bluuebunny/crossref_metadata_2025_split huggingface dataset:
Listening to Stakeholders: Initiating Research on Subseasonal-to-Seasonal Heavy Precipitation Events in the Contiguous United States by First Understanding What Stakeholders Need
Authors: VanBuskirk Olivia , Ćwik Paulina , McPherson Renee A. , Lazrus Heather , Martin Elinor , Kuster Charles , Mullens Esther 
Published: June 2021

AbstractHeavy precipitation events and their associated flooding can have major impacts on communities and stakeholders. There is a lack of knowledge, however, about how stakeholders make decisions at the subseasonal-to-seasonal (S2S) time scales (i.e., 2 weeks to 3 months). To understand how decisions are made and S2S predictions are or can be used, the project team for “Prediction of Rainfall Extremes at Subseasonal to Seasonal Periods” (PRES2iP) conducted a 2-day workshop in Norman, Oklahoma, during July 2018. The workshop engaged 21 professionals from environmental management and public safety communities across the contiguous United States in activities to understand their needs for S2S predictions of potential extended heavy precipitation events. Discussions and role-playing activities aimed to identify how workshop participants manage uncertainty and define extreme precipitation, the time scales over which they make key decisions, and the types of products they use currently. This collaboration with stakeholders has been an integral part of PRES2iP research and has aimed to foster actionable science. The PRES2iP team is using the information produced from this workshop to inform the development of predictive models for extended heavy precipitation events and to collaboratively design new forecast products with our stakeholders, empowering them to make more-informed decisions about potential extreme precipitation events.
Distinguishing Characteristics of the Tropical Cyclone Gigantic Jet Environment
Authors: Lazarus Steven M. , Chiappa Jason , Besing Hadley , Splitt Michael E. , Riousset Jeremy A. 
Published: June 2021

AbstractThe meteorological characteristics associated with thunderstorm-top turbulence and tropical cyclone (TC) gigantic jets (GJs) are investigated. Using reanalysis data and observations, the large-scale environment and storm-top structure of three GJ-producing TCs are compared to three non-GJ oceanic thunderstorms observed via low-light camera. Evidence of gravity wave (GW) breaking is manifest in the IR satellite images with cold ring and enhanced-V signatures prevalent in TCs Hilda and Harvey and embedded warm spots in the Dorian and null storms. Statistics from an additional six less prodigious GJ environments are also included as a baseline. Distinguishing features of the TC GJ environment include higher tropopause, colder brightness temperatures, more stable lower stratosphere/distinct tropopause, and reduced tropopause penetration. These factors support enhanced GW breaking near the cloud top (overshoot). The advantage of a higher tropopause is that both electrical conductivity and GW breaking increase with altitude and thus act in tandem to promote charge dilution by increasing the rate at which the screening layer forms as well as enhancing the storm-top mixing. The roles of the upper-level ambient flow and shear are less certain. Environments with significant upper-tropospheric shear may compensate for a lower tropopause by reducing the height of the critical layer which would also promote more intense GW breaking and turbulence near the cloud top.
Ten-year follow-up of social functioning and behaviour problems in people with schizophrenia and related disorders
Authors: Vázquez-Reyes Antonio , Ángeles Pérez-San-Gregorio María , Martín-Rodríguez Agustín , Vázquez-Morejón Antonio J 
Published: June 2021

Background: In recent years, several variables in the course of schizophrenia and related psychotic disorders have been studied. However, an instrumental analysis of the evolution of social functioning and behaviour problems has scarcely been explored. Aim: To analyse the evolution of social functioning and behaviour problems and find any diagnosis or gender differences. Method: The Social Functioning Scale (SFS) and the Behaviour Problems Inventory (BPI) were administered in Stages I (2003–2007) and II (2014–2017) to 100 close relatives of patients under treatment at a Community Mental Health Unit. A related samples t-test, analysis of variance and multivariate analysis of variance were performed to study the evolution and differences in social functioning and behaviour problems. Then a stepwise multiple linear regression analysis was done to predict the evolution of social functioning. Results: No deterioration in the evolution of social functioning or behaviour problems was observed, and schizophrenia patient scores were lower. Women scored higher in withdrawal/social engagement, interpersonal behaviour, independence-performance, independence-competence and total social functioning, with no significant differences in behaviour problems. Previous social functioning, underactivity/social withdrawal and education are predictive factors in the evolution of social functioning. Conclusion: The results show the need for implementing psychosocial intervention programs that promote functional recovery and keep problems from becoming chronic.
Using GTFS to Calculate Travel Time Savings Potential of Bus Preferential Treatments
Authors: Arias Daniel , Todd Kara , Krieger Jennifer , Maddox Spencer , Haley Pearse , Watkins Kari Edison , Berrebi Simon 
Published: June 2021

Dedicated bus lanes and other transit priority treatments are a cost-effective way to improve transit speed and reliability. However, creating a bus lane can be a contentious process; it requires justification to the public and frequently entails competition for federal grants. In addition, more complex bus networks are likely to have unknown locations where transit priority infrastructure would provide high value to riders. This analysis presents a methodology for estimating the value of bus preferential treatments for all segments of a given bus network. It calculates the passenger-weighted travel time savings potential for each inter-stop segment based on schedule padding. The input data, ridership data, and General Transit Feed Specification (GTFS) trip-stop data are universally accessible to transit agencies. This study examines the 2018 Metropolitan Atlanta Rapid Transit Authority (MARTA) bus network and identifies a portion of route 39 on Buford Highway as an example candidate for a bus lane corridor. The results are used to evaluate the value of time savings to passengers, operating cost savings to the agency, and other benefits that would result from implementing bus lanes on Buford Highway. This study does not extend to estimating the cost of transit priority infrastructure or recommending locations based on traffic flow characteristics. However, it does provide a reproducible methodology to estimate the value of transit priority treatments, and it identifies locations with high value, all using data that are readily available to transit agencies. Conducting this analysis provides a foundation for beginning the planning process for transit priority infrastructure.
Lead in Mineral or Multivitamin-Multimineral Products
Authors: White C. Michael 
Published: June 2021

Objective Assess the current daily interim reference level of lead and the amount contained in current mineral and multivitamin-multimineral (MVM) products. Data Sources PubMed search from 1980 to May 15, 2021, limited to the English language, via the search strategy ((mineral OR multivitamin OR calcium OR iron OR magnesium OR copper OR zinc OR chromium OR selenium) AND (heavy metals OR Pb OR lead)). Study Selection and Data Extraction Narrative review of studies assessing lead content in mineral or MVM products. Data Synthesis Products containing different calcium forms (dolomite, bone meal, natural carbonate) have historically had higher lead levels than others (refined carbonate, lactate, gluconate, acetate, sevelamer), but the gap has closed considerably since the year 2000. Although only limited assessments of magnesium and zinc supplements have been conducted, no alarming average lead amounts were found. MVM products assessed since 2007 had low median or mean lead concentrations. However, large interproduct differences exist, with many products having very little lead and some products having concerning amounts. Relevance to Patient Care and Clinical Practice It is difficult for pharmacists and consumers to know the amount of lead in an actual product unless it is tested in an independent third-party lab. The United States Pharmacopeia and NSF International will provide a seal on the products stating that the products have a low level of lead, but even so, children could receive more lead than the Food and Drug Administration’s Interim Reference Level. Conclusions The threat from lead exposure in mineral and MVM products have diminsihed considerably over time but some products can still have excessive amounts. Without third-party testing, it is difficult for clinicians and consumers to know which outlier products to avoid.
Incidence of dural sac puncture during neuraxial anesthesia in cats: an observational, retrospective study
Authors: Rondelli Vincenzo , Otero Pablo E , Romano Francesca , Verdier Natali , Bettschart-Wolfensberger Regula , Portela Diego A 
Published: June 2021

Objectives The aim of this study was to determine the occurrence of dural puncture, indicated by cerebrospinal fluid (CSF) outflow, in cats receiving neuraxial anesthesia through a lumbosacral injection guided by a pop sensation method. Methods This was an observational, retrospective study. Cats that were scheduled for lumbosacral neuraxial anesthesia were included. Medical records were analyzed to investigate: (1) demographic data; (2) neuraxial anesthesia performed (epidural/spinal); (3) type of needle used, including gauge and length; (4) presence of CSF (yes/no) and/or blood (yes/no) in the hub of the needle; and (5) flicking of the tail during needle advancement (yes/no). Results A total of 94 medical records were analyzed. A 22 G 50 mm Tuohy needle was used in all cats scheduled for an epidural injection (n = 60), whereas a 22 G 40 mm Quincke needle was used in all cats scheduled for an intrathecal injection (n = 34). CSF outflow was detected in 55/60 (91.7%) cats in which a Tuohy needle was used, and 34/34 (100%) of the cats in which a Quincke needle was used ( P = 0.15). Flicking of the tail was detected in 41/60 (68.3%) and in 24/34 (70.6%) injections with Tuohy and Quincke needles, respectively ( P >0.99). Traces of blood, but not active blood outflow, were detected via staining of the first drops of CSF in 2/34 cats in which Quincke needles were used and in none of the cats in which Tuohy needles were used ( P = 0.12). Conclusions and relevance This study shows that the lumbosacral approach for neuraxial anesthesia in cats may result in a dural sac puncture when 22 G Quincke or Tuohy needles are used. The pop sensation method should be deemed effective in predicting intrathecal but not epidural needle placement.
Peripheral central catheter insertion in low eGFR patients: Retrospective single institution study
Authors: Othman Khalid , Abdulrahman Shaima , Salman Refaat , Al Harbi Asma , Al Malik Wafa , Arabi Mohammad 
Published: June 2021

Purpose: To identify the rate of Peripherally Inserted Central Catheter (PICC) placement in patients with chronic kidney disease (CKD), stage 3B or higher (glomerular filtration rate (eGFR) <45 mL/min/1.73 m2). Material and methods: A retrospective study of 2825 adult patients (male 51.2%, female 48.8%) who had a PICC insertion from January 2017 to December 2019. The data collected includes gender, eGFR value at the date of insertion, accessed vein and side, ongoing or subsequent dialysis within 1 year, and death within 1 year of the insertion date. The study excluded pediatric patients, patients with missing eGFR values prior to the procedure and follow-up information. Result: PICC insertion was done in patients with eGFR⩽45 mL/min/1.73 m2 in 26.7% (724/2709) of the sample. Ongoing dialysis was documented in 10.2% (198/1946) and subsequent dialysis in 6.5% of the patients within the year after insertion. The overall death rate for the year post PICC insertion was 38.7% (1094/2825), which was significantly higher in low eGFR patients (413/724, 57%) compared to patients with eGFR>45 mL/min/1.73 m2 (632/1985, 31.8%) ( p-value < 0.0001, odds ratio 2.84 (95% confidence interval 2.38–3.38)). The rate of dialysis initiated in the year post PICC insertion was 5.9% (98/1657). This was significantly higher in patients with a low eGFR and not previously dialyzed (59/310, 19%) compared to patients with eGFR>45 who required dialysis in the year post insertion (39/1347, 2.9%) ( p < 0.0001, odds ratio 7.88 (95% confidence interval 5.14–12.07)). Conclusion: PICC insertion in patients with CKD is practiced frequently. Rigorous strategies should be implemented to improve adherence to clinical practice guidelines and reduce unnecessary insertions and preserve veins for when an AVF may be required.
Adherence to National Consensus Guidelines and Association with Clinical Outcomes in Patients with Candidemia
Authors: Junco Shauna Jacobson , Chehab Sarah , Giancarelli Amanda , Bowman Mary Catherine , Turner R Brigg 
Published: June 2021

Background: National consensus guidelines outline recommendations for best practices in treating patients with candidemia. This study evaluated the impact of receiving care adherent to the best practice recommendations on clinical outcomes in patients with candidemia. Methods: This retrospective, multicenter study included patients with candidemia from 2010 to 2015 at 9 hospitals. The primary outcome was the composite of 30-day in-hospital mortality and 90-day candidemia recurrence. Outcomes were compared between those receiving and not receiving care adherent to the guideline recommendations. Inverse probability weights with regression adjustment were utilized to determine the average treatment effect of adherent care on the composite outcome Results: 295 patients were included with 14.2% meeting criteria for the composite outcome (11.9% mortality and 2.4% recurrence). The average treatment effect of adherent care was not significant ( P = .75). However, receiving appropriate initial antifungal treatment and central venous catheter removal were both associated with the composite (average treatment effect of −17.5%, P = .011 and −8.8%, P = .013, respectively). In patients with a source of infection other than the central line, central venous catheter removal was not associated with the composite ( P = .95). The most common reason for failure to receive appropriate initial antifungal treatment was omission of the loading dose. Conclusions: Central venous catheter removal and appropriate initial antifungal treatment were associated with a lower incidence of the composite of mortality and recurrence. Additional studies are needed to determine the optimal duration of therapy following candidemia clearance.
Hysterectomy in India: Spatial and multilevel analysis
Authors: Singh Angad , Govil Dipti 
Published: June 2021

Objective: Using the unit-level data of women aged 15–49 years from National Family Health Survey-IV (2015–2016), the article maps the prevalence of hysterectomy across districts in India and examines its determinants. Methods: Descriptive statistics, multivariate techniques, Moran’s Index and Local indicators of Spatial Association were used to understand the objectives. The data were analysed in STATA 14.2, Geo-Da and Arc-GIS. Results: In India, the prevalence of hysterectomy operation was 3.2%, the highest in Andhra Pradesh (8.9%) and the lowest in Assam (0.9%). Rural India had higher a prevalence than urban India. The majority of women underwent the operation in private hospitals. Hysterectomy prevalence ranged between 3% and 5% in 126 districts, 5% and 7% in 47 districts and more than 7% in 26 districts. Moran’s Index (0.58) indicated the positive autocorrelation for the prevalence of hysterectomy among districts; a total of 202 districts had significant neighbourhood association. Variation in the prevalence of hysterectomy was attributed to the factors at the primary sampling unit, district and state level. Age, parity, wealth and insurance were positively associated with the prevalence of hysterectomy, whereas education and sterilization was negatively associated. Conclusion: Hysterectomy operation in India presented the geographical, socio-economic, demographic and medical phenomenon. The high prevalence of hysterectomy in many parts of the country suggested conducting in-depth studies, considering the life cycle approach and providing counselling and education to women about their reproductive rights and informed choice. Surveillance and medical audits and promoting the judicial use of health insurance can be of great help.
Usefulness of black-blood magnetic resonance angiography generated from vessel wall imaging after the stent-assisted treatment of intracranial arterial diseases
Authors: Gomyo Miho , Tsuchiya Kazuhiro , Goto Shun , Hosoi Shinsuke , Tahara Takahiro , Yokoyama Kenichi 
Published: June 2021

Purpose After stent-assisted treatment for intracranial diseases, three-dimensional time-of-flight magnetic resonance angiography is a noninvasive follow-up method, but susceptibility artifacts prevent accurate evaluations of stented arteries. Sampling perfection with application-optimized contrast using different flip angle evolution (SPACE) sequence often used for vessel wall imaging is less susceptible to susceptibility artifacts, since it is a spin-echo sequence. Hence, we evaluated the feasibility of black-blood magnetic resonance angiography generated from vessel wall imaging data obtained using the SPACE sequence in the depiction of stented arteries by comparing with three-dimensional time-of-flight magnetic resonance angiography and digital subtraction angiography. Methods Our study group comprised 11 consecutive patients. For both three-dimensional time-of-flight magnetic resonance angiography and black-blood magnetic resonance angiography, the contrast ratio obtained from the stented artery and the normal artery proximal to the stent were calculated. And the depiction of stented arteries was visually evaluated. Additionally, the relative diameter index obtained from the stented artery and the normal artery proximal to the stent were calculated for three-dimensional time-of-flight magnetic resonance angiography, black-blood magnetic resonance angiography and digital subtraction angiography. Results The contrast ratio of the stented artery was significantly lower than that of the normal artery on three-dimensional time-of-flight magnetic resonance angiography, but no significant difference was seen using black-blood magnetic resonance angiography. Regarding both the diameter index and the visual assessment score, black-blood magnetic resonance angiography was significantly better than three-dimensional time-of-flight magnetic resonance angiography. On black-blood magnetic resonance angiography, the diameter index was equal to that of digital subtraction angiography, and the flow signal was homogeneous and continuous in most the cases.
Rasch Analysis of Lebanese Nurses’ Responses to the Copenhagen Burnout Inventory Alternative to the Maslach Burnout Inventory
Authors: Clinton Michael , Shehadeh, MSN, RN Roula 
Published: June 2021

Introduction Lebanon struggled with political and economic crises before it was affected by the COVID-19 pandemic. Executive nurses and hospital administrations need reliable open-source measures to monitor burnout and prioritize nurses for intervention as Lebanon struggles with the multiple crises compounded by rising numbers of COVID-19 cases and deaths. Objectives The study aimed to determine whether the Copenhagen Burnout Inventory scales are suitable for settings experiencing multiple crises. Its objectives were to investigate the CBI scales' measurement properties, identify burnout levels in a sample of nurses experiencing compound stressors, assess whether the scales' three-dimensional burnout model is plausible, and establish norms for using the scales in work settings subject to compound external stressors. Methods The study is a psychometric analysis of the anonymous survey data of 142 registered nurses working in acute hospitals in Lebanon. We fitted the data to unidimensional and multidimensional Rasch rating scale models. Item fit, person separation and reliability, targeting, differential item functioning, and scale norms were estimated. Results Nurses in the sample had a high level of burnout. The Copenhagen Burnout Inventory scales have excellent reliability. The personal burnout and work-related scales were highly correlated and moderately correlated with the client-related burnout scale. Possible differential functioning in the work-related burnout scale requires further investigation. Conclusion More extensive and diverse studies in workplaces subjected to compound stressors are required to confirm the study results. Meanwhile, executive nurses and hospital administrations can use the norms reported to prioritize nurses for burnout prevention and intervention programs. In Lebanon, our reported CBI scale values can be used as baseline standards for studies tracking how the COVID-19 pandemic is impacting the nursing workforce.
Incidental Thyroid Nodules Found During Acute Stroke Angiography: Prevalence, Outcomes, and Suggested Management Guidelines
Authors: Lin Diana M. , Arevalo Yurany A. , Lin Chen 
Published: June 2021

Objective: In stroke patients, extensive interventions for incidental thyroid nodules can be burdensome and costly. It appears that the risk of malignancy has not been reported in angiographically detected nodules and outcomes have not yet been described in patients, receiving acute stroke work-up. Materials and Methods: Incidental thyroid nodules were found on neck computerized tomography angiography or magnetic resonance angiography performed during inpatient stroke workup (January 2017 to September 2019). These patient cases were reviewed based on sonography reports, diagnosis, and follow-up care. Results: Of the 13 563 patients, 192 had incidental thyroid nodules (prevalence 1.4%). Twenty-six died from comorbidities and 22 received thyroid sonography. Twelve nodules from 10 patients had sonographic characteristics for biopsy: 10 benign, 1 indeterminate, and 1 papillary thyroid cancer (risk of malignancy: 8%). The cancer patient underwent hemithyroidectomy and is disease-free. Follow-up of the remaining patients showed no worsening or suspicious nodules. The American College of Radiology (ACR) guidelines would have prevented 8 unnecessary sonograms and 1 biopsy without missing malignancy. Conclusion: Although a small risk of malignancy was noted, 95% of patients undergoing additional diagnostic thyroid testing had clinically insignificant results. The ACR guidelines can prevent unnecessary interventions. Given the 14% mortality rate in the study cohort, it is proposed that a clinical evaluation of patients is important before undergoing further diagnostics, as comorbidities may be worse than a thyroid cancer.