bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Subtropical Rossby Waves in Amplifying the Divergent Circulation of the Madden–Julian Oscillation
Authors: Barpanda Pragallva , Tulich Stefan N. , Dias Juliana , Kiladis George N. 
Published: July 2023

Abstract
The composite structure of the Madden–Julian oscillation (MJO) has long been known to feature pronounced Rossby gyres in the subtropical upper troposphere, whose existence can be interpreted as the forced response to convective heating anomalies in the presence of a subtropical westerly jet. The question of interest here is whether these forced gyre circulations have any subsequent effects on divergence patterns in the tropics and the Kelvin-mode component of the MJO. A nonlinear spherical shallow water model is used to investigate how the introduction of different background jet profiles affects the model’s steady-state response to an imposed MJO-like stationary thermal forcing. Results show that a stronger jet leads to a stronger Kelvin-mode response in the tropics up to a critical jet speed, along with stronger divergence anomalies in the vicinity of the forcing. To understand this behavior, additional calculations are performed in which a localized vorticity forcing is imposed in the extratropics, without any thermal forcing in the tropics. The response is once again seen to include pronounced equatorial Kelvin waves, provided the jet is of sufficient amplitude. A detailed analysis of the vorticity budget reveals that the zonal-mean zonal wind shear plays a key role in amplifying the Kelvin-mode divergent winds near the equator, with the effects of nonlinearities being of negligible importance. These results help to explain why the MJO tends to be strongest during boreal winter when the Indo-Pacific jet is typically at its strongest.

Significance Statement
The MJO is a planetary-scale convectively coupled equatorial disturbance that serves as a primary source of atmospheric predictability on intraseasonal time scales (30–90 days). Due to its dominance and spontaneous recurrence, the MJO has a significant global impact, influencing hurricanes in the tropics, storm tracks, and atmosphere blocking events in the midlatitudes, and even weather systems near the poles. Despite steady improvements in subseasonal-to-seasonal (S2S) forecast models, the MJO prediction skill has still not reached its maximum potential. The root of this challenge is partly due to our lack of understanding of how the MJO interacts with the background mean flow. In this work, we use a simple one-layer atmospheric model with idealized heating and vorticity sources to understand the impact of the subtropical jet on the MJO amplitude and its horizontal structure.
Seasonal Variations of Recharge–Storage–Runoff Process over the Tibetan Plateau
Authors: Lei Yonghui , Li Rui , Letu Husi , Shi Jiancheng 
Published: July 2023

Abstract
The Tibetan Plateau (TP) is a vital and vulnerable water tower that supports the livelihoods of billions of people. The use of a data-driven recharge–storage–runoff perspective enables a more comprehensive estimation of multiple aspects of the water cycle. Through an analysis of the diagnostic net water flux from ERA5, water storage changes (dS/dt) from GRACE, runoff estimations (R) from the land–atmosphere water balance, and river discharge measurements (Rd), the annual cycle of recharge–storage–runoff has been studied over the TP and its basins. The net water flux determines a recharge of 326 mm yr−1 over the TP. Recharge in coupled storages, leading to an increase in water mass (dS/dt > 0) and runoff (R > 0) during the wet season, is considered the fast response and is measured using the ratio of runoff to net water flux (r1). Conversely, the slow response determined by the water storage release (dS/dt < 0) during the dry season is quantified by the ratio of storage release to runoff (r2). The ratios of r1 and r2 are influenced by climatic and terrain drivers, indicating specific characteristics of recharge–storage–runoff at the basin scale. Small r1 values and large r2 values suggest high buffer capacity, while the basin of Amu Darya (Salween) is characterized by the highest (lowest) buffer capacity over the TP. However, measurements of river discharge at Amu Darya suggest an uncoupled recharge–storage–runoff. The imbalance between river discharge and runoff estimation was most severe in the first decade of the twenty-first century but has been mitigated since 2012. River discharge at Amu Darya is likely constrained by energy during summer.
The Distressed Communities Index: A Measure of Community-Level Economic Deprivation and Rate of Firearm Injuries in Maryland
Authors: Akinyemi Oluwasegun A. , Weldeslase Terhas A. , Hughes Kakra , Williams Mallory , Cornwell Edward E. 
Published: July 2023

Background This study aimed to investigate the relationship between community-level economic deprivation, as measured by the Distressed Communities Index (DCI) and ED visits on account of firearm injuries (assaults and unintentional). Methods A retrospective analysis was conducted using the Maryland State Emergency Department Databases (SEDD) from January 2019 to December 2020 to explore the association between the DCI and ED visits because of firearm injuries (assaults and unintentional). The DCI utilizes 7 variables, based on zip codes, generating 5 levels of socioeconomic distress (prosperous, comfortable, mid-tier, at-risk, and distressed). In a multivariate analysis, we adjusted for age, sex, mental conditions, alcohol addiction, substance abuse, smoking, race/ethnicity, insurance type, and median income. Results Of the 2725 ED visits for firearm injuries, 84.5% were Black and 88.5% male. The median age was 27 (21-35) years, and the mortality rate was 17.7%. A statistically significant association was found between economic deprivation and ED visits for firearm injuries. Compared to prosperous communities, the odds ratios (ORs) were comfortable (OR = 1.33, 95% CI 1.04-1.71, P = .03), mid-tier (OR = 1.69, 95% CI 1.33-2.15, P < .001), at-risk (OR = 1.53, 95% CI 1.17-1.99, P < .001), and distressed (OR = 2.65, 95% CI 2.11-3.33, P < .001). Discussion The study highlights the significant association between community-level economic deprivation, as measured by the Distressed Communities Index, and the incidence of firearm injuries in Maryland. The findings underscore the importance of addressing socioeconomic disparities and implementing targeted interventions to reduce firearm-related injuries in economically distressed communities.
“Do you Really Believe that There is Something More?” – The Offer of Transcendental Communication by Pastoral Care Workers in German Hospices and Palliative Care Units: A Qualitative Study
Authors: Nassehi Armin , Saake Irmhild , Breitsameter Christof , Bauer Anna , Barth Niklas , Berger Katharina , Gigou Sophie 
Published: July 2023

Background Palliative Care also encompasses the dimension of spiritual pain. Pastoral care workers and chaplains are specialists in the provision of spiritual care. Decreasing religious affiliation and increasing spiritual diversification in modern societies raise the question of the function of pastoral care. Aim The goal of this study is to answer the question of what pastoral care workers can offer to dying residents in hospices and palliative care units. Design A qualitative interview study was designed to explore the specific perspective of pastoral care workers in a multidisciplinary environment. The study is based on differentiation theory which is particularly well adjusted to reveal differences in perspectives in so called ‘holistic’ care settings. The reporting follows the COREQ guidelines. Setting Problem centered interviews were conducted at five hospices and two palliative care units. Results Eight pastoral care workers were interviewed (5 Catholic, 3 Protestant, mean age of 58 years). The analysis of the interviews revealed three major themes: (A) Self-positioning in relation to the organization, (B) Offering conversations to patients and relatives, (C) Performing religious rituals. Minor themes were: mediating conflicts between patients, relatives and staff, sensing moods in silence with patients and organizing workshops for staff. Conclusion In modern hospice care, pastoral care workers routinely address the problem of making death more tangible and of answering the unanswerable question of what comes afterwards. Through this, they support dying residents in hospices and palliative care units in dealing with the inexplicability of death.
Using the Unified Theory of Acceptance and Use of Technology (UTAUT) to predict the behavioral intent of teledentistry utilization amongst United States adults
Authors: VanDeWiele Mercedes D , Hastings Angela M , Evans Michael D , O’Connell Megan S , Flynn Priscilla M 
Published: July 2023

Introduction Teledentistry is an innovative health care delivery platform that can potentially improve oral health access and outcomes. The purpose of this study was to predict teledentistry utilization intentions of U.S. adults using the Unified Theory of Acceptance and Use of Technology (UTAUT) as a framework. Methods This mixed-method, cross-sectional study surveyed 899 participants from two independent samples in August and September 2021. Convenience samples of Minnesota State Fair attendees and ResearchMatch volunteers completed electronic surveys to identify the behavioral intention (BI) for teledentistry use within the next 6 months. Independent variables were the UTAUT constructs of performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC). Data were analyzed using univariate analysis and multiple linear regression adjusting for age, gender and educational level. Qualitative analysis used thematic analysis using UTAUT as a coding framework. Results Univariate analysis showed statistical significance between each construct with BI ( P < 0.0001). Adjusted multiple linear regression revealed statistical significance between PE and SI with BI ( P < 0.0001). Qualitative responses corroborated quantitative results and revealed a lack of teledentistry knowledge. Conclusion The majority of participants indicated an intention not to use teledentistry within the next 6 months. The lack of prior experience of telehealth or teledentistry use in addition to lack of knowledge regarding teledentistry may contribute to these results. Future interventions to improve the BI to use teledentistry may benefit from focusing on PE and SI constructs for educational and marketing strategies.
Outcomes for young people in out of home care accessing tiered mental health services in Sydney, Australia
Authors: Drever Saskia , Foord Rachael , Mendoza Diaz Antonio , Eapen Valsa , Jairam Rajeev 
Published: July 2023

Young people in OOHC have complex mental health concerns, therefore the South Western Sydney Local Health District (SWSLHD) has trialled a tiered model of mental health care. Under this model the OOHC mental health team (OOHC-MHT) provides specialist tier four service delivery for those with the most severe, intense mental health needs. OOHC consumers with a reduced level of severity access services at a tier three centre-based iCAMHS. This study aims to understand the characteristics of young people in OOHC accessing different service provision options in Sydney, Australia. Sixty-six OOHC consumers 8–17 years accessing mental health services across SWSLHD from January 2020–December 2021 participated in the study. Group differences in OOHC-MHT and iCAMHS outcome measures were compared. HoNOSCA scores were significantly worse for OOHC-MHT than iCAMHS, indicating more severe psychopathology for OOHC-MHT at baseline. In OOHC-MHT, HoNOSCA decreased significantly from admission to discharge and scores on the CGAS increased significantly, indicating significant improvements in psychopathology and functioning. In the iCAMHS group scores on the HoNOSCA significantly decreased indicating improved psychopathology over this period. These findings support a tiered model of service delivery for OOHC consumers, with this tailored level of care resulting in significantly improved outcomes across a range of complexity.
Interposition Arthroplasty versus Dual Cup Mobility Prosthesis in Treatment of Trapeziometacarpal Joint Osteoarthritis: A Prospective Randomized Study
Authors: Guzzini Matteo , Arioli Leopoldo , Annibaldi Alessandro , Pecchia Stefano , Latini Francesca , Ferretti Andrea 
Published: July 2023

Background: Osteoarthritis (OA) of the trapeziometacarpal (TMC) joint is a common cause of pain and functional disability of the hand and is the second most frequent site in the hand of OA. This prospective randomized study analyses and compares the outcomes and global assessment of 2 different surgical techniques for rhizarthrosis treatment: trapeziectomy with tendon interposition arthroplasty and total joint replacement with Touch® (KeriMedical; Geneva, Switzerland) TMC prosthesis. Methods: The enrolled patients were randomly divided into 2 groups: group A included 71 patients (75 hands) treated with tendon interposition arthroplasty, while group B included 65 patients (72 hands) treated with total joint replacement. Clinical and radiological outcomes were collected before surgery and at 1, 3, 6, 12, and 24 months of follow-up. Results: Although the values of all clinical tests performed during follow-up demonstrated statistically significant improvement over preoperative ones in both groups, patients treated with prosthesis showed faster improvement, especially in tests of strength and range of motion, which showed better results than patients treated with trapeziectomy and tendon interposition arthroplasty throughout the follow-up. Conclusions: Our study suggests that joint replacement should be preferred to interposition arthroplasty as the treatment of rhizarthrosis, choosing the latter in case of prosthetic replacement complications or scaphoid-trapezium-trapezoid OA.
Therapeutic plasma exchange in the management of stiff person syndrome spectrum disorders: a case series and review of the literature
Authors: Mercure-Corriveau Nicolas , Roy Shuvro , Hu Chen , Crowe Elizabeth P. , Zhu Xianming , Obando Danielle , Patel Eshan U. , Tobian Aaron A. R. , Wang Yujie , Bloch Evan M. , Newsome Scott D. 
Published: July 2023

Background: Stiff person syndrome spectrum disorders (SPSD) are a rare group of disabling neuroimmunological disorders. SPSD often requires immune therapies, especially in the setting of inadequate response to symptomatic treatments. The safety and efficacy of therapeutic plasma exchange (TPE) in SPSD remains uncertain. Objectives: To describe the safety, tolerability, and efficacy of TPE in patients with SPSD. Design: A retrospective observational study. Methods: A retrospective review of SPSD patients seen at Johns Hopkins Hospital (JHH) from 1997 to 2021 was performed. Patient demographics/history, examination/diagnostic findings, treatment response, and TPE-related complications were recorded. Assessment for any associations between clinical characteristics, including age, sex, clinical phenotype, and time on immunotherapy, and response to TPE 3 months after treatment was performed. A subgroup of 18 patients treated with TPE at JHH and 6 patients treated with TPE at outside institutions were evaluated for any change in usage of symptomatic medications 3 months after the TPE treatment. Literature review of SPSD and TPE was also conducted. Results: Thirty-nine SPSD patients were treated with TPE (21 at JHH and 18 at outside institutions); median age 48 years, 77% female, median modified Rankin Scale 3; mean initial anti-GAD65 antibody titer was 23,508 U/mL. Twenty-four patients (62%) had classic SPS, 10 (26%) had SPS-plus, 2 (5%) had progressive encephalomyelitis with rigidity and myoclonus, and 3 (8%) had pure cerebellar ataxia. All patients were on symptomatic treatments, 30 (77%) previously received IVIg, and 3 (8%) previously received rituximab. Four patients (10%) had a TPE-related adverse event. One developed asymptomatic hypotension, another had both line thrombosis and infection, and two had non-life-threatening bleeding events. Twenty-three (59%) patients reported improvement in symptoms after TPE. Of the subgroup of 24 patients evaluated for any change in usage of symptomatic medications 3 months after the TPE treatment, 14 (58%) required fewer GABAergic symptomatic medications. Literature review identified 57 additional patients with SPSD; 43 (75%) reported temporary improvement after TPE. Conclusion: The majority of patients treated with TPE had improvement. Moreover, most patients evaluated for any change in usage of symptomatic medications after the TPE treatment no longer required as much symptomatic medications months after TPE. TPE appears safe and well-tolerated in SPSD. Further studies are needed to assess the long-term efficacy of TPE in SPSD and identify which patients may benefit the most from TPE.
Real-world data in patients with congenital hemophilia and inhibitors: final data from the FEIBA Global Outcome (FEIBA GO) study
Authors: Ettingshausen Carmen Escuriola , Hermans Cedric , Holme Pål A. , Cid Ana R. , Khair Kate , Oldenburg Johannes , Négrier Claude , Botha Jaco , Lelli Aurelia , Windyga Jerzy 
Published: July 2023

Background: The bypassing agent, activated prothrombin complex concentrate [aPCC, FEIBA (factor VIII inhibitor bypass activity); Baxalta US Inc, a Takeda company, Lexington, MA, USA], is indicated for the treatment of bleeding episodes, perioperative management, and routine prophylaxis in patients with hemophilia A or B with inhibitors. In certain countries, aPCC is also indicated for the treatment of bleeding episodes and perioperative management in patients with acquired hemophilia A. Objectives: To describe long-term, real-world effectiveness, safety, and quality-of-life outcomes for patients with congenital hemophilia A or B and high-responding inhibitors receiving aPCC treatment in routine clinical practice. Design: FEIBA Global Outcome (FEIBA GO; EUPAS6691) was a prospective, observational study. Methods: Investigators determined the treatment regimen and clinical monitoring frequency. The planned patient observation period was 4 years. Data are from the safety analysis set (patients who received ⩾1 aPCC infusion). Results: Overall, 50 patients received either aPCC prophylaxis ( n = 37) or on-demand therapy ( n = 13) at screening [hemophilia A, n = 49; hemophilia B, n = 1; median (range) age, 16.5 [2–71] years). Mean ± standard deviation overall annualized bleeding rate and annualized joint bleeding rate for patients receiving prophylaxis were 6.82 ± 11.52 and 3.77 ± 5.71, respectively, and for patients receiving on-demand therapy were 10.94 ± 11.27 and 6.94 ± 7.39, respectively. Overall, 177 and 31 adverse events (AEs) were reported in 28 of 40 and 10 of 13 patients receiving prophylaxis or on-demand therapy, respectively. Two serious AEs were considered possibly related to aPCC: acute myocardial infarction due to coronary artery embolism in one patient receiving prophylaxis. No thrombotic microangiopathy was reported. No AEs resulted in death. Conclusion: This study demonstrated the long-term, real-world effectiveness and consistent safety profile of aPCC as on-demand therapy and prophylactic treatment in patients with hemophilia and high-responding inhibitors. Trial registry: FEIBA Global Outcome Study; EUPAS6691 https://www.encepp.eu/encepp/viewResource.htm?id=32774
Funding and financial sustainability of pharmacovigilance: suggested models for funding pharmacovigilance in resource-limited African countries
Authors: Isah Ambrose O. , Opadeyi Abimbola O. , Tumwijukye Henry , Cobelens Frank , Smith Diede , Ndomondo-Sigonda Margareth , Harmark Linda , Tanui Paul , Tiemersma Edine , Mmbaga Blandina T. , Mahlangu Gugu , Ayinbuomwan Stephen A. , Soulaymani Rachida , Pandit Jayesh M. 
Published: July 2023

Background: An important factor hindering the growth of pharmacovigilance (PV) in resource-limited settings is the lack of adequate funds to establish a functional National Pharmacovigilance System. Consequently, the crucial function of monitoring and ensuring the availability of safe medicines in these settings cannot be guaranteed considering the peculiarities of diseases and medicines used. Objectives: The objective of this paper is to provide an overview as to the availability of potential sources of funds, which could be explored to ensure Medicine Safety and to proffer a potential framework likely to ensure sustainable funding of PV in Africa. Methods/processes: The process of developing this framework entailed a review of PV financing in some developed economies, a landscape study of funding of PV in some African countries, an in-depth understanding of the PV system and the organisational structure and nexus between the regulatory agencies and National Pharmacovigilance Centre. Critical points for consideration included the sources of funds, revenue pool, the disbursement of funds, budgeting and expenditure profile and the legal framework. Consultative meetings, webinars and interviews with experts were carried out. Results: The findings showed that most of the PV systems were mainly integrated into the regulatory agencies regarding operational and fiscal governance with few facilities being independent of the regulatory agencies. The main source of funding was from the government with significant donor funding which is ad hoc and non-sustainable. Several potential sources were identified but yet to be exploited. There were no legal provisions for PV financing. A framework likely to ensure sustainable PV financing is suggested to capture all available sources of funding, mine the potential sources providing a sizeable pool of revenue to address its activities and enabling legal framework which will engender autonomy. Furthermore, it will address the nexus between the regulatory agencies and the PV outfits, thus enabling appropriate share of resources and blockage of diversions. Conclusion: In all, addressing the various elements identified in this study and providing the legal provisions which guarantees some degree of autonomy will provide a sustainable mechanism for PV funding in the resource-limited setting of Africa.