bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vertical Convergence of Turbulent and Double-Diffusive Heat Flux Drives Warming and Erosion of Antarctic Winter Water in Summer
Authors: Giddy I. S. , Fer I. , Swart S. , Nicholson S.-A. 
Published: May 2023

Abstract
The seasonal warming of Antarctic Winter Water (WW) is a key process that occurs along the path of deep water transformation to intermediate waters. These intermediate waters then enter the upper branch of the circumpolar overturning circulation. Despite its importance, the driving mechanisms that mediate the warming of Antarctic WW remain unknown, and their quantitative evaluation is lacking. Using 38 days of glider measurements of microstructure shear, we characterize the rate of turbulent dissipation and its drivers over a summer season in the northern Weddell Sea. Observed dissipation rates in the surface layer are mainly forced by winds and explained by the stress scaling (r2 = 0.84). However, mixing to the base of the mixed layer during strong wind events is suppressed by vertical stratification from sea ice melt. Between the WW layer and the warm and saline circumpolar deep water, a subsurface layer of enhanced dissipation is maintained by double-diffusive convection (DDC). We develop a WW layer temperature budget and show that a warming trend (0.2°C over 28 days) is driven by a convergence of heat flux through mechanically driven mixing at the base of the mixed layer and DDC at the base of the WW layer. Notably, excluding the contribution from DDC results in an underestimation of WW warming by 23%, highlighting the importance of adequately representing DDC in ocean models. These results further suggest that an increase in storm intensity and frequency during summer could increase the rate of warming of WW with implications for rates of upper-ocean water mass transformation.

Significance Statement
Around Antarctica, the summer warming of the subsurface cold Antarctic Winter Water feeds the upper layer of the overturning circulation. This study aims to quantify the mechanisms that mediate the warming of Antarctic Winter Water. Our results reveal that the observed warming of this layer can be explained by both surface wind-driven mixing processes as well as double-diffusive convection occurring beneath the Winter Water layer. Understanding the role of these mechanisms is important for understanding the regions upper-ocean heat distribution, the rates of water mass transformation and how they might respond to changes in sea ice, stratification, and the overlying large-scale winds.
High Temporal Resolution Analyses with GOES-16 Atmospheric Motion Vectors of Mesovortex Rapid Intensification in Subtropical Cyclone Henri (2021)
Authors: Elsberry Russell L. , Feldmeier Joel W. , Chen Hway-Jen , Velden Christopher S. 
Published: May 2023

Abstract
Four-dimensional COAMPS dynamic initialization (FCDI) analyses with high temporal and spatial resolution GOES-16 atmospheric motion vectors (AMVs) are utilized to analyze the development and rapid intensification of a mesovortex about 150 km to the south of the center of the subtropical cyclone, Cyclone Henri (2021). During the period of the unusual Henri westward track along 30°N, the FCDI z = 300-m wind vector analyses demonstrate highly asymmetric wind fields and a horseshoe-shaped isotach maximum that is about 75 km from the center, which are characteristics more consistent with the definition of a subtropical cyclone than of a tropical cyclone. Furthermore, the Henri westward track and the vertical wind shear have characteristics resembling a Rossby wave breaking conceptual model. The GOES-16 mesodomain AMVs allow the visualization of a series of outflow bursts in space and time in association with the southern mesovortex development and intensification. Then the FCDI analyses forced by those thousands of AMVs each 15 min depict the z = 13 910-m wind field responses and the subsequent z = 300-m wind field adjustments in the southern mesovortex. A second northern outflow burst displaced to the southeast of the main Henri vortex also led to a strong low-level mesovortex. It was when the two outflow bursts joined to create an eastward radial outflow all along the line between them that the southern mesovortex reached maximum intensity and maximum size. In contrast to the numerical model predictions of intensification, outflow from the mesovortex directed over the main Henri vortex led to a decrease in intensity.
A Standardized Protocol for Opioid Prescribing After Surgery Decreases Total Morphine Equivalents Prescribed
Authors: Millard Jessica L. , Hahn Elizabeth A. , Schumann Emily , Register Lindsey , Blackhurst Dawn , Carbonell Alfredo M. , Cobb William S. , Warren Jeremy A. 
Published: May 2023

Introduction Perioperative opioid analgesia has been extensively reexamined during the opioid epidemic. Multiple studies have demonstrated over prescription of opioids, demonstrating the need for change in prescribing practices. A standard opioid prescribing protocol was implemented to evaluate opioid prescribing trends and practices. Objectives To evaluate opioid use after primary ventral, inguinal, and incisional hernia repair and to assess clinical factors that may impact opioid prescribing and consumption. Secondary outcomes include the number of refills, patients without opioid requirement, difference in opioid use based on patient characteristics and adherence to prescribing protocol. Methods This is a prospective observational study examining patients undergoing inguinal, primary ventral and incisional hernias between February and November 2019. A standardized prescribing protocol was implemented and utilized for postoperative prescribing. All data was captured in the abdominal core health quality collaborative (ACHQC) and opioid use was standardized via morphine milligram equivalents (MME). Results 389 patients underwent primary ventral, incisional, and inguinal hernia repair, with a total of 285 included in the final analysis. 170 (59.6%) of patients reported zero opioid use postoperatively. Total opioid MME prescribed and high MME consumption were significantly higher after incisional hernia repair with a greater number of refills were required. Compliance with prescribing protocol resulted in lower MME prescription, but not actual lower MME consumption. Conclusions Implementation of a standardized protocol for opioid prescribing after surgery decreases the total MME prescribed. Compliance with our protocol significantly reduced this disparity, which has the potential for decreasing abuse, misuse, and diversion of opioids by better estimating actual postoperative analgesic requirements.
Relationships of serum VILIP-1, NSE, and ADP levels with postoperative cognitive dysfunction in elderly patients undergoing general anesthesia: a retrospective, observational study
Authors: Xie Yuhai , Yao Zeyu 
Published: May 2023

Objective To investigate the relationships of serum visinin-like protein-1 (VILIP-1), neuron-specific enolase (NSE), and adiponectin (ADP) levels with postoperative cognitive dysfunction (POCD) in elderly patients undergoing general anesthesia and provide a reference for the prevention and treatment of POCD. Methods In this retrospective, observational study, 162 elderly patients who underwent general anesthesia were divided into POCD and non-POCD groups according to whether POCD occurred with 24 hours after surgery. Serum VILIP-1, NSE, and ADP levels were measured. Results Immediately after and 24 hours after surgery, serum VILIP-1 and NSE levels were significantly higher in the POCD group than in the non-POCD group, whereas serum ADP levels were significantly lower in the POCD group. Mini-mental state examination (MMSE) scores significantly differed between the two groups. At 24 hours after surgery, serum VILIP-1 and NSE levels were negatively correlated with MMSE scores in the POCD group, whereas serum ADP levels were positively correlated with MMSE scores in this group. Conclusion Increased serum VILIP-1 and NSE levels and decreased serum ADP levels could be involved in the pathophysiology of POCD in elderly patients after general anesthesia. These serum markers could be used as indicators of POCD in elderly patients undergoing general anesthesia.
Suicide literacy and attitudes toward psychological help-seeking: a cross-sectional study of students
Authors: Žilinskas Emilijus , Lesinskienė Sigita 
Published: May 2023

Objective Higher education students express high levels of suicidal ideation. However, data on students’ knowledge of suicide and attitudes toward seeking professional psychological help are lacking. Therefore, a cross-sectional study was conducted to evaluate students’ suicidal ideation, suicide literacy and attitudes toward seeking professional psychological help, and to assess whether these variables were interrelated. Methods Higher education students completed an online survey that consisted of 12 questions on suicide literacy (based on the Literacy of Suicide Scale), the Attitudes Toward Seeking Professional Psychological Help Scale and the Suicidal Ideation Attributes Scale. Results A total of 2004 students completed the survey. Female students and biomedical students showed the highest suicide literacy and most positive help-seeking attitudes. Higher study year was associated with more positive help-seeking attitudes. Art students expressed the highest levels of suicidal ideation. Suicide literacy had a weak positive correlation with help-seeking attitudes (Spearman’s rho = 0.186). Conclusions Suicidal ideation, suicide literacy and help-seeking attitudes may differ according to student’s gender, study year and study field. Better suicide literacy may promote psychological help-seeking behavior.
The Idealization of Infant Formula: A Longitudinal Analysis of Labels in Uruguay
Authors: Rodríguez Raquel , de León Carolina , Girona Alejandra , Alcaire Florencia , Antúnez Lucía , Ares Gastón , Vidal Leticia 
Published: May 2023

Background: Labels are a key element of the marketing strategies of infant formula companies, and often include text or images that idealize their use, undermining efforts to promote breastfeeding. Research Aims: To evaluate the prevalence of marketing cues that idealize infant formula on labels of products commercialized in Uruguay and to assess changes after a periodic monitoring of compliance with the International Code of Marketing of Breast-Milk Substitutes (IC). Method: This study is a descriptive, observational, and longitudinal assessment of the information included on infant formula labels. The first data collection was in 2019, as part of a periodic assessment to monitor the marketing of human-milk substitutes. In 2021, the same products were purchased to evaluate changes in their labels. Thirty-eight products were identified in 2019, of which 33 were still available in 2021. All information available on the labels was analyzed through content analysis. Results: Most products included at least one textual or visual marketing cue idealizing infant formula in both 2019 (n = 30, 91%) and 2021 (n = 29, 88%). This represents a violation of both the IC and national regulations. References to nutritional composition were the most frequent marketing cue, followed by references to child growth and development. No relevant changes were observed after the periodic assessment conducted by the Uruguayan government. Conclusions: Monitoring compliance with the IC per se cannot be expected to trigger changes in the marketing strategies of infant formula companies. More explicit regulations and strong enforcement mechanisms are needed to end the inappropriate marketing practices on infant formula labels.
Cell-free DNA-based prenatal screening via rolling circle amplification: Identifying and resolving analytic issues
Authors: Palomaki Glenn E , Lambert-Messerlian Geralyn M , Fullerton Donna , Hegde Madhuri , Conotte Stéphanie , Saidel Matthew L , Jani Jacques C 
Published: May 2023

Objective A rolling circle amplification (RCA) based commercial methodology using cell-free (cf)DNA to screen for common trisomies became available in 2018. Relevant publications documented high detection but with a higher than expected 1% false positive rate. Preliminary evidence suggested assay variability was an issue. A multi-center collaboration was created to explore this further and examine whether subsequent manufacturer changes were effective. Methods Three academic (four devices) and two commercial (two devices) laboratories provided run date, chromosome 21, 18, and 13 run-specific standard deviations, number of samples run, and reagent lot identifications. Temporal trends and between-site/device consistency were explored. Proportions of run standard deviations exceeding pre-specified caps of 0.4%, 0.4% and 0.6% were computed. Results Overall, 661 RCA runs between April 2019 and July 30, 2022 tested 39,756 samples. In the first 24, subsequent 9, and final 7 months, proportions of capped chromosome 21 runs dropped from 39% to 22% to 6.0%; for chromosome 18, rates were 76%, 36%, and 4.0%. Few chromosome 13 runs were capped using the original 0.60%, but capping at 0.50%, rates were 28%, 16%, and 7.6%. Final rates occurred after reformulated reagents and imaging software modifications were fully implemented across all devices. Revised detection and false positive rates are estimated at 98.4% and 0.3%, respectively. After repeat testing, failure rates may be as low as 0.3%. Conclusion Current RCA-based screening performance estimates are equivalent to those reported for other methods, but with a lower test failure rate after repeat testing.
Advanced Non-small Cell Lung Cancer: EGFR Mutation Analysis Using Pyrosequencing and the Fully Automated qPCR-Based IdyllaTM System
Authors: Boustany Youssra , Laraqui Abdelilah , El Zaitouni Sara , Ghaouti Merieme , Benzekri Asmae , Kettani Fouad , Oukabli Mohammed , Ennibi Khalid , Belkadi Bouchra , Sekhsokh Yassine 
Published: May 2023

Background Epidermal growth factor receptor (EGFR) mutation status is of a major clinical significance in non-small cell lung cancer (NSCLC) management, as it guides therapeutic decision making to target patients for a better response to therapy. This implicates the introduction of EGFR mutation analysis as the standard of care for Moroccan NSCLC patients, which in itself entails the implementation of targeted methods for routine EGFR mutation analysis in our laboratories. In this study, we aimed to present 2 targeted methods for EGFR mutation identification and to determine the prevalence and spectrum of EGFR mutations in NSCLC Moroccan patients. Methods A retrospective investigation of a cohort of 340 patients was undertaken to analyze somatic EGFR mutations in exons 18 to 21 using pyrosequencing and the IdyllaTM system. Results Of the enrolled patients, 70.9% were males and 29.1% were females. Predominately, 92% of cases had adenocarcinoma, and 53.7% of patients self-reported a history of smoking. Overall, 73 patients (21.7%) harbored an EGFR mutation, the most prevalent of which were the exon 19 deletions (53.4%) followed by exon 21 substitutions (31%). Exon 18 mutations and exon 20 alterations occurred in 8.1% and 6.7% of the positive EGFR mutation cases, respectively. Of the analyzed cases, all of the EGFR-mutated patients had adenocarcinoma. EGFR mutation prevalence was significantly higher in females (females vs males: 38.4% vs 14.5%, P < .001) and non-smokers (non-smokers vs non-smokers: 36% vs 10.3%, P < .001). The featured pyrosequencing and the IdyllaTM system are targeted methods endowed with high sensitivity and specificity as well as other compelling characteristics which make them great options for routine EGFR mutation testing for advanced NSCLC patients. Conclusion These findings underline the imperious need for implementing quick and efficient targeted methods for routine EGFR mutation testing among NSCLC patients, which is particularly useful in determining patients who are more likely to benefit from targeted therapy.
Sustainability in orthodontics: Challenges and opportunities for improving our environmental impact
Authors: Ahmed Tanya , Brierley Catherine , Barber Sophy 
Published: May 2023

Objective: To highlight the potential environmental impact of different aspects of orthodontic care in the United Kingdom, outline the major barriers and challenges to reducing this impact, and summarise the possible action that could help the orthodontic community to tackle the climate change crisis. Impact: Travel, procurement and supply, material use, waste management, energy use and water consumption within dentistry have a considerable effect on the environment. There are, however, marked knowledge gaps pertaining to the impact of orthodontic treatment. Challenges: The lack of awareness of the NHS contribution to the carbon footprint and net-zero goals among healthcare workers, the NHS backlogs and budget cuts, and cross-infection control requirements particularly following the COVID-19 pandemic are some of the many challenges to making healthcare delivery more sustainable. Opportunities: By considering the triple bottom line (social, environmental and economic), incorporating the four Rs (Reduce, Reuse, Recycle, Rethink), taking practical action, including steps to educate ourselves and the wider team, and to promote research on environmental sustainability, we can get one step closer to reaching the NHS net-zero goals. Conclusion: Climate change is a global health threat with multiple contributors associated with orthodontic treatment delivery, which can be tackled on an individual, organisational and system level.
Is platelet-rich plasma a new solution for shoulder adhesive capsulitis? A systematic scoping review of the literature
Authors: El-Swaify Seif Tarek , Refaat Mazen A , AbdelWahab Aly A , Seddik Mohamed ElSayed E , Mostafa Abdelrazek Abdelrahman E , Doas Youssef , Beshay Pavly Wagih 
Published: May 2023

Background Platelet-rich plasma (PRP) has shown promising results for adhesive shoulder capsulitis (AC) in pre-clinical models. The aim of this review is to investigate the clinical outcomes of using PRP in AC. Materials and Methods We conducted a systematic scoping review of the literature using bibliographic databases from inception until the 9th of January 2022 [PubMed, Web of Science, Scopus, and CENTRAL]. Randomized studies were included if they investigated the use of PRP in human patients with a diagnosis of AC. Authors performed individual study quality assessments using the RoB 2 tool. Results We screened a total of 470 results and 6 were included in the final synthesis. Studies included data of 578 patients with 263 patients receiving PRP (45.5%). All studies used PRP as part of non-operative treatment. PRP was compared to another intervention in all six studies. Four of these studies found PRP to be more effective. No major adverse effects were reported in any study. Conclusion PRP is a safe treatment option that can be added to the investigative treatment arsenal of AC. Despite showing some favorable results, several limitations and patient-centered questions remain to be addressed by future studies. Level of Evidence IV.
Readability assessment of patient educational materials for pediatric spinal conditions from top academic orthopedic institutions
Authors: Michel Christopher , Dijanic Christopher , Abdelmalek George , Sudah Suleiman , Kerrigan Daniel , Gorgy George , Yalamanchili Praveen 
Published: May 2023

Background: The Internet has become a popular source of health information for patients and their families. Healthcare experts recommend that the readability of online education materials be at or below a sixth grade reading level. This translates to a standardized Flesch Reading Ease Score between 81 and 90, which is equivalent to conversational English. However, previous studies have demonstrated that the readability of online education materials of various orthopedic topics is too advanced for the average patient. To date, the readability of online education materials for pediatric spinal conditions has not been analyzed. The objective of this study was to assess the readability of online educational materials of top pediatric orthopedic hospital websites for pediatric spinal conditions. Methods: Online patient education materials from the top 25 pediatric orthopedic institutions, as ranked by the U.S. News and World Report hospitals for pediatric orthopedics, were assessed utilizing multiple readability assessment metrics including Flesch–Kincaid, Flesch Reading Ease, Gunning Fog Index, and others. Correlations between academic institutional ranking, geographic location, and the use of concomitant multimedia modalities with Flesch–Kincaid scores were evaluated using a Spearman regression. Results: Only 32% (8 of 25) of top pediatric orthopedic hospitals provided online health information at or below a sixth grade reading level. The mean Flesch–Kincaid score was 9.3 ± 2.5, Flesch Reading Ease 48.3 ± 16.2, Gunning Fog Score 10.7 ± 3.0, Coleman–Liau Index 12.1 ± 2.8, Simple Measure of the Gobbledygook Index 11.7 ± 2.1, Automated Readability Index 9.0 ± 2.7, FORCAST 11.3 ± 1.2, and Dale–Chall Readability Index 6.7 ± 1.4. There was no significant correlation between institutional ranking, geographic location, or use of video material with Flesch–Kincaid scores (p = 0.1042, p = 0.7776, p = 0.3275, respectively). Conclusion: Online educational material for pediatric spinal conditions from top pediatric orthopedic institutional websites is associated with excessively complex language which may limit comprehension for the majority of the US population. Type of study/Level of evidence: Economic and Decision Analysis/level III.
A four-year clinical and sonographic longitudinal follow-up of clubfeet treated according to Ponseti with normal references
Authors: Johansson G Arne , Aurell Ylva B , Romanus Bertil H 
Published: May 2023

Purpose: To follow children with a clubfoot by ultrasonography during the entire treatment period up to 4 years and compare with controls. Method: Thirty clubfeet in 20 children treated using the Ponseti method and 29 controls were followed by repeated ultrasonography investigations from neonates to the age of 4 years. The previously established coronal medial and lateral, sagittal dorsal and posterior projections were used. Changes over time, correlations to the Diméglio score, and the course of treatment were studied. Results: The medial malleolus–navicular distance was shorter, while the talar tangent–navicular distance and the talo-navicular angle were larger in clubfeet than in controls even after the initial correction. The healthy feet in unilateral cases did not differ significantly from the controls. The range of motion in the talo-navicular joint was approximately 20° less in clubfeet than in controls during the first four years of life. The medial malleolus–navicular distance ( r = –0.58) and the talo-navicular angle ( r = 0.66) at the first ultrasonography showed the highest correlation to the number of casts needed to correct the deformities. Conclusion: Ultrasonography can be used to evaluate the initial degree of deformities in clubfeet and to follow the progress of the treatment and growth. Ultrasonography showed a clear difference between clubfeet and controls during the first four years of life. Although it was not possible to define specific limit values as benchmarks in the treatment, dynamic ultrasonography can provide valuable support in the decision-making process when complementary treatment may be needed. Level of evidence: III