bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the Complex Loyalty of Lawyers
Authors: Wendel W. Bradley
Published: June 2023

Lawyers understand themselves as having strong client-centered duties, often summarized as “zealous advocacy.” These duties flow from the highly fiduciary relationship between lawyers and clients and include loyalty, competence, and keeping client secrets. But lawyers also have responsibilities to maintain the integrity of the legal system, not just in litigation but in transactional and counseling clients as well. How to account for these duties is a puzzle for fiduciary theory. This chapter considers three models that have been proposed for complex fiduciary duties—dual mandates, governance mandates, and internally limited duties. It contends that the model of internally limited duties best accounts for the obligation not to pursue objectives on behalf of a client that are not adequately supported by the client’s lawful powers. Lawyers do not have a conflict of interest when taking account of the interests of others. Rather, these interests are built into the limits of the client’s own legal authorization to engage in a course of conduct.
Social Movements as Actors and Systems
Authors: Rucht Dieter
Published: June 2023

The common assumption that a social movement is a goal-oriented actor is relativized. In any major protest activity, all types of social action identified by Habermas can be found. Occasionally, a movement operates as a unified actor. At other times, only some components of a movement are active. In these situations, we can refer to the movement as an action system based on a directional collective identity. Related to this, we should not a priori classify a social movement as a social system or a unified actor. Movements have different functions: their activities are processes of communication in which, both internally and externally, power plays an important role.
How to Pool Risks Across Generations
Authors: Otsuka Michael
Published: June 2023

How to Pool Risks across Generations makes the case for the collective provision of pensions, on fair terms of social cooperation. Through the insurance of a mutual association which extends across society and over multiple generations, we share one another’s fates by pooling risks across both space and time. Resources are transferred, not simply between different people, but also within the possible future lives of each person: from one’s more fortunate to one’s less fortunate future selves. The book opens with an investigation of the longevity and investment risk that even a single individual on a desert island would face in providing for her old age. From this atomistic starting point, it builds up, within and across the chapters, to increasingly collective forms of pension provision. By joining together, it is possible to tame the risks we would face as individuals, each with our own private pension pot. A collective pension can be justified as a ‘social union of social unions’: an enduring corporate body, which is formed by agreements to pool risks, in a manner that involves reciprocity between the various individuals who constitute the collective. Even though all individuals age and die, a collective pension scheme remains evergreen, as the average age of members remains relatively unchanged, through the influx of new members to replace those who retire. It is therefore possible to smooth risks indefinitely across as well as within generations, to the mutual advantage of each.
The Case for Collective Defined Contribution
Authors: Otsuka Michael
Published: June 2023

Chapter 1—‘The Case for Collective Defined Contribution’—shows how the tontine provides an elegant theoretical basis for increasingly collective solutions—involving the pooling of risks associated with longevity and investment returns—to the ‘nastiest, hardest problem in finance’. In a typical defined contribution (DC) retirement savings plan involving the drawing down of income, one bears the risk of living so long that one spends one’s last years on earth in poverty because one has outlived the savings in one’s own private pension pot that have been invested for one’s retirement. This predicament has famously been described by a Nobel laureate in economics as the aforementioned ‘nastiest, hardest problem’. This risk can be mitigated through an arrangement known as a tontine, whereby the assets of those who die earlier are redistributed to those who manage to outlive them. Although tontines have become historical relics that now survive mainly as fictional murder plots in film and cartoon, they provide the theoretical underpinnings for a promising form of pension provision known as ‘collective defined contribution’ (CDC). In one variant of CDC, the risks are collectively pooled only among the members of each age cohort. In another form, they are collectively pooled across different cohorts. This chapter explicates the innovative design of a version of the latter that Royal Mail is introducing for its members.
Introduction
Authors: Clift Aaron
Published: June 2023

This chapter introduces the topic of anticommunism in postwar France. It demonstrates the importance of anticommunism to French politics between 1945 and 1953. It overviews the historiography of anticommunism in France, highlighting a general lack of attention to its social ramifications. It also discusses the relationship between French anticommunism and the international context of the Cold War, arguing that while external developments were important, anticommunism also had domestic roots and was not merely an American import or a carbon copy of anticommunism elsewhere. The structure and methodology of the monograph are set out. Finally, common themes of French anticommunism are summarized, noting the relationship of anticommunism to wider anxieties about social change.
Marx vs. La Fontaine
Authors: Clift Aaron
Published: June 2023

This chapter analyses the role of anticommunism in France’s developing middle-class politics. The ‘classes moyennes’ rather than the older concept of the bourgeoisie became important to a wide range of activists. Anticommunism played a fundamental role in this process, as Marxism operated as the foil against which the ‘classes moyennes’ defined themselves. Since they resisted an ‘objective’ definition of class based on economic or material conditions, a cultural and civilizational conception juxtaposed the ‘classes moyennes’ with the communist barbarians who threatened their heritage. Therefore, this chapter highlights the importance of the concept of ‘Western civilization’ to anticommunism, as well as links to class anxiety, anti-statism, and anti-Americanism.
Conclusion
Authors: Clift Aaron
Published: June 2023

This conclusion summarizes the findings of the study, briefly discusses post-1953 developments, highlights similarities and differences between French anticommunism and that of other countries, and demonstrates the wider significance of anticommunism to French and global history. It explains the decision to conclude the study in 1953. The common discourses, aims, and tactics of French anticommunists identified by the case studies are summarized, and a final conceptualization of anticommunism’s relationship to French society is provided. The significance of anticommunism for the development of French politics generally and particular issues such as decolonization, agricultural politics, feminism, and the labour movement is highlighted.
Power struggles: Police and crime commissioners, chief constables, and the battle over operational policing
Authors: Derfoufi Zin
Published: June 2023

This paper reviews the challenges that directly-elected Police and Crime Commissioners (PCCs) face in reforming controversial police tactics that are favoured by chief constables, but generate significant concerns among the electorate. Focusing on reforms to police-initiated stops, namely ‘stop and account’ and ‘stop and search’, the results suggest PCCs tend to achieve incremental changes, at best, as they struggle to overcome resistance from their chief constables and the legal constraints of ‘operational independence’. The results have significant implications because it suggests PCCs are not as powerful as has been assumed. However, PCCs can enhance the prospects of reform and better navigate resistance by exercising their rarely used soft powers, such as commissioning national regulatory bodies to review areas of concern or appealing to their local Police and Crime Panel for support in scrutiny. The results of this study are based on interviews with PCCs and chief constables, their deputies and assistants, local campaign groups and staff from national regulatory bodies, as well as participant observations across several police forces.
Effects of a Physical Therapist Intervention on GPS Indicators of Community Mobility in Older Adults: A Secondary Analysis of a Randomized Controlled Trial
Authors: Dunlap Pamela M , Crane Breanna M , Perera Subashan , Moored Kyle D , Carlson Michelle C , Brach Jennifer S , Klatt Brooke N , Rosso Andrea L
Published: June 2023

Objective

The authors compared the effects of a standard strength and endurance intervention with a standard plus timing and coordination training intervention on community mobility measured using global positioning systems (GPS) among community-dwelling older adults in this secondary analysis of a randomized controlled trial.

Methods

Participants were randomized to a standard or a standard plus timing and coordination training program. Community mobility was measured using the Life Space Assessment (LSA) and GPS indicators of community mobility at baseline, as well as at 12 (immediately after the intervention), 24, and 36 weeks. Linear mixed models were used for analysis.

Results

There were 166 participants with GPS data at baseline, including 81 in the standard plus group and 85 in the standard group. The groups did not differ in participant characteristics or GPS measures at baseline. There were no significant within-group changes in GPS indicators of community mobility or LSA score over time, nor between-group differences of the same.

Conclusion

There were no significant changes in community mobility with either intervention or between-intervention differences. These findings suggest that interventions targeting physical function alone may not be sufficient to improve community mobility or participation in older adults. Future research should focus on the development of multifaceted interventions targeted to improve real-world participation.

Impact

The studied interventions did not significantly change community mobility measured using GPS-derived community mobility measures or self-report measures in older adults, suggesting that more comprehensive interventions may be needed to target improvements in community mobility.
The Effect of Different Types of Exercise on Sleep Quality and Architecture in Parkinson Disease: A Single-Blinded Randomized Clinical Trial Protocol
Authors: Cristini Jacopo , Potvin-Desrochers Alexandra , Seo Freddie , Dagher Alain , Postuma Ronald B , Rosa-Neto Pedro , Carrier Julie , Amara Amy W , Steib Simon , Paquette Caroline , Roig Marc
Published: June 2023

Objectives

The purpose of this trial is to (1) determine the best exercise modality to improve sleep quality and sleep architecture in people with Parkinson disease (PD); (2) investigate whether exercise-induced improvements in sleep mediate enhancements in motor and cognitive function as well as other non-motor symptoms of PD; and (3) explore if changes in systemic inflammation after exercise mediate improvements in sleep.

Methods

This is a multi-site, superiority, single-blinded randomized controlled trial. One hundred fifty persons with PD and sleep problems will be recruited and randomly allocated into 4 intervention arms. Participants will be allocated into 12 weeks of either cardiovascular training, resistance training, multimodal training, or a waiting list control intervention. Assessments will be conducted at baseline, immediately after each intervention, and 8 weeks after each intervention by blinded assessors. Objective sleep quality and sleep architecture will be measured with polysomnography and electroencephalography. Motor and cognitive function will be assessed with the Unified PD Rating Scale and the Scale for Outcomes in PD-Cognition, respectively. Subjective sleep quality, fatigue, psychosocial functioning, and quality of life will be assessed with questionnaires. The concentration of inflammatory biomarkers in blood serum will be assessed with enzyme-linked immunosorbent assays.

Impact

This study will investigate the effect of different types of exercise on sleep quality and architecture in PD, exploring interactions between changes in sleep quality and architecture with motor and cognitive function and other non-motor symptoms of the disease as well as mechanistic interactions between systemic inflammation and sleep. The results will provide important practical information to guide physical therapists and other rehabilitation professionals in the selection of exercise and the design of more personalized exercise–based treatments aimed at optimizing sleep, motor, and cognitive function in people with PD.
Kinesiophobia Is Associated With Poor Function and Modifiable Through Interventions in People With Patellofemoral Pain: A Systematic Review With Individual Participant Data Correlation Meta-Analysis
Authors: Rethman Katherine K , Mansfield Cody J , Moeller Josh , De Oliveira Silva Danilo , Stephens Julie A , Di Stasi Stephanie , Briggs Matthew S
Published: June 2023

Objective

The aim of this systematic review and correlation meta-analysis was to identify factors associated with kinesiophobia in individuals with patellofemoral pain (PFP) and to identify interventions that may reduce kinesiophobia in individuals with PFP.

Methods

Seven databases were searched for articles including clinical factors associated with kinesiophobia or interventions that may reduce kinesiophobia in individuals with PFP. Two reviewers screened articles for inclusion, assessed risk of bias and quality, and extracted data from each study. A mixed-effects model was used to calculate correlations of function and pain with kinesiophobia using individual participant data. Meta-analyses were performed on interventional articles; Grading of Recommendations, Assessment, Development, and Evaluation was used to evaluate certainty of evidence. Results were reported narratively when pooling was not possible.

Results

Forty-one articles involving 2712 individuals were included. Correlation meta-analyses using individual participant data indicated a moderate association between self-reported function and kinesiophobia (n = 499; r = −0.440) and a weak association between pain and kinesiophobia (n = 644; r = 0.162). Low-certainty evidence from 2 articles indicated that passive treatment techniques were more effective than minimal intervention in reducing kinesiophobia (standardized mean difference = 1.11; 95% CI = 0.72 to 1.49). Very low-certainty evidence from 5 articles indicated that interventions to target kinesiophobia (psychobehavioral interventions, education, and self-managed exercise) were better in reducing kinesiophobia than physical therapist treatment approaches not specifically targeting kinesiophobia (standardized mean difference = 1.64; 95% CI = 0.14 to 3.15).

Conclusion

Higher levels of kinesiophobia were moderately associated with poorer function and weakly associated with higher pain in individuals with PFP. Taping and bracing may reduce kinesiophobia immediately after use, and specific kinesiophobia-targeted interventions may reduce kinesiophobia following the full intervention; however, the certainty of evidence is very low.

Impact

Assessment of kinesiophobia in clinical practice is recommended, on the basis of the relationships identified between kinesiophobia and other important factors that predict outcomes in individuals with PFP.
Cigarette smoking and risk of severe infectious respiratory diseases in UK adults: 12-year follow-up of UK biobank
Authors: McGeoch Luke J , Ross Stephanie , Massa M Sofia , Lewington Sarah , Clarke Robert
Published: June 2023

Background

The relevance of tobacco smoking for infectious respiratory diseases (IRD) is uncertain. We investigated the associations of cigarette smoking with severe IRD resulting in hospitalization or death in UK adults.

Methods

We conducted a prospective study of cigarette smoking and risk of severe IRD in UK Biobank. The outcomes included pneumonia, other acute lower respiratory tract infections (OA-LRTI) and influenza. Multivariable Cox regression analyses were used to estimate hazard ratios (HRs) of severe IRD associated with smoking habits after adjusting for confounding factors.

Results

Among 341 352 participants with no prior history of major chronic diseases, there were 12 384 incident cases with pneumonia, 7054 with OA-LRTI and 795 with influenza during a 12-year follow-up. Compared with non-smokers, current smoking was associated with ⁓2-fold higher rates of severe IRD (HR 2.40 [2.27–2.53] for pneumonia, 1.99 [1.84–2.14] for OA-LRTI and 1.82 [95% confidence interval: 1.47–2.24] for influenza). Incidence of all severe IRDs were positively associated with amount of cigarettes smoked. The HRs for each IRD (except influenza) also declined with increasing duration since quitting.

Conclusions

Current cigarette smoking was positively associated with higher rates of IRD and the findings extend indications for tobacco control measures and vaccination of current smokers for prevention of severe IRD.
Phenomenological and Cognitive Features Associated With Auditory Hallucinations in Clinical and Nonclinical Voice Hearers
Authors: Gold James M , Corlett Philip R , Erickson Molly , Waltz James A , August Sharon , Dutterer Jenna , Bansal Sonia
Published: June 2023

Background and Hypotheses

Auditory verbal hallucinations (AVH) are central features of schizophrenia (SZ). However, AVH also occur in a small percentage of the general population who do not have a need for care, termed nonclinical voice hearers (NCVH). We sought to determine the degree to which the experience of AVH was similar in NCVH and in people with schizophrenia (PSZ) and evaluate the degree to which NCVH shared other features of SZ such as delusional beliefs, cognitive impairment, and negative symptoms.

Study Design

We recruited 76 people with a DSM-V diagnosis of SZ/schizoaffective disorder (PSZ; 49 with current AVH, 27 without), 48 NCVH, and 51 healthy controls. Participants received a broad battery of clinician-administered and self-report symptom assessments and a focused cognitive assessment.

Study Results

The AVH of NCVH and PSZ shared very similar sensory features. NCVH experienced less distress, had greater control over their AVH, and, unlike PSZ, rarely heard 2 voices speaking to each other. NCVH demonstrated a wide range of deeply held unusual beliefs, but reported less paranoia, and fewer first-rank symptoms such as passivity and alterations in self-experience. NCVH showed no evidence of cognitive deficits or negative symptoms.

Conclusions

The AVH in NCVH and PSZ demonstrate important similarities as well as clear differences. Specific features, rather than the presence, of AVH appear to determine the need for care. NCVH do not share the cognitive and motivational deficits seen in PSZ. These results suggest that AVH and unusual beliefs can be separated from the broader phenotype of SZ.
Long-Acting Injectable Second-Generation Antipsychotics vs Placebo and Their Oral Formulations in Acute Schizophrenia: A Systematic Review and Meta-Analysis of Randomized-Controlled-Trials
Authors: Wang Dongfang , Schneider-Thoma Johannes , Siafis Spyridon , Burschinski Angelika , Dong Shimeng , Wu Hui , Zhu Yikang , Davis John M , Priller Josef , Leucht Stefan
Published: June 2023

Background and Hypothesis

Long-acting injectable antipsychotic drugs (LAIs) are mainly used for relapse prevention but could also be advantageous for acutely ill patients with schizophrenia.

Study Design

We conducted a systematic review and meta-analysis of randomized-controlled-trials (RCTs) comparing the second-generation long-acting injectable antipsychotics (SGA-LAIs) olanzapine, risperidone, paliperidone, and aripiprazole with placebo or their oral counterparts in acutely ill patients with schizophrenia. We analyzed 23 efficacy and tolerability outcomes, with the primary outcome being overall symptoms of schizophrenia. The results were obtained through random effects, pairwise meta-analyses, and subgroup tests. The study quality was assessed using the Cochrane-Risk-of-Bias-Tool version-1.

Study Results

Sixty-six studies with 16 457 participants were included in the analysis. Eleven studies compared second-generation long-acting injectable antipsychotics (SGA-LAIs) with a placebo, 54 compared second-generation oral antipsychotics (SGA-orals) with a placebo, and one compared an SGA-LAI (aripiprazole) with its oral formulation. All 4 SGA-LAIs reduced overall symptoms more than placebo, with mean standardized differences of −0.66 (95% CI: −0.90; −0.43) for olanzapine, −0.64 (−0.80; −0.48) for aripiprazole, −0.62 (−0.76; −0.48) for risperidone and −0.42 (−0.53; −0.31) for paliperidone. The side-effect profiles of the LAIs corresponded to the patterns known from the oral formulations. In subgroup tests compared to placebo, some side effects were less pronounced under LAIs than under their oral formulations.

Conclusions

SGA-LAIs effectively treat acute schizophrenia. Some side effects may be less frequent than under oral drugs, but due to the indirect nature of the comparisons, this finding must be confirmed by RCTs comparing LAIs and orals head-to-head.
Addressing Health Inequities in Survivors of Domestic Violence
Authors: Jolie Angelina
Published: June 2023

New bruise detection technologies for diverse skin tones can help.
CE: Overcoming Movement-Evoked Pain to Facilitate Postoperative Recovery
Authors: Arnstein Paul , van Boekel Rianne , Booker Staja Q.
Published: June 2023

Severe postoperative movement-evoked pain (MEP) can be immobilizing, instilling in patients the fear that further activity will produce unbearable pain. This impedes healing and restoration of function while also extending time to recovery. Therefore, it is critical to manage MEP effectively through timely evaluation and comprehensive care planning. This article builds on recent calls to standardize testing of MEP to inform care planning in a way that both reduces pain and improves functioning. Subsequent reassessment of MEP can guide the refinement of therapy. Although this approach may seem intuitive, it challenges common practices that focus too heavily on pain intensity, resulting in overtreating, undertreating, or not treating pain, while ignoring the risks of immobility and the importance of movement for improving functional capacity. The authors propose a multifaceted approach to overcoming MEP that nurse clinicians, educators, researchers, and compliance professionals can use to enhance the quality and safety of nursing practice.
Improving Bruise Detection in Patients with Dark Skin Tone
Authors: Benjamin Ellen , Giuliano Karen K.
Published: June 2023

This is the fifth article in a series on nurse innovators, which focuses whenever possible on nurse–engineer partnerships and outlines working, replicable models of collaboration between the two disciplines. In this installment, we profile Katherine N. Scafide, a forensic nurse and researcher, who has partnered with engineers over many years to improve bruise detection in patients with dark skin tone.
Introduction to Statistical Hypothesis Testing in Nursing Research
Authors: Keeler Courtney , Curtis Alexa Colgrove
Published: June 2023

Editor's note: This is the 16th article in a series on clinical research by nurses. The series is designed to be used as a resource for nurses to understand the concepts and principles essential to research. Each column will present the concepts that underpin evidence-based practice—from research design to data interpretation. To see all the articles in the series, go to https://links.lww.com/AJN/A204.
Creating a Community Advisory Board
Authors: Zadvinskis Inga , Hoying Jacqueline
Published: June 2023

Health leaders in an academic setting sought to engage with community members to gain insight into their health information needs. Using evidence-based practice methodology, they established a community advisory board that represents and articulates patients' perspectives, which are then incorporated into educational efforts to assist the public in using evidence to make health decisions.
30-Minute Spontaneous Breathing Trial May Be Too Short for Children with ARDS
Authors: Rosenberg Karen
Published: June 2023

According to this study:
Becoming Who We Are: Releasing Hope for a Better Past
Authors: Wecker Fabien
Published: June 2023

A moving encounter with a former counseling patient
Direct Anterior versus Posterior Approach for Total Hip Arthroplasty Performed for Displaced Femoral Neck Fractures
Authors: Shah Ishan D. , Piple Amit S. , Schlauch Adam M. , Crawford Benjamin D. , Tamer Pierre , Prentice Heather A. , Grimsrud Christopher D.
Published: June 2023

Objectives:

To compare perioperative, 90-day, and 1-year postoperative complications and outcomes between the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) in geriatric patients with displaced femoral neck fractures (FNF).

Design:

Retrospective Cohort Study

Setting:

Multicenter Healthcare Consortium

Patients:

709 patients > 60 years of age with acute displaced FNF between 2009 and 2021

Intervention:

THA using either DAA or PA

Main Outcome Measurements:

Rates of postoperative complications including dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. Secondary outcome measures included ambulation capacity at discharge, ambulation distance with inpatient physical therapy, discharge disposition, and narcotic prescription quantities (morphine milligram equivalents [MME]).

Results:

Through a multivariable regression analysis, DAA was associated with significantly shorter operative time ​​(B = -6.89 minutes; 95% CI, -12.84 to -0.93; P = 0.024), lower likelihood of blood transfusion during the index hospital stay (aOR = 0.54; 95% CI, 0.27 to 0.96; P = 0.045), and decreased average narcotic prescription amounts at 90 days (B = -230.45 MME; 95% CI, -440.24 to -78.66; P = 0.035) postoperatively. There were no significant differences in medical complications, dislocations, reoperations, and mortality at 90 days and 1 year postoperatively.

Conclusion:

When comparing the DAA versus PA for THA performed for displaced FNF, DAA was associated with shorter operative time, a lower likelihood of blood transfusion, and lower 90-day postoperative narcotic prescription amounts.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifying Reasons for Non-Medical Delays in Fixation of Femur, Pelvis and Acetabular Fractures at a Level One Trauma Center
Authors: Strage Katya E , Hadeed Michael M , Mauffrey Cyril , Parry Joshua A
Published: June 2023

Objective:

To identify reasons for non-medical delays in femur, pelvis, and acetabular fracture fixation at an institution with a dedicated orthopaedic trauma room (DOTR) and an early appropriate care (EAC) practice model.

Design:

Retrospective review of a prospective registry

Setting:

Urban level one trauma center

Patients/Participants: 294 patients undergoing 313 procedures for 226 femur, 63 pelvis, and 42 acetabular fractures

Intervention:

Definitive fixation

Main Outcome Measurements:

Reasons for delays in fixation after hospital day 2

Results:

Delays occurred in 12.5% of procedures (39/313), with 7.7% (24/313) having medical delays and 4.8% (15/313) having non-medical delays. Non-medical delays were most commonly due to the operating room being at-capacity (n=6) and non-pelvic trauma specialists taking weekend call (n=5). Procedures with non-medical delays were associated with younger age (median difference (MD) -16.0 years, 95% confidence interval (CI) -28 to -5.0; p=0.006), high-energy mechanisms (proportional difference (PD) 58.5%, CI 37.0 to 69.7%; p<0.0001), Thursday through Saturday hospital admission (PD 30.3%, CI 5.0 to 50.0%; p<0.0001), pelvis/acetabular fractures (PD 51.8%, CI 26.7 to 71.0%; p<0.0001), and external fixation (PD 33.0%, CI 11.8 to 57.3%; p<0.0001).

Conclusion:

Only 4.8% of procedures experienced non-medical delays utilizing an EAC model and a DOTR. Non-medical delays were most commonly due to two modifiable factors – the DOTR being at-capacity and non-pelvis trauma specialists taking weekend call. Patients with non-medical delays were more likely to be younger, with pelvis/acetabular fractures, high-energy mechanisms, external fixation, and to be admitted between Thursday and Saturday.

Level of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Epidural Versus Local Anesthesia for Percutaneous Endoscopic Lumbar Discectomy
Authors: Mooney James , Erickson Nicholas , Laskay Nicholas , Salehani Arsalaan , Mahavadi Anil , Ilyas Adeel , Mainali Bipul , Godzik Jake
Published: June 2023

Study Designs:

Systematic Review.

Objective:

To examine the impact of anesthesia type on patient-reported outcomes (PROs) and complications after percutaneous endoscopic lumbar discectomy (PELD).

Summary of Background Data:

A significant advantage of PELD involves the option to use alternative sedation to general anesthesia (GA). Two options include local anesthesia (LA) and epidural anesthesia (EA). While EA is more involved, it may yield improved pain control and surgical results compared with LA. However, few studies have directly examined outcomes for PELD after LA versus EA, and it remains unknown which technique results in superior outcomes.

Materials and Methods:

A systematic review and meta-analysis of the PubMed, EMBASE, and SCOPUS databases examining PELD performed with LA or EA from inception to August 16, 2021 were conducted. All studies reported greater than 6 months of follow-up in addition to PRO data. PROs, including visual analog scale (VAS)-leg/back, and Oswestry Disability Index (ODI) scores were collected. Complications, recurrent disk herniation, durotomy, and reoperation rates, as well as surgical data, were recorded. All outcomes were compared between pooled studies examining LA or EA.

Results:

Fifty-six studies consisting of 4465 patients (366 EA, 4099 LA) were included. Overall complication rate, durotomy rate, length of stay, recurrent disk herniation, and reoperation rates were similar between groups. VAS back/leg and ODI scores were all significantly improved at the first and last follow-up appointments in the LA group. VAS leg and ODI scores were significantly improved at the first and last follow-up appointments in the EA group, but VAS back was not.

Conclusions:

EA can be a safe and feasible alternative to LA, potentially minimizing patient discomfort during PELD. Conclusions are limited by a high level of study bias and heterogeneity. Further investigation is necessary to determine if PELD under EA may have greater short-term PRO benefits compared with LA.
Achilles Tendon Ruptures: From Treatment to the Playing Field
Authors: Hoenshel Robby , Polzer Hans , Vosseller J. Turner
Published: June 2023

Achilles tendon ruptures are significant injuries that require intensive treatment and rehabilitation to return to full function. This statement is especially true for high-level athletes that seek to return to the highest levels of physical function. Outcomes after Achilles tendon ruptures have historically been good, although perhaps more guarded in those that require high levels of physical function. Essentially, the primary issue from a rehabilitation standpoint relates to strength and its relationship with the appropriate tension on the Achilles tendon. For reasons that remain somewhat elusive, patients with Achilles ruptures get profoundly weak after injury and well into recovery. Indeed, recovery is often protracted due to the length of time required to achieve full strength. In this review, we will focus on optimal rehabilitation of these injuries, how we can perhaps best prevent these injuries, and finally look at outcomes with a special focus on high-level athletes.

Level of Evidence:

Level V—Review.
Advancing research, awareness, screening, and linkage to care to eliminate HDV in the U.S.
Authors: Glynn Megan , Cohen Chari , Gish Robert G , Andrews Richard , Trang Amy , Zovich Beatrice , Hall Warren , Clary Ryan , Balestreri Joseph , Scott Lori , Scott Rachel , Jackson Tamika , Ntiri-Reid Boatemaa , Southworth Alia , Dieterich Douglas , Sepe Thomas
Published: June 2023

HDV, which coinfects individuals living with HBV, is the most aggressive form of viral hepatitis. Compared with hepatitis B monoinfection, hepatitis delta is associated with more rapid progression to cirrhosis and an increased risk of liver cancer and death. Despite being a major contributor to hepatitis B-associated liver disease, hepatitis delta remains largely unknown to the general public, health care providers, and at-risk communities. Given the widespread lack of awareness and underdiagnosis of hepatitis delta in the US, the American Liver Foundation (ALF) and the Hepatitis B Foundation (HBF) convened a virtual Hepatitis Delta Roundtable Meeting on April 21 and 22, 2022. The Roundtable Panel included persons living with hepatitis delta, caregivers, liver disease specialists, primary care providers, state and federal public health professionals, and community-based organizations. The Panel identified several major challenges surrounding hepatitis delta, including a lack of awareness of hepatitis delta among the public and health care providers; complex risk-based testing protocols; a lack of accurate prevalence data; limited data on linkage to care; and inadequate communications among stakeholders. Potential strategies to address these challenges include improving and expanding education for different audiences; advocating for simplified protocols for hepatitis B screening with hepatitis delta reflex testing; expanding surveillance for hepatitis delta; requiring automated reporting and national notification; improving data sharing for research; and enhancing communications around hepatitis delta. The recent CDC recommendations for universal adult screening and vaccination against hepatitis B and the anticipated availability of new therapies for hepatitis delta present a unique opportunity to focus attention on this dangerous virus. The Roundtable Panel calls for urgent action to make significant progress in addressing hepatitis delta among individuals living with hepatitis B.
Incidental findings of bilateral vocal cord polyps and asymptomatic pulmonary embolism during EBUS-guided mediastinal staging: a case report highlighting teamwork in management decision making
Authors: Abdelmalak Basem B. , Choi Humberto , Bryson Paul C.
Published: June 2023

We report on two significant incidental findings in a patient during the course of a routine Endobronchial ultrasound (EBUS) guided trans-bronchial needle aspiration (TBNA) procedure, namely smoking related bilateral vocal cord polyps, and pulmonary embolism. We discuss the sequence of events, the needed reassessment of risk/benefit analysis of the planned procedure and the rationale behind the decisions made as the case has evolved. Thoughtful stepwise approach to diagnosis and management through a real-time multidisciplinary collaboration resulted in a favorable outcome despite the complex medical scenario.
Characterization of Thermoluminescent Dosimetry Systems According to the IEC 62387:2020 Standard
Authors: Kržanović Nikola , Stanković Petrović Jelena , Živanović Miloš , Krajinović Marko , Božović Predrag , Kojić Andrea , Topalović Dušan
Published: June 2023

A need for detailed testing of individual monitoring systems used in accredited service at the Vinca Institute of Nuclear Sciences was recognized following changes in individual, workplace, and environmental monitoring passive dosimetry systems acceptability criteria stated in IEC 62387:2020 and changes related to reference fields used in radiation protection defined in ISO 4037:2019. Reliability and accuracy of dosimetry data acquired by passive dosimetry systems used for individual monitoring is assured by carrying out type tests. In this manner, the effects of different radiation influence quantities are examined. Passive dosimetry systems comprised of an LiF:Mg,Ti (TLD-100) detector card placed in two different holder models (8814 and 8850) and the Harshaw TLD Model 6600 Plus Automated Reader were tested. Type tests were done in an extended range of photon energies from 40 keV up to 1.25 MeV, angle of incidence values of ±45° and ± 60° for both vertical and horizontal dosimeter orientation, and in the dose range from 0.05 mSv to 1 Sv. Both dosimetry system configurations perform in line with IEC 62387:2020 within mandatory range for tested influence quantities. Dosimeters that use the 8850 holder type showed less pronounced energy and angular dependence of the response in the low-energy range.
Evaluation of new approach to enhance visualization performance in cataract surgery: 3D visualization system with coaxial illumination
Authors: Wang Yan , Hu Yingfeng , Zhang Rong , Wang Zheng , Zhang Guangbin , Chen Wei , Ma Jack X. , Wang Daoguang , Ye Xiangyu
Published: June 2023

Purpose:

To evaluate the visualization performance of different approaches, including the 3D visualization system with coaxial illumination and the 3D system or microscope with standard illumination.

Setting:

Fuzhou Eye Hospital, Fuzhou City, China.

Design:

Cross-sectional study.

Methods:

This 2-part performance assessment for visualization composed of an objective analysis using surgical video images and a subjective survey collecting feedback from surgeons. Data of each eye were obtained with 3 approaches: standard operating microscope with standard illumination (SOM-S), 3D visualization system with standard illumination (3D-S), and 3D visualization system with coaxial illumination (3D-C).

Results:

112 eyes (107 cases) and 6 cataract surgeons were involved. The red reflex value was markedly greater in the 3D-C approach compared with other 2 approaches (P < .001). Compared with the SOM-S approach, the red reflex increased by 55%, 57%, and 53% in the 3D-C approach, corresponding to nuclear grades of II, III, and IV, respectively. In the questionnaire survey, red reflex scores were consistently significantly higher in the 3D-C approach than those in the others (P < .001). Depth of field was enhanced in both 3D approaches compared with the SOM-S approach (P < .05). The only minor advantage of the SOM system over the 3D-C approach was in the surrounding field clarity score, and the difference was not statistically significant (P = 1.000).

Conclusions:

The 3D-C approach significantly increased the red reflex in both objective and subjective assessments. Surgeon responses also showed a superior performance for the 3D-C approach.
Clinicopathological characteristics and prognostic factors of small bowel lymphomas: a retrospective single-center study
Authors: Dias Emanuel , Medas Renato , Marques Margarida , Andrade Patrícia , Cardoso Hélder , Macedo Guilherme
Published: June 2023

Background:

There is little information on diagnosis and management of small bowel lymphomas, and optimal management strategies are still undefined. This study aims to describe their main clinical and pathological characteristics and identify poor prognostic factors.

Methods:

A retrospective observational study of all patients with histological diagnosis of small bowel lymphoma between January 2010 and December 2020 was performed.

Results:

We included 40 patients, with male predominance (60%) and mean age of 60.7 years. The ileum was the most common location, and the most common histological subtypes were follicular lymphoma and diffuse large B-cell lymphoma. Clinical presentation was variable from asymptomatic patients (30%) to acute surgical complications (35%) including perforation, intestinal obstruction, ileal intussusception, or severe bleeding. Diagnosis was established by endoscopy in 22 patients (55%), and the most common findings included polyps, single mass, diffuse infiltration, or ulceration, whereas 18 (45%) required surgery because of acute presentations or tumor resection, and lymphoma was diagnosed postoperatively. Surgery was curative in one-third of those patients. Median survival was 52 months. Acute presentation (P = 0.001), symptomatic disease (P = 0.003), advanced stage (P = 0.008), diffuse large B-cell lymphoma (P = 0.007), anemia (P = 0.006), hypoalbuminemia (P < 0.001), elevated lactate dehydrogenase (P = 0.02), elevated C-reactive protein (P < 0.001), and absence of treatment response (P < 0.001) were significant predictors of mortality.

Conclusion:

Small bowel lymphoma is a rare malignancy with diverse clinical and endoscopic presentations that require a high index of suspicion. Primary factors associated with worse outcome included acute presentation, advanced stage, histological subtype, biochemical abnormalities, and absence of treatment response.
Strategic Budget Planning for Complex Medical Devices: A Case Study on Surgical Microscopes
Authors: Nazeri Simin , Janvier Marie-Ange , Greenwood Kim
Published: June 2023

Dramatic developments in medical device technologies significantly influence the cost of equipment acquisition and operating expenses. Sometimes the budget estimation needed for rudimentary medical equipment can be complicated, even more so for a complex device with several add-on features. In Canada, the budget allocated to capital equipment purchases is challenging because the budget comes from the provincial government to the hospitals. The capital equipment budget amount is challenging because of the public healthcare funding model, whereby fiscal budgets come from the provincial government to the hospitals. The capital equipment budget allocation is limited and restricted in hospital as “big ticket” items compete with other capital requests. Having a strategic budgeting plan, completed by a clinical engineer, ensures a sufficient budget for the capital request. A strategic budgeting plan was central to this study to estimate the required funding for replacing aged existing surgical microscopes at the Children's Hospital of Eastern Ontario. This study demonstrates the development of a methodology to guide budget planning and includes inventory assessment, market analysis, the identification of clinical requirements, cost analysis, and the utilization of the outputs of these steps for capital planning requests. A basic step-by-step approach can be followed by any clinical engineering department before submitting a capital planning request for complex medical devices.
Human Versus Machine
Authors: Ayers Michael , Sabella Daniela , Ramirez Nury , Arscott Richard
Published: June 2023

This article implements a method for classifying adverse incidents involving reusable medical devices according to their underlying cause and assesses the level of agreement between different raters. To achieve this, the adverse incidents were classified into 1 or more of 62 separate categories, and the level of agreement between 3 experienced human raters was established. Moreover, the ChatGPT artificial intelligence tool was used to replicate the classification process used by human raters. The results showed that there was a fair level of agreement between human raters and a slight agreement between human raters and ChatGPT. This suggests that, although ChatGPT can intelligently classify adverse incidents, it was not able to replicate the performance of experienced human raters when given access to only the limited incident details and classification categories as provided for in this study.
A new procedure for elimination of atrial fibrillation associated with mitral valve disease：a proof-of-concept study
Authors: Chen Liangwan , Li Qianzhen , Chen Junyi , Qiu Zhihuang , Xiao Jun , Tang Mirong , Wu Qingsong , Shen Yue , Dai Xiaofu , Fang Guanhua , Lu Heng
Published: June 2023

Background:

Left atrial enlargement and fibrosis have been linked to the pathogenesis of atrial fibrillation (AF). We aimed to introduce a novel concept and develop a new procedure for AF treatment based on these characteristics.

Methods:

The study included three stages. The first stage was a descriptive study to clarify the characteristics of the left atrial enlargement and fibrosis’ distribution in patients with mitral valve disease and long-standing persistent AF. Based on these characteristics, we introduced a novel concept for AF treatment, and then translated it into a new procedure. The second stage was a proof-of-concept study with this new procedure. The third stage was a comparative effectiveness research to compare the clinical outcomes between patients with this new procedure and those who received Cox-Maze IV treatment.

Results:

Based on non-uniform fashion of left atrial enlargement and fibrosis’ distribution, we introduced a novel concept: reconstructing a left atrium with appropriate geometry and uniform fibrosis’ distribution for proper cardiac conduction, and translated it into a new procedure: left atrial geometric volume reduction combined with left appendage base closure. As compared to Cox-Maze IV procedure, the new procedure spent significantly shorter total surgery time, cardiopulmonary bypass time and aortic cross-clamp time (P<0.001). Besides, the new procedure was related to a shorter ICU stay period (OR=0.45, 95%CI=0.26-0.78), lower costs (OR=0.15, 95%CI=0.08-0.29) and a higher rate of A wave of transmitral and transtricuspid flow reappearance (OR=1.76, 95%CI=1.02-3.04).

Conclusions:

The new procedure is safe and effective for eliminating AF associated with mitral valve disease.
Predicting First-Time National Physical Therapy Examination Performance for Graduates of an Entry-Level Physical Therapist Education Program
Authors: Dombkowski Ryan , Sullivan Steven , Widenhoefer Tricia , Buckland Abigail , Almonroeder Thomas Gus
Published: June 2023

Introduction.

The National Physical Therapy Examination (NPTE) is a standardized examination designed to assess competence after graduation from an entry-level physical therapist education program.

Review of Literature.

Previous studies have identified applicant and student variables that are related to NPTE performance, with applicant variables reflecting performance before admission and student variables reflecting performance after admission. However, there are very few articles describing how these variables can be combined to predict NPTE performance. The purpose of this study was to develop, evaluate, and describe models to predict first-time NPTE scores and NPTE outcomes (pass vs fail), based on various applicant and student variables related to academic performance.

Subjects.

Pre- and postadmission data and NPTE scores were recorded for 185 individuals who graduated from an entry-level physical therapist education program.

Methods.

Multiple linear regression was used to develop a model to predict NPTE scores, and binary logistic regression was used to develop a model to predict NPTE outcomes (pass vs fail).

Results.

A model including undergraduate prerequisite grade point average, grade point average in basic science courses taken during the program, and comprehensive examination scores combined to explain 30.9% of the variance in NPTE scores and accurately predicted NPTE outcomes (pass vs fail) 81.1% of the time.

Discussion.

In general, our findings support the notion that prediction of NPTE performance should be based on a combination of applicant and student variables. The models described in this article could be used to identify students who may be likely to struggle on the NPTE, making it possible to provide additional support to these students.

Conclusion.

Various applicant and student variables related to academic performance can be combined to predict NPTE performance. The results of this study provide a framework for programs interested in applying models to predict NPTE performance.