bluuebunny/crossref_metadata_2025_split huggingface dataset:
Herring submesoscale dynamics through a major spawning wave: duration, abundance fluctuation, distribution, and schooling
Authors: Skaret Georg , Slotte Aril 
Published: October 2016

In this study, a series of 17 repeated acoustic trawl surveys within a ca. 1500 km2 area covering the major spawning location for Norwegian spring-spawning herring (Clupea harengus) was conducted over a period of about 1 month. Local herring abundance increased from ca. 25 000 to 237 000 t, a significant proportion of the total spawning stock, in just 3 d and subsequently decreased to &lt;30 000 t over the next 7 d. The abundance change was due to a single major spawning wave developing over the observation period, and an estimated 46 000 t of eggs and milt were deposited during the short time spent at the spawning ground. There was no difference in spawning activity between day and night, but herring were more associated with deep trenches and also generally stayed deeper in more dense schools during daylight than night-time. Schooling behaviour and distribution were also strongly state-dependent, and both school swimming depth and school height decreased as spawning progressed, as did the bottom depth where the schools were located. The massive herring spawning events seem to be low-risk adaptations to an environment where predators are abundant, with rapid spawning in huge aggregations as a strategy for predator swamping.
Physician Decisions to Defer Antiretroviral Therapy in Key Populations: Implications for Reducing Human Immunodeficiency Virus Incidence and Mortality in Malaysia
Authors: Ferro Enrico G. , Culbert Gabriel J. , Wickersham Jeffrey A. , Marcus Ruthanne , Steffen Alana D. , Pauls Heather A. , Westergaard Ryan P. , Lee Christopher K. , Kamarulzaman Adeeba , Altice Frederick L. 
Published: October 2016

Abstract

Background
Antiretroviral therapy (ART) is recommended for all people living with human immunodeficiency virus (HIV), yet physician attitudes and prescribing behaviors toward members of key risk populations may limit ART access and undermine treatment as prevention strategies.

Methods
Physicians in Malaysia (N = 214) who prescribe antiretroviral therapy (ART) responded in an Internet-based survey to hypothetical clinical scenarios of HIV patients, varying by key risk population and CD4+ T-cell count, on whether they would initiate or defer ART compared with a control patient with sexually acquired HIV.

Results
The proportion of physicians who would defer ART in patients with advanced HIV (CD4 = 17 cells/μL) was significantly higher (P &lt; .0001) for 4 key populations, including people who inject drugs ([PWID] 45.3%) or consume alcohol (42.1%), released prisoners (35.0%), and those lacking social support (26.6%), compared with a control patient (4.2%). People who inject drugs with advanced HIV (CD4 = 17 cells/μL) were 19-fold (adjusted odds ratio [AOR] = 18.9; 95% confidence interval [CI], 9.8–36.5) more likely to have ART deferred compared with the control. This effect was partially mitigated for PWID receiving methadone (AOR = 2.9; 95% CI, 1.5–5.7). At the highest CD4+ T-cell count (CD4 = 470 cells/μL), sex workers (AOR = 0.55; 95% CI, .44–.70) and patients with an HIV-uninfected sexual partner (AOR = 0.43; 95% CI, .34–.57) were significantly less likely to have ART deferred.

Conclusions
Physicians who prescribe antiretroviral therapy in Malaysia may defer ART in some key populations including PWID and released prisoners, regardless of CD4+ T-cell count, which may help to explain very low rates of ART coverage among PWID in Malaysia. Reducing HIV incidence and mortality in Malaysia, where HIV is concentrated in PWID and other key populations, requires clinician-level interventions and monitoring physician adherence to international evidence-based treatment guidelines.
Artemether-Lumefantrine and Dihydroartemisinin-Piperaquine Exert Inverse Selective Pressure on Plasmodium Falciparum Drug Sensitivity-Associated Haplotypes in Uganda
Authors: Taylor Aimee R. , Flegg Jennifer A. , Holmes Chris C. , Guérin Philippe J. , Sibley Carol H. , Conrad Melissa D. , Dorsey Grant , Rosenthal Philip J. 
Published: October 2016

Abstract

Background
Altered sensitivity to multiple antimalarial drugs is mediated by polymorphisms in pfmdr1, which encodes the Plasmodium falciparum multidrug resistance transporter. In Africa the N86Y and D1246Y polymorphisms have been shown to be selected by treatment, with artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) selecting for wild-type and mutant alleles, respectively. However, there has been little study of pfmdr1 haplotypes, in part because haplotype analyses are complicated by multiclonal infections.

Methods
We fit a haplotype frequency estimation model, which accounts for multiclonal infections, to the polymorphic pfmdr1 N86Y, Y184F, and D1246Y alleles in samples from a longitudinal trial comparing AL and DP to treat uncomplicated P falciparum malaria in Tororo, Uganda from 2007 to 2012. We regressed estimates onto covariates of trial arm and selective drug pressure.

Results
Yearly trends showed increasing frequency estimates for haplotypes with wild type pfmdr1 N86 and D1246 alleles and decreasing frequency estimates for haplotypes with the mutant pfmdr1 86Y allele. Considering days since prior therapy, we saw evidence suggestive of selection by AL for haplotypes with N86 combined with 184F, D1246, or both, and against all haplotypes with 86Y, and evidence suggestive of selection by DP for 86Y only when
combined with Y184 and 1246Y (haplotype YYY) and against haplotypes NFD and NYY.

Conclusions
Based on our model, AL selected several haplotypes containing N86, whereas DP selection was haplotype specific, demonstrating the importance of haplotype analyses. Inverse selective pressure of AL and DP on the complementary haplotypes NFD and YYY suggests that rotating artemisinin-based antimalarial combination regimens may be the best treatment option to prevent resistance selection.
The Discriminatory Patient and Family: Strategies to Address Discrimination Towards Trainees
Authors: Whitgob Emily E. , Blankenburg Rebecca L. , Bogetz Alyssa L. 
Published: October 2016

Purpose
Trainee mistreatment remains an important and serious medical education issue. Mistreatment toward trainees by the medical team has been described; mistreatment by patients and families has not. Motivated by discrimination towards a resident by a family in their emergency department, the authors sought to identify strategies for trainees and physicians to respond effectively to mistreatment by patients and families.

Method
A purposeful sample of pediatric faculty educational leaders was recruited from April–June 2014 at Stanford University. Using a constructivist grounded theory approach, semistructured one-on-one interviews were conducted. Participants were asked to describe how they would respond to clinical scenarios of families discriminating against trainees (involving race, gender, and religion). Interviews were audio-recorded, transcribed, and anonymized. The authors analyzed interview transcripts using constant comparative analysis and performed post hoc member checking. This project was IRB approved.

Results
Four themes emerged from interviews with 13 faculty: assess illness acuity, cultivate a therapeutic alliance, depersonalize the event, and ensure a safe learning environment. Participants wanted trainees to feel empowered to remove themselves from care when necessary but acknowledged that removal was not always possible or easy. Nearly all participants agreed that trainee and faculty development was needed. Suggested educational strategies included team debriefing and critical reflection.

Conclusions
Discrimination towards trainees by patients and families is an important issue. As this type of mistreatment cannot be fully prevented, effective preparation is essential. Effective response strategies exist and can be taught to trainees to empower responses that protect learners and preserve patient care.
Professionalism in the Twilight Zone: A Multicenter, Mixed-Methods Study of Shift Transition Dynamics in Surgical Residencies
Authors: Coverdill James E. , Alseidi Adnan , Borgstrom David C. , Dent Daniel L. , Dumire Russell D. , Fryer Jonathan , Hartranft Thomas H. , Holsten Steven B. , Nelson M. Timothy , Shabahang Mohsen , Sherman Stanley , Termuhlen Paula M. , Woods Randy J. , Mellinger John D. 
Published: October 2016

Purpose
Duty hours rules sparked debates about professionalism. This study explores whether and why general surgery residents delay departures at the end of a day shift in ways consistent with shift work, traditional professionalism, or a new professionalism.

Method
Questionnaires were administered to categorical residents in 13 general surgery programs in 2014 and 2015. The response rate was 76% (N = 291). The 18 items focused on end-of-shift behaviors and the frequency and source of delayed departures. Follow-up interviews (N = 39) examined motives for delayed departures. The results include means, percentages, and representative quotations from the interviews.

Results
A minority (33%) agreed that it is routine and acceptable to pass work to night teams, whereas a strong majority (81%) believed that residents exceed work hours in the name of professionalism. Delayed departures were ubiquitous: Only 2 of 291 residents were not delayed for any of 13 reasons during a typical week. The single most common source of delay involved a desire to avoid the appearance of dumping work on fellow residents. In the interviews, residents expressed a strong reluctance to pass work to an on-call resident or night team because of sparse night staffing, patient ownership, an aversion to dumping, and the fear of being seen as inefficient.

Conclusions
Resident behavior is shaped by organizational and cultural contexts that require attention and reform. The evidence points to the stunted development of a new professionalism, little role for shift-work mentalities, and uneven expression of traditional professionalism in resident behavior.
Individual and Institutional Components of the Medical School Educational Environment
Authors: Gruppen Larry D. , Stansfield R. Brent 
Published: October 2016

Purpose
To examine, using a systems framework, the relative influence of individual-level and institution-level factors on student perceptions of the medical school educational environment.

Method
A series of hierarchical linear models were fit to a large, 18-school longitudinal dataset of student perceptions of the educational environment, various demographics, and student empathy, tolerance of ambiguity, coping, and patient–provider orientation. Separate models were evaluated for individual-level factors alone, institution-level factors alone, and the combination of individual- and institution-level factors.

Results
The individual-level model accounted for 56.7% of the variance in student perceptions of the educational environment. However, few specific variables at the individual level had noteworthy direct effects on these perceptions. Similarly, the institution-level model accounted for 10.3% of the variance in student perceptions, but the specific characteristics of the institution explained little of this impact. The combined individual- and institution-level model attributed 45.5% of the variance in student perceptions to individual-level factors and 10.8% to institution-level factors. Again, specific variables explained little of this impact.

Conclusions
These findings indicate that the impact of individual-level factors on perceptions of the educational environment is about four times greater than institution-level factors. This contrast reflects the fact that the educational environment is defined through a learner, not institutional lens. Nonetheless, institutions vary in learner perceptions of their environments, and these differences may provide some support for institutional initiatives to improve the educational environment. More broadly, these results evidence the complexity of the educational environment, both in defining it and in understanding its dynamics.
The Learning Environment Counts: Longitudinal Qualitative Analysis of Study Strategies Adopted by First-Year Medical Students in a Competency-Based Educational Program
Authors: Bierer S. Beth , Dannefer Elaine F. 
Published: October 2016

Purpose
The move toward competency-based education will require medical schools and postgraduate training programs to restructure learning environments to motivate trainees to take personal ownership for learning. This qualitative study explores how medical students select and implement study strategies while enrolled in a unique, nontraditional program that emphasizes reflection on performance and competence rather than relying on high-stakes examinations or grades to motivate students to learn and excel.

Method
Fourteen first-year medical students volunteered to participate in three, 45-minute interviews (42 overall) scheduled three months apart during 2013–2014. Two medical educators used structured interview guides to solicit students’ previous assessment experiences, preferred learning strategies, and performance monitoring processes. Interviews were digitally recorded and transcribed verbatim. Participants confirmed accuracy of transcripts. Researchers independently read transcripts and met regularly to discuss transcripts and judge when themes achieved saturation.

Results
Medical students can adopt an assessment for learning mind-set with faculty guidance and implement appropriate study strategies for mastery-learning demands. Though students developed new strategies at different rates during the year, they all eventually identified study and performance monitoring strategies to meet learning needs. Students who had diverse learning experiences in college embraced mastery-based study strategies sooner than peers after recognizing that the learning environment did not reward performance-based strategies.

Conclusions
Medical students can take ownership for their learning and implement specific strategies to regulate behavior when learning environments contain building blocks emphasized in self-determination theory. Findings should generalize to educational programs seeking strategies to design learning environments that promote self-regulated learning.
“Staying in the Game”: How Procedural Variation Shapes Competence Judgments in Surgical Education
Authors: Apramian Tavis , Cristancho Sayra , Watling Chris , Ott Michael , Lingard Lorelei 
Published: October 2016

Purpose
Emerging research explores the educational implications of practice and procedural variation between faculty members. The potential effect of these variations on how surgeons make competence judgments about residents has not yet been thoroughly theorized. The authors explored how thresholds of principle and preference shaped surgeons’ intraoperative judgments of resident competence.

Method
This grounded theory study included reanalysis of data on the educational role of procedural variations and additional sampling to attend to their impact on assessment. Reanalyzed data included 245 hours of observation across 101 surgical cases performed by 29 participants (17 surgeons, 12 residents), 39 semistructured interviews (33 with surgeons, 6 with residents), and 33 field interviews with residents. The new data collected to explore emerging findings related to assessment included two semistructured interviews and nine focused field interviews with residents. Data analysis used constant comparison to refine the framework and data collection process until theoretical saturation was reached.

Results
The core category of the study, called staying in the game, describes how surgeons make moment-to-moment judgments to allow residents to retain their role as operators. Surgeons emphasized the role of principles in making these decisions, while residents suggested that working with surgeons’ preferences also played an important role in such intraoperative assessment.

Conclusions
These findings suggest that surgeons’ and residents’ work with thresholds of principle and preference have significant implications for competence judgments. Making use of these judgments by turning to situated assessment may help account for the subjectivity in assessment fostered by faculty variations.
Effects of Long-Term Musical Training on Cortical Auditory Evoked Potentials
Authors: Brown Carolyn J. , Jeon Eun-Kyung , Driscoll Virginia , Mussoi Bruna , Deshpande Shruti Balvalli , Gfeller Kate , Abbas Paul J. 
Published: October 2016

Objective:Evidence suggests that musicians, as a group, have superior frequency resolution abilities when compared with nonmusicians. It is possible to assess auditory discrimination using either behavioral or electrophysiologic methods. The purpose of this study was to determine if the acoustic change complex (ACC) is sensitive enough to reflect the differences in spectral processing exhibited by musicians and nonmusicians.Design:Twenty individuals (10 musicians and 10 nonmusicians) participated in this study. Pitch and spectral ripple discrimination were assessed using both behavioral and electrophysiologic methods. Behavioral measures were obtained using a standard three interval, forced choice procedure. The ACC was recorded and used as an objective (i.e., nonbehavioral) measure of discrimination between two auditory signals. The same stimuli were used for both psychophysical and electrophysiologic testing.Results:As a group, musicians were able to detect smaller changes in pitch than nonmusician. They also were able to detect a shift in the position of the peaks and valleys in a ripple noise stimulus at higher ripple densities than non-musicians. ACC responses recorded from musicians were larger than those recorded from non-musicians when the amplitude of the ACC response was normalized to the amplitude of the onset response in each stimulus pair. Visual detection thresholds derived from the evoked potential data were better for musicians than non-musicians regardless of whether the task was discrimination of musical pitch or detection of a change in the frequency spectrum of the ripple noise stimuli. Behavioral measures of discrimination were generally more sensitive than the electrophysiologic measures; however, the two metrics were correlated.Conclusions:Perhaps as a result of extensive training, musicians are better able to discriminate spectrally complex acoustic signals than nonmusicians. Those differences are evident not only in perceptual/behavioral tests but also in electrophysiologic measures of neural response at the level of the auditory cortex. While these results are based on observations made from normal-hearing listeners, they suggest that the ACC may provide a non-behavioral method of assessing auditory discrimination and as a result might prove useful in future studies that explore the efficacy of participation in a musically based, auditory training program perhaps geared toward pediatric or hearing-impaired listeners.
Approach to cutaneous vasculitides with special emphasis on small vessel vasculitis: histopathology and direct immunofluorescence
Authors: Demirkesen Cuyan 
Published: October 2016

Purpose of review
The present review will focus on recent publications in cutaneous vasculitides.

Recent findings
Some histopathological and clinical features, such as papillary dermal edema, perivascular C3 deposition, clinically evident edema, and lesions above the waist, may point out renal or gastrointestinal involvement in Henoch–Schönlein purpura (HSP). HSP associated with familial Mediterranean fever differs from typical isolated HSP by showing no deposits of IgA, much younger age, and location of the lesions on the face or the trunk. Single-organ cutaneous small vessel vasculitis is a more restricted entity than hypersensitivity vasculitis and HSP. Because cutaneous polyarteritis nodosa and macular lymphocytic arteritis share some clinicopathologic features, the question is raised whether they are not two different entities. Several histopathological features defining IgG4-related disease are found in granuloma faciale and erythema elevatum diutinum, two localized chronic cutaneous vasculitis; however, in a recent series no diagnostic criteria for IgG4-related disease was detected in them.

Summary
When a patient presents with skin lesions, in which necrotizing or leukocytoclastic vascuitis is confirmed histologically, irrespective of the size of the affected vessel, the possibility of systemic vasculitis, an infection, medication, or a systemic disease such as systemic lupus erythematosus must be searched before reaching definitive diagnosis.
Cervical Decompression Surgery for Cervical Spondylotic Myelopathy and Concomitant Hypertension
Authors: Yang Liang , Yang Cheng , Pang Xiaodong , Li Duanming , Chen Xiongsheng , Shi Jiangang , Zhou Xuhui , Wu Ye , Lu Xiang , Yang Hong , Jia Lianshun , Peng Baogan 
Published: October 2016

Study Design.
We performed decompression surgery or conservative treatments on 135 cervical spondylotic myelopathy (CSM) patients with concomitant hypertension and did follow-up assessments up to 1 year to examine the change of blood pressure, spinal cord function, and cervical pain.

Objective.
The aim of this study was to determine whether concomitant hypertension is relieved after decompression surgery, and whether it is related to the improvement of spinal cord function or cervical pain.

Summary of Background Data.
In clinical practice, we often found that some patients with CSM have concomitant hypertension. Interestingly, after CSM was treated successfully by decompression surgery, some patients’ high blood pressure returned to normal range even without oral medications.

Methods.
We enrolled 135 CSM patients with hypertension, 103 of whom received decompression surgery, and remaining 32 patients accepted conservative treatments. We did follow-up assessments at 3, 6, and 12 months. The primary endpoints were changes of blood pressure, and secondary endpoints were changes of modified Japanese Orthopedic Association (mJOA) score and cervical pain visual analogue scale (VAS). Spearman correlation coefficients were calculated between changes in systolic blood pressure (SBP) and mJOA scores, VAS scores.

Results.
In patients with decompression surgery, the significant decrease in both SBP and diastolic blood pressure (DBP) that was seen 3 months and sustained through subsequent visit at 12 months. Paired-samples t test showed that both SBP and DBP were significantly lower than baseline blood pressure at all time points after procedure (P < 0.001). Significant correlation was found between the improvement rates of mJOA score and changes in SBP (r = −0.579, P < 0.001). But the correlation between changes in VAS score and changes in SBP was not significant (r = 0.58, P = 0.571).

Conclusion.
Cervical decompression surgery could reduce concomitant high blood pressure in CSM patients, indicating a significant association between the decrease in blood pressure and the improvement of spinal cord function.

Level of Evidence: 2