bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of a computerised diagnostic decision support tool on diagnostic quality in emergency departments: study protocol of the DDx-BRO multicentre cluster randomised cross-over trial
Authors: Marcin Thimo , Hautz Stefanie C , Singh Hardeep , Zwaan Laura , Schwappach David , Krummrey Gert , Schauber Stefan K , Nendaz Mathieu , Exadaktylos Aristomenis Konstantinos , Müller Martin , Lambrigger Cornelia , Sauter Thomas C , Lindner Gregor , Bosbach Simon , Griesshammer Ines , Hautz Wolf E 
Published: March 2023

IntroductionComputerised diagnostic decision support systems (CDDS) suggesting differential diagnoses to physicians aim to improve clinical reasoning and diagnostic quality. However, controlled clinical trials investigating their effectiveness and safety are absent and the consequences of its use in clinical practice are unknown. We aim to investigate the effect of CDDS use in the emergency department (ED) on diagnostic quality, workflow, resource consumption and patient outcomes.Methods and analysisThis is a multicentre, outcome assessor and patient-blinded, cluster-randomised, multiperiod crossover superiority trial. A validated differential diagnosis generator will be implemented in four EDs and randomly allocated to a sequence of six alternating intervention and control periods. During intervention periods, the treating ED physician will be asked to consult the CDDS at least once during diagnostic workup. During control periods, physicians will not have access to the CDDS and diagnostic workup will follow usual clinical care. Key inclusion criteria will be patients’ presentation to the ED with either fever, abdominal pain, syncope or a non-specific complaint as chief complaint. The primary outcome is a binary diagnostic quality risk score composed of presence of an unscheduled medical care after discharge, change in diagnosis or death during time of follow-up or an unexpected upscale in care within 24 hours after hospital admission. Time of follow-up is 14 days. At least 1184 patients will be included. Secondary outcomes include length of hospital stay, diagnostics and data regarding CDDS usage, physicians’ confidence calibration and diagnostic workflow. Statistical analysis will use general linear mixed modelling methods.Ethics and disseminationApproved by the cantonal ethics committee of canton Berne (2022-D0002) and Swissmedic, the Swiss national regulatory authority on medical devices. Study results will be disseminated through peer-reviewed journals, open repositories and the network of investigators and the expert and patients advisory board.Trial registration numberNCT05346523.
Types of diagnostic errors reported by paediatric emergency providers in a global paediatric emergency care research network
Authors: Mahajan Prashant , Grubenhoff Joseph A , Cranford Jim , Bhatt Maala , Chamberlain James M , Chang Todd , Lyttle Mark , Oostenbrink Rianne , Roland Damian , Ruddy Richard M , Shaw Kathy N , Zuniga Robert Velasco , Belle Apoorva , Kuppermann Nathan , Singh Hardeep 
Published: March 2023

BackgroundDiagnostic errors, reframed as missed opportunities for improving diagnosis (MOIDs), are poorly understood in the paediatric emergency department (ED) setting. We investigated the clinical experience, harm and contributing factors related to MOIDs reported by physicians working in paediatric EDs.MethodsWe developed a web-based survey in which physicians participating in the international Paediatric Emergency Research Network representing five out of six WHO regions, described examples of MOIDs involving their own or a colleague’s patients. Respondents provided case summaries and answered questions regarding harm and factors contributing to the event.ResultsOf 1594 physicians surveyed, 412 (25.8%) responded (mean age=43 years (SD=9.2), 42.0% female, mean years in practice=12 (SD=9.0)). Patient presentations involving MOIDs had common undifferentiated symptoms at initial presentation, including abdominal pain (21.1%), fever (17.2%) and vomiting (16.5%). Patients were discharged from the ED with commonly reported diagnoses, including acute gastroenteritis (16.7%), viral syndrome (10.2%) and constipation (7.0%). Most reported MOIDs (65%) were detected on ED return visits (46% within 24 hours and 76% within 72 hours). The most common reported MOID was appendicitis (11.4%), followed by brain tumour (4.4%), meningitis (4.4%) and non-accidental trauma (4.1%). More than half (59.1%) of the reported MOIDs involved the patient/parent–provider encounter (eg, misinterpreted/ignored history or an incomplete/inadequate physical examination). Types of MOIDs and contributing factors did not differ significantly between countries. More than half of patients had either moderate (48.7%) or major (10%) harm due to the MOID.ConclusionsAn international cohort of paediatric ED physicians reported several MOIDs, often in children who presented to the ED with common undifferentiated symptoms. Many of these were related to patient/parent–provider interaction factors such as suboptimal history and physical examination. Physicians’ personal experiences offer an underexplored source for investigating and mitigating diagnostic errors in the paediatric ED.
Targeting tumor vasculature to improve antitumor activity of T cells armed ex vivo with T cell engaging bispecific antibody
Authors: Park Jeong A , Espinosa-Cotton Madelyn , Guo Hong-fen , Monette Sebastien , Cheung Nai-Kong V 
Published: March 2023

BackgroundSuccess of T cell immunotherapy hinges on the tumor microenvironment (TME), and abnormal tumor vasculature is a hallmark of most solid tumors and associated with immune evasion. The efficacy of T cell engaging bispecific antibody (BsAb) treatment relies on the successful trafficking and cytolytic activity of T cells in solid tumors. Normalization of tumor vasculature using vascular endothelial growth factor (VEGF) blockades could improve efficacy of BsAb-based T cell immunotherapy.MethodsAnti-human VEGF (bevacizumab, BVZ) or anti-mouse VEGFR2 antibody (DC101) was used as VEGF blockade, and ex vivo armed T cells (EATs) carrying anti-GD2, anti-HER2, or anti-glypican3 (GPC3) IgG-(L)-scFv platformed BsAb were used. BsAb-driven intratumoral T cell infiltration and in vivo antitumor response were evaluated using cancer cell line-derived xenografts (CDXs) or patient-derived xenografts (PDXs) carried out in BALB-Rag2-/-IL-2R-γc-KO (BRG) mice. VEGF expression on human cancer cell lines was analyzed by flow cytometry, and VEGF levels in mouse serum were measured using VEGF Quantikine ELISA Kit. Tumor infiltrating lymphocytes (TILs) were evaluated using flow cytometry and by bioluminescence; both TILs and tumor vasculature were studied using immunohistochemistry.ResultsVEGF expression on cancer cell lines increased with seeding density in vitro. BVZ significantly reduced serum VEGF levels in mice. BVZ or DC101 increased high endothelial venules (HEVs) in the TME and substantially enhanced (2.1–8.1 fold) BsAb-driven T cell infiltration into neuroblastoma and osteosarcoma xenografts, which was preferential for CD8(+) TILs versus CD4(+) TILs, leading to superior antitumor effects in multiple CDX and PDX tumor models without added toxicities.ConclusionsVEGF blockade using specific antibodies against VEGF or VEGFR2 increased HEVs in the TME and cytotoxic CD8(+) TILs, significantly improving the therapeutic efficacy of EAT strategies in preclinical models, supporting the clinical investigation of VEGF blockades to further enhance BsAb-based T cell immunotherapies.
Risk of relapse of ANCA-associated vasculitis among patients homozygous for the proteinase 3 gene Val119Ile polymorphism
Authors: Casal Moura Marta , Deng Zuoming , Brooks Stephen R , Tew Wei , Fervenza Fernando C , Kallenberg Cees G M , Langford Carol A , Merkel Peter A , Monach Paul A , Seo Philip , Spiera Robert F , St Clair E William , Stone John H , Prunotto Marco , Grayson Peter C , Specks Ulrich 
Published: March 2023

BackgroundThe frequency of proteinase 3 gene (PRTN3) polymorphisms in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is not fully characterised. We hypothesise that the presence of a PRTN3 gene polymorphism (single nucleotide polymorphism (SNP) rs351111) is relevant for clinical outcomes.MethodsDNA variant calling for SNP rs351111 (chr.19:844020, c.355G>A) in PRTN3 gene assessed the allelic frequency in patients with PR3-AAV included in the Rituximab in ANCA-Associated Vasculitis trial. This was followed by RNA-seq variant calling to characterise the mRNA expression. We compared clinical outcomes between patients homozygous for PRTN3-Ile119or PRTN3-Val119.ResultsWhole blood samples for DNA calling were available in 188 patients. 75 patients with PR3-AAV had the allelic variant: 62 heterozygous PRTN3-Val119Ile and 13 homozygous for PRTN3-Ile119. RNA-seq was available for 89 patients and mRNA corresponding to the allelic variant was found in 32 patients with PR3-AAV: 25 heterozygous PRTN3-Val119Ile and 7 homozygous for PRTN3-Ile119. The agreement between the DNA calling results and mRNA expression of the 86 patients analysed by both methods was 100%. We compared the clinical outcomes of 64 patients with PR3-AAV: 51 homozygous for PRTN3-Val119and 13 homozygous for PRTN3-Ile119. The frequency of severe flares at 18 months in homozygous PRTN3-Ile119was significantly higher when compared with homozygous PRTN3-Val119(46.2% vs 19.6%, p=0.048). Multivariate analysis identified homozygous PR3-Ile119as main predictor of severe relapse (HR 4.67, 95% CI 1.16 to 18.86, p=0.030).ConclusionIn patients with PR3-AAV, homozygosity for PRTN3-Val119Ile polymorphism appears associated with higher frequency of severe relapse. Further studies are necessary to better understand the association of this observation with the risk of severe relapse.
Amiata donkey body conformation, udder characteristics, and their relationship with milk yield and quality
Authors: Salari Federica , Altomonte Iolanda , Boselli Carlo , Martini Mina 
Published: March 2023

To date, no selective actions have been taken to improve milk traits in dairy donkeys, and the characteristics of the udder are not well defined in relation to the productive characteristics. This study aimed at increasing knowledge on Amiata dairy donkey body conformation, udder traits, and their relationship with milk yield and quality. Morphological, udder, and teat measurements and milk evaluations of 45 pluriparous jennies were carried out. The average wither height of the jennies was 126 cm and the chest girth was 148 cm; a large standard deviation of some body measurements was found. Forty-nine percent of the animals showed a moderately developed udder, while most of the jennies had symmetrical half-udders (96%) and the intermammary cleft was clearly visible in 53% of subjects. Correlation analysis indicated that bigger animals tend to have bigger udders, higher teat diameter, and greater distance between teat tips. A positive correlation between the teat length and the milk fat was found ( p < 0.01), which suggests that jennies with longer teats have a better ability to release milk fat. The results of this paper may be useful to define the characteristics of the milking device and address selective choices of the animals.
Formación en promoción de autonomía y apoyo pedagógico durante confinamiento por covid-19
Authors: Rojas-Ospina Tatiana , Ochoa-Angrino Solanlly , Tovar-Aguirre Alexander 
Published: March 2023

(analítico)Se analiza la implementación de un programa de formación docente en promoción de autonomía y apoyo pedagógico y su relación con el compromiso de niños en el aula. El programa se desarrolló durante el cierre de escuelas por la pandemia causada por el covid-19. Se usó diseño mixto convergente-paralelo. Participaron cinco docentes de primaria, de escuelas públicas de Cali, Colombia, y sus estudiantes (N=110). La formación consistió en dos talleres grupales y tressesiones de acompañamiento individual en modalidad virtual. Se grabaron las clases antes y durante el proceso, codificándose las interacciones. Se observó alta variabilidad en promoción de autonomía y apoyo pedagógico. El compromiso de los niños fue mayor cuando las profesoras promovían mayor autonomía y apoyo pedagógico. Se discutieron variables que afectan el aprovechamiento de la formación.
Palabras clave: Apoyo a la autonomía; apoyo pedagógico; compromiso; programa de formación; pandemia; educación básica; docentes; TIC. Tesauro de Ciencias Sociales de la Unesco.
Improving Estimates of Transitions from Satellite Data: A Hidden Markov Model Approach
Authors: Torchiana Adrian L. , Rosenbaum Ted , Scott Paul T. , Souza-Rodrigues Eduardo 
Published: March 2023

Abstract
Satellite-based image classification facilitates low-cost measurement of the Earth’s surface composition. However, misclassified imagery can lead to misleading conclusions about transition processes. We propose a correction for transition rate estimates based on the econometric measurement error literature to extract the signal (truth) from its noisy measurement (satellite-based classifications). No ground-truth data are required in the implementation. Our proposed correction produces consistent estimates of transition rates, confirmed by longitudinal validation data, while transition rates without correction are severely biased. Using our approach, we show how eliminating deforestation in Brazil’s Atlantic forest region through 2040 could save $100 billion in CO2 emissions.
Man vs. Machine: Technological Promise and Political Limits of Automated Regulation Enforcement
Authors: Browne Oliver R. , Gazze Ludovica , Greenstone Michael , Rostapshova Olga 
Published: March 2023

Abstract
New technologies allow perfect detection of environmental violations at near-zero marginal cost, but take-up is low. We conducted a field experiment to evaluate enforcement of water conservation rules with smart meters in Fresno, CA. Households were randomly assigned combinations of enforcement method (automated or in-person inspections) and fines. Automated enforcement increased households' punishment rates from 0.1 to 14%, decreased summer water use by 3%, and reduced violations by 17%, while higher fine levels had little effect. However, automated enforcement also increased customer complaints by 1,102%, ultimately causing its cancellation and highlighting that political considerations limit technological solutions to enforcement challenges.
On the Fringes of Aid: Humanitarian Organisations and Sudanese Refugees in the Democratic Republic of Congo, 1966–1972
Authors: Rich Jeremy 
Published: March 2023

Abstract
Thousands of Southern Sudanese refugees fled southward into the Orientale province of the Democratic Republic of Congo in the late 1960s. This article examines the challenges posed by fragmentary archival sources from humanitarian organisations, and a small number of interviews, for understanding the actions of Sudanese refugees as they entered a province already battered by civil war. Expatriate staff struggled to negotiate with the Congolese and Sudanese governments, who both wanted to limit the threat of rebels. Furthermore, the particular goals and recordkeeping methods of humanitarian organisations post major challenges for interpreting the sources. However, oral testimonies of former aid workers and refugees demonstrate that Sudanese refugees did clearly shape their journeys and how they negotiated with refugee assistance programmes. This article thus offers new perspectives for researchers on the value and pitfalls of various individual humanitarian agency records.
Remarks on the Character Yan 延 in the Geling 葛陵 Chu Manuscripts
Authors: Feng (馮馳) Chi 
Published: March 2023

Abstract
In the Geling 葛陵 Chu 楚 manuscripts, there are a number of characters usually transcribed as yan 延 in published transcriptions. This essay suggests a tentative interpretation of these characters. The first section examines four types of direct transcriptions and their interpretive transcriptions. Then, the essay argues these variations are graphic rather than lexical. In its context, the phrase yan zhong 延鐘 can be translated as “melodic bells,” and the emphasis on melodic bells serves to highlight the high rank of ritual.
Reconsidering the Slip Order and Reading of the Yuelu Academy Qin Wei li zhi guan ji qianshou 爲吏治官及黔首 Manuscript
Authors: Chen (陳松長) Songchang 
Published: March 2023

Abstract
In light of recent advances made in research on the Yuelu Academy Qin Wei li zhi guan ji qianshou manuscript, the present article reconsiders issues surrounding the manuscript’s slip order and the reading of its text. A new arrangement is given, with two missing slips restored to the manuscript, an additional fragment re-pieced together, and an explanation provided for the logic behind the overall organization of the text’s content.
Evaluation of Pulse Aerosol Forcing on Marine Stratocumulus Clouds in the Context of Marine Cloud Brightening
Authors: Prabhakaran Prasanth , Hoffmann Fabian , Feingold Graham 
Published: March 2023

Abstract
We explore the effect of aerosol perturbations on stratocumulus clouds in the context of marine cloud brightening (MCB) using high-resolution large-eddy simulations. We use a Lagrangian cloud microphysical model with a very detailed treatment of aerosol activation and droplet growth. The aerosol forcing is represented as a finite-width rectangular pulse in time (uniform in space). We analyze three stratocumulus cloud systems differing in their surface precipitation rate: namely, nonprecipitating, intermediate, and precipitating. We report on the diurnal evolution of these cloud systems subjected to a range of perturbations characterized by varying the amplitude and duration of the aerosol forcing pulse. Our simulations show that in the nonprecipitating system, the clouds are relatively insensitive to duration and amplitude, and are sensitive only to the total number concentration of the injected aerosol. In contrast, the precipitating cloud system is affected by the duration and the amplitude of the forcing, with the sensitivity conditional on the state of the cloud system before the injection of aerosol particles. We use these case studies to assess the efficacy of potential MCB spraying strategies. Our analysis shows that negative LWP adjustments offset a substantial fraction of the Twomey-induced brightening in all three cloud systems. This is countered by substantial cloud brightening obtained through precipitation-suppression-induced cloud-fraction adjustments.
Modulation of Mid–High-Latitude Intraseasonal Variability on the Occurrence Frequency of Northeast China Cold Vortex in Early Summer
Authors: Zhou Fang , Fang Yi-He , Shi Jian , Liu Chenghan 
Published: March 2023

Abstract
The influence of mid–high-latitude intraseasonal variability (ISV) on the occurrence frequency of the Northeast China cold vortex (NCCV) in early summer was examined through statistical analysis and thermal–dynamic diagnostics. A multivariable empirical orthogonal function (MVEOF) was employed to extract the thermal–pressure coupled ISV mode. Our results show that the geopotential height and air temperature over the NCCV active region exhibit a statistically significant intraseasonal periodicity of 20–60 days. The dominant ISV mode features a westward-propagated zonal dipole pattern, which is generated over the Lake Baikal region and triggered by intraseasonal wave energy accumulation. By dividing the ISV cycle into eight phases, it is found that more NCCVs with a large scope occur in phases 5–8 than those in phases 1–4. The positive (negative) geopotential height and air temperature tendencies in phases 1–4 (5–8) act to suppress (facilitate) the NCCV activity. The thermodynamic tendency budget and scale decomposition reveal that when an anomalous intraseasonal cyclonic circulation propagates westward from Lake Baikal to the Ural Mountains, the anomalous southwesterly transports mean negative vorticity from the north side of the Tibetan Plateau to Northeast Asia and transports mean warm air temperature from low latitudes to high latitudes, leading to the positive geopotential height and air temperature tendencies and thereby restraining the NCCV activity. The opposite is also true for the facilitation of the NCCV modulated by the negative geopotential height and air temperature tendencies.

Significance Statement
The purpose of this study is to better understand the factors controlling the Northeast China cold vortex (NCCV) activity in early summer. It is important because influences of the subtropical monsoonal circulation are usually confined to southern China in this season and the anomalous atmospheric circulation from the mid–high latitudes plays a more important role in the generation of the NCCV. Our results provide a guide on how intraseasonal variability at mid–high latitudes controls the occurrence frequency of the NCCV and highlight the process of thermal and dynamical modulation in the NCCV.
Flippin’ χSOLO, an Upper-Ocean Autonomous Turbulence-Profiling Float
Authors: Moum James N. , Rudnick Daniel L. , Shroyer Emily L. , Hughes Kenneth G. , Reineman Benjamin D. , Grindley Kyle , Sherman Jeffrey T. , Vutukur Pavan , Appledorn Craig Van , Latham Kerry , Moulin Aurélie J. , Johnston T. M. Shaun 
Published: March 2023

Abstract
A new autonomous turbulence profiling float has been designed, built, and tested in field trials off Oregon. Flippin’ χSOLO (FχS) employs a SOLO-II buoyancy engine that not only changes but also shifts ballast to move the center of mass to positions on either side of the center of buoyancy, thus causing FχS to flip. FχS is outfitted with a full suite of turbulence sensors—two shear probes, two fast thermistors, and pitot tube, as well as a pressure sensor and three-axis linear accelerometers. FχS descends and ascends with turbulence sensors leading, thereby permitting measurement through the sea surface. The turbulence sensors are housed antipodal from communication antennas so as to eliminate flow disturbance. By flipping at the sea surface, antennas are exposed for communications. The mission of FχS is to provide intensive profiling measurements of the upper ocean from 240 m and through the sea surface, particularly during periods of extreme surface forcing. While surfaced, accelerometers provide estimates of wave height spectra and significant wave height. From 3.5 day field trials, here we evaluate (i) the statistics from two FχS units and our established shipboard profiler, Chameleon, and (ii) FχS-based wave statistics by comparison to a nearby NOAA wave buoy.

Significance Statement
The oceanographic fleet of Argo autonomous profilers yields important data that define the state of the ocean’s interior. Continued deployments over time define the evolution of the ocean’s interior. A significant next step will be to include turbulence measurements on these profilers, leading to estimates of thermodynamic mixing rates that predict future states of the ocean’s interior. An autonomous turbulence profiler that employs the buoyancy engine, mission logic, and remote communication of one particular Argo float is described herein. The Flippin’ χSOLO is an upper-ocean profiler tasked with rapid and continuous profiling of the upper ocean during weather conditions that preclude shipboard profiling and that includes the upper 10 m that is missed by shipboard turbulence profilers.