bluuebunny/crossref_metadata_2025_split huggingface dataset:
Observations of Hail–Wind Ratios from Convective Storm Reports across the Continental United States
Authors: Bunkers Matthew J. , Fleegel Steven R. , Grafenauer Thomas , Schultz Chauncy J. , Schumacher Philip N. 
Published: January 2020

Abstract
The objective of this study is to provide guidance on when hail and/or wind is climatologically most likely (temporally and spatially) based on the ratio of severe hail reports to severe wind reports, which can be used by National Weather Forecast (NWS) forecasters when issuing severe convective warnings. Accordingly, a climatology of reported hail-to-wind ratios (i.e., number of hail reports divided by the number of wind reports) for observed severe convective storms was derived using U.S. storm reports from 1955 to 2017. Owing to several temporal changes in reporting and warning procedures, the 1996–2017 period was chosen for spatiotemporal analyses, yielding 265 691 hail and 294 449 wind reports. The most notable changes in hail–wind ratios occurred around 1996 as the NWS modernized and deployed new radars (leading to more hail reports relative to wind) and in 2010 when the severe hail criterion increased nationwide (leading to more wind reports relative to hail). One key finding is that hail–wind ratios are maximized (i.e., relatively more hail than wind) during the late morning through midafternoon and in the spring (March–May), with geographical maxima over the central United States and complex/elevated terrain. Otherwise, minimum ratios occur overnight, during the late summer (July–August) as well as November–December, and over the eastern United States. While the results reflect reporting biases (e.g., fewer wind than hail reports in low-population areas but more wind reports where mesonets are available), meteorological factors such as convective mode and cool spring versus warm summer environments also appear associated with the hail–wind ratio climatology.
Identifying key elements for paediatric advance care planning with parents, healthcare providers and stakeholders: A qualitative study
Authors: Hein Kerstin , Knochel Kathrin , Zaimovic Vedrana , Reimann Daniel , Monz Anna , Heitkamp Nari , Borasio Gian Domenico , Führer Monika 
Published: January 2020

Background: Although international guidelines recommend discussions about goals of care and treatment options for children with severe and life-limiting conditions, there are still few structured models of paediatric advance care planning. Aim: The study aimed at identifying key components of paediatric advance care planning through direct discussions with all involved parties. Design: The study had a qualitative design with a participatory approach. Participants constituted an advisory board and took part in two transdisciplinary workshops. Data were collected in discussion and dialogue groups and analysed using content analysis. Setting/participants: We included bereaved parents, health care providers and stakeholders of care networks. Results: Key elements were discussions, documentation, implementation, timing and participation of children and adolescents. Parents engage in discussions with facilitators and persons of trust to reach a decision. Documentation constitutes the focus of professionals, who endorse brief recommendations for procedures in case of emergencies, supplemented by larger advance directives. Implementation hindrances include emotional barriers of stakeholders, disagreements between parents and professionals and difficulties with emergency services. Discussion timing should take into account parental readiness. The intervention should be repeated at regular intervals, considering emerging needs and increasing awareness of families over time. Involving children and adolescents in advance care planning remains a challenge. Conclusion: A paediatric advance care planning intervention should take into account potential pitfalls and barriers including issues related to timing, potential conflicts between parents and professionals, ambiguity towards written advance directives, the role of non-medical carers for paediatric advance care planning implementation, the need to involve the child and the necessity of an iterative process.
Prevalence of Exposure to Sexual Orientation Change Efforts and Associated Sociodemographic Characteristics and Psychosocial Health Outcomes among Canadian Sexual Minority Men
Authors: Salway Travis , Ferlatte Olivier , Gesink Dionne , Lachowsky Nathan J. 
Published: January 2020

Objective: Sexual orientation change efforts (SOCE), or “conversion therapy,” are pseudoscientific practices intended to suppress or deny sexual attraction to members of the same gender/sex. There are currently no data available to inform estimates of the prevalence of SOCE exposure in Canada. The objective of this study is therefore to describe the prevalence, social–demographic correlates, and health consequences of SOCE among Canadian sexual minority men. Methods: Sex Now 2011 to 2012 was a cross-sectional nonprobability survey of Canadian sexual minority men. Respondents were asked about lifetime SOCE exposure. We estimated prevalence of SOCE exposure by sociodemographic characteristics and examined psychosocial health outcomes among those exposed to SOCE. Results: Of N = 8,388 respondents, 3.5% (95% confidence interval, 3.2% to 4.1%) reported having ever been exposed to SOCE. Exposure to SOCE was higher among gay men (as compared with bisexual men), transgender respondents (as compared with cisgender respondents), those who were “out” about their sexuality (as compared with those who were not “out”), Indigenous men (as compared with White men), other racial minorities (as compared with White men), and those earning a personal income <$30,000 (as compared with those earning ≥$60,000 CAD). Exposure to SOCE was positively associated with loneliness, regular illicit drug use, suicidal ideation, and suicide attempt. Conclusions: SOCE exposure remains prevalent and associated with substantial psychosocial morbidity among sexual minority men in Canada. All levels of government in Canada should consider action to ban SOCE. SOCE survivors likely require intervention and support from the Canadian health-care system.
Imaging-Based Surrogate Markers of Epidermal Growth Factor Receptor Mutation in Lung Adenocarcinoma: A Local Perspective
Authors: AlGharras Abdulaziz , Kovacina Bojan , Tian Zhe , Alexander James W. , Semionov Alexandre , van Kempen Léon C. , Sayegh Karl 
Published: January 2020

Purpose: To identify computed tomography (CT) features of epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma in Canadian population and whether imaging-based surrogate markers of EGFR mutation in our population were similar to those found in the Asian population. Materials and Methods: Pretreatment CT scans of 223 patients with adenocarcinoma of the lung (112 with EGFR mutation and 111 without mutation) were retrospectively assessed for 20 specific CT features by 2 radiologists, who were blinded to the status of EGFR mutation. Univariate and multivariate logistic regression analyses as well as areas under the receiver operating characteristic curve were performed to discriminate characteristics of EGFR-activating mutation features. Results: Epidermal growth factor receptor mutation-positive adenocarcinomas were more frequently found in female ( P < .03), less than 20 pack-year smoking history ( P < .001), smaller tumor ( P < .01), spiculated margins ( P < .05), without centrilobular emphysema ( P < .001), and without lymphadenopathy ( P < .05), similarly to the Asian population. Multivariate logistic regression analyses of combined clinical and radiological features identified less than 20 pack-year smoking history, smaller tumor diameter, fine or coarse spiculations, noncentral location of the tumor, and lack of centrilobular emphysema and pleural attachment as the strongest independent prognostic factors for the presence of an EGFR mutation. These combined features improved prognostic ability area under the curve to 0.879, compared to 0.788 for clinical features only. Conclusion: Several CT findings may help predict the presence of an activating mutation in EGFR in lung adenocarcinomas in our Canadian population. Combining clinical and radiological features improves prognostic ability to determine the EGFR mutation status compared to clinical features alone.
Use of Multiphase CT Protocols in 18 Countries: Appropriateness and Radiation Doses
Authors: Rastogi Shivam , Singh Ramandeep , Borse Riddhi , Valkovic Zujic Petra , Segota Doris , Diklic Ana , Jurkovic Slaven , Ali Antar , Mohammed Kharita Hassan , Al-Naemi Huda M. , Alkalbani Jokha , Al-Rasbi Amaal , Gershan Vesna , Galic Stipe , Yusuf Mohammad , Avramova-Cholakova Simona , Zulkipli Ili Majidah Binti Hj , Shein Nilar , Teferi Seife , Rehani Madan M. , Vassileva Jenia , Kalra Mannudeep K. 
Published: January 2020

Purpose: To assess the frequency, appropriateness, and radiation doses associated with multiphase computed tomography (CT) protocols for routine chest and abdomen–pelvis examinations in 18 countries. Materials and Methods: In collaboration with the International Atomic Energy Agency, multi-institutional data on clinical indications, number of scan phases, scan parameters, and radiation dose descriptors (CT dose–index volume; dose–length product [DLP]) were collected for routine chest (n = 1706 patients) and abdomen–pelvis (n = 426 patients) CT from 18 institutions in Asia, Africa, and Europe. Two radiologists scored the need for each phase based on clinical indications (1 = not indicated, 2 = probably indicated, 3 = indicated). We surveyed 11 institutions for their practice regarding single-phase and multiphase CT examinations. Data were analyzed with the Student t test. Results: Most institutions use multiphase protocols for routine chest (10/18 institutions) and routine abdomen–pelvis (10/11 institutions that supplied data for abdomen–pelvis) CT examinations. Most institutions (10/11) do not modify scan parameters between different scan phases. Respective total DLP for 1-, 2-, and 3-phase routine chest CT was 272, 518, and 820 mGy·cm, respectively. Corresponding values for 1- to 5-phase routine abdomen–pelvis CT were 400, 726, 1218, 1214, and 1458 mGy cm, respectively. For multiphase CT protocols, there were no differences in scan parameters and radiation doses between different phases for either chest or abdomen–pelvis CT ( P = 0.40-0.99). Multiphase CT examinations were unnecessary in 100% of routine chest CT and in 63% of routine abdomen–pelvis CT examinations. Conclusions: Multiphase scan protocols for the routine chest and abdomen–pelvis CT examinations are unnecessary, and their use increases radiation dose.
Efficacy of Intraprocedural Superior Hypogastric Nerve Block in Reduction of Postuterine Artery Embolization Narcotic Analgesia Use
Authors: Park Peter J. , Kokabi Nima , Nadendla Pallavi , Lindsey Towanda , Dariushnia Sean R. 
Published: January 2020

Purpose: Uterine artery embolization (UAE) is an effective treatment for the management of symptomatic uterine fibroids. We aim to evaluate the efficacy of superior hypogastric nerve block (SHNB) in reducing narcotic analgesia use for postprocedural pain after UAE. Methods: A retrospective review of 88 consecutive patients with symptomatic fibroids who underwent UAE between August 2015 and August 2018 was performed. A total of 44 patients had intraprocedural SHNB and 44 patients had no SHNB. They were placed on a morphine patient-controlled anesthesia (PCA) pump after the procedure and were admitted for overnight observation. The total amount of PCA narcotic analgesia received was recorded for each patient. Additional factors including fibroid size, fibroid location, and patient age were evaluated to determine the predictors of narcotic use reduction after SHNB. Results: The mean amount of postprocedural morphine use was 51.7 mg in patients who did not receive an SHNB versus 35.9 mg in patients who did receive an SHNB ( P = .008), resulting in a 47.2% reduction in narcotic analgesia use in the SHNB cohort. A significant reduction in morphine use with SHNB was associated with fibroid size greater than 5 cm ( P = .009), intramural fibroid location ( P = .04), and patients 45 years or younger ( P = .006). Conclusion: The use of SHNB could significantly reduce the amount of narcotic analgesia required for pain control after UAE with larger intramural fibroids and younger patients as predictors of increased efficacy.
Workplace Well-Being Factors That Predict Employee Participation, Health and Medical Cost Impact, and Perceived Support
Authors: Grossmeier Jessica , Castle Patricia H. , Pitts Jennifer S. , Saringer Colleen , Jenkins Kristi Rahrig , Imboden Mary T. , Mangen David J. , Johnson Sara S. , Noeldner Steven P. , Mason Shawn T. 
Published: January 2020

Purpose:This study tested relationships between health and well-being best practices and 3 types of outcomes.Design:A cross-sectional design used data from the HERO Scorecard Benchmark Database.Setting:Data were voluntarily provided by employers who submitted web-based survey responses.Sample:Analyses were limited to 812 organizations that completed the HERO Scorecard between January 12, 2015 and October 2, 2017.Measures:Independent variables included organizational and leadership support, program comprehensiveness, program integration, and incentives. Dependent variables included participation rates, health and medical cost impact, and perceptions of organizational support.Analysis:Three structural equation models were developed to investigate the relationships among study variables.Results:Model sample size varied based on organizationally reported outcomes. All models fit the data well (comparative fit index > 0.96). Organizational and leadership support was the strongest predictor ( P < .05) of participation (n = 276 organizations), impact (n = 160 organizations), and perceived organizational support (n = 143 organizations). Incentives predicted participation in health assessment and biometric screening ( P < .05). Program comprehensiveness and program integration were not significant predictors ( P > .05) in any of the models.Conclusion:Organizational and leadership support practices are essential to produce participation, health and medical cost impact, and perceptions of organizational support. While incentives influence participation, they are likely insufficient to yield downstream outcomes. The overall study design limits the ability to make causal inferences from the data.
Job-Related Characteristics and Obesity in Australian Employees: Evidence From a Longitudinal Nationally Representative Sample
Authors: Keramat Syed Afroz , Alam Khorshed , Gow Jeff , Biddle Stuart J. H. 
Published: January 2020

Objective: This study aimed to examine the longitudinal association between 9 job-related characteristics and obesity among Australian employees using a nationally representative sample. Design: Longitudinal research design. Setting: Workplace. Participants: This study was conducted by pooling 2 cross-sectional surveys of nationally representative longitudinal data collected across 2-time points in 2013 and 2017. This study limited the sample to current employees aged 15 to 64 years. The total number of observation included in the analysis is 16 980 of 11 521 employees. Measures: The outcome variable is weight status and the main exposure variables are 9 job-related characteristics (work hours per week, work schedule, job type, employment contract type, firm size, supervisory responsibility, paid sick leave, self-perceived job stress, and self-perceived job insecurity). Generalized estimating equation logistic regression was employed to explore the association between job-related characteristics and obesity. Results: This study found that 59% of Australian employees were either overweight or obese. Employees working more than 40 hours per week were 1.11 times (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.03-1.21) and 1.07 times (OR: 1.07, 95% CI: 1.01-1.13) more prone to become overweight and obese, respectively, compared to their counterparts who work 31 to 40 hours per week. The study also revealed that self-perceived job insecurity was positively associated with obesity (OR: 1.03, 95% CI: 1.02-1.04). However, this study did not find evidence that work schedule, job type, employment contract, firm size, supervisory role, paid sick leave, and self-perceived job stress were associated with obesity. Conclusions: Working more than 40 hours per week and self-perceived job insecurity were significantly associated with obesity among Australian employees. A better understanding of why prolonged work hours and self-perceived job insecurity are associated with obesity may help policy makers to implement workplace wellness policies and for employers to take measures to tackle the obesity problem of their employees.
Care situations demanding moral courage: Content analysis of nurses’ experiences
Authors: Kleemola Emmi , Leino-Kilpi Helena , Numminen Olivia 
Published: January 2020

Background: Nurses encounter complex ethical dilemmas in everyday nursing care. It is important for nurses to have moral courage to act in these situations which threaten patients’ safety or their good care. However, there is lack of research of moral courage. Purpose: This study describes nurses’ experiences of care situations demanding moral courage and their actions in these situations. Method: A qualitative descriptive research design was applied. The data were collected with an open-ended question in the questionnaire used in validation of the Nurses’ Moral Courage Scale. The sample consisted of 286 nurses from four different clinical fields in a major university hospital in Finland, providing a total of 611 answers. Data were analyzed using inductive content analysis. Ethical considerations: The study followed the commonly recognized principles of good scientific practice. The use of data was authorized by the developer of the instrument, the data collector, and the participating hospital. Ethical approval was obtained from the university ethics committee. Findings: Nurses acted morally courageously in most situations but sometimes they failed to do so. Although situations demanding moral courage varied, they could be categorized into seven main domains relating to colleagues, physicians, patients, relatives, nurses themselves, managers, and organizations. Nurses acted in the situations in different ways. The main acts in solving the situations were verbal communication or immediate action, such as interrupting of action. Conclusion: Care situations demanding moral courage focus on good and safe patient care and the patient’s good is at the center of attention. The situations are mostly related to the activities of other healthcare professionals. Findings may be applied in developing ethical nursing care through basic and continuing nursing education. Research is needed on the moral courage of physicians and managers, as well as on patients’ and their relatives’ experiences of care situations demanding moral courage.
Prevalence of depressive symptoms and associated factors in an urban, ophthalmic population
Authors: Mayro Eileen L , Murchison Ann P , Hark Lisa A , Silverstein Marlee , Wang Olivia Y , Gilligan John P , Leiby Benjamin E , Pizzi Laura T , Casten Robin J , Rovner Barry W , Haller Julia A 
Published: January 2020

Objective: To determine the prevalence of depressive symptoms in an adult ophthalmic patient population and to delineate correlates. Design: Cross-sectional study. Participants: Adult patients (⩾18 years) were approached in general and sub-specialty cornea, retina, and glaucoma ophthalmic clinics. A total of 367 patients from the four clinics were enrolled. Methods: Depressive symptoms were assessed using the Patient Health Questionnaire-9. A cut-off score of ⩾10 was used to indicate clinically significant depressive symptoms. Patient Health Questionnaire-9 scores were used to evaluate bivariate relationships between depressive symptoms and distance visual acuity, ocular diagnosis, diabetes status, smoking status, demographic information, and medications. Results: The majority of patients were female (52.9%) and Caucasian (48.6%). The mean age was 52.0 years (standard deviation: 16.7). Clinically significant depressive symptoms were present in 19.9% of patients overall; this rate varied slightly by clinic. Patients with low vision and blindness (visual acuity worse than 20/60) were more likely to have depressive symptoms (odds ratio = 2.82; 95% confidence interval: 1.90–4.21). Smoking and diabetes were also associated with depressive symptoms (odds ratio = 3.11 (2.66–3.64) and 3.42 (1.90–6.16), respectively). Conclusion: In a sample of urban ophthalmic adult patients, depressive symptoms were highly associated with low vision, smoking, and diabetes. This information can be used to target interventions to those at greatest risk of depressive symptoms.
A secondary iris cyst with 3 years of asymptomatic period following a blunt ocular trauma
Authors: Li Hong-Yang , Li Mei-Jun , Xu Zhi-Yi , Li Jia-Hui , Zheng Wen-Lin , Wu Yi , Pan Hong-Wei 
Published: January 2020

Purpose: To present a relatively uncommon case with a secondary iris cyst in the anterior chamber and its successful management with an anterior chamber mass excision surgery. Case report: A 46-year-old Chinese woman presented with a dark shadow in her left eye for 6 months without any other discomfort. She had a history of blunt ocular trauma by a badminton strike 3 years ago. Slit-lamp examination showed a small, nearly circular, sharply demarcated, and movable mass in the anterior chamber OS, which could change its position with head tilt. The anterior segment optical coherence tomography revealed a well-circumscribed cystic lesion in the anterior chamber with higher reflective outer layer and lower internal reflectivity. An anterior chamber mass removal surgery was performed without recurrence up to 1 year. Conclusion: Secondary free-floating iris cyst following a blunt trauma is rarely reported. It is relatively stable and nonprogressive so it may remain asymptomatic for a long time. Appropriate imaging techniques are necessary for facilitating diagnosis and therapy. Therapeutic management should be considered if visual symptoms arise, especially when complications occur.