bluuebunny/crossref_metadata_2025 huggingface dataset:
Laterally confined growth of cells induces nuclear reprogramming in the absence of exogenous biochemical factors
Authors: Roy Bibhas , Venkatachalapathy Saradha , Ratna Prasuna , Wang Yejun , Jokhun Doorgesh Sharma , Nagarajan Mallika , Shivashankar G. V.
Published: May 2018

Significance

In this study, we demonstrate a platform for reprogramming somatic cells with high efficiency in the absence of exogenous reprogramming factors. Sustained laterally confined growth of cells on micropatterned substrates results in sequential changes to the nucleus and chromatin with each cell division, leading to the progressive erasure of lineage specific characteristics and incorporation of pluripotency. After 10 days of confined growth, the cells exhibit stemness and have multilineage differentiation potential. Our observation highlights a previously unknown role of mechanical constraints in nuclear reprogramming. Our method provides a unique approach to greatly improve stem cell technologies for developing patient specific disease models and regenerative medicine.
Strategic investment explains patterns of cooperation and cheating in a microbe
Authors: Madgwick Philip G. , Stewart Balint , Belcher Laurence J. , Thompson Christopher R. L. , Wolf Jason B.
Published: May 2018

Significance

Contributing to cooperation is costly, while its rewards are often available to all members of a social group. Therefore, cooperation is vulnerable to exploitation by individuals that do not contribute but nevertheless share the benefits. So why contribute to cooperation? This dilemma can be resolved if individuals modulate their ‟investment” into cooperation dependent on whether benefits go to relatives or nonrelatives, which maximizes the return on investment to their genes. To evaluate this idea, we derived a model for cooperative investment and tested its predictions using a social microbe that cooperatively builds a stalk to facilitate spore dispersal. We find that cooperative investment into stalk closely matches predictions, with strains strategically adjusting investment according to their relatedness to their group.
Identification of cytokine-specific sensory neural signals by decoding murine vagus nerve activity
Authors: Zanos Theodoros P. , Silverman Harold A. , Levy Todd , Tsaava Tea , Battinelli Emily , Lorraine Peter W. , Ashe Jeffrey M. , Chavan Sangeeta S. , Tracey Kevin J. , Bouton Chad E.
Published: May 2018

Significance

Evolution conferred animals with molecular sensors that monitor cellular and organ function to detect changes in the environment. These activate sensory neural responses that drive the action of reflexes that maintain cellular and physiological homeostasis. Recent advances reveal that neural reflexes modulate the immune system, but it was previously unknown whether cytokine mediators of immunity mediate specific neural signals. Here we develop methods to isolate and decode specific neural signals recorded from the vagus nerve to discriminate between the cytokines IL-1β and TNF. This methodological waveform successfully detects and discriminates between specific cytokine exposures using neural signals.
Specificity and robustness of long-distance connections in weighted, interareal connectomes
Authors: Betzel Richard F. , Bassett Danielle S.
Published: May 2018

Significance

Interareal communication occurs along physical pathways. The prevailing hypothesis is that long-distance connections reduce the processing length between brain areas, facilitating efficient communication. We show, in five weighted interareal network datasets, that the correlation of connection weight with distance implies that long-distance connections play only a minor role in reducing path length. Instead, long-distance connections add diversity to brain area inputs and outputs, leading to increasingly complex brain dynamics. These findings help to clarify our understanding of how brain structure contributes to interareal communication.
Convergent evolution of tertiary structure in rhodopsin visual proteins from vertebrates and box jellyfish
Authors: Gerrard Elliot , Mutt Eshita , Nagata Takashi , Koyanagi Mitsumasa , Flock Tilman , Lesca Elena , Schertler Gebhard F. X. , Terakita Akihisa , Deupi Xavier , Lucas Robert J.
Published: May 2018

Significance

Complex photoreceptors have independently evolved in animals with radial and bilateral symmetry, but little is known about the proteins that transduce light information (opsins) in radially symmetrical animals. We use homology modeling and heterologous action spectroscopy to study the structure of an opsin (JellyOp) from the lens eye of the visually competent box jellyfish,
Carybdea rastonii
. We find that a key structural feature of animal opsins—the counterion—maintains visible-light sensitivity in JellyOp from a unique location, E94 in the transmembrane bundle. This unique position for the counterion, the third only discovered in animal opsins, closely mirrors the location in vertebrate visual proteins, which was thought to be a unique adaptation in vertebrates to achieve higher fidelity photoreception.
Diurnal down-regulation of ethylene biosynthesis mediates biomass heterosis
Authors: Song Qingxin , Ando Atsumi , Xu Dongqing , Fang Lei , Zhang Tianzhen , Huq Enamul , Qiao Hong , Deng Xing Wang , Chen Z. Jeffrey
Published: May 2018

Significance

Heterosis is a fundamental biological phenomenon and important to crop and animal production. However, molecular mechanisms for heterosis remain elusive. Ethylene promotes fruit ripening but inhibits vegetative growth. Here we report that diurnal down-regulation of ethylene biosynthesis genes in
Arabidopsis thaliana
F1 hybrids corresponds to the decrease of ethylene production and biomass heterosis. Expression of
ACS
genes is diurnally and indirectly regulated by CCA1 during the day and directly regulated by PIF5 at night. Disruption of ethylene biosynthesis or signaling transduction leads to higher biomass, while application of exogenous ethylene reduced growth vigor, further validating the negative roles of ethylene in biomass heterosis. Thus, ethylene can integrate circadian rhythms and light signaling to regulate growth vigor in plant hybrids.
Flight motor networks modulate primary olfactory processing in the moth
Manduca sexta
Authors: Chapman Phillip D. , Burkland Rex , Bradley Samual P. , Houot Benjamin , Bullman Victoria , Dacks Andrew M. , Daly Kevin C.
Published: May 2018

Significance

Across vertebrates and invertebrates, corollary discharge circuits (CDCs) project to and inform sensory networks about an animal’s movements, which directly impact sensory processing. Failure of CDCs likely underlie sensory hallucinations in schizophrenia, Parkinson’s disease, and dyspnea, highlighting the fundamental importance of CDCs for successfully interpreting sensory cues to adaptively interact with the external world. Ultimately, understanding the role of CDCs in integrating sensory motor function will be vital to understand these diseases, but mechanistically little is known about how CDCs function. CDCs have been identified in most sensory domains except olfaction. Our findings indicate that a histaminergic CDC enhances the ability of the olfactory system to more precisely encode stimulus temporal structure, resulting in enhanced olfactory acuity.
T7 phage factor required for managing RpoS inEscherichia coli
Authors: Tabib-Salazar Aline , Liu Bing , Barker Declan , Burchell Lynn , Qimron Udi , Matthews Steve J. , Wigneshweraraj Sivaramesh
Published: May 2018

Significance

Viruses that infect bacteria (phages) represent the most abundant living entities on the planet, and many aspects of our fundamental knowledge of phage–bacteria relationships have been derived in the context of exponentially growing bacteria. In the case of the prototypicalEscherichia coliphage T7, specific inhibition of the housekeeping form of the RNA polymerase (Eσ70) by a T7 protein, called Gp2, is essential for the development of viral progeny. We now reveal that T7 uses a second specific inhibitor that selectively inhibits the stationary phase RNA polymerase (EσS), which enables T7 to develop well in exponentially growing and stationary phase bacteria. The results have broad implications for our understanding of phage–bacteria relationships and the therapeutic application of phages.
Structural basis for
Acinetobacter baumannii
biofilm formation
Authors: Pakharukova Natalia , Tuittila Minna , Paavilainen Sari , Malmi Henri , Parilova Olena , Teneberg Susann , Knight Stefan D. , Zavialov Anton V.
Published: May 2018

Significance

Nosocomial infections and infections of indwelling devices are major healthcare problems worldwide. These infections are strongly associated with the ability of pathogens to form biofilms on biotic and abiotic surfaces. Panantibiotic-resistant
Acinetobacter baumannii
is one of the most troublesome pathogens, capable of colonizing medical devices by means of Csu pili, an adhesive organelle that belongs to the widespread class of archaic chaperone–usher pili. Here, we report an atomic-resolution insight into the mechanism of bacterial attachment to abiotic surfaces. We show that archaic pili use a binding mechanism that enables bacterial adhesion to structurally variable substrates. The results suggest a simple and cheap solution to reduce infections of
A. baumannii
and related pathogens.
Looking for religious logos in Singapore
Authors: Fischer Johan
Published: May 2018

Within the last couple of decades, new types of religious logos have emerged. Notably, halal (in Arabic, halal literally means “permissible” or “lawful”) logos are increasingly appearing on products, certificates, websites as well as in restaurants, shops, and
advertisements globally. However, little empirical attention has been paid to these religious logos as elements of visual systems, or to their effects. This article fills that gap. I argue that religious logos are not well understood theoretically, conceptually, or empirically and that they
signify a new phase in logo development characterized by forms of religious regulation, certification, and standardization on a global scale. Building on empirical research on halal logos in Singapore, this paper shows that modern religious logos can fruitfully be explored at the interface
between archive studies and ethnography.
AC Power at Power Frequencies: Bilateral comparison between SASO NMCC and TÜBİTAK UME
Authors: Çaycı Hüseyin , Yılmaz Özlem , AlRobaish Abdullah M , AlAnazi Shafi S , AlAyali Ahmed R , AlRumie Rashed A
Published: May 2018

A supplementary bilateral comparison measurement on AC Power at 50/60 Hz between SASO NMCC (GULFMET) and TÜBİTAK UME (EURAMET) was performed with the primary power standards of each partner. Measurement methods and setups which are very similar of the participants, measurement results, calculation of differences in the results, evaluation of uncertainties are given within this report.

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCEM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Carbon footprints of 13 000 cities
Authors: Moran Daniel , Kanemoto Keiichiro , Jiborn Magnus , Wood Richard , Többen Johannes , Seto Karen C
Published: May 2018

While it is understood that cities generate the majority of carbon emissions, for most cities, towns, and rural areas around the world no carbon footprint (CF) has been estimated. The Gridded Global Model of City Footprints (GGMCF) presented here downscales national CFs into a 250 m gridded model using data on population, purchasing power, and existing subnational CF studies from the US, China, EU, and Japan. Studies have shown that CFs are highly concentrated by income, with the top decile of earners driving 30%–45% of emissions. Even allowing for significant modeling uncertainties, we find that emissions are similarly concentrated in a small number of cities. The highest emitting 100 urban areas (defined as contiguous population clusters) account for 18% of the global carbon footprint. While many of the cities with the highest footprints are in countries with high carbon footprints, nearly one quarter of the top cities (41 of the top 200) are in countries with relatively low emissions. In these cities population and affluence combine to drive footprints at a scale similar to those of cities in high-income countries. We conclude that concerted action by a limited number of local governments can have a disproportionate impact on global emissions.
Microglia: An Intrinsic Component of the Proliferative Zones in the Fetal Rhesus Monkey (Macaca mulatta) Cerebral Cortex
Authors: Barger Nicole , Keiter Janet , Kreutz Anna , Krishnamurthy Anjana , Weidenthaler Cody , Martínez-Cerdeño Verónica , Tarantal Alice F , Noctor Stephen C
Published: May 2018

Microglial cells are increasingly recognized as modulators of brain development. We previously showed that microglia colonize the cortical proliferative zones in the prenatal brain and regulate the number of precursor cells through phagocytosis. To better define cellular interactions between microglia and proliferative cells, we performed lentiviral vector-mediated intraventricular gene transfer to induce enhanced green fluorescent protein expression in fetal cerebrocortical cells. Tissues were collected and counterstained with cell-specific markers to label microglial cells and identify other cortical cell types. We found that microglial cells intimately interact with the radial glial scaffold and make extensive contacts with neural precursor cells throughout the proliferative zones, particularly in the rhesus monkey fetus when compared to rodents. We also identify a subtype of microglia, which we term ‘periventricular microglia’, that interact closely with mitotic precursor cells in the ventricular zone. Our data suggest that microglia are structural modulators that facilitate remodeling of the proliferative zones as precursor cells migrate away from the ventricle and may facilitate the delamination of precursor cells. Taken together, these results indicate that microglial cells are an integral component of cortical proliferative zones and contribute to the interactive milieu in which cortical precursor cells function.
Universal Series for Hilbert Schemes and Strange Duality
Authors: Johnson Drew
Published: May 2018

We show how the “finite Quot scheme method” applied to Le Potier’s strange duality on del Pezzo surfaces leads to conjectures (valid for all smooth complex projective surfaces) relating two sets of universal power series on Hilbert schemes of points on surfaces: those for top Chern classes of tautological sheaves and those for Euler characteristics of line bundles. We have verified these predictions computationally for low order. We then give an analysis of these conjectures in small ranks. We also give a combinatorial proof of a formula predicted by our conjectures: the top Chern class of the tautological sheaf on $S^{[n]}$ associated to the structure sheaf of a point is equal to $(-1)^n$ times the nth Catalan number.
Hospitals’ adoption of intra-system information exchange is negatively associated with inter-system information exchange
Authors: Vest Joshua R , Simon Kosali
Published: May 2018

Introduction

U.S. policy on interoperable HIT has focused on increasing inter-system (ie, between different organizations) health information exchange. However, interoperable HIT also supports the movement of information within the same organization (ie, intra-system exchange).

Methods

We examined the relationship between hospitals’ intra- and inter-system information exchange capabilities among health system hospitals included in the 2010-2014 American Hospital Association’s Annual Health Information Technology Survey. We described the factors associated with hospitals that adopted more intra-system than inter-system exchange capability, and explored the extent of new capability adoption among hospitals that reported neither intra- or inter-system information capabilities at baseline.

Results

The prevalence of exchange increased over time, but the adoption of inter-system information exchange was slower; when hospitals adopt information exchange, adoption of intra-system exchange was more common. On average during our study period, hospitals could share 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange. Controlling for other factors, hospitals exchanged more types of information in an intra-system manner than inter-system when the number of different inpatient EHR vendors in use in health system is larger.

Conclusion

Consistent with the U.S. goals for more widely accessible patient information, hospitals’ ability to share information has increased over time. However, hospitals are prioritizing within-organizational information exchange over exchange between different organizations. If increasing inter-system exchanges is a desired goal, current market incentives and government policies may be insufficient to overcome hospitals’ motivations for pursuing an intra-system-information-exchange-first strategy.
Evaluating utility and compliance in a patient-based eHealth study using continuous-time heart rate and activity trackers
Authors: Speier William , Dzubur Eldin , Zide Mary , Shufelt Chrisandra , Joung Sandy , Van Eyk Jennifer E , Bairey Merz C Noel , Lopez Mayra , Spiegel Brennan , Arnold Corey
Published: May 2018

Telemedicine has been used to remotely diagnose and treat patients, yet previously applied telemonitoring approaches have been fraught with adherence issues. The primary goal of this study was to evaluate the adherence rates using a consumer-grade continuous-time heart rate and activity tracker in a mid-risk cardiovascular patient population. As a secondary analysis, we show the ability to utilize the information provided by this device to identify information about a patient’s state by correlating tracker information with patient-reported outcome survey scores. We showed that using continuous-time activity trackers with heart rate monitors can be effective in a telemonitoring application, as patients had a high level of adherence (90.0% median usage) and low attrition (0.09% decrease per day) over a 90-day period. Furthermore, data collected correlated significantly with clinically relevant patient surveys (r2=0.15 for PROMIS global health scores, p < .00001), and therefore might provide an effective signal for identifying patients in need of intervention.
Conversational agents in healthcare: a systematic review
Authors: Laranjo Liliana , Dunn Adam G , Tong Huong Ly , Kocaballi Ahmet Baki , Chen Jessica , Bashir Rabia , Surian Didi , Gallego Blanca , Magrabi Farah , Lau Annie Y S , Coiera Enrico
Published: May 2018

Objective

Our objective was to review the characteristics, current applications, and evaluation measures of conversational agents with unconstrained natural language input capabilities used for health-related purposes.

Methods

We searched PubMed, Embase, CINAHL, PsycInfo, and ACM Digital using a predefined search strategy. Studies were included if they focused on consumers or healthcare professionals; involved a conversational agent using any unconstrained natural language input; and reported evaluation measures resulting from user interaction with the system. Studies were screened by independent reviewers and Cohen’s kappa measured inter-coder agreement.

Results

The database search retrieved 1513 citations; 17 articles (14 different conversational agents) met the inclusion criteria. Dialogue management strategies were mostly finite-state and frame-based (6 and 7 conversational agents, respectively); agent-based strategies were present in one type of system. Two studies were randomized controlled trials (RCTs), 1 was cross-sectional, and the remaining were quasi-experimental. Half of the conversational agents supported consumers with health tasks such as self-care. The only RCT evaluating the efficacy of a conversational agent found a significant effect in reducing depression symptoms (effect size d = 0.44, p = .04). Patient safety was rarely evaluated in the included studies.

Conclusions

The use of conversational agents with unconstrained natural language input capabilities for health-related purposes is an emerging field of research, where the few published studies were mainly quasi-experimental, and rarely evaluated efficacy or safety. Future studies would benefit from more robust experimental designs and standardized reporting.

Protocol Registration

The protocol for this systematic review is registered at PROSPERO with the number CRD42017065917.
Patient informaticians: Turning patient voice into patient action
Authors: Petersen Carolyn
Published: May 2018

Historically, patients have held a passive role within healthcare, seeking consultation from and following the directions of providers and their care teams. However, changes in culture, education, and technology are making it possible for patients to proactively develop and implement technologies and approaches for health management and quality of life enhancement—to act as patient informaticians. This perspective reviews the societal shifts facilitating the evolution of patient informaticians as discrete actors within healthcare, describes the work of patient informaticians and how this work differs from that of other patient roles (eg, patient advocates), considers examples of patient informaticians in action, and defines patient informaticians’ position relative to the healthcare system.
Bootstrap Prediction Intervals for Small Area Means from Unit-Level Nonlinear Models
Authors: Erciulescu Andreea L , Fuller Wayne A
Published: May 2018

For analyses based on nonlinear models, agencies and policy makers are often interested in prediction intervals for small area means. We give statistics for small area predictions that can be used to construct prediction intervals in the same way that standard errors and degrees of freedom are used to construct prediction intervals based on the Student-t distribution. In a simulation study, the new parametric bootstrap prediction interval has good coverage properties and much better coverage than the bootstrap percentile prediction interval. The methods are applied in a study of soil erosion and water runoff conducted by the US Department of Agriculture.
Mobilization of the Anterior/Posterior Inferior Cerebellar Artery on the Cerebellar Surface in Microvascular Decompression Surgery for Hemifacial Spasm: Potential Effect on Hearing Preservation
Authors: Amagasaki Kenichi , Watanabe Saiko , Hosono Atushi , Nakaguchi Hiroshi
Published: May 2018

BACKGROUND

The infrafloccular approach in microvascular decompression (MVD) for hemifacial spasm (HFS) reduces the risk of postoperative hearing impairment. However, location of the anterior/posterior inferior cerebellar artery (AICA/PICA) on the cerebellar surface in the surgical route requires mobilization to maintain the approach direction for the protection of hearing function.

OBJECTIVE

To evaluate the effectiveness of mobilization of the AICA/PICA on the cerebellar surface in the surgical route.

METHODS

Retrospective review of 101 patients dividing their cases into 2 groups, the mobilized group and nonmobilized group. Surgical results, brainstem auditory evoked potentials (BAEPs), age, and duration of microsurgery were compared. In the mobilized group, whether the artery was responsible for the HFS or not, and whether the artery branched perforators to the cerebellar surface or choroid plexus or not, were analyzed.

RESULTS

No permanent hearing impairment occurred in any patient. The AICA/PICA was mobilized in 26 patients. No significant difference was found in surgical results, BAEP findings, and duration of microsurgery between the 2 groups, but age was younger in the mobilized group (P < .01). The mobilized artery was responsible in 14 cases and branched perforators in 7 cases in the mobilized group. The perforators did not obstruct mobilization.

CONCLUSION

Mobilization of the AICA/PICA from the cerebellar surface is a useful technique to maintain the infrafloccular approach in MVD for HFS. This technique reduces the risk of postoperative hearing impairment.
A 4-year randomized trial comparing three outreach interventions to promote screening mammograms
Authors: Luckmann Roger , Costanza Mary E , White Mary Jo , Frisard Christine F , Rosal Milagros , Sama Susan , Landry Michelle R , Yood Robert
Published: May 2018

As population health has become a focus of health care payers and providers, interest has grown in mail, phone, and other forms of outreach for improving population rates of cancer screening. Translational research is needed to compare the effectiveness and cost of low- and high-intensity behavioral outreach interventions for promoting cancer screening. The purpose of the article is to compare the effectiveness in promoting biannual mammograms of three interventions delivered over 4 years to a primary care population with a high baseline mammography adherence of 83.3%. We randomized women aged 40–84 to reminder letter only (LO arm), letter + reminder call (RC arm), and two letters + counseling call (CC arm) involving tailored education and motivational interviewing. Mammography adherence (≥1 mammogram in the previous 24 months) at four time points was determined from insurance claims records. Over 4 years, 30,162 women were randomized. At the end of 4 years, adherence was highest in the RC arm (83.0%) compared with CC (80.8%) and LO (80.8%) arms (p = .03). Only 23.5% of women in the CC arm were reached and accepted full counseling. The incremental cost per additional mammogram for RC arm women was $30.45 over the LO arm cost. A simple reminder call can increase screening mammogram adherence even when baseline adherence is high. Some more complex behavioral interventions delivered by mail and phone as in this study may be less effective, due to limited participation of patients, a focus on ambivalence, lack of follow-up, and other factors.
Cesarean Delivery: A Multimodality Imaging Review of Acute and Chronic Complications
Authors: Massa Peter Joseph , Rheinboldt Matthew
Published: May 2018

Cesarean deliveries account for approximately 30% of deliveries in the United States yearly.1 Approximately 14% of cesarean deliveries have associated short-term complications, most commonly endometritis or incisional cellulitis.2 Other complications include rectus sheath and bladder flap hematomas, endometrial hemorrhage, superficial and deep abscess formation, uterine dehiscence or rupture, ovarian vein thrombophlebitis, and, rarely, retained products of conception. Long-term risks include an increased incidence of ectopic implantation at the uterine scar site and potential invasive placentation, intrauterine device malpositioning, and endometriosis within the abdominal wall incision site.2 Familiarity with both the normal appearance and the potential acute and chronic complications of the patient with postpartum cesarean delivery will facilitate timely and accurate diagnosis and expedite appropriate patient care.
Shifting and Sharing: Academic Physicians’ Strategies for Navigating Underperformance and Failure
Authors: LaDonna Kori A. , Ginsburg Shiphra , Watling Christopher
Published: May 2018

Purpose

Medical practice is uncertain and complex. Consequently, even outstanding performers will inevitably experience moments of underperformance and failure. Coping relies on insight and resilience. However, how physicians develop and use these skills to navigate struggle remains underexplored. A better understanding may reveal strategies to support both struggling learners and stressed practitioners.

Method

In 2015, 28 academic physicians were interviewed about their experiences with underperformance or failure. Constructivist grounded theory informed data collection and analysis.

Results

Participants’ experiences with struggle ranged from patient errors and academic failures to frequent, smaller moments of interpersonal conflict and work–life imbalance. To buffer impact, participants sometimes shifted their focus to an aspect of their identity where they felt successful. Additionally, although participants perceived that insight develops by acknowledging and reflecting on error, they sometimes deflected blame for performance gaps. More often, participants seemed to accept personal responsibility while simultaneously sharing accountability for underperformance or failure with external forces. Paradoxically, participants perceived learners who used these strategies as lacking in insight.

Conclusions

Participants demonstrated the protective and functional value of distributing responsibility for underperformance and failure. Shifting and sharing may be an element of reflection and resilience; recognizing external factors may provide a way to gain perspective and to preserve the self. However, this strategy challenges educators’ assumptions that learners who deflect are avoiding personal responsibility. The authors’ findings raise questions about what it means to be resilient, and how assumptions about learners’ responses to failure may affect strategies to support underperforming learners.
“Being on Both Sides”: Canadian Medical Students’ Experiences With Disability, the Hidden Curriculum, and Professional Identity Construction
Authors: Stergiopoulos Erene , Fernando Oshan , Martimianakis Maria Athina
Published: May 2018

Purpose

Medical students with disabilities hold firsthand knowledge as health care recipients, yet face barriers to disclosure and support. Their experiences provide a unique lens for understanding professional identity construction; this study explored how disabled medical students experience training as both patients and trainees.

Method

The authors conducted qualitative interviews with 10 medical students at the University of Toronto Faculty of Medicine with self-identified disabilities. They performed textual analysis of documents concerning medical student wellness from 13 Canadian universities, including policies, student services, and student blogs (July 2016 to March 2017). Using principles of critical discourse analysis, the authors coded the interviews and texts to identify operating discourses and core themes, drawing from sociocultural theories of professional identity construction and the hidden curriculum.

Results

Two dominant discourses emerged from the interviews and texts, revealing institutionalized notions of the perceived “good student” and “good patient.” These roles held contradictory demands, demonstrating how institutions often implicitly and explicitly framed wellness as a means to optimal academic performance. Two additional themes, “identity compartmentalization” and “identity intersection,” captured students’ experiences navigating identities as patients and trainees. Although students lacked explicit opportunities to express their expertise as patients in the formal curriculum, their experiences in both roles led to improved communication, advocacy, and compassion.

Conclusions

Institutional discourses around disability and academic performance hold material implications for curricular content, clinical teaching, and availability of supports in medical school. By repositioning students’ experiences with disability as sources of expertise, this study highlights opportunities for teaching compassionate care.
Does the Neuroimmune Modulator Ibudilast Alter Food Craving? Results in a Sample With Alcohol Use Disorder
Authors: Cummings Jenna R. , Tomiyama A. Janet , Ray Lara A.
Published: May 2018

Objective:

Ibudilast (IBUD) is a neuroimmune modulator that inhibits phosphodiesterase-4 and -10 and macrophage migration inhibitory factor. A randomized, placebo-control, crossover human laboratory trial advanced IBUD development for alcohol use disorder and found that IBUD reduced tonic levels of alcohol craving. Given the importance of considering medication effects on other appetitive behavior, the present study tested the effect of IBUD (50 mg bid) on food craving.

Method:

The present study was a secondary data analysis of the trial of IBUD in non-treatment seekers with alcohol use disorder (N = 19). High-fat/high-sugar food craving was measured daily. Moreover, because substantial literatures show that small alcohol doses and psychological stress increase eating of high-fat/high-sugar food, craving for high-fat/high-sugar food was measured after alcohol infusion and stress reactivity.

Results:

Results indicated that IBUD did not alter tonic high-fat/high-sugar food craving. Alcohol infusion did not generally increase high-fat/high-sugar food craving but psychological stress did. Likewise, IBUD did not affect high-fat/high-sugar food craving after alcohol infusion but IBUD did increase high-fat/high-sugar food craving after psychological stress. Follow-up analyses revealed that, among individuals with lower depressive symptomatology, IBUD compared to placebo heightened the effect of psychological stress on high-fat/high-sugar food craving.

Conclusions:

These results advance the development of IBUD for addiction indications by demonstrating that IBUD compared to placebo does not suppress other appetitive responses, namely craving for high-fat/high-sugar food among individuals with alcohol use disorder.
Staff Nurse Perceptions of Open-Pod and Single Family Room NICU Designs on Work Environment and Patient Care
Authors: Winner-Stoltz Regina , Lengerich Alexander , Hench Anna Jeanine , O'Malley Janet , Kjelland Kimberly , Teal Melissa
Published: May 2018

Background:

Neonatal intensive care units have historically been constructed as open units or multiple-bed bays, but since the 1990s, the trend has been toward single family room (SFR) units. The SFR design has been found to promote family-centered care and to improve patient outcomes and safety. The impact of the SFR design NICU on staff, however, has been mixed.

Purpose:

The purposes of this study were to compare staff nurse perceptions of their work environments in an open-pod versus an SFR NICU and to compare staff nurse perceptions of the impact of 2 NICU designs on the care they provide for patients/families.

Methods/Search Strategy:

A prospective cohort study was conducted. Questionnaires were completed at 6 months premove and again at 3, 9, and 15 months postmove. A series of 1-way analyses of variance were conducted to compare each group in each of the 8 domains. Open-ended questions were evaluated using thematic analysis.

Findings/Results:

The SFR design is favorable in relation to environmental quality and control of primary workspace, privacy and interruption, unit features supporting individual work, and unit features supporting teamwork; the open-pod design is preferable in relation to walking.

Implications for Practice:

Incorporating design features that decrease staff isolation and walking and ensuring both patient and staff safety and security are important considerations.

Implications for Research:

Further study is needed on unit design at a microlevel including headwall design and human milk mixing areas, as well as on workflow processes.
Motivational Profiles and Motivation for Lifelong Learning of Medical Specialists
Authors: van der Burgt Stéphanie M. E. , Kusurkar Rashmi A. , Wilschut Janneke A. , Tjin A Tsoi Sharon L. N. M. , Croiset Gerda , Peerdeman Saskia M.
Published: May 2018

Introduction:

Medical specialists face the challenge of maintaining their knowledge and skills and continuing professional development, that is, lifelong learning. Motivation may play an integral role in many of the challenges facing the physician workforce today including maintenance of a high performance. The aim of this study was to determine whether medical specialists show different motivational profiles and if these profiles predict differences in motivation for lifelong learning.

Methods:

An online questionnaire was sent to every medical specialist working in five hospitals in the Netherlands. The questionnaire included the validated Multidimensional Work Motivation Scale and the Jefferson Scale of Physician Lifelong Learning together with background questions like age, gender, and type of hospital. Respondents were grouped into different motivational profiles by using a two-step clustering approach.

Results:

Four motivational profiles were identified: (1) HAMC profile (for High Autonomous and Moderate Controlled motivation), (2) MAMC profile (for Moderate Autonomous and Moderate Controlled motivation), (3) MALC profile (for Moderate Autonomous and Low Controlled motivation), and (4) HALC profile (for High Autonomous and Low Controlled motivation). Most of the female specialists that work in an academic hospital and specialists with a surgical specialty were represented in the HALC profile.

Discussion:

Four motivational profiles were found among medical specialists, differing in gender, experience and type of specialization. The profiles are based on the combination of autonomous motivation (AM) and controlled motivation (CM) in the specialists. The profiles that have a high score on autonomous motivation have a positive association with lifelong learning.
Comforting Comes Full Circle
Authors: McCroskey Diane
Published: May 2018

Nurses' personal grief and loss experiences can enhance their ability to comfort family members of seriously ill and dying patients. Spiritual care in these situations can include empathy, listening, and sharing of Scripture, when appropriate. Additionally, caring for emotional needs of patients in critical care situations also may enable a nurse to resolve personal grief experiences.
Driving Comparisons Between Young Adults with Autism Spectrum Disorder and Typical Development
Authors: Patrick Kristina E. , Hurewitz Felicia , McCurdy Mark D. , Agate Frederic Taylor , Daly Brian P. , Tarazi Reem A. , Chute Douglas L. , Schultheis Maria T.
Published: May 2018

Objective:

Many individuals with autism spectrum disorder (ASD) are reluctant to pursue driving because of concerns about their ability to drive safely. This study aimed to assess differences in simulated driving performance in young adults with ASD and typical development, examining relationships between driving performance and the level of experience (none, driver's permit, licensed) across increasingly difficult driving environments.

Method:

Participants included 50 English-speaking young adults (16–26 years old) with ASD matched for sex, age, and licensure with 50 typically-developing (TD) peers. Participants completed a structured driving assessment using a virtual-reality simulator that included increasingly complex environmental demands. Differences in mean speed and speed and lane variability by diagnostic group and driving experience were analyzed using multilevel linear modeling.

Results:

Young adults with ASD demonstrated increased variability in speed and lane positioning compared with controls, even during low demand tasks. When driving demands became more complex, group differences were moderated by driving experience such that licensed drivers with ASD drove similarly to TD licensed drivers for most tasks, whereas unlicensed drivers with ASD had more difficulty with speed and lane management than TD drivers.

Conclusion:

Findings suggest that young adults with ASD may have more difficulty with basic driving skills than peers, particularly in the early stages of driver training. Increased difficulty compared with peers increases as driving demands become more complex, suggesting that individuals with ASD may benefit from a slow and gradual approach to driver training. Future studies should evaluate predictors of driving performance, on-road driving, and ASD-specific driving interventions.
High-density poultry operations and community-acquired pneumonia in Pennsylvania
Authors: Poulsen Melissa N. , Pollak Jonathan , Sills Deborah L. , Casey Joan A. , Nachman Keeve E. , Cosgrove Sara E. , Stewart Dalton , Schwartz Brian S.
Published: May 2018

Background:

Air pollution from industrial food animal production may increase vulnerability to pneumonia among individuals living in nearby communities. We evaluated the association between individual-level residential proximity to high-density poultry operations and diagnosis with community-acquired pneumonia (CAP).

Methods:

We conducted a nested case–control study among patients of a large health system in Pennsylvania, USA. We used diagnostic codes for pneumonia and chest imaging from electronic health records from 2004 to 2015 to identify 11,910 child and adult cases of CAP and 59,550 frequency-matched outpatient controls. We estimated exposure to poultry operations using data from nutrient management plans, calculating an inverse-distance squared activity metric based on operation and residential addresses that incorporated number, size, and location of operations. Mixed effects logistic regression models evaluated associations between quartiles of the activity metric and CAP diagnosis. Models controlled for sex, age, race/ethnicity, Medical Assistance (proxy for low socioeconomic status), and smoking status.

Results:

Individuals living in the highest (versus lowest) quartile of the poultry operation metric had 66% increased odds of CAP diagnosis (adjusted odds ratio [confidence interval]) Q2, 0.98 [0.74, 1.31]; Q3, 1.17 [0.93, 1.46]; Q4, 1.66 [1.27, 2.18]).

Conclusions:

Findings suggest that living in closer proximity to more and larger poultry operations may increase risk of CAP, contributing to growing concern regarding public health impacts of industrial food animal production.
Genitourinary Syndrome of Menopause
Authors: SHIFREN JAN L.
Published: May 2018

Genitourinary syndrome of menopause (GSM) describes a collection of exam findings and bothersome symptoms associated with estrogen deficiency involving changes to the labia, introitus, clitoris, vagina, urethra, and bladder. Vulvovaginal atrophy is a component of GSM. GSM is a highly prevalent medical condition with adverse effects on the health and quality of life of midlife women. There are many effective treatment options, including nonhormonal lubricants and moisturizers, physical therapy, low-dose vaginal estrogen therapy, vaginal dehydroepiandrosterone, and oral ospemifene. Despite the availability of safe and effective therapies, GSM often remains unrecognized and untreated.
Management of Herpes Simplex Virus Keratitis in the Pediatric Population
Authors: Vadoothker Saujanya , Andrews Laura , Jeng Bennie H. , Levin Moran Roni
Published: May 2018

Herpes simplex virus (HSV) keratitis is a highly prevalent and visually disabling disease in both the pediatric and adult population. While many studies have investigated the treatment of HSV keratitis in adult patients, few have focused on managing this condition in children. Children are at particularly high risk for visual morbidity due to unique challenges in diagnosis and treatment, and the often more aggressive disease course that results in corneal scarring, and subsequently amblyopia. This review presents the pathogenesis and most current recommendations for the medical and surgical management of HSV keratitis in the pediatric population.
Decrease in the Prevalence of Methicillin-Resistant Staphylococcus Aureus Nasal Colonization of Children Admitted to Driscoll Children’s Hospital
Authors: Okoye Mekam T. , Sofowora Kolawole , Singh Amar , Fergie Jaime
Published: May 2018

Compared with a similar 2005 study, this 2016 study showed a significant decrease from 22% to 3% in the prevalence of methicillin-resistant Staphylococcus aureus nasal colonization in children admitted to our facility. Of the sampled 360 children, 21% were colonized with S. aureus and 14% of those isolates were methicillin-resistant S. aureus, whereas 61% of the isolates in 2005 were methicillin-resistant S. aureus.
Optimizing Gentamicin Dosing in Pediatrics Using Monte Carlo Simulations
Authors: Alsultan Abdullah , Abouelkheir Manal , Elsharawy Yasmine , Alkoraishi Aljawharah , Osman Reem , Neely Michael N. , Mansy Wael , Algahtani Saeed
Published: May 2018

Gentamicin is known to have concentration-dependent bactericidal activity, and its nephrotoxic effect is well described. We developed a population pharmacokinetic/pharmacodynamic model to optimize gentamicin dosing in pediatrics. Data were retrospectively collected for pediatric patients 1 month to 12 years of age, admitted to general pediatric wards or intensive care units and received gentamicin for suspected or proven Gram-negative infections at King Saud University Medical City, Riyadh, Saudi Arabia. A total of 306 gentamicin peak and trough concentrations sets from 107 patients were analyzed with mean (±standard deviation) patient age and weight of 4.5 ± 3.5 years and 16.7 ± 10.8 kg, respectively. Gentamicin pharmacokinetics were adequately described with a one compartment system (R
2 = 0.82, bias = 1.75% and precision = 88% for population predictions and R
2 = 0.94, bias = 5% and precision = 29% for individual predictions). The gentamicin pharmacokinetic parameters were as follows: volume of distribution = 8.9 L, total body clearance = 2.8 L/h for a 20-kg patient. Monte Carlo simulations showed that doses of 5–6 mg/kg/dose once daily are adequate only to treat infections with Gram-negative organisms having minimal inhibitory concentration less than 1 µg/mL. While, at minimal inhibitory concentration of 1 µg/mL, higher doses (7–8 mg/kg/dose once daily) are needed to maximize the efficacy of gentamicin. However, at minimal inhibitory concentration of 2 µg/mL, even a 10 mg/kg dose showed poor target attainment (52%). The finding of this study highlights the need to reevaluate the current breakpoints of gentamicin and also to assess the safety of higher doses of gentamicin in pediatrics.
Grip Force Control Using Prosthetic and Anatomical Limbs
Authors: Trujillo Michael S. , Russell Daniel M. , Anderson David I. , Mitchell Marilyn
Published: May 2018

Introduction

Skillful object manipulation in various activities of daily living requires accurate and economical modulation of grip force, yet experimental studies investigating grip force using a prosthesis are lacking. The purpose of this study was to compare grip force output between two types of upper-limb prosthetic prehensors. We hypothesized a relationship between grip force output and the muscular tension needed to control the prehensor.

Materials and Methods

Ten able-bodied participants attempted to produce a static target grip force using a voluntary opening and voluntary closing prosthetic simulator and their anatomical hand. The target forces were 0.49 N, 4 N, and 10.5 N. Each target force was produced three times, with and without augmented visual feedback. Performance was evaluated for error and variability.

Results

Using the voluntary closing device resulted in more accuracy and less variability for two of the three grip forces and followed the same trends as the anatomical hand, both of which performed inversely to the voluntary opening device.

Conclusions

Compared with the voluntary opening prosthesis, there may exist a more intuitive compatibility between the muscle tension used to control cable tension of a voluntary closing prosthesis and the resulting grip force of the prehensor that may benefit performance on some tasks.