bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phase II Trial of Adjuvant Nivolumab Following Salvage Resection in Patients with Recurrent Squamous Cell Carcinoma of the Head and Neck
Authors: Leddon Jennifer L. , Gulati Shuchi , Haque Sulsal , Allen Casey , Palackdharry Sarah , Mathews Maria , Kurtzweil Nicky , Riaz Muhammed Kashif , Takiar Vinita , Nagasaka Misako , Patil Yash , Zender Chad , Tang Alice , Cervenka Brian , McGrath Julie , Korn W. Michael , Hinrichs Benjamin H. , Jandarov Roman , Harun Nusrat , Sukari Ammar , Wise-Draper Trisha M. 
Published: June 2022

Abstract

Purpose:
Locoregional relapse in patients with head and neck squamous cell carcinoma (HNSCC) is common, approaching 50% for some subsites despite multimodality therapy. Salvage surgery is the standard of care, but able to achieve durable control in only a minority of patients. While adjuvant radiotherapy or chemo-radiotherapy is offered to select patients, this approach can be prohibitively toxic. Given the activity and tolerability of programmed death-1 inhibitors in metastatic HNSCC, we investigated the safety and efficacy of adjuvant nivolumab after salvage surgical resection.

Patients and Methods:
This was an open-label, multi-institutional phase II clinical trial (NCT03355560). Patients with recurrent, resectable HNSCC were enrolled within 6 weeks of salvage surgery. Six 28-day cycles of adjuvant nivolumab were planned. The primary endpoint was 2-year disease-free survival (DFS) more than 58%, based on an institutional historical control group of 71 patients with recurrent HNSCC who underwent salvage surgery.

Results:
Between February 2018 and February 2020, 39 patients were enrolled. At a median follow-up of 22.1 months, 2-year DFS was 71.4% [95% confidence interval (CI), 57.8–88.1] and the 2-year overall survival (OS) was 73% (95% CI, 58–91.8). Three of 39 (8%) patients experienced grade 3 treatment-related adverse events and 3 of 39 (8%) discontinued treatment due to side effects. Ten of 39 had locoregional recurrence, while 2 of 10 also had synchronous metastatic disease. There was no difference in DFS between PD ligand-1 (PD-L1)–positive and PD-L1–negative patients. There was a nonsignificant trend toward improved DFS in patients with high tumor mutational burden (P = 0.083).

Conclusions:
Adjuvant nivolumab after salvage surgery in locally recurrent HNSCC is well tolerated and showed improved DFS compared with historical controls.
Artificial Intelligence and Machine Learning Technologies in Cancer Care: Addressing Disparities, Bias, and Data Diversity
Authors: Dankwa-Mullan Irene , Weeraratne Dilhan 
Published: June 2022

Summary:
Artificial intelligence (AI) and machine learning (ML) technologies have not only tremendous potential to augment clinical decision-making and enhance quality care and precision medicine efforts, but also the potential to worsen existing health disparities without a thoughtful, transparent, and inclusive approach that includes addressing bias in their design and implementation along the cancer discovery and care continuum. We discuss applications of AI/ML tools in cancer and provide recommendations for addressing and mitigating potential bias with AI and ML technologies while promoting cancer health equity.
Diagnostic Utility of Computed Tomography Perfusion in the Telestroke Setting
Authors: Arora Kshitij , Gaekwad Aaron , Evans James , O’Brien William , Ang Timothy , Garcia-Esperon Carlos , Blair Christopher , Edwards Leon S. , Chew Beng L.A. , Delcourt Candice , Spratt Neil J. , Parsons Mark W. , Butcher Ken S. 
Published: June 2022

Background:
Definitive diagnosis of acute ischemic stroke is challenging, particularly in telestroke settings. Although the prognostic utility of CT perfusion (CTP) has been questioned, its diagnostic value remains under-appreciated, especially in cases without an easily visible intracranial occlusion. We assessed the diagnostic accuracy of routine CTP in the acute telestroke setting.

Methods:
Acute and follow-up data collected prospectively from consecutive suspected patients with stroke assessed by a state-wide telestroke service between March 2020 and August 2021 at 12 sites in Australia were analyzed. All patients in the final analysis had been assessed with multimodal CT, including CTP, which was post-processed with automated volumetric software. Diagnostic sensitivity and specificity were calculated for multimodal CT and each individual component (noncontrast CT [NCCT], CT angiogram [CTA], and CTP). Final diagnosis determined by consensus review of follow-up imaging and clinical data was used as the reference standard.

Results:

During the study period, complete multimodal CT examination was obtained in 831 patients, 457 of whom were diagnosed with stroke. Diagnostic sensitivity for ischemic stroke increased by 19.5 percentage points when CTP was included with NCCT and CTA compared with NCCT and CTA alone (73.1% positive with NCCT+CTA+CTP [95% CI, 68.8–77.1] versus 53.6% positive with NCCT+CTA alone [95% CI, 48.9–58.3],
P
<0.001). No difference was observed between specificities of NCCT+CTA and NCCT+CTA+CTP (98.7% [95% CI, 98.5–100] versus 98.7% [95% CI, 96.9–99.6],
P
=0.13). Multimodal CT, including CTP, demonstrated the highest negative predictive value (75.0% [95% CI, 72.1–77.7]). Patients with stroke not evident on CTP had small volume infarcts on follow-up (1.2 mL, interquartile range 0.5–2.7mL).

Conclusions:
Acquisition of CTP as part of a telestroke imaging protocol permits definitive diagnosis of cerebral ischemia in 1 in 5 patients with normal NCCT and CTA.
Measles seroprevalence in Thailand: are adolescents and young adults at risk of measles?
Authors: Takkinsatian Panit , Wannaphahoon Kamolmart , Upapan Prasit , Senawong Sansnee , Prommalikit Olarn 
Published: June 2022

Abstract

Introduction:
During the last decade, measles has become an important re-emerging disease in Thailand. The objective of this study was to measure measles seroprevalence and its influencing factors so as to plan an improved vaccination programme.

Methods:
A total of 600 participants aged between 9 months and 50 years were divided into seven groups representing birth cohorts that experienced different measles vaccination policies. Participants’ blood samples were obtained to measure measles immunoglobulin G (IgG) levels.

Results:
None of the participants in the age group of 9 months had measles IgG levels beyond a protective level. Participants in the age groups 2.5, 5–15, 16–29, 30–33, 34–40 and 41–50 years had 82% (95% confidence interval [CI] 73.3–90.7), 50% (95% CI 36.1–63.9), 52% (95% CI 42.3–62.7), 70% (95% CI 61.1–78.9), 88.8% (95% CI 84.1–93.5) and 98.8% (95% CI 96.4–100.0) measles seropositivity, respectively. The study did not find any significant factors affecting measles seropositivity.

Conclusion:
Individuals aged 15–34 years are vulnerable to measles infections. Supplementary vaccination should be encouraged in special situations, including postexposure prophylaxis for young adults during an outbreak and for high-risk occupations such as healthcare personnel.
Evaluation of ERA5-Land and HARv2 Reanalysis Data at High Elevation in the Upper Dudh Koshi Basin (Everest Region, Nepal)
Authors: Khadka Arbindra , Wagnon Patrick , Brun Fanny , Shrestha Dibas , Lejeune Yves , Arnaud Yves 
Published: June 2022

Abstract
We present a multisite evaluation of meteorological variables in the Everest region (Nepal) from ERA5-Land and High Asian Refined Analysis, version 2 (HARv2), reanalyses in comparison with in situ observations, using classical statistical metrics. Observation data have been collected since 2010 by seven meteorological stations located on or off glacier between 4260 and 6352 m MSL in the upper Dudh Koshi basin; 2-m air temperature, specific and relative humidities, wind speed, incoming shortwave and longwave radiations, and precipitation are considered successively. Overall, both gridded datasets are able to resolve the mesoscale atmospheric processes, with a slightly better performance for HARv2 than that for ERA5-Land, especially for wind speed. Because of the complex topography, they fail to reproduce local- to microscale processes captured at individual meteorological stations, especially for variables that have a large spatial variability such as precipitation or wind speed. Air temperature is the variable that is best captured by reanalyses, as long as an appropriate elevational gradient of air temperature above ground, spatiotemporally variable and preferentially assessed by local observations, is used to extrapolate it vertically. A cold bias is still observed but attenuated over clean-ice glaciers. The atmospheric water content is well represented by both gridded datasets even though we observe a small humid bias, slightly more important for ERA5-Land than for HARv2, and a spectacular overestimation of precipitation during the monsoon. The agreement between reanalyzed and observed shortwave and longwave incoming radiations depends on the elevation difference between the station site and the reanalysis grid cell. The seasonality of wind speed is only captured by HARv2. The two gridded datasets ERA5-Land and HARv2 are applicable for glacier mass and energy balance studies, as long as either statistical or dynamical downscaling techniques are used to resolve the scale mismatch between coarse mesoscale grids and fine-scale grids or individual sites.
Mixing in a Salinity Variance Budget of the Salish Sea is Controlled by River Flow
Authors: Broatch Erin M. , MacCready Parker 
Published: June 2022

Abstract
A salinity variance framework is used to study mixing in the Salish Sea, a large fjordal estuary. Output from a realistic numerical model is used to create salinity variance budgets for individual basins within the Salish Sea for 2017–19. The salinity variance budgets are used to quantify the mixing in each basin and estimate the numerical mixing, which is found to contribute about one-third of the total mixing in the model. Whidbey Basin has the most intense mixing, due to its shallow depth and large river flow. Unlike in most other estuarine systems previously studied using the salinity variance method, mixing in the Salish Sea is controlled by the river flow and does not exhibit a pronounced spring–neap cycle. A “mixedness” analysis is used to determine when mixed water is expelled from the estuary. The river flow is correlated with mixed water removal, but the coupling is not as tight as with the mixing. Because the mixing is so highly correlated with the river flow, the long-term average approximation M = Qrsoutsin can be used to predict the mixing in the Salish Sea and Puget Sound with good accuracy, even without any temporal averaging. Over a 3-yr average, the mixing in Puget Sound is directly related to the exchange flow salt transport.
The Generation of Linear and Nonlinear Internal Waves Forced by Subinertial Tides over the Yermak Plateau, Arctic Ocean
Authors: Urbancic Gabin H. , Lamb Kevin G. , Fer Ilker , Padman Laurie 
Published: June 2022

Abstract
The propagation of internal waves (IWs) of tidal frequency is inhibited poleward of the critical latitude, where the tidal frequency is equal to the Coriolis frequency (f). These subinertial IWs may propagate in the presence of background vorticity, which can reduce rotational effects. Additionally, for strong tidal currents, the isopycnal displacements may evolve into internal solitary waves (ISWs). In this study, wave generation by the subinertial K1 and M2 tides over the Yermak Plateau (YP) is modeled to understand the linear response and the conditions necessary for the generation of ISWs. The YP stretches out into Fram Strait, a gateway into the Arctic Ocean for warm Atlantic-origin waters. We consider the K1 tide for a wide range of tidal amplitudes to understand the IW generation for different forcing. For weak tidal currents, the baroclinic response is predominantly at the second harmonic due to critical slopes. For sufficiently strong diurnal currents, ISWs are generated and their generation is not sensitive to the range of f and stratifications considered. The M2 tide is subinertial yet the response shows propagating IW beams with frequency just over f. We discuss the propagation of these waves and the influence of variations of f, as a proxy for variations in the background vorticity, on the energy conversion to IWs. An improved understanding of tidal dynamics and IW generation at high latitudes is needed to quantify the magnitude and distribution of turbulent mixing, and its consequences for the changes in ocean circulation, heat content, and sea ice cover in the Arctic Ocean.
Atmospheric River Reconnaissance 2021: A Review
Authors: Cobb Alison , Ralph F. Martin , Tallapragada Vijay , Wilson Anna M. , Davis Christopher A. , Monache Luca Delle , Doyle James D. , Pappenberger Florian , Reynolds Carolyn A. , Subramanian Aneesh , Black Peter G. , Cannon Forest , Castellano Chris , Cordeira Jason M. , Haase Jennifer S. , Hecht Chad , Kawzenuk Brian , Lavers David A. , Murphy Michael J. , Parrish Jack , Rickert Ryan , Rutz Jonathan J. , Torn Ryan , Wu Xingren , Zheng Minghua 
Published: June 2022

Abstract
Atmospheric River Reconnaissance (AR Recon) is a targeted campaign that complements other sources of observational data, forming part of a diverse observing system. AR Recon 2021 operated for ten weeks from January 13 to March 22, with 29.5 Intensive Observation Periods (IOPs), 45 flights and 1142 successful dropsondes deployed in the northeast Pacific. With the availability of two WC-130J aircraft operated by the 53rd Weather Reconnaissance Squadron (53 WRS), Air Force Reserve Command (AFRC) and one National Oceanic and Atmospheric Administration (NOAA) Aircraft Operations Center (AOC) G-IVSP aircraft, six sequences were accomplished, in which the same synoptic system was sampled over several days.
The principal aim was to gather observations to improve forecasts of landfalling atmospheric rivers on the U.S. West Coast. Sampling of other meteorological phenomena forecast to have downstream impacts over the U.S. was also considered. Alongside forecast improvement, observations were also gathered to address important scientific research questions, as part of a Research and Operations Partnership.
Targeted dropsonde observations were focused on essential atmospheric structures, primarily atmospheric rivers. Adjoint and ensemble sensitivities, mainly focusing on predictions of U.S. West Coast precipitation, provided complementary information on locations where additional observations may help to reduce the forecast uncertainty. Additionally, Airborne Radio Occultation (ARO) and tail radar were active during some flights, 30 drifting buoys were distributed, and 111 radiosondes were launched from four locations in California. Dropsonde, radiosonde and buoy data were available for assimilation in real-time into operational forecast models. Future work is planned to examine the impact of AR Recon 2021 data on model forecasts.
Impact of Robotic Approach on Post-Anastomotic Leaks After Esophagectomy for Esophageal Cancer
Authors: Wu Jessica , Putnam Luke R. , Silva Jack P. , Houghton Caitlin , Bildzukewicz Nikolai , Lipham John C. 
Published: June 2022

Introduction Although mortality rates after esophagectomy have decreased over the last 30 years, anastomotic leaks still commonly persist and portend significant morbidity. Previous studies have analyzed patient and perio-perative risk factors for leaks, yet data describing the association of leaks and an open or minimally invasive approach are lacking. The purpose of this study was to evaluate the impact of operative approach on leak rates and subsequent management of the leaks. Methods We queried the Procedure-Targeted National Surgical Quality Improvement Program Database for patients undergoing esophagectomy for cancer in the years from 2016 to 2019. Patient demographics, disease-related information, peri-operative data, and short-term outcomes were reviewed. Multivariable, stepwise logistic regression analysis was performed to investigate factors associated with post-operative anastomotic leaks. Results Of the 2696 patients who underwent esophagectomy for cancer, anastomotic leaks occurred in 374 (14%). Based on approach, 13% of open, 14% of laparoscopic, and 18% of robotic cases were complicated by leak ( P = .123). Multivariable analysis identified the following significant risk factors for leak: diabetes (OR 1.32, P = .047), hypertension (OR 1.32, P = .022), and longer operative time (OR 1.61, P < .001). The percentage of leaks requiring endoscopic or operative intervention was 75% for open, 79% for laparoscopic, and 54% for robotic cases ( P = .004). Conclusions Anastomotic leaks after esophagectomy for cancer occur frequently regardless of surgical approach. Furthermore, these leaks are managed differently after an open, laparoscopic, or robotic approach. Robotic esophagectomies complicated by anastomotic leak required less invasive management.
Technostress, anxiety, and depression among university students: A report from Paraguay
Authors: Torales Julio , Torres-Romero Anthon Daniel , Di Giuseppe Matías Franco , Rolón-Méndez Elías René , Martínez-López Patricia Lorena , Heinichen-Mansfeld Katja Victoria , Barrios Iván , O’Higgins Marcelo , Almirón-Santacruz José , Melgarejo Osvaldo , Ruiz Díaz Noelia , Castaldelli-Maia João Mauricio , Ventriglio Antonio 
Published: June 2022

Background: Although technologies (including information, e-learning, and communication) have been daily employed by University students in the last years, the COVID-19 pandemic has led to a considerable increase in their use. Technostress is a modern term referring to levels of stress caused by the prolonged exposure to technology. Aim: The aim of this study is to assess the technostress and related anxiety and depression among Paraguayan University students, describing their sociodemographic characteristics and relevant associations. Methods: A cross-sectional and descriptive study has been conducted. Participants were recruited through an Internet-based survey. Technostress, anxiety, and depression have been assessed with the Technostress Questionnaire (TechQ), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and the Patient Health Questionnaire-2 (PHQ-2), respectively. Results: A total of 378 participants were included, 74.1% of whom were women. According to the TechQ scores, 47.4% of the participants reported a low/moderate level of technostress whereas 5.2% showed severe scores. About 58.5% of participants reported a GAD-7 score ⩾10, meeting diagnostic criteria for generalized anxiety. About 60.3% scored ⩾3 at the PHQ-2 reporting significant levels of depression. Technostress has been significantly associated with levels of anxiety ( p < .001) as well as depression ( p < .001). Conclusion: Our results suggest further research regarding the implications of technostress on the well-being of University students. Specific measures aimed to improve students’ coping with the challenges of technology and technostress should be promoted.
Seventy-seven days on veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome from SARS-CoV-2
Authors: Shuster Constantin , Kanji Hussein , Isac George , Jeovens Roxanne , Sidhu Amandeep , Kalan Simmie , Yee John , Finlayson Gordon 
Published: June 2022

Throughout the COVID-19 pandemic veno-venous extracorporeal membrane oxygenation (VV ECMO) has emerged as a valid supportive intervention for severe COVID-19 pneumonia. In this report we describe the use of prolonged ECMO (77 days) to support a patient with COVID-19, ultimately resulting in lung recovery and discharge home. This report also emphasizes the value of physiotherapy in patients on ECMO and the importance of collaboration between ECMO programs and lung transplant teams in the care of these patients.
Access Benefits of Shared Autonomous Vehicle Fleets: Focus on Vulnerable Populations
Authors: Lee Jooyong , Kockelman Kara M. 
Published: June 2022

This research monetizes the access benefits of making shared autonomous vehicles (SAVs) available to residents of Texas’ Dallas-Fort Worth metroplex in the U.S. Residents’ willingness to pay for SAV access under different fares and modes was estimated and compared across the region’s 5,386 traffic zones, with emphasis on those housing the regions’ most vulnerable or access-limited travelers. Assuming a $0.50/mi SAV fare, the average per-person-trip benefit is estimated to be $0.64 per trip. With $0.50/mi SAV fare, HV mode share will be reduced from 92.4% to 40.3%, while SAV will take 55.8% of the share. However, if HVs are then disallowed (removed from everyone s mode choice set) after $0.50/mile SAVs have been added, the average net impact is estimated to be −$0.31 per trip, across the metroplex. If HVs were to be replaced by access to SAVs, the impacts are positive, with region-wide average access benefits ranging from $0.16 to $0.33 per trip, depending on the SAV fare, and urban zones have a greater access benefit than rural zones with low SAV fare. Vulnerable populations and their neighborhoods were identified based on the share of persons living below the poverty level, income per capita, share of persons aged 65 years or older, those with disabilities, those owning no vehicle, and share of persons from a racial minority group. Results suggest that the access benefits of SAVs will be higher in locations/neighborhoods housing more vulnerable populations, but some vulnerabilities (e.g., those over age 65) results in lower levels of access improvement. Across those zones with highest shares of vulnerable persons, the range of differences in welfare impacts, from adding SAVs to travelers mode choice sets, widened as fares rose. As is true with many innovations, careful attention to disadvantaged groups and thoughtful policy (via smart contracting and SAV-user subsidies by public agencies, for example) can better ensure valuable access improvements for those with limited mobility and resources.
Valgus Second Toe Deformity Treated With a Percutaneous Extracapsular Closing-Wedge Osteotomy of the Proximal Phalanx
Authors: Ray Robbie , Lewis Thomas L. , Robinson Peter , Dearden Paul M. C. , Goff Thomas A. J. , Watt Clare , Lam Peter 
Published: June 2022

Background: Coronal and sagittal plane deformities of the lesser toes are common yet challenging to treat. Traditional open releases and translational Weil osteotomies can be unpredictable and lead to postoperative stiffness. We present the results of a percutaneous closing wedge extracapsular osteotomy of the proximal phalanx to treat valgus deformity of the second toe. Methods: Thirty-one patients underwent 40 percutaneous osteotomies at a median age of 58.6±9.4 years. Using a small dorsomedial incision, a percutaneous proximal metaphyseal medial closing-wedge extracapsular osteotomy of the second toe is performed, leaving the dorsolateral cortex intact. An irrigated low-speed, high-torque 2- × 8-mm burr is used under image guidance. The osteotomy is then closed to correct deformity and taped for 2 weeks. Patient-reported outcomes and weightbearing radiographs were obtained. Results: Questionnaire data was available for 89.7% (n=35) of cases. Most cases (91.4%) were either satisfied or extremely satisfied with the procedure. Radiographs were available for 90.0% of osteotomies, with a median length from surgery to radiographic follow-up of 1.6 years (range 0.5-6.3; SD ±1.5). Median second-toe valgus angle (STVA) decreased from 16.2±10.7 degrees to 5.0±7.0 degrees ( P < .001) at final follow-up. All osteotomies united with no delayed union. There were no wound complications or infections. We found 2 cases of radiographic recurrence. Conclusion: Percutaneous proximal phalanx base metaphyseal closing wedge extracapsular osteotomies of lesser toes to correct coronal plane deformity is useful adjunct to first-ray corrective surgery and is associated with high levels of patient satisfaction. Level of Evidence: Level IV, retrospective case series