bluuebunny/crossref_metadata_2025 huggingface dataset:
The tortoise, the hare, and the hybrid: effects of prior employment on the development of an entrepreneurial ecosystem
Authors: Donegan Mary , Forbes Allison , Clayton Paige , Polly Alyse , Feldman Maryann , Lowe Nichola
Published: May 2019

Prior employment imprints nascent entrepreneurs with logics for organizing startups. Within a regional ecosystem, entrepreneurs with different employment backgrounds pursue alternative entrepreneurial pathways, each generating distinct, though complementary, regional impacts. By analyzing diverse pre-entrepreneurial employment experiences, no one pathway leads to superior firm performance; prior industry experience generates strong early performance that tapers off, while prior academic experience engenders slow, steady, long-lasting growth. Our approach is well-suited for theorizing ecosystem development and generating policy recommendations in support of ecosystem diversity.
Information-theoretic measures of ecosystem change, sustainability, and resilience
Authors: Boschetti Fabio , Prunera Karine , Vanderklift Mathew A , Thomson Damian P , Babcock Russell C , Doropoulos Christopher , Cresswell Anna , Lozano-Montes Hector
Published: May 2019

We introduce five measures describing the system-wide behaviour of complex ecological systems. Within an information-theoretic framework, these measures account for changes in both species diversity and total biomass to describe (i) overall system change, (ii) sustainability to external pressure, (iii) shift from a baseline state and two types of resilience: (iv) ability to recover from local pressures and (v) overall potential to return to a baseline state. We apply these measures to study the behaviour of three computer models: a large 59-functional groups complex ecological model (Ecopath with Ecosim) of north Western Australia undergoing internal dynamics, a smaller 6-group coral reef model subjected to various combinations of single and multiple stressors and a prey–predator model displaying limit cycles. We demonstrate the state-dependency of properties like resilience and sustainability by showing how these measures change in time as a function of internal dynamics and external forcing. Furthermore, we show how our proposed measures can simplify system analysis and monitoring by providing indicators of changes in system behaviour, sustainability, and resilience.
Early and mid-term outcomes of total arch replacement with the frozen elephant trunk technique for type A acute aortic dissection
Authors: Furutachi Akira , Takamatsu Masanori , Nogami Eijiro , Hamada Kohei , Yunoki Junji , Itoh Manabu , Kamohara Keiji
Published: May 2019

OBJECTIVES

The aim of this study was to evaluate the outcomes of the frozen elephant trunk (FET) technique, using the J Graft FROZENIX for Stanford type A acute aortic dissection, in comparison with the unfrozen elephant trunk technique.

METHODS

Between January 2010 and August 2018, we performed total arch replacement for Stanford type A acute aortic dissection in our hospital. Thirty patients were treated by the elephant trunk procedure (ET group), and 20 patients were treated by the FET procedure (FET group). To evaluate aortic remodelling, we measured the area of the aorta, the true lumen and the false lumen at 12 months of follow-up.

RESULTS

Preoperative characteristics and operation time were not significantly different between the 2 groups. The quantity of blood transfused was much greater in the ET group than in the FET group. Resection or closure of the most proximal entry tear was obtained in 73.3% (22 out of 30 patients) in the ET group and 100% (20 out of 20 patients) in the FET group (P = 0.015). There was no case that had recurrent nerve palsy or paraplegia in the FET group. Stent graft-induced new entry occurred in 3 cases (15.8%) in the FET group. There were no significant differences between the 2 groups in aortic area, true lumen area or false lumen area.

CONCLUSIONS

Total arch replacement with the FET technique in Stanford type A acute aortic dissection carries a risk of distinct complications; however, with thorough advance planning, it should be possible to safely institute this treatment. Further randomization, with a comparison of each technique, is required to provide clear conclusions whether the FET is useful for acute Stanford type A aortic dissection.
Suffer the Little Children to Come: The Legal Rights of Unaccompanied Alien Children under United States Federal Court Jurisprudence
Authors: Braaten Claire Nolasco , Braaten Daniel
Published: May 2019

This article analyses United States (US) federal court jurisprudence to determine the legal rights of unaccompanied alien children (UAC) in various stages of immigration enforcement proceedings. After briefly discussing statistics on UAC in the US, it explains the legal context of US laws governing unaccompanied minors. Through examining 40 cases decided by the 12 US Circuit Courts of Appeals and various federal district courts, the article specifies how these courts interpreted and expanded on the procedural legal rights of UAC upon apprehension by immigration officials, during placement or detention decisions of the Office of Refugee Resettlement (ORR), prior to voluntary departure, during asylum proceedings, when rearrested after release, and while released pending immigration proceedings. According to the US federal courts, the government must grant unaccompanied minors procedural due process if it denies their release to the custody of an available and willing legal custodian. Case law examining the rights of UAC prior to voluntary departure emphasizes the need to grant them the opportunity to consult with a responsible adult, including a lawyer from a free legal services list that should be provided to them. Federal courts have also tackled various procedural issues concerning asylum claims filed by UAC. These include the right of third parties to custody of the unaccompanied minor, the minority age at the time of the asylum application, and the right of UAC to request consent for a state juvenile court’s jurisdiction prior to applying for Special Immigrant Juvenile status. In removal proceedings against UAC, federal courts have elaborated on the scope and meaning of the right to counsel and the right to a bond rehearing upon their rearrest because of allegations of gang membership. Finally, federal courts have also examined issues concerning the rights of UAC while detained in ORR facilities and while in US territory. These include the right of an unaccompanied alien child to terminate a pregnancy while in ORR custody and the right not to be subjected to physical and sexual abuse while placed in a detention facility.
Density Problems for second order Sobolev Spaces and Cut-off Functions on Manifolds With Unbounded Geometry
Authors: Impera Debora , Rimoldi Michele , Veronelli Giona
Published: May 2019

We consider complete non-compact manifolds with either a sub-quadratic growth of the norm of the Riemann curvature, or a sub-quadratic growth of both the norm of the Ricci curvature and the squared inverse of the injectivity radius. We show the existence on such a manifold of a distance-like function with bounded gradient and mild growth of the Hessian. As a main application, we prove that smooth compactly supported functions are dense in $W^{2,p}$. The result is improved for $p=2$ avoiding both the upper bound on the Ricci tensor, and the injectivity radius assumption. As further applications we prove new disturbed Sobolev and Calderón–Zygmund inequalities on manifolds with possibly unbounded curvature and highlight consequences about the validity of the full Omori–Yau maximum principle for the Hessian.
Prescribers’ experience and opinions on antimicrobial stewardship programmes in hospitals: a French nationwide survey
Authors: Perozziello A , Lescure F X , Truel A , Routelous C , Vaillant L , Yazdanpanah Y , Lucet J C ,   CEFECA study group, Burdet Charles , Kardas Lidia , Lepeule Raphaël , Lesprit Philippe , L’Heriteau François , Liem-Binh Luong Nguyen , Bruno Mourvillier , Jean-Ralph Zahar , Burdet Charles , Kardas Lidia , Lepeule Raphaël , Lesprit Philippe , L’Heriteau François , Luong Nguyen Liem-Binh , Mourvillier Bruno , Zahar Jean-Ralph
Published: May 2019

Objectives

To assess prescribers’ experiences and opinions regarding antimicrobial stewardship programme (ASP) activities.

Methods

A cross-sectional paper-based survey was conducted among prescribers in 27 out of 35 randomly selected large hospitals in France.

Results

All 27 investigated hospitals (20 non-university public, 4 university-affiliated and 3 private hospitals) had an ASP and an appointed antibiotic advisor (AA), with a median of 0.9 full-time equivalents per 1000 acute-care beds (IQR 0–1.4). Of the 1963 distributed questionnaires, 920 were completed (46.9%). Respondents were mainly attending physicians (658/918, 71.7%) and medical specialists (532/868, 61.3%). Prescribers identified two main ASP objectives: to limit the spread of resistance (710/913, 77.8%) and to improve patient care and prognosis (695/913, 76.1%). The presence of an AA constituted a core element of ASP (96.2% agreement between answers of ASP leader and respondents). Respondents acknowledged an AA’s usefulness especially on therapeutic issues, i.e. choosing appropriate antibiotic (agreement 84.7%) or adapting treatment (89.6%), but less so on diagnostic issues (31.4%). Very few respondents reported unsolicited counselling and post-prescription controls. Three-quarters of prescribers identified local guidelines (692/918, 75.4%). Prescribers did not approve of measures counteracting their autonomy, i.e. automatic stop orders (agreement 23.4%) or pre-approval by AAs (28.8%). They agreed more with educational interventions (73.0%) and clinical staff meetings (70.0%).

Conclusions

Prescribers perceived ASP mainly through its ‘on-demand’ counselling activities. They preferred measures that did not challenge their clinical autonomy. High levels of antibiotic consumption in French hospitals bring into question the effectiveness of such an approach. However, limited ASP staffing and resources may preclude extended activities.
Dispersal of linezolid-resistant enterococci carrying poxtA or optrA in retail meat and food-producing animals from Tunisia
Authors: Elghaieb Houyem , Freitas Ana R , Abbassi Mohamed Salah , Novais Carla , Zouari Mohamed , Hassen Abdennaceur , Peixe Luísa
Published: May 2019

Objectives

The epidemiology of Enterococcus resistant to priority antibiotics including linezolid has mainly been investigated in developed countries and especially in hospitals. We aimed to evaluate the contribution of different non-human reservoirs for the burden of MDR enterococci in Tunisia, where scarce data are available.

Methods

Samples (n = 287) were collected from urban wastewater (n = 57), retail meat (n = 29; poultry/bovine/ovine), milk (n = 89; bovine/ovine), farm animal faeces (n = 80; poultry/bovine/ovine) and pets (n = 32; rabbit/dogs/cats/birds) in different Tunisian regions (2014–17). They were plated onto Slanetz–Bartley agar after pre-enrichment without antibiotics. Standard methods were used for bacterial identification and characterization of antibiotic resistance and virulence genes (PCR), antibiotic susceptibility testing (disc diffusion/broth microdilution; EUCAST/CLSI) and clonality (SmaI-PFGE/MLST).

Results

All samples carried Enterococcus (n = 377 isolates) resistant to antibiotics considered to be critical or highly important by WHO. Even without antibiotic selection, 38% of Enterococcus faecalis (Efs) and 22% of Enterococcus faecium (Efm) were identified as MDR. Linezolid-resistant isolates (5%; MIC = 8 mg/L) comprised six poxtA-carrying Efm (cow milk), seven optrA-carrying Efs (chicken faeces/meat) and five Efm lacking cfr/optrA/poxtA (poultry/bovine/ovine/wastewater). Clinically relevant Efm clones (clade A1) were identified in animal/meat sources. Ampicillin resistance (1%) was confined to ST18/ST78-like MDR Efm clones from bovine meat/milk samples carrying relevant virulence markers (e.g. ptsD/IS16).

Conclusions

This study provides evidence of the contribution of livestock and foodstuffs to the dispersal of acquired linezolid resistance genes including poxtA and optrA. We report the first poxtA-carrying Efm in Tunisia, and for the first time in bovine samples, stressing the urgent need for alternative measures to counteract the spread of linezolid-resistant enterococci globally.
From Worldly Powers to Jīvanmukti: Ritual and Soteriology in the Early Tantras of the Cult of Tripurasundarī
Authors: Golovkova Anna A
Published: May 2019

This article diachronically charts the distinctive soteriologies articulated in the earliest scriptures of the cult of Tripurasundarī, a popular trans-regional Śākta tradition, which was promulgated in south India as Śrīvidyā. First, I analyse contexts, beginning in the tenth-century CE, in which words for liberation (mukti and mokṣa) were discussed in the unpublished tantras of the antecedent Nityā cult and the Vāmakeśvarīmata, a foundational text of the cult of Tripurasundarī. Although these texts eulogised the transcendent aspect of the Goddess, they exhibited little interest in salvific practices. In contrast, the later Yoginīhṛdaya emphasised the soteriological meaning of practices, embracing internalised, meditative techniques dedicated to the realisation of liberation during one’s lifetime (jīvanmukti), associated with non-dual Śaivism. I argue that the Yoginīhṛdaya built on the existing ritual and mantra system and developed it toward a sophisticated and robust doctrine by which adherents deepened the resilience and longevity of this ritual tradition.
Long noncoding RNA in cardiac aging and disease
Authors: Lozano-Vidal Noelia , Bink Diewertje I , Boon Reinier A
Published: May 2019

Cardiovascular diseases (CVDs) are the main cause of morbidity and mortality in Western society and present an important age-related risk. With the constant rise in life expectancy, prevalence of CVD in the population will likely increase further. New therapies, especially in the elderly, are needed to combat CVD. This review is focused on the role of long noncoding RNA (lncRNA) in CVD. RNA sequencing experiments in the past decade showed that most RNA does not code for protein, but many RNAs function as ncRNA. Here, we summarize the recent findings of lncRNA regulation in the diseased heart. The potential use of these RNAs as biomarkers of cardiac disease prediction is also discussed.
Clinical outcomes for 61 cases of hypopharyngeal cancer with synchronous esophageal cancer
Authors: Yang Shixuan , Yang Shuang , Liao Wenjun , Huang Rui , Li Baisen , Lu Shun , Li Chao , Wang Zhaohui , Li Chunhua , Pei Jiao , Wen Hao , Zhang Shichuan
Published: May 2019

The aim of this research was to provide data from a single-center study of the treatment of synchronous hypopharyngeal cancer (HPC) and esophageal cancer (EC) with different treatment modalities. A total of 61 patients with synchronous HPC and EC were included in this study. Patients were treated with radiotherapy/chemoradiotherapy (28 cases), surgery (9 cases), palliative radiotherapy and/or chemotherapy (17 cases), or supportive care (7 cases). The median radiotherapy doses for EC and HPC in the radiotherapy/chemoradiotherapy group were 64.5 Gy (range, 0–70) and 70 Gy (range, 60–75.2), respectively. Seven patients in the surgery group received pharyngoesophagectomy with gastric pull-up reconstruction, and two received esophagectomy followed by radiotherapy at the hypopharynx. Cox proportional hazard analysis revealed that the outcome of active treatments, including surgery and radiotherapy/chemoradiotherapy, was better than that of conservative care. In survival analysis, patients in the surgery group tended to have a better 3-year overall survival rate than those in the radiotherapy/chemoradiotherapy group (55.6% vs 30.9%); however, this difference was not statistically different (P = 0.493). The two groups had similar 3-year progression-free survival rates (30.6% and 33.3%, P = 0.420). The current study suggested that radiotherapy/chemoradiotherapy should be considered as an important treatment modality in addition to surgery for synchronous HPC and EC.
Equivariant ZFA and the foundations of nominal techniques
Authors: Gabbay Murdoch
Published: May 2019

We give an accessible presentation to the foundations of nominal techniques, lying between Zermelo–Fraenkel set theory and Fraenkel–Mostowski set theory, which has several nice properties including being consistent with the Axiom of Choice. We give two presentations of equivariance, accompanied by detailed yet user-friendly discussions of its theory and application.
Congruence/Genuineness
Authors: Kolden Gregory G. , Wang Chia-Chiang , Austin Sara B. , Chang Yunling , Klein Marjorie H.
Published: May 2019

Congruence or genuineness is a relationship element with an extensive and important history within psychotherapy. Congruence is an aspect of the therapy relationship with two facets, one intrapersonal and one interpersonal. This chapter defines and provides clinical examples of congruence. It presents an original meta-analysis of its relation with psychotherapy improvement. Analysis of 21 studies, representing 1,192 patients, resulted in a weighted aggregate effect size (r) of .23 or an estimated d of .46. In closing, the chapter addresses patient contributions, limitations of the extant research, diversity considerations, and therapeutic practices that might promote congruence and improve psychotherapy outcomes.
The Real Relationship
Authors: Gelso Charles J. , Kivlighan Dennis M. , Markin Rayna D.
Published: May 2019

Although writing about the real relationship has existed from the beginnings of the talking cure,” it is only in recent years that empirical research has focused on this phenomenon. The real relationship is the personal relationship between patient and therapist marked by the extent to which each is genuine with the other and perceives/experiences the other in ways that are realistic. The strength of the real relationship is determined by both the extent to which it exists and the degree to which it is positive or favorable. In this chapter, a meta-analysis is presented on the association between the real relationship and the outcome of psychotherapy. Summed across 16 studies, this meta-analysis revealed a moderate association with outcome (r =.38, 95% confidence interval [.30, .47], p<.001, d = 0.80, N = 1,502 participants). This real relationship–outcome association was independent of the type of outcome studies and of the source of the measure. We also present frequent measures of the real relationship, limitations of the research, and patient contributions. The chapter concludes with diversity considerations and practice recommendations for developing and strengthening the real relationship.
Managing Countertransference
Authors: Hayes Jeffrey A. , Gelso Charles J. , Kivlighan D. Martin , Goldberg Simon B.
Published: May 2019

This chapter reviews the history and definition of countertransference, as well as empirical research on countertransference, its management, and the relation of both to psychotherapy outcome. Three meta-analyses are presented, as well as studies that illustrate findings from the meta-analyses. The first meta-analysis indicated that countertransference reactions are related inversely and modestly to psychotherapy outcomes (r = –.16, d = –.33, k = 14 studies, N = 973). A second meta-analysis supported the notion that countertransference management factors attenuate countertransference reactions (r = –.27, d = –.55, k = 13 studies, N = 1,065). The final meta-analysis revealed that successful countertransference management is related to better therapy outcomes (r = .39, d = .84, k = 9 studies, N = 392 participants). The authors conclude by summarizing the limitations of the research base, noting diversity considerations, and highlighting the therapeutic practices predicated on research.
Dizziness
Authors: Brody David L.
Published: May 2019

Dizziness means many different things to different people: lightheadedness, vertigo, poor balance, mental fogginess, and other concerns. Lightheadedness, meaning a feeling like the patient may pass out, is usually due to low blood pressure, often orthostatic hypotension. Vertigo, meaning a sensation of spinning or movement, can be an inner ear problem or a brain problem. Stop toxic substances; if there is nystagmus, refer to an ear, nose, and throat specialist (ENT) for a full evaluation. Perform the Dix Hallpike maneuvers to assess for benign paroxysmal positional vertigo and refer to physical therapy for repositioning maneuvers if positive. Consider vestibular rehabilitation; consider a short course of medication such as scopolamine or meclizine; consider ordering a magnetic resonance imaging (MRI) scan of the brain, because the concussion sometimes unmasks another unrelated problem. Dizziness meaning “mental fogginess” usually turns out to be attention deficit. Dizziness meaning vague and nonspecific malaise usually turns out to be fatigue, depression, or anxiety.
Fatigue
Authors: Brody David L.
Published: May 2019

A systematic approach to fatigue: Figure out how bad it is; rule out the complaint of concussion-related fatigue as an excuse to get out of school, work, or unpleasant chores at home by asking the collateral source how fatigued the patient acts in everyday life; rule out depression; rule out a primary sleep disorder; rule out alcohol, sedating medications, and other drugs; rule out withdrawal from stimulants; rule out a systemic cause such as hypotension, hypoxemia, renal failure, liver failure, anemia, hyponatremia, hypothyroidism, vitamin D deficiency, and chronic urinary tract infection. If these are not present or fatigue persists after treatment, consider prescribing one or more of the following: a very gradually progressive exercise program, bright light treatment, complete alcohol cessation, a diet that is low in refined sugar, a stimulant, amantadine, and modafinil. Consider using a quantitative measure, such as The Fatigue Severity Scale.
Blurry Vision
Authors: Brody David L.
Published: May 2019

Blurry vision after concussion can mean different things. A loss of acuity in one eye is often due to direct injury to the eye, which happens frequently in concussion. Refer to ophthalmology right away. Intact acuity in each eye, but worse vision with both eyes open is often due to a subtle cranial nerve injury. Subtle third cranial nerve or fourth cranial injuries typically cause vision to be worse looking up or down, whereas sixth nerve injuries are typically worse looking to one side. Consider referral to neuro-ophthalmology and an ocular rehabilitation prescription. Visual attention deficit is sometimes described as blurry vision. Treat the attention deficit. Migraine auras often cause visual impairment of some kind: distorted vision, double vision, loss of central vision, loss of vision on one side of the visual world, sparkling lights, jagged lines, and so forth. Paroxysmal changes in vision after concussion should be treated as presumptive migraine, or migraine equivalent even if there is not a severe headache. Patients will benefit from best corrected vision when starting aggressive cognitive rehabilitation even if preexisting visual impairments didn’t impair them much in everyday life before the concussion.
Return to Driving
Authors: Brody David L.
Published: May 2019

Return to driving decision-making can be challenging because the risks of driving need to be balanced with the effects on autonomy and financial consequences. Obtain confidential collateral source information given that the patient may not be aware of his or her own deficits. Assess for definite contraindication including seizures, other cause of intermittent unpredictable loss of consciousness (e.g., sleep attacks, cardiac arrhythmia), performance impairing medications, visual impairment including peripheral fields, psychosis, severe impulsivity, poor decision-making, and physical impairments. Consider an on-the-road driving assessment performed by occupational therapy or a specialized service.
The Suprachiasmatic Nucleus
Authors: Lundkvist Gabriella , Block Gene D.
Published: May 2019

Diurnal variations in physiology and behavior are ubiquitous in higher organisms. Although some rhythms are driven directly by geophysical cycles of light or temperature, most are generated by internal timers, commonly referred to as biological clocks. In mammals, including humans, these circadian (near 24-h) properties are controlled by a central timer formed by a distinct regional network in the anterior hypothalamus close to the optic chiasm, the bilateral suprachiasmatic nuclei (SCN). Rodents, with their SCN lesioned, fail to exhibit diurnal variations in behavior. The mechanism generating rhythmicity is contained within individual neurons; however, many of the properties of the circadian timing system derive from cellular interactions within SCN. These microcircuits give rise to a functional clock capable of maintaining a circadian rhythm with a stable period and phase and driving or synchronizing circadian rhythms in other tissues.
Microcircuits of the Striatum
Authors: Doig Natalie M. , Bolam J. Paul
Published: May 2019

The striatum (or caudate-putamen, or caudate nucleus and putamen in those species in which they are divided by the internal capsule) is the major division of the basal ganglia, a group of structures involved in a variety of processes, including movement and cognitive and mnemonic functions. The striatum consists of a population of principal neurons, the medium-sized, densely spiny neurons (MSNs)—accounting for up to 97% of all neurons depending on species—which are the projection neurons of the striatum, several populations of GABAergic interneurons, and a population of cholinergic interneurons. The principal afferents of the striatum are glutamatergic, are derived from the cortex and thalamus, and mainly innervate the spines of MSNs. The essential computation performed by the striatum is the decision about which MSNs will fire, the consequence of which is altered firing of basal ganglia output neurons, and hence the selection of the basal ganglia–associated behavior.
Mesolimbic Dopamine and the Circuitry of Reward
Authors: Robison A. J. , Nestler Eric J.
Published: May 2019

The meaning of the word reward, “payment for something good that has been done,” is useful when considering the concept from an evolutionary perspective. It is widely believed that neurocircuitry has evolved to reward behaviors contributing to evolutionary fitness, motivating individuals to perform actions that increase the likelihood of propagating their genetic material. For a behavior to be rewarding (and thus be reinforced), it must create positive emotions, but it also must induce learning and produce consummatory behavior (i.e., eating, copulating, interacting). In fact, many neural systems formerly proposed to encode feelings of reward are now understood to be more complex. Therefore, the brain circuitry underlying reward must involve regions and connections that drive feelings of pleasure, formation and storage of memories, and decision-making and behavioral output. This chapter focuses on neurocircuits associated with these aspects of reward and their integration into a network responsible for reward processing.
Amygdala Microcircuits
Authors: Johnson Luke R. , LeDoux Joseph E.
Published: May 2019

The amygdala is one of the most intensely researched regions in the brain for cell types and circuit connectivity that are linked closely to behavior. Most research into amygdala microcircuits and their function relates to Pavlovian threat conditioning. Microcircuit-level analysis of threat conditioning relates neuronal circuit responsivity to aversive unconditioned stimuli (UCS) and neutral conditioned stimuli (CS). The consequent associative learning leads to long-term memory formation. Amygdala circuits are also being studied in relation to the essential functional role in appetitive behavior. In this chapter, we describe the amygdala microcircuitry at several levels, including key afferent and efferent circuits, intra-amygdala circuits among major amygdala subdivisions and subcircuits within these subdivisions, and the plasticity within the circuits underlying associative learning.
Understanding Retinal Microcircuitry: Then to Now
Authors: Werblin Frank S. , Dowling John E.
Published: May 2019

This chapter focuses on the history of understanding retinal microcircuitry. To understand the microcircuitry underlying the responses of all ganglion cell types that exist in vertebrate retinas will require much work. We have a fairly good notion of how ON and OFF center ganglion cells are established by excitatory and inhibitory inputs in the outer plexiform layer (OPL) and inner plexiform layer (IPL), as well as how direction selection (DS) properties are imparted to ON-OFF ganglion cells in the IPL; but we have only fragmentary information regarding the microcircuitry of the other ganglion cell types. We do know where to look—along the various strata in the IPL. With electron microscope methods to determine synaptic circuitry and methods to record responses of single neurons in a circuit available, the microcircuitry of the strata in the IPL can be elucidated.
The Circuit for Chemotaxis and Exploratory Behavior in Caenorhabditis Elegans
Authors: Bargmann Cornelia I.
Published: May 2019

A wiring diagram of the Caenorhabditis elegans nervous system was constructed from serial-section electron micrographs 30 years ago. This wiring diagram divides the 302 neurons in the nervous system of the adult hermaphrodite into three overall classes: sensory neurons, motor neurons that form neuromuscular junctions, and interneurons that connect sensory neurons with motor neurons. Most sensory neurons and interneurons belong to bilaterally symmetric pairs with similar connections and morphologies, while motor neurons belong to larger classes. The C. elegans nervous system presents an exceptional situation in which neuroanatomical connections are extremely well defined and reproducible among animals. These detailed anatomical studies and a parallel genetic attack have increasingly been joined by functional and electrophysiological characterization.
Taste Coding and Feedforward/Feedback Signaling in Taste Buds
Authors: Roper Stephen D. , Chaudhari Nirupa
Published: May 2019

Taste buds are the sensory end organs of the gustatory system. Thousands of these tiny sensory structures are embedded throughout the lingual epithelium and palate. As well-defined anatomical structures, taste buds can provide valuable insight into microcircuit organization. Information transmitted by taste buds to the brain results in conscious perceptions of taste—sweet, sour, salty, bitter, umami, and perhaps fat and others, but they also generate signals that initiate physiological reflexes such as a rapid burst of insulin secretion from the pancreatic islets to prepare the digestive tract for food. These responses are termed cephalic phase reflexes. This chapter presents an overview of how cell-cell communication and synaptic transmission within taste buds might underlie information processing in these sensory end organs, and perhaps also sheds light on the problem of taste coding, at least at its initial stages in the periphery.
Nucleus Laminaris
Authors: Sanchez Jason Tait , Wang Yuan , Lu Yong , Burger R. Michael , Seidl Armin H. , Rubel Edwin W.
Published: May 2019

This chapter focuses on the microcircuitry of the chicken nucleus laminaris (NL), which is an excellent example of neural architecture exquisitely tailored for its specialized function in sound localization. Neurons in NL are binaural coincidence detectors, encoding temporal information of sound arriving at the two ears by responding maximally when resulting action potentials arrive simultaneously. The text will discuss the important anatomical and physiological specializations of NL that optimize this fundamental ability for binaural hearing in most birds and mammals.
Respiratory Central Pattern Generator: Microcircuit Generation of the Rhythms and Patterns of Breathing
Authors: Kam Kaiwen , Feldman Jack L.
Published: May 2019

Breathing is a vital rhythmic motor behavior that mediates gas exchange to support metabolism and regulate pH. All mammals must breathe continuously and reliably from birth and modulate their breathing throughout life in response to changes in metabolic demand and environmental stimuli. A number of congenital and neurodegenerative disorders affect the neural control of breathing in humans and lead to serious adverse health consequences, even death. Since the previous edition of this book, there have been considerable advances in our understanding of the breathing central pattern generator (CPG). This chapter focuses on the neural microcircuit within the preBötzinger Complex (preBötC); a second oscillator near the facial nucleus that appears to generate active expiration; and the microcircuit for sighing.
Neuronal Circuits That Generate Swimming Movements in Leeches
Authors: Friesen Wolfgang Otto
Published: May 2019

Swimming undulations in leeches arise from iterated segmental oscillators that are coupled by intersegmental interactions. Oscillator subunits, comprising individually identified intersegmental interneurons (INs) and local inhibitory motoneurons, control the activity of excitatory motoneurons that command body wall tension. Synaptic interactions within ganglia are almost exclusively non-spike-mediated; however, intersegmental connections, which together with sensory feedback from segmental muscle tension receptors set rostrocaudal phase lags, are mediated by impulses. The latter have an interganglionic transit time of about 15 ms. Overall, swimming in leeches is generated by local oscillators linked by individually weak, but in the aggregate strong, intersegmental interactions. Driven by an extensive set of multisegmental excitatory interneurons, the system functions as a unit.
The Swimming Circuit in the Pteropod Mollusk Clione limacina
Authors: Arshavsky Yuri I. , Deliagina Tatiana G. , Orlovsky Grigory N.
Published: May 2019

The pelagic marine mollusk Clione limacina (class Gastropoda, subclass Opisthobranchaea, order Pteropoda), 3–5 cm in length, swims by rhythmically moving (1–2-Hz) two winglike appendages. Each swim cycle consists of two phases—the dorsal (D) and ventral (V) wing flexions. The nervous system of Clione consists of five pairs of ganglia. The wing movements are controlled by the pedal ganglia giving rise to the wing nerves. The neuronal circuit of the swim central pattern generator (CPG) is located in the pedal ganglia, which is able to generate the basic pattern of rhythmic activity after isolation from the organism (fictive swimming). Approximately 120 pedal neurons exhibit rhythmic activity during fictive swimming. According to their morphology, rhythmic neurons are divided into motoneurons (MNs), with axons exiting via the wing nerves to wing muscles, and interneurons (INs), with axons projecting to the contralateral ganglion.
Travel-Related Infectious Diseases
Authors: Brunette Gary W. , Nemhauser Jeffrey B.
Published: May 2019

Amebiasis

Jennifer R. Cope, Ibne K. Ali

Angiostrongyliasis, Neurologic

Anne Straily, Barbara L. Herwaldt

Anthrax

Kate Hendricks, Antonio R. Vieira, Chung K. Marston

B Virus (Macacine Herpesvirus 1)

D. Scott Schmid

Bartonella Infections

Christina A. Nelson

Brucellosis

María E. Negrón, Rebekah Tiller, Grishma Kharod

Campylobacteriosis...
Health Care Abroad
Authors: Brunette Gary W. , Nemhauser Jeffrey B.
Published: May 2019

Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance

Rhett J. Stoney

Obtaining Health Care Abroad

Carolina Uribe

Avoiding Poorly Regulated Medicines and Medical Products During Travel

Michael D. Green

Travel Health Kits

Calvin Patimeteeporn

Severe illness or injury abroad may result in a financial burden to travelers. Travelers can substantially reduce their out-of-pocket costs for medical care received abroad by purchasing in advance specialized insurance policies for their trip, regardless of whether or not they have a domestic health insurance plan. The 3 types of policies are travel insurance, travel health insurance, and medical evacuation insurance. Each provides different types of coverage in the event of an illness or injury and may be of particular importance to travelers with preexisting medical conditions....
Travel by Air, Land & Sea
Authors: Brunette Gary W. , Nemhauser Jeffrey B.
Published: May 2019

Air Travel

Paul J. Edelson, Phyllis E. Kozarsky, Clive Brown

Deep Vein Thrombosis & Pulmonary Embolism

Nimia L. Reyes, Michele G. Beckman, Karon Abe

Jet Lag

Greg Atkinson, Ronnie Henry, Alan M. Batterham, Andrew Thompson

Road & Traffic Safety

Erin K. Sauber-Schatz, Erin M. Parker...
Cranial Nerves
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: May 2019

This chapter describes each cranial nerve (CN I through XII) and the Handles and Red Flags associated with disorders of each. These range from trauma, neoplastic lesions, infectious and inflammatory causes, and the effects of aging, to psychological manifestations. Diagnosing disorders of the cranial nerves requires various combinations of history and careful examination.
Stroke
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: May 2019

This chapter outlines Handles of importance in the history of stroke and transient ischemic attack. It explores how a stroke or transient ischemic attack may be distinguished from migraine, seizure, syncope, and amyloid spells. Disorders that mimic a stroke and focal cortical and brainstem syndromes are elaborated. Features that would allow the identification of internal carotid artery stenosis are delineated. Unusual cortical syndromes are identified, such as the cortical borderzone infarct, man-in-a-barrel syndrome, Fabry’s syndrome and Susac’s syndrome, cerebral hyperperfusion syndrome, CADASIL, crossed monoparesis, top of the basilar syndrome, one-and-a-half syndrome. Specific lacunar stroke and cortical sinus thrombosis disorders are detailed.
Primary Care and the Social Determinants of Health: Lessons on Care Models, Capacity, and Culture for the Journey Upstream
Authors: Manchanda Rishi
Published: May 2019

This chapter looks at the issue of advances in public health and efforts with collaboration from the perspective of a primary care physician at a community health center. It specifically looks at how much has evolved in a ten-year span. Thanks to increasing payer commitment to value-based care, the concept of moving forwards to address social determinants of health appears to be entering the mainstream in US health care. If the last decade was about health care's awakening to the realities of social determinants of health and why they matter, the next ten years will hopefully focus on how to address them as clinicians, as organizations, and as partners to the civic, public health, and social sector peers.
The Role of Primary Care in Population and Community Health: Pragmatic Approaches to Integration
Authors: Wood Julie , Grumbach Kevin
Published: May 2019

This chapter looks at the role of primary health care in community health. Primary care, it argues, has built on its historical roots of holistic family-centered care to embrace the broader concept of population health. The chapter looks at the evolution of care models from patient/family-centered to panel management (the sum of patients being cared for by a primary care practice), to community health management. This broader concept of health necessitates collaboration with partners outside the clinical practice, including public health professionals, policymakers, schools, housing, parks and recreation, law enforcement, transportation, and food systems. The chapter describes the population and community framework and its historical role in the development of primary care, and then turns to the proposal of pragmatic approaches that busy primary care clinicians and care teams can use to integrate population health approaches into their practices.
The Role of Elected Officials in Multisector Partnerships
Authors: Garcia Sylvia , Mendoza Elsa
Published: May 2019

This chapter presents a personal perspective on how multi-sector collaborations can appear to produce superior results. The chapter tells the story of the Near Northside community in Houston. It describes in detail the formation and success of an initiative called the Safe Walk Home initiative. It provides an analysis on what constitutes an effective collaboration between constituents and elected officials, and elected officials and health care professionals.
Engaging Elected Officials to Improve Community Health
Authors: Hunter Edward L.
Published: May 2019

Improving the health of populations and communities requires all sorts of actors to be involved. This chapter looks at the importance of involving elected officials in collaboration for community health improvements. Elected officials can be important allies in efforts to achieve health goals at all levels of government it states, but these people are often overlooked as potential collaborators. In fact, the chapter notes, public health and health care partners can enhance the impact of cross-sector collaborations with greater awareness and preparation for working with elected officials. The chapter ends with some useful tips for engaging with public officials.
Case Study—Addressing Behavioral Health with a Multisector Approach: Why We Started Community of Solutions
Authors: Phillips Robert L. , Davis Carol V. , Phillips Ethan J. , Davies Heather , Flowe Valerie , Quick Mary Beth , Terry Lauren
Published: May 2019

This chapter shares a compelling and personal story of collaboration among primary care, mental health, schools, students, foundations, and government which aimed to reduce the risk of suicide in a given community. The chapter notes both positive and some negative experiences that the “community of solutions” faced in reducing substance abuse and building student resiliency.
Overview—Innovation: Enhancing Coordinated Impact Through New Roles and Tools
Authors: Michener J. Lloyd , Hunter Edward L.
Published: May 2019

This chapter looks forward to the next set of chapters in this book which broadly speaking cover the topic of innovation in public health collaborations. This section of the book provides a concise overview of the types and forms of innovation, the factors driving it, guidance on some of the more successful innovations that are under way, and how to engage in those changes. Innovation does not need to be new as such. It also can be facilitated by new partners, from new perspectives, and using new tools. Not all innovation is effective. The chapter gives an overview of future directions for innovation, which will be covered in one of the chapters in this section.
Identifying and Addressing Patients’ Social Needs in Health Care Delivery Settings
Authors: Gottlieb Laura , Fichtenberg Caroline
Published: May 2019

This chapter describes both patient- and community-level risk assessment tools and provides a framework for existing intervention models. It also highlights emerging payment models that may facilitate health care delivery-based social and economic needs screening and interventions, and underscore outstanding knowledge gaps in this rapidly evolving field. In response to mounting evidence that patients' social and economic risk factors affect health and could be important targets for reducing health care costs, a wave of health care innovation has emerged around identifying and addressing patients' social needs as part of clinical care delivery. Future work is needed, however, to explore the workforce needed to support social health screening and intervention programs, the role of technology, and policy and payment reforms needed.
Overview—Sustainability and Finance: Supporting Partnerships over Time
Authors: Thomas Craig W. , Castrucci Brian C.
Published: May 2019

This chapter introduces the next section of the book which is about sustainability and finance when it comes to cross-sector collaboratives for population health improvements. It states that the focus should be on closing the gap when it comes to health disparities and a goal needs to be reducing the need for health care services. Effectively acquiring, managing, and sustaining financial investments in health is fundamental to the success of multi-sector and community-led health improvement initiatives. The chapter outlines the topics covered by the individual chapters in this section.
Rethinking the Mission of Health Systems: Improving Community Health as Anchor Institutions
Authors: Zuckerman David , Ansell David , Davis Michellene
Published: May 2019

This chapter describes a new and compelling role for hospitals and health systems as anchor institutions. Representing significant economic and human capital resources, anchor institutions are grounded, sound business practices, and in the realities of the local communities they serve, they are well placed to effectively align, leverage, and invest resources to improve the health of their communities. An important and highly effective partner for health, examples of successful institutions that have adopted this approach are described, as is a national network to help hospitals and other institutions adopt and advance an anchor mission within their organizations and communities.
Shaping the Next Generation of Providers
Authors: Mattson Gerri , Remley Karen
Published: May 2019

This chapter is about the changing role of the primary carer in the health setting with a particular focus on the training of primary carers. Primary care providers are already increasingly called on to expand their practice beyond their traditional knowledge and skills in clinical medicine. The chapter looks at the population health competency of primary health carers. Primary care providers, once trained, in the community can serve as mentors for trainees, which can provide additional perspective and experience outside of the academic setting. The chapter goes on to argue that the health and well-being of the entire community are dependent on the collaborative work of health care providers, public health, community organizations, faith-based organizations, and the community itself. Understanding the myriad connections, competencies, and impacts of these partnerships allows clinicians to engage with the community early in their careers; to deepen their engagement, understanding, and ability over time; and to be effective advocates with and on behalf of the communities they serve.
Case Study: State Innovations in Rural Training
Authors: Martinsen Kristi , Goodman Michelle
Published: May 2019

This chapter's focus is on the development and implementation of innovative health care solutions in rural communities in the United States. It looks at the challenges for finding the most appropriate health care innovation in a rural community. The chapter gives a number of examples in order to provide a glimpse into initiatives and programs that assess community needs, address provider shortages in rural areas, and continue to bring a population health focus to the system of care in rural areas, given provider shortages.
Triumphs, Disasters, and Near Misses
Authors: Ryle Cym Anthony
Published: May 2019

This chapter refers to the evidence that error occurs in about 10% of diagnoses and is a potent source of harm to patients. Most error is judged to be potentially avoidable and to result from defects in the thinking of the individuals involved, defects in the systems within which they work, or more commonly from problems occurring simultaneously in both. It notes that systems factors and fallible cognition each contributes to this figure and often coexist. The chapter offers a set of clinical anecdotes that illustrate the cognitive processes described in Chapters 2 and 4, with examples of common pitfalls, including the influence of bias. The chapter includes critical reflection on these case studies, considers what lessons may be taken, and identifies opportunities for the introduction of safeguards.