bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thoracoscopic surgery for lung cancer is associated with improved survival and shortened admission length: a nationwide propensity-matched study
Authors: Valo Johanna Katariina , Kytö Ville , Sipilä Jussi , Rautava Päivi , Sihvo Eero , Gunn Jarmo 
Published: June 2019

Abstract

OBJECTIVES
Population-based studies comparing long-term survival after minimally invasive and open surgery for lung cancer are lacking. The aim of this study was to compare long-term survival rates between minimally invasive [video-assisted thoracoscopic surgery (VATS)] and open surgery for lung cancer in an unselected nationwide setting.

METHODS
Patients undergoing minimally invasive (n = 710) or open (n = 2814) lung resection for lung cancer between 2004 and 2014 were identified from nationwide complete registries in Finland. Propensity score matching resulted in groups of 632 patients who had VATS and 632 who had a thoracotomy. The primary outcome was the 1-year survival rate. Secondary outcomes were 30-day, 90-day and 5-year survival rates and the length of surgical admission. Cox models were adjusted for sex, age, comorbidity, centre size, year of surgery, histological diagnosis, stage and adjuvant therapy.

RESULTS
In the propensity-matched cohort, the 1-year survival rate was 90.8% [confidence interval (CI) 88.3–92.8%] after VATS and 87.1% (CI 84.3–89.6%) after open surgery. The 5-year survival rate in the propensity-matched cohort was 59.6% (CI 54.9–63.9%) after VATS and 53.3% (CI 48.6–57.7%) after open surgery. The 30-day mortality rates showed no differences between approaches, but the 90-day mortality rate was better after VATS when adjusted for patient-, tumour- and operation-specific features (hazard ratio 0.56, 95% CI 0.30–0.92; P = 0.024).

CONCLUSIONS
According to this population-based nationwide study from Finland, minimally invasive surgery for lung cancer is associated with improved long- and short-term survival rates, supporting the use of VATS as a primary surgical method for treating lung cancer. Due to the complexity of confounding factors in this study, one should, however, interpret the results critically. Additional studies are needed.
Performance Surface Analysis Identifies Consistent Functional Patterns across 10 Morphologically Divergent Terrestrial Turtle Lineages
Authors: Stayton C Tristan 
Published: June 2019

AbstractNewly-developed methods for utilizing performance surfaces—multivariate representations of the relationship between phenotype and functional performance—allow researchers to test hypotheses about adaptive landscapes and evolutionary diversification with explicit attention to functional factors. Here, information from performance surfaces of three turtle shell functions—shell strength, hydrodynamics, and self-righting—is used to test the hypothesis that turtle lineages transitioning from aquatic to terrestrial habitats show patterns of shell shape evolution consistent with decreased importance of hydrodynamic performance. Turtle shells are excellent model systems for evolutionary functional analysis. The evolution of terrestriality is an interesting test case for the efficacy of these methods because terrestrial turtles do not show a straightforward pattern of morphological convergence in shell shape: many terrestrial lineages show increased shell height, typically assumed to decrease hydrodynamic performance, but there are also several lineages where the evolution of terrestriality was accompanied by shell flattening. Performance surface analyses allow exploration of these complex patterns and explicit quantitative analysis of the functional implications of changes in shell shape. Ten lineages were examined. Nearly all terrestrial lineages, including those which experienced decreased shell height, are associated with morphological changes consistent with a decrease in the importance of shell hydrodynamics. This implies a common selective pattern across lineages showing divergent morphological patterns. Performance studies such as these hold great potential for integrating adaptive and performance data in macroevolutionary studies.
Potential relationship between dietary long-chain saturated fatty acids and hypothalamic dysfunction in obesity
Authors: Sergi Domenico , Williams Lynda M 
Published: June 2019

AbstractDiet-induced hypothalamic inflammation, which leads to hypothalamic dysfunction and a loss of regulation of energy balance, is emerging as a potential driver of obesity. Excessive intake of long-chain saturated fatty acids is held to be the causative dietary component in hypothalamic inflammation. This review summarizes current evidence on the role of long-chain saturated fatty acids in promoting hypothalamic inflammation and the related induction of central insulin and leptin insensitivity. Particularly, the present review focuses on the molecular mechanisms linking long-chain saturated fatty acids and hypothalamic inflammation, emphasizing the metabolic fate of fatty acids and the resulting lipotoxicity, which is a key driver of hypothalamic dysfunction. In conclusion, long-chain saturated fatty acids are key nutrients that promote hypothalamic inflammation and dysfunction by fostering the build-up of lipotoxic lipid species, such as ceramide. Furthermore, when long-chain saturated fatty acids are consumed in combination with high levels of refined carbohydrates, the proinflammatory effects are exacerbated via a mechanism that relies on the formation of advanced glycation end products.
Practical Oomph: A Case for Subjectivism
Authors: Bedke Matthew 
Published: June 2019

AbstractThis paper examines the empirical and armchair evidence concerning the practical profiles of normative judgments. It then argues that the theory of normative judgment that best explains these practical profiles is a version of cognitivism: subjectivism. The preferred version says, roughly, i) each normative predicate is conventionally associated with a certain conative attitude, and ii) for S to judge that x has normative status N is for S to judge that x has a property picked out by the conative attitude associated with N. In short, having a normative judgment about x semantically necessitates having a conative attitude toward x's properties, to be contrasted with conceptual necessitation, metaphysical necessitation, rational necessitation, etiological necessitation, and other flavors of necessitation.
Introducing a dispensing power in English succession law
Authors: Hedlund Richard 
Published: June 2019

Abstract
Executing a will is one of the most important legal acts that a person will undertake. To be valid, the will must comply with the formality requirements in the Wills Act 1837. However, some wills fail to do so, and are invalidated on technicalities. Other jurisdictions, such as Australia, have given the courts a dispensing power to validate documents that would otherwise fail as wills, provided that it represents the testator’s true testamentary wishes. This article will consider whether such a dispensing power should be introduced into English law.
Gender Differences and Similarities in Accelerated Nursing Education Programs: Evidence of Success From the New Careers in Nursing Program
Authors: Spurlock Darrell R. , Patterson Barbara J. , Colby Normajean 
Published: June 2019

Abstract

AIM
The aim of the study was to examine the profile of male students in accelerated nursing education programs (ANEPs) focusing on key demographic, educational, and outcome variables and compare male and female students on these variables.

BACKGROUND
Though ANEPs have proliferated over the last two decades, there has been little study of students enrolled in these programs and, consequently, the role ANEPs could play in enhancing nursing workforce diversity.

METHOD
This study is a secondary analysis of data collected from 3,502 students who participated in the Robert Wood Johnson Foundation New Careers in Nursing Program from 2008 to 2016.

RESULTS
ANEP completion and NCLEX-RN® success rates were strong overall. Male and female ANEP students differed on several dimensions often associated with academic success, differences that have relevance for purposes of teaching, research, and program planning.

CONCLUSION
ANEPs could be an effective mechanism for increasing the gender, racial, and ethnic diversity of the nursing workforce.
Use of Music Lyrics to Engage Millennial Learners in Undergraduate Research
Authors: Sethares Kristen A. , Chin Elizabeth 
Published: June 2019

Abstract
Undergraduate research, a high-impact learning practice, peaks interest and enthusiasm for research and contributes to development of research process knowledge, skills, and competency. Fifty millennial sophomore nursing students participated in the innovative learning activity using lyrics from popular songs to complete qualitative analysis in a research course. Students analyzed, synthesized, and developed themes from music lyrics that helped them to more fully understand the processes and perspectives of qualitative research. This activity taught students about qualitative research and provided an opportunity to develop analysis, synthesis, and teamwork knowledge and skills transferable to the professional environment.
Using High-Fidelity Simulation to Evaluate Clinical Skills in Prelicensure Nursing Students
Authors: Turner Douglas M. 
Published: June 2019

Abstract
A prelicensure associate degree nursing program identified the need to formally validate clinical skills and decision-making within nursing students across the program and implemented a process using high-fidelity simulation. The simulated experiences provided an opportunity for both formative and summative evaluation while also affording an opportunity to level student performance across the program. Faculty reported improved consistency in their expectations of student performance within each nursing course, and students reported improved confidence in their clinical practice skills.
Second generation antihistamines: an update
Authors: Sánchez-Borges Mario , Ansotegui Ignacio J. 
Published: June 2019

Purpose of review
This article presents an update on the clinical pharmacology, mechanisms of action, and safety of second generation antihistamines (SGAHs).

Recent findings
Recent research has shown the efficacy and good tolerance of SGAHs supporting its indication as first line medications for the treatment of allergic rhinoconjunctivitis and urticaria.

Summary
The information contained in this review is relevant for the correct utilization of SGAHs by practicing physicians who take care of these highly prevalent clinical disorders.
Alliance, Trust, and Loss: Experiences of Patients Cared for by Students in a Longitudinal Integrated Clerkship
Authors: Flick Robert J. , Felder-Heim Caitlin , Gong Jennifer , Corral Janet , Kalata Kathryn , Marin Alejandro , Adams Jennifer E. 
Published: June 2019

Purpose
The longitudinal integrated clerkship (LIC) model, which allows medical students to participate in comprehensive care of a panel of patients over time, is rapidly expanding because of recognized benefits to students and faculty. This study aimed to determine how LIC student contact affected patients’ experiences and self-described health outcomes.

Method
This qualitative case study used semistructured patient interviews to understand the impact of LIC learners at the University of Colorado School of Medicine on patients at Denver Health. Patients with at least 3 encounters with an LIC student and over age 18 were selected. Thirty patients were invited to participate in 2016–2017; 14 (47%) completed interviews before the thematic analysis reached saturation. Four researchers independently analyzed interview transcripts and reached consensus on emergent categories and themes.

Results
Six broad themes were identified: beginnings of a relationship, caring demonstrated by student, growing to trust student, reaching a therapeutic alliance, improvement of patient outcomes due to student involvement, and a sense of loss after students completed the LIC program.

Conclusions
Patients deeply valued the therapeutic alliances built with LIC students involved in their care over time. These alliances led to improved patient experience, mitigation of perceived health system failures, and subjective improvement in health outcomes. Patients described a sense of loss at the end of the LIC when students were no longer involved in their care. Curricula that support students building longitudinal therapeutic relationships with their patients are an opportunity to improve patient experience while promoting students’ professional development.
Competency Committees in Undergraduate Medical Education: Approaching Tensions Using a Polarity Management Framework
Authors: Monrad Seetha U. , Mangrulkar Rajesh S. , Woolliscroft James O. , Daniel Michelle M. , Hartley Sarah E. , Gay Tamara L. , Highet Alexandra , Vijayakumar Nithya , Santen Sally A. 
Published: June 2019

Implementing competency-based medical education in undergraduate medical education (UME) poses similar and unique challenges to doing so in graduate medical education (GME). To ensure that all medical students achieve competency, educators must make certain that the structures and processes to assess that competency are systematic and rigorous. In GME, one such key structure is the clinical competency committee. In this Perspective, the authors describe the University of Michigan Medical School’s (UMMS’s) experience with the development of a UME competency committee, based on the clinical competency committee model from GME, and the first year of implementation of that committee for a single cohort of matriculating medical students in 2016–2017.
The UMMS competency committee encountered a number of inter dependent but opposing tensions that did not have a correct solution; they were “both/and” problems to be managed rather than “either/or” decisions to be made. These tensions included determining the approach of the committee (problem identification versus developmental); committee membership (curricular experts versus broad-based membership); student cohort makeup (phase-based versus longitudinal); data analyzed (limited assessments versus programmatic assessment); and judgments made (grading versus developmental competency assessment).
The authors applied the Polarity Management framework to navigate these tensions, leveraging the strengths of each while minimizing the weaknesses. They describe this framework as a strategy for others to use to develop locally relevant and feasible approaches to competency assessment in UME.
Moving Toward Summative Competency Assessment to Individualize the Postclerkship Phase
Authors: Keeley Meg G. , Gusic Maryellen E. , Morgan Helen K. , Aagaard Eva M. , Santen Sally A. 
Published: June 2019

In the move toward competency-based medical education, leaders have called for standardization of learning outcomes and individualization of the learning process. Significant progress has been made in establishing defined expectations for the knowledge, skills, attitudes, and behaviors required for successful transition to residency training, but individualization of educational processes to assist learners in reaching these competencies has been predominantly conceptual to date. The traditional time-based structure of medical education has posed a challenge to individualization within the curriculum and has led to more attention on innovations that facilitate transition from medical school to residency. However, a shift of focus to the clerkship-to-postclerkship transition point in the undergraduate curriculum provides an opportunity to determine how longitudinal competency-based assessments can be used to facilitate intentional and individualized structuring of the long-debated fourth year.
This Perspective demonstrates how 2 institutions—the University of Virginia School of Medicine and the University of Michigan Medical School—are using competency assessments and applying standardized outcomes in decisions about individualization of the postclerkship learning process. One institution assesses Core Entrustable Professional Activities for Entering Residency, whereas the other has incorporated Accreditation Council for Graduate Medical Education core competencies and student career interests to determine degrees of flexibility in the postclerkship phase. Individualization in addition to continued assessment of performance presents an opportunity for intentional use of curriculum time to develop each student to be competently prepared for the transition to residency.
Implications of juvenile idiopathic arthritis genetic risk variants for disease pathogenesis and classification
Authors: Nigrovic Peter A. , Martínez-Bonet Marta , Thompson Susan D. 
Published: June 2019

Purpose of review
We assess the implications of recent advances in the genetics of juvenile idiopathic arthritis (JIA) for the evolving understanding of inflammatory arthritis in children.

Recent findings
JIA exhibits prominent genetic associations with the human leukocyte antigen (HLA) region, extending perhaps surprisingly even to the hyperinflammatory systemic JIA category. Some HLA associations resemble those for adult-onset inflammatory arthritides, providing evidence for pathogenic continuity across the age spectrum. Genome-wide association studies have defined an increasing number of JIA-linked non-HLA loci, many again shared with adult-onset arthritis. As most risk loci contain only noncoding variants, new experimental methods such as SNP-seq and innovative big-data strategies help identify responsible causative mutations, termed functional SNPs (fSNPs). Alternately, gene hunting in multiplex families implicates new genes in monogenic childhood arthritis, including MYD88 and the intriguing innate immune gene LACC1.

Summary
Genetic data indicate a continuity between JIA and adult arthritis poorly reflected in current nomenclature. Advancing methodologies will help to identify new pathogenic mechanisms that inform the understanding of biologic subdivisions within JIA. Resulting insights will facilitate the application of lessons learned across the age spectrum to the treatment of arthritis in children and adults.
The Natural History of Lower Extremity Malalignment
Authors: McClure Philip K. , Herzenberg John E. 
Published: June 2019

Background:
Lower extremity malalignment is a common problem presented to pediatric orthopaedists. Risk for early arthritis is often a concern among parents seeking advice and treatment. We seek to review previous research with regard to the natural history of malalignment.

Methods:
A search of available literature on PubMed was constructed to capture articles covering the natural history of malalignment, secondary to childhood fracture as well as congenital and acquired pediatric deformity. In order to remain strictly relevant to pediatrics, articles reviewing deformities acquired in adulthood were not referenced. Biomechanical data and animal studies were included when deemed appropriate.

Results:
High-quality data with regard to long-term risk of arthritis due to malalignment is lacking. Through a combination of biomechanical data, animal models, and a small body of longitudinal clinical data, it is clear that some patients with malalignment progress to early arthritic change. Unfortunately, detailed risk factors of who is at high risk versus low risk remains difficult to determine.

Conclusions:
Treatment of minor lower extremity malalignment is not supported by the current orthopaedic literature. Treatment plans should focus on the presence of symptoms, and in asymptomatic but severe cases. Even in more severe cases, strong evidence to support prophylactic realignment is not available. Evidence to suggest that preventative realignment is superior to intervention at the time of symptom onset does not exist.
The Natural History of Femoroacetabular Impingement
Authors: Wylie James D. , Kim Young-Jo 
Published: June 2019

Background:
Structural hip abnormalities have long been suspected of causing hip osteoarthritis. The concept of deformity of the proximal femur as a cause of osteoarthritis (OA) started with description of the tilt deformity and progressed to the pistol grip, then eventually cam-type femoroacetabular impingement (FAI). Acetabular over-coverage or retroversion as a cause of impingement is commonly referred to as pincer-type FAI. The primary research question we asked was: what is the natural history of hips with FAI?

Methods:
We reviewed the literature to identify studies with cross-sectional and longitudinal evidence of the effect of FAI on the development of or association with hip OA.

Results:
In cross-sectional and longitudinal natural history studies of hip OA, cam-type FAI has consistently shown an association with developing OA. In regard to pincer-type FAI, the data are less convincing with some studies suggesting an increased risk and others showing a protective effect of the acetabular over-coverage. It is clear that not all patients with cam FAI get OA but the altered anatomy does increase the relative risk of developing OA.

Conclusions:
Cam-type FAI is associated with the development of hip OA; however, there is no role for prophylactic surgery in the asymptomatic hip with the anatomy predisposing to FAI. Further interventional studies are needed to determine whether surgical correction of cam-type FAI in the symptomatic hip alters the natural history of the condition.
Leg Length Discrepancy: The Natural History (And What Do We Really Know)
Authors: Gordon J. Eric , Davis Lauren E. 
Published: June 2019

Background:
The long-term effects of small limb length discrepancies have been poorly documented in the literature. References to low back pain, hip pathology, knee pathology, and foot problems abound in the popular literature. Health care providers frequently recommend the use of lifts for structural and functional limb length discrepancies, yet the natural history of limb length inequality as well as the effectiveness of treatments that may be recommended are obscure. The purpose of this paper is to document and evaluate the literature associated with small limb length discrepancies.

Methods:
A search of the English literature was carried out using PubMed to identify papers dealing with the effects of limb length discrepancies. Papers reporting only expert opinion or case reports were excluded.

Results:
Papers dealing with the natural history of limb length discrepancy as well as studies in which gait analysis was performed in patients with limb length discrepancy were identified. Only 10% of the population has exactly equal lower limb lengths. Approximately 90% of the population has a limb length discrepancy <1.0 cm. Hip and knee pathology is present in an increased number of patients with limb length discrepancies over 5 mm. Hip pathology is more often present in the long leg, knee pathology has been reported in various studies to be more common in either the long or short leg. Low back problems seem to be more common on the short side in patients with limb length discrepancies. A number of different compensatory mechanisms for limb length discrepancy have been identified during gait analysis.

Conclusions:
There seems to be a consensus that limb length discrepancies >2.0 cm are frequently a problem. There is some evidence that limb length discrepancies as little as 5 mm can lead to long-term pathology.