bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterizing the Clamor: An In-Depth Analysis of Inpatient Paging Communication
Authors: Kummerow Broman Kristy , Kensinger Clark , Phillips Charles , Fesseha Betiel , Fill Mary-Margaret , Borges Nyal , Mathisen Jason , Allen Duncan , Land Ed , Patel Neal 
Published: February 2016

Purpose
Communication failures contribute to adverse clinical events and health care inefficiencies. Paged messaging remains a predominant communication mechanism at many academic medical centers. An interprofessional, institutionally sponsored initiative to improve inpatient care team communication sought to understand the content and quantity of paged messages.

Method
A retrospective analysis at Vanderbilt University Medical Center was performed for messages delivered to the 15 highest-volume pagers carried by inpatient medical, surgical, and pediatric residents over two monthlong periods of data collection between November 2013 and February 2014. An interprofessional team defined message content categories a priori. Descriptive statistics were used to demonstrate message volume and distribution by content category. Team members and stakeholder groups discussed common message themes during and after categorization to identify targets for improving care efficiency.

Results
During the data collection period, 10,928 messages were paged (median 38 messages per pager per shift). The most common primary content categories were bedside nursing (2,570; 30%) and medication (2,285; 26%). Common bedside nursing communications included notification of vital signs (915; 36%), patient activity (481; 19%), and diet (444; 18%). Most medication messages were requests to start (1,253; 55%) or change (694; 30%) a common medication. The team recommended implementing anticipatory orders for common medications and routine nursing staff needs using computerized order algorithms to reduce the volume of noncritical messages.

Conclusions
An interprofessional assessment of the content and volume of paged communication identified high volumes of noncritical messages that could be eliminated through better anticipation of patient care needs.
Unprofessional Behaviors Among Tomorrow’s Physicians: Review of the Literature With a Focus on Risk Factors, Temporal Trends, and Future Directions
Authors: Fargen Kyle M. , Drolet Brian C. , Philibert Ingrid 
Published: February 2016

Purpose
Recent reports have identified concerning patterns of unprofessional and dishonest behavior by physician trainees. Despite this publicity, the prevalence and impact of these behaviors is not well described; thus, the authors aimed to review and analyze the various studies on unprofessional behavior among U.S. medical trainees.

Method
The authors performed a literature review. They sought all reports on unprofessional and dishonest behavior among U.S. medical school students or resident physicians published in English and indexed in PubMed between January 1980 and May 2014.

Results
A total of 51 publications met criteria for inclusion in the study. The data in these reports suggest that plagiarism, cheating on examinations, and listing fraudulent publications on residency/fellowship applications were reported in 5% to 15% of the student and resident populations that were studied. Other behaviors, such as inaccurately reporting that a medical examination was performed on a patient or falsifying duty hours, appear to be even more common (reportedly occurring among 40% to 50% of students and residents).

Conclusions
“Unprofessional behavior” lacks a unified definition. The data on the prevalence of unprofessional behavior in medical students and residents are limited. Unprofessional behaviors are common and appear to be occurring in various demographic groups within the medical trainee population. The relationship between unprofessional behaviors in training and future disciplinary action is poorly understood. Going forward, defining “unprofessional behavior”; developing validated instruments to evaluate such behaviors scientifically; and studying their incidence, motivations, and consequences are critical.
Combined Coronary Revascularization: Single-Center 10-Year Experience
Authors: Aymami Marie , Ruggieri Vito Giovanni , Rouzé Simon , Flécher Erwan , Guihaire Julien , Anselmi Amedeo , Harmouche Majid , Langanay Thierry , Boulmier Dominique , Roisne Antoine , Leguerrier Alain , Verhoye Jean-Philippe , Corbineau Hervé 
Published: February 2016

Objective This study aimed to assess the long-term outcome of combined coronary revascularization. Methods Between January 2000 and September 2010, 106 consecutive patients underwent combined coronary revascularization, either the same day or staged within 90 days. Percutaneous coronary intervention was always performed before coronary artery bypass grafting. We identified three groups as follows: one-stop combined coronary revascularization (n = 20), percutaneous coronary intervention for acute coronary syndrome before subsequent surgery (n = 39), and percutaneous coronary intervention for stable coronary artery disease before subsequent surgery (n = 47). Off-pump technique was used in all cases. Results A total of 107 angioplasties were realized (drug-eluting stents, 21; bare metal stents, 114; balloon angioplasty, 4). Percutaneous coronary intervention was mostly performed in the right coronary artery or branches (85%). The mean (SD) number of grafts was 1.9 (0.6), among them 1.8 (0.7) with arterial grafts. A total of 87.7% of the patients underwent exclusive arterial revascularization. There was one reexploration for bleeding and no in-hospital death. Eleven patients died in the follow-up. Repeat percutaneous coronary intervention was necessary for six patients and repeat surgery for one patient. The mean (SD) follow-up was 6.1 (2.7) years. Complete follow-up was obtained in 96.2% of the patients. Freedom from ischemic events (all-cause deaths, angina, acute coronary syndrome, myocardial infarction) was 86.3% (3.7%) at 5 years and 79.7% (5.2%) at 8 years (no difference between groups). Freedom from major adverse cardiac or cerebrovascular events was 88.8% (3.4%) at 5 years and 75.7% (5.2%) at 8 years (no difference between groups). Conclusions Combined coronary revascularization increases the use of arterial grafts, with good long-term outcome.
The Revised Direct Transconjunctival Approach to the Orbital Floor
Authors: Bernardini Francesco P. , Nerad Jeffrey , Fay Aaron , Zambelli Alessandra , Cruz Antonio Augusto V. 
Published: February 2016

Purpose:To review common surgical approaches to the orbital floor and to evaluate the utility of canthal-sparing, single incision transconjunctival method.Methods:A retrospective chart review of a consecutive series of patients who underwent transconjunctival, direct incision surgery without eyelid dissection or lateral canthotomy and inferior cantholysis and review of the literature were conducted.Results:Twenty-three consecutive patients (33 orbits) were operated using a canthal-sparing direct single cut approach, including 10 unilateral pediatric orbital floor fractures, 1 orbital floor implant removal, 2 unilateral post-traumatic enophthalmos repairs, and 10 bilateral orbital floor decompressions. Surgical exposure was adequate to complete the surgical objective in each patient. Mean follow up was 13 months and no complications were observed.Conclusions:The transconjunctival approach to the orbital floor can be performed using a pre- or post-septal dissection, with infratarsal or fornix incision commonly associated with lateral canthotomy and inferior cantholysis. The direct approach spares the lateral canthus, minimizes lower eyelid dissection, and provides rapid and effective access to the inferior orbital rim and orbital floor. It offers sufficient exposure to allow insertion of large floor implants even in children. Although apparently abandoned in the recent literature, canthal-sparing technique is a useful method for the management of orbital floor fractures, enophthalmos correction, implant removal, and orbital decompression.
Experience of Circuit Survival in Extracorporeal Continuous Renal Replacement Therapy Using Small-Calibre Venous Cannulae
Authors: Westrope Claire , Morris Kevin Paul , Kee Chor Yek , Farley Margaret , Fleming Sarah , Morrison Gavin 
Published: February 2016

Objectives:
To describe an experience of circuit survival in extracorporeal continuous renal replacement therapy using small-calibre (< 7 French gauge [F]) venous cannulae.

Design:
An observational study.

Setting:
A multidisciplinary, university-affiliated PICU.

Subjects:
Case note review of all continuous renal replacement therapy episodes (1998–2010), which used vascular access cannulae of an external diameter less than 7F, was performed.

Measurements and Main Results:
Forty-nine patients underwent continuous renal replacement therapy treatment during which circuit blood flow was delivered using either 5F or 6.5F double-lumen cannulae. One hundred thirty-nine circuits were employed (median per patient, 2; interquartile range, 1–3) in providing 4,903 hours of therapy (median duration of therapy, 43 hr; interquartile range, 22–86 hr); allowing for censoring, the median circuit survival time was 40 hours (95% CI, 28–66). Eighty-one circuits (58%) failed because of clotting/technical problems, equating to a circuit failure rate of 16.5 (95% CI, 13.3–20.5) per 1,000 hours of continuous renal replacement therapy. The probability of a circuit surviving 40 hours or greater was 50% with 43% (95% CI, 34–53%) expected to survive 60 hours or more. No significant relationship between circuit survival and the calibre of the cannula deployed was identified; however, placement of venous access in an internal jugular vein was associated with improved circuit survival.

Conclusions:
Contrary to previous reports, vascular access cannulae of a caliber less than 7F can support sufficiently prolonged continuous renal replacement therapy to make them a useful means of delivering renal support in neonates and small infants.
A Strategy for Addressing Population Health Management
Authors: Kapp Julie M. , Oliver Debra Parker , Simoes Eduardo J. 
Published: February 2016

Context:
Population health management in the era of the Affordable Care Act focuses on identifying needs of health care service areas for targeted strategies. The United States has a “health disadvantage” compared with peer countries, particularly regarding obesity and women's life expectancy, while having high rates of mammography screening. Emphasizing lifestyle factors is a strategy to reduce one's risk of obesity and heart disease, as well as some breast cancers.

Objective:
We explored perceptions of the risk of female population-based breast cancer mortality compared with heart disease mortality; perceived likelihood of developing breast cancer; and recognition of the association between modifiable lifestyle factors and breast cancer risk.

Design:
Cross-sectional online survey.

Setting:
Service area of one mid-Missouri health care system.

Participants:
Female US residents ages 35 to 49 years who did not have a personal history of any cancer.

Results:
Minority women and women with a college education or less had greater odds of reporting that breast cancer, rather than heart disease, would cause more deaths in women this year. Women who had ever had a mammogram had greater odds of reporting a moderate/high compared with low likelihood of developing breast cancer. Women with less than a college education had greater odds of not knowing of any lifestyle behaviors or reporting only clinical behaviors related to reducing one's risk of breast cancer.

Conclusions:
The present study illuminates areas of lagging information dissemination that may be used for targeted strategies for population health management in the era of the Affordable Care Act, that of bridging healthy lifestyle strategies for heart health with messages for breast health.
Strategic Methodologies in Public Health Cost Analyses
Authors: Whittington Melanie , Atherly Adam , VanRaemdonck Lisa , Lampe Sarah 
Published: February 2016

Context:
The National Research Agenda for Public Health Services and Systems Research states the need for research to determine the cost of delivering public health services in order to assist the public health system in communicating financial needs to decision makers, partners, and health reform leaders.

Objective:
The objective of this analysis is to compare 2 cost estimation methodologies, public health manager estimates of employee time spent and activity logs completed by public health workers, to understand to what degree manager surveys could be used in lieu of more time-consuming and burdensome activity logs.

Design:
Employees recorded their time spent on communicable disease surveillance for a 2-week period using an activity log. Managers then estimated time spent by each employee on a manager survey. Robust and ordinary least squares regression was used to measure the agreement between the time estimated by the manager and the time recorded by the employee.

Main Outcome Measures:
The 2 outcomes for this study included time recorded by the employee on the activity log and time estimated by the manager on the manager survey.

Setting:
This study was conducted in local health departments in Colorado.

Participants:
Forty-one Colorado local health departments (82%) agreed to participate.

Results:
Seven of the 8 models showed that managers underestimate their employees' time, especially for activities on which an employee spent little time. Manager surveys can best estimate time for time-intensive activities, such as total time spent on a core service or broad public health activity, and yet are less precise when estimating discrete activities.

Conclusions:
When Public Health Services and Systems Research researchers and health departments are conducting studies to determine the cost of public health services, there are many situations in which managers can closely approximate the time required and produce a relatively precise approximation of cost without as much time investment by practitioners.
Barriers to and Correlates of Retention in Behavioral Health Treatment Among Latinos in 2 Different Host Countries: The United States and Spain
Authors: Falgas Irene , Ramos Zorangeli , Herrera Lizbeth , Qureshi Adil , Chavez Ligia , Bonal Covadonga , McPeck Samantha , Wang Ye , Cook Benjamin , Alegría Margarita 
Published: February 2016

Context:
Latino immigrants constitute a large portion of the Spanish and US immigrant populations, yet a dearth of research exists regarding barriers to retention in behavioral health care.

Objectives:
To identify and compare perceived barriers related to behavioral health care among first- and second-generation Latinos in Boston, Madrid, and Barcelona, and evaluate whether the frequency of behavioral health care use in the last year was related to these barriers.

Design, Setting, and Participants:
Data were obtained from the International Latino Research Partnership project. First- or second-generation self-identified Latino immigrants aged 18 years and more who resided more than 1 year in the host country were recruited from community agencies and primary care, mental health, substance abuse, and HIV clinics.

Main Outcome Measures:
Eleven barriers were assessed and compared across sites. The relationship between barriers and behavioral services visits within the last year was evaluated, adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors.

Results:
Wanting to handle the problem on one's own, thinking that treatment would not work, and being unsure of where to go or who to see were the most frequently reported barriers for Latino immigrants. Previous treatment failure, difficulties in transportation or scheduling, and linguistic barriers were more likely to be reported in Boston; trying to deal with mental health problems on one's own was more commonly reported in Barcelona and Madrid. Two barriers associated with the number of visits were concerns about the cost of services and uncertainty about where to go or who to see.

Conclusions:
After adjusting for sociodemographics, clinical measures, degree of health literacy, cultural, and social factors, barriers still differed significantly across sites. Efforts to improve behavioral health services must be tailored to immigrants' context, with attention to changing attitudes of self-reliance and outreach to improve access to and retention in care.
Profile of Public Health Leadership
Authors: Little Ruth Gaskins , Greer Annette , Clay Maria , McFadden Cheryl 
Published: February 2016

Context:
Public health leaders play pivotal roles in ensuring the population health for our nation. Since 2000, the number of schools of public health has almost doubled. The scholarly credentials for leaders of public health in academic and practice are important, as they make decisions that shape the future public health workforce and important public health policies.

Objective:
This research brief describes the educational degrees of deans of schools of public health and state health directors, as well as their demographic profiles, providing important information for future public health leadership planning.

Design:
Data were extracted from a database containing information obtained from multiple Web sites including academic institution Web sites and state government Web sites. Variables describe 2 sets of public health leaders: academic deans of schools of public health and state health directors.

Results:
Deans of schools of public health were 73% males and 27% females; the PhD degree was held by 40% deans, and the MD degree by 33% deans. Seventy percent of deans obtained their terminal degree more than 35 years ago. State health directors were 60% males and 40% females. Sixty percent of state health directors had an MD degree, 4% a PhD degree, and 26% no terminal degree at all. Sixty-four percent of state health directors received their terminal degree more than 25 years ago. In addition to terminal degrees, 56% of deans and 40% of state health directors held MPH degrees.

Conclusion:
The findings call into question competencies needed by future public health professionals and leadership and the need to clarify further the level of public health training and degree type that should be required for leadership qualifications in public health.
The Importance of Partnerships in Local Health Department Practice Among Communities With Exceptional Maternal and Child Health Outcomes
Authors: Klaiman Tamar , Chainani Anjali , Bekemeier Betty 
Published: February 2016

Objectives:
The purpose of this study was to identify unique practices underway in communities that have been empirically identified as having achieved exceptional maternal and child health (MCH) outcomes compared with their peers.

Methods:
We used a qualitative, positive deviance approach to identify practices implemented by local health department (LHD) jurisdictions in Florida, Washington, and New York that achieved better MCH outcomes than expected compared with their in-state peer jurisdictions. We identified a total of 50 LHDs in jurisdictions that had better than expected MCH outcomes compared with their peers, and we conducted 39 hour-long semistructured interviews with LHD staff. We conducted inductive thematic analysis to identify key themes and subthemes across all LHD cases in the sample.

Results:
Partnerships with providers, partnerships for data collection/assessment, and partnerships with community-based organizations were associated with exceptional MCH outcomes based on our interviews.

Discussion:
This study offers specific examples of practices LHDs can implement to improve MCH outcomes, even with limited resources, based on the practices of high-performing local health jurisdictions.
Eco-evolutionary buffering: rapid evolution facilitates regional species coexistence despite local priority effects
Authors: Wittmann Meike J. , Fukami Tadashi 
Published: February 2016

AbstractInhibitory priority effects, in which early-arriving species exclude competing species from local communities, are thought to enhance regional species diversity via community divergence. Theory suggests, however, that these same priority effects make it difficult for species to coexist in the region unless individuals are continuously supplied from an external species pool, often an unrealistic assumption. Here we develop an eco-evolutionary hypothesis to solve this conundrum. We build a metacommunity model in which local priority effects occur between two species via interspecific interference. Within each species there are two genotypes: one is more resistant to interspecific interference than the other, but pays a fitness cost for its resistance. Because of this trade-off, species evolve to become less resistant as they become regionally more common. Rare species can then invade some local patches and consequently recover in regional frequency. This “eco-evolutionary buffering” enables the regional coexistence of species despite local priority effects, even in the absence of immigration from an external species pool. Our model predicts that eco-evolutionary buffering is particularly effective when local communities are small and connected by infrequent dispersal.
Multiscale simulations reveal key features of the proton pumping mechanism in cytochromecoxidase
Authors: Liang Ruibin , Swanson Jessica M. J. , Peng Yuxing , Wikström Mårten , Voth Gregory A. 
Published: February 2016

AbstractCytochromecoxidase (CcO) reduces oxygen to water and uses the released free energy to pump protons across the membrane, contributing to the transmembrane proton electrochemical gradient that drives ATP synthesis. We have used multiscale reactive molecular dynamics simulations to explicitly characterize (with free energy profiles and calculated rates) the internal proton transport events that enable pumping and chemistry during the A→PR→F transition in theaa3-type CcO. Our results show that proton transport from amino acid residue E286 to both the pump loading site (PLS) and to the binuclear center (BNC) are thermodynamically driven by electron transfer from hemeato the BNC, but that the former (i.e., pumping) is kinetically favored while the latter (i.e., transfer of the chemical proton) is rate-limiting. The calculated rates are in quantitative agreement with experimental measurements. The back flow of the pumped proton from the PLS to E286 and from E286 to the inner side of membrane are prevented by the fast reprotonation of E286 through the D-channel and large free energy barriers for the back flow reactions. Proton transport from E286 to the PLS through the hydrophobic cavity (HC) and from D132 to E286 through the D-channel are found to be strongly coupled to dynamical hydration changes in the corresponding pathways. This work presents a comprehensive description of the key steps in the proton pumping mechanism in CcO.SignificanceThe long studied proton pumping mechanism in cytochromecoxidase (CcO) continues to be a source of debate. This work provides a comprehensive computational characterization of the internal proton transport dynamics, while explicitly including the role of Grotthuss proton shuttling, that lead to both pumping and catalysis. Focusing on the A to F transition, our results show that the transfer of both the pumped and chemical protons are thermodynamically driven by electron transfer, and explain how proton back leakage is avoided by kinetic gating. This work also explicitly characterizes the coupling of proton transport with hydration changes in the hydrophobic cavity and D-channel, thus advancing our understanding of proton transport in biomolecules in general.