bluuebunny/crossref_metadata_2025_split huggingface dataset:
Public Perception of General Surgery Resident Autonomy and Supervision
Authors: Dickinson Karen J. , Bass Barbara L. , Nguyen Duc T. , Graviss Edward A. , Pei Kevin Y. 
Published: October 2020

BACKGROUND:
Despite patients being important stakeholders in surgical training, little is known about the public's perception of trainee participation in surgical care. This study evaluates the public's perception of surgical resident autonomy and supervision.

STUDY DESIGN:
An anonymous electronic survey was sent to adult panelists older than 18 years in the US using SurveyGizmo. The design of the survey used Dillman's Tailored Design Method to optimize response rate. Participants completed surveys including demographic characteristics and perceptions toward general surgery resident autonomy. Univariable and multivariable analyses were used as appropriate.

RESULTS:
Survey response rate was 93% (2,005 of 2,148). Demographic characteristics including age, gender, race or ethnicity, and highest level of education were nationally representative. Most respondents (87%) had health insurance. On multivariable logistic regression analysis, factors associated with participants who would never allow a resident to perform any portion of the operation include: female gender (odds ratio [OR] 1.58; 95% CI, 1.28 to 1.95), no health insurance (OR 1.38; 95% CI, 1.03 to 1.84), Black race (OR 1.82; 95% CI, 1.38 to 2.41), and Hispanic ethnicity (OR 1.49; 95% CI, 1.03 to 2.15). Participants who were younger than 50 years (OR 1.57; 95% CI, 1.24 to 1.98), male (OR 1.90; 95% CI, 1.56 to 2.32), of Black race (OR 1.45; 95% CI, 0.10 to 1.91), Hispanic ethnicity (OR 1.49; 95% CI, 1.05 to 2.11), working in healthcare (OR 2.18; 95% CI, 1.67 to 2.86), or insured (OR 1.46; 95% CI, 1.07 to 1.99) were more likely to believe that resident involvement increases complications.

CONCLUSIONS:
Among survey participants broadly representing the US population, resident participation in operations is not universally accepted. Public perception of surgical resident autonomy and supervision is important, as GME continues to evolve to address readiness for independent practice.
Geographic Coverage and Verification of Trauma Centers in a Rural State: Highlighting the Utility of Location Allocation for Trauma System Planning
Authors: Amato Stas S. , Benson Jamie S. , Murphy Serena , Osler Turner M. , Hosmer David , Cook Alan D. , Wolfson Daniel L. , Erb Andrew , Malhotra Ajai , An Gary 
Published: October 2020

BACKGROUND:
Care at verified trauma centers has improved survival and functional outcomes, yet determining the appropriate location of potential trauma centers is often driven by factors other than optimizing system-level patient care. Given the importance of transport time in trauma, we analyzed trauma transport patterns in a rural state lacking an organized trauma system and implemented a geographic information system to inform potential future trauma center locations.

STUDY DESIGN:
Data were collected on trauma ground transport during a 3-year period (2014 through 2016) from the Statewide Incident Reporting Network database. Geographic information system mapping and location-allocation modeling of the best-fit facility for trauma center verification was computed using trauma transport patterns, population density, road network layout, and 60-minute emergency medical services transport time based on current transport protocols.

RESULTS:
Location-allocation modeling identified 2 regional facilities positioned to become the next verified trauma centers. The proportion of the Vermont population without access to trauma center care within 60 minutes would be reduced from the current 29.68% to 5.81% if the identified facilities become verified centers.

CONCLUSIONS:
Through geospatial mapping and location-allocation modeling, we were able to identify gaps and suggest optimal trauma center locations to maximize population coverage in a rural state lacking a formal, organized trauma system. These findings could inform future decision-making for targeted capacity improvement and system design that emphasizes more equitable access to trauma center care in Vermont.
Education Time Out and Debrief: Structured Implementation of Perioperative Resident Technical Education Discussion
Authors: Popat Shreeya , Hubbard Caroline , Mayer Wesley A. , Taylor Jennifer M. 
Published: October 2020

BACKGROUND:
We designed a model for pre- and postoperative discussions between faculty and trainees to maximize educational yield of cases and accelerate residents' technical development. We sought to study its effect on surgical education via participant perceptions and longitudinal validated performance evaluations.

STUDY DESIGN:
Our model included preoperative collaborative technical goal-setting, specific to the resident, or “Time Out,” and immediate postoperative granular feedback guided by validated evaluation tools, or “Debrief.” We encouraged routine use for two 3-month rotations. We administered surveys with Likert scale and open-ended questions before and after implementation to assess adoption and perceptions. Likert scale survey data were analyzed using Mann-Whitney U tests; reported time durations were analyzed using t-tests. At 2 time points per rotation, designated faculty evaluated participating residents using the Objective Structured Assessment of Technical Skills (OSATS) for open/endoscopic cases or Global Evaluative Assessment of Robotic Skills (GEARS). OSATS and GEARS data were analyzed using paired t-tests.

RESULTS:
Before our intervention, we noted significant differences between attending and resident physicians' perceptions of the frequency, importance, and challenges of perioperative educational discussions. After our intervention, these disparities resolved. In addition, participants reported significantly improved satisfaction with pre- and postoperative educational discussions (p = 0.01). Use of the model did not require increased time per participants' report. Paired GEARS/OSATS were completed for 9 trainees during the intervention, with faculty ratings revealing significant improvement in resident technical skills (p = 0.03).

CONCLUSIONS:
Our structured model for perioperative educational discussions, consisting of the preoperative “Education Time Out” and postoperative “Education Debrief,” significantly improved faculty and resident satisfaction and was associated with measurable improvements in resident technical skills without requiring significantly more time.
Mid-Term Survival after Thoracic Endovascular Aortic Repair by Indication in the Medicare Population
Authors: Ho Vy T. , Itoga Nathan K. , Tran Kenneth , Lee Jason T. , Stern Jordan R. 
Published: October 2020

BACKGROUND:
Thoracic endovascular aortic repair (TEVAR) is indicated for treatment of aneurysms, dissections, and traumatic injury. We describe mid-term mortality and reintervention rates in Medicare beneficiaries undergoing TEVAR.

STUDY DESIGN:
Patients who underwent TEVAR between 2006 and 2014 were identified by CPT codes in a 20% Medicare sample. Indication for aortic repair (aneurysm, dissection, trauma) was ascertained via ICD-9 codes. Follow-up was evaluated until 2015. Kaplan-Meier survival analysis and Cox regression were used to compare mortality, with reintervention and mortality rates expressed as a composite outcome in a hazard ratio with 95% confidence interval (hazard ratio [HR] 95% CI).

RESULTS:
There were 3,095 patients who underwent TEVAR during the study period: 1,465 (47%) for aneurysm, 1,448 (47%) for dissection, and 182 (5.9%) for trauma. Mean patient age was 74.4 years, and 44.5% were female. Median follow-up was 2.7 years. The overall 30-day, 1-year, and 5-year, and 8-year survival rates were 93%, 78%, 49%, and 33%, respectively. Thirty-day mortality was highest in traumatic indications, but overall mortality was highest in patients undergoing TEVAR for aneurysm. Freedom from combined reintervention and mortality at 30 days, 1 year, 5 years, and 8 years was 89%, 73%, 43%, and 29%, respectively. Reintervention was highest in patients undergoing TEVAR for dissection (12.8%), followed by aneurysm (10.0%) and trauma (5.5%). Advanced age (HR 1.03 per year, 95% CI 1.02–1.03), congestive heart failure (CHF) (HR 1.48, 95% CI 1.33–1.65), dementia (HR 1.40, 95% CI 1.14–1.28), and rupture (HR 1.38, 95% CI 1.24–1.54) were associated with mortality.

CONCLUSIONS:
Midterm survival is lower in patients who undergo TEVAR for dissection and aneurysm compared with trauma. Aneurysmal disease, advanced age, CHF, dementia, and aortic rupture are associated with mortality and reintervention in TEVAR.
Outpatient Mastectomy: Factors Influencing Patient Selection and Predictors of Return to Care
Authors: Vuong Brooke , Dusendang Jennifer R. , Chang Sharon B. , Mentakis Margaret Ann , Shim Veronica C. , Schmittdiel Julie , Kuehner Gillian 
Published: October 2020

BACKGROUND:
After implementation of the Surgical Home Recovery (SHR) initiative for mastectomy within a large, integrated health delivery system, most patients are discharged on the day of the procedure. We sought to identify predictors of SHR and unplanned return to care (RTC).

STUDY DESIGN:
Mastectomy cases with and without reconstruction from October 2017 to August 2019 were analyzed. Patient characteristics, operative variables, and multimodal pain management were compared between admitted patients and SHR patients using logistic regression. We identified predictors of RTC in SHR patients, defined as 7-day readmission, reoperation, or emergency department visit.

RESULTS:
Of 2,648 mastectomies, 1,689 (64%) were outpatient procedures and the mean age of patients was 58.5 years. Predictors of SHR included perioperative IV acetaminophen (odds ratio [OR] 1.59; 95% CI, 1.28 to 1.97), perioperative opiates (OR 1.47; 95% CI, 1.06 to 2.02), and operation performed by a high-volume breast surgeon (OR 2.12; 95% CI, 1.42 to 3.18). Bilateral mastectomies (OR 0.70; 95% CI, 0.54 to 0.91), immediate reconstruction (OR 0.52; 95% CI, 0.39 to 0.70), and American Society of Anesthesiologists class 3 to 4 (OR 0.69; 95% CI, 0.54 to 0.87) decreased the odds of SHR. Of SHR patients, 111 of 1,689 patients (7%) experienced RTC. Patients with American Society of Anesthesiologists class 3 to 4 (OR 2.01; 95% CI, 1.29 to 3.14) and African American race (OR 2.30; 95% CI, 1.38 to 4.91) were more likely to RTC; receiving IV acetaminophen (OR 0.56; 95% CI, 0.35 to 0.88) and filling an opiate prescription (OR 0.51; 95% CI, 0.34 to 0.77) decreased the odds of RTC.

CONCLUSIONS:
Surgeon volume and multimodal pain medication increased the odds of SHR. Within the SHR group, American Society of Anesthesiologists Class 3 to 4 and African American patients increased the likelihood of RTC. This study helps optimize patient selection and perioperative practice for successful SHR.
Environmental Association of Burning Agricultural Biomass in the Indus River Basin
Authors: Usmani Moiz , Kondal Ashish , Wang Jun , Jutla Antarpreet 
Published: October 2020

AbstractIntensification of smog episodes, following harvesting of paddy crops in agricultural plains of the Indus basin in the Indian subcontinent, are often attributed to farming practice of burning standing stubble during late autumn (October, November) months. Biomass burning (paddy stubble residual) is a preferred technique to clear farmlands for centuries by farmers in that basin. However, despite stable agricultural landholding and yield, smog is being increasingly associated with burning agricultural biomass, thus creating a paradox. Here, we show that the concentration of smog (NOx, PM2.5, SO2) in the ambient air exceeds the safe threshold limits throughout the entire year in the region. This study argues that agricultural biomass burning is an ephemeral event in the basin that may act as a catalyst to a deteriorated air quality in the entire region. Results further demonstrate that simultaneous saturation of air pollutants along with high ambient moisture content and low wind speeds following the monsoon season are strongly related to aggravated smog events. Findings from this study should help make holistic mitigation and intervention policies to monitor air quality for sustainability of public health in agricultural regions where farming activities are a dominant economic driver for society.
Exploring Hydrologic Model Process Connectivity at the Continental Scale Through an Information Theory Approach
Authors: Konapala Goutam , Kao Shih‐Chieh , Addor Nans 
Published: October 2020

AbstractExploring water fluxes between hydrological model (HM) components is essential to assess and improve model realism. Many classical metrics for HM diagnosis rely solely on streamflow and hence provide limited insights into model performance across processes. This study applies an information theory measure known as “transfer entropy” (TE) to systematically quantify the transfer of information among major HM components. To test and demonstrate the benefits of TE, we use the Framework for Understanding Structural Errors (FUSE) model to mimic and compare four commonly used HM structures, VIC, PRMS, SACRAMENTO, and TOPMODEL, across 671 catchments spanning a variety of hydrologic regimes in the conterminous United States. We explore connections between HM components and catchment landscape characteristics (e.g., climate, topography, soil, and vegetation) and characterize their nonlinear associations using distance correlation and Spearman correlation coefficients. Our results indicate that while the information transferred from precipitation to runoff is similar across model structures (likely as a result of calibration), the information transferred among other components can vary significantly from a FUSE structure to another. We find that aridity, precipitation duration and frequency, snow fraction, mean elevation, forest area, and leaf area index are often significantly associated with TE between the main HM components. We propose that the presence of meaningful nonlinear associations can be used to diagnose process representation in HMs. Our results highlight the necessity to enhance the conventional streamflow‐only calibration approach for a more realistic representation of water dynamics in the models.
Centennial‐Scale Shifts in Hydrophysical Properties of Peat Induced by Drainage
Authors: Liu Haojie , Price Jonathan , Rezanezhad Fereidoun , Lennartz Bernd 
Published: October 2020

AbstractHydrophysical properties of peat influence the partitioning of rainfall into infiltration versus runoff, determine water flow and solute transport patterns, and regulate the carbon and nitrogen cycles in peatlands. Compared with mineral soils, our understanding of hydraulic properties of peat soils is limited, especially of the temporal dynamics of peat properties. A data set of peat subsidence as well as the bulk density (BD) change rate following artificial drainage was assembled from the literature. The collected data cover a time period of up to 272 years of land drainage for forestry and agriculture in boreal and temperate climate zones. The results show that the subsidence rate and BD change rate, and hydrophysical properties of peat can be estimated based on land drainage duration and land use. The most severe shift in pore structure of peat occurs within the first 20 years of land drainage. Peatland drainage reduces macroporosity with pore diameter greater than 50 μm, but increases the volume of pores <5 μm. In the long term, peat thickness loss is responsible for more than 80% of water storage loss. In conclusion, the derived functions between subsidence rate, BD change rate, and drainage duration provide a new approach to estimate the hydrophysical properties of peat (pore structure, saturated hydraulic conductivity, specific yield, and soil water storage) on a centennial scale. The derived hydrophysical parameter values can be used for long‐term hydrological modeling, especially if measured hydraulic parameters of peat are not available.
Sensitivity of Simulated Mountain Block Hydrology to Subsurface Conceptualization
Authors: Rapp G. A. , Condon L. E. , Markovich K. H. 
Published: October 2020

AbstractMountain block systems are critical to water resources and have been heavily studied and modeled in recent decades. However, due to lack of field data, there is little consistency in how models represent the mountain block subsurface. While there is a large body of research on subsurface heterogeneity, few studies have evaluated the effect that common conceptual choices modelers make in mountainous systems have on simulated hydrology. Here we simulate the hydrology of a semi‐idealized headwater catchment using six common conceptual models of the mountain block subsurface. These scenarios include multiple representations of hydraulic conductivity decaying with depth, changes in soil depth with topography, and anisotropy. We evaluate flow paths, discharge, and water tables to quantify the impact of subsurface conceptualization on hydrologic behavior in three dimensions. Our results show that adding higher conductivity layers in the shallow subsurface concentrates flow paths near the surface and increases average saturated flow path velocities. Increasing heterogeneity by adding additional layers or introducing anisotropy increases the variance in the relationship between the age and length of saturated flow paths. Discharge behavior is most sensitive to heterogeneity in the shallow subsurface layers. Water tables are less sensitive to layering than they are to the overall conductivity in the domain. Anisotropy restricts flow path depths and controls discharge from storage but has little effect on governing runoff. Differences in the response of discharge, water table depth, and residence time distribution to subsurface representation highlight the need to consider model applications when determining the level of complexity that is needed.
Basin‐Scale River Runoff Estimation From GRACE Gravity Satellites, Climate Models, and In Situ Observations: A Case Study in the Amazon Basin
Authors: Chen Jianli , Tapley Byron , Rodell Matt , Seo Ki‐Weon , Wilson Clark , Scanlon Bridget R. , Pokhrel Yadu 
Published: October 2020

AbstractRiver runoff is estimated as a water budget residual using Gravity Recovery and Climate Experiment (GRACE) terrestrial water storage time series, ERA5 reanalysis data, and precipitation observations for January 2003 through December 2015 for the Obidos upstream drainage basin and for the entire Amazon basin. Estimated runoff based on the water budget agrees remarkably well with in situ gauge observations at Obidos, especially at seasonal time scales, with nearly perfect phase agreement but slightly larger seasonal amplitude. The discrepancy in the seasonal amplitude may be attributed to underestimation of river gauge runoff during the wet season when water overflows the riverbanks. The ERA5 model appears to overestimate long‐term mean evapotranspiration in the Amazon by ~2 cm/month based on comparisons with precipitation and runoff observations. Using precipitation data based on satellites and gauge observations relative to gauge observations alone improved agreement between water budget runoff estimates and in situ runoff observations. Seasonal variations in ERA5‐simulated runoff are about twice as large as those from in situ observations and show a large phase lag as well. Water budget‐based runoff for the entire Amazon (~7,200 km3 averaged over the 13‐year period) is significantly larger than observed runoff (~5,700 km3) at Obidos and notably larger than previous estimates for the entire Amazon. These differences may be partly related to submarine runoff from the Amazon basin that cannot be captured by surface gauges.
Hydrological Basis of the Budyko Curve: Data‐Guided Exploration of the Mediating Role of Soil Moisture
Authors: Chen Xi , Sivapalan Murugesu 
Published: October 2020

AbstractWe present a data‐guided framework to explore the hydrological basis of the Budyko curve, focusing on the role of soil moisture in mediating the partitioning of precipitation into runoff and evaporation and the role of climate in this partitioning. The conceptual framework for the derivation of the Budyko curve builds on empirically based power law relationships for long‐term average scaled runoff (Q/P) and scaled evaporation (E/Ep), both as functions of long‐term average (equilibrium) soil moisture. A second component of the framework is an empirical power law relationship between equilibrium soil moisture and the aridity index, Ep/P. Combinations of these empirical power law relationships with the long‐term water balance equation give rise to a form of the Budyko curve, which is a close approximation to Budyko's original relationship and is mathematically similar to the Turc‐Pike equation, thus supporting the role of equilibrium soil moisture in giving rise to the Budyko curve. In the remainder of the paper, for special cases of the parameter values of the power law relationships, we independently derive both the soil moisture dependence on Ep/P as well as the Budyko curve itself that not only reproduces a new Budyko‐type curve, but can also explain the spread of the empirical data points away from the mean curve. The paper also raises fresh questions about how the empirical power law relationships that govern the soil‐mediated precipitation partitioning may have emerged and the role of vegetation in that mediation.
Effects of Downward Intrusion of Saline Water on Nested Groundwater Flow Systems
Authors: Zhang Xiaolang , Jiao Jiu Jimmy , Li Hailong , Luo Xin , Kuang Xingxing 
Published: October 2020

AbstractNested groundwater flow systems (NGFS) are commonplace in various hydrogeological environments, including endorheic basins and coastal aquifers. The subsystems of the NGFS can be spatially separated by streamlines around the internal stagnation points. At the discharge zones of the topographic depressions, saline water often emerges due to high evaporation in endorheic drainage basins or the combined effects of evaporation and intermittent seawater submersion in coastal areas. To date, there are limited studies that have considered the impact of local‐scale downward migration of saline plumes in the topographic depressions on the NGFS. In this study, the classic NGFS are revisited by considering saline water in their discharge zones. To quantify the effects of salinity in the discharge zones on the NGFS, scenarios of various salinities in the discharge zones are simulated. The displacements of the internal stagnation points are used to quantify the evolution of the NGFS in response to salinity changes in the discharge zones. The results show that, as the salinity in the discharge zones increases, the hydraulic gradient near the discharge zone can be significantly reduced, the internal stagnation points shift upward, and the local groundwater flow systems retreat upward so that their original spaces are replaced by intermediate or regional flow systems. The discharge zone is expanded, and the overall groundwater flow velocity magnitude of the entire system decreases with salinity. This study may shed light on the management of saline wetlands, for example, the control of groundwater salinization, evolution of saline groundwater basins, and seawater intrusion.