bluuebunny/crossref_metadata_2025_split huggingface dataset:
Provider Care Team Segregation and Operative Mortality Following Coronary Artery Bypass Grafting
Authors: Hollingsworth John M. , Yu Xianshi , Yan Phyllis L. , Yoo Hyesun , Telem Dana A. , Yankah Ekow N. , Zhu Ji , Waljee Akbar K. , Nallamothu Brahmajee K. 
Published: April 2021

Background:
Black patients die more frequently following coronary artery bypass grafting (CABG) than their White counterparts for reasons not explained by disease severity or comorbidity. We analyzed medical claims to determine the contribution of provider care team segregation within hospitals contributes to this inequity.

Methods:
We analyzed national Medicare data, identifying beneficiaries who underwent coronary artery bypass grafting at hospitals where procedures were performed between 2008 and 2014 (n=12 414). After determining the providers who delivered perioperative care, we examined the extent to which Black and White patients were cared for by unique provider care team networks within the same hospital. We evaluated whether a lack of overlap in composition of these networks treating Black versus White patients (ie, high segregation) was associated with higher 90-day operative mortality among Black patients.

Results:

Levels of provider care team segregation were moderate (median, 0.493) and varied across hospitals (interquartile range, 0.439–0.542). Compared with patients treated at low segregation hospitals, those treated at medium and high segregation hospitals were more likely to be older, white, and undergo an elective procedure (
P
<0.01 for each comparison). After controlling for these and other differences, Black patients treated at high segregation hospitals had numerically higher mortality than those treated at low segregation hospitals (6.4% [95% CI, 3.4%–11.6%] versus 4.4% [95% CI, 2.3%–8.1%], respectively), but this difference was nonsignificant (
P
=0.495). In contrast, White patients treated at high segregation hospitals had significantly lower mortality than those treated at low segregation hospitals (4.9% [95% CI, 4.1%–5.8%] versus 7.5% [95% CI, 5.8%–6.3%];
P
=0.007).

Conclusions:
There are often unique systems of provider care teams, which treat Black patients but do not overlap with those of White patients undergoing coronary artery bypass grafting. Provider care team differences may contribute to surgical outcome variability between Black and White patients.
Variability in Isolated Convective Activity between Louisville, Kentucky, and Nearby Rural Locations
Authors: Naylor Jason , Kennedy Aaron D. 
Published: May 2021

AbstractThis study analyzes the frequency of strong, isolated convective cells in the vicinity of Louisville, Kentucky. Data from the Severe Weather Data Inventory are used to compare the frequency of convective activity over Louisville with the observed frequency at nearby rural locations from 2003 to 2019. The results show that Louisville experiences significantly more isolated convective activity than do the rural locations. The difference in convective activity between Louisville and the rural locations is strongest during summer, with peak differences occurring between May and August. Relative to the rural locations, Louisville experiences more isolated convective activity in the afternoon and early evening but less activity after midnight and into the early morning. Isolated convective events over Louisville are most likely during quiescent synoptic conditions, whereas rural events are more likely during active synoptic patterns. To determine whether these differences can be attributed primarily to urban effects, two additional cities are shown for comparison—Nashville, Tennessee, and Cincinnati, Ohio. Both Nashville and Cincinnati experience more isolated convective activity than all five of their nearby rural comparison areas, but the results for both are statistically significant at four of the five rural locations. In addition, the analysis of Cincinnati includes a sixth comparison site that overlaps the urbanized area of Columbus, Ohio. For that location, differences in convective activity are not statistically significant.
A Lagrangian Study of Interfaces at the Edges of Cumulus Clouds
Authors: Nair Vishnu , Heus Thijs , van Reeuwijk Maarten 
Published: April 2021

AbstractInterfaces at the edge of an idealized, nonprecipitating, warm cloud are studied using direct numerical simulation (DNS) complemented with a Lagrangian particle tracking routine. Once a shell has formed, four zones can be distinguished: the cloud core, visible shell, invisible shell, and the environment. The union of the visible and invisible regions is the shell commonly referred to in literature. The boundary between the invisible shell and the environment is the turbulent–nonturbulent interface (TNTI), which is typically not considered in cloud studies. Three million particles were seeded homogeneously across the domain and properties were recorded along individual trajectories. The results demonstrate that the traditional cloud boundary (separating cloudy and noncloudy regions using thresholds applied on liquid condensate or updraft velocity) are some distance away from the TNTI. Furthermore, there is no dynamic difference between the traditional liquid-condensate boundary and the region extending to the TNTI. However, particles crossing the TNTI exhibit a sharp jump in enstrophy and a smooth increase in buoyancy. The traditional cloud boundary coincides with the location of minimum buoyancy in the shell. The shell premixes the entraining and detraining air and analysis reveals a highly skewed picture of entrainment and detrainment at the traditional cloud boundary. A preferential entrainment of particles with velocity and specific humidity higher than the mean values in the shell is observed. Large-eddy simulation of a more realistic setup detects an interface with similar properties using the same thresholds as in the DNS, indicating that the DNS results extrapolate beyond their idealized conditions.
An independent, replicable, functional and significant risk variant block at intron 3 of CACNA1C for schizophrenia
Authors: Wang Zuxing , Chen Wenzhong , Cao Yuping , Dou Yikai , Fu Yingmei , Zhang Yong , Luo Xingqun , Kang Longli , Liu Na , Shi Yun Stone , Li Chiang-shan R , Xu Yifeng , Guo Xiaoyun , Luo Xingguang 
Published: May 2021

Objectives: Genome-wide association studies have identified a significant risk gene, CACNA1C, for schizophrenia. In this study, we comprehensively investigated a large set of CACNA1C single-nucleotide polymorphisms (SNPs) to identify the replicable risk alleles for schizophrenia and explore their biological functions. Methods: One Jewish (1044 cases vs 2052 controls), one European (1350 cases vs 1378 controls) and one exploratory African American samples (98 cases vs 20 controls) were analyzed to identify replicable single-nucleotide polymorphism–schizophrenia associations. The regulatory effects of risk alleles on CACNA1C messenger RNA expression were examined. The most robust risk tagSNP (rs1006737) was meta-analyzed on 17 studies (74,122 cases vs 109,062 controls), and associated with the gray matter volumes of seven subcortical structures in 38,258 Europeans, and the surface areas and thickness of 34 cortical regions in 33,992 Europeans and 2944 non-Europeans. Results: Forty-seven replicable risk single-nucleotide polymorphisms, including a 20-single-nucleotide polymorphism haplotype block, were identified in our samples (1.8 × 10−4 ⩽  p ⩽ 0.049). This variant block was consistently associated with schizophrenia across four independent Psychiatric Genomics Consortium cohorts (79,645 cases vs 109,590 controls; 2.5 × 10–17 ⩽  p ⩽ 0.017). This block showed significant expression quantitative trait loci in three independent European brain cohorts (5.1 × 10–12 ⩽  p ⩽ 8.3 × 10–3) and could be tagged by the most significant risk single-nucleotide polymorphism rs1006737. The minor allele A of rs1006737 significantly increased risk for schizophrenia across the Jewish and European samples ( p = 0.029 and 0.004, respectively), and this association was highly significant in the meta-analysis ( p = 1.62 × 10–42). This allele also significantly altered the CACNA1C messenger RNA expression in five brain regions (5.1 × 10–12 ⩽  p ⩽ 0.05), decreased the gray matter volume of thalamus ( p = 0.010), the surface area of isthmus cingulate cortex ( p = 0.013) and the thickness of transverse temporal and superior temporal sulcus cortexes (0.005 ⩽  p ⩽ 0.043). Conclusion: We identified an independent, replicable, functional, and significant risk variant block at CACNA1C for schizophrenia, which could be tagged by the most robust risk marker rs1006737, suggesting an important role of CACNA1C in the pathogenesis of schizophrenia.
Examining the magnitude and perception of summertime overheating in London care homes
Authors: Gupta Rajat , Howard Alastair , Davies Mike , Mavrogianni Anna , Tsoulou Ioanna , Oikonomou Eleni , Wilkinson Paul 
Published: May 2021

This paper brings together objective and subjective data on indoor temperature and thermal comfort to examine the magnitude and perception of summertime overheating in two London-based care homes occupying modern and older buildings. Continuous monitoring of indoor and outdoor temperature, relative humidity and CO2 levels was conducted in summer 2019 along with thermal comfort surveys and semi-structured interviews with older residents and staff of the care settings. Indoor temperatures were found to be high (>30°C) with bedroom temperatures often higher at night than daytime across both care settings. Limited opening due to window restrictors constrained night-time ventilation. Overheating was prevalent with four out of the five monitored bedrooms failing all four overheating metrics investigated. While 35–42% of staff responses perceived indoor temperatures to be uncomfortably hot, only 13–19% of resident responses were found to do so, indicating that elderly residents tend to be relatively insensitive to heat, leaving them open to overheating without realising it. Residents and staff in the modern care setting were less satisfied with their thermal conditions. As hybrid buildings, care settings need to keep both residents and staff comfortable and healthy during hot weather through night-time ventilation, management of heating and supportive institutional practices. Practical application: Care home designs have focused on keeping residents warm through the winter, neglecting the risks of summertime overheating. Care homes are hybrid buildings serving as living spaces for vulnerable older residents and offices/workspaces for staff. Providing comfort to both groups during periods of hot weather is challenging. Opportunities for ventilation are limited by Health & Safety regulations that mandate up to 10 cm maximum window openings and institutional practices that result in windows routinely kept closed, particularly at night. Utilising natural and where possible cross-ventilation should be considered along with external shading. Heating should be managed to avoid unwanted heat gains in the summer.
Frequency domain analysis and clinical outcomes of pulsatile and non-pulsatile blood flow energy during cardiopulmonary bypass
Authors: Jiang Qiliang , Sun Jian , Xu Lingfeng , Chang Xin , Sun Lin , Zhen Yue , Guo Zhen 
Published: April 2021

Introduction: The superiority of pulsatile perfusion during cardiopulmonary bypass remains controversial. We analyzed the frequency-domain characteristics and organ protection of pulsatile and nonpulsatile flow in adult patients with valvular disease. Methods: EEP and SHE were used to calculate blood flow energy in 60 patients. The Fast Fourier Transform was employed to analyze the power spectral density and power density ratio (Rvpd) of flow energy. Changes in endothelin-1, nitric oxide, interleukin-6,10, tumor necrotic factor, S100β, NSE, blood and urinary β2-microglobulin levels were investigated to assess the endothelial function, inflammatory reaction, kidney and brain injury during CPB. Results: EEP and SHE in PP group at each time point were 1.52–1.62 times and 2.03–2.22 times higher respectively compared with NP group. Power spectral density analysis demonstrated that the blood flow energy frequencies in each group were all within 40 Hz and the low frequency energy (0–5 Hz) was dominant in physiological perfusion (>90%). The energy ratio of 0–5 Hz at radial artery was significantly decreased compared with that of post arterial filter in PP (81% vs 64%) and NP (63% vs 37%) group. The power density ratio (Rvpd) was higher than that of NP in all frequency ranges at the radial artery (9.51 vs 4.68 vs 3.59) and arterial filter (3.87 vs 2.69 vs 2.38). The S100β, NSE Urinary and plasma β2-microglobulin level were significantly increased at 6 and 24 hours after surgery in two group, and significantly higher in group NP. Conclusion: PP provided more energy than NP. The proportion of low frequency energy in the pulsatile or nonpulsatile flow is significantly reduced. The low-frequency energy is significantly attenuated during conduction to peripheral tissues in nonpulsatile flow. The surplus pulsatile energy influences the secretion of endothelial and inflammatory factors, and demonstrate better cerebral and kidney protective effect at the biological marker level.
The importance of living well now and relationships: A qualitative study of the barriers and enablers to engaging frail elders with advance care planning
Authors: Combes Sarah , Gillett Karen , Norton Christine , Nicholson Caroline Jane 
Published: May 2021

Background: The population of frail elders is growing, and due to their vulnerability to sudden deterioration, advance care planning is particularly important. However, advance care planning is uncommon for multiple reasons, some of which are linked to the perceptions of frail elders and their families. Aim: To explore the barriers and enablers to advance care planning engagement with frail elders. Design: Qualitative in-depth interviews with thematic analysis. Setting/participants: Purposive sample of 10 frail elders and 8 nominated family members using a community-based older persons’ service run by a large urban UK hospice. Frail elders had capacity, were ⩾65 (median 85, range 71–95), scored 6 or 7 (median 6.5) on the Clinical Frailty Scale, and 70% were female. Results: Key barriers were: Advance care planning is unclear, in terms of meaning and the language used; Lack of relevance, with frail elders preferring to focus on living well now; and the Importance of family, relationships and home, and the influence of relationship on end of life decision-making. Engagement strategies included preparing the frail elder for advance care planning conversations and using a gentle, honest, individualised approach. Conclusions: Essential enablers for frail elders are understanding what advance care planning is and why it may be relevant to them. For professionals, enablers include recognising the importance of living well now and relational decision-making. To further support advance care planning, recommendations include early engagement and re-conceptualising advance care planning as an ongoing process which encompasses current and future care. Further research is needed in different cultures and care contexts.
Versatile Uses of Crimpable Hooks
Authors: Shenoi Susmita Bala , Badavannavar Anand 
Published: April 2021

The crimpable hook is a widely accepted tool onto which active elements can be fixed to aid in orthodontic tooth movement. This clinical pearl aims at showing the different ways in which crimpable hooks can be used to better orthodontic treatment mechanics, which are Crimpable hooks used for buccolingual force mechanics and Crimpable hooks used in conjunction with orthodontic miniscrews. The above-mentioned simple methods aim to facilitate and make easy the attachment of force elements for various kinds of tooth movements. It can help the operator to save time, prevent unwanted side effects of forces, as well as reduce the need for ligature wires for the attachment of force systems onto implant heads or lingual sheaths.
Determinants of pain interference and headache impact in patients who have chronic migraine with medication overuse: Results from the MOTS trial
Authors: Schwedt Todd J , Sahai-Srivastava Soma , Murinova Natalia , Birlea Marius , Ahmed Zubair , Digre Kathleen , Lopez Kristina , Mullally William , Blaya Maike Tiede , Pippitt Karly , Cutrer Fred Michael , DeLange Justin , Schecht Howard , Rizzoli Paul , Lane Judy , Wald John , Cortez Melissa M , Martin Vincent T , Spare Nicole M , Hentz Joseph G , Robert Teri , Dodick David W ,   on behalf of the MOTS Investigators
Published: May 2021

Objective “Pain interference” and “headache impact” refer to negative consequences that pain and headache have on one’s life. This study investigated determinants of these negative impacts in a large patient cohort who have chronic migraine with medication overuse. Methods Six hundred and eleven adults were enrolled from 34 headache, neurology, and primary care clinics. Negative consequences of chronic migraine with medication overuse were determined using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference 6b questionnaire and the Headache Impact Test 6. Relationships between PROMIS-6b and Headache Impact Test 6 scores with demographics, headache characteristics, medication use, anxiety symptoms, and depression symptoms were assessed with linear regression. Elastic Net regression was used to develop a multiple regression model. Results PROMIS-6b T-Scores averaged 65.2 (SD 5.4) and Headache Impact Test 6 scores averaged 65.0 (SD 5.3), indicating severe negative consequences of chronic migraine with medication overuse. Chronic migraine with medication overuse interfered with enjoyment of life, concentration, daily activities, doing tasks away from home, and socializing. Depression symptom severity had the strongest relationship with pain interference and headache impact. Moderate-to-severe headache frequency, headache intensity, and anxiety symptoms were also associated with pain interference and headache impact. Conclusions Chronic migraine with medication overuse is associated with substantial negative consequences, the extent of which is most strongly related to depression symptoms.
Evaluation of GLP-1 Receptor Agonists in Combination With Multiple Daily Insulin Injections for Type 2 Diabetes
Authors: Sassenrath Kimberly , Phillips Beth Bryles , Stone Rebecca H. 
Published: April 2021

Objective: To assess the available literature evaluating the efficacy and safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with multiple daily insulin injections (MDII). Data Sources: A literature search of MEDLINE and Embase was performed (2004 to May 2020) using the following search terms: glucagon-like 1 receptor agonist, liraglutide, albiglutide, dulaglutide, exenatide, semaglutide, diabetes mellitus, and prandial insulin or bolus insulin. Additional references were obtained from cross-referencing the bibliographies of selected articles. Study Selection and Data Extraction: All information obtained from the searches were reviewed. All relevant trials are included in this review. Data Synthesis: Eight studies met criteria for inclusion. The addition of a GLP-1 RA to multiple daily insulin injections was associated with a reduction in A1c in 7 out of 8 studies, and weight loss in 5 studies. In studies that allowed insulin adjustment after the addition of GLP-1 RA, the average total daily insulin dose was reduced in 3 studies. When evaluated, hypoglycemia frequency or other adverse events were not increased when GLP-1 RAs were added to MDII. Relevance to Patient Care and Clinical Practice: Guidelines do not offer recommendations regarding the use of GLP-1 RAs in combination with MDII regimens. This review evaluates current studies demonstrating efficacy and safety considerations of this combination. Conclusions: While some studies did demonstrate an improvement in A1c and reduction in insulin doses without increased hypoglycemia, larger randomized controlled trials are needed to adequately assess the benefit and safety of GLP-1 RAs in combination with MDII.
Recovery from anorexia nervosa: the influence of women’s sociocultural milieux
Authors: Allison Stephen , Warin Megan , Bastiampillai Tarun , Looi Jeffrey C L , Strand Mattias 
Published: May 2021

Objective: Young women living in industrialised westernised societies have a higher prevalence of anorexia nervosa, partly due to a cultural emphasis on thinness as a beauty ideal. Sociocultural milieux might promote recovery from anorexia nervosa amongst young women. The current article is a commentary about the social influences on recovery from anorexia nervosa – based on social anthropology, narratives of people with lived experience, and clinical studies. Conclusion: Anorexia nervosa increases social withdrawal, and recovery leads to re-engagement with meaningful relationships. Recovery also empowers women as ‘cultural critics’ who challenge assumptions about the thinness beauty ideal and gender roles. The gradual process of full or partial recovery often occurs during emerging adulthood (aged 20–29). In this life stage, adolescent friendship groups are dissolving as women move from education to work, reducing the danger of weight-based teasing by peers, which is an environmental risk factor for disordered eating. Women recovering from anorexia nervosa may connect with those aspirations of peers and mentors that eschew a focus on weight and shape, but relate to the life-stage tasks of starting careers, beginning new friendships, selecting life partners and family formation – that is, a broader role in larger relationship networks.
Protamine Sulfate Neutralization Profile of Various Dosages of Bovine, Ovine and Porcine UFHs and Their Depolymerized Derivatives in Non-Human Primates
Authors: Kouta Ahmed , Jeske Walter , Cera Lee , Farshid Azarfrooz , Duff Richard , Hoppensteadt Debra , Fareed Jawed 
Published: April 2021

Introduction: Currently used unfractionated heparins (UFHs) and low molecular weight heparins (LMWHs) are derived from porcine intestinal mucosa. However, heparins have also been manufactured from tissues of other mammalian species such as cow (Bovine) and sheep (Ovine). Protamine sulphate (PS) is an effective inhibitor of heparin and is used clinically to neutralize both LMWH and UFH. In this study, we determined the PS neutralization profile of these agents in non-human primate model using anti-Xa and anti-IIa methods. Material and Methods: UFHs obtained from bovine, ovine and porcine mucosal tissues and their respective depolymerized LMWHs were administered at both, gravimetric (0.5 mg/kg) and potency adjusted (100 U/kg) dosages regimen intravenously to individual groups of primates in cross over studies. PS was administered at a fixed dosage and the relative neutralization of these anticoagulants was measured utilizing amidolytic anti-Xa and anti-IIa methods. Results: These studies have demonstrated that, the equi-gravimetric dosages of BMH, PMH and OMH have comparable PS neutralization profiles. At potency adjusted dosages, all UFHs were completely neutralized by PS. Although comparable, the LMWHs were not fully neutralized by PS in both the anti-Xa and anti-IIa assays. PS was more efficient in neutralizing the anti-IIa effects of LMWHs. Conclusion: Heparins of diverse origins showed comparable neutralization profiles by PS in the amidolytic anti-Xa and anti-IIa assays.