bluuebunny/crossref_metadata_2025_split huggingface dataset:
Numerical Simulations of Two-Layer Flow past Topography. Part II: Lee Vortices
Authors: Rotunno Richard , Bryan George H. 
Published: January 2020

Abstract
This study considers a two-layer fluid with constant density in each layer connected by a layer of continuously varying density for flows past topography in which hydraulic jumps with lee vortices are expected based on shallow-water theory. Numerical integrations of the Navier–Stokes equations at a Reynolds number high enough for a direct numerical simulation of turbulent flow allow an examination of the internal mechanics of the turbulent leeside hydraulic jump and how this mechanics is related to lee vortices. Analysis of the statistically steady state shows that the original source of lee-vortex vertical vorticity is through the leeside descent of baroclinically produced spanwise vorticity associated with the hydraulic jump. This spanwise vorticity is tilted to the vertical at the spanwise extremities of the leeside hydraulic jump. Turbulent energy dissipation in flow through the hydraulic jump allows this leeside vertical vorticity to diffuse and extend downstream. The present simulations also suggest a geometrical interpretation of lee-vortex potential-vorticity creation, a concept central to interpretations of lee vortices based on the shallow-water equations.
Roles of Sea Ice–Surface Wind Feedback in Maintaining the Glacial Atlantic Meridional Overturning Circulation and Climate
Authors: Sherriff-Tadano Sam , Abe-Ouchi Ayako 
Published: January 2020

AbstractDuring glacial periods, climate varies between two contrasting modes, the interstadials and stadials. These climate changes are often associated with drastic reorganizations of the Atlantic meridional overturning circulation (AMOC). Previous studies highlight the important role of sea ice in maintaining contrasting modes of the AMOC through its insulating effect on the oceanic heat flux and the buoyancy flux (sea ice–buoyancy flux feedback); however, the effect of feedback from the atmosphere remains unclear. Here, the effect of sea ice–surface wind interactions over the North Atlantic Ocean on the AMOC is explored. For this purpose, results from comprehensive atmosphere–ocean coupled general circulation models (AOGCMs) are analyzed. Then, sensitivity experiments are conducted with the atmospheric component of the AOGCM. Last, to explore the impact of modifications in surface winds induced by sea ice on the maintenance of the AMOC, partially coupled experiments are conducted with the AOGCMs. Experiments show that the expansion of sea ice associated with a weakening of the AMOC reduces surface winds by suppressing the oceanic heat flux and increasing the atmospheric static stability. This wind anomaly then causes a weakening of the wind-driven ocean salt transport to the northern North Atlantic and maintains the weak AMOC, therefore working as a positive feedback. It is shown that, together with the sea ice–buoyancy flux and sea ice–surface wind feedback, changes in sea ice and oceanic heat flux sustain the contrasting modes of the AMOC. These results may provide useful information for interpreting the differences in the self-sustained internal oscillations of the AMOC produced by recent AOGCMs.
Emotional Well-Being in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom
Authors: Ardouin Kenny , Hare Jess , Stock Nicola Marie 
Published: January 2020

Objectives: Previous research with adults born with cleft lip and/or palate (CL/P) has identified a range of concerns regarding mental health and quality of life, concluding that overall emotional functioning is poorer compared to the general population. The aim of the current study was to build on this previous work by investigating the self-reported emotional well-being of adults born with CL/P in the United Kingdom. Design: An online, mixed methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received between July and October 2018. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics and independent t tests. Results: Almost half of the sample reported a diagnosis of a mental health condition. Scores on standardized measures indicated significantly lower global self-worth, higher levels of fear of negative appearance evaluation, and lower self-perceived job competence compared to normative data. Scores of overall body esteem were in line with the general population. Most participants had not received psychological support from their regional CL/P team and 41% were unaware of their entitlement to treatment from the National Health Service. Conclusions: Individuals with CL/P may be at risk of emotional distress persisting into adulthood. The integration of routine psychological support from an early age is highly recommended, as is information for young adults about to complete routine treatment. Comprehensive psychological screening for adults returning to the service later in life is also strongly advised.
Predictive risk factors for postoperative pneumonia after heart transplantation
Authors: Vidal Charles , Pasqualotto Romain , James Arthur , Dureau Pauline , Rasata Julie , Coutance Guillaume , Varnous Shaida , Leprince Pascal , Amour Julien , Bouglé Adrien 
Published: January 2020

Abstract
Background
Pneumonia is a frequent complication in patients undergoing heart transplantation (HTx) that increases morbidity and mortality in this population. Nevertheless, the risk factors for postoperative pneumonia (POP) are still unknown. The aim of this study was to investigate the predictive risk factors for POP in HTx recipients.

Methods
In this retrospective study, all patients undergoing HTx between January 2014 and December 2015 were included. All cases of POP occurring until hospital discharge were investigated. The study aimed to determine risk factors using univariate and multivariate Cox regression models. Data are expressed in Odds Ratio [95% CI]. P < 0.05 was necessary to reject the null hypothesis.

Results
A total of 175 patients were included without any patients being lost to follow-up, and 89 instances of POP were diagnosed in 59 (34%) patients. Enterobacteriaceae and Pseudomonas aeruginosa were the most common pathogens. In the multivariate analysis, the risk factors were preoperative mechanical ventilation (OR 1.42 [1.12–1.80], P < 0.01) and perioperative blood transfusion (OR 1.42 [95% CI: 1.20–1.70], P < 0.01). POP significantly impacted mortality at 30 days (OR: 4 [1.3–12.4], P = 0.01) and 1 year (OR: 6.8 [2.5–8.4], P < 0.01) and was associated with a longer duration of mechanical ventilation, time to weaning from venoarterial extracorporeal membrane oxygenation and stay in an intensive care unit. Plasma exchanges and intravenous administration of immunoglobulins did not increase the risk of POP.

Conclusion
After HTx, preoperative mechanical ventilation and blood transfusion were risk factors for POP and were associated with increased mortality. Enterobacteriaceae and Pseudomonas aeruginosa are the most common pathogens of POP.
Identifying appropriate outcomes to help evaluate the impact of the Canadian Guideline for Safe and Effective Use of Opioids for Non-Cancer Pain
Authors: Allen Michael , Sproule Beth , MacDougall Peter , Furlan Andrea , Murphy Laura , Borg Debono Victoria , Buckley Norman 
Published: January 2020

Abstract
Background
The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (COG) was developed in response to increasing rates of opioid-related hospital visits and deaths in Canada, and uncertain benefits of opioids for chronic non-cancer pain (CNCP). Following publication, we developed a list of evaluable outcomes to assess the impact of this guideline on practice and patient outcomes.

Methods
A working group at the National Pain Centre at McMaster University used a modified Delphi process to construct a list of clinical and patient outcomes important in assessing the uptake and application of the COG. An advisory group then reviewed this list to determine the relevance and feasibility of each outcome, and identified potential data sources. This feedback was reviewed by the National Faculty for the Guideline, and a National Advisory Group that included the creators of the COG, resulting in the final list of 5 priority outcomes.

Results
Five outcomes were judged clinically important and feasible to measure: 1) Effects of opioids for CNCP on quality of life, 2) Assessment of patient’s risk of addiction before starting opioid therapy, 3) Monitoring patients on opioid therapy for aberrant drug-related behaviour, 4) Mortality rates associated with prescription opioid overdose and 5) Use of treatment agreements with patients before initiating opioid therapy for CNCP. Data sources for these outcomes included patient’s medical charts, e-Opioid Manager, prescription monitoring programs and administrative databases.

Conclusion
Measuring the impact of best practice guidelines is infrequently done. Future research should consider capturing the five outcomes identified in this study to evaluate the impact of the COG in promoting evidence-based use of opioids for CNCP.
Youth StepCare: a pilot study of an online screening and recommendations service for depression and anxiety among youth patients in general practice
Authors: Parker Belinda Louise , Achilles Melinda Rose , Subotic-Kerry Mirjana , O’Dea Bridianne 
Published: January 2020

Abstract
Background
General Practitioners (GPs) are ideally placed to identify and manage emerging mental illness in young people, however, many report low levels of confidence in doing so. A web-based universal screening service delivered via a mobile tablet, Youth StepCare, was developed to assist GPs in identifying depression and anxiety symptoms in youth patients. This service also provided evidence-based treatment recommendations and fortnightly monitoring of symptoms. The current study assessed the feasibility and acceptability of delivering the Youth StepCare service in Australian general practices.

Methods
A 12-week uncontrolled trial was undertaken between August 2018 and January 2019 in two general practices in NSW, Australia. The service was offered to all youth patients aged 14 to 17 years who visited a participating GP during the screening period with their parent or guardian. Youth patients reported the presence of depressive and anxiety symptoms using the self-report Patient Health Questionnaire-9 and the Generalised Anxiety Disorder Questionnaire-7. New cases were defined as those who reported symptoms but were not currently seeking help from their GP, nor had sought help in the past. Feasibility and acceptability among GPs and practice staff were assessed using a battery of questionnaires.

Results
Five GPs and 6 practice staff took part. A total of 46 youth patients were approached, 28 consented, and 19 completed the screener (67.9%). Nine reported symptoms of anxiety or depression, two of which were new cases (22.2%). GPs and practice staff were satisfied with the service, reporting that there was a need for the service and that they would use it again.

Conclusions
The Youth StepCare service appears to be a useful tool for identifying youth with unidentified symptoms of mental illness that can be easily embedded into general practice. Further research would benefit from exploring the factors affecting initial GP uptake and a larger trial is required to determine the efficacy of the service on young people’s symptom reduction.
Evaluating implementation and impact of a provincial quality improvement collaborative for the management of chronic diseases in primary care: the COMPAS+ study protocol
Authors: Vachon Brigitte , Gaboury Isabelle , Menear Matthew , Pomey Marie-Pascale , Roy Denis , Houle Lise , Breton Mylaine , Duhoux Arnaud , Émond Valérie , Giasson Guylaine , Kaczorowski Janusz , Légaré France , Lussier Marie-Thérèse , Pluye Pierre , Vanasse Alain 
Published: January 2020

Abstract
Background
Chronic conditions such as diabetes and chronic obstructive pulmonary disease (COPD) are common and burdensome diseases primarily managed in primary care. Yet, evidence points to suboptimal quality of care for these conditions in primary care settings. Quality improvement collaboratives (QICs) are organized, multifaceted interventions that can be effective in improving chronic disease care processes and outcomes. In Quebec, Canada, the Institut national d’excellence en santé et en services sociaux (INESSS) has developed a large-scale QIC province-wide program called COMPAS+ that aims to improve the prevention and management of chronic diseases in primary care. This paper describes the protocol for our study, which aims to evaluate implementation and impact of COMPAS+ QICs on the prevention and management of targeted chronic diseases like diabetes and COPD.

Methods
This is a mixed-methods, integrated knowledge translation study. The quantitative component involves a controlled interrupted time series involving nine large integrated health centres in the province. Study sites will receive one of two interventions: the multifaceted COMPAS+ intervention (experimental condition) or a feedback only intervention (control condition). For the qualitative component, a multiple case study approach will be used to achieve an in-depth understanding of individual, team, organizational and contextual factors influencing implementation and effectiveness of the COMPAS+ QICs.

Discussion
COMPAS+ is a QI program that is unique in Canada due to its integration within the governance of the Quebec healthcare system and its capacity to reach many primary care providers and people living with chronic diseases across the province. We anticipate that this study will address several important gaps in knowledge related to large-scale QIC projects and generate strong and useful evidence (e.g., on leadership, organizational capacity, patient involvement, and implementation) having the potential to influence the design and optimisation of future QICs in Canada and internationally.
First report of Cryptosporidium viatorum and Cryptosporidium occultus in humans in China, and of the unique novel C. viatorum subtype XVaA3h
Authors: Xu Ning , Liu Hua , Jiang Yanyan , Yin Jianhai , Yuan Zhongying , Shen Yujuan , Cao Jianping 
Published: January 2020

Abstract
Background
Cryptosporidium is a genus of common intestinal protozoa, members of which cause diarrhea in a wide variety of hosts. Previous studies on Cryptosporidium in China have mainly focused on diarrhea sufferers, children, and immunodeficient individuals such as HIV/AIDS patients. However, the epidemiological characteristics of Cryptosporidium in the population in rural areas remain unclear. Herein, we investigated the prevalence of, and risk factors for, Cryptosporidium in rural areas of Binyang County, Guangxi Zhuang Autonomous Region, China, and genetically characterized the Cryptosporidium isolates we obtained.

Methods
From August to December 2016, two villages in Binyang County, Guangxi, were sampled using a random cluster sampling method. Fresh fecal samples were collected from all eligible residents (residence time > 6 months). Molecular characterization of Cryptosporidium was carried out based on its SSU rRNA, gp60, actin and hsp70 gene sequences. Fisher’s exact test were conducted to assess the risk factors for Cryptosporidium infection.

Results
A total of 400 fecal samples were collected from 195 males (48.8%) and 205 females (51.2%). Two samples (0.5%) were positive for Cryptosporidium and were identified as C. viatorum and C. occultus respectively. Moreover, a new C. viatorum subtype XVaA3h was identified based on the sequence of the gp 60 gene.

Conclusions
To our knowledge, this is the first report of C. viatorum and C. occultus infections in humans in China and of C. viatorum subtype XVaA3h. The findings provide important information on the prevalence of Cryptosporidium in the Chinese population, and expand the range of Cryptosporidium species known to infect people in China.
A man with recurrent fever, arthritis, and rashes-brucellosis? A case report
Authors: Wang Wen , Lu Xu , Li Chengbo , Ri Myong Jun , Cui Wei 
Published: January 2020

Abstract
Background
We report a rare case of chronic brucellosis accompanied with myelodysplastic syndrome and neutrophilic dermatosis, which to the best of our knowledge, has never been reported.

Case presentation
A young man was admitted to our hospital complaining of recurrent fever, arthritis, rashes and anemia. He had been diagnosed with brucellosis 6 years prior and treated with multiple courses of antibiotics. He was diagnosed with myelodysplastic syndrome and neutrophilic dermatosis following bone marrow puncture and skin biopsy. After anti-brucellosis treatment and glucocorticoid therapy, the symptoms improved.

Conclusions
Clinicians should consider noninfectious diseases when a patient who has been diagnosed with an infectious disease exhibits changing symptoms.
Case report: targeted whole exome sequencing enables the first prenatal diagnosis of the lethal skeletal dysplasia Osteocraniostenosis
Authors: Pemberton Lara , Barker Robert , Cockell Anna , Ramachandran Vijaya , Haworth Andrea , Homfray Tessa 
Published: January 2020

Abstract
Background
Osteocraniostenosis (OCS) is a rare genetic disorder characterised by premature closure of cranial sutures, gracile bones and perinatal lethality. Previously, diagnosis has only been possible postnatally on clinical and radiological features. This study describes the first prenatal diagnosis of OCS.

Case presentation
In this case prenatal ultrasound images were suggestive of a serious but non-lethal skeletal dysplasia. Due to the uncertain prognosis the parents were offered Whole Exome Sequencing (WES), which identified a specific gene mutation in the FAMIIIa gene. This mutation had previously been detected in two cases and was lethal in both perinatally. This established the diagnosis, a clear prognosis and allowed informed parental choice regarding ongoing pregnancy management.

Conclusions
This case report supports the use of targeted WES prenatally to confirm the underlying cause and prognosis of sonographically suspected abnormalities.
Experienced pain after stroke: a cross-sectional 5-year follow-up study
Authors: Westerlind Emma , Singh Ramanjit , Persson Hanna C. , Sunnerhagen Katharina S. 
Published: January 2020

Abstract
Background
Stroke is one of the most common cause of disability worldwide. Pain is common in both stroke survivors and in the general population. Consequences of post-stroke pain (PSP) include reduced quality of life and are important to consider. The aim of the current study was to explore the experience of pain 5 years after stroke, and factors associated with the experience of pain.

Methods
Inclusion criteria were: First ever stroke, treated at Sahlgrenska University Hospital, Sweden, during an 18 months period in 2009–2010, aged 18 years or older. Furthermore, the participants had to respond to a set of questionnaires 5 years post-stroke. Baseline data were collected from medical records and follow-up data from the set of questionnaires. The primary outcome was based on the question Do you experience pain? Predictors and explanatory factors for experiencing more frequent pain were analysed with logistic regression.

Results
A total of 281 participants were included. Almost 40% experienced pain to some degree 5 years post-stroke (15% reported pain frequently), and 25% felt that their needs for pain treatment were not met. The participants experiencing more frequent pain reported poorer quality of life, self-perceived health status and recovery post-stroke. Functional dependency at discharge from hospital, experiencing depression at follow up and restricted mobility at follow up were all associated with more frequent pain.

Conclusion
Pain is common 5 years post-stroke and the treatment is not perceived as optimal. The persons experiencing more frequent pain seem to rate their health and recovery worse than the persons experiencing less frequent pain. Most of the factors associated with more frequent pain were treatable and this emphasize the importance of standardised follow-up care that takes pain into consideration.
Prevalence of stroke and stroke related risk factors: a population based cross sectional survey in southwestern China
Authors: Yi Xingyang , Luo Hua , Zhou Ju , Yu Ming , Chen Xiaorong , Tan Lili , Wei Wei , Li Jie 
Published: January 2020

AbstractBackgroundStroke and its risk factors epidemiological survey can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and high risk stroke population, and evaluate stroke associated risk factors in southwestern China.MethodsThis was a multi-center, cross sectional survey in southwestern China from May 2015 to September 2015. The eight communities were selected at random, and 17,413 residents aged ≥40 years volunteered to participate in this survey. Data were collected through face-to-face survey using a structured questionnaire. Five hundred twenty-one participants with incomplete questionnaires on stroke history or risk factors records were excluded.ResultsA total of 16,892 people included in analysis. The overall prevalence of stroke was 3.1% (95% CI 2.6–3.9%), 17.1% of participants were the high risk stroke population. After full adjustments, hypertension, diabetes, dyslipidemia, overweight, lack of exercise and family history of stroke were significantly associated with overall stroke and ischemic stroke. The largest contributor was hypertension (population-attributable risk 23.6%), followed by dyslipidemia, physical inactivity, family history of stroke, diabetes, and overweight. However, only hypertension (OR = 3.66, 95% CI 1.82–8.23) was significantly associated with hemorrhagic stroke.ConclusionsThe prevalence of stroke and high risk stroke population was high among adults aged ≥40 years in southwestern China. Hypertension, dyslipidemia and lack of exercise were stronger contributors for stroke, these findings suggest that individual-level and population-level interventions for these leading risk factors are necessary to prevent stroke.