bluuebunny/crossref_metadata_2025_split huggingface dataset:
Macular hole morphology and measurement using an automated three-dimensional image segmentation algorithm
Authors: Chen Yunzi , Nasrulloh Amar V , Wilson Ian , Geenen Caspar , Habib Maged , Obara Boguslaw , Steel David H W 
Published: August 2020

ObjectiveFull-thickness macular holes (MH) are classified principally by size, which is one of the strongest predictors of anatomical and visual success. Using a three-dimensional (3D) automated image processing algorithm, we analysed optical coherence tomography (OCT) images of 104 MH of patients, comparing MH dimensions and morphology with clinician-acquired two-dimensional measurements.Methods and AnalysisAll patients underwent a high-density central horizontal scanning OCT protocol. Two independent clinicians measured the minimum linear diameter (MLD) and maximum base diameter. OCT images were also analysed using an automated 3D segmentation algorithm which produced key parameters including the respective maximum and minimum diameter of the minimum area (MA) of the MH, as well as volume and surface area.ResultsUsing the algorithm-derived values, MH were found to have significant asymmetry in all dimensions. The minima of the MA were typically approximately 90° to the horizontal, and differed from their maxima by 55 μm. The minima of the MA differed from the human-measured MLD by a mean of nearly 50 μm, with significant interobserver variability. The resultant differences led to reclassification using the International Vitreomacular Traction Study Group classification in a quarter of the patients (p=0.07).ConclusionMH are complex shapes with significant asymmetry in all dimensions. We have shown how 3D automated analysis of MH describes their dimensions more accurately and repeatably than human assessment. This could be used in future studies investigating hole progression and outcome to help guide optimum treatments.
Promoting hot debriefing in an emergency department
Authors: Gilmartin Stephen , Martin Laura , Kenny Siobhain , Callanan Ian , Salter Nigel 
Published: August 2020

IntroductionDebriefing is a process of communication that takes place between a team following a clinical case. Debriefing facilitates discussion of individual and team level performance and identifies points of excellence as well as potential errors made. This helps to develop plans to improve subsequent performance. While the American Heart Association and the UK Resuscitation Council recommend debriefing following every cardiac arrest attended by a healthcare professional, it has not become part of everyday practice. In the emergency department (ED), this is in part attributable to time pressures and workload. Hot debriefing is a form of debriefing which should occur ‘there and then’ following a clinical event. The aim of this quality improvement project was to introduce hot debriefing to our ED following all cardiac arrests.MethodsThe STOP5 model used was originally created by Drs Craig Walker, Laura McGregor and Sara Robinson in 2017, in partnership with Edinburgh Emergency Medicine, the Scottish Centre for Clinical Human Factors and NHS Education Scotland. Additional headings for discussion that specifically focus on cardiac arrest management were added to the model by the project team. This tool was then introduced to the ED for use after all cardiac arrests. The team lead was asked to complete a debrief form. These completed hot debrief forms were collated monthly and compared with the department’s cardiac arrest register. Any changes made to cardiac arrest management following hot debriefing were recorded. Qualitative feedback was obtained through questionnaires.ResultsDuring the 6-month study period, 42% of all cardiac arrest cases were followed by a hot debrief. Practice changes were made to resus room equipment, practitioners’ non-technical skills and the department’s educational activities. 95% of participants felt the hot debriefing tool was of ‘just right’ duration, 100% felt the process helped with their clinical practice, and 90% felt they benefited psychologically from the process.ConclusionThe introduction of a hot debriefing tool in our department has led to real-world changes to cardiac arrest care. The process benefits participants’ clinical practice as well as psychological well-being.
A pharmacist-led pilot using a performance dashboard to improve psychotropic medication use in a skilled nursing facility
Authors: Bell Kristin , Hartmann Christine , Baughman Amy Wisteria 
Published: August 2020

ObjectivesInappropriate use of psychotropic medications in the elderly, particularly those with dementia, is a critical safety and quality concern. This pilot quality improvement study used a novel Department of Veterans Affairs (VA) Psychotropic Drug Safety Initiative performance dashboard (PDSI dashboard) to implement a pharmacist-led intervention to improve psychotropic medication prescribing practices in a VA skilled nursing facility (SNF). While clinical dashboard data have become commonplace, literature describing successful implementation for improved clinical care is scant.MethodsThis study took place from November 2015 to February 2016 at a 112-bed VA SNF. A pharmacist used the PDSI dashboard to identify ‘actionable’ patients with potentially inappropriate psychotropic prescribing and then completed chart reviews to confirm clinical indications. The pharmacist provided recommendations to providers for dose reductions or deprescribing via in-person communication and notes written in the electronic medical record. SNF providers completed anonymous surveys about their experience in receiving recommendations.ResultsOver a 5-month period, the PDSI dashboard identified 21 patients with potentially inappropriate psychotropic medication use, with approximately one new patient identified each week. Prescribing recommendations were accepted 66% of the time. All seven SNF providers reported that recommendations were helpful in improving their psychotropic prescribing practices.ConclusionsThe PDSI dashboard was efficient and effective in identifying patients at risk for inappropriate use of psychotropic medications. A clinical pharmacist was essential for implementing and communicating recommendations from the dashboard to providers.
Intratumoral TIGIT+ CD8+ T-cell infiltration determines poor prognosis and immune evasion in patients with muscle-invasive bladder cancer
Authors: Liu Zhaopei , Zhou Quan , Wang Zewei , Zhang Hongyu , Zeng Han , Huang Qiuren , Chen Yifan , Jiang Wenbin , Lin Zhiyuan , Qu Yang , Xiong Ying , Bai Qi , Xia Yu , Wang Yiwei , Liu Li , Zhu Yu , Xu Le , Dai Bo , Guo Jianming , Wang Jiajun , Chang Yuan , Zhang Weijuan 
Published: August 2020

BackgroundT-cell immunoglobulin and ITIM domain (TIGIT) is identified as a novel checkpoint receptor that can facilitate immune escape via mediating T-cell exhaustion in tumors. However, the clinical significance and immune contexture correlation of intratumoral TIGIT+ CD8+ T-cells remain to be further explored in muscle-invasive bladder cancer (MIBC).Methods259 patients with MIBC from two clinical centers (Zhongshan Hospital, n=141; Shanghai Cancer Center, n=118) were analyzed to evaluate the prognostic value and immune contexture association of TIGIT+ CD8+ T-cells through immunohistochemistry. Fresh tumor tissue samples from 26 patients with MIBC were examined to discover the phenotype of this CD8 subpopulation by flow cytometry.ResultsHigh infiltration of intratumoral TIGIT+ CD8+ T-cells predicted poor overall survival (OS) and recurrence-free survival (RFS) in MIBC. For patients with stage II MIBC with low infiltration of TIGIT+ CD8+ cells, adjuvant chemotherapy (ACT) could significantly prolong their OS and RFS. Intratumoral TIGIT+ CD8+ T-cell abundance was correlated with impaired CD8+ T-cell cytotoxicity and exhibited production of immunosuppressive cytokine IL-10. Further analysis of tumor-infiltrating immune cell landscape revealed TIGIT+ CD8+ T-cells were associated with suppressive immune contexture, including Th2 cells, regulatory T-cells, mast cells and neutrophils.ConclusionIntratumoral TIGIT+ CD8+ T-cell abundance could serve as an independent prognosticator for clinical outcome and a predictive biomarker for inferior ACT responsiveness. Intratumoral TIGIT+ CD8+ T-cell abundance correlated with dampened CD8+ T-cell antitumor immunity and immunosuppressive contexture abundance, highlighting a tumor-promoting role of TIGIT+ CD8+ T-cells.
Development of a liquid scintillator based active fission target for FIPPS
Authors: Kandzia F. , Belier G. , Michelagnoli C. , Aupiais J. , Barani M. , Dudouet J. , Düllmann Ch. E. , Iskra Ł. W. , Jentschel M. , Kim Y. H. , Köster U. , Turturica A. 
Published: August 2020

AbstractAn active fission target has been developed for the FIPPS instrument at ILL, enabling for the first time an efficient suppression of $$\upbeta $$
β
-delayed $$\upgamma $$
γ
rays in high-resolution and high-efficiency $$\upgamma $$
γ
-ray spectroscopy of fission fragments at a neutron beam. The target is based on a liquid scintillator in which the actinide is dissolved, resulting in a 4$$\pi $$
π
fragment detection. Measurements have been performed with $$^{233, 235}$$

233
,
235

U, with a fission tagging efficiency of 97.8(25)%. The high efficiency, together with the good time resolution of the scintillator target, provide high-selectivity data for $$\upgamma $$
γ
-ray spectroscopy studies of fission fragments.
On the generalised eigenvalue method and its relation to Prony and generalised pencil of function methods
Authors: Fischer M. , Kostrzewa B. , Ostmeyer J. , Ottnad K. , Ueding M. , Urbach C. 
Published: August 2020

AbstractWe discuss the relation of a variety of different methods to determine energy levels in lattice QCD simulations: the generalised eigenvalue, the Prony, the generalised pencil of function and the Gardner methods. All three former methods can be understood as special cases of a generalised eigenvalue problem. We show analytically that the leading corrections to an energy $$E_l$$

E
l

in all three methods due to unresolved states decay asymptotically exponentially like $$\exp (-(E_{n}-E_l)t)$$

exp
(
-

(

E
n

-

E
l

)

t
)

. Using synthetic data we show that these corrections behave as expected also in practice. We propose a novel combination of the generalised eigenvalue and the Prony method, denoted as GEVM/PGEVM, which helps to increase the energy gap $$E_{n}-E_l$$

E
n

-

E
l

. We illustrate its usage and performance using lattice QCD examples. The Gardner method on the other hand is found less applicable to realistic noisy data.
Effect of magnetic field on the charge and thermal transport properties of hot and dense QCD matter
Authors: Rath Shubhalaxmi , Patra Binoy Krishna 
Published: August 2020

AbstractWe have studied the effect of strong magnetic field on the charge and thermal transport properties of hot QCD matter at finite chemical potential. For this purpose, we have calculated the electrical conductivity ($$\sigma _\mathrm{el}$$σel) and the thermal conductivity ($$\kappa $$κ) using kinetic theory in the relaxation time approximation, where the interactions are subsumed through the distribution functions within the quasiparticle model at finite temperature, strong magnetic field and finite chemical potential. This study helps to understand the impacts of strong magnetic field and chemical potential on the local equilibrium by the Knudsen number ($$\Omega $$Ω) through $$\kappa $$κ and on the relative behavior between thermal conductivity and electrical conductivity through the Lorenz number (L) in the Wiedemann–Franz law. We have observed that, both $$\sigma _\mathrm{el}$$σel and $$\kappa $$κ get increased in the presence of strong magnetic field, and the additional presence of chemical potential further increases their magnitudes, where $$\sigma _\mathrm{el}$$σel shows decreasing trend with the temperature, opposite to its increasing behavior in the isotropic medium, whereas $$\kappa $$κ increases slowly with the temperature, contrary to its fast increase in the isotropic medium. The variation in $$\kappa $$κ explains the decrease of the Knudsen number with the increase of the temperature. However, in the presence of strong magnetic field and finite chemical potential, $$\Omega $$Ω gets enhanced and approaches unity, thus, the system may move slightly away from the equilibrium state. The Lorenz number ($$\kappa /(\sigma _\mathrm{el} T))$$κ/(σelT)) in the abovementioned regime of strong magnetic field and finite chemical potential shows linear enhancement with the temperature and has smaller magnitude than the isotropic one, thus, it describes the violation of the Wiedemann–Franz law for the hot and dense QCD matter in the presence of a strong magnetic field.
Intratumoral IL12 mRNA Therapy Promotes TH1 Transformation of the Tumor Microenvironment
Authors: Hewitt Susannah L. , Bailey Dyane , Zielinski John , Apte Ameya , Musenge Faith , Karp Russell , Burke Shannon , Garcon Fabien , Mishra Ankita , Gurumurthy Sushma , Watkins Amanda , Arnold Kristen , Moynihan James , Clancy-Thompson Eleanor , Mulgrew Kathy , Adjei Grace , Deschler Katharina , Potz Darren , Moody Gordon , Leinster David A. , Novick Steve , Sulikowski Michal , Bagnall Chris , Martin Philip , Lapointe Jean-Martin , Si Han , Morehouse Chris , Sedic Maja , Wilkinson Robert W. , Herbst Ronald , Frederick Joshua P. , Luheshi Nadia 
Published: August 2020

AbstractPurpose:While immune checkpoint inhibitors such as anti–PD-L1 are rapidly becoming the standard of care in the treatment of many cancers, only a subset of treated patients have long-term responses. IL12 promotes antitumor immunity in mouse models; however, systemic recombinant IL12 had significant toxicity and limited efficacy in early clinical trials.Experimental Design:We therefore designed a novel intratumoral IL12 mRNA therapy to promote local IL12 tumor production while mitigating systemic effects.Results:A single intratumoral dose of mouse (m)IL12 mRNA induced IFNγ and CD8+ T-cell–dependent tumor regression in multiple syngeneic mouse models, and animals with a complete response demonstrated immunity to rechallenge. Antitumor activity of mIL12 mRNA did not require NK and NKT cells. mIL12 mRNA antitumor activity correlated with TH1 tumor microenvironment (TME) transformation. In a PD-L1 blockade monotherapy-resistant model, antitumor immunity induced by mIL12 mRNA was enhanced by anti–PD-L1. mIL12 mRNA also drove regression of uninjected distal lesions, and anti–PD-L1 potentiated this response. Importantly, intratumoral delivery of mRNA encoding membrane-tethered mIL12 also drove rejection of uninjected lesions with very limited circulating IL12p70, supporting the hypothesis that local IL12 could induce a systemic antitumor immune response against distal lesions. Furthermore, in ex vivo patient tumor slice cultures, human IL12 mRNA (MEDI1191) induced dose-dependent IL12 production, downstream IFNγ expression and TH1 gene expression.Conclusions:These data demonstrate the potential for intratumorally delivered IL12 mRNA to promote TH1 TME transformation and robust antitumor immunity.See related commentary by Cirella et al., p. 6080
Time Trends in Pulmonary Embolism Mortality Rates in the United States, 1999 to 2018
Authors: Martin Karlyn A. , Molsberry Rebecca , Cuttica Michael J. , Desai Kush R. , Schimmel Daniel R. , Khan Sadiya S. 
Published: August 2020

Background
Although historical trends before 1998 demonstrated improvements in mortality caused by pulmonary embolism (PE), contemporary estimates of mortality trends are unknown. Therefore, our objective is to describe trends in death rates caused by PE in the United States, overall and by sex‐race, regional, and age subgroups.

Methods and Results

We used nationwide death certificate data from Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research to calculate age‐adjusted mortality rates for PE as underlying cause of death from 1999 to 2018. We used the Joinpoint regression program to examine statistical trends and average annual percent change. Trends in PE mortality rates reversed after an inflection point in 2008, with an average annual percent change before 2008 of −4.4% (−5.7, −3.0,
P
<0.001), indicating reduction in age‐adjusted mortality rates of 4.4% per year between 1999 and 2008, versus average annual percent change after 2008 of +0.6% (0.2, 0.9,
P
<0.001). Black men and women had approximately 2‐fold higher age‐adjusted mortality rates compared with White men and women, respectively, before and after the inflection point. Similar trends were seen in geographical regions. Age‐adjusted mortality rates for younger adults (25–64 years) increased during the study period (average annual percent change 2.1% [1.6, 2.6]) and remained stable for older adults (>65 years).

Conclusions
Our study findings demonstrate that PE mortality has increased over the past decade and racial and geographic disparities persist. Identifying the underlying drivers of these changing mortality trends and persistently observed disparities is necessary to mitigate the burden of PE‐related mortality, particularly premature preventable PE deaths among younger adults (<65 years).
Thermal Signatures of Peri-Urban Landscapes
Authors: Gough William A. 
Published: August 2020

AbstractA new thermal metric is examined that is based on the ratio of day-to-day warm and cold surface temperature transitions. Urban and rural sites in Canada are examined using this new metric for the minimum temperature, maximum temperature, and mean temperature of the day. A distinctive signature emerges for “peri-urban” landscapes—landscapes at the urban–rural interface—and thus may provide a useful and relatively easy way to detect such environments using the current and historical climate records. A climatological basis for the presence of these distinct thermal signatures in peri-urban landscapes is proposed.
Microphysical Insights into Ice Pellet Formation Revealed by Fully Polarimetric Ka-Band Doppler Radar
Authors: Kumjian Matthew R. , Tobin Dana M. , Oue Mariko , Kollias Pavlos 
Published: August 2020

AbstractFully polarimetric scanning and vertically pointing Doppler spectral data from the state-of-the-art Stony Brook University Ka-band Scanning Polarimetric Radar (KASPR) are analyzed for a long-duration case of ice pellets over central Long Island in New York from 12 February 2019. Throughout the period of ice pellets, a classic refreezing signature was present, consisting of a secondary enhancement of differential reflectivity ZDR beneath the melting layer within a region of decreasing reflectivity factor at horizontal polarization ZH and reduced copolar correlation coefficient ρhv. The KASPR radar data allow for evaluation of previously proposed hypotheses to explain the refreezing signature. It is found that, upon entering a layer of locally generated columnar ice crystals and undergoing contact nucleation, smaller raindrops preferentially refreeze into ice pellets prior to the complete freezing of larger drops. Refreezing particles exhibit deformations in shape during freezing, leading to reduced ρhv, reduced co-to-cross-polar correlation coefficient ρxh, and enhanced linear depolarization ratio, but these shape changes do not explain the ZDR signature. The presence of columnar ice crystals, though apparently crucial for instigating the refreezing process, does not contribute enough backscattered power to affect the ZDR signature, either.
The Tropical Cyclone as a Divergent Source in a Background Flow
Authors: Ryglicki David R. , Hodyss Daniel , Rainwater Gregory 
Published: August 2020

AbstractThe interactions between the outflow of a tropical cyclone (TC) and its background flow are explored using a hierarchy of models of varying complexity. Previous studies have established that, for a select class of TCs that undergo rapid intensification in moderate values of vertical wind shear, the upper-level outflow of the TC can block and reroute the environmental winds, thus reducing the shear and permitting the TC to align and subsequently to intensify. We identify in satellite imagery and reanalysis datasets the presence of tilt nutations and evidence of upwind blocking by the divergent wind field, which are critical components of atypical rapid intensification. We then demonstrate how an analytical expression and a shallow water model can be used to explain some of the structure of upper-level outflow. The analytical expression shows that the dynamic high inside the outflow front is a superposition of two pressure anomalies caused by the outflow’s deceleration by the environment and by the environment’s deceleration by the outflow. The shallow water model illustrates that the blocking is almost entirely dependent upon the divergent component of the wind. Then, using a divergent kinetic energy budget analysis, we demonstrate that, in a full-physics TC, upper-level divergent flow generation occurs in two phases: pressure driven and then momentum driven. The change happens when the tilt precession reaches left of shear. When this change occurs, the outflow blocking extends upshear. We discuss these results with regard to prior severe weather studies.
Sensitivities and Responses of Land Surface Temperature to Deforestation-Induced Biophysical Changes in Two Global Earth System Models
Authors: Liao Weilin , Liu Xiaoping , Burakowski Elizabeth , Wang Dagang , Wang Linying , Li Dan 
Published: August 2020

AbstractWhile the significance of quantifying the biophysical effects of deforestation is rarely disputed, the sensitivities of land surface temperature (LST) to deforestation-induced changes in different biophysical factors (e.g., albedo, aerodynamic resistance, and surface resistance) and the relative importance of those biophysical changes remain elusive. Based on the subgrid-scale outputs from two global Earth system models (ESMs, i.e., the Geophysical Fluid Dynamics Laboratory Earth System Model and the Community Earth System Model) and an improved attribution framework, the sensitivities and responses of LST to deforestation are examined. Both models show that changes in aerodynamic resistance are the most important factor responsible for LST changes, with other factors such as albedo and surface resistance playing secondary but important roles. However, the magnitude of the contributions from different biophysical factors to LST changes is quite different for the two ESMs. We find that the differences between the two models in terms of the sensitivities are smaller than those of the corresponding biophysical changes, indicating that the dissimilarity between the two models in terms of LST responses to deforestation is more related to the magnitude of biophysical changes. It is the first time that the attribution of subgrid surface temperature variability is comprehensively compared based on simulations with two commonly used global ESMs. This study yields new insights into the similarity and dissimilarity in terms of how the biophysical processes are represented in different ESMs and further improves our understanding of how deforestation impacts on the local surface climate.