bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories
Authors: Novotny Vojtech , Khanevski Andrej N. , Bjerkreim Anna T. , Kvistad Christopher E. , Fromm Annette , Waje-Andreassen Ulrike , Næss Halvor , Thomassen Lars , Logallo Nicola 
Published: September 2019

Background and Purpose—
Patients with acute cerebral infarcts in multiple arterial territories (MACI) represent a substantial portion of the stroke population. There are no data on short-term outcome and in-hospital complications in patients with MACI. We compared patients with MACI with patients having acute cerebral infarct(s) in a single arterial territory.

Methods—
We analyzed 3343 patients with diffusion-weighted imaging-confirmed acute cerebral infarcts. MACI was defined as at least 2 acute cerebral ischemic lesions in at least 2 arterial cerebral territories. Patients with MACI were compared with patients with acute cerebral infarct(s) in a single arterial territory for relevant in-hospital complications and short-term outcome, namely National Institutes of Health Stroke Scale and modified Rankin Scale at day 7 after admission or at discharge when earlier.

Results—
A total of 311 patients (9.3%) met the definition of MACI. Both median National Institutes of Health Stroke Scale (2 [1–7] versus 1 [0–4]) and modified Rankin Scale (3 [1–4] versus 2 [1–3]) were higher in patients with MACI. MACI was independently associated with higher National Institutes of Health Stroke Scale and modified Rankin Scale. Deep venous thrombosis, myocardial infarction, and any complications were more frequent in patients with MACI.

Conclusions—
In-hospital complications were more frequent in patients with MACI, which may adversely affect short-term clinical and functional outcome. Closer follow-up of patients with MACI during hospitalization may prevent such events and negative progression.
Dynamics of Subsiding Shells in Actively Growing Clouds with Vertical Updrafts
Authors: Nair Vishnu , Heus Thijs , van Reeuwijk Maarten 
Published: September 2019

Abstract
The dynamics of a subsiding shell at the edges of actively growing shallow cumulus clouds with updrafts is analyzed using direct numerical simulation. The actively growing clouds have a fixed in-cloud buoyancy and velocity. Turbulent mixing and evaporative cooling at the cloud edges generate a subsiding shell that grows with time. A self-similar regime is observed for first- and second-order moments when normalized with respective maximum values. Internal scales derived from integral properties of the flow problem are identified. A self-similarity analysis using these scales reveals that contrary to classical self-similar flows, the turbulent kinetic energy budget terms and velocity moments scale according to the buoyancy and not with the mean velocity. The shell thickness is observed to increase linearly with time. The buoyancy scale remains time invariant and is set by the initial cloud–environment thermodynamics. The shell accelerates ballistically with a magnitude set by the saturation value of the buoyancy of the cloud–environment mixture. In this regime, the shell is buoyancy driven and independent of the in-cloud velocity. Relations are obtained for predicting the shell thickness and minimum velocities by linking the internal scales with external flow parameters. The values thus calculated are consistent with the thickness and velocities observed in typical shallow cumulus clouds. The entrainment coefficient is a function of the initial state of the cloud and the environment, and is shown to be on the same order of magnitude as fractional entrainment rates calculated for large-scale models.
Atmospheric Predictability: Revisiting the Inherent Finite-Time Barrier
Authors: Leung Tsz Yan , Leutbecher Martin , Reich Sebastian , Shepherd Theodore G. 
Published: September 2019

Abstract
The accepted idea that there exists an inherent finite-time barrier in deterministically predicting atmospheric flows originates from Edward N. Lorenz’s 1969 work based on two-dimensional (2D) turbulence. Yet, known analytic results on the 2D Navier–Stokes (N-S) equations suggest that one can skillfully predict the 2D N-S system indefinitely far ahead should the initial-condition error become sufficiently small, thereby presenting a potential conflict with Lorenz’s theory. Aided by numerical simulations, the present work reexamines Lorenz’s model and reviews both sides of the argument, paying particular attention to the roles played by the slope of the kinetic energy spectrum. It is found that when this slope is shallower than −3, the Lipschitz continuity of analytic solutions (with respect to initial conditions) breaks down as the model resolution increases, unless the viscous range of the real system is resolved—which remains practically impossible. This breakdown leads to the inherent finite-time limit. If, on the other hand, the spectral slope is steeper than −3, then the breakdown does not occur. In this way, the apparent contradiction between the analytic results and Lorenz’s theory is reconciled.
The Influence of Static Factors on Seating Comfort of Motorcycles: An Initial Investigation
Authors: Velagapudi Sai Praveen , Ray Gaur Gopal 
Published: September 2019

Objective: The aim of the current study is to examine the influence of static factors on overall seating comfort in motorcycles and validate the use of static lab-based setups for evaluating seating comfort in motorcycles. Background: Seating comfort in automobiles has two factors, static and dynamic. Research on seating comfort of passenger cars has shown that when the magnitude of vibration reaching the seat is low, comfort is largely determined by static factors. Studies have also validated the use of static lab-based setups for research on seating comfort in passenger cars. Static lab-based setups are easy to develop, provide a controlled environment, and efficient for experimental research. The riding posture, mass distribution, and dynamics of a motorcycle differ from a passenger car and warrant further investigation to extend the results from the research on passenger cars. Method: The study compares subjective rating of seating comfort and objective measurement of seat interface pressure in two test conditions: a static lab-based setup and actual driving on a flat test track where the magnitude of vibration reaching the seat is low. The vibration at the seat is measured for the driving trial. A group of 18 male volunteers from TVS Motor Company participated in the study, and two motorcycles from the economy/executive segment of India are used in the study. The subjective ratings are analyzed statistically using analysis of variance (ANOVA) and Pearson’s correlation. The vibration data are analyzed as per ISO 2631-1 to calculate the frequency-weighted acceleration, aw. Results: The results show that there is no significant difference between the two test conditions either in the objective measurements or in the subjective rating of comfort. There is also a statistically significant correlation between the subjective ratings of seating comfort in static lab-based setup and actual riding ( r = .77, p < .01, n = 36). The mean aw at the seat while driving in the test track used in this study is 0.2 m/s2. Conclusion: Static factors have a significant influence on seating comfort in motorcycles. When the vibration reaching the seat is low ( aw ≤ 0.2 m/s2), seating comfort is largely determined by the static factors. The use of static lab-based setups for evaluating static factors of seating comfort in motorcycles is validated. Application: The results of this study enable further research to understand the human criterion for seating comfort in motorcycles using static lab-based setups which are easier to develop and provide controlled environment that is essential for any research.
The light and dark sides of social capital: Depressive symptoms among incarcerated older adults
Authors: Archuleta Adrian J , Prost Stephanie Grace , Golder Seana 
Published: September 2019

Background: Adults aged 55 or above represent a large and growing proportion of the US and international correctional populations and more physical and mental health problems than their non-incarcerated peers. Social capital represents the collective cognitive and network structure resources accessible through social relationships and may serve as a potential asset in carceral settings in the amelioration of depressive symptoms among older adults. Method: A sample of men drawn from a study of older adults in Kentucky prisons ( n = 91) was used to meet the following aims: (1) explore relationships among cognitive and structural facets of social capital, chronic health conditions and depressive symptoms and (2) identify the role of social capital (viz. trust) alongside chronic health conditions as a determinant of depressive symptoms. We hypothesized that each indicator of social capital would relate negatively to depressive symptoms and that trust would emerge as most strongly associated with depressive symptoms. Results: Bivariate correlations between depression and social capital variables related as we hypothesized. However, our hypotheses were only partially supported. Higher trust was correlated to fewer depressive symptoms ( r = .21, p < .05) revealing a lighter side of trust in the correctional milieu but was unrelated to depression when controlling for variables. An interaction term in the final model indicated a different role for trust. Factors accounted for 64% of variance in depressive symptoms among older adults in a state prison ( F(10, 80) = 14.25, p < .001). In this model, higher trust was related to depressive symptoms when included alongside additional measures of social capital, indicating that a darker side of this facet may exist within correctional settings. Conclusion: Many indicators of social capital (e.g., network size) demonstrated potentially protective benefits against depression, while trust revealed a more complex role related to chronic health conditions. Limited measures and the agnostic behavior of trust require attention by future researchers.
Deficiencies in Scientific Evidence for Medical Management of Gender Dysphoria
Authors: Hruz Paul W. 
Published: September 2019

Individuals who experience a gender identity that is discordant with biological sex are increasingly presenting to physicians for assistance in alleviating associated psychological distress. In contrast to prior efforts to identify and primarily address underlying psychiatric contributors to gender dysphoria, interventions that include uncritical social affirmation, use of gonadotropin-releasing hormone agonists to suppress normally timed puberty, and administration of cross-sex steroid hormones to induce desired secondary sex characteristics are now advocated by an emerging cohort of transgender medicine specialists. For patients with persistent gender dysphoria, surgery is offered to alter the appearance of breasts and genital organs. Efforts to address ethical concerns regarding this contentious treatment paradigm are dependent upon reliable evidence on immediate and long-term risks and benefits. Although strong recommendations have been made for invasive and potentially irreversible interventions, high-quality scientific data on the effects of this approach are generally lacking. Limitations of the existing transgender literature include general lack of randomized prospective trial design, small sample size, recruitment bias, short study duration, high subject dropout rates, and reliance on “expert” opinion. Existing data reveal significant intervention-associated morbidity and raise serious concern that the primary goal of suicide prevention is not achieved. In addition to substantial moral questions, adherence to established principles of evidence-based medicine necessitates a high degree of caution in accepting gender-affirming medical interventions as a preferred treatment approach. Continued consideration and rigorous investigation of alternate approaches to alleviating suffering in people with gender dysphoria are warranted. Summary: This paper provides an overview of what is currently known about people who experience a gender identity that differs from their biological sex and the associated desire to engage the medical profession in alleviating associated discomfort and distress. The scientific evidence used to support current recommendations for affirming one’s preferred gender, halting normally timed puberty, administering cross-sex hormones, and surgically altering primary and secondary sexual traits are summarized and critically evaluated. Serious deficits in understanding the cause of this condition, the reasons for the marked increase in people presenting for medical care, together with immediate and long-term risks relative to benefit of medical intervention are exposed.
Trends in Elevated Blood Lead Levels Using 5 and 10 µg/dL Levels of Concern Among Refugee Children Resettled in Massachusetts, 1998-2015
Authors: Geltman Paul L. , Smock Laura , Cochran Jennifer 
Published: September 2019

Objectives: Refugee children are known to have a high prevalence of elevated blood lead levels (EBLLs). We sought to determine trends in EBLLs among refugee children during an 18-year period and examine relationships between descriptive characteristics and EBLLs by using 10 µg/dL and 5 µg/dL levels of concern. Methods: We retrospectively evaluated refugee health screening data from Massachusetts for 1998 through 2015 for refugee children aged <7 years. We performed bivariate and multivariate analyses of variables including sex, age, region of origin, anemia, intestinal parasites, tuberculosis test results, and anthropometric measurements and used both 5 µg/dL and 10 µg/dL levels of concern for EBLLs. Results: Of 3421 eligible refugee children, 3054 (88.2%) were tested. Using 5 µg/dL and 10 µg/dL levels of concern, 1279 (41.9%) and 241 (7.9%) children, respectively, had EBLLs. Mean BLLs declined steadily from 7.58 µg/dL in 2004 to 4.03 µg/dL in 2015. African (adjusted odds ratio [aOR] = 2.49; 95% confidence interval [CI], 1.81-3.43), East Asian and Pacific (aOR = 1.98; 95% CI, 1.35-2.91), and South-Central Asian (aOR = 2.47; 95% CI, 1.53-4.01) regions of origin and anemia (aOR = 1.50; 95% CI, 1.14 -1.97) were significantly associated with BLLs ≥5 µg/dL. Conclusions: The prevalence of EBLLs among refugees compared with US-born children is high. Because EBBLs increase the risk for neurocognitive impairment in children, public health professionals, policy makers, researchers, refugee resettlement staff members, and health care providers must remain vigilant in screening for lead poisoning and educating refugees about the hazards posed to young children by lead.
Challenges in the ethics review process of clinical scientific research projects in China
Authors: Wang Zhu-Heng , Zhou Guan-Hua , Sun Li-Ping , Gang Jun 
Published: September 2019

Purpose Ethics review processes have become increasingly complex. The objective of this study was to explore the challenges currently faced in ethics reviews of clinical scientific research projects in China, with the goal of standardizing the structure of medical ethics committees and better protecting the rights and interests of research participants. Methods We reviewed and comprehensively analyzed the available literature discussing standardized ethics reviews of clinical scientific research projects. Results We identified the following problems: incomplete legislation, absence of supervision, vague review criteria, limitations of ethics committee competence, inadequate ethics consciousness, and poor tracking of reviews. In this paper, we suggest strategies for the development of future ethical reviews of clinical scientific research projects. Conclusion To standardize the ethics review process of clinical scientific research projects in China, it is necessary to establish relevant laws and regulations and implement supervisory responsibilities. Professional training of medical ethics committees is suggested as an effective way to improve the quality of ethics reviews.
A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks
Authors: Terrin Alberto , Mainardi Federico , Lisotto Carlo , Mampreso Edoardo , Fuccaro Matteo , Maggioni Ferdinando , Zanchin Giorgio 
Published: September 2019

Background In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. Methods We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. Results In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Conclusion Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.
Psychometric Testing of a Value-Achievement-Cost Motivation Survey for 12th Grade Health Sciences Students for Use in Simulation-Based-Games
Authors: Glover Kevin R. , Bodzin Alec 
Published: September 2019

Background. There is a gap in our understanding of the determinants of individual student variation of perceived cost longitudinally in high-effort educational activities within self-selected, context-specific academic domains using the Expectancy-Value framework. At present, an instrument to conduct such research on the motivational dynamics of students who choose to persist in high cost behaviors to achieve mastery in health sciences multi-level simulation-based-games is lacking. Method. In this study, a 10-construct, 46-item Value-Achievement-Cost (VAC) student motivation survey was administered on two separate occasions to 44 12th grade students who had self-selected to participate in a year-long, dual enrollment, health-sciences, Career and Technical Education (CTE) program. The VAC survey was used to measure motivation associated with science in general, health sector science learning, and playing health sciences-related games. Results. Convergent validity was established in five of the ten constructs by comparing the α coefficients of the modified 10-construct, 46-item VAC survey compared to three source instruments previously tested in dissimilar STEM student populations. Internal consistency for each of the 10 VAC survey constructs were strong with α coefficients between 0.82 and 0.90. The VAC survey exhibited reliability between the two administration timepoints with statistically significant nonparametric correlation coefficients in forty-four of the 46-items tested displaying strong monotonic relationships between 0.30 and 0.79. Conclusion. This study has provided the psychometric evidence needed so that the VAC survey can be confidently used to assess cost-related motivational dynamics in longitudinal health science multi-level simulation-based-games. An experimental intervention correlating VAC survey measures with health-science students’ achievement in a simulation-based, multi-level game is proposed. Students’ value, achievement, and cost motivation, related to level achievement, may lead to a better understanding of which health-science game design elements encourage learners to independently persist to mastery.
Radiographic and Magnetic Resonance Imaging of the Symptomatic Synthetic Cartilage Implant
Authors: An Tonya W. , Cassinelli Spenser , Charlton Timothy P. , Pfeffer Glenn B. , Thordarson David B. 
Published: September 2019

Background: Synthetic Cartilage Implantation (SCI; Cartiva) is a treatment of hallux rigidus associated with mixed clinical outcomes in the United States. Patients with persistent pain typically undergo diagnostic imaging for evaluation. We aimed to characterize the radiologic findings of SCI and surrounding tissues. Methods: This is a retrospective review of patients treated using SCI who underwent magnetic resonance imaging (MRI) for persistent pain. Metatarsophalangeal (MTP) joint spaces were compared on plain radiographs of the foot immediately postoperatively and at most recent follow-up. MRI of the foot were assessed for dimensions of the implant, bony channel, and presence of peri-implant fluid. Clinical follow-up, including Patient-Reported Outcome Measures Informational System (PROMIS) scores, satisfaction rating, and revision surgery, was collected. Eighteen cases of symptomatic SCI from 16 patients (13 females, 3 males) were included. All but 1 case involved a 10-mm implant. Results: Mean satisfaction rating was 2.25 (1-5 Likert scale). PROMIS scores indicated moderate physical dysfunction (41) and moderate pain interference (63). Six of 16 patients (37.5%) underwent revision surgery at average 20.9 months of follow-up. Plain radiographs over a 13.3-month interval showed joint space narrowing of 2 mm medially and 1.6 mm laterally ( P < .001). One hundred percent of cases had radiographic evidence of osteoarthritis (OA) progression. MRI studies were obtained on average 11.5 months postoperatively. The implant diameter averaged 9.7 mm, which mismatched the bony channel diameter of 11.2 mm ( P < .001). Fourteen of 18 cases had peri-implant fluid. All cases had edema in the metatarsal, proximal phalanx, and soft tissues. Conclusion: Radiographic loss of MTP joint space and progression of arthritis were present for all cases studied. MRI revealed bony channel widening and a smaller implant, with peri-implant fluid suggesting instability at the implant-bone interface. Persistent edema was observed in soft tissues and bone. Diagnostic imaging of SCI in symptomatic patients demonstrated concerning findings that merit further correlation with patient outcomes. Level of Evidence: Level IV, case series.