bluuebunny/crossref_metadata_2025 huggingface dataset:
Spring
Authors: Burt Stephen , Burt Tim
Published: August 2022

Spring is very much a season of transition. Like a longer version of March, spring comes in like a lion and goes out like a lamb, but the journey is sometimes a disappointing one: warm weather raises expectations, only for hopes to be dashed by spells of cool—even cold—weather. Spring marks the transition from snow and frost to the warmth of high summer, as the days lengthen, and the temperature rises. This chapter examines the long-term records (averages and extremes) of temperature, precipitation, sunshine, barometric pressure, wind direction and speed, snowfall, and fog at Durham during the spring season. The chapter includes descriptive accounts and local photographs of notable weather events during the March–April–May period.
Autumn
Authors: Burt Stephen , Burt Tim
Published: August 2022

Just as spring, autumn is a season of transition. It often starts with hot, summery days but can end with snow; strong winds and rainstorms are likely at some stage in between. But there can be calm conditions and fog, too, redolent of John Keats’ ‘season of mists and mellow fruitfulness’; temperatures fall steeply during autumn. This chapter examines the long-term records (averages and extremes) of temperature, precipitation, sunshine, barometric pressure, wind direction and speed, snowfall and fog at Durham during the autumn season. The chapter includes descriptive accounts and local photographs of notable weather events during the September-October-November period.
Warmest, driest, sunniest …
Authors: Burt Stephen , Burt Tim
Published: August 2022

This brief chapter is based upon daily statistics for the Durham Observatory, Durham over the standard 30-year period 1991–2020, and considers the warmest and coldest, driest and wettest, sunniest and dullest days and weeks in an average year.
Temperature extremes in Durham
Authors: Burt Stephen , Burt Tim
Published: August 2022

This chapter examines Durham’s extremes of air and grass temperature, considering the earliest and latest dates in the year for various threshold temperatures, the hottest and coldest days, nights and months on record in almost 180 years, and prolonged heatwaves and cold spells.
Barometric pressure extremes in Durham
Authors: Burt Stephen , Burt Tim
Published: August 2022

Durham’s barometric pressure record is by far the longest digital pressure record in northern England. This chapter examines Durham’s extremes of barometric pressure over the period 1843 to 1960, considering both high and low barometric pressure on individual days and by monthly means, for each month of the year and for the near 120-year record as a whole.
The role of functional heads in syntactic change
Authors: Egedi Barbara , Hegedűs Veronika
Published: August 2022

This introductory chapter presents an overview on how formal syntactic studies interact with the theory of grammaticalization. Making a clear distinction between changes in the lexical and in the functional domains, the study focuses on the role of functional hierarchies, extended projections, and syntactic phases in structural changes, specifically in grammaticalization and reanalysis. These general considerations are connected to the case studies addressed in the subsequent chapters of the book. The problem of what syntactic changes are possible, predictable, or impossible is also addressed from various perspectives including the issues of unidirectionality and economy principles. Finally, a brief summary of each chapter of the volume is given, presenting their major assumptions and claims.
Changing patterns of clausal complementation in Latin
Authors: Danckaert Lieven
Published: August 2022

This chapter offers a unified account of two (at first blush independent) instances of syntactic change in Latin. Both developments are related to the system of clausal complementation. First, whereas Classical Latin typically uses infinitival clauses (so-called AcIs) to express embedded declaratives, these structures are later replaced by finite clauses, usually introduced by a complementizer. The opposite happens in the case of causatives, where a non-finite (infinitival) strategy is innovated. I propose that the key aspects of these two changes can be reduced to a single, more general, parametric change affecting Latin clause structure, namely the way in which the clausal EPP-requirement is satisfied, a change which affected possible patterns of subject placement (Danckaert 2017). The main mechanism needed to account for the observed facts is reanalysis of the Primary Linguistic Data by the language acquiring child.
The diachronic path ofsenão
Authors: Martins Ana Maria , Pereira Sandra , Pinto Clara
Published: August 2022

Early Old Portuguese exhibits a type of exceptive construction that soon vanished from the extant texts, but nevertheless demonstrates how exceptive subordination can evolve into exceptive coordination, and furthermore pinpoints a word order change. The exceptive construction consisted of a conditional structure associated to negation, in a discontinuous configuration of the type [se … NEG]. Adjacency between se and NEG was disrupted by constituents receiving information focus prominence, corresponding to the exceptive phrase. These exceptive conditionals signal that in 13th-century Portuguese two structural positions where available for elements with information focus prominence: a clause-final position, which can still be found in Contemporary Portuguese and a position at the left periphery. With the loss of this left-peripheral position, thus of focus fronting as a strategy to assign information focus, the word order pattern exhibited by discontinuous [se … NEG] was also lost, leading to the emergence of senõ/senão as a single lexical unit.
On Italian relative complementizers and relative pronouns
Authors: Sanfelici Emanuela , Garzonio Jacopo , Poletto Cecilia
Published: August 2022

This chapter explores the syntactic status of relativizers, i.e., what are standardly referred to as relative complementizers and relative pronouns, in Old and Modern Italian varieties. We propose a unified analysis for both types of items: both relative ‘complementizers’ and ‘pronouns’ have the same categorial status, i.e. they are wh-items, through the history of Italian. The diachronic change in the relativizer system from Old to Modern Italian varieties cannot be as an instance of a grammaticalization process in terms of van Gelderen’s Head Preference Principle, which assumes that heads are preferred over full XPs for economy reasons. We argue that the grammaticalization process that the relativizer undergoes can be considered as the reflex of the well known cartographic assumption that each projection expresses a single feature (see Cinque and Rizzi 2010b) but this feature can be realized by its specifier and not only by its head.
Tense recursion, perfect doubling, and the grammaticalization of auxiliaries
Authors: Larsson Ida , Brandner Ellen
Published: August 2022

The chapter deals with some notable differences in the construal of the perfect within the Germanic languages. Whereas German shows auxiliary selection between HAVE and BE, allows positional past adverbials, and has so called perfect doubling (where a perfect is construed with an additional participle of the AUX and which may induce—in addition to a pluperfect reading—an interpretation where the target state does not hold any more at speech time), English/Swedish have neither of these properties. It is suggested that nevertheless all the Germanic languages build the perfect by using a bi-clausal structure (with two T-projections) and the differences are due to different grammaticalization stages of the auxiliaries: German has developed a temporally impoverished HAVE, lacking the prepositional AT-component, cf. Kayne (1993) and thus allowing more flexibility in its use.
General Introduction
Authors: Dimmock Matthew , Hadfield Andrew
Published: August 2022

The introduction provides an overview of the anthology and explains the key concepts in the volume. Travel, it is argued, was valued because it was thought to provide new knowledge based on experience but it also exposed the traveller to dangers, in particular, of losing their identity through an excessive enthusiasm for other cultures and so maintaining a firm religious conviction was vital. English travellers often carried racial and religious prejudice but they were also open to new ideas as the extracts included here demonstrate. Concentrating on specific situations is vital if we wish to understand how the variety of ways of thinking about peoples could be activated in very different forms.
Europe
Authors: Dimmock Matthew , Hadfield Andrew
Published: August 2022

This chapter explores the ways in which English travellers observed Europe, its people, culture, and institutions. In the early sixteenth century the English court was painfully aware of its cultural inferiority to the most advanced states of Europe and accordingly intellectuals as well as ambassadors were sent abroad to bring back useful information to help England become more sophisticated, a practice that became much more complicated after the Reformation. England considered itself intimately connected to Europe as well as isolated from it. The chapter includes Robert Dallington’s survey of French practices and institutions; Thomas Coryat’s observations of Venice, Germany, and Switzerland; William Harborne’s account of his journey back from Constantinople; Sir Charles Somerset’s diary of his European travels to Paris and Florence; Fynes Moryson, the first professional English traveller, on Italy and Ireland; and William Lithgow’s harrowing account of his imprisonment by the Inquisition in Spain.
The North
Authors: Dimmock Matthew , Hadfield Andrew
Published: August 2022

This chapter includes material written by sailors on voyages to the Arctic, most eager to discover the North-West Passage which would have revolutionized English trade routes into the Pacific, as well as established a Northern Empire, as John Dee, the man who probably invented the term ‘British Empire’, urged. Fishing emerges as a significant issue as well. The explorers learned that the north-west was very different than they had imagined, full of ice and people of very different cultures who resisted Anglicization. Passages in this chapter include George Abbot’s overview of the northern regions; Fynes Moryson on his visit to Denmark; Giles Fletcher the elder on his voyage to and travels in Russia; George Best’s account of Martin Frobisher’s voyage to Baffin Island; Sir George Peckham’s account of Humphrey Gilbert’s voyage to Newfoundland, which provides a fascinating insight into the ways in which colonial occupation was undertaken; and John Davis on his encounters with the Inuit in Greenland.
Africa
Authors: Dimmock Matthew , Hadfield Andrew
Published: August 2022

The chapter provides an overview of English voyages to and knowledge of Africa. While Africa was to feature largely in the English imagination later, especially in Victorian times, in this period it was often imagined as two distinct locations: a cultured, Islamic North and a wild, pagan South. These assumptions had a deep influence on travellers’ experiences and accounts. Africa was to assume greater importance as the Atlantic slave trade developed, but at this time the trade was dominated by the Spanish and Portuguese. Representations were largely based on the history of Africa by Al-Hasan ibn Muhammad al-Wazzan al-Fasi, known to English audiences as Leo Africanus. As the extract included here demonstrates, his history was largely concerned with North Africa. Also included are extracts from Sebastian Munster on the islands of East Africa; Sir John Hawkins, notorious as the first English slave trader; Richard Madox on Sierra Leone; a translation of the voyage of the Portuguese adventurer, Duarte Lopez, to the Congo; and the traveller, George Sandys’ account of his journey to Egypt.
Islamic West Asia and the Eastern Mediterranean
Authors: Dimmock Matthew , Hadfield Andrew
Published: August 2022

This area, from the Black and Caspian Seas to the Mediterranean, was dominated by Islam and the Ottoman Empire, which had expanded impressively in the later Middle Ages, especially under the imperial rule of the powerful Sultan, Suleiman the Magnificent, whose Pan-Ottoman strategy absorbed a range of diverse peoples under his sole rule. The English were eager to trade with the Ottomans and to forge an alliance with the empire in particular to counteract the hegemony of Spain in Western Europe and a number of trade missions were sent which are reproduced here. The increased prominence of Ottoman power then led English dramatists to produce stage figures caricaturing the bombastic Turk. This chapter includes extracts from Anthony Jenkinson on his journey to the Caspian Sea through the lands of the Tatars; Thomas Dallam, who travelled to Istanbul to deliver an organ to the emperor, Mehmed III; Anthony Sherley, a wily and self-serving diplomat who was entrusted with establishing relations in Persia; Fynes Moryson on the nature and characteristics of the Ottoman Empire; and George Sandys, Henry Timberlake, and William Lithgow on the Jews in Ottoman Palestine and Jerusalem.
Sexual Violence Against Men in Contemporary Warfare
Authors: Žarkov Dubravka
Published: August 2022

While there has been an increased acknowledgment of the fact that males are subjected to sexual violence, these crimes are rarely acknowledged as gendered, and there is still a need to identify the full range of gendered harms experienced by males and to ensure accountability for these crimes. This chapter analyses sexual violence and more specifically rape as a war practice from the perspective of the male victim. It focuses on the violated male body and argues that there are different meanings of war rapes for male and female victims and their different (in)visibilities indicate differences in the ways modern masculinities and femininities are produced. The author argues that war and armed conflict—and sexual violence therein—are social processes in which these differences come to the forefront.
Children, Gender, and International Criminal Justice
Authors: Atiba-Davies Gloria , Nwoye Leo C
Published: August 2022

Insufficient attention has been paid within international criminal law (ICL) to the distinctive features of gender-based crimes against children, although the Office of the Prosecutor (OTP) of the International Criminal Court’s (ICC) 2016 Policy Paper on Children makes significant strides in this direction. This chapter examines international jurisprudence on crimes against children and considers strategies to better uncover and recognize the role of gender in those crimes.
Reproductive Crimes in International Criminal Law
Authors: Grey Rosemary
Published: August 2022

Although some states have taken concrete steps to protect reproductive autonomy within their borders, there is no international consensus on the issue and as a result, no international instrument that criminalizes reproductive crimes. This chapter seeks to incentivize greater attention to reproductive violence in international law going forward. This chapter starts by explaining the concept of reproductive violence and its links to gender, race, and other identities. It then traces the process of ‘surfacing’ reproductive violence in international criminal law (ICL), taking into account broader debates about global ‘over-population’, women’s empowerment, and human rights. This historic overview gives a sense of the political challenges to protecting and promoting the value of reproductive autonomy in international law. Finally, the chapter explores strategies for prosecuting violations of reproductive autonomy in the International Criminal Court (ICC) and other international courts. This includes a discussion of genocide, forced pregnancy, enslavement, sexual violence, persecution, outrages on personal dignity, torture, and inhumane acts.
Using International Criminal Law to Curb Discriminatory Practices Against Females
Authors: Mulvey Antonia
Published: August 2022

A number of discriminatory acts and practices against females are ordered or tolerated by many states. These might include domestic or family violence, as well as harmful practices such as female genital mutilation (FGM). This chapter discusses the broader potential of the crimes against humanity category to address state-ordered or tolerated regimes of discrimination against females in peacetime, using FGM as a case study. This chapter seeks to redefine FGM as the crime against humanity of torture in some contexts. In doing so, it looks to reshape the way the legal community, and society more generally, considers and responds to FGM. It also explores the potential benefits to the international community, society and victims of redefining FGM and other discriminatory practices as torture.
Fragmentation Fears or Interaction Opportunities?
Authors: O’Rourke Catherine
Published: August 2022

Article 21(3) of the Rome Statute allows for potential interaction between international human rights law (IHRL) and international criminal law (ICL), especially in the area of gender jurisprudence. However this interaction has been limited and the International Criminal Court (ICC) has interpreted article 21(3) narrowly. This chapter sets out to do three things: first, it illuminates the Court’s narrow approach to article 21(3) in its gender jurisprudence through the case study of the ICC’s child soldier jurisprudence emerging from the conflict in the Democratic Republic of the Congo (DRC); second, it contextualizes these findings within broader debates on fragmentation and women’s rights in conflict under international law; and third, it proposes strategies for the pursuit of more productive interactions between ICL and IHRL in order to enhance the overall protection of women’s rights in conflict under international law.
Contemporary Armed Conflict and Gender
Authors: Durham Helen , Green Laura
Published: August 2022

This chapter addresses the gendered effects of armed conflict and certain types of violence. The authors examine recent changes in warfare, in particular the increasingly protracted nature of war, the role of women in the military, the role of new technologies, and the impact of counterterrorism. This examination includes how these changes have affected society and women more specifically.
Being Realistic about Kant’s Idealism
Authors: Rosefeldt Tobias
Published: August 2022

This chapter deals with the question of whether Kant’s transcendental idealism is realistic in the sense of allowing for an explanation of the a posteriori aspects of mental content by the properties of empirical objects. The author first shows that a phenomenalist interpretation has severe problems with assuming that we perceive an object as being red or as being cubical partly because the perceived object is red and cubical, and then presents an interpretation that allows us to save the realistic intuition behind these claims. According to this interpretation, Kantian phenomenal properties are understood as response-dependent properties of extra-mental objects that also have to have some response-independent (in-itself-) properties. This interpretation is well supported by Kant’s remarks about the transcendental object in the A-edition of the first Critique and it also makes intelligible why Kant took explanations of mental content by means of empirical properties to imply an explanation by means of noumenal properties without thereby violating his own doctrine of noumenal ignorance. This not only allows us to establish a realistic reading of Kant idealism but also to discern the true kernel in Adickes’s infamous talk about Kant’s theory of double affection.
Relation to an Object
Authors: Allais Lucy
Published: August 2022

The aim of this chapter is to address one part of Kant’s argument in the Transcendental Deduction of the categories: why he thinks that the application of the categories is necessary for thought to have “relation to an object.” At the center of the Deduction is the idea that having a unified self-consciousness that one can be aware of as such requires having thoughts about a world of objective particulars. I take this to be an answer to Humean/empiricist skepticism about a priori concepts. Kant thinks that in representing something as objective we represent it as constraining our representations of it; but also that the spontaneity of combination means that combination is not given. Kant takes this to create a problem with how we could manage to represent objects as that which is opposed to our cognitions being determined at pleasure or arbitrarily. His solution is the transcendental concept of an object in general: representing objects’ properties as having necessary connections with each other enables us to represent objects as constraining our cognition. This addresses a problem about concept application faced even by the realist empiricist who takes us to be presented with empirical particulars and accepts Kant’s account of the spontaneity and generality of conceptual thought. Thinking that there are objects which, independently of us, are spatiotemporal causal unities is not enough to explain what it takes for us to have successful concept application in which we think of objects as such.
How Does Kant Conceive of Self-Consciousness?
Authors: Emundts Dina
Published: August 2022

This chapter focuses on the question of how to best understand Kant’s conception of self-consciousness. Is it something that exists or is it a conceptual construction? If there is an existing Self, what can we say about it? If it is a conceptual construct, what kind of construct is it? The first section sketches out three interpretations of Kant’s concept of self-consciousness. In the second section it is argued that self-consciousness is best understood to involve a consciousness of a real, existing thing as opposed to a consciousness of a merely intentional object or “thought-thing.” This idea is further developed and discussed in the third and fourth sections. These sections are particularly concerned with the questions of how Kant can claim this, even though—by Kant’s own standards—this cannot be a case of knowledge or cognition.
Kant’s Derivation of the Moral “Ought” from a Metaphysical “Is”
Authors: Marshall Colin
Published: August 2022

This chapter argues that Kant can be read as holding that “ought” judgments follow from certain “is” judgments by mere analysis. More specifically, an interpretation is defended according to which (1) Kant holds that “S ought to F” is analytically equivalent to “If, as it can and would were there no other influences on the will, S’s faculty of reason determined S’s willing, S would F” and (2) Kant’s notions of reason, the will, and freedom are all fundamentally non-normative. Not only does this reading have significant textual support, but it also sheds light on why Kant takes freedom and morality to mutually imply one another. Moreover, while Kant does take there to be a gap between moral judgments and empirical descriptive statements, that gap is consistent with the analysis in question. The author concludes by arguing that this rejection of the is-ought gap is not as philosophically implausible as it might seem, with a focus on G. E. Moore and Hume’s arguments for certain “gaps” between the normative and the non-normative.
First Insight
Authors: Dorogovtsev Sergey N. , Mendes José F. F.
Published: August 2022

Look at the two graphs in Figure 1.1. Could you say which graph is random, left or right? The typical student’s response is: ‘Of course, the right one!’ This immediate answer is dramatically incorrect. It is actually impossible to say whether a finite graph is random or non-random (deterministic) since one can generate any finite graph by some deterministic algorithm. The example in Figure 1.2 explains what is really a random graph. This graph has a number of different realizations (individual graphs), and each of them occurs with some associated probability. Thus a random graph (random network) is a statistical ensemble of individual graphs, in which each member has its probability of realization. (Note that we do not distinguish the terms ‘graph’, or its generalization—‘hypergraph’, and ‘network’.) In particular, all these probabilities may be equal, which provides a uniform ensemble. In short, a random graph is a statistical ensemble of graphs. In this picture, the result of the measurement of some characteristic of a random graph, an observable, is the average of this characteristic over the statistical ensemble accounting for the probabilities of realization of its members.
Evolving Networks
Authors: Dorogovtsev Sergey N. , Mendes José F. F.
Published: August 2022

Most real networks are evolving. Here we discuss how basic models of these networks provide a spectrum of complex architectures. We begin with the simplest growing networks, the random recursive trees introduced in namely the labelled recursive trees where each added vertex is attached to a vertex chosen uniformly at random. Recall that the total number of arbitrary labelled recursive trees of N vertices equals which readily follows from the uniform selection of existing vertices for the attachment of the new one. This is a specific feature of random recursive trees.
Epidemics and Spreading Phenomena
Authors: Dorogovtsev Sergey N. , Mendes José F. F.
Published: August 2022

In this chapter we mainly focus on the results of activation processes in networks and on various combinations of activation and deactivation processes. The bootstrap percolation problem is about the basic activation process on networks, in which vertices can be in active and inactive states. A vertex becomes active when the number of its active neighbours exceeds some threshold; and once active, a vertex never becomes inactive (Adler and Aharony, 1988; Adler, 1991). This is one of the spreading processes with discontinuous phase transitions (Bizhani, Paczuski, and Grassberger, 2012). Let us define bootstrap percolation on undirected graphs in more strict terms. In the initial state, a fraction f of vertices is active (seed vertices). These vertices are chosen uniformly at random. Each inactive vertex becomes active if it has at least kb active nearest neighbours. Here we introduce the subscript ‘b’ to distinguish this threshold from a threshold in the k-core percolation problem.
Inference and Reconstruction
Authors: Dorogovtsev Sergey N. , Mendes José F. F.
Published: August 2022

Inference is generally about drawing conclusions about the whole on the basis of a sample. Statistical inference is ‘the process of deducing properties of an underlying distribution by analysis of data’ (Zdeborová and Krzakala, 2016). More specifically, in statistical mechanics inference usually implies concluding characteristics of a statistical ensemble (or its model, which is practically the same) on the basis of a sample (Clauset, Moore, and Newman, 2006). Here we touch upon a more restricted problem. Consider a branching process taking place on a given graph, which started from some unknown initial vertex, a root. At some instant, an observer makes a snapshot of this process and records its result—a tree subgraph of the substrate graph. The questions are: is it possible to guess the root from this observation; and, when it is possible, what is the best root-finding algorithm? The answers to these questions depend on the branching process and on the substrate graph. Remarkably, root finding is possible for a wide range of branching processes and substrate graphs.
Modeling conflict risk with real-time traffic data for road safety assessment: a copula-based joint approach
Authors: Hu Yuping , Li Ye , Yuan Chen , Huang Helai
Published: August 2022

This study proposes a conflict-based traffic safety assessment method by associating conflict frequency and severity with short-term traffic characteristics. Instead of analysing historical crash data, this study employs microscopic trajectory data to quantify the relationship between conflict risk and traffic characteristics. The time-to-collision (TTC) index is used to detect conflicts, and a severity index (SI) is proposed on the basis of time-integrated TTC. With SI, the k-means algorithm is applied to classify the conflict severity level. Then the severity of regional conflict risk is split to three levels. Zero truncated Poisson regression and ordered logit regression methods are employed to estimate the effects of short-term traffic characteristics on conflict frequency and severity, respectively. Furthermore, the copula-based joint modelling method is applied to explore the potential non-linear dependency of conflict risk outcomes. A total of 18 copula models are tested to select the optimal ones. The HighD dataset from Germany is utilized to examine the proposed framework. Both between-lane and within-lane factors are considered. Results show that the correlations between traffic characteristics and conflict risk are significant, and the dependency of conflict outcomes varies among different severity levels. The difference of speed variation between lanes significantly influences the conflict frequency and severity simultaneously. Findings indicate that the proposed method is practicable to assess real-time traffic safety within a specific region by using short-term (30-second time interval) traffic characteristics. This study also contributes to develop targeted proactive safety strategies by evaluating road safety based on conflict risk, and considering different severity levels.
Maintaining Medical Student Motivation During Remote Clinical Learning
Authors: Charondo Leslie Bernal , Duque Jackeline Barajas , Kirsch Heidi E. , Brondfield Sam
Published: August 2022

Purpose

Remote clinical learning (RCL) may result in learner disengagement. The factors that influence medical student motivation during RCL remain poorly understood. The authors aimed to explore factors that affect medical student motivation during RCL and determine potential strategies to optimize student motivation during RCL.

Method

In December 2020, the authors conducted semistructured interviews with third- and fourth-year medical students at the University of California, San Francisco, who had experienced RCL. The authors coded transcripts and conducted an inductive thematic analysis using self-determination theory (SDT), which describes autonomy, competence, and relatedness as essential for motivation, as a sensitizing framework.

Results

Twelve students were interviewed. Four themes were identified and aligned with SDT: balancing flexibility and structure (autonomy), selecting appropriate resources (competence), setting reasonable expectations (competence), and building and maintaining community (relatedness). Students described a sense of tension between desiring flexibility and appreciating structure and accountability during RCL; a preference for high-yield, curated resources presented in an organized format during RCL; instances in which the remote curriculum fell short of their expectations or professional goals or in which they felt they had missed out on key clinical learning; and support sought from peers, mentors, and instructors during RCL, as well as the contribution of remote learning technology to a sense of community.

Conclusions

The authors propose 4 guiding principles to address implementation of remote clinical curricula: provide students with choice within the bounds of a well-defined curriculum, curate and organize learning materials carefully and intentionally, orient students to the goals and objectives of the curriculum and discuss students’ expectations for professional development, and incorporate structured opportunities for remote mentorship and peer–peer interaction and optimize these opportunities using technology. Educators can draw on the themes, guiding principles, and potential strategies identified to promote and maintain learner motivation during RCL.
Inclusivity in Leader Selection: An 8-Step Process to Promote Representation of Women and Racial/Ethnic Minorities in Leadership
Authors: Holladay Courtney L. , Cavanaugh Katelyn J. , Perkins Larry D. , Woods Amanda L.
Published: August 2022

At a systemic level, organizations need to take intentional steps to build inclusion, equity, and diversity at all levels. In accordance with this need, organizations have been catalyzed by national conversations surrounding gender and racial/ethnic discrimination to generate sustainable change that addresses the disenfranchisement of women and racial/ethnic minorities. Although progress toward addressing the systemic issues that perpetuate these inequities has been made in recent years, research indicates that underrepresentation at the leadership level persists in academic medicine. Further, those in more senior roles are more likely to select, sponsor, and/or mentor individuals like themselves, thereby depriving minority populations of experiences directly correlated with career development and advancement. Hence, the authors posit a focus on the characteristics and competencies of a leader along with a structured selection process is an effective intervention to reduce bias and support inclusion by recalibrating the representation of leadership within academic medical centers. To this end, the authors developed a sequential 8-step leader selection process informed by their model of leadership characteristics and competencies. This process includes a policy update, selection of interview panels, training of panelists, screening the candidate pool, structured interview guides, final candidate slates, assessments of final candidates, and development of newly selected leaders. By following this process, the authors’ organization has seen an increase in the representation of women and racial/ethnic minority leaders, an increase in employees’ favorable perceptions specific to representation, and data indicative of developing and maintaining an internal diverse leadership candidate pipeline. Ultimately, inclusion makes stronger and more resilient organizations. By following a standardized process grounded in leadership characteristics and competencies, academic medical centers can see changes in their leadership that mirror the populations they lead and serve. Using such processes can lead to the kind of systemic change needed to create inclusive environments.
An Analysis and Evaluation of Kumpfer's Resilience Framework
Authors: Zhang Zhihong , Stein Karen F. , Norton Sally A. , Flannery Marie A.
Published: August 2022

Kumpfer's resilience framework (KRF) was initially developed from evidence on resilience and its predictors among at-risk youth. This framework has been expanded to guide resilience research in diverse populations facing a variety of stressors. However, KRF's strengths and weaknesses have not been evaluated since its publication. Guided by Walker and Avant's method, an analysis of KRF was conducted drawn from 41 publications. A revised KRF diagram was proposed on the basis of the analysis to improve clarity, consistency, logical structure, and parsimony in the diagram of KRF. Overall, KRF provides a useful, generalizable, and testable theoretical framework for future resilience research.
Palliative Care Clinicians’ Perspectives of an Integrated Caregiver Patient-Portal System in Oncology
Authors: Longacre Margaret L. , Chwistek Marcin , Collins Molly , Odelberg Michelle , Siemon Mark , Keleher Cynthia , Fang Carolyn Y.
Published: August 2022

Background:

Despite recommendations and policies to integrate family caregivers into US healthcare settings, caregivers are not systematically involved. Thus, we developed an Integrated Caregiver Patient-Portal system that (1) allows a patient to identify their primary caregiver and their communication preferences; (2) connects the caregiver to a unique portal page to indicate their needs; and (3) informs the care team of dyad responses to aid in integrating the caregiver.

Objective:

This formative research explored palliative care clinicians’ perceptions of the system to inform refinements before usability testing.

Methods:

We conducted two focus groups with palliative care clinicians (N = 11) at an NCI-designated cancer center. Transcripts were analyzed using an integrated approach to specify system benefits and concerns.

Results:

The most referenced benefits included: Learning information that they might not have known without the system; giving caregivers a voice or a way to express needs; and supporting an ideal model of care. Top concerns included lacking capacity to respond; needing to clarify clinician roles and expertise in responding to caregivers’ needs; and ensuring ongoing system adaptability.

Conclusions:

The clinicians’ feedback resulted in revisions including: (1) modifying the caregiver questions; (2) integrating social workers in the response; and (3) adding a text-based report to the care team.

Implications for Practice:

This formative research provided valuable feedback for portal development, and also contributes more broadly to recommendations related to integrating caregivers in healthcare.

What is Foundational:

This research provides practical and logistical relevance to the discussion on how to integrate caregivers into clinical care.
Rediscovering the Joy of Eating in Older Adults With Gastrointestinal Cancer Undergoing Treatment
Authors: Yagasaki Kaori , Komatsu Hiroko , Hamamoto Yasuo
Published: August 2022

Background:

Cancer treatment significantly impacts the diet of older adults with cancer. Professional support is required for such patients to manage their eating problems at home.

Objective:

To explore the dietary experiences of older adults with gastrointestinal cancer undergoing treatment, and their perceptions of how the disease and its treatment affected their eating.

Interventions/Methods:

Semi-structured interviews were conducted with 21 older patients (aged ≥ 70 years) with gastrointestinal cancer in Japan. Interview data were analyzed using thematic analysis.

Results:

Three key themes were identified: impact on daily life, significance of eating, and rediscovering the joy of eating. Participants experienced dietary changes and reduced social interactions. Challenging situations allowed them to reassess their eating values and habits. By seeking their own coping strategies, they rediscovered the pleasure of eating.

Conclusions:

Older adults with gastrointestinal cancer tried to cope with dietary changes based on their reaffirmed values while seeking the joy of eating.

Implications for Practice:

A multidisciplinary healthcare team can support patients’ self-management by seeking to understand patients’ eating values and habits rather than focusing only on patients’ weight control and nutritional status.

Foundational:

Older adults with gastrointestinal cancer reaffirm the significance of eating and rediscover the joy of eating through the experience of dietary changes due to the disease and its treatment. Health care professionals who encourage patients to find pleasure in eating encourage a new patient perspective to support their self-management with eating.
Adaption of the Quality From the Patient’s Perspective Instrument for Use in Assessing Gynecological Cancer Care and Patients’ Perceptions of Quality Care Received
Authors: Olsson Cecilia , Wilde Larsson Bodil , Larsson Maria , Holmberg Erik , Marcickiewicz Janusz , Tholander Bengt , Flöter-Rådestad Angelique , Bjurberg Maria , Dahm-Kähler Pernilla , Hellman Kristina , Kjølhede Preben , Stålberg Karin , Högberg Thomas , Åvall Lundqvist Elisabeth , Borgfeldt Christer
Published: August 2022

Background:

Research focusing on patients’ perceptions of the quality of gynecological cancer care is needed.

Objective:

To adapt the Quality from the Patient’s Perspective instrument for use in gynecological cancer care (QPP-GynCa) and describe patients’ perceptions of their quality of care in terms of the care received and the subjective importance of the aspects of care.

Methods:

A cross-sectional study 6–8 months after diagnosis was conducted, involving 1511 patients (response rate of 50.4%) included in the Swedish quality registry for gynecologic cancer.

Results:

The exploratory factor analysis (n = 1431) resulted in the QPP-GynCa with a 5-factor structure and an eigenvalue of ≥1, explaining 73.1% of the total scale variance. The final 27-item version of the QPP-GynCa consisted of 18 items with 8 additional single items and 1 global single item. The Cronbach’s alpha was acceptable for most factors (>.80). Subjective importance scores were higher than corresponding quality of care scores for care received (P ≤ .01)in all dimensions, factors, and items.

Conclusions:

The QPP-GynCa instrument reflects all 4 dimensions of the theoretical model of quality of care and achieved good validity as a reliable instrument in assessing the quality of gynecological cancer care.

Implication for Practice:

Information related to self-care, aspects of sexuality, and reducing patient waiting times need improvement.

What Is Foundational:

This study contributes to a better understanding of quality of gynecological cancer treatment and care. The validated QPP-GynCa instrument will be a platform for more research on how this group of patients experience their received care, as well as importance of each aspect of care.
Ductal prostate cancer: Clinical features and outcomes from a multicenter retrospective analysis and overview of the current literature
Authors: Cozzi Salvatore , Bardoscia Lilia , Najafi Masoumeh , Igdem Sefik , Triggiani Luca , Magrini Stefano Maria , Botti Andrea , Guedea E. Ferràn , Melocchi Laura , Ciammella Patrizia , Iotti Cinzia , Gutierrez M. Cristina
Published: August 2022

Objective

The aim of the study is to evaluate clinical features and outcomes after different therapeutic strategies for ductal prostate adenocarcinoma (DPC), a rare but aggressive subtype of invasive prostate cancer (PCa) accounting for, in the pure and mixed form, 1% or less and 5% or less, respectively, of all the newly diagnosed PCa.

Materials and methods

Patients with a proven diagnosis of DPC undergoing surgery, radiotherapy, and androgen deprivation therapy, alone or in combination, were considered for this multicenter, retrospective study. The study assessed overall survival (OS), disease-free survival (DFS), and age-related disease-specific survival.

Results

Eighty-one patients met the study inclusion criteria. Pure DPC was found in 29 patients (36%) and mixed ductal-acinar-PCa in 52 patients (64%). After a median follow-up of 63 months (range, 3–206 months), 3- and 5-year OS rates were 84% and 67%, respectively, and 3- and 5-year DFS rates were 54% and 34%, respectively. There were no significant differences in OS or DFS between the pure and mixed DPC groups. Pure DPC was associated with a higher rate of metastatic disease at onset. Patients 74 years or younger had better disease-specific survival (p = 0.0019). A subgroup analysis favored radiotherapy as the primary treatment for nonmetastatic, organ-confined DPC (3- and 5-year DFS of 80% and 50%, respectively, compared with 5-year DFS of 35% for surgical patients; p = 0.023).

Conclusions

Our study found DPC to be rarer, more aggressive, more likely to metastasize, and have a worse prognosis than the common acinar variant, especially in its pure form. Multicenter series are encouraged to obtain large data sets, or propensity score matching analyses with patients with conventional PCa are desirable to understand the best therapeutic approach and improve outcomes.
Primary testicular lymphoma: Clinical characteristics and oncological outcomes
Authors: Medina Alberto Artiles , Lorca Álvaro Javier , Carretero del Barrio Irene , Laso García Inés , García Cosío Mónica , Mata Alcaraz Marina , Hevia Palacios Manuel , Gómez Dos Santos Victoria , Burgos Revilla Francisco Javier
Published: August 2022

Background

Primary testicular lymphoma (PTL) is a rare testicular malignancy, despite being considered the most common testicular tumor in patients older than 60 years. Primary testicular lymphoma represents only 1%–9% of testicular neoplasms. Few studies have been published regarding its clinical features and management. This study aimed to analyze the clinical characteristics and outcomes of PTL.

Materials and methods

Orchiectomy specimens of 15 patients with PTL diagnosed during 2000–2020 at our institution were retrospectively studied. We collected information on demographic data, clinical features, management aspects, and outcomes of PTL treatment. Kaplan-Meier survival curves and Cox regression analyses were used to study survival.

Results

The median patient age was 69 years (interquartile range, 61–72 years). The most prevalent clinical presentation was testicular swelling (80%), and only 13.33% of the patients presented with systemic symptoms. Central nervous system involvement was detected in 6 patients (40%). Of the 15 patients, 5 (33.33%) had stage IE and 10 (66.67%) had stage IVE lymphoma. Diffuse large B-cell lymphoma was the most common histological subtype. Twelve patients (80%) received chemotherapy. During follow-up, 4 patients (26.67%) relapsed. The recurrence rate in the contralateral testicle was 13.33%. The median cancer-specific survival was 21.58 months (95% confidence interval, 0–43.95 months). Univariate Cox regression analysis showed that central nervous system involvement and International Prognostic Index score were significantly associated with shorter cancer-specific survival.

Conclusions

Primary testicular lymphoma has a high relapse rate and poor prognosis. Management strategies typically include radical orchiectomy and systemic chemotherapy. Central nervous system involvement and International Prognostic Index scores were associated with lymphoma-specific survival.
Prevalence of pelvic floor disorders and the associated quality of life among institutionalized and noninstitutionalized elderly women: A cross-sectional study
Authors: Souza Heloisa da Costa , Pires Lívia M. T. , Vieira Gláucia C. , Castro Edna A. B. , Moura Elaine A. , Engelmann Júlia , Fonseca Diogo S.
Published: August 2022

Background

An increase in life expectancy has led to an increased elderly population. In turn, this aging population is more likely to develop health conditions, such as pelvic floor disorders (PFDs). This study aimed to assess the prevalence of these disorders and the associated quality of life in institutionalized and noninstitutionalized elderly women.

Materials and methods

A cross-sectional study was conducted with 80 female participants older than 60 years, divided into 2 groups: institutionalized and noninstitutionalized participants. The Pelvic Floor Distress Inventory Short-Form and a sociodemographic questionnaire were used. A chi-squared test was used to assess the differences in prevalence between groups.

Results

There was no statistically significant difference between the groups in the prevalence of PFDs or quality of life. In this study, the prevalence of PFDs was higher than that reported previously. In institutionalized women, a higher prevalence of PFDs and impaired quality of life were expected, although not observed.

Conclusions

There was a higher prevalence of pelvic disorders and impaired quality of life due to these disorders in elderly women.
Pulmonary Embolism in Pregnancy
Authors: La Rosa Mauricio , Emezienna Nkechinyere , Olson Gayle
Published: August 2022

Pulmonary embolism during and after pregnancy remains a significant contributor to maternal morbidity and mortality. Symptoms that would be a clear indicator of a pulmonary embolus in the nonpregnant population can be masked by pregnancy and its routine pregnancy-related symptoms. To affect a reduction in this severe maternal mortality indicator, physicians need to maintain a high degree of suspicion coupled with expedient testing.