bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lack of July effect in the utilization of neuraxial and peripheral nerve block in US teaching hospitals: a retrospective analysis
Authors: Kim Sang Jo , Wilson Lauren , Liu Jiabin , Kim David H , Fiasconaro Megan , Poeran Jashvant , Freeman Carrie , Beathe Jonathan , Memtsoudis Stavros 
Published: March 2020

BackgroundGiven the steep learning curve for neuraxial and peripheral nerve blocks, utilization of general anesthesia may increase as new house staff begin their residency programs. We sought to determine whether “July effect” affects the utilization of neuraxial anesthesia, peripheral nerve blocks, and opioid prescribing for lower extremity total joint arthroplasties (TJA) in July compared with June in teaching and non-teaching hospitals.MethodsNeuraxial anesthesia, peripheral nerve block use, and opioid prescribing trends were assessed using the Premier database (2006–2016). Analyses were conducted separately for teaching and non-teaching hospitals. Differences in proportions were evaluated via χ2test, while differences in opioid prescribing were analyzed via Wilcoxon rank-sum tests.ResultsA total of 1 723 256 TJA procedures were identified. The overall proportion of neuraxial anesthesia use in teaching hospitals was 14.4% in both June and July (p=0.940). No significant changes in neuraxial use were seen in non-teaching hospitals (24.5% vs 24.9%; p=0.052). Peripheral nerve block utilization rates did not differ in both teaching (15.4% vs 15.3%; p=0.714) and non-teaching hospitals (10.7% vs 10.5%; p=0.323). Overall median opioid prescribing at teaching hospitals changed modestly from 262.5 oral morphine equivalents (OME) in June to 260 in July (p=0.026) while median opioid prescribing remained at a constant value of 255 OME at non-teaching hospitals (p=0.893).ConclusionUtilization of neuraxial and regional anesthesia techniques was not affected during the initial transition period of new house staff in US teaching institutions. It is feasible that enough resources are available in the system to accommodate periods of turnover and maintain levels of regional anesthetic care including additional attending anesthesiologist oversight.
Spectral action approach to higher derivative gravity
Authors: Mistry Ravi , Pinzul Aleksandr , Rachwał Lesław 
Published: March 2020

AbstractWe study the spectral action approach to higher derivative gravity. The work focuses on the classical aspects. We derive the complete and simplified form of the purely gravitational action up to the 6-derivative terms. We also derive the equivalent forms of the action, which might prove useful in different applications, namely Riemann– and Weyl–dominated representations. The spectral action provides a rather rigid structure of the higher derivative part of the theory. We discuss the possible consequences of this rigidness. As one of the applications, we check whether the conformal backgrounds are preferred in some way on the classical level, with the conclusion that at this level, there is no obvious reason for such a preference, the space $$S^1 \times S^3$$S1×S3 studied in earlier works being a special case. Some other possible properties of the higher derivative gravity given by the spectral action are briefly discussed.
Design of Micro Robot for Minimally Invasive Surgery
Authors: Ganesh A Deiva 
Published: March 2020

<p>Micro robots for medical applications need to be compatible with human body, remotely controllable, smooth in movement, less painful to the patients and capable of performing the designated functions. In this paper, state of the art in the design, fabrication and control of micro robots are presented. First the benefits of micro robots in medical applications are listed out. Second, the predominantly used micro robot designs are discussed. Third, the various fabrication process used in micro robot construction are presented. Fourth, the different approaches used for its operation and control in micro robot technology are narrated. Next based on the review we have designed a swimming micro robot driven by external magnetic fields for minimally invasive surgery. The advantage of EMA is that it can generate a wireless driving force. Then, the locomotive mechanism of the micro robot using EMA is presented. Using the EMA system setup various experiments have been conducted. Finally, the performance of the swimming micro robot is evaluated.</p> <p><strong> </strong></p> <p><strong> </strong></p> <p><strong></strong></p> <p> </p>
Evaluating Implementations of the Immersed Boundary Method in the Weather Research and Forecasting Model
Authors: Arthur Robert S. , Lundquist Katherine A. , Wiersema David J. , Bao Jingyi , Chow Fotini K. 
Published: March 2020

AbstractThe terrain-following coordinate system used by many atmospheric models can cause numerical instabilities due to discretization errors as resolved terrain slopes increase and the grid becomes highly skewed. The immersed boundary (IB) method, which does not require the grid to conform to the terrain, has been shown to alleviate these errors, and has been used successfully for high-resolution atmospheric simulations over steep terrain, including vertical building surfaces. Since many previous applications of IB methods to atmospheric models have used very fine grid resolution (5 m or less), the present study seeks to evaluate IB method performance over a range of grid resolutions and aspect ratios. Two classes of IB algorithms, velocity reconstruction and shear stress reconstruction, are tested within the common framework of the Weather Research and Forecasting (WRF) Model. Performance is evaluated in two test cases, one with flat terrain and the other with the topography of Askervein Hill, both under neutrally stratified conditions. WRF-IB results are compared to similarity theory, observations, and native WRF results. Despite sensitivity to the location at which the IB intersects the model grid, the velocity reconstruction IB method shows consistent performance when used with a hybrid RANS/LES surface scheme. The shear stress reconstruction IB method is not sensitive to the grid intersection, but is less consistent and near-surface velocity errors can occur at coarse resolutions. This study represents an initial investigation of IB method variability across grid resolutions in WRF. Future work will focus on improving IB method performance at intermediate to coarse resolutions.
Subseasonal Predictions of Tropical Cyclone Occurrence and ACE in the S2S Dataset
Authors: Lee Chia-Ying , Camargo Suzana J. , Vitart Fréderic , Sobel Adam H. , Camp Joanne , Wang Shuguang , Tippett Michael K. , Yang Qidong 
Published: March 2020

Abstract
Probabilistic tropical cyclone (TC) occurrence, at lead times of week 1–4, in the Subseasonal to Seasonal (S2S) dataset are examined here. Forecasts are defined over 15° in latitude × 20° in longitude regions, and the prediction skill is measured using the Brier skill score with reference to climatological reference forecasts. Two types of reference forecasts are used: a seasonally constant one and a seasonally varying one, with the latter used for forecasts of anomalies from the seasonal climatology. Models from the European Centre for Medium-Range Weather Forecasts (ECMWF), Australian Bureau of Meteorology, and Météo-France/Centre National de Recherche Météorologiques have skill in predicting TC occurrence four weeks in advance. In contrast, only the ECMWF model is skillful in predicting the anomaly of TC occurrence beyond one week. Errors in genesis prediction largely limit models’ skill in predicting TC occurrence. Three calibration techniques, removing the mean genesis and occurrence forecast biases, and a linear regression method, are explored here. The linear regression method performs the best and guarantees a higher skill score when applied to the in-sample dataset. However, when applied to the out-of-sample data, especially in areas where the TC sample size is small, it may reduce the models’ prediction skill. Generally speaking, the S2S models are more skillful in predicting TC occurrence during favorable Madden–Julian oscillation phases. Last, we also report accumulated cyclone energy predictions skill using the ranked probability skill score.
Oxytocin and vasopressin modulation of prisoner’s dilemma strategies
Authors: Neto Maria Leonor , Antunes Marília , Lopes Manuel , Ferreira Duarte , Rilling James , Prata Diana 
Published: March 2020

Background: The neuropeptides oxytocin and vasopressin have been repeatedly implicated in social decision making by enhancing social salience and, generally, cooperation. The iterated and sequential version of the prisoner’s dilemma (PD) game is a social dilemma paradigm eliciting strategies of cooperation versus competition. Aims: We aimed to characterise the role of PD players’ sex, game partner type (computer vs. human) and oxytocin or vasopressin inhalation on the player’s strategy preference. Methods: Participants (153 men; 151 women) were randomised to intranasal 24 IU oxytocin, 20 IU vasopressin or placebo, double-blind, and played the PD. We examined main and interactive effects of sex, drug and partner type on strategy preference. Results: We found a pervasive preference for a tit-for-tat strategy (i.e. general sensitivity to the partner’s choices) over unconditional cooperation, particularly when against a human rather than a computer partner. Oxytocin doubled this sensitivity in women (i.e. the preference for tit-for-tat over unconditional cooperation strategies) when playing against computers, which suggests a tendency to anthropomorphise them, and doubled women’s unconditional cooperation preference when playing against humans. Vasopressin doubled sensitivity to the partner’s previous choices (i.e. for tit-for-tat over unconditional cooperation) across sexes and partner types. Conclusions: These findings suggest that women may be more sensitive to oxytocin’s social effects of anthropomorphism of non-humans and of unconditional cooperation with humans, which may be consistent with evolutionary pressures for maternal care, and that vasopressin, irrespective of sex and partner type, may be generally sensitising humans to others’ behaviour.
Arthroscopic Versus Open Broström-Gould Repair for Chronic Ankle Instability
Authors: Woo Bo Jun , Lai Mun Chun , Koo Kevin 
Published: March 2020

Background: The open Broström-Gould procedure for the repair of lateral ankle ligament remains the gold standard in operative management of chronic ankle instability. Nevertheless, the arthroscopic technique has been gaining attention among foot and ankle surgeons in the past decade. Our study aimed to compare the clinical outcomes of patients who underwent the arthroscopic and open Brostom-Gould technique over a 12-month follow-up period. Methods: We retrospectively reviewed the database in a tertiary hospital foot and ankle registry from 2015 to 2019. We then performed a 1:1 matching of 26 ankles that underwent the arthroscopic Broström-Gould technique to 26 ankles with the open technique, all performed by a fellowship-trained foot and ankle surgeon, for age, sex, and body mass index. To assess clinical outcomes, visual analog scale scores, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scores, and Short Form 36 Health Survey scores were collected at the preoperative and 6- and 12-month follow-up visits, respectively. Results: The arthroscopic group demonstrated significantly less pain in the perioperative period (arthroscopic, 1.0 ± 1.2; open, 2.4 ± 2.2; P = .015) and had higher AOFAS scores at 6 months (arthroscopic, 87.2 ± 11.1; open, 73.5 ± 21.9; P = .028) and 12 months (arthroscopic, 94.2 ± 10.0; open, 70.9 ± 33.1; P = .020). No complications were reported in either group. Twenty patients (76.9%) in the arthroscopic group had preoperative intra-articular abnormalities compared with 24 patients (92.3%) in the open group. Conclusion: The arthroscopic Broström-Gould technique produced better clinical outcomes than the open technique at 12 months of follow-up. Level of Evidence: Level III, retrospective comparative series.
Uni-hemispheric hyperperfusion in the early postictal state: case report
Authors: Velasco Gonzalez A. , Schülke C. , Buerke B. 
Published: March 2020

Abstract
Background
In the emergency setting of acute ischemic stroke, seizures have been reported in up to 4% of patients. In the absence of arterial occlusion, seizures may also cause abnormalities in CT perfusion in 78% of cases when the time window from onset to imaging is short. Both hyperperfusion and hypoperfusion in the postictal state have been described. Also, though rarely reported, postictal perfusion changes can be uni-hemispheric. In these cases, perfusion maps should be analyzed thoroughly, since perfusion reconstruction software relies heavily on a “normal” contralateral perfusion status.

Case presentation
A 39-year-old man was found on the ground with a minor head injury. On admission, his reactions were generally slow, but there were no other neurological symptoms, and blood pressure was low. The patient had a history of primary generalized epilepsy and admitted to dropping off his anti-epileptic medication. He was transferred to the radiological department for imaging but shortly before began to experience generalized onset tonic-clonic seizures which were brought under control by intravenous therapy with 10 mg diazepam. After approximately 15 min, a multimodal CT scan was performed, revealing marked changes in the perfusion of the brain hemispheres and posterior fossa, with sharp delimitation at the midline. Blood gas analysis was congruent with respiratory acidosis. Clinically, the patient remained awake without developing any new symptoms. He gradually recovered over the following 3 h and, against our medical recommendation, discharged himself from the hospital.

Conclusions
To the authors’ knowledge, this is the first report of an early postictal state describing sharply delimited uni-hemispheric hyperperfusion and hemispheric alteration of the cerebellum with an equally split rhombencephalon. Surprisingly, these changes were not associated with any focal neurological signs. To prevent misdiagnosis of perfusion alterations in seizures, radiologists and neurologists should be aware of the limitations of CT perfusion maps and software reconstructions. Novel use of CT perfusion reconstruction using peak enhancement helped in identifying the cerebral pathology.
Peters plus syndrome and Chorioretinal findings associated with B3GLCT gene mutation - a case report
Authors: Wang Ye Elaine , Ramirez Dhariana Acon , Chang Ta Chen , Berrocal Audina 
Published: March 2020

Abstract
Background
Peters plus syndrome (PPS) is a combination of congenital Peters anomaly and systemic abnormalities. It is inherited most commonly in an autosomal recessive pattern with homozygous B3GLCT mutations. Ocular findings consist predominantly anterior segment abnormalities without posterior segment involvement.

Case presentation
In this presentation, we report a case of PPS with homozygous pathogenic variant in B3GLCT who presented with classic anterior segment findings, systemic abnormalities, as well as atypical bilateral chorioretinal atrophy. The chorioretinal findings were characterized with spectral-domain optical coherence tomography.

Conclusions
Our report expands the phenotypic descriptions of PPS by characterizing posterior segment findings.
An analysis of clinical risk factors for adolescent scoliosis caused by spinal cord abnormalities in China: proposal for a selective whole-spine MRI examination scheme
Authors: Xu Wei , Zhang Xiangyang , Zhu Ying , Zhu Xiaodong , Li Zhikun , Li Dachuan , Jia Jianjun , Chen Liwei , Wang Silian , Bai Yushu , Li Ming 
Published: March 2020

Abstract
Background
Approximately 80% of adolescent scoliosis cases are idiopathic, and some non-idiopathic scoliosis cases caused by spinal cord abnormalities are misdiagnosed as idiopathic scoliosis. This study examined the risk factors for non-idiopathic scoliosis with intramedullary abnormalities, explored the feasibility of whole-spine MRI, and provided a theoretical basis for the routine diagnosis and treatment of adolescent idiopathic scoliosis.

Method
The clinical data of adolescent scoliosis patients who were admitted to Shanghai Tongren Hospital and Shanghai Changhai Hospital between July 1, 2013, and December 31, 2018, were reviewed. According to the whole-spine MRI results, the patients were divided into either the idiopathic group or the intramedullary abnormality group. Sex, age, main curvature angle, main curvature direction, kyphosis angle, scoliosis type, coronal plane balance, sagittal plane balance, abdominal wall reflex, sensory abnormality, ankle clonus and tendon reflexes were compared between the two groups. Student’s t test was used to evaluate the differences in the continuous variables, and the chi-square test was used to evaluate the differences in the categorical variables. Fisher’s exact test was applied to detect the difference in the rate of intraspinal anomalies between the groups. Logistic regression was used to evaluate the correlation between the multivariate risk factors and intramedullary abnormalities.

Result
A total of 714 adolescent scoliosis patients with a mean age of 13.5 (10–18 years) were included in the study, and intramedullary abnormalities were found in 68 (9.5%) patients. There were statistically significant differences in the incidence rates of intramedullary abnormalities between males and females, left and right thoracic curvatures, angular scoliosis and smooth scoliosis, and abnormal abdominal wall reflex and ankle clonus (P < 0.01). Logistic regression showed that the ratios for sex, scoliosis direction, scoliosis type, abdominal wall reflex and ankle clonus were 2.987, 3.493, 4.823, 3.94 and 8.083, respectively. The ROC curve showed a sensitivity of 66.18% and a specificity of 89.01%, and the Youden index corresponding to the optimal critical point was 0.5519.

Conclusion
Risk factors associated with adolescent scoliosis caused by abnormal intramedullary abnormalities included male sex, thoracic scoliosis on the left side, sharp curvature of the spine, abnormal abdominal wall reflex and ankle clonus. In adolescent scoliosis patients, the incidence of scoliosis caused by intramedullary abnormalities was approximately 9.5%. These clinical indicators suggest that there is a high-risk adolescent scoliosis population who should undergo whole-spinal MRI preoperatively to rule out intramedullary abnormalities.
A patient with 46,XY/47,XYY karyotype and female phenotype: a case report
Authors: Liu Zhi-Hui , Zhou Shi-Chao , Du Jun-Wen , Zhang Kun , Wu Tao 
Published: March 2020

Abstract
Background
47,XYY is a chromosomal abnormality syndrome that is typically observed in patients with a male phenotype. Few patients with XYY syndrome will have infertility. We here report a case of 46,XY/47,XYY syndrome diagnosed in a patient with a female phenotype.

Case presentation
A 15-year-old patient with a female phenotype visited our hospital owing to a chief complaint of short stature as of the age of 6 years. She was diagnosed with dwarf syndrome at the age of 10, but no change was noted after 2 months of growth hormone treatment. The patient’s height was 136 cm and the weight was 29 kg, both of which were below the third percentile for her age/gender. In addition to short stature, the 4th and 5th metacarpals were short and there was no significant sex development. Karyotype analysis showed 47,XYY, and chromosomal microarray examination showed a chimera of 46,XY/47,XYY.

Conclusion
This is an extremely rare case of 47,XYY abnormality in a patient with a female phenotype, with only one such known case reported previously. Since the cause is unknown, and symptoms of this syndrome are highly atypical and variable in childhood, clinicians should be aware of this possibility to avoid misdiagnosis and offer counseling and hormone therapy as needed to patients and their parents to improve their quality of life.
Using a Facebook group to facilitate faculty-student interactions during preclinical medical education: a retrospective survey analysis
Authors: Henry David S. , Wessinger William D. , Meena Nikhil K. , Payakachat Nalin , Gardner Jerad M. , Rhee Sung W. 
Published: March 2020

Abstract
Background
Strong learner-teacher relationships are associated with more successful learning outcomes. With shortened modular curricula and increased availability of online resources, fostering faculty interaction with preclinical medical students has become more challenging. We sought to enhance learner-teacher relationships by engaging in discussion with preclinical medical students in their own online space.

Methods
We utilized a closed Facebook discussion group, where faculty and students voluntarily joined in informal discussions and shared announcements related to their courses. The closed discussion group allowed only participating students and faculty to see others’ posts within the group. This provided a platform to freely interact within the confines of the group while maintaining privacy for the personal Facebook accounts of both faculty and students. We utilized the discussion group through three separate organ system-based modules for 14 weeks. Afterward, students were asked to complete an anonymous, voluntary online survey about their experience.

Results
94.1% (160/170) of enrolled second-year medical students joined the voluntary FB discussion group. There were 214 posts, 628 comments, and 4166 reactions in this discussion group during the three modules. Of the students in the group, 74.4% (119/160) responded to the online survey. Overall, students strongly agreed that the Facebook discussion group fostered better rapport with faculty, helped content learning, and improved emotional well-being. Also, they felt more comfortable seeking academic help after using the discussion group. They reported a slight preference for Facebook over email as a medium for asking questions, but no preference for either as a medium for distributing announcements. Students overwhelmingly recommended that the discussion group should be continued in future years.

Conclusion
The Facebook discussion group was a free, efficient, and effective method of cultivating the learner-teacher relationship with the preclinical medical students, resulting in reported enhancement of learning and morale.