bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atlantic Multidecadal Variability Response to External Forcing during the Past Two Millennia
Authors: Dai Zhangqi , Wang Bin , Zhu Ling , Liu Jian , Sun Weiyi , Li Longhui , Lü Guonian , Ning Liang , Yan Mi , Chen Kefan 
Published: September 2022

Abstract
Atlantic multidecadal variability (AMV) is a cornerstone for decadal prediction and profoundly influences regional and global climate variability, yet its fundamental drivers remain an issue for debate. Studies suggest that external forcing may have affected AMV during the Little Ice Age (AD 1400–1860). However, the detailed mechanism remains elusive, and the AMV’s centennial to millennial variations over the past 2000 years have not yet been explored. We first show that proxy-data reconstructions and paleo-data assimilations suggest a significant 60-yr AMV during AD 1250–1860 but not during AD 1–1249. We then conducted a suite of experiments with the Community Earth System Model (CESM) to unravel the causes of the changing AMV property. The simulation results under all external forcings match the reconstructions reasonably well. We find that the significant 60-yr AMV during 1250–1860 arises predominantly from the volcano forcing variability. During the period 1–1249, the average volcanic eruption intensity is about half of the 1250–1860 intensity, and a 20–40-yr internal variability dominates the AMV. The volcanic radiative forcing during 1250–1860 amplifies AMV and shifts the internal variability peak from 20–40 years to 60 years. The volcano forcing prolongs AMV periodicity by sustaining Arctic cooling, delaying subpolar sea ice melting and atmospheric feedback to reduce surface evaporation. These slow-response processes over the subpolar North Atlantic results in a persisting reduction of sea surface salinity, weakening the Atlantic overturning circulation, and warm water transport from the subtropical North Atlantic. The results reveal the cause of the nonstationary AMV over the past two millennia and shed light on the AMV’s response to external forcing.

Significance Statement
AMV plays an important role in the regional and global climate variability. The purpose of this study is to better understand the secular change of AMV during the past 2000 years and its response to the external forcing. Proxy data and model simulation consistently show a significant 60-yr AMV during AD 1250–1860 that is absent during AD 1–1249. Active volcanic eruptions during 1250–1860 amplify the AMV and shift its intrinsic 20–40-yr to a prominent 60-yr variance peak. Volcanoes prolong AMV periodicity by sustaining Arctic cooling, delaying subpolar sea ice melting, reducing evaporation, and increasing surface salinity. These results help us better understand nonstationary AMV and highlight the role of external forcing over the past two millennia.
Headland Rip Very Low Frequency Fluctuations and Surfzone Eddies During High-Energy Wave Events
Authors: Mouragues Arthur , Martins Kévin , Bonneton Philippe , Castelle Bruno 
Published: September 2022

Abstract
A wave-group-resolving model is used to investigate the driving mechanisms and the spatiotemporal variability of very low frequency (VLF) fluctuations of a headland deflection rip, measured during a 4-m oblique wave event. Surfzone eddies (SZE) occurring in the presence of a strongly sheared longshore current V at a longshore-uniform beach are first modeled. The spectral signature and the variability of SZE are displayed and compared with the literature. The model is then used to explore the dynamics of vorticity in the surf zone and against a headland under energetic oblique wave conditions. The resulting weakly sheared V is found to host large-scale SZE propagating toward the headland at a speed decreasing seaward. Vorticity animations and spectral diagrams indicate that VLF fluctuations of the deflection rip are driven by the deflection of the upstream SZE. In line with measurements, periods from 40 min to 1 h dominate the spectrum hundreds of meters from the headland at low tide. At high tide, vorticity spectra in the rip are much narrower than in the surf zone, suggesting that the headland enforces the merging of SZE. This mechanism is further analyzed using idealized simulations with varying headland lengths, aiming at extending traditional deflection patterns at the VLF scale. Finally, we discuss the existence of a continuum in SZE driving mechanisms, going from fully wave-group-driven to both wave-group- and shear-instability-driven SZE for weakly and strongly sheared V, respectively. This continuum suggests the importance of wave groups to produce SZE under energetic wave conditions.
Simulation of Heavy Precipitation and the Production of Graupel Related to the Passage of a Cold Front over the Australian Snowy Mountains
Authors: Gevorgyan Artur , Ackermann Luis , Huang Yi , Siems Steven , Manton Michael 
Published: September 2022

Abstract
The case study of a heavy precipitation event associated with the passage of cold front over the Australian Snowy Mountains (ASM) on 3 August 2018 has been examined using the observational data from an intensive field campaign and high-resolution (1 km) Weather Research and Forecasting (WRF) simulation. We divided this event into prefrontal, cold front, and postfrontal periods. The cold front and postfrontal periods were characterized by higher production of graupel, while relatively low graupel was produced in the prefrontal period. Overall, aggregation along with deposition are likely the main growth mechanisms of snow in the prefrontal clouds, while heavy rain was produced below the melting level over windward slopes of the ASM. The simulated melting level is lower compared to the observations, which is consistent with model cold bias. Stronger orographic uplift and frontal forcing were mainly responsible for the enhanced supercooled liquid water (SLW) production over the ASM in the cold front period. A drop in elevation of the freezing level and increase in low-level relative humidity further enhanced the SLW production. The production of graupel through riming processes was highly efficient in the cold front period given the high concentration of ice-phase hydrometeors in the frontal clouds and the development of clouds comprising supercooled liquid water. The orographic updrafts and embedded convection were the main dynamical processes generating postfrontal SLW clouds and graupel. Ice initiation processes were activated once SLW cloud tops reached −15°C level followed by graupel production through riming processes.
Infant Feeding Practices and Social Support Networks Among Immigrant Chinese American Mothers With Economic Disadvantage in New York City
Authors: Duh-Leong Carol , Yin H. Shonna , Salcedo Vanessa , Mui Angel , Perrin Eliana M. , Yi Stella S. , Zhao Qiuqu , Gross Rachel S. 
Published: September 2022

Background: Maternal social support promotes healthy infant feeding practices, which influence healthy growth and development. Less is known about how the interplay of social support networks and multicultural health beliefs may influence infant feeding practices, particularly among immigrant Chinese American mothers with economic disadvantage and low breastfeeding rates. Research Aim: To explore the role of social support networks in the development of infant feeding practices in immigrant Chinese American mothers with infants. Methods: This was a prospective, cross-sectional qualitative study where we conducted semi-structured interviews in Mandarin, Cantonese, or English with Chinese American mothers of infants ( N = 25) at a federally qualified health center in the Sunset Park neighborhood of Brooklyn, New York. Data were analyzed by a multicultural, multidisciplinary team using qualitative thematic analysis and the constant comparative method to identify and iteratively refine emerging codes. Results: Three themes emerged describing how broad transnational communities and close family and friends influence maternal-infant feeding practices: (1) Gathering and processing infant feeding information from broad transnational resources (i.e., from both the mother’s country of residence and the mother’s country of origin); (2) aligning maternal feeding attitudes with cultural health beliefs of local social networks; and (3) gaining confidence with transactional maternal–infant feeding interactions. Conclusions: Strategies to promote healthy infant feeding should consider how family supports and culturally-relevant coaching can help align multilevel transnational social networks with healthy infant feeding practices.
Self-Perception and Psychological Well-Being as Determinants of Classroom Behavior of Students With and Without Learning Disability
Authors: Veni R.K.  , Merlene Annie Marie 
Published: September 2022

Background: Studies in the field of learning disability (LD) have repeatedly shown that majority of the LD students experience negative social comparisons, result in negative self-perception (SP), especially in the classrooms. Literature has also described that these students are more prone to develop mental health issues which may reflect in the way they behave within the classroom. Though studies have been found done separately on some of the dimensions of SP, psychological well-being (PWB), and classroom behavior (CRB) on learning disabled and their normal peers, no scientific study was found done together either in India or abroad. Objectives: The study aims at comparing the differences in SP, PWB, and CRB of students with and without LD. The study has also attempted to assess the relationship and influence of SP and PWB on CRB of the learning-disabled students from the schools of Kerala. Method: A representative sample of learning disabled (N = 225) and normal pupils (N = 260) was selected for the study. The data was collected using a scale of SP, mental health profile, and CRB inventory along with a personal information sheet. The data was analyzed using (a) independent t test (two tailed t test for significant difference between the means of independent samples), (b) computation of statistical indices like mean, percentages, and standard deviation, (c) Pearson’s product moment coefficient of correlation ( r), and (d) stepwise multiple regression analysis. Result: Results indicated that the pupils with LD were found to show lower SP, low PWB, and exhibit poor CRB in comparison to their normal peers. It was observed that there is a significant positive relationship found among all the major variables under the study namely, SP, PWB, and CRB of the learning-disabled students in the schools of Kerala. Findings also revealed that SP and PWB has a combined effect on CRB and PWB was found to be a better predictor of CRB of the learning-disabled students. Conclusion: The result of the study implies the need for enhancing the SP and PWB of LD students so as to improve their CRB with the help of psychologists, special educators, teachers, and other school authorities.
Bilateral synchronous conjunctival myxoma and review of the literature
Authors: Lin Timothy P.H. , Wan Kelvin H. , Cheuk Wah , Leung Enne , Yuen Hunter K.L. , Lam Dennis S.C. 
Published: September 2022

Purpose The purpose of this study was to report the clinicopathological features and management of the first case of bilateral synchronous conjunctival myxoma. Methods This study was a case report and literature review. Results A 66-year-old Chinese male with past ocular history of uncomplicated bilateral phacoemulsification and intraocular lens (IOLs) 3 years ago prior to presentation presented with bilateral red and swollen conjunctiva for over a year. On examination his corrected distance visual acuity (CDVA) was 25/20 in the right eye 20/20 in the left eye. Slit lamp examination revealed swollen temporal conjunctiva bilaterally which appeared as painless, well-circumscribed, salmon-pink, fleshy patches. The lesion in the right eye was subsequently excised, followed by excision of the lesion in the left eye at 3-week interval. Microscopically, histopathological examination of both excised specimens revealed hypocellular conjunctival mucosa covered by non-dysplastic epithelium, with presence of myxoid degeneration in the subepithelial stroma and immunostaining findings consistent with conjunctival myxoma. At his latest follow-up at 24 months, there were no recurrences of the conjunctival masses and the CDVA was the same as preoperatively.
Barriers and facilitators for obtaining support services among underserved families with an autistic child: A systematic qualitative review
Authors: Wallace-Watkin Carla , Sigafoos Jeff , Waddington Hannah 
Published: September 2022

Families of autistic children from underserved populations participate in support services at lower rates than other families. To better understand possible reasons for this inequity, we reviewed qualitative studies examining parent-reported barriers and facilitators to accessing and participating in support services. A systematic search identified 18 articles that met inclusion criteria. Resulting thematic analysis located three themes: (a) support service accessibility, (b) diversity of support services, and (c) community. Parents reported that financial pressures, geographic location, and service flexibility influenced their ability to obtain support services. Implications for service delivery and areas for future research are discussed. Lay abstract Families from underrepresented ethnic or racial groups and those with limited financial resources could experience more difficulty in accessing support services for their autistic child due to certain types of barriers. We searched academic journals, websites, and other sources for studies which looked at what barriers might be present for such families and what might help families access support services for their autistic child. The search found 18 studies. Results from each study were examined and coded into themes. Parents reported that accessibility, diversity of support services, and stigma influenced their experiences with support services. We discuss what these findings might mean for future research and for service delivery.
Rainbows over the world’s public health: determinants of health models in the past, present, and future
Authors: Dyar Oliver J. , Haglund Bo J. A. , Melder Cecilia , Skillington Tracey , Kristenson Margareta , Sarkadi Anna 
Published: September 2022

The need to visualise the complexity of the determinants of population health and their interactions inspired the development of the rainbow model. In this commentary we chronicle how variations of this model have emerged, including the initial models of Haglund and Svanström (1982), Dahlgren and Whitehead (1991), and the Östgöta model (2014), and we illustrate how these models have been influential in both public health and beyond. All these models have strong Nordic connections and are thus an important Nordic contribution to public health. Further, these models have underpinned and facilitated other examples of Nordic leadership in public health, including practical efforts to address health inequalities and design new health policy approaches. Apart from documenting the emergence of rainbow models and their wide range of contemporary uses, we examine a range of criticisms levelled at these models – including limitations in methodological development and in scope. We propose the time is ripe for an updated generic determinants of health model, one that elucidates and preserves the core value in older models, while recognising the developments that have occurred over the past decades in our understanding of the determinants of health. We conclude with an example of a generic model that fulfills the general purposes of a determinants of health model while maintaining the necessary scope for further adjustments to be made in the future, as well as adjustments to location or context-specific purposes, in education, research, health promotion and beyond.
Sociodemographic characterisation of antibiotic heavy users in the Danish elderly population
Authors: Jensen Maria L.V. , Aabenhus Rune M. , Holzknecht Barbara J. , Bjerrum Lars , Siersma Volkert , COrdoba Gloria , Jensen Jette N. 
Published: September 2022

Aims: The development of effective interventions to reduce inappropriate use of antibiotics in the elderly population requires knowledge on who can benefit from such interventions. Thus, we aimed to identify and characterise antibiotic heavy users among elderly patients in general practice with respect to sociodemographic variables. Methods: We conducted a retrospective nationwide register-based study on all Danish elderly citizens (⩾65 years) who redeemed an antibiotic prescription in 2017. Heavy users were defined as the 10% with the highest excess use, that is, their recorded use minus the average use for their sex, age group and comorbidity level as estimated from a linear regression model. Comparative analyses of sociodemographic characteristics (civil status, employment status, urbanity, educational level and country of origin) of heavy users and non-heavy users were performed using logistic regression models. Results: The study population consisted of 251,733 elderly individuals, who in total redeemed 573,265 prescriptions of antibiotics. Heavy users accounted for 68% of all excess use of antibiotics. In multivariable analyses, individuals with an educational level above basic schooling, non-retired, residing in an urban municipality and being born in a country outside Scandinavia all had lower odds of being a heavy user. Widowed, divorced or single individuals had higher odds of being a heavy user compared with married individuals. Relative importance analyses showed that civil status and educational level contributed considerably to the explained variance. Conclusions: This study found an association between sociodemographic characteristics and risk of being a heavy user, indicating that sociodemographic variation exists with regard to antibiotic prescribing.
Assessing the Quality of Vascular Ultrasound Examinations Using the IAC QI Self-Assessment Tool: Inter-Rater and Intra-Rater Agreement Between Vascular Technologists and Interpreting Physicians
Authors: Bajwa Bakhtawar N. , Esterson Yonah B. , Naidich James B. , Burke Brian J. , D’Agostino Catherine A. , Kline Myriam , Pellerito John S. 
Published: September 2022

Introduction: Vascular laboratories need to improve efficiency while maintaining examination quality. Vascular ultrasound examinations were retrospectively evaluated using the Intersocietal Accreditation Commission (IAC) Quality Improvement (QI) Self-Assessment Tool to evaluate the quality of the examinations and to determine inter-rater and intra-rater agreement between groups of vascular technologists and interpreting physicians. Methods: Vascular technologists and attending interpreting physicians evaluated 100 carotid Doppler and 100 lower extremity venous Doppler examinations utilizing the IAC QI Self-Assessment Tool. Gwet’s First-Order Agreement Coefficient (AC1) statistic and 95% confidence intervals were calculated to determine both inter-rater and intra-rater agreement. Results: The inter-rater agreement for 91% of all questions ranged from substantial (AC1 = 0.6) to almost perfect (AC1 = 1) for both examination types across all reviewers. Agreement on 2 questions was suboptimal: specifically, the technical quality section for the vascular technologists showed slight agreement for carotid Doppler and venous Doppler examinations (AC1 = 0.108 and 0.087, respectively), and the case review section for the interpreting physicians showed poor agreement for carotid Doppler examinations (AC1 = –0.087) and fair agreement for venous Doppler examinations (AC1 = 0.329). The intra-rater agreement among the interpreting physicians for both examinations was in the almost perfect range (Carotid AC1 = 0.875-1; Venous AC1 = 0.871-1). The intra-rater agreement among the vascular technologists for both examinations ranged from slight to almost perfect (Carotid AC1 = 0.191-1; Venous AC1 = 0.155-1). Conclusion: Substantial to almost perfect agreement among all reviewers was observed for most of the quality review questions. The IAC QI Self-Assessment Tool aided in identifying areas for improvement in vascular studies and the comments captured in the technical quality section of the tool were instrumental in establishing areas for quality improvement.
Clinical response to belumosudil in bronchiolitis obliterans syndrome: a combined analysis from 2 prospective trials
Authors: DeFilipp Zachariah , Kim Haesook T. , Yang Zhongming , Noonan John , Blazar Bruce R. , Lee Stephanie J. , Pavletic Steven Z. , Cutler Corey 
Published: September 2022

Abstract
Chronic graft-versus-host disease (cGVHD) of the lung, or bronchiolitis obliterans syndrome (BOS), is a high-risk disease manifestation associated with poor outcomes. Currently available treatments have demonstrated limited clinical efficacy in this setting. Belumosudil is a novel oral selective rho-associated coiled-coil–containing protein kinase-2 inhibitor that was recently approved by the US Food and Drug Administration in the treatment of cGVHD. We identified 59 subjects with BOS who were enrolled and treated in 2 prospective clinical trials of belumosudil. Patients with BOS had a percentage predicted forced expiratory volume in 1 second (FEV1) of ≤79% at enrollment and clinician attribution of lung disease owing to cGVHD. The National Institutes of Health (NIH) cGVHD lung scores at enrollment were 1 (n = 30, 59%), 2 (n = 23, 39%), or 3 (n = 6, 10%). According to NIH response criteria, the best overall response rate (ORR) for lung cGVHD was 32% (partial response: 17%; complete response: 15%). Response rates were inversely proportional to baseline NIH GVHD lung score at enrollment (lung score 1: ORR 50%; lung score 2: ORR 17%, lung score 3: ORR 0%) (P = .006). In multivariable analysis, male sex, lower baseline NIH cGVHD lung score, and partial response to previous line of cGVHD therapy before enrollment were associated with higher rates of lung-specific response. No significant correlation was identified between pulmonary function evaluations and measures of patient symptoms (NIH lung symptom score or Lee Symptom Scale score for lung). In conclusion, belumosudil treatment was associated with lung-specific clinical responses for subjects with BOS, which were more commonly observed in less advanced disease. Optimization of treatment response evaluations remains a challenge in patients with BOS.