bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamical Controls on Bottom Water Transport and Transformation across the Antarctic Circumpolar Current
Authors: Schmidgall Carlyn R. , Si Yidongfang , Stewart Andrew L. , Thompson Andrew F. , Hogg Andrew McC. 
Published: May 2023

Abstract
The export of Antarctic Bottom Water (AABW) supplies the bottom cell of the global overturning circulation and plays a key role in regulating climate. This AABW outflow must cross, and is therefore mediated by, the Antarctic Circumpolar Current (ACC). Previous studies present widely varying conceptions of the role of the ACC in directing AABW across the Southern Ocean, suggesting either that AABW may be zonally recirculated by the ACC, or that AABW may flow northward within deep western boundary currents (DWBC) against bathymetry. In this study the authors investigate how the forcing and geometry of the ACC influences the transport and transformation of AABW using a suite of process-oriented model simulations. The model exhibits a strong dependence on the elevation of bathymetry relative to AABW layer thickness: higher meridional ridges suppress zonal AABW exchange, increase the strength of flow in the DWBC, and reduce the meridional variation in AABW density across the ACC. Furthermore, the transport and transformation vary with density within the AABW layer, with denser varieties of AABW being less efficiently transported between basins. These findings indicate that changes in the thickness of the AABW layer, for example, due to changes in Antarctic shelf processes, and tectonic changes in the sea floor shape may alter the pathways and transformation of AABW across the ACC.

Significance Statement
The ocean plays an outsized role in the movement of heat and trace gases around Earth, and the northward export of dense Antarctic Bottom Water is a crucial component of this climate-regulating process. This study aims to understand what sets the pathways of Antarctic Bottom Water as it travels northward across the Antarctic Circumpolar Current, and thus what controls its partitioning between the Atlantic, Indian, and Pacific basins. Our results highlight the importance of seafloor elevation relative to the thickness of the Antarctic Bottom Water layer for directing the flow northward versus between basins. This study motivates future investigation of long-term changes in Antarctic Bottom Water properties and their consequences for its global distribution.
Media Manipulation in Young Democracies: Evidence From the 1989 Brazilian Presidential Election
Authors: Cavgias Alexsandros , Corbi Raphael , Meloni Luis , Novaes Lucas M. 
Published: May 2023

We investigate how dominant media networks can manipulate voters in young democracies. During the first presidential election after the democratic transition in Brazil, TV Globo, the largest and most-watched network in the country, unexpectedly manipulated the news coverage of the last debate 2 days before the decisive second round. In a video segment, Globo unfavorably depicted the left-wing candidate, Luiz Inácio Lula da Silva. Using the geographical distribution of broadcaster-specific TV signals and the timing of election events, we identify the effect of the manipulation net of the effect of the debate itself, showing that Globo’s misleading reporting caused Lula to lose millions of votes. Our results showcase how the media can reshape an election in a single stroke, especially where the media is concentrated and politically inexperienced voters have few other sources of information.
Does Parental Absence Harm Children’s Education? Evidence from Vietnam
Authors: Nguyen Cuong Viet , Vu Linh Hoang 
Published: May 2023

This study analyzes the impacts of parental absence due to migration, death, or divorce on children’s school enrollment in Vietnam. We find children from two-parent families have a better chance of enrolling at all levels of education than those from single-parent families. Within single-family types, the negative effect on children of parental divorce is higher than that of parental death, while the effect of parental migration is the lowest. We find that children living with a single mother tend to have higher school enrollment than those living with a single father, indicating the critical role of mothers in children’s education. JEL Classification: I1, I2, O1.
Increasing Visibility of Sickle Cell Disease in Indiana: Establishing Baseline Prevalence Using Integrated Data From Multiple Sources
Authors: Okolo Amanda I. , Jacob Seethal A. , Dixon Brian E. , Valvi Nimish R. , Janson Isaac A. , Hardesty Brandon M. 
Published: May 2023

Objective: The Indiana Sickle Cell Data Collection (IN-SCDC) program aims to provide timely, reliable, and locally relevant information on the sickle cell disease (SCD) population in Indiana to inform public health interventions, research, and policy development. We describe the development of the IN-SCDC program and report the prevalence and geographic distribution of people with SCD in Indiana using an integrated data collection approach. Methods: Using multiple integrated data sources and case definitions established by the Centers for Disease Control and Prevention, we classified cases of SCD in Indiana during 2015-2019. We calculated the prevalence and incidence of SCD and described characteristics of people with SCD. Results: We identified 1695 people living with SCD in Indiana during the study period. The median age of people living with SCD was 21 years, and 1474 (87.0%) were Black or African American. Most (n = 1596, 91%) resided in metropolitan counties. The age-adjusted prevalence of SCD was 24.7 cases per 100 000 people. The prevalence of SCD among Black or African American people was 209.3 per 100 000 people. The incidence was 1 in 2608 live births overall and 1 in 446 live births among Black or African American people. Eighty-six deaths were confirmed in this population during 2015-2019. Conclusions: Our results establish a baseline for the IN-SCDC program. Baseline and future surveillance program efforts will help accurately inform standards of care for treatments, identify gaps in coverage and access to care, and provide guidance for legislators and community-based organizations.
How patients with advanced cancer conceptualize prognosis: A phenomenological qualitative inquiry
Authors: Polacek Laura C , Saracino Rebecca M , Walsh Leah E , Jutagir Devika R , Costas-Muniz Rosario , Applebaum Allison J , Rosenfeld Barry 
Published: May 2023

Background: Despite the importance of accurate prognostic understanding in patients with advanced cancer, there is little consensus around how to conceptualize and measure the multidimensional construct. Most studies focus on single aspects of prognostic understanding (e.g., curability) that clinicians have identified as important; no previous research has asked patients how they define “prognosis.” Aim: The present study examined how patients with advanced cancer conceptualize their “prognosis.” It also explored how patients assigned value to prognostic information and the impact of prognosis on life perspectives. Design: A phenomenological approach was used to analyze semi-structured interviews with individuals with advanced cancer to examine how patients define prognosis. Setting/participants: English and Spanish-speaking patients with advanced cancer ( N = 29) were recruited from ambulatory clinics at a comprehensive cancer center in New York City. Results: To conceptualize prognosis, patients focused on concrete medical data, anticipated survival and quality of life, impact on meaningful life events, uncertainty, and physician affect. They discussed the importance of maintaining normalcy despite prognosis, knowledge as a form of coping, information reframing, and altered decision-making as means of coping with prognostic information. Conclusions: Given the range of ways patients define prognosis and assign value to prognostic information, clinicians should incorporate a thorough assessment of patient information preferences, values, and coping styles when engaging in end-of-life discussions. Trainings should emphasize the importance of nonverbal cues (i.e., affect management, body language) in prognostic disclosure.
Evaluation of Safety Outcomes of Undiluted Levetiracetam Intravenous Push Compared to Intravenous Piggyback
Authors: Shim Ashley , Radparvar Sara , Davis Nicole , Kaplan Andrew , Kantaris Kyriaki , Devlin Amanda , Liang John , Ciummo Francesco 
Published: May 2023

Background: Breakthrough seizures and status epilepticus require urgent management. Administration of intravenous push (IVP) levetiracetam has been demonstrated to be safe as compared to intravenous piggyback (IVPB). This transition can potentially offer faster time to administration and reduced drug and material cost. The objective of this study was to observe safety of administration in patients receiving levetiracetam via IVP compared to IVPB in acute care settings. Methods: This is a multi-center, observational, retrospective cohort study of 1214 adult patients who received levetiracetam pre- and post-implementation of IVP over a 6 month timespan. Primary outcome was time from order verification to administration of urgent first-time doses. Secondary outcomes included time to administration of loading doses and cost. Safety outcome was infusion site related reactions. Results: Time from order verification to administration of urgent first-time doses pre- and post-implementation of IVP administration was reduced from 61 minutes to 47 minutes ( P=0.0002). Infusion site related reactions were observed in 6 out of 5432 doses in the IVPB arm and in 5 out of 4700 doses in the IVP arm ( P=1). Total estimated cost was $76,171.96 for the 5449 IVPB total doses and $11,484.33 for the 4721 IVP total doses. Conclusions: Transition from IVPB to IVP administration reduced time from order verification to administration of urgent first-time doses with both administrations having similar incidence of infusion site related reactions. Cost savings and improved workflow were observed. Levetiracetam administered via IVP may be considered as a safe alternative method of administration in the acute care setting.
Intensive care unit professionals’ responses to a new moral conflict assessment tool: A qualitative study
Authors: Joolaee Soodabeh , Cook Deborah , Kozak Jean , Dodek Peter 
Published: May 2023

Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research Design In this qualitative study, we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. Participants and Research Context A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. Ethical Considerations This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. Results The main causes of moral distress related to goals of care, communication, teamwork, respect for patient’s preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Conclusions Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions.
Plasma Rich in Growth Factors as an Adjuvant Treatment for the Management of Frontal Fibrosing Alopecia: A Retrospective Observational Clinical Study
Authors: García Alejandro , Navarro M.R. , Ramirez Ana , Pino Ander , Navarro Ariadna , Moles Isabel , Gallego Estefanía , Anitua Eduardo 
Published: May 2023

Background Frontal fibrosing alopecia (FFA) is a scarring alopecia in which the exact etiopathogenesis has not been completely elucidated and the available treatments are not very effective. Plasma rich in growth factors (PRGF) has shown to induce folliculogenesis in hair loss related disorders. However, the scientific evidence when facing FFA is scarce. Objectives The aim of this study was to retrospectively analyze the adjuvant use of PRGF compared to the conventional treatment in the management of FFA. Methods Participants with clinically diagnosed FFA who had been treated with either conventional therapy (Control Group) or conventional therapy combined with PRGF (PRGF Group) were identified from the center’s medical records. The clinical assessment was based on the “Frontal Fibrosing Alopecia Severity Score” (FFASS), which was fulfilled during a period of two and 4 years. Results This study included 118 patients with clinically diagnosed FFA (Control Group: 57 and PRGF Group: 61). No adverse effects related to the treatments were observed. Both treatments showed to halt the steady progression of hair loss compared to baseline. PRGF treatment also induced significant hair regrowth compared to the Control Group. The scalp inflammation was reduced in response to treatments. The FFASS score indicated that PRGF Group improved the symptoms and severity of FFA in a significant manner. Conclusions The adjuvant use of PRGF may exert long-term beneficial effects on hair loss reduction and might reduce the symptoms and severity of FFA.
Individual and environmental factors in internalizing disorders in children and adolescents
Authors: Viswanathan Poornima , Kishore M Thomas , Seshadri Shekhar P , V S Binu 
Published: May 2023

Background Literature has emphasized the role of biopsychosocial factors in internalizing disorders; however, the role of developmental competencies of a child have not been explored much in this context. The current study aimed to understand the differences in developmental competencies, temperament, parenting practices and psychosocial adversities between children with and without internalizing disorders. Method The sample consisted of 200 children and adolescents aged seven to 18 years, with equal number of those with and without an internalizing disorder; and one of their parents. Psychopathology, temperament, interpersonal competence, emotion regulation, executive function, self-concept, adaptive behaviour, parenting practices, life events, family environment and abnormal psychosocial situations were measured using standardized tools. Findings Discriminant analysis revealed that temperamental domains of sociability and rhythmicity, developmental competencies of adaptive behaviour and self-concept, parenting practices involving father’s involvement and overall positive parenting differentiated the clinical and control groups better. Among psychosocial adversities, family environment domains of cohesion and organization, and subjective stress from life events and abnormal psychosocial situations were the most important discriminators. Conclusion The current study reveals that specific individual factors involving temperament and developmental competencies and environmental factors involving parenting practices and psychosocial adversities are significantly associated with internalizing disorders. This has implications for the mental health care of children and adolescents with internalizing disorders.
No-reflow phenomenon in stroke patients: A systematic literature review and meta-analysis of clinical data
Authors: Mujanovic Adnan , Ng Felix , Meinel Thomas R , Dobrocky Tomas , Piechowiak Eike I , Kurmann Christoph C , Seiffge David J , Wegener Susanne , Wiest Roland , Meyer Lukas , Fiehler Jens , Olivot Jean Marc , Ribo Marc , Nguyen Thanh N , Gralla Jan , Campbell Bruce CV , Fischer Urs , Kaesmacher Johannes 
Published: May 2023

Background: The no-reflow phenomenon refers to the absence of microvascular reperfusion despite macrovascular reperfusion. Aim: The aim of this analysis was to summarize the available clinical evidence on no-reflow in patients with acute ischemic stroke. Methods: A systematic literature review and a meta-analysis of clinical data on definition, rates, and impact of the no-reflow phenomenon after reperfusion therapy was carried out. A predefined research strategy was formulated according to the Population, Intervention, Comparison, and Outcome (PICO) model and was used to screen for articles in PubMed, MEDLINE, and Embase up to 8 September 2022. Whenever possible, quantitative data were summarized using a random-effects model. Results: Thirteen studies with a total of 719 patients were included in the final analysis. Most studies (n = 10/13) used variations of the Thrombolysis in Cerebral Infarction scale to evaluate macrovascular reperfusion, whereas microvascular reperfusion and no-reflow were mostly assessed on perfusion maps (n = 9/13). In one-third of stroke patients with successful macrovascular reperfusion (29%, 95% confidence interval (CI), 21–37%), the no-reflow phenomenon was observed. Pooled analysis showed that no-reflow was consistently associated with reduced rates of functional independence (odds ratio (OR), 0.21, 95% CI, 0.15–0.31). Conclusion: The definition of no-reflow varied substantially across studies, but it appears to be a common phenomenon. Some of the no-reflow cases may simply represent remaining vessel occlusions, and it remains unclear whether no-reflow is an epiphenomenon of the infarcted parenchyma or causes infarction. Future studies should focus on standardizing the definition of no-reflow with more consistent definitions of successful macrovascular reperfusion and experimental set-ups that could detect the causality of the observed findings.
Syndesmotic Suture Button Fixation Results in Higher Tegner Activity Scale Scores When Compared to Screw Fixation: A Multicenter Investigation
Authors: Obey Mitchel R. , Schafer Kevin , Matheny Lauren M. , McAndrew Christopher M. , Gardner Michael J. , Ricci William M. , Clanton Thomas O. , Backus Jonathon D. 
Published: May 2023

Background Suture buttons and metal screws have been used and compared in biomechanical, radiographic, and clinical outcome studies for syndesmotic injuries, with neither implant demonstrating clear superiority. The aim of this study was to compare clinical outcomes of both implants. Methods Patients who underwent syndesmosis fixation at 2 separate academic centers from 2010 through 2017 were compared. Thirty-one patients treated with a suture button and 21 patients treated with screws were included. Patients in each group were matched by age, sex, and Orthopaedic Trauma Association fracture classification. Tegner Activity Scale (TAS), Foot and Ankle Ability Measure (FAAM), patient satisfaction score, surgical failure, and reoperation rates were compared. Results Patients who underwent suture button fixation had significantly higher TAS scores than those who underwent screw fixation (p < 0.001). There was no significant difference in FAAM ADL scores between cohorts (p = 0.08). Symptomatic hardware removal rates were similar (3.2% suture button cohort vs 9.0% in screw cohort). One patient (4.5%) underwent revision surgery secondary to syndesmotic malreduction after screw fixation, for a reoperation rate of 13.5%. Conclusion Patients with unstable syndesmotic injuries treated with suture button fixation had higher mean TAS scores compared to patients treated with screws. Foot and Ankle Ability Measure and ADL scores in these cohorts were similar. Level of Evidence: Level 3 Retrospective Matched Case-Cohort
Relationship between lower urinary tract symptoms (LUTS) and prostate cancer: A persistent myth
Authors: Al-Zubaidi Mohammed , Hawks Cynthia , Fernando Sunimal , Moe Andrew , Swarbrick Nicole , McCombie Steve P , Brown Matthew , Hayne Dickon 
Published: May 2023

Background: The presence of lower urinary tract symptoms (LUTS) is described as an early symptom of prostate cancer in some patient guidelines; however, a statistical association has never been established. Methods: This study was conducted using a prospective electronic database at a single tertiary institution between January 2015 and November 2017. LUTS were assessed using the International Prostate Symptom Score (IPSS), and prostate cancer was graded according to the International Society of UroPathologists (ISUP) grading system. The association between IPSS and Grade Group was tested using parametric one-way analysis of variance (ANOVA) with post hoc analysis using Tukey’s honestly significant difference (Tukey’s HSD). Results: A total of 611 men attended the One-Stop Prostate Clinic (OSPC) and IPSSs were available for 557 men. Overall, 46% had mild LUTS (IPSS: 1–7), 38% had moderate LUTS (IPSS: 8–19) and 16% had severe LUTS (IPSS: 20–35). Almost 85% proceeded to have transrectal ultrasound (TRUS) prostate biopsies, and clinically significant prostate cancer (CSPC) was detected in 37% with mild LUTS, 35% with moderate LUTS and 42% with severe LUTS. Correlation between histopathology and IPSSs was assessed in all 78.8% of men who had IPSS data available and underwent prostate biopsies. Conclusion: This large series did not establish any correlation between LUTS and prostate cancer in men undergoing investigation for the suspicion of prostate cancer. Level of evidence: Not applicable