bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kinematic Structure and Dynamics of the Denmark Strait Overflow from Ship-Based Observations
Authors: Lin Peigen , Pickart Robert S. , Jochumsen Kerstin , Moore G. W. K. , Valdimarsson Héðinn , Fristedt Tim , Pratt Lawrence J. 
Published: September 2020

AbstractThe dense outflow through Denmark Strait is the largest contributor to the lower limb of the Atlantic meridional overturning circulation, yet a description of the full velocity field across the strait remains incomplete. Here we analyze a set of 22 shipboard hydrographic–velocity sections occupied along the Látrabjarg transect at the Denmark Strait sill, obtained over the time period 1993–2018. The sections provide the first complete view of the kinematic components at the sill: the shelfbreak East Greenland Current (EGC), the combined flow of the separated EGC, and the North Icelandic Jet (NIJ), and the northward-flowing North Icelandic Irminger Current (NIIC). The total mean transport of overflow water is 3.54 ± 0.29 Sv (1 Sv ≡ 106m3s−1), comparable to previous estimates. The dense overflow is partitioned in terms of water mass constituents and flow components. The mean transports of the two types of overflow water—Atlantic-origin Overflow Water and Arctic-origin Overflow Water—are comparable in Denmark Strait, while the merged NIJ–separated EGC transports 55% more water than the shelfbreak EGC. A significant degree of water mass exchange takes place between the branches as they converge in Denmark Strait. There are two dominant time-varying configurations of the flow that are characterized as a cyclonic state and a noncyclonic state. These appear to be wind-driven. A potential vorticity analysis indicates that the flow through Denmark Strait is subject to symmetric instability. This occurs at the top of the overflow layer, implying that the mixing/entrainment process that modifies the overflow water begins at the sill.
Challenges in Upgrading Emergency Power in Florida Nursing Homes following Hurricane Irma
Authors: Hutton Nicole S. , Allen Michael J. 
Published: September 2020

AbstractMaintaining and restoring electricity after a disaster helps to preserve the health and well-being of the elderly who are at increased risk of heat stress and may be dependent upon life-sustaining medical equipment. Mitigation policies altered in reaction to increased public interest without thorough consideration of industry-specific resources may contribute to delays in implementation and unrealized potential for emergency power coverage within individual facilities. The objectives of this research are twofold: (i) to examine the relationship between preexisting conditions of life-safety systems at facilities and date of implementation of emergency power regulation improvements and (ii) to assess the role of interagency connections—such as emergency management, fire safety, health care administration, and electricity providers—in facilitating compliance with safety regulations. A case study regarding the capacity to implement new emergency power regulations was conducted in Florida with 12 nursing homes affected by Hurricane Irma. The proposals to maintain temperatures and life-sustaining equipment under the updated regulations were not consistent among nursing homes within each county or between counties. Facilities with no preexisting life-safety violations were among the first to comply with new emergency power regulations. Those with prior violations often utilized procedural updates and external resources to comply. Nursing facilities that required additional support for remediation prior to the storm had plans approved earlier or without a second review as compared with those relying on internal resources. These results establish a baseline for the conditions associated with timely compliance including the importance of collective agency to mitigate risk.
Public service bargains and non-partisan ministerial advisors: servants of two masters
Authors: Cole Rose 
Published: September 2020

To what extent can the public service bargain framework be applied to non-partisan ministerial advisors? Public service bargains are defined as ‘explicit or implicit agreements between public servants – the civil or uniformed services of the state – and those they serve’. The public service bargain framework has increasingly been used as an analytical tool with which to examine the elements of the bargain as experienced by various actors in different jurisdictions. The elements of the public service bargain framework are explored through the experiences of a distinct subgroup of non-partisan advisors – portfolio private secretaries – serving in the politicised environment of ministers’ offices. The minister’s office has been characterised as the ‘purple zone’ where politics (represented by the colour blue) and administration (represented by the colour red) converge to transform political will into administrative action. This qualitative research article: briefly reviews the public service bargain literature; describes the actors and setting; gives voice to their experience of the public service bargain; applies the public service bargain heuristic; and reveals new insights into how the public service bargain operates with dual principals. Points for practitioners The public service bargain framework allows for dual principal–single agent relationships within public administration settings. Applying the public service bargain heuristic to this group of non-partisan advisors: enables a view of how the public service bargain operates at different levels (macro, meso and micro); shows that the public service bargain for these advisors has changed over time in response to administrative reforms; and demonstrates that these advisors are professionally and personally affected through the misaligned expectations of dual principals.
Circular RNA circ-NCOR2 accelerates papillary thyroid cancer progression by sponging miR-516a-5p to upregulate metastasis-associated protein 2 expression
Authors: Luan Sha , Fu Peng , Wang Xinyu , Gao Yue , Shi Ke , Guo Youmin 
Published: September 2020

Objective Papillary thyroid cancer (PTC) is one of the most prevalent endocrine malignancies and the fifth most common cancer in women. Circular RNAs (circRNAs) have been shown to play vital functions in cancers, but few studies have focused on the functions and mechanism of dysregulated circRNAs in PTC. Methods Quantitative reverse transcription PCR was used to measure circ-NCOR2 levels in PTC tissues and cell lines. The functions of circ-NCOR2 in PTC were examined by analysis using the cell counting kit-8, clone forming, flow cytometry, and Transwell experiments. Bioinformatic analysis and dual luciferase reporter gene testing were used to identify the mechanisms of circ-NCOR2. Results Circ-NCOR2 overexpression was observed in PTC tissues and cells. Silenced or overexpressed expression of circ-NCOR2 strikingly attenuated or facilitated, respectively, the growth, migration, and invasion of PTC cells. Mechanistically, miR-615a-5p was identified as the target of circ-NCOR2. Moreover, circ-NCOR2 enhanced the expression of metastasis-associated protein 2 (MTA2) by sponging miR-615a-5p, thereby facilitating PTC cell progression. Conclusions Taken together, our findings reveal a novel circ-NCOR2/miR-615a-5p/MTA2 axis in PTC, which could become a potential therapeutic target for this disease.
Characteristics of the intestinal flora in patients with peripheral neuropathy associated with type 2 diabetes
Authors: Wang Yayun , Ye Xiaolong , Ding Dafa , Lu Yibing 
Published: September 2020

Objective To study the characteristics of the intestinal flora in patients with diabetic peripheral neuropathy (DPN) and analyze the association between the intestinal flora and clinical indicators. Methods We classified 80 subjects into three groups: patients with DPN (n = 45), patients type 2 diabetes without DPN (n = 21), and healthy controls (n = 14). The intestinal flora composition was compared among the three groups, and the correlation between the intestinal flora and clinical indicators was analyzed. Results At the phylum level, the richness of Firmicutes and Actinobacteria was elevated in the DN group, and that of Bacteroidetes was decreased. At the genus level, the richness of Bacteroides and Faecalibacterium was significantly decreased in the DPN group, whereas that of Escherichia- Shigella, Lachnoclostridium, Blautia, Megasphaera, and Ruminococcus torques group was increased. The homeostasis model assessment insulin resistance index was positively correlated with Megasphaera richness. Glycine ursodeoxycholic acid was positively correlated with Ruminococcus gnavus group and Phascolarctobacterium richness. Tauroursodeoxycholic acid was positively correlated with Ruminococcus gnavus group and Parabacteroides richness. Conclusion There was obvious intestinal microbiota disorder in patients with DPN, which may be related to insulin resistance. These changes may have important roles in the development of DPN.
Patterns of supraclavicular area failure after mastectomy in breast cancer patients: implications for target volume delineation
Authors: Lin Pei-cheng , Lin Xi-jin , Li Jin-luan , Lin Fei-fei , Zhuang Qing-yang , Tang Li-rui , Huang Yun-xia , Zhang Xue-qing , Wu Jun-xin 
Published: September 2020

Purpose To characterize the pattern of post-mastectomy supraclavicular lymph node (LN) metastases in patients with breast cancer (BC) and to provide insights for individualized clinical target volume delineation for radiotherapy. Methods We retrospectively analyzed 88 patients with BC who developed post-mastectomy regional LN metastases. The affected regional LNs were categorized as the ipsilateral medial supraclavicular LN area (IMSC-LN), ipsilateral lateral supraclavicular LN area (ILSC-LN), ipsilateral infraclavicular LN area (IIC-LN), and ≥2 groups in the ipsilateral clavicular LN area (MMIC-LN). Clinical characteristics were included in a multivariate analysis to identify risk factors for clavicular LN metastases. Results The ILSC-LNs (68.2%) were the most common metastatic site. IMSC-LN metastases showed a significant association with estrogen-receptor (ER) negative status, left-sided BC, and positive axillary LNs. Tumor size ≥2.4 cm and Her2 type were predictors of ILSC-LN metastases. Additionally, tumor size ≥2.4 cm, and level I ipsilateral axillary metastases were associated with MMIC-LN metastasis. Conclusion ILSC-LN was the most frequently affected group of supraclavicular lymph nodes. ER-negative status, left-sided BC, tumor size, and positive ipsilateral axillary LNs are potentially associated with the pattern of supraclavicular LN metastatic involvement.
Impact of a Pharmacist-Driven Protocol to Improve Guideline-Concordant Prescribing of Diabetes Medications in Patients With Atherosclerotic Cardiovascular Disease: A Pilot Study
Authors: Freudenberg Dakota L. , Covington Les P. , Young Rodney B. , Lopez Nicole D. , Patel Miti V. , MacLaughlin Eric J. 
Published: September 2020

Purpose: To determine whether a pharmacist-driven protocol improves guideline-concordant prescribing of diabetes medications in patients with atherosclerotic cardiovascular disease (ASCVD). Methods: A retrospective pre- and post-intervention study was conducted at a university-based family medicine clinic. A pharmacist-driven protocol was implemented which involved the creation of an algorithm recommending specific diabetes medications in patients with ASCVD. An in-service presentation reviewing the algorithm and process for referral of eligible patients to an appointment with a clinical pharmacist was delivered to providers. Clinical pharmacist appointments focus was on improving diabetes management and initiating cardiovascular risk-reducing medications if appropriate. Results: A total of 234 patients were screened, and 108 met inclusion criteria. Upon completion of patient outreach, 34% were scheduled with a pharmacist. Forty-three percent of patients (16 of 37) attended the appointment. Of those, 31% were initiated on an evidence-based regimen indicated for diabetes and ASCVD. In comparing pre- to post-implementation of the pharmacist-driven protocol, the rate of guideline-concordant prescribing increased by 48% (3.8% to 5.6%). Conclusion: Implementation of a pharmacist-driven protocol can increase guideline-concordant prescribing. However, further exploration of patient- and system-level barriers is necessary to implement such a program more broadly.
Prevalence, involved domains, and predictor of cognitive dysfunction in systemic lupus erythematosus
Authors: Yue Rui , Gurung Ishwor , Long Xin-Xin , Xian Jia-Yi , Peng Xue-Biao 
Published: September 2020

Background Cognitive Dysfunction (CD) can occur in Systemic Lupus Erythematosus (SLE) before the occurrence of Neuropsychiatric Lupus Erythematosus (NPSLE). Given the reversibility and fluctuation of SLE-related CD, the research for possible predictors is of great significance for early detection and intervention. Objective We sought to determine the prevalence, involved domains, and possible predictors of CD in SLE patients. Methods We conducted a retrospective cross-sectional study at Nanfang Hospital from 2018 to 2019. A total of 78 SLE patients were recruited. The Montreal Cognitive Assessment (MoCA) scale was used to screen cognitive function. Demographic, clinical, and laboratory characteristics were collected. The serum anti-methyl-d-aspartate receptor (anti-NMDAR) antibody and S100β were measured by enzyme-linked immunosorbent assay (ELISA). Multivariate logistic regression analysis and ROC curve were used to assess the predictor of SLE-related CD. Results Of 78 recruited patients,53 (67.9%) had CD. It mainly involved delayed recall, abstract generalization, verbal repetition, and fluency. The disease activity index (SLEDAI) was not associated with SLE-related CD ( p > 0.05). Multivariate logistic regression showed that an increase in each year of education there was a decrease in the likelihood of CD (OR 0.261, CI 0.080-0.857, p = 0.027) whereas with each unit increase in serum anti-NMDAR antibody there was an increased likelihood of SLE-related CD (OR 1.568, CI 1.073–2.292, p = 0.020). Conclusion The prevalence of SLE-related CD was 67.9% in our study and SLE-related CD was not associated with disease activity. Serum anti-NMDAR antibody can be used as a predictor for SLE-related CD.
Treatment of Lower Extremity Edema by Controlled Subcutaneous Drainage at Home: A Case Report
Authors: Julião Miguel , Costa Elisabeth , Calaveiras Patrícia , Daniel Sara , de Sousa Paulo Faria , Dias Rute 
Published: September 2020

Lower severe edema is a common condition faced by advanced cancer patients with an impact on comfort, quality of life, and care planning. Diuresis and mechanical interventions are the mainstream options for the treatment of edema, but, although effective, may not be indicated for frail, bed-bound, and dependent patients cared for in the community setting. We present a case report of a young female with severe edema to her right lower limb, which accepted controlled subcutaneous fluid drainage at her home. Subcutaneous fluid drainage at home was effective, safe, and feasible and improved the patient’s comfort and well-being.
Pharmacist value-added to neuro-oncology subspecialty clinics: A pilot study uncovers opportunities for best practices and optimal time utilization
Authors: Lee Grant W , Mathur Anupama D , Andrick Benjamin J , Leese Erika , Zally Durga , Gatson Na Tosha N 
Published: September 2020

Purpose To evaluate neuro-oncology clinician time utilization for medication management and identify a cost beneficial role for integration of a dedicated pharmacy specialists. Methods A pharmacist was temporarily integrated into a neuro-oncology clinic for a 30-day period to evaluate the clinical practice and perform a 14-day clinical chart evaluation and patient interactions as part of a single institutional exploratory analysis. The pharmacist completed screenings for drug-drug interactions, new therapies, medication reconciliation, and advanced interventions as part of a collaborative practice agreement for pharmacist autonomy. Pharmacist time spent was calculated and documented within the patient encounters to support physician decision-making. A comparative estimate of pharmacist versus physician time utilization and cost for each was completed to derive a savings analysis for integration of a dedicated clinic pharmacist. Result During the 14-day clinical assessment, the pharmacist completed 147 encounters with 338 interventions. Of the encounters, 90% (n = 132) were higher complexity requiring plan modification, and approximately 48% (n = 162) of all interventions required ≥10 minutes of the pharmacist’s time. Physician non-patient-facing time devoted to medication tasks was 5-hours weekly (0.125 FTE, full time equivalents), an estimated direct salary cost of $937/week ($45,000 yearly). Hire of a part-time pharmacist at 0.50 FTE would cover the clinical need with supported documentation and medication monitoring at a cost of $45,000/year. Conclusion Defining the roles for dedicated neuro-oncology clinic pharmacists allows for cost-savings through re-allocation of physician time and improves subspecialty clinic operations as well as patient care.
Trends in older people’s drinking habits, Sweden 2004–2017
Authors: Raninen Jonas , Agahi Neda 
Published: September 2020

Aims: To examine if and how the drinking habits of older people aged 60–79 years in Sweden have changed during 2004–2017, with a specific focus on age groups and gender. Data and measures: A Swedish, nationally representative, repeated cross-sectional telephone survey covering the years 2004–2017 ( n = 225,134) was used. Four aspects of alcohol consumption were investigated: proportion of alcohol consumers, frequency of drinking, amount per drinking occasion, and prevalence of heavy episodic drinking. Results: Three of the four measures investigated showed increases in alcohol consumption in the older age groups, particularly among women. Proportion of alcohol consumers, frequency of drinking and prevalence of heavy episodic drinking during the past month increased in most older age groups among both women and men, while the average amount per drinking occasion remained stable. Thus, total consumption in older age groups has increased over time, since the proportion of drinkers and the frequency of drinking has increased. Increases were particularly marked among women and in the age groups 70–74 and 75–79 years. In age groups below 60 years, these measures showed either declines or stability. Conclusions: There has been a steady increase in alcohol consumption across all the older age groups studied, which implies that the changing drinking habits are not isolated only to certain birth cohorts. Instead there seems to be a continuous shift in older people’s drinking habits which can be expected to continue. However, these increases are from very low levels, and older people’s drinking is still at modest levels. Public health implications must be studied further.
Model-based evaluation of the cost effectiveness of 3 versus 6 months’ adjuvant chemotherapy in high-risk stage II colon cancer patients
Authors: Jongeneel Gabrielle , Greuter Marjolein J. E. , van Erning Felice N. , Koopman Miriam , Vink Geraldine R. , Punt Cornelis J. A. , Coupé Veerle M. H. 
Published: September 2020

Background: Our aim was to evaluate the cost effectiveness of 3 months’ adjuvant chemotherapy versus 6 months in high-risk (T4 stage + microsatellite stable) stage II colon cancer (CC) patients. Methods: Using the validated PATTERN Markov cohort model, which simulates the disease progression of stage II CC patients from diagnosis to death, we first evaluated a reference strategy in which high-risk patients were treated with chemotherapy for 6 months. In the second strategy, treatment duration was shortened to 3 months. Both strategies were evaluated for CAPOX (capecitabine plus oxaliplatin) and FOLFOX (fluorouracil, leucovorin and oxaliplatin). Based on trial data, we assumed that shortened treatment duration compared with a 6-month regimen was equally effective for CAPOX and less effective for FOLFOX. Adverse events were highest in the 6-month strategy. Analyses were conducted from a societal perspective using a lifelong time horizon. Outcomes were number of CC deaths per 1000 patients and total discounted costs and quality-adjusted life-years (QALYs) per patient (pp). Incremental net monetary benefit (iNMB) was calculated using a willingness-to-pay value of €50,000/QALY. Results: For CAPOX, the 6-month strategy resulted in 316 CC deaths per 1000 patients, 6.71 QALYs pp and total costs of €41,257 pp. The 3-month strategy resulted in an equal number of CC deaths, but higher QALYs (6.80 pp) and lower costs (€37,645 pp), leading to a iNMB of €8454 per person for 3 months versus 6 months. For FOLFOX, the 6-month strategy resulted in 316 CC deaths per 1000 patients, 6.71 QALYs pp and total costs of €47,135 pp. The 3-month strategy resulted in more CC deaths (393), lower QALYs (6.19 pp) and lower costs (€44,389 pp). An iNMB of −€23,189 was found for 3 months versus 6 months. Conclusion: Our findings indicate that 3 months’ adjuvant chemotherapy should be considered as standard of care in high-risk stage II CC patients for CAPOX, but not for FOLFOX.
Recruitment of Shoulder Complex and Torso Stabilizer Muscles With Rowing Exercises Using a Suspension Strap Training System
Authors: Youdas James W. , Kleis Mary , Krueger Erik T. , Thompson Stephen , Walker Whitney A. , Hollman John H. 
Published: September 2020

Background: Suspension training systems, which use body weight resistance under unstable conditions, may be effective for muscle strengthening in persons with scapular dyskinesis or subacromial impingement syndrome. Hypothesis: Greater arm, scapular, and trunk muscle recruitment will occur during horizontal abduction row exercises. Study Design: Descriptive laboratory study. Level of Evidence: Level 5. Methods: Surface electromyography data were collected from 28 participants (14 men, 14 women). A total of 13 right-sided muscles were studied at a sampling frequency of 1000 Hz. Maximal voluntary isometric contractions (MVICs) were established. Participants completed 3 repetitions per exercise in random order. We compared muscle recruitment during 3 rowing exercises: low row, high row, and horizontal abduction row. Data were compared with repeated-measures analyses of variance and post hoc Bonferroni corrections. Results: For high row and horizontal abduction row conditions, the upper, middle, and lower trapezius and posterior deltoid demonstrated >60% MVIC magnitudes of recruitment, and the upper erector spinae demonstrated 40% to 60% MVIC magnitudes of recruitment, respectively. In contrast, in the low row exercise, 40% to 60% MVIC magnitudes of recruitment were observed only in the middle trapezius, latissimus dorsi, and posterior deltoid. Conclusion: With the suspension system, high row and horizontal abduction row exercises promote muscle strengthening (>50% MVIC) in the upper, middle, and lower fibers of the trapezius, posterior deltoid, and upper erector spinae. Clinical Relevance: Rowing exercises performed with suspension straps may be recommended for muscle strengthening in patients with scapular dyskinesis and subacromial impingement syndrome as well as for healthy persons in need of enhanced scapular muscle performance.