bluuebunny/crossref_metadata_2025_split huggingface dataset:
Model independent prediction of the spectral index of primordial quantum fluctuations
Authors: Gómez César , Jimenez Raul 
Published: October 2021

Abstract
One of the most important achievements of inflationary cosmology is to predict a departure from scale invariance of the power spectrum for cosmological scalar perturbations. This tilt is understood as a consequence of a quasi de Sitter classical equation of state describing the inflationary dark energy dominated era. Here, following previous work, we find a departure of scale invariance for the quantum Fisher information associated to de Sitter vacuum for scalar quantum spectator modes. This gives rise to a purely quantum cosmological tilt with a well defined dependence on energy scale. This quantum tilt is imprinted, in a scale dependent energy uncertainty for the spectator modes. The effective quasi de Sitter description of this model independent energy uncertainty uniquely sets the effective quasi de Sitter parameters (i.e., the small deviation from the cosmological constant equation of state) at all energy scales. In particular, in the slow-roll regime characterized by an almost constant ϵ, the quantum Fisher — model independent — prediction for the spectral index is n
s = 0.9672. Moreover, the energy scale dependence of the quantum cosmological tilt implies the existence of a cosmological phase transition at energies higher than the CMB scale and of the order of 1 Mpc-1 where the tilt goes from red into blue. This strongly suggest the existence of a pre-inflationary phase where the effective scalaron contributes to the spectral index as normal relativistic matter and where the corresponding growth of the power spectrum can result in dark matter in the form of small mass primordial black holes. The source and features of the quantum cosmological tilt leading to these predictions are determined by the entanglement features of the de Sitter α- vacuum states.
Power exhaust concepts and divertor designs for Japanese and European DEMO fusion reactors
Authors: Asakura N. , Hoshino K. , Kakudate S. , Subba F. , Vorpahl C. , Homma Y. , Utoh H. , Someya Y. , Sakamoto Y. , Hiwatari R. , Suzuki S. , You J.-H. , Siccinio M. , Federici G. 
Published: October 2021

Abstract
Concepts of the power exhaust and divertor design have been developed, with a high priority in the pre-conceptual design phase of the Japan–Europe broader approach DEMO design activity (BA DDA). Common critical issues are the large power exhaust and its fraction in the main plasma and divertor by the radiative cooling (P
rad
tot/P
heat ⩾ 0.8). Different exhaust concepts in the main plasma and divertor have been developed for Japanese (JA) and European (EU) DEMOs. JA proposed a conventional closed divertor geometry to challenge large P
sep/R
p handling of 30–35 MW m−1 in order to maintain the radiation fraction in the main plasma at the ITER-level (f
rad
main = P
rad
main/P
heat ∼ 0.4) and higher plasma performance. EU challenged both increasing f
rad
main to ∼0.65 and handling the ITER-level P
sep/R
p in the open divertor geometry. Power exhaust simulations have been performed by SONIC (JA) and SOLPS5.1 (EU) with corresponding P
sep = 250–300 MW and 150–200 MW, respectively. Both results showed that large divertor radiation fraction (P
rad
div/P
sep ⩾ 0.8) was required to reduce both peak q
target (⩽10 MW m−2) and T
e,i
div. In addition, the JA divertor performance with EU-reference P
sep of 150 MW showed benefit of the closed geometry to reduce the peak q
target and T
e,i
div near the separatrix, and to produce the partial detachment. Integrated designs of the water cooled divertor target, cassette and coolant pipe routing have been developed in both EU and JA, based on the tungsten (W) monoblock concept with Cu-alloy pipe. For year-long operation, DEMO-specific risks such as radiation embrittlement of Cu-interlayers and Cu-alloy cooling pipe were recognized, and both foresee higher water temperature (130 °C–200 °C) compared to that for ITER. At the same time, several improved technologies of high heat flux components have been developed in EU, and different heat sink design, i.e. Cu-alloy cooling pipes for targets and RAFM steel ones for the baffle, dome and cassette, was proposed in JA. The two approaches provide important case-studies of the DEMO divertor, and will significantly contribute to both DEMO designs.
Numerical study on nonlinear double tearing mode in ITER
Authors: Lu S.S. , Ma Z.W. , Tang W. , Zhang W. , Liu Y. 
Published: October 2021

Abstract
The nonlinear dynamics of the m/n = 2/1 double tearing mode (DTM) in ITER are systematically studied using the three-dimensional toroidal magnetohydrodynamic code, CLT. We carefully investigate the effects of the radial locations and magnetic shear strengths of the inner and outer rational surfaces r
1, r
2, s
1 and s
2, as well as the safety factor at the magnetic axis q
0 on DTM. It is found that the explosive burst takes place only with the moderate separation of the two rational surfaces or the stronger magnetic shear strength in which the strong interaction of magnetic islands in the two rational surfaces happens in the early nonlinear phase of the island development. The explosive burst can result from either the direct mutual driving associated with the fast growth island in the two rational surfaces or a strong nonlinear mode–mode coupling. For a large separation and a weak shear strength of the two rational surfaces, the magnetic islands saturate without strong interaction with each other, and (w
in + w
out)/2 is always below the separation Δr
s. For a small separation, the kinetic evolution of DTM only exhibits an oscillation with a very low level and then decreases.
Projected changes in global terrestrial near-surface wind speed in 1.5 °C–4.0 °C global warming levels
Authors: Zha Jinlin , Shen Cheng , Li Zhibo , Wu Jian , Zhao Deming , Fan Wenxuan , Sun Ming , Azorin-Molina Cesar , Deng Kaiqiang 
Published: October 2021

Abstract
Understanding future changes in global terrestrial near-surface wind speed (NSWS) in specific global warming level (GWL) is crucial for climate change adaption. Previous studies have projected the NSWS changes; however, the changes of NSWS with different GWLs have yet to be studied. In this paper, we employ the Max Planck Institute Earth System Model large ensembles to evaluate the contributions of different GWLs to the NSWS changes. The results show that the NSWS decreases over the Northern Hemisphere (NH) mid-to-high latitudes and increases over the Southern Hemisphere (SH) as the GWL increases by 1.5 °C–4.0 °C relative to the preindustrial period, and that these characteristics are more significant with the stronger GWL. The probability density of the NSWS shifts toward weak winds over NH and strong winds over SH between the current climate and the 4.0 °C GWL. Compared to 1.5 °C GWL, the NSWS decreases −0.066 m s−1 over NH and increases +0.065 m s−1 over SH with 4.0 °C GWL, especially for East Asia and South America, the decrease and increase are most significant, which reach −0.21 and +0.093 m s−1, respectively. Changes in the temperature gradient induced by global warming could be the primary factor causing the interhemispheric asymmetry of future NSWS changes. Intensified global warming induces the reduction in Hadley, Ferrell, and Polar cells over NH and the strengthening of the Hadley cell over SH could be another determinant of asymmetry changes in NSWS between two hemispheres.
Species-specific herbivore grazing of type-specific grassland can assist with promotion of shallow layer of soil carbon sequestration
Authors: Li Jie , Chai Hua , Ding Shiwen , Wang Jinsong , Li Xincheng , Li Yinong , Li Tianyun , Liu Jushan , Wang Hongjun , Liang Cunzhu , Wang Chengjie , Liu Yuan , Luo Yiqi , Wang Ling , Wang Deli 
Published: October 2021

Abstract
Grassland soils represent a significant potential pool for the sequestering of atmospheric CO2; however, the magnitude of this pool depends to a certain extent on the grazing management of the grassland. Whether different herbivore species and combinations (herbivore assemblage) influence the soil organic carbon (SOC) in various grasslands remains unclear. Here we have investigated the impacts of herbivore assemblages (NG, no grazing; SG, sheep grazing; CG, cattle grazing; and MG, mixed grazing of sheep and cattle) under moderate grazing intensity on a shallow layer of SOC storage across the three different grassland types (meadow steppe, typical steppe, and desert steppe) in the temperate steppes of Eastern Eurasia. We found that herbivore-species-specific effects on SOC storage depended on the grassland type. In mesic grasslands (i.e. meadow steppe and typical steppe), CG enhanced SOC storage, but there were no effects from SG. In contrast, SG in the xeric grassland (i.e. desert steppe) dramatically increased SOC storage while no effects were observed for CG. Importantly, MG of sheep and cattle consistently increased SOC storage across all grassland types. We suggest that adopting herbivore-type-specific stewardship in different grasslands could assist with the enhancement of ecosystem C functionality and services; large herbivores and small herbivores are suitable for grazing in mesic grasslands and xeric grasslands, respectively. Moreover, MG with diverse herbivores may be the optimal moderate grazing mode for soil C sequestration in most grasslands of northern China.
Anhedonic Depression Is Not Associated With Risk of Recurrent Major Adverse Cardiac Events and All-Cause Mortality in Acute Coronary Syndrome Patients
Authors: Sanchez Gabriel J , Sumner Jennifer A , Schwartz Joseph E , Burg Matthew M , Ye Siqin , Whang William , Peacock James , Duer-Hefele Joan , Clemow Lynn , Kronish Ian M , Davidson Karina W 
Published: October 2021

Abstract

Background
Depression after acute coronary syndrome (ACS) is common and increases risks of adverse outcomes, but it remains unclear which depression features are most associated with major adverse cardiac events (MACE) and all-cause mortality (ACM).

Purpose
To examine whether a subtype of depression characterized by anhedonia and major depressive disorder (MDD) predicts 1-year MACE/ACM occurrence in ACS patients compared to no MDD history. We also consider other depression features in the literature as predictors.

Methods
Patients (N = 1,087) presenting to a hospital with ACS completed a self-report measure of current depressive symptoms in-hospital and a diagnostic interview assessing MDD within 1 week post-hospitalization. MACE/ACM events were assessed at 1-, 6-, and 12-month follow-ups. Cox regression models were used to examine the association of the anhedonic depression subtype and MDD without anhedonia with time to MACE/ACM, adjusting for sociodemographic and clinical covariates.

Results
There were 142 MACE/ACM events over the 12-month follow-up. The 1-year MACE/ACM in patients with anhedonic depression, compared to those with no MDD, was somewhat higher in an age-adjusted model (hazard ratio [HR] = 1.63, p = .08), but was not significant after further covariate adjustment (HR = 1.24, p = .47). Of the additional depression features, moderate-to-severe self-reported depressive symptoms significantly predicted the risk of MACE/ACM, even in covariate-adjusted models (HR = 1.72, p = .04), but the continuous measure of self-reported depressive symptoms did not.

Conclusion
The anhedonic depression subtype did not uniquely predict MACE/ACM as hypothesized. Moderate-to-severe levels of total self-reported depressive symptoms, however, may be associated with increased MACE/ACM risk, even after accounting for potential sociodemographic and clinical confounders.
Aortic Root Diameter in Hypertensive Patients With Various Stages of Obstructive Sleep Apnea
Authors: Wang Dian , Xu Jian-Zhong , Kang Yuan-Yuan , Zhang Wei , Hu Lei-Xiao , Wang Ji-Guang 
Published: October 2021

Abstract

BACKGROUND
Obstructive sleep apnea (OSA) is a risk factor of several cardiovascular diseases. We investigated the association between aortic root diameter and hypoxia-related parameters in hypertensive patients with OSA.

METHODS
Our study included 242 hypertensive patients with OSA (52 mild, 71 moderate, and 119 severe). All the patients underwent echocardiography for measuring aortic root diameter and polysomnography for measuring apnea–hypopnea index (AHI), oxygen desaturation index, and time spent with oxygen desaturation less than 90%.

RESULTS
The study patients included 19.8% women and had a mean (±SD) age of 49.9 ± 12.9 years, a mean aortic root diameter of 33.4 ± 2.6 mm, and a prevalence of echocardiographic aortic root dilation of 3.7%. Patients with mild, moderate, and severe OSA had similar echocardiographic left ventricular structure. However, patients with severe OSA had a significantly (P &lt; 0.05) greater aortic root diameter (33.9 ± 2.4 mm vs. 32.4 ± 2.2 and 33.4 ± 2.9 mm, respectively) and higher prevalence of aortic root dilatation (5% vs. 1% and 3%, respectively) than those with mild and moderate OSA. Aortic root diameter corrected by body height was significantly (P &lt; 0.001) associated with AHI, oxygen desaturation index and time spent with oxygen desaturation less than 90% (r = 0.23–0.33). After adjustment for various confounding factors, the associations between aortic root diameter and polysomnography parameters remained statistically significant (P &lt; 0.05).

CONCLUSIONS
The severity of OSA was associated with the aortic root diameter. Patients with severe OSA had a greater aortic root diameter.
Identifying key roles of the pharmacy technician in primary care settings
Authors: Gadd Shannon , Lopez Conrad E , Nelson Cory A , Le Trung Q , Valle-Oseguera Cynthia S , Cox Nicholas , Buu Jenni , Turner Kyle 
Published: October 2021

Abstract

Purpose
As the pharmacist’s role expands, particularly in primary care practice settings, there is an opportunity for expansion of pharmacy technician duties to aid in administrative and clinical tasks that do not require the pharmacist’s professional judgment. Identifying, defining, and expanding the roles of pharmacy technicians has been deemed a key part of the pharmacy practice model. These roles have been shown to enhance pharmacist efficiency and patient outreach; however, examples of the various innovative activities performed by technicians in the primary care setting are lacking in the literature.

Methods
The duties of primary care pharmacy technicians were compiled and defined in 2 different healthcare systems. The role of the technician was separately implemented at each institution, and study designs and protocols were individually created and executed. One institution utilized a 4-round consensus-building process to systematically refine and codify tasks for a dictionary of duties. The second institution utilized a free-text survey, task documentation data in the electronic medical record, and a telephone discussion with the technicians.

Results
Despite a lack of methods- and data-sharing between the 2 institutions, similar tasks were identified, including conducting patient outreach, assisting with medication affordability and access, providing patient education, managing referrals, and scheduling appointments. Differences in technician involvement were noted in areas such as prior authorization, care coordination meetings, and quality improvement projects.

Conclusion
Pharmacy technicians are a helpful, yet underutilized, resource in the primary care setting. Further exploration of technician roles is needed to determine the financial and clinical impact of expanding these roles.
Comparison of premade clevidipine and pharmacy-prepared nicardipine in time to goal systolic blood pressure in acute cerebrovascular accident
Authors: Martini Bethany E , Schalk Amber L 
Published: October 2021

Abstract

Purpose
To compare pharmacy-prepared nicardipine and premade clevidipine with regard to time to goal systolic blood pressure (SBP) in acute cerebrovascular accident (CVA).

Methods
A retrospective, observational study was conducted comparing patients with acute CVA who received nicardipine or clevidipine. The primary objective was time to goal SBP. Secondary objectives included time from order to administration, time from administration to goal SBP, percentage of SBP readings below goal, total volume administered, hospital and intensive care unit lengths of stay, inpatient mortality and adverse events.

Results
Seventy-one patients were included in the study, 37 in the nicardipine group and 34 in the clevidipine group. A significant difference was found in mean time to goal SBP (150.9 minutes in the nicardipine group vs 69.3 minutes in the clevidipine group, P &lt; 0.01). Time from order to administration was 80.1 minutes in the nicardipine group and 35.2 minutes in the clevidipine group (P &lt; 0.01). Mean time from administration to goal SBP was 70.9 minutes in the nicardipine group and 42.3 minutes in the clevidipine group (P = 0.02). There was no difference between groups in percentage of SBP readings below goal, total volume administered, length of stay, or inpatient mortality. Adverse events occurred in 13 (35.1%) of the nicardipine-treated patients and 17 (50%) of the clevidipine-treated patients (P = 0.42).

Conclusion
Compared to use of pharmacy-prepared nicardipine, use of premade clevidipine was associated with a shorter time to goal SBP in patients with acute CVA. There were no significant between-group differences in safety outcomes. Premade clevidipine should be considered over pharmacy-prepared nicardipine when rapid blood pressure lowering is warranted in acute CVA.
The New Formalism in Private Law
Authors: Miller Paul B 
Published: October 2021

Abstract:
Private law scholarship is experiencing a reawakening in the United States with the rise of the New Private Law. New Private Lawyers have emphasized our common commitment to the scholarly interest and practical importance held by legal concepts; a belief that private law ought to be analyzed (in part) from an internal point of view; and a conviction that functionalist and conceptual analyses of private law doctrines, procedures and institutions are, or can be, complementary. We are also joined in criticism of aspects of American legal realism and in lament over some of its continuing legacies in private law. However, New Private Law scholars have yet to articulate a scholarly methodology that defines and differentiates our work. I argue that the New Private Law is rooted in a shared—if implicit—new formalist methodology and provide the first programmatic explanation of it. The Article does several things. It provides a clear statement of methodological tenets of the new formalism. It relates these to wider developments in general jurisprudence, with particular attention to scholarship on law and practical reason. It explains the sense in which the new formalism is novel, especially relative to older varieties of legal formalism. It distances the new formalism from foolish and implausible claims prominent in pejorative renderings of legal formalism. It shows how the new formalism is reflected in New Private Law scholarship. And it explains how a clear grasp of new formalist methodology enables reconciliation of the otherwise baffling eclecticism in the New Private Law while promising new and fruitful avenues for its future development.
283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre
Authors: Nathan A , Fricker M , De Groote R , Arora A , Phuah Y , Flora K , Patel S , Kasivisvanathan V , Sridhar A , Shaw G , Kelly J , Briggs T , Rajan P , Sooriakumaran P , Nathan S 
Published: October 2021

Abstract

Aim
Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy.

Method
1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre.

Results
There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p &lt; 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p &lt; 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145).

Conclusions
SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.
1551 Patient Safety Audit: Adherence to The ENT Referral Proforma
Authors: Nkuliza D , Najuko-Mafemera A , Tiwari D 
Published: October 2021

Abstract
Medway Hospital’s ENT on-call team triages referrals according to the local ENT Emergency referral guideline. Recently, a poor referral and handover resulted in a patient with post-tonsillectomy bleeding collapsing while on an immovable trolley in ED minors. Following reflection, a referral proforma was formulated to help the on-call ENT doctor ensure safe patient management through a traffic light system. The proforma includes patient and referrer detail along with four referral outcomes or colours, depending on patient stability, each with prompts for initial management. This audit aims to measure adherence to the ENT referral proforma.
We performed a retrospective cohort analysis of compliance to the new ENT referral pathway. Proformas completed between 18th October and 17th November 2020 were included. A quasi-random method of sampling was utilized, every two of three paper forms. The data was inputted on Excel. Each proforma was marked for documentation of ten aspects.
Of the total seventy-seven proformas, one scored 100%. On average, proformas were 80% completed. The most documented, at 100%, was patient detail. While the least documented, at 8%, was stating if ED were informed of the plan. 5% of referrals required potential resuscitation in ED, of which none met all criteria for a safe handover.
The audit shows that the referral proforma is currently not adequately completed. This provides a basis for further intervention to improve patient safety for ENT referrals. The next step would be to inform the department to discuss why adherence is poor and maximize future documentation.