bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Academic Relative Value Unit System for Incentivizing the Academic Productivity of Surgery Faculty Members
Authors: LeMaire Scott A. , Trautner Barbara W. , Ramamurthy Uma , Green Susan Y. , Zhang Qianzi , Fisher William E. , Rosengart Todd K. 
Published: July 2018

Objective:
The objective of this study was to evaluate a new academic relative-value unit (aRVU) scoring system linked to faculty compensation and analyze its association with overall departmental academic productivity.

Summary Background Data:
Faculty are often not incentivized or financially compensated for educational and research activities crucial to the academic mission.

Methods:
We launched an online, self-reporting aRVU system in 2015 to document and incentivize the academic productivity of our faculty. The system captured 65 specific weighted scores in 5 major categories of research, education, innovation, academic service, and peer review activities. The aRVU scores were rank-aggregated annually, and bonuses were distributed to faculty members in 3 tiers: top 10%, top third, and top half. We compared pre-aRVU (academic year 2015) to post-aRVU (academic year 2017) departmental achievement metrics.

Results:
Since 2015, annual aRVU bonuses totaling $493,900 were awarded to 59 faculty members (58% of eligible department faculty). Implementing aRVUs was associated with significant increases in several key departmental academic achievement metrics: presentations (579 to 862; P = 0.02; 49% increase), publications (390 to 446; P = 0.02; 14%), total research funding ($4.6 M to $8.4 M; P < 0.001; 83%), NIH funding ($0.6 M to $3.4 M; P < 0.001; 467%), industry-sponsored clinical trials (8 to 23; P = 0.002; 188%), academic society committee positions (226 to 298; P < 0.001; 32%), and editorial leadership positions (50 to 74; P = 0.01; 48%).

Conclusions:
Implementing an aRVU system was associated with increases in departmental academic productivity. Although other factors undoubtedly contributed to these increases, an aRVU program may represent an important mechanism for tracking and rewarding academic productivity in surgery departments.
Hyperthyroidism is Underdiagnosed and Undertreated in 3336 Patients
Authors: Asban Ammar , Chung Sebastian K. , Tresler Margaret A. , Huilgol Priyanka , Xie Rongbing , Kirklin James K. , Balentine Courtney J. , Lindeman Brenessa M. , Chen Herbert 
Published: July 2018

Objective:
The aim of this study was to determine the prevalence of undiagnosed and untreated hyperthyroidism among patients with suppressed thyroid-stimulating hormone (TSH).

Background:
Hyperthyroidism can significantly diminish patient quality of life and increase the financial burden on patients and health systems. We hypothesized that many patients with hyperthyroidism remain undiagnosed because physicians fail to recognize and evaluate suppressed TSH as the first indication of disease.

Methods:
We reviewed administrative data on 174011 patients with TSH measured at a tertiary referral center between 2011 and 2017 to identify individuals with hyperthyroidism (TSH <0.05 mU/L) and their subsequent outcomes: evaluation (measurement of T4, T3, radioactive iodine (RAI) uptake scan, thyroid-stimulating immunoglobulin, thyroid peroxidase antibodies) diagnosis, referral and treatment. We used Kaplan-Meier methods and multivariable time-related parametric hazard modeling to measure our outcomes.

Results:
We found 3336 patients with hyperthyroidism. The mean age of our cohort was 52 ± 17 years, with 79% females and 59% whites. Only 1088 patients (33%) received any appropriate evaluation and hyperthyroidism remained undiagnosed in 37% of patients who had the appropriate workup. Among those diagnosed with hyperthyroidism, only 21% were referred for surgery and 34% received RAI. Predictors for hyperthyroidism diagnosis include lower TSH (0.01u/L), younger age, African-American race, private commercial insurance, being seen in an outpatient setting, absence of medical comorbidities, presentation with ophthalmopathy, or weight loss.

Conclusions:
Hyperthyroidism is frequently unrecognized and untreated, which can lead to adverse outcomes and increased costs. Improved systems for detection and treatment of hyperthyroidism are needed to address this gap in care.
IdeS (Imlifidase): A Novel Agent That Cleaves Human IgG and Permits Successful Kidney Transplantation Across High-strength Donor-specific Antibody
Authors: Lonze Bonnie E. , Tatapudi Vasishta S. , Weldon Elaina P. , Min Elijah S. , Ali Nicole M. , Deterville Cecilia L. , Gelb Bruce E. , Benstein Judith A. , Dagher Nabil N. , Wu Ming , Montgomery Robert A. 
Published: July 2018

Objectives:
The presence of a donor-specific positive crossmatch has been considered to be a contraindication to kidney transplantation because of the risk of hyperacute rejection. Desensitization is the process of removing hazardous preformed donor-specific antibody (DSA) in order to safely proceed with transplant. Traditionally, this involves plasmapheresis and intravenous immune globulin treatments that occur over days to weeks, and has been feasible when there is a living donor and the date of the transplant is known, allowing time for pre-emptive treatments. For sensitized patients without a living donor, transplantation has been historically difficult.

Summary of Background Data:
IdeS (imlifidase) is an endopeptidase derived from Streptococcus pyogenes which has specificity for human IgG, and when infused intravenously results in rapid cleavage of IgG.

Methods:
Here we present our single-center's experience with 7 highly sensitized (cPRA98–100%) kidney transplant candidates who had DSA resulting in positive crossmatches with their donors (5 deceased, 2 living) who received IdeS within 24 hours prior to transplant.

Results:
All pre-IdeS crossmatches were positive and would have been prohibitive for transplantation. All crossmatches became negative post-IdeS and the patients underwent successful transplantation. Three patients had DSA rebound and antibody-mediated rejection, which responded to standard of care therapies. Three patients had delayed graft function, which ultimately resolved. No serious adverse events were associated with IdeS. All patients have functioning renal allografts at a median follow-up of 235 days.

Conclusion:
IdeS may represent a groundbreaking new method of desensitization for patients who otherwise might have no hope for receiving a lifesaving transplant.
Per-oral Pyloromyotomy (POP) for Medically Refractory Gastroparesis
Authors: Rodriguez John , Strong Andrew T. , Haskins Ivy N. , Landreneau Joshua P. , Allemang Matthew T. , El-Hayek Kevin , Villamere James , Tu Chao , Cline Michael S. , Kroh Matthew , Ponsky Jeffrey L. 
Published: July 2018

Objective:
For patients with gastroparesis, temporary pyloric disruption has been shown to improve symptoms and gastric emptying. Per-oral pyloromyotomy (POP) is an innovative endoscopic procedure to divide the pylorus from within a submucosal tunnel, as a corollary to surgical pyloromyotomy. Here we evaluate subjective and objective outcomes 12-weeks after POP at a high volume center.

Methods:
The first 100 consecutive patients undergoing POP were included, with procedure dates between January 2016 and October 2017. Patients were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and 4-hour solid-phase scintigraphic gastric emptying studies (GES) prior to procedure and at 90 days post-POP

Results:
The study cohort was 85% female with a mean age of 45.0 ± 14.6 years. Gastroparesis etiologies were divided among idiopathic (56%), diabetic (21%), postsurgical (19%), and other in 4%. There were 67% of the patients who had previous endoscopic or surgical interventions for gastroparesis. Most POP procedures were performed in the operating room (97%) and were completed in an average of 33 minutes. Ten patients incurred complications (10%), which included 1 diagnostic laparoscopy and 2 cases of gastrointestinal bleeding. Overall GCSI improved from a preoperative mean of 3.82 ± 0.86 to 2.54 ± 1.2 (P < 0.001). The improvement in each GCSI subscore was also highly statistically significant. Among the patients with postoperative GES available, 78% had objectively better 4-hour emptying with a mean improvement in retention by 23.6% (P < 0.001). This included 57% of patients with normal gastric emptying post-POP.

Conclusion:
For patients with medically refractory gastroparesis, POP results in both subjective and objective improvement in the majority of patients. Prior intervention does not obviate POP as a therapeutic option. POP should be included along the treatment algorithm for patients with gastroparesis as an organ-sparing procedure.
Timing of Carotid Endarterectomy After Stroke
Authors: Tanious Adam , Pothof Alexander B. , Boitano Laura T. , Pendleton Alaska A. , Wang Linda J. , de Borst Gert J. , Rattner David W. , Schermerhorn Marc L. , Eslami Mohammad H. , Malas Mahmoud B. , Eagleton Matthew J. , Clouse William Darrin , Conrad Mark F. 
Published: July 2018

Objective:
Our objective was to identify the postoperative risk associated with different timing intervals of repair.

Background:
Timing of carotid intervention in poststroke patients is widely debated with the scales balanced between increased periprocedural risk and recurrent neurologic event. National database reviews show increased risk to patients treated within the first 2 days of a neurologic event compared to those treated after 6 days.

Methods:
Utilizing Vascular Quality Initiative data, all carotid interventions performed on stroke patients between the years 2012 and 2017 were queried. Patients were then stratified based on the timing of surgery from their stroke (<48 hours, 3–7 days, 8–14 days, >15 days). Major outcomes included postoperative stroke, death, and myocardial infarction.

Results:
A total of 8404 patients were included being predominantly men (5281, 62.8%), with an average age of 69 (±10). Patients treated at greater than 8 days showed significantly less risk of postoperative combined stroke/death and postoperative stroke. There were no significant differences in postoperative stroke or death between the 8 to 14 and greater than 15 days groups.
Multivariate regression analysis showed that delayed timing of surgery between 3 and 7 days was protective for postoperative stroke/death (P = 0.003) and any postoperative complication (P = 0.028). Delaying surgery to more than 8 days after stroke was protective for postoperative stroke/death (P < 0.001), postoperative stroke (P < 0.001), and any postoperative complication (P < 0.001).

Conclusions:
Carotid revascularization should occur no sooner than 48 hours after index stroke event. Surgeons should strive to operate between 8 and 14 days to protect against postoperative stroke/death.
Ensuring Equity, Diversity, and Inclusion in Academic Surgery
Authors: West Michaela A. , Hwang Shelley , Maier Ronald V. , Ahuja Nita , Angelos Peter , Bass Barbara L. , Brasel Karen J. , Chen Herbert , Davis Kimberly A. , Eberlein Timothy J. , Fong Yuman , Greenberg Caprice C. , Lillemoe Keith D. , McCarthy Mary C. , Michelassi Fabrizio , Numann Patricia J. , Parangi Sareh , Reyes Jorge D. , Sanfey Hilary A. , Stain Steven C. , Weigel Ronald J. , Wren Sherry M. 
Published: July 2018

Objective:
The leadership of the American Surgical Association (ASA) appointed a Task Force to objectively address issues related to equity, diversity, and inclusion with the discipline of academic surgery.

Summary of Background Data:
Surgeons and the discipline of surgery, particularly academic surgery, have a tradition of leadership both in medicine and society. Currently, we are being challenged to harness our innate curiosity, hard work, and perseverance to address the historically significant deficiencies within our field in the areas of diversity, equity, and inclusion.

Methods:
The ASA leadership requested members to volunteer to serve on a Task Force to comprehensively address equity, diversity, and inclusion in academic surgery. Nine work groups reviewed the current literature, performed primary qualitative interviews, and distilled available guidelines and published primary source materials. A work product was created and published on the ASA Website and made available to the public. The full work product was summarized into this White Paper.

Results:
The ASA has produced a handbook entitled: Ensuring Equity, Diversity, and Inclusion in Academic Surgery, which identifies issues and challenges, and develops a set of solutions and benchmarks to aid the academic surgical community in achieving these goals.

Conclusion:
Surgery must identify areas for improvement and work iteratively to address and correct past deficiencies. This requires honest and ongoing identification and correction of implicit and explicit biases. Increasing diversity in our departments, residencies, and universities will improve patient care, enhance productivity, augment community connections, and achieve our most fundamental ambition—doing good for our patients.
Insurance Status Biases Trauma-system Utilization and Appropriate Interfacility Transfer
Authors: Zogg Cheryl K. , Schuster Kevin M. , Maung Adrian A. , Davis Kimberly A. 
Published: July 2018

Objective:To identify the association between insurance status and the probability of emergency department admission versus transfer for patients with major injuries (Injury Severity Score >15) and other complex trauma likely to require higher-level trauma center (TC) care across the spectrum of TC care.Background:Trauma systems were developed to facilitate direct transport and transfer of patients with major/complex traumatic injuries to designated TCs. Emerging literature suggests that uninsured patients are more likely to be transferred.Methods:Nationally weighted Nationwide Emergency Department Sample (2010–2014) and longitudinal California State Inpatient Databases/State Emergency Department Databases (2009–2011) data identified adult (18–64 yr), pediatric (≤17 yr), and older adult (≥65 yr) trauma patients. Risk-adjusted multilevel (mixed-effects) logistic regression determined differences in the relative odds of direct admission versus transfer and outcome measures based on initial level of TC presentation.Results:In all 3 age groups, insured patients were more likely to be admitted [eg, nontrauma center (NTC) private vs uninsured odds ratio (95% confidence interval): adult 1.54 (1.40–1.70), pediatric 1.95(1.45–2.61)]. The trend persisted within levels III and II TCs (eg, level II private vs uninsured adult 1.83 (1.30–2.57)] and among other forms of trauma likely to require transfer. At the state level, among transferred NTC patients, 28.5% (adult), 34.1% (pediatric), and 39.5% (older adult) of patients with major injuries were not transferred to level I/II TCs. An additional 44.3% (adult), 50.9% (pediatric), and 57.6% (older adult) of all NTC patients were never transferred. Directly admitted patients experienced higher morbidity [adult: 19.6% vs 8.2%, odds ratio (95% confidence interval):2.74 (2.17–3.46)] and mortality [3.3% vs 1.8%, 1.85 (1.13–3.04)].Conclusions:Insured patients with significant injuries initially evaluated at NTCs and level III/II TCs were less likely to be transferred. Such a finding appears to result in less optimal trauma care for better-insured patients and questions the success of transfer-guideline implementation.
A Prospective Observational Study of Hypogammaglobulinemia in the First Year After Lung Transplantation
Authors: Petrov Andrej A. , Traister Russell S. , Crespo Maria M. , Silveira Fernanda P. , Xie Maylene , Coffey Kara , Ensor Christopher R. , Landsittel Douglass , Pilewski Joseph M. 
Published: July 2018

Background
Immunosuppressive therapies have led to improved survival for lung transplant (LT) recipients but these therapies can lead to hypogammaglobulinemia (HGG) and potentially an increased risk of infection. Large prospective studies have not been performed to evaluate the impact of HGG on outcomes for LT recipients.

Methods
This is a single-center prospective observational study of LT recipients. Pretransplant and posttransplant IgG levels were measured and related to infection, rejection, antibiotic use, and immunosuppression use.

Results
One hundred thirty-three LT recipients were prospectively evaluated. Pretransplant IgG values were higher than IgG values at the time of transplant or any time thereafter (all P < 0.0001). Severe HGG (IgG < 400 mg/dL) was highest at the time of transplant (32.4%) while at 3, 6, 9, and 12 months posttransplant the prevalence of severe HGG was 7.4%, 7.5%, 8.9%, and 6.3%, respectively. Severe HGG was associated with 2 or more pneumonias (P = 0.0006) and increased number of antibiotic courses (P = 0.003) compared with the subjects without severe HGG. Pretransplant IgG level and less than 30% of pretransplant protective pneumococcal antibody levels were identified as pretransplant risk factors for severe HGG. In multivariate analysis, chronic obstructive pulmonary disease as the underlying disease and the use of basiliximab as the induction agent in conjunction with higher prednisone and mycophenolate dosing were most predictive of severe HGG (P = 0.005), whereas the combination of age, severe HGG and number of acute steroid courses were most predictive of total days of pneumonia (P = 0.0001).

Conclusions
Our large prospective study identifies risk factors for severe HGG after LT and demonstrates that LT recipients with severe HGG are at increased risk for recurrent pneumonias and more antibiotic courses.
Pimavanserin for Psychotic Symptoms in People With Parkinsonism: A Second Chart Review
Authors: Friedman Joseph H. 
Published: July 2018

Introduction
Pimavanserin (Pim) is a 5HT2A inverse agonist that is the only Food and Drug Administration–approved treatment for Parkinson disease (PD) psychosis. The published open-label experience is limited.

Methods
This report is a chart review of all patients who were started on the drugs since the one earlier report on 15 patients. All patients were included, whether or not they completed 6 weeks of treatment, the time required for maximum benefit found in the published phase 3 trial.

Results
Twenty-six patients are reported. Three patients had dementia with Lewy bodies; one had an atypical parkinsonism; 22 had PD, including one with schizophrenia and neuroleptic exacerbated, dopamine transporter scan–positive idiopathic PD; and another had PD complicated by strokes. Six stopped before 6 weeks due to adverse effects, including 1 with worsened psychosis. Eighteen completed at least 6 weeks of treatment. Of these, 3 stopped due to lack of efficacy and 3 due to worsened psychosis. Twelve found it helpful. Of the 18 who took Pim for at least 6 weeks, 12 improved and continue to take it.

Conclusions
Almost 50% of parkinsonian patients with psychotic symptoms found Pim to be a useful medication, which they continue to take. Reasons for intolerance varied and were thought to be unrelated to the drug.
Connectivity and network state-dependent recruitment of long-range VIP-GABAergic neurons in the mouse hippocampus
Authors: Francavilla Ruggiero , Villette Vincent , Luo Xiao , Chamberland Simon , Muñoz-Pino Einer , Camiré Olivier , Wagner Kristina , Kis Viktor , Somogyi Peter , Topolnik Lisa 
Published: July 2018

AbstractGABAergic interneurons in the hippocampus provide for local and long-distance coordination of neurons in functionally connected areas. Vasoactive intestinal peptide-expressing (VIP+) interneurons occupy a distinct niche in circuitry as many of them specialize in innervating GABAergic cells, thus providing network disinhibition. In the CA1 hippocampus, VIP+ interneuron-selective cells target local interneurons. Here, we discovered a novel type of VIP+ neuron whose axon innervates CA1 and also projects to the subiculum (VIP-LRPs). VIP-LRPs showed specific molecular properties and targeted interneurons within the CA1 area but both interneurons and pyramidal cells within subiculum. They were interconnected through gap junctions but demonstrated sparse spike coupling in vitro. In awake mice, VIP-LRPs decreased their activity during theta-run epochs and were more active during quiet wakefulness but not coupled to sharp-wave ripples. Together, the data provide new evidence for VIP interneuron molecular diversity and functional specialization in controlling cell ensembles along the hippocampo-subicular axis.
Next Generation-Targeted Amplicon Sequencing (NG-TAS): An optimised protocol and computational pipeline for cost-effective profiling of circulating tumour DNA
Authors: Gao Meiling , Callari Maurizio , Beddowes Emma , Sammut Stephen-John , Grzelak Marta , Biggs Heather , Jones Linda , Boumertit Abdelhamid , Linn Sabine C , Cortes Javier , Oliveira Mafalda , Baird Richard , Chin Suet-Feung , Caldas Carlos 
Published: July 2018

AbstractCirculating tumour DNA (ctDNA) detection and monitoring has enormous potential clinical utility in oncology. We describe here a fast, flexible and cost-effective method to profile multiple genes simultaneously in low input cell-free DNA (cfDNA): Next Generation-Targeted Amplicon Sequencing (NG-TAS). We designed a panel of 377 amplicons spanning 20 cancer genes and tested the NG-TAS pipeline using cell-free DNA from two hapmap lymphoblastoid cell lines. NG-TAS consistently detected mutations in cfDNA when mutation allele fraction was >1%. We applied NG-TAS to a clinical cohort of metastatic breast cancer patients, demonstrating its potential in monitoring the disease. The computational pipeline is available at: https://github.com/cclab-brca/NGTAS_pipeline.
SLIC-CAGE: high-resolution transcription start site mapping using nanogram-levels of total RNA
Authors: Cvetesic Nevena , Leitch Harry G. , Borkowska Malgorzata , Müller Ferenc , Carninci Piero , Hajkova Petra , Lenhard Boris 
Published: July 2018

ABSTRACTCap analysis of gene expression (CAGE) is a methodology for genome-wide quantitative mapping of mRNA 5’ends to precisely capture transcription start sites at a single nucleotide resolution. In combination with high-throughput sequencing, CAGE has revolutionized our understanding of rules of transcription initiation, led to discovery of new core promoter sequence features and discovered transcription initiation at enhancers genome-wide. The biggest limitation of CAGE is that even the most recently improved version (nAnT-iCAGE) still requires large amounts of total cellular RNA (5 micrograms), preventing its application to scarce biological samples such as those from early embryonic development or rare cell types. Here, we present SLIC-CAGE, a Super-Low Input Carrier-CAGE approach to capture 5’ends of RNA polymerase II transcripts from as little as 5-10 ng of total RNA. The dramatic increase in sensitivity is achieved by specially designed, selectively degradable carrier RNA. We demonstrate the ability of SLIC-CAGE to generate data for genome-wide promoterome with 1000-fold less material than required by existing CAGE methods by generating a complex, high quality library from mouse embryonic day (E) 11.5 primordial germ cells.