bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Vicious Cycle of Bias: Residents’ Perceptions of Leadership in Health Care
Authors: Ju Mindy , van Schaik Sandrijn M. 
Published: August 2021

Purpose
Despite growing interest in shared leadership models, autocratic physician leadership remains the norm in health care. Stereotype and bias limit leadership by members of other professions. Furthermore, traditional views of effective clinical leadership emphasize agentic behaviors associated with male gender. To shift the prototypical concept of a leader from a male physician to a more inclusive prototype, a better understanding of prototype formation is needed. This study examines leader prototypes and their development among resident physicians through the lens of leadership categorization theory.

Method
One researcher conducted semistructured interviews with anesthesia and internal medicine residents at a single institution, asking participants to describe their ideal team leader and comment on the video-recorded performance of either a male or female nurse practitioner (NP) leading a simulated resuscitation. Interview questions explored participants’ perceptions of NPs as team leaders and how these perceptions developed. The researchers conducted deductive analysis to examine leadership prototypes and prototype formation, and inductive analysis to derive additional themes.

Results
The majority of residents described a male physician as the ideal resuscitation team leader. Exposure to male physician leaders, and lack of exposure to NP leaders, contributed to this prototype formation. Residents described a vicious cycle in which bias against female and NP leaders diminished acceptance of their leadership by team members, resulting in decreased confidence and performance, further aggravating bias.

Conclusions
These results provide suggestions for interventions that can help shift the leadership prototype in health care and promote shared leadership models. These include increasing exposure to different professionals of either gender in leadership roles and increased representation in educational materials, education about effective leadership strategies to create awareness of the benefits of shared leadership, and reflection during team training to increase awareness of bias and the backlash effect faced by individuals whose behaviors counter established stereotypes.
Defining Successful Practice Within Health Systems Science Among Entering Residents: A Single-Institution Qualitative Study of Graduate Medical Education Faculty Observations
Authors: Ridinger Heather A. , Bonnet Kemberlee , Schlundt David G. , Tekian Ara , Riddle Janet , Lomis Kimberly D. 
Published: August 2021

Purpose
The American Medical Association’s Accelerating Change in Medical Education consortium defined health systems science (HSS) as the study of how health care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. This framework is increasingly being incorporated into medical school curricula. Graduate medical education (GME) had previously elevated systems-based practice (SBP) as a core competency, but expectations are defined by specialty-specific milestones. The lack of a shared competency framework between undergraduate medical education (UME) and GME makes it challenging to ensure that entering residents are prepared to implement HSS/SBP concepts in the workplace. The authors explored GME faculty observations of residents exemplifying successful practice across HSS domains to inform targets for UME training and assessment.

Method
Authors performed a single-institution qualitative study using transcribed phone interviews with eligible Vanderbilt residency program directors, associate program directors, and core faculty. Participants described observations of successful residents within each HSS domain. Two researchers independently coded, discussed, and reconciled deidentified transcripts using inductive–deductive approaches to identify themes.

Results
Seventeen faculty participated across specialties (17/39, 45%). Faculty responses emphasize precurricular experiences including professional degrees, work experience, extracurriculars, and medical school exposure. Importantly, successful residents exhibit foundational core workforce characteristics including growth mindset, curiosity, and a desire to learn about systems. GME faculty identified HSS domain-specific skills, noting distinctions among learning environments. Outcomes resulting from residents’ application of HSS concepts include delivering high-quality, person-centered care and systems improvements.

Conclusions
Descriptions of successful practice within HSS domains highlight preparatory experiences and core workforce characteristics and outline entry-level HSS behaviors. Conceptualized in a logic model framework, these findings describe key inputs, learning activities, outputs, and outcomes for systems-prepared entering residents bridging the UME–GME transition.
Evaluation of a Tool for Measuring Temporal Modulation Detection
Authors: Landsberger David M. , Stupak Natalia 
Published: August 2021

Objectives:
A software tool (EasyMDT) that measures temporal modulation detection thresholds of a broadband noise carrier is presented. EasyMDT is designed to be both easy and quick to promote the use in environments where testing time is limited, and testers may not have extensive technical expertise to use typical research software. In addition, by providing a standardized stimulus and protocol, data collected by all groups using the software can be compared directly. Details of EasyMDT, including a description of the protocol, stimuli, interface and how to obtain the software, are provided along with representative sample data from both normal-hearing listeners and cochlear implant (CI) users. Performance with the EasyMDT is compared with speech understanding metrics as well as a metric of spectral-temporal resolution.

Design:
A “Full Curve” of modulation detection thresholds is measured using a three-interval forced-choice adaptive task in a single block for 7 modulation frequencies (10, 50, 75, 100, 150, 200, and 300 Hz). Similarly, the modulation detection thresholds were measured for only one modulation frequency in a block (either 100 Hz or 150 Hz). Modulation detection thresholds and block duration were recorded. In addition, performance on speech recognition tasks (CNC words, consonant identification, vowel identification, and AzBio sentences in noise) and a spectral-temporal resolution task (SMRT; Aronoff and Landsberger) were measured. Modulation detection thresholds were measured for both normal-hearing listeners and CI users. Only CI users participated in the speech and spectral-temporal tests.

Results:
Modulation detection thresholds measured with EasyMDT were consistent with those previously reported from other laboratories. Modulation detection thresholds at a single modulation frequency (100 Hz or 150 Hz) were predictive of modulation detection thresholds measured as part of the Full Curve consisting of all 7 modulation frequencies. Testing durations for CI users dropped from an average of over 18 minutes for the Full Curve to under 3 minutes for either of the single modulation frequency measures. Modulation detection thresholds at 100 Hz correlated with CNC words, consonant identification, and AzBio sentences in noise, but not vowel identification. No correlations were found between modulation detection and spectral-temporal resolution.

Conclusions:
The EasyMDT is designed to be an easy-to-use tool that provides a nonlinguistic measure that can predict speech understanding. The test duration is short enough that it can be incorporated into clinical practice or as part of an experimental battery. The software is available for free download at https://www.ear-lab.org/software-downloads.html. The software is designed to have a minimum barrier of entry as well as provide a standardized protocol allowing direct comparison of modulation detection thresholds across studies and groups.
Changes in Orientation Behavior due to Extended High-Frequency (5 to 10 kHz) Spatial Cues
Authors: Whitmer William M. , McShefferty David , Levy Suzanne C. , Naylor Graham , Edwards Brent 
Published: August 2021

Objectives:
Current hearing aids have a limited bandwidth, which limits the intelligibility and quality of their output, and inhibits their uptake. Recent advances in signal processing, as well as novel methods of transduction, allow for a greater useable frequency range. Previous studies have shown a benefit for this extended bandwidth in consonant recognition, talker-sex identification, and separating sound sources. To explore whether there would be any direct spatial benefits to extending bandwidth, we used a dynamic localization method in a realistic situation.

Design:
Twenty-eight adult participants with minimal hearing loss reoriented themselves as quickly and accurately as comfortable to a new, off-axis near-field talker continuing a story in a background of far-field talkers of the same overall level in a simulated large room with common building materials. All stimuli were low-pass filtered at either 5 or 10 kHz on each trial. To further simulate current hearing aids, participants wore microphones above the pinnae and insert earphones adjusted to provide a linear, zero-gain response.

Results:
Each individual trajectory was recorded with infra-red motion-tracking and analyzed for accuracy, duration, start time, peak velocity, peak velocity time, complexity, reversals, and misorientations. Results across listeners showed a significant increase in peak velocity and significant decrease in start and peak velocity time with greater (10 kHz) bandwidth.

Conclusions:
These earlier, swifter orientations demonstrate spatial benefits beyond static localization accuracy in plausible conditions; extended bandwidth without pinna cues provided more salient cues in a realistic mixture of talkers.
Epidemiologic Trends in Oculoplastics-Related Emergency Department Visits in the United States, 2006–2015
Authors: Ahmad Meleha , Zhao Jiawei , Iftikhar Mustafa , Canner Joseph K. , Rajaii Fatemeh , Mahoney Nicholas , Zafar Sidra , Woreta Fasika 
Published: August 2021

Purpose:
To characterize demographics and trends in oculoplastics-related emergency department (ED) visits.

Methods:
The authors conducted a retrospective, multiyear study of the nationwide ED sample database. The nationwide ED sample was queried for oculoplastics-related International Classification of Disease-ninth revision codes identified from a comprehensive list and categorized based on anatomic location, urgency, and trauma status. Demographics, clinical characteristics, procedure requirement, and cost data were analyzed. Variables associated with inpatient admission were assessed using univariate and multivariate logistic regression.

Results:
The authors identified an estimated 4.2 million ED visits in the United States with oculoplastics-related primary diagnoses, of which pathology was 80.8% eyelid/adnexal, 17.4% orbital, and 1.74% lacrimal. Overall, 31.3% of the visits were deemed to be nonurgent. Orbital pathology was more likely to be caused by trauma (70.6%), to be urgent (98.0%), and to require a procedure (45.6%) (p < 0.001). While less than 5% of all patients required hospitalization, predictors for inpatient admission were urgent diagnoses (odds ratio, 14.9; CI, 13.7–16.1), presentation to a level 1 trauma center (odds ratio, 3.19; CI, 2.7–3.79), and presence of orbital pathology (odds ratio, 6.09; CI 5.73–6.47). Incidence of ED visits decreased in all categories; however, total inflation-adjusted charges increased.

Conclusions:
Over half of oculoplastics-related ED visits are for trauma, with orbital pathology being less common but requiring a high level of care. Although trends show a potentially decreasing incidence of oculoplastics-related ED visits, increasing costs and high proportion of nonurgent visits pose an opportunity for mitigating periocular trauma and increasing outpatient access to care, respectively.
Etiology and risk factors of intracranial hemorrhage and ischemic stroke in young adults
Authors: Chen Chun-Yu , Lin Po-Tso , Wang Yun-Huei , Syu Ruei-Wun , Hsu Shao-Lun , Chang Li-Hsin , Tsai Jui-Yao , Huang Hui-Chi , Liu Tzu-Ching , Lin Chun-Jen , Tang Chih-Wei , Hsu Li-Chi , Chung Chih-Ping , Liu Hung-Yu , Chi Nai-Fang , Lee I-Hui 
Published: August 2021

Background:
Young stroke incidence has increased worldwide with lifestyle changes. Etiology and risk factors for both ischemic and hemorrhagic stroke in young Asians remain underexplored.

Methods:
We retrospectively reviewed consecutive acute stroke patients aged 16–45 years admitted to the Taipei Veterans General Hospital between 2009 and 2019 to analyze etiologic subtypes, risk factors, and serial modified Rankin Scale scores for 1 year and compare the age groups of 16–30 and 31–45 years.

Results:
Among 670 young Taiwanese patients (mean age at onset 37.5 ± 7.0 years; male 65.1%), there were 366 nontraumatic spontaneous hemorrhagic stroke (including 259 intracerebral hemorrhage [ICH] and 107 subarachnoid hemorrhage, SAH), 292 ischemic stroke and 12 cerebral venous thromboses. Notably, ICH was more prevalent in patients aged 16–30 than in those aged 31–45 (54.8% vs 36.8%). Specifically, structural vasculopathy (e.g., arteriovenous malformation, cavernoma) was the most common etiologic subtype in patients aged 16–30 (p < 0.001), whereas hypertensive ICH was the most common subtype in patients aged 31–45 (p < 0.001). On the other hand, the top ischemic subtype for both age groups was other determined diseases (e.g., arterial dissection, autoimmune diseases, moyamoya disease, etc.) rather than large artery atherosclerosis. Hyperlipidemia, diabetes, and cigarette smoking were more common risk factors for infarction than ICH. Familial stroke patients whose first- or second-degree relatives had a stroke by age 80 (n = 104, 15.5%) had more infarctions than those without a familial stroke history. In multivariate analyses, initial stroke severity, and infarction type were important predictors of favorable outcomes after 3 months. At the 1-year follow-up, patients with ICH and SAH had worse functional outcomes and survival rates than those with infarction.

Conclusion:
An aggressive approach to elucidate the etiology of stroke is indicated because structural vasculopathy-induced ICH and other determined infarction are distinctively prevalent in young adults, particularly those aged 16–30.
Neutrophil-to-lymphocyte ratio in predicting neurologic outcome of patients with acute ischemic stroke treated with intravenous thrombolytics
Authors: Chen Chung-Ting , Li Li-Hua , Su Pei-Ying , Chang Yu-Chin , Lee I-Hui , Yen David Hung-Tsang , How Chorng-Kuang 
Published: August 2021

Background:
Recombinant tissue plasminogen activator (rtPA) is currently the most standard treatment for patients with acute ischemic stroke (AIS). However, rtPA treatment may further enhance the immune response poststroke. This study is to investigate the clinical utility of white blood–based inflammatory biomarkers in predicting neurologic outcomes among AIS patients receiving rtPA.

Methods:
A retrospective observational cohort study of 100 patients with AIS treated with intravenous rtPA was conducted in an urban tertiary hospital in Taiwan. Favorable neurological outcome defined as modified Rankin Scale (mRS) score 0 to 2 in poststroke follow-up was the primary outcome measure. Baseline and post-rtPA neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were investigated for potential predictors.

Results:
These patients had a mean age of 71.3 ± 13.7 years and the average of initial National Institute of Health Stroke Scale was 12.7 ± 6.5. Using multiple regression analysis, PLR was not an independent factor; however, both baseline and post-rtPA NLR were independent factors predicting favorable neurological outcome at 3, 6, 12 months after a stroke. The area under the receiver operating characteristic curve for baseline and post-rtPA NLR were 0.645 (95% confidence interval [CI], 0.537-0.753) and 0.769 (95% CI, 0.676-0.862) (Z score = 2.086) in 3-month, 0.645 (95% CI, 0.537-0.752) and 0.791 (95% CI, 0.701-0.880) (Z score = 2.471) in 6-month, and 0.646 (95% CI, 0.538-0.754) and 0.813 (95% CI, 0.728-0.898) (Z score = 2.857) in 12-month poststroke follow-up.

Conclusion:
For AIS patients treated with rtPA, both lower baseline and post-rtPA NLR levels were independently associated with a favorable neurologic outcome in serial mid- and long-term follow-up. Post-rtPA NLR was superior to baseline NLR in discriminative performance for neurologic prognosis.
Relationship between astrocyte reactivity, using novel11C-BU99008 PET, and glucose metabolism, grey matter volume and amyloid load in cognitively impaired individuals
Authors: Livingston Nicholas R , Calsolaro Valeria , Hinz Rainer , Nowell Joseph , Raza Sanara , Gentleman Steve , Tyacke Robin J , Myers Jim , Venkataraman Ashwin V , Perneczky Robert , Gunn Roger N , Rabiner Eugenii A , Parker Christine A , Murphy Philip S , Wren Paul B , Nutt David J , Matthews Paul M , Edison Paul 
Published: August 2021

AbstractPost mortemneuropathology suggests that astrocyte reactivity may play a significant role in neurodegeneration in Alzheimer’s disease. We explored thisin vivousing multimodal PET and MRI imaging. Twenty subjects (11 older, cognitively impaired subjects and 9 age-matched healthy controls) underwent brain scanning using the novel reactive astrocyte PET tracer11C-BU99008,18F-FDG and18F-florbetaben PET, and T1-weighted MRI. Differences between cognitively impaired subjects and healthy controls in voxel-wise levels of astrocyte reactivity, glucose metabolism and grey matter volume were explored, and their relationship to each other was assessed using Biological Parametric Mapping (BPM). Aβ-positive cognitively impaired subjects showed greater brain astrocyte reactivity, except in the temporal lobe, with further increased astrocyte reactivity in Mild Cognitive Impairment compared to Alzheimer’s subjects in the cingulate cortices. BPM correlations revealed regions which showed reduced11C-BU99008 uptake in Aβ-positive cognitively impaired subjects, such as the temporal lobe, also showed reduced18F-FDG uptake and grey matter volume. BPM analysis also revealed a regionally-dynamic relationship between astrocyte reactivity and amyloid uptake: increased amyloid load in cortical association areas of the temporal lobe and cingulate cortices was associated withreducedastrocyte reactivity, whilst increased amyloid uptake in primary motor and sensory areas (in which amyloid load occurs later) was associated withincreasedastrocyte reactivity. These novel observations add to the hypothesis that while astrocyte reactivity may be triggered by early Aβ-deposition, sustained pro-inflammatory astrocyte reactivity with greater amyloid deposition may lead to astrocyte dystrophy and amyloid-associated neuropathology such as grey matter atrophy and glucose hypometabolism.
The individual and global impact of copy number variants on complex human traits
Authors: Auwerx Chiara , Lepamets Maarja , Sadler Marie C. , Patxot Marion , Stojanov Miloš , Baud David , Mägi Reedik , Porcu Eleonora , Reymond Alexandre , Kutalik Zoltán 
Published: August 2021

SUMMARYCopy number variations (CNVs) have been involved in multiple genomic disorders but their impact on complex traits remains understudied. We called CNVs in the UK Biobank and performed genome-wide association scans (GWASs) between the copy-number of CNV-proxy probes and 57 continuous traits, revealing 131 signals spanning 47 phenotypes. Our analysis recapitulated well-known associations (1q21 and height), revealed the pleiotropy of recurrent CNVs (26 traits for 16p11.2-BP4-BP5), and suggested new gene functionalities (MARF1in female reproduction). Forty CNV signals overlapped known GWAS loci (RHDdeletion and hematological traits). Conversely, others overlapped Mendelian disorder regions, suggesting variable expressivity and a broad impact of these loci, as illustrated by signals mapping to Rotor syndrome (SLCO1B1/3), renal cysts and diabetes (HNF1B), or Charcot-Marie-Tooth (PMP22) loci. The total CNV burden negatively impacted 35 traits, leading to increased adiposity, liver/kidney damage, and decreased intelligence and physical capacity. Thirty traits remained burden-associated after correcting for CNV-GWAS signals, pointing to a polygenic CNV-architecture. The burden negatively correlated with socio-economic indicators, parental lifespan, and age (survivorship proxy), suggesting that CNVs contribute to decreased longevity. Together, our results showcase how studying CNVs can reveal new biological insights, emphasizing the critical role of this mutational class in shaping complex traits.
Potential autoimmunity resulting from molecular mimicry between SARS-CoV-2 Spike and human proteins
Authors: Nunez-Castilla Janelle , Stebliankin Vitalii , Baral Prabin , Balbin Christian A , Sobhan Masrur , Cickovski Trevor , Mondal Ananda Mohan , Narasimhan Giri , Chapagain Prem , Mathee Kalai , Siltberg-Liberles Jessica 
Published: August 2021

SummarySARS-CoV-2 causes COVID-19, a disease curiously resulting in varied symptoms and outcomes, ranging from asymptomatic to fatal. Autoimmunity due to cross-reacting antibodies resulting from molecular mimicry between viral antigens and host proteins may provide an explanation. We computationally investigated molecular mimicry between SARS-CoV-2 Spike and known epitopes. We discovered molecular mimicry hotspots in Spike and highlight two examples with tentative autoimmune potential and implications for understanding COVID-19 complications. We show that a TQLPP motif in Spike and thrombopoietin shares similar antibody binding properties. Antibodies cross-reacting with thrombopoietin may induce thrombocytopenia, a condition observed in COVID-19 patients. Another motif, ELDKY, is shared in multiple human proteins such as PRKG1 and tropomyosin. Antibodies cross-reacting with PRKG1 and tropomyosin may cause known COVID-19 complications such as blood-clotting disorders and cardiac disease, respectively. Our findings illuminate COVID-19 pathogenesis and highlight the importance of considering autoimmune potential when developing therapeutic interventions to reduce adverse reactions.