bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Decompressive Hemicraniectomy in Successfully Recanalized Patients With Anterior Circulation Emergency Large‐Vessel Occlusion
Authors: Heiferman Daniel M. , Tsivgoulis Georgios , Singh Savdeep , Alsbrook Diana , Zaid Ghaida , Gachechiladze Leila , Krishnaiah Balaji , Inoa‐Acosta Violiza , Khan Nickalus , Nickele Christopher M. , Hoit Daniel A. , Alexandrov Andrei V. , Elijovich Lucas , Arthur Adam S. , Goyal Nitin 
Published: June 2022

Background
Mechanical thrombectomy (MT) has been shown to improve functional outcome in patients with anterior circulation strokes and emergent large‐vessel occlusion (ELVO). Despite successful recanalization, some of these patients require decompressive hemicraniectomy (DHC). We aimed to study the predictors of DHC in successfully recanalized anterior circulation ELVO patients.

Methods
Consecutive patients with anterior circulation ELVO treated with MT during a 6‐year period were evaluated. Only successfully recanalized patients (modified Thrombolysis in Cerebral Infarction grades 2b, 2c, or 3) after MT were included in the analysis. Baseline demographic, clinical, and procedural variables were compared between patients requiring DHC after successful recanalization versus those who did not.

Results

Of 453 successfully recanalized patients with ELVO, 47 who underwent DHC had higher admission blood glucose levels (170±88 versus 142±66 mg/dL;
P
=0.008), lower median Alberta Stroke Program Early CT Scores (9 [interquartile range, 8–10] versus 10 [interquartile range, 9–10];
P
=0.002), higher prevalence of poor collaterals on pretreatment computed tomography angiogram (75% versus 26%;
P
<0.001), and required more passes during MT (median, 3 [interquartile range, 3–4] versus 2 [interquartile range, 1–2];
P
=0.001) compared with those who did not undergo DHC. In a multivariable model after adjusting for multiple confounders, higher admission blood glucose levels (
P
=0.031), poor collaterals on computed tomography angiography (
P
<0.001), and higher number of passes during MT (
P
<0.001) emerged as independent predictors of DHC in successfully recanalized patients with ELVO.

Conclusions
Higher admission blood glucose levels, poor collateral pattern on computed tomography angiography, and higher number of passes during MT were independently associated with DHC in patients with anterior circulation ELVO achieving successful recanalization following MT.
On the Dynamics of Indian Ocean Teleconnections into the Southern Hemisphere during Austral Winter
Authors: Gillett Z. E. , Hendon H. H. , Arblaster J. M. , Lin H. , Fuchs D. 
Published: June 2022

Abstract
Stationary Rossby waves, forced by the Indian Ocean dipole (IOD), have an important role in Southern Hemisphere (SH) weather and climate, including promoting Australian drought and driving Antarctic sea ice variations. However, the dynamics of these teleconnections are not fully understood. During winter, the subtropical jet (STJ) should prohibit continuous propagation of a stationary Rossby wave into the SH extratropics due to the negative meridional gradient of absolute vorticity () on its poleward flank. The mechanisms that enable this teleconnection are investigated using observational and reanalysis datasets, a hierarchy of atmospheric model experiments and Rossby wave diagnostics. We conduct 90-member simulations using the Community Atmosphere Model, version 5, with an imposed local diabatic heating anomaly over the eastern Indian Ocean. We find an initial zonal propagation along the STJ waveguide, but after about 10 days, a poleward-arcing wave train appears in the extratropics that has the characteristics of the observed IOD teleconnection. Our results suggest that the Rossby wave can overcome the negative barrier by (i) propagating directly poleward in the midtroposphere and thus avoiding this evanescent region in the upper troposphere, (ii) partly propagating directly through this barrier, and (iii) propagating around this barrier farther upstream to the west. A transient eddy feedback, previously postulated to be the key mechanism to allow the stationary Rossby wave to appear on the poleward side of the negative region, reinforces the response but is not a requisite, which we confirm through comparison with a simplified linear model.
Observation of Abyssal Circulation to the West of the Luzon Strait, South China Sea
Authors: Zheng Hua , Zhu Xiao-Hua , Zhang Chuanzheng , Zhao Ruixiang , Zhu Ze-Nan , Ren Qiang , Liu Yansong , Nan Feng , Yu Fei 
Published: June 2022

Abstract
South China Sea (SCS) abyssal circulation largely contributes to water renewal, energy budget, and sedimentary processes in the deep ocean. The three-dimensional abyssal circulation west of the Luzon Strait (LS) in the northern SCS was investigated using an array comprising 27 current- and pressure-recording inverted echo sounders. Over 400 days of measurements from June 2018 to July 2019 showed a narrow and strong (∼70 km, ∼2.3 cm s−1 at 2500 dbar) northward current near the steep eastern boundary, while a wide and weak (∼180 km, ∼1.5 cm s−1 at 2500 dbar) southwestward current lies along the subdued western boundary. The circulation showed conspicuous cyclonic patterns with a volume transport of ∼1.21 ± 0.93 Sv (1 Sv ≡ 106 m3 s−1) and ∼1.59 ± 0.95 Sv below 2500 dbar along the eastern and western boundaries, respectively. The current near the LS was strong in late autumn and early winter but weak in late winter and spring, following the seasonal variation of LS deep-water overflow. However, the southwestward current in the interior SCS was stronger in summer and early autumn but weaker in late winter and early spring. The different seasonal patterns identified near the LS and the interior SCS are attributed to the propagation of seasonal variation. The weak current along the western boundary in August 2018 and February 2019 was dominated by LS deep-water overflow with a time lag of ∼7.5 months. Although eddies in the upper ocean may also contribute to such variation through pressure work, the effect is minor.

Significance Statement
Cyclonic circulation in the deep South China Sea (SCS) largely contributes to water renewal, energy budget, and sedimentary processes and influences the transport of dissolved elements, minerals, and pollutants. As an important part of the SCS throughflow, an in-depth analysis of the SCS abyssal circulation may also contribute to understanding Indonesian Throughflow and global climate change. The three-dimensional abyssal circulation west of the Luzon Strait was investigated using large-scale data from June 2018 to July 2019, which provided unprecedented coverage of abyssal circulation in the northeast SCS. The study provides important observational evidence for the existence of SCS abyssal cyclonic circulation. Detailed spatiotemporal structure of abyssal circulation and its variations are presented, and related dynamic processes are discussed.
A Gradient Tensor–Based Subgrid-Scale Parameterization for Large-Eddy Simulations of Stratified Shear Layers Using the Weather Research and Forecasting Model
Authors: Khani Sina , Porté-Agel Fernando 
Published: June 2022

Abstract
The transition process from laminar stratified shear layer to fully developed turbulence is usually captured using direct numerical simulations, in which the computational cost is extremely high and the numerical domain size is limited. In this work, we introduce a scale-aware subgrid-scale (SGS) parameterization, based on the gradient tensor of resolved variables, which is implemented in the Weather Research and Forecasting (WRF) Model. With this new SGS model, we can skillfully resolve the characteristics of transition process, including formation of vortex cores, merging vorticity billows, breaking waves into smaller scales, and developing secondary instability in the stratified shear layer even at coarse-resolution simulations. Our new model is developed such that the time scales of the eddy viscosity and diffusivity terms are represented using the tensor of the gradient and not that of the rate-of-strain, which is commonly used in the parameterization of turbulent-viscosity models. We show that time scales of unresolved transition processes in our new model are correlated with those of vorticity fields. At early times, the power-law slopes in the kinetic and available potential energy spectra are consistent with the process of formation and merging waves with an upscale energy transfer. At later times, the power-law slopes are in line with the process of breaking waves into small-scale motions with a downscale transfer. More importantly, the efficiency of turbulent mixing is mainly high at the edge of vortex filaments and not at the vortices’ eyes. These findings can improve our understanding of turbulent mixing process in large-scale wind-induced events, such as tropical cyclones, using the WRF Model.

Significance Statement
The evolution of instabilities in stratified shear layers has significant impacts on the structure of large-scale geophysical flows and also on the energy pathway to smaller-scale motions in internal waves and turbulence. Resolving transition processes in stratified shear layers requires very high-resolution simulations in climate models. We propose a new subgrid-scale parameterization that is implemented in the Weather Research and Forecasting Model to capture the dynamics of transition process from laminar to three-dimensional turbulence in stratified shear layers at coarse-resolution simulations. Our new scale-aware parameterization can reduce biases in climate models by skillfully representing unresolved fluxes, leading to higher accuracy in weather predictions of temperature, precipitation, and surface fluxes with an affordable computational cost.
Investigating the impact of brief training in decision-making on treatment escalation to intensive care using objective structured clinical examination-style scenarios
Authors: Riad Hisham M , Boulton Adam J , Slowther Anne-Marie , Bassford Christopher 
Published: June 2022

Background The decision to admit patients to the intensive care unit (ICU) is complex. Structuring the decision-making process may be beneficial to patients and decision-makers alike. The aim of this study was to investigate the feasibility and impact of a brief training intervention on ICU treatment escalation decisions using the Warwick model- a structured decision-making framework for treatment escalation decisions. Methods Treatment escalation decisions were assessed using Objective Structured Clinical Examination-style scenarios. Participants were ICU and anaesthetic registrars with experience of making ICU admission decisions. Participants completed one scenario, followed by training with the decision-making framework and subsequently a second scenario. Decision-making data was collected using checklists, note entries and post-scenario questionnaires. Results Twelve participants were enrolled. Brief decision-making training was successfully delivered during the normal ICU working day. Following training participants demonstrated greater evidence of balancing the burdens and benefits of treatment escalation. On visual analogue scales of 0–10, participants felt better trained to make treatment escalation decisions (4.9 vs 6.8, p = 0.017) and felt their decision-making was more structured (4.7 vs 8.1, p = 0.017). Overall, participants provided positive feedback and reported feeling more prepared for the task of making treatment escalation decisions. Conclusion Our findings suggest that a brief training intervention is a feasible way to improve the decision-making process by improving decision-making structure, reasoning and documentation. Training was implemented successfully, acceptable to participants and participants were able to apply their learning. Further studies of regional and national cohorts are needed to determine if training benefit is sustained and generalisable.
An accurate prognostic prediction for aneurysmal subarachnoid hemorrhage dedicated to patients after endovascular treatment
Authors: Lu Han , Xue Gaici , Li Sisi , Mu Yangjiayi , Xu Yi , Hong Bo , Huang Qinghai , Li Qiang , Yang Pengfei , Zhao Rui , Fang Yibin , Luo Qiang , Zhou Yu , Liu Jianmin 
Published: June 2022

Background: Endovascular treatment for aneurysmal subarachnoid hemorrhage (aSAH) has high fatality and permanent disability rates. It remains unclear how the prognosis is determined by the complex interaction between clinical severity and aneurysm characteristics. Objective: This study aimed to design an accurate prognostic prediction model for aSAH patients after endovascular treatment and elucidate the interaction between clinical severity and aneurysm characteristics. Methods: We used a clinically homogeneous data set with 1029 aSAH patients who received endovascular treatment to develop prognostic models. Aneurysm characteristics were measured by variables, such as aneurysm size, neck size, and dome-to-neck ratio, while clinical severity on admission was measured by both comorbidities and neurological condition. In total, 18 clinical variables were used for prognostic prediction. Considering the imbalance between the favorable and the poor outcomes in this clinical population, both ensemble learning and deep reinforcement learning approaches were used for prediction. Results: The random forest (RF) model was selected as the best approach for the prognostic prediction for all patients and also for patients with good-grade aSAH. Using an independent test data set, the model made accurate predictions (AUC = 0.869 ± 0.036, sensitivity = 0.709 ± 0.087, specificity = 0.805 ± 0.034) with the clinical severity on admission as a leading contributor to the prediction. For patients with good-grade aSAH, the RF model performed the best (AUC = 0.805 ± 0.034, sensitivity = 0.620 ± 0.172, specificity = 0.696 ± 0.043) with aneurysm characteristics as leading contributors. The classic scoring systems failed in this patient group (AUC < 0.600; sensitivity = 0.000, specificity = 1.000). Conclusion: The proposed prognostic prediction model outperformed the classic scoring systems for patients with aSAH after endovascular treatment, especially when the classic scoring systems failed to make any informative prediction for patients with good-grade aSAH, who constitute the majority group (79%) of this clinical population.
Digital exclusion and its impact on journalism in Kashmir
Authors: Hassan Ruheela 
Published: June 2022

With the introduction of personal computer systems and subsequent technologies that make flow of information fast and efficient, a new age emerged that is often termed as ‘digital age’ or ‘digital era’. During this age, the capabilities of individuals and societies to access and use multiple forms of convergent media content got enhanced manifold. It also led to a revolution in the industry of ‘news and views’. This convergent media is popularly known as the ‘New Media’. While this new (digital) media is taking new shapes across the globe, it is still struggling for survival in one part of the world called Kashmir. Due to frequent suspensions of internet service in the valley, the digital media of Kashmir faces multiple challenges that are mostly unknown to other parts of the world. During 2010, 2012 and 2016 uprisings in Kashmir and more recently in 2019–2020, when Indian government decided to scrap the autonomy and special status of the valley, this place was excluded digitally that had a huge setback not only to the growth of New Media, but on education, health and economy as well. This paper studies this digital exclusion and its impact on journalism and mass communication in Kashmir.
Technical and oncological safety of laparoscopic gastrectomy for gastric cancer in elderly patients ≥ 80 years old
Authors: Ueda Yoshitake , Shiraishi Norio , Fujishima Hajime , Kawasaki Takahide , Ninomiya Shigeo , Shiroshita Hidefumi , Etoh Tsuyoshi , Inomata Masafumi 
Published: June 2022

Abstract
Background
As the incidence of gastric cancer increases in elderly patients worldwide, laparoscopic gastrectomy (LG) for elderly patients with gastric cancer is also increasing. However, whether LG is an optimal surgical modality for elderly patients with gastric cancer remains unclear. This study aimed to evaluate the technical and oncological safety of LG for elderly patients ≥ 80 years old with gastric cancer.

Methods
Patients who received curative gastrectomy for gastric cancer from 2003 to 2015 were enrolled in the study. They were divided into the LG in elderly patients aged over 80 years (LG-E) group, open gastrectomy (OG) in elderly patients (OG-E) group, and LG in non-elderly patients < 80 years (LG-NE) group. Patients’ demographics and short- and long-term outcomes, such as postoperative complications and 5-year survival rate, were compared between the three groups, retrospectively.

Results
The LG-E, OG-E, and LG-NE groups comprised 45, 43, and 329 patients, respectively. In the comparison between the LG-E and OG-E groups, the incidence of distal gastrectomy (DG) and the proportions of patients with pathological tumor stage T1, pathological N0, and final stage I were significantly higher in the LG-E versus OG-E group (89 vs. 56%, 76% vs. 16%, 82% vs. 37%, and 84% vs. 35%, p < 0.01, respectively). Blood loss and the incidence of overall postoperative complications in the LG-E group were significantly lower than those in the OG-E group (40 vs. 240 g, p < 0.01, and 29% vs. 53%, p < 0.05, respectively). Although the 5-year overall survival (OS) rate was not significantly different between the two groups, the 5-year disease-specific survival (DSS) rate was significantly higher in the LG-E group versus OG-E group (93% vs. 78%, p < 0.05). Overall comorbidities were significantly higher in the LG-E group versus LG-NE group, but there were no significant differences in short-term outcomes between the two groups. Further, although the 5-year OS rate was significantly lower in the LG-E group versus LG-NE group (67% vs. 87%, p < 0.01), there was no significant difference between the two groups in 5-year DSS rate.

Conclusion
LG is technically and oncologically safe for the treatment of gastric cancer in both elderly patients aged ≥ 80 years and the non-elderly and can be an optimal surgical modality for elderly patients with gastric cancer.
Determinants of fetal macrosomia among live births in southern Ethiopia: a matched case–control study
Authors: Woltamo Deginesh Dawit , Meskele Mengistu , Workie Shimelash Bitew , Badacho Abebe Sorsa 
Published: June 2022

Abstract
Background
Fetal macrosomia defined as birth weight of 4000 g and above regardless of gestational age and associated with adverse maternal and fetal outcomes, especially among women in developing countries like Ethiopia. Despite the observed burden, there is limited evidence on determinants of fetal macrosomia. This study aimed to identify determinants of fetal macrosomia among live births at Wolaita Sodo town Southern Ethiopia.

Methods
A facility-based matched case–control study design involved 360 singletons deliveries attended at hospitals in Wolaita Sodo town, southern Ethiopia, with 120 cases and 240 controls included. Cases and control were matched by maternal age. Cases were neonates with a birth weight of ≥ 4000, while controls were neonates with a birthweight between 2500gm and less than 4000gm. Data were collected by interviews, measuring, and reviewing mothers' medical documents. Conditional logistic regression analysis was carried to identify the independent predictor variables. Statistical significance was set using a p-value < 0.05 and 95% CI for AOR.

Results
Male neonates were four times more likely to be macrosomia than female neonates MAOR = 4.0 [95%CI; 2.25–7.11, p < 0.001]. Neonates born at gestational age ≥ 40 weeks were 4.33 times more likely to be macrosomia with MAOR = 4.33 [95%CI; 2.37–7.91, p < 0.001]. Neonates born from physically inactive mothers were 7.76 times more likely to be macrosomia with MAOR = 7.76 [95CI; 3.33–18.08, p < 0.001]. Neonates born from mothers who consumed fruits and dairy products in their diet frequently were 2 and 4.9 times more likely to be macrosomia MAOR = 2.03 [95%CI; 1.11–3.69, p = 0.021] and AOR = 4.91[95%CI; 2.36–10.23, p < 0.001] respectively.

Conclusion
Mothers' physical exercise and consumption of fruit and dairy products were significant predictor variables for fetal macrosomia. Hence, health care providers may use these factors as a screening tool for the prediction, early diagnosis, and timely intervention of fetal macrosomia and its complications.
Burden, patterns, and impact of multimorbidity in North India: findings from a rural population-based study
Authors: Gupta Priti , Patel Shivani A. , Sharma Hanspria , Jarhyan Prashant , Sharma Rakshit , Prabhakaran Dorairaj , Tandon Nikhil , Mohan Sailesh 
Published: June 2022

Abstract
Aim
To estimate the prevalence, socio-demographic determinants, common disease combinations, and health impact of multimorbidity among a young rural population.

Methods
We conducted a cross-sectional survey among participants aged ≥30 years in rural Punjab, North India, from Jan 2019 to April 2019. Multimorbidity was defined as the coexistence of ≥two conditions using a 14-condition tool validated in India. We also calculated a multimorbidity-weighted index (MWI), which provides a weight to each disease based on its impact on physical functioning. Logistic regression was conducted to evaluate the association with sociodemographic variables, mental health (PHQ-9), physical functioning (ADL scale), and self-rated health (SRH).

Results
We analyzed data from 3213 adults [Mean age 51.5 (±13), 54% women]. Prevalence of single chronic condition, multimorbidity, and MWI was 28.6, 18% and − 1.9 respectively. Age, higher wealth index and ever use alcohol were significantly associated with multimorbidity. Overall, 2.8% of respondents had limited physical functioning, 2.1% had depression, and 61.5% reported low SRH. Poorer health outcomes were more prevalent among the elderly, women, less educated, and those having lower wealth index and multimorbidity, were found to be significantly associated with poor health outcomes.

Conclusions
The burden of multimorbidity was high in this young rural population, which portends significant adverse effects on their health and quality of life. The Indian health system should be reconfigured to address this emerging health priority holistically, by adopting a more integrated and sustainable model of care.
Anticancer potential of alkaloids: a key emphasis to colchicine, vinblastine, vincristine, vindesine, vinorelbine and vincamine
Authors: Dhyani Praveen , Quispe Cristina , Sharma Eshita , Bahukhandi Amit , Sati Priyanka , Attri Dharam Chand , Szopa Agnieszka , Sharifi-Rad Javad , Docea Anca Oana , Mardare Ileana , Calina Daniela , Cho William C. 
Published: June 2022

AbstractCancer, one of the leading illnesses, accounts for about 10 million deaths worldwide. The treatment of cancer includes surgery, chemotherapy, radiation therapy, and drug therapy, along with others, which not only put a tremendous economic effect on patients but also develop drug resistance in patients with time. A significant number of cancer cases can be prevented/treated by implementing evidence-based preventive strategies. Plant-based drugs have evolved as promising preventive chemo options both in developing and developed nations. The secondary plant metabolites such as alkaloids have proven efficacy and acceptability for cancer treatment. Apropos, this review deals with a spectrum of promising alkaloids such as colchicine, vinblastine, vincristine, vindesine, vinorelbine, and vincamine within different domains of comprehensive information on these molecules such as their medical applications (contemporary/traditional), mechanism of antitumor action, and potential scale-up biotechnological studies on an in-vitro scale. The comprehensive information provided in the review will be a valuable resource to develop an effective, affordable, and cost effective cancer management program using these alkaloids.