bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Influence of Midlevel Shear and Horizontal Rotors on Supercell Updraft Dynamics
Authors: Muehr Andrew J. , Ruppert James H. , Flournoy Matthew D. , Peters John M. 
Published: November 2023

Abstract
Large midlevel (3–6 km AGL) shear is commonly observed in supercell environments. However, any possible influence of midlevel shear on an updraft has been relatively unexplored until now. To investigate, we ran 10 simulations of supercells in a range of environments with varying midlevel shear magnitudes. In most cases, larger midlevel shear results in a storm motion that is faster relative to the low-level hodograph, meaning that larger midlevel shear leads to stronger low-level storm-relative flow. Because they are physically connected, we present an analysis of the effects of both midlevel shear and low-level storm-relative flow on supercell updraft dynamics. Larger midlevel shear does not lead to an increase in cohesive updraft rotation. The tilting of midlevel environmental vorticity does lead to localized areas of larger vertical vorticity on the southern edge of the updraft, but any dynamical influence of this is overshadowed by that of much larger horizontal vorticity in the same area associated with rotor-like circulations. This storm-generated horizontal vorticity is the primary driver behind lower nonlinear dynamic pressure on the southern flank of the midlevel updraft when midlevel shear and low-level storm-relative flow are larger, which leads to a larger nonlinear dynamic pressure acceleration in those cases. Storm-generated horizontal vorticity is responsible for the lowest nonlinear dynamic pressure anywhere in the midlevel updraft, unless the mesocyclone becomes particularly intense. These results clarify the influence of midlevel shear on a supercell thunderstorm, and provide additional insight on the role of low-level storm-relative flow on updraft dynamics.

Significance Statement
Persistent rotation in supercell thunderstorms results from the tilting of horizontal spin into the vertical direction. This initially horizontal spin is the result of shear, which is a change in wind speed and/or direction with height. More shear in the layer 0–3 km above ground level is well understood to lead to stronger rotation within the storm, but the influence of shear in the 3–6-km layer is unclear and is investigated here. We find that horizontal spin originating in the 3–6-km layer has little impact on vertically oriented thunderstorm rotation. Instead, intense regions of horizontal spin that are generated by the storm itself (rather than having originated from the background environment) dominate storm dynamics at midlevels.
‘Sometimes I feel like dancing afterwards’: Exploring experiences of Pilates as a ‘return to sport’ intervention after the COVID-19 lockdown in UK adults with visual impairment
Authors: Strongman Clare , Lindsay Rosie K , Riches Andie , Cavallerio Francesca , Gordon Dan , Morrison Andrew 
Published: November 2023

Objectives: People with visual impairment participate in less physical activity than sighted people, and may have been further affected due to the COVID-19 pandemic and associated social distancing and lockdown measures. The aim of this study was to evaluate the use of mat-based group Pilates as a possible ‘return to sport’ intervention for adults with visual impairment. Methods: A 10-month intervention of community-based instructor-led mat-based group Pilates sessions was conducted with 14 participants with visual impairment. Measures of quality of life and balance confidence were collected at the start and end of the intervention. In addition, qualitative surveys and participant interviews were conducted pre- and post-intervention to gather data about the participants views and lived experiences of participating in the session. Results: There were no statistically significant changes to overall quality of life or balance confidence over the 10-month intervention period, but participants started with good scores with limited scope for improvement. Participants scored lower on the environmental domain ( p = .042) after the intervention, which may be due to services struggling to return to pre-pandemic levels. Reflexive thematic analysis identified themes relating to becoming a community, (re)gaining competence, and developing independence with the intervention having a positive effect on both physical and mental health. Conclusions: Despite no quantifiable positive changes in balance confidence or quality of life, the qualitative analysis identified that the participants valued and benefitted from the intervention and found it helpful to their overall function as well as wellbeing and mental health. This suggests that mat-based group Pilates classes as a physical activity intervention is useful in this population and warrants further research.
Predisposing Factors of Intercultural Sensitivity Among Nursing Students: A Predictive Correlational Design
Authors: Ayaz-Alkaya Sultan , Simones Joyce 
Published: November 2023

Introduction: Intercultural sensitivity in health care improves health care quality due to effective communication, intervention, and increased satisfaction. The present study aimed to compare the intercultural sensitivity of undergraduate nursing students in two different countries and identify predisposing factors of intercultural sensitivity. Methods: A predictive correlational study was conducted with 980 undergraduate nursing students at a university in Turkey and the United States. A questionnaire and the Intercultural Sensitivity Scale were used for data collection. Results: Multiple linear regression revealed that the country in which nursing students were studying, and speaking a second language were found as significant predictors of intercultural sensitivity in the current study. The findings of the two-way variance analysis indicated that the interaction effect between nursing students in two schools and sociodemographic variables was not statistically significant ( p > .05). Discussion: Nursing students from both universities presented a moderate level of intercultural sensitivity. This level is low compared with previous results reported in the literature. The study findings may help faculty administrators make new arrangements in the nursing curriculum and contribute to providing equal, and non-discriminatory health services to people. Intercultural education programs within the curriculum should be offered as independent courses and/or integrated within courses to develop culturally competent knowledge, awareness, and skills throughout undergraduate nursing education.
The Prognostic Significance of Adjuvant Chemotherapy in Adult Ovarian Granulosa Cell Tumors: A Systematic Review and Meta-analysis
Authors: Zhuang Yuan , Yang Hua 
Published: November 2023

Introduction This study aimed to evaluate the oncological and prognostic significance of adjuvant chemotherapy (CT) in patients with adult granulosa cell tumors of the ovary (AOGCT). Methods We searched the Chinese National Knowledge Infrastructure, Clinical Trials, Wanfang Database, Web of Science, Cochrane Library, and MEDLINE electronic databases for articles published up to May 2023. Reference lists of the enrolled studies, Google Scholar, and scientific meeting reports were also manually searched. Results We enrolled 5641 patients with AOGCT from 33 eligible studies, including 1674 (29.7%) and 3967 (70.3%) patients in the CT and non-CT groups, respectively. Based on the cumulative results, adjuvant CT did not affect the risk of recurrence or progression (R/P) (odds ratio [OR]: 1.67, 95% confidence interval [CI]: 1.01–2.78, I2 = 63%, P = .05) and 5-year overall survival (OR: .86, 95% CI: .70–1.04, I2 = 0%, P = .12) of patients with AOGCT. However, adjuvant CT might reduce the 5-year disease-free survival (OR: 2.90, 95% CI: 1.19–7.08, I2 = 55%, P = .02). Sub-group analysis revealed that adjuvant CT did not affect the risk of R/P in patients with early-stage AOGCT (OR: .78, 95% CI: .43–1.43, I2 = 2%, P = .43) and advanced or recurrent AOGCT (OR: .78, 95% CI: .43–1.43, I2 = 2%, P = .43). Conclusion This meta-analysis suggests that patients with AOGCT might not benefit from adjuvant CT, even those with advanced or recurrent disease. The results should be interpreted with caution because of the inherent limitations of retrospective studies.
Bilateral retinal vasculitis due to presumed sarcoidosis with rickettsial retinitis
Authors: Mahendradas Padmamalini , Acharya Isha , Mishra Sai Bhakti , Sanjay Srinivasan , Kawali Ankush , Shetty Rohit , Ghosh Arkasubhra , Sethu Swaminathan 
Published: November 2023

Objective To describe a case of bilateral retinal vasculitis due to presumed sarcoidosis and rickettsial retinitis complicated with neovascularization with tear biomarker analysis. Methods A retrospective case report. Results A 16-year-old male presented with bilateral retinal vasculitis and retinitis in both eyes with inferotemporal quadrant neovascularization in the right eye. Multimodal imaging revealed the presence of active inflammation in both eyes. Weil Felix test was positive with raised ACE levels. This patient was treated with local and systemic steroids, doxycycline, and laser photocoagulation followed by oral methotrexate therapy which resulted in clinical resolution with recovery of visual acuity. Tear biomarker analysis showed raised sICAM-1 and MMP-9 levels in both eyes which significantly reduced following treatment. Conclusion Ocular sarcoidosis with rickettsial infection is a rare association. Tear biomarkers correlated well with clinical and imaging manifestations. High index of suspicion and aggressive anti-inflammatory therapy can help control inflammation and restore good vision.
Neutrophil to lymphocyte ratio (NLR) prognostic effects on heart failure; a systematic review and meta-analysis
Authors: Vakhshoori Mehrbod , Nemati Sepehr , Sabouhi Sadeq , Yavari Behzad , Shakarami Mehrnaz , Bondariyan Niloofar , Emami Sayed Ali , Shafie Davood 
Published: November 2023

AbstractBackgroundNeutrophil to lymphocyte ratio (NLR), as a recent inflammatory index, has been reported to be a prognostic tool in different diseases. However, implication of this ratio in heart failure (HF) is less investigated. In this systematic review and meta-analysis, we aimed to assess the potential impact of NLR on HF clinical outcomes.MethodsRelevant English published records in PubMed, Scopus, Embase, and Web of Science were screened up to July 2023. Articles reporting clinical outcomes (follow-up or in-hospital mortality, readmission, HF prediction, extended hospital stay length, pulmonary vascular resistance, atrial fibrillation, renal disease and functional capacity) in HF sufferers were collected for further analysis with addition of NLR difference stratified by death/survived and HF status.ResultsThirty-six articles (n = 18231) were finally selected which reported NLR in HF sufferers (mean: 4.38, 95% confidence interval (CI): 4.02–4.73). We found 25 articles reported NLR and total mortality (either follow-up death (N = 19): 4.52 (95% CI: 4.03–5.01) or in-hospital death (N = 10): 5.33 (95% CI: 4.08–6.57)) with mean NLR of 4.74 (95% CI: 4.28–5.20). NLR was higher among deceased patients compared to survived ones (standard mean difference: 0.67 (95% CI: 0.48–0.87),P < 0.001)). NLR was found to be related with higher mortality risk (continuous variable: hazard ratio (HR): 1.12, 95% CI: 1.02–1.23,P = 0.013), categorical variable: HR: 1.77, 95% CI: 1.27–2.46,P = 0.001, T2 vs. T1: HR:1.56, 95%CI: 1.21–2.00,P = 0.001, T3 vs. T1: HR:2.49, 95%CI: 1.85–3.35,P < 0.001). Other aforementioned variables were not feasible to analyze due to presence of few studies.ConclusionsNLR is a simple and acceptable prognostic tool for risk stratification and prioritizing high risk patients in clinical settings, especially in resource limited nations.
Factors associated with patency of self-expandable metal stents in malignant biliary obstruction
Authors: Suksai Nottawan , Kamalaporn Patarapong , Chirnaksorn Supphamat , Siriyotha Sukanya 
Published: November 2023

Abstract
Introduction
Endoscopic self-expandable metal stent (SEMS) placement is the key endoscopic treatment for unresectable malignant biliary obstruction. The benefit of covered SEMS over uncovered SEMS remains unknown as are risk factors for SEMS dysfunction. This study aimed to determine the factors associated with patency of SEMS.

Methods
Patients with unresectable malignant biliary obstruction who underwent endoscopic SEMS placement at Ramathibodi Hospital, during January 2012 to March 2021 were included. Patient characteristics, clinical outcomes and patency of SEMS were collected. The primary outcome were stent patency and factors associated with patency of SEMS. The factors were analyzed by univariate and multivariate analyses. Median days of stent patency, median time of patient survival, rate of reintervention and complications after SEMS placement were collected.

Results
One hundred and fourteen patients were included. SEMS dysfunction was found in 37 patients (32.5%). Size of cancer (Hazard ratio (HR), 1.20, (95% CI 1.02, 1.40), p 0.025), presence of stones or sludge during SEMS placement (Hazard ratio (HR), 3.91, (95% CI 1.74, 8.75), p 0.001), length of SEMS, 8 cm (HR 2.96, (95% CI 1.06, 8.3), p 0.039), and total bilirubin level above 2 mg/dL at one month after SEMS placement (HR 1.14, (95% CI 1.06, 1.22), p < 0.001) were associated with SEMS dysfunction. The median stent patency was 97 days. The median patient survival was 133 days, (95% CI 75–165). The rate of reintervention was 86% in patients with SEMS dysfunction.

Conclusion
The size of cancer, presence of stones or sludge during SEMS placement, the length of SEMS, and total bilirubin level above 2 mg/dL at 1 month after SEMS placement were associated with SEMS dysfunction. The median time of stent patency were not statistically different in each type of stent, covered stent, partially covered stent and uncovered stent. Median survival time of patients did not associate with SEMS patency or dysfunction.
Comparison of the 12-month impact of COVID-19 and SARS on physiological capacity and health-related quality of life
Authors: Chan Ken Ka Pang , Ng Susanna So Shan , Lui Grace Chung Yan , Leung Ho Sang , Wong Ka Tak , Chu Winnie Chiu Wing , Chan Tat On , Yiu Karen Yee Shan , Tso Eugene Yuk Keung , To Kin Wang , Ngai Jenny Chun Li , Yip Tommy Wing Ho , Lo Rachel Lai Ping , Ng Joyce Ka Ching , Ko Fanny Wai San , Hui David Shu Cheong 
Published: November 2023

Abstract
Background
Little is known about the differences in medium to long-term recovery on spirometry, 6-minute walking distance (6MWD) and health-related quality of life (HRQoL) between COVID-19 and SARS.

Methods
We performed a 12-month prospective study on COVID-19 survivors. The changes in dynamic lung volumes at spirometry (%predicted FEV1, %predicted FVC), 6MWD and HRQoL at 1–3, 6 to 12 months were compared against a historical cohort of SARS survivors using the same study protocol. The residual radiological changes in HRCT in COVID-19 survivors were correlated with their functional capacity.

Results
108 COVID-19 survivors of various disease severity (asymptomatic 2.9%, mild 33.3%, moderate 47.2%, severe 8.3%, critical 8.3%) were recruited. When compared with 97 SARS survivors, 108 COVID-19 survivors were older (48.1 ± 16.4 vs. 36.1 ± 9.5 years, p < 0.001) and required less additional support during hospitalization; with lower dynamic lung volumes, shorter 6MWD and better physical component score. Both groups of survivors had comparable changes in these parameters at subsequent follow-ups. Both COVID-19 and SARS survivors had similar mental component score (MCS) at 6 and 12 months. COVID-19 survivors initially experienced less (between-group difference, -3.1, 95% confidence interval [CI] -5.5 to -0.7, p = 0.012) and then more improvement (between-group difference 2.9, 95%, CI 0.8 to 5.1, p = 0.007) than SARS survivors in the MCS at 1–3 to 6 months and 6 to 12 months respectively. Forty (44.0%) out of 91 COVID-19 survivors had residual abnormalities on HRCT at 12 months, with a negative correlation between the severity scores of parenchymal changes and 6MWD (r=-0.239, p < 0.05).

Conclusions
COVID-19 survivors demonstrated a similar recovery speed in dynamic lung volumes and exercise capacity, but different paces of psychological recovery as SARS survivors in the convalescent phase. The severity of parenchymal changes in HRCT is negatively correlated with the 6MWD of COVID-19 survivors.

Trial registration
This prospective study was registered at ClinicalTrials.gov on 2 November 2020 (Identifier: NCT04611243).
Prediction of postoperative complications after hepatectomy with dynamic monitoring of central venous oxygen saturation
Authors: Ida Shinya , Morita Yoshifumi , Matsumoto Akio , Muraki Ryuta , Kitajima Ryo , Furuhashi Satoru , Takeda Makoto , Kikuchi Hirotoshi , Hiramatsu Yoshihiro , Takeuchi Hiroya 
Published: November 2023

Abstract
Background
The usefulness of static monitoring using central venous pressure has been reported for anesthetic management in hepatectomy. It is unclear whether intra-hepatectomy dynamic monitoring can predict the postoperative course. We aimed to investigate the association between intraoperative dynamic monitoring and post-hepatectomy complications. Furthermore, we propose a novel anesthetic management strategy to reduce postoperative complication.

Methods
From 2018 to 2021, 93 patients underwent hepatectomy at our hospital. Fifty-three patients who underwent dynamic monitoring during hepatectomy were enrolled. Flo Trac system was used for dynamic monitoring. The baseline central venous oxygen saturation (ScvO2) was defined as the average ScvO2 for 30 min after anesthesia induction. ScvO2 fluctuation (ΔScvO2) was defined as the difference between the baseline and minimum ScvO2. Postoperative complications were evaluated using the comprehensive complication index (CCI).

Results
Patients with ΔScvO2 ≥ 10% had significantly higher CCI scores (0 vs. 20.9: p = 0.043). In univariate analysis, patients with higher CCI scores demonstrated significantly higher preoperative C-reactive protein-to-lymphocyte ratio (7.51 vs. 24.49: p = 0.039), intraoperative bleeding (105 vs. 581 ml: p = 0.008), number of patients with major hepatectomy (4/45 vs. 3/8: p = 0.028), and number of patients with ΔScvO2 ≥ 10% (11/45 vs. 6/8; p = 0.010). Multivariate logistic regression analysis revealed that ΔScvO2 ≥ 10% (odds ratio: 9.53, p = 0.016) was the only independent predictor of elevated CCI.

Conclusions
Central venous oxygen saturation fluctuation during hepatectomy is a predictor of postoperative complications. Anesthetic management based on intraoperative dynamic monitoring and minimizing the change in ScvO2 is a potential strategy for decreasing the risk of post-hepatectomy complications.
Effects of different removal methods of excess resin adhesive on the microleakage of alumina all-ceramic crowns
Authors: Zhang Haiyang , Yu Hao , Jiang Shangfei , Dong Haidao , Yan Chengdong , Liu Hong , Li Qing , Jiang Haiwei 
Published: November 2023

Abstract
Background
Microleakage is a common problem that affects the quality and longevity of all-ceramic crowns. It is influenced by factors such as the resin cement, crown margin design and curing technique. However, few studies focus on the effect of different methods of removing excess resin adhesive on the microleakage of all-ceramic crowns. This study aimed to compare two methods of removing excess resin adhesive (the small brush and sickle methods) on the microleakage of all-ceramic crowns with different marginal clearances.

Methods
Forty extracted third molars were prepared with a 90° shoulder margin and randomly divided into four groups according to their marginal lift (30, 60, 90 or 0 μm). Procera alumina crowns were fabricated using computer-aided design/computer-aided modelling and cemented onto the teeth with 3 M RelyX Unicem (3 M Company, United States) resin cement. Excess resin cement was removed by either the small brush or the sickle scalpel method. The marginal adaptation was observed with a digital microscope. After thermal cycling of the teeth, microleakage was assessed using the dye penetration test under a stereomicroscope. The Mann–Whitney U test and Kruskal–Wallis H test were used to compare the microleakage scores among different groups.

Results
The small-brush group showed significantly better marginal adaptation and lower microleakage scores than the sickle group (p < 0.05). There was no significant difference in the microleakage score (grade 0) among different marginal clearances within each group (p > 0.05).

Conclusion
The small-brush method was more effective than the sickle scalpel method in reducing the microleakage of all-ceramic crowns with different marginal clearances. This method can improve the marginal adaptation and sealability of all-ceramic crowns, thus preventing secondary caries and other complications.
Molecular-based classification of endometrial carcinoma in Northern Thailand: impact on prognosis and potential for implementation in resource-limited settings
Authors: Dankai Wiyada , Pongsuvareeyakul Tip , Phinyo Phichayut , Tejamai Chontichaporn , Teerapakpinyo Chinachote , Cheewakriangkrai Chalong , Lekawanvijit Suree , Siriaunkgul Sumalee , Khunamornpong Surapan 
Published: November 2023

Abstract
Background
Endometrial carcinoma is molecularly categorized into four subgroups: polymerase-E exonuclease domain-mutant (POLE-mut), mismatch repair-deficient (MMR-d), p53-abnormal (p53-abn), and no specific molecular profile (NSMP). This classification scheme has been included into clinical recommendation for post-operative risk-based management, although there have been few Asian studies on this topic. The present study aimed to evaluate the prevalence and clinical outcomes of endometrial carcinoma using this classification in Northern Thailand and the feasibility of implementation in resource-limited settings.

Methods
Endometrial carcinomas from hysterectomy specimens were classified using immunohistochemistry for MMR proteins and p53, as well as POLE mutation testing. Clinicopathological variables and outcomes were analyzed. The costs of the molecular information-based approach were compared to those incurred by the conventional approach (without molecular classification).

Results
Of 138 patients, 52.9% in the NSMP subgroup, 28.2% were in the MMR-d, 13.8% in the p53-abn, and 5.1% in the POLE-mut. After adjusting for other variables, patients with POLE-mut showed the most favorable outcomes, while those with p53-abn had the poorest survival. When estimating the costs for post-operative management, the use of molecular classification resulted in a 10% increase over the conventional approach. However, the cost increased only by 1% if only POLE testing was used to identify patients for treatment omission.

Conclusion
In Northern Thailand, endometrial carcinoma had comparable subgroup distribution and prognostic implications to previous reports, supporting the implementation of management guidelines that incorporate molecular information. In resource-limited settings, at least POLE mutation testing in early-stage patients should be considered.