bluuebunny/crossref_metadata_2025_split huggingface dataset:
What We Hear That Physicians Don’t
Authors: Weiner Saul J. , Schwartz Alan 
Published: July 2023

Abstract
Chapter 4, “What We Hear That Physicians Don’t,” is a technical breakdown of how to analyze contextualization of care using data collected from audio-recorded encounters and the medical record. In particular, it describes in detail the “4C” content coding system introduced in the previous chapter. Coding content, in contrast to coding of process, requires following the thread and logic of a conversation. 4C identifies contextual red flags (clues that there may be relevant context), contextual probes (attempts to explore the clues), contextual factors (discovered by probes or revealed by the patient), and contextualized care plans (responsive to patient context). This chapter also explains the need for 4C, which is that other approaches to assessing communication in doctor–patient communication research do not capture information on whether clinicians are actually paying attention to and addressing key information that comes up during the medical encounter.
High versus Low Performers
Authors: Weiner Saul J. , Schwartz Alan 
Published: July 2023

Abstract
Chapter 5, “High versus Low Performers,” asks and answers the question “What makes a clinician good at this?” From an analysis of high, medium, and low performers, the authors have identified six attributes that lead a physician either to overlook context or to recognize and incorporate it. The archetype of a clinician who exemplifies all of the skills for attending to the complexity of context in decision-making is an individual who is flexible rather than rigid in conversation, does not let checklists get in the way of building and testing theories about what might be going on, avoids drawing conclusions prematurely in the face of conflicting evidence, looks for opportunities in every visit to provide some level of care to the patient right now, manages rather than is managed by electronic medical record technology, and is capable of seeing the linkages between patients’ life situations and their clinical care.
Is Lasting Change Possible?
Authors: Weiner Saul J. , Schwartz Alan 
Published: July 2023

Abstract
Chapter 7, “Is Lasting Change Possible?,” describes three different interventions designed to reduce contextual error rates, improving contextualization of care. In the first, termed “audit and feedback,” physicians and other health-care professionals receive ongoing data on their performance at contextualizing care, based on analysis of audio recordings of encounters with their patients. In the second, the feedback is based on data collected by unannounced standardized patients. These interventions are like “holding a mirror up” to the clinician so that they can see what their care looks like, both the good (contextualized care) and the bad (contextual errors), and adapt accordingly. In the third intervention, clinical decision support tools in the electronic medical record guide physicians to contextualize care, drawing on data provided by patients before the visits and from their medical record.
What We Can’t Measure That Matters
Authors: Weiner Saul J. , Schwartz Alan 
Published: July 2023

Abstract
Chapter 8, “What We Can’t Measure That Matters,” addresses the limitations of the measures described in this book for capturing what they are designed to measure. In an effort not to overreach and to retain high levels of inter-rater agreement and strong evidence for validity of the construct of contextual error, the coding methodology “4C” applies the term only to the most straightforward instances during clinical encounters where it applies. The benefit of the approach is that the system is highly specific in identifying contextual errors but not particularly sensitive. The concepts of engagement and boundary clarity are introduced to describe ideal clinician behaviors that result in highly contextualized care, beyond the bounds of what is currently measurable.
Bringing Context Back into Care
Authors: Weiner Saul J. , Schwartz Alan 
Published: July 2023

Abstract
Chapter 9, “Bringing Context Back into Care,” reviews the core findings of research on contextualizing of care—that contextual errors are measurable, pervasive, diminish health-care outcomes, increase costs, and are preventable. Addressing the problem will require a broader appreciation of its significance and a commitment to change. Stakeholders, particularly payers and regulators, must hold physicians and all providers accountable for improved attention to patient context in care planning. Doing so will likely require widespread audit and feedback methods, including the use of unannounced standardized patients and real patients who are comfortable audio-recording their care. Medical schools and medical educators must also address a deficit in contextual reasoning skills by revising curricula to include attention to patient context in all clinical case-based instruction.
Introduction
Authors: Navin Mark C. , Attwell Katie 
Published: July 2023

AbstractIn 2015, California eliminated nonmedical exemptions to school vaccine mandates. Unvaccinated children were excluded from school if they did not have medical reasons not to be vaccinated. California’s new mandatory vaccination policy was a watershed moment in the history of American public health. It replaced efforts to persuade and nudge parents to vaccinate with potentially coercive threats: Either vaccinate your children or miss out on school. California’s elimination of nonmedical exemptions—and the political battles that preceded and followed that policy change—heralded a new kind of partisan politics for childhood immunization policy. Immunization policy changes in California illustrate the emergence of national and international trends in immunization governance that precede and will likely extend past the COVID-19 pandemic.
The Mandates & Exemptions Regime
Authors: Navin Mark C. , Attwell Katie 
Published: July 2023

AbstractEvery state in the United States has had school vaccine mandates for decades, but until recently, almost all states offered nonmedical exemptions (NMEs). The widespread availability of NMEs helped state vaccine mandates to be objects of political consensus. Recent efforts to eliminate nonmedical exemptions therefore aim to transform America’s immunization governance. This chapter identifies the origins of the “mandates & exemptions” regime in the United States and traces the recent history of school vaccine requirements. It explains why schools were natural locations for immunization governance, and it reviews the history, law, and ethics of religious and philosophical exemptions to vaccine mandates.
Mobilizing for the Nonmedical Exemptions Bill
Authors: Navin Mark C. , Attwell Katie 
Published: July 2023

AbstractThis chapter explains how a network of California parents and civil society organizations worked with elected officials to eliminate nonmedical exemptions. Parent activists responded to outbreaks in their communities by mobilizing against the permissive attitude that California’s government took toward vaccine refusal. After the Disneyland measles outbreak of 2014, pro-vaccine parents contacted Dr. Richard Pan, a California state senator who had led successful efforts to limit California’s nonmedical exemptions in 2012. Pan encouraged parents to be the public face of his new campaign to eliminate nonmedical exemptions. Their organization, Vaccinate California, lobbied for Pan’s new bill and recruited other parents to their movement. Along with health and medical civil society organizations, Vaccinate California shepherded a bill to eliminate nonmedical exemptions, Senate Bill 277, through California’s legislature.
Drawing the Wrong Lessons from the History of Mandates
Authors: Navin Mark C. , Attwell Katie 
Published: July 2023

AbstractContemporary advocates of eliminating nonmedical exemptions—or of otherwise tightening vaccine mandates—often invoke historical examples to support their cause. However, previous eras’ more coercive vaccine mandates were enforced against populations whose ethical and political sensibilities were very different from those of today. Recent decades have witnessed the institutionalization of many limits on public health powers, including resistance to coercive interventions on the bodies of America’s most vulnerable members, institutional protections of individual liberty, and the promotion of informed consent. Furthermore, previous instances of coercive vaccine mandates sometimes caused popular backlashes against immunization governance, as in the case of late-19th-century England. Current efforts to introduce greater coercion into vaccine policy risk similar kinds of political backlash.
The Ethics and Public Acceptability of Mandates
Authors: Navin Mark C. , Attwell Katie 
Published: July 2023

AbstractThis chapter evaluates efforts to eliminate nonmedical exemptions to school entry vaccinate mandates from an ethical and pragmatic standpoint. It examines three arguments that critics often raise against coercive vaccine mandates for daycare or school: parents’ rights, informed consent, and children’s rights to care and education. Then it evaluates four arguments that proponents offer in defense of such policies: children’s right to receive vaccines, preventing disease transmission, the duty to contribute to herd immunity, and the overall social benefits associated with high rates of vaccination. Finally, it expresses skepticism about the potential for today’s coercive vaccine mandates to eradicate or eliminate disease (or even to achieve stable disease control). Accordingly, today’s vaccine mandates need to be justified by their short-term and often more moderate benefits, and their potential harms must be given greater comparative weight.
Simulation of polarized emission from recollimation shocks in relativistic jets
Authors: Kaye C , Cawthorne T V , Marti J-M , Hughes P A 
Published: July 2023

ABSTRACT
This paper presents a method for obtaining synthetic images of linearly polarized synchrotron radiation from steady-state numerical simulations of relativistic jets, in which the magnetic field is assumed to be initially either partially or completely disordered. The method is based on the earlier work which characterized the deformation of the fluid using infinitessimal fluid elements that are initially cubic, and which evolve into parallelepipeds. The method is described for a range of models for the initial magnetic field, including ordered components that are axial, helical, and toroidal with a bi-directional axial component. The method is then applied to steady, axisymmetric simulations of initially overpressured jets and the initial results are discussed. Some characteristic patterns and trends in polarization angle are identified. Although the recollimation shocks that form in these jets are not clearly visible in the total intensity images presented here, arcs of strongly polarized emission associated with radial velocity gradients in the vicinity of the shock waves are seen, and might prove to be a useful diagnostic feature of this model.
Diagnosis of 3D magnetic field and mode composition in MHD turbulence with Y-parameter
Authors: Malik Sunil , Yuen Ka Ho , Yan Huirong 
Published: July 2023

ABSTRACT
Magnetic fields are crucial in numerous astrophysical processes within the interstellar medium (ISM). However, the detailed determination of magnetic field geometry is notoriously challenging. Based on the modern magnetohydrodynamic (MHD) turbulence theory, we introduce a novel statistical technique, the ‘Y-parameter’, to decipher the magnetic field inclination in the ISM and identify dominant turbulence modes. The Y-parameter, calculated as the ratio of anisotropies of different Stokes parameter combinations, displays contrasting trends with the mean-field inclination angle in Alfvénic and compressible turbulence modes. A Y-parameter value around 1.5 ± 0.5 provide a statistical boundary to determine the dominant MHD turbulence modes. We have discovered specific correlations between the Y-parameter value and the inclination angle that unveil the dominant turbulence mode. This methodology, when applied to future radio polarization surveys such as LOFAR and SKA, promises to significantly enhance our knowledge of 3D magnetic field in the ISM and improve our understanding of interstellar turbulence.
Non-Equilibrium Abundances Treated Holistically (NEATH): the molecular composition of star-forming clouds
Authors: Priestley F D , Clark P C , Glover S C O , Ragan S E , Fehér O , Prole L R , Klessen R S 
Published: July 2023

ABSTRACT
Much of what we know about molecular clouds, and by extension star formation, comes from molecular line observations. Interpreting these correctly requires knowledge of the underlying molecular abundances. Simulations of molecular clouds typically only model species that are important for the gas thermodynamics, which tend to be poor tracers of the denser material where stars form. We construct a framework for post-processing these simulations with a full time-dependent chemical network, allowing us to model the behaviour of observationally important species not present in the reduced network used for the thermodynamics. We use this to investigate the chemical evolution of molecular gas under realistic physical conditions. We find that molecules can be divided into those that reach peak abundances at moderate densities ($10^3 \, {\rm cm}^{-3}$) and decline sharply thereafter (such as CO and HCN), and those that peak at higher densities and then remain roughly constant (e.g. NH3, N2H+). Evolving the chemistry with physical properties held constant at their final values results in a significant overestimation of gas-phase abundances for all molecules, and does not capture the drastic variations in abundance caused by different evolutionary histories. The dynamical evolution of molecular gas cannot be neglected when modelling its chemistry.
On the pollution of white dwarfs by exo-Oort cloud comets
Authors: O’Connor Christopher E , Lai Dong , Seligman Darryl Z 
Published: July 2023

ABSTRACT
A large fraction of white dwarfs (WDs) have metal-polluted atmospheres, which are produced by accreting material from remnant planetary systems. The composition of the accreted debris broadly resembles that of rocky Solar system objects. Volatile-enriched debris with compositions similar to long-period comets (LPCs) is rarely observed. We attempt to reconcile this dearth of volatiles with the premise that exo-Oort clouds (XOCs) occur around a large fraction of planet-hosting stars. We estimate the comet accretion rate from an XOC analytically, adapting the ‘loss cone’ theory of LPC delivery in the Solar system. We investigate the dynamical evolution of an XOC during late stellar evolution. Using numerical simulations, we show that 1–30 per cent of XOC objects remain bound after anisotropic stellar mass-loss imparting a WD natal kick of ${\sim}1 \, {\rm km \, s^{-1}}$. We also characterize the surviving comets’ distribution function. Surviving planets orbiting a WD can prevent the accretion of XOC comets by the star. A planet’s ‘dynamical barrier’ is effective at preventing comet accretion if the energy kick imparted by the planet exceeds the comet’s orbital binding energy. By modifying the loss cone theory, we calculate the amount by which a planet reduces the WD’s accretion rate. We suggest that the scarcity of volatile-enriched debris in polluted WDs is caused by an unseen population of 10–$100 \, \mathrm{au}$ scale giant planets acting as barriers to incoming LPCs. Finally, we constrain the amount of volatiles delivered to a planet in the habitable zone of an old, cool WD.
Apical fibrobullous lung disease in spondyloarthritis patients with biologic DMARDs indication
Authors: Ozsoy Zehra , Ayan Gizem , Durhan Gamze , Kalyoncu Umut 
Published: July 2023

Abstract

Objective
The rate of pleuroparenchymal involvement in patients with SpA varies widely, from 0% to 85%. The most common form is apical fibrobullous disease (AFLD). The aim of this study was to determine the incidence of AFLD and associated factors in SpA patients under and/or planned to start biologic DMARDs (bDMARDs) therapy.

Methods
The records of 3021 SPA patients registered with HUR-BIO who had indication of bDMARDs between 2010 and 2021 were scanned. The study included 2489 patients with at least one chest radiograph (X-ray). Patient demographics, comorbidities, laboratory data, bDMARDs used, baseline DASs, and purified protein derivative and/or QuantiFERON test results before initiation of bDMARDs were recorded.

Results
Of the 2489 patients, 36 (1.4%) were found to have AFLD by X-ray and/or CT. The mean disease duration was 11.7 (7.1) years. Patients with AFLD were more likely to be male [28 (77.8%) vs 1321 (53.9%), P = 0.004], older [56.3 (10.5) years vs 44.8 (11.4) years, P &lt; 0.001], heavy smokers [27 (79.4%) vs 1468 (60.9%), P = 0.028] and have had longer disease duration [17. 7 (9.7) years vs 11.6 (7) years, P = 0.001]. QuantiFERON positivity was higher in the AFLD group [9 (36%) vs 309 (16.1%), P = 0.013]. While treatment with adalimumab was less preferred in those with AFLD, treatment with etanercept was more frequently preferred.

Conclusion
As the radiological findings of AFLD can be confused with those of tuberculosis, special attention should be paid to differentiating between tuberculosis and the disease in males and in patients who have had long disease duration.
Human cell-based in vitro systems to assess respiratory toxicity: a case study using silanes
Authors: Sharma Monita , Stucki Andreas O , Verstraelen Sandra , Stedeford Todd J , Jacobs An , Maes Frederick , Poelmans David , Van Laer Jo , Remy Sylvie , Frijns Evelien , Allen David G , Clippinger Amy J 
Published: July 2023

Abstract
Inhalation is a major route by which human exposure to substances can occur. Resources have therefore been dedicated to optimize human-relevant in vitro approaches that can accurately and efficiently predict the toxicity of inhaled chemicals for robust risk assessment and management. In this study—the IN vitro Systems to PredIct REspiratory toxicity Initiative—2 cell-based systems were used to predict the ability of chemicals to cause portal-of-entry effects on the human respiratory tract. A human bronchial epithelial cell line (BEAS-2B) and a reconstructed human tissue model (MucilAir, Epithelix) were exposed to triethoxysilane (TES) and trimethoxysilane (TMS) as vapor (mixed with N2 gas) at the air-liquid interface. Cell viability, cytotoxicity, and secretion of inflammatory markers were assessed in both cell systems and, for MucilAir tissues, morphology, barrier integrity, cilia beating frequency, and recovery after 7 days were also examined. The results show that both cell systems provide valuable information; the BEAS-2B cells were more sensitive in terms of cell viability and inflammatory markers, whereas MucilAir tissues allowed for the assessment of additional cellular effects and time points. As a proof of concept, the data were also used to calculate human equivalent concentrations. As expected, based on chemical properties and existing data, the silanes demonstrated toxicity in both systems with TMS being generally more toxic than TES. Overall, the results demonstrate that these in vitro test systems can provide valuable information relevant to predicting the likelihood of toxicity following inhalation exposure to chemicals in humans.
Longitudinal dose patterns among patients newly initiated on long-term opioid therapy in the United States, 2018 to 2019: an observational cohort study and time-series cluster analysis
Authors: Rikard S. Michaela , Nataraj Nisha , Zhang Kun , Strahan Andrea E. , Mikosz Christina A. , Guy Gery P. 
Published: July 2023

Abstract
Opioid prescribing varies widely, and prescribed opioid dosages for an individual can fluctuate over time. Patterns in daily opioid dosage among patients prescribed long-term opioid therapy have not been previously examined. This study uses a novel application of time-series cluster analysis to characterize and visualize daily opioid dosage trajectories and associated demographic characteristics of patients newly initiated on long-term opioid therapy. We used 2018 to 2019 data from the IQVIA Longitudinal Prescription (LRx) all-payer pharmacy database, which covers 92% of retail pharmacy prescriptions dispensed in the United States. We identified a cohort of 277,967 patients newly initiated on long-term opioid therapy during 2018. Patients were stratified into 4 categories based on their mean daily dosage during a 90-day baseline period (<50, 50-89, 90-149, and ≥150 morphine milligram equivalent [MME]) and followed for a 270-day follow-up period. Time-series cluster analysis identified 2 clusters for each of the 3 baseline dosage categories <150 MME and 3 clusters for the baseline dosage category ≥150 MME. One cluster in each baseline dosage category comprised opioid dosage trajectories with decreases in dosage at the end of the follow-up period (80.7%, 98.7%, 98.7%, and 99.0%, respectively), discontinuation (58.5%, 80.0%, 79.3%, and 81.7%, respectively), and rapid tapering (50.8%, 85.8%, 87.5%, and 92.9%, respectively). These findings indicate multiple clusters of patients newly initiated on long-term opioid therapy who experience discontinuation and rapid tapering and highlight potential areas for clinician training to advance evidence-based guideline-concordant opioid prescribing, including strategies to minimize sudden dosage changes, discontinuation, or rapid tapering, and the importance of shared decision-making.
The effect of brace use on balance in individuals with adolescent idiopathic scoliosis
Authors: Yilmaz Kamil , Akkoyun Sert Ozlem , Bagcaci Sinan , Kimyongok Ozan 
Published: July 2023

Background:
Patients with adolescent idiopathic scoliosis (AIS) have poorer standing balance compared with their healthy peers. However, the immediate effects of the braces used in the treatment on balance remain uncertain.

Objective:
To investigate the effect of brace use on balance and weight-bearing symmetry in patients with AIS and to compare the results of different brace designs.

Study design:
Observational.

Methods:
A total of 21 patients with AIS aged 10–17 years using 10 Boston and 11 Cheneau braces participated. Immediate balance and weight-bearing symmetries of patients with and without their own braces were evaluated. Balance assessment was performed using the Sensory Organization Test (SOT) on a computerized dynamic posturography device. Weight-bearing symmetry was evaluated on the computerized dynamic posturography device with the knees in full extension, with the knees flexed at 30°, 60°, and 90°.

Results:
Regardless of its design, it was found that brace use had no effect on immediate balance and weight-bearing symmetry (p > 0.05). Of the patients using a Boston brace, unbraced SOT condition 2, 3, and 5 and composite scores were found to be higher than their braced scores (p < 0.05). Braced SOT condition 3 scores of the patients using a Cheneau brace were higher than those using a Boston brace (p = 0.037). Brace use and brace types have no statistical effect on weight-bearing symmetry.

Conclusions:
It was observed that brace use in patients with AIS has no positive effect on immediate balance and weight-bearing symmetry, and the use of Boston brace negatively affects immediate balance scores and increases visual dependence.