bluuebunny/crossref_metadata_2025_split huggingface dataset:
One less mystery in Coleoptera systematics: the position of Cydistinae (Elateriformia incertae sedis) resolved by multigene phylogenetic analysis
Authors: Kundrata Robin , Blank Stephan M , Prosvirov Alexander S , Sormova Eliska , Gimmel Matthew L , Vondráček Dominik , Kramp Katja 
Published: August 2019

AbstractCydistinae are a rare monogeneric beetle lineage from Asia with a convoluted history of classification, historically placed in various groups within the series Elateriformia. However, their position has never been rigorously tested. To resolve this long-standing puzzle, we are the first to present sequences of two nuclear and two mitochondrial markers for four species of Cydistinae to determine their phylogenetic position. We included these sequences in two rounds of analyses: one including a broad Elateriformia dataset to test placement at the superfamily/family level, and a second, including a richer, targeted sampling of presumed close relatives. Our results strongly support Cydistinae as sister to Phengodidae in a clade with Rhagophthalmidae. Based on our molecular phylogenetic results and examination of morphological characters, we hereby transfer the formerly unplaced Cydistinae into Phengodidae and provide diagnoses for the newly circumscribed Phengodidae, Cydistinae and Cydistus. Since both Phengodidae and Rhagophthalmidae have bioluminescent larvae and strongly neotenic females, similar features can be hypothesized for Cydistinae. Additionally, Cydistus minor is transferred to the new genus Microcydistus.
Through the Lens of Postcolonial Theory: Establishing Global North-South Partnerships
Authors: Healey-Walsh Judith , Stuart-Shor Eileen , Muchira James 
Published: August 2019

Abstract

AIM
This study used postcolonial theory as a critical lens to examine the factors that supported or hindered equitable partnership formation within an innovative international service-learning (ISL) program in nursing education.

BACKGROUND
As ISL programs proliferate, ethical concerns have arisen as minimal attention has been given to both the host and visiting partners’ experience and perceptions and how these impact partnership development and outcomes.

METHOD
A hybrid intrinsic, instrumental, single embedded case study design, including observations, interviews (n = 70), and document analysis, was used to analyze in depth varied partnerships within a US-Kenyan ISL program.

RESULTS
Central themes of dispelling assumptions, making connections, revealing privilege, and sharing power emerged and formed a theoretical model, Establishing and Strengthening Partnerships.

CONCLUSION
Attention needs to be given to preconceived assumptions, imbalances in privilege, and issues surrounding power and decision-making for equitable, impactful, partnership development. Leadership philosophy, style, and approach make a difference.
The Diversity and Success of Medical School Applicants With Scores in the Middle Third of the MCAT Score Scale
Authors: Terregino Carol A. , Saguil Aaron , Price-Johnson Tanisha , Anachebe Ngozi F. , Goodell Kristen 
Published: August 2019

Admissions officers assemble classes of medical students with different backgrounds and experiences who can contribute to their institutions’ service, leadership, and research goals. While schools’ local interests vary, they share a common goal: meeting the health needs of an increasingly diverse population. Despite the well-known benefits of diversity, the physician workforce does not yet reflect the nation’s diversity by socioeconomic status, race/ethnicity, or other background characteristics.
The authors reviewed the Medical College Admission Test (MCAT) scores and backgrounds of 2017 applicants, accepted applicants, and matriculants to U.S. MD-granting schools to explore avenues for increasing medical school class diversity. They found that schools that accepted more applicants with midrange MCAT scores had more diverse matriculating classes. Many schools admitting the most applicants with scores in the middle of the MCAT score scale were public, community-based, and primary care-focused institutions; those admitting the fewest of these applicants tended to be research-focused institutions and to report pressure to accept applicants with high MCAT scores to maintain or improve their national rankings.
The authors argue that reexamining the use of MCAT scores in admissions provides an opportunity to diversify the physician workforce. Despite evidence that most students with midrange MCAT scores succeed in medical school, there is a tendency to overlook these applicants in favor of those with higher scores. To improve the health of all, the authors call for admitting more students with midrange MCAT scores and studying the learning environments that enable students with a wide range of MCAT scores to thrive.
Parenthood During Graduate Medical Education: A Scoping Review
Authors: Stack Shobha W. , Eurich Katrin E. , Kaplan Elizabeth A. , Ball Andrea L. , Mookherjee Somnath , Best Jennifer A. 
Published: August 2019

Purpose
To conduct a scoping review of the literature on parenthood during graduate medical education (GME) and to develop a conceptual framework to inform policy and guide research.

Method
The authors searched PubMed and Embase for articles published from January 1993 through August 7, 2017, using a query framework that combined the concepts of “person” (e.g., “trainee”) and “parenthood” (e.g., “breastfeeding”). They included studies describing parenthood or pregnancy of trainees in U.S. GME training programs. Two authors independently screened citations and abstracts and performed kappa coefficient tests to evaluate interreviewer reliability. Two authors performed a full-text review of and extracted data from each included article, and 4 authors coded data for all articles. The authors used descriptive statistics and qualitative synthesis to analyze data.

Results
Ninety articles met inclusion criteria, and nearly half (43/90; 48%) were published between 2010 and 2017. The authors developed 6 themes that surround resident parenthood: well-being, maternal health, others’ perceptions, relationships, program preparation, and policy. They mapped these themes by relationship of stakeholders (e.g., infant and family, institutions) to the resident-parent to create a conceptual framework describing parenthood during GME.

Conclusions
The findings from this scoping review have implications for policy and research. Those authoring parental leave policies could collaborate with national board leaders to develop consistent standards and include nontraditional families. Gaps in the literature include the effect of resident parenthood on patient care, postpartum health, and policy execution. Research in these areas would advance the literature on parenthood during residency.
How to Use Cognitively Diagnostic Assessments of Student Performance as a Method for Monitoring and Managing the Instructional Quality in Undergraduate Medical Education
Authors: Bangeranye Catherine , Lim Youn Seon 
Published: August 2019

Purpose
Course evaluations by students are a standard tool that U.S. universities use to monitor the quality of their product. Here, the authors examine an alternative method of monitoring instructional quality that differs from traditional approaches in that it does not rely on students’ ratings. The authors sought to glean relevant diagnostic information about course effectiveness from in-class exams used to assess students’ learning progress (i.e., cognitively diagnostic assessments that explicitly target instructional content).

Method
The authors used data from an end-of-course, cumulative exam given in 2015 and in 2016 to 200 first-year medical students. They mapped the exam questions to 4 attributes and analyzed the students’ overall mastery of the content tested and the percentage of students mastering each attribute.

Results
Analyses of the cognitively diagnostic assessment data revealed the percentage of the cohort who achieved/failed to achieve mastery of each of the attributes, discreet mastery profiles that distinguish among students with similar scores, and the percentage of the cohort within each of the 16 attribute mastery profiles. Analysis allowed the authors to evaluate how well the course content was delivered.

Conclusions
Cognitively diagnostic assessments enable in-class tests to appraise which skills specified in the curriculum have/have not been mastered by the students and how many students have mastered/failed to master which particular skills. Hence, if the learning goals have been well defined at the beginning of a course, then cognitively diagnostic assessments can show to what degree the instructional objectives have actually been accomplished.
Pharmacodynamic Interaction of Remifentanil and Dexmedetomidine on Depth of Sedation and Tolerance of Laryngoscopy
Authors: Weerink Maud A. S. , Barends Clemens R. M. , Muskiet Ernesto R. R. , Reyntjens Koen M. E. M. , Knotnerus Froukje H. , Oostra Martine , van Bocxlaer Jan F. P. , Struys Michel M. R. F. , Colin Pieter J. 
Published: August 2019

Background
Dexmedetomidine is a sedative with modest analgesic efficacy, whereas remifentanil is an opioid analgesic with modest sedative potency. Synergy is often observed when sedative–hypnotics are combined with opioid analgesics in anesthetic practice. A three-phase crossover trial was conducted to study the pharmacodynamic interaction between remifentanil and dexmedetomidine.

Methods
After institutional review board approval, 30 age- and sex- stratified healthy volunteers were studied. The subjects received consecutive stepwise increasing target-controlled infusions of dexmedetomidine, remifentanil, and remifentanil with a fixed dexmedetomidine background concentration. Drug effects were measured using binary (yes or no) endpoints: no response to calling the subject by name, tolerance of shaking the patient while shouting the name (“shake and shout”), tolerance of deep trapezius squeeze, and tolerance of laryngoscopy. The drug effect was measured using the electroencephalogram-derived “Patient State Index.” Pharmacokinetic–pharmacodynamic modeling related the administered dexmedetomidine and remifentanil concentration to these observed effects.

Results
The binary endpoints were correlated with dexmedetomidine concentrations, with increasing concentrations required for increasing stimulus intensity. Estimated model parameters for the dexmedetomidine EC50 were 2.1 [90% CI, 1.6 to 2.8], 9.2 [6.8 to 13], 24 [16 to 35], and 35 [23 to 56] ng/ml, respectively. Age was inversely correlated with dexmedetomidine EC50 for all four stimuli. Adding remifentanil did not increase the probability of tolerance of any of the stimuli. The cerebral drug effect as measured by the Patient State Index was best described by the Hierarchical interaction model with an estimated dexmedetomidine EC50 of 0.49 [0.20 to 0.99] ng/ml and remifentanil EC50 of 1.6 [0.87 to 2.7] ng/ml.

Conclusions
Low dexmedetomidine concentrations (EC50 of 0.49 ng/ml) are required to induce sedation as measured by the Patient State Index. Sensitivity to dexmedetomidine increases with age. Despite falling asleep, the majority of subjects remained arousable by calling the subject’s name, “shake and shout,” or a trapezius squeeze, even when reaching supraclinical concentrations. Adding remifentanil does not alter the likelihood of response to graded stimuli.
Cortical Oscillations and Connectivity During Postoperative Recovery
Authors: Zierau Mackenzie , Li Duan , Lapointe Andrew P. , Ip Ka I. , McKinney Amy M. , Thompson Aleda , Puglia Michael P. , Vlisides Phillip E. 
Published: August 2019

Background:
The objective of this study was to test whether postoperative electroencephalographic (EEG) biomarkers, parietal alpha power and frontal-parietal connectivity, were associated with measures of clinical recovery in adult surgical patients.

Methods:
This is a secondary analysis of a prospective cohort study that analyzed intraoperative connectivity patterns in adult surgical patients (N=53). Wireless, whole-scalp EEG data were collected in the postanesthesia care unit and assessed for relevance to clinical and neurocognitive recovery. Parietal alpha power and frontal-parietal connectivity (estimated by weighted phase lag index) were tested for associations with postanesthesia care unit discharge readiness and University of Michigan Sedation Scale scores upon postoperative admission. Bivariable correlation and regression models were constructed to test for unadjusted associations, then multivariable regression models were constructed to adjust for confounding.

Results:
Postoperative EEG patterns were characterized by a predominance of alpha parietal power and frontal-parietal connectivity. Neither relative parietal alpha power (% alpha, −0.25; 95% confidence interval [CI], −1.41 to 0.90; P=0.657) nor alpha frontal-parietal connectivity (weighted phase lag index, −82; 95% CI, −237 to 73; P=0.287) were associated with time until postanesthesia discharge criteria were met. Furthermore, neither alpha power (−0.03; 95% CI, −0.07 to 0.01; P=0.206) nor alpha frontal-parietal connectivity (−4.2; 95% CI, −11 to 2.6; P=0.226) were associated with sedation scores upon initial assessment.

Conclusions:
In a pragmatic study investigating clinically relevant endpoints of postoperative recovery, we found no correlation with surrogate measures of brain neurodynamics. These data contribute to the overall impetus of developing anesthetic-invariant and generalizable markers of brain recovery.
Calcaneal Avulsion Fractures: A Multicenter Analysis of Soft-Tissue Compromise and Early Fixation Failure
Authors: Mitchell Phillip M. , O'Neill David E. , Branch Eric , Mir Hassan R. , Sanders Roy W. , Collinge Cory A. 
Published: August 2019

Objective:
To characterize the presentation and outcomes of calcaneal avulsion fractures.

Design:
Case series.

Setting:
Two ACS Level I trauma centers.

Patients/Participants:
Forty-seven calcaneal avulsion fractures isolated from a cohort of 1365 calcaneus fractures treated over a 17-year period.

Main Outcome Measurements:
We collected instances of soft-tissue compromise at presentation, evidence of implant failure or fracture displacement after fixation, and reoperation.

Results:
Forty-one patients were treated operatively, and 6 were treated without surgery. Twenty-one patients (44.7%) had either soft-tissue compromise or an open fracture necessitating urgent treatment at the time of presentation. Of those patients treated operatively with 3-month follow-up (n = 39), 28.2% of patients (11/39) had evidence of implant failure or fracture displacement. Age was the only predictor of catastrophic fixation failure (P = 0.01). The use of washer(s), suture anchor(s), or addition of soft-tissue procedures (eg, Strayer) did not have a significant effect on failure rate. Neither the number of screws used nor size of screw impacted the failure rate. Fourteen patients (35.9%) underwent a secondary operation.

Discussion:
Avulsion fractures of the calcaneus commonly present with soft-tissue compromise and have a significant rate of treatment failure and reoperation. This injury should be identified early and approached thoughtfully, acknowledging that risks are high.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Interobserver Reliability in Imaging-Based Fracture Union Assessment—Two Systematic Reviews
Authors: Ten Berg Paul W. L. , Kraan Rik B. J. , Jens Sjoerd , Maas Mario 
Published: August 2019

Objectives:
(A) To investigate the specialty of observers involved in imaging-based assessment of bone fracture union in recent orthopaedic trials and (B) to provide a general overview of observer differences (in terms of interobserver reliability) in radiologic fracture union assessment that have been reported between surgeons and radiologists.

Data Sources:
Two separate systematic reviews (A, B) of English-, German-, and French-language articles in MEDLINE and Embase databases using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were done, with the following time frames: (A) January 2016–August 2017 and (B) through November 2017.

Study Selection:
(A) Clinical trials of surgical fracture treatment evaluating radiologic (non) union. (B) Interobserver studies reporting kappa-values or intraclass correlation coefficients as reliability coefficient for radiologic fracture union assessment. Inclusion criteria for both reviews were fractures of the appendicular skeleton and the use of radiographs or computed tomography.

Data Extraction:
Data were independently retrieved by 2 reviewers.

Data Synthesis:
Descriptive statistics and percentages were reported.

Results:
(A) Forty-eight trials were included, whereof 33 (68%) did not report the observer's specialty. Six trials (13%) reported surgeon observers only, and 6 (13%) reported radiologist observers only. The median number of observers is 1 (interquartile range, 1–2). (B) Thirty-one interobserver studies were included, whereof 11 (35%) included at least 1 surgeon and 1 radiologist. Interobserver reliability varied considerably across the various fracture types studied and outcome scale used and was often unsatisfactory (kappa or intraclass correlation coefficients of <0.7).

Conclusions:
In most trials providing observer's characteristics, radiologic fracture union was either rated by 1 surgeon or 1 radiologist. As interobserver reliability can be unsatisfactory, we recommend surgeons and radiologists to further intensify collaboration and trials to include at least 2 observers and associated reliability statistics.
Does Implant Choice Affect the Episode Cost of Pertrochanteric Hip Fracture for US Veterans?
Authors: Patterson Joseph T. , Takemoto Steven K. , Shearer David W. , Kuo Alfred C. 
Published: August 2019

Objective:
To investigate an association between a surgeon's choice of a cephalomedullary nail (CMN) or sliding hip screw (SHS) with the cost of treating a pertrochanteric hip fracture.

Design:
Multicenter retrospective cohort study.

Setting:
US Veterans Health Administration Sierra Pacific Network.

Patients/Participants:
Two hundred ninety-four consecutive US veterans admitted for a principal diagnosis of an OTA/AO 31A-type pertrochanteric hip fracture of a native hip from 2000 to 2015.

Intervention:
Internal fixation using a CMN or an SHS.

Main Outcome Measurements:
Veterans Administration Health Economic Resource Center average national cost estimate of combined acute and postacute care episode cost, excluding implant cost, normalized to 2015 US dollars by the Consumer Price Index.

Results:
Median episode cost was $8223 lower with a CMN than an SHS (95% confidence interval, $5700–$10,746, P < 0.001) after matching on a propensity score for treatment with a CMN based on age, sex, body mass index, Charlson Comorbidity Index, fracture characteristics, study site, and admission year. A subgroup propensity-matched analysis excluding reverse obliquity pertrochanteric fractures was not sufficiently powered to detect a difference in episode cost (β = 0.76, P = 0.311).

Conclusions:
Implant choice significantly affected the episode cost of care of hip fracture at Veterans Health Administration facilities.

Level of Evidence:
Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Incidence, Predictors, and Fracture Mapping of (Occult) Posterior Malleolar Fractures Associated With Tibial Shaft Fractures
Authors: Hendrickx Laurent A.M. , Cain Megan E. , Sierevelt Inger N. , Jadav Bhavin , Kerkhoffs Gino M.M.J. , Jaarsma Ruurd L. , Doornberg Job N. 
Published: August 2019

Objectives:
To (1) evaluate the incidence of posterior malleolar fractures (PMFs) in patients with tibial shaft fractures (TSFs) using advanced imaging; (2) identify predictors for patients at risk of an (occult) PMF; and (3) describe PMF characteristics to guide “malleolus-first” fixation.

Design:
Retrospective diagnostic imaging study.

Setting:
Level-I trauma center.

Patients:
One hundred sixty-four patients treated with intramedullary nailing for TSFs who underwent low-dose postoperative computed tomography (CT) scans to assess (mal)rotational alignment.

Intervention:
Analysis of advanced imaging for the presence of PMFs. Univariate and multivariate analyses to identify predictors. Qualitative analysis of PMFs by fracture mapping.

Main Outcome Measures:
(1) Incidence of PMFs in patients with TSFs as diagnosed on post-op CT scans; (2) independent predictors for the presence of PMFs; and (3) PMF patterns.

Results:
One in five patients with a TSF has an associated PMF (22%), increasing to one-in-two in patients with simple spiral fractures (56%). In 25% of patients, these fractures were occult. Univariate analysis identified simple spiral and distal third TSFs, proximal third and spiral fibula fractures, and low-energy trauma as predictors for PMFs. Multivariate analysis demonstrated that distal third and simple spiral TSFs were the only independent predictors. Haraguchi type I is the pattern specific to PMFs associated with TSF.

Conclusions:
Half of patients presenting with a simple spiral TSF have an associated PMF. In one in four patients, these are occult. Additional preoperative CT scan imaging may be considered in patients presenting with simple spiral distal third TSFs, despite negative lateral radiographs, so that PMFs can be identified and managed with “malleolus-first” fixation.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Sirtuin 3, Endothelial Metabolic Reprogramming, and Heart Failure With Preserved Ejection Fraction
Authors: Zeng Heng , Chen Jian-Xiong 
Published: August 2019

Abstract:The incidences of heart failure with preserved ejection fraction (HFpEF) are increased in aged populations as well as diabetes and hypertension. Coronary microvascular dysfunction has contributed to the development of HFpEF. Endothelial cells (ECs) depend on glycolysis rather than oxidative phosphorylation for generating adenosine triphosphate to maintain vascular homeostasis. Glycolytic metabolism has a critical role in the process of angiogenesis, because ECs rely on the energy produced predominantly from glycolysis for migration and proliferation. Sirtuin 3 (SIRT3) is found predominantly in mitochondria and its expression declines progressively with aging, diabetes, obesity, and hypertension. Emerging evidence indicates that endothelial SIRT3 regulates a metabolic switch between glycolysis and mitochondrial respiration. SIRT3 deficiency in EC resulted in a significant decrease in glycolysis, whereas, it exhibited higher mitochondrial respiration and more prominent production of reactive oxygen species. SIRT3 deficiency also displayed striking increases in acetylation of p53, EC apoptosis, and senescence. Impairment of SIRT3-mediated EC metabolism may lead to a disruption of EC/pericyte/cardiomyocyte communications and coronary microvascular rarefaction, which promotes cardiomyocyte hypoxia, Titin-based cardiomyocyte stiffness, and myocardial fibrosis, thus leading to a diastolic dysfunction and HFpEF. This review summarizes current knowledge of SIRT3 in EC metabolic reprograming, EC/pericyte interactions, coronary microvascular dysfunction, and HFpEF.