bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Shelf Valleys on the Spread of Surface-Trapped River Plumes
Authors: Xiao Canbo , Zhang Weifeng , Chen Ying 
Published: November 2020

AbstractThis study focuses on mechanisms of shelf valley bathymetry affecting the spread of riverine freshwater in the nearshore region. In the context of Changjiang River, a numerical model is used with different no-tide idealized configurations to simulate development of unforced river plumes over a sloping bottom, with and without a shelf valley off the estuary mouth. All simulated freshwater plumes are surface-trapped with continuously growing bulges near the estuary mouth and narrow coastal currents downstream. The simulations indicate that a shelf valley tends to compress the bulge along the direction of the valley long axis and modify the incident angle of the bulge flow impinging toward the coast, which then affects the strength of the coastal current. The bulge compression results from geostrophic adjustment and isobath-following tendency of the depth-averaged flow in the bulge region. Generally, the resulting change in the direction of the bulge impinging flow enhances down-shelf momentum advection and freshwater delivery into the coastal current. Sensitivity simulations with altered river discharges Q, Coriolis parameter, shelf bottom slope, valley geometry, and ambient stratification show that enhancement of down-shelf freshwater transport in the coastal current, ΔQc, increases with increasing valley depth within the bulge region and decreasing slope Burger number of the ambient shelf. Assuming potential vorticity conservation, a scaling formula of ΔQc/Q is developed, and it agrees well with results of the sensitivity simulations. Mechanisms of valley influences on unforced river plumes revealed here will help future studies of topographic influence on river plumes under more realistic conditions.
Dynamics of Deep Recirculation Cells Offshore of the Deep Western Boundary Current in the Subtropical North Atlantic (15°–30°N)
Authors: Biló Tiago Carrilho , Johns William E , Zhao Jian 
Published: November 2020

AbstractThe dynamics of the deep recirculation offshore of the deep western boundary current (DWBC) between 15° and 30°N within the upper North Atlantic Deep Water layer (1000 ≤ z ≤ 3000 m) is investigated with two different eddy-resolving numerical simulations. Despite some differences in the recirculation cells, our assessment of the modeled deep isopycnal circulation patterns (36.77 ≤ σ2 ≤ 37.06 kg m−3) shows that both simulations predict the DWBC flowing southward along the continental slope, while the so-called Abaco Gyre and two additional cyclonic cells recirculate waters northward in the interior. These cells are a few degrees wide, located along the DWBC path, and characterized by potential vorticity (PV) changes occurring along their mean streamlines. The analysis of the mean PV budget reveals that these changes result from the action of eddy forcing that tends to erode the PV horizontal gradients. The lack of a major upper-ocean boundary current within the study region, and the fact that the strongest eddy forcing is constrained within a few hundreds of kilometers of the western boundary, suggest that the DWBC is the primary source of eddy forcing. Finally, the eddies responsible for forcing the recirculation have dominant time scales between 100 and 300 days, which correspond to the primary observed variability scales of the DWBC transport at 26.5°N.
Internal compression therapy, a novel method in the treatment of deep venous insufficiency: 18-month clinical results
Authors: Eroğlu Erdinc , Yasim Alptekin , Doganer Adem , Acipayam Mehmet , Kocarslan Aydemir , Kabalci Mehmet , Kara Hakan 
Published: November 2020

Objective To present 18-month clinical results for internal compression therapy (ICT) applied percutaneously and as a novel method in the treatment of primary deep venous insufficiency. Material and Method Thirty patients diagnosed with isolated primary femoral vein (FV) insufficiency between October 2017 and February 2018 were included in the study. Pre-procedural femoral vein diameters and reflux durations were measured. CEAP classification and Venous Clinical Severity Score (VCSS) were recorded. Pre-procedural CEAP classifications were CEAP 4 in nine patients and CEAP 3 in 21. Quality of life assessments were carried out using a Chronic Venous Insufficiency Questionnaire (CIVIQ-2). FV diameters were then reduced, and valve coaptation was established with the percutaneous application of hyaluronic acid and cyanoacrylate injected adjacent to a valve with non coapting leaflets. Venous diameters and reflux duration were again measured immediately after the procedure. Patients were followed-up at months 1, 6, and 18, at which times all parameters were re-evaluated. Results Eighteen of the 30 patients were women, and 12 were men. The mean duration of the procedure was 22.7 ± 2.9 (20–30) min. Patients’ FV diameters were 12.8 (11–14.7) mm before the procedure, 9.9 (9–11.5) mm immediately after, and also 9.9 (9–11.2) mm after 1.5 years (p < 0.001). Pre-procedural reflux duration ranged between 2 and 6 (median: 3) sec, and no reflux was observed in any patient immediately or one month after the procedure (p < 0.001). At 18-month follow-up, reflux lasting only 1 sec was determined in two patients. VCSS scores were 11 (10–12) pre-procedurally and 6 (4–9) at 18 months (p < 0.001). Venous Quality of Life scores were 32 (30–36) before the procedure and 18 (14–24) at 18 months (p < 0.001). Conclusion Preliminary investigation of the injection of cyanoacrylate and hyaluronic acid around one valve in an incompetent FV can result in improved hemodynamics, CEAP, VCSS and patient QOL at 18 months, without complications.
Blood Flow Restriction Training for Athletes: A Systematic Review
Authors: Wortman Ryan J. , Brown Symone M. , Savage-Elliott Ian , Finley Zachary J. , Mulcahey Mary K. 
Published: November 2020

Background: Blood flow restriction (BFR) is a novel technique involving the use of a cuff/tourniquet system positioned around the proximal end of an extremity to maintain arterial flow while restricting venous return. Purpose: To analyze the available literature regarding the use of BFR to supplement traditional resistance training in healthy athletes. Study Design: Systematic review. Methods: A systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. From November to December 2018, studies that examined the effects of BFR training in athletes were identified using PubMed and OVID Medline. Reference lists from selected articles were analyzed for additional studies. The inclusion criteria for full article review were randomized studies with control groups that implemented BFR training into athletes’ resistance training workouts. Case reports and review studies were excluded. The following data were extracted: patient demographics, study design, training protocol, occlusive cuff location/pressure, maximum strength improvements, muscle size measurements, markers of sports performance (eg, sprint time, agility tests, and jump measurements), and other study-specific markers (eg, electromyography, muscular torque, and muscular endurance). Results: The initial search identified 237 articles. After removal of duplicates and screening of titles, abstracts, and full articles, 10 studies were identified that met the inclusion criteria. Seven of 9 (78%) studies found a significant increase in strength associated with use of BFR training as compared with control; 4 of 8 (50%) noted significant increases in muscle size associated with BFR training; and 3 of 4 (75%) reported significant improvements in sport-specific measurements in the groups that used BFR training. Occlusive cuff pressure varied across studies, from 110 to 240 mm HG. Conclusion: The literature appears to support that BFR can lead to improvements in strength, muscle size, and markers of sports performance in healthy athletes. Combining traditional resistance training with BFR may allow athletes to maximize athletic performance and remain in good health. Additional studies should be conducted to find an optimal occlusive pressure to maximize training improvements. Registration: CRD42019118025 (PROSPERO).
Remarks on conspiracy theory entrepreneurs
Authors: Campion-Vincent Véronique 
Published: November 2020

AbstractThis note presents an outline of the social and intellectual conditions accounting for the rise of “conspiracy entrepreneurs”, that is these heterodox thinkers who make a living from their denunciations and revelations on the malevolent organisations and characters who really lead the universe. A special attention has been focused on the reports concerning conspiracy entrepreneurs in the media, which describe them as eccentric and thus entertaining. After the presentation of some studies of David Icke's reptilian hypothesis, a question is raised: is it not legitimate to assert that academics studying conspiracy theories are themselves conspiracy entrepreneurs through their role in the spread of the subject of their studies.
Reduction in Tamoxifen Metabolites Endoxifen and N-desmethyltamoxifen With Chronic Administration of Low Dose Cannabidiol: A CYP3A4 and CYP2D6 Drug Interaction
Authors: Parihar Vikas , Rogers Annarita , Blain Allison Marie , Zacharias Samuel Ramesh Kumar , Patterson Lisa Laureen , Siyam Mahmoud Abdel-Magid 
Published: November 2020

Background: Cannabidiol (CBD) serves as a promising medicine, with few known adverse effects apart from the potential of drug interactions with the cytochrome P450 system. It has been hypothesized drug interactions may occur with chemotherapeutic agents, but no supporting evidence has been published to date. Case: A 58-year-old female with a history of bilateral breast carcinoma in remission, was treated with tamoxifen for breast cancer prevention for over 6 years. CBD was instituted to treat persistent postsurgical pain, inadequately managed by alternate analgesics. It was postulated that CBD may diminish tamoxifen metabolism by CYP3A4 and 2D6 to form active metabolite endoxifen, which exerts the anticancer benefits. Endoxifen, tamoxifen, N-desmetyltamoxifen and 4-hydroxytamoxifen levels were collected while the patient chronically received CBD 40 mg/day, and after a 60-day washout. Upon discontinuation of CBD 40 mg/day, it was observed that endoxifen levels increased by 18.75% and N-desmethyltamoxifen by 9.24%, while 4-hydroxytamoxifen remained unchanged. Conclusion: CBD at a low dose of 40 mg/day resulted in the potential inhibition of CYP3A4 and/or CYP2D6. Patients receiving CBD and interacting chemotherapeutic drugs, such as tamoxifen, require monitoring to identify possible subtherapeutic response to treatment. Further pharmacokinetic studies are required to ascertain the dynamics of this drug interaction.
Non-Squamous, Non-Basal Cell Cancers of the Skin: Exploring Associations Between Site of Disease and Depression
Authors: Almodallal Yahya , Lee Minji K. , Le-Rademacher Jennifer G. , Smith Caleb J. , Carroll Jamie L. , Robinson Steven I. , Jatoi Aminah 
Published: November 2020

Background: Earlier studies report a direct association between diseases of the skin—particularly those on the face—and depression. However, to our knowledge, such associations have not been examined in patients with non-squamous, non-basal call skin cancers. Methods: The primary goal was to assess whether malignant skin disease—specifically on the face as opposed to other sites—was associated with depression. The medical records of patients with cutaneous cancer (either primary or metastatic but non-squamous, non-basal cell) were reviewed for the relevant data. Results: One hundred and sixty-five patients were studied. Only 23 patients (14%) had metastases to the face, and 115 (70%) had a readily viewable skin cancer. Twenty-one patients (13%) developed depression after a diagnosis of cutaneous cancer (of note, the rate of missing data for depression was 37%). Only one patient with facial cutaneous cancer manifested depression, yielding an odds ratio for not developing depression (95% confidence interval (CI)) of 4.4 (0.5,35); p = 0.13. Depression appeared to occur more often in women (62% versus 43%), patients with a history of depression (52% versus 6%), and younger patients (median age with and without depression 55 years and 67 years, respectively). Conclusion: In contrast to other cutaneous diseases, no association was found between cutaneous cancer to the face and depression. Nonetheless, high rates of missing data underscore the need to focus on depression in patients with cutaneous cancers in the future.
Direct Oral Anticoagulants Versus Warfarin in the Treatment of Left Ventricular Thrombus
Authors: Willeford Andrew , Zhu Wenhong , Stevens Craig , Thomas Isac C. 
Published: November 2020

Background Use of direct oral anticoagulants (DOACs) for the treatment of left ventricular (LV) thrombus has gained considerable interest. Objective We aimed to evaluate if DOACs are effective in the treatment of LV thrombus compared with warfarin. Methods We evaluated the medical records of patients diagnosed with a new LV thrombus at a tertiary medical center. The primary outcome was the composite of thrombus persistence, stroke, or systemic embolism. We adjusted for potential confounders using multiple logistic regression. The safety outcome was the composite of hemorrhagic stroke or bleeding requiring blood transfusion. Results A total of 129 patients were treated with warfarin and 22, with a DOAC. In unadjusted analysis, 54.3% of patients treated with warfarin met criteria for the efficacy outcome as compared with 40.9% of patients treated with a DOAC ( P = 0.25). In adjusted analysis, no difference between groups was observed (odds ratio = 0.39; 95% CI = 0.14-1.06; P = 0.07 for DOAC vs warfarin). In all, 3.9% of patients treated with warfarin met safety criteria as compared with 4.5% of patients treated with a DOAC. A total of 8 patients in the warfarin group had a stroke or systemic embolism as compared with 0 patients in the DOAC group ( P = 0.37). Conclusion and Relevance Our data suggest that DOACs may be reasonable alternatives for treatment of LV thrombus. When added to the totality of available studies, this study demonstrates that the effectiveness of DOACs in LV thrombus remains uncertain. Randomized clinical trials are needed.
Survival prediction models since liver transplantation - comparisons between Cox models and machine learning techniques
Authors: Kantidakis Georgios , Putter Hein , Lancia Carlo , Boer Jacob de , Braat Andries E. , Fiocco Marta 
Published: November 2020

AbstractBackgroundPredicting survival of recipients after liver transplantation is regarded as one of the most important challenges in contemporary medicine. Hence, improving on current prediction models is of great interest.Nowadays, there is a strong discussion in the medical field about machine learning (ML) and whether it has greater potential than traditional regression models when dealing with complex data. Criticism to ML is related to unsuitable performance measures and lack of interpretability which is important for clinicians.MethodsIn this paper, ML techniques such as random forests and neural networks are applied to large data of 62294 patients from the United States with 97 predictors selected on clinical/statistical grounds, over more than 600, to predict survival from transplantation. Of particular interest is also the identification of potential risk factors. A comparison is performed between 3 different Cox models (with all variables, backward selection and LASSO) and 3 machine learning techniques: a random survival forest and 2 partial logistic artificial neural networks (PLANNs). For PLANNs, novel extensions to their original specification are tested. Emphasis is given on the advantages and pitfalls of each method and on the interpretability of the ML techniques.ResultsWell-established predictive measures are employed from the survival field (C-index, Brier score and Integrated Brier Score) and the strongest prognostic factors are identified for each model. Clinical endpoint is overall graft-survival defined as the time between transplantation and the date of graft-failure or death. The random survival forest shows slightly better predictive performance than Cox models based on the C-index. Neural networks show better performance than both Cox models and random survival forest based on the Integrated Brier Score at 10 years.ConclusionIn this work, it is shown that machine learning techniques can be a useful tool for both prediction and interpretation in the survival context. From the ML techniques examined here, PLANN with 1 hidden layer predicts survival probabilities the most accurately, being as calibrated as the Cox model with all variables.Trial registrationRetrospective data were provided by the Scientific Registry of Transplant Recipients under Data Use Agreement number 9477 for analysis of risk factors after liver transplantation.
High-density lipoprotein cholesterol is a predictor of survival in cirrhotic patients with acute gastrointestinal bleeding: a retrospective study
Authors: Cheng Ran , Tan Ning , Kang Qian , Luo Hao , Chen Hongyu , Pan Jiali , Han Yifan , Yang Yuqing , Xu Xiaoyuan 
Published: November 2020

Abstract
Background
Lipid profiles are declined in patients with viral liver cirrhosis and correlated with severity of liver disease. Hepatitis B virus (HBV) is the leading cause of liver cirrhosis in China. Our primary aim was to investigate whether serum lipids and lipoproteins associate with survival in patients with HBV-related cirrhosis and acute gastrointestinal bleeding, and develop a 6-week mortality risk score that incorporates it.

Methods
From January 2008 to December 2015, consecutive cirrhotic patients with acute gastrointestinal bleeding admitted to our hospital were evaluated and randomly divided into the derivation (n = 629) and validation (n = 314) cohorts. A logistic regression model was established to confirm the association between lipoprotein cholesterol and mortality. Accuracy to predict mortality were assessed by area under the receiver operating characteristic curves (AUROCs) and compared using the Hanley and McNeil test.

Results
Among study subjects, the 6-week mortality rate was 10.6%. High-density lipoprotein cholesterol (HDL-C) level was found to correlate most strongly with prognostic scores. On ROC analysis, HDL-C showed excellent diagnostic accuracy for 6-week mortality. Logistic regression analysis provided a simple algorithm based on the combined use of 4 variables (total bilirubin (TBIL), HDL-C, International normalized ratio, and hemoglobin), allowing accurate discrimination of 3 distinct prognostic subgroups with 1.7% (low risk), 12.3% (intermediate risk), and 56.9% (high risk) mortality. Its accuracy was significantly better than that of Child–Pugh, model of end-stage liver disease, albumin-bilirubin score, D’Amico model, Augustin model, AIMS65 score and Glasgow-Blatchford score. Baseline HDL-C values ≤ 0.54 mmol/L were associated with markedly lower 6-week survival. Comparable results were found in the validation set.

Conclusion
HDL-C is a potential indicator for the prognosis of patients with cirrhosis and acute gastrointestinal bleeding. The new algorithm based on HDL-C allowed an accurate predictive assessment of 6-week mortality after bleeding attack.
Effect of a patient-centred deprescribing procedure in older multimorbid patients in Swiss primary care - A cluster-randomised clinical trial
Authors: Zechmann Stefan , Senn Oliver , Valeri Fabio , Essig Stefan , Merlo Christoph , Rosemann Thomas , Neuner-Jehle Stefan 
Published: November 2020

Abstract
Background
Management of patients with polypharmacy is challenging, and evidence for beneficial effects of deprescribing interventions is mixed. This study aimed to investigate whether a patient-centred deprescribing intervention of PCPs results in a reduction of polypharmacy, without increasing the number of adverse disease events and reducing the quality of life, among their older multimorbid patients.

Methods
This is a cluster-randomised clinical study among 46 primary care physicians (PCPs) with a 12 months follow-up. We randomised PCPs into an intervention and a control group. They recruited 128 and 206 patients if ≥60 years and taking ≥five drugs for ≥6 months. The intervention consisted of a 2-h training of PCPs, encouraging the use of a validated deprescribing-algorithm including shared-decision-making, in comparison to usual care. The primary outcome was the mean difference in the number of drugs per patient (dpp) between baseline and after 12 months. Additional outcomes focused on patient safety and quality of life (QoL) measures.

Results
Three hundred thirty-four patients, mean [SD] age of 76.2 [8.5] years participated. The mean difference in the number of dpp between baseline and after 12 months was 0.379 in the intervention group (8.02 and 7.64; p = 0.059) and 0.374 in the control group (8.05 and 7.68; p = 0.065). The between-group comparison showed no significant difference at all time points, except for immediately after the intervention (p = 0.002). There were no significant differences concerning patient safety nor QoL measures.

Conclusion
Our straight-forward and patient-centred deprescribing procedure is effective immediately after the intervention, but not after 6 and 12 months. Further research needs to determine the optimal interval of repeated deprescribing interventions for a sustainable effect on polypharmacy at mid- and long-term. Integrating SDM in the deprescribing process is a key factor for success.

Trial registration
Current Controlled Trials, prospectively registered ISRCTN16560559 Date assigned 31/10/2014.
The Prevention of Polypharmacy in Primary Care Patients Trial (4P-RCT).