bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19–Associated Nonocclusive Fibrin Microthrombi in the Heart
Authors: Bois Melanie C. , Boire Nicholas A. , Layman Andrew J. , Aubry Marie-Christine , Alexander Mariam P. , Roden Anja C. , Hagen Catherine E. , Quinton Reade A. , Larsen Christopher , Erben Young , Majumdar Ramanath , Jenkins Sarah M. , Kipp Benjamin R. , Lin Peter T. , Maleszewski Joseph J. 
Published: November 2020

Background:
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant clinical presentation, coronavirus disease 2019 (COVID-19), is an emergent cause of mortality worldwide. Cardiac complications secondary to this infection are common; however, the underlying mechanisms of such remain unclear. A detailed cardiac evaluation of a series of individuals with COVID-19 undergoing postmortem evaluation is provided, with 4 aims: (1) describe the pathological spectrum of the myocardium; (2) compare with an alternate viral illness; (3) investigate angiotensin-converting enzyme 2 expression; and (4) provide the first description of the cardiac findings in patients with cleared infection.

Methods:
Study cases were identified from institutional files and included COVID-19 (n=15: 12 active, 3 cleared), influenza A/B (n=6), and nonvirally mediated deaths (n=6). Salient information was abstracted from the medical record. Light microscopic findings were recorded. An angiotensin-converting enzyme 2 immunohistochemical H-score was compared across cases. Viral detection encompassed SARS-CoV-2 immunohistochemistry, ultrastructural examination, and droplet digital polymerase chain reaction.

Results:

Male sex was more common in the COVID-19 group (
P
=0.05). Nonocclusive fibrin microthrombi (without ischemic injury) were identified in 16 cases (12 COVID-19, 2 influenza, and 2 controls) and were more common in the active COVID-19 cohort (
P
=0.006). Four active COVID-19 cases showed focal myocarditis, whereas 1 case of cleared COVID-19 showed extensive disease. Arteriolar angiotensin-converting enzyme 2 endothelial expression was lower in COVID-19 cases than in controls (
P
=0.004). Angiotensin-converting enzyme 2 myocardial expression did not differ by disease category, sex, age, or number of patient comorbidities (
P
=0.69,
P
=1.00,
P
=0.46,
P
=0.65, respectively). SARS-CoV-2 immunohistochemistry showed nonspecific staining, whereas ultrastructural examination and droplet digital polymerase chain reaction were negative for viral presence. Four patients (26.7%) with COVID-19 had underlying cardiac amyloidosis. Cases with cleared infection had variable presentations.

Conclusions:
This detailed histopathologic, immunohistochemical, ultrastructural, and molecular cardiac series showed no definitive evidence of direct myocardial infection. COVID-19 cases frequently have cardiac fibrin microthrombi, without universal acute ischemic injury. Moreover, myocarditis is present in 33.3% of patients with active and cleared COVID-19 but is usually limited in extent. Histological features of resolved infection are variable. Cardiac amyloidosis may be an additional risk factor for severe disease.
Cardiotoxicity and Cardiovascular Biomarkers in Patients With Breast Cancer: Data From the GeparOcto‐GBG 84 Trial
Authors: Rüger Alexandra Maria , Schneeweiss Andreas , Seiler Sabine , Tesch Hans , van Mackelenbergh Marion , Marmé Frederik , Lübbe Kristina , Sinn Bruno , Karn Thomas , Stickeler Elmar , Müller Volkmar , Schem Christian , Denkert Carsten , Fasching Peter A. , Nekljudova Valentina , Garfias‐Macedo Tania , Hasenfuß Gerd , Haverkamp Wilhelm , Loibl Sibylle , von Haehling Stephan 
Published: November 2020

Background
Patients with breast cancer can be affected by cardiotoxic reactions through cancer therapies. Cardiac biomarkers, like NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) and high‐sensitivity cardiac troponin T, might have predictive value.

Methods and Results

Echocardiography, ECG, hemodynamic parameters, NT‐proBNP and high‐sensitivity cardiac troponin T were assessed in 853 patients with early‐stage breast cancer randomized in the German Breast Group GeparOcto‐GBG 84 phase III trial. Patients received neo‐adjuvant dose‐dense, dose‐intensified epirubicin, paclitaxel, and cyclophosphamide (iddEPC group, n=424) or paclitaxel, non‐pegylated doxorubicin, and in triple negative breast cancer, (paclitaxel, non‐pegylated doxorubicin, carboplatin group, n=429) treatment for 18 weeks. Patients positive for human epidermal growth receptor 2 (n=354, 41.5%) received monoclonal antibodies on top of allocated therapy; 119 (12.9%) of all patients showed a cardiotoxic reaction during therapy (15 [1.8%] using a more strict definition). Presence of cardiotoxic reactions was irrespective of treatment allocation (
P
=0.31). Small but significant increases in NT‐proBNP developed early in patients with a cardiotoxic reaction as compared with those without in whom NT‐proBNP rose only towards the end of therapy (
P
=0.04). High‐sensitivity cardiac troponin T rose early in both groups. Logistic regression showed that NT‐proBNP (odds ratio [OR], 1.03; 95% CI, 1.008–1.055;
P
=0.01) and hemoglobin (OR, 1.31; 95% CI, 1.05–1.63;
P
=0.02) measured at 6 weeks after treatment initiation were significantly associated with cardiotoxic reactions.

Conclusions
NT‐proBNP and hemoglobin are significantly associated with cardiotoxic reactions in patients with early‐stage breast cancer undergoing dose‐dense and dose‐intensified chemotherapy, but high‐sensitivity cardiac troponin T is not.

Registration

URL:
http://www.clinicaltrials.gov
; Unique identifier: NCT02125344.
Deep-Learning-Based Gridded Downscaling of Surface Meteorological Variables in Complex Terrain. Part II: Daily Precipitation
Authors: Sha Yingkai , Gagne II David John , West Gregory , Stull Roland 
Published: November 2020

AbstractStatistical downscaling (SD) derives localized information from larger-scale numerical models. Convolutional neural networks (CNNs) have learning and generalization abilities that can enhance the downscaling of gridded data (Part I of this study experimented with 2-m temperature). In this research, we adapt a semantic-segmentation CNN, called UNet, to the downscaling of daily precipitation in western North America, from the low resolution (LR) of 0.25° to the high resolution (HR) of 4-km grid spacings. We select LR precipitation, HR precipitation climatology, and elevation as inputs; train UNet over the subset of the south- and central-western United States using Parameter–Elevation Regressions on Independent Slopes Model (PRISM) data from 2015 to 2018, and test it independently in all available domains from 2018 to 2019. We proposed an improved version of UNet, which we call Nest-UNet, by adding deep-layer aggregation and nested skip connections. Both the original UNet and Nest-UNet show generalization ability across different regions and outperform the SD baseline (bias-correction spatial disaggregation), with lower downscaling error and more accurate fine-grained textures. Nest-UNet also shares the highest amount of information with station observations and PRISM, indicating good ability to reduce the uncertainty of HR downscaling targets.
Roles of Barotropic Instability across the Moat in Inner Eyewall Decay and Outer Eyewall Intensification: Three-Dimensional Numerical Experiments
Authors: Lai Tsz-Kin , Hendricks Eric A. , Menelaou Konstantinos , Yau M. K. 
Published: November 2020

Abstract
Radar imagery of some double-eyewall tropical cyclones shows that the inner eyewalls became elliptical prior to their dissipation during the eyewall replacement cycles, indicating that the barotropic instability (BI) across the moat (also known as type-2 BI) may play a role. To further examine the physics of inner eyewall decay and outer eyewall intensification under the influence of the type-2 instability, three-dimensional numerical experiments are performed. In the moist full-physics run, the simulated vortex exhibits the type-2 instability and the associated azimuthal wavenumber-2 radial flow pattern. The absolute angular momentum (AAM) budget calculation indicates, after the excitation of the type-2 instability, a significant intensification in the negative radial advection of AAM at the inner eyewall. It is further shown that the changes in radial AAM advection largely result from the eddy processes associated with the type-2 instability and contribute significantly to the inner eyewall decay. The budget calculation also suggests that the type-2 instability can accelerate the inner eyewall decay in concert with the boundary layer cutoff effect. Another dry no-physics idealized experiment is conducted and the result shows that the type-2 instability alone is able to weaken the inner eyewall and also strengthen the outer eyewall with nonnegligible effect.
Object-Based Comparison of Data-Driven and Physics-Driven Satellite Estimates of Extreme Rainfall
Authors: Li Zhe , Wright Daniel B. , Zhang Sara Q. , Kirschbaum Dalia B. , Hartke Samantha H. 
Published: November 2020

AbstractThe Global Precipitation Measurement (GPM) constellation of spaceborne sensors provides a variety of direct and indirect measurements of precipitation processes. Such observations can be employed to derive spatially and temporally consistent gridded precipitation estimates either via data-driven retrieval algorithms or by assimilation into physically based numerical weather models. We compare the data-driven Integrated Multisatellite Retrievals for GPM (IMERG) and the assimilation-enabled NASA-Unified Weather Research and Forecasting (NU-WRF) model against Stage IV reference precipitation for four major extreme rainfall events in the southeastern United States using an object-based analysis framework that decomposes gridded precipitation fields into storm objects. As an alternative to conventional “grid-by-grid analysis,” the object-based approach provides a promising way to diagnose spatial properties of storms, trace them through space and time, and connect their accuracy to storm types and input data sources. The evolution of two tropical cyclones are generally captured by IMERG and NU-WRF, while the less organized spatial patterns of two mesoscale convective systems pose challenges for both. NU-WRF rain rates are generally more accurate, while IMERG better captures storm location and shape. Both show higher skill in detecting large, intense storms compared to smaller, weaker storms. IMERG’s accuracy depends on the input microwave and infrared data sources; NU-WRF does not appear to exhibit this dependence. Findings highlight that an object-oriented view can provide deeper insights into satellite precipitation performance and that the satellite precipitation community should further explore the potential for “hybrid” data-driven and physics-driven estimates in order to make optimal usage of satellite observations.
A Unifying Approach to Subtidal Salt Intrusion Modeling in Tidal Estuaries
Authors: Dijkstra Yoeri M. , Schuttelaars Henk M. 
Published: November 2020

AbstractThe salinity structure in estuaries is classically described in terms of the salinity structure as well mixed, partially mixed, or salt wedge. The existing knowledge about the processes that result in such salinity structures comes from highly idealized models that are restricted to either well-mixed and partially mixed cases or subtidal salt wedge estuaries. Hence, there is still little knowledge about the processes driving transitions between these different salinity structures and the estuarine parameters at which such a transition is found. As an important step toward a unified description of the dominant processes driving well-mixed, partially mixed, and salt wedge estuaries, a subtidal width-averaged model applicable to all these salinity structures is developed and systematically analyzed. Using our model, we identify four salinity regimes, resulting from different balances of dominant processes. It is shown that each regime is uniquely determined by two dimensionless parameters: an estuarine Froude and Rayleigh number, representing freshwater discharge and tidal mixing, respectively, resulting in a classification of the regimes in terms of these two parameters. Furthermore, analytical expressions to approximate the salt intrusion length in each regime are developed. These expressions are used to illustrate that the salt intrusion length in different regimes responds in a highly different manner to changes in depth and freshwater discharge. As one of the key results, we show that there are only very weak relations between the process-based regime of an estuary and the salt intrusion length and top–bottom stratification. This implies that the salinity structure of an estuary cannot be uniquely matched to a regime.
Zero Preventable Deaths by 2020: Analysis of Prehospital and Emergency Department Deaths Following Penetrating Trauma Stratified by Anatomic Location
Authors: Houghton August C. , Friedman Jessica K. , Smith Alison A. , Toraih Eman A. , Flanagan Megan R. , Schroll Rebecca W. , Guidry Chrissy , McGrew Patrick R. , Fakhry Samir M. , Duchesne Juan C. 
Published: November 2020

Introduction Preventable deaths following trauma are high and unchanged over the last two decades. The objective of this study was to describe the location of death in patients with penetrating trauma, stratified by anatomic location of injury, in order to better tailor our approach to reducing preventable deaths from trauma. Methods This retrospective analysis of a prospectively maintained trauma registry included consecutive adult trauma activations with penetrating trauma at a level 1 trauma center between 07/2012 and 03/2018. Injuries were categorized as extremity, junctional, and torso. Head and neck injuries were excluded. Patients injured in >1 defined location were categorized as “multiple.” Location of death was defined as on-scene, emergency department (ED), or hospital. Two-sided χ2 tests were used to compare groups. Multivariate analysis was performed using logistic regression. Results A total of 1024 patients were included with an overall case fatality rate (CFR) of 7.8%. The CFR following extremity injury (3.0%) was significantly lower than all other injury sites ( P = .02).There were no significant differences in CFR for junctional (10.4%), torso (8.3%), or multiple injuries (9.6%). Forty percent of fatalities following junctional injury occurred on-scene and an additional 20% occurred in the ED. Discussion To our knowledge, this is the first study to describe location of death stratified by anatomic location of injury. There was no difference in the CFRs of junctional and torso injuries, and a large proportion of deaths occurred prior to reaching the hospital or in the trauma bay. These findings support reevaluating the classical algorithms and care pathways for patients with proximal penetrating trauma.
Prevalence and Determinants of Stunting and Thinness/Wasting Among Schoolchildren of Ethiopia: A Systematic Review and Meta-Analysis
Authors: Hailegebriel Tamirat 
Published: November 2020

Background: Several studies have been carried out assessing the prevalence of undernutrition and possible determinants among schoolchildren in Ethiopia, but there is a lack of systematically gathered and analyzed information. Objective: This systematic review and meta-analysis aimed to summarize epidemiological data on undernutrition and possible determinants among schoolchildren in Ethiopia. Methods: We conducted a systematic review using open access articles that report the prevalence of stunting and wasting/thinness among schoolchildren from PubMed Central, Scopus, and Science direct. The pooled prevalence was determined using a random-effect model while heterogeneities between studies were evaluated by I 2 test. Results: A total of 24 716 schoolchildren were included in the 39 eligible articles. The prevalence of stunting and wasting/thinness among schoolchildren in Ethiopia were 23.1% (95% CI: 19.0-27.0) and 22% (95% CI: 17-26), respectively. There was a marked difference in the prevalence of stunting and wasting/thinness across regions of Ethiopia. The risk of stunting was increased with meal frequency ≤3 times a day (odds ratio [OR] = 3.02, 95% CI: 1.90-4.14), age >10 years (OR = 2.16, 95% CI: 1.47-2.85), and family size ≥5 (OR = 1.88, 95% CI: 1.40-2.35). Similarly, the risk of wasting/thinness was increased with male sex (OR = 2.06, 95% CI: 1.54-2.58), low family income (OR = 2.16, 95% CI: 1.30-3.01), and age >10 years (OR = 1.78, 95% CI: 0.74-2.82). Conclusion: This study revealed that more than one-fifth of schoolchildren are stunted or wasted/thin in Ethiopia. Large family size, male sex, and student age were consistently associated with stunting and wasting/thinness among schoolchildren. This study highlights the importance of an integrated effort to reduce undernutrition in Ethiopia.
Trust, ethical climate and nurses’ turnover intention
Authors: Simha Aditya , Pandey Jatin 
Published: November 2020

Background: Nursing turnover is a very serious problem, and nursing managers need to be aware of how ethical climates are associated with turnover intention. Objectives: The article explored the effects of ethical climates on nurses’ turnover intention, mediated through trust in their organization. Methods: A cross-sectional survey of 285 nurses from three Indian hospitals was conducted to test the research model. Various established Likert-type scales were used to measure ethical climates, turnover intention and trust in organization. Hierarchical regression analysis and mediation analysis were used to test the model. Results: Hierarchical regression analysis and mediation analysis were used to test the model. The indirect effect of benevolent ethical climate on turnover intention through trust in organization was –0.20 with a 95% bootstrap confidence interval of lower level = –0.31 and upper level = –0.01. The indirect effect of principled ethical climate on turnover intention through trust in organization was –0.39 with a 95% bootstrap confidence interval of lower level = –0.58 and upper level = –0.17. Ethical considerations: The study adheres to the ethical standards recommended by the American Psychological Association for conducting research with informed consent, confidentiality and privacy. Conclusion: Both benevolent and principled ethical climates decreased turnover intention indirectly through trust in organization. Only principled ethical climates were directly associated with turnover intention. Our results suggest that nurse managers and leaders should try and establish principled and benevolent climates in order to engender trust in organization and to reduce turnover intention.
Establishment and Validation of Nomogram Model Integrated With Inflammation-Based Factors for the Prognosis of Advanced Non-Small Cell Lung Cancer
Authors: Huang Zhiliang , Xing Shan , Zhu Yuanying , Qu Yuanye , Jiang Lina , Sheng Jiahe , Wang Qian , Xu Songtao , Xue Ning 
Published: November 2020

Objects: Inflammation is one of the hallmarks of cancer. Tumor-associated inflammatory response plays a crucial role in enhancing tumorigenesis. This study aimed to establish an effective predictive nomogram based on inflammation factors in patients with advanced non-small cell lung cancer (NSCLC). Methods: We retrospectively evaluated 887 patients with advanced NSCLC between November 2004 and December 2015 and randomly divided them into primary (n = 520) and validation cohorts (n = 367). Cox regression analysis was used to identify prognostic factors for building the nomogram. The predictive accuracy and discriminative ability of the nomogram were determined using a concordance index (C-index), calibration plot, and decision curve analysis and were compared to the TNM staging system. Results: The nomogram was established using independent risk factors ( P < 0.05): age, TNM stage, C reaction protein-to-albumin ratio (CAR), and neutrophils (NEU). The C-index of the model for predicting OS had a superior discrimination power compared to that of the TNM staging system both in the primary [0.711 (95% CI: 0.675-0.747) vs 0.531 (95% CI: 0.488-0.574), P < 0.01] and validation cohorts [0.703, 95% CI: 0.671 -0.735 vs 0.582, 95% CI: 0.545-0.619, P < 0.01]. Decision curves also demonstrated that the nomogram had higher overall net benefits than that of the TNM staging system. Subgroup analyses revealed that the nomogram was a favorable prognostic parameter in advanced NSCLC ( P < 0.05). The results were internally validated using the validation cohorts. Conclusions: The proposed nomogram with inflammatory factors resulted in an accurate prognostic prediction in patients with advanced NSCLC.
Multimodal Neuroimaging Using Concurrent EEG/fNIRS for Poststroke Recovery Assessment: An Exploratory Study
Authors: Li Rihui , Li Sheng , Roh Jinsook , Wang Chushan , Zhang Yingchun 
Published: November 2020

Background Persistent motor deficits are very common in poststroke survivors and often lead to disability. Current clinical measures for profiling motor impairment and assessing poststroke recovery are largely subjective and lack precision. Objective A multimodal neuroimaging approach was developed based on concurrent functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) to identify biomarkers associated with motor function recovery and document the poststroke cortical reorganization. Methods EEG and fNIRS data were simultaneously recorded from 9 healthy controls and 18 stroke patients during a hand-clenching task. A novel fNIRS-informed EEG source imaging approach was developed to estimate cortical activity and functional connectivity. Subsequently, graph theory analysis was performed to identify network features for monitoring and predicting motor function recovery during a 4-week intervention. Results The task-evoked strength at ipsilesional primary somatosensory cortex was significantly lower in stroke patients compared with healthy controls ( P < .001). In addition, across the 4-week rehabilitation intervention, the strength at ipsilesional premotor cortex (PMC) ( R = 0.895, P = .006) and the connectivity between bilateral primary motor cortices (M1) ( R = 0.9, P = .007) increased in parallel with the improvement of motor function. Furthermore, a higher baseline strength at ipsilesional PMC was associated with a better motor function recovery ( R = 0.768, P = .007), while a higher baseline connectivity between ipsilesional supplementary motor cortex (SMA)–M1 implied a worse motor function recovery ( R = −0.745, P = .009). Conclusion The proposed multimodal EEG/fNIRS technique demonstrates a preliminary potential for monitoring and predicting poststroke motor recovery. We expect such findings can be further validated in future study.