bluuebunny/crossref_metadata_2025 huggingface dataset:
PRECISION ATTAINED
Authors: Betts Jonathan
Published: June 2023

With a standard chronometer established in use, the world’s navies were supplied with British chronometers for most of this period, but with rival manufactures in Switzerland (Ulysse Nardin), Germany, and the United States (Hamilton) developing in its closing decades. Some of the many innovations made to improve the standard machine, in particular in its temperature compensation, and the testing and rating of machines is described. Astronomical regulators changed little for most of the nineteenth century, but with the development of ‘free pendulums’, electric drive, vacuum environments, and metals with low thermal coefficients, such as Invar and Elinvar, were spectacularly improved in the early twentieth century before being replaced by atomic clocks.
RESPONDING TO CUSTOMER DEMAND
Authors: Cardinal Catherine
Published: June 2023

This wide-ranging survey explores the decoration of clocks and watches in the stylistic context of different periods. It links the decoration and embellishment of watches to those prevalent for the decoration of other small objects of personal use, and those of clocks to architectural trends. The chapter then examines the use of different materials, including gold, silver, jewels, and enamel, as well as engraving. It then discusses the important part played by the use of pattern books, and describes in detail the growth in importance of the concept of ‘design’ in twentieth-century production.
KEEPING CLOCKS AND WATCHES
Authors: Betts Jonathan
Published: June 2023

This chapter underlines the importance of repairing and maintenance of clocks and watches in the history of horology, a subject very little studied until now. It discusses the role of the activity in the economic life of horologists, as well as several of the methods used across the centuries, and the difficulties involved. It discusses the question of lubrification in detail. It covers the deontology of clock and watch restoration in the twentieth century. In conclusion, it then outlines the manner in which this practice has developed in the context of wider considerations of the conservation of art and archaeological objects.
ACCESSORIES IN HOROLOGY
Authors: Fallet Estelle
Published: June 2023

This chapter provides a wide-ranging survey of all the items ancillary to the mechanism of a clock or watch—cases, pendants, chains, chatelaines, attachments, keys—its marketing—presentation cases, display cases, packaging—and its protection—outer cases, watch stands. The role and changing styles of these items are discussed
THE LITERATURE OF HOROLOGY
Authors: Huber Bernhard
Published: June 2023

This chapter provides a survey of the primary literature of horology in its fullness from the fifteenth to the twentieth centuries. It covers literature for both sundials and mechanical horology. Particular attention is paid to professional journals, to trade literature, and to repairers manuals, as well as advertisements and consumer catalogues.
The (Positive) Complementarity Turn in International Criminal Justice
Authors: Labuda Patryk I.
Published: June 2023

This chapter explains the origins of today’s emphasis on domestic accountability in international criminal law and its rhetorical association with complementarity. It traces the ascendancy of (positive) complementarity as a vocabulary of global governance before introducing the book’s tripartite analytical framework—accommodation, iteration, and isolation—for analysing tribunal–state relations. The chapter ends with the ideational implications of prioritizing state-driven accountability and embracing the language of positive complementarity for the evolving justifications of international criminal law. It suggests that the turn to complementarity may epitomize deeper transformations in the discipline which has evolved from a counter-hegemonic to a statebuilding project.
In the Court’s Shadow
Authors: Labuda Patryk I.
Published: June 2023

Against the backdrop of the (positive) complementarity turn, this chapter examines trends in the field of international criminal justice and offers lessons to guide the design of future international criminal tribunals. It analyses the turn from ‘coercive’ and ‘top-down’ intervention to ‘cooperative’ and ‘bottom-up’ rule-of-law strategies and the phenomenon of ‘unintended diversionary complementarity’, where states nominally appropriate international norms but systematic crimes committed by incumbent government actors go unpunished. After identifying three intervening factors in tribunal–state relations—temporal constraints, intrastate politics, and prosecutorial leadership—the chapter turns to reforms that can be implemented at the International Criminal Court to avoid complementarity’s authoritarian shadow and enhance the enforcement of international criminal law in an increasingly illiberal political climate.
EpilogueInterrogating the Ideology of (Positive) Complementarity: Should the Future of International Criminal Justice Be Domestic?
Authors: Labuda Patryk I.
Published: June 2023

The Epilogue considers the wider implications of the rise of domestic accountability in international criminal law. It argues that the vocabulary of (positive) complementarity has revolutionized how civil society, scholars, states, and tribunals think, talk, and act in regard to serious crimes. Altering the imaginary of international criminal law stakeholders, complementarity’s emphasis on the domestic sphere has evolved into an ideology extending beyond the ICC with the turn away from international to domestic trials transforming the ontology of international criminal law from a counter-hegemonic project to a consent-based statebuilding enterprise geared to consolidating the authority of governments and directed against non-state actors.
The Role of Creativity in Granting and Limiting Trademark Rights
Authors: Fromer Jeanne C.
Published: June 2023

This chapter explores the role of creativity in trademark law’s grant and limitation of rights. Trademark law—unlike patent and copyright law, its intellectual property cousins—is not structured to reward creators for producing particular content. That is unsurprising because trademark law and theory is significantly different than that of patent and copyright. As the U.S. Supreme Court has remarked, trademark law was “not designed to protect originality or creativity,” while patent and copyright law were. Nonetheless, there are critical ways in which trademark law, like patent and copyright law, seeks to encourage creative activity, even without directly rewarding marks’ creators. At the same time, trademark law discourages certain types of activity thought to lack creativity, which are deemed to be less deserving of protection. This underappreciated current of incentive to be creative in certain ways courses through trademark law in ways that complement trademark law’s basic purposes. At the same time, however, trademark law has a particular vision of creativity that might or might not align with society’s. In addition, the law’s drive to reward creativity has also paradoxically helped justify its expansion in certain ways unmoored from core trademark theory.
Limitations on Pharmaceutical Trade Marks in Britain in the Twentieth Century
Authors: Bently Lionel
Published: June 2023

The story of the treatment of pharmaceutical trademarks in twentieth-century Britain highlights that not all trademarks function in the same way; the linguistic, cultural, scientific, and commercial context may matter. The specific context may enhance the costs of trademarks and limit their social benefits, or reinforce their value, with costs and benefits changing over time. While international law governing trademarks may require that the goods or services are not to be an obstacle to registration as trademarks, some of the social disadvantages in the way trademarks operate in different contexts can be accommodated through limitations. The story also highlights that limitations on the practical impact of the legal protection of trade marks may be found outside, as well as within, trademark laws. The emasculation of pharmaceutical trademarks was achieved piece by piece, through the construction of a system of generic nomenclature, the establishment of governmental controls over product quality, through education and incentivization of doctors, and has been driven by a persistent government interest in minimizing the cost of health care.
Corruption and Global Justice
Authors: Brock Gillian
Published: June 2023

Corruption is a pervasive problem across the world and is regularly ranked as among the greatest global challenges. Furthermore, considering the role that corruption plays in exacerbating deprivation and fueling social tension, peaceful and just societies are unlikely to come about without tackling corruption. Addressing corruption should be a high priority for those concerned with poverty eradication, peace, security, and justice. Yet, curiously, corruption has not yet been the focus of any books by philosophers working on global justice topics. This book does so. The book offers a normatively justified account of how to allocate responsibilities for addressing corruption across the many agents who can and should play a role. In order to know who should take responsibility and how they should do so, we need to understand multiple forms of corruption, the corruption risks associated with various activities, the interventions that tackle corruption effectively, and current policy and legal frameworks in place for addressing corruption, all topics covered in the book. In addition, the book offers a new framework for navigating responsibility to address injustice, one that is action-oriented and forward-looking. Adopting an agent-empowering approach, this book addresses a significant global problem in a comprehensive way, providing the tools we need for progress as we collaborate to tackle this global scourge.
Corruption, Responsibilities, and Global Justice
Authors: Brock Gillian
Published: June 2023

This chapter offers an introduction to many of the core issues necessary for the normative work to follow and offers an indication of how the argument unfolds. Studying corruption comprehensively is a multi-disciplinary endeavor. We need to understand some of the complex forms corruption takes and its facilitators to have any hope of reducing it. These topics are introduced in this chapter. In addition, the chapter offers two kinds of maps that will guide the reader through the book’s project, including a chapter-by-chapter overview that summarizes key themes from each of the chapters to come. The chapter also clarifies why normative theorists should find this book valuable, highlighting several original aspects to the project. In addition, the chapter clarifies Brock’s position on complex conceptual issues concerning corruption, some of which are further discussed in Chapter 8 and the Appendix.
Sharing Responsibilities for Action
Authors: Brock Gillian
Published: June 2023

This chapter addresses the normative issue of who ought to take actions to combat corruption. The chapter offers a framework that assists with particular agent’s responsibility assignments. It involves a new and complex model of responsibility that is action-oriented and forward-looking. We can use it in determining responsibility for a wide range of actors including local officials, CEOs of multinational corporations, lawyers, accountants, bankers, engineers, citizens, and many more diverse agents. The chapter discusses some of the factors relevant to sharing responsibility for tackling corruption fairly. Responsibilities track a variety of factors including specific corruption risks that we are directly able to address, capacity to assist, contributions to the corruption, benefits derived from corruption, role-related responsibilities, and assistance already provided. The chapter offers textured analysis of how agents have different roles to play in tackling responsibilities to reduce corruption. The chapter also argues that we have obligations to enlarge capacities to address corruption. Our different capacities, roles, and situations can also be grounds for obligations to assist in creating capacity in different ways as well. As I argue, the different ways of creating capacity also amplify responsibilities. We should aim to create resilient communities and mechanisms that are human rights supporting. Forming broad coalitions and joining up with others often makes our task more manageable while at the same time amplifying our efforts. Joining up with others making complementary efforts increases our power to create corruption-curbing capacity.
Addressing Common Challenges and Future Directions
Authors: Brock Gillian
Published: June 2023

This chapter addresses some key objections to my approach and policy recommendations and it also discusses some notable areas for future work. One set of important objections concerns the view that cultural differences should be more relevant to the arguments of the book, such as in identifying what corruption is and appropriate tools for addressing it. Several responses to these concerns are discussed. There are issues about just how widely accepted some purported cultural norms are and whether ordinary citizens from those cultures really do endorse particular norms as appropriate ones for the public sphere, when they deprive citizens of their basic entitlements and human rights. Furthermore, in places where corrupt norms do seem widespread, people often comply with them because they believe they are too difficult to change, given how deeply embedded they seem to be and perceptions about their actions’ efficacy. In such cases we have collective action problems and we have a number of resources that can be, and have been, brought to bear in challenging those cultural norms and reforming them. The chapter discusses some of these resources, shows how they have contributed to progress around the world, and identifies some of their core features that can be applied to other contexts. The chapter also outlines some areas that might be the focus of future research in this complex terrain.
Equivalence in the EU: Key Requirements, Equivalence Decision, and Legal Consequences
Authors: Schürger Jonas
Published: June 2023

The second chapter provides an in-depth analysis of EU equivalence regimes and is divided into three parts. The first part identifies the key requirements of equivalence provisions and discusses whether equivalence can be referred to as a uniform concept. The second part deals with the equivalence decision as the core prerequisite of each mechanism. First, it is examined what is to be understood by the term ‘equivalent’ and how equivalence can be determined in theory and practice. Afterwards, the focus shifts to the European Commission as the key player in equivalence assessments and the question of discretionary elements in the decision-making process. Subsequently, potential grounds for withdrawal decisions and their administrative as well as constitutional limits are analysed. Thereafter, the possibilities of judicial review of equivalence-related decisions are outlined. The third part concludes with a description and categorization of the legal consequences of equivalence.
A Liberal Access to Financial Markets in Switzerland: Equivalence and Appropriateness
Authors: Schürger Jonas
Published: June 2023

The third chapter leaves the legal framework of the EU. Deference is not a particular European phenomenon. Instead, it is advocated at the G20 level, and various countries have implemented this concept. Among these jurisdictions, this chapter concentrates on Switzerland due to its unique role for the European financial sector, which does not only derive from its location in the heart of Europe. The chapter describes the Swiss approach regarding the regulation of foreign financial service providers. The author demonstrates that Switzerland pursues a more liberal policy with extensive market access rights compared to the EU and the US. The chapter then derives characteristics of the Swiss regulatory approach from this analysis and develops a systematic framework for the Swiss regulation of foreign financial firms. Finally, it attempts to explain this regulation against the background of Switzerland’s economic and geographic situation.
General Sociological Foundations
Authors: Rucht Dieter
Published: June 2023

The study of social movements is linked to general sociological theory in an attempt to avoid the problematic dichotomies of structure vs. agency, functions vs. norms, and strategic vs. communicative action. In this regard, Habermas’ theory of modern society serves as a starting point. Four revisions of this approach are proposed: (1) to relativize the rigid juxtaposition of functional systems and lifeworld; (2) to enrich the concept of systems by adopting some of Bourdieu’s ideas on fields and struggles over various forms of capital; (3) to narrow Habermas’ broad concept of lifeworld; and (4) to introduce the public sphere as a separate third societal sector next to functional systems and the daily lifeworld. In addition, concepts offered by Pierre Bourdieu and Anthony Giddens will be considered.
The Historical and Process Dimension
Authors: Rucht Dieter
Published: June 2023

The process dimension is crucial to understanding social movement structures, activities, and outcomes. Processes should be studied with attention to brief interactions, protest campaigns, and the longue durée of societal developments in which social movements are involved. This last aspect in particular has been largely neglected by the minority of historians who dare to cover very long periods but tend to overlook the role of social movements. Even when writing about upheavals and revolutions, most historians ignore the sociological toolkit that would enrich their analyses. At the same time, sociologists are generally fascinated by contemporary conflicts. Therefore, they do not make use of the rich material that historians have unearthed. This material would be useful for broadening the empirical perspective and could be used to test theories on social movements, including their generalizability.
Addressing the Social Determinants of Health Equity
Authors: Edward Jean
Published: June 2023

A call to action for nurses
Primary Care Intervention Provides Modest Gains in Prevention, Not Treatment, of Alcohol Use Disorder
Authors: Rosenberg Karen
Published: June 2023

According to this study:
Outcomes of fracture surgery in patients with escalating hemoglobin A1C in the setting of unmanaged diabetes
Authors: Lawson Michelle M. , Stuart Ariana , Ramsey Katrina L , Friess Darin , Working Zachary M
Published: June 2023

Objective:

To determine if there is a threshold of elevated HbA1c above which the complication risk is so high that fracture fixation should be avoided.

Design:

Retrospective cohort study.

Setting:

Academic, level I trauma center, 2008-2018

Patients/Participants:

A cohort of 187 patients with Hgb A1c values >7 and operatively treated extremity fractures.

Intervention:

Surgical fixation of extremity fractures.

Main Outcome Measurements:

Rate of major orthopedic complication (loss of reduction, nonunion, infection, and need for salvage procedure)

Results:

34.8% demonstrated HgA1c >9 and 12.3% with HgA1c>11. Major complications occurred in 31.4%; HgA1c values were not predictive. We found no evidence of a clinically or statistically significant relationship between HbA1c and risk of major complication. The odds ratio for a one-point increase in HbA1c was 1.006 (p=0.9439), and the area under the receiver operating characteristic curve (AUC), which reflects the average probability that someone with a major complication will have a higher HbA1c than someone without, was 0.51 (95% CI 0.42 – 0.61), equivalent to random chance.

Conclusion:

Diabetic fracture patients demonstrated an extremely high overall rate of complications, with 30.5% experiencing a major complication. However, patients with extreme diabetic neglect did not have higher complication rates after extremity fracture fixation when compared to patients with controlled and uncontrolled diabetes. There was no correlation between rate of complication and level of HbA1c. In addition, there was no difference in complication rate between upper and lower extremity fractures, or between fractures treated with open or percutaneous fixation. This suggests that fracture treatment decision-making should not be altered for patients with poor diabetic control, and that surgery is not contraindicated in patients with an extremely high HbA1c.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Increase in daily asthma medication sales in association with air pollution levels in Greater Stockholm
Authors: Tornevi Andreas , Olstrup Henrik , Forsberg Bertil
Published: June 2023

Background:

Daily air pollution levels are known to influence the number of patients with acute asthma. We investigated the short-term effects of air pollution exposure on the daily number of asthma medication purchases in the Greater Stockholm area, Sweden.

Methods:

We conducted a time-series study with data on asthma medication purchases and daily mean values of particulate matter ≤10 µm (PM10), nitrogen oxides (NO
x
), and ozone during 2018–2019. We used nonlinear distributed lag quasi-Poisson regression models to estimate the associations between air pollution levels and medication purchases, adjusting for meteorological variables, pollen levels, day of the week, and long-term trends. The models established linear relationships between air pollutants and the outcome, and potential delayed effects were smoothed with a spline across a lag period of 2 weeks. We applied separate models for each municipality (n = 21) in Greater Stockholm, and calculated pooled estimates to achieve combined results for the whole region.

Results:

We observed associations between daily levels of air pollution and purchases of asthma medications, most clearly for PM10. The pooled estimates of the relative risks for asthma medication purchases across all 21 municipalities associated with a 10 μg m−3 increase in PM10 the same day (lag 0) was 1.7% [95% confidence interval (CI): 1.2%, 2.1%], a cumulative increase of 4.6% (95% CI: 3.7%, 5.6%) over one week (lag 0−6), and a 6.5% (95% CI: 5%, 8%) increase over 2 weeks (lag 0−13). The corresponding pooled effect per 10 μg m−3 increase in NO
x
and ozone were 2.8% (95% CI: 1.6%, 4.1%) and 0.7% (95% CI: 0%, 1.4%) over 2 weeks (lag 0−13), respectively.

Conclusions:

Our study revealed short-term associations between air pollution, especially PM10, and purchases of asthma medications.
Postoperative Psychological Impact on Teenagers after Gynecomastia Correction
Authors: Lashin Riham , Youssef Ramy A. , Elshahat Ahmed , Mohamed Eman Nagy
Published: June 2023

Background:

Gynecomastia is common among teenagers. Most published research focused on how surgery is effective in enhancing the aesthetic appearance of the breast. Limited information is already known about the psychosocial benefits of surgical interventions. This study explores and assesses the surgical, cosmetic, and psychological outcome of gynecomastia correction in teenagers.

Methods:

This prospective study included 20 teenagers with Simon grade IIA gynecomastia. The assessment included complications, patients’ satisfaction, Manchester Scar Scale, and Li et al questionnaire at 12 months postoperative. Rosenberg Self-Esteem Scale, 36-Item Short Form Survey (SF-36) for quality of life, and school achievement level were evaluated 1 month preoperative and 12 months postoperative. Statistical analysis was done.

Results:

Patients were aged 13-19 years old. The follow-up period was 12 ± 36 months. Postoperative complications included seroma formation (n = 1) and mild asymmetry (n = 3). Results were “uniformly good to excellent” on a satisfaction scale. The Manchester Scar Scale shows the lowest score, which denotes the highest outcomes. The Li et al questionnaire showed a positive overall change. Comparing Rosenberg Scale scores pre- and postoperatively revealed higher scores postoperatively, which indicate higher self esteem. Comparing SF-36 pre- and postoperatively showed a significant increase in postoperative quality of life. Comparing school achievement pre- and postoperatively showed marked improvement postoperatively. Results were highly statistically significant.

Conclusions:

Surgical treatment of teenage gynecomastia is beneficial for different psychosocial domains. Pull-through of the mammary gland combined with liposuction provides satisfactory cosmetic results. Patients who underwent surgery reported a significant improvement in psychosocial load, better school achievement, higher quality of life, and better self-esteem.
A practical approach to assessment of non-adherence to antihypertensive treatment
Authors: Kociánová Eva , Táborský Miloš , Václavik Jan
Published: June 2023

Non-adherence to antihypertensive treatment is frequent, complicates the care of hypertensive patients, represents one of the major causes of treatment failure and is linked with the increased risk of cardiovascular events. Identifying a non-adherent patient is one of the recent daily-practice tasks for which the ideal solution has not yet been found. Presence of certain clinical red flags should prompt the clinician to consider non-adherence. Chemical adherence testing using serum or urine antihypertensive levels is regarded as the best method so far and should be used if available. Alternatively, the check for prescription refills in the patient electronic medical records, or directly observed therapy with subsequent ambulatory blood pressure monitoring may be used. We suggest a simple algorithm to guide the clinicians to detect non-adherence in the practice.
The Development and Validation of a Psychometric Tool to Assess Behavioral Factors Impacting Personal Dosimeter Use among Medical Radiation Workers
Authors: Mohd Ridzwan Siti Farizwana , Fritschi Lin , Bhoo-Pathy Nirmala , Hum Wee Lei
Published: June 2023

Personal dosimeters are used by medical radiation workers (MRWs) to monitor their radiation dose from external sources and comply with radiation safety guidelines. Nevertheless, there is evidence of inconsistent use of the devices among MRWs. Behavioral factors influencing the use of personal dosimeters have never been explored. Using established behavioral models, we aimed to develop a psychometric tool to measure the behavioral factors influencing dosimeter use and establish its feasibility, reliability, and validity. A 37-item tool was developed based on a qualitative study and review of the literature. The content relevancy was assessed by six field experts before it was piloted and re-tested on MRWs. The construct validity of the tool was analyzed using exploratory factor analysis to confirm its psychometric properties. Face validation was performed by academicians, field experts, and MRWs to enhance the tool’s readability. The 37 items in the tool belonged to five constructs in the early phase. However, the validation study revealed a reliable 27 item tool with seven constructs, namely: “Attitude,” “Social factors,” “Ability to perform if facilitated,” “Ability to overcome shortcomings,” “Self-efficacy,” “Complexity,” and “Perceived usefulness.” The item-construct validity index of accepted items was >0.83, and Cronbach’s alpha for each construct ranged between 0.70 to 0.96, while factor loading for each item was between 0.723 to 0.963. All results were considered “good” and “excellent.” The new tool appears to be valid, reliable, and feasible to measure behavioral factors influencing personal dosimeter use among MRWs, which is helpful to facilitate the planning of interventions to improve behaviors in occupational radiation monitoring.
Does Arterial Stiffness Predict Cardiovascular Disease in Older Adults With an Intellectual Disability?
Authors: O'Brien Frances , McCallion Philip , Ryan Caitriona , Paul Avejay , Burke Éilish , Echiverri Simmoune , McCarron Mary
Published: June 2023

Background

Arterial stiffness has been associated with an increased risk of cardiovascular disease (CVD) in some patient populations.

Objectives

The aims of this study were to investigate (1) whether there is an association between arterial stiffness, as measured by the Mobil-O-Graph, and risk for CVD in a population of individuals with intellectual disability and (2) whether arterial stiffness can predict the risk for CVD.

Methods

This cross-sectional study included 58 individuals who participated in wave 4 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Aging (2019–2020). Statistical models were used to address the first aim, whereas machine learning models were used to improve the accuracy of risk predictions in the second aim.

Results

Sample characteristics were mean (SD) age of 60.69 (10.48) years, women (62.1%), mild/moderate level of intellectual disability (91.4%), living in community group homes (53.4%), overweight/obese (84.5%), high cholesterol (46.6%), alcohol consumption (48.3%), hypertension (25.9%), diabetes (17.24%), and smokers (3.4%). Mean (SD) pulse wave velocity (arterial stiffness measured by Mobil-O-Graph) was 8.776 (1.6) m/s. Cardiovascular disease risk categories, calculated using SCORE2, were low-to-moderate risk (44.8%), high risk (46.6%), and very high risk (8.6%). Using proportional odds logistic regression, significant associations were found between arterial stiffness, diabetes diagnosis, and CVD risk SCORE2 (P < .001). We also found the Mobil-O-Graph can predict risk of CVD, with prediction accuracy of the proportional odds logistic regression model approximately 60.12% (SE, 3.2%). Machine learning models, k-nearest neighbor, and random forest improved model predictions over and above proportional odds logistic regression at 75.85% and 77.7%, respectively.

Conclusions

Arterial stiffness, as measured by the noninvasive Mobil-O-Graph, can be used to predict risk of CVD in individuals with intellectual disabilities.
Neoadjuvant Intensity Modulated Radiotherapy for a Single and Small (<= 5cm) Hepatitis B Virus-Related Hepatocellular Carcinoma Predicted to Have High Risks of Microvascular Invasion: A Randomized Clinical Trial
Authors: Wei Xubiao , Jiang Yabo , Feng Shuang , Lu Chongde , Huo Lei , Zhou Bin , Meng Yan , Lau Wan Yee , Zheng Yaxin , Cheng Shuqun
Published: June 2023

Background:

The presence of microvascular invasion (MVI) significantly impairs postoperative long-term survival of patients with hepatocellular carcinoma (HCC). The role of neoadjuvant radiotherapy (RT) in treating patients with an early-stage HCC predicted to have high risks of MVI remains to be explored.

Materials and Methods:

Consecutive patients with a resectable single and small (<= 5 cm) Hepatitis B Virus (HBV)-related HCC predicted to have high risks of MVI were randomized 1:1 to receive either neoadjuvant intensity modulated radiation therapy (18Gy with fractionated doses of 3Gy) followed by surgery 4 weeks later or upfront surgery. The primary endpoint was disease-free survival (DFS). The secondary outcomes included overall survival (OS), objective response rate, RT-related toxicity and surgical complications.

Results:

There were 30 patients randomized to each of the 2 groups. In the neoadjuvant RT group, 3 patients violated the study protocol, with 2 having upfront hepatectomy and 1 radiofrequency ablation after RT. The objective response rate after RT was 25.0% (7/28), but 2 patients suffered from grade 3 liver toxicity. The median follow-up was 68 months (interquartile range, 58-70 mo) in the neoadjuvant RT group, and 68 months (interquartile range, 62-75 mo) in the upfront surgery group. On intention-to-treat analysis, the median DFS and median OS were not reached in both the 2 arms. The 1-, 2-, 3- and 5-year DFS rates for the neoadjuvant RT group were 86.7%, 76.7%, 60.0% and 56.3%, versus 90.0%, 66.7%, 52.8% and 45.7% in the upfront surgery group (P = 0.448), respectively. The corresponding OS rates were 96.7%, 86.7%, 83.3% and 72.7%, versus 100.0%, 93.3%, 79.6% and 60.7% (P = 0.399).

Conclusion and Relevance:

For patients with a resectable single and small HBV-related HCC predicted to have high risks of MVI, neoadjuvant RT gave a promising response rate with a mild toxicity. Nevertheless, the neoadjuvant RT yielded similar long-term DFS and OS rates compared to patients who underwent upfront surgery.
Delirium in the Era of COVID-19
Authors: Byrnes Tru , Pate Kimberly , Cochran Allyson R. , Belin Latasia
Published: June 2023

Background:

Delirium has been associated with poor outcomes in hospitalized older adults. Rates of delirium have increased in the context of coronavirus disease 2019 (COVID-19).

Purpose:

To explore the prevalence of delirium in older adult patients hospitalized with COVID-19 as well as correlations with age, gender, length of stay (LOS), occurrence of an intensive care unit admission or transfer, and in-hospital mortality in 2 hospitals in the southeast United States.

Methods:

A retrospective study of 1502 patients admitted between 2020 and 2021 was completed.

Results:

Older adult patients hospitalized with delirium and COVID-19 demonstrated significantly prolonged LOS (14.1 days vs 7.1 days, P < .0001) and higher rates of in-hospital mortality (33.5% vs 12.8%, P < .0001).

Conclusions:

Findings of this study add to the growing literature on delirium in hospitalized patients and support the need for future initiatives to create protocols for monitoring and nursing care management of delirium to improve care delivery.
Description and Implications of Falls in Patients Hospitalized Due to COVID-19
Authors: Venema Dawn M. , Hester Amy , Clapper Kellie , Kennel Victoria , Quigley Patricia , Reames Christina , Skinner Anne
Published: June 2023

Background:

Many hospital quality indicators, including falls, worsened during the COVID-19 pandemic. Patients hospitalized with COVID-19 may be at risk for falling due to the disease itself, patient characteristics, or aspects of care delivery.

Purpose:

To describe and explore falls in patients hospitalized with COVID-19.

Methods:

We pooled data from 107 hospitalized adult patients who fell between March 2020 and April 2021. Patients who fell had a current, pending, or recent diagnosis of COVID-19. We analyzed patient characteristics, fall circumstances, and patient and organizational contributing factors using frequencies, the chi-square test, and Fisher's exact test.

Results:

Patient contributing factors included patients' lack of safety awareness, impaired physical function, and respiratory concerns. Organizational contributing factors related to staff and the isolation environment.

Conclusions:

Recommendations for managing fall risk in patients hospitalized with COVID-19 include frequent reassessment of risk, consideration of respiratory function as a risk factor, ongoing patient education, assisted mobility, and adequate staff training.
Relationship Between Self-Directed Learning, Grit, and Compassionate Teaching in Doctoral Nursing Education
Authors: White Krista A. , Ruth-Sahd Lisa A. , Slota Peggy
Published: June 2023

Background:

The capacity to be self-directed, take responsibility for one's learning, and possess grit, perseverance, and passion for long-term goals is fundamental to doctoral education. Compassionate teaching (CT) strategies may help foster these traits.

Purpose:

This study explored CT strategies, self-directedness, and grit in doctoral nursing education.

Methods:

A mixed-methods design examined doctor of nursing (DNP) graduates' (N = 227) perceptions of self-directedness, grit, and CT using an online survey and interviews.

Results:

A weak direct correlation existed between CT strategies and grit. A weak-to-moderate direct significant correlation existed between CT strategies and self-directedness. Participants were moderately self-directed with postmasters-DNP graduates being more self-directed than postbaccalaureate-DNP graduates. Qualitative results validated that CT strategies include committing time to relationship building, providing timely critical feedback while being kind, and treating students fairly.

Conclusions:

Faculty who embrace rigor and compassion are appreciated by students and are perceived to foster self-directedness and grit.
Acculturative Stress, Resilience, and a Syndemic Factor Among Latinx Immigrants
Authors: Gonzalez-Guarda Rosa M. , McCabe Brian E. , Nagy Gabriela A. , Stafford Allison M. , Matos Lisvel , Lu Min , Felsman Irene , Rocha-Goldberg Pillar , Cervantes Richard C.
Published: June 2023

Background

The process of immigration and subsequent adaptation can expose Latinx immigrants to chronic and compounding challenges (i.e., acculturative stress), but little is known about how resilience factors and these stressors interact to influence syndemic conditions, intertwined epidemics that disproportionally affect historically marginalized communities.

Objectives

The purpose of this study was to describe the influence of acculturative stress and resilience on the syndemic factor underlying substance abuse, intimate partner violence, HIV risk, and mental conditions.

Methods

Baseline cross-sectional data from a community-engaged, longitudinal study of 391 adult (ages 18–44 years) Latinx immigrants in North Carolina were obtained using standardized measures available in English and Spanish. Structural equation modeling tested the syndemic model, and random forest variable importance identified the most influential types of acculturative stressors and resilience factors, including their interactions, on the syndemic factor.

Results

Results indicated that a single syndemic factor explained variations in heavy drinking, drug use, intimate partner violence, depression, and anxiety and fit the data well. Age, being a woman, acculturative stress, acculturation to the United States, and emotional support were significantly related to the syndemic factor. The relationship between acculturative stress and the syndemic factor was buffered by ethnic pride, coping, enculturation, social support, and individual resilience. The most influential acculturative stressors were marital, family, and occupation/economic stress.

Discussion

Findings from this study underscore the importance of considering the co-occurrence of behavioral and mental health conditions among Latinx immigrants. Health promotion programs for Latinx immigrants should address acculturative stress and bolster ethnic pride, social support, and coping as sources of resilience.
Hospital Community Benefit Reporting: How Group Reporting Practices Limit Accountability
Authors: Cronin Cory E. , Singh Simone , Puro Neeraj , Franz Berkeley
Published: June 2023

Objective:

To identify the prevalence of group reporting of hospital community benefit efforts to the Internal Revenue Service (IRS) and understand hospital and community characteristics associated with this practice.

Design:

The study was based on data collected from publicly available community benefit reports from 2010 to 2019, as well as secondary data from the 2020 American Hospital Association (AHA) Annual Survey. The sample was drawn from the entire nonprofit US hospital population reporting community benefit activities. The analytic plan employed descriptive statistics and bivariate analysis.

Setting:

The United States.

Participants:

All data are self-reported by US hospitals, either through the publication of community benefit reports (IRS Form 990 Schedule H) or a response to the AHA Annual Survey.

Main Outcome Measure(s):

Analyzed variables include whether a hospital reported its community benefit expenditures individually or as a group member; community benefit spending as a percentage of hospital operating expenses; and whether the hospital was part of a multihospital system, with consideration of hospital and community characteristics.

Results:

Between 2010 and 2019, more than 40% of hospitals participated in group reporting, with most doing so consistently. System membership and hospital size were significantly and positively tied to group reporting, with state community benefit policy tied to the lower prevalence of group reporting.

Conclusions:

The high prevalence of group reporting limits accountability to communities and restricts an accurate assessment of community benefit expenditures, counter to policy intentions. Stakeholders should consider what modifications to reporting rules could be made to promote transparency and to ensure that the effects of community benefit policies align with intentions.
The Keller Funnel, Capsular Contracture, and Conflict of Interest
Authors: Swanson Eric
Published: June 2023

Background

The Keller funnel (Allergan; AbbVie Inc, North Chicago, IL) is commonly used to insert breast implants as part of a “no touch” protocol. Many plastic surgeons believe that this device reduces the risk of capsular contracture. This review was undertaken to evaluate the evidence regarding any reduction in capsular contracture rate, other possible benefits, safety and to investigate financial conflict of interest.

Methods

A PubMed electronic literature search was conducted to identify studies comparing capsular contracture rates with and without the Keller funnel. The Open Payments database was accessed for information regarding corporate payments to plastic surgeons.

Results

Two retrospective historical case-control studies, published in 2016 and 2018, were identified. Both studies had important confounders, including implant type and placement, which are known to affect capsular contracture rates. Major financial conflicts of interest were present. Most authors did not disclose these conflicts, which totaled more than $1 million and were usually categorized as gifts from Allergan, which purchased the Keller funnel in 2017.

Discussion

Financial conflict of interest, along with publication bias, creates a bias toward publication of positive findings. No reliable evidence supports a “no touch” technique, which is a misnomer because manual handling of implants is unavoidable, even when using a funnel. Recent microbiological studies do not support a specific bacterial etiology for capsular contracture. No evidence supports contamination by the surgeon touching the implant. Among other proposed benefits, such as reduced operating time, less contamination, a shorter incision, and less implant trauma, only a slightly shorter incision (1 cm) is supported by the evidence. The cost is $150 per funnel.

Conclusions

No reliable evidence supports the use of a Keller funnel to reduce the risk of capsular contracture. Both supportive studies contain confounding variables, limited follow-up time, and no plausible scientific basis for efficacy. Institutional review board approval of studies on human subjects is not optional. Financial conflicts of interest are extraordinary in their magnitude and potential for creating undue influence. Greater transparency and honest disclosures are needed.
A Systematic Review of Exercise Therapy for Bowel Preparation
Authors: Zhang Yuan-Yuan , Vimala Ramoo , Chui Ping Lei , Hilmi Ida Normiha
Published: June 2023

This systematic review aims to evaluate (1) the effectiveness of exercise therapy in bowel preparation for colonoscopy, and (2) the characteristics of exercise programs for bowel preparation. Systematic searches were done in PubMed, EMBASE, the Cochrane Library, Web of Science, and CINAHL from inception to November 2022. Randomized controlled trials and quasi-experimental studies assessing the efficacy of exercise during bowel preparation were included in this review. Two reviewers independently assessed the methodological quality using a modified Downs and Black checklist. A narrative synthesis was conducted. A total of five studies (1,109 participants) were included in this review. In all eligible studies, the characteristics of the exercise programs varied and included mainly two types of exercise (walking and yoga), various amount of exercise (3,000–10,000 steps or 0.5–1.9 hours), and two exercise timing (during and 1 hour after taking the laxative). Available evidence indicated that exercise therapy is effective in improving the quality of bowel preparation. However, there was insufficient high-quality evidence to conclude the effects on procedure-related indicators, adverse events, and willingness to repeat preparation. Exercise should be recommended as an important part of routine bowel preparation for patients undergoing colonoscopy to improve the quality of bowel preparation. More rigorous studies focusing on the effects on procedure-related indicators, adverse events, and willingness to repeat preparation are needed. To ensure the effectiveness and safety of the intervention, it is critical to establish a standard, well-structured exercise program for bowel preparation.
Fecal Incontinence and the Risk of Urinary Tract Infection in Patients Presenting for Urogynecological Consultation
Authors: Jansen Sierra M. , Pellino Katherine , Zhou Qianqian , Brown Heidi W. , Heisler Christine A.
Published: June 2023

Importance

Urinary tract infection (UTI) is common in urogynecology patients. Patients with fecal incontinence (FI) often attribute their UTIs to FI, but this association has not been evaluated.

Objectives

The objectives of this study were to compare the prevalence of UTI in urogynecology patients with and without FI and to characterize factors associated with UTI and recurrent UTI.

Study Design

This retrospective cohort study included all new adult patients who presented to an academic female pelvic medicine and reconstructive surgery practice with FI from January 2014 through December 2017. Patients were age-matched to new adult patients with stage <2 pelvic organ prolapse without FI. All urine culture results from 1 year before and 1 year after the first visit were identified. Logistic regression identified factors associated with UTI.

Results

Among 399 patients, 106 (27%) had a culture-confirmed UTI in the year before or after their first urogynecology visit; the prevalence of UTI was 23% (45/198) in patients with FI and 30% (61/201) in those without FI (P = 0.09). The rate of recurrent UTI was 11.5% overall and did not differ among those with and without FI. In multivariate models, variables that were statistically significantly associated with UTI included age, diabetes mellitus, anterior vaginal wall prolapse, and sexual activity. Fecal incontinence was not associated with any or recurrent UTI.

Conclusions

The prevalence of UTI and recurrent UTI was similar in urogynecology patients with and without FI. Variables that were associated with UTI risk included older age, sexual activity, diabetes mellitus, and anterior vaginal wall prolapse.
Antidepressant emergent mood switch in major depressive disorder: onset, clinical correlates and impact on suicidality
Authors: Olgiati Paolo , Serretti Alessandro
Published: June 2023

Antidepressant (AD)- emergent mood switch (AEMS) is a common complication of bipolar depression. This study aimed to investigate the prevalence and clinical correlates of subthreshold AEMS (i.e. not fulfilling DSM criteria for hypomanic episodes) in major depressive disorder (MDD) and, prognostically, its impact on AD treatment outcome and suicidality. The study involved 425 outpatients with MDD followed during the acute phase (12 weeks) and continuation (weeks 13–28) AD treatment. AEMS was assessed through the Altman Self-Rating Mania scale (ASRM ≥ 6). Several clinical features differentiated individuals with or without subthreshold AEMS (n = 204 vs. 221): negative self-perception [odds ratio (OR) 1.017–1.565]; panic disorder (OR 1.000–1.091); subthreshold hypomanic episodes (OR 1.466–13.352); childhood emotional abuse (OR 1.053–2.447); lifetime suicidal behaviour (OR 1.027–1.236); AD-related remission (χ2 = 22.903P < 0.0001) and suicide ideation (χ2 = 16.701P < 0.0001). In AEMS earlier onset showed a strong correlation with bipolar spectrum disorder (overall score:P = 0.0053; mixed depression:P = 0.0154; subthreshold hypomania:P = 0.0150) whereas late-onset was associated with more severe suicidal behaviour (P < 0.001). In conclusion, our results demonstrate that subthreshold mood switches occur frequently in unipolar depression during acute AD treatment as well as in continuation phase. Time of switch onset seems to have the greatest diagnostic and prognostic value.