bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chameleon project: a children’s end-of-life care quality improvement project
Authors: Wolff Toni , Dorsett Caroline , Connolly Alexander , Kelly Nicola , Turnbull Jennifer , Deorukhkar Anjum , Clements Helena , Griffin Hayley , Chhaochharia Anjana , Haynes Sarah , Webb Kerry , Manning Joseph C 
Published: December 2021

In response to there being no specialist paediatric palliative care (PPC) team in a region of England, we undertook a 12-month quality improvement project (funded by National Health Service England’s Marginal Rate Emergency Threshold and Readmission fund) to improve children’s end-of-life care.Improvements were implemented during two plan–do–study–act (PDSA) cycles and included specialist experts, clinical champions, focused education and training, and tools and materials to support identification, care planning and communication. A lead paediatrician with expertise in PPC (10 hours/week) led the project, supported by a PPC nurse (3 days/week) and a network administrator (2 days/week).Children who died an expected death were identified from the child death review teams. Numbers of non-elective hospital admissions, bed days, and costs were identified.Twenty-nine children died an expected death during the 12 months of the project and coincidentally 29 children died an expected death during the previous 12 months. The median number of non-elective admissions in the last 12 months of life was reduced from two per child to one. There was a reduction in specialist hospital (14%) and district general hospital (38%) bed days. The percentage of children who died an expected death who had anticipatory care plans rose from 50% to 72%.The results indicate that a network of clinicians with expertise in PPC working together across a region can improve personalised care planning and reduce admissions and bed days for children in their last year-of-life with reduced bed utilisation costs.
Deviated and early unsustainable stunted development of gut microbiota in children with autism spectrum disorder
Authors: Lou Mingxing , Cao Aihua , Jin Cuiyuan , Mi Kai , Xiong Xiyue , Zeng Zhaoyang , Pan Xu , Qie Jinlong , Qiu Shangfeng , Niu Yaofang , Liang Hao , Liu Yanping , Chen Lin , Liu Zhi , Zhao Qing , Qiu Xiyan , Jin Yuanxiang , Sheng Xiaoqi , Hu Zhibin , Jin Gulei , Liu Jingshi , Liu Xingyin , Wang Yichao 
Published: December 2021

ObjectiveRecent studies have provided insights into the gut microbiota in autism spectrum disorder (ASD); however, these studies were restricted owing to limited sampling at the unitary stage of childhood. Herein, we aimed to reveal developmental characteristics of gut microbiota in a large cohort of subjects with ASD combined with interindividual factors impacting gut microbiota.DesignA large cohort of 773 subjects with ASD (aged 16 months to 19 years), 429 neurotypical (NT) development subjects (aged 11 months to 15 years) were emolyed to determine the dynamics change of gut microbiota across different ages using 16S rRNA sequencing.ResultIn subjects with ASD, we observed a distinct but progressive deviation in the development of gut microbiota characterised by persistently decreased alpha diversity, early unsustainable immature microbiota, altered aboudance of 20 operational taxonomic units (OTUs), decreased taxon detection rate and 325 deregulated microbial metabolic functions with age-dependent patterns. We further revealed microbial relationships that have changed extensively in ASD before 3 years of age, which were associated with the severity of behaviour, sleep and GI symptoms in the ASD group. This analysis demonstrated that a signature of the combination of 2 OTUs, Veillonella and Enterobacteriaceae, and 17 microbial metabolic functions efficiently discriminated ASD from NT subjects in both the discovery (area under the curve (AUC)=0.86), and validation 1 (AUC=0.78), 2 (AUC=0.82) and 3 (AUC=0.67) sets.ConclusionOur large cohort combined with clinical symptom analysis highlights the key regulator of gut microbiota in the pathogenesis of ASD and emphasises the importance of monitoring and targeting the gut microbiome in future clinical applications of ASD.
Disrupted reward processing in Parkinson’s disease and its relationship with dopamine state and neuropsychiatric syndromes: a systematic review and meta-analysis
Authors: Costello Harry , Berry Alex J , Reeves Suzanne , Weil Rimona S , Joyce Eileen M , Howard Robert , Roiser Jonathan P 
Published: December 2021

BackgroundNeuropsychiatric symptoms are common in Parkinson’s disease (PD) and predict poorer outcomes. Reward processing dysfunction is a candidate mechanism for the development of psychiatric symptoms including depression and impulse control disorders (ICDs). We aimed to determine whether reward processing is impaired in PD and its relationship with neuropsychiatric syndromes and dopamine replacement therapy.MethodsThe Ovid MEDLINE/PubMed, Embase and PsycInfo databases were searched for articles published up to 5 November 2020. Studies reporting reward processing task performance by patients with PD and healthy controls were included. Summary statistics comparing reward processing between groups were converted to standardised mean difference (SMD) scores and meta-analysed using a random effects model.ResultsWe identified 55 studies containing 2578 participants (1638 PD and 940 healthy controls). Studies assessing three subcomponent categories of reward processing tasks were included: option valuation (n=12), reinforcement learning (n=37) and reward response vigour (n=6). Across all studies, patients with PD on medication exhibited a small-to-medium impairment versus healthy controls (SMD=0.34; 95% CI 0.14 to 0.53), with greater impairments observed off dopaminergic medication in within-subjects designs (SMD=0.43, 95% CI 0.29 to 0.57). Within-subjects subcomponent analysis revealed impaired processing off medication on option valuation (SMD=0.57, 95% CI 0.39 to 0.75) and reward response vigour (SMD=0.36, 95% CI 0.13 to 0.59) tasks. However, the opposite applied for reinforcement learning, which relative to healthy controls was impaired on-medication (SMD=0.45, 95% CI 0.25 to 0.65) but not off-medication (SMD=0.28, 95% CI −0.03 to 0.59). ICD was the only neuropsychiatric syndrome with sufficient studies (n=13) for meta-analysis, but no significant impairment was identified compared tonon-ICD patients (SMD=−0.02, 95% CI −0.43 to 0.39).ConclusionReward processing disruption in PD differs according to subcomponent and dopamine medication state, and warrants further study as a potential treatment target and mechanism underlying associated neuropsychiatric syndromes.
Medical management for the prevention of kidney stones
Authors: Finger Mark , Finger Evan , Bellucci Alessandro , Malieckal Deepa A 
Published: December 2021

Abstract
The alarming fact is that approximately one out of every 10 of us will have a kidney stone during our lifetime. The increasing prevalence and associated costs of kidney stones have resulted in it being one of the most commonly encountered and impactful medical conditions. Contributing factors include, but are not limited to, diet, climate, genetics, medications, activity and underlying medical conditions. Symptoms generally parallel stone size. Treatment varies from supportive to procedural (invasive and non-invasive). Prevention remains the best way to avoid this condition especially given the high recurrence rate. First time stone formers require counselling regarding dietary adjustments. Certain risk factors ultimately require a more in-depth metabolic investigation, especially if stones are recurrent. Ultimately, management is defined by stone composition. Where appropriate, we review both pharmacologic and non-pharmacologic options. Pivotal to successful prevention is patient education and the encouragement of compliance with the appropriate regimen.
Cigarette smoking and misperceived norms among adults in rural Uganda: a population-based study
Authors: Perkins Jessica M , Kakuhikire Bernard , Baguma Charles , Evans Claire Q , Rasmussen Justin D , Satinsky Emily N , Kyokunda Viola , Juliet Mercy , Ninsiima Immaculate , Bangsberg David R , Tsai Alexander C 
Published: December 2021

BackgroundLittle is known about perceived norms about cigarette smoking in Uganda or the extent to which perceptions drive personal cigarette smoking behaviour.MethodsWe conducted a cross-sectional study in 2016–2018 that targeted all adults who resided within eight villages in Rwampara District, southwestern Uganda. Personal cigarette smoking frequency was elicited by self-report. We also asked participants what they believed to be the cigarette smoking frequency of most other adult men and women in their villages (i.e., perceived norms). Frequent cigarette smoking was defined as 4+ times/week. We compared perceived norms to cigarette smoking frequency reports aggregated at the village level. We used multivariable Poisson regression to estimate the association between perceived norms and personal cigarette smoking behaviour.ResultsAmong 1626 participants (91% response rate), 92 of 719 men (13%) and 6 of 907 women (0.7%) reported frequent smoking. However, 1030 (63%) incorrectly believed most men in their villages smoked cigarettes frequently. Additionally, 116 (7%) incorrectly believed that most women in their villages smoked cigarettes frequently. These misperceptions were pervasive across social strata. Men who misperceived frequent cigarette smoking as the norm among other men in their villages were more likely to smoke frequently themselves (adjusted relative risk=1.49; 95% CI, 1.13 to 1.97).ConclusionsMost adults overestimated cigarette smoking frequency among village peers. Men who incorrectly believed that frequent smoking was the norm were more likely to engage in frequent smoking themselves. Applying a ‘social norms approach’ intervention by promoting existing healthy norms may prevent smoking initiation or motivate reductions in smoking among men in rural Uganda.
Computed tomography angiography is associated with low added utility for detecting clinically relevant vascular injuries among patients with extremity trauma
Authors: Brian Riley , Bennett Daniel J , Kim Woon Cho , Stein Deborah M 
Published: December 2021

BackgroundExtremity CT angiography (CTA) is frequently used to assess for vascular injury among patients with extremity trauma. The injured extremity index (IEI), defined as the ratio of systolic occlusion pressure between injured and uninjured extremities, has been implemented to screen patients being considered for CTA. Physical examination together with IEI is extremely sensitive for significant extremity vascular injury. Unfortunately, IEI cannot always be calculated. This study aimed to determine whether patients with normal pulse examinations and no hard signs of vascular injury benefitted from further imaging with CTA. We hypothesized that CTA has become overused among patients with extremity trauma, as determined by the outcome of vascular abnormalities that underwent vascular intervention but were missed by physical examination.MethodsThe charts of traumatically injured patients who underwent extremity CTA were retrospectively reviewed. This study was performed at a level 1 trauma center for patients who presented as trauma activations from September 1, 2019 to September 1, 2020.ResultsOne hundred and thirty-six patients with 167 injured limbs were included. Eight limbs (4.8%) underwent an open vascular operation, whereas five limbs (3.0%) underwent an endovascular procedure. One of the 167 limbs (0.6%) had a vascular injury seen on CTA and underwent intervention that was not associated with a pulse abnormality or hard signs of vascular injury. This patient presented in a delayed fashion after an initially normal IEI and examination. Proximity injuries and fractures alone were not highly associated with vascular injuries.DiscussionMany patients with normal pulse examination and no hard signs of vascular injury underwent CTA; the vast majority of these patients did not then have a vascular intervention. Given the consequences of missed vascular injuries, further work is required to prospectively assess the utility of CTA among patients with extremity trauma.Level of evidenceIII.
Thirty-year effects of liming on soil and foliage chemistry and growth of northern hardwoods in Pennsylvania, USA
Authors: Long Robert P. , Bailey Scott W. , Horsley Stephen B. , Hall Thomas J. 
Published: December 2021

The longevity of a single 22.4 Mg·ha−1 application of dolomitic limestone at four northern hardwood stands was evaluated over 30 years (1986–2016) to determine whether changes in soils, foliage, and tree growth were sustained on the unglaciated Allegheny Plateau in northern Pennsylvania, USA. In limed plots, soils, sampled to 45–55 cm depth, and sugar maple (Acer saccharum Marsh.) and black cherry (Prunus serotina Ehrh.) foliage had significantly (P ≤ 0.05) greater concentrations of calcium (Ca) and magnesium (Mg) through 2016 compared with samples from unlimed plots. Ca and Mg capitals (g·m−2) in the Oi through A horizons combined were greater on limed plots than unlimed plots, largely due to increases in the thickness and nutrient concentration in the A horizon. Over 30 years, sugar maple basal area increment (cm2·year−1 BAINC) was greater in limed plots (30.6 cm2·year−1 vs unlimed 13.3), American beech (Fagus grandifolia Ehrh.) BAINC was unaffected by lime application, and black cherry BAINC was reduced in limed plots compared with unlimed plots. The sustained effect of this one-time lime treatment shows the strong role of efficient nutrient cycling in forests and suggests that the benefits over a substantial portion of a stand rotation may increase the feasibility of operational liming.
When Language Contact Says Nothing: A Contrastive Analysis of Queísta Structures in Two Varieties of Peninsular Spanish
Authors: Blas Arroyo José Luis 
Published: December 2021

Abstract
Based on the existence of some structural conflict between Spanish and Catalan in certain points of the syntax, this study tests the hypothesis about the influence of the latter on the distribution of queísmo uses (‘Me alegro que vengas’ [‘I’m glad you come’]) in the Spanish spoken in an eastern peninsular variety in contact with Catalan. Using the tools of comparative sociolinguistics, and the analysis of three corpora of contemporary Spanish, the study exhaustively examines the conditioning of this variable. The starting hypothesis is that the influence of the contact can be inferred from the comparison between different magnitudes derived from a multivariable statistical analysis. In addition to several linguistic and extra-linguistic predictors previously analysed in the literature, we also take into account other factor groups that may be particularly informative about that potential influence. Thus, from a structural point of view, we consider the contrast between: a) conjunctive queísmo in verbal structures, in which the structural conflict with Spanish is more evident (‘me acuerdo (de) que vino con su mujer/em recorde Ø que va vindre amb la seua dona’ [‘I remember that he came with his wife’]; and b) pronominal queísmo in relative sentences, in which the coincidence between both languages is greater (‘el día (en) que nos conocimos / el día (en) què ens vam conéixer’). From an extralinguistic perspective, the incidence of two additional factors is also examined: a) the speech community (without contact (Madrid/Alcalá) vs. in contact (Castellón), and b) the main language of the speakers (Spanish/Catalan-Valencian). The results of several mixed-effect regression analyses performed do not support the hypothesis of contact. The distributional differences between the above-mentioned groups are minimal, and in no case significant. On the other hand, the variation is basically affected by the same structural and non-structural predictors, regardless of the speech community or the ethnolinguistic group examined. Even the few divergences that are observed point in a direction contrary to that expected by the contact hypothesis. The study concludes with some potential explanations about these results and the contrast with other cases of syntactic convergence with Catalan.
On the Effect of Surface Friction and Upward Radiation of Energy on Equatorial Waves
Authors: Lin Jonathan , Emanuel Kerry 
Published: December 2021

Abstract
In theoretical models of tropical dynamics, the effects of both surface friction and upward wave radiation through interaction with the stratosphere are oft-ignored, as they greatly complicate mathematical analysis. In this study, we relax the rigid-lid assumption and impose surface drag, which allows the barotropic mode to be excited in equatorial waves. In particular, a previously developed set of linear, strict quasi-equilibrium tropospheric equations is coupled with a dry, passive stratosphere, and surface drag is added to the troposphere momentum equations. Theoretical and numerical model analysis is performed on the model in the limits of an inviscid surface coupled to a stratosphere, as well as a frictional surface under a rigid lid. This study confirms and extends previous research that shows the presence of a stratosphere strongly shifts the growth rates of fast-propagating equatorial waves to larger scales, reddening the equatorial power spectrum. The growth rates of modes that are slowly propagating and highly interactive with cloud radiation are shown to be negligibly affected by the presence of a stratosphere. Surface friction in this model framework acts as purely a damping mechanism and couples the baroclinic mode to the barotropic mode, increasing the poleward extent of the equatorial waves. Numerical solutions of the coupled troposphere–stratosphere model with surface friction show that the stratosphere stratification controls the extent of tropospheric trapping of the barotropic mode, and thus the poleward extent of the wave. The superposition of phase-shifted barotropic and first baroclinic modes is also shown to lead to an eastward vertical tilt in the dynamical fields of Kelvin wave–like modes.
The Influence of Weather on Fatal Accidents in Austrian Mountains
Authors: Neumair Matthias , Estrella Nicole , Menzel Annette , Ankerst Donna P. 
Published: December 2021

Abstract
Projections of warmer global temperatures in fast-approaching time horizons warrant planning strategies for reducing impacts on human morbidity and mortality. This study sought to determine whether increases in temperature and other changes in weather indices had an impact on rates of fatal accidents occurring in the popular mountainous regions of Austria, with the purpose of improving prevention and accident-mitigation strategies in the mountains. The study was based on the merging of 3285 fatal outdoor accidents reported by the Austrian Alpine Safety Board for the period 2006 to 2018 with daily meteorological data from 43 nearby climate stations during the same period. Multivariable logistic regression was used to model the odds of one or more fatal accidents per station and day with weather indices as predictors, controlling for weekend effects bringing more visitors to the mountains. Separate prediction models were performed for summer and winter activities, as well as for specific disciplines. Even after adjustment for concomitant effects impacting mountain fatal accidents, the daily weather indices of temperature, relative humidity, global radiation, cloudiness, snow cover and precipitation were statistically significantly associated with fatal-accident risk. In particular, a 1° increase in temperature was associated with a 13% increase in odds of a mountain-biking accident in the summer and an 8% increase in odds of a mountain suicide in the winter. An increase in global radiation by 1 kW h m−2 was associated with an 11% and 28% increase in fatal-accident odds for mountaineering in the summer and touring in the winter, respectively.
Examining More Lymph Nodes May Improve the Prognosis of Patients With Right Colon Cancer: Determining the Optimal Minimum Lymph Node Count
Authors: Wu Wentao , Li Daning , Ma Wen , Zheng Shuai , Han Didi , Xu Fengshuo , Yan Hong , Lyu Jun 
Published: December 2021

Objectives The objective is to determine the optimal minimum lymph node examination number for right colon cancer (RCC) patients. Methods We comprehensively analysed the Surveillance, Epidemiology and End Results database data from 2004 to 2016 to determine the 13-year trend in the number of lymph nodes examined among 108,703 left colon cancer and 165,937 RCC patients. 133,137 RCC patients eligible for inclusion were used to determine the optimal minimum for lymph node examination. We used restricted cubic splines to analyse the dose-response relationship between the number of lymph nodes examined and prognosis. X-tiles and decision trees were used to determine the optimal cutoff for the number of lymph nodes based on the survival outcomes of patients with RCC. The Kaplan–Meier method and COX model were used to estimate the overall survival and independent prognostic factors, and a prediction model was constructed. The C-index, calibration curve, net reclassification improvement and integrated discrimination improvement were used to determine the predictive performance of the model, and decision curve analysis was used to evaluate the benefits. Results Lymph node examinations were common among colon cancer patients over the 13-year study period. It is generally agreed that at least 12 lymph nodes must be examined to ensure proper dissection and accurate staging of RCC; however, the optimal number of lymph nodes to be examined is controversial. The dose-response relationship indicated that 12 was not the optimal minimum number of lymph nodes for RCC patients. X-tile and survival decision-tree analysis indicated that 20 nodes was the optimal number. Survival analysis indicated that <20 nodes examined was a risk factor for poor prognosis, and the classification performance was superior for 20 nodes compared to 12 nodes. Conclusion Lymph node examination in RCC patients should be altered. Our research suggests that a 20-node measure may be more suitable for RCC patients.
Salvaging the 'irreparable' tear: Superior Capsular Reconstruction augmented with partial cuff repair
Authors: Wong Seng Juong , Neo Jun Hao Benjamin , Marian Lie Hannah , Tjoen Lie Denny Tjiauw 
Published: December 2021

Introduction Massive rotator cuff tears (MRCTs) have long posed a complex problem for both patients and surgeons. If not treated promptly, tendon retraction, fatty infiltration and muscle atrophy of the rotator cuff muscles occur. These lead to irreparable RCTs with poor functional outcomes. We describe our technique of superior capsular reconstruction (SCR) augmented with partial cuff repair and report on our short term outcomes Method Seven consecutive patients who underwent the procedure were recruited at our institution from January 2019 to December 2019. Medical records of these patients were reviewed looking at pre-operative symptoms and examination findings, imaging studies, intra-operative findings, the surgical technique employed, post-operative progress in terms of pain, affected shoulder range of movement and outcome scores. Results All patients showed complete tears of at least two tendons and were deemed irreparable intra-operatively. All patients exhibited Goutalier grade 2–4 wasting of the affected tendons on MRI and Patte grade 3 intra-operatively. At 12 months, the mean improvement shown in Constant score is 12.1 points, in University of California Los Angeles (UCLA) score is 9.4 points and in Oxford Shoulder Score is 17 points. Active forward flexion improved in all patients with a mean improvement of 40 degrees. Numerical Pain Rating Scale improved in all patients with a mean of 5.1 points. Conclusion Our case series shows good short-term outcomes can be achieved with SCR augmented with partial cuff repair. Notably, our SCR results showed encouraging results even for challenging revision rotator cuff repairs.