{
  "abstract": "PurposeWe introduce the Temporal Index of Divergent Evidence (TIDE), a metric that evaluates how the topic center of gravity of a corresponding corpus of literature aligns with, or shifts relative to, a recommendations semantics over time.\n\nMethodsTIDE computes annual mean cosine similarity using MedCPT embedding vectors between a recommendation and corresponding PubMed records binned by year (2000-2024), testing for monotonic temporal trend (Kendall {tau}). Three recommendations with expected divergent, stable, and convergent trajectories were examined: two-stage exchange for periprosthetic joint infection (PJI), emergent fasciotomy for acute compartment syndrome (ACS), and non-operative management of distal radius fractures (DRF) in adults [≥] 65 years. The signal was characterized by an additive per-token attribution, an isolated vs. in-context analysis, and an adversarial minimal-pair test.\n\nResultsPJI diverged ({tau} = -0.84, year-shuffle p = 0.001), DRF converged ({tau} = +0.42, p = 0.005), and ACS showed no detectable trend ({tau} = -0.07, p = 0.66). The two significant directions (PJI, DRF) held under matched input [CLS] pooling, while ACS remained near zero. Publication volume baselines did not distinguish the three trajectories (publication count was universally positive, {tau} = +0.77 to +0.97). A reversed-meaning minimal-pair control showed little cosine sensitivity to reversal. Paper-level TF-IDF recovered the qualitative three-case pattern.\n\nConclusionEmbedding-based drift analysis is a proof-of-concept candidate pre-triage signal that tracks topical alignment, not evidentiary direction; superiority over TF-IDF remains unproven. The present study is hypothesis-generating, showing potential use of embedding representations as an analytical unit rather than simply for retrieval.",
  "abstract_shown": true,
  "affiliations": [
    "Loma Linda University School of Medicine, Loma Linda, CA, USA"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "C. Grames"
    },
    {
      "name": "P. Zakarian"
    },
    {
      "name": "C. Franquemont"
    },
    {
      "name": "A. Cabrera"
    },
    {
      "name": "J. Elsissy"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/apds9vabwqv90.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.28.26364191",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.28.26364191v1.full",
  "id": "apds9vabwqv90",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.28.26364191v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "health informatics"
    ],
    [
      "openalex",
      "2739|Clinical practice guidelines implementation"
    ]
  ],
  "openalex": "W7215112090",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.28.26364191v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/apds9vabwqv90.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:37Z",
      "native_id": "10.64898/2026.09.28.26364191",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.28.26364191v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:health informatics",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "What Embedding-Based Guideline-Literature Drift Measures (and What It Doesn't): A Proof-of-Concept and Mechanistic Dissection of TIDE in Orthopedic Surgery",
  "title_text": "What Embedding-Based Guideline-Literature Drift Measures (and What It Doesn't): A Proof-of-Concept and Mechanistic Dissection of TIDE in Orthopedic Surgery",
  "type": "preprint",
  "updated_at": "2026-10-30T12:19:37Z",
  "url": "https://research.draconitic.com/paper/apds9vabwqv90",
  "venue": "medRxiv",
  "versions": []
}