bluuebunny/crossref_metadata_2025 huggingface dataset:
Vacuum ultraviolet photoionization cross section of the hydroxyl radical
Authors: Dodson Leah G. , Savee John D. , Gozem Samer , Shen Linhan , Krylov Anna I. , Taatjes Craig A. , Osborn David L. , Okumura Mitchio
Published: May 2018

The absolute photoionization spectrum of the hydroxyl (OH) radical from 12.513 to 14.213 eV was measured by multiplexed photoionization mass spectrometry with time-resolved radical kinetics. Tunable vacuum ultraviolet (VUV) synchrotron radiation was generated at the Advanced Light Source. OH radicals were generated from the reaction of O(1D) + H2O in a flow reactor in He at 8 Torr. The initial O(1D) concentration, where the atom was formed by pulsed laser photolysis of ozone, was determined from the measured depletion of a known concentration of ozone. Concentrations of OH and O(3P) were obtained by fitting observed time traces with a kinetics model constructed with literature rate coefficients. The absolute cross section of OH was determined to be σ(13.436 eV) = 3.2 ± 1.0 Mb and σ(14.193 eV) = 4.7 ± 1.6 Mb relative to the known cross section for O(3P) at 14.193 eV. The absolute photoionization spectrum was obtained by recording a spectrum at a resolution of 8 meV (50 meV steps) and scaling to the single-energy cross sections. We computed the absolute VUV photoionization spectrum of OH and O(3P) using equation-of-motion coupled-cluster Dyson orbitals and a Coulomb photoelectron wave function and found good agreement with the observed absolute photoionization spectra.
An analytic current-voltage model for quasi-ballistic III-nitride high electron mobility transistors
Authors: Li Kexin , Rakheja Shaloo
Published: May 2018

We present an analytic model to describe the DC current-voltage (I-V) relationship in scaled III-nitride high electron mobility transistors (HEMTs) in which transport within the channel is quasi-ballistic in nature. Following Landauer's transport theory and charge calculation based on two-dimensional electrostatics that incorporates negative momenta states from the drain terminal, an analytic expression for current as a function of terminal voltages is developed. The model interprets the non-linearity of access regions in non-self-aligned HEMTs. Effects of Joule heating with temperature-dependent thermal conductivity are incorporated in the model in a self-consistent manner. With a total of 26 input parameters, the analytic model offers reduced empiricism compared to existing GaN HEMT models. To verify the model, experimental I-V data of InAlN/GaN with InGaN back-barrier HEMTs with channel lengths of 42 and 105 nm are considered. Additionally, the model is validated against numerical I-V data obtained from DC hydrodynamic simulations of an unintentionally doped AlGaN-on-GaN HEMT with 50-nm gate length. The model is also verified against pulsed I-V measurements of a 150-nm T-gate GaN HEMT. Excellent agreement between the model and experimental and numerical results for output current, transconductance, and output conductance is demonstrated over a broad range of bias and temperature conditions.
Thickness-dependent transition of the valence band shape from parabolic to Mexican-hat-like in the MBE grown InSe ultrathin films
Authors: Kibirev I. A. , Matetskiy A. V. , Zotov A. V. , Saranin A. A.
Published: May 2018

Using molecular beam epitaxy, InSe films of thicknesses from one to six quadruple layers were grown on Si(111). The surface morphology and structure of the InSe films were monitored using reflection high-energy electron diffraction and scanning tunneling microscopy observations. Angle resolved photoemission experiments revealed that the bulk-like parabolic shape of the valence band of InSe/Si(111) changes for the so-called “Mexican hat” shape when the thickness of the InSe film reduces to one and two quadruple layers. The observed effect is in a qualitative agreement with the reported calculation results on the free-standing InSe films. However, in the InSe/Si(111) system, the features used to characterize the Mexican hat dispersion appear to be more pronounced, which makes the one- and two-quadruple InSe layers on Si(111) promising candidates as thermoelectric materials.
On the possibility of singlet fission in crystalline quaterrylene
Authors: Wang Xiaopeng , Liu Xingyu , Cook Cameron , Schatschneider Bohdan , Marom Noa
Published: May 2018

Singlet fission (SF), the spontaneous down-conversion of a singlet exciton into two triplet excitons residing on neighboring molecules, is a promising route to improve organic photovoltaic (OPV) device efficiencies by harvesting two charge carriers from one photon. However, only a few materials have been discovered that exhibit intermolecular SF in the solid state, most of which are acene derivatives. Recently, there has been a growing interest in rylenes as potential SF materials. We use many-body perturbation theory in the GW approximation and the Bethe-Salpeter equation to investigate the possibility of intermolecular SF in crystalline perylene and quaterrylene. A new method is presented for determining the percent charge transfer (%CT) character of an exciton wave-function from double-Bader analysis. This enables relating exciton probability distributions to crystal packing. Based on comparison to known and predicted SF materials with respect to the energy conservation criterion (ES-2ET) and %CT, crystalline quaterrylene is a promising candidate for intermolecular SF. Furthermore, quaterrylene is attractive for OPV applications, thanks to its high stability and narrow optical gap. Perylene is not expected to exhibit SF; however, it is a promising candidate for harvesting sub-gap photons by triplet-triplet annihilation.
Pressure dependence of excited-state charge-carrier dynamics in organolead tribromide perovskites
Authors: Liu X. C. , Han J. H. , Zhao H. F. , Yan H. C. , Shi Y. , Jin M. X. , Liu C. L. , Ding D. J.
Published: May 2018

Excited-state charge-carrier dynamics governs the performance of organometal trihalide perovskites (OTPs) and is strongly influenced by the crystal structure. Characterizing the excited-state charge-carrier dynamics in OTPs under high pressure is imperative for providing crucial insights into structure-property relations. Here, we conduct in situ high-pressure femtosecond transient absorption spectroscopy experiments to study the excited-state carrier dynamics of CH3NH3PbBr3 (MAPbBr3) under hydrostatic pressure. The results indicate that compression is an effective approach to modulate the carrier dynamics of MAPbBr3. Across each pressure-induced phase, carrier relaxation, phonon scattering, and Auger recombination present different pressure-dependent properties under compression. Responsiveness is attributed to the pressure-induced variation in the lattice structure, which also changes the electronic band structure. Specifically, simultaneous prolongation of carrier relaxation and Auger recombination is achieved in the ambient phase, which is very valuable for excess energy harvesting. Our discussion provides clues for optimizing the photovoltaic performance of OTPs.
An Efficient One-Pot, Four-Component Synthesis of Pyrazolo[3,4-b]pyridines Catalyzed by Tetrapropylammonium Bromide (TPAB) in Water
Authors: Ezzati Mahnaz , Khalafy Jabbar , Marjani Ahmad Poursattar , Prager Rolf H.
Published: May 2018

A novel and one-pot pseudo-four-component reaction between a series of arylglyoxals, malononitrile, 3-methyl-1-phenyl-1H-pyrazol-5-amine, and acetone in the presence of tetrapropylammonium bromide (TPAB) has been developed to synthesize a series of new substituted pyrazolo[3,4-b]pyridines, using water as an environmentally friendly solvent, in high to excellent yields.
Molecular Epidemiology of Candida auris in Colombia Reveals a Highly Related, Countrywide Colonization With Regional Patterns in Amphotericin B Resistance
Authors: Escandón Patricia , Chow Nancy A , Caceres Diego H , Gade Lalitha , Berkow Elizabeth L , Armstrong Paige , Rivera Sandra , Misas Elizabeth , Duarte Carolina , Moulton-Meissner Heather , Welsh Rory M , Parra Claudia , Pescador Luz Angela , Villalobos Nohora , Salcedo Soraya , Berrio Indira , Varón Carmen , Espinosa-Bode Andrés , Lockhart Shawn R , Jackson Brendan R , Litvintseva Anastasia P , Beltran Mauricio , Chiller Tom M
Published: May 2018

Background

Candida auris is a multidrug-resistant yeast associated with hospital outbreaks worldwide. During 2015–2016, multiple outbreaks were reported in Colombia. We aimed to understand the extent of contamination in healthcare settings and to characterize the molecular epidemiology of C. auris in Colombia.

Methods

We sampled patients, patient contacts, healthcare workers, and the environment in 4 hospitals with recent C. auris outbreaks. Using standardized protocols, people were swabbed at different body sites. Patient and procedure rooms were sectioned into 4 zones and surfaces were swabbed. We performed whole-genome sequencing (WGS) and antifungal susceptibility testing (AFST) on all isolates.

Results

Seven of the 17 (41%) people swabbed were found to be colonized. Candida auris was isolated from 37 of 322 (11%) environmental samples. These were collected from a variety of items in all 4 zones. WGS and AFST revealed that although isolates were similar throughout the country, isolates from the northern region were genetically distinct and more resistant to amphotericin B (AmB) than the isolates from central Colombia. Four novel nonsynonymous mutations were found to be significantly associated with AmB resistance.

Conclusions

Our results show that extensive C. auris contamination can occur and highlight the importance of adherence to appropriate infection control practices and disinfection strategies. Observed genetic diversity supports healthcare transmission and a recent expansion of C. auris within Colombia with divergent AmB susceptibility.
Noël-Antoine Pluche’s
Le Spectacle de la nature, ou, Entretiens sur les particularités de l’histoire naturelle
as an Instrument for the Government of Bodies
Authors: Wallmann Elisabeth
Published: May 2018

This article reads Noël-Antoine Pluche’s bestseller
Le Spectacle de la nature, ou, Entretiens sur les particularités de l’histoire naturelle
as a contribution to eighteenth-century theories of government. It contends that the work’s didactic as well as entertaining volumes on animals, building on and reinforcing the vogue for natural history among the eighteenth-century reading public, helped formulate and disseminate new ideas about how to increase France’s prosperity. Interpreting Pluche’s descriptions of animals in the light of Foucault’s claims about the emergence of ‘biopolitics’, this article argues that his natural histories of animals provided the upper-class readers of the
Spectacle de la nature
with tools for rendering the bodies of those lower down the social hierarchy as productive as possible without external coercion and, hence, for contributing to the country’s political economy by exercising their management functions. Through interpretation of several examples from Pluche’s bestiary of hard-working animals, it shows how descriptions of animals were used as an instrument for reconstructing and disseminating the concept of ‘work’. In this way, the article provides an account of the intertwining of natural history, political economy, and the shaping of the individual in the first half of the eighteenth century.
Improving Aztreonam Stewardship and Cost Through a Penicillin Allergy Testing Clinical Guideline
Authors: Chen Justin R , Tarver Scott A , Alvarez Kristin S , Wei Wenjing , Khan David A
Published: May 2018

Background

Patients reporting penicillin allergy often receive unnecessary and costly broad-spectrum alternatives such as aztreonam with negative consequences. Penicillin allergy testing improves antimicrobial therapy but is not broadly used in hospitals due to insufficient testing resources and short-term expenses. We describe a clinical decision support (CDS) tool promoting pharmacist-administered penicillin allergy testing in patients receiving aztreonam and its benefits toward antimicrobial stewardship and costs.

Methods

A CDS tool was incorporated into the electronic medical record, directing providers to order penicillin allergy testing for patients receiving aztreonam. An allergy-trained pharmacist reviewed orders placed through this new guideline and performed skin testing and oral challenges to determine whether these patients could safely take penicillin. Data on tests performed, antibiotic utilization, and cost-savings were compared with patients tested outside the new guideline as part of our institution’s standard stewardship program.

Results

The guideline significantly increased penicillin allergy testing among patients receiving aztreonam from 24% to 85% (P < .001) while reducing the median delay between admission and testing completion from 3.31 to 1.05 days (P = 0.008). Patients tested under the guideline saw a 58% increase in penicillin exposure (P = .046). Institutional aztreonam administration declined from 2.54 to 1.47 administrations per 1000 patient-days (P = .016). Average antibiotic costs per patient tested before and after CDS decreased from $1265.81 to $592.08 USD, a 53% savings.

Conclusions

Targeting penicillin allergy testing to patients on aztreonam yields therapeutic and economic benefits during a single admission. This provides a cost-effective model for inpatient testing.
PA use of point-of-care ultrasound
Authors: Rizzolo Denise , Krackov Rachel
Published: May 2018

Limited research exists on PAs and use of point-of-care (POC) ultrasound. This pilot survey sought to determine current views on and use of POC ultrasound in a small group of PAs.

Methods:

The authors developed an anonymous voluntary survey on PA views and use of POC ultrasound. The survey was entered into Qualtrics and e-mailed three times.

Results:

Nearly 27% of the subjects use ultrasound with 62% feeling confident in their ability to use ultrasound. The top reason for not using ultrasound was lack of access to a machine (50%). Only 35.3% of those without access to a machine were interested in bringing ultrasound into their practices. Sixty-seven percent of respondents felt that PAs should have standardized ultrasound training.

Conclusions:

Results demonstrate that more research is needed into the applicability of POC ultrasound to all PA practice areas as well as how PAs should be trained in POC ultrasound.
What Makes “Difficult Patients” Difficult for Medical Students?
Authors: Steinauer Jody E. , O’Sullivan Patricia , Preskill Felisa , ten Cate Olle , Teherani Arianne
Published: May 2018

Purpose

Physicians can find it challenging to provide high-quality care to “difficult patients.” While studies support that medical students also find some patients “difficult,” little is known about why they do or how being a student affects their perceptions. The authors conducted this study to gain a deeper understanding of students’ experiences with “difficult patients” to inform clinical teaching about effective patient communication and patient-centered care.

Method

In 2016, the authors conducted interviews with fourth-year medical students, who were asked to describe patient interactions in which they felt negative emotions toward the patient, as well as describe the clinical setting and their feelings. The authors audiorecorded and transcribed the interviews. Then, using a constructivist grounded theory approach, they reviewed the transcripts, coded the data using a codebook they had developed, and grouped the codes into themes.

Results

Twenty-six students (of 44 volunteers and 180 students invited) were interviewed. Students described negative feelings toward patients and patients’ behaviors, which were exacerbated by three situations related to their role and expectations as learners: (1) patients’ interference with students’ ability to “shine”; (2) patients’ interference with students’ expectations of patient-centered care; and (3) students’ lack of the tools or authority to improve patients’ health.

Conclusions

Educators should consider these findings, which can be explained by the professional identity formation and goal orientation theory frameworks, as they teach medical students to provide high-quality care for patients they find “difficult.”
Ketamine Alters Hippocampal Cell Proliferation and Improves Learning in Mice after Traumatic Brain Injury
Authors: Peters Austin J. , Villasana Laura E. , Schnell Eric
Published: May 2018

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Traumatic brain injury induces cellular proliferation in the hippocampus, which generates new neurons and glial cells during recovery. This process is regulated by N-methyl-d-aspartate–type glutamate receptors, which are inhibited by ketamine. The authors hypothesized that ketamine treatment after traumatic brain injury would reduce hippocampal cell proliferation, leading to worse behavioral outcomes in mice.

Methods

Traumatic brain injury was induced in mice using a controlled cortical impact injury, after which mice (N = 118) received either ketamine or vehicle systemically for 1 week. The authors utilized immunohistochemical assays to evaluate neuronal, astroglial, and microglial cell proliferation and survival 3 days, 2 weeks, and 6 weeks postintervention. The Morris water maze reversal task was used to assess cognitive recovery.

Results

Ketamine dramatically increased microglial proliferation in the granule cell layer of the hippocampus 3 days after injury (injury + vehicle, 2,800 ± 2,700 cells/mm3, n = 4; injury + ketamine, 11,200 ± 6,600 cells/mm3, n = 6; P = 0.012). Ketamine treatment also prevented the production of astrocytes 2 weeks after injury (sham + vehicle, 2,400 ± 3,200 cells/mm3, n = 13; injury + vehicle, 10,500 ± 11,300 cells/mm3, n = 12; P = 0.013 vs. sham + vehicle; sham + ketamine, 3,500 ± 4,900 cells/mm3, n = 14; injury + ketamine, 4,800 ± 3,000 cells/mm3, n = 13; P = 0.955 vs. sham + ketamine). Independent of injury, ketamine temporarily reduced neurogenesis (vehicle-exposed, 105,100 ± 66,700, cells/mm3, n = 25; ketamine-exposed, 74,300 ± 29,200 cells/mm3, n = 27; P = 0.031). Ketamine administration improved performance in the Morris water maze reversal test after injury, but had no effect on performance in sham-treated mice.

Conclusions

Ketamine alters hippocampal cell proliferation after traumatic brain injury. Surprisingly, these changes were associated with improvement in a neurogenesis-related behavioral recall task, suggesting a possible benefit from ketamine administration after traumatic brain injury in mice. Future studies are needed to determine generalizability and mechanism.
“It Is Hard Work, But It Is Worth It”
Authors: Haahr Anita , Østergaard Karen , Kirkevold Marit
Published: May 2018

This article evaluates the feasibility of a nursing intervention when adjusting to deep brain stimulation for Parkinson disease. Eight couples were included in the study. Main activities of the intervention were a diary and individualized meetings between nurses, patients, and spouses with a focus on everyday life and expectations to deep brain stimulation. All meetings were audio recorded and analyzed together with the content of the diary. The intervention was evaluated as feasible and experienced as meaningful. It supports the need for individualized care involving both patients and spouses and contributes to the development of an evidence-based nursing practice.
Evidence-based Medicine in Pediatric Orthopaedics: Evidence-based Practice Committee Summary of Levels of Evidence, Clinical Practice Guidelines, Appropriate Use Criteria, and Best Practice Guidelines
Authors: Gandhi Jigar S. , Shea Kevin G. , Sponseller Paul D. , Brighton Brian K. , Ganley Theodore J.
Published: May 2018

The concept of evidence-based medicine has evolved over the past 2 decades, and has become a cornerstone to clinical decision-making in virtually every aspect of medicine. With a commitment to providing its members with high-quality evidence-based guidelines, the American Academy of Orthopaedic Surgeons has instituted concerted efforts since 2006 to develop clinical practice guidelines (CPGs) and appropriate use criteria (AUCs) for certain orthopaedic conditions. Many of these CPGs and AUCs detail the management of pediatric orthopaedic conditions. By the same token, members of the Pediatric Orthopaedic Society of North America (POSNA) Evidence Based Practice Committee have been publishing succinct evaluations of randomized controlled trials in pediatric orthopaedic surgery to create an evidence-based repository for quick reference to available high-level evidence as well as resource to identify gaps in the current research and identify opportunities for future investigation. In instances where higher-level evidence needed to develop CPGs is not available to address a critically important clinical question, consensus recommendations from experts in the field have been obtained to develop best practice guidelines (BPGs). The purpose of this review is to provide readers with a deeper understanding of the key principles of evidence-based medicine and methodologies used for the development of CPGs, AUCs, and BPGs.
Routine Adaptive Replanning of p16-Positive Stage N2b Oropharyngeal Cancer
Authors: Zhu James H. , Amdur Robert J. , Lu Bo , Liu Chihray , Hitchcock Kathryn E. , Mendenhall William M.
Published: May 2018

Purpose/Objective(s):

To determine if routinely replanning patients treated for oropharyngeal cancer that is p16-positive and clinical neck stage N2b (AJCC 7th edition) is likely to result in dose changes that will improve patient outcomes to a meaningful degree.

Methods:

In 10 consecutive patients treated with primary radiotherapy (RT) and concurrent weekly chemotherapy for p16-positive N2b oropharyngeal carcinoma, we prospectively evaluated dose changes from replanning for the final 4 or 2 weeks of RT of a 7-week RT program.

Results:

Replanning for the final 4 or 2 weeks improved planning target volume coverage by an average of 4 and 2 percentage points, respectively. For all normal structures, the dose change was small (<1 Gy) with replanning.

Conclusions:

In patients with p16-positive N2b oropharynx cancer, the value of replanning RT is a small improvement in target coverage with minimal improvement in normal tissue sparing. In response to our study, some of the physicians in our group replan most node-positive oropharyngeal cancer cases while others think routine replanning is not valuable.
The University of Florida Department of Radiation Oncology Guidelines for Treatment of Differentiated Thyroid Cancer With I-131 or External-beam Radiotherapy
Authors: Amdur Robert J. , Dagan Roi
Published: May 2018

The purpose of this paper is to summarize the University of Florida Department of Radiation Oncology guidelines for treatment of differentiated thyroid cancer with I-131 or external-beam radiotherapy. This article is not meant to compete with the many excellent book chapters and consensus guidelines that present comprehensive discussions of treatment options. This is a streamlined, “How we do it?” reference without substantial discussion of background or supporting data. To serve as a treatment reference, the great majority of the information is presented in topic-specific tables.
The Use of Temporoparietal Fascia Flap for Surgical Treatment of Traumatic Auricle Defects
Authors: Kurbonov Ubaidullo , Davlatov Abdumalik , Janobilova Sitora , Kurbanov Ziyodullo , Mirshahi Massoud
Published: May 2018

Background:

Auricular reconstruction is 1 of the biggest challenges of facial plastic surgery. The aim of this study was to evaluate the efficacy of 1-stage reconstruction of an auricle using a temporoparietal fascia flap (TPFF).

Methods:

In this nonrandomized study, autologous auricle bodies with emergency condition and cartilaginous graft from projection of a costal arch from the VI–VII ribs were used. Temporal fascia sample with vascular pedicle (a temporal artery with the accompanying veins) by the Z-shaped incision of skin in temporal area for auricular reconstruction was extracted. Skin grafts were taken from the supraclavicular area or from the left or right flank. Grafts of partial auricle bodies (n = 8) along with cartilaginous framework from a costal arch (n = 21) were used for auricle reconstruction. The follow-up period studied after 6 months in 29 operated patients.

Results:

The graft of partial auricle bodies or the graft of a cartilaginous framework from a costal arch presented a perfect auricular reconstruction. By avoiding a difficult microsurgery and its possible complications, the use of TPFF led to beneficial results in 75% and 90.4% of cases, respectively. Overall, no major complication (alopecia, hematoma, or necrosis) occurred, and further surgery was not required.

Conclusion:

TPFF is a technique of choice for surgical treatment of traumatic auricle defects.
Perforator Propeller Flaps for the Coverage of Middle and Distal Leg Soft-tissue Defects
Authors: Mendieta Mauricio , Cabrera Rodrigo , Siu Armando , Altamirano Roderick , Gutierrez Sandra
Published: May 2018

Background:

Local propeller flaps preserve the main vascular arteries of the lower extremity and muscle function, avoiding the need for a microsurgical anastomosis and the benefit of providing a “like with like” coverage. Our goal in this study was to demonstrate the versatility, safety, and complications of the local propeller flaps for lower extremity reconstruction.

Methods:

We present a series of 28 patients in whom we used local propeller flaps to restore small-to-medium soft-tissue defects of the lower limb in different hospitals of Managua, Nicaragua.

Results:

Flap average dimensions were of 48 cm2. Flap rotation was performed in 180 degrees in 85% of the cases. The propeller flaps were based on a single perforator, from the posterior tibial artery in 50%, anterior tibial artery in 39.3%, and peroneal artery in 10.7% of the cases. Complications occurred in 14% of the propeller flaps performed, with 3 partial necrosis of less than 15% of the flap transposed. Complications of the patients occurred in both sex groups; however, for the female group, there was a 75% of complications with a tendency toward statistical significance of P = 0.038. Donor site of the flap was closed primarily in 85.7% (24) of the cases.

Conclusions:

In our opinion, the availability and safety of local propeller flaps, justifies its use in cases where microsurgical techniques are not an option for the reconstruction of the middle and distal extremity, in small-to-medium defects of soft-tissue coverage of the lower limb.
Clinical Utility of Next‐generation Sequencing in the Management of Myeloproliferative Neoplasms: A Single‐Center Experience
Authors: Alduaij Waleed , McNamara Caroline J. , Schuh Andre , Arruda Andrea , Sukhai Mahadeo , Kanwar Nisha , Thomas Mariam , Spiegel Jay , Kennedy James A. , Stockley Tracy , Tsui Hubert , Devlin Rebecca , Sibai Hassan , Maze Dawn , Schimmer Aaron , Yee Karen , Chan Steven , Kamel‐Reid Suzanne , Gupta Vikas
Published: May 2018

Supplemental Digital Content is available in the text
Physician Assistant Student Perceptions of “Muddiest Point” Classroom Assessment Technique Implementation
Authors: Aycock Mallory M. , Sikes Martha L. , Stevens Gregg A.
Published: May 2018

Purpose

To assess student perceptions of the use of the “Muddiest Point” as a type of formative classroom assessment technique (CAT) in a clinical skills laboratory course.

Methods

Physician assistant (PA) students enrolled in a private university were invited to complete a perception survey regarding the use of the Muddiest Point at the conclusion of the course.

Results

Survey results showed positive overall student perceptions of the Muddiest Point and desire for broader use of this CAT in other courses.

Conclusions

The Muddiest Point is a CAT that is simple for the instructor to implement and showed overall perceived benefit to the PA student. The Muddiest Point is an effective method to gauge student learning and allows students to be active participants in their education.
Quality and Importance of Health Policy, Reform, and Public Health Topics: A Study in Physician Assistant Education
Authors: Angerer-Fuenzalida Frances M.
Published: May 2018

Purpose

As key players in a changing US health care system, physician assistants (PAs) must be prepared to act with a clear understanding of health policy as reform changes are enacted. The purpose of this study was to assess the perceptions of graduating PA students about the importance of health policy, reform, and public health and their perception of their preparedness in these areas. The research question was: Do PA students identify these topic areas as important, and, for each topic area, do they feel adequately prepared with sufficient knowledge for clinical practice?

Methods

Participants in the study included 352 PA students from 14 PA programs randomly selected from 4 geographic regions of the continental United States. A 20-item instrument, the Health Policy Perception Tool, was developed and validated for data collection.

Results

Physician assistant students rated content items high on the importance scale and displayed a wide range of ratings on their perceived preparedness in each content area. Health policy/reform items demonstrated the highest disparity, with students indicating that they were least prepared in content areas relating to the Affordable Care Act, such as patient-centered medical home and accountable care organizations. They also rated health system structure/function items as moderately important, but indicated that they were ill prepared on this topic. Public health topics were rated highly on both scales.

Conclusions

Physician assistant programs appear to be addressing public health issues well; however, PA education leaders must address the low levels of preparedness in the other areas of health care, specifically those related to health structure/function and health reform.
Perceptions of Home Health Nurses Regarding Suffering, Artificial Nutrition, and Hydration in Late-Stage Dementia
Authors: Smith Lenora , Amella Elaine J. , Nemeth Lynne
Published: May 2018

The purpose of this study was to explore perceptions of home healthcare nurses related to suffering, artificial nutrition and hydration in people with late-stage dementia, and if these perceptions influence care to people with dementia and their families. Part of a mixed-methods study, the qualitative portion examined perceptions of home healthcare nurses in a rural area in the southern United States. Seventeen home healthcare nurses participated in this study. Semistructured focus group interview questions were used. Constant comparative analysis was the method used for coding transcripts. Three themes emerged from the analysis: patient/family comfort, futility, and symbols of suffering. Although many of the nurses reported that artificial nutrition and hydration was of comfort to the patient and family because of the potential for “starving,” they also felt it prolonged the patient's suffering due to the invasive procedure, need for restraints, and possibility of fluid overload. Several nurses felt that artificial nutrition and hydration gave a sense of false hope to the family that the patient would live longer. The perceptions of these home healthcare nurses influence their care to people with dementia and their families related to artificial nutrition and hydration, possibly based on experience. Their perceptions could influence family decisions regarding treatment options. Further research and education with home healthcare nurses is vital to ensure nurses are appropriately caring for patients with dementia and their families.
Hiring and Retaining Home Care Nurses
Authors: Mitchell Leslie Jo , Oermann Marilyn
Published: May 2018

Home care agencies are tasked with finding increasingly cost-efficient care processes to improve the quality of patient care outcomes. Hiring and retaining nurses who are well suited for home care are important factors that can influence the cost and provision of quality care in the home. The purpose of this article is to identify characteristics of home healthcare nurses that enable them to be successful home healthcare team members and leaders. A search of the literature was conducted to compile a list of questions with which to screen home healthcare nurse applicants for the required knowledge and skills as well as to improve retention rates of nurses hired. The nature of home healthcare practice makes nurse qualification screening and interviewing a challenge. To assist hiring managers in the screening and interviewing of nurse applicants in this challenging environment, we identified targeted interview questions that will help discern those nurses who are most likely to succeed and be productive, long-term members of the home healthcare agency.
Straight Talk About Birth Control
Authors: Schoenberg Leslie
Published: May 2018

Home healthcare providers play a critical role in the prevention of unintended pregnancies by providing evidence-based contraception education during home visits. This article describes an innovative and comprehensive contraception protocol that was developed for Nurse-Family Partnership to improve contraception education for home healthcare patients. The protocol focused on increasing uptake of long-acting reversible contraception (LARC) for high-risk prenatal and postpartum home healthcare patients. The protocol was designed to reduce early subsequent pregnancies and thereby improve outcomes for mothers and their infants. An evidence-based translation project was designed and piloted in three California counties. The protocol consisted of a contraception education module for nurses and a patient education toolkit. The toolkit included an interactive patient education workbook emphasizing LARC methods for nurses to complete with their patients along with other teaching tools. The project was evaluated using pre- and posttest surveys that measured changes in nurses' knowledge, attitudes, and practice before, after, and 2 months after implementation. Outcomes revealed the following statistically significant results: (a) nurses' knowledge doubled at the first posttest and persisted at 2 months, (b) nurses' attitudes improved on two of the three measures, and (c) there was a 17.7% increase in the frequency of LARC birth control education 2 months after implementation. An evidence-based contraception protocol can promote acceptance of LARC methods and improve home healthcare clinician comfort with and frequency of birth control education.
Integrating Preventive Cardiovascular Healthcare Into Home Health
Authors: Lynch Janet R. , Sun Cynthia K. , Deslich Stacie
Published: May 2018

The viability of measuring and integrating preventive cardiovascular care into home healthcare was investigated through a pilot study fielded during 2013 and 2014. The study tested the feasibility of using a data registry to measure preventive cardiovascular care delivered in home healthcare, examined opportunities for quality improvement, and looked at the association between exposure to evidence-based tools and improvement in aspirin use and blood pressure screening and control among a convenience sample of 20 agencies. Based on promising results, the home healthcare cardiovascular quality initiative continues in alignment with Million Hearts® and offers tools that clinicians can use to understand the risks for heart attack and stroke within their agency's population of patients and respond with best practices.
End-of-Life Care for WW II, Korea, and Vietnam-Era Veterans
Authors: Elliott Brenda
Published: May 2018

Military Veterans have made many sacrifices for our country and deserve high-quality care at end of life. The purpose of this article is to discuss the WW II, Korean and Vietnam Veteran population, and common concerns at the end of life. Areas of focus include spiritual and emotional needs, posttraumatic stress disorder, and pain management. Understanding of military/Veteran culture, the stoic mindset, and moral injury may provide foundational knowledge for nonmilitary home care and hospice clinicians to understand Veteran patients and their families. In addition, resources and other references are offered to enhance the knowledge of Veteran-related care.
Home Healthcare and the Medicare Fraud Strike Force
Authors: Clark Kyle , George Andrew
Published: May 2018

Modern federal healthcare fraud investigations use big data to find outliers among providers who are then targeted for enforcement actions. This approach is being used to pursue an outsized number of criminal cases against home healthcare agencies, resulting in decades-long prison sentences and tens of millions in fines. But it is remarkably transparent, giving home healthcare providers ample opportunity to stay out of harm's way. The government has provided the statistical characteristics by which it searches for fraud among home healthcare agencies, along with the benchmarks it uses to determine who is an outlier. And enforcement actions against home healthcare agencies have consistently targeted the same conduct: payments to payment recruiters and physicians in return for referring patients who often do not need the services billed. This article provides practical advice on how home healthcare agencies can gauge and limit their own legal exposure by monitoring their statistics against the government's benchmarks and by instituting basic controls to prevent targeted conduct.
An Intervention to Reduce Medication Noncompliance and Hospitalizations
Authors: Panozzo Gina
Published: May 2018

Medication noncompliance is a major healthcare problem contributing to patients being rehospitalized shortly after they are discharged. In addition to financial penalties for certain diagnoses, health systems are penalized on quality measures for all rehospitalizations within 30 days, regardless of diagnosis. The purpose of this quality improvement project was to develop and implement a tool utilizing principles of the Theory of Goal Attainment to assist clinicians and patients in mutual goal setting to improve medication compliance, thus indirectly decreasing hospitalization rates. A tool that addresses mutual goal setting in the home healthcare setting was developed by a consultant and implemented at a midsized home healthcare agency. The tool stresses the patient's role in the process to attain goals and presents the clinician as a support system and educator. Effectiveness was evaluated based on data gathered from Home Health Compare. Improvement was noted in five quality indicators.
Helping Older Adults Improve Their Medication Experience (HOME) by Addressing Medication Regimen Complexity in Home Healthcare
Authors: Sheehan Orla C. , Kharrazi Hadi , Carl Kimberly J. , Leff Bruce , Wolff Jennifer L. , Roth David L. , Gabbard Jennifer , Boyd Cynthia M.
Published: May 2018

In skilled home healthcare (SHHC), communication between nurses and physicians is often inadequate for medication reconciliation and needed changes to the medication regimens are rarely made. Fragmentation of electronic health record (EHR) systems, transitions of care, lack of physician–nurse in-person contact, and poor understanding of medications by patients and their families put patients at risk for serious adverse outcomes. The aim of this study was to develop and test the HOME tool, an informatics tool to improve communication about medication regimens, share the insights of home care nurses with physicians, and highlight to physicians and nurses the complexity of medication schedules. We used human computer interaction design and evaluation principles, automated extraction from standardized forms, and modification of existing EHR fields to highlight key medication-related insights that had arisen during the SHHC visit. Separate versions of the tool were developed for physicians/nurses and patients/caregivers. A pilot of the tool was conducted using 20 SHHC encounters. Home care nurses and physicians found the tool useful for communication. Home care nurses were able to implement the HOME tool into their clinical workflow and reported improved communication with physicians about medications. This simple and largely automated tool improves understanding and communication around medications in SHHC.
Applying Intelligent Algorithms to Automate the Identification of Error Factors
Authors: Jin Haizhe , Qu Qingxing , Munechika Masahiko , Sano Masataka , Kajihara Chisato , Duffy Vincent G. , Chen Han
Published: May 2018

Objectives

Medical errors are the manifestation of the defects occurring in medical processes. Extracting and identifying defects as medical error factors from these processes are an effective approach to prevent medical errors. However, it is a difficult and time-consuming task and requires an analyst with a professional medical background. The issues of identifying a method to extract medical error factors and reduce the extraction difficulty need to be resolved.

Methods

In this research, a systematic methodology to extract and identify error factors in the medical administration process was proposed. The design of the error report, extraction of the error factors, and identification of the error factors were analyzed.

Results

Based on 624 medical error cases across four medical institutes in both Japan and China, 19 error-related items and their levels were extracted. After which, they were closely related to 12 error factors. The relational model between the error-related items and error factors was established based on a genetic algorithm (GA)–back-propagation neural network (BPNN) model. Additionally, compared to GA-BPNN, BPNN, partial least squares regression and support vector regression, GA-BPNN exhibited a higher overall prediction accuracy, being able to promptly identify the error factors from the error-related items.

Conclusions

The combination of “error-related items, their different levels, and the GA-BPNN model” was proposed as an error-factor identification technology, which could automatically identify medical error factors.
Perfect Registration Leads to Imperfect Performance
Authors: Dilley James W. R. , Hughes-Hallett Archie , Pratt Philip J. , Pucher Philip H. , Camara Mafalda , Darzi Ara W. , Mayer Erik K.
Published: May 2018

Objective:

To compare surgical safety and efficiency of 2 image guidance modalities, perfect augmented reality (AR) and side-by-side unregistered image guidance (IG), against a no guidance control (NG), when performing a simulated laparoscopic cholecystectomy (LC).

Background:

Image guidance using AR offers the potential to improve understanding of subsurface anatomy, with positive ramifications for surgical safety and efficiency. No intra-abdominal study has demonstrated any advantage for the technology. Perfect AR cannot be provided in the operative setting in a patient; however, it can be generated in the simulated setting.

Methods:

Thirty-six experienced surgeons performed a baseline LC using the LapMentor simulator before randomization to 1 of 3 study arms: AR, IG, or NG. Each performed 3 further LC. Safety and efficiency-related simulator metrics, and task workload (SURG-TLX) were collected.

Results:

The IG group had a shorter total instrument path length and fewer movements than NG and AR groups. Both IG and NG took a significantly shorter time than AR to complete dissection of Calot triangle. Use of IG and AR resulted in significantly fewer perforations and serious complications than the NG group. IG had significantly fewer perforations and serious complications than the AR group. Compared with IG, AR guidance was found to be significantly more distracting.

Conclusion:

Side-by-side unregistered image guidance (IG) improved safety and surgical efficiency in a simulated setting when compared with AR or NG. IG provides a more tangible opportunity for integrating image guidance into existing surgical workflow as well as delivering the safety and efficiency benefits desired.
10th Anniversary of ALPPS—Lessons Learned and quo Vadis
Authors: Lang Hauke , de Santibañes Eduardo , Schlitt Hans J. , Malagó Massimo , van Gulik Thomas , Machado Marcel A. , Jovine Elio , Heinrich Stefan , Ettorre Giuseppe Maria , Chan Albert , Hernandez-Alejandro Roberto , Robles Campos Ricardo , Sandström Per , Linecker Michael , Clavien Pierre-Alain
Published: May 2018

Objective:

Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) has been tested in various indications and clinical scenarios, leading to steady improvements in safety. This report presents the current status of ALPPS.

Summary Background Data:

ALPPS offers improved resectability, but drawbacks are regularly pointed out regarding safety and oncologic benefits.

Methods:

During the 12th biennial congress of the European African-Hepato-Pancreato-Biliary Association (Mainz, Germany, May 23–26, 2017) an expert meeting “10th anniversary of ALPP” was held to discuss indications, management, mechanisms of regeneration, as well as pitfalls of this novel technique. The aim of the meeting was to make an inventory of what has been achieved and what remains unclear in ALPPS.

Results:

Precise knowledge of liver anatomy and its variations is paramount for success in ALPPS. Technical modifications, mainly less invasive approaches like partial, mini- or laparoscopic ALPPS, mostly aiming at minimizing the extensiveness of the first-stage procedure, are associated with improved safety. In fibrotic/cirrhotic livers the degree of future liver remnant hypertrophy after ALPPS appears some less than that in noncirrhotic. Recent data from the only prospective randomized controlled trial confirmed significant higher resection rates in ALPPS with similar peri-operative morbidity and mortality rates compared with conventional 2-stage hepatectomy including portal vein embolization. ALPPS is effective reliably even after failure of portal vein embolization.

Conclusions:

Although ALPPS is now an established 2-stage hepatectomy additional data are warranted to further refine indication and technical aspects. Long-term oncological outcome results are needed to establish the place of ALPPS in patients with initially nonresectable liver tumors.
Pursuing Excellence
Authors: Gardner Aimee K. , Dunkin Brian J.
Published: May 2018

Introduction:

As current screening methods for selecting surgical trainees are receiving increasing scrutiny, development of a more efficient and effective selection system is needed. We describe the process of creating an evidence-based selection system and examine its impact on screening efficiency, faculty perceptions, and improving representation of underrepresented minorities.

Methods:

The program partnered with an expert in organizational science to identify fellowship position requirements and associated competencies. Situational judgment tests, personality profiles, structured interviews, and technical skills assessments were used to measure these competencies. The situational judgment test and personality profiles were administered online and used to identify candidates to invite for on-site structured interviews and skills testing. A final rank list was created based on all data points and their respective importance. All faculty completed follow-up surveys regarding their perceptions of the process. Candidate demographic and experience data were pulled from the application website.

Results:

Fifty-five of 72 applicants met eligibility requirements and were invited to take the online assessment, with 50 (91%) completing it. Average time to complete was 42 ± 12 minutes. Eighteen applicants (35%) were invited for on-site structured interviews and skills testing—a greater than 50% reduction in number of invites compared to prior years. Time estimates reveal that the process will result in a time savings of 68% for future iterations, compared to traditional methodologies. Fellowship faculty (N = 5) agreed on the value and efficiency of the process. Underrepresented minority candidates increased from an initial 70% to 92% being invited for an interview and ranked using the new screening tools.

Discussion:

Applying selection science to the process of choosing surgical trainees is feasible, efficient, and well-received by faculty for making selection decisions.