bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coupling of Atmospheric Rivers and Levee Failure Events in California’s Sacramento–San Joaquin Delta, 1980–2021
Authors: Rittelmeyer Pamela , Bowers Corinne , Guan Bin 
Published: January 2025

Abstract
California’s Sacramento–San Joaquin delta is situated at the confluence of the Sacramento and San Joaquin Rivers, where more than 60 agricultural islands are protected by levees. The region has experienced hundreds of floods since the levees were first built in the mid-1800s; however, the state of California has contributed millions of dollars to levee maintenance and improvements since the 1970s. Using a novel dataset of 57 levee failure events recorded from 1980 to 2021, this study 1) assesses the historical relationship between levee failures and the intensity and occurrence of atmospheric rivers (ARs) and 2) analyzes changes in ARs and failure events over time. Results show a strong relationship between ARs and levee failure events at the seasonal scale, and a more granular analysis at the daily scale reveals that AR conditions in the days and weeks prior to the levee failure are at least as influential as conditions on the day of failure. Over 90% of weather-related levee failure events were preceded by ARs, the major flood producers in the region, within the preceding 2 weeks. These findings highlight the importance of watershed memory for levee failure risk. A trend analysis finds that levee failures have significantly decreased in frequency since 1980, possibly due to levee improvements, and a watershed-level extreme value analysis shows differences in AR behavior across the Delta. The study concludes by offering hypotheses about how levee failure risk will continue to evolve in the future based on projected shifts in AR behavior.

Significance Statement
Levee failures along the low-lying islands of the Sacramento–San Joaquin delta have become less frequent in recent decades; however, as the atmosphere warms under climate change, atmospheric rivers (ARs) may become more frequent and intense and cause more floods. This study looks at trends in levee failure events and the AR intensity and frequency both separately and together. Some highlights from our results include the importance of watershed memory, the effectiveness of California’s levee improvement investments, and the influence of changing AR conditions on levee failure risk. An understanding of changes in the characteristics of the ARs and where they are occurring can help residents and flood managers better prepare for future flood events.
What Does It Mean to Stand Out? How Visual Design and Presentation Affect Attention and Memory in a Warning Message
Authors: Waugh Nicholas , Sutton Jeannette , Fischer Laura , Orton Ginger 
Published: January 2025

Abstract
In emergency communication, it is essential to call attention to key information that can be interpreted quickly and remembered easily. Individuals possess a limited number of cognitive resources to allocate to message processing in an emergency. Because of this, they are more likely to allocate attention to messages they are motivated to care about or to message attributes that stand out. In this study, we focus on how warning messages are attended to when they are viewed in a busy media environment and ask the question: “What does it mean to stand out?” To address the research questions, we used a sequential explanatory design, mixed-methods approach. We employed eye tracking, a memory exercise, and think-aloud interviews to investigate visual attention, memory, and perceptions in response to warnings communicated via Twitter and Wireless Emergency Alerts (WEAs) for snow squall (SS) and dust storm (DS) hazards. Our findings revealed insights to assist message designers as they develop warning messages without burdening the message receiver with contents that require additional cognitive load. Colors help to draw attention to key elements and evoke a feeling of risk. Icons also draw attention and can serve as a signal that catches the eye, especially when actively viewed in a busy messaging environment. Additionally, techniques to make key text stand out through bold or the use of ALL CAPS may reduce effortful processing and eliminate the need for conscious fixations while resulting in easily remembered content.

Significance Statement
Visual risk communication messaging is often used to provide individuals with quick decision-making and protective action information in response to hazards. As messages increase in length and complexity, a burden is placed on risk communicators to capture the attention of message receivers. This study uses eye tracking, a memory exercise, and think-aloud interviews to investigate what factors influence visual attention, memory, and perceptions in response to warning messages over different channels. These methods allow us to not only answer questions about where people look, what they remember, and what draws their attention but also recommend tactics such as using ALL CAPS, colors, symbols, and icons, that can be used by message creators to maximize message effectiveness.
Development of Chinese Medicinal Ointment with Antibacterial Properties from Tripterygium wilfordii
Authors: Wong Ching , Law Siu Kan , Wu Xiao Xiao , Tong Christy Wing Sum , Wang Yanping , Chow Wesley Yeuk Lung , Au Dawn Ching Tung 
Published: January 2025

Background Chinese medicinal ointment was first recorded in the Shan Hai Jing ( The Classic of Mountains and Seas). Different formulations of Chinese medicinal ointments have been made based on the traditional Chinese medicine (TCM) theory. Many TCMs possessed antibacterial properties that were used as microecological regulators to inhibit the growth of gram-negative bacteria, “ Escherichia coli.” Purpose To develop and make an antibacterial ointment by Tripterygium wilfordii (TW) and evaluate its antibacterial function. Materials and Methods The methodologies included physical (cream selection), chemical [ultraviolet–visible (UV–Vis) and high-performance liquid chromatography-diode array detector (HPLC-DAD)], and biological (agar assay) experiments for making TW ointment. Results An active ingredient, “celastrol,” was extracted from TW. Aqueous Cream BP was chosen as the base for ointment making since it did not have any smell and contained only natural substances. UV–Vis and HPLC-DAD identified the active ingredient of “celastrol” from TW with an absorption peak at 230 nm and a symmetrical peak at a retention time of 19.855 min. The 1%, 2%, and 5% TW ointments with antibacterial properties and inhibitory effects on the colony formation units of E. coli were 109.33 ± 14.32, 85.67 ± 10.22, and 44.00 ± 6.66, respectively. Conclusion The Chinese medicinal ointment with antibacterial properties from TW was successfully developed using an Aqueous Cream BP and the Chinese medicinal plant “TW.” An active ingredient, “celastrol,” from “TW,” was determined by using UV–Vis and HPLC-DAD studies. The 1%, 2%, and 5% TW ointments were evaluated for its effectiveness for antibacterial properties. These Chinese medicinal ointments were the starting milestone for further studying the biological mechanisms or applications on human skin.
Racial Variation of Donor-Derived Cell-Free DNA in Kidney Transplant Recipients
Authors: Ralph Oliver G. , Williams Michael D. , Chan Edie Y. , Olaitan Oyedolamu 
Published: January 2025

Introduction There is a need for a noninvasive, affordable, sensitive, and specific biomarker to diagnose early acute rejection, to negate the need for frequent biopsies. Dd-cfDNA is a powerful adjunct yet there is limited data on the ethnic differences in its values. There is anecdotal evidence that dd-cfDNA values at rejection may be higher in Black as compared to non-Black recipients. This study aims to add to this literature while defining such variability and comparing it to previously validated cutoffs for dd-cfDNA of 0.5% or 1%. Design This was a single-center retrospective observational study of patients who underwent graft biopsies with a preceding, paired, dd-cfDNA value. Recipients were separated into White, Black, and Hispanic racial and ethnic groups, and dd-cfDNA values at rejection versus nonrejection were compared. Results With 0.5% and 1% cutoffs, false negative rates for rejection were 13% and 22%, respectively. The false positive rate was 38.4%. 12.2% of Black recipients, 11.8% of Hispanic recipients, and 44% of White recipients had rejection with a negative AlloSure®. Values >0.5% corresponded to histologic rejection in 61.5% of Black, 66.7% of White, and 56.3% of Hispanic recipients. Antibody-mediated rejection occurred in 65.5% of rejection cases in Black recipients, while exhibiting the lowest rate of T-cell-mediated rejection. Dd-cfDNA values gave an accurate diagnosis of rejection in 52.8% of recipients with AMR versus 19.3% in TCMR. Conclusion This study demonstrated that dd-cfDNA was applicable to Black recipients with a robust ability to detect antibody-mediated rejection, as compared to White and Hispanic recipients.
Psychosocial moderators of the association between pain intensity and physical function in people with systemic sclerosis
Authors: Whibley Daniel , Minhas Deeba , Sturgeon John A , Chen Yen T , Kratz Anna , Khanna Dinesh , Murphy Susan L 
Published: January 2025

Background: Pain is a prevalent symptom of systemic sclerosis. While previous studies have demonstrated a correlation between higher pain intensity and lower physical function in individuals with systemic sclerosis, the potentially moderating effect of psychosocial factors on the association has yet to be explored. Methods: This cross-sectional study used data from a fatigue self-management trial for adults with systemic sclerosis. Baseline questionnaire instruments measured pain intensity (11-point scale), physical function (PROMIS 4a short form), and psychosocial factors: positive and negative affect (Positive and Negative Affect Schedule), resilience (Connor–Davidson Resilience Scale), anxiety, depression (PROMIS short forms), and self-efficacy domains (PROMIS item banks). Linear regression quantified the pain intensity–physical function association with interaction terms for candidate psychosocial moderators included in separate models (adjusted for age, systemic sclerosis subtype, and disease duration). Results: Among 173 participants (mean age 54.5, Standard Deviation 11.7, 93% female, 83% White), 47% had diffuse cutaneous systemic sclerosis, 35% limited, 13% overlap, and 5% other/unsure. Mean pain intensity was 4.9 (Standard Deviation 2.3) and mean physical function T-score was 38.5 (Standard Deviation 6.4). Pain intensity accounted for 31% of the variability in physical function (B −1.34, 95% confidence interval −1.69, −0.99). Statistically significant interactions were found between pain intensity and negative affect and anxiety, with higher levels of these factors amplifying the negative pain–physical function association. Conclusion: These findings suggest that higher levels of negative affect and anxiety exacerbate the negative effect of pain on physical function in individuals with systemic sclerosis. Interventions targeting these factors may help improve overall physical function regardless of pain intensity.
Operationalising routinely collected patient data in research to further the pursuit of social justice and health equity: a team-based scoping review
Authors: Chadd Katie , Caute Anna , Pettican Anna , Enderby Pam 
Published: January 2025

Abstract

Background
Vast volumes of routinely collected data (RCD) about patients are collated by health professionals. Leveraging this data – a form of real-world data - can be valuable for quality improvement and contributing to the evidence-base to inform practice. Examining routine data may be especially useful for examining issues related to social justice such as health inequities. However, little is known about the extent to which RCD is utilised in health fields and published for wider dissemination.

Objectives
The objective of this scoping review is to document the peer-reviewed published research in allied health fields which utilise RCD and evaluate the extent to which these studies have addressed issues pertaining to social justice.

Methods
An enhanced version of the Arksey and O’Malley’s framework, put forth by Westphalm et al. guided the scoping review. A comprehensive literature search of three databases identified 1584 articles. Application of inclusion and exclusion criteria was piloted on 5% of the papers by three researchers. All titles and abstracts were screened independently by 2 team members, as were full texts. A data charting framework, developed to address the research questions, was piloted by three researchers with data extraction being completed by the lead researcher. A sample of papers were independently charted by a second researcher for reliability checking.

Results
One hundred and ninety papers were included in the review. The literature was diverse in terms of the professions that were represented: physiotherapy (33.7%) and psychology/mental health professions (15.8%) predominated. Many studies were first authored by clinicians (44.2%), often with clinical-academic teams. Some (33.25%) directly referenced the use of their studies to examine translation of research to practice. Few studies (14.2%) specifically tackled issues pertaining to social justice, though many collected variables that could have been utilised for this purpose.

Conclusion
Studies operationalising RCD can meaningfully address research to practice gaps and provide new evidence about issues related to social justice. However, RCD is underutilised for these purposes. Given that vast volumes of relevant data are routinely collected, more needs to be done to leverage it, which would be supported by greater acknowledgement of the value of RCD studies.
Barriers and facilitators to the implementation of PHAROS, a perioperative pharmaceutical management intervention for older adults – a qualitative interview study from the perspective of healthcare providers
Authors: Schönfeld Moritz Sebastian , Rinke Julia , Langebrake Claudia , Kriston Levente , Olotu Cynthia , Kiefmann Rainer , Bergelt Corinna 
Published: January 2025

Abstract

Background
Number of drugs are increasing with older age and present a risk factor for various adverse health outcomes. A comprehensive medication therapy management (MTM) before admission for elective surgery may help reduce unnecessary and potentially inadequate medications (PIM) and thus improve patient health. Our goal was to evaluate the implementation of PHAROS, a perioperative MTM intervention study, from the perspective of health care providers. The PHAROS intervention aimed to improve medication appropriateness in older inpatients at the outpatient / inpatient interface.

Methods
We performed a qualitative interview study within a pilot intervention study comparing a comprehensive MTM with standard care in older inpatients (≥ 65 years) in Germany. Semi-structured interviews with health care professionals were performed from March to July 2021. The Consolidated Framework for Implementation Research (CFIR) was used to guide development of interview guide, data coding, analysis, and reporting of findings.

Results
Ten health care professionals involved in the implementation of PHAROS were interviewed. Based on CFIR-constructs, facilitators included need for and meaningfulness of the intervention as well as positive and supportive cooperation within the project team. Implementation of MTM at the interface of inpatient to outpatient care before elective surgery was hampered by personal and organizational barriers as well as barriers resulting from broader health care structures in Germany. In particular, lack of documentation standards, missing compatibility with clinical workflow, difficulties in stakeholder engagement, as well as communication barriers between outpatient and inpatient care interfaces hindered implementation of the intervention.

Conclusions
Further studies should consider focusing on facilitators to pharmaceutical implementations such as transparent and clear communication structures between stakeholders, standardization of medication documentation, and intervention structures that are adapted to hospital workflows.

Trial registration

https://drks.de Identifier: DRKS00014621, this study was part of the PHAROS study.
Network analysis of caffeine use disorder, withdrawal symptoms, and psychiatric symptoms
Authors: Davoudi Mohammadreza , Abdoli Fatemeh , Momeni Fereshte , Asgarabad Mojtaba Habibi 
Published: January 2025

Abstract

Objective
Caffeine Use Disorder (CUD) is not currently recognized as a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). However, recent studies within the DSM-5 context have explored this issue. Also, this disorder is closely associated with caffeine withdrawal symptoms, which are formally recognized as a diagnosis in the DSM-5. Additionally, there is limited evidence regarding the connection between caffeine-related issues and psychiatric symptoms. The main aim of the present study was to determine the network structure of CUD and caffeine withdrawal symptoms among the general population. Also, the bridge symptoms among CUD, psychiatric symptoms, and caffeine withdrawal have been estimated.

Method
Participants were 1228 adults (50.3% females, Mean age (x̄±sd) 35.49 ± 11.70 years) who completed Caffeine Use Disorder Questionnaire (CUDQ), Caffeine Withdrawal Symptoms Questionnaire (CWSQ), and Symptom Checklist-25 (SCL-25). All estimations were conducted according to the Gaussian Graphical Model.

Results
“Excessive consumption” and “role obligations” were central symptoms in the CUD network. Difficulty in concentration was the most central node in the caffeine withdrawal network. Also, the obsessive-compulsive symptom emerged as a central and highly influential node in the relationship between caffeine-related nodes and psychiatric symptoms.

Conclusions
Mental health providers should target these specific symptoms in clinical interventions to mitigate caffeine-related problems among individuals in the general population effectively.
Pilot study of a ketogenic diet in bipolar disorder: a process evaluation
Authors: P. Rigby Benjamin , Needham Nicole , Grossi Helen , Kamenska Ivana , H. Campbell Iain , Meadowcroft Ben , Creasy Frances , Fisher Cheryl , Bahuguna Pankaj , Norrie John , Thompson Gerard , C. Gibbs Melissa , Mitchell-Grigorjeva Maja , McLellan Ailsa , Moses Tessa , Burgess Karl , Brown Rachel , J. Thrippleton Michael , Campbell Harry , J. Smith Daniel , A. Simpson Sharon 
Published: January 2025

Abstract

Background
Bipolar disorder is a serious mental illness, which requires new strategies for prevention and management. Recent evidence suggests that a ketogenic diet may be an effective intervention. This research aimed to explore the feasibility and acceptability of a ketogenic diet intervention for bipolar disorder, fidelity to its behavioural components and the experiences of the participants and research clinicians involved.

Methods
A mixed-methods process evaluation was conducted. Semi-structured telephone interviews were carried out with 15 participants 1–2 months after completing a 6–8 week modified ketogenic diet intervention, and 4 research clinicians from the study team following the completion of data collection. Data were thematically analysed. Fidelity checklists completed by research dietitians were analysed using descriptive count and percentage statistics. Findings are reported post-hoc, following the analysis and publication of the main pilot study findings. Reporting was guided by the COREQ checklist.

Results
Five themes were identified in the qualitative data: (1) ‘Encouraging entry and supporting exit’ (e.g. recognising and managing participants’ varied motives and expectations, including around weight loss and symptom alleviation); (2) ‘Challenging but potentially transformational,’ which reflects that while it can be difficult to initiate and maintain a ketogenic diet day-to-day, many participants perceived physical and psychological benefits (e.g. significant weight loss, mood stability and enhanced ability to focus); (3) ‘Intervention facilitators,’ including a range of behavioural (e.g. goal setting), social (e.g. family and dietitians) and technological (e.g. apps for monitoring) support mechanisms; (4) ‘Intervention barriers’ (e.g. dietary preferences, concerns about the diet and its impact, the testing burden and capacity of the delivery team); and (5) ‘The wider context’ (e.g. the cost of living and sociocultural expectations) was a crucial factor explaining differential experiences. Overall, descriptive analyses indicated moderate-to-good fidelity to the behaviour change components of the study.

Conclusion
We provide novel insight into the experiences of people living with bipolar disorder initiating and following a ketogenic diet, as well as those of research clinicians who support the intervention. Future trials may benefit from increased clinical research capacity, better-defined entry and exit routes, additional interpersonal support, and greater understanding of how social and societal factors impact participation.

Trial registration
Study registration number: ISRCTN61613198 (02/03/22).
Deep learning for the classification of atrial fibrillation using wavelet transform-based visual images
Authors: Sun Ling-Chun , Lee Chia-Chiang , Ke Hung-Yen , Wei Chih-Yuan , Lin Ke-Feng , Lin Shih-Sung , Hsiu Hsin , Chen Ping-Nan 
Published: January 2025

Abstract

Background
As the incidence and prevalence of Atrial Fibrillation (AF) proliferate worldwide, the condition has become the epicenter of a plethora of ECG diagnostic research. In recent diagnostic methodologies, Morse Continuous Wavelet Transform (MsCWT) is a feature extraction technique utilized to draw out distinctive attributes of ECG signals. In our study, we explore the employment of MsCWT in the classification of AF with ECG signals in a continuum.

Results
We present a MsCWT image-based deep learning machine for AF differentiation. For the training, validation, and test sets, we achieved average accuracies of 97.94%, 97.84%, and 91.32%; and overall F1 scores of 97.13%, 96.86%, and 89.41% respectively. Moreover, AUC ROC curves of over 0.99 were obtained for all classes in the training and validation sets; and were over 0.9679 for the test set.

Conclusions
Training deep learning machines for the classification of AF with MsCWT-based images demonstrated to yield favorable outcomes and achieved superior performance amongst studies utilizing the same dataset. Though minimal, the conversion of signals into wavelet form with MsCWT may drastically improve outcomes not only in future ECG signal studies; but all signal-based diagnostics.