bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Definition of Faculty Must Evolve: A Call to Action
Authors: Bellini Lisa M. , Kaplan Brian , Fischel Janet E. , Meltzer Carolyn , Peterson Pamela , Sonnino Roberta E. 
Published: January 2020

As academic medical centers and academic health centers continue to adapt to the changing landscape of medicine in the United States, the definition of what it means to be faculty must evolve as well. Both institutional economic priorities and the need to recalibrate educational programs to address current and future societal and patient needs have brought new complexity to faculty identity, faculty value, and the educational mission.
The Council of Faculty and Academic Societies, 1 of 3 membership councils of the Association of American Medical Colleges (AAMC), established working groups in 2014 to provide a strong voice for academic faculty within the AAMC governance and leadership structures. The Faculty Identity and Value Working Group was charged with identifying the attributes and qualities of future academic medicine faculty in light of the transformational changes occurring at many medical schools and teaching hospitals. The working group developed a framework that could be applied throughout the United States by AAMC member schools to define and value teaching activities. This report adds to the work of others by offering a contemporary construct that is flexible and easily adaptable to enable fair and transparent implementation of an education value system; it is especially relevant for systems in which mergers and acquisitions lead to a large number of clinicians. An example of such an implementation at a large and growing academic medical center is provided.
The ability to identify and quantify educational effort by faculty could be transformative by highlighting the fundamental importance of faculty to the development of the future medical workforce.
Pregnancy Status is Associated With Screening for Alcohol and Other Substance Use in the Emergency Department
Authors: Greenmyer Jacob R. , Stacy John M. , Klug Marilyn G. , Foster Katrina , Tiongson Christopher , Burd Larry 
Published: January 2020

Objectives:
Determine the rates of screening for substance use in pregnant women versus non-pregnant women attending the emergency department (ED).

Methods:
We captured all ED visits by women of childbearing age (12–50 years in our study) over a 5-year period (2012–2017) (n = 72,752) from a local community hospital. The 2742 pregnant women were then matched by ethnicity, marital status, and arrival method to 9888 non-pregnant women. We then compared rates of screening for substance use by pregnancy status stratifying by age and diagnosis.

Results:
The proportion of non-pregnant women who were screened for substance use was 3.66% compared to 1.90% of pregnant women, yielding an odds ratio (OR) of 1.96 (95% CI = 1.44 to 2.67). We then stratified the results by presenting complaint and age. Non-pregnant women 14 to 19 and 30 to 34 had the highest likelihood for screening (OR > 3.0). The presenting complaint showed little effect on screening.

Conclusion:
Pregnant women were screened only 51% as often as non-pregnant women for substance use in the ED. These results are of particular concern as we continue to see a rise in substance use during pregnancy which results in an increased burden on the healthcare system and society. This study replicates a previous study showing that the rates of screening are lower for pregnant women than non-pregnant women presenting to the ED. Earlier recognition of substance use offers increased opportunities for intervention and prevention of adverse outcomes from substance use during both the current pregnancy and future pregnancies.
Framework to Support the Process of Decision-Making on Life-Sustaining Treatments in the ICU: Results of a Delphi Study
Authors: Kerckhoffs Monika C. , Senekal Jannien , van Dijk Diederik , Artigas Antonio , Butler Jenie , Michalsen Andrej , van Mol Margo M. C. , Moreno Rui , Pais da Silva Filipa , Picetti Edoardo , Póvoa Pedro , Robertsen Annette , van Delden Johannes J. M. 
Published: January 2020

Objectives:
To develop a consensus framework that can guide the process of decision-making on continuing or limiting life-sustaining treatments in ICU patients, using evidence-based items, supported by caregivers, patients, and surrogate decision makers from multiple countries.

Design:
A three-round web-based international Delphi consensus study with a priori consensus definition was conducted with experts from 13 countries. Participants reviewed items of the decision-making process on a seven-point Likert scale or with open-ended questions. Questions concerned terminology, content, and timing of decision-making steps. The summarized results (including mean scores) and expert suggestions were presented in the subsequent round for review.

Setting:
Web-based surveys of international participants representing ICU physicians, nurses, former ICU patients, and surrogate decision makers.

Patients:
Not applicable.

Interventions:
Not applicable.

Measurements and Main Results:
In three rounds, respectively, 28, 28, and 27 (of 33 invited) physicians together with 12, 10, and seven (of 19 invited) nurses participated. Patients and surrogates were involved in round one and 12 of 27 responded. Caregivers were mostly working in university affiliated hospitals in Northern Europe. During the Delphi process, most items were modified in order to reach consensus. Seven items lacked consensus after three rounds. The final consensus framework comprises the content and timing of four elements; three elements focused on caregiver-surrogate communication (admission meeting, follow-up meeting, goals-of-care meeting); and one element (weekly time-out meeting) focused on assessing preferences, prognosis, and proportionality of ICU treatment among professionals.

Conclusions:
Physicians, nurses, patients, and surrogates generated a consensus-based framework to guide the process of decision-making on continuing or limiting life-sustaining treatments in the ICU. Early, frequent, and scheduled family meetings combined with a repeated multidisciplinary time-out meeting may support decisions in relation to patient preferences, prognosis, and proportionality.
Complications of cosmetic iris implants: French series of 87 eyes
Authors: El Chehab Hussam , Gatinel Damien , Baudouin Christophe , Muraine Marc , Hoffart Louis , Rozot Pascal , Mehanna Chadi , Bonnet Clémence , Nordmann Jean-Philippe , Santiago Pierre-Yves , Burillon Carole , Baillif Stéphanie , Pisella Pierre Jean , Weber Michel , Robinet-Perrin Antoine , Deidier Danielle , Hay Aurélien , Villain Max , Baïkoff Georges , Gauthier Anne Sophie , Mathis Thibaud , Dot Corinne 
Published: January 2020

Purpose:
Iris intraocular implants were developed to manage congenital or traumatic iris defects. However, they are also used to change the color of patient eyes. The aim of this retrospective series was to report complications in patients managed in France after cosmetic implantation.

Setting:
Ophthalmological institutions and private ophthalmologists in France.

Design:
Multicenter retrospective observational study.

Methods:
Questionnaires were sent to all ophthalmology departments in university hospitals and to private ophthalmologists. This questionnaire listed demographic and clinical data for each implanted eye with a focus on safety, the description of ocular complications (corneal edema, endothelial cell loss, increased intraocular pressure, and intraocular inflammation), and the therapeutic management implemented.

Results:
Forty-four questionnaires (87 eyes) were collected, and ultimately, 33 questionnaires (65 eyes) were considered complete and analyzed. Two types of implants were identified. Of the 65 eyes analyzed, only 5 eyes (7.7%) did not experience any complication and 60 eyes (92.3%) had at least 1 complication. The most commonly reported complication was corneal decompensation (78.5%). The diagnosis of glaucoma was made in over half (52.3%) of the cases. Explantation was needed in 81.5% of cases. The mean final visual acuity was 0.45 ± 0.08 logarithm of the minimum angle of resolution (logMAR) (0 to 2 logMAR).

Conclusions:
Several ocular complications with a decreased mean visual acuity were described in a young healthy population. In addition, patient information on the safety of this procedure appeared insufficient.
Assessment of the image quality of extended depth-of-focus intraocular lens models in polychromatic light
Authors: Lee Yumi , Łabuz Grzegorz , Son Hyeck-Soo , Yildirim Timur M. , Khoramnia Ramin , Auffarth Gerd U. 
Published: January 2020

Purpose:
The use of monochromatic light in the assessment of intraocular lenses (IOLs) has been criticized for not representing the real-world situation. This study aimed to measure and compare the image quality of 3 extended depth-of-focus (EDOF) IOL models in monochromatic and polychromatic light.

Setting:
David J Apple Laboratory, Heidelberg, Germany.

Design:
In vitro study.

Methods:
An optical metrology instrument was used to study image quality metrics of diffractive IOLs with chromatic aberration correction (Symfony and AT Lara) and a refractive lens (Mini Well). The modulation transfer function (MTF) was measured in green and polychromatic light at a 2.0 mm, 3.0 mm, and 4.0 mm aperture. The EDOF IOL's tolerance to defocus was tested against a monofocal lens.

Results:
The mean MTF of the EDOF IOL at far distance was decreased in polychromatic compared with monochromatic light. The largest effect was found in the refractive lens; however, at intermediate distance, only small differences occurred. In their tolerance to defocus, the EDOF IOLs were superior to the monofocal IOL. The diffractive IOL had higher MTFs than that of the refractive IOL at 2 primary foci, the refractive IOL's optical quality varied less with defocus at 3.0 mm. The refractive lens was the most susceptible to changes in aperture size.

Conclusion:
The diffractive EDOF IOL was more resistant to chromatic effects than the refractive IOL. The EDOF IOLs provided an extended through-focus performance compared with the monofocal IOL, but differences in optical design, particularly pupil dependency, should be considered when refining IOL selection for patients.
Diagnostic utility of neuroretinal rim thickness, measured in clock-hour sectors with HD optical coherence tomography, in preperimetric glaucoma
Authors: Tai Tzu-Yang , Ko Yu-Chieh , Chang Yu-Fan , Liu Catherine Jui-Ling , Chen Mei-Ju 
Published: January 2020

Background:
We evaluated the usefulness of neuroretinal rim (NRR) thicknesses, measured in clock-hour sectors with Cirrus HD optical coherence tomography, for diagnosing preperimetric glaucoma (PPG).

Methods:
This prospective study included 39 eyes of 39 patients with PPG and 39 eyes of 39 controls that were matched to patients for age and refractive error. We measured the circumpapillary retinal nerve fiber layer (cpRNFL) thickness, macular ganglion cell–inner plexiform layer (GCIPL) thickness, and optic nerve head (ONH) parameters with optical coherence tomography. The clock-hour NRR thicknesses were derived from a 360° circumferential rim thickness curve. We analyzed the area under the receiver operating characteristics curve (AUROC), cutoff values, and sensitivities at specificities of 90% and 95%.

Results:
The largest area under the receiver operating characteristics curves were observed for the NRR thickness at 6 o’clock (0.823), the inferior RNFL thickness (0.821), the average RNFL thickness (0.819), and the NRR thickness at 7 o’clock (0.818). The performance of the NRR thickness at 6 o’clock was comparable to the best performances of the cpRNFL, GCIPL, and ONH parameters (all p > 0.05).

Conclusion:
The ability of the clock-hour NRR thickness assessment to diagnose PPG was comparable to the diagnostic abilities of cpRNFL, GCIPL, and ONH parameters. The best indicator of PPG was the NRR thickness parameter that was at 6 o’clock. This finding could play a role in detecting early structural changes in PPG.
Added Potential of the Pap Smear
Authors: Yorozuya Lauren I. , Moore Diana , Jacob Sharon E. 
Published: January 2020

ABSTRACT
The field of dermatology and syphilology has relied on diagnostic laboratory and pathology tools to aid in the clinician in care of the patient for the better part of two centuries. The purpose of the diagnostics in dermatology column is to highlight commonly encountered diagnostic tools in dermatology and review the indications for use and result interpretation. This article discusses the anal Pap smear, a useful and cost-effective tool to screen for anal intraepithelial neoplasia in at-risk groups.
Reducing Unnecessary Phlebotomy Testing Using a Clinical Decision Support System
Authors: Strockbine Valerie L. , Gehrie Eric A. , Zhou Qiuping (Pearl) , Guzzetta Cathie E. 
Published: January 2020

ABSTRACT

Introduction:
Reducing unnecessary tests reduces costs without compromising quality. We report here the effectiveness of a clinical decision support system (CDSS) on reducing unnecessary type and screen tests and describe, estimated costs, and unnecessary provider ordering.

Methods:
We used a pretest posttest design to examine unnecessary type and screen tests 3 months before and after CDSS implementation in a large academic medical center. The clinical decision support system appears when the test order is initiated and indicates when the last test was ordered and expires. Cost savings was estimated using time-driven activity-based costing. Provider ordering before and after the CDSS was described.

Results:
There were 26,206 preintervention and 25,053 postintervention specimens. Significantly fewer unnecessary type and screen tests were ordered after the intervention (12.3%, n = 3,073) than before (14.1%, n = 3,691; p < .001) representing a 12.8% overall reduction and producing an estimated yearly savings of $142,612. Physicians had the largest weighted percentage of unnecessary orders (31.5%) followed by physician assistants (28.5%) and advanced practice nurses (11.9%).

Conclusions:
The CDSS reduced unnecessary type and screen tests and annual costs. Additional interventions directed at providers are recommended. The clinical decision support system can be used to guide all providers to make judicious decisions at the time of care.
Association of 17q24 rs1859962 gene polymorphism with prostate cancer risk
Authors: Ren Feiqiang , Zhang Peihai , Ma Ziyang , Zhang Ling , Li Guangsen , Huang Xiaopeng , Chang Degui , Yu Xujun 
Published: January 2020

Abstract

Background:
Recently, several genome-wide association studies have demonstrated a cumulative association of 17q24 rs1859962 gene variants with prostate cancer (PCa) risk, but conflicting results on this issue have been reported. Hence, we performed a systematic literature review and meta-analysis to assess the association between 17q24 rs1859962 gene and PCa risk.

Methods:
Systematic literature searches were conducted with PubMed, EMBASE, Science Direct/Elsevier, CNKI, and the Cochrane Library up to January 2019 for studies focusing on the association of 17q24 rs1859962 gene polymorphism with PCa risk. Meta-analysis was performed with Review Manager and stata software. Combined OR were identified with 95% confidence intervals (95% CI) in a random or fixed effects model.

Results:
Eight studies were identified, including 7863 cases of PCa patients and 17122 normal controls. Our results revealed significant associations between the 17q24 rs1859962 gene polymorphism and PCa in all genetic models (P < 0.05). The combined odds ratios and 95% confidence intervals were as follows: Additive model (odds ratios [ORs] 1.44, 95%, confidence interval [CI] [1.32, 1.57]); Codominant model (ORs 1.22, 95% CI [1.08, 1.39]); Dominant model (ORs 1.25, 95%, CI [1.17, 1.34]); recessive model (ORs 1.27, 95% CI [1.18, 1.36]); allele model (ORs 1.32, 95% CI [1.12, 1.55]).

Conclusion:
The present study supports the proposed association between the 17q24 gene rs1859962 and PCa progression. Specifically, this polymorphism is suggested to be a risk factor of PCa. However, studies with larger sample sizes are needed to better illuminate the correlation between 17q24 rs1859962 gene polymorphism and PCa.
Assessment of spinal cord stimulation and radiofrequency
Authors: Corallo Francesco , De Salvo Simona , Floridia Daniela , Bonanno Lilla , Muscarà Nunzio , Cerra Francesco , Cannistraci Cecilia , Di Cara Marcella , Lo Buono Viviana , Bramanti Placido , Marino Silvia 
Published: January 2020

Abstract
Pain has a major impact on anxiety and depression levels. The aim of this study is to demonstrate how these symptoms (depression and anxiety) could positively influence the perception of pain after neurostimulation system implantation.
We enrolled 100 patients and divided in 2 different groups, by using tests screening such as Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Nursing Rating Scale (NRS): the group with spinal cord stimulation (SCS) and the group with pulsed spinal cord radiofrequency (RFP).
We highlighted a significant decrease of scores (BDI, HAM-A, NRS) in each group between T0 (baseline) and T1. Moreover, the intra-group analysis showed a positive significant correlation between NRS and depressive and anxiety symptoms.
We assert that the use of alternative methods (SCS and RFP) to the traditional pharmaceutical-surgical treatments, provide the reduction of the algic and anxiety-depressant symptoms, restoring also the perception of psychological well-being.
PTX3 Gene 3’UTR polymorphism and its interaction with environmental factors are correlated with the risk of preeclampsia in a Chinese Han population
Authors: Xu Ning , Zhang Wei 
Published: January 2020

Abstract
To investigate the interaction between the single nucleotide polymorphism of the 3’ untranslated region (3’UTR) of the pentraxin 3 (PTX3) gene, as well as environmental factors and the preeclampsia risk in a Chinese Han population.
Sanger sequencing was used to analyze rs5853783 and rs73158510 loci of the PTX3 gene 3’UTR from 235 patients with preeclampsia and 235 control subjects. The plasma PTX3 protein level was measured by enzyme-linked immunosorbent assay (ELISA).
The risk of preeclampsia in the PTX3 gene rs5853783 locus D allele carriers was 0.72 times higher than that of the I allele carriers (95% CI: 0.60–0.84, P < .001). The risk of preeclampsia in the PTX3 gene rs73158510 locus A allele carriers was 1.36 times higher than in the G allele carriers (95% CI: 1.16–1.55, P < .001). The area under the ROC curve (AUC) for the diagnosis of preeclampsia by plasma PTX3 protein levels was 0.906 (P < .001). The PTX3 gene rs5853783 and rs73158510 single nucleotide polymorphisms (SNPs) were associated with plasma PTX3 protein levels. The AUC of plasma PTX3 protein level diagnosis of preeclampsia in PTX3 gene rs5853783 locus II genotype subjects was up to 0.9371, followed by the ID genotype (AUC = 0.8586); the DD genotype was the lowest (AUC = 0.8154). The AUC of plasma PTX3 protein level diagnosis of preeclampsia in rs73158510 locus GG genotype subjects was 0.9102, GA genotype was 0.8766, and AA genotype was 0.8750.
The rs5853783 and rs73158510 SNPs in the 3’UTR region of the PTX3 gene are associated with the risk of preeclampsia in a Chinese Han population.
Interpretation bias of high trait anxiety Chinese military servicemen in ambiguous military scenarios
Authors: Zhang Fan , Zhang Xiaomin , Mao Xiaofei , Chen Aibin , Yin Qianlan , Deng Guanghui 
Published: January 2020

Abstract
Converging evidence reveals the negative interpretation bias in anxiety. Given that anxiety is a severe psychological problem among Chinese military personnel, the present study examined whether high trait anxiety military personnel showed negative interpretation bias in real-world situations and whether their interpretations were influenced by self-relevance.
The sample included 24 high trait anxiety (H-TA) and 22 low trait anxiety (L-TA) Chinese military servicemen. Participants completed 20 open-ended ambiguous scenarios by deciding how much they believed in the positive and negative ending of each sentence. The 20 scenarios were designed according to real life in military and half of them were self-relevant and the others were non-self-relevant.
A 2(group) ×2(self-relevance) ANOVA of positive and negative endings revealed that compared to L-TA, H-TA believed more in negative continuations and less in positive continuations. Moderate correlations were found between samples’ believes in positive and negative endings and their trait anxiety scores. Military personnel showed more positive interpretation biases in non-self-relevant scenarios than in self-relevant scenarios.
These findings are the first to show interpretation bias in military situations, and interventional strategies to modify servicemen's interpretation bias could be designed according to military situations.
Expression and clinical significance of p62 protein in colon cancer
Authors: Lei Cheng , Zhao Bing , Liu Lin , Zeng Xiangyue , Yu Zhen , Wang Xiyan 
Published: January 2020

Abstract
p62 is a multifunctional protein involved in multiple cellular processes including proliferation, drug sensitivity and autophagy-associated cancer cell growth. However, the role of p62 in colon cancer remains controversial. Here we investigated the expression of p62 protein in colon cancer and its clinical significance.
Patients with colon adenocarcinoma who underwent resection at the Third Affiliated Teaching Hospital of Xinjiang Medical University (Affiliated Cancer Hospital) were retrospectively analyzed. The expression of p62 protein in tumor tissues and adjacent normal tissues was detected by immunohistochemistry and western-blotting. Real-time quantitative polymerase chain reaction was used to detect the expression level of p62 messenger ribonucleic acid in specimens. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier method and the log-rank test.
A total of 85 colon cancer patients were enrolled, including 55 (64.71%) patients with high p62 expression, and 30 (35.29%) patients with low p62 expression. The transcription and expression level of p62 in colon cancer tissues were higher than those in adjacent normal tissues (P < .01). High expression of p62 was an independent risk factor for the poor prognosis (PFS and OS) of colon cancer.
p62 may be a potential indicator of determining the progression and prognosis evaluation of colon cancer.
Tranexamic acid for postpartum hemorrhage prevention in vaginal delivery
Authors: Xia Yimeng , Griffiths Brian B. , Xue QingSheng 
Published: January 2020

Abstract

Background:
Tranexamic acid (TA) has been demonstrated to reduce blood loss and the incidences of postpartum hemorrhage (PPH) during caesarean sections. We compared the clinical efficacy of TA administration on vaginal deliveries with recently published papers.

Methods:
Electronic databases of PubMed, Cochrane Library, Embase and Chinese CNKI (Chinese database) and Wanfang were searched through November 2019.The randomized controlled trials were selected between TA and control groups. The relevant studies included four trials with a total of 4579 patients.

Results:
Patients treated with TA had a reduction in total blood loss (P = .009), lower postoperative blood loss (P < .00001), a reduced number of PPH (P = .02). However, the occurrence of nausea or/and vomiting is higher in the TA group (the incidence of nausea or vomiting [P < .00001], nausea [P < .00001] and vomiting [P < .00001]).

Conclusion:
TA resulted in fewer occurrence rates of PPH, and no significant increase in occurrences of dizziness or photopsia, but higher incidence of vomiting and nausea.