bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstruction of the Distal Leg and Foot Using Free Anterolateral Thigh Flaps in Patients With High-Voltage Electrical Burns
Authors: Uslu Asım 
Published: April 2019

AbstractIn a patient with a high-voltage electrical burns, the extent of burning is greatest at the entrance and exit points of the electric current. As the exit point is usually the ankle and/or foot, these areas may be the most severely damaged. As local tissue is limited in this region, free tissue transfer is usually required for reconstruction. Eleven anterolateral thigh free flaps were placed for the reconstruction of foot and ankle defects caused by electrical burns. When the defects were large, we placed the flaps with two or three perforators. In six patients, recipient vessels were prepared in the trauma region or immediately adjacent thereto. Reconstructions were performed at an average of 23.18 days after the burns, and the average hospitalization time was 42.27 days. Patients with burns on the dorsum of the foot often required toe amputations. In patients who underwent direct reconstruction (without debridement), re-operations were required because of graft loss in other burnt areas. The foot and ankle are the regions most damaged by electrical burns. Vessels in the trauma zone or immediately proximal thereto can serve as recipient vessels. Even when the defect is sizeable, a large anterolateral thigh flap with multiple perforators can be harvested. No vascular problem was encountered during early or late reconstruction. The free flap is very reliable when used to reconstruct foot tissue defects caused by electrical burns.
Endogenous Market Formation and Monetary Trade: An Experiment
Authors: Camera Gabriele , Goldberg Dror , Weiss Avi 
Published: April 2019

Abstract
The theory of money assumes decentralized bilateral exchange and excludes centralized multilateral exchange. However, endogenizing the exchange process is critical for understanding the conditions that support the use of money. We develop a “traveling game” to study the emergence of decentralized and centralized exchange, theoretically and experimentally. Players located on separate islands can either trade locally, or pay a cost to trade elsewhere, so decentralized and centralized markets can both emerge in equilibrium. The former minimize trade costs through monetary exchange; the latter maximizes overall surplus through nonmonetary exchange. Monetary trade emerges when coordination is problematic, whereas centralized trade emerges otherwise. This shows that to understand the emergence of money it is important to amend standard theory such that the market structure is endogenized.
Summer rest site selection by Appalachian eastern spotted skunks
Authors: Eng Robin Y Y , Jachowski David S 
Published: April 2019

AbstractEastern spotted skunks (Spilogale putorius) have suffered a dramatic range-wide decline leading to concern that the species is likely vulnerable to extinction, but were recently discovered to persist in a portion of the southern Appalachian Mountains (United States). For 2 years we investigated habitat selection by eastern spotted skunks to develop an understanding of their habitat and conservation needs in northwestern South Carolina. We used a discrete choice modeling framework to evaluate vegetative and topographic features that we predicted would influence rest site selection by male and female spotted skunks. Using VHF telemetry, we tracked 15 spotted skunks (10 males and 5 females) to 215 day-time rest sites between the months of April and August. Spotted skunks selected rest sites in close proximity to drainage channels, where the relative probability of selection decreased 18% and 50% with every 20-m increase in distance to a drainage channel for males and females, respectively. Relative probability of selection by female spotted skunks increased 30% for every one-unit increase in coarse woody debris (CWD), and relative probability of selection by male spotted skunks increased 25% for every 10% increase in understory cover. These results are consistent with previous studies that have identified cover as important for protection from predators; however, we additionally identified CWD and drainage channels as important to habitat selection by spotted skunks. These latter attributes are likely selected based on prey availability, but alternate ecological functions of these features warrant further investigation. Preservation of understory vegetation and CWD within drainage networks might benefit conservation of eastern spotted skunks in the southern Appalachians.
Microhabitat use by plateau pikas: living on the edge
Authors: Paruchuri Spurthi , Smith Andrew T , Fan Zhaofei , Dobson F Stephen 
Published: April 2019

AbstractMammals rely on habitat resources for survival and reproduction. We studied microhabitats used by plateau pikas (Ochotona curzoniae) of the Qinghai-Tibetan Plateau. Microhabitat features used by pikas include sedge meadows that provide forage, burrows that provide safety from predators and cover for nests, degraded open-dirt patches, and edges between sedge meadow and open dirt patches that often have a “lip” between those microhabitats. We investigated the extent to which these edges might serve as a preferred pika microhabitat. GIS techniques were used to overlay individual pika home ranges, determined by focal and scan sampling, on a digitized map containing microhabitat features. Regions that contained multiple coinciding individual home ranges, referred to as overlap polygons, were categorized numerically based on the number of individual home ranges that overlapped each polygon. These overlap polygons were used as relative measures of pika activity. We tested the spatial relationship between pika activity and the microhabitat features of edges, burrows, and proportional area of sedge. There was a significant relationship between the number of pikas in an overlap polygon and the number of pikas in an adjacent polygon. This pattern was controlled statistically to test whether activity was influenced by the presence of potentially favorable microhabitat features. Most of the variation in number of pikas that overlapped a habitat polygon was associated with the relative amount of “edge microhabitat” between sedge meadow and degraded open dirt patches (Cohen’s effect size, f2 = 0.91). Neither burrow openings nor sedge had a strong influence on the number of pika home ranges that overlapped. The importance of microhabitat edges appeared high for plateau pikas.
No cores in dark matter-dominated dwarf galaxies with bursty star formation histories
Authors: Bose Sownak , Frenk Carlos S , Jenkins Adrian , Fattahi Azadeh , Gómez Facundo A , Grand Robert J J , Marinacci Federico , Navarro Julio F , Oman Kyle A , Pakmor Rüdiger , Schaye Joop , Simpson Christine M , Springel Volker 
Published: April 2019

ABSTRACT
Measurements of the rotation curves of dwarf galaxies are often interpreted as requiring a constant density core at the centre, at odds with the ‘cuspy’ inner profiles predicted by N-body simulations of cold dark matter (CDM) haloes. It has been suggested that this conflict could be resolved by fluctuations in the inner gravitational potential caused by the periodic removal of gas following bursts of star formation. Earlier work has suggested that core formation requires a bursty and extended star formation history (SFH). Here we investigate the structure of CDM haloes of dwarf galaxies ($M_{{\rm DM}} \sim 10^9\!-\!5\times 10^{10}\, {\rm M}_\odot$) formed in the apostle (‘A Project of Simulating the Local Environment’) and auriga cosmological hydrodynamic simulations. Our simulations have comparable or better resolution than others that make cores ($M_{{\rm gas}} \sim 10^4\, {\rm M}_\odot$, gravitational softening ∼150 pc). Yet, we do not find evidence of core formation at any mass or any correlation between the inner slope of the DM density profile and temporal variations in the SFH. apostle and auriga dwarfs display a similar diversity in their cumulative SFHs to available data for Local Group dwarfs. Dwarfs in both simulations are DM-dominated on all resolved scales at all times, likely limiting the ability of gas outflows to alter significantly the central density profiles of their haloes. We conclude that recurrent bursts of star formation are not sufficient to cause the formation of cores, and that other conditions must also be met for baryons to be able to modify the central DM cusp.
Peers’ Income and Financial Distress: Evidence from Lottery Winners and Neighboring Bankruptcies
Authors: Agarwal Sumit , Mikhed Vyacheslav , Scholnick Barry 
Published: April 2019

Abstract
We examine whether relative income differences among peers can generate financial distress. Using lottery winnings as plausibly exogenous variations in the relative income of peers, we find that the dollar magnitude of a lottery win of one neighbor increases subsequent borrowing and bankruptcies among other neighbors. We also examine which factors may mitigate lenders’ bankruptcy risk in these neighborhoods. We show that bankruptcy filers obtain more secured, but not unsecured, debt, and lenders provide additional credit to low-risk, but not high-risk, debtors. In addition, we find evidence consistent with local lenders taking advantage of soft information to mitigate credit risk.
Received October 12, 2016; editorial decision January 15, 2019 by Editor Philip Strahan. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Dealing With Patient Death on International Health Electives: A Qualitative Study of Residents’ Experiences
Authors: Bashir M. Usmaan , Nordhues Hannah C. , Merry Stephen P. , Sawatsky Adam P. 
Published: April 2019

Purpose
International health electives (IHEs) provide numerous educational benefits; potential harms are less well understood. One potential harm is trainee distress associated with increased patient death during IHEs. The purpose of this study was to explore residents’ and fellows’ IHE experiences with patient death.

Method
The authors used applied thematic analysis to explore residents’ and fellows’ IHE experiences with patient death. The Mayo International Health Program supports IHEs from all specialties across three Mayo Clinic sites. Data were collected and analyzed in two steps. First the authors collected, coded, and analyzed narrative reflections from 43 postrotation reports gathered in 2001–2017 and identified themes relating to experiences with patient death. Second, in 2016–2017 the authors conducted semistructured interviews with six previous participants to refine thematic analysis.

Results
Participants described impacts of experiencing increased patient death and identified themes in two domains: difficult experiences with patient death and potential interventions to help residents process their experiences. They identified four themes illustrating why these experiences were difficult: lack of preparation for increased exposure to death, lack of closure, consequences of limited resources, and differences in cultural beliefs regarding death. While pretrip preparation for dealing with death was viewed as important, trainees identified support during and debriefing after IHEs as additional important interventions.

Conclusions
Given the popularity of IHEs, residency programs should consider the effect on trainees of increased exposure to patient death. Study findings can inform IHE preparation, support, and debriefing to minimize distress associated with witnessing patient deaths on IHEs.
The Hidden Curriculum of Compassionate Care: Can Assessment Drive Compassion?
Authors: Wright Sarah R. , Boyd Victoria A. , Ginsburg Shiphra 
Published: April 2019

Purpose
Medical schools are expected to promote compassionate care among learners. Assessment is a key way to communicate values to learners but can create a hidden curriculum. Assessing compassionate care is challenging; however, not assessing it can communicate to students that such care is not valued. The purpose of this study was to explore how current assessment strategies promote or suppress the idea that caring behaviors are valued learning objectives.

Method
Data sources were third-year course documents; interviews of 9 faculty, conducted between December 2015 and February 2016; and focus groups with 13 third-year medical students and an interview with 1 third-year medical student, conducted between February and June 2016. The stated intentions of third-year assessments were compared with the behaviors rewarded through the assessment process and the messages students received about what is valued in medical school.

Results
Syllabi did not include caring as a learning outcome. Participants recognized assessment as a key influence on student focus. Faculty perspectives varied on the role of medical schools in assessing students’ caring and compassion. Students prioritized studying for assessments but described learning about caring and compassion from interactions such as meaningful patient encounters and both positive and negative role models that were not captured in assessments.

Conclusions
Faculty members expressed concern about not assessing caring and compassion but acknowledged the difficulty in doing so. While students admitted that assessments influenced their studying, their reported experiences revealed that the idea that “assessment drives learning” did not capture the complexity of their learning.
Placement of Provisional External Fixation of Pediatric Femoral Shaft Fractures Using Radiopaque Markers in the Setting of Severe Polytrauma: A Technical Report
Authors: Haidar Layla A. , Sliwinski Lisa , Warth Ryan J. , Mansour Alfred 
Published: April 2019

Background:
In polytraumatic pediatric patients, life-saving or stabilizing measures must often be prioritized over permanent orthopedic solutions to a fractured extremity. The standard application of external fixation to femur fractures can be difficult in the pediatric intensive care unit setting due to the limited mobility of the patient and adaptability of C-arm radiography. We propose a technique utilizing radiopaque markers and digital radiographs in lieu of C-arm imaging to accurately plan the pin placement in a reproducible manner that eases application and reduces errant placement that may result in physeal injury.

Methods:
Two patients are reported, aged 7 and 11, involved in motor vehicle accidents who sustained multiple injuries including femur fractures which were addressed with this method. Beekley Medical 7″×7.5″ Guidelines calibrated radiopaque markers were placed on the involved thigh and a single digital radiograph was performed. On the basis of preoperative templating from the radiographic markers, the fracture site and proposed pin sites were marked and the pins were placed.

Results:
Both patients eventually had the external fixators removed and underwent definitive fixation with internal fixation. They both healed with successful union of the femoral fracture.

Conclusions:
The use of radiopaque markers reproducibly aids radiologically guided placement of threaded Shanz pins during external fixation of femur fractures in polytraumatized pediatric patients undergoing damage control orthopaedics. The technique also minimizes radiation exposure, uses equipment readily available in the hospital setting, and alleviates the need to have a radiolucent bed in the pediatric intensive care unit.

Level of Evidence:
Case report.
Large Variation in Provincial Guidelines for Urine Drug Screening During Opioid Agonist Treatment in Canada
Authors: Moss Eloise , McEachern Jasmine , Adye-White Lauren , Priest Kelsey C. , Gorfinkel Lauren , Wood Evan , Cullen Walter , Klimas Jan 
Published: April 2019

ABSTRACT
Urine drug screening (UDS) is commonly used to detect or validate self-reported substance use, particularly when beginning and maintaining opioid agonist therapy. However, there is currently no summary of the published clinical practice guidelines for UDS in Canada, and no measure of the consistency with which different provinces suggest administering UDS. Therefore, we conducted a policy scan of UDS guidelines, examining the published clinical practice guidelines for each Canadian province and extracting all relevant data in March 2017. Our Canadian guideline and policy scan found that UDS frequency recommendations vary greatly among Provinces for persons receiving opioid agonist therapy for opioid use disorder.
Le dépistage des drogues par l’urine (UDS) est couramment utilisé pour détecter ou valider l’utilisation de substances auto-déclarées, en particulier lorsque l’on commence et que l’on maintient un traitement par des agonistes opioïdes (OAT). Cependant, il n’y a actuellement aucun résumé des lignes directrices de pratique clinique publiées pour le UDS au Canada, et aucune mesure de l’uniformisation avec laquelle les différentes provinces suggèrent d’administrer le UDS. Par conséquent, nous avons effectué une analyse des lignes directrices UDS, en examinant les lignes directrices de pratique clinique publiées pour chaque province canadienne et en extrayant toutes les données pertinentes en mars 2017. Notre analyse des lignes directrices et des politiques canadiennes révèle que les recommandations de fréquence UDS varient grandement d’une province à l’autre pour les personnes recevant une OAT pour trouble d’utilisation des opioïdes.
Limits for the Magnitude of M-bias and Certain Other Types of Structural Selection Bias
Authors: Flanders W. Dana , Ye Dongni 
Published: April 2019

Background:
Structural selection bias and confounding are key threats to validity of causal effect estimation. Here, we consider M-bias, a type of selection bias, described by Hernán et al as a situation wherein bias is caused by selecting on a variable that is caused by two other variables, one a cause of the exposure, the other a cause of the outcome. Our goals are to derive a bound for (the maximum) M-bias, explore through examples the magnitude of M-bias, illustrate how to apply the bound for other types of selection bias, and provide a program for directly calculating M-bias and the bound.

Methods:
We derive a bound for selection bias assuming specific, causal relationships that characterize M-bias and further evaluate it using simulations.

Results:
Through examples, we show that, in many plausible situations, M-bias will tend to be small. In some examples, the bias is not small–but plausibility of the examples, ultimately to be judged by the researcher, may be low. The examples also show how the M-bias bound yields bounds for other types of selection bias and also for confounding. The latter illustrates how Lee’s bound for confounding can arise as a limiting case of ours.

Conclusions:
We have derived a new bound for M-bias. Examples illustrate how to apply it with other types of selection bias. They also show that it can yield tighter bounds in certain situations than a previously published bound for M-bias. Our examples suggest that M-bias may often, but not uniformly, be small.
Estimation of Blood Sirolimus Concentration Based on Tacrolimus Concentration/Dose Normalized by Body Weight Ratio in Lung Transplant Patients
Authors: Kikuchi Masafumi , Shigeta Kensuke , Tanaka Masaki , Takasaki Shinya , Akiba Miki , Oishi Hisashi , Sado Tetsu , Matsuda Yasushi , Noda Masafumi , Okada Yoshinori , Mano Nariyasu , Yamaguchi Hiroaki 
Published: April 2019

Background:Sirolimus and tacrolimus require accurate drug dosing based on their target blood levels to produce better clinical outcomes, specifically, the avoidance of drug-induced adverse effects and the maintenance of efficacy. However, because the ideal dose of sirolimus and the schedule for measuring its blood levels are unclear in lung transplant patients, an index is required for estimating sirolimus blood concentrations. The aim of this work is to study the correlation between the trough concentration/dose normalized by body weight (C0/D) ratios of sirolimus and tacrolimus in lung transplant patients.Methods:Thirteen lymphangiomyomatosis patients who underwent lung transplantation and were treated with sirolimus and tacrolimus from February 2015 to July 2018 were divided into 2 groups, one receiving twice-daily (TD, n = 6) and the other once-daily (OD, n = 7) tacrolimus formulations. The correlation between the C0/D ratio of sirolimus and patient background was evaluated using Spearman's rank correlation coefficient. Correlations between sirolimus and tacrolimus C0/D ratios or doses were analyzed by single regression analysis.Results:Significant correlations were found between the C0/D ratios of sirolimus and tacrolimus. The regression equations from the initial data of TD and OD groups at steady state were y = 1.880x + 32.636 (adjustedR2= 0.743,P= 0.017) and y = 1.684x + 38.816 (adjustedR2= 0.919,P< 0.001), respectively. In addition, the regression equations from all data of TD and OD groups were y = 1.883x + 4.170 (adjustedR2= 0.546,P< 0.001) and y = 1.950x + 43.188 (adjustedR2= 0.898,P< 0.001), respectively. A significant correlation between the dosage of sirolimus and tacrolimus was observed only in the OD group, with relatively low accuracy.Conclusions:Blood sirolimus concentrations can be estimated using the C0/D ratio of tacrolimus, suggesting that the C0/D ratio of tacrolimus is an index of required sirolimus dosage and the frequency of blood sirolimus concentration measurements.
The Level of Compliance With the Use of Personal Radiation Monitoring Devices by Qualified Radiographers at Provincial Hospitals in the Tshwane District Area
Authors: Sethole Khethiwe Margaret , Ahrens Erika , Kruger Ursula 
Published: April 2019

Abstract
When researchers accompanied radiography students during their work integrated learning, it was observed that there is non-compliance with regards the use of personal radiation monitoring devices by radiographers in the Radiology Departments at Provincial hospitals in the Tshwane district area. The aim of this research study was to identify the level of compliance with the use of radiation monitoring devices by radiographers. A quantitative descriptive study method was used, and the data collection tool was questionnaires that were hand delivered to all settings. The sample size of radiographers was 96, and consent was received from 61 participants. The data was collated in a Microsoft Excel® spreadsheet, and the variables were statistically analyzed for frequencies and percentages. The Fisher’s exact test was used for association to answer the level of compliance and management of the radiation monitoring device. Results showed compliance of radiographers in the wearing of radiation monitoring devices but inconsistency as to where the radiation monitoring device should be worn. A lack of awareness about policies from the Radiation Board was also noted.