bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategic Complements or Substitutes? The Case of Adopting Health Information Technology by U.S. Hospitals
Authors: Lin Jianjing 
Published: August 2021

Abstract
This paper explores the adoption choice of electronic medical records by U.S. hospitals, which could exhibit strategic complements or substitutes. I find complementarities in adoption through a reduced-form analysis with instruments for unobserved market characteristics. I further develop a dynamic oligopoly model to allow for strategic timing incentives that are missing in the static model. Adopting a dominant local vendor could increase per period profits from adoption by 9.2% over choosing a marginal vendor. A counterfactual analysis suggests that an incentive program rewarding coordination, not just adoption, is more effective in achieving interoperability, especially before the widespread adoption of the technology.
Cognitive Biases: Mistakes or Missing Stakes?
Authors: Enke Benjamin , Gneezy Uri , Hall Brian , Martin David , Nelidov Vadim , Offerman Theo , van de Ven Jeroen 
Published: August 2021

Abstract
Despite decades of research on heuristics and biases, evidence on the effect of large incentives on cognitive biases is scant. We test the effect of incentives on four widely documented biases: base-rate neglect, anchoring, failure of contingent thinking, and intuitive reasoning. In laboratory experiments with 1,236 college students in Nairobi, we implement three incentive levels: no incentives, standard lab payments, and very high incentives. We find that very high stakes increase response times by 40% but improve performance only very mildly or not at all. In none of the tasks do very high stakes come close to debiasing participants.
Occult Economies, Demonic Gifts, and Ontological Alterity: An Evangelical Biography of Evil and Redemption in Rural South Sudan
Authors: O’Byrne Ryan Joseph 
Published: August 2021

Abstract
This paper recounts the autobiography of an evangelical South Sudanese pastor who has been under water to the land of demons, telling of cosmic flows of persons, power, and wealth between times, places, and dimensions. Although it builds on stories circulating across Africa since colonial times and emphasises paradigms found throughout the occult economies literature, what is significant about this autobiography is that it relates the narrator’s own experience. This is important because although these occult elements reference global processes, the narrative given is as much about the local as it is the global. Likewise, it as much spiritual as it is material or economic. My analysis thus goes beyond the occult economy or its material effects and instead demonstrates the ontological alterity and spiritual meaningfulness of such incursions and attempts to push the envelope of academic analyses and interpretations relating to the diverse complexity of religious experience, African or otherwise.
Effects of Double Taxation Agreements between Tanzania and India on the Foreign Direct Investments
Authors: Haji Hatibu Haji Semboja 
Published: August 2021

Abstract
The paper analyzed policy effects of Double Taxation Agreements (DTA) between Tanzania and India. The study employed desk study and mini-field research survey purposely to obtain primary data and qualitative information from the Tanzania Revenue Authority (TRA), High Commission of India and Indian companies. The paper found that Tanzania has no comprehensive national taxation policy which incorporates DTAs. The current treaties do not protect the government revenue losses. The loopholes include the denial of taxing the gains made by investors selling assets. However, the contribution of Tanzania-India DTAs in Foreign Direct Investment, (FDIs) flow in Tanzania has been significant positive. Indian FDIs have positive effects on Tanzanian employment. Moreover, the investments from India have brought massive capital flows and new technologies into the country. Tanzania-India DTA is more potential for sustainable national development. The study recommends the need to review and formulate New National Investment Policy 2019 that effectively integrate into sustainable fiscal and sector policies. Tanzania has to review all DTAs with aim of minimizing government revenue losses and to renegotiate all existing DTAs adopting UN Model Tanzania. It has to rationalize favoured bilateral treaties to signal their commitments to stable, correct, and often favourable treatment of foreign investors. Tanzania has to implement the Goal #17 of Sustainable Development Goal as that of “Partnering for Development” as a strategy to strengthen the means of implementation and revitalize the global partnership for sustainable development.
High-Resolution Observations of a Destructive Macroburst
Authors: Childs Samuel J. , Schumacher Russ S. , Adams-Selin Rebecca D. 
Published: August 2021

AbstractShortly after 0600 UTC (midnight MDT) on 9 June 2020, a rapidly intensifying and elongating convective system produced a macroburst and extensive damage in the town of Akron on Colorado’s eastern Plains. Instantaneous winds were measured as high as 51.12 m s−1 at 2.3 m AGL from an eddy covariance (EC) tower, and a 50.45 m s−1 wind gust from an adjacent 10-m tower became the highest official thunderstorm wind gust ever measured in Colorado. Synoptic-scale storm motion was southerly, but surface winds were northerly in a post-frontal airmass, creating strong vertical wind shear. Extremely high-resolution temporal and spatial observations allow for a unique look at pressure and temperature tendencies accompanying the macroburst and reveal intriguing wave structures in the outflow. At 10-Hz frequency, the EC tower recorded a 5-hPa pressure surge in 19 seconds immediately following the strongest winds, and a 15-hPa pressure drop in the following three minutes. Surface temperature also rose 1.5°C in less than one minute, concurrent with the maximum wind gusts, and then fell sharply by 3.5°C in the following minute. Shifting wind direction observations and an NWS damage survey are suggestive of both radial outflow and a gust front passage, and model proximity soundings reveal a well-mixed surface layer topped by a strong inversion and large low-level vertical wind shear. Despite the greatest risk of severe winds forecast to be northeast of Colorado, convection-allowing model forecasts from 6-18 h in advance did show similar structures to what occurred, warranting further simulations to investigate the unique mesoscale and misoscale features associated with the macroburst.
Prognostic significance of subclassifying stage pT3a renal tumors with fat invasion: a retrospective study of 99 patients
Authors: Xu Xiangfei , Zhu Dongsheng 
Published: August 2021

Purpose To analyze the recurrence in patients with clinic stage T1 renal cell carcinoma (RCC) who were upstaged to stage T3a after partial nephrectomy (PN) using a new sub-classification criterion. Methods A retrospective study of pathological characteristics was performed in patients who were upstaged to pT3a on the basis of fat invasion (FI). Results After analyzing the pathological findings, we proposed the following new sub-classification criteria for pT3a RCC with FI: (1) renal tumor invades the pseudo-capsule and contacts the perinephric adipose tissue directly or the tumor protrudes into the perinephric adipose tissue like a tongue (Type A); and (2) tumor nodules are distributed in perinephric adipose tissues (Type B). A significant difference was observed in the recurrence rate between the two subtypes A and B. For Type B, the recurrence rate after radical nephrectomy (RN) and PN was 15.79% and 63.64%, respectively. The recurrence rates for Types A and B after PN were 11.11% and 63.64%, respectively. Conclusions T3a RCC with tumor nodules in perinephric adipose and/or an irregular tumor protruding into the adipose tissues lead to a higher recurrence rate. We recommend that T3a RCC be carefully analyzed and patients be treated on an individual basis.
Incidence of Heparin-Induced Thrombocytopenia in Patients With Newly Implanted Mechanical Circulatory Support Devices
Authors: To Long , Attar Dana , Lines Brittany , McCarty Melissa , Nemeh Hassan , Lopez-Plaza Ileana , Smith Zachary , Coba Victor , Lekura Jona 
Published: August 2021

Background: Heparin exposure and device-related thrombocytopenia complicate the diagnosis of heparin-induced thrombocytopenia (HIT) in patients receiving mechanical circulatory support (MCS). To improve anticoagulation management for patients with newly implanted MCS devices, incidence of confirmed HIT needs to be further characterized. Objectives: The purpose of this study is to describe the incidence of HIT and clinical utility of the 4Ts score in patients with newly implanted MCS devices. Methods: This is a retrospective analysis of MCS patients receiving unfractionated heparin from 2014 to 2017. The primary end point was incidence of laboratory-confirmed HIT. Strong positive, likely positive, low probability, and negative HIT categories were established based on heparin-induced platelet antibody (HIPA) and serotonin release assay (SRA). Secondary end points include characterization of platelet trends, argatroban use, incidence of HIT among each of the MCS devices, and utility of 4Ts score. Results: A total of 342 patient encounters met inclusion criteria, of which 68 HIPA tests and 25 SRAs were ordered. The incidence of HIT was 0.88% (3/342) and 4.4% (3/68) in patients with suspected HIT. Of the 68 HIPA tests, 3 (4.4%) were considered strong positive and 3 of the 25 SRAs were positive. Median 4Ts score was 4 [2.5-4] and optical density 0.19 [0.11-0.54]. The positive predictive value for the 4Ts score was 0.15 (CI = 0.03-0.46) and negative predictive value, 0.93 (CI = 0.82-0.98). Conclusion and Relevance: HIT occurs infrequently with newly implanted MCS devices. The 4Ts score appears to have a high negative predictive value for ruling out HIT.
Changes in ocular pulse amplitude and choroidal thickness in childhood obesity patients with and without insulin resistance
Authors: Aydemir Gözde Aksoy , Aydemir Emre , Asik Abdulvahit , Bolu Semih 
Published: August 2021

Purpose: To compare choroidal thickness (CT) and ocular pulse amplitude (OPA) in childhood obesity with insulin resistance (IR) and without IR. Methods: Seventy-three childhood obesity and 62 healthy children, who were both age-matched and gender-matched, comprised the study population in this prospective study. Obesity was determined as having a body mass index (BMI) – standard deviation (SD) score that was > 2 SD. Intraocular pressure (IOP) and OPA were measured using a dynamic contour tonometer. The CT measurements were performed using enhanced depth imaging optical coherence tomography at three locations, comprising at the fovea, at a position 500 µm nasal, and also at a position 500 µm temporal to the fovea. Results: Mean BMI value was 28.72 ± 4.85 in the patients with childhood obesity and 21.47 ± 1.14 in the control group. The mean IOP and OPA values were determined 15.90 ± 2.30 and 14.10 ± 2.16 mm Hg, 1.50 ± 0.28 and 1.74 ± 0.32 mm Hg in the patients with childhood obesity and the control group, respectively ( p < 0.001, p < 0.001). The mean subfoveal CT value was 350.50 ± 81.51 μm in the eyes with childhood obesity and 390.02 ± 71.50 μm in those of the control group ( p = 0.003). When the patient groups with and without IR were compared, no significant difference was found between CT, OPA and IOP values ( p > 0.005). Conclusions: Our results showed that both OPA and CT values were significantly decreased in childhood obesity patients. We suggest further studies to verify longitudinal changes in OPA and CT, as also the evaluation of these parameters in other populations.
Ocrelizumab treatment for relapsing-remitting multiple sclerosis after a suboptimal response to previous disease-modifying therapy: A nonrandomized controlled trial
Authors: Weinstock-Guttman Bianca , Bermel Robert , Cutter Gary , Freedman Mark S , Leist Thomas P , Ma Xiaoye , Kile Deidre , Musch Bruno , Reder Anthony T , Wolinsky Jerry S 
Published: August 2021

Background: Many patients with multiple sclerosis (MS) experience suboptimal disease control despite the use of disease-modifying therapy (DMT). Objective: To assess the efficacy and safety of ocrelizumab (OCR) in patients with relapsing-remitting MS (RRMS) and suboptimal response to prior DMTs. Methods: Patients with RRMS and suboptimal responses (one clinically reported relapse and/or lesion activity) after ⩾ 6 months on another DMT were enrolled. OCR 600 mg was given intravenously every 24 weeks. The primary outcome was no evidence of disease activity (NEDA), defined as the absence of protocol-defined relapse, confirmed disability progression (CDP), T1 Gd-enhancing lesions, and new/enlarging T2 lesions. Results: The intention-to-treat (ITT) population included 608 patients; NEDA was analyzed in a modified ITT (mITT) population ( n = 576 (94.7%)). Over 96 weeks, 48.1% of mITT patients achieved NEDA, and most were free from protocol-defined relapse (89.6%), CDP (89.6%), and T1 Gd-enhancing lesions (95.5%); 59.5% had no new/enlarging T2 lesions. Safety observations were consistent with findings in the pivotal trials. Conclusion: Consistent efficacy of OCR on clinical and magnetic resonance imaging (MRI) disease activity measures and progression was shown in patients with RRMS and a suboptimal response to prior DMTs; no new safety signals were observed.
Isolated giant true intercostal artery aneurysm with arteriovenous fistula: A case report
Authors: Honma Kenichi , Yamaoka Terutoshi , Matsuda Daisuke 
Published: August 2021

Objectives Intercostal artery aneurysm (IAA) is a very rare condition. Interestingly, only one study reported a case of intercostal aneurysm caused by an arteriovenous fistula (AVF). Here, we report the case of a patient with non-ruptured isolated giant true IAA caused by an AVF (size, 28 × 41 mm). Methods Treatment options for IAA include open surgery and endovascular treatment (EVT). We chose EVT, as it is minimally invasive. The right 11th intercostal artery and aneurysm diverged from the aorta. Two outflow arteries, one inflow artery, and an AVF from the aneurysm were confirmed, and coil embolization was performed. The artery of Adamkiewicz did not communicate with the right 11th intercostal artery. We performed angiography and confirmed occlusion of IAA with endoleak. Results There were no clinical findings indicative of spinal cord infarction after treatment. The patient did not develop complications and was discharged the day after treatment. Endoleak was not observed on computed tomography angiography findings at 1 month after treatment. Conclusions In our patient, an AVF might have caused IAA. Endovascular treatment for non-ruptured isolated giant IAA is a safe and minimally-invasive treatment. We found that performing EVT is beneficial when the size of the IAA exceeds 30 mm.
Randomised controlled trial of a prognostic assessment and management pathway to reduce the length of hospital stay in normotensive patients with acute pulmonary embolism
Authors: Jiménez David , Rodríguez Carmen , León Francisco , Jara-Palomares Luis , López-Reyes Raquel , Ruiz-Artacho Pedro , Elías Teresa , Otero Remedios , García-Ortega Alberto , Rivas-Guerrero Agustina , Abelaira Jaime , Jiménez Sonia , Muriel Alfonso , Morillo Raquel , Barrios Deisy , Le Mao Raphael , Yusen Roger D. , Bikdeli Behnood , Monreal Manuel , Lobo José Luis 
Published: August 2021

BackgroundThe length of hospital stay (LOS) for acute pulmonary embolism (PE) varies considerably. Whether the upfront use of a PE prognostic assessment and management pathway is effective in reducing the LOS remains unknown.MethodsWe conducted a randomised controlled trial of adults hospitalised for acute PE: patients were assigned either to a prognostic assessment and management pathway involving risk stratification followed by predefined criteria for mobilisation and discharge (intervention group) or to usual care (control group). The primary end-point was LOS. The secondary end-points were the cost of prognostic tests and of hospitalisation, and 30-day clinical outcomes.ResultsOf 500 patients who underwent randomisation, 498 were included in the modified intention-to-treat analysis. The median LOS was 4.0 days (interquartile range (IQR) 3.7–4.2 days) in the intervention group and 6.1 days (IQR 5.7–6.5 days) in the control group (p<0.001). The mean total cost of prognostic tests was EUR 174.76 in the intervention group, compared with EUR 233.12 in the control group (mean difference EUR −58.37, 95% CI EUR −84.34­ to −32.40). The mean total hospitalisation cost per patient was EUR 2085.66 in the intervention group, compared with EUR 3232.97 in the control group (mean difference EUR −1147.31, 95% CI EUR −1414.97­ to −879.65). No significant differences were observed in 30-day readmission (4.0%versus4.8%), all-cause mortality (2.4%versus2.0%) or PE-related mortality (0.8%versus1.2%) rates.ConclusionsThe use of a prognostic assessment and management pathway was effective in reducing the LOS for acute PE.
Lrig1expression identifies airway basal cells with high proliferative capacity and restricts lung squamous cell carcinoma growth
Authors: Succony Laura , Gómez-López Sandra , Pennycuick Adam , Alhendi Ahmed S.N. , Davies Derek , Clarke Sarah E. , Gowers Kate H.C. , Wright Nicholas A. , Jensen Kim B. , Janes Sam M. 
Published: August 2021

BackgroundLung squamous cell carcinoma (LUSC) accounts for a significant proportion of cancer deaths worldwide, and is preceded by the appearance of progressively disorganised pre-invasive lesions in the airway epithelium. Yet the biological mechanisms underlying progression of pre-invasive lesions into invasive LUSC are not fully understood.LRIG1(leucine-rich repeats and immunoglobulin-like domains 1) is downregulated in pre-invasive airway lesions and invasive LUSC tumours and this correlates with decreased lung cancer patient survival.Methods and resultsUsing anLrig1knock-in reporter mouse and human airway epithelial cells collected at bronchoscopy, we show that during homeostasis LRIG1 is heterogeneously expressed in the airway epithelium. In basal airway epithelial cells, the suspected cell of origin of LUSC, LRIG1 identifies a subpopulation of progenitor cells with higherin vitroproliferative and self-renewal potential in both the mouse and human. Using the N-nitroso-tris-chloroethylurea (NTCU)-induced murine model of LUSC, we find thatLrig1loss-of-function leads to abnormally high cell proliferation during the earliest stages of pre-invasive disease and to the formation of significantly larger invasive tumours, suggesting accelerated disease progression.ConclusionTogether, our findings identify LRIG1 as a marker of basal airway progenitor cells with high proliferative potential and as a regulator of pre-invasive lung cancer progression. This work highlights the clinical relevance of LRIG1 and the potential of the NTCU-induced LUSC model for functional assessment of candidate tumour suppressors and oncogenes.
The AWESCORE, a patient-reported outcome measure: development, feasibility, reliability, validity and responsiveness for adults with cystic fibrosis
Authors: Button Brenda M. , Wilson Lisa M. , Burge Angela T. , Kimmel Lara , Finlayson Felicity , Williams Elyssa , Talbot Anthony , Tierney Audrey , King Susannah , Holland Anne E. , Keating Dominic , Kotsimbos Tom , Wilson John W. 
Published: August 2021

BackgroundQuality of life has improved dramatically over the past two decades in people with cystic fibrosis (CF). Quantification has been enabled by patient-reported outcome measures (PROMs); however, many are lengthy and can be challenging to use in routine clinical practice. We propose a short-form PROM that correlates well with established quality-of-life measures.MethodsWe evaluated the utility of a 10-item score (AWESCORE) by measuring reliability, validity and responsiveness in adults with CF. The questions were developed by thematic analysis of survey questions to patients in a single adult CF centre. Each question was scored using a numerical rating scale 0 to 10. Total scores ranged from 0 to 100. Test–retest reliability was assessed over 24 h. To determine validity, comparisons were sought between stable subjects and those in pulmonary exacerbation, and between AWESCORE and Cystic Fibrosis Questionnaire – Revised (CFQ-R). Responsiveness to pulmonary exacerbation in individual subjects was evaluated.ResultsFive domains, each with two questions, were identified for respiratory, physical, nutritional, psychological and general health. A total of 246 consecutive adults attending the outpatient clinic completed the AWESCORE. Scores were higher during clinical stability compared to pulmonary exacerbation (mean±sd):73±11versus48±11 (p<0.001). Each domain scored worse during an acute exacerbation (p<0.001). No differences in reliability were observed in scores on retesting using Bland–Altman comparison. The CFQ-R scores (mean±sd: 813±125) and AWESCORE (81±13) were moderately correlated (Pearson's r=0.649; p=0.002).ConclusionsThe AWESCORE is valid, reliable and responsive to altered health status in CF.
Prothrombotic state in patients with stable COPD: an observational study
Authors: Kyriakopoulos Christos , Chronis Christos , Papapetrou Evaggelia , Tatsioni Athina , Gartzonika Konstantina , Tsaousi Christina , Gogali Athena , Katsanos Christos , Vaggeli Aikaterini , Tselepi Charikleia , Daskalopoulos Georgios , Konstantopoulos Stavros , Kostikas Konstantinos , Konstantinidis Athanasios 
Published: August 2021

BackgroundCOPD patients have an increased risk of cardiovascular disease and venous thromboembolism.MethodsThis study aimed to investigate whether patients with stable COPD have a prothrombotic state compared to COPD-free smokers. We conducted an observational study comparing levels of: D-dimers, INR, aPTT, coagulation factors; fibrinogen, FII, FV, FVII, FVIII, FIX, FX and coagulation inhibitors; protein S, proteins C and antithrombin between stable COPD patients and control subjects.ResultsA total of 103 COPD patients and 42 controls with similar age, sex, current smoking status, comorbidity burden and cardiovascular risk met the inclusion criteria. Compared to controls, COPD patients had higher levels of D-dimers (median (interquartile range): 360 (230–600) ng·mL−1versus240 (180–400) ng·mL−1, p=0.001), fibrinogen (mean±sd: 399±82 mg·dL−1versus346±65 mg·dL−1, p<0.001), FII (122±22%versus109±19%, p=0.004), FV (131±25%versus121±19%, p=0.015), FVIII (143±32%versus122±20%, p<0.001) and FX (111 (94–134)%versus98 (88–107)%, p=0.002), and lower levels of protein S (95 (85–105)%versus116 (98–121)%, p<0.001) and antithrombin (94.4±11.5%versus102.3±13.2%, p=0.001). In the COPD group, patients with more severe airflow limitation and frequent exacerbations had significantly higher levels of FII, FV and FX, whereas patients with higher COPD assessment test score had significantly higher levels of FX and lower levels of protein S.ConclusionPatients with stable COPD exhibited increased levels of key coagulation factors and decreased levels of coagulation inhibitors, namely protein S and antithrombin, compared to COPD-free smokers. Among COPD patients, increased levels of FII, FV and FX and decreased levels of protein S were found in patients with more severe disease.