bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of Integrated Vapor Transport Biases
Authors: Reynolds Carolyn A. , Crawford William , Huang Andrew , Barton Neil , Janiga Matthew A. , McLay Justin , Flatau Maria , Frolov Sergey , Rowley Clark 
Published: February 2022

Abstract
High-fidelity analyses and forecasts of integrated vapor transport (VT) are central to the study of Earth’s hydrological cycle as well as high-impact phenomena such as monsoons and atmospheric rivers. The impact of the in-line analysis correction-based additive inflation (ACAI) on IVT biases and forecast errors is examined within the Navy Earth System Prediction Capability (Navy ESPC) global coupled system. The ACAI technique uses atmospheric analysis corrections from the data assimilation system to approximate model bias and as a representation of stochastic model error to simultaneously reduce systematic and random errors and improve ensemble performance. ACAI reduces the global average magnitude of the 7- and 14-day IVT bias by 16%–17% during Northern Hemisphere summer, reaching 70% reductions in some tropical regions. The global average IVT bias reduction is similar to the bias reduction for low-level wind speed bias and considerably smaller than the bias reduction in total precipitable water. The localized regions where ACAI increases IVT bias occur where the control IVT biases change sign and structure with increasing forecast lead time, such as the South Asian monsoon region. Substituting analyzed wind or moisture fields for the forecast fields when calculating the forecast IVT confirms that, on average, wind errors dominate the IVT error calculation in the tropics, although wind and moisture error contributions are comparable in the extratropics. The existence of regions where using either analyzed winds or analyzed moisture increases IVT bias or mean absolute error reveals areas with compensating errors.
Tumor Deposits and Perineural Invasion had Comparable Impacts on the Survival of Patients With Non-metastatic Colorectal Adenocarcinoma: A Population-Based Propensity Score Matching and Competing Risk Analysis
Authors: Luo Bin , Chen Xianzhe , Cai Guanfu , Hu Weixian , Li Yong , Wang Junjiang 
Published: February 2022

Background Both tumor deposits (TD) and perineural invasion (PNI) have been identified as risk factors for poor survival in patients with non-metastatic colorectal adenocarcinoma (CRC). However, the adverse impacts of TD and PNI on the survival of patients with non-metastatic CRC have not been compared. Method Patients with non-metastatic CRC with known TD and PNI status were selected from the Surveillance, Epidemiology, and End Results (SEER) database. First, bivariate logistic regression analysis was utilized to identify the factors associated with TD and PNI status. Then, patients were divided into four groups, according to TD and PNI status. Propensity score matching (PSM) was performed to balance the baseline covariates. The impact of TD and PNI on survival was assessed by analyzing overall survival (OS) and cancer-specific mortality (CSM) rates. OS was calculated by the Kaplan–Meier method with log-rank analysis. CSM was estimated by competing risk analysis using the Fine and Gray model. Results A total of 70 689 patients with CRC met the inclusion and exclusion criteria. The positive rates of TD and PNI were 9.37% and 9.91%, respectively. For TD, the most important risk factor was N stage. With respect to PNI, the most significant factor was T stage. Tumor location, tumor size, differentiation grade, and serum CEA level were also correlated with TD and PNI status. After PSM, 1849 pairs were selected. Patients with TD+PNI+ status had the worst 5 year CSM and 5 year OS. In addition, the long-term survival outcomes of patients with TD+PNI− and TD−PNI+ status were comparable. Conclusion The adverse impacts of TD and PNI on the survival of patients with non-metastatic CRC were comparable. CRC patients with both TD and PNI positive had the worst survival outcome.
Digital Health Testbeds in Sweden: An exploratory study
Authors: Jabin Md Shafiqur Rahman , Nilsson Evalill , Nilsson Anna-Lena , Bergman Patrick , Jokela Päivi 
Published: February 2022

Objective This study explored the Swedish digital health testbeds through the lens of complexity science. Methods The purposive sampling was used to identify 38 digital health testbed organizations to conduct interviews in written or audio-conferencing. The interview responses were aggregated and analyzed using thematic analysis. The themes were mainly generated through complexity theory and the principles of complex adaptive systems. Results Fifteen testbed organizations responded, comprising 13 written responses and two audio-conferencing. Five main theoretical themes were generated: agents and diversity, connections and communication, adaptation and learning, perturbations, and path dependence. Agents and diversity depicted different types of testbeds, stakeholders and innovation, and the primary function and purpose of the testbeds. Various factors enhancing connections and communications among multiple stakeholders were identified, such as the quality of e-health solutions and the 2030 Agenda for Sustainable Development. Some adaptation and learning factors, such as internal reorganization, sharing and creating learning opportunities, and additional funding, guaranteed the sustainability of testbeds. Perturbations were characterized by two factors: non-linear interactions – lack of commitment and transparency in stakeholders' engagement, and uncertainty about testbed definitions and concepts. Path dependence highlighted the importance of history, such as previous positive and negative experiences. Conclusion This study provided insights into testbeds' organization, their functions, how various aspects were challenged, and how they adapted to overcome and improve the system issues. Identifying the stakeholders and relevant factors, commissioning an evaluation, backing up with a contingency plan, securing adequate funding, and disseminating the findings can improve the testbeds' design and implementation.
Strategies to Improve Compliance with Clinical Nursing Documentation Guidelines in the Acute Hospital Setting: A Systematic Review and Analysis
Authors: Bunting Jeanette , de Klerk Melissa 
Published: February 2022

Introduction This systematic review attempts to answer the following question – which strategies to improve clinical nursing documentation have been most effective in the acute hospital setting? Methods A keyword search for relevant studies was conducted in CINAHL and Medline in May 2019 and October 2020. Studies were appraised using the Joanna Briggs Institute (JBI) critical appraisal for quasi-experimental studies. The studies were graded for level of evidence according to GRADE principles. The data collected in each study were added to a Summary of Data (SOD) spreadsheet. Pre intervention and a post intervention percentage compliance scores were calculated for each study where possible i.e. (mean score/possible total score) × (100/1). A percentage change in compliance for each study was calculated by subtracting the pre intervention score from the post intervention score. The change in compliance score and the post intervention compliance score were both added to the SOD and used as a basis for comparison between the studies. Each study was analyzed thematically in terms of the intervention strategies used. Compliance rates and the interventions used were compared to determine if any strategies were effective in achieving a meaningful improvement in compliance. Results Seventy six full text articles were reviewed for this systematic review. Fifty seven of the studies were before and after studies and 66 were conducted in western countries. Publishing dates for the studies ranged from 1991 to 2020. Eleven studies included documentation audits with personal feedback as one of the strategies used to improve nursing documentation. Ten of these studies achieved a post intervention compliance rate ≥ 70%. Conclusion Notwithstanding the limitations of this study, it may be that documentation audit with personal feedback, when combined with other context specific strategies, is a reliable method for gaining meaningful improvements in clinical nursing documentation. The level of evidence is very low and further research is required.
Witness Protection: An Imperative for Criminal Justice
Authors: Qureshi Daniyal 
Published: February 2022

India is one of the few democracies in the world that does not have a witness protection law in spite of such high crimes rates. The incompetence of the bureaucratic setup of democracy condemned the criminal justice system to being reduced to a mere namesake. This article attempts to provide an understanding of the condition of a witness in the criminal justice system. Without any witness protection laws, the courts have suffered from having to afford security and protection to the citizens that present themselves to testify before the court. Witnesses turn hostile in such a large number of cases and are exposed to threats and manipulation in the course of any criminal proceedings. The legislative efforts in the past have largely failed to provide any solution to this problem. While it is undoubtedly contented that witness protection is non-dispensable for a fair trial, this article explores the avenue of whether witness protection could be a judicial function. While most jurisdictions across the world run witness protection programmes through the executive, these programmes are wildly transparent and directly answerable to the government. However, in India, given the vast population of the land and the already available infrastructure of the courts and the concerns regarding a full-fledged witness protection programme expressed by various sources from the government over time, it takes considerable deliberation to vest power in the judiciary for an efficient criminal justice system. Nonetheless, at present, the 2018 scheme of witness protection is the only legislative entity available to the criminal justice system which is inexecutable and offers little relief to the problems.
BTK inhibitors impair humoral and cellular responses to recombinant zoster vaccine in CLL
Authors: Pleyer Christopher , Laing Kerry J. , Ali Mir A. , McClurkan Christopher L. , Soto Susan , Ahn Inhye E. , Nierman Pia , Maddux Emeline , Lotter Jennifer , Superata Jeanine , Tian Xin , Wiestner Adrian , Cohen Jeffrey I. , Koelle David M. , Sun Clare 
Published: February 2022

Abstract
Vaccinations effectively prevent infections; however, patients with chronic lymphocytic leukemia (CLL) have reduced antibody responses following vaccinations. Combined humoral and cellular immune responses to novel adjuvanted vaccines are not well characterized in CLL. In an open-label, single-arm clinical trial, we measured the humoral and cellular immunogenicity of the recombinant zoster vaccine (RZV) in CLL patients who were treatment naïve (TN) or receiving Bruton tyrosine kinase inhibitor (BTKi) therapy. The primary endpoint was antibody response to RZV (≥fourfold increase in anti-glycoprotein E [anti-gE]). Cellular response of gE-specific CD4+ T cells was assessed by flow cytometry for upregulation of ≥2 effector molecules. The antibody response rate was significantly higher in the TN cohort (76.8%; 95% confidence interval [CI], 65.7-87.8) compared with patients receiving a BTKi (40.0%; 95% CI, 26.4-53.6; P = .0002). The cellular response rate was also significantly higher in the TN cohort (70.0%; 95% CI, 57.3-82.7) compared with the BTKi group (41.3%; 95% CI, 27.1-55.5; P = .0072). A concordant positive humoral and cellular immune response was observed in 69.1% (95% CI, 56.9-81.3) of subjects with a humoral response, whereas 39.0% (95% CI, 24.1-54.0) of subjects without a humoral response attained a cellular immune response (P = .0033). Antibody titers and T-cell responses were not correlated with age, absolute B- and T-cell counts, or serum immunoglobulin levels (all P &gt; .05). RZV induced both humoral and cellular immune responses in treated and untreated CLL patients, albeit with lower response rates in patients on BTKi therapy compared with TN patients. This trial was registered at www.clinicaltrials.gov as #NCT03702231.
Do older adults with multimorbidity prefer institutional care than those without multimorbidity? The role of functional limitation
Authors: Zhao Dan , Li Jie , Gao Tingting , Sun Jingjie , Wang Yi , Wang Qiong , Zhou Chengchao 
Published: February 2022

Abstract
Background
Population ageing and social transformation present tremendous challenges to the informal support system of older adults, which engendered institutional care in China. This study aimed to examine the association between multimorbidity and institutional care willingness, and investigate whether there is an interaction effects between multimorbidity and functional limitations on institutional care willingness among Chinese older adults.

Methods
Data were obtained from the sixth National Health Service Survey of Shandong province, China. The sample included 8583 older adults (age ≥ 60 years; 51.7% women), 44.8% without chronic diseases, 34.8% and 20.4% with one chronic condition and multimorbidity, respectively. Multivariable logistic regression models and marginal effects analysis were used to the interaction effects analysis.

Results
A total of 666 (7.8%) participants had institutional care willingness in Shandong, China. Participants with multimorbidity were more likely to have institutional care willingness than their peers without chronic condition (OR = 1.25, 95% CI = 1.06, 1.55) after adjusted for confounders. Marginal effect analysis showed that under the condition that other variables remain unchanged, the probability of them with multimorbidity choosing institutional care for older adults with functional limitations was 6.9% lower than those without multimorbidity (95% CI = -0.128, -0.010, P = 0.023). The interaction effect between chronic health conditions and functional limitation for older adults to choose institutional care was statistically significant, and the average interaction effect was 4.83% (Z = -2.70, $${S}_{\overline{x} }$$

S

x
¯

= 0.0189, P < 0.05).

Conclusions
This relationship between multimorbidity and institutional care willingness varied by functional limitations. To better meet the care needs among older adults with multimorbidity and functional limitations, more resources and incentives should be provided to encourage the building-up of eldercare institutions. The governments should also establish long-term care system and to provide better home-based care for older adults, as older adults who prefer home care remain the majority.
Characterizing patients with rare mucormycosis infections using real-world data
Authors: Zhang Yayue , Sung Anita H. , Rubinstein Emily , Benigno Michael , Chambers Richard , Patino Nataly , Aram Jalal A. 
Published: February 2022

Abstract
Background
Invasive mucormycosis (IM) is a rare and often life-threatening fungal infection, for which clinical and epidemiological understanding is lacking. Electronic health record (EHR) data can be utilized to elucidate large populations of patients with IM to address this unmet need. This study aimed to descriptively assess data on patients with IM using the Optum® EHR dataset.

Methods
US patient data from the Optum® deidentified EHR dataset (2007–2019) were analyzed to identify patients with IM. Patients with hematologic malignancies (HM), at high risk of IM, were selected and sorted by IM diagnosis (ICD9 117.7; ICD10 B46). Demographics, comorbidities/other diagnoses, and treatments were analyzed in patients with IM.

Results
In total, 1133 patients with HM and IM were identified. Most were between 40 and 64 years of age, Caucasian, and from the Midwest. Essential primary hypertension (50.31%) was the most common comorbidity. Of the 1133 patients, only 33.72% were prescribed an antifungal treatment. The most common antifungal treatments were fluconazole (24.27%) and posaconazole (16.33%), which may have been prophylactic, and any AmB (15.62%).

Conclusions
A large population of patients with IM were identified, highlighting the potential of analyzing EHR data to investigate epidemiology, diagnosis, and the treatment of apparently rare diseases.
Evaluating the effectiveness of the Play Active policy intervention and implementation support in early childhood education and care: a pragmatic cluster randomised trial protocol
Authors: Nathan Andrea , Adams Emma , Trost Stewart , Cross Donna , Schipperijn Jasper , McLaughlin Matthew , Thornton Ashleigh , Trapp Georgina , Lester Leanne , George Phoebe , Wenden Elizabeth , Christian Hayley 
Published: February 2022

Abstract
Background
Daily physical activity is critical during the early years of life for facilitating children’s health and development. A large proportion of preschool children do not achieve the recommended 3 h of daily physical activity. Early childhood education and care (ECEC) services are a key setting to intervene to increase physical activity. There is a significant need for ECEC specific physical activity policy, including clearer guidelines on the amount of physical activity children should do during care, and strategies for implementation of these guidelines.

Methods
This study is a pragmatic cluster randomised trial to evaluate the effectiveness of the Play Active physical activity policy intervention to improve early childhood education and care educator’s physical activity-related practices. The central component of Play Active is an evidence-informed physical activity policy template which includes 25 practices to support nine age-specific recommendations on the amount of physical activity and sedentary time, including screen time, young children should do while in care. There are six implementation support strategies to facilitate physical activity policy implementation: (i) personalise policy (services select at least five of the 25 practices to focus on initially); (ii) policy review and approval; (iii) a resource guide; (iv) a brief assessment tool for monitoring children’s energetic play; (v) professional development; and (vi) Project Officer implementation support (phone calls). A total of 60 early childhood education and care services will be recruited from metropolitan Perth, Western Australia. After baseline assessment, services will be randomly allocated to either intervention or wait-listed comparison conditions. Primary (educator-reported frequency and amount of daily time provided for children’s physical activity, sedentary and screen time) and secondary (educator physical activity-related practices, self-efficacy, motivation, attitudes and beliefs, social support, and supportive physical environment) outcomes will be assessed at baseline and post-intervention, after intervention services have had a minimum 3 months of policy implementation within their service.

Discussion
The Play Active trial will rigorously evaluate a novel physical activity policy intervention with implementation support that promotes positive physical activity behaviours in educators and children attending ECEC. If effective, the program could be adapted, scaled-up and delivered in ECEC services nationally.

Trial registration
Australian New Zealand Clinical Trials Registry ACTRN12620001206910 (date of registration 13/11/2020).
Advance care planning in primary care: a retrospective medical record study among patients with different illness trajectories
Authors: Bekker Yvonne A. C. , Suntjens Ankie F. , Engels Y. , Schers H. , Westert Gert P. , Groenewoud A. Stef 
Published: February 2022

AbstractBackgroundAdvance Care Planning (ACP) enables physicians to align healthcare with patients’ wishes, reduces burdensome life-prolonging medical interventions, and potentially improves the quality of life of patients in the last phase of life. However, little objective information is available about the extent to which structured ACP conversations are held in general practice.Our aim was to examine the documentation of ACP for patients with cancer, organ failure and multimorbidity in medical records (as a proxy for ACP application) in Dutch general practice.MethodsWe chose a retrospective medical record study design in seven primary care facilities. Medical records of 119 patients who died non-suddenly (55 cancer, 28 organ failure and 36 multimorbidity) were analysed. Other variables were: general characteristics, data on ACP documentation, correspondence between medical specialist and general practitioner (GP), and healthcare utilization in the last 2 years of life.ResultsIn 65% of the records, one or more ACP items were registered by the GP. Most often documented were aspects regarding euthanasia (35%), the preferred place of care and death (29%) and concerns and hopes towards the future (29%). Median timing of the first ACP conversation was 126 days before death (inter-quartile range (IQR) 30–316). ACP was more often documented in patients with cancer (84%) than in those with organ failure (57%) or multimorbidity (42%) (p = 0.000). Patients with cancer had the most frequent (median 3 times, IQR 2–5) and extensive (median 5 items, IQR 2–7) ACP consultations.ConclusionDocumentation of ACP items in medical records by GPs is present, however limited, especially in patients with multimorbidity or organ failure. We recommend more attention for – and documentation of – ACP in daily practice, in order to start anticipatory conversations in time and address the needs of all people living with advanced conditions in primary care.
Addressing health disparities in hispanic communities through an innovative team-based medical spanish program at the medical school level – a single-institution study
Authors: Oliver Michael , Fernberg Taylor , Lyons Paul , Elango Sambandam , Green Gordon J. , Talib Zohray M. 
Published: February 2022

Abstract
Background
There are insufficient Spanish-speaking physicians to effectively serve a large and rapidly growing Spanish-speaking patient population.

Methods
A team-based hybrid medical Spanish program was designed and implemented at a single medical school in Southern California. This pilot program consisted of a weekly in-person portion where students reviewed Spanish vocabulary and grammar and practiced clinical encounters in teams through active role play. Students supplemented in-class learning with online coursework. Program success was measured through physician-evaluated clinical encounters with Spanish-speaking standardized patients, a 100-question multiple-choice exam, and pre- and post-program surveys.

Results
97% of students in the program (n = 32) received a passing grade at program completion. Student surveys demonstrated enthusiasm and engagement in weekly sessions (95% overall attendance, 97% reported feeling either excited or ready to learn prior to class). In a post-program survey, 100% of students felt better suited and increased desire to treat Hispanic patients. Additionally, all students indicated an interest in the continued use of Spanish in both their schooling and future practice. In a follow-up survey after three months of clinical experience in their 3rd year of medical school, 100% of students reported that medical Spanish is "very beneficial" in patient care and that students with medical Spanish proficiency have advantages over non-speaking students when it comes to patient care opportunities. 100% felt that time spent learning medical Spanish during pre-clinical years was time well spent and that the medical Spanish program enhanced their care of Spanish-speaking students.

Conclusions
The results of the pilot program show a significant increase in the ability of students to engage in clinical interaction in Spanish. The results of our study demonstrate a significant increase in the knowledge, clinical skills, and self-reported confidence of students to treat Hispanic patients. Furthermore, all students not only felt better equipped and more confident to treat Hispanic patients, but they also had an increased desire to do so moving forward in their careers. We conclude that an effective medical Spanish program can be executed simultaneously with a pre-clinical medical school curriculum.