bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effective Senior Surgical Residents as Defined by Their Peers
Authors: Coe Taylor M. , Jogerst Kristen M. , Petrusa Emil , Phitayakorn Roy , Lipman Jeremy 
Published: August 2021

Objective:
This study aims to define an effective senior resident and understand the process of leadership and nontechnical skill development in the transition from junior to senior surgery resident.

Summary Background:
General surgery residents are responsible for patient care, technically demanding operations, and diverse care team management. However, leadership skill development for the transition from junior to senior resident roles is often overlooked.

Methods:
We conducted 15 semi-structured focus groups with surgery residents from an urban, academic institution. Focus group transcripts were inductively coded. Using content analysis and constant comparative methodology, primary codes were refined into categories and organized into higher-level themes.

Results:
Thirty-three general surgery residents completed fifteen focus groups. Six themes were identified. Three themes describe the process of becoming an effective senior resident: how to define a senior resident's scope of practice, the transition process, and the importance of personal investment. Three themes were identified regarding effective seniors: ideal traits, teachable skills, and the team and patient impact.

Conclusions:
Surgery residents define an effective senior resident as the team member with the highest level of experience who manages the big picture of patient care. The transition is improved by personal engagement and acknowledgement of the transition. Ideal traits of effective seniors, including emotional intelligence and inherent personality traits, allow a resident to more naturally assume this role; however, teachable skills, such as communication, expectation setting and competence, can be taught to improve one's effectiveness. The actions of a senior resident impact the team and patient care, underscoring the importance of understanding this role.
Risk Factors for Tumor Positive Resection Margins After Neoadjuvant Chemoradiotherapy for Esophageal Cancer: Results From the Dutch Upper GI Cancer Audit
Authors: Defize Ingmar L. , Goense Lucas , Borggreve Alicia S. , Mook Stella , Meijer Gert J. , Ruurda Jelle P. , van Hillegersberg Richard ,   on behalf of the Dutch Upper GI Cancer Audit Group
Published: August 2021

Objective:
To identify risk factors for tumor positive resection margins after neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy for esophageal cancer.

Summary Background Data:
Esophagectomy after nCRT is associated with tumor positive resection margins in 4% to 9% of patients. This study evaluates potential risk factors for positive resection margins after nCRT followed by esophagectomy.

Methods:
All patients who underwent an elective esophagectomy following nCRT in 2011 to 2017 in the Netherlands were included. A multivariable logistic regression was performed to assess the association between potential risk factors and tumor positive resection margins.

Results:
In total, 3900 patients were included. Tumor positive resection margins were observed in 150 (4%) patients. Risk factors for tumor positive resection margins included tumor length (in centimeters, OR: 1.1, 95% CI: 1.0–1.1), cT4-stage (OR: 3.0, 95% CI: 1.2–6.7), and an Ivor Lewis esophagectomy (OR: 1.6, 95% CI: 1.0–2.6). Predictors associated with a lower risk of tumor positive resection margins were squamous cell carcinoma (OR: 0.4, 95% CI: 0.2–0.7), distal tumors (OR: 0.5, 95% CI: 0.3–1.0), minimally invasive surgery (OR: 0.6, 95% CI: 0.4–0.9), and a hospital volume of >60 esophagectomies per year (OR: 0.6, 95% CI: 0.4–1.0).

Conclusions:
In this nationwide cohort study, tumor and surgical related factors (tumor length, histology, cT-stage, tumor location, surgical procedure, surgical approach, hospital volume) were identified as risk factors for tumor positive resection margins after nCRT for esophageal cancer. These results can be used to improve the radical resection rate by careful selection of patients and surgical approach and are a plea for centralization of esophageal cancer care.
Surgical Management of Retrorectal Tumors
Authors: Aubert Mathilde , Mege Diane , Parc Yann , Rullier Eric , Cotte Eddy , Meurette Guillaume , Zerbib Philippe , Trilling Bertrand , Lelong Bernard , Sabbagh Charles , Lakkis Zaher , Ouaissi Mehdi , Lebreton Gil , Rouanet Philippe , Manceau Gilles , Tuech Jean-Jacques , Piessen Guillaume , Bresler Laurent , Beyer-Berjot Laura , Denost Quentin , Lefèvre Jérémie H , Panis Yves 
Published: August 2021

Objective:
To report the largest multicentric experience on surgical management of retrorectal tumors (RRT).

Background:
Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT.

Methods:
Patients operated for RRT in 18 academic French centers were retrospectively included (2000–2019).

Results:
A total of 270 patients were included. Surgery was performed through abdominal (n = 72, 27%), bottom (n = 190, 70%), or combined approach (n = 8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, P = 0.02), larger [mean diameter = 60.5 ± 24 (range, 13–107) vs 51 ± 26 (20–105) mm, P = 0.02] and located above S3 vertebra (n = 3/42, 7% vs 0%, P = 0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n = 4/53, 7.5% vs 0%, P = 0.002) and rectal fistula (n = 3/53, 6% vs 0%, P=0.01) but less wound abscess (n = 1/53, 2% vs 24/169, 14%, P = 0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 ±39 (1–221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; P = 0.3).

Conclusions:
Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results.
Preemptive Endoluminal Vacuum Therapy to Reduce Morbidity After Minimally Invasive Ivor Lewis Esophagectomy
Authors: Müller Philip C. , Morell Bernhard , Vetter Diana , Raptis Dimitri A. , Kapp Joshua R. , Gubler Christoph , Gutschow Christian A. 
Published: August 2021

Objective:
Preemptive endoluminal vacuum therapy (pEVT) is a novel concept to reduce postoperative morbidity and has the potential to disrupt current treatment paradigms for patients undergoing esophagectomy.

Summary of Background Data:
Endoluminal vacuum therapy is an accepted treatment for AL after esophagectomy.

Methods:
Retrospective analysis of patients undergoing minimally invasive Ivor Lewis esophagectomy with pEVT between 11/2017 and 10/2020. The sponge was removed endoscopically after 4–6 days, and anastomosis and gastric conduit were assessed according to a novel endoscopic grading system. Further management was customized according to endoscopic appearance and clinical course. Endpoints were postoperative morbidity and AL rate, defined according to the Clavien-Dindo (CD) and International Esodata Study Group classifications.

Results:
PEVT was performed in 67 consecutive patients, 57 (85%) were high-risk patients with an ASA score >2, WHO/ECOG score >1, age >65 years, or BMI >29 kg/m2. Thirty patients experienced textbook outcome, and overall minor (≤CD IIIa) and major (≥CD IIIb) morbidity was 40.3% and 14.9% respectively. 30-day-mortality was 0%. Forty-nine patients (73%) had uneventful anastomotic healing after pEVT without further endoscopic treatment. The remaining 18 patients (27%) underwent prolonged EVT with uneventful anastomotic healing in 13 patients (19%), contained AL in 4 patients (6%), and 1 uncontained leakage (1.5%) in a case with proximal gastric conduit necrosis, resulting in an overall AL rate of 7.5%.

Conclusions:
PEVT is an innovative and safe procedure with a promising potential to reduce postoperative morbidity after minimally invasive Ivor Lewis esophagectomy and may be particularly valuable in highly comorbid cases.
Cerebellar Brain Inhibition Is Associated With the Severity of Cervical Dystonia
Authors: Sondergaard Rachel E. , Strzalkowski Nicholas D. J. , Gan Liu Shi , Jasaui Yamile , Furtado Sarah , Pringsheim Tamara M. , Sarna Justyna R. , Avanzino Laura , Kiss Zelma H. T. , Martino Davide 
Published: August 2021

Purpose:
Cerebellar connectivity is thought to be abnormal in cervical dystonia (CD) and other dystonia subtypes, based on evidence from imaging studies and animal work. The authors investigated whether transcranial magnetic stimulation–induced cerebellar brain inhibition (CBI), a measure of cerebellar efficiency at inhibiting motor outflow, is abnormal in patients with CD and/or is associated with clinical features of CD. Because of methodological heterogeneity in CBI reporting, the authors deployed additional controls to reduce potential sources of variability in this study.

Methods:
Cerebellar brain inhibition was applied in 20 CD patients and 14 healthy control subjects. Cerebellar brain inhibition consisted of a cerebellar conditioning stimulus delivered at four different interstimulus intervals (ISIs) before a test stimulus delivered to hand muscle representation in the motor cortex. The average ratio of conditioned to unconditioned motor evoked potential was computed for each ISI. Cervical dystonia clinical severity was measured using the Toronto Western Spasmodic Torticollis Rating Scale. Control experiments involved neuronavigated transcranial magnetic stimulation, neck postural control in patients, and careful screening for noncerebellar pathway inhibition via cervicomedullary evoked potentials.

Results:
There was no difference between CBI measured in healthy control subjects and CD patients at any of the four ISIs; however, CBI efficiency was significantly correlated with worsening CD clinical severity at the 5 ms ISI.

Conclusions:
Cerebellar brain inhibition is a variable measure in both healthy control subjects and CD patients; much of this variability may be attributed to experimental methodology. Yet, CD severity is significantly associated with reduced CBI at the 5 ms ISI, suggestive of cerebello-thalamo-cortical tract dysfunction in this disorder.
Gadd45α is involved in regulating activity-dependent and exon-specific BDNF expression in postmitotic cortical neurons
Authors: Feng Yu , Wang Zhen , Wei Wei , Zhang Tingbao , Li Zhengwei , Chen† Jincao , Liu† Kui 
Published: August 2021

Objective
This study aimed to explore the epigenetic regulation of activity-dependent and exon-specific brain-derived neurotrophic factor (BDNF) expression under KCl depolarization in primary cortical neurons.

Methods
We investigated BDNF exon I, exon IV and the growth arrest and DNA damage-inducible protein 45 alpha (Gadd45α) transcription levels under KCl-induced neuronal activation in postmitotic neurons. Gadd45α occupancy at BDNF I and IV promoter was measured by chromatin immunoprecipitation (ChIP) followed by quantitative PCR; DNA methylation level was checked by methylated DNA immunoprecipitation (MeDIP) followed by qPCR. In addition, lentiviral shRNA targeting Gadd45α was used to knockdown Gadd45α expression.

Results
BDNF exon I and IV mRNA expressions were both highly induced by KCl depolarization. However, ChIP analysis demonstrated a significantly increased Gadd45α occupancy only at the BDNF P1 promotor, but not P4, which is associated with reducing DNA methylation within BDNF P1 promoter. Furthermore, after the lentiviral-mediated knockdown of Gadd45α, the increased Gadd45α occupancy at the BDNF P1 was inhibited, which was accompanying the complete blocking of the demethylation effect at P1. Nonetheless, the induction of BDNF exon I mRNA by KCl was only partially prevented by Gadd45α shRNA, indicting other mechanisms involved in regulating BDNF exon I expression.

Conclusions
DNA demethylation mediated by Gadd45α protein involves promoting the regulation of activity-dependent BDNF exon I expression in neurons.
From vesicles to materials: bioinspired strategies for fabricating hierarchically structured soft matter
Authors: Amstad Esther , Harrington Matthew J. 
Published: August 2021

Certain organisms including species of mollusks, polychaetes, onychophorans and arthropods produce exceptional polymeric materials outside their bodies under ambient conditions using concentrated fluid protein precursors. While much is understood about the structure-function relationships that define the properties of such materials, comparatively less is understood about how such materials are fabricated and specifically, how their defining hierarchical structures are achieved via bottom-up assembly. Yet this information holds great potential for inspiring sustainable manufacture of advanced polymeric materials with controlled multi-scale structure. In the present perspective, we first examine recent work elucidating the formation of the tough adhesive fibres of the mussel byssus via secretion of vesicles filled with condensed liquid protein phases (coacervates and liquid crystals)—highlighting which design principles are relevant for bio-inspiration. In the second part of the perspective, we examine the potential of recent advances in drops and additive manufacturing as a bioinspired platform for mimicking such processes to produce hierarchically structured materials.This article is part of the theme issue ‘Bio-derived and bioinspired sustainable advanced materials for emerging technologies (part 1)’.
Staffing and Capacity Planning for SARS-CoV-2 Monoclonal Antibody Infusion Facilities: A Performance Estimation Calculator based on Discrete-Event Simulations
Authors: Çağlayan Çağlar , Thornhill Jonathan , Stewart Miles A. , Lambrou Anastasia S. , Richardson Donald , Rainwater-Lovett Kaitlin , Freeman Jeffrey D. , Pfundt Tiffany , Redd John T. 
Published: July 2021

AbstractObjectiveThe COVID-19 pandemic has significantly stressed healthcare systems. The addition of monoclonal antibody (mAb) infusions, which prevent severe disease and reduce hospitalizations, to the repertoire of COVID-19 countermeasures offers the opportunity to reduce system stress but requires strategic planning and use of novel approaches. Our objective was to develop a web-based decision-support tool to help existing and future mAb infusion facilities make better and more informed staffing and capacity decisions.Materials and MethodsUsing real-world observations from three medical centers operating with federal field team support, we developed a discrete-event simulation model and performed simulation experiments to assess performance of mAb infusion sites under different conditions.Results162,000 scenarios were evaluated by simulations. Our analyses revealed that it was more effective to add check-in staff than to add additional nurses for middle-to-large size sites with ≥ 2 infusion nurses; that scheduled appointments performed better than walk-ins when patient load was not high; and that reducing infusion time was particularly impactful when load on resources was only slightly above manageable levels.DiscussionPhysical capacity, check-in staff, and infusion time were as important as nurses for mAb sites. Health systems can effectively operate an infusion center under different conditions to provide mAb therapeutics even with relatively low investments in physical resources and staff.ConclusionSimulations of mAb infusion sites were used to create a capacity planning tool to optimize resource utility and allocation in constrained pandemic conditions, and more efficiently treat COVID-19 patients at existing and future mAb infusion sites.
DERIVATION AND VALIDATION OF A CLINICAL SCORE TO PREDICT DEATH AMONG NON-PALLIATIVE COVID-19 PATIENTS PRESENTING TO EMERGENCY DEPARTMENTS: THE CCEDRRN COVID MORTALITY SCORE
Authors: Hohl Corinne M. , Rosychuk Rhonda J. , Archambault Patrick M. , O’Sullivan Fiona , Leeies Murdoch , Mercier Éric , Clark Gregory , Innes Grant D. , Brooks Steven C. , Hayward Jake , Ho Vi , Jelic Tomislav , Welsford Michelle , Sivilotti Marco L.A. , Morrison Laurie J. , Perry Jeffrey J. 
Published: July 2021

ABSTRACTBackgroundPredicting mortality from coronavirus disease 2019 (COVID-19) using information available when patients present to the Emergency Department (ED) can inform goals-of-care decisions and assist with ethical allocation of critical care resources.MethodsWe conducted an observational study to develop and validate a clinical score to predict ED and in-hospital mortality among consecutive non-palliative COVID-19 patients. We recruited from 44 hospitals participating in the Canadian COVID-19 ED Rapid Response Network (CCEDRRN) between March 1, 2020 and January 31, 2021. We randomly assigned hospitals to derivation or validation, and pre-specified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort, and examined its performance in predicting ED and in-hospital mortality in a validation cohort.ResultsOf 8,761 eligible patients, 618 (7·01%) died. The score included age, sex, type of residence, arrival mode, chest pain, severe liver disease, respiratory rate, and level of respiratory support. The area under the curve was 0·92 (95% confidence intervals [CI] 0·91–0·93) in derivation and 0·92 (95%CI 0·89–0·93) in validation. The score had excellent calibration. Above a score of 15, the observed mortality was 81·0% (81/100) with a specificity of 98·8% (95%CI 99·5–99·9%).InterpretationThe CCEDRRN COVID Mortality Score is a simple score that accurately predicts mortality with variables that are available on patient arrival without the need for diagnostic tests.Trial registrationClinicaltrials.gov, NCT04702945
Impact of B.1.351 (beta) SARS-CoV-2 variant on BNT162b2 mRNA vaccine effectiveness in long-term care facilities of eastern France: a retrospective cohort study
Authors: Lefèvre Benjamin , Tondeur Laura , Madec Yoann , Grant Rebecca , Lina Bruno , van der Werf Sylvie , Rabaud Christian , Fontanet Arnaud , Legoff Antoine 
Published: July 2021

AbstractBackgroundWe aimed to assess the effectiveness of the BNT162b2 mRNA vaccine against B.1.351 (beta) variant among residents of long-term care facilities (LCTFs) in eastern France.MethodsWe used routinely collected surveillance and COVID-19 vaccination data to conduct a retrospective cohort study of SARS-CoV-2 B.1.351 infection incidence and vaccine effectiveness among LCTFs residents in eastern France between 15 January and 19 May 2021. Data from secondary RT-PCR screening were used to identify B.1.351 variants.FindingsIncluded in our analysis were 378 residents from five LCTFs: 287 (76%) females, with median (IQR) age of 89 (83-92) years. Two B.1.351 outbreaks took place in LTCFs in which more than 70% of residents had received two doses of BNT162b2 mRNA vaccine, which included 11 cases of severe disease and six deaths among those who had received two doses. Vaccine effectiveness (95% CI) seven days after the second dose of vaccine was 49% (14-69) against any infection with B.1.351 and 86% (67-94) against severe forms of COVID-19. In multivariable analysis, females were less likely to develop severe forms of disease (IRR = 0.35, 95% CI = 0.20-0.63).InterpretationWe observed reduced vaccine effectiveness associated with B.1.351, as well as B.1.351 outbreaks in two LTCFs among individuals who had received two doses of vaccine. Our findings highlight the need to maintain SARS-CoV-2 surveillance in these high-risk settings beyond the current COVID-19 mass vaccination campaign, and advocate for a booster vaccine dose prior to the next winter season.
Virological and serological kinetics of SARS-CoV-2 Delta variant vaccine-breakthrough infections: a multi-center cohort study
Authors: Chia Po Ying , Xiang Ong Sean Wei , Chiew Calvin J , Ang Li Wei , Chavatte Jean-Marc , Mak Tze-Minn , Cui Lin , Kalimuddin Shirin , Chia Wan Ni , Tan Chee Wah , Ann Chai Louis Yi , Tan Seow Yen , Zheng Shuwei , Pin Lin Raymond Tzer , Wang Linfa , Leo Yee-Sin , Lee Vernon J , Lye David Chien , Young Barnaby Edward 
Published: July 2021

ObjectivesHighly effective vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed but variants of concerns (VOCs) with mutations in the spike protein are worrisome, especially B.1.617.2 (Delta) which has rapidly spread across the world. We aim to study if vaccination alters virological and serological kinetics in breakthrough infections.MethodsWe conducted a multi-centre retrospective cohort study of patients in Singapore who had received a licensed mRNA vaccine and been admitted to hospital with B.1.617.2 SARS-CoV-2 infection. We compared the clinical features, virological and serological kinetics (anti-nucleocapsid, anti-spike and surrogate virus neutralization titres) between fully vaccinated and unvaccinated individuals.ResultsOf 218 individuals with B.1.617.2 infection, 84 had received a mRNA vaccine of which 71 were fully vaccinated, 130 were unvaccinated and 4 received a non-mRNA. Despite significantly older age in the vaccine breakthrough group, the odds of severe COVID-19 requiring oxygen supplementation was significantly lower following vaccination (adjusted odds ratio 0.07 95%CI: 0.015-0.335, p=0.001). PCR cycle threshold (Ct) values were similar between both vaccinated and unvaccinated groups at diagnosis, but viral loads decreased faster in vaccinated individuals. Early, robust boosting of anti-spike protein antibodies was observed in vaccinated patients, however, these titers were significantly lower against B.1.617.2 as compared with the wildtype vaccine strain.ConclusionThe mRNA vaccines are highly effective at preventing symptomatic and severe COVID-19 associated with B.1.617.2 infection. Vaccination is associated with faster decline in viral RNA load and a robust serological response. Vaccination remains a key strategy for control of COVID-19 pandemic.
Promoting Resilience in Healthcare Workers during the COVID-19 Pandemic with a Brief Online Intervention
Authors: DeTore NR , Sylvia L , Park ER , Burke A , Levison JH , Shannon A , Choi KW , Jain FA , Coman DC , Herman J , Perlis R , Fava M , Holt DJ 
Published: July 2021

AbstractIntroductionThe psychological wellbeing of healthcare workers has been impacted by the high levels of stress many have experienced during the COVID-19 pandemic. This study aimed to examine the feasibility and acceptability of a brief online course focused on introducing skills that could increase resilience and decreases emotional distress in healthcare workers during the pandemic.Materials and MethodsEmployees of a large healthcare system completed a survey at baseline, one month, and two months later. The online course, called Resilience Training for Healthcare Workers, consists of three 12-20 minute videos focused on evidence-based skills that support aspects of emotional resilience: mindfulness, mentalization, and self-compassion.ResultsA total of 554 participants completed the baseline survey, endorsing moderate to high levels of emotional distress. Of those who completed all three assessments and participated in the course (n = 38), significant improvements in resilience and reductions in emotional distress were found across two months, in comparison to those who did not participate in the course.DiscussionThese findings suggest that a brief, online intervention can improve the mental health of healthcare workers during a crisis such as the COVID-19 pandemic.