bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Disparities, a Social Determinant of Health and Risk: Considerations for Health and Risk Messaging
Authors: Harrington Nancy Grant
Published: January 2017

Health disparities are differences in health outcomes between socially disadvantaged and advantaged groups. This essay provides a brief review of the voluminous literature on health disparities, with a focus on several major threads including populations of interest, incidence and prevalence of morbidity and mortality, determinants of health, health literacy and health information seeking, media influences on health disparities, and efforts to reduce disparities. Populations of interest tend to be defined primarily by socioeconomic status (income/education), race, ethnicity, and sex or gender; however, differences in sexual orientation, immigrant status, geography, and physical and mental disability are also of concern. Determinants of health can be categorized along a number of dimensions, but common designations consider behavioral, social, and environmental factors that lead to health disparities, as well as differences in access to health care and health services. Of central interest to communication researchers, differences in health literacy and health information seeking are revealed between advantaged and disadvantaged groups. Media influences involve the effects of access or exposure to different kinds of health information on the health behavior and health outcomes of different groups, as well as the effects of health disparity media coverage on public support for initiatives to reduce health disparities. Efforts to reduce health disparities are extensive and involve government and foundation efforts and research-driven interventions.

Taking a broader view, this essay briefly discusses trends in scholarship on health disparities, noting the precipitous increase in academic journal article publications on the topic, including the publication of journals specifically focused on publishing health disparities scholarship. Future directions for research are suggested, and recommendations for interventions to improve health disparities offered by the Principal Investigators of the 10 Centers for Population Health and Health Disparities are presented. Finally, an annotated list of primary sources (books, special issues of journals, reports) and a list of sources for further reading are offered to provide a starting point for beginning scholars to orient themselves to research in health disparities.
Appeals to Morality in Health and Risk Messaging
Authors: Miller Ann Neville
Published: January 2017

Many health- and risk-related behaviors have moral implications. Most obvious are altruistic behaviors like blood donation. However, issues related to promoting the wellbeing of friends and family members, such as being sure that they don’t drive drunk, and the generalized obligations that attend environmentally relevant behaviors like participating in recycling programs, also tap into moral concerns. For promoting such issues, moral appeals may be appropriate. Moral appeals are messages that acknowledge individuals’ evaluative beliefs about universal rights and wrongs. Appeals to morality produce a sense of obligation and responsibility because morals are viewed as self-evident facts.

Three explanations for why people engage in moral behavior are discernible in current scholarship, each with implications for structuring moral appeals: activation of social expectations, activation of personal norms, and arousal of emotion. The first of these is based on the subjective expected utility tradition. From this perspective, the key to successfully encouraging morally relevant behavior is maximizing benefits and minimizing costs. Because prosocial behaviors are enforced by social sanctions, many of these costs and benefits are socially bestowed. Thus, altruism at its core is hedonism. Theories that focus on activation of personal norms, in contrast, contend that people sometimes make decisions to donate blood, demonstrate for healthcare reform, recycle, and so on simply because they view it as their duty and responsibility to do so. When people realize in a concrete situation that their actions have consequences for the welfare of others, and that they are personally responsible for those outcomes, personal norms for the specific case are generated from internalized moral values. In this view, a central concern with moral appeals is ensuring that messages are aligned with internalized norms and that relevance and personal responsibilities are clearly communicated. Finally, theories of emotional arousal stress that although cognitive appraisals of personal and social norms are necessary, they are insufficient to incite people to selfless behavior. Rather, people engage in helping or altruistic behavior because moral appeals are emotionally arousing. Emotions associated with such appeals include empathic concern and guilt. Guilt appeals especially have been found to be as effective in eliciting compliance when behaviors have moral significance as other popular compliance-gaining strategies. Positive emphasis on responsibility and induction of hypocrisy are also techniques that rely on the appeal to moral beliefs.
Argument Quality and Strength in Health and Risk Messaging
Authors: Hoeken Hans
Published: January 2017

In an ideal world, people would adopt a positive attitude toward a healthy lifestyle as a result of carefully considering relevant and strong arguments. Attitudes based upon such considerations are believed to be stable and good predictors of related behavior, and less vulnerable to counterattitudinal messages. However, carefully evaluating arguments in such messages is difficult. First, people need to identify what information can serve as an argument and construe the argumentative relation between the information and the advocated claim. Next, they need to assess the extent to which the argument satisfies the criteria for a strong argument. What these criteria are depends on the type of argument at hand: an argument from analogy, for instance, should be evaluated with different criteria than an argument from authority. Argument scrutiny thus entails reconstruction, identification, and evaluation.

The good news is that even though argument scrutiny is a complex task, it seems that people are pretty well equipped to carry it out. Meta-analyses have shown that messages containing strong arguments are more persuasive than those containing weak arguments. In addition, there is evidence that people are sensitive to what extent a specific argument satisfies relevant criteria when evaluating arguments. The bad news is that people may use these skills not so much to make objective evaluations to reach a better decision, but rather to defend the type of behavior that they already feel they want to perform. That is, they use their argument evaluation skills to reason why the arguments in support of the behavior that they favor are stronger than the arguments against that behavior.
Network Analysis and Health and Risk Messaging
Authors: Tutzauer Frank , Feeley Thomas Hugh
Published: January 2017

A network is a collection of nodes that are somehow connected to each other. Typically, the pattern of ties among nodes is of central interest to scholars in communication and the allied social sciences, with particular salience for health and risk communication. Network analyses of patterns of communication began in the 1940s in work done at the Massachusetts Institute of Technology (MIT) and was popularized in the early 1980s in the communication discipline with the work of Everett Rogers, Larry Kincaid, and others. Networks are measured by using self-report or observational procedures to determine the presence and/or strength among nodes in a given structure. If there is a tie or relation between a pair of nodes, it is said that the two are adjacent to one another or that the two nodes are neighbors, and the neighborhood of a node consists of all nodes adjacent to this first node. Several measures describe networks, including measures of position and measures of the entire network. Positional measures consider the position of any given node in relation to others in the network, and centrality is a popular measure to account for one’s level of influence in a network. Density is an overall network measure of level of activity among network pairs. Finally, network measures allow researchers to compare dependent and independent networks. Network analysis represents one of the more powerful and elegant procedures for measuring small-group, organizational, and international communication patterns among nodes or actors of interest in health and risk communication.
Rhetorical Judgment
Authors: Arthos John
Published: January 2017

Rhetorical judgment is a syncretic term that marries the classical concepts of prudence and rhetoric, and suggests their mutual interdependence. The traditions of rhetoric and prudence have had uneven histories, their legitimacy and utility ebbing and flowing within the dominant strains of Western culture. There are four key moments in histories to help find their points of contact, their disjunctions, and their fickle alliance. The key points of tension in their collaboration occur, first, within the Aristotelian corpus itself, next between Greek and Roman conceptions of social reason, then between the ancient and early modern conceptions of prudence, and finally in the fitful return of interest in both of these classical approaches to social reason in late modernity. Their alliance is actuated most potently when the inherently social dynamism of rhetoric transforms prudence from a virtue into a practice. The capacity for prudence to trade in the contingent circumstance then becomes a powerful political resource. Rhetorical judgment is now realizing this potential as critical theory engages it to redefine the terrain of the political, and to reimagine the contours of a seemingly antiquated body of traditions. The dimensions of power, contingency, and expedience that have always had a place within rhetorical and prudential practices are now finding radical new forms of expression and pointing toward new conceptions of democratic practice.
Toward an Evolutionary Theory of International Relations
Authors: McDermott Rose , Davenport Christian
Published: January 2017

The current practice of conceiving and examining international relations within the dogma of the existing dominant paradigm in international relations unnecessarily truncates our understanding of how historical factors influence current events and restricts our ability to generate flexible and creative hypotheses to predict, and perhaps more successfully intervene in, future events. In many ways, these constraints result, at least in part, from the temporal, strategic, and behavioral isolation embedded in these models, which limit our ability to understand, integrate, and address how states deal with one another comprehensively. Substantial theoretical and empirical purchase can be gained through the application of an integrated explanatory rubric of evolutionary modeling, invoking the central concepts of variation, selection, and retention. Models derived from evolutionary psychology, applied not only to human cognitive architecture, but also to the interaction of these psychological dynamics with environmental factors including institutions, provides a richly generative framework from which to derive meaningful and novel hypotheses about politics in general and international relations in particular. It also allows for a progressive and cumulative research agenda that can build a more comprehensive and descriptively accurate foundation for understanding the nature of interaction between people and societies as well as between states themselves. Such an approach provides a useful framework for understanding the dynamic and interactive nature of international relations, sheds light on existing limitations as well as empirical findings, and facilitates insight into areas not yet explored.
Moderator Variables
Authors: Fritz Matthew S. , Arthur Ann M.
Published: January 2017

Moderation occurs when the magnitude and/or direction of the relation between two variables depend on the value of a third variable called a moderator variable. Moderator variables are distinct from mediator variables, which are intermediate variables in a causal chain between two other variables, and confounder variables, which can cause two otherwise unrelated variables to be related. Determining whether a variable is a moderator of the relation between two other variables requires statistically testing an interaction term. When the interaction term contains two categorical variables, analysis of variance (ANOVA) or multiple regression may be used, though ANOVA is usually preferred. When the interaction term contains one or more continuous variables, multiple regression is used. Multiple moderators may be operating simultaneously, in which case higher-order interaction terms can be added to the model, though these higher-order terms may be challenging to probe and interpret. In addition, interaction effects are often small in size, meaning most studies may have inadequate statistical power to detect these effects.

When multilevel models are used to account for the nesting of individuals within clusters, moderation can be examined at the individual level, the cluster level, or across levels in what is termed a cross-level interaction. Within the structural equation modeling (SEM) framework, multiple group analyses are often used to test for moderation. Moderation in the context of mediation can be examined using a conditional process model, while moderation of the measurement of a latent variable can be examined by testing for factorial invariance. Challenges faced when testing for moderation include the need to test for treatment by demographic or context interactions, the need to account for excessive multicollinearity, and the need for care when testing models with multiple higher-order interactions terms.
Organized Child Sexual Abuse in the Media
Authors: Salter Michael
Published: January 2017

Organized sexual abuse refers to the coordinated sexual abuse of multiple children by multiple perpetrators. It has proved to be a particularly controversial form of sexual abuse. Initial reports of organized abuse in the 1980s were met with shock and disbelief, followed by a significant backlash as journalists and academics claimed that organized abuse allegations were the product of “moral panic” and “false memories.” In the mass media, investigations into organized abuse were presented throughout the 1990s as evidence that public anxiety about child sexual abuse had generated a “witch-hunt” in which even the most outrageous allegation of abuse was considered credible. While this argument was advanced by journalists and academics, it developed first in the mass media, where the culture of news production promoted a particularly skeptical view of sexual abuse allegations. Claims of a sexual abuse witch-hunt were embedded within a broader backlash against feminism and child protection that called into question the prevalence and severity of sexual violence. Journalists and editors took a particularly activist role in the social construction of organized abuse as synonymous with false and exaggerated allegations.

A number of recent developments have fragmented an apparent journalistic consensus over the incredibility of organized abuse claims. The mass media has played a key role in publicizing the problem of clergy abuse, focusing in particular on institutionalized cultures of silence and disbelief. Sexual abuse by celebrities and authority figures has also received global media coverage and emphasized the failure of authorities to act on reports or suspicion of sexual abuse. Such media stories directly contest prior claims by journalists that society and major institutions are overly reactive to sexual abuse disclosures. Instead, the contemporary mass media includes expanded opportunities for recognition and reporting on the diversity of sexual abuse including organized abuse. The emergence of social media has also generated new possibilities for reporting, information dissemination, and debate on organized abuse. Accordingly, public discussion of organized abuse has taken on polyvocal and increasingly agonistic qualities, as older tropes about “false memories” and “moral panics” are contradicted by factual reporting on organized abuse investigations and convictions. The capacity of victims, survivors, and others impacted by organized abuse to speak for themselves on social media, rather than through the mediation of a journalist, is a key development that introduces a new dynamic of accountability and transparency that had previously been absent in media coverage of this challenging issue.
Parsi Traders in Western India, 1600–1900
Authors: Subramanian Lakshmi
Published: January 2017

The Parsi community enjoyed a special status in western India as enterprising traders, who were quick to appreciate the advantages of the British connection especially in driving a huge trade in the Indian Ocean and specifically with China from roughly the latter half of the 18th century. Arriving in India as asylum seekers, the community quickly adapted to the host society by adopting the local language (Gujarati) and by deploying their commercial and manufacturing skills in consolidating their social location in the region. They were mindful of the ruling powers and developed over time important strategies of working closely with local interests, so much so that they acquired a foothold in landed and commercial society. It was in the late 17th and 18th centuries that they forged important links with European traders and trading companies, working as brokers for procurement of textiles and in the process acquiring a very close understanding of foreign markets. This was an important resource that enabled the community to play a major role on the emerging proto-colonial trade of western India, largely channeled through Bombay. The late 18th and 19th centuries saw the community produce major players and merchants of renown who amassed considerable wealth from the trade in raw cotton and opium with China and invested that wealth in philanthropy and subsequently in entrepreneurship. The community was primarily located in Bombay and western India, although their ventures took them as far as Calcutta and Canton. More recently there has been a considerable volume of scholarship on the community, emphasizing its origins, its histories and self-representation, and its use of the English colonial law in defining its own status and streamlining its customs.
Modern Saudi Arabia
Authors: Lawson Fred
Published: January 2017

Modern Saudi Arabia emerged in the 1920s as the successor to a collection of local political entities on the Arabian peninsula, whose histories are only starting to be investigated. Existing studies of Saudi history emphasize the actions and objectives of successive rulers, most notably the founder of the kingdom, 'Abd al-'Aziz bin 'Abd al-Rahman Al Sa'ud, and his sons Faisal, Khalid, Fahd, and 'Abdullah. Popular responses to the rise and consolidation of Saudi rule have received little sustained attention. Equally lacking is an objective analysis of the pivotal period of the late 1950s, when elite and mass movements for political reform took shape. Instability during this period is generally attributed to the personal failings of King Sa'ud bin 'Abd al-'Aziz, rather than to conflicts among influential social forces. Current scholarship explores the emergence of radical Islamist movements in the Sunni and Shi'i communities alike.
Georgia before the Mongols
Authors: Rapp Jr. Stephen H.
Published: January 2017

Nestled in one of Eurasia’s most energetic crossroads, Georgia has a long and multifaceted history. The remains of Homo georgicus excavated at Dmanisi in southern Georgia belong to the oldest hominids yet discovered outside Africa. They have been reliably dated to 1.8 million years ago. Subsequent Neolithic, Chalcolithic, and Bronze Age sites are distributed throughout the region between the Black and Caspian Seas. But it is not until the early 1st millennium bce that the immediate ancestors of modern Georgians emerge in the historical record. Their attestation sharpens in the Achaemenid and early Hellenistic epochs.

The peoples of Caucasia were thrust upon the Eurasian stage principally as a result of their associations with Iran. They were, at the same time, active members in the first Iranian Commonwealth, a massive cross-cultural enterprise stretching from Central Asia to the Balkans. Toward the end of the 4th century bce, the disruption triggered by Alexander’s conquest of Achaemenid Persia sparked the formation of a kingdom anchored in the eastern Georgian territory of Kʻartʻli (Iberia). Caucasia’s Iranian and especially Iranic (“Persianate”) cultures proved remarkably durable. The Irano-Caucasian nexus pushed into the medieval period, having endured the Christianization of the realms of Kʻartʻli, Armenia, and Caucasian Albania. As was the case elsewhere, Christianity’s long-term success hinged on its adaptation to the existing social pattern. Caucasia’s social landscape continued to be dominated by dynastic noble houses, but the hybrid Zoroastrianisms they had long favored were eclipsed by Christianity starting in the 4th century. Meanwhile, in western Georgia the polities based in Egrisi (cf. Greek Colchis) fell under the stronger influence of the Graeco-Roman Mediterranean. They too were brought into the Christian fold in late antiquity.

The Kʻartʻvelian monarchy was abolished by the Sasanians circa 580 and remained in abeyance until 888. In the afterglow of the interregnum, the ascendant Bagratid dynasty—following the “Byzantinizing” path blazed by the Georgian Church—consciously reoriented kingship from an Iranian to a Byzantine basis as it politically integrated eastern and western Georgia for the first time. Nevertheless, at the height of the all-Georgian kingdom, many aspects of Iranic culture flourished, including epic literature. Mongol hegemony across much of the 13th century marks a crucial turning point in Georgian history. Under Īlkhānid rule, Caucasia’s access to the Eurasian ecumene expanded significantly, but the political fragmentation of Georgia intensified. In the new phase of imperialism ushered by Timur (Tamerlane), the Irano-Caucasian nexus blossomed one last time under the Safavids before the isthmus fell under Russian and then Soviet control.
The Expansion of the Qing Dynasty of China and the Zunghar Mongol State
Authors: Perdue Peter
Published: January 2017

The Manchus, a powerful military state in northeast Eurasia, declared the founding of the Qing dynasty in the early 17th century. They conquered Beijing in 1644, and the core of Ming China by the end of the century, but they continued to expand into Central Eurasia, creating China’s largest enduring empire. Their most formidable rivals were the Mongols organized in the Zunghar state, which dominated western Mongolia, Xinjiang, and Tibet. Through daring military expeditions, adroit diplomacy, and extensive economic mobilization, the Qing rulers eliminated the Zunghar state, establishing uncontested power over Central Eurasia. After the conquest, the Manchus consolidated control of the region with productive economic policies, with extensive surveying and mapping, and by producing an official account of their military achievements. Qing expansion and Zunghar resistance left strong legacies for the definition of the territory of the empire and the Chinese nation that succeeded it in the 20th century.
Creation and Contingency
Authors: Evers Dirk
Published: January 2017

Contingency is a term that occurs in philosophical discourse as well as in theology in a number of contexts and with a number of meanings. In its modern sense the English term contingency refers to events, processes, or properties that may occur, but are not certain to occur; or that have, but might not have, occurred, because they depend on factors beyond our knowledge or which themselves are contingent. Generally speaking, it refers to events, objects, and properties that could be otherwise, that do not have to be as they are, and that do not have to be at all, and for whose existence we cannot give a sufficient cause. Thus contingency covers a whole range of meanings, including “not necessary,” “by chance,” “random,” and “unpredictable.”

In the discourse on science, the debate pivots on questions of determinism vs. indeterminism in physics (especially in quantum physics and in systems theory), on the contingent character of the cosmos and its fundamental physical laws, and on the question of whether the development of evolution and the actual forms of life that result from it are merely coincidental in biology. Some have referred to the first form of contingency as nomological and to the second as local contingency (Robert J. Russell, “Contingency in Physics and Cosmology: A Critique of the Theology of Wolfhart Pannenberg,” Zygon 23.1 [1988]). The alternative is between physical determinism (all events necessarily follow from prior initial conditions, so that contingency only refers to a lack of knowledge) and indeterminism (some events are not determined by prior conditions, hence contingency is an ontological fact). In religion and theology, contingency often marks the fundamental difference between the Creator and creation. It is used in ontological and cosmological proofs of the existence of God in the sense that all created beings cannot account for their own existence, but—in their contingency—point to a Creator, who is not contingent, but the necessary ground of his or her own being. However, it is disputed whether such a conclusion is valid or itself contingent. Another divide is between those who argue for total divine predestination (God determines everything that happens; again contingency is only a human category regarding insufficient knowledge and insight) and those who argue that God leaves some things to chance or to being determined autonomously by created entities. A consequence of the latter view seems to be that God cannot have sufficient fore-knowledge with regard to the process of creation so that God’s omniscience and omnipotence seem in danger. On the other hand, the option of total predestination faces the problem that in its view the Creator seems to be responsible for everything, including all evil.
Alternative Religious Movements and Race in America
Authors: Clark Emily Suzanne
Published: January 2017

Alternative religious movements have played a significant role in American history. There is no easy definition for these types of groups; their ideas and practices vary. One clear commonality, though, is their development on the sociocultural margins. Thus, inherent in alternative religious movements is a critique of dominant culture, and this offers a powerful means of engaging issues of race in America. Other groups, however, choose to echo prevailing racial ideas as a means of making themselves mainstream. The typical narrative of American religious history is white and Protestant, and alternative religious movements have provided both criticism and approval of that story.

While a close look at every alternative religious movement would be impossible, even an abbreviated exploration is revealing. During the antebellum period the question of slavery and the white supremacy that supported it prompted alternative religious movements to ask questions about equality. While many Shakers and Spiritualists recognized value in all, other groups, like the Mormons, encoded contemporary racial assumptions in their early theology. Throughout the 19th and into the 20th century, African Americans and Native Americans criticized white supremacy by offering alternative explanations of humanity’s history and destiny. The 1890s Ghost Dance movement envisioned an Indian paradise devoid of whites, and in the early 20th century black alternative movements in northern cities emphasized the religious significance of their blackness. Though these groups criticized the white supremacy surrounding them, others continued to emphasize the superiority of whiteness. In the latter part of the 20th century, many Americans associated racialized alternative religious movements, such as the Nation of Islam, the International Society of Krishna Consciousness, and the Peoples Temple, with fear or brainwashing. In examining how alternative religious movements engage racial assumptions, articulate racial discourse, or create religio-racial identities, a study of these movements illuminates the interplay between religion and culture in American history.
Panskoye I
Authors: Stolba Vladimir F.
Published: January 2017

Panskoye I is one of the most prominent and best-studied settlements in the rural territory of Chersonesus on the Tarkhankut Peninsula (north-western Crimea). Founded in the late 5th century bce as a fortified outpost (tetrapyrgia) protecting the south-eastern frontiers of Olbian territory, around 360 bce it was subjugated to Tauric Chersonesus, a close relationship which it maintained until the settlement’s catastrophic destruction around 270 bce. In 1969–1994, a significant part of the settlement and associated necropolis were investigated by the Tarkhankut Archaeological Expedition of the Leningrad Institute of Archaeology, Academy of Sciences of the USSR (since 1991, Institute for the History of Material Culture, Russian Academy of Sciences, St. Petersburg). The settlement’s stratigraphy and size, as well as its unique structure and layout, representing an agglomeration of compactly placed free-standing farmsteads, adjoining house blocks, and monumental buildings accommodating more than one household, distinguish it from other rural settlements in the area. Its rich and original material culture shows a remarkable intermingling of various cultural components, both Greek and non-Greek.
Corpus Phonology
Authors: Durand Jacques
Published: January 2017

Corpus Phonology is an approach to phonology that places corpora at the center of phonological research. Some practitioners of corpus phonology see corpora as the only object of investigation; others use corpora alongside other available techniques (for instance, intuitions, psycholinguistic and neurolinguistic experimentation, laboratory phonology, the study of the acquisition of phonology or of language pathology, etc.). Whatever version of corpus phonology one advocates, corpora have become part and parcel of the modern research environment, and their construction and exploitation has been modified by the multidisciplinary advances made within various fields. Indeed, for the study of spoken usage, the term ‘corpus’ should nowadays only be applied to bodies of data meeting certain technical requirements, even if corpora of spoken usage are by no means new and coincide with the birth of recording techniques. It is therefore essential to understand what criteria must be met by a modern corpus (quality of recordings, diversity of speech situations, ethical guidelines, time-alignment with transcriptions and annotations, etc.) and what tools are available to researchers. Once these requirements are met, the way is open to varying and possibly conflicting uses of spoken corpora by phonological practitioners. A traditional stance in theoretical phonology sees the data as a degenerate version of a more abstract underlying system, but more and more researchers within various frameworks (e.g., usage-based approaches, exemplar models, stochastic Optimality Theory, sociophonetics) are constructing models that tightly bind phonological competence to language use, rely heavily on quantitative information, and attempt to account for intra-speaker and inter-speaker variation. This renders corpora essential to phonological research and not a mere adjunct to the phonological description of the languages of the world.
Comparative Transcriptome Analyses inZymoseptoria triticiReveal Significant Differences in Gene Expression Among Strains During Plant Infection
Authors: Palma-Guerrero Javier , Ma Xin , Torriani Stefano F. F. , Zala Marcello , Francisco Carolina S. , Hartmann Fanny E. , Croll Daniel , McDonald Bruce A.
Published: January 2017

Zymoseptoria tritici is an ascomycete fungus that causes Septoria tritici blotch, a globally distributed foliar disease on wheat. Z. tritici populations are highly polymorphic and exhibit significant quantitative variation for virulence. Despite its importance, the genes responsible for quantitative virulence in this pathogen remain largely unknown. We investigated the expression profiles of four Z. tritici strains differing in virulence in an experiment conducted under uniform environmental conditions. Transcriptomes were compared at four different infection stages to characterize the regulation of gene families thought to be involved in virulence and to identify new virulence factors. The major components of the fungal infection transcriptome showed consistent expression profiles across strains. However, strain-specific regulation was observed for many genes, including some encoding putative virulence factors. We postulate that strain-specific regulation of virulence factors can determine the outcome of Z. tritici infections. We show that differences in gene expression may be major determinants of virulence variation among Z. tritici strains, adding to the already known contributions to virulence variation based on differences in gene sequence and gene presence/absence polymorphisms.
Compassionate care for teens who self-injure
Authors: Murphy Kathryn
Published: January 2017

Nurses caring for adolescents across healthcare settings play a crucial role in the assessment of nonsuicidal self-injury.
The Use of Short, Animated, Patient-Centered Springboard Videos to Underscore the Clinical Relevance of Preclinical Medical Student Education
Authors: Adam Maya , Chen Sharon F. , Amieva Manuel , Deitz Jennifer , Jang Heeju , Porwal Aarti , Prober Charles
Published: January 2017

Problem

Medical students often struggle to appreciate the clinical relevance of material taught in the preclinical years. The authors believe videos could be effectively used to interweave a patient’s illness script with foundational basic science concepts.

Approach

In collaboration with four other U.S. medical schools, educators at the Stanford University School of Medicine created 36 short, animated, patient-centered springboard videos (third-person, narrated accounts of authentic patient cases conveying foundational pathophysiology) in 2014. The videos were used to introduce students to 36 content modules, created as part of a microbiology, immunology, and infectious diseases curriculum. The videos were created with input from faculty content experts and in some cases medical students, and were piloted using a flipped classroom pedagogical approach in January 2015–June 2016.

Outcomes

Student feedback from course evaluations and focus groups was analyzed using a mixed-methods approach. On the course evaluations, the majority of students rated the patient-centered videos positively, and the majority of comments on the videos were positive, highlighting both enhanced engagement and enhanced learning and retention. Comments from focus groups mirrored the course evaluation comments and highlighted different usage patterns for the videos.

Next Steps

The authors will continue to gather and analyze data from schools using the videos as part of their core preclinical curriculum, and will produce similar videos for use in other areas of undergraduate medical education. These videos could support students’ review of content taught previously and be repurposed for use in continuing and graduate medical education, as well as patient education.
The Net Present Value and Other Economic Implications of a Medical Career
Authors: Reinhardt Uwe E.
Published: January 2017

College graduates’ career choices are driven by a complex mixture of factors, one of which is economics. The author comments on the report by Marcu and colleagues in this issue, which focuses strictly on the economics of this decision. Specifically, Marcu and colleagues modeled career choices as long-term financial investments in human capital, which consists of the knowledge and clinical skills physicians gain in undergraduate and graduate medical education. They distill the numerous factors that shape the economics of career choice into a commonly used criterion for long-term financial investments of any kind—namely, the so-called net present value (NPV) of the investment. For them, that investment is the decision to pursue a medical career rather than the next best nonmedical, alternative career. This NPV calculation determines the increase or decrease in wealth, relative to that of the next best alternative career, that a college graduate is thought to experience as of the moment she or he enters medical school simply by choosing a medical career rather than the next best alternative. Marcu and colleagues use this human capital model to explore how different plans to finance a medical school education impact the NPV, all other parameters being equal. The author of this Commentary explains in layman’s terms how the NPV is calculated and then raises a number of other issues concerning the economics of a medical career, including medical school tuition, residents’ salaries, and investments in human capital as tax deductible.
Lidocaine Induces Apoptosis and Suppresses Tumor Growth in Human Hepatocellular Carcinoma Cells In Vitro and in a Xenograft Model In Vivo
Authors: Xing Wei , Chen Dong-Tai , Pan Jia-Hao , Chen Yong-Hua , Yan Yan , Li Qiang , Xue Rui-Feng , Yuan Yun-Fei , Zeng Wei-An
Published: January 2017

Background

Recent epidemiologic studies have focused on the potential beneficial effects of regional anesthetics, and the differences in cancer prognosis may be the result of anesthetics on cancer biologic behavior. However, the function and underlying mechanisms of lidocaine in hepatocellular carcinoma both in vitro and in vivo have been poorly studied.

Methods

Human HepG2 cells were treated with lidocaine. Cell viability, colony formation, cell cycle, and apoptosis were assessed. The effects of lidocaine on apoptosis-related and mitogen-activated protein kinase protein expression were evaluated by Western blot analysis. The antitumor activity of lidocaine in hepatocellular carcinoma with or without cisplatin was investigated with in vitro experiments and also with animal experiments.

Results

Lidocaine inhibited the growth of HepG2 cells in a dose- and time-dependent manner. The authors also found that lidocaine arrested cells in the G0/G1 phase of the cell cycle (63.7 ± 1.7% vs. 72.4 ± 3.2%; P = 0.0143) and induced apoptosis (1.7 ± 0.3% vs. 5.0 ± 0.7%; P = 0.0009). Lidocaine may exert these functions by causing an increase in Bax protein and activated caspase-3 and a corresponding decrease in Bcl-2 protein through the extracellular signal-regulated kinase 1/2 and p38 pathways. More importantly, for the first time, xenograft experiments (n = 8 per group) indicated that lidocaine suppressed tumor development (P < 0.0001; lidocaine vs. control) and enhanced the sensitivity of cisplatin (P = 0.0008; lidocaine plus cisplatin vs. cisplatin).

Conclusions

The authors’ findings suggest that lidocaine may exert potent antitumor activity in hepatocellular carcinoma. Furthermore, combining lidocaine with cisplatin may be a novel treatment option for hepatocellular carcinoma.
The microenvironment in primary cutaneous melanoma with associated spontaneous tumor regression: evaluation for T-regulatory cells and the presence of an immunosuppressive microenvironment
Authors: Gray Arielle , Grushchak Solomiya , Mudaliar Kumaran , Kliethermes Stephanie , Carey Kyle , Hutchens Kelli A.
Published: January 2017

Spontaneous tumor regression, regression in the absence of therapeutic intervention, can be identified histologically in over 25% of primary cutaneous melanomas at initial diagnosis. A unique subset of T lymphocytes found in areas of regression can be histologically distinguished from tumor-infiltrating T lymphocytes (TIL) found in areas of tumor progression. We call this unique subset of T lymphocytes regression-associated T lymphocytes (RATs). The aim of this study is to determine the phenotype of lymphocytes and the density of specific cell types linked to immunosuppression in areas of tumor progression compared with areas of tumor regression. These specific cell types include T-regulatory cells (Tregs) and S100A9+ cells. A total of 14 primary cutaneous melanomas with areas of progression and regression were used. Immunohistochemistry staining was used to identify CD4+ cells, CD8+ cells, Tregs, and S100A9+ cells. Two independent observers manually counted three high-powered ×40 fields. There was no predominance of CD4+ or CD8+ T lymphocytes in either RATs or TIL. We identified a lower density of Tregs in RATs compared with TIL when using the FOXP3+/CD4+ Treg marker (P=0.04) and a marginal difference when using our second, confirmatory Treg marker, FOXP3+/CD25+ (P=0.11). We observed a lower density of S100A9+ cells in RATs compared with TIL (P=0.002). There was an observable difference in the tumor microenvironments of RATs and TIL, with RATs having a significantly lower density of Tregs and S100A9+ cells. We deduce that the absence of immunosuppression in areas of regression allows for a more robust immune response and thus effective eradication of tumor cells.
A cannabigerol-rich Cannabis sativa extract, devoid of ∆9-tetrahydrocannabinol, elicits hyperphagia in rats
Authors: Brierley Daniel I. , Samuels James , Duncan Marnie , Whalley Benjamin J. , Williams Claire M.
Published: January 2017

Nonpsychoactive phytocannabinoids (pCBs) from Cannabis sativa may represent novel therapeutic options for cachexia because of their pleiotropic pharmacological activities, including appetite stimulation. We have recently shown that purified cannabigerol (CBG) is a novel appetite stimulant in rats. As standardized extracts from Cannabis chemotypes dominant in one pCB [botanical drug substances (BDSs)] often show greater efficacy and/or potency than purified pCBs, we investigated the effects of a CBG-rich BDS, devoid of psychoactive ∆9-tetrahydrocannabinol, on feeding behaviour. Following a 2 h prefeed satiation procedure, 16 male Lister-hooded rats were administered CBG-BDS (at 30–240 mg/kg) or vehicle. Food intake, meal pattern microstructure and locomotor activity were recorded over 2 h. The total food intake was increased by 120 and 240 mg/kg CBG-BDS (1.53 and 1.36 g, respectively, vs. 0.56 g in vehicle-treated animals). Latency to feeding onset was dose dependently decreased at all doses, and 120 and 240 mg/kg doses increased both the number of meals consumed and the cumulative size of the first two meals. No significant effect was observed on ambulatory activity or rearing behaviour. CBG-BDS is a novel appetite stimulant, which may have greater potency than purified CBG, despite the absence of ∆9-tetrahydrocannabinol in the extract.
Therapeutic Drug Monitoring of Everolimus: Comparability of Concentrations Determined by 2 Immunoassays and a Liquid Chromatography Tandem Mass Spectrometry Method
Authors: Shipkova Maria , Rapp Sonja , Rigo-Bonnin Raül , Wieland Eberhard , Peter Andreas
Published: January 2017

Background:

Therapeutic drug monitoring is recommended to guide therapy with the immunosuppressant everolimus (EVL) in solid organ transplantation to prevent rejections and to limit toxicity. For therapeutic drug monitoring, predose EVL concentrations are measured in whole blood mainly by liquid chromatography tandem mass spectrometry (LC-MS/MS). In addition, 2 immunoassays [Quantitative Microsphere System (QMS) EVL and Elecsys EVL] are commercially available. The aim of this study was to evaluate the comparability of EVL results determined with the 2 immunoassays and a validated LC-MS/MS test using samples from kidney, liver, and heart transplant (KT, LT, and HT, respectively) recipients.

Methods:

Analysis of predose samples from KT (n = 56), LT (n = 60), and HT (n = 59) recipients, obtained at variable time points after transplantation, was performed by LC-MS/MS and with the 2 immunoassays. The QMS EVL assay was applied on Dimension Xpand Plus and the Elecsys EVL assay on cobas e 411 analyzer. Results were compared by the Spearman's rank correlation coefficient, unbiased Passing and Bablok linear regression test, and Bland–Altman plot.

Results:

Results generated with both immunoassays correlated well with those of LC-MS/MS. An overestimation of EVL concentrations by the Elecsys EVL compared with LC-MS/MS was observed (mean bias: 34.2%). Using the QMS EVL, a small but significant negative deviation (mean bias: −8.0%) was found. Looking at KT, HT, and LT samples separately, the bias to LC-MS/MS seen with the Elecsys EVL was similar. With the QMS EVL, the best agreement was observed with the KT samples followed by LT and HT.

Conclusions:

Results generated by the 3 methods are not consistent regarding their diagnostic value. Both laboratories and manufacturers should take care to inform their costumers about the between-method differences to avoid misinterpretation of the results in clinical practice.
The role of accountable care organization affiliation and ownership in promoting physician practice participation in quality improvement collaboratives
Authors: Hurley Vanessa B. , Rodriguez Hector P. , Shortell Stephen M.
Published: January 2017

Background:

Quality improvement collaboratives (QICs) have emerged as an important strategy to improve processes and outcomes of clinical care through interorganizational learning. Little is known about the organizational factors that support or deter physician practice participation in QICs.

Purpose:

The aim of this study was to examine organizational influences on physician practices' propensity to participate in QICs. We hypothesized that practice affiliation with an accountable care organization (ACO) and practice ownership by a system or community health center (CHC) would increase the propensity of physician practices to participate in a QIC.

Methodology:

Data from the third wave of the National Study of Physician Organizations, a nationally representative sample of medical practices (n = 1,359), were analyzed. Weighted multivariate regression analyses were estimated to examine the association of ACO affiliation, ownership, and QIC participation, controlling for practice size, health information technology capacity, public reporting participation, and practice revenue from Medicaid and uninsured patients. The Sobel–Goodman Test was used to explore the extent to which practice use of quality improvement (QI) methods such as Lean, Six Sigma, and use of plan-do-study-act cycles mediates the relationship between ACO affiliation and QIC participation.

Findings:

Only 13.6% of practices surveyed in 2012–2013 participated in a QIC. In adjusted analyses, ACO affiliation (odds ratio [OR] = 1.51, p < .01), CHC ownership (OR = 6.57, p < .001), larger practice size (OR = 14.72, p < .001), and health information technology functionality (OR = 1.15, p < .001) were positively associated with QIC participation. Practice use of QI methods partially mediated (13.1%–46.7%) the association of ACO affiliation with QIC participation.

Practice Implications:

ACO-affiliated practices are more likely than non-ACO practices to participate in QICs. Practice size rather than system ownership appears to influence QIC participation. QI methods often promoted and used by health care systems such as CHCs and ACOs may promote QIC participation.