bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complement Component C3 Binds to the A3 Domain of von Willebrand Factor
Authors: Nolasco Jennifer , Nolasco Leticia , Da Qi , Cirlos Sonya , Ruggeri Zaverio , Moake Joel , Cruz Miguel 
Published: September 2018

Abstractvon Willebrand factor (VWF) is a multimeric protein composed of monomeric subunits (∼280 kD) linked by disulfide bonds. During hemostasis and thrombosis, ultralarge (UL) VWF (ULVWF) multimers initiate platelet adhesion. In vitro, human C3 binds to ULVWF multimeric strings secreted by and anchored to human endothelial cell to promote the assembly and activation of C3 convertase (C3bBb) and C5 convertase (C3bBbC3b) of the alternative complement pathway (AP). The purified and soluble C3 avidly binds to recombinant human VWF A1A2A3, as well as the recombinant isolated human VWF A3 domain. Notably, the binding of soluble human ULVWF multimers to purified human C3 was blocked by addition of a monovalent Fab fragment antibody to the VWF A3 domain. We conclude that the A3 domain in VWF/ULVWF contains a docking site for C3. In contrast, purified human C4, an essential component of the classical and lectin complement pathways, binds to soluble, isolated A1, but not to ULVWF strings secreted by and anchored to endothelial cells. Our findings should facilitate the design of new therapeutic agents to suppress the initiation of the AP on ULVWF multimeric strings during thrombotic and inflammatory disorders.
IL-15 regulates susceptibility of CD4+T cells to HIV infection
Authors: Manganaro Lara , Hong Patrick , Hernandez Matthew M. , Argyle Dionne , Mulder Lubbertus C. F. , Potla Uma , Diaz-Griffero Felipe , Lee Benhur , Fernandez-Sesma Ana , Simon Viviana 
Published: September 2018

SignificanceHIV creates a persistent reservoir, which is largely resistant to current antiretroviral treatment aimed at inhibiting HIV replication. CD4+T memory lymphocytes, key components of this reservoir, are generally refractory to infection, but stimulation with γc-chain cytokines, such as IL-15, renders these cells more susceptible to HIV. We found that, by inducing cell cycle entry of CD4+T cells, JAK1 is a key mediator responsible for counteracting the antiviral activity of SAM domain and HD domain-containing protein 1 (SAMHD1). Pharmacological inhibition of these kinases resulted in restoration of SAMHD1 in CD4+T cells. Protecting these cells during the critical IL-15 surge observed during primary infection has the potential to limit reservoir establishment.
ERβ-mediated induction of cystatins results in suppression of TGFβ signaling and inhibition of triple-negative breast cancer metastasis
Authors: Reese Jordan M. , Bruinsma Elizabeth S. , Nelson Adam W. , Chernukhin Igor , Carroll Jason S. , Li Ying , Subramaniam Malayannan , Suman Vera J. , Negron Vivian , Monroe David G. , Ingle James N. , Goetz Matthew P. , Hawse John R. 
Published: September 2018

Significance
Triple-negative breast cancer (TNBC) is the most aggressive form of breast cancer and patients exhibit high rates of recurrence and mortality in part due to lack of treatment options beyond standard-of-care chemotherapy regimens. In the subset of TNBCs that express estrogen receptor beta (ERβ), ligand-mediated activation of ERβ elicits potent anticancer effects. We report here the elucidation of the ERβ cistrome and transcriptome in TNBC and identify a mechanism whereby ERβ induces cystatin gene expression resulting in inhibition of canonical TGFβ signaling and a blockade of metastatic phenotypes. These findings suggest that ERβ-targeted therapies represent a treatment option for the subset of women with ERβ-expressing TNBC.
Analysis of running stability during 5000 m running*
Authors: Hoenig Tim , Hamacher Daniel , Braumann Klaus‐Michael , Zech Astrid , Hollander Karsten 
Published: September 2018

AbstractIn the analysis of human walking, the assessment of local dynamic stability (LDS) has been widely used to determine gait stability. To extend the concepts of LDS to the analysis of running biomechanics, this study aimed to compare LDS during exhaustive running between competitive and recreational runners. Fifteen recreational and fifteen competitive runners performed an exhaustive 5000 m run. Inertial measurement units at foot, pelvis, and thorax were used to determine local dynamic running stability as quantified by the largest Lyapunov exponent. In addition, we measured running velocity, lactate levels, perceived exertion, and foot strike patterns. LDS at the start, mid, and end of a 5000 m run was compared between the two groups by a two‐way repeated‐measures analysis of variance (ANOVA). Local dynamic stability increased during the run (thorax, pelvis) in both recreational and competitive runners (PThorax = 0.006; PPelvis = 0.001). During the whole run, competitive runners showed a significantly higher LDS (P = 0.029) compared to recreational runners at the foot kinematics. In conclusion, exhaustive running can lead to improvements in LDS, indicating a higher local dynamic stability of the running technique with increasing exhaustion. Furthermore, LDS of the foot differs between the two groups at all measurement points. The results of this study show the value of determining LDS in athletes as it can give a better understanding into the biomechanics of running.
‘Race was a motivating factor’: re-segregated schools in the American states
Authors: Johnson Richard , King Desmond 
Published: September 2018

AbstractDuring the Obama presidency, Republicans made major gains in state legislative elections, especially in the South and the Midwest. Republicans’ control grew from 13 legislatures in 2009 to 32 in 2017. A major but largely unexamined consequence of this profound shift in state-level partisan control was the resurgence of efforts to re-segregate public education. We examine new re-segregation policies, especially school district secession and anti-busing laws, which have passed in these states. We argue that the marked reversal in desegregation patterns and upturn in re-segregated school education is part of the Republican Party's anti-civil rights and anti-federal strategies, dressed up in the ideological language of colour-blindness.
Exponential self-similar mixing by incompressible flows
Authors: Alberti Giovanni , Crippa Gianluca , Mazzucato Anna 
Published: September 2018

We study the problem of the optimal mixing of a passive scalar under the action of an incompressible flow in two space dimensions. The scalar solves the continuity equation with a divergence-free velocity field, which satisfies a bound in the Sobolev spaceWs,pW^{s,p}, wheres≥0s \geq 0and1≤p≤∞1\leq p\leq \infty. The mixing properties are given in terms of a characteristic length scale, called the mixing scale. We consider two notions of mixing scale, one functional, expressed in terms of the homogeneous Sobolev norm H˙−1\dot H^{-1}, the other geometric, related to rearrangements of sets. We study rates of decay in time of both scales under self-similar mixing. For the case s=1s=1and1≤p≤∞1 \leq p \leq \infty(including the case of Lipschitz continuous velocities and the case of physical interest of enstrophy-constrained flows), we present examples of velocity fields and initial configurations for the scalars that saturate the exponential lower bound, established in previous works, on the time decay of both scales. We also present several consequences for the geometry of regular Lagrangian flows associated to Sobolev velocity fields.
Some examples of composition operators and their approximation numbers on the Hardy space of the bidisk
Authors: Li Daniel , Queffélec Hervé , Rodríguez-Piazza Luis 
Published: September 2018

We give examples of composition operatorsCΦC_\PhionH2(D2)H^2 ({\mathbb D}^2)showing that the condition‖Φ‖∞=1\|\Phi \|_\infty = 1is not sufficient for their approximation numbersan(CΦ)a_n (C_\Phi )to satisfylimn→∞[an(CΦ)]1/n=1\lim _{n \to \infty } [a_n (C_\Phi ) ]^{1/\sqrt {n}} = 1, contrary to the11-dimensional case. We also give a situation where this implication holds. We make a link with the Monge–Ampère capacity of the image ofΦ\Phi.
Submillimetre dust polarization and opacity in the HD163296 protoplanetary ring system
Authors: Dent W R F , Pinte C , Cortes P C , Ménard F , Hales A , Fomalont E , de Gregorio-Monsalvo I 
Published: September 2018

ABSTRACT
We present ALMA images of the sub-mm continuum polarization and spectral index of the protoplanetary ringed disc HD163296. The polarization fraction at 870 µm is measured to be ∼0.9 per cent in the central core and generally increases with radius along the disc major axis. It peaks in the gaps between the dust rings, and the largest value (∼4 per cent) is found between rings 1 and 2. The polarization vectors are aligned with the disc minor axis in the central core, but become more azimuthal in the gaps, twisting by up to ±9° in the gap between rings 1 and 2. These general characteristics are consistent with a model of self-scattered radiation in the ringed structure, without requiring an additional dust alignment mechanism. The 870/1300 µm dust spectral index exhibits minima in the centre and the inner rings, suggesting these regions have high optical depths. However, further refinement of the dust or the disc model at higher resolution is needed to reproduce simultaneously the observed degree of polarization and the low spectral index.
External Governance and Debt Structure
Authors: Bharath Sreedhar T , Hertzel Michael 
Published: September 2018

Abstract
This paper examines how external governance pressure affects the type of debt that firms issue. Consistent with a governance mechanism substitution effect, we find that an exogenous increase (decrease) in governance pressure from the product (takeover) market has a significant negative (positive) impact on the use of bank (public debt) financing over public debt (bank loan) issuance. Tests using changes in the strictness of loan covenants provide corroborative evidence. These findings are consistent with the notion that firms endogenously substitute governance mechanisms and that demand for creditor governance depends on the relative strength of alternative external governance mechanisms.
Received May 18, 2016; editorial decision November 11, 2017 by Editor David Denis.
An Analysis of the Nulliparous, Term, Singleton, Vertex Cesarean Birth Rate Among Practice Groups in a High-Volume Community Teaching Hospital
Authors: Wang Tiffany , Kawakita Tetsuya , Fernandez Miguel , Tefera Eshetu , Fernandez Stephen , Moxley Michael 
Published: September 2018

PURPOSE:
Data regarding factors that influence the nulliparous, term, singleton, vertex (NTSV) cesarean birth rate is limited. This study's purpose was to compare the NTSV cesarean rate across practice groups at Virginia Hospital Center (VHC).

BACKGROUND:
VHC is a high-volume community teaching hospital in Arlington, Virginia. Labor and Delivery is managed by different practice groups: hospitalists with resident coverage, hospitalists without resident coverage, and private attendings. Hospitalists are attending physicians who provide 24-hour in-house management of laboring patients, whereas private attendings are only expected to be in-house for patients in active labor.

METHODS:
This was a retrospective cohort study of all NTSV pregnant women who delivered at VHC from 2014 to 2016. Chi-square tests were used to determine whether NTSV cesarean rates were significantly different over time and across different practice groups.

RESULTS:
There were 2,339, 2,090, and 1,673 NTSV pregnancies in 2014, 2015, and 2016, respectively. The NTSV cesarean rate decreased significantly by 30.8% (31.8% in 2014, 27.7% in 2015, and 22.0% in 2016, 0.01). The NTSV cesarean rate was significantly lower with hospitalists, with the lowest rate in the hospitalists with resident coverage (NTSV rate of 19.8% for hospitalists plus residents, 25.7% for hospitalists without residents, 30.3% for private attendings, 0.01). All groups decreased their NTSV cesarean birth rate over time, with significant decreases in the hospitalists without residents and private attending groups (0.01).

DISCUSSION:
Having 24-hour in-house attending coverage is associated with lower NTSV cesarean rates. Resident involvement may also be a factor in lowering this rate.
Teaching Wellness Skills: Effect of a Curriculum Designed to Increase Physician Resilience on Obstetrics and Gynecology Intern Burnout, Mindfulness and Self-compassion
Authors: Fitzmaurice Laura , Peterson Brennan , Boehm Julia 
Published: September 2018

PURPOSE:
To assess whether a curriculum targeting psychological resilience impacts the burnout, mindfulness and self-compassion of obstetrics and gynecology interns.

BACKGROUND:
Physician burnout impacts more than half of obstetrician/gynecologists nationwide. One strategy to reduce burnout is to improve individual physicians' resiliency through cognitive and behavioral strategies linked to wellness in other populations.

METHODS:
A prospective, longitudinal cohort, mixed-methods evaluation of a 12-hour curriculum taught to a residency class of seven obstetrics and gynecology interns was conducted using paired, de-identified, pre- and post-curriculum assessments of Maslach Burnout Inventory (MBI), Five Facets of Mindfulness Questionnaire (FFMQ) and Self-Compassion Scale for Researchers (SCS) scores. Data were analyzed descriptively looking primarily at changes in paired scores. A post-curriculum focus group was conducted to further investigate curriculum acceptance and impact.

RESULTS:
Burnout exhaustion and depersonalization scores increased following the curriculum (median difference 3 and 3, respectively). FFMQ and SCS scores also increased (median difference 20 and 7, respectively). Focus group findings suggested interns valued the curriculum, but described an acute increase in distress as they were taken out of their prior “just powering through” coping strategy.

DISCUSSION:
A wellness curriculum targeting improved resident resilience was associated with an acute worsening of burnout, but with short-term improvements in mindfulness and self-compassion, both of which have been associated with improved well-being and resilience in other populations. Worsened burnout may have been a result of increased awareness of uncomfortable thoughts and feelings. Extensive further research is needed on how to develop and measure physician resilience, including long-term implications of improved mindfulness and self-compassion.
The Impact of a Structured Wellness Curriculum on Burnout Among Obstetrics and Gynecology Residents
Authors: Tedrick Laura , Lawrence Elizabeth , Stonehocker Jody , Crawley Ashlee , Jeppson Peter 
Published: September 2018

PURPOSE:
Our primary aim was to evaluate the effects of a formalized wellness curriculum on the rate of burnout among University of New Mexico (UNM) obstetrics and gynecology (OBGyn) residents. Our secondary aim was to evaluate the effect of a wellness curriculum on rates of depression, alcohol abuse and suicide risk.

BACKGROUND:
Burnout is a pathological syndrome characterized by depersonalization, emotional exhaustion and a low sense of personal achievement. Burnout is a concern for resident physicians due to their heavy workload and low sense of autonomy.

METHODS:
A structured wellness curriculum was instituted at the start of the 2016 academic year. A 45-item survey, consisting of the Maslach Burnout Inventory Human Services Survey (MBI-HSS), personal health questionnaire-9 (PHQ9), suicide behaviors questionnaire-revised (SBQr), and the alcohol use disorders identification test (AUDIT), was to be administered at the start, midpoint, and end of the academic year.

RESULTS:
The study included 23 UNM OBGyn residents. Midpoint and end of curriculum surveys were collected as planned and demonstrated no difference in rate of burnout. Upon completion of the 2016 academic year 18 (78.2%) residents reported moderate to severe emotional exhaustion; 13 (59.1%) moderate to severe depersonalization; and 5 (21.7%) low personal achievement. SBQ-R identified 4 (18.2%) residents at high risk for suicide and AUDIT-C identified 15 (68.2%) at high risk for alcohol abuse.

DISCUSSION:
High rates of burnout, depression, alcohol abuse, and suicide risk did not change between the midpoint and end of a structured wellness curriculum.
Ultrasound Training in Obstetrics and Gynecology Residency: A National Portrait
Authors: Doyle Nora 
Published: September 2018

PURPOSE:
To understand current training in obstetric and gynecologic ultrasound.

BACKGROUND:
Modern obstetrics and gynecology practice requires the frequent use of ultrasound (US) and therefore US training has become an important part of resident education. We sought to understand how residents are currently being trained in obstetric and gynecologic US by surveying residency program directors.

METHODS:
We developed a 36 item self-administered questionnaire targeted for residency program directors (PD). PD from all 261 accredited programs were invited to participate. We inquired about US curriculums, time spent in US training, types of US taught, learning environments and instructors, feedback regarding resident competence and resident input of the learning experience. IRB approval was obtained prior to study onset.

RESULTS:
We received 108 completed responses. PD from all geographical US areas and Canada responded. PD self-described their programs as 52% university based, 28% community based, 18% combination of university/community based and 2% military. Over 65% reported US education was built into the curriculum as a distinct rotation. Of the US rotations >50% were described as a one month separate block. 40% stated 1–4 hours week devoted to US education. 99% said supervised instruction was the norm with the majority of teachers being MFM physicians/sonographers. A mixture of observational and hands-on ultrasound experience is the norm for most programs. Over 76% PD gave residents US reading assignments and have formal lectures, mostly by MFM and REI faculty. Less than 20% of programs supported any experience with ultrasound simulator training. 90% of PD give formal feedback to the residents about their skills. Only 69% state that their residents can evaluate the learning experience.

DISCUSSION:
We recount details of the current status of US education in OB/Gyn residency programs as reported by PD across the country. Our questions were designed to understand the amount of time actually committed to ultrasound education. With the inception of widespread US need in the daily life of obstetrics and gynecology the challenge of ensuring adequate resident training exists. More structure and protected learning time may assist in resident training. Simulator training for US education seems underutilized.
The Use of Standardized Patients to Increase Medical Student Awareness of and Confidence in Screening for Human Trafficking
Authors: Mercer Laura , Ludwig Amy , Smith Jeremi , Erickson Laurie , Manriquez Maria 
Published: September 2018

Local Mentor:

Laurie Erickson, MD

APGO Advisor:

Jody Steinauer, MD, MAS

PROBLEM:
Human trafficking is a growing problem, but is often unrecognized. Victims are frequently kept in isolation with little freedom and autonomy, limiting their access to resources and recovery. Skilled health care providers can be the first to intervene on the victim’s behalf. A healthcare provider’s knowledge of the signs/symptoms of trafficking, the use of skillful communication techniques, and a familiarity of the patient's rights and resources are vital.

INTERVENTION:
Medical students are assigned a web-based independent learning module about human trafficking, its signs and symptoms, intervention strategies, and resources. Each student then participates in a simulation with a standardized patient (SP) who is a victim of trafficking, a detail the student must uncover with history taking. They then complete reflective writing, receive individual feedback from the SP, and participate in a group faculty/peer debrief session.

CONTEXT:
The intervention occurs at the University of Arizona College of Medicine – Phoenix during the required OBGYN clerkship, with the standardized patient and follow-up experiences occurring during the final week of the six-week clerkship.

OUTCOME/LESSONS LEARNED:
Comparing pre-and post-intervention surveys of medical students identified a significant rise in confidence both in their ability to identify and also support victims of sex trafficking. In reflective essays, students most often feel sad, disappointed, or helpless during the SP encounter, but they remain committed develop rapport, provide resources, and empower their patient. These findings suggest that this is an effective educational intervention to teach medical students about sex trafficking.
Hysteroscopic Resection Training Utilizing a Virtual Reality and Low Fidelity Model: A Pilot Study
Authors: Patel Nima R. , Johnson Christina M. , Makai Gretchen E. 
Published: September 2018

Faculty Advisor:

Amy Boardman, MD

PURPOSE:
To evaluate effectiveness of Virtual Reality (VR) and low-fidelity inanimate model for training OB/GYN residents in hysteroscopic resection.

BACKGROUND:
While surgical training in gynecology is often accomplished through supervision in the operating room, simulation allows risk-free surgical skills practice. VR and low-fidelity models provide training of different surgical procedures, which could improve resident confidence and knowledge with less common procedures. As mechanical resection device use continues to increase, residents have fewer opportunities to train with hysteroscopic resectoscopes.

METHODS:
This prospective, cohort trial at Christiana Care, a large community hospital, enrolled 24 PGY1-4 OBGYN residents. All participants served as their own controls and underwent pre-intervention objective skills assessment testing (OSAT) for hysteroscopic resection using a low-fidelity potato model. Intervention included completion of a VR hysteroscopic simulator module to achieve a score >95%. Participants then underwent immediate post-intervention OSAT. All participants completed a subjective survey assessing comfort levels with the procedure pre- and post-intervention. All low-fidelity hysteroscopic resections were recorded and scored by a single, blinded evaluator.

RESULTS:
Seven OSAT surgical skills and subjective measures were assessed using a Likert Scale of 1 (low) to 5 (high). PGY 3&4 residents showed improvement in camera management, tissue handling, and instrument management (P=<.05). Three-month repeat OSATs showed retention of the same skills plus flow of procedure in all residents. Subjectively, there was significant improvement in comfort level of knowledge of procedural steps and energy, and using the loop resectoscope.

DISCUSSION:
Simulation improved baseline surgical skills and led to retention and improvement of same skills. Resident training should include simulation to increase both baseline development and retention of surgical skills.
Diabetic autonomic neuropathy resulting in sexual dysfunction
Authors: Wooton Angela K. , Melchior Lynne M. 
Published: September 2018

Abstract:
Although diabetic autonomic neuropathy (DAN), a complication associated with diabetes, is increasing in prevalence, it is often overlooked. Knowledge regarding the development and progression of this complication is limited. NPs are in a key position to prevent complications of DAN, including sexual dysfunction, in this vulnerable population.