bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systems engineering analysis of diagnostic referral closed-loop processes
Authors: Nehls Nicole , Yap Tze Sheng , Salant Talya , Aronson Mark , Schiff Gordon , Olbricht Suzanne , Reddy Swapna , Sternberg Scot B , Anderson Timothy S , Phillips Russell S , Benneyan James C 
Published: November 2021

BackgroundClosing loops to complete diagnostic referrals remains a significant patient safety problem in most health systems, with 65%–73% failure rates and significant delays common despite years of improvement efforts, suggesting new approaches may be useful. Systems engineering (SE) methods increasingly are advocated in healthcare for their value in studying and redesigning complex processes.ObjectiveConduct a formative SE analysis of process logic, variation, reliability and failures for completing diagnostic referrals originating in two primary care practices serving different demographics, using dermatology as an illustrating use case.MethodsAn interdisciplinary team of clinicians, systems engineers, quality improvement specialists, and patient representatives collaborated to understand processes of initiating and completing diagnostic referrals. Cross-functional process maps were developed through iterative group interviews with an urban community-based health centre and a teaching practice within a large academic medical centre. Results were used to conduct an engineering process analysis, assess variation within and between practices, and identify common failure modes and potential solutions.ResultsProcesses to complete diagnostic referrals involve many sub-standard design constructs, with significant workflow variation between and within practices, statistical instability and special cause variation in completion rates and timeliness, and only 21% of all process activities estimated as value-add. Failure modes were similar between the two practices, with most process activities relying on low-reliability concepts (eg, reminders, workarounds, education and verification/inspection). Several opportunities were identified to incorporate higher reliability process constructs (eg, simplification, consolidation, standardisation, forcing functions, automation and opt-outs).ConclusionFrom a systems science perspective, diagnostic referral processes perform poorly in part because their fundamental designs are fraught with low-reliability characteristics and mental models, including formalised workaround and rework activities, suggesting a need for different approaches versus incremental improvement of existing processes. SE perspectives and methods offer new ways of thinking about patient safety problems, failures and potential solutions.
Bayesian analysis of multimessenger M-R data with interpolated hybrid EoS
Authors: Ayriyan A. , Blaschke D. , Grunfeld A. G. , Alvarez-Castillo D. , Grigorian H. , Abgaryan V. 
Published: November 2021

AbstractWe introduce a family of equations of state (EoS) for hybrid neutron star (NS) matter that is obtained by a two-zone parabolic interpolation between a soft hadronic EoS at low densities and a set of stiff quark matter EoS at high densities within a finite region of chemical potentials $$\mu _H< \mu < \mu _Q$$

μ
H

<
μ
<

μ
Q

. Fixing the hadronic EoS as the APR one and choosing the color-superconducting, nonlocal NJL model with two free parameters for the quark phase, we perform Bayesian analyses with this two-parameter family of hybrid EoS. Using three different sets of observational constraints that include the mass of PSR J0740+6620, the tidal deformability for GW170817, and the mass-radius relation for PSR J0030+0451 from NICER as obligatory (set 1), while set 2 uses the possible upper limit on the maximum mass from GW170817 as an additional constraint and set 3 instead of the possibility that the lighter object in the asymmetric binary merger GW190814 is a neutron star. We confirm that in any case, the quark matter phase has to be color superconducting with the dimensionless diquark coupling approximately fulfilling the Fierz relation $$\eta _D=0.75$$

η
D

=
0.75

and the most probable solutions exhibiting a proportionality between $$\eta _D$$

η
D

and $$\eta _V$$

η
V

, the coupling of the repulsive vector interaction that is required for a sufficiently large maximum mass. We used the Bayesian analysis to investigate with the method of fictitious measurements the consequences of anticipating different radii for the massive $$2~M_\odot $$

2

M
⊙

PSR J0740+6220 for the most likely equation of state. With the actual outcome of the NICER radius measurement on PSR J0740+6220 we could conclude that for the most likely hybrid star EoS would not support a maximum mass as large as $$2.5~M_\odot $$

2.5

M
⊙

so that the event GW190814 was a binary black hole merger.
Establishment of Normal Range for Thromboelastography in Healthy Middle-Aged and Elderly People of Weihai in China
Authors: Ni Lina , Xue Peng , An Changjuan , Yu Xia , Qu Jiangli , Yao Yingjie , Li Yingbo 
Published: November 2021

TEG can monitor the dynamic changes of blood clot formation and lysis by activating the coagulation system of a small sample of whole blood in vitro. The parameters can reflect the level of coagulation factors, the function of fibrinogen and platelet, and the presence or absence of hyperfibrinolysis. At present, the normal reference range of the parameters of TEG is mainly based on the reference values established by the Western population. Due to the differences in the distribution of ethnic groups, many countries have established their reference ranges for healthy populations. In China, some scholars have tried to establish the corresponding TEG reference range according to the characteristics of the population in different regions. This study tried to establish the reference range for thromboelastography in healthy middle-aged and elderly people of Weihai in China and compare it with the reference range provided by the manufacturer. The fasting venous blood of 454 healthy middle-aged and elderly people was collected, including 239 males and 215 females. The thromboelastography TEG-5000 was used to measure the reaction time (R), coagulation formation time (K), coagulation angle (Angle), and maximum amplitude (MA). The reference range of TEG parameters of middle-aged and elderly healthy males was R: 4.38–8.27 min, K: 1.44–2.82 min, Angle: 48.53–72.17 deg, and MA: 51.95–72.02 mm; respectively, in the females, the normal value was R: 3.43–7.40 min, K: 1.07–2.53 min, Angle: 48.22–77.22 deg, and MA: 53.10–74.58 mm; The difference of R, K, Angle, and MA between the male group and the female group was statistically significant (

P

< 0.05); In this study, if we use the reference range established by the manufacturer, the R specificity for males was 91.6%, K specificity was 98.7%, Angle specificity was 85.8%, and MA specificity was 93.7%; the range for females was 68.4%, 99.5%, 75.8%, and 87.4%, respectively. There are statistically significant differences between R, K, Angle, and MA in middle-aged and elderly healthy women and men. It is necessary to establish a TEG reference range for healthy females and males.
First-in-human HER2-targeted Bispecific Antibody KN026 for the Treatment of Patients with HER2-positive Metastatic Breast Cancer: Results from a Phase I Study
Authors: Zhang Jian , Ji Dongmei , Cai Li , Yao Herui , Yan Min , Wang Xiaojia , Shen Weina , Du Yiqun , Pang Hui , Lai Xiuping , Zeng Huiai , Huang Jian , Sun Yan , Peng Xinxin , Xu Junfang , Yang Jing , Yang Fei , Xu Ting , Hu Xichun 
Published: November 2021

Abstract

Purpose:
KN026 is a novel bispecific antibody that simultaneously binds to two distinct HER2 epitopes. This first-in-human phase I study evaluated the safety/tolerability, pharmacokinetics, preliminary efficacy, and potential predictive biomarker activity of KN026 administered as monotherapy to patients with HER2-positive metastatic breast cancer (MBC).

Patients and Methods:
Female patients with HER2-positive MBC who had progressed on prior anti HER2 therapies received intravenous KN026 monotherapy at 5 mg/kg (once weekly), 10 mg/kg (once weekly), 20 mg/kg (once every 2 weeks), or 30 mg/kg (once every 3 weeks). Dose escalation was guided by a “3+3” dose escalation rule followed by dose expansion.

Results:
Sixty-three patients were enrolled. The most common treatment-related adverse events (TRAE) were pyrexia (23.8%), diarrhea (22.2%), aspartate aminotransferase increased (22.2%), alanine aminotransferase increased (22.2%). Only 4 patients reported grade 3 TRAEs. Results from exposure-response analysis supported the selection of the recommended phase II doses at 20 mg/kg once every 2 weeks or 30 mg/kg once every 3 weeks, which had objective response rates (ORR) of 28.1% and median progression-free survival (PFS) of 6.8 months (95% confidence interval: 4.2–8.3) in 57 patients. Translational research in 20 HER2-amplified patients further confirmed that co-amplification (vs. no co-amplification) of CDK12 was a promising biomarker in predicting better response to KN026 (ORR of 50% vs. 0% and median PFS of 8.2 vs. 2.7 months, P = 0.05 and 0.04, respectively).

Conclusions:
KN026, a HER2 bispecific antibody, was well tolerated and achieved comparable efficacy as trastuzumab and pertuzumab doublet even in the more heavily pretreated patients. Co-amplification of HER2/CDK12 may define patients who benefit more from KN026.
“The World Was Given Us to Fix It”
Authors: Koplowitz-Breier Anat 
Published: November 2021

Abstract
This article explores the ecopoetry written by three women poets who also identify themselves as Jewish poets: Alicia Ostriker, Marge Piercy and Naomi Ruth Lowinsky. It examines whether they employ any or some/all of the “emancipatory strategies” characteristic of the ecofeminist re-imagination of nature and human relationships with the natural world, seeking to answer several questions: How far can these poems be considered part of eco-Judaism? Does the fact that their authors are women also make them ecofeminist works? Does the poets’ Jewish feminist identity contribute to their ecopoetic call for ecological change?
The Promise of Jewish Theistic Naturalism for Jewish Environmental Ethics
Authors: Guzi Bar 
Published: November 2021

Abstract
This paper seeks to explain the greater appeal of Jewish naturalistic theologies given our greater appreciation today of the ecological vulnerability of our world. By examining the theological writings of two prominent twentieth-century Jewish thinkers—Hans Jonas and Arthur Green. The paper demonstrates that their espousal of naturalistic yet theistic worldview in their interpretations and reconstructions of Jewish tradition shares significant affinities and promotes an ethical attitude toward the environment. First, I show that Jonas and Green reject reductive forms of naturalism and embrace a nonreductive or “expansive” style of naturalism. Then, I argue that their theologies intend to stimulate a sense of responsibility toward all creation by envisioning humans as partners of a non-omnipotent God. I conclude by noting the metaphysical, epistemological, and moral promises of theistic naturalism to Jewish environmental ethics.
Increased Mortality in Hip Fracture Patients With Aortic Stenosis and Pulmonary Hypertension Compared to Aortic Stenosis Alone
Authors: Cignoni Christian B. , Vuu Steven K. M. , Liu Huazhi , Clark Jason M. , Watson Carrie D. , Ferber Laurence R. , Richards Winston T. , Ang Darwin N. 
Published: November 2021

Introduction Hip fractures are one of the most common traumatic injuries in the United States, secondary to an aging population. Multiple comorbidities are found in patients who present to trauma centers (TCs) with isolated hip fractures (IHFs) including significant cardiac disease. Aortic stenosis (AS) among these patients has been recently shown to increase mortality. However, factors leading to death from AS are unknown. We hypothesize that pulmonary hypertension (PH) is a significant mechanism of death among IHF patients with AS. Methods This is a multicenter retrospective cohort study examining IHF patients treated at Level I and II TCs within a large hospital system from 2015 to 2019. Patients who had IHFs and AS were compared to those who had IHFs, AS, and PH. Multivariable logistic regression was used to risk adjust by age, race, insurance status, and comorbidities. The primary outcome was inpatient mortality. The secondary outcomes were hospital-acquired complications. Results A total of 1388 IHF patients with AS were included in the study. Eleven percent of these patients also had PH. The crude mortality rate was higher if IHF patients had both AS and PH compared to IHF with AS alone (9% vs 3.7%, P-value .003). After risk adjustment, a higher risk of mortality was still significant (aOR 2.56 [95% CI 1.28, 5.11]). In addition, IHF patients with both AS and PH had higher complication rates; the exposure group had higher percentage of pulmonary embolism (1.4% vs .2%, adjusted P-value .03), new-onset congestive heart failure (4.1% vs 1%, adjusted P-value .01), and sepsis/septicemia (3.5% vs 1.4%, adjusted P-value .05). Conclusion In patients with IHFs, PH and AS increase the likelihood of inpatient mortality by 2.5 times compared to AS alone. Pulmonary hypertension among IHF patients with AS is an important risk factor to identify in the preoperative period. Early identification may lead to better perioperative management and counseling of patients at higher risk of complications.
The Impact of Flame Burn Injuries on Patients Who Sustain Mild Injuries From Motor Vehicle Crashes
Authors: Campbell Brady A. , Rozycki Grace F. , Haut Elliott R. , Fang Raymond , Hultman Charles Scott 
Published: November 2021

Background The purpose of this study was to determine the differences in patient outcomes between motor vehicle crash (MVC) victims with an ISS < 15 and those with a similar ISS and a flame burn injury. Methods Data for patients involved in a MVC with a GCS ≥12 and an ISS < 15 with and without flame burn injury were reviewed from the American College of Surgeons National Trauma Data Bank between 2007 and 2017. International Classification of Diseases-9 and -10 revisions and External Injury Codes were used to identify patients who were divided into MVC only (Group 1) and MVC with additional flame burn injury (Group 2). In-hospital mortality was the primary outcome whereas secondary outcomes included ICU admission, ICU length of stay (LOS), hospital LOS, sepsis, deep vein thrombosis, acute respiratory distress syndrome, and pneumonia. Simple linear regression was used in the form of odds ratios to investigate risk factors for mortality and secondary outcomes. Results The mean LOS and ICU LOS were longer in Group 2 (5.9 vs 4.0 days, p-value <0.001, and 1.2 vs 0.6 days, p-value <0.001, respectively), with more patients being admitted to the ICU as well (22.9% vs 17.3%, p-value <0.001). Also, there were significantly higher rates of pneumonia (0.8% vs 0.5%, p-value 0.0014), deep vein thrombosis (0.6% vs 0.4%, p-value 0.028), and acute respiratory distress syndrome (0.5% vs 0.3%, p-value 0.004) in Group 2. Patients in Group 1 were older and more likely had hypertension, congestive heart failure, and COPD. There was no significant difference in mortality between Groups by odds ratios (OR 0.85, p-value 0.743) or raw percentages (0.3% vs 0.3%, p-value = 0.874). Conclusion MVC victims with mild injuries who also sustain a burn injury are more likely to require admission to the ICU regardless of their comorbidities and more likely to develop respiratory complications, especially pneumonia and an increase in ICU and hospital LOS.
Clinical and Microbiological Factors Associated With Abscess Formation in Adult Acute Epiglottitis
Authors: Sideris Giorgos , Papadimitriou Nikolaos , Korres Georgios F. , Karaganis Anastasios , Maragkoudakis Pavlos , Nikolopoulos Thomas , Delides Alexander 
Published: November 2021

Objectives: To evaluate clinical and microbiological findings that are correlated with abscess formation in adult acute epiglottitis (AE). Methods: We reviewed 140 cases of adult AE. Demographic, clinical, imaging, and microbiological findings are analyzed for all patients with AE in comparison to those with epiglottic abscess (EA). Results: A total of 113 patients presented with AE and 27 presented or progressed to EA (19.3%). Age, sex, seasonality, smoking, body mass index (BMI), and comorbidities were statistically insignificant between the 2 groups. Muffled voice ( P < .013), respiratory distress ( P < .001), and pre-existence of epiglottic cyst ( P < .001) are symptoms and signs connected with abscess formation. A total of 120 patients were treated conservatively. Surgical treatment was performed on 20 patients with EA. About 72 out of 80 cultures revealed monomicrobial infection. Mixed flora was isolated in 8 patients with EA. Streptococcus was isolated in 51 out of 80 positive cultures (64%). Haemophilus Influenza ( Hib) was not isolated in any sample. EA and mixed flora relates to a higher rate of airway intervention ( P < .001). Conclusion: A high level of suspicion for abscess formation is required if clinical examination reveals dyspnea, muffled voice, or an epiglottic cyst in adult with AE. The existence of EA doubles the duration of hospitalization. EA is typically found on the lingual surface of the epiglottis. Supraglottic or deep neck space expansion should be treated surgically. EA is associated with a mixed flora and a higher rate of airway obstruction. Streptococcus is discovered to be the most common pathogen.
Major depression as a predictor of the intergenerational transmission of attachment security: Findings from a pregnancy cohort study
Authors: Galbally Megan , Watson Stuart J , Tharner Anne , Luijk Maartje , Blankley Gaynor , MacMillan Kelli K , Power Josephine , Lewis Andrew J 
Published: November 2021

Objective: Understanding the relationship between attachment and mental health has an important role in informing management of perinatal mental disorders and for infant mental health. It has been suggested that experiences of attachment are transmitted from one generation to the next. Maternal sensitivity has been proposed as a mediator, although findings have not been as strong as hypothesised. A meta-analysis suggested that this intergenerational transmission of attachment may vary across populations with lower concordance between parent and infant attachment classifications in clinical compared to community samples. However, no previous study has examined major depression and adult attachment in pregnancy as predictors of infant–parent attachment classification at 12 months postpartum. Methods: Data were obtained on 52 first-time mothers recruited in early pregnancy, which included 22 women who met diagnostic criteria for current major depression using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. The Adult Attachment Interview was also administered before 20 weeks of pregnancy. A history of early trauma was measured using the Childhood Trauma Questionnaire and maternal sensitivity was measured at 6 months postpartum using the observational measure of the Emotional Availability Scales. Infant–parent attachment was measured using the Strange Situation Procedure at 12 months. Results: Overall, we found no significant association between the Adult Attachment Interview and the Strange Situation Procedure classifications. However, a combination of maternal non-autonomous attachment on the Adult Attachment Interview and major depression was a significant predictor of insecure attachment on the Strange Situation Procedure. We did not find that maternal sensitivity mediated parental and infant attachment security in this sample. Conclusion: While previous meta-analyses identified lower concordance in clinical samples, our findings suggest women with major depression and non-autonomous attachment have a greater concordance with insecure attachment on the Strange Situation Procedure. These findings can guide future research and suggest a focus on depression in pregnancy may be important for subsequent infant attachment.
A Two-Wave Study On The Associations Of Burnout With Depression And Anxiety: The Mediating And Moderating Role Of Perceived Family Support
Authors: Koutsimani Panagiota , Montgomery Anthony 
Published: November 2021

Studies have shown strong associations between burnout and depression and burnout and anxiety but their exact interrelationships still remain unclear. Few studies have examined the psychosocial mechanisms that might underlie these two relationships. Non-work social factors such as perceived family support can affect mental health. The present study investigated the distinctiveness and the reciprocal associations between burnout and depression, and burnout and anxiety by collecting data twice over an 8 month interval. Perceived family support was examined as a mediating and a moderating factor underlying the two relationships. The Maslach Burnout Inventory-General Survey, the Hospital Depression and Anxiety Scale, and the Julkunen Family Support Scale were administered to employees of the general working population ( N = 52). First, our results revealed moderate associations between burnout and depression, and burnout and anxiety, supporting the distinctiveness of burnout from the two psychological phenomena. Second, the exhaustion and cynicism burnout dimensions showed reciprocal associations with depression. Moreover, anxiety was found to be a consequence of cynicism while it presented reciprocal associations with the exhaustion dimension of burnout. Perceived family support did not mediate the burnout-depression and burnout-anxiety relationships. However, it moderated the depression-exhaustion relationship in a direction opposite from our hypothesis.
The Hazards to Higher Education of Reformist Pragmatism in Cuba: Proposals for an Agenda
Authors: García-Chediak Rosa , Quintana Nedelcu Danay 
Published: November 2021

A critical study of public policy involving the 2016–2017 reforms of higher education in Cuba points to the hazards of the pragmatic approach to this policy evidenced in numerous educational indicators and official discourse. Although such features are still far from possessing a neoliberal imprint, uncontrolled pragmatism could lead to a neoliberal trend in Cuban educational policy. Various indicators show the slow mutation of educational policy, increasingly measured and understood as an economic policy (in its fiscal aspects) rather than as a social one. Un estudio crítico de las políticas públicas ligadas a las reformas cubanas a la educación superior de 2016–2017 muestra los peligros del enfoque pragmático tomado por este proceso, los cuales se hacen evidente en numerosos indicadores educativos y discursos oficiales. Aunque aún no podemos hablar de una impronta neoliberal, el pragmatismo descontrolado podría conducir a la política educativa cubana en dicha dirección. Diversos indicadores muestran la lenta mutación de la política educativa, la cual se mide y entiende cada vez más como una política económica (en sus aspectos fiscales) que social.
From Lula to Bolsonaro: The Crisis of Neodevelopmentalism in Brazil
Authors: Clemente Dario 
Published: November 2021

Examination of the rise of Bolsonaro in Brazil shows that, since 2013, neodevelopmentalism has been shattered in all its dimensions—a true crisis of hegemony that has led to a reconfiguration of power relations and the end of the state cycle that began in 1988. Calculating the depth of the collapse produced in the previous phase is essential in reflecting on the current situation. Un análisis del ascenso de Bolsonaro en Brasil muestra cómo, a partir de 2013, el neodesarrollismo se ha resquebrajado en todas sus dimensiones—una verdadera crisis de hegemonía que ha llevado a una reconfiguración de las relaciones de fuerza y al cierre del ciclo estatal comenzado en 1988. Dimensionar la profundidad del quiebre que se ha producido en la etapa anterior es una tarea fundamental para poder reflexionar sobre la situación actual.