bluuebunny/crossref_metadata_2025_split huggingface dataset:
Building Sustainable Professional Development Programs: Applying Strategies From Implementation Science to Translate Evidence Into Practice
Authors: Baldwin Constance D. , Chandran Latha , Gusic Maryellen E. 
Published: May 2017

Introduction:
Multisite and national professional development (PD) programs for educators are challenging to establish. Use of implementation science (IS) frameworks designed to convert evidence-based intervention methods into effective health care practice may help PD developers translate proven educational methods and models into successful, well-run programs. Implementation of the national Educational Scholars Program (ESP) is used to illustrate the value of the IS model.

Methods:
Four adaptable elements of IS are described: (1) replication of an evidence-based model, (2) systematic stages of implementation, (3) management of implementation using three implementation drivers, and (4) demonstration of program success through measures of fidelity to proven models and sustainability.

Results:
Implementation of the ESP was grounded on five established principles and methods for successful PD. The process was conducted in four IS stages over 10 years: Exploration, Installation, Initial Implementation, and Full Implementation. To ensure effective and efficient processes, attention to IS implementation drivers helped to manage organizational relationships, build competence in faculty and scholars, and address leadership challenges. We describe the ESP's fidelity to evidence-based structures and methods, and offer three examples of sustainability efforts that enabled achievement of targeted program outcomes, including academic productivity, strong networking, and career advancement of scholars.

Discussion:
Application of IS frameworks to program implementation may help other PD programs to translate evidence-based methods into interventions with enhanced impact. A PD program can follow systematic developmental stages and be operationalized by practical implementation drivers, thereby creating successful and sustainable interventions that promote the academic vitality of health professions educators.
Incorporating Lifelong Learning From Residency to Practice: A Qualitative Study Exploring Psychiatry Learners' Needs and Motivations
Authors: Sockalingam Sanjeev , Soklaridis Sophie , Yufe Shira , Rawkins Sian , Harris Ilene , Tekian Ara , Silver Ivan , Wiljer David 
Published: May 2017

Introduction:
There has been an increased focus on lifelong learning (LLL) as a core competency to develop master learners in medical education across the learner continuum. The purpose of this study was to explore the perceptions of psychiatry residents and faculty about LLL implementation, motivation, and training needs.

Methods:
This qualitative study was conducted in a large, urban, multisite psychiatry training program as part of a larger mixed methods study of LLL in psychiatry education. Using a purposive sampling approach, psychiatry residents were recruited to participate in focus groups; early career psychiatrists and psychiatry educators were recruited to participate in semistructured interviews. Content analysis of interviews and focus groups was done using the iterative, inductive method of constant comparative analysis.

Results:
Of the 34 individuals participating in the study, 23 were residents, six were psychiatry educators, and five were early career psychiatrists. Three predominant themes were identified in participants' transcripts related to (1) the need for LLL training in residency training; (2) the implementation of LLL in residency training and practice; and (3) the spectrum of motivation for LLL from residency training into practice.

Discussion:
This study identified the lack of preparation for LLL in residency training and the impact of this gap for psychiatrists transitioning into practice. All participants described the importance of integrating LLL training within clinical rotations and the importance of grounding LLL within the clinical workplace early in residency training to support the delivery of effective, high-quality patient care.
Vitamin D in human reproduction
Authors: Franasiak Jason M. , Lara Evelin E. , Pellicer Antonio 
Published: May 2017

Purpose of review
Vitamin D deficiency has been associated with a wide range of human disease states and the global epidemic, particularly in reproductive aged women, has led to a focus on this complex hormones role in human reproduction. Indeed vitamin D receptors are found throughout the reproductive tract in the ovary, endometrium, and the placenta. It has roles both in calcium-dependent and independent pathways. However, agreement upon the most appropriate way to assess vitamin D status and ultimately its activity at various sites has proven challenging.

Recent findings
Investigators have studied vitamin D's role in assisted reproduction and found successful outcomes are correlated with vitamin D replete status. However, subsequent studies have found mixed results when parsing its role in folliculogenesis and oogenesis versus its impact on embryonic implantation in the endometrium. Correlation was shown in a donor oocyte model which suggests endometrial involvement; however, in a euploid blastocyst transfer model with attention to embryo and endometrial synchrony this was not seen. It may be that the major impact is proximal to blastocyst formation at the site of folliculogenesis as has been shown in a primate model. Taken together, these studies suggest that vitamin D's role may be more sophisticated when it comes to reproductive success. Further, it has become clear that the nonstandard method of determining vitamin D status in the clinical and research settings requires clarification to ensure more comparable data in future studies.

Summary
Vitamin D has clear roles in human health and disease, and its impact on human reproduction seems promising but requires clarification. With new techniques for assessing its status in patients and its impact at end organs as well as evolving theories regarding its potential to influence folliculogenesis, endometrial receptivity, and ovarian aging, we will soon gain additional clarity and hope to be able to impact reproductive success in a positive way.
Does obesity increase the risk of hot flashes among midlife women?: a population-based study
Authors: Saccomani Sylvio , Lui-Filho Jeffrey Frederico , Juliato Cassia Raquel , Gabiatti Jose Roberto , Pedro Adriana Orcesi , Costa-Paiva Lucia 
Published: May 2017

Abstract

Objective:
To evaluate the association between vasomotor symptoms and obesity in climacteric women.

Methods:
We conducted a cross-sectional population-based study of 749 women aged 45 to 60 years. The dependent variable was intensity of menopausal symptoms evaluated by the menopause rating scale questionnaire. Independent variables were sociodemographic and clinical characteristics, and obesity evaluated by body mass index.

Results:
There was no significant difference in the majority of clinical and sociodemographic characteristics between the body mass index groups. Obese women had less physical activity (P = 0.019) and a higher prevalence of hypertension (P < 0.001), diabetes (P = 0.002), urinary incontinence (P < 0.001), and urge incontinence (P = 0.0006). The total mean menopause rating scale score was 9.7. Scores for hot flashes increased progressively and were higher for participants with body mass index greater than 30 kg/m2 (P = 0.027). Joint and muscle pain scores also increased with increased body mass index (P < 0.001). Regarding urogenital symptoms, there was a significant difference in urinary problems only, which were more intense in obese women (body mass index >30 kg/m2) (P < 0.0001). There was no significant difference in any psychological symptoms on the menopause rating scale. Factors associated with hot flash scores were higher body mass index, presence of urinary urgency, and vaginal dryness.

Conclusions:
We found that menopausal symptoms, including vasomotor, joint, and urinary symptoms, were related to obesity. Hot flashes were associated with higher body mass index, urinary urgency, and vaginal dryness. Understanding this relationship may contribute to the development of healthcare strategies aimed at minimizing the impact of obesity on several health issues of climacteric women.
Ultrasonographic Images of Nasal Bone Fractures with Water Used as the Coupling Medium
Authors: Shigemura Yuka , Ueda Koichi , Akamatsu Jun , Sugita Naoya , Nuri Takashi , Otsuki Yuki 
Published: May 2017

Background:
Ultrasonography can show local and superficial fractures of the nasal bone. However, it is difficult to see the whole nasal bone. We used water as the coupling medium for ultrasonography.

Methods:
This method was used in 76 nasal bone fracture cases from July 2011 to March 2013, and we could obtain clear images of the entire nasal bone and surrounding bones. However, in some images, there were artifacts and blurred areas. The patterns of blurring were classified and their causes were analyzed.

Results:
The 6 patterns of artifacts and blurred images were (1) Blurred side wall of the nasal bone in 68 cases, (2) air bubbles in the water in 68 cases, (3) unclear deep portions by attenuation in 23 cases, (4) distorted images caused by shaking of the probe in 44 cases, (5) parallel shadows due to multiple reflections in 18 cases, and (6) mysterious shadows caused by side lobes of the ultrasound beams in 55 cases. Almost all of them could be avoided by adding some small changes of techniques.

Conclusions:
Our methods can provide whole clear images of the nasal bone and surrounding bones in 1 field. Almost all the artifacts and blurred images which occurred during the performance of our methods could be avoided by adding some small changes, for example, tilting the probe, pouring the water slowly, and moving the probe closer to the nose.
RISK FACTORS FOR RECURRENCES OF CENTRAL SEROUS CHORIORETINOPATHY
Authors: Matet Alexandre , Daruich Alejandra , Zola Marta , Behar-Cohen Francine 
Published: May 2017

Purpose:
To describe recurrence patterns and investigate candidate risk factors for recurrences of central serous chorioretinopathy.

Methods:
In 46 patients with acute central serous chorioretinopathy and follow-up >12 months after first episode resolution, parameters influencing recurrences were retrospectively evaluated using a frailty Cox proportional hazard survival model. Covariates included baseline systemic findings: age, gender, corticosteroid use, stress, shift work, sleep disorder, depression, allergy, cardiovascular risk; baseline optical coherence tomography findings: subfoveal choroidal thickness, pigment epithelial detachment pattern (regular/bump/irregular), number of subretinal hyperreflective foci at leakage site; baseline angiographic findings: fluorescein leakage intensity (intense/moderate/subtle/absent), hyperpermeability pattern on indocyanine-green angiography (focal/multifocal); and episode-related findings: duration and treatment of previous episode.

Results:
Twenty of 46 subjects (43%) presented ≥1 recurrences during a mean follow-up of 29.9 ± 9.5 months (range, 15–54 months). Follow-up duration did not differ between cases with or without recurrences (P = 0.3). Worse final visual acuity levels (logarithm of the minimal angle of resolution) were associated with a higher number of episodes during follow-up (P = 0.032, r = 0.28). In a univariate analysis, higher subfoveal choroidal thickness (P = 0.021), nonintense fluorescein leakage (= moderate/subtle/absent, P = 0.033), multiple subretinal hyperreflective foci (P = 0.026), and shift work (P < 0.0001) were significantly associated with recurrences, with a near-significant influence of irregular pigment epithelial detachment (P = 0.093). In a multivariate analysis, higher subfoveal choroidal thickness (P = 0.007), nonintense fluorescein leakage (P = 0.003) and shift work (P < 0.0001) remained significant and independent risk factors for recurrences.

Conclusion:
Multiple factors influence the risk of central serous chorioretinopathy recurrence. These findings may contribute to identify patients at higher risk, who could benefit from earlier or more intensive treatment.
Comparative Efficacy of Transfemoral Prosthetic Interfaces: Analysis of Gait and Perceived Disability
Authors: Klenow Tyler D. , Kahle Jason T. , Fedel Frank J. , Ropp Jeffrey , Highsmith M. Jason 
Published: May 2017

ABSTRACT

Introduction
The High-Fidelity (HiFi) interface is an emerging transfemoral interface technology. However, no comparison of this interface to traditional transfemoral interface designs is currently available. The purpose of this study is to measure the effects of the HiFi system on gait and perceived disability compared with a traditional socket design in a subject with transfemoral amputation.

Methods
The subject was first tested with a traditional ischial containment socket, then fit with the HiFi system, and tested again after a 30-day accommodation period. Three-dimensional motion analysis was performed using an 8-camera Vicon Motion Capture system. The Oswestry Low Back Pain Disability Questionnaire v2.0 and Western Ontario and McMaster University Osteoarthritis index were administered at initial and secondary testing to evaluate perceived disability. A one-way analysis of variance and Fischer's least significant difference were used to determine statistical difference between conditions. The level of significance for all tests was set at P ≤ 0.05.

Results
Notable results included an increase in self-selected gait velocity, prosthetic hip adduction, and hip extension. Reductions in lateral center of mass deviation during gait and in perceived disability was also shown with use of the HiFi condition.

Discussion
This study analyzed the effects of the HiFi Interface System on biomechanical parameters of gait and perceived disability compared with a baseline IRC condition in this elderly subject with history of TF amputation. Several improvements and markers of increased stability with use of the HiFi were noted. Perceived disability was also greatly improved comparatively.

Conclusions
The HiFi Interface System presented some biomechanical advantages to traditional IRC socket designs in this case, which may allow for increased stability in patients utilizing a TF prosthesis. Further research with larger samples is warranted.
Cochlear Implant Electrode Localization Using an Ultra-High Resolution Scan Mode on Conventional 64-Slice and New Generation 192-Slice Multi-Detector Computed Tomography
Authors: Carlson Matthew L. , Leng Shuai , Diehn Felix E. , Witte Robert J. , Krecke Karl N. , Grimes Josh , Koeller Kelly K. , Bruesewitz Michael R. , McCollough Cynthia H. , Lane John I. 
Published: May 2017

Hypothesis:
A new generation 192-slice multi-detector computed tomography (MDCT) clinical scanner provides enhanced image quality and superior electrode localization over conventional MDCT.

Background:
Currently, accurate and reliable cochlear implant electrode localization using conventional MDCT scanners remains elusive.

Methods:
Eight fresh-frozen cadaveric temporal bones were implanted with full-length cochlear implant electrodes. Specimens were subsequently scanned with conventional 64-slice and new generation 192-slice MDCT scanners utilizing ultra-high resolution modes. Additionally, all specimens were scanned with micro-CT to provide a reference criterion for electrode position. Images were reconstructed according to routine temporal bone clinical protocols. Three neuroradiologists, blinded to scanner type, reviewed images independently to assess resolution of individual electrodes, scalar localization, and severity of image artifact.

Results:
Serving as the reference standard, micro-CT identified scalar crossover in one specimen; imaging of all remaining cochleae demonstrated complete scala tympani insertions. The 192-slice MDCT scanner exhibited improved resolution of individual electrodes (p < 0.01), superior scalar localization (p < 0.01), and reduced blooming artifact (p < 0.05), compared with conventional 64-slice MDCT. There was no significant difference between platforms when comparing streak or ring artifact.

Conclusion:
The new generation 192-slice MDCT scanner offers several notable advantages for cochlear implant imaging compared with conventional MDCT. This technology provides important feedback regarding electrode position and course, which may help in future optimization of surgical technique and electrode design.
Differential significance of early surgical complications for acute and long-term recurrence-free survival following surgical resection of hepatocellular carcinoma: do comorbidities play a role?
Authors: Khandoga Andrej , Drefs Moritz , Schoenberg Markus , Schiergens Tobias , Frenes Katharina , op den Winkel Mark , Trumm Christoph , Angele Martin K. , Guba Markus , Werner Jens , Rentsch Markus 
Published: May 2017

Background
Postoperative complications of Clavien–Dindo grade 3 or more are of prognostic significance in patients who undergo liver resection for hepatocellular carcinoma (HCC). However, perioperative mortality and patient comorbidities represent relevant factors that interfere with postoperative long-term survival. To clarify this, a retrospective single-center study was carried out.

Patients and methods
Patient data were prospectively collected in a continuously updated liver resection database. Overall, 184 consecutive patients who underwent liver resection for HCC with a curative intent between March 2003 and December 2013 were selected for the study. The patients were assigned to two groups according to the presence or absence of postoperative complications. Pre-existing comorbidities, perioperative mortality, surgical outcome, and long-term survival data were analyzed.

Results
Postoperative complications requiring revision surgery were identified in 17.4% of the patients. The in-house mortality rate was 4.8%. Compared with patients without complications, patients with complications were older and had significantly more pre-existing comorbidities, more advanced tumors, more intrahepatic metastasis, longer operation times, greater blood loss, and more extensive resections. The overall 5-year survival rates were 40.1 and 52.5% in patients with or without postoperative complications, respectively. The corresponding 5-year recurrence-free survival rates were 46.3 and 46.7% (perioperative mortality excluded). Multivariate analysis showed that elevation of the Charlson Comorbidity Index was associated independently with decreased overall and recurrence-free survival.

Conclusion
In patients with HCC, posthepatectomy complications are confirmed to have predictive value. However, closer analysis and exclusion of perioperative mortality effects show an independent impact of pre-existing comorbidities on long-term overall und recurrence-free survival.
The Challenge of Patient Notification and the Work of Follow-Up Generated by a 2-Step Testing Protocol for Group A Streptococcal Pharyngitis in the Pediatric Emergency Department
Authors: Russo Michael E. , Kline Jennifer , Jaggi Preeti , Leber Amy L. , Cohen Daniel M. 
Published: May 2017

Objective
Current guidelines recommend confirmatory testing for negative rapid antigen detection tests (RADTs) for group A streptococcal pharyngitis in children. We sought to describe the work of follow-up generated by this process and frequency of our inability to notify patients of positive results.

Methods
We retrospectively reviewed laboratory and outreach nurse records of patients who had group A streptococcal pharyngitis testing performed in an academic pediatric emergency department during 2014. For patients with a negative RADT and subsequent positive backup direct nucleic acid probe test, we recorded whether the patient was successfully notified of the positive result, the number of contact attempts, and the time to antibiotic prescription.

Results
There were 6504 patients who had an RADT performed, of which 5474 (84.2%) were negative with a confirmatory test performed. There were 234 patients with positive confirmatory testing and not prescribed antibiotics at the time of the initial visit. Of these, 90.1% were ultimately contacted and prescribed appropriate antibiotics, whereas 7.3% were lost to follow-up and 2.6% had potentially unnecessary repeat visits. Of those contacted, 43.1% were reached only after multiple telephone calls or a letter. The median time from the negative RADT to the submission of an electronic prescription was 19.6 hours (interquartile range, 7.5–24.9 hours; range, 6–144 hours).

Conclusions
Although confirmatory testing after a negative RADT in children is currently the standard of care, this practice requires a substantial amount of work. Furthermore, a significant fraction of patients are lost to follow-up or have unnecessary repeat visits.
Point-of-Care Ultrasound Identification of a Psoas Abscess in a Child Presenting With Hip Pain
Authors: Deanehan Julia K. 
Published: May 2017

Abstract
This case-report describes a 4-year-old girl brought to the emergency department for the evaluation of limp and elevated inflammatory markers. The patient’s history and physical examination did not reveal a clear source of pathology. Point-of-care ultrasound identified a right-sided psoas abscess that was confirmed with computed tomography scan. This case demonstrates the potential utility of point-of-care ultrasound in the diagnosis and management of patients presenting to the emergency department with symptoms concerning for pathology in the hip or lower abdomen.
Reduced intraepidermal nerve fiber density after a sustained increase in insular glutamate: a proof-of-concept study examining the pathogenesis of small fiber pathology in fibromyalgia
Authors: Harte Steven E. , Clauw Daniel J. , Hayes John M. , Feldman Eva L. , St Charles Irene C. , Watson Christopher J. 
Published: May 2017

Abstract

Introduction:
Neuroimaging reveals increased glutamate within the insula of patients with fibromyalgia (FM), suggesting a link between FM symptoms and increased central excitatory neurotransmission. Many patients with FM also present with decreased intraepidermal nerve fiber density (IENFD), consistent with small fiber pathology. It remains unknown, however, whether either of these mechanistic findings represent a cause or a consequence of the other. This study tests the hypothesis that an excitatory imbalance within the insula leads to small fiber pathology.

Objectives:
This is a proof-of-concept study to examine whether a chronic, bilateral increase in insular glutamate can be a causal factor in the development of small fiber neuropathy in FM.

Methods:
The glutamate transport inhibitor l-trans-Pyrrolidine-2,4-dicarboxylic acid (PDC), which increases endogenous levels of glutamate, was dissolved in Ringer solution and bilaterally delivered into the insula of rats for 6 weeks. Naive rats that did not undergo any surgery or treatment and rats administered Ringer vehicle solution into the insula served as controls. Multimodal nociceptive sensitivity was assessed weekly. Hind paw tissue biopsies were collected for IENFD assessment, at the end of the experiment.

Results:
Compared with controls, increasing endogenous glutamate in the insula with PDC caused sustained decreases in mechanical paw withdrawal threshold and thermal paw withdrawal latency, increased aversion to noxious mechanical stimulation, and a decrease in IENFD. Cold reactivity was not altered by PDC administration.

Conclusion:
Bilateral insular PDC administration produced a persistent increase in multimodal pain behaviors and a decrease in peripheral nerve fibers in rat. These preclinical findings offer preliminary support that insular hyperactivity may be a casual factor in the development of small fiber pathology in FM.