bluuebunny/crossref_metadata_2025 huggingface dataset:
Globalization and Education
Authors: Jackson Liz
Published: October 2016

Few would deny that processes of globalization have impacted education around the world in many important ways. Yet the term “globalization” is relatively new, and its meaning or nature, conceptualization, and impact remain essentially contested within the educational research community. There is no global consensus on the exact time period of its occurrence or its most significant shaping processes, from those who focus on its social and cultural framings to those that hold global political-economic systems or transnational social actors as most influential. Intersecting questions also arise regarding whether its influence on human communities and the world should be conceived of as mostly good or mostly bad, which have significant implications for debates regarding the relationship between globalization and education. Competing understandings of globalization also undergird diverse methodologies and perspectives in expanding fields of research into the relationship between education and globalization.

There are many ways to frame the relationship of globalization and education. Scholars often pursue the topic by examining globalization’s perceived impact on education, as in many cases global convergence around educational policies, practices, and values has been observed in the early 21st century. Yet educational borrowing and transferal remains unstraightforward in practice, as educational and cultural differences across social contexts remain, while ultimate ends of education (such as math competencies versus moral cultivation) are essentially contested. Clearly, specificity is important to understand globalization in relation to education. As with globalization generally, globalization in education cannot be merely described as harmful or beneficial, but depends on one’s position, perspective, values, and priorities.

Education and educators’ impacts on globalization also remain a worthwhile focus of exploration in research and theorization. Educators do not merely react to globalization and related processes, but purposefully interact with them, as they prepare their students to respond to challenges and opportunities posed by processes associated with globalization. As cultural and political-economic considerations remain crucial in understanding globalization and education, positionality and research ethics and reflexivity remain important research concerns, to understand globalization not just as homogeneity or oppressive top-down features, but as complex and dynamic local and global intersections of people, ideas, and goods, with unclear impacts in the future.
Intellectual Trends in Imperial China
Authors: Ong Chang Woei
Published: October 2016

In a letter to his friend Wang Hui王回 (1023–1065), the great Song dynasty (960–1279) politician, scholar, thinker, and writer Wang Anshi王安石 (1021–1086) makes a distinction between the golden age of the ancients and the less-than-desirable world of the present. More importantly, it claims that the golden era was marked by a commitment to unity. Not only were morality and customs of the world made the same, but the learned were united in their learnings and opinions. The periods after the golden age, on the other hand, were marked by diversity and confusion arising from how the truth is understood. Wang believed that he had found the truth about unity and how it could be achieved from reading the Classics. His ambitious political reform (called New Policies) was a grand program that sought to bring the ideal of unity to the world through government.

Wang Anshi was of course not the only major thinker in Chinese history to ponder the question of unity. In fact, a dominant and enduring theme in the history of Chinese thought is the search for unity. Faced with uncertainties arising from a diverse and complex world, thinkers in different periods and with different intellectual orientations saw it as their main mission to discover the true nature of unity and ways of realizing it for attaining a harmonious world. The process began when Confucius (551–479 bce) was confronted with the chaotic reality following the gradual collapse of the Zhou dynasty (1046–256 bce) and its institutions and cultures. It ended with the fall of the Qing dynasty (1644–1911), the last imperial regime, when new ideas of nation-state began to drastically transform the Chinese worldviews. During the two millennia in between, the search for unity spanned distinctive intellectual trends often labeled as Confucian, Daoist, or Buddhist. But such loose and often retrospective labeling cannot do justice to the complexity of history. It is therefore important to go beyond the labels and examine the common assumptions about unity among the major thinkers during a given period and how that changed over time. In doing so, we will be able to trace the emergence, development, and sometimes decline of distinctive intellectual trends before the 20th century.
Asian Indentured Labor in the 19th and Early 20th Century Colonial Plantation World
Authors: Allen Richard B.
Published: October 2016

The period between the mid-1830s and early 1920s witnessed the migration of some 3.7 million Africans, Chinese, Indians, Japanese, Melanesians, and other peoples throughout and beyond the colonial plantation world to work as laborers under long-term written and short-term oral contacts. Studies of this global labor migration over the last forty years have been heavily influenced by Hugh Tinker’s 1974 argument that the indentured labor system was essentially “a new system of slavery.” There has also been a propensity toward specialized and compartmentalized studies of the indentured experience in various parts of Africa, the Caribbean, the southwestern Indian Ocean, India, Southeast Asia, and Australasia, with a particular emphasis on systems of labor control and worker resistance. Recent scholarship reveals that this labor system began two decades earlier than previously believed, and illustrates the need to explore new topics and issues in more fully developed local, regional, and global contexts.
Historical Geography of the Pamirs
Authors: Kreutzmann Hermann
Published: October 2016

The Pamirs have been a contested space in different periods of time. Access to fertile pastures characterized the local economic competition between nomads and mountain farmers. International attention reached its peak when the Pamirs became a pawn in the “Great Game”; during the second half of the 19th century, Great Britain and Russia disputed control over the mountainous area. Local and regional interests took on a subordinate role. The imperial contest resulted in dividing the Pamirs among four interested parties that are nowadays independent countries: Afghanistan, Pakistan, Tajikistan, and China. Since the division, separate developments have emerged in all parts that are abodes of farmers and pastoralists who share a common heritage but have experienced quite different political and social developments. Thus the Pamirs represent a focal region of similar ecological properties in which political and socioeconomic developments that originated in the 19th century have changed development paths through the Cold War period until the early 21st century. From Tsarist Russia to post-independence Tajikistan, from the Afghan monarchy to the post-Taliban republic, from British India to Pakistan, and from the Middle Kingdom to contemporary China, political interventions such as nationality policies and regional autonomy, sociotechnical experiments such as collectivization and subsequent deregulation, and varying administrative systems provide insight into external domination that has shaped separate developments in the Pamirs. In the early 21st century, the Pamirs experienced a revaluation as a transit corridor for transcontinental traffic arteries.
Precolonial History of South Sudan
Authors: Beswick Stephanie
Published: October 2016

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of African History. Please check back later for the full article.

Histories of South Sudan are rare. Indeed a pre-colonial history of what is actually, geographically, the world’s largest swamp (South Sudan) is challenging and at present impossible without the use of oral histories, along with a very few archaeological and linguistic studies. Only two scholarly accounts lend information about the obscure history of this region of Africa. Oral histories suggest that the very earliest inhabitants of South Sudan were a mound-building folk known to the Dinka as the Luel, and to archaeologists as the Turkwel. Sometime after the later Middle Ages and the fall of the 11th-century Christian kingdom of Alwa, the Western Nilotic Dinka claim to have migrated with their cattle into South Sudan from the Gezira because of fear of slave raiders. The Dinka claim to have found Bari, on the East Bank of the Nile, a historical point that is corroborated by Bari oral histories. Some decades later, the Dinka crossed the Nile following the rich soils that were most favorable to their favorite agricultural food, kec. Over time they penetrated deeply into the western swamps of Southern Sudan. Sometime around the 15th century, another Nilotic people, now known as the Shilluk, thrust northwards beyond the depths of the South Sudanese swamps, settling approximately at the junction of the Nile and the Sobat rivers. Oral histories claim the Shilluk were led to this homeland by a great leader, Nyikang, the first in a long line of kings. The last great ethnic groups to migrate into what is now the boundary of modern South Sudan were the non-Nilotic Azande.

Of interest is that all of these ethnic groups were slave-holding cultures and, with the exception of the Azande, were agro-pastoralists. The Bari were prominent iron-making specialists, as were the highly martial Azande. All of these cultures had social hierarchies, and migration is a connecting theme among the larger societies; none of the present cultures of South Sudan appear to have originated in South Sudan except the Nilotic Luo. By the late 17th century, with the fall of Sultan Sanusi of the Central African Republic, numbers of non-Nilotic peoples fled into various western regions of South Sudan. Additionally, with the fall of the Islamic sultanate of Sinnar and the coming of the Turco-Egyptians in the early 19th century, much of South Sudan had been historically peopled by the Nilotic Luo, whose progeny appeared to have evolved into numerous ethnic groups of South Sudan; groups that would now include the Shilluk-Luo, the Nuer, the Atuot, Anyuak, and various Luo communities that now exist under various names.
Latinos and the Law
Authors: Brownell Tirres Allison
Published: October 2016

Latino Americans have intersected with the law in complicated ways throughout American history. Latinos themselves are a diverse and heterogeneous racial, ethnic, and cultural group, with members hailing from all parts of the Spanish-speaking world and representing all variations on the spectrum of race. Each group has a unique origin story, but all have been shaped by law and legal process. Legal historians and legal scholars explore the role of law in incorporating Latino groups in American society, the effects of law on Latino communities, and the struggles of Latino lawyers, activists, and ordinary people against legal discrimination and for equality. The civil rights story of Latinos bears strong resemblance to that of African Americans: In each case, members have been subjected to de jure and de facto discrimination and social subordination. But the Latino civil rights story has unique valences, particularly in the areas of language discrimination and immigration law and policy. Latino legal history demonstrates the complex ways that Latinos interact with the color line in American law and politics.
Financing Community Resilience Before Disaster Strikes: Lessons From the United States
Authors: Kirschner Charlotte L. , Singla Akheil , Flick Angie
Published: October 2016

As more and more of the population moves to areas prone to natural hazards, the costs of disasters are on the rise. Given that these events are an eventuality, governments must aid their communities in promoting disaster resilience, enabling their communities to reduce their susceptibility to natural hazards, and adapting to and recovering from disasters when they occur.

The federal system in the United States divides these responsibilities among national, state, and local governments. Local and state governments are largely responsible for the direct provision of services to their communities, and the Stafford Act of 1988 provides that the federal government will pay at least 75% of all eligible expenses once a presidential major disaster declaration has been made. As a result, state and local governments have become largely reliant on transfers from the federal government to pay for disaster relief and recovery efforts. This system encourages state and local governments to ignore the risks they face and turn to the federal government for aid after a disaster.

This system also seems to underemphasize an important mechanism that can bolster disaster resilience: financing the costs of disasters in advance through ex ante budgeting. Four tools for budgeting ex ante—intergovernmental grants, disaster stabilization funds, the municipal bond market, and hazard insurance—are described and examples of their use provided. Despite limited use by state governments, these tools provide governments the opportunity to build community resilience to disasters by budgeting ex ante for them.
Natural Hazards Governance in Australia
Authors: Minnery John , Childs Iraphne
Published: October 2016

Natural hazards governance varies across Australia for two critical reasons: first, the country’s large size and latitudinal range; and second, its divided federal government structure. The first feature—the magnitude and latitudinal spread—results in a number of climatic zones, from the tropical north, through the sub-tropics, to temperate southern zones and the arid central deserts. Consequently, state and local government jurisdictions must respond to different natural hazard types and variable seasonality. In addition, the El Niño-La Niña southern oscillation cycle has a strong impact. Flooding can occur throughout the continent and is the most frequent natural hazard and most extensive in scope, although extreme heat events cause the greatest number of fatalities. In summer, cyclones frequently occur in northern Australia and severe bushfires in the southeast and southwest. Hence, governance structures and disaster response mechanisms across Australia, while sharing many similarities, of necessity vary according to hazard type in different geographical locations. Climatological hazards dominate the range and occurrence of hazard events in Australia: floods, cyclones, storms, storm surge, drought, extreme heat events, and bushfire (but local landslips and earthquakes also occur).

The second major reason for variation is that Australia has three formal levels of government (national, State, and local) with each having their own responsibilities and resources. The national government has constitutional powers only over matters of national importance or those which cross State boundaries. In terms of hazards governance, it can advise and support the states but is intimately involved only with major hazards. The six States have the principal constitutional responsibility for hazards planning, usually with a responsible State minister, and each can have a different approach. The strong vertical fiscal imbalance among the levels of government does give the national government powerful financial leverage. Local governments are the front-line hazards planning and management authorities, but because they represent local communities their approaches and capacities vary enormously. There are a number of ways in which the resultant potential for fragmentation is addressed. Regional groupings of local governments (usually assisted by the relevant state government) can work together. State governments collaborate through joint Ministerial meetings and policies. The intergovernmental Council of Australian Governments has produced a National Strategy for Disaster Resilience, which guides each state’s approach. Under these circumstances a clear national hierarchical chain of command is not possible, but serious efforts have been made to work collaboratively.
Risks and Food Safety in a Global Economy
Authors: Assmann Stephanie
Published: October 2016

This is an advance summary of a forthcoming article in the Oxford Research Encyclopedia of Environmental Science. Please check back later for the full article.

In recent years, a number of food safety incidents in Europe and East Asia have led to concerns about threats to the environment and human health. In this context, the significance of a re-evaluation of risks with regards to food safety is essential, which includes re-visiting Western risk theories advanced by Ulrich Beck and Anthony Giddens. The dimensions of risks and food safety are four-fold.

First, major incidents, such as the disaster at the Fukushima nuclear plant in Japan in 2011 and the melamine crisis in China in 2008, have impacted the perception of food safety among consumers. These incidents led to fears of an increase of food safety incidents and to a collapse of trust in established brand products and technologies in post-industrial societies. It is necessary, therefore, to re-assess the risks of utilizing future-oriented technologies and mass food production systems.

Second, the use of genetically modified organisms in food products and the consumption of food additives have produced new food-related risks. This underlines the significance of risk assessment, in particular, as “reflexive modernization” requires individuals to familiarize themselves with new and possibly harmful food technologies and to assess, manage, and avoid risks on their own responsibility and on a highly personalized basis.

Third, various food-related incidents, such as the case of imported poisoned dumplings in Japan in 2008, have triggered the emergence of civil engagement in the form of consumer education initiatives. Both governmental and non-governmental initiatives stress the significance of locality, providence, and food heritage preservation as a way to ensure and maintain food safety and balanced nutritional habits. In other words, the notion of locality is linked to the desire to minimize the risk.

Fourth, poor individual eating habits, as self-imposed risks, have attracted scholarly attention. Food education initiatives in European and Asian nations seek to strengthen the culinary competence of individuals and embrace national staple foods and local food specialties at the same time. Efforts to provide adequate information about nutrition and to counter the rise of health conditions such as obesity and diabetes often coincide with a return to conservative gender perceptions and family values. This calls for new forms of culinary education that take the demands of working parents, individualized work schedules, and dining outside the home into consideration.
Dairy, Science, Society, and the Environment
Authors: Lu Christopher
Published: October 2016

Dairy has intertwined with human society since the beginning of civilization. It evolves from art in ancient society to science in the modern world. Its roles in nutrition and health are underscored by the continuous increase in global consumption. Milk production increased by almost 50% in just the past quarter century alone. Population growth, income rise, nutritional awareness, and science and technology advancement contributed to a continuous trend of increased milk production and consumption globally. With a fourfold increase in milk production per cow since the 1940s, the contemporary dairy industry produces more milk with fewer cows, and consumes less feed and water per liter of milk produced. The dairy sector is diversified, as people from a wider geographical distribution are consuming milk, from cattle to species such as buffalo, goat, sheep, and camel. The dairy industry continues to experience structural changes that impact society, economy, and environment. Organic dairy emerged in the 1990s as consumers increasingly began viewing it as an appropriate way of both farming and rural living. Animal welfare, environmental preservation, product safety, and health benefit are important considerations in consuming and producing organic dairy products. Large dairy operations have encountered many environmental issues related to elevated greenhouse gas emissions. Dairy cattle are second only to beef cattle as the largest livestock contributors in methane emission. Disparity in greenhouse gas emissions per dairy animal among geographical regions can be attributed to production efficiency. Although a number of scientific advancements have implications in the inhibition of methanogenesis, improvements in production efficiency through feeding, nutrition, genetic selection, and management remain promising for the mitigation of greenhouse gas emissions from dairy animals. This article describes the trends in milk production and consumption, the debates over the role of milk in human nutrition, the global outlook of organic dairy, the abatement of greenhouse gas emissions from dairy animals, as well as scientific and technological developments in nutrition, genetics, reproduction, and management in the dairy sector.
Indigenous Polynesian Agriculture in Hawaiʻi
Authors: Lincoln Noa Kekuewa , Vitousek Peter
Published: October 2016

Agriculture in Hawaiʻi was developed in response to the high spatial heterogeneity of climate and landscape of the archipelago, resulting in a broad range of agricultural strategies. Over time, highly intensive irrigated and rainfed systems emerged, supplemented by extensive use of more marginal lands that supported considerable populations. Due to the late colonization of the islands, the pathways of development are fairly well reconstructed in Hawaiʻi. The earliest agricultural developments took advantage of highly fertile areas with abundant freshwater, utilizing relatively simple techniques such as gardening and shifting cultivation. Over time, investments into land-based infrastructure led to the emergence of irrigated pondfield agriculture found elsewhere in Polynesia. This agricultural form was confined by climatic and geomorphological parameters, and typically occurred in wetter, older landscapes that had developed deep river valleys and alluvial plains. Once initiated, these wetland systems saw regular, continuous development and redevelopment. As populations expanded into areas unable to support irrigated agriculture, highly diverse rainfed agricultural systems emerged that were adapted to local environmental and climatic variables. Development of simple infrastructure over vast areas created intensive rainfed agricultural systems that were unique in Polynesia. Intensification of rainfed agriculture was confined to areas of naturally occurring soil fertility that typically occurred in drier and younger landscapes in the southern end of the archipelago. Both irrigated and rainfed agricultural areas applied supplementary agricultural strategies in surrounding areas such as agroforestry, home gardens, and built soils. Differences in yield, labor, surplus, and resilience of agricultural forms helped shape differentiated political economies, hierarchies, and motivations that played a key role in the development of sociopolitical complexity in the islands.
ReconMap: an interactive visualization of human metabolism
Authors: Noronha Alberto , Daníelsdóttir Anna Dröfn , Gawron Piotr , Jóhannsson Freyr , Jónsdóttir Soffía , Jarlsson Sindri , Gunnarsson Jón Pétur , Brynjólfsson Sigurður , Schneider Reinhard , Thiele Ines , Fleming Ronan M T
Published: October 2016

Motivation

A genome-scale reconstruction of human metabolism, Recon 2, is available but no interface exists to interactively visualize its content integrated with omics data and simulation results.

Results

We manually drew a comprehensive map, ReconMap 2.0, that is consistent with the content of Recon 2. We present it within a web interface that allows content query, visualization of custom datasets and submission of feedback to manual curators.

Availability and Implementation

ReconMap can be accessed via http://vmh.uni.lu, with network export in a Systems Biology Graphical Notation compliant format released under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. A Constraint-Based Reconstruction and Analysis (COBRA) Toolbox extension to interact with ReconMap is available via https://github.com/opencobra/cobratoolbox.
Herring submesoscale dynamics through a major spawning wave: duration, abundance fluctuation, distribution, and schooling
Authors: Skaret Georg , Slotte Aril
Published: October 2016

In this study, a series of 17 repeated acoustic trawl surveys within a ca. 1500 km2 area covering the major spawning location for Norwegian spring-spawning herring (Clupea harengus) was conducted over a period of about 1 month. Local herring abundance increased from ca. 25 000 to 237 000 t, a significant proportion of the total spawning stock, in just 3 d and subsequently decreased to <30 000 t over the next 7 d. The abundance change was due to a single major spawning wave developing over the observation period, and an estimated 46 000 t of eggs and milt were deposited during the short time spent at the spawning ground. There was no difference in spawning activity between day and night, but herring were more associated with deep trenches and also generally stayed deeper in more dense schools during daylight than night-time. Schooling behaviour and distribution were also strongly state-dependent, and both school swimming depth and school height decreased as spawning progressed, as did the bottom depth where the schools were located. The massive herring spawning events seem to be low-risk adaptations to an environment where predators are abundant, with rapid spawning in huge aggregations as a strategy for predator swamping.
Physician Decisions to Defer Antiretroviral Therapy in Key Populations: Implications for Reducing Human Immunodeficiency Virus Incidence and Mortality in Malaysia
Authors: Ferro Enrico G. , Culbert Gabriel J. , Wickersham Jeffrey A. , Marcus Ruthanne , Steffen Alana D. , Pauls Heather A. , Westergaard Ryan P. , Lee Christopher K. , Kamarulzaman Adeeba , Altice Frederick L.
Published: October 2016

Background

Antiretroviral therapy (ART) is recommended for all people living with human immunodeficiency virus (HIV), yet physician attitudes and prescribing behaviors toward members of key risk populations may limit ART access and undermine treatment as prevention strategies.

Methods

Physicians in Malaysia (N = 214) who prescribe antiretroviral therapy (ART) responded in an Internet-based survey to hypothetical clinical scenarios of HIV patients, varying by key risk population and CD4+ T-cell count, on whether they would initiate or defer ART compared with a control patient with sexually acquired HIV.

Results

The proportion of physicians who would defer ART in patients with advanced HIV (CD4 = 17 cells/μL) was significantly higher (P < .0001) for 4 key populations, including people who inject drugs ([PWID] 45.3%) or consume alcohol (42.1%), released prisoners (35.0%), and those lacking social support (26.6%), compared with a control patient (4.2%). People who inject drugs with advanced HIV (CD4 = 17 cells/μL) were 19-fold (adjusted odds ratio [AOR] = 18.9; 95% confidence interval [CI], 9.8–36.5) more likely to have ART deferred compared with the control. This effect was partially mitigated for PWID receiving methadone (AOR = 2.9; 95% CI, 1.5–5.7). At the highest CD4+ T-cell count (CD4 = 470 cells/μL), sex workers (AOR = 0.55; 95% CI, .44–.70) and patients with an HIV-uninfected sexual partner (AOR = 0.43; 95% CI, .34–.57) were significantly less likely to have ART deferred.

Conclusions

Physicians who prescribe antiretroviral therapy in Malaysia may defer ART in some key populations including PWID and released prisoners, regardless of CD4+ T-cell count, which may help to explain very low rates of ART coverage among PWID in Malaysia. Reducing HIV incidence and mortality in Malaysia, where HIV is concentrated in PWID and other key populations, requires clinician-level interventions and monitoring physician adherence to international evidence-based treatment guidelines.
Artemether-Lumefantrine and Dihydroartemisinin-Piperaquine Exert Inverse Selective Pressure on Plasmodium Falciparum Drug Sensitivity-Associated Haplotypes in Uganda
Authors: Taylor Aimee R. , Flegg Jennifer A. , Holmes Chris C. , Guérin Philippe J. , Sibley Carol H. , Conrad Melissa D. , Dorsey Grant , Rosenthal Philip J.
Published: October 2016

Background

Altered sensitivity to multiple antimalarial drugs is mediated by polymorphisms in pfmdr1, which encodes the Plasmodium falciparum multidrug resistance transporter. In Africa the N86Y and D1246Y polymorphisms have been shown to be selected by treatment, with artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP) selecting for wild-type and mutant alleles, respectively. However, there has been little study of pfmdr1 haplotypes, in part because haplotype analyses are complicated by multiclonal infections.

Methods

We fit a haplotype frequency estimation model, which accounts for multiclonal infections, to the polymorphic pfmdr1 N86Y, Y184F, and D1246Y alleles in samples from a longitudinal trial comparing AL and DP to treat uncomplicated P falciparum malaria in Tororo, Uganda from 2007 to 2012. We regressed estimates onto covariates of trial arm and selective drug pressure.

Results

Yearly trends showed increasing frequency estimates for haplotypes with wild type pfmdr1 N86 and D1246 alleles and decreasing frequency estimates for haplotypes with the mutant pfmdr1 86Y allele. Considering days since prior therapy, we saw evidence suggestive of selection by AL for haplotypes with N86 combined with 184F, D1246, or both, and against all haplotypes with 86Y, and evidence suggestive of selection by DP for 86Y only when

combined with Y184 and 1246Y (haplotype YYY) and against haplotypes NFD and NYY.

Conclusions

Based on our model, AL selected several haplotypes containing N86, whereas DP selection was haplotype specific, demonstrating the importance of haplotype analyses. Inverse selective pressure of AL and DP on the complementary haplotypes NFD and YYY suggests that rotating artemisinin-based antimalarial combination regimens may be the best treatment option to prevent resistance selection.
The Discriminatory Patient and Family: Strategies to Address Discrimination Towards Trainees
Authors: Whitgob Emily E. , Blankenburg Rebecca L. , Bogetz Alyssa L.
Published: October 2016

Purpose

Trainee mistreatment remains an important and serious medical education issue. Mistreatment toward trainees by the medical team has been described; mistreatment by patients and families has not. Motivated by discrimination towards a resident by a family in their emergency department, the authors sought to identify strategies for trainees and physicians to respond effectively to mistreatment by patients and families.

Method

A purposeful sample of pediatric faculty educational leaders was recruited from April–June 2014 at Stanford University. Using a constructivist grounded theory approach, semistructured one-on-one interviews were conducted. Participants were asked to describe how they would respond to clinical scenarios of families discriminating against trainees (involving race, gender, and religion). Interviews were audio-recorded, transcribed, and anonymized. The authors analyzed interview transcripts using constant comparative analysis and performed post hoc member checking. This project was IRB approved.

Results

Four themes emerged from interviews with 13 faculty: assess illness acuity, cultivate a therapeutic alliance, depersonalize the event, and ensure a safe learning environment. Participants wanted trainees to feel empowered to remove themselves from care when necessary but acknowledged that removal was not always possible or easy. Nearly all participants agreed that trainee and faculty development was needed. Suggested educational strategies included team debriefing and critical reflection.

Conclusions

Discrimination towards trainees by patients and families is an important issue. As this type of mistreatment cannot be fully prevented, effective preparation is essential. Effective response strategies exist and can be taught to trainees to empower responses that protect learners and preserve patient care.
Professionalism in the Twilight Zone: A Multicenter, Mixed-Methods Study of Shift Transition Dynamics in Surgical Residencies
Authors: Coverdill James E. , Alseidi Adnan , Borgstrom David C. , Dent Daniel L. , Dumire Russell D. , Fryer Jonathan , Hartranft Thomas H. , Holsten Steven B. , Nelson M. Timothy , Shabahang Mohsen , Sherman Stanley , Termuhlen Paula M. , Woods Randy J. , Mellinger John D.
Published: October 2016

Purpose

Duty hours rules sparked debates about professionalism. This study explores whether and why general surgery residents delay departures at the end of a day shift in ways consistent with shift work, traditional professionalism, or a new professionalism.

Method

Questionnaires were administered to categorical residents in 13 general surgery programs in 2014 and 2015. The response rate was 76% (N = 291). The 18 items focused on end-of-shift behaviors and the frequency and source of delayed departures. Follow-up interviews (N = 39) examined motives for delayed departures. The results include means, percentages, and representative quotations from the interviews.

Results

A minority (33%) agreed that it is routine and acceptable to pass work to night teams, whereas a strong majority (81%) believed that residents exceed work hours in the name of professionalism. Delayed departures were ubiquitous: Only 2 of 291 residents were not delayed for any of 13 reasons during a typical week. The single most common source of delay involved a desire to avoid the appearance of dumping work on fellow residents. In the interviews, residents expressed a strong reluctance to pass work to an on-call resident or night team because of sparse night staffing, patient ownership, an aversion to dumping, and the fear of being seen as inefficient.

Conclusions

Resident behavior is shaped by organizational and cultural contexts that require attention and reform. The evidence points to the stunted development of a new professionalism, little role for shift-work mentalities, and uneven expression of traditional professionalism in resident behavior.
Individual and Institutional Components of the Medical School Educational Environment
Authors: Gruppen Larry D. , Stansfield R. Brent
Published: October 2016

Purpose

To examine, using a systems framework, the relative influence of individual-level and institution-level factors on student perceptions of the medical school educational environment.

Method

A series of hierarchical linear models were fit to a large, 18-school longitudinal dataset of student perceptions of the educational environment, various demographics, and student empathy, tolerance of ambiguity, coping, and patient–provider orientation. Separate models were evaluated for individual-level factors alone, institution-level factors alone, and the combination of individual- and institution-level factors.

Results

The individual-level model accounted for 56.7% of the variance in student perceptions of the educational environment. However, few specific variables at the individual level had noteworthy direct effects on these perceptions. Similarly, the institution-level model accounted for 10.3% of the variance in student perceptions, but the specific characteristics of the institution explained little of this impact. The combined individual- and institution-level model attributed 45.5% of the variance in student perceptions to individual-level factors and 10.8% to institution-level factors. Again, specific variables explained little of this impact.

Conclusions

These findings indicate that the impact of individual-level factors on perceptions of the educational environment is about four times greater than institution-level factors. This contrast reflects the fact that the educational environment is defined through a learner, not institutional lens. Nonetheless, institutions vary in learner perceptions of their environments, and these differences may provide some support for institutional initiatives to improve the educational environment. More broadly, these results evidence the complexity of the educational environment, both in defining it and in understanding its dynamics.
The Learning Environment Counts: Longitudinal Qualitative Analysis of Study Strategies Adopted by First-Year Medical Students in a Competency-Based Educational Program
Authors: Bierer S. Beth , Dannefer Elaine F.
Published: October 2016

Purpose

The move toward competency-based education will require medical schools and postgraduate training programs to restructure learning environments to motivate trainees to take personal ownership for learning. This qualitative study explores how medical students select and implement study strategies while enrolled in a unique, nontraditional program that emphasizes reflection on performance and competence rather than relying on high-stakes examinations or grades to motivate students to learn and excel.

Method

Fourteen first-year medical students volunteered to participate in three, 45-minute interviews (42 overall) scheduled three months apart during 2013–2014. Two medical educators used structured interview guides to solicit students’ previous assessment experiences, preferred learning strategies, and performance monitoring processes. Interviews were digitally recorded and transcribed verbatim. Participants confirmed accuracy of transcripts. Researchers independently read transcripts and met regularly to discuss transcripts and judge when themes achieved saturation.

Results

Medical students can adopt an assessment for learning mind-set with faculty guidance and implement appropriate study strategies for mastery-learning demands. Though students developed new strategies at different rates during the year, they all eventually identified study and performance monitoring strategies to meet learning needs. Students who had diverse learning experiences in college embraced mastery-based study strategies sooner than peers after recognizing that the learning environment did not reward performance-based strategies.

Conclusions

Medical students can take ownership for their learning and implement specific strategies to regulate behavior when learning environments contain building blocks emphasized in self-determination theory. Findings should generalize to educational programs seeking strategies to design learning environments that promote self-regulated learning.
“Staying in the Game”: How Procedural Variation Shapes Competence Judgments in Surgical Education
Authors: Apramian Tavis , Cristancho Sayra , Watling Chris , Ott Michael , Lingard Lorelei
Published: October 2016

Purpose

Emerging research explores the educational implications of practice and procedural variation between faculty members. The potential effect of these variations on how surgeons make competence judgments about residents has not yet been thoroughly theorized. The authors explored how thresholds of principle and preference shaped surgeons’ intraoperative judgments of resident competence.

Method

This grounded theory study included reanalysis of data on the educational role of procedural variations and additional sampling to attend to their impact on assessment. Reanalyzed data included 245 hours of observation across 101 surgical cases performed by 29 participants (17 surgeons, 12 residents), 39 semistructured interviews (33 with surgeons, 6 with residents), and 33 field interviews with residents. The new data collected to explore emerging findings related to assessment included two semistructured interviews and nine focused field interviews with residents. Data analysis used constant comparison to refine the framework and data collection process until theoretical saturation was reached.

Results

The core category of the study, called staying in the game, describes how surgeons make moment-to-moment judgments to allow residents to retain their role as operators. Surgeons emphasized the role of principles in making these decisions, while residents suggested that working with surgeons’ preferences also played an important role in such intraoperative assessment.

Conclusions

These findings suggest that surgeons’ and residents’ work with thresholds of principle and preference have significant implications for competence judgments. Making use of these judgments by turning to situated assessment may help account for the subjectivity in assessment fostered by faculty variations.
Scholarly Conversations in Medical Education
Authors: O’Brien Bridget C. , May Win , Horsley Tanya
Published: October 2016

This supplement includes the eight research papers accepted by the 2016 Research in Medical Education Program Planning Committee. In this Commentary, the authors use “conversations in medical education” as a guiding metaphor to explore what these papers contribute to the current scholarly discourse in medical education. They organize their discussion around two domains: the topic of study and the methodological approach. The authors map the eight research papers to six “hot topics” in medical education: (1) curriculum reform, (2) duty hours restriction, (3) learner well-being, (4) innovations in teaching and assessment, (5) self-regulated learning, and (6) learning environment, and to three purposes commonly served by medical education research: (1) description, (2) justification, and (3) clarification. They discuss the range of methods employed in the papers. The authors end by encouraging educators to engage in these ongoing scholarly conversations.
Cutting Close to the Bone: Student Trauma, Free Speech, and Institutional Responsibility in Medical Education
Authors: Kumagai Arno K. , Jackson Brittani , Razack Saleem
Published: October 2016

Learning the societal roles and responsibilities of the physician may involve difficult, contentious conversations about topics such as race, gender, sexual orientation, and class, as well as violence, inequities, sexual assault, and child abuse. If not done well, these discussions may be deeply traumatizing to learners for whom these subjects “cut close to the bone.” Equally traumatizing is exposure to injustice and mistreatment, as well as to the sights, sounds, and smells of suffering and pain in the clinical years. This potential for iatrogenic educational trauma remains unaddressed, and medical educators must take responsibility for attending to it. Possible solutions include trigger warnings or statements given to students before an educational activity that may cause personal discomfort. The authors of this Perspective assert, however, both that this concept does not distinguish between psychological trauma and discomfort and that well-intentioned trigger warnings target the wrong goal—the avoidance of distress. Exposure to discomfort not only is unavoidable in the practice of medicine but may be crucial to personal and professional moral development. The authors argue that a more appropriate solution is to create safe spaces for dialogues about difficult topics and jarring experiences. This approach places even the notion of free speech under a critical lens—it is not an end in itself but a means to create a professional ethic dedicated to treating all individuals with excellence and justice. Ultimately, this approach aspires to create an inclusive curriculum sensitive to the realities of teaching and learning in increasingly diverse societies.
Knowledge Syntheses in Medical Education: Demystifying Scoping Reviews
Authors: Thomas Aliki , Lubarsky Stuart , Durning Steven J. , Young Meredith E.
Published: October 2016

An unprecedented rise in health professions education (HPE) research has led to increasing attention and interest in knowledge syntheses. There are many different types of knowledge syntheses in common use, including systematic reviews, meta-ethnography, rapid reviews, narrative reviews, and realist reviews. In this Perspective, the authors examine the nature, purpose, value, and appropriate use of one particular method: scoping reviews. Scoping reviews are iterative and flexible and can serve multiple main purposes: to examine the extent, range, and nature of research activity in a given field; to determine the value and appropriateness of undertaking a full systematic review; to summarize and disseminate research findings; and to identify research gaps in the existing literature. Despite the advantages of this methodology, there are concerns that it is a less rigorous and defensible means to synthesize HPE literature. Drawing from published research and from their collective experience with this methodology, the authors present a brief description of scoping reviews, explore the advantages and disadvantages of scoping reviews in the context of HPE, and offer lessons learned and suggestions for colleagues who are considering conducting scoping reviews. Examples of published scoping reviews are provided to illustrate the steps involved in the methodology.
Effects of Long-Term Musical Training on Cortical Auditory Evoked Potentials
Authors: Brown Carolyn J. , Jeon Eun-Kyung , Driscoll Virginia , Mussoi Bruna , Deshpande Shruti Balvalli , Gfeller Kate , Abbas Paul J.
Published: October 2016

Objective:

Evidence suggests that musicians, as a group, have superior frequency resolution abilities when compared with nonmusicians. It is possible to assess auditory discrimination using either behavioral or electrophysiologic methods. The purpose of this study was to determine if the acoustic change complex (ACC) is sensitive enough to reflect the differences in spectral processing exhibited by musicians and nonmusicians.

Design:

Twenty individuals (10 musicians and 10 nonmusicians) participated in this study. Pitch and spectral ripple discrimination were assessed using both behavioral and electrophysiologic methods. Behavioral measures were obtained using a standard three interval, forced choice procedure. The ACC was recorded and used as an objective (i.e., nonbehavioral) measure of discrimination between two auditory signals. The same stimuli were used for both psychophysical and electrophysiologic testing.

Results:

As a group, musicians were able to detect smaller changes in pitch than nonmusician. They also were able to detect a shift in the position of the peaks and valleys in a ripple noise stimulus at higher ripple densities than non-musicians. ACC responses recorded from musicians were larger than those recorded from non-musicians when the amplitude of the ACC response was normalized to the amplitude of the onset response in each stimulus pair. Visual detection thresholds derived from the evoked potential data were better for musicians than non-musicians regardless of whether the task was discrimination of musical pitch or detection of a change in the frequency spectrum of the ripple noise stimuli. Behavioral measures of discrimination were generally more sensitive than the electrophysiologic measures; however, the two metrics were correlated.

Conclusions:

Perhaps as a result of extensive training, musicians are better able to discriminate spectrally complex acoustic signals than nonmusicians. Those differences are evident not only in perceptual/behavioral tests but also in electrophysiologic measures of neural response at the level of the auditory cortex. While these results are based on observations made from normal-hearing listeners, they suggest that the ACC may provide a non-behavioral method of assessing auditory discrimination and as a result might prove useful in future studies that explore the efficacy of participation in a musically based, auditory training program perhaps geared toward pediatric or hearing-impaired listeners.