bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurology
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon 
Published: October 2018

Abstract
This chapter discusses neurology, including coma and reduced GCS and coma and reduced GCS emergency, adult seizures emergency, paediatric seizures emergency, seizures, neurodegenerative disorders, stroke and stroke/CVA/TIA emergency, focal neurology, back pain, headache, and dizziness.
Emergency department
Authors: Raine Tim , Collins George , Hall Catriona , Hjelde Nina , Dawson James , Sanders Stephan , Eccles Simon 
Published: October 2018

Abstract
This chapter explores the emergency department, including trauma, head injury, neck injury, falls and collapse, acutely painful limb emergency, acute limb pain, chronic limb pain, limb swelling, joint pain, neck lumps, ENT, groin lumps, burns and burns emergency, anaphylaxis in adults, hypotension emergency, hypotension, shock, pyrexia, overdose emergency, overdose and deliberate self-harm, vaginal bleeding, gynaecological causes of pain, contraception, early pregnancy (1st trimester), later pregnancy (2nd/3rd trimester), delivery, and after delivery (post-partum).
Li-ion battery material under high pressure: amorphization and enhanced conductivity of Li4Ti5O12
Authors: Huang Yanwei , He Yu , Sheng Howard , Lu Xia , Dong Haini , Samanta Sudeshna , Dong Hongliang , Li Xifeng , Kim Duck Young , Mao Ho-kwang , Liu Yuzi , Li Heping , Li Hong , Wang Lin 
Published: October 2018

Abstract
Lithium titanium oxide (Li4Ti5O12, LTO), a ‘zero-strain’ anode material for lithium-ion batteries, exhibits excellent cycling performance. However, its poor conductivity highly limits its applications. Here, the structural stability and conductivity of LTO were studied using in situ high-pressure measurements and first-principles calculations. LTO underwent a pressure-induced amorphization (PIA) at 26.9 GPa. The impedance spectroscopy revealed that the conductivity of LTO improved significantly after amorphization and that the conductivity of decompressed amorphous LTO increased by an order of magnitude compared with its starting phase. Furthermore, our calculations demonstrated that the different compressibility of the LiO6 and TiO6 octahedra in the structure was crucial for the PIA. The amorphous phase promotes Li+ diffusion and enhances its ionic conductivity by providing defects for ion migration. Our results not only provide an insight into the pressure depended structural properties of a spinel-like material, but also facilitate exploration of the interplay between PIA and conductivity.
Automobile Prices in Market Equilibrium with Unobserved Price Discrimination
Authors: D’Haultfœuille Xavier , Durrmeyer Isis , Février Philippe 
Published: October 2018

AbstractIn markets where sellers are able to price discriminate, individuals pay different prices that may be unobserved by the econometrician. This article considers the structural estimation of a demand and supply model of differentiated products with such price discrimination and limited information on prices taking the form of, e.g., observing list prices from catalogues or average prices. Within this framework, identification is achieved not only with usual moment conditions on the demand side, but also through supply-side restrictions. The model can be estimated by GMM using a nested fixed point algorithm that extends the usual contraction mapping algorithm to our setting. We apply our methodology to estimate the demand and supply in the French new automobile market. Our results suggest that discounting arising from price discrimination is important. The average discount is estimated to be 9.6%, with large variation depending on buyers’ characteristics and cars’ specifications. Our results are consistent with other evidence on transaction prices in France.
Use of Fibrin Sealant for Split-Thickness Skin Grafts in Patients with Hand Burns: A Prospective Cohort Study
Authors: Kim Youngmin , Kym Dohern , Cho Yong Suk , Yoon Jaechul , Yim Haejun , Hur Jun , Chun Wook 
Published: October 2018

ABSTRACT

OBJECTIVE:
To evaluate the efficacy of fibrin sealant as a topical hemostatic agent and for graft fixation during skin grafting of hand burns.

METHODS:
This prospective cohort study enrolled 40 patients with hand burns from January 2013 to December 2016. They were all treated with excision and split-thickness skin graft and divided into the fibrin sealant with tourniquet group (20 patients) and epinephrine tumescence group (20 patients).

MAIN OUTCOME MEASURES:
Demographic and clinical data such as age, sex, burn characteristics, operation time, estimated blood loss, and take rate were collected from each patient.

MAIN RESULTS:
The demographic and burn characteristics were not statistically different between the two groups. Estimated blood loss per cm2 (0.30 vs 1.00; P < .001) was significantly lower and the graft take rate (99.2% vs 98.2%; P = .032) was significantly higher in the fibrin sealant with tourniquet group.

CONCLUSIONS:
The use of fibrin sealants accompanied by tourniquets for hand burns exhibited superior results in terms of decreasing blood loss and had a better graft take rate compared with treatment with epinephrine tumescence.
Advance care planning
Authors: Tully Jessica 
Published: October 2018

Abstract

Purpose.
To improve the healthcare team's comfort and efficacy with end-of-life conversations at a 474-licensed bed community acute care hospital through training on advance care planning (ACP) and advance directives (ADs).

Methods.
This instructional program utilized training sessions, including pre- and posttests, to demonstrate enhanced knowledge of and confidence in discussing ACP and ADs among healthcare professionals engaging in end-of-life conversations with patients and their families.

Results.
There were 138 participants included in the program. A pretest and a posttest were completed by the attendees at the beginning and end of training, respectively. Data indicated improved preparedness for end-of-life conversations following the training sessions.

Conclusion.
Training specific to ACP and ADs increases confidence with end-of-life conversations. With the proper knowledge and resources, the healthcare staff can foster these difficult conversations. Although the program exceeded expectations, the sample is considered small and more research will be needed.
Electronic Knowledge Resources and Point-of-Care Learning: A Scoping Review
Authors: Aakre Christopher A. , Pencille Laurie J. , Sorensen Kristi J. , Shellum Jane L. , Del Fiol Guilherme , Maggio Lauren A. , Prokop Larry J. , Cook David A. 
Published: October 2018

Purpose
The authors sought to summarize quantitative and qualitative research addressing electronic knowledge resources and point-of-care learning in a scoping review.

Method
The authors searched MEDLINE, Embase, PsycINFO, and the Cochrane Database for studies addressing electronic knowledge resources and point-of-care learning. They iteratively revised inclusion criteria and operational definitions of study features and research themes of interest. Two reviewers independently performed each phase of study selection and data extraction.

Results
Of 10,811 studies identified, 305 were included and reviewed. Most studies (225; 74%) included physicians or medical students. The most frequently mentioned electronic resources were UpToDate (88; 29%), Micromedex (59; 19%), Epocrates (50; 16%), WebMD (46; 15%), MD Consult (32; 10%), and LexiComp (31; 10%). Eight studies (3%) evaluated electronic resources or point-of-care learning using outcomes of patient effects, and 36 studies (12%) reported objectively measured clinician behaviors. Twenty-five studies (8%) examined the clinical or educational impact of electronic knowledge resource use on patient care or clinician knowledge, 124 (41%) compared use rates of various knowledge resources, 69 (23%) examined the quality of knowledge resource content, and 115 (38%) explored the process of point-of-care learning. Two conceptual clarifications were identified, distinguishing the impact on clinical or educational outcomes versus the impact on test setting decision support, and the quality of information content versus the correctness of information obtained by a clinician–user.

Conclusions
Research on electronic knowledge resources is dominated by studies involving physicians and evaluating use rates. Studies involving nonphysician users, and evaluating resource impact and implementation, are needed.
Testing Test-Enhanced Continuing Medical Education: A Randomized Controlled Trial
Authors: Feldman Mark , Fernando Oshan , Wan Michelle , Martimianakis Maria Athina , Kulasegaram Kulamakan 
Published: October 2018

Purpose
The authors investigated the impact of the use of an efficient multiple-choice question (MCQ) test-enhanced learning (TEL) intervention for continuing professional development (CPD) on knowledge retention as well as self-reported learning behaviors.

Method
The authors conducted a randomized controlled trial comparing knowledge retention among learners who registered for an annual CPD conference at the University of Toronto in April 2016. Participants were randomized to receive an online preworkshop stand-alone MCQ test (no feedback) and a postworkshop MCQ test (with feedback) after a 14-day delay. Controls received no pre-/posttesting. The primary outcome measure was performance on a clinical vignette-based retention and application test delivered to all participants four weeks post conference. Secondary outcomes included self-reported changes in learning behavior, satisfaction, and efficiency of TEL.

Results
Three hundred eight physicians from across Canada registered for the four-day conference; 186 physicians consented to participate in the study and were randomized to receive TEL or to the control group in 1 of 15 workshops, with 126 providing complete data. A random-effects meta-analysis demonstrated a pooled effect size indicating moderate effect of TEL (Hedges g of 0.46; 95% CI: 0.26–0.67). The majority of respondents (65%) reported improved CPD learning resulting from pretesting.

Conclusions
Testing for learning can be leveraged to efficiently and effectively improve outcomes for CPD. Testing remains an underused education intervention in CPD, and the use of formative assessment to enhance professional development should be a key target for research.
How to Make or Break Implicit Bias Instruction: Implications for Curriculum Development
Authors: Gonzalez Cristina M. , Garba Ramya J. , Liguori Alyssa , Marantz Paul R. , McKee M. Diane , Lypson Monica L. 
Published: October 2018

Purpose
To analyze faculty experiences regarding facilitating discussions as part of the institution’s curriculum on racial and ethnic implicit bias recognition and management.

Method
Between July 2014 and September 2016, the authors conducted 21 in-depth interviews with faculty who had experience teaching in implicit bias instruction or were interested in facilitating discussions related to implicit bias and the Implicit Association Test. Grounded theory methodology was used to analyze interview transcripts.

Results
Participants identified challenges that affect their ability to facilitate instruction in implicit bias. Faculty described the influence of their own background and identities as well as the influence of institutional values on their ability to facilitate implicit bias discussions. They noted the impact of resistant learners and faculty during discussions and made suggestions for institutional measures including the need for implementation of formalized longitudinal implicit bias curricula and faculty development.

Conclusions
Faculty facilitating sessions on implicit bias must attend faculty development sessions to be equipped to deal with some of the challenges they may face. Buy-in from institutional leadership is essential for successful implementation of implicit bias teaching, and medical educators need to consider formalized longitudinal curricula addressing the recognition and management of implicit biases.
Patterns of Hysteresis Between Induction and Emergence of Neuroanesthesia Are Present in Spinal and Intracranial Surgeries
Authors: Ferreira Ana Leitão , Correia Rui , Vide Sérgio , Ferreira Ana Dias , Kelz Max B. , Mendes Joaquim Gabriel , Nunes Catarina S. , Amorim Pedro 
Published: October 2018

Background:
Recovery of consciousness is usually seen as a passive process, with emergence from anesthesia depicted as the inverse process of induction resulting from the elimination of anesthetic drugs from their central nervous system sites of action. However, that need not be the case. Recently it has been argued that we might encounter hysteresis to changes in the state of consciousness, known as neural inertia. This phenomenon has been debated in neuroanesthesia, as manipulation of the brain might further influence recovery of consciousness. The present study is aimed at assessing hysteresis between induction and emergence under propofol-opioid neuroanesthesia in humans using estimated propofol concentrations in both spinal and intracranial surgeries.

Methods:
We identified the moments of loss (LOR) and recovery of responsiveness (ROR) in 21 craniotomies and 25 spinal surgeries. Propofol was given slowly until loss of responsiveness and stopped at the end of surgery. An opioid was present at induction and recovery. Propofol infused was recorded and plasma and effect-site concentrations were estimated using 2 pharmacokinetic models. Dose-response curves were generated. Estimated propofol plasma and effect-site concentrations were compared to assess hysteresis.

Results:
Estimated propofol concentrations at LOR and ROR showed hysteresis. Whether for spinal or intracranial surgeries, the EC50 of propofol at which half of the patients entered and exited the state of responsiveness was significantly different.

Conclusions:
Hysteresis was observed between propofol concentrations at LOR and ROR, in both patients presenting for spinal and intracranial surgeries. Manipulation of the brain does not appear to change patterns of hysteresis, suggesting that neural inertia may occur in humans, in a way similar to that found in animal species. These findings justify performing a clinical study in patients using measured propofol concentrations to assess neural inertia.
Cervical Versus Thoracolumbar Spinal Deformities
Authors: Passias Peter G. , Poorman Gregory W. , Lafage Virginie , Smith Justin , Ames Christopher , Schwab Frank , Shaffrey Chris , Segreto Frank A. , Horn Samantha R. , Bortz Cole A. , Varlotta Christopher G. , Hockley Aaron , Wang Charles , Daniels Alan , Neuman Brian , Hart Robert , Burton Douglas , Javidan Yashar , Line Breton , LaFage Renaud , Bess Shay , Sciubba Daniel 
Published: October 2018

Study Design:
Retrospective analysis of 2 prospectively collected multicenter databases, one for cervical deformity (CD) and the other for general adult spinal deformity.

Objective:
To investigate the relative quality-of-life and disability burden in patients with uncompensated cervical, thoracolumbar, or cervical and thoracolumbar deformities.

Summary of Background Data:
The relative quality-of-life burden of cervical and thoracolumbar deformities have never been compared with each other. This may have significant implications when deciding on the appropriate treatment intervention for patients with combined thoracolumbar and cervical deformities.

Methods:
When defining CD C2–C7 sagittal vertical axis (SVA)>4 cm was used while a C7–S1 SVA>5 cm was used to defined thoracolumbar deformity. Patients with both SVA criteria were defined as “combined.” Primary analysis compared patients in the different groups by demographic, comorbidity data, and quality-of-life scores [EuroQOL 5 dimensions questionnaire (EQ-5D)] using t tests. Secondary analysis matched deformity groups with propensity scores matching based on baseline EQ-5D scores. Differences in disease-specific metrics [the Oswestry Disability Index, Neck Disability Index, modified Japanese Orthopaedic Association questionnaire (mJOA)] were analyzed using analysis of variance tests and post hoc analysis.

Results:
In total, 212 patients were included in our analysis. Patients with CD only had less neurological deficits (mJOA: 14.6) and better EQ-5D (0.746) scores compared with patients with combined deformities (11.9, 0.716), all P<0.05. Regarding propensity score–matched deformity cohorts, 99 patients were matched with similar quality-of-life burden, 33 per deformity cohort. CD only patients had fewer comorbidities (1.03 vs. 2.12 vs. 2.70; P<0.001), whereas patients with combined deformity had more baseline neurological impairment compared with CD only patients (mJOA: 12.00 vs. 14.25; P=0.050).

Conclusions:
Combined deformity patients were associated with the lowest quality-of-life and highest disability. Furthermore, regarding deformity cohorts matched by similar baseline quality-of-life status (EQ-5D), patients with combined deformities were associated with significantly worse neurological impairments. This finding implies that quality of life may not be a direct reflection of a patient’s disability status, especially in patients with combined cervical and thoracolumbar deformities.

Level of Evidence:
Level III.
Syringotropic Lichen Planus: A Potential Histopathologic Mimicker of Syringotropic Mycosis Fungoides
Authors: Mazzeo Mauro , Saggini Andrea , Rocco Tea , Fargnoli Maria Concetta , Cerroni Lorenzo 
Published: October 2018

Abstract:
Perieccrine inflammation may be observed in several different dermatoses, but true permeation of the secretory coil by lymphocytes (lymphocytic syringotropism) is a rather uncommon finding, usually observed in mycosis fungoides (MF—syringotropic MF). Rare cases of syringotropic lichen striatus and lymphocytic autoimmune hidradenitis showing a similar pattern have been described as well. We describe an exceptional case of lichen planus (LP) characterized by marked lymphocytic syringotropism with focal hyperplasia of the eccrine epithelium. Histopathology was characterized by the combination of features of conventional LP, prominent permeation of the secretory portion of the eccrine glands by reactive lymphocytes, and focal involvement of a hair follicle. Syringotropic LP may be regarded as a histologic mimicker of syringotropic MF, thus representing a potential diagnostic pitfall.
Aspirin Attenuates the Bioactivation of and Platelet Response to Vicagrel in Mice
Authors: Jia Yu-Meng , Gu Tong-Tong , Ji Jin-Zi , Tai Ting , Zhang Meng-Ran , Huang Bei-Bei , Zhou Huan , Mi Qiong-Yu , Xie Hong-Guang 
Published: October 2018

Abstract:
Vicagrel, a novel acetate analogue of clopidogrel, exerts more potent antiplatelet effect than clopidogrel in rodents. Relevant evidence indicated that aspirin and vicagrel are the drug substrate for carboxylesterase 2. Accordingly, it is deduced that concomitant use of aspirin could attenuate the bioactivation of and platelet response to vicagrel. To clarify whether there could be such an important drug–drug interaction, the differences in both the formation of vicagrel active metabolite H4 and the inhibition of adenosine diphosphate–induced platelet aggregation by vicagrel were measured and compared between mice treated with vicagrel alone or in combination with aspirin. The plasma H4 concentration was determined by liquid chromatography–tandem mass spectrometry, and the inhibition of platelet aggregation by vicagrel was assessed by whole-blood platelet aggregation. Compared with vicagrel (2.5 mg·kg−1) alone, concurrent use of aspirin (5, 10, or 20 mg·kg−1) significantly decreased systemic exposure of H4, an average of 38% and 41% decrease in Cmax and AUC0–∞ in mice when in combination with aspirin at 10 mg·kg−1, respectively. Furthermore, concomitant use of aspirin (10 mg·kg−1) and vicagrel (2.5 mg·kg−1) resulted in an average of 66% reduction in the inhibition of adenosine diphosphate–induced platelet aggregation by vicagrel. We conclude that aspirin significantly attenuates the formation of vicagrel active metabolite H4 and platelet response to vicagrel in mice, and that such an important drug–drug interaction would appear in clinical settings if vicagrel is taken with aspirin concomitantly when marketed in the future.
FIRST-IN-HUMAN CLINICAL STUDY TO INVESTIGATE THE EFFECTIVENESS AND SAFETY OF PARS PLANA VITRECTOMY SURGERY USING A NEW HYPERSONIC TECHNOLOGY
Authors: Stanga Paulo E. , Williams Jon I. , Shaarawy Sherif A. , Agarwal Amar , Venkataraman Anusha , Kumar Dhivya A. , You Timothy T. , Hope Richard S. 
Published: October 2018

Purpose:
Investigate the effective performance and safety of a new hypersonic vitrector technology.

Methods:
Postapproval, prospective, single-arm, noncomparative, open-label study at one clinical site in India. Indications: macular hole (9/20), vitreous hemorrhage (7/20), vitreomacular traction (3/20), and vitreomacular traction with pseudomacular hole (1/20). Safety endpoints included intraoperative and postoperative adverse events. Effective performance endpoints were surgeon-rated effectiveness, range of surgical time, and device settings. Other performance measures were preoperative and postoperative best-corrected visual acuity, slit-lamp and indirect ophthalmoscopy, applanation tonometry, color fundus photography, fundus fluorescein angiography, and spectral domain optical coherence tomography.

Results:
Core vitreous removal (20/20 subjects), peripheral vitreous removal (18/20), and posterior vitreous detachment induction (13/15) surgeries were successfully completed. Total surgical time was 22.5 minutes to 106 minutes. Serious adverse events through 3 months were 2 device-associated retinal tears and detachment (one intraoperative) and one unrelated postoperative enlargement of macular hole with subretinal fluid.

Conclusion:
This first-in-human study suggests that this new hypersonic vitrector technology is a promising alternative to commercially available guillotine vitrectors. The hypersonic vitrector was effective in core vitreous removal in all cases. Larger-scale studies are required to expand on our initial findings for induction of a posterior vitreous detachment or peripheral vitrectomy.
High-Dose Steroid Treatment of Bacterial Keratitis
Authors: Green Matthew , Hughes Ian , Hogden John , Sara Sergio , Apel Andrew , Stapleton Fiona 
Published: October 2018

Purpose:
To describe the usage patterns of steroids in bacterial keratitis and to analyze the effect of steroids on patients' visual outcomes.

Methods:
This was a single-center retrospective review of patients with culture-positive bacterial keratitis treated between 1999 and 2015 at Princess Alexandra Hospital (Brisbane, Australia). Patients with culture-positive bacterial keratitis were identified through the Queensland Pathology Database, and clinical information was gathered through a subsequent medical record review. High-dose steroid treatment was classified as 6 or more drops of a steroid a day started within 7 days of corneal scraping. The outcome of a patient's episode of keratitis was classified as good if their final visual acuity was 6/12 or better; poor if it was 6/60 or worse or required a corneal transplant, otherwise it was classified as average. Microbiological and clinical variables' association with outcomes was evaluated in univariate analyses. Variables significant at P < 0.1 were examined in a multivariate ordinal logistic regression analysis created with forward variable selection with forced inclusion of steroid treatment (high, regular, low dose, and none).

Results:
A total of 328 patients were included from the 1002 reviewed charts. Of these patients, 164 (50.0%) were treated with steroids. Factors significantly associated with outcomes in the multivariate model were high-dose steroid treatment, visual acuity on presentation, age group, cause of keratitis, infiltrate size, and location. The odds ratio of better outcomes with high-dose steroids was 5.49 (confidence interval, 1.6–19.0, P = 0.007).

Conclusions:
High-dose steroid treatment is significantly associated with better visual outcomes in patients with culture-positive bacterial keratitis in this case series.