bluuebunny/crossref_metadata_2025_split huggingface dataset:
ENSO–Rainfall Teleconnection over the Maritime Continent Enhances and Shifts Eastward under Warming
Authors: Chen Chen , Sahany Sandeep , Moise Aurel F. , Chua Xin Rong , Hassim Muhammad E. , Lim Gerald , Prasanna Venkatraman 
Published: March 2023

Abstract
The Maritime Continent (MC), located in the heart of the Indo-Pacific warm pool, plays an important role in the global climate. However, the future MC climate is largely unknown, in particular the ENSO–rainfall teleconnection. ENSO induces a zonal dipole pattern of rainfall variability across the Indo-Pacific Ocean, that is, positive variability in the tropical Pacific and negative variability toward the MC. Here, new CMIP6 models robustly project that, for both land and sea rainfall, the negative ENSO teleconnection over the MC (drier during El Niño and wetter during La Niña) could intensify significantly under the Shared Socioeconomic Pathway 5–8.5 (SSP585) warming scenario. A strengthened teleconnection may cause enhanced droughts and flooding, leading to agricultural impacts and altering rainfall predictability over the region. Models also project that both the Indo-Pacific rainfall center and the zero crossing of dipole-like rainfall variability shift eastward; these adjustments are more notable during boreal summer than during winter. All these projections are robustly supported by the model agreement and scale up with the warming trend.
Universalising Healthcare in India: Managing the Provider–Purchaser Split
Authors: Nagarajan Shyama , Tripathy Shruti , Sodani P. R. , Sharma Rachna 
Published: March 2023

Several countries with diverse health systems have achieved universalization (UHC). The trajectory towards universal coverage almost always has three typical features: (i) a political process driven by a range of regulatory changes to simplify access; (ii) an increase in health spending; (iii) an increase in the share of pooled spending rather than paid out-of-pocket. Therefore, a study was undertaken to understand the extent of the provider-purchaser relationship of governments to achieve UHC while reforming healthcare. The present paper focuses on extensive secondary research across countries and evaluates the experiences of select developed and developing economies with India’s experiments on- Financing mechanisms, management arrangements, governance and health outcomes; to offer a comparison of practices and their impact. While Italy, the UK, Germany, Australia, Japan, Canada and most recently China are countries that have achieved UHC; countries like USA and Brazil are on the verge of achieving UHC. These nine countries represent the entire spectrum of pure purchasing models, mixed and pure provisioning models to help us leverage from their experience. All countries that have attained UHC have a well-defined package of services that the government commits to fund and provide for (both public and private). Additionalities around wellness and cosmetic care is managed through supplementary insurance. Overall funding is through an autonomous body, at arm’s length of government; primarily to govern and manage the state’s health priorities. And the government purely behaves as a regulator setting policy and giving directions to the providers. However, ensuring the sustenance of such a mixed model requires; (i) a well-regulated ecosystem that thrives on evidence, (ii) the governments must clearly define the role/s of each stakeholder and hold them accountable for their deliverables in attaining UHC.
Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study
Authors: Füssenich Wout , Seeber Gesine H. , van Raaij Tom M. , van Lingen Christiaan P. , Zuurmond Rutger G. , Stevens Martin , Somford Matthijs P. 
Published: March 2023

Background: Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion. Methods: A retrospective multicenter cohort study was performed that included 794 patients. Univariate and multiple logistic regression was conducted to determine associations between joint preparation, fixation techniques, postoperative immobilization, weightbearing, and pre- and postoperative HVA with nonunion. Results: Nonunion incidence was 15.2%, with 11.1% symptomatic and revised. Joint preparation using hand instruments (OR 3.75, CI 1.90-7.42) and convex/concave reamers (OR 2.80, CI 1.52-5.16) were associated with greater odds of a nonunion compared to planar cuts. Joint fixation with crossed screws was associated with greater odds of nonunion (OR 2.00, CI 1.11-3.42), as was greater preoperative HVA (OR 1.02, CI 1.00-1.03). However, the latter effect disappeared after inclusion of postoperative HVA in the model, with a small association identified between residual postoperative HVA and nonunion (OR 1.04, CI 1.01-1.08). Similarly, we found an association between odds of nonunion and higher body weight (OR 1.02, CI 1.01-1.04) but not of body mass index. Conclusion: Based on our results, first metatarsophalangeal joint arthrodesis with planar cuts and fixation with a plate and interfragmentary screw is associated with the lowest odds of resulting in a nonunion. Higher body weight and greater preoperative HVA were associated with slight increase in rates of nonunion. It is crucial to properly correct the hallux valgus deformity during surgery. Level of Evidence: Level III, retrospective case control study.
Anatomic Utility of Single Branched Thoracic Endograft During Thoracic Endovascular Aortic Repair
Authors: Kumins Norman H. , Ambani Ravi N. , Bose Saideep , King Alexander H. , Cho Jae S. , Colvard Benjamin , Kashyap Vikram S. 
Published: March 2023

Introduction Single branched thoracic endografts (SBTEs) have been designed for pathology requiring zone 2 seal during thoracic endovascular aortic repair (TEVAR). Numerous criteria must be met to allow for their implantation. Our aim was to analyze anatomic suitability for a next generation SBTE. Methods We reviewed 150 TEVAR procedures between 2015 and 2019. Proximal seal was: zone 0 in 21 (16%), zone 1 in 4 (3%), zone 2 in 52 (40%), zone 3 in 45 (35%), and zone 4 or distal in 7 (5%). We analyzed the Zone 2 patient’s angiograms and CT angiograms using centerline software to measure arterial diameters and length in relation to the left common carotid artery (LCCA), left subclavian artery (LSA) and proximal extent of aortic disease to determine if patients met anatomic criteria of a novel SBTE. Results Zone 2 average age was 64.4 ± 16.3 years; 34 patients were male (65%). Indications for repair were aneurysm (N = 9, 17%), acute dissection (N = 14, 27%), chronic dissection with aneurysmal degeneration (N = 7, 13%), intramural hematoma (N = 9, 17%), penetrating aortic ulcer (N = 5, 10%), and blunt traumatic aortic injury (BTAI, N = 8, 15%). LSA revascularization occurred in 27 patients (52%). Overall, 20 (38.5%) of the zone 2 patients met anatomic criteria. Patients with dissection met anatomic criteria less frequently than aneurysm (33% [10 of 30] vs 64% [9 of 14]). Patients treated for BTAI rarely met the anatomic criteria (1 of 8, 13%). The main anatomic constraints were an inadequate distance from the LCCA to the LSA takeoff and from the LCCA to the start of the aortic disease process. Conclusion Less than half of patients who require seal in zone 2 met criteria for this SBTE. Patients with aneurysms met anatomic criteria more often than those with dissection. The device would have little applicability in treating patients with BTAI.
Glycoprotein IIb/IIIa inhibitors in the treatment of thromboembolic events related to endovascular treatment of cerebral aneurysms-systematic review and meta-analysis
Authors: Hasanpour Mohammad , Maleki Samane , Rezaee Hamid , Aminzadeh Behzad , Abbasi Shaye Zahra , Keykhosravi Ehsan 
Published: March 2023

Background and Aims Thromboembolism complication is considered the most common complication associated with the treatment of endovascular. This systematic review and meta-analysis aimed to assess the studies investigating the effect of glycoprotein IIb/IIIa inhibitor agents on thromboembolic complications during endovascular aneurysm coiling. Materials and Methods This systematic review investigated the outcome of the use of three glycoprotein IIb/IIIa inhibitor agents (ie abciximab, tirofiban, and eptifibatide) on the thromboembolic complications during endovascular aneurysm coiling. The electronic databases of PubMed, Web of Science, Scopus, and Medline were searched up to 25 June 2021, using the keywords “Abciximab,” “Tirofiban,” and “Eptifibatide” incombination with “Thromboembolism Complication,” “Aneurysms,” and “Endovascular Aneurysm Coiling.” Results A total of 21 articles were found to be eligible and included in this review. The rates of complete and partial recanalization were estimated to be 56% and 92% in patients who underwent abciximab and tirofiban therapy, respectively. Rupture aneurysms were found in the majority of patients. In general, the mortality rate of the patients treated for thromboembolic complications during endovascular treatment of cerebral aneurysms with glycoprotein IIb/IIIa inhibitors was found to be 4.8% (CI 95%:0.027–0.067; p < .005). The average remission rate in studies investigating thromboembolism was 91% (CI 95%:0.88–0.95, I2 : 65.65/ p < .001). Conclusion Based on the obtained results, a higher mean rate of complete recanalization by eptifibatide was found in studies in which abciximab or tirofiban were used, compared to other mentioned agents. Moreover, the amount of hemorrhage was reported to be less after using tirofiban rather than abciximab.
Prediction of delayed reperfusion in patients with incomplete reperfusion following thrombectomy
Authors: Mujanovic Adnan , Brigger Robin , Kurmann Christoph C , Ng Felix , Branca Mattia , Dobrocky Tomas , Meinel Thomas R , Windecker Daniel , Almiri William , Grunder Lorenz , Beyeler Morin , Seiffge David J , Pilgram-Pastor Sara , Arnold Marcel , Piechowiak Eike I , Campbell Bruce , Gralla Jan , Fischer Urs , Kaesmacher Johannes 
Published: March 2023

Background: The clinical course of patients with incomplete reperfusion after thrombectomy, defined as an expanded Thrombolysis in Cerebral Infarction (eTICI) score of 2a–2c, is heterogeneous. Patients showing delayed reperfusion (DR) have good clinical outcomes, almost comparable to patients with ad-hoc TICI3 reperfusion. We aimed to develop and internally validate a model that predicts DR occurrence in order to inform physicians about the likelihood of a benign natural disease progression. Patients and methods: Single-center registry analysis including all consecutive, study-eligible patients admitted between 02/2015 and 12/2021. Preliminary variable selection for the prediction of DR was performed using bootstrapped stepwise backward logistic regression. Interval validation was performed with bootstrapping and the final model was developed using a random forests classification algorithm. Model performance metrics are reported with discrimination, calibration, and clinical decision curves. Primary outcome was concordance statistics as a measure of goodness of fit for the occurrence of DR. Results: A total of 477 patients (48.8% female, mean age 74 years) were included, of whom 279 (58.5%) showed DR on 24 follow-up. The model’s discriminative ability for predicting DR was adequate (C-statistics 0.79 [95% CI: 0.72–0.85]). Variables with strongest association with DR were: atrial fibrillation (aOR 2.06 [95% CI: 1.23–3.49]), Intervention-To-Follow-Up time (aOR 1.06 [95% CI: 1.03–1.10]), eTICI score (aOR 3.49 [95% CI: 2.64–4.73]), and collateral status (aOR 1.33 [95% CI: 1.06–1.68]). At a risk threshold of R = 30%, use of the prediction model could potentially reduce the number of additional attempts in one out of four patients who will have spontaneous DR, without missing any patients who do not show spontaneous DR on follow-up. Conclusions: The model presented here shows fair predictive accuracy for estimating chances of DR after incomplete thrombectomy. This may inform treating physicians on the chances of a favorable natural disease progression if no further reperfusion attempts are made.
Complete sequence verification of plasmid DNA using the Oxford Nanopore Technologies’ MinION device
Authors: Brown Scott D. , Dreolini Lisa , Wilson Jessica F. , Balasundaram Miruna , Holt Robert A. 
Published: March 2023

Abstract
Background
Sequence verification is essential for plasmids used as critical reagents or therapeutic products. Typically, high-quality plasmid sequence is achieved through capillary-based Sanger sequencing, requiring customized sets of primers for each plasmid. This process can become expensive, particularly for applications where the validated sequence needs to be produced within a regulated and quality-controlled environment for downstream clinical research applications.

Results
Here, we describe a cost-effective and accurate plasmid sequencing and consensus generation procedure using the Oxford Nanopore Technologies’ MinION device as an alternative to capillary-based plasmid sequencing options. This procedure can verify the identity of a pure population of plasmid, either confirming it matches the known and expected sequence, or identifying mutations present in the plasmid if any exist. We use a full MinION flow cell per plasmid, maximizing available data and allowing for stringent quality filters. Pseudopairing reads for consensus base calling reduces read error rates from 5.3 to 0.53%, and our pileup consensus approach provides per-base counts and confidence scores, allowing for interpretation of the certainty of the resulting consensus sequences. For pure plasmid samples, we demonstrate 100% accuracy in the resulting consensus sequence, and the sensitivity to detect small mutations such as insertions, deletions, and single nucleotide variants. In test cases where the sequenced pool of plasmids contains subclonal templates, detection sensitivity is similar to that of traditional capillary sequencing.

Conclusions
Our pipeline can provide significant cost savings compared to outsourcing clinical-grade sequencing of plasmids, making generation of high-quality plasmid sequence for clinical sequence verification more accessible. While other long-read-based methods offer higher-throughput and less cost, our pipeline produces complete and accurate sequence verification for cases where absolute sequence accuracy is required.
A deep generative adversarial network capturing complex spiral waves in disinhibited circuits of the cerebral cortex
Authors: Boucher-Routhier Megan , Thivierge Jean-Philippe 
Published: March 2023

Abstract
Background
In the cerebral cortex, disinhibited activity is characterized by propagating waves that spread across neural tissue. In this pathological state, a widely reported form of activity are spiral waves that travel in a circular pattern around a fixed spatial locus termed the center of mass. Spiral waves exhibit stereotypical activity and involve broad patterns of co-fluctuations, suggesting that they may be of lower complexity than healthy activity.

Results
To evaluate this hypothesis, we performed dense multi-electrode recordings of cortical networks where disinhibition was induced by perfusing a pro-epileptiform solution containing 4-Aminopyridine as well as increased potassium and decreased magnesium. Spiral waves were identified based on a spatially delimited center of mass and a broad distribution of instantaneous phases across electrodes. Individual waves were decomposed into “snapshots” that captured instantaneous neural activation across the entire network. The complexity of these snapshots was examined using a measure termed the participation ratio. Contrary to our expectations, an eigenspectrum analysis of these snapshots revealed a broad distribution of eigenvalues and an increase in complexity compared to baseline networks. A deep generative adversarial network was trained to generate novel exemplars of snapshots that closely captured cortical spiral waves. These synthetic waves replicated key features of experimental data including a tight center of mass, a broad eigenvalue distribution, spatially-dependent correlations, and a high complexity. By adjusting the input to the model, new samples were generated that deviated in systematic ways from the experimental data, thus allowing the exploration of a broad range of states from healthy to pathologically disinhibited neural networks.

Conclusions
Together, results show that the complexity of population activity serves as a marker along a continuum from healthy to disinhibited brain states. The proposed generative adversarial network opens avenues for replicating the dynamics of cortical seizures and accelerating the design of optimal neurostimulation aimed at suppressing pathological brain activity.
Adenosine 2 receptor regulates autophagy and apoptosis to alleviate ischemia reperfusion injury in type 2 diabetes via IRE-1 signaling
Authors: Yacouba Moukeila Mohamed Bassirou , Thokerunga Erick , He Feng , Bongolo Christian Cedric , Xia Yun , Wang Fuyu , Gado Adamou Foumakoye , Mamoudou Hama , Khan Shahzad , Ousseina Bonkano , Ousmane Hadjara Abdoulkarim , Diarra Drissa , Ke Jianjuan , Zhang Zongze , Wang Yanlin 
Published: March 2023

Abstract
Purpose
This study aimed to determine the effect and mechanism of action of adenosine 2 receptor (A2R) activation on myocardial ischemia reperfusion injury (MIRI) under diabetic conditions.

Methods
MIRI type 2 diabetic rats and H9C2 cardiomyocytes were treated with A2R agonist and then subjected to hypoxia for 6 h and reoxygenation for 18 h. Myocardial damage, and infarct size were determined by cardiac ultrasound. Indicators of cardiomyocyte injury, creatine kinase-MB and cardiac troponin I were detected by Enzyme Linked Immunosorbent Assay. Endoplasmic reticulum stress (ERS) was determined through measuring the expression levels of ERS related genes GRP78, p-IRE1/IRE1, and p-JNKJNK. The mechanism of A2R cardio protection in MIRI through regulating ERS induced autophagy was determined by investigating the ER resident protein IRE-1. The ER-stress inducer Tunicamycin, and the IRE-1 inhibitor STF in combination with the A2R agonist NECA were used, and the cellular responses were assessed through autophagy proteins expression Beclin-1, p62, LC3 and apoptosis.

Results
NECA improved left ventricular function post MIRI, limited myocardial infarct size, reduced myocardial damage, decreased cardiomyocytes apoptosis, and attenuated ERS induced autophagy through regulating the IRE-XBP1s-CHOP pathway. These actions resulted into overall protection of the myocardium against MIRI.

Conclusion
In summary, A2R activation by NECA prior to ischemia attenuates apoptosis, reduces ERS induced autophagy and restores left ventricular function. This protective effect occurs through regulating the IRE1-XBPs-CHOP related mechanisms. NECA is thus a potential target for the treatment of MIRI in patient with type 2 diabetes.
Magnitude of troponin elevation in patients with biomarker evidence of myocardial injury: relative frequency and outcomes in a cohort study across a large healthcare system
Authors: McIlvennan Colleen K. , Urra Manuel , Helmkamp Laura , Messenger John C. , Raymer David , Ream Karen S. , Oldemeyer J. Bradley , Ambardekar Amrut V. , Barnes Kathleen , Allen Larry A. 
Published: March 2023

Abstract
Background
Serum troponin levels correlate with the extent of myocyte necrosis in acute myocardial infarction (AMI) and predict adverse outcomes. However, thresholds of cardiac troponin elevation that could portend to poor outcomes have not been established.

Methods
In this cohort study, we characterized all cardiac troponin elevations > 0.04 ng/mL (upper limit of normal [ULN]) from patients hospitalized with an ICD-9/10 diagnosis of AMI across our health system from 2012–2019. We grouped events into exponential categories of peak cardiac troponin and evaluated the association of these troponin categories with all-cause mortality, heart transplants, or durable left ventricular assist devices (LVAD). Patients with cardiac troponin > 10,000 × ULN were manually chart reviewed and described.

Results
There were 18,194 AMI hospitalizations with elevated cardiac troponin. Peak troponin was 1–10 × ULN in 21.1%, 10–100 × ULN in 34.8%, 100–1,000 × ULN in 30.1%, 1,000–10,000 × ULN in 13.1%, and > 10,000 × ULN in 0.9% of patients. One-year mortality was 17–21% across groups, except in > 10,000 × ULN group where it was 33% (adjusted hazard ratio (99%CI) for > 10,000 × ULN group compared to all others: 1.86 (1.21, 2.86)). Hazards of one-year transplant and MCS were also significantly elevated in the > 10,000 × ULN group.

Conclusions
Elevation in cardiac troponin levels post AMI that are > 10,000 × ULN was rare but identified patients at particularly high risk of adverse events. These patients may benefit from clarification of goals of care and early referral for advanced heart failure therapies. These data have implications for conversion to newer high-sensitivity cardiac troponin assays whose maximum assay limit is often lower than traditional assays.
Seeking lifestyle counselling at primary health care centres: a cross-sectional study in the Swedish population
Authors: Lundin Gurné Frida , Svensson Per-Arne , Björkman Ida , Lidén Eva , Jakobsson Sofie 
Published: March 2023

Abstract
Background
Millions of people follow an unhealthy lifestyle in terms of tobacco consumption, hazardous use of alcohol, poor eating habits, and insufficient physical activity. Healthy lifestyles can to a large extent prevent and/or delay progression of non-communicable diseases. Factors influencing persons health-seeking behaviour regarding unhealthy lifestyles are of importance for sustainable health-promotive and disease-preventive work in primary health care. Generally, lifestyle interventions within primary health care are seen as feasible, but rarely reach all members of the general population. Few studies have been conducted about the likelihood among the general population to voluntarily contact a primary health care centre for support regarding lifestyle changes. The present study therefore aimed to investigate the general population’s likelihood of contacting a primary health care centre regarding their lifestyles, and factors associated with a lower such likelihood.

Methods
A probability sample of adults living in Sweden (n = 3 750) were invited to participate in a cross-sectional survey regarding how societal developments affect attitudes and behaviours of the adult Swedish population. Data were collected between September and December 2020. Participants completed a questionnaire about lifestyle changes, and the data were analysed using descriptive statistics, Chi-square test and logistic regression analysis.

Results
The response rate was 52.0% (n = 1 896). Few persons responded that they would be likely to contact a primary health care centre for support regarding their lifestyles. Factors predicting a lower likelihood of contacting primary health care included few yearly visits to a primary health care centre, male sex, and living in a rural area.

Conclusions
Primary health care centres are not the first choice for lifestyle counselling for the majority of adults living in Sweden. We have identified factors predicting low likelihood of using the support available at these centres. In order to work with sustainable and visible health-promotive and disease-preventive strategies at primary health care centres, these settings need to find valid methods to involve and collaborate with the members of the general community, to meet the needs of a population struggling with unhealthy lifestyles.