bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beyond Divisive Categorization in Young Adult Fiction: Lessons from Divergent
Authors: Cronshaw Darren 
Published: November 2021

Abstract
Veronica Roth’s Divergent is a young adult fiction and movie franchise that addresses issues of political power, social inequity, border control, politics of fear, gender, ethnicity, violence, surveillance, personal authenticity and mind control. It is possible a large part of the popularity of the series is its attention to these issues which young Western audiences are concerned about. The narrative makes heroes of protagonists who become activists for justice and struggle against oppressive social-political systems. What follows is a literary analysis of Divergent, evaluating its treatment of public theology and social justice themes, and discussing implications for Christian activism, especially for youth and young adults. It affirms the ethos in the books of resisting oppression, and questions assumptions about gender and abuse, violence and imperial control, personal authenticity and categorization, and difference and sameness.
Quasi-Naturalism and the Problem of Alternative Normative Concepts
Authors: Golub Camil 
Published: November 2021

Abstract
The following scenario seems possible: a community uses concepts that play the same role in guiding actions and shaping social life as our normative concepts, and yet refer to something else. As Eklund (2017) argues, this apparent possibility poses a problem for any normative realist who aspires to vindicate the thought that reality itself favors our ways of valuing and acting. How can realists make good on this idea, given that anything they might say in support of the privileged status of our normative concepts can be mirrored by the imagined community? E.g., the realist might claim that using our concepts is what we ought to do if we are to describe normative facts correctly, but members of the other community can claim the same about their concepts, using their own concept of ought. A promising approach to this challenge is to try to rule out the possibility of alternative normative concepts, by arguing that any concepts that have the same normative role must share a reference as well. (Eklund calls this referential normativity.) In this paper I argue that normative quasi-naturalism, a view that combines expressivism about normative discourse with a naturalist metaphysics of normativity, supports referential normativity and solves the problem of alternative normative concepts.
Effect of Medialization on Dyspnea Index in Unilateral Vocal Fold Paralysis
Authors: Hoffman Matthew R. , Vandiver Beau , Derise Natalie , Hapner Edie R. , Leverson Glen , Simpson C. Blake 
Published: November 2021

ObjectivePatients with unilateral vocal fold paralysis commonly report dysphonia and dysphagia. Dyspnea also occurs, with studies on treatment‐related change producing mixed results. Studies including patient‐reported outcomes have focused on single‐question global scales. The Dyspnea Index (DI) includes 10 questions, is specific to upper airway–related dyspnea, and may better capture these patients’ symptoms. We evaluated change in DI after treatment.Study DesignRetrospective review.SettingAcademic medical center.MethodsForty‐three patients with unilateral vocal fold paralysis underwent injection augmentation (n = 25) or framework surgery (n = 18). DI was recorded preprocedure, 2 to 4 weeks afterward, and at approximately 3 months afterward in 19 patients. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 were also recorded. Change in parameters and correlations were assessed. Obesity, cardiac disease, pulmonary disease, and procedure (injection vs framework surgery) were evaluated for effect on DI.ResultsTwenty‐four patients had an abnormal baseline DI (>10). DI decreased from 14.9 ± 13.8 to 6.5 ± 9.3 after treatment (P <. 001; 95% CI, 4.7‐12.1). Twenty‐eight scores decreased, 9 remained unchanged, and 6 increased. Change in DI was influenced by the presence of cardiac disease. Decreased DI persisted at 3‐month follow‐up. Voice Handicap Index–10, Glottal Function Index, Cough Severity Index, and Eating Assessment Tool–10 scores decreased and were correlated with change in DI.ConclusionUpper airway–related dyspnea is common in unilateral vocal fold paralysis, occurring in half of this cohort. Correcting glottic insufficiency may alleviate symptoms. Treatment decision making should consider postprocedural change in dyspnea, especially in patients for whom dyspnea is a motivating factor for seeking treatment.
Depression and Anxiety: Considerations for Interpretation of the SNOT‐22 (22‐Item Sinonasal Outcome Test)
Authors: Phillips Katie M. , Sedaghat Ahmad R. 
Published: November 2021

ObjectiveThe objective of this study was to determine whether depression and anxiety symptoms affect and confound scoring on the 22‐item Sinonasal Outcome Test (SNOT‐22), a commonly used outcome measure for chronic rhinosinusitis.Study DesignProspective cross‐sectional.SettingTertiary care academic center.Methods240 participants completed the SNOT‐22, from which nasal, sleep, ear/facial pain, and emotional subdomain scores were calculated. They also completed the 8‐item Patient Health Questionnaire (PHQ‐8) as a reflection of depression symptoms and 7‐item Generalized Anxiety Disorder (GAD‐7) questionnaire as a reflection of anxiety symptoms. Correlations were calculated between the 4 SNOT‐22 subdomains and the PHQ‐8 and GAD‐7. Additionally, the predictive ability of subdomains and individual items of the SNOT‐22 to predict depression and anxiety was calculated.ResultsThe SNOT‐22 sleep and emotional subdomains most strongly correlated with the PHQ‐8 and the GAD‐7. The emotional and sleep subdomain scores were predictive of having depression or anxiety. An emotional subdomain score ≥4 had 62.5% sensitivity and 90.1% specificity for detecting depression and 78.8% sensitivity and 88.9% specificity for detecting anxiety. A sleep subdomain score ≥21 had 81.2% sensitivity and 71.4% specificity for detecting depression and 87.9% sensitivity and 68.6% specificity for detecting anxiety. The emotional subdomain item related to sadness and the sleep subdomain items related to functional impairment were most predictive of depression and anxiety.ConclusionThe SNOT‐22 emotional and sleep subdomain scores may be used to predict active depression and anxiety symptoms, especially when items related to sadness or functional impairment are scored with moderate burden.
Difficulties detaching psychologically from work among German teachers: prevalence, risk factors and health outcomes within a cross-sectional and national representative employee survey
Authors: Varol Yasemin Z. , Weiher Gerald M. , Wendsche Johannes , Lohmann-Haislah Andrea 
Published: November 2021

Abstract
Background
Teachers often face high job demands that might elicit strong stress responses. This can increase risks of adverse strain outcomes such as mental and physical health impairment. Psychological detachment has been suggested as a recovery experience that counteracts the stressor-strain relationship. However, psychological detachment is often difficult when job demands are high. The aims of this study were, first, to gain information on the prevalence of difficulties detaching from work among German teachers, second, to identify potential person-related/individual (i.e., age, sex), occupational (e.g., tenure, leadership position), and work-related (e.g., overload, cognitive, emotional, and physical demands) risk factors and, third, to examine relationships with mental and physical health impairment and sickness absence.

Methods
A secondary analysis of cross-sectional data from a national and representative survey of German employees was conducted (BIBB/BAuA Employment Survey 2018). For the analyses data from two groups of teachers (primary/secondary school teachers: n = 901, other teachers: n = 641) were used and compared with prevalence estimates of employees from other occupations (n = 16,266).

Results
Primary/secondary school teachers (41.5%) and other teachers (30.3%) reported more difficulties detaching from work than employees from other occupations (21.3%). Emotional demands and deadline/performance pressure were the most severe risk factors in both groups of teachers. In the group of primary/secondary school teachers multitasking demands were further risk factors for difficulties to detach from work whereas support from colleagues reduced risks. In both groups of teachers detachment difficulties can be linked to an increase in psychosomatic and musculoskeletal complaints and, additionally, to a higher risk of sickness absence among primary/secondary school teachers.

Conclusions
Difficulties detaching from work are highly prevalent among German teachers. In order to protect them from related risks of health impairment, interventions are needed which aim at optimizing job demands and contextual resources (i.e., work-directed approaches) or at improving coping strategies (i.e., person-directed approaches).
Clinical analysis of the “small plateau” sign on the flow-volume curve followed by deep learning automated recognition
Authors: Wang Yimin , Chen Wenya , Li Yicong , Zhang Changzheng , Liang Lijuan , Huang Ruibo , Liang Jianling , Gao Yi , Zheng Jinping 
Published: November 2021

Abstract
Background
Small plateau (SP) on the flow-volume curve was found in parts of patients with suspected asthma or upper airway abnormalities, but it lacks clear scientific proof. Therefore, we aimed to characterize its clinical features.

Methods
We involved patients by reviewing the bronchoprovocation test (BPT) and bronchodilator test (BDT) completed between October 2017 and October 2020 to assess the characteristics of the sign. Patients who underwent laryngoscopy were assigned to perform spirometry to analyze the relationship of the sign and upper airway abnormalities. SP-Network was developed to recognition of the sign using flow-volume curves.

Results
Of 13,661 BPTs and 8,168 BDTs completed, we labeled 2,123 (15.5%) and 219 (2.7%) patients with the sign, respectively. Among them, there were 1,782 (83.9%) with the negative-BPT and 194 (88.6%) with the negative-BDT. Patients with SP sign had higher median FVC and FEV1% predicted (both P < .0001). Of 48 patients (16 with and 32 without the sign) who performed laryngoscopy and spirometry, the rate of laryngoscopy-diagnosis upper airway abnormalities in patients with the sign (63%) was higher than those without the sign (31%) (P = 0.038). SP-Network achieved an accuracy of 95.2% in the task of automatic recognition of the sign.

Conclusions
SP sign is featured on the flow-volume curve and recognized by the SP-Network model. Patients with the sign are less likely to have airway hyperresponsiveness, automatic visualizing of this sign is helpful for primary care centers where BPT cannot available.
The impact of external academic accreditation of undergraduate medical program on students’ satisfaction
Authors: Al-Eyadhy Ayman , Alenezi Shuliweeh 
Published: November 2021

Abstract
Background
The external academic accreditation is a quality assurance and auditing process that focuses on the structure, process, and outcome of the education. It is an interrupting and highly demanding process in terms of effort, time, financial, and human resources. However, it is unclear in the literature how much of these external quality assurance practices impeded in the accreditation processes would reflect on the other end of the learning pathway, including student satisfaction.

Methods
A retrospective quantitative secondary data analysis, with a before-after comparison research design, was performed to evaluate external accreditation’s impact on students’ mean satisfaction score within two accreditation cycles at King Saud University (KSU)-Bachelor of Medicine, Bachelor of Surgery (MBBS) program.

Results
The overall average students’ satisfaction scores pre-and-post the first accreditation cycle were 3.46/5 (±0.35), 3.71 (±0.39), respectively, with a P-value of < 0.001. The effect of post first accreditation cycle was sustainable for a couple of years, then maintained above the baseline of the pre-first accreditation cycle until the pre-second accreditation cycle. Similarly, the overall average students’ satisfaction scores pre-and-post the second accreditation cycles were 3.57/5 (±0.30) and 3.70 (±0.34), respectively, with a P-value of 0.04. Compared to the first accreditation cycle, the improvement of the mean score of students’ satisfaction rates was not sustained beyond the year corresponding to the post-second accreditation cycle.

Conclusion
Both accreditation cycles were associated with an increased score in students’ satisfaction. The preparatory phase activities and navigation through the self-study assessment while challenging the program’s competencies are essential triggers for quality improvement practices associated with accreditation.
Offspring's risk for suicidal behaviour in relation to parental death by suicide: systematic review and meta-analysis and a model for familial transmission of suicide
Authors: Calderaro Mara , Baethge Christopher , Bermpohl Felix , Gutwinski Stefan , Schouler-Ocak Meryam , Henssler Jonathan 
Published: November 2021

BackgroundExposure to parental suicide has been associated with increased risk for suicide and suicide attempts, although the strength of this association is unclear as evidence remains inconsistent.AimsTo quantify this risk using meta-analysis and identify potential effect modifiers.MethodA systematic search in PubMed, PsycInfo and Embase databases to 2020 netted 3614 articles. Inclusion criteria were: observation of history of parental death by suicide, comparison with non-exposed populations and definition of suicide and suicide attempt according to standardised criteria. We focused on population-based studies. The primary outcome was the pooled relative risk (RR) for incidence of suicide attempt and suicide in offspring of a parent who died by suicide compared with offspring of two living parents. Additionally, we compared the RR for attempted and completed suicide after parental suicide with the RR for attempted and completed suicide after parental death by other causes.ResultsTwenty studies met our inclusion criteria. Offspring exposed to parental suicide were more likely to die by suicide (RR = 2.97, 95% CI 2.50–3.53) and attempt suicide (RR = 1.76, 95% CI 1.58–1.96) than offspring of two living parents. Furthermore, their risk of dying by or attempting suicide was significantly higher compared with offspring bereaved by other causes of death.ConclusionsThe experience of losing a parent to suicide is a strong and independent risk factor for suicidal behaviour in offspring. Our findings highlight the need for prevention strategies, outreach programmes and support interventions that target suicide-related outcomes in the exposed population.
Machine Learning Applied to Electronic Health Records: Identification of Chemotherapy Patients at High Risk for Preventable Emergency Department Visits and Hospital Admissions
Authors: Peterson Dylan J. , Ostberg Nicolai P. , Blayney Douglas W. , Brooks James D. , Hernandez-Boussard Tina 
Published: November 2021

PURPOSE Acute care use (ACU) is a major driver of oncologic costs and is penalized by a Centers for Medicare & Medicaid Services quality measure, OP-35. Targeted interventions reduce preventable ACU; however, identifying which patients might benefit remains challenging. Prior predictive models have made use of a limited subset of the data in the electronic health record (EHR). We aimed to predict risk of preventable ACU after starting chemotherapy using machine learning (ML) algorithms trained on comprehensive EHR data. METHODS Chemotherapy patients treated at an academic institution and affiliated community care sites between January 2013 and July 2019 who met inclusion criteria for OP-35 were identified. Preventable ACU was defined using OP-35 criteria. Structured EHR data generated before chemotherapy treatment were obtained. ML models were trained to predict risk for ACU after starting chemotherapy using 80% of the cohort. The remaining 20% were used to test model performance by the area under the receiver operator curve. RESULTS Eight thousand four hundred thirty-nine patients were included, of whom 35% had preventable ACU within 180 days of starting chemotherapy. Our primary model classified patients at risk for preventable ACU with an area under the receiver operator curve of 0.783 (95% CI, 0.761 to 0.806). Performance was better for identifying admissions than emergency department visits. Key variables included prior hospitalizations, cancer stage, race, laboratory values, and a diagnosis of depression. Analyses showed limited benefit from including patient-reported outcome data and indicated inequities in outcomes and risk modeling for Black and Medicaid patients. CONCLUSION Dense EHR data can identify patients at risk for ACU using ML with promising accuracy. These models have potential to improve cancer care outcomes, patient experience, and costs by allowing for targeted, preventative interventions.
Association of Race With Cancer-Related Financial Toxicity
Authors: Panzone John , Welch Christopher , Morgans Alicia , Bhanvadia Sumeet K. , Mossanen Matthew , Shenhav-Goldberg Rachel , Chandrasekar Thenappan , Pinkhasov Ruben , Shapiro Oleg , Jacob Joseph M. , Basnet Alina , Bratslavsky Gennady , Goldberg Hanan 
Published: November 2021

PURPOSE: We investigated the association between race and FT among previous patients with cancer. Studies show that patients with cancer experience financial toxicity (FT) because of their cancer treatment. METHODS: Data on individuals with a cancer history were collected in this cross-sectional study during 2012, 2014, and 2017, from the US Health Information National Trends Survey. This survey is conducted by mail with monetary compensation as an incentive. We specifically assessed responses to two questions: Has cancer hurt you financially? Have you been denied health insurance because of cancer? Multivariable logistic regression analyses were used to assess the associations between these questions and race. RESULTS: Of 10,592 individuals participating, 1,328 men and women (12.5%) with a cancer history were assessed. Compared with Blacks, Whites were found to have a higher rate of insurance (95.4% v 90.0%), were more likely to receive cancer treatment (93.9% v 85%), and had a higher rate of surgical treatment than Blacks (77% v 60%), Hispanics (55%), and others (77%, 60%, 55%, and 74.2%, respectively, P < .001). On multivariable analysis, Blacks were more than five times as likely to be denied insurance (odds ratio, 5.003; 95% CI, 2.451 to 10.213; P < .001) and more than twice as likely to report being hurt financially because of cancer (odds ratio, 2.448; 95% CI, 1.520 to 3.941; P < .001) than Whites. Of all cancer groups analyzed (genitourinary, gynecologic, gastrointestinal, and breast), genitourinary malignancies were the only group in which the rate of reporting being hurt financially varied in a statistically significant manner (Whites 36.7%, Hispanics 62.5%, and Blacks 59.3%, P = .004). CONCLUSION: Our data suggest that race is significantly associated with FT because of cancer. Awareness of racial inequality with regards to FT should be raised among health care workers.
COVID Vaccination in Athletes & Updated Interim Guidance on the Preparticipation Physical Examination during the SARS-CoV-2 Pandemic
Authors: Narducci Dusty Marie , Diamond Alex B. , Bernhardt David T. , Roberts William O. 
Published: November 2021

Abstract
The American Medical Society for Sports Medicine (AMSSM) convened an expert panel to address the current evidence, knowledge gaps, and recommendations surrounding the COVID vaccination in athletes during the SARS-CoV-2 pandemic. The group held a series of meetings beginning in July 2021 and reviewed the available literature while using an iterative process and expert consensus to finalize this guidance statement. This document is intended to provide clinicians with suggestions on how to incorporate the COVID vaccination during the preparticipation physical examination for athletes in all levels of training and competition. The statement is not intended to address treatment, infection control principles, safety, ethical discussion, or public health issues related to SARS-CoV-2. The AMSSM task force acknowledges the clinical uncertainty, evolving public health objectives, and the limited data currently available to create this guidance statement.
THE STUDENT NURSES’ SKILL OF MANAGING THEIR TIME
Authors: Hristova Irinka , Koleva Greta , Georgieva Despina 
Published: November 2021

Introduction: Time is one of the basic resources in each human activity. It holds a special place in health care. Either its deficiency or underestimation may lead to the negative and even fatal aftermath for human life.
Objective: The purpose of this report is to identify the reasons for poor time management of student nurses.
Methods: A standardized questionnaire was answered by a total of 89 student nurses from the 1st year and 3rd year courses, in the nursing bachelor degree from the Ruse University of Angel Kanchev, Bulgaria. The questionnaire was held in January 2021.
Results: From this study we have determined that those who are capable of managing their time and always plan well are just 26%(23n) of all respondents, more than a half of them only sometimes plan their tasks, 61%(54n), whereas 13%(12n) never do. As for the compliance of the deadlines, only 31.5% (28n) of them always manage to do so, while the rest of the students only sometimes do so.
Conclusions: The inability of student nurses to plan their time is just one of the reasons for concern. It was determined that the lack of training for effective time management, intense workload in higher education, not realizing they have to manage their time and their young age, significantly affect the student nurses’ proper management of time.
UDC Classification: 37.04, DOI: https://doi.org/10.12955/pmp.v2.170
eRESEARCH IN THE DEGREE OF ADHERENCE BY ASTHMA PATIENTS – A PILOT STUDY
Authors: Todorova Anna , Tsvetkova Antoaneta , Mihaylova Silvia 
Published: November 2021

Introduction: Non-adherence to treatment is a global issue which in recent years has reached epidemic proportions. The WHO has reported that treatment adherence in chronic patients is 50% in developed countries on average. According to data from the Association of Bulgarians with Bronchial Asthma (ABBA) the percentage of asthma patients who are not regularly treated is the highest compared with other chronic diseases. Non-adherence to treatment not just influences the patient’s quality of life but increases the health care costs in society.
Objectives: The aim of this study is to analyse the degree of adherence to prescribed treatment in asthma patients.
Methods: An anonymous survey was made among 50 outpatients with asthma using an adapted survey card consisting of two parts: a questionnaire that collects information about the demographic profile of the patient (gender, age, educational background, etc) and a validated tool, the Morisky test, which is a questionnaire that defines the degree of treatment adherence.
Results: The results from the Morisky test (Morisky coefficient 2.22) showed a mean degree of adherence both for the whole sample and for men and women separately, with a minimal difference of 0.01 in favour of men (Morisky coefficient 2.24 in men and 2.23 in women).
Conclusions: The studied asthma patients show unsatisfactory adherence to the prescribed treatment. The mean degree of adherence reported in the study indicates the need for educating patients, monitoring and collaboration among doctors, patients, pharmacists and other healthcare professionals.