bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Search for Binary Supermassive Black Holes among Quasars with Offset Broad Lines Using the Very Long Baseline Array
Authors: Breiding Peter , Burke-Spolaor Sarah , Eracleous Michael , Bogdanović Tamara , Lazio T. Joseph W. , Runnoe Jessie , Sigurdsson Steinn 
Published: June 2021

Abstract
In several previous studies, quasars exhibiting broad emission lines with ≳1000 km s−1 velocity offsets with respect to the host galaxy rest frame have been discovered. One leading hypothesis for the origin of these velocity-offset broad lines is the dynamics of a binary supermassive black hole (SMBH). We present high-resolution radio imaging of 34 quasars showing these velocity-offset broad lines with the Very Long Baseline Array (VLBA), aiming to find evidence for the putative binary SMBHs (such as dual radio cores), and testing the competing physical models. We detect exactly half of the target sample from our VLBA imaging, after implementing a 5σ detection limit. While we do not resolve double radio sources in any of the targets, we obtain limits on the instantaneous projected separations of a radio-emitting binary for all of the detected sources under the assumption that a binary still exists within our VLBA angular resolution limits. We also assess the likelihood that a radio-emitting companion SMBH exists outside of our angular resolution limits, but its radio luminosity is too weak to produce a detectable signal in the VLBA data. Additionally, we compare the precise sky positions afforded by these data to optical positions from both the SDSS and Gaia DR2 source catalogs. We find projected radio/optical separations on the order of ∼10 pc for three quasars. Finally, we explore how future multi-wavelength campaigns with optical, radio, and X-ray observatories can help discriminate further between the competing physical models.
Toi et moi. Les racines de la relation
Authors: Lo Re Emanuela 
Published: June 2021

L’article montre comment l’art théâtral peut se révéler une méthode utile et efficace dans la formation à la relation dans le soin et le conseil. L’auteure considère la pédagogie par le corps comme une théorie qui souligne l’importance de l’expérience corporelle dans la formation aux relations. Elle montre comment à travers la formation théâtrale, certains aspects théoriques de l’Analyse Transactionnelle peuvent être « rendus vivants », enseignés et appris. Elle donne également quelques indications méthodologiques pour guider le formateur dans le choix de propositions théâtrales à offrir à ceux qui participent à l’activité de formation consacrée à la relation, et qui favorisent le processus de restitution du sens de ce qui se passe pendant l’expérience.
Comparison of Oxidant Stress Levels among Healthy, Chronic Periodontitis, and Ischemic Heart Disease Subjects with Presence or Absence of Chronic Periodontitis
Authors: Pampani Priyanka , Shenoy Santhosh , Punj Anahita , Kamath Vinayak B 
Published: June 2021

Objective:
To investigate the total oxidant levels in healthy, chronic periodontitis (CP), and ischemic heart disease (IHD) and to check for any correlation among them.

Materials and Methods:
A sample of 80 were split into four groups of healthy subjects (Group I), CP subjects (Group II), IHD subjects (Group III), and IHD subjects having periodontitis (Group IV). The serum and saliva samples collected were analyzed for levels of hydrogen peroxide (H2O2), hydroxyl radical (OH-), nitric oxide (NO), and superoxide radical (O2
-).

Results:
There were significant (P < 0.05) variances in the mean serum and salivary levels of hydrogen peroxide, hydroxyl radical, NO, and superoxide within the 4 groups. Oxidant levels of both serum and saliva were lower in disease groups of Group II, III, and IV as compared to healthy controls, with different patterns.

Conclusion:
The oxidant levels (H2O2, OH-, NO, and O2
-) are significantly hampered in periodontitis and IHD subjects as compared to healthy subjects. The oxidants, whether serum or salivary, did not always show the proportional change as a result of change in oxidant stress due to disease as positive correlation was observed only in the serum H2O2 and salivary NO radical levels and between serum superoxide dismutase radical and salivary H2O2 in Group I. In Group III, there was a positive correlation between serum NO radical and salivary H2O2.
Historical Analysis of the Risk of Hepatitis E and Its Complications in Pregnant Women in Nepal, 1996–1998
Authors: Scott Robert McNair , Kmush Brittany L. , Norkye Kundu , Hada Meera , Shrestha Mrigendra Prasad , Vaughn David W. , Myint Khin Saw Aye , Endy Timothy P. , Shrestha Sanjaya K. , Innis Bruce L. 
Published: June 2021

ABSTRACT.
Hepatitis E (HE) during pregnancy can be fatal; there are no prospective risk estimates for HE and its complications during pregnancy. We followed 2,404 pregnant women for HE and pregnancy outcomes from 1996 to 1998. Subjects from Nepal were enrolled at an antenatal clinic with pregnancy of ≤ 24 weeks. Most women (65.1%) were anti-HE virus negative. There were 16 cases of HE (6.7 per 1,000); three mothers died (18.8%) having had intrauterine fetal death (IUFD). Thirteen mothers survived: five preterm and seven full-term deliveries, one IUFD. HE among seronegative women was the sole cause of maternal death and increased the risk of IUFD (relative risk [RR]: 10.6; 95% confidence interval [CI]: 4.29–26.3) and preterm delivery (RR: 17.1, 95% CI 7.56–38.5). HE vaccination of females in at-risk regions before or as they attain reproductive age would reduce their risk for preterm delivery, IUFD, and maternal death.
Stratifying Sepsis in Uganda Using Rapid Pathogen Diagnostics and Clinical Data: A Prospective Cohort Study
Authors: Cummings Matthew J. , Bakamutumaho Barnabas , Owor Nicholas , Kayiwa John , Namulondo Joyce , Byaruhanga Timothy , Muwanga Moses , Nsereko Christopher , Baldwin Matthew R. , Lutwama Julius J. , O’Donnell Max R. 
Published: June 2021

ABSTRACT.
The global burden of sepsis is concentrated in sub-Saharan Africa, where extensive pathogen diversity and limited laboratory capacity challenge targeted antimicrobial management of life-threatening infections. In this context, established and emerging rapid pathogen diagnostics may stratify sepsis patients into subgroups with prognostic and therapeutic relevance. In a prospective cohort of adults (age ≥18 years) hospitalized with suspected sepsis in Uganda, we stratified patients using rapid diagnostics for HIV, tuberculosis (TB), malaria, and influenza, and compared clinical characteristics and 30-day outcomes across these pathogen-driven subgroups. From April 2017 to August 2019, 301 adults were enrolled (median age, 32 years [interquartile range, 26–42 years]; female, n = 178 [59%]). A total of 157 patients (53%) were HIV infected. Sixty-one patients (20%) tested positive for malaria, 52 (17%), for TB (including 49 of 157 [31%] HIV-infected patients), and 17 (6%), for influenza. Co-infection was identified in 33 (11%) patients. The frequency of multi-organ failure, including shock and acute respiratory failure, was greatest among patients with HIV-associated TB. Mortality at 30 days was 19% among patients with malaria, 40% among patients with HIV-associated TB, 32% among HIV-infected patients without microbiological evidence of TB, 6% among patients with influenza, and 11% among patients without a pathogen identified. Despite improvements in anti-retroviral delivery, the burden of sepsis in Uganda remains concentrated among young, HIV-infected adults, with a high incidence of severe HIV-associated TB. In parallel with improvements in acute-care capacity, use of rapid pathogen diagnostics may enhance triage and antimicrobial management during emergency care for sepsis in sub-Saharan Africa, and could be used to enrich study populations when trialing pathogen-specific treatment strategies in the region.
US Primary Care vs Specialty Care Trainee Positions and Physician Incomes: Trends From 2001 to 2019
Authors: Royce Trevor J. , Jones Gavin P. , Muralidhar Vinayak , Chowdhary Mudit , Holmes George M. 
Published: June 2021

ABSTRACT

Background
Much of the Affordable Care Act (ACA) and subsequent US health care policies were designed to address deficiencies in health care access and enhance primary care services. How residency positions and physician incomes have changed in the post-ACA era is not well characterized.

Objective
We evaluated the growth of US trainee positions and physician income, in the pre- vs post-ACA environment by specialty and among primary care vs specialty care.

Methods
Total resident complement by specialty and year was extracted from the National Graduate Medical Education (GME) Census and stratified into primary care vs specialty care. Median incomes were extracted from Medical Group Management Association surveys. Piecewise linear regression with interaction terms (pre-ACA, 2001–2010, vs post-ACA, 2011–2019) assessed growth rate by specialty and growth rate differences between primary care and specialty care. Sensitivity analyses were performed by focusing on family medicine and excluding additional GME positions contributed by the introduction of the 2015 single GME accreditation system.

Results
Resident complements increased for primary care (+0.16%/year pre-ACA to +2.06%/year post-ACA, P &lt; .001) and specialty care (+1.49%/year to +2.07%/year, P = .005). Specialty care growth outpaced primary care pre-ACA (P &lt; .001) but not post-ACA (P = .10). Family medicine had the largest increase in the pre- vs post-ACA era (-0.77%/year vs +2.09%/year, P &lt; .001). Excluding positions contributed by the single GME accreditation system transition did not result in any statistically significant changes to the findings. Income growth increased for primary care (+0.84%/year to +1.37%/year, P = .044), but decreased for specialty care (+1.44%/year to +0.49%/year, P = .011). Specialty care income growth outpaced primary care pre-ACA (P &lt; .001), but not post-ACA (P = .22).

Conclusions
We found significant growth differences in resident complement and income among primary care versus specialty care in the pre-/post-ACA eras.
Peer Discussion Decreases Practice Intensity and Increases Certainty in Clinical Decision-Making Among Internal Medicine Residents
Authors: Etherington Neha Bansal , Clancy Caitlin , Jones R. Benson , Dine C. Jessica , Diemer Gretchen 
Published: June 2021

ABSTRACT

Background
Team-based decision-making has been shown to reduce diagnostic error, increase clinical certainty, and decrease adverse events.

Objective
This study aimed to assess the effect of peer discussion on resident practice intensity (PI) and clinical certainty (CC).

Methods
A vignette-based instrument was adapted to measure PI, defined as the likelihood of ordering additional diagnostic tests, consultations or empiric treatment, and CC. Internal medicine residents at 7 programs in the Philadelphia area from April 2018 to June 2019 were eligible for inclusion in the study. Participants formed groups and completed each item of the instrument individually and as a group with time for peer discussion in between individual and group responses. Predicted group PI and CC scores were compared with measured group PI and CC scores, respectively, using paired t testing.

Results
Sixty-nine groups participated in the study (response rate 34%, average group size 2.88). The measured group PI score (2.29, SD = 0.23) was significantly lower than the predicted group PI score (2.33, SD = 0.22) with a mean difference of 0.04 (SD = 0.10; 95% CI 0.02–0.07; P = .0002). The measured group CC score (0.493, SD = 0.164) was significantly higher than the predicted group CC score (0.475, SD = 0.136) with a mean difference of 0.018 (SD = 0.073; 95% CI 0.0006–0.0356; P = .022).

Conclusions
In this multicenter study of resident PI, peer discussion reduced PI and increased CC more than would be expected from averaging group members' individual scores.
Reasons for Data-Prompted Site Visits: Field Staff Findings and Review Committee Decisions
Authors: Caniano Donna A. , Martinez Serge A. , Nace Cathy , Hogan Sean O. 
Published: June 2021

ABSTRACT

Background
A major component of the ACGME's Next Accreditation System (NAS) is the annual review of key performance indicators by each review committee (RC) for all programs under its oversight. The RC may request a site visit that is data-prompted for either a full review of all common and specialty-specific program requirements or a focused review of specific concerns for programs identified as underperforming.

Objective
The aims of this study were to: (1) identify the reasons that RCs requested data-prompted site visits; (2) describe the findings by accreditation field representatives as reflected in their site visit reports; and (3) summarize the accreditation decisions of RCs that followed the data-prompted site visits (DPSVs).

Methods
RC letters to programs informing them of a DPSV, site visit reports, and RC letters with accreditation decisions were reviewed for all programs having DPSVs from 2015 to 2020.

Results
DPSVs were performed in 312 programs, including 59 hospital-based, 122 medical-based, and 131 surgery-based programs; 214 programs had a single DPSV, and 98 programs had repeat DPSV. The most frequent reason that RCs requested a DPSV was noncompliance on the annual ACGME Resident/Fellow Survey. Notification of a DPSV prompted a change in program director in 7% of programs in the single DPSVs group and 57% of programs in the repeat DPSVs group. Surgery-based programs in the single and repeat DPSVs groups were more likely to receive an unfavorable accreditation status. The majority of programs in the single DPSVs group (78%) and repeat DPSVs group (70%) had a status of continued accreditation as of March 2020.

Conclusions
Noncompliance on the Resident/Fellow survey was the most frequent reason that RCs requested a DPSV. The majority of programs in the single and repeat DPSV groups achieved a favorable accreditation status.
Neurociencia: el juego como conector del aprendizaje
Authors: González de la Roca Corina Irene , Chocoj González Magdalena , Guzmán Pérez Monica Miriam , Alfaro Méndez Idania Marisol , Ríos Ramírez Alejandro 
Published: June 2021

En los primeros años de vida, el juego es el principal elemento del aprendizaje. Por ello al niño no se le dificulta la transición de la casa al centro de estudio. Los niños observan en el entorno académico un lugar de encuentro con amigos, asocian el aprender de forma fácil y divertida.

La neurociencia cognitiva se enfoca en el estudio del aprendizaje humano y de toda la actividad neuronal que se estimula a través del juego. Así mismo la neuroplasticidad es la flexibilidad que tiene el cerebro para adaptarse a los cambios a través de sus redes neuronales. El cerebro cambia y puede ser modificado según las experiencias como el proceso de enseñanza-aprendizaje que se da a lo largo de la vida.

A través de este ensayo se resaltan puntos importantes sobre el juego como conector del aprendizaje humano. Se pretende ampliar y analizar la importancia de incorporar elementos dinámicos en el proceso de enseñanza-aprendizaje, siendo el alumno el guionista de su propio aprendizaje y el profesor el facilitador del mismo.
“NÃO SOMOS FÃS DE CANALHA”: poéticas políticas afrodiaspóricas na 34ª Bienal de São Paulo
Authors: Machado Janaína 
Published: June 2021

O presente texto busca propor uma reflexão crítica a respeito das poéticas políticas da negritude apresentadas na mostra Vento da programação da 34ª Bienal de São Paulo realizada em 2020. Com intuito de analisar essas intervenções artísticas a partir da noção de corpo-testemunha de Stênio Soares, autodeterminação e autorrevelação da escritora feminista Audre Lorde, noções de poéticas dos filósofos Achille Mbembe e Édouard Glissant, e a radiografia dos Racionais MC´S, busco sistematizar as poéticas políticas apresentadas na mostra Vento pelo recorte da produção artística afrodiaspórica em torno da reflexão sobre os discursos éticos e poéticos nelas presentes. Neste texto, as poéticas políticas afrodiaspóricas são interpretadas como síntese da radiografia poética da negritude. Em suma, busca-se contribuir para os estudos da participação e mapeamento de artistas afrodiaspóricos na história das bienais de São Paulo.
Authors: Wahyuni Nurindah , Seniwati Tuti , Mulhaeriah Mulhaeriah 
Published: June 2021

ABSTRAK

Pendahuluan:Kelahiran prematur merupakan penyebab kematian bayi terbesar. Kangaroo Mother Care (KMC) salah satu perawatan paling efektif untuk bayi lahir prematur.
Tujuan: Tujuan penelitian ini untuk mengetahui pengaruh metode Kangaroo Mother Care terhadap Tanda-Tanda Vital Refleks Hisap dan Berat Badan Bayi Prematur.
Metode : Penelitian ini adalah desain penelitian one-group pre dan posttest. Teknik pengambilan sampel menggunakan teknik accidental sampling dengan menggunakan lembar observasi. Besar sampel 12 bayi prematur.
Hasil: Hasil penelitian ini didapatkan selisi tanda-tanda vital (suhu mengalami peningkatan 0.17ºC, pernapasan mengalami peningkatan 2.16 kali permenit, nadi mengalami peningkatan 2.21 kali permenit), nilai refleks hisap mengalami peningkatan 1.099 dan berat badan bayi mengalami peningkatan 15.71-gram setelah KMC.
Kesimpulan dan saran: Terdapat pengaruh tanda-tanda vital dan berat badan bayi lahir prematur sebelum dan sesudah KMC namun KMC tidak mempengaruhi refleks hisap bayi lahir prematur. Disarankan petugas kesehatan memberikan penyuluhan dan pelahitan KMC kepada masyarakat sehingga masyarakat mengetahui manfaat KMC dalam merawat bayi prematur.

Kata kunci : bayi prematur, kangaroo mother care, tanda-tanda vital, refleks hisap, berat badan
The Lived Experience of Sexuality Among Adults With Intellectual and Developmental Disabilities: A Scoping Review
Authors: Bathje Molly , Schrier Mallory , Williams Katherine , Olson Linda 
Published: June 2021

Abstract
Importance: Sexuality is an important part of the human experience. However, little is known about the experience of sexuality from the perspective of adults with intellectual and developmental disabilities (IDD).
Objective: To review evidence about the lived experience of sexuality among adults with IDD to inform future research and practice.
Data Sources: We located articles using search terms summarized into three categories: intellectual disability, sexual activity, and feelings/opinions. Articles were indexed in the following electronic databases: CINAHL, Scopus, PubMed, and PsycINFO.
Study Selection and Data Collection: Arksey and O’Malley’s methodology was used to review scientific literature published between 2008 and 2018. The studies were in English, were located in peer-reviewed journals, and described the experience of sexuality from the perspective of people with IDD or observations of expressed sexuality.
Findings: Seventeen articles met inclusion criteria. Four main themes emerged: intimate relationships, oppressed sexual activity, knowledge, and identity. Findings indicate that sexuality is a part of the lives of many adults with IDD, regardless of their engagement in sexual activity.
Conclusions and Relevance: Barriers to expression of sexuality exist for people with IDD. Some of these barriers are internal, although many are external. The results provide support for addressing sexuality among adults with IDD.
What This Article Adds: This review provides evidence to support occupational therapy practitioners in including sexuality as a part of their holistic view of clients and as an area for advocacy.
Empowering Caregivers of Children With Disabilities in Zambia: A Photovoice Study
Authors: Rabaey Paula , Hepperlen Renee , Manley Hayley , Ament-Lemke Amanda 
Published: June 2021

Abstract
Importance: Families with a child or children with a disability (CWD) living in low- and middle-income countries (LMICs) are a marginalized population experiencing multiple contextual factors within a social model of disability that contribute to decreased occupational participation.
Objective: To understand the advocacy messages that caregivers of CWD, living in an LMIC, wanted their community to learn about CWD.
Design: Photovoice methodology was used with 10 parents of a CWD. Photographs, accompanying narratives, and focus group session transcripts were analyzed using Wang and Burris’s (1997) original Photovoice technique.
Setting: Urban subdistrict of Lusaka, Zambia. A community venue was used for the focus group, and the community photograph exhibition occurred in the subdistrict.
Participants: Ten parents of a CWD living in an urban subdistrict of Zambia who were currently participating in a community-based program, Kusamala+, which addressed stigma in the community and supported parents of children with disabilities through training.
Results: Three themes were revealed: (1) “our children with disabilities should be shown love,” (2) “our children with disabilities should be well taken care of,” and (3) “our children with disabilities need help because they have different needs.”
Conclusions and Relevance: The findings indicate that a social disability model lens and participatory action research can be used to reveal occupational injustices that hinder parents’ engagement in caregiving for their CWD in a marginalized community. Use of visual methodologies can be a powerful advocacy tool for marginalized populations.
What This Article Adds: Our findings suggest that occupational therapists can better understand, and provide services to, families living in marginalized communities by using a social model of disability as a framework for evaluation and service provision. By highlighting issues of occupational injustice, occupational therapists can advocate for and empower communities of people with disabilities who face stigma and discrimination.