bluuebunny/crossref_metadata_2025_split huggingface dataset:
Volume and Heat Budgets in the Coastal California Current System: Means, Annual Cycles, and Interannual Anomalies of 2014–16
Authors: Zaba Katherine D. , Rudnick Daniel L. , Cornuelle Bruce D. , Gopalakrishnan Ganesh , Mazloff Matthew R. 
Published: March 2020

AbstractThe data-assimilating California State Estimate (CASE) enables the explicit evaluation of spatiotemporally varying volume and heat budgets in the coastal California Current System (CCS). An analysis of over 10 years of CASE model output (2007–17) diagnoses the physical drivers of the CCS mean state, annual cycles, and the 2014–16 temperature anomalies associated with a marine heat wave and an El Niño event. The largest terms in the mean mixed layer (from−50 to 0 m) volume budgets are upward vertical transport at the coast and offshore-flowing ageostrophic Ekman transport at the surface, the two branches of the coastal upwelling overturning cell. Contributions from onshore geostrophic flow in the Southern California Bight and alongshore geostrophic convergence in the central CCS balance the mean volume budgets. The depth-dependent annual cycle of vertical velocity exhibits the strongest upward velocity between −40- and −30-m depth in April. Interannual volume budgets show that over 50% of the 2013.5–16.5 time period experienced downwelling anomalies, which were balanced predominantly by alongshore transport convergence and, less often, by onshore transport anomalies. Mixed layer temperature anomalies persisted for the entirety of 2014–16, reaching a maximum of +3° in October 2015. The mixed layer heat budget shows that intermittent high air–sea heat flux anomalies and alongshore and vertical heat advection anomalies all contributed to warming during 2014–16. A subsurface (from −210 to −100 m) heat budget reveals that in September 2015 anomalous poleward heat advection into the Southern California Bight by the California Undercurrent caused deeper warming during the 2015/16 El Niño.
The Role of Mastoidectomy in Draining Ventilation Tubes
Authors: Jones Joel W. , Archbold Robert , Hillman Todd A. , Chen Douglas A. 
Published: March 2020

Objectives: To discuss the indication for performing a mastoidectomy with catheter placement in patients with chronic tympanostomy tube otorrhea. Methods: The Medical Literature Analysis and Retrieval System Online was searched via PubMed for relevant articles using serous mastoiditis, mastoidectomy, chronic otorrhea, tube otorrhea, tympanostomy tubes, and biofilm as keywords. Results: Further understanding of the pathophysiology of otorrhea and the development of ototopical fluoroquinolones have made a draining tympanostomy tube more manageable. Nevertheless, chronic otorrhea refractory to an otolaryngologist’s traditional treatment algorithm still occurs and may benefit from a mastoidectomy with antibiotic irrigation using a catheter in certain cases. We theorize that resolution of otorrhea results from this technique by decreasing the burden of diseased mucosa and providing a larger concentration or dose of antibiotic to the middle ear cleft through the antrum. High-resolution images of the technique and catheter placement are included in this review. Conclusions: Despite being an uncommon management strategy, the literature suggests an indication for performing a mastoidectomy in a small percentage of patients with a chronically draining tympanostomy tube.
Moral distress and professors of nursing: A cluster analysis
Authors: Toescher Aline Marcelino Ramos , Barlem Edison Luiz Devos , Lunardi Valéria Lerch , Brum Aline Neutzling , Barlem Jamila Geri Tomaschewski , Dalmolin Graziele de Lima 
Published: March 2020

Background Professors of nursing sometimes experience specific situations in their daily practice that conflict with their values and ethical principles and may culminate in moral distress. Moral distress occurs when one is prevented from acting according to his or her knowledge or values, or what one considers to be ethically sound. Objectives To identify the profile of professors of nursing through grouping sociodemographic characteristics and intensity of moral distress. Method Cross-sectional and exploratory study addressing 373 nurses teaching in Brazilian federal public higher education institutions. Data were collected from June to December 2018 through email, using the Google Docs tool. A moral distress scale directed to nurse educators was used. Data were analyzed using descriptive statistics, variance analysis, and cluster analysis. Ethical considerations The Institutional Review Board at the Federal University of Rio Grande approved this study. Findings Initially, four clusters emerged for each variable predicting the profile of Brazilian professors of nursing: sex; whether the individual worked in a graduate program; age; experience in years in their respective higher education institution; and intensity of moral distress. The profile of Brazilian professors of nursing was represented by the largest cluster, 36.5% (n = 136), composed of women working in graduate programs, aged 37 years old on average, having worked in their respective institutions for approximately 5 years, and presenting a moderate intensity of moral distress. Conclusion Assigning individuals into groups facilitates seeing similarities among the predictors that compose the profile of Brazilian professors of nursing, thus recognizing those workers experiencing moral distress in their daily work routine. In addition, this study’s results are expected to encourage reflection on the planning of efficacious interventions directed to the context of education and health.
Pharmacy-Led Quality Improvement Project on Pain Control Using Continuous Subcutaneous Infusion of Opioids in an Inpatient Hospice Unit
Authors: Romero Nayma Moya , DiScala Sandra , Quellhorst Jennifer , Silverman Michael A. 
Published: March 2020

Objectives: The purpose of this quality improvement (QI) project was to improve the overall process of implementing continuous subcutaneous infusion of opioids (CSCIOs) at the West Palm Beach Veterans Affairs Medical Center and characterize their use in the hospice unit. Methods: A retrospective chart review from July 2014 to August 2017 was conducted to identify patients who had received CSCIO. Results were analyzed with descriptive statistics.The business philosphy, LEAN methodology “The 5 Whys” was utilized to identify the root causes for delayed infusion timeliness and corrections were implemented by August 2018. Follow-up retrospective time study completed from September 2018 to February 2019. Results: Of the 107 patients identified, 7 were excluded and 100 were reviewed. The mean age was 73 years, 94% male, and 86% Caucasian. A total of 55 veterans received morphine with an average final infusion rate of 2.5 mg/h. A total of 45 Veterans received hydromorphone with a final infusion rate of 1.3 mg/h. The average infusion duration until death was 5 days. Pharmacy verified 94 (94%) orders and nursing verified 55 (55%) orders within 1 hour (gold standard). Sixteen (16%) patients received CSCIO within 1 hour. The 5 Whys identified nursing order verification and pharmacy lack of visual STAT order notification for priority as the potential sources for infusion timeliness improvement. The follow-up time study confirmed improvement in pharmacy delivery time from 29% to 75% on time. Conclusion: Pharmacist-led intervention directed to improve CSCIO processes in an inpatient hospice unit utilizing LEAN QI methodology increased timeliness of pharmacy CSCIO delivery.
Pegfilgrastim-associated large-vessel vasculitis developed during adjuvant chemotherapy for breast cancer: A case report and review of the literature
Authors: Nakamura Jun , Nishi Tomoyo M , Yamashita Shun , Nakamura Hiroaki , Sato Ken , Oda Yoshimasa , Iyama Akihiro 
Published: March 2020

Introduction Granulocyte colony-stimulating factor (G-CSF) is widely used as a neutrophil supportive therapy in breast cancer chemotherapy. Common adverse events of G-CSF include bone pain, headache, and fatigue; however, reports of G-CSF-associated vasculitis are few. Case report A 66-year-old woman who had undergone surgery for breast cancer received adjuvant chemotherapy with prophylactic use of pegfilgrastim (peg-G). She developed peg-G-associated vasculitis 11 days after initially receiving peg-G. Management and outcome: Although various blood and culture tests were required to rule out other vasculitis syndromes and infections, her symptoms spontaneously disappeared without any treatment other than discontinuation of the causal drug. Discussion G-CSF-associated vasculitis is occasionally accompanied by severe complications such as aortic dissection and aneurysm formation. This case report is important to draw attention towards this rare and difficult-to-diagnosis adverse event of peg-G.
Teledermatology in paediatrics: Health-care impact on the early treatment of infantile haemangiomas
Authors: Betlloch-Mas Isabel , Martínez-Miravete María-Teresa , Berbegal-DeGracia Laura , Sánchez-Vázquez Laura , Sánchez-Payá José 
Published: March 2020

Introduction Teledermatology can solve diagnostic and therapeutic problems in paediatrics, for example in infantile haemangiomas (IHs) requiring early treatment with propranolol. This study aims to assess the impact of teledermatology following its implementation in a health area of Spain, specifically analysing its effectiveness in reducing the age of first propranolol treatment for IH. Methods This was a descriptive study of paediatric teledermatology from 2015 to 2018, studying age, sex, diagnosis, time and mode of resolution. All IHs referred via teledermatology were analysed, and age at propranolol initiation was compared to the period prior to implementation (2008–2014). We also analysed IHs according to referral pathways (teledermatology vs. conventional pathways). Results We included 432 consultations (47.7% boys). The main diagnoses were IH, erythematous-desquamative diseases and infections. Concordance in diagnosis between paediatricians and dermatologists was good, and 48.12% of cases consulted via teledermatology were resolved remotely. Response time was 2.81 days on average. Children younger than two months of age showed the highest proportion of in-person visits. In 2015–2018, children with IHs began treatment with propranolol at a mean age of 4.5 months (1.9 months in those referred via teledermatology vs. 5.6 months in those using conventional referral pathways). In 2008–2014, the mean age at referral was 7.1 months. These differences were significant. Discussion Teledermatology is a fast and effective tool to resolve paediatric cases, enabling a significant decrease in the age of treatment in infants with IH.
Parents’ perceived social support and children’s psychological adjustment
Authors: Nunes Cristina , Martins Cátia , Ayala-Nunes Lara , Matos Filomena , Costa Emilia , Gonçalves Andrea 
Published: March 2020

Summary Perceived social support has often been investigated due to its direct and indirect effects in reducing the impact of several risk factors on physical and psychological well-being. Moreover, many studies have revealed a link between social support and positive parenting, which in turn has an impact on children’s well-being. In Portugal, there is a significant lack of studies in this area. The aim of the present study was to analyze the relationship between parents’ perceived social support and children’s psychological adjustment. The sample consisted of 409 parents (83.13% mothers) living in the region of Algarve (South of Portugal). The Duke-UNC Functional Social Support and the Strengths and Difficulties Questionnaires were used. Findings The results showed that, on average, families had a social support network of nine people, with a balanced presence of family ( M = 4.25, SD = 3.54) and friends ( M = 4.36, SD = 3.17). Parents reported medium-high levels of confidant and affective support, but instrumental support was lower. However, single-parent families, immigrant families, and divorced parents were found to be more socially isolated and received less support than they needed. Affective social support showed predictive value for child psychological adjustment. Applications These findings suggest that developing universal and selective parental education and support programs that focus on strengthening informal social support networks is needed, especially for vulnerable families. Implications for social workers who intervene with families are discussed.
Natural History of 321 Flatfoot Reconstructions in Adult Acquired Flatfoot Deformity Over a 14-Year Period
Authors: Goss Madison , Stauch Christopher , Lewcun Joseph , Ridenour Ryan , King Jesse , Juliano Paul , Aynardi Michael 
Published: March 2020

The purpose of this study was to report the natural history, demographics, and mechanisms of requirement for additional surgery in patients undergoing flatfoot reconstruction for adult acquired flatfoot. A total of 321 consecutive patients undergoing flatfoot reconstruction over a 14-year period were included (2002-2016). All procedures were performed by a senior orthopaedic foot and ankle surgeon at our institution. Demographic data, operative reports, clinic notes, and radiographs were available for review. Statistical analysis included calculation of relative risk (RR) ratios. The majority of patients were female (83.2%,) and most patients were overweight with a body mass index greater than 25 kg/m2 (56.4%). Patient comorbidities included diabetes (13.7%) and rheumatoid arthritis (3.7%). Additional surgery was required for 54 patients (16.8%). The most common reasons for additional surgery were the following: painful calcaneal hardware (57.4%), conversion to triple arthrodesis (16.7%), and wound healing complications (9.1%). An increased risk of need for additional surgery was associated with female gender (RR = 3.4; P = .0005), smoking status (RR = 1.9; P = .0081), and age (<60 years of age; RR = 1.8; P = .042). Although retrospective, the results provide insight into the natural history of this procedure. Clinicians may use these data to appropriately counsel patients who are at increased risk of requirement for additional surgery, such as smokers, women, and patients <60 years old, regarding treatment options. Levels of Evidence: Level IV
Pilot Investigation: Prospective Needs Assessment of Knowledge, Attitude, and Insight About Mental Health Treatment Options in Patients With Chronic Rhinosinusitis
Authors: Mattos Jose L. , Ashby Shaelene , Payne Spencer C. , Newberry Ian , Alt Jeremiah 
Published: March 2020

Introduction Mood disorders frequently coexist with chronic rhinosinusitis (CRS), yet patient views of how mental health impacts their disease, and their willingness to engage in treatment is not well understood. Methods Subjects with CRS were enrolled regardless of their mental health status and completed a needs questionnaire on mental health as it related to CRS. In addition, demographic and disease-specific data were collected. Results We enrolled 55 subjects. In addition, 29.1% of them had polyps, with mean endoscopy/computed tomography (CT)/Sino-Nasal Outcome Test (SNOT-22) scores of 3.9/9.7/41.2, respectively and 45% thought depression was common in CRS patients. In total, 78.2% were open to taking a depression screener and would be comfortable discussing mental health with their Ear Nose and Throat provider, 76.4% of patients felt that treating mental health problems could improve sinus-related quality of life (QOL), and 87.3% were open to meeting with a mental health professional or participating in a course on managing stress/anxiety/mental health issues. The multivariate regression model of whether patients felt that treating the mind would improve sinus-related QOL as predicted by age, gender, SNOT-22, CT scores, and endoscopy scores was statistically significant ( P = .027) and explained 42% of the variance in answers, but only age and gender approached statistical significance ( P = .06 and .04). Conclusions CRS patients acknowledged the high prevalence of comorbid mood disorders and were willing to discuss and be treated for mental health issues. Many patients felt that treating their mental health would improve their disease-specific QOL. These findings warrant further study of how to incorporate the management of metal health into CRS treatment algorithms.
Refreshing China’s Labor Education in the New Era: Policy Review on Education Through Physical Labor
Authors: Fan Guorui , Zou Jiaxin 
Published: March 2020

Purpose: This study reviews China’s labor education theories and policies to reveal the main objectives, contents, and methods of the new era, as well as analyzes future development in labor education. Design/Approach/Methods: In addition to reviewing the relevant labor education theories, this study examines China’s labor education policies using historical documents and current policy texts. Marxist and traditional approaches to labor education, as well as the historical development of education in China, provide the macroscopic backdrop of this study’s analysis of the persistence and innovativeness of China’s labor education policies. Findings: China’s labor education policy has placed labor education on the same level as that in morality, intellect, sports, and aesthetics, thereby endowing labor education with new meaning. Labor education seeks to cultivate workers with all-round physical and mental development. Becoming more varied over time, labor education now involves the cultivation of skills, technological capacities, creative thinking, labor habits, and emotional development. Approaches and methods include formal programs and teaching, education in daily life at home and school, as well as practical activities outside of school. Originality/Value: This study identifies the meaning of labor education in different eras and analyzes the objectives, contents, and methods of China’s current policies on labor education, as well as its future developmental trends. In doing so, this study provides a useful reference for the implementation of labor education in elementary and middle schools.
Skateboarding Injuries in Spain: A Web-Based Survey Approach
Authors: Rodríguez-Rivadulla Adrián , Saavedra-García Miguel Ángel , Arriaza-Loureda Rafael 
Published: March 2020

Background: The inclusion of skateboarding in the Tokyo 2020 Olympic Games reinforces this activity as a sport. As the number of skateboarders around the world and the difficulty of skateboarding maneuvers continue to increase, the number of skateboarding injuries may also rise. Thus, there is a need for more comprehensive investigations into the practice habits and injuries of skateboarders. Purpose: To describe the sports habits and skateboarding injuries of a sample of skateboarders in Spain. Study Design: Descriptive epidemiology study. Methods: A web-based survey was shared among skateboarders in Spain. The survey collected data related to sports habits, skateboarding practice habits, and injury history. Comparisons between subgroups of sex, age, and experience were also conducted. Results: The survey was completed by 197 participants (89.3% male) with a mean age of 24.4 ± 7.1 years and a mean experience of 9.7 ± 7.2 years. Most respondents (87.8%) reported not participating in any type of skateboarding-specific physical training program. Only 27.4% took part in skateboarding competitions, with a larger number of respondents younger than 18 years participating in competitive events. The mean number of sessions per week was 3.3 ± 1.7, and the mean length of sessions was 3.3 ± 1.5 hours. The majority of participants (87.8%) reported having suffered injuries (n = 323) as a result of skateboarding, mainly affecting the lower limbs (69.7%). The most common injury type was a ligament sprain (39.6%), especially of the ankle (39.3%). This injury was also reported as the most likely to recur (70.1%). A large number of injuries (54.2%) were considered severe (ie, >21 days to recover). Most injuries occurred while skateboarding gaps or stairs, including any type of a jump that involved a difference in height between the take-off and landing surfaces (25.7%). Female participants accounted for a larger number of ligament sprains than expected, and experienced skateboarders were more likely to suffer more severe injuries and head/trunk injuries. Conclusion: Respondents to this survey were mainly young male adults who practiced skateboarding recreationally. Respondents of different sexes, ages, and experiences demonstrated different habits and injury patterns. The greater number of severe injuries highlights the need for injury surveillance in skateboarding to inform better prevention and rehabilitation practices.
Novel Chemo-Photothermal Therapy in Breast Cancer Using Methotrexate-Loaded Folic Acid Conjugated Au@SiO2 Nanoparticles
Authors: Agabeigi Reza , Rasta Seyed Hossein , Rahmati-Yamchi Mohammad , Salehi Roya , Alizadeh Effat 
Published: March 2020

AbstractLow level laser therapy (LLLT) is known as a safe type of phototherapy to target tumor tissue/cells. Besides, using targeted nanoparticles increases the successfulness of cancer therapy. This study was designed for investigating the combined effect of folate (FA)/Methotrexate (MTX) loaded silica coated gold (Au@SiO2) nanoparticles (NPs) and LLLT on the fight against breast cancer.NPs were synthesized and characterized using FTIR, TEM and DLS-Zeta. The NPs had spherical morphology with mean diameter of around 25 nm and positive charge (+13.3 mV) while after conjugation with FA and MTX their net charge reduced to around -19.7 mV.Our findings in cell uptake studies clearly showed enhanced cellular uptake of NPs after FA and MTX loaded NPs in both breast cancer cell lines especially on MDA-MB-231 due to high expression of folate receptors. The results indicated that LLLT had a proliferative effect on both breast cancer cell lines but in the presence of engineered breast cancer targeted nanoparticle, the efficacy of combination chemo-photothermal therapy was significantly increased using MTT assay (p<0.05), DAPI staining, and cell cycle findings. The highest apoptotic effect on breast cancer cell lines was observed in the cells exposed to a combination of MTX-FA loaded Au@SiO2 NP and LLLT proved by DAPI staining and cell cycle(by increasing the cell arrest in subG0/G1). Taken together a combination of chemotherapy and LLLT improves the potential of breast cancer therapy with minimum side effects.