bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applying Metacognition Through Patient Encounters and Illness Scripts to Create a Conceptual Framework for Basic Science Integration, Storage, and Retrieval
Authors: Hennrikus Eileen F , Skolka Michael P , Hennrikus Nicholas 
Published: May 2018

Problem: Medical school curriculum continues to search for methods to develop a conceptual educational framework that promotes the storage, retrieval, transfer, and application of basic science to the human experience. To achieve this goal, we propose a metacognitive approach that integrates basic science with the humanistic and health system aspects of medical education. Intervention: During the week, via problem-based learning and lectures, first-year medical students were taught the basic science underlying a disease. Each Friday, a patient with the disease spoke to the class. Students then wrote illness scripts, which required them to metacognitively reflect not only on disease pathophysiology, complications, and treatments but also on the humanistic and health system issues revealed during the patient encounter. Evaluation of the intervention was conducted by measuring results on course exams and national board exams and analyzing free responses on the illness scripts and student course feedback. The course exams and National Board of Medical Examiners questions were divided into 3 categories: content covered in lecture, problem-based learning, or patient + illness script. Comparisons were made using Student t-test. Free responses were inductively analyzed using grounded theory methodology. Context: This curricular intervention was implemented during the first 13-week basic science course of medical school. The main objective of the course, Scientific Principles of Medicine, is to lay the scientific foundation for subsequent organ system courses. A total of 150 students were enrolled each year. We evaluated this intervention over 2 years, totaling 300 students. Outcome: Students scored significantly higher on illness script content compared to lecture content on the course exams (mean difference = 11.1, P = .006) and national board exams given in December (mean difference = 21.8, P = .0002) and June (mean difference = 12.7, P = .016). Themes extracted from students’ free responses included the following: relevance of basic science, humanistic themes of empathy, resilience, and the doctor-patient relationship, and systems themes of cost, barriers to care, and support systems. Lessons learned: A metacognitive approach to learning through the use of patient encounters and illness script reflections creates stronger conceptual frameworks for students to integrate, store, retain, and retrieve knowledge.
Lesser Tuberosity Osteotomy Outcomes After Anatomic Shoulder Arthroplasty in Patients With Atraumatic Avascular Necrosis
Authors: Maier Stephen P , Lopez Cesar D , Bloom Zachary J , Shiu Brian B , Petkovic Djuro , Levine William N , Jobin Charles M 
Published: May 2018

Introduction Lesser tuberosity osteotomy (LTO) is an attractive option for subscapularis management during anatomic shoulder arthroplasty due to the biomechanical strength and reliable bone-to-bone healing. Patients with humeral head avascular necrosis (AVN) may have compromised bone healing, and the outcomes of LTO during AVN are unknown. Methods A retrospective consecutive case series of 6 patients with Cruess grade 4 or 5 humeral head AVN who underwent anatomic shoulder arthroplasty with LTO from 2010 to 2016 was performed. Postoperative radiographic evaluation for LTO healing at 6 months was analyzed, and clinical outcomes at latest follow-up, including range of motion (ROM), strength, and pain were studied.> Results Average age was 50.3 years. AVN was secondary to sickle cell in 1 patient, steroid use for systemic lupus erythematosus in 4, and chronic alcoholism in 1. By 6 months after arthroplasty, 100% had radiographically united and healed LTO. Patients averaged 140 ± 21° of active forward elevation and 42 ± 7° of active external rotation. Patients reported an improvement in visual analogue scale pain from 8.3 preoperatively to 3.8 postoperatively. All patients had a normal abdominal compression test. No patients required revision surgery. Conclusion The use of LTO during anatomic shoulder arthroplasty for AVN has an excellent bony healing rate with improvements in pain, ROM, and strength. The diseases that cause humeral head AVN do not negatively influence LTO healing outcomes during anatomic shoulder replacement. Level of Evidence IV Case Series
Reactivation of γ-globin in adult β-YAC mice after ex vivo and in vivo hematopoietic stem cell genome editing
Authors: Li Chang , Psatha Nikoletta , Sova Pavel , Gil Sucheol , Wang Hongjie , Kim Jiho , Kulkarni Chandana , Valensisi Cristina , Hawkins R. David , Stamatoyannopoulos George , Lieber André 
Published: May 2018

Key Points
CRISPR/Cas9-mediated disruption of a BCL11A binding site in HSCs of β-YAC mice results in the reactivation of γ-globin in erythrocytes. Our approach for in vivo HSC genome editing that does not require HSC transplantation and myeloablation should simplify HSC gene therapy.
Socioeconomic inequalities in suicide in Europe: the widening gap
Authors: Lorant Vincent , de Gelder Rianne , Kapadia Dharmi , Borrell Carme , Kalediene Ramune , Kovács Katalin , Leinsalu Mall , Martikainen Pekka , Menvielle Gwenn , Regidor Enrique , Rodríguez-Sanz Maica , Wojtyniak Bogdan , Strand Bjørn Heine , Bopp Matthias , Mackenbach Johan P. 
Published: May 2018

BackgroundSuicide has been decreasing over the past decade. However, we do not know whether socioeconomic inequality in suicide has been decreasing as well.AimsWe assessed recent trends in socioeconomic inequalities in suicide in 15 European populations.MethodThe DEMETRIQ study collected and harmonised register-based data on suicide mortality follow-up of population censuses, from 1991 and 2001, in European populations aged 35–79. Absolute and relative inequalities of suicide according to education were computed on more than 300 million person-years.ResultsIn the 1990s, people in the lowest educational group had 1.82 times more suicides than those in the highest group. In the 2000s, this ratio increased to 2.12. Among men, absolute and relative inequalities were substantial in both periods and generally did not decrease over time, whereas among women inequalities were absent in the first period and emerged in the second.ConclusionsThe World Health Organization (WHO) plan for ‘Fair opportunity of mental wellbeing’ is not likely to be met.Declaration of interestNone.
Selection of Optimal Adjuvant Chemotherapy and Targeted Therapy for Early Breast Cancer: ASCO Clinical Practice Guideline Focused Update
Authors: Denduluri Neelima , Chavez-MacGregor Mariana , Telli Melinda L. , Eisen Andrea , Graff Stephanie L. , Hassett Michael J. , Holloway Jamie N. , Hurria Arti , King Tari A. , Lyman Gary H. , Partridge Ann H. , Somerfield Mark R. , Trudeau Maureen E. , Wolff Antonio C. , Giordano Sharon H. 
Published: May 2018

Purpose To update key recommendations of the ASCO guideline adaptation of the Cancer Care Ontario guideline on the selection of optimal adjuvant chemotherapy regimens for early breast cancer and adjuvant targeted therapy for breast cancer. Methods An Expert Panel conducted targeted systematic literature reviews guided by a signals approach to identify new, potentially practice-changing data that might translate to revised practice recommendations. Results The Expert Panel reviewed phase III trials that evaluated adjuvant capecitabine after completion of standard preoperative anthracycline- and taxane-based combination chemotherapy by patients with early-stage breast cancer HER2-negative breast cancer with residual invasive disease at surgery; the addition of 1 year of adjuvant pertuzumab to combination chemotherapy and trastuzumab for patients with early-stage, HER2-positive breast cancer; and the use of neratinib as extended adjuvant therapy for patients after combination chemotherapy and trastuzumab-based adjuvant therapy with early-stage, HER2-positive breast cancer. Recommendations Patients with early-stage HER2-negative breast cancer with pathologic, invasive residual disease at surgery following standard anthracycline- and taxane-based preoperative therapy may be offered up to six to eight cycles of adjuvant capecitabine. Clinicians may add 1 year of adjuvant pertuzumab to trastuzumab-based combination chemotherapy in patients with high-risk, early-stage, HER2-positive breast cancer. Clinicians may use extended adjuvant therapy with neratinib to follow trastuzumab in patients with early-stage, HER2-positive breast cancer. Neratinib causes substantial diarrhea, and diarrhea prophylaxis must be used. Additional information can be found at www.asco.org/breast-cancer-guidelines .
“Modified Dynamic Needle Tip Positioning” Short-Axis, Out-of-Plane, Ultrasound-Guided Radial Artery Cannulation in Neonates: A Randomized Controlled Trial
Authors: Liu Lifei , Tan Yanzhe , Li Shangyingying , Tian Jie 
Published: May 2018

BACKGROUND:
Radial artery cannulation is extremely challenging in neonatal patients. Herein, we compared the success rate of the modified dynamic needle tip positioning short-axis, out-of-plane, ultrasound-guided technique with that of the traditional palpation technique in neonatal radial artery cannulation.

METHODS:
Sixty term neonates undergoing major abdominal surgery were randomized into the ultrasound or palpation group via the sealed-envelope method. The ultrasound group underwent radial artery cannulation using an ultrasonic apparatus, while traditional palpation of arterial pulsation was used in the palpation group. The arterial diameter and depth were measured on ultrasound before the puncture. We recorded age, weight, sex, and other background characteristics. The primary outcomes included the first-attempt, total success rates, and the total puncture procedure duration. Secondary outcomes included the incidence of complications (hematoma and thrombosis). Data were compared between the 2 groups.

RESULTS:
Sixty term neonates were enrolled in the study. The success rates of the first attempt in the ultrasound and palpation groups were 40% (n = 30) and 10% (n = 30), respectively (P = .007; relative risk, 4.0; 95% confidence interval, 1.3–12.8). The total success rate was 96.7% in the ultrasound group and 60.0% in the palpation group (P = .001; relative risk, 1.61; 95% confidence interval, 1.19–2.17). The average time to accomplish radial artery cannulation in the ultrasound and palpation groups was 91.4 ± 55.4 and 284.7 ± 153.6 seconds, respectively (P < .001; estimated difference, −193; 95% confidence interval, −256 to −130). In addition, 3.3% of the patients in the ultrasound group and 26.7% in the palpation group suffered puncture hematoma (P = .026; relative risk, 0.13; 95% confidence interval, 0.02–0.94).

CONCLUSIONS:
Modified dynamic needle tip positioning short-axis, out-of-plane, ultrasound-guided radial artery cannulation in neonates improves the first-attempt and total success rates and decreases the total procedural time and incidence of cannulation-related complications.
Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid Responsiveness in Mechanically Ventilated Patients? A Systematic Review and Meta-analysis
Authors: Si Xiang , Xu Hailin , Liu Zimeng , Wu Jianfeng , Cao Daiyin , Chen Juan , Chen Minying , Liu Yongjun , Guan Xiangdong 
Published: May 2018

BACKGROUND:
We performed a systematic review and meta-analysis of studies investigating the diagnostic accuracy of respiratory variation in inferior vena cava diameter (ΔIVC) for predicting fluid responsiveness in patients receiving mechanical ventilation.

METHODS:
MEDLINE, EMBASE, the Cochrane Library, and Web of Science were screened from inception to February 2017. The meta-analysis assessed the pooled sensitivity, specificity, diagnostic odds ratio, and area under the receiver operating characteristic curve. In addition, heterogeneity and subgroup analyses were performed.

RESULTS:
A total of 12 studies involving 753 patients were included. Significant heterogeneity existed among the studies, and meta-regression indicated that ventilator settings were the main sources of heterogeneity. Subgroup analysis indicated that ΔIVC exhibited better diagnostic performance in the group of patients ventilated with tidal volume (TV) ≥8 mL/kg and positive end-expiratory pressure (PEEP) ≤5 cm H2O than in the group ventilated with TV <8 mL/kg or PEEP >5 cm H2O, as demonstrated by higher sensitivity (0.80 vs 0.66; P = .02), specificity (0.94 vs 0.68; P < .001), diagnostic odds ratio (68 vs 4; P < .001), and area under the receiver operating characteristic curve (0.88 vs 0.70; P < .001). The best ΔIVC threshold for predicting fluid responsiveness was 16% ± 2% in the group of TV ≥8 mL/kg and PEEP ≤5 cm H2O, whereas in the group of TV <8 mL/kg or PEEP >5 cm H2O, this threshold was 14% ± 5%.

CONCLUSIONS:
ΔIVC shows limited ability for predicting fluid responsiveness in distinct ventilator settings. In patients with TV ≥8 mL/kg and PEEP ≤5 cm H2O, ΔIVC was an accurate predictor of fluid responsiveness, while in patients with TV <8 mL/kg or PEEP >5 cm H2O, ΔIVC was a poor predictor. Thus, intensivists must be cautious when using ΔIVC.
Perianesthetic and Anesthesia-Related Mortality in a Southeastern United States Population: A Longitudinal Review of a Prospectively Collected Quality Assurance Data Base
Authors: Pollard Richard J. , Hopkins Thomas , Smith C. Tyler , May Bryan V. , Doyle James , Chambers C. Labron , Clark Reese , Buhrman William 
Published: May 2018

BACKGROUND:Perianesthetic mortality (death occurring within 48 hours of an anesthetic) continues to vary widely depending on the study population examined. The authors study in a private practice physician group that covers multiple anesthetizing locations in the Southeastern United States. This group has in place a robust quality assurance (QA) database to follow all patients undergoing anesthesia. With this study, we estimate the incidence of anesthesia-related and perianesthetic mortality in this QA database.METHODS:Following institutional review board approval, data from 2011 to 2016 were obtained from the QA database of a large, community-based anesthesiology group practice. The physician practice covers 233 anesthetizing locations across 20 facilities in 2 US states. All detected cases of perianesthetic death were extracted from the database and compared to the patients’ electronic medical record. These cases were further examined by a committee of 3 anesthesiologists to determine whether the death was anesthesia related (a perioperative death solely attributable to either the anesthesia provider or anesthetic technique), anesthetic contributory (a perioperative death in which anesthesia role could not be entirely excluded), or not due to anesthesia.RESULTS:A total of 785,467 anesthesia procedures were examined from the study period. A total of 592 cases of perianesthetic deaths were detected, giving an overall death rate of 75.37 in 100,000 cases (95% CI, 69.5–81.7). Mortality judged to be anesthesia related was found in 4 cases, giving a mortality rate of 0.509 in 100,000 (95% CI, 0.198–1.31). Mortality judged to be anesthesia contributory were found in 18 cases, giving a mortality of 2.29 in 100,000 patients (95% CI, 1.45–3.7). A total of 570 cases were judged to be nonanesthesia related, giving an incidence of 72.6 per 100,000 anesthetics (95% CI, 69.3–75.7).CONCLUSIONS:In a large, comprehensive database representing the full range of anesthesia practices and locations in the Southeastern United States, the rate of perianesthestic death was 0.509 in 100,000 (95% CI, 0.198–1.31). Future in-depth analysis of the epidemiology of perianesthetic deaths will be reported in later studies.
Gestational low-protein intake enhances whole-kidney miR-192 and miR-200 family expression and epithelial-to-mesenchymal transition in rat adult male offspring
Authors: Sene Letícia B. , Rizzi Victor Hugo Gonçalves , Gontijo José A. R. , Boer Patricia A. 
Published: May 2018

ABSTRACT
Studies have shown that adult offspring of mothers fed a protein-restricted diet during pregnancy present a pronounced reduction of nephron number associated with decreased fractional urinary sodium excretion and arterial hypertension. Additionally, recent advances in our understanding of the molecular pathways that govern the association of gestational nutritional restriction, intrauterine growth retardation and inflammation with impaired nephrogenesis, nephron underdosing and kidney fibrosis point to the epithelial to mesenchymal transition (EMT) as a common factor. In the current study, protein and sodium urinary excretion rates were evaluated in rats, and immunohistochemistry and western blot techniques were used to characterize kidney structure changes in 16 week old male offspring of mothers fed a low-protein diet during pregnancy (LP group) compared with age-matched (NP) controls. We also verified the expression of miRNA, mRNA and protein markers of fibrosis and the EMT in whole kidney prepared from LP offspring. We found, surprisingly, that arterial hypertension and long-term hyperfiltration, manifest by proteinuria, were associated with increased renal miR-192 and miR-200 family expression in 16 week old LP relative to age-matched NP rats. Measurement of kidney fibrosis and EMT-related protein markers, by histochemistry and immunoblot techniques, showed a significant rise of TGF-β1 and type-I collagen content in glomeruli and tubulointerstitial areas, accompanied by enhanced fibronectin and ZEB1 and decreased E-cadherin immunoreactivity in 16 week old LP offspring. The results were partially confirmed by increased gene (mRNA) expression of collagen 1α1, collagen 1α2 and ZEB1 in LP whole kidneys compared with those of age-matched NP offspring. In view of the presumed functional overload in the remaining nephrons, we suggest that hypertension and proteinuria development following maternal protein restriction may be a preponderant factor for EMT and structural kidney changes in LP offspring. However, our study was not wholly able to establish the precise role of miRNAs in LP kidney disorders. Thus, further studies will be required to assess the contribution of the miR family to renal injury in a gestational protein-restricted model of fetal programming.
Technical Note—A Robust Perspective on Transaction Costs in Portfolio Optimization
Authors: Olivares-Nadal Alba V. , DeMiguel Victor 
Published: May 2018

We prove that the portfolio problem with transaction costs is equivalent to three different problems designed to alleviate the impact of estimation error: a robust portfolio optimization problem, a regularized regression problem, and a Bayesian portfolio problem. Motivated by these results, we propose a data-driven approach to portfolio optimization that tackles transaction costs and estimation error simultaneously by treating the transaction costs as a regularization term to be calibrated. Our empirical results demonstrate that the data-driven portfolios perform favorably because they strike an optimal trade-off between rebalancing the portfolio to capture the information in recent historical return data and avoiding the large transaction costs and impact of estimation error associated with excessive trading.The online companion is available at https://doi.org/10.1287/opre.2017.1699 .
When Memory and Sexuality Collide: The Homosentimental Style of Gay Liberation
Authors: Reyes G. Mitchell , Schulz David P. , Hovland Zoe 
Published: May 2018

Abstract
Commemorating both the Stonewall Riots of 1969 and the subsequent Gay Liberation Movement, the Gay Liberation Monument projects a quiet, muted homosexuality that stands in sharp contrast to the courageous and violent assertion of homosexual identity that was Stonewall. Our essay examines this strange incongruity, revealing in the process the homosentimental style—a unique rhetorical form that attempts to negotiate the many contradictory motives animating LGBT advocacy. The Gay Liberation Monument’s use of homosentimentality refracts in many directions, simultaneously challenging dehumanizing rhetorics with affective appeals to care and friendship, presenting itself as assimilationist even as it offers coded indices of clone culture, and producing a doubled homosexual body—at once assimilationist and queer. Both the monument and the homosentimental style thus pose a challenge to binary conceptualizations of LGBT rights advocacy that separate assimilationist and queer politics.
“A Spirit That Can Never Be Told”: Commemorative Agency and the Texas A&M University Bonfire Memorial
Authors: Gaffey Adam J. , Barbour Jennifer L. Jones 
Published: May 2018

Abstract
On November 18, 1999, Texas A&M University (TAMU) experienced profound tragedy when the famed Aggie Bonfire collapsed, killing 12 students and injuring 27 others. This essay examines the rhetorical dynamics of the TAMU Bonfire Memorial and explores how it navigates the tension created when a constitutive symbol is implicated in a moment of tragedy. Specifically, we use this case to explore how memorials help shape perceptions of victim agency in commemorative form. As we argue, the memorial taps into resonant modes of public reasoning—including temporal metaphors, Christian theology, and campus tradition—to imply the tragic outcome of the 1999 collapse had cause beyond human or institutional control. Our analysis of the Bonfire Memorial illustrates the importance of commemorative agency and, in particular, how eliding victim agency can limit epideictic encounters that might foster a sense of present and future engagement on unreconciled issues.
Scalable training of hierarchical topic models
Authors: Chen Jianfei , Zhu Jun , Lu Jie , Liu Shixia 
Published: May 2018

Large-scale topic models serve as basic tools for feature extraction and dimensionality reduction in many practical applications. As a natural extension of flat topic models, hierarchical topic models (HTMs) are able to learn topics of different levels of abstraction, which lead to deeper understanding and better generalization than their flat counterparts. However, existing scalable systems for flat topic models cannot handle HTMs, due to their complicated data structures such as trees and concurrent dynamically growing matrices, as well as their susceptibility to local optima.
In this paper, we study the hierarchical latent Dirichlet allocation (hLDA) model which is a powerful nonparametric Bayesian HTM. We propose an efficient partially collapsed Gibbs sampling algorithm for hLDA, as well as an initialization strategy to deal with local optima introduced by tree-structured models. We also identify new system challenges in building scalable systems for HTMs, and propose efficient data layout for vectorizing HTM as well as distributed data structures including dynamic matrices and trees. Empirical studies show that our system is 87 times more efficient than the previous open-source implementation for hLDA, and can scale to thousands of CPU cores. We demonstrate our scalability on a 131-million-document corpus with 28 billion tokens, which is 4--5 orders of magnitude larger than previously used corpus. Our distributed implementation can extract 1,722 topics from the corpus with 50 machines in just 7 hours.