bluuebunny/crossref_metadata_2025_split huggingface dataset:
Update on biphasic anaphylaxis
Authors: Lee Sangil , Sadosty Annie T. , Campbell Ronna L. 
Published: June 2016

Purpose of review
Biphasic anaphylaxis is a well documented complication of anaphylaxis, but it has been inconsistently defined in the literature. Analysis of contemporary studies of biphasic anaphylaxis based on modern definitions is needed.

Recent findings
The rate of biphasic reactions in contemporary literature ranges from 0.4 to 14.7% depending on the study population. Observational studies have reported risk factors associated with the development of biphasic reactions; however, findings have been inconsistent and of questionable generalizability. Although life-threatening biphasic reactions are rare, up to 50% of biphasic reactions will require treatment with epinephrine. Early epinephrine administration may have a role in prevention of biphasic reactions, but the role of steroids needs further investigation. The optimal duration of observation is yet to be determined.

Summary
Given the relative rarity of life-threatening biphasic anaphylaxis and the new context of the NIAID/FAAN standardized definition, further research regarding biphasic anaphylaxis is needed to better elucidate the care model for anaphylaxis patients with a focus on: prevention of biphasic reactions; identification of patients at increased risk of a biphasic reaction; determination of appropriate observation strategies for anaphylaxis patients; and patient education and preparation for management of potential biphasic reactions.
A Mixed-Methods Investigation of the Motivations, Goals, and Aspirations of Male and Female Academic Medical Faculty
Authors: Jones Rochelle DeCastro , Griffith Kent A. , Ubel Peter A. , Stewart Abigail , Jagsi Reshma 
Published: June 2016

Purpose
Understanding the goals and aspirations of the physician–scientist workforce can inform policies to promote retention. The authors explored gender differences therein, given women’s increasing representation.

Method
In 2010–2011, the authors qualitatively analyzed interviews with 100 former recipients of National Institutes of Health career development awards and 28 of their mentors. They also compared survey responses of 1,267 clinician–investigators who received these awards from 2006 to 2009, using logistic regression to evaluate gender differences after adjusting for other characteristics.

Results
Interview participants described relatively consistent career goals, including scientific contribution and desire to positively affect lives through research, clinical care, and teaching. For many, the specific ways they sought to achieve and measure goal attainment evolved over time. Survey respondents endorsed a goal of publishing high-quality research with highest frequency (97.3%, no significant gender difference). Women were more likely to endorse the importance of balancing work and other activities (95.5% vs. 90.5%, P < .001). There were no significant gender differences in the importance of patient care (86.6%), teaching (71.6%), or publishing prolifically (64.9%). Men were more likely than women to consider salary (49.4% vs. 41.8%, P < .001), reputation (84.2% vs. 77.6%, P = .004), and leadership positions (38.9% vs. 34.3%, P = .03) important.

Conclusions
In an elite research-oriented sample, gender differences in initial aspirations were generally limited. Gender differences in career outcomes in such groups are unlikely to exclusively result from different baseline aspirations. Goals appear to evolve in response to challenges experienced.
Promoting the Development of Adaptive Expertise: Exploring a Simulation Model for Sharing a Diagnosis of Autism With Parents
Authors: Kawamura Anne , Mylopoulos Maria , Orsino Angela , Jimenez Elizabeth , McNaughton Nancy 
Published: June 2016

Purpose
To explore how a simulation model promoted the development of integrated competencies associated with adaptive expertise in senior health professions trainees as they learned to share a diagnosis of autism with parents.

Method
A qualitative instrumental case study method was used at the University of Toronto in 2014 to explore what eight developmental pediatrics residents and two clinical psychology interns learned from participating in a simulation model designed to enable trainees to practice sharing a diagnosis of autism with parents. This model incorporated variability (three cases), active experimentation in a safe environment, and feedback from multiple perspectives (peers, faculty, standardized patients, and a parent). Field notes were collected, and semistructured interviews were conducted to explore what participants learned. Constant comparative analysis was used to identify themes iteratively. Team analysis continued until a stable thematic structure was developed and applied to the entire data set.

Results
Four themes were identified. Three themes described how participating in the simulation model changed residents’ and interns’ approaches to sharing a diagnosis of autism with parents from using a structured, scripted framework to share the diagnosis; to being flexible within the structured framework; and, finally, to being attentive and responsive to parents by adapting and creating new approaches for sharing the diagnosis. The fourth theme described how the multiple perspectives in the simulation model prompted learners to develop adaptive approaches.

Conclusions
This simulation model helped residents and interns move beyond use of a structured, scripted communication framework toward development of adaptive expertise.
Post-tenure Review at U.S. Medical Schools
Authors: Bunton Sarah A. , Walling Anne , Durham Dianne 
Published: June 2016

Purpose
To assess post-tenure review policies at U.S. medical schools by examining how prevalent post-tenure review is, what models of post-tenure review are employed, and what outcomes result from post-tenure review processes.

Method
In late 2014, a Web-based survey was sent to the associate dean for faculty affairs (or equivalent) at each U.S. medical school accredited by the Liaison Committee on Medical Education (N = 141). The survey addressed elements of post-tenure review policies, including whether a policy was in place, the frequency of the review, and the review outcomes. Descriptive statistics were calculated.

Results
Of the 94 responding schools with a tenure system, 39 (41%) had an established post-tenure review policy. Although these policies showed great variability across schools in duration, having been in place from 1 to 50 years, 12 (31%) were established within the last 5 years. The outcomes of post-tenure review also varied. Superior performance ratings generally resulted in notations in the faculty member’s personnel file and notifications to school leadership. Conversely, when a faculty member received an unsatisfactory rating, a remediation or development plan was sometimes required.

Conclusions
At least 40% of medical schools with a tenure system have post-tenure review, and it is becoming more common. These findings about the prevalence and use of post-tenure review across institutions can assist medical school leaders as they strive to shape policies to facilitate faculty engagement and productivity. They also can provide the foundation for future evaluative studies on the effectiveness, outcomes, and impact of post-tenure review.
Central Corneal Thickness in Aphakic Children With Microcornea-Microphthalmia
Authors: Bayoumi Nader H.L. , El Shakankiri Nihal M. 
Published: June 2016

Purpose:
To study the central corneal thickness (CCT) in eyes with microcornea and aphakia and without glaucoma, compare it with normal controls, and correlate it with the measured intraocular pressure (IOP).

Methods:
The study was conducted on 62 eyes of 31 aphakic children with microcornea. Controls (20 children) were selected from age-matched children presenting for routine refraction. Detailed anterior-segment and fundus examinations were conducted. The CCT and the axial length were measured. Medical records of the study patients were reviewed for the stability of the ocular parameters over time to exclude glaucoma.

Results:
The mean±SD age of the study patients and controls were 4.0 (±3.1, 1.0 to 12.0) and 3.1 (±2.7, 0.6 to 12.0) years, respectively. The mean±SD CCT, the corneal diameter, the measured IOP, the cup/disc ratio, and the axial length of the study patients and the controls were 667.01±72.90 μm, 8.9±0.8 mm, 10.9±5.7 mm Hg, 0.1±0.1, 20.35±2.90 mm and 545.22±28.14 μm, 11.7±0.5 mm, 5.3±1.8 mm Hg, 0.1±0.1, and N/A, respectively. The difference between the study eyes and the controls in the CCT and the measured IOP was statistically significant (P<0.05).

Conclusions:
Aphakic eyes with microcornea have thicker CCTs and greater measured IOPs than normal eyes. Hence, the measurement of CCT is recommended in the assessment of aphakic eyes with microcornea for possible glaucoma. The measured IOP, although a reliable parameter, in isolation does not provide a diagnosis of glaucoma and must be viewed in conjunction with other patient findings, such as the cup/disc ratio, the progression of which over time must be considered for a more solid diagnosis.
The Visual Function Questionnaire: Utility Index: Does It Measure Glaucoma-related Preference-based Status?
Authors: Goh Rachel L.Z. , Fenwick Eva , Skalicky Simon E. 
Published: June 2016

Purpose:
As health budgets tighten globally, evaluating the cost-effectiveness of glaucoma services is vital; however, there is a lack of validated instruments that measure utility specific to glaucoma patients. We thus evaluated the validity of the Visual Function Questionnaire—Utility Index (VFQ-UI) as a measure of vision-related function and preference-based status in glaucoma.

Patients and Methods:
Cross-sectional study of 141 volunteer patients over 40 years of age with moderate (n=64) or severe (n=36) glaucoma, and 41 controls. Sociodemographic information, visual acuity, and visual field test parameters were obtained. The VFQ-UI and Glaucoma Activity Limitation-9 patient-reported outcome tools were administered, and their psychometric properties explored using Rasch analysis. Criterion, convergent, and divergent validity of the VFQ-UI were also assessed.

Results:
Mean age was 69.7 (±10.8) years, with a mean better eye visual acuity (LogMAR) of 0.074 (±0.356) (approximate Snellen acuity of 20/24). Overall, the VFQ-UI had satisfactory fit to the Rasch model, however targeting and precision were suboptimal with a person separation index of 1.72 and person reliability coefficient of 0.75. VFQ-UI scores significantly increased as glaucoma severity worsened between controls (−4.54, ±1.15) and patients with moderate (−3.77, ±1.57) and severe glaucoma (−1.98, ±2.98), indicating good criterion validity (P<0.001). Strong correlation between VFQ-UI and Glaucoma Activity Limitation-9 scores (r=0.764, P<0.001) demonstrated good convergent validity. There was no significant correlation between VFQ-UI scores and age and sex (r=0.150 and 0.026, respectively), demonstrating good divergent validity.

Conclusions:
The VFQ-UI shows potential to measure preference-based status in a cohort of glaucoma patients, with the means to calculate utility. Although the VFQ-UI displayed reasonable fit to the Rasch model overall and had good criterion, convergent and divergent validity, its lack of precision is a limitation. The difficulty of the VFQ-UI in discriminating among patients with varying glaucoma severity may be improved by including items specific to glaucomatous visual dysfunction.
Vision-related Quality of Life in Glaucoma Suspect or Early Glaucoma Patients
Authors: Alqudah Asem , Mansberger Steven L. , Gardiner Stuart K. , Demirel Shaban 
Published: June 2016

Purpose:
To determine the association of vision-related quality of life (QoL) to demographic factors and visual function in glaucoma suspect or early glaucoma patients.

Materials and Methods:
We administered the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) on the same day as a comprehensive ocular examination to participants either with glaucoma or at high risk for developing glaucoma. Regression models were used to determine the association between VFQ-25 composite and subscale scores, visual field status, logMAR equivalent visual acuity (VA), age, and sex. In all analyses we used data from the eye with the best mean deviation (MD), best pattern SD, and best VA.

Results:
Data from 198 participants were analyzed. The mean best MD (±SD) was 0.02±1.52 dB (range, −5.11 to 2.63 dB) and the mean best pattern SD was 1.75±1.03 dB (range, 0.91 to 8.36 dB). The mean VFQ-25 composite score was 91.6±6.7 (range, 54.5 to 100.0). Composite score and the Distance Activities, Color Vision subscale scores were associated with best MD (P≤0.05). The General Vision and Driving subscale scores were associated with best VA (P≤0.03). The composite score and the Distance Activities, Driving, and Color Vision subscale scores were associated with age (P≤0.05). Finally, the Distance Activities, Driving, and Peripheral Vision subscale scores were associated with sex (P≤0.04).

Conclusions:
Vision-related QoL is associated with visual field status even in early and suspected glaucoma. It is also associated with VA, age, and sex. Particular decreases in QoL are related to distance activities, driving, and color vision.
Endogenous opioidergic dysregulation of pain in fibromyalgia: a PET and fMRI study
Authors: Schrepf Andrew , Harper Daniel E. , Harte Steven E. , Wang Heng , Ichesco Eric , Hampson Johnson P. , Zubieta Jon-Kar , Clauw Daniel J. , Harris Richard E. 
Published: June 2016

Abstract
Endogenous opioid system dysfunction potentially contributes to chronic pain in fibromyalgia (FM), but it is unknown if this dysfunction is related to established neurobiological markers of hyperalgesia. We previously reported that µ-opioid receptor (MOR) availability was reduced in patients with FM as compared with healthy controls in several pain-processing brain regions. In the present study, we compared pain-evoked functional magnetic resonance imaging with endogenous MOR binding and clinical pain ratings in female opioid-naive patients with FM (n = 18) using whole-brain analyses and regions of interest from our previous research. Within antinociceptive brain regions, including the dorsolateral prefrontal cortex (r = 0.81, P < 0.001) and multiple regions of the anterior cingulate cortex (all r > 0.67; all P < 0.02), reduced MOR availability was associated with decreased pain-evoked neural activity. Additionally, reduced MOR availability was associated with lower brain activation in the nucleus accumbens (r = 0.47, P = 0.050). In many of these regions, pain-evoked activity and MOR binding potential were also associated with lower clinical affective pain ratings. These findings are the first to link endogenous opioid system tone to regional pain-evoked brain activity in a clinical pain population. Our data suggest that dysregulation of the endogenous opioid system in FM could lead to less excitation in antinociceptive brain regions by incoming noxious stimulation, resulting in the hyperalgesia and allodynia commonly observed in this population. We propose a conceptual model of affective pain dysregulation in FM.
Postoperative bleeding and coagulation disorders
Authors: Samama Charles Marc 
Published: June 2016

Purpose of review
New data have been made available in the field of haemostasis and thrombosis. Some long-awaited answers to important questions have been published, and some debates have benefited from an updated perspective.

Recent findings
Two important domains are addressed in this update: massive bleeding (1/1/1 ratios and fibrinogen concentrates) and the management of direct oral anticoagulants (monitoring and antidotes). Both are highly controversial topics. Higher plasma/platelets/red blood cells units ratios are now partly supported by a new study in trauma. Several studies show that preemptive doses of fibrinogen do not appear to bring any benefit. Monitoring of direct oral anticoagulants is now possible, and it has to be recommended in some circumstances. Specific antidotes are being developed, but there are still more questions than answers.

Summary
These new data should help anaesthesiologists and intensivists to better understand and manage massively bleeding patients or direct oral anticoagulants treated patients.
Bedside nutrition evaluation and physical assessment techniques in critical illness
Authors: Simpson Fiona , Doig Gordon S. 
Published: June 2016

Purpose of review
The purpose of this review is to highlight emerging techniques used to determine body composition early in ICU stay, their prediction of poor outcome, and what is required before they can be more widely used.

Recent findings
Opportunistic use of imaging techniques to assess muscle mass shows promise with regard to predicting patient outcomes; however, some of these techniques are expensive. Mid-arm muscle circumference and physical assessments of muscle wasting and subcutaneous fat loss using the subjective global assessment (SGA) are simple cheap tools that can be undertaken at the ICU patient bedside. Furthermore, each of these simple measures is a better predictor of patient outcome than BMI.

Summary
Mid-arm muscle circumference, SGA fat loss, and SGA muscle wasting have each been found to be better predictors of poor outcome than BMI in ICU patients.
Mid-arm muscle circumference, SGA fat loss, and SGA muscle wasting may be able to identify patients who are most likely to benefit from enhanced nutrition support.
We need further research incorporating the use of these simple measures to evaluate their ability to accurately identify patients most likely to benefit from enhanced nutritional support.
Protein delivery in critical illness
Authors: Weijs Peter J.M. 
Published: June 2016

Purpose of review
Protein delivery in the critically ill still is a highly debated issue. Here, we discuss only the most recent updates in the literature concerning protein nutrition of the critically ill.

Recent findings
Up to now, there are no randomized controlled trials (RCTs) published on enteral provision of protein that were randomized for protein level of intake. In the past year, there have been two new observational studies published, one of which in critically ill children. Also, two randomized controlled trials with high parenteral amino acid provision have been published. The overall view on nutrition support has not been changed convincingly by these studies. Recent findings have confirmed that protein and amino acid provision are highly important for outcome in critically ill patients. For the first time, a randomized study confirmed this, however, only on the short term. The other RCT confirmed that an extreme dosing of amino acids is not related to improvement in outcome. One observational study showed that the effect of protein on outcome should be adjusted for energy intake and vice versa, showing that adequate protein is related to improved outcome and adequate energy provision is not. The other observational study confirmed importance of protein in paediatric ICU but also gained some insight into improvement of protein delivery by postpyloric feeding and usefulness of a dedicated dietitian in the ICU.

Summary
We will continue to improve protein delivery to critically ill patients; however, the quest for evidence and feeding guidelines still remains.
Nucleic acid biomarkers of β cell stress and death in type 1 diabetes
Authors: Syed Farooq , Evans-Molina Carmella 
Published: June 2016

Purpose of review
The purpose of this review is to summarize recent advances in the development of nucleic acid-based biomarkers of type 1 diabetes (T1D).

Recent findings
Recent rodent and human studies have identified new roles for stress pathways intrinsic to the β cell during the development of T1D. As such, methods to identify an authentic nucleic acid signature of β cell stress and/or death may improve our ability to predict T1D at earlier timepoints, allowing for optimal timing of immunomodulatory interventions. To this end, both targeted and unbiased approaches have begun to identify changes in microRNA expression patterns in T1D. Moreover, a number of groups have developed distinct assays that quantitatively detect circulating unmethylated insulin DNA, which is thought to primarily emanate from dying β cells.

Summary
Here we highlight unique blood and urine microRNA signatures identified in T1D cohorts, compare differences between first, second, and third-generation assays that detect circulating unmethylated insulin DNA, and review recent technological advances that have the capacity to improve T1D biomarker development.
Type B insulin resistance syndrome
Authors: Willard Devina L. , Stevenson Mary , Steenkamp Devin 
Published: June 2016

Purpose of review
To review the epidemiology, pathophysiology, clinical features, and management of type B insulin resistance syndrome.

Recent findings
Type B insulin resistance syndrome is a rare disorder caused by autoantibodies to the insulin receptor. This disorder is most frequently reported in middle-aged black women and is invariably associated with other autoimmune diseases. Typically, refractory transient hyperglycemia and extreme insulin resistance are the cardinal features, but hypoglycemia may also occur. Traditionally, the high reported mortality rate was typically attributed to the hypoglycemia. There is no well standardized treatment regimen. However, recent therapeutic advances with combination immunomodulatory therapy have led to significant reported improvements in hypoglycemia-associated mortality and durability of remission.

Summary
We review the literature on the pathophysiology and clinical features of type B insulin resistance syndrome and highlight the complexities and recent advances in the management of this disorder.
Pituitary diseases and sleep disorders
Authors: Romijn Johannes A. 
Published: June 2016

Purpose of review
Patients with pituitary diseases have decreased quality of life. Sleep disorders are prevalent among patients with pituitary diseases and contribute to decreased quality of life.

Recent findings
Patients previously treated for compression of the optic chiasm by surgery, and in some cases postoperative radiotherapy, suffer from sleep disorders. These are characterized by decreased sleep quality, delayed onset of sleep, and daytime sleepiness. Circumstantial evidence suggests that this may be caused by hypothalamic dysfunction. A challenging speculation is that previous compression of the optic chiasm compromised the function of the retinohypothalamic tract. Through this tract the eyes convey information on day–night cycles to the hypothalamic nuclei. Patients with acromegaly, even despite biochemical control, suffer frequently from obstructive sleep apnea. Patients with Cushing's disease suffer from fragmented sleep, sleep apnea, and snoring. Prolactinomas do not seem to affect sleep characteristics. The association between appropriately substituted pituitary insufficiency and sleep disorders is less clear. The effects of recombinant human growth hormone on sleep characteristics in adults are inconsistent.

Summary
Pituitary disorders are associated with different sleep disorders. Different studies point to irreversible changes in sleep–wake rhythmicity in patients treated previously for pituitary tumors with chiasm compression.

Video abstract

http://links.lww.com/COE/A12