bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic Value of Ankle-Brachial Index in Prediction of Cardiovascular Events in an Asian Population with Multiple Atherosclerotic Risk Factors
Authors: Suwannasom Pannipa , Phinyo Phichayut , Leemasawat Krit , Chichareon Ply , Nantsupawat Teerapat , Osataphan Nichanan , Thonghong Tasalak , Suwanugsorn Saranyou , Wongvipaporn Chaiyasith , Phrommintikul Arintaya ,   and the CORE-Thailand investigators
Published: September 2022

We aimed to evaluate the incremental prognostic value after incorporation of the ankle-brachial index (ABI) into the 10-year pool cohort equation (PCE) risk model in patients with multiple risk factors (MRFs). A total of 4332 MRFs patients were divided into 2 groups as ABI ≤.9 or >.9. The primary outcome was hard cardiovascular events (hCVE: including cardiovascular death, myocardial infarction, or ischemic stroke) over a median follow-up of 36 months. The Cox proportional hazards survival model, C-statistic, and net reclassification indices (NRI) were used. The occurrence of the primary outcome in the ABI ≤.9 group (3.7%) was significantly greater than in the ABI > .9 group (1.3%), P < .001. ABI is an independent predictor of hCVE in addition to the variables in the standard risk model (age, gender, and smoking status). ABI modestly improved the C-index when added to the PCE risk model (PCE .70 vs ABI+PCE .74). The addition of ABI to the PCE risk model did not significantly improve the classification of patients (NRI -.029; 95% CI: −.215 to .130). Despite ABI being one of the independent predictors of hCVE, integration of ABI into the PCE model did not improve the efficacy of risk reclassification in patients with MRFs.
Evaluation of Simulated Recognition Aids for Human Sensemaking in Applied Surveillance Scenarios
Authors: Frame Mary E. , Maresca Anna M. , Christensen-Salem Amanda , Patterson Robert E. 
Published: September 2022

Objective We determined whether the human capability for sensemaking, or for identifying essential elements of information (EEIs), could be enhanced by a simulated recognition aid that directed attention to people and vehicles in scenes or by a simulated recognition aid that directed attention to EEIs. Background For intelligence analysts, sensemaking is challenging because it frequently involves making inferences about uncertain data. One way to enhance sensemaking may involve collaboration from a machine recognition aid such as Project Maven, an established algorithm that directs analysts’ attention to people and vehicles in scenes. We simulated the directed attention of Project Maven as well as a machine recognition aid that directed attention to EEIs. Method We created full-motion videos of simulated compounds viewed by an overhead camera. Sensemaking was assessed by measuring participants’ ability to predict events and identify signs. Participants’ attention was directed by placing small globe symbols above either all people and vehicles, or all EEIs. Novices and intelligence analysts participated. Results Simulated recognition aids directing participants’ attention to EEIs improved EEI identification but directing attention to people and vehicles (emulating Project Maven) did not. Participants’ sensemaking was not enhanced by either type of simulated recognition aid. Conclusion Guiding attention to features in a scene improves their identification whereas indiscriminate steering of attention to entities in the scene does not improve understanding of the holistic meaning of events, unless attention is drawn to relevant signs of those events. Application Results contribute to our goal of determining which human-machine systems improve the sensemaking capability of intelligence analysts in the field.
Water and Socio-Environmental Crisis in Guatemala City’s Metropolitan Area
Authors: Illmer Patrick 
Published: September 2022

The water crisis in Guatemala City’s metropolitan area reflects the interaction of two dimensions of the deployment of power in low-income neighborhoods—the direct exercise of power over actors and spaces by elites or political centers and micropolitical operations. This interaction produces patterns of behavior that deepen socio-spatial segregation, social fragmentation, and the delimitation of horizons of political possibility among broad sectors of the urban population. La crisis del agua en el área metropolitana de la Ciudad de Guatemala refleja la interacción de dos dimensiones a partir del despliegue del poder en barrios de bajos ingresos—esto es, el ejercicio directo del poder sobre actores y espacios por parte de élites o centros políticos y operaciones micropolíticas. Esta interacción produce patrones de comportamiento que profundizan la desegregación socio-espacial, la fragmentación social y la delimitación de horizontes de posibilidad política entre amplios sectores de la población urbana.
Power, Emotion, and Privilege: “Discomfort” as Resistance to Transgender Student Affirmation
Authors: Payne Elizabethe , Smith Melissa 
Published: September 2022

Context: This research contributes to a growing body of scholarship on affirming and accommodating transgender and gender-diverse students in elementary school spaces by exploring how institutional resistance to gender-inclusive practices manifested in a single rural school district. Purpose/Objective/Research Question/Focus of Study: The study was shaped by the following questions: (1) How is “successful” support of a transgender child defined by the educators who worked with a child as her gender identity and expression changed? (2) What were the educators’ strategies for facilitating the student’s in-school transition? (3) What (if any) actions were taken to recognize or affirm gender diversity? This article focuses on one educator advocate’s experiences navigating a district administrator’s expressions of discomfort with transgender inclusion, which he deployed in situations in which he believed proposals for gender-inclusive policies and practices were “running wild” and too far from the institutional status quo. Participants: Interview participants were school personnel, including administrators, teachers, and counselors, who worked in the school while the child was in kindergarten through third grade, and the student’s mother. Research Design: Eleven interviews were conducted. Limited observation included a school assembly focused on learning to accept differences and observation of gendered images throughout the school building. A semi-structured interview protocol was used that included questions about (1) first learning of the presence of a transgender child; (2) the process for learning about transgender identity; (3) implementing procedures for including and accommodating the transgender student; (4) integrating gender differences into the curriculum; (5) discussing gender differences with students; and (6) perceptions of the school district’s success in working with the transgender student and her family. Interview questions were designed to encourage descriptive accounts in which participants describe what happened, their interpretation of the events, and their understanding of their own positions within the events. Conclusions: This study addresses how discomfort serves as a socially acceptable narrative for school personnel to prioritize the (actual or perceived) feelings of cisgender adults and children over the needs of transgender students.
The Fallacy of a Single Diagnosis
Authors: Redelmeier Donald A. , Shafir Eldar 
Published: September 2022

Background Diagnostic reasoning requires clinicians to think through complex uncertainties. We tested the possibility of a bias toward an available single diagnosis in uncertain cases. Design We developed 5 different surveys providing a succinct description of a hypothetical individual patient scenaric. Each scenario was formulated in 2 versions randomized to participants, with the versions differing only in whether an alternative diagnosis was present or absent. The 5 scenarios were designed as separate tests of robustness using diverse cases, including a cautious scenario, a risky scenario, a sophisticated scenario, a validation scenario, and a comparative scenario (each survey containing only 1 version of 1 scenario). Participants included community members ( n = 1104) and health care professionals ( n = 200) who judged the chances of COVID infection in an individual patient. Results The first scenario described a cautious patient and found a 47% reduction in the estimated odds of COVID when a flu diagnosis was present compared with absent (odds ratio = 0.53, 95% confidence interval 0.30 to 0.94, P = 0.003). The second scenario described a less cautious patient and found a 70% reduction in the estimated odds of COVID in the presence of a flu diagnosis (odds ratio = 0.30, 95% confidence interval 0.13 to 0.70, P < 0.001). The third was a more sophisticated scenario presented to medical professionals and found a 73% reduction in the estimated odds of COVID in the presence of a mononucleosis diagnosis (odds ratio = 0.27, 95% confidence interval 0.10 to 0.75, P < 0.001). Two further scenarios—avoiding mention of population norms—replicated the results. Limitations Brief hypothetical scenarios may overestimate the extent of bias in more complicated medical situations. Conclusions These results demonstrate that an available simple diagnosis can lead individuals toward premature closure and a failure to fully consider additional severe diseases. Highlights Occum’s razor has been debated for centuries yet rarely subjected to experimental testing for evidence-based medicine. This article offers direct evidence that people favor an available simple diagnosis, thereby neglecting to consider additional serious diseases. The bias can lead individuals to mistakenly lower their judged likelihood of COVID or another disease when an alternate diagnosis is present. This misconception over the laws of probability appears in judgments by community members and by health care workers. The pitfall in reasoning extends to high-risk cases and is not easily attributed to information, incentives, or random chance.
Informed Decision Making for Anticoagulation Therapy for Atrial Fibrillation
Authors: Martinez Kathryn A. , Linfield Debra T. , Shaker Victoria , Rothberg Michael B. 
Published: September 2022

Background Patients with atrial fibrillation (AF) must decide between warfarin and direct oral anticoagulants (DOACs), a decision involving important tradeoffs. Our objective was to understand whether physicians engage patients in informed decision making for anticoagulants. Design We performed an analysis of recorded conversations between physicians and anticoagulation-naïve patients in the Verilogue Point-of-Practice database. We assessed the presence of 7 elements of informed decision making, as well as a discussion of financial costs. Results Of 37 encounters with 21 physicians, 92% resulted in a DOAC prescription and 8% resulted in a warfarin prescription. Seventy percent met criteria for discussion of pros and cons, 70% for discussion of the alternatives, 43% presented the decision, 30% included an assessment of patient understanding, 22% included an explanation of the patient’s role in decision making, 22% included an assessment of patient preferences, and 19% included a discussion of uncertainty. Two encounters (5%) included all 7 elements and 9 (24%) included none. Physicians discussed treatment costs with patients in 43% of encounters. Limitations We assessed informed decision making in a single encounter. Physicians and patients may have had other discussions that were not captured in our data. Conclusions Physicians often presented the alternatives but did not generally engage patients in informed decision making. The high rate of DOAC prescriptions is likely the result of physician preferences, as patient preferences were rarely assessed. Implications Strategies to support physicians in engaging patients in informed decision making for anticoagulation are needed. Highlights While physicians discussed the alternatives and presented pros and cons with patients, they rarely assessed patient preferences, explained the patient’s role in decision making, or addressed uncertainty. The cost of treatment with DOACs versus warfarin was discussed by physicians in less than half of encounters, limiting patients’ ability to make informed decisions for anticoagulation. Only 2 encounters (5%) fulfilled all 7 elements of informed decision making.
Water reduces iron toxicity
Authors: Wu Bo-Sheng , Chu Feng-Yuan , Yang Chih-Yu 
Published: September 2022

An 86-year-old man presented to the emergency room with vomiting and melena. The patient was hemodynamically stable and remained alert and orientated. According to his family, ingestion of a pack of disposable hand warmers, which he mistook for black sesame powder, occurred 17 h prior to admission. Before ingestion, he mixed the powder with warm water. Physical examination revealed no thermal injury of the oral mucosa with no abdominal pain or tenderness. An abdominal plain film showed multiple scattered radiopaque material with zonal distribution over the right abdomen. An intravenous 500-mg deferoxamine challenge test showed no vin rosé urine discoloration. Serial serum iron levels remained within the normal range. The patient remained clinically stable with no medical complications. He was discharged 3 days after admission. The hand warmers consisted of iron powder (50% w/w), sodium chloride, activated charcoal, and nontoxic vermiculite: a potential risk for intestinal thermal injury. In this case, the water added beforehand rapidly terminated the iron oxidation reaction. This explained the lack of thermal injury. Ferric oxide is poorly absorbed by the digestive tract and explained the absence of iron intoxication. Therefore, clinicians should clarify the method of ingestion. If a hand warmer has been premixed with water, less mucosa injury can be expected with a lower risk of iron intoxication. This report also provided evidence that abdominal plain films can be used to confirm the ingestion of iron and monitor its elimination.
Screening asymptomatic men for prostate cancer: A comparison of international guidelines on prostate-specific antigen testing
Authors: Jackson Sherena D , de la Rue May R , Greenslade Thomas PL , John Anna M , Wahid Shahida , Martin Richard M , Williams Naomi J , Turner Emma L 
Published: September 2022

Objective To summarise and compare the key recommendations on prostate-specific antigen (PSA)-based screening for prostate cancer, and so highlight where more evidence is required to facilitate consistent recommendations. Methods The Medline database and websites of 18 national screening organisations and professional associations were searched between January 2010 and November 2020 to identify screening guidelines published in English, considering recent clinical trials. Results Population-based PSA testing of asymptomatic men is not widely recommended. Guidelines emphasize shared patient-clinician decision making. For ‘average-risk’ men choosing to be screened, the recommended age varies from 50–55 to 70 years, alongside consideration of life expectancy (ranging from 7–15 years). Screening intervals, when specified, are biennial (most common), annual, or determined from baseline PSA. The earliest age for screening high-risk men (frequently defined as of African descent or with a family history of prostate cancer) is 40 years, but recommendations often defer to clinical judgement. Conclusions Population screening of asymptomatic men is not widely recommended. Instead, balancing the potential harms and benefits of PSA testing is endorsed. Variation between guidelines stems from differing interpretations of key trials and could lead to clinician-dependent screening views. The development of clinical decision aids and international consensus on guidelines may help reduce national and international variation on how men are counselled.
Branch retinal vein occlusion following ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine
Authors: Karageorgiou Georgia , Chronopoulou Konstantina , Georgalas Ilias , Kandarakis Stylianos , Tservakis Ioannis , Petrou Petros 
Published: September 2022

Purpose To present a case of branch retinal vein occlusion (BRVO) following ChAdOx1 nCoV-19 (Oxford-AstraZeneca) Vaccine. Methods Case report. Results A 60-year old otherwise healthy Caucasian male, presented to the ophthalmology emergency clinic complaining of sudden, painless vision loss in his right eye of 24 h” duration. The patient had received Vaxveria seven days prior. The clinical and fundus examination of the right eye established the diagnosis of BRVO. Conclusion The present case descibes the occurrence of BRVO soon after the vaccination with the Oxford-AstraZeneca vaccine. The close temporal relationship between the BRVO incidence and the vaccination is reinforced by the lack of othe subjective cause to justify the episode.
From stories at bedtime to a love of reading: Parental practices and beliefs about reading with infants
Authors: Egan Suzanne M , Moloney Mary , Pope Jennifer , Breatnach Deirdre , Hoyne Clara 
Published: September 2022

Although it is well established that reading with young children supports early language and literacy development, few studies have focused on the importance of parental beliefs about reading with infants. The current study, which sheds light on parental beliefs had three main aims. The first was to examine practices of shared reading in infancy (birth to 1 year old), while the second, sought to examine parents’ views on benefits of and potential barriers to reading with infants. The third aim was to explore how parents’ beliefs about reading, and their own enjoyment of reading, may influence the early home literacy environment they create for their infants. Drawing upon a mixed methods approach, comprising surveys and interviews with parents of infants ( n = 31), this paper highlights the importance of parents’ own enjoyment of reading. The findings, which are considered from a bioecological perspective, indicate that parents’ enjoyment of reading was significantly and positively associated with the number of children’s books in their home, and the frequency of reading with their infant, as well as their hope for their child’s future enjoyment of reading. Parents noted that one of the main benefits of reading with their infants related to socio-emotional development and the one-to-one time, rather than the language and literacy benefits, which constitute the focus of much research in this area. The findings further point to an intergenerational transfer of a love of reading.
The relationship between sarcopenia and one-year mortality in patients with critical limb ischemia undergoing endovascular therapy below the knee
Authors: Guler Arda , Gurbak Ismail , Aydin Sinem , Kahraman Serkan , Tasbulak Omer , Ucar Servet U , Dogan Arda C , Topel Cagdas , Panc Cafer , Cizgici Ahmet Y , Kalkan Ali K , Yalcin Ahmet A , Erturk Mehmet 
Published: September 2022

Objective Critical limb ischemia (CLI) is a progressive form of peripheral artery disease (PAD). Patients with CLI have poor long-term prognosis. The aim of this study was to investigate the value of sarcopenia in terms of 1-year mortality in patients with below-the-knee lesions who underwent endovascular treatment for CLI. Methods A total of 190 patients with critical limb ischemia who underwent endovascular treatment (EVT) for below-the-knee (BTK) lesions were enrolled in this study. Sarcopenia was defined using the psoas muscle index (PMI). PMI was obtained by calculating the average psoas muscle area (APMA) of the left and right psoas muscles at the third lumbar vertebra level and dividing by the square of the height (cm2/m2). The primary endpoint of the study was 1-year mortality and the secondary endpoint was 1-year amputation. Patients were divided into 2 groups according to presence of sarcopenia. Results We detected sarcopenia in 64 patients. The mean age, height, and EF were higher in sarcopenia group. The psoas muscle area, weight, psoas muscle index, body-mass index, albumin level, and GFR were lower in sarcopenia group. The incidence of amputation (11.9% vs 29.7%, p = 0.003) and mortality (15.1% vs 35.9%, p = 0.001) were higher in patients with sarcopenia. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of amputation and mortality. The survival curve for 1-year using the sarcopenia was analyzed using the Kaplan–Meier method, and statistical analysis was performed with the log-rank test. The presence of sarcopenia, glomerular filtration rate level, and low ejection fraction were found to be independent predictors of mortality. Conclusions Sarcopenia was associated with 1-year mortality in patients with CLI undergoing EVT for BTK lesions. Also, patients with sacropenia had higher 1-year amputation rates. Sarcopenia may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.
Index diagnoses of gastric intestinal metaplasia in the United States: patient characteristics, endoscopic findings, and clinical practice patterns at a large tertiary care center
Authors: Parbhu Sheeva K. , Shah Shailja C. , Sossenheimer Michael J. , Fang John C. , Peterson Kathryn A. , Gawron Andrew J. 
Published: September 2022

Background: Gastric intestinal metaplasia (GIM) is a premalignant gastric mucosal change that is often incidentally detected during esophagogastroduodenoscopy (EGD). Despite the established higher risk of gastric cancer associated with GIM, the incidence, prevalence, and outcomes data for GIM are limited in the United States (US), and practice patterns are highly variable. Objectives: Our primary objectives were to accurately identify incident histology-confirmed GIM cases and determine patient characteristics, endoscopy findings, Helicobacter pylori (HP) detection, and eradication treatment outcomes, as well as surveillance and follow-up recommendations. Design: We conducted a retrospective cohort study using administrative data. Methods: We first developed and validated a rule-based natural language processing tool to identify the patients with GIM on gastrointestinal pathology reports between 2011 and 2016. We then performed a manual chart review of all EGD procedures and associated pathology notes to confirm cases and obtain clinically relevant data. Results: In all, 414 patients with an index diagnosis of GIM were confirmed (prevalence = 2.5% of patients undergoing any EGD). A majority (52.4%) of patients were non-Hispanic white. The most common indication for EGD was abdominal pain (46.9%). A majority (55%) did not receive specific follow-up recommendations or were asked to see their primary care provider. HP testing was documented in 86% of patients, and detected in 94 patients (prevalence = 26.4%). Treatment was documented in 94.7% of cases, and eradication confirmed in only 34.8% of these cases. Conclusion: A large group of US patients with an index diagnosis of GIM was accurately identified. There was wide variability in clinical practice patterns including biopsy practice, HP treatment and eradication confirmation testing, and surveillance recommendations. This work demonstrates that there is a major unmet need for quality improvement efforts to standardize care for patients with GIM, a premalignant condition, and inform future prospective studies in a US population.