bluuebunny/crossref_metadata_2025_split huggingface dataset:
Considerations for Gender‐Affirming Hormonal and Surgical Care Among Transgender and Gender Diverse Adolescents and Adults With Congenital Heart Disease
Authors: Harrison David J. , Prada Francisco , Nokoff Natalie J. , Iwamoto Sean J. , Pastor Tony , Jacobsen Roni M. , Yeung Elizabeth 
Published: January 2024

Background
Transgender and gender diverse (TGD) individuals and long‐term survivors with adult congenital heart disease (ACHD) are both growing populations with specialized needs. No studies assess temporal trends or evaluate the care of TGD individuals with ACHD.

Methods and Results
Meetings between congenital cardiology and gender‐affirming care specialists identified unique considerations in TGD individuals with ACHD. A retrospective chart review was then performed to describe patient factors and outpatient trends in those with an ACHD diagnosis undergoing gender‐affirming hormonal or surgical care (GAHT/S) at 1 adult and 1 pediatric tertiary care center. Thirty‐three TGD individuals with ACHD were identified, 21 with a history of GAHT/S. Fourteen (66%) had moderate or complex ACHD, 8 (38%) identified as transgender male, 9 (43%) transgender female, and 4 (19%) other gender identities. Three had undergone gender‐affirming surgery. There were zero occurrences of the composite end point of unplanned hospitalization or thrombotic event over 71.1 person‐years of gender‐affirming care. Median age at first gender‐affirming appointment was 16.8 years [interquartile range 14.8–21.5]. The most common treatment modification was changing estradiol administration from oral to transdermal to reduce thrombotic risk (n=3). An increasing trend was observed from zero TGD patients with ACHD attending a gender diversity appointment in 2012 to 14 patients in 2022.

Conclusions
There is a growing population of TGD patients with ACHD and unique medical and psychosocial needs. Future studies must fully evaluate the reassuring safety profile observed in this small cohort. We share 10 actionable care considerations for providers with a goal of overseeing a safe and fulfilling gender transition across all TGD patients with ACHD.
Changing or Retaining Direct Oral Anticoagulant After Ischemic Stroke Despite Direct Oral Anticoagulant Treatment
Authors: Lin Shin‐Yi , Liao Yun‐Tsz , Tang Sung‐Chun , Lin Ching‐Ching Claire , Wang Chi‐Chuan 
Published: January 2024

Background
The optimal antithrombotic strategies for patients with atrial fibrillation who experience ischemic stroke (IS) despite direct oral anticoagulant (DOAC) therapy remain inconclusive. This study compared outcomes for patients with DOAC treatment failure who changed or retained their prestroke DOAC.

Methods and Results
This retrospective cohort study analyzed data from the National Health Insurance Research Database from 2012 to 2020. Patients with atrial fibrillation who experienced IS during DOAC therapy were assigned to either (1) the DOAC‐change group: changing prestroke DOAC or (2) the DOAC‐retain group: retaining prestroke DOAC. The primary outcome was a composite of recurrent IS and transient ischemic attack. The secondary outcomes included intracranial hemorrhage, major bleeding, systemic thromboembolism, and all‐cause death. Propensity score–based inverse probability of treatment weighting was applied to balance the baseline characteristics between the DOAC‐change and DOAC‐retain groups. The Cox proportional hazards model compared the risk of outcomes between the 2 groups. In total, 1979 patients were enrolled (609 DOAC‐change patients and 1370 DOAC‐retain patients). The incidence rates of recurrent IS or transient ischemic attack were 7.20 and 6.56 per 100 person‐years in the DOAC‐change and DOAC‐retain groups, respectively (hazard ratio [HR], 1.07 [95% CI, 0.87–1.30]). A nonsignificantly higher incidence rate of intracranial hemorrhage was observed in the DOAC‐change group compared with the DOAC‐retain group (0.75 versus 0.53 per 100‐person‐years; HR, 1.49 [95% CI, 0.78–2.83]). The systemic thromboembolism, major bleeding, and death rates were comparable between the DOAC‐change and DOAC‐retain groups.

Conclusions
Changing prestroke DOAC does not reduce the risk of recurrent cerebral ischemia in patients with atrial fibrillation who develop IS during DOAC therapy. However, future studies should continue to observe the potential trends of increased intracranial hemorrhage risk.
Noninvasive Advanced Cardiovascular Magnetic Resonance–Derived Fontan Hemodynamics Are Associated With Reduced Kidney Function But Not Albuminuria
Authors: Van den Eynde Jef , Westenberg Jos J. M. , Hazekamp Mark G. , Lamb Hildo J. , Jongbloed Monique R. M. , Wentzel Jolanda J. , Kenjeres Sasa , Dekkers Ilona A. , Van De Bruaene Alexander , Rijnberg Friso M. , Roest Arno A. W. 
Published: January 2024

Background
Kidney disease is the most important predictor of death in patients with a Fontan circulation, yet its clinical and hemodynamic correlates have not been well established.

Methods and Results

A total of 53 ambulatory patients with a Fontan circulation (median age, 16.2 years, 52.8% male patients) underwent advanced cardiovascular magnetic resonance assessment, including 4‐dimensional flow imaging and computational fluid dynamics. Estimated glomerular filtration rate (eGFR) <90 mL/min per 1.73 m
2
was observed in 20.8% and albumin‐to‐creatinine ratio >3 mg/mmol in 39.6%. The average eGFR decline rate was −1.83 mL/min per 1.73 m
2
per year (95% CI, −2.67 to −0.99;
P
<0.001). Lower eGFR was associated with older age, larger body surface area at examination, longer time since Fontan procedure, and lower systemic ventricular ejection fraction. Higher albumin‐to‐creatinine ratio was associated with absence of fenestration at the Fontan operation, and older age and lower systemic ventricular ejection fraction at the assessment. Lower cross‐sectional area of the Fontan conduit indexed to flow (r=0.32,
P
=0.038), higher inferior vena cava–conduit velocity mismatch factor (r=−0.35,
P
=0.022), higher kinetic energy indexed to flow in the total cavopulmonary connection (r=−0.59,
P
=0.005), and higher total cavopulmonary connection resistance (r=−0.42,
P
=0.005 at rest; r=−0.43,
P
=0.004 during exercise) were all associated with lower eGFR but not with albuminuria.

Conclusions
Kidney dysfunction and albuminuria are common among clinically well adolescents and young adults with a Fontan circulation. Advanced cardiovascular magnetic resonance–derived metrics indicative of declining Fontan hemodynamics are associated with eGFR and might serve as targets to improve kidney health. Albuminuria might be driven by other factors that need further investigation.
Anterior Circulation Thrombectomy in Patients With Low National Institutes of Health Stroke Scale Score: Analysis of the National Inpatient Sample
Authors: Patel Karan , Taneja Kamil , Shu Liqi , Zhang Linda , Yu Yunting , Abdalkader Mohamad , Obusan Matthew B. , Yaghi Shadi , Nguyen Thanh N. , Asdaghi Negar , Oak Solomon , Tonetti Daniel A. , Siegler James E. 
Published: January 2024

Background
Prior studies have shown benefit for endovascular therapy (EVT) in patients with large‐vessel occlusion and severe deficits, as captured by the National Institutes of Health Stroke Scale (NIHSS). However, the benefit of EVT in patients with NIHSS score of <6 is unclear.

Methods
We queried the National Inpatient Sample (2018–2020) for patients with a large‐vessel occlusion of the internal carotid or middle cerebral artery with an NIHSS score of <6, and compared outcomes between patients treated with EVT versus best medical management, using propensity score matching. The primary outcome was routine discharge (home or self‐care). Secondary outcomes were in‐hospital mortality, intracerebral hemorrhage, and length of stay. Primary and secondary outcomes were evaluated using multivariable regression adjusted for baseline characteristics, stroke severity, and treatment with thrombolysis.

Results

Of the 212 515 patients with an internal carotid artery/middle cerebral artery stroke, 49 115 met the inclusion criteria for our study. There were 3490 (7.1%) patients treated with EVT and 45 625 (92.9%) treated with best medical management. Patients treated with EVT had no difference in ofdds of routine discharge (adjusted odds ratio (OR), 0.99; 95% CI, 0.82–1.19;
P
= 0.91), but there were longer lengths of hospital stay (adjusted β, 1.26; 95% CI, 0.78–1.74;
P
<0.001) and higher rates of death (adjusted OR, 2.11; 95% CI, 1.20–3.70;
P
= 0.01), compared with patients treated with best medical management. In multivariable models, intravenous thrombolysis was independently associated with higher odds of routine discharge (adjusted OR, 1.78; 95% CI, 1.57–2.01;
P
<0.001) and shorter hospital stay (adjusted β, −0.41; 95% CI, −0.63 to −0.19;
P
<0.001), but no difference in in‐hospital mortality (adjusted OR, 0.70; 95% CI, 0.39–1.24;
P
= 0.22). These relationships persisted in the propensity‐matched cohort.

Conclusion
Patients treated with EVT compared with best medical management had worse clinical outcomes, and this may be attributable to residual confounding (eg, deterioration following an initially low NIHSS score) or procedural factors. Patients treated with intravenous thrombolysis had greater odds of routine discharge. Our findings suggest potential real‐world benefits for intravenous thrombolysis in patients with occlusion of the internal carotid artery/middle cerebral artery and low NIHSS score.
Psalm 40 and the “New Covenant” of Jeremiah 31?
Authors: Lasater Phillip M. 
Published: January 2024

Abstract
This paper discusses how Ps 40 reflects a widely attested and complex discourse on how legalities relate to the human self—a discourse involving matters such as law’s relation to human flourishing and perfectibility (e.g., Deut 30:6–14; Jer 31:31–34; Ps 19; Wis 6 and 9; Philo; for others views of perfectibility, cf. Gen 6:5; 8:21; Qoh 9:3). Psalm 40 combines praise and lament, with divine law as a key factor in this liturgical text’s logic. After clarifying literary-historical and form-critical issues in studies of Ps 40, it will be argued that whether or not there is a literary relationship to Jer 31, these texts display divergent logic on law’s relationship to human flourishing. The paper contributes to scholarly understanding of legal discourse and lament in Jewish antiquity.
Minority Rights Denials in Ethiopia
Authors: Mohammed Awol Ali 
Published: January 2024

Abstract
This article explores the constitutional promises and practices of self-rule in Ethiopia federal system focusing on the Konso ethnic group’s quest for self-rule. Given that the federal project in Ethiopia is a new model (synthesis) that has replaced the failed ‘Nation-State’ building effort since 1991, self-rule has become the ideological heart of the incumbent party and a pillar of the constitution. To this end, the article used a qualitative research approach that relied on both primary and secondary sources of data. Interviews, field observation, focus group discussions, and document analysis were utilised to obtain data. The findings show that, despite the fact that both the fdre and snnprs constitutions promised “unconditional right to every national, nationality, and people to have the right to self-determination up to secession,” the Konso quest for self-rule was rejected, their previous semi-autonomous status was dissolved, and they were relegated to ordinary Woreda. The merger transformed Special Woredas into ordinary Woredas while also shifting nationality self-rule to multi-ethnic self-rule, resulting in a paradigm shift in terms of self-rule practice. The Woredas lack essential identity-related self-government autonomy, such as the capacity to choose the working language and the right to appoint and remove officials as needed. A major source of concern is the decline in capital budgets and the delayed development of infrastructure. As a result, the snnp regional government has breached both its original ideological vows and the framework of the constitution.
Navigating Mangrove Protection: A Jurisdictional Approach to Climate Action in South Sumatra, Indonesia
Authors: Martin Edwin , Arifatul Ulya Nur , Yunardy Syafrul , Agustina Karlin , Meidalima Dewi , Chuzaimah Chuzaimah 
Published: January 2024

Abstract
Mangrove ecosystems in Indonesia, essential for coastal protection and carbon sequestration, are under severe threat from deforestation. This article emphasizes their significance and their role in Indonesia’s climate change mitigation strategies. Their carbon sequestration capacity is substantial, potentially preventing significant CO2 emissions. Indonesia is committed to climate change mitigation, with its Enhanced Nationally Determined Contribution focusing on the Forest and Other Land Use (folu) sector, where mangroves are pivotal. However, optimizing this potential and involving local communities present challenges due to weak enforcement, policy conflicts, and limited community engagement. Based on a case study in South Sumatra, this study highlights the importance of involving local governments and communities in mangrove conservation efforts as a climate change mitigation measure. By applying a jurisdictional approach, especially through social-forestry schemes (e.g. Village Forests and mangrove-based ecotourism), local governments can play a crucial role in preserving mangrove ecosystems, integrating them into climate policies, and supporting community empowerment while achieving climate change mitigation goals.
Physics of the Eddy Memory Kernel of a Baroclinic Midlatitude Atmosphere
Authors: Vanderborght Elian , Demaeyer Jonathan , Manucharyan Georgy , Moon Woosok , Dijkstra Henk A. 
Published: January 2024

Abstract
In recent theory trying to explain the origin of baroclinic low-frequency atmospheric variability, the concept of eddy memory has been proposed. In this theory, the effect of synoptic-scale heat fluxes on the planetary-scale mean flow depends on the history of the mean meridional temperature gradient. Mathematically, this involves the convolution of a memory kernel with the mean meridional temperature gradient over past times. However, the precise shape of the memory kernel and its connection to baroclinic wave dynamics remains to be explained. In this study we use linear and proxy response theory to determine the shape of the memory kernel of a truncated two-layer quasigeostrophic atmospheric model. We find a memory kernel that relates the eddy heat flux to the zonal mean meridional temperature gradient on time scales greater than 2 days. Although the shape of the memory kernel is complex, we show that it may be well approximated as an exponential, particularly when reproducing baroclinic low-frequency intraseasonal modes of variability. By computing the terms in the Lorenz energy cycle, we find that the shape of the memory kernel can be linked to the finite time that growing baroclinic instabilities require to adapt their growth properties to the local zonal mean atmospheric flow stability. Regarding the explanation for observed baroclinic annular modes in the Southern Hemisphere, our results suggest that it is physical for these modes to be derived directly from the thermodynamic equation by considering an exponentially decaying memory kernel, provided accurate estimates of the necessary parameters are incorporated.

Significance Statement
The goal of this study was to derive the memory of the zonal mean temperature field contained in eddy heat fluxes. To do this we used recent developments in a theory stemming from statistical mechanics, called proxy response theory. This theory facilitated direct numerical computations of the parameterization that links eddy heat fluxes to the zonal mean temperature field. Notably, this parameterization incorporates a crucial memory component, which we demonstrated to be essential in explaining the periodicity of low-frequency modes of variability, specifically the baroclinic annular mode (BAM). Understanding the role of memory as a driver of this variability holds great significance, as the BAM constitutes a dominant pattern of large annular variability within the Southern Hemisphere circulation. Enhanced comprehension of this driver, which is memory, can lead to improved understanding and predictive capabilities concerning observed annular weather patterns.
On CCN Effects upon Convective Cold Pool Timing and Features
Authors: Ross Tobias I. D. , Lasher-Trapp Sonia 
Published: January 2024

Abstract
Cold pools produced by deep convection can initiate new convection, and their representation in larger-scale weather and climate models could improve prediction of the extent and timing of upscale growth. Cold pools originate from latent cooling from precipitation changing phase, but little attention has been paid to microphysical influences on cold pool characteristics, particularly CCN effects. Datasets obtained from the CACTI and RELAMPAGO field campaigns, along with idealized numerical modeling, are utilized to investigate the hypothesis that convective storms forming in higher-CCN environments generate their first surface rainfall later, delaying cold pool initiation. Aircraft observations of CCN and shallow convection on 9 days do suggest a CCN effect. Those ingesting more CCN contained fewer drizzle drops, although a decreased cloud depth with increasing CCN was also likely a limiting factor. In three of those cases that later developed into deep convection, the timing of cold pool onset was not ubiquitously delayed in environments with more CCN. Idealized numerical simulations suggest that an ordinary thunderstorm can experience small delays in cold pool onset with increasing CCN due to changes in graupel production, but CCN effects on the cold pool from a supercell thunderstorm can be easily overpowered by its unique dynamics. A strong inverse relationship between cold pool strength, expansion rate, and depth with increasing CCN is suggested by the results of the ordinary thunderstorm simulation. Further consideration of CCN appears warranted for future cold pool parameterization development, but other environmental factors affecting storm morphology and precipitation cannot be ignored.
Nomogram for predicting neutropenia in patients with esophageal, gastric, or colorectal cancer treated by chemotherapy in the first cycle
Authors: Tian Tian , Hu Wenjun , Hao Jiqing 
Published: January 2024

Objectives Development and validation of a predictive model including serum vitamin concentration to estimate the risk of chemotherapy-induced grade 3/4 neutropenia in esophageal cancer, gastric cancer, or colorectal cancer patients who receive the first cycle of chemotherapy. Methods Data from 535 patients treated at the Affiliated Fuyang People's Hospital of Anhui Medical University from January 1, 2020, to March 2, 2022, were used to derive the predictive model. Least absolute shrinkage and selection operator regression analysis was performed to screen potential risk characteristics, and multivariate logistic regression was utilized to investigate efficient factors associated with chemotherapy-induced neutropenia. A nomogram was constructed using this logistic model. This nomogram was then tested on a temporal validation cohort containing 212 consecutive patients. Results In the cohort of all 747 eligible patients, grade 3/4 neutropenia incidence was 45.2%. Age, Eastern Cooperative Oncology Group-performance status, neutrophil count, serum albumin, and hemoglobin data were entered into the final model. The performance of the final predictive nomogram was assessed by the area under the receiver operating characteristic curve in both the development and validation datasets. The calibration curves indicated that the estimated risks were accurate. Decision curve analysis for the predictive model exhibited improved clinical practicality. Conclusion In the present study, we established an accessible risk predictive model and identified valuable serum vitamin concentration parameters associated with chemotherapy-induced neutropenia. The predictive model may improve the grade 3/4 neutropenia risk prediction in patients with gastrointestinal malignancies who receive oxaliplatin- and fluoropyrimidine-based chemotherapy and help physicians make appropriate decisions for disease management.
Relationship between visual acuity and OCT angiography parameters in diabetic retinopathy eyes after treatment
Authors: Wei-Zhang Selena , He Kai , Zhou Wei , Yu Jinguo , Zhao Jing , He Tiangeng , Chen Song , Kaysar Parhat , Sun Zhiyong , Jia Dagong , Zhu Yun , Yan Hua 
Published: January 2024

Purpose To assess the relationship between visual acuity and OCT angiography parameters in diabetic retinopathy eyes after treatment, and to analyze the relative factors in PDR eyes. Methods A total of 89 eyes, including 42 eyes with non-PDR (NPDR), and 47 eyes after vitrectomy with PDR were included and underwent OCTA. All images were processed by Python or FIJI. Multivariable linear regression models were used to analyze the associations between postoperative BCVA and OCTA parameters in PDR patients. Results Postoperative OCTA parameters including deep capillary plexus (DCP) parafoveal and perifoveal vessel density (VD), DCP parafoveal and perifoveal vessel length density (VLD), DCP fractal dimension (FD), choriocapillaris plexus (CCP) VD, CCP VLD, were significantly lower in the PDR group than in the NPDR group. In the superficial capillary plexus (SCP), we found a negative correlation between the postoperative BCVA and VD (parafovea: β coefficient = -0.351, p = 0.023; perifovea: β coefficient = -0.338, p = 0.036). Perifoveal VLD (β coefficient = -0.343, p = 0.031) and FD (β coefficient = -0.375, p = 0.016) of the SCP were also negatively correlated with postoperative BCVA. Regarding the DCP, perifoveal VD (β coefficient = -0.396, p = 0.008), perifoveal VLD (β coefficient = -0.334, p = 0.025), vessel tortuosity (VT) (β coefficient = -0.369, p = 0.015) were negatively correlated with postoperative BCVA. In CCP, VLD (β coefficient = -0.373, p = 0.023) and number of flow voids (β coefficient = -0.334, p = 0.036) exhibited a negative association with postoperative BCVA. Conclusions Postoperative BCVA of PDR patients was related to OCTA parameters of the SCP (parafoveal and perifoveal VD, perifoveal VLD and FD), DCP (perifoveal VD, VLD, and VT) and CCP (VLD and number of flow voids).