bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single‐Port Three‐Dimensional Endoscopic‐Assisted Axillary Lymph Node Dissection (S‐P 3D E‐ALND): Surgical Technique and Preliminary Results
Authors: Sae-Lim Chayanee , Lai Hung-Wen , Chennavasin Papawee , Huang Hsin-I , Lin Shih-Lung , Huang Ren-Hung , Chen Shou-Tung , Chen Dar-Ren 
Published: December 2024

Background: Endoscopic‐assisted breast surgery (EABS) provides better cosmetic outcomes for breast cancer patients with small incisions in an inconspicuous area. However, an extended incision and heavy assistant retraction are usually required for an adequate exposure for conventional axillary lymph node dissection (ALND). Therefore, we propose an innovative single‐port three‐dimensional endoscopic‐assisted ALND (S‐P 3D E‐ALND) to facilitate better visualization, and report its preliminary outcomes herein.Methods: The surgical technique of the S‐P 3D E‐ALND, using either monopolar Endo Hook, LigaSure, or Sonicision, is described. A total of 11 breast cancer patients who received the S‐P 3D E‐ALND in a single institution from January 2023 to September 2023 were enrolled. The preliminary results of the S‐P 3D E‐ALND, including perioperative parameters, complication, and short‐term oncological outcomes, were retrospectively analyzed.Results: Endoscopic breast and axillary procedures were conducted via a single axillary incision. The primary success rate of the S‐P 3D E‐ALND was 100% without a conversion to open surgery. The median operative time for the S‐P 3D E‐ALND was 39 (IQR = 28, 49) minutes. Average blood loss during E‐ALND was 3 (IQR = 3, 5) mL. The median number of harvested LN was 10 (IQR = 8, 11) LNs. During the median follow‐up time of 7 months, there was no complication, lymphedema, shoulder stiffness, or chronic arm numbness found. None of the patients reported locoregional recurrence, distant metastasis, or mortality.Conclusion: The S‐P 3D E‐ALND can serve as an alternative approach for ALND in breast cancer patients undergoing EABS, as our findings indicate it results in only minor complications.
A History of Learned Courtesy: Habsburg-Ottoman Diplomatic Encounters in the 17th Century (1606–83)
Authors: Kolçak Özgür 
Published: December 2024

Abstract
This article discusses the historical development of Ottoman-Habsburg diplomatic interactions in the 17th century with an emphasis on etiquette and formal appelations. It provides an account of diplomatic encounters between the Porte and the Hofburg, based on the cases of important envoys and ambassadors exchanged by them throughout the century. The study places particular emphasis on the formal exchange of diplomatic representatives along the Ottoman-Austrian Habsburg border, as elaborated by officials from both states after tactful disputations. It also pays due attention to ceremonial proceedings towards imperial emissaries at the Sublime Porte and the political implications of gift exchange between the two courts during diplomatic encounters. By using a wide range of academic literature and narrative and archival sources, the article sheds light on progressive change in the prevailing practices in 17th-century Ottoman-Habsburg diplomatic relations, which are furthermore juxtaposed with those of the previous century.
Evaluation of 8-Day Typhoon Quantitative Precipitation Forecasts in Taiwan by the 2.5-km CReSS Model: Overall Performance during 2012–16 and Impact of Domain Size
Authors: Wang Chung-Chieh , Chien Chih-Wei , Soong Wei-Kuo , Chen Shin-Hau 
Published: December 2024

Abstract
The skill of 24-h daily quantitative precipitation forecasts (QPFs) in Taiwan by a cloud-resolving model out to 8 days was evaluated for 27 typhoons (84 days) during 2012–16. Overall, the skill increased as the lead time shortened, and most of the QPFs were of high quality on both day 1 (0–24 h) and day 2 (24–48 h) with a minimum tendency to overforecast rainfall. At longer lead times from day 4 (72–96 h) to day 8 (168–192 h), where underforecasting became increasingly apparent, decent QPFs that resembled the observation could still be realized if the track errors were small enough due to better quality in the initial and boundary conditions from the global model. For the 14 typhoons that had an observed peak daily amount of ≥350 mm, such QPFs occurred in 10 of them (71%) and the earliest around day 5 on average. Thus, good rainfall scenarios could be provided quite early for many typhoons by this high-resolution system. By comparing the QPF results above to those by the 3-day forecasts that used a smaller domain, potential benefits of an enlarged fine domain were assessed. The only major difference occurred on day 1 at the 750-mm threshold, where the threat score (TS) was 0.17 (0.05) using a larger (smaller) domain, contributed only by two typhoons. While this result appeared random, the larger domain simulated the responsible rainband slightly better and had a higher accumulation to produce hits at a key station on both occasions despite a very similar tropical cyclone (TC) track and thus could be beneficial for typhoon QPFs.
The Role of the Subtropical Jet Stream in Dry Season Severe Caribbean Rainstorms: Climatology and Composite Analyses
Authors: Pfahler Marshall , Bosart Lance , Laing Arlene 
Published: December 2024

Abstract
Although high-impact heavy rainfall events in the Caribbean are typically associated with tropical cyclones (TCs) during the wet season, significant heavy rainfall events can also occur during the Caribbean dry season, absent of TCs. Dry season severe Caribbean rainstorms (CRs) can produce rainfall totals that surpass climatological dry season monthly mean rainfall, ranging from 25 to 200 mm, by >3 sigma over a relatively short duration (2–16 days), resulting in infrastructure- and life-threatening flooding and mudslides. This paper introduces a 35-yr (1983–2017) dry season severe CR climatology derived from the PERSIANN-CDR precipitation dataset, revealing that dry season severe CRs occur, on average, eight times per year with some interannual variability and exhibit a seasonality that includes relative maxima in November/December and April/May as well as a relative minimum in February. Self-organizing map (SOM) analyses are applied to detect subtropical jet stream (STJS) flow patterns governing events in this climatology which include an upper-level trough reaching the Caribbean (Trough cases, 23% of all events), a frontal boundary extending into the Caribbean attendant to an extratropical cyclone (EC) at midlatitudes (EC Front cases, 54% of all events), or a potential vorticity stream (PVS) forming near the Caribbean (PVS cases, 7% of all events). In these events, extratropical forcing, occasionally combined with orographic forcing, can promote intense, organized, and widespread deep, moist convection that produces heavy rainfall. The remaining events do not have a discernable extratropical connection and are not considered to be influenced by the STJS (16% of events).

Significance Statement
High-impact heavy rainfall events in the Caribbean are typically associated with tropical cyclones during the wet season, but significant heavy rainfall events can also occur during the Caribbean dry season without tropical cyclones. Dry season Caribbean rainstorms (CRs) can result in infrastructure- and life-threatening flooding and mudslides from rainfall totals that substantially surpass normal dry season monthly rainfall in a short duration (2–16 days). A 35-yr dry season severe CR climatology is constructed, indicating that these events occur on average eight times per year. The subtropical jet stream is recognized as an important driver and influencer of thunderstorms with heavy rainfall in most (84% of all cases) dry season severe CRs. The results of this study could help Caribbean weather forecasters recognize the nature of dry season severe CRs and associated weather patterns to provide more information and advanced warning to local emergency management and the public.
Making decisions about long-term foster family care as a permanence plan in England: An investigation of the implementation of the first government regulations and guidance for long-term foster care
Authors: Schofield Gillian , Larsson Birgit , Neil Elsbeth , Young Julie 
Published: December 2024

Long-term foster family care has been included as a permanence option in policy in England since the 1980s, however it was not until 2015 that it was defined in government regulations and guidance, with a required practice framework for local authorities, including reporting placement numbers annually to the government. This was intended to give long-term foster care a more formal status as a permanence option, ensure high standards of practice and promote positive outcomes for children. This project aimed: (1) to identify the profiles and pathways of children in long-term foster care and (2) to investigate the impact of the regulations and guidance on procedure and practice in local authorities. The second aim provides the focus for the findings presented in this article. The research design included analysis of administrative data, a national survey of local authorities and interviews with 43 managers in 30 local authorities. The survey results and interview data suggested that the regulations and guidance have had a positive impact by raising the profile of long-term foster care and supporting improved procedures. But there were varying patterns of implementation and significant differences in rates of long-term foster care, which did not relate to differences in local authority populations. This article concludes, therefore, that there is a need for the provision of government support to provide greater consistency in the implementation of the regulations and guidance.
Research on mood monitoring and intervention for anxiety disorder patients based on deep learning wearable devices
Authors: Gu Xiao , Hu Xuedan 
Published: December 2024

Background Anxiety disorders are common mental health issues that have a significant effect on people's quality of life. Conventional techniques for tracking emotional states frequently lack the accuracy and sensitivity needed for successful intervention. Objectives This project aims to create a sophisticated monitoring system that uses deep learning methods to evaluate physiological data from wearables, emphasizing heart rate variability (HRV), to forecast patients’ emotional states who suffer from anxiety disorders. Methods Wearable equipment monitors physiological characteristics, which we used to obtain patient HRV data. We processed the data using a Bidirectional Long-Short-Term Memory (Bi-LSTM) network to evaluate time-dependent variables and enhance the precision of emotional state predictions. The physiological signals were used to teach the model to recognize different emotional states, such as neutral, happy, and sad. Results Outperforming conventional machine learning models, the Bi-LSTM model showed a high accuracy rate of up to 97% in predicting emotional states. The findings suggest that ongoing HRV monitoring can accurately track shifts in emotional states and enable prompt responses. Conclusion This work emphasizes the possibility of real-time emotional state monitoring in patients with anxiety disorders with wearable technology and deep learning. The results point to the potential benefits of this strategy for improving emotional regulation and improving anxiety sufferers’ quality of life, opening new avenues for investigation and advancement in the field of mental health therapies.
Accelerated initiation of antiretroviral therapy by virtual health in service members newly diagnosed with HIV infection
Authors: Openshaw Anatole , Okulicz Jason , Yabes Joseph 
Published: December 2024

Objectives Delays in HIV antiretroviral therapy (ART) have been associated with HIV disease progression and forward transmission. We evaluated the effectiveness of an accelerated ART virtual protocol (VP) for active duty (AD) members with incident HIV diagnosis. Methods Under the traditional protocol (TP), service members stationed worldwide were evaluated in-person at Brooke Army Medical Center (BAMC) and received comprehensive HIV care. In February 2020, a VP was adopted to initiate HIV care at the local base. Chart reviews were conducted to obtain patient demographics and clinical data. Continuous variables were compared using 2-tailed t tests, categorical variables were evaluated with Fisher’s exact or Chi squared tests. Results Time from HIV notification to ART initiation was significantly shorter with the VP compared to the TP (15 days vs 25 days; p = <0.05). The VP had a shorter time to viral suppression compared to the TP (96 days [SD ± 86] compared to 269 days [SD ± 300], p = <0.05). Conclusions The VP was associated with a shorter time to HIV specialty evaluation, ART initiation, and viral suppression. The use of virtual health protocols for other time sensitive medical interventions and/or for access to limited specialties should be considered as these may improve quality of care.
A non-inferiority, phase III trial of gemcitabine plus capecitabine versus gemcitabine plus carboplatin as first-line therapy and tumor-infiltrating lymphocytes as a prognostic biomarker in patients with advanced triple-negative breast cancer
Authors: Liu Xiaodong , Zhao Weipeng , Jia Yongsheng , Shi Yehui , Wang Xu , Li Shufen , Zhang Pin , Wang Chen , Hao Chunfang , Tong Zhongsheng 
Published: December 2024

Background: Gemcitabine plus capecitabine (GX) shows survival benefit and manageable safety in patients with advanced triple-negative breast cancer (TNBC) but there is a paucity of phase III trial evidence. We aimed to compare the efficacy and safety of GX with gemcitabine plus carboplatin (GC) as first-line treatment for patients with advanced TNBC and validate the prognostic value of tumor-infiltrating lymphocytes (TILs). Methods: Patients with advanced TNBC were randomly assigned 1:1 to receive gemcitabine (1000 mg/m2) on days 1 and 8 plus oral capecitabine (1000 mg/m2 twice a day) on days 1–14, or gemcitabine (1000 mg/m2) on days 1 and 8 plus carboplatin area under curve 2 on days 1 and 8. The primary endpoint was progression-free survival (PFS). TILs were analyzed by immunohistochemistry. The margin used to establish non-inferiority was 1.2. Results: In all, 187 patients were randomly assigned, with 93 in GX and 94 in GC. Median PFS was 6.1 months in the GX arm compared with 6.3 months in the GC arm. The hazard ratio for PFS was 1.148, and a 95% CI was 0.856–1.539, exceeding the non-inferiority margin of 1.2. The median overall survival (OS) was 21.0 months in the GX arm compared with 21.5 months in the GC arm. The safety profile for the GX regimen was superior to the GC regimen, especially regarding hematological toxicity. Patients with high CD8+ TILs had significantly longer PFS and OS compared with patients with low CD8+ TILs. In the high CD8+ TIL group, the GC arm had prolonged PFS and OS compared with the GX arm. Conclusion: The trial did not meet the prespecified criteria for the primary endpoint of PFS in patients with advanced TNBC. Moreover, the GC regimen showed better efficacy compared with the GX regimen in patients with high CD8+ TILs. However, the GX regimen should be considered in patients who cannot tolerate hematological toxicity. Trial registration: ClinicalTrials.gov identifier: NCT02207335.
Dual-targeting CAR T cells for B-cell acute lymphoblastic leukemia and B-cell non-Hodgkin lymphoma
Authors: de Oliveira Canedo Gustavo , Roddie Claire , Amrolia Persis J. 
Published: December 2024

Abstract
Relapse after CD19-directed chimeric antigen receptor (CAR) T-cell therapy remains a major challenge in B-cell acute lymphoblastic leukemia (ALL) and B-cell non-Hodgkin lymphoma (B-NHL). One of the main strategies to avoid CD19-negative relapse has been the development of dual CAR T cells targeting CD19 and an additional target, such as CD22 or CD20. Different methods have been used to achieve this, including coadministration of 2 products targeting 1 single antigen, cotransduction of autologous T cells, use of a bicistronic vector, or the development of bivalent CARs. Phase 1 and 2 trials across all manufacturing strategies have shown this to be a safe approach with equivalent remission rates and initial product expansion. CAR T-cell persistence remains a significant issue, with the majority of relapses being antigen-positive after CAR T-cell infusion. Further, despite adding a second antigen, antigen-negative relapses have not yet been eliminated. This review summarizes the state of the art with dual-targeting CAR T cells for B-cell ALL and B-NHL, the challenges encountered, and possible next steps to overcome them.
Respiratory muscle dysfunction in acute and chronic respiratory failure: how to diagnose and how to treat?
Authors: Poddighe Diego , Van Hollebeke Marine , Rodrigues Antenor , Hermans Greet , Testelmans Dries , Kalkanis Alexandros , Clerckx Beatrix , Gayan-Ramirez Ghislaine , Gosselink Rik , Langer Daniel 
Published: December 2024

Assessing and treating respiratory muscle dysfunction is crucial for patients with both acute and chronic respiratory failure. Respiratory muscle dysfunction can contribute to the onset of respiratory failure and may also worsen due to interventions aimed at treatment. Evaluating respiratory muscle function is particularly valuable for diagnosing, phenotyping and assessing treatment efficacy in these patients. This review outlines established methods, such as measuring respiratory pressures, and explores novel techniques, including respiratory muscle neurophysiology assessments using electromyography and imaging with ultrasound.Additionally, we review various treatment strategies designed to support and alleviate the burden on overworked respiratory muscles or to enhance their capacity through training interventions. These strategies range from invasive and noninvasive mechanical ventilation approaches to specialised respiratory muscle training programmes. By summarising both established techniques and recent methodological advancements, this review aims to provide a comprehensive overview of the tools available in clinical practice for evaluating and treating respiratory muscle dysfunction. Our goal is to present a clear understanding of the current capabilities and limitations of these diagnostic and therapeutic approaches. Integrating advanced diagnostic methods and innovative treatment strategies should help improve patient management and outcomes. This comprehensive review serves as a resource for clinicians, equipping them with the necessary knowledge to effectively diagnose and treat respiratory muscle dysfunction in both acute and chronic respiratory failure scenarios.
A Systematic Review Investigating the Impact of Dual Use of E-Cigarettes and Conventional Cigarettes on Smoking Cessation
Authors: Hamoud Josef , Hanewinkel Reiner , Andreas Stefan , Ammous Omar , Saalfrank Marc , Sussman Steve , Unger Jennifer B. , Pisinger Charlotta , Mathes Tim 
Published: December 2024

BackgroundDual use (DU) of conventional cigarettes (CC) and e-cigarettes (EC) has emerged as a common pattern among youth and adult populations. This review aims to investigate whether dual use can promote smoking cessation.MethodsA systematic search was conducted in accordance with PRISMA guidelines, and all longitudinal studies reporting transitions between DU, exclusive e-cigarette use and exclusive conventional cigarette use were included. Two independent reviewers screened and read all records. Use status transitions among dual users were compared to transitions among exclusive e-cigarette users and exclusive CC smokers.ResultsForty-six records (sixteen original studies) were identified. Of sixteen included studies, eight could be pooled for meta-analysis. The studies showed great heterogeneity, and many presented moderate to high risks of bias. Most dual users who changed state transitioned to cigarette smoking. Baseline dual users were less likely to report a transition into complete abstinence compared to exclusive CC smokers and exclusive EC users. About one-fifth of dual users remained in the same use status after >16–24 months, exposing them to DU for a prolonged time. After >24–48 months, 8% of DU maintained DU.ConclusionCurrent evidence suggests that DU is not a first step toward smoking cessation, with most DUs continuing cigarette consumption either through persistent DU or exclusive CC smoking. Relatively fewer dual users transitioned into complete nicotine abstinence compared to exclusive CC and exclusive EC users. The concerns raised about limitations of current evidence highlight the need for more research focussed on use status transitions among dual users.
Unmet needs in patients with COPD in Germany: a retrospective, cross-sectional study
Authors: Herth Felix J.F. , Vogelmeier Claus F. , Trudzinski Franziska C. , Watz Henrik , Skowasch Dirk , Beeh Kai-Michael , Compton Chris , Mohan Tharishini , Richter Hartmut , Claussen Jing , Bartel Sabine 
Published: December 2024

BackgroundEarlier diagnosis and treatment of chronic obstructive pulmonary disease (COPD), particularly preventing exacerbations, are key to slowing disease progression and reducing mortality. This study focused on the identification of patients in Germany with unstable COPD due to suboptimal treatments.MethodsThe IQVIA™ LRx database, capturing 80% of Statutory Health Insurance prescriptions was used to identify patients with COPD using a machine learning (ML) model. Patients with unstable COPD were identified through high prescriptions of oral corticosteroid (OCS) and/or rescue inhalers during the period from April 2022 to March 2023.ResultsThe ML model identified around 2.6 million treated patients with COPD, with 77% precision. The mean age was 71 years, 48% were female and 86% were aged ≥60 years. About 14% patients (n=363k) exhibited unstable COPD due to high OCS prescriptions, while 10% patients (n=256k) had high rescue inhaler prescriptions. Among those with high OCS and high rescue inhaler prescriptions, respectively, 43% and 38% were on dual therapy, 17% and 21% were on single inhaler triple therapy, 14% and 16% were on multiple inhaler triple therapy, 11% and 9% were on monotherapy and 15% and 17% had no maintenance therapy.ConclusionsA substantial portion of unstable COPD patients were either on suboptimal maintenance therapy (monotherapy or inhaled corticosteroid-based dual therapy) or not receiving any maintenance therapy. The study highlights a substantial need in Germany for improved maintenance therapy, which could reduce disease burden, improve disease stability and reduce reliance on OCS and rescue therapies, thereby minimising side effects.