bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pneumococcal and Legionella Urinary Antigen Tests in Community-acquired Pneumonia: Prospective Evaluation of Indications for Testing
Authors: Bellew Shawna , Grijalva Carlos G , Williams Derek J , Anderson Evan J , Wunderink Richard G , Zhu Yuwei , Waterer Grant W , Bramley Anna M , Jain Seema , Edwards Kathryn M , Self Wesley H 
Published: September 2018

Abstract

Background
Adult, community-acquired pneumonia (CAP) guidelines from the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) include indications for urinary antigen tests (UATs) for Streptococcus pneumoniae (SP) and Legionella pneumophila (LP). These recommendations were based on expert opinions and have not been rigorously evaluated.

Methods
We used data from a multicenter, prospective, surveillance study of adults hospitalized with CAP to evaluate the sensitivity and specificity of the IDSA/ATS UAT indications for identifying patients who test positive. SP and LP UATs were completed on all included patients. Separate analyses were completed for SP and LP, using 2-by-2 contingency tables, comparing the IDSA/ATS indications (UAT recommended vs not recommended) and UAT results (positive vs negative). Additionally, logistic regression was used to evaluate the association of each individual criterion in the IDSA/ATS indications with positive UAT results.

Results
Among 1941 patients, UATs were positive for SP in 81 (4.2%) and for LP in 32 (1.6%). IDSA/ATS indications had 61% sensitivity (95% confidence interval [CI] 49–71%) and 39% specificity (95% CI 37–41%) for SP, and 63% sensitivity (95% CI 44–79%) and 35% specificity (95% CI 33–37%) for LP. No clinical characteristics were strongly associated with positive SP UATs, while features associated with positive LP UATs were hyponatremia, fever, diarrhea, and recent travel.

Conclusions
Recommended indications for SP and LP urinary antigen testing in the IDSA/ATS CAP guidelines have poor sensitivity and specificity for identifying patients with positive tests; future CAP guidelines should consider other strategies for determining which patients should undergo urinary antigen testing.
Colon Surgery Risk With Corticosteroids Versus Immunomodulators or Biologics in Inflammatory Bowel Disease Patients With Clostridium difficile Infection
Authors: Solanky Dipesh , Pardi Darrell S , Loftus Edward V , Khanna Sahil 
Published: September 2018

Abstract

Background
Inflammatory bowel disease (IBD) is an independent risk factor for Clostridium difficile infection (CDI), and CDI often precipitates IBD exacerbation. Because CDI cannot be distinguished clinically from an IBD exacerbation, management is difficult. We aimed to assess factors associated with adverse outcomes in IBD with CDI, including the role of escalating or de-escalating IBD therapy and CDI treatment.

Methods
Records for patients with IBD and CDI from 2008 to 2013 were abstracted for variables including IBD severity before CDI diagnosis, CDI management, subsequent IBD exacerbation, CDI recurrence, and colon surgery. Colon surgery was defined as resection of any colonic segment within 1 year after CDI diagnosis.

Results
We included 137 IBD patients (median age, 46 years; 55% women): 70 with ulcerative colitis (51%), 63 with Crohn’s disease (46%), and 4 with indeterminate colitis (3%). Overall, 70% of CDIs were mild-moderate, 14% were severe, and 15% were severe-complicated. Clostridium difficile infection treatment choice did not vary by infection severity (P = 0.27). Corticosteroid escalation (odds ratio [OR], 5.94; 95% confidence interval [CI], 2.03–17.44) was a positive predictor of colon surgery within 1 year after CDI; older age (OR, 0.09; 95% CI, 0.01–0.44) was a negative predictor. Modifying the corticosteroid regimen did not affect CDI recurrence or risk of future IBD exacerbation. Adverse outcomes did not differ with CDI antibiotic regimens or biologic or immunomodulator regimen modification.

Conclusions
Corticosteroid escalation for IBD during CDI was associated with higher risk of colon surgery. Type of CDI treatment did not influence IBD outcomes. Prospective studies are needed to further elucidate optimal management in this high-risk population.
The utility of spatial model-based estimators of unobserved bycatch
Authors: Stock Brian C , Ward Eric J , Thorson James T , Jannot Jason E , Semmens Brice X 
Published: September 2018

Abstract
Quantifying effects of fishing on non-targeted (bycatch) species is an important management and conservation issue. Bycatch estimates are typically calculated using data collected by on-board observers, but observer programmes are costly and therefore often only cover a small percentage of the fishery. The challenge is then to estimate bycatch for the unobserved fishing activity. The status quo for most fisheries is to assume the ratio of bycatch to effort is constant and multiply this ratio by the effort in the unobserved activity (ratio estimator). We used a dataset with 100% observer coverage, 35 440 hauls from the US west coast groundfish trawl fishery, to evaluate the ratio estimator against methods that utilize fine-scale spatial information: generalized additive models (GAMs) and random forests. Applied to 15 species representing a range of bycatch rates, including spatial locations improved model predictive ability, whereas including effort-associated covariates generally did not. Random forests performed best for all species (lower root mean square error), but were slightly biased (overpredicting total bycatch). Thus, the choice of bycatch estimation method involves a tradeoff between bias and precision, and which method is optimal may depend on the species bycatch rate and how the estimates are to be used.
Mitigating the Gender Gap in the Willingness to Compete: Evidence from a Randomized Field Experiment
Authors: Alan Sule , Ertac Seda 
Published: September 2018

Abstract
We evaluate the impact on competitiveness of a randomized educational intervention that aims to foster grit, a skill that is highly predictive of achievement. The intervention is implemented in elementary schools, and we measure its impact using a dynamic competition task with interim performance feedback. We find that when children are exposed to a worldview that emphasizes the role of effort in achievement and encourages perseverance, the gender gap in the willingness to compete disappears. We show that the elimination of this gap implies significant efficiency gains. We also provide suggestive evidence on a plausible causal mechanism that runs through the positive impact of enhanced grit on girls' optimism about their future performance.
Helium giant stars as progenitors of rapidly fading Type Ibc supernovae
Authors: Kleiser Io , Fuller Jim , Kasen Daniel 
Published: September 2018

ABSTRACT
Type I rapidly fading supernovae (RFSNe) appear to originate from hydrogen-free stars with large radii that produce predominantly shock-cooling light curves, in contrast with more typical $^{56}\rm {Ni}$-rich SNe Ibc. However, it remains to be determined what types of stars would produce bright shock-cooling light curves without significant contribution from radioactive nickel. Bare helium stars in the mass range ${\sim }2\hbox{--}4 \, \rm {M}_\odot$ are known to hydrostatically develop radii as large as 100 $\rm {R}_\odot$ or more due to strong He and C shell burning outside of a core with a sharp density gradient. We produce several such stellar models and demonstrate that, when exploded, these helium giants can naturally produce RFSN light curves. Since many prototypical SNe Ibc should come from large-radius stars in this mass range as well, we predict that these RFSNe may be distinct from SNe Ibc solely due to the absence of substantial $^{56}\rm {Ni}$.
Attitudes toward fertility and fertility preservation in women with glioma
Authors: Stiner Rachel K , Clarke Jennifer L , Sinha Nikita , Chan Jessica , Letourneau Joseph M , Niemasik Erin E , Rabbitt Jane E , Chang Susan M , Butowski Nicholas A , Prados Michael D , Rosen Mitchell P 
Published: September 2018

Abstract

Background
No studies have examined the fertility priorities of women undergoing treatment for their glioma. Glioma patients frequently undergo chemotherapy as part of their treatment; however, it is unknown whether patients truly are aware of its possible effects on their fertility. Our objective was to assess the fertility priorities of glioma patients and ascertain whether female glioma patients are being effectively counseled on the effects of chemotherapy on their fertility prior to beginning treatment.

Methods
The sample was composed of female patients from the Neuro-oncology clinic of the University of California, San Francisco. Participants completed a cross-sectional survey between October 2010 and December 2013 exploring their attitudes toward fertility and their experience with fertility counseling prior to chemotherapy initiation.

Results
Seventy-two women completed the survey. Analysis of the survey results showed that 30% of women receiving chemotherapy reported having a discussion regarding fertility preservation prior to beginning treatment. Of those who reported having this discussion, 80% were aware that chemotherapy could negatively affect their fertility. Many women reported that while fertility preservation was not important to them at the time of diagnosis, it was a priority for them at the time of survey completion. Although interest in having children tended to decrease after cancer treatment, the majority of respondents reported wanting a child after treatment.

Conclusions
The data obtained in this study suggest a lack of understanding of reproductive priorities, which may be addressed with a more comprehensive fertility discussion prior to beginning treatment.
Assessing the Impact of Acupuncture Therapy on Medical Resident Well-being: A Feasibility and Acceptance Study
Authors: Guan Xin , Citkovitz Claudia , Kraus Tzivya , Garcia Alexandra , Kesavan Nasir Meera 
Published: September 2018

PURPOSE:
The aim of this study is to determine the feasibility and acceptability of group auricular acupuncture therapy to address burnout during residency training.

BACKGROUND:
Resident physicians experience high levels of job-related stress and associated symptoms of burnout. Auricular acupuncture has found to be associated with reductions in burnout, secondary traumatic stress and measurements of state and trait anxiety among health care providers.

METHODS:
In this single-arm study, residents of the NYU Brooklyn Campus Ob/Gyn Program were offered three acupuncture treatments over one month. The ProQOL (Professional Quality of Life) instrument was administered before and after each treatment. The residents' scores were calculated using the instrument's three domains: compassion satisfaction (CS), burnout (BO) and secondary traumatic stress (STS). Pre- and post-treatment scores were compared using the Wilcoxon Rank Sum test. A post-treatment survey at 1 week was administered.

RESULTS:
The study included 11 residents. Although the study was not powered for hypothesis testing, post-treatment scores on the ProQOL improved significantly in all domains. Mean CS scores were higher (m=40.35 vs. 37.75, P=.004), while BO and STS were lower (m=24.05 vs. 26.55, P=.002 and m=19.95 vs. 23.2, P<.001, respectively). Eighty percent of the residents responded to the post-treatment survey. All denied negative impacts of the therapy and 80% reported positive impacts. All responded positively to adding acupuncture to the workflow, although 20% would rather have time to relax or do other activities.

DISCUSSION:
Auricular acupuncture therapy was accepted by residents and can be a feasible intervention for reducing burnout in medical residents as measured by the ProQOL instrument.
The Effect of a Shortened OB/GYN Clerkship on Student Performance and Perception of Quality
Authors: Kempner Samantha , Zaidi Nikki , Skinner Bethany , Santen Sally , Hammoud Maya 
Published: September 2018

PURPOSE:
To examine medical student performance and perception of clerkship quality during the shortened, third-year OB/GYN rotation.

BACKGROUND:
As medical school curricula evolve, core clinical clerkships often become shortened to allow more time for career exploration and other professional development. There is conflicting data regarding the impact of duration of clerkships on student performance, and little is known about the impact of shortened clerkships on student satisfaction.

METHODS:
We collected data from NBME subject exam scores and clerkship evaluation scores for third-year clerkships over three academic years. In years 2014-2015 and 2015-2016, students had traditional clerkship lengths. In 2016-2017, clerkship durations were shortened by 25%. Analysis of variance was conducted to examine the effect of academic year on mean NBME scores and student evaluation scores.

RESULTS:
There was no significant difference in mean OB/GYN NBME scores between students participating in the traditional vs. shortened clerkship (mean score 79.7±8.1 in 2014-2015, 79.7±6.8 in 2015-2016, and 79.8±7.0 in 2016-2017; P=.991). Student perception of quality of the OB/GYN clerkship decreased with the shortened clerkships; however, these differences were not statistically significant (4.0±0.9 in 2014-2015, 4.0±0.9 in 2015-2016, and 3.8±0.9 in 2016-2017; P=.074). By comparison, other clerkships experienced an increase in perception of quality over the same time-period.

DISCUSSION:
A shortened OB/GYN student clerkship does not appear to adversely affect objective performance on the rotation; however, medical student perception of quality of the rotation did trend towards lower clerkship scores.
Describing Surgical Skill Learning Curves in OBGYN Residency: A Process Using myTIPreport
Authors: Schuler Kevin , Maetzold Erin , Buys Elizabeth , Galvin Shelley , Connolly AnnaMarie 
Published: September 2018

Faculty Advisor:

Nancy Gaba, MD

PURPOSE:
To describe a process for generating procedural learning curves in OB/GYN Residency.

BACKGROUND:
Most data demonstrating OB/GYN resident surgical proficiency have used operative time as a surrogate for proficiency. The actual number of procedures required to achieve proficiency has not been reported. Our goal was to describe a process for reporting the number of procedures needed to achieve a mean “Supervision Only” rating as reported by faculty using the myTIPreport program.

METHODS:
This descriptive study was a secondary analysis of the myTIPreport database from July 2015–June 2016. For this database, each resident receives a procedure-specific surgical proficiency score, rated 1-5, with surgical proficiency defined as Level 4 (Resident requires “Supervision Only”). Using database time stamps, chronologic case numbers were generated. Fitted Linear Modeling was used to generate an approximate number of cases to achieve this proficiency. To reduce the effect of prior experience influencing the data, only PGY-1 residents were included. To reduce type I error, procedures were examined when at least 100 feedback encounters were reported.

RESULTS:
Of the 1045 intern feedback encounters reported, 2 procedures met inclusion criteria. Using this modeling, PGY-1's needed 13 cesarean deliveries to achieve a mean Level 4 rating. Similarly, 9 procedures were needed for PGY-1 spontaneous deliveries.

DISCUSSION:
A process for reporting surgical skill progression for PGY-1 learners on select procedures was demonstrated using the myTIPreport program. Learner and faculty development tool use may allow for both establishing “learning curves” for other procedures as well as eventually allow for earlier identification and remediation of at-risk learners.
Changing theories on the pathogenesis and risk factors for diverticulitis
Authors: Liner Kristina , Sandor Peter 
Published: September 2018

ABSTRACT
Diverticulitis was thought to be a simple complication of an even simpler disease (diverticulosis), but may in fact result from an entirely new set of complex pathologies. Considering diverticulitis is increasing in annual incidence and becoming more prevalent in younger populations, the implications of appropriate management become more vital than ever. This article reviews old and new understandings of diverticulitis and current recommendations for prevention and clinical management.
Staircase-evoked Pain May be More Sensitive Than Traditional Pain Assessments in Discriminating Analgesic Effects
Authors: Treister Roi , Suzan Erica , Lawal Oluwadolapo D. , Katz Nathaniel P. 
Published: September 2018

Objectives:
Analgesic trials often fail to show a significant effect even when medications with known efficacy are tested. This could be attributed to insufficient assay sensitivity of analgesic trials, which may be due, in part, to the insensitivity of pain-related outcome measures. The aim of this methodological study was to assess the responsiveness of evoked pain generated by the staircase procedure compared with other commonly used pain outcomes in knee osteoarthritis.

Methods:
This was a randomized, double-blind, placebo-controlled, cross-over trial of 1-week treatment of naproxen versus placebo. Participants were assigned to one of the 2 treatment sequences (naproxen-placebo or placebo-naproxen). Pain-at-rest, evoked pain using the Staircase-Evoked Pain Procedure (StEPP), pain diary, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) data were collected before and at the end of each treatment sequence.

Results:
A total of 55 osteoarthritis patients (30 M, 25 F) completed the study. Among all pain assessments, evoked pain was the most sensitive outcome to detect treatment effects, with Standardized Effect Size (SES) of 0.47 followed by the WOMAC and pain-at-rest with SES of 0.43 and 0.36, respectively. Sample size calculations demonstrated that compared with spontaneous pain, the evoked pain model reduces required number of subjects by 40%.

Discussion:
Study results support our hypothesis that evoked pain using the StEPP may demonstrate greater responsiveness to treatment effects compared with traditional pain-related outcome measures. Accordingly, these results may facilitate development and validation of other chronic pain-related evoked pain models, which could contribute to future research and development of new analgesics.
Evaluation of the Neuropathic Component of Chronic Low Back Pain
Authors: Andrasinova Tereza , Kalikova Eva , Kopacik Roman , Srotova Iva , Vlckova Eva , Dusek Ladislav , Bednarik Josef , Adamova Blanka 
Published: September 2018

Objectives:
Assessment of neuropathic pain in chronic low back syndromes is important. However, there is currently no gold standard for its diagnosis. The aim of this observational cross-sectional study was to assess the neuropathic component of pain in various chronic low back pain syndromes using a range of diagnostic tests.

Materials and Methods:
Included in this study were 63 patients with chronic axial low back pain (ALBP), 48 patients with chronic radicular syndromes (CRS) comprising 23 with discogenic compression (CDRS) and 25 with lumbar spinal stenosis (LSS), and 74 controls. PainDETECT questionnaire (PDQ), quantitative sensory testing (QST), and skin biopsy with evaluation of intraepidermal nerve fiber density (IENFD) were used to assess the neuropathic pain component.

Results:
Positive PDQ (≥19) was obtained more frequently in patients with CDRS and LSS (26.1% and 12.0%, respectively) compared with patients with ALBP (1.6%, P<0.001). The proportion of patients with sensory loss confirmed by QST was lowest in the ALBP subgroup (23.8%) compared with CDRS (47.8%), and LSS (68.0%) subgroups (P<0.001). A reduction in IENFD was disclosed in a proportion of up to 52.0% of affected roots in patients with CRS.

Discussion:
Neuropathic pain is quite frequent in CRS, and QST reveals sensory loss as a frequent abnormality in patients with CRS. Using a cut-off value of 19, PDQ identified a neuropathic component in a relatively low proportion of patients with CRS. CRS may be associated with a reduction in IENFD.
Modification of Descending Analgesia in Aging
Authors: Lithfous Ségolène , Després Olivier , Pebayle Thierry , Dufour André 
Published: September 2018

Objective:
Aging has been associated with increases in pain threshold and reductions in tolerance threshold, as well as a deficiency in endogenous pain inhibition. Top-down pain modulation mainly involves the frontal cortex network, which is also one of the most vulnerable brain regions in aging. As the frontal cortex also sustains executive functions, we aimed to determine whether reductions in executive functions subtended by the frontal network are associated with the lack of descending inhibitor control in pain-free elderly participants.

Methods:
Executive functions were assessed in pain-free elderly participants using neuropsychological tests. Endogenous inhibition of pain was investigated using the paradigm of conditioned pain modulation. We compared pain thresholds before and after the conditioned pain modulation procedure in older and younger participants and in seniors with poor and good performances on executive tests.

Results:
Younger participants showed a significant inhibitory effect of phasic pain during prolonged pain stimulation. Older participants with good performance on executive tests showed an absence of inhibiting effect, whereas older participants with poor performance showed a facilitating effect, indicating a significant link between cognitive functions and mechanisms of endogenous inhibition of pain.

Discussion:
These results highlight a significant link between cognitive functions and mechanisms of endogenous inhibition of pain and open new perspectives in investigations of chronic pain in aging.
The Magnitude of Offset Analgesia as a Measure of Endogenous Pain Modulation in Healthy Participants and Patients With Chronic Pain
Authors: Szikszay Tibor M. , Adamczyk Waclaw M. , Luedtke Kerstin 
Published: September 2018

Objective:
Offset analgesia (OA) is a test paradigm increasingly used to estimate endogenous pain modulation characterized by a disproportionally profound analgesia after a small decrease of a heat stimulus. This systematic review and meta-analysis examined the magnitude and difference of OA in healthy participants and chronic pain patients.

Materials and Methods:
Controlled trials, case-control studies, cross-sectional studies, case-series or other observational studies evaluating the effect of a ±1°C offset trial in healthy controls and patients with chronic pain were searched in PubMed, Web of Science, CINAHL, PEDro, PsycINFO, and Cochrane CENTRAL. An additional hand search was conducted. Studies fulfilling the eligibility criteria were independently assessed for methodological quality with the Downs and Black scale by 2 reviewers.

Results:
Twenty-six studies (healthy participants n=758; chronic pain patients n=134) were included in the qualitative synthesis and 12 in meta-analyses (healthy participants n=366; chronic pain patients n=73). A significant difference between offset and constant temperature trials was found for continuous pain intensity rating immediately after a 1°C decrease in temperature (−0.46 [visual analogue scale, 0 to 10]; 95% confidence interval, −0.75 to −0.17; P=0.002), but not after a fixed time period of 5 seconds. Furthermore, a significant difference of the magnitude of OA between chronic pain patients and healthy controls was calculated (−29.9%; 95% confidence interval, −40.3 to −19.5; P<0.00001).

Discussion:
Results indicate that pain-free participants show a larger OA response when rating pain continuously compared with individuals with chronic pain.