bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing time to pregnancy and facilitating the birth of healthy children through functional analysis of embryo physiology†
Authors: Ferrick Laura , Lee Yee Shan Lisa , Gardner David K 
Published: January 2019

AbstractAn ever-increasing number of couples rely on assisted reproductive technologies (ART) in order to conceive a child. Although advances in embryo culture have led to increases in the success rates of clinical ART, it often takes more than one treatment cycle to conceive a child. Ensuring patients conceive as soon as possible with a healthy embryo is a priority for reproductive medicine. Currently, selection of embryos for transfer relies predominantly on the morphological assessment of the preimplantation embryo; however, morphology is not an absolute link to embryo physiology, nor the health of the resulting child. Non-invasive quantitation of individual embryo physiology, a key regulator of both embryo viability and health, could provide valuable information to assist in the selection of the most viable embryo for transfer, hence reducing the time to pregnancy. Further, according to the Barker Hypothesis, the environment to which a fetus is exposed to during gestation affects subsequent offspring health. If the environment of the preimplantation period is capable of affecting metabolism, which in turn will affect gene expression through the metaboloepigenetic link, then assessment of embryo metabolism should represent an indirect measure of future offspring health. Previously, the term viable embryo has been used in association with the potential of an embryo to establish a pregnancy. Here, we propose the term healthy embryo to reflect the capacity of that embryo to lead to a healthy child and adult.
‘Personal’ troubles and public spaces: the community as a site of care and social action
Authors: Crean Mags 
Published: January 2019

Abstract
The crisis in community development in Ireland has been discussed by community workers, academics and equality experts. This article contributes to this analysis with empirical research encompassing the voice of people living with inequality, including a number of community activists. The research shows how affective relations take precedence in women’s discussions about social class inequality and activism at a community level. Yet, this everyday concern with the affective is not given a legitimate status in academic and political discourse about community development. It is argued that this depoliticization of affective relations is part of the crisis in community development when it fails to incorporate a political analysis of what matters most to people at a community level.
A Novel Olfactometer for Efficient and Flexible Odorant Delivery
Authors: Burton Shawn D , Wipfel Mia , Guo Michael , Eiting Thomas P , Wachowiak Matt 
Published: January 2019

Abstract
Understanding how sensory space maps to neural activity in the olfactory system requires efficiently and flexibly delivering numerous odorants within single experimental preparations. Such delivery is difficult with current olfactometer designs, which typically include limited numbers of stimulus channels and are subject to intertrial and interchannel contamination of odorants. Here, we present a novel olfactometer design that is easily constructed, modular, and capable of delivering an unlimited number of odorants in air with temporal precision and no detectable intertrial or interchannel contamination. The olfactometer further allows for the flexible generation of odorant mixtures and flexible timing of odorant sequences. Odorant delivery from the olfactometer is turbulent but reliable from trial to trial, supporting operant conditioning of mice in an odorant discrimination task and permitting odorants and concentrations to be mapped to neural activity with a level of precision equivalent to that obtained with a flow dilution olfactometer. This novel design thus provides several unique advantages for interrogating olfactory perception and for mapping sensory space to neural activity in the olfactory system.
Long-term outcome of third, fourth and fifth kidney transplantation: technical aspects and immunological challenges
Authors: Benkö Tamas , Halfmann Patrizia , Gäckler Anja , Radünz Sonia , Treckmann Jürgen W , Kaiser Gernot M , Hoyer Dieter P 
Published: January 2019

Abstract

Background
The number of patients on waiting lists for repeated kidney transplantation has increased. However, retransplanted patients have a greater surgical and immunological risk than first-time kidney recipients.

Methods
We retrospectively analysed all kidney recipients that underwent third, fourth or fifth kidney transplantation (Group 3+) at the University Hospital Essen, Essen, Germany from October 1973 to January 2017. A historical cohort of recipients retransplanted with a second kidney (Group 2) served as the control. Donor and recipient demographic data, cold ischaemia time (CIT), warm ischaemia time, overall operation time and methods, transplantectomy of previous kidney grafts, incidence of surgical and immunological complications as well as patient- and death-censored survival were analysed.

Results
We identified 108 recipients transplanted with the third, fourth or fifth renal allograft. Patients with more than one transplantation had significantly higher surgical risk due to atherosclerosis (P = 0.002) and higher immunological risk due to higher panel reactive antibody levels preoperatively (current panel reactive antibody P = 0.004; highest panel reactive antibody value P = 0.0001). Group 3+ patients had more often undergone previous transplant nephrectomy (P = 0.0001). There was a significant difference in CIT (P = 0.009), overall operative time (P = 0.0001) and post-transplantation thrombotic events (P = 0.02). We could not demonstrate any differences in graft and patient survival.

Conclusion
Third, fourth and fifth transplant recipients are a high-risk patient cohort. Our results suggest that patient survival after more than three renal transplantations is similar to that of second graft recipients. This supports the concept of repeated kidney retransplantations.
Fluoroquinolone resistance in carbapenem-resistant Elizabethkingia anophelis: phenotypic and genotypic characteristics of clinical isolates with topoisomerase mutations and comparative genomic analysis
Authors: Jian Ming-Jr , Cheng Yun-Hsiang , Chung Hsing-Yi , Cheng Yu-Hsuan , Yang Hung-Yi , Hsu Chih-Sin , Perng Cherng-Lih , Shang Hung-Sheng 
Published: January 2019

AbstractBackgroundMDR Elizabethkingia anophelis strains are implicated in an increasing number of healthcare-associated infections worldwide, including a recent cluster of E. anophelis infections in the Midwestern USA associated with significant morbidity and mortality. However, there is minimal information on the antimicrobial susceptibilities of E. anophelis strains or their antimicrobial resistance to carbapenems and fluoroquinolones.ObjectivesOur aim was to examine the susceptibilities and genetic profiles of clinical isolates of E. anophelis from our hospital, characterize their carbapenemase genes and production of MBLs, and determine the mechanism of fluoroquinolone resistance.MethodsA total of 115 non-duplicated isolates of E. anophelis were examined. MICs of antimicrobial agents were determined using the Sensititre 96-well broth microdilution panel method. QRDR mutations and MBL genes were identified using PCR. MBL production was screened for using a combined disc test.ResultsAll E. anophelis isolates harboured the blaGOB and blaB genes with resistance to carbapenems. Antibiotic susceptibility testing indicated different resistance patterns to ciprofloxacin and levofloxacin in most isolates. Sequencing analysis confirmed that a concurrent GyrA amino acid substitution (Ser83Ile or Ser83Arg) in the hotspots of respective QRDRs was primarily responsible for high-level ciprofloxacin/levofloxacin resistance. Only one isolate had no mutation but a high fluoroquinolone MIC.ConclusionsOur study identified a strong correlation between antibiotic susceptibility profiles and mechanisms of fluoroquinolone resistance among carbapenem-resistant E. anophelis isolates, providing an important foundation for continued surveillance and epidemiological analyses of emerging E. anophelis opportunistic infections. Minocycline or ciprofloxacin has the potential for treatment of severe E. anophelis infections.
Multilocus phylogeny, species delimitation and biogeography of Iberian valvatiform springsnails (Caenogastropoda: Hydrobiidae), with the description of a new genus
Authors: Delicado Diana , Arconada Beatriz , Aguado Amanda , Ramos Marian A 
Published: January 2019

AbstractValvatiform gastropods of the family Hydrobiidae are frequently found in European spring-fed systems. Their simplified and sometimes convergent morphological structures and restricted geographical ranges make the description and identification of valvatiform species challenging. In the Iberian Peninsula, to date, 20 valvatiform species have been described morphologically. To test morphological species delimitations and to evaluate the role of physical geography on their evolutionary history, we analysed two mitochondrial (COI and 16S rRNA) and two nuclear (28S rRNA and 18S rRNA) gene fragments of 16 valvatiform species from the Iberian Peninsula. Molecular species delimitation methods consistently inferred 11 of the nominal species. Our phylogenetic analyses recovered the species Islamia azarum as an independent lineage, distantly related to other genera, which we place in the new genus Deganta. Furthermore, Iberian valvatiform hydrobiids do not form a monophyletic subunit, but they are included in two distinct clades of Hydrobiidae. Divergence times indicate that speciation in these clades is likely to have coincided with the formation of major Iberian mountain ranges and river basins. Similarities of geographical subdivision and divergent times between this assemblage and the non-valvatiform genus Corrosella provide strong evidence for the role of the Iberian geographical barriers in shaping the biogeography of these springsnails.
Single inhaler maintenance and reliever therapy in pediatric asthma
Authors: Nalin Ug , Stout Sean , Portnoy Jay M. 
Published: January 2019

Purpose of review
Asthma affects more than 25 million people worldwide and continues to grow in prevalence. According to a center for disease control and prevention (CDC) report, the total annual cost of asthma in the United States between 2008 and 2013, including medical care, absenteeism, and mortality, was $81.9 billion. Although the National Institute of Health guidelines recommend fixed inhaled corticosteroid (ICS) dosing, the 2008–2010 Medical Expenditure Panel Survey showed that asthma is still poorly controlled. Single inhaler maintenance and reliever therapy (SMART) offers a possible alternative management plan. This is a review of SMART vs. current treatment guidelines.

Recent findings
SMART addresses variable inflammation with symptom-driven dosing of ICS. It relies on a combination inhaler that has a long-acting β-agonist, which has an immediate onset of action to provide quick relief, in combination with an ICS. Recent studies show that SMART decreases the frequency and severity of asthma exacerbations when compared to fixed ICS dosing. In addition, intermittent use of ICS gave a reduced effect on growth and permitted a lower total amount of ICS to be delivered.

Summary
SMART appears to outperform treatment that is based on current guidelines in the United States. As inhalers capable of being used for SMART are already approved, what is needed is Food and Drug Administration approval of the SMART strategy.
Aligning Delivery System and Training Missions in Academic Medical Centers to Promote High-Value Care
Authors: Gupta Reshma , Sehgal Niraj , Arora Vineet M. 
Published: January 2019

Academic medical centers (AMCs) are transforming to improve their care delivery and learning environments so that they build a culture that fosters high-value care. However, AMCs struggle to create learning environments where trainees are part of the reason for institutional success and their initiatives have high impact and are sustainable. The authors believe that AMCs can reach these goals if they codevelop strategic priorities and provide infrastructure to support alignment between the missions of health delivery systems and graduate medical education (GME).
They outline four steps for AMCs and policy makers to create an infrastructure that supports this alignment to deliver value-based care. First, AMCs can align strategic priorities between delivery systems and educators by creating a common understanding of why initiatives require priorities within the health care system. Second, AMCs can support alignment with data from multiple sources that are reliable, valid, and actionable for trainees. Third, resident initiatives can create sustained impact by linking trainees to the institutional staff and infrastructure supporting value improvement efforts. Fourth, incentive payment programs through medical education could augment current system incentives to propel further alignment between education and delivery systems. The authors support their recommendations with concrete examples from emerging models created by GME and health delivery system leaders at AMCs across the country.
Medical Students’ Perceptions of and Responses to Health Care Disparities During Clinical Clerkships
Authors: Glaser Johanna , Pfeffinger Alana , Quan Judy , Fernandez Alicia 
Published: January 2019

Purpose
To measure the frequency and nature of student-perceived clinician-driven health care disparities, and determine their impact on medical students’ professional development.

Method
Retrospective study of fourth-year medical students at the University of California, San Francisco School of Medicine, August 2016 to June 2017. Conducted via an electronic survey asking about frequency/nature of directly witnessed health care disparities and barriers/facilitators to action during third-year clerkships; and individual, semistructured interviews focusing on clinical details and impact on students’ professional development.

Results
Respondents were 103/159 students (65%). In internal medicine clerkships, a majority perceived disparities as occurring sometimes (2–7 times in eight-week clerkship) or often (at least once weekly or nearly daily) based on language barriers (90%), patients’ homelessness (77%), history of substance abuse (76%), obesity (67%), and race/ethnicity: Latino (72%), black (71%), and Asian (56%). Results from other clerkships were similar. Barriers to student action to perceived disparities included fear of poor evaluations, hierarchy/powerlessness, a “don’t speak up” culture, the desire to be a team player, limited clinical experience, and perceiving doctors as “good people” who provide disparate care unintentionally. Impact on professional development varied, ranging from students’ normalization of disparities as stemming from clinical constraints to increased motivation to provide equitable care.

Conclusions
Medical students routinely witness health care disparities during clerkships, and their observations spotlight specific clinical practices. For some students, these observations lead to a normalization of disparities; for others, they heighten commitment to equity. Clinical curricula should incorporate responding to health care disparities.
Expert Consensus on Inclusion of the Social Determinants of Health in Undergraduate Medical Education Curricula
Authors: Mangold Karen A. , Bartell Tami R. , Doobay-Persaud Ashti A. , Adler Mark D. , Sheehan Karen M. 
Published: January 2019

Purpose
Accreditation bodies have mandated teaching social determinants of health (SDH) to medical students, but there has been limited guidance for educators on what or how to teach, and how to evaluate students’ competence. To fill this gap, this study aimed to develop an SDH curricular consensus guide for teaching SDH to medical students.

Method
In 2017, the authors used a modified Delphi technique to survey an expert panel of educators, researchers, students, and community advocates about knowledge, skills, and attitudes (KSA) and logistics regarding SDH teaching and assessment. They identified the panel and ranked a comprehensive list of topics based on a scoping review of SDH education studies and discussions with key informants. A total of 57 experts were invited.

Results
Twenty-two and 12 panelists participated in Delphi rounds 1 and 2, respectively. The highest-ranked items regarding KSA were “Appreciation that the SDH are some of the root causes of health outcomes and health inequities” and “How to work effectively with community health workers.” The panel achieved consensus that SDH should constitute 29% of the total curriculum and be taught continuously throughout the curriculum. Multiple-choice tests were ranked lowest as an assessment method, and patient feedback was ranked highest. Panelists noted that SDH content must be a part of standardized exams to be prioritized by faculty and students.

Conclusions
An expert panel endorsed essential curricular content, teaching methods, and evaluation approaches that can be used to help guide medical educators regarding SDH curriculum development.
Outcomes of Arthroscopy-assisted Closed Reduction and Percutaneous Pinning for a Displaced Pediatric Lateral Condylar Humeral Fracture
Authors: Kang Michael S. , Alfadhil Rheema A. , Park Soo-Sung 
Published: January 2019

Background:
Since 2015, we have performed arthroscopy-assisted closed reduction and percutaneous pinning (A/S-CRPP) for children with a displaced lateral condylar humeral fracture (LCF). The purpose of this study is to introduce our A/S-CRPP method and present its outcomes.

Methods:
In total, 39 displaced (>2 mm) LCFs for which A/S-CRPP was initially attempted and with available follow-up data of >12 months were retrospectively reviewed. A/S-CRPP is performed in the following order: closed reduction, 1 provisional K-wire fixation, arthroscopic verification of the reduction status, rereduction if needed, and additional fixation. Our reduction technique using articulations of the ulnohumeral and radiohumeral joints and direct compression is introduced. For rereduction, modified reduction forces were applied based on the arthroscopic findings. To evaluate the learning curve effect, the initial 6 months after the first case of A/S-CRPP was regarded as the “initial period.” There were 12 cases during this period.

Results:
Among the 39 cases, surgical method was intraoperatively converted to open reduction and percutaneous pinning in 9 and A/S-CRPP was completed in 30. Among the 9 open reduction and percutaneous pinning conversion cases, 7 conversions occurred in the initial period. Among the 30 patients who underwent A/S-CRPP alone, 10 needed rereduction after an arthroscopic examination. No patients presented with >10-degree angular deformity or elbow motion limited >20 degrees, compared with the contralateral elbow. Postoperative radial nerve palsy occurred in 2 patients, all in the initial period. Both were resolved within 5 months, postoperatively.

Conclusions:
We suggested our A/S-CRPP surgical technique for displaced pediatric LCF. It may require a 6-month learning curve period. Although more studies are needed, it seems to be a safe and appropriate surgical technique for treatment.

Level of Evidence:
Level IV—therapeutic study.
Rare Presentation of a Rare Cutaneous Neoplasm: Nonacral Sclerosing Perineuroma
Authors: Lukach Alexis J. , Donnelly Kevin M. , Cusack Carrie A. 
Published: January 2019

Abstract:
Sclerosing perineuromas are rare, benign peripheral nerve sheath tumors classically reported on the fingers and palms of young men. We present the case of a 12-year-old boy with a slow-growing nodule on his right knee. Excision was performed, and pathology was consistent with a sclerosing perineuroma. This case highlights an atypical presentation of a rare lesion and provides useful knowledge of the clinical scenarios in which sclerosing perineuromas should be included in a differential diagnosis.
The Effect of Optimism and Connectedness on Psychological Adjustment of Children with Cancer and Comparison Peers
Authors: Ehman Anandi C. , Schepers Sasja A. , Phipps Sean 
Published: January 2019

ABSTRACT:

Objective:
The present study aimed to examine the relationship of optimism and connectedness with psychological adjustment outcomes in children with cancer and determine whether these relations differ for children with cancer and comparison peers.

Methods:
Participants were 155 children with cancer and 143 comparison youth without a history of cancer, aged 8 to 17 years at study entry, who were followed longitudinally over a 3-year period. Participants completed self-report measures at 3 time points: baseline optimism at study entry (T1), connectedness at 1 year after baseline (T2), and emotional symptoms at 3 years after baseline (T3). A series of regression analyses were conducted using conditional process analysis to examine whether connectedness mediated the relationship between optimism and psychological adjustment and whether this was moderated by health status (i.e., history of childhood cancer vs no history of cancer or other serious or chronic illness).

Results:
Connectedness to parents, peers, and friends significantly mediated the relationship between optimism and psychological adjustment (b parents = −0.1387, 95% confidence interval [CI] [–0.2341 to −0.0515]; b peers = –0.2021, 95% CI [–0.3575 to −0.0818]; b friends = −0.0703, 95% CI [–0.1640 to −0.0050]). However, this mediation was not significantly moderated by having a history of cancer. Cancer history did moderate the direct relationship between optimism and psychological adjustment and between connectedness to parents and psychological adjustment.

Conclusion:
Findings suggest that patients with cancer are doing remarkably well with regard to adjustment. Connectedness with parents and peers mediates the relationship between optimism and psychological adjustment. As such, children with cancer who are identified as experiencing poor adjustment may benefit from interventions to foster connectedness.