bluuebunny/crossref_metadata_2025_split huggingface dataset:
Molecular filament formation and filament–cloud interaction: Hints from Nobeyama 45 m telescope observations
Authors: Arzoumanian Doris , Shimajiri Yoshito , Inutsuka Shu-ichiro , Inoue Tsuyoshi , Tachihara Kengo 
Published: August 2018

AbstractWe present Nobeyama 45 m telescope C18O, 13CO, and 12CO(1–0) mapping observations towards an interstellar filament in the Taurus molecular cloud. We investigate the gas velocity structure along the filament and in its surrounding parent cloud. The filament is detected in the optically thin C18O emission as a single velocity component with a ∼1 pc long, ∼0.06 pc wide structure. The C18O emission traces dust column densities larger than ∼5 × 1021 cm−2. The line-of-sight (LOS) velocity fluctuates along the filament crest with an average amplitude of ∼0.2 km s−1. The 13CO and 12CO integrated intensity maps show spatially extended emission around the elongated filament. We identify three extended structures with LOS velocities redshifted and blueshifted with respect to the average velocity of the filament identified in C18O. Based on combined analyses of velocity-integrated channel maps and intensity variations of the optically thick 12CO spectra on and off the filament, we propose a three-dimensional structure of the cloud surrounding the filament. We further suggest a multi-interaction scenario where sheet-like extended structures interact, in space and time, with the filament and are responsible for its compression and/or disruption, playing an important role in the star formation history of the filament. We also identify, towards the same field, a very faint filament showing a velocity field compatible with the filament formation process proposed by Inoue et al. (2018, PASJ, 70, S53), where a filament is formed due to convergence of a flow of matter generated by the bending of the ambient magnetic field structure induced by an interstellar shock compression.
Use of Immersive Learning and Simulation Techniques to Teach and Research Opioid Prescribing Practices
Authors: Heirich Marissa S , Sinjary Lanja S , Ziadni Maisa S , Sacks Sandra , Buchanan Alexandra S , Mackey Sean C , Newmark Jordan L 
Published: August 2018

AbstractIntroductionUnsafe opioid prescribing practices to treat acute and chronic pain continue to contribute to the opioid overdose crisis in the United States, a growing public health emergency that harms patients and their communities. Poor opioid prescribing practices stem in part from a lack of education and skills training surrounding pain and opioid management.MethodsAs part of the Clinical Pain Medicine Fellowship at Stanford University, physicians were given the opportunity to participate in a pilot program to practice opioid management in a live, simulated interaction. Twenty-seven physician trainees participated in the simulation with a live, standardized patient actor. Before beginning the simulation, participants were given a detailed patient history that included the patient’s risk for opioid abuse. They were also provided with relevant risk evaluation and mitigation (REM) tools. All simulation interactions were video-recorded and coded by two independent reviewers. A detailed coding scheme was developed before video analysis, and an inter-rater reliability score showed substantial agreement between reviewers.ResultsContrary to expectations, many of the observed performances by trainees contained aspects of unsafe opioid prescribing, given the patient history. Many trainees did not discuss their patient’s aberrant behaviors related to opioids or the patient’s risk for opioid abuse. Marked disparities were also observed between the trainees’ active patient interactions and their written progress notes.DiscussionThis simulation addresses a pressing need to further educate, train, and provide point-of-care tools for providers prescribing opioids. We present our experience and preliminary findings.
The Impact of a National Competency-Based Medical Education Initiative in Family Medicine
Authors: Ellaway Rachel H. , Palacios Mackay Maria , Lee Sonya , Hofmeister Marianna , Malin Greg , Archibald Douglas , Lawrence Katherine , Dogba Joyce , Côté Luc , Ross Shelley 
Published: August 2018

Purpose
Triple C is the Canadian competency-based medical education (CBME) initiative for family medicine. The authors report on a study exploring the impacts Triple C has had across Canada.

Method
A multi-institutional team conducted a realist study to explore the impact of Triple C implementation in different programs across Canada. Data were collected between March and June 2016 from interviews and focus groups with key medical school stakeholders. Data were analyzed using thematic and template analysis techniques.

Results
Data were acquired from 16 of the 17 Canadian medical schools from a combination of program leaders, educators, and trainees. Triple C was implemented in different ways and to different extents depending on context. Newer sites tended to have a more comprehensive implementation than established sites. Urban sites afforded different opportunities to implement Triple C from those afforded by rural sites. Although it was too early to assess its impact on the quality of graduating residents, Triple C was seen as having had a positive impact on identifying and remediating failing learners and on energizing and legitimizing the educational mission in family medicine. Negative impacts included greater costs and tensions in the relationships with other specialties. A principles-based approach to CBME offered flexibility to programs to incorporate variation in their interpretation and implementation of Triple C. Although there was a degree of normalization of practice, it was not standardized across sites or programs.

Conclusions
Triple C has been successfully implemented across Canada but in differing ways and with different impacts.
Iodide Improves Outcome After Acute Myocardial Infarction in Rats and Pigs
Authors: Morrison Michael L. , Iwata Akiko , Keyes Christopher C. , Langston Will , Insko Michael A. , Langdale Lorrie A. , Roth Mark B. 
Published: August 2018

Objectives:
In this study, we tested whether iodide would reduce heart damage in rat and pig models of acute myocardial infarction as a risk analysis for a human trial.

Design:
Prospective blinded and randomized laboratory animal investigation.

Setting:
Animal research laboratories.

Subjects:
Sexually mature rats and pigs.

Interventions:
Acute myocardial infarction was induced by temporary ligation of the coronary artery followed by reperfusion. Iodide was administered orally in rats or IV in rats and pigs just prior to reperfusion.

Measurements and Main Results:
Damage was assessed by blood cardiac troponin and infarct size; heart function was determined by echocardiography. Blood peroxide scavenging activity was measured enzymatically, and blood thyroid hormone was determined using radioimmune assay. Iodide administration preserved heart function and reduced blood cardiac troponin and infarct size by approximately 45% in pigs and approximately 60% in rats. Iodide administration also increased blood peroxide scavenging activity and maintained thyroid hormone levels.

Conclusions:
Iodide administration improved the structure and function of the heart after acute myocardial infarction in rats and pigs.
Influence of Inflammation on the Pharmacokinetics of Perampanel
Authors: Yamamoto Yoshiaki , Takahashi Yukitoshi , Horino Asako , Usui Naotaka , Nishida Takuji , Imai Katsumi , Kagawa Yoshiyuki , Inoue Yushi 
Published: August 2018

Background:
It is well-known that the pharmacokinetics of various drugs are influenced by inflammation. This study evaluated the relationship between C-reactive protein (CRP; an inflammation marker) and the pharmacokinetics of perampanel.

Methods:
Among 111 patients who underwent measurement of both CRP and perampanel, 23 patients had a serum CRP level exceeding 1.5 mg/dL (CRP-positive). We compared the concentration/dose ratio (CD ratio) of perampanel in these 23 patients between the times when they were CRP-positive and CRP-negative. To evaluate the effect of CRP on the CD ratio, multiple regression analysis was performed with the following covariates: CRP-positive status, body weight, and use of phenytoin, carbamazepine, or phenobarbital, and combinations of these drugs.

Results:
In 10 patients using enzyme-inducing antiepileptic drugs (AEDs), the mean CD ratio increased by 53.5% [from 1389 to 2132 (ng/mL)/(mg/kg)] when they were CRP-positive. In 13 patients without enzyme-inducing AEDs, the mean CD ratio increased by 100.8% [from 3826 ng/mL to 7683 (ng/mL)/(mg/kg)] when they were CRP-positive. By multiple regression analysis, the CRP level was a significant independent determinant of the CD ratio of perampanel. Despite a marked increase of the CD ratio, no adverse events were reported.

Conclusions:
Irrespective of concomitant administration of enzyme-inducing AEDs, the serum perampanel concentration showed a marked increase in patients with inflammation. However, this increase was not associated with central nervous system toxicity. Although it is unknown whether the concentration of free and/or bound perampanel was increased, it seems likely that dose reduction is unnecessary for elevation of the serum perampanel level in patients with inflammation.
Mineralocorticoid Receptor Antagonist Utilization in a Nationally Representative Heart Failure With Reduced Ejection Fraction Outpatient Population: A Cross-Sectional Study
Authors: Joyner Kayla Rena , Soric Mate Michael , Boyle Jaclyn Ann , Moorman John Michael , Fredrickson Mary Elizabeth , Turosky Jodie Zlotnik , Kleven Casondra Lee 
Published: August 2018

Background:
Mineralocorticoid receptor antagonists (MRAs) improve survival among patients with heart failure with reduced ejection fraction (HFrEF); however, studies have identified low utilization rates. No study has evaluated the prevalence and predictors of MRA prescribing in a nationally representative outpatient cohort.

Study Question:
What is the prevalence and predictors of MRA prescribing among outpatients with HFrEF in the United States?

Study Design:
A national cross-sectional secondary analysis of the National Ambulatory Medical Care Survey from 2007 to 2014 including all office visits for HFrEF in patients aged >55 years. Office visits involving patients with any history of chronic renal failure and hyperkalemia were excluded.

Measures and Outcomes:
The primary end point was the MRA prescribing rate. Multivariable logistic regression models were created to identify predictors of use.

Results:
In total, 1259 visits were eligible for inclusion, representing more than 30 million visits when weighted. MRAs were initiated or continued in 11.1% of HFrEF visits (95% confidence interval [CI] 8.8–13.8). In the full model, predictors included diabetes mellitus (OR 2.27; 95% CI 1.12–4.61), Northeast region (OR 0.20; 95% CI 0.05–0.74), and ≥4 chronic conditions (OR 0.26; 95% CI 0.10–0.71). Among symptomatic patients, predictors included non-Hispanic black patients (OR 4.55; 95% CI 1.81–11.43), patients aged 65–74 years (OR 3.38; 95% CI 1.53–7.44), and office systolic blood pressure >130 mm Hg (OR 0.31; 95% CI 0.16–0.60). Physician specialty, visit year, patient sex, and payor type were not significant predictors of MRA utilization.

Conclusions:
Although significant data support the use of MRA in HFrEF, utilization is lower than previously estimated.
A Multilevel Approach to Stakeholder Engagement in the Formulation of a Clinical Data Research Network
Authors: Boyer Alaina P. , Fair Alecia M. , Joosten Yvonne A. , Dolor Rowena J. , Williams Neely A. , Sherden Lisa , Stallings Sarah , Smoot Duane T. , Wilkins Consuelo H. 
Published: August 2018

Objectives:
To ensure meaningful engagement of stakeholders (patients, clinicians, and communities) in developing the Mid-South Clinical Data Research Network (MS-CDRN), we implemented a comprehensive, multilevel approach: (1) identify barriers to involving stakeholders in governance, network design, and implementation; (2) engage stakeholders in priority setting and research topic generation; (3) develop strategies to fully integrate stakeholders in CDRN governance and oversight; and (4) solicit guidance on patient-centered tools and strategies for recruiting research participants.

Methods:
We engaged stakeholders: (1) as integral research team members; (2) on oversight and advisory committees; (3) as consultants (using Community Engagement Studios); and (4) through interviews and surveys. We recruited stakeholders from community health centers, churches, barbershops, health fairs, a volunteer registry, and a patient portal. We prioritized recruitment from populations often underrepresented in research.

Results:
During the first 18 months, we engaged 5670 stakeholders in developing the MS-CDRN. These were research team members and on governance committees (N=10), consultants (N=58), survey respondents (N=5543), and interviewees (N=59). Stakeholders identified important barriers and facilitators to engagement, developed stakeholder-informed policies, provided feedback on priority topics and research questions, and developed an intake process for data requests and interventional studies that included reviewing for appropriate patient-centeredness, patient engagement, and dissemination.

Discussion:
Multilevel stakeholder engagement is a novel systematic approach to developing a meaningful patient-centered and patient-engaged research program. This approach allows ongoing input from highly engaged stakeholders while leveraging focused input from larger, more diverse groups to enhance the patient-centeredness of research and increase relevance to broader audiences.
Exploring Meaningful Patient Engagement in ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-term Effectiveness)
Authors: Faulkner Madelaine , Alikhaani Jacqueline , Brown Linda , Cruz Henry , Davidson Desiree , Gregoire Ken , Berdan Lisa , Rorick Ty , Jones W. Schuyler , Pletcher Mark J. 
Published: August 2018

Background:
Genuine patient engagement can improve research relevance, impact and is required for studies using the National Patient-Centered Clinical Research Network including major multicenter research projects. It is unclear, however, how best to integrate patients into governance of such projects.

Methods:
ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-term Effectiveness) is the first major multicenter research project to be conducted in National Patient-Centered Clinical Research Network. Here, we provide a description of how we implemented patient engagement in ADAPTABLE thus far, including a description of committee structures and composition, first-hand patient testimonials, specific contributions, and lessons learned during the planning and early implementation of ADAPTABLE.

Results:
We recruited 1 patient leader from 6 of the 7 enrolling networks to serve on a Patient Review Board for ADAPTABLE, supported the Board with an experienced patient engagement team including an “investigator-advocate” not otherwise involved in the trial, and facilitated bidirectional communication between the Board and ADAPTABLE Coordinating Center. The Board has reviewed and provided substantial input on the informed consent procedure, recruitment materials, patient portal design, and study policy including compensation of participants. Although it was “too late” for some suggested modifications, most modifications suggested by the patient leaders have been implemented, and they are enthusiastic about the study and their role. The patient leaders also attend Steering and Executive Committee calls; these experiences have been somewhat less productive.

Conclusions:
With adequate support, a cadre of committed patient leaders can provide substantial value to design and implementation of a major multicenter clinical trial.
Characteristics of Hepatitis B Virus–associated Hepatocellular Carcinoma in Children
Authors: Mogul Douglas B. , Ling Simon C. , Murray Karen F. , Schwarzenberg Sarah J. , Rudzinski Erin R. , Schwarz Kathleen B. 
Published: August 2018

ABSTRACTIntroduction:Pediatricians and liver specialists in the United States and Canada continue to encounter hepatitis B virus (HBV) infection in high‐risk populations, including unvaccinated children, adopted children, and immigrants. Although hepatocellular carcinoma (HCC) is a known complication of HBV, there exists a paucity of data regarding the clinical presentation of HBV‐associated HCC in children in these countries.Methods:Investigators at 4 medical centers with large numbers of HBV‐positive children queried their pathology and/or oncology databases to identify all cases of HBV‐infected children <18 years old presenting with HCC between 1990 and 2015. Clinical data were extracted from chart review.Results:The group identified 8 patients, 8 to 17 years old, including 6 (75%) males. All individuals were assumed to be infected through vertical transmission. Three (38%) presented initially to the emergency room, 2 (25%) to a general pediatrician, 1 (13%) to a hepatologist, and the initial location was not documented in 2 (25%) cases. Three patients were asymptomatic, but the most common symptoms were abdominal pain (50%) and fatigue (38%). Hepatomegaly was present in 5 (63%) patients. Viral load was not documented in any patient. Only 3 patients had their HBeAg status documented and all individuals were HBeAg(−) and anti‐HBe(+). Aspartate aminotransferase (AST) ranged from 13 to 575 IU/L, and alanine aminotransferase (ALT) ranged from 14 to 212 IU/L; 4 patients had AST and ALT < 1.5 times the upper limit of normal. Three patients had elevated bilirubin and gamma glutamyl transpeptidase (GGT), and 3 had normal bilirubin and GGT; 1 patient had unknown bilirubin and a separate patient had unknown GGT. Alpha‐fetoprotein (AFP) was elevated in 3 patients (range 2.556–7.600 ng/mL), normal in 2 patients, and not documented in 3 patients. Ultrasound was initially used to identify the tumor in 5 patients whereas computerized axial tomography scan was used in 3 patients. Six patients had multiple nodules on initial imaging.Conclusions:Although rare, HBV‐associated HCC occurs in young children, often with normal liver enzymes, bilirubin, GGT, and AFP. Only routine imaging with ultrasound or computerized axial tomography scan consistently identified the tumor. These data may help inform screening for HCC including age of initiation and the role for imaging over laboratory testing.
Longitudinal Growth Outcomes Following First‐line Treatment for Pediatric Patients With Eosinophilic Esophagitis
Authors: Jensen Elizabeth T. , Huang Kevin Z. , Chen Hannah X. , Landes Lisa E. , McConnell Kristen A. , Almond Mary Angie , Safta Anca M. , Johnston Douglas T. , Durban Raquel , Jobe Laura , Frost Carrie , Donnelly Sarah , Antonio Brady , Quiros Antonio , Markowitz Jonathan E. , Dellon Evan S. 
Published: August 2018

ABSTRACTObjectives:No formal comparative effectiveness studies have been conducted to evaluate the effect of eosinophilic esophagitis (EoE) treatment choice on long‐term growth in pediatric patients. Long‐term studies of inhaled corticoid steroids in asthma, however, suggest possible effects on linear growth. The aim of this study was to compare longitudinal, anthropometric growth in children with EoE according to treatment approach.Methods:We conducted a retrospective, multicenter cohort study of anthropometric growth (height and body mass index [BMI] z scores) in pediatric (<18 years of age) patients newly diagnosed with EoE across 5 clinical sites between 2005 and 2014. We compared differences in growth according to treatment approach over a 12‐month period. Modification by sex and age was examined and sensitivity analyses were conducted to assess robustness of results given study assumptions.Results:In the 409 patients identified, the mean age and proportion male differed by treatment (P = < 0.01 and P = 0.04, respectively). Baseline growth measures were associated with slight impairment of height at diagnosis (median baseline height z score of −0.1 [interquartile range −0.9, 0.8]). In general, treatment approach was not associated with any significant increase or decrease in expected growth over a 12‐month period. Subtle decrease in linear growth was observed with treatment using a combined elemental and topical steroid (Δ height z score [adjusted]: −0.04; 95% confidence interval [CI]: −0.08, −0.01). Differences in linear growth differed by sex (P for interaction <0.01). For elemental formula in combination with topical steroids, only girls exhibited a significant decline in linear growth (Δ height z score [adjusted]: −0.24; 95% CI: −0.32, −0.17). A slight reduction in BMI was observed for patients treated with a combination of elemental diet and dietary elimination (Δ BMI z score [adjusted]: −0.07; 95% CI: −0.13, −0.01).Conclusions:Treatment of EoE, in general, is not associated with major anthropometric growth changes in most pediatric patients. Slight linear growth impairment was observed for topical steroid treatment, and sex differences in growth by treatment approach were observed. Future prospective studies should evaluate the effect of treatment on optimal growth and development and over a longer period of follow‐up.
Pilonidal Disease
Authors: Vartanian Emma , Daniel J. Gould , Lee Sang W. , Patel Ketan 
Published: August 2018

Background
Pilonidal disease (PD) is a recalcitrant condition associated with significant morbidity. It affects 26 in 100,000 individuals; however, there is no consensus on optimal surgical treatment, and up to half of patients struggle with recurrence. This review appraises the current literature on techniques and outcomes of PD surgery, to better guide decision making.

Methods
A literature review using directed search terms was performed to identify studies addressing PD management, in accordance with the PRISMA guidelines. Data on techniques, outcomes, and complications were collected.

Results
Open healing remains the most widely used treatment method and achieves reliable outcomes at the expense of prolonged wound healing, between 21 and 71 days. Asymmetric closure reduces healing time to 10 to 23 days and produces significantly fewer recurrences relative to midline closure (P < 0.05). Outcomes are similar between various asymmetric techniques; the Bascom cleft lift, Karydakis flap, and Limberg transposition are commonly used approaches which all demonstrate recurrence rates under 6%. Deroofing is associated with a significantly lower rate of complications than any closure procedure at 1.4% (P < 0.05), with recurrence in only 1% to 10% of patients, and represents a favorable treatment alternative.

Conclusions
Despite the heterogeneous nature of studies on PD, certain techniques have been consistently shown to optimize postoperative outcomes. Deroofing sinuses and allowing secondary healing results in low rates of recurrence with minimal morbidity. When closure is preferred, off-midline flaps provide more effective coverage than midline repair. Treatment recommendations should be guided by individualized patient preferences and be grounded in high-quality data.