bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rural ecotourism planning and design based on SWOT analysis
Authors: Shang Yunfeng , Sun Yunpeng , Xu Aidi 
Published: February 2020

Abstract
With the increasing pace of urban life, people are yearning more and more for a slow-paced rural life. Rural ecotourism is a new type of tourism produced for people to experience rural scenery. In order to ensure the sustainable development of rural eco-tourism, it is necessary to analyze its planning in many aspects. In this study, Tianjin rural eco-tourism was analyzed using the superiority, weakness, opportunity and threats analysis method. Then, according to the analysis, the superiority, weakness, opportunity and threat were obtained, and they were quantitatively analyzed by means of a questionnaire. The results showed that the development of Tianjin rural eco-tourism had four superiorities, i.e. convenient transportation, rich water resources, rich animal and plant resources and rich eco-tourism resources; three weakness, i.e. homogeneous content, unclear theme and low quality of staff; three opportunities, i.e. government support, effective combination of local culture with tourism activities and increased demand for tourism; and two threats, i.e. fierce competition among peers and diversified demands of tourists. In the comprehensive quantitative analysis, the comprehensive scores of superiorities, weakness, opportunities and threats were 3.6, −2.8, 4.4 and −4.4, respectively. To sum up, Tianjin rural ecotourism has superiorities over weakness and equivalent opportunities and threats; i.e. it is basically in a state of sustainable development.
Densities of Currents on Non-Kähler Manifolds
Authors: Vu Duc-Viet 
Published: February 2020

AbstractWe give a natural generalization of the Dinh–Sibony notion of density currents in the setting where the ambient manifold is not necessarily Kähler. As an application, we show that the algebraic entropy of meromorphic self-maps of compact complex surfaces is a finite bi-meromorphic invariant.
Racial and Ethnic Disparities Among Burn Surgery Leadership
Authors: Kettering Caroline E , Egro Francesco M , Konanur Anisha , Smith Brandon T , Corcos Alain C , Stofman Guy M , Ziembicki Jenny A 
Published: February 2020

Abstract
The underrepresentation of racial and ethnic minority groups has been well-documented in general and plastic surgery but not in burn surgery. The aim of this study is to evaluate current minority group disparities among burn surgery leadership. A cross-sectional analysis was performed. Burn surgeons included directors of American Burn Association-verified burn centers in the United States, past and current presidents of the American Burn Association, and editorial board members of five major burn journals (Journal of Burn Care & Research, Burns, Burns & Trauma, Annals of Burns & Fire Disasters, and the International Journal of Burns and Trauma). Surgeons were compared based on factors including age, gender, training, academic rank, and Hirsch index (h-index). Among 71 burn center directors, 50 societal presidents, and 197 journal editors, minority groups represented 18.3, 2.0, and 34.5%, respectively. Among burn center directors, the group classified collectively as nonwhite was significantly younger (49 vs 56; P &lt; .01), graduated more recently (2003 vs 1996; P &lt; .01), and had a lower h-index (9.5 vs 17.4; P &lt; .05). There were no significant differences in gender, type of residency training, advanced degrees obtained, fellowships, academic rank, and academic leadership positions between white and nonwhite groups. When compared with the 2018 U.S. National Census, burn unit directors had a 5.1% decrease in nonwhite representation. Disparities in representation of ethnic and racial minorities exist in burn surgery despite having similar qualifying factors.
High-mass star formation in Orion possibly triggered by cloud–cloud collision. III. NGC 2068 and NGC 2071
Authors: Fujita Shinji , Tsutsumi Daichi , Ohama Akio , Habe Asao , Sakre Nirmit , Okawa Kazuki , Kohno Mikito , Hattori Yusuke , Nishimura Atsushi , Torii Kazufumi , Sano Hidetoshi , Tachihara Kengo , Kimura Kimihiro , Ogawa Hideo , Fukui Yasuo 
Published: February 2020

AbstractUsing the NANTEN2 Observatory, we carried out a molecular-line study of high-mass star forming regions with reflection nebulae, NGC 2068 and NGC 2071, in Orion in the $^{13}$CO($J = 2$–1) transition. The $^{13}$CO distribution shows that there are two velocity components at ${9.0}$ and ${10.5}\:$km$\:$s$^{-1}$. The blue-shifted component is in the northeast associated with NGC 2071, whereas the red-shifted component is in the southwest associated with NGC 2068. The total intensity distribution of the two clouds shows a gap of $\sim\!\! 1\:$pc, suggesting that they are detached at present. A detailed spatial comparison indicates that the two show complementary distributions. The blue-shifted component lies toward an intensity depression to the northwest of the red-shifted component, where we find that a displacement of ${0.8}\:$pc makes the two clouds fit well with each other. Furthermore, a new simulation of non-frontal collisions shows that observations from $60^\circ$ off the collisional axis agreed well with the velocity structure in this region. On the basis of these results, we hypothesize that the two components collided with each other at a projected relative velocity of ${3.0}\:$km$\:$s$^{-1}$. The timescale of the collision is estimated to be ${0.3}\:$Myr for an assumed axis of the relative motion $60^\circ$ off the line of sight. We assume that the two most massive early B-type stars in the cloud, illuminating stars of the two reflection nebulae, were formed by collisional triggering at the interfaces between the two clouds. Given the other young high-mass star-forming regions, namely, M 42, M 43, and NGC 2024 (Fukui et al. 2018a, ApJ, 859, 166; Ohama et al. 2017, arXiv: 1706.05652), it seems possible that collisional triggering has been independently working to form O-type and early B-type stars in Orion in the last Myr over a projected distance of ∼80 pc.
Electrophysiological Estimates of the Electrode–Neuron Interface Differ Between Younger and Older Listeners With Cochlear Implants
Authors: Jahn Kelly N. , Arenberg Julie G. 
Published: February 2020

Objectives:The primary objective of this study was to quantify differences in evoked potential correlates of spiral ganglion neuron (SGN) density between younger and older individuals with cochlear implants (CIs) using the electrically evoked compound action potential (ECAP). In human temporal bone studies and in animal models, SGN density is the lowest in older subjects and in those who experienced long durations of deafness during life. SGN density also varies as a function of age at implantation and hearing loss etiology. Taken together, it is likely that younger listeners who were deafened and implanted during childhood have denser populations of SGNs than older individuals who were deafened and implanted later in life. In animals, ECAP amplitudes, amplitude growth function (AGF) slopes, and their sensitivity to stimulus interphase gap (IPG) are predictive of SGN density. The authors hypothesized that younger listeners who were deafened and implanted as children would demonstrate larger ECAP amplitudes, steeper AGF slopes, and greater IPG sensitivity than older, adult-deafened and implanted listeners.Design:Data were obtained from 22 implanted ears (18 individuals). Thirteen ears (9 individuals) were deafened and implanted as children (child-implanted group), and nine ears (9 individuals) were deafened and implanted as adults (adult-implanted group). The groups differed significantly on a number of demographic variables that are implicitly related to SGN density: (1) chronological age; (2) age at implantation; and (3) duration of preimplantation hearing loss. ECAP amplitudes, AGF linear slopes, and thresholds were assessed on a subset of electrodes in each ear in response to two IPGs (7 and 30 µsec). Speech recognition was assessed using a medial vowel identification task.Results:Compared with the adult-implanted listeners, individuals in the child-implanted group demonstrated larger changes in ECAP amplitude when the IPG of the stimulus was increased from 7 to 30 µsec (i.e., greater IPG sensitivity). On average, child-implanted participants also had larger ECAP amplitudes and steeper AGF linear slopes than the adult-implanted participants, irrespective of IPG. IPG sensitivity for AGF linear slope and ECAP threshold did not differ between age groups. Vowel recognition performance was not correlated with any of the ECAP measures assessed in this study.Conclusions:The results of this study support the theory that young CI listeners who were deafened and implanted during childhood may have denser neural populations than older listeners who were deafened and implanted as adults. Potential between-group differences in SGN integrity emphasize a need to investigate optimized CI programming parameters for younger and older listeners.
Iatrogenic Peroneal Nerve Palsy Rates Secondary to Open Reduction Internal Fixation for Tibial Plateau Fractures Using an Intraoperative Distractor
Authors: Pattyn Ryan , Loder Randall , Mullis Brian H. 
Published: February 2020

Objective:
To report the rate of peroneal nerve palsy after routine use of intraoperative distraction during open reduction internal fixation (ORIF) for lateral unicondylar and bicondylar tibial plateau fracture (TPF) repairs.

Design:
Retrospective chart review.

Setting:
Level I trauma center.

Patients:
Patients with traumatic TPF treated with ORIF between 2007 and 2017.

Intervention:
ORIF for lateral unicondylar and bicondylar TPF.

Main Outcome Measurement:
Presence and resolution of neurovascular injury.

Results:
There were a total of 21 lateral unicondylar and 40 bicondylar TPFs repaired through ORIF in 60 patients identified during the study period with 1-year follow-up and complete records for review. Thirty-six patients had staged external fixation before ORIF while 24 were treated with ORIF initially. Of the staged patients, 9 of 36 (25%) developed nerve palsy while those undergoing initial ORIF (not staged) developed palsy in only one case (1 of 24, or 4%). Of the patients who developed nerve palsy, 9 of 10 (90%) were staged with an initial external fixator before ORIF. The incidence of iatrogenic peroneal nerve palsy secondary to intraoperative distraction was 16.4% (10 of 61). Only 60% (6 of 10) of peroneal nerve palsies recovered clinically with a mean recovery time of approximately 14 weeks. Comparison of demographics in patients with peroneal nerve palsy versus those without yielded no significant difference by sex (P = 0.08), age (P = 0.27), fracture type (P = 0.29), tobacco use (P = 0.44), or alcohol use (P = 0.78).

Conclusions:
Peroneal nerve palsy is a common sequela of ORIF for TPFs involving the lateral compartment using an intraoperative distractor. Staged external fixation followed by definitive ORIF using intraoperative distraction was associated with significant risk for developing nerve palsy (9/10). Many patients (40%) who develop peroneal nerve palsies do not recover, leading to permanent loss of motor and/or sensory function for 7% of patients studied. None of the epidemiologic variables evaluated yielded predictive value for development of peroneal nerve palsy or subsequent resolution. Caution should be exercised in avoiding overdistraction when using intraoperative distraction, especially in those cases that had staged fixation, most notably bicondylar injuries.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Order of Live and Inactivated Vaccines and Risk of Non–vaccine-targeted Infections in US Children 11–23 Months of Age
Authors: Newcomer Sophia R. , Daley Matthew F. , Narwaney Komal J. , Xu Stan , DeStefano Frank , Groom Holly C. , Jackson Michael L. , Lewin Bruno J. , McLean Huong Q. , Nordin James D. , Zerbo Ousseny , Glanz Jason M. 
Published: February 2020

Background:
Some findings from observational studies have suggested that recent receipt of live vaccines may be associated with decreased non–vaccine-targeted infection risk and mortality. Our objective was to estimate risk of non–vaccine-targeted infections based on most recent vaccine type (live vaccines only, inactivated vaccines only or both concurrently) received in US children 11–23 months of age.

Methods:
We conducted a retrospective cohort study within the Vaccine Safety Datalink. We examined electronic health record and immunization data from children born in 2003–2013 who received 3 diphtheria-tetanus-acellular pertussis vaccines before their first birthday. We modeled vaccine type as a time-varying exposure and estimated risk of non–vaccine-targeted infections identified in emergency department and inpatient settings, adjusting for multiple confounders.

Results:
Among 428,608 children, 48.9% were female, 4.9% had ≥1 immunization visit with live vaccines only and 10.3% had a non–vaccine-targeted infection. In males, lower risk of non–vaccine-targeted infections was observed following last receipt of live vaccines only or live and inactivated vaccines concurrently as compared with last receipt of inactivated vaccines only [live vaccines-only adjusted hazard ratio (aHR) = 0.83, 95% confidence interval (CI): 0.72–0.94; live and inactivated vaccines concurrently aHR: 0.91, 95% CI: 0.88–0.94]. Among females, last receipt of live and inactivated vaccines concurrently was significantly associated with non–vaccine-targeted infection risk (aHR = 0.94, 95% CI: 0.91–0.97 vs. last receipt of inactivated vaccines only).

Conclusions:
We observed modest associations between live vaccine receipt and non–vaccine-targeted infections. In this observational study, multiple factors, including healthcare-seeking behavior, may have influenced results.
The Effect of Patient Volume and Experience on Management of Menière's Disease
Authors: Sacks Cody , Saadi Robert , Isildak Huseyin 
Published: February 2020

Hypothesis:
Treatment modalities administered by Otolaryngologists vary based on patient volume and years of experience.

Objective:
It was our goal to evaluate the current trends in treatment modalities administered by Otolaryngologists based on patient volume and years of experience.

Methods:
An electronic questionnaire was distributed to all General Otolaryngologists and fellowship-trained Neurotologist members of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS). Respondents were separated into groups by patients per year (<10, 10–29, 30–49, 50–99, or >100 patients) and years in practice (0–5, 6–10, 11–15, 16–20, or >20 yrs).

Results:
Eight hundred and sixty members replied for a response rate of 14.5% for generalists and 35% for neurotologists. Patient volume was found to have a positive association with perceived benefit of lifestyle and diet modification, and use of intratympanic steroids, intratympanic gentamycin, oral steroids, benzodiazepines, acetazolamide, endolymphatic sac procedures, vestibular nerve section, and surgical labyrinthectomy. Only endolymphatic sac procedures were found to have a significant positive association with a physician's length in practice. The only negative association was between intratympanic steroids and a physician's length in practice.

Conclusion:
Physicians who see more MD patients annually are more likely to use these treatment modalities: diet and lifestyle modification, intratympanic steroids, intratympanic gentamycin, surgical labyrinthectomy, vestibular nerve section, acetazolamide, alprazolam, lorazepam, dexamethasone, and prednisone. Physicians with a longer length of time in practice are more likely to use only endolymphatic sac procedures, and they are less likely to use intratympanic steroids.
Stereologic Investigation of Mastoid Air Cell Geometry: Volume, Surface Area, and Anisotropy
Authors: Søndergaard Nikolaj , Nyengaard Jens Randel , Bloch Sune Land 
Published: February 2020

Objective:
To assess mastoid geometry using computed tomography (CT) scans and design-based stereological methods.

Background:
The anatomical organization of the mastoid air cell system (MACS) remains debated. Geometrical parameters have previously been determined by automated image-analysis algorithms. Stereology is an alternative approach, which has previously been applied to estimate the volume of the MACS, but has not previously been used to estimate surface area or study anisotropy.

Methods:
Twenty-three clinical CT scans of aerated temporal bones obtained from various ENT patients were studied. The structural orientation and anisotropy of the MACS was investigated by test-grid rotation and rose plots. Volume, surface area, and surface area-to-volume ratio were estimated with design-based stereology.

Results:
Anisotropy of the mastoid air cells was demonstrated by a significant difference in surface area estimates between the axial and coronal planes (p = 0.0065). Rose plots illustrated variances in surface area estimates with different grid rotations, and a minimum value in the craniocaudal direction was shown. Sampling in the axial plane provided the least variance due to anisotropy. The mean (±SD) volume and surface area estimates were 5.71 ± 2.98 cm3 and 117 cm2 ± 60 cm2, respectively. A large biological variation was noted. The mean (±SD) surface-to-volume ratio was 20.6 ± 2.8 cm−1.

Conclusions:
The stereological technique proved to be a robust method for volume and surface area estimation in clinical CT scans. The mastoid air cells constitute an anisotropic cell-system that seems to have a predominant orientation in the craniocaudal direction.
Early detection of progressive disease using thyroglobulin doubling-time in metastatic differentiated thyroid carcinoma treated with radioactive iodine
Authors: Zhang Xieyi , Higuchi Tetsuya , Tomonaga Hiroyasu , Lamid-Ochir Oyunbold , Bhattarai Anu , Nguyen-Thu Huong , Taketomi-Takahashi Ayako , Hirasawa Hiromi , Tsushima Yoshito 
Published: February 2020

Objective
Detectable serum thyroglobulin (Tg) in patients with differentiated thyroid carcinoma (DTC) after total thyroidectomy indicates progression of the disease. Thyroglobulin doubling-time (TgDT) is a powerful prognostic predictor in patients with DTC. We aimed to evaluate the value of the dynamic TgDT for early detection of progressive disease (PD) in the patients of metastatic DTC with 131I radioactive iodine (RAI) therapy.

Methods
We retrospectively evaluated 21 patients undergoing RAI therapy with metastatic DTC. Patients were defined as PD or non-PD according to Response Evaluation Criteria in Solid Tumors 1.1. TgDT was calculated by Excel-based software using Tg values measured during routine follow-up. Whole data (WDT), initial four data (IDT) and recent four data (RDT) of TgDT after total thyroidectomy were calculated and compared.

Results
Among the 21 patients (10 men; median age, 62 years old; range, 33–80), 11 patients were classified into PD and 10 were into non-PD. The initial Tg after total thyroidectomy showed a significant difference between PD and non-PD patients (P = 0.013). Short WDT, IDT and RDT (less than one year) showed a high correlation with PD (P < 0.05). RDT showed the highest predictive value for PD (P < 0.001). All the 11 PD patients showed RDT less than one year before PD (median follow-up, 157 days; range, 88–252).

Conclusions
RDT is a powerful PD predictor in patients with metastatic DTC. Dynamic monitoring of RDT should be applied for the early detection of PD in clinic.
Instilling Hope and Resiliency
Authors: Lurie Jacob Michael , Lever Hazel , Goodson Lucy , Lyons Daniel Jack , Yanagisawa Robert T. , Katz Craig L. 
Published: February 2020

Abstract
On March 11, 2011 (“3/11”), a magnitude 9.0 earthquake in Northeastern Japan triggered a tsunami and nuclear power plant meltdown that killed 16,000 people and displaced more than 470,000 people. Since 2012, a group of volunteer docents from the September 11th Families Association in New York City has traveled throughout Northeastern Japan and held organized meetings where 9/11 and 3/11 survivors share their experiences and stories of trauma as part of an intercultural exchange to promote posttraumatic recovery. We sought to elucidate whether participating 9/11 docents developed a sense of increased resiliency by participating in this international outreach. This study employed photo-taking as well as framing questions, which were developed by 9/11 docents from the August 2016 trip. These questions guided photo-taking and resulting photographs informed discussion in individual and group sharing sessions. This process helped identify codes that guided analysis. Participants acquired a deeper appreciation of their own ability to overcome adversity and experienced a gratifying desire to help 3/11 survivors better cope with their experiences. This narrative photo-taking and group sharing experience demonstrates that a cross-cultural exchange between survivors of different disasters can instill feelings of resilience among participants. It additionally provides early evidence of the efficacy of such an exchange in benefitting disaster survivors in the long term.
Prepectoral Direct-to-Implant Breast Reconstruction: Safety Outcome Endpoints and Delineation of Risk Factors
Authors: Nealon Kassandra P. , Weitzman Rachel E. , Sobti Nikhil , Gadd Michele , Specht Michelle , Jimenez Rachel B. , Ehrlichman Richard , Faulkner Heather R. , Austen William G. , Liao Eric C. 
Published: February 2020

Background:
Continued evolution of implant-based breast reconstruction involves immediate placement of the implant above the pectoralis muscle. The shift to prepectoral breast reconstruction is driven by goals of decreasing morbidity such as breast animation deformity, range-of-motion problems, and pain, and is made possible by improvements in mastectomy skin flap viability. To define clinical factors to guide patient selection for direct-to-implant prepectoral implant reconstruction, this study compares safety endpoints and risk factors between prepectoral and subpectoral direct-to-implant breast reconstruction cohorts. The authors hypothesized that prepectoral direct-to-implant breast reconstruction is a safe alternative to subpectoral direct-to-implant breast reconstruction.

Methods:
Retrospective chart review identified patients who underwent prepectoral and subpectoral direct-to-implant breast reconstruction, performed by a team of five surgical oncologists and two plastic surgeons. Univariate analysis compared patient characteristics between cohorts. A penalized logistic regression model was constructed to identify relationships between postoperative complications and covariate risk factors.

Results:
A cohort of 114 prepectoral direct-to-implant patients was compared with 142 subpectoral direct-to-implant patients. The results of the penalized regression model demonstrated equivalence in safety metrics between prepectoral direct-to-implant and subpectoral direct-to-implant breast reconstruction, including seroma (p = 0.0883), cancer recurrence (p = 0.876), explantation (p = 0.992), capsular contracture (p = 0.158), mastectomy skin flap necrosis (p = 0.769), infection (p = 0.523), hematoma (p = 0.228), and revision (p = 0.122).

Conclusions:
This study demonstrates that prepectoral direct-to-implant reconstruction is a safe alternative to subpectoral direct-to-implant reconstruction. Given the low morbidity and elimination of animation deformity, prepectoral direct-to-implant reconstruction should be considered when the mastectomy skin flap is robust.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.