bluuebunny/crossref_metadata_2025 huggingface dataset:
Japan-EU Relations
Authors: Söderberg Marie
Published: February 2021

Japan and the European Union have recently made several agreements aiming to deepen their cooperation. An example of this is the “Partnership on Sustainable Connectivity and Quality Infrastructure between the European Union and Japan,” by which both EU and Japan agreed to “promote free, open, rules-based, fair, non-discriminatory and predictable regional and international trade and investment, transparent procurement practices, the ensuring of debt sustainability and the high standards of economic, fiscal, financial, social and environmental sustainability.” This is just the latest part in an effort by both to revive multilateral cooperation in the face of US withdrawal from international agreements and the rise of a more assertive China. Japan and EUs Strategic Partnership Agreement provides a legally binding framework for further cooperation in the field of politics, security, and development. Underpinning it are shared values and principles of democracy, the rule of law, human rights, and fundamental freedoms. For the protection of democracy and the liberal world order, Japan and the EU seem like ideal partners. The question is whether ongoing shifts in the power balance, geopolitics, crises of liberalism, domestic politics, and legal and technological changes will lead to broader and deeper cooperation. This chapter provides a historical background to Japan-European relations from WWII until today. The relation started with a heavy emphasis on trade and business. It is only recently that the two have broadened their cooperation and now stand up as two of the strongest defenders of a liberal rule-based world order.
Music Festival Capitalism
Authors: Anderton Chris
Published: February 2021

This chapter adds to a growing subfield of music festival studies by examining the business practices and cultures of the commercial outdoor sector, with a particular focus on rock, pop, and dance music events. The events of this sector require substantial financial and other capital in order to be staged and achieve success, yet the market is highly volatile, with relatively few festivals managing to attain longevity. It is argued that these events must balance their commercial needs with the socio-cultural expectations of their audiences for hedonistic, carnivalesque experiences that draw on countercultural understanding of festival culture (the countercultural carnivalesque). This balancing act has come into increased focus as corporate promoters, brand sponsors, and venture capitalists have sought to dominate the market in the neoliberal era of late capitalism. The chapter examines the riskiness and volatility of the sector before examining contemporary economic strategies for risk management and audience development, and critiques of these corporatizing and mainstreaming processes.
The Impact of Digitalization on Minority Music: Technological Change and Cultural Belonging among the Swedish-speaking Finns
Authors: Brusila Johannes
Published: February 2021

This chapter looks at the impact of digitalization on minority music. According to an often-recurring optimistic vision, digitalization has led to larger cultural diversification and democratization, whereas critical voices claim that social and industrial structures have not changed radically after all. From a cultural perspective, a key question is to what extent the technological changes have affected cultural belonging and the relationships between identity and music. These questions are discussed by applying theories related to identity and digitalization on the Swedish-speaking population of Finland. Based on the material, it appears that digitalization incorporates both opportunities and limits for preserving and developing cultural practices that are connected to the ethnicity. As a complex aesthetic practice, music also offers a variety of means of negotiating identity, tradition, and locality. Thus, it would be a simplification to expect any single one-way causal connection between digitalization and culture.
The Sunni Islamic Revival
Authors: Rock-Singer Aaron
Published: February 2021

Over the past century, waves of Sunni reformers from the Middle East to South Asia to central Asia have called for a return to Islam’s foundations by invoking well-established concepts in Islamic thought such as tajdid (renewal) and islah (reform). Yet, far from constituting a straightforward return to a well-established playbook, the revivalist movements of the 20th century have emerged at the intersection of longer Islamic theological and legal traditions, the ideological challenges of secular nationalism, and radical shifts in the nature of religious authority enabled by the linked spread of print and literacy. This chapter provides an overview of these movements, beginning in the late 19th century with the efforts of Jamal al-Din al-Afghani, Muhammad ‘Abduh, and Muhammad Rashid Rida, and then moving forward to varied revivalist trends, national and transnational, in the modern Middle East.
Excluded Generations in Non-Inclusive Nations
Authors: Fargues Philippe
Published: February 2021

This chapter offers an interpretation of the political link in Arab societies through the lens of demography. The first section shows how young generations today do not resemble those of earlier times. Rising education has raised expectations, and the reduction of fertility and postponement of childbearing have provided young adults with unprecedented individual freedom of movement. If expectations are not met by opportunities and young people have a feeling of exclusion, freedom of movement becomes a driver of emigration and rebellion. The second section of the chapter focuses on specific patterns of reproduction among Arab populations and the obstacles to building inclusive nations. On one side, the uniquely high prevalence of kinship endogamy means that marriage does not help unrelated population groups to integrate, so that blood bonds remain stronger than national bonds. On the other side, while the circulation of people is the most significant form of exchange between Arab countries, nationality laws based on exclusive jus sanguinis do not provide newcomers with pathways to full membership; and therefore, non-citizens have emerged as a category in Arab countries. Excluded generations in non-inclusive nations set the stage for prolonged political crises.
Genetics and Genomics of Posttraumatic Stress Disorder
Authors: Cusack Shannon , Sheerin Christina , Bountress Kaitlin , Uddin Monica , Nugent Nicole R. , Koenen Karestan C. , Amstadter Ananda B.
Published: February 2021

Posttraumatic stress disorder (PTSD) is a complex disorder; a range of molecular features likely contributes to individuals’ increased risk for, or resistance to, developing PTSD when exposed to trauma. The focus here is on studies that investigate molecular factors that may be associated with this disorder. This chapter reviews the existing studies on molecular genetic, epigenetic, and gene expression associations with PTSD. This chapter also reviews novel statistical approaches used with genome-, methylome-, and expression-wide data. Future research in this rapidly evolving area should focus on the combined examination of genetic sequence, epigenetic effects, and gene expression to obtain a more complete picture of the systems biology of PTSD.
Empirically Supported Psychological Treatments: Cognitive Processing Therapy
Authors: Chard Kathleen M. , Schuster Wachen Jennifer
Published: February 2021

Cognitive processing therapy (CPT) has been recognized by recent clinical practice guidelines as one of the most effective treatments for posttraumatic stress disorder (PTSD). This chapter provides a brief overview of the CPT session content, the underlying mechanisms of the therapy, a review of the empirically based literature outlining the treatment effectiveness, limitations of the therapy, and areas of future research. In addition, the authors discuss the utility of the various versions of CPT, including CPT+Account, group, individual, and combination. Further, the research supporting the effectiveness of CPT for treating PTSD related to a variety of traumas (e.g., combat, child abuse, and rape) and the significant impact CPT can have in areas of mental health related to PTSD (e.g., anger, guilt, social functioning) are described.
Treating Trauma-Related Symptoms in Special Populations
Authors: Hinton Devon E. , Pickover Alison M.
Published: February 2021

Although there is much research on the treatment of posttraumatic psychological reactions in survivors of civilian trauma, there is much less empirical evidence to drive interventions with survivors of other kinds of trauma, including persecution, torture, and sexual abuse, particularly in other cultural groups. This chapter illustrates some of the factors that should be taken into consideration when treating such populations. The chapter is divided into sections that address key issues relevant to special populations of trauma survivors: type of trauma, current stressors, comorbidity, anger, cultural issues such as culturally specific interpretations of trauma-related symptoms, and bereavement. The implications of these issues for the treatment of refugees and asylum seekers are examined. As this chapter indicates, the treatment of traumatic distress in special populations warrants more research to ensure that the optimal psychological interventions are available to such highly traumatized groups.
Pharmacotherapy for PTSD
Authors: West James C. , Wynn Gary H. , Benedek David M.
Published: February 2021

Psychotropic medications offer some benefit in treatment of posttraumatic stress disorder (PTSD) symptoms. This chapter reviews classes of medications used as monotherapy and augmentation agents and evidence for their use. Antidepressant medications, particularly selective serotonin reuptake inhibitors, have the greatest body of evidence to support their use in treatment of PTSD, but the benefit they offer is modest, and they are ineffective in some populations. This chapter also reviews novel pharmacologic approaches to treatment of PTSD still under investigation. Beyond sleep, studies to date have not identified strategies to target specific symptom clusters in PTSD. Such studies may help tailor future treatment to symptoms that are either particularly disabling or refractory to other medications of psychosocial intervention. “Repurposing” studies of older agents originally approved for other illnesses may prove effective for specific symptoms or symptom clusters of PTSD.
Persistence of Complexity
Authors: Lourandos Harry , Ross Annie
Published: February 2021

The Intensification debate of the late 1970s–1980s in world and Australian archaeology challenged conventional environmental theories of human behaviour, and the concept of hunter-gatherers in general. It emphasized change and dynamics in past hunter-gatherer societies, arguing against predominant environmental control and comparing, rather than contrasting, hunter-gatherers with other societies such as agriculturalists and horticulturalists. The debate was directed at questions of resource use and economy, demography, and sociostructural change, and it set forth paradigmatic changes and new narratives regarding the conceptualization of hunter-gatherers and their history (prehistory). Discussed here are the debate’s theoretical history and development in the Australian context, its results, its lasting influence and critique, and its continued relevance in debates today.
The Study of Peaceful Change in World Politics
Authors: Paul T. V.
Published: February 2021

This introductory chapter offers an overview of the core themes addressed in The Oxford Handbook of Peaceful Change in International Relations. It begins with a discussion of the neglect of peaceful change and the overemphasis on war as the source of change in the discipline of international relations. Definitions of peaceful change in their different dimensions, in particular the maximalist and minimalist varieties, are offered. Systemic, regional, and domestic level changes are explored. This is followed by a discussion of the study and understanding of peaceful change during the interwar, Cold War, and post–Cold War eras. The chapter offers a brief summary of different theoretical perspectives in IR—realism, liberalism, constructivism, and critical as well as eclectic approaches—and how they explore peaceful change, its key mechanisms, and its feasibility. The chapter considers the role of great powers and key regional states as agents of change. The economic, social, ideational, ecological, and technological sources of change are also briefly discussed.
Science, Technology, and Peaceful Change in World Politics
Authors: Clunan Anne L.
Published: February 2021

This chapter undertakes a three-dimensional survey of the role of science and technology in peaceful change in world politics. One dimension is a sociology of knowledge on S/T and change in IR and its influence on the subdisciplines of security studies, international organization, and international political economy. The second dimension is the manner in which S/T has shaped the emergence of actors, interests, material power, social purposes, and grammars of international order to produce our contemporary late-modern Anthropocene age. Woven through this survey is the third dimension, contestation over S/T and its effects—at the micro and meso levels of analysis—that create the dynamic, open-ended movements and countermovements that brought humankind from the preindustrial order to the Anthropocene. The chapter considers next how IR can improve its theories of change and the prospects for this volume’s maximalist definition of peaceful change, beginning with some criteria for distinguishing what actually constitutes “peaceful” change. One of the most profound changes the world faces is rethinking both our paradigms and governance structures in light of climate change and the Fourth Industrial Revolution, as these will profoundly alter the actual workings of economies and societies, remaking global politics in the process.
Disability in Deuteronomy and its Reception
Authors: Melcher Sarah J.
Published: February 2021

The chapter begins with a section offering highlights from a history of interpretation about Deuteronomy and disability. Especially prevalent among earlier interpretations is the association of disability with exclusion: exclusion from the community, from the tent of meeting, or from the priesthood. The second section maps out an overview of major works that include the study of disability and Deuteronomy. Scholars point out that infertility was considered a disability in ancient times. They also discuss how idols are represented as humans with disabilities while YHWH is portrayed as someone without disabilities. People who violate the covenant can be punished with disabilities. In the third section, the chapter explores how the conversation about disability and Deuteronomy is trending.
Research with Human Participants in the United States
Authors: Coleman Carl H.
Published: February 2021

This chapter discusses research with human participants in the United States, most of which has been subject to federal regulations requiring prospective ethical oversight by entities known as institutional review boards (IRBs) since the 1970s. Research that is subject to the federal regulations may not begin until IRB approval has been obtained. The chapter begins by examining key aspects of the federal regulations governing IRB review of research with human participants, including the type of activities that fall under the IRB’s jurisdiction, how IRBs are organized, and some of the key substantive standards that IRBs apply. It then looks at additional regulatory standards that apply to studies involving particular populations, including pregnant women and fetuses, prisoners, and children. Finally, the chapter examines several other bodies of law related to research with human participants, including policies governing the inclusion of women and racial minorities in clinical trials; legal principles governing compensation for injuries to research participants; and requirements for registering clinical trials, reporting trial results, and disclosing research-related conflicts of interest.
Staggered Terms in Majoritarian and Nonmajoritarian Institutions
Authors: Willumsen David M.
Published: February 2021

Staggered terms, that is, the partial renewal of terms of office, are widespread in both majoritarian and nonmajoritarian institutions, but they are little studied or understood. While the goals of staggered terms are to lengthen the time horizons of individual and institutions and to lead to more stable policy outcomes, this may not occur, as members often have the ability to influence their chances of obtaining additional terms of office and may alter their behavior in the pursuit of this. This chapter discusses the different forms staggered terms can take and the wide range of institutions where staggered terms are found. It then discusses the literature on the effects of staggered terms on behavior and outcomes, as well as how staggered terms have been used as a research design. Finally, the chapter sets out potential future research avenues.
Realigning Theory, Practice, and Justice in Global South Youth Studies
Authors: Cooper Adam , Swartz Sharlene , Batan Clarence M. , Kropff Causa Laura
Published: February 2021

This essay outlines an agenda for youth studies from the vantage point of the Global South and describes the structure of the Oxford handbook of Global South Youth Studies. Youth in the Global South emerge in the postcolonial world in relation to material and social precarity, with their everyday practices constituting embodied forms of knowing, responses to their social, material, economic, and political circumstances. Research with Southern youth therefore involves working alongside, documenting, and acknowledging these practices, an exercise that constitutes a form of ‘epistepraxis’: a knowledge creation endeavor underpinned by contextually relevant theory, aligned with people’s innovative practices, in search of social justice. This approach is reflected in the structure of the handbook. An introductory section distils the conditions that precipitated the Global South and the characteristics of youthful populations that inhabit it. The second part grapples with features of life for youth in the Global South, unpacking eleven relevant concepts, using Southern theory. The final section continues to explore the intersections of theory, practice, and politics, shifting focus to look specifically at examples of methodological, practical, and policy-related interventions, in an attempt to disrupt business-as-usual knowledge production.
Tagore’s Vision of Postcolonial Youth Futurities in Education and Literature
Authors: Dasgupta Sreemoyee
Published: February 2021

Rabindranath Tagore (1861–1941), the first non-European to win the Nobel Prize in Literature, was a prolific writer. He left, as a legacy, many poems, essays, novels, plays, and songs, written in both English and Bengali. Tagore was an ardent believer in the beauty of humanity, with strongly anticolonial and antinationalist views. This essay explores his beliefs about youth, education, and pedagogical practices, through his poetry anthologies on childhood and his prose writings on nationalism and education. It argues that his vision of childhood represents the confluence of his educational philosophy and his imaginings of nascent Indian nationhood. Furthermore, Tagore’s indigenization of the Romantic child, and his establishment of a native pedagogical system based on Romantic ideals, provides the Global South with a path to decoloniality which avoids both the violence of extreme nationalism and the symbolic violence perpetuated by colonial education systems.
Voting for IslamistsMapping the Role of Religion
Authors: Lust Ellen , Kao Kristen , Okar Gibran
Published: February 2021

Much has been written on political advantages conferred to Islamist parties. These advantages are often viewed as resulting from the parties’ organizational strength, their economic policies, or the expected material benefits they award. The role of religion in motivating Islamist support has been largely underplayed, and even less attention has been given to the various dimensions of Islam. This gap in the research remains conspicuous, as evidence from European, African, and American contexts point to a very real relationship between various facets of religion and electoral patterns. This chapter reviews how historical legacies and social conditions in Tunisia, Libya, and Egypt have shaped electoral behavior, including the ways in which organizational, economic, or religious factors are associated with Islamist support. Employing original survey data, it investigates the dominant explanations of electoral support as well as the influence of three religious factors—religious identity, practice, and preferences toward the role of Islam in the state. We find evidence in all three countries that citizens’ preferences for a role of religion in the state is strongly correlated with voting for Islamist parties. In Tunisia, religious practice was also significantly associated with support for Islamists. Religious identity was never significant in our cases, however. Attitudes toward party organization and toward service provision were associated with Islamist support in Tunisia and Libya, respectively. Importantly, religious factors were more consistently related to Islamist support than the organizational, economic, and material incentives that have been given so much attention elsewhere.
Polarized Partisanship and Voting Behavior in Zimbabwe: A Public Opinion Perspective
Authors: Bratton Michael
Published: February 2021

The chapter argues that voting behaviour and public opinion are deeply influenced by official controls applied by the entrenched ruling Zimbabwe African National Union Patriotic Front (ZANU-PF) party. Popular voting behaviour in Zimbabwe is associated with an assortment of political, cultural, and economic views. In regard to the ruling ZANU-PF’s series of electoral triumphs, leading considerations are whether persons trust traditional leaders as a guide to vote choice, the extent to which they think the economy has been administered properly, and whether they fear retribution for not voting for incumbent political elites. However, the chapter further argues, to best appreciate Zimbabwean voting behaviour, scholars must pay significant attention to Zimbabwe’s acute hyper-partisan polarization. Zimbabweans are more divided politically than in any other African country in which party affiliation has been systematically measured. Ruling and opposition parties are divided by mutual distrust, conflicting standpoints on policy debates, and over electoral choice. Polarization is partly a construction by Zimbabwean political elites, but it also has substantial traction amongst ordinary citizens who have accepted partisan loyalty as an important facet in their range of identities.
The Anthropology of Indigenous Australia and Native Title Claims
Authors: Burke Paul
Published: February 2021

While most anthropological analyses of native title remain in an applied mode of assisting anthropologists to better perform their role as expert witnesses in claims, recent research has sought to move beyond this professional discourse by drawing on Bordieuan concepts supplemented by ideas of individual agency in resolving key indeterminate requirements in the legal formulation of native title. In considering the interaction of law and anthropology in native title claims as the interaction of distinct social fields, each with its own habitus, submerged issues are brought to light concerning the differential reception of anthropological expertise and the willingness of some judges to overrule a disciplinary consensus. Anthropological analyses have also been broadened to include the effects of the native title process on the Indigenous participants, including tendencies towards a more rapid objectification and regimentation of traditional culture, intensification of disputes, and juridification of Indigenous lifeworlds. Some macro analyses attempt to situate native title claims as a particular statecraft of late liberalism. There remains plenty of scope for further research to link the analysis of native title to the perennial themes of legal anthropology.
Brexit and Territorial Preferences: Evidence from Scotland and Northern Ireland
Authors: Daniels Lesley-Ann , Kuo Alexander
Published: February 2021

Has the UK referendum to leave the EU (Brexit) affected territorial preferences within the UK? We draw on comparative theories of such preferences to address this question, as Brexit can be seen as a shock to a political unit. We test hypotheses in two key regions, Scotland and Northern Ireland, with original surveys fielded at a unique time (September 2019). We randomize making salient different Brexit scenarios and measure support for Scottish independence and unification with Ireland within each region. We find in Scotland the prospect of leaving the EU increases support for independence. This effect is pronounced among those who support the UK remaining in the EU. In Northern Ireland, religious background correlates highly with territorial views, and we find little evidence of Brexit or border-scenario effects. Our results contribute to the literature on decentralization processes and the EU, and provide evidence of when negative shocks affect such preferences.
Projecting the Nation(s) in Multinational Federal Systems: International Education and Nation Branding in Canada/Quebec
Authors: Moscovitz Hannah
Published: February 2021

This article pursues a novel endeavor by anchoring the study of nation branding in the context of multinational federal systems. Through an examination of the manner in which international education strategies are used to cultivate images of “nation” in Canada and Quebec, the study underlines how the “politics of recognition” at the heart of Canada/Quebec relations play out in the international education sphere. The results point to the significance of policy effectiveness for the “politics of recognition,” contributing to the literature on majority–minority tensions, which tends to highlight the symbolic role of policy control as opposed to the realization of said policies. The research also sheds light on the potential interplay between the political autonomy of minority nations and their symbolic recognition, by highlighting how the provision of policy control can work to substantiate the (external) recognition of their distinct nation status.
JAK inhibitors are effective in a subset of patients with juvenile dermatomyositis: a monocentric retrospective study
Authors: Le Voyer Tom , Gitiaux Cyril , Authier François-Jérôme , Bodemer Christine , Melki Isabelle , Quartier Pierre , Aeschlimann Florence , Isapof Arnaud , Herbeuval Jean Philippe , Bondet Vincent , Charuel Jean-Luc , Frémond Marie-Louise , Duffy Darragh , Rodero Mathieu P , Bader-Meunier Brigitte
Published: February 2021

Objective

To evaluate the efficacy and safety of Janus kinase inhibitors (JAKis) in JDM.

Methods

We conducted a single-centre retrospective study of patients with JDM treated by JAKi with a follow-up of at least 6 months. Proportion of clinically inactive disease (CID) within 6 months of JAKi initiation was evaluated using PRINTO criteria and skin Disease Activity Score. Serum IFN-α concentration was measured by Simoa assay.

Results

Nine refractory and one new-onset patients with JDM treated with ruxolitinib (n = 7) or baricitinib (n = 3) were included. The main indications for treatment were refractory muscle involvement (n = 8) and ulcerative skin disease (n = 2). CID was achieved in 5/10 patients (two/two anti-MDA5, three/four anti-NXP2, zero/three anti-TIF1γ-positive patients) within 6 months of JAKi introduction. All responders could withdraw plasmatic exchange, immunoadsorption and other immunosuppressive drugs. The mean daily steroid dose decreased from 1.1 mg/kg (range 0.35–2 mg/kg/d) to 0.1 (range, 0–0.3, P = 0.008) in patients achieving CID, and was stopped in two. Serum IFN-α concentrations were elevated in all patients at the time of treatment initiation and normalized in both responder and non-responder. A muscle biopsy repeated in one patient 26 months after the initiation of JAKi, showed a complete restoration of muscle endomysial microvascular bed. Herpes zoster and skin abscesses developed in three and two patients, respectively.

Conclusion

JAKis resulted in a CID in a subset of new-onset or refractory patients with JDM and may dramatically reverse severe muscle vasculopathy. Overall tolerance was good except for a high rate of herpes zoster infection.
Not all errors are alike: modulation of error-related neural responses in musical joint action
Authors: Paas Anita , Novembre Giacomo , Lappe Claudia , Keller Peter E
Published: February 2021

During joint action, the sense of agency enables interaction partners to implement corrective and adaptive behaviour in response to performance errors. When agency becomes ambiguous (e.g. when action similarity encourages perceptual self–other overlap), confusion as to who produced what may disrupt this process. The current experiment investigated how ambiguity of agency affects behavioural and neural responses to errors in a joint action domain where self–other overlap is common: musical duos. Pairs of pianists performed piano pieces in synchrony, playing either the same pitches (ambiguous agency) or different pitches (unambiguous agency) while electroencephalography (EEG) was recorded for each individual. Behavioural and event-related potential results showed no effects of the agency manipulation but revealed differences in how distinct error types are processed. Self-produced ‘wrong note’ errors (substitutions) were left uncorrected, showed post-error slowing and elicited an error-related negativity (ERN) peaking before erroneous keystrokes (pre-ERN). In contrast, self-produced ‘extra note’ errors (additions) exhibited pre-error slowing, error and post-error speeding, were rapidly corrected and elicited the ERN. Other-produced errors evoked a feedback-related negativity but no behavioural effects. Overall findings shed light upon how the nervous system supports fluent interpersonal coordination in real-time joint action by employing distinct mechanisms to manage different types of errors.
Experiences, challenges and looking to the future in a clinical tuberculosis cohort in the time of COVID-19 in the Philippines
Authors: Ferrer Julius Patrick , Suzuki Shuichi , Alvarez Cristelyn , Berido Clarinda , Caballero Michelle , Caraig Bliss , Flores Paul Ian , Juson Romil Jeffrey , Lustresano Ann , Opinion Trivon , Saavedra Michelle , Verde Ares , Faguer Benjamin N , Cox Sharon E , Solon Juan A
Published: February 2021

A cohort study of Filipino tuberculosis patients is currently undergoing data collection amidst the coronavirus disease 2019 pandemic. In this article we present the current experiences, challenges and obstacles of our team during this period as we attempt to fulfil our roles and responsibilities in Metro Manila, Cebu and Negros Occidental in the Philippines. Each site had different lockdown restrictions and experienced problems to different degrees. The underlying themes were similar, covering the supply chain, mobility, communication, physical and mental health and disruption of health services due to reallocation of staff. While we maximized the use of mobile devices, logistical challenges remained. Institutional support for the field teams, creative problem solving and resilience are required to adapt in a rapidly changing environment.
Fully Integrated Readiness for Service Training (FIRST): An Accelerated Medical Training Program for Rural and Underserved North Carolina
Authors: Coe Catherine L. , Baker Hannah M. , Byerley Julie S. , Page Cristen P.
Published: February 2021

Problem

The U.S. primary care workforce remains inadequate to meet the health needs of the U.S. population. Effective programs are needed to provide workforce development for rural and other underserved areas.

Approach

At the University of North Carolina (UNC) School of Medicine (SOM), between November 2014 and July 2015, the authors developed and implemented the Fully Integrated Readiness for Service Training (FIRST) Program, an accelerated curriculum focused on rural and underserved care that links 3 years of medical school with a conditional acceptance into UNC’s 3-year family medicine residency, followed by 3 years of practice support post-graduation. Students are recruited to the FIRST Program during the fall of their first year of medical school. The FIRST Program promotes close faculty mentorship and familiarity with the health care system, includes a longitudinal quality improvement project with an assigned patient panel, includes early integration into the clinic, and fosters a close cohort of fellow students.

Outcomes

As of March 2020, the FIRST Program had successfully recruited 5 classes of medical students, and 3 of those classes had matched into residency. In total, as of March 2020, 18 students had participated in the FIRST Program.

Next Steps

The FIRST Program will be expanded to additional clinical sites across North Carolina and to specialties beyond family medicine, including pediatrics, general surgery, and psychiatry.
National Survey of Wellness Programs in U.S. and Canadian Medical Schools
Authors: Schutt Alison , Chretien Katherine C. , Woodruff James N. , Press Valerie G. , Vela Monica , Lee Wei Wei
Published: February 2021

Purpose

To describe the prevalence and scope of wellness programs at U.S. and Canadian medical schools.

Method

In July 2019, the authors surveyed 159 U.S. and Canadian medical schools regarding the prevalence, structure, and scope of their wellness programs. They inquired about the scope of programming, mental health initiatives, and evaluation strategies.

Results

Of the 159 schools, 104 responded (65%). Ninety schools (93%, 90/97) had a formal wellness program, and across 75 schools, the mean full-time equivalent (FTE) support for leadership was 0.77 (standard deviation [SD] 0.76). The wellness budget did not correlate with school type or size (respectively, P = .24 and P = .88). Most schools reported adequate preventative programming (62%, 53/85), reactive programming (86%, 73/85), and cultural programming (52%, 44/85), but most reported too little focus on structural programming (56%, 48/85). The most commonly reported barrier was lack of financial support (52%, 45/86), followed by lack of administrative support (35%, 30/86). Most schools (65%, 55/84) reported in-house mental health professionals with dedicated time to see medical students; across 43 schools, overall mean FTE for mental health professions was 1.62 (SD 1.41) and mean FTE per student enrolled was 0.0024 (SD 0.0019). Most schools (62%, 52/84) evaluated their wellness programs; they used the Association of American Medical Colleges Graduation Questionnaire (83%, 43/52) and/or annual student surveys (62%, 32/52). The most commonly reported barrier to evaluation was lack of time (54%, 45/84), followed by lack of administrative support (43%, 36/84).

Conclusions

Wellness programs are widely established at U.S. and Canadian medical schools, and most focus on preventative and reactive programming, as opposed to structural programming. Rigorous evaluation of the effectiveness of programs on student well-being is needed to inform resource allocation and program development. Schools should ensure adequate financial and administrative support to promote students’ well-being and success.
The Surgical Program in Innovation (SPIN): A Design and Prototyping Curriculum for Surgical Trainees
Authors: Wong Daniel J. , Miranda-Nieves David , Nandivada Prathima , Patel Madhukar S. , Hashimoto Daniel A. , Kent Daniel O. , Gómez-Márquez José , Lin Samuel J. , Feldman Henry J. , Chaikof Elliot L.
Published: February 2021

Problem

Health professions education does not routinely incorporate training in innovation or creative problem solving. Although some models of innovation education within graduate medical education exist, they often require participants’ full-time commitment and removal from clinical training or rely upon participants’ existing expertise. There is a need for curricula that teach innovation skills that will enable trainees to identify and solve unmet clinical challenges in everyday practice. To address this gap in surgical graduate education, the authors developed the Surgical Program in Innovation (SPIN).

Approach

SPIN, a 6-month workshop-based curriculum, was established in 2016 in the Beth Israel Deaconess Medical Center Department of Surgery to teach surgical trainees the basics of the innovation process, focusing on surgeon-driven problem identification, product design, prototype fabrication, and initial steps in the commercialization process. Participating surgical residents and graduate students attend monthly workshops taught by medical, engineering, and medical technology (MedTech) industry faculty. Participants collaborate in teams to develop a novel device, fabricate a protype, and pitch their product to a panel of judges.

Outcomes

From academic years 2015–2016 to 2017–2018, 49 trainees, including 41 surgical residents, participated in SPIN. Across this period, 13 teams identified an unmet need, ideated a solution, and designed and pitched a novel device. Ten teams fabricated prototypes. The 22 SPIN participants who responded to both pre- and postcourse surveys reported significant increases in confidence in generating problem statements, computer-aided design, fabrication of a prototype, and initial commercialization steps (product pitching and business planning).

Next Steps

Incorporating innovation education and design thinking into clinical training will prove essential in preparing future physicians to be lifelong problem finders and solvers. The authors plan to expand SPIN to additional clinical specialties, as well as to assess its impact in fostering future innovation and collaboration among program participants.
Increasing Short- and Long-Term Buprenorphine Treatment Capacity: Providing Waiver Training for Medical Students
Authors: Stokes Daniel C. , Perrone Jeanmarie
Published: February 2021

In the face of an ongoing opioid crisis in the United States, persistent treatment gaps exist for vulnerable populations. Among the 3 Food and Drug Administration-approved medications used to treat opioid use disorder, many patients prefer buprenorphine. But physicians are currently required to register with the Drug Enforcement Administration and complete 8 hours of qualifying training before they can receive a waiver to prescribe buprenorphine to their patients. In this article, the authors summarize the evolution of buprenorphine waiver training in undergraduate medical education and outline 2 potential paths to increase buprenorphine treatment capacity going forward: the curriculum change approach and the training module approach.

As part of the 2018 Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, the Substance Abuse and Mental Health Services Administration has provided funding for medical schools to adapt their curricula to meet waiver training requirements. To date, however, only one school has had its curriculum approved for this purpose. Additionally, recent political efforts have been directed at eliminating aspects of the waiver training requirement and creating a more direct path to integrating waiver qualification into undergraduate medical education (UME).

Other medical schools have adopted a more pragmatic approach involving the integration of existing online, in-person, and hybrid waiver-qualifying training modules into the curricula, generally for fourth-year students. This training module approach can be more rapidly, broadly, and cost-effectively implemented than the curriculum change approach. It can also be easily integrated into the online medical curricula that schools developed in response to the COVID-19 pandemic. Ultimately both curricular changes and support for student completion of existing training modules should be pursued in concert, but focus should not be single-mindedly on the former at the expense of the latter.
Longitudinal Narrative Analysis of Parent Experiences During Graded Exposure Treatment for Children With Chronic Pain
Authors: Corey Jenelle R. , Heathcote Lauren C. , Mahmud Farah , Kronman Corey , Mukerji Cora , McGinnis Ellen , Noel Melanie , Sieberg Christine , Simons Laura E.
Published: February 2021

Objectives:

Parents have a vital influence over their child’s chronic pain treatment and management. Graded exposure in vivo treatment (GET) is emerging as a promising intervention for youth with chronic pain. Yet, little is known about how parents perceive GET and its impact on their child’s pain condition. This study aimed to characterize caregivers’ experiences over the course of their child’s GET using longitudinal coding and thematic analysis of parent narratives.

Materials and Methods:

Parent narratives of 15 youth who participated in GET for pediatric chronic pain (GET Living) were elicited from an unstructured dialogue at the start of each treatment session held between the parent(s) and pain psychologist. Narratives were coded for affect and content, and trends were examined in these codes across sessions. Common themes in parent narratives were developed through inductive thematic analysis.

Results:

Parents showed an increase in positive affect, treatment confidence, and optimism over the course of treatment. Narratives also expressed more benefit-finding/growth and less anxiety and protectiveness across GET sessions, with more parents having a resolved orientation towards their child’s pain by the final session. Five common themes were generated: Self-Awareness, Understanding of Their Child’s Perspective, Perceived Treatment Benefit, Internalization of Treatment Principles, and Hopeful Concern for the Future.

Discussion:

Analysis of parent narratives provides a rich and unique method for understanding a parent’s journey during their child’s chronic pain treatment. Clinical application of our findings can be used to guide future developments of targeted topics and interventions in the context of parenting a child with chronic pain.
MicroRNA-23a reduces lipopolysaccharide-induced cellular apoptosis and inflammatory cytokine production through Rho-associated kinase 1/sirtuin-1/nuclear factor-kappa B crosstalk
Authors: Shi Xiao-Jun , Jin Ye , Xu Wei-Ming , Shen Qing , Li Jun , Chen Kang
Published: February 2021

Background:

MicroRNAs are closely associated with the progression and outcomes of multiple human diseases, including sepsis. In this study, we examined the role of miR-23a in septic injury.

Methods:

Lipopolysaccharide (LPS) was used to induce sepsis in a rat model and H9C2 and HK-2 cells. miR-23a expression was evaluated in rat myocardial and kidney tissues, as well as H9C2 and HK-2 cells. A miR-23a mimic was introduced into cells to identify the role of miR-23a in cell viability, apoptosis, and the secretion of inflammatory cytokines. Furthermore, the effect of Rho-associated kinase 1 (ROCK1), a miR-23a target, on cell damage was evaluated, and molecules involved in the underlying mechanism were identified.

Results:

In the rat model, miR-23a was poorly expressed in myocardial (sham vs. sepsis 1.00 ± 0.06 vs. 0.27 ± 0.03, P < 0.01) and kidney tissues (sham vs. sepsis 0.27 ± 0.03 vs. 1.00 ± 0.06, P < 0.01). Artificial overexpression of miR-23a resulted in increased proliferative activity (DNA replication rate: Control vs. LPS vs. LPS + Mock vs. LPS + miR-23a: H9C2 cells: 34.13 ± 3.12 vs. 12.94 ± 1.21 vs. 13.31 ± 1.43 vs. 22.94 ± 2.26, P < 0.05; HK-2 cells: 15.17 ± 1.43 vs. 34.52 ± 3.46 vs. 35.19 ± 3.12 vs. 19.87 ± 1.52, P < 0.05), decreased cell apoptosis (Control vs. LPS vs. LPS + Mock vs. LPS + miR-23a: H9C2 cells: 11.39 ± 1.04 vs. 32.57 ± 2.29 vs. 33.08 ± 3.12 vs. 21.63 ± 2.35, P < 0.05; HK-2 cells: 15.17 ± 1.43 vs. 34.52 ± 3.46 vs. 35.19 ± 3.12 vs. 19.87 ± 1.52, P < 0.05), and decreased production of inflammatory cytokines, including interleukin-6 (Control vs. LPS vs. LPS + Mock vs. LPS + miR-23a: H9C2 cells: 59.61 ± 5.14 vs. 113.54 ± 12.30 vs. 116.51 ± 10.69 vs. 87.69 ± 2.97 ng/mL; P < 0.05, F = 12.67, HK-2 cells: 68.12 ± 6.44 vs. 139.65 ± 16.62 vs. 143.51 ± 13.64 vs. 100.82 ± 9.74 ng/mL, P < 0.05, F = 9.83) and tumor necrosis factor-α (Control vs. LPS vs. LPS + Mock vs. LPS + miR-23a: H9C2 cells: 103.20 ± 10.31 vs. 169.67 ± 18.84 vs. 173.61 ± 15.91 vs. 133.36 ± 12.32 ng/mL, P < 0.05, F = 12.67, HK-2 cells: 132.51 ± 13.37 vs. 187.47 ± 16.74 vs. 143.51 ± 13.64 vs. 155.79 ± 15.31 ng/mL, P < 0.05, F = 9.83) in cells. However, ROCK1 was identified as a miR-23a target, and further up-regulation of ROCK1 mitigated the protective function of miR-23a in LPS-treated H9C2 and HK-2 cells. Moreover, ROCK1 suppressed sirtuin-1 (SIRT1) expression to promote the phosphorylation of nuclear factor-kappa B (NF-κB) p65, indicating the possible involvement of this signaling pathway in miR-23a-mediated events.

Conclusion:

Our results indicate that miR-23a could suppress LPS-induced cell damage and inflammatory cytokine secretion by binding to ROCK1, mediated through the potential participation of the SIRT1/NF-κB signaling pathway.
Are periods of feeding and fasting protective during critical illness?
Authors: Puthucheary Zudin , Gunst Jan
Published: February 2021

Purpose of review

To review the mechanisms how intermittent feeding regimens could be beneficial in critically ill patients.

Recent findings

Large randomized controlled trials (RCTs) have failed to demonstrate consistent benefit of early, enhanced nutritional support to critically ill patients, and some trials even found potential harm. Although speculative, the absence of a clear benefit could be explained by the continuous mode of feeding in these trials, since intermittent feeding regimens had health-promoting effects in healthy animals and humans through mechanisms that also appear relevant in critical illness. Potential protective mechanisms include avoidance of the muscle-full effect and improved protein synthesis, improved insulin sensitivity, better preservation of circadian rhythm, and fasting-induced stimulation of autophagy and ketogenesis. RCTs comparing continuous versus intermittent feeding regimens in critically ill patients have shown mixed results, albeit with different design and inclusion of relatively few patients. In all studies, the fasting interval was relatively short (4–6 h maximum), which may be insufficient to develop a full fasting response and associated benefits.

These findings open perspectives for the design and clinical validation of intermittent feeding regimens for critically ill patients. The optimal mode and duration of the fasting interval, if any, remain unclear.