bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring Medical Students’ Empathy: Exploring the Underlying Constructs of and Associations Between Two Widely Used Self-Report Instruments in Five Countries
Authors: Costa Patrício , de Carvalho-Filho Marco Antonio , Schweller Marcelo , Thiemann Pia , Salgueira Ana , Benson John , Costa Manuel João , Quince Thelma 
Published: November 2016

Purpose
Understanding medical student empathy is important to future patient care; however, the definition and development of clinical empathy remain unclear. The authors sought to examine the underlying constructs of two of the most widely used self-report instruments—Davis’s Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Empathy version for medical students (JSE-S)—plus, the distinctions and associations between these instruments.

Method
Between 2007 and 2014, the authors administered the IRI and JSE-S in three separate studies in five countries, (Brazil, Ireland, New Zealand, Portugal, and the United Kingdom). They collected data from 3,069 undergraduate medical students and performed exploratory factor analyses, correlation analyses, and multiple linear regression analyses.

Results
Exploratory factor analysis yielded identical results in each country, confirming the subscale structures of each instrument. Results of correlation analyses indicated significant but weak correlations (r = 0.313) between the total IRI and JSE-S scores. All intercorrelations of IRI and JSE-S subscale scores were statistically significant but weak (range r = −0.040 to 0.306). Multiple linear regression models revealed that the IRI subscales were weak predictors of all JSE-S subscale and total scores. The IRI subscales explained between 9.0% and 15.3% of variance for JSE-S subscales and 19.5% for JSE-S total score.

Conclusions
The IRI and JSE-S are only weakly related, suggesting that they may measure different constructs. To better understand this distinction, more studies using both instruments and involving students at different stages in their medical education, as well as more longitudinal and qualitative studies, are needed.
Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty for Recurrence of Granular Corneal Dystrophy in Postkeratoplasty Eyes
Authors: Taneja Mukesh , Rathi Varsha M. , Murthy Somasheila I. , Bagga Bhupesh , Vaddavalli Pravin Krishna 
Published: November 2016

Purpose:
To report the clinical and visual outcome of sutureless femtosecond laser-assisted anterior lamellar keratoplasty (FALK) for recurrent granular corneal dystrophy (GCD) in patients who had previously undergone penetrating keratoplasty and phototherapeutic keratectomy (PTK) performed for recurrent dystrophy in the grafted eyes.

Methods:
Four eyes of 4 patients who underwent FALK for recurrence of GCD in previously grafted eyes and underwent PTK performed for initial recurrence in the grafts were included. Patients who had undergone FALK for other indications were excluded. The patients were evaluated for preoperative and postoperative best-corrected visual acuities (BCVA), and intraoperative and postoperative complications. Visual outcomes and complications, if any, were noted.

Results:
FALK was uneventful in all 4 eyes. At last follow-up, BCVA improved by >2 lines in all eyes. Myopic shift in the refractive error was noted in 2 eyes. None of the eyes had any intraoperative or postoperative complications. One case had dissection margins cross the graft–host junction; however, no dehiscence occurred in this case. The grafts were clear at the last follow-up examinations.

Conclusions:
FALK is a safe and effective technique for the management of recurrence of GCD in post-penetrating keratoplasty and post-PTK eyes. BCVA improved by >2 lines after the FALK procedure. None of the patients in this series had any intraoperative or postoperative complications, which was indicative of the safety of the procedure.
Validation of CADS Grading Scale: An Ophthalmic Specific Grading Instrument for Facial Nerve Palsy
Authors: Tan Petrina , Siah We Fong , Wong Johnny , Malhotra Raman 
Published: November 2016

Purpose:
To evaluate the inter- and intraobserver reliability of the CADS score, a previously described facial nerve grading instrument for ophthalmic grading of facial nerve palsy.

Methods:
This is a cross-sectional validation study. Two clinicians independently assessed and graded each patient on the same day, masked to each other’s grading. Four parameters are assessed in the CADS scale: Cornea (0–3, ±a), static Asymmetry (0–2), Dynamic function (0–3), and Synkinesis (0–2). One clinician reassessed the patients and performed the grading again at a minimum time interval of 1 hour later. A weighted κ analysis was performed to determine inter- and intraobserver reliability using 95% bootstrapped bias-corrected and accelerated (BCa) confidence intervals (CIs).

Results:
Thirty-three patients (27 women, mean age 51.7, range 23–80 years) with unilateral facial nerve palsy were graded. The overall interobserver reliability was 0.80 (95% BCa CI: 0.68–0.91) for cornea, 0.93 for resting asymmetry (95% BCa CI: 0.55–1.00), 0.80 for dynamic function (95% BCa CI: 0.50–0.96), and 0.88 (95% BCa CI: 0.71–0.96) for synkinesis. The overall intraobserver reliability was 0.93 for cornea (95% BCa CI: 0.83–0.98), 0.82 for resting asymmetry (95% BCa CI: 0.53–0.96), 0.92 for dynamic function (95% BCa CI: 0.72–1.00), and 0.98 for synkinesis (95% BCa CI: 0.84–1.00).

Conclusion:
The CADS grading scale demonstrates good interobserver reliability and very good intraobserver reliability. It incorporates all ophthalmic complications for facial nerve palsy and remains easy to use and refer to.
Wingtip Flap for Reconstruction of Full-Thickness Upper and Lower Eyelid Defects
Authors: Vrcek Ivan , Chou Eva , Blaydon Sean , Shore John 
Published: November 2016

Purpose:
Pentagonal wedge resection is a technique used to address a wide variety of eyelid pathology. This procedure frequently results in excess skin at the apex of the wound, commonly known as a “dog ear.” A variety of methods have been described to address the cutaneous redundancy, the most classic of which is the Burow’s triangle repair. The authors present a technique to address the anterior lamellar excess that avoids placement of a vertical scar traversing the pretarsal and preseptal portion of the affected eyelid. The repair moves the preseptal closure of the wound temporally, away from the moving portion of the eyelid. The horizontal incision that transposes the vertical closure temporally is concealed in the eyelid crease.

Methods:
A retrospective review of all patients undergoing this technique for eyelid reconstruction was undertaken. The surgical technique is described in detail.

Results:
The procedure has been performed on 7 patients (8 eyelids). Patients were followed for an average of 12 weeks. Indications for surgery were floppy eyelid syndrome requiring horizontal shortening of the upper eyelid and neoplastic lesions involving the upper or lower eyelid. There were no complications. All patients had a satisfactory outcome with regard to function and cosmesis.

Conclusions:
Full-thickness excision of the central two-thirds of the lower and upper eyelid is used extensively to manage a wide variety of conditions. The authors present a technique for addressing the anterior lamellar closure with notable advantages over previously described methods. The major advantages of this technique are that it results in a vertical closure that is horizontally displaced from the primary action of the levator aponeurosis and avoids anterior and midlamellar scarring of the upper and lower eyelid that may inhibit vertical movement. In addition, the cutaneous scar is more easily concealed.
Therapeutic Endoscopy for the Control of Nonvariceal Upper Gastrointestinal Bleeding in Children
Authors: Banc‐Husu Anna M. , Ahmad Nuzhat A. , Chandrasekhara Vinay , Ginsberg Gregory G. , Jaffe David L. , Kochman Michael L. , Rajala Michael W. , Mamula Petar 
Published: November 2016

AbstractObjectives:Gastrointestinal bleeding is one of the most common indications for urgent endoscopy in the pediatric setting. The majority of these procedures are performed for control of variceal bleeding, with few performed for nonvariceal upper gastrointestinal (NVUGI) bleeding. The data on therapeutic endoscopy for NVUGI are sparse. The aims of our study were to review our experience with NVUGI bleeding, describe technical aspects and outcomes of therapeutic endoscopy, and determine gastroenterology fellows’ training opportunities according to the national training guidelines.Methods:We performed a retrospective review of endoscopy database (Endoworks, Olympus Inc, Center Valley, PA) from January 2009 to December 2014. The search used the following keywords: bleeding, hematemesis, melena, injection, epinephrine, cautery, clip, and argon plasma coagulation. The collected data included demographics, description of bleeding lesion and medical/endoscopic therapy, rate of rebleeding, relevant laboratories, physical examination, and need for transfusion and surgery. The study was approved by the institutional review board.Results:During the study period 12,737 upper endoscopies (esophagogastroduodenoscopies) were performed. A total of 15 patients underwent 17 esophagogastroduodenoscopies that required therapeutic intervention to control bleeding (1:750 procedures). The mean ± standard deviation (median) age of patients who required endoscopic intervention was 11.6 ± 6.0 years (14.0 years). Seven out of 17 patients received dual therapy to control the bleeding lesions. All but 3 patients received medical therapy with intravenous proton pump inhibitor, and 3 received octreotide infusions. Six of the patients experienced rebleeding (40%), with 4 out of 6 initially only receiving single modality therapy. Two of these patients eventually required surgical intervention to control bleeding and both patients presented with bleeding duodenal ulcers. There were no cases of aspiration, perforation, or deaths. There were a total of 24 fellows trained in our program during the study period. Less than 1 therapeutic endoscopy per fellow for NVUGI bleeding was performed.Conclusions:NVUGI bleeding requiring therapeutic endoscopic intervention is rare in pediatrics. A high rate (40%) of rebleeding was noted with a large proportion (66%) of patients receiving single modality therapy. Two patients required surgical intervention to control bleeding and both presented with bleeding duodenal ulcers. An insufficient number of therapeutic procedures is available for adequate fellow training requiring supplemental simulator and hands‐on animal model, or adult endoscopy unit training.
Objectively Measured Light Exposure in Emmetropic and Myopic Adults
Authors: Ostrin Lisa A. 
Published: November 2016

ABSTRACT

Purpose
Light exposure has a close link with numerous aspects of human physiology including circadian rhythm, mood disorders, metabolism, and eye growth. Here, a lightweight wrist-worn device was employed to continuously measure light exposure and activity across seasons and between refractive error groups to assess objectively measured differences and compare with subjectively reported data.

Methods
Subjects, aged 21–65 years (n = 55), wore an actigraph device (Actiwatch Spectrum) continuously for 14 days to quantify light exposure, activity, and sleep. Subjects were classified as emmetropic (n = 18) or myopic (n = 37), and answered an activity questionnaire. Additionally, devices were calibrated against a lux meter and UV sensor for indoor and outdoor settings, and used to measure ambient illumination in various environmental conditions.

Results
Subjects spent 1:52 ± 0:56 hours outside per day, as measured objectively. Subjectively reported measures overestimated objective measures by 0:25 ± 1:19 hours per day (range −1:49 to +4:29 hours, P < .05). Subjects spent 1:04 hours more outdoors in summer and received an increased cumulative light dose compared to winter (P < .005). There were no significant differences in objective measurements of time outdoors between myopic and emmetropic subjects. Ambient illumination measures from the Actiwatch correlated with a lux meter for all locations tested (R
2 = 0.99, P < .001). Ambient illumination was highest in the summer at 176,497 ± 20,310 lux and lowest for indoor artificial light at 142 ± 150 lux.

Conclusions
Subjects spent more time outdoors and received an increased light dose in summer, with no differences between refractive error groups in this adult population. Various environmental and seasonal measurements revealed significantly different available light in winter versus summer and indoors versus outdoors. Objective devices such as the Actiwatch can be valuable in studies where quantification of environmental factors is critical.
Triggers Contributing to Health Care Clinicians’ Disruptive Behaviors
Authors: Bae Sung-Heui , Dang Deborah , Karlowicz Karen A. , Kim Miyong T. 
Published: November 2016

Objectives
This study’s objective was to explore the possible triggers of clinicians’ disruptive behavior and to consider whether the type of trigger resulting in disruptive behavior differed by type of clinician, clinician characteristics, professional role, and ethnic background.

Methods
Using data collected from 1559 clinicians working at an urban academic medical center in the United States, we examined intrapersonal, interpersonal, and organizational triggers. In addition, we measured 3 subscales of disruptive behavior including incivility, psychological aggression, and violence. Multivariate regression and logit models were used to examine the relationship between triggers and disruptive behavior.

Results
We found that higher levels of intrapersonal, interpersonal, and organizational triggers related to a greater frequency of disruptive behaviors after controlling for clinician characteristics. Among nurses, all 3 types of triggers were significantly related to disruptive behaviors with the same direction and magnitude of difference. However, in the physician/affiliate group, only intrapersonal and interpersonal triggers were statistically significant factors for disruptive behavior.

Conclusions
In the present study, important triggers were found to contribute to clinicians’ disruptive behaviors. Strategies to prevent disruptive behaviors should be multipronged and reflect intrapersonal and interpersonal features for both clinician groups. For nurses, organizational triggers should be addressed through process and system improvements. Because disruptive behavior continues to be frequent among clinicians, efforts to implement evidence-based practices to prevent disruptive behaviors must continue, and future research should evaluate them.
Similarities and Differences in Nurse-Reported Care Rationing Between Critical Care, Surgical, and Medical Specialties
Authors: Higgs Megan , Fernandez Ritin , Polis Suzanne , Manning Vicki 
Published: November 2016

Objective
The aim of this study was to determine the similarities and differences in elements of nursing care that are commonly rationed in the critical care, medical, and surgical specialties within an acute hospital environment.

Methods
Registered nurses who provide bedside nursing care within the medical, surgical, and critical specialties at a single center were invited to anonymously complete the self-administered MISSCARE questionnaire. The frequency of rationing for each individual care element within the 4 broader care groups (assessment, intervention—individual needs, intervention—basic care, and planning) of the MISSCARE questionnaire was determined. A mean score for each care group was also determined, and multiple regression analysis was undertaken to determine the demographic predictors of care rationing.

Results
Interventions related to basic care was the most frequently rationed care group in the critical care/emergency specialty (missed care mean of 50.1%), whereas planning was the most frequently rationed care group among both the medical (missed care mean of 43.6%) and surgical (missed care mean of 44.8%) specialties. Assessment was the least frequently rationed care group among all 3 specialties (missed care mean of 19.7%–26.7%). Length of time practicing as a registered nurse was an independent predictor of care rationing in the critical care/emergency specialty, and age older than 50 was an independent predictor in the medical specialty.

Conclusions
There are numerous similarities and differences in care rationing between critical care, surgical, and medical nurses. The development and implementation of specialty-based strategies should be undertaken to reduce the incidence of nursing care rationing.
Predictors of At-Home Arterial Oxygen Desaturation Events in Ambulatory Surgical Patients
Authors: Biddle Chuck , Elam Charles , Lahaye Laura , Kerr Gordon , Chubb Laura , Verhulst Brad 
Published: November 2016

Objectives
Little is known about the early recovery phase occurring at-home after anesthesia and surgery in ambulatory surgical patients. We studied quantitative oximetry and quality-of-life metrics in the first 48 hours after same-day orthopedic surgery examining the association between the recovery metrics and specific patient and procedural factors.

Methods
We used the STOP-Bang score to quantify patient risk for obstructive sleep apnea in 50 adult patients at 2 centers using continuous portable oximetry and patient journaling. Parametric statistical procedures were used to assess relationships among patient and procedural factors and desaturation events.

Results
Higher STOP-Bang scores were predictive of the number and duration of desaturation events below mild and severe thresholds for arterial oxygen saturation during their first 48 hours after discharge from ambulatory surgery. Older patients and patients with higher BMI in particular were at an increased risk of mild and severe arterial oxygen desaturation. Using a home CPAP reduced the number of desaturation events. Of interest, taking opiate analgesics decreased the number of desaturation events.

Conclusions
Given the absence of systematic research of early ambulatory anesthesia/surgery recovery at home and concerns of postoperative respiratory events, our results have clear implications for patient safety. Our results imply that screening based on noninvasive STOP-Bang scores may allow for suggestions for recovery from ambulatory surgery, such as encouraging patients with high scores to use home CPAP and aggressive education regarding use of opiates.
PopPAnTe: population and pedigree association testing for quantitative data
Authors: Visconti Alessia , Al-Shafai Mashael , Al Muftah Wadha A. , Zaghlool Shaza B. , Mangino Massimo , Suhre Karsten , Falchi Mario 
Published: November 2016

AbstractFamily-based designs, from twin studies to isolated populations with their complex genealogical data, are a valuable resource for genetic studies of heritable molecular biomarkers. Existing software for family-based studies have mainly focused on facilitating association between response phenotypes and genetic markers, and no user-friendly tools are at present available to straightforwardly extend association studies in related samples to large datasets of generic quantitative data, as those generated by current -omicstechnologies.We developed PopPAnTe, a user-friendly Java program, which evaluates the association of quantitative data in related samples. Additionally, Pop-PAnTe implements data pre and post processing, region based testing, and empirical assessment of associations.PopPAnTe is an integrated and flexible framework for pairwise association testing in related samples with a large number of predictors and response variables. It works either with family data of any size and complexity, or, when the genealogical information is unknown, it uses genetic similarity information between individuals as those inferred from genome-wide genetic data. It can therefore be particularly useful in facilitating usage of biobank data collections from population isolates when extensive genealogical information is missing.
HiC-bench: comprehensive and reproducible Hi-C data analysis designed for parameter exploration and benchmarking
Authors: Lazaris Charalampos , Kelly Stephen , Ntziachristos Panagiotis , Aifantis Iannis , Tsirigos Aristotelis 
Published: November 2016

AbstractBackgroundChromatin conformation capture techniques have evolved rapidly over the last few years and have provided new insights into genome organization at an unprecedented resolution. Analysis of Hi-C data is complex and computationally intensive involving multiple tasks and requiring robust quality assessment. This has led to the development of several tools and methods for processing Hi-C data. However, most of the existing tools do not cover all aspects of the analysis and only offer few quality assessment options. Additionally, availability of a multitude of tools makes scientists wonder how these tools and associated parameters can be optimally used, and how potential discrepancies can be interpreted and resolved. Most importantly, investigators need to be ensured that slight changes in parameters and/or methods do not affect the conclusions of their studies.ResultsTo address these issues (compare, explore and reproduce), we introduce HiC-bench, a configurable computational platform for comprehensive and reproducible analysis of Hi-C sequencing data. HiC-bench performs all common Hi-C analysis tasks, such as alignment, filtering, contact matrix generation and normalization, identification of topological domains, scoring and annotation of specific interactions using both published tools and our own. We have also embedded various tasks that perform quality assessment and visualization. HiC-bench is implemented as a data flow platform with an emphasis on analysis reproducibility. Additionally, the user can readily perform parameter exploration and comparison of different tools in a combinatorial manner that takes into account all desired parameter settings in each pipeline task. This unique feature facilitates the design and execution of complex benchmark studies that may involve combinations of multiple tool/parameter choices in each step of the analysis. To demonstrate the usefulness of our platform, we performed a comprehensive benchmark of existing and new TAD callers exploring different matrix correction methods, parameter settings and sequencing depths. Users can extend our pipeline by adding more tools as they become available.ConclusionsHiC-bench consists an easy-to-use and extensible platform for comprehensive analysis of Hi-C datasets. We expect that it will facilitate current analyses and help scientists formulate and test new hypotheses in the field of three-dimensional genome organization.