Predictors of Six-month Change in the Voice Handicap Index in a Treatment-seeking Population.

Objective: To evaluate predictors of longitudinal change in patient-perceived voice impact as determined by the Voice Handicap Index (VHI).

Study Design: Prospective, survey study.

Methods: Patients consented to the University of Wisconsin Voice and Swallow Clinics Outcomes Database with voice, concerns with a baseline clinic visit from November 2012 to January 2014 were eligible for the study.

Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study.

Background: Less than 1% of severely obese US adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization.

Objectives: To understand how primary care physicians (PCPs) make decisions regarding severe obesity treatment and bariatric surgery referral.

A rare case of Niemann-Pick disease type C without neurological involvement in a 66-year-old patient.

Unlabelled: The case of a 66 year-old female - the oldest known living patient with Niemann-Pick disease type C (NP-C) who remains free of any neurological or psychiatric manifestations 18 years after presentation - is presented. An incidental finding of massive splenomegaly was detected during a routine pelvic ultrasound. The pathology report after splenectomy showed the presence of lipid-laden macrophages.

Which Complications Matter Most? Prioritizing Quality Improvement in Emergency General Surgery.

Background: Because preoperative risk factor modification is generally not possible in the emergency setting, complication prevention represents an important focus for quality improvement in emergency general surgery (EGS). The objective of our study was to determine the overall impact that specific postoperative complications have in this patient population.

Study Design: Our study sample consisted of patients from the 2012-2013 ACS-NSQIP database who underwent an EGS procedure.

Optimizing Cancer Care Delivery through Implementation Science.

The 2013 Institute of Medicine report investigating cancer care concluded that the cancer care delivery system is in crisis due to an increased demand for care, increasing complexity of treatment, decreasing work force, and rising costs. Engaging patients and incorporating evidence-based care into routine clinical practice are essential components of a high-quality cancer delivery system. However, a gap currently exists between the identification of beneficial research findings and the application in clinical practice.

Trajectories and Prognosis of Older Patients Who Have Prolonged Mechanical Ventilation After High-Risk Surgery.

Objectives: Surgical patients often receive routine postoperative mechanical ventilation with excellent outcomes. However, older patients who receive prolonged mechanical ventilation may have a significantly different long-term trajectory not fully captured in 30-day postoperative metrics. The objective of this study is to describe patterns of mortality and hospitalization for Medicare beneficiaries 66 years old and older who have major surgery with and without prolonged mechanical ventilation.

Advancing the Development of the Guidelines for the Nursing of Children, Adolescents, and Families: 2014 Revision: Process, Development, and Dissemination.

This article details the process used to develop the revision of the original Guidelines that resulted in the development of the 2014 Health Care Quality and Outcomes Guidelines for Nursing of Children, Adolescents, and Families. Members of the 2014 Guidelines Revision Task Force conducted an extensive process of revision, which included the input and approval of 16 pediatric and child health nursing and affiliated organizational endorsements. The revised Guidelines were presented to and endorsed by the American Academy of Nursing Board.

Temporal Trends in Postmastectomy Radiation Therapy and Breast Reconstruction Associated With Changes in National Comprehensive Cancer Network Guidelines.

Importance: Evolving data on the effectiveness of postmastectomy radiation therapy (PMRT) have led to changes in National Comprehensive Cancer Network (NCCN) recommendations, counseling clinicians to "strongly consider" PMRT for patients with breast cancer with tumors 5 cm or smaller and 1 to 3 positive nodes; however, anticipation of PMRT may lead to delay or omission of reconstruction, which can have cosmetic, quality-of-life, and complication implications for patients.

Objective: To determine whether revised guidelines have increased PMRT and affected receipt of breast reconstruction. We hypothesized that (1) PMRT rates would increase for women affected by the revised guidelines while remaining stable in other cohorts and (2) receipt of breast reconstruction would decrease in these women while increasing in other groups.

Surgeons' Leadership Styles and Team Behavior in the Operating Room.

Background: The importance of leadership is recognized in surgery, but the specific impact of leadership style on team behavior is not well understood. In other industries, leadership is a well-characterized construct. One dominant theory proposes that transactional (task-focused) leaders achieve minimum standards and transformational (team-oriented) leaders inspire performance beyond expectations.

Oncologists' Perspectives of Their Roles and Responsibilities During Multi-disciplinary Breast Cancer Follow-Up.

Background: Improving the quality of follow-up provided to the 3 million U.S. breast cancer survivors is a high priority.

Molecular architecture of the yeast Mediator complex.

The 21-subunit Mediator complex transduces regulatory information from enhancers to promoters, and performs an essential role in the initiation of transcription in all eukaryotes. Structural information on two-thirds of the complex has been limited to coarse subunit mapping onto 2-D images from electron micrographs. We have performed chemical cross-linking and mass spectrometry, and combined the results with information from X-ray crystallography, homology modeling, and cryo-electron microscopy by an integrative modeling approach to determine a 3-D model of the entire Mediator complex.

Architecture of the Human and Yeast General Transcription and DNA Repair Factor TFIIH.

TFIIH is essential for both RNA polymerase II transcription and DNA repair, and mutations in TFIIH can result in human disease. Here, we determine the molecular architecture of human and yeast TFIIH by an integrative approach using chemical crosslinking/mass spectrometry (CXMS) data, biochemical analyses, and previously published electron microscopy maps. We identified four new conserved "topological regions" that function as hubs for TFIIH assembly and more than 35 conserved topological features within TFIIH, illuminating a network of interactions involved in TFIIH assembly and regulation of its activities.

Characterization of Pesticide Exposure in a Sample of Pregnant Women in Ecuador.

Few studies have detailed the prenatal pesticide exposure levels of women employed in or residing near large-scale agricultural industries. This study reports pesticide metabolite levels during and shortly after pregnancy in a pilot study of workers in Ecuador. Urine samples were collected for 16 rose workers and 10 nonagricultural workers enrolled into the study in early pregnancy.

Effect of Chronic Blood Transfusion on Biomarkers of Coagulation Activation and Thrombin Generation in Sickle Cell Patients at Risk for Stroke.

Hypercoagulability in sickle cell disease (SCD) is associated with multiple SCD phenotypes, association with stroke risk has not been well described. We hypothesized that serum levels of biomarkers of coagulation activation correlate with high transcranial Doppler ultrasound velocity and decreases with blood transfusion therapy in SCD patients. Stored serum samples from subjects in the Stroke Prevention in Sickle Cell Anemia (STOP) trial were analyzed using ELISA and protein multiplexing techniques.

Using Human Factors and Systems Engineering to Evaluate Readmission after Complex Surgery.

Background: Our objective was to use a human factors and systems engineering approach to understand contributors to surgical readmissions from a patient and provider perspective. Previous studies on readmission have neglected the patient perspective. To address this gap and to better inform intervention design, we evaluated how transitions of care relate to and influence readmission from the patient and clinician perspective using the Systems Engineering Initiative for Patient Safety (SEIPS) model.

Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients: The American Society of Breast Surgeons Consensus Conference.

Background: Multiple recent reports have documented significant variability of reoperation rates after initial lumpectomy for breast cancer. To address this issue, a multidisciplinary consensus conference was convened during the American Society of Breast Surgeons 2015 annual meeting.

Methods: The conference mission statement was to "reduce the national reoperation rate in patients undergoing breast conserving surgery for cancer, without increasing mastectomy rates or adversely affecting cosmetic outcome, thereby improving value of care.

The use of error analysis to assess resident performance.

Background: The aim of this study was to assess validity of a human factors error assessment method for evaluating resident performance during a simulated operative procedure.

Methods: Seven postgraduate year 4-5 residents had 30 minutes to complete a simulated laparoscopic ventral hernia (LVH) repair on day 1 of a national, advanced laparoscopic course. Faculty provided immediate feedback on operative errors and residents participated in a final product analysis of their repairs.

Serum lipids, lipoproteins, and risk of breast cancer: a nested case-control study using multiple time points.

Background: There is strong evidence that breast cancer risk is influenced by environmental factors. Blood lipid and lipoprotein levels are also influenced by environmental factors and are associated with some breast cancer risk factors. We examined whether serial measures of serum lipids and lipoproteins were associated with breast cancer risk.

Development of a list of high-risk operations for patients 65 years and older.

Importance: No consensus exists regarding the definition of high-risk surgery in older adults. An inclusive and precise definition of high-risk surgery may be useful for surgeons, patients, researchers, and hospitals.

Objective: To develop a list of high-risk operations.

Leveraging comparative effectiveness research to improve the quality of multidisciplinary care for breast cancer patients.

Breast cancer is the most commonly diagnosed cancer among women. To date, the use of efficacy randomized controlled trials (RCTs) in breast cancer have resulted in dramatic improvements in oncologic outcomes for this disease. However, not every question pertinent to breast cancer is amenable to such efficacy trials.

Ring closure activates yeast γTuRC for species-specific microtubule nucleation.

The γ-tubulin ring complex (γTuRC) is the primary microtubule nucleator in cells. γTuRC is assembled from repeating γ-tubulin small complex (γTuSC) subunits and is thought to function as a template by presenting a γ-tubulin ring that mimics microtubule geometry. However, a previous yeast γTuRC structure showed γTuSC in an open conformation that prevents matching to microtubule symmetry.

Use of decision-based simulations to assess resident readiness for operative independence.

Background: Recent literature has called into question resident readiness for operative independence at the end of general surgery training.

Methods: We used a simulation-based exit examination to assess resident readiness. Six chief residents performed 3 simulated procedures: bowel anastomosis, laparoscopic ventral hernia (LVH) repair, and pancreaticojejunostomy.