bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perfusion Computed Tomography Study: A Utility Tool in Traumatic Cerebral Contusions
Authors: Velho Vernon , Valsangkar Shonali A. , Singh Jasmit , Survashe Pravin , Aher Sucheta , Kharosekar Hrushikesh U. 
Published: April 2016

Aim To assess the usefulness of CT perfusion scans of the brain in patients with traumatic brain injury having cerebral contusion on CT scan.
Material and Methods This prospective study included 76 patients with cerebral contusion on plain CT of the brain, aged 5 to 86 years, admitted in our institution. They underwent perfusion CT as part of their admission CT survey and follow-up scan 48 hours later. Clinical data, unenhanced CT brain findings, and perfusion CT scans were evaluated with respect to the postoperative GCS (Glasgow Coma Score) and neurologic deficit.
Results Perfusion CT gave additional information when done with conventional unenhanced CT in the detection of cerebral contusions. Perfusion CT featured specific patterns with respect to patient outcome, patients with unfavorable outcome having significant decrease in cerebral perfusion. In patients having less GCS score, a significant decrease in cerebral blood flow and cerebral blood volume was detected.
Conclusion Perfusion CT provides independent useful information regarding functional outcome. In the acute phase of mild head injury, disturbed cerebral perfusion is seen in patients with normal noncontrast CT correlating with evolution, severity of injury, and outcome.
Elongation factor 4 remodels the A-site tRNA on the ribosome
Authors: Gagnon Matthieu G. , Lin Jinzhong , Steitz Thomas A. 
Published: April 2016

Significance
Many protein factors interact with the ribosome during protein synthesis. Elongation factor 4 (EF-4/LepA) is a widely distributed and highly conserved translational GTPase for which several physiological roles have been proposed. Despite this, the function of EF-4 remains unknown. We have determined a high-resolution crystal structure of the ribosome bound to EF-4 in its GTP-bound state and A-, P-, and E-site tRNAs. Notably, EF-4 induces a distinct conformation of the tRNA bound in the A site, which deviates substantially from that of a canonical A-tRNA. EF-4 interacts with both helical domains of the A-site tRNA, indicating that EF-4 recognizes the L-shaped conformation of tRNA. Our results provide insights into the tRNA remodeling capacity of EF-4 on the ribosome.
Dynamics of prebiotic RNA reproduction illuminated by chemical game theory
Authors: Yeates Jessica A. M. , Hilbe Christian , Zwick Martin , Nowak Martin A. , Lehman Niles 
Published: April 2016

SignificanceThe origins of life required a means for information-containing molecules to compete with one another for survival and reproduction. Using an analysis based on game theory, we can predict the situations in which cooperation, selfishness, or a mixture of the two is beneficial to the future evolutionary success of RNAs.
Structures of the nucleoid occlusion protein SlmA bound to DNA and the C-terminal domain of the cytoskeletal protein FtsZ
Authors: Schumacher Maria A. , Zeng Wenjie 
Published: April 2016

Significance
The bacterial protein FtsZ polymerizes into protofilaments to create the cytokinetic ring responsible for directing cell division. Cellular levels of FtsZ are above the concentration required for Z-ring formation. Hence, FtsZ-binding proteins have evolved that control its spatiotemporal formation. The SlmA protein is one such factor that, when bound to specific chromosomal DNA, inhibits FtsZ polymerization to prevent Z rings from forming through the bacterial chromosome. This inhibition depends on complex formation between SlmA-DNA and the FtsZ C-terminal domain (CTD). Here we describe SlmA–DNA–FtsZ CTD structures. These structures and complementary biochemistry unveil the molecular basis for the unique requirement that SlmA be DNA-bound to interact with FtsZ, a mechanism that appears to be conserved among SlmA-containing bacteria.
The Association between Benzodiazepine Prescription and Aberrant Drug-Related Behaviors in Primary Care Patients Receiving Opioids for Chronic Pain
Authors: Park Tae Woo , Saitz Richard , Nelson Kerrie P. , Xuan Ziming , Liebschutz Jane M. , Lasser Karen E. 
Published: April 2016

Background: Benzodiazepine use has been associated with addiction-related risks, but little is known about its association with aberrant drug-related behaviors in patients receiving opioids for chronic pain. The authors examined the association between receipt of a benzodiazepine prescription and 2 aberrant drug-related behaviors, early opioid refills and illicit drug (cocaine) use in patients receiving opioids for noncancer chronic pain. Methods: This was a retrospective cohort study of 847 patients with ≥1 visit to either a hospital-based primary care clinic or one of two community health centers between September 1, 2011, and August 31, 2012. All patients received ≥3 opioid prescriptions written at least 21 days apart within 6 months, and ≥1 urine drug screen during the study period. A Cox proportional hazards model estimated the hazard of a second early opioid refill, defined as an opioid prescription written 7–25 days after the previous prescription for the same drug, as a function of time-varying benzodiazepine prescription. A logistic regression model examined the relationship between benzodiazepine prescription and a positive urine test for cocaine. Models were adjusted for demographics and mental/substance use disorder diagnoses. Results: Twenty-three percent ( n = 196) of patients received ≥1 benzodiazepine prescription during the study period. Twenty-two percent ( n = 183) of patients had ≥2 early opioid refills, and 11% ( n = 93) had ≥1 positive urine drug tests for cocaine. Receipt of benzodiazepine prescription was associated with an increased hazard of having a second early opioid refill, adjusted hazard ratio = 1.54 (95% confidence interval [CI]: 1.09–2.18), but not associated with a positive cocaine test, adjusted odds ratio = 1.07 (95% CI: 0.55–2.23). Conclusions: Among primary care patients receiving chronic opioid therapy, benzodiazepine prescription was associated with early opioid refills but not with cocaine use. Further research should better elucidate the risks and benefits of prescribing benzodiazepines to patients receiving opioids for chronic pain.
Shortening the Miles to the Milestones: Connecting EPA-Based Evaluations to ACGME Milestone Reports for Internal Medicine Residency Programs
Authors: Choe John H. , Knight Christopher L. , Stiling Rebekah , Corning Kelli , Lock Keli , Steinberg Kenneth P. 
Published: April 2016

The Next Accreditation System requires internal medicine training programs to provide the Accreditation Council for Graduate Medical Education (ACGME) with semiannual information about each resident’s progress in 22 subcompetency domains. Evaluation of resident “trustworthiness” in performing entrustable professional activities (EPAs) may offer a more tangible assessment construct than evaluations based on expectations of usual progression toward competence. However, translating results from EPA-based evaluations into ACGME milestone progress reports has proven to be challenging because the constructs that underlay these two systems differ.
The authors describe a process to bridge the gap between rotation-specific EPA-based evaluations and ACGME milestone reporting. Developed at the University of Washington in 2012 and 2013, this method involves mapping EPA-based evaluation responses to “milestone elements,” the narrative descriptions within the columns of each of the 22 internal medicine subcompetencies. As faculty members complete EPA-based evaluations, the mapped milestone elements are automatically marked as “confirmed.” Programs can maintain a database that tallies the number of times each milestone element is confirmed for a resident; these data can be used to produce graphical displays of resident progress along the internal medicine milestones.
Using this count of milestone elements allows programs to bridge the gap between faculty assessments of residents based on rotation-specific observed activities and semiannual ACGME reports based on the internal medicine milestones. Although potentially useful for all programs, this method is especially beneficial to large programs where clinical competency committee members may not have the opportunity for direct observation of all residents.
Increasing Scholarly Activity Productivity During Residency: A Systematic Review
Authors: Stevenson Michelle D. , Smigielski Elizabeth M. , Naifeh Monique M. , Abramson Erika L. , Todd Christopher , Li Su-Ting T. 
Published: April 2016

Purpose
Although resident participation in scholarly activity is mandated by the Accreditation Council for Graduate Medical Education, programmatic factors associated with success are not defined. This systematic review’s objective was to determine which interventions are effective in increasing resident scholarly activity productivity (RSAP), as measured by participation in scholarly activity, presentations, or publications.

Method
The PubMed, MEDLINE, Cochrane Library of Systematic Reviews, PsycINFO, CINAHL, and ERIC databases were searched through October 2013. English-language articles evaluating interventions to increase RSAP in U.S. or Canadian residency programs were included, without date limits. Two independent reviewers selected articles for inclusion and extracted data. Discrepancies were resolved by consensus.

Results
Of the 6,248 records screened, 80 studies underwent data abstraction. Twenty-six described outcomes without a comparison group, leaving 54 studies representing 13 medical and surgical specialties. Interventions included required scholarly activity participation, protected research time, research curricula, research directors, dedicated research days, and research tracks. Focusing on the 35 studies reporting statistical analysis, RSAP was associated with all interventions. There were some differences in intervention effectiveness between medical and surgical specialties.

Conclusions
Interventions, including protected time, research curricula, or specialized research tracks, generally result in increased participation in scholarly activity in residency programs, with mixed effects on resident presentations or publications. In many studies, interventions were bundled, suggesting that programs may need to provide increased structure and rigor through multiple pathways. The findings highlight the need for a clear definition of resident scholarly activity success aligned specifically to individual program and resident aims.
Health Systems Science Curricula in Undergraduate Medical Education: Identifying and Defining a Potential Curricular Framework
Authors: Gonzalo Jed D. , Dekhtyar Michael , Starr Stephanie R. , Borkan Jeffrey , Brunett Patrick , Fancher Tonya , Green Jennifer , Grethlein Sara Jo , Lai Cindy , Lawson Luan , Monrad Seetha , O’Sullivan Patricia , Schwartz Mark D. , Skochelak Susan 
Published: April 2016

Purpose
The authors performed a review of 30 Accelerating Change in Medical Education full grant submissions and an analysis of the health systems science (HSS)-related curricula at the 11 grant recipient schools to develop a potential comprehensive HSS curricular framework with domains and subcategories.

Method
In phase 1, to identify domains, grant submissions were analyzed and coded using constant comparative analysis. In phase 2, a detailed review of all existing and planned syllabi and curriculum documents at the grantee schools was performed, and content in the core curricular domains was coded into subcategories. The lead investigators reviewed and discussed drafts of the categorization scheme, collapsed and combined domains and subcategories, and resolved disagreements via group discussion.

Results
Analysis yielded three types of domains: core, cross-cutting, and linking. Core domains included health care structures and processes; health care policy, economics, and management; clinical informatics and health information technology; population and public health; value-based care; and health system improvement. Cross-cutting domains included leadership and change agency; teamwork and interprofessional education; evidence-based medicine and practice; professionalism and ethics; and scholarship. One linking domain was identified: systems thinking.

Conclusions
This broad framework aims to build on the traditional definition of systems-based practice and highlight the need for medical and other health professions schools to better align education programs with the anticipated needs of the systems in which students will practice. HSS will require a critical investigation into existing curricula to determine the most efficient methods for integration with the basic and clinical sciences.
The Two-Stage Examination: A Method to Assess Individual Competence and Collaborative Problem Solving in Medical Students
Authors: Lindsley Janet E. , Morton David A. , Pippitt Karly , Lamb Sara , Colbert-Getz Jorie M. 
Published: April 2016

Problem
Effectively solving problems as a team under stressful conditions is central to medical practice; however, because summative examinations in medical education must test individual competence, they are typically solitary assessments.

Approach
Using two-stage examinations, in which students first answer questions individually (Stage 1) and then discuss them in teams prior to resubmitting their answers (Stage 2), is one method for rectifying this discordance. On the basis of principles of social constructivism, the authors hypothesized that two-stage examinations would lead to better retention of, specifically, items answered incorrectly at Stage 1.
In fall 2014, they divided 104 first-year medical students into two groups of 52 students. Groups alternated each week between taking one- and two-stage examinations such that each student completed 6 one-stage and 6 two-stage examinations. The authors reassessed 61 concepts on a final examination and, using the Wilcoxon signed ranked tests, compared performance for all concepts and for just those students initially missed, between Stages 1 and 2.

Outcomes
Final examination performance on all previously assessed concepts was not significantly different between the one-and two-stage conditions (P = .77); however, performance on only concepts that students initially answered incorrectly on a prior examination improved by 12% for the two-stage condition relative to the one-stage condition (P = .02, r = 0.17).

Next Steps
Team assessment may be most useful for assessing concepts students find difficult, as opposed to all content. More research is needed to determine whether these results apply to all medical school topics and student cohorts.
Curriculum Development and Evaluation of a Hemodynamic Critical Care Ultrasound: A Systematic Review of the Literature
Authors: Kanji Hussein D. , McCallum Jessica L. , Bhagirath Kapil M. , Neitzel Andrew S. 
Published: April 2016

Objective:
The application of ultrasound to assess a patient’s cardiac function and volume status is becoming commonplace in the practice of critical care. These skills have been taught through varying curricula; however, no consensus on the optimal curriculum has been established. The purpose of this systematic review is to evaluate the literature regarding critical care ultrasound curriculum development and evaluation.

Data Sources:
Studies were identified using MEDLINE, Embase, CINAHL, PsycInfo, the Cochrane Center Register of Controlled Trials, and ERIC according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through June 2014.

Study Selection:
Included studies were limited to those that described adult (age, > 16 yr) cardiac or hemodynamic critical care ultrasound curricula for physicians. Two reviewers independently screened studies based on predetermined exclusion criteria, and disagreements were resolved by a third reviewer.

Data Extraction:
Data were abstracted, and quality was assessed by two reviewers using the Newcastle-Ottawa Scale. Data abstracted from the studies included the learner population, examination type, duration, composition, and setting of the curriculum, means of evaluation, and outcomes.

Data Synthesis:
The search yielded 654 studies; of which, 15 met inclusion criteria. All curricula used a combination of didactic and hands-on components. The highest agreement between novice and experts, coupled with the most time-efficient application, was achieved when the study was limited to a basic qualitative approach for the assessment of global function or contractility and assessment of inferior vena cava collapsibility. The mode of delivery seemed most efficient when a hybrid method was used, including online instruction. Minimum scanning competency may be achieved with 30 scans although more rigorous study on this element is necessary.

Conclusions:
Assessment of cardiac function and volume assessment is becoming an essential skill in critical care medicine. Physicians can be taught bedside echocardiography in a time-effective manner with positive benefit to patients by applying a concise curriculum with limited content.
Low Tidal Volume Ventilation Use in Acute Respiratory Distress Syndrome*
Authors: Weiss Curtis H. , Baker David W. , Weiner Shayna , Bechel Meagan , Ragland Margaret , Rademaker Alfred , Weitner Bing Bing , Agrawal Abha , Wunderink Richard G. , Persell Stephen D. 
Published: April 2016

Objective:
Low tidal volume ventilation lowers mortality in the acute respiratory distress syndrome. Previous studies reported poor low tidal volume ventilation implementation. We sought to determine the rate, quality, and predictors of low tidal volume ventilation use.

Design:
Retrospective cross-sectional study.

Setting:
One academic and three community hospitals in the Chicago region.

Patients:
A total of 362 adults meeting the Berlin Definition of acute respiratory distress syndrome consecutively admitted between June and December 2013.

Measurements and Main Results:
Seventy patients (19.3%) were treated with low tidal volume ventilation (tidal volume < 6.5 mL/kg predicted body weight) at some time during mechanical ventilation. In total, 22.2% of patients requiring an Fio
2 greater than 40% and 37.3% of patients with Fio
2 greater than 40% and plateau pressure greater than 30 cm H2O received low tidal volume ventilation. The entire cohort received low tidal volume ventilation 11.4% of the time patients had acute respiratory distress syndrome. Among patients who received low tidal volume ventilation, the mean (sd) percentage of acute respiratory distress syndrome time it was used was 59.1% (38.2%), and 34% waited more than 72 hours prior to low tidal volume ventilation initiation. Women were less likely to receive low tidal volume ventilation, whereas sepsis and Fio
2 greater than 40% were associated with increased odds of low tidal volume ventilation use. Four attending physicians (6.2%) initiated low tidal volume ventilation within 1 day of acute respiratory distress syndrome onset for greater than or equal to 50% of their patients, whereas 34 physicians (52.3%) never initiated low tidal volume ventilation within 1 day of acute respiratory distress syndrome onset. In total, 54.4% of patients received a tidal volume less than 8 mL/kg predicted body weight, and the mean tidal volume during the first 72 hours after acute respiratory distress syndrome onset was never less than 8 mL/kg predicted body weight.

Conclusions:
More than 12 years after publication of the landmark low tidal volume ventilation study, use remains poor. Interventions that improve adoption of low tidal volume ventilation are needed.
Routine Chest Radiography Is Not Necessary After Ultrasound-Guided Right Internal Jugular Vein Catheterization
Authors: Hourmozdi Justin J. , Markin Abraham , Johnson Brad , Fleming Patrick R. , Miller Joseph B. 
Published: April 2016

Objectives:
Central venous catheter placement is a common procedure performed on critically ill patients. Routine postprocedure chest radiographs are considered standard practice. We hypothesize that the rate of clinically relevant complications detected on chest radiographs following ultrasound-guided right internal jugular vein catheterization is exceedingly low.

Design:
Retrospective chart review.

Setting:
Adult ICUs, emergency departments, and general practice units at an academic tertiary care hospital system.

Patients:
All 1,322 ultrasound-guided right internal jugular vein central venous catheter attempts at an academic tertiary care hospital system over a 1-year period.

Interventions:
None.

Measurements and Main Results:
Data from standardized procedure notes and postprocedure chest radiographs were extracted and individually reviewed to verify the presence of pneumothorax or misplacement, and any intervention performed for either complication. The overall success rate of ultrasound-guided right internal jugular vein central venous catheter placement was 96.9% with an average of 1.3 attempts. There was only one pneumothorax (0.1% [95% CI, 0–0.4%]), and the rate of catheter misplacement requiring repositioning or replacement was 1.0% (95% CI, 0.6–1.7%). There were no arterial placements found on chest radiographs. Multivariate regression analysis showed no correlation between high-risk patient characteristics and composite complication rate.

Conclusions:
In a large teaching hospital system, the overall rate of clinically relevant complications detected on chest radiographs following ultrasound-guided right internal jugular vein catheterization is exceedingly low. Routine chest radiograph after this common procedure is an unnecessary use of resources and may delay resuscitation of critically ill patients.