bluuebunny/crossref_metadata_2025_split huggingface dataset:
Debiasing Causal Inferences: Over and Beyond Suboptimal Sampling
Authors: Rodríguez-Ferreiro Javier , Vadillo Miguel A. , Barberia Itxaso 
Published: October 2021

Background We have previously presented two educational interventions aimed to diminish causal illusions and promote critical thinking. In both cases, these interventions reduced causal illusions developed in response to active contingency learning tasks, in which participants were able to decide whether to introduce the potential cause in each of the learning trials. The reduction of causal judgments appeared to be influenced by differences in the frequency with which the participants decided to apply the potential cause, hence indicating that the intervention affected their information sampling strategies. Objective In the present study, we investigated whether one of these interventions also reduces causal illusions when covariation information is acquired passively. Method Forty-one psychology undergraduates received our debiasing intervention, while 31 students were assigned to a control condition. All participants completed a passive contingency learning task. Results We found weaker causal illusions in students that participated in the debiasing intervention, compared to the control group. Conclusion The intervention affects not only the way the participants look for new evidence, but also the way they interpret given information. Teaching implications Our data extending previous results regarding evidence-based educational interventions aimed to promote critical thinking to situations in which we act as mere observers.
Massive Cervical Lymphadenopathy Post-COVID-19 Vaccination
Authors: Ganga Kiran , Solyar Alla Y , Ganga Roopa 
Published: October 2021

The coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2. Rapid spread with rampant growth of cases and deaths brought forth an urgent need for novel therapies including vaccinations. The mRNA vaccines for COVID-19 disease have been implemented at an unprecedented scale in an effort to combat the unrelenting pandemic. Such a massive scale vaccination program is bound to coincide with adverse events related to treatment. We present a case of massive cervical lymphadenopathy in a 58-year-old male patient post-Moderna COVID-19 vaccination. Additional investigations did not identify malignancy and he was diagnosed with vaccine-related lymphadenopathy. Patient significantly improved with corticosteroid treatment within 2 days of admission. Lymphadenopathy is reported as the second most common local reaction to the Moderna vaccine. Promoting knowledge of this side effect, particularly in the setting widespread vaccination efforts, would allow for better management of cases, especially in relation to oncologic patients.
Psychological and Social Factors Associated with Coexisting Frailty and Cognitive Impairment: A Systematic Review
Authors: Ellwood Alison , Quinn Catherine , Mountain Gail 
Published: October 2021

Those living with coexistent frailty and cognitive impairment are at risk of poorer health outcomes. Research often focuses on identifying biological factors. This review sought to identify the association psychological and social factors have with coexisting physical and cognitive decline. Six databases were systematically searched in July 2020. Studies included individuals aged 60 years or older identified as being both frail and cognitively impaired. A narrative synthesis examined patterns within the data. Nine studies were included, most employed a cross-sectional design. Depression was investigated by all nine studies, those with coexistent frailty and cognitive impairment had higher levels of depressive symptoms than peers. Findings were mixed on social factors, although broadly indicate lower education, living alone and lower material wealth were more frequent in those living with coexistent decline. Further research is needed to explore potentially modifiable psychological and social factors which could lead to the development of supportive interventions.
Recalibration Methods for Improved Clinical Utility of Risk Scores
Authors: Mishra Anu , McClelland Robyn L. , Inoue Lurdes Y. T. , Kerr Kathleen F. 
Published: October 2021

Background An established risk model may demonstrate miscalibration, meaning predicted risks do not accurately capture event rates. In some instances, investigators can identify and address the cause of miscalibration. In other circumstances, it may be appropriate to recalibrate the risk model. Existing recalibration methods do not account for settings in which the risk score will be used for risk-based clinical decision making. Methods We propose 2 new methods for risk model recalibration when the intended purpose of the risk model is to prescribe an intervention to high-risk individuals. Our measure of risk model clinical utility is standardized net benefit. The first method is a weighted strategy that prioritizes good calibration at or around the critical risk threshold. The second method uses constrained optimization to produce a recalibrated risk model with maximum possible net benefit, thereby prioritizing good calibration around the critical risk threshold. We also propose a graphical tool for assessing the potential for recalibration to improve the net benefit of a risk model. We illustrate these methods by recalibrating the American College of Cardiology (ACC)–American Heart Association (AHA) atherosclerotic cardiovascular disease (ASCVD) risk score within the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Results New methods are implemented in the R package ClinicalUtilityRecal. Recalibrating the ACC-AHA-ASCVD risk score for a MESA subcohort results in higher estimated net benefit using the proposed methods compared with existing methods, with improved calibration in the most clinically impactful regions of risk. Conclusion The proposed methods target good calibration for critical risks and can improve the net benefit of a risk model. We recommend constrained optimization when the risk model net benefit is paramount. The weighted approach can be considered when good calibration over an interval of risks is important.
Antihypertensive Medications Prior to Shock Onset Do Not Impact Initial Vasopressor Requirements in Patients With Shock
Authors: Patel Jaimini S. , Colon Hidalgo Daniel , Capistrano Irene , Mancl Erin , Rech Megan A. 
Published: October 2021

Purpose: The effect of the use of antihypertensive agents in patients prior to the development of shock is unclear. The purpose of this study was to determine the impact of antihypertensive agents on vasopressor dose and duration in shock. Materials and Methods: This retrospective, single-center study included patients with shock who received at least one vasopressor for at least 24 hours after shock onset from January 1 to June 30, 2017. Patients taking an antihypertensive agent(s) were compared to those who were not. The primary outcome was the number of vasopressor-free hours at 72 hours. Secondary outcomes included maximum and cumulative vasopressor doses, intensive care unit length of stay, and 30-day mortality. Results: One hundred and sixty-eight patients were included and 99 (59%) were on antihypertensives. Distributive shock was the most common type of shock (75.5%) and more patients taking antihypertensives had hypertension, coronary artery disease, and dyslipidemia at baseline. There was no difference in the number of vasopressor-free hours at 72 hours between patients taking an antihypertensive medication(s) and the control group (2 hours vs 1 hour; P = .11). No difference was found between any of the secondary outcomes. Conclusion: Patients taking antihypertensive agents prior to shock onset did not require increased vasopressor doses or duration.
Hybrid control of piezoelectric flexible manipulator based on Volterra filtered-xLMS algorithm
Authors: Pu Yuxue , Li Xiaobao , Zhang Fang 
Published: October 2021

To suppress the nonlinear vibration of the flexible manipulator during motion, this article presents a hybrid control strategy based on a servo motor and a piezoelectric actuator. The dynamic model of the piezoelectric flexible manipulator is established first. To realize the trajectory tracking, a proportional derivative control method is used to schedule the control torque. Because the Volterra filter can approximate the nonlinear system model, a Volterra filtered-xLMS algorithm based on a second-order Volterra filter structure is proposed, by which the active nonlinear vibration control of flexible link is realized. Simulation results show that the proposed Volterra filtered-xLMS algorithm can not only make use of the advantages of the classical filtered-xLMS algorithm but also solve the problem of effective modeling of nonlinear secondary path. The proposed hybrid control strategy based on Volterra filtered-xLMS algorithm and proportional derivative control algorithm can improve the position accuracy of joint and effectively suppress the vibration response of the nonlinear flexible link. A piezoelectric flexible manipulator with PZT (lead zirconate titanate) sensor and actuator is designed to demonstrate the validity and efficiency of the proposed method by experiments. Experiment results demonstrate that the attenuation time of vibration response is reduced from 5 s to 1.5 s, the vibration response at the first-order frequency is reduced by 60%, and the proposed methodology has an important advantage in application of active vibration control of piezoelectric flexible manipulator.
PLAG1 Immunohistochemical Staining Is a Surrogate Marker for PLAG1 Fusions in Lipoblastomas
Authors: Warren Mikako , Tiwari Nishant , Sy Sabrina , Raca Gordana , Schmidt Ryan J , Pawel Bruce 
Published: October 2021

Background The hallmark of lipoblastoma is a PLAG1 fusion. PLAG1 protein overexpression has been reported in sporadic PLAG1-rearranged lipoblastomas. Methods We evaluated the utility of PLAG1 immunohistochemical staining (IHC) in 34 pediatric lipomatous tumors, correlating the results with histology and conventional cytogenetics, FISH and/or next generation sequencing (NGS) results. Results The study included 24 lipoblastomas, divided into 2 groups designated as “Lipoblastoma 1” with both lipoblastoma histology and PLAG1 rearrangement (n = 16) and “Lipoblastoma 2” with lipoblastoma histology but without PLAG1 cytogenetic rearrangement (n = 8), and 10 lipomas with neither lipoblastoma histology nor a PLAG1 rearrangement. Using the presence of a fusion as the “gold standard” for diagnosing lipoblastoma (Lipoblastoma 1), the sensitivity of PLAG1 IHC was 94%. Using histologic features alone (Lipoblastoma 1 + 2), the sensitivity was 96%. Specificity, as defined by the ability to distinguish lipoma from lipoblastoma, was 100%, as there were no false positives in the lipoma group. Conclusions Cytogenetics/molecular testing is expensive and may not be ideal for detecting PLAG1 fusions because PLAG1 fusions are often cytogenetically cryptic and NGS panels may not include all partner genes. PLAG1 IHC is an inexpensive surrogate marker of PLAG1 fusions and may be useful in distinguishing lipoblastomas from lipomas.
Tourism and Gross Domestic Product short-run causality revisited: A symbolic transfer entropy approach
Authors: Camacho Maximo , Romeu Andres 
Published: October 2021

We employ a symbolic transfer entropy panel data test in a large-scale data set to provide new insights on the worldwide short-term causality relations between growth and inbound tourists. Using a large data set on 145 countries from the World Bank Open Data website, we show that, despite the evidently strong correlation between these two magnitudes, claiming that the increases in inbound tourists Granger-cause positive shocks in GDP is not supported by the data. By contrast, the data seem to point out in the direction of a reverse causality in that it is GDP growth what drives international inbound tourists in the short run. JEL classification C12, C14, C33, C55.
Human self-selection as a mechanism of human societal evolution: A critique of the cultural selection argument
Authors: Zhao Shanyang 
Published: October 2021

Natural selection is the main mechanism that drives the evolution of species, including human societies. Under natural selection, human species responds through genetic and cultural adaptations to internal and external selection pressures for survival and reproductive success. However, this theory is ineffective in explaining human societal evolution in the Holocene and a cultural selection argument has been made to remedy the theory. The present article provides a critique of the cultural selection argument and proposes an alternative conception that treats human self-selection as an emergent mechanism of human societal evolution characterized by a new type of selection pressure and a separate fitness criterion. Specifically, the evolution of human societies is divided into two major periods, each driven by a different mode of selection: natural selection acting on genes and cultures for survival and reproductive success prior to the Neolithic Revolution, and human self-selection acting on cultures – and potentially genes as well – for thrival and prosperous living after the Neolithic Revolution. The conditions for the transition from the first mode of selection to the second and the implications of this transition for social research are also discussed.
The Association Between Revised Cardiac Risk Index and Postoperative Mortality Following Elective Colon Cancer Surgery: A Retrospective Nationwide Cohort Study
Authors: Hulme Rebecka Ahl , Forssten Maximilian Peter , Pourlotfi Arvid , Cao Yang , Bass Gary Alan , Matthiessen Peter , Mohseni Shahin 
Published: October 2021

Introduction: Despite improvements in the perioperative care during the last decades for oncologic colon resection, there is still a substantial risk for postoperative complications and mortality. Opportunities exist for improvement in preoperative risk stratification in this patient population. We hypothesize that the Revised Cardiac Risk Index, a user-friendly tool, could better identify patients with high postoperative mortality risks. Methods: A retrospective analysis of operated patients between the years 2007 and 2017 was undertaken, using the prospectively recorded Swedish Colorectal Cancer Registry, which has a 99.5% national coverage for all cases of colon cancer. Patients were cross-referenced with the Swedish National Board of Health and Welfare dataset, a government registry of mortality and comorbidity data. Revised Cardiac Risk Index (RCRI) scores were calculated for each patient and stratified into four groups (RCRI 1, 2, 3, ⩾ 4). A Poisson regression model with robust standard errors of variance was employed to correlate the 90-day postoperative survival with each level of the Revised Cardiac Risk Index. Results: A total of 24,198 patients met the study inclusion criteria. 90-day postoperative mortality increased from 2.4% in patients with RCRI 1 to 10.1% in patients with RCRI ⩾ 4 ( p < 0.001). Adjusted 90-day postoperative mortality increased linearly with an increasing RCRI, where an RCRI of 2, 3, and ≥ 4 respectively led to a 46%, 80%, and 167% increased risk of mortality compared to RCRI 1 ( p < 0.001). Conclusions: A strong association between an increasing Revised Cardiac Risk Index score and increased 90-day postoperative mortality risk was detected. The Revised Cardiac Risk Index may facilitate risk stratification of patients undergoing elective colon cancer surgery.
Imaging findings of neurologic complications in lung transplantation: Review of a 9-year cohort
Authors: Marín-Díez Elena , Drake-Pérez Marta , Valle-San Román Natalia , Mora Cuesta Víctor Manuel , Hernández-Hernández Miguel Ángel , Marco de Lucas Enrique 
Published: October 2021

Background Lung transplantation (LT) requires complex multidisciplinary organization and constitutes a therapeutic option and a life-saving procedure. Although the number of lung recipients continues to increase, neurological complications and death rates following lung transplantation are still higher than desirable. Purpose This study aims to analyse the neuroimaging findings in a cohort of adult patients with LT. Material and Methods A retrospective cohort study of all lung transplant recipients (344 patients: 205 men and 139 women) at a single institution from January 2011 to January 2020. The collected data included demographic features, clinical data and evaluation of the imaging findings. We also recorded the date of neurological complication(s) and the underlying disease motivating lung transplantation. Results We found an elevated rate of neuroimaging findings in patients following LT with 32.6% of positive studies. In our cohort, the average time after LT to a neurological complication was 4.9 months post-transplant. Encephalopathy, critical illness polyneuropathy and stroke, in that order, were the most frequent neurological complications. Structural abnormalities in brain imaging were more often detected using MRI than CT for indications of encephalopathy and seizures. Conclusions LT recipients constitute an especially vulnerable group that needs close surveillance, mainly during the early post-transplant period.
Nursing Students’ Willingness and Confidence to Volunteer in a Pandemic
Authors: Al Gharash Hassan , Smith Morgan , Cusack Lynette 
Published: October 2021

Introduction The current coronavirus disease 2019 pandemic may result in shortages of health care workers in some areas of the health care system. With adequate support, nursing students could potentially play a role in easing health worker shortages. Objective To describe and explore nursing students’ willingness and confidence to contribute to the health care workforce during a pandemic. Methods A mixed-methods descriptive survey design was used to explore the perspectives of second-year nursing students at an Australian University. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using directed content analysis. Results A total of 280 nursing students were invited to complete the survey with a response rate of 32%. The majority of the participants showed moderate to high levels of willingness to volunteer in a pandemic. Of the participants, 50% reported slight confidence that their knowledge and skills would assist them during their volunteering. Reasons that influenced students’ willingness to volunteer included perception of lack of personal protective equipment, need for incentives, fear of transmitting infection to family members, barriers to volunteering, inadequate knowledge and skills to handle a pandemic situation, study and clinical placement arrangements, and disease hazardousness. Conclusion Most nursing students have a level of willingness to volunteer but low confidence that their knowledge and skills would assist them while volunteering in pandemic situations. Universities and health care organizations can benefit from these findings by developing strategies to increase students’ willingness to volunteer, as well as their confidence in their knowledge and skills.
COVID-19 Pandemic Impact on Nursing Student Education: Telenursing with Virtual Clinical Experiences
Authors: Hargreaves Linda , Zickgraf Petra , Paniagua Nikaesha , Evans Teena Lee , Radesi Lisa 
Published: October 2021

Introduction The COVID-19 pandemic affected nursing students dramatically when the clinical sites and the onsite classrooms closed to physical participation. This necessitated a move to virtual classrooms and virtual clinical experiences. Some nursing schools adopted telenursing to comply with their Board of Registered Nursing direct patient care requirements. Students value the hands-on nursing in a direct care facility and clinical instructors must replicate this in a virtual setting. This article discusses telenursing and Teach-Back processes with student active engagement that facilitates learning and meets the direct care requirement. The purpose is to share best practice ideas for clinical instructors to educate when clinical settings are unavailable. Methods This innovation includes examples from five clinical instructors when in-person clinicals were not available due to the COVID-19 pandemic. They used virtual teaching and telenursing for nursing students which complied with clinical requirements of preconference, clinical experience, and post-conference. Telenursing combines case studies or shared documents, student collaboration, and includes a patient or patient actor via telehealth. Clinical instructors present a patient history or case study and allow students time for preparation. Socratic questioning helps students focus on determining the correct questions to ask. Telenursing call to the patient and teach-back questioning validated patient learning. Following the call, the instructor leads a post-conference debrief and students independently document the call. Conclusion Five clinical instructors follow the process of pre-brief, case presentation, and debrief while students develop critical thinking, strong communication skills, documentation requirements, and utilize the nursing process of assessment, diagnosis, outcome, plan, interventions, and evaluation. Students will have future opportunities to develop hands-on skills as they return to the clinical setting.
Advanced Multimodal Communication Curriculum for Pediatric Residents
Authors: Marsh Melanie C , Reed Suzanne M , Mahan John D , Schneider Lydia , Fernandes Ashley K , Liao Nancy , Spears Isaac , Lauden Stephanie 
Published: October 2021

Background Medical educators juggle competing demands as they seek to integrate medical advancements and new technology with the call for earlier introduction to clinical experiences. Newer models of medical education place even greater emphasis on the importance of deliberate training of providers who can deliver compassionate patient-centered care. The need for adaptable, effective communication skills training has never been more relevant than now, in our high-tech and ever-evolving learning climate. Methods At a large pediatric academic center, we used Kern's six-step approach to complete a needs assessment, identify goals and learning preferences of trainees, and ultimately develop and evaluate a multimodal communication curriculum. This curriculum was rooted in the Accreditation Council for Graduate Medical Education's Pediatric Milestones, with the goal of enhancing knowledge, skills, and competency. Pediatric interns were randomized to either the new curriculum ( n = 19) or the existing didactic-based communication training ( n = 17) from 2019 to 2020. We evaluated the impact of the new and traditional curriculum through evaluations by expert facilitators, learner surveys, and faculty-assigned resident milestones. Results Many trainees self-identified performance gaps in communication skills at baseline. Eighteen residents attended 1 to 6 in-person deliberate practice workshops. Workshop participation by the residents varied over time due to a variety of factors. All residents, regardless of curricular exposure, showed statistically significant improvement in communication milestones from first to second year and those enrolled in the deliberate practice curriculum highly valued the workshops and coaching. Discussion Our curriculum demonstrates the value of deliberate practice opportunities for residents to gain skills in advanced communication. Residents appreciated this type of training and the time devoted to expand these skills. Lessons learned and barriers to implementation from this curriculum can be helpful for educators interested in integrating active, deliberate practice, simulation-based communication training into their current educational model.