bluuebunny/crossref_metadata_2025_split huggingface dataset:
“We Just Think of Her as One of the Girls”: Applying a Trans Inclusion Staged Model to the Experiences of Trans Children and Youth in UK Primary and Secondary Schools
Authors: Horton Cal , Carlile Anna 
Published: September 2022

Background/Context: Throughout the past decade increasing numbers of trans children are being supported in childhood, with schools in countries across the world tasked with educating a generation of (known) trans pupils. Schools can adopt diverse approaches to inclusion or exclusion of trans pupils, with consequences for trans children’s well-being and safety at school. The literature includes extensive critique of the limitations of common approaches to trans inclusion, highlighting negative impacts on trans pupils. Purpose: This article aims to reframe and bring nuance to conversations on trans inclusion in education, drawing on primary research in the UK to make explicit different approaches to trans inclusion, their ideological underpinnings, and their implications for how trans children are welcomed in our schools. Setting: The research took place in the UK, with interviews conducted at a time of escalation of anti-trans discourse in UK courts and media. Population: This article draws on data from two qualitative research projects focusing on the experiences of trans and nonbinary children and their parents in the UK: one focusing on trans children aged 3–12 years, and the other on trans young people aged 12–18 years. Research Design: Semi-structured interviews explored trans children’s experiences in education in the UK, with a focus on trans-inclusive approaches to school culture, restrooms, and team sports. Data were analyzed against the trans inclusion staged model (TISM), a framework for distinguishing between different approaches to trans inclusion. Findings: Within the TISM we differentiate between trans-oppressive, trans-assimilationist, trans-accommodative, and trans-emancipatory approaches to educational inclusion. Interviews highlighted the harms and injustices in nonemancipatory approaches, revealing the role of cis supremacy in forcing trans pupils into positions of vulnerability. Conclusion/Recommendations: The TISM emphasizes the structural and systemic nature of trans oppression, illuminating the power imbalances embedded in nonemancipatory approaches, and acknowledging the need for fundamental reform. We recommend analysis and recognition of school practices that are trans-oppressive, trans-assimilationist, trans-accommodative, or trans-emancipatory. We call for increased recognition of cis supremacy within education and commitment to emancipatory approaches to trans inclusion, enabling progress toward equity and gender justice in our schools.
“Basement Boys” in the All-Gender Bathroom: Investigating Student-Inspired Trans-Activism and White Cisgenderist Barriers to Supporting Trans Students in School
Authors: Omercajic Kenan 
Published: September 2022

Background/Context: The experiences of trans students in all-gender bathrooms are largely underexplored, as is the trans-activism by students to procure these spaces. Additionally, the role of teachers in supporting the creation of these spaces is largely absent from research regarding bathroom spaces. Purpose: This article elucidates the impact of student-inspired trans-activism that was mobilized through a gender studies educator in an urban school and her class project to foster trans inclusivity that resulted in the creation of two all-gender bathrooms. Participants: Four participants were involved in this study: a gender studies teacher, and her three students who either contributed to the creation of the all-gender bathrooms or actively used them following their implementation. Research Design: This qualitative paradigmatic case study took place at one high school (Capital High) and employs thematic and trans-informed theoretical analysis to semi-structured interviews to elucidate the potentialities and limitations of student-led trans-activism and the barriers to bathroom access. Findings: Emergent from this research is the significance of supportive educators and trans-inclusive education that collectively contribute to the overall trans-inclusive climate. However, pervasive white cistems exposed white male gender entitlement and the forces of cisgenderism at play in the school system, which amounted to the colonization of the all-gender bathrooms at Capital High by the “Basement Boys.” Conclusion/Recommendations: The findings endorse the need to move beyond bathroom policy reform, and rely on a singular gender facilitative teacher to address the problem of cisgenderism. More gender-expansive commitments beyond one teacher’s classroom are required, such as system-level directives that support integrating trans-affirmative education across the curriculum and resources to foster ongoing professional development in schools.
Efficiency of endovenous laser and glue ablation methods in comparison with conventional surgery for the treatment of venous ulcers
Authors: Erdinc Ibrahim 
Published: September 2022

Introduction In this study, we aimed to investigate the efficiency of endovenous laser and glue ablation techniques and compared the results with conventional surgical stripping. Patients and Methods Between January 2005 and January 2020, among 3133 consecutive patients with superficial venous reflux disease receiving treatment at our institution, there were 112 consecutive patients with active venous ulcers. Patients were divided into 3 groups as receiving conventional open surgical treatment (Group 1, n: 70), endovenous glue ablation (Group 2, n: 20), and endovenous laser ablation (Group 3, n: 22). Comorbidity factors, duration and size of the ulcers, deep, perforating, and small saphenous vein disease detected with detailed Doppler ultrasonography, and duration for healing and recurrence were investigated. Results The age, gender, comorbidities, smoking, history of previous treatment, diameter of the small saphenous vein, number of refluxing perforating veins, size of the ulcer, and ulcer recurrence ratio were not significantly different between groups. There were 7 patients with bilateral disease and in total 119 legs were intervened. Mean durations for complete ulcer healing were significantly lower in Group 1 (53.28 ± 22.1 days) than Group 2 (73.7 ± 39.6 days); however, it did not differ significantly between Group 1 and Group 3 (62.59 ± 19.65 days), and Group 2 and Group 3 ( p: 0.26). Ulcers recurred in 23 patients (33%) in stripping group at a mean follow up of 14.42 ± 4.6 months, in 7 patients (35%) in glue ablation group at a mean follow up of 11.97 ± 2.94 months, and in 5 patients (23%) in laser ablation group at a mean follow up of 12.66 ± 3.48 months ( p > 0.05 for all). Increased body mass index, co-existence of chronic venous insufficiency, active cigarette smoking, non-compliance with physician advises and exercise and compression stockings, and depth of the ulcers were correlated with recurrence. Conclusion The rationelle beyond treatment of the venous ulcers and prevention of recurrence relies on relief of the venous hypertension by interventional methods and/or compression therapy. None of the methods is superior over the others. Healing in short term without further recurrence may be achieved with successful intervention as well as good patient compliance.
Operating on Anxiety: Negative Affect toward Breast Cancer and Choosing Contralateral Prophylactic Mastectomy
Authors: Silverstein Michael C. , Lee Clara N. , Scherer Laura D. , Phommasathit Crystal , Merrill Andrea L. , Peters Ellen 
Published: September 2022

Background Rates of contralateral prophylactic mastectomy (CPM)—removal of the healthy breast following breast cancer diagnosis—have increased, particularly among women for whom CPM provides no survival benefit. Affective (i.e., emotional) decision making is often blamed for this increase. We studied whether greater negative breast cancer affect could motivate uptake of CPM through increased cancer risk perceptions and biased treatment evaluations. Methods We randomly assigned healthy women with average breast-cancer risk ( N = 1,030; Mage = 44.14, SD = 9.23 y) to 1 of 3 affect conditions (negative v. neutral v. positive narrative manipulation) in a hypothetical online experiment in which they were asked to imagine being diagnosed with cancer in one breast. We assessed 1) treatment choice, 2) affect toward CPM, and 3) perceived risk of future breast cancer in each breast (cancer affected and healthy) following lumpectomy, single mastectomy, and CPM. Results The manipulation caused women in the negative and neutral narrative conditions (26.9% and 26.4%, respectively) to choose CPM more compared with the positive narrative condition (19.1%). Across conditions, women’s CPM affect did not differ. However, exploratory analyses addressing a possible association of affect toward cancer-related targets suggested that women in the negative narrative condition may have felt more positively toward CPM than women in the positive narrative condition. The manipulation did not have significant effects on breast cancer risk perceptions. Limitations The manipulation of affect had a small effect size, possibly due to the hypothetical nature of this study and/or strong a priori knowledge and attitudes about breast cancer and its treatment options. Conclusion Increased negative affect toward breast cancer increased choice of CPM over other surgical options and might have motivated more positive affective evaluations of CPM. Highlights This study used narratives to elicit different levels of negative integral affect toward breast cancer to investigate the effects of affect on breast cancer treatment choices. Increased negative affect toward breast cancer increased the choice of double mastectomy over lumpectomy and single mastectomy to treat a hypothetical, early-stage cancer. The narrative manipulation of negative affect toward breast cancer did not change the perceived risks of future cancer following any of the surgical interventions. Negative affect toward breast cancer may have biased affective evaluations of double mastectomy.
A Quantitative Study of Decision Thresholds for Initiation of Antibiotics in Suspected Sepsis
Authors: Taylor Stephanie Parks , Weissman Gary E. , Kowalkowski Marc , Admon Andrew J. , Skewes Sable , Xia Yunfei , Chou Shih-Hsuing 
Published: September 2022

Background Clinicians’ decision thresholds for initiating antibiotics in patients with suspected sepsis have not been quantified. We aimed to define an average threshold of infection likelihood at which clinicians initiate antibiotics when treating a patient with suspected infection and to evaluate the influence of severity of illness and clinician-related factors on the threshold. Design This was a prospective survey of 153 clinicians responding to 8 clinical vignettes constructed from real-world data from 3 health care systems in the United States. We treated each hour in the vignette as a decision to treat or not treat with antibiotics and assigned an infection probability to each hour using a previously developed infection prediction model. We then estimated decision thresholds using regression models based on the timing of antibiotic initiation. We compared thresholds across categories of severity of illness and clinician-related factors. Results Overall, the treatment threshold occurred at a 69% probability of infection, but the threshold varied significantly across severity of illness categories—when patients had high severity of illness, the treatment threshold occurred at a 55% probability of infection; when patients had intermediate severity, the threshold for antibiotic initiation occurred at an infection probability of 69%, and the threshold was 84% when patients had low severity of illness ( P < 0.001 for group differences). Thresholds differed significantly across specialty, highest among infectious disease and lowest among emergency medicine clinicians and across years of experience, decreasing with increasing years of experience. Conclusions The threshold infection probability above which physicians choose to initiate antibiotics in suspected sepsis depends on illness severity as well as clinician factors. Implications Incorporating these context-dependent thresholds into discriminating and well-calibrated models will inform the development of future sepsis clinical decision support systems. Clinician-related differences in treatment thresholds suggests potential unwarranted variation and opportunities for performance improvement. Highlights Decision making about antibiotic initiation in suspected sepsis occurs under uncertainty, and little is known about clinicians’ thresholds for treatment. In this prospective study, 153 clinicians from 3 health care systems reviewed 8 real-world clinical vignettes representing patients with sepsis and indicated the time that they would initiate antibiotics. Using a model-based approach, we estimated decision thresholds and found that thresholds differed significantly across illness severity categories and by clinician specialty and years of experience.
All-star approach to a small medical imaging dataset: combined deep, transfer, and classical machine learning approaches for the determination of radial head fractures
Authors: Koska Ozgur I , Çilengir Atilla Hikmet , Uluç Muhsin Engin , Yücel Aylin , Tosun Özgür 
Published: September 2022

Background Radial head fractures are often evaluated in emergency departments and can easily be missed. Automated or semi-automated detection methods that help physicians may be valuable regarding the high miss rate. Purpose To evaluate the accuracy of combined deep, transfer, and classical machine learning approaches on a small dataset for determination of radial head fractures. Material and Methods A total of 48 patients with radial head fracture and 56 patients without fracture on elbow radiographs were retrospectively evaluated. The input images were obtained by cropping anteroposterior elbow radiographs around a center-point on the radial head. For fracture determination, an algorithm based on feature extraction using distinct prototypes of pretrained networks (VGG16, ResNet50, InceptionV3, MobileNetV2) representing four different approaches was developed. Reduction of feature space dimensions, feeding the most relevant features, and development of ensemble of classifiers were utilized. Results The algorithm with the best performance consisted of preprocessing the input, computation of global maximum and global mean outputs of four distinct pretrained networks, dimensionality reduction by applying univariate and ensemble feature selectors, and applying Support Vector Machines and Random Forest classifiers to the transformed and reduced dataset. A maximum accuracy of 90% with MobileNetV2 pretrained features was reached for fracture determination with a small sample size. Conclusion Radial head fractures can be determined with a combined approach and limitations of the small sample size can be overcome by utilizing pretrained deep networks with classical machine learning methods.
Comparison of serum Kim-1 and Miox levels in patients that underwent percutaneous nephrolithotomy and flexible ureterorenoscopy
Authors: Altun Abdulsemet , Bozkurt Aliseydi , Erdogan Abdullah , Mertoğlu Cuma , Hirik Erkan , Keskin Ercüment , Turan Abdullah 
Published: September 2022

Objective: Percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) are common surgical methods in the treatment of kidney stones. Possible effects on kidneys are an important factor in determining the surgical procedure and the surgical method. In our study, kidney injury molecule-1 (KIM-1) and myo-inositol oxygenase (MIOX) were used to compare acute kidney injury in patients that underwent PNL and RIRS. Material and Method: Eighty patients aged 20–75, who underwent PNL or RIRS in our urology clinic between November 2018 and February 2020 were included in the study. In this prospective study, the demographic characteristics, stone size, operation time, preoperative and postoperative hemoglobin and biochemistry values of the patients were recorded. About 5 cc blood samples taken from the patients before the operation and at the fourth hour after the operation were centrifuged and kept at −80°C, and the KIM-1 and MIOX levels were measured in the biochemistry department. Results: There was no difference between the groups in terms of demographic data; however, the operation time and length of hospital stay were significantly longer in the PNL group. The mean increase in MIOX was 10.583 ± 9.73 and 7.501 ± 16.46 ng/ml in the PNL and RIRS groups, respectively. Although there was a statistically significant increase in both groups, this increase was greater in the PNL group. A significant increase was observed only in the PNL group in the postoperative period ( p = 0.003). Discussion and Conclusion: The findings of the study suggest that the PNL procedure causes more damage to the kidneys than RIRS.
Accuracy, Reproducibility and User Experience With Standardized Instructions for Measurement of Total Kidney Volume in Autosomal Dominant Polycystic Kidney Disease
Authors: Bevilacqua Micheli , Hague Cameron J. , Romann Alexandra , Levin Adeera 
Published: September 2022

Purpose Total kidney volume (TKV) measurement is integral in clinical management of autosomal dominant polycystic kidney disease (ADPKD) but the gold standard of measurement via stereology/manual planimetry is time-consuming and not readily available to clinicians. This study assessed whether standardized measurement instructions based on an ellipsoid equation enhanced TKV assessment on computed tomographic (CT) images of the kidneys as determined by accuracy, reproducibility, efficiency and/or user acceptability. Methods Participating radiologists were randomized to perform TKV measurements with or without standardized instructions. All participants measured the same 3 non-contrast, low-dose CT scans. Accuracy was assessed as variation from TKV measurements obtained by planimetry. Intraclass correlation coefficients and time to complete the measurements were assessed. Surveys assessed prior experience with TKV measurement and user acceptability of the instructions. Results 49 radiologists participated. There was no difference in accuracy or measurement time between instructed and non-instructed participants. There was a trend towards greater reproducibility with standardized instructions (ICC .8 vs .6). 92% of respondents indicated the instructions were easy to use, 86% agreed the instructions would enhance their comfort with TKV measurement and 75% agreed they would recommend these instructions to colleagues. Conclusions Instructed and non-instructed participants demonstrated similar accuracy and time required for TKV measurement, but instructed participants had a trend towards greater reproducibility. There was high acceptability including enhanced user confidence with the instructions. Standardized instructions may be of value for radiologists seeking to improve their confidence in providing clinicians with TKV measurements necessary to appropriately manage this patient population.
Associations Between Mothers’ Adverse Childhood Experiences, Material Hardship, and Breastfeeding Challenges in the United States
Authors: McCloskey Rebecca J. , Pei Fei 
Published: September 2022

Background: Breastfeeding is the biological norm and is associated with numerous superior health outcomes for children and mothers when compared to human milk substitutes. Yet, breastfeeding difficulties and the inability to meet one’s breastfeeding goals are common in the United States and maybe more common among mothers who have experienced trauma. Research Questions: (1) Are mothers’ adverse childhood experiences, and current experiences of discrimination, material hardship, and decreased social support associated with breastfeeding challenges; and (2) are these experiences associated with the number of breastfeeding challenges reported? Methods: A prospective, non-probability, cross-sectional study design with a diverse sample who had delivered a live baby within the previous year ( N = 306) was conducted. Results: Over 70% of participants reported breastfeeding challenges and 45.2% reported material hardship. Among those who attempted breastfeeding ( n = 286), 74.1% had at least one adverse childhood experience; 30.3% had four or more. Logistic and negative binomial regression models determined that adverse childhood experiences, experiences of discrimination, material hardship, and decreased social support were not associated with experiencing any breastfeeding challenges. However, adverse childhood experiences were associated with the number of breastfeeding challenges reported. (The adjusted rate ratio was 1.05; 95% CI [1.00, 1.09], p = .034). Conclusion: We recommend further research on adverse childhood experiences and potential relationships with discrimination, material hardship, and social support to prevent and intervene in cases of breastfeeding challenges to maximize infant, maternal, and public health.
Evaluation of remote assessment reliability in the follow-up of patients with diabetic macular edema
Authors: Bellot Lucas , Anthony Norah , Maucourant Yann , Viana Michel , Bussat Aurore , Mouriaux Fréderic 
Published: September 2022

Purpose To compare the reliability of office versus remote assessments in the decision to use intravitreal injection for patients with diabetic macular edema (DME). Method We retrospectively evaluated office and remote assessments for decision agreement regarding treatment by intravitreal injection or non-treatment for DME. Remote assessment consisted in remote evaluation of patient medical data by three reviewers with different skills. Two OCT analysis strategies were performed with the same office assessment data: 1) macular mapping with only two OCT B-scans passing through the fovea, and 2) macular mapping with complete macular scans. Agreement for treatment decisions and OCT analysis strategies were analysed using Cohen's Kappa coefficient (κ). Results Data from 49 patients (96 eyes) were included. Treatment decision agreement with two OCT B-scans passing through the fovea was considered excellent for all reviewers (κ between 0.80 and 0.85, varying between reviewers). Treatment decision agreement with complete macular scans was considered excellent (κ between 0.85 and 0.93, varying between reviewers). Agreement between the two OCT analysis strategies and reviewers was considered excellent. Conclusion Remote assessment in a telemedicine model can be a useful alternative for DME patient follow-up.