bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurosurgical Resident Training in Germany
Authors: Gempt Jens , Gautschi Oliver , Demetriades Andreas , Netuka David , Kuhlen Dominique , Schaller Karl , Ringel Florian , Stienen Martin 
Published: November 2016

Introduction Efficient neurosurgical training is of paramount importance to provide continuing high-quality medical care to patients. In this era of law-enforced working hour restrictions, however, maintaining high-quality training can be a challenge and requires some restructuring. We evaluated the current status of resident training in Germany.
Methods An electronic survey was sent to European neurosurgical trainees between June 2014 and March 2015. The responses of German trainees were compared with those of trainees from other European countries. Logistic regression analysis was performed to assess the effect size of the relationship between a trainee being from Germany and the outcome (e.g., satisfaction, working time).
Results Of 532 responses, 95 were from German trainees (17.8%). In a multivariate analysis corrected for baseline group differences, German trainees were 29% as likely as non-German trainees to be satisfied with clinical lectures given at their teaching facility (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.18–0.49; p < 0.0001). The satisfaction rate with hands-on operating room exposure was 73.9% and equal to the rate in Europe (OR: 0.94; 95% CI, 0.56–1.59; p = 0.834). German trainees were 2.3 times as likely to perform a lumbar spine intervention as the primary surgeon within the first year of training (OR: 2.27; 95% CI, 1.42–3.64; p = 0.001). However, they were less likely to perform a cervical spine procedure within 24 months of training (OR: 0.38; 95% CI, 0.17–0.82; p = 0.014) and less likely to perform a craniotomy within 36 months of training (OR: 0.49; 95% CI, 0.31–0.79; p = 0.003). Only 25.6% of German trainees currently adhere to the weekly limit of 48 hours as requested from the European Working Time Directive 2003/88/EC, and in an international comparison, German trainees were twice as likely to work > 50 hours per week (OR: 2.13; 95% CI, 1.25–3.61; p = 0.005). This working time, however, is less spent in the operating suite (OR: 0.26; 95% CI, 0.11–0.59; p = 0.001) and more doing administrative work (OR: 1.83; 95% CI, 1.13–2.96; p = 0.015).
Conclusion Some theoretical and practical aspects of neurosurgical training are superior, but a considerable proportion of relevant aspects are inferior in Germany compared with other European countries. The present analyses provide the opportunity for a critical review of the local conditions in German training facilities.
Exploration of joint redundancy but not task space variability facilitates supervised motor learning
Authors: Singh Puneet , Jana Sumitash , Ghosal Ashitava , Murthy Aditya 
Published: November 2016

Significance
Theories of reinforcement learning claim that motor variability helps in motor learning and are supported by recent experimental work. In contrast, theories of motor control propose that variability is noise that needs to be suppressed. We attempt to reconcile these apparent contradictory positions. Using the formulation of the unconstrained manifold hypothesis, we show that motor variability has two components—a part arising out of the redundancy that does not affect task-space and another component related to task-space variability. We show that the motor variability component resulting from the redundancy determines both dynamic and kinematic learning ability across subjects without affecting task-space variability.
Should we embed careers education in STEM lessons?
Authors: Reiss Michael J. , Mujtaba Tamjid 
Published: November 2016

ABSTRACTSchools have a particular responsibility to introduce young people to the range of possible options for them after they leave education as few families can provide this. However, in the United Kingdom, careers education is currently not strong in most schools for a number of reasons but principally due to its low status and shifts in government policy and funding. As a result, too many young people make subject choices for post‐16 study that they subsequently regret. In particular, fewer young people in the United Kingdom choose post‐16 STEM subjects than might do. Yet, STEM (science, technology, engineering and mathematics) graduates are especially valued by employers. We draw on the findings of two research projects, ASPIRES and UPMAP, and argue that one way forward may be to embed careers education in STEM lessons. This can be done in ways that are respectful of and helpful to students. We recommend that an England‐ or UK‐based project to investigate the consequences of embedding careers education in STEM lessons be undertaken.
Conspicuous Consumption of Time: When Busyness and Lack of Leisure Time Become a Status Symbol
Authors: Bellezza Silvia , Paharia Neeru , Keinan Anat 
Published: November 2016

Abstract
While research on conspicuous consumption has typically analyzed how people spend money on products that signal status, this article investigates conspicuous consumption in relation to time. The authors argue that a busy and overworked lifestyle, rather than a leisurely lifestyle, has become an aspirational status symbol. A series of studies shows that the positive inferences of status in response to busyness and lack of leisure time are driven by the perceptions that a busy person possesses desired human capital characteristics (e.g., competence and ambition) and is scarce and in demand in the job market. This research uncovers an alternative kind of conspicuous consumption that operates by shifting the focus from the preciousness and scarcity of goods to the preciousness and scarcity of individuals. Furthermore, the authors examine cultural values (perceived social mobility) and differences among cultures (North America vs. Europe) to demonstrate moderators and boundary conditions of the positive associations derived from signals of busyness.
Medical therapy, refractory chronic rhinosinusitis, and productivity costs
Authors: Smith Kristine A. , Rudmik Luke 
Published: November 2016

Purpose of review
The purpose of this review is to address the most recent advances in the medical therapy for chronic rhinosinusitis (CRS), define recalcitrant and refractory CRS, and discuss the productivity costs associated with CRS.

Recent findings
Recent studies evaluating anti-IL-4 receptor α antibodies and calcium channel blockers have demonstrated promising early results during management of CRS. Recent appropriateness criteria have been developed to assist clinicians with defining which patients have ‘refractory’ CRS and may be considered candidates for endoscopic sinus surgery. Productivity costs appear to be associated with disease severity and can be reduced with appropriate interventions.

Summary
Topical corticosteroid therapy and high volume saline irrigation continue to be the cornerstone to medical therapy, whereas use of systemic corticosteroids and antibiotics depends on CRS phenotype and presence of acute exacerbation. More research is needed before routine use of novel immunomodulatory therapies such as anti-IL5, anti-IgE, anti-IL4, and calcium channel blockers. Clinicians should apply an appropriate definition for refractory CRS when discussing role of sinus surgery. Assessing the degree of work productivity impairment can assist in treatment decision-making and may help predict treatment outcomes.
Applying Advanced Analytical Approaches to Characterize the Impact of Specific Clinical Gaps and Profiles on the Management of Rheumatoid Arthritis
Authors: Ruiz-Cordell Karyn D. , Joubin Kathy , Haimowitz Steven 
Published: November 2016

Introduction:
The goal of this study was to add a predictive modeling approach to the meta-analysis of continuing medical education curricula to determine whether this technique can be used to better understand clinical decision making. Using the education of rheumatologists on rheumatoid arthritis management as a model, this study demonstrates how the combined methodology has the ability to not only characterize learning gaps but also identify those proficiency areas that have the greatest impact on clinical behavior.

Methods:
The meta-analysis included seven curricula with 25 activities. Learners who identified as rheumatologists were evaluated across multiple learning domains, using a uniform methodology to characterize learning gains and gaps. A performance composite variable (called the treatment individualization and optimization score) was then established as a target upon which predictive analytics were conducted.

Results:
Significant predictors of the target included items related to the knowledge of rheumatologists and confidence concerning 1) treatment guidelines and 2) tests that measure disease activity. In addition, a striking demographic predictor related to geographic practice setting was also identified.

Discussion:
The results demonstrate the power of advanced analytics to identify key predictors that influence clinical behaviors. Furthermore, the ability to provide an expected magnitude of change if these predictors are addressed has the potential to substantially refine educational priorities to those drivers that, if targeted, will most effectively overcome clinical barriers and lead to the greatest success in achieving treatment goals.
Impact of Mental Health Comorbidities on the Community-Based Pediatric Treatment and Outcomes of Children with Attention Deficit Hyperactivity Disorder
Authors: Al Ghriwati Nour , Langberg Joshua M. , Gardner William , Peugh James , Kelleher Kelly J. , Baum Rebecca , Brinkman William B. , Lichtenstein Phil , Epstein Jeffery N. 
Published: November 2016

ABSTRACT:

Objective:
Children with attention deficit hyperactivity disorder (ADHD) often exhibit psychiatric comorbidities, which may impact illness presentation, diagnosis, and treatment outcomes. Guidelines exist for dealing with these complex cases but little is known about how comorbidities are being handled in community pediatric settings. The purpose of this study was to evaluate how mental health comorbidities affect community physicians' ADHD care practices and patients' symptom trajectories.

Method:
Medical charts of 319 children presenting at primary care clinics for ADHD-related concerns were reviewed. Physician assessment and treatment behaviors were extracted and parents rated ADHD symptoms at the time of diagnosis and at 3, 6, and 12 months. Baseline ratings were used to group children, as no comorbid mental health condition, internalizing, or externalizing comorbid condition. Multilevel analyses compared community physician care behaviors and ADHD symptom trajectories across groups.

Results:
Approximately, 50 percent of the sample met screening criteria for a comorbid mental health condition. For children diagnosed with ADHD and treated with medication, community physician care largely did not differ across groups, but children with internalizing comorbidities made significantly smaller improvements in inattentive and hyperactive/impulsive symptoms compared with children with no comorbidities.

Conclusion:
Children with ADHD and mental health comorbidities, particularly internalizing disorders, exhibit less robust response to ADHD medication and may require additional testing before starting medication and/or alternative treatment approaches. Potential barriers to conducting comprehensive assessments and to providing multi-modal treatment are discussed.
Nursing Practices and Policies Related to Family Presence During Resuscitation
Authors: Powers Kelly A. , Candela Lori 
Published: November 2016

Background:
Despite its shown benefits, family presence during resuscitation (FPDR) is a controversial topic among critical care nurses and is not routinely implemented.

Objectives:
The objective of this study was to describe FPDR practices among critical care nurses, as well as the prevalence of FPDR policies and education.

Methods:
The study used a descriptive survey design. Data were collected from a convenience sample of critical care nurses obtained at a national level. A 25-item demographic and professional attribute survey was administered to all participants.

Results:
There were 124 critical care nurses who participated. Results indicated critical care nurses have vast resuscitative care experience; however, FPDR is not a routine component. In the past year, 23% (n = 29) had never experienced FPDR, and only 17% (n = 21) had experienced it more than 5 times. Furthermore, 48% (n = 59) had never invited FPDR, and 45% (n = 56) had invited it only 1 to 5 times. A lack of FPDR policy was noted, with 73% (n = 91) indicating their facility or unit did not have a policy or they were unsure if one existed. Only 38% (n = 47) had ever received education on FPDR.

Discussion:
Despite the shown benefits of FPDR, it is not a routine component of resuscitation in critical care settings. Nurse managers and educators should focus on policy creation and education to help guide nurses at the bedside. The impact of policy and education on critical care nurses’ support for and implementation of FPDR requires further study.
Paecilomyces lilacinus Keratitis in a Soft Contact Lens Wearer
Authors: Monno Rosa , Alessio Giovanni , Guerriero Silvana , Capolongo Carmen , Calia Carla , Fumarola Luciana , Pazzani Carlo , Di Taranto Anna , Miragliotta Giuseppe 
Published: November 2016

Abstract:
We describe a case of keratitis caused by Paecilomyces lilacinus in a contact lens wearer with a history of diabetes.
Increased Brain Lactate During Depressive Episodes and Reversal Effects by Lithium Monotherapy in Drug-Naive Bipolar Disorder
Authors: Machado-Vieira Rodrigo , Zanetti Marcus V. , Otaduy Maria C. , De Sousa Rafael T. , Soeiro-de-Souza Marcio G. , Costa Alana C. , Carvalho Andre F. , Leite Claudia C. , Busatto Geraldo F. , Zarate Carlos A. , Gattaz Wagner F. 
Published: November 2016

Abstract

Objective
Mitochondrial dysfunction and energy metabolism impairment are key components in the pathophysiology of bipolar disorder (BD) and may involve a shift from aerobic to anaerobic metabolism. Measurement of brain lactate in vivo using proton magnetic resonance spectroscopy (1H-MRS) represents an important tool to evaluate mitochondrial and metabolic dysfunction during mood episodes, as well as to monitor treatment response. To date, very few studies have quantified brain lactate in BD. In addition, no study has longitudinally evaluated lactate using 1H-MRS during depressive episodes or its association with mood stabilizer therapy. This study aimed to evaluate cingulate cortex (CC) lactate using 3-T 1H-MRS during acute depressive episodes in BD and the possible effects induced by lithium monotherapy.

Methods
Twenty medication-free outpatients with short length of BD (80% drug-naive) in a current major depressive episode were matched with control subjects. Patients were treated for 6 weeks with lithium monotherapy at therapeutic doses in an open-label trial (blood level, 0.48 ± 0.19 mmol/L). Cingulate cortex lactate was measured before (week 0) and after lithium therapy (week 6) using 1H-MRS. Antidepressant efficacy was assessed with the 21-item Hamilton Depression Rating Scale as the primary outcome.

Results
Subjects with BD depression showed a significantly higher CC lactate in comparison to control subjects. Furthermore, a significant decrease in CC lactate was observed after 6 weeks of lithium treatment compared with baseline (P = 0.002). CC Lactate levels was associated with family history of mood disorders and plasma lithium levels.

Conclusions
This is the first report of increased CC lactate in patients with bipolar depression and lower levels after lithium monotherapy for 6 weeks. These findings indicate a shift to anaerobic metabolism and a role for lactate as a state marker during mood episodes. Energy and redox dysfunction may represent key targets for lithium’s therapeutic actions.
Development and Pilot Testing of an International Knowledge Assessment of Prosthetic Management for Patients Using Lower-Limb Prostheses
Authors: Goodworth Adam D. , Veneri Diana A. , Burger John , Lee Daniel J. 
Published: November 2016

ABSTRACT

Introduction
Individuals using a lower-limb prosthesis need knowledge about many aspects of management to maximize use and comfort and minimize secondary complications. Knowledge assessments are used in other health fields, yet no assessment has been published in prosthetics. Therefore, a knowledge assessment was developed for international use and pilot tested in the United States and East Africa.

Materials and Methods
The assessment contained 36 questions and was written at a 4.7-grade reading level. Content was based on professional input and literature. The assessment was pilot tested with 16 prosthetic users in the United States, 19 prosthetic users in East Africa, and 24 nonprosthetic users in the United States. Assessment scores were analyzed across questions, between prosthetic users and nonprosthetic users, and correlated with patient demographics.

Results
We found the assessment was understandable among all subject groups. United States prosthesis users scored higher than nonprosthesis users. Prosthetic experience was positively correlated with assessment scores in the United States and negatively correlated with assessment scores in East Africa.

Conclusions
Clinicians can use this knowledge assessment to identify gaps or misunderstanding and track progress in comprehension with their patients. Clinicians can adapt questions to their local context, individual needs and componentry, and time constraints.
Potential for treatment and a Zika virus vaccine
Authors: Quanquin Natalie , Wang Lulan , Cheng Genhong 
Published: November 2016

Purpose of review
Zika virus (ZIKV) has only recently been exposed as a significant public health threat, and much of our limited knowledge of its pathogenesis and triggered immune responses were discovered in only the last few years. There are currently no ZIKV-specific therapeutics or vaccines available. This review seeks to bring the reader up-to-date with the latest developments in finding a way to combat this emerging infectious disease.

Recent findings
Current strategies used for developing ZIKV vaccines or treatments follow proven methods used against other flaviviruses. Unfortunately, ZIKV carries many unique challenges, such as the need to target drugs and vaccines towards immunocompromised populations (pregnant mothers and fetuses), the risk of stimulating harmful immune responses (either autoimmune or antibody-dependent enhancement of infection in those with previous flavivirus exposure), frequently silent infection that may delay treatment and increase risk of transmission to others, and multiple routes of transmission (arthropod vector, sexual, bloodborne, and potentially other body fluids).

Summary
Current medical recommendations are directed towards resolving symptoms and not the actual infection; however, ZIKV treatments and vaccines are in development. Vector control and travel restrictions to endemic areas may remain our only available interventions for some time.
Prostaglandin E‐major Urinary Metabolite as a Biomarker for Pediatric Ulcerative Colitis Activity
Authors: Hagiwara Shin‐ichiro , Okayasu Isao , Fujiwara Mutsunori , Matsuura Masaaki , Ohnishi Hiromitsu , Ito Satoru , Kishimoto Hiroshi , Nambu Ryusuke , Kagimoto Seiichi 
Published: November 2016

ABSTRACTObjectives:Prostaglandin E‐major urinary metabolite (PGE‐MUM) is a useful biomarker for adult ulcerative colitis (UC) activity. In the present study, we evaluated whether PGE‐MUM can also be a biomarker of pediatric UC activity and compared its efficacy in predicting UC activity with that of C‐reactive protein and erythrocyte sedimentation rate.Methods:Twenty‐nine pediatric patients with UC (8–18 years) and 29 healthy age‐ and sex‐matched subjects were enrolled. UC activity was evaluated using the Pediatric Ulcerative Colitis Activity Index, highest Mayo endoscopic scoring (Mayo), and Matts grading (Matts) for histologic scoring, and the sum of Mayo (total of 6 segments) and Matts in all patients with UC. PGE‐MUM levels were measured using a radioimmunoassay.Results:PGE‐MUM levels were elevated in endoscopically and histologically active UC patients, but not in patients with endoscopic and histologic remission or controls. PGE‐MUM levels positively and significantly correlated with UC activity. PGE‐MUM levels were positively correlated with Pediatric Ulcerative Colitis Activity Index (r = 0.594), highest Mayo (r = 0.462), the sum of Mayo (r = 0.694), and the sum of Matts (r = 0.613), but not with highest Matt (r = 0.352). The sum of Mayo and the sum of Matts, which reflect total colon inflammation, showed highest correlation with PGE‐MUM. C‐reactive protein levels did not correlate with any UC activity scores. Erythrocyte sedimentation rate exhibited correlation (r = 0.490) with the sum of Mayo only.Conclusions:PGE‐MUM is a reliable biomarker that reflects both the endoscopic and histologic activity of the entire colon in pediatric UC.
Antitissue Transglutaminase Normalization Postdiagnosis in Children With Celiac Disease
Authors: Isaac Daniela Migliarese , Rajani Seema , Yaskina Maryna , Huynh Hien Q. , Turner Justine M. 
Published: November 2016

ABSTRACTObjectives:Limited pediatric data exist examining the trend and predictors of antitissue transglutaminase (atTG) normalization over time in children with celiac disease (CD). We aimed to evaluate time to normalization of atTG in children after CD diagnosis, and to assess for independent predictors affecting this duration.Methods:A retrospective chart review was completed in pediatric patients with CD diagnosed from 2007 to 2014 at the Stollery Children's Hospital Celiac Clinic (Edmonton, Alberta, Canada). The clinical predictors assessed for impact on time to atTG normalization were initial atTG, Marsh score at diagnosis, gluten‐free diet compliance (GFDC), age at diagnosis, sex, ethnicity, medical comorbidities, and family history of CD. Kaplan‐Meier survival analysis was completed to assess time to atTG normalization, and Cox regression to assess for independent predictors of this time.Results:A total of 487 patients met inclusion criteria. Approximately 80.5% of patients normalized atTG levels. Median normalization time was 407 days for all patients (95% confidence interval [CI: 361–453]), and 364 days for gluten‐free diet compliant patients (95% CI [335–393]). Type 1 diabetes mellitus (T1DM) patients took significantly longer to normalize at 1204 days (95% CI [199–2209], P < 0.001). Cox regression demonstrated T1DM (hazard ratio = 0.36 [0.24–0.55], P < 0.001) and higher baseline atTG (hazard ratio = 0.52 [0.43–0.63], P < 0.001) were significant predictors of longer atTG normalization time. GFDC was a significant predictor of earlier normalization (OR = 13.91 [7.86–24.62], P < 0.001).Conclusions:GFDC and lower atTG at diagnosis are predictors of earlier normalization. Patients with T1DM are less likely to normalize atTG levels, with longer normalization time. Additional research and education for higher‐risk populations are needed.