bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of a Polygenic Risk Score With Osteoporosis in People Living With HIV: The Swiss HIV Cohort Study
Authors: Schwenke Johannes M , Thorball Christian W , Schoepf Isabella C , Ryom Lene , Hasse Barbara , Lamy Olivier , Calmy Alexandra , Wandeler Gilles , Marzolini Catia , Kahlert Christian R , Bernasconi Enos , Kouyos Roger D , Günthard Huldrych F , Ledergerber Bruno , Fellay Jacques , Burkhalter Felix , Tarr Philip E ,   for the Swiss HIV Cohort Study, Abela I , Aebi-Popp K , Anagnostopoulos A , Battegay M , Bernasconi E , Braun D L , Bucher H C , Calmy A , Cavassini M , Ciuffi A , Dollenmaier G , Egger M , Elzi L , Fehr J , Fellay J , Furrer H , Fux C A , Günthard H F , Hachfeld A , Haerry D , Hasse B , Hirsch H H , Hoffmann M , Hösli I , Huber M , Jackson-Perry D , Kahlert C R , Kaiser L , Keiser O , Klimkait T , Kouyos R D , Kovari H , Kusejko K , Labhardt N , Leuzinger K , Martinez de Tejada B , Marzolini C , Metzner K J , Müller N , Nemeth J , Nicca D , Notter J , Paioni P , Pantaleo G , Perreau M , Rauch A , Salazar-Vizcaya L , Schmid P , Speck R , Stöckle M , Tarr P , Trkola A , Wandeler G , Weisser M , Yerly S
Published: May 2023

Background

Bone mineral density (BMD) loss may be accelerated in people with HIV (PLWH). It is unknown whether a polygenic risk score (PRS) is associated with low BMD in PLWH.

Methods

Swiss HIV Cohort Study participants of self-reported European descent underwent ≥2 per-protocol dual x-ray absorptiometry (DXA) measurements ≥2 years apart (2011–2020). Univariable and multivariable odds ratios (ORs) for DXA-defined osteoporosis were based on traditional and HIV-related risk factors and a genome-wide PRS built from 9413 single-nucleotide polymorphisms associated with low BMD in the general population. Controls were free from osteoporosis/osteopenia on all DXA measurements.

Results

We included 438 participants: 149 with osteoporosis and 289 controls (median age, 53 years; 82% male, 95% with suppressed HIV RNA). Participants with unfavorable osteoporosis PRS (top vs bottom quintile) had univariable and multivariable-adjusted osteoporosis ORs of 4.76 (95% CI, 2.34–9.67) and 4.13 (1.86–9.18), respectively. For comparison, hepatitis C seropositivity, 5-year tenofovir disoproxil fumarate exposure, and parent history of hip fracture yielded univariable osteoporosis ORs of 2.26 (1.37–3.74), 1.84 (1.40–2.43), and 1.54 (0.82–2.9).

Conclusions

In PLWH in Switzerland, osteoporosis was independently associated with a BMD-associated PRS after adjustment for established risk factors, including exposure to tenofovir disoproxil fumarate.
Comparison of Resting State Functional Connectivity in Persons With and Without HIV: A Cross-sectional Study
Authors: Thippabhotla Sharmila , Adeyemo Babatunde , Cooley Sarah A , Roman June , Metcalf Nicholas , Boerwinkle Anna , Wisch Julie , Paul Robert , Ances Beau M
Published: May 2023

Background

This study examined the effects of human immunodeficiency virus (HIV) on resting state functional connectivity (RSFC) in a large cohort of people with HIV (PWH) and healthy controls without HIV (PWoH). Within PWH analyses focused on the effects of viral suppression and cognitive impairment on RSFC.

Methods

A total of 316 PWH on stable combination antiretroviral therapy and 209 demographically matched PWoH were scanned at a single institution. Effects of the virus were examined by grouping PWH by detectable (viral load > 20 copies/mL; VLD) and undetectable (VLU) viral loads and as being cognitively impaired (CI) (Global Deficit Score ≥ 0.5) or cognitively normal (CN). Regression analysis, object oriented data analysis, and spring embedded graph models were applied to RSFC measures from 298 established brain regions of interest comprising 13 brain networks to examine group differences.

Results

No significant RSFC differences were observed between PWH and PWoH. Within PWH, there were no significant differences in RSFC between VLD and VLU subgroups and CI and CN subgroups.

Conclusions

There were no significant effects of HIV on RSFC in our relatively large cohort of PWH and PWoH. Future studies could increase the sample size and combine with other imaging modalities.
The Legitimation of International Organizations: Introducing a New Dataset
Authors: Schmidtke Henning , Schirmer Swantje , Krösche Niklas , Lenz Tobias
Published: May 2023

This article introduces a new dataset on how international organizations (IOs) justify their authority. For a long time, IOs were believed to derive legitimacy from member-state consent and technocratic problem-solving capacities. Over recent decades, the growing politicization of IOs, political polarization within Western democracies, and power shifts in the international system have spurred IOs’ efforts to justify their right to rule, using a variety of legitimation practices. While research on the theory and practice of IO legitimation has grown considerably over the past decade, much of this work builds on case studies of prominent global and regional IOs. As a result, we lack data suitable for systematic comparative analyses across time, IOs, and world regions. The Legitimation Strategies of Regional Organizations (LegRO) dataset aims to narrow this gap, providing data on the standards, intensity, and modes of legitimation for twenty eight regional IOs from 1980 to 2019. These variables inform theoretical and policy-relevant research on contemporary global governance by providing the first systematic overview of IOs’ legitimation practices.
Instruction over Incentives: Assessing Reading Strategies for International Security Studies
Authors: Gilbert Danielle , Bezerra Paul , Becker Karin L
Published: May 2023

Discussion-based courses in international relations rely on students’ careful reading of complex texts in advance of class. However, instructors face a perennial problem: many students do not read effectively, or at all. We argue that students often want to, but do not always know how to, read such material effectively. With instruction and guidance on effective reading strategies, students can improve reading comprehension. To test our hypotheses, we measure the effects of (1) receiving course-preparation assignment worksheets (CPAs), (2) receiving critical/active reading strategies instruction, or (3) receiving both interventions (1) and (2) on students’ consumption of reading assignments and reading comprehension. Across four sections of an “International Security Studies” course, we tested our hypotheses using student self-assessment. Results indicate that both CPAs and reading strategies instruction increase student consumption and self-assessed comprehension of assigned material, but with intriguing nuance across the range of possible responses. Generally, no added benefit upon comprehension is realized by offering both treatments together. These effective reading strategies offer benefits beyond our classroom, imparting students with long-lasting skills and offering instructors easily adaptable activities for use in other courses.
Religion and (Global) Politics: The State of the Art and Beyond
Authors: Kratochvíl Petr
Published: May 2023

The religion–politics nexus has become a thriving field within the study of global politics. However, the fast development has translated only into a moderate diversification of the research. Building on Bourdieu’s analysis of the social field, this paper argues that this limited pluralization is related to the strong heteronomy of the field. This heteronomy has three “concentric” sources—the dependence on the field of politics, the continued influence of the secularist bias of Western social science, and the dependence on the theoretical developments in the broader discipline of international relations. Methodologically, the article builds on a detailed analysis of eighteen top academic journals and their scholarly output related to religion in global politics.
The WHO costing and budgeting tool for national action plans on antimicrobial resistance—a practical addition to the WHOle toolkit
Authors: Glover Rebecca E , Naylor Nichola R
Published: May 2023

Objectives

The development of national action plans (NAPs) for antimicrobial resistance (AMR) has been promoted and supported by the WHO, with recent support in the form of costing and budgeting tools to aid in finance-allocation decisions within governments.

Methods

In this brief report we review this WHO costing and budgeting tool, discuss the strengths and weaknesses, and consider its place alongside other health economics and policy-support tools developed.

Results

We call for future analyses of the costs of AMR NAPs to consider costs beyond that of only implementation, through use of other available, open-access data and tools. These include the Global Antimicrobial Resistance and Use Surveillance System (GLASS) data and One Health tools already within the existing ‘WHO toolbox’.

Conclusions

We suggest that future work on evaluating AMR along the impact pipeline use this toolbox where possible, ensuring empirical work is in turn open access.
Local labour tasks and patenting in US commuting zones
Authors: Divella Marialuisa , Lo Turco Alessia , Sterlacchini Alessandro
Published: May 2023

In this article, we adopt a task approach to measure the local pool of capabilities which can more effectively spur innovation. By focusing on the core activities that workers undertake in their jobs, we build an abstract task intensity measure of occupations to proxy the ability in analysing and solving complex problems, as well as in coordinating and integrating people with different knowledge endowments, that should be especially relevant for the process of invention and innovation. We thus estimate the relationship between the local abstract intensity and the inventive performance, proxied by granted patents, of US Commuting Zones (CZs) during the period 2000–2015. The evidence provided, robust to a wide array of sensitivity checks, points to the extent of workers’ engagement in abstract tasks across CZs as a crucial determinant of the local inventive activity.
MHCII+CD80+ thymic eosinophils increase in abundance during neonatal development in mice and their accumulation is microbiota dependent
Authors: Gatti Dominique M , Gauthier Courtney M , Moeller Brandon E , FitzPatrick Rachael D , Kennedy Mia H E , Pluzhnikova Victoria , Conway Kate M E , Smazynski Julian , Chow Robert L , Reynolds Lisa A
Published: May 2023

Eosinophils are present in the thymus of mammals, yet their function at this site during homeostatic development is unknown. We used flow cytometry to determine the abundance and phenotype of eosinophils (here defined as SSchigh SiglecF+ CD11b+ CD45+ cells) in the thymus of mice during the neonatal period, the later postnatal period, and into adulthood. We show that both the total number of thymic eosinophils and their frequency among leukocytes increase over the first 2 wk of life and that their accumulation in the thymus is dependent on the presence of an intact bacterial microbiota. We report that thymic eosinophils express the interleukin-5 receptor (CD125), CD80, and IDO, and that subsets of thymic eosinophils express CD11c and major histocompatibility complex II (MHCII). We found that the frequency of MHCII-expressing thymic eosinophils increases over the first 2 wk of life, and that during this early-life period the highest frequency of MHCII-expressing thymic eosinophils is located in the inner medullary region. These data suggest a temporal and microbiota-dependent regulation of eosinophil abundance and functional capabilities in the thymus.
Myxoma of the upper lip: a case report and brief review of the literature
Authors: Tilaveridis Ioannis , Kalaitsidou Ioanna , Karakostas Panagiotis , Tsavos Ioannis , Tilaveridou Sofia , Hliopoulos Michael , Zarampouka Katerina
Published: May 2023

Myxomas are rare neoplasms of mesenchymal origin, which consist of many undifferentiated stellate and spindle-shaped cells in abundant loose myxoid stroma with collagen fibers. A 74-year-old patient presented in our oral and maxillofacial department with a slow growing mass within the upper lip. The mass was surgically excised in the toto, followed by a histological and immunohistochemical examination. The findings revealed that it was a myxoma. These tumors are very rare and should be included in the differential diagnosis of damage of the upper lip. As long as the myxoma is properly removed, there is no risk of recurrence.
Middle East respiratory syndrome coronavirus and the 2022 world cup football tournament in Qatar
Authors: Butt Adeel A , Coyle Peter V , Abu-Raddad Laith J , Tang Patrick , Khalife Sara , Yacoubian Talar , Bertollini Roberto
Published: May 2023

No Middle East respiratory syndrome coronavirus cases were detected during the 2022 FIFA World Cup in Qatar in November–December 2022, which attracted 1.4 million visitors. Robust monitoring mechanisms instituted by Qatar before and during the FIFA WC can serve as a template for future similar events to detect infectious diseases of global importance.
First Principles
Authors: Lemma Alessandra
Published: May 2023

The book’s main objective is to make the case for the centrality of applied ethics to psychoanalytic practice. It focuses on the articulation of an accessible framework for developing and exercising an identifiable method—an ethical self-discipline—to support therapists’ critical reflection on their psychoanalytic work with patients and to help them to approach more systematically the resolution of ethical dilemmas. The book integrates key concepts from the field of applied ethics, and bioethics specifically, and reinterprets them for use within a psychoanalytic framework. It provides applied examples and a dedicated chapter to how to teach ethics during psychoanalytic trainings and outlines a curriculum with specified readings to assist trainers.
Gastric cancer
Authors: Chevallay Mickael , Goetze Thorsten Oliver , Al-Batran Salah-Eddin , Mönig Stefan
Published: May 2023

Definitive treatment in the majority of cases of gastric cancer no longer relies on surgery alone but on the efforts of a multidisciplinary team. Chemotherapy, radiotherapy, and immunotherapy are now pillars of treatment of gastric cancer and their use should be considered in each patient. Surgery should be evaluated even in metastatic disease. Patients should be evaluated in the multidisciplinary setting with appropriate input from surgeons, medical oncologists, and radiation oncologists with extensive experience in the treatment of gastric malignancies. Especially in advanced gastric cancer, a multimodal approach will improve the outcome of the patient and should be proposed. This chapter summarizes the place of each part of the multimodal treatment for gastric cancer: surgery, chemotherapy, radiotherapy, and immunotherapy.
The Palliative APRN in Administration
Authors: Mulvihill Karen
Published: May 2023

Palliative advanced practice registered nurses (APRNs) are in a prime position to move into leadership roles. However, many APRNs receive inadequate education in leadership within graduate nursing education because graduate and doctoral programs do not provide skill development. Therefore, palliative APRNs interested in leadership roles must seek leadership education elsewhere or by trial and error. Moreover, they must seek opportunities to lead; but to do so, they need skills, coaching, and mentoring to be effective. There are many opportunities to learn leadership competencies from continuing education, professional organizations, and academic programs. Additionally, palliative APRNs need management skills for building teams and programs, communication skills to manage conflict, and change management theory to lead interdisciplinary teams.
The Palliative APRN in the Medical, Surgical, and Geriatrics Patient Care Unit
Authors: Whitehead Phyllis B. , White Carolyn
Published: May 2023

This chapter discusses the specialized role of the palliative care advanced practice registered nurse (APRN) in the ever-changing acute care environment. More than 50% of all deaths occur in medical, surgical, and oncology units where the focus is on active, curative treatment, not on managing symptoms and establishing realistic goals of care. Palliative APRNs are uniquely qualified to care for seriously ill patients by providing comprehensive, effective, compassionate, and cost-effective care that improves end-of-life care in acute care settings. Care must be focused on patients with common conditions, including end-stage renal disease dementia, hip fractures, and oncological conditions and their associated sequalae.
The Palliative APRN in the Intensive Care Setting
Authors: Wiencek Clareen
Published: May 2023

Palliative care is an essential component of high-quality critical care. This chapter reviews the imperative for the advanced practice registered nurse (APRN) with the skills needed to integrate palliative care into caring for critically ill patients and their families. Distressing symptoms are common in the critically ill and amenable to the intervention of palliative care clinicians. This chapter provides content on how the APRN, whether in a consultative or integrative role, can influence positive outcomes for critically ill patients in the areas of pain and symptom management, communication enhancement and family meeting structures, withholding and withdrawing of life-sustaining treatments, and the planning and implementation of quality improvement activities.
The Palliative APRN in Specialty Cardiology
Authors: Fahlberg Beth , Laramee Ann , Donaho Erin
Published: May 2023

Heart disease is the leading cause of mortality in the United States, accounting for approximately 655,000 deaths per year or 1 in every 4 deaths. However, despite this fact, palliative specialists infrequently participate in the care of patients with heart disease. Patients with cardiac conditions have unique needs, experiences, pathophysiologies, and treatments that necessitate a specialized approach to palliative care for this population. Patients with heart problems represent only 17.6% of Medicare patients who received the support of hospice. The advanced practice registered nurse (APRN) can promote individualized decisions. To do so, the APRN must understand common cardiac diagnoses, tests, treatments, and medications. The attitude of the patient with cardiac disease and the provider’s mindset will facilitate effective teamwork between the palliative APRN and cardiac team members.
The Palliative APRN in the Community Setting
Authors: DePace Nicole
Published: May 2023

Community-based palliative care is developing rapidly, with increasing diversity in program design and reimbursement structures. Yet many patients living with serious illness still lack access to reliable community-based palliative services in their homes. Advanced practice registered nurses (APRNs) possess a unique skill set and are able to meet the complex needs of seriously ill patients and their families. APRNs are leaders in developing and providing community-based palliative care. In addition to expertise in comprehensive and holistic assessment skills, expert-level pain and symptom management, and advanced communication skills, the APRN needs to have an understanding of program structure and sustainability. The work of APRNs in community-based palliative care needs to be supported and the barriers to practicing at the highest level of ability and scope of practice need to be removed for the preservation of the role and to benefit patients with serious illness.
The Palliative APRN in Rehabilitation
Authors: Trainor Lorie Resendes
Published: May 2023

Rehabilitation care is widely utilized in the United States. Patients entering rehabilitation care represent an increasingly frail and medically complex population. There are many benefits to receiving rehabilitation care at all stages of disease, including improved symptom management, physical function, and quality of life. There is significant overlap between rehabilitation and palliative care; both focus on patient-centered goals of care and are interdisciplinary in nature. The palliative APRN is a key member of the rehabilitation team in providing expert symptom management. They support patients and families as they navigate both sudden disability and chronic disease progression. The palliative APRN assists in setting realistic expectations of functional recovery and facilitating goals-of-care discussions in all rehabilitation settings.
The Palliative APRN in Telehealth
Authors: Kyle Katherine , Dahlin Constance
Published: May 2023

This chapter examines the current role of the advanced practice registered nurse (APRN) in providing care across the country using telehealth. Telehealth palliative care extends the boundaries of palliative care by promoting access to individuals previously limited by geography and providers while simultaneously complementing in-person provider visits. The chapter provides an overview of telehealth technology, with a synopsis of telehealth integration into healthcare and palliative care. It reviews the types of telehealth platforms available and discusses implementation as well as opportunities and barriers. It offers steps on how to provide a telehealth visit and the necessary documentation. It concludes with billing and coding.
Health Disparities in Palliative Care and Social Determinants of Health
Authors: Dixon Alma Y. , Motschenbacher Cecilia R.
Published: May 2023

Patients are more than a diagnosis; they are complex beings who live in various social situations. It has been long understood that social determinants of health play a role in palliative care. This has been highlighted by the ongoing COVID-19 pandemic. Palliative advanced practice registered nurses (APRNs) must integrate social determinants of health into care delivery, through their role as a patient and family advocate who assesses all patients for structural vulnerability. In delivering unbiased palliative care, the interdisciplinary team plays a key role in securing needed resources for the structurally vulnerable patient and for self-monitoring to determine if implicit biases exist. To be effective, they must reflect on any implicit biases and then practice through a lens of structural vulnerability.
Recurrent Disease and Long-Term Survivorship
Authors: Economou Denice , Bradford Brittany
Published: May 2023

The coordination of services between the survivorship clinic and palliative care is an essential part of the role of the palliative advanced practice registered nurse (APRN) role. Cancer survivors experience different trajectories from diagnosis to survivorship and potential recurrence. Managing long-term survivors who are experiencing recurrent disease and who also may be experiencing comorbidities related to aging and the long-term side effects of cancer treatment requires comprehensive and coordinated care. Integrating the principles of palliative care to improve the quality of care in long-term cancer survivors provides more effective and efficient management of recurrent cancer survivors, reducing suffering, conserving costs, and sharing resources.
The Pediatric Palliative APRN
Authors: Thaxton Cheryl Ann , Sartor Nicole
Published: May 2023

The role of the pediatric palliative advanced practice registered nurse (APRN) is dynamic; it extends into the realms of clinical expert, educator, business marketing champion, and transformational leader. This chapter focuses on several vital aspects of the role, including specifics on how to excel in the role of the pediatric palliative APRN and build key partnerships. Furthermore, the case study clearly articulates the impact of the pediatric palliative APRN role on child- and family-centered care in addition to indicating the need to continue a holistic approach to the management of children with complex and chronic conditions. A review of the history of the pediatric palliative APRN role supports the recognition of key advances in the field of pediatric palliative care (PPC) over several decades. Role qualifications and a sample job description have been integrated into the chapter.
The Pediatric Palliative APRN in the Clinic
Authors: Bass Alice , Battista Vanessa
Published: May 2023

This chapter explores the unique role of the pediatric palliative care (PPC) advanced practice registered nurse (APRN) in delivering high-quality PPC in the ambulatory setting. Common barriers to ambulatory PPC include misperceptions about PPC only being appropriate at end of life, fears of “giving up” or abandonment, and discomfort around pediatric advance care planning or goals of care discussions. In the outpatient clinic, the PPC APRN provides comprehensive pain and symptom management, decision-making support, advance care planning, and support for the child or adolescent and his or her family. The role of the PCC APRN is discussed, along with the considerations of caring for special populations. A description of the different PPC clinic models is offered. The opportunities and challenges of the PPC APRN in the pediatric clinic are explored.
Family Meetings
Authors: Gentry Jennifer , McDowell Kerrith , McKinzie Paula
Published: May 2023

Excellent communication is the foundation for effective family meetings, and leading family meetings is a key role for the advanced practice registered nurse (APRN). Facilitated family meetings can go far to improve communication and goal-concordant care in the course of serious illness. APRNs frequently lead formal and informal family meetings, discuss prognosis, clarify goals of care, assist with advance care planning, deliver bad news, and provide care when death is imminent. APRNs must be skilled in the principles of good communication, including attending to emotion and negotiating conflict, to provide effective care through family meetings.
Challenging Symptoms
Authors: Bobb Barton T. , Wojcikewych Devon S.
Published: May 2023

Dry mouth, hiccups, fevers, pruritus, and sleep disorders are symptoms often found in palliative care patients. They can be challenging to treat and require the palliative advanced practice registered nurse (APRN) to have a working knowledge to effectively manage them. Pruritus can be challenging, and determining the cause when possible can help tailor treatment. Hiccups and dry mouth are common; although seemingly benign, they can affect quality of life. Fever may require scheduled antipyretic treatment at end of life if it is distressing. Sleep disorders can also cause distress, but there are a variety of potential treatment options that may require titration/rotation. Appropriate assessment tools for these common symptoms are reviewed in this chapter. Nonpharmacological, pharmacological, and interventional treatments are discussed, always while emphasizing the importance of all interventions being individualized to the patient’s needs and goals of care.
Navigating Ethical Dilemmas
Authors: Coyle Nessa , Kirk Timothy W.
Published: May 2023

This chapter provides the advanced practice registered nurse (APRN) with the structure and language that complement the classic patient-centered care model of autonomy, beneficence, nonmaleficence, and justice. The chapter builds on the ethical foundation already inherent in the practice of palliative nursing, explaining ethical principles and skills to facilitate and guide navigation of ethical discussions. Throughout, the palliative APRN is recognized as being uniquely well-trained and situated within palliative care teams to be an advocate to ensure that the values, goals, perspectives, and concerns of patients, families, and fellow clinicians are appropriately heard in patient care conversations. Progressive illness with a long trajectory provides both the opportunity and the obligation for the palliative APRN to have these ongoing conversations. The importance of these conversations and clearly documenting them becomes even more urgent when the patient presents with advanced disease. An appendix is provided with common definitions and distinctions in palliative care ethics.
Developmental Disabilities
Authors: Kuehl Justin
Published: May 2023

Individuals with developmental disabilities may present with psychiatric emergencies. Given that developmental disabilities can be broadly defined, this chapter narrows the focus of discussion to intellectual and developmental disabilities (IDD) with an emphasis on intellectual disabilities and autism spectrum disorder. The estimated prevalence of co-occurring mental illness and IDD is taken into consideration, which includes a discussion regarding the challenges in accurately quantifying these data. The remainder of the chapter discusses best practices and offers recommendations for conducting a thorough and accurate psychiatric assessment. A good evaluation begins with clearly identifying the presenting problem that precipitated the emergency situation. It is also important to gather collateral information from reliable sources, which should include efforts to verify the presence of an IDD diagnosis. The assessment should be modified to account for communication and comprehension deficits in this population. It is important to recognize the impact of co-occurring medical conditions, and some of the most common are reviewed in this chapter. The risks and benefits of psychopharmacological treatment are discussed, including further consideration of commonly occurring side effects. There is also an emphasis on recognizing and addressing any history of trauma. The chapter concludes by acknowledging the role of primary caregivers and the responsibility to support their needs.
Institutional Responses and the Role of the Chief Wellness Officer
Authors: Ripp Jonathan A. , Kiely Sharon , Frieman Amy
Published: May 2023

Health care organizations and academic health centers are beginning to address the well-being of the workforce, medical students, and graduate medical education (GME) trainees through large-scale institutional commitments. Some are doing so through the naming of a Chief Wellness Officer (CWO). The CWO role is relatively new and still evolving, with a host of responsibilities being defined. The position varies considerably in terms of scope of constituencies served and programs under its purview. When effective, the CWO can help guide an institution in its strategic decision-making with a result that optimizes well-being. This commitment has clear implications and ultimately benefit for the well-being of medical students and GME trainees who learn in these environments. The growing understanding of how CWOs can influence well-being in partnership with other institutional undergraduate and graduate medical education well-being leaders is also positively influencing the overall landscape of well-being programs.
Mixed-status informal couples in a cascading crisis. Immobilisation, mobilisation, and normalisation?
Authors: Odasso Laura
Published: May 2023

In France, the COVID-19 pandemic was experienced as a cascading crisis, with its effects rippling out beyond its initial health domain. Due to the lockdown and ban on travel, the closure of borders, and the slowdown of administrative services, the pandemic had an unanticipated effect on transnational French/foreign couples lacking formal legal relationship status, causing separation and uncertainty. Overlapping health and migration concerns generated a new specific border regime, which reinforced the already existing ‘deservingness’ criteria for seeking to move to and integrate into the nation. The imposed geographical and administrative immobilisation led to some couples creating online self-help communities, which offered emotional support and shared coping strategies for couples caught in the deadlock. These communities have given the challenges faced by mixed-status couples fresh visibility. Drawing on an ethnography conducted in four online communities, in-depth interviews with transnational couples, and an analysis of politico-juridical materials and grey literature, this article focuses on marriage becoming the option for French/foreign couples seeking the right to reunite in France during an uncertain period. More precisely, by using crisis studies to frame the impact of the pandemic and articulating the scholarship on socio-legal and intimate citizenship, the experiences of such couples can be understood as specific processes in legal consciousness, producing acts of intimate citizenship. This perspective helps demonstrate how the pandemic emphasised the policing of migrant couples, and how institutional and legal opportunities narrowed the choices available to such couples, reducing the potential of change that is generally inherent in crises.
Students’ Leadership Development During a High-fidelity Military Medical Field Practicum
Authors: Van Shufflin Matthew W , Barry Erin S , Vojta Leslie , Yarnell Angela , Cole Rebekah
Published: May 2023

Introduction

Leadership development is a cornerstone aspect of military medical education. Operation Bushmaster, a medical field practicum (MFP) conducted by the USU, tests fourth-year medical students’ clinical skills and leadership acumen in an operational environment. No studies have examined students’ perceptions of their own leadership development during this MFP. Therefore, this study explored leadership development from the students’ perspectives.

Materials and Methods

Using a qualitative phenomenological design, we analyzed the reflection papers of 166 military medical students who participated in Operation Bushmaster during the fall of 2021. Our research team coded and categorized the data. Once defined, these categories served as the themes in this study.

Results

Three central themes were expressed: (1) the importance of direct and decisive communication, (2) unit cohesion and interpersonal relationships enhance the team’s ability to adapt, and (3) followership quality determines leadership outcomes. The students’ leadership ability was maximized by established relationships within their unit and well-practiced communication, and a decreased propensity for followership negatively affected leadership. Overall, Operation Bushmaster increased students’ appreciation of the importance of leadership development and overall enhanced their leadership outlook as a future military medical officer.

Conclusions

This study provided an introspective vantage from military medical students pertaining to their own leadership development, as participants described how the challenging environment of a military MFP challenged them to hone and develop their leadership skills. As a result, the participants gained a greater appreciation of continued leadership development and realization of their future roles and responsibilities within the military health care system.
Medical Students’ Integration of Formative Feedback During Simulation: A Grounded Theory Study
Authors: Cole Rebekah , Garrigan Audra G , Peters Sidney A , Tilley Laura , Conley Sean P , Schwartz James , Vojta Leslie , Rudinsky Sherri L
Published: May 2023

Introduction

Formative feedback is critical for trainees’ growth and development. However, there is a gap in the professional literature regarding the ways in which formative feedback affects student performance during simulation. This grounded theory study addresses this gap by exploring the ways in which medical students received and integrated ongoing formative feedback throughout a multiday, high-fidelity military medical simulation, Operation Bushmaster.

Materials and Methods

Our research team interviewed 18 fourth-year medical students in order to investigate how they processed formative feedback during the simulation. Guided by the grounded theory tradition of qualitative research, our research team used open coding and axial coding to categorize the data. We then used selective coding to determine the casual relationships between each of the categories that emerged from the data. These relationships determined our grounded theory framework.

Results

Four phases emerged from the data and provided a framework to delineate the process in which students received and integrated formative feedback throughout the simulation: (1) ability to self-assess, (2) self-efficacy, (3) leadership and teamwork, and (4) appreciation of feedback for personal and professional growth. The participants first focused on feedback related to their individual performance but then shifted to a teamwork and leadership mindset. Once they adapted this new mindset, they began to intentionally provide feedback to their peers, increasing their team’s performance. At the end of the simulation, the participants recognized the benefits of formative feedback and peer feedback for ongoing professional development throughout their careers, signifying a growth mindset.

Conclusions

This grounded theory study provided a framework for determining how medical students integrated formative feedback during a high-fidelity, multiday medical simulation. Medical educators can use this framework to intentionally guide their formative feedback in order to maximize student learning during simulation.
The Impact of High-fidelity Simulations on Medical Student Readiness
Authors: Cole Rebekah , Egan Sean J , Schwartz James , Rudinsky Sherri L
Published: May 2023

Introduction

Simulation is a key aspect of the military unique curriculum at the Uniformed Services University (USU). The Department of Military and Emergency Medicine conducts rigorous high-fidelity simulations for military medical students during each year of their medical school training: Patient Experience (first year), Advanced Combat Medical Experience (second year), Operation Gunpowder (third year), and Operation Bushmaster (fourth year). There is currently a gap in the professional literature regarding students’ progression through each of these simulations. This study, therefore, explores the experiences of military medical students at USU in order to understand how they learn and develop as they progress through these high-fidelity simulations.

Materials and Methods

Using a grounded theory approach to qualitative research design, we analyzed qualitative data from 400 military medical students across all four years of military school who participated in the four high-fidelity simulations during 2021–2022. Our research team used open and axial coding to categorize the data and to make connections between each of these categories, which we articulated in a theoretical framework and illustrated in a consequential matrix. This research was approved by the Institutional Review Board at USU.

Results

During Patient Experience, the first-year medical students described the stress, chaos, and lack of resources that military physicians face as they experienced the realism of the operational environment. Later at Advanced Combat Medical Experience, the second-year medical students practiced their medical skills hands-on for the first time in the simulated stressful operational environment. As a result, they gained confidence and began to formulate their professional identity. Next, at Operation Gunpowder, the third-year medical students advanced to more complex tactical field care as they performed prolonged casualty care, forward resuscitative care, forward resuscitative surgical care, and en route care as a team, often revealing gaps in their knowledge that needed to be filled. During the capstone simulation, Operation Bushmaster, the fourth-year medical students closed these gaps and solidified their professional identity as leaders and physicians, culminating in a strong confidence regarding their readiness for their first deployment.

Conclusions

Each of the four high-fidelity simulations impacted the students in unique ways as they were incrementally challenged to practice and build upon their knowledge, skills, and abilities related to combat casualty care, teamwork, and leadership in the operational environment. As they completed each of the simulations, their skills improved, confidence grew, and professional identity solidified. Therefore, completing these rigorous simulations progressively over the course of 4 years of medical school appears to be a vital process and foundation for the deployment readiness of early-career military physicians.
“Not for the Faint of Heart”: First-year Military Medical Students’ Professional Identity Formation During the Innovative Patient Experience at Operation Bushmaster
Authors: Rudinsky Sherri L , Weissbrod Elizabeth , Cole Rebekah
Published: May 2023

Introduction

The role of a military medical officer (MMO) is complex. Therefore, it is essential that military medical students formulate their professional identity early on in medical school in order to prepare them for their first deployment. At the Uniformed Services University, students are challenged to progressively develop their professional identity through yearly high-fidelity military medical field practicums (MFPs). One of these MFPs, Operation Bushmaster, consists of an innovative “Patient Experience” in which first-year medical students portray patients cared for by fourth-year medical students in a simulated operational environment. The purpose of this qualitative study was to examine how participating in the Patient Experience impacted first-year medical students’ professional identity formation.

Materials and Methods

Our research team used a phenomenological, qualitative research design to analyze the end-of-course reflection papers of 175 first-year military medical students who participated in the Patient Experience during Operation Bushmaster. Our research team members individually coded each student’s reflection paper and then came to consensus on how to organize these codes into themes and subthemes.

Results

Two themes and seven subthemes emerged from the data regarding the first-year medical students’ understanding of the MMO: (1) multiple roles of the MMO (educator, leader, diplomat, and advisor) and (2) role of the MMO in the operational environment (navigates hazardous environment, adaptability, and position within health care team). As they participated in the Patient Experience, the first-year medical students not only recognized the complexity of the MMO’s multiple roles within the operational environment but also envisioned themselves in these roles.

Conclusions

The Patient Experience provided first-year medical students with a unique opportunity to formulate their professional identity as they portrayed patients during Operation Bushmaster. This study’s results hold implications for both military and civilian medical schools regarding the benefits of innovative military MFPs for professional identity formation in junior medical students, preparing them early on in medical school for their first deployment.
Impact of a Multiday, High-fidelity, Immersive Simulation on Military Medical Students’ Self-confidence
Authors: Cole Rebekah , Wightman John M
Published: May 2023

Introduction

Decision-making is a critical competence that all medical students must develop before becoming independently licensed physicians. One aspect of the decision-making process is confidence, which has not been extensively studied in undergraduate medical education. Intermittent simulation has been found to improve medical students’ self-confidence across a wide range of clinical scenarios; however, no research to date has examined how a more extensive medical and operational simulation impacts miltary medical students’ confidence in their decision-making abilities.

Materials and Methods

This study was conducted online through the Uniformed Services University and in person at Operation Bushmaster, a multiday, out-of-hospital, high-fidelity, immersive simulation held at Fort Indiantown Gap, PA. This investigation focused on examining the impacts of asynchronous coursework and simulation-based learning on improving decision-making confidence for senior medical students 7 months before graduation. Thirty senior medical students volunteered. Each completed a 10-point confidence scale before and after either accomplishing asynchronous online coursework (control group) or attending a medical field practicum (experimental group). We conducted a repeated-measures analysis of variance to examine any change in students’ confidence scores before and after completing each educational modality.

Results

The results of the analysis of variance indicated a significant time effect for our students’ confidence in both the experimental and control groups as measured on our confidence scale, suggesting that Operation Bushmaster and asynchronous coursework both possessed the potential to increase students’ confidence in their decision-making.

Conclusions

Both simulation-based learning and asynchronous online learning can increase students’ decision-making confidence. Future larger-scale research is needed to calculate the impact of each modality on military medical students’ confidence.
The magnetohydrodynamic-particle-in-cell module in athena++: implementation and code tests
Authors: Sun Xiaochen , Bai Xue-Ning
Published: May 2023

We present a new magnetohydrodynamic-particle-in-cell (MHD-PIC) code integrated into the athena++ framework. It treats energetic particles as in conventional PIC codes, while the rest of thermal plasmas are treated as background fluid described by MHD, thus primarily targeting at multiscale astrophysical problems involving the kinetic physics of the cosmic rays (CRs). The code is optimized towards efficient vectorization in interpolation and particle deposits, with excellent parallel scaling. The code is also compatible with static/adaptive mesh refinement, with dynamic load balancing to further enhance multiscale simulations. In addition, we have implemented a compressing/expanding box framework that allows adiabatic driving of CR pressure anisotropy, as well as the δf method that can dramatically reduce Poisson noise in problems where distribution function f is only expected to slightly deviate from the background. The code performance is demonstrated over a series of benchmark test problems, including particle acceleration in non-relativistic parallel shocks. In particular, we reproduce the linear growth of the CR gyro-resonant (streaming and pressure anisotropy) instabilities, under both the periodic and expanding/compressing box settings. We anticipate the code to open up the avenue for a wide range of astrophysical and plasma physics applications.
Sustained super-Eddington accretion around neutron stars & black holes
Authors: Ghodla Sohan , Eldridge J J
Published: May 2023

Recently, it was shown that the formation of a photon-trapping surface might not be sufficient to ensure unimpeded super-Eddington (SE) accretion. In light of this finding, here we derive a condition such that sustained and unimpeded SE accretion could be achieved in optically thick slim accretion discs surrounding neutron stars (NSs) and black holes (BHs). For this, we calculate a semi-analytic approximation of the self-similar global radial velocity expression for an advection-dominated flow. Neglecting the influence of relativistic jets on the accretion flow, we find that for Eddington fraction $\dot{m} \gtrsim 1.5 (\epsilon /0.1)^{3/5}$ (ϵ being the accretion efficiency) sustained SE accretion might be possible in slim discs around BHs irrespective of their spin. The same condition holds for NSs when ϵ ≳ 0.03. The presence of a surface magnetic field might truncate the disc at the magnetosphere of the NS, resulting in lower efficiencies and consequently changing the condition to $\dot{m} \gt 0.013 \epsilon ^{-19/31}$. Our approach suggests that sustained SE accretion might almost always be possible around NSs and BHs hosting accretion discs.