bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current Trends in Upper and Lower Eyelid Blepharoplasty Among American Society of Ophthalmic Plastic and Reconstructive Surgery Members
Authors: Kossler Andrea L. , Peng Grace L. , Yoo Donald B. , Azizzadeh Babak , Massry Guy G. 
Published: February 2017

Purpose:
To assess current practice patterns for management of upper and lower eyelid blepharoplasty by active American Society of Ophthalmic Plastic and Reconstructive Surgery members.

Methods:
An invitation to participate in a web-based anonymous survey was sent to the active American Society of Ophthalmic Plastic and Reconstructive Surgery membership via email. The survey consists of 34 questions, both multiple choice and free response, regarding upper and lower eyelid blepharoplasty surgery. Practice patterns for both aesthetic and functional blepharoplasty are assessed.

Results:
Thirty-four percent (161/472) of American Society of Ophthalmic Plastic and Reconstructive Surgery members polled responded to the survey. Members perform an average of 196 upper eyelid, 46 lower eyelid, and 53 four-eyelid blepharoplasty procedures per year, with 70% of cases being functional and 30% purely aesthetic. Most members prefer monitored care (71%) to local (21%) or general (8%) anesthesia. Eighty-nine percent of surgeons use topical antibiotics after surgery, erythromycin being the most common (51%). Fourteen percent of members use postoperative oral antibiotics, with cephalexin (81%) being most common. In upper eyelid blepharoplasty, orbicularis muscle is excised by 86% of respondents. Orbital fat is excised, when deemed appropriate, in 97% of cases, with nasal fat excised most commonly (88%). Less commonly, fat repositioning (36%) and adjunctive fat grafting (33%) are performed. In lower eyelid blepharoplasty, surgeons report using one or more of the following approaches: transconjunctival (96%), transcutaneous (82%), and both transconjunctival and transcutaneous (51%). Common adjunctive procedures include orbital fat excision (99%), fat repositioning (80%), and lateral canthal suspension (96%). Less common adjunctive procedures include laser skin resurfacing (36%) and chemical peels (29%).

Conclusions:
This report outlines contemporary practice patterns among active American Society of Ophthalmic Plastic and Reconstructive Surgery members in the management of upper and lower eyelid blepharoplasty. It is important to quantify such data periodically to update the membership as to how this common surgical procedure is approached. This also allows eyelid surgeons to compare their practice patterns with a national group specializing in such surgery.
Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: a prospective study
Authors: Holley Amy Lewandowski , Wilson Anna C. , Palermo Tonya M. 
Published: February 2017

Abstract
Strategies directed at the prevention of disabling pain have been suggested as a public health priority, making early identification of youth at risk for poor outcomes critical. At present, limited information is available to predict which youth presenting with acute pain are at risk for persistence. The aims of this prospective longitudinal study were to identify biopsychosocial factors in the acute period that predict the transition to persistent pain in youth with new-onset musculoskeletal (MSK) pain complaints. Participants were 88 children and adolescents (age 10-17 years) presenting to the emergency department (n = 47) or orthopedic clinic (n = 41) for evaluation of a new MSK pain complaint (<1 month duration). Youth presented for 2 study visits (T1 ≤1 month post pain onset; T2 = 4-month follow-up) during which they completed questionnaires (assessing pain characteristics, psychological factors, sleep quality) and participated in a laboratory task assessing conditioned pain modulation. Regression analyses tested T1 predictors of longitudinal pain outcomes (pain persistence, pain-related disability, quality of life [QOL]). Results revealed approximately 35% of youth had persistent pain at 4-month follow-up, with persistent pain predicted by poorer conditioned pain modulation and female sex. Higher depressive symptoms at T1 were associated with higher pain-related disability and poorer QOL at T2. Findings highlight the roles of depressive symptoms and pain modulation in longitudinally predicting pain persistence in treatment-seeking youth with acute MSK pain and suggest potential mechanisms in the transition from acute to chronic MSK pain in children and adolescents.
Spots on the Trunk
Authors: So Jessica Kim , Jacob Sharon E. 
Published: February 2017

ABSTRACT
Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. In this modality, patient medical information (history and visual data) is transferred electronically to a provider who is in another location (Roman & Jacob, 2015). The construct of the TeleDermViewPoint column is such that cases are presented in a standardized teledermatology reader format reflective of an actual teledermatology report. This is a case of spots on the trunk.
EBUS-STAT Subscore Analysis to Predict the Efficacy and Assess the Validity of Virtual Reality Simulation for EBUS-TBNA Training Among Experienced Bronchoscopists
Authors: Scarlata Simone , Palermo Patrizio , Candoli Piero , Tofani Ariela , Petitti Tommasangelo , Corbetta Lorenzo 
Published: February 2017

Background:
Linear endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) represents a pivotal innovation in interventional pulmonology; determining the best approach to guarantee systematic and efficient training is expected to become a main issue in the forthcoming years. Virtual reality simulators have been proposed as potential EBUS-TBNA training instruments, to avoid unskilled beginners practicing directly in real-life settings. A validated and perfected simulation program could be used before allowing beginners to practice on patients. Our goal was to test the reliability of the EBUS-Skills and Task Assessment Tool (STAT) and its subscores for measuring the competence of experienced bronchoscopists approaching EBUS-guided TBNA, using only the virtual reality simulator as both a training and an assessment tool.

Methods:
Fifteen experienced bronchoscopists, with poor or no experience in EBUS-TBNA, participated in this study. They were all administered the Italian version of the EBUS-STAT evaluation tool, during a high-fidelity virtual reality simulation. This was followed by a single 7-hour theoretical and practical (on simulators) session on EBUS-TBNA, at the end of which their skills were reassessed by EBUS-STAT.

Results:
An overall, significant improvement in EBUS-TBNA skills was observed, thereby confirming that (a) virtual reality simulation can facilitate practical learning among practitioners, and (b) EBUS-STAT is capable of detecting these improvements. The test’s overall ability to detect differences was negatively influenced by the minimal variation of the scores relating to items 1 and 2, was not influenced by the training, and improved significantly when the 2 items were not considered. Apart from these 2 items, all the remaining subscores were equally capable of revealing improvements in the learner. Lastly, we found that trainees with presimulation EBUS-STAT scores above 79 did not show any significant improvement after virtual reality training, suggesting that this score represents a cutoff value capable of predicting the likelihood that simulation can be beneficial.

Conclusions:
Virtual reality simulation is capable of providing a practical learning tool for practitioners with previous experience in flexible bronchoscopy, and the EBUS-STAT questionnaire is capable of detecting these changes. A pretraining EBUS-STAT score below 79 is a good indicator of those candidates who will benefit from the simulation training. Further studies are needed to verify whether a modified version of the questionnaire would be capable of improving its performance among experienced bronchoscopists.
Bronchoscopy: Oral or Nasal Insertion?
Authors: de Boer Geertje M. , Türk Yasemin , Meuleman-van Waning Virginie H. , Braunstahl Gert-Jan 
Published: February 2017

Background:
Flexible bronchoscopy is a frequently used procedure for the diagnosis and treatment of various lung disorders. As there is no standardized guideline on the insertion of the bronchoscope, and few studies are available on the subject, we conducted a prospective randomized controlled trial to compare nasal and oral insertion.

Methods:
In total, 66 patients who underwent bronchoscopy without sedation were randomly assigned to either oral or nasal insertion. Primary and secondary outcome parameters were time to pass the vocal chords (VC) from first insertion and willingness to return (WTR).

Results:
Time to pass the VC was significantly shorter with oral insertion compared with nasal insertion (median 24.43 vs. 52.33 s; P<0.001). WTR did not differ between the 2 groups [median score 4 (nasal) vs. 5 (oral); P=0.358 on a 10-point scale]. However, a significant correlation was found between WTR and the patients’ experience with the insertion of the bronchoscope in both groups (r=0.639; P=<0.001). This correlation was strongest in the nasal group (r=0.809; P=<0.001). Conversion occurred more often in the nasal group than in the oral group (51.6% vs. 1.5%).

Conclusions:
Time to pass the VC is shorter in oral insertion compared with that in nasal insertion. In particular, after nasal insertion, a negative experience of the patient was associated with a lower score on WTR. Therefore, we advise oral insertion for a nonsedated bronchoscopy with a >6.0-mm bronchoscope when there is no indication for inspection of the upper airways.
Utilizing a Human Factors Nursing Worksystem Improvement Framework to Increase Nurses’ Time at the Bedside and Enhance Safety
Authors: Probst C. Adam , Carter Megan , Cadigan Caton , Dalcour Cortney , Cassity Cindy , Quinn Penny , Williams Tiana , Montgomery Donna Cook , Wilder Claudia , Xiao Yan 
Published: February 2017

OBJECTIVE
The aim of this study is to increase nurses’ time for direct patient care and improve safety via a novel human factors framework for nursing worksystem improvement.

BACKGROUND
Time available for direct patient care influences outcomes, yet worksystem barriers prevent nurses adequate time at the bedside.

METHODS
A novel human factors framework was developed for worksystem improvement in 3 units at 2 facilities. Objectives included improving nurse efficiency as measured by time-and-motion studies, reducing missing medications and subsequent trips to medication rooms and improving medication safety.

RESULTS
Worksystem improvement resulted in time savings of 16% to 32% per nurse per 12-hour shift. Requests for missing medications dropped from 3.2 to 1.3 per day. Nurse medication room trips were reduced by 30% and nurse-reported medication errors fell from a range of 1.2 to 0.8 and 6.3 to 4.0 per month.

CONCLUSIONS
An innovative human factors framework for nursing worksystem improvement provided practical and high priority targets for interventions that significantly improved the nursing worksystem.
IgG4 Expression in Primary Cutaneous Marginal Zone Lymphoma: A Multicenter Study
Authors: De Souza Aieska , Ferry Judith A. , Burghart Daniel R. , Tinguely Marianne , Goyal Amrita , Duncan Lyn M. , Kutzner Heinz , Kempf Werner 
Published: February 2017

Background:
Primary cutaneous marginal zone lymphoma (PCMZL) is the second most common B-cell lymphoma of the skin. A recent study has demonstrated a strikingly high prevalence of immunoglobulin (Ig)G4 expression in PCMZL with plasmacytic differentiation.

Objective:
The objective was to investigate the incidence of IgG4 expression in PCMZL, and its correlation with clinical and immunophenotypic features.

Materials and Methods:
Multicenter study that utilized immunohistochemistry and in-situ hybridization to evaluate the expression of IgG4, Ig light (κ and λ), and heavy chains (IgM, IgG), and the ratio of T (CD3+) and B (CD20+) cells in biopsy specimens from 30 patients with PCMZL and to correlate these findings with the clinical features.

Results:
IgG4 expression was observed in 4 out of 30 patients (13%) with PCMZL. Patients with IgG4-positive lymphomas were 57 to 77 years of age (mean, 69) at biopsy. The lesions were solitary in 2 patients with IgG4-positive lymphomas, and were most commonly located on the trunk. Patients with IgG4-negative lymphomas experienced earlier disease onset at an average age of 53 years. The majority of the IgG4-negative cases presented with localized disease, on the trunk and upper extremities. There was no significant difference in the IgG4-positive versus negative cases for the following parameters: Ig κ or λ restriction, B-cell or T-cell predominance, and site of the lesions.

Conclusions:
IgG4 expression was observed in a minority of PCMZL patients. We did not identify significant clinical or immunophenotypic differences between IgG4 positive and negative cases.
Prognostic Significance of Stromal Versus Intratumoral Infiltrating Lymphocytes in Different Subtypes of Breast Cancer Treated With Cytotoxic Neoadjuvant Chemotherapy
Authors: Khoury Thaer , Nagrale Vidya , Opyrchal Mateusz , Peng Xuan , Wang Dan , Yao Song 
Published: February 2017

Background:
The aim of the study was to investigate if there were differences in associations of stromal versus intratumoral tumor infiltrating lymphocytes (TILs) with pathology complete response (pCR) among breast cancer (BC) subtypes treated with neoadjuvant therapy.

Materials and Methods:
The hematoxylin and eosin slides of BC-core biopsy consecutive cases (n=331) were reviewed from a single institution between 2000 and 2014. TIL-stroma (TIL-str) was scored from 0% to 100%. Intratumoral lymphocytes (iTu-Ly) were scored semiquantitatively incorporating the infiltrate grade (0 to 3) and the corresponding percentage resulting in a score ranging from 0 to 300. pCR was defined as no residual infiltrating tumor in the tumor bed and the lymph nodes.

Results:
pCR was achieved in 29 of 95 (30.9%) triple negative cases, 25 of 77 (32.5%) HER2+, and 9 of 159 (5.6%) luminal tumors. In univariate analysis, invasive nonlobular carcinoma, higher Nottingham grade, nonluminal subtypes, trastuzumab therapy, nonadvanced clinical T stage (T1 and T2), TIL-str, and iTu-Ly-predicted pCR. In luminal subtype, iTu-Ly but not TIL-str was an independent predictor for pCR [odds ratio (OR)=1.44, 95% confidence interval (CI), 1.08-1.9, P=0.013]. In triple negative subtype, both TIL-str and iTu-Ly were independent predictors for pCR (OR=1.68, 95% CI, 1.29-2.18, P=0.001; OR=1.31, 95% CI, 1.05-1.63, P=0.017, respectively). In HER2+ subtype, neither TIL-str nor iTu-Ly predicted pCR.

Conclusions:
TILs are variably correlated with better neoadjuvant chemotherapy response depending on their location and clinical subtype of BC. It could indicate that TILs might be functionally heterogeneous with regard to their role in mediating antitumor immune response, depending on their location and BC subtypes.
The Relationship Between Safety Culture and Voluntary Event Reporting in a Large Regional Ambulatory Care Group
Authors: Miller Nina , Bhowmik Shelly , Ezinwa Margarete , Yang Ting , Schrock Susan , Bitzel Daniel , McGuire Maura Joyce 
Published: February 2017

Objectives
The safety culture in the workplace may affect event reporting. We evaluated the relationship of safety culture and voluntary event reporting within a large network of ambulatory practices, most of which provided primary care.

Methods
This study was an observational, retrospective cohort study. Patient safety event reporting rates for 35 ambulatory practices were collected using a standard tool (UHC Patient Safety Net [PSN]) and normalized based on the number of patient visits in each practice. The overall and domain-specific safety culture of each practice was measured with a validated instrument (Safety Attitudes Questionnaire [SAQ]), distributed to 828 employees in 2013. We compared safety culture scores and the average event reporting rates during a 4-month window before and after the survey distribution. Poisson regression analyses were performed to determine the relationship between PSN reporting rates and SAQ results.

Results
The SAQ response rate was 87%. Practices varied widely in rates of reporting events, from 0.00 to 6.99 reports per 1000 total patient visits per month. Regression analyses indicated a positive association between PSN reporting rates and SAQ scores for the domains of overall culture (incidence rate ratio [IRR], 1.019; P = 0.004) and 4 safety culture domains: teamwork climate (IRR, 1.016; P = 0.019), safety climate (IRR, 1.018; P = 0.004), working conditions (IRR, 1.017; P = 0.006), and perceptions of local management (IRR, 1.016; P = 0.040).

Conclusions
Our work provides new evidence to show that in the ambulatory setting more events and near misses are reported when there is a strong culture of safety.
Making Residents Part of the Safety Culture: Improving Error Reporting and Reducing Harms
Authors: Fox Michael D. , Bump Gregory M. , Butler Gabriella A. , Chen Ling-Wan , Buchert Andrew R. 
Published: February 2017

Objectives
Reporting medical errors is a focus of the patient safety movement. As frontline physicians, residents are optimally positioned to recognize errors and flaws in systems of care. Previous work highlights the difficulty of engaging residents in identification and/or reduction of medical errors and in integrating these trainees into their institutions’ cultures of safety.

Methods
The authors describe the implementation of a longitudinal, discipline-based, multifaceted curriculum to enhance the reporting of errors by pediatric residents at Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center. The key elements of this curriculum included providing the necessary education to identify medical errors with an emphasis on systems-based causes, modeling of error reporting by faculty, and integrating error reporting and discussion into the residents’ daily activities. The authors tracked monthly error reporting rates by residents and other health care professionals, in addition to serious harm event rates at the institution.

Results
The interventions resulted in significant increases in error reports filed by residents, from 3.6 to 37.8 per month over 4 years (P < 0.0001). This increase in resident error reporting correlated with a decline in serious harm events, from 15.0 to 8.1 per month over 4 years (P = 0.01).

Conclusions
Integrating patient safety into the everyday resident responsibilities encourages frequent reporting and discussion of medical errors and leads to improvements in patient care. Multiple simultaneous interventions are essential to making residents part of the safety culture of their training hospitals.
Prevalence of Anal HPV and Anal Dysplasia in HIV-Infected Women From Johannesburg, South Africa
Authors: Goeieman Bridgette J. , Firnhaber Cynthia S. , Jong Eefje , Michelow Pam , Kegorilwe Patricia , Swarts Avril , Williamson Anna-Lise , Allan Bruce , Smith Jennifer S. , Wilkin Timothy J. 
Published: February 2017

Background:
Anal cancer is a relatively common cancer among HIV-infected populations. There are limited data on the prevalence of anal high-risk human papillomavirus (HR-HPV) infection and anal dysplasia in HIV-infected women from resource-constrained settings.

Methods:
A cross-sectional study of HIV-infected women aged 25–65 years recruited from an HIV clinic in Johannesburg, South Africa. Cervical and anal swabs were taken for conventional cytology and HR-HPV testing. Women with abnormal anal cytology and 20% of women with negative cytology were seen for high-resolution anoscopy with biopsy of visible lesions.

Results:
Two hundred women were enrolled. Anal HR-HPV was found in 43%. The anal cytology results were negative in 51 (26%); 97 (49%) had low-grade squamous intraepithelial lesions (SIL), 32 (16%) had atypical squamous cells of unknown significance, and 19 (9.5%) had high-grade SIL or atypical squamous cells suggestive of high-grade SIL. On high-resolution anoscopy, 71 (36%) had atypia or low-grade SIL on anal histology and 17 (8.5%) had high-grade SIL. Overall, 31 (17.5%) had high-grade SIL present on anal cytology or histology. Abnormal cervical cytology was found in 70% and cervical HR-HPV in 41%.

Conclusions:
We found a significant burden of anal HR-HPV infection, abnormal anal cytology, and high-grade SIL in our cohort. This is the first study of the prevalence of anal dysplasia in HIV-infected women from sub-Saharan Africa. Additional studies are needed to define the epidemiology of these conditions, as well as the incidence of anal cancer, in this population.
Quantitative characterization of CTLA4 trafficking and turnover using a combinedin vitroandin silicoapproach
Authors: Khailaie Sahamoddin , Rowshanravan Behzad , Robert Philippe A. , Walker Lucy S. K. , Sansom David M. , Meyer-Hermann Michael 
Published: February 2017

AbstractCTLA4 is an essential negative regulator of T cell immune responses and is a key checkpoint regulating autoimmunity and anti-tumour immunity. Genetic mutations resulting in a quantitative defect in CTLA4 are associated with the development of an immune dysregulation syndrome. Endocytosis of CTLA4 is rapid and continuous with subsequent degradation or recycling. CTLA4 has two natural ligands, the surface transmembrane proteins CD80 and CD86 that are shared with the T cell co-stimulatory receptor CD28. Upon ligation with CD80/CD86, CTLA4 can remove these ligands from the opposing cells by transendocytosis. The efficiency of ligand removal is thought to be highly dependent on the processes involved in CTLA4 trafficking. With a combinedin vitro-in silicostudy, we quantify the rates of CTLA4 internalization, recycling and degradation. We incorporate experimental data from cell lines and primary human T cells. Our model provides a framework for exploring the impact of altered affinity of natural ligands or therapeutic anti-CTLA4 antibodies and for predicting the effect of clinically relevant CTLA4 pathway mutations. The presented methodology for extracting trafficking rates can be transferred to the study of other transmembrane proteins.