The ISCB Accomplishment by a Senior Scientist recognizes a leading member of the computational biology community for his or her significant contributions to the field through research, service, and training. The 2013 ISCB Accomplishment by a Senior Scientist Award honors Dr. David Eisenberg of the University of California Los Angeles (UCLA).The International Society for Computational Biology  meeting. This meeting is being held jointly with the 12th European Conference on Computational Biology and will take place in Berlin, Germany on July 19–23, 2013 (http://www.iscb.org/ismbeccb2013).Dr. Eisenberg  was seleDavid Eisenberg's love of medicine and science was cultivated first during his childhood by his father, a gentle and beloved pediatrician. Eisenberg recalled, “Every night after dinner he would make house calls. I saw how appreciated—even loved—he was in our village.”Eisenberg's father also stoked his scientific curiosity by encouraging him to try some experiments in their basement, including attempts to petrify an egg and to grow worms in chocolate. Eisenberg reminisced, “None of these [experiments] worked, but they were fun!”Eisenberg strongly considered following in his father's footsteps and pursuing a career in medicine. With that goal in mind, he focused his undergraduate studies on biochemical sciences at Harvard University. As a sophomore, he was assigned to Dr. John T. Edsall as a tutor.Science.”Edsall was a pioneering researcher in the field of biophysical chemistry, and under his guidance, Eisenberg had his first encounter with laboratory research. “In my junior year, he assigned me to read scientific papers, most of which baffled me, and at the end of that year, I started a research project in his lab, which became the subject of my senior thesis,” Eisenberg recounted. “After graduation, Dr. Edsall turned my thesis into a short paper which was published in In spite of Eisenberg's eye-opening undergraduate research experiences, he applied and was accepted to medical school. Edsall was also trained as a medical doctor, but Eisenberg remembered how “Dr. Edsall convinced me that if my goal was to improve the health of mankind, I might have a greater impact working in biochemistry, than as a practicing physician.”Eisenberg took Edsall's advice to heart and “finessed making an immediate choice by going to Oxford to study theoretical chemistry under Dr. Charles Coulson, one of the founders of quantum chemistry.” Edsall's guidance had also given him a strong foundation in math and physics, which served him well as a graduate student at Oxford as he recalled being “(just) able to work with Coulson on the energetics of hydrogen bonding.”Eisenberg's postdoctoral studies took him to Princeton in 1964 to work with Dr. Walter Kauzmann, well known for his discovery of the hydrophobic interaction. Eisenberg recollected his ambitious postdoctoral plan “to compute the energy of the hydrophobic interaction in myoglobin, the first protein with a known 3D structure. This plan now seems hopelessly naïve: computers were not yet up to such a calculation, potential functions and theory had not advanced to the point that this was a practical problem, and the early protein crystallographers were not eager to release their atomic coordinates.”In light of these challenges, Eisenberg's work with Kauzmann culminated in “a monograph on ice and water, which, incidentally, is still in print 44 years later.”His failed postdoctoral research plan also opened his eyes. He knew that if he wanted to pursue protein energetics, which required knowing protein coordinates, he had to learn X-ray crystallography. Eisenberg's next postdoc took him “to Caltech to study X-ray crystallography with Richard Dickerson, who had been part of the team who had determined the structure of myoglobin.”His X-ray crystallography training was pivotal to establishing his own lab at UCLA, which focused on studying diverse protein structures. Melittin, a component of bee venom, was one of the first structures he determined with his then graduate student Tom Terwilliger. Eisenberg vividly recalled that, “At last I was able to get down to energetic calculations on a protein, and came up with the idea of the hydrophobic moment. This and related ideas gave me, for the first time, the feeling that I could make discoveries.”Eisenberg also remembers the excitement of solving the structure of diphtheria toxin dimer, which he worked on with John Collier, Senyon Choe, and Melanie Bennett (Brewer). He recalled the excitement that stemmed from Bennett's observation that “two monomers of the dimer swapped their third domains, and we called this phenomenon “3D domain swapping.” We explored the implications of 3D domain swapping, again calling on my background in energetics. Diphtheria toxin was the first structural example of 3D domain swapping; now there are hundreds.”Eisenberg's work on protein structures awakened his interest in how protein sequences related to 3D structures. While on sabbatical at the Laboratory of Molecular Biology in Cambridge, he worked with Andrew McLachlan and Mike Gribskov to develop methods to examine protein sequences and use profile analysis to predict the presence of potential structural motifs. These studies led to his work on 3D profiles with Jim Bowie and Roland Luethy, which Eisenberg has now seen “applied to many protein problems.”Burkhard Rost, president of the ISCB, considers Eisenberg's work on hydrophobicity profiling as groundbreaking because it “describes an important feature of the constituents of proteins (amino acids), namely their preferences to stay away from the solvent water . Many other outstanding, original methods followed for the prediction of protein structure and function; many of those methods were so visionary that they started entire fields of research.”The availability of the first complete genome sequences in the late 1990s inspired Eisenberg's work with “colleague Todd Yeates and our two talented postdoctoral fellows Edward Marcotte and Matteo Pellegrini, [in which] we found we could extract information on protein interactions from sequenced genomes.” These cutting edge studies resulted in several publications that showed how protein function and protein-protein interactions could be predicted from genome sequences.Eisenberg has focused his research over the last decade on studying amyloid-forming proteins. Several neurodegenerative diseases are associated with amyloid-forming proteins, including Alzheimer's, Parkinson's and amyotrophic lateral sclerosis (Lou Gehrig's) disease. “Just before the turn of the century, I realized that amyloid diseases represent the greatest unmet medical problem facing the world,” Eisenberg recounted. “And at the same time, I realized that structural and computational biology, which have illuminated other areas of biomedicine so well, have not been widely applied to the fundamental problems of amyloid disease. In particular, there had been almost no single crystal X-ray studies of amyloid-forming proteins.”The use of computational biology with this structural data has helped support the definition of the “amyloid state” of proteins. “Bioinformatics and computational biology are great partners with structural biology. Using the tools together can be surprisingly powerful,” said Eisenberg. Eisenberg's group has studied the structural basis of how normal proteins convert to amyloid fibrils. They have gained great insight into this conversion process by determining the atomic structures of the spines of many different types of amyloid fibrils. Eisenberg also acknowledges that, “Having several friends afflicted with amyloid disorders is a great inspiration. I would love to be able to help them, and others. If we can, it would validate Dr. Edsall's advice that sometimes biochemists can do as much, or more, to help mankind than physicians.”Eisenberg remains humble about his accomplishments. When asked about being the recipient of the ISCB Senior Scientist Accomplishment Award, he felt “honored, but perhaps over-honored. There are many others who are equally, or more, deserving of this recognition.” But he also recognizes that this award helps highlight the importance of studying amyloid diseases, especially by using the tools of computational biology.Eisenberg speaks warmly of the mentors that have guided and shaped his scientific training. “I was enormously fortunate to find myself in the research groups of four great mentors: John Edsall, Charles Coulson, Walter Kauzmann, and Richard Dickerson, not to mention my father. All were creative scientists, and also humanists. Watching them I saw their pleasure in scientific discovery, and also saw their insistence on fairness to all those involved in the process of science.”Their examples have not only served him well as a scientist, but also as a mentor. Eisenberg delights in working with trainees because he loves “their eagerness to learn and to succeed, and their willingness to think freshly about hard problems.”Eisenberg's scientific curiosity remains insatiable, and when asked for advice to motivate young scientists, his sage answer was “work on fundamental problems, maintain your curiosity, and above all, persevere.”Over the past 20 years, the ISMB conference has grown to become the world's largest bioinformatics/computational biology conference, and ISMB/ECCB 2013 will be the year's most important computational biology event globally.The ISMB conferences provide a multidisciplinary forum for disseminating the latest developments in bioinformatics/computational biology. ISMB/ECCB brings together scientists from computer science, molecular biology, mathematics, statistics, and related fields. Its principal focus is on the development and application of advanced computational methods for biological problems. ISMB/ECCB 2013 offers a strong scientific program and the broadest scope of any international bioinformatics/computational biology conference.ISMB/ECCB 2013 takes place July 19–23, at the Messe Berlin (ICC Berlin), Germany. For two days preceding the conference, additional opportunities including Satellite Meetings, Junior Principal Investigator Symposium, Student Council Symposium, and a selection of Special Interest Group Meetings and Tutorials are all offered to enable registered participants to learn more on the latest methods and tools within specialty research areas.


The proper allocation of public health resources for research and control requires quantification of both a disease's current burden and the trend in its impact. Infectious diseases that have been labeled as “emerging infectious diseases” (EIDs) have received heightened scientific and public attention and resources. However, the label ‘emerging’ is rarely backed by quantitative analysis and is often used subjectively. This can lead to over-allocation of resources to diseases that are incorrectly labelled “emerging,” and insufficient allocation of resources to diseases for which evidence of an increasing or high sustained impact is strong. We suggest a simple quantitative approach, segmented regression, to characterize the trends and emergence of diseases. Segmented regression identifies one or more trends in a time series and determines the most statistically parsimonious split(s) (or joinpoints) in the time series. These joinpoints in the time series indicate time points when a change in trend occurred and may identify periods in which drivers of disease impact change. We illustrate the method by analyzing temporal patterns in incidence data for twelve diseases. This approach provides a way to classify a disease as currently emerging, re-emerging, receding, or stable based on temporal trends, as well as to pinpoint the time when the change in these trends happened. We argue that quantitative approaches to defining emergence based on the trend in impact of a disease can, with appropriate context, be used to prioritize resources for research and control. Implementing this more rigorous definition of an EID will require buy-in and enforcement from scientists, policy makers, peer reviewers and journal editors, but has the potential to improve resource allocation for global health. Developing a consistent and reproducible definition to EIDs is not simply a semantic issue because proper designation of a disease as “emerging” implies an increased impact in the future and is part of a valid utilitarian approach to determine the importance of different diseases and to the allocation of scarce public health resources A rigorous analysis of trends in disease impact must overcome several challenges. First, authors usually do not put temporal bounds on emergence so that diseases for which incidence increased in a prior period, but is now diminishing, are still considered ‘emerging’. Although an influential review from the Institute of Medicine suggested a timescale of 20 years In this paper, we illustrate a simple, reproducible and quantitative method to add objectivity to previous definitions of emergence 0β is the intercept, 1β is the initial slope, the kτ are the unknown points of inflection (or joinpoints), kδ are the changes in slope after the inflection point, and the kφ are 1 if k)>0. We compared models using a permutation method in which the residuals of the null model (for 0 joinpoints the null model is a simple linear regression) are repeatedly permuted (randomly reordered) and added to the predicted values from the null model to generate thousands of permuted data sets To develop a quantitative definition of disease emergence, trends in incidence (the number of cases a disease produces in a defined population within a given time period) or public health impact  must be examined over a given time period and in a defined population. The simplest method for quantifying trends in disease incidence or impact is a linear regression with time as the predictor. This produces an increasing (emerging) or decreasing (recending) slope, or no significant change (stable) in incidence in the population over the time period examined. For diseases that have undergone changes in trends, an additional tool for examining time series, segmented linear regression, can be used. The model can be written assegmented package in R To illustrate this approach we analyzed yearly incidence data for twelve diseases from the GIDEON database The best fitting joinpoints (points of inflection) are estimates of the beginning of an emergence or receding event. Additionally, disease “re-emergence” can be rigorously defined using this approach. For a disease to be re-emerging, the incidence or impact of a disease must be shown to increase initially (the first emergence event), then either stabilize or recede, and then increase again (the re-emergence). These patterns are illustrated with actual incidence data below.There were six patterns apparent in trends of disease incidence that likely capture most of the variation that is likely to occur. First, incidence trends for several diseases show simple and relatively consistent increases and are characterized as emerging , the analysis provides a more general way of defining an EID than previous studies. Following our approach, diseases can emerge within a population that is a subset of a larger but spatially contiguous population , or within a region (in which case a disease is emerging within that region) or in all humans . This implies that a disease can be classified as an EID in one population at one scale and be stable or receding in another at a different scale One issue which merits discussion is the emergence of diseases associated with spatial spread to new regions. Our framework for detecting trends in temporal data (time series) does not directly address spatial spreading of diseases, but it can still provide a broad perspective of temporal trends. For example a disease may invade a new region and fade out , this approach could be used to analyze diseases that are thought to have emerged due to increased impact, even without changes in incidence. Our approach can be easily applied to diseases affecting populations of plants, wildlife or livestock.Using a quantitative approach to determine whether a disease is emerging presents some challenges. First, it requires time series data in a common currency to accurately classify a disease as emerging, and to compare the rate or significance of emergence among different diseases. The ideal would be time series of DALYs for each disease. While this is a challenge for analyzing some historical trends, we believe it is a strength, in that it brings rigor to the analysis. Second, surveillance data, like those used in our example analyses, are influenced by changes in reporting, case definitions, diagnostic capabilities, and other aspects that determine the measured case burden. Third, simple measures like case numbers may be a poor measure of disease impact, especially if populations have different resources for treatment (e.g. AIDS in the USA vs. Africa). As a result, more explicit measures of disease burden should be used whenever possible. Fourth, although we have presented a simple approach based on segmented linear regression, nonlinear approaches may be more appropriate for some data  for twelve diseases. Figure S1, Brucellosis. Figure S2, Crimean-Congo hemorrhagic fever. Figure S3, Dengue. Figure S4, Hantavirus pulmonary syndrome. Figure S5, Hepatitis B. Figure S6, Hepatitis C. Figure S7, Legionellosis. Figure S8, Lyme disease. Figure S9,Plague. Figure S10, Rabies. Figure S11, Rocky mountain spotted fever. Figure S12, Salmonellosis. Maps show countries for which the current trend (ending in 2010) of a disease is emerging (red), receding (green), no significant trend (yellow) or not analyzed (white). The segments of the time series are similarly coded. See (PDF)Click here for additional data file.


This desire is brought on by stress, which is determined by the presence and dominance of onlookers, and by unsuccessful recovery attempts. We study this theory in two experiments similar to those done with real birds with a kind of ‘virtual bird’, whose behavior depends on a set of basic assumptions about corvid cognition, and a well-established model of human memory. Our results show that the ‘virtual bird’ acts as the real birds did; its re-caching reflects whether it has been watched, how dominant its onlooker was, and how close to that onlooker it has cached. This happens even though it cannot attribute mental states, and it has only a single behavioral rule assumed to be previously learned. Thus, our simulations indicate that corvid re-caching can be explained without sophisticated social cognition. Given our specific predictions, our theory can easily be tested empirically.Scrub jays are thought to use many tactics to protect their caches. For instance, they predominantly bury food far away from conspecifics, and if they must cache while being watched, they often re-cache their worms later, once they are in private. Two explanations have been offered for such observations, and they are intensely debated. First, the birds may reason about their competitors' mental states, with a ‘theory of mind’; alternatively, they may apply behavioral rules learned in daily life. Although this second hypothesis is cognitively simpler, it does seem to require a different, ad-hoc behavioral rule for every caching and re-caching pattern exhibited by the birds. Our new theory avoids this drawback by explaining a large variety of patterns as side-effects of stress and the resulting memory errors. Inspired by experimental data, we assume that re-caching is not motivated by a deliberate effort to safeguard specific caches from theft, but by a general desire to  Over the last decade, the social cognition of corvids – the extended family of crows – has been the subject of much scientific attention. Experiments have shown, for instance, that Clark's nutcrackers can use human cues to find food intend to steal its worms, and that if others see it caching they will know where its worms are. Furthermore, a scrub jay could realize that caching far away from onlookers makes it difficult for them to see its caches, and that re-caching when alone will ensure that they no longer know the locations of its items. According to this hypothesis, scrub jays thus have some elements of a ‘theory of mind’. Alternatively, the birds could be applying behavioral rules that they have learned previously, from experience in daily life The two explanations that have been offered for these results are the subject of intense debate A reason to favor this ‘prior learning hypothesis’ is that it seems cognitively simpler than ‘theory of mind’; it does not require corvids to be capable of mental state attribution, which is a controversial claim for all species other than humans stress. The model consists of a ‘virtual bird’. Its basic behavior is driven by a memory system, based on broadly validated, similar models built for humans Therefore, our aim is to develop a cognitively simple theory that can explain the re-caching behavior of scrub jays without these drawbacks. We do this by taking our existing computational model of corvid cognition, as we have already shown that it generates caching behavior that resembles that of real corvids stress, we assume that stress causes increased caching and, as a special case, increased re-caching. This is inspired by work explicitly linking stress to caching finding caches missing is a source of stress, and this, accordingly, makes our ‘virtual bird’ re-cache more.With regards to our model extensions related to We investigate the consequences of these assumptions by exposing our ‘virtual bird’ to simulated versions of two experiments. The first compares caching in front of a conspecific to caching alone, as done in an experiment by Emery and Clayton caching session and one recovery session, in which the scrub jays were tested individually, in their home cages d, governing how quickly memories decay, n, specifying the noise in their likelihood of recall, and st, determining the stress threshold at which recovering ‘virtual birds’ re-cache. They were kept constant across experiments, and set so that the performance of the ‘virtual birds’ matched that of the real birds. Our results were robust, and depended only mildly on the model's exact parameter values; see The experiments that we simulated consisted of one Emery and Clayton n = 7, V = 0, p = 0.03), and they re-cached more from the tray in which they had cached with an onlooker, than from the tray in which they had cached alone . In the model, this is due to memory errors. In the caching session, watched ‘virtual birds’ already re-cached, because they were stressed by the presence of the spectator. Consequently, in the recovery session, they remembered caching in many more sites than actually contained worms. This confusion of their memory caused them to experience more failed recovery attempts, which in turn caused them to be more stressed – and thus, to re-cache more.These results seem to suggest that the scrub jays remembered whether they had been watched or not, and then re-cached in order to protect themselves from future theft Dally, Emery and Clayton 22 = 11.67, p<0.01). This was because the ‘virtual birds’ re-cached more when they had been watched by a dominant than by a subordinate , or than when they had been alone .These results seem to suggest that the re-caching behavior of the birds depended on their memory of the social status of the onlooker, but our ‘virtual birds’ remembered only the locations of cache sites. Nevertheless, like in the empirical data, we found a difference in re-caching rates between conditions . Thus, the stronger a ‘virtual bird's’ memory of having cached somewhere, the more attractive it finds it to recover there.Every time a ‘virtual bird’ must decide where to recover, it chooses the site with the highest ‘recovery attractiveness’ ksafety risk S associated with the site k where it just found its worm. This safety risk depends on its previous recovery experiences with site k's tray, but only on those recovery experiences directed at its actual cache sites or their neighbors. This is in line with our previous work all their recovery attempts, but only from those that are directed at sites where they have cached.If a ‘virtual bird’ recovers a worm, it needs to decide whether to re-cache it. To do so, it first calculates the kS associated with site k, a ‘virtual bird’ compares the ratio of ‘unsuccessful recovery attempts’ to ‘total recovery attempts’ within site k's tray, according to Equation 6, where uA is the total activation of chunks encoding unsuccessful recovery attempts, and sA the total activation of chunks encoding successful recovery attempts. This ratio is then compared to the stress threshold st, which is a parameter that we tune Click here for additional data file.Model Code S1Simulations implemented in a Java program, CogCor.(ZIP)Click here for additional data file.Table S1Range of parameter values evaluated.(DOCX)Click here for additional data file.Table S2Patterns present at different parameter combinations.(DOCX)Click here for additional data file.Text S1Robustness.(DOC)Click here for additional data file.


In an ensemble exposed to these laser beams, the donor excitation is modulated at f1, and the acceptor excitation, and therefore the degree of saturation of the excited electronic state of the acceptors, is modulated at f2. Since the ensemble contains donor acceptor pairs engaged in FRET, the released donor fluorescence is modulated not only at f1 but also at the beat frequency Δf: = |f1 − f2|. The depth of the latter modulation, detectable via a lock-in amplifier, quantitatively indicates the FRET efficiency.The process of radiationless energy transfer from a chromophore in an excited electronic state (the “donor”) to another chromophore (an “acceptor”), in which the energy released by the donor effects an electronic transition, is known as “Förster Resonance Energy Transfer” (FRET). The rate of energy transfer is dependent on the sixth power of the distance between donor and acceptor. Determining FRET efficiencies is tantamount to measuring distances between molecules. A new method is proposed for determining FRET efficiencies rapidly, quantitatively, and non-destructively on ensembles containing donor acceptor pairs: at wavelengths suitable for mutually exclusive excitations of donors and acceptors, two laser beams are intensity-modulated in rectangular patterns at duty cycle  In 1923, based on theoretical considerations by Klein and Rosseland   measurements  at confocal spatial resolution for quantitative measurements, since FRET-based [Ca2+] indicators are now available  measurements employing the “Cameleon” dye, with which CFP and YFP can be excited selectively by specific Ti-Sap laser wavelengths [Using one or two phase modulating EOMs, a beat situation could be simulated. The phase modulation would accelerate or retard one or both of the laser beams. Thus, a beat can be simulated by electronic means, provided two titanium sapphire lasers are available and the two chromophores in the respective donor acceptor pair can be excited selectively, each chromophore by one of the beams. The method then could for example, be used for semi-quantitative or even quantitative [Caelengths ,13.The system can be extended to include appropriate numbers of laser lines, EOMs, PMTs, and LIAs, in order to quantitatively determine competing FRET processes in one sample. In this case, several different donors interact with one acceptor or one donor interacts with several different acceptors. It is essential that there be available illumination and detection wavelength bands for the involved chromophores, which must not cause too much mutual cross-excitation or cross-channel detection. In a situation where for example, there would be one donor interacting with three different acceptors, one laser line and EOM would be needed for the donor and one laser line and EOM would be needed for each acceptor, in addition to one LIA for each acceptor and one LIA for each FRET process, requiring altogether four laser lines, four EOMs, three PMTs, and seven LIAs.i.e., triangular co-localization situations.While it is not a problem to understand that the method can be used in situations, where, for example, each of the donor molecules interacts with an acceptor of either the first, second, or third type, the method would even allow determination of how much FRETing would occur between the donor and several acceptors if, in an ensemble, a large fraction or even all of the donor molecules could enter FRET processes with two acceptors, at which the donors would be in FRET range distance to acceptors molecules of both types at the same time, The outline of a new, non-destructive method for the quantitative and fast measurement of FRET processes has been presented. Experiments will have to prove whether the method will be useful in praxi. The method is independent of any specific method of observation and may be applied to imaging as well as purely photometric methods. The method promises to be a useful tool, especially in high-resolution light microscopy.


Medical schools frequently experience challenges related to diversity and inclusiveness. The authors conducted this study to assess, from a student body’s perspective, the climate at one medical school with respect to diversity, inclusiveness and cross-cultural understanding.In 2008 students in the doctor of medicine (MD), physical therapy (PT) and physician assistant programs at a public medical school were asked to complete a diversity climate survey consisting of 24 Likert-scale, short-answer and open-ended questions. Questions were designed to measure student experiences and attitudes in three domains: the general diversity environment and culture; witnessed negative speech or behaviors; and diversity and the learning environment. Students were also asked to comment on the effectiveness of strategies aimed at promoting diversity, including diversity and sensitivity training, pipeline programs, student scholarships and other interventions. Survey responses were summarized using proportions and 95 percent confidence intervals (95% CI), as well as inductive content analysis.Of 852 eligible students, 261 (31%) participated in the survey. Most participants agreed that the school of medicine (SOM) campus is friendly  and welcoming to minority groups . Ninety percent (95% CI 86 to 93) found educational value in a diverse faculty and student body. However, only 37 percent (95% CI 30 to 42) believed the medical school is diverse. Many survey participants reported they have witnessed other students or residents make disparaging remarks or exhibit offensive behaviors toward minority groups, most often targeting persons with strong religious beliefs , low socioeconomic status , non-English speakers , women , racial or ethnic minorities , or gay, lesbian, bisexual or transgendered (GLBT) individuals . Students witnessed similar disparaging or offensive behavior by faculty members toward persons with strong religious beliefs , persons of low socioeconomic status , non-English speakers , women , racial or ethnic minorities  and GLBT individuals . Students’ open-ended comments reinforced the finding that persons holding strong religious beliefs or conservative values were the most common targets of disparaging or offensive behavior.These data suggest that medical students believe that diversity and a climate of inclusiveness and respect are important to a medical school’s educational and clinical care missions. However, according to these students, the institution must embrace a broader definition of diversity, such that all minority groups are valued, including individuals with conservative viewpoints or strong religious beliefs, the poor and uninsured, GLBT individuals, women and non-English speakers. There is widespread agreement in medical education that a diverse student body and faculty enhance the educational experience for medical students. Numerous expert opinions and empiric studies suggest that diversity strengthens the learning environment, improves learning outcomes and helps prepare students to care for an increasingly diverse population-9. ThereWhile there are clear benefits to medical school diversity, the task of improving diversity in medical education is complicated by a variety of financial, legal, educational and recruitment-related challenges. In addition, there is no consensus regarding the best definition of “diversity”. The AAMC and most medical schools agree that race, ethnicity, socioeconomic status, sexual orientation and geography are essential elements of diversity. HoweverIn 2007 the faculty and administration of the University of Colorado School of Medicine (SOM) adopted a broad definition of diversity embracing “race, ethnicity, gender, religion, socioeconomic status, sexual orientation and disability”. The definition of diversity also includes “life experiences, record of service and employment and other talents and personal attributes that can enhance the scholarly and learning environment”. The purWe asked every student enrolled in the doctor of medicine (MD), physical therapy (PT) and child-health associate/physician assistant (CHA/PA) programs at the University of Colorado SOM to complete an online survey about diversity. The SOM is a public medical school within the University of Colorado system.The survey was composed of 24 Likert-scale, short-answer and free-text questions. The majority of the questions were derived from published survey instruments. All que(1) General environment and culture: How do students perceive the climate and culture within and outside the classroom? For example, is the SOM welcoming to people from minority groups? Is it sexist, racist or homophobic?(2) Witnessed negative speech or behaviors: Have students witnessed other students, residents or faculty members make disparaging remarks or engage in offensive or intimidating behaviors toward members of minority groups? If so, which minority groups are most frequently targeted?(3) Diversity and the learning environment: Do students feel that learning is enhanced by having a student body and faculty who represent diverse backgrounds?In addition, the survey contained several demographic questions that asked students to identify their gender, academic program , religious affiliation and racial and ethnic minority status. We also asked students to comment on the perceived effectiveness of a variety of strategies aimed at promoting diversity and inclusiveness, including recruitment of a more diverse faculty, student scholarships, mentoring for minority students, diversity and sensitivity training, workshops and other interventions.For the majority of questions, we asked students whether they agreed or disagreed with a statement . Each statement was followed by four Likert-scale response options, ranging from 1 (“strongly disagree”) to 4 (“strongly agree”). Open-ended prompts asking for examples or more detailed information followed many of the Likert-scale questions.With respect to “witnessed negative speech or behaviors”, we asked students if they had “ever witnessed residents or fellow students make disparaging remarks or engage in offensive, hostile or intimidating behaviors toward members of minority groups”. Seven groups were listed: racial or ethnic minorities; persons with disabilities; women; people with strong religious beliefs; people who speak English as a second language; people of low socioeconomic status; and people who are gay, lesbian, bisexual or transgendered. For each minority group, students responded by choosing one of four options: “no, never”; “yes, on one occasion”; “yes, a few times”; or “yes, frequently”. A similar question addressed disparaging remarks or offensive behaviors made by faculty members. Participants were then asked an open-ended question regarding the setting and nature of the witnessed speech or behaviors.We distributed the online survey between May 21st and June 11th, 2008 to all students enrolled in the School of Medicine’s MD, PT and CHA/PA programs. All students enrolled at the School of Medicine have their email address incorporated into a master email listserv maintained by their respective academic program, and all students on these email lists were contacted by email to participate in the study. A single reminder email was sent one week later. The survey was voluntary and anonymous, and students could leave any question unanswered. The study was approved as exempt by the Colorado Multiple Institutional Review Board prior to data collection (Protocol # 07–0976).We calculated proportions and 95 percent confidence limits (95% CI) to summarize survey responses. We also performed bivariate analyses to test for associations between the experiences, attitudes and observations reported by students and two salient demographic attributes (self-identified gender and membership in a minority group). We measured statistical significance using the chi-square test . To measure the strength of the associations, we calculated odds ratios and 95 percent confidence limits. To facilitate ease of interpretation, we collapsed the ordinal Likert-scale responses into dichotomous categories: “Agree” (which included “strongly agree” and “agree”) and “disagree” (which included “disagree” or “strongly disagree”). For the open-ended questions requiring typed responses, we utilized inductive content analysis, with themes and categories that emerged from the data through careful examination and comparison. We summOf the 852 students eligible for the survey, 261 (31%) participated. Question-specific response rates ranged from 73 to 100 percent. The response rate for students in the MD program was 34 percent, compared with only 12 percent for PT and CHA/PA students.Over half of the participants (58%) were female, and most (87%) were enrolled in the MD program. One hundred ninety-four students (83%) said they were white and non-Hispanic; 20 students (9%) identified themselves as African-American, Hispanic, Native American, Native Alaskan or Hawaiian Native; and 21 students (9%) reported they were members of “another minority group”. Students were asked about their religious affiliation: almost half (48%) reported their religious affiliation as “Christian”; 43 percent reported “no religious affiliation”; and 9 percent said they had a religious affiliation “other than Christian”. Ten students (4%) said they considered themselves members of a minority group due to their sexual orientation.Based on available demographic data from the School of Medicine, there were no significant differences between the survey participants and the student body-at-large with respect to race, ethnicity, or gender. Seventeen percent of survey participants identified themselves as racial or ethnic minorities, compared with 16 percent among all students in the SOM. Women composed 58 percent of participants, compared with 58 percent among all students in the SOM. Hence, survey participants and non-participants do not appear to differ with respect to race, ethnicity or gender.The majority of students “strongly agreed” or “agreed” that the SOM is friendly  and is welcoming to people from minority groups . Smaller percentages of participants “strongly agreed” or “agreed” that the SOM campus is homophobic , racist  or sexist . When asked whether the SOM itself is “diverse”, only 36 percent (95% CI 30 to 42) of participants agreed. There were no significant differences between the responses of minority and non-minority students with one notable exception. Students who identified themselves as a minority due to their sexual orientation were much more likely to agree that the SOM was “homophobic”, when compared with students who did not identify with this minority group .With respect to offensive, hostile or intimidating remarks or behaviors made by fellow students or residents, participants reported witnessing incidents targeting each of the seven minority groups listed Table . “PeopleWhen students were asked to state whether they had witnessed incidents perpetrated by faculty members, positive responses were far less common Table . But as The open-ended responses revealed a similar theme. According to the free-text descriptions and examples provided by the students, individuals demonstrating “strong religious faith or conservative values” were the most common targets of disparaging remarks Figure . Forty-tThe following is a list of representative comments from an open-ended prompt asking students to clarify the nature and setting of witnessed negative remarks and behaviors toward minorities. The selected comments are from the four thematic areas most often discussed by students.It is disrespectful to imply that belief in a higher being or creator is ignorant, especially when there are many prominent scientists who share such beliefs. I would like to think that by the time we are in medical school, lecturers would respect the fact that there are people who disagree with them and not feel the need to use their platform as a soapbox for disparaging those whose religious or political views may differ from their own.One professor in first year drew a blastocyst on the board and erased it. Then he suddenly covered his head as if to protect himself and said, “Uh-oh, the anti-abortionists are going to hurt me for erasing that”.The remarks that have been the most personally disturbing to me have been the complete lack of respect towards people who have religious beliefs of any kind…VA and [community hospital] patients have become synonymous with “low-income”, “substance-abusing”, “non-compliant”, “resource-depleting”, “unappreciative” and, to a lesser extent, “undeserving”. This sentiment is pervasive.There are general comments about a patient with a certain pathology, and residents and attendings will comment something like "I'll bet they don't have insurance" or "This one's on the hospital" or something like that - without knowing anything about the patient.Sometimes it seems that people with low incomes do not have the right to complain, because they don’t pay for their care.Comments regarding women, such as “how much easier is for them to get into medical school” and “how they won’t work full-time anyway”.I was once on a service that had a daily rating scale going of which female on the [floor] had the best [physical appearance].One comment made by an elderly male attending was directed to the two female students on the team ---- “this field is not ideal for women because we take time off to have babies”.Many of the professors get the terms "sex" and "gender" confused. During one lecture…a professor made some comments that were very, very insensitive to transgendered individuals.Our school’s [diversity] efforts are so focused on racial and ethnic minorities that other aspects of diversity are being excluded. This is especially true for GLBTI issues.Students were asked whether they believed their learning was “enhanced by having students and faculty who represent diverse backgrounds”. Almost all (90%) “strongly agreed” or “agreed”. There was no significant difference between the responses of self-identified minority students as compared with non-minorities .The final series of questions asked students to comment on the school’s diversity climate and to offer recommendations for programmatic improvement. The majority of participants spoke positively about ongoing diversity efforts and the current diversity climate. At the same time, some students offered more critical comments, many asserting that the school’s diversity definition was too narrow. These students argued that demographic characteristics, including race, ethnicity and gender, should be replaced or augmented by characteristics such as life experiences, political and social ideologies, values, family structure and socioeconomic status. For example, one student wrote “the SOM should define diversity based on socio-economic status and history, rather than…race and ethnicity. Those [attributes] are not a true representation of students’ pasts, presents and futures”. Another wrote, “rather than singling individuals out because of race, religion, sexual preference or gender, the SOM ought to promote a climate of acceptance towards all beliefs --- this means creating a culture that does not promote one political or religious view over another”. Some students were also unhappy with the School’s continued focus on what they perceived to be targeted recruitment of racial and ethnic minorities; a few students referred to such programs as “quotas” or “affirmative action”. Students highlighted the importance of pipeline programs in high schools and colleges as the most effective way to recruit underrepresented minorities into the health professions. Students also reported that GLBT issues were not addressed adequately in the curriculum or during public forums about diversity.In this survey we sought to assess the diversity climate at one medical school, from the student body’s point of view. The results suggest that the majority of MD, PT and PA students perceive the medical school campus to be friendly and welcoming to minority groups. Furthermore, the vast majority of students believe that learning is enhanced by a diverse student body and faculty. At the same time, less than 40 percent of students view their own campus as diverse.Students also reported that they frequently hear disparaging remarks or witness offensive behaviors targeting minority groups. These incidents occur in classroom, small group and clinical settings. Survey participants were 2–3 times more likely to witness offensive behaviors perpetrated by fellow students or residents than by faculty members. We were surprised to learn that individuals holding or expressing strong, even fundamentalist, religious beliefs and conservative political values are most often targeted during these incidents. This finding highlighted a potential minority group and source of diversity not previously considered in the working definition of diversity at the School of Medicine. Other groups frequently targeted include people of low socioeconomic status, non-EngWhile the results of this survey offer important insights into student perceptions of diversity and inclusiveness, there are several important limitations. First, the survey was conducted at a single public medical school (in a Western state), which may limit the generalizability of the results. Second, the survey was voluntary, and the response rate was 31 percent. While survey participants and non-participants did not differ with respect to race, ethnicity or gender, participants may differ from non-participants with respect to their views on diversity and the campus climate. We cannot assess the magnitude or direction of any non-participation bias. Nonetheless, when the survey results were presented to the student body in large group settings, there was a general consensus, by a show of hands, that the survey results were representative of student experiences at the medical school. Moreover, in the context of the diversity climate at medical schools, our novel finding that individuals with strong religious beliefs and conservative political values are often targets of biased behavior is significant irrespective of the response rate, as it is the first time this has ever been reported in any quantitative or qualitative fashion. A third limitation is the relatively small sample. Although the overall sample size (n = 261) allowed us to summarize responses with adequate precision, some subgroup comparisons  were not possible due to small sample sizes. Fourth, the survey data do not permit calculation of true rates. For example, our data suggest that that 12 percent of participants report witnessing faculty make disparaging remarks or engage in offensive behaviors toward people who speak English as a second language at least once in the past year. However, we have no information about true “denominators” --- that is the number of encounters between the survey participant and the faculty member, or the number of witnessed encounters between the faculty member and people who speak English as a second language, whether positive or negative.Three recommendations emerge from these data. First, medical schools should consider adopting a broader definition of diversity, one that includes religious and spiritual values and political beliefs. Medical schools should be vigilant in ensuring that students with strong religious beliefs and conservative political views are respected. According to the data from this study, the diversity definition must also include women, members of the GLBT community, non-English speakers, the uninsured and the poor. Second, medical school diversity climate surveys should include questions about tolerance and respect for individuals holding strong religious beliefs and conservative social and political values. Third, our study found that students, residents and faculty were all involved; therefore, diversity awareness and training programs must include all members of a medical school’s learning community.At our institution, the results of this climate survey have been shared with the MD student body, department chairs and faculty senate, and also with the leaders of the undergraduate medical curriculum and the residency program directors. Initially, some faculty members expressed concerns that a focus on recognizing conservative beliefs, spirituality and religious values could be used to mandate curricular changes --- for example, forcing a reconsideration of topics such as immunization, reproductive health or even evolution. Ultimately, the vast majority of faculty members understood that students were not calling for changes in lecture topics or how science is presented; rather, the message of the survey was that students holding differing political or religious views should always be treated with respect. Students and faculty members also heard about the importance of respectful treatment of individuals from racial or ethnic minority groups, the GLBT community, and women and respectful treatment of patients and other individuals who do not speak English or who are poor or uninsured. Faculty members who heard these results appeared to gain a greater appreciation of this broader definition of diversity, as seen through their students’ eyes.The medical school has taken several actions since the survey results were released. First, the School’s Diversity Mission Statement and the teacher-learner contract, a document that outlines the expectations and shared responsibilities of students and teachers, were modified to include respect for “political values and beliefs”. In addition, the following statement was added to both documents: “In all educational, research and clinical care settings, the school will welcome and respect all religious, spiritual and political beliefs and will welcome and respect patients and others who are poor, disadvantaged, uninsured or non-English speaking”. Lastly, the medical school has developed an anonymous and confidential online professionalism reporting system that will permit students to report incidents of exemplary or poor professional behavior by residents or faculty. Taken together, these three changes signify a renewed commitment to improving the campus diversity climate and ensuring a safe and vibrant learning environment for all students.This study, though limited by a low response rate, supports previously published studies indicating that diversity climate issues exist at American medical schools. Our data also highlight that individuals with conservative religious and political views are often targets of disparaging remarks and offensive behaviors. This is a novel finding. Lastly, our study emphasizes the importance of assessing a medical school’s climate and working definition of diversity from a student body perspective.The authors declare that they have no competing interests.JD designed the survey instrument, collected survey data, aided in data analysis and drafted the manuscript. LC aided in survey design, data analysis and interpretation. MV performed the statistical analysis and aided in drafting the manuscript. SL conceived of the study, aided in survey design and data collection, conducted the data analysis and aided in drafting the manuscript. All authors read, edited and approved the final manuscript.


A commentary onToward an integrative account of social cognition: marrying theory of mind and interactionism to study the interplay of Type 1 and Type 2 processesby Bohl, V., and van den Bos, W. (2012). Front. Hum. Neurosci. 6:274. doi: 10.3389/fnhum.2012.00274Bohl and van den Bos  sketch anecessity of including interactive factors in at least some forms of social understanding, and, as a consequence, for the insufficiency of mindreading to account for all of social cognition. But the authors misinterpret our position. They suggest that it implies the sufficiency of interactive factors for explaining all of social understanding and, therefore, the non-necessity of mindreading in any particular case of social cognition. Overlooking the caveat “in some cases” in this quote “[…] we can conceive of interaction dynamics as, in some cases, delivering the necessary cognitive performance” . In effect, they make universal a claim about particulars. In our view, they suggest, everything reduces to a monopolizing strategy (understanding interactions) and individual factors, including reasoning about others, are only secondary.Here, we clarify that what the authors describe as “interactionism”—and attribute in its radical form to us—is, in important ways, different from the enactive approach we defend. We argue for the This misperception may result from a “contrast effect” whereby after staring into the dark for too long new shades of gray are initially seen as blinding white.Social interaction is a coupling between two or more autonomous agents that is co-regulated by the interactors  and the resulting relational dynamics acquires a form of autonomy , as noted by the authors (p. 8). And deliberative Type 2 processes that are not involved in the performance of mindreading can still occur in interactions: for instance, when two people try to solve a maths problem together. Such processes can constrain the interaction dynamics and influence how interaction affects mutual understanding.We therefore understand the proposal as an analogy (case 2) that calls for similar methodologies as those used in researching Type1/Type2 processes.However, the proposal must not amount to an uncritical combination of two approaches. A theory of intersubjectivity should address issues like: what are the underlying principles that relate skilful interaction and individual sense-making of others? What neural/bodily mechanisms are involved in each or indeed shared? Is there a developmental “flow” between skilful interactive and individual sense-making capabilities? Is it a two-way flow? How much do the two “types” interpenetrate, not just developmentally but in the enaction of social understanding? Can they always (ever?) be described as distinct in principled ways?Like other hybrid approaches in cognitive science and biology , the proposal must avoid certain pitfalls. One is the risk of reifying the descriptive elements (Types 1 and 2). Another is to take the distinction between them as clear-cut, foregoing considerations of how they interpenetrate. A hybrid approach can also lead to explanations based on “contributions” (“a performance is 80% interactive and 20% mindreading”). This strategy is weak in the long term. And in general, there is a risk of adding epi-cycles when arguably what the field needs is a Copernican shift.not thereby hold true its exact opposite . The enactive stance attempts to supersede such a dichotomy. In that sense, the motivations of the authors are aligned with those of enactivism.We applaud the authors for recognizing interaction as important. But we don't think dichotomous frameworks can achieve long-term theoretical integration. Hence our clarifications: enactivists already do not think that all that matters happens only in interaction. We criticize methodological individualism but do


Many of India’s estimated 40 million migrant workers in the construction industry migrate with their children. Though India is undergoing rapid economic growth, numerous child protection issues remain. Migrant workers and their children face serious threats to their health, safety, and well-being. We examined risk and protective factors influencing the basic rights and protections of children and families living and working at a construction site outside Delhi.Using case study methods and a rights-based model of child protection, the SAFE model, we triangulated data from in-depth interviews with stakeholders on and near the site ; 14 participants, interviews with child protection and corporate policy experts in greater Delhi (8 participants), and focus group discussions (FGD) with workers  and their children .Analyses illuminated complex and interrelated stressors characterizing the health and well-being of migrant workers and their children in urban settings. These included limited access to healthcare, few educational opportunities, piecemeal wages, and unsafe or unsanitary living and working conditions. Analyses also identified both protective and potentially dangerous survival strategies, such as child labor, undertaken by migrant families in the face of these challenges.By exploring the risks faced by migrant workers and their children in the urban construction industry in India, we illustrate the alarming implications for their health, safety, livelihoods, and development. Our findings, illuminated through the SAFE model, call attention to the need for enhanced systems of corporate and government accountability as well as the implementation of holistic child-focused and child-friendly policies and programs in order to ensure the rights and protection of this hyper-mobile, and often invisible, population. In India, there are an estimated 40 million migrant laborers in the construction industry , who togMigrants worldwide comprise a heterogeneous population that includes more than 214 million international and 740 million internal migrants . There iMigration has implications for family well-being, including the safety, development, and education of children of migrant workers. Parental absence and struggle for survival have been tied to harmful socio-emotional impacts on children left behind -28. WithThe drivers and consequences of labor migration in India are as diverse as its regions and peoples . While rCyclical migration has long been an important livelihood strategy for the rural poor of India ,45. SeasThe impact of migration on families and communities varies. While longitudinal field studies in India indicate improved wages and income among migrants over time ,48,51, tAn emerging body of literature documents numerous threats to the health and well-being of migrant children in India, including poor living conditions -5,54, frSafety/freedom from harm; Access to basic physiological needs and healthcare; Family and connection to others; Education and economic security  [t]he ones who have some problem or are suffering would come here”. Most laborers and families came to the construction site through jamadars or thekedars from their village, middlemen hired by contractors to sort out logistics related to recruitment, transport, and, in some cases, on-site accommodation. Others arrived through previously migrated family members or through direct company recruitment. A number of respondents had recently migrated for the first or second time: “It’s been five days since I arrived here. I have just come from home. Earlier when I was here, I stayed for nine months”. . Many had spent years in pardes, moving from work site to work site, often in association with the same company. As one male worker described, “We came here and have stayed here since 1995. And we used to go to our native place and come back. I go once or twice in a year to my village. Again, I come to join the same construction firm” (age 55). Citing the costs and risks associated with travel, many migrants would visit the village infrequently. One group of male laborers referred to as “Malda workers” work on short-term, 50-day contracts, which permit them to pay off small debts, work in their agricultural “off season”, and return home  to their families and land regularly. No indication of forced labor, coercion, or human trafficking emerged from our observations or discussions with children and adults.The laborers, many from the rural areas of distant states such as Bihar and West Bengal . One mother explained, “We have three children two boys and one girl. We have a house that is made up of mud that is falling down. With the thought to re-build our house and to educate my children we have come here” (age 25). Another described how her family was compelled to migrate, “I do not have fields, and there are no rains. In the village, we were dying from hunger and thirst, so we have left children there and have come only with one son to work here on this site”. (age 30). Still, others cited their intent to help secure a better life for their children. A female migrant (age 22) explained, “We are poor. We are taking care of, raising our children … to make them move forward, we are earning money. If we educate our children, we will make them into something”. All of the women in our focus groups were parents; two-thirds of these mothers had children living with them and their husbands on the site, nearly half of whom also had children living with grandparents in the village.Frequently cited drivers for migration included the opportunity to “earn and eat”, family indebtedness, limited land ownership, and poor fertility of land in villages. Laborers shared stories of migration to meet basic needs for their families: “Parents must warn children that this is an unsafe area”. Large machinery, moving vehicles, and precariously-situated construction materials were ever-present on the site. Children, in particular, expressed worry about their parents’ safety. They recalled incidents that had occurred at other sites where children or workers had been severely hurt or killed, resulting in a preoccupation with the safety of their parents: “When people work in this site … [they] climb from a rope … then they fall, then people die”, said a girl, age 8. In fact, between July 2010 and January 2011, two workers had died in falls on the worksite.Displayed prominently at the entrance of the construction site was a sign that read, “jhuggis, made of either corrugated tin or brick and mortar. During the course of our fieldwork, entire portions of the housing area were destroyed and moved due to expanding construction on the site. Many families spent their day off rebuilding or tending to their shelters, a time-consuming and labor-intensive task. While the site manager cited the danger electricity would pose in the tin jhuggis, the lack of electricity for fans or other cooling systems proved especially burdensome and potentially dangerous given high humidity and temperatures exceeding 100°F in the summer months: “Poor people come from far off and feel so hot here. We stay inside and are drenched in sweat, but still they do not provide us with any electricity…” . To cope with the extreme heat, particularly when the crèche was closed, children would spend time in half-built, multi-story towers where, as one boy (age 12) put it, “winds … [give] people a calm and cool situation”. Unsupervised, they were placed at risk of falling from the towers or being injured.Workers and their families lived in cramped, temporary structures, termed jhuggis, and lack of open space. One girl (age 7) insisted, “Everyone, boys and girls, says it is better back home”. Although workers were generally satisfied with the availability of clean water, some reported conflicts over communal pipelines. Food was also readily available near the site; however, given their lack of access to ration cards and the high price of food around Delhi, some migrants struggled to afford food and needed to purchase it from the grocery shop owner, or lala, on credit. Sanitation at the site was observed to be poor, with latrines that were often full and seldom cleaned. The lack of separate facilities for men and women was distressing for female workers. Despite these various concerns, the multiple layers of accountability and relative powerlessness of workers meant change was unlikely; as one man (age 55) lamented, “We cannot do anything. If we will ask, we will be kicked out of this place”.The quality and availability of basic amenities, including housing, access to drinking water, affordable food, and proper sanitation were also of primary concern to participants. Many children expressed nostalgia for their village life, citing the heat, cramped [n]othing for the children” and that “the facilities are only for the workers”. Conversely, a supervisor for a sub-contractor claimed that their facilities were available to both workers and their families. Options for workers themselves were also limited as employers only took responsibility for provision of, transportation to, and payment for care related to work place injury or illness. Basic first aid was provided on the construction site and in the crèche, and an ambulance was reportedly available around the clock. However, in case of off-duty health problems among workers or of more serious injuries or illnesses among children, workers and families had to seek off-site care and pay out of pocket. Informed choice of providers was uncommon, and many participants reported going to informal practitioners of herbal and other alternative medicine as well as unlicensed providers without any medical background in the nearby market. One female worker (age 25) lamented, “Here there are doctors, some are good and some are bad … there is no fixed doctor, so what do we do? [When we’re] in trouble, we have to go back to our village”. Primary care services, such as adult health screening, mental health services, and chronic disease management, did not appear readily available.Many migrate to a worksite in hopes of improving family well-being; yet the health challenges they encounter in pursuing this survival strategy may put children and families at further peril. Respondents familiar with the site described health issues ranging from water-borne and other infectious diseases to heat-exhaustion, dehydration and other work-related problems. Unresolved malnutrition and anemia were both common among children . While tIf [the doctor] gives us two injections, it costs us Rs.200 [$4.45 USD]. We are already in so much debt, and if we are not well, how would we go to work?” Missed work meant lost wages for ill workers, posing additional risk to their families. To save time, many visited private hospitals rather than seek the largely free services at a government hospital, which was reportedly farther away. By law, the contractors are responsible for covering costs of work-related injuries; however, as a manager with the development company admitted, “…not everyone gets to take advantage of the contractor all risk policy because migrants are … a floating population and are not necessarily recognized by the contractor”. Similarly, due to barriers to registering as local labor welfare board beneficiaries or obtaining documentation of Below Poverty Line (BPL) status, very few workers had access to locally-implemented health insurance schemes intended to provide financial assistance for hospitalizations and chronic care. Thus, in the face of high healthcare costs, workers often turned to their jamadars or thekadars for loans and accompaniment to medical care, adding potentially substantial debt which could force them to extend their work or contract periods.The costs of paying for healthcare, medications, and other associated expenses (e.g. transportation) were a resounding concern among workers. As one woman (age 35) explained, “I saw that earlier young girls [migrated] with their parents, but many crimes occurred like assault … When they went back to their village, they talked about these problems, and awareness increased. Now they leave their young girls at their home”. Issues of family conflict arose infrequently in focus groups and interviews. However, the use of alcohol, and cramped living spaces, were both mentioned as linked to domestic and intimate partner violence. A local teacher, who noted that children were at times reluctant to go home due to violence, reflected on these factors: “Society demands certain things from kids, and parents have zero economic power. Sometimes they beat kids and women when children ask for their needs to be met”. Child labor was also a seldom-raised topic, but in addition to the adolescent Malda workers and a few teenage children working on the site with their parents, a number of children worked at the worksite canteen, businesses in the nearby market, and in rag-picking in exchange for food and shelter. These children were some of the most vulnerable in this site. We were unable to interview these children and adolescents without being observed by their supervisors and were unable to obtain parental consent given limited information about their family members.Construction work meant that many parents were spending long hours without direct capacity to monitor their young children at the site, which became additionally challenging without the presence of extended family. The existence of a functioning crèche at the site greatly mitigated some of the risks due to parental inability to monitor their children. According to both male and female laborers, sexual violence was of diminishing concern. This may be linked to a trend towards leaving school age girls with extended family in the village. One crèche staff member reflected on this survival strategy: “jhuggis, a generally poor study environment at home, inability to afford or access tutors, as well as domestic responsibilities that led to school absenteeism. As a local teacher at a private school observed, “Our kids who are migrants, they really struggle. They have a really difficult time because they compare themselves to [non-migrant] kids”. These prevailing concerns around education were tied to most parents’ decision to leave their school-aged children (particularly girls) with extended family in the village, allowing uninterrupted schooling. As one man (age 35) asserted, “We cannot keep our children here; otherwise their education will spoil”. Not surprisingly, most school-age children on the site were not in school. Apparently having no other safe place to go, many spent their days in the crèche.Children at the site faced numerous barriers to education and learning due to issues of distance, expense, lack of documentation, and frequent movement. A few older boys and one girl were able to attend a nearby private school due to reduced-payment options that were offered for children of migrant workers. However, the nearest government school was far away and across a busy highway. While a few children did attend, responses suggested it was too dangerous to access for many children at this site, thus impeding their right to universal primary education . Speakindo not express concern over wages”, construction workers told a story of working extended hours for low, piecemeal wages and having only every other Sunday off. Malda workers instead received payment in advance of their 50-day contract period and had no days off. Many workers claimed that payments for piecemeal work and other wages could be delayed, even for months, although not universally reported. However, workers did commonly describe an improvement in wages and financial circumstances relative to opportunities in the village. Nonetheless, many workers, particularly unskilled laborers, were still struggling to provide for their families, much less to save earnings. As one mother (age 35) explained, “We have to take care of the whole family; we came here to save money. If he would increase the rate, we would save a little. The amount we earn goes to eating”. In response to these difficulties, delayed payments, and other unexpected costs, respondents reported borrowing money from family, friends, coworkers, or their jamadars or thekadars. Parents also worked overtime to provide for and meet the basic needs of their families. In contrast to other sites, where participants described that women are generally subject to reprimands and deductions in wages for breastfeeding, this site was notably sensitive to the needs of breastfeeding mothers, and women did not report difficulty feeding their infants. Yet, given that the law allows only two nursing breaks per day The Maternity Benefits Act,  such a service or facility, where would we have left our children? Children would come after us to the site … How would we earn our livelihood then?” The crèche provided basic health care services and regular doctor visits , meals to children during the day, and informational sessions for parents on issues like school enrollment. Although not designed to replace school, it also provided younger children an opportunity to develop cognitive, motor, and language skills as well as classroom discipline important for school readiness. The crèche also served to free older siblings from the task of childrearing. The crèche was a safe, child-friendly haven in an otherwise harsh physical environment, in utter contrast to most construction sites, where, as one key informant described, “the young child is invariably either left alone, unattended, or in the care of siblings … [and] the implications for a child’s development can easily be gauged”. The NGO also worked to mainstream older children into local schools and to encourage provision of basic amenities at this site.The crèche also served a protective role that had broader implications for families. One of its primary functions was to provide a safe and caring environment for children during the day, allowing both mothers and fathers to work. As one mother (age 22) noted, “Our key informants from government agencies and non-governmental organizations reflected upon a scenario in which vulnerable and hyper-mobile migrant families are surrounded by the complex layers of accountability of a rapidly expanding Indian economy. Grappling with the confluence of challenges facing migrant workers and their children, our respondents emphasized the obligations of local and national governments as well as corporations towards the fulfillment of the rights of this marginalized and often “invisible” population.I would describe this as compounding vulnerabilities … Indeed, the caste system is there; there are other minority groups that are discriminated against too. For example, some Muslim communities – many of them are what we call “backwards” [per the “Other Backward Classes” classification]. There are absolutely no opportunities for these people; they have no hope for the future and are therefore quite vulnerable”. Another respondent from a child protection NGO saw migration as leveling the playing field of vulnerability across castes: “Once they come here, the vulnerabilities are quite the same for them as migrants … Except that of economic status – may be able to afford services … Looking at similar economic standard with people migrating, the vulnerabilities are very similar”.As described in the Indian labor migration literature, our key informants discussed the overlapping factors that both drive already vulnerable families towards migrant labor and make them more vulnerable in the process. One labor expert highlighted the role of discrimination and lack of economic opportunity: “We have very bright children who study in the village but who have migrated or have shifted schools four or five times a year, and they are in an inappropriate class because they have missed so much. And there is no scope for them to ever get on with the education and ever do anything but manual work in the future”. Furthermore, though Indian policy prohibits requiring children to present birth or transfer certificates in order to access a new school Right of Children to Free and Compulsory Education Act,  dialog and information-sharing with subcontractors, with children and families, about their legal right for safety and fair treatment”. Another respondent argued against use of the term “corporate social responsibility”, remarking, “If they would just follow the law, that would be fine”.In order to improve accountability and uphold existing policy, local experts offered various suggestions, including: maximizing interstate coordination; developing memoranda of understanding among development stakeholders with a monitoring agency; granting corporate and government contracts to builders only upon provision of required services (e.g. crèche); and empowering and educating workers and children to advocate for their rights. As one key informant advised, “Safety); limited access to appropriate medical care as well as risks of malnutrition ; reduced parental monitoring, family separation, and trade-offs between time with children and the need to work (Family connection); and limited school access for school-age children as well as a tenuous economic state (Education/Economic Security). These basic security domains were also interrelated and interdependent. In general, as explained by Orellana and colleagues, migrating “families who are pressed for household survival do not have the luxury to foreground children’s ‘developmental needs’” . Despite these laws and efforts like India’s Unique Identification Card pilot project, obtaining such documentation is often a challenge due to migrants’ transitory status and short-term residency. This lack of documentation impedes access to various basic services at migrants’ destination, including food rations and children’s education. While India’s Right of Children to Free and Compulsory Education Act  dictatesWhile responsibility for providing services and protections is delineated in law and policy, lack of enforcement leaves many corporations shirking responsibility for providing for their workers and their families. For example, the BOCWA describes responsibilities for construction project employers , to provide drinking water, latrines and urinals, accommodations, first aid, canteens, and other services to mothers and their families. With accountability diffused so broadly across different stakeholders at the study construction site, viewpoints expressed across various layers of management were at best disconnected from and at worst disingenuously ignorant of the daily realities of migrant workers and their families. However, while there is also the requirement for provision of childcare for children under six at sites with more than 50 women, this task is not explicitly assigned to the employer nor is it enforced. In the site where the present case study was situated, the crèche played a fundamental role in nurturing child development and monitoring child safety and nutrition. Sector-wide provision of such services, implemented by corporate actors in partnership with local governments, would fill a critical void in the rights of migrant children, with long-term benefits to their health and capability -78.Clearly, the government plays a crucial role in delineating the obligations of corporations, ensuring these obligations are met, and shaping policy that affects migrant families. Using the IMWA and BOCWA as well as myriad other broader labor policies as guidelines, each state’s labor welfare board has flexibility to implement their own rules and local schemes. For instance, the local labor welfare board near our case study site recently announced, though has yet to implement, a school transportation scheme for children of construction workers. Similarly, large sums of funds collected from corporations according to the Building and Other Construction Workers’ Welfare Cess Act  have yetMoreover, the Government of India has developed cross-sectoral efforts and government-civil society partnerships to protect children from maltreatment and exploitation, such as the newly implemented Integrated Child Protection Scheme (ICPS). With explicit mention of children of migrant families, this policy aims to “create a protective environment by improving regulatory frameworks, strengthening structures and professional capacities at national, state, and district levels so as to cover all child protection issues and provide child friendly services at all levels” . The ICPThis study intended to capture an in-depth understanding of the complex dynamics facing migrant families in one construction site in India. While the analysis was successful in this regard, several limitations should be acknowledged. First, the use of a case study methodology limits our ability to generalize to other construction sites locally or nationally in India. While the external validity of the study is limited in this manner, the internal validity of our qualitative approach was bolstered by the inclusion of a range of stakeholders as well as the triangulation of key informant interviews, focus groups, observations, and document review. Along this same theme, our study focused on the status of children and families living and working on the construction site with minimal probing regarding the children left at home in the village. These children may face yet uncovered and significant health and protection risks; more research focused on these populations is required. Second, the existence of a crèche at the site studied allowed us to gain access to the site and our participants, but may also have successfully mitigated the intensity of some of the child protection threats that might be present in sites without a crèche. We would hypothesize that a site managed by a developer receptive to providing a crèche, such as the one used in this study, might generally be more child-, family-, and worker-friendly than those sites that do not have a crèche. However, despite an estimated 40 million migrant laborers in India’s construction industry alone, the law requiring crèches at construction sites is rarely implemented, and most sites would likely paint a much worse picture. Finally, though various techniques in data collection and analysis were utilized to minimize biased responses , the sensitive nature of focus group discussions and the relative powerlessness of migrant workers may have limited the sensitivity for uncovering the full depth of adversity faced by families on the site. Nonetheless, our discussions with workers and their children yielded a substantial variety of child protection issues and related coping mechanisms, which did not vary significantly by respondent.As the Indian economy continues to expand and urbanize, labor migration will undoubtedly continue as a mode of subsistence or survival among rural families. Through analyses using the SAFE model of children's security, this study provides a lens for viewing the constraints faced by migrant children and families who undertake a broader array of survival strategies to cope with their circumstances. It demonstrates the feasibility and utility of taking this holistic and human rights-based approach to child protection analyses. In light of the complex conditions facing this hyper-mobile population, findings suggest policymakers, corporations, and civil society must work to develop initiatives to implement and enforce the rights of migrant workers and their children to identity, family, health, safety, development, education and economic security. The Government of India is certainly legally bound by the Convention on the Rights of the Child to protect these rights for all children, without discrimination based on gender, caste, or other status . CorporaThe authors declare that they have no competing interests.TSB conceived of the study and participated in its design and coordination along with TW and AS. TW and AS conducted the primary qualitative fieldwork. TSB, ND, and AS conducted the validity-enhancing member checks. All authors, including SK, contributed to the qualitative data analysis and helped draft and finalize the manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/13/858/prepub