bluuebunny/crossref_metadata_2025_split huggingface dataset:
Locomotion Mode Affects the Physiological Strain during Exercise at Walk-Run Transition Speed inElderly Men
Authors: Freire Raul , Farinatti Paulo , Cunha Felipe , Silva Brenno , Monteiro Walace 
Published: May 2017

AbstractThis study investigated cardiorespiratory responses and rating of perceived exertion (RPE) during prolonged walking and running exercise performed at the walk-run transition speed (WRTS) in untrained healthy elderly men. 20 volunteers (mean±SE, age: 68.4±1.2 yrs; height: 170.0±0.02 cm; body mass: 74.7±2.3 kg) performed the following bouts of exercise: a) maximal cardiopulmonary exercise test (CPET); b) specific protocol to detect WRTS; and c) two 30-min walking and running bouts at WRTS. Expired gases were collected during exercise bouts via the Ultima CardiO2 metabolic analyzer. Compared to walking, running at the WRTS resulted in higher oxygen uptake (>0.27 L·min−1), pulmonary ventilation (>7.7 L·min−1), carbon dioxide output (>0.23 L·min−1), heart rate (>15 beats·min−1), oxygen pulse (>0.88 15 mL·beats−1), energy expenditure (>27 kcal) and cost of oxygen transport (>43 mL·kg−1·km−1·bout−1). The increase of overall and local RPEs with exercise duration was similar across locomotion modes (P<0.001). In all participants, %HRR and %VO2R throughout walking and running bouts were around or above the gas exchange threshold. In conclusion, elderly men exhibited higher cardiorespiratory responses during 30-min bouts of running than walking at WRTS. Nevertheless, walking corresponded to relative metabolic intensities compatible with preservation or improvement of cardiorespiratory fitness and should be preferable over running at WRTS in the untrained elderly characterized by poor fitness and reduced exercise tolerance.
Primäres gemischtes adeno-neuroendokrines Karzinom (MANEC) der Harnblase – eine seltene Entität
Authors: Eckstein Markus , Rasper Bernd , Busche Jörg , Stachetzki Ulf , Wistuba D. , Agaimy Abbas , Hartmann Arndt , Bertz Simone 
Published: May 2017

ZusammenfassungEin 67-jähriger Mann stellte sich wegen eines zufällig diagnostizierten Blasentumors im Bereich der Hinterwand zur transurethralen Resektion vor. Bei der initialen histopathologischen Untersuchung wurde die Diagnose eines Adenokarzinoms mit partieller neuroendokriner Differenzierung gestellt. Mittels Röntgen-Thorax und Computertomografie des Abdomens konnte kein anderer Primarius identifiziert werden. Aufgrund der ungewöhnlichen Diagnose wurde der Fall zur konsiliarpathologischen Untersuchung an unser Pathologisches Institut geschickt. Hier wurde die Diagnose eines gemischten adeno-neuroendokrinen Karzinoms der Blase bestätigt. Gemischte adeno-neuroendokrine Karzinome (MANEC) sind seltene Tumore, die meist im Dickdarm auftreten. Nach unserem Wissen präsentieren wir hier den weltweit fünften Fall eines primären MANEC der Harnblase.
Two-stage endoscopic mucosal resection is a safe and effective salvage therapy after a failed single-session approach
Authors: Tate David , Desomer Lobke , Hourigan Luke , Moss Alan , Singh Rajvinder , Bourke Michael 
Published: May 2017

Abstract
Background and study aims Endoscopic mucosal resection (EMR) of laterally spreading colonic lesions ≥ 20 mm (LSLs) is ideally performed in a single session (ssEMR) and avoids surgery in > 90 % of patients. We investigated whether a second attempt is safe or useful when ssEMR fails at a tertiary center.
Patients and methods In a multicenter prospective observational study of patients with LSL treated by EMR at four tertiary centers over 8 years, incompletely resected LSLs were referred for surgery or underwent two-stage EMR (tsEMR). At tsEMR, the scar was located and all visible residual tissue removed by snare, with thermal treatment permitted thereafter. Scheduled surveillance was performed at 5 months (SC1) and 18 months (SC2). The primary outcome was avoidance of surgery.
Results A total of 1944 LSLs (median size 35 mm) underwent EMR. ssEMR was unsuccessful in 127 lesions, 43 of which underwent tsEMR, with success in 36 (83.7 %). Compared with ssEMR, tsEMR lesions were larger (median size 50 mm vs. 30 mm; P < 0.001), exhibited more submucosal fibrosis (P < 0.001), and histology was more often tubular adenoma and less often serrated (P = 0.005). Lesions mainly required tsEMR for nonlifting (41.9 %) or poor endoscopic access (37.2 %). Failure of tsEMR was predicted by larger LSL (P = 0.03). Safety was comparable to ssEMR. Of the 33 LSLs that underwent tsEMR for benign disease and completed first surveillance, 27 (81.8 %) avoided surgery to long term follow-up.
Conclusions tsEMR shows promise as a salvage therapy for LSLs that cannot be resected in a single session for patients in whom other options such as surgery are not preferred or not possible.Trial registered at ClinicalTrials.gov (NCT01368289).
Endoscopic submucosal dissection for early gastric cancer: are expanded resection criteria safe for Western patients?
Authors: Probst Andreas , Schneider Annette , Schaller Tina , Anthuber Matthias , Ebigbo Alanna , Messmann Helmut 
Published: May 2017

Abstract
Background and study aims Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer (EGC) fulfilling guideline resection criteria or the expanded resection criteria in Asia. It is unclear whether the expanded criteria can be transferred to European patients, and long-term follow-up data are lacking. The aim of this study was to evaluate long-term follow-up data after ESD of EGCs in Europe.
Patients and methods Patients with EGC who underwent ESD were included in this single-center study at a German referral center. Patient and lesion characteristics, procedure characteristics, and follow-up data were recorded prospectively.
Results A total of 179 patients with 191 EGCs were included over a period of 141 months, with 29.6 % of lesions meeting guideline criteria and 48.6 % meeting expanded criteria. The en bloc resection rate was 98.4 % for guideline criteria and 89.0 % for expanded criteria lesions (P = 0.09), and the R0 resection rate was 90.2 % and 73.6 %, respectively (P = 0.02). The main reason for the expanded criteria was a lesion diameter > 20 mm (81.6 %). Complications: perforation 1 %, delayed bleeding 6.3 %, stricture 2.1 %, procedure-related mortality 1.1 %. Local recurrence rate was 0 % for guideline criteria and 4.8 % for expanded criteria lesions (P = 0.06), and the rate of metachronous neoplasia was 15.1 % and 7.1 %, respectively (median follow-up 51 and 56 months, respectively); 92.9 % of metachronous neoplasia were treated curatively with repeat ESD. One patient developed lymph node metastasis after ESD of a submucosal invasive expanded criteria lesion. Long-term-survival was comparable between the two criteria (P = 0.58). No gastric cancer-related death was observed in either group.
Conclusions ESD can achieve high rates of long-term curative treatment using the expanded criteria in EGCs in Western countries. We recommend ESD as treatment of choice not only for guideline criteria EGCs but also for intramucosal nonulcerated EGCs regardless of their diameter.
Tropical cyclone activity enhanced by Sahara greening and reduced dust emissions during the African Humid Period
Authors: Pausata Francesco S. R. , Emanuel Kerry A. , Chiacchio Marc , Diro Gulilat T. , Zhang Qiong , Sushama Laxmi , Stager J. Curt , Donnelly Jeffrey P. 
Published: May 2017

Significance
Our modeling study shows the crucial role of vegetation cover over the Sahara and reduced dust emission in altering tropical cyclone activity during the mid-Holocene (6,000 yBP). Our results also demonstrate how these regional changes in land cover and dust emission are able to affect areas far afield through changes of large-scale atmospheric circulation. Our study strongly suggests that an appropriate representation of land cover and dust emission is of paramount importance to be able to capture past—and potentially future—climate changes.
Myosin Va’s adaptor protein melanophilin enforces track selection on the microtubule and actin networks in vitro
Authors: Oberhofer Angela , Spieler Peter , Rosenfeld Yuliya , Stepp Willi L. , Cleetus Augustine , Hume Alistair N. , Mueller-Planitz Felix , Ökten Zeynep 
Published: May 2017

Significance
Inner organization of eukaryotic cells intimately depends on the active transport of diverse intracellular cargo on the ubiquitous actin and microtubule networks. The underlying mechanisms of such directional transport processes have been of outstanding interest. We studied a motor complex composed of Rab27a, melanophilin, and myosin Va and found, surprisingly, that the adaptor protein melanophilin toggled the binding preference toward actin or microtubules in vitro. Our results offer unexpected mechanistic insights into biasing the directionality of a moving organelle on the cytoskeleton through phospho-targeting the adaptor protein rather than its motor in vivo.
A corpus-based study of contextual factors influencing Korean EFL learners’ dative alternation
Authors: Song Eu-Jong , Sung Min-Chang 
Published: May 2017

AbstractEnglish datives show two syntactic patterns, the double object dative (DOD) and the prepositional dative (PD). The alternation between DOD and PD is influenced by three contextual factors: lexical verbs, syntactic weights, and information structures. However, it has been observed that English dative alternation by second language (L2) learners significantly deviates from the native norm. Accordingly, this study examines whether the three factors are influential when L2 learners produce dative sentences, by analyzing a learner corpus and a native speaker corpus. Results show that the learners produced PD significantly more frequently than the native speakers did. Even when DOD should be contextually preferred, the learners produced many PD sentences. These results suggest that L2 learners have trouble noticing the contextual factors when structuring English datives. The finding is further discussed as it relates to the major tenets of L2 acquisition such as cross-linguistic transfer, constructional knowledge, and language processing.
Road sign romanization in Oman
Authors: Jamoussi Rafik , Roche Thomas 
Published: May 2017

AbstractThroughout the Arab Gulf States, bilingual road signs are the norm, employing both Arabic and a romanized counterpart for the large expatriate population. The existing romanization is inconsistent, with potentially misleading variant spellings of place names signposting the region. This study provides a linguistic analysis of signs on the arterial road running from Muscat, Oman, toward Dubai in the United Arab Emirates in an effort to identify linguistic factors leading to discrepant renderings. The authors identify the wavering between transcription and transliteration and the hesitancy between the local and the standard language varieties as the main sources of discrepancies. These findings constitute the groundwork for initiatives intent on addressing the situation. Guidelines are provided for policy makers indicating the various aspects remedial work on signage in Oman should take into account.
Preparation of Chitosan/Collagen Blend Membranes for Wound Dressing: A Study on FTIR Spectroscopy and Mechanical Properties
Authors: Indrani D J , Lukitowati F , Yulizar Y 
Published: May 2017

Abstract
The effect of different gamma-ray irradiations on the functional groups and the mechanical properties of chitosan, collagen, and chitosan/collagen blend have been studied. Commercially available chitosan and extract of collagen from bovine tendon by acid dissolution method were employed. Chitosan, collagen and chitosan/collagen blend membranes were prepared using the solvent evaporation method. The dried membranes were subjected to gamma-ray irradiation using 0, 15, and 25 kGy. The membranes then characterized by Infrared spectroscopy and measured in tensile and elongation at break. The irradiated chitosan membranes displayed reduced intensity of -OH, -CH, -NH and -C-O-C groups, whereas, the collagen membranes revealed amide I, II and III groups. The irradiated chitosan/collagen (50/50%) blend membranes demonstrated the decreased intensities in the –OH and amide groups. The application of gamma-ray irradiation had produced chitosan/collagen blend membranes with a tensile strength and elongation at break between the chitosan and collagen membranes. It was further determined that the decrease in the mechanical properties of the membranes was likely to be due to some changes of the functional groups.
The rising incidence of nonalcoholic fatty liver disease
Authors: Wisocky Jessica , Paul Sonali 
Published: May 2017

Abstract:
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in the United States and will soon be the leading indication for liver transplantation. NAFLD can lead to cirrhosis of the liver and is usually asymptomatic. Prompt referral to a hepatologist may halt the morbidity and mortality associated with NAFLD.
SimZones: An Organizational Innovation for Simulation Programs and Centers
Authors: Roussin Christopher J. , Weinstock Peter 
Published: May 2017

The complexity and volume of simulation-based learning programs have increased dramatically over the last decade, presenting several major challenges for those who lead and manage simulation programs and centers. The authors present five major issues affecting the organization of simulation programs: (1) supporting both single- and double-loop learning experiences; (2) managing the training of simulation teaching faculty; (3) optimizing the participant mix, including individuals, professional groups, teams, and other role-players, to ensure learning; (4) balancing in situ, node-based, and center-based simulation delivery; and (5) organizing simulation research and measuring value. They then introduce the SimZones innovation, a system of organization for simulation-based learning, and explain how it can alleviate the problems associated with these five issues.
Simulations are divided into four zones (Zones 0–3). Zone 0 simulations include autofeedback exercises typically practiced by solitary learners, often using virtual simulation technology. Zone 1 simulations include hands-on instruction of foundational clinical skills. Zone 2 simulations include acute situational instruction, such as clinical mock codes. Zone 3 simulations involve authentic, native teams of participants and facilitate team and system development.
The authors also discuss the translation of debriefing methods from Zone 3 simulations to real patient care settings (Zone 4), and they illustrate how the SimZones approach can enable the development of longitudinal learning systems in both teaching and nonteaching hospitals. The SimZones approach was initially developed in the context of the Boston Children’s Hospital Simulator Program, which the authors use to illustrate this innovation in action.
Exploring the Relationships Between USMLE Performance and Disciplinary Action in Practice: A Validity Study of Score Inferences From a Licensure Examination
Authors: Cuddy Monica M. , Young Aaron , Gelman Andrew , Swanson David B. , Johnson David A. , Dillon Gerard F. , Clauser Brian E. 
Published: May 2017

Purpose
Physicians must pass the United States Medical Licensing Examination (USMLE) to obtain an unrestricted license to practice allopathic medicine in the United States. Little is known, however, about how well USMLE performance relates to physician behavior in practice, particularly conduct inconsistent with safe, effective patient care. The authors examined the extent to which USMLE scores relate to the odds of receiving a disciplinary action from a U.S. state medical board.

Method
Controlling for multiple factors, the authors used non-nested multilevel logistic regression analyses to estimate the relationships between scores and receiving an action. The sample included 164,725 physicians who graduated from U.S. MD-granting medical schools between 1994 and 2006.

Results
Physicians had a mean Step 1 score of 214 (standard deviation [SD] = 21) and a mean Step 2 Clinical Knowledge (CK) score of 213 (SD = 23). Of the physicians, 2,205 (1.3%) received at least one action. Physicians with higher Step 2 CK scores had lower odds of receiving an action. A 1-SD increase in Step 2 CK scores corresponded to a decrease in the chance of disciplinary action by roughly 25% (odds ratio = 0.75; 95% CI = 0.70–0.80). After accounting for Step 2 CK scores, Step 1 scores were unrelated to the odds of receiving an action.

Conclusions
USMLE Step 2 CK scores provide useful information about the odds a physician will receive an official sanction for problematic practice behavior. These results provide validity evidence supporting current interpretation and use of Step 2 CK scores.
The Problem and Goals Are Global, the Solutions Are Local: Revisiting Quality Measurements and the Role of the Private Sector in Global Health Professions Education
Authors: Hamdy Hossam 
Published: May 2017

The shortage of a competent health workforce is a global challenge. However, its manifestations and proposed solutions are very much context related (i.e., local). In addition to the shortage of health professionals, the quality of health professions education programs, institutions, and graduates, and how to measure quality, are also problematic. Commonly used metrics like the Credit Hours System and the European Credit Transfer and Accumulation System have limitations (e.g., being more focused on quantity than quality).
In this Invited Commentary, the author discusses the need to revisit quality measurements in health professions education and the issue of whether the private sector has a role to play in narrowing the ever-increasing gap between the demand for health care professionals and the health care workforce shortage.
Factors Affecting the Development and Sustainability of Communities of Practice Among Primary Care Physicians in Hong Kong
Authors: Poon Man Kay , Lam Tai Pong 
Published: May 2017

Introduction:
Primary care physicians (PCPs) maintain high standards of medical care by partaking in continuous learning. The learning model of communities of practice (COPs) is increasingly being used in the field of health care. This study explores the establishment and maintenance of COPs among PCPs in Hong Kong.

Methods:
Sequential, semi-structured individual interview and focus group interview were conducted to explore the purposes for partaking in continuous learning, as well as barriers and facilitators for attendance among private nonspecialist PCPs in Hong Kong. Data were drawn from the discourses related to COPs. Thematic analysis with constant comparison was performed until data saturation was reached.

Results:
PCPs voluntarily established COPs to solve clinical problems from the existing networks. Clinical interest, practice orientation, and recruitment of new members through endorsement by the existing members fostered group coherence. Conversation and interaction among members generated the “best” practice with knowledge that was applicable in specific clinical scenarios in primary care setting. COPs rejected commercial sponsorship to minimize corporate influences on learning. Updating medical knowledge, solving clinical problems, maintaining openness, engendering a sense of trust and ownership among members, and fulfilling psychosocial needs were integral to sustainability. Seeking secretariat support to aid in the logistics of meetings, enhancing external learning resources, and facilitation skills training of facilitators from professional bodies may further incentivize members to maintain COPs.

Discussion:
Autonomy of group learning activities, recruiting specialists and allied health professionals, training facilitators, and undertaking discussion in multimedia may achieve the sustainability of COPs.
Spiradenocarcinoma: A Comprehensive Data Review
Authors: Staiger Roxane D. , Helmchen Birgit , Papet Claudia , Mattiello Diana , Zingg Urs 
Published: May 2017

Introduction:
Spiradenocarcinomas (SCs) are rare and potentially aggressive skin adnexal tumors. Optimal treatment has not yet been established. Experiences with this carcinoma are mostly presented in case reports and few case series.

Objective:
To generate to a synopsis of published data on SC with regard to diagnostic procedures, treatment, and outcome.

Results:
Median patient age was 60 years and sex distribution was balanced. Tumor manifestations were evenly distributed within the sweat gland carrying skin. The most commonly reported symptom was accelerated growth of a longstanding indolent lesion, typically present for more than 2 years. Metastatic spread to the lung, bone, lymph nodes, liver, kidney, and breast has been documented. For staging computed tomography (CT) and positron emission tomography-CT are recommended, especially for detection of hematogenic metastases and lymph node involvement. Clear resection margins and tumor free regional lymph nodes reduce recurrence and carcinoma related death. Although low-grade SCs were reported over 3 times more often, high-grade carcinomas show a greater likelihood for recurrence and lethal outcome.

Conclusion:
Suspicion of an SC should lead to performance of a magnetic resonance imaging for defining tumor extent, and a fludeoxyglucose positron emission tomography-CT for detection of metastases. Radical tumor excision and resection of tumor involved regional lymph nodes are essential for a curative approach. Histopathological evaluation should involve determination of tumor differentiation grade, because high-grade carcinomas seem to have a much more aggressive behavior. Excision of distant metastases has no therapeutic value. Follow-up needs to be carried out in short intervals with frequent imaging.
Prevention of Surgical Site Infections and Biofilms: Pharmacokinetics of Subcutaneous Cefazolin and Metronidazole in a Tumescent Lidocaine Solution
Authors: Klein Jeffrey A. , Langman Loralie J. 
Published: May 2017

Background:
Tumescent anesthesia antibiotic delivery (TAAD) consists of subcutaneous infiltration of antibiotic(s) dissolved tumescent lidocaine anesthesia. Tumescent lidocaine anesthesia contains lidocaine (≤ 1 g/L), epinephrine (≤ 1 mg/L), sodium bicarbonate (10 mEq/L) in 0.9% saline. Our aim was to measure cefazolin and metronidazole concentrations over time in subcutaneous tumescent interstitial fluid (TISF) after TAAD, in serum after TAAD and after intravenous antibiotic delivery (IVAD). We hypothesize that the pharmacokinetic/pharmacodynamic profiles of TAAD + IVAD are superior to IVAD alone for the prevention of surgical site infections and biofilms.

Methods:
Concentrations of cefazolin and metronidazole in TISF and serum following TAAD and in serum following IVAD were compared in 5 female volunteers. Subjects received cefazolin or cefazolin plus metronidazole by IVAD alone and by TAAD alone. One subject also received concomitant IVAD and TAAD of these 2 antibiotics. Sequential samples of serum or subcutaneous TISF were assayed for antibiotic concentration.

Results:
Cefazolin (1 g) by TAAD resulted in an area under the curve of the concentration–time profile and a maximum concentration (Cmax) in subcutaneous tissue that were 16.5 and 5.6 times greater than in serum following 1 g by IVAD. Metronidazole (500 mg) by TAAD resulted in an area under the curve and Cmax that were 8.1 and 24.7 times greater in TISF, than in serum after 500 mg by intravenous delivery. IVAD + TAAD resulted in superior antibiotic concentrations to IVAD alone.

Conclusions:
TAAD + IVAD produced superior antibiotic bioavailability in both subcutaneous interstitial fluid and serum compared with IVAD alone. There was no evidence that TAAD of cefazolin and metronidazole poses a significant risk of harm to patients.