bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Various Techniques in the Reconstruction of Mohs Chin Defects
Authors: Arnaoutakis Demetri , Rihani Jordan , Thornton James 
Published: May 2018

Introduction: Defects of the chin after Mohs resection of skin cancer are relatively uncommon yet technically challenging. This is due in part from the numerous topographic features and multiple soft-tissue components such as the underlying muscle layers, the well-defined submental crease, and the bony gonion, all of which contribute to the intricacy of the reconstruction. We review our results over an 11-year period to assess the most commonly used closure techniques and to provide a simplified algorithm for closure of chin defects. Materials and Methods: Retrospective chart review. Approval was obtained by the Institutional Review Board of the University of Texas Southwestern Medical Center for this retrospective medical chart review. All patients undergoing reconstruction of chin defects by the senior author (J.T.) following Mohs excisional chemosurgery from 2005–2013 were included. Pre- and postoperative photographs were reviewed in addition to defect size, location, operative technique, and postoperative complications. Photograph consent forms were obtained at the time of surgery. Patients were excluded if the defect involved the lower lip. One patient was excluded for incomplete data. Results: A total of 35 patients were identified over the period in question. There was a wide range with regard to patient age and race. Both sexes were operated on in roughly equal proportions. The average defect size was 4.29 cm (range, 2–15 cm). Linear closure was performed on 26 patients (72%). Other choices for repair included rhombic flaps (n = 3), submental perforator V to Y advancement flaps (n = 3), bilobed flap (n = 1), and rotational flap (n = 1). All patients achieved a good final aesthetic result with complete functional maintenance of the lower lip with no lower lip retractions. Scars were well healed by the second and third follow-up appointments. Conclusion: Optimal chin reconstruction, defined by successful wound closure, careful scar placement, and minimal postoperative complications, may be accomplished by taking advantage of the inherent characteristics of the chin. In most small defects of the chin, primary closure is attainable. In larger defects of the chin, recruitment of flaps from the cervical region is preferred, with preference toward submental island flaps when allowed.
Eye Whitening Using Subconjunctival Injections
Authors: Campion Michael , Campion Robert J. , Campion Vincent M. 
Published: May 2018

Introduction: Recent reports have alerted medical providers about the danger of certain eye whitening procedures that involve a combination of removing generous areas of conjunctiva, cautery, laser, and the later use of antimetabolites. This case report describes an alternative technique using subconjunctival injections. This novel procedure may avoid risks associated with previously described techniques. Materials and Methods: The subconjunctival space was entered and lidocaine 2% with epinephrine was injected. White tattoo ink was then injected into the subconjunctival space and spread throughout with external pressure. The patient was observed as to the appearance, longevity, and tolerance of the ink as well as possible side effects. Results: The ink could be spread easily throughout the eye in a homogeneous fashion and remained visibly apparent throughout the observation period. The patient reported mild transient tearing, light sensitivity, and seepage of ink during the first 5 days, but it quickly abated after that time period. Visual acuity, intraocular pressure, and corneal appearance were unchanged throughout the observation period. The appearance of the eyes postoperatively was consistent for 24 months. Conclusions: The technique of using subconjunctival injections as a means to whiten eye appearance is feasible and avoids the risks associated with previously used techniques.
Learning Together: Facing the Reality of Shared Learning in Health Care
Authors: Jones Lesley , Evans Nici 
Published: May 2018

An exploration of health professionals' perceptions of the concept of shared learning and of the belief that shared learning can improve professional relationships in practice. A shared learning event was arranged as a forum for information exchange within an NHS trust. Ten per cent of total staff (87 people) attended. Questionnaires were completed by the delegates on the day of the event and repeated 10 weeks later. Thematic analysis of the questionnaire data guided the development of an interview schedule for two focus groups, carried out three months later. This paper reports on the findings from the focus group interviews. The main finding is that shared learning events can give health professionals the opportunity to learn about other professionals' roles. Patient-focused, work-based learning within a multi-disciplinary team is the most realistic way of implementing shared interprofessional learning successfully. The paper concludes that shared learning can positively influence effective interprofessional working. However, the focus may need to be on work-based learning opportunities rather than on formal events, thus leading to the promotion of interprofessional learning.
When Learning Comes of Age? Continuing Education into Later Life
Authors: Jackson Sue 
Published: May 2018

It is estimated that in 30 years time nearly half the population of Britain will be over 50. In his introduction to The Learning Age, David Blunkett proclaimed that ‘we must all develop and sustain a regard for learning at whatever age (Blunkett, 1998, my italics). Yet such activity does not extend to higher education, where numbers of students aged over 50 are shamefully low. This paper will begin by outlining a range of issues for older students (aged 50+), whilst recognising differences and diversities between this group of students, not least of which is age, but also including, gender, social class, ethnicity, disability and more. It will move on to raise some key areas for discussion, including ways in which teachers and institutions incorporate, adapt or change pedagogic approaches in order to facilitate and negotiate effective learning for ‘older’ students. Drawing on examples from non-formal learning, it will go on to show how universities can develop effective learning communities for ‘older’ students. It will conclude by emphasising the need for strategies for inclusive learning for older people to be incorporated into both policy and practice, to enable us to move towards a future when learning can come of age.
Hand hygiene: A self reported practice among health care workers in tertiary health institutions in Plateau State, Nige
Authors: Afolaranmi Tolulope , Zuwaira I Hassan , Enoch N Nianglong , Issac I Adem , Azi B Atsi , Kenneth I Onyedibe , Danjuma A Bello 
Published: May 2018

Background: Effective hand hygiene is the simplest proven and most cost effective means of reducing hospital acquired infections both among the health care providers and the receipts of health care services. Hospital acquired infections have currently been identified as one of the challenges of health care delivery worldwide in view of its contribution to morbidity and mortality. Hence, it became imperative to assess the knowledge and practices of hand hygiene as well as its determinant among frontline health care workers in tertiary health institutions in Jos Plateau state Nigeria.Methodology: This was a cross sectional study conducted among 236 health care workers in two tertiary health institutions using quantitative method of data collection. Epi info version 7 was used for data analysis, Chi square test was used with odds ratio as point estimates and 95% confidence interval as the interval estimate. A probability value of less than 0.05 was considered statistically significant.Results: The mean age of the respondents was 37.1 ± 7.2 years while 121 (51.3%) of the respondents had good knowledge of hand hygiene and self reported good hand hygiene practice found among 134 (56.8%) of the health care workers.Conclusion: This study has brought to light the unsatisfactory level of practice of hand hygiene among health workers and the need to urgently provide interventions to addressing it.
Occupational fatigue score and risk of preterm birth
Authors: Bansal Aditi , Surbhi Saini , Srivastava Ankita , Rajoria Lata , Shweta Gangal 
Published: May 2018

The aim of this study was to determine the elements of fatigue in occupations which constitute possible risk factors for the course of a pregnancy, and, in particular, that could cause premature birth. A total of 400 women with singleton pregnancies at ≥ 28 weeks’ gestation were enrolled in the study conducted at the Labor room, Zenana Hospital , Jaipur. Patients reported the number of hours worked per week and answered specific questions designed to determine the following 5 sources of occupational fatigue: posture, work with industrial machines, physical exertion, mental stress, and environmental stress. Fatigue was quantified (0-5 index) according to the number of these sources positively reported. Simple and Mantel-Haenszel χ2 tests were used to test the univariate association and hypothesis of a linear trend between sources of occupational fatigue and spontaneous preterm delivery. Covariables were considered by multivariate logistic regression analysis. Women who did not work outside the home were considered separately from those who worked but did not report any sources of occupational fatigue.Result: women with sternous activity had higher occurrence of preterm birth. 18 % preterm mothers had high occupational fatigue index as compared to 75% term mothers, with p value <0.1,which was significant.
Is the future already here? The impact of climate change on the distribution of the eastern coral snake (Micrurus fulvius)
Authors: Archis Jennifer N. , Akcali Christopher , Stuart Bryan L. , Kikuchi David , Chunco Amanda J. 
Published: May 2018

Anthropogenic climate change is a significant global driver of species distribution change. Although many species have undergone range expansion at their poleward limits, data on several taxonomic groups are still lacking. A common method for studying range shifts is using species distribution models to evaluate current, and predict future, distributions. Notably, many sources of ‘current’ climate data used in species distribution modeling use the years 1950–2000 to calculate climatic averages. However, this does not account for recent (post 2000) climate change. This study examines the influence of climate change on the eastern coral snake (Micrurus fulvius). Specifically, we: (1) identified the current range and suitable environment of M. fulvius in the Southeastern United States, (2) investigated the potential impacts of climate change on the distribution of M. fulvius, and (3) evaluated the utility of future models in predicting recent (2001–2015) records. We used the species distribution modeling program Maxent and compared both current (1950–2000) and future (2050) climate conditions. Future climate models showed a shift in the distribution of suitable habitat across a significant portion of the range; however, results also suggest that much of the Southeastern United States will be outside the range of current conditions, suggesting that there may be no-analog environments in the future. Most strikingly, future models were more effective than the current models at predicting recent records, suggesting that range shifts may already be occurring. These results have implications for both M. fulvius and its Batesian mimics. More broadly, we recommend future Maxent studies consider using future climate data along with current data to better estimate the current distribution.
Impact of a clinical pharmacist–managed clinic in primary care mental health integration at a Veterans Affairs health system
Authors: Herbert Christina , Winkler Holly 
Published: May 2018

Abstract

Introduction:
The demand for mental health (MH) services has increased as more veterans seek MH care. At the South Texas Veterans Health Care System, Primary Care Mental Health Integration (PCMHI) was developed to manage patients with uncomplicated MH conditions, including depression, anxiety, or posttraumatic stress disorder (PTSD), within an interdisciplinary primary care (PC) team that includes clinical pharmacy specialists (CPSs). Pharmacists have improved outcomes and access to care for many chronic medical conditions, but limited data demonstrate the impact of MH pharmacists within PC.

Methods:
This project evaluated the impact of a PCMHI CPS clinic on managing patients with recent antidepressant initiation and CPS clinic intake from September 2015 through December 2016, including follow-up through January 2017. Markers used to evaluate effectiveness of the service included the Patient Health Questionnaire-9 scores, antidepressant medication possession ratio, number of emergency department visits for MH-related concerns, patient engagement in concurrent psychotherapy, and referrals to specialty MH providers.

Results:
A total of 196 unique patients had intake with the PCMHI CPS in the time specified; 172 of these patients were included in analyses. There were 155 patients maintained in PC. Average Patient Health Questionnaire-9 scores decreased from 14.5 to 8.5, with 63 patients (46%) achieving response and 42 patients (31%) achieving remission. The average antidepressant medication possession ratio was 0.93 for all included patients.

Discussion:
A PCMHI CPS successfully manages and maintains patients with uncomplicated MH conditions in PC through evidence-based pharmacotherapy, as evidenced by symptom improvement, medication adherence, and low rate of specialty MH referrals.
Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis
Authors: Bellnier Terrance , Brown Geoffrey W. , Ortega Tulio R. 
Published: May 2018

Abstract

Introduction:
Medical cannabis (MC) is commonly claimed to be an effective treatment for chronic or refractory pain. With interest in MC in the United States growing, as evidenced by the 29 states and 3 US districts that now have public MC programs, the need for clinical evidence supporting this claim has never been greater.

Methods:
This was a retrospective, mirror-image study that investigated MC's effectiveness in patients suffering from chronic pain associated with qualifying conditions for MC in New York State. The primary outcome was to compare European Quality of Life 5 Dimension Questionnaire (EQ-5D) and Pain Quality Assessment Scale (PQAS) scores at baseline and 3 months post-therapy. The secondary outcomes included comparisons of monthly analgesic prescription costs and opioid consumption pre- and post-therapy. Tolerability was assessed by side effect incidence.

Results:
This investigation included 29 subjects. Quality of life and pain improved, measured by change in EQ-5D (Pre 36 – Post 64, P &lt; .0001) and change in PQAS paroxysmal (Pre 6.76 – Post 2.04, P &lt; .0001), surface (Pre 4.20 – Post 1.30, P &lt; .0001), deep (Pre 5.87 – Post 2.03, P &lt; .0001), unpleasant (Pre “miserable” – Post “annoying”, P &lt; .0001). Adverse effects were reported in 10% of subjects.

Discussion:
After 3 months treatment, MC improved quality of life, reduced pain and opioid use, and lead to cost savings. Large randomized clinical trials are warranted to further evaluate the role of MC in the treatment of chronic pain.
Antipsychotic discontinuation after the initiation of selective serotonin reuptake inhibitors therapy for the treatment of behavioral and psychological symptoms associated with dementia
Authors: Mathys Monica , Fang Steven , John Jini , Carter Jasmine 
Published: May 2018

Abstract

Introduction:
Antipsychotics are used off label to treat behavioral and psychological symptoms of dementia (BPSD). Due to the emerging data of selective serotonin reuptake inhibitors (SSRIs) for treatment of BPSD, clinicians may choose to use this medication class instead of antipsychotics when pharmacologic therapy is necessary. The objective of this study was to evaluate the prevalence of antipsychotic discontinuation 6 months after SSRI initiation for the treatment of BPSD.

Methods:
Patients with Alzheimer dementia who were prescribed an antipsychotic and later prescribed an SSRI for BPSD during January 1, 2009, through December 30, 2014, were studied. Exclusion criteria included (1) a dementia diagnosis besides Alzheimer; (2) scheduled benzodiazepines, mood stabilizers, or non-SSRI antidepressant use during the study period; (3) diagnoses of bipolar or psychotic disorders; and (4) diagnosis of delirium during the study period. Patients' age, sex, race, and functional assessment of staging for Alzheimer disease scores were collected. The names, doses, and stop dates of SSRIs and antipsychotics were also recorded.

Results:
Thirty-six patients were included in the analyses. Overall, antipsychotic use was reduced in 11 patients (30.6%). Ten patients (27.8%) discontinued the antipsychotic, and 1 additional patient had a reduction in dose. When comparing specific SSRIs, 8 (72%) responders were prescribed citalopram, and 15 (60%) nonresponders were prescribed sertraline.

Discussion:
Approximately 30% of patients with Alzheimer dementia who were prescribed antipsychotics for BPSD were able to discontinue the medication or had a dose reduction after starting SSRI therapy. Most SSRI responders were prescribed citalopram.
Disilylation of Palladacycles that were Generated through the C−H Activation of Aryl Halides
Authors: Ma Xiaotian , Lu Ailan , Ji Xiaoming , Shi Guangfa , Zhang Yanghui 
Published: May 2018

AbstractThe reactions of various C,C‐palladacycles that were generated through the C−H activation of aryl halides with disilanes have been studied. The reaction of arylnorbornyl palladacycles, which were generated through a Catellani reaction, with hexamethyldisilane proceeded very efficiently to afford disilylated products. Palladacycles that were obtained through the remote C−H activation of aryl halides that contained a styrene moiety with an ether linkage also underwent a disilylation reaction with hexamethyldisilane. Furthermore, the reactions of dibenzopalladacyclopentadienes, which were generated from 2‐iodobiphenyls, with diphenyltetramethyldisilane were also investigated and a range of 2‐iodobiphenyls were disilylated in moderate yields.
Supramolecular Reassembly of Self‐Exfoliated Ionic Covalent Organic Nanosheets for Label‐Free Detection of Double‐Stranded DNA
Authors: Mal Arindam , Mishra Rakesh K. , Praveen Vakayil K. , Khayum M. Abdul , Banerjee Rahul , Ajayaghosh Ayyappanpillai 
Published: May 2018

AbstractIonic covalent organic nanosheets (iCONs), a member of the two‐dimensional (2D) nanomaterials family, offer a unique functional platform for a wide range of applications. Herein, we explore the potential of an ethidium bromide (EB)‐based covalent organic framework (EB‐TFP) that self‐exfoliates in water resulting in 2D ionic covalent organic nanosheets (EB‐TFP‐iCONs) for the selective detection of double‐stranded DNA (dsDNA). In an aqueous medium, the self‐exfoliated EB‐TFP‐iCONs reassemble in the presence of dsDNA resulting in hybrid EB‐TFP‐iCONs‐DNA crystalline nanosheets with enhanced fluorescence at 600 nm. Detailed steady‐state and time‐resolved emission studies revealed that the reassembly phenomenon was highly selective for dsDNA when compared to single‐stranded DNA (ssDNA), which allowed us to use the EB‐TFP‐iCONs as a 2D fluorescent platform for the label‐free detection of complementary DNA strands.
Bifunctional Electrocatalysts for Overall Water Splitting from an Iron/Nickel‐Based Bimetallic Metal–Organic Framework/Dicyandiamide Composite
Authors: Zhao Xiaojia , Pachfule Pradip , Li Shuang , Simke Jan Ron Justin , Schmidt Johannes , Thomas Arne 
Published: May 2018

AbstractPyrolysis of a bimetallic metal–organic framework (MIL‐88‐Fe/Ni)‐dicyandiamide composite yield a Fe and Ni containing carbonaceous material, which is an efficient bifunctional electrocatalyst for overall water splitting. FeNi3 and NiFe2O4 are found as metallic and metal oxide compounds closely embedded in an N‐doped carbon–carbon nanotube matrix. This hybrid catalyst (Fe‐Ni@NC‐CNTs) significantly promotes the charge transfer efficiency and restrains the corrosion of the metallic catalysts, which is shown in a high OER and HER activity with an overpotential of 274 and 202 mV, respectively at 10 mA cm−2 in alkaline solution. When this bifunctional catalyst was further used for H2 and O2 production in an electrochemical water‐splitting unit, it can operate in ambient conditions with a competitive gas production rate of 1.15 and 0.57 μL s−1 for hydrogen and oxygen, respectively, showing its potential for practical applications.
Synthesis of 5‐Cyano‐Tryptophan as a Two‐Dimensional Infrared Spectroscopic Reporter of Structure
Authors: Chalyavi Farzaneh , Gilmartin Philip H. , Schmitz Andrew J. , Fennie Michael W. , Tucker Matthew J. 
Published: May 2018

AbstractA concise synthesis of protected 5‐cyano‐l‐tryptophan (Trp5CN) has been developed for 2D IR spectroscopic investigations within either peptides or proteins. To assess the potential of differently substituted cyano‐tryptophans, several model cyano‐indole systems were characterized using IR spectroscopy. Upon assessment of their spectroscopic properties, Trp5CN was integrated into a model peptide sequence, Trp5CN‐Gly‐Phe4CN, to elucidate its structure. This peptide demonstrates the capability of this probe to capture structural information by 2D IR spectroscopy. The 2D IR spectrum of the peptide in water was simulated to reveal a unique spectral signature resulting from the presence of dipolar coupling. The coupling strength between cyano labels was determined to be 1.4 cm−1 by matching the slopes along the max contour for the simulated and experimental spectrum. Using transition dipole coupling, a distance between the two probes of 13 Å was calculated.
Synthesis of β‐Substituted γ‐Aminobutyric Acid Derivatives through Enantioselective Photoredox Catalysis
Authors: Ma Jiajia , Lin Jiahui , Zhao Lifang , Harms Klaus , Marsch Michael , Xie Xiulan , Meggers Eric 
Published: May 2018

Abstractβ‐Substituted chiral γ‐aminobutyric acids feature important biological activities and are valuable intermediates for the synthesis of pharmaceuticals. Herein, an efficient catalytic enantioselective approach for the synthesis of β‐substituted γ‐aminobutyric acid derivatives through visible‐light‐induced photocatalyst‐free asymmetric radical conjugate additions is reported. Various β‐substituted γ‐aminobutyric acid analogues, including previously inaccessible derivatives containing fluorinated quaternary stereocenters, were obtained in good yields (42–89 %) and with excellent enantioselectivity (90–97 % ee). Synthetically valuable applications were demonstrated by providing straightforward synthetic access to the pharmaceuticals or related bioactive compounds (S)‐pregabalin, (R)‐baclofen, (R)‐rolipram, and (S)‐nebracetam.
Synthesis of Renewable meta‐Xylylenediamine from Biomass‐Derived Furfural
Authors: Scodeller Ivan , Mansouri Samir , Morvan Didier , Muller Eric , de Oliveira Vigier Karine , Wischert Raphael , Jérôme François 
Published: May 2018

AbstractWe report the synthesis of biomass‐derived functionalized aromatic chemicals from furfural, a building block nowadays available in large scale from low‐cost biomass. The scientific strategy relies on a Diels–Alder/aromatization sequence. By controlling the rate of each step, it was possible to produce exclusively the meta aromatic isomer. In particular, through this route, we describe the synthesis of renewably sourced meta‐xylylenediamine (MXD). Transposition of this work to other furfural‐derived chemicals is also discussed and reveals that functionalized biomass‐derived aromatics (benzaldehyde, benzylamine, etc.) can be potentially produced, according to this route.