bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical education should teach heuristics rather than train them away
Authors: Feufel Markus A , Flach John M 
Published: January 2019

ContextAmple research suggests that most decisions are based on heuristics—simple rules of thumb—that violate prescriptions of logic and probability theory and should therefore be avoided. Yet findings on decision making in everyday work contexts support the idea that heuristics are in fact the very basis of good decision making if adapted to the challenges and performance criteria of the specific work domain. Because traditional pedagogies aim at circumventing heuristics in (clinical) decision making, ways in which to improve the use of heuristics via (medical) education have rarely been explored.ObjectiveTo describe the rationale for teaching and learning proper use of heuristics, rather than stigmatising them, and to identify principles and potential implications for the design and improvement of pedagogies for training in clinical decision making.ResultsBased on theory and evidence concerning heuristic decision making in everyday work domains, we suggest that heuristics should not be avoided as irrational or a mere source of errors, in particular in domains where errors are unavoidable. Instead, we should teach and learn how to use heuristics to make fewer and ‘smarter’ mistakes rather than ‘dumb’ ones. Based on concepts borrowed from signal detection and control theory, we demonstrate that, to improve heuristic decision making, teaching should focus on differential diagnoses and learning from feedback and mistakes, in teams and in contextually rich settings where the frequencies, costs and trade‐offs between different types of errors (misses versus false alarms) can be experienced. We discuss three possible teaching formats and how to best implement them based on our findings.ConclusionsThe most promising way to train (future) physicians and other health professionals in clinical decision making is not to circumvent heuristics or correct deviations from logic and probability theory but to enhance the use of heuristics by improving perspicacity, that is, by tuning the (recognition) processes that underlie the domain‐specific adaptive selection of heuristics and management of ensuing errors.
Factors predicting the health status of caregivers of stroke survivors: A cross‐sectional study
Authors: Long Ngo X. , Pinyopasakul Wanpen , Pongthavornkamol Kanaungnit , Panitrat Rungnapa 
Published: January 2019

AbstractIn this cross‐sectional study, we aimed to determine factors influencing the health status of caregivers of stroke survivors. A total of 126 caregivers of stroke survivors were recruited from three outpatient clinics in Thai Nguyen National General Hospital, Vietnam, from November 2016 to March 2017. Data were collected through six instruments: a demographic questionnaire, the Modified Barthel Index, the Zarit Burden Interview Scale, the Multidimensional Scale of Perceived Social Support, the Family Caregiver Conflict Scale, and the Short Form‐36 Health Survey. Stepwise multiple regression was employed to analyze the data. Caregiver burden, patient's functional status, caregiver's age, and social support together explained 80.3% of the variations in health status of caregivers of stroke survivors. Caregiver burden was the strongest predictor of health status of these caregivers. Based on the findings, nurses should take caregiver's age, functional status of stroke survivors, caregiver burden, and social support into consideration when preparing family caregivers to provide care for stroke survivors. To reduce perceived caregiver burden, family support interventions should be embraced to enhance health status of the caregivers of stroke survivors.
IDD16 negatively regulates stomatal initiation via trans‐repression of SPCH in Arabidopsis
Authors: Qi Shi‐Lian , Lin Qing‐Fang , Feng Xuan‐Jun , Han Hui‐Ling , Liu Jie , Zhang Liu , Wu Shuang , Le Jie , Blumwald Eduardo , Hua Xue‐Jun 
Published: January 2019

SummaryIn Arabidopsis, the initiation and proliferation of stomatal lineage cells is controlled by SPEECHLESS (SPCH). Phosphorylation of SPCH at the post‐translational level has been reported to regulate stomatal development. Here we report that IDD16 acts as a negative regulator for stomatal initiation by directly regulating SPCH transcription. In Arabidopsis, IDD16 overexpression decreased abaxial stomatal density in a dose‐dependent manner. Time course analysis revealed that the initiation of stomatal precursor cells in the IDD16‐OE plants was severely inhibited. Consistent with these findings, the transcription of SPCH was greatly repressed in the IDD16‐OE plants. In contrast, IDD16‐RNAi transgenic line resulted in enhanced stomatal density, suggesting that IDD16 is an intrinsic regulator of stomatal development. ChIP analysis indicated that IDD16 could directly bind to the SPCH promoter. Furthermore, Arabidopsis plants overexpressing IDD16 exhibited significantly increased drought tolerance and higher integrated water use efficiency (WUE) due to reduction in leaf transpiration. Collectively, our results established that IDD16 negatively regulates stomatal initiation via trans‐repression of SPCH, and thus provide a practical tool for increasing plant WUE through the manipulation of IDD16 expression.
Leaf morphology, rather than plant water status, underlies genetic variation of rice leaf rolling under drought
Authors: Cal Andrew J. , Sanciangco Millicent , Rebolledo Maria Camila , Luquet Delphine , Torres Rolando O. , McNally Kenneth L. , Henry Amelia 
Published: January 2019

AbstractSoil drying causes leaf rolling in rice, but the relationship between leaf rolling and drought tolerance has historically confounded selection of drought‐tolerant genotypes. In this study on tropical japonica and aus diversity panels (170–220 genotypes), the degree of leaf rolling under drought was more affected by leaf morphology than by stomatal conductance, leaf water status, or maintenance of shoot biomass and grain yield. A range of canopy temperature and leaf rolling (measured as change in normalized difference vegetation index [ΔNDVI]) combinations were observed among aus genotypes, indicating that some genotypes continued transpiration while rolled. Association mapping indicated colocation of genomic regions for leaf rolling score and ΔNDVI under drought with previously reported leaf rolling genes and gene networks related to leaf anatomy. The relatively subtle variation across these large diversity panels may explain the lack of agreement of this study with earlier reports that used small numbers of genotypes that were highly divergent in hydraulic traits driving leaf rolling differences. This study highlights the large range of physiological responses to drought among rice genotypes and emphasizes that drought response processes should be understood in detail before incorporating them into a varietal selection programme.
Uncompensated emotional labor, racial battle fatigue, and (in)civility in digital spaces
Authors: Williams Apryl A. , Bryant Zaida , Carvell Christopher 
Published: January 2019

AbstractEmotional labor was originally theorized by Arlie Hochschild in the context of domestic labor. Since her early theorization, popular culture and social scientists have adopted the term to refer to emotion work that is exhibited in a manner of financially compensated social settings. Emotional labor refers to the process by which individuals are expected to conform to a set of societal guidelines, ensuring that their emotions conform to that performance. As the use of social media grows, emotional labor plays an increasing role in the lives of people of color—across media platforms. We frame the ever‐present negotiation involved in racialized interactions online as a type of uncompensated emotional labor that results in racial battle fatigue. Next, we position emotional labor as an intrinsic part of the experience for social media users of color because digital media is by default a White, racialized space. Lastly, we argue that current research on civility does not account for the emotional labor of people of color. We offer an original view of uncompensated emotional labor that is inclusive of cross‐platform, racialized emotional labor that can result in racial battle fatigue.
The impact of Daratumumab on transfusion service costs
Authors: Cushing Melissa M. , DeSimone Robert A. , Goel Ruchika , Hsu Yen‐Michael S. , Parra Priscilla , Racine‐Brzostek Sabrina E. , Degtyaryova Diana , Lo Dian T. , Morrison Meta , Crowley Kathleen M. , Rossi Adrianna , Vasovic Ljiljana V. 
Published: January 2019

BACKGROUNDDaratumumab (DARA) is a human IgG1κ monoclonal antibody directed against CD38, approved for the treatment of multiple myeloma. As CD38 is expressed on RBCs, DARA can interfere with pretransfusion testing. DARA interference can be negated by denaturation of CD38 on RBCs with dithiothreitol (DTT) reagents. Because of this interference in pretransfusion testing, our hospital implemented a notification and testing/transfusion algorithm (NATTA) for pretransfusion testing and RBC product provision for DARA patients. This standardized approach combines DTT‐based testing with selective genotyping and the provision of phenotypically similar RBCs for patients with clinically significant antibodies.STUDY DESIGN AND METHODSWe evaluated pretransfusion test results and transfusion requirements for 91 DARA patients in an academic medical center over 1 year to determine the incremental cost of pretransfusion testing and RBC selection. The actual costs for the NATTA approach were compared to a theoretical approach using universal genotyping with a provision of phenotypically similar RBC transfusions.RESULTSThe annual cost of testing related to DARA after NATTA implementation was $535.76 per patient. The simulated annual cost for the alternative genotyping with provision of phenotypically similar RBC transfusions approach was $934.83 per patient.CONCLUSIONIn our entire cohort of DARA patients, a DTT‐based testing algorithm with selective genotyping and provision of phenotypically similar RBCs only for patients with clinically significant antibodies was less expensive than a simulated model of universal genotyping and provision of phenotypically similar RBCs.
Molecular identification of Ehrlichia ewingii in a polyarthritic Texas dog
Authors: Modarelli Joseph J. , Borst Mindy M. , Piccione Julie , Esteve‐Gasent Maria D. 
Published: January 2019

AbstractAn 8‐year‐old, neutered male, Golden Retriever presented for bilateral carpal joint effusion. A complete blood count revealed mild leukopenia and marked thrombocytopenia. Samples were sent to the Texas A&M Veterinary Medical Diagnostic Laboratory for blood smear review and serologic testing for tick‐borne diseases. Numerous morulae were observed within neutrophils, and antibodies against Ehrlichia canis were detected at a 1:512 dilution via the indirect fluorescent antibody (IFA) test. As neutrophilic morulae are morphologically indistinguishable between Ehrlichia ewingii and Anaplasma phagocytophilum, and genus‐wide cross‐reactivity is possible with serologic testing, additional molecular testing was performed. Quantitative real‐time polymerase chain reaction (qPCR) followed by conventional PCR and Sanger sequencing were performed on serum identified with E ewingii as the sole disease‐causing agent. Three months after diagnosis and treatment, no morulae were found, molecular testing for E ewingii detected no DNA, and convalescent IFA testing demonstrated a continued detection of antibodies for E canis at a 1:512 dilution. To the authors’ knowledge, this is the first reported case of E ewingii confirmed with molecular diagnostics in a Texas dog. The zoonotic transmission potential of E ewingii should be noted as Texas supports competent tick vectors, and dogs represent effective sentinels for human ehrlichiosis. This report also highlights the utility of molecular diagnostics when serologic and microscopic evaluations are not sufficient in providing the species‐level identity of a causative agent.
The supply chain of migrant blood donors: an organisational interview study
Authors: Klinkenberg Elisabeth F. , Langi Sasongko Praiseldy K. B. , de Kort Wim L. A. M. , van Weert Julia C. M. , Fransen Mirjam P. , Huis in ‘t Veld Elisabeth M. J. 
Published: January 2019

Background and ObjectivesMigrant blood donors are underrepresented worldwide resulting in shortages of compatible blood products. Prior studies focused on individual barriers and motivators of potential blood donors, but no studies addressed organisational factors of the blood supply chain. This study explored the perceptions and experiences in recruitment and retention of migrant – and potentially rare‐blood donors among staff members within the blood supply chain and identified obstacles and solutions in this chain.Materials and MethodsThe study was conducted at Sanquin, the national blood supply organisation of the Netherlands. Qualitative in‐depth interviews were done among key staff members (N = 17). Expert validity was assessed in three feedback meetings.ResultsSeven staff members believed there is a shortage of migrant blood donors, while five believed there is not. However, there was a consensus that it may become a problem in the future due to demographic changes. The perceived obstacles to recruit and retain migrant donors were difficulties in determining how many migrant donors are needed and recruiting them, excluding potentially rare donors prior to donation, limited use of extended phenotyping and high blood typing and frozen storage costs. The possible solutions to increase blood pool diversity lay in registering donor ethnicity, specialised information provision for donors, reconsidering eligibility criteria and optimising blood typing strategies.ConclusionWhilst recruitment of migrant blood donors is perceived by staff as difficult, various organisational policies and guidelines seem to hinder retention. Improvements in the blood supply chain may be achieved by addressing logistics, current procedures and registration of ethnicity.
Startup Suns
Authors: Winters Jeffery 
Published: January 2019

A number of startups have attracted millions of dollars from tech investors with the goal to buld a commercial fusion reactor by the end of the next decade. Befitting the merging of plasma physics and startup culture, each company has a bit of secret sauce that they hope will make the difference between success and failure.
This article takes a look at three such startups that are pushing the limits of energy.
The Relative Importance of Wind Straining and Gravitational Forcing in Driving Exchange Flows in Tidally Energetic Estuaries
Authors: Lange Xaver , Burchard Hans 
Published: January 2019

AbstractIn straight tidal estuaries, residual overturning circulation results mainly from a competition between gravitational forcing, wind forcing, and friction. To systematically investigate this for tidally energetic estuaries, the dynamics of estuarine cross sections is analyzed in terms of the relation between gravitational forcing, wind stress, and the strength of estuarine circulation. A system-dependent basic Wedderburn number is defined as the ratio between wind forcing and opposing gravitational forcing at which the estuarine circulation changes sign. An analytical steady-state solution for gravitationally and wind-driven exchange flow is constructed, where tidal mixing is parameterized by parabolic eddy viscosity. For this simple but fundamental situation, is calculated, meaning that the up-estuary wind forcing needs to be 15% of the gravitational forcing to invert estuarine circulation. In three steps, relevant physical processes are added to this basic state: (i) tidal dynamics are resolved by a prescribed semidiurnal tide, leading to caused by tidal straining; (ii) lateral circulation is added by introducing cross-channel bathymetry, smoothly increasing from 0.47 (flat bed) to 1.3 (parabolic bed) due to an increasing effect of lateral circulation on estuarine circulation; and (iii) full dynamics of a real tidally energetic inlet with highly variable forcing, where results from a two-dimensional linear regression.
Abyssal Mixing through Critical Reflection of Equatorially Trapped Waves off Smooth Topography
Authors: Delorme Bertrand L. , Thomas Leif N. 
Published: January 2019

AbstractThe inferred diapycnal upwelling in the abyssal meridional overturning circulation (AMOC) is intensified near the equator, but little is known as to why this is so. In this study, it is shown that the reflection of equatorially trapped waves (ETWs) off the bottom leads to seafloor-intensified mixing and substantial diapycnal upwelling near the equator when the full Coriolis force and the so-called nontraditional effects are taken into account. Using idealized simulations run with the MITgcm of downward-propagating ETWs of various types (i.e., inertia–gravity, Yanai, Kelvin, and Rossby waves) accounting for nontraditional effects, it is demonstrated that the reflection of ETWs off a flat seafloor generates beams of short inertia–gravity waves with strong vertical shear and low Richardson numbers that result in bottom-intensified, persistent, zonally invariant mixing at the inertial latitude of the ETW through the mechanism of critical reflection. The beams are more intense with weaker stratification and, for a given wave type, are stronger for waves with shorter periods and longer vertical wavelengths. The intensity of the beams also differs between wave types because their distinct meridional structures modulate the amount of energy fluxed to the bottom at the inertial latitude. As a result, equatorial inertia–gravity, Rossby, and eastward-propagating Yanai waves yield stronger mixing than Kelvin and westward-propagating Yanai waves in the simulations. It is estimated that this process can result in order 10 Sv (1 Sv ≡ 106 m3 s−1) of diapycnal upwelling per wavelength of ETW in the abyss and thus could play an important role in closing the AMOC.
The effect of methylprednisolone prophylaxis on inflammatory monocyte subsets and suppressive regulatory T cells of patients undergoing cardiopulmonary bypass
Authors: Hao Xing , Han Junyan , Zeng Hui , Wang Hong , Li Guoli , Jiang Chunjing , Xing Zhichen , Hao Yu , Yang Feng , Hou Xiaotong 
Published: January 2019

Background: Cardiopulmonary bypass (CPB) during open-heart surgery triggers an inflammatory response that can cause significant morbidity and mortality. Human monocytes and regulatory T (Treg) cells are phenotypically and functionally heterogeneous and have been shown to play a significant role in the inflammatory dysfunction triggered by CPB. Glucocorticoids (GCs) have been widely administered for decades in patients undergoing CPB to reduce this inflammatory response. However, it has not been clearly established how routine prophylactic administration of glucocorticoids (GCs) affects monocyte and Treg subsets. Methods: Thirty-six patient who underwent heart surgery with CPB were randomly assigned to a methylprednisolone group (MG, N = 18; 500 mg in the CPB priming) and a non-methylprednisolone group (NMG, N = 18). The circulating monocyte and Treg subsets were analyzed by flow cytometry. Results: The MG and NMG groups had comparable percentages of monocyte subsets and similar expression levels of HLA-DR, CD86, CD64 and toll-like receptor 4 (TLR4). Remarkably, methylprednisolone increased the percentage of CD4+CD25+ Treg cells among CD4+ T cells in patients undergoing CPB, but did not increase the proportion of suppressive Treg cells, either resting or activated, in these patients undergoing CPB. Conclusions: Our results showed that prophylactic administration of methylprednisolone neither decreased the percentages and counts of inflammatory monocyte subsets nor did it induce the expansion of suppressive Treg cells in patients undergoing CPB. These results clarified the effects of GCs on cell-mediated immune responses and provided additional evidence in practice. Trial registration: Clinicaltrials.gov : NCT01296074. Registered 14 February 2011.
Methods and Challenges in a Cohort Study of Infants and Toddlers With Craniofacial Microsomia: The Clock Study
Authors: Luquetti Daniela V. , Speltz Matthew L. , Wallace Erin R. , Siebold Babette , Collett Brent R. , Drake Amelia F. , Johns Alexis L. , Kapp-Simon Kathleen A. , Kinter Sara L. , Leroux Brian G. , Magee Leanne , Norton Susan , Sie Kathleen , Heike Carrie L. 
Published: January 2019

Objective:The Craniofacial microsomia: Longitudinal Outcomes in Children pre-Kindergarten (CLOCK) study is a longitudinal cohort study of neurobehavioral outcomes in infants and toddlers with craniofacial microsomia (CFM). In this article, we review the data collection and methods used to characterize this complex condition and describe the demographic and clinical characteristics of the cohort.Setting:Craniofacial and otolaryngology clinics at 5 study sites.Participants:Infants with CFM and unaffected infants (controls) ages 12 to 24 months were recruited from the same geographical regions and followed to age 36 to 48 months.Methods:Phenotypic, neurodevelopmental, and facial expression assessments were completed during the first and third waves of data collection (time 1 and time 3, respectively). Medical history data were taken at both of these time points and during an intermediate parent phone interview (time 2).Results:Our cohort includes 108 cases and 84 controls. Most cases and controls identified as white and 55% of cases and 37% of controls identified as Hispanic. Nearly all cases had microtia (95%) and 59% had mandibular hypoplasia. Cases received extensive clinical care in infancy, with 59% receiving care in a craniofacial clinic and 28% experiencing at least one surgery. Study visits were completed at a study site (92%) or at the participant’s home (8%).Conclusions:The CLOCK study represents an effort to overcome the challenges of characterizing the phenotypic and neurodevelopmental outcomes of CFM in a large, demographically and geographically diverse cohort.
Programmed Death-ligand 1 Expression With Clone 22C3 in Non-small Cell Lung Cancer: A Single Institution Experience
Authors: Takeda Maiko , Kasai Takahiko , Naito Maiko , Tamiya Akihiro , Taniguchi Yoshihiko , Saijo Nobuhiko , Naoki Yoko , Okishio Kyoichi , Shimizu Shigeki , Kojima Kensuke , Nagoya Akihiro , Sakamoto Tetsuki , Utsumi Tomoki , Yoon Hyung-Eun , Matsumura Akihide , Atagi Shinji 
Published: January 2019

Background: In recent years, the anti-programmed cell death 1 (PD-1) drug pembrolizumab (Keytruda) was approved for treatment of unresectable advanced non-small cell lung cancer (NSCLC) as first- or second-line therapy depending on the clone 22C3-programmed death-ligand 1 (PD-L1) immunohistochemical expression score by the companion diagnostic assay. We herein evaluated 22C3-PD-L1 expression of NSCLC in a single institution experience and compared it with clinicopathologic features. Materials and methods: We assessed 22C3-PD-L1 expressions of 411 patients with NSCLC from our institution, including in past specimens. Programmed death-ligand 1 immunohistochemistry (IHC) testing was performed using the PD-L1 clone 22C3 pharmDx kit (Agilent Technologies/Dako, Carpinteria, CA, USA). Patients were separated into 3 groups with <1% (no expression), 1% to 49% (low expression), or ⩾50% (high expression) positive tumor cells. Results: In all, 137 patients (33%) did not express PD-L1, 155 (38%) showed low expression, and 119 (29%) demonstrated high expression. Archival samples showed lower PD-L1 expression than that of recent samples, and the ratios of no expression case significantly increased by using paraffin blocks embedded particularly in more than 4 years ago. Programmed death-ligand 1 positivity was significantly associated with male sex, smoking, higher tumor grade, squamous cell carcinoma in histologic type, wild-type EGFR, and ALK rearrangement positive. Conclusions: The rate of 22C3-PD-L1 expression of NSCLC detected in this study was similar to the frequencies of the previous reports, although the ratio of expression case decreased when using old paraffin blocks.