bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preparing Interprofessional Faculty to Be Humanistic Mentors for Medical Students: The GW-Gold Mentor Development Program
Authors: Blatt Benjamin , Plack Margaret M. , Simmens Samuel J. 
Published: May 2018

Introduction:
The GW-Gold Humanistic Mentor Development Program addresses the challenge faced by medical schools to educate faculty to prepare students for humanistic practice. Grounded in Branch's Teaching Professional and Humanistic Values model, the program prepares interprofessional faculty mentoring teams in humanistic communities of practice. The teams consist of physician-psychosocial professional pairs, each mentoring a small student group in their professional development course. Through GW-Gold workshops, faculty mentors develop interprofessional humanistic communities of practice, preparing them to lead second such communities with their students. This article describes the program and its evaluation.

Methods:
To assess outcomes and better understand the mentor experience, we used a mixed-method validating triangulation design consisting of simultaneous collection of quantitative (mentor and student surveys) and qualitative (open-ended survey questions and focus group) data. Data were analyzed in parallel and merged at the point of interpretation, allowing for triangulation and validation of outcomes.

Results:
Mentors rated the program highly, gained confidence in their humanistic skills, and received high scores from students. Three themes emerged that validated program design, confirmed outcomes, and expanded on the mentor experience: (1) Interprofessional faculty communities developed through observation, collaboration, reflection, and dialogue; (2) Humanistic mentors created safe environments for student engagement; and (3) Engaging in interprofessional humanistic communities of practice expanded mentors' personal and professional identities.

Discussion:
Outcomes support the value of the GW-Gold program's distinctive features in preparing faculty to sustain humanism in medical education: an interprofessional approach and small communities of practice built on humanistic values.
Joint Hypermobility Classes in 9-Year-Old Children from the General Population and Anxiety Symptoms
Authors: Ezpeleta Lourdes , Navarro José Blas , Osa Núria de la , Penelo Eva , Bulbena Antoni 
Published: May 2018

ABSTRACT:

Objective:
To obtain joint hypermobility classes in children from the general population and to study their characteristics in relation to anxiety measures.

Methods:
A total of 336 nine-year-old children from the general population were clinically assessed through 9 items of hypermobility, and their parents reported about the severity of anxiety symptoms. Latent class analysis was estimated to group the children according to the presence of hypermobility symptoms, and the obtained classes were related to anxiety.

Results:
A 2-class solution, labeled as high hypermobility and low hypermobility, best fitted the data. Children in the high hypermobility group scored higher in separation anxiety, social phobia, physical injury fears, and total anxiety than did those in the low group. When applying the threshold reference scores to the total anxiety score, 7.4% of children in the high hypermobility group versus 6% in the low group were reported to experience clinical elevations on total anxiety.

Conclusion:
High symptoms of hypermobility are associated with higher scores in anxiety symptoms in children from the general population. Children with frequent symptoms of hypermobility may benefit from screening for anxiety symptoms because a subset of them are experiencing clinical elevations and may need comprehensive physical and psychological treatment.
Nurse Satisfaction With Medical Emergency Team Nurses
Authors: Halupa Colleen M. , Halupa Michael S. , Warren Marty S. 
Published: May 2018

Background
This 3-year study measured the satisfaction of staff nurses with medical emergency team (MET) nurse services at a 573-bed hospital in the south from 2015 through 2017. Nurse satisfaction is a key management issue. Barriers to effective MET use can negatively impact patient outcomes, staffing, and nurse turnover.

Objectives
The purpose of this study was to assess nurse satisfaction with MET nurses at a large county hospital in the south over a 3-year period.

Methods
Satisfaction was analyzed by shift, nurse role, the number of times the nurse contacted the MET nurse, and the way in which contact was initiated (MET nurse initiated vs nurse initiated). In addition, nurses responded to open-ended questions.

Results
Nurse satisfaction with MET nurse services was improved with both education and communication over time and stabilized over the 3-year period. More than 95% of nurses were satisfied or very satisfied overall with MET nurse services. There were statistically significant differences in satisfaction by shift worked, nurse role, and method of activation. There were no statistically significant differences by nursing floor.

Discussion
Nurse leaders can consider this MET nurse service as a potential model to help with increasing staff satisfaction, staff engagement, and, potentially, staff retention. More than 95% of nurses were satisfied or very satisfied overall with MET nurse services.
Patient Preferences for the Treatment of Basal Cell Carcinoma: A Mapping Review of Discrete Choice Experiments
Authors: Neal Donald E. , Feit Elea M. , Etzkorn Jeremy R. 
Published: May 2018

BACKGROUND
Treatment options for skin cancer differ in several attributes including efficacy, convenience, cost, scarring, and side effects. Discrete choice experiments (DCEs) provide insight into how patients value the attributes of their treatment options.

OBJECTIVE
To review published DCE data on skin cancer treatment.

METHODS
PubMed database was systematically searched using predefined keyword combinations for articles pertaining to skin cancer treatment and DCEs through October 2017. Three hundred seventy unique article titles were evaluated, and titles that did not mention skin cancer treatment were excluded leaving 44 studies. Abstracts of 44 studies were examined, and studies that used DCEs to query preference for skin cancer treatment were included in this mapping review.

RESULTS
Six articles that used DCEs to query patient preference for skin cancer treatment were reviewed. All DCE studies identified focused on basal cell carcinoma.

CONCLUSION
Discrete choice experiments are a rigorous method of eliciting patient preference for skin cancer surgery. Recurrence was the most important attribute in 4 of the 6 studies reviewed. Appearance was the most important attribute in 1 study and the second most important in 3 studies. Comparisons between studies are limited by the heterogeneity of the treatment attributes and levels included in DCEs.
Mediation of Neighborhood Effects on Adolescent Substance Use by the School and Peer Environments
Authors: Rudolph Kara E. , Sofrygin Oleg , Schmidt Nicole M. , Crowder Rebecca , Glymour M. Maria , Ahern Jennifer , Osypuk Theresa L. 
Published: May 2018

Background:Evidence suggests that aspects of the neighborhood environment may influence risk of problematic drug use among adolescents. Our objective was to examine mediating roles of aspects of the school and peer environments on the effect of receiving a Section 8 housing voucher and using it to move out of public housing on adolescent substance use outcomes.Methods:We used data from the Moving to Opportunity (MTO) experiment that randomized receipt of a Section 8 housing voucher. Hypothesized mediators included school climate, safety, peer drug use, and participation in an after-school sport or club. We applied a doubly robust, semiparametric estimator to longitudinal MTO data to estimate stochastic direct and indirect effects of randomization on cigarette use, marijuana use, and problematic drug use. Stochastic direct and indirect effects differ from natural direct and indirect effects in that they do not require assuming no posttreatment confounder of the mediator–outcome relationship. Such an assumption would be at odds with any causal model that reflects an intervention affecting a mediator and outcome through adherence to treatment assignment.Results:Having friends who use drugs and involvement in after-school sports or clubs partially mediated the effect of housing voucher receipt on adolescent substance use (e.g., stochastic indirect effect 0.45% [95% confidence interval: 0.12%, 0.79%] for having friends who use drugs and 0.04% [95% confidence interval: −0.02%, 0.10%] for involvement in after-school sports or clubs mediating the relationship between housing voucher receipt and marijuana use among boys). However, these mediating effects were small, contributing only fractions of a percent to the effect of voucher receipt on probability of substance use. No school environment variables were mediators.Conclusions:Measured school- and peer-environment variables played little role in mediating the effect of housing voucher receipt on subsequent adolescent substance use.
Transmissibility of Norovirus in Urban Versus Rural Households in a Large Community Outbreak in China
Authors: Tsang Tim K. , Chen Tian-Mu , Longini Ira M. , Halloran M. Elizabeth , Wu Ying , Yang Yang 
Published: May 2018

Background:
Norovirus is a leading cause of outbreaks of acute infectious gastroenteritis worldwide, yet its transmissibility within households and associated risk factors remain unknown in developing countries.

Methods:
Household, demographic, and clinical data were collected from a semi-urban area in south China where an outbreak occurred in the winter of 2014. Using a Bayesian modeling framework, we assessed the transmissibility and potential risk modifiers in both urban and rural households.

Results:
In urban apartment buildings, the secondary attack rates were 84% (95% credible interval [CI] = 60%, 96%) among households of size two and 29% (95% CI = 9.6%, 53%) in larger households. In the rural village, secondary attack rate estimates were lower than the urban setting, 13% (0.51%, 54%) for households of size two and 7.3% (0.38%, 27%) for larger households. Males were 31% (95% CI = 3%, 50%) less susceptible to the disease than female. Water disinfection with chlorine was estimated to reduce environmental risk of infection by 60% (95% CI = 26%, 82%), and case isolation was estimated to reduce person-to-person transmission by 65% (95% CI = 15%, 93%). Nausea and vomiting were not associated with household transmission.

Conclusions:
Norovirus is highly contagious within households, in particular in small households in urban communities. Our results suggest that water disinfection and case isolation are associated with reduction of outbreaks in resource-limited communities.
Evaluation of the Danish AirGIS air pollution modeling system against measured concentrations of PM2.5, PM10, and black carbon
Authors: Hvidtfeldt Ulla Arthur , Ketzel Matthias , Sørensen Mette , Hertel Ole , Khan Jibran , Brandt Jørgen , Raaschou-Nielsen Ole 
Published: May 2018

Background:
Adverse health effects of air pollution have been reported in previous studies with varying methodological approaches to the exposure assessment. Measuring individual air pollution exposure for large-scale epidemiological studies is infeasible, calling for refined modeling tools. We evaluated the performance of the Geographical Information System–based air pollution and human exposure modeling system (AirGIS).

Methods:
Modeled concentrations were evaluated against measured concentrations of particulate matter (PM) less than 10 and 2.5 μm in aerodynamic diameter (PM10/PM2.5) from two fixed-site monitoring stations (background and street) and from two measurement campaigns in Copenhagen, Denmark. Modeled concentrations of black carbon (BC) were evaluated against measured PM2.5 absorbance and PM10 absorbance.

Results:
Mean concentrations measured in the four series were in the range of 10.4–15.3 μg/m3 for PM2.5 and 17.8–25.1 μg/m3 for PM10. The model underestimated by 7%–13% in comparison to the fixed-site monitoring stations. Correlation coefficients of 0.82 and 0.73 were observed for monthly and daily averages of measured and modeled PM2.5 at the background site and, correspondingly, 0.85 and 0.74 at the street site. The spatial variation, as evaluated from the two measurement campaigns, was also well reproduced. Correlation coefficients of 0.77 and 0.79 were observed for BC and PM2.5 absorbance and 0.76 for PM10 absorbance.

Conclusion:
The AirGIS framework showed an overall high degree of accuracy and will be applicable to future epidemiological studies on health effects of PM and BC.
Development of an Enzyme-Linked Immune Sorbent Assay to Measure Nivolumab and Pembrolizumab Serum Concentrations
Authors: Basak Edwin A. , Wijkhuijs Annemarie J. M. , Mathijssen Ron H. J. , Koolen Stijn L. W. , Schreurs Marco W. J. 
Published: May 2018

Background:
Treatment with monoclonal antibodies (mAbs) against programmed cell death protein 1 receptor is subject to high variation in treatment outcome among cancer patients. For these agents, no exposure–response (ER) relationships have been investigated in routine health care settings. However, ER relationships have been identified for several other mAbs used in oncology. Methods to conveniently measure serum concentrations of anti–programmed cell death protein 1 mAbs in routine health care may clarify possible ER relationships. Therefore, the authors aimed to develop an enzyme-linked immune sorbent assay (ELISA) for the measurement of both nivolumab and pembrolizumab serum concentrations of treated cancer patients.

Methods:
Optimal capture antigen and detection antibody concentrations were selected based on titrations. Nivolumab calibration standards ranging from 0.2 to 300 ng/mL were tested in duplicate. Accuracy was assessed in 2 recovery experiments. Intra- and interassay variations were assessed on 3 different days by 2 independent technicians. The developed ELISA was also set up for pembrolizumab calibration curves. Cross-reactivity of nivolumab measurements with ipilimumab was assessed. Of one nivolumab treated patient, serum concentrations in follow up samples were measured and presented.

Results:
Nivolumab calibration standards of 0.20–25 ng/mL were used. Nivolumab trough concentrations after 1 cycle in 8 patients ranged from 17.3 to 31.1 mcg/mL. The range of accuracy was 84%–105%, whereas intra- and interassay variations showed a coefficient of variation of 5.5% and 10.1%, respectively. No cross-reactivity with ipilimumab was detected. Pembrolizumab trough concentrations (n = 8) ranged from 9.1 to 19.7 mcg/mL after 1 infusion.

Conclusions:
The in-house–developed ELISA provides the opportunity to measure both nivolumab and pembrolizumab serum concentrations. This may help identify possible ER relationships in treated cancer patients and may potentially lead to dose adjustments in the future.
Comparison of Epithelium-Off Versus Transepithelial Corneal Collagen Cross-Linking for Keratoconus: A Systematic Review and Meta-Analysis
Authors: Wen Daizong , Song Benhao , Li Qi , Tu Ruixue , Huang Yingying , Wang Qinmei , McAlinden Colm , O'Brart David , Huang Jinhai 
Published: May 2018

Purpose:
To systematically compare standard epithelium-off corneal collagen cross-linking (SCXL) and transepithelial corneal collagen cross-linking (TECXL) for treating keratoconus.

Methods:
PubMed, EMBASE, the Cochrane Library, the US trial registry (ClinicalTrials.gov), VIP Database, Wanfang Databse, and China National Knowledge Infrastructure searches up to February 2017 were conducted. Primary outcomes were changes at 1 year in uncorrected distance visual acuity, maximum keratometry (Kmax), and mean keratometry (mean K). Secondary outcomes were changes at 1 year in corrected distance visual acuity, mean refractive spherical equivalent, central corneal thickness, endothelial cell density, and the occurrence of adverse events.

Results:
Eight studies with a total of 455 eyes were included. For primary outcomes, SCXL showed a greater reduction in mean K [standardized mean difference (SMD) 0.28; 95% confidence interval (CI), 0.03–0.53; P = 0.03] compared with TECXL. Subgroup analysis indicated that SCXL had a comparable effect on reducing mean K with TECXL protocols using chemical enhancers (SMD 0.05; 95% CI, −0.36 to 0.45; P = 0.82) but a greater reduction in mean K compared with TECXL with current iontophoretic protocols (SMD 0.43; 95% CI, 0.10–0.75; P = 0.01). For the other outcomes, there were no statistically significant differences.

Conclusions:
With the exception of less reduction in mean K with current iontophoretic protocols, analysis of the limited number of comparative studies available seems to demonstrate that SCXL and TECXL have a comparable effect on visual, refractive, pachymetric, and endothelial parameters at 1 year after surgery. Further follow-up is required to determine whether these techniques are comparable in the long-term.
Selective deficiencies in descending inhibitory modulation in neuropathic rats: implications for enhancing noradrenergic tone
Authors: Patel Ryan , Qu Chaoling , Xie Jennifer Y. , Porreca Frank , Dickenson Anthony H. 
Published: May 2018

Abstract
Pontine noradrenergic neurones form part of a descending inhibitory system that influences spinal nociceptive processing. Weak or absent descending inhibition is a common feature of chronic pain patients. We examined the extent to which the descending noradrenergic system is tonically active, how control of spinal neuronal excitability is integrated into thalamic relays within sensory-discriminative projection pathways, and how this inhibitory control is altered after nerve injury. In vivo electrophysiology was performed in anaesthetised spinal nerve–ligated (SNL) and sham-operated rats to record from wide dynamic range neurones in the ventral posterolateral thalamus (VPL). In sham rats, spinal block of α2-adrenoceptors with atipamezole resulted in enhanced stimulus-evoked and spontaneous firing in the VPL, and produced conditioned place avoidance. However, in SNL rats, these conditioned avoidance behaviours were absent. Furthermore, inhibitory control of evoked neuronal responses was lost, but spinal atipamezole markedly increased spontaneous firing. Augmenting spinal noradrenergic tone in neuropathic rats with reboxetine, a selective noradrenergic reuptake inhibitor, modestly reinstated inhibitory control of evoked responses in the VPL but had no effect on spontaneous firing. By contrast, clonidine, an α2 agonist, inhibited both evoked and spontaneous firing, and exhibited increased potency in SNL rats compared with sham controls. These data suggest descending noradrenergic inhibitory pathways are tonically active in sham rats. Moreover, in neuropathic states, descending inhibitory control is diminished, but not completely absent, and distinguishes between spontaneous and evoked neuronal activity. These observations may have implications for how analgesics targeting the noradrenergic system provide relief.
Characteristics of Involuntarily Admitted Patients and Treatment Patterns Over a 21-Year Observation Period
Authors: Welte Anna-Sophia , Edlinger Monika , Kemmler Georg , Yalcin-Siedentopf Nursen , Fleischhacker W. Wolfgang , Hofer Alex 
Published: May 2018

Abstract

Background
Patients suffering from psychiatric disorders are often treated in locked psychiatric units owing to psychomotor agitation, hostility and aggressive behavior, or suicidality. Because of legal conditions, investigations of these acutely ill patients are difficult, and many studies do not represent real-life psychiatry. In Austria, admission to a locked psychiatric unit is regulated by a national law for involuntary admission, which came into effect in 1991. The current retrospective study investigated the management of patients who were admitted involuntarily to an academic treatment center after the inauguration of this law.

Methods
Data collection comprised all admissions to a locked unit at the Department of Psychiatry, Psychotherapy and Psychosomatics of the Medical University Innsbruck in the years 1992, 1997, 2002, 2007, and 2012. Demographics, admission diagnosis, current danger posed to self or others, and the initial psychopharmacological intervention were assessed.

Results
The rate of admissions to a locked unit increased significantly throughout the course of the study, and the length of stay decreased from 8.57 days in 1997 to 6.43 days in 2012. Most patients received medication orally. Dosage of antipsychotics and benzodiazepines decreased throughout the investigation period. Self-endangering patients were treated with somewhat (nonsignificantly) higher benzodiazepine and significantly lower antipsychotic mean doses than patients posing danger to others.

Conclusions
Although dosage of medication was reduced, the duration of stay in a locked unit decreased significantly over the investigated years. These findings suggest that a carefully considered pharmacological treatment may be at least as effective as a more aggressive approach.
Multidisciplinary management of oculo-auriculo-vertebral spectrum
Authors: Vong Angela , Funamura Jamie 
Published: May 2018

Purpose of review
Oculo-auriculo-vertebral spectrum (OAVS) is a complex disorder that is represented by wide variations in phenotypic presentation. Recent publications and systematic reviews of the available literature are presented here.

Recent findings
Treatment strategies vary among craniofacial centers across the country. Advances in presurgical planning, virtual surgical planning, and computer-aided manufacturing have been incorporated in the treatment of patients. The psychosocial effect of OAVS with longitudinal follow-up is now being studied.

Summary
Optimal evaluation and management of the OAVS patient requires an awareness of the phenotypic and genetic differences and involves a multidisciplinary team in order to effectively and appropriately diagnose and treat such patients.
Factors Associated With Length of Stay and 30‐Day Revisits in Pediatric Acute Pancreatitis
Authors: Gay Anna C. , Barreto Nicolas B. , Schrager Sheree M. , Russell Christopher J. 
Published: May 2018

ABSTRACTObjective:The objective of the study was to identify factors associated with length of stay (LOS) and 30‐day hospital revisit for patients hospitalized with acute pancreatitis (AP).Method:Multicenter, retrospective cohort study using the Pediatric Health Information System database. Multilevel linear and logistic regression was used to identify factors independently associated with the primary outcome variables of LOS and 30‐day hospital revisit in children aged 1 and 18 years discharged with a primary discharge diagnosis of AP from participating hospitals between 2008 and 2013.Results:For the 7693 discharges, median LOS was 4 days (interquartile range 3–7 days) and 30‐day revisit rate 17.6% (n = 1356). Discharges were primarily girls (55%), Caucasian (46%), and 6 years old or older (85%). On multilevel regression, factors independently associated with both longer LOS and higher revisit odds included malignant and gastrointestinal complex chronic conditions (CCCs) and total parenteral nutrition use while hospitalized. Male gender was associated with both lower LOS (adjusted length of stay = −0.6 days, 95% confidence interval [CI] = −0.8 to −0.4) and decreased revisit odds (aOR 0.85; 95% CI = 0.74 to 0.97). Hispanic ethnicity was associated with increased LOS (adjusted length of stay = +0.8 days, 95% CI = +0.5 to +1.1), but no change in revisit odds.Conclusions:Certain demographic and clinical factors, including gender, ethnicity, and type of CCC, were independently associated with LOS and risk of 30‐day hospital revisit for pediatric AP. Children with malignant and gastrointestinal CCCs who require total parenteral nutrition are at highest risk for both longer LOS and hospital revisit when admitted with AP. These patient populations may benefit from intensive care coordination when hospitalized for AP.