bluuebunny/crossref_metadata_2025 huggingface dataset:
Top Management Gender Diversity and Internationalisation in Different Institutional Contexts: Evidence from Germany and Poland
Authors: Küpper Anja , Dauth Tobias
Published: December 2021

The diversity of top management teams is a topic of increasing scholarly and practical interest. It is argued that globalisation requires international operating firms to staff their management teams with international and diverse members. We investigate the influence of institutional environments on gender and internationality diversity in boards to shed light on the question “Why do top management teams look the way they do?” Our sample includes top management team members of the largest stock listed firms in Germany and Poland. The sample consists of 60 firms and 852 individuals from 2019. Our findings suggest that the presence of non-natives and women on corporate boards and the international orientation of board members, in terms of education, work experience and directorships, are attributable to national institutional systems. While Germany´s top managers are becoming increasingly internationally diverse and have increasing gender diversification, the figures for Poland are also increasing, but on a much smaller scale. We argue that country-level institutions play an important role in shaping the diversity of corporate boards. Future research should place more emphasis on the external national environment when investigating board diversity.
How Companies Should Manage Their Human Resources to Respond to the Disruptive Innovation Brought About by the Sharing Economy
Authors: Turulja Lejla , Delalic Elma
Published: December 2021

In recent years, the sharing economy has become a new buzzword, providing various business opportunities and challenges to conventional businesses. It is characterized by the transformation of conventional business sectors and many companies are already facing the pressure of adapting their operations to the changing conditions. Human resource management, especially when it comes to experts and knowledge workers, is among the affected business activities. In particular, due to the apparent high demand, this type of workforce has the opportunity to share services among many businesses. Therefore, human resource managers should tackle the issue of cultivating employee organizational identification to increase employee retention and achieve the desired performance. In this regard, this paper proposes a model that binds human resource management practices to employee organizational identification, innovative behaviour, knowledge sharing, and finally, employee job performance. The model is estimated using the survey method and structural equation modelling technique for data analysis. The results imply that selective recruiting, participation in decision-making, and rewarding contribute to employees' organizational identification, while training does not directly affect it. The findings, therefore, indicate that adequate human resource management practices, mainly through the simultaneous impact of the critical capabilities examined by this model, can serve as a foundation for business success in the sharing economy.
Cooperatives and the Question of Democracy
Authors: Kaswan Mark J.
Published: December 2021

Obwohl Demokratie im allgemeinen als Kernelement von Genossenschaften angesehen wird, scheint sie - außer bei gewählten Verwaltungsräten - weder in der Leitung noch in der Geschäftstätigkeit der meisten Genossenschaften eine wichtige Rolle zu spielen. Das ist mit zwei Problemen verbunden. Eines ist die Vorstellung, dass Genossenschaften dazu neigen, ihren demokratischen Charakter zu verlieren. Das zweite ist, dass viele Genossenschaften aus primär wirtschaftlichen Gründen gegründet werden; Demokratie ist zweitrangig. Dieser Essay geht der Frage nach, wie wichtig Demokratie für Genossenschaften ist, identifiziert Warnsignale und ermutigt Genossenschaften, Partizipation aktiv zu fördern. Demokratie ist nicht selbstverständlich; sie kann ganz verschwinden.
Partizipation und Sinnstiftung in Genossenschaften
Authors: Hühn Melanie , Rybnikova Irma , Tümpel Markus , Hartz Ronald
Published: December 2021

Der vorliegende Beitrag stellt Ergebnisse eines Forschungsprojektes zu Partizipationspraktiken in Genossenschaften dar. Angelehnt an die Sinnstiftungsperspektive in Organisationen (Weick 1995) wurde mit Hilfe von 14 qualitativen Fallstudien in Genossenschaften ausgewählter Wirtschaftssektoren in Deutschland untersucht, welche Partizipationspraktiken in Genossenschaften existieren und inwiefern deren Vielfalt und Muster im Zusammenhang mit Prozessen organisationaler Sinnstiftung stehen. Es konnten vier Typen der Partizipation in Genossenschaften herausgearbeitet werden, die jeweils ein spezifisches Muster von Praktiken und damit verschränkten Sinnzuschreibungen in Bezug auf Partizipation abbilden: Der managementgelenkte Typus zeichnet sich durch ein hierarchisches und marktorientiertes Agieren aus. Beim kundenorientierten Typus werden die Mitglieder vor allem als finanziell profitierende Kund*innen gesehen. Der projektbasierte Typus beruht auf Partizipation als Teil des gemeinsamen Projekts, während der werteorientierte Typus durch eine nachhaltigkeitsorientierte und milieu-spezifische Ausrichtung geprägt ist.
Tackling ill-structured problems with cooperatives. A proposal for further research and application
Authors: Niedworok Anja , Bolli Monique , Gutmann Martin
Published: December 2021

In diesem Artikel führen wir mögliche Gründe an, dass Genossenschaften geeignet sind, komplexe Probleme in der Nachhaltigkeit zu lösen. Statt uns auf existierende Forschung zu stützen, ist der Inhalt dieses Aufsatzes hypothetisch und verbindet zwei Forschungsgebiete, nämlich Genossenschaften und komplexe Probleme. Komplexe Probleme wie der Klimawandel oder Ressourcenknappheit sind schwierig zu definieren und sind von verschiedenen Akteuren mit konkurrierenden Interessen und widersprüchlichen Anforderungen gekennzeichnet. In diesem Beitrag legen wir dar, warum und wie gewisse Eigenschaften von Genossenschaften sich für die Lösung von komplexen Problemen eignen - allen voran Nachhaltigkeit. Die Erörterung gliedert sich in zwei Teile: zuerst skizzieren wir die Charakteristika von komplexen Problemen und zeigen zwei Beispiele mit dem Schwerpunkt auf die Art der Problemlösungsfindung aus der Geschichte der Genossenschaften. In dem zweiten Teil des Beitrages beschreiben wir drei Merkmale von Genossenschaften, die aus unserer Sicht das Potential haben, zu Nachhaltigkeits-Herausforderungen beizutragen. Statt fertige Forschungsergebnisse zu liefern, möchten wir in der laufenden Diskussion aufzeigen, wie Genossenschaften zu den aktuellen Herausforderungen, mit denen sich die Gesellschaft konfrontiert sieht, beitragen können.
Erkenntnisse zur erfolgreichen Neubesetzung von Führungspositionen indeutschen Museen – eine empirische Untersuchung von Beschaffungsprozessen
Authors: Stegmann Anna , Hausmann Andrea
Published: December 2021

In Museen kommt es immer wieder zu Fehlbesetzungen auf Top-Führungspositionen - mit langfristigen negativen Auswirkungen. Im vorliegenden Beitrag führen die Autorinnen daher eine theoriebasierte explorative Interviewstudie durch mit dem Ziel, erstmals empirische Erkenntnisse zum Status quo der Führungskräftebeschaffung in Museen zu gewinnen und Implikationen für die erfolgreiche Neubesetzung von Führungspositionen abzuleiten. Die Studie offenbart unterschiedliche Vorgehensweisen und Strategien von öffentlichen und privaten Museen und diskutiert diese. Insgesamt zeigt sich Optimierungspotential hinsichtlich der Definition von relevanten Anforderungskriterien, der Transparenz der Auswahlverfahren und dem Einsatz valider Auswahlinstrumente.
The Link Between External and Internal Body-Image Shame and Binge Eating in Men and Women: The Mediating Role of Self-criticism
Authors: Salarian Kaleji Zahra , Poursharifi Hamid , Dolatshahi Behrooz , Momeni Fereshte
Published: December 2021

Background: Binge eating is a public health problem associated with reduced physical health (ie, being overweight and obese) and mental health. Binge eating symptoms are so prevalent that many people who struggle with the symptoms have never been diagnosed with the binge eating disorder (BED). Examining the underlying emotional mechanisms of this behavior and the gender differences in these mechanisms remains largely unexplored. Objectives: The present study aimed to investigate the association between internal and external body-image shame and binge eating symptoms in men and women mediated by self-criticism. Methods: This correlation study was based on structural equation modeling. The statistical population of the study included all students of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Finally, using multi-stage cluster random sampling, a total of 313 participants were included in the study. Instruments including Body-Image Shame Scale (BISS), Forms of Self-criticizing/Self-reassuring Scale (FSCRS), and Binge Eating Scale (BES) were used in the study. Results: According to the results, the severity of binge eating symptoms had a positive and significant relationship with external and internal body-image shame, hated-self, and inadequate-self, while it had a negative and significant relationship with reassured-self. The results also indicated that in men, inadequate-self, and reassured-self, and in women, hated-self, inadequate-self, and reassured-self mediated the association between internal and external body-image shame and the severity of binge eating symptoms. Conclusions: Our results indicated that forms of self-criticism could differently mediate the relationship between external and internal body-image shame and the severity of binge eating symptoms in Iranian men and women. This gender difference in the mediation model can be considered in clinical practice, and appropriate treatment methods can be used accordingly.
Historical Knowledge as Self-Understanding in the Films of Whit Stillman
Authors: Yenter Timothy ,   Society for the Philosophic Study of the Contemporary Visual Arts
Published: December 2021

Whit Stillman’s films depict characters attempting to gain relevant knowledge of their historical situation so that they can shape their lives. Through an analysis of scenes from each of Stillman’s films, this essay demonstrates that historical knowledge is presented as a kind of self-understanding in the films. That historical knowledge is useful for gaining control over one’s future as well as for properly evaluating one’s life reveals a philosophically interesting approach to self-knowledge. Stillman’s complex approach of layering contexts further suggests an elusive account of the self.
Financial Power and Democratic Legitimacy
Authors: Prinz Janosch , Rossi Enzo ,   Department of Philosophy, Florida State University
Published: December 2021

To what extent are questions of sovereign debt a matter for political rather than scientific or moral adjudication? We answer that question by defending three claims. We argue that (i) moral and technocratic takes on sovereign debt tend to be ideological in a pejorative sense of the term, and that therefore (ii) sovereign debt should be politicised all the way down. We then show that this sort of politicisation need not boil down to the crude Realpolitik of debtor-creditor power relations—a conclusion that would leave no room for normative theory, among other problems. Rather, we argue that (iii) in a democratic context, a realist approach to politics centred on what Bernard Williams calls ‘The Basic Legitimation Demand’ affords a deliberative approach to the normative evaluation of public debt policy options.
Del ritmo en los refranes, cantinelas y fórmulas
Authors: Oddo Alexandra , Anscombre Jean-Claude , Darbord Bernard
Published: December 2021

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Prólogo
Authors: Oddo Alexandra , Anscombre Jean-Claude , Darbord Bernard
Published: December 2021

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L’enfance du rythme – À propos de comptines
Authors: De Cornulier Benoît
Published: December 2021

Les comptines sont constituées majoritairement de suites de mots ou de quasi-mots dont chacune, associée à deux pulsations d’une séquence isochrone, est un 2coups; ces séquences composent des 22coups, paires de 2coups de même durée. Ces paires sont parfois inclusives plutôt que successives, l’équivalence appariant deux 2coups à des niveaux diff érents d’isochronie. Les relations de métrique inclusive se manifestent morphologiquement dans des successions transformationnelles du type «Eenie meenie miney moe » dans des langues diverses.
Intonation, structure prosodique et versification
Authors: Martin Philippe
Published: December 2021

Les contraintes rythmiques fortes de la versifi cation classique ont évolué dans la versifi cation contemporaine vers une totale liberté. Alors que la versifi cation classique, par des contraintes rythmiques et des permutations syntaxiques, rend l’accès au sens parfois diffi cile, la versifi cation contemporaine au contraire rend plus facile l’accès au sens poétique en optimisant la mise en jeu des mécanismes cognitifs des lecteurs et auditeurs par l’intonation et les pauses.
Ritmo y variación de los refranes: diacronía, diatopía y manipulaciones
Authors: Oddo Alexandra
Published: December 2021

La importancia del metro, del ritmo y de la rima en los refranes ha sido señalada en repetidas ocasiones y se verifica en numerosos ejemplos que, para su observación, se han limitado hasta ahora al estudio de un refrán «fijado» en un estado de lengua sincrónico, sin tener en cuenta su potencial variabilidad tanto en diacronía como en diatopía. Este trabajo pretende investigar la permanencia de dichas características cuando los enunciados se ven sometidos a transformaciones que se mantienen en diacronía o en diatopía, o incluso cuando son manipulados voluntariamente.
Cantinela infantil y rimas en el teatro de Federico García Lorca
Authors: Utrera Torremocha María Victoria
Published: December 2021

Se estudia en este trabajo la cantinela infantil en el teatro de Federico García Lorca. El artículo muestra la importancia de ciertos recursos de repetición entre los que la rima se revela como procedimiento rítmico unificador de la heterometría y del aparente sinsentido. Puede hablarse, por lo tanto, de rima hilada, creadora y generatriz del sentido poemático.
Paying a Church Musician in the Nineteenth Century: Between Possibilities and Necessities
Authors: Budzinauskienė Laima
Published: December 2021

In Europe, the nineteenth century had its own kind of an impact on the development of church music: fellowships that looked over the repertoire of music played in churches and encouraged research into the sources of the old church music and the Gregorian chant started emerging in many different countries. In the middle of the said century, the Holy See released documents that repeatedly and strictly regulated music and especially the music played during masses. Bishops were ordered to establish new music schools, reinforce the existing ones, and form committees in charge of the repertoire, musical performance and care of musicians in dioceses. The salary of the members of church chapels depended on the length of their work and the level of their professionalism. Sometimes the best musicians earned as much as the chapel leader. The leader, who received a certain amount of money to be spent on salaries from the seniors of the church every quarter of the year, distributed it on their own accord, taking into the account the intensity and quality of the instrumentalists’ performance. Each choir singer received the same amount of money, and the salary of the organist depended on the number of masses. Gregorian chanters received smallest salaries. Often the musicians were paid in kind: in food, candles, clothes, footwear, vodka, beer, honey, and the like. Some church chapels even had a cook who prepared breakfasts and lunches specifically for the musicians. Unfortunately, at the end of the nineteenth century, the financial situation of church chapels the financial situation of church chapels changed for the worse much worse.
The Criminals in Vilnius
Authors: Wójtowicz Agnieszka
Published: December 2021

On 29 April 1930, the premiere of Ferdinand Bruckner’s The Criminals (original title Die Verbrecher) directed by Aleksander Zelwerowicz took place at the Teatr Wielki na Pohulance in Vilnius. After two performances, the play was cancelled by the mayor of Vilnius. The authorities of the city were outraged by the ‘drastic amoral scenes (homosexual love, abortion)’. Zelwerowicz submitted his resignation, which he withdrew a few days later. A performance combined with a debate on the drama was organised. One of the Literary Wednesdays was also devoted to a discussion about The Criminals. The Słowo daily published an open letter to the director Zelwerowicz ‘supporting his repertoire policy’. Eventually, The Criminals was cancelled. Based on the unique documents I have found, publications in the press, photographs, and reminiscences of the participants, I will try to reconstruct these events and, above all, to describe and reinterpret the performance that was to ‘introduce the cultural Vilnius to the truly modern and European track’.
Qualities of Musical Instruments as a Device of Hierarchisation
Authors: Yukhymuk Yanina
Published: December 2021

The conflict between specialisation and personality is the main theme in the novels by Peter Høeg, Vladimir Orlov, Jose Saramago, and Patrick Süskind. The protagonists are brought together in their attempts to find and prove their new identities but quite different problems are discovered in the process. The violinist Kasper Krone, the violist Vladimir Danilov, and the unnamed cellist and the double bassist have their own status in the hierarchy of the musical world: this element of the narrative is a lure for readers who would like to learn the secrets of different professions. Sometimes the ways postmodern authors create images both in correlation with professional stereotypes and drama overcomplicate the plot for the unprepared recipient. For them, the variety of allusions and the brilliant game of intertextuality make no sense; however, this problem can be the reason to seek more information about the aforementioned musical opuses for a better understanding. In this case, readers will build strong links between implicit information and the motives of the protagonist’s behaviour.
Historical Context in the Latest Lithuanian Music: Contemporary Tensions
Authors: Landsbergytė Jūratė
Published: December 2021

The historical context opens its unresolved issues inside contemporary cultural consciousness. It gives the language of music a specific dimension of dramatic tensions. Here, composers’ propositions acquire a coded imagery close to the aesthetics of modernist catastrophe. The musical text becomes highly contextual and filled with the knowledge arisen from history. It is like an encrypted message about the current transformation of history. The texture of the work becomes an expression of the signs incorporating also non-musical sounds or visual space. Semantics play a crucial role in soundscapes. In this sense, we can talk about the war and post-war semantics, which is making its comeback into Lithuanian music. Here, the aesthetic poles of tension or the dramaturgy of conflict arise and are realised through the spectra of hum or expression of identities. In this context, two recent works by Lithuanian composers should be mentioned: they accurately respond to the tensions and wounds of the Second World War that continue to bleed inside the identity consciousness of the Lithuanian nation. These wounds are the Holocaust and the post-war partisan struggle against the Soviet occupation. The topic of ‘war after war’ acquires its musical task in Vytautas Germanavičius’s (b.1969) work Red Trees (2018) for flute, cello, and organ dedicated to the partisan commander Adolfas Ramanauskas-Vanagas. It is important to stress that Vanagas has been recognised as a de facto leader of the state and, thanks to sustained efforts of historians and archaeologists, his remains, which were discovered in the Vilnius Orphans’ Cemetery, were reburied in the Pantheon of State Leaders. All this forms an exceptional historical dimension, which finds an original reflection in Germanavičius’s work. Meanwhile, the Holocaust theme connects vividly with the 80th anniversary (late in 2020), of the deed of Chiune Sugihara, the Japanese diplomat who saved over 6,000 Jews in 1940. Algirdas Martinaitis (b.1950) work Visa for Life (2020) for two flutes, oboe, and organ is dedicated to Chiune Sugihara. Here, the composer combines, in a unique way, the worlds of the Japanese, the European tradition and Jewish music. His musical expression is based on the dramaturgy of transformation (the constant running of the toccata). In this way, each composer voices the context of the past: its tension transforms the language of music. It should be noted that both works bring back the catastrophe of the Second World War and the post-war period, which is a painful drama of the history of the Baltic States and not yet sufficiently understood in the world. As a result, the former meditative face of Baltic music identity changes accordingly.
Transformation of the world job market in the conditions of the Fourth Industrial Revolution
Authors: Shirinkina Elena Viktorovna
Published: December 2021

The relevance of this research is substantiated by the fact that the world job market is currently under the influence of the Fourth Industrial Revolution (Industry 4.0). The goal lies in assessing the impact of cyclic and unexpected trends upon the job market, and thus, the forms of job management and employment functions. In this regard, analysis is conducted on the academic theories in the context of conceptualization of the impact of Industry 4.0 upon the job market and employment functions. The long-term trends in transformation of the job market are determined. The empirical basis of this research is comprised of the statistical data provided by Rosstat and the Ministry of Science and Higher Education of the Russian Federation, as well as the resources of analytical articles and scientific publications, including the materials of international organizations, leading consulting companies, global associations, leading educational institutions, other active participants of global educational environment, and job market experts. An overview is given to the trends that affect the companies, their strategies and business models; the impact of such trends upon the transformation of current professions and the emergence of new professions; skills required for these professions. The scientific novelty lies in substantiation of the concept of skill-biased technical change (SBTC) and the theory of routine-biased technological change (RBTC). The presented materials would allow the companies to combine business news with fundamental training of specialists for going along the new career trajectiory in light of the new technological challenges, which defines the practical value of this research.
Preventive activities aimed at strengthening the discipline of the personnel of educational institutions of the Ministry of Internal Affairs of Russia
Authors: Udilov Timofei Vasil'evich , Aleksandroi Vladimir Ivanovich
Published: December 2021

The research is meant to systematize the form of preventive work with subordinate personnel of educational institutions in terms of official discipline, including the road and transport discipline. The research object is social relations emerging during the provision of official discipline and legality of internal affairs officers. The research subject is the preventive activities meant to eliminate disciplinary violations, including those in the field of road and traffic when using personal or official cars.  The research methodology includes the system-structural method, the method of logical analysis and synthesis, the formal-legal and comparative-legal methods.  The research is aimed at studying the issue within the educational discipline “The fundamentals of management in internal affairs bodies of the Russian Federation” of the main professional training programs for the profession of a policeman.  Based on the analysis of literary sources and students’ disciplinary practice, the author analyzes the problems connected with the enforcement of discipline and legality in internal affairs bodies of Russia, including the sphere of road traffic.  The author defines the optimum directions, forms and methods of preventive work aimed at strengthening discipline.  The research results can be used in the work of educational institutions and local internal affairs bodies by the specialists of departments of psychological support and HR, and in the system of professional training.   
Editorial
Authors: Osgood Jayne , Andersen Camilla Eline , Johansson Lotta , Otterstad Ann Merete
Published: December 2021

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From swings, through physics, with pendulums, to gendering: Re-turning diffractive analyses on science and gender in preschool
Authors: Günther-Hanssen Anna , Jobér Anna , Andersson Kristina
Published: December 2021

In this paper we re-turn (Barad, 2014) parts of the diffractive analyses conducted in a research project on science and gender in preschool (Günther-Hanssen, 2018, 2020; Günther-Hanssen, Danielsson, & Andersson, 2020). In our first re-turning, we explore how a swing and scientific phenomena in the data co-created the knowledge construction in entanglements with the researcher. To do this, we engage with how embodiment and re-actualized experiences of swinging came to matter. We then re-turn how certain events in the data are always part of other events, both in time and space. For this task, we elaborate with writing different situations from the data through one another. As we continue re-turning the analysis, new diffraction patterns emerge with each turn. By the end of the paper, our diffractive writings and readings have been re-turned into explanations of how pendulums can be used to think-with and approach gendering in preschool
A tale of grappling: Performative duoethnography as expanded methodological thinking
Authors: Hestad Jenssen Runa , Martin Rose
Published: December 2021

This article is a tale of two researchers, teachers, and artists grappling and playing with duoethnography. By expanding the methodology, we aim to bridge duoethnography into pedagogy. Grappling with the methodological to pedagogical bridge, we found that intertwined performative aspects of doing a duoethnography could challenge our knowledge production and roles as researchers and the current and more dominant practices that we operate within. We engage with a performative paradigm (Bolt, 2016) and lean on relevant theories from new materialist feminist thinkers such as Karen Barad (2003, 2007), Lenz Taguchi (2009, 2012) and Tami Spry (2011, 2016), while dialoguing with Joe Norris and Richard D. Sawyer’s (2012) tenets of duoethnography. Our embodiment of these tenets, intertwined with our theoretical positioning, allows our investigation to expand into a performative duoethnography. As an end, we propose duoethnography as a critical performative pedagogy (Pineau, 2002) and offer this article as a playful impulse connecting methodological considerations with pedagogy.
The Ethos of Citation in Qualitative Research Methodology
Authors: Kuecker Elliott
Published: December 2021

Framed through Kenneth Burke’s famous parlor metaphor, this article considers how decisions related to citation are foundational to scholarly communication, with particular emphasis on qualitative research logics. Each citation decision implicates academicians in complex rhetorical and ethical situations that have material impact on other scholars, students receiving curriculum, and even existential notions related to the very survival of ideas. Believing that the texts we produce matter—both as objects of care and material constructions in themselves—this inquiry walks through theoretical and practical considerations for citation. Additionally, this article incorporates writing activities, and three writing artifacts from contributors, into the text to explore simple ways to play with citation in the classroom and research.
Long-Term Outcomes of Laparoscopic Roux-en-Y Gastric Bypass vs Laparoscopic Sleeve Gastrectomy for Obesity
Authors: Kraljević Marko , Süsstrunk Julian , Wölnerhanssen Bettina Karin , Peters Thomas , Bueter Marco , Gero Daniel , Schultes Bernd , Poljo Adisa , Schneider Romano , Peterli Ralph
Published: February 2025

Importance

Reports on long-term outcomes from randomized clinical trials comparing laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are scarce.

Objective

To compare long-term weight and metabolic outcomes, reoperation rates, and quality of life for patients undergoing SG vs RYGB at 10 years and beyond.

Design, Setting, and Participants

The SM-BOSS (Swiss Multicenter Bypass or Sleeve Study) randomized clinical trial was conducted from January 2007 to November 2011 at 4 bariatric centers in Switzerland. (The last follow-up was obtained in July 2023.) A total of 3971 patients with severe obesity were assessed, and 217 patients were enrolled and randomized to undergo SG or RYGB.

Interventions

Laparoscopic SG or RYGB.

Main Outcomes and Measures

The primary outcome of the SM-BOSS trial was the percentage excess body mass index loss (%EBMIL) at 5 years. The present study reports on the long-term weight and metabolic outcomes at 10 years and beyond, including changes in weight and obesity-related diseases, reoperation rates, and quality of life.

Results

Of 217 patients randomized to undergo SG or RYGB, mean (SD) age was 42.5 (11.1) years, mean (SD) baseline BMI was 43.9 (5.3), and 156 patients (71.9%) were female. Of 217 patients, 110 patients were randomized to RYGB and 107 to SG. Complete 10-year follow-up is available for 65.4% of patients. In the intention-to-treat population, mean (SD) %EBMIL was 60.6% (25.9) after SG and 65.2% (26.0) after RYGB (P = .29). Patients who underwent SG had significantly higher conversion rates because of insufficient weight reduction or reflux compared to RYGB (29.9% vs 5.5%; P < .001). Patients undergoing RYGB had significantly higher mean (SD) %EBMIL compared to SG after 10 years in the per-protocol (PP) population (65.9% [26.3] vs 56.1% [25.2]; P = .048). However, mean (SD) percentage total weight loss was not significantly different between groups (RYGB: 27.7% [10.8]; SG: 25.5% [15.1]; P = .37). SG patients had significantly more de novo gastroesophageal reflux (GERD) compared with RYGB (P = .02).

Conclusions and Relevance

In the SM-BOSS randomized clinical trial, RYGB led to significantly higher %EBMIL in the PP population compared with SG beyond 10 years of follow-up, with better results for GERD. Patients undergoing SG experienced a significantly higher number of conversions to different anatomy compared with RYGB.

Trial Registration

ClinicalTrials.gov Identifier NCT00356213
Early vs Delayed Bypass Surgery in Patients With Acute Coronary Syndrome Receiving Ticagrelor
Authors: So Derek Y. F. , Wells George A. , Lordkipanidzé Marie , Chong Aun Yeong , Ruel Marc , Perrault Louis P. , Le May Michel R. , Sun Louise , Tran Diem , Labinaz Marino , Glover Christopher , Russo Juan , Welman Mélanie , Chan Vincent , Chen Lily , Bernick Jordan , Rubens Fraser , Tanguay Jean-Francois ,   RAPID CABG Investigators, Salapang Gerri , MacPhee Poppy , Abarbanel Tanya , Mitchell Carol , Racine Kendra , Amche Rima , Davies Richard , Davis Darryl , Poulin Anthony , Nair Girish , De Roock Sophie , Tran My-Linh
Published: February 2025

Importance

Perioperative bleeding is a major concern in patients receiving ticagrelor for acute coronary syndromes (ACS) when coronary artery bypass graft (CABG) surgery is required.

Objective

To evaluate whether early CABG surgery at 2 to 3 days after ticagrelor cessation is noninferior to waiting 5 to 7 days.

Design, Setting, and Participants

RAPID CABG was a noninferiority, open-label randomized trial with 6 months of follow-up. Participants were patients with ACS who had received ticagrelor and required CABG. Patients were enrolled in tertiary centers in Canada between January 2016 and March 2021. Data were analyzed from March 2021 to December 2023.

Intervention

Early or delayed CABG.

Main Outcomes and Measures

The primary outcome was based on noninferiority comparison of class 3 or 4 universal definition of perioperative bleeding (UDPB). Noninferiority was prespecified as 8% between groups. Twelve-hour chest tube drainage was reported as a noninferiority comparison. Other bleeding, ischemic, and length-of-stay outcomes were assessed for superiority.

Results

Among 143 randomized patients, the median (IQR) age was 65 (58-72) years; there were 117 male patients (82%) and 26 female (18%). Of these, 123 patients (86.0%) underwent surgery in the allocated time frame (per protocol). The median (IQR) time to surgery was 3 (2-3) days in the early group and 6 (5-7) days in the delayed group (P < .001). In a per-protocol analysis, severe or massive UDPB occurred in 3 of 65 early-group patients (4.6%) and 3 of 58 patients (5.2%) in the delayed group (between-group difference, −0.6%; 95% CI, −8.3% to 7.1%; P = .03 for noninferiority). Median (IQR) chest tube drainage was 470 (330-650) mL vs 495 (380-610) mL (between-group difference −25 mL; 95% CI, −111.25 to 35; P = .01 for noninferiority). Median (IQR) hospital stay was 9 (7-13) days and 12 (10-15) days for the early and delayed groups (P < .001).

Conclusion and Relevance

This study found that an early surgical strategy, 2 to 3 days after ticagrelor cessation, was noninferior in incurring perioperative bleeding. The data support a reduction in the delay between ticagrelor cessation and CABG surgery and may decrease hospital length of stay.

Trial Registration

ClinicalTrials.gov Identifier: NCT02668562
Preoperative SGLT2 Inhibitor Use and Postoperative Diabetic Ketoacidosis
Authors: Dixit Anjali A. , Bateman Brian T. , Hawn Mary T. , Odden Michelle C. , Sun Eric C.
Published: February 2025

Importance

Case reports of postoperative diabetic ketoacidosis in patients using sodium-glucose cotransporter 2 inhibitor (SGLT2i) medications underlie guidance by the US Food and Drug Administration to withhold SGLT2i medication for at least 3 days prior to surgery. Given the potential negative consequences associated with preoperative medication withholding, a large-scale evaluation of the risk of diabetic ketoacidosis in this population is needed.

Objective

To estimate the association between preoperative SGLT2i medication use and postoperative diabetic ketoacidosis in a population of patients who underwent a variety of emergency surgeries. Emergency surgery was chosen given the assumption that a patient would be unable to withhold their SGLT2i medication per the current guidance.

Design, Setting, and Participants

This retrospective cohort study was conducted among a nationwide sample of patients aged 18 years or older with type 2 diabetes who were enrolled in commercial or Medicare fee-for-service insurance plans and who underwent 1 of 13 emergency surgeries between January 1, 2016, and December 15, 2022. Emergency surgeries were defined as those occurring on the same day or the 1 to 2 days after an emergency department claim. Data were analyzed from November 2023 through December 2024.

Exposure

SGLT2i medication use.

Main Outcomes and Measures

Diabetic ketoacidosis, defined by diagnosis codes, in the 0 to 14 days after surgery.

Results

Among 34 671 patients with type 2 diabetes who underwent emergency surgery (mean [SD] age, 63.9 [14.0] years; 19 175 female [55.3%] and 15 496 male [44.7%]), the most common surgeries were laparoscopic cholecystectomy (9385 patients) and transurethral procedures (12 246 patients). There were 2607 patients (7.5%) who used SGLT2i medications and 32 064 patients (92.5%) who did not. Unadjusted incidence of diabetic ketoacidosis was 127 patients (4.9%) for those exposed to SGLT2i medications and 1115 patients (3.5%) for those unexposed. After accounting for covariates, including demographic characteristics, indicators of diabetic severity, comorbidities, and surgery type, the incidence of the outcome was 3.8% for those exposed to SGLT2i medications and 3.5% for those unexposed. The average treatment effect [ATE] was 0.2% (95% CI, −1.7% to 2.2%). Results were robust to alternate specifications (eg, intensive care unit–level care as the outcome: ATE, −1.0%; 95% CI, −2.9% to 1.1%).

Conclusions and Relevance

This study found that preoperative use of SGLT2i medications in patients undergoing emergency surgery was not associated with an increased risk for postoperative diabetic ketoacidosis compared with no use of SGLT2i medications. These findings may justify liberalizing current guidance on preoperative SGLT2i medication withholding periods.
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