bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Joint Curriculum for Surgical Skills Performance and Resident-as-Teacher Training
Authors: Urban Renata R. , Fuchs Esther , Fialkow Michael , Chiang Seine , Goff Barbara 
Published: October 2019

PROBLEM:
The simulation experience for residents at our institution does not include longitudinal teaching and assessment of surgical skills. Residents frequently teach during surgical procedures, but do not receive training nor feedback on these teaching skills.

INTERVENTION:
Develop simulation curriculum to improve surgical skills and surgical teaching skills through structured practice, feedback and assessment of all residents, with an emphasis of senior residents as surgical teachers.

CONTEXT:
Needs assessment of faculty and current/graduated residents, was performed to assess perceived surgical abilities of residents, define basic surgical skills, and define relevant teaching skills needed in the operating room. The results were used to define didactic content and to create a supplemental gynecologic surgical skills video. The curriculum backbone included General Surgery videos on surgical skills. Among residents who completed pre and post surveys, 52.1% noted an improvement (≥1 level of confidence) in ≥50% of surgical skills surveyed; 17.4% noted an improvement in all surgical skills surveyed. Nine PGY 3-4 residents completed pre and post surveys pertaining to teaching skills; five (55.6%) noted improvement in all teaching skills surveyed. Six of nine (66.7%) noted improvement in at least one teaching skill.

OUTCOME/LESSONS LEARNED:
Sessions resulted in improvements in self-perceived surgical and teaching skills. Challenges to implementation include faculty and resource availability. We plan to repeat the sessions later in the year, with PGY-2 and PGY-3 acting as teachers. A follow-up survey to query residents on their self-perceived surgical skills, and a survey to query faculty on perceived resident surgical technique will be completed.
Evaluation and Improvement of a Formative Standardized Patient Encounter on Post-Partum Fever in the Core Clerkship of Obstetrics and Gynecology
Authors: Waltner-Toews Rebecca , Hohmann Heather 
Published: October 2019

BACKGROUND:
Medical students need to be able to recognize post-partum endometritis, which occurs after up to 27% of cesarean births and is an important cause of preventable maternal death worldwide. We incorporated a formative standardized patient (SP) encounter, in which students evaluate a patient with postpartum fever and receive feedback.

METHODS:
We reviewed students’ primary and differential diagnoses, quantitative feedback (Likert scale, 7 very useful and 1 not at all useful), and qualitative feedback. We then made changes and compared the new encounter with the original.

RESULTS:
Of 283 students, 51% listed endometritis as the most likely diagnosis and 59% listed it in the differential. Students rated the encounter as 5.8 out of 7. Based on feedback, we purchased a new pelvic model, incorporated a speculum exam, and added immediate feedback. Students rated the new encounter as 6.1, and approximately the same proportion listed endometritis appropriately in the differential. Students appreciated the in-person feedback following the new encounter.

CONCLUSION:
Students found an SP about post-partum fever acceptable, and they learned to identify endometritis as an important diagnosis in their differential.
Race and Gender in the Obstetrics and Gynecology Clerkship: A Mixed Methods Assessment
Authors: Young Omar M. , Sonn Tammy 
Published: October 2019

OBJECTIVE:
To assess perceptions of the obstetrics and gynecology (OBGYN) clerkship and to observe if either race or gender informs selection of specialty.

METHODS:
A prospective cross-sectional study was performed among third and fourth year medical students from February-June 2018. Respondents completed an anonymous and confidential online survey examining their perceptions of the field, the clinical clerkship itself and the potential influence of race and gender during the clerkship. Qualitative responses were coded in an iterative process to evaluate for specific themes. Categorical variables were analyzed using the χ2 test. A p-value of less than 0.05 was considered statistically significant.

RESULTS:
123 out of 229 (53.7%) medical students responded to the survey. Students were more likely to consider OBGYN as a career choice upon completion of the clerkship compared to before (44.9% vs 31.7%, p=0.03). Eleven percent (11%) of respondents reported race personally affecting their clerkship experience whereas 66% identified gender to be a personal influencer on clerkship experience. Male and under-represented minority (URM) students delineated more negative clinical interactions along with fewer meaningful educational experiences on the clerkship due to a perceived lack of cultural inclusivity. The lack of both racial and gender diversity of faculty, residents and ancillary staff was perceived as fostering an environment of discomfort due to displays of both unconscious and conscious bias.

CONCLUSION:
Male and URM medical students have disparate experiences on the OBGYN clerkship as compared those who are female or white, with the racial/gender composition of the clinical environment being contributory.
Perceived Self-Efficacy of Teaching for Creativity Among Nurse Faculty in Taiwan: A Preliminary Study
Authors: Liu Hsing-Yuan , Wang I-Teng , Han Hui-Mei , Huang Ding-Hau , Hsu Ding-Yang 
Published: October 2019

Abstract
Many health care education programs, particularly those in Taiwan, have begun offering capstone product-based curricula, not only to improve nursing students’ problem-solving skills but also to foster creativity and innovation regarding health care issues. This study used a cross-sectional quantitative design to explore the efficacy of teaching for creativity among nurse faculty in Taiwan. Results showed knowledge of intellectual property rights was low, as was ability to creatively evaluate trademark and patent designs. Curiosity was the main predictor associated with self-efficacy of teaching for creativity.
Acute acetaminophen toxicity in adults
Authors: Saccomano Scott J. 
Published: October 2019

Abstract:
When taken in the recommended dosage, acetaminophen is a safe and effective analgesic and antipyretic agent. Its wide availability and easy accessibility make accidental or intentional overdose, leading to hepatotoxicity, a common occurrence. To prevent morbidity and mortality, prompt recognition of acetaminophen toxicity is essential. This article covers the stages of acetaminophen toxicity, recommended treatments, and NP considerations, including patient education recommendations.
Attitudes of Trainees in Obstetrics and Gynecology Regarding the Structure of Residency Training
Authors: Alston Meredith J. , Autry Amy (Meg) , Wagner Sarah A. , Kohl-Thomas Belinda M. , Ehrig Jessica , Allshouse Amanda A. , Gottesfeld Marshall , Stephenson-Famy Alyssa 
Published: October 2019

OBJECTIVE:
To measure future and current resident perspectives on obstetrics and gynecology residency training structure and possible future models.

METHODS:
Medical students invited for obstetrics and gynecology residency interviews and residents (postgraduate year [PGY]-1–4) at the University of Colorado, the University of Washington, the University of California San Francisco, Loyola University, Saint Joseph's Hospital, and Texas A&M in 2017–2018 received a voluntary, electronic survey regarding possible models for restructuring residency training. Student and resident responses were compared using χ2 test for categorical and two-sample t-test for continuous items.

RESULTS:
Applicants (63%, 280/444) and residents (66%, 101/153) had similar response rates (overall response rate 64%). Applicants (24%) and residents (29%) reported having concerns about the current structure of residency training. The ideal residency duration was reported as 4 years by 72% of applicants and 85% of residents. Lack of gynecologic surgical volume was the most frequently reported concern among applicants (75%) and residents (72%). Fourth-year tracking (focusing on training aligned with postgraduation career path) was preferred by 90% of applicants and 77% of residents (P=.002) and 92% among respondents planning fellowship. Most applicants (68%) and residents (75%) preferred not starting fellowship training after the 3rd year of residency.

DISCUSSION:
The majority of learners surveyed support a 4-year training structure but likewise support individualizing training in PGY-4. It is imperative that obstetrics and gynecology leadership consider this and other feedback from learners when considering modifications to the current training paradigm.
Locking Hole Inserts: Effect of Insertion Torque on Fatigue Performance and Insert Loosening in Locking Plates
Authors: Zhang Joanne Y. , Tornetta Paul , Jones Bob , Zheng Yanming , Whitten Andy , Cartner Jacob , Ricci William M. 
Published: October 2019

Objectives:
To evaluate the effect of locking hole inserts (LHIs) and their insertion torque on locking plate fatigue life.

Methods:
Eighteen standard 3.5-mm locking plates were instrumented with LHIs (Smith & Nephew, Memphis, TN) of 1.70 or 3.96 Nm insertion torque, or without LHIs, whereas eleven 4.5-mm locking plates were instrumented with LHIs at 3.96 Nm insertion torque or without LHIs. Plates were cyclically loaded to failure (ie, plate fracture) in four-point bending. Number of cycles to plate failure were measured.

Results:
The 3.5-mm plates with 1.70 Nm LHI insertion torque had a 52% increase in cycles to failure compared with plates without LHIs (114,300 ± 23,680 vs. 75,487 ± 15,746 cycles; P = 0.01). Increasing insertion torque to 3.96 Nm led to a further increase of 36% in fatigue life (155,177 ± 32,493 cycles; P = 0.02) and a 106% increase compared with plates without LHIs (P = 0.001). The 4.5-mm plates with 3.96 Nm insertion torque had a 48% increase in cycles to failure when compared with plates without LHIs (74,369 ± 10,181 vs. 50,214 ± 5544 cycles; P = 0.001).

Conclusions:
LHIs significantly extend plate fatigue length, which would be advantageous in the setting of delayed fracture healing. We recommend the use of LHIs in round locking holes over bony gaps whenever possible; however, we recognize that these findings are limited to implants manufactured by Smith & Nephew.
Apparent Proximal Ulna Dorsal Angulation Variation Due to Ulnar Rotation
Authors: Jarvie Geoff C. , Kilb Brett , Willing Ryan , King Graham J. , Daneshvar Parham 
Published: October 2019

Objective:
To investigate the effect of ulna rotation on the apparent proximal ulna dorsal angulation (PUDA).

Methods:
Computed tomography images of 59 ulnas were included in this study, 48 being bilateral specimens and the remaining 11 were unilateral. Three-dimensional models of the entire ulna were obtained, and the ulnas were rotated in 5-degree increments in internal rotation or external rotation from neutral. PUDA, PUDA apex, varus angulation, and varus apex were measured on each ulna.

Results:
With the ulna in neutral rotation, the mean (95% CI) PUDA was 3.7 (2.9–4.5) degrees, whereas the mean varus angle was 10.5 (9.8–11.1) degrees. The varus angle apex and PUDA apex were 28.9 (27.5–30.2)% and 19.6 (18.7–20.6)% along the total length of the ulna, respectively. As the ulna was rotated externally by 5, 10, and 15 degrees, the PUDA increased by 0.7 (0.5–0.9) degrees, 1.2 (0.9–1.4) degrees, and 1.4 (1.1–1.8) degrees, respectively. Conversely, with internal rotation of 5, 10, and 15 degrees, the PUDA decreased by 0.9 (0.8–1.1) degrees, 2.0 (1.8–2.3) degrees, and 3.3 (2.7–3.9) degrees, respectively.

Conclusions:
This study demonstrates that small degrees of ulna rotation result in a statistically significant change in the apparent PUDA; however, this may not represent a clinically significant difference. Because of the anatomic variation between patients, it is important to obtain a contralateral film to determine the PUDA for anatomic reduction of the ulna in complex cases. When using a contralateral image, it is important to obtain a true lateral film or consider using 3-dimensional imaging for preoperative planning.
Precontoured Quadrilateral Surface Acetabular Plate Fixation Demonstrates Increased Stability When Compared With Pelvic Reconstruction Plates: A Biomechanical Study
Authors: Ryan Weston , Alfonso Nicholas A. , Baldini Todd , Kumparatana Pam , Reiter Michael , Joyce Christopher , Wei Chen , Zhang Yingzhe , Mauffrey Cyril 
Published: October 2019

Objective:
To compare the stability of 3 fixation strategies for a transverse acetabular fracture: a reconstruction plate with anterior and posterior column screws (group A); an infrapectineal precontoured quadrilateral surface buttress (iPQSB) plate alone (group B); and an anterior column lag-screw and iPQSB plate (group C).

Methods:
A transverse acetabular fracture was created in 18 synthetic hemipelvises. Six were fixed by each of the 3 methods described. Specimens underwent cyclic axial compressive loading to 1700N for 42,000 cycles while anterior and posterior column displacements were measured, followed 4800N for 50 cycles. Displacement and stiffness data were analyzed with analysis of variance and Tukey HSD. A Cox proportional hazards regression model was used to determine survival rate. P values < 0.05 were considered significant.

Results:
Group C had significantly less posterior column displacement (0.16 ± 0.06 mm) compared with group B (0.38 ± 0.37 mm, P < 0.0001) and group A (0.38 ± 0.37 mm, P < 0.0001). In addition, group A had significantly more anterior column displacement (0.28 ± 0.11 mm) than group B (0.22 ± 0.14 mm, P = 0.0310) and group C (0.18 ± 0.09 mm, P = 0.0001). Group C was 10.5% stiffer than group A (P = 0.0037). Group B had a 7.27x greater rate of failure than group C (95% confidence interval, 1.6–33.2).

Discussion and Conclusion:
Under anatomical loading, iPQSB plates with anterior column lag-screw fixation demonstrate increased stability in a synthetic bone transverse acetabular fracture model. Based on our data, we support additional evaluation of early weight-bearing after transverse acetabular fracture fixation in patients with healthy bone when an anterior column screw-iPQSB plate construct is used.
Long-Term Treatment Effect and Predictability of Spinopelvic Alignment After Surgical Correction of Adult Spine Deformity With Patient-Specific Spine Rods
Authors: Kleck Christopher J. , Calabrese David , Reeves Bradley J. , Cain Christopher M.J. , Patel Vikas V. , Noshchenko Andriy , Burger-Van der Walt Evalina L. 
Published: October 2019

Study Design.
Retrospective case series.

Objective.
To evaluate the short- and long-term treatment effect (TE) of spinopelvic parameters after surgical correction of adult spine deformity (ASD) utilizing preoperative planning and patient-specific spine rods (PSSRs), and to assess the correspondence between planned and real outcomes.

Summary of Background Data.
PSSR have been used in ASD correction for the last decade. However, a TE and predictability of spinopelvic alignment at long-term follow-up has not been studied.

Methods.
Inclusion criteria: male or female; age more than 20 years; correction of ASD with PSSR; 24-month follow-up (or revision surgery). Studied parameters: sagittal vertical axis; lumbar lordosis (LL); pelvic tilt (PT); sacral slope; pelvic incidence (PI); and PI-LL. The measurement error, TE (the differences between postoperative and preoperative values), standardized TE, and predictability of the studied parameters assessed. The variables included categorical (optimal/nonoptimal) and continuous obtained by direct measurements and weighted by individual optimal values. Statistical significance was set at P ≤ 0.05.

Results.
Thirty-four patients were included: 56% women; the mean age, 63.4 (standard deviation, 12.7); at each follow-up: 32 at 1 to 3 months, 34 at 11 to 13, and 14 at 23 to 25 with 9 followed to the revision surgery. Strong or moderate TE was shown for sagittal vertical axis, LL, and PI-LL. The TE of PT and sacral slope was less significant and lower than planned. PI was not stable in 18%. The changes of continuous variables were more prominent and statistically significant then categorical. The mean values did not show significant differences between planned and postoperative outcomes except for PT. However, the individual deviations were substantial for all parameters. Significant predictability was shown only for LL and PI.

Conclusion.
Use of PSSR showed strong and relatively stable TE in ASD during 2 postoperative years. However, improvement of the planning accuracy may contribute to further enhancement of the method's efficacy.

Level of Evidence: 4.
Quantitation Analysis of PCDH10 Methylation in Adolescent Idiopathic Scoliosis Using Pyrosequencing Study
Authors: Shi Benlong , Mao Saihu , Xu Liang , Li Yang , Sun Xu , Liu Zhen , Zhu Zezhang , Qiu Yong 
Published: October 2019

Study Design.
A retrospective and comparative study.

Objective.
To evaluate the difference of DNA methylation in protocadherin10 (PCDH10) genes between adolescent idiopathic scoliosis (AIS) and normal controls, and to assess the association between DNA methylation and the etiology of AIS.

Summary of Background Data.
The PCDH10 gene showed abnormal expression in AIS. However, the mechanism was still unclear. DNA methylation was an important epigenetic mechanism at the interface between genetics and environmental phenotype, seeming to be a suitable epigenetic mark for the abnormal expression of PCDH10 in AIS.

Methods.
There were 50 AIS patients and 50 healthy controls included in the study. The peripheral blood sample of each participant was taken. The pyrosequencing assay was used to assess the methylation status of PCDH10 promoter and real time PCR (RT-PCR) was used to detect the PCDH10 gene expression. The comparison analysis was performed using independent t test and 2-tailed Pearson coefficients was calculated for the correlation analysis.

Results.
The average methylation level was 4.32 ± 0.73 in AIS patients and 3.14 ± 0.97 in healthy controls (P < 0.001). The PCDH10 gene expression was 0.23 ± 0.04 in AIS patients and 0.36 ± 0.08 in normal controls (P < 0.0001). Statistically significant linear correlation was found between PCDH10 gene methylation level and Cobb angle of major curve (P < 0.001). Besides, a significant negative correlation between PCDH10 methylation and PCDH10 gene expression was found (P < 0.001).

Conclusion.
AIS patients were associated with high DNA methylation level and low gene expression of PCDH10 gene rather than normal controls. The high methylation level indicated high Cobb angle of major curves in AIS. The abnormal DNA methylation may widely exist and serve as a potential mechanism for AIS.

Level of Evidence: 3
Very Low Density Lipoprotein Receptor Sequesters Lipopolysaccharide Into Adipose Tissue During Sepsis
Authors: Shimada Tadanaga , Topchiy Elena , Leung Alex K. K. , Kong HyeJin J. , Genga Kelly R. , Boyd John H. , Russell James A. , Oda Shigeto , Nakada Taka-aki , Hirasawa Hiroyuki , Walley Keith R. 
Published: October 2019

Objectives:
Obese patients have lower sepsis mortality termed the “obesity paradox.” We hypothesized that lipopolysaccharide, known to be carried within lipoproteins such as very low density lipoprotein, could be sequestered in adipose tissue during sepsis; potentially contributing a survival benefit.

Design:
Retrospective analysis.

Setting:
University research laboratory.

Subjects and Patients:

Vldlr knockout mice to decrease very low density lipoprotein receptors, Pcsk9 knockout mice to increase very low density lipoprotein receptor, and Ldlr knockout mice to decrease low density lipoprotein receptors. Differentiated 3T3-L1 adipocytes. Caucasian septic shock patients.

Interventions:
We measured lipopolysaccharide uptake into adipose tissue 6 hours after injection of fluorescent lipopolysaccharide into mice. Lipopolysaccharide uptake and very low density lipoprotein receptor protein expression were measured in adipocytes. To determine relevance to humans, we genotyped the VLDLR rs7852409 G/C single-nucleotide polymorphism in 519 patients and examined the association of 28-day survival with genotype.

Measurements and Main Results:
Lipopolysaccharide injected into mice was found in adipose tissue within 6 hours and was dependent on very low density lipoprotein receptor but not low density lipoprotein receptors. In an adipocyte cell line decreased very low density lipoprotein receptor expression resulted in decreased lipopolysaccharide uptake. In septic shock patients, the minor C allele of VLDLR rs7852409 was associated with increased survival (p = 0.010). Previously published data indicate that the C allele is a gain-of-function variant of VLDLR which may increase sequestration of very low density lipoprotein (and lipopolysaccharide within very low density lipoprotein) into adipose tissue. When body mass index less than 25 this survival effect was accentuated and when body mass index greater than or equal to 25 this effect was diminished suggesting that the effect of variation in very low density lipoprotein receptor function is overwhelmed when copious adipose tissue is present.

Conclusions:
Lipopolysaccharide may be sequestered in adipose tissue via the very low density lipoprotein receptor and this sequestration may contribute to improved sepsis survival.
Intrapatient Molecular and Histologic Heterogeneity After First-generation or Second-generation TKI Therapy of NSCLC Patients
Authors: Iacono Daniela , Osman Giorgia A. , Migliorino Maria R. , Grillo Lucia , Remotti Daniele , Nunnari Josè , Ricciardi Serena , Rossi Antonio , Mancuso Andrea , Graziano Paolo , Di Lorenzo Angela , Bronzini Monica , Signora Mauro , Leone Alvaro 
Published: October 2019

Objectives:
The discovery of tyrosine kinase inhibitors (TKI) has remarkably improved the clinical course of patients with non–small cell lung cancer driven by Epidermal Growth Factor Receptor (EGFR) mutations. However, virtually in all cases, the disease resurfaces in a TKI-resistant form that is mainly linked to an acquired EGFR-T790M mutation, a MET amplification, or small cell lung cancer (SCLC) transformation. Third-generation TKIs are able to block tumor growth through an irreversible binding to the T790M-mutated receptor. Such new treatments require the diagnostic analysis of new pathologic tissue or a liquid biopsy to detect the presence of the T790M mutation.

Materials and Methods:
Pre-TKI and post-TKI biopsies from 27 patients with an activating EGFR mutation were collected and analyzed for EGFR-T790M mutation, MET amplification, and SCLC transformation.

Results:
The T790M mutation was found in 16 patients (59%) whereas MET gene amplification was found in 2 (10.5%) of 19 evaluated cases. The histologic transformation from adenocarcinoma (ADC) to SCLC was identified in 3 patients (11%). In one of them reversal from SCLC back to adenocarcinoma was observed. One patient had the T790M mutation concordantly detected in 2 synchronous lesions whereas another patient showed T790M positivity only in one of 2 specimens. In 4 patients longitudinal biopsies revealed T790M gains and losses not always according to biological expectations.

Conclusions:
Intrapatient molecular or histologic heterogeneity may be frequently found during routine treatment of non–small cell lung cancer patients. This biological aspect may have profound repercussions on subsequent therapeutic decisions, and therefore requires in-depth investigation.