bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of the Circulation Patterns in Projected Changes in Spring and Summer Precipitation Extremes in the U.S. Midwest
Authors: Chen Liang , Ford Trent W. , Swenson Erik 
Published: December 2022

Abstract
Recent studies suggest springtime wet extremes and summertime dry extremes will occur more frequently in the U.S. Midwest, potentially leading to devastating agricultural consequences. To understand the role of circulation patterns in the projected changes in seasonal precipitation extremes, the k-means clustering approach is applied to the large-ensemble experiments of Community Earth System Model, version 2 (CESM2-LE), and ensemble projections of CMIP6. We identify two key atmospheric circulation patterns that are associated with the extremely wet spring and extremely dry summer in the U.S. Midwest. The springtime wet extremes are typically linked to baroclinic waves with a northward shift of the North American westerly jet and positive anomalies in sea level pressure over the western Atlantic, which favor the development of the Great Plains low-level jet. The summertime dry extremes are associated with the development of an anomalous ridge with suppressed storm tracks over the central United States. The projected increase in springtime wet extremes and summertime dry extremes can be attributed to significantly more frequent occurrences of the associated atmospheric regimes. Particularly, the intensity of wet extremes is expected to increase mainly due to the enhanced moisture flux from the Gulf of Mexico. The moisture budget analysis suggests that the precipitation extremes are mainly associated with the dynamic component of atmospheric circulation. CESM2-LE and CMIP6 exhibit good agreement in the projected changes in circulation patterns and precipitation extremes. Our results explain the mechanism of the projected changes in the Midwest seasonal precipitation and highlight the contribution of circulation patterns to hydroclimatic extremes.
Capturing and Attributing the Rainfall Regime Intensification in the West African Sahel with CMIP6 Models
Authors: Chagnaud G. , Panthou G. , Vischel T. , Lebel T. 
Published: December 2022

Abstract
Rainfall in the Sahel is extremely variable on daily to multidecadal time scales, challenging climate models to realistically simulate its past and future evolution and questioning their relevance for defining suitable climate change adaptation strategies. Improving confidence in climate models may be achieved by (i) evaluating their capacity for reproducing observed climatic evolution and (ii) attributing these evolutions. Moreover, there is a need to consider relevant climatic indicators, from an end-user point of view. Fully coupled (CMIP6-AOGCM) models with idealized detection and attribution forcings (DAMIP) as well as atmosphere-only simulations (AMIP) are used to investigate the respective roles of external forcing factors and internal climate variability in the observed intensification of the Sahelian rainfall regime. We show that CMIP6 models contain signs of the intensification of the rainfall regime as detected over the past 35 years from a regional daily observations network. Both the increase in intensity and occurrence of wet days, as well as that of extreme daily rainfall, are remarkably well reproduced by historical simulations incorporating anthropogenic forcing factors, with anthropogenic aerosols contributing the largest share of this trend. Though more strongly affected by model structure uncertainty, the greenhouse gas forcing also displays noticeably robust features. Models are shown to fail at simulating the observed dry extreme evolution. These findings give incentive for further investigating the underlying physical mechanisms that drive the Sahelian rainfall regime evolution at regional to subregional scales. Furthermore, future hydroclimatic trajectories in the Sahel should be explored, though particular caution is required as to which rainfall indicator to consider.

Significance Statement
The rainfall regime at a particular location is crucial to human and ecosystem livelihoods. Changes in rainfall regime characteristics on multidecadal time scales result from both the effects of external forcing factors on the climate and of its internal variability, with this latter aspect becoming more prominent on small spatial scales. In this study, several state-of-the-art climate simulations are used to document the rainfall regime evolution of the past 65 years in the Sahel, in terms of amplitude, timing, and causes. It is shown that large-scale anthropogenic factors have a substantial imprint, modulated to some extent by internal variability. These findings demonstrate that coarse-resolution climate models are a well-suited tool to investigate the recent intensification of rainfall in the Sahel, and may provide valuable information for climate change adaptation planning.
Multitasking While Driving: Central Bottleneck or Problem State Interference?
Authors: Held Moritz , Rieger Jochem W. , Borst Jelmer P. 
Published: December 2022

Objective The objective of this work was to investigate if visuospatial attention and working memory load interact at a central control resource or at a task-specific, information processing resource during driving. Background In previous multitasking driving experiments, interactions between different cognitive concepts (e.g., attention and working memory) have been found. These interactions have been attributed to a central bottleneck or to the so-called problem-state bottleneck, related to working memory usage. Method We developed two different cognitive models in the cognitive architecture ACT-R, which implement the central vs. problem-state bottleneck. The models performed a driving task, during which we varied visuospatial attention and working memory load. We evaluated the model by conducting an experiment with human participants and compared the behavioral data to the model’s behavior. Results The problem-state-bottleneck model could account for decreased driving performance due to working memory load as well as increased visuospatial attentional demands as compared to the central-bottleneck model, which could not account for effects of increased working memory load. Conclusion The interaction between working memory and visuospatial attention in our dual tasking experiment can be best characterized by a bottleneck in the working memory. The model results suggest that as working memory load becomes higher, drivers manage to perform fewer control actions, which leads to decreasing driving performance. Application Predictions about the effect of different mental loads can be used to quantify the contribution of each subtask allowing for precise assessments of the current overall mental load, which automated driving systems may adapt to.
Factors associated with COVID-19 vaccination for patients in an inpatient forensic psychiatric hospital
Authors: McCulley Lauren N. , Lang Shelby E. , Kriz Carrie R. , Iuppa Courtney A. , Nelson Leigh Anne , Gramlich Nicole A. , Elliott Ellie S. R. , Sommi Roger W. 
Published: December 2022

Objective The aim of this study was to assess factors associated with SARS-CoV-2 (COVID-19) vaccination in patients in 2 inpatient forensic psychiatric hospitals. Methods This was a retrospective chart review evaluating factors associated with COVID-19 vaccination for patients residing in two inpatient forensic psychiatric hospitals between January 1, 2021 and February 28, 2022. Data was collected through electronic medical records utilizing MetaCare Enterprise™ and secure facility computer drives, individual patient paper charts, and Missouri’s vaccination records database, ShowMeVax. Several variables were collected to assess factors associated with COVID-19 vaccination. Additionally, COVID-19 vaccination rates were compared to the influenza vaccination rates at these hospitals. Results Overall, 229 patients (84.5%) were vaccinated against COVID-19 during or before the study period and 42 (15.5%) were unvaccinated. Patients who were deemed incompetent to stand trial were less likely to receive the COVID-19 vaccine. Those that had a higher body mass index (BMI), were diagnosed with multiple comorbid conditions, not prescribed involuntary medications, were offered incentives, and received the influenza vaccine were more likely to receive the COVID-19 vaccine. Education level, race, sex, age, and being prescribed psychiatric medications did not affect vaccination status. Conclusions Patient specific factors should be used when educating and offering COVID-19 vaccines to patients in an inpatient forensic psychiatric unit. Awareness of these results can facilitate targeted interventions for optimal care in a psychiatric population.
Epoxidized natural rubber composites containing K0.15Cr0.02Ni0.83O nanoparticles: Curing characteristics, dynamic mechanical, mechanical, morphological, and dielectric properties
Authors: Khumpaitool Bualan , Jantachum Punyarat , Utara Songkot 
Published: December 2022

Many researchers have been trying to improve rubber composites because they are commonly used in a wide range of applications. Incorporation of nano-fillers in a rubber matrix is the most acceptable way to improve the mechanical and electrical properties of rubber composites. A nanometer-sized filler, such as K0.15Cr0.02Ni0.83O (KCNO), has rarely been used to improve the properties of rubber composites. Epoxidized natural rubber (ENR) was chosen for blending with KCNO nanoparticles based on its polarity and chemical resistance. The aim of this work is to investigate the effects of filler loading (0.5, 1.5, and 5 phr) on the curing characteristics, dynamic mechanical, mechanical, morphological, and dielectric properties of rubber composites. From the results, rubber vulcanizates with 1.5 phr of KCNO as filler exhibit better tensile strength and 500% modulus compared to other ENR specimens containing KCNO. ENR containing 1.5 phr of KCNO also has a higher storage modulus (E′) and glass transition temperature (Tg). The results of a microstructural characterization on a sample containing 1.5 phr of KCNO show that the natural rubber matrix and KCNO are effectively dispersed, indicating that the rubber and KCNO are likely well-matched, therefore curing simultaneously and forming a continuous phase. Furthermore, ENR containing 1.5 phr of KCNO has a greater dielectric constant (12.87 at 5 kHz) than other samples.
Relationships of Low Cognitive Performance and Sleep Disorder With Functional Disabilities Among Older Adults
Authors: Alam Rifat , Quintero Silva Laura , Jahan Nilufer , Chodzko-Zajko Wojtek , Ogunjesa Babatope , Selzer Ninomiya Ana , Schwingel Andiara 
Published: December 2022

Objectives This study examined the relationships of low cognitive performance and sleep disorder with functional disabilities among older adults. Methods: NHANES 2011–2014 data on 3179 individuals [Mage=69.71] were analyzed. Functional domains included: activities of daily living (ADL), instrumental ADL (IADL) and leisure and social activities (LSA). Animal Fluency Test and the Digit Symbol Substitution Test assessed cognitive performance. Participants self-reported having physician-diagnosed sleep disorder. Results: Participants with both low cognitive performance and sleep disorder had 4- to 10-times greater odds for ADL, IADL, and LSA difficulties compared to the participants with no low cognitive performance/sleep disorder. Participants with only low cognitive performance and those with only sleep disorder were two to three times more likely to experience these difficulties. Discussion: Low cognitive performance and sleep disorder together or independently were associated with functional disabilities. Participants with both low cognitive performance and sleep disorder had higher odds of functional disabilities.
Different pregnancy outcomes in patients with systemic lupus erythematosus treated with belimumab
Authors: Lai Yupeng , Li Bin , Huang Jiaming , Du Jingning , Yue Mengli , Shen Xin , Liu Xingjiao , Huang Lingfeng , Lin Jiehua , Yang Aicheng , Wang Meiying 
Published: December 2022

Objectives Systemic lupus erythematosus (SLE) predominantly occurs in women of child-bearing age. Selecting drugs for pregnant SLE patients has always been a difficult choice. Although there have been several reports of safety of belimumab in SLE patients during pregnancy, the data are far from sufficient. Methods We report on 4 cases of belimumab exposure in pregnant SLE patients. We also summarized 6 case reports and case series which were previously published. Further, we compared the different outcomes among SLE patients and their babies who continued with belimumab during pregnancy with those who discontinued belimumab in early pregnancy. Results Two cases discontinued belimumab in the early pregnancy, while the other two received belimumab until the late pregnancy. All the four women tolerated belimumab. Newborns have all developed normally and continue without complications during 1 year of follow-up. Conclusion In this small case series, we found that belimumab was well tolerated in pregnant SLE patients. There were no safety signals for the mothers or their babies.
Influencing factors of self-disclosure and its impact on quality of life in patients with systemic lupus erythematosus
Authors: Hu Yang , Gao Rui-Chen , Sang Ni , Wu Li , Shi Pei-Li , Wu Guo-Cui 
Published: December 2022

Background Self-disclosure may enhance positive illness perceptions, whereas patients with systemic lupus erythematosus (SLE) always facing negative illness perceptions due to multiple reasons, so elucidation of factors affecting self-disclosure may facilitate the development of quality of life. Methods A total of 161 hospitalized patients with SLE were recruited. Scales on demographic and clinical characteristics, self-disclosure, psychosocial status (e.g. Social Support Rating Scale – SSRS) and quality of life were used to collect related information from clients. Univariate analysis was performed by Kruskal–Wallis rank-sum test or chi-square test, and multivariate analysis by ordinal logistic regression. Results Social support, drinking, depression and cause of hospitalization were found to be influencing factors of self-disclosure. Multiple logistic regression analyses revealed that the significant and independent factors associated with self-disclosure in patients with SLE were social support, drinking and depression. Domains of LupusQoL, except physical health and fatigue, were positively correlated with self-disclosure. Conclusions With the increase of social support, the level of self-disclosure become worse, drinking, depression and cause of hospitalization are risk factors for it. Moreover, the level of self-disclosure is positively related to the LupusQoL. Medical staff should formulate effective measures according to the results to improve self-disclosure in patients with SLE and promote their quality of life.
Safety and Effectiveness of Medical Therapy and Surgical Intervention for Renal Angiomyolipoma Associated With Tuberous Sclerosis Complex
Authors: Wang Zhiyu , Zhang Wei , Fan Yafeng , Zhang Xuepei 
Published: December 2022

Purpose Our study aimed to evaluate the effect of daily oral dose of everolimus in the treatment of patients with tuberous sclerosis complex (TSC) associated with renal angiomyolipoma (RAML), and the feasibility and safety of surgical treatment approach. Methods We retrospectively investigated a total of 13 patients diagnosed of TSC-associated renal angiomyolipoma (TSC-RAML) who were scheduled for everolimus therapy. At 3-9 months after starting everolimus therapy, 4 of the study patients were symptomatic and underwent partial renal resection surgery. Two of these surgeries were performed open nephron sparing surgery (NSS) after TAE (Trans-arterial embolization), while the remaining 2 underwent robot-assisted partial nephrectomy (RAPN). A multi-slice helical CT scan performed among all the patients every 3 months, which was used to measure the volume and the density of the lesion. Results Follow-up CT images revealed a significant reduction (P < .05) in the RAML volume, at a rate ranging from 11.6 to 42.5%, in response to everolimus therapy (10 mg/day) in TSC-RAML patients. Further, a significant decrease in the mean tumor density (P < .05), as compared to its baseline value, was also observed. Super-selective renal arterial embolization done prior to NSS was effective in reducing the intraoperative bleeding and stabilizing the patient during the NSS procedure: mean warm ischemia time was 29.5 minutes (range 18-40 minutes) and mean intraoperative bleeding volume was 275 mL (range 200-350 mL). Post-surgical (both NSS and RAPN) follow-up showed a favorable perioperative morbidity profile with good renal functional preservation. At the end of 2 years, all patients were well, with no signs of progression or recurrence of the condition, and demonstrated normal renal function. Conclusions The results suggested oral everolimus as an effective non-invasive therapy to treat TSC-RAML patients. Post mTOR inhibitor therapy, NSS and RAPN are preferred mode of surgical intervention in symptomatic patients. TAE prior to NSS is beneficial.
Management of inflammation in dry eye disease: Recommendations from a European panel of experts
Authors: Messmer Elisabeth M , Ahmad Sajjad , Benitez del Castillo José M , Mrukwa-Kominek Ewa , Rolando Maurizio , Vitovska Oksana , Baudouin Christophe ,   on behalf of a panel of European dry eye disease experts
Published: December 2022

Introduction Early initiation of anti-inflammatory therapies is recommended for dry eye disease (DED) to break the vicious cycle of pathophysiology. However, there is limited guidance on how to implement topical ciclosporin (CsA) and corticosteroid treatment into clinical practice. This expert-led consensus provides practical guidance on the management of DED, including when and how to use topical CsA. Methods A steering committee (SC) of seven European DED experts developed a questionnaire to gain information on the unmet needs and management of DED in clinical practice. Consensus statements on four key areas (disease severity and progression; patient management; efficacy, safety and tolerability of CsA; and patient education) were generated based on the responses. The SC and an expanded expert panel of 22 members used a nine-point scale (1  =  strongly disagree; 9  =  strongly agree) to rate statements; a consensus was reached if ≥75% of experts scored a statement ≥7. Results A stepwise approach to DED management is required in patients presenting with moderate corneal staining. Early topical CsA initiation, alone or with corticosteroids, should be considered in patients with clinical risk factors for severe DED. Patient education is required before and during treatment to manage expectations regarding efficacy and tolerability in order to optimise adherence. Follow-up visits are required, ideally at Month 1 and every 3 months thereafter. Topical CsA may be continued indefinitely, especially when surgery is required. Conclusion This consensus fills some of the knowledge gaps in previous recommendations regarding the use of topical corticosteroids and CsA in patients with DED.
Femtosecond laser-assisted Bowman layer transplantation for advanced keratoconus
Authors: Barbosa Gonçalves Thiago , Forseto Adriana dos Santos , Martins Anderson de Lima , Pereira Nicolas Cesário 
Published: December 2022

Background/Aims To assess the technical feasibility and outcomes of femtosecond laser-assisted Bowman layer transplantation (FLABOLT) in stabilizing progressive, advanced keratoconus, which is ineligible for corneal crosslinking. Methods This single-center retrospective study included 50 eyes of 49 patients with progressive advanced keratoconus, ineligible for corneal crosslinking, that underwent FLABOLT with both the donor graft and recipient mid-stromal pocket using a femtosecond laser. Results The mean follow-up was 13.2 ± 4.9 months (range 7–35 months). Donor graft preparation and accurate dissection of the recipient mid-stromal pocket were successful in 96% and 100% of cases, respectively. The mean maximum keratometry decreased by 1.93 D at 6 months after surgery and there was no change in the mean preoperative best contact lens-corrected visual acuity (BCLVA). Three eyes developed hydrops postoperatively and recovered after clinical treatment. One eye that achieved useful BCLVA postoperatively, worsened 2 years after the surgery due to progressive corneal scarring and required corneal transplantation for visual rehabilitation. Preoperative corneal scarring was a risk factor for BCLVA loss. All other eyes remained stable (92%), and no other procedure was required until the last follow-up. Conclusion In this series, FLABOLT was successfully performed as an alternative to stabilize advanced progressive keratoconus. This technique is highly reproducible for graft preparation and recipient pocket dissection when assisted by femtosecond laser. Despite promising initial results, more studies with longer follow-up periods are needed to evaluate the effectiveness of FLABOLT in stabilizing advanced progressive keratoconus.
Mohs Micrographic Surgery for Facial Merkel Cell Carcinoma
Authors: Nguyen Brian J. , Meer Elana A. , Bautista Sana A. , Kim Diana H. , Etzkorn Jeremy R. , McGeehan Brendan , Miller Christopher J. , Briceno Cesar A. 
Published: December 2022

Background Merkel cell carcinoma (MCC) is a rare malignant cutaneous tumor with frequent metastases. They often appear in the face where cosmetic and functional outcome is critical. Mohs micrographic surgery (MMS) is a controlled intervention that optimizes negative margins without sacrificing tissue. Objective A comprehensive assessment of outcomes of MMS-treated facial MCC will help guide clinicians in surgical and medical management. Methods & Materials Retrospective review identified facial MCC cases treated with MMS at a single institution from January 2005 to August 2020. Tumor characteristics and outcomes were recorded and descriptive and predictive analyses were performed. Results 34 cases were reviewed with a mean followup of 34.4 months. The most common sites were the forehead, cheek-jaw region, and nasal ala. 2 (5.9%) patients had local recurrence by a mean of 4.3 months. No documented variables were significantly associated with local recurrence. 8 (23.5%) patients had progression to metastasis by a mean of 9.4 months. Younger age at biopsy and surgery, male sex, and intraoperative detection of in-transit disease were significantly associated with progression to metastasis. Conclusions In summary, the tissue-sparing approach of MMS may be beneficial for MCC in cosmetically and functionally sensitive facial locations as it preserves tissue without compromising outcomes.