{"id":"https://openalex.org/W7215112090","doi":"https://doi.org/10.64898/2026.09.28.26364191","title":"What Embedding-Based Guideline\u2013Literature Drift Measures (and What It Doesn\u2019t): A Proof-of-Concept and Mechanistic Dissection of TIDE in Orthopedic Surgery","display_name":"What Embedding-Based Guideline\u2013Literature Drift Measures (and What It Doesn\u2019t): A Proof-of-Concept and Mechanistic Dissection of TIDE in Orthopedic Surgery","publication_year":2026,"publication_date":"2026-09-29","ids":{"openalex":"https://openalex.org/W7215112090","doi":"https://doi.org/10.64898/2026.09.28.26364191"},"language":"en","primary_location":{"id":"doi:10.64898/2026.09.28.26364191","doi":"https://doi.org/10.64898/2026.09.28.26364191","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.28.26364191","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.28.26364191.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.28.26364191.full.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5153974872","display_name":"Colby Grames","orcid":"https://orcid.org/0009-0006-0073-2916","observed_orcids":["https://orcid.org/0009-0006-0073-2916"]},"institutions":[{"id":"https://openalex.org/I26347476","display_name":"Loma Linda University","ror":"https://ror.org/04bj28v14","country_code":"US","type":"education","lineage":["https://openalex.org/I26347476"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Colby Grames","raw_affiliation_strings":["Loma Linda University School of Medicine, Loma Linda, CA, USA"],"raw_orcid":"https://orcid.org/0009-0006-0073-2916","affiliations":[{"raw_affiliation_string":"Loma Linda University School of Medicine, Loma Linda, CA, USA","institution_ids":["https://openalex.org/I26347476"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5151367826","display_name":"Paul Zakarian","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I114493937","display_name":"Creighton University","ror":"https://ror.org/05wf30g94","country_code":"US","type":"education","lineage":["https://openalex.org/I114493937"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Paul Zakarian","raw_affiliation_strings":["Creighton University School of Medicine, Phoenix, AZ, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Creighton University School of Medicine, Phoenix, AZ, USA","institution_ids":["https://openalex.org/I114493937"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5128900802","display_name":"Christopher Franquemont","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I26347476","display_name":"Loma Linda University","ror":"https://ror.org/04bj28v14","country_code":"US","type":"education","lineage":["https://openalex.org/I26347476"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Christopher Franquemont","raw_affiliation_strings":["Loma Linda University School of Medicine, Loma Linda, CA, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Loma Linda University School of Medicine, Loma Linda, CA, USA","institution_ids":["https://openalex.org/I26347476"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5047299684","display_name":"Andrew Cabrera","orcid":"https://orcid.org/0000-0002-9521-9181","observed_orcids":["https://orcid.org/0000-0002-9521-9181"]},"institutions":[{"id":"https://openalex.org/I1293502524","display_name":"Loma Linda University Medical Center","ror":"https://ror.org/03et1qs84","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1293502524"]},{"id":"https://openalex.org/I26347476","display_name":"Loma Linda University","ror":"https://ror.org/04bj28v14","country_code":"US","type":"education","lineage":["https://openalex.org/I26347476"]},{"id":"https://openalex.org/I4210095401","display_name":"Loma Linda University Health Care","ror":"https://ror.org/00saxze38","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210095401"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Andrew Cabrera","raw_affiliation_strings":["Department of Orthopedics, Loma Linda University Health, Loma Linda, CA, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopedics, Loma Linda University Health, Loma Linda, CA, USA","institution_ids":["https://openalex.org/I1293502524","https://openalex.org/I26347476","https://openalex.org/I4210095401"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5023608166","display_name":"Joseph G Elsissy","orcid":"https://orcid.org/0000-0002-8469-2205","observed_orcids":["https://orcid.org/0000-0002-8469-2205"]},"institutions":[{"id":"https://openalex.org/I2799587377","display_name":"Arrowhead Regional Medical Center","ror":"https://ror.org/00yvh2s32","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2799587377"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Joseph Elsissy","raw_affiliation_strings":["Department of Orthopedics, Arrowhead Regional Medical Center, Colton, CA, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Orthopedics, Arrowhead Regional Medical Center, Colton, CA, USA","institution_ids":["https://openalex.org/I2799587377"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":5,"corresponding_author_ids":["https://openalex.org/A5153974872"],"corresponding_institution_ids":["https://openalex.org/I26347476"],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12664","display_name":"Clinical practice guidelines implementation","score":0.32199999690055847,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T12664","display_name":"Clinical practice guidelines implementation","score":0.32199999690055847,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10102","display_name":"scientometrics and bibliometrics research","score":0.19089999794960022,"subfield":{"id":"https://openalex.org/subfields/3309","display_name":"Library and Information Sciences"},"field":{"id":"https://openalex.org/fields/33","display_name":"Social Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10206","display_name":"Meta-analysis and systematic reviews","score":0.038600001484155655,"subfield":{"id":"https://openalex.org/subfields/1804","display_name":"Statistics, Probability and Uncertainty"},"field":{"id":"https://openalex.org/fields/18","display_name":"Decision Sciences"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/cosine-similarity","display_name":"cosine similarity","score":0.6779999732971191},{"id":"https://openalex.org/keywords/periprosthetic-joint-infection","display_name":"periprosthetic joint infection","score":0.8159999847412109},{"id":"https://openalex.org/keywords/acute-compartment-syndrome","display_name":"acute compartment syndrome","score":0.8970000147819519},{"id":"https://openalex.org/keywords/distal-radius-fracture","display_name":"distal radius fracture","score":0.9470000267028809},{"id":"https://openalex.org/keywords/publication-trends","display_name":"publication trends","score":0.5139999985694885},{"id":"https://openalex.org/keywords/tf-idf-comparison","display_name":"TF-IDF comparison","score":0.722000002861023}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.6473000049591064},{"id":"https://openalex.org/C103278499","wikidata":"https://www.wikidata.org/wiki/Q254465","display_name":"Similarity (geometry)","level":3,"score":0.5149000287055969},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.41269999742507935},{"id":"https://openalex.org/C2780762811","wikidata":"https://www.wikidata.org/wiki/Q1784941","display_name":"Cosine similarity","level":3,"score":0.4083000123500824},{"id":"https://openalex.org/C185429906","wikidata":"https://www.wikidata.org/wiki/Q1130160","display_name":"Estimator","level":2,"score":0.4065999984741211},{"id":"https://openalex.org/C68312169","wikidata":"https://www.wikidata.org/wiki/Q216685","display_name":"Orthopedic surgery","level":2,"score":0.4049000144004822},{"id":"https://openalex.org/C41608201","wikidata":"https://www.wikidata.org/wiki/Q980509","display_name":"Embedding","level":2,"score":0.39959999918937683},{"id":"https://openalex.org/C2775862295","wikidata":"https://www.wikidata.org/wiki/Q2660911","display_name":"Dissection (medical)","level":2,"score":0.39719998836517334},{"id":"https://openalex.org/C176217482","wikidata":"https://www.wikidata.org/wiki/Q860554","display_name":"Metric (unit)","level":2,"score":0.3864000141620636},{"id":"https://openalex.org/C2779843651","wikidata":"https://www.wikidata.org/wiki/Q7390335","display_name":"SIGNAL (programming language)","level":2,"score":0.3571000099182129},{"id":"https://openalex.org/C2779662492","wikidata":"https://www.wikidata.org/wiki/Q468787","display_name":"Hematoma","level":2,"score":0.3140999972820282},{"id":"https://openalex.org/C88516994","wikidata":"https://www.wikidata.org/wiki/Q1268863","display_name":"Dynamic time warping","level":2,"score":0.30559998750686646},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.30379998683929443},{"id":"https://openalex.org/C146599234","wikidata":"https://www.wikidata.org/wiki/Q511093","display_name":"Centroid","level":2,"score":0.3012000024318695},{"id":"https://openalex.org/C178635117","wikidata":"https://www.wikidata.org/wiki/Q747499","display_name":"RADIUS","level":2,"score":0.29600000381469727},{"id":"https://openalex.org/C33923547","wikidata":"https://www.wikidata.org/wiki/Q395","display_name":"Mathematics","level":0,"score":0.29190000891685486},{"id":"https://openalex.org/C2777382242","wikidata":"https://www.wikidata.org/wiki/Q6017816","display_name":"Index (typography)","level":2,"score":0.2913999855518341},{"id":"https://openalex.org/C146849305","wikidata":"https://www.wikidata.org/wiki/Q370766","display_name":"Ground truth","level":2,"score":0.28790000081062317},{"id":"https://openalex.org/C1921717","wikidata":"https://www.wikidata.org/wiki/Q1334846","display_name":"Mahalanobis distance","level":2,"score":0.2809000015258789},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.2791000008583069},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.2759999930858612},{"id":"https://openalex.org/C178009071","wikidata":"https://www.wikidata.org/wiki/Q93344","display_name":"Trigonometric functions","level":2,"score":0.27149999141693115},{"id":"https://openalex.org/C2779145032","wikidata":"https://www.wikidata.org/wiki/Q191494","display_name":"Digraph","level":2,"score":0.25949999690055847},{"id":"https://openalex.org/C2778120723","wikidata":"https://www.wikidata.org/wiki/Q16872681","display_name":"Periprosthetic","level":3,"score":0.2574000060558319},{"id":"https://openalex.org/C105795698","wikidata":"https://www.wikidata.org/wiki/Q12483","display_name":"Statistics","level":1,"score":0.2535000145435333}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.64898/2026.09.28.26364191","doi":"https://doi.org/10.64898/2026.09.28.26364191","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.28.26364191","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.28.26364191.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.64898/2026.09.28.26364191","doi":"https://doi.org/10.64898/2026.09.28.26364191","is_oa":true,"landing_page_url":"https://doi.org/10.64898/2026.09.28.26364191","pdf_url":"https://www.medrxiv.org/content/medrxiv/early/2026/09/29/2026.09.28.26364191.full.pdf","source":{"id":"https://openalex.org/S3005729997","display_name":"medRxiv","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310315909"],"host_organization_lineage_names":["Cold Spring Harbor Laboratory Press"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"acceptedVersion","is_accepted":true,"is_published":false,"raw_source_name":"medRxiv","raw_type":"posted-content"},"sustainable_development_goals":[],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7215112090.pdf","grobid_xml":"https://content.openalex.org/works/W7215112090.grobid-xml"},"referenced_works_count":24,"referenced_works":["https://openalex.org/W1554476382","https://openalex.org/W1994307831","https://openalex.org/W2079575346","https://openalex.org/W2095623039","https://openalex.org/W2114387609","https://openalex.org/W2124597509","https://openalex.org/W2164762515","https://openalex.org/W2294453571","https://openalex.org/W2756868207","https://openalex.org/W2963780471","https://openalex.org/W3035858552","https://openalex.org/W3087185831","https://openalex.org/W4237467126","https://openalex.org/W4283158077","https://openalex.org/W4387339894","https://openalex.org/W4388409299","https://openalex.org/W4389816703","https://openalex.org/W4391944559","https://openalex.org/W4405651244","https://openalex.org/W4409861609","https://openalex.org/W4415428394","https://openalex.org/W7126260974","https://openalex.org/W7147632866","https://openalex.org/W7161949585"],"related_works":["https://openalex.org/W6948298754","https://openalex.org/W2396410109","https://openalex.org/W3003309613","https://openalex.org/W1540118995","https://openalex.org/W7146601472","https://openalex.org/W2949482178","https://openalex.org/W2050177506","https://openalex.org/W4382359965","https://openalex.org/W4298162143","https://openalex.org/W7208368658"],"abstract_inverted_index":{"ABSTRACT":[0],"Purpose":[1],"We":[2],"introduce":[3],"the":[4,16,177,203],"Temporal":[5],"Index":[6],"of":[7,19,21,25,95,237],"Divergent":[8],"Evidence":[9],"(TIDE),":[10],"a":[11,22,33,50,212],"metric":[12],"that":[13,217],"evaluates":[14],"how":[15],"topic":[17],"center":[18],"gravity":[20],"corresponding":[23,53],"corpus":[24],"literature":[26],"aligns":[27],"with,":[28],"or":[29],"shifts":[30],"relative":[31],"to,":[32],"recommendation\u2019s":[34],"semantics":[35],"over":[36,225],"time.":[37],"Methods":[38],"TIDE":[39],"computes":[40],"annual":[41],"mean":[42],"cosine":[43,196],"similarity":[44],"using":[45],"MedCPT":[46],"embedding":[47,238],"vectors":[48],"between":[49],"recommendation":[51],"and":[52,73,92,119,142],"PubMed":[54],"records":[55],"binned":[56],"by":[57,109],"year":[58],"(2000-2024),":[59],"testing":[60],"for":[61,80,87,247],"monotonic":[62],"temporal":[63],"trend":[64,147],"(Kendall":[65],"\u03c4).":[66],"Three":[67],"recommendations":[68],"with":[69],"expected":[70],"divergent,":[71],"stable,":[72],"convergent":[74],"trajectories":[75,179],"were":[76],"examined:":[77],"two-stage":[78],"exchange":[79],"periprosthetic":[81],"joint":[82],"infection":[83],"(PJI),":[84],"emergent":[85],"fasciotomy":[86],"acute":[88],"compartment":[89],"syndrome":[90],"(ACS),":[91],"non-operative":[93],"management":[94],"distal":[96],"radius":[97],"fractures":[98],"(DRF)":[99],"in":[100],"adults":[101],"\u2265":[102],"65":[103],"years.":[104],"The":[105,154,229],"signal":[106,216],"was":[107,182],"characterized":[108],"an":[110,114,120,241],"additive":[111],"per-token":[112],"attribution,":[113],"isolated":[115],"vs.":[116],"in-context":[117],"analysis,":[118],"adversarial":[121],"minimal-pair":[122,192],"test.":[123],"Results":[124],"PJI":[125],"diverged":[126],"(\u03c4":[127,136,148],"=":[128,132,137,140,149,152,186],"\u22120.84,":[129],"year-shuffle":[130],"p":[131,139,151],"0.001),":[133],"DRF":[134],"converged":[135],"+0.42,":[138],"0.005),":[141],"ACS":[143,167],"showed":[144,194],"no":[145],"detectable":[146],"\u22120.07,":[150],"0.66).":[153],"two":[155],"significant":[156],"directions":[157],"(PJI,":[158],"DRF)":[159],"held":[160],"under":[161],"matched":[162],"input":[163],"[CLS]":[164],"pooling,":[165],"while":[166],"remained":[168],"near":[169],"zero.":[170],"Publication":[171],"volume":[172],"baselines":[173],"did":[174],"not":[175,221],"distinguish":[176],"three":[178],"(publication":[180],"count":[181],"universally":[183],"positive,":[184],"\u03c4":[185],"+0.77":[187],"to":[188,198],"+0.97).":[189],"A":[190],"reversed-meaning":[191],"control":[193],"little":[195],"sensitivity":[197],"reversal.":[199],"Paper-level":[200],"TF-IDF":[201,226],"recovered":[202],"qualitative":[204],"three-case":[205],"pattern.":[206],"Conclusion":[207],"Embedding-based":[208],"drift":[209],"analysis":[210],"is":[211,232],"proof-of-concept":[213],"candidate":[214],"pre-triage":[215],"tracks":[218],"topical":[219],"alignment,":[220],"evidentiary":[222],"direction;":[223],"superiority":[224],"remains":[227],"unproven.":[228],"present":[230],"study":[231],"hypothesis-generating,":[233],"showing":[234],"potential":[235],"use":[236],"representations":[239],"as":[240],"analytical":[242],"unit":[243],"rather":[244],"than":[245],"simply":[246],"retrieval.":[248]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-10-02T00:00:00"}