bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effective Time Scale of the Northern Hemisphere Winter Circulation Waviness
Authors: Chen Gang , Nie Yu 
Published: December 2024

Abstract
Midlatitude weather extremes such as blocking events and Rossby wave breaking are often related to large meridional shifts in the westerly jet stream. Numerous diagnostic methods have been developed to characterize these weather events, each emphasizing different yet interrelated aspects of circulation waviness, including identifying large-amplitude ridges or persistent anomalies in geopotential height. In this study, we introduce a new metric to quantify the circulation waviness in terms of effective time scale. This is based on the Rossby wave packet from the one-point correlation map of anomalous meridional wind, applicable to jet waviness involving multiple wavenumbers. Specifically, we estimate the intrinsic frequency of Rossby waves and decay time scale of wave amplitude in the reference frame moving at the local time mean zonal wind. The resulting effective time scale, derived from linear theory, serves as a proxy for the eddy mixing time scale in jet meandering. Remarkably, its spatial distribution roughly resembles that of circulation waviness in the Northern Hemisphere winter as depicted by local wave activity (LWA). In the high-latitude regions characterized by weak zonal winds, the long time scale in waviness aligns with large values in LWA. By contrast, short waviness time scales in subtropical jet regions correspond to the suppressed amplitude in waviness despite large values in eddy kinetic energy (EKE). Furthermore, the effective time scale in waviness largely captures the interannual variability of LWA in observations and its projected future changes in climate model simulations. Thus, this relation between the waviness time scale and zonal wind provides a physical mechanism for understanding how zonal wind changes impact regional weather patterns in a changing climate.

Significance Statement
The purpose of this study is to better understand what controls weather extremes in midlatitude regions such as blocking events and Rossby wave breaking. We introduce a novel concept, the effective time scale of jet stream meandering, which sheds light on these phenomena. Through analyzing Rossby waves in the reference frame moving at the local time mean zonal wind, we derive a scaling relation between circulation waviness and eddy mixing time scale. Our findings reveal that this time scale closely mirrors the spatial distribution of circulation waviness in the Northern Hemisphere winter. Importantly, it captures interannual variability and climate change responses. These insights provide a physical basis for understanding how changes in zonal wind impact regional weather patterns in observations and climate models.
Effectiveness of psychosocial intervention and functionality among homeless persons with mental illness
Authors: Raman K Janaki , Muralidhar D , Raj E Aravind , Venkatasubramanian G 
Published: December 2024

Background: Homelessness is a deeply ingrained aspect of our culture. It has a detrimental influence on people of all ages’ physical and mental well-being, child development, academic success and the establishment and upkeep of families. Homelessness and mental illness have a reciprocal relationship that makes them two interrelated social issues that affect people’s ability to function and communities all over the world. Methods: The study followed a Quasi-experimental research design – Pre and Post without control group, conducted in an urban rehabilitation center. A basic random sampling technique was used to select a sample of the respondents. All eligible participants who gave their consent were given the WHO Disability Assessment Schedule (WHODAS 2.0) and a semi-structured interview schedule. Statistics procedures used frequency distribution and inferential statistics such as t-tests, chi-square and correlation. Results: The results of the study show that the majority of the respondents (60.00%) were in the age group 20 to 40 years, 73.3% were male, 50% were married, 62.7% had no children and their educational status shows that the majority of them (63.3%) were literate 56.7% were unemployed prior to institutionalisation. The mean percentage of disability of the respondents followed by the intervention (30.9 ± 16.4) was found to be significantly lesser than ( t = 11.6, df = 29, p < .001) their level of disability (52.7 ± 17.8) before the psychosocial intervention. A significant negative correlation exists between disability and income ( r = −.48, p < .01). Discussion: Psychosocial intervention plays an essential role in enhancing functionality among homeless persons with mental illness in terms of self-help skills, social skills development, casework, group work, working with family and community and networking with community-based organisations to develop a support system. The present study revealed a significant negative correlation between disability and income.
Systematic Review on the Efficacy of Moisturizing Therapy in Treating Nipple Trauma and Nipple Pain
Authors: Nakamura Maya , Luo Yunjie , Ebina Yasuhiko 
Published: December 2024

Background: Nipple trauma and pain pose a challenge, leading to premature discontinuation of breastfeeding. Moisturizing therapies, including lanolin and hydrogel dressings, have been proposed for nipple trauma and pain management. Despite the availability of multiple approaches, evidence for moisturizing therapy is lacking. Research Aim: This review aimed to determine the efficacy of moisturizing therapy in treating nipple trauma and nipple pain in lactating women. Methods: A systematic review based on the PRISMA-P guidelines was conducted. Seven databases were systematically searched and screened, and 24 studies were analyzed. The interventions were categorized as high, moderate, or low, based on their moisturization levels. Sample characteristics, interventions, and outcomes were examined. Results: A total of 21 interventions were identified: high moisturization (two types), moderate moisturization (12 types), and low moisturization (seven types). Hydrogel dressings, lanolin, and breast milk are commonly used interventions. Although intervention and effectiveness evaluation methods differed between studies and could not be compared, results in 10 (41%) of the studies demonstrated that one intervention with more moistening was more effective. Of the three studies categorized as including high moistening interventions, two (66%) supported their effectiveness compared to low moistening interventions; however, two of the three studies were judged to be at high risk of bias, and some reported adverse events. Conclusions: Moisturization interventions show promise for treating nipple trauma and pain more than drying nipples or using breast milk, but high moisturization needs cautious use due to few rigorous trials and the presence of reported risks. Methodological challenges and the lack of robust trials hinder evidence synthesis and robust conclusions. Abstract in Japanese 背景： 乳頭損傷や乳頭痛は産褥早期に授乳を断念する要因である。その対処法として、ラノリンやハイドロジェルドレッシングによる保湿療法が提案されている。しかし、乳頭損傷や乳頭痛に対する保湿療法の効果に関する検討は不足している。 目的： 本システマティックレビューは、授乳中の乳頭損傷と乳頭痛の治療における保湿の有効性を検討することを目的とした。 方法： PRISMA-Pガイドラインに基づく系統的レビューを実施した。7つのデータベースを用いて、体系的に検索とスクリーニングを行い、最終的に24件の文献を対象とした。介入方法を保湿レベルに基づいて高保湿、中保湿、低保湿に分類し、サンプル特性や、介入、および結果について検討した。 結果： 高保湿（2種類）、中保湿（12種類）、低保湿（7種類）の合計21種類の介入が特定された。ハイドロジェルドレッシング、ラノリン、母乳の塗布が一般的な介入として使用されていた。介入および効果の測定方法は研究間で異なり、結果の統合は困難であったが、10件（41％）でより高い保湿の介入が効果的であるとされていた。高保湿に分類された3件のうち2件（66％）が低保湿の介入と比較して効果的であるとされたが、2件（66％）はバイアスリスクが高いと判定された文献であり、有害事象の報告もあった。 結論： 保湿療法は乾燥や母乳の塗布と比較して乳頭損傷や乳頭痛の対処法として有望であるが、高保湿の対処法には厳密な無作為化比較試験の不足と有害事象の報告があり、慎重な検討が必要である。堅牢な実験研究の不足と方法論的な課題が、結果の統合とエビデンスの確立の妨げとなっている。 Back translated by Katsumi Mizuno, PhD, MD, IBCLC
Lack of hospital resilience as the main challenge of hospital management during the COVID-19 pandemic: A grounded theory study
Authors: Ghahramani Sulmaz , Bagheri Lankarani Kamran , Zakeri Mohammadreza , Ghahramani Sahar , Shojaei Payam 
Published: December 2024

Background Traditional hospital management responses during the coronavirus disease 2019 (COVID-19) pandemic proved ineffective, particularly considering the pre-existing challenges in healthcare systems. The study examines hospital management challenges during the COVID-19 pandemic, transforming their lived experiences into a conceptual approach to prevent repetition and benefit health planners and policymakers in future crises and normal times. Methods This qualitative study utilized the grounded theory methodology, conducting in-depth interviews with 12 hospital administrators from seven major referral hospitals in Shiraz, Bushehr, and Tehran, focusing on COVID-19 patients’ complex conditions. The participants had a mean age of 46.6 ± 8.8 years. Data analysis was conducted using the grounded theory (Straussian approach). Results A total of 98 subthemes and 25 themes were identified during the data analysis process. Using axial and selective coding, we found that in the presence of contextual and causal conditions, the lack of hospital resilience was recognized as the core theme in the final model. Intervening conditions, strategies to overcome the challenges of hospital management, and the outcomes were identified. Conclusions Iranian hospital administrators dealing with COVID-19 recognize the lack of hospital resilience as their main management obstacle. Non-resilient hospitals’ response to crises with new management strategies can fail due to insufficient documentation and information sharing, leading to persistent problems. Prioritizing evidence-based strategies and sharing successful approaches from other healthcare systems can improve resilience. Nationwide guidelines will ensure equitable patient treatment and reduce lawsuits against physicians for resource-efficient use. Hospital resilience implementation in real-world settings is widely sought for evidence.
CleftTok: An Analysis of Cleft-Related Content on TikTok
Authors: Richlak Ethan , Pope Avery , Arroyo Mariana , Umbaugh Hailey , Crerand Canice E. 
Published: December 2024

To analyze the content and sources of TikTok posts regarding cleft conditions; to examine the quality and reliability of educational content related to cleft conditions. Cross-sectional, observational study of cleft-related TikTok content. N/A N/A N/A  Frequencies of TikTok post likes, views, comments, shares, and saves; engagement rate; post themes; and post educational content accuracy, quality, and reliability (assessed with the Patient Education Materials Assessment Tool and modified DISCERN [mDISCERN] rating scales). A total of 252 cleft-related TikTok posts were reviewed. Most posts were created by family members of patients (n = 193, 76.59%), while posts from plastic surgeons were underrepresented (n = 11, 4.37%). Positive Messages were the most common video theme (n = 80; 31.75%), and 24 (9.52%) of the TikTok posts were classified as providing educational content. Plastic surgeons had the highest mDISCERN score (2.75) among all content creator categories, indicating more accurate and reliable educational content. When content creator categories were stratified by physician versus nonphysician creators, physician posts had significantly higher mDISCERN scores ( P = .001). Despite objectively better educational content, plastic surgeons had the lowest engagement rate (1.82%), while family members had the highest engagement rate (7.04%). Cleft teams should anticipate that patients and their caregivers will most likely access social media to learn more about cleft conditions and seek support. Patients and caregivers should be urged to stay cautious of the information they find online and ideally be offered reputable sources of information and support.
Noninvasive therapeutic ultrasound to increase perfusion in chronic limb-threatening ischemia: An early feasibility study
Authors: Khalsa Bhavraj , Archie Meena , Nazer Babak , Razavi Mahmood K 
Published: December 2024

Background: Preclinical studies have demonstrated that therapeutic ultrasound (TUS) increases perfusion in peripheral artery disease (PAD). This pilot study assessed the safety and effectiveness of a noninvasive TUS device in patients with advanced PAD. Methods: A phased array of TUS transducers was fabricated on a wearable sleeve, designed to sonicate the posterior and anterior tibial arteries (and their collaterals) at the calf level. Twelve patients with PAD (Rutherford classes 3–5) were enrolled in a single-arm study in which they underwent 30–40 daily 90-minute TUS sessions to the diseased limb. Changes in pedal flow and tissue oxygenation (StO2) were measured by laser speckle and spatial frequency domain imaging, respectively. A subset of five patients underwent evaluation by laser Doppler, transcutaneous oximetry (TcPO2), and quality of life questionnaires (Vascular Quality of Life Questionnaire [VascuQoL] and the Walking Impairment Questionnaire [WIQ]). Results: Eleven out of 12 enrolled patients completed the study. During 90-minute TUS sessions pedal flow improved by 180% ( p < 0.001) on laser speckle imaging, and 18% ( p = 0.12) on laser Doppler. Tissue oxygenation improved by 18% ( p = 0.43) on TcPO2 and by 6% ( p = 0.097) on StO2. After all sessions, tissue oxygenation improved by 17% ( p = 0.020) on StO2, without significant changes in laser Doppler (+39%, p = 0.41) or TcPO2 (–3%, p = 0.70), which was largely in the normal range (56 ± 15 mmHg) at baseline. VascuQoL improved by 2.4 points (14%, p = 0.080) and WIQ improved by 8.2 points (11%, p = 0.053). Conclusions: TUS for patients with symptomatic PAD was safe and well tolerated. Most metrics of tissue perfusion and oxygenation improved, but future sham-controlled studies are needed and planned.
Adherence Monitor for Measurement of Removable Cast Walker Wear-Time: Multiple Sensors and Predictive Analytics Improve Accuracy
Authors: Havey Robert M. , Patwardhan Avinash G. , Stuck Rodney M. , Keen Stephanie A. , Muriuki Muturi G. 
Published: December 2024

Background: Treatment of diabetes and its complications is a primary health care expense. Up to 25% of people with diabetes will develop diabetic foot ulcers (DFUs). Removable cast walker (RCW) boots commonly prescribed for DFU treatment, promote healing, and provide offloading and wound protection. Patient RCW removal for hygiene and wound care can lead to decreased adherence and treatment effectiveness. This study evaluated a new system for wear-time adherence measurement using multiple sensor types. Methods: An electronic wear-time monitor was developed, which included internal and external temperature sensors, an accelerometer, and capacitive proximity foot and ankle sensors. Time-stamped and date-stamped data were saved once per minute for up to 22 days. Ten healthy volunteer subjects were recruited to wear an RCW for two weeks while keeping a diary of don/doff times. Sensor data were then compared with volunteers’ wear diaries using confusion matrix predictive analytics. Results: Algorithms were developed for data processing. Correlation coefficients between algorithms and diaries were calculated for individual and multiple sensor combinations. Differential temperature and accelerometer algorithms were significantly better at predicting subject wear-time than individual temperature sensor algorithms ( P = .009, P = .001, respectively). Foot proximity had significantly better correlation with subject diaries than temperature ( P = .024), and acceleration algorithms ( P = .005). Multi-sensor analysis showed high correlation (.96) with wear-time from subject diaries. Conclusions: Removable cast walker wear-time can be accurately determined using an electronic data recorder and multiple sensors. Wear-time measurement accuracy can be improved using algorithms that operate on data from multiple sensors that use a variety of sensor technologies.
Impact of a nurse practitioner-led dedicated outpatient parenteral antibiotic therapy clinic on patient outcomes and administrative workload: a retrospective cohort study
Authors: Ibaraki Makoto , Gruss Zachary , Wings Emily , Geronimo Jaclyn E. , Varnes Janine M. , Kammeyer Joel A. 
Published: December 2024

Background: Outpatient parenteral antibiotic therapy (OPAT) enhances patient safety, improves outcomes, and reduces healthcare costs by decreasing 30-day readmissions and adverse events. However, the optimal structure and follow-up protocols for OPAT programs remain undefined. Identifying high-risk patients for readmission and managing adverse drug events (ADEs) are critical components of OPAT care. Objectives: This study aimed to evaluate the impact of a dedicated OPAT clinic on hospital readmissions, and quantified the administrative workload required to manage patients on OPAT post-discharge. Design: A retrospective, pre-post cohort study compared patient outcomes before and after the implementation of a dedicated OPAT clinic across a single clinic and multiple hospitals. Methods: Patients discharged on OPAT from October 2018 to March 2019 (control group) and from September 2021 to February 2022 (intervention group) were included. The primary outcome was 30-day hospital readmission. Secondary outcomes included administrative workload measured by telephone calls and nursing tasks. Data were analyzed using univariate and multivariate logistic regression models to identify independent risk factors for readmission. Results: A total of 361 patients were included (median age 63 years, 62.1% men). Of these, 239 patients (66.2%) received OPAT post-clinic implementation. Common diagnoses included bacteremia (17.7%) and osteomyelitis (17.5%), with MRSA (17.2%) and Streptococci (14.4%) as predominant pathogens. The median OPAT duration was 14 days, and the median hospital stay was 7 days. Readmissions within 30 days occurred in 24.9% of patients, while 27.7% visited the emergency department. ADEs were reported in 18.9% of patients. Readmission rates decreased from 30.5% in the pre-clinic cohort to 20.1% in the post-clinic cohort ( p ⩽ 0.05). The OPAT clinic managed 690 calls, illustrating the substantial administrative burden associated with coordinating care. Most calls addressed lab results (22.6%) and peripherally inserted central catheter-related issues (11.3%). Conclusion: The implementation of a dedicated OPAT clinic was associated with reduced readmissions and improved patient management, suggesting that structured follow-up care may improve outcomes. This study highlights the administrative challenges of OPAT, emphasizing the need for dedicated personnel and efficient coordination. Future research should focus on optimizing OPAT care models and establishing sustainable funding strategies.
Changes in Foot Width in Minimally Invasive Bunionectomy
Authors: El Masry Seif , DiGiovanni Grace , Srikumar Syian , Boden Allison L. , Palma Joaquin , Johnson A. Holly 
Published: December 2024

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux Valgus (HV) is a common foot condition often requiring surgical intervention. Minimally invasive bunionectomy (MISB) has gained popularity for HV correction. While previous research has focused on distal foot width changes following surgery, this study introduces a novel midshaft measurement to assess proximal transverse midfoot width. The study aims to provide a comprehensive evaluation of foot width changes post-MISB. Methods: A retrospective review of prospectively collected data was conducted for 44 patients who underwent MISB for HV via an institutional outcome registry. Demographic data, surgical details, radiographs, and foot width measurements were collected. Changes in hallux valgus angle (HVA) and intermetatarsal angle (IMA) were also measured. The novel midshaft bony and soft tissue foot width measurements were included. Two independent observers conducted all preoperative and postoperative measurements. Results: Intraclass correlation coefficients (ICCs) demonstrated high interobserver reliability (all ICCs >0.70) for all measurements. MISB resulted in a consistent reduction in distal foot width, both bony (8.17%) and soft tissue (5.24%)(p < 0.001). These reductions correlated with changes in HVA and IMA, suggesting the extent of deformity correction influenced distal foot width (all r > 0.375, p < 0.05). However, the study revealed that proximal foot width, as measured by midshaft bony width, increased (5.27%) in the majority of cases (p < 0.001). Changes in midshaft foot width showed no correlation with HVA or IMA alterations. Conclusion: MISB for HV leads to an increase in midshaft foot width due to the unique mechanics of the procedure. Simultaneously, there is a decrease in distal foot width, which correlates with the extent of deformity correction. This results in a more uniform foot width. These findings may influence patient satisfaction, comfort, and shoe wear capabilities post-surgery. Further research should assess patient perception and comfort regarding these foot width changes after MISB.
Changes in the Subtalar Joint Alignment after Supramalleolar Osteotomy for Varus Ankle Arthritis
Authors: Zhang Ming-Zhu 
Published: December 2024

Category: Ankle; Hindfoot Introduction/Purpose: The subtalar joint may compensate for tibio-talar deformity, but what would happen to the joint after the deformity was corrected is not well known. Supramalleolar osteotomy (SMOT) is an effective procedure for the treatment of varus deformity of ankle arthritis. The objective of this study was to investigate the subtalar joint alignment pre and postoperatively following SMOT, and the factors which influenced the alignment of the subtalar joint. Methods: Thirty-one patients with varus ankle arthritis (Takakura stage 2, 3a and 3b) who were treated using SMOT were retrospectively reviewed. The subtalar and ankle joint alignment was measured on weightbearing radiograph and weightbearing computerized tomography (WBCT). Results: The foot ankle offset (FAO), tibial articular surface angle (TAS), tibio-talar surface angle (TTS), subtalar vertical angle (SVA) and subtalar inclination angle (SIA) were significantly corrected (P<0.05). There were 19 cases with the subtalar joints shifted medially after surgery (ΔSIA=-4.27±3.23°), and the other 12 cases with the subtalar joints moved to the lateral side (ΔSIA=2.79±1.68°). The shift of subtalar joint (ΔSIA) showed an inverse correlation with the preoperative FAO (P<0.001, r=-0.621). Conclusion: The shift of subtalar joint after SMOT could maintain the neutral position of the hindfoot and showed a negative correlation with the preoperative FAO. The ΔSIA was greater in the severer preoperative hindfoot deformity. Figure 1 The varus deformation of the ankle joint was corrected by the supramalleolar osteotomy, and the increased SIA after surgery resulted in the stenosis of the lateral joint space. (A and C, preoperative; B and D, postoperative, the pre and postoperatively SIA were 3 degrees and 10 degrees; the pre and postoperatively FAO were -5.77% and -1.89%). Abbreviations: TAS, tibia articular surface angle; SIA, subtalar inclination ankle; FAO, foot ankle offset.