bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamical analysis of a reduced model for the North Atlantic Oscillation
Authors: Quinn Courtney , Harries Dylan , O’Kane Terence J. 
Published: March 2021

AbstractThe dynamics of the North Atlantic Oscillation (NAO) are analyzed through a data-driven model obtained from atmospheric reanalysis data. We apply a regularized vector autoregressive clustering technique to identify recurrent and persistent states of atmospheric circulation patterns in the North Atlantic sector (110°W-0°E, 20°N-90°N). In order to analyze the dynamics associated with the resulting cluster-based models, we define a time-dependent linear delayed map with a switching sequence set a priori by the cluster affiliations at each time step. Using a method for computing the covariant Lyapunov vectors (CLVs) over various time windows, we produce sets of mixed singular vectors (for short windows) and approximate the asymptotic CLVs (for longer windows). The growth rates and alignment of the resulting time-dependent vectors are then analyzed. We find that the window chosen to compute the vectors acts as a filter on the dynamics. For short windows, the alignment and changes in growth rates are indicative of individual transitions between persistent states. For long windows, we observe an emergent annual signal manifest in the alignment of the CLVs characteristic of the observed seasonality in the NAO index. Analysis of the average finite-time dimension reveals the NAO− as the most unstable state relative to the NAO+, with persistent AR states largely stable. Our results agree with other recent theoretical and empirical studies that have shown blocking events to have less predictability than periods of enhanced zonal flow.
Observation Impact Study of an Arctic Cyclone Associated with a Tropopause Polar Vortex (TPV)-Induced Rossby Wave Initiation Event
Authors: Johnson Aaron , Wang Xuguang 
Published: March 2021

AbstractA case study characterized by Arctic cyclogenesis following a tropopause polar vortex (TPV)-induced Rossby wave initiation event is used to better understand how well existing observations constrain analyses of processes influencing Arctic cyclone predictive skill. Complementary techniques of observation system experiments (OSE) and ensemble sensitivity analysis (ESA) are used to investigate the impacts of existing observation networks on predictions for this case. The ESA reveals that the large-scale Rossby wave structure is correlated with both Arctic cyclone track and amplitude errors. The ensemble analyses of midlevel moisture in the warm conveyor belt region were correlated with forecast cyclone amplitude, but this feature was poorly sampled in existing observations. There is also a sensitivity of Arctic cyclone forecast amplitude error to low-level temperature in the air mass of the cyclogenesis region at analysis time and a sensitivity of Arctic cyclone forecast track error to low-level temperature in the region of an Arctic cold front and a coastal front at the analysis time. The OSEs for this case reveal that Arctic cyclone track error is more sensitive to denial of existing observations than amplitude error. While lower-level (below 700 hPa) observations had the greatest impact on the surface cyclone during the early stages, upper-level (above 500 hPa) observations had the dominant impact during its later evolution. Denying temperature from just three well-placed sondes substantially increased track error by degrading analyses of the TPV amplitude and its interaction with the waveguide and developing Rossby wave packet. These results are encouraging for further Arctic cyclone forecast improvements through addition of even a small number of well-placed observations.
Use of Measuring Tools in Practice Development Projects: A Critical Perspective
Authors: Glasdam Stinne , Sudmann Tobba Therkildsen 
Published: March 2021

Background. Occupational therapists are generally positive towards use of measuring tools. However, such use may be problematic. Purpose. To illuminate hidden and adverse effects of using measuring tools in occupational therapy. Method. A Foucauldian inspired thematic analysis of the use of measuring tools in 13 reports of practice development projects in Denmark. Findings. Three themes were constructed: “Categorisation of loss”, “Conduct of conduct: Self-tracking and competition”, and “Conforming to expected forms of everyday living”. Measuring tools tended to produce generalised truths about older adults and were used to predict outcome of or access to reablement programs. The measurements guided both older people and professionals, and measurements created both motivation and resistance. The tools served as an extension of the healthcare professionals’ authority. Implications. When appropriately situated, measuring tools have the potential to empower and enhance older adults’ lives and should be the focus of greater clinical attention.
Use of Off-Label Nasal Steroid Irrigations in Long-Term Management of Chronic Rhinosinusitis
Authors: Jiramongkolchai Pawina , Patel Siddharth , Schneider John S. 
Published: March 2021

Objective: Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses and mucosa. Topical nasal corticosteroids are a mainstay treatment for CRS by reducing sinonasal inflammation and improving mucociliary clearance. However, topical corticosteroids have limited paranasal distribution, and patient response to treatment has been variable in randomized controlled trials (RCT). Thus, there is significant interest in evaluating the efficacy of nasal steroids delivered by nasal irrigation in order to improve penetration and absorption of topical steroids into the sinonasal mucosa. In this review, we discuss the use of off-label nasal steroid irrigations in the management of CRS. Methods: A review of clinical trials evaluating the use of nasal steroid irrigations for CRS in the PubMed electronic database was performed. Results: Of the 12 clinical studies identified, 10 evaluated budesonide irrigations while the remaining 2 focused on mometasone. The overwhelming majority of studies for both budesonide and mometasone supported the use of nasal irrigations with corticosteroids over nasal corticosteroid sprays alone. However, the heterogeneity in study design, patient cohort, and volume of steroid irrigation limit the interpretations of these studies. Conclusions: Nasal irrigation with corticosteroids is beneficial and safe for the treatment of CRS. Future RCTs controlling for type of surgical intervention, CRS pheno- and endo-type, as well as dosing and duration of nasal corticosteroid irrigations are warranted.
Clinical study of use of large C suture in procedure for prolapse and hemorrhoids for treatment of mixed hemorrhoids
Authors: Yu Jia-He , Huang Xiang-Wu , Wu Ze-Jiang , Lin Hui-Zhong , Zheng Feng-Wu 
Published: March 2021

Objective To investigate the clinical use of a large C suture in the procedure for prolapse and hemorrhoids (PPH) for treatment of mixed hemorrhoids. Methods Patients with mixed hemorrhoids (grade III or IV) who underwent treatment with a large C suture during PPH in the Affiliated Hospital (Group) of Putian University from 1 April 2018 to 31 March 2019 were enrolled in this retrospective study. The incidences of anastomotic stenosis and anastomotic hemorrhage after the operation were observed. Results The study population comprised 126 patients (46 men and 80 women) ranging in age from 30 to 78 years (mean, 46.1 ± 2.5 years). Of these patients, 60 had circular mixed hemorrhoids, 36 had grade III circular internal hemorrhoids, and 30 had grade IV circular internal hemorrhoids. The onset time among all patients ranged from 0.5 to 25 years. All patients underwent 6 months of postoperative follow-up. None of the patients with mixed hemorrhoids developed anastomotic stenosis, although two patients developed secondary anastomotic bleeding. Conclusion Placement of a large C suture during PPH is a reliable technique for treatment of mixed hemorrhoids. It is simple, effective, and applicable and can be helpful for a large number of patients in primary hospitals.
Patients Living With HIV Are Less Likely to Receive Appropriate Statin Therapy for Cardiovascular Disease Risk Reduction
Authors: Emmons Roshni P. , Hastain Nicholas V. , Miano Todd A. , Schafer Jason J. 
Published: March 2021

Background: Recent studies suggest that statins are underprescribed in patients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD), but none have assessed if eligible patients receive the correct statin and intensity compared to uninfected controls. Objectives: The primary objective was to determine whether statin-eligible PLWH are less likely to receive appropriate statin therapy compared to patients without HIV. Methods: This retrospective study evaluated statin eligibility and prescribing among patients in both an HIV and internal medicine clinic at an urban, academic medical center from June-September 2018 using the American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk. Patients were assessed for eligibility and actual treatment with appropriate statin therapy. Characteristics of patients appropriately and not appropriately treated were compared with chi-square testing and predictors for receiving appropriate statin therapy were determined with logistic regression. Results: A total of 221/300 study subjects were statin-eligible. Fewer statin-eligible PLWH were receiving the correct statin intensity for their risk benefit group versus the uninfected control group (30.2% vs 67.0%, p < 0.001). In the multivariable logistic regression analysis, PLWH were significantly less likely to receive appropriate statin therapy, while those with polypharmacy were more likely to receive appropriate statin therapy. Conclusion: Our study reveals that PLWH may be at a disadvantage in receiving appropriate statin therapy for ASCVD risk reduction. This is important given the heightened risk for ASCVD in this population, and strategies that address this gap in care should be explored.
Effects on pain of percutaneous treatment of cervical disc herniations using DiscoGel: A retrospective analysis
Authors: Fiori Roberto , Forcina Marco , Di Donna Carlo , Spiritigliozzi Luigi , Cavallo Armando Ugo , Floris Roberto 
Published: March 2021

Background and purpose Cervical discogenic pain originates from degenerated intervertebral discs and is a common condition in the middle-aged population. Cervical discs may herniate and give compressions to cervical nerves, with pain and functional limitation of the arms. DiscoGel is a device that can be useful in the treatment of cervical disc herniation, with very short operating time and low radiation dose. Material and methods Between March 2018 and April 2019 we performed this procedure on 38 patients with non-fissurated cervical herniation using 0.3–0.4 mL of DiscoGel injected under fluoroscopic guidance. The most common discs affected were C5–C6, C6–C7 and C4–C5. Outcomes were evaluated with Visual Analogue Scale (VAS) and Neuropathic Pain Symptom Inventory (NPSI) scores at 3, 6 and 12 months follow-up. A magnetic resonance imaging (MRI) scan of the cervical spine was performed 3 months after the procedure. Results Postoperative examinations showed: VAS 2.15 ± 1.34 and NPSI 2.29 ± 0.71. Postoperative MRI performed 3 months after the procedure showed a good improvement of cervical disc herniation or bulging or protrusion. The mean dose area product (DAP) was 2803 mGy/cm2 with a mean fluoroscopy time of 4 minutes 22 seconds. Conclusion DiscoGel is a suitable approach for non-fissurated cervical disc herniations, especially in patients that are not suitable for open surgery, with excellent postoperative results, fast recovery and a low radiation dose.
Early Experience With Pulmonary Root Translocation in Transposition of the Great Arteries With Left Ventricular Outflow Tract Obstruction
Authors: Dharmapuram Anil Kumar , Ramadoss Nagarajan , Goutami Vejendla , Verma Sudeep , Pande Shantanu 
Published: March 2021

Background: The optimal surgical management of patients with transposition of the great arteries (TGA), ventricular septal defect (VSD), and left ventricular outflow tract obstruction (LVOTO) is debatable. This is our initial experience with pulmonary root translocation (PRT), a technique that aims to preserve the pulmonary valve function. Methods: From July 2012 to October 2019, 16 patients underwent anatomical repair for TGA, VSD, and LVOTO. The median age was 12 months (range: 7 months to 13 years), and the median weight was 7.75 kg (range: 5.6-29.5 kg). Thirteen patients had a diagnosis of d-TGA and three had congenitally corrected transposition of the great arteries (cc-TGA). The surgical technique involved PRT from the left ventricle (LV) to the right ventricle and routing the LV to the aorta. The left ventricular outflow tract orifice resulting from the pulmonary root extraction was closed with a pericardial patch. In patients with cc-TGA, an atrial switch operation was added. A bidirectional Glenn was necessary in four patients with a long LV to aorta tunnel. One patient required a transannular patch to reconstruct the right ventricular outflow tract (RVOT). Results: The median follow-up was 27 months. There was one hospital death due to residual mitral regurgitation. One patient died at home four months after hospital discharge. The remaining patients are doing well with adequate RVOT function and no valve regurgitation. Conclusions: Complete correction of TGA, VSD, and LVOTO using PRT was achieved with acceptable risk in patients with pliable and nondysplastic pulmonary valve. The translocated pulmonary root performed well in this short follow-up.
Safe Decompression of the Right Ventricle for PAIVS in Neonates With Coronary Fistulae: Including the Selective Use of Fistula Ligation to Avoid Coronary Steal
Authors: Davidson Noveen , Doig Fiona , Dimpalapang Eliazar , Stirling John , Gentles Thomas , Wilson Nigel , Artrip John , Finucane Kirsten 
Published: March 2021

Background: There are a number of surgical and interventional treatment options for infants with pulmonary atresia with intact ventricular septum (PAIVS). In our practice, we characterize coronary fistulae and interruptions with angiography in the newborn and have developed a strategy to safely decompress the right ventricle in association with ligation of fistulae if necessary. Methods: All infants operated for PAIVS at age < 60 days from 1999 to 2018 were retrospectively studied. Pre- and postoperative variables were collected, angiograms were reviewed, and a territory score was created to grade the severity of coronary abnormalities. This study focused on the subgroup of patients who had early surgical decompression of the right ventricle. Results: A total of 77 patients were included, with a mean follow-up of 8.6 years. Of these, 55 (71%) had coronary fistulae, including 28 (36%) with coronary artery interruption. Right ventricular decompression (RVD) was performed in 47 (60.5%) patients. There was no 30-day mortality in those who underwent RVD, whereas 6 (20%) without RVD died within 30 days ( P = .003). Ten-year survival was 97.8% and 73.3% for RVD and non-RVD, respectively. In order to prevent coronary steal, 17 patients underwent coronary fistula ligation as their RV was decompressed with 100% early and late survival. Conclusion: Early and late survival in infants with PAIVS is better if the RV can be decompressed. Coronary fistula ligation with RVD has been introduced without an adverse outcome in selected patients with large fistulae.
Outcomes Following Heterotopic Placement of Right Ventricle to Pulmonary Artery Conduits
Authors: Saxena Akshat , Salve Gananjay G. , Betts Kim , Arora Nitin , Cole Andrew D. , Sholler Gary F. , Orr Yishay , Ayer Julian G. , Winlaw David S. 
Published: March 2021

Background: We sought to evaluate the outcomes following right ventricle to pulmonary artery (RV-PA) conduit placement in pediatric patients, excluding those with a RV-PA conduit for the Ross procedure which is associated with improved conduit durability, partly related to its orthotopic position. Methods: Outcomes for 119 patients who underwent RV-PA conduit placement at a single institution from January 2004 to December 2016 were reviewed. Primary outcome measures were reintervention-free survival (RFS) and overall survival. Survival analyses were performed using the Kaplan-Meier method, and risk factors associated with reintervention were evaluated. Results: The median age at the time of conduit placement was 6 months (interquartile range, IQR: 1-14), and the median length of follow-up was 63 months (range: 0-156). During follow-up, 39 patients required conduit-related reintervention, while 6 patients died perioperatively with an overall survival of 90% at 10 years. Among the remaining 113 patients, the RFS at one, five, and ten years was 91% (84%-95%), 72% (60%-80%), and 33% (16%-50%), respectively. The median time to conduit replacement in the series was 43.5 months (IQR: 19.3-76.2). The use of a pulmonary homograft was associated with improved RFS ( P = .03), and this was particularly pronounced in comparison with aortic homografts in neonates. Infection was the indication for replacement in only one patient. Conclusions: The majority of the conduits placed during the neonatal period required conduit replacement before the age of five years. Endocarditis was not a common indication for replacement. In neonates and infants, we prefer pulmonary homografts for most indications.
Return to Play After Low-Energy Lisfranc Injuries in High-Demand Individuals: A Systematic Review and Meta-Analysis of Athletes and Active Military Personnel
Authors: Attia Ahmed Khalil , Mahmoud Karim , Alhammoud Abduljabbar , d’Hooghe Pieter , Farber Daniel 
Published: March 2021

Background: Although studies are available on high-energy Lisfranc injuries, the evidence for increasingly reported low-energy Lisfranc injuries in active individuals, including athletes and military personnel, remains scarce and mostly retrospective. Purpose: This meta-analysis aimed to review the return-to-play (RTP) and return-to-duty (RTD) rates with regard to the anatomic type and the management of low-energy Lisfranc injuries in a high-demand, active population. Study Design: Systematic review; Level of evidence, 4. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the MEDLINE (PubMed), EMBASE, Google Scholar, and Cochrane databases through June 2019 to identify studies on low-energy Lisfranc injuries in athletes and military personnel. The primary outcomes were RTP/RTD rates and time to RTP/RTD, and the secondary outcomes were time missed from practice, games missed, time to full recovery, midfoot arthritis rate, and reoperation rate. Results: Overall, 15 studies (N = 441 patients) were included in the meta-analysis. Of these, 6 studies were of level 3 evidence, 8 studies were level 4 (case series), and 1 study was level 5. Of the 441 subjects, 380 (86.17%) were able to RTP and RTD. There was no statistically significant difference in RTP rates for operative versus nonoperative treatment, ORIF versus PA, or bony versus ligamentous injuries. The mean time missed from practice/duty for operative versus nonoperative treatment was 58.02 days (95% CI, 13.6-102.4 days; I 2 = 98.03%) and 116.4 days (95% CI, 62.4-170.4 days; I 2 = 99.45%), respectively. The mean time missed from practice/duty for bony versus ligamentous injury was 98.9 days (95% CI, 6.1-191.7 days; I 2 = 99.82%) and 76.5 days (95% CI, 37.9-115.02 days; I 2 = 99.83%), respectively, with no statistically significant differences (standardized mean difference = 3.62 days [95% CI: –5.7 to 13 days]; I 2 = 83.17%). Conclusion: This review indicated an overall excellent RTP/RTD rate for low-energy Lisfranc injuries in high-demand individuals. The time missed from athletic participation/military duty was not affected by injury treatment type, the bony versus ligamentous nature of the injury, or athlete player position. However, the low evidence levels and significant heterogeneity of the included studies precludes making conclusions regarding length of time missed or optimal management. Higher-quality studies on low-energy Lisfranc injuries are needed.
Prognostic factors for CNS control in children with acute lymphoblastic leukemia treated without cranial irradiation
Authors: Tang Jingyan , Yu Jie , Cai Jiaoyang , Zhang Li , Hu Shaoyan , Gao Ju , Jiang Hua , Fang Yongjun , Liang Changda , Ju Xiuli , Jin Runming , Zhai Xiaowen , Wu Xuedong , Tian Xin , Hu Qun , Wang Ningling , Jiang Hui , Sun Lirong , Leung Alex W. K. , Yang Minghua , Pan Kaili , Cheng Cheng , Zhu Yiping , Zhang Hui , Li Chunfu , Yang Jun J. , Li Chi-kong , Zhu Xiaofan , Shen Shuhong , Pui Ching-Hon 
Published: March 2021

Abstract
To identify the prognostic factors that are useful to improve central nervous system (CNS) control in children with acute lymphoblastic leukemia (ALL), we analyzed the outcome of 7640 consecutive patients treated on Chinese Children’s Cancer Group ALL-2015 protocol between 2015 and 2019. This protocol featured prephase dexamethasone treatment before conventional remission induction and subsequent risk-directed therapy, including 16 to 22 triple intrathecal treatments, without prophylactic cranial irradiation. The 5-year event-free survival was 80.3% (95% confidence interval [CI], 78.9-81.7), and overall survival 91.1% (95% CI, 90.1-92.1). The cumulative risk of isolated CNS relapse was 1.9% (95% CI, 1.5-2.3), and any CNS relapse 2.7% (95% CI, 2.2-3.2). The isolated CNS relapse rate was significantly lower in patients with B-cell ALL (B-ALL) than in those with T-cell ALL (T-ALL) (1.6%; 95% CI, 1.2-2.0 vs 4.6%; 95% CI, 2.9-6.3; P &lt; .001). Independent risk factors for isolated CNS relapse included male sex (hazard ratio [HR], 1.8; 95% CI, 1.1-3.0; P = .03), the presence of BCR-ABL1 fusion (HR, 3.8; 95% CI, 2.0-7.3; P &lt; .001) in B-ALL, and presenting leukocyte count ≥50×109/L (HR, 4.3; 95% CI, 1.5-12.2; P = .007) in T-ALL. Significantly lower isolated CNS relapse was associated with the use of total intravenous anesthesia during intrathecal therapy (HR, 0.2; 95% CI, 0.04-0.7; P = .02) and flow cytometry examination of diagnostic cerebrospinal fluid (CSF) (HR, 0.2; 95% CI, 0.06-0.6; P = .006) among patients with B-ALL. Prephase dexamethasone treatment, delayed intrathecal therapy, use of total intravenous anesthesia during intrathecal therapy, and flow cytometry examination of diagnostic CSF may improve CNS control in childhood ALL. This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-IPR-14005706).