bluuebunny/crossref_metadata_2025_split huggingface dataset:
Weakening and Poleward Shifting of the North Pacific Subtropical Fronts from 1980 to 2018
Authors: Xu Lixiao , Wang Keyao , Wu Baolan 
Published: December 2021

Abstract
Recent evidence shows that the North Pacific subtropical gyre and the Kuroshio Extension (KE) and Oyashio Extension (OE) fronts have moved poleward in the past few decades. However, changes of the North Pacific Subtropical Fronts (STFs), anchored by the North Pacific subtropical countercurrent in the southern subtropical gyre, remain to be quantified. By synthesizing observations, reanalysis, and eddy-resolving ocean hindcasts, we show that the STFs, especially their eastern part, weakened (20% ± 5%) and moved poleward (1.6° ± 0.4°) from 1980 to 2018. Changes of the STFs are modified by mode waters to the north. We find that the central mode water (CMW) (180°–160°W) shows most significant weakening (18% ± 7%) and poleward shifting (2.4° ± 0.9°) trends, while the eastern part of the subtropical mode water (STMW) (160°E–180°) has similar but moderate changes (10% ± 8%; 0.9° ± 0.4°). Trends of the western part of the STMW (140°–160°E) are not evident. The weakening and poleward shifting of mode waters and STFs are enhanced to the east and are mainly associated with changes of the northern deep mixed layers and outcrop lines—which have a growing northward shift as they elongate to the east. The eastern deep mixed layer shows the largest shallowing trend, where the subduction rate also decreases the most. The mixed layer and outcrop line changes are strongly coupled with the northward migration of the North Pacific subtropical gyre and the KE/OE jets as a result of the poleward expanded Hadley cell, indicating that the KE/OE fronts, mode waters, and STFs change as a whole system.
Increased Incidence of Injury Among Runners With COVID-19
Authors: Toresdahl Brett G. , Robinson James N. , Kliethermes Stephanie A. , Metzl Jordan D. , Dixit Sameer , Quijano Brianna , Fontana Mark A. 
Published: December 2021

Background: Coronavirus disease 2019 (COVID-19) affects multiple organ systems. Whether and how COVID-19 affects the musculoskeletal system remains unknown. We aim to assess the association between COVID-19 and risk of injury. Hypothesis: Runners who report having COVID-19 also report a higher incidence of injury. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: An electronic survey was distributed from July through September 2020, by New York Road Runners, ASICS North America, race medical directors, and through social media. Inclusion criteria were runners 18 years or older who had participated in ≥1 race (running or triathlon) in 2019. Results: A total of 1947 runners participated and met inclusion criteria. Average age was 45.0 (SD, 12.2) years and 56.5% were women. A total of 123 (6.3%) runners self-reported having COVID-19; 100 (81%) reported their diagnosis was from a laboratory test (polymerase chain reaction or antibody) and 23 reported being diagnosed by a medical professional without confirmatory laboratory testing. Since March 2020, 427 (21.9%) reported an injury that prevented running for at least 1 week, including 38 of 123 (30.9%) who self-reported having COVID-19 and 389 of 1435 (21.3%) who did not report having COVID-19 ( P = 0.01). After adjusting for age, sex, the number of races in 2019, and running patterns before March 2020, runners who self-reported a diagnosis of COVID-19 had a higher incidence of injury compared with those who did not (odds ratio, 1.66; 95% CI, 1.11-2.48; P = 0.01). Conclusion: Injuries were more often self-reported by runners with laboratory-confirmed or clinically diagnosed COVID-19 compared with those who did not report COVID-19. Given the limitations of the study, any direct role of COVID-19 in the pathophysiology of injuries among runners remains unclear. Clinical Relevance: Direct and indirect musculoskeletal sequelae of COVID-19 should be further investigated, including the risk of exercise- and sports-related injury after COVID-19.
Mapping pre-harvest sprouting resistance loci in AAC Innova × AAC Tenacious spring wheat population
Authors: Dhariwal Raman , Hiebert Colin W. , Sorrells Mark E. , Spaner Dean , Graf Robert J. , Singh Jaswinder , Randhawa Harpinder S. 
Published: December 2021

Abstract
Background
Pre-harvest sprouting (PHS) is a major problem for wheat production due to its direct detrimental effects on wheat yield, end-use quality and seed viability. Annually, PHS is estimated to cause > 1.0 billion USD in losses worldwide. Therefore, identifying PHS resistance quantitative trait loci (QTLs) is crucial to aid molecular breeding efforts to minimize losses. Thus, a doubled haploid mapping population derived from a cross between white-grained PHS susceptible cv AAC Innova and red-grained resistant cv AAC Tenacious was screened for PHS resistance in four environments and utilized for QTL mapping.

Results
Twenty-one PHS resistance QTLs, including seven major loci (on chromosomes 1A, 2B, 3A, 3B, 3D, and 7D), each explaining ≥10% phenotypic variation for PHS resistance, were identified. In every environment, at least one major QTL was identified. PHS resistance at most of these loci was contributed by AAC Tenacious except at two loci on chromosomes 3D and 7D where it was contributed by AAC Innova. Thirteen of the total twenty-one identified loci were located to chromosome positions where at least one QTL have been previously identified in other wheat genotype(s). The remaining eight QTLs are new which have been identified for the first time in this study. Pedigree analysis traced several known donors of PHS resistance in AAC Tenacious genealogy. Comparative analyses of the genetic intervals of identified QTLs with that of already identified and cloned PHS resistance gene intervals using IWGSC RefSeq v2.0 identified MFT-A1b (in QTL interval QPhs.lrdc-3A.1) and AGO802A (in QTL interval QPhs.lrdc-3A.2) on chromosome 3A, MFT-3B-1 (in QTL interval QPhs.lrdc-3B.1) on chromosome 3B, and AGO802D, HUB1, TaVp1-D1 (in QTL interval QPhs.lrdc-3D.1) and TaMyb10-D1 (in QTL interval QPhs.lrdc-3D.2) on chromosome 3D. These candidate genes are involved in embryo- and seed coat-imposed dormancy as well as in epigenetic control of dormancy.

Conclusions
Our results revealed the complex PHS resistance genetics of AAC Tenacious and AAC Innova. AAC Tenacious possesses a great reservoir of important PHS resistance QTLs/genes supposed to be derived from different resources. The tracing of pedigrees of AAC Tenacious and other sources complements the validation of QTL analysis results. Finally, comparing our results with previous PHS studies in wheat, we have confirmed the position of several major PHS resistance QTLs and candidate genes.
Changes in peripheral arterial blood pressure after resuscitative endovascular balloon occlusion of the aorta (REBOA) in non-traumatic cardiac arrest patients
Authors: Brede Jostein Rødseth , Skjærseth Eivinn , Klepstad Pål , Nordseth Trond , Krüger Andreas Jørstad 
Published: December 2021

Abstract
Background
Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be an adjunct treatment to cardiopulmonary resuscitation (CPR). Aortic occlusion may increase aortic pressure and increase the coronary perfusion pressure and the cerebral blood flow. Peripheral arterial blood pressure is often measured during or after CPR, however, changes in peripheral blood pressure after aortic occlusion is insufficiently described. This study aimed to assess changes in peripheral arterial blood pressure after REBOA in patients with out of hospital cardiac arrest.

Methods
A prospective observational study performed at the helicopter emergency medical service in Trondheim (Norway). Eligible patients received REBOA as adjunct treatment to advanced cardiac life support. Peripheral invasive arterial blood pressure and end-tidal CO2 (EtCO2) was measured before and after aortic occlusion. Differences in arterial blood pressures and EtCO2 before and after occlusion was analysed with Wilcoxon Signed Rank test.

Results
Five patients were included to the study. The median REBOA procedural time was 11 min and median time from dispatch to aortic occlusion was 50 min. Two patients achieved return of spontaneous circulation. EtCO2 increased significantly 60 s after occlusion, by a mean of 1.16 kPa (p = 0.043). Before occlusion the arterial pressure in the compression phase were 43.2 (range 12–112) mmHg, the mean pressure 18.6 (range 4–27) mmHg and pressure in the relaxation phase 7.8 (range − 7 – 22) mmHg. After aortic occlusion the corresponding pressures were 114.8 (range 23–241) mmHg, 44.6 (range 15–87) mmHg and 14.8 (range 0–29) mmHg. The arterial pressures were significant different in the compression phase and as mean pressure (p = 0.043 and p = 0.043, respectively) and not significant in the relaxation phase (p = 0.223).

Conclusion
This study is, to our knowledge, the first to assess the peripheral invasive arterial blood pressure response to aortic occlusion during CPR in the pre-hospital setting. REBOA application during CPR is associated with a significantly increase in peripheral artery pressures. This likely indicates improved central aortic blood pressure and warrants studies with simultaneous peripheral and central blood pressure measurement during aortic occlusion.

Trial registration
The study is registered in ClinicalTrials.gov (NCT03534011).
Towards enhanced telephone triage for chest pain: a Delphi study to define life-threatening conditions that must be identified
Authors: Alotaibi Ahmed , Body Richard , Carley Simon , Pennington Elspeth 
Published: December 2021

Abstract
Background
Improving telephone triage for patients with chest pain has been identified as a national research priority. However, there is a lack of strong evidence to define the life-threatening conditions (LTCs) that telephone triage ought to identify. Therefore, we aimed to build consensus for the LTCs associated with chest pain that ought to be identified during telephone triage for emergency calls.

Methods
We conducted a Delphi study in three rounds. Twenty experts in pre-hospital care and emergency medicine experience from the UK were invited to participate. In round I, experts were asked to list all LTCs that would require priority 1, 2, and 4 ambulance responses. Round II was a ranking evaluation, and round III was a consensus round. Consensus level was predefined at > = 70%.

Results
A total of 15 participants responded to round one and 10 to rounds two and three. Of 185 conditions initially identified by the experts, 26 reached consensus in the final round. Ten conditions met consensus for requiring priority 1 response: oesophageal perforation/rupture; ST elevation myocardial infarction; non-ST elevation myocardial infarction with clinical compromise (defined, also by consensus, as oxygen saturation < 90%, heart rate < 40/min or systolic blood pressure < 90 mmHg); acute heart failure; cardiac tamponade; life-threatening asthma; cardiac arrest; tension pneumothorax and massive pulmonary embolism. An additional six conditions met consensus for priority 2 response, and three for priority 4 response.

Conclusion
Using expert consensus, we have defined the LTCs that may present with chest pain, which ought to receive a high-priority ambulance response. This list of conditions can now form a composite primary outcome for future studies to derive and validate clinical prediction models that will optimise telephone triage for patients with a primary complaint of chest pain.
Outcomes from colonoscopy following referral from New Zealand general practice: a retrospective analysis
Authors: Lawrenson Ross , Moosa Sheena , Warren Judy , van Dalen Ralph , Chepulis Lynne , Blackmore Tania , Lao Chunhuan , Mayo Christopher , Kidd Jacquie , Firth Melissa , Stokes Tim , Elwood Mark , Weller David , Emery Jon 
Published: December 2021

Abstract
Background
New Zealand has high rates of colorectal cancer (CRC) but poor outcomes. Most patients with CRC are diagnosed following referral from general practice, where a general practitioner (GP) assesses symptoms according to national guidelines. All referred patients are then re-prioritised by the hospital system. The first objective of this study was to identify what proportion of patients referred by general practice to surgical/gastroenterology at Waikato District Health Board (DHB) had a colonoscopy. The second objective was to determine what proportion of these referrals have an underlying CRC and the factors associated with the likelihood of this diagnosis.

Methods
This study is a retrospective analysis of e-referral data for patients aged 30–70+ who were referred from 75 general practices to general surgery, gastroenterology or direct to colonoscopy at Waikato DHB, 01 January 2015–31 December 2017. Primary and secondary outcome measures included the proportion and characteristics of patients who were having colonoscopy, and of those, who were diagnosed with CRC. Data were analysed using chi square and logistic regression.

Results
6718/20648 (32.5%) patients had a colonoscopy and 372 (5.5%) of these were diagnosed with CRC. The probability of having CRC following a colonoscopy increased with age (p value < 0.001). Females (p value < 0.001), non-Māori (p value < 0.001), and patients with a high suspicion of cancer (HSCan) label originating from their GP were more likely to have a colonoscopy, while the odds ratio of Māori having a colonoscopy was 0.66 (95% CI 0.60–0.73). The odds ratio of a CRC diagnosis following colonoscopy was 1.67 (95% CI 1.35–2.07) for men compared to women, and 2.34 (95% CI 1.70–3.22) for those with a GP HSCan label. Of the 585 patients referred with a GP HSCan, 423 (72.3%) were reprioritised by the hospital and 55 patients had their diagnosis unnecessarily delayed.

Conclusions
If a GP refers a patient with an HSCan, and the patient receives a colonoscopy, then the likelihood of having CRC is almost 15.0%. This would suggest that these patients should be routinely prioritised without further triage by the hospital. Further research is needed to understand why Māori are less likely to receive a colonoscopy following referral from general practice.
Geriatric Choosing Wisely choice of recommendations in France: a pragmatic approach based on clinical audits
Authors: Tannou T. , Menand E. , Veillard D. , Contreras J. Berthou , Slekovec C. , Daucourt V. , Somme D. , Corvol A. ,   on behalf of French Choosing Wisely Geriatric Group of the SFGG, Tannou T. , Menand E. , Veillard D. , Somme D. , Corvol A. 
Published: December 2021

Abstract
Background
The international Choosing Wisely campaign seeks to improve the appropriateness of care, notably through large campaigns among physicians and users designed to raise awareness of the risks inherent in overmedication.

Methods
In deploying the Choosing Wisely campaign, the French Society of Geriatrics and Gerontology chose early operationalization via a tool for clinical audit over a limited area before progressive dissemination. This enabled validation of four consensual recommendations concerning the management of urinary tract infections, the prolonged use of anxiolytics, the use of neuroleptics in dementia syndromes, and the use of statins in primary prevention. The fifth recommendation concerns the importance of a dialogue on the level of care. It was written by patient representatives directly involved in the campaign.

Results
The first cross-regional campaign in France involved 5337 chart screenings in 43 health facilities. Analysis of the results showed an important variability in practices between institutions and significant percentage of inappropriate prescriptions, notably of psychotropic medication.

Discussion
The high rate of participation of target institutions shows that geriatrics professionals are interested in the evaluation and optimization of professional practices. Frequent overuse of psychotropic medication highlights the need of campaigns to raise awareness and encourage deprescribing.
A multifaceted approach increased staff confidence to develop outside of school hours care as a health promoting setting
Authors: Forde Karen , Costello Leesa , Devine Amanda , Sambell Ros , Wallace Ruth 
Published: December 2021

Abstract
Background
Outside-of-school-hours-care (OSHC) services are well positioned to influence the health behaviours of 489, 800 Australian children, and are an important setting for health promotion given the current rates of childhood overweight and obesity and associated health risks. OSHC Professionals are ideally placed to become positive influencers in this setting, although they may require training and support to confidently perform this role. This study piloted a multifaceted intervention strategy to increase OSHC Professional’s confidence and competencies, to support a health promoting OSHC environment with a nutrition and physical activity focus.

Methods
A mixed methods approach was used. Nineteen OSHC Professionals participated in the study, including a face-to-face workshop, supported by a closed Facebook group and website. Role adequacy (self-confidence) and legitimacy (professional responsibility) were measured pre and post workshop and evaluated using non-parametric statistics. Facebook interactions were monitored, and four participants undertook qualitative exit interviews to discuss their experiences with the intervention.

Results
Pre-workshop 68% of participants had not received any OSHC-specific health promotion training. Post-workshop significant improvements in confidence about menu planning, accessing nutrition information, activities and recipes was observed (P < 0.05 for all). A significant improvement was observed in role support and role related training (P < 0.05). A high level of support and interaction was observed between participants on Facebook and the website was reported a useful repository of information.

Conclusions
Health promotion training, combined with positive social connections, shared learning experiences, and a website improved OSHC Professionals confidence and capacity to provide a health promoting OSHC environment. Health promotion professional development for OSHC professionals should be mandated as a minimum requirement, and such learning opportunities should be scaffolded with support available through social media interactions and website access.
Complications and risk factors of percutaneous endoscopic transforaminal discectomy in the treatment of lumbar spinal stenosis
Authors: Fan Ning , Yuan Shuo , Du Peng , Wu Qichao , Wang Tianyi , Wang Aobo , Li Jian , Kong Xiaochuan , Zhu Wenyi , Zang Lei 
Published: December 2021

Abstract
Background
With the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective and minimally invasive procedure to treat lumbar spinal stenosis (LSS) in recent years. Few studies have focused on the complications associated with the treatment of LSS using percutaneous endoscopic lumbar discectomy (PELD). This study aimed to summarize the complications of PETD and identify the associated risk factors.

Methods
Complications in a total of 738 consecutive LSS patients who underwent single-level PETD were retrospectively recorded and analyzed between January 2016 and July 2020. In addition, a matched case-control study was designed, and according to the date of operation, the control group was matched with patients without complications, with a matching ratio of 1:3. Demographic parameters included age, sex, BMI, smoking and drinking status, comorbidity, and surgical level. The radiological parameters included grade of surgical-level disc degeneration, number of degenerative lumbar discs, grade of lumbar spinal stenosis, degenerative lumbar scoliosis, lumbar lordosis, disc angle, and disc height index. Univariate analysis was performed using independent samples t-test and chi-squared test.

Results
The incidence of different types of complications was 9.76% (72/738). The complications and occurrence rates were as follows: recurrence of LSS (rLSS), 2.30% (17/738); persistent lumbosacral or lower extremity pain, 3.79% (28/738); dural tear, 1.90% (14/738); incomplete decompression, 0.81% (6/738); surgical site infection, 0.41% (3/738); epidural hematoma, 0.27% (2/738); and intraoperative posterior neck pain, 0.27% (2/738). Univariate analysis demonstrated that age, the grade of surgical-level disc degeneration (P < 0.001) and the number of disc degeneration levels (P = 0.004) were significantly related to the complications.

Conclusion
Complications in the treatment of LSS using PELD included rLSS, persistent pain of the lumbosacral or lower extremity, dural tear, incomplete decompression, surgical site infection, epidural hematoma, and intraoperative posterior neck pain. In addition, old age, severe grade of surgical-level disc degeneration and more disc degeneration levels significantly increased the incidence of complications.
Safer prescription of drugs: impact of the PREFASEG system to aid clinical decision-making in primary care in Catalonia
Authors: Pons-Mesquida M. Àngels , Oms-Arias Míriam , Diogène-Fadini Eduard , Figueras Albert 
Published: December 2021

Abstract
Background
In 2008, the Institut Català de la Salut (ICS, Catalan Health Institute) implemented a prescription decision support system in its electronic clinical workstation (ECW), which automatically generates online alerts for general practitioners when a possible medication-related problem (MRP) is detected. This tool is known as PREFASEG, and at the time of beginning a new treatment, it automatically assesses the suitability of the treatment for the individual patient. This analysis is based on ongoing treatments, demographic characteristics, existing pathologies, and patient biochemical variables. As a result of the assessment, therapeutic recommendations are provided. The objective of this study is to present the PREFASEG tool, analyse the main alerts that it generates, and determine the degree of alert acceptance.

Methods
A cross-sectional descriptive study was carried out to analyse the generation of MRP-related alerts detected by PREFASEG during 2016, 2017, and 2018 in primary care (PC) in Catalonia. The number of MRP alerts generated, the drugs involved, and the acceptance/rejection of the alerts were analysed. An alert was considered "accepted" when the medication that generated the alert was not prescribed, thereby following the recommendation given by the tool. The MRP alerts studied were therapeutic duplications, safety alerts issued by the Spanish Medicines Agency, and drugs not recommended for use in geriatrics. The prescriptions issued by 6411 ICS PC physicians who use the ECW and provide their services to 5.8 million Catalans through 288 PC teams were analysed.

Results
During the 3 years examined, 67.2 million new prescriptions were analysed, for which PREFASEG generated 4,379,866 alerts (1 for every 15 new treatments). A total of 1,222,159 alerts (28%) were accepted. Pharmacological interactions and therapeutic duplications were the most detected alerts, representing 40 and 30% of the total alerts, respectively. The main pharmacological groups involved in the safety alerts were nonsteroidal anti-inflammatory drugs and renin-angiotensin system inhibitors.

Conclusions
During the period analysed, 28% of the prescriptions wherein a toxicity-related PREFASEG alert was generated led to treatment modification, thereby helping to prevent the generation of potential safety MRPs. However, the tool should be further improved to increase alert acceptance and thereby improve patient safety.