bluuebunny/crossref_metadata_2025 huggingface dataset:
Bias
Authors: Kelly Thomas , McGrath Sarah
Published: May 2022

In this chapter the authors aim to illuminate the concept of bias. In the first section, they propose that a potentially fruitful project in this area is to identify, from among the many things to which bias is attributed, those that are fundamental in the order of explanation (e.g., given that bias is frequently attributed to both people and their opinions, can one of these be understood in terms of the other?) In pursuing this project, they offer and defend a hypothesis, the priority of processes, according to which facts about biased people, groups, and outcomes are typically grounded in more fundamental facts about biased processes and procedures. In the second section, they take up questions about the relationship between a whole’s being biased and bias among its parts. In the third section, they offer an account of the concept of bias as it applies to human beings and other entities. According to this account, biases are dispositions to depart from salient symmetry standards in systematic, patterned, or predictable ways. In the final two sections, they offer some remarks about the way in which the concept of bias interacts with the concepts of reliability and knowledge, respectively.
United States Case Study
Authors: Fischerkeller Michael P. , Goldman Emily O. , Harknett Richard J.
Published: May 2022

The United States represents a “least likely” case for cyber persistence theory. Until 2018, the United States applied a deterrence strategy to cyberspace, practicing restraint that further emboldened adversaries. An assessment of US cyber strategy shows that the core logic of cyber persistence theory was applied by 2018, although unevenly across government agencies. The clearest pivot away from deterrence was the Department of Defense’s adoption of “defend forward” and “persistent engagement.” Department of State attribution diplomacy and efforts to establish norms, and Department of Justice public indictments, mostly focused on setting redlines, signaling, and imposing costs to deter, despite little evidence that such actions impact adversary cyber behavior. Uneven adoption of a new cyber paradigm is consistent with Thomas Kuhn’s observations about paradigm change. States best equipped to manage interconnectedness and constant contact will be those that align intergovernmental, private sector, and citizenry efforts with other States in a whole-of-nation-plus approach.
Beliefs and Degrees of Belief
Authors: Titelbaum Michael G.
Published: May 2022

This chapter explains why epistemologists are interested in degrees of belief (also known as "credences"). It compares working with degrees of belief to working with full beliefs and confidence comparisons. The chapter introduces the basic principles of Bayesian epistemology, then describes the contents of the rest of the book.
Phonological phrasing
Authors: Lahiri Aditi , Plank Frans
Published: May 2022

The speech stream is divided up in chunks as it is being planned, delivered, and processed. Focusing on domains at the lower levels of prosodic complexity, in particular that of the phonological word, we trace the history of the scholarly study of prosodic chunking, contrasting two basic approaches. One, prominently espoused in generative grammar, sees prosodic grouping determined by surface-syntactic constituency, directly or mediated through a hierarchy of specifically prosodic units. For the other, with a substantial tradition behind it (here illustrated through a few landmark studies), prosodic grouping is rhythmically motivated, instantiating metrical patterns of prominence alternations rather than being dictated by the groupings of morphology and syntax.
Phonology in the Soviet Union
Authors: Iosad Pavel
Published: May 2022

This chapter considers the development of phonological theory in the Soviet Union, both within the context of its origins in the intellectual atmosphere of late 19th- and early 20th-century linguistics in Russia, and within the light of its later separation into two different frameworks, known as the Moscow and Leningrad Schools. It is shown that both approaches are closely related to other varieties of phonological structuralism, notably the Prague School, and share important similarities in how they addressed issues of phonological analysis. In particular, I argue that many of the analytical choices and controversies were shaped in a significant way by the properties of the phonological grammar of Russian, with which both schools were preoccupied.
Government Phonology in historical perspective
Authors: Ritter Nancy A.
Published: May 2022

This chapter looks at the foundations of, and developments within, the phonological research programme known as ‘Government Phonology’ (GP). Government Phonology is an approach that incorporates a system of fixed principles in conjunction with language-specific parameters, which together operate on representations in terms of minimal computation. This approach, which falls in line with the approach of Government-Binding theory in syntax of the time, brings phonology in line with syntax to yield a unified cognitive approach and further captures why phonology is ‘not’ different from syntax. The chapter discusses the seminal works that underlie GP, and, in so doing, points out how GP diverges from earlier rule-based approaches, shifting the onus to fully enriched representations. This would include the crucial role that the melodic content or internal structure of phonological segments plays in terms of building the sound inventory of a language, and in concepts such as, sonority, and in the manner in which certain processes operate, such as vowel harmony.
Optimality Theory
Authors: van Oostendorp Marc
Published: May 2022

In the mid-1990s, Optimality Theory (OT) was an immediate success within phonological theory. Within a few years, the theory became a lingua franca of phonologists. People would not just work on the theoretical aspects of OT, but also used it to present their results that might also have easily been presented in other frameworks. An unforeseen result of this immense popularity was that the theory had to very rapidly expand its theoretical coverage; and a result of this in turn was that many proposals came on the market to deal with opacity, with faithfulness relations beyond input-output and with language variation and lexical exceptions. If we take all of these proposals, the theory probably overgenerates massively; but that does not take away from its original appeal.
The Measurement of Prisoner Literacy and its Uses
Authors: Crone Rosalind
Published: May 2022

Chapter 2 shows how the spread of schemes to instruct prisoners in reading and writing gave rise to statistics on prisoner literacy. This data, initially recorded in prison registers, and publicised by chaplains in their annual reports, came to the attention of educational reformers, who recognised its utility as educational data which could be used to shape policy on education for the masses. The data was interpreted in such a way as to reinforce the importance of a moral—that is, religious—core in popular education. Prison chaplains became central players in this interpretation, and thus contributed to the entrenchment of the ‘religious problem’ in educational policymaking, further delaying the introduction of a national system of elementary education in England.
Neighbours, Distrust, and the State
Authors: Brodie Marc
Published: May 2022

There has been a growing acceptance among historians that significant social and personal tensions and divisions existed even within the apparently homogeneous and solid ‘traditional’ working-class communities in Britain before World War Two. But no work has been undertaken on how any such conflicts and distrust also affected political views—and particularly attitudes held towards external institutions such as the state. A larger role for government, it has continued to be argued, was generally rejected by these communities. This book investigates, across a range of topics, whether it is true that the poor in particular were hostile towards the interventions of the state in Britain in this period. It suggests that the evidence previously used by historians looking at this question painted a somewhat distorted picture of uniformity. There was a far more diverse range of attitudes than realized within these communities. Power differences (including between men and women) and struggles with neighbours or others of the working class were crucial in the development of individuals’ attitudes. Many of the poor wanted authorities to have a larger role, and for there to be greater intervention, in neighbourhoods, institutions, and lives. As well as being a direct challenge to current historical understandings on this topic, this book’s themes have a contemporary political relevance. Many of the points it makes are also important for further challenging the idea, held across much of the political spectrum, that understanding a ‘lost’ solidarity of working-class neighbourhoods is essential to comprehending current political responses in these communities.
Police
Authors: Brodie Marc
Published: May 2022

Widespread community hostility towards the police—perhaps the most visible arm of the state—is one of the most entrenched historical ideas about how the working class reacted to the intervention of outsiders. This chapter shows that, in fact, fear of the more powerful and threatening within their own neighbourhoods led many of the poor to support, and want more action from, the police. Previous historical views have largely been based upon what men said and did (particularly those who were coming into conflict with the police) and have largely ignored how the less powerful, such as women and the elderly, felt about the role of these authorities. We should recognize that those in working-class neighbourhoods in this period could be ‘terrorised’ by antisocial behaviour, and want assistance, in just the same way that we might accept now.
Conclusion
Authors: Brodie Marc
Published: May 2022

A key theme emphasized throughout the book is that it is vital to recognize power differences within working-class communities when considering diversity in their views, particularly in this case towards the state. Differences in gender, age, or other types of vulnerability (or their feelings of ‘threat’) matter a great deal. We also saw how important it is, with this topic as with others, to look closely at whether historical evidence has been drawn too much from the responses and actions of a particular group. The themes of the book are also connected by a recognition that a less positive view of human nature (and a focus on personal failings—including of those in their own neighbourhood) was—(and still is) very important in the political views of the poorer working class. They also often wanted better provision of state services, rather than a withdrawal of government interference.
The Statute of the Pan-African Intellectual Property Organisation: A Human Rights Perspective
Authors: Kolawole Oke Emmanuel
Published: May 2022

This chapter focuses on the interface between intellectual property and human rights in the African context. This is important because of the African Union (AU) legal order’s emphasis on human rights as encapsulated in Article 3(c) of the AU Constitutive Act. The chapter examines the Statute of the Pan-African Intellectual Property Organisation (PAIPO Statute) in light of the potential impact that it could have on human rights to health and education (which are both recognized in the African Charter on Human and Peoples’ Rights). It contends that there is a need to incorporate a human rights perspective into the PAIPO Statute by amending its provisions accordingly. Specifically, the provisions of Article 4 of the Statute which outlines the functions of PAIPO needs to be revised to bring it in line with the objectives of the AU and also to avoid any incoherence between the Statute and the African Charter on Human and Peoples’ Rights.
The Quasi-Supranational AU and the International Criminal Court
Authors: Chigara Benedict Abrahamson
Published: May 2022

The Eurocentric inclinations of international law that lie at the core of its foundations have become a deliberate target of the quasi-supranational African Union (AU) that, unlike its predecessor, the Organisation of African Union (OAU), regards non-compliance with a perceived discriminatory international legal system as a duty. International law’s perceived historic inferiorization of African situations from slavery, colonialism, economic structural adjustment projects sponsored by Bretton Woods institutions, among others, collectively appear to be the main basis of the reactionary attitude of the AU to the International Criminal Court – one of international law’s youngest and most powerful institutions. African Member States Parties of the ICC appear to be asserting that an international legal order that maintains a disdainful look at Africa while its strictures may be under scot-free attack elsewhere is no longer sustainable. By modernizing and transforming their regional organization around the same time that the ICC came into force, discarding the OAU and replacing it with the quasi-supranational AU, African states appear to have been quietly and deliberately readying themselves for the next phase in their own approach to international relations, namely, one that challenges inferiorization of African situations by insisting on the UN value of equality of sovereign independent states.
Land, Property, and Human Rights in AU Law and Policy
Authors: Home Robert
Published: May 2022

The importance of land as property and a natural resource is increasingly recognized internationally and in the Banjul Charter of Human and Peoples’ Rights. UN-Habitat operates a Global Land Tools Network (GLTN) to improve access to land for the poor and regularization of informal settlements. The AU recognizes the importance of land policy and its legal regulatory framework, for instance in the AU Declaration on Land Issues (2009), and recent judgments of the African Court of Human and Political Rights relate to land in violations of the right to property. Many disputes and conflicts over land in sub-Saharan Africa occur, both between and within states. Land can be a ‘site of struggle’ between elites and the people, and between competing legal systems (such as communal land regimes and land titling programmes advancing de Soto’s support to private property rights). Early determinations by the African Court of Human and Political Rights have supported Indigenous peoples, but implementation is not progressing, both because of opposition by the state and the complex and long-standing nature of the cases. This chapter draws from theories of historic institutionalism. Case law and the importance of group claims to ancestral lands are investigated in the context of an emerging AU law.
Sustainable Development and the AU Legal Order
Authors: Ekhator Eghosa
Published: May 2022

Sustainable development has been at the centre of discourse in the African Union (AU) and its Member States in recent times. Over time, the AU has developed mechanisms on sustainable development including conventions and different policies and programmes. This chapter critically analyses these mechanisms and their possible implications in the development of sustainable development norms in Africa. This chapter argues that the various AU treaties on the environment and initiatives on sustainable development are an integral part of the emergent AU legal order on the continent. This chapter discusses the utility of the African Charter on Human and People’s Right and Agenda 2063 as integral aspects of sustainable development under the AU and hence contributing to the emergent AU legal order. This chapter focuses on the contribution of the African Charter and Agenda 2063 to the development of sustainable development norms under the AU’s framework.
Machiavelli's Broken World
Authors: Najemy John M.
Published: May 2022

Machiavelli was painfully aware of living in a disastrous moment of Italy’s history: foreign invasions, occupations, and shattered states. This is a study of his evaluation of the failures of Italy’s political leaders, professional soldiers, and popes—and of the underlying causes of those failures. The first chapter presents Machiavelli’s reactions to Italy’s travails during his years in Florence’s chancery. Chapter two surveys his critique of Italy’s republics and princes. The next two explore the dispatches from Machiavelli’s diplomatic missions (legations) when he observed the self-destructive delusions and ambitions of the would-be prince, Cesare Borgia, and the recklessness of Pope Julius II. Searching for the causes of the dysfunctions of this “broken” political world, Machiavelli focused on the “ambition” and “avarice” of Italy’s elite families. The central fifth chapter analyzes his theorization of this class’s relentless ambition and abuses of power, particularly its preference for extra-constitutional private power through factions that weaken law and governments—what he called corruption. Four chapters examine his understanding of elite politics in the historical context of the Florentine republic: the ambition of elite families leading to competing private factions aiming to control the republic from outside the institutions of government, and eventually to the dominance of the Medici faction, which, after suppressing its rivals, tolerated no dissent and drove all opposition into conspiracy, itself living in fear of conspiracies, real or imagined. The last chapter contends that, for Machiavelli, those who corrupted legal institutions in pursuit of private power represent the most dangerous kind of tyranny, the collective tyranny of the wealthy and powerful.
The Papacy and Julius II
Authors: Najemy John M.
Published: May 2022

Chapter 4 explores Machiavelli’s assessment of the Church’s role in Italy’s troubles. In his major works he outlines the growth of the Church’s political power, scathingly criticizes the papacy for eroding the piety of Italians and keeping Italy disunited, blames Christianity for teaching the passive acceptance of sufferings instead of the vigorous defense of one’s country, and blames Saints Francis and Dominic for teaching that “it is evil to speak evil of evil” and allowing churchmen “to do the worst they can.” Machiavelli praises Roman religion but shows how the nobles manipulated the oath and the auspices to deceive the plebs. Savonarola was learned and virtuous, but misused his political influence. In 1503 Machiavelli witnessed Pope Julius’s destruction of Cesare Borgia and in 1506 accompanied Julius on his seemingly reckless campaign to humble Giampaolo Baglioni of Perugia and remove the Bentivoglio of Bologna. Throughout he emphasizes Julius’s erratic, impulsive, indecisive, choleric, and imperious nature. In 1510 Machiavelli was sent to France to persuade Louis not to pressure Florence to send troops to support French positions in Lombardy. After tense meetings that focused on Julius’s threats against Florence and the danger he represented to peace in Italy, Machiavelli succeeded in persuading the king to drop the demand. Julius’s successes despite his lack of prudence posed theoretical issues that Machiavelli explored in the Ghiribizzi, The Prince, and the Discourses. Ultimately, he portrayed him as the author of Italy’s ruin.
Decision Weights for Experimental Asset Prices Based on Visual Salience
Authors: Bose Devdeepta , Cordes Henning , Nolte Sven , Schneider Judith Christiane , Camerer Colin Farrell
Published: May 2022

We apply a machine-learning algorithm, calibrated using general human vision, to predict the visual salience of prices of stock price charts. We hypothesize that the visual salience of adjacent prices increases the decision weights on returns computed from those prices. We analyze the inferred impact of these weights in two experimental studies that use either historical price charts or simpler artificial sequences. We find that decision weights derived from visual salience are associated with experimental investments. The predictability is not subsumed by statistical features and goes beyond established models.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Dominance of Ciliophora and Chlorophyta Among Phyllosphere Protists of Solanaceous Plants
Authors: Taerum Stephen J. , Steven Blaire , Gage Daniel , Triplett Lindsay R.
Published: May 2022

Phyllosphere microbiota play an important role in shaping plant health and function but most research has focused only on bacterial and fungal communities. As a result, little is known about the composition of diverse microeukaryotes in the phyllosphere, including protist predators and algae, or how they are affected by host species or cooccurring bacteria. Using universal eukaryotic primers and a peptide nucleic acid clamp to block amplification of the plant 18S ribosomal RNA gene, we profiled the phyllosphere and rhizosphere microbiomes of five solanaceous crop species grown in a field plot in Connecticut, United States. Phyllosphere communities of protists, like those of bacteria, were far less diverse and more variable than those of the rhizosphere. Phyllosphere samples contained hundreds of protist sequence variants from at least seven major eukaryotic lineages, of which one-fifth were not observed in bulk soil or rhizosphere samples. Phyllosphere samples were highly enriched for a few specific sequence variants representing green algae (Chlorophyta order Chlamydomonales) and ciliates (Ciliophora class Colpodea), while rhizospheres were dominated by protists from the phylum Cercozoa. Correlation analysis identified Sphingomonas spp. bacteria as central network hubs positively associated with protists in the phyllosphere and rhizosphere. These findings indicate that, although leaf surfaces host a highly variable protist community of limited diversity, certain ciliates and green algae may be well adapted for the phyllosphere habitat.
Sources, Detection, and Inoculum Quantification of Flower Blight Pathogens in Macadamia
Authors: Prasannath Kandeeparoopan , Galea Victor J. , Akinsanmi Olufemi A.
Published: May 2022

Dry flower disease caused by Pestalotiopsis/Neopestalotiopsis spp., green mold caused by Cladosporium spp., and gray mold caused by Botrytis spp., collectively known as flower blight cause significant yield losses in macadamia. Potential sources of inoculum of the various pathogens in macadamia tree canopy were examined using pathogenicity tests and a multiplex quantitative PCR (qPCR) assay developed in this study. The qPCR assay detected and quantified the relative abundance of the inoculum of flower blight pathogens. The assay revealed that remnant racemes contributed a high amount of inoculum of all the three groups of flower blight pathogens, while the yellow halo leaf spot contributed only Pestalotiopsis/Neopestalotiopsis species. The amount of conidia per gram of remnant racemes ranged from 7 × 103 to 2 × 104 for dry flower disease, 3 × 103 to 1 × 104 for green mold, and 5 to 8 × 103 for gray mold pathogens. Conidia of Pestalotiopsis/Neopestalotiopsis species quantified from leaf spots varied from 1 × 102 to 1 × 103 per cm2. Pathogenicity tests performed on developing racemes under field conditions, using conidial suspensions from both sources of inoculum (remnant racemes and yellow halo leaf spot), resulted in severe flower bight symptoms. Disease severity was not significantly different ( P > 0.05) when remnant racemes were incubated directly with the developing racemes compared with inoculation with conidial suspension from the material. This suggests that racemes from preceding seasons that remain in the tree canopy carryover inoculum between seasons and should be removed as a control option for flower blights in macadamia orchards.
Understanding the Radiation Soaking Effect in Neutron Survey Instruments
Authors: Mozhayev Andrey V. , Piper Roman K.
Published: May 2022

The drift in response of neutron survey meters that employ moderated 3He and BF3 proportional counters has been reported and investigated by instrument calibration laboratories for over 20 y. When within a constant radiation rate field of high intensity, dose rate readings of an instrument may steadily increase with a rate proportional to the field intensity before reaching a relatively stable plateau. This phenomenon, commonly referred to as the radiation soaking effect, has been attributed to the accumulation of charge on insulating surfaces inside the detector. This paper provides results of a study specifically conducted to better understand the effect and, hence, to possibly identify mitigation techniques. The magnitude of the effect in different instruments tested under the same conditions has been assessed, and a reason for the detector response variance has been clearly identified. In addition to measures used in calibration practice to compensate for the radiation soaking effect, a potential method to return an instrument sensitivity to its baseline level is also discussed.
Indications and Results of Emergency Penetrating Keratoplasty With Simultaneous Cataract Surgery (“Triple-PKP à Chaud”)
Authors: Berger Tim , Seitz Berthold , Flockerzi Elias , Suffo Shady , Daas Loay
Published: May 2022

Purpose:

The purpose of this study was to analyze the indications and clinical results of emergency penetrating keratoplasty with simultaneous cataract surgery (“Triple-PKP à chaud”).

Methods:

This study included all subjects who underwent Triple-PKP à chaud between 2006 and 2020 at the Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar in Germany. Data obtained from patient records were retrospectively analyzed.

Results:

Triple-PKP à chaud was successfully performed in 27 of 29 eyes with a mean age of 66.0 ± 19.9 years. Previous surgery was performed in 20 eyes (69.0%), most frequently amniotic membrane transplantation in 11 eyes (37.9%) and previous keratoplasty in 9 eyes (31.0%). The most common indication was infectious keratitis (62.1%). In 27 subjects (93.1%), capsulorhexis was performed using the open-sky technique. The most frequent intraoperative complication was positive vitreous pressure (24.1%). In 2 eyes (6.9%), no intraocular lens implantation was performed because of posterior capsule rupture. The preoperative uncorrected visual acuity improved from 2.2 ± 0.6 logMAR (range = 3.0–0.7 logMAR) to 1.3 ± 0.7 logMAR (range = 3.0–0.18 logMAR) postoperatively (P < 0.001). Common postoperative complications were suture loosening (44.4%) and corneal epithelial defects (33.3%). Repeat keratoplasty was necessary in 14 eyes (51.9%), including 9 eyes (64.2%) within 12 months postoperatively. The mean graft survival was 12.2 ± 17.9 months (range = 1–69 mo).

Conclusions:

Triple-PKP is also feasible in emergency conditions. Nevertheless, the surgery is associated with an increased risk of intraoperative and postoperative complications. Combined surgery should, therefore, only be performed in severely diseased eyes with progressed stage of cataract.
What Hundreds of Millions of Patients With Dry Eye Will Find on YouTube: A Quality and Reliability Research of the YouTube Videos
Authors: Sakallioğlu Ahmet Kürşad , Garip Rüveyde
Published: May 2022

Purpose:

The aim of this study was to evaluate the demographic features, quality, and reliability of YouTube videos addressing dry eye disease (DED).

Methods:

The term “dry eye disease” has been searched on YouTube. The first 500 videos that emerged using the defined search term were evaluated. Duplicated-split videos, videos shorter than 60 seconds, videos with a language other than English or videos with an unintelligible English accent, and videos unrelated to DED were excluded. Video uploaders, types, origins, durations, and viewer interactions of the videos were noted. DISCERN, the Global Quality Score, and the Video Quality Score (created by the authors) were used to evaluate the video quality.

Results:

Of the 500 videos, 262 videos were excluded, and the remaining 238 videos were evaluated. Videos were of moderate quality on all 3 scoring systems. The medical institute and academic society videos had the highest quality (P < 0.05). The quality of videos uploaded by physicians was significantly lower than medical institute and academic society videos and was higher than the others (P < 0.05). User interactions and video duration were weakly positively correlated with the video quality (P < 0.05).

Conclusions:

Among YouTube videos on DED, only a minority are of good or excellent quality. Videos uploaded by medical institutes or academic societies scored higher in quality than those uploaded by physicians, which, in turn, scored higher than those uploaded by all others. User interactions were weakly correlated with quality values, suggesting user interactions are not good indicators of the quality of YouTube videos on DED.
Physical Therapy Education Program Faculty Challenges, Concerns, and Priorities During the COVID-19 Pandemic: Looking Back and Moving Forward
Authors: Majsak Michael J. , Hall Cheryl A. , Kirsch Nancy R. , Krencicki Dennise B. , Locke Elizabeth , Hyland Nannette
Published: May 2022

Introduction.

Faculty in U.S. physical therapy education programs made a rapid, reactive curricular modifications in response to the COVID-19 pandemic. The purpose of this study was to analyze the challenges and concerns of faculty in New York (NY) and New Jersey (NJ) during the pandemic, and their priorities for being adaptable, well-resourced programs moving forward.

Review of Literature.

The COVID-19 pandemic was a major program disruption for many physical therapy education programs. Historically, health profession programs making curricular transitions in response to unplanned disruptions realize benefits, but also challenges, limitations, and resource needs.

Subjects.

One hundred thirty-seven faculty across the 47 physical therapy education programs in NY and NJ participated in this study.

Methods.

A team of NY and NJ physical therapy education program directors and directors of clinical education generated an internet-based survey for analyzing the challenges and concerns NY and NJ faculty experienced during the COVID-19 pandemic in online teaching, personal challenges, academic issues, and campus activities. A mixed-methods approach was used to analyze the data from closed-end and open-ended questions. Statistical analysis was carried out on faculty demographics and ratings of challenges and concerns, and inductive thematic analysis of faculty responses to the open-ended questions.

Results.

Major faculty challenges were lack of contact, increased workload, and learning online technology. Major concerns were decreased quantity of hands-on laboratories, difficulty assessing student hands-on skills, delays in clinical education experiences, and student and faculty safety during on-campus activities. Six themes were identified: online education challenges, student and faculty safety, faculty personal needs, quality of student outcomes, communication, and administrative/institutional support.

Discussion and Conclusion.

An appreciation of faculty challenges and concerns during the COVID-19 pandemic and priorities for moving forward are important for programs making curricular transformations hybrid education to be better prepared for program disruptions.
A Guide to the Postmortem Investigation of Starvation in Adults
Authors: Garland Jack , Irvine Rebecca
Published: May 2022

Starvation is a rare cause of death in developed countries and is a complex multifaceted pathological process. To complicate the forensic investigation of starvation further, many medical conditions independent of starvation may cause wasting. This article provides one of the first comprehensive guides to the postmortem investigation of starvation in adults, with reference tables on organ-specific macroscopic and microscopic features, as well as features for excluding alternative causes of wasting. The eclectic literature on this complex topic is summarized in an accessible and easily referenced format, including mechanisms of death and ancillary postmortem investigations.
Prostatic Carcinoma With Aberrant Expression of p63: A Case Report and Review of the Literature
Authors: Paulk Adina , McCool Isaac , Sesterhenn Isabell , Burke Allen
Published: May 2022

Prostatic carcinoma with aberrant expression of p63 is a rare variant of prostate cancer, which represents a potential diagnostic pitfall, as it may be easily confused with either benign prostatic glands or high-grade prostatic carcinoma. In studies of radical prostatectomies, these tumors appear to behave like low-grade carcinomas despite frequent poorly formed architecture. We report a case of prostatic carcinoma with aberrant expression of p63 with a review of the literature and helpful features in the differential diagnosis of this entity.
The Morphologic Spectrum of Castration-Resistant Prostate Cancer: Case Reports and Literature Review
Authors: Burke Allen , Legesse Teklu , Paulk Adina
Published: May 2022

Conventional acinar prostatic carcinomas are dependent on the androgen receptor (AR) to proliferate. Androgen deprivation therapy (ADT) is a common treatment for prostate cancers that have metastasized and is also being administered as first-line therapy with or without radiation therapy for intermediate- or high-risk disease. Cancers that recur after initially responding to ADT, or castration-resistant prostatic carcinomas (CRPCs), have a poor prognosis and are more likely to show divergent differentiation than de novo carcinomas. This review will present four cases of CRPC to highlight the morphologic spectrum, discuss effects of ADT on prostatic tumors, and discuss neuroendocrine prostatic tumors.
Malignant Cells in Urine Cytology: Not Always High-Grade Urothelial Carcinoma
Authors: Jager Lucy , Morency Elizabeth G. , Choy Bonnie
Published: May 2022

The main purpose of urine cytology is the detection of high-grade urothelial carcinoma (HGUC). When malignant cells of nonurothelial origin are present, it is often misdiagnosed as HGUC due to the rarity of this event and difficulty in distinguishing subtle cytomorphologic differences. To arrive at the appropriate diagnosis, evaluation of urine cytology specimens requires correlation with clinical and radiologic findings and utilization of cytologic-histologic correlation. We present the case of a 64-year-old woman with gross hematuria. Imaging located an infiltrative mass involving the left renal pelvis, highly suggestive of urothelial carcinoma. Lymphadenopathy and multiple bony lesions in the spine were concerning for metastatic disease. Urine cytology specimens taken during cystoscopy contained malignant cells, which were interpreted as HGUC. The workup of a subsequent lymph node biopsy showed a metastatic high grade carcinoma of renal origin with SMARCB1 loss. This finding led to the reexamination of the urine cytology specimens, revealing the malignant cells were not HGUC but rather renal carcinoma. This case highlights a potential pitfall in the evaluation of urine cytology and the importance of cytologic-histologic correlation.
The Importance of Mentorship in Shaping the Careers of Academic Leaders in Plastic Surgery
Authors: Janes Lindsay E. , Kearney Aaron M. , Taub Peter J. , Gosain Arun K.
Published: May 2022

Background:

The majority of successful academic physicians cite mentorship as a critical element of their achievements. The goal of this study was to survey established leaders in plastic surgery to identify the importance that mentorship played in their career development, and to identify common themes that enabled them to “pay it forward” in helping to develop the next generation of leaders in plastic surgery.

Methods:

The authors performed a qualitative survey of 14 established leaders in plastic surgery (mentors) in the United States with a strong reputation for mentorship. The authors asked each to identify a key mentor (senior mentor) and mentee, grouping them in triads of a senior mentor, mentor, and mentee. The authors then submitted a similar survey to the mentee.

Results:

Thirteen mentor-mentee pairs for which both members had responded were included. After reviewing responses to these questions, the authors elicited a number of recurring themes. All respondents emphasized the importance of mentorship to their success in academic plastic surgery. Additional themes included encouraging mentees to find their passion, leading by example, discussing complex cases with residents/students, and using research time as an opportunity.

Conclusions:

Strong patterns of mentorship are highlighted among the careers of leaders in academic plastic surgery. The authors advocate for formation of mentorship relationships within training programs and more national mentorship programs such as those emerging through the American Society of Plastic Surgeons and the Plastic Surgery Research Council for interested medical students, residents, and junior faculty.
The Barriers and Enhancers to Trust in a Just Culture in Hospital Settings: A Systematic Review
Authors: van Marum Sjoerd , Verhoeven Daan , de Rooy Diederik
Published: May 2022

Objectives

Healthcare workers wanting to report errors often encounter a culture of fear or blame. A just culture can improve patient safety by promoting safe and open communication, trust is hereby essential. We defined trust in a just culture when healthcare professionals believe that error communication is honest, safe, and reliable. In this study, we investigated barriers and enhancers to trust in error reporting in a just culture.

Methods

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, Emcare, and Web of Science database were searched on June 21, 2021.

Results

Several factors were found to influence trust in error reporting in a just culture, namely, organizational factors, team factors, and experience. Trust depends on the management style, open information about error handling, a focus on patient safety instead of blaming an individual, a well-executed walk-round, a code of professionalism, and a departmental incident reporting system (organizational factors). A close relationship between employee and primary supervisor, with discussion of the nature of an error and ascribing clear roles to physicians in care teams, can be enhancers of trust in error reporting. Moreover, creating a mutual understanding of the challenges faced by professionals can enhance trust (team factors). Trust in error reporting is also influenced by a health professional’s experience and training in patient safety. Factors such as a lack of confidence in clinical skills, more fear of shame/blame by less experienced workers, and knowledge of the existing error reporting system will influence a person’s trust in error reporting (experience).

Conclusions

This systematic review identified barriers and enhancers to trust in error reporting in a just culture. The barriers and enhancers can be divided into 3 main themes: organizational factors, team factors, and experience. Findings show that trust can be learned and created based on practical principles.
Pressure Injury Prediction Model Using Advanced Analytics for At-Risk Hospitalized Patients
Authors: Do Quan , Lipatov Kirill , Ramar Kannan , Rasmusson Jenna , Pickering Brian W. , Herasevich Vitaly
Published: May 2022

Objective

Analyzing pressure injury (PI) risk factors is complex because of multiplicity of associated factors and the multidimensional nature of this injury. The main objective of this study was to identify patients at risk of developing PI.

Method

Prediction performances of multiple popular supervised learning were tested. Together with the typical steps of a machine learning project, steps to prevent bias were carefully conducted, in which analysis of correlation covariance, outlier removal, confounding analysis, and cross-validation were used.

Result

The most accurate model reached an area under receiver operating characteristic curve of 99.7%. Ten-fold cross-validation was used to ensure that the results were generalizable. Random forest and decision tree had the highest prediction accuracy rates of 98%. Similar accuracy rate was obtained on the validation cohort.

Conclusions

We developed a prediction model using advanced analytics to predict PI in at-risk hospitalized patients. This will help address appropriate interventions before the patients develop a PI.
Clinical and Cost-Saving Effects of the Drug Utilization Review Modernization Project in Inpatient and Outpatient Settings in Korea
Authors: Yoon Dongwon , Song Inmyung , Jeon Ha-Lim , Bea Sungho , Choi Ahhyung , Lee Hyesung , Shin Ju-Young
Published: May 2022

Objectives

Korea’s national health insurance authority introduced a drug utilization review modernization pilot project in which health professionals provided follow-up services to monitor adverse drug events. We aimed to evaluate the effects of the project on clinical and economic outcomes.

Methods

We conducted difference-in-differences analysis using National Health Insurance claims data from the Health Insurance Review and Assessment Service. We calculated the number of adverse drug events and allergic reactions as a clinical indicator and medical costs incurred to manage these events as an economic indicator. Absolute difference in each outcome measure was defined as the value after the project minus the value before the project. Difference-in-differences was defined as a difference in absolute differences between the intervention group and the control group.

Results

Overall, difference-in-differences were −43 and −826 for the number of drug-related adverse events and allergic reactions and −$198,700 and $53,318 for medical costs in the inpatient and outpatient settings, respectively. For outpatients, the monthly number of adverse drug events and allergic reactions has grown higher for the control group than for the intervention group after implementation of the pilot project.

Conclusions

Implementation of the pilot project lowered the number of adverse drug events and allergic reactions in the inpatient and outpatient setting. The project also lowered medical costs incurred to manage these events in the inpatient setting only. Based on our findings, we recommend that the pilot project be expanded on a nationwide level at least in the inpatient setting.
How do primary care providers perceive their role at ensuring opioid safety? A qualitative exploration from those on the front lines
Authors: Gillette Chris , Garvick Sarah , Ip Edward Hak-Sing , Hurley Robert , Kirk Julienne , Crandall Sonia
Published: May 2022

Introduction

Prescribing naloxone is recommended by the Centers for Disease Control and Prevention to reduce the risk of death from an opioid overdose. Naloxone is rarely prescribed, even when indicated; improving our understanding of how primary care providers (PCP) perceive their role in naloxone prescribing is essential to increase opioid medication safety. The objectives of this study were to: (1) describe how PCPs perceive their role in prescribing naloxone for patients who are at high risk of an overdose and (2) describe PCP-reported barriers and facilitators of naloxone prescribing.

Methods

Currently practicing providers completed semi-structured interviews, based on Theory of Planned Behavior, to understand their attitudes toward naloxone, their perceived role in naloxone prescribing, and facilitators/barriers to prescribing naloxone.

Results

Eleven interviews were conducted with physicians (n=2), physician assistants (n=8), and a nurse practitioner (n=1). Providers held generally positive attitudes toward naloxone as a ‘rescue’ medication. Negative attitudes toward naloxone include the perception of facilitating risky opioid use. Providers suggested that whomever prescribes the opioid pain medication should be primarily responsible for prescribing naloxone. Providers noted that stigma may prevent them from discussing naloxone during clinic visits. Increasing visit time and receiving support/education from organizational and professional society leadership were identified as important facilitators of naloxone prescribing.

Conclusions

While providers were aware of what naloxone was used for, there was reticence in discussing this medication with patients. Providers reported that whomever prescribes a pain medication should be primarily responsible for ensuring medication safety. If primary care organizations would like to improve opioid medication safety, ensuring that providers feel supported and receive needed education are essential.
Psychometric properties of the Copenhagen Burnout Inventory (CBI) in Italian physicians
Authors: Nicolò Aiello Edoardo , Fiabane Elena , Margheritti Simona , Magnone Stefano , Bolognini Nadia , Miglioretti Massimo , Giorgi Ines
Published: May 2022

Background

Assessing burnout in physicians is relevant as it can adversely affect both their mental and physical health by also decreasing the quality of care, especially since the onset of the COVID-19 pandemic. This study aimed at standardizing the Copenhagen Burnout Inventory (CBI), a psychometrically sound, worldwide-spread tool, in Italian physicians.

Methods

Nine-hundred and fifteen Italian physicians were web-administered the CBI, Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder-7 (GAD-7) and General Self-Efficacy Scale (GSE). The present CBI is a self-report questionnaire including 18 Likert items (range=19-90) assessing Personal, Work-related and Client-related Burnout. Client-related adaptation was performed. Construct validity, factorial structure (Confirmatory Factor Analysis) and internal consistency were tested. Diagnostic accuracy was assessed simultaneously against the PHQ-8, GAD-7 and GSE.

Results

All CBI measures yielded optimal internal consistency (Cronbach’s α=.90-.96). The CBI met its original three-factor model (CFI=.94; TLI=.93; RMSEA=.09; SRMR=.04), was positively related with the PHQ-8 (r=.76) and GAD-7 (r.=73), whereas negatively with the GSE (r=-.39), and yielded optimal diagnostics (AUC=.93; sensitivity=.91 and specificity=.85 at the optimal cut-off of 69/90).

Discussion

The CBI is a valid, reliable and normed tool to assess burnout levels in physicians, whose use is encouraged in both clinical practice and research as being short-lived, easy to use and openly accessible.