bluuebunny/crossref_metadata_2025_split huggingface dataset:
Miocene Climate and Habitat Change Drove Diversification inBicyclus, Africa’s Largest Radiation of Satyrine Butterflies
Authors: Aduse-Poku Kwaku , van Bergen Erik , Sáfián Szabolcs , Collins Steve C , Etienne Rampal S , Herrera-Alsina Leonel , Brakefield Paul M , Brattström Oskar , Lohman david J , Wahlberg Niklas 
Published: August 2021

AbstractCompared to other regions, the drivers of diversification in Africa are poorly understood. We studied a radiation of insects with over 100 species occurring in a wide range of habitats across the Afrotropics to investigate the fundamental evolutionary processes and geological events that generate and maintain patterns of species richness on the continent. By investigating the evolutionary history of Bicyclus butterflies within a phylogenetic framework, we inferred the group’s origin at the Oligo-Miocene boundary from ancestors in the Congolian rainforests of central Africa. Abrupt climatic fluctuations during the Miocene (ca. 19–17 Ma) likely fragmented ancestral populations, resulting in at least eight early-divergent lineages. Only one of these lineages appears to have diversified during the drastic climate and biome changes of the early Miocene, radiating into the largest group of extant species. The other seven lineages diversified in forest ecosystems during the late Miocene and Pleistocene when climatic conditions were more favorable—warmer and wetter. Our results suggest changing Neogene climate, uplift of eastern African orogens, and biotic interactions have had different effects on the various subclades of Bicyclus, producing one of the most spectacular butterfly radiations in Africa. [Afrotropics; biodiversity; biome; biotic interactions; Court Jester; extinction; grasslands; paleoclimates; Red Queen; refugia forests; dependent-diversification; speciation.]
A qualitative study on retailer experiences with Philadelphia’s sweetened beverage tax
Authors: Hua Sophia V , Uzwiak Beth , Hudgins Anastasia , Peterhans Ana , Lawman Hannah G , Bleich Sara N , Falbe Jennifer , Roberto Christina A 
Published: August 2021

Abstract
The Philadelphia Beverage Tax was implemented on January 1, 2017 for some sugar- and artificially-sweetened beverages. Few qualitative studies have assessed retailers’ reactions to beverage taxes. We aimed to understand food retailers’ knowledge and attitudes about the Philadelphia beverage tax and how they responded to it with the goal of informing the framing and implementation of beverage taxes in other interested jurisdictions. Researchers conducted semi-structured interviews with retailers within Philadelphia before (n = 15) and after (n = 11) the Philadelphia Beverage Tax was implemented. Purposeful sampling was used to recruit participants with different store locations and customer base characteristics. A priori codes based on the interview guide were used to organize data, and analytic memos were developed and reviewed to identify themes that emerged within the data using a grounded theory approach. Five themes emerged: (a) concerns about the tax purpose, amount, and use of revenue; (b) concerns about the tax’s impact on finances and business operations; (c) business strategies implemented to lessen financial burden of the tax; (d) perceptions of customer responses to the tax based on income; and (e) confusion around tax implementation. Results highlighted ways to improve implementation. Retailers in Philadelphia implemented various strategies to offset negative effects on taxed beverage sales. Cities implementing a beverage tax would benefit from investment in educational outreach and support to business owners prior to tax implementation and ensure transparency in how tax revenue will be spent.
Using Individual Residents’ Learning Trajectories to Better Understand the Impact of Gaps in Practice
Authors: Scott Stephanie A. , Van Eyk Nancy , Eva Kevin 
Published: August 2021

Purpose
To optimize learning, health professional training programs need to achieve the right balance between depth of practice (gaining more experience with particular skills) and breadth of practice (spreading experience across an array of activities). Better understanding how training for a particular skill set is impacted by periods of focus on a different skill set would allow improved curriculum and assessment design, thereby enhancing the efficiency of training and effectiveness of care. To this end, learning curves were used to compare performance in surgery after prolonged periods of practice to performance after gaps in surgical training.

Method
Daily operative assessments from the Dalhousie obstetrics and gynecology program were analyzed retrospectively and learning curves were generated. In addition to examining the variability in learning trajectories, the impact of gaps was systematically assessed by comparing resident scores after 2 successive months in which they were not assessed operatively to those collected after 2 successive months in which they were assessed at least once.

Results
Four thousand four hundred sixteen scores for 33 residents over a 10-year period were analyzed. Trajectories and peak performances were identified. Residents performed better during their third sequential month of being assessed (mean = 4.40, 95% CI = 4.33–4.46) relative to during months following a period of being away from the operating room for at least 2 months (mean = 4.21, 95% CI = 4.13–4.29; P < .01; d = 0.7). However, maximum performance achieved was more strongly related to the number of times residents experienced a gap in training (r = 0.50) than to the number of times residents experienced 3 consecutive months of training (r = 0.25).

Conclusions
Distinct patterns of development exist for individual residents. Time away from surgical practice and assessment negatively impacted short-term performance, but may improve long-term learning trajectories. This speaks to the value of spaced education and is important for the design of longitudinal skills-based training programs.
The Cognitive Load of Inpatient Consults: A Convergent Parallel Mixed Methods Study Using the Consult Cognitive Load Instrument
Authors: Brondfield Sam , Lee Kewchang , O’Sullivan Patricia S. 
Published: August 2021

Purpose
Consultation is crucial for patient care and a primary responsibility of fellows. Understanding the cognitive load associated with the complex skill of consultation would enhance fellow learning. The authors aimed to determine themes describing the fellow experience during inpatient consults specifically, align these themes with Consult Cognitive Load (CCL) scores, and identify strategies to manage cognitive load to enhance fellow education and performance, and, consequently, patient care.

Method
The authors studied 16 fellows using mixed methods. Fellows who accepted an invitation completed an inpatient consult followed by the CCL, a measure of cognitive load during consults, and an interview. Three authors conducted a thematic analysis. Member checks and triangulation supported theme trustworthiness. Subsequently, 3 authors rated the extent and cognitive demand of each theme expressed in each transcript. The authors measured interrater reliability and used Spearman correlation to describe the association of these ratings with CCL scores. The authors examined themes to identify strategies that educators might use.

Results
Analysis revealed 4 themes: “nature and scope,” which conceptually aligned with intrinsic load (IL); “leveraging resources,” which had elements of both IL and extraneous load (EL); “extraneous factors,” which aligned with EL; and “drivers,” which aligned with germane load (GL). Interrater reliability for extent and demand ratings ranged from 0.57 to 0.79. The correlation between “nature and scope” and IL was 0.37, “extraneous factors” and EL 0.71, and “drivers” and GL 0.32. “Leveraging resources” did not correlate with IL (0.06) or EL (−0.09). Potential strategies based on themes included offering level-appropriate assistance to match IL, focusing the fellow’s attention to reduce EL, and providing succinct teaching to promote GL.

Conclusions
This study provided deep insight into the fellow consult experience and suggested strategies for educators to guide consult learning. The theme “leveraging resources” merits further exploration.
How Teachers Adapt Their Cognitive Strategies When Using Entrustment Scales
Authors: Forte Milena , Morson Natalie , Mirchandani Natasha , Grundland Batya , Fernando Oshan , Rubenstein Warren 
Published: August 2021

Purpose
Rater cognition is a field of study focused on individual cognitive processes used by medical teachers when completing assessments. Much has been written about the role of rater cognition in the use of traditional assessment scales. Entrustment scales (ES) are becoming the tool of choice for workplace-based assessments. It is not known how moving to an entrustment framework may cause teachers to adapt their cognitive rating strategies. This study aimed to explore this gap by asking teachers to describe their thinking when making rating decisions using a validated ES.

Method
Using purposive sampling, family medicine teachers supervising obstetrical care were invited to participate in cognitive interviews. Teachers were interviewed between December 2018 and March 2019 using retrospective verbal protocol analysis. They were asked to describe their experiences of rating residents in the last 6 months using new ES. Constructivist grounded theory guided data collection and analysis. Interviews were recorded, transcribed, and analyzed iteratively. A constant comparative approach was used to code and analyze the data until consensus was reached regarding emerging themes.

Results
There was variability in how teachers used the ES. Faculty describe several ways in which they ultimately navigated the tool to say what they wanted to say. Four key themes emerged: (1) teachers interpreted the anchors differently based on their cognitive framework, (2) teachers differed in how they were able to cognitively shift away from traditional rating scales, (3) teachers struggled to limit assessments to a report on observed behavior, and (4) teachers contextualized their ratings.

Conclusions
Variability in teachers’ interpretation of learner performance persists in entrustment frameworks. Rater’s individual cognitive strategies and how they observe, process, and integrate their thoughts into assessments form part of a rich picture of learner progress. These insights can be harnessed to contribute to decisions regarding readiness for unsupervised practice.
Artificial Intelligence in Undergraduate Medical Education: A Scoping Review
Authors: Lee Juehea , Wu Annie Siyu , Li David , Kulasegaram Kulamakan (Mahan) 
Published: August 2021

Purpose
Artificial intelligence (AI) is a rapidly growing phenomenon poised to instigate large-scale changes in medicine. However, medical education has not kept pace with the rapid advancements of AI. Despite several calls to action, the adoption of teaching on AI in undergraduate medical education (UME) has been limited. This scoping review aims to identify gaps and key themes in the peer-reviewed literature on AI training in UME.

Method
The scoping review was informed by Arksey and O’Malley’s methodology. Seven electronic databases including MEDLINE and EMBASE were searched for articles discussing the inclusion of AI in UME between January 2000 and July 2020. A total of 4,299 articles were independently screened by 3 co-investigators and 22 full-text articles were included. Data were extracted using a standardized checklist. Themes were identified using iterative thematic analysis.

Results
The literature addressed: (1) a need for an AI curriculum in UME, (2) recommendations for AI curricular content including machine learning literacy and AI ethics, (3) suggestions for curriculum delivery, (4) an emphasis on cultivating “uniquely human skills” such as empathy in response to AI-driven changes, and (5) challenges with introducing an AI curriculum in UME. However, there was considerable heterogeneity and poor consensus across studies regarding AI curricular content and delivery.

Conclusions
Despite the large volume of literature, there is little consensus on what and how to teach AI in UME. Further research is needed to address these discrepancies and create a standardized framework of competencies that can facilitate greater adoption and implementation of a standardized AI curriculum in UME.
Training for Professional Uncertainty: Socialization of Medical Students Through the Residency Application Process
Authors: Russel Sarah M. , Geraghty Joseph R. , Renaldy Hilary , Thompson Trevonne M. , Hirshfield Laura E. 
Published: August 2021

Purpose
Uncertainty in medical decision making is a well-described phenomenon, and numerous scholars have acknowledged and illustrated the process of training medical students to grapple with this aspect of medical practice. While clinical uncertainty has been defined previously, medical trainees face additional forms of uncertainty beyond the clinical setting that have not, as yet, been investigated empirically. One area in which uncertainty can manifest outside of the clinical setting is during professional development. Medical students face substantial stress and ambiguity throughout their training, with the residency application period representing a culmination of these pressures. Here, the authors examined medical students’ experiences during the residency application period and used these findings to define training for professional uncertainty.

Method
In 2018–2019, 6 focus groups of fourth-year medical students were conducted exploring students’ experiences during the residency application period, including but not limited to Step 2 Clinical Knowledge, away rotations, and securing letters of recommendation. The authors then used constructivist, phenomenological methods to analyze participant responses.

Results
Students frequently discussed challenges they faced during the residency application period. From these conversations, 2 themes were identified: (1) professional uncertainty related to career-based advice, which resulted from mixed messaging and inadequate information, and (2) professional uncertainty related to competing responsibilities, which students experienced when determining how to allocate a limited amount of time to multiple conflicting forces.

Conclusions
These results were used to define a novel concept—training for professional uncertainty. By navigating the residency application process, students learned to face various facets of professional uncertainty that they will continue to face throughout their careers. Since uncertainty can have many negative effects, including declining performance and burnout, defining professional uncertainty and training students to grapple with it is necessary to maximize their success throughout their careers.
Postinjury Sepsis—Associations With Risk Factors, Impact on Clinical Course, and Mortality: A Retrospective Observational Study
Authors: Eriksson Jesper , Lindström Ann-Charlotte , Hellgren Elisabeth , Friman Ola , Larsson Emma , Eriksson Mikael , Oldner Anders 
Published: August 2021

OBJECTIVES:
Overall outcomes for trauma patients have improved over time. However, mortality for postinjury sepsis has been reported to be unchanged. Estimate incidence of and risk factors for sepsis in ICU patients after major trauma and the association between sepsis, mortality, and clinical course.

DESIGN, SETTING, AND PATIENTS:
ICU in a large urban trauma center in Sweden with a well-developed trauma system. Retrospective cohort study of trauma patients admitted to the ICU for more than 24 hours were included.

MEASUREMENTS AND MAIN RESULTS:
Primary outcome measure was 30-day mortality. Secondary outcomes were 1-year mortality and impact on clinical course. In total, 722 patients with a median Injury Severity Score of 26 (interquartile range, 18–38) were included. Incidence of sepsis was 22%. Septic patients had a four-fold increase in length of stay and need for organ supportive therapy. The overall 30-day mortality rate was 9.3%. After exclusion of early trauma-related deaths in the first 48 hours, the 30-day mortality rate was 6.7%. There was an association between sepsis and this adjusted 30-day mortality (day 3 odds ratio, 2.1 [95% CI, 1.1–3.9]; day 4 odds ratio, 3.1 [95% CI, 1.5–6.1]; day 5 odds ratio, 3.0 [95% CI, 1.4–6.2]). Septic patients had a 1-year mortality of 17.7% (nonseptic 11.0%). Development of sepsis was independently associated with age, spine and chest injury, shock, red cell transfusion, and positive blood alcohol concentration at admission. The risk of sepsis increased, in a dose-dependent manner, with the number of transfusions.

CONCLUSIONS:
Postinjury sepsis was associated with a complicated clinical course and with mortality after exclusion of early, trauma-related deaths.
Coronavirus disease 2019 vaccines: landscape of global studies and potential risks
Authors: Jiang Hu-Da-Chuan , Tao Yan-Yang , Jia Si-Yue , Li Jing-Xin , Zhu Feng-Cai 
Published: August 2021

Abstract
With the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, the importance of vaccines in epidemic prevention and public health has become even more obvious than ever. However, the emergence of multiple severe acute respiratory syndrome coronavirus 2 variants worldwide has raised concerns about the effectiveness of current COVID-19 vaccines. Here, we review the characteristics of COVID-19 vaccine candidates in five platforms and the latest clinical trial results of them. In addition, we further discuss future directions for the research and development of the next generation of COVID-19 vaccines. We also summarize the serious adverse events reported recently after the large-scale vaccination with the current COVID-19 vaccines, including the thromboembolism caused by the AstraZeneca and Johnson & Johnson vaccines.
Sepsis Hospitalizations With Versus Without Cancer
Authors: Sharma Aditi , Nguyen Paul , Taha Muhanad , Soubani Ayman O. 
Published: August 2021

Background:
Sepsis and cancer continue to be one of the leading causes of death in the United States. Concomitantly, hospitalizations for sepsis with underlying cancer over the years have shown a decrease in mortality. However, large-scale contemporary data on mortality trends in sepsis hospitalizations with underlying malignancy are lacking.

Research Question:
Are there any identifiable trends in patients hospitalized for sepsis with underlying malignancy versus without malignancy?

Study Design and Methods:
We performed a retrospective cohort study using the National Inpatient Sample database from 2008 to 2017 to identify sepsis hospitalizations with versus without cancer. Baseline variables and mortality trends were compared between the 2 groups.

Results:
Of the 19,160,734 sepsis hospitalizations identified between 2008 and 2017, 3,913,813 (20.4%) were associated with cancer and 15,246,921 (79.6%) did not have underlying malignancy. Compared with 2008 to 2009, the multivariable-adjusted odds ratio (aOR) of death was lower in 2016 to 2017 for both cancer (aOR: 0.55, 95% confidence interval [CI]: 0.53-0.57) and noncancer-associated (aOR: 0.55, 95% CI: 0.53-0.57) sepsis hospitalizations. The nonsignificant interaction term (P=0.2239) revealed that the rate of decline in mortality did not differ between the 2 groups. Stratification of the mortality in sepsis hospitalizations by various age groups revealed that the odds of death associated with cancer were highest in the younger population (18 to 44 y) with an aOR: 3.40, 95% CI: 3.24-3.57. The aOR: showed a declining trend with increasing age until cancer-associated admissions had slightly lower odds of mortality than the noncancer group at age 85 years old and older (aOR: 0.93, 95% CI: 0.91-0.95).

Conclusion:
In the 10-year study period, mortality in cancer and noncancer-associated sepsis hospitalizations has shown a declining trend. Furthermore, differences in mortality between the 2 groups decreased with increasing age.
Patient Outcomes After Applied Behavior Analysis for Autism Spectrum Disorder
Authors: Choi Kristen R. , Bhakta Bhumi , Knight Elizabeth A. , Becerra-Culqui Tracy A. , Gahre Teri L. , Zima Bonnie , Coleman Karen J. 
Published: August 2021

Abstract:

Objectives:
The purpose of this study was to examine patterns of service receipt and patient outcomes for children receiving applied behavior analysis (ABA) for autism spectrum disorder (ASD) in an integrated health care system in which commercially insured children were covered by a state autism mandate.

Methods:
This retrospective, observational study used a random sample of children with ASD (3–17 yrs) who were members of a large integrated health care system in Southern California and referred for ABA between January 2016 and November 2018. From the 4145 children referred, a random stratified sample of 334 was selected to extract data from clinical reports over 24 months of services. The primary outcome measures were time in ABA and child adaptive behavior.

Results:
Thirteen percent of the sample never received ABA after referral. Of those who were referred for ABA, 66% initiated ABA and remained in services for 12 months, whereas less than half (46%) remained in services for 24 months. Having a history of special education was associated with longer time spent in ABA, whereas having a single parent was associated with discontinuation of ABA. A minority of children received a full ABA dose (28%), but the lowest functioning children still experienced clinically significant adaptive behavior gains after 24 months of ABA (p = 0.02).

Conclusion:
In a health system implementation of ABA for children with ASD, there were high rates of ABA discontinuation and low ABA dosing. These challenges may diminish the potential benefits of ABA, even in a context in which there is mandated commercial insurance coverage.
Comparing Water Absorption of Food and Drug Administration–Approved Hyaluronic Acid Fillers
Authors: Woodward Julie , Ranjit-Reeves Roshni , Katz David F. , Bernardini Francesco P. , Fagien Steven 
Published: August 2021

BACKGROUND
To compare the water absorption of 12 FDA-approved hyaluronic acid (HA) facial fillers in vitro in conditions relevant to in vivo injection.

OBJECTIVE
The goal of this study was to provide long-term insight into an improved, tailored facial rejuvenation approach and to understand sequelae that could affect preoperative surgical planning.

METHODS
In 2 experiments, 12 FDA-approved HA fillers were loaded into test tubes with nonpreserved normal saline and then placed in a 94.5°F–96°F environment for 1 month to allow water absorption by passive diffusion. The test tubes were centrifuged so that the hydrated filler could pass to the bottom of the tube. The tubes were centrifuged for 12 minutes at 1,200 revolutions per minute in the first experiment and for 7 minutes in the second experiment. A blue dye was then instilled to demarcate the filler/saline interface.

RESULTS
There was variation in the water absorption of different HAs. Low absorption occurred in non–animal-stabilized hyaluronic acid.

CONCLUSION
The pattern of water absorption was similar in the 2 experiments. The results inform us about in vivo conditions and provide guidance for filler selection.