bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Employee Voice About Transgressive or Disruptive Behavior: A Case Study
Authors: Dixon-Woods Mary , Campbell Anne , Martin Graham , Willars Janet , Tarrant Carolyn , Aveling Emma-Louise , Sutcliffe Kathleen , Clements Janice , Carlstrom Michelle , Pronovost Peter 
Published: September 2018

Purpose
Employee voice plays an important role in organizational intelligence about patient safety hazards and other influences on quality of patient care. The authors report a case study of an academic medical center that aimed to understand barriers to voice and make improvements in identifying and responding to transgressive or disruptive behaviors.

Method
The case study focused on an improvement effort at Johns Hopkins Medicine that sought to improve employee voice using a two-phase approach of diagnosis and intervention. Confidential interviews with 67 individuals (20 senior leaders, 47 frontline personnel) were conducted during 2014 to diagnose causes of employee reluctance to give voice about behavioral concerns. A structured intervention program to encourage voice was implemented, 2014–2016, in response to the findings.

Results
The diagnostic interviews identified gaps between espoused policies of encouraging employee voice and what happened in practice. A culture of fear pervaded the organization that, together with widespread perceptions of futility, inhibited personnel from speaking up about concerns. The intervention phase involved four actions: sharing the interview findings; coordinating and formalizing mechanisms for identifying and dealing with disruptive behavior; training leaders in encouraging voice; and building capacity for difficult conversations.

Conclusions
The problems of giving voice are widely known across the organizational literature but are difficult to address. This case study offers an approach that includes diagnostic and intervention phases that may be helpful in remaking norms, facilitating employee voice, and improving organizational response. It highlights specific actions that are available for other organizations to adapt and test.
Data, Big and Small: Emerging Challenges to Medical Education Scholarship
Authors: Ellaway Rachel H. , Topps David , Pusic Martin 
Published: September 2018

The collection and analysis of data are central to medical education and medical education scholarship. Although the technical ability to collect more data, and medical education’s dependence on data, have never been greater, it is getting harder for medical schools and educational scholars to collect and use data, particularly in terms of the regulations, security issues, and growing reluctance of learners and others to participate in data collection activities. These two countervailing trends present a growing threat to the viability of medical education scholarship. In response, there must either be a more conducive data environment for medical education scholarship or medical education must move to become less dependent on data.
There is, therefore, a growing need for a system-wide correction: a shift in practice that makes data use more viable and productive while maintaining high professional standards. There are five core areas that can contribute to a system-wide correction: greater clarity over what can be used as data; greater clarity on what constitutes “good” data; changes to the ways in which data are collected; better strategic stewardship of existing data; and deliberate and strategic attention to “data readiness” in support of medical education and medical education scholarship. These solutions are primarily practical and conceptual changes in the face of what are mainly regulatory challenges. However, medical educators also need to engage with emerging areas of practice such as learning analytics, and they need to consider the shifting social contract for using data in medical education.
Medical Student- and Resident-Authored Publications in Academic Medicine From 2002 to 2016: A Growing Trend and Its Implications
Authors: Munzer Brendan W. , Griffith Max , Townsend Whitney A. , Burk-Rafel Jesse 
Published: September 2018

Purpose
The extent of medical trainees’ engagement in scholarly medical education publication is not well described. This study sought to quantify the prevalence of medical student- and resident-authored medical education publications over 15 years, a benchmark essential for understanding current and future trends in trainee scholarship.

Method
Of 91 identified journals, 16 met inclusion criteria as indexed general medical education journals. Only Academic Medicine provided complete author role information, allowing identification of medical student and resident authors. The authors retrospectively compiled and analyzed citation records from Academic Medicine from 2002 to 2016, tracking trainee authorship, author position, and publication type.

Results
A total of 6,280 publications were identified, of which 4,635 publications, by 16,068 authors, met inclusion criteria. Trainees were 6.0% (966/16,068) of all authors and authored 14.5% (673/4,635) of all publications. Trainee authorship rates varied by publication type: Trainees authored 33.3% (160/480) of medical humanities publications versus 6.9% (27/392) of commentaries. From 2002–2004 to 2014–2016, the proportion of authors who were trainees increased from 3.9% (73/1,853) to 7.1% (330/4,632) (P < .001 for trend). Over the same period, the percentage of trainee-authored publications increased: 9.4% (58/620) to 18.8% (225/1,199) (P < .001 for trend), driven primarily by increased trainee first authorship.

Conclusions
Trainees constitute a small but growing proportion of authors and authored publications in Academic Medicine. Further work is needed to understand what trainee-, institutional-, and journal-level factors contribute to this trend, and whether similar increases in trainee authorship are occurring in other journals and fields.
Key Factors in Clinical Competency Committee Members’ Decisions Regarding Residents’ Readiness to Serve as Supervisors: A National Study
Authors: Schumacher Daniel J. , Martini Abigail , Bartlett Kathleen W. , King Beth , Calaman Sharon , Garfunkel Lynn C. , Elliott Sean P. , Frohna John G. , Schwartz Alan , Michelson Catherine D. 
Published: September 2018

Purpose
Entrustment has become a popular assessment framework in recent years. Most research in this area has focused on how frontline assessors determine when a learner can be entrusted. However, less work has focused on how these entrustment decisions are made. The authors sought to understand the key factors that pediatric residency program clinical competency committee (CCC) members consider when recommending residents to a supervisory role.

Method
CCC members at 14 pediatric residency programs recommended residents to one of five progressive supervisory roles (from not serving as a supervisory resident to serving as a supervisory resident in all settings). They then responded to a free-text prompt, describing the key factors that led them to that decision. The authors analyzed these responses, by role recommendation, using a thematic analysis.

Results
Of the 155 CCC members at the participating programs, 84 completed 769 supervisory role recommendations during the 2015–2016 academic year. Four themes emerged from the thematic analysis: (1) Determining supervisory ability follows from demonstrated trustworthiness; (2) demonstrated performance matters, but so does experience; (3) ability to lead a team is considered; and (4) contextual considerations external to the resident are at play.

Conclusions
CCC members considered resident and environmental factors in their summative entrustment decision making. The interplay between these factors should be considered as CCC processes are optimized and studied further.
Measuring Clinical Productivity of Anesthesiology Groups
Authors: Abouleish Amr E. , Hudson Mark E. , Whitten Charles W. 
Published: September 2018

Abstract
Benchmarking and comparing group productivity is an essential activity of data-driven management. For clinical anesthesiology, accomplishing this task is a daunting effort if meaningful conclusions are to be made. For anesthesiology groups, productivity must be done at the facility level in order to reduce some of the confounding factors. When industry or external comparisons are done, then the use of total ASA units per anesthetizing sites allows for overall productivity comparisons. Additional productivity components (total ASA units/h, h/case, h/operating room/d) allow for leaders to develop productivity dashboards. With the emergence of large groups that provide care in multiple facilities, these large groups can choose to invest more effort in collecting data and comparing facility productivity internally with group-defined measurements including total ASA units per full time equivalent.
Association Between Gestational Weight Gain and Perinatal Outcomes
Authors: Kominiarek Michelle A. , Saade George , Mele Lisa , Bailit Jennifer , Reddy Uma M. , Wapner Ronald J. , Varner Michael W. , Thorp John M. , Caritis Steve N. , Prasad Mona , Tita Alan T.N. , Sorokin Yoram , Rouse Dwight J. , Blackwell Sean C. , Tolosa Jorge E. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: September 2018

OBJECTIVE:
To evaluate the association between gestational weight gain and maternal and neonatal outcomes in a large, geographically diverse cohort.

METHODS:
Trained chart abstractors at 25 hospitals obtained maternal and neonatal data for all deliveries on randomly selected days over 3 years (2008–2011). Gestational weight gain was derived using weight at delivery minus prepregnancy or first-trimester weight and categorized as below, within, or above the Institute of Medicine (IOM) guidelines in this retrospective cohort study. Maternal (primary or repeat cesarean delivery, third- or fourth-degree lacerations, severe postpartum hemorrhage, hypertensive disease of pregnancy) and neonatal (preterm birth, shoulder dystocia, macrosomia, hypoglycemia) outcomes were compared among women in the gestational weight gain categories in unadjusted and adjusted analyses with odds ratios (ORs) and 95% CI reported. Covariates included age, race-ethnicity, tobacco use, insurance type, parity, prior cesarean delivery, pregestational diabetes, hypertension, and hospital type.

RESULTS:
Of the 29,861 women included, 51% and 21% had gestational weight gain above and below the guidelines, respectively. There was an association between gestational weight gain above the IOM guidelines and cesarean delivery in both nulliparous women (adjusted OR 1.44, 95% CI 1.31–1.59) and multiparous women (adjusted OR 1.26, 95% CI 1.13–1.41) and hypertensive diseases of pregnancy in nulliparous and multiparous women combined (adjusted OR 1.84, 95% CI 1.66–2.04). For the neonatal outcomes, gestational weight gain above the IOM guidelines was associated with shoulder dystocia (adjusted OR 1.74, 95% CI 1.41–2.14), macrosomia (adjusted OR 2.66, 95% CI 2.03–3.48), and neonatal hypoglycemia (adjusted OR 1.60, 95% CI 1.16–2.22). Gestational weight gain below the guidelines was associated with spontaneous (adjusted OR 1.50, 95% CI 1.31–1.73) and indicated (adjusted OR 1.34, 95% CI 1.12–1.60) preterm birth.

CONCLUSION:
In a large, diverse cohort with prospectively collected data, gestational weight gain below or above guidelines is associated with a variety of adverse pregnancy outcomes.
Intrapartum Fetal Heart Rate Tracing Among Small-for-Gestational Age Compared With Appropriate-for-Gestational-Age Neonates
Authors: Chauhan Suneet P. , Weiner Steven J. , Saade George R. , Belfort Michael A. , Reddy Uma M. , Thorp John M. , Tita Alan T. N. , Miller Russell S. , Dinsmoor Mara J. , McKenna David S. , Stetzer Bradley , Rouse Dwight J. , Gibbs Ronald S. , El-Sayed Yasser Y. , Sorokin Yoram , Caritis Steve N. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: September 2018

OBJECTIVE:
To compare fetal heart rate (FHR) patterns during the last hour of labor between small-for-gestational-age (SGA; birth weight less than the 10th percentile for gestational age) and appropriate-for-gestational-age (AGA; birth weight at the 10–90th percentile) neonates at 36 weeks of gestation or greater. We also compared the rate of cesarean delivery and composite neonatal morbidity among SGA and AGA newborns.

METHODS:
This is a secondary analysis of a randomized trial of intrapartum fetal electrocardiographic ST-segment analysis. We excluded women with chorioamnionitis, insufficient duration of FHR tracing in the hour before delivery, and anomalous newborns. Fetal heart rate patterns were categorized by computerized pattern recognition software (PeriCALM Patterns). Composite neonatal morbidity was defined as any of the following: intrapartum fetal death, Apgar score 3 or less at 5 minutes, cord artery pH 7.05 or less, base deficit 12 mmol/L or greater, neonatal seizure, intubation at delivery, neonatal encephalopathy, and neonatal death. Logistic regression was used to evaluate the association between FHR patterns and SGA adjusted for magnesium sulfate exposure and stage of labor.

RESULTS:
Of the 11,108 women randomized, 85% (n=9,402) met inclusion criteria, of whom 9% were SGA. In the last hour, the likelihood of accelerations was significantly lower among SGA than AGA neonates (72.4% vs 66.8%; P=.001). Variable decelerations lasting greater than 60 seconds, with depth greater than 60 beats per minute (bpm) or nadir less than 60 bpm, were significantly more common with SGA than AGA (all P<.001). The rate of late decelerations, prolonged decelerations, or bradycardia were similar between SGA and AGA (all P>.05). Cesarean delivery for fetal indications was significantly more common with SGA (7.0%) than AGA (4.0%; P<.001). The composite neonatal morbidity was 1.4% among SGA and 1.0% among AGA (odds ratio 1.40, 95% CI 0.74–2.64).

CONCLUSION:
Although the FHR patterns in the last hour of labor differ among SGA and AGA neonates, as does the rate of cesarean delivery, the composite neonatal morbidity was similar.
Development and Validation of a Simulation Model for Laparoscopic Colpotomy
Authors: Frazzini Padilla Pamela M. , Farag Sara , Smith Katherine A. , Zimberg Stephen E. , Davila G. Willy , Sprague Michael L. 
Published: September 2018

OBJECTIVE:
To develop a realistic simulation model for performance of laparoscopic colpotomy and evaluate its construct and face validity.

METHODS:
A simulation model was developed and constructed using polyvinyl chloride piping, a uterine manipulator, and synthetic vaginal tissue paired with a commercially available laparoscopic trainer. An observational study was conducted to validate the simulation model for use as a teaching tool. Construct validity was measured through performance evaluation of novice and expert surgeons using a standard and modified Global Operative Assessment of Laparoscopic Skills scale with possible score ranges of 5–25 and 5–40, respectively. Expert surgeons included attending surgeons across various gynecologic subspecialties who teach total laparoscopic hysterectomy to trainees and perform more than 50 total laparoscopic hysterectomies annually. Novice surgeons included residents who perform total laparoscopic hysterectomy as part of their training. Standards were set using a modified contrasting groups approach. Interrater reliability was calculated using Kendall’s τ correlation coefficient. Participants were surveyed regarding the realism of the model and its utility as a teaching tool to assess face validity.

RESULTS:
Five expert and 15 novice surgeons volunteered to participate. Expert surgeons scored higher than novice surgeons on the Global Operative Assessment of Laparoscopic Skills scale (22.8±1.52 vs 13.53±2.69, respectively) with a mean difference of 9.27 (95% CI 7.12–11.4, P<.01) and on a modified Global Operative Assessment of Laparoscopic Skills scale (36.9±2.19 vs 22.6±3.95, respectively) with a mean difference of 14.30 (95% CI 11.2–17.4, P<.01). Suggested passing range was set at 30.5–32.5 out of 40 total points. Kendall’s τ interrater reliability was 0.86 (95% CI 0.798–0.923) and 0.87 (95% CI 0.818–0.922), respectively. All participants agreed that the training model was useful for teaching and learning laparoscopic colpotomy and for assessing the learner’s ability to perform colpotomy before live surgery.

CONCLUSION:
This validated simulation system offers novice surgeons an opportunity to practice the skill set necessary to perform laparoscopic colpotomy efficiently and may be used as an educational tool.
T cells and cytokines in systemic sclerosis
Authors: Fuschiotti Patrizia 
Published: September 2018

Purpose of review
Dysregulation of both the innate and the adaptive immune systems has been identified in systemic sclerosis (SSc). However, the mechanisms underlying aberrant immune cell function remain poorly understood. T cells represent a predominant cell type in the affected tissues of patients, particularly in the early inflammatory stage of the disease. Antigen specificity of infiltrating T cells has not been identified; however, recent studies implicate specific T-cell subsets and the cytokines they produce in SSc pathogenesis by modulating the development of autoimmunity, inflammation and fibrosis.

Recent findings
The phenotype and function of distinct T-cell subsets have been identified in the affected tissues of SSc patients as well as in SSc animal models, implying their contribution to disease process. The molecular mechanisms underlying cytokine dysregulation by specific T-cell subpopulations are also becoming clear.

Summary
A better understanding of SSc pathogenesis will allow the development of novel therapeutic strategies targeting specific cell types and the pathways that are abnormally activated as well as the cytokines produced that may be directly involved with disease process. A further goal is to tailor therapy to address dysregulation specific to individual patients, leading to better efficacy and reduced toxicity.
Antisynthetase syndrome pathogenesis: knowledge and uncertainties
Authors: Gallay Laure , Gayed Catherine , Hervier Baptiste 
Published: September 2018

Purpose of review
Antisynthetase syndrome (ASyS) is an acquired myopathy characterized by the presence of myositis-specific autoantibodies directed against tRNA-synthetases. ASyS is potentially life threatening due to lung involvement and treatment remains a challenge to date. With symptoms not limited to muscles but also involving lung, skin and joints, ASyS appears specific and has a particular pathogenesis, different from the other inflammatory myopathies. This review is intended to discuss the current understanding of ASyS pathogenesis, pointing its current knowledge and also the crucial prospects that may lead to critical improvement of ASyS care.

Recent findings
Regarding ASyS pathogenesis, initiation of the disease seems to arise in a multifactorial context, with first lesions occurring within the lungs. This may lead to aberrant self-antigen exposure and tolerance breakdown. The consequences are abnormal activation of both innate and adaptive immunity, resulting in the patients with favourable genetic background to autoimmune-mediated organ lesions. Immune and nonimmune roles of the antigen, as well as antigen presentation leading to specific T-cell and B-cell activation and to the production of specific autoantibodies belong to the disease process.

Summary
This work aims to detail ASyS pathogenesis understanding, from initiation to the disease propagation and target tissue lesions, in order to considering future treatment directions.
Rate of Open Reduction for Supracondylar Humerus Fractures Varies Across Pediatric Orthopaedic Surgeons: A Single-Institution Analysis
Authors: DeFrancesco Christopher J. , Shah Apurva S. , Brusalis Christopher M. , Flynn Kelly , Leddy Kelly , Flynn John M. 
Published: September 2018

Objectives:
To (1) define a single institution's rate of open reduction for operative pediatric supracondylar humerus (SCH) fractures; (2) describe variability by surgeon in rates of irreducible fracture (IRF) and open reduction; and (3) determine whether variation in opening rate correlated with surgeon experience.

Design:
Retrospective analytic study.

Setting:
Urban tertiary care Level 1 trauma center.

Patients/Participants:
Twelve fellowship-trained pediatric orthopaedists.

Main Outcome Measurements:
Rate of open reduction for operatively treated SCH fractures (OTA/AO 13-M/3).

Results:
One thousand two hundred twenty-nine type II SCH fractures (none of which required open reduction) were excluded from the analysis. A total of 1365 other SCH fractures were included: 1302 type III fractures, 27 type IV fractures, and 36 fractures with unspecified type. 2.9% of type III and 22.2% of type IV fractures required open reduction. None of the injuries with unspecified type required open reduction. The rate of open reduction among 11 surgeons ranged from 0% to 15.0% in type III–IV fractures (P = 0.001). 86% (38/44) of open reductions were performed for IRF. In regression analysis, patient age was associated with open reduction for IRF (odds ratio 1.22, P = 0.001), but surgeon years-in-practice (0.321) and number of previous cases (0.327) were not associated with open reduction. Other indications for opening included suspected vascular or neurologic injury.

Conclusions:
Open reduction was rarely performed in this sample, but IRF was the dominant indication for opening. We found true variation in surgeons' rates of performing open reductions. More experience was not correlated with decreased likelihood of open reduction.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Partnership in Ethiopia: University of Utah's and UCLA's Departments of Orthopaedics Collaboration With Soddo Christian Hospital in Ethiopia
Authors: Anderson Lucas A. , Bernthal Nicholas M. , Haller Justin M. , Higgins Thomas F. , Elliott Iain S. , Anderson Duane R. 
Published: September 2018

Summary:
Collaborations between orthopaedic training programs in developed countries and international sites in austere environments offer abundant benefits and mutual enrichment. It is often assumed that the exchange is one-sided and we hope to dispel that assumption. Despite the logistical challenges inherent in these partnerships, our experience has been unanimously reviewed as “greatly beneficial” to visiting residents/faculty and surgeons/trainees at the host location. We hope that this article will (1) encourage faculty at training programs to permit and enable residents to experience international orthopaedics while still in training; (2) encourage faculty to visit international hospitals while contributing expertise in subspecialty surgery, research, and teaching; and (3) encourage international hospitals to create opportunities for clinical and research collaboration with academic orthopaedics departments.