bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interpretation of Net Surface Heat Fluxes and Meridional Overturning Circulations in Global Coupled HadGEM3 Climate Simulations
Authors: Bell Michael J. , Nurser A. J. George , Storkey David 
Published: March 2023

Abstract
The annual mean net surface heat fluxes (NSHFs) from the ocean to the atmosphere generated by historical forcing simulations using the HadGEM3-GC3.1 coupled climate model are shown to be relatively independent of resolution, for model horizontal grid spacings between 1° and 1/12°, and to agree well with those based on the DEEP-C (Diagnosing Earth’s Energy Pathways in the Climate System) analyses. Interpretations of the geographical patterns of the NSHFs are suggested that use basic ideas extracted from the theory of the ventilated thermocline and planetary geostrophic layer models. As a step toward investigation of the validity of the assumptions underlying the interpretations, we examine the contributions to the rate of change of the active tracers from the main terms in their prognostic equations as a function of the active tracer and latitude. We find that, consistent with our assumptions, the main contributions from vertical diffusion occur in “near-surface” layers. We also find that, except at high latitudes, the sum of the NSHF and vertical diffusion is mainly balanced by time-mean advection of potential temperature. A corresponding statement holds for potential density but not salinity. We also show that the heat input by latitude bands is dominated by the NSHFs, the time-mean advection, and the equatorial Pacific. It is usually assumed that global integrals of tracer tendencies due to advection as a function of the tracer should be identically zero. We show that nonnegligible contributions to them arise from net freshwater surface fluxes.

Significance Statement
Our aim is to understand better how the heat and freshwater that are input into the ocean from the atmosphere are then redistributed within the ocean and released back into the atmosphere. We show that the geographical patterns of the heat that is input to or released from the ocean surface in coupled climate models agree well with observations. We outline a dynamically based interpretation of these surface fluxes and provide evidence that supports some of its assumptions. This work might in future help us to understand how the patterns of the surface fluxes will respond to changes in greenhouse gas forcing.
Epiglottopexy in Infants Younger Than 6 Months Old: A Case Series
Authors: Hazkani Inbal , Stein Eli , Ghadersohi Saied , Ida Jonathan , Thompson Dana M. , Valika Taher 
Published: March 2023

Background: Severe laryngomalacia, characterized by apnea, hypoxia, and feeding difficulties, is an uncommon diagnosis that often requires surgical intervention with supraglottoplasty. Children who require surgery at a young age and those with additional comorbidities pose a special challenge and may require further surgical interventions. Posterior displacement of the epiglottis has been noted in some infants with congenital stridor and is commonly treated with epiglottopexy. The goal of our study is to review the outcomes of epiglottopexy combined with supraglottoplasty in our cohort of infants younger than 6 months old with severe laryngomalacia. Methods: A retrospective chart review of infants younger than 6 months old who underwent epiglottopexy combined with supraglottoplasty for severe laryngomalacia from January 2018 to July 2021 at a tertiary care children’s hospital. Results: 13 patients (age 1.3 week-5.2 months) underwent supraglottoplasty and epiglottopexy for severe laryngomalacia and epiglottis retroflection. The patients were admitted to the intensive care unit and remained intubated for at least one night. All patients demonstrated subjective and objective improvement in upper airway respiratory signs and symptoms. Ten patients demonstrated aspiration immediately postoperatively, despite 4 of them having no concern for aspiration at preoperative evaluation. On follow-up, 1 patient required revision supraglottoplasty and epiglottopexy for persistent laryngomalacia, and 2 patients required tracheostomy tube placement due to cardiopulmonary comorbidities. Conclusion: Infants younger than 6 months old with medical comorbidities undergoing epiglottopexy with supraglottoplasty may demonstrate significant improvement in respiratory symptoms. Worsening dysphagia may complicate the postoperative period, particularly among children with medical comorbidities.
Nonoperative Management, Repair, or Reconstruction of the Medial Collateral Ligament in Combined Anterior Cruciate and Medial Collateral Ligament Injuries—Which Is Best? A Systematic Review and Meta-analysis
Authors: Shultz Christopher L. , Poehlein Emily , Morriss Nicholas J. , Green Cynthia L. , Hu Jessica , Lander Sarah , Amoo-Achampong Kelms , Lau Brian C. 
Published: March 2023

Background: Combined injury of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) is a common injury pattern and accounts for 20% of all ligamentous knee injuries. Despite advancements in surgical technique, there is no up-to-date consensus regarding the superiority of nonoperative versus operative management in higher-grade MCL tears of combined ACL-MCL injuries. Purpose: To interpret recent literature on treatment options and to provide an updated evidence-based approach for management of combined ACL-MCL knee injuries. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: We performed a systematic review on outcomes following treatment of concomitant ACL and MCL injuries. A computerized search was conducted in PubMed, Embase.com , and Scopus.com . Authors independently assessed eligible studies and screened titles and abstracts. Articles reporting on patients with concomitant ACL and MCL injuries with or without concomitant procedures were included. Data regarding study design, sample size, patient age and sex, length of follow-up, timing of surgery, indications, surgical methods, concomitant procedures, outcomes, and complications were recorded. Patient-reported outcomes (PROs) and functional outcomes, including Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee scores, Lysholm and Tegner scores, and range of motion, were estimated via meta-analysis and compared statistically by surgical approach. Results: In total, 18 studies were included in the systematic review with level 1 to level 4 evidence, with a total of 1,534 cases, were included in the systematic review. Of these, 16 studies with sufficient statistical reporting including 997 cases with sufficient follow-up were included in meta-analysis. Three different approaches to combined ACL-MCL injuries were identified: ACL reconstruction with (1) nonoperative MCL, (2) MCL repair, and (3) MCL reconstruction. There was no statistical difference between nonoperative versus surgically managed MCL injuries for PROs, range of motion at final follow up, or quadriceps strength. Conclusion: Reconstruction of combined injury in a delayed fashion facilitates return of range of motion and may allow time for low-grade MCL tears to heal. If residual valgus or anteromedial rotatory laxity remains after a period of rehabilitation, then concomitant surgical management of ACL and MCL injuries is warranted. Avulsion MCL injuries and Stener-type lesions may benefit from early repair techniques.
Asian Healthcare Workers and Their Experiences of Racism in North America: A Scoping Review
Authors: Louie-Poon Samantha , Chiu Patrick , Kung Janice Y. 
Published: March 2023

Background The rising rates of anti-Asian sentiments has recently been called into question by several community activists and scholars. While this collective work has heightened awareness to address anti-Asian racism, the experiences of Asian healthcare workers in particular remains limited. Purpose To map the existing literature on anti-Asian racism experienced by Asian healthcare workers in North American healthcare settings, identify gaps in the current literature base, and inform future areas of anti-Asian racism research. Methods A scoping review following Arksey and O'Malley’s (2005) methodology with updated guidance by Levac et al. (2010) and Peters et al. (2020) was undertaken. Findings A total of 3565 articles from database searches were identified from eight databases, with 64 full text articles screened and 15 articles included in this review. Anti-Asian racism amongst healthcare workers has been conceptualized, studied, and understood in three broad categories: levels of racism, descriptions of anti-Asian racism, and the impact of racism. In 60% of the included articles, interpersonal level of racism was solely studied, while 40% articles simultaneously studied interpersonal and institutional levels of racism. Anti-Asian racism was described through three key perspectives: otherness, inferior professional status, and general racial discrimination. Lastly, the impact of Asian healthcare workers’ experiences of anti-Asian racism was studied by exploring the impact on mental health and barriers to career advancement. Conclusion Despite the presence of anti-Asian racism, the limited literature examining the complexities of the experiences of anti-Asian racism for Asian healthcare workers is concerning. Future scholarship requires further investigation that comprehensively explores the multiple pathways of anti-Asian racism, the contestation of monolithic stereotypes, and how Asian healthcare workers negotiate both hypervisibility and invisibility within healthcare spaces.
Machine Learning for Opportunistic Screening for Osteoporosis and Osteopenia Using Knee CT Scans
Authors: Sebro Ronnie , Elmahdy Mahmoud 
Published: March 2023

Purpose To predict whether a patient has osteoporosis/osteopenia using the attenuation of trabecular bone obtained from knee computed tomography (CT) scans. Methods Retrospective analysis of 273 patients who underwent contemporaneous knee CT scans and dual-energy X-ray absorptiometry (DXA) within 1 year. Volumetric segmentation of the trabecular bone of the distal femur, proximal tibia, patella, and proximal fibula was performed to obtain the bone CT attenuation. The data was randomly split into training/validation (78%) and test (22%) datasets and the performance in the test dataset were evaluated. The predictive properties of the CT attenuation of each bone to predict osteoporosis/osteopenia were assessed. Multivariable support vector machines (SVM) and random forest classifiers (RF) were used to predict osteoporosis/osteopenia. Results Patients with a mean age (range) of 67.9 (50–87) years, 85% female were evaluated. Seventy-seven (28.2%) of patients had normal bone mineral density (BMD), 140 (51.3%) had osteopenia, and 56 (20.5%) had osteoporosis. The proximal tibia had the best predictive ability of all bones and a CT attenuation threshold of 96.0 Hounsfield Units (HU) had a sensitivity of .791, specificity of .706, and area under the curve (AUC) of .748. The AUC for the SVM with cubic kernel classifier (AUC = .912) was better than the RF classifier (AUC = .683, P < .001) and better than using the CT attenuation threshold of 96.0 HU at the proximal tibia (AUC = .748, P = .025). Conclusions Opportunistic screening for osteoporosis/osteopenia can be performed using knee CT scans. Multivariable machine learning models are more predictive than the CT attenuation of a single bone.
How Do Religious and Political Beliefs Predict COVID-19 Vaccination Behavior Among U.S. College Students? A Study Using the Health Belief Model
Authors: Chen Yixin 
Published: March 2023

Purpose Predicting COVID-19 vaccination behavior among U.S. college students using the Health Belief Model (HBM). Design Cross-sectional survey. Setting Online. Sample A convenience sample of students in a public university in the U.S. (N = 411). Measures Demographics; COVID-19 vaccination behavior as outcome variable; HBM variables (perceived threat of COVID-19, perceived individual benefit of vaccination, perceived community benefit of vaccination, perceived vaccine-safety barrier, perceived vaccination-cost barrier [time and effort], self-efficacy), and fear of COVID-19 as proximal predictors; religious beliefs and political beliefs as distal predictors. Questions/items measuring all variables in the survey data collection were taken from relevant and peer-reviewed publications and were modified to reflect the context of COVID-19. Analysis Structural equation modeling (SEM). Results The model fit the data very well (χ2/df = 2.27/5 = .45, p = .810; RMSEA = .000). Perceived individual benefit (β = .489, p < .001), perceived vaccine-safety barrier (β = −.151, p = .001), perceived vaccination-cost barrier (β = −.152, p < .001), and political beliefs (β = −.094, p = .029) are significant predictors of vaccination behavior. Effects of religious beliefs are completely, and effects of political beliefs are partially mediated by perceived individual benefit and the two barrier variables. Conclusion Perceived individual benefit, the two barrier variables, and political beliefs are direct predictors, while religious beliefs are an indirect predictor, of COVID-19 vaccination behavior, suggesting that the HBM can effectively inform strategies to promote vaccination. Political beliefs are a much stronger predictor than religious beliefs. Students who are more religious or conservative tend to perceive less individual benefit and greater barriers to vaccination, making them less likely to get vaccinated. A limitation of this study is the disproportionate number of female participants (77.9%).
Implementation of clinical assistants in a pediatric oncology department: An impact analysis
Authors: Adroher Cristina , Calvo Celia , Pavon Laura , Casadevall Ricard , Alvarez Esther , Marsal Mariona , Lopez Francesc , Pons Miquel , del Castillo Manel , Morales Andres 
Published: March 2023

Bureaucratic and administrative tasks associated with health care provision have historically fallen on health care professionals, which is one among the factors contributing to low job satisfaction and lower productivity. Incorporating new professional roles that help to better respond to the needs of both patients and professionals can increase the quality and efficiency of service provision. This article aims to evaluate the impact of the clinical assistant’s introduction in the Sant Joan de Déu Barcelona Children’s Hospital’s pediatric oncology department, in terms of (i) displacement of activity loads carried out by this new professional role and the consequent time freed up for physicians, (ii) physicians’ satisfaction and (iii) efficiency of the new care model. This is an observational and retrospective study using administrative data based on the type of activity performed by clinical assistants and the measurement of the time freed up in favor of the physicians. The potential skill mix productivity increase, survey of physicians’ satisfaction, and reduction in costs with the new model was analyzed. During the first year of its implementation in the pediatric oncology department, clinical assistants have performed 13,553 requests (69% of the total), representing a total saving of 266.83 hours or 6.67 workweeks of 40 hours. They performed 74% of outpatient surgical requests in the oncology department, 87% of day hospital requests and 54% of total requests in the outpatient consultations area. Physicians are overall satisfied with the new role and think they can use the time gained to do other things such as research or improving the quality of care. The role change allows reducing the cost per request by 56% in relation to the conventional model. In conclusion, the introduction of clinical assistants in the oncology department could be efficient to the extent that it displaces a significant part of the bureaucratic and administrative tasks previously performed by health care professionals and thus enables to reduce the cost of these processes. This delegation allows them to work more closely to the maximum of their competences and the physicians to have more time for higher added value clinical tasks and increase professional satisfaction.
Outpatient administration of paclitaxel, ifosfamide, and cisplatin (TIP) for germ cell tumor
Authors: Schepers Allison J , Smith David C , McDevitt Rachel L 
Published: March 2023

Purpose The combination of paclitaxel, ifosfamide, and cisplatin (TIP) is frequently used for the treatment of metastatic germ cell tumors. Due to complex supportive care and infusion requirements, TIP is typically given in the inpatient setting. This analysis describes the development and implementation of a protocol for complete outpatient administration of TIP chemotherapy. Methods From July 2020 to June 2021, adults receiving TIP for germ cell tumor at University of Michigan Rogel Cancer Center were evaluated for outpatient administration. The primary outcome was number of inpatient bed days saved by giving outpatient TIP chemotherapy, with the goal of giving 75% of TIP cycles outpatient. Patients receiving outpatient TIP were also assessed for chemotherapy dose reduction or delays and acute toxicities of kidney injury, encephalopathy, and hemorrhagic cystitis. Results From July 2020 to July 2021, three patients received 13 cycles of TIP. Ten cycles (77%) were administered in the outpatient setting, resulting in a savings of 50 inpatient bed days in one year. No patients required a dose reduction or delay in chemotherapy or experienced acute kidney injury, encephalopathy, or hemorrhagic cystitis during outpatient TIP treatment. Conclusion Despite logistic and supportive care challenges, TIP can be administered completely in the outpatient setting.
A Population-Based Study on Injury Risk and Disparities Among Children With ADHD
Authors: Shen Jiabin , Shi Junxin , Gauthier Lynne , Li Wenjun 
Published: March 2023

Objective: Impaired attention and inhibitory control put children with ADHD at potentially high risk of injury—one of the leading causes of disability in the general pediatric population. Existing research has yet to examine this important health risk using nationally representative samples. This population-based study aimed to address this gap. Methods: National estimates of injury occurrences were generated from 66,236 children in the Medical Expenditures Panel Survey 2010–2019 datasets. Multiple logistic regression models further examined the impact of injury type, age, race/ethnicity, sex, parental education, income, marital and insurance status on injury prevalence. Results: Compared to children without ADHD, those with ADHD have significantly higher injury prevalence ( OR = 1.20, 95% CI [1.07, 1.33]) across injury types and most sociodemographic subgroups. Conclusions: Children with ADHD are more likely to experience injury. Future research should investigate mechanisms of injury disparities to inform future preventive efforts.
Evaluation of Radiation Sensitivity Differences in Mouse Liver Tumor Organoids Using CRISPR/Cas9-Mediated Gene Mutation
Authors: Jeon Wan , Jung Se Yeon , Lee Chae Young , Kim Won-Tae , Kim Hyun , Jang Kyoung Won , Lim Heuijin , Lee Manwoo , Jeong Dong Hyeok , Kim Sung Dae , Kim In Ah , Choi Si Ho , Son Tae Gen , Kim Kyung Su 
Published: March 2023

Background To assess the radiosensitivity of liver tumors harboring different genetic mutations, mouse liver tumors were generated in vivo through the hydrodynamic injection of clustered regularly interspaced short palindromic repeat/caspase 9 (CRISPR/Cas9) constructs encoding single-guide RNAs (sgRNAs) targeting Tp53, Pten, Nf1, Nf2, Tsc2, Cdkn2a, or Rb1. Methods The plasmid vectors were delivered to the liver of adult C57BL/6 mice via hydrodynamic tail vein injection. The vectors were injected into 10 mice in each group. Organoids were generated from mouse liver tumors. The radiation response of the organoids was assessed using an ATP cell viability assay. Results The mean survival period of mice injected with vectors targeting Nf2 (4.8 months) was lower than that of other mice. Hematoxylin and eosin staining, immunohistochemical (IHC) staining, and target sequencing analyses revealed that mouse liver tumors harbored the expected mutations. Tumor organoids were established from mouse liver tumors. Histological evaluation revealed marked morphological similarities between the mouse liver tumors and the generated tumor organoids. Moreover, IHC staining indicated that the parental tumor protein expression pattern was maintained in the organoids. The results of the ATP cell viability assay revealed that the tumor organoids with mutated Nf2 were more resistant to high-dose radiation than those with other gene mutations. Conclusions This study developed a radiation response assessment system for mouse tumors with mutant target genes using CRISPR/Cas9 and organoids. The Tp53 and Pten double mutation in combination with the Nf2 mutation increased the radiation resistance of tumors. The system used in this study can aid in elucidating the mechanism underlying differential intrinsic radiation sensitivity of individual tumors.
Effectiveness of Brachial Plexus Blocks in Obesity: Secondary Analysis of Randomized Controlled Trial
Authors: Ali Barkat , Palazzo Michelle D. , Tien Huey 
Published: March 2023

Background: Brachial plexus block for hand and upper extremity procedures in the obese presents a unique set of technical challenges. The authors examined how obesity affects procedural success, quality of anesthesia, and patient satisfaction. Methods: Secondary analysis of a randomized control trial comparing the retroclavicular versus supraclavicular brachial plexus block for distal upper extremity surgery was conducted. Patients were randomized to supraclavicular or retroclavicular brachial plexus block groups in the original trial. In this study, the authors dichotomized patients by obesity to compare differences in outcomes. Results: Sixteen of 117 patients (13.7%) were obese. The groups were statistically well balanced in terms of baseline and operative variables. Obese patients had increased imaging time 2.7 minutes (95% confidence interval [CI], 1.44-3.92) versus 1.9 minutes (95% CI, 1.64-2.16), P value = .05; needling time 6.6 minutes (95% CI, 5.17-7.95) versus 5.8 minutes (95% CI, 5.04-5.74), P = .02; and procedure time 9.3 minutes (95% CI, 7.04-11.46) versus 7.3 minutes (95% CI, 6.79-7.79), P = .01. Block success and complications were not statistically significant. The visual analog scores during the block, at 2 hours, and 24 hours after were not statistically different. Patient satisfaction score among obese patients was 9.1 (95% CI, 8.6-9.6) versus 9.2 (95% CI, 9.1-9.4), P = .63. Conclusion: Findings from this trial suggest that despite an increased procedural difficulty, the use of both supraclavicular and retroclavicular brachial plexus blocks is associated with comparable quality of anesthesia, similar complication profile, equal opioid requirements, and similar patient satisfaction in the obese.