bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence, Risk Factors, and Outcomes of Platelet Transfusion Refractoriness in Critically Ill Patients: A Retrospective Cohort Study
Authors: Arabi Saeed , Almahayni Abdullah O. , Alomair Abdulrahman A. , Masuadi Emad M. , Damlaj Moussab , Al-Dorzi Hasan M. 
Published: September 2021

Background. Refractoriness to platelet transfusion is an understudied phenomenon in critically ill patients. Our objective was to evaluate the prevalence, risk factors, and clinical outcomes of platelet refractoriness among patients in a tertiary-care intensive care unit (ICU). Methods. A retrospective cohort study included all patients (age >14 years) who were admitted to a tertiary-care medical-surgical ICU between 2011 and 2016 and received ≥2 platelet transfusions during their ICU stay. We calculated platelet increment (PI) and corrected count increment (CCI). Results. A total of 267 patients were enrolled in the study, collectively receiving 1357 transfusions with a median of 4.0 (interquartile range: 2.0, 6.0) transfusions per patient. The median pretransfusion platelet count was 31000.0 × 106/L (interquartile range: 16000.0, 50000.0). The median PI was 6000 × 106/L. The prevalence of platelet transfusion refractoriness was 54.8% based on PI < 10000 × 106/L and 57.0% based on CCI <5000. Patients admitted under hepatology/liver transplant had the highest rates of platelet refractoriness (69.6%), while those under general surgery had the lowest rate (43.2%). Younger age, nontrauma admission, and larger spleen size were associated with platelet refractoriness. Finally, refractoriness was associated with increased length of stay in the ICU (

p

= 0.02), but not with mortality. Conclusions. Platelet transfusion refractoriness was highly (>50%) prevalent in ICU patients. However, it was not associated with increased mortality.
Glioblastoma Clinical Trials: Current Landscape and Opportunities for Improvement
Authors: Bagley Stephen J. , Kothari Shawn , Rahman Rifaquat , Lee Eudocia Q. , Dunn Gavin P. , Galanis Evanthia , Chang Susan M. , Nabors Louis Burt , Ahluwalia Manmeet S. , Stupp Roger , Mehta Minesh P. , Reardon David A. , Grossman Stuart A. , Sulman Erik P. , Sampson John H. , Khagi Simon , Weller Michael , Cloughesy Timothy F. , Wen Patrick Y. , Khasraw Mustafa 
Published: September 2021

Abstract
Therapeutic advances for glioblastoma have been minimal over the past 2 decades. In light of the multitude of recent phase III trials that have failed to meet their primary endpoints following promising preclinical and early-phase programs, a Society for Neuro-Oncology Think Tank was held in November 2020 to prioritize areas for improvement in the conduct of glioblastoma clinical trials. Here, we review the literature, identify challenges related to clinical trial eligibility criteria and trial design in glioblastoma, and provide recommendations from the Think Tank. In addition, we provide a data-driven context with which to frame this discussion by analyzing key study design features of adult glioblastoma clinical trials listed on ClinicalTrials.gov as “recruiting” or “not yet recruiting” as of February 2021.
Endothelial Stromal PD-L1 (Programmed Death Ligand 1) Modulates CD8
+
T-Cell Infiltration After Heart Transplantation
Authors: Bracamonte-Baran William , Gilotra Nisha A. , Won Taejoon , Rodriguez Katrina M. , Talor Monica V. , Oh Byoung C. , Griffin Jan , Wittstein Ilan , Sharma Kavita , Skinner John , Johns Roger A. , Russell Stuart D. , Anders Robert A. , Zhu Qingfeng , Halushka Marc K. , Brandacher Gerald , Čiháková Daniela 
Published: September 2021

Background:
The role of checkpoint axes in transplantation has been partially addressed in animal models but not in humans. Occurrence of fulminant myocarditis with allorejection-like immunologic features in patients under anti-PD1 (programmed death cell protein 1) treatment suggests a key role of the PD1/PD-L1 (programmed death ligand 1) axis in cardiac immune homeostasis.

Methods:
We cross-sectionally studied 23 heart transplant patients undergoing surveillance endomyocardial biopsy. Endomyocardial tissue and peripheral blood mononuclear cells were analyzed by flow cytometry. Multivariate logistic regression analyses including demographic, clinical, and hemodynamic parameters were performed. Murine models were used to evaluate the impact of PD-L1 endothelial graft expression in allorejection.

Results:

We found that myeloid cells dominate the composition of the graft leukocyte compartment in most patients, with variable T-cell frequencies. The CD (cluster of differentiation) 4:CD8 T-cell ratios were between 0 and 1.5. The proportion of PD-L1 expressing cells in graft endothelial cells, fibroblasts, and myeloid leukocytes ranged from negligible up to 60%. We found a significant inverse logarithmic correlation between the proportion of PD-L1
+
HLA (human leukocyte antigen)-DR
+
endothelial cells and CD8
+
T cells (slope, −18.3 [95% CI, −35.3 to −1.3];
P
=0.030). PD-L1 expression and leukocyte patterns were independent of demographic, clinical, and hemodynamic parameters. We confirmed the importance of endothelial PD-L1 expression in a murine allogeneic heart transplantation model, in which
Tie2

Cre

pdl1

fl/fl

grafts lacking PD-L1 in endothelial cells were rejected significantly faster than controls.

Conclusions:

Loss of graft endothelial PD-L1 expression may play a role in regulating CD8
+
T-cell infiltration in human heart transplantation. Murine model results suggest that loss of graft endothelial PD-L1 may facilitate alloresponses and rejection.
Physician Network Connections Associated With Faster De-Adoption of Dronedarone for Permanent Atrial Fibrillation
Authors: Stecher Chad , Everhart Alexander , Smith Laura Barrie , Jena Anupam , Ross Joseph S. , Desai Nihar R. , Shah Nilay , Karaca-Mandic Pinar 
Published: September 2021

Background:
Physicians’ professional networks are an important source of new medical information and have been shown to influence the adoption of new treatments, but it is unknown how physician networks impact the de-adoption of harmful practices.

Methods:
We analyzed changes in physicians’ use of dronedarone after the PALLAS trial (Palbociclib Collaborative Adjuvant Study; November 2011) showed that dronedarone increased the risk of death from cardiovascular events among patients with permanent atrial fibrillation. Deidentified administrative claims from the OptumLabs Data Warehouse were combined with physicians’ demographic information from the Doximity database and publicly available data on physicians’ patient-sharing relationships compiled by the Centers for Medicare and Medicaid Services. We used a linear probability model with an interrupted linear time trend specification to model the impact of the PALLAS trial on physicians’ dronedarone usage between 2009 and 2014.

Results:

Before the PALLAS trial, the use of dronedarone was increasing by 0.22 percentage points per quarter (95% CI, 0.19–0.25) in our Medicare Advantage sample (N=343 429 patient-quarter observations) and 0.63 percentage points per quarter (95% CI, 0.52–0.75) in our commercially insured sample (N=44 402 patient-quarter observations). After the PALLAS trial and subsequent United States Food and Drug Administration black box warning, physicians in the Medicare Advantage sample with an above-median number of network connections to other physicians decreased their quarterly usage of dronedarone by 0.12 percentage points more per quarter (95% CI, −0.20 to −0.04;
P
=0.031) than physicians with equal to or below the median number of network connections. Similar patterns existed in the commercially insured sample (
P
=0.0318).

Conclusions:
After controlling for a wide range of patient, physician, and geographic characteristics, physicians with a greater number of network connections were faster de-adopters of dronedarone for patients with permanent atrial fibrillation after the PALLAS trial and subsequent United States Food and Drug Administration black box warning detailed the harmfulness of dronedarone for these patients. Policies for improving physicians’ responsiveness to new medical information should consider utilizing the influence of these important professional network relationships.
Effect of Posting on Social Media on Systolic Blood Pressure and Management of Hypertension: A Randomized Controlled Trial
Authors: Mancheno Christina , Asch David A. , Klinger Elissa V. , Goldshear Jesse L. , Mitra Nandita , Buttenheim Alison M. , Barg Frances K. , Ungar Lyle H. , Yang Lin , Merchant Raina M. 
Published: September 2021

Background
Online platforms are used to manage aspects of our lives including health outside clinical settings. Little is known about the effectiveness of using online platforms to manage hypertension. We assessed effects of tweeting/retweeting cardiovascular health content by individuals with poorly controlled hypertension on systolic blood pressure (SBP) and patient activation.

Methods and Results

We conducted this 2‐arm randomized controlled trial. Eligibility included diagnosis of hypertension; SBP >140 mm Hg; and an existing Twitter account or willingness to create one to follow study Twitter account. Intervention arm was asked to tweet/retweet health content 2×/week using a specific hashtag for study duration (6 months). The main measures include primary outcome change in SBP; secondary outcome point change in Patient Activation Measure (PAM). We remotely recruited and enrolled 611 participants, mean age 52 (SD, 11.7). Mean baseline SBP for the intervention group was 155.8 and for control was 155.6. At 6 months, mean SBP for intervention group was 137.6 and for control was 135.7. Mean change in SBP from baseline to 6 months for the intervention group was −18.5 and for control was −19.8
(P
=0.48). Mean PAM at baseline for the intervention group was 70.3 for control was 72.7. At 6 months, mean PAM scores were 71.1 (intervention) and 75.6 (control). Mean change in PAM score for the intervention group was 0.0 and for control was 3.3 (
P
=0.12).

Conclusions
Recruiting and engaging patients and collecting outcome measures remotely are feasible using Twitter. Encouraging patients with poorly controlled hypertension to tweet or retweet health content on Twitter did not improve SBP or PAM score at 6 months.

Registration

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02622256.
Sex Disparities in Organ Donation: Finding an Equitable Donor Pool
Authors: Yee Erika , Hosseini Seyedeh Maryam , Duarte Bianca , Knapp Shannon M. , Carnes Molly , Young Bessie , Sweitzer Nancy K. , Breathett Khadijah 
Published: September 2021

Background
The majority of living organ donors are women, but few are deceased organ donors, which increases risks associated with sex mismatched organs. We sought to identify reasons for sex disparities in organ donation and strategies for equity.

Methods and Results

Using Amazon's Mechanical Turk, we examined US adults' perceptions regarding donation in a mixed‐methods survey study. Results were compared by sex with Fisher's exact test and T‐tests for quantitative results and qualitative descriptive analyses for write‐in responses. Among 667 participants (55% women), the majority of men (64.8%) and women (63.4%) self‐identified as registered donors. Women's willingness to donate their own organs to family members (
P
=0.03) or strangers (
P
=0.03) was significantly higher than men. Donors from both sexes were guided by: desire to help, personal experience, and believing organs would be useless to deceased donors. Non‐donors from both sexes were guided by: no reason, medical mistrust, contemplating donation. When considering whether to donate organs of a deceased family member, women were equally guided by a family member's wishes and believing the family member had no further use for organs. Men had similar themes but valued the family member's wishes more. Among non‐donors, both sexes would consider donation if more information was provided.

Conclusions
In a national survey, both sexes had similar reasons for becoming and not becoming an organ donor. However, compared with men, women were more willing to donate their organs to family members and strangers. Improving education and communicating wishes regarding organ donation with direct relatives may increase sex equity in deceased organ donation.
Narrative Question Answering with Cutting-Edge Open-Domain QA Techniques: A Comprehensive Study
Authors: Mou Xiangyang , Yang Chenghao , Yu Mo , Yao Bingsheng , Guo Xiaoxiao , Potdar Saloni , Su Hui 
Published: September 2021

Abstract
Recent advancements in open-domain question answering (ODQA), that is, finding answers from large open-domain corpus like Wikipedia, have led to human-level performance on many datasets. However, progress in QA over book stories (Book QA) lags despite its similar task formulation to ODQA. This work provides a comprehensive and quantitative analysis about the difficulty of Book QA: (1) We benchmark the research on the NarrativeQA dataset with extensive experiments with cutting-edge ODQA techniques. This quantifies the challenges Book QA poses, as well as advances the published state-of-the-art with a ∼7% absolute improvement on ROUGE-L. (2) We further analyze the detailed challenges in Book QA through human studies.1 Our findings indicate that the event-centric questions dominate this task, which exemplifies the inability of existing QA models to handle event-oriented scenarios.
Identity Crisis and the Pseudo-Minorities in Bangladesh: Is the Right to Cultural Identity the Answer?
Authors: Mizan Arpeeta Shams 
Published: September 2021

Abstract
This article studies the process of minoritising members of majority groups through the use of narrow identity markers in heterogeneous countries like Bangladesh. Through historical analysis of the State’s influence on people's sense of cultural identity, it argues that when a group does not identify with State-imposed identity markers, they are alienated by the State and reduced to pseudo-minorities. Pseudo-minorities are groups of individuals who do not satisfy objective elements of minority identity, yet are discriminated against by the State in a minority-like manner. These individuals identify themselves as a group, and while they have formal equality, they lack de facto equality. These pseudo-minorities have no precise legal mechanism to redress such discrimination either under domestic or international law. The emerging right to cultural identity can become a tool to protect these groups.
Some Considerations on Why (and How) Criminal Law Should Turn International
Authors: Dellavalle Sergio 
Published: September 2021

Abstract
This article analyses the three theoretical presuppositions for an international dimension of criminal law to be successfully established. The first consists in the redefinition of the concept of sovereignty. Indeed, since sovereign power is usually understood as located within the boundaries of the individual states, it is necessary, for criminal law to turn international, that sovereignty is made compatible with cosmopolitan obligations. On the other hand, the reshaping of sovereignty can only be conceived on the basis of a universalistic understanding of the common good. Accordingly, the second step must lead to the transition from a particularistic to a universalistic idea of the well-ordered society. Thirdly, to avoid a hierarchical and centralized approach to international criminal justice, a notion of universalism should be preferred that, by making it sensitive to pluralism, also advocates an implementation of international criminal law which is prone to empowering national and local communities.
Networks of Innovation: Measuring Structure and Dynamics between and within Helices, Regions and Spatial Levels. Empirical Evidence from the Baltic Sea Region
Authors: Virkkala Seija , Mariussen Åge 
Published: September 2021

Abstract
In the quantitative, macro-oriented triple helix literature, synergy is measured indirectly, through patent data, firm data and other secondary statistical sources. These macro-level quantitative studies do not open up for understanding how different processes of cooperation create different outcomes, in terms of synergies. This article presents an alternative method of measuring quantitatively how different networks of innovation in a variety of ways create different types of complex synergies. This opens up for an empirical analysis of variations of synergy formation, seen as innovation networks with different structures, formed within and between helices, regions and geographical levels. Data was collected through a snapshot survey in 10 regional cases in the Baltic Sea Region. The analysis presents how different networks of innovation within and between helices are formed by different combinations of expectations, experiences and gaps.
Language change in multidimensional space
Authors: Hua Xia , Meakins Felicity , Algy Cassandra , Bromham Lindell 
Published: September 2021

Abstract
Linguistic coherence—the co-variation of language variants within speaker repertoires—has been proposed as a key process driving the divergence of language dialects. Previous studies on coherence have been often limited by dataset sizes and analyses. We analyze the use of 185 variables across 78 speakers from the Gurindji community in Australia. We use two multivariate statistical approaches to test whether clusters of variables co-vary with generation, family, household, exposure to Gurindji language speakers and education. Using Discriminant Correspondence Analysis, we find generation is the strongest grouping factor of speakers and co-varies with clusters of variants. Using the Generalized Linear Mixed Model, we find these clusters of variants not only represent a gradual loss of Gurindji language use across generations, but also contribute to distinct patterns of language usage in the different generations. Our study demonstrates the use of multivariate analyses on big datasets to identify sociolects, an important step in linking the ‘micro-level’ processes to the ‘macro-level’ outcomes.
“Toward a Shamanic Daily Life”
Authors: Rivadossi Silvia 
Published: September 2021

Abstract
This article contributes to the discussion on reactions and responses to the coronavirus pandemic in Japan, with specific reference to the field of “new spirituality” and, within this broad category, of shamanic spirituality. The case of the dance therapist, or “dance movement shaman,” Ms. Hiroda demonstrates how she managed to keep in contact with her practitioners and to design new ways to help them cope with the situation. The solution she offers, in line with the characteristics of shamanic spirituality, is to help each individual to acknowledge the importance of interconnectedness. In particular, Ms. Hiroda emphasizes body, community, and nature: to become aware of one’s own body again and of the necessity of connection with others and nature, especially in times of interpersonal distancing and crisis. Her response to the first wave of COVID-19 is thus to offer a strategy to live peacefully with—and despite—the virus.
A Non-Anglican View of Orthodoxy and Unorthodoxy in the Church of England
Authors: Mulder Frederik 
Published: September 2021

Abstract
Internal debates about orthodoxy and unorthodoxy inside the Church of England have been going on for centuries. The new contribution this article hopes to make is to provide an outsider’s view of these issues which will incorporate personal experiences, historical analyses, doctrinal developments, and diversifications, reflecting on three test cases, engagement with recent voices, and finally, retrospective reflection on key biblical texts which suggest that faithfulness to Scripture should lead to re-alignment from a dividing Church of England.
Perceptions of Sound Quality and Enjoyment After Cochlear Implantation
Authors: Bessen Sarah Y. , Saunders James E. , Eisen Eric A. , Magro Isabelle L. 
Published: September 2021

ObjectivesTo characterize the quality and enjoyment of sound by cochlear implant (CI) recipients and identify predictors of these outcomes after cochlear implantation.Study DesignCross‐sectional study.SettingA tertiary care hospital.MethodsSurveys based on the Hearing Implant Sound Quality Index were sent to all patients who received a CI at a tertiary care hospital from 2000 to 2019. Survey questions prompted CI recipients to characterize enjoyment and quality of voices, music, and various sounds.ResultsOf the 339 surveys, 60 (17.7%) were returned with complete data. CI recipients had a mean ± SD age of 62.5 ± 17.4 years with a mean 8.0 ± 6.1 years since CI surgery. Older current age and age at implantation significantly predicted lower current sound quality (P <. 05) and sound enjoyment (P <. 05), as well as worsening of sound quality (P <. 05) and sound enjoyment (P <. 05) over time. Greater length of implantation was associated with higher reported quality and enjoyment (r = 0.4, P <. 001; r = 0.4, P <. 05), as well as improvement of sound quality (r = 0.3, P <. 05) but not sound enjoyment over time.ConclusionRecipients who had CIs for a longer period had improved quality of sound perception, suggesting a degree of adaptation. However, CI recipients with implantation at an older age reported poorer sound quality and enjoyment as well as worsening sound quality and enjoyment over time, indicating that age‐related changes influence outcomes of cochlear implantation.
Linking doctor-patient relationship to medical residents’ work engagement: The influences of role overload and conflict avoidance
Authors: Deng Guangwei , Cai Wenjun , Yang Monica , Lio Jonathan , Feng Chenpeng , Ma Xiaopeng , Liang Liang 
Published: September 2021

Abstract
Background
Chinese residents’ practical work experiences are different from those described in Western studies. To explore potential mechanisms underlying the effects of doctor-patient relationships on medical residents’ work engagement, verifying a posited mediating effect of role overload, and moderating effect of conflict avoidance, in the Chinese context.

Methods
Based on the conservation of resources theory, a composite model was constructed. This study’s data were collected from four different Chinese tertiary hospitals; 195 residents undergoing regularization training took this survey. Hierarchical moderated and mediated regression analyses were utilized.

Results
Doctor-patient relationship were found to be positively related to residents’ work engagement (β=0.31, p≤0.001). Role overload partially mediated the effect of these relationships on work engagement, and the moderating role of conflict avoidance in the relationship between doctor-patient relationship and conflict avoidance was negative.

Conclusion
Maintaining good doctor-patient relationship can prompt residents to increase their engagement in work in order to meet their patients’ needs. Furthermore, role overload has a particular influence in early career stages. Not only is it necessary for residents to gain a sense of recognition and support while they carry out their job responsibilities, especially while dealing with complex doctor-patient relationship, but it is also important to create work environments that can help residents shape their professional competency.