bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multidimensional Computational Fluid Dynamics Combustion Process Modeling of a 6V150 Diesel Engine
Authors: Liu Zhentao , Zhang Yu , Fu Jiahong , Liu Jinlong 
Published: March 2022

Abstract
The smart diesel program requires the engine electronic control unit to consider additional parameters, such as altitude and climatic conditions, in the mapping calibration process. A specially designed environmental simulation cabin, which can simulate environmental conditions at any longitude and dimension, would allow dynamometer testing to be performed indoors. Considering its high cost, a three-dimensional (3D) computational fluid dynamics (CFD) is needed to guide and/or complement experimental researches. As a result, the main objective of this study was to establish a 3D RANS model (i.e., reasonable computational cost and running time) that can provide in-cylinder details and predict the efficiency of a 6V150 diesel engine under varied operating conditions. A sector mesh approach was employed, considering only the compression, combustion, and expansion periods from intake valve closing to exhaust valve opening. The results indicated that the model simulated cylinder pressure agreed well with the experimental data, with relative errors of less than 6% during the primary compression, combustion, and expansion. Further, the model predicted heat release phasing was inconsistent with the experimental results, with absolute errors of less than one crank angle degree for peak pressure location, CA50, and ignition delay. In addition, the multidimensional model captured the effects of environmental pressure and temperature on spray formation (i.e., the dominant phenomenological event). Moreover, the model reasonably reproduced the effects of engine control variables on performance and emissions. All these observations demonstrated the validity of the selection and calibration of geometry, chemistry, and submodels including turbulence, spray, heat transfer, combustion, etc. Overall, the model was deemed capable of predicting combustion characteristics under extreme conditions, including high-temperature, high-cold, and high-altitude environments, which can facilitate the development of smart engines.
Pole Walking Is Faster but Not Cheaper During Steep Uphill Walking
Authors: Giovanelli Nicola , Mari Lara , Patini Asia , Lazzer Stefano 
Published: March 2022

Purpose: The aim of this study was to compare pole walking (PW) and walking without poles (W) on a steep uphill mountain path (1.3 km, 433 m of elevation gain) at 2 different intensities: a maximal effort that would simulate a vertical kilometer intensity and a lower intensity (80% of maximal) simulating an ultratrail race. Methods: On the first day, we tested the participants in the laboratory to determine their maximal physiological parameters, respiratory compensation point, and gas exchange threshold. Then, they completed 4 uphill tests along a mountain path on 4 separate days, 2 at their maximum effort (PWmax and Wmax, randomized order) and 2 at 80% of the mean vertical velocity maintained during the first 2 trials (PW80 and W80, randomized order). We collected metabolic data, heart rate, blood lactate concentration, and rating of perceived exertion at the end of each trial. We also collected rating of perceived exertion at every 100 m of elevation gain during PW80 and W80. Results: Participants completed the maximal effort faster with poles versus without poles (18:51 [03:12] vs 19:19 [03:01] in min:s, P = .013, d = 0.08, small). Twelve of the 15 participants (80%) improved their performance when they used poles. During PW80 and W80, none of the physiological or biomechanical parameters were different. Conclusion: In the examined condition, athletes should use poles during steep uphill maximal efforts to obtain the best performance. Conversely, during submaximal effort, the use of poles does not provide advantages in uphill PW.
Multicultural Training and Awareness Among Sport Psychology Practitioners
Authors: Curvey Rena M.G. , White Shannon C. , Murphy Emily A. , Scheadler Travis R. , Englis Myles T. , Phelps Laura L. , Hargons Candice N. 
Published: March 2022

Guided by an interpretivist–constructivist paradigm and phenomenological framework, this study explored sport psychology professionals’ lived experiences to better understand their multicultural training and competence within the field of sport psychology. Twelve sport psychology professionals participated in semistructured interviews from March 2020 to May 2020. The following four themes emerged: (a) a call to reform training programs, (b) a shift from multicultural competence to cultural humility, (c) professional and ethical responsibilities of sport psychology practitioners, and (d) reflexive practice and culturally sensitive interventions. Study findings support expanding multicultural training for students of sport psychology graduate programs and suggest that sport psychology professionals have an ethical responsibility to be culturally aware. Further study findings and clinical implications are discussed.
Thin vs. thick-skinned tectonics in the Umbria-Marche fold-and-thrust belt: Contrast or coexistence?
Authors: Barchi Massimiliano Rinaldo , Tavarnelli* Enrico 
Published: March 2022

ABSTRACTThe structural style at depth of the Umbria-Marche fold-and-thrust belt, which occupies the outer province of the Northern Apennines of peninsular Italy, has long been debated and interpreted in terms of thin-skinned or thick-skinned deformation models, respectively. Thin-skinned models predict that the Mesozoic–Tertiary sedimentary cover was detached along Upper Triassic evaporites and translated northeastward along stepped thrust faults above a relatively undeformed basement. On the other hand, thick-skinned models predict the direct involvement of conspicuous basement slices within thrust-related folds. A description of selected examples in the southeastern part of the Umbria-Marche belt reveals that some compressional structures are indeed thin-skinned, their style being controlled by rheological properties of a mechanically heterogeneous stratigraphy containing multiple décollements, whereas other structures are genuinely thick-skinned, their style being dominated by the reverse-reactivation of pre-orogenic normal faults deeply rooted within the basement. Therefore, the contrast of thin- versus thick-skinned structural styles, an issue that has generated a long-lasting debate, is only apparent, since both styles are documented to coexist and to have concurred in controlling the final compressional geometry of the fold-and-thrust belt.
Clinical outcomes of penetrating canaloplasty in patients with traumatic angle recession glaucoma: a prospective interventional case series
Authors: Cheng Huanhuan , Ye Wenqing , Zhang Shaodan , Xie Yanqian , Gu Juan , Le Rongrong , Deng Yuxuan , Hu Cheng , Zhao Zhenquan , Ke Zhisheng , Liang Yuanbo 
Published: March 2022

Background/aimTo evaluate the clinical outcomes of penetrating canaloplasty in traumatic angle recession glaucoma at 1 year.MethodsPatients with angle recession glaucoma underwent penetrating canaloplasty, a new Schlemm’s canal-based internal drainage procedure, which creates a direct canal for flow of aqueous humour from the anterior chamber to the ostia of Schlemm’s canal via a window created at the corneal scleral bed without use of antimetabolites. Postoperative intraocular pressure (IOP), number of glaucoma medications, and procedure-related complications were evaluated. Success was defined as an IOP ≤21 mm Hg without (complete) or with (qualified) use of glaucoma medication.ResultsForty eyes in 40 patients with angle recession glaucoma underwent successful circumferential catheterisation. The mean patient age was 42±13 years. In patients with penetrating canaloplasty that was deemed to be completely successful, the mean IOP decreased from a preoperative value of 37.8±12.3 mm Hg on 3.3±1.2 anti-glaucoma medications to 18.5±6.4 mm Hg on 1.2±1.4 medications, 14.9±4.6 mm Hg on 0.1±0.5 medications, 15.7±5.4 mm Hg on 0.1±0.4 medications and 14.8±3.6 mm Hg on 0.1±0.5 medications at 1, 3, 6 and 12 months postoperatively (p<0.05). Complete success was achieved in 35/40 eyes (87.5%) at 6 months and in 34/38 (89.5%) at 12 months. Hyphema (18/40, 45.0%) and transient IOP elevation (≥30 mm Hg, 9/40, 22.5%) were the most common postoperative complications.ConclusionPenetrating canaloplasty significantly reduces IOP and has a high success rate in angle recession glaucoma.Trial registration numberChiCTR1900020511.
Overestimating women’s representation in medicine: a survey of medical professionals’ estimates and their(un)willingness to support gender equality initiatives
Authors: Begeny Christopher T , Grossman Rebecca C , Ryan Michelle K 
Published: March 2022

ObjectiveAmidst growing numbers of women in certain areas of medicine (eg, general practice/primary care), yet their continued under-representation in others (eg, surgical specialties), this study examines (1) whether medical professionals mistakenly infer that women are now broadly well represented, overestimating women’struerepresentation in several different areas and roles; and (2) whether this overestimation of women’s representation predicts decreased support for gender equality initiatives in the field, in conjunction with one’s own gender.DesignCross-sectional survey.SettingUK-based medical field.Participants425 UK medical consultants/general practitioners and trainees (ST/CT1+/SHO/Registrar); 47% were female.Main outcome measuresEstimates of women’s representation in different areas/roles within medicine, examined as a composite estimate and individually; and a multi-item measure of support for gender-based initiatives in medicine.ResultsMedical professionals tended to overestimate women’s true representation in several different areas of medicine (general practice, medical specialties, surgical specialties) and in various roles (consultants/general practitioners, trainees, medical school graduates). Moreover, these erroneous estimates predicted a decreased willingness to support gender-based initiatives, particularly among men in the field: composite overestimation*respondent gender interaction,B=−0.04, 95% CI −0.07 to −0.01, p=0.01. Specifically, while female respondents’ (over)estimates were unrelated to their level of support (B=0.00, 95% CI −0.02 to 0.02, p=0.92), male respondents’ tendency to overestimate the proportion of women in medicine predicted lower support for gender-based initiatives (B=−0.04, 95% CI −0.06 to −0.02, p<0.001).ConclusionsWhile some progress has been made in gender representation in the medical field, this research illustrates that there are still barriers to gender equality efforts and identifies who within the field is focally maintaining these barriers. It is those individuals (particularly men) who overestimate thetrueprogress that has been made in women’s representation who are at highest risk of undermining it.
Rapid implementation of an outpatient arthroplasty care pathway: a COVID-19-driven quality improvement initiative
Authors: Peacock Sharon , Wolfstadt Jesse , Peer Miki , Gleicher Yehoshua 
Published: March 2022

BackgroundHip and knee total joint arthroplasty (TJA) procedures are two of the most common inpatient surgical procedures worldwide. Outpatient TJA has emerged as a feasible option. COVID-19 caused significant constraints on inpatient surgical resources and contributed to a growing surgical backlog. We present a quality improvement (QI) initiative aimed at adding an outpatient TJA pathway to our pre-existing inpatient TJA programme, with the target of performing 25% of our primary TJA as outpatients.MethodsThis was a QI study at a tertiary level arthroplasty centre. To achieve our aim, a patient-centred needs analysis revealed the need to develop patient selection criteria, perform a specific and tailored anaesthetic, provide patient education and conduct virtual care follow-up. Based on these findings, an outpatient TJA intervention bundle was developed and implemented.ResultsAfter implementing the outpatient pathway, 65 patients were scheduled for outpatient TJA. Fifty-five (84.6%) patients were successfully discharged home on the day of surgery. Successful outpatient TJA accounted for 33.3% of all primary TJAs performed at our intuition throughout the study period. There was excellent adherence to the intervention protocols, with the success hinging on multidisciplinary team and supported QI culture. Thirty-day emergency department visits for inpatient and outpatient TJAs were 8.93% and 6.15%, respectively. No outpatient TJA patients required hospital readmission within 30 days.ConclusionOur study demonstrates that implementation of an outpatient TJA pathway in response to inpatient resource constraints during the COVID-19 pandemic is feasible. The findings of this report will be of interest to surgical centres facing surgical backlog and constraints on inpatient resources during and after the pandemic.
Use of e-triggers to identify diagnostic errors in the paediatric ED
Authors: Lam Daniel , Dominguez Fidelity , Leonard Jan , Wiersma Alexandria , Grubenhoff Joseph A 
Published: March 2022

BackgroundDiagnostic errors (DxEs) are an understudied source of patient harm in children rarely captured in current adverse event reporting systems. Applying electronic triggers (e-triggers) to electronic health records shows promise in identifying DxEs but has not been used in the emergency department (ED) setting.ObjectivesTo assess the performance of an e-trigger and subsequent manual screening for identifying probable DxEs among children with unplanned admission following a prior ED visit and to compare performance to existing incident reporting systems.Design/methodsRetrospective single-centre cohort study of children ages 0–22 admitted within 14 days of a previous ED visit between 1 January 2018 and 31 December 2019. Subjects were identified by e-trigger, screened to identify cases where index visit and hospital discharge diagnoses were potentially related but pathophysiologically distinct, and then these screened-in cases were reviewed for DxE using the SaferDx Instrument. Cases of DxE identified by e-trigger were cross-referenced against existing institutional incident reporting systems.ResultsAn e-trigger identified 1915 unplanned admissions (7.7% of 24 849 total admissions) with a preceding index visit. 453 (23.7%) were screened in and underwent review using SaferDx. 92 cases were classified as likely DxEs, representing 0.4% of all hospital admissions, 4.8% among those selected by e-trigger and 20.3% among those screened in for review. Half of cases were reviewed by two reviewers using SaferDx with substantial inter-rater reliability (Cohen’s κ=0.65 (95% CI 0.54 to 0.75)). Six (6.5%) cases had been reported elsewhere: two to the hospital’s incident reporting system and five to the ED case review team (one reported to both).ConclusionAn e-trigger coupled with manual screening enriched a cohort of patients at risk for DxEs. Fewer than 10% of DxEs were identified through existing surveillance systems, suggesting that they miss a large proportion of DxEs. Further study is required to identify specific clinical presentations at risk of DxEs.
Decision-making in palliative care: patient and family caregiver concordance and discordance—systematic review and narrative synthesis
Authors: Mulcahy Symmons Sophie , Ryan Karen , Aoun Samar M , Selman Lucy E , Davies Andrew Neil , Cornally Nicola , Lombard John , McQuilllan Regina , Guerin Suzanne , O'Leary Norma , Connolly Michael , Rabbitte Mary , Mockler David , Foley Geraldine 
Published: March 2022

BackgroundDecision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and function between patients and family caregivers in palliative care is not well understood.ObjectivesTo identify key factors and/or processes which underpin concordance and/or discordance between patients and family caregivers with respect to their preferences for and decisions about palliative care; and ascertain how patients and family caregivers manage discordance in decision-making in palliative care.MethodsA systematic review and narrative synthesis of original studies published in full between January 2000 and June 2021 was conducted using the following databases: Embase; Medline; CINAHL; AMED; Web of Science; PsycINFO; PsycARTICLES; and Social Sciences Full Text.ResultsAfter full-text review, 39 studies were included in the synthesis. Studies focused primarily on end-of-life care and on patient and family caregiver preferences for patient care. We found that discordance between patients and family caregivers in palliative care can manifest in relational conflict and can result from a lack of awareness of and communication about each other’s preferences for care. Patients’ advancing illness and impending death together with open dialogue about future care including advance care planning can foster consensus between patients and family caregivers.ConclusionsPatients and family caregivers in palliative care can accommodate each other’s preferences for care. Further research is needed to fully understand how patients and family caregivers move towards consensus in the context of advancing illness.
Percutaneous coronary intervention in patients with documented coronary vasospasm during long-term follow-up
Authors: Kim Ju Hyeon , Park Jinoh , Yang Yujin , Lee Sahmin , Kim Dae-Hee , Song Jong-Min , Kang Duk-Hyun , Park Seong-Wook , Park Seung-Jung , Song Jae-Kwan 
Published: March 2022

ObjectiveAlthough recurring coronary artery spasm (CAS) may lead to the development of fixed atherosclerotic coronary stenosis (FS), the relationship between coronary atherosclerosis and CAS is still speculative. We evaluated the incidence of FS requiring percutaneous coronary intervention (PCI) in patients with documented CAS during long-term follow-up and analysed their clinical features.MethodsClinical data of 3556 patients during a median follow-up of 9.4 years after non-invasive ergonovine spasm provocation testing with echocardiographic monitoring of left ventricular wall motion (erg echo) were analysed.ResultsErg echo documented CAS in 830 (23.3%) patients, who had higher frequencies of coronary risk factors than those without CAS. Patients with documented CAS on erg echo showed significantly lower 10-year overall (90.5% vs 94.2%, p<0.001) and PCI-free (97.4% vs 98.4%, p=0.002) survival rates than those without CAS. Documented CAS was an independent factor associated with later PCI after adjustment by either Cox regression model or Fine-Gray competing risk model. There was no significant difference in baseline clinical characteristics between patients who needed later PCI and those who did not. Among 28 patients who needed later PCI after documentation of CAS, the original CAS and later PCI territory were concordant in 25 (89.3%), while 3 (10.7%) showed discordance.ConclusionsCAS is a risk factor for the development of FS requiring PCI during long-term follow-up, and warrants physicians’ vigilance and careful follow-up of patients with documented CAS and insignificant stenosis of major epicardial coronary arteries at the time of initial diagnosis.
Invasive coronary physiology in patients with angina and non-obstructive coronary artery disease: a consensus document from the coronary microvascular dysfunction workstream of the British Heart Foundation/National Institute for Health Research Partnership
Authors: Perera Divaka , Berry Colin , Hoole Stephen P , Sinha Aish , Rahman Haseeb , Morris Paul D , Kharbanda Rajesh K , Petraco Ricardo , Channon Keith 
Published: March 2022

Nearly half of all patients with angina have non-obstructive coronary artery disease (ANOCA); this is an umbrella term comprising heterogeneous vascular disorders, each with disparate pathophysiology and prognosis. Approximately two-thirds of patients with ANOCA have coronary microvascular disease (CMD). CMD can be secondary to architectural changes within the microcirculation or secondary to vasomotor dysfunction. An inability of the coronary vasculature to augment blood flow in response to heightened myocardial demand is defined as an impaired coronary flow reserve (CFR), which can be measured non-invasively, using imaging, or invasively during cardiac catheterisation. Impaired CFR is associated with myocardial ischaemia and adverse cardiovascular outcomes.The CMD workstream is part of the cardiovascular partnership between the British Heart Foundation and The National Institute for Health Research in the UK and comprises specialist cardiac centres with expertise in coronary physiology assessment. This document outlines the two main modalities (thermodilution and Doppler techniques) for estimation of coronary flow, vasomotor testing using acetylcholine, and outlines a standard operating procedure that could be considered for adoption by national networks. Accurate and timely disease characterisation of patients with ANOCA will enable clinicians to tailor therapy according to their patients’ coronary physiology. This has been shown to improve patients’ quality of life and may lead to improved cardiovascular outcomes in the long term.
1α,25(OH)2D3reverses exhaustion and enhances antitumor immunity of human cytotoxic T cells
Authors: Li Peng , Zhu Xinhai , Cao Guangchao , Wu Ruan , Li Ke , Yuan Wenhui , Chen Biyun , Sun Guodong , Xia Xichun , Zhang Hua , Wang Xiao , Yin Zhinan , Lu Ligong , Gao Yunfei 
Published: March 2022

BackgroundEpidemiological surveys have revealed that low serum vitamin D level was correlated with increased risk of tumors. Dysfunctional T cells in patients with tumor are characterized as exhausted with high levels of immune checkpoint receptors (ICRs). However, whether the reduced level of vitamin D in patients with cancer correlates with cytotoxic T-cell exhaustion is unknown.MethodsPeriphery blood samples from 172 patients with non-small cell lung cancer (NSCLC) were prospectively collected. Patients with NSCLC received one course of intravenous docetaxel (75 mg/m2) followed by treatment with or without rocaltrol at a dose of 0.5–2.0 µg/day for total of 3 weeks. We performed phenotypical and functional analysis of T-cell through flow cytometry. Vitamin D receptor (VDR) knockout and overexpression CD8+and Vδ2+T cells were constructed using Cas9-gRNA targeted and overexpressing approaches to identify 1α,25(OH)2D3/VDR-mediated transcription regulation for ICRs or antitumor activity in T cells.ResultsWe show that serum level of vitamin D is negatively correlated with expression of programmed cell death-1 (PD-1), T-cell immunoreceptor with Ig and ITIM domains (TIGIT), and T-cell immunoglobulin and mucin-domain containing-3 (Tim-3), but positively correlated with CD28 expression on CD8+and Vγ9Vδ2+T cells in patients with NSCLC. 1α,25(OH)2D3, the active form of vitamin D, promotes the nuclear translocation of VDR, which binds to the promoter region ofPdcd1,Tim3, andTigitgenes and inhibits their expression. Besides, 1α,25(OH)2D3pretreatment also promotes the methylation of CpG island in the promoter region of thePdcd1gene and increases H3K27 acetylation at the promoter region of theCd28gene, which leads to surface PD-1 downregulation and CD28 upregulation, respectively. We further reveal that VDR-mediated Ca2+influx enhanced expression of Th1 cytokines via T-cell receptor activation. Functionally, 1α,25(OH)2D3pretreated CD8+T cells or Vγ9Vδ2+T cells showed increased Th1 cytokine production and enhanced antitumor immunity. Finally, oral 1α,25(OH)2D3could also decrease expression of PD-1, Tim-3, TIGIT and increase expression of CD28, resulting in cytokine production (associated with antitumor immunity) by cytotoxic T cells of patients with NSCLC.ConclusionsOur findings uncover the pleiotropic effects of 1α,25(OH)2D3in rescuing the exhausted phenotype of human cytotoxic T cells in patients with tumor and in promoting their antitumor immunity.Trial registration numberChiCTR2100051135.