bluuebunny/crossref_metadata_2025_split huggingface dataset:
Joint associations of occupational standing and occupational exertion with musculoskeletal symptoms in a US national sample
Authors: Friel Ciaran P , Pascual Christian B , Duran Andrea T , Goldsmith Jeff , Diaz Keith M 
Published: December 2020

ObjectiveObservational studies have linked occupational standing or walking to musculoskeletal pain. These prior studies, however, are flawed as few accounted for physical exertion; a potential confounder that accompanies many standing-based occupations. The purpose of this study was to examine the individual and joint associations of occupational standing/walking and exertion with musculoskeletal symptoms.MethodsData for this analysis come from the 2015 National Health Interview Survey, a US nationally representative survey. Occupational standing/walking and exertion were assessed by self-report on a 5-point Likert scale. The presence of musculoskeletal symptoms (pain, aching and stiffness) for upper extremities (neck, shoulders, elbows, wrists and fingers), lower extremities (hips, knees, ankles and toes) and lower back was also assessed.ResultsOccupational standing/walking was associated with a greater likelihood of upper extremity, lower extremity and lower back musculoskeletal symptoms; however, associations were attenuated and no longer significant with adjustment for exertion. When stratified by levels of occupational exertion, occupational standing/walking was associated with musculoskeletal symptoms only among the group with high exertion (eg, OR=1.69 (95% CI: 1.48 to 1.94) for lower back symptoms comparing high/high for standing or walking/exertion vs low/low). Among groups with low exertion, occupational standing/walking was not associated with musculoskeletal symptoms (eg, OR=1.00 (95% CI: 0.85 to 1.16) for lower back symptoms comparing high/low for standing or walking/exertion vs low/low).ConclusionResults from this US representative survey suggest that the association between occupational standing/walking and musculoskeletal symptoms is largely driven by the co-occurrence of occupational exertion and does not provide evidence that standing or walking incurs adverse musculoskeletal symptoms.
Mask-associated ‘de novo’ headache in healthcare workers during the COVID-19 pandemic
Authors: Ramirez-Moreno José María , Ceberino David , Gonzalez Plata Alberto , Rebollo Belen , Macias Sedas Pablo , Hariramani Roshan , Roa Ana M , Constantino Ana B 
Published: December 2020

ObjectivesThe pandemic caused by the new coronavirus (COVID-19) has changed care activities of health professionals. We analysed the possible association between the appearance of ‘de novo’ headache according to the type of mask used, the related factors and the impact of the cephalalgia on health professionals.MethodsCross-sectional study in a tertiary hospital in Extremadura, Spain. We provided an online questionnaire to healthcare workers during the period of maximum incidence of COVID-19 in our setting.ResultsThe subjects are n=306, 244 women (79.7%), with an average age of 43 years (range 23–65). Of the total, 129 (42.2%) were physicians, 112 (36.6%) nurses and 65 (21.2%) other health workers. 208 (79.7%) used surgical masks and 53 (20.3%) used filter masks. Of all those surveyed, 158 (51.6%) presented ‘de novo’ headache. The occurrence of a headache was independently associated with the use of a filter mask, OR 2.14 (95% CI 1.07 to 4.32); being a nurse, OR 2.09 (95% CI 1.18 to 3.72) or another health worker, OR 6.94 (95% CI 3.01 to 16.04); or having a history of asthma, OR 0.29 (95% CI 0.09 to 0.89). According to the type of mask used, there were differences in headache intensity, and the impact of a headache in the subjects who used a filter mask was worse in all the aspects evaluated.ConclusionThe appearance of ‘de novo’ headache is associated with the use of filter masks and is more frequent in certain healthcare workers, causing a greater occupational, family, personal and social impact.
Serum pepsinogen levels and OLGA/OLGIM staging in the assessment of atrophic gastritis types
Authors: Ogutmen Koc Deniz , Bektas Sibel 
Published: December 2020

AbstractBackgroundWe assessed the validity of using serum pepsinogen tests (sPGTs) to differentiate autoimmune atrophic gastritis (AAG) from environmental atrophic gastritis (EAG). We also investigated the correlation and prognostic value between disease stage, according to Operative Link for Gastritis Assessment (OLGA)/Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM), and sPGT results in patients with gastric atrophy.MethodsWe enroled 115 patients in this prospective study: 95 with atrophic gastritis (16 with AAG and 79 with EAG) and 20 non-atrophic gastritis. These patients, along with 32 control patients, underwent esophagogastroduodenoscopy. Atrophy and intestinal metaplasia of the gastric biopsy specimens were staged according to the OLGA/OLGIM staging systems.ResultsThe median (IQR) age of the patients (83 females (56.5%)) was 58 (46–67) years. Patients in the AAG group represented histologically advanced stages. The AAG group had lower pepsinogen (PG) I and II levels, as well as a lower PGI/PGII ratio, compared with the EAG group (p&lt;0.01, p&lt;0.05 and p&lt;0.01, respectively). The optimal PGI/PGII ratio for predicting AAG was ≤1.9 (100% sensitivity and 100% specificity), and that for predicting EAG was ≤9.2 (47.5% sensitivity and 90.6% specificity). The OLGA/OLGIM stage was negatively correlated with the PGI level and PGI/PGII ratio. In the AAG group, four of five patients with low-grade dysplasia had OLGA/OLGIM stage III–IV disease.ConclusionssPGT may provide valuable information for differentiating advanced-stage AAG from EAG, and in patients with atrophic gastritis, use of sPGTs and OLGA/OLGIM staging together may predict gastric cancer risk.
Direct admission to improve timely access to care for patients requiring transfer to a level 1 trauma center
Authors: Safavi Kyan C , Gaitanidis Apostolos , Breen Kerry , Seelen Mark , Raja Ali , Velmahos George C , Dunn Peter F 
Published: December 2020

BackgroundEmergency departments (EDs) at level 1 trauma centers are often overcrowded and deny ED-to-ED transfers from lower-tiered centers. Lack of access to timely level 1 care is associated with increased mortality. We evaluated the feasibility of a direct admission (DA) protocol as a method to increase timely access to a level 1 trauma center during periods of ED overcrowding.MethodsDuring periods of ED overcrowding between 1 May and 31 December 2019, we admitted patients from referring EDs directly to the intensive care unit (ICU) or inpatient ward using the DA protocol. In a prospective comparative study design, we compared their outcomes to patients during the same period who were admitted through the ED when the ED was not overcrowded.ResultsDuring periods of ED overcrowding, transfer was requested and clinically accepted for 28 patients, of which 23 (82.1%, age 63±20.3 years, men 52.2% men) were successfully admitted via the DA protocol. Five (17.9%) were not successfully transferred due to lack of available inpatient beds. During periods when the ED was not overcrowded, 106 patients (age 62.8±23.1 years, men 52.8%) were admitted via the ED. There were no morbidity or mortality events attributed to the DA process. Time to patient arrival was 2.7 hours (95% CI 2.3 to 3.1) in the DA cohort and 1.9 hours (95% CI 1.5 to 2.4) in the ED-to-ED cohort (p=0.104). Up-triage to the ICU within 24 hours was performed in only one patient (4.3%). In-hospital mortality did not differ (3 (13%) vs. 8 (7.6%), p=0.392).DiscussionThe DA pathway is a feasible method to safely transfer patients from a referring ED to a higher-care trauma center when its ED is overcrowded.Level of evidenceLevel III, care management.
A Surface of Heteroclinic Connections Between Two Saddle Slow Manifolds in the Olsen Model
Authors: Musoke Elle , Krauskopf Bernd , Osinga Hinke M. 
Published: December 2020

The Olsen model for the biochemical peroxidase-oxidase reaction has a parameter regime where one of its four variables evolves much slower than the other three. It is characterized by the existence of periodic orbits along which a large oscillation is followed by many much smaller oscillations before the process repeats. We are concerned here with a crucial ingredient for such mixed-mode oscillations (MMOs) in the Olsen model: a surface of connecting orbits that is followed closely by the MMO periodic orbit during its global, large-amplitude transition back to another onset of small oscillations. Importantly, orbits on this surface connect two one-dimensional saddle slow manifolds, which exist near curves of equilibria of the limit where the slow variable is frozen and acts as a parameter of the so-called fast subsystem. We present a numerical method, based on formulating suitable boundary value problems, to compute such a surface of connecting orbits. It involves a number of steps to compute the slow manifolds, certain submanifolds of their stable and unstable manifolds and, finally, a first connecting orbit that is then used to sweep out the surface by continuation. If it exists, such a surface of connecting orbits between two one-dimensional saddle slow manifolds is robust under parameter variations. We compute and visualize it in the Olsen model and show how this surface organizes the global return mechanism of MMO periodic orbits from the end of small oscillations back to a region of phase space where they start again.
Assessing the Severity of Smart Attacks in Industrial Cyber-Physical Systems
Authors: Khaled Abdelaziz , Ouchani Samir , Tari Zahir , Drira Khalil 
Published: December 2020

Industrial cyber-physical systems (<monospace>ICPS</monospace>) are heterogeneous inter-operating parts that can be physical, technical, networking, and even social like agent operators. Incrementally, they perform a central role in critical and industrial infrastructures, governmental, and personal daily life. Especially with the Industry 4.0 revolution, they became more dependent on the connectivity by supporting novel communication and distance control functionalities, which expand their attack surfaces that result in a high risk for cyber-attacks. Furthermore, regarding physical and social constraints, they may push up new classes of security breaches that might result in serious economic damages. Thus, designing a secure <monospace>ICPS</monospace> is a complex task, since this needs to guarantee security and harmonize the functionalities between the various parts that interact with different technologies. This article highlights the significance of cyber-security infrastructure and shows how to evaluate, prevent, and mitigate <monospace>ICPS</monospace>-based cyber-attacks. We carried out this objective by establishing an adequate semantics for <monospace>ICPS</monospace>’s entities and their composition, which includes social actors that act differently than mobile robots and automated processes. This article also provides the feasible attacks generated by a reinforcement learning mechanism based on multiple criteria that selects both appropriate actions for each <monospace>ICPS</monospace> component and the possible countermeasures for mitigation. To efficiently analyze <monospace>ICPS</monospace>’s security, we proposed a model-checking-based framework that relies on a set of predefined attacks from where the security requirements are used to assess how well the model is secure. Finally, to show the effectiveness of the proposed solution, we model, analyze, and evaluate the <monospace>ICPS</monospace> security on two real use cases.
Idealized Aquaplanet Simulations of Tropical Cyclone Activity: Significance of Temperature Gradients, Hadley Circulation, and Zonal Asymmetry
Authors: Zhang Gan , Silvers Levi G. , Zhao Ming , Knutson Thomas R. 
Published: December 2020

AbstractEarlier studies have proposed many semiempirical relations between climate and tropical cyclone (TC) activity. To explore these relations, this study conducts idealized aquaplanet experiments using both symmetric and asymmetric sea surface temperature (SST) forcings. With zonally symmetric SST forcings that have a maximum at 10°N, reducing meridional SST gradients around an Earth-like reference state leads to a weakening and southward displacement of the intertropical convergence zone. With nearly flat meridional gradients, warm-hemisphere TC numbers increase by nearly 100 times due particularly to elevated high-latitude TC activity. Reduced meridional SST gradients contribute to a poleward expansion of the tropics, which is associated with a poleward migration of the latitudes where TCs form or reach their lifetime maximum intensity. However, these changes cannot be simply attributed to the poleward expansion of Hadley circulation. Introducing zonally asymmetric SST forcings tends to decrease the global TC number. Regional SST warming—prescribed with or without SST cooling at other longitudes—affects local TC activity but does not necessarily increase TC genesis. While regional warming generally suppresses TC activity in remote regions with relatively cold SSTs, one experiment shows a surprisingly large increase of TC genesis. This increase of TC genesis over relatively cold SSTs is related to local tropospheric cooling that reduces static stability near 15°N and vertical wind shear around 25°N. Modeling results are discussed with scaling analyses and have implications for the application of the “convective quasi-equilibrium and weak temperature gradient” framework.
A Multidecadal-Scale Tropically Driven Global Teleconnection over the Past Millennium and Its Recent Strengthening
Authors: Feng Xiaofang , Ding Qinghua , Wu Liguang , Jones Charles , Baxter Ian , Tardif Robert , Stevenson Samantha , Emile-Geay Julien , Mitchell Jonathan , Carvalho Leila M. V. , Wang Huijun , Steig Eric J. 
Published: December 2020

AbstractIn the past 40 years, the global annual mean surface temperature has experienced a nonuniform warming, differing from the spatially uniform warming simulated by the forced responses of large multimodel ensembles to anthropogenic forcing. Rather, it exhibits significant asymmetry between the Arctic and Antarctic, with intermittent and spatially varying warming trends along the Northern Hemisphere (NH) midlatitudes and a slight cooling in the tropical eastern Pacific. In particular, this “wavy” pattern of temperature changes over the NH midlatitudes features strong cooling over Eurasia in boreal winter. Here, we show that these nonuniform features of surface temperature changes are likely tied together by tropical eastern Pacific sea surface temperatures (SSTs), via a global atmospheric teleconnection. Using six reanalyses, we find that this teleconnection can be consistently obtained as a leading circulation mode in the past century. This tropically driven teleconnection is associated with a Pacific SST pattern resembling the interdecadal Pacific oscillation (IPO), and hereafter referred to as the IPO-related bipolar teleconnection (IPO-BT). Further, two paleo-reanalysis reconstruction datasets show that the IPO-BT is a robust recurrent mode over the past 400 and 2000 years. The IPO-BT mode may thus serve as an important internal mode that regulates high-latitude climate variability on multidecadal time scales, favoring a warming (cooling) episode in the Arctic accompanied by cooling (warming) over Eurasia and the Southern Ocean (SO). Thus, the spatial nonuniformity of recent surface temperature trends may be partially explained by the enhanced appearance of the IPO-BT mode by a transition of the IPO toward a cooling phase in the eastern Pacific in the past decades.
The 5-Factor Modified Frailty Index in the Geriatric Surgical Population
Authors: Subramaniam Sneha , Aalberg Jeffrey J. , Soriano Rainier P. , Divino Celia M. 
Published: December 2020

Background The modified frailty index (mFI-11) is a National Surgical Quality Improvement Program (NSQIP)–based 11-factor index that has been proven to adequately reflect frailty and predict mortality and morbidity. In the past years, certain NSQIP variables have been removed from the database; as of 2015, only 5 out of the original 11 factors remain. While the predictive power and usefulness of this 5-factor index (mFI-5) has been proven in previous work, it has yet to be studied in the geriatrics population. The goal of our study was to compare the mFI-5 to the mFI-11 in terms of value and predictive ability for mortality, postoperative infection, and unplanned 30-day readmission for patients aged 65 years and older. Methods Spearman’s Rho was calculated to compare the value, and unadjusted and adjusted logistic regressions were created for three outcomes in nine surgical subspecialties. Correlation coefficients were above .86 across all surgical specialties except for cardiac surgery. Adjusted and unadjusted models showed similar C-statistics for mFI-5 and 11. Results Overall predictive values of geriatric mFI-5 and mFI-11 were lower than those for the general population but still had effective predictive value for mortality and post-operative complications (C-Stat ≥ .7) and weak predictive value for 30-day readmission. Conclusions The mFI-5 is an equally effective predictor as the mFI-11 in all subspecialties and an effective predictor of mortality and postoperative complication in the geriatric population. This index has credibility for future use to study frailty within NSQIP, within other databases, and for clinical assessment and use.
Enhanced Recovery Programs for Colorectal Surgery and Postoperative Acute Kidney Injury: Results From a Systematic Review and Meta-Analysis of Observational Studies
Authors: Zorrilla-Vaca Andrés , Mena Gabriel E. , Cata Juan , Healy Ryan , Grant Michael C. 
Published: December 2020

Background Enhanced recovery programs (ERPs) for colorectal surgery bundle evidence-based measures to reduce complications, accelerate postoperative recovery, and improve the value of perioperative health care. Despite these successes, several recent studies have identified an association between ERPs and postoperative acute kidney injury (AKI). We conducted a systematic review and meta-analysis to determine the association between ERPs for colorectal surgery and postoperative AKI. Methodology After conducting a search of major databases (PubMed, Embase, Scopus, Google Scholar, and ScienceDirect), we conducted a meta-analysis of observational studies that reported on the association between ERPs and postoperative AKI. Results Six observational studies (n = 4765 patients) comparing ERP (n = 2140) to conventional care (n = 2625) were included. Overall, ERP patients had a significantly greater odds of developing postoperative AKI (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.31-3.00, P = .001) than those who received conventional care. There was no evidence of publication bias (Begg’s test P = 1.0, Egger’s P value = .95). Conclusions Based upon pooled results from observational studies, ERPs are associated with increased odds of developing postoperative AKI compared to conventional perioperative care. The mechanism for this effect is likely multifactorial. Additional research targeting high risk patient populations should evaluate the role of restrictive fluid administration, hemodynamic goals, and scheduled nephrotoxic agents in ERP protocols.
Predictors of Mortality Among Very Low Birth Weight Infants With Gastrointestinal Perforation
Authors: Reppucci Marina L. , Hersh Eliza H. , Khetan Prerna , Coakley Brian A. 
Published: December 2020

Background Gastrointestinal (GI) perforation is a risk factor for mortality in very low birth weight (VLBW) infants. Little data exist regarding pretreatment factors and patient characteristics known to independently correlate with risk of death. Materials and Methods A retrospective review of all VLBW infants who sustained GI perforation between 2011 and 2018 was conducted. Birth, laboratory, and disease-related factors of infants who died were compared to those who survived. Results 42 VLBW infants who sustained GI perforations were identified. Eleven (26.19%) died. There were no significant differences in birth-related factors, hematological lab levels at diagnosis, presence of pneumatosis, or bacteremia. Portal venous gas ( P = .03), severe metabolic acidosis ( P < .01), and elevated lactate at diagnosis ( P < .01) were statistically more likely to occur among infants who died. Discussion Portal venous gas, severe metabolic acidosis, and elevated lactate were associated with an increased risk of mortality among VLBW infants who develop a GI perforation. Further research is required to better identify risk factors.
Self-Efficacy, Perceived Barriers to Care, and Health-Promoting Behaviors Among Franco-Americans Across Cardiovascular Risk Factors: A Cross-Sectional Study
Authors: Mszar Reed , Buscher Sara , McCann Dervilla , Taylor Heidi L. 
Published: December 2020

Purpose: To assess the prevalence of perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors among Franco-Americans as a higher-risk group for familial hypercholesterolemia (FH), stratified by cardiovascular risk factors. Design: Cross-sectional survey based on components of the Health Belief Model Setting: Administered in-person at a Franco-American cultural center and online through mailing lists and social media platforms in the Northeastern United States Sample: Franco-Americans and French Canadians (n = 170) Measures: Demographic and clinical characteristics (i.e. high cholesterol, prior heart attack or stroke, family history of atherosclerotic cardiovascular disease (ASCVD), diagnosis of FH), perceived barriers to accessing health care services, self-efficacy, and health-promoting behaviors (i.e. taking lipid-lowering medications, seeing a cardiovascular specialist). Results: In a cohort of Franco-Americans, 42 (25%) had both high cholesterol and family history of ASCVD. Among Franco-Americans with both cardiovascular risk factors, 22% had low self-efficacy and only 16% had discussed FH with their physician. Individuals with both risk factors were significantly more likely to report a concern over a future diagnosis as a barrier to accessing health care services when compared with those with neither risk factor (36% vs. 15%, p = 0.014). Overall, other prominent barriers to care included knowledge of when to seek help (27%) and a distrust in medicine (26%). Conclusion: Franco-Americans report significant barriers to accessing health care services. Our findings strengthen the case for developing focused public health strategies to raise awareness for FH, particularly among high-risk subpopulations with unmet cardiovascular needs.