bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impacts of CP- and EP-El Niño events on the Antarctic sea ice in austral spring
Authors: Zhang Chao , Li Tim , Li Shuanglin 
Published: September 2021

AbstractBased on observational data analyses and idealized modeling experiments, we investigated the distinctive impacts of central Pacific (CP-) El Niño and eastern Pacific (EP-) El Niño on the Antarctic sea ice concentration (SIC) in austral spring (September to November). The tropical heat sources associated with EP-El Niño and the co-occurred positive phase of Indian Ocean Dipole (IOD) excite two branches of Rossby wave trains that propagate southeastward, causing an anomalous anticyclone over the eastern Ross-Amundsen-Bellingshausen Seas. Anomalous northerly (southerly) wind west (east) of the anomalous anticyclone favor poleward (offshore) movements of sea ice, resulting in a sea ice loss (growth) in the eastern Ross-Amundsen Seas (the Bellingshausen-Weddell Seas). Meanwhile, the anomalous northerly (southerly) wind also advected warmer and wetter (colder and drier) air into the eastern Ross-Amundsen Seas (the Bellingshausen-Weddell Seas), causing surface warming (cooling) through the enhanced (reduced) surface heat fluxes and thus contributing to the sea ice melting (growth). CP-El Niño, however, forces a Rossby wave train that generates an anomalous anticyclone in the eastern Ross-Amundsen Seas, 20° west of that caused by EP-El Niño. Consequently, a positive SIC anomaly occurs in the Bellingshausen Sea. A dry version of the Princeton atmospheric general circulation model was applied to verify the roles of anomalous heating in the tropics. The result showed that EP-El Niño can remotely induce an anomalous anticyclone and associated dipole temperature pattern in the Antarctic region, whereas CP-El Niño generates a similar anticyclone pattern with its location shift westward by 20° in longitudes.
The 20-y spatio-temporal trends of remotely sensed soil moisture and vegetation and their response to climate change over the Third Pole
Authors: Shi Pengfei , Zeng Jiangyuan , Chen Kun-Shan , Ma Hongliang , Bi Haiyun , Cui Chenyang 
Published: September 2021

AbstractThe Tibetan Plateau (TP), known as the “Third Pole”, is a climate-sensitive and ecology-fragile region. In this study, the spatio-temporal trends of soil moisture (SM) and vegetation were analyzed using satellite-based ESA CCI SM and MODIS LAI data respectively in the growing season during the last 20 years (2000-2019) over the TP covering diverse climate zones. The climatic drivers (precipitation and air temperature) of SM and LAI variations were fully investigated by using both ERA5 reanalysis and observation-based gridded data. The results reveal the TP is generally wetting and significantly greening in the last 20 years. The SM with significant increasing trend accounts for 21.80% (fraction of grid cells) of the TP, and is about twice of the SM with significant decreasing trend (10.19%), while more than half of the TP (58.21%) exhibits significant increasing trend of LAI. Though the responses of SM and LAI to climatic factors are spatially heterogeneous, precipitation is the dominant driver of SM variation with 48.36% (ERA5) and 32.51% (observation-based) precipitation data showing the strongest significant positive partial correlation with SM. Temperature rise largely explains the vegetation greening though precipitation also plays an important role in vegetation growth in arid and semi-arid zones. The combined trend of SM and LAI indicates the TP is mainly composed of wetting and greening areas, followed by drying and greening regions. The change rate of SM is negative at low altitudes and becomes positive as altitude increases, while the LAI value and its change rate decrease as altitude increases.
Improved survival of patients with aggressive ATL by increased use of allo-HCT: a prospective observational study
Authors: Ito Ayumu , Nakano Nobuaki , Tanaka Takashi , Fuji Shigeo , Makiyama Junya , Inoue Yoshitaka , Choi Ilseung , Nakamae Hirohisa , Nagafuji Koji , Takase Ken , Machida Shinichiro , Takahashi Tsutomu , Sawayama Yasushi , Kamimura Tomohiko , Kato Koji , Kawakita Toshiro , Ogata Masao , Sakai Rika , Shiratori Souichi , Uchimaru Kaoru , Inamoto Yoshihiro , Utsunomiya Atae , Fukuda Takahiro 
Published: September 2021

Abstract
Aggressive adult T-cell leukemia/lymphoma (ATL) is a hematological malignancy that is difficult to treat with chemotherapy alone, and allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapy. We conducted a multicenter, prospective, observational study to clarify the treatment outcomes of aggressive ATL in the current era. Between 2015 and 2018, 113 patients aged 70 years or younger with newly diagnosed aggressive ATL were enrolled. The median age at diagnosis was 61 years. Treatment outcomes were compared with those of 1792 ATL patients diagnosed between 2000 and 2013 in our previous retrospective study. The inclusion criteria were the same in both studies. The prospective cohort demonstrated better overall survival (OS) than the retrospective cohort (2-year OS, 45% vs 29%, respectively; P &lt; .001), with a much higher proportion of patients receiving allo-HCT (80% vs 34%, respectively; P &lt; .001) and a shorter interval from diagnosis to allo-HCT (median, 128 vs 170 days, respectively; P &lt; .001). Among the 90 patients who received allo-HCT (cord blood, n = 30; HLA-haploidentical related donors, n = 20; other related donors, n = 14; other unrelated donors, n = 26), the 2-year probabilities of OS, non-relapse mortality (NRM), and disease progression were 44%, 23%, and 46%, respectively. OS and NRM did not differ statistically according to donor type. Our results suggest that increased application of allo-HCT improved the survival of patients with aggressive ATL. The use of cord blood or HLA-haploidentical donors may be feasible for aggressive ATL when HLA-matched related donors are unavailable. This study was registered at the UMIN Clinical Trials Registry as #000017672.
Screening male prisoners for depression and anxiety with the PHQ-9 and GAD-7 at NHS Healthcheck: patterns of symptoms and caseness threshold
Authors: Butcher Elizabeth , Packham Christopher , Williams Marie , Miksza Joanne , Kaul Adarsh , Khunti Kamlesh , Morriss Richard 
Published: September 2021

Abstract
Background
Screening for depression and anxiety disorders has been proposed in prison populations but little is known about caseness thresholds on commonly used self-report measures in relation to core symptoms, risk factors and symptom patterns.

Method
A cross-sectional prevalence survey measured depression and anxiety caseness (threshold scores > 10 and > 15 on PHQ-9 and GAD-7 and diagnostic algorithm on PHQ-9) in 1205 male prisoners aged 35–74 years eligible for an NHS Healthcheck from six English prisons. Caseness scores were compared with the presence or absence of daily core symptoms of depression and generalised anxiety disorder (GAD), demographic, prison and cardiovascular risk factors. Cluster analysis was applied to PHQ-9 and GAD-7 items in prisoners scoring > 10 on PHQ-9.

Results
453(37.6%) and 249(20.7%) prisoners scored > 10 and > 15 respectively on PHQ-9; 216 (17.9%) had a depressive episode on the PHQ-9 algorithm; 378(31.4%) and 217(18.0%) scored > 10 and > 15 on GAD-7 respectively. Daily core items for depression were scored in 232(56.2%) and 139(74.3%) prisoners reaching > 10 and > 15 respectively on PHQ-9; daily core anxiety items in 282(74.9%) and 179(96.3%) reaching > 10 and > 15 on GAD-7. Young age, prison and previous high alcohol intake were associated with > 15 on the PHQ-9. Cluster analysis showed a cluster with core symptoms of depression, slowness, restlessness, suicidality, poor concentration, irritability or fear. Altered appetite, poor sleep, lack of energy, guilt or worthlessness belonged to other clusters and may not be indicative of depression.

Conclusions
In male prisoners > 35 years, a score of > 10 on the PHQ-9 over diagnoses depressive episodes but a score of > 10 on the GAD-7 may detect cases of GAD more efficiently. Further research utilising standardised psychiatric interviews is required to determine whether the diagnostic algorithm, a higher cut-off on the PHQ-9 or the profile of symptoms on the PHQ-9 and GAD-7 used singly or in combination may be used to screen depressive episodes efficiently in prisoners.
Psychometric evaluation of medication safety competence scale for clinical nurses
Authors: Yang Zhen , Chen Fengmin , Lu Yingying , Zhang Huijun 
Published: September 2021

Abstract
Background
Nurses are the most important members of the health care system for medication safety, there are few tools to evaluate their medication safety competence. This study aimed to translate the Medication Safety Competence Scale into Chinese and validate its reliability and validity among clinical nurses.

Methods
A total of 894 clinical nurses were recruited from three cities in China. The original version of the Medication Safety Competence Scale was translated into Chinese using the backward and forward translation procedure. The reliability of the scale was measured by internal consistency, split-half reliability, and stability. The validity of the scale was assessed by the content validity index, exploratory factor analysis and confirmatory factor analysis.

Results
The Cronbach’s coefficient of the scale was 0.940, and the coefficient values for the six domains ranged between 0.843 and 0.948. The split-half reliability and stability were 0.671 and 0.703, respectively. The content validity index of the scale was 0.952. The 6-factor structure, supported by the eigenvalues, total variance explained, and scree plot accounted for 71.485 % of the total variance. Moreover, as a result of the confirmatory factor analysis, the average variance extracted values were 0.55 to 0.70, and the model fitting indexes were all in the acceptable range.

Conclusions
The Chinese version of the Medication Safety Competence Scale had ideal reliability and validity among clinical nurses. The evaluation results of the scale can provide a reference for nursing managers to formulate education plans and intervention measures to improve clinical nurses’ safe medication competence.
Health economic benefits through the use of diagnostic support systems and expert knowledge
Authors: Willmen Tina , Völkel Lukas , Ronicke Simon , Hirsch Martin C. , Kaufeld Jessica , Rychlik Reinhard P. , Wagner Annette D. 
Published: September 2021

Abstract
Background
Rare diseases are difficult to diagnose. Due to their rarity, heterogeneity, and variability, rare diseases often result not only in extensive diagnostic tests and imaging studies, but also in unnecessary repetitions of examinations, which places a greater overall burden on the healthcare system.
Diagnostic decision support systems (DDSS) optimized by rare disease experts and used early by primary care physicians and specialists are able to significantly shorten diagnostic processes. The objective of this study was to evaluate reductions in diagnostic costs incurred in rare disease cases brought about by rapid referral to an expert and diagnostic decision support systems.

Methods
Retrospectively, diagnostic costs from disease onset to diagnosis were analyzed in 78 patient cases from the outpatient clinic for rare inflammatory systemic diseases at Hannover Medical School. From the onset of the first symptoms, all diagnostic measures related to the disease were taken from the patient files and documented for each day.
The basis for the health economic calculations was the Einheitlicher Bewertungsmaßstab (EBM) used in Germany for statutory health insurance, which assigns a fixed flat rate to the various medical services.
For 76 cases we also calculated the cost savings that would have been achieved by the diagnosis support system Ada DX applied by an expert.

Results
The expert was able to achieve significant savings for patients with long courses of disease. On average, the expert needed only 27 % of the total costs incurred in the individual treatment odysseys to make the correct diagnosis. The expert also needed significantly less time and avoided unnecessary examination repetitions.
If a DDSS had been applied early in the 76 cases studied, only 51–68 % of the total costs would have incurred and the diagnosis would have been made earlier. Earlier diagnosis would have significantly reduced costs.

Conclusion
The study showed that significant savings in the diagnostic process of rare diseases can be achieved through rapid referral to an expert and the use of DDSS. Faster diagnosis not only achieves savings, but also enables the right therapy and thus an increase in the quality of life for patients.
Optimising symptom management in children with cancer using a novel mobile phone application: protocol for a controlled hybrid effectiveness implementation trial (RESPONSE)
Authors: Bradford Natalie , Condon Paula , Pitt Erin , Tyack Zephanie , Alexander Kimberly 
Published: September 2021

Abstract
Background
Intense and aggressive treatment regimens for most children’s cancer have achieved vast improvements in survival but are also responsible for both a high number and burden of symptoms. The use of Patient Reported Outcome Measures (PROMs) demonstrates a range of benefits for improved symptom management in adults with cancer. There are, however, multiple barriers to integrating PROMs into routine care in children and adolescents with cancer. This study aims to evaluate: (1) the effectiveness of electronic PROMs to generate stratified alerts, symptom management recommendations and graphical summaries (the RESPONSE system) to improve health outcomes and (2) the implementation of the RESPONSE system by assessing feasibility, acceptability, satisfaction, and sustainability.

Methods
A pragmatic hybrid II effectiveness-implementation controlled trial, using mixed methods, will be undertaken, advancing both knowledge of the effectiveness of the intervention and implementation factors. One-hundred and sixty children with cancer receiving active treatment will be recruited 1:1 to a non-randomised study involving two groups with an equal number of participants in each group. The intervention group (n = 80) will be prospectively recruited to receive the RESPONSE system intervention over eight weeks, versus the historical matched control group (n = 80) who will complete the ePROMs without access to the RESPONSE system. The primary outcome of the effectiveness trial is change between groups in total symptom burden. Secondary outcomes include child health-related quality-of-life and implementation outcomes. Trial data will be analysed using linear mixed-effects models. Formative implementation evaluation is informed by CFIR and ERIC frameworks and implementation outcomes will be mapped to the RE-AIM framework and include interviews, field notes, as well as administrative data to evaluate feasibility, acceptability, satisfaction and sustainability.

Trial registration number
ACTRN12621001084875. Retrospectively Registered 16 August 2021.
Healthcare professionals’ practice and interactions in older peoples’ cross-sectoral clinical care trajectories when acutely hospitalized - a qualitative observation study
Authors: Persson Maiken Hjuler , Mogensen Christian Backer , Søndergaard Jens , Skjøt-Arkil Helene , Andersen Pernille Tanggaard 
Published: September 2021

AbstractBackgroundHealthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals’ identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals’ practice.AimThis study aimed to explore and analyse how healthcare professionals’ interactions and practice influence older peoples’ clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged.MethodsThis qualitative study arises from a hermeneutical stand within the interpretative paradigm.Focusing on the healthcare professionals’ interactions and practice we followed the clinical care trajectories of seven older people (aged> 65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines.ResultsThe analysis revealed four themes: 1)“The end justifies the means – ‘I know what is best for you’”, 2)“Basic needs of care overruled by system effectiveness”, 3)“Treatment as a bargain”, and 4)“Healthcare professionals as solo detectives”.ConclusionDissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.
A budget impact analysis of bezlotoxumab versus standard of care antibiotics only in patients at high risk of CDI recurrence from a hospital management perspective in Germany
Authors: Jakobs Florian , Wingen-Heimann Sebastian Marcel , Jeck Julia , Kron Anna , Cornely Oliver Andreas , Kron Florian 
Published: September 2021

Abstract
Background
Clostridioides difficile infection (CDI) is one of the leading nosocomial infections, resulting in increased hospital length of stay and additional treatment costs. Bezlotoxumab, the first monoclonal antibody against CDI, has an 1 A guideline recommendation for prevention of CDI, after randomized clinical trials demonstrated its superior efficacy vs. placebo.

Methods
The budget impact analysis at hand is focused on patients at high risk of CDI recurrence. Treatment with standard of care (SoC) + bezlotoxumab was compared with current SoC alone in the 10 most associated Diagnosis Related Groups to identify, analyze, and evaluate potential cost savings per case from the German hospital management perspective. Based on variation in days to rehospitalization, three different case consolidation scenarios were assessed: no case consolidation, case consolidation for the SoC + bezlotoxumab treatment arm only, and case consolidation for both treatment arms.

Results
On average, the budget impact amounted to € 508.56 [range: € 424.85 - € 642.19] for no case consolidation, € 470.50 [range: € 378.75 - € 601.77] for case consolidation in the SoC + bezlotoxumab treatment arm, and € 618.00 [range: € 557.40 - € 758.41] for case consolidation in both treatment arms.

Conclusions
The study demonstrated administration of SoC + bezlotoxumab in patients at high risk of CDI recurrence is cost-saving from a hospital management perspective. Reduced length of stay in bezlotoxumab treated patients creates free spatial and personnel capacities for the treating hospital. Yet, a requirement for hospitals to administer bezlotoxumab is the previously made request for additional fees and a successful price negotiation.
Potential biomarkers of miRNA in non-functional pituitary adenomas
Authors: Zhang Qizhi , Wang Ying , Zhou Yinting , Zhang Qiujuan , Xu Chuan 
Published: September 2021

Abstract
Background
The abnormal expression of microRNA (miRNA) has been proved to be closely related to the occurrence and progression of tumors. A unique expression of multiple miRNAs has been found in different types of tumors. However, the correlation between miRNA and non-functional pituitary adenoma (NFPA) is not clear. In this study, miRNAs (miRNA-26b, miRNA-138, miRNA-206, and miRNA-let-7e) have been used as detection genes to compare the miRNA expression levels of NFPA subjects and healthy controls and to explore the expression of four different miRNAs in NFPA.

Methods
Ten untreated NFPA volunteers were served as subjects, and 10 normal subjects were selected as controls. Peripheral blood samples were collected, and four differentiated expressed miRNAs (miRNA-26b, miRNA-138, miRNA-206, and miRNA-let-7e) obtained in the early stage of the test group were detected, recorded, and archived by quantitative real-time PCR (qPCR). The difference and significance of endogenous miRNA expressions were explored through statistical analysis, hoping to find biomarkers for clinical treatment.

Results
The levels of miRNA-26b, miRNA-138, miRNA-206, and miRNA-let-7e in the peripheral serum of patients with NFPA were significantly lower than those in normal subjects (P < 0.05).

Conclusion
miRNA-26b, miRNA-138, miRNA-206, and miRNA-let-7e may be involved in the occurrence and progress of NFPAs. This study aims to study the biological targets of NFPA. It starts from the study of whether miRNA, miRNA-26b, miRNA-138, miRNA-206, and miRNA-let-7e may be tumor suppressor genes in NFPA, which provides a basis for further exploration of tumor markers of pituitary adenoma.
Antimicrobial peptides: mechanism of action, activity and clinical potential
Authors: Zhang Qi-Yu , Yan Zhi-Bin , Meng Yue-Ming , Hong Xiang-Yu , Shao Gang , Ma Jun-Jie , Cheng Xu-Rui , Liu Jun , Kang Jian , Fu Cai-Yun 
Published: September 2021

AbstractThe management of bacterial infections is becoming a major clinical challenge due to the rapid evolution of antibiotic resistant bacteria. As an excellent candidate to overcome antibiotic resistance, antimicrobial peptides (AMPs) that are produced from the synthetic and natural sources demonstrate a broad-spectrum antimicrobial activity with the high specificity and low toxicity. These peptides possess distinctive structures and functions by employing sophisticated mechanisms of action. This comprehensive review provides a broad overview of AMPs from the origin, structural characteristics, mechanisms of action, biological activities to clinical applications. We finally discuss the strategies to optimize and develop AMP-based treatment as the potential antimicrobial and anticancer therapeutics.