bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nivkh
Authors: Mattissen Johanna 
Published: November 2017

AbstractNivkh (Paleosiberian group), spoken on the lower reaches of the Amur River and on Sakhalin island in Siberia by a few hundred speakers in four main varieties, but rapidly dying out, is a polysynthetic head-marking but configurational SOV language, with defective polypersonalism, noun incorporation, verb root serialization, and complex noun forms. Its dominant structural principle and characteristic design is dependent-head-synthesis, with dependents lexically head-marked and still referentially active. Nivkh displays compositional polysynthesis with a mixed internal structure, as the suffixal domain of a word-form may be described by a template, whereas the pre-root domain is scope-ordered due to dependent chaining. The evolutionary path of complex forms is best conceived of as coalescence of formerly adjacent words. Morphophonemic processes at the word-internal morpheme boundaries, especially consonant dissimilation and assimilation, and bound allomorphs prove the wordhood of the complexes. Non-root bound morphemes encode modalities, degree, scalar, and focus operators and phase of action.
Polysynthesis in Ainu
Authors: Bugaeva Anna 
Published: November 2017

AbstractAinu is a typical polysynthetic language in that a single complex verb can express what takes a whole sentence in most other languages. A single verb form may include more than one heavy element: up to two applicative prefixes (out of three), two causative suffixes (out of five), two incorporated objects, one lexical prefix (out of two originating in nouns ‘head’ and ‘bottom’), one verbalizing suffix (originating in the verb ‘make’), as well as reciprocal, reflexive, and general object (=antipassive) prefixes and agreement affixes for the first/second person subject and object. The degree of combinability of voice markers and noun incorporation is spectacular. Nevertheless, it has been claimed that Ainu deviates from more typical polysynthetic languages in having less freedom of word order, interrogative phrases in situ, and unrestricted morphological causatives (Baker 1996). This chapter aims to distinguish what Ainu shares with other polysynthetic languages from what is unique.
Sub-Types of Polysynthesis
Authors: Mattissen Johanna 
Published: November 2017

AbstractThe structural heterogeneity of polysynthetic languages is captured by a sublassification of allegedly polysynthetic languages according to their word-formational type (number of roots allowed in a verb form), namely, compositional, transitional, or affixal, and their internal organization (template vs. scope or both). Further parameters show correlations to these independent ones: the number of participants encoded on a verb, the imaginable evolutionary path via which the structure has come about, namely layering (“onion type”), internal expansion (“sandwich type”) or coalescence (“burdock type”), and the characteristic design of a complex verb form: Grammatical category accumulation (integration of non-obligatory, rather grammatical information); ping-pong recategorization (multiple verbalization and nominalization); productive in/excorporation; dependent-head synthesis; multiple packing (integration of rather lexical information); holophrasis (all wordforms being predicates—or particles); composite-stem layout (composite root-like morphemes, unitary concept); and building-block design (multiple classifer-like morphemes make up a wordform). The classification along these parameters reconciles conflicting approaches to polysynthesis.
Polysynthesis in Sora (Munda) with Special Reference to Noun Incorporation
Authors: Anderson Gregory D. S. 
Published: November 2017

AbstractThe Munda language Sora, an Austroasiatic language, has a developed system of noun incorporation. One can always distinguish a structure with incorporation from one that lacks this as the nominal component that is found incorporated into the Sora verbal stem appears in the so-called ‘combining form’ (CF). This CF contrasts with an obligatorily bimoraic syntactically free-standing form of the noun that is lexically associated with the CF, derived through a lexically-determined means of affixation or compounding that includes reduplication, prefixation, infixation, and compounding. Only certain incorporated structures in Sora reduce the valence of the resulting structure, while others do not. Sora is also among the few languages attested that permits verbal constructs with more than one noun incorporated. In Sora a transitive verb may also incorporate its agent argument. Further, these incorporated stems remain transitive in Sora: they allow for the formal indexing of objects as well within in the incorporated complex.
Translating Theory Into Practice: Implementing a Program of Assessment
Authors: Hauer Karen E. , O’Sullivan Patricia S. , Fitzhenry Kristen , Boscardin Christy 
Published: November 2017

Problem
A program of assessment addresses challenges in learner assessment using a centrally planned, coordinated approach that emphasizes assessment for learning. This report describes the steps taken to implement a program of assessment framework within a medical school.

Approach
A literature review on best practices in assessment highlighted six principles that guided implementation of the program of assessment in 2016–2017: (1) a centrally coordinated plan for assessment aligns with and supports a curricular vision; (2) multiple assessment tools used longitudinally generate multiple data points; (3) learners require ready access to information-rich feedback to promote reflection and informed self-assessment; (4) mentoring is essential to facilitate effective data use for reflection and learning planning; (5) the program of assessment fosters self-regulated learning behaviors; and (6) expert groups make summative decisions about grades and readiness for advancement. Implementation incorporated stakeholder engagement, use of multiple assessment tools, design of a coaching program, and creation of a learner performance dashboard.

Outcomes
The assessment team monitors adherence to principles defining the program of assessment and gathers and responds to regular feedback from key stakeholders, including faculty, staff, and students.

Next Steps
Next steps include systematically collecting evidence for validity of individual assessments and the program overall. Iterative review of student performance data informs curricular improvements. The program of assessment also highlights technology needs that will be addressed with information technology experts. The outcome ultimately will entail showing evidence of validity that the program produces physicians who engage in lifelong learning and provide high-quality patient care.
Resources Used to Teach the Physical Exam to Preclerkship Medical Students: Results of a National Survey
Authors: Uchida Toshiko , Achike Francis I. , Blood Angela D. , Boyle Mary , Farnan Jeanne M. , Gowda Deepthiman , Hojsak Joanne , Ovitsh Robin K. , Park Yoon Soo , Silvestri Ronald 
Published: November 2017

Purpose
To examine resources used in teaching the physical exam to preclerkship students at U.S. medical schools.

Method
The Directors of Clinical Skills Courses developed a 49-question survey addressing resources and pedagogical methods employed in preclerkship physical exam curricula. The survey was sent to all 141 Liaison Committee on Medical Education–accredited medical schools in October 2015. Results were averaged across schools, and data were weighted by class size.

Results
Results from 106 medical schools (75% response rate) identified a median of 59 hours devoted to teaching the physical exam. Thirty-eight percent of time spent teaching the physical exam involved the use of standardized patients, 30% used peer-to-peer practice, and 25% involved examining actual patients. Approximately half of practice time with actual patients was observed by faculty. At 48% of schools (51), less than 15% of practice time was with actual patients, and at 20% of schools (21) faculty never observed students practicing with actual patients. Forty-eight percent of schools (51) did not provide compensation for their outpatient clinical preceptors.

Conclusions
There is wide variation in the resources used to teach the physical examination to preclerkship medical students. At some schools, the amount of faculty observation of students examining actual patients may not be enough for students to achieve competency. A significant percentage of faculty teaching the physical exam remain uncompensated for their effort. Improving faculty compensation and increasing use of senior students as teachers might allow for greater observation and feedback and improved physical exam skills among students.
An Anesthesiologist’s Perspective on the History of Basic Airway Management
Authors: Matioc Adrian A. 
Published: November 2017

Abstract
This third installment of the history of basic airway management discusses the transitional—“progressive”—years of anesthesia from 1904 to 1960. During these 56 yr, airway management was provided primarily by basic techniques with or without the use of a face mask. Airway maneuvers were inherited from the artisanal era: head extension and mandibular advancement. The most common maneuver was head extension, also used in bronchoscopy and laryngoscopy. Basic airway management success was essential for traditional inhalation anesthesia (ether, chloroform) and for the use of the new anesthetic agents (cyclopropane, halothane) and intravenous drugs (thiopental, curare, succinylcholine). By the end of the era, the superiority of intermittent positive pressure ventilation to spontaneous ventilation in anesthesia and negative pressure ventilation in resuscitation had been demonstrated and accepted, and the implementation of endotracheal intubation as a routine technique was underway.
Three-Dimensional Analysis of the Fundus of the Human Internal Acoustic Canal
Authors: Schart-Morén Nadine , Larsson Sune , Rask-Andersen Helge , Li Hao 
Published: November 2017

Objectives:
Documentation of the nerve components in the internal acoustic canal is essential before cochlea implantation surgery. Interpretations may be challenged by wide anatomical variations of the VIIIth nerve and their ramifications. Malformations may further defy proper nerve identification.

Design:
Using microcomputed tomography, we analyzed the fundus bone channels in an archival collection of 113 macerated human temporal bones and 325 plastic inner molds. Data were subsequently processed by volume-rendering software using a bony tissue algorithm. Three-dimensional reconstructions were made, and through orthogonal sections, the topographic anatomy was established.

Results:
The technique provided additional information regarding the anatomy of the nerve foramina/channels of the human fundus region, including variations and destinations. Channel anastomosis were found beyond the level of the fundus. A foramen of the transverse crest was identified.

Conclusions:
Three-dimensional reconstructions and cropping outlined the bone canals and demonstrated the highly variable VIIIth nerve anatomy at the fundus of the human inner acoustic canal. Myriad channel interconnections suggested an intricate system of neural interactive pathways in humans. Particularly striking was the variable anatomy of the saccule nerve channels. The results may assist in the preoperative interpretation of the VIIIth nerve anatomy.
Hospital Differences Drive Antibiotic Delays for Black Patients Compared With White Patients With Suspected Septic Shock
Authors: Taylor Stephanie Parks , Karvetski Colleen H. , Templin Megan A. , Taylor Brice T. 
Published: November 2017

Objective:
Evaluate racial disparities in sepsis processes of care.

Design:
Observational cohort study.

Setting:
Nine hospitals in the Southeastern United States between 2014 and 2016.

Patients:
Two thousand two hundred twenty-one white and 707 black patients treated in the emergency department through “code sepsis” pathway for suspected septic shock.

Measurements and Main Results:
Black patients were less likely to receive timely antibiotics than were white patients using multiple definitions (1 hr from code sepsis activation [odds ratio, 0.57; 95% CI, [0.44–0.74]; 85.6% vs. 91.2%; p < 0.0001]; 1 hr from triage [odds ratio, 0.83; 95% CI, [0.69–1.00]; 28.0% vs. 31.8%; p = 0.06]; 3 hr from triage [odds ratio, 0.71; 95% CI, [0.57–0.88]; 80.1% vs. 85.0%; p = 0.002]). Focusing on antibiotic administration within 1 hour of triage, these differences were enhanced after adjusting for patient-level factors (adjusted odds ratio, 0.80; 95% CI, [0.66–0.96]; p = 0.02), but attenuated after adjusting for hospital-level differences (adjusted odds ratio, 0.90; 95% CI, [0.81–1.01]; p = 0.07). Black and white patients did not differ on other sepsis quality indicators or adjusted mortality.

Conclusions:
Black patients appear to be less likely than white patients to receive timely antibiotic therapy for sepsis. These differences were largely explained by variation in care among hospitals, such that hospitals that disproportionately treat black patients were less likely to provide timely antibiotic therapy overall. There were no differences between races in other sepsis quality measures or adjusted mortality.
A Randomized Control Trial of Preoperative Oral Antibiotics as Adjunct Therapy to Systemic Antibiotics for Preventing Surgical Site Infection in Clean Contaminated, Contaminated, and Dirty Type of Colorectal Surgeries
Authors: Anjum Nadeem , Ren Jianan , Wang Gefei , Li Guanwei , Wu Xiuwen , Dong Hu , Wu Qin , Li Jieshou 
Published: November 2017

BACKGROUND:
Preoperative bowel preparation with or without oral antibiotics is controversial in terms of postoperative surgical site infections.

OBJECTIVE:
This study aimed to evaluate the efficacy of oral antibiotics as adjunct therapy to systemic antibiotics with mechanical bowel preparation for preventing surgical site infections in clean contaminated, contaminated, and dirty colorectal procedures.

DESIGN:
This was a single-center, prospective randomized study.

SETTING:
This study was conducted at the General Surgery Department at Jinling Hospital, Nanjing University, China, from July 15, 2014 to January 20, 2016.

PATIENTS:
Patients aged ≥18 years scheduled for abdominal surgery with clean-contaminated, contaminated, and dirty wounds were selected.

INTERVENTIONS:
Patients were randomly assigned to receive preoperative mechanical bowel preparation or mechanical bowel preparation with oral antibiotics.

MAIN OUTCOMES:
The primary outcome was the rate of surgical site infections. The secondary outcomes were extra-abdominal complications, duration of postoperative ileus, and readmission rate.

RESULTS:
Ninety-five patients were allocated to each group. Eight and 26 surgical site infections (8.42% vs 27.3 %, p = 0.004) occurred in the mechanical bowel preparation with oral antibiotics and mechanical bowel preparation groups. Thirteen extra-abdominal complications were reported: 6 in the mechanical bowel preparation with oral antibiotics group and 7 in the mechanical bowel preparation group (6.3% vs 7.3%, p = 0.77). Postoperative ileus duration did not differ between groups (p = 0.23). There were 4 readmissions in the mechanical bowel preparation group and none in the mechanical bowel preparation with oral antibiotics group (p = 0.04). On multivariable analysis, blood loss ≥500 mL (OR, 5.1; 95% CI, 1.27–20.4; p = 0.02), ASA score ≥3 (OR, 3.9; 95% CI, 1.2–12.5; p = 0.01), contaminated types (OR, 3.6; 95% CI, 1.5–8.6; p = 0.01), and administration of preoperative oral antibiotics (OR, 0.20; 95% CI, 0.06–0.60; p = 0.005) independently affected the incidence of surgical site infections.

LIMITATIONS:
This was a single-center study.

CONCLUSION:
Preoperative oral antibiotics, as adjunct therapy to systemic antibiotics and mechanical bowel preparation, significantly reduced surgical site infections and minimized the readmission rates in clean contaminated, contaminated, and dirty types of colorectal surgery. See Video Abstract at http://links.lww.com/DCR/A437.
Rectal Eversion Technique: A Method to Achieve Very Low Rectal Transection and Anastomosis With Particular Value in Laparoscopic Cases
Authors: Poylin Vitaliy , Mowschenson Peter , Nagle Deborah , Cataldo Thomas 
Published: November 2017

INTRODUCTION:
Transection of the rectum at the anorectal junction is required for proper resection in ulcerative colitis and restorative proctocolectomy. Achieving stapled transection at the pelvic floor is often challenging, particularly during laparoscopic proctectomy. Transanal mucosectomy and handsewn anastomosis are frequently used to achieve adequate resection. Rectal eversion provides an alternative for low anorectal transection and maintains the ability to perform stapled anastomosis.

TECHNIQUE:
The purpose of this article is to describe a technique for low anorectal transection. The work was conducted at tertiary care center by 2 colon and rectal surgeons on patients undergoing total proctocolectomy with creation of ileal pouch rectal anastomosis for ulcerative colitis. We measured the ability to achieve low stapled anastomosis.

RESULTS:
Very low transection was achieved, allowing for creation of IPAA without leaving significant rectal cuff. This study was limited because it is an early experience that was not performed in the setting of a scientific investigation. No sphincter or bowel functional data were obtained or evaluated.

CONCLUSIONS:
Rectal eversion technique provides an alternative to mucosectomy when low pelvic transection is difficult to achieve. See Video at http://links.lww.com/DCR/A441.
Stromal Cell-Derived Factor 1 Plasmid Regenerates Both Smooth and Skeletal Muscle After Anal Sphincter Injury in the Long Term
Authors: Sun Li , Kuang Mei , Penn Marc , Damaser Margot S. , Zutshi Massarat 
Published: November 2017

BACKGROUND:
Regenerating muscle at a time remote from injury requires re-expression of cytokines to attract stem cells to start and sustain the process of repair.

OBJECTIVE:
We aimed to evaluate the sustainability of muscle regeneration after treatment with a nonviral plasmid expressing stromal cell-derived factor 1.

DESIGN:
This was a randomized study.

SETTINGS:
The study was conducted with animals in a single research facility.

INTERVENTIONS:
Fifty-six female age-/weight-matched Sprague–Dawley rats underwent excision of the ventral half of the anal sphincter complex. Three weeks later, rats were randomly allocated (n = 8) to one of the following groups: no treatment, 100 μg of plasmid encoding stromal cell-derived factor 1 injected locally, local injection of plasmid and 8 × 105 bone marrow–derived mesenchymal stem cells, and plasmid encoding stromal cell-derived factor 1 injected locally with injection of a gelatin scaffold mixed with bone marrow–derived mesenchymal stem cells.

MAIN OUTCOME MEASURES:
Anal manometry, histology, immunohistochemistrym and morphometry were performed 8 weeks after treatment. Protein expression of cytokines CXCR4 and Myf5 was investigated 1 week after treatment (n = 6 per group). ANOVA was used, with p < 0.0083 indicating significant differences for anal manometry and p < 0.05 for all other statistical analysis.

RESULTS:
Eight weeks after treatment, all of the groups receiving the plasmid had significantly higher anal pressures than controls and more organized muscle architecture in the region of the defect. Animals receiving plasmid alone had significantly greater muscle in the defect (p = 0.03) than either animals with injury alone (p = 0.02) or those receiving the plasmid, cells, and scaffold (p = 0.03). Both smooth and skeletal muscles were regenerated significantly more after plasmid treatment. There were no significant differences in the protein levels of CXCR4 or Myf5.

LIMITATIONS:
The study was limited by its small sample size and because stromal cell-derived factor 1 was not blocked.

CONCLUSIONS:
A plasmid expressing stromal cell-derived factor 1 may be sufficient to repair an injured anal sphincter even long after the injury and in the absence of mesenchymal stem cell or scaffold treatments. See Video Abstract at http://links.lww.com/DCR/A451.
Nodal Disease in Rectal Cancer Patients With Complete Tumor Response After Neoadjuvant Chemoradiation: Danger Below Calm Waters
Authors: Baucom Rebeccah B. , Maguire Lillias H. , Kavalukas Sandra L. , Geiger Timothy M. , Ford Molly M. , Muldoon Roberta L. , Hopkins M. Benjamin , Hawkins Alexander T. 
Published: November 2017

BACKGROUND:
A subset of patients with rectal cancer who undergo neoadjuvant chemoradiation therapy will develop a complete pathologic tumor response. Complete nodal response is not universal in these patients and is difficult to assess clinically. Quantifying the risk of nodal disease would allow for targeted therapy with either radical resection or “watchful waiting.”

OBJECTIVE:
This study aimed to identify risk factors for residual nodal disease in ypT0 rectal adenocarcinoma.

DESIGN:
This is a retrospective case control study.

SETTINGS:
The National Cancer Database 2006 to 2014 was used to identify patients for this study.

PATIENTS:
Patients with stage II/III rectal adenocarcinoma who completed chemoradiation therapy followed by resection and who had ypT0 tumors were included. Patients with metastatic disease and <2 lymph nodes evaluated were excluded. Patients were divided into 2 groups: node positive and node negative.

MAIN OUTCOME MEASURES:
The main outcome was nodal disease. The secondary outcome was overall survival.

RESULTS:
A total of 42,257 patients with stage II/III rectal cancer underwent chemoradiation therapy and radical resection; 4170 (9.9%) patients had ypT0 tumors and 395 (9.5%) were node positive. Of patients with clinically node-negative disease (ie, pretreatment imaging), 6.2% were node positive after chemoradiation therapy and resection. In multivariable analysis, factors predictive of nodal disease included increasing (pretreatment) clinical N-stage, high tumor grade (3/4), perineural invasion, and lymphovascular invasion. Higher clinical T-stage was inversely associated with residual nodal disease. Overall 5-year survival was significantly different between patients with ypN0, ypN1, and ypN2 disease (87.4%, 82.2%, and 62.5%, p = 0.002).

LIMITATIONS:
This study was limited by the lack of clinical detail in the database and the inability to assess recurrence.

CONCLUSIONS:
Ten percent of patients with ypT0 tumors had positive nodes after chemoradiation therapy and resection. Factors associated with residual nodal disease included clinical nodal disease at diagnosis and poor histologic features. Patients with any of these features should consider radical resection regardless of tumor response. Others could be suitable for “watchful waiting” strategies. See Video Abstract at http://links.lww.com/DCR/A458.