bluuebunny/crossref_metadata_2025_split huggingface dataset:
Compass for antibiotic stewardship: using a digital tool to improve guideline adherence and drive clinician behaviour for appendicitis treatment in the emergency department
Authors: Vu Mai Trang , Schwartz Hope , Straube Steven , Pondicherry Neha , Emanuels David , Dhanoa Jaskirat , Bains Jaskaran , Singh Malini , Stark Nicholas , Peabody Christopher 
Published: October 2023

BackgroundAntibiotic stewardship in the ED is important given the increasing prevalence of multidrug resistance associated with poorer patient outcomes. The use of broad-spectrum antibiotics in the ED for infections like appendicitis is common. At baseline, 75% of appendicitis cases at our institution received broad-spectrum ertapenem rather than the recommended narrower-spectrum ceftriaxone/metronidazole combination. We aimed to improve antibiotic stewardship by identifying barriers to guideline adherence and redesigning our appendicitis antibiotic guideline.MethodsUsing the ‘Fit between Individuals, Task and Technology (FITT)’ framework, we identified barriers that preventclinicians from adhering to guidelines. We reformatted a clinical guideline and disseminated it using our ED’s clinical decision support system (CDSS), E*Drive. Next, we examined E*Drive’s user data and clinician surveys to assess utilisation and satisfaction. Finally, we conducted a retrospective chart review to measure clinician behaviour change in antibiotic prescription for appendicitis treatment.ResultsData demonstrated an upward trend in the number of monthly users of E*Drive from 1 April 2021 to 30 April 2022, with an average increase of 46 users per month. Our clinician survey results demonstrated that >95% of users strongly agree/agree that E*Drive improves access to clinical information, makes their job more efficient and that E*Drive is easy to access and navigate, with a Net Promoter Score increase from 26.0 to 78.3. 69.4% of patients treated for appendicitis in the post-intervention group received antibiotics concordant with our institutional guideline compared with 20.0% in the pre-intervention group (OR=9.07, 95% CI (3.84 to 21.41)).ConclusionAntibiotic stewardship can be improved by ensuring clinicians have access to convenient and up-to-date guidelines through clinical decision support systems. The FITT model can help guide projects by identifying individual, task and technology barriers. Sustained adherence to clinical guidelines through simplification of guideline content is a potentially powerful tool to influence clinician behaviour in the ED.
What impact would reducing low-acuity attendance have on emergency department length of stay? A discrete event simulation modelling study
Authors: Squires Hazel , Mason Suzanne , O'Keeffe Colin , Croft Susan , Millington George 
Published: October 2023

BackgroundLong waiting times in the ED have been shown to cause negative outcomes for patients. This study aims to assess the effect in reducing length of stay of (1) preventing low-acuity attenders from attending the ED and (2) diverting low-acuity attenders at triage to a colocated general practice (GP) service.MethodsDiscrete event simulation was used to model a large urban teaching hospital in the UK, as a case study, with a colocated GP service. The Centre for Urgent and Emergency Care research database patient-level database (May 2015–April 2016), secondary literature and expert elicitation were used to inform the model. The model predicted length of stay, the percentage of patients being seen within 4 hours and the incremental cost-effectiveness of the colocated GP service.ResultsThe model predicted that diverting low-acuity patients to a colocated GP open 9:00 to 17:00 reduces the average time in the system for higher acuity attenders by 29 min at an estimated additional cost of £6.76 per patient on average. The percentage of higher acuity patients being seen within 4 hours increased from 61% to 67% due to the reduction in the length of stay of those who were in the ED for the longest time. However, the model is sensitive to changes in model inputs and there is uncertainty around ED activity durations, for which further primary data collection would be useful.ConclusionReducing the proportion of low-acuity attenders at the ED could have an impact on the time in the ED for higher acuity patients due to their use of shared resources, but is insufficient alone to meet current targets. The simulation model could be adapted for further analyses to understand which other changes would be needed to meet current government targets.
Are we survivors of the sudden past singularity?
Authors: Balcerzak Adam , Denkiewicz Tomasz , Lisaj Mateusz 
Published: October 2023

AbstractIn this paper, we investigate the viability of cosmological models featuring a type II singularity that occurs during the past evolution of the Universe. We construct a scenario in which the singularity arises and then constrain the model parameters using observational data from type Ia supernovae, cosmic chronometers, and gamma ray bursts. We find that the resulting cosmological models based on scenarios with the past type II singularity cannot be excluded by kinematical tests using current observations.
Cost-Effectiveness of AF Screening With 2-Week Patch Monitors: The mSToPS Study
Authors: Reynolds Matthew R. , Stein Amy B. , Sun Xiaowu , Hytopoulos Evangelos , Steinhubl Steven R. , Cohen David J. 
Published: October 2023

BACKGROUND:
The mSToPS study (mHealth Screening to Prevent Strokes) reported screening older Americans at risk for atrial fibrillation (AF) and stroke using 2-week patch monitors was associated with increased rates of AF diagnosis and anticoagulant prescription within 1 year and improved clinical outcomes at 3 years relative to matched controls. Cost-effectiveness of this AF screening approach has not been explored.

METHODS:
We conducted a US-based health economic analysis of AF screening using patient-level data from mSToPS. Clinical outcomes, resource use, and costs were obtained through 3 years using claims data. Individual costs, survival, and quality-adjusted life years (QALYs) were projected over a lifetime horizon using regression modeling, US life tables, and external data where needed. Adjustment between groups was performed using propensity score bin bootstrapping.

RESULTS:

Screening participants (mean age, 74 years, 41% female, median CHA
2
DS
2
-VASC score 3) wore on average 1.7 two-week monitors at a mean cost of $614/person. Over 3 years, outpatient visits were more frequent for monitored than unmonitored individuals (difference 190 per 100 patient-years [95% CI, 82–298]), but emergency department visits (−8.3 [95% CI, −12.6 to −4.1]) and hospitalizations (−15.2 [CI, −22 to −8.6]) were less frequent. Total adjusted 3-year costs were slightly higher (mean difference, $1551 [95% CI, −$1047 to $4038]) in the monitoring group. In patient-level projections, the monitoring group had slightly greater quality-adjusted survival (8.81 versus 8.71 QALYs, difference, 0.09 [95% CI, −0.05 to 0.24]) and slightly higher lifetime costs, resulting in an incremental cost-effectiveness ratio of $36 100/QALY gained. With bootstrap resampling, the incremental cost-effectiveness ratio for monitoring was <$50 000/QALY in 64% of study replicates, and <$150 000/QALY in 91%.

CONCLUSIONS:
Using lifetime projections derived from the mSToPS study, we found that AF screening using 2-week patch monitors in older Americans was associated with high economic value. Confirmation of these uncertain findings in a randomized trial is warranted.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02506244.
Children’s Reasoning About Empathy and Social Relationships
Authors: Smith-Flores Alexis S. , Bonamy Gabriel J. , Powell Lindsey J. 
Published: October 2023

AbstractAcross the lifespan, empathic and counter-empathic emotions are shaped by social relationships. Here we test the hypothesis that this connection is encoded in children’s intuitive theory of psychology, allowing them to predict when others will feel empathy versus counter-empathy and to use vicarious emotion information to infer relationships. We asked 4- to 7-year-old children (N = 79) to make emotion predictions or relationship inferences in response to stories featuring two characters, an experiencer and an observer, and either a positive or negative outcome for the experiencer. In the context of positive outcomes, we found that children engaged in robust joint reasoning about relationships and vicarious emotions. When given information about the characters’ relationship, children predicted empathy from a friendly observer and counter-empathy from a rival observer. When given information about the observer’s response to the experiencer, children inferred positive and negative relationships from empathic and counter-empathic responses, respectively. In the context of negative outcomes, children predicted that both friendly and rival observers would feel empathy toward the experiencer, but they still used information about empathic versus counter-empathic responses to infer relationship status. Our results suggest that young children in the US have a blanket expectation of empathic concern in response to negative outcomes, but otherwise expect and infer that vicarious emotions are connected to social relationships. Future research should investigate if children use this understanding to select social partners, evaluate their own relationships, or decide when to express empathy toward others.
Post-diasporic Resilience to Assimilation via the Heritagisation of the Diasporic Legacy among the Descendants of Lithuanian Exiles to Trans-Volga Russia
Authors: Ciubrinskas Vytis 
Published: October 2023

Abstract
The Trans-Volga Lithuanian diaspora has for more than 150 years traversed the challenges of assimilation into a majoritarian Russian society. However, in the contemporary era, the third- and fourth-generation descendants’ resilience to assimilation is focused on sensitivity to roots and a valorisation of the diasporic past. The role of agency in diasporic memory, place-making and cultural representations is of key importance. The aim of this paper is to focus on the post-diasporic domains of communality by highlighting the shared values and aspirations, strategies and experiences of the reclamation and heritagisation of diasporic legacy. Analysis of fieldwork among the descendants has shown that their resilience to assimilation is grounded in the dominant narrative of the heroic past of the diaspora firstcomers: in terms of—Lithuanians as pioneers of the Kazakh steppe; in the heritagisation of Lithuanian objects and places via collection and museumisation of ethnographic objects, and co-memorising; the re-Lithuanianisation of diaspora places through erecting Catholic chapels and crosses; and in the festive representations of traditional Trans-Volga Lithuanian culture at state-sponsored local multicultural festivals.
Neither Israelisation nor Zionisation
Authors: Hazran Yusri 
Published: October 2023

Abstract
For decades, the Druze community on the Golan Heights has waged a political struggle against Israeli sovereignty over the Golan, demonstrating its loyalty to Syria by refusing to accept Israeli citizenship, ostracizing (religiously and socially) anyone who does so, vetoing service in the idf, not teaching Hebrew in schools, celebrating Syrian national holidays, attending Syrian universities, etc. In the wake of the outbreak of the popular uprising in Syria in 2011, however, it has begun showing clear signs of cracks, most prominently amongst the younger generation. Due first and foremost to utilitarian factors. Characterised by a utilitarian wish to integrate into Israeli economy and society, this trend finds various expressions. Firstly, the number of Druze seeking Israeli citizenship has risen, albeit not dramatically, a clear correlation existing between this fact and the decline of the Ba’ath regime. Secondly, and at the same time, more young adults have begun applying to Israeli universities, the decade between 2011 and 2021 witnessing a significant rise in the number of Golan Druze students studying therein. Thirdly, in continuation of the same trend, the members of the Golan Druze community also began adopting an economic-focused orientation—which Israel met by launching an ambitious plan in 2014 for developing the 1052 Druze settlements in the Golan.
The Veil of Purity: Tropes of Nineteenth-Century Islamic Reform and Ahmad Khan’s naicar
Authors: Burney Fatima 
Published: October 2023

Abstract
Syed Ahmad Khan (1817–1898) was one of the most prominent Indian Muslim reformists of the nineteenth century and was exceptional for the ways in which he proposed that nature and observations of nature were central to Islam. Like many nineteenth-century reformist narratives, Khan’s ideals on naicar (nature) routinely employed a rhetoric of ‘break,’ ‘renewal,’ and ‘purity’ to imply that Indo-Persian culture was in a state of malaise and in need of rejuvenation. Yet despite this outward denunciation, Khan’s reformist project also ironically reflected many qualities of Persianate Islam that had characterized Indo-Muslim culture before the nineteenth century. This article reconsiders Ahmad Khan’s modernism in light of the Persianate modes that he maintained to point out some of the rhetorical inconsistencies of modernist writing, and the historical lacunae which they create.
Nonlocal Controls on Tropical Cyclogenesis: A Trajectory-Based Genesis Potential Index
Authors: Meng Lingwei , Garner Stephen T. 
Published: October 2023

Abstract
Tropical cyclone (TC) genesis is initiated by convective precursors or “seeds” and influenced by environmental conditions along the seed-to-TC trajectories. Genesis potential indices (GPIs) provide a simple way to evaluate TC genesis likelihood from environmental conditions but have two limitations that may introduce bias. First, the globally fixed GPIs fail to represent interbasin differences in the relationship between environments and genesis. Second, existing GPIs are only functions of local environmental conditions, whereas nonlocal factors may have a significant impact. We address the first limitation by constructing basin- and time-scale-specific GPIs (local-GPIs) over the eastern North Pacific (ENP) and North Atlantic (NA) using Poisson regression. A sequential feature selection (SFS) algorithm identifies vertical wind shear and a heating condition as leading factors controlling TC genesis in the ENP and the NA, respectively. However, only a slight improvement in performance is achieved, motivating us to tackle the second limitation with a novel trajectory-based GPI (traj-GPI). We merge adjacent nonlocal environments into each grid point based on observed seed trajectory densities. The seed activity, driven mainly by upward motion, and the transition to TCs, controlled primarily by vertical wind shear or heating conditions, are captured simultaneously in the traj-GPI, yielding a better performance than the original GPIs. This study illustrates the importance of seed activity in modeling TC genesis and identifies key environmental factors that influence the process of TC genesis at different stages.

Significance Statement
The genesis potential index (GPI) is an effective tool for modeling the likelihood of tropical cyclone (TC) genesis for a given time and location. This study reveals that existing GPIs are primarily biased by a lack of information about nonlocal TC seed activity, since they are based only on local large-scale environmental variables. According to our study, upward motion and vertical wind shear are the most influential environmental factors in seed genesis and the transition from seed to TC, respectively. Based on the observed seed trajectories, we build trajectory-based GPIs that include the information from seed activity. Spatiotemporal performances of TC genesis are significantly improved over the original GPIs.
On the Contribution of Transient Diabatic Processes to Ocean Heat Transport and Temperature Variability
Authors: Yung Claire K. , Holmes Ryan M. 
Published: October 2023

Abstract
Time-varying processes contribute to ocean heat transport and are important to understand for accurate climate modeling. While past studies have quantified time-varying contributions to advective transport, less attention has been given to diabatic processes such as surface forcing and mixing. Using a global eddy-permitting ocean model we quantify the contribution of time-variable processes to meridional and diathermal (warm to cold) heat transport at different time scales using a temporal eddy-mean decomposition performed in the temperature–latitude plane. Time-varying contributions to meridional heat transport occur predominantly at mesoscale eddy-dominated midlatitudes and in the tropics, associated with the seasonal cycle and tropical instability waves. The seasonal cycle is a dominant driver of surface flux– and mixing-driven diathermal heat transports. Nonseasonal (and nondiurnal) processes contribute up to about 10% of the total. We show that transient contributions to diathermal heat transport can be interpreted as sources of Eulerian temperature variance. We thus extend recent work on the drivers of temperature variability by evaluating the role of mixing. Mixing dampens seasonal and diurnal temperature variability, except near the equator where it can be a source of seasonal variability. At mesoscale time scales mixing drives variability within and near the base of the boundary layer, the mechanisms of which are explored using a column model. We suggest that climate models that do not resolve the mesoscale may be missing the rectified heat transport associated with high-frequency diabatic processes, in addition to the adiabatic eddy fluxes that are commonly parameterized.

Significance Statement
Ocean heat transport plays a key role in determining how the climate responds to changes in forcing. This transport is influenced by a range of processes that vary with time. Previous research has quantified time-varying sources of lateral heat transport, such as mesoscale eddies and overturning circulation cells. However, time-varying “diabatic processes,” such as surface forcing and unresolved turbulent mixing, have received less attention. Here, we quantify these effects using a global ocean model. We find a dominant role for the seasonal cycle in driving diabatic heat transport, but processes on shorter time scales also contribute. Our results suggest that temporal variations in turbulent mixing are an important contributor to heat transport but may not be resolved in coarse-resolution climate models.
Comparison of three radiographic assessment methods for detecting slipped capital femoral epiphyses in cats: Klein’s line, modified Klein’s line and the S-sign
Authors: Butts Daniel , Smith Alex J , Bradley Kate , Meeson Richard , Parsons Kevin , Langley-Hobbs Sorrel J 
Published: October 2023

Objectives The aim of the present study was to investigate whether diagnostic assessment methods used on radiographs in humans with slipped capital femoral epiphysis (SCFE) can be used in cats. Methods The ventrodorsal (VD) extended-leg and VD frog-leg pelvic radiographs of 20 cats with SCFE without fully displaced femoral capital epiphyses (FCE), eight cats with fully displaced FCE and five control cats with normal pelvic anatomy were assessed by five observers on two separate occasions 3 months apart. The Klein’s line and modified Klein’s line were assessed on each VD extended-leg radiograph, and the S-sign was assessed on each VD extended-leg and VD frog-leg radiograph. Results Excluding cases of fully displaced FCE, the S-sign on the VD frog-leg radiographs more accurately diagnosed SCFE than the S-sign on the VD extended-leg radiographs and the Klein’s line (92.4% vs 88.8% vs 60.6%, respectively), and had the greatest sensitivity (93.9% vs 79.2% vs 30.6%, respectively). The S-sign on the VD extended-leg radiographs had greater specificity than the Klein’s line and S-sign on the VD frog-leg radiographs (99.2% vs 97.9% vs 90.9%, respectively). The modified Klein’s line detected SCFE in 40.2% of cases that were negative for the Klein’s line. Conclusions and relevance The S-sign in both VD extended-leg and VD frog-leg views successfully detected SCFE in cats and can be used to increase early diagnosis and treatment in cats with SCFE that have only subtle radiographic changes.
Foreign body ingestion due to detachment of pill dispenser tips in cats: a retrospective study of 13 cases
Authors: M de Souza Heloisa Justen , Alves Camila R , Castro Sarah M , Pedro Julia F , Meirelles Ana Carolina A 
Published: October 2023

Objectives The aim of this study was to evaluate and describe 13 cases in which a pet piller broke during the administration of medication, and the tip was accidentally ingested by the cat. Methods A total of 15 presentations to the clinic were identified in a private practice database involving 13 cats in which the silicone tip broke. Two of these cats ingested foreign bodies on two separate occasions. Routine radiographic examination enabled the identification of silicone tips in all animals. On 2/15 occasions, the cats did not receive an emetic drug. Intramuscular xylazine (0.2 mg/kg) and dexmedetomidine (6 μg/kg) were administered to 12/15 and 1/15 cats, respectively. Results The cats were aged 3–17 years (mean age 11.00 ± 4.35 years). Vomiting occurred in 13 cats that received alpha-2 adrenoceptor agonists, although the silicone tip was recovered in only five occurrences. In 9/15 occurrences, endoscopy was performed under general inhalation anesthesia, and the silicone tip was successfully removed. Natural elimination occurred in only one case. Conclusions and relevance The use of pet pillers with detachable silicone tips increases the risk of accidental foreign body ingestion by animals. Therefore, guidelines regarding safety standards for manufacturing would be beneficial. No cat in this series developed clinical signs related to the ingestion of the piller tip, probably because of the quick presentation by the owners and early intervention, including endoscopic retrieval. Surgical intervention was not required in any case, including one in which the foreign body was lodged within the small intestine before being passed naturally by the cat.
The ethics of intra-amniotic drug administration in perinatal clinical practice
Authors: Hong Grace , Baden Kyrie Eleyson , Olds Rolanda , Injeti Elisha , Muzzy Julia , Cole Justin W , Sullivan Dennis 
Published: October 2023

Providing in-utero treatments to target specific conditions in the fetus is a relatively new approach in perinatal care, with the vast majority of these treatments being used off-label. The high degree of off-label medication use in the perinatal and neonatal settings raises concern for the safety of both the fetuses and expectant mothers. This report presents two examples of intra-amniotic drug administration based on reported clinical cases. From the ethical framework of medical principlism, we examine the competing ethical duties of autonomy, beneficence, and non-maleficence in this setting. We then lay out three fundamental ethical principles for obtaining informed consent and maximizing clinical benefit.