bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Atazanavir‐Induced Hyperbilirubinemia and Cardiovascular Disease in Patients Infected with HIV
Authors: Li Michael , Chan Walter W. , Zucker Stephen D. 
Published: September 2020

BACKGROUND:
Serum bilirubin is inversely associated with cardiovascular risk. Atazanavir, an HIV protease inhibitor that competitively inhibits bilirubin conjugation, provides a unique opportunity to examine whether selectively increasing bilirubin is cardioprotective. We sought to determine whether patients receiving atazanavir manifest a reduced risk of cardiovascular disease compared with those receiving darunavir, an HIV protease inhibitor that does not increase serum bilirubin.

METHODS AND RESULTS:

This was a retrospective cohort study of 1020 patients with HIV. The main outcome was time to myocardial infarction or ischemic stroke. Mean follow‐up was 6.6±3.4 years, with 516 receiving atazanavir and 504 darunavir. Atazanavir patients exhibited significantly higher serum total bilirubin (1.7 versus 0.4 mg/dL;
P
<0.001) and longer mean time to ischemic event (10.2 versus 9.4 years;
P
<0.001). On Cox regression, atazanavir treatment (hazard ratio [HR], 0.38; 95% CI, 0.21–0.71;
P
=0.002) and serum bilirubin (HR, 0.60; 95% CI, 0.41–0.89;
P
=0.011) were independently associated with a lower risk of an ischemic event. Notably, when atazanavir and bilirubin were included together in the Cox regression model, atazanavir lost significance (HR, 0.55; 95% CI, 0.24–1.29;
P
=0.169) consistent with bilirubin being an intermediate variable on the causal pathway between atazanavir and its effect on cardiovascular disease. Patients on atazanavir also had a significantly lower risk of developing new cardiovascular disease (HR, 0.53; 95% CI, 0.33–0.86;
P
=0.010) and longer mean time to death (12.2 versus 10.8 years;
P
<0.001).

CONCLUSIONS:
Patients with HIV on atazanavir manifest a decreased risk of cardiovascular disease when compared with those on darunavir, an effect that appears to be mediated by serum bilirubin.
A Climatology of Atmospheric Rivers and Associated Precipitation for the Seven U.S. National Climate Assessment Regions
Authors: Slinskey Emily A. , Loikith Paul C. , Waliser Duane E. , Guan Bin , Martin Andrew 
Published: September 2020

AbstractAtmospheric rivers (ARs) are long, narrow filamentary regions of enhanced vertically integrated water vapor transport (IVT) that play an important role in regional water supply and hydrometeorological extremes. Here, an AR detection algorithm is applied to global reanalysis from Modern-Era Retrospective Analysis for Research and Applications, version 2 (MERRA-2), to objectively and consistently characterize ARs regionally across the continental United States (CONUS). The characteristics of AR and associated precipitation are computed at the gridpoint scale and summarized over the seven U.S. National Climate Assessment regions. ARs are most frequent in the autumn and winter in the West, spring in the Great Plains, and autumn in the Midwest and Northeast. ARs show regional and seasonal variability in basic geometry and IVT. AR IVT composites reveal annually consistent northeastward-directed moisture transport from the Pacific Ocean in the West, whereas moisture transport patterns vary seasonally across the Southern Great Plains and Midwest. Linked AR precipitation characteristics suggest that a substantial proportion of extreme events, defined as the top 5% of 3-day precipitation totals, are associated with ARs over many parts of CONUS, including the East. Regional patterns of AR-associated precipitation highlight that seasonally varying moisture transport and lifting mechanisms differ between the East and the West where orographic lifting is key. Our study aims to contribute a comprehensive and consistent CONUS-wide, regional-scale analysis of ARs in support of ongoing NCA efforts. Given the CONUS-wide role ARs play in extreme precipitation, findings motivate continued study of associated climate change impacts.
Warm Spiral Streamers over Gulf Stream Warm-Core Rings
Authors: Zhang Weifeng , McGillicuddy Dennis J. 
Published: September 2020

AbstractThis study examines the generation of warm spiral structures (referred to as spiral streamers here) over Gulf Stream warm-core rings. Satellite sea surface temperature imagery shows spiral streamers forming after warmer water from the Gulf Stream or newly formed warm-core rings impinges onto old warm-core rings and then intrudes into the old rings. Field measurements in April 2018 capture the vertical structure of a warm spiral streamer as a shallow lens of low-density water winding over an old ring. Observations also show subduction on both sides of the spiral streamer, which carries surface waters downward. Idealized numerical model simulations initialized with observed water-mass densities reproduce spiral streamers over warm-core rings and reveal that their formation is a nonlinear submesoscale process forced by mesoscale dynamics. The negative density anomaly of the intruding water causes a density front at the interface between the intruding water and surface ring water, which, through thermal wind balance, drives a local anticyclonic flow. The pressure gradient and momentum advection of the local interfacial flow push the intruding water toward the ring center. The large-scale anticyclonic flow of the ring and the radial motion of the intruding water together form the spiral streamer. The observed subduction on both sides of the spiral streamer is part of the secondary cross-streamer circulation resulting from frontogenesis on the stretching streamer edges. The surface divergence of the secondary circulation pushes the side edges of the streamer away from each other, widens the warm spiral on the surface, and thus enhances its surface signal.
Toward the Standardization of Mesoscale Meteorological Networks
Authors: Fiebrich Christopher A. , Brinson Kevin R. , Mahmood Rezaul , Foster Stuart A. , Schargorodski Megan , Edwards Nathan L. , Redmond Christopher A. , Atkins Jennie R. , Andresen Jeffrey A. , Lin Xiaomao 
Published: September 2020

AbstractAlthough they share many common qualities in design and operation, mesonetworks across the United States were established independently and organically over the last several decades. In numerous instances, the unique ways each network matured and developed new protocols has led to important lessons learned. These experiences have been shared in informal ways among various network operators over the years to promote reliable operation. As existing networks begin to introduce new sensors and technologies, and as new networks come online, there is a common need for guidance on best practices. This paper aims to formally provide recommendations to improve and harmonize the various aspects of operating a “mesonet,” including siting, sensors, maintenance, quality assurance, and data processing.
Spontaneous Chest Wall Herniation in Centrally Obese Patients: A Single-Center Experience of a Rare Problem
Authors: Sinopoli Jillian , Strong Andrew , Kroh Matthew , Allemang Matthew , Raymond Daniel P. 
Published: September 2020

Background Spontaneous rib fractures, especially in association with chest wall herniation, represent an uncommon pathology. As such, there are little data analyzing approaches to treatment or regarding the success of intervention. The goal of this study was to analyze our cumulative experience with this unusual condition. Methods A case series of 12 patients was gathered from a single institution based on outpatient visits between February 2015 and October 2018. Each chart was retrospectively reviewed with particular attention to age, gender, BMI, area of injury, and smoking history. Patients presented with complaints of dyspnea or pain related to rib fractures with or without intercostal neuralgia. Each of these patients was noted to have rib fractures with lung herniation either on imaging, outside hospital records, or physical exam. A thorough medical history was obtained with attempts to find common predisposing factors as well as data regarding any previous surgical intervention for their herniation. Results Nine of the 12 patients reviewed had recent or prior surgical intervention. Every patient seen in the clinic with a spontaneous fracture and herniation incidentally had a BMI >30 and was therefore classified as obese. Additionally, every patient who had a recurrence after their first surgical attempt at repair had a BMI greater than or equal to 35. All 12 patients seen at our institution were males. The failure rate of operative intervention was 66%. Conclusions Obesity was a prevalent comorbidity in the patient population we reviewed. Given the role obesity plays in abdominal and hiatal hernia repair success rates, it should be considered that obesity is a significant contributor to chest wall herniation if rib fractures occur. With 66% chest wall repair failure, patient selection is critical in the success of surgical intervention. Perhaps additional patient optimization, especially weight loss, should be considered prior to surgery.
Laparoscopic Ladd Procedure for Malrotation in Newborns and Infants
Authors: da Costa Karina M. , Saxena Amulya K. 
Published: September 2020

Background Laparoscopic approach for malrotation has become more popular for neonates and in cases with volvulus, but its safety and efficacy remains controversial. This study reviewed laparoscopy outcomes in neonate/infant malrotation. Methods Medline/PubMed and Lilacs databases were reviewed. Data from studies published in English/Spanish between 1995 and 2019 were collected. Results are presented as percentages and means/medians; logistic regression was used to study possible associations. Results Nineteen papers offered 99 neonates/infants with median age and weight of 10.5 days and 3.5 kg, respectively. Ladd’s procedure was performed in 95 (96%) patients and bands’ division in 4 (4%); appendectomy was not included in 16 (16.2%) patients, and cecopexy was not performed in all cases. Volvulus was reported in 39 (39.4%) patients. There were 11 conversions (11.1%) and 10 recurrences of symptoms (10.1%) that required reintervention. An association was found between volvulus and recurrence ( P = .05) and the need for conversion ( P < .01). There were 10 (10.1%) minor complications and no mortality. The median follow-up was 10 months. Discussion Laparoscopic approach to malrotation is feasible and safe in hemodynamically stable neonates/infants without intestinal necrosis and is associated with 11% conversion rate and 10% reinterventions. The presence of volvulus is associated with recurrence and conversion. Laparoscopic Ladd’s procedure with appendectomy and without cecopexy is the commonly practiced approach that is associated with minor complications.
Systematic Review of Second Primary Oropharyngeal Cancers in Patients With p16+ Oropharyngeal Cancer
Authors: Bollig Craig A. , Lee David S. , Mazul Angela L. , Stepan Katelyn , Puram Sidharth V. , Massa Sean T. , Zenga Joseph , Faden Daniel L. , Doering Michelle M. , Jackson Ryan S. , Pipkorn Patrik 
Published: September 2020

ObjectiveTo systematically review the literature to determine the prevalence and clinical outcomes of second primary oropharyngeal squamous cell carcinoma (OPSCC).Data SourcesSearch strategies created with a medical librarian were implemented using multiple databases in October 2019.Review MethodsThe population of interest included adults age >18 years with a p16+ or human papillomavirus‐positive OPSCC. The outcome was a synchronous or metachronous second primary OPSCC. Inclusion and exclusion criteria were designed to capture all study designs. In total, 685 records were identified by the search strategy. Two reviewers independently performed the review, extracted data, and performed a quality assessment. Primary Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed. A random‐effects model was used for the meta‐analysis.ResultsA total of 2470 patients with 35 second primary OPSCCs from 15 studies were identified. The pooled prevalence of second primary OPSCC was 1.4% (range, 0%‐14.3%). In the random‐effects model, the prevalence was estimated at 1.3% (95% CI, 0.7%‐2.3%; P =. 51, I2 = 52%). Of the 30 patients with treatment information, 26 (86.7%) received surgical treatment, while 4 (13.3%) underwent nonsurgical therapy. Of the 29 patients with available survival information, 22 (75.9%) had no evidence of disease at last follow‐up, 5 (17.2%) ultimately died of disease, and 2 (6.9%) were alive with disease.ConclusionOverall, the rate of second primary OPSCC in patients with an index p16+ OPSCC is low, and most patients are successfully treated. Insufficient evidence currently exists to recommend routine elective tonsillectomy during surgical treatment of p16+ OPSCC.
Racial and Insurance Inequalities in Access to Early Pediatric Cochlear Implantation
Authors: Liu Xinliang , Rosa‐Lugo Linda I. , Cosby Janel L. , Pritchett Cedric V. 
Published: September 2020

ObjectiveTo evaluate the association between race/ethnicity and insurance status on the access to early cochlear implantation.Study DesignPopulation‐based retrospective analysis of pediatric cochlear implantation procedures.SettingState Ambulatory Surgery and Services Databases of Florida from 2005 to 2017.MethodsAll children aged 18 years or younger in the state of Florida undergoing cochlear implantation were identified. The outcome measures were access to early cochlear implantation (before 1 and 2 years of age). Descriptive and multivariate logistic regression analyses were conducted.ResultsAmong 1511 pediatric cochlear implantation procedures with complete data, 65 (4.3%) procedures were performed by 1 year of age and 348 (23.0%) by 2 years of age. Black children (odds ratio [OR], 0.44; 95% CI, 0.28‐0.70), Hispanic children (OR, 0.70; 95% CI, 0.52‐0.94), and children with Medicaid (OR, 0.64; 95% CI, 0.48‐0.84) were significantly less likely to be implanted before 2 years of age. Even when insured by private insurance, black and Hispanic children were still less likely to be implanted before 2 years of age compared to white children with private insurance. Greater racial and insurance disparities existed in access to cochlear implantation before 1 year of age compared to implantation before 2 years of age.ConclusionRacial/ethnic and insurance disparities in pediatric cochlear implantation can be observed at the population level. To address these racial and insurance inequalities, a multidisciplinary care team is needed and priorities should be given to research endeavors and policy interventions that target these disparities.
Are family carers part of the care team providing end-of-life care? A qualitative interview study on the collaboration between family and professional carers
Authors: Vermorgen Maarten , Vandenbogaerde Isabel , Van Audenhove Chantal , Hudson Peter , Deliens Luc , Cohen Joachim , De Vleminck Aline 
Published: September 2020

Background: The attention of healthcare professionals is directed mainly towards the recipients of care and often insufficiently towards family carers. However, an effective collaboration between professionals and family carers is vital to provide quality palliative and end-of-life care. Such collaboration is under-studied in a palliative care context. Aim: This study aimed to investigate how family carers of people who live at home with a life-limiting chronic illness experience and perceive collaboration with different healthcare professionals in the last phase of life. Design: Face-to-face semi-structured interviews were conducted with the primary family carers of people with a life-limiting chronic illness. Interpretative phenomenological analysis was used to analyse the data. Setting/participants: A heterogeneous sample of 30 family carers of people with cancer, heart failure or dementia was recruited through a variety of care providers and services, in order to reflect the heterogeneity of caregiving in serious illness. Results: Five main themes emerged from interpretative phenomenological analysis that describe the quality of the collaboration between family carers and professionals: respecting family carers both as someone with care needs and as a member of the care team; the continuous availability and accessibility of healthcare professionals; the provision of information and communication including family carer issues; the coordination of care between all parties and contextual factors. The dominant experience by family carers was one of missed opportunities across these themes. Conclusions: This qualitative study about the experiences and perceptions of family carers of people with a chronic life-limiting illness living at home regarding the collaboration with different healthcare providers in the last phase life, showed that family carers experience a lot of possibilities, but perceive missed opportunities as well, for healthcare professionals to effectively collaborate with them for palliative care.
Network Autocorrelation of Perceived Physical Activity Skill Competence Among Adolescents at a Summer Care Program: A Pilot Study
Authors: Prochnow Tyler , Patterson Megan S. , Bridges Hamilton Christina N. , Delgado Haley , Craig Sam , Umstattd Meyer M. Renee 
Published: September 2020

Purpose: This study investigates the possible association between adolescent friendship networks and perceived physical activity skill competence in a summer care program. Design: Adolescents participated in researcher-administered surveys at the start (T1) and end (T2) of summer. Setting: Adolescents at a Boys & Girls Club were sampled. Sample: Adolescents (age 8-12) completed researcher-administered surveys at T1 (n = 100; µ age = 9.9 years; 47% male; 55% Black) and T2 (n = 77; µ age = 9.8 years; 51% male; 49% Black). Measures: Perceived skill competence was measured by asking adolescents to rate how good they felt they were at physical activity at the club. Adolescents were also asked to provide names of up to 5 peers whom they hung around with, talked to, and did things with the most while at the club. Analysis: Linear network autocorrelation models were used to determine network effects or clustering of perceived physical activity skill competence within the club. Results: There were significant network effects for adolescent perceived skill competency scores at T1 (β = 0.05, p < 0.01) and T2 (β = 0.05, p = 0.02), indicating adolescent perceived skill competence scores were associated with those of their friends. Conclusions: Practitioners may wish to encourage the use of group or collaborative skill competency improvement activities as well as possibly pairing adolescents with differing skill competencies to foster improvement and possible diffusion of perceived skill competency.
Hand-Print CARE: Towards Ethics-led Action Learning for ESD in School Subject Disciplines
Authors: O’Donoghue Rob , Henze Christa , Shimray Chong , Sarabhai Kartikeya V. , Rivera Juan Carlos A. Sandoval 
Published: September 2020

The Hand-Print concept emerged as a proposition for learner-led action learning in the Centre for Environment Education, Ahmedabad, Gujarat, India. Hand-Print CARE as an ethics-led action learning proposition was developed at a Local Culture for Understanding Mathematics and Science (LOCUMS) research group meeting with some educators in Alta, Norway. Here ‘CARE’ emerged as an acronym reflecting an ethic of inclusive respect through Concern for others, being Attentive to needs, showing Respect for each other and being Engaged in learning actions for the common good. Hand-Print CARE was thus activated as a co-engaged mediation process towards ‘Learning to look after others to best care for ourselves and the surroundings we all share’. Conceptual tools towards a Hand-Print CARE rationale were clarified in subsequent ESD workshops in Malaysia and Mexico and the challenge of developing a schema for ESD in school subject disciplines emerged at an ESD training workshop with National Council for Education Research and Training (NCERT) in Delhi, India. This article explores the emergence of Hand-Print CARE and the framing of an open-ended schema for mediating better-situated and ethics-led action learning in school subject disciplines. A formative perspective towards more locally situated and co-engaged processes for mediating learning was refined through an ESD Expert-Net collaboration to clarify ESD learning progressions in school subject disciplines. Some start-up materials were developed with partnering NGOs in the small town of Howick in KwaZulu-Natal, South Africa, and in an expanding collaboration involving partners in India, Mexico, Germany and South Africa. Each of us worked to refine Hand-Print CARE learning progressions for ESD processes of action learning in diverse subject discipline and school-in-community settings.
A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Lung Transplant
Authors: Moraes Josiane Luzia Sibioni , Oliveira Ramon Antonio , Samano Marcos Naoyuki , Poveda Vanessa de Brito 
Published: September 2020

Background: Surgical site infections (SSIs) are among the leading health care–associated infections as well as a major problem in the postoperative period of lung transplant recipients. Little is known about the risk factors in this specific population. The objective of this study was to identify the incidence, risk factors, and outcomes of SSI following lung transplant. Methods: Digital medical records of adult recipients subjected to lung transplant from July 2011 and June 2016 in a large Brazilian referral teaching public center were analyzed in this retrospective cohort follow-up. Results: Among the 121 recipients analyzed, 19 (15.7%) had SSI; of these, 11 (57.8%) had superficial incisional infections, 1 (5.2%) had a deep incisional infection, and 7 (36.8%) had organ/space infection. Recipient-related risk factors for SSI were high body mass index ( P = .041), prolonged surgery time ( P = .043), and prolonged duration of chest drain placement ( P = .009). At the multiple logistic regression was found that each hour elapsed in the surgical time increased the odds of SSI by around 2 times (odds ratio 2.34; 95% CI, 1.46-4.53; P = .002). Donor-related risk factors included smoking status ( P = .05) and positive bronchoalveolar lavage ( P < .001). Having an SSI was associated with an increased length of stay in intensive care units ( P = .003), reoperation ( P = .014), and a higher 1-year mortality rate ( P = .02). Conclusions: The identified incidence rate was higher to that observed in the previous studies. The risk factors duration of chest tube placement and donor smoking status are different from those reported in the scientific literature.