bluuebunny/crossref_metadata_2025 huggingface dataset:
A Life Course Approach to Addressing Exponential Inequalities
Authors: Blackham Alysia
Published: January 2023

This chapter argues that age is an exponential amplifier of inequality. It puts forward a life course perspective as a nuanced lens for enriching our understanding of discrimination and its impacts over time. A life course approach offers a targeted focus for addressing exponential inequalities, drawing our attention to discrimination at critical transition points. Building on this life course perspective, experiences of discrimination over time can be seen as non-linear and multi-directional, but still interlinked and biographic, punctuating and shaping life stories in unpredictable ways. These ideas are illustrated through a case study of gendered ageism at work, drawing on empirical evidence to map how gender inequality is amplified with age and time, and further exacerbated by the impacts of the Covid-19 pandemic. Viewed with this life course lens, this chapter argues that discrimination law appears fundamentally ill-adapted for responding to exponential inequalities. The chapter therefore considers the extent to which ‘next generation’ positive duties—like the Gender Equality Act 2020 (Vic)—might address these concerns.
Covid-19 and Exponential Reproductive Rights-related Inequalities in Brazil
Authors: Machado Marta , Penteado Taís
Published: January 2023

The exponentiation of gender inequalities during the pandemic and the centrality of care work and sexual violence in this equation make the Covid-19 crisis a critical juncture that exposes the inextricable relation between sexual and reproductive rights and equality. Aggravating the situation, during the Covid-19 crisis, the Brazilian government accelerated the process of hollowing out the access to contraception and legal abortion services in the public health system. This has taken many forms—the most serious being the issuing of an executive measure imposing new formal barriers to access the right to legal abortion (Ordinance No 2282 of 27 August 27 2020). By using the Reproductive Justice Framework as a critical lens, this chapter unearths the inequality dimensions of reproduction—exponentiated by the combination of the Covid-19 crisis and the government’s attacks on reproductive rights. Grounded in empirical data, it proposes the formulation of legal challenges to the Ordinance through the mobilization of the substantive equality approach. The equality-based argument envisioned in the chapter has as premise the idea that intersectional inequalities are related to social hierarchies and that equality, in turn, would demand the dismantling of such relations. It is argued that restrictions on abortion, when seen in context, emerge as issues that arise from, are permeated by, and perpetuate inequalities and, as such, should be legally treated accordingly.
War and Democratic Conflict
Authors: Arterton F. Christopher
Published: January 2023

This chapter confronts the reality that war and politics are two ends of a spectrum defined by the management of social conflict. The differences are instructive. Democratic politics takes place within institutions that define appropriate conduct. In contrast, the existential threats faced by a nation may justify military actions that otherwise would be considered unethical. Military strategists must consider the importance of thinking long term and the necessity of preparedness for the enemy’s actions. In both war and politics, it is essential to rise above the day-to-day tactical complications and focus upon larger and enduring objectives. Reliance upon predictability of the opponent’s movements focuses one’s attention squarely on the aspects of the conflict that one can control and those that one cannot. Both military leaders and political managers must function in the face of substantial volatility, uncertainty, complexity, and ambiguity.
Strategic Planning
Authors: Arterton F. Christopher
Published: January 2023

The most common conception of “strategy” refers to careful planning to achieve one’s goals. Formal planning leads the reader through stages emphasizing the importance of specifying, in concrete detail, one’s goals, resources, and assumptions. Rational decision-making should be based upon four key factors that we refer to as a SOAR analysis: Situation, Objectives, Assumptions, and available Resources. These elements define the strategic layer of planning in a political context. The biggest shortcoming of the planning process, however, is that it tends to focus the political manager’s attention on the actions she/he can take while downplaying the importance of predicting the moves and reactions of the opponent. Political managers must give particular attention to the tasks of defining the objective(s) to be achieved and the assumptions upon which the strategy rests. If the assumptions prove to be wrong, the strategy will most likely need to be revised.
Strategic Political Communications
Authors: Arterton F. Christopher
Published: January 2023

The heart of politics lies in effective communication. The understandings imparted here take place in the realm of election politics where political managers wish to induce large-scale behavioral compliance. But the same principles of effective messaging also apply to governing and in managing issues in the public’s thinking. Readers should concentrate their attention on two crucial factors in communicating on a strategic level: the audiences to be reached and the messages that need to be delivered. How to undertake these communications is important but tactical and therefore secondary. Effective communications demand three strategic guidelines: simplicity, repetition, and responsiveness. At a tactical level, ongoing and significant changes in the technologies and processes of communications are occurring in the 21st century and will continue to grow and change in the future. However, the evolving forms of technological capacity will not change the fundamental strategic dynamics of political communications.
Strategy and Negotiations in Politics
Authors: Arterton F. Christopher
Published: January 2023

Because exercising power in politics is essential to accomplishing its purposes, strategy will inevitably emphasize Machiavellian actions. But that is not the only way to achieve and exercise political power. This chapter discusses the dynamics of finding agreement through negotiations as an alternative means of securing desired objectives. The other party should be treated as a “counterpart,” not an enemy, even recognizing that they will have interests that conflict with yours. Before entering a negotiation, you should always calculate your minimum acceptable demand (MAD), consider your best alternative to a negotiated agreement (BATNA), and diagnose whether there exists a zone of possible agreement (ZOPA). Need, desire, competition, time deadlines, and sunk costs all work to diminish the parties’ leverage over the outcome. Given that negotiations in the political realm more commonly produce coalitions and enduring relationships, political managers should act to achieve at least some minimal benefit for all parties.
Evangelicalism and Gender
Authors: McKinney Jennifer
Published: January 2023

The popularity of Seattle’s Mars Hill Church and its theology under the leadership of pastor Mark Driscoll emerged in a specific social context. This chapter addresses how historical shifts in American culture resulted in shifting Protestant gender theologies. Beginning with the Baptist and Methodist “upstart sects” in Colonial America, the chapter traces changing Protestant gender theologies through the twentieth century. By the beginning of the twenty-first century some evangelicals had begun to despair that the country and Christianity was experiencing a “crisis in masculinity.” The birth of Mars Hill Church coincided with the evangelical reaction to the perceived crisis in masculinity. Driscoll’s focus on men at Mars Hill served to buttress a masculine-centered Christianity Driscoll believed had been compromised by more egalitarian ideals in American culture that was also infiltrating evangelicalism.
Real Family
Authors: McKinney Jennifer
Published: January 2023

This chapter describes how complementarianism functions—in dating and marriage—within the context of a hypermasculine theology. In this theology, marriage is the ultimate expression of a complementarian Christian relationship. Men are expected to be responsible husbands and fathers by financially providing for their families and taking authority in the home to model biblical manhood to their children. Women are expected to be respectful to their husbands and to let their husbands lead (take authority) in the home. Men and women were told that adherence to these role expectations would result in stable families and good sex—the distinctive marker of Christian marriages. How complementarian roles were negotiated led to their being embraced, rejected, or something in between by members of Mars Hill Church.
Vulnerability, Sami Identity, and the Law
Authors: Fitzmaurice Malgosia , Attard Felicity G.
Published: January 2023

This chapter sets out a comprehensive analysis of the legal frameworks of Norway, Sweden, and Finland in respect of the rights of the Sami people. The study includes a comparative analysis of the three Nordic States, taking into account their distinct juridical characteristics, as well as shared environmental threats due to their Arctic geography. The focus of the study is on identity through Martha Fineman’s theory, which enables an innovative and extensive study shedding new light into the ways in which Sami resilience can be protected and enhanced. This is an original perspective in the context of the rights of Indigenous people. By rooting their analysis in an Indigenous perspective, the chapter is able to extend a constructive critique to Fineman’s theory, adding substance to some of the more abstract elements of Fineman’s work. The analysis highlights in particular the need to ensure the preservation of collective identities of Indigenous peoples.
Power, Immortality, and International Law
Authors: Beres Louis René
Published: January 2023

International law scholarship routinely identifies power as the preeminent goal of states and empires. What has regularly been ignored, however, is that lucid definitions of power can be problematic and that the most starkly compelling form of global power is never calculated. This form is power over death. In order to acquire this ultimate form of power, various leaders have felt obligated to seek the “death” of other states or empires. Now, by examining this zero-sum calculus more deliberately, international law scholars may discover that any such seemingly interminable struggle is marked by an ironic reciprocity: In essence, each state’s struggle for the elimination of certain designated others may actually represent a considered defense against its own annihilation. Such perplexing simultaneity suggests that the truest rationale of realpolitik, or power politics, is never “just” acquisition of territory, wealth, or “victory.” Though unacknowledged and inconspicuous, this truest rationale is nothing less than personal immortality. Expressed more tangibly, and recalling Heinrich von Treitschke’s Lectures on Politics: “Individual man sees in his country the realization of his earthly immortality.”
L’Epuisement des Recours Internes Est-il une Condition de Fond, de Procédure ou les Deux à la Fois?
Authors: Kolb Robert
Published: January 2023

In this short contribution, the question as to whether the exhaustion of local remedies rule in the context of diplomatic protection pertains to the admissibility of the claim or the substance of the wrongful act. In the first case the exhaustion goes to the requirements of claims and litigation; in the second case, it goes to the existence of the substantive legal position. The various arguments made in legal writings are discussed and practice as far as is available is examined. The position taken by this author is that overall the admissibility explanation better fits the configuration of the law of international responsibility in this subject matter, but that also both explanations are legally possible and have arguments to their advantage.
Covid-19, the Belt and Road Initiative, Tianxia/The Chinese Universe, and Universal Human Rights
Authors: Diana Lin Xiaoqing
Published: January 2023

This chapter discusses how the Belt and Road Initiative (BRI) developed from an internally driven geopolitical undertaking to tackle the bottleneck in China’s domestic economic development and regional security into a more ideological and global phenomenon. During the 2018 trade war with the United States, the Chinese started to redefine democracy, human rights, and a global political system with terms such as Tianxia/All-Under-Heaven and a Community with a Shared Future for Humankind. The chapter focuses on the impact that COVID-19 has had on the BRI and how the latter has adjusted to the pandemic since early 2020. The BRI, so one suggestion is, should be viewed as a dynamically emerging series of projects that can be shaped and directed to outcomes that benefit global security and prosperity.
International Human Rights Law in International and Hybrid Criminal Courts and Tribunals
Authors: Pérez-León-Acevedo Juan-Pablo
Published: January 2023

Several international and hybrid criminal courts and tribunals (ICTs) have been established in the last decades. Generally speaking, international crimes constitute serious violations of international human rights law (IHRL). In the establishment of ICTs, diverse actors have sought that the procedural and institutional frameworks of ICTs include and respect the rights of the accused in the light of IHRL standards. Against such background, the present paper addresses this main research question: How is IHRL present in the law and especially the practice of ICTs? It is argued and shown herein that IHRL is, to a larger or lesser extent, embedded in the law and, particularly, the jurisprudence of ICTs, but subject and adapted to the nature and mandate of ICTs. Importantly, it is also sustained herein that IHRL has been useful for ICTs to interpret and/or apply norms on crimes against humanity (substantive international criminal law) and defence rights (international criminal procedure).
Introductory Note
Authors: Milanov Momchil L. , Kolb Robert
Published: January 2023

In this very difficult first year of the pandemic, the functioning of the Court was affected by COVID-19 without, however, significantly disrupting it. The year 2020 was interesting because the Court had to deal with three diverse cases (appeals jurisdiction, diplomatic law, validity of arbitral award), two of which concerned its so-called “supervisory jurisdiction,” which has not happened before. Only the judgment in Equatorial Guinea v. France concerned the merits. The judgment in Guyana v. Venezuela is of particular interest for any person interested in international procedural law. Never in its history has the Court been presented with this particular type of compromissory clause, which does not resemble any other jurisdictional basis relied on by a state before the International Court of Justice. The orders in Gambia v. Myanmar and the appointment of experts in Congo v. Uganda complete the picture.
Introductory Note
Authors: Tanaka Yoshifumi
Published: January 2023

This introductory note examines the development at the International Tribunal for the Law of the Sea for the year 2020. While there was no judgment in 2020, proceedings of two cases, the M/T “San Padre Pio” (No. 2) Case (Switzerland/Nigeria) and the Dispute Concerning Delimitation of the Maritime Boundary between Mauritius and Maldives in the Indian Ocean (Mauritius/Maldives), continue. Accordingly, this note discusses the issues of the two pending cases. Furthermore, there were some important events regarding the Tribunal in 2020. Among other things, this note focuses on an adoption of a Model Agreement between ITLOS and Singapore, the election of the seven members of the Tribunal, and amendments of the Rules of the Tribunal.
Introductory Note
Authors: Knoops Geert-Jan Alexander , Pedroso Sara
Published: January 2023

It has been a challenging yet productive year for the International Criminal Court (ICC). Similar to other judicial institutions worldwide, the ICC was faced with new challenges brought about by the global COVID-19 pandemic, which has affected almost all aspects of the Court’s activities. For instance, ongoing investigations were significantly affected, due to travel restrictions, remote work, and states parties’ grappling with internal health crises. Despite those challenges, the Court has seen an expansion of its docket of cases, as well as new developments in its situation cases, including investigations, ongoing trial proceedings, and preliminary examinations, including a new contempt case initiated by the surrender of Mr. Paul Gicheru. At the request of the Assembly of States Parties, the Court also underwent a critical review aiming to strengthen the ICC and the Rome Statute system, resulting in a comprehensive expert report which presents concrete recommendations for enhancing the performance, efficiency, and effectiveness of the Court.
Introductory Note
Authors: Lenaerts Koen
Published: January 2023

In this introductory note, President Lenaerts looks back at the main highlights of events occurring at the Court of Justice of the European Union. Two major events stood out during 2020: the COVID-19 pandemic and the withdrawal of the United Kingdom from the European Union. The Court withstood the impact of both events and continued to set the pace rendering judgments in the fields of fundamental rights, asylum policy, data protection, consumer protection, air transport, state aid and competition, workers and social security, banking and taxation, copyright and intellectual property, as well as EU institutional law. President Lenaerts provides an overview of the most important judgments in each of these fields.
Introductory Note
Authors: Spano Robert
Published: January 2023

The European Convention on Human Rights celebrated its seventieth anniversary in 2020. The year was also marked by a global pandemic and the Court had to surmount significant obstacles posed by the crisis and sanitary responses in order to continue its vital functions. Despite the challenges, the Court has handled a wide variety of human rights issues. It also made significant advancements in the clarification and development of concepts under the Convention and within the Court’s case-law. Four Grand Chamber cases are discussed in greater depth, covering: the notion of a “tribunal established by law”; the applicability of the prohibition of slavery and forced labour to a victim of trafficking and exploitation for the purposes of prostitution, and of the prohibition of collective expulsion of aliens to those immediately and forcibly removed from a land border; and whether a state’s ruling on a visa application can create a jurisdictional link.
Introductory Note
Authors: Benito Elizabeth Odio
Published: January 2023

In 2020, the Inter-American Court of Human Rights issued twenty-one judgments on merits, and one on interpretation, as well as the record forty-nine orders on monitoring compliance with judgment and twenty-five orders on provisional measures. In addition to adapting its functions to the global context of the COVID-19 pandemic, last year the Court saw the greatest jurisdictional production in its history. The contentious cases in this edition of the Yearbook shed light on some of these advances in the Court’s jurisprudence.
Introductory Note
Authors: Reinisch August , Tropper Johannes
Published: January 2023

The 2020 jurisprudence of ICSID tribunals and ad hoc committees addressed among others the jurisdictional issues of the notions of “investment” and “investor” under Article 25 ICSID Convention, the establishment of jurisdiction by means of a most-favoured nation provision, the so-called intra-EU objection to jurisdiction as well as jurisdiction over national treatment claims in relation to national security review and mass claims proceedings. Prominent procedural issues concerned the challenges of arbitrators, provisional measures, and stay of enforcement requests. The 2020 cases also dealt with expropriation, fair and equitable treatment, full protection and security, and umbrella clauses. Annulment proceedings most prominently concerned the question of the impartiality and independence.
Introductory Note
Authors: Seatzu Francesco
Published: January 2023

The year 2020 was characterized for the international administrative tribunals by (at least) the following three elements: the EBRDAT’s delivery of the judgment in the case Appellant v. European Bank for Reconstruction and Development, examining the issue of whether lack of procedures leads to an annulment of the administrative decision; the decision in the case A., G., L. and S. A. v. CERN, where the ILOAT acknowledged the principle according to which the staff members of international organizations are not entitled to have the conditions of their employment laid down in the provisions of the staff rules in force at the time of their recruitment applied to them throughout their career; and the decision on July 2020 in the case L. L. v. ILO, where the ILOAT reiterated that it is an inherent power of any international organization to chose the measure to be imposed on its officials for misconduct.
How to Constitute a Global Community Through International Law and Jurisprudence?
Authors: Petersmann Ernst-Ulrich
Published: January 2023

United Nations law and the World Trade Organization have failed to prevent today’s unprecedented global governance problems undermining human rights and the UN sustainable development goals (SDGs). Limiting the related abuses of public and private power requires democratic struggles for constitutional and democratic rights and judicial remedies limiting multilevel governance powers. The more China, Russia, the United States, and other veto-powers in the UN Security Council prioritize nationalism and hegemonic rivalries, the more difficult becomes the task of institutionalizing public reason and human and constitutional rights for holding multilevel governance more accountable. European integration law illustrates the institutions necessary for transforming the constitutional ideals underlying UN law into more effective restraints on power-oriented UN legal practices. Constitutional construction of transnational community law can succeed only if driven by democratic and judicial institutions supporting public-private partnerships in multilevel protection of the SDGs.
Antônio Augusto Cançado Trindade’s Vision for the Humanization of International Law and the Realization of Justice—A Note of Gratitude
Authors: Ziccardi Capaldo Giuliana
Published: January 2023

In this In Memoriam, the General Editor Professor Giuliana Ziccardi Capaldo marks the death of H.E. Judge Antônio Augusto Cançado Trindade, an active and esteemed editorial Board Member and colleague. By accentuating Cançado Trindade’s global and humanist vision, she captures the essential features of his influential scholarship. The loss of Cançado Trindade is equivalent to that of a heavyweight; and Ziccardi Capaldo notes that we all must honor his legacy.
Shrimp to Whale
Authors: Pacheco Pardo Ramon
Published: January 2023

South Korea has a remarkable history. Born from the ashes of imperial domination, partition, and a devastating war, back in the 1950s there were real doubts about its survival as an independent state. Yet South Korea endures: today it is a boisterous democracy, a vibrant market economy, a tech powerhouse, and home to the coolest of cultures. In just seventy years, this society has grown from a shrimp into a whale. What explains this extraordinary transformation? For some, it was individual South Koreans who fought to change their country, and still strive to shape it. For others, it was forward-looking political and business leaders with a vision. Either way, it's clear that this is the story of a people who dreamt big, and whose dreams came true. Shrimp to Whale is a lively history of South Korea, from its millennia-old roots, through the division of the Peninsula, dictatorship and economic growth, to today's global powerhouse.
Spontaneity and Form in Modern Prose
Authors: Ravinthiran Vidyan
Published: January 2023

This study analyses post-Romantic prose whose authors—in terms of race, gender, class, nationality, and more—occupy a range of subject positions, for, in that prose, the dialectical interplay of spontaneity with form. Modern literary prose has no rhetorical repertoire, unlike poetry no structures (beyond those of grammar) one could tabulate. As a result, it becomes a zone of experimentation as to what spontaneous creativity might be like, as well as a means to investigate the concept of spontaneity, understood as post-secular. Heeding separate histories and peculiar particularities, the author’s readings nevertheless conjointly foreground a literary shaping that reveals writers discovering their ideas as they go, in a prose whose sound, rhythm, syntax, and imagery escapes the preordained and makes intensely available to the reader—and therefore both contagious, and vulnerably susceptible to demurral—the experiential morphing of impulse into structure. There are chapters on William Hazlitt, Ralph Waldo Emerson, and Walt Whitman (and Hindu philosophy), Gerard Manley Hopkins, Herman Melville, D. H. Lawrence, and Saul Bellow, Virginia Woolf and Marion Milner, Gwendolyn Brooks, Adil Jussawalla, and Chimamanda Ngozi Adichie. These writers are intelligently vexed by two transitions: first, the movement from impulse into form; and second, the overlap between literary forms and social forms. They explore the yearning for renovated societies which, expressive of our deepest selves, would also enable those selves (in times of panicked fragmentation, moral relativism, and communication imperilled) to interact as citizens.
Live tracking metabolic networks and physiological responses within microbial assemblages at single-cell level
Authors: Cui Li , Xin Yuhan , Yang Kai , Li Hongzhe , Tan Fengjiao , Zhang Yulong , Li Xingrui , Zhu Zhi , Yang Jun , Kao Shuh-Ji , Ren Bin , Zhu Yong-Guan , Musat Florin , Musat Niculina
Published: January 2023

Microbial interactions impact the functioning of both natural and engineered systems, yet our ability to directly monitor these highly dynamic and spatially resolved interactions in living cells is very limited. Here, we developed a synergistic approach coupling single-cell Raman microspectroscopy with 15N2 and 13CO2 stable isotope probing in a microfluidic culture system (RMCS-SIP) for live tracking of the occurrence, rate, and physiological shift of metabolic interactions in active microbial assemblages. Quantitative and robust Raman biomarkers specific for N2 and CO2 fixation in both model and bloom-forming diazotrophic cyanobacteria were established and cross-validated. By designing a prototype microfluidic chip allowing simultaneous microbial cultivation and single-cell Raman acquisition, we achieved temporal tracking of both intercellular (between heterocyst and vegetative cells of cyanobacteria) and interspecies N and C metabolite exchange (from diazotroph to heterotroph). Moreover, single-cell N and C fixation and bidirectional transfer rate in living cells were quantified via SIP-induced characteristic Raman shifts. Remarkably, RMCS captured physiological responses of metabolically active cells to nutrient stimuli through comprehensive metabolic profiling, providing multimodal information on the evolution of microbial interactions and functions under fluctuating conditions. This noninvasive RMCS-SIP is an advantageous approach for live-cell imaging and represents an important advancement in the single-cell microbiology field. This platform can be extended for real-time tracking of a wide range of microbial interactions with single-cell resolution and advances the understanding and manipulation of microbial interactions for societal benefit.
Human monocarboxylate transporters accept and relay protons via the bound substrate for selectivity and activity at physiological pH
Authors: Geistlinger Katharina , Schmidt Jana D R , Beitz Eric
Published: January 2023

Human monocarboxylate/H+ transporters, MCT, facilitate the transmembrane translocation of vital weak acid metabolites, mainly l-lactate. Tumors exhibiting a Warburg effect rely on MCT activity for l-lactate release. Recently, high-resolution MCT structures revealed binding sites for anticancer drug candidates and the substrate. Three charged residues, Lys 38, Asp 309, and Arg 313 (MCT1 numbering) are essential for substrate binding and initiation of the alternating access conformational change. However, the mechanism by which the proton cosubstrate binds and traverses MCTs remained elusive. Here, we report that substitution of Lys 38 by neutral residues maintained MCT functionality in principle, yet required strongly acidic pH conditions for wildtype-like transport velocity. We determined pH-dependent biophysical transport properties, Michaelis–Menten kinetics, and heavy water effects for MCT1 wildtype and Lys 38 mutants. Our experimental data provide evidence for the bound substrate itself to accept and shuttle a proton from Lys 38 to Asp 309 initiating transport. We have shown before that substrate protonation is a pivotal step in the mechanisms of other MCT-unrelated weak acid translocating proteins. In connection with this study, we conclude that utilization of the proton binding and transfer capabilities of the transporter-bound substrate is probably a universal theme for weak acid anion/H+ cotransport.
Meeting a Pandemic Challenge for Interprofessional Education for Nurse Graduate Students: Development of a Remote Session Using Case Studies
Authors: Nicoteri Jo Ann L.
Published: January 2023

Interprofessional education has become a mainstay of undergraduate and graduate nursing curricula. However, with limitations to physical contact brought about by the COVID-19 pandemic, the ability to provide such an experience was challenged. A remote session involving graduate family nurse practitioner, physical therapy, and occupational therapy students was devised using case studies in small groups with a faculty facilitator. Students evaluated the event using the Student Perceptions of Interprofessional Clinical Education-Revised instrument, version 2. This article focuses on the development of the program and use of the instrument with graduate students.
A 7-Domain Framework That Can Bridge Clinical Care, Health Systems Science, and Health Equity: Lessons From the H&P 360
Authors: Williams Brent C. , Hayer Rupinder , Henderson David D. , Johnson Eric L. , Kulkarni-Date Mrinalini , Tang Joyce W. , Whisenant Ebony B. , Kirley Kate ,   for the American Medical Association Accelerating Change in Medical Education Chronic Disease Prevention and Management and H&P 360 Working Group
Published: January 2023

The H&P 360 is a reconceptualized history and physical (H&P), which clinical medical students have reported reveals clinically relevant information not elicited by the traditional H&P, informs care planning, promotes interprofessional team care, and enhances patient rapport. In addition to the traditional checklist focused on patients’ medical conditions, the H&P 360 includes prompts for gathering limited but critical information in 6 other domains directly relevant to patients’ overall health—patient values, goals, and priorities; mental health; behavioral health; social support; living environment and resources; and function. Clinicians are thus reminded to elicit relevant information from each domain appropriate to the context of each clinical encounter.

As health systems explore ways to identify and address social drivers of health, medical schools are rapidly expanding curricula beyond biomedical conditions, as reflected in the multifaceted health systems science curriculum. Many of today’s medical students struggle to find connections among the core tasks of mastering biomedical clinical medicine, their evolving professional identity and career trajectory, and addressing systemic and societal barriers to population health.

The authors argue that the 7-domain framework can serve as a conceptual bridge that links the care of individual patients with topics in the health systems science curriculum to promote health equity. The authors provide illustrative examples of the 7 domains as an organizing lens that can promote curiosity and understanding of seemingly disparate topics, such as interpersonal violence, social drivers of health, and structural racism, as well as help students expand and define their professional identities as physicians beyond diagnosis and treatment of biomedical conditions.

The authors invite discussion and experimentation around the use of the 7-domain framework in teaching, assessment, and curriculum development and point to resources for clinical educators for teaching and measuring the effects of the H&P 360 on learners, preceptors, and patients.
Perioperative Sleep Disturbance Following Mastectomy
Authors: Azizoddin Desiree R. , Soens Mieke A. , Beck Meghan R. , Flowers K. Mikayla , Edwards Robert R. , Schreiber Kristin L.
Published: January 2023

Objectives:

Sleep disturbance negatively impacts the quality of life and recovery. Our objective was to evaluate the relationship between the individual patient and surgical factors with greater sleep disturbance following breast surgery.

Methods:

In this prospective longitudinal study, patients completed validated measures regarding sleep disturbance, pain, opioid use, and psychological symptoms preoperatively and then 2 weeks, 6 and 12 months postoperatively. Univariable and multivariable generalized estimating equations evaluated demographic, surgical, pain, and psychological predictors of sleep disturbance during the first year after breast surgery.

Results:

Female patients (n=259) reported varying degrees of sleep disturbance, which were longitudinally associated with pain and psychosocial factors (eg, anxiety, depression, and affect). Independent preoperative predictors of worse sleep disturbance included younger age (B=−0.09, P=0.006), opioid use (B=3.09, P=0.02), and higher pain (B=0.19, P=<0.001) and anxiety (B=0.45, P=<0.001) at baseline. In addition, higher baseline positive affect (B=−0.14, P=<0.012) and the surgical category total mastectomy without reconstruction (B=−2.81, P=<0.006) were independently associated with lower sleep disturbance. Those with worse baseline sleep required more opioid analgesics during surgical recovery, and continued use of opioids at 2 weeks postsurgery was associated with disturbed sleep.

Discussion:

Certain patient characteristics, including younger age and baseline anxiety, positive affect, pain, and opioid use, were associated with greater sleep disturbance in the first year after breast surgery. Sleep disturbance was also associated with the greater perioperative and postoperative opioid requirements. Preoperative interventions (eg, anxiety management, cultivating positive affect, and multimodal pain management) in high-risk individuals may enhance sleep and recovery postoperatively, and allow more moderate and less prolonged opioid use.
Douching and Genital Talc Use: Patterns of Use and Reliability of Self-reported Exposure
Authors: O’Brien Katie M. , Ogunsina Kemi , Wentzensen Nicolas , Sandler Dale P.
Published: January 2023

Background:

Feminine hygiene products contain chemicals that may be harmful to human health. Observational studies of the long-term health effects of such products largely rely on self-reported, recalled exposure. We sought to capture patterns of use over the life course and evaluate the reliability of self-reported data.

Methods:

We collected retrospective data on douching and genital talc use in the US-based Sister Study at two-time points and evaluated the consistency of reporting. At enrollment (2003–2009), participants were asked to report use in the last year and during ages 10–13. On a follow-up questionnaire (2017–2019), participants were asked about their use of douche or genital talc over their lifetimes.

Results:

Among 36,202 women who completed both questionnaires, 14% initially reported ever douching and 27% initially reported ever using genital talc. On the follow-up questionnaire, 51% of participants reported ever douching and 32% reported ever using genital talc. Comparisons across the two questionnaires for use in the year before enrollment showed good consistency, with 90% providing the same responses about douching and 87% providing the same responses about genital talc use. Reliability did not vary by cancer status, race and ethnicity, attained education, or age, though there was some evidence of recall bias for genital talc use among ovarian cancer survivors.

Conclusions:

Classification of ever use of feminine hygiene products may be recalled with good consistency, but agreement was lower for specific time periods and trends may vary by subgroup. These potential differences warrant careful consideration in future studies.
Marked Decreases in Time Lost From Work Among COVID-19 Claimants During the SARS-CoV-2 Pandemic
Authors: Hunt Dan L. , Bernacki Edward J. , Kalia Nimisha , Lavin Robert A. , Yuspeh Larry , Tsourmas Nicholas F. , Leung Nina , Green-McKenzie Judith , Tao Xuguang (Grant)
Published: January 2023

Objective

To explore the long-term persistence of COVID-19–related impairment and the ability to work after the acute phase of the illness.

Method

The 19,101 COVID-19 workers' compensation claims filed between January 1, 2020, and December 31, 2021, with follow-up to May 31, 2022, were analyzed.

Results

The average time lost from work decreased from 77 days in the first quarter of 2020 to 9.2 days in the fourth quarter of 2021, and the proportion of claims with 30 days or more of lost time decreased from 40.4% to 2.8 days in the same time frame.

Conclusion

COVID-19 indemnity claims filed in later quarters of the SARS-CoV-2 pandemic have much lower average time lost from work and lower proportions of workers' compensation claims with more than 30, 60, and 150 days of lost time compared with earlier quarters.
Prevalence and Risk Factors for Post-Discharge Feeding Problems in Children Born Extremely Preterm
Authors: Alm Stina , Stoltz Sjöström Elisabeth , Domellöf Magnus
Published: January 2023

Objectives:

Preterm infants have a high risk of post-discharge feeding problems, but there is a lack of population-based studies in infants born extremely preterm and little is known about underlying mechanisms. The objectives were to assess the incidence of post-discharge feeding problems and underweight in a population-based cohort of infants born extremely preterm in Sweden (EXPRESS) and identify perinatal risk factors.

Methods:

Perinatal health data and prenatal/postnatal growth data was prospectively collected in the cohort. Data on clinical diagnoses related to feeding problems were obtained from the Swedish Patient Register and population prevalence data was also obtained. The main outcome was a composite of post-discharge feeding problem diagnosis and/or underweight at 2.5 years of age.

Results:

In total, 66 children (19%) had post-discharge feeding problems diagnosed before 2 years and/or underweight at 2.5 years of age. The risk of feeding problems when compared to the general population was significantly higher, with an odds ratio (OR) of 193 (95% confidence interval (CI) 137.6–270.9). The strongest risk factors for feeding problems were the number of days on mechanical ventilation during the first 8 postnatal weeks, OR of 1.59 (CI 95% 1.29–1.98), and the Clinical Risk Index for Babies-score, OR of 1.14 (CI 95% 1.03–1.26).

Conclusions:

Post-discharge feeding problems and underweight are common in children born extremely preterm. The strongest perinatal risk factor for later feeding problems was early treatment with mechanical ventilation. Identifying infants at risk of post-discharge feeding problems might be useful for targeting of nutritional support.
Clinical Nurse Specialist Tracheostomy Management Improves Patient Outcomes
Authors: Richardson Janette , Girardot Kellie , Powers Jan , Kadenko-Monirian Michele
Published: January 2023

Background:

Patients with a tracheostomy are a low-volume, high-risk population with long lengths of hospital stay and high health care costs.

Problem:

Because of the complex nature of caring for patients with a tracheostomy, it is essential to provide a standardized care approach with ongoing monitoring to optimize outcomes.

Approach:

A pre/postimplementation design was used. A formal tracheostomy care management process using clinical nurse specialists (CNSs) was implemented.

Outcomes:

Between April 2019 and December 2020, this process resulted in a significant reduction in time between tracheostomy placement and discharge, from 16 to 12.9 days (P = .02). Reductions were also seen in length of stay and incidence of tracheostomy-related pressure injuries.

Conclusions:

This project shows that a CNS-led care management process can improve patient outcomes. These improvements in patient outcomes resulted in a significant cost savings to the organization.
Challenges in Reporting Adverse Events From Dietary Supplements
Authors: Costello Rebecca B. , Lindsey Andrea T. , Deuster Patricia A.
Published: January 2023

In 2008, the Institute of Medicine Committee on Dietary Supplement Use by Military Personnel recommended the development of service-wide military policies (eg, education or regulations) to guide commanders in management practices for safe use of dietary supplements (DSs). This review summarizes the activities the military has undertaken to advance the safe use of DSs by service members and develop best practices on reporting adverse events across the Department of Defense (DoD). In March 2022, the Department of Defense issued a DoD Instruction (DoDI) regarding the use of DSs by members of the US military. This DoDI provides guidelines to establish an official list of prohibited substances. The DoDI also identifies Operation Supplement Safety at CHAMP as DoD's “go-to” program for DS use and information about DSs and ingredients. Noted are a number of gaps in the reporting of adverse events from DSs that need to be addressed by multiple constituencies.
Trends in Follow-up Testing Among Patients Positive for Chlamydia and Gonorrhea in the Veterans Health Administration, 2013 to 2019
Authors: Schirmer Patricia , Sharma Aditya , Lucero-Obusan Cynthia , Oda Gina , Holodniy Mark
Published: January 2023

Background

The Centers for Disease Control and Prevention (CDC) recommends testing patients with chlamydia (CT)/gonorrhea (GC) for other sexually transmitted infections (STIs) and repeating CT/GC testing 3 to 12 months later. We assessed repeat CT/GC testing and testing for HIV/syphilis in accordance with CDC guidelines in the US Veterans Health Administration.

Methods

Molecular laboratory testing for CT/GC during January 1, 2013–December 31, 2020 was retrieved from Veterans Health Administration data sources. Patients were evaluated for syphilis, HIV, and repeat CT/GC testing within 1 year after a positive CT/GC test result. Differences of CT/GC-positive patients associated with receiving recommended testing were assessed using χ
2/Fisher exact tests.

Results

A total of 41,630 of 1,005,761 CT (4.1%) and 17,649 of 1,013,198 GC (1.7%) results were positive. Median ages of positive CT/GC patients were 29 and 36 years, respectively. Repeat testing rates for CT/GC within 90 to 119 days were 3.9% and 2.9%, and rates within 90 to 365 days were 32.8% and 34.7%, with 8.6% and 15% being positive again, respectively. Guideline-compatible repeat testing in known HIV-positive patients nearly doubled (75.7% for CT and 67.8% for GC). The CDC-recommended HIV testing was performed for 72.4% and 65.5% CT and GC first positives, respectively, whereas syphilis testing was completed for 66.5% and 60.5% CT and GC, respectively. Compared with 25- to 34-year-old patients with CT or GC, those younger than 25 years had higher odds of guideline-discordant repeat testing but had lower odds of not receiving HIV/syphilis testing.

Conclusions

Nearly two-thirds of patients did not receive recommended repeat testing, and nearly one-third were not tested for HIV/syphilis. Veterans Health Administration providers may benefit from additional education on CDC-recommended sexually transmitted infection guidelines and testing recommendations.
Immobility and the High Risk of Not Recovering Function in Older Adults
Authors: Moersch Lila S. , Vandermause Roxanne K. , Fish Anne F.
Published: January 2023

Purpose

The objective of the study was to explore the experiences of older adults with immobility posthospitalization.

Design

We conducted a focused ethnography qualitative study.

Methods

Data collection included in-depth interviews with 10 individuals ages 69–82 years who had been hospitalized for at least 1 week, field notes, and observations of mobility. An inductive approach was used to analyze the data.

Findings

Older adults believe mobility is a central element in their life. Hospitalizations lasting 1 week or longer often result in a loss of the older adult's ability to function as before, a pattern that we identified as The Crushing Assault: Consequences of Immobility. Rehabilitation involves a Rocky Road to Regaining Mobility that is challenging but possible.

Conclusions

Immobility after hospitalization has unexpected and profound consequences that are life-changing and distressing for older adults at home. Recovering function is prolonged and difficult. An individualized training program that includes flexibility and progressive resistance exercises is recommended over longer periods and with extended medical follow-up.

Clinical Relevance

Lingering problems with immobility at home are frequently overlooked. Active programming promoting preservation of function and an optimistic attitude as well as focusing on milestones to reach are key to optimal function.
Occurrence and Severity of Suicidal Ideation in Adults With Neurofibromatosis Participating in a Mind–Body RCT
Authors: Lester Ethan G. , Wang Katherine E. , Blakeley Jaishri O. , Vranceanu Ana-Maria
Published: January 2023

Background:

Emotional distress can lead to suicidal ideation and potentially suicide completion, yet there is very little literature on suicidal ideation in individuals with a diagnosis of neurofibromatosis (NF; NF1, NF2, and schwannomatosis).

Objective:

To examine the baseline occurrence, severity, and clinical correlates of suicidal ideation in adults with NF.

Method:

Individuals with NF (N = 220) completed assessments measuring depression (Patient Health Questionnaire–9), anxiety (Generalized Anxiety Disorder–7), perceived stress (Perceived Stress Scale–10), pain (Graded Chronic Pain Scale and PROMIS Pain Interference Short Form 8a), and general quality of life (World Health Organization Quality of Life–Brief version) before beginning a two-arm, single-blind randomized control trial of a live-video mind–body program for stress management and resiliency.

Results:

Nineteen percent (n = 42) of the individuals experienced suicidal ideation (ie, >0; ideation present several days or greater). More individuals with NF2 experienced suicidal ideation compared with those with NF1 or schwannomatosis. All of the clinical variables except pain intensity were significantly correlated (P < 0.01) with greater suicidal ideation. Suicidal ideation in individuals with NF was comparable to or higher than that in other medical populations (eg, cancer, dermatological, neurologic). Depression and poor psychological quality of life significantly increased the risk for suicidal ideation.

Conclusion:

Suicidal ideation was relatively prevalent in individuals with NF seeking participation in a mind–body randomized controlled trial. NF clinicians should be prepared to discuss these concerns and provide resources when suicidal ideation is present.

Clinical Trial Registration:

ClinicalTrials.gov (Identifier NCT03406208).