bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determining the Optimal Age for Extracranial-Intracranial Bypass Surgery: A Post Hoc Analysis of the CMOSS Randomized Trial
Authors: Li Xin , Li Yaowei , Wang Tao , Sun Xinyi , Lu Guangdong , Xu Xinjuan , Yang Renjie , Luo Jichang , Bai Xuesong , Tong Xiaoguang , Gu Yuxiang , Wang Jiyue , Tong Zhiyong , Wang Yufeng , Cai Yiling , Ren Jun , Wang Donghai , Duan Lian , Maimaitili Aisha , Hang Chunhua , Yu Jiasheng , Chen Tong , Ma Yan , Jiao Liqun ,   for the CMOSS Investigators
Published: December 2024

BACKGROUND:
Previous trials have failed to demonstrate the benefits of extracranial-intracranial (EC-IC) bypass surgery for patients with carotid or middle cerebral artery occlusion. However, little evidence has focused on the effect of age on prognosis. This study aimed to explore whether EC-IC bypass surgery can provide greater benefits than medical therapy alone in specific age groups.

METHODS:
A post hoc analysis was performed of the CMOSS (Carotid or Middle Cerebral Artery Occlusion Surgery Study), which was a randomized, open-label, outcome assessor-blinded trial conducted at 13 centers in China between June 2013 and March 2018. A total of 324 patients with internal carotid artery or middle cerebral artery occlusion with transient ischemic attack or nondisabling ischemic stroke attributed to hemodynamic insufficiency were randomized into a surgical group (n=161) that underwent EC-IC bypass surgery with medical therapy, and a medical group (n=163) that received antiplatelet therapy and stroke risk factor control alone. The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days up to 2 years after randomization. Receiver operating characteristic curves were drawn to explore the optimal age boundary, and survival analyses were used to explore differences between groups.

RESULTS:

Among the 324 patients (median age, 52.7 years; 79.3% men), an age cutoff of 55.5 years predicted the primary outcome in the surgical group (area under the curve, 0.649 [95% CI, 0.530–0.769]). Patients were further divided into an older group (>55.5 years) and a younger group (≤55.5 years). Younger patients who underwent bypass surgery showed a lower risk of the primary outcome (log-rank
P
=0.001) than older patients. Patients who underwent EC-IC bypass surgery had a lower risk than patients with medical therapy alone in the younger group (3.2% versus 11.6%; hazard ratio, 0.255 [95% CI, 0.071–0.916];
P
=0.036), but not in the older group (17.5% versus 13.3%; adjusted hazard ratio, 0.597 [95% CI, 0.225–1.580];
P
=0.298).

CONCLUSIONS:
In patients aged 55.5 years or younger with symptomatic atherosclerotic occlusion of the internal carotid artery or middle cerebral artery and hemodynamic insufficiency, the addition of EC-IC bypass surgery to medical therapy significantly improved prognosis. These findings suggest that the clinical application of EC-IC bypass surgery needs more research to explore refined patient selection criteria incorporating more clinical features.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01758614.
Do Fire Weather Conditions Significantly Affect Wildfires in Subtropical Forests in Taiwan?
Authors: Yu Hong-Wen , Wang S.-Y. Simon , Liu Wan-Yu 
Published: December 2024

Abstract
The previous establishment of Taiwan’s Forest Fire Danger Rating Warning System in 2002 relied solely on ground-based fuel aridity considerations, leaving a gap between fire weather information and fire detection. In view of the warming climate and the increasing trend in wildfire frequency, this study analyzes meteorological conditions that promote wildfire occurrence using modern atmospheric reanalysis and satellite data. Correlation coefficient matrix and generalized additive models (GAMs) were constructed to investigate the associations between the interannual variance of wildfire occurrence during regional fire seasons over a 58-yr period (1964–2021) and various fire-related indices, including meteorological conditions, vegetation, soil moisture, and collective indicators represented by the fire weather index (FWI). The study finds that precipitation and humidity, rather than temperature, are the primary climatic drivers of increased wildfire risk in Taiwan. Specifically, prolonged droughts during the summer and fall enhance fuel aridity, deplete groundwater, and deteriorate vegetation, subsequently increasing wildfire probability. Furthermore, a significant inverse relationship between southwestern wildfires and antecedent groundwater 12 months prior suggests that fuel flammability and availability preceding drought events compound the likelihood of widespread wildfires. This study highlights a robust tendency toward increased wildfires in response to drought starting almost a year before, suggesting the feasibility of seasonal prediction application.

Significance Statement
This study revealed a robust relationship between fire weather conditions and historical wildfire occurrences in Taiwan, the first such finding for its subtropical forests. The importance of considering the drought severity for effective wildfire management was emphasized.
Convectively Coupled Global Rossby Modes in an Idealized Moist GCM
Authors: MacDonald Cameron G. , Zurita-Gotor Pablo , Held Isaac M. , Ming Yi 
Published: December 2024

Abstract
The westward-propagating convectively coupled equatorial wave (CCEW) variability produced by an idealized general circulation model (GCM) is investigated. The model is a zonally symmetric aquaplanet with a slab ocean. Water vapor in the model may condense and produce latent heating, but there is no parameterization of cloud processes, only a quasi-equilibrium convection scheme. The CCEWs produced by the model are found to be sensitive to the heat capacity of the slab and the strength of surface friction. In spectral space, the westward-propagating precipitation variability in the model is dominated by sharp peaks in spectral power at zonal wavenumbers 5 and 6. These precipitation peaks are situated along the dispersion curve of the Rossby–Haurwitz waves, suggesting a connection between the global Rossby modes and precipitation variability. Composites of these disturbances reveal global circulation patterns that extend into the midlatitudes. The moisture variance budget of these disturbances shows that moisture advection by the global Rossby modes maintains the accompanying moisture signal. This is interpreted as downgradient advection of the background moisture gradient of the intertropical convergence zone. The locations of the precipitation peaks are sensitive to Doppler shifting by the zonal winds; when this Doppler shift becomes too weak, the frequencies of the global Rossby modes become too high to effectively couple to convection. A linearized primitive equation model shows that the presence of vertical shear in the background zonal winds is vital for producing a forced response that resembles the modes produced by the GCM. The forced response of the linear model is optimally located to enhance the original circulation of the global mode.
Buoyancy Flux and Mixing Efficiency from Direct, Near-Bottom Turbulence Measurements in a Submarine Canyon
Authors: Alford Matthew H. , Wynne-Cattanach Bethan , Le Boyer Arnaud , Couto Nicole , Voet Gunnar , Spingys Carl P. , Fernandez Castro Bieito , Forryan Alex , Naveira Garabato Alberto C. , van Haren Hans 
Published: December 2024

Abstract
Turbulent kinetic energy and thermal variance dissipation rates ϵ and χ, buoyancy flux Jb, diffusivity κρ, and mixing coefficient , which is simply related to the mixing efficiency , are estimated from highly resolved microstructure measurements collected in a submarine canyon that has been previously shown to be experiencing near-bottom diapycnal upwelling. It is demonstrated that turbulence arises primarily from the convective instability of the internal tide. Twelve tidally resolving stations (12–48 h long) were conducted, wherein profiles were collected from between 5–15 m and 400 m above the bottom every 13–15 min using a custom turbulence vehicle. Turbulent buoyancy flux is estimated using the Osborn and Winters and D’Asaro methods, allowing direct estimation of the mixing coefficient as a function of time, temperature, and height above bottom. Turbulent dissipation and buoyancy flux generally increase toward the seafloor. The associated turbulent diapycnal diffusivity is 10−4–10−2 m2 s−1. Observed is ∼0.2 ± 0.05 near the top of our measurement range, as expected in the ocean interior, and increases to 0.3–0.7 approaching the bottom, consistent with turbulence generated by convective instability.

Significance Statement
We report detailed direct turbulence measurements very close to the seafloor in a submarine canyon that are well resolved enough in time to confidently understand the processes responsible for the turbulence. We compute the fraction of turbulent power that goes toward mixing, which is an important quantity to understand the role of turbulence in supporting the ocean’s large-scale circulation.
Functional Septorhinoplasty in Unilateral and Bilateral Nasal Obstruction: A Comparison of Patient-Reported Outcomes
Authors: Randall Nicholas R. , Barrett Dane M. , Frank-Ito Dennis O. , Ji Keven Seung Yong , Hoang Thien , Wang Tom D. , Loyo Myriam 
Published: December 2024

Purpose: Functional septorhinoplasty is an effective treatment for nasal airway obstruction. Little distinction exists between bilaterally and unilaterally obstructed patients in literature. Our study evaluates outcomes in patients with unilateral nasal airway obstruction compared to those with bilateral nasal airway obstruction as measured by nasal obstruction symptom evaluation scores following functional septorhinoplasty. Materials and Methods: A total of 227 patients underwent functional septorhinoplasty for nasal airway obstruction. Patients were grouped into unilateral (n = 64) and bilateral (n = 163) nasal obstruction cohorts based on patient report and physician assessment. Nasal obstruction symptom evaluation (NOSE) scores were obtained pre-operatively and post-operatively at least 3 months following surgery. Results: Patients with unilateral nasal obstruction had slightly less severe symptoms preoperatively than patients with bilateral obstruction. Average preoperative NOSE scores for patients with unilateral obstruction was 64 (SD = 19) and 72 (SD = 18) for patients with bilateral obstruction ( P = .004). Postoperative NOSE scores following septorhinoplasty were significantly reduced for patients with both unilateral and bilateral nasal obstruction (postoperative NOSE scores unilateral: 17, SD = 16 ; bilateral: 23, SD = 21). There was no statistical significance in outcomes between patients with unilateral or bilateral nasal obstruction groups. Conclusions: Symptoms in patients with unilateral obstruction are similar but slightly less severe than patients with bilateral obstruction. Patients with unilateral and bilateral nasal obstruction experienced a similar degree of improvement in symptom following functional septorhinoplasty.
Prevalence of cardiovascular instability during hemodialysis therapy in hospitalized patients: A systematic review and meta-analysis
Authors: Arcentales-Vera Karla , Vera-Mendoza María Fernanda , Cevallos-Salas Cristian , García-Aguilera María Fernanda , Fuenmayor-González Luis 
Published: December 2024

Background Intradialytic hypotension (IDH) is a common and serious complication in renal replacement therapy, especially in hospitalized patients. The absence of a standardized definition complicates data synthesis and the development of evidence-based guidelines. Current definitions vary, including different blood pressure thresholds, clinical symptoms, and the need for medical intervention during dialysis. IDH is linked to increased mortality and cardiovascular morbidity and may impede renal recovery in patients with acute kidney injury and chronic kidney disease. Methods A systematic review was conducted using MEDLINE via PubMed, Embase, and Web of Science to identify studies reporting IDH prevalence. A meta-analysis of proportions was performed to determine the global prevalence of IDH, with subgroup analyses to explore heterogeneity. The Joanna Briggs Institute's checklist was used to assess the risk of bias in prevalence studies. The PRISMA guidelines were followed to report the results of this study, PROSPERO registration number CRD42024500622. Results The meta-analysis found a global IDH prevalence of 31% (95% CI 0.18–0.44) across nine studies. Significant heterogeneity was observed (I²: 97.87%; p < 0.01), with prevalence rates ranging from 10.7% to 64% based on patient demographics and session characteristics. Sensitivity analysis suggested prevalence could range between 27% and 33% depending on study criteria. Conclusions IDH is a significant complication during hospital-based renal replacement therapy, with a global prevalence of 31%. These findings highlight the need for a standardized, evidence-based definition of IDH to improve diagnostic consistency and clinical outcomes through more accurate diagnosis, better treatment strategies, and tailored patient management.
“A Little Too Helicoptery”: Reconciling Parental Involvement During Autistic Students’ Transitions into College
Authors: Nachman Brett Ranon 
Published: December 2024

Background: Parents have long held an important role in their autistic children’s lives. As autistic individuals enroll in higher education institutions at much higher rates, new issues emerge. In particular, autistic college students and their parents must reconcile the major transition with the extent to which parents must be involved and exert their influence. Purpose/Objective/Research Question/Focus of Study: This phenomenological study set in a community college aimed to answer this question: How do autistic students, their parents, and college staff make meaning of parental involvement during autistic students’ transitions into postsecondary education? Parental involvement is of great relevance not only to autism-specific college support programs, such as the one featured in this study that helps students and parents negotiate these relationships, but also to colleges writ large. To disentangle the nuanced elements of parental involvement, I incorporated interdependence theory that explores the impacts of each stakeholder group’s outcomes on one another. Uncovering these dynamics may help in identifying realistic solutions that honor stakeholders’ various priorities and allow autistic students to leverage greater agency in their college journeys. Research Design: This study was set in a community college boasting an autism-specific college support program featuring programming to support autistic learners in their college experiences, inclusive of issues around independence and advocacy. Employing a descriptive phenomenological approach allowed for deconstructing the nuanced interactions among parents, adult autistic children navigating college, and college staff. Here parental involvement served as the phenomenon of focus. Participants included 13 autistic college students, 5 mothers, and 15 college staff. Students engaged in surveys, interviews, observations, and written reflections, whereas mothers and college staff participated in interviews. Conclusions/Recommendations: Parents and their children—autistic college students—must constantly re-evaluate and recalibrate their relationships as students gradually gain more independence. This study illuminates how institutional supports and stakeholders, including those associated with the autism-specific college support program, enable autistic college students to demonstrate growth in their agency. This study puts forward many recommendations for varied stakeholders, including, but not limited to, elevating self-advocacy training in forming students’ transition plans (high school personnel) and engaging in role-playing activities (parents and children). Regarding future research, takeaways call for longitudinal work to track autistic students’ distinct presentations of independence over time, as well as embedding journals or other reflective materials for parents to make sense of their communication patterns with their children.
Optimization of dynamic multi-leaf collimator based on multi-objective particle swarm optimization algorithm
Authors: Lv Jun , Chen Liuli , Zhu Zhiqiang , Long Pengcheng , Hu Liqin ,   FDS Consortium
Published: December 2024

Background The dynamic multi-leaf collimator (DMLC) plays a crucial role in shaping X-rays, significantly enhancing the precision, efficiency, and quality of tumor radiotherapy. Objective To improve the shaping effect of X-rays by optimizing the end structure of the DMLC leaf, which significantly impacts the collimator's performance. Methods This study introduces the innovative application of the multi-objective particle swarm optimization (MOPSO) algorithm to optimize DMLC parameters, including leaf end radius, source-to-leaf distance, leaf height, and tangent angle between the leaf end and the central axis. The main optimization objectives are to minimize the width and variance of the penumbra, defined as the distance between the 80% and 20% dose of X-rays on the isocenter plane, which directly impacts treatment accuracy. Results Structural optimization across various scenarios showed significant improvements in the size and uniformity of the penumbra, ensuring a more precise radiation dose. Based on the optimized structure, a three-dimensional model of the MLC was designed and an experimental prototype was fabricated for performance testing. The results indicate that the optimized MLC exhibits a smaller penumbra. Conclusion The proposed optimization method significantly enhances the precision of radiotherapy while minimizing radiation exposure to healthy tissue, representing a notable advancement in radiotherapy technology.
Teenage mothers’ perspectives, knowledge, and attitudes toward pregnancy and the utilization of sexual and reproductive health services in the Eastern Province of Rwanda
Authors: Nshutiyukuri Claudine , Uwingabire Fauste , Musabwasoni Marie Grace Sandra , Rutayisire Jean Bosco , Rutayisire Reverien , Kaberuka Gerard , Ishimwe Bazakare Laetitia , Benimana Immaculée , Mutabazi Leon , Mukeshimana Madeleine 
Published: December 2024

Background: Adolescents worldwide engage in sexual activity, with the proportion rising gradually from the middle to late stages of adolescence. The incidence of early sexual initiation among female youth in sub-Saharan Africa is reported to be 46%. The increasing number of teenage pregnancies in Rwanda indicates that adolescents do not correctly use sexual and reproductive health services. In 2019, the Eastern Province of Rwanda documented 36% of all teenage pregnancies. Despite the availability of these services to youth through adolescent sexual and reproductive health (ASRH) focal persons, nurses, or midwives leading youth corners at the Health Center level, why they are not used remains unknown. Objectives: To explore teenage mothers’ perspectives, knowledge, and attitudes toward pregnancy and the utilization of sexual and reproductive health services in the Eastern Province of Rwanda. Design: Qualitative descriptive study. Methods: A qualitative descriptive design combined with the theory of reasoned action was used to capture teenagers’ unique perspectives on knowledge about teenage pregnancy and attitudes toward ASRH service utilization. An in-depth interview was used to collect data from 25 informants across 3 districts in the Eastern Province of Rwanda, followed by traditional content analysis. Results: Three major themes emerged, including lack of knowledge about teenage pregnancy, unfavorable attitudes toward ASRH service utilization, and the perceived negative impact of teenage pregnancy, including disrupting education, limiting career opportunities, and posing health risks to both mothers and infants. Conclusion: While all young mothers were under pressure from the multitude of impacts of teenage pregnancy, parenthood, and social responsibilities, they had limited knowledge and selective utilization of ASRH services, mimicking potential gaps in education and mobilization of youth on available ASRH services with special emphasis on preventive components. Exploring the perceived enablers and challenges facing ASRH service utilization among the study population is necessary.
The effectiveness of weighted blankets on sleep quality in intensive care unit patients: A prospective randomised controlled trial
Authors: Hasegawa Takayuki , Yoshida Keisuke , Hakozaki Takahiro , Inoue Satoki 
Published: December 2024

Background: Sleep deprivation is frequently observed among critically ill patients, and sleep aids still lack robust evidence of efficacy. Thus, the present randomised controlled study aimed to investigate the effectiveness of weighted blankets as non-pharmacological sleep aids for patients in the intensive care unit. Methods: Patients scheduled to be admitted to the intensive care unit after elective hepatobiliary-pancreatic surgery were randomly assigned to one of two groups: a weighted blanket group or a normal blanket group. Sleep quality was evaluated using the Japanese version of the Richards-Campbell Sleep Questionnaire. Results: A total of 50 patients were included in this study: 25 in the weighted blanket group and 25 in the normal blanket group. There were no significant differences between the two groups regarding the average total score of Japanese version of the Richards-Campbell Sleep Questionnaire: 46 [interquartile range = 30–70] versus 56 [36–70] ( p = 0.62). All five domains of Japanese version of the Richards-Campbell Sleep Questionnaire also showed no significant difference between the two groups. Conclusion: The results of this study did not show an improvement in the Japanese version of the Richards-Campbell Sleep Questionnaire scores in intensive care unit patients following major abdominal surgery with the use of weighted blankets, indicating a lack of efficacy as a sleep aid for acute sleep deprivation.
Declining trends in the incidence of Parkinson's disease: A cohort study in Germany
Authors: Fink Anne , Pavlou Maria Angeliki S , Roomp Kirsten , Schneider Jochen G 
Published: December 2024

Background Epidemiologic evidence from different countries shows both increasing and decreasing incidence rates of Parkinson's disease over time without clear trends. Objective We aimed to investigate age-specific incidence rates of Parkinson's disease and possible explanations for the observed trends in Germany over a 10-year period. Methods Two different random samples of subjects aged ≥50 years included in 2004–2009 and 2014–2019, each consisting of 250,000 individuals, were drawn from Germany's largest health care insurance company followed up for new Parkinson's disease cases. We compared the age-specific incidence rates of Parkinson's disease for both cohorts and performed Cox regression models to calculate the hazard ratios (HR) of PD in the second period compared with the first period, adjusted for age, sex, and risk factors for Parkinson's disease. Results For most age groups in men and in women, we found lower age-specific Parkinson's disease incidence rates in the second period. Cox regression analysis showed an overall 18% risk reduction in Parkinson's disease incidence (HR = 0.82, 95% confidence interval [0.76–0.89]). Mean age at diagnosis increased in men (+1.9 years) and women (+0.8 years). After adjustment for risk factors, the HR was 0.78 [0.72–0.85]. Sensitivity analysis considering the competing event of death showed an HR of 0.79 [0.73–0.86]), demonstrating the independence of time trends from changes in death rates. Conclusions Our data show that the risk of Parkinson's disease has decreased over time and that this decrease is independent of factors such as changes in death rates, age structure, sex, and specific risk factors.