bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interannual Variability of Barrier Layer in the Tropical Atlantic and Its Relationship with the Tropical Atlantic Modes
Authors: Ma Xiao , Liu Hailong , Wang Xidong 
Published: November 2022

Abstract
This study reveals the role of the tropical Atlantic variability in modulating barrier layer thickness (BLT) in peak seasons. Based on reanalysis data during 1980–2016, statistical and dynamical analyses are performed to investigate the mechanism of BLT variability associated with the tropical Atlantic modes. The regions with significant correlation between BLT and tropical Atlantic modes are located on the northwest and southeast coasts of the tropical Atlantic, which are consistent with BLT maximum variability regions. In boreal spring, BLT decreases in the northwest because less latent heat release affected by weak trade wind related to the Atlantic meridional mode (AMM) shoals the isothermal layer depth (ITLD). In the south equatorial Atlantic, deepened mixed layer depth (MLD) is controlled by the decreasing freshwater input brought by a northward shift of the intertropical convergence zone (ITCZ) and further leads to a thinner barrier layer (BL). However, a shoaling MLD appears in the north equatorial Atlantic, which results from excessive freshwater input, causing a thick BL there. In boreal summer, positive runoff anomaly caused by the Atlantic equatorial mode (AEM) leads to upper warming of the tropical northwest Atlantic and a shallowing ITLD, favoring a thinner BL there. However, a southward shift of ITCZ brings more freshwater into the south equatorial Atlantic, inducing a shallowing MLD as well as a thicker BL. AEM-driven horizontal heat advection of the south equatorial current contributes to a thick ITLD in the central southern tropical Atlantic and thus increases BLT.

Significance Statement
This research aims to reveal how the tropical Atlantic meridional and equatorial interannual climatic modes affect barrier layer thickness (BLT). These two climate modes can affect the wind field, ocean current, and precipitation through air–sea interaction processes, and further affect mixing, heat–salt transport, and stratification in the upper ocean and thus BLT. This finding is important because the barrier layer restricts the exchange of heat, momentum, mass, and nutrients between the mixed layer and the thermocline, thereby impacting local and remote weather events, the ecological environment, and the climate. Our results provide guidance for interpreting the interannual variability of BLT in the tropical Atlantic.
Hartmann’s Reversal is More Complex Than Elective Left Colectomy
Authors: Nasseri Yosef , Liu Andy , Kasheri Eli , Oka Kimberly , Cohen Jason , Ellenhorn Joshua , Bergamaschi Roberto , Barnajian Moshe 
Published: November 2022

Background Hartmann’s reversal (HR) is associated with significant technical complexity and morbidity. The decision to perform HR is difficult and up to 50% of patients with colostomies do not undergo a reversal. To better guide surgeons and patients with this decision, we sought to assess the surgical risks and outcomes of HR as compared to elective left colectomy (LC). Methods We conducted a retrospective analysis of a prospective database at a tertiary medical center. Patients undergoing elective Hartmann’s reversal and left colectomy between January 2014 and November 2021 were identified. We compared preoperative variables, intraoperative events, and short-term postoperative outcomes. Results 135 patients were identified: 30 HR and 105 LC. There were no significant differences in demographics or preoperative comorbidities between HR and LC. There were more open and fewer robotic cases in HR (23.3% vs 2.9%, P < .0001; 46.6% vs 76.0%, P < .01). Total operative time was significantly longer in HR than LC (261.8 vs 211.7 minutes, P = .02). There was a significantly higher percentage of intraoperative complications in HR (13.3% vs 1.9%, P < .01). There was a significantly higher rate of minor postoperative complications in HR than LC (46.7% vs 26.7%, P = .04), but not major (6.7% vs 5.8%, P = .85). Time to first flatus/bowel movement was significantly longer in HR than LC (3.6 vs 2.5 days, P < .001). Conclusion Hartmann’s reversal is a more technically challenging operation than elective left colectomy and is associated with significantly higher rates of intraoperative and minor postoperative complications. Future studies should focus on mitigating these risk factors to optimize patient outcomes.
Why patients in specialist palliative care in-patient settings are at high risk of falls and falls-related harm: A realist synthesis
Authors: Louise Forrow Helen , Lhussier Monique , Scott Jason , Atkinson Joanne 
Published: November 2022

Background: Falls are the third highest reported safety incident in Specialist Palliative Care in-patient settings and yet specific risk factors connected with falling and associated outcomes in this setting are poorly understood. Aim: To understand the key individualised risk factors leading to falls in specialist in-patient palliative care settings and understand the implications and outcomes for the patients who fall. Design: A realist synthesis of the literature, reported following the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) standards. Data sources: An iterative literature search was conducted across three recognised health collections as well as grey literature from policy, practice and other relevant areas. Results: Falls taking place within in-patient specialist palliative care settings can cause significant harm to patients. The risk factors for these patients are multifaceted and often interlinked with underpinning complex realist mechanisms including a history of falls, the age of the person, impact of complex medications, improving functional status and the presence of delirium. Conclusion: In-patients in specialist palliative care settings are at risk of falling and this is multifactorial with complex reasoning mechanisms underpinning the identified risks. There is a significant impact of a fall in this cohort of patients with many sustaining serious harm, delayed discharge and both physical and psychological impacts.
Liquidity shocks and pension fund performance: Evidence from early access
Authors: Brugler James , Kim Minsoo , Zhong Zhuo 
Published: November 2022

We study how expectations of fund flows causally affect fund performance by exploiting a quasi-natural experiment in the Australian pension system where an unexpected policy change temporarily allowed fund withdrawals from a prespecified date in the future. Using fractions of young members, middle-aged members, and government co-contributions for low-income earners as instrumental variables, we find an insignificant effect of expected fund outflows on performance. A potential explanation is that Australian superannuation funds preemptively engage in liquidity management in response to changes in expectations of future fund flows and this helps to limit direct and indirect costs in the rebalancing process. JEL Classification: G11, G12, G14, G23, G51
Early Postoperative CT Scan Provides Prognostic Data on Clinical Outcomes of Fresh Osteochondral Transplantation of the Knee
Authors: Gelber Pablo Eduardo , Ramírez-Bermejo Eduard , Fariñas Oscar 
Published: November 2022

Background: There is a lack of information regarding the ability of imaging studies to predict clinical outcomes after fresh osteochondral allograft (FOCA) transplantation of the knee. Purpose: To determine the value of computed tomography (CT) scans to predict the clinical outcome of FOCA transplantation using the assessment computed tomography osteochondral allograft (ACTOCA) score. Study Design: Cohort study; Level of evidence, 3. Methods: We prospectively collected data from all consecutive patients who underwent FOCA transplantation for osteochondral knee lesions at one institution between August 2017 and August 2019. All patients were followed up for a minimum of 2 years. CT scans performed 6 months after surgery were evaluated by a musculoskeletal radiologist using the ACTOCA scoring system. The radiologist was blinded to the patient’s medical history. Clinical outcomes were assessed preoperatively and at 12 and 30 months postoperatively using the International Knee Documentation Committee (IKDC) score, the Kujala score, the Tegner activity scale, and the Western Ontario Meniscal Evaluation Tool (WOMET) score. Results: A total of 38 cases were included. The ACTOCA score at 6 months after surgery showed a statistically significant correlation with clinical results at 12 and 30 months. The correlation was better at 30 months, showing a high negative correlation with the IKDC score (−0.663) and a moderate negative correlation with the Kujala, WOMET, and Tegner scores (−0.593; −0.547, and −0.593, respectively) ( P < .001). Conclusion: A statistically significant correlation between the mean ACTOCA score on CT scans at 6 months and the clinical results measured by the IKDC, Kujala, WOMET, and Tegner scores at 30 months confirmed the predictive value of the ACTOCA score for use in clinical practice.
Comparisons of Outcomes of Chin Implantation Using the Transoral Versus Submental Technique: A Systematic Review
Authors: Best Corliss , Best Brittany , Choi Ji Yun , Sykes Jonathan , Javidnia Hedyeh 
Published: November 2022

Background: Chin implantation is a commonly performed facial plastic surgery procedure. There are 2 approaches to this procedure: submental and transoral. There is no consensus as to which is the best and safest approach. Objective: The objective of this review is to ascertain the risks and benefits of using an intraoral versus submental approach for chin implantation. Methods: A systematic review of all articles published in MEDLINE, Embase, Cochrane Library, and Google Scholar was performed from 1966 to 2020. Results: A total of 1410 articles were reviewed and 38 were chosen for the review based on predetermined selection criteria. Total complication rates in the transoral group ranged from 0% to 14.7%, whereas total complication rates in the submental group ranged from 0% to 15%. No clear difference in the rates of any specific complication was found between the 2 groups. Conclusion: There is no demonstrated difference in complication rates between the 2 approaches to chin implantation. Individual patient assessment and surgeon preference remain the most important determinants of surgical approach.
Use, response and outcomes of second-line chemotherapy in patients with advanced biliary tract cancers
Authors: Mathers Brittney , Abadi Shirin , Davies Janine M , McIntyre Connor , Ho Cheryl 
Published: November 2022

Introduction First-line chemotherapy for advanced biliary tract cancers has been established as gemcitabine and cisplatin; however, there is currently no recognized standard second-line chemotherapy. The purpose of this study is to review and evaluate the outcomes of second-line chemotherapy for advanced biliary tract cancers. Methods Patients who received chemotherapy for unresectable or metastatic biliary tract cancers at BC Cancer between August 2009 and December 2015 were retrospectively studied to identify second-line chemotherapy treatments used and to determine overall survival, time-to-treatment discontinuation and characteristics predicting for improved overall survival. Results Of 325 patients who received first-line chemotherapy for advanced biliary tract cancer, 90 (30%) received second-line chemotherapy. Median overall survival for patients who received only first-line chemotherapy was 9.5 months versus 17.3 months for patients who received second-line chemotherapy. Median time-to-treatment discontinuation for second-line chemotherapy was 2.0 months. Common drugs used in second-line chemotherapy treatments included capecitabine (30%), 5-fluorouracil and irinotecan (17%) and 5-fluorouracil monotherapy (15%). There was no difference in overall survival for patients who received single-agent second-line chemotherapy compared to doublet second-line chemotherapy Conclusions Patients who are fit enough to receive second-line chemotherapy may benefit in terms of overall survival and should be offered treatment with single-agent therapy. Capecitabine was the most common second-line chemotherapy treatment. The improved median overall survival for patients who received second-line chemotherapy may be impacted by independent patient-specific factors which are unknown at this time.
Caring from a distance: how a COVID-19 visitor ban affects relatives when a loved one is admitted to a neurological or neurosurgical ward
Authors: Loft Mia I , Guldager Rikke , Poulsen Ingrid 
Published: November 2022

Background Neurological patients often suffer physical, cognitive, communicative, behavioural or psychosocial limitations. This may weaken the preconditions for participating in decisions about their treatment, rehabilitation and future. These impairments often cause relatives to care and advocate for the patient. This practice was gravely interrupted by the COVID-19 visitor ban. Aims This study aims to investigate how relatives of neurological patients experienced the visitor ban and to identify potential areas for improvement. Methods Twelve semi-structured interviews with relatives of neurological patients were conducted. Data were analysed by performing a thematic analysis inspired by Braun and Clark. Results The following six themes emerged: Visitor ban as a necessary evil, Losing control and feeling checkmate, Mending the information gap, Waiting by the phone, Empathy and compassion as the core of a good relationship and Caring for a loved one from a distance. Conclusions Having a loved one admitted to a neurological ward during the COVID-19 visitor ban greatly restrains relatives and affects the relationship with their loved one and the hospital healthcare staff. Healthcare staff need to take responsibility and reach out, while simultaneously exploring new ways of communicating.
Moral distress experienced by neonatal intensive and paediatric care nurses in Northern Ghana: a qualitative study
Authors: Afoko Vivian , Hewison Alistair , Neilson Susan , Newham Roger 
Published: November 2022

Background: Moral distress has been studied widely in nursing but not in developing economies. Aim: To investigate how moral distress is experienced by nurses working in neonatal intensive care and paediatric wards in Northern Ghana and to determine support measures offered by nurse managers. Method: Qualitative descriptive method. Forty nurses and fourteen nurse managers working with children in four hospitals in Northern Ghana were interviewed. Thematic data analysis was carried out. Results: Six themes were identified: nurses experience morally distressing situations due to a variety of causes; the impact of morally distressing situations on nurses; coping mechanisms of nurses who experienced morally distressing situations; recommendations made by the nurses to reduce the incidence of moral distress; inadequate support measures available to nurse managers and nurse managers experience moral distress too. Conclusion: The causes of moral distress in developed and developing economies are similar. The frequency and intensity of moral distress is high in Northern Ghana. Consistent with other studies conducted in Africa, nurses and nurse managers relied on their religious faith as a form of resilience. No support measures are available to nurse managers to support nurses who experience moral distress.
Coaching special Olympics: A scoping review
Authors: Turgeon Stéphanie , Turgeon Jessica , Morin Diane 
Published: November 2022

Background Special Olympics enables individuals with an intellectual disability across all continents to take part in sport year-round. Through its mission, Special Olympics provides a setting for athletes that aims to foster performance, participation, and personal development. Coaches play a central role in achieving these outcomes. As such, this scoping review aims to answer the following question: What is known about Special Olympics’ coach training and practices? Method Our scoping review was conducted according to Peters et al.'s (2020) guidelines. Keywords pertaining to Special Olympics, Program evaluation, and Coaches were searched in six databases to extract articles published between 1988 and October 1, 2021. Results In all, 16 studies were included in our scoping review. Of these studies, nine included information on coach training and 13 included information on coach practices. No randomized control trials were identified. Conclusions There is currently very little knowledge on Special Olympics coach training and practices. Moreover, there is no existing data to support the effectiveness of Special Olympics coaches formal training on coaches’ practices nor on athletes’ outcomes. There is an urgent need for research in this field.
Data collection framework for electronic medical record-based real-world data to evaluate the effectiveness and safety of cancer drugs: a nationwide real-world study of the Korean Cancer Study Group
Authors: Han Hye Sook , Lee Kyoung Eun , Suh Young Ju , Jee Hee-Jung , Kim Bum Jun , Kim Hyeong Su , Lee Keun-Wook , Ryu Min-Hee , Baek Sun Kyung , Park In Hae , Ahn Hee Kyung , Jeong Jae Ho , Kim Min Hwan , Lee Dae Hyung , Kim Siheon , Moon Hyemi , Son Serim , Byun Ji-Hye , Kim Dong Sook , An Hyonggin , Park Yeon Hee , Zang Dae Young 
Published: November 2022

Background: Electronic medical records (EMRs) have the highest value among real-world data (RWD). The aim of the present study was to propose a data collection framework of EMR-based RWD to evaluate the effectiveness and safety of cancer drugs by conducting a nationwide real-world study based on the Korean Cancer Study Group. Methods: We considered all patients who received ramucirumab plus paclitaxel (RAM/PTX) for gastric cancer and trastuzumab emtansine (T-DM1) for breast cancer at relevant institutions in South Korea. Standard operating procedures for systematic data collection were prospectively developed. Investigator reliability was evaluated using the concordance rate between the recommended input value for representative fictional cases and the input value of each investigator. Reliability of collected data was evaluated twice during the study period at three institutions randomly selected using the concordance rate between the previously collected data and data collected by an independent investigator. The reliability results of the investigators and collected data were used for revision of the electronic data capture system and site training. Results: Between the starting date of medical insurance coverage and December 2018, a total of 1063 patients at 56 institutions in the RAM/PTX cohort and 824 patients at 60 institutions in the T-DM1 cohort were included. Mean investigator reliability in the RAM/PTX and T-DM1 cohorts was 73.5% and 71.9%, respectively. Mean reliability of collected data in the RAM/PTX and T-DM1 cohort was 90.0% for both cohorts in the first analysis and 89.0% and 84.0% in the second analysis, respectively. Mean missing values of the RAM/PTX and T-DM1 cohorts at the time of simulation of fictional cases and final data analysis decreased from 20.7% to 0.46% and from 18.5% to 0.76%, respectively. Conclusion: This real-world study provides a framework that ensures relevance and reliability of EMR-based RWD for evaluating the effectiveness and safety of cancer drugs.
Impact of COVID social distancing measures on eating and exercise behaviors among a sample of Hispanic parents of young children in the United States
Authors: Vazquez Christian E , Hess Katherine E , McBride Megan J , Cubbin Catherine , Bearman Sarah Kate , Calzada Esther J 
Published: November 2022

Background: In the United States, healthy behaviors, such as eating fruits/vegetables and exercise, are well below recommended levels, particularly for Hispanics. The COVID pandemic may have exacerbated existing health behavior disparities. The current study examines the impact of COVID social distancing measures on Hispanic parents’ eating and exercise behaviors, and how the impact may differ by socioeconomic status (SES) and distress levels. Design and methods: This cross-sectional logistic regression study utilized data from a sample of Hispanic parents in Texas ( n = 237). COVID-related questions were collected in Summer 2020. Dependent variables included self-reported changes in exercise and eating behaviors due to the pandemic (i.e. got better or got worse). Primary independent variables included family-SES, neighborhood-SES, and distress due to COVID. Results: More than half (60%) of parents reported that their eating and exercise behaviors worsened. Results showed a significant relationship between distress due to COVID and both dependent variables; changes in eating (OR = 1.38, 95% CI [1.20, 1.58]) and changes in exercise (OR = 1.28, 95% CI [1.11, 1.48]). There were no observed differences by SES. Conclusions: Results suggest distress due to COVID was associated with worsening of eating and exercise behaviors, regardless of SES. The direction of the relationship between distress and healthy eating and exercise behaviors requires further attention.
How I diagnose and treat atypical hemolytic uremic syndrome
Authors: Fakhouri Fadi , Schwotzer Nora , Frémeaux-Bacchi Véronique 
Published: November 2022

AbstractOur understanding and management of atypical hemolytic uremic syndrome (aHUS) have dramatically improved in the last decade. aHUS has been established as a prototypic disease resulting from a dysregulation of the complement alternative C3 convertase. Subsequently, prospective nonrandomized studies and retrospective series have shown the efficacy of C5 blockade in the treatment of this devastating disease. C5 blockade has become the cornerstone of the treatment of aHUS. This therapeutic breakthrough has been dulled by persistent difficulties in the positive diagnosis of aHUS, and the latter remains, to date, a diagnosis by exclusion. Furthermore, the precise spectrum of complement-mediated renal thrombotic microangiopathy is still a matter of debate. Nevertheless, long-term management of aHUS is increasingly individualized and lifelong C5 blockade is no longer a paradigm that applies to all patients with this disease. The potential benefit of complement blockade in other forms of HUS, notably secondary HUS, remains uncertain.