bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE PAEDIATRICIAN AS A LEADER: AN EDUCATIONAL INTERVENTION FOR HIGH-VALUE CARE
Authors: Foulds Jessica , Rajani Hasu , Forbes Karen 
Published: May 2018

Abstract

BACKGROUND
The CanMEDS framework for physician competency defines necessary competencies of medical practice, laying the foundation for medical education and subsequent practice in Canada to meet patient needs. The role of Leader highlights the importance of quality improvement, stewardship, health care resource allocation and ability to apply evidence and management processes to facilitate cost-appropriate care. Educational innovations in this domain have not previously been described.

OBJECTIVES
To evaluate the impact of an educational intervention developed to foster stewardship of health care resources for paediatricians in training.

DESIGN/METHODS
An educational workshop on high-value care was created for general paediatric residents. Prior to workshop development, the study team procured local costing information from microbiology, general chemistry/laboratory, pharmacy, and radiology. During the workshop, individual, small group and interactive activities were used to explore clinical decision making and associated costs, radiation dosing, and non-monetary implications of care. A pocket-card reference was developed for use during the exercises. To assess the impact of the workshop, participants completed a post-workshop reflection asking them to identify lessons learned and an action plan for providing high-value care. Qualitative exploration of statements was conducted using thematic analysis; individual responses were coded and grouped into three overarching themes for both lessons learned and action plan.

RESULTS
Forty-three learners participated in the workshop. Post-workshop reflections yielded 93 lessons learned statements, and 67 action plan statements. Lessons learned were grouped into three themes: Scope, Content and Judgement Statements. Within Scope, most statements were general (80%) versus specific. Content areas most frequently cited included cost (61%), diagnostic imaging (28%) including radiation exposure (14%), and non-monetary costs of care (17%). Inferences about aspects of learnings, such as those referring to expense, value or waste, were labelled as Judgement Statements, and were present in 50% of the responses. Action plan statements were grouped into themes of Scope, Content and Action Words. Responses were again generally focused (87%). Most frequent Content subtheme responses were: tests (37%), non-monetary costs of care (21%), and diagnostic imaging (12%). Action words were grouped into seven categories as depicted in Figure 1, with Consider as most frequent (46%).

CONCLUSION
Reflections on non-monetary costs and action plans that consider how investigations might change management seemed to resonate with our single centre paediatric trainees. Longitudinal follow-up may help identify most impactful components of this educational workshop.
CARING FOR THE CAREGIVER: EXPLORING THE EXPERIENCE OF CAREGIVING FOR A CHID WITH MEDICAL COMPLEXITY
Authors: Teicher Jessica , Weiser Natalie , Arje Danielle , Orkin Julia 
Published: May 2018

Abstract

BACKGROUND
Children with medical complexity (CMC) represent a growing population in the paediatric healthcare system. CMCs’ multiple health needs, illness severity, and fragility lead to a high degree of caregiver burnout, parental employment loss, and other social and financial consequences. Healthcare providers must consider a holistic view of the family, including consideration of social determinants of health [SDOH]: socio-economic status, employment, quality of housing, availability of social support, and access to healthcare services. This study addresses a gap in current research by exploring how caring for a CMC exacerbates social inequalities, and how these challenges may be mitigated.

OBJECTIVES
1. What are the SDOH impacting CMC and their families?
2. How do families report the impact of their child’s medical complexity on their social circumstances?

DESIGN/METHODS
A qualitative description approach was used to enable rich data collection through semi-structured interviews until thematic saturation was reached. Nine interviews were conducted with CMC caregivers who were chosen by purposeful sampling. The interview guide was developed by expert consultation and iteratively refined. Ethics approval and written consent were obtained. Interviews were recorded and transcribed verbatim. Three team members independently coded the interviews for recurrent themes to inform qualitative content analysis.

RESULTS
Caregiving for a CMC is all-consuming, requiring parents to take on roles including planner, medical professional, medical educator, and advocate. Parents of CMC report three major areas negatively impacted by caregiving: 1) physical and mental health; 2) personal relationships; and 3) finances. Additionally, three themes emerged describing enablers for resiliency: 1) the CMC’s health status when well or stable in hospital; 2) acceptance of one’s limitations as a caregiver and of the family’s ‘new normal’; and 3) broad supports including medical, personal, financial, and educational.

CONCLUSION
The wellbeing of CMC families is impacted by medical and social factors. An interdisciplinary model of care may offset some of the caregiver’s advocacy and medical educator responsibilities. Paediatricians can support families of CMC by providing comprehensive care for all components of the child’s health status, and by including routine assessment of the family’s SDOH. Finally, explicit discussion about parental expectations and caregiver burnout helps foster a positive therapeutic relationship with the family.
A Tale of Two States: How State Immigration Climate Affects Belonging to State and Country among Latinos
Authors: Schildkraut Deborah J , Jiménez Tomás R , Dovidio John F , Huo Yuen J 
Published: May 2018

AbstractThis study assesses the impact of different immigrant policy climates on how Latinos feel about themselves, their place in their state and country, and how they think they are viewed by others. Using survey data from Arizona and New Mexico, we find that Latinos in Arizona exhibit lower levels of belonging than Latinos in New Mexico, but their alienation is confined to the state level. We also find that the U.S. born are most sensitive to the state climate. We conclude that policies that delineate outsiders from insiders by immigration status have wide ranging effects that fall prominently on the U.S. born.
Race to the Bottom (of the Well): Groundwater in an Agricultural Production Treadmill
Authors: Sanderson Matthew R , Hughes Vivian 
Published: May 2018

Abstract
Groundwater from the Ogallala-High Plains Aquifer supports one of the most productive agriculture regions in the world. Yet, despite nearly 40 years of policies designed to conserve and sustain this vital resource, the Aquifer continues to be depleted at an unsustainable rate. We integrate propositions from treadmill of production theory and ecological modernization theory to develop a structural model, focusing especially on the role of technological modernization as a key mechanism motivating depletion. A time-sequenced path analysis of all counties in the Ogallala Aquifer region reveals that groundwater depletion has a strong internal momentum characteristic of an agricultural production treadmill. Technological modernization promotes depletion through Jevon’s Paradox. Increases in water efficiency—more crop per drop—are associated with less groundwater consumption, but more extensive deployments of irrigation infrastructures overwhelm the beneficial effects of increased water efficiency. An income-subsidy mechanism supports the treadmill dynamic. Agricultural production and increased water efficiency do not influence incomes. Instead, incomes are influenced mainly by expansions of irrigation technologies, which generates subsidies, and this dynamic puts further “spin” on the treadmill. The implications of the findings for theory and policy are discussed.
The Paradox of Legibility: Domestic Violence and Institutional Survivorhood
Authors: Sweet Paige L 
Published: May 2018

AbstractExisting literature has demonstrated that victims of domestic violence and rape undergo processes of discipline when they interact with legal structures, transforming themselves into “worthy victims.” Intervening in this literature, I show how the medicalization of institutions surrounding domestic violence creates conditions under which women must prove their survivorhood, performing psychological recovery to achieve institutional legibility. Legal and therapeutic institutions create a matrix of demands on women’s lives, shaping their practices of survival and performances of self. Through interviews with domestic violence survivors, I show that women engage three strategies of transformation to make themselves credible survivors: (1) extracting domestic violence from their life stories; (2) explaining abuse through “self-esteem;” (3) performing survivorhood through “respectable” motherhood and sexuality. Through these processes, women craft a domestic violence narrative and an institutional performance of survivorhood, both of which allow them to navigate institutional pressures. These therapeutic narratives and performances, however, also rewrite the structural elements of violence into (feminized) accounts of psychological failure and overcoming. Thus, women navigate a paradox when they become survivors: they must tell stories of psychological recovery, even as those stories obfuscate the very infrastructure of violence. It is this disjuncture between individualized narratives of harm and the structural work of survival that I examine in this work. I develop the concept of the “paradox of legibility” to generalize this disjuncture, and to highlight women’s labor of making themselves credible amidst structural and institutional constraints.
Intravenous Immunoglobulin Therapy in Refractory Autoimmune Dysautonomias: A Retrospective Analysis of 38 Patients
Authors: Schofield Jill R. , Chemali Kamal R. 
Published: May 2018

Background:
Intravenous immunoglobulin (IVIG) has recognized efficacy in autoimmune peripheral nerve disorders, but there has been limited study of the use of IVIG in autoimmune dysautonomias.

Study Question:
To determine the efficacy and safety of IVIG in patients with disabling, refractory autoimmune dysautonomias, including patients with postural tachycardia syndrome and gastrointestinal dysmotility.

Study Design:
Patients with one or more autonomic disorder(s) and persistent serological evidence for autoimmunity who were unable to work or attend school despite usual treatments for dysautonomia were treated with IVIG for at least 3 months at a dose of at least 1 gm/kg monthly.

Measures and Outcomes:
Outcome measures included the composite autonomic symptom scale 31 survey and a functional ability score.

Results:
There were 38 patients, 84% female and mean age of 28.4 years. Of patients, 83.5% improved on IVIG as defined by at least 20% improvement in the composite autonomic symptom scale 31 and/or functional ability score. The mean pretreatment functional ability score was 21% (mostly bedridden), which improved to a mean of 74% (nearing able to return to work/school) for responsive patients after at least 1 year of IVIG. The mean time to the first sign of response was 5.3 weeks. There were no serious adverse events. The Mayo autoimmune dysautonomia panel antibodies and traditional Sjögren antibodies were present in only 13% and 8% of patients, respectively, but antiphospholipid antibodies and novel Sjögren antibodies were present in 76% and 42% of patients, respectively.

Conclusions:
There is increasing evidence that IVIG is safe and effective in a subset of patients with autonomic disorders and evidence for autoimmunity. A 4-month IVIG trial should be considered in severely affected patients who are refractory to lifestyle and pharmacological therapies. Antiphospholipid antibodies and novel Sjögren antibodies are often present in these patients and correlate with a high response rate to IVIG.
Genetic risk for schizophrenia and developmental delay is associated with shape and microstructure of midline white matter structures
Authors: Drakesmith Mark , Parker Greg D , Smith Jacqueline , Linden Stefanie C , Rees Elliott , Williams Nigel , Owen Micheal J , Van Den Bree Marianne , Hall Jeremy , Jones Derek K , Linden David E J 
Published: May 2018

AbstractGenomic copy number variants (CNVs) are amongst the most highly penetrant genetic risk factors for neuropsychiatric disorders. The scarcity of carriers of individual CNVs and their phenotypical heterogeneity limits investigations of the associated neural mechanisms and endophenotypes. We applied a novel design based on CNV penetrance for schizophrenia and developmental delay that allows us to identify structural sequelae that are most relevant to neuropsychiatric disorders. Our focus on brain structural abnormalities was based on the hypothesis that convergent mechanisms contributing to neurodevelopmental disorders would likely manifest in the macro- and microstructure of white matter and cortical and subcortical grey matter. 21 adult participants carrying neuropsychiatric risk CNVs (including those located at 22q11.2, 15q11.2, 1q21.1, 16p11.2, and 17q12) and 15 age- and gender matched controls underwent T1-weighted structural, diffusion and quantitative T1 relaxometry MRI.The macro- and microstructural properties of the cingulum bundles were associated with penetrance for both developmental delay and schizophrenia, in particular curvature along the anterior-posterior axis (Sz: pcorr=0.026; DD: pcorr=0.035) and intracellular volume fraction (Sz: pcorr=0.019; DD: pcorr=0.064) Further principal component analysis showed alterations in the interrelationships between the volumes of several mid-line white matter structures (Sz: pcorr=0.055; DD, pcorr=0.027). In particular, the ratio of volumes in the splenium and body of the corpus callosum was significantly associated with both penetrance scores (Sz: p=0.037; DD; p=0.006). Our results are consistent with the notion that a significant alteration in developmental trajectories of mid-line white-matter structures constitutes a common neurodevelopmental aberration contributing to risk for schizophrenia and intellectual disability.
Longitudinal increases in structural connectome segregation and functional connectome integration are associated with better recovery after mild TBI
Authors: Kuceyeski Amy F. , Jamison Keith W. , Owen Julia P. , Raj Ashish , Mukherjee Pratik 
Published: May 2018

AbstractTraumatic brain injury damages white matter pathways that connect brain regions, disrupting transmission of electrochemical signals and causing cognitive and emotional dysfunction. Connectome-level mechanisms for how the brain compensates for injury have not been fully characterized. Here, we collected serial MRI-based structural and functional connectome metrics and neuropsychological scores in 26 mild traumatic brain injury subjects (29.4±8.0 years, 20 male) at 1 and 6 months post-injury. We quantified the relationship between functional and structural connectomes using network diffusion model propagation time, a measure that can be interpreted as how much of the structural connectome is being utilized for the spread of functional activation, as captured via the functional connectome. Overall cognition showed significant improvement from 1 to 6 months (t25=−2.15, p=0.04). None of the structural or functional global connectome metrics were significantly different between 1 and 6 months, or when compared to 34 age- and gender-matched controls (28.6±8.8 years, 25 male). We predicted longitudinal changes in overall cognition from changes in global connectome measures using a partial least squares regression model (cross-validated R2= 0.27). We observe that increased network diffusion model propagation time, increased structural connectome segregation and increased functional connectome integration were related to better cognitive recovery. We interpret these findings as suggesting two connectome-based post-injury recovery mechanisms: one of neuroplasticity that increases functional connectome integration and one of remote white matter degeneration that increases structural connectome segregation. We hypothesize that our inherently multi-modal measure of network diffusion model propagation time captures the interplay between these two mechanisms.Abbreviationsmild traumatic brain injury (mTBI), structural connectome (SC), functional connectome (FC), network diffusion (ND), functional MRI (fMRI), diffusion MRI (dMRI), principal component analysis (PCA), partial least squares regression (PLSR), confidence interval (CI), Attention Network Test (ANT), California Verbal Learning Test II (CVLT-II), Coma Recovery Scale – Revised (CRS-R)
Hybridization and postzygotic isolation promote reinforcement of male mating preferences in a diverse group of fishes with traditional sex roles
Authors: Moran Rachel L. , Zhou Muchu , Catchen Julian M. , Fuller Rebecca C. 
Published: May 2018

AbstractBehavioral isolation is thought to arise early in speciation due to differential sexual and/or natural selection favoring different preferences and traits in different lineages. Alternatively, behavioral isolation can arise due to reinforcement favoring traits and preferences that prevent maladaptive hybridization. In darters, female preference for male coloration has been hypothesized to drive speciation, because behavioral isolation evolves before F1 inviability. However, as with many long-lived organisms, the fitness of second generation hybrids has not been assessed because raising animals to adulthood in the lab is challenging. Recently, reinforcement of male preferences has been implicated in darters because male preference for conspecific females is high in sympatry but absent in allopatry in multiple species pairs. The hypothesis that reinforcement accounts for behavioral isolation in sympatry assumes that hybridization and postzygotic isolation are present. Here, we used genomic and morphological data to demonstrate that hybridization is ongoing between orangethroat and rainbow darters and used hybrids collected from nature to measure postzygotic barriers across two hybrid generations. We observed sex ratio distortion in adult F1s and a dramatic reduction in backcross survival. Our findings indicate that selection to avoid hybridization promotes the evolution of male-driven behavioral isolation via reinforcement in this system.
TreeSwift: a massively scalable Python tree package
Authors: Moshiri N. 
Published: May 2018

AbstractPhylogenetic trees are essential to evolutionary biology, and numerous methods exist that attempt to extract phylogenetic information applicable to a wide range of disciplines, such as epidemiology and metagenomics. Currently, the three main Python packages for trees are Bio.Phylo, DendroPy, and the ETE Toolkit, but as dataset sizes grow, parsing and manipulating ultra-large trees becomes impractical for these tools. To address this issue, we present TreeSwift, a user-friendly and massively scalable Python package for traversing and manipulating trees that is ideal for algorithms performed on ultra-large trees.
Reproduction costs can drive the evolution of groups
Authors: Pichugin Yuriy , Traulsen Arne 
Published: May 2018

AbstractA fascinating wealth of life cycles is observed in biology, from unicellularity to the concerted fragmentation of multi-cellular units. However, the understanding of factors driving the evolution of life cycles is still limited. We investigate how reproduction costs influence this process. We consider a basic model of a group structured population of undifferentiated cells, where groups reproduce by fragmentation. Fragmentation events are associated with a cost expressed by either a fragmentation delay, a fragmentation risk, or a fragmentation loss. The introduction of such fragmentation costs vastly increases the set of potentially optimal life cycles. Based on these findings, we suggest that the evolution of life cycles and the splitting into multiple offspring can be directly associated with the fragmentation cost. Moreover, the impact of this cost alone is strong enough to drive the emergence of multicellular groups, even under scenarios that strongly disfavour groups compared to solitary individuals.
Renoprotective effects Of Dexmedetomidine against ischemia-reperfusion injury in streptozotocin-induced diabetic rats
Authors: Kim Seung Hyun , Jun Ji Hae , Oh Ju Eun , Shin Eun-Jung , Oh Young Jun , Choi Yong Seon 
Published: May 2018

AbstractBackgroundDiabetic patients are susceptible to renal ischemia-reperfusion injury, which leads to perioperative complications. Nucleotide binding and oligomerization domain (NOD)-like receptor 3 inflammasome participates in the development of diabetes, and contributes to renal ischemia-reperfusion injury. Dexmedetomidine, a highly selective α2-adrenoreceptor agonist, shows renoprotective effects against ischemia-reperfusion injury. We aimed to elucidate the effects, underlying mechanisms, and optimal timing of dexmedetomidine treatment in diabetic rats.MethodsMale Sprague-Dawley rats (60 animals, weighing 250-300 g) were randomly divided into normal-sham, diabetes-sham, diabetes-ischemia-reperfusion-control, diabetes-ischemia-reperfusion-dexmedetomidine-pre-treatment, and diabetes-ischemia-reperfusion-dexmedetomidine-post-treatment groups. Renal ischemia-reperfusion injury was induced in diabetic rats by occlusion of both renal arteries for 45 minutes followed by reperfusion for 24 hours. Dexmedetomidine (10 μg/kg) was administered intraperitoneally 1 hour before ischemia (pre-treatment) or upon reperfusion (post-treatment). After reperfusion, renal tissue was biochemically and histopathologically evaluated.ResultsDexmedetomidine treatment attenuated IR-induced increase in NLRP3, caspase-1, IL-1β, phospho-AKT, and phospho-ERK signaling. Moreover, oxidative stress injury, inflammatory reactions, apoptosis, and renal tubular damage were favorably modulated by dexmedetomidine treatment. Furthermore, post-reperfusion treatment with dexmedetomidine was significantly more effective than pre-treatment in modulating inflammasome, AKT and ERK signaling, and oxidative stress.ConclusionsThis study shows that protective effects of dexmedetomidine in renal ischemia-reperfusion injury are preserved in diabetic conditions and may potentially provide a basis for the use of dexmedetomidine in clinical treatment of renal ischemia-reperfusion injury.