bluuebunny/crossref_metadata_2025 huggingface dataset:
Multidecadal trends in area burned with high severity in the Selway-Bitterroot Wilderness Area 1880–2012
Authors: Morgan Penelope , Hudak Andrew T. , Wells Ashley , Parks Sean A. , Baggett L. Scott , Bright Benjamin C. , Green Patricia
Published: October 2017

Multidecadal trends in areas burned with high severity shape ecological effects of fires, but most assessments are limited to ~30 years of satellite data. We analysed the proportion of area burned with high severity, the annual area burned with high severity, the probability areas burned with high severity and also the area reburned (all severities and high burn severity only) over 133 years across 346265ha within the Selway-Bitterroot Wilderness (SBW) Area in Idaho, United States. We used burn severity class inferred from digitised aerial photography (1880–2000) and satellite imagery (1973–2012). Over this long record, the proportion burned with high severity did not increase, despite extensive area burned in recent decades. Much greater area burned with high severity during the Early (1880–1934) and Late (1975–2012) periods than during the Middle period (1935–1974), paralleling trends in area burned. Little area reburned with high severity, and fires in the Early period limited the extent of fires burning decades later in the Late period. Our results suggest that long-term data across large areas provides useful context on recent trends, and that projections for the extent and severity of future fires must consider prior fires and fire management.
Increased intracellular Ca
2+
concentrations prevent membrane localization of PH domains through the formation of Ca
2+
-phosphoinositides
Authors: Kang Jin Ku , Kim Ok-Hee , Hur June , Yu So Hee , Lamichhane Santosh , Lee Jin Wook , Ojha Uttam , Hong Jeong Hee , Lee Cheol Soon , Cha Ji-Young , Lee Young Jae , Im Seung-Soon , Park Young Joo , Choi Cheol Soo , Lee Dae Ho , Lee In-Kyu , Oh Byung-Chul
Published: October 2017

Significance

Insulin resistance is a metabolic disorder in which target cells fail to respond to physiological levels of circulating insulin, leading to hyperinsulinemia and glucose intolerance. The molecular mechanism underlying insulin resistance is still largely unknown. Here, we found that intracellular Ca
2+
overloading in obesity attenuates insulin-stimulated phosphorylation of protein kinase B and its downstream signaling by preventing membrane localization of various pleckstrin homology (PH) domains. When at high intracellular levels, Ca
2+
binds tightly with phosphoinositides to yield Ca
2+
-phosphoinositides (PIPs), abrogating the membrane targeting of PH domains and disrupting insulin signaling. Thus, we identified a previously unknown physiological function of intracellular Ca
2+
as a critical negative regulator of insulin signaling, especially through the formation of Ca
2+
-PIPs.
Modeling and replicating statistical topology and evidence for CMB nonhomogeneity
Authors: Adler Robert J. , Agami Sarit , Pranav Pratyush
Published: October 2017

Significance

Under the general heading of “topological data analysis” (TDA), the recent adoption of topological methods for the analysis of large, complex, and high-dimensional data sets has established that the abstract concepts of algebraic topology provide powerful tools for data analysis. However, despite the successes of TDA, most applications have lacked formal statistical veracity, primarily due to difficulties in deriving distributional information about topological descriptors. We present an approach, Replicating Statistical Topology (RST), which takes the most basic descriptor of TDA, the persistence diagram, and, using models based on Gibbs distributions and Markov chain Monte Carlo, provides replications of it. These allow for formal statistical hypothesis testing, without requiring costly, or perhaps intrinsically unavailable, replications of the original data set.
Three-dimensional mesostructures as high-temperature growth templates, electronic cellular scaffolds, and self-propelled microrobots
Authors: Yan Zheng , Han Mengdi , Shi Yan , Badea Adina , Yang Yiyuan , Kulkarni Ashish , Hanson Erik , Kandel Mikhail E. , Wen Xiewen , Zhang Fan , Luo Yiyue , Lin Qing , Zhang Hang , Guo Xiaogang , Huang Yuming , Nan Kewang , Jia Shuai , Oraham Aaron W. , Mevis Molly B. , Lim Jaeman , Guo Xuelin , Gao Mingye , Ryu Woomi , Yu Ki Jun , Nicolau Bruno G. , Petronico Aaron , Rubakhin Stanislav S. , Lou Jun , Ajayan Pulickel M. , Thornton Katsuyo , Popescu Gabriel , Fang Daining , Sweedler Jonathan V. , Braun Paul V. , Zhang Haixia , Nuzzo Ralph G. , Huang Yonggang , Zhang Yihui , Rogers John A.
Published: October 2017

Significance

Exploiting advanced 3D designs in micro/nanomanufacturing inspires potential applications in various fields including biomedical engineering, metamaterials, electronics, electromechanical components, and many others. The results presented here provide enabling concepts in an area of broad, current interest to the materials community––strategies for forming sophisticated 3D micro/nanostructures and means for using them in guiding the growth of synthetic materials and biological systems. These ideas offer qualitatively differentiated capabilities compared with those available from more traditional methodologies in 3D printing, multiphoton lithography, and stress-induced bending––the result enables access to both active and passive 3D mesostructures in state-of-the-art materials, as freestanding systems or integrated with nearly any type of supporting substrate.
Crystal structures of Mmm1 and Mdm12–Mmm1 reveal mechanistic insight into phospholipid trafficking at ER-mitochondria contact sites
Authors: Jeong Hanbin , Park Jumi , Jun Youngsoo , Lee Changwook
Published: October 2017

Significance

The endoplasmic reticulum (ER) forms membrane contact sites (MCSs) with other organelles such as mitochondria, endosomes, and peroxisomes in eukaryotic cells. The MCS plays a pivotal role in exchanging cellular materials such as ions and lipids. More importantly, nonvesicular lipid trafficking occurring at the ER-mitochondria MCS is essential for the biogenesis of the mitochondrial membrane. In yeast, the ER-mitochondria encounter structure (ERMES) complex comprising the ER proteins Mmm1 and cytosolic Mdm12 and the mitochondria proteins Mdm34 and Mdm10 provides a tethering force between the ER and the mitochondria and mediates lipid trafficking. Here, we present two crystal structures of Mmm1 and the Mdm12–Mmm1 complex. Based on these structures, we propose the model by which the Mdm12–Mmm1 complex contributes to phospholipid trafficking at the ER-mitochondria MCS.
Twenty-five years of mTOR: Uncovering the link from nutrients to growth
Authors: Sabatini David M.
Published: October 2017

Significance

The mechanisms that regulate organismal growth and coordinate it with the availability of nutrients were unknown until a few decades ago. We now know that one pathway—the mechanistic target of rapamycin (mTOR) pathway—is the major nutrient-sensitive regulator of growth in animals and plays a central role in physiology, metabolism, the aging process, and common diseases. This work describes the development of the mTOR field, from its origins in studies into the mechanism of action of the drug rapamycin to our increasingly sophisticated understanding of how nutrients are sensed.
Definitive screening design enables optimization of LC–ESI–MS/MS parameters in proteomics
Authors: Aburaya Shunsuke , Aoki Wataru , Minakuchi Hiroyoshi , Ueda Mitsuyoshi
Published: October 2017

In proteomics, more than 100,000 peptides are generated from the digestion of human cell lysates. Proteome samples have a broad dynamic range in protein abundance; therefore, it is critical to optimize various parameters of LC–ESI–MS/MS to comprehensively identify these peptides. However, there are many parameters for LC–ESI–MS/MS analysis. In this study, we applied definitive screening design to simultaneously optimize 14 parameters in the operation of monolithic capillary LC–ESI–MS/MS to increase the number of identified proteins and/or the average peak area of MS1. The simultaneous optimization enabled the determination of two-factor interactions between LC and MS. Finally, we found two parameter sets of monolithic capillary LC–ESI–MS/MS that increased the number of identified proteins by 8.1% or the average peak area of MS1 by 67%. The definitive screening design would be highly useful for high-throughput analysis of the best parameter set in LC–ESI–MS/MS systems.
A proof of the shuffle conjecture
Authors: Carlsson Erik , Mellit Anton
Published: October 2017

We present a proof of the compositional shuffle conjecture by Haglund, Morse and Zabrocki [Canad. J. Math., 64 (2012), 822–844], which generalizes the famous shuffle conjecture for the character of the diagonal coinvariant algebra by Haglund, Haiman, Loehr, Remmel, and Ulyanov [Duke Math. J., 126 (2005), 195–232]. We first formulate the combinatorial side of the conjecture in terms of certain operators on a graded vector spaceV∗V_*whose degree zero part is the ring of symmetric functionsSym⁡[X]\operatorname {Sym}[X]overQ(q,t)\mathbb {Q}(q,t). We then extend these operators to an action of an algebraA~\tilde {\mathbb A}acting on this space, and interpret the right generalization of the∇\nablausing an involution of the algebra which is antilinear with respect to the conjugation(q,t)↦(q−1,t−1)(q,t)\mapsto (q^{-1},t^{-1}).
Lefschetz properties for Artinian Gorenstein algebras presented by quadrics
Authors: Gondim Rodrigo , Zappalà Giuseppe
Published: October 2017

We introduce a family of Artinian Gorenstein algebras, whose combinatorial structure characterizes the ones presented by quadrics. Under certain hypotheses these algebras have non-unimodal Hilbert vector. In particular we provide families of counterexamples to the conjecture that Artinian Gorenstein algebras presented by quadrics should satisfy the weak Lefschetz property.
Topology of spaces of valuations and geometry of singularities
Authors: de Felipe Ana
Published: October 2017

Given an algebraic variety

X
X

defined over an algebraically closed field, we study the space

R
Z

(
X
,
x
)

\mathrm {RZ}{(X,x)}

consisting of all the valuations of the function field of

X
X

which are centered in a closed point

x
x

of

X
X

. We concentrate on its homeomorphism type. We prove that, when

x
x

is a regular point, this homeomorphism type only depends on the dimension of

X
X

. If

x
x

is a singular point of a normal surface, we show that it only depends on the dual graph of a good resolution of

(
X
,
x
)

(X,x)

up to some precise equivalence. This is done by studying the relation between

R
Z

(
X
,
x
)

\mathrm {RZ}{(X,x)}

and the normalized non-Archimedean link of

x
x

in

X
X

coming from the point of view of Berkovich geometry. We prove that their behavior is the same.
The art of bonding: informational capital in Dutch green urban citizens’ initiatives
Authors: van Dam Rosalie , Salverda Irini , Hassink Jan , Vaandrager Lenneke , Wentink Carlijn
Published: October 2017

Today’s western society is characterized by a transition towards self-organization by citizens in communities. Increasingly, societal problems are addressed by groups of citizens who take action to find concrete solutions. A second feature of western society is that it is an information society in which information and communication play a key role. In this paper, we analyse how these two societal trends come together at the community level. Applying a relational and contingent perspective to how green urban citizens’ initiatives develop, we look into the role of information in their interactions with other people, organizations and institutions. We analyse the mechanisms whereby information plays a role in the citizens’ initiatives. This leads to the conclusion that informational capital is fundamental to the realization of citizens’ initiatives and that informational capital is generated, identified, used and enlarged through the relational strategies of bonding, bridging and linking. It is a process that works in both ways and reinforces citizens’ initiatives.
Competition for the fish – fish extraction from the Baltic Sea by humans, aquatic mammals, and birds
Authors: Hansson Sture , Bergström Ulf , Bonsdorff Erik , Härkönen Tero , Jepsen Niels , Kautsky Lena , Lundström Karl , Lunneryd Sven-Gunnar , Ovegård Maria , Salmi Juhani , Sendek Dmitry , Vetemaa Markus
Published: October 2017

Seals and fish-eating birds have increased in the Baltic Sea and there is concern that they compete with fisheries. Using data from around year 2010, we compare consumption of different fish species by seals and birds to the catch in the commercial and recreational fishery. When applicable this is done at the geographical resolution of ICES subdivisions. Predation by birds and mammals likely has limited impact on the populations of the commercially most important species (herring, sprat, and cod). In the central and southern Baltic, seals and birds consume about as much flatfish as is caught by the fishery and competition is possible. Birds and seals consume 2-3 times as much coastal fish as is caught in the fishery. Many of these species are important to the fishery (e.g. perch and whitefish) and competition between wildlife and the fishery is likely, at least locally. Estimated wildlife consumption of pike, sea trout and pikeperch varies among ICES subdivisions and the degree of competition for these species may differ among areas. Competition between wildlife and fisheries need to be addressed in basic ecosystem research, management and conservation. This requires improved quantitative data on wildlife diets, abundances and fish production.
The scaling relationship between baryonic mass and stellar disc size in morphologically late-type galaxies
Authors: Wu (吳柏鋒) Po-Feng
Published: October 2017

Here I report the scaling relationship between the baryonic mass and scale-length of stellar discs for ∼1000 morphologically late-type galaxies. The baryonic mass–size relationship is a single power law $R_\ast \propto M_{\rm b}^{0.38}$ across ∼3 orders of magnitude in baryonic mass. The scatter in size at fixed baryonic mass is nearly constant and there are no outliers. The baryonic mass–size relationship provides a more fundamental description of the structure of the disc than the stellar mass–size relationship. The slope and the scatter of the stellar mass–size relationship can be understood in the context of the baryonic mass–size relationship. For gas-rich galaxies, the stars are no longer a good tracer for the baryons. High-baryonic-mass, gas-rich galaxies appear to be much larger at fixed stellar mass because most of the baryonic content is gas. The stellar mass–size relationship thus deviates from the power-law baryonic relationship, and the scatter increases at the low-stellar-mass end. These extremely gas-rich low-mass galaxies can be classified as ultra-diffuse galaxies based on the structure.
Early incidence of glucocorticoid-induced diabetes in patients with brain tumors: a retrospective study of the first 7 days of treatment
Authors: Schultz Helga , Rasmussen Birthe Krogh , Kristensen Peter Lommer , Jensen Andreas Kryger , Pedersen-Bjergaard Ulrik
Published: October 2017

Background

Hyperglycemia or diabetes is a well-known side effect of treatment with glucocorticoids. In patients with brain tumors, glucocorticoids are widely used to treat symptoms of peritumoral edema. We conducted a retrospective study of patients with suspected brain tumor to determine the incidence of and risk factors for glucocorticoid-induced diabetes.

Methods

This was a retrospective study of patients referred with suspected brain tumor to a neurological department, using data from a clinical database, electronic medical records, the laboratory system, and the pathology information bank. . Nondiabetic patients with a neuroimaging-verified brain tumor treated with high-dose glucocorticoid and monitored with glucose measurements were included in the study.

Results

Among 809 patients referred with suspected brain tumor, 171 were eligible for the study. Thirty-eight (22%) patients developed glucocorticoid-induced diabetes, defined as 2 glucose measurements ≥200 mg/dl (11.1 mmol/l) within the first week of treatment, and 4 of the patients were treated with insulin. The majority of patients with glucocorticoid-induced diabetes were identified on days 2, 3, and 4, and glucose levels were highest in the afternoon and evening. We were not able to identify any risk factors for glucocorticoid-induced diabetes and glucocorticoid-induced diabetes had no influence on survival in our cohort.

Conclusions

Glucocorticoid-induced diabetes is frequent in the first 7 days of treatment in patients with brain tumors. The results emphasize the need for screening for glucocorticoid-induced diabetes in this group of patients to avoid comorbidity expected to arise from hyperglycemia.
Madeleine and Catherine Des Roches
Authors: Tarte Kendall
Published: October 2017

Madeleine Neveu (b. c. 1520–d. 1587) and Catherine Fradonnet (b. 1542–d. 1587), the mother-daughter pair known as the “Dames Des Roches,” were prolific writers and the celebrated hosts of a humanist salon in their hometown of Poitiers, France. Catherine was the only surviving child of Madeleine, who took responsibility for her daughter’s education. Catherine famously refused to marry, and the two lived on their own after the death of Madeleine’s second husband in 1578. That same year they published their first collection of poetry and prose, Les Œuvres de Mes-Dames Des Roches. Their use of a surname based on landholdings, rather than the name of a husband or father, gave the women a means to affirm their mother-daughter bond on the title pages of their works. The name “Des Roches” (“of the rocks”) also offered rich topographical associations that the two women and their contemporaries exploited in their writings. By the time special court sessions, the Grands Jours, brought Parisian legists to Poitiers in 1579, the Des Roches were well known. Étienne Pasquier’s visit, and his conversation with Catherine during which he claimed to see a flea on her breast, led to a salon game in which many male participants wrote jocular verse in the blason tradition. Catherine’s flea poem is a nimble refutation of the corporeal, often bawdy subtext of the male-authored poems. The collected texts—primarily in French and Latin—were published as La Puce de Madame Des-Roches in 1582–1583. Madeleine and Catherine Des Roches jointly published two more collections, Les Secondes œuvres (1583) and Les Missives (1586). Their first and third collections were published by Abel L’Angelier in Paris, an association that brought their works to a wider audience. The Des Roches treat themes common to Renaissance women’s writing, such as female education and the life of the mind, and they address poems to their salon contemporaries and to members of the French court. Madeleine’s poetry bears witness to her personal difficulties; she also engages with local events of the Wars of Religion. Catherine’s writing is more abundant and varied; it includes poetry, prose dialogues, and verse translations and adaptations of classical and biblical texts. The Des Roches were the first French women to publish their private letters. Their contemporaries often remarked on the strong bond between the mother and daughter, and eulogized them after their death of the plague in 1587—which apparently occurred, appropriately and poetically, on the same day.
Arsenic Contamination in South and Southeast Asia
Authors: Ayers John C. , Goodbred Steven , Dietrich Matthew
Published: October 2017

Rural populations in South and Southeast Asia often rely on groundwater for drinking and irrigation. Usually water is obtained by installing a tubewell consisting of PVC pipe with a cast-iron hand pump mounted on top. The well is usually drilled deep enough to reach unconsolidated sand layers that have high permeability and therefore make good aquifers. Many of these tubewells are now known to deliver water with arsenic concentration >10 μg/L, the World Health Organization (WHO) guideline for safe drinking water, and even greater than the Bangladesh government guideline of 50 ug/L. Increased groundwater usage has also exacerbated the threat of previously uncontaminated aquifers being contaminated with arsenic through drawdown, and crops such as rice accumulating high levels of arsenic through irrigation with arsenic contaminated groundwater. The affected areas are generally located in river floodplains and deltas that have relatively low elevation and low-gradient topography. The principal areas fall within five river basins that drain the Himalayas: the relatively well-studied Ganges–Brahmaputra–Meghna River basin that includes portions of Bangladesh, India, Nepal, Bhutan, and China; the comparatively little-studied Indus and Irrawaddy river basins, affecting primarily Pakistan, India, and Myanmar, respectively; and the moderately well-studied Mekong system flowing through China, Myanmar, Laos, Thailand, Cambodia, and Vietnam; and the Red River basin in China and Vietnam. In these areas, at least 100 million people are affected by unsafe levels of arsenic in untreated groundwater, with the greatest number living in Bangladesh and West Bengal. Affected areas continue to be identified. Arsenic poisoning symptoms appeared eight to ten years after residents began drinking contaminated well water. Acronyms used in this review: hydrous ferric oxide or oxyhydroxide (HFO) and dissolved organic carbon (DOC).
Amiodarone-induced pulmonary toxicity
Authors: Colby Rebecca , Geyer Holly
Published: October 2017

Amiodarone is widely used to prevent ventricular and supraventricular dysrhythmias but has a number of toxicities. One of the most devastating adverse reactions to this drug is pulmonary toxicity, which can present in a myriad of different ways. Toxicity is difficult to diagnose because many of its features also are seen in nontoxic patients. This article reviews the pathophysiology, presentation, diagnosis, and treatment of amiodarone-induced pulmonary toxicity.
Synthetic cannabinoids
Authors: Freund Shaina A. , Banning Adrian S.
Published: October 2017

Synthetic marijuana use is an emerging public health problem in the United States, and can cause agitation, severe psychosis, bizarre hallucinations, and possibly death. This article describes these products, which are unregulated and can vary widely in composition, and how clinicians can recognize patients with synthetic cannabinoid toxicity and treat them appropriately to minimize morbidity and mortality.
A Randomized Cohort Study of Diagnostic and Therapeutic Thresholds in Medical Student Clinical Reasoning
Authors: Stojan Jennifer N. , Daniel Michelle , Morgan Helen K. , Whitman Laurie , Gruppen Larry D.
Published: October 2017

Purpose

Learning to make decisions under uncertain conditions is a critical component of diagnostic and therapeutic reasoning. This study sought to determine treatment decisions medical students make when presented with different thresholds of diagnostic uncertainty and whether they appropriately adjust diagnostic probabilities with test information.

Method

Two classes (2015, 2016) of fourth-year students (N = 342) were presented a patient with viral pneumonia and given 10%, 20%, or 50% pretest probabilities of that patient having a superimposed bacterial infection. Students decided to not treat, order a diagnostic test to guide management, or treat without testing based on these probabilities. The 2015 class was provided a posttest probability of 10% or 50% and asked to adjust their initial treatment decision.

Results

When given a low (10%) pretest probability, students were less likely to decide to treat (6%) and more likely to decide not to treat (36%). The percentage of students deciding to treat increased as the pretest probability of a superimposed infection increased from 10% to 50%, while the percentage of students not wanting to treat decreased. Interestingly, at 10%, 20%, and 50% pretest probability levels, most students were unable to decide and chose to order another test (57%, 67%, and 64%, respectively). When provided low and high posttest probabilities, students appropriately adjusted their decision making, but 29% to 32% still wanted additional testing.

Conclusions

Students adjusted treatment decisions to reflect different levels of diagnostic uncertainty, but varied considerably in their individual thresholds to make decisions, possibly contributing to unnecessary testing.
“You Have to Know the End of the Story”: Motivations to Follow Up After Transitions of Clinical Responsibility
Authors: Bowen Judith L. , Ilgen Jonathan S. , Irby David M. , ten Cate Olle , O’Brien Bridget C.
Published: October 2017

Purpose

Physicians routinely transition responsibility for patient care to other physicians. When transitions of responsibility occur before the clinical outcome is known, physicians may lose opportunities to learn from the consequences of their decision making. Sometimes curiosity about patients does not end with the transition and physicians continue to follow them. This study explores physicians’ motivations to follow up after transitioning responsibilities.

Method

Using a constructivist grounded theory approach, the authors conducted 18 semistructured interviews in 2016 with internal medicine hospitalist and resident physicians at a single tertiary care academic medical center. Constant comparative methods guided the qualitative analysis, using motivation theories as sensitizing constructs.

Results

The authors identified themes that characterized participants’ motivations to follow up. Curiosity about patients’ outcomes determined whether or not follow-up occurred. Insufficient curiosity about predictable clinical problems resulted in the choice to forgo follow-up. Sufficient curiosity due to clinical uncertainty, personal attachment to patients, and/or concern for patient vulnerability motivated follow-up to fulfill goals of knowledge building and professionalism. The authors interpret these findings through the lenses of expectancy-value (EVT) and self-determination (SDT) theories of motivation.

Conclusions

Participants’ curiosity about what happened to their patients motivated them to follow up. EVT may explain how participants made choices in time-pressured work settings. SDT may help interpret how follow-up fulfills needs of relatedness. These findings add to a growing body of literature endorsing learning environments that consider task-value trade-offs and support basic psychological needs of autonomy, competency, and relatedness to motivate learning.
Concerns and Responses for Integrating Health Systems Science Into Medical Education
Authors: Gonzalo Jed D. , Caverzagie Kelly J. , Hawkins Richard E. , Lawson Luan , Wolpaw Daniel R. , Chang Anna
Published: October 2017

With the aim of improving the health of individuals and populations, medical schools are transforming curricula to ensure physician competence encompasses health systems science (HSS), which includes population health, health policy, high-value care, interprofessional teamwork, leadership, quality improvement, and patient safety. Large-scale, meaningful integration remains limited, however, and a major challenge in HSS curricular transformation efforts relates to the receptivity and engagement of students, educators, clinicians, scientists, and health system leaders. The authors identify several widely perceived challenges to integrating HSS into medical school curricula, respond to each concern, and provide potential strategies to address these concerns, based on their experiences designing and integrating HSS curricula. They identify two broad categories of concerns: the (1) relevance and importance of learning HSS—including the perception that there is inadequate urgency for change; HSS education is too complex and should occur in later years; early students would not be able to contribute, and the roles already exist; and the science is too nascent—and (2) logistics and practicality of teaching HSS—including limited curricular time, scarcity of faculty educators with expertise, lack of support from accreditation agencies and licensing boards, and unpreparedness of evolving health care systems to partner with schools with HSS curricula. The authors recommend the initiation and continuation of discussions between educators, clinicians, basic science faculty, health system leaders, and accrediting and regulatory bodies about the goals and priorities of medical education, as well as about the need to collaborate on new methods of education to reach these goals.
Broadening the Scope of Feedback to Promote Its Relevance to Workplace Learning
Authors: van der Leeuw Renée M. , Teunissen Pim W. , van der Vleuten Cees P.M.
Published: October 2017

The common goal in medical education is to support the health care workforce, both present and future, in becoming and remaining competent professionals. Both during and after medical training, learning takes place in the clinical workplace. Yet, how feedback is defined in medical education and how it is practiced in clinical training situations, combined with a research focus on “what works,” limits its potential for learning. This article explores the theoretical background of learning in interaction and current trends in medical education to broaden the scope of feedback and promote its relevance to workplace learning.

A new, wider perspective is outlined in which feedback could be redefined as “performance-relevant information” (PRI). PRI can incorporate all information that is deemed relevant to the learner, drawn from interaction in workplace learning and one’s interpretation of performance in the clinical workplace. This information can, for example, come from the evaluation of patient outcomes after treatment; observations of role models’ performance; evaluations and assessments; exploring feelings of failure or success; and responses of colleagues and peers.

PRI draws attention to learning opportunities that better fit the highly social learning of clinical workplaces and current trends in medical education. It supports the interpretation of individual or team performance in terms of relevance to learning. This allows for a comprehensive way of viewing and stimulating workplace learning and the performance of professionals, providing an opportunity to create lifelong learning strategies and potentially improving the care of patients.
Race/Ethnicity and Success in Academic Medicine: Findings From a Longitudinal Multi-Institutional Study
Authors: Kaplan Samantha E. , Raj Anita , Carr Phyllis L. , Terrin Norma , Breeze Janis L. , Freund Karen M.
Published: October 2017

Purpose

To understand differences in productivity, advancement, retention, satisfaction, and compensation comparing underrepresented medical (URM) faculty with other faculty at multiple institutions.

Method

A 17-year follow-up was conducted of the National Faculty Survey, a random sample from 24 U.S. medical schools, oversampled for URM faculty. The authors examined academic productivity, advancement, retention, satisfaction, and compensation, comparing white, URM, and non-URM faculty. Retention, productivity, and advancement data were obtained from public sources for nonrespondents. Covariates included gender, specialty, time distribution, and years in academia. Negative binomial regression was used for count data, logistic regression for binary outcomes, and linear regression for continuous outcomes.

Results

In productivity analyses, advancement, and retention, 1,270 participants were included; 604 participants responded to the compensation and satisfaction survey. Response rates were lower for African American (26%) and Hispanic faculty (39%) than white faculty (52%, P < .0001). URM faculty had lower rates of peer-reviewed publications (relative number 0.64; 95% CI: 0.51, 0.79), promotion to professor (OR = 0.53; CI: 0.30, 0.93), and retention in academic medicine (OR = 0.49; CI: 0.32, 0.75). No differences were identified in federal grant acquisition, senior leadership roles, career satisfaction, or compensation between URM and white faculty.

Conclusions

URM and white faculty had similar career satisfaction, grant support, leadership, and compensation; URM faculty had fewer publications and were less likely to be promoted and retained in academic careers. Successful retention of URM faculty requires comprehensive institutional commitment to changing the academic climate and deliberative programming to support productivity and advancement.
Antidepressant-like effect of fluoxetine may depend on translocator protein activity and pretest session duration in forced swimming test in mice
Authors: Kudryashov Nikita V. , Kalinina Tatiana S. , Shimshirt Alexander A. , Korolev Anton O. , Volkova Anna V. , Voronina Tatiana A.
Published: October 2017

The antidepressant-like effect of fluoxetine (20 mg/kg i.p.) has been assessed using the forced swimming test (FST) in IRC (CD-1) mice exposed or not to a pretest session of different duration (5 or 20 min). The influence of the mitochondrial translocator protein (TSPO) activity on the antidepressant-like effect of fluoxetine (20 mg/kg i.p.) in the FST was also studied. The antidepressant-like effect of fluoxetine was observed only in mice subjected to a 5-min pretest session 24 h before the FST. The TSPO antagonist PK11195 [1-(2-chlorophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquinolinecarboxamide; 1 or 3 mg/kg i.p.] inhibited the antidepressant activity of fluoxetine in the FST. In the present study, fluoxetine or PK11195 was administered for a short duration. We suppose that the functional activity of TSPO may depend on a pretest session and that using this procedure is necessary to detect antidepressant activity of fluoxetine-like drugs.
New Grading System for Limbal Dermoid: A Retrospective Analysis of 261 Cases Over a 10-Year Period
Authors: Zhong Jing , Deng Yuqing , Zhang Ping , Li Saiqun , Huang Haixiang , Wang Bowen , Zhang Henan , Peng Lulu , Yang Ruhui , Xu Jiangang , Yuan Jin
Published: October 2017

Purpose:

To establish a new scoring system for limbal dermoid, in order to unify the diagnostic criteria and assess the prognosis.

Methods:

A retrospective study was conducted on 261 patients with limbal dermoid. The basic information, clinical features, and pathology of dermoids were recorded, and the prognosis at 1 year after keratoplasty was assessed at follow-up. A new visual scoring system was created for the area of corneal involvement, the area of conjunctival involvement, and the surface shape.

Results:

There were 154 females and 107 males with mean age of 4 ± 3 years at surgery. After scoring, 59% (136) of patients were classified as grade I, 26% (60) as grade II, and 14% (33) as grade III. The pathological results were 124 dermoid cases, 76 lipodermoid, 5 complex choristoma, and 10 epibulbar osseous choristoma. Moreover, patients with lower clinical scores presented a better prognosis; the mean logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity in grade I patients was 0.38 ± 0.05, which was better than the grade II value of 0.61 ± 0.09 (P < 0.05) and the grade III value of 0.94 ± 0.11 (P < 0.001).

Conclusions:

New grading systems for limbal dermoid were useful for clinical diagnosis and may have prognostic value in predicting visual acuity. A lower-grade dermoid exhibited better vision postoperatively.
Infected Nasal Dermoid Cyst/Sinus Tract Presenting With Bilateral Subperiosteal Supraorbital Abscesses: The Midline Nasal Tuft of Hair, an Overlooked Finding
Authors: Ray Coby N. , Betteridge Bryce C. , Demke Joshua C.
Published: October 2017

This case is, to the authors’ knowledge, the first reported case in the literature of bilateral orbital abscesses as result of an infected nasal dermoid. The baby presented with what proved to be bilateral supraorbital subperiosteal abscesses with associated frontal osteitis/osteomyelitis and soft tissue infection of the glabella. Methicillin-sensitive staphylococcus aureus infection was found in the setting of a midline nasal dermoid with tuft of hair and infected sinus tract that was at least initially missed on diagnosis.
Bone-conducted Vestibular-evoked Myogenic Potentials Before and After Stapes Surgery
Authors: Akazawa Kazuyuki , Ohta Shigeto , Tsuzuki Kenzo , Sakagami Masafumi
Published: October 2017

Objective:

To identify whether stapes surgery causes otolith dysfunction using bone-conducted vestibular-evoked myogenic potentials (VEMPs).

Study Design:

Prospective study.

Setting:

Hyogo College of Medicine Hospital.

Patients:

Twenty primary ears (19 otosclerosis, 1 congenital stapes fixation) in 17 patients (2 men, 15 women; mean age 51 yr, range 20–68 yr) who had normal cervical VEMP (cVEMP) and ocular VEMP (oVEMP) results with bone-conducted stimulation were included.

Intervention:

Stapes surgery.

Main Outcome Measure:

Both VEMP tests with bone-conducted stimulation were performed before and after stapes surgery. The normalized p13-n23 amplitude of cVEMPs and the nI-pI amplitude of oVEMPs were measured within 3 months after stapes surgery. Then, the asymmetry ratio (AR) was calculated to examine the effect of surgery on otolith function.

Results:

Seven patients complained of temporary dizziness postoperatively, but their symptoms disappeared within approximately a week. Deterioration of VEMPs of the operated ear was not seen in any ears. Significantly greater amplitude compared with the opposite ear was found for cVEMP in one ear and oVEMP in two ears after the surgery. Their VEMP results recovered to the normal range at 6 months postoperatively.

Conclusions:

These findings suggest that stapes surgery causes no or undetectably small otolith dysfunction from the perspective of VEMP evaluation.
The Gastric Acid Pocket (or Coat) and Its Attenuation in Helicobacter pylori-infected Subjects
Authors: McColl Kenneth E.L.
Published: October 2017

In 2001, it was observed that the cardia region of the lumen of the stomach remained highly acidic after a meal and escaped the buffering effect of the food. This phenomenon was termed the acid pocket and is thought to explain why reflux symptoms occur after meals despite the buffering effect of food. This review describes the discovery of the acid pocket and our progress in understanding the intragastric physiology producing it, its exaggeration in hiatus hernia and role in reflux disease. The recent discovery that the acid pocket is attenuated in the Helicobacter pylori-infected population and the significance of this to the negative association between H. pylori and reflux disease and its complications is also addressed. Finally, the role of the acid pocket in providing protection from potentially pathogenic ingested microorganisms is discussed.
Gut colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae may increase disease activity in biologic-naive outpatients with ulcerative colitis: an interim analysis
Authors: Skuja Vita , Derovs Aleksejs , Pekarska Katrina , Rudzite Dace , Lavrinovica Elvira , Piekuse Linda , Kempa Inga , Straume Zane , Eglite Jelena , Lejnieks Aivars , Krumina Angelika , Eliakim Rami
Published: October 2017

Background

Certain Enterobacteriaceae strains have been associated with the development of ulcerative colitis (UC). Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are the most commonly found multi-drug-resistant (MDR) bacteria colonizing the gut in UC patients and might trigger a more severe disease activity in UC patients.

Objective

The aim of this study was to evaluate whether disease activity is higher in UC patients with gut colonization with ESBL-producing Enterobacteriaceae.

Materials and methods

A cross-sectional, pilot study was carried out in a tertiary medical center in Latvia. Demographic data were collected; UC disease activity and extent were evaluated according to the full Mayo score, Montreal classification, and adapted Truelove and Witt’s index. Rectal swabs with fecal biomaterial were collected, ESBL-producing Enterobacteriaceae were isolated, and bacterial plasmid genes responsible for ESBL production, blaCTX-M, blaTEM, and blaSHV, were detected. UC disease activity was compared in patients with and without gut colonization with ESBL-producing Enterobacteriaceae.

Results

A total of 65 patients with UC were included in the initial analysis. Gut colonization with ESBL-producing Enterobacteriaceae was found in seven (11%) patients – mostly Escherichia coli [5 (71%)] containing the blaCTX-M bacterial plasmid gene. Patients with gut colonization with ESBL-producing Enterobacteriaceae had more severe disease compared with patients without gut colonization according to the full Mayo score (5.86 vs. 3.40; P=0.015), Montreal classification (moderate disease vs. clinical remission; P=0.031), and adapted Truelove and Witt’s index (moderate disease vs. mild disease; P=0.008).

Conclusion

Gut colonization with ESBL-producing Enterobacteriaceae may increase UC disease activity. Further research is needed to analyze the possible confounding factors that could contribute toward this outcome.
Prevalence, incidence, and autoimmune comorbidities of celiac disease: a nation-wide, population-based study in Denmark from 1977 to 2016
Authors: Grode Louise , Bech Bodil H. , Jensen Thomas M. , Humaidan Peter , Agerholm Inge E. , Plana-Ripoll Oleguer , Ramlau-Hansen Cecilia H.
Published: October 2017

Aim

The aim of this study was to describe and identify potential trends with respect to prevalence, incidence, age, sex, and autoimmune comorbidity of celiac disease (CD).

Patients and methods

A Danish nationwide cohort study of CD using data from The National Patient Register. Patients with a primary or secondary diagnosis code of CD during the period 1977 to 2016 were identified. Information on sex, date of birth, death, or immigration was obtained from the Danish Civil Registration System, and autoimmune comorbidities were identified in the Danish National Patient Register. The CD cohort was compared with the general Danish population using a control cohort and aggregated data obtained from Statistics Denmark.

Results

The CD cohort consisted of 11 802 (65% women) patients. The median age at diagnosis of CD varied between 30 years in 1980–1984 and 45 years in 1995–1999 and 27 years in 2015–2016. The prevalence of CD in 1986 and 2016 was 14 and 180 per 100 000 persons, respectively, with a female/male ratio changing from 1.3 to 2.0. Incidence rates (per 100 000 person-years) changed from 1.6 in 1980–1984 to 15.2 in 2015–2016, with the largest increase among females aged 0–9 years. In 2016, prevalence of autoimmune comorbidities was 16.4% among the CD patients compared with 5.3% in the general population.

Conclusion

The prevalence of diagnosed CD has doubled every decade in Denmark from 1986 to 2016, and in the same period the female/male ratio has increased and the median age at diagnosis has decreased. The prevalence of autoimmune comorbidity in 2016 was three times higher among CD patients compared with the general Danish population.
Combining Best Practices and Patient, Caregiver, and Healthcare Provider Perspectives for Late-Life Supportive Care
Authors: Anderson Eric W. , Frazer Monica S. , Schellinger Sandra E.
Published: October 2017

Healthcare systems seek effective ways to support and treat the growing number of individuals living with serious illness. The nature of these care episodes challenges delivery systems to attain proficiency in dealing with the multiplicity of chronic conditions in individuals and populations through understanding and attending to patients’ medical and nonmedical aspects of health. This article describes LifeCourse, a healthcare approach that provides palliative care practices to patients with serious illness years prior to death.
Preparing for Electronic Medical Record Implementation
Authors: Carroll Tracy , Tonges Mary , Ray Joel
Published: October 2017

This article describes 1 organization's successful approach to mitigating the potential negative effects of a new electronic medical record on patient experience. The Carolina Care model, developed at the University of North Carolina Hospitals to actualize caring theory in practice, helped to structure and greatly facilitate this work. Seven focus areas were integrated to create the “Communication in an Electronic Environment” program with a strong emphasis on nurse-patient communication.
On the Role of Illness Duration and Nutrient Restriction in Cholestatic Alterations that Occur During Critical Illness
Authors: Jenniskens Marc , Güiza Fabian , Oorts Marlies , Vander Perre Sarah , Derde Sarah , Dufour Thomas , Thiessen Steven , Annaert Pieter , Van den Berghe Greet , Langouche Lies
Published: October 2017

Background and Aims:

Elevated markers of cholestasis are common in response to critical illness, and associated with adverse outcome. The role of illness duration and of nutrient restriction on underlying molecular pathways of such cholestatic responses have not been thoroughly investigated.

Methods:

In a mouse model of surgery- and sepsis-induced critical illness, molecular pathways of cholestasis were investigated up to 7 days. To assess which changes are explained by illness-induced lack of feeding, nutrient-restricted healthy mice were studied and compared with ad libitum fed healthy mice. Furthermore, serum bile acid (BA) concentrations were quantified in 1,114 human patients with either short or long intensive care unit (ICU) stay, matched for type and severity of illness, up to ICU-day-7.

Results:

In critically ill mice, either evoked by surgery or sepsis, circulating and hepatic BA-levels progressively increased with time from day-3 onward, preceded by unsuppressed or upregulated CYP7A1 and CYP27A1 protein expression. From 30 h onward, nuclear farnesoid-X-receptor-retinoid-X-receptor staining was significantly suppressed in both critically ill groups, followed from day-3 onward by decreased gene expression of the apical exporter BA-specific export pump and increased expression of basolateral exporters multidrug resistance-associated protein 3 (MRP3) and MRP4. Nutrient restriction in healthy mice only partly mirrored illness-induced alterations in circulating BA and BA-transporters, without changing nuclear receptors or synthesis markers expression. Also in human critically ill patients, serum BA increased with time in long-stay patients only, similarly for patients with or without sepsis.

Conclusions:

Circulating BA concentrations rose days after onset of sepsis- and surgery-induced, critical illness, only partially explained by lack of feeding, preceded by suppressed nuclear feedback-sensors and ongoing BA synthesis. Expression of transporters suggested ongoing reversed BA-flow toward the blood.
Production of spherical granule type yogurt with improving convenience and preservation
Authors: Shin Myung-Gon
Published: October 2017

Yogurt contains many microorganisms that are beneficial to human health, and is a probiotic that supplies many nutrients such as calcium and protein. It is difficult to safety preserve for a long time because it possesses a high content of water. To address this problem, powdered “instant” yogurt has been developed, but it has flaws low flowability and solubility. Therefore, yogurt was granulated using a fluidized bed granulator to increase flowability and solubility. The fluidized bed granulator was designed by using response surface methodology (RSM), whose variables were feeding rate (FR), atomization air pressure (AP) and product temperature (PT). After being granulated, the yogurt was analyzed for yield and lactic acid bacteria count. The maximum yield of yogurt granules was 79.42%, at FR of 0.54 mL/min, AP of 2.64 kPa, and PT of 58.18℃, and the colony count for lactic acid bacteria was more than 6 log10 CFU/g. Therefore, spherical granulation of yogurt using a fluidized bed granulator could be used for making convenient probiotic products with improved flowability and solubility.