bluuebunny/crossref_metadata_2025_split huggingface dataset:
Designing Well-Being: Using Design Thinking to Engage Residents in Developing Well-Being Interventions
Authors: Thomas Larissa R. , Nguyen Rita , Teherani Arianne , Lucey Catherine R. , Harleman Elizabeth 
Published: February 2020

Problem
Improving well-being in residency requires solutions that focus on organizational factors and the individual needs of residents, yet there are few examples of successful strategies to address this challenge. Design thinking (DT), or human-centered design, is an approach to problem-solving that focuses on understanding emotions and human dynamics and may be ideally suited to tackling well-being as a complex problem. The authors taught residents to use DT techniques to identify, analyze, and address organizational well-being challenges.

Approach
Internal medicine residents at the University of California, San Francisco completed an 8-month DT program in 2016–2017. The program consisted of four 2-hour workshops with small group project work between sessions. In each session, resident teams shared their progress and analyzed emerging themes to solve well-being problems. At the conclusion of the program, they summarized the final design principles and recommendations that emerged from their work and were interviewed about DT as a strategy for developing well-being interventions for residents.

Outcomes
Eighteen residents worked in teams to design solutions to improve: community and connection, space for reflection, peer support, and availability of individualized wellness. The resulting recommendations led to new interventions to improve well-being through near-peer communities. Residents emphasized how DT enhanced their creative thinking and trust in the residency program. They reported that not having enough time to work on projects between sessions and losing momentum during their clinical rotations were their biggest challenges.

Next Steps
Residents found DT useful for completing needs assessments, piloting interventions, and outlining essential design principles to improve well-being in residency. DT’s focus on human values may be particularly suited to developing well-being interventions to enhance institutional community and culture. One outcome—that DT promoted creativity and trust for participants—may have applications in other spheres of medical education.
Lower Success Rate of Débridement and Implant Retention in Late Acute versus Early Acute Periprosthetic Joint Infection Caused by Staphylococcus spp. Results from a Matched Cohort Study
Authors: Wouthuyzen-Bakker Marjan , Sebillotte Marine , Huotari Kaisa , Escudero Sánchez Rosa , Benavent Eva , Parvizi Javad , Fernandez-Sampedro Marta , Barbero José Maria , Garcia-Cañete Joaquín , Trebse Rihard , Del Toro Maria , Diaz-Brito Vicens , Sanchez Marisa , Scarborough Matthew , Soriano Alex ,   on behalf of the ESCMID Study Group for Implant-Associated Infections (ESGIAI)
Published: February 2020

Abstract

Background
Surgical débridement, antibiotics and implant retention (DAIR) is currently recommended by international guidelines for both early acute (postsurgical) and late acute (hematogenous) periprosthetic joint infections (PJIs). However, due to a different pathogenesis of infection, a different treatment strategy may be needed.

Questions/purposes
(1) Compared with early acute PJIs, are late acute PJIs associated with a higher risk of DAIR failure? (2) When stratified by microorganism, is the higher risk of failure in late acute PJI associated with Staphylocococcus aureus infection? (3) When analyzing patients with S. aureus infection, what factors are independently associated with DAIR failure?

Methods
In this multicenter observational study, early acute and late acute PJIs treated with DAIR were retrospectively evaluated and matched according to treating center, year of diagnosis, and infection-causing microorganism. If multiple matches were available, the early acute PJI diagnosed closest to the late acute PJI was selected. A total of 132 pairs were included. Treatment success was defined as a retained implant during follow-up without the need for antibiotic suppressive therapy.

Results
Late acute PJIs had a lower treatment success (46% [60 of 132]) compared with early acute PJIs (76% [100 of 132]), OR 3.9 [95% CI 2.3 to 6.6]; p < 0.001), but the lower treatment success of late acute PJIs was only observed when caused by Staphylococcus spp (S. aureus: 34% versus 75%; p < 0.001; coagulase-negative staphylococci: 46% versus 88%; p = 0.013, respectively). On multivariable analysis, late acute PJI was the only independent factor associated with an unsuccessful DAIR when caused by S. aureus (OR 4.52 [95% CI 1.79 to 11.41]; p < 0.001).

Conclusions
Although DAIR seems to be a successful therapeutic strategy in the management of early acute PJI, its use in late acute PJI should be reconsidered when caused by Staphylococcus spp. Our results advocate the importance of isolating the causative microorganism before surgery.

Level of Evidence
Level III, therapeutic study.
Incidence of diabetes according to metabolically healthy or unhealthy normal weight or overweight/obesity in postmenopausal women: the Women's Health Initiative
Authors: Cordola Hsu Amber R. , Ames Susan L. , Xie Bin , Peterson Darleen V. , Garcia Lorena , Going Scott B. , Phillips Lawrence S. , Manson JoAnn E. , Anton-Culver Hoda , Wong Nathan D. 
Published: February 2020

Abstract

Objective:
To determine the relationship of metabolic weight categories with incident diabetes mellitus (DM) in postmenopausal women.

Methods:
The Women's Health Initiative (WHI) enrolled 161,808 postmenopausal women aged 50 to 79 years. We included those with cardiovascular disease (CVD) biomarkers and free of CVD and prevalent DM (n = 17,043) at baseline. Normal weight was defined as a body mass index (BMI) ≥18.5 and <25 kg/m2, and waist circumference (WC) <88 cm and overweight/obesity as a BMI ≥25 kg/m2 or WC ≥88 cm. Metabolically healthy was based on <2 and metabolically unhealthy ≥2 traits of the following: triglycerides ≥150 mg/dL, systolic blood pressure (BP) ≥130 mm Hg or diastolic BP ≥85 mm Hg, or antihypertensives or diuretics, fasting glucose ≥100 mg/dL or DM medication, and high-density lipoprotein cholesterol <50 mg/dL. Cox regression was performed to determine the risk of incident DM among metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUHNW), metabolically healthy overweight/obese (MHO), and metabolically unhealthy overweight/obese (MUHO).

Results:
Among our sample, 2,253 (13.3%) participants developed DM over a mean ± standard deviation follow-up time of 15.6 ± 3.4 years. Compared with MHNW (n = 162 incident DM cases), an increased risk of incident DM was observed in MUHNW (n = 102 cases) (hazard ratio [HR] 2.24, 95% confidence interval [CI] 1.74-2.88, P < 0.0001), MHO (n = 624 cases) (HR 1.68, 95% CI 1.40-2.00, P < 0.0001), and MUHO (n = 1,365 cases) (HR 4.51, 95% CI 3.82-5.35, P < 0.0001).

Conclusions:
Among postmenopausal women, MUHNW and MHO confer an approximate doubling in the risk and MUHO more than a four-fold increased risk for developing DM.
Using cationic polyurethane-short branch PEI as microRNA-driven nano-delivery system for stem cell differentiation
Authors: Chien Chian-Shiu , Wang Chien-Ying , Yang Yi-Ping , Chou Shih-Jie , Ko Yu-Ling , Tsai Fu-Ting , Yu Wen-Chung , Chang Chia-Ching , Cherng Jong-Yuh , Yang Meng-Yin 
Published: February 2020

Background:
Non-viral gene delivery, such as using biodegradable polyurethane short-branch polyethylenimine (PU-PEI), has been considered a potentially safer gene delivery system in comparison to conventional virus systems.

Methods:
The polycationization of DNA complexes protects DNA from nuclease degradation, and these DNA complexes are nanoscale in size to enter the cell through endocytosis.

Results:
Due to the net positive surface charge of the cell, these polyplexes efficiently bind to the cell through electrostatic interactions with negatively charged membrane components. Cationic PU-PEI has been shown to be non-cytotoxic and has a high transfection efficiency, making it a practical gene delivery material in diseases.

Conclusion:
We developed a PU-PEI nanomedicine-based platform to efficiently deliver microRNA in promoting differentiation capacity of stem cells, especially on induced pluripotent stem cells.
Mastopexy
Authors: Cohen-Shohet Rachel , Bloom Joshua , Mast Bruce 
Published: February 2020

Introduction
Training residents for cosmetic surgery is challenging. This study's goal is to identify the mastopexy spectrum, comparing private and academic practice, and determine the impact on resident training and readiness.

Methods
An institutional review board-approved retrospective analysis of the senior author's mastopexy practice was performed: 5 years private; 5 years academics consecutively. Indications for surgery, type of surgery, and complications (return to operating room, hospital readmission, prosthesis loss, nonoperative hematoma, seroma, wound dehiscence, infection) were recorded. Surveys were sent to all graduated, board-certified plastic surgeons (all in private practice) who trained in performing mastopexy with the lead surgeon in our apprenticeship model.

Results
A total of 246 mastopexies were reviewed (155 in private practice and 91 in academic setting). There were 7 main indications for mastopexy identified: ptosis, postpartum atrophy, nonsurgical weight loss, surgical weight loss, asymmetry, reconstruction/balancing, revision from previous augmentation. Fisher exact test was performed. Primary mastopexy alone was significantly more prevalent in private practice (P = 0.0184). Revisional mastopexy/augmentation was significantly more prevalent in academic practice (P = 0.0047). There was no statistical difference in major or minor complications between private and academic setting (P = 0.077 and P = 0.219, respectively). All graduated trainees reported being “comfortable” or “very comfortable” performing mastopexies.

Discussion
Primary mastopexy is more commonly performed in a private practice setting. Mastopexy, in academics, is more likely in conjunction with reconstruction/balancing. Despite lesser representation of pure cosmetic mastopexy, trainees are well prepared for mastopexy. This indicates that principles and techniques of aesthetic surgery are adequately taught.
The Cost of the “July Effect” in Microsurgery
Authors: Ayyala Haripriya S. , Weisberger Joseph S. , Malhotra Radhika , Lee Edward S. 
Published: February 2020

Abstract
The existence of the “July effect,” or the idea that the new academic year intrinsically has an increased complication rate is evaluated in microsurgical free tissue transfer procedures. The National Surgical Quality Improvement Program registry was queried for all free flap procedures performed between 2005 and 2016 (n = 3405). Cases were grouped as having occurred in the first academic quarter (Q1: July 1–September 30) or fourth quarter (Q4: April 1–June 30). Demographical data and complications were compared using univariate χ
2 analysis, multivariate logistic regression was used to control for confounding variables, and inpatient stay and operating cost estimates were created. Of a total of 1722 cases, 905 were performed in the first academic quarter and 817 were performed in the fourth academic quarter. There was no significant difference between Q1 and Q4 in readmission rate (P = 0.378) or reoperation rate (P = 0.730). Patients in Q1 had significantly longer operative times (P = 0.001) and length of stay (P = 0.002) compared with those in Q4. In addition, cost of inpatient stay and operating costs associated with each free flap were significantly increased in Q1 compared with Q4 (P = 0.029; P = 0.001). The total cost per quarter for free flaps was also significantly more expensive in Q1 vs Q4, with the highest average difference in cost of $350,010.64 (P = 0.001). Having surgery early in the academic year does not put patients at any increased risk for major complications but is associated with increased operating time, length of stay, and total cost.
On a new fractional uncertainty relation and its implications in quantum mechanics and molecular physics
Authors: El-Nabulsi Rami Ahmad 
Published: February 2020

A new generalized uncertainty relation is constructed based on Li-Ostoja-Starzewski fractional gradient operator of order 0 <
α
≤ 1 introduced recently in literature which is motivated from dimensional regularization method. The new generalized uncertainty relation leads to a new form of Schrödinger equation and emergent position-dependent mass. Special forms of position-dependent mass were studied and the problem of a particle in a box was explored. Dissimilar forms of allowed quantum energies were obtained which lead to different scenarios. We have confronted the theory with observations by evaluating the maximum wavelength obtained in the 1,3-butadiene molecule. Several features were discussed accordingly.
Clinical and pathological characteristics of 2019 novel coronavirus disease (COVID-19): a systematic reviews
Authors: Mao Yaqian , Lin Wei , Wen Junping , Chen Gang 
Published: February 2020

AbstractsImportanceIn 2002-2003, a severe pulmonary infectious disease occurred in guangdong, China. The disease was caused by severe acute respiratory syndrome coronavirus (SARS-CoV), 17 years apart, also happen in China, and also a novel coronavirus (SARS-CoV-2), this epidemic has posed a significant hazard to people’s health both China and the whole world.ObjectiveSummarized the latest epidemiological changes, clinical manifestations, auxiliary examination and pathological characteristics of COVID-19.Evidence ReviewPubMed database were searched from 2019 to 2020 using the index terms “novel coronavirus” or “COVID-19” or “2019-nCoV” or “SARS-CoV-2” and synonyms. Articles that reported clinical characteristics, laboratory results, imageological diagnosis and pathologic condition were included and were retrospectively reviewed for these cases. This paper adopts the method of descriptive statistics.Results34 COVID-19-related articles were eligible for this systematic review,Four of the articles were related to pathology. We found that Fever (86.0%), cough (63.9%) and Malaise/Fatigue (34.7%) were the most common symptoms in COVID-19. But in general, the clinical symptoms and signs of COVID-19 were not obvious. Compared with SARS, COVID-19 was transmitted in a more diverse way. The mortality rates of COVID-19 were 2.5%, and the overall infection rate of healthcare worker of COVID-19 was 3.9%. We also found that the pathological features of COVID-19 have greatly similar with SARS, which manifested as ARDS. But the latest pathological examination of COVID-19 revealed the obvious mucinous secretions in the lungs.InterpretationThe clinical and pathological characteristics of SARS and COVID-19 in China are very similar, but also difference. The latest finds of pathological examination on COVID-19 may upend existing treatment schemes, so the early recognition of disease by healthcare worker is very important.Key PointsQuestionWhat can we learn from the clinical manifestations and pathological features of 2019 novel coronavirus disease (COVID-19)?FindingsIn this review, we found COVID-19 was transmitted in a more diverse way than Severe acute respiratory syndrome (SARS). Fever, cough and Malaise/Fatigue were the most common symptoms. We also found that the SARS-CoV-2 has the same cell entry receptor ACE2 as SARS-CoV, and they have similar pathological mechanisms like Acute respiratory distress syndrome (ARDS).MeaningThis review aims to give people a more comprehensive understanding of COVID-19 and to continuously improve the level of prevention, control, diagnosis and treatment.
Control of E-S Potentiation at two different sites in the dendro-somatic axis
Authors: Clark Jason K. , Madison Daniel V. 
Published: February 2020

AbstractEPSP-Spike (E-S) Potentiation occurs alongside synaptic Long-Term Potentiation (LTP), both triggered by high-frequency synaptic stimulation (HFS). In this study, we confirm the earlier findings that E-S potentiation appears to be prevented by prior reduction of GABAAreceptor-mediated inhibitory synaptic transmission. However, we demonstrate that this is a result of an occlusion of E-S potentiation, not a block. E-S potentiation and GABAAantagonism each saturate postsynaptic action potential discharge, but E-S potentiation can still be induced by high frequency activation of synapses, even in the presence of pharmacological GABAAblockade. These results suggest that GABAAblockers/antagonists and E-S potentiation share an expression mechanism, namely the reduction of GABAA-mediated synaptic inhibition. We also assayed changes in the electrical coupling between dendrite and soma, and were surprised to find that this coupling is decreased following HFS, a change that would oppose E-S potentiation. This decrease in dendritic-soma electrical coupling (D-S coupling) was induced through the action of GABABreceptors, but not maintained or expressed via the activity of these receptors. These data all together suggest that there are two distinct and opposing changes that occur as a result of HFS: 1) A decrease in passive dendro-somatic electrical coupling, and 2), an increase in coupling between the somatic EPSP and action potential generation. These two opposing influences may function as a homeostatic mechanism to balance the excitatory/inhibitory relationship between primary neurons and interneurons, and may represent a separate mechanism by which feedback and feed-forward synaptic inhibition can influence E-S coupling in opposite directions.Significance statementE-S Potentiation is an activity-dependent form of plasticity that boosts the efficiency of the coupling between synaptic input and action potential output in a neuron. Because it is induced by synaptic activity in series with the more familiar long-term potentiation (LTP), and is similarly persistent, it represents an additional mechanism by which memory traces may be stored within neural circuits. The significance of this paper is that it shows that there are at least two points of control for E-S potentiation which influence it in opposite directions, thereby providing additional basic mechanisms by which memory traces may be modulated.
SARS-CoV-2 transmission in cancer patients of a tertiary hospital in Wuhan
Authors: Yu Jing , Ouyang Wen , Chua Melvin L.K. , Xie Conghua 
Published: February 2020

AbstractIn December 2019, an outbreak of atypical pneumonia known as 2019 novel coronavirus disease (COVID-19) occurred in Wuhan, China. This new type of pneumonia is characterized by rapid human-to-human transmission. Among the different disease types, cancer patients are often recalled to the hospital for treatment and disease surveillance, and the majority of cancer treatments such as chemotherapy and radiotherapy are immunosuppressive. This prompts us to consider if cancer patients were at an elevated risk of SARS-CoV-2 infection.A total of 1,524 cancer patients who were managed at our tertiary cancer institution – Zhongnan hospital of Wuhan University were reviewed during the period of Dec 30, 2019 to Feb 17, 2020. It was found that cancer patients had an estimated 2-fold increased risk of COVID-19 than the general population. We identified twelve patients who were infected with SARS-CoV-2, with two recorded deaths (16.7%), albeit one patient passed away from a COVID-19 unrelated cause. Interestingly, only five of these patients were ongoing treatment at the time of contracting the virus, suggesting that hospital visitation was the likely factor contributing to the elevated incidence in cancer patients. Moreover, we also observed that the incidence of severe COVID-19 was not higher than in the general population. Consequently, for cancer patients who require treatment, proper isolation protocols must be in place to mitigate the risk of SARS-CoV-2 infection.
Proteomic analysis of extracellular vesicles in cerebrospinal fluid of patients with Alzheimer’s disease
Authors: Chiasserini Davide , Bijnsdorp Irene , Bellomo Giovanni , Orvietani Pier Luigi , Piersma Sander R. , Pham Thang V. , Parnetti Lucilla , Jiménez Connie R. 
Published: February 2020

AbstractCerebrospinal fluid (CSF) contains different types of extracellular vesicles (EVs) with undisclosed biomarker potential for neurodegenerative diseases. The aims of the present study were: i) to compare the proteome EVs isolated using different ultracentrifugation speed ii) to preliminary explore the EVs proteome in a common neurodegenerative disorder, Alzheimer’s disease (AD) compared to neurological controls. CSF samples from control subjects and AD patients were pooled separately (15 mL) and subjected to ultracentrifugation (UC) at different speeds (20,000g and 100,000g) to isolate separate EV fractions (P20 and P100). The proteome was analysed using high-resolution mass spectrometry (LC-MS/MS) and comparisons were made using bioinformatic analysis. EVs isolated at 100,000g (P100) had a proteome consistent with vesicles secreted via an ESCRT-dependent mechanism, being highly enriched in alix (PDCD6IP), syntenin-1 (SDCBP) and TSG101. EVs isolated at 20,000g were substantially different, showing enrichment in cytoskeletal and cell adhesion molecules. The pools from patients diagnosed with AD showed a distinct protein profile of CSF EVs, with increased levels of ADAM10, SPON1, CH3IL1 and MDK in the P100 fraction. CSF EV offer a new potential biosource of protein markers for AD detection and a complementary framework to the analysis of whole biological fluids for biomarker discovery.
Global Motion Detection and Censoring in High-Density Diffuse Optical Tomography
Authors: Sherafati Arefeh , Snyder Abraham Z. , Eggebrecht Adam T. , Bergonzi Karla M. , Burns-Yocum Tracy M. , Lugar Heather M. , Ferradal Silvina L. , Robichaux-Viehoever Amy , Smyser Christopher D. , Palanca Ben J. , Hershey Tamara , Culver Joseph P. 
Published: February 2020

AbstractMotion-induced artifacts can significantly corrupt optical neuroimaging, as in most neuroimaging modalities. For high-density diffuse optical tomography (HD-DOT) with hundreds to thousands of source-detector pair measurements, motion detection methods are underdeveloped relative to both functional magnetic resonance imaging (fMRI) and standard functional near-infrared spectroscopy (fNIRS). This limitation restricts the application of HD-DOT in many challenging situations and subject populations (e.g., bedside monitoring and children). Here, we evaluate a new motion detection method for multichannel optical imaging systems that leverages spatial patterns across channels. Specifically, we introduce a global variance of temporal derivatives (GVTD) metric as a motion detection index. We show that GVTD strongly correlates with external measures of motion and has high sensitivity and specificity to instructed motion - with area under the receiver operator characteristic curve of 0.88, calculated based on five different types of instructed motion. Additionally, we show that applying GVTD-based motion censoring on both task and resting state HD-DOT data with natural head motion results in an improved spatial similarity to fMRI mapping for the same respective protocols (task or rest). We then compare the GVTD similarity scores with several commonly used motion correction methods described in the fNIRS literature, including correlation-based signal improvement (CBSI), temporal derivative distribution repair (TDDR), wavelet filtering, and targeted principal component analysis (tPCA). We find that GVTD motion censoring outperforms other methods and results in spatial maps more similar to matched fMRI data.