bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postpartum Puzzler
Authors: Croskerry Pat 
Published: June 2020

Abstract
In this case, a 24-year-old female presents to the emergency department (ED) of a community hospital late in the evening. At triage, she is weeping, distressed, very anxious, and complaining of paresthesias in her extremities. She had a normal vaginal delivery approximately 4 weeks ago and has been healthy since. The ED physician is asked to do a quick assessment as the ED is about to close. A consensus quickly develops among the staff that the patient probably has postpartum depression and could be managed through the mental health crisis team in daytime hours the following day. Her physical exam is normal other than some weakness in both legs. The physician feels uncomfortable with the patient’s presentation and considers the possibility of an uncommon neurological disorder. The neurology service reluctantly accepts the patient though doubting the physician’s diagnosis. He later learns that his zebra was correct.
Explosions, Expletives, and Erroneous Explanations
Authors: Croskerry Pat 
Published: June 2020

Abstract
The case of a French-speaking 14-year-old female presenting to an emergency department is reviewed. She has explosive, uncontrollable diarrhea, which provides a significant challenge for the nurses, who have difficulty maintaining a clean environment. Considerable confusion arises over her actual diagnosis, complicated by language problems and an unusual sequence of events.
A Search Satisfied Skateboarder
Authors: Croskerry Pat 
Published: June 2020

Abstract
In this case, a clinical clerk sees a young male who has sustained an injury to his hand while skateboarding. She focuses on his middle finger and orders an X-ray. It shows a fracture at the proximal interphalangeal joint, often associated with injuries to the volar plate. In the course of reviewing the case with the attending physician, further injuries come to light. The case is a good example of search satisficing bias, the tendency to call off a search before it is complete. Search satisficing is probably one of the older “evolutionary” biases and is the second most common error in radiology.
The Vacillated Vagrant
Authors: Croskerry Pat 
Published: June 2020

Abstract
In this case, a middle-aged male is brought to the emergency department of a tertiary care hospital from the airport. He has had an episode of shortness of breath and chest tightness, associated with nausea, paresthesias, and headache. Initially, he undergoes a cardiac workup and is cleared of any problems with his heart. He is discharged to the community and advised to return if there is any recurrence of symptoms. He does return for a further four visits over a 2-week period, during which he is referred to various other disciplines and services before his correct diagnosis is made. The case illustrates how a variety of biases influence the course of his management, notably diagnosis momentum, fundamental attribution error, and affective bias.
Sweet Nothings
Authors: Croskerry Pat 
Published: June 2020

Abstract
In this case, a young female presents to a community hospital complaining of headache. She has a history of migraine and reports that this headache feels typical. Routine blood work is drawn, and treatment is begun for her headache. However, before it is initiated, she has a seizure and is rendered comatose. A diagnosis of subarachnoid hemorrhage is made. She is intubated and transferred to another hospital for a computed tomography scan of her head. In the meantime, her blood work is returned, which reveals the cause of her seizure and her correct diagnosis. The case illustrates the potential benefit of medical caveats (cognitive forcing strategies).
Conclusion
Authors: Croskerry Pat 
Published: June 2020

Abstract
In the past two decades, there has been growing interest in the process of clinical decision making (CDM). Importantly, a strong interest has flourished in the process of diagnosis, particularly its failure rate. Two major strategies have been proposed to ameliorate diagnostic failure: minimizing system error and strategies to promote optimal clinical decision making. Many health care environments are not optimal. A variety of factors have been identified that influence the safe operation of the system, and clinicians need to be cognizant of them. In this chapter, a number of strategies are reviewed to optimize the CDM that occurs within the system, including the promotion of rationality, metacognition, thinking skills, flexibility, innovation and creativity in thinking, lateral thinking, cognitive bias mitigation, the incorporation of artificial intelligence, and distributed cognition. Instead of assuming that competence in CDM will be tacitly acquired in the course of medical education, clinicians need to advocate for explicit interventions that are known to raise the caliber of CDM.
Procedural Volume Within Military Treatment Facilities—Implications for a Ready Medical Force
Authors: Carius Brandon M , April Michael D , Schauer Steve G 
Published: June 2020

AbstractIntroductionConsistent procedural volume is important for emergency physicians (EPs) to maintain opportunities for critical lifesaving skills. While non-EP literature demonstrates improved patient outcomes with higher volumes, few studies examine the optimal number of repetitions needed to maintain procedural competency in EP populations. The largely young, healthy active duty population that constitutes the majority of patients in military treatment facilities (MTFs) decreases the likelihood to utilize emergent procedures. Despite this likelihood, EPs are expected to maintain proficiency and readiness to perform critical procedures in deployed settings.Materials and MethodsA retrospective analysis of de-identified data obtained through the Military Health System Mart was performed for procedural codes involving surgical airway, central venous access, and intubation. Data were sought for 2014–2016 calendar years from seven Army hospitals under the Southwest Region Medical Command. Procedural numbers were obtained for both overall volume and those performed per 1,000 encounters. Additionally, we analyzed for volume differences with the highest volume MTF (Brooke Army Medical Center [BAMC]) removed from the data set.ResultsA total of 1,450 procedures were performed among the MTFs analyzed, including 973 intubations, 473 central venous catheter placements, and 4 surgical airways. MTFs averaged 69.5 intubations and 38.8 venous catheters placed each year, but decreased to 28.1 intubations and 13.0 venous catheters placed annually when BAMC was removed from the data set (a 59.6 and 61.6% decrease, respectively). Monthly averages of 40.5 intubations and 19.7 central venous catheterizations per month among all included MTFs decreased to 14.0 and 6.5 when BAMC was removed. All surgical airways were performed at BAMC. Procedural frequency per 1,000 encounters was highest at BAMC, although ordinal differences were noted in the remaining six MTFs compared with overall procedural volumes.ConclusionsThis retrospective analysis demonstrates a significant variation in procedural volumes across MTFs, illustrating disproportionate opportunities for procedural skill maintenance among Army EPs. Low procedural volume threatens the maintenance of critical EP skills. These numbers could also suggest low skills for other providers (such as physician assistants), further illustrating decreased skill readiness throughout the force. Further research is needed to examine procedural volumes per individual EP, as well as those performed by other providers to evaluate for overall procedural readiness across the military force.
Measures to Limit COVID-19 Outbreak Effects Among Military Personnel: Preliminary Data
Authors: Segal David , Rotschield Jacob , Ankory Ran , Kutikov Sergey , Moaddi Bian , Verhovsky Guy , Benov Avi , Twig Gilad , Glassberg Elon , Fink Noam , Bader Tarif , Karp Erez 
Published: June 2020

ABSTRACT

Introduction
The COVID-19 outbreak posed a threat to the readiness of military forces as well as their ability to fulfill missions. Seeing that military forces have been encountering similar challenges, we found it eminent to share the Israeli Defense Force (IDF) Northern Command’s (NC) preliminary experience.

Materials and Methods
We retrospectively summarized the actions that were taken by our team, focusing on 18 battalions at the Israeli NC. These actions included promoting a series of organizational changes in terms of social distancing and medical regulations as well as working to strengthen medical leadership through designated video meetings with medical commanders across our organization. Meetings included relevant clinical education, updates, and leadership building. These actions and others were aimed to increase our influence on the decision-making processes. While we conducted real-time reverse transcriptase polymerase chain reaction SARS-CoV-2 laboratory tests for soldiers who were suspected to have COVID-19 (those presenting with compatible signs and symptoms after having been exposed to a confirmed COVID-19 patient), we were not able to screen healthy populations, nor did we have serum antibody serologic tests available during the study period. We reviewed the COVID-19 outbreak national data, obtained from Ministry of Health publishings and the IDF databases. Data were included from February 26th, 2020 (day 0, first COVID-19 patient in Israel) to April 19th, 2020 (day 53, about 1 month after most of the COVID-19 regulation were issued in the NC).

Results
The mean age of the battalion soldiers was 21.29 ± 4.06 (range 18–50), 81.34% male. Most restrictions were issued on day 18. On day 53, 98.85% of the personnel in the battalions were kept active and asymptomatic in their units.

Conclusions
Despite the limited availability of laboratory testing for COVID-19 our actions enabled us to lead a strict risk-management policy while maintaining most of the available workforce.
Multipole expansion for H i intensity mapping experiments: simulations and modelling
Authors: Cunnington Steven , Pourtsidou Alkistis , Soares Paula S , Blake Chris , Bacon David 
Published: June 2020

ABSTRACT
We present a framework and an open-source python toolkit to analyse the two-point statistics of 3D fluctuations in the context of H i intensity maps using the multipole expansion formalism. We include simulations of the cosmological H i signal using N-body and lognormal methods, foregrounds and their removal, as well as instrumental effects. Using these simulations and analytical modelling, we investigate the impact of foreground cleaning and the instrumental beam on the power spectrum multipoles as well as on the Fourier space clustering wedges. We find that both the instrumental beam and the foreground removal can produce a quadrupole (and a hexadecapole) signal, and demonstrate the importance of controlling and accurately modelling these effects for precision radio cosmology. We conclude that these effects can be modelled with reasonable accuracy using our multipole expansion technique. We also perform a Markov Chain Monte Carlo (MCMC) analysis to showcase the effect of foreground cleaning on the estimation of the H i abundance and bias parameters. The accompanying python toolkit is available at https://github.com/IntensityTools/MultipoleExpansion, and includes an interactive suite of examples to aid new users.
Uncovering distinct environments in an extended physical system around the W33 complex
Authors: Dewangan L K , Baug T , Ojha D K 
Published: June 2020

ABSTRACT
We present a multiwavelength investigation of a large-scale physical system containing the W33 complex. The extended system (∼50 pc × 37 pc) is selected based on the distribution of molecular gas at [29.6, 60.2] km s−1 and of 88 ATLASGAL 870-μm dust clumps at d ∼2.6 kpc. The extended system/molecular cloud traced in the maps of 13CO and C18O emission contains several H ii regions excited by OB stars (age ∼0.3–1.0 Myr) and a thermally supercritical filament (fs1, length ∼17 pc). The filament, which is devoid of ionized gas, shows a dust temperature (Td) of ∼19 K, while the H ii regions have a Td of ∼21–29 K. It suggests the existence of two distinct environments in the cloud. The distribution of Class I young stellar objects (mean age ∼0.44 Myr) traces the early stage of star formation (SF) towards the cloud. At least three velocity components (around 35, 45 and 53 km s−1) are investigated towards the system. The analysis of 13CO and C18O reveals spatial and velocity connections of cloud components at around 35 and 53 km s−1. The observed positions of previously known sources, W33 Main, W33 A and O4–7I stars, are found towards a complementary distribution of these two cloud components. The filament fs1 and a previously known object W33 B are seen towards the overlapping areas of the clouds, where ongoing SF activity is evident. A scenario related to converging/colliding flows from two different velocity components appears to explain well the observed indications of SF activity in the system.
Linking the small-scale relativistic winds and the large-scale molecular outflows in the z = 1.51 lensed quasar HS 0810+2554
Authors: Chartas G , Davidson E , Brusa M , Vignali C , Cappi M , Dadina M , Cresci G , Paladino R , Lanzuisi G , Comastri A 
Published: June 2020

ABSTRACT
We present Atacama Large Millimeter/submillimeter Array (ALMA) observations of the quadruply lensed z = 1.51 quasar HS 0810+2554 which provide useful insight on the kinematics and morphology of the CO molecular gas and the ∼ 2 mm-continuum emission in the quasar host galaxy. Lens modelling of the mm-continuum and the spectrally integrated CO(J = 3→2) images indicates that the source of the mm-continuum has an eccentricity of e ∼ 0.9 with a size of ∼1.6 kpc and the source of line emission has an eccentricity of e ∼ 0.7 with a size of ∼1 kpc. The spatially integrated emission of the CO(J = 2→1) and CO(J = 3→2) lines shows a triple peak structure with the outer peaks separated by Δv21 = 220 ± 19 km s−1 and Δv32 = 245 ± 28 km s−1, respectively, suggesting the presence of rotating molecular CO line emitting gas. Lensing inversion of the high spatial resolution images confirms the presence of rotation of the line emitting gas. Assuming a conversion factor of αCO = 0.8 M⊙ (K km s−1 pc2)−1 we find the molecular gas mass of HS 0810+2554 to be MMol = (5.2 ± 1.5)/μ32 × 1010 M⊙, where μ32 is the magnification of the CO(J = 3→2) emission. We report the possible detection, at the 3.0–4.7σ confidence level, of shifted CO(J = 3→2) emission lines of high-velocity clumps of CO emission with velocities up to 1702 km s−1. We find that the momentum boost of the large-scale molecular wind is below the value predicted for an energy-conserving outflow given the momentum flux observed in the small-scale ultrafast outflow.
The post-maximum behaviour of the changing-look Seyfert galaxy NGC 1566
Authors: Oknyansky V L , Winkler H , Tsygankov S S , Lipunov V M , Gorbovskoy E S , van Wyk F , Buckley D A H , Jiang B W , Tyurina N V 
Published: June 2020

ABSTRACT
We present results of the long-term multiwavelength study of optical, UV, and X-ray variability of the nearby changing-look (CL) Seyfert NGC 1566 observed with the Swift Observatory and the MASTER Global Robotic Network from 2007 to 2019. We started spectral observations with South African Astronomical Observatory 1.9-m telescope soon after the brightening was discovered in July 2018 and present here the data for the interval between 2018 August and 2019 September. This paper concentrates on the remarkable post-maximum behaviour after 2018 July when all bands decreased with some fluctuations. We observed three significant re-brightenings in the post-maximum period during 2018 November 17–2019 January 10, 2019 April 29–2019 June 19, and 2019 July 27–2019 August 6. An X-ray flux minimum occurred in 2019 March. The UV minimum occurred about 3 months later. It was accompanied by a decrease of the LUV/LX-ray ratio. New post-maximum spectra covering (2018 November 31–2019 September 23) show dramatic changes compared to 2018 August 2, with fading of the broad lines and [Fe X] λ6374 until 2019 March. These lines became somewhat brighter in 2019 August–September. Effectively, two CL states were observed for this object: changing to type 1.2 and then returning to the low state as a type 1.8 Sy. We suggest that the changes are due mostly to fluctuations in the energy generation. The estimated Eddington ratios are about 0.055 ${{\ \rm per\ cent}}$ for minimum in 2014 and 2.8 ${{\ \rm per\ cent}}$ for maximum in 2018.
Uncovering the orbit of the hercules dwarf galaxy
Authors: Gregory Alexandra L , Collins Michelle L M , Erkal Denis , Tollerud Erik , Delorme Maxime , Hill Lewis , Sand David J , Strader Jay , Willman Beth 
Published: June 2020

ABSTRACT
We present new chemo-kinematics of the Hercules dwarf galaxy based on Keck II-DEIMOS spectroscopy. Our 21 confirmed members, including 9 newly confirmed members, have a systemic velocity of vHerc = 46.4 ± 1.3 km s−1 and a velocity dispersion $\sigma _{v,\mathrm{Herc}}=4.4^{+1.4}_{-1.2}$ km s−1, consistent with previous studies. From the strength of the Ca ii triplet, we obtain a metallicity of [Fe/H] = −2.48 ± 0.19 dex and dispersion of $\sigma _{\rm {[Fe/H]}}= 0.63^{+0.18}_{-0.13}$ dex. This result is within 1σ of previous measurements, and makes Hercules a particularly metal-poor galaxy, placing it slightly below the standard mass–metallicity relation. Previous photometric and spectroscopic evidence suggests that Hercules is tidally disrupting and may be on a highly radial orbit. From our identified members, we measure no significant velocity gradient. By cross-matching with the second Gaia data release, we determine an uncertainty-weighted mean proper motion of $\mu _{\alpha }^*=\mu _{\alpha }\cos (\delta)=-0.153\pm {0.074}$ mas yr−1, μδ = −0.397 ± 0.063 mas yr−1. This proper motion is slightly misaligned with the elongation of Hercules, in contrast to models which suggest that any tidal debris should be well aligned with the orbital path. Future observations may resolve this tension.
The X-ray emission in young radio active galactic nuclei
Authors: Liao Mai , Gu Minfeng , Zhou Minhua , Chen Liang 
Published: June 2020

ABSTRACT
In this work, we investigated the X-ray emission for a sample of young radio active galactic nuclei (AGNs) by combining data from Chandra/XMM–Newton with data for other wavebands. We find strong correlations between the X-ray luminosity LX at 2–10 keV and the radio luminosities LR at 5 GHz for the VLBI radio-core, VLA radio-core and Faint Images of the Radio Sky at Twenty-Centimeters (FIRST) component, indicating that both parsec- and kiloparsec-scale radio emissions are strongly correlated with X-ray emission in these sources. We find an approximately linear dependence of the radio on the X-ray luminosity in the sources with radiatively efficient accretion flows (i.e. the Eddington ratio Redd ≳ 10−3), with b ∼ 1 ($L_{\rm R}\, \propto \, L_{\rm X} ^{b}$) and $\xi _{\rm RX}\, \sim$ 1 in the fundamental plane using the VLBI data. The dependence is consistent with the re-analysed results of a previous study of Fan and Bai at Redd ≳ 10−3, but is significantly different from the theoretical prediction of accretion flow as the origin of X-ray emission. In contrast to the case for radio-quiet quasars, there is no significant correlation between Γ and the Eddington ratio. Our results seem to indicate that the X-ray emission of high-accretion young radio AGNs may be from the jet. We constructed the spectral energy distributions (SEDs) for 18 sources (most of which are in radiatively efficient accretion), namely nine galaxies and nine quasars with high-quality X-ray data, and find that the X-ray emission of most quasars is more luminous than that of normal radio-quiet quasars. This is clearly seen from the quasar composite SED, in which the X-ray emission is apparently higher than that of radio-quiet quasars, probably supporting jet-related X-ray emission in young radio AGNs. The possibility that the X-ray emission is from self-synchrotron Compton is discussed.
MR imaging features of diffuse intrinsic pontine glioma and relationship to overall survival: report from the International DIPG Registry
Authors: Leach James L , Roebker James , Schafer Austin , Baugh Joshua , Chaney Brooklyn , Fuller Christine , Fouladi Maryam , Lane Adam , Doughman Renee , Drissi Rachid , DeWire-Schottmiller Mariko , Ziegler David S , Minturn Jane E , Hansford Jordan R , Wang Stacie S , Monje-Deisseroth Michelle , Fisher Paul G , Gottardo Nicholas G , Dholaria Hetal , Packer Roger , Warren Katherine , Leary Sarah E S , Goldman Stewart , Bartels Ute , Hawkins Cynthia , Jones Blaise V 
Published: June 2020

Abtract

Background
This study describes imaging features of diffuse intrinsic pontine glioma (DIPG) and correlates with overall survival (OS) and histone mutation status in the International DIPG Registry (IDIPGR).

Methods
Four hundred cases submitted to the IDIPGR with a local diagnosis of DIPG and baseline MRI were evaluated by consensus review of 2 neuroradiologists; 43 cases were excluded (inadequate imaging or alternative diagnoses). Agreement between reviewers, association with histone status, and univariable and multivariable analyses relative to OS were assessed.

Results
On univariable analysis imaging features significantly associated with worse OS included: extrapontine extension, larger size, enhancement, necrosis, diffusion restriction, and distant disease. On central review, 9.5% of patients were considered not to have DIPG. There was moderate mean agreement of MRI features between reviewers. On multivariable analysis, chemotherapy, age, and distant disease were predictors of OS. There was no difference in OS between wild-type and H3 mutated cases. The only imaging feature associated with histone status was the presence of ill-defined signal infiltrating pontine fibers.

Conclusions
Baseline imaging features are assessed in the IDIPGR. There was a 9.5% discordance in DIPG diagnosis between local and central review, demonstrating need for central imaging confirmation for prospective trials. Although several imaging features were significantly associated with OS (univariable), only age and distant disease were significant on multivariable analyses. There was limited association of imaging features with histone mutation status, although numbers are small and evaluation exploratory.
False Rifampicin Resistance in Xpert Ultra Applied to Lymph Node Aspirate: A Case Report
Authors: Ng Kamela C S , Rigouts Leen , de Jong Bouke C , Lynen Lutgarde 
Published: June 2020

Abstract
A 36-year-old male patient was diagnosed with tuberculosis in Antwerp, Belgium, in May 2018. His lymph node aspirate initially tested rifampicin resistant in Xpert MTB/RIF Ultra, but tested susceptible in all other tests including targeted deep sequencing due to a rare matrix effect in the Xpert MTB/RIF Ultra reaction tube.