bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Upper Airway Collapse and Sleep Parameters on Daytime Sleepiness and Sleep Quality
Authors: Gurpinar Berk , Friedman Michael , Senel Gulcin Benbir , Sayin Sevgi , Boroosan Avrahan , Uyar Yavuz , Karadeniz Derya 
Published: March 2020

Objective:
Standard overnight polysomnography (PSG) scores only the apneahypopnea index (AHI) as a predictor of sleep apnea. It is proven that the arousals also contribute especially to the daytime symptoms of obstructive sleep apnea syndrome (OSA). The authors aimed to search the relevance of arousals and obstruction site in the upper airway with the sleep parameters, daytime sleepiness and the sleep quality.

Materials and Methods:
A total number of 118 subjects were recruited. All of them received a full-night attended PSG and a thorough otolaryngologic examination to identify the site of obstruction in the upper airway and 2 different sleep questionnaires to present the daytime sleepiness and the sleep quality.

Results:
The level of nasal airway blockage had no impact on AHI, daytime sleepiness and the sleep quality. The increase in level of tonsillar hypertrophy had a negative impact on oxygen desaturation index (ODI) only (P = 0.021). The level of retrolingual obstruction worsen ODI (P = 0.022), AHI (P = 0.041), daytime sleepiness (P = 0.047) and sleep quality (P = 0.033).

Conclusion:
Arousals during sleep deserve better attention in scoring PSG events, as they reliably reflect daytime somnolence and sleep quality. Retrolingual obstruction was the main contributor for cortical arousals. It is imperative to cure retrolingual obstruction properly which may be easily detected in sleep endoscopy.
Comparison of Resident Self-Evaluation to Standardized Patient Evaluators in a Multi-Institutional Objective Structured Clinical Examination
Authors: Diaczok Benjamin John , Brennan Simone , Levine Diane , Hilu Raymond , Thati Neelimi , Kruer James , Ahsan Samira , McNally Patricia , Pieper David 
Published: March 2020

Background
For the past 30 years, there has been a growing emphasis on communication and self-evaluation skills training in graduate medical education. This is reflected in the Next Accreditation System. The Objective Structured Clinical Examination (OSCE) is widely used in graduate medical education for assessing dimensions of interpersonal communication and counseling skills. The OSCEs may be developed to target challenging clinical scenarios difficult to capture in clinical practice and can be used as a medium for resident self-evaluation.

Objectives
The aims of the study were to evaluate residents' interpersonal, communication, and counseling skills using Kalamazoo Essential Elements Communication Checklist in 4 clinically challenging scenarios and to compare standardized patient (SP) evaluations to residents' self-evaluation by category of medical school.

Methods
South East Michigan Center for Medical Education is a consortium of teaching hospitals. Member residents participate in 4 OSCEs as part of their postgraduate 1 curriculum. The OSCEs were developed to evaluate clinically relevant but difficult to capture scenarios including: (a) error disclosure/counseling an angry patient; (b) delivering bad news/end of life; (c) domestic violence; and (d) counseling a patient with colon cancer requesting alternative treatments. At the conclusion of each OSCE, SPs evaluated and residents self-evaluated their performance. Once evaluations were completed, SPs provided residents with feedback.

Results
Six member institutions and 344 residents participated during the 2014, 2015, and 2016 academic years. There were more international medical graduates (59%) than graduates of Liaison Committee for Medical Education–accredited medical schools. There were more males (62.2%) than females. Standardized patients rated residents higher than residents rated themselves in 2014 (<0.001), but not in 2015 or 2016. When combining all years and all residents, there was no correlation of SP and resident scores. Standardized patients rated female residents higher than female residents rated themselves (P < 0.0001). Male residents scored themselves similarly to the SPs, but male residents rated themselves higher than female residents rated themselves (P < 0.001). Standardized patient scores for male and female residents were not significantly different.

Conclusions
Targeted OSCEs provide an objective format to evaluate residents in challenging clinical scenarios. Resident self-evaluations did not correlate with SPs. In addition, female residents rated themselves lower than male residents and lower than SPs. There is need to develop interventions and curricula to improve resident's self-evaluation skills and in particular address lower self-evaluation by female trainees.
Lack of Diversity in Simulation Technology
Authors: Conigliaro Rosemarie L. , Peterson Kerstin D. , Stratton Terry D. 
Published: March 2020

Summary Statement
Despite increased attention on diversity in medicine and healthcare, heterogeneity in simulation technology has been slow to follow suit. In a nonsystematic review of simulation technology available in 2018 with respect to skin tone, age and sex, we found limited diversity in these offerings, suggesting limitations to educators' abilities to represent the full array of patients, conditions, and scenarios encountered in medicine and training. We highlight these limitations and propose basic strategies by which educators can increase awareness of and incorporate diversity into the simulation arena.
Transfer of Clinical Reasoning Trained With a Serious Game to Comparable Clinical Problems
Authors: Middeke Angélina , Anders Sven , Raupach Tobias , Schuelper Nikolai 
Published: March 2020

Introduction
Serious Games can be used effectively for clinical reasoning training in medical education. Case specificity of learning outcome elicited by Serious Games has not been studied in detail. This study investigated whether learning outcome elicited by repeated exposure to virtual patient cases is transferable to other cases addressing similar problems.

Methods
In this monocentric, prospective, randomized trial, 69 fifth-year medical students participated in ten 90-minute sessions of using a computer-based emergency ward simulation game. Students were randomized to 3 groups (A, B, AB) and subsequently exposed to up to 46 different virtual patients. Group A was presented with 2 specific cases that were not shown in group B and vice versa. Group AB was exposed to all 4 specific cases. After 6 weeks of using the game as a learning resource, students were presented with 4 cases addressing similar problems. For each case, an aggregate score reflecting clinical reasoning was calculated, and performance was compared across groups.

Results
In the final session, there were no significant between-group differences regarding the sum score reflecting aggregated performance in all 4 cases (A: 66.5 ± 7.2% vs. B: 61.9 ± 12.4% vs. AB: 64.8 ± 11.1%, P = 0.399). An item-by-item analysis revealed that there were no between-group differences regarding correct therapeutic interventions.

Conclusions
Previous exposure had limited impact on subsequent performance in similar cases. This study suggests that case specificity of learning outcome elicited by the serious game is low and that acquired higher-order cognitive functions may transfer to similar virtual patients.
Survivors of gun violence and the experience of recovery
Authors: O'Neill Kathleen M. , Vega Cecilio , Saint-Hilaire Sidney , Jahad Leonard , Violano Pina , Rosenthal Marjorie S. , Maung Adrian A. , Becher Robert D. , Dodington James 
Published: March 2020

BACKGROUND
Survivors of gun violence may develop significant mental health sequelae and are at higher risk for reinjury through repeat violence. Despite this, survivors of gun violence often return to the community where they were injured with suboptimal support for their mental health, emotional recovery, and well-being. The goal of this study was to characterize the posthospitalization recovery experience of survivors of gun violence.

METHODS
We conducted a qualitative research study with a community-based participatory research approach. In partnership with a community-based organization, we conducted in-depth one-on-one interviews and used snowball sampling to recruit survivors of gun violence. We applied the constant comparison method of qualitative analysis to catalogue interview transcript data by assigning conceptual codes and organizing them into a consensus list of themes. We presented the themes back to the participants and community members for confirmation.

RESULTS
We conducted 20 interviews with survivors of gun violence; all were black men, aged 20 years to 51 years. Five recurring themes emerged: (1) Isolation, physical and social restriction due to fear of surroundings; (2) Protection, feeling unsafe leading to the desire to carry a gun; (3) Aggression, willingness to use a firearm in an altercation; (4) Normalization, lack of reaction driven by the ubiquity of gun violence in the community; and (5) Distrust of health care providers, a barrier to mental health treatment.

CONCLUSION
Survivors of gun violence describe a disrupted sense of safety following their injury. As a result, they experience isolation, an increased need to carry a firearm, a normalization of gun violence, and barriers to mental health treatment. These maladaptive reactions suggest a mechanism for the violent recidivism seen among survivors of gun violence and offer potential targets to help this undertreated, high-risk population.

LEVEL OF EVIDENCE
Care management/Therapeutic V.
Massive transfusion and the response to prehospital plasma: It is all in how you define it
Authors: Sim Edward S. , Guyette Frank X. , Brown Joshua B. , Daley Brian J. , Miller Richard S. , Harbrecht Brian G. , Claridge Jeffrey A. , Phelan Herb A. , Neal Matthew D. , Forsythe Raquel , Zuckerbraun Brian S. , Sperry Jason L. 
Published: March 2020

BACKGROUND
A recent analysis derived from the Prehospital Air Medical Plasma trial data set demonstrated no significant independent plasma survival benefit in those who required massive transfusion (≥10 units of red cells in 24 hours). The definition of massive transfusion has evolved over time to minimize bias and predict those at highest risk of death. We sought to characterize the definition of massive transfusion, their associated mortality risks and the survival benefit associated with prehospital plasma.

METHODS
A secondary analysis was performed using data from a recent prehospital plasma trial. Patients transferred directly from the scene were characterized. We defined historic massive transfusion using ≥10 units red cells in 24 hours and critical administration threshold (CAT) as ≥3 units per hour in the first hour (CAT1hr) or in any of the first 4 hours (CAT4hr) from arrival. The primary outcome was 30-day mortality. Kaplan-Meier analysis and Cox hazard regression were used to characterize the survival benefit of prehospital plasma.

RESULTS
There were a total of 390 enrolled patients who were transferred from the scene and represent the study cohort. Overall, 126 patients were positive for the CAT1hr metric, 183 patients were positive for the CAT4hr metric and 84 patients were positive for historic massive transfusion metric. The overall study mortality rate for those patients who met each transfusion definition was 13.1%, 17.4% and 10.0%, respectively. The CAT4hr metric had the lowest potential for survival bias. Kaplan-Meier survival analysis demonstrated a prehospital plasma survival benefit in the patients who were CAT4hr positive.

CONCLUSION
The current analysis demonstrates the superior utility of the CAT4hr definition with optimization of survival bias while conserving mortality risk prediction. This transfusion definition was associated with a prehospital plasma survival benefit and may be the most appropriate definition of massive transfusion for pragmatic studies which focus on hemorrhagic shock.

LEVEL OF EVIDENCE
Epidemiologic, Level II
A systematic review and meta-analysis of traumatic intracranial hemorrhage in patients taking prehospital antiplatelet therapy: Is there a role for platelet transfusions?
Authors: Alvikas Jurgis , Myers Sara P. , Wessel Charles B. , Okonkwo David O. , Joseph Bellal , Pelaez Carlos , Doberstein Cody , Guillotte Andrew R. , Rosengart Matthew R. , Neal Matthew D. 
Published: March 2020

BACKGROUND
Platelet transfusion has been utilized to reverse platelet dysfunction in patients on preinjury antiplatelets who have sustained a traumatic intracranial hemorrhage (tICH); however, there is little evidence to substantiate this practice. The objective of this study was to perform a systematic review on the impact of platelet transfusion on survival, hemorrhage progression and need for neurosurgical intervention in patients with tICH on prehospital antiplatelet medication.

METHODS
Controlled, observational and randomized, prospective and retrospective studies describing tICH, preinjury antiplatelet use, and platelet transfusion reported in PubMed, Embase, Cochrane Reviews, Cochrane Trials and Cochrane DARE databases between January 1987 and March 2019 were included. Investigations of concomitant anticoagulant use were excluded. Risk of bias was assessed using the Newcastle-Ottawa scale. We calculated pooled estimates of relative effect of platelet transfusion on the risk of death, hemorrhage progression and need for neurosurgical intervention using the methods of Dersimonian-Laird random-effects meta-analysis. Sensitivity analysis established whether study size contributed to heterogeneity. Subgroup analyses determined whether antiplatelet type, additional blood products/reversal agents, or platelet function assays impacted effect size using meta-regression.

RESULTS
Twelve of 18,609 screened references were applicable to our questions and were qualitatively and quantitatively analyzed. We found no association between platelet transfusion and the risk of death in patients with tICH taking prehospital antiplatelets (odds ratio [OR], 1.29; 95% confidence interval [CI], 0.76–2.18; p = 0.346; I
2 = 32.5%). There was no significant reduction in hemorrhage progression (OR, 0.88; 95% CI, 0.34–2.28; p = 0.788; I
2 = 78.1%). There was no significant reduction in the need for neurosurgical intervention (OR, 1.00; 95% CI, 0.53–1.90, p = 0.996; I
2 = 59.1%; p = 0.032).

CONCLUSION
Current evidence does not support the use of platelet transfusion in patients with tICH on prehospital antiplatelets, highlighting the need for a prospective evaluation of this practice.

LEVEL OF EVIDENCE
Systematic Reviews and Meta-Analyses, Level III.
Putting a halt to unnecessary transfers: Do patients with isolated subarachnoid hemorrhage and Glasgow Coma Scale of 13 to 15 need a trauma center?
Authors: Sharma Jyoti , Defoe Danielle , Gillen Jenna , Kuo Yen-Hong , Perez Javier , Dalal Setu , Dayal Saraswati , Kiselak Elizabeth , Rippey Kelly , Kaul Sanjeev , Cohn Stephen 
Published: March 2020

OBJECTIVES
Trauma patients with isolated subarachnoid hemorrhage (iSAH) presenting to nontrauma centers are typically transferred to an institution with neurosurgical availability. However, recent studies suggest that iSAH is a benign clinical entity with an excellent prognosis. This investigation aims to evaluate the neurosurgical outcomes of traumatic iSAH with Glasgow Coma Scale (GCS) of 13 to 15 who were transferred to a higher level of care.

METHODS
The American College of Surgeon Trauma Quality Improvement Program was retrospectively analyzed from 2010 to 2015 for transferred patients 16 years and older with blunt trauma, iSAH, and GCS of 13 or greater. Those with any other body region Abbreviated Injury Scale of 3 or greater, positive or unknown alcohol/drug status, and requiring mechanical ventilation were excluded. The primary outcome was need for neurosurgical intervention (i.e., intracranial monitor or craniotomy/craniectomy).

RESULTS
A total of 11,380 patients with blunt trauma, iSAH, and GCS of 13 to 15 were transferred to an American College of Surgeon level I/II from 2010 to 2015. These patients were 65 years and older (median, 72 [interquartile range (IQR), 59–81]) and white (83%) and had one or more comorbidities (72%). Eighteen percent reported a bleeding diathesis/chronic anticoagulation on admission. Most patients had fallen (80%), had a GCS of 15 (84%), and were mildly injured (median Injury Severity Score, 9 [IQR, 5–14]). Only 1.7% required neurosurgical intervention with 55% of patients being admitted to the intensive care unit for a median of 2 days (IQR, 1–3 days). Furthermore, 2.2% of the patients died. The median hospital length of stay was only 3 days (IQR, 2–5 days), and the most common discharge location was home with self-care (62%). Patient factors favoring neurosurgical intervention included high Injury Severity Score, low GCS, and chronic anticoagulation.

CONCLUSION
Trauma patients transferred for iSAH with GCS of 13 to 15 are at very low risk for requiring neurosurgical intervention.

LEVEL OF EVIDENCE
Therapeutic/care management, Level IV.
Identification of a new genetic variant associated with cholecystitis: A multicenter genome-wide association study
Authors: Bonde Alexander , Gaitanidis Apostolos , Breen Kerry , El Hechi Majed , Nederpelt Charlie , Christensen Mathias , Kokoroskos Nikolaos , Mendoza April , Velmahos George , Sillesen Martin , Farhat Maha R. , Kaafarani Haytham M.A. 
Published: March 2020

BACKGROUND
The genomic landscape of gallbladder disease remains poorly understood. We sought to examine the association between genetic variants and the development of cholecystitis.

METHODS
The Biobank of a large multi-institutional health care system was used. All patients with cholecystitis were identified using International Statistical Classification of Diseases, 10th Revision, codes and genotyped across six batches. To control for population stratification, data were restricted to that from individuals of European genomic ancestry using a multidimensional scaling approach. The association between single nucleotide polymorphisms and cholecystitis was evaluated with a mixed linear model–based analysis, controlling for age, sex, and obesity. The threshold for significance was set at 5 × 10−8.

RESULTS
Of 24,635 patients (mean ± SD age, 60.1 ± 16.7 years; 13,022 females [52.9%]), 900 had cholecystitis (mean ± SD age, 65.4 ± 14.3 years; 496 females [55.1%]). After meta-analysis, three single nucleotide polymorphisms on chromosome 5p15 exceeded the threshold for significance (p < 5 × 10−8). The phenotypic variance of cholecystitis explained by genetics and controlling for sex and obesity was estimated to be 17.9%.

CONCLUSION
Using a multi-institutional genomic Biobank, we report that a region on chromosome 5p15 is associated with the development of cholecystitis that can be used to identify patients at risk.

LEVEL OF EVIDENCE
Prognostic and epidemiological, Level III.
Brain-Derived Neurotrophic Factor in the Cerebrospinal Fluid Increases During Electroconvulsive Therapy in Patients With Depression
Authors: Mindt Sonani , Neumaier Michael , Hellweg Rainer , Sartorius Alexander , Kranaster Laura 
Published: March 2020

Objective
Preclinical evidence suggests a role for brain-derived neurotrophic factor (BDNF) in the mode of action of electroconvulsive therapy (ECT). Clinical data regarding BDNF levels in serum or plasma are more inconsistent. We measured BDNF levels from the cerebrospinal fluid (CSF) in patients with major depression before and shortly after a course of ECT.

Methods
Cerebrospinal fluid and serum BDNF levels were determined using commercially available enzyme-linked immunosorbent assay (ELISA) kits.

Results
We included 9 patients with a severe depressive episode within a major depressive disorder into the study. The CSF BDNF concentrations at baseline were lower compared with those CSF BDNF levels after the complete ECT treatment (P = 0.042), whereas no such a constellation was found for serum BDNF. No associations between the BDNF levels and the amount of individual ECT sessions or the reduction of the depressive symptoms were found.

Conclusions
For the first time, it has been shown that CSF BDNF concentrations increase during a course of ECT in patients with a severe unipolar depressive episode, which is in line with the neurotrophin hypothesis as a mode of action of ECT, although it was not possible to demonstrate either a dose-effect relation or a relationship with the actual antidepressant effects in our small sample. Major limitation is the small sample size.
Predicting Individual Remission After Electroconvulsive Therapy Based on Structural Magnetic Resonance Imaging
Authors: Takamiya Akihiro , Liang Kuo-ching , Nishikata Shiro , Tarumi Ryosuke , Sawada Kyosuke , Kurokawa Shunya , Hirano Jinichi , Yamagata Bun , Mimura Masaru , Kishimoto Taishiro 
Published: March 2020

Objective
To identify important clinical or imaging features predictive of an individual's response to electroconvulsive therapy (ECT) by utilizing a machine learning approach.

Methods
Twenty-seven depressed patients who received ECT were recruited. Clinical demographics and pretreatment structural magnetic resonance imaging (MRI) data were used as candidate features to build models to predict remission and post-ECT Hamilton Depression Rating Scale scores. Support vector machine and support vector regression with elastic-net regularization were used to build models using (i) only clinical features, (ii) only MRI features, and (iii) both clinical and MRI features. Consistently selected features across all individuals were identified through leave-one-out cross-validation.

Results
Compared with models that include only clinical variables, the models including MRI data improved the prediction of ECT remission: the prediction accuracy improved from 70% to 93%. Features selected consistently across all individuals included volumes in the gyrus rectus, the right anterior lateral temporal lobe, the cuneus, and the third ventricle, as well as 2 clinical features: psychotic features and family history of mood disorder.

Conclusions
Pretreatment structural MRI data improved the individual predictive accuracy of ECT remission, and only a small subset of features was important for prediction.
Transmitter and receiver technologies for optical wireless
Authors: O'Brien Dominic , Rajbhandari Sujan , Chun Hyunchae 
Published: March 2020

Providing a reliable link, with sufficient signal-to-noise ratio (SNR) and bandwidth to deliver high-capacity communications is a critical challenge for optical wireless (OW) communications and understanding and jointly optimizing the performance of the transmitter and receiver subsystems is a key part of this. At the transmitter a source of light, either a laser or a light-emitting diode, must be modulated with the communications signal. The resulting emission must be directed, using optics or steering systems, as required for the particular application, and must be within any safety levels set by relevant standards. The receiver is the most critical part of any optical link, as its design is a dominant factor in determining the received SNR, which determines the capacity and ultimately the utility of the link. A receiver must collect, filter and concentrate signal radiation, then detect and amplify the resulting electrical signal. This review surveys the state-of–the-art transmitter and receiver technologies. Details of design constraints are discussed, and potential future directions discussed.
This article is part of the theme issue ‘Optical wireless communication’.