bluuebunny/crossref_metadata_2025 huggingface dataset:
Cosmic voids uncovered – first-order statistics of depressions in the biased density field
Authors: Ronconi T , Contarini S , Marulli F , Baldi M , Moscardini L
Published: July 2019

Cosmic voids occupy most of the volume of the Universe, and their statistical properties can be exploited for constraining dark energy, as well as for testing theories of gravity. Nevertheless, in spite of their growing popularity as cosmological probes, a gap of knowledge between cosmic void observations and theory still persists. In particular, the void size function models proposed in literature have been proven unsuccessful in reproducing the results obtained from cosmological simulations in which cosmic voids are detected from biased tracers of the density field. The goal of this work is to cover this gap. In particular, we make use of the findings of a previous work in which we have improved the void selection procedure, presenting an algorithm that redefines the void ridges and, consequently, their radii. By applying this algorithm, we validate the volume conserving model of the void size function on a set of unbiased simulated density field tracers. We highlight the difference in the internal structure between voids selected in this way and those identified by the popular vide void finder. We also extend the validation of the model to the case of biased tracers. We find that a relation exists between the tracer used to sample the underlying dark matter density field and its unbiased counterpart. Moreover, we demonstrate that, as long as this relation is accounted for, the size function is a viable approach for studying cosmology with cosmic voids.
M87 black hole mass and spin estimate through the position of the jet boundary shape break
Authors: Nokhrina E E , Gurvits L I , Beskin V S , Nakamura M , Asada K , Hada K
Published: July 2019

We propose a new method of estimating the mass of a supermassive black hole residing in the centre of an active galaxy. The active galaxy M87 offers a convenient test case for the method due to the existence of a large amount of observational data on the jet and ambient environment properties in the central area of the object. We suggest that the observed transition of a jet boundary shape from a parabolic to a conical form is associated with the flow transiting from the magnetically dominated regime to the energy equipartition between plasma bulk motion and magnetic field. By coupling the unique set of observations available for the jet kinematics, environment and boundary profile with our MHD modelling under assumption on the presence of a dynamically important magnetic field in the M87 jet, we estimate the central black hole mass and spin. The method leads us to believe that the M87 supermassive black hole has a mass somewhat larger than typically accepted so far.
Structural characterization of Class 2 OLD family nucleases supports a two-metal catalysis mechanism for cleavage
Authors: Schiltz Carl J , Lee April , Partlow Edward A , Hosford Christopher J , Chappie Joshua S
Published: July 2019

Overcoming lysogenization defect (OLD) proteins constitute a family of uncharacterized nucleases present in bacteria, archaea, and some viruses. These enzymes contain an N-terminal ATPase domain and a C-terminal Toprim domain common amongst replication, recombination, and repair proteins. The in vivo activities of OLD proteins remain poorly understood and no definitive structural information exists. Here we identify and define two classes of OLD proteins based on differences in gene neighborhood and amino acid sequence conservation and present the crystal structures of the catalytic C-terminal regions from the Burkholderia pseudomallei and Xanthamonas campestris p.v. campestris Class 2 OLD proteins at 2.24 Å and 1.86 Å resolution respectively. The structures reveal a two-domain architecture containing a Toprim domain with altered architecture and a unique helical domain. Conserved side chains contributed by both domains coordinate two bound magnesium ions in the active site of B. pseudomallei OLD in a geometry that supports a two-metal catalysis mechanism for cleavage. The spatial organization of these domains additionally suggests a novel mode of DNA binding that is distinct from other Toprim containing proteins. Together, these findings define the fundamental structural properties of the OLD family catalytic core and the underlying mechanism controlling nuclease activity.
Archaeology and Material Culture of Phoenicia and the Phoenicians
Authors: Lehmann Gunnar
Published: July 2019

The Phoenicians are the population of ancient Lebanon during the first millennium bce. However, Phoenician settlement was also located on the coast of modern Syria and Israel. The Phoenicians were not immigrants and developed out of the local Bronze Age populations of the second millennium bce. Some scholars do not distinguish the Late Bronze Age (1550–1150 bce) city-states of Lebanon from those of the Phoenicians in the Iron Age of the 1st millennium bce. Rather than defining “Phoenicia” with ethnic features, the approach chosen here emphasizes aspects of the political economy. With the sociopolitical changes at the end of the Late Bronze Age, new communities emerged with a specific pattern of social and political organization and economic activities that increasingly included “private” entrepreneurial initiatives. With these developments, a new form of Levantine city-state emerged from previous Bronze Age formations. Another specific feature of the Phoenician phenomenon is the development of an alphabetic writing that had significant influence on ancient scripts of the first millennium bce, such as Hebrew, Aramaic, or ancient Greek writing. This bibliography focuses on the archaeology of the Phoenician homeland in the Levant during the Iron Age and the Persian period (c. 1150–330 bce). Scholars have repeatedly investigated the problem of defining the Phoenicians—if this is at all possible. The appellation “Phoenicians” originates in ancient Greek views and does not represent the self-definition of “Phoenicians” themselves, who preferred to identify themselves with their urban communities, such as “man of Tyre” or “woman of Arwad.” The unprecedented rise of the Phoenician economy after the ninth century bce had a significant impact on social and cultural changes in the Levant and the Mediterranean. Phoenician material culture appeared in all the neighboring economies of Phoenicia and led eventually to a colonization in the western Mediterranean. However one wants to define the Phoenicians, they were among the principal agents of an early globalization of the Mediterranean and the ancient Near East.
Richard Maidstone
Authors: Russell Arthur
Published: July 2019

Richard Maidstone (d. 1396) was a Carmelite friar, theologian, and poet whose career flourished during the reign of Richard II (r. 1377–1399). Maidstone is thought to hail from Kent, perhaps near Aylesford, where he joined the Carmelite order. Maidstone’s name first appears in the registers of bishop William Wykeham (b. 1367–d. 1404), who presided over his ordination on 20 December 1376 at the convent church of Merton priory in London. Sometime before 1390, Maidstone moved to Oxford, where he earned a bachelor degree and, presumably, a doctorate in theology; his records of attendance and degrees granted have yet to be discovered. While at Oxford, he authored a series of Latin theological treatises and sermons on the office of the priesthood, interpretation of scripture, and in defense of apostolic poverty. During this period, Maidstone likely composed his verse translation and meditation on the seven penitential psalms in Middle English. Maidstone obtained license to preach and hear confession in the diocese of Rochester in 1390 and, soon after, is believed to have served as confessor to John of Gaunt. Maidstone’s surviving Anglo-Latin court poetry includes Concordia, celebrating Richard II’s return to London in 1393, and possibly “Nobis natura florem,” commemorating the death of Anna of Bohemia in 1394. Richard Maidstone died on 1 June 1396 and was laid to rest in the cloister at Aylesford.
Environmental Flows
Authors: Morrison Ryan , Bray Erin
Published: July 2019

Environmental flows are commonly defined as the river-flow characteristics necessary to maintain the integrity of riverine ecosystems. The concept of environmental flows has evolved over the past half-century, beginning with the development of minimum instream flows necessary to protect a single fish species to current frameworks for holistically including all aspects of river health that depend on natural flow regimes. This also includes the interaction of terrestrial environments with riverine ecosystems during large flooding events. The challenges associated with defining and implementing environmental flows are numerous, and they sometimes lack data necessary to define flow-ecology relationships, appropriate temporal and spatial scales for environmental flow applications, and incorporate environmental flows into water management policy. Given these challenges, researchers and practitioners have made incredible advances in better understanding the relationships between river health and flow dynamics, including the links among flow, sediment, temperature, and human activities. In addition, computational advances have allowed researchers to more accurately model flow-habitat relationships at fine scales, providing a more complete understanding of the connection between flow and habitat needs for riverine species. All these advances benefit from holistic frameworks that guide environmental flow development and applications while considering the needs of other water uses in a river system. This article presents relevant studies regarding approaches for developing environmental flows, relationships between riverine ecology and flow dynamics, and policy frameworks and tools useful for implementing environmental flows in practice.
France and its Empire in the Indian Ocean
Authors: Marvin Nathan , Smith Blake
Published: July 2019

France was a latecomer to the Indian Ocean among European powers. After some tentative and short-lived initiatives by private merchants, the first French East India Company was founded in 1664 by a French monarchy eager to catch up with England and the Netherlands, which had founded companies of their own at the beginning of the 17th century. Competing with the English and Dutch to replace the Portuguese as the preeminent European power in the Indian Ocean, France gradually established a network of colonial holdings that included the island colonies of the Mascarenes in the southwestern Indian Ocean (Réunion and Mauritius) as well as a network of trading posts along the shores of the Indian subcontinent. Plans to expand this colonial empire to Madagascar, however, met with repeated failure. Established as a regional power by the middle of the 18th century, France would be reduced by the century’s end to the role of a spectator of Britain’s rising hegemony. Nevertheless, France held on to some of its Indian Ocean territories, including Réunion and Pondicherry in South Asia. These outposts of French imperialism would inspire nostalgia, regret, and new colonial ambitions among metropolitan observers, and they would become sites of cultural hybridity and exchange. Indeed, while France’s empire in the Indian Ocean is often overshadowed by the emergence of British dominance in the 19th century, or by the intensity of French investment in the Caribbean, the Indian Ocean was a key area of French military, diplomatic, economic, and cultural interest in the 17th and 18th centuries, and beyond.
Shakers
Authors: Laborie Lionel
Published: July 2019

The Shakers, officially known as the United Society of Believers in Christ’s Second Appearing, are a millenarian religious movement still active today in the United States, whose roots can be traced back to the English evangelical Awakening. According to their oral history, Shakerism started when two Quaker tailors from Manchester, James and Jane Wardley, began their own religious society in Bolton in 1747. Because of their charismatic worship, these enthusiasts became known locally as the “Shaking Quakers.” By their own account, the Shakers were an offshoot of both the Quakers and the Camisards, or French Prophets, who had arrived in England from France in 1706, even though no hard evidence exists of any direct link with the latter. In 1758, the Wardleys welcomed along their followers the young Ann Lee, who soon rose to prominence within the group as “Mother Ann.” Lee married Abraham Stanley in 1761 and all four of their offspring died in infancy. She became convinced as a result that marriage and sexual intercourse were intrinsically sinful, paving the way for the Shakers’ belief in celibacy. Increasing persecution forced the Shakers to leave England for America in 1774. Lee and her followers settled in Watervliet, New York, and other communities were rapidly established in New England. Early believers in pacificism, the Shakers remained neutral during the American Revolution. In the early 19th century, they sent missionaries across the Appalachians and founded important communities in Kentucky and Ohio. Their movement peaked in the mid-1800s, with an estimated 5,000 followers nationwide, but it declined sharply after the American Civil War. Most of their villages died out in the 20th century. The Shakers are generally known to the wider public for their celibate and communal lifestyle, but they are celebrated today mainly for the quality and distinctive, yet simple design of their furniture. Sabbathday Lake, Maine, remains the last active Shaker community today, with only two members left.
The Arab Diaspora in Brazil
Authors: Ferreira Silvia C.
Published: July 2019

The Arab diaspora in Brazil refers to the movement of people from countries with Arab populations to Brazil, a process that began in the last decades of the 19th century and reached its height during the years leading up to WWI and the subsequent dissolution of the Ottoman Empire. This diaspora was part of a larger movement of people from the Greater Syria area to the Americas, with the United States, Argentina, and Brazil serving as the first, second, and third most popular destinations for these populations. Due to scant record-keeping and a lack of uniformity in travel documents and demographic classifications, it is difficult to find reliable estimates of the number of Arab people who made their way to Brazil. Today, many Brazilians trace their roots to Arab countries. In addition to árabes (Arabs), other common terms for this population that researchers and students should be aware of include sírios (Syrians), sírio-libaneses (Syro-Lebanese), and turcos (Turks), the latter being an older term that was often used pejoratively and has thus fallen out of favor in more current sources. In Arabic, the South American countries to which Arabs migrated are often collectively referred to in the scholarship as al-mahjar al-janūbī (the Southern Mahjar, with “mahjar” meaning place of emigration). Scholarship on this topic has traditionally been divided along linguistic lines, with researchers relying on either Portuguese-language or Arabic-language primary sources. In fact, early primary sources exist in both languages, and more recent scholarship has attempted to bridge this divide by offering translingual and transnational perspectives on the Arab diaspora in Brazil.
Urban Ecology
Authors: Strohbach Michael W. , Schröder Boris
Published: July 2019

Humans have become an urban species, but this is a rather recent phenomena. The first cities appeared around six thousand years ago and while their number increased, their population remained relatively small. This changed in the industrial revolution and today cities are home to more than 50 percent of the world’s human population. Considering that most people live in cities and that ecology has been around for more than one hundred years, it seems obvious to have a subdiscipline called urban ecology. Not until the 1960s and 1970s, however, did urban ecology fully emerge and not until the 1990s did it become wildly popular. Most ecologists shunned urban areas, which have traditionally been viewed in opposition to natural, pristine, and wilderness places. It is true enough that water, air, and soil in cities are often polluted, open spaces are scarce and heavily managed, and communities resemble a wild mix of native and non-native species. It took a while until ecologists perceived this not just as a mess, but also as a research opportunity for understanding key ecological principles. Such principles are treated in separate Oxford Bibliographies in Ecology articles “Competition and Coexistence in Animal Communities,” “Metapopulations and Spatial Population Processes,” “Island Biogeography Theory,” “Succession,” and “Invasive Species.” The study of these phenomena is often referred to as ecology in cities. In the 1970s, a broader, interdisciplinary perspective took hold. It is often referred to as ecology of cities and understands urban areas as social-ecological systems. This shift in perspective stemmed from a recognition that people are influencing ecosystems everywhere on earth. In fact, cities are at the heart of many environmental problems and, therefore, they are a good place to look for solutions. Today, urban ecology is a key discipline for an urban planet. The need to adapt cities to climate change, maintain vegetation in the face of climate extremes, balance the need for development with the need for green space, or decrease the negative local-to-global environmental impacts of cities can be achieved without the interdisciplinary perspective urban ecology provides. This article gives an overview of the ever-increasing urban ecology literature. Of course, the list is subjective, reflecting our academic background, professional network, and research interest as well as our language skills. We acknowledge that we may have ignored important publications, published perhaps in a language we cannot read, or we may have focused too much on one topic and too little on another. We ask readers to understand these limitations and we encourage them to help us improve this article in the future.
Team Composition
Authors: Bell Suzanne T. , Vazquez Melissa M.
Published: July 2019

Team composition, or the configuration of team member attributes, is a key enabling condition for effective teamwork. A well-composed team has the required complement of knowledge and skills, while also considering how the individual differences of team members, such as personality traits, values, and demographics, combine to shape teamwork and, ultimately, team performance. Theories from social, personality, and organizational psychology are used to explain how team composition influences the attitudes, behaviors, and thinking of teams and their members. Team member attributes can range from malleable characteristics, such as knowledge and expertise, to relatively enduring differences between team members, such as demographic variables (e.g., race) or personality traits; attributes are often referred to as knowledge, skills, abilities, and other characteristics (KSAOs). A distinction is often made between surface-level and deep-level composition variables. Surface-level variables are readily detectable characteristics (e.g., race) or easily accessible information (e.g., professional background) that can shape perceptions prior to interaction as well as affect, behavior, and cognition as team members interact. Deep-level variables are underlying, psychological differences between team members, such as personality traits, that shape affect, behavior, and cognition as team members interact. In general, deep-level composition variables have a stronger and longer lasting influence on teamwork and performance than surface-level variables. In team composition research, the unit-level configuration is of interest. Different models and operationalizations are used to capture how characteristics of team members combine to shape teamwork and performance. They range from simple operationalizations, such as the team mean on a specific trait (e.g., team mean conscientiousness), to complex diversity operationalizations that consider the alignment of multiple attributes (i.e., faultline strength). The goal of team composition research is to identify the KSAOs and configurations that shape teamwork and team performance, and then use this information in the management of teams. Teams can be composed ahead of time to maximize team effectiveness; members can be selected to have optimal fit with other team members and the team task. Team composition information can also be used to inform how to best manage a team over time; for example, how to reward the team. High-level information on team composition can be found in books on team effectiveness, with more comprehensive reviews in annual reviews and book chapters. Cutting-edge team composition theories and research are published in peer-reviewed academic journals, with secondary coverage in news outlets, trade journals, and magazines.
Proactive Work Behavior
Authors: Parker Sharon K. , Cai Zijun
Published: July 2019

In the current fast-changing and highly uncertain workplace, it has become especially important for employees to actively anticipate challenges, identify opportunities, and take corresponding action. As a result, the subject of proactive behavior has received an increasing amount of attention among scholars in the past decade. Specifically, scholars have identified various kinds of proactive behaviors; investigated performance and, more recently, well-being outcomes; identified individual and contextual antecedents of proactive behavior; and considered mostly motivational mechanisms linking proactive behavior to outcomes.
Innovation Policy in China
Authors: Baark Erik
Published: July 2019

The Chinese government places high priority on promoting innovation in the country, viewing it as an essential element of economic and social modernization. From an early period of reliance on import of technology from the Soviet Union in the 1950s, China moved to a period of self-reliance and “reverse engineering” in the 1960s, followed by the Open Door phase since the 1980s, where the primary goal was to catch up with the most advanced countries in the world. Since 2006, China has increasingly sought to develop its own advanced technology and become an “innovation superpower.” In the following article on innovation, it is important to be aware of the fact that Chinese policymakers and academics have traditionally seen this field as part of science and technology policy, which emphasized scientific research as a vital element in the development of new technology. However, this approach tended to limit policymakers’ concern to support for research institutes and ignored the crucial role that enterprises could play in developing and implementing technology. This included the delicate balance between transfer of overseas technology and the independent development of technology by Chinese organizations. Therefore, concepts of innovation and of research and development have become very popular in China in recent decades, and policies promoting a Chinese national innovation system are prominent in government statements as well as in the academic literature. This article will focus on policies that the Chinese government has pursued to promote or regulate technology and innovation, including the controversial policy of promoting indigenous innovation. In addition, it addresses the literature on the protection of intellectual property rights, human resources for innovation, development of high-tech industries and high-tech parks, and university-industry linkages.
Course participation and the recognition and reporting of occupational ill-health
Authors: Beach J , Cherry N
Published: July 2019

Background

The Foundation Course in Occupational Medicine for community-based physicians was started in Alberta in 2012 and has since been implemented across Canada. As part of the evaluation of the first 4 years, two studies were initiated to assess the impact of the course on assessment of work-relatedness and case-reporting.

Aims

To determine whether assessment of work-relatedness, intention to report cases and number of cases reported to the Workers’ Compensation Board (WCB) changed during/after the course.

Methods

In study 1, course participants were asked to rate scenarios describing ill-health potentially resulting from work. They rated work-relatedness on a visual analogue scale and recorded whether they would report to the WCB. Assessments were made before the course started, after course completion or both. In study 2, numbers of reports to the WCB were documented for physicians giving consent, both for Foundation Course participants and a comparison group of community-based physicians. Multilevel regression models were fitted to allow for potential confounders and clustering within respondent.

Results

Among 102 physicians completing at least one set of scenario assessments, ratings of work-relatedness (β = 6.5; 95% CI 2.6–10.4) and likelihood of reporting to the WCB (OR = 1.9; 95% CI 1.2–3.1) increased significantly post-course. The mean annual number of cases reported to the WCB increased from 91.8 to 125.7 among the 35 Alberta physicians included in study 2. This change was only significant (P < 0.05) on a one-sided test.

Conclusion

The two evaluative studies showed good evidence of changes in perceptions and intentions but only weak evidence of behavioural change.
Returning to the parental home after the Great Recession: a matter of partnership dissolution or unemployment?
Authors: Mazzotta Fernanda , Parisi Lavinia
Published: July 2019

This article provides an analysis of the return of young people to the parental home in 23 European countries. It analyses the effect of the Great Recession, considering the period between 2006 and 2014 and controlling for two key determinants of living arrangements: employment and partnership. The main finding is that the Great Recession has increased the probability of returning home: two peaks are observed in 2009 and 2011, with a percentage of returnees almost double that at the beginning of the period under consideration. Returning home seems more closely linked to partnership than to employment.
The United States As A Developing Nation: Revisiting The Peculiarities Of American History*
Authors: Link Stefan , Maggor Noam
Published: July 2019

It has recently been suggested that the economic departure of the United States after the Civil War marked a ‘Second Great Divergence’. Compared to the ‘First’, the rise of Britain during the Industrial Revolution, this Second Great Divergence is curiously little understood: because the United States remains the template for modernization narratives, its trajectory is more easily accepted as preordained than interrogated as an unlikely historical outcome. But why should development have been problematic everywhere but the United States? This Viewpoint argues that a robust explanation for the United States's rise is lacking: it can neither be found in an economic history literature focused on factor endowments nor in internalist Americanist historiography, which often reproduces overdetermined accounts of modernization inspired by Max Weber. The most promising avenue of inquiry, we argue, lies in asking how American political institutions configured what should properly be called an American developmental state. Such a perspective opens up a broad comparative research agenda that provincializes the United States from the perspective of development experiences elsewhere.
Can Nonclinician Raters Be Trained to Assess Clinical Reasoning in Postencounter Patient Notes?
Authors: Yudkowsky Rachel , Hyderi Abbas , Holden Jaime , Kiser Robert , Stringham Richard , Gangopadhyaya Ananya , Khan Asra , Park Yoon Soo
Published: July 2019

Purpose

Clinical reasoning is often assessed through patient notes (PNs) following standardized patient (SP) encounters. While nonclinicians can score PNs using analytic tools such as checklists, these do not sufficiently encompass the holistic judgments of clinician faculty. To better model faculty judgments, the authors developed checklists with faculty-specified scoring formulas embedded in spreadsheets and studied the resulting interrater reliability (IRR) of nonclinician raters (SPs and medics) and student pass/fail status.

Method

In Study 1, nonclinician and faculty raters rescored PNs of 55 third-year medical students across 5 cases of the 2017 Graduation Competency Examination (GCE) to determine IRR. In Study 2, nonclinician raters scored all notes of the 5-case 2018 GCE (178 students). Faculty rescored all notes of failing students and could modify formula-derived scores if faculty felt appropriate. Faculty also rescored and corrected scores of additional notes for a total of 90 notes (3 cases, including failing notes).

Results

Mean overall percent exact agreement between nonclinician and faculty ratings was 87% (weighted kappa, 0.86) and 83% (weighted kappa, 0.88) for Study 1 and Study 2, respectively. SP and medic IRRs did not differ significantly. Four students failed the note section in 2018; 3 passed after faculty corrections. Few corrections were made to nonfailing students’ notes.

Conclusions

Nonclinician PN raters using checklists and scoring rules may provide a feasible alternative to faculty raters for low-stakes assessments and for the bulk of well-performing students. Faculty effort can be targeted strategically at rescoring notes of low-performing students and providing more detailed feedback.
Medical Spanish Standardization in U.S. Medical Schools: Consensus Statement From a Multidisciplinary Expert Panel
Authors: Ortega Pilar , Diamond Lisa , Alemán Marco A. , Fatás-Cabeza Jaime , Magaña Dalia , Pazo Valeria , Pérez Norma , Girotti Jorge A. , Ríos Elena
Published: July 2019

Medical Spanish (MS) education is in growing demand from U.S. medical students, providers, and health systems, but there are no standard recommendations for how to structure the curricula, evaluate programs, or assess provider performance or linguistic competence. This gap in medical education and assessment jeopardizes health care communication with Hispanic/Latino patients and poses significant quality and safety risks. The National Hispanic Health Foundation and University of Illinois College of Medicine convened a multidisciplinary expert panel in March 2018 to define national standards for the teaching and application of MS skills in patient–physician communication, establish curricular and competency guidelines for MS courses in medical schools, propose best practices for MS skill assessment and certification, and identify next steps needed for the implementation of the proposed national standards. Experts agreed on the following consensus recommendations: (1) create a Medical Spanish Taskforce to, among other things, define educational standards; (2) integrate MS educational initiatives with government-funded research and training efforts as a strategy to improve Hispanic/Latino health; (3) standardize core MS learner competencies; (4) propose a consensus core curricular structure for MS courses in medical schools; (5) assess MS learner skills through standardized patient encounters and develop a national certification exam; and (6) develop standardized evaluation and data collection processes for MS programs. MS education and assessment should be standardized and evaluated with a robust interinstitutional medical education research strategy that includes collaboration with multidisciplinary stakeholders to ensure linguistically appropriate care for the growing Spanish-speaking U.S. population.
Defining Rural: The Predictive Value of Medical School Applicants’ Rural Characteristics on Intent to Practice in a Rural Community
Authors: Wendling Andrea L. , Shipman Scott A. , Jones Karen , Kovar-Gough Iris , Phillips Julie
Published: July 2019

Purpose

To understand the predictive value of medical student application characteristics on rural practice intent.

Method

The authors constructed a linked database of 2012–2017 medical school matriculants from American Medical College Application Service applications and Association of American Medical Colleges Matriculating Student Questionnaire (MSQ, 2012–2017) and Graduation Questionnaire (GQ, 2016–2018). Using logistic regression, they compared application variables (birth, high school, childhood county, and self-declared geographical origin) to students’ MSQ and GQ intent to practice rurally. Rural practice intent from matriculation to graduation was compared using the McNemar test for paired nominal data.

Results

The number of students meeting inclusion criteria was 115,027. More students self-declared rural origin (18,662; 16.4%) than were identified using geographically coded variables (6,097–8,784; 6.1%–8.1%). Geographically coded rural variables were all strongly and similarly associated with rural practice intent, with rural high school being the most predictive on both MSQ (odds ratio [OR], 6.51; CI, 6.1–7.0) and GQ (OR, 5.4; CI, 4.9–6.0). Self-declared geographical origin was associated with a similar rural practice intent on both MSQ (OR, 6.93; CI, 6.5–7.3) and GQ (OR, 5.69; CI, 5.2–6.2). Rural practice intent declined for all groups from matriculation to graduation.

Conclusions

Considering students who self-declare as rural identifies a larger group of rural medical school applicants than more “objective” geographic variables, without negatively impacting students’ predicted interest in eventual rural practice. Further research should track actual practice location and explore strategies to mitigate declining rural career interest.
Effect of Professional Background and Gender on Residents’ Perceptions of Leadership
Authors: Ju Mindy , van Schaik Sandrijn M.
Published: July 2019

Purpose

To examine the impact of professional background and gender of a resuscitation team leader on residents’ perceptions of leadership skills.

Method

The authors video-recorded a scripted, simulated resuscitation scenario twice, with either a male or a female team leader. They copied each video and labeled the leader as physician (MD) or nurse practitioner (NP), creating 4 conditions: female NP, female MD, male NP, or male MD. The authors recruited resident participants from 5 specialties at 4 institutions; they randomly assigned residents to view one version of the video and rate the team leader’s performance using the Ottawa Crisis Resource Management Global Rating Scale (Ottawa CRM) in an online survey. The authors conducted 2-way ANOVA to examine interactions between team leader gender and profession on Ottawa CRM ratings.

Results

One hundred sixty residents responded (89 females, 71 males). A statistically significant main effect of team leader gender on residents’ ratings was found in 2 of the 6 Ottawa CRM domains, leadership (F
1,156 = 6.97, P = .009) and communication skills (F
1,156 = 8.53, P = .004), due to lower ratings for female than male leaders (5.29 ± 0.95 vs 5.74 ± 1.17; 5.05 ± 1.20 vs 5.57 ± 1.06). There was no effect of profession on ratings and no significant interaction between profession and gender of the team leader on ratings for any of the domains.

Conclusions

These findings indicate bias among residents against females as team leaders. Mitigating such bias is essential to successfully establish shared leadership models in health care.
Monoclonal Antibody Monitoring: Clinically Relevant Aspects, A Systematic Critical Review
Authors: Regazzi Mario , Golay Joseè , Molinaro Mariadelfina
Published: July 2019

Monoclonal antibody (mAb) therapy does not usually lead to a clinical response in all patients and resistance may increase over time after repeated mAb administration. This lack or loss of response to the treatment may originate from different and little-known epigenetic, biomolecular, or pathophysiological mechanisms, although an inadequate serum concentration is perhaps the most likely cause, even if not widely recognized and investigated yet. Patient factors that influence the pharmacokinetics (PK) of a mAb should be taken into account. Multiple analyses of patient-derived PK data have identified various factors influencing the clearance of mAbs. These factors include the presence of antidrug antibodies, low serum albumin, high serum levels of C-reactive protein, high body weight, and gender differences among others. The same clearance processes involved in systemic clearance after intravenous administration are also involved in local first-pass catabolism after subcutaneous administration of mAbs. Therapeutic drug monitoring has been proposed as a way to understand and respond to the variability in clinical response and remission. For both classes of mAbs with anti-inflammatory and antitumor effects, dose-guided optimization based on the measurement of serum concentrations in individual patients could be the next step for a personalized and targeted mAb therapy.
Emotional Suppression and Hypervigilance in Military Caregivers: Relationship to Negative and Positive Affect
Authors: Sander Angelle M. , Boileau Nicholas R. , Hanks Robin A. , Tulsky David S. , Carlozzi Noelle E.
Published: July 2019

Objective:

To investigate the relationship of 2 health-related quality-of-life (QOL) item banks (Emotional Suppression and Caregiver Vigilance), developed for caregivers of service members/veterans with traumatic brain injury (TBI), to caregivers' positive and negative affect.

Setting:

Community.

Participants:

One hundred sixty-five caregivers of service members/veterans with TBI.

Design:

Retrospective database analysis.

Main Measures:

TBI-CareQOL Emotional Suppression; TBI-CareQOL Caregiver Vigilance; measures of negative (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression, PROMIS Anger, TBI-CareQOL Caregiver-Specific Anxiety, National Institutes of Health Toolbox [NIHTB] Perceived Stress, GAD-7) and positive affect (Neuro-QOL Positive Affect and Well-being, NIHTB Self-efficacy, NIHTB General Life Satisfaction, Family Resilience Scale for Veterans, TBI-QOL Resilience).

Results:

When considered separately, linear regression showed that higher levels of Emotional Suppression and greater Caregiver Vigilance were individually associated with more negative affect and less positive affect. When considered together, the pattern of findings was generally consistent for both Emotional Suppression and Caregiver Vigilance with regard to negative affect and for Emotional Suppression with regard to positive affect. However, when considered together, Caregiver Vigilance was no longer related to positive affect.

Conclusions:

Caregivers with high emotional suppression and/or vigilance are more likely to show emotional distress and less likely to have positive affect than caregivers with lower levels of emotional suppression and vigilance. A combination of education and individual counseling targeting coping with negative emotions and TBI-related problems may be beneficial.
Topical Povidone-Iodine for Treatment of Giant Fornix Syndrome
Authors: Vahdani Kaveh , Rose Geoffrey E.
Published: July 2019

Over a 2-year period, a 68-year-old woman suffered multiple recurrences of left giant fornix syndrome during the repeated tailing of intensive topical steroids and antibiotics; she had also undergone surgery to reduce the left upper fornix. After a further recurrence during tailing of topical therapy for bilateral disease, treatment with 4 times daily preservative-free povidone-iodine 5% eyedrops was started—with a marked improvement of symptoms and signs within a week. The patient is maintained, symptom-free, on once-daily povidone-iodine drops and dexamethasone 0.1% drops. The dramatic improvement on topical povidone-iodine therapy might suggest that, as an initial therapy, this might be more effective than the previously-recommended regime of hourly potent topical steroids and antibiotics.
A Case of Lacrimal Gland Ductal Carcinoma With Regional Lymph Node Metastasis
Authors: Everett Lesley A. , Copperman Thomas S. , Kersten Robert C.
Published: July 2019

Ductal carcinoma of the lacrimal gland is a very rare and aggressive neoplasm, with clinical and histopathologic similarities to salivary ductal carcinoma. Of the 25 previously reported cases, 2 patients had metastases to local lymph nodes confirmed on pathologic examination. The authors now report the clinical presentation, histopathologic and immunohistochemical features, and the treatment of a third patient with lacrimal gland ductal carcinoma with spread to local lymph nodes. In contrast to ductal carcinoma, lymph node involvement has not been reported in the largest series of adenoid cystic carcinoma, a much more common lacrimal gland malignancy. This case highlights the need for possible lymph node surveillance in patients with lacrimal gland ductal carcinoma.
Adherence to Treatment of Female Patients With Coronary Heart Disease After a Percutaneous Coronary Intervention
Authors: Kähkönen Outi , Saaranen Terhi , Kankkunen Päivi , Miettinen Heikki , Kyngäs Helvi
Published: July 2019

Background:

Adherence to treatment is essential to prevent the progression of coronary heart disease (CHD), which is the most common cause of death among women. Coronary heart disease in women has special characteristics: the conventional risk factors are more harmful to women than men, accumulation of risk factors is common, and women have nontraditional risk factors such as gestational diabetes and preeclampsia. In addition, worse outcomes, higher incidence of death, and complications after percutaneous coronary intervention have been reported more often among females than among male patients.

Objective:

The aim of this study was to test a model of adherence to treatment among female patients with CHD after a percutaneous coronary intervention.

Methods:

A cross-sectional, descriptive, and explanatory survey was conducted in 2013 with 416 patients with CHD, of which the 102 female patients were included in this substudy. Self-reported instruments were used to assess female patient adherence to treatment. Data were analyzed using descriptive statistics and a structural equation model.

Results:

Motivation was the strongest predictor for female patients' perceived adherence to treatment. Informational support, physician support, perceived health, and physical activity were indirectly, but significantly, associated with perceived adherence to treatment via motivation. Furthermore, physical activity was positively associated with perceived health, whereas anxiety and depression were negatively associated with it.

Conclusions:

Secondary prevention programs and patient education have to take into account individual or unique differences. It is important to pay attention to issues that are known to contribute to motivation rather than to reply on education alone to improve adherence.
Assessment of School-Aged Children of Mothers With Idiopathic Generalized Epilepsy
Authors: Kishk Nirmeen , Hassan Amr , Madbouly Nagwan , Nawito Amani , Maher Eman , Heneidy Sara
Published: July 2019

The aim is to examine the cognitive domains, behavioral domains, and electroencephalogram (EEG) findings in children of mothers with idiopathic generalized epilepsy who had been exposed to antiepileptic drugs (AEDs) in utero. Forty school-aged children born to 23 mothers with idiopathic generalized epilepsy were compared with 40 healthy children born to 34 healthy mothers. Stanford-Binet Intelligence Scale was applied to all children to assess their cognitive functions. Child Behavior Checklist was used to assess their behavioral characteristics. EEG was done for the epileptic mothers and their children. Children exposed to AEDs showed significantly lower scores in the verbal reasoning, visual reasoning, and global intelligence quotient (IQ). There was a significantly positive correlation between children's global IQ and maternal global IQ. Multiple regression analysis showed that in utero exposure to valproate and maternal IQ were the most independent factors affecting children's IQ. EEG findings of participating children were normal. Exposure to valproic acid during fetal life and maternal IQ represent confounding factors affecting the IQ of children with in utero exposure to AEDs.
An Intervention for Person-Centered Support in Irritable Bowel Syndrome
Authors: Björkman Ida , Ringström Gisela , Simrén Magnus , Myrgren Jenny , Jakobsson Ung Eva
Published: July 2019

Irritable bowel syndrome is a common and often chronic functional bowel disorder that can cause severe disruption of daily functioning in those affected, with subsequent high healthcare utilization and work absenteeism. Nurses represent an underutilized group in the current management of irritable bowel syndrome. The aim of this study was to systematically develop a person-centered support intervention in irritable bowel syndrome and evaluate this in a pilot study. The development followed the revised framework for complex interventions from the Medical Research Council and involved literature reviews and multiprofessional expert groups. The intervention was then tested in a pilot study including 17 patients and evaluated through validated questionnaires measuring irritable bowel syndrome symptom severity, gastrointestinal-specific anxiety, and self-efficacy as well as through interviews. There was a significant improvement in irritable bowel syndrome symptom severity between baseline and follow-up, but not for self-efficacy or gastrointestinal-specific anxiety. The patients' perceptions of participating in the intervention were positive and induced a learning process; they were able to form a supportive relationship with the nurse and their ability to self-manage improved. The promising results from this small pilot study in terms of feasibility, potential efficacy, and the patients' positive feedback make this intervention a suitable candidate for a larger controlled trial.
High-Frequency Oscillations in the Scalp EEG of Intensive Care Unit Patients With Altered Level of Consciousness
Authors: Ferrari-Marinho Taissa , Perucca Piero , Amiri Mina , Dubeau Francois , Gotman Jean , Caboclo Luis Otavio
Published: July 2019

Purpose:

In comatose patients, distinguishing between nonconvulsive status epilepticus and diffuse structural or metabolic encephalopathies is often challenging. Both conditions can generate periodic discharges on EEG with similar morphology and periodicity. We investigated the occurrence of high-frequency oscillations—potential biomarkers of epileptogenesis—on scalp EEG of comatose patients with periodic discharges in the EEG.

Methods:

Fifteen patients were included. Patients were divided into three groups, according to underlying etiology: Group 1, seizure related; group 2, structural; group 3, nonstructural. EEG recordings were compared with respect to the presence and rates of gamma (30–80 Hz) and ripples (80–250 Hz).

Results:

Patients were 23 to 106 years old (median, 68 years); 60% were female. 206 channels were eligible for analysis (median, 15 channels/patient). Overall, 43% of channels showed gamma, and 24% had ripples. Group 2 showed the highest proportion of channels with gamma (47%), followed by group 1 (38%) and group 3 (36%). Mean gamma rates were higher in group 2 (4.65 gamma/min/channel) than in group 1 (1.52) and group 3 (1.44) (P < 0.001). Group 2 showed the highest proportion of channels with ripples (29.2%), followed by group 1 (15%) and group 3 (24.2%). Mean ripple rates were higher in group 2 (5.09 ripple/min/channel) than in group 1 (0.96) and group 3 (0.83) (P < 0.001).

Conclusions:

Fast oscillations, including high-frequency oscillations, can be detected in scalp EEG of patients with altered consciousness. High rates of fast activity may suggest an underlying structural brain lesion. Future studies are needed to determine whether fast oscillations in the setting of acute/subacute brain lesions are a biomarker of subsequent development of human epilepsy.