bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lime Burning as a Religious Metaphor in Buddhist India
Authors: Hanneder Jürgen 
Published: April 2021

Abstract
The Buddhist author Ravigupta compares the destruction of afflictions, thought to come about through jñāna and samādhi, to a “sudhopala”, a limestone thrown into water for the production of quicklime. The article explores the realia and Sanskrit terminology behind the image and its intertextual ramifications.
A new genus and two new species of Tarsonemidae (Acari: Heterostigmata) associated with bark beetles (Coleoptera: Curculionidae: Scolytinae) from Peru
Authors: KHAUSTOV ALEXANDER A. , PETROV ALEXANDER V. , KOLESNIKOV VASILIY B. 
Published: April 2021

A new genus and species, Unguitarsonemus paradoxus n. gen., n. sp. and a new species, Pseudotarsonemoides peruviensis n. sp. (Acari: Trombidiformes: Tarsonemidae), are described based on phoretic females collected on bark beetles Phloeotribus pilula and Ph. biguttatus, respectively, from Peru. A key to species of the genus Pseudotarsonemoides is provided.
Lightning Occurrence and Casualties in U.S. National Parks
Authors: Holle Ronald L. , Brooks William A. , Cummins Kenneth L. 
Published: April 2021

AbstractNational park visitors travel primarily to view natural features while outdoors; however, visits often occur in warmer months when lightning is present. This study uses cloud-to-ground flashes from 1999 to 2018 and cloud-to-ground strokes from 2009 to 2018 from the National Lightning Detection Network to identify lightning at the 46 contiguous United States national parks larger than 100 km2. The largest density is 6.10 flashes per kilometer squared per year within Florida’s Everglades, and the smallest is near zero in Pinnacles National Park. The six most-visited parks are Great Smoky Mountains, Grand Canyon, Rocky Mountain, Zion, Yosemite, and Yellowstone. For each of these parks, lightning data are described by frequency and location as well as time of year and day. The four parks west of the Continental Divide have most lightning from 1 July to 15 September and from 1100 to 1900 LST. Each park has its own spatial lightning pattern that is dependent on local topography. Deaths and injuries from lightning within national parks have the same summer afternoon dominance shown by lightning data. Most casualties occur to people visiting from outside the parks’ states. The most common activities and locations are mountain climbing, hiking, and viewing canyons from overlooks. Lightning fatality risk, the product of areal visitor and CG flash densities, shows that many casualties are not in parks with high risk, while very small risk indicates parks where lightning awareness efforts can be minimized. As a result, safety advice should focus on specific locations such as canyon rims, mountains, and exposed high-altitude roads where lightning-vulnerable activities are engaged in by many visitors.
Transoral Laser-Assisted Diverticulectomy: Swallow Study Results after Complete Endoscopic Pouch Excision for Zenker’s Diverticulum
Authors: McMillan Ryan A. , Bowen Andrew J. , Wells Michael L. , Ekbom Dale C. 
Published: April 2021

Objective: Transoral endoscopic laser-assisted diverticulotomy (TELD) with diverticulectomy and diverticuloplasty (TELD + DD) for the management of Zenker’s diverticulum (ZD) has been utilized by our institution since 2016 in attempts to reduce residual pouch size. This technique involves complete endoscopic pouch excision with partial advancement of mucosal flaps. Our study compares the subjective outcomes, objective outcomes, and complication rates between TELD and TELD + DD. Methods: A retrospective cohort study was performed on patients who underwent TELD or TELD + DD by a single surgeon at a tertiary academic center (2013-2019). Videofluoroscopic swallow studies (VFSS) with esophagram, Eating Assessment Tool (EAT-10), Reflux Symptom Index (RSI), and Functional Outcome Swallowing Scale (FOSS) were collected at preoperative and 3 month follow-up visits. A single blinded reviewer recorded height, width, and depth of pre and postoperative pouches with volumetric analysis performed assuming an ellipsoid shape. Comorbidities, complications, postoperative course, and recurrence were recorded. Results: Of the 75 patients that met criteria, 27 underwent TELD + DD and 48 underwent TELD. Eighteen TELD + DD and 37 TELD had both pre and post-operative VFSS. TELD + DD and TELD had a 96 ± 7% and 87 ± 16% reduction in pouch volume, respectively ( t-test; P = .01). Complications (TELD + DD 7%, TELD 17%, fisher’s exact; P = .31) and final subjective outcomes after adjusting for initial were not significantly different between methods (EAT-10 with TELD + DD ∆ + 1.3, P = .18; RSI ∆ + 1.4, P = .29; FOSS ∆-0.02, P = .91). One short-term recurrence was reported with TELD. Conclusion: Use of TELD + DD is associated with a statistically significantly decreased residual pouch size with no significant difference in short-term subjective outcomes. Complication rates and short-term recurrence rates are comparable. Long-term recurrence rates will require further studies to characterize. Level of Evidence: Level 3.
Concordance between adolescents and parents on the Strengths and Difficulties Questionnaire: Analysis of an Australian nationally representative sample
Authors: Gray Emma J , Scott James G , Lawrence David M , Thomas Hannah J 
Published: April 2021

Objective: Differences between adolescent self-reported and parent-reported emotional and behavioural difficulties may influence psychiatric epidemiological research. This study examined concordance between adolescents and their parents about mental health symptoms using the Strengths and Difficulties Questionnaire. Methods: The study comprised a randomly selected, nationally representative sample of adolescents aged 11–17 years who participated in the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing ( N = 2967). Matched adolescent and parent responses across the five Strengths and Difficulties Questionnaire subscales (emotional problems, hyperactivity, peer problems, conduct problems and prosocial behaviour), as well as total difficulties and total impact scores were examined to estimate concordance. Concordance patterns were analysed by sex, after stratifying the sample by age group (younger adolescents: 11–14 years; older adolescents: 15–17 years). Results: Concordance was 86.7% for total difficulties, 77.5% for total impact and ranged from 82.4% to 94.3% across the five Strengths and Difficulties Questionnaire subscales. There were no differences in concordance between sexes on the total difficulties score. Older females were more likely to disagree with their parents about emotional problems compared to males of the same age. Younger males were more likely to disagree with their parents compared to same-aged females about peer problems, hyperactivity, conduct problems and prosocial skills, as well as the impact of their problems. Older males were more likely to disagree with their parents about their prosocial skills compared to older females. Conclusion: Overall, concordance between adolescents and parents on the Strengths and Difficulties Questionnaire was largely driven by the high proportion of respondents who reported having no problems. Discordance on a subscale increased as the prevalence of problems in a sex and age demographic subgroup increased. These findings highlight the need for a multi-informant approach to detect emotional and behavioural difficulties in adolescents, particularly when assessing the impact of symptoms, as this subscale had the lowest concordance.
Feasibility of ultrashort echo time (UTE) T2* cartilage mapping in the hip: a pilot study
Authors: Wong Tony T , Quarterman Patrick , Lynch Thomas S , Rasiej Michael J , Jaramillo Diego , Jambawalikar Sachin R 
Published: April 2021

Background Ultrashort echo time (UTE) T2* is sensitive to molecular changes within the deep calcified layer of cartilage. Feasibility of its use in the hip needs to be established to determine suitability for clinical use. Purpose To establish feasibility of UTE T2* cartilage mapping in the hip and determine if differences in regional values exist. Material and Methods MRI scans with UTE T2* cartilage maps were prospectively acquired on eight hips. Hip cartilage was segmented into whole and deep layers in anterosuperior, superior, and posterosuperior regions. Quantitative UTE T2* maps were analyzed (independent one-way ANOVA) and reliability was calculated (ICC). Results UTE T2* mean values (anterosuperior, superior, posterosuperior): full femoral layer (19.55, 18.43, 16.84 ms) ( P=0.004), full acetabular layer (19.37, 17.50, 16.73 ms) ( P=0.013), deep femoral layer (18.68, 17.90, 15.74 ms) ( P=0.010), and deep acetabular layer (17.81, 16.18, 15.31 ms) ( P=0.007). Values were higher in anterosuperior compared to posterosuperior regions (mean difference; 95% confidence interval [CI]): full femur layer (2.71 ms; 95% CI 0.91–4.51: P=0.003), deep femur layer (2.94 ms; 95% CI 0.69–5.19; P=0.009), full acetabular layer (2.63 ms 95% CI 0.55–4.72; P=0.012), and deep acetabular layer (2.50 ms; 95% CI 0.69–4.30; P=0.006). Intra-reader (ICC 0.89–0.99) and inter-reader reliability (ICC 0.63–0.96) were good to excellent for the majority of cartilage layers. Conclusion UTE T2* cartilage mapping was feasible in the hip with mean values in the range of 16.84–19.55 ms in the femur and 16.73–19.37 ms in the acetabulum. Significantly higher values were present in the anterosuperior region compared to the posterosuperior region.
Role of HEART score in evaluating clinical outcomes among emergency department patients with different ethnicities
Authors: Meyering Stefan H. , Schrader Chet D. , Kumar Darren , Zhou Yuan , Alanis Naomi , Shaikh Sajid , Cheeti Radhika , Smiley Rebecca , Iloma Chukwuagozie , Wang Hao 
Published: April 2021

Objective We aimed to examine the role of the HEART (history, EKG, age, risk factors, and troponin) score in the evaluation of six clinical outcomes among three groups of patients in the emergency department (ED). Methods We performed a retrospective observational study among three ED patient groups including White, Black, and Hispanic patients. ED providers used the HEART score to assess the need for patient hospital admission and for emergent cardiac imaging tests (CITs). HEART scores were measured using classification accuracy rates. Performance accuracies were measured in terms of HEART score in relation to four clinical outcomes (positive findings of CITs, ED returns, hospital readmissions, and 30-day major adverse cardiac events [MACE]). Results A high classification accuracy rate (87%) was found for use of the HEART score to determine hospital admission. HEART scores showed moderate accuracy (area under the receiver operating characteristic curve 0.66–0.78) in predicting results of emergent CITs, 30-day hospital readmissions, and 30-day MACE outcomes. Conclusions Providers adhered to use of the HEART score to determine hospital admission. The HEART score may be associated with emergent CIT findings, 30-day hospital readmissions, and 30-day MACE outcomes, with no differences among White, Black, and Hispanic patient populations.
Epidemiology of Anterior Cruciate Ligament Tears in the National Football League
Authors: Palmieri-Smith Riann M. , Mack Christina D. , Brophy Robert H. , Owens Brett D. , Herzog Mackenzie M. , Beynnon Bruce D. , Spindler Kurt P. , Wojtys Edward M. 
Published: April 2021

Background: Anterior cruciate ligament (ACL) tears are common in contact athletics and have a significant effect on the athletic performance and well-being of affected players. The prevalence, timing, and characteristics of ACL tears in National Football League (NFL) athletes are lacking. Purpose: To define the epidemiology of ACL tears among NFL athletes. Study Design: Descriptive epidemiology study. Methods: This retrospective study includes all ACL injuries entered into the NFL injury database through the centralized leaguewide electronic health record system for the 2015-2019 seasons. Results: A total of 314 ACL injuries occurred during the 5-year study period, with a mean of 62 per year. The overall 1-season injury risk of an NFL player sustaining an ACL injury was 1.9% (95% CI, 1.7%-2.1%). Most ACL injuries occurred during games (n = 199), with a higher rate observed in the preseason games as compared with the regular season games (6.1 vs 2.7 per 10,000 player-plays; P < .01). NFL players with ≤3 of experience had a higher preseason injury rate (9.57 ACL tears per 1000 player-seasons) than those with ≥4 years of experience (5.12 ACL tears per 1000 player-seasons; P < .01). NFL athletes playing on special teams had the highest rate of ACL injuries (7.6 per 10,000 player-plays) in comparison with all other player positions. Conclusion: ACL injury incidence was fairly consistent across all years studied and occurred more frequently in players with ≤3 years of NFL experience. Tears were more common during games, special teams play, and the preseason.
Amnion and Umbilical Cord–Derived Products in Sports Medicine: From Basic Science to Clinical Application
Authors: Fortier Lisa A. , Cercone Marta , Keller Laura E. , Delco Michelle L. , Becktell Lilia , Wells Kristina V. 
Published: April 2021

Background: Birth tissue products from amnion, chorion, umbilical cord, amniotic fluid, or cord blood are frequently marketed as viable sources of stem cells and growth factors. It can be difficult for health care professionals to differentiate implied from explicit conclusions in reported product analyses. Purpose: To provide an educational platform for health care professionals to interpret data presented in the promotion of birth tissue products. Study Design: Descriptive laboratory study and expert opinion; Level of evidence, 5. Methods: A cord blood product was analyzed by 3 methods for cell viability, 2 methods for assessment of cell morphology and cell type, multicolor flow cytometry to identify stem cells, and enzyme-linked immunosorbent assay (ELISA) plus Western blot for analysis of interleukin 1 receptor antagonist protein (IL-1ra). These data were compared with analyses reported by the manufacturer. Results: Cell viability in the cord blood product was less than reported by the manufacturer, the cells were primarily leukocytes, no stem cells were present, and the concentration of IL-1ra was falsely increased due to nonspecific antibody binding in the sample. Conclusion: To assess birth tissue products, health care professionals should consider the following: (1) Understanding fluorescent dyes is important for assessing cell viability data—green does not always mean alive. (2) The report of “cells” in the product does not necessarily mean “stem cells”; microscopic images of at least ×20 or a hemogram should be evaluated to determine cell type (leukocyte, red blood cells, etc). (3) There is no single cluster of differentiation (CD) marker on flow cytometry to identify stem cells. (4) Biological tissues are complex substances, and inaccurately increased measurements of growth factors could be present in ELISA results because most ELISAs are not designed or validated for use in biologics. Furthermore, the reported measurement of growth factors should be considered relative to concentrations in native biological tissues and plasma. Clinical Relevance: Health care professionals should be able to interpret cell viability, cell morphology, stem cell analysis using CD markers, and growth factor analysis when considering use of a birth tissue product in patients.
Herpes Simplex Virus Type 1 Pneumonia—A Review
Authors: Jellinge Marlene Ersgaard , Hansen Frank , Coia John Eugenio , Song Zhijun 
Published: April 2021

Background: Pneumonia due to herpes simplex virus (HSV) is uncommon but can be seen in immunocompromised patients and has been associated with poor prognosis in this population. Aim: The aim was to study the results, outcome and mortality of HSV pneumonia in immunocompromised patients and patients receiving mechanical ventilation. Furthermore, it has been unclear whether to initiate prophylactic treatment with acyclovir or not. Methods: We have conducted a literature search using the keywords herpes simplex pneumonia, critically ill patients and intensive care unit for identification of relevant publications. Findings: HSV pneumonia can cause severe infection or even death in immunocompromised patients and critically ill patients. A clear diagnosis of HSV pneumonia can be difficult to establish. Respiratory condition may improve after initiation of acyclovir but data is scarce. Conclusion: HSV pneumonia should be considered in the immunocompromised patient and/or the intensive care patient who continues to deteriorate despite appropriate treatment. The value of prophylactic treatment with acyclovir is unproven but should be considered.
Older migrants’ experience of existential loneliness
Authors: Olofsson Jonas , Rämgård Margareta , Sjögren-Forss Katarina , Bramhagen Ann-Cathrine 
Published: April 2021

Background: With rapidly ageing population worldwide, loneliness among older adults is becoming a global issue. Older migrants are considered being a vulnerable population and ethical issues are often raised in care for elderly. A deeper sense of loneliness, existential loneliness is one aspect of loneliness also described as the ultimate loneliness. Making oneself understood or expressing emotions, have shown to be particularly challenging for older migrants which could lead to experience of existential loneliness. Ageing and being a migrant are potential triggers for experiencing existential loneliness. There appears to be, however, little known about being a migrant experiencing existential loneliness in old age. Aim: This study explored older migrants’ experience of existential loneliness. Research design: Qualitative study. Participants and research context: Data were collected through interviews (n = 15) with older (>65) migrants’ in Swedish nursing homes or senior citizen centres. A thematic analysis was performed to analyse the data. Ethical considerations: The study was conducted in accordance with the principles of research ethics. Findings: The result was described in terms of three themes: (1) Choices made in life, (2) seeking reconciliation with life and (3) thoughts about death and dying in a foreign country. Discussion: Ethical reflection and knowledge about how older migrants’ life story can lead to experiencing existential loneliness, could be of use in care for older migrants’. Conclusion: This study indicates that the experience of existential loneliness derived from being a migrant is a long-term and significant process. Migration was a hope of creating a meaningful life, the experience of existential loneliness occurred as migrants sought reconciliation with life, reflected upon their past choices, and thought about death and dying in a foreign country.
Quality of Life for Older Cancer Patients: Relation of Psychospiritual Distress to Meaning-Making During Dignity Therapy
Authors: Bluck Susan , Mroz Emily L. , Wilkie Diana J. , Emanuel Linda , Handzo George , Fitchett George , Chochinov Harvey Max , Bylund Carma L. 
Published: April 2021

Background: Nearly 500,000 older Americans die a cancer-related death annually. Best practices for seriously ill patients include palliative care that aids in promoting personal dignity. Dignity Therapy is an internationally recognized therapeutic intervention designed to enhance dignity for the seriously ill. Theoretically, Dignity Therapy provides opportunity for patients to make meaning by contextualizing their illness within their larger life story. The extent to which Dignity Therapy actually elicits meaning-making from patients, however, has not been tested. Aim: The current study examines (i) extent of patient meaning-making during Dignity Therapy, and (ii) whether baseline psychospiritual distress relates to subsequent meaning-making during Dignity Therapy. Design: Participants completed baseline self-report measures of psychospiritual distress (i.e., dignity-related distress, spiritual distress, quality of life), before participating in Dignity Therapy. Narrative analysis identified the extent of meaning-making during Dignity Therapy sessions. Participants: Twenty-five outpatients ( M age = 63, SD = 5.72) with late-stage cancer and moderate cancer-related symptoms were recruited. Results: Narrative analysis revealed all patients made meaning during Dignity Therapy but there was wide variation (i.e., 1—12 occurrences). Patients who made greater meaning were those who, at baseline, reported significantly higher psychospiritual distress, including greater dignity-related distress ( r = .46), greater spiritual distress ( r = .44), and lower quality of life ( r = -.56). Conclusion: Meaning-making was found to be a central component of Dignity Therapy. Particularly, patients experiencing greater distress in facing their illness use the Dignity Therapy session to express how they have made meaning in their lives.
Effect of PARP Inhibitors as Maintenance Treatment on Restricted Mean Survival Time in Platinum-Sensitive Recurrent Ovarian Cancer: A Systematic Review and Meta-analysis
Authors: Kaneko Masayuki 
Published: April 2021

Background Earlier trials on the efficacy of poly (ADP-ribose) polymerase (PARP) inhibitors in platinum-sensitive relapsed ovarian cancer used the hazard ratio (HR) as an efficacy parameter. Objective The present meta-analysis was focused on improving the robustness and clinical interpretability of the efficacy evaluation of PARP inhibitors using the restricted mean survival time (RMST). Methods A search for relevant studies published up to July 31, 2020, was performed in electronic databases to identify eligible trials comparing PARP inhibitors with placebo. The difference in RMST was used as a PARP inhibitor efficacy parameter. Combined differences in RMST with 95% CIs across studies were calculated using a random-effects model. Results Four trials (6 articles) were assessed, including 1079 patients treated with PARP inhibitors and 598 with placebo. The combined RMST differences for up to 360 days (PARP inhibitors minus placebo: point estimate and 95% CI) among all patients and the patients of subgroups with BRCA mutations, homologous recombination-deficient (HRD) carcinoma, and BRCA wild-type carcinoma were 87 days (95% CI = 71, 102), 112 days (95% CI = 96, 129), 99 days (95% CI = 80, 119), and 69 days (95% CI = 47, 92), respectively. The combined RMST differences for up to 660 and 720 days were also larger among patients with BRCA mutations than among those with HRD carcinoma. Conclusion and Relevance Based on using the RMST difference as an alternative measure to the HR, this meta-analysis suggests that PARP inhibitors are the most effective for patients with BRCA mutations, followed by patients with HRD carcinoma.