhao Yiyi 
Published: November 2020

AbstractThe Nuclear receptor 4A (NR4A) subfamily, which belongs to the nuclear receptor (NR) superfamily, has three members: NR4A1 (Nur77), NR4A2 (Nurr1) and NR4A3 (Nor1). They are gene regulators with broad involvement in various signaling pathways and human disease responses, including autophagy. Here, we provide a concise overview of the current understanding of the role of the NR4A subfamily members in human diseases and review the research into their regulation of cell autophagy. A deeper understanding of these mechanisms has potential to improve drug development processes and disease therapy.
Fragmentation and propulsive effect of shock wave lithotripsy in treatment of small renal calculi
Authors: Abid Ammar Fadil , Hussein Nasser Sabah 
Published: November 2020

Abstract

Background
Small renal calculi are frequently observed in clinical practice, and chemo-lytic therapy has limited effects. The purpose of the study is to evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of small renal calculi.

Methods
We studied 60 patients with small renal stones from March 2017 to March 2019. After excluding eight patients with incomplete data, the remaining 52 patients were evaluated. Patients with symptomatic single or multiple stones of 6–8 mm in diameter or asymptomatic on ultrasound and kidney-ureter-bladder radiograph were eligible for inclusion. Small stones were treated by ESWL. The data were analyzed using the Statistical Packages for Social Sciences - version 25 (IBM Corporation).

Results
The mean age of the 52 patients was 34.5 ± 9.5 years. Forty-one (78.8%) patients were symptomatic, while 11 (21.2%) were asymptomatic. Forty-seven (90.4%) had single small renal stones, while four patients had two stones (7.7%) and only one patient had three stones (1.9%). Forty-five stones were successfully treated by ESWL, while 13 stones failed to respond.

Conclusion
ESWL is a useful tool for treating small renal calculi; it works either by fragmenting the stones or by acting as a pushing force. However, further large prospective studies are needed to corroborate the above conclusions.
Role of microsurgical varicocelectomy in the management of non-obstructive azoospermia with varicocele: our tertiary care centre experience
Authors: Thakur Avinash P. S. , Sadasivan Darsan , Sharma Vivek , Ramasamy Vasantharaja , Parol Subeesh , Singh Sangeeta , Soni Jatin 
Published: November 2020

AbstractBackgroundVaricocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pampiniform plexus of the spermatic cord. Varicocele is associated with progressive testicular damage and infertility. Azoospermia is associated with a varicocele in approximately 4–14% cases. For men with azoospermia or severe oligoasthenospermia, varicocele repair may result in modest improvement in semen quality which may have a significant advantage on couple’s fertility options. The aim of the study was to evaluate the role of microsurgical varicocelectomy in the men of non-obstructive azoospermia (NOA) with clinical varicocele.MethodsThis was a retrospective study conducted between August 2012 and January 2017, a backward review of 104 patients with the diagnosis of infertility and NOA with palpable varicocele that underwent microsurgical varicocelectomy at our institution was performed. In addition, microdissection testicular sperm extraction (MDTESE) results of these post-varicoceletomy patients were compared with the patients of NOA without varicocele.ResultsA total of 104 patients underwent varicocelectomy; out of these, 19 patients (18.26%) had sperm on sperm analysis post-operatively. Two of them had spontaneous pregnancy (10.5%), and 3 had children by intracytoplasmic sperm injection (15.78%). Out of the 85 patients who had MDTESE, 29 patients (34.11%) had sperms in their testis. The fertilization rate was 89.65%. Sperm retrieval rate (SRR) in NOA men with varicocele was 34.11% which was higher from those who had NOA without varicocele (24.03%). Live birth rate was 31.03% in NOA men who had varicocelectomy which was more in comparison to NOA men without varicocele (24%).ConclusionsIn NOA men with varicocele microsurgical varicocelectomy may have favourable effects which results in recovery of motile sperms in the post-operative ejaculate and also on spontaneous or assisted pregnancies, but it appears that this effect was more remarkable on MDTESE results when following successful intracytoplasmic sperm injection. Importantly, Sperm retrieval rate, pregnancy rate and subsequent live birth rate were higher in these patients in comparison to patients affected by NOA alone. In patients with NOA and coexisting varicocele, varicocelectomy can be considered to be essential to the overall reproductive outcome in these patients.