bluuebunny/crossref_metadata_2025_split huggingface dataset:
АКТУАЛЬНІСТЬ СИМУЛЯЦІЙНИХ МЕТОДІВ НАВЧАННЯ НА ЕТАПІ ПІСЛЯДИПЛОМНОЇ ОСВІТИ ВИПУСКНИКІВ ВИЩИХ МЕДИЧНИХ НАВЧАЛЬНИХ ЗАКЛАДІВ
Authors: Malyutina N. V. , Babak S. I. , Klymenko L. V. , Pogorila O. I. 
Published: February 2020

Згідно із сучасними світовими тенденціями та запитом вітчизняної медицини, найдоцільнішим способом оволодіння практичними навичками як студентами, починаючи з першого курсу, так і лікарями-практиками, є тренінги у симуляційних центрах.
Мета – визначення рівня компетентності випускників вищих медичних навчальних закладів щодо володіння переліком практичних навичок та умінь.
Матеріал і методи. Проведено анкетування за шкалою оцінки знань Королівського коледжу лікарів загальної практики у двох групах лікарів-інтернів першого року навчання зі спеціальності «Загальна практика – сімейна медицина» до та після практичного заняття у симуляційному центрі. До 1 групи увійшли лікарі-інтерни, які під час отримання освіти не мали практичного медичного досвіду за межами вищого навчального закладу (n=86); до 2 групи (n=16) – лікарі-інтерни, які під час навчання працювали у закладах охорони здоров’я на посадах середніх медичних працівників.
Результати. У результаті аналізу отриманих даних було встановлено, що лікарі-інтерни 1 групи оцінили свій рівень володіння практичними навичками, як такий, що потребує підвищення. Лікарі-інтерни, які під час отримання освіти у медичних вищих навчальних закладах працювали у закладах охорони здоров’я, мали достовірно вищий рівень показників володіння практичними навичками, що належать до компетенції середнього медичного персоналу.
Висновки. Тренінги щодо рівня оволодіння практичними навичками та уміннями при застосуванні симуляційних методів навчання є високоефективними, що доводять результати наших досліджень.
Simulation and Projection of Circulations Associated with Atmospheric Rivers along the North American Northeast Coast
Authors: Hsu Huang-Hsiung , Chen Ying-Ting 
Published: February 2020

AbstractTorrential rainfall occurring along the North American northeast coast (NANC) in summer and autumn is accompanied by strong atmospheric rivers (ARs), which efficiently transport abundant moisture along a narrow-stretched path associated with a low pressure system. In this study, an autodetection method was used to identify ARs that reached the NANC, based on the 6-hourly data of the ERA-Interim reanalysis conducted by the European Centre for Medium-Range Weather Forecasts, in summer and autumn from 1979 to 2016. Stronger ARs tended to occur in the eastern flank of a cyclonic anomaly that covered the entire North American east coast from Florida to Newfoundland, with a positive precipitation anomaly over the NANC. The cyclonic anomalies and precipitation in autumn were stronger but less frequent than those in summer. Cyclonic anomalies were parts of westward-tilting wavelike circulation perturbations moving into North America from the extratropical North Pacific and moving continuously eastward, reaching the east coast in approximately five days. The Geophysical Fluid Dynamics Laboratory (GFDL) High-Resolution Atmospheric Model (HiRAM), which realistically simulates the occurrence frequency and key characteristics of ARs in current climatic conditions, was used to project the AR activity and corresponding circulations in the future warmer climate under the representative concentration pathway 8.5 scenario. The HiRAM that was driven by sea surface temperature changes projected an overall increase in the occurrence of stronger ARs in both summer and autumn and the precipitation strength in autumn along the NANC by the end of the twenty-first century. This projected enhancement was contributed to by two processes—a smaller contribution was from the weakened basin-scale North Atlantic anticyclone but with higher moisture content, and a larger contribution was from the enhancement in anomalous circulation during AR events with integrated vapor transport exceeding the 75th percentile. These results suggest that the influence of strong ARs on the NANC may increase in the warmer future due to the combination of increased water vapor in the large-scale environment (thermodynamic effect) and enhanced anomalous circulations (dynamic effect). The AR-associated circulations in autumn were also projected to have a stronger tropical connection in the warmer future.
How Does the Winter Jet Stream Affect Surface Temperature, Heat Flux, and Sea Ice in the North Atlantic?
Authors: Ma Liping , Woollings Tim , Williams Richard G. , Smith Doug , Dunstone Nick 
Published: February 2020

AbstractThe role of the atmospheric jet stream in driving patterns of surface heat flux, changes in sea surface temperature, and sea ice fraction is explored for the winter North Atlantic. Seasonal time-scale ensemble hindcasts from the Met Office Hadley Centre are analyzed for each winter from 1980 to 2014, which for each year includes 40 ensemble members initialized at the start of November. The spread between ensemble members that develops during a season is interpreted to represent the ocean response to stochastic atmospheric variability. The seasonal coupling between the winter atmosphere and the ocean over much of the North Atlantic reveals anomalies in surface heat loss driving anomalies in the tendency of sea surface temperature. The atmospheric jet, defined either by its speed or latitude, strongly controls the winter pattern of air–sea latent and sensible heat flux anomalies, and subsequent sea surface temperature anomalies. On time scales of several months, the effect of jet speed is more pronounced than that of jet latitude on the surface ocean response, although the effect of jet latitude is important in altering the extent of the ocean subtropical and subpolar gyres. A strong jet or high jet latitude increases sea ice fraction over the Labrador Sea due to the enhanced transport of cold air from west Greenland, while sea ice fraction decreases along the east side of Greenland due either to warm air advection or a strong northerly wind along the east Greenland coast blowing surface ice away from the Fram Strait.
Uncertainty Propagation Using Polynomial Chaos Expansions for Extreme Sea Level Hazard Assessment: The Case of the Eastern Adriatic Meteotsunamis
Authors: Denamiel Cléa , Huan Xun , Šepić Jadranka , Vilibić Ivica 
Published: February 2020

AbstractThis study quantifies the hazard associated with extreme sea levels due to eastern Adriatic meteotsunamis—long waves generated by traveling atmospheric disturbances—and assesses the sensitivity of the ocean response to the disturbances responsible for those events. In this spirit, a surrogate model of meteotsunami maximum elevation based on generalized polynomial chaos expansion (gPCE) methods, is implemented. The approach relies on the definition of a synthetic pressure disturbance—depending on six different stochastic parameters known to be important for meteotsunami generation, which is used as forcing to produce series of meteotsunami simulations defined with sparse grid methods (up to 10 689 used in this study). The surrogate model and the sensitivity study are then obtained with a pseudo-spectral approximation (PSA) method based on the chosen meteotsunami simulations. This study mainly presents the developed methodology and discusses the feasibility of implementing such gPCE-based surrogate models to assess the hazard and to study the sensitivity of meteorologically driven extreme sea levels.
The novel potential biomarkers for multidrug-resistance tuberculosis using UPLC-Q-TOF-MS
Authors: Huang Huai , Han Yu-Shuai , Chen Jing , Shi Li-Ying , Wei Li-Liang , Jiang Ting-Ting , Yi Wen-Jing , Yu Yi , Li Zhi-Bin , Li Ji-Cheng 
Published: February 2020

The lack of rapid and efficient diagnostics impedes largely the epidemic control of multidrug-resistant tuberculosis, and might misguide the therapeutic strategies as well. This study aimed to identify novel multidrug-resistant tuberculosis biomarkers to improve the early intervention, symptomatic treatment and control of the prevalence of multidrug-resistant tuberculosis. The serum small molecule metabolites in healthy controls, patients with drug-susceptible tuberculosis, and patients with multidrug-resistant tuberculosis were screened using ultra-high-performance liquid chromatography combined with quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF-MS). The differentially abundant metabolites were filtered out through multidimensional statistical analysis and bioinformatics analysis. Compared with drug-susceptible tuberculosis patients and healthy controls, the levels of 13 metabolites in multidrug-resistant tuberculosis patients altered. Among them, the most significant changes were found in N1-Methyl-2-pyridone-5-carboxamide (N1M2P5C), 1-Myristoyl-sn-glycerol-3-phosphocholine (MG3P), Caprylic acid (CA), and D-Xylulose (DX). And a multidrug-resistant tuberculosis/drug-susceptible tuberculosis differential diagnostic model was built based on these four metabolites, achieved the accuracy, sensitivity, and specificity of 0.928, 86.7%, and 86.7%, respectively. The enrichment analysis of metabolic pathways showed that the phospholipid remodeling of cell membranes was active in multidrug-resistant tuberculosis patients. In addition, in patients with tuberculosis, the metabolites of dipalmitoyl phosphatidylcholine (DPPC), a major component of pulmonary surfactant, were down-regulated. N1M2P5C, MG3P, CA, and DX may have the potential to serve as novel multidrug-resistant tuberculosis biomarkers. This research provides a preliminary experimental basis to further investigate potential multidrug-resistant tuberculosis biomarkers. Impact statement The MDR-TB incidence remains high, making the effective control of TB epidemic yet challenging. Rapid and accurate diagnosis is vitally important for improving the therapeutic efficacy and controlling the prevalence of drug resistance TB. Metabolomics has dramatic potential to distinguish MDR-TB and DS-TB. N1M2P5C, MG3P, CA, and DX that we identified in this study might have potential as novel MDR-TB biomarkers. The phospholipid remodeling of cell membranes was highly active in MDR-TB. The DPPC metabolites in TB were significantly down-regulated. This work aimed to investigate potential MDR-TB biomarkers to enhance the clinical diagnostic efficacy. The metabolic pathway distinctly altered in MDR-TB might provide novel targets to develop new anti-TB drugs.
Vascular Neurologists’ Involvement in the Care of Medicare Patients With Ischemic Stroke
Authors: Sacchetti Daniel C. , Gupta Ajay , Chung Caroline D. , Chatterjee Abhinaba , Zhang Yi , Navi Babak B. , Segal Alan Z. , Kamel Hooman 
Published: February 2020

Background and Purpose: We sought to determine the proportion of patients with ischemic stroke evaluated by vascular neurologists in the United States. Methods: Using 2009 to 2015 claims from a 5% nationally representative sample of Medicare beneficiaries, we identified patients ≥65 years of age who were hospitalized for ischemic stroke. We ascertained the proportion of patients evaluated during the hospitalization or within 90 days of discharge by nonvascular and vascular neurologists. We assessed the relationship between county-level socioeconomic status and the likelihood of neurologist evaluation and between neurologist evaluation and diagnostic testing. Results: Among 66 989 patients with ischemic stroke, 37 820 (56.5%) were evaluated by a nonvascular neurologist and 11 700 (17.5%) by a board-certified vascular neurologist. Across increasing quartiles of county socioeconomic advantage, the proportion of patients evaluated by a vascular neurologist was 12.2%, 16.5%, 19.8%, and 23.0%. Relative to evaluation by a nonvascular neurologist, evaluation by a vascular neurologist was associated with a higher likelihood of postdischarge heart rhythm monitoring (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.6-1.9), echocardiography (OR, 1.4; 95% CI, 1.3-1.4), cervical vessel imaging (OR, 1.3; 95% CI, 1.2-1.3), and intracranial vessel imaging (OR, 2.1; 95% CI, 2.0-2.2). Conclusions: In a nationally representative cohort of Medicare beneficiaries, we found that about three quarters of patients with ischemic stroke were evaluated by a neurologist, and about one-sixth were evaluated by a vascular neurologist. Patients who were evaluated by a vascular neurologist were significantly more likely to undergo diagnostic testing.
ushr: Understanding suppression of HIV in R
Authors: Morris Sinead E , Dziobek-Garrett Luise , Yates Andrew J , collaboration with the EPIICAL Cons in 
Published: February 2020

AbstractBackgroundHIV/AIDS is responsible for the deaths of one million people every year. Although mathematical modeling has provided many insights into the dynamics of HIV infection, there is still a lack of accessible tools for researchers unfamiliar with modeling techniques to apply them to their own clinical data.ResultsHere we present , a free and open-source R package that models the decline of HIV during antiretroviral treatment (ART) using a popular mathematical framework. can be applied to longitudinal data of viral load measurements, and provides processing tools to prepare it for computational analysis. By mathematically fitting the data, important biological parameters can then be estimated, including the lifespans of short and long-lived infected cells, and the time to reach viral suppression below a defined detection threshold. The package also provides visualization and summary tools for fast assessment of model results.Conclusionsenables researchers without a strong mathematical or computational background to model the dynamics of HIV using longitudinal clinical data. Increasing accessibility to such methods may facilitate quantitative analysis across a broader range of independent studies, so that greater insights on HIV infection and treatment dynamics may be gained.
Association between cumulative social risk, particulate matter environmental pollutant exposure, and cardiovascular disease risk
Authors: Canterbury Ann , Echouffo-Tcheugui Justin B. , Shpilsky Daniel , Aiyer Aryan , Reis Steven E. , Erqou Sebhat 
Published: February 2020

Abstract
Background
Long-term exposure to pollution has been shown to increase risk of cardiovascular disease (CVD) and mortality, and may contribute to the increased risk of CVD among individuals with higher social risk.

Methods
Data from the community-based Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to quantify Cumulative Social Risk (CSR) by assigning a score of 1 for the presence of each of 4 social risk factors: racial minority, single living, low income, and low educational status. 1-year average air pollution exposure to PM2.5 was estimated using land-use regression models. Associations with clinical outcomes were assessed using Cox models, adjusting for traditional CVD risk factors. The primary clinical outcome was combined all-cause mortality and nonfatal CVD events.

Results
Data were available on 1933 participants (mean age 59 years, 66% female, 44% Black). In a median follow up time of 8.3 years, 137 primary clinical outcome events occurred. PM2.5 exposure increased with higher CSR score. PM2.5 was independently associated with clinical outcome (adjusted hazard ratio [HR]: 1.19 [95% CI: 1.00, 1.41]). Participants with ≥2 CSR factors had an adjusted HR of 2.34 (1.48–3.68) compared to those with CSR = 0. The association was attenuated after accounting for PM2.5 (HR: 2.16; [1.34, 3.49]). Mediation analyses indicate that PM2.5 explained 13% of the risk of clinical outcome in individuals with CSR score ≥ 2.

Conclusion
In a community-based cohort study, we found that the association of increasing CSR with higher CVD and mortality risks is partially accounted for by exposure to PM2.5 environmental pollutants.
Longitudinal study of the relationship between patients’ medication adherence and quality of life outcomes and illness perceptions and beliefs about cardiac rehabilitation
Authors: Thomson Patricia , Rushworth Gordon F. , Andreis Federico , Angus Neil J. , Mohan Andrea R. , Leslie Stephen J. 
Published: February 2020

Abstract
Background
Adherence to medication regimens is essential for preventing and reducing adverse outcomes among patients with coronary artery disease (CAD). Greater understanding of the relation between negative illness perceptions, beliefs about cardiac rehabilitation (CR) and medication adherence may help inform future approaches to improving medication adherence and quality of life (QoL) outcomes. The aims of the study are: 1) to compare changes in illness perceptions, beliefs about CR, medication adherence and QoL on entry to a CR programme and 6 months later; 2) to examine associations between patients’ illness perceptions and beliefs about CR at baseline and medication adherence and QoL at 6 months.

Methods
A longitudinal study of 40 patients with CAD recruited from one CR service in Scotland. Patients completed the Medication Adherence Report Scale, Brief Illness Perception Questionnaire, Beliefs about CR questionnaire and the Short-Form 12 Health Survey. Data were analysed using the Wilcoxon Signed Ranks test, Pearson Product Moment correlation and Bayesian multiple logistic regression.

Results
Most patients were men (70%), aged 62.3 mean (SD 7.84) years. Small improvements in ‘perceived suitability’ of CR at baseline increased the odds of being fully adherent to medication by approximately 60% at 6 months. Being fully adherent at baseline increased the odds of staying so at 6 months by 13.5 times. ‘Perceived necessity, concerns for exercise and practical barriers’ were negatively associated with reductions in the probability of full medication adherence of 50, 10, and 50%. Small increases in concerns about exercise decreased the odds of better physical health at 6 months by about 50%; and increases in practical barriers decreased the odds of better physical health by about 60%. Patients perceived fewer consequences of their cardiac disease at 6 months.

Conclusions
Patients’ beliefs on entry to a CR programme are especially important to medication adherence at 6 months. Negative beliefs about CR should be identified early in CR to counteract any negative effects on QoL. Interventions to improve medication adherence and QoL outcomes should focus on improving patients’ negative beliefs about CR and increasing understanding of the role of medication adherence in preventing a future cardiac event.
Perspectives of general practitioners and nursing staff on acute hospital transfers of nursing home residents in Germany: results of two cross-sectional studies
Authors: Fassmer Alexander Maximilian , Pulst Alexandra , Spreckelsen Ove , Hoffmann Falk 
Published: February 2020

Abstract
Background
Visits in emergency departments and hospital admissions are common among nursing home (NH) residents and they are associated with significant complications. Many of these transfers are considered inappropriate. This study aimed to compare the perceptions of general practitioners (GPs) and NH staff on hospital transfers among residents and to illustrate measures for improvement.

Methods
Two cross-sectional studies were conducted as surveys among 1121 GPs in the German federal states Bremen and Lower Saxony and staff from 1069 NHs (preferably nursing staff managers) from all over Germany, each randomly selected. Questionnaires were sent in August 2018 and January 2019, respectively. The answers were compared between GPs and NH staff using descriptive statistics, Mann-Whitney U tests and χ2-tests.

Results
We received 375 GP questionnaires (response: 34%) and 486 NH questionnaires (response: 45%). GPs estimated the proportion of inappropriate transfers higher than NH staff (hospital admissions: 35.0% vs. 25.6%, p < 0.0001; emergency department visits: 39.9% vs. 20.9%, p < 0.0001). The majority of NH staff and nearly half of the GPs agreed that NH residents do often not benefit from hospital admissions (NHs: 61.4% vs. GPs: 48.8%; p = 0.0009). Both groups rated almost all potential measures for improvement differently (p < 0.0001), however, GPs and NH staff considered most areas to reduce hospital transfers importantly. The two most important measures for GPs were more nursing staff (91.6%) and better communication between nursing staff and GP (90.9%). NH staff considered better care / availability of GP (82.8%) and medical specialists (81.3%) as most important. Both groups rated similarly the importance of explicit advance directives (GPs: 77.2%, NHs: 72.4%; p = 0.1492).

Conclusions
A substantial proportion of hospital transfers from NHs were considered inappropriate. Partly, the ratings of possible areas for improvement differed between GPs and NH staff indicating that both groups seem to pass the responsibility to each other. These findings, however, support the need for interprofessional collaboration.
Validity of self-reported and objectively measured sedentary behavior in pregnancy
Authors: Barone Gibbs Bethany , Paley Joshua L. , Jones Melissa A. , Whitaker Kara M. , Connolly Christopher P. , Catov Janet M. 
Published: February 2020

Abstract
Background
Sedentary behavior (SED) is a potential risk factor for poor pregnancy outcomes. We evaluated the validity of several common and one new method to assess SED across three trimesters of pregnancy.

Methods
This cohort study of pregnant women measured objective and self-reported SED each trimester via thigh-worn activPAL3 micro (criterion), waist-worn Actigraph GT3X, and self-report from the Pregnancy Physical Activity Questionnaire (PPAQ) and the de novo Sedentary Behavior Two Domain Questionnaire (SB2D). SED (hours per day) and percent time in SED (SED%) from activPAL were compared to GT3X, SB2D, and PPAQ using Pearson’s r, ICC, Bland-Altman analysis, and comparison of criterion SED and SED% across tertiles of alternative methods.

Results
Fifty-eight women (mean age 31.5 ± 4.8 years; pre-pregnancy BMI 25.1 ± 5.6 kg/m2; 76% white) provided three trimesters of valid activPAL data. Compared to activPAL, GT3X had agreement ranging from r = 0.54–0.66 and ICC = 0.52–0.65. Bland-Altman plots revealed small mean differences and unpatterned errors, but wide limits of agreement (greater than ±2 h and ± 15%). The SB2D and PPAQ had r < 0.5 and ICC < 0.3 vs. activPAL SED, with lower agreement during the 2nd and 3rd trimesters, and performed poorly in Bland-Altman analyses. SED% from the modified SB2D performed best of the self-reported instruments with modest mean differences, r ranging from 0.55 to 0.60, and ICCs from 0.31–0.33; though, limits of agreement were greater than ±35%. Significant trends in activPAL SED were observed across increasing tertiles of SB2D SED in the 1st and 3rd trimesters (both p ≤ 0.001), but not the 2nd trimester (p = 0.425); and for PPAQ SED in the 1st and 2nd trimesters (both p < 0.05), but not the 3rd trimester (p = 0.158). AcitvPAL SED and SED% increased significantly across tertiles of GT3X SED and SED% as well as SB2D SED% (all p-for-trend ≤ 0.001).

Conclusions
Compared to activPAL, waist-worn GT3X produced moderate agreement, though similar mean estimates of SED across pregnancy. Self-report questionnaires had large absolute error and wide limits of agreement for SED hr./day; SB2D measurement of SED% was the best self-report method. These data suggest activPAL be used to measure SED when possible, followed by GT3X, and – when necessary – SB2D assessing SED% in pregnancy.

Trial registration
www.clinicaltrials.govNCT03084302 on 3/20/2017.