bluuebunny/crossref_metadata_2025_split huggingface dataset:
La pregunta de investigación en educación médica
Authors: Martínez González Adrián , Sánchez-Mendiola Melchor 
Published: April 2015

La pregunta de investigación es un elemento fundamental del proceso científico en educación médica, como parte del continuo integrado por una secuencia lógica de actividades que procura descubrir las características de los fenómenos y procesos educativos así como las relaciones entre sus elementos, mediante la observación, el raciocinio y la comprobación, permitiendo avanzar el conocimiento de la disciplina.
En este artículo se analiza el inicio de la investigación en educación médica cuando el investigador tiene conciencia de un problema que genera interrogantes ante las cuales se buscan respuestas. La pregunta de investigación es una aproximación estructurada ante la incertidumbre en torno de un problema que el investigador pretende resolver o aclarar; incertidumbre relacionada con un vacío en el conocimiento de la realidad o incertidumbre ante una contradicción. Se revisan los propósitos de la pregunta de investigación. Se reflexiona sobre los retos a superar al plantearla y se ejemplifica con tres enfoques: los aspectos de una actividad educacional (quién, cuándo, dónde, qué, cómo y porqué); el enfoque "PICOT", similar al utilizado en Medicina Basada en Evidencias; el método sistemático de Bordaee y Dawson con nueve preguntas. Asimismo, se sugiere valorar las preguntas con los siguientes criterios: factibilidad, interés, novedad, ética y relevancia.Los enfoques que se recomiendan tienen elementos comunes y complementarios por lo que cada investigador puede seleccionar el que responda mejor a sus necesidades y objetivos, dado que en el proceso de la investigación no hay "recetas de cocina" rígidas sino se trata de un proceso de razonamiento creativo y complejo que no tiene límites o rutas lineales específicas.
Anselm of Canterbury on the fall of the devil: the hard problem, the harder problem, and a new formal model of the first sin
Authors: WOOD WILLIAM 
Published: April 2015

AbstractThe fall of the devil poses two distinct philosophical problems. Only one of those problems has received sufficient scholarly attention. The hard problem asks how the devil's choice to disobey God can be both suitably free and morally significant. The harder problem asks how it can be subjectively rational. Explaining the former does not suffice for explaining the latter. Drawing on the thought of Anselm of Canterbury, I develop a model of the first sin that uses the framework of consumer preference theory to show how Satan's act of disobedience can be free, morally significant, and subjectively rational.
Reflecting Absence, or How Ground Zero Was Purged of Its Material History (2001–2010)
Authors: Toor Bob van , Ronnes Hanneke 
Published: April 2015

Abstract:The development of the urban space of Ground Zero has been a long and difficult process, resulting in the removal of almost all of its material history. The material objects formerly present on the site had an important part and significant agency in the struggle between different stakeholders of Ground Zero. The Port Authority of New York and New Jersey and Larry Silverstein, owner and leaseholder of the sixteen acres that held the Twin Towers, intended to rebuild the ten million square feet of office space that was destroyed on 9/11. This force of production asserted itself over possible modes of consumption of the space, each championed and represented by overlapping groups of people. Some wished to see the space redeveloped as a site of mourning, others as a site fit for touristic consumption, as a space for residence, or as a site representing a material past older than 9/11. It shall be argued that for these consumer groups the symbolic complexity of the site, and its potential power in political performances, was intricately connected to space and the material agency of objects remaining on Ground Zero post 2001.
Nazi-Looted Art from East and West in East Prussia: Initial Findings on the Erich Koch Collection
Authors: Grimsted Patricia Kennedy 
Published: April 2015

Abstract:The article contrasts long-suppressed details of German art seizures during the Second World War from Ukrainian state museums and Western Jewish dealers, ordered to Königsberg by Erich Koch, Gauleiter of East Prussia and Reich Commissar of Ukraine. While most of the art from Kyiv was destroyed by retreating Germans when the Red Army arrived (February 1945), here we investigate “survivors.” Initial provenance findings about the collection Koch evacuated to Weimar in February 1945 reveal some paintings from Kyiv. More, however, were seized from Dutch and French Holocaust victims by Reichsmarschall Hermann Göring and his cohorts, including Jewish dealers Jacques Goudstikker (Amsterdam) and Georges Wildenstein (Paris). Many paintings deposited in Weimar disappeared west; others seized by Soviet authorities were transported to the Hermitage. These initial findings draw attention to hitherto overlooked contrasting examples of patterns of Nazi art looting and destruction in the East and West, and the pan-European dispersal of important works of art.
Excessive bird collecting in Malawi: a new threat
Authors: DOWSETT-LEMAIRE FRANCOISE , WILSON JOHN G. M. , MEDLAND ROBERT D. , ROXBURGH LIZANNE 
Published: April 2015

SummaryMalawi is under heavy pressure for land by an increasing human population, and there is little natural habitat left outside gazetted wildlife and forest reserves. Widespread collecting of birds in Malawi’s small protected rain forests by the National Museum of Malawi in conjunction with Western academic institutions has been taking place almost yearly since 2001 and has continued until at least 2011. The collection of specimens, although often a contentious issue, does have scientific value but should be undertaken in a limited way with careful evaluation of the populations from which birds are being taken. We consider that the numbers collected are likely to pose a threat to some bird populations in view of their isolation and the slow turn-over rates of breeding individuals. Collecting has been carried out in some of the same reserves two or three times within a few years. Examples are given of very small populations in Malawi and adjacent Mozambique where the slightest off-take would be very dangerous. Many species have been collected during their breeding season, which we find both wasteful and unethical. Several of the species collected occur in no more than one or two reserves today in Malawi and in such instances we recommend their complete protection. We are also concerned about the example presented to the local communities, reserve wardens and young conservation biologists by the off-take of hundreds of birds in official reserves which were primarily set up for the protection of wildlife.
Long-term atorvastatin–ezetimibe–probucol triple therapy for homozygous familial hypercholesterolaemia from early childhood
Authors: Lin Minjie , Dai Helong , Zhao Shuiping 
Published: April 2015

AbstractIn this observational case report, we share our experience of achieving >40% LDL cholesterol reduction in four Chinese homozygous familial hypercholesterolaemia children below 8 years of age with a triple combination of atorvastatin, probucol, and ezetimibe for >6 years. Within a follow-up duration of 6–13 years, this triple therapy achieved significant reduction of LDL cholesterol as well as an impressive regression of xanthomas in all paediatric cases. All the children remained free from treatment-related adverse responses and cardiovascular events throughout follow-up.
Popular Nationalism in the Wake of the 2011 National Elections in Singapore
Authors: LIM JASON 
Published: April 2015

AbstractThis article is about the contestation of two different forms of nationalism in Singapore during and after two elections in 2011. Manufactured nationalism is top-down, state-defined and economically driven, concerned mainly about accumulation of national wealth through globalization that would eventually ‘trickle down’ to the masses. This view is promoted by the ruling People's Action Party (PAP). The PAP projects Singapore as a state born out of the party's triumph over colonialism, racial violence, and communist insurgency. Popular nationalism, on the other hand, is bottom-up and people driven, concerned about local issues concerning national identity, social cohesion, and an appreciation (or at least an understanding) of local heritage. Proponents of popular nationalism emphasize a common beginning (birth of independent Singapore on 9 August 1965), shared historical memories (local heritage), several elements of a common culture (such as the use of Singlish), and an association with a specific ‘homeland’ (born and raised in Singapore and, for males, the completion of conscription). They view Singapore as a nation-state with a unique and evolving identity destabilized by a liberal immigration policy. The elections generated considerable attention due to the gains by the opposition parties and the public airing of frustrations against the PAP government. These frustrations are strongly driven by the influx of new migrants, especially those classified as ‘foreign talent’ by the PAP government. In this article, I argue that popular nationalism has emerged in twenty-first century Singapore and examine the debates over the future of Singapore during and after the elections.
Calcite-accumulating large sulfur bacteria of the genus Achromatium in Sippewissett Salt Marsh
Authors: Salman Verena , Yang Tingting , Berben Tom , Klein Frieder , Angert Esther , Teske Andreas 
Published: April 2015

Abstract
Large sulfur bacteria of the genus Achromatium are exceptional among Bacteria and Archaea as they can accumulate high amounts of internal calcite. Although known for more than 100 years, they remain uncultured, and only freshwater populations have been studied so far. Here we investigate a marine population of calcite-accumulating bacteria that is primarily found at the sediment surface of tide pools in a salt marsh, where high sulfide concentrations meet oversaturated oxygen concentrations during the day. Dynamic sulfur cycling by phototrophic sulfide-oxidizing and heterotrophic sulfate-reducing bacteria co-occurring in these sediments creates a highly sulfidic environment that we propose induces behavioral differences in the Achromatium population compared with reported migration patterns in a low-sulfide environment. Fluctuating intracellular calcium/sulfur ratios at different depths and times of day indicate a biochemical reaction of the salt marsh Achromatium to diurnal changes in sedimentary redox conditions. We correlate this calcite dynamic with new evidence regarding its formation/mobilization and suggest general implications as well as a possible biological function of calcite accumulation in large bacteria in the sediment environment that is governed by gradients. Finally, we propose a new taxonomic classification of the salt marsh Achromatium based on their adaptation to a significantly different habitat than their freshwater relatives, as indicated by their differential behavior as well as phylogenetic distance on 16S ribosomal RNA gene level. In future studies, whole-genome characterization and additional ecophysiological factors could further support the distinctive position of salt marsh Achromatium.
Impact of charge transport on current–voltage characteristics and power-conversion efficiency of organic solar cells
Authors: Würfel Uli , Neher Dieter , Spies Annika , Albrecht Steve 
Published: April 2015

AbstractThis work elucidates the impact of charge transport on the photovoltaic properties of organic solar cells. Here we show that the analysis of current–voltage curves of organic solar cells under illumination with the Shockley equation results in values for ideality factor, photocurrent and parallel resistance, which lack physical meaning. Drift-diffusion simulations for a wide range of charge-carrier mobilities and illumination intensities reveal significant carrier accumulation caused by poor transport properties, which is not included in the Shockley equation. As a consequence, the separation of the quasi Fermi levels in the organic photoactive layer (internal voltage) differs substantially from the external voltage for almost all conditions. We present a new analytical model, which considers carrier transport explicitly. The model shows excellent agreement with full drift-diffusion simulations over a wide range of mobilities and illumination intensities, making it suitable for realistic efficiency predictions for organic solar cells.
Real-time submillisecond single-molecule FRET dynamics of freely diffusing molecules with liposome tethering
Authors: Kim Jae-Yeol , Kim Cheolhee , Lee Nam Ki 
Published: April 2015

AbstractSingle-molecule fluorescence resonance energy transfer (smFRET) is one of the powerful techniques for deciphering the dynamics of unsynchronized biomolecules. However, smFRET is limited in its temporal resolution for observing dynamics. Here, we report a novel method for observing real-time dynamics with submillisecond resolution by tethering molecules to freely diffusing 100-nm-sized liposomes. The observation time for a diffusing molecule is extended to 100 ms with a submillisecond resolution, which allows for direct analysis of the transition states from the FRET time trace using hidden Markov modelling. We measure transition rates of up to 1,500 s–1 between two conformers of a Holliday junction. The rapid diffusional migration of Deinococcus radiodurans single-stranded DNA-binding protein (SSB) on single-stranded DNA is resolved by FRET, faster than that of Escherichia coli SSB by an order of magnitude. Our approach is a powerful method for studying the dynamics and movements of biomolecules at submillisecond resolution.
An Examination of Strategy Implementation During Abstract Nonlinguistic Category Learning in Aphasia
Authors: Vallila-Rohter Sofia , Kiran Swathi 
Published: April 2015

PurposeOur purpose was to study strategy use during nonlinguistic category learning in aphasia.MethodTwelve control participants without aphasia and 53 participants with aphasia (PWA) completed a computerized feedback-based category learning task consisting of training and testing phases. Accuracy rates of categorization in testing phases were calculated. To evaluate strategy use, strategy analyses were conducted over training and testing phases. Participant data were compared with model data that simulated complex multi-cue, single feature, and random pattern strategies. Learning success and strategy use were evaluated within the context of standardized cognitive–linguistic assessments.ResultsCategorization accuracy was higher among control participants than among PWA. The majority of control participants implemented suboptimal or optimal multi-cue and single-feature strategies by testing phases of the experiment. In contrast, a large subgroup of PWA implemented random patterns, or no strategy, during both training and testing phases of the experiment.ConclusionsPerson-to-person variability arises not only in category learning ability but also in the strategies implemented to complete category learning tasks. PWA less frequently developed effective strategies during category learning tasks than control participants. Certain PWA may have impairments of strategy development or feedback processing not captured by language and currently probed cognitive abilities.Supplemental Materialhttps://doi.org/10.23641/asha.6170330
Symptoms of Sternal Nonunion Late after Cardiac Surgery
Authors: Rinta-Kiikka Irina , Tarkka Matti , Laurikka Jari , Hautalahti Juha 
Published: April 2015

Background A cohort of patients having symptoms of sternal nonunion late after sternotomy was studied to find out whether the complaints were related to true sternal nonunion or decreased bone density.
Methods A survey was mailed to 2,053 cardiac surgical patients operated in our institution between July 2007 and June 2010. The patients were requested about symptoms referring to sternal instability. A group of symptomatic individuals as well as 1:1 age- and time-matched asymptomatic controls were examined with sternal palpation, ultrasound during standardized sternal pressure provocation, and computed tomography (CT).
Results The number of patients replied in the survey was 1,918 (93.4%); 2.3% (44 patients) reported sensation of movement or clicking in sternum during body movements and during coughing. Symptomatic patients living within 200 km to the hospital (21) and their asymptomatic controls (21) were selected for further clinical and imaging studies. Mean period between the initial operation and the examinations was 36 (22–56) months. Sternal palpation pain was significantly associated with reported symptoms suggestive of sternal nonunion (odds ratio [OR] 22.0; 95% confidence interval [CI] 2.5–195); however, none of the patients had clinically unstable sternum or nonunion in the sternal imaging. The symptoms of sternal instability were more frequent in patients whose bone mineralization rate (as measured with T-scores) was higher.
Conclusion Symptoms suggestive of sternal nonunion were experienced by 2.3%. However, their symptoms did not correlate with CT scans or provocation ultrasound although palpation pain was evident. Thus the pain is derived from nonmechanical etiologies. Higher bone mineralization rate correlated with abnormal symptoms of sternal wound.
Emergence of homeostatic epithelial packing and stress dissipation through divisions oriented along the long cell axis
Authors: Wyatt Tom P. J. , Harris Andrew R. , Lam Maxine , Cheng Qian , Bellis Julien , Dimitracopoulos Andrea , Kabla Alexandre J. , Charras Guillaume T. , Baum Buzz 
Published: April 2015

Significance
Animal cells undergo a remarkable series of shape changes as they pass through mitosis and divide. In an epithelial tissue, the impact of these morphogenetic processes depends strongly on the orientation of division. However, the cues orienting divisions remain poorly understood. Here, we combine live imaging and mechanical perturbations with computational modeling to investigate the effects of shape changes accompanying mitosis and division in stretched monolayers in the absence of neighbor exchange. We show that divisions orient with the long cell axis rather than with the stress direction, and show how oriented divisions contribute to the restoration of cell packing and stress relaxation. In doing so, we identify a clear role for oriented cell division in morphogenetically active tissues.
Seasonal small-scale variation in distribution among depth zones in a coastal Baltic Sea fish assemblage
Authors: Mustamäki N. , Jokinen H. , Scheinin M. , Bonsdorff E. , Mattila J. 
Published: April 2015

AbstractWe studied seasonal and small-scale spatial variation in fish assemblage structure in the northern Baltic Proper archipelago. The study was conducted in a shallow coastal basin during three consecutive production-seasons. The structure of the fish assemblage changes significantly seasonally, from early summer (May–June) to late summer (August–September), and spatially over short distances (ca. 500 m) and small depth intervals (ca. 5 m) in an area without physical barriers. The magnitude of the seasonal variation was depth zone-specific, indicating that seasonal patterns from a given depth zone cannot be directly extrapolated to adjacent ones, let alone to a whole water body. In early summer, the adult fish displayed spawning aggregations, and their abundance was highest closest to the shoreline. In late summer, the adult fish were more evenly distributed and the assemblage was dominated by high abundances of juvenile fish. The results underline the importance of including several spatial and temporal scales into studies on fish distribution. The resulting patterns from such studies may appear idiosyncratic unless the nature and magnitude of seasonal variation and small-scale depth zone distribution are taken into account.
Developing a Comprehensive Model of Intensive Care Unit Processes: Concept of Operations
Authors: Romig Mark , Tropello Steven P. , Dwyer Cindy , Wyskiel Rhonda M. , Ravitz Alan , Benson John , Gropper Michael A. , Pronovost Peter J. , Sapirstein Adam 
Published: April 2015

Objectives
This study aimed to use a systems engineering approach to improve performance and stakeholder engagement in the intensive care unit to reduce several different patient harms.

Methods
We developed a conceptual framework or concept of operations (ConOps) to analyze different types of harm that included 4 steps as follows: risk assessment, appropriate therapies, monitoring and feedback, as well as patient and family communications. This framework used a transdisciplinary approach to inventory the tasks and work flows required to eliminate 7 common types of harm experienced by patients in the intensive care unit. The inventory gathered both implicit and explicit information about how the system works or should work and converted the information into a detailed specification that clinicians could understand and use.

Prototype ConOps to Eliminate Harm
Using the ConOps document, we created highly detailed work flow models to reduce harm and offer an example of its application to deep venous thrombosis. In the deep venous thrombosis model, we identified tasks that were synergistic across different types of harm. We will use a system of systems approach to integrate the variety of subsystems and coordinate processes across multiple types of harm to reduce the duplication of tasks. Through this process, we expect to improve efficiency and demonstrate synergistic interactions that ultimately can be applied across the spectrum of potential patient harms and patient locations.

Conclusions
Engineering health care to be highly reliable will first require an understanding of the processes and work flows that comprise patient care. The ConOps strategy provided a framework for building complex systems to reduce patient harm.
Sustained Improvement in Neonatal Intensive Care Unit Safety Attitudes After Teamwork Training
Authors: Murphy Thomas , Laptook Abbot , Bender Jesse 
Published: April 2015

Objectives
This study aimed to measure safety attitudes in the neonatal intensive care unit (NICU) before and serially after a compulsory, multidisciplinary teamwork and communication training initiative and novel sustainment program.

Methods
Training was administered to NICU staff and subsequent sustainment efforts were directed at enculturating core principles over the following year. A modified Agency for Healthcare Research and Quality Survey on Patient Safety Culture was administered before as well as 3 and 12 months after training. Longitudinal survey results were compared with the national Agency for Healthcare Research and Quality survey data.

Results
Ninety-six percent of 350 NICU staff were trained over 2 months. Survey response rates were 84%, 71%, and 83% before, at 3 months, and at 12 months after training, respectively. Items with sustained improvement pertained to staff empowerment and patient hand-offs. The proportion of participants who agreed with the statement, “Staff feel free to question the decisions or actions of those with more authority” increased from 55% to 76% and 83% at 3 and 12 months, respectively (P < 0.0001). The proportion of participants who disagreed with the statement, “Things ‘fall between the cracks’ when transferring patients from one unit to another” increased from 36% to 48% and 52% at 3 and 12 months, respectively (P < 0.01). The only significant decline was for the statement, “We are actively doing things to improve patient safety.” The proportion of respondents who agreed dropped from 93% to 83% at 3 months (P = 0.02).

Conclusions
A novel sustainment program after teamwork and communication training measurably improved most staff safety attitudes over 1 year.