bluuebunny/crossref_metadata_2025_split huggingface dataset:
Forcing, Cloud Feedbacks, Cloud Masking, and Internal Variability in the Cloud Radiative Effect Satellite Record
Authors: Raghuraman Shiv Priyam , Paynter David , Menzel Raymond , Ramaswamy V. 
Published: March 2023

Abstract
Satellite observations show a near-zero trend in the top-of-atmosphere global-mean net cloud radiative effect (CRE), suggesting that clouds did not further cool nor heat the planet over the last two decades. The causes of this observed trend are unknown and can range from effective radiative forcing (ERF) to cloud feedbacks, cloud masking, and internal variability. We find that the near-zero NetCRE trend is a result of a significant negative trend in the longwave (LW) CRE and a significant positive trend in the shortwave (SW) CRE, cooling and heating the climate system, respectively. We find that it is exceptionally unlikely (<1% probability) that internal variability can explain the observed LW and SW CRE trends. Instead, the majority of the observed LWCRE trend arises from cloud masking wherein increases in greenhouse gases reduce OLR in all-sky conditions less than in clear-sky conditions. In SWCRE, rapid cloud adjustments to greenhouse gases, aerosols, and natural forcing agents (ERF) explain a majority of the observed trend. Over the northeast Pacific, we show that ERF, hitherto an ignored factor, contributes as much as cloud feedbacks to the observed SWCRE trend. Large contributions from ERF and cloud masking to the global-mean LW and SW CRE trends are supplemented by negative LW and positive SW cloud feedback trends, which are detectable at 80%–95% confidence depending on the observational uncertainty assumed. The large global-mean LW and SW cloud feedbacks cancel, leaving a small net cloud feedback that is unconstrained in sign, implying that clouds could amplify or dampen global warming.
Long-Term Changes, Synoptic Behaviors, and Future Projections of Large-Scale Anomalous Precipitation Events in China Detected by a Deep Learning Autoencoder
Authors: Huang Zeqin , Tan Xuezhi , Wu Xinxin , Tan Xuejin , Fu Jianyu , Liu Bingjun 
Published: March 2023

Abstract
The frequency of large-scale anomalous precipitation events over China has increased during 1961–2018. However, it remains challenging to understand the mechanisms associated with these anomalous events showing different spatial patterns. Here, we applied an autoencoder technique to identify large-scale anomalous precipitation events for both observations and model simulations, which were then classified into several patterns through a self-organizing map method. The synoptic behavior and atmospheric circulation background of different anomalous patterns were also analyzed using simultaneous composite analyses. Results show that occurrences of different anomalous precipitation patterns have increased significantly, except those centered in North China, Northeast China, and the Yangtze River basin. The anomalous precipitation patterns manifest various intraseasonal distributions, which are linked to zonal oscillations of the western North Pacific subtropical high (WNPSH) and meridional displacements of East Asia westerly jet (EAJ). Accompanied by the westward movement of WNPSH, anticyclonic systems transport warm moist air from the Indian Ocean and the South China Sea to converge with the cold air caused by anomalous cyclones over the northwest flank of the WNPSH, leading to large-scale anomalous precipitation in these regions. Besides WNPSH, the northward and southward displacements of EAJ also favor the occurrence of anomalous precipitation events in northern and southern China, respectively. Our study also illustrates that the occurrence frequency of anomalous precipitation events is projected to increase remarkably under the Shared Socioeconomic Pathway 5–8.5 (SSP585) scenario by rates of twofold to fourfold.
User Engagement Testing with a Pilot Decision Support Tool Aimed to Support Species Managers
Authors: Cashwell Haven J. , McNeal Karen S. , Dello Kathie , Boyles Ryan , Davis Corey 
Published: March 2023

Abstract
Species status assessments (SSAs) are required for endangered species by the U.S. Fish and Wildlife Service and focus on the resiliency, redundancy, and representation of endangered species. SSAs must include climate information, because climate is a factor that will impact species in the future. To aid in the inclusion of climate information, a decision support system (DSS) entitled Climate Analysis and Visualization for the Assessment of Species Status (CAnVAS) was developed by the State Climate Office of North Carolina using a coproduction approach. In this study, users viewed a mock-up version of the CAnVAS interface displaying a sample layout of future projections for three key climate variables (average precipitation, average maximum temperature, and occurrence of maximum temperature) at a location of interest. This assessment of the pilot version of the CAnVAS DSS was the first step in refining CAnVAS for species-manager use. This research analyzed the differences in usability between two pilot versions of the CAnVAS DSS through eye tracking and subsequent interviews with novice users. The two pilot versions of CAnVAS differed in the way data were displayed on graphs and the color ramps used on regional maps. We found that graphically displaying temporal climate information through box-and-whisker plots and spatially through a sequential color ramp from white to purple were more effective than alternative displays at communicating climate information on endangered species. The results of this research will be used to further develop the CAnVAS DSS tool for future implementation.

Significance Statement
A decision support system was developed for U.S. Fish and Wildlife Service biologists to incorporate more climate information in species status assessments for endangered species. This tool was tested through eye tracking and interviews with a novice undergraduate student sample to best refine the tool for stakeholder use. This work was able to discover that graphically displaying data in box-and-whisker format and spatially displaying data with a sequential color scheme of white to purple was best for usability purposes. The authors provide these recommendations for those who are producing usable products.
Poor Outcomes of Patients From Delayed Care After Ground Level Falls
Authors: Heard Matthew A. , Suresh Shreyas , Leonard Matthew , Burns J. Bracken 
Published: March 2023

Background Ground level falls are a common cause of morbidity and mortality in trauma patients. Delayed presentation in many conditions has been proven to lead to worsened outcomes. Currently, there are limited data on outcomes of those who have a delayed presentation after a ground level fall. Materials and Methods This study was a retrospective analysis of the Trauma Registry at our center. Any adult patient who presented after a ground level fall was grouped based on their time to presentation post-injury: less than or greater than 24 h. Age, gender, hospital length of stay (LOS), intensive care unit (ICU) LOS, mechanical ventilation days, Injury Severity Score, and mortality were patient characteristics gathered. A Student’s t-test and Chi-squared testing were utilized to determine the presence of significant differences between the groups. Significance was set at P < .05. Results Two hundred of 4018 patients had delayed presentation. Those with delayed presentation were more likely to be male ( P = .028), younger in age (71 vs 74 years old, P < .01), had greater hospital LOS (6 vs. 5, P < .01), ICU LOS (5 vs. 3, P < .01), and mechanical ventilation days (13 vs. 5 days, P < .01). They also had higher ISS (8 vs. 7, P < .01), and mortality was significantly higher in those who presented after 24 h ( P = .034). Conclusion Patients with delayed presentation after a ground level fall have worsened Injury Severity Scores and outcomes to include hospital and ICU LOS, ventilator days, and overall mortality.
Adult Traumatic Brain Injury and Likelihood of Routine Discharge: Do Comorbidities Matter?
Authors: Rhodes Heather , Anderson Stephanie , Pecheny Yelena , Pepe Antonio , Courtney Donald 
Published: March 2023

The current literature demonstrates an association between both size and presence of traumatic brain injury (TBI) and its effects on mortality, however it does not readily address the morbidity and associated functional outcomes of those who survive. We hypothesize that the likelihood of discharge to home decreases with advancement of age in the presence of TBI. This is a single-center study of Trauma Registry data, inclusive years July 1, 2016 to October 31, 2021. The inclusion criteria was based upon age (≥40 years), and ICD10 diagnosis of a TBI. Disposition to home without services was the dependent variable. 2031 patients were included in the analysis. We hypothesized correctly that the likelihood of discharge to home decreases (by 6%) with advancement of age (per year) in the presence of intracranial hemorrhage.
Ambulance Response in Eight Minutes or Less: Are Comorbidities a Factor
Authors: Rhodes Heather , Rourke Blaine , Pepe Antonio 
Published: March 2023

A recommended emergency medical services ambulance response time to a medical emergency is within eight minutes for at least 90% of calls. This study aimed to evaluate scene times for rural education and outreach to improve the quality of trauma care. This is a single-center study of Trauma Registry data from July 1, 2016 to February 28, 2022. The inclusion criteria were based upon age (≥18 years). A logistic regression was performed to identify predictor variables on the likelihood that an adult trauma patient will experience scene times greater than eight minutes. 19 321 patients were included in the analysis; 7233 (37%) experienced an elapsed scene time within eight minutes. This research identified an opportunity to improve rural trauma team response time, which is only reaching 37% of the patient population within eight minutes. Prehospital cardiac arrest and unique pre-existing comorbidities may play a role in extended response times by EMS.
Factors influencing political corruption. An empirical research study of regional governments
Authors: Raya-Quero Daniel , Navarro-Galera Andrés , Sáez-Lozano José Luis 
Published: March 2023

International organisations assert that political corruption is a major global problem. However, it is still unclear how to combat corruption. Previous research has studied corruption in central or local governments, rarely in regional ones. In this paper, we aim to identify factors influencing political corruption in regional governments. Using panel data, we analyse the statistical association between 29 economic, financial, political and socioeconomic variables and the corruption perceived by citizens, from January 2006 to September 2019. The results reveal that perceived political corruption is affected by government spending and ideological distance, among other factors. We propose several measures to reduce political corruption. Points for practitioners The study has found that political corruption needs to be combatted through different measures for each administrative level. Our results support the idea that the following variables influence the perceived level of corruption within the regional governments: the volume of government borrowing, the ideological distance between the voter and the government, the percentage electoral participation and the volume of dependent and immigrant population of the region. Likewise, we also confirm that regional governments with higher values on the Quality of Government Index are perceived as less corrupt.
The Association Between Nasal Skin Thickness and Body Mass Index in Preoperative Rhinoplasty Patients: A Prospective Study
Authors: Assiri Hassan , Abdelkader Waleed , Alfallaj Rayan , Alarimah Yasser , AlMajed Hadeel , Alarfaj Ahmed 
Published: March 2023

Objectives Skin quality plays a major role in aesthetics, particularly in determining the success of rhinoplasty. Efficient preoperative estimation of nasal skin thickness can improve postoperative results and patient satisfaction. This study aimed to report on the relationship between nasal skin thickness and body mass index (BMI) as a possible tool to measure skin thickness preoperatively among rhinoplasty patients. Methods This prospective cross-sectional study targeted patients who visited a rhinoplasty clinic at King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia, between January 2021 and November 2021, and agreed to participate in the study. Data on age, sex, height, weight, and Fitzpatrick skin types were collected. The participant visited the radiology department and underwent ultrasound nasal skin thickness measurement for the five different nasal points. Results The study included 43 participants (16 males and 27 females). The average skin thickness of the supratip area and the tip was significantly higher in males than in females ( P < 0.05). The average BMI of the participants was 25.8 ± 5.26 Kg/m2. Participants with a normal BMI or less represented 50% of the study sample, whereas overweight and obese represented one-quarter (27.9%) and one-fifth (21%), respectively. Conclusion BMI was not associated with nasal skin thickness. Differences in nasal skin thickness were found between the sexes.
Return to Sport After Nonoperative Management of Elbow Ulnar Collateral Ligament Injuries: A Systematic Review and Meta-analysis
Authors: Gopinatth Varun , Batra Anjay K. , Khan Zeeshan A. , Jackson Garrett R. , Jawanda Harkirat S. , Mameri Enzo S. , McCormick Johnathon R. , Knapik Derrick M. , Chahla Jorge , Verma Nikhil N. 
Published: March 2023

Background: Elbow ulnar collateral ligament (UCL) injuries can result in significant functional impairment in throwing and overhead athletes. UCL reconstruction and repair are proven treatments to restore stability, but the efficacy of nonoperative management is unclear. Purpose: To determine the rate of return to sports (RTS) and return to previous level of play (RTLP) in athletes sustaining medial elbow ulnar collateral ligament (UCL) injuries treated nonoperatively. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed using Scopus, PubMed, Medline, the Cochrane Database for Systematic Review, and the Cochrane Central Register for Controlled Trials according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Inclusion criteria were limited to level 1 to 4 human studies reporting on RTS outcomes after nonoperative management of UCL injuries. Results: A total of 15 studies, consisting of 365 patients with a mean age of 20.45 ± 3.26 years, were identified. Treatment primarily consisted of platelet-rich plasma (PRP) injections with physical therapy (n = 189 patients; n = 7 studies) versus physical therapy alone (n = 176 patients; n = 8 studies). The overall RTS rate was 79.7% and the overall RTLP rate was 77.9%. Increasing UCL injury severity grade was associated with lower RTS rates. The RTS rate for proximal tears (89.7%; n = 61/68) was significantly greater than that for distal tears (41.2%; n = 14/34) ( P < .0001). No significant difference in RTS rate was seen in patients treated with PRP versus those who did not receive PRP ( P = .757). Conclusion: For athletes undergoing nonoperative management of UCL injuries, the overall RTS and RTLP rates were 79.7% and 77.9%, respectively, with excellent outcomes in grade 1 and grade 2 UCL injuries, specifically. The RTS rate for proximal tears was significantly higher than that for distal tears. Athletes were most commonly treated with PRP injection and physical therapy.
Manufacture and characterisation of polylactic acid biocomposites with high-purity cellulose isolated from olive pruning waste
Authors: Rodríguez-Liébana José A. , Navas-Martos Francisco J. , Jurado-Contreras Sofía , Morillas-Gutiérrez Francisca , Mateo Soledad , Moya Alberto J. , La Rubia M.Dolores 
Published: March 2023

A two-step chemical process was carried out on olive pruning residues according to an optimised sequence that led to the isolation of natural fibre with a high cellulose content. Reaction time, temperature and HNO3 concentration in the acid hydrolysis stage were optimised by means of the Response Surface Methodology to achieve the highest removal of hemicellulose and lignin and the highest crystallinity index, minimising cellulose hydrolysis. Subsequent hydrolysis with NaOH allowed to obtain a pulp enriched in cellulose (83.28 wt.%). Analysis revealed that the cellulose isolated had a high crystallinity index (70.06%) and thermal stability ( T max = 357°C). The cellulose obtained was finally used for the manufacture of polymer biocomposites and to evaluate its viability as a filler for polymeric materials. The selected polymer matrix used was polylactic acid (PLA) and the amount of filler was 5 and 15% by weight, respectively. In general, the fibres did not improve the mechanical properties of PLA, and maintained unchanged its melting temperature. Microscopic analysis revealed that PLA/fibre adhesion was stronger for treated fibres. Contradictorily, the composites with untreated fibres presented slightly higher thermal stability. Water uptake increased with the concentration of fibres, being higher in those materials with untreated fibre.
The scope of ethical dilemmas in paediatric nursing: a survey of nurses from a tertiary paediatric centre in Australia
Authors: Schulz Ingrid , O’Neill Jenny , Gillam Peter , Gillam Lynn 
Published: March 2023

Background No previous study has provided evidence for the scope and frequency of ethical dilemmas for paediatric nurses. It is essential to understand this to optimise patient care and tailor ethics support for nurses. Research aim The aim of this study was to explore the scope of nurses’ ethical dilemmas in a paediatric hospital and their engagement with the hospital clinical ethics service. Research design This study used a cross-sectional survey design. Participants and research context Paediatric nursing staff in a tertiary paediatric centre in Australia completed an online survey asking about their exposure to a range of ethical dilemmas and their knowledge of the clinical ethics service. Analysis used descriptive and inferential statistics. Ethical considerations Ethical approval was granted from the hospital research committee. The survey was anonymous, and no identifying details of participants were collected. Results Paediatric nurses experienced a wide range of ethical dilemmas frequently, both in the intensive care and general areas. Knowledge and use of the clinical ethics service was poor and the most frequent challenge for nurses in managing dilemmas was feeling powerless. Conclusion There is a need to recognise the moral burden of ethical dilemmas for paediatric nurses in order to foster ethical sensitivity, and to provide adequate support to improve care and mitigate nursing moral distress.
Use of Hyaluronic Acid Filler in Patients with Secondary Cleft Lip Deformity
Authors: Rivers C. M. , Skimming C. , Chong D. , Drake D. , Russell C. J. H. , Devlin M. F. 
Published: March 2023

When considering the management of asymmetry, volume deficiency, scarring and vermillion notching following cleft lip repair, surgical techniques are commonly applied. However, surgery may not be suitable for all patients. Hyaluronic acid (HA) is a common, non-permanent filler widely used in non-surgical aesthetic practice. We present our unit's two-year experience of the regular use of HA filler in a dedicated Adult Cleft Facial Augmentation Clinic. Methods Retrospective case note review was undertaken of all patients treated in the clinic over a two-year period. Results 20 patients underwent HA filler injections to the upper lip 26 times. Most were female (F:M = 3:1) and patients were aged 18-58 years. Most patients had a unilateral cleft lip +/− palate (n = 13, 65%). The most common indication was to address upper lip volume (n = 13, 65%). Other indications included vermillion notch (n = 5, 25%), cupid bow peak height asymmetry (n = 4, 20%), scar asymmetry (n = 1, 5%) and nasal sill flattening (n = 1, 5%). Small volumes of filler were used with an average of 0.34 ml (range 0.05-1.2 ml). There were no complications and one patient reported pruritis post procedure. Conclusions HA filler is a safe and reliable treatment for certain aspects of asymmetry following cleft lip repair. It can be used to address volume deficiency and asymmetry, cupid bow peak height discrepancies and a vermillion notch for patients who do not want surgery. Injection of HA to the lips can be performed easily, with appropriate training, in the outpatient setting.
Evaluation of chemotherapy infusion and phlebitis among cancer patients: A prospective observational single-center study
Authors: Sudhakar Shivani , Jacob Angelamol , Hegde Nidisha N , Chaudhary Raushan Kumar , Mateti Uday Venkat , Shetty Vijith 
Published: March 2023

Introduction Chemotherapy is an integral part of cancer management which is associated with phlebitis in around 70% of patients receiving intravenous chemotherapy infusion. Thus, we aimed to estimate the incidence, severity, and management of phlebitis associated with chemotherapy infusion among cancer patients. Methods A prospective study was conducted among 145 patients receiving intravenous chemotherapy for the duration of six months in the oncology department. The relevant data for phlebitis was obtained and assessed using Phlebitis Grading Scale and Visual Analogue Scale for the assessment of severity and pain due to phlebitis, respectively. Results Out of 145 patients, female (56.6%) patients predominated over male patients (43.5%) with a mean age of 53.5 ± 11.82 years. Phlebitis was encountered in 30.34% of patients among whom 22.8% (33) were females followed by 7.6% were males and the majority of patients (13.1%) were from the 46 to 60 years age group. Phlebitis was observed frequently among stage 2 (11%) and satge 4 (11%) patients. The highest incidence of phlebitis was seen among hypertensive (34.09%) and diabetic patients (27.27%) followed by those receiving chemotherapy through the 20-gauge intravenous cannula (22.8%) and 22-gauge (6.9%). Platinum compounds (56.8%) were commonly associated with phlebitis, followed by cyclophosphamide (20.5%). Heparin and benzyl nicotinate topical gel were used to treat phlebitis. Conclusion Platinum and cyclophosphamide are commonly associated with phlebitis which can be managed by topical heparin plus benzyl nicotinate. Phlebitis shouldn’t be ignored as it has a high incidence, affects the quality of life, and increases the treatment burden.