bluuebunny/crossref_metadata_2025_split huggingface dataset:
Making doctors available for rural India:
Authors: Subrahmanian Prasanth , Rai Shivangi , Bhushan Himanshu 
Published: May 2020

In the backdrop of acute shortage of allopathic doctors in rural India, this paper looks at the interplay and tension between central and state regulatory measures aimed at improving the availability and retention of allopathic doctors in the rural areas, within the overarching framework of centre-state relations and division of legislative powers between them, with respect to regulation of medical education. While the Central Government has introduced certain provisions in the central law to promote availability of doctors in rural areas, some States have implemented provisions with the same objective, that go beyond the stipulations of the Central Act. Several such measures taken by state governments; be it reservation of post graduate seats for doctors serving in government rural institutions or developing cadre of medical practitioners for rural area under certain conditionalities; have been challenged in courts and held to be violative of the central legislation which inter alia, regulates standards of medical education and registration of doctors. The measures introduced by the state governments for increasing availability of doctors in rural areas, even though struck down as invalid, were intended as instruments of equity and social justice, with far reaching implications for improving availability of health care services in underserved areas. Unless the Medical Council of India Act is amended or the subject matter of medical education is moved from Union list to State list, state interventions are likely to continue to be struck down if they are found to be affecting the standards of medical education.
(In)capacidade civil da pessoa com doença de Alzheimer:
Authors: Monteiro Luzia Cristina Antoniossi , Alexandre Tiago da Silva , Silva Nayara Mendes 
Published: May 2020

Com o envelhecimento populacional, tendem a aumentar os problemas de saúde e, consequentemente, as demandas jurídicas nessa área. A partir do Estatuto da Pessoa com Deficiência, que dissocia a capacidade da deficiência, torna-se emblemática a interdição da pessoa com doença de Alzheimer. Nesse sentido, este artigo objetiva proporcionar subsídios jurídicos à tomada de decisão dos profissionais de saúde. Trata-se de um estudo qualitativo, desenvolvido por meio da análise documental do Código Civil e do Estatuto da Pessoa com Deficiência, bem como da revisão narrativa para identificar reflexões sobre as referidas legislações e a doença de Alzheimer. Observam-se avanços legais na busca pela equidade entre os seres humanos, mas, no caso de uma doença progressiva, irreversível e insidiosa como o Alzheimer, percebe-se a necessidade de atuação das equipes de saúde e jurídicas na proteção dos direitos e da dignidade da pessoa humana por meio da curatela.
Complex and Novel Arrhythmias Precede Stillbirth in Fetuses With De Novo Long QT Syndrome
Authors: Strand Sarah , Strasburger Janette F. , Cuneo Bettina F. , Wakai Ronald T. 
Published: May 2020

Background:
Long QT syndrome (LQTS) is a leading cause of sudden cardiac death in early life and has been implicated in ≈10% of sudden infant deaths and unexplained stillbirths. The purpose of our study was to use fetal magnetocardiography to characterize the electrophysiology and rhythm phenotypes of fetuses with de novo and inherited LQTS variants and identify risk factors for sudden death before birth.

Methods:
We reviewed the fetal magnetocardiography database from the University of Wisconsin Biomagnetism Laboratory for fetuses with confirmed LQTS. We assessed waveform intervals, heart rate, and rhythm, including the signature LQTS rhythms: functional 2° atrioventricular block, T-wave alternans, and torsade de pointes (TdP).

Results:
Thirty-nine fetuses had pathogenic variants in LQTS genes: 27 carried the family variant, 11 had de novo variants, and 1 was indeterminate. De novo variants, especially de novo SCN5A variants, were strongly associated with a severe rhythm phenotype and perinatal death: 9 (82%) showed signature LQTS rhythms, 6 (55%) showed TdP, 5 (45%) were stillborn, and 1 (9%) died in infancy. Those that died exhibited novel fetal rhythms, including atrioventricular block with 3:1 conduction ratio, QRS alternans in 2:1 atrioventricular block, long-cycle length TdP, and slow monomorphic ventricular tachycardia. Premature ventricular contractions were also strongly associated with TdP and perinatal death. Fetuses with familial variants showed a lower incidence of signature LQTS rhythm (6/27=22%), including TdP (3/27=11%). All were live born.

Conclusions:
The malignancy of de novo LQTS variants was remarkably high and demonstrate that these mutations are a significant cause of stillbirth. Their ability to manifest rhythms not known to be associated with LQTS increases the difficulty of echocardiographic diagnosis and decreases the likelihood that a resultant fetal loss is attributed to LQTS.

Registration:

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT03047161.
Phosphodiesterase 9a Inhibition in Mouse Models of Diastolic Dysfunction
Authors: Methawasin Mei , Strom Joshua , Borkowski Tomasz , Hourani Zaynab , Runyan Ray , Smith John E. , Granzier Henk 
Published: May 2020

Background:
Low myocardial cGMP-PKG (cyclic guanosine monophosphate-protein kinase G) activity has been associated with increased cardiomyocyte diastolic stiffness in heart failure with preserved ejection fraction. Cyclic guanosine monophosphate is mainly hydrolyzed by PDE (phosphodiesterases) 5a and 9a. Importantly, PDE9a expression has been reported to be upregulated in human heart failure with preserved ejection fraction myocardium and chronic administration of a PDE9a inhibitor reverses preestablished cardiac hypertrophy and systolic dysfunction in mice subjected to transverse aortic constriction (TAC). We hypothesized that inhibiting PDE9a activity ameliorates diastolic dysfunction.

Methods:

To examine the effect of chronic PDE9a inhibition, 2 diastolic dysfunction mouse models were studied: (1) TAC-deoxycorticosterone acetate and (2)
Lepr

db/db

. PDE9a inhibitor (5 and 8 mg/kg per day) was administered to the mice via subcutaneously implanted osmotic minipumps for 28 days. The effect of acute PDE9a inhibition was investigated in intact cardiomyocytes isolated from TAC-deoxycorticosterone acetate mice. Atrial natriuretic peptide together with PDE9a inhibitor were administered to the isolated intact cardiomyocytes through the cell perfusate.

Results:

For acute inhibition, no cellular stiffness reduction was found, whereas chronic PDE9a inhibition resulted in reduced left ventricular chamber stiffness in TAC-deoxycorticosterone acetate, but not in
Lepr

db/db

mice. Passive cardiomyocyte stiffness was reduced by chronic PDE9a inhibition, with no differences in myocardial fibrosis or cardiac morphometry. PDE9a inhibition increased the ventricular-arterial coupling ratio, reflecting impaired systolic function.

Conclusions:
Chronic PDE9a inhibition lowers left ventricular chamber stiffness in TAC-deoxycorticosterone acetate mice. However, the usefulness of PDE9a inhibition to treat high-diastolic stiffness may be limited as the required PDE9a inhibitor dose also impairs systolic function, observed as a decline in ventricular-arterial coordination, in this model.
Comorbid Conditions and Health-Related Quality of Life in Ambulatory Heart Failure Patients
Authors: Cascino Thomas M. , Kittleson Michelle M. , Lala Anuradha , Stehlik Josef , Palardy Maryse , Pamboukian Salpy V. , Ewald Gregory A. , Mountis Maria M. , Horstmanshof Douglas A. , Robinson Shawn W. , Shah Palak , Jorde Ulrich P. , McLean Rhondalyn C. , Richards Blair , Khalatbari Shokoufeh , Spino Cathie , Taddei-Peters Wendy C. , Grady Kathleen L. , Mann Douglas L. , Stevenson Lynne W. , Stewart Garrick C. , Aaronson Keith D. ,   for the REVIVAL Investigators
Published: May 2020

Background:
Patients with heart failure (HF) often have multiple chronic conditions that may impact health-related quality of life (HRQOL) despite HF therapy. We sought to determine the association between noncardiac comorbidities and HRQOL in ambulatory patients with advanced HF.

Methods:
Baseline data from 373 subjects in REVIVAL (Registry Evaluation of Vital Information for Ventricular Assist Devices in Ambulatory Life) were analyzed using multivariable general linear models to evaluate the relationship between comorbidities and HRQOL (EuroQol Visual Analogue Scale, EQ-5D-3L Index Score, and Kansas City Cardiomyopathy Questionnaire). The primary independent variables were a comorbidity index (sum of 14 noncardiac conditions), a residual comorbidity index (without depression), and depression alone. The median (25th to 75th percentile) number of comorbidities was 3 (2–4).

Results:

Increasing comorbidity burden was associated with a reduction in generic (EQ-5D Index,
P
=0.005) and HF-specific (Kansas City Cardiomyopathy Questionnaire,
P
=0.001) HRQOL. The residual comorbidity index was not associated with HRQOL when depression included in the model independently, while depression was associated with HRQOL across all measures. Participants with depression (versus without) scored on average 13 points (95% CI, 8–17) lower on the EuroQol Visual Analogue Scale, 0.15 points (95% CI, 0.12–0.18) lower on the EQ-5D Index, and 24.9 points (95% CI, 21.2–28.5) lower on the Kansas City Cardiomyopathy Questionnaire overall summary score.

Conclusions:
While noncardiac comorbidities were prevalent in ambulatory advanced HF patients, only depression was associated with decreased generic and HF-specific HRQOL. Other than depression, the presence of noncardiac comorbidities should not impact expected gains in HRQOL following ventricular assist device implantation, provided the conditions are not a contraindication to implant.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01369407.
Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Wuhan, China
Authors: Zhang Li , Feng Xiaokai , Zhang Danqing , Jiang Chunguo , Mei Heng , Wang Jing , Zhang Cuihong , Li Hong , Xia Xiaoling , Kong Shuangshuang , Liao Jia , Jia Huijun , Pang Xueqin , Song Yue , Tian Ying , Wang Bin , Wu Chun , Yuan Hongliang , Zhang Yongxing , Li Yuman , Sun Wei , Zhang Yanting , Zhu Shuangshuang , Wang Shuyuan , Xie Yuji , Ge Shuping , Zhang Liming , Hu Yu , Xie Mingxing 
Published: May 2020

Background:
To investigate deep vein thrombosis (DVT) in hospitalized patients with coronavirus disease 2019 (COVID-19), we performed a single institutional study to evaluate its prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center.

Methods:
We studied a total of 143 patients with COVID-19 from January 29, 2020 to February 29, 2020. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities, and outcome variables were obtained, and comparisons were made between groups with and without DVT.

Results:

Of the 143 patients hospitalized with COVID-19 (age 63±14 years, 74 [51.7%] men), 66 patients developed lower extremity DVT (46.1%: 23 [34.8%] with proximal DVT and 43 [65.2%] with distal DVT). Compared with patients who did not have DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis, including an increased proportion of deaths (23 [34.8%] versus 9 [11.7%];
P
=0.001) and a decreased proportion of patients discharged (32 [48.5%] versus 60 [77.9%];
P
<0.001). Multivariant analysis showed an association only between CURB-65 (confusion status, urea, respiratory rate, and blood pressure) score 3 to 5 (odds ratio, 6.122;
P
=0.031), Padua prediction score ≥4 (odds ratio, 4.016;
P
=0.04), D-dimer >1.0 μg/mL (odds ratio, 5.818;
P
<0.014), and DVT in this cohort, respectively. The combination of a CURB-65 score 3 to 5, a Padua prediction score ≥4, and D-dimer >1.0 μg/mL has a sensitivity of 88.52% and a specificity of 61.43% for screening for DVT. In the subgroup of patients with a Padua prediction score ≥4 and whose ultrasound scans were performed >72 hours after admission, DVT was present in 18 (34.0%) patients in the subgroup receiving venous thromboembolism prophylaxis versus 35 (66.0%) patients in the nonprophylaxis group (
P
=0.010).

Conclusions:
The prevalence of DVT is high and is associated with adverse outcomes in hospitalized patients with COVID-19. Prophylaxis for venous thromboembolism may be protective in patients with a Padua protection score ≥4 after admission. Our data seem to suggest that COVID-19 is probably an additional risk factor for DVT in hospitalized patients.
Qur’anic Perspective on Empowering Humanistic Foreign Language Teaching
Authors: As’ad Mahrus , Bukhori Muslim Ahmad , Ghozali Budiharjo Imam 
Published: May 2020

Abstract
Divinity-based humanistic education which includes foreign language teaching has become a growing concern. Within the development of humanistic foreign language teaching over decades, however, discussion on how Qur’anic perspective may have contributed to this area is still under study. This document analysis explores the contribution of Islamic scripture on the development of humanistic foreign language teaching. Data were derived from about 11 Qur’anic terminologies addressing aspects of Stevick’s pedagogy as a model of humanistic language teaching. Content analysis shows that these Qur’anic verses have provided some essential guidelines for developing an empowering humanistic foreign language learning necessarily required by language teachers, regardless of their faith affiliations. This issue is comprehensively addressed in various Qur’anic terms such as qawlan baliighan (effectiveness) qawlan sadiidan (responsibility), qawlan ma’ruufan (feelings and social relations) and bilisaani qawmih (intellectuality and self-actualization). Although these Qur’anic terminologies are more frequently used as communication principles, their impacts in developing a more empowering humanistic language teaching is also of paramount importance.
To Collect and to Order: the Siku quanshu 四庫全書 and its Organization
Authors: Gandolfo Stefano 
Published: May 2020

Abstract
Collecting and hoarding are distinguished by order. An agglomeration of objects is defined by chaos while a collection comes into being through its organization. The largest collection of texts undertaken in Chinese dynastic history, the Complete Writings of the Four Repositories (Siku quanshu 四庫全書), is the high point of late imperial compilation projects (congshu 叢書). While much scholarship has been devoted to explaining the criteria of inclusion, the question of order remains largely unexplored. In this article, I investigate the link between the collection of knowledge and its organization in the high Qing. Specifically, I explore the poetic understanding of knowledge, the intellectual, non-political purposes behind the collection and its fundamental principle of order. I end this essay offering some remarks on the nature of the Complete Writings, high Qing scholarship, and contemporary attitudes towards classification.
Inertial Waves in Axisymmetric Tropical Cyclones
Authors: O’Neill Morgan E , Chavas Daniel R. 
Published: May 2020

AbstractThe heat engine model of tropical cyclones describes a thermally direct overturning circulation. Outflowing air slowly subsides as radiative cooling to space balances adiabatic warming, a process that does not consume any work. However, we show here that the lateral spread of the outflow is limited by the environmental deformation radius, which at high latitudes can be rather small. In such cases, the outflowing air is radially constrained, which limits how far downward it can subside via radiative cooling alone. Some literature has invoked the possibility of “mechanical subsidence” or “forced descent” in the storm outflow region in the presence of high inertial stability, which would be a thermally indirect circulation. Mechanical subsidence in the subsiding branch of a tropical cyclone has not before been observed or characterized. A series of axisymmetric tropical cyclone simulations at different latitudes and domain sizes is conducted to study the impact of environmental inertial stability on storm dynamics. In higher-latitude storms in large axisymmetric domains, the outflow acts as a wavemaker to excite an inertial wave at the environmental inertial (Coriolis) frequency. This inertial wave periodically ventilates the core of a high-latitude storm with its own low-entropy exhaust air. The wave response is in contrast to the presumed forced descent model, and we hypothesize that this is because inertial stability provides less resistance than buoyant stability, even in highly inertially stable environments.
The Influence of an Eddy in the Success Rates and Distributions of Passively Advected or Actively Swimming Biological Organisms Crossing the Continental Slope
Authors: Rypina Irina I. , Pratt Larry J. , Entner Samuel , Anderson Amanda , Cherian Deepak 
Published: May 2020

AbstractThe Lagrangian characteristics of the surface flow field arising when an idealized, anticyclonic, mesoscale, isolated deep-ocean eddy collides with continental slope and shelf topography are explored. In addition to fluid parcel trajectories, we consider the trajectories of biological organisms that are able to navigate and swim, and for which shallow water is a destination. Of particular interest is the movement of organisms initially located in the offshore eddy, the manner in which the eddy influences the ability of the organisms to reach the shelf break, and the spatial and temporal distributions of organisms that do so. For nonswimmers or very slow swimmers, the organisms arrive at the shelf break in distinct pulses, with different pulses occurring at different locations along the shelf break. This phenomenon is closely related to the episodic formation of trailing vortices that are formed after the eddy collides with the continental slope, turns, and travels parallel to the coast. Analysis based on finite-time Lyapunov exponents reveals initial locations of all successful trajectories reaching the shoreline, and provides maps of the transport pathways showing that much of the cross-shelf-break transport occurs in the lee of the eddy as it moves parallel to the shore. The same analysis shows that the onshore transport is interrupted after a trailing vortex detaches. As the swimming speeds are increased, the organisms are influenced less by the eddy and tend to show up en mass and in a single pulse.
Decadal Changes in Meridional Overturning Circulation in the East Sea (Sea of Japan)
Authors: Han MyeongHee , Cho Yang-Ki , Kang Hyoun-Woo , Nam SungHyun 
Published: May 2020

AbstractMeridional overturning circulation (MOC) is vital to distributing heat, freshwater, and dissolved matter in semienclosed deep marginal seas such as the East Sea (ES) (Sea of Japan). As our understanding of the ES MOC remains incomplete, we attempted to fill this research gap. We analyzed the ES MOC and its decadal change (1993–2012), employing Hybrid Coordinate Ocean Model (HYCOM) global reanalysis. We found that the ES MOC, consisting of two counterrotating overturning cells in the late 1990s, changed into a single full-depth cell in the 2000s and reverted to two cells in the 2010s. The decadal change relates to weakening of the southward western boundary current at the intermediate layer and northward eastern boundary currents at the deep abyssal layer. We propose that surface warming and salinification favored reduced intermediate water formation and enhanced bottom water formation in the northwestern ES in the 2000s and were, therefore, key to the decadal change. Conditions unfavorable to intermediate water formation and favorable to bottom water formation in the winters of the 2000s, compared with the late 1990s, enhanced northward (westward) Ekman transport in the southern (northeastern) ES, successive advection of surface warm, saline water into water formation areas, and air–sea heat and freshwater exchanges linked to the January Arctic Oscillation. Our results indicated that the ES MOC is sensitive to both external atmospheric forcing and internal ES processes, which have implications for significant changes in the response of other marginal seas and global oceans to future climate variability.
Implantation of Squamous Cell Carcinoma in a Free Flap Donor Site
Authors: Pichardo Priscilla , Purdy Nicholas , Haugen Thorsen 
Published: May 2020

Introduction: It is well known that malignant cells can be implanted at distant donor sites due to iatrogenic surgical contamination. Only a small number of reports, however, have been published describing this. Case Presentation: We present a case of oral cavity Squamous Cell Carcinoma (SCC) reconstructed with a radial forearm free flap in which SCC developed in the subcutaneous tissues beneath the donor incision site 6 months after surgery. Management: The implanted tumor was excised and the field was subsequently treated with radiation. The patient remains disease-free on follow-up. Discussion: We present the second report of tumor implanted in a free flap donor site. Additionally, we discuss the risks of tumor implantation, review the literature, and make recommendations to avoid this complication.
Assessment of ventilator-associated pneumonia by combining 8-isoprostane and nitric oxide levels in exhaled breath condensate with the clinical pulmonary infection score
Authors: Jin Zhaoquan , Zhang Wenbin , Zhu Minghui , Xu Juxian , Deng Guohua , Wang Daming 
Published: May 2020

Objective To investigate the effectiveness of combining the 8-isoprostane and nitric oxide (NO) levels in exhaled breath condensate (EBC) with the clinical pulmonary infection score (CPIS) to assess ventilator-associated pneumonia (VAP) in patients on mechanical ventilation. Methods Thirty-two patients with VAP served as the observation group and 32 patients without VAP served as the control group. The correlations of 8-isoprostane and NO levels in EBC with CPIS, chest X-ray score, oxygenation index, and lung injury score (LIS) were analyzed. The area under the curve (AUC) was compared with experimental data using the receiver operating characteristic curve (ROC) to predict VAP. Results The 8-isoprostane and NO levels in EBC of VAP patients on mechanical ventilation were positively correlated with CPIS, chest X-ray score, and LIS, but negatively correlated with oxygenation index. The AUC of simplified CPIS combined with 8-isoprostane and NO levels in EBC for predicting VAP was 0.914, which suggests that this is a highly effective for making a diagnosis. Conclusions The simplified CPIS combined with the 8-isoprostane and NO levels in EBC of patients on mechanical ventilation is effective for evaluating and diagnosing VAP. 8-Isoprostane and NO levels in EBC could be used as biomarkers to evaluate VAP.