bluuebunny/crossref_metadata_2025_split huggingface dataset:
Top-down modulation of sensory cortex gates perceptual learning
Authors: Caras Melissa L. , Sanes Dan H. 
Published: August 2017

Significance
With training, stimulus detection or discrimination abilities can improve dramatically. This process, called perceptual learning, supports language acquisition, musical expertise, and professional judgments, such as the identification of abnormalities in X-rays. To explore neural mechanisms that support perceptual learning, we measured and manipulated auditory cortex activity as animals trained on an auditory task. We found improvements in neural sensitivity that correlated tightly with perceptual learning, both in absolute magnitude and time course, and depended strongly on task engagement. Disrupting auditory cortical function impaired learning while leaving perception largely intact. Our findings indicate that improvements in cortical sensitivity could plausibly explain perceptual learning, and suggest that plasticity within top-down networks may be a general mechanism for perceptual improvement.
Spatiotemporal Variability of Benthic Communities on Weathervane Scallop Beds off Alaska
Authors: Glass Jessica R. , Kruse Gordon H. 
Published: August 2017

Abstract
Marine benthic communities are critical biotic components of habitat due to their roles in ecosystem function and health and as indicators of ecosystem change. Benthic communities are receiving increasing attention as institutions adopt ecosystem-oriented research approaches. We conducted a multidecadal analysis of benthic communities in areas targeted by a commercial weathervane scallop Patinopecten caurinus fishery on the continental shelf off Alaska. Using bycatch data collected by onboard observers during 1996–2012, we analyzed spatiotemporal patterns in community composition on weathervane scallop beds. We also explored whether spatiotemporal differences were related to environmental (sediment and depth) and anthropogenic (dredging effort) variables. Statistically significant (P &lt; 0.05) temporal changes in community composition occurred during 1996–2012, with a split between 1996 and 1999 and subsequent years. Taxa contributing to temporal changes were not consistent across fishery registration areas. Significant spatial differences in community structure were detected both at the scale of registration areas (200–2,000 km) and individual scallop beds (&lt;50 km). We also found significant correlations between benthic species composition and environmental and anthropogenic variables over space and time. Although the relationships were generally weak, the ecological associations were consistent with expected depth and sediment relationships in this region. Our results are directly relevant to the habitat objective of the scallop fishery management plan, inform essential fish habitat designations for weathervane scallops and other commercially important species, and serve as a baseline against which to compare future changes associated with fishing and climate change. Ensuing research should include the collection of environmental data at the spatial scale of individual scallop beds as well as controlled experiments on the impacts of fishing on benthic communities and their recovery.
Evacuating People and Their Pets: Older Floridians’ Need for and Proximity to Pet-Friendly Shelters
Authors: Douglas Rachel , Kocatepe Ayberk , Barrett Anne E , Ozguven Eren Erman , Gumber Clayton 
Published: August 2017

Abstract

Objectives
Pets influence evacuation decisions, but little is known about pet-friendly emergency shelters’ availability or older adults’ need for them. Our study addresses this issue, focusing on the most densely populated area of Florida (Miami-Dade)—the state with the oldest population and greatest hurricane susceptibility.

Method
We use Geographic Information Systems (GIS)–based methodology to identify the shortest paths to pet-friendly shelters, based on distance and congested and uncongested travel times—taking into account the older population’s spatial distribution. Logistic regression models using the 2013 American Housing Survey’s Disaster Planning Module examine anticipated shelter use as a function of pet ownership and requiring pet evacuation assistance.

Results
Thirty-four percent of older adults in the Miami-Dade area have pets—35% of whom report needing pet evacuation assistance. However, GIS accessibility measures show that travel time factors are likely to impede older adults’ use of the area’s few pet-friendly shelters. Logistic regression results reveal that pet owners are less likely to report anticipating shelter use; however, the opposite holds for pet owners reporting they would need help evacuating their pets—they anticipate using shelters.

Discussion
High pet shelter need coupled with low availability exacerbates older adults’ heightened vulnerability during Florida’s hurricane season.
Quality in Spine Surgery
Authors: Graves Christopher , Meyer Scott , Knightly John , Glassman Steven 
Published: August 2017

Abstract
Health care is expensive in the United States. There is an increasing focus on value rather than volume. Accurately measuring quality is a critically important step in determining value of care delivered. This article discusses the trials and techniques of measuring quality in spine surgery. A detailed analysis of advantages and disadvantages of various measures of quality, including process measurements, patient-reported outcome measurements, and safety measurements is included—from a historical perspective through modern practice.
Competency-Based Medical Education and the Ghost of Kuhn: Reflections on the Messy and Meaningful Work of Transformation
Authors: Holmboe Eric S. 
Published: August 2017

The transition, if not transformation, to outcomes-based medical education likely represents a paradigm shift struggling to be realized. Paradigm shifts are messy and difficult but ultimately meaningful if done successfully. This struggle has engen dered tension and disagreements, with many of these disagreements cast as either–or polarities. There is little disagreement, however, that the health care system is not effectively achieving the triple aim for all patients. Much of the tension and polarity revolve around how more effectively to prepare students and residents to work in and help change a complex health care system.
Competencies were an initial attempt to facilitate this shift by creating frameworks of essential abilities needed by physicians. However, implementation of competencies has proven to be difficult. Entrustable professional activities (EPAs) in undergraduate and graduate medical education and Milestones in graduate medical education are recent concepts being tried and studied as approaches to guide the shift to outcomes. Their primary purpose is to help facilitate implementation of an outcomes-based approach by creating shared mental models of the competencies, which in turn can help to improve curricula and assessment. Understanding whether and how EPAs and Milestones effectively facilitate the shift to outcomes has been and will continue to be an iterative and ongoing reflective process across the entire medical education community using lessons from implementation and complexity science. In this Invited Commentary, the author reflects on what got the community to this point and some sources of tension involved in the struggle to move to outcomes-based education.
The High-Value Care Rounding Tool: Development and Validity Evidence
Authors: McDaniel Corrie E. , White Andrew A. , Bradford Miranda C. , Sy Carolyn D. , Chen Tiffany , Brock Doug , Foti Jeffrey , Beck Jimmy B. 
Published: August 2017

Little is known about current practices in high-value care (HVC) bedside teaching. A lack of instruments for measuring bedside HVC behaviors confounds efforts to assess the impact of curricular interventions. The authors aimed to define observable HVC concepts by developing an instrument to measure the content and frequency of HVC discussions.
The authors developed the HVC Rounding Tool in four iterative phases, using Messick’s validity framework. Phases 1 and 2 were designed to collect evidence of content validity, Phases 3 and 4 to collect evidence of response process and internal structure. Phase 1 identified HVC topics within the literature. Phase 2 used a modified Delphi approach for construct definition and tool development. Through two rounds, the Delphi panel narrowed 16 HVC topics to 11 observable items, categorized into three domains (quality, cost, and patient values). Phase 3 involved rater training and creation of a codebook. Phase 4 involved three iterations of instrument piloting. Six trained raters, in pairs, observed bedside rounds during 148 patient encounters in 2016. Weighted kappas for each domain demonstrated improvement from the first to third iteration: Quality increased from 0.65 (95% CI 0.55–0.79) to 1.00, cost from 0.58 (95% CI 0.4–0.75) to 0.96 (95% CI 0.80–1.00), and patient values from 0.41 (95% CI 0.19–0.68) to 1.00. Percent positive agreement for all domains improved from 65.3% to 98.1%. This tool, the first with established validity evidence, addresses an important educational gap for measuring the translation of HVC from theoretical knowledge to bedside practice.
Competitive Antagonism of Anesthetic Action at the γ-Aminobutyric Acid Type A Receptor by a Novel Etomidate Analog with Low Intrinsic Efficacy
Authors: Ma Celena , Pejo Ervin , McGrath Megan , Jayakar Selwyn S. , Zhou Xiaojuan , Miller Keith W. , Cohen Jonathan B. , Raines Douglas E. 
Published: August 2017

Abstract

Background
The authors characterized the γ-aminobutyric acid type A receptor pharmacology of the novel etomidate analog naphthalene–etomidate, a potential lead compound for the development of anesthetic-selective competitive antagonists.

Methods
The positive modulatory potencies and efficacies of etomidate and naphthalene–etomidate were defined in oocyte-expressed α1β3γ2L γ-aminobutyric acid type A receptors using voltage clamp electrophysiology. Using the same technique, the ability of naphthalene–etomidate to reduce currents evoked by γ-aminobutyric acid alone or γ-aminobutyric acid potentiated by etomidate, propofol, pentobarbital, and diazepam was quantified. The binding affinity of naphthalene–etomidate to the transmembrane anesthetic binding sites of the γ-aminobutyric acid type A receptor was determined from its ability to inhibit receptor photoaffinity labeling by the site-selective photolabels [3H]azi-etomidate and R-[3H]5-allyl-1-methyl-5-(m-trifluoromethyl-diazirynylphenyl) barbituric acid.

Results
In contrast to etomidate, naphthalene–etomidate only weakly potentiated γ-aminobutyric acid–evoked currents and induced little direct activation even at a near-saturating aqueous concentration. It inhibited labeling of γ-aminobutyric acid type A receptors by [3H]azi-etomidate and R-[3H]5-allyl-1-methyl-5-(m-trifluoromethyl-diazirynylphenyl) barbituric acid with similar half-maximal inhibitory concentrations of 48 μM (95% CI, 28 to 81 μM) and 33 μM (95% CI, 20 to 54 μM). It also reduced the positive modulatory actions of anesthetics (propofol > etomidate ~ pentobarbital) but not those of γ-aminobutyric acid or diazepam. At 300 μM, naphthalene–etomidate increased the half-maximal potentiating propofol concentration from 6.0 μM (95% CI, 4.4 to 8.0 μM) to 36 μM (95% CI, 17 to 78 μM) without affecting the maximal response obtained at high propofol concentrations.

Conclusions
Naphthalene–etomidate is a very low-efficacy etomidate analog that exhibits the pharmacology of an anesthetic competitive antagonist at the γ-aminobutyric acid type A receptor.
Lumbar Spine Fusion Surgery in Solid Organ Transplant Recipients Is Associated With Increased Medical Complications and Mortality
Authors: Amin Raj , Puvanesarajah Varun , Qureshi Rabia , Jain Amit , Kebaish Khaled , Shen Frank H. , Hassanzadeh Hamid 
Published: August 2017

Study Design.
Retrospective database review.

Objective.
To characterize the outcomes of solid organ transplant (SOT) patients after one- or two-level lumbar fusion surgery.

Summary of Background Data.
Over the past decade advances in SOT patients have improved graft survival. As such, this patient population is increasingly eligible for elective surgery such as lumbar fusion procedures to improve mobility and quality of life. However, the outcomes of spine surgery in this population are not well defined.

Methods.
Data from the full 100% Medicare sample between 2005 and 2014 were used for the study. Patients were included if they had an elective one- or two-level lumbar spine fusion and previous history of renal, heart, liver, or lung SOT patients during this period. SOT patients were compared to non-SOT patients with respect to baseline characteristics, 90-day medical complications, 1-year rate of revision surgery, and 1-year mortality.

Results.
There were 961 patients in the transplant cohort and 258,342 in the non-SOT cohort. Seventy-seven percent of the SOT patients had prior renal transplant. SOT patients had a longer length of stay (P < 0.001), and a higher 30-day readmission rate compared to non-SOT patients (P =  < 0.001). In addition, SOT patients experienced a 23.8% rate of 90-day postoperative major medical complications and 3.0%, 1-year mortality, significantly larger than respective rates in the control population (P < 0.001). One-year infection, revision surgery rates, and wound dehiscence were not significantly different between the two cohorts.

Conclusion.
Spine surgery is associated with significant medical complications and 1-year mortality in the SOT population. Although there may be a substantial benefit from lumbar fusion in the SOT population, judicious patient selection is of paramount importance.

Level of Evidence: 3
Metabolic Syndrome and 30-Day Outcomes in Elective Lumbar Spinal Fusion
Authors: Chung Andrew S. , Campbell David , Waldrop Robert , Crandall Dennis 
Published: August 2017

Study Design.
A retrospective cohort study.

Objective.
The aim of this study was to evaluate the effect of metabolic syndrome (MetS) on 30-day morbidity and mortality following elective lumbar spinal fusion.

Summary of Background Data.
MetS is a variable combination of hypertension, obesity, elevated fasting plasma glucose, and dyslipidemia.
MetS has been associated with an increased risk of postoperative morbidity and mortality in multiple surgical settings. To our knowledge, the effect of MetS on 30-day outcomes following elective lumbar spinal fusion has not been well studied.

Methods.
An analysis of ACS-NSQIP data was performed between 2006 and 2013. Patients undergoing elective posterior lumbar fusion were identified. Emergency procedures, infections, tumor cases, and revision surgeries were excluded. Patients were defined as having MetS if they had a history of hypertension requiring medication, diabetes, and a body mass index (BMI) ≥30 kg/m2.

Results.
One thousand five hundred ninety (10.2%) patients with MetS were identified. A mild increase in major (P = 0.040) and minor complications (P = 0.003) in patients with MetS was noted. MetS was associated with increased rates of pulmonary complications (1.9% compared with 1.0%; P = 0.001), sepsis (1.7% compared with 0.9%; P = 0.005), and acute post-op renal failure (0.4% compared with 0%; P < 0.001). Multivariate analysis confirmed MetS to be an independent predictor of pulmonary complications [odds ratio (OR) 1.51; 95% confidence interval (95% CI 1.00–2.27); P = 0.048], sepsis (OR 1.56; 95% CI 1.01–2.42; P = 0.039), and acute postoperative renal failure (OR 6.95; 95% CI 2.23–21.67; P = 0.001). MetS status was associated with a mild increase in total hospital length of stay (4.38 compared with 3.81 days; P < 0.001).

Conclusion.
While MetS is a predictor of postoperative acute renal failure, it only slightly increases the risk of overall complications and is not associated with increased rates of 30-day reoperations or readmissions following elective lumbar fusion.

Level of Evidence: 3
Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock
Authors: Miller P. Elliott , Solomon Michael A. , McAreavey Dorothea 
Published: August 2017

Objectives:
To review temporary percutaneous mechanical circulatory support devices for the treatment of cardiogenic shock, including current evidence, contraindications, complications, and future directions.

Data Sources:
A MEDLINE search was conducted with MeSH terms: cardiogenic shock, percutaneous mechanical circulatory support, extracorporeal membrane oxygenation, Impella, and TandemHeart.

Study Selection:
Selected publications included randomized controlled trial data and observational studies describing experience with percutaneous mechanical circulatory support in cardiogenic shock.

Data Extraction:
Studies were chosen based on strength of association with and relevance to cardiogenic shock.

Data Synthesis:
Until recently, there were few options if cardiogenic shock was refractory to vasopressors or intra-aortic balloon pump counterpulsation. Now, several percutaneous mechanical circulatory support devices, including Impella (Abiomed, Danvers, MA), TandemHeart (CardiacAssist, Pittsburgh, PA), and extracorporeal membrane oxygenation, are more accessible. Compared with intra-aortic balloon pump, Impella provides greater hemodynamic support but no reduction in mortality. Similarly, TandemHeart improves hemodynamic variables but not survival. Comparative studies have been underpowered for mortality because of small sample size. Veno-arterial extracorporeal membrane oxygenation offers the advantage of biventricular circulatory support and oxygenation, but there are significant vascular complications. Comparative studies with extracorporeal membrane oxygenation have not been completed. Despite lack of randomized controlled data, there has been a substantial increase in use of percutaneous mechanical circulatory support. Several ongoing prospective studies with larger sample sizes may provide answers, and newer devices may become smaller, easier to insert, and more effective.

Conclusions:
Mortality from cardiogenic shock remains unacceptably high despite early coronary revascularization or other therapies. Although evidence is lacking and complications rates are high, improvements and experience with percutaneous mechanical circulatory support may offer the prospect of better outcomes.
“It Was the Only Thing I Could Hold Onto, But…”: Receiving a Letter of Condolence After Loss of a Loved One in the ICU: A Qualitative Study of Bereaved Relatives’ Experience*
Authors: Kentish-Barnes Nancy , Cohen-Solal Zoé , Souppart Virginie , Galon Marion , Champigneulle Benoît , Thirion Marina , Gilbert Marion , Lesieur Olivier , Renault Anne , Garrouste-Orgeas Maïté , Argaud Laurent , Venot Marion , Demoule Alexandre , Guisset Olivier , Vinatier Isabelle , Troché Gilles , Massot Julien , Jaber Samir , Bornstain Caroline , Gaday Véronique , Robert René , Rigaud Jean-Philippe , Cinotti Raphaël , Adda Mélanie , Thomas François , Azoulay Elie 
Published: August 2017

Objectives:
Family members of patients who die in the ICU often remain with unanswered questions and suffer from lack of closure. A letter of condolence may help bereaved relatives, but little is known about their experience of receiving such a letter. The objective of the study was to understand bereaved family members’ experience of receiving a letter of condolence.

Design:
Qualitative study using interviews with bereaved family members who received a letter of condolence and letters written by these family members to the ICU team. This study was designed to provide insight into the results of a larger randomized, controlled, multicenter study.

Setting:
Twenty-two ICUs in France.

Subjects:
Family members who lost a loved one in the ICU and who received a letter of condolence.

Measurements and Main Results:
Thematic analysis was used and was based on 52 interviews and 26 letters. Six themes emerged: 1) a feeling of support, 2) humanization of the medical system, 3) an opportunity for reflection, 4) an opportunity to describe their loved one, 5) continuity and closure, and 6) doubts and ambivalence. Possible difficulties emerged, notably the re-experience of the trauma, highlighting the absence of further support.

Conclusions:
This study describes the benefits of receiving a letter of condolence; mainly, it humanizes the medical institution (feeling of support, confirmation of the role played by the relative, supplemental information). However, this study also shows a common ambivalence about the letter of condolence’s benefit. Healthcare workers must strive to adapt bereavement follow-up to each individual situation.
Toll-Like Receptor 7 Staining in Malignant Epithelial Tumors
Authors: Franz Regina , Ritter Nathalie , Hein Rüdiger , Biedermann Tilo , Al-Sisi Mohammed , Eyerich Kilian , Garzorz-Stark Natalie , Andres Christian 
Published: August 2017

Background:
As important players of the innate immune system, Toll-like receptors (TLRs) and their role for tumorigenesis have been in the focus of research. In particular TLR7 is an interesting candidate, as TLR7 agonists are broadly used for the treatment of cutaneous tumors. However, data addressing the baseline expression of TLR7 in both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) on the protein level are lacking, while on the genomic level significantly elevated expression of TLR7 in SCC but not in BCC has been demonstrated.

Aim:
Our aim was to characterize the immunohistochemical staining pattern of TLR7 in SCC and BCC. Besides, we aimed to clarify if, in case of different TLR7 expression between SCC and BCC, TLR7 expression would help to define basosquamous carcinoma (BSC), a tumor entity sharing characteristics of both SCC and BCC.

Methods:
We examined histopathological samples from 23 BCC, 4 BSC, and 24 SCC and characterized the expression of TLR7 by immunohistochemistry and immunofluorescence.

Results:
We found that TLR7 was not expressed by the tumor tissue of SCC, BCC, and BSC, but by inflammatory cells located within the tumoral and/or peritumoral tissue. Whereas the overall expression of TLR7 did not differ between BCC and SCC (30.4% vs. 45.8%, respectively), we found that within the group of SCC, the well-differentiated SCC showed strong tumoral and/or peritumoral immunocellular TLR7 reactivity in contrast to the poorly differentiated SCC (73.33% vs. 11.1%, respectively). Besides, immunofluorescence double staining revealed the expression of TLR7 in immune cells closely interacting with T cells and natural killer cells.

Conclusions:
In contrast to genomic data, we did not find a general difference between baseline TLR7 expression of SCC and BCC on the protein level. Nevertheless, the expression of TLR7 by the inflammatory infiltrate associated with SCC may correlate with the degree of differentiation of SCC possibly indicating better outcome.