bluuebunny/crossref_metadata_2025_split huggingface dataset:
Toward Automated Detection of Silent Cerebral Infarcts in Children and Young Adults With Sickle Cell Anemia
Authors: Chen Yasheng , Wang Yan , Phuah Chia-Ling , Fields Melanie E. , Guilliams Kristin P. , Fellah Slim , Reis Martin N. , Binkley Michael M. , An Hongyu , Lee Jin-Moo , McKinstry Robert C. , Jordan Lori C. , DeBaun Michael R. , Ford Andria L. 
Published: June 2023

BACKGROUND:
Silent cerebral infarcts (SCI) in sickle cell anemia (SCA) are associated with future strokes and cognitive impairment, warranting early diagnosis and treatment. Detection of SCI, however, is limited by their small size, especially when neuroradiologists are unavailable. We hypothesized that deep learning may permit automated SCI detection in children and young adults with SCA as a tool to identify the presence and extent of SCI in clinical and research settings.

METHODS:
We utilized UNet—a deep learning model—for fully automated SCI segmentation. We trained and optimized UNet using brain magnetic resonance imaging from the SIT trial (Silent Infarct Transfusion). Neuroradiologists provided the ground truth for SCI diagnosis, while a vascular neurologist manually delineated SCI on fluid-attenuated inversion recovery and provided the ground truth for SCI segmentation. UNet was optimized for the highest spatial overlap between automatic and manual delineation (dice similarity coefficient). The optimized UNet was externally validated using an independent single-center prospective cohort of SCA participants. Model performance was evaluated through sensitivity and accuracy (%correct cases) for SCI diagnosis, dice similarity coefficient, intraclass correlation coefficient (metric of volumetric agreement), and Spearman correlation.

RESULTS:

The SIT trial (n=926; 31% with SCI; median age, 8.9 years) and external validation (n=80; 50% with SCI; age, 11.5 years) cohorts had small median lesion volumes of 0.40 and 0.25 mL, respectively. Compared with the neuroradiology diagnosis, UNet predicted SCI presence with 100% sensitivity and 74% accuracy. In magnetic resonance imaging with SCI, UNet reached a moderate spatial agreement (dice similarity coefficient, 0.48) and high volumetric agreement (intraclass correlation coefficient, 0.76; ρ=0.72;
P
<0.001) between automatic and manual segmentations.

CONCLUSIONS:
UNet, trained using a large pediatric SCA magnetic resonance imaging data set, sensitively detected small SCI in children and young adults with SCA. While additional training is needed, UNet may be integrated into the clinical workflow as a screening tool, aiding in SCI diagnosis.
Maneuvering between Baghdad and Tehran: North Korea's Relations with Iraq and Iran during the Cold War
Authors: Szalontai Balázs , Jinil Yoo 
Published: June 2023

Abstract
This article explores how North Korean leaders tried to maneuver between Iran and Iraq to gain greater leverage in the Cold War. Both of these Middle Eastern countries seemed potentially attractive partners for Pyongyang, but they were often on hostile terms with each other. The article considers how the Iraq-Iran rivalry and domestic changes in Iraq and Iran affected North Korean policy. Even when Pyongyang's cooperation with one or the other of the two states reached a high level, the North Koreans also reached out to the other country, regardless of the position of either state and of external actors such as the Soviet Union and China. The North Koreans generally avoided taking a public stand on the Iraq-Iran dispute, but on occasion they became more deeply involved. Mainly, the North Korean government sought to maximize the number of its partners, rather than to make a stable commitment to just one state. In turn, both Iraq and Iran eventually came to perceive North Korea as a state that was mostly out to benefit itself rather than helping either of them.
The Eyes and Ears of the Dragon: Open-Source Intelligence and Chinese Foreign Policy during the Cold War
Authors: Jiang Huajie , Minami Kazushi 
Published: June 2023

Abstract
Drawing on recently declassified Chinese sources, this article traces the history of open-source intelligence (OSINT) research in the PRC and discusses its impact on Chinese foreign policymaking during the Cold War. From the time the Fourth Bureau of the Central Investigation Department (CID) was founded, it was headed by veteran intelligence expert Xue Qiao, who collected and analyzed OSINT to produce intelligence estimates for Chinese political leaders. These intelligence estimates covered a host of global and regional topics crucial for Chinese foreign policy, including U.S. politics and foreign policy, decolonization movements in the Third World, and political and economic developments around the world. Available evidence shows that politics and ideology marred the quality of China's OSINT research. When Mao Zedong launched the Great Leap Forward in the late 1950s, the CID's intelligence estimates were distorted to advance his radical political agenda. Later on, China's intelligence research came under attack during Mao's Cultural Revolution. Kang Sheng and other radicals attacked OSINT analysts as traitors, and the CID ceased to function in the late 1960s and 1970s. After Mao's death, the CID was revived, but its intelligence estimates no longer served the new Chinese leader, Deng Xiaoping. Deng's personal tension with CID Director Luo Qingchang, who had criticized him during the Cultural Revolution, hindered the CID's estimates. This political schism in the post-Mao years contributed to the CID's dissolution in 1983.
Hanoi's Balancing Act: The Vietnamese Communists and the Sino-Soviet Split, 1960–1965
Authors: You Lan 
Published: June 2023

Abstract
The split between the Soviet Union and China had a great impact on other Communist countries, including the Democratic Republic of Vietnam (DRV, or North Vietnam), under the leadership of the Vietnamese Workers’ Party (VWP). As the rift between the PRC and the Soviet Union intensified, the VWP tried hard to balance between the two Communist powers so that it could focus on the war against the United States and the conquest of the South. Interactions between the DRV, China, and the Soviet Union highlighted the frequently complex nature of relations within the Communist world during the Cold War.
Denigrating Taoism in the West: A typology of Late Qing Chinese scholars’ discourse in Western languages
Authors: Ciaudo Joseph 
Published: June 2023

Abstract
The purpose of this short article is to offer a typology of the speech acts deployed by Chinese scholars who wrote in Western languages in the late Qing era. By identifying passages dealing with Taoism in their writings, and classifying them into five types of arguments – 1) using the orthodox-heterodox dichotomy; 2) ignoring it; 3) presenting it as an already defeated rival to Confucianism; 4) describing it as a superstition; 5) claiming that it is a form of extremism – the present paper argues that the denigration of Taoism by these Chinese scholars writing in Western languages was profoundly affected by transcultural writing practices, and that in the end Taoism was often but a pawn in the intellectual and political projects of these intellectuals. It served as an awful counterpoint when one tried to project a positive light on Confucianism.
Mechanisms for Abrupt Summertime Circumpolar Surface Warming in the Southern Ocean
Authors: Wilson Earle A. , Bonan David B. , Thompson Andrew F. , Armstrong Natalie , Riser Stephen C. 
Published: June 2023

Abstract
In recent years, the Southern Ocean has experienced unprecedented surface warming and sea ice loss—a stark reversal of the sea ice expansion and surface cooling that prevailed over the preceding decades. Here, we examine the mechanisms that led to the abrupt circumpolar surface warming events that occurred in late 2016 and 2019 and assess the role of internal climate variability. A mixed layer heat budget analysis reveals that these recent circumpolar surface warming events were triggered by a weakening of the circumpolar westerlies, which decreased northward Ekman transport and accelerated the seasonal shoaling of the mixed layer. We emphasize the underappreciated effect of the latter mechanism, which played a dominant role and amplified the warming effect of air–sea heat fluxes during months of peak solar insolation. An examination of the CESM1 large ensemble demonstrates that these recent circumpolar warming events are consistent with the internal variability associated with the Southern Annular Mode (SAM), whereby negative SAM in austral spring favors shallower mixed layers and anomalously high summertime SST. A key insight from this analysis is that the seasonal phasing of springtime mixed layer depth shoaling is an important contributor to summertime SST variability in the Southern Ocean. Thus, future Southern Ocean summertime SST extremes will depend on the coevolution of mixed layer depth and surface wind variability.

Significance Statement
This study examines how reductions in the strength of the circumpolar westerlies can produce abrupt and extreme surface warming across the Southern Ocean. A key insight is that the mixed layer temperature is most sensitive to surface wind perturbations in late austral spring, when the regional mixed layer depth and solar insolation approach their respective seasonal minimum and maximum. This heightened surface temperature response to surface wind variability was realized during the austral spring of 2016 and 2019, when a dramatic weakening of the circumpolar westerlies triggered unprecedented warming across the Southern Ocean. In both cases, the anomalously weak circumpolar winds reduced the northward Ekman transport of cool subpolar waters and caused the mixed layer to shoal more rapidly in the spring, with the latter mechanism being more dominant. Using results from an ensemble of coupled climate simulations, we demonstrate that the 2016 and 2019 Southern Ocean warming events are consistent with the internal variability associated with the Southern Annular Mode (SAM). These results suggest that future Southern Ocean surface warming extremes will depend on both the evolution of regional mixed layer depths and interannual wind variability.
Firearm Assaults in Communities: The Impact of COVID-19 Lockdown
Authors: Krzyzaniak Andrea , Carroll Alyssa N. , Rooney Alexandra S. , Calvo Richard Y. , Bansal Vishal , Sise Michael J. 
Published: June 2023

Background Firearm violence has increased nationwide, with recent surges linked to the COVID-19 pandemic. We measured traumatic assault trends at our urban Level I trauma center and assessed rates of firearm violence over time and pre/post local COVID-19 lockdown based on levels of socioeconomic disadvantage. Methods We conducted a retrospective review (2016-2022) of assault patients 16 years and older. Demographics and hospital outcomes were assessed by assault mechanism (firearm, knife, blunt). Patient address was correlated to Area Deprivation Index (ADI), a measure of socioeconomic disadvantage. COVID-19 lockdown onset was defined as initial date of lockdown (3/19/2020). Trend and time-series analyses compared all assault mechanisms and firearm-specific assaults pre/post-lockdown. Poisson regression assessed firearm assault risk. Results Of the 1583 total assaults, firearm patients (n = 335) were younger (median 29 years), had longer hospital stays (median 2 days), and greater mortality (12%) than other mechanisms. The 2 years post-lockdown had significantly more firearm assaults (27% vs 15% pre-lockdown, P < .001) and time-series analysis found this abrupt and significant increase in firearm assaults occurred at lockdown onset (P = .01). Also post-lockdown, the rate of firearm assaults increased by 10% for every unit increase in socioeconomic deprivation (P < .01). There was no change in assault type by race/ethnicity. Discussion Firearm assaults increased dramatically immediately post-COVID lockdown at our center and have maintained higher rates through 2022. Greater ADI was associated with increasing firearm assaults and has magnified post-lockdown, demonstrating lower socioeconomic groups are disproportionately and increasingly affected by firearm violence.
Laing and Rogers in London: An unfortunate meeting or something else?
Authors: Balbuena Rivera Francisco 
Published: June 2023

Background: In the summer of 1978 a large 1-day event was scheduled to take place in the Grand Ballroom at the Hilton Hotel in Park Lane, London between the psychotherapists Carl R. Rogers (1902–1987), and his associates, and Ronald D. Laing (1927–1989) and his group. From among all the eyewitness accounts of that meeting, I have found only the testimonies of Maureen O’Hara, Ian Cunningham, Charles Elliot, and Emmy van Deurzen. According to O’Hara, Laing behaved in a rude, impolite, and aggressive way toward his American colleague Rogers. For his part, Cunningham says that Rogers came over as he had expected: a genuinely nice, caring, humane person. Laing, though, was even more impressive in person than in his books. Similarly, Elliot observes that Laing and Rogers held a genuine encounter, one in which both sat like two real mutually respecting persons who asked each other questions, while the perspective of van Deurzen is more in line with that of O’Hara than that of Elliot. Aims: Taking into account the different versions given on the Laing-Rogers event, I will analyze whether this encounter was only an unfortunate meeting or something else. Methods: Narrative review; combining eyewitness accounts with the few sources found in the literature on this topic. Results/conclusions: As I will show here, all these accounts taken jointly paint a picture of Laing as a brilliant clinician and as a terrible man. Without exculpating Laing for committing all sorts of mischief, I will offer a tentative account of his behavior sustained by his own psychic dynamics. In doing so, I will attempt to explain why Laing reacted in so censurable a way, going beyond Thomas S. Szasz’s (1920–2012) condemnation in his essay on antipsychiatry, which gives credence only to O’Hara’s version without quoting more sources or posing more questions.
Prevalence of Prolonged Grief Disorder and Related Clinical Factors Among Turkish Psychiatric Outpatients During the COVID-19 Pandemic
Authors: Yıldırım Yusuf Ezel 
Published: June 2023

Prolonged grief disorder (PGD), a new diagnosis in some classification systems, has gained prominence due to the high mortality rates observed during the Covid-19 pandemic. Herein, the prevalence of PGD (diagnosed with structured clinical interviews), death-related features, and associated clinical factors were investigated among outpatient psychiatric patients who lost a first-degree relative within the past 12–24 months. PGD was diagnosed in 30/68 patients (44.1%). PGD development did not differ based on cause of death (Covid-19-related vs. other causes) but was associated with higher age of the bereaved, younger age of the deceased, and degree of kinship. Higher rates of depression, insomnia, and anxious attachment were also observed in PGD patients. Finally, the unexpectedness of death predicted the development of PGD. Due to the high prevalence of PGD among psychiatric patients, clinicians should be aware of the disorder, monitor grief processes in high-risk patients, and consider PGD in treatment planning.
Influenza and Tetanus, Diphtheria, and Acellular Pertussis Vaccination Coverage During Pregnancy: Pregnancy Risk Assessment Monitoring System, 2020
Authors: Kortsmit Katherine , Oduyebo Titilope , Simeone Regina M. , Kahn Katherine E. , Razzaghi Hilda , Galang Romeo R. , Ellington Sascha , Ruffo Nan , Barfield Wanda D. , Warner Lee , Cox Shanna 
Published: June 2023

Objectives: Estimates of vaccination coverage during pregnancy and identification of disparities in vaccination coverage can inform vaccination campaigns and programs. We reported the prevalence of being offered or told to get the influenza vaccine by a health care provider (hereinafter, provider); influenza vaccination coverage during the 12 months before delivery; and tetanus, diphtheria, and acellular pertussis (Tdap) vaccination coverage during pregnancy among women with a recent live birth in the United States. Methods: We analyzed 2020 data from the Pregnancy Risk Assessment Monitoring System from 42 US jurisdictions (n = 41 673). We estimated the overall prevalence of being offered or told to get the influenza vaccine by a provider and influenza vaccination coverage during the 12 months before delivery. We estimated Tdap vaccination coverage during pregnancy from 21 jurisdictions with available data (n = 22 020) by jurisdiction and select characteristics. Results: In 2020, 84.9% of women reported being offered or told to get the influenza vaccine, and 60.9% received it, ranging from 35.0% in Puerto Rico to 79.7% in Massachusetts. Influenza vaccination coverage was lower among women who were not offered or told to get the influenza vaccine (21.4%) than among women who were offered or told to get the vaccine (68.1%). Overall, 72.7% of women received the Tdap vaccine, ranging from 52.8% in Mississippi to 86.7% in New Hampshire. Influenza and Tdap vaccination coverage varied by all characteristics examined. Conclusions: These results can inform vaccination programs and strategies to address disparities in vaccination coverage during pregnancy and may inform vaccination efforts for other infectious diseases among pregnant women.
Examining the Association Between Financial Education and Financial Risk Tolerance
Authors: Tharayil Ashley 
Published: June 2023

An individual’s financial risk tolerance (FRT) has an important role in their financial decisions. Hence, it is a recent topic of interest. Research shows a strong relationship between financial literacy and risk aversion. Little research, however, has been done investigating the correlation between financial education and FRT. In this paper, it is proposed that financial education and FRT may be positively correlated. Since risk preferences are an innate characteristic and can also be motivated by personal and psychological attributes, the relationship between financial education and FRT may not be causal. Results obtained from analyzing data from the 2021 NFCS dataset through multivariate analysis show that financial education courses are positively correlated with reporting higher measures of financial risk tolerance for college educated individuals and for financially low literate individuals who have not attended college. These results hold even after controlling for financial literacy and a myriad of other background variables. JEL Codes: D14, G00, D81, A20
Administering a Soda Beverage With the Hepatitis C Treatment Sofosbuvir/Velpatasvir and the Proton-Pump Inhibitor Pantoprazole: A Case Report
Authors: Stark Jennifer E. , Montgomery Clarice M. 
Published: June 2023

Purpose: The manufacturer of sofosbuvir/velpatasvir recommends avoiding coadministration with proton pump inhibitors (PPI) due to decreased velpatasvir serum concentrations which could translate to an increased risk of HCV treatment failure. A recent open-label study in healthy adults reported overcoming this interaction through co-administration of velpatasvir and a PPI with soda, but there is no clinical outcome data in HCV-infected patients. Summary: A 64 year-old male with a past medical history significant for decompensated cirrhosis, chronic HCV infection, upper gastrointestinal bleed, anemia, esophagitis, and previous HCV treatment failures required HCV treatment. The patient’s medications included a PPI but no other significant DDI were present. The patient was instructed to take one sofosbuvir/velpatasvir tablet, soda, and pantoprazole 40 mg tablet at the same time once daily. Treatment was well tolerated, and clinical cure of HCV was achieved. Conclusion: Scenarios may arise during HCV treatment that necessitate coadministration of a PPI. Interfering with optimal absorption of HCV treatment could lead to development of resistance or treatment failure. Future studies should include this strategy for overcoming this common DDI. This case demonstrates sofosbuvir/velpatasvir administered orally with soda and a PPI is potentially safe and effective for treatment of chronic HCV infection.
A survey of the psychiatric care provided for medically ill older adults in general hospitals in New Zealand
Authors: Hopkins John R , Skudder Ella , Sundram Frederick , Cullum Sarah 
Published: June 2023

Objective The aim of this study was to conduct an in-depth survey of the psychiatric care provided for medically ill older adults in general hospitals in New Zealand (NZ). Method As part of a larger survey of Consultation-Liaison Psychiatry (CLP) services for all ages in NZ (CLPSNZ-2), a 44-question survey was emailed to clinicians who were involved in providing psychiatric care for medically ill older adults at each of the 16 general hospitals with designated CLP services. Results Responses were obtained from 22 services at 16 hospitals – 14 CLP services and eight Psychiatry of Old Age (POA) in-reach services. These services were found to be under-resourced, operate with highly variable service models, and predominantly provide inpatient consultations. Services could be conceptualised as six prototypes with variations of POA in-reach to hospitals, scope of CLP cover and collaboration between services. Conclusion The heterogeneity in the psychiatric care for medically ill older adults in NZ means that there is an urgent need to develop more consistent CLP service models that better serve the specialist needs of older adults, and establish the policies, resources and standards needed to support them.
A Review of Topical Sirolimus for the Treatment of Facial Angiofibromas in Tuberous Sclerosis Complex
Authors: Dao Diem-Phuong D. , Pixley Jessica N. , Akkurt Zeynep M. , Feldman Steven R. 
Published: June 2023

Objective: This article assesses the efficacy, safety, pharmacology, and clinical applications of topical sirolimus 0.2% gel for the treatment of tuberous sclerosis complex (TSC)–associated facial angiofibromas. Data sources: A review of the literature was conducted using the Medline (PubMed) and EMBASE databases using the keywords topical sirolimus, rapamycin, Hyftor, and tuberous sclerosis. Study selection and data extraction: Articles written in English and relevant to the topic were included. Data synthesis: In the phase 2 trial, the mean improvement factor, a composite measure of improved tumor size and redness, was achieved in all patient groups ( P < 0.001) with significant responses among the adult and pediatric subgroups at week 12. There were no serious adverse events recorded. In the phase 3 trial, 60% of participants responded to treatment in the sirolimus group compared with 0% in the placebo group with different response rates between the adult and pediatric subgroups at week 12. Sirolimus gel had no serious adverse events, and dry skin was the most common adverse reaction. Patients who had completed the 12-week trials were then enrolled in a long-term trial; angiofibromas had response rates of 78.2% to 0.2% sirolimus gel. Relevance to patient care and clinical practice in comparison to existing drugs: Topical sirolimus 0.2% is a first-in-class, newly Food and Drug Administration (FDA)–approved, mammalian target of rapamycin (mTOR) inhibitor that is a promising and safe, noninvasive alternative to surgical procedures for TSC-associated angiofibromas. Conclusions: Topical sirolimus 0.2% gel is a moderately effective treatment for TSC-associated facial angiofibromas with an adequate safety profile.