bluuebunny/crossref_metadata_2025 huggingface dataset:
Women in the Workforce
Authors: Argys Laura M. , Averett Susan L.
Published: February 2023

The transformation of women’s lives (and hence the lives of their families) has upended society as we once thought we knew it. This book takes a holistic view of the economic lives of women in the workforce from the viewpoint of an economist. As women acquire more education, marry later, and have fewer children, they have changed their allocation of time from household production to market work. Women have entered the workforce in increasing numbers, making inroads as entrepreneurs and leaders. Yet women remain the primary caregivers of children, and so issues such as work/life balance and the glass ceiling remain at the forefront of policy discussions in the United States and around the world. In addition, despite inroads into male-dominated jobs, many occupations remain stubbornly segregated by gender and a gender wage gap persists that has not changed appreciably in the past twenty years. As economists, the authors recognize that many outcomes that lead to gender disparities are the result of choices women make, but they also reflect constraints faced by women based on social norms, practices, and laws. One of the themes that emerges in nearly every chapter is that societal expectations of women as responsible for caretaking hold women back in the workplace. Overall, this volume uses an economic framework to highlight the importance of women in the economy, the challenges they face in claiming equal status with men, and policies that can further improve gender equity.
Women in the Workforce: An Overview
Authors: Argys Laura M. , Averett Susan L.
Published: February 2023

Stories about women in the workforce permeate media devoted to news and commentary in contemporary society. Historically, because women devoted nearly all of their time to unpaid work (what we now term household or caring labor), women were a nearly invisible part of the economy, but their contributions are invisible no more. Two important changes propelled women into the mainstream of economics. First, during the involvement of the United States in World War II, American women surged into the workforce and they began to make inroads as entrepreneurs and leaders. Second, women’s movement into the paid workforce has transformed their lives and has in many ways reshaped society. Women have begun to marry later in life, have fewer children, and acquire more education—changes that are consistent with spending a far greater portion of their adult lives working for pay and entering historically male-dominated jobs. In large part due to these changes, women’s earnings as a percentage of men’s increased from 60 percent in 1960 to just over 80 percent in 2019, yet, because women usually remain the primary caregivers of children, issues such as work/life balance, equal pay, and the “glass ceiling” remain at the forefront of policy discussions in the United States and around the world. It is important to examine the economic lives of women in workforce by highlighting the importance of women’s participation in the workforce, their contributions to the economy, and the challenges they face in claiming status, influence, and compensation equal to men’s.
How Do Men and Women Interact in the Workplace?
Authors: Argys Laura M. , Averett Susan L.
Published: February 2023

Women have made great strides in recent years in climbing the proverbial corporate ladder, yet obstacles still stand in the way of gender equity. Against this backdrop, in this chapter we explore interactions between men and women in the workplace, the ways in which men’s and women’s interpersonal communication styles and behaviors are valued, and how these affect outcomes on the job. In addition to economists’ contributions, substantial work in this area has been undertaken by scholars in management, business administration, gender studies, organizational psychology, and communication and media studies. Much of this work illuminates important aspects of women’s experiences in the workplace that we highlight in this chapter. We also focus on how women’s professional interactions and behaviors and the presence of female role models and leaders contribute to women’s success.
Do Women Earn Less Because Men Rule the World?
Authors: Argys Laura M. , Averett Susan L.
Published: February 2023

Measuring the gender pay ratio and exploring underlying causes for the gap between women’s and men’s rates of pay revealed some justifiable reasons for gender pay differences. Yet even after accounting for measurable productivity factors, gender pay differences remain. This unexplained residual is sometimes described as a measure of pay discrimination, but the issue is not that simple. There are a number of reasons pay discrimination is particularly difficult to quantify. In this chapter we define discrimination and then explore several economic theories aimed at explaining the causes of such discrimination. Understanding the source of discrimination against women in the labor market is crucial for designing policies to eradicate it. Following a discussion of the techniques used to measure discrimination, the chapter concludes with a summary of the evidence regarding gender-based discrimination in the labor market.
Why Can’t the Government Just Fix the Pay Gap?
Authors: Argys Laura M. , Averett Susan L.
Published: February 2023

A series of legal provisions that have been enacted at the federal level throughout the past six decades address various forms of discrimination, including discrimination on the basis of sex. States have also enacted their own provisions. Unfortunately, however, legislation alone does not fully confer protection from discrimination. We have already seen the difficulty researchers have understanding if, and identifying when, discrimination has occurred. It is also difficult to prove discrimination in a court of law. In this chapter we discuss the evolution, enforcement, and effectiveness of anti-discrimination policies in the United States. At the end of the chapter, we focus our attention on some new approaches to eradicating discrimination. Any policies designed to correct pay distortions associated with discrimination can benefit not just women themselves but the economy as a whole. However, as we note, some policies, while well-intentioned, may themselves create inefficiencies.
Old Rules
Authors: Ker-Lindsay James , Fabry Mikulas
Published: February 2023

When did modern states emerge?

States, as we now understand them, began to emerge in Europe in the first half of the sixteenth century in a process closely tied to the rise of the Reformation in Western Christianity and the appearance of the concept of...
An Overview of Business Ethics
Authors: Nelson J.S. , Stout Lynn A.
Published: February 2023

Business ethics are the set of moral principles that govern behavior in a specific sphere of life: the world of business. Some people think of the business environment as a cutthroat place in which people will do whatever they can get away with, including violating the law and misleading and harming others, in order to get ahead. This view, however, is misleading and inaccurate. Certainly, you can see instances of bad behavior in the business world (as in other areas of life), but most people with real experience in business will tell you that sound ethics are integral to a successful business career.
The Benefits of Acting Ethically
Authors: Nelson J.S. , Stout Lynn A.
Published: February 2023

This chapter addresses an important gap in most discussions of business ethics by describing the positive benefits of acting ethically. Most business ethics texts emphasize the negative consequences of being caught violating ethical principles. This chapter presents some important and often-overlooked benefits of business ethics. Some of its questions include: Being ethical sounds like hard work. What is the upside? Won’t I be at a competitive disadvantage if I always act ethically? What are the material advantages of ethical action for individuals? What are the physical and psychological advantages of acting ethically for individuals? What if being ethical means that I make less money? Won’t that make me unhappy? What can I do to increase the chances that my ethical behavior will be rewarded? How do organizations benefit when their employees and executives act ethically? How do societies benefit when individuals and organizations act ethically?
Moral Philosophical Bases for Business Ethics
Authors: Nelson J.S. , Stout Lynn A.
Published: February 2023

This chapter presents the classical philosophical bases for ethical arguments. We introduce the major schools of important ethical thought developed by moral philosophers, and we discuss their application in the business setting. The chapter will help the businessperson examine his or her moral compass, and to evaluate moral philosophical arguments in considering which action he or she believes is right. Questions include: What are the major schools of philosophical ethical thought? What are the strengths and limits of virtue ethics such as in Aristotle’s writings? What are the strengths and limits of ethics-of-care rationales such as communitarian ethics? What are the strengths and limits of cost–benefit rationales such as utilitarianism? What are the strengths and limits of rights-and-duties rationales such as Kant’s categorical imperative? What are the strengths and limits of distributive-justice rationales such as Rawls’s principles? Where do the Golden Rule and other common maxims fit in?
Legal Foundations of Business Ethics
Authors: Nelson J.S. , Stout Lynn A.
Published: February 2023

This chapter describes the relationship between ethics and law and the typical legal duties applied to businesspersons in more detail. It addresses additional basic questions about why businesspeople should act more ethically than the law requires. Questions include: What is the relationship between law and business ethics? What does it mean to owe a legal duty to a partner or other natural person? What does it mean to owe a legal duty to a corporation or other “legal person”? When do I have a duty of obedience? What does the duty of loyalty mean? When do I have a duty of good faith? When do I have a duty of care? What are duties of confidentiality? When do I have a duty not to lie? What are disclosure duties? Why should businesspeople act more ethnically than the law requires? Isn’t the law enough?
The Costs of Acting Unethically
Authors: Nelson J.S. , Stout Lynn A.
Published: February 2023

This chapter explains why it can be costly to be inattentive or indifferent to ethical obligations. It addresses the costs of unethical conduct to both individuals and organizations. Questions include: What are the legal consequences to individuals for unethical business behavior? What are the reputational penalties to individuals for unethical behavior? What are the other consequences to individuals for unethical behavior? What are the legal consequences to organizations for unethical behavior? What are the reputational penalties to organizations for unethical behavior? What if I think I won’t be caught?
Negotiations
Authors: Nelson J.S. , Stout Lynn A.
Published: February 2023

Negotiations are a specialized area of business ethics that deserve their own consideration and discussion. Questions include: Why are there special ethical issues in negotiations? What is fraud in negotiations? When is it permissible to lie? When is it permissible to stay silent? What special responsibilities flow from power imbalances in negotiations? What are some special ethical issues in negotiating for a client such as your firm? What are some special ethical issues in negotiating for a job? What are some special ethical issues in negotiating solely for price? How important are personal relationships in negotiation?
Introduction
Authors: Afsaruddin Asma
Published: February 2023

The word jihad seems to be everywhere. It is frequently used, especially in the Western media, to refer to violent acts carried out by militants from Muslim backgrounds as part of a civilizational battle against the West. This is what even an educated...
Jihad in the Hadith Literature
Authors: Afsaruddin Asma
Published: February 2023

The hadith literature contains the sayings of Muhammad, as reported by his Companions, the name given to the women and men who were his closest associates. The Arabic word hadith literally means “speech,” “a statement.” These statements of the Prophet were circulated primarily...
Jihad in the Thought of Modern and Contemporary Mainstream Scholars
Authors: Afsaruddin Asma
Published: February 2023

In contrast to militants, modern mainstream scholars and thinkers approach the concept of jihad in a contextualized and holistic manner. They tend to emphasize the term’s different layers of meaning that become apparent in specific situations and historical contexts. They maintain that jihad cannot be...
Jihad As Nonviolent Struggle and Peacemaking
Authors: Afsaruddin Asma
Published: February 2023

Modern thinkers and practitioners in different religious traditions have begun to emphasize the notion of nonviolent struggle against social and political injustices to bring about long-term sociopolitical changes. They argue that the prospect of armed conflict in a modern, globally connected world, where various nation-states...
Economic Sanctions
Authors: Jentleson Bruce W.
Published: February 2023

This chapter establishes the baseline definition of economic sanctions as “the actual or threatened denial of economic relations by one or more states [sender(s)] intended to influence the behavior of another state or non-state actors [target] on foreign policy and other political issues.” From there it builds the analytic framework: What are the different types of sanctions (trade, finance, foreign aid, travel, sports, cultural; comprehensive, sectoral, targeted, secondary, formal/informal)? Who are the key actors (sender, target, third parties)? Why are sanctions imposed in terms of the policy objectives being pursued (primary policy change: limit military capabilities, foreign policy restraint, domestic political change; secondary signaling: target deterrence, third party deterrence, symbolic action)? How are sanctions supposed to achieve their objectives (sender strategy, target counterstrategy, third parties)?
China’s Use of Sanctions
Authors: Jentleson Bruce W.
Published: February 2023

China’s views on economic sanctions have changed in recent years. Interference in national sovereignty, extensions of Western imperialism, violations of international law—for decades the People’s Republic’s opposition to sanctions wielded by the US and others was, as one scholar put it, “legendary.” But while China continues to be resistant to being targeted with sanctions over human rights and other domestic political change issues, as its economic power has grown it has become a frequent wielder of sanctions. This chapter focuses on the following main questions: Why does China impose sanctions? What types of sanctions does it use, those informal “cued” sanctions in particular? How successful have China’s sanctions been? Case studies (also following the what-who-why-how framework) include Taiwan, France and Tibet, Norway and the Liu Xiaobo 2010 Nobel Peace Prize, South Korea and the THAAD missile system, Australia’s “anti-Chinese” domestic politics, and the National Basketball Association (NBA) and Hong Kong protests.
Conclusion
Authors: Jentleson Bruce W.
Published: February 2023

Why do sanctions get used? How to measure success? What key factors affect success? The Conclusion integrates and further develops the chapter analyses. Sanctions are here to stay, very much a weapon of choice. The United States continues to use them frequently. China has been using them more than in the past. So too the United Nations and the European Union. All told, sanctions pose complex questions for international relations theory and real challenges for foreign policy strategy. These are especially intense on issues like human rights. And as the Russia 2022 Ukraine invasion shows, they can bear in fundamental ways on war and peace. The blend of scholarly perspective and policy strategizing running through the book culminates here.
Life Inside the Public School
Authors: Kirp David , Macpherson Kevin
Published: February 2023

Chapter 4 concentrates on issues that affect district offices, schools, and classrooms. It begins with a review of popular strategies that schools rely on in order to reduce the achievement and opportunity gaps. The chapter unpacks an array of topics—among them school climate (the quality and character of school life), deeper learning, the use of technology in schools, and the effects of mass shootings. It discusses the growing emphasis on social-emotional (as well as academic) learning and the use of nudges, all in the service of improving student outcomes. The impact of high school achievement on life prospects and career education as a pathway to prepare students for good jobs is also examined.
The Composition of the Classroom
Authors: Kirp David , Macpherson Kevin
Published: February 2023

Classrooms across the nation are rapidly becoming more diverse. Educators must respond to the challenges that this diversity poses while taking advantage of the new opportunities that diversity presents. Chapter 5 describes the experience of students with special needs, immigrant students, English Language Learners, Native American students, and LGBTQ youth. It explores the research over how best to educate some of these groups. Some of these issues—the inclusion of students with special needs, and the treatment of LGBT issues, for example—have caused social and political controversies, which this chapter highlights. Courts have weighed in on a host of education policy issues—desegregation and school finance, for example—discussed in earlier chapters. They have also set constitutional standards for some aspects of student life. The chapter discusses judicial decisions that defined the right of students to free speech, to form clubs, and to receive some form of due process hearing prior to suspension; and established the constitutional permissibility of searches of student lockers by school administrators or police.
Campaigns, Elections, and the Threat to Democracy
Authors: Johnson Dennis W.
Published: February 2023

This book offers the most up-to-date examination of campaigns and elections, along with the threats to democracy coming from the 2020 presidential election, the Big Lie, and more recent attempts to stifle democratic involvement. Frequent and fair elections, open to all, are fundamental elements of a democracy. The United States, through its local, state, and national contests, holds more elections, more often, than any other democracy in the world. But in recent years, there have been troubling signs that the US system of campaigns and elections has become much more fragile than previously thought. Campaigns have changed profoundly: social media and viral messaging compete with traditional media; Supreme Court decisions on campaign-finance law now encourage mega-donors and have given the green light to all-out partisan gerrymandering. Voters are more polarized, and thanks mostly to Donald Trump, the whole legitimacy of elections is called into question. Further, the United States has faced the threat of foreign influence in our national elections. This book addresses fundamental questions about who votes in American elections, how legislative districts are drawn up, the empty charges of voter fraud, the pros and cons of reforming the Electoral College, the impact of dark money on campaigns, and the role of political consultants. This is not simply a book on how campaigns are run, but why campaigns and elections are integral components of American democracy and how those fundamental elements are vulnerable to abuse.
Voting and Participation
Authors: Johnson Dennis W.
Published: February 2023

The United States has a long history of denying citizens the right to vote. One of the most important protections, the Voting Rights Act of 1965, has been stripped of its enforcement powers; impediments to voting and voter suppression have resulted. Elections are administered at the state and local levels, but despite federal assistance, many of the state systems are fragile and vulnerable. Individual voter fraud, while employed as an excuse for further restricting, is nearly nonexistent. Mail-in voting and absentee voting have proven to be safe and valid exercises. Though the 2020 elections set all-time highs in voting participation, at the state and local levels, voter participation remains unremarkable.
Carving Out Legislative Districts
Authors: Johnson Dennis W.
Published: February 2023

Reapportionment and redistricting are defined and discussed. Congressional districts are reapportioned every ten years. Then comes redistricting, drawing district lines so that districts are of relatively equal population. In recent years there has been a great deal of criticism over partisanship and charges of racial gerrymandering. While racial gerrymandering is prohibited by the Voting Rights Act of 1965, the courts have permitted partisan gerrymandering. For the most part, state legislatures, especially the majority party, make decisions on how the boundaries of legislative districts will be established. There have been attempts to take redistricting and gerrymandering out of the hands of partisan legislators.
Political Parties and Elections
Authors: Johnson Dennis W.
Published: February 2023

At one time, the political party was the central vehicle for organizing and executing political campaigns. But by the 1960s, the party had been replaced by professional consultants, and campaigns became more candidate focused than party focused. The policies and allegiances of the two major parties have changed dramatically, and there has been a steady increase in the percentage of independent voters. More and more, the Republican Party is the party of Donald Trump, demanding fealty to him. The Democratic Party is becoming more progressive, with moderate voices often forced to the sidelines. With the growing influence of outside money and super political action committees, political parties have found themselves less relevant in today’s campaigns and elections.
Money, Mega-Donors, and Wide-Open Spending
Authors: Johnson Dennis W.
Published: February 2023

Congress enacted the first important campaign-finance law in 1971 that regulated and limited how much could be contributed and spent in federal elections. But so much has changed since then. In recent years, federal campaign laws have been eviscerated by court decisions, and federal elections have been flooded with money coming from outside interests. Much of the money spent in federal campaigns is not reported and not regulated, coming from tax-free groups with feel-good, misleading names. How did we get here? How much difference does a lot of money really make in a campaign? Who are some of the biggest campaign spenders?
Threats to Democracy
Authors: Johnson Dennis W.
Published: February 2023

American democracy depends on honest, clean, and fair elections in which all eligible adults are free to participate. But today, those fundamental requirements are under attack as never before. The biggest threat today is the continued insistence by former president Trump that the elections were stolen. That falsehood—that Big Lie—and its acceptance by such a significant portion of his followers and allies undermine democratic values. But there are plenty of other ways that our democratic systems have been undermined, from lack of citizen involvement to disparagement of government institutions and the free press, the influence of mega-donors trying to buy elections, and foreign and domestic interference.
Sustainable Investing
Authors: Baker H. Kent , Holzhauer Hunter M. , Nofsinger John R.
Published: February 2023

Can investors do well fi-nancially and at the same time do good for the world? Should they try? Many assume that investors “don’t care who wins” if they’re making mon-ey. For some investors, this mindset still rings true. Yet, many other investors challenge this stereotype and prefer to “make money mean more.” Thus, they have dual goals: making money and doing good. This viewpoint, called sustainable investing, has gained considerable momentum in the last few decades. Sustainable investing delivers value by balancing traditional investing with environmental, social, and governance-related (ESG) insights to improve long-term outcomes. Some view sustainable investing as critical to the sustainability of investing. This book aims to demystify sustainable investing for “average” investors. It uses a question-and-answer format to examine whether such investments are suitable investor portfolios. Each chapter also contains in-sightful and amusing quotes by investment professionals and others. The book has six chap-ters. Chapter 1 examines the changing investment landscape. Chapter 2 explores corporate social responsibility and the evolving responsibilities and obligations of a business. Chapter 3 focuses on the roles of social and religious values in shaping sustainable investing. Chapter 4 discusses the many investment options available to sustainable investors, such as stocks, bonds, mutual funds, and exchange-traded funds. Chapter 5 reviews the performance implications of sustainable investing. This re-search-oriented chapter investigates the intriguing question, “Can sustainable in-vestors have their cake and eat it too?” Finally, Chapter 6 ends by focusing on building a portfolio with a purpose.
Corporate Social Responsibility
Authors: Baker H. Kent , Holzhauer Hunter M. , Nofsinger John R.
Published: February 2023

This chapter pro-vides a modern view of a company’s responsibilities and obligations. Many companies have vast amounts of wealth and the power to make positive societal changes. Many businesses actively advocate against social injustice, pollution, and climate change. A company can support these activities by changing its supply chains, manufacturing processes, and hiring practices. Firms can also be socially responsible by making charitable donations, engaging in community projects, and enabling employees to donate and volunteer. Corporate social respon-sibility (CSR) starts with business ethics and how a company views its various stakeholders, like stockholders, employees, customers, the community, and the environment. This chapter de-scribes firms’ socially responsible activities and helps sustainable investors assess inevi-table trade-offs and inconsistencies that arise. For example, a firm may appear socially responsi-ble but not environmentally responsible.
Sustainable Investing
Authors: Baker H. Kent , Holzhauer Hunter M. , Nofsinger John R.
Published: February 2023

Deciding how to invest money can be complicated. For traditional investors, the primary criterion is profitability. However, the process becomes more challenging for sustainable investors because they add an-other layer of complexity by integrating personal values and societal issues into investment deci-sion-making. In addition, these investors have many methods available to help them meet their goals. These approaches include screening, ESG integration, socially responsible investing, shareholder engagement and activism, thematic investing, and impact investing. As a result, no “one size fits all” approach is available for sustainable investing. Many vehi-cles are also available to help sustainable investors align values with investments, such as stocks, bonds, mutual funds, and ETFs. In summary, this chapter helps sustainable investors sort through various investment approaches and choices that provide more than just a financial re-turn.
Mapping of Major Resistance Gene Qse.xn-2BL for Sharp Eyespot in the Wheat-Psathyrostachys huashanica Introgression Line H83
Authors: Bai Sheng Sheng , Lv Bo Ya , Wu Jun , Hong Chen Xin
Published: February 2023

Sharp eyespot, a soil-borne disease of wheat (Triticum aestivum L.), is one of the most devastating diseases and severely affects grain production. The most efficient and economical method of controlling the disease is the utilization of genetic resistance. In this study, the wheat-Psathyrostachys huashanica introgression line H83 processed the enhanced resistance to Rhizoctonia cerealis isolate R0301 than its wheat parent 7182. A resistance locus in the 600 to 800 Mb interval of chromosome 2BL was screened using 244 segregation population F2 plants of H83×Huixianhong with bulked segregant analysis and wheat axiom 660K genotyping array. Furthermore, by using 12 kompetitive allele-specific PCR markers, a major resistance gene, designated as Qse.xn-2BL, was identified in a secondary segregating population with 138 F3:4 lines and initially mapped to a 765.6 to 775.5 Mb interval on chromosome 2BL. Molecular cytology analysis revealed that H83 probably has an alien introgression at the distal of chromosome 2BL, where it overlapped with the mapping target gene. Above all, H83 showed great potential to improve wheat resistance to sharp eyespot and can be expected to improve resistance in wheat breeding.
Efficacy of Organic Fungicides for Downy Mildew in Field-Grown Sweet Basil
Authors: McGrath Margaret Tuttle
Published: February 2023

Downy mildew is a common, widespread disease affecting basil leaves. No tolerance for disease symptoms, especially on leaves for fresh consumption, necessitates management. Six replicated experiments were conducted between 2010 and 2016 with field-grown basil of a susceptible cultivar exposed to naturally occurring, wind-dispersed sporangiospores of Peronospora belbahrii to evaluate fungicides approved for use on organically produced crops and products in development. Products tested currently registered for use on basil in the U.S. and labeled for downy mildew were Actinovate (Streptomyces lydicus), Companion (Bacillus subtilis), Cueva (copper octanoate), Double Nickel (Bacillus amyloliquefaciens), Forticept EP #1 (thyme oil), Milagrum Plus (Bacillus subtilis), Organocide (sesame oil), Oso (polyoxin D zinc salt), OxiDate (hydrogen dioxide), Procidic (citric acid), Regalia (Reynoutria sachalinensis extract), Stargus (Bacillus amyloliquefaciens), and Trilogy (neem oil). Most are biopesticides. A conventional fungicide, Revus (mandipropamid), was included in most experiments as a positive control. Applications were made weekly to foliage with a backpack sprayer starting before symptoms were seen, except in 2013 when disease onset was early and 2015 when applications were made twice weekly. Organic treatments tested in 2013 started with a soil drench application around the base of plants two days after transplantation. Fungicide efficacy was assessed based on incidence of symptomatic leaves rather than disease severity because there is no tolerance for disease on fresh-market herbs. None were effective based on weekly severity assessments or AUDPC values, confirming results from other researchers that downy mildew cannot be effectively managed with organic fungicides applied to susceptible basil cultivars.
Launching telemedicine in a tertiary ambulatory pediatric orthopedic clinic during the coronavirus disease-19 pandemic: a retrospective study
Authors: Wong Cynthis , Bent Melissa A , Omar Hanna , Abousamra Oussama
Published: February 2023

Objective

Telemedicine services increased dramaticallyduring the coronavirus disease (COVID-19) pandemic, with limited studies on its implementation within pediatric orthopedics. The goal of this study was to examine patient satisfaction and the efficacy of pediatric orthopedic telemedicine visits.

Methods

Two hundred and sixty-nine qualifying telehealth visits took place at a metropolitan area pediatric institute between 1 March and 30 May 2020. Patients were invited to complete an anonymous satisfaction survey on their telemedicine experience. Sixty-seven patients responded to the survey. A chart review was completed for all 269 telemedicine visits.

Results

Ninety-two percent (249/269) of telemedicine visits were with established patients, and 95% (256/269) of visits were satisfactorily completed without further evaluation, with one visit requiring urgent in-person evaluation. Overall, patients were satisfied with initiating the telemedicine visit (mean score of 4.56/5), as they felt comfortable discussing needs with the provider (4.68/5), and the visit saved time (4.61/5). However, patients were less enthused when deciding if telemedicine was of comparable quality to an in-person visit (3.68/5).

Conclusion

Our analysis showed that telemedicine is a viable alternative to in-person visits for various pediatric orthopedic visits, with minimal urgent complications. Patients benefited primarily from the time savings when using a telemedicine visit. However, our study also demonstrates certain limitations of telemedicine, likely due to patients’ perceived value of an in-person evaluation. Our study’s findings should encourage the continued implementation of pediatric orthopedic telemedicine as an adjunct to in-person clinical practice.
HIV and comorbidities – the importance of gut inflammation and the kynurenine pathway
Authors: MacCann Rachel , Landay Alan L. , Mallon Patrick W.G.
Published: February 2023

Purpose of review

The purpose of this article is to review alterations in microbiota composition, diversity, and functional features in the context of chronic inflammation and comorbidities associated with HIV infection.

Recent findings

The gut microbiome is an important mediator of host immunity, and disruption of gut homeostasis can contribute to both systemic inflammation and immune activation. Ageing and HIV share features of intestinal damage, microbial translocation and alterations in bacterial composition that contribute to a proinflammatory state and development of age-related comorbidities. One such inflammatory pathway reviewed is the nicotinamide adenine dinucleotide (NAD+) producing kynurenine pathway (KP). Kynurenine metabolites regulate many biological processes including host-microbiome communication, immunity and oxidative stress and the KP in turn is influenced by the microbiome environment. Age-associated decline in NAD+ is implicated as a driving factor in many age-associated diseases, including those seen in people with HIV (PWH). Recent studies have shown that KP can influence metabolic changes in PWH, including increased abdominal adiposity and cardiovascular disease. Furthermore, KP activity increases with age in the general population, but it is elevated in PWH at all ages compared to age-matched controls. Host or microbiome-mediated targeting of this pathway has merits to increase healthy longevity and has potential therapeutic applications in PWH.

As a growing proportion of PWH age, many face increased risks of developing age-related comorbidities. Chronic inflammation, a pillar of geroscience, the science of ageing and of age-related disease, is influenced by the gut microbiome and its metabolites. Combined, these contribute to a systemic inflammatory signature. Advances in geroscience-based approaches and therapeutics offer a novel paradigm for addressing age-related diseases and chronic inflammation in HIV infection. Whether targeted inhibition of KP activity alleviates pathological conditions or promotes successful ageing in PWH remains to be determined.
Impact of coronavirus disease 2019 on co-morbidities in HIV
Authors: Guaraldi Giovanni , Milic Jovana
Published: February 2023

Purpose of review

This perspective paper offers some reflections on an hypothesized changing scenario of HIV comorbidities in the years to come and provides some insights on how to improve screening and management of people with HIV (PWH) in the coronavirus disease 2019 (COVID-19) era.

Recent findings

PWH may experience a higher burden of excess disease and mortality associated with noninfectious comorbidities in the COVID-19 era. HIV care must move beyond viral–immunological success to incorporate patient-centered outcomes based on the intrinsic characteristics of the individual and its environment, assessment and screening for comorbidities, evaluation of aging and geriatric syndromes and last but not least fight stigma, ageism and inequality to access to care.

COVID-19 is widening the gap between unmet needs of PWH and healthcare systems. An increasing burden of comorbidities, multimorbidity and frailty is affecting PWH which requires redesign of care delivery oriented around the diverse needs of individuals, rather than the prerequisites of providers, and must ensure health equity. In particular, any changes to care delivery must address existing disparities in access and care among PWH and fight stigma.
The importance of post marketing quality control
Authors: Buehler Philipp K. , Weiss Markus , Wendel-Garcia Pedro D. , Both Christian P. , Schmidt Alexander R. , Wehren Martin P. , Thomas Jörg
Published: February 2023

BACKGROUND

A previously published study reported on the nonlinear behaviour for airway pressure and tidal volume of the adjustable pressure-limiting (APL) valve of the Aisys CS2 anaesthesia machine (GE Healthcare, Madison, Wisconsin, USA) during manual bag ventilation. In co-operation with the manufacturer, an adapted APL valve was developed.

OBJECTIVE

To test and characterise the performance of an adapted APL valve and assess its clinical usability.

DESIGN

Two-stage study, consisting of an in-vitro testing of an adapted APL valve in a baby and adolescent lung model, followed by a clinical experience survey of anaesthesia personnel after the official implementation of the new APL valve into clinical routine.

SETTING

Anaesthesia Department at the University Children's Hospital Zurich.

MAIN OUTCOME MEASURES

Airway pressures and inspiratory tidal volumes during opening and closure of the APL valve at different settings. Likert scale assessment of performance expectance, effort expectance, behavioural intention and safety of the APL valve during clinical use.

RESULTS

In contrast to the original APL valve of the GE Aisys CS2, the adapted APL valve showed a nearly linear increase in airway pressures as well as in the tidal volumes measured. Most importantly, the measured pressures never exceeded the set pressures. Based on the experimental findings, all original APL valves of the GE Aisys CS2 were replaced by the adapted APL valve. Two months later, an anonymised and standardised questionnaire was handed out to all employees working with the adapted APL valve. Analysis of the questionnaire indicated that the adapted APL valve is easier and more precise to handle in the daily routine than the original one.

CONCLUSION

The newly adapted APL valve for the GE Aisys CS2 has considerably improved its linearity at lower pressures and supports our institution's bag mask ventilation practices.
When Does Differential Outcome Misclassification Matter for Estimating Prevalence?
Authors: Edwards Jessie K. , Cole Stephen R. , Shook-Sa Bonnie E. , Zivich Paul N. , Zhang Ning , Lesko Catherine R.
Published: February 2023

Background:

When accounting for misclassification, investigators make assumptions about whether misclassification is “differential” or “nondifferential.” Most guidance on differential misclassification considers settings where outcome misclassification varies across levels of exposure, or vice versa. Here, we examine when covariate-differential misclassification must be considered when estimating overall outcome prevalence.

Methods:

We generated datasets with outcome misclassification under five data generating mechanisms. In each, we estimated prevalence using estimators that (a) ignored misclassification, (b) assumed misclassification was nondifferential, and (c) allowed misclassification to vary across levels of a covariate. We compared bias and precision in estimated prevalence in the study sample and an external target population using different sources of validation data to account for misclassification. We illustrated use of each approach to estimate HIV prevalence using self-reported HIV status among people in East Africa cross-border areas.

Results:

The estimator that allowed misclassification to vary across levels of the covariate produced results with little bias for both populations in all scenarios but had higher variability when the validation study contained sparse strata. Estimators that assumed nondifferential misclassification produced results with little bias when the covariate distribution in the validation data matched the covariate distribution in the target population; otherwise estimates assuming nondifferential misclassification were biased.

Conclusions:

If validation data are a simple random sample from the target population, assuming nondifferential outcome misclassification will yield prevalence estimates with little bias regardless of whether misclassification varies across covariates. Otherwise, obtaining valid prevalence estimates requires incorporating covariates into the estimators used to account for misclassification.
Anatomical Study of the Penile Suspensory System: A Surgical Application to Micropenis
Authors: Danino Michel Alain , Benkahdra Mehdi , El Khatib Arij , Yafi Nazhat , Trouilloud Pierre , Danino Ruben Pierre , Laurent Romain
Published: February 2023

Background:

Penile enlargement surgery is the second most desired cosmetic procedure in men worldwide. The mainstay of penile lengthening procedures is a partial release of the penile suspensory ligament system. Concerns regarding erect penis stability after this procedure have been raised by the surgical community. This study describes the anatomical features of the penile suspensory ligament system and explores the stability mechanisms of the penis.

Methods:

This study is subdivided in two parts: an anatomical analysis and a clinical analysis. The anatomical part consists of a dissection of eight male cadavers to describe the anatomy and test the stability after sectioning successively the suspensory ligaments. The clinical part consists of an analysis of 30 patients with micropenis operated on for penile lengthening by a penile suspensory ligament release and lipofilling.

Results:

The suspensory apparatus consists of four distinct ligamentous structures: fundiform, suspensory, dense vertical, and arcuate ligaments. These different structures are lax superficially but become firm and tense posteriorly. The section of the fundiform and suspensory ligaments did not destabilize the penis.

Conclusion:

Penile lengthening by way of cautious suspensory ligament release can be performed without erection instability.
Glove-shaped Foam with Negative Pressure Wound Therapy for Skin Graft Fixation on the Hand
Authors: Yoshida Eriko , Maeda Shogo , Nuri Takashi , Iwanaga Hiroyuki , Hirota Yuka , Takei Asuka , Umeda Chizuru , Fujiwara Kurumi , Ueda Koichi
Published: February 2023

Tie-over bolster dressing has been the gold standard for skin graft immobilization. However, skin grafting onto the hand remains challenging. To prevent shearing of the skin, joint fixation with Kirschner wire and casting is often required. However, wire fixation through the joint can disrupt finger growth and cause joint contracture, especially in pediatric patients. So, we performed graft fixation with negative pressure wound therapy (NPWT). The use of NPWT with skin grafting has recently been reported. Previous studies have reported that NPWT can provide even pressure on irregular wounds and in highly mobile areas. However, application of NPWT in the digital region often results in air leaks. This report includes four patients who required skin grafting on the hand. All patients received skin grafts in the affected area. Graft fixation was performed with NPWT. A glove-shaped form was designed. The hand was encased on the ventral and dorsal sides and small pieces of foam were placed between the fingers. The fixation was maintained for 7 days at a pressure of −50 to −80 mmHg. None of the cases had air leak requiring reattachment of the system and graft take was successful in all cases without any complications. The NPWT “glove-shape” technique enabled maintenance of average negative pressure for all skin grafts on the hand. This technique does not require joint fixation and may help to prevent growth disturbance and joint contracture.
Surgical Nipple Delay and its Expanded Indications for Nipple-sparing Mastectomy
Authors: Lee Phoebe L. , Ma Irene T. , Schusterman Mark Asher , Beiriger Justin , Ahrendt Gretchen , De La Cruz Carolyn , Diego Emilia J. , Steiman Jennifer G. , McAuliffe Priscilla F. , Gimbel Michael L.
Published: February 2023

Background:

Necrosis of the nipple-areolar complex (NAC) or surrounding skin has been reported in 6%–30% of nipple-sparing mastectomy (NSM) patients, with higher rates associated with larger breasts, previous breast surgery, previous radiation, and active smoking. The nipple delay (ND) procedure is known to improve viability of the NAC in NSM patients with high-risk factors.

Methods:

A single-institution retrospective review was done of patients who underwent ND and NSM or NSM alone from 2012 to 2022. Patient demographics, risk factors, and outcomes were compared.

Results:

Forty-two breasts received ND-NSM and 302 breasts received NSM alone. The ND-NSM group had significantly more high-risk factors, including elevated BMI (26.3 versus 22.9; P < 0.001), elevated prior breast surgery (50% versus 25%; P < 0.001), and greater mastectomy specimen weight (646.6 versus 303.2 g; P < 0.001). ND-NSM was more likely to have undergone preparatory mammoplasty before NSM (27% versus 1%; P < 0.001). There was no delay in NSM treatment from decision to pursue NSM (P = 0.483) or difference in skin necrosis (P = 0.256), NAC necrosis (P = 0.510), hematoma (P = 0.094), seroma (P = 0.137), or infection (P = 0.437) between groups. ND-NSM and NSM patients differed in total NAC necrosis (0% versus 3%) and implant loss (0% vs 13%), but not significantly.

Conclusions:

We demonstrated no NAC necrosis and no significant delay of treatment in higher risk ND-NSM patients. ND may allow higher risk patients to undergo NSM with similar morbidity as lower risk patients.
The nonalcoholic steatohepatitis extended hepatocyte ballooning score: histologic classification and clinical significance
Authors: Gill Ryan M. , Allende Daniela , Belt Patricia H. , Behling Cynthia A. , Cummings Oscar W. , Guy Cynthia D. , Carpenter Daniela , Neuschwander-Tetri Brent A. , Sanyal Arun J. , Tonascia James , Van Natta Mark L. , Wilson Laura A. , Yamada Goro , Yeh Matthew , Kleiner David E. ,   for the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN)
Published: February 2023

Background and Aims:

The NAFLD activity score was developed to measure histologic changes in NAFLD during therapeutic trials. Hepatocyte ballooning (HB) is the most specific feature in steatohepatitis diagnosis, yet the impact of variations in HB has not been incorporated.

Approach and Results:

Liver biopsies from patients enrolled in the NASH Clinical Research Network with an initial diagnosis of NASH or NAFL (n=1688) were evaluated to distinguish classic hepatocyte ballooning (cHB) from smaller, nonclassic hepatocyte ballooning (nHB), and also to designate severe ballooning and assign an extended hepatocyte ballooning (eB) score [0 points, no ballooning (NB); 1 point, few or many nHB; 2 points, few cHB; 3 points, many cHB; 4 points, severe cHB] to the biopsy assessment. The eB score was reproducible among NASH CRN liver pathologists (weighted kappa 0.76) and was significantly associated with older age (mean 52.1 y, cHB; 48.5 y, nHB, p<0.001), gender (72.3% female, cHB; 54.5% female, nHB, p<0.001), diabetes (49.8% diabetes, cHB; 28.2% diabetes, nHB, p<0.001), metabolic syndrome (68.5% metabolic syndrome, nHB; 50.2% metabolic syndrome, NB, p<0.001), and body mass index [33.2, 34.2, 35 mean body mass index (kg/m2); NB, nHB, and cHB, respectively, p<0.05]. Finally, fibrosis stage, as a marker of disease severity, was significantly correlated with the eB score (p<0.001).

Conclusions:

The eB score allows for a reproducible and more precise delineation of the range of ballooned hepatocyte morphology and corresponds with both clinical features of NASH and fibrosis stage.