bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delayed Impact of Indian Ocean Warming on the East Asian Surface Temperature Variation in Boreal Summer
Authors: Kim Sunyong , Kug Jong-Seong 
Published: January 2021

AbstractA significant negative relationship is found between the summer mean north Indian Ocean sea surface temperature (SST) and East Asian surface temperature anomalies. However, the relationship is distinctively different for each month and shows a time-lagged relation rather than a simultaneous one. The north Indian Ocean warming in June is responsible for significant cold anomalies over the region of the Korean Peninsula and Japan (KJ region) that peak in July, exhibiting a 1-month leading role. The SST increase is closely associated with enhanced convective activity in the region in June, but the relationship between SST and resultant precipitation is substantially weakened afterward. This dependency of the precipitation sensitivity on SST anomalies is related to the climatological evolution of SST. The relatively low background SST due to the strengthening of southwesterly monsoons in the late summer can weaken the sensitivity of the precipitation to SST anomalies, yet the background SST in June is strong enough to maintain an increased sensitivity of precipitation. Thus, the Indian Ocean warming in June effectively drives atmospheric Kelvin waves that propagate into the equatorial western Pacific. In the western North Pacific (WNP), the resultant Kelvin wave–induced Ekman divergence triggers suppressed convection and anticyclonic anomalies. The WNP suppressed convection and anticyclonic anomalies move slowly northeastward until they are located near 20°N through the local air–sea interaction, and act as a source of the Pacific–Japan teleconnection. This teleconnection pathway brings clod surface anomalies to the KJ region due to the cyclonic circulation that causes the radiative and horizontal advection.
How Does the Relationship between Ambient Deep-Tropospheric Vertical Wind Shear and Tropical Cyclone Tornadoes Change between Coastal and Inland Environments?
Authors: Schenkel Benjamin A. , Coniglio Michael , Edwards Roger 
Published: January 2021

AbstractThis work investigates how the relationship between tropical cyclone (TC) tornadoes and ambient (i.e., synoptic-scale) deep-tropospheric (i.e., 850–200-hPa) vertical wind shear (VWS) varies between coastal and inland environments. Observed U.S. TC tornado track data are used to study tornado frequency and location, while dropsonde and radiosonde data are used to analyze convective-scale environments. To study the variability in the TC tornado–VWS relationship, these data are categorized by both 1) their distance from the coast and 2) reanalysis-derived VWS magnitude. The analysis shows that TCs produce coastal tornadoes regardless of VWS magnitude primarily in their downshear sector, with tornadoes most frequently occurring in strongly sheared cases. Inland tornadoes, including the most damaging cases, primarily occur in strongly sheared TCs within the outer radii of the downshear-right quadrant. Consistent with these patterns, dropsondes and coastal radiosondes show that the downshear-right quadrant of strongly sheared TCs has the most favorable combination of enhanced lower-tropospheric near-surface speed shear and veering, and reduced lower-tropospheric thermodynamic stability for tornadic supercells. Despite the weaker intensity farther inland, these kinematic conditions are even more favorable in inland environments within the downshear-right quadrant of strongly sheared TCs, due to the strengthened veering of the ambient winds and the lack of changes in the TC outer tangential wind field strength. The constructive superposition of the ambient and TC winds may be particularly important to inland tornado occurrence. Together, these results will allow forecasters to anticipate how the frequency and location of tornadoes and, more broadly, convection may change as TCs move inland.
Neck Strength and Endurance and Associated Personal and Work-Related Factors
Authors: Chowdhury Suman K. , Zhou Yu , Wan Bocheng , Reddy Curran , Zhang Xudong 
Published: January 2021

Objective The present study aimed to establish a normative database of neck strength and endurance while exploring personal and work-related factors that can significantly influence neck strength and endurance. Background A normative database combining both neck strength and endurance and delineating how they are affected by personal and work-related factors is currently lacking. It is needed for the development of tools and guidelines for designing work requiring head-neck exertions to contain the risk of occupational neck pain. Methods Forty healthy participants (20 males and 20 females) performed sustained-till-exhaustion head-neck exertions, while seated, at 50% and 100% of their maximal efforts in anterior, anterior-superior, and posterior-superior directions in neutral, 40° extended, and 40° flexed neck postures. Exertion force and endurance time data from 38 participants were recorded and analyzed using regression models. Results Overall, multiple regression analyses of the neck strength and endurance database revealed that head-neck posture is the most significant determinant of both neck strength and endurance. The time of day significantly influenced neck endurance. Among the personal factors, a significant sex effect on neck strength and significant age and body mass index (BMI) effects on neck endurance were identified. Conclusion The work-related factors play a more significant role in shaping both neck strength and endurance than personal factors and therefore are more important modifiable factors in meeting the physical demands of work. Application The study findings can aid in work design as well as in pre-employment screening to reduce the incidence of neck pain in the workplace.
International public administration on the tip of the tongue: language as a feature of representative bureaucracy in the Economic Community of West African States
Authors: Murdoch Zuzana , Gravier Magali , Gänzle Stefan 
Published: January 2021

Recent scholarship shows increasing interest in gender, ethnic or national representation within regional and international organizations. In contrast, language as a criterion of representation has rarely been scrutinized. We argue that this constitutes an important oversight for two reasons: (1) language is an important identity marker; and (2) language regimes in international public administrations can uniquely address representativeness relative to both member states and groups of citizens. Our article explores language representation in the Economic Community of West African States, and pursues a twofold objective: first, it extends the applicability of representative bureaucracy theory to the issue of language; and, second, it broadens the scope of representative bureaucracy studies by providing the first study on a prominent West African regional organization. As such, we develop avenues for future research on other regional and international organizations. Points for practitioners The article is of particular relevance for managers in multilingual international and regional organizations. Organizations tend to overlook the role and impact of languages on their functioning, often considering them as a technicality. Taking the example of the Economic Community of West African States, the article argues that linguistic regimes are important for the performance and the legitimacy of the organization in terms of acceptance by both citizens and its member states.
Observational study of thrombosis and bleeding in COVID-19 VV ECMO patients
Authors: Ripoll Brianda , Rubino Antonio , Besser Martin , Patvardhan Chinmay , Thomas William , Sheares Karen , Shanahan Hilary , Agrawal Bobby , Webb Stephen , Vuylsteke Alain 
Published: January 2021

Introduction: COVID-19 has been associated with increased risk of thrombosis, heparin resistance and coagulopathy in critically ill patients admitted to intensive care. We report the incidence of thrombotic and bleeding events in a single center cohort of 30 consecutive patients with COVID-19 supported by veno-venous extracorporeal oxygenation (ECMO) and who had a whole body Computed Tomography Scanner (CT) on admission. Methodology: All patients were initially admitted to other hospitals and later assessed and retrieved by our ECMO team. ECMO was initiated in the referral center and all patients admitted through our CT scan before settling in our intensive care unit. Clinical management was guided by our institutional ECMO guidelines, established since 2011 and applied to at least 40 patients every year. Results: We diagnosed a thrombotic event in 13 patients on the initial CT scan. Two of these 13 patients subsequently developed further thrombotic complications. Five of those 13 patients had a subsequent clinically significant major bleeding. In addition, two patients presented with isolated intracranial bleeds. Of the 11 patients who did not have baseline thrombotic events, one had a subsequent oropharyngeal hemorrhage. When analyzed by ROC analysis, the area under the curve for % time in intended anticoagulation range did not predict thrombosis or bleeding during the ECMO run (0.36 (95% CI 0.10–0.62); and 0.51 (95% CI 0.25–0.78); respectively). Conclusion: We observed a high prevalence of VTE and a significant number of hemorrhages in these severely ill patients with COVID-19 requiring veno-venous ECMO support.
Assisted Living Administrators’ Approaches to Advance Care Planning
Authors: Abken Elise S. , Perkins Molly M. , Bender Alexis A. 
Published: January 2021

Objectives: This project examined administrator processes, barriers, and facilitators for conducting advance care planning in assisted living. Method: Data from qualitative interviews with 27 administrators from seven diverse assisted living communities in the metropolitan Atlanta area were linked with descriptive and administrative data collected from each site and analyzed using thematic analysis. Results: Although administrators generally contended with a lack of staff training and stakeholders’ reluctance to discuss advance care planning and end-of-life care, important facilitators of advance care planning in some assisted living communities included periodic follow-up discussions of residents’ wishes and successfully educating consumers about the importance of planning. Three study communities whose administrators discussed planning with residents and informal caregivers during regular care plan meetings had more advance care planning documents on file. Discussion: These findings demonstrate the potential for nonmedical organizations, such as assisted living, to successfully promote advance care planning among their members.
Homocysteine Associated With Low Cognitive Function Independent of Asymptomatic Intracranial and Carotid Arteries Stenoses in Chinese Elderly Patients: An Outpatient-Based Cross-Sectional Study
Authors: Wang Xiaona , Qiao Tian , Liu Min , Wang Xiang 
Published: January 2021

Introduction: A high homocysteine (Hcy) concentration is correlated with cognitive impairment; however, the exact underlying mechanism is still not fully elucidated. The present study aimed to investigate whether asymptomatic intracranial and carotid arteries stenoses are involved in Hcy-related low cognitive function. Methods: This was a cross-sectional study in outpatient clinics. Residents aged ≥60 years, who came to the Stroke and Rehabilitation Clinic of Shandong Provincial Third Hospital in Jinan, Shandong Province from December 2019 to May 2020 to seek consultation due to abnormal transcranial Doppler reports (eg., increased cerebral blood flow velocity) were eligible. Information including demographics, medical history, lifestyle habits were collected. Fasting blood was used to detect total serum homocysteine level (tHcy). Cerebrovascular magnetic resonance angiography and neck vascular ultrasound examination were used to confirm the diagnosis of intracranial and carotid artery stenoses. The Mini-Mental State Examination was used to assess the cognitive function of each participant. Logistic regression was used to evaluate the relationship between tHcy levels and cognitive function. Results: This study included 236 participants (mean age: 64.0 (SD, 7.5) years, female: 58.1%). Multivariable analyses adjusted for several potential confounders, including creatinine and cardiovascular risk factors, showed that tHcy was associated with carotid artery stenosis (CAS). After adjusting for CAS, ICAS and several potential confounders, the association between tHcy level and low cognitive function remained significant (odds ratio: 1.09, 95% confidence interval: (1.03, 1.16), P = 0.032) . Conclusion: Increased serum tHcy level was associated with low cognitive function independent of asymptomatic intracranial and carotid arteries stenoses.
Suicide risk assessment in a large public mental health service: do suicide risk classifications identify those at risk?
Authors: Wyder Marianne , Ray Manaan Kar , Russell Samara , Kinsella Kieran , Crompton David , van den Akker Jeremy 
Published: January 2021

Introduction: Risk assessment tools are routinely used to identify patients at high risk. There is increasing evidence that these tools may not be sufficiently accurate to determine the risk of suicide of people, particularly those being treated in community mental health settings. Methods: An outcome analysis for case serials of people who died by suicide between January 2014 and December 2016 and had contact with a public mental health service within 31 days prior to their death. Results: Of the 68 people who had contact, 70.5% had a formal risk assessment. Seventy-five per cent were classified as low risk of suicide. None were identified as being at high risk. While individual risk factors were identified, these did not allow to differentiate between patients classified as low or medium. Discussion: Risk categorisation contributes little to patient safety. Given the dynamic nature of suicide risk, a risk assessment should focus on modifiable risk factors and safety planning rather than risk prediction. Conclusion: The prediction value of suicide risk assessment tools is limited. The risk classifications of high, medium or low could become the basis of denying necessary treatment to many and delivering unnecessary treatment to some and should not be used for care allocation.
The Role and Activities of Board-Certified Chaplains in Advance Care Planning
Authors: Kwak Jung , Cho Soyeon , Handzo George , Hughes Brian P. , Hasan Sami S. , Luu Albert 
Published: January 2021

Background: Healthcare chaplains have key roles in providing palliative support to patients and families, and they are well-suited to facilitate advance care planning (ACP). However, empirical data on the roles and responsibilities of chaplains in facilitating ACP are limited. Objectives: To examine the roles of board-certified healthcare chaplains in ACP in various healthcare settings. Methods: A cross-sectional, web-based self-report survey was conducted with 585 board-certified chaplains recruited from 3 major professional chaplains’ organizations in the U.S. The survey data included chaplains’ demographic and professional characteristics, their roles and responsibilities, and responses regarding communication and participation with other healthcare team members in facilitating ACP, including experienced barriers. Results: More participants worked in community hospital settings (42%) and academic medical centers (19.6%) than in any other setting. Over 90% viewed ACP as an important part of their work, 70% helped patients complete advance directives, and 90% helped patients discuss their preferences about end-of-life treatments. Many chaplains were not consistently included in team discussions regarding decision-making, although most chaplains reported that they could always find ways to communicate with their teams. Conclusion: Professional board-certified chaplains regularly engage in facilitating ACP discussions with patients and families in various healthcare settings. There is a need to recognize and provide systematic support for the role of chaplains in facilitating ACP conversations and to integrate chaplains into routine interdisciplinary team and family meetings.
Craniofacial Features in Richieri-Costa-Pereira Syndrome
Authors: Pardo Milena P. , Santos Gabriela Lopes dos , Carvalho Izabel M.M. , Tjioe Kellen Cristine 
Published: January 2021

Objective: Patients with Richieri-Costa-Pereira syndrome (RCPS) present severe craniofacial alterations and frequently require orthodontic and surgical procedures. Thus, this study aims to describe the craniofacial relationships in patients with RCPS. Design: Panoramic radiographs and lateral cephalometric teleradiographs of 7 patients with RCPS and 7 age- and sex-matched nonsyndromic patients were analyzed. Cephalometric measurements were used to determine the size of apical bases, the relationship between them, the pattern of craniofacial growth, and the facial heights of the patients. Interobservers’ concordance was verified by intraclass coefficient. For comparison between the groups, paired t test was employed. P values <.05 indicated statistical significance. Results: Average age of patients with RCPS was 18.5 years. Six patients were female. All patients with RCPS had Pierre-Robin sequence while 2 also presented cleft mandible. Most patients with RCPS had missing lower central incisors (100%), lower lateral incisors (85.7%), lower second premolars (85.7%), and/or upper lateral incisors (57.1%). Concordance between observers was excellent for all cephalometric measurements (0.87-0.99). Patients with RCPS presented severe craniofacial alterations when compared to control group: sella–nasion–B point (SNB) angle (73.8o ± 4.86o vs 78.85o ± 4.53o, P = .029), maxillary length (7.89 cm ± 0.58 cm vs 16.36 cm ± 0.75 cm, P = .001), mandibular length (9.90 cm ± 0.46 cm vs 20.61 cm ± 0.45 cm, P = .001), upper anterior face height (5.41 cm ± 0.50 cm vs 9.40 cm ± 0.47 cm, P = .001), lower anterior face height (5.48 cm ± 0.75 cm vs 11.66 cm ± 0.55 cm, P = .001), and posterior face height (6.70 cm ± 0.33 cm vs 13.65 cm ± 1.06 cm, P = .001). There was no difference in SNB, A point–nasion–B point, pogonion–nasion–B point, and mandibular place angles between the groups ( P > .05). Conclusion: Patients with RCPS present deficient development of maxilla and mandible when compared with nonsyndromic patients.
DNA Methylation Based Molecular Subtypes Predict Prognosis in Breast Cancer Patients
Authors: Wu Zeng-Hong , Tang Yun , Zhou Yan 
Published: January 2021

Background: Epigenetic changes are tightly linked to tumorigenesis development and malignant transformation’ However, DNA methylation occurs earlier and is constant during tumorigenesis. It plays an important role in controlling gene expression in cancer cells. Methods: In this study, we determining the prognostic value of molecular subtypes based on DNA methylation status in breast cancer samples obtained from The Cancer Genome Atlas database (TCGA). Results: Seven clusters and 204 corresponding promoter genes were identified based on consensus clustering using 166 CpG sites that significantly influenced survival outcomes. The overall survival (OS) analysis showed a significant prognostic difference among the 7 groups (p<0.05). Finally, a prognostic model was used to estimate the results of patients on the testing set based on the classification findings of a training dataset DNA methylation subgroups. Conclusions: The model was found to be important in the identification of novel biomarkers and could be of help to patients with different breast cancer subtypes when predicting prognosis, clinical diagnosis and management.
Cancer patient experience of telephone clinics implemented in light of COVID-19
Authors: Dalby Melanie , Hill Alison , Nabhani-Gebara Shereen 
Published: January 2021

Introduction Due to the pandemic of COVID-19 a number of National Health Service (NHS) Trusts in the UK adopted telephone consultations for patients who were shielding. As the pandemic continues to affect these services an evaluation was conducted to determine whether telephone consultations implemented during the pandemic should be maintained long term. The objective was to evaluate this new service and to understand patient experience. Methods This study was conducted via a telephone survey. Staff working in the Macmillan centres across the Trust called patients to survey them about their experience of telephone consultations. Data were collected 23/06/20 – 17/07/20. A mix of eight open and closed questions were asked. Data were collected on an Excel spreadsheet and patient identifiable information was anonymised. Results 55 patients accepted to participate in this study. Out of 55, 39 patients rated the phone consultation they had as either 4 or 5 out of 5. When asked if they would like to continue with phone clinics 33 said they would. The majority of consultations were conducted by doctors (43/55). Patients commented they had received great support from their healthcare professionals and they felt that phone consultations were safer in the current climate. Three of the patients felt the calls were rushed and others found it difficult to discuss pain management, sides effects and post-surgery issues. Conclusions This evaluation provides a brief snapshot of the experience cancer patients are having with phone clinics. A re-evaluation will take place once video consultations are implemented.
Natural course of acquired vitelliform lesions associated with pigment epithelial detachments in dry age related macular degeneration
Authors: Yanık Özge , Demirel Sibel , Batıoğlu Figen , Özmert Emin 
Published: January 2021

Purpose: To describe the natural history of acquired vitelliform lesions (AVLs) associated with different types of pigment epithelial detachments (PEDs) in dry age-related macular degeneration. Methods: A retrospective review of clinical examination and multimodal imaging data of patients with AVLs associated with PED(s) was performed. Results: This study included 25 eyes of 17 patients. The mean age of patients was 67.2 ± 9.7 (47–83) years. The mean follow-up time was 32.6 ± 16.2 (12–66) months, excluding four patients (five eyes) that were lost to follow-up. The mean logMAR BCVA was 0.21 ± 0.16 at baseline and 0.38 ± 0.28 at final visit ( p = 0.016). At the end of the follow-up period, PEDs enlarged in eight eyes (40%) and were unchanged in two eyes (10%). Spontaneous resolution of the central PED(s) with AVLs was seen in four (20%) eyes. Rupture of the PED(s) occurred in four eyes (20%), with two developing central foveolar atrophy afterwards. Overall, central foveolar atrophy was seen ultimately in four eyes (20%). Conclusion: It seems that high PED size may be a risk factor for PED rupture during follow-up. 1/3 of the eyes ended up with unfavorable anatomical outcome.