bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incorporating non-stomatal limitation improves the performance of leaf and canopy models at high vapour pressure deficit
Authors: Yang J , Duursma R A , De Kauwe M G , Kumarathunge D , Jiang M , Mahmud K , Gimeno T E , Crous K Y , Ellsworth D S , Peters J , Choat B , Eamus D , Medlyn B E 
Published: October 2019

Abstract
Vapour pressure deficit (D) is projected to increase in the future as temperatures rise. In response to increased D, stomatal conductance (gs) and photosynthesis (A) are reduced, which may result in significant reductions in terrestrial carbon, water, and energy fluxes. It is thus important for gas exchange models to capture the observed responses of gs and A with increasing D.
We tested a series of coupled A-gs models against leaf gas exchange measurements from the Cumberland Plain Woodland (Australia), where D regularly exceeds 2 kPa and can reach 8 kPa in summer. Two commonly used A-gs models (Leuning 1995 and Medlyn et al. 2011) were not able to capture the observed decrease in A and gs with increasing D at the leaf scale. To explain this decrease in A and gs, two alternative hypotheses were tested: hydraulic limitation (i.e., plants reduce gs and/or A due to insufficient water supply) and non-stomatal limitation (i.e., downregulation of photosynthetic capacity). We found that the model that incorporated a non-stomatal limitation captured the observations with high fidelity and required the fewest number of parameters. While the model incorporating hydraulic limitation captured the observed A and gs, it did so via a physical mechanism that is incorrect.
We then incorporated a non-stomatal limitation into the stand model, MAESPA, to examine its impact on canopy transpiration and gross primary production. Accounting for a non-stomatal limitation reduced the predicted transpiration by ~19%, improving the correspondence with sap flow measurements, and gross primary production by ~14%. Given the projected global increases in D associated with future warming, these findings suggest that models may need to incorporate non-stomatal limitation to accurately simulate A and gs in the future with high D. Further data on non-stomatal limitation at high D should be a priority, in order to determine the generality of our results and develop a widely applicable model.
A Signal Through the Noise: Do Professionalism Concerns Impact the Decision Making of Competence Committees?
Authors: Odorizzi Scott , Cheung Warren J. , Sherbino Jonathan , Lee A.C. , Thurgur Lisa , Frank Jason R. 
Published: October 2019

Purpose
To characterize how professionalism concerns influence individual reviewers’ decisions about resident progression using simulated competence committee (CC) reviews.

Method
In April 2017, the authors conducted a survey of 25 Royal College of Physicians and Surgeons of Canada emergency medicine residency program directors and senior faculty who were likely to function as members of a CC (or equivalent) at their institution. Participants took a survey with 12 resident portfolios, each containing hypothetical formative and summative assessments. Six portfolios represented residents progressing as expected (PAE) and 6 represented residents not progressing as expected (NPAE). A professionalism variable (PV) was developed for each portfolio. Two counterbalanced surveys were developed in which 6 portfolios contained a PV and 6 portfolios did not (for each PV condition, 3 portfolios represented residents PAE and 3 represented residents NPAE). Participants were asked to make progression decisions based on each portfolio.

Results
Without PVs, the consistency of participants giving scores of 1 or 2 (i.e., little or no need for educational intervention) to residents PAE and to those NPAE was 92% and 10%, respectively. When a PV was added, the consistency decreased by 34% for residents PAE and increased by 4% for those NPAE (P = .01).

Conclusions
When reviewing a simulated resident portfolio, individual reviewer scores for residents PAE were responsive to the addition of professionalism concerns. Considering this, educators using a CC should have a system to report, collect, and document professionalism issues.
Validity Evidence for a Knowledge Assessment Tool for a Mastery Learning Scrub Training Curriculum
Authors: Hasty Brittany N. , Lau James N. , Tekian Ara , Miller Sarah E. , Shipper Edward S. , Bereknyei Merrell Sylvia , Lee Edmund W. , Park Yoon Soo 
Published: October 2019

Purpose
To examine the validity evidence for a scrub training knowledge assessment tool to demonstrate the utility and robustness of a multimodal, entrustable professional activity (EPA)-aligned, mastery learning scrub training curriculum.

Method
Validity evidence was collected for the knowledge assessment used in the scrub training curriculum at Stanford University School of Medicine from April 2017 to June 2018. The knowledge assessment had 25 selected response items that mapped to curricular objectives, EPAs, and operating room policies. A mastery passing standard was established using the Mastery Angoff and Patient-Safety approaches. Learners were assessed pre curriculum, post curriculum, and 6 months after the curriculum.

Results
From April 2017 to June 2018, 220 medical and physician assistant students participated in the scrub training curriculum. The mean pre- and postcurriculum knowledge scores were 74.4% (standard deviation [SD] = 15.6) and 90.1% (SD = 8.3), respectively, yielding a Cohen’s d = 1.10, P < .001. The internal reliability of the assessment was 0.71. Students with previous scrub training performed significantly better on the precurriculum knowledge assessment than those without previous training (81.9% [SD = 12.6] vs 67.0% [SD = 14.9]; P < .001). The mean item difficulty was 0.74, and the mean item discrimination index was 0.35. The Mastery Angoff overall cut score was 92.0%.

Conclusions
This study describes the administration of and provides validity evidence for a knowledge assessment tool for a multimodal, EPA-aligned, mastery-based curriculum for scrub training. The authors support the use of scores derived from this test for assessing scrub training knowledge among medical and physician assistant students.
Teaching Motivational Interviewing to Medical Students: A Systematic Review
Authors: Kaltman Stacey , Tankersley Amelia 
Published: October 2019

PurposeMedical students must be prepared to work with patients with maladaptive health behaviors and chronic health conditions. Motivational interviewing (MI) is an evidence-based, patient-centered, directive communication style designed to help patients address behaviors that are detrimental to their health (e.g., substance abuse, poor diet). In this study, the authors systematically reviewed the evidence pertaining to MI curricula in medical schools. Their aims were to describe the pedagogical and content-related features of MI curricular interventions and to assess the effectiveness of the interventions and the quality of the research evidence.MethodIn March 2019, the authors searched databases, seeking studies on MI in medical schools. They manually extracted descriptive information, used the Medical Education Research Study Quality Instrument to assess the quality of the included studies, and synthesized the included studies’ results.ResultsSixteen studies met inclusion criteria. The majority of included studies were pre-post evaluation designs; the most rigorous were randomized controlled trials. MI curricula were heterogeneous, varying in timing, content, pedagogical approaches, and outcomes measured.ConclusionsThe results of this review suggest that the implementation of MI curricula in medical schools can be feasible and effective and that students can achieve beginning levels of proficiency. The results support the inclusion of MI in undergraduate medical education curricula and highlight next steps to advance this area of medical education research: achieving consensus around essential early MI skills that should be taught in medical schools and identifying the most effective scaffolding strategies to teach this complex mode of communication.
Variation in Prescribing and Factors Associated With the Use of Prophylactic Antibiotics for Mohs Surgery: A Single-Institution Retrospective Study
Authors: Barbieri John S. , Fix William C. , Miller Christopher J. , Sobanko Joseph F. , Shin Thuzar M. , Howe Nicole , Margolis David J. , Etzkorn Jeremy R. 
Published: October 2019

BACKGROUND
Antibiotic use associated with Mohs surgery is increasing.

OBJECTIVE
To understand variation in practice patterns and factors associated with antibiotic use.

MATERIALS AND METHODS
The authors conducted a retrospective cohort study of antibiotic use among patients treated with Mohs micrographic surgery between July 1, 2013, and June 30, 2017, at an academic medical center. Multivariate logistic regression was used to evaluate for associations between antibiotic prescribing and the surgeon, site, reconstruction, and patient characteristics.

RESULTS
The odds of prescribing antibiotics differed significantly between each surgeon evaluated; 3.35-fold variation in postoperative antibiotic use was observed. Increasing number of surgical sites (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.09–1.41), number of Mohs stages required (OR 1.18; 95% CI 1.08–1.28), and defect area (OR 1.31; 95% CI 1.25–1.37), as well as patient female sex (OR 1.14; 95% CI 1.03–1.27), were associated with increased postoperative antibiotic use, whereas age >80 was associated with decreased use (OR 0.75; 95% CI 0.64–0.87) compared with age <60.

CONCLUSION
Antibiotics are more commonly prescribed for repairs that are considered higher risk for infection. However, significant variation exists between surgeons, even within a single institution, suggesting a need for prospective trials and consensus guideline development.
Effect of Orthokeratology Lens on Contrast Sensitivity Function and High-Order Aberrations in Children and Adults
Authors: Chang Chiung-Fang , Cheng Huey-Chuan 
Published: October 2019

Objectives:
Overnight orthokeratology (OOK) lenses are used to temporarily decrease myopic refractive error and improve uncorrected vision. Overnight orthokeratology lenses significantly increase ocular and corneal high-order aberrations (HOAs) and compromise contrast sensitivity function (CSF) to a degree correlated with myopic correction achieved. In Taiwan, OOK lenses are mainly used in children for myopia control. However, information regarding its effects in this population remains limited. This study discusses the change in HOAs and CSF after 28 nights of OOK lens use in children compared with that in adults.

Methods:
In total, 46 children (9–18 years) and 26 adults (>18 years) who visited Ophthalmology Department of Mackay Memorial Hospital from October to December 2013 were enrolled. Contrast sensitivity and ocular/corneal total high-order, coma, and spherical aberrations (SA) were tested before OOK treatment. After 28 days of overnight use, CSF and topography were reexamined, and data were collected and analyzed using t test and Pearson correlation coefficients.

Results:
In total, 23 eyes of 23 children and 14 eyes of 14 adults were evaluated. The treatment resulted in a significant increase in ocular total HOA, coma, and SA in both groups. However, CSF declined more in adults than children.

Conclusion:
Our study revealed that OOK lenses decrease CSF to a greater extent in adults than that in children despite no significant differences in the change of ocular HOAs between both subject groups. We proposed children may have better neural adaptation to compensate for optical aberrations induced by OOK lens use.
Clinical Outcomes of an Asymmetric Model of Intrastromal Corneal Ring Segments for the Correction of Keratoconus
Authors: Prisant Olivier , Pottier Elodie , Guedj Tony , Hoang Xuan Thanh 
Published: October 2019

Purpose:
To evaluate the clinical outcomes of a new model of intrastromal corneal ring segments (ICRSs) (Keraring AS) in patients with keratoconus and quantify subsequent changes in refraction and corneal topography.

Methods:
This nonrandomized, single-center, retrospective observational study explores the effect of progressive thickness ICRS implantation in patients with keratoconus with a 3-month follow-up. After creating an intrastromal tunnel using a femtosecond laser, 1 or 2 ICRSs of progressive thicknesses (150/250 μm or 200/300 μm) and 160-degree arc length were implanted. Changes in uncorrected distance visual acuity, best-corrected distance visual acuity, refractive outcomes, corneal astigmatism, and maximum keratometry readings were recorded before and after surgery.

Results:
The study cohort consisted of 82 patients (104 eyes) with a mean age of 31.2 ± 10 years. At 3 months, ICRS implantation significantly improved uncorrected and corrected visual acuities from 0.82 to 0.46 (logarithm of the minimum angle of resolution [LogMAR]) and from 0.31 to 0.21 (LogMAR), respectively (P < 0.001). The mean spherical error reduced from −1.74 diopters (D) to −0.90 D (P < 0.001), and the mean cylindrical error reduced from −4.22 D to −2.01 D (P < 0.001). The manifest refraction spherical equivalent reduced from −3.85 D to −1.91 D (P < 0.001). All topographic parameters were reduced, including maximum keratometry (53.6 D vs. 50.3 D) and keratometric astigmatism (−4.6 D vs. −2.2 D) (P < 0.001).

Conclusions:
The Keraring AS provides a new, apparently safe, and effective means of improving visual acuity and reducing the refractive error and mean keratometry in eyes with asymmetric keratoconus.
Clinicopathological Features and Outcomes in Lymphoma of Extraocular Muscles
Authors: Eade Edwina L. , Hardy Thomas G. , McKelvie Penelope A. , McNab Alan A. 
Published: October 2019

A retrospective review of 25 patients with lymphoma of the extraocular muscles demonstrates excellent prognosis with a high rate of local remission (96%), 2 treatment-related complications, one recurrence, and no disease-related deaths.

Purpose:
To describe the clinicopathological features and report the outcomes of treatment in lymphoma involving the extraocular muscles (EOM), the largest reported case-series.

Methods:
A retrospective case series of patients with lymphoma involving the EOM from a single tertiary referral orbital center, between March 1992 and March 2018. Patients with other histopathologic diagnoses or who did not have an EOM biopsy were excluded. The main outcome measures were histologic evaluation and clinical follow-up including tumor response, recurrence, and survival.

Results:
Twenty-five patients were included, 16 female; 9 male; median age 64.7 years (range 33.8–92.6 years). Unilateral involvement was present in 23 cases (92%). Lymphoma was found to be primary in 15 patients (60%), and any EOM could be affected by disease. Fourteen patients (56%) displayed impaired duction in the direction of the affected muscle. The commonest histologic type was extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in 16 cases (64%) followed by follicular lymphoma in 3 cases (12%), diffuse large B-cell lymphoma in 2 cases (8%), gamma delta T-cell lymphoma in 2 cases (8%), small lymphocytic lymphom and lymphoplasmacytic lymphoma in 1 case each (4%). All 4 patients with high-grade lymphomas (diffuse large B-cell or T cell lymphoma) were found to have systemic disease. Patients were treated with combinations of radiotherapy, chemotherapy, or immunotherapy, with low toxicity. Two patients developed treatment-related complications. With a median follow-up of 26 months (range 3–108 months), there was only 1 recurrence, which was successfully salvaged with Rituximab, and no deaths due to lymphoma.

Conclusions:
Lymphoma of the EOM is a rare tumor with good response to treatment, few treatment-related complications and low risk of recurrence or mortality.
Selective-cold output through a distinct subset of lamina I spinoparabrachial neurons
Authors: Hachisuka Junichi , Koerber H. Richard , Ross Sarah E. 
Published: October 2019

Abstract
Spinal projection neurons are a major pathway through which somatic stimuli are conveyed to the brain. However, the manner in which this information is coded is poorly understood. Here, we report the identification of a modality-selective spinoparabrachial (SPB) neuron subtype with unique properties. Specifically, we find that cold-selective SPB neurons are differentiated by selective afferent input, reduced sensitivity to substance P, distinct physiological properties, small soma size, and low basal drive. In addition, optogenetic experiments reveal that cold-selective SPB neurons do not receive input from Nos1 inhibitory interneurons and, compared with other SPB neurons, show significantly smaller inhibitory postsynaptic currents upon activation of Pdyn inhibitory interneurons. Together, these data suggest that cold output from the spinal cord to the parabrachial nucleus is mediated by a specific cell type with distinct properties.
A whole-food plant-based experiential education program for health care providers results in personal and professional changes
Authors: Lessem Alexandra , Gould Susan Martin , Evans Joanne , Dunemn Kathleen 
Published: October 2019

ABSTRACT
Diet-related diseases are the primary contributor to morbidity and mortality. The risk for these diseases can be reduced with a whole-food plant-based (WFPB) diet, but most people are never counseled on this dietary pattern. An experiential education program was designed and conducted in which sample of 30 nurse practitioners, registered nurses, and physicians learned about and followed a WFPB diet for 3 weeks. The objective was for the health care providers to increase their knowledge and acceptance of WFPB diets and increase their likelihood of counseling patients on this dietary pattern. Participants completed preintervention and postintervention questionnaires assessing dietary intake, knowledge, weight, mood, energy, benefits, barriers, self-efficacy, and likelihood of continuing to follow, or counsel patients about a WFPB diet. Participants decreased intake of animal-derived foods, increased intake of WFPB foods, had improvements in mood and energy, and lost weight. Perceived barriers to following and counseling about a WFPB diet declined and self-efficacy improved. Participants were likely to continue a WFPB diet and discuss the diet with their patients. The three-week intervention changed providers' knowledge, skills, and attitudes about WFPB diets. If nurse practitioners and other providers accept WFPB diets, more patients may be educated on this dietary pattern, helping to reduce the burden of diet-related chronic diseases.
Peripheral osteoma of the nasal bone after laser treatment
Authors: Hwang Jae ha , Lee Dong gyu , Kim Kwang seog , Lee Sam yong 
Published: October 2019

Abstract

Introduction:
Peripheral osteoma, which arises from the periosteum, commonly develops in the head and neck region and is found frequently in the mandible, maxilla, and paranasal sinuses. However, osteoma of the face, especially from the nasal bone, is quite rare.

Patient concerns:
A 34-year-old female visited our outpatient department with a small mass on the nose. She had n laser treatment of nevus at the same spot 14 years before, and it had enlarged slowly since 10 years before.

Diagosis:
Computed tomography scan revealed a 0.7 × 0.5 cm sized radio-opaque tumor of the nasal bone.

Interventions:
Under general anesthesia, surgical excision was performed through a transcolumellar and infracartilaginous incision. The excised tumor was a 0.7 × 0.5 cm sized hard mass.

Outcomes:
Biopsy confirmed it as a peripheral osteoma. After tumor removal, structural stability of nasal framework including bone and cartilage was maintained, and symmetry of the nasal dorsum was acquired.

Conclusion:
Chronic osteoma can compress the abutting structures. In the case of the nose, either structural instability or asymmetry can occur. By applying open rhinoplasty techniques, postoperative scars could be hidden and additional correction of the affected structure could be carried out if necessary. As a result, the surgeon can achieve the functional and esthetic outcomes simultaneously.
Association between the IL-10 rs1800872 polymorphisms and periodontitis susceptibility
Authors: Wang Zao , Li Yafang , Zhou Yanheng , Qiao Yiqiang 
Published: October 2019

AbstractBackground:Periodontitis is a common disease with an unclear pathological mechanism. No precise consensus has been reached to evaluate the association between the IL-10 rs1800872 (- 592, -590, -597 C>A) polymorphism and periodontal disease. Thus, we performed this meta-analysis to collect more evidence-based information.Methods:Four online databases, PubMed, Embase, Web of Science, and China Biology Medicine disc (CBM), were searched in August 2018. An odds ratio (OR) with a 95% confidence interval (CI) was applied to evaluate the association of the rs1800872 with periodontitis susceptibility.Results:Twenty three case–control studies with 2714 patients and 2373 healthy controls were evaluated. The overall analyses verified that the IL-10 rs1800872 polymorphism was significantly associated with an increased risk of periodontitis in the allelic model, homozygote model, dominant model, and recessive model (A vs C: OR = 1.28, 95%CI = 1.11–1.49,P = .00,I2 = 56.87%; AA vs CC: OR = 2.06, 95%CI = 1.32–3.23,P = .00,I2 = 73.3%; AA + AC vs CC: OR = 1.42, 95%CI = 1.03–1.96,P = .03,I2 = 76.2%; AA vs AC + CC: OR = 1.78, 95%CI = 1.26–2.56,P = .00,I2 = 76.7%). Moreover, the subgroup analysis based on ethnicity, periodontitis type, and smoking status showed significant differences.Conclusions:The results of our meta-analysis demonstrate that rs1800872 is associated with periodontitis susceptibility in Caucasians and Asians. Moreover, A allele, AA genotype, CC genotype may be closely associated with chronic periodontitis (CP), while A allele, AA genotype may be closely associated with aggressive periodontitis (AgP).
Tai Chi for patients with mild cognitive impairment
Authors: Yang Juan , Chon Tony Y. , Li Guangxi , Mallory Molly J. , Bublitz Sara E. , Do Alexander , Xiao Lizu , Xiong Donglin , Bauer Brent A. 
Published: October 2019

Abstract

Background:
Mild cognitive impairment (MCI) is an intermediate stage between the cognitive changes of normal aging and early dementia. Tai Chi (TC) may be particularly beneficial to patients with MCI due to its whole-body coordination characteristics. This systematic review protocol aims to outline the methods that will be used to assess the comparative effectiveness and safety of TC for MCI through a systematic review and meta-analysis.

Methods:
A systematic review will identify and evaluate randomized controlled trials (RCTs) that examined the effects and safety of TC compared to a placebo, conventional treatment, and no treatment on cognitive function in individuals with MCI. Studies from databases of MEDLINE, PubMed, Embase, Global Health, Cochrane Library, and Scopus from January 1990 to March 2019 reported in English will be searched. Two independent reviewers will screen the studies for inclusion with the eligibility criteria and extract data. Risk of bias of individual studies will be assessed in line with Cochrane risk of bias tool. The overall quality of cumulative evidence will be assessed using selected Grading of Recommendations, Assessment, Development, and Evaluations criteria. Statistics will be used for heterogeneity assessment, sensitivity analysis, data synthesis, generating funnel plots, and subgroup analysis. Meta-analysis will be performed, if sufficiently homogeneous studies are found. A narrative synthesis will be conducted, grouping studies by exposure and outcome definitions, and describing any differences by subgroups.

Results:
This study will provide practical and targeted evidence in investigating the impact of TC exercise for individuals with MCI.

Conclusion:
The findings of our study will provide updated evidence to determine whether TC is an effective intervention to patients with MCI.

Trial registration number:
International Prospective Register for Systematic Reviews (PROSPERO) number CRD42019125104.