bluuebunny/crossref_metadata_2025_split huggingface dataset:
Process Evaluation of an Implementation Study in Dementia Care (EIT-4-BPSD): Stakeholder Perspectives
Authors: Behrens Liza , Boltz Marie , Riley Kiernan , Eshraghi Karen , Resnick Barbara , Galik Elizabeth , Ellis Jeanette , Kolanowski Ann , Haitsma Kimberly Van 
Published: May 2021

Abstract
Background: Behavioral and psychological symptoms of distress in dementia (BPSD) are major drivers of poor quality of life, caregiver burden, institutionalization, and cost of care in nursing homes. The Evidence Integration Triangle (EIT)-4-BPSD in nursing homes was a pragmatic Hybrid III trial of an implementation strategy to help staff use evidence-based non-pharmacological interventions to prevent and manage BPSD. This study aimed to describe and explore the stakeholders’ perceptions of the process to implement the EIT-4-BPSD strategy including its utility, and the barriers and facilitators to implementation in real-world settings. Methods: EIT-4-BPSD was a multi-layer implementation strategy that engaged nursing home stakeholder groups to define community specific goals towards reducing BPSD over a 12-month period. Stakeholder groups from nursing homes that completed all 12-months of the implementation strategy were invited to participate in this process evaluation study. Qualitative data from focus group transcripts were analyzed using a conventional content analysis. Emerging codes were sorted into categories, then organized in meaningful clusters based on the domains of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Results: The EIT-4-BPSD implementation strategy was completed in 21 nursing homes; 93 stakeholders participated in focus groups. Over half of participating nursing homes reported meeting their BPSD goals as expected or more. Challenges, facilitators, and contextual factors reported by stakeholder members explains variability in the implementation of EIT-4-BPSD strategy in 11 key categories: family; staff; organizational; staff, environmental, and resident outcomes; utility of EIT resources; adoption barriers and facilitators; care process adaptations; and future planning. Conclusion: Stakeholders offered guidance on salient factors influencing the feasibility and utility of EIT-4-BPSD adoption and implementation to consider in future implementation research that aims to improve behavioral well-being in NH residents living with dementia. Engagement of family and staff at all levels of the organization (Management, leadership, and direct care); and measurement of staff, environmental, and resident outcomes were perceived as critical for future implementation success. While regulations, finances, and competing demands on staff time were perceived as reducing implementation success. Trial Registration: The Testing the Implementation of EIT-4-BPSD study was registered in the ClinicalTrials.gov (NCT03014570) January 9, 2017
Spotting Areas Critical to Storm Waves and Surge Impacts on Coasts with Data Scarcity: A Case Study in Santa Catarina, Brazil
Authors: Pazini Karen Cristina , Bonetti Jarbas , Silva Paula Gomes da , Klein Antonio Henrique da Fontoura 
Published: May 2021

Abstract
The impacts of severe storms on the coastal zone, combined with rapid population growth in this area, has made coastal risk management an urgent need. However, integrated risk assessment can be a challenging task for many locations worldwide, as it normally requires the use of a large amount of data. The Coastal Risk Assessment Framework phase one (CRAF1), is a recently proposed analytical scheme based on empirical models and spatial analysis that combines different indicators to identify storm-induced hotspots. The methodology, however, requires accurate data at the regional scale and was conceived and validated for the European region. In this study, we show that this approach can be applied, with some simplifications, on data-poor areas, allowing the identification of hotspots considering one or multiple hazards. Here, the coastal risk was assessed for erosion and coastal flooding events with return periods of 10 and 50 years on the Santa Catarina Central Coast. The study area is characterized by the occurrence of storm-induced impacts that historically cause disruption and damage to local communities. Although the components of risk have been assessed using various methods along this sector, to date, no integrated risk analysis has been presented in probabilistic terms. Predicted scenarios for the Santa Catarina Central Coast suggest that extreme episodes may cause several impacts, exposing urban settlements as well local road systems, especially in the municipalities of Tijucas and Florianópolis. The results show that the CRAF1 is an appropriate approach for a first-level risk analysis, even when implemented with poor data resolution, as it effectively points to some of the most vulnerable stretches detected in the study area.
The Modulation of Interdecadal Pacific Oscillation and Atlantic Multidecadal Oscillation on winter Eurasian Cold Anomaly via the Ural Blocking Change
Authors: Luo Binhe , Luo Dehai , Dai Aiguo , Ian Simmonds , Wu Lixin 
Published: May 2021

Abstract
Observations revealed distinct interdecadal winter Eurasian cold anomaly (ECA) centered over central Eurasia (40o-60oN,60o-120oE), with a more southwestward extension during 1965-1976 than during 2002-2013. In this paper, Ural blockings (UB) in association with the Interdecadal Pacific Oscillation (IPO) and Atlantic Multi-decadal Oscillation (AMO) are analyzed to explain the ECA’s interdecadal change using reanalysis data. It is found that the 1965-1976 winter ECA is associated with the negative-phase IPO (IPO-) together with negative-phase AMO (AMO-), while the 2002-2013 ECA is related to positive-phase AMO (AMO+) concurring with IPO-.
The UB mainly related to positive North Atlantic Oscillation is long-lived during IPO- and AMO+ and shows different longitudinal position and movement, but short-lived and retrograde during both IPO+ and AMO-. During IPO-, the UB grows rapidly and decays slowly due to weak westerly winds and small meridional potential vorticity gradient (PVy) over North Atlantic mid-high latitudes, and moves westward mainly during its decay stage, causing strong cold anomalies over central Eurasia and its upstream region (30o-50oN, 30o-70oE). Such a slow blocking decay is also seen during AMO-. However, during AMO+ the UB grows slowly, decays rapidly and shows eastward movement due to strong westerly winds and large PVy over North Atlantic high latitudes, causing strong cold anomalies over central Eurasia and its downstream region (30o-50oN, 90o-130oE). Through these UB-induced sub-seasonal changes, the interdecadal IPO-, AMO- and AMO+ help explain the variation of the winter-mean ECA from 1965-1976 to 2002-2013.
Morphomolecular identification, metabolic profile, anticancer, and antioxidant capacities of Penicillium sp. NRC F1 and Penicillium sp. NRC F16 isolated from Egyptian remote cave
Authors: Elkhateeb Waill A. , Mettwally Walaa S. A. , Saleh Shireen A. A. , Fayad Walid , Nafady Ibrahim M. , Daba Ghoson 
Published: May 2021

Abstract
The authors have requested that this preprint be removed from Research Square.
The Effect of Anesthesia Depth Monitoring on Postoperative Delirium and Postoperative Cognitive Dysfunction in Non-cardiac Surgery Patients---- A Systematic Review and Meta-Analysis
Authors: Huang Ping , Sun Shufang , Liu Hongliang 
Published: May 2021

Abstract
Objective: To systematically evaluate the influence of intraoperative anesthesia depth monitoring on the prognosis of non-cardiac surgery to guide clinical work.Methods: Search literature in the database The Cochrane Library, Ovid MEDLINE, EMBASE, Google search ，National Knowledge Infrastructure (CNKI), Wanfangdata library and VIP network. We conducted meta-analysis by searching the literature of randomized controlled studies on the effects of different depth of anesthesia monitoring on patients with postoperative delirium and postoperative cognitive dysfunction. The depth of anesthesia monitoring methods include: Bispectral index of EEG, Auditory evoked potential, Primitive EEG monitoring, narcotrend, index of consciousness monitor, entropy, neuroSENSE monitor, SEDline monitor. Two authors independently completed literature retrieval and inclusion, and two authors independently completed literature data collection and bias analysis. The registration number of this study on PROSPERO is CRD42021232899Results: A total of 7 randomized controlled English literatures with full texts were finally included, with a sample size of 3845 cases. In 5 trials, the depth of anesthesia was monitored by bispectral index (BIS) monitoring, 2 was monitoring of auditory evoked potentials, and 1 was monitoring of raw EEG. They were grouped into monitoring group and control group. Analysis suggests that the depth of anesthesia monitoring, especially the anesthesia guided by BIS monitoring, can reduce the incidence of postoperative delirium. Intraoperative anesthesia depth monitoring reduced the impact of cognitive dysfunction at 1 and 12 weeks after surgery and was statistically significant.Conclusion: Depth of anesthesia monitoring, especially intraoperative bispectral index monitoring can reduce the occurrence of postoperative delirium in patients undergoing non-cardiac surgery. More clinical trials are needed to evaluate the role of primitive EEG monitoring. Monitoring of the depth of anesthesia is meaningful for reducing postoperative cognitive dysfunction at 1 and 12 weeks after surgery.
Universal origin of heavy elements
Authors: Orce Jose , Dey Balaram , Ngwetsheni Cebo , Lesch Brenden , Zulu Andile , Bhattacharya Srijit , Pandit Deepak , Gopal Sumeera , Khumalo Siphamandla , Mngonyama Sifiso , Mthethwa Gift , Ndala Yandisa , Ndingi Asive , Wakudyanaye Ignasio 
Published: May 2021

Abstract
The abundance of heavy elements above iron through the rapid neutron capture process or r-process is intimately related to the competition between neutron capture and $\beta$ decay rates, which ultimately depends on the binding energy of atomic nuclei. The well-known Bethe-Weizsacker semi-empirical mass formula describes the binding energy of ground states in nuclei with temperatures of T~0 MeV, where the nuclear symmetry energy saturates between 23-26 MeV. Here we find a larger saturation energy of ~30 MeV for nuclei at T~0.7-1.3 MeV, which corresponds to the typical temperatures where seed elements are created during the cooling down of the ejecta following neutron-star mergers and collapsars. This large symmetry energy yields a reduction of the binding energy per nucleon for neutron-rich nuclei; hence, the close in of the neutron dripline, where nuclei become unbound. This finding constrains exotic paths in the nucleosynthesis of heavy elements -- as supported by microscopic calculations of radiative neutron-capture rates -- and further supports the universal origin of heavy elements, as inferred from the abundances in extremely metal-poor stars and meteorites.
Moist convection drives an upscale energy transfer at Jovian high latitudes
Authors: Siegelman Lia , Klein Patrice , Ingersoll Andrew , Ewald Shawn , Young William , Bracco Annalisa , Mura Alessandro , Adriani Alberto , Grassi Davide , Plainaki Christina , Sindoni Giuseppe 
Published: May 2021

Abstract
Jupiter’s atmosphere is one of the most turbulent places in the solar system. While lightning and thunderstorm observations point to moist convection as a small-scale energy source for Jupiter’s large-scale vortices and zonal jets, it has never been demonstrated due to the coarse resolution of pre-Juno measurements. Since 2017, the Juno spacecraft discovered that Jovian high-latitudes host a cluster of large cyclones (diameter of ~ 5,000 km each) associated with intermediate (~ 1,600--500 km) and smaller-scale vortices and filaments (~ 100 km). Here, we analyze Juno-infrared images with an unprecedented high-resolution of 10 km. We unveil a new dynamical regime associated with a significant energy source of convective origin that peaks at 100 km-scales and in which energy gets subsequently transferred upscale to the large circumpolar and polar cyclones. While this energy route has never been observed on another planet, it is surprisingly consistent with idealized studies of rapidly rotating Rayleigh-Bénard convection, lending robust theoretical support to our analyses. This energy route is expected to enhance the heat transfer from Jupiter’s hot interior to its troposphere and may also be relevant to the Earth’s atmosphere, helping us better understand the dynamics of our own planet.
Emergency Care of Sepsis in Sub-Saharan Africa: Incidence, Mortality and Non-Physician Clinician Management of Sepsis in rural Uganda from 2010 to 2019
Authors: Rice Brian , Calo Sal , Kamugisha John Bosco , Kamara Nicholas , Chamberlain Stacey , n/a Global Emergency Care Investigator Study Group 
Published: May 2021

Abstract
Introduction:Little data exists from sub-Saharan Africa describing incidence and outcomes of sepsis in emergency units and uncertainty exists surrounding optimal management of sepsis in low-income settings. There exists limited data regarding quality care metrics for non-physician clinicians trained in emergency care.Methods:Data were obtained for patients seen from 2010-2019 in a rural Ugandan emergency unit staffed by non-physician clinicians. Sepsis was defined as suspected infection with a qSOFA score ≥ 2. Descriptive analysis was performed and a multi-variable logistic regression mortality model was created. Analysis included Wilcoxon rank-sum test, t-test, one-way ANOVA, and Fisher’s exact test.Results:Overall, 48,653 patient visits from 2010-2019 yielded 17,490 encounters for patients age≥18 who had suspected infection, including 3,323 with sepsis. Overall sepsis incidence from 2010 to 2019 decreased from 16.4% to 4.7%, and malarial sepsis incidence decreased from 4.3% to 0.1%. From 2012 to 2019, the proportion of septic patients receiving quality care (both fluids and anti-infectives) increased from 36.2% to 44.7% but observed mortality rates for non-malarial sepsis increased from 6.3% to 14.9% and predicted mortality rates increased from 8.8% to 12.0%. Higher qSOFA scores were significantly associated with higher rates of both interventions and mortality. All interventions for non-malarial sepsis were independently associated with increased relative risks for death: “fluids alone” RR=1.22 [95%CI 0.57 – 1.87]; “antibiotics alone” RR=1.25 [95%CI 0.60 – 1.91]; “both fluids and antibiotics”: RR=1.85 [95%CI 1.02 – 2.69]. Conclusion: The largest study of sepsis management and outcomes ever published in both Uganda and sub-Saharan Africa showed decreasing incidence, increasing quality of non-physician clinician care and increasing predicted and observed mortality from 2010 to 2019. With causal associations between antibiotics and mortality deemed implausible, associations between sepsis mortality and interventions likely represent confounding by indication. Defining optimal sepsis care regionally will likely require randomized controlled trials.
WITHDRAWN: Reduction in Microbial Manifestation on In Vitro Culture of Eucalyptus Microcorys
Authors: Atala Laura Ribeiro , Faria Júlio Cézar Tannure , Molinari Letícia V , Avelar Maria Lopes Martins , Brondani Gilvano Ebling 
Published: May 2021

Abstract
Micropropagation is one of the main applications of tissue culture of plants. It allows rejuvenation and, consequently, improves explant rooting of woody species. However, one of its main problems is the risk of microbial manifestation. Here, we aimed to evaluate the survival and the reduction in microbial manifestations on in vitro cultures of Eucalyptus microcorys with the addition of chemical agents (sodium hypochlorite or streptomycin) to WPM culture medium. We used in vitro cultivated explants from adventitious shoots from two E. microcorys mother plants, over at 44 years-old. We drew from the multiplication phase explants with clumps of 8 to 12 shoots that displayed bacterial manifestation and submitted them to microbe control, adding different chemical agents at different concentrations to the culture medium: sodium hypochlorite (NaClO) and the antibiotic streptomycin. The results indicated that the best concentrations to reduce the manifestation of microorganisms on in vitro cultivation were 100 mg L− 1 of streptomycin and sodium hypochlorite with 0.003% of active chlorine, since these concentrations maintained 100% of the explants alive and reduced microbial manifestation more efficiently.
Are Combined Techniques Using Video Laryngoscopes and Dynamic Stylets Superior to Fiberoptic Techniques for Anticipated Difficult Intubations? A Retrospective Case Control Study
Authors: Shah Ashka , Knecht Lauren , Jacobson Cameron , Runnels Sean , Presson Angela , Zhang Chong , Durnford Kathryn 
Published: May 2021

Abstract
Difficult intubations can require advanced intubation techniques. Studies point to potential advantages of combined techniques using video laryngoscopes (VL) and dynamic stylets for anticipated difficult intubations. This study is designed to compare combined techniques to awake and asleep fiberoptic (FOB) techniques.Methods: 138,387 consecutive anaesthesia cases were reviewed for use of: FOB awake, FOB asleep, or combined technique (VL for visualization and either a FOB or a novel TCITM articulating introducer ((TCITM; Through The Cords, LLC; Salt Lake City, UT)) as dynamic stylets as a primary approach for anticipated difficult intubations. Primary end points measured: first attempt success rate, failure to intubate with the primary technique, “in-room to intubation’ time, reported traumatic intubation rate, and reported ease of intubation.Results: Significant differences were found between techniques. First pass success rate was highest in combined techniques (either VL + FOB or VL + TCITM) (88.7%) followed by FOB awake (74.2%, P<0.001) and FOB asleep (80.7%, P=0.06). “Failure to intubate with the primary technique” was lowest in combined techniques (1.8%) followed by FOB asleep (4.6%, P=0.11) and FOB awake (9.2%, P=0.002). “In room to intubated” time was fastest in combined techniques (13.0 minutes) followed by FOB asleep (15.1 minutes, P=0.002) and FOB awake (21.2 minutes, P<0.001). Combined techniques were rated as ‘easy’ more often (72%) followed by FOB asleep (62.9%, P=0.12) and FOB awake (38.2%, P<0.001). Combined techniques were rated as “atraumatic” more often (91.1%) followed by FOB asleep (89.4%, P=0.91) and FOB awake (75.8%, P<0.001). In subgroup analysis of combined techniques, VL + TCITM had the highest first attempt success rate (90.2%), lowest failure rate (1%, P=0.56), and shortest “in room to intubated time” (12.1 minutes, P=0.12). It was also rated as "easy” (83.3%, P<0.001), and “atraumatic“ (96.1%, P=0.009) more often than VL + FOB, FOB awake or FOB asleep.Conclusions: Combined techniques outperformed FOB techniques in terms of effectiveness, speed, ease of use, and patient injury in patients with risk factors for difficult intubation. As a sub-group of combined technique, VL + TCITM outperformed all other techniques. Combined techniques should be considered when managing difficult intubations.
Analysis of Three-Dimensional Flow Field Inside the Pilot Stage of the Deflector Jet Servo Valve
Authors: Li Shuanglu , Yin YaoBao , Yuan JiaYang , Guo ShengRong 
Published: May 2021

Abstract
Current two-dimensional flow field model has some defects in describing the pilot stage’s flow field and static characteristics of the deflector jet servo valve(DJSV) because the three-dimensional(3D) jet of the flow field is ignored. In order to overcome the shortcomings, a new flow field model is proposed and the energy transfer process of the pilot stage is obtained. In this model, the flow field is divided into five regions: pressure jet region, free jet region, mixed collision region, secondary jet region and pressure recovery region. Especially, three-dimensional turbulent jet is adopted in the free jet region for the first time to describe the structure of the flow field, and the jet entrainment model is proposed in pressure recovery region to describe the coupling relationship between the pressure in the receiving chamber and the jet flow which has never been considered before. The static characteristics of the pilot stage, such as pressure-flow characteristics, pressure characteristics and flow characteristics are obtained, and the relationship between zero-position valve coefficients and the key structural parameters of the pilot stage is analyzed. The results show that main structural parameters that affect the pressure gain include the length of receiving chamber, the width of guide groove outlet and the width of the wedge; The thickness of jet-pan has the most significant influence on flow gain. The flow field structure and the static characteristics are verified respectively by finite element analysis(FEA) and experimental results, and the results show that the pilot stage mathematical model has good reliability which is beneficial to understand the working mechanism of the pilot stage provide theoretical basis for parameter optimization.
In-depth Insights into Alzheimer's Disease by using Explainable Machine Learning Approach - Existing Hypothesis Confronted
Authors: Bogdanovic Bojan , Eftimov Tome , Simjanoska Monika 
Published: May 2021

Abstract
Background: Alzheimer's disease is still a field of research with lots of open questions. The complexity of the disease prevents the early diagnosis before visible symptoms regarding the individual's cognitive capabilities occur. This research presents an in-depth analysis of a huge data set encompassing medical, cognitive and lifestyle's measurements from more than 12,000 individuals. Several hypothesis were established whose validity has been questioned considering the obtained results.Methods: The importance of appropriate experimental design is highly stressed in the research. Thus, a sequence of methods for handling missing data, redundancy, data imbalance, and correlation analysis have been applied for appropriate preprocessing of the data set, and consequently Random Forest and XGBoost models have been trained and evaluated with special attention to the hyperparameters tuning. Both of the models were explained by using the Shapley values produced by the SHAP method.Results: XGBoost produced the best f1-score of 0.84 and as such is considered to be highly competitive among those published in the literature. This achievement, however, was not the main contribution of this paper. This research's goal was to perform global and local interpretability of both the intelligent models and derive valuable conclusions over the established hypothesis. Those methods led to a single scheme which presents either positive, or, negative influence of the values of each of the features whose importance has been confirmed by means of Shapley values. This scheme might be considered as additional source of knowledge for the physicians and other experts whose concern is the exact diagnosis of early stage of Alzheimer's disease.Conclusion: The conclusions derived from the intelligent models interpretability rejected all the established hypothesis. This research clearly showed the importance of Machine learning explainability approach that opens the black box and clearly unveils the relationships among the features and the diagnoses.