bluuebunny/crossref_metadata_2025 huggingface dataset:
Desire
Authors: Heath J. M. F.
Published: May 2024

Bourdieu has a very thin account of desire in his theory of taste. Christian theologians emphasize that Christian ‘taste’ is oriented to the love of God, but the way they parse that varies widely. To the extent we can tell from the extant sources, Clement was the first to make philanthrōpia as a divine attribute central to constructive Christian theology both in anti-pagan polemic and in theological debate with Christians from other sects. This chapter shows how Clement interprets divine philanthrōpia theologically in relation to doctrines of creation, redemption, and scriptural pedagogy, and how he makes these ‘tasty’ (i.e. viscerally attractive, pleasing) to his audience through the way they may be inhabited in embodied and ecclesial life.
Constitutional Globalization is Smoothened by Sanctions, Frames Terrorism Along Fiscal Lines, Fosters Militarism and Dims Democracy in the Third World
Authors: Sripati Vijayashri
Published: May 2024

The UNSC targeted individuals (for example, rebels toppling Constitution-conditionality-implementing governments)/or activities (illicit trade in diamonds) that hindered the Constitution’s uninterrupted adoption/implementation. Here lies the Constitutional origins of the targeted/smart sanctions. Which contextualizes the global war on terrorism (GWOT). This concept was coined to address the threats posed by Al Qaeda’s September 9, 2001, terrorist attacks to the Constitution’s globalization (hereafter Globalization with a capital G) initiated in 1999. By outlining the GWOT’s Constitutional content, this chapter establishes this point and situates the GWOT within the broader story of securing the Constitution’s adoption (1989–2001) through targeted sanctions. An analysis of the UNSC Resolutions 1373 (2001) and how Pakistan was made to wage the GWOT illustrates the GWOT’s Constitutional content. Pakistan adopted Constitutional reforms and an anti-money laundering (AML) and terrorist financing law (globalized by UNSC Resolution 1373 (2001) to combat economic crimes, opened the FATA region to arms, benefiting the US military-industrial complex, and permitted surveillance. This chapter argues that GWOT promotes militarism in the Third World. As a conclusion, this chapter summarizes how these sibling agendas interact and what their status is: Women, peace and security, protection of civilians, Human Security, and the GWOT.
Introduction
Authors: Hardwick Lorna
Published: May 2024

The Introduction provides extensive material that illustrates and explains the aims of the book and the ideas and concepts used in it. It summarizes the historical and literary contexts that shaped the poetry of the First World War, discusses the choice of poets and poems and explains the categories that are used in the detailed commentaries to analyse the range of connections between ancient and modern texts and their literary mediations in the centuries between. Key terms are glossed and the poetry of unease and the poetry of survival are identified as key themes. The discussion of the historical context includes examination of class, education, and social attitudes as well as the impact of war service. The place of religion in the literary language and cultural perspectives of the poets is considered, especially in relation to notions of suffering and sacrifice, as well as of conflict and vengeance. The various types of paramaterial that can inform analysis of texts, literary biographies, and life experience are discussed. The Introduction also sets out the relationship between the book and classical reception scholarship, including its potential for enhancing understanding of the place of war poetry in the development of the public imagination and the cultural memory and for contributing to eco-criticism and trauma studies.
Services, Investment, and Public Procurement
Authors: Artiran Pinar
Published: May 2024

Following years of being a member of the most advanced economic integration model in the world, the orderly separation of the UK from the EU and the further regulation of the bilateral preferential trade framework through the TCA proved to be both historic and challenging. Considering both parties’ economic profiles and aspirations, trade in services, investment flows, and public procurement form a crucial part of their welfare; therefore, the analysis of the extent to which the TCA facilitates their transactions in those areas becomes all the more important. This chapter first sets the scene by providing an overview of the TCA’s relevant chapters in services, investment, and public procurement, and then takes stock of the performance results of the TCA in the past two years and attempts to make a projection into the future steps to improve liberalization efforts even further.
Capital Movements, Digital Trade, and Intellectual Property
Authors: Amstalden Mariela de
Published: May 2024

The purpose of this chapter is to analyse key features of the European Union (EU)-United Kingdom (UK) Trade and Cooperation Agreement (TCA) relating to capital movements, digital trade, and intellectual property rights (IPRs). It first identifies the relevant legal provisions of the TCA, mapping their structure, to highlight the minimum standard of protection they afford. It then examines the operationalization of selected applicable provisions, taking into account the social, political, and economic realities they are situated in, including limits and opportunities. The analysis shows that regulatory autonomy, coupled with greater deference to rules under the WTO system and its underlying principles of non-discrimination and national treatment are consistently infusing the text of the TCA, suggesting that a rules-based approach to international cooperation continues to be relevant, in spite of growing pressures towards geopolitical and economic fragmentation.
Health, Climate, Energy, and Cyber
Authors: Fahey Elaine
Published: May 2024

There are arguably few genuine multilateral engagements in the EU-UK Trade and Cooperation Agreement (TCA), with foreign policy omitted and generally evidence of limited ambitions. There are also limited commitments to international regulatory cooperation in the TCA, unusually for an EU trade agreement in contrast with many other major economies. The chapter contrasts international qua transnational cooperation objectives provided for in the TCA as to cyber, health, energy, and climate, embodying areas presenting significant global challenges. On the one hand, the general lack of ambition is a key feature of the TCA. As a result, it is difficult to see the TCA as a model for the transnational in any sense. On the other hand, the TCA is clearly a modern and contemporary agreement that deploys a contemporary lexicon as to trade, concluded in a rushed and highly politicized environment and where its aims and objectives need to be viewed in such a light.
Review and Reform Options for Deepening EU-UK Cooperation in a Renewing Europe
Authors: Fabbrini Federico
Published: May 2024

The chapter examines options for the United Kingdom (UK) to deepen cooperation with the European Union (EU) after Brexit, going beyond the current Trade and Cooperation Agreement (TCA). In particular, the chapter highlights the possibilities offered by the TCA review, mandated in 2026, and the avenues that this provides to revise the very limited free trade agreement currently in place between the EU and the UK. Moreover, the chapter maps broader developments occurring in the European institutional landscape following the war in Ukraine, including the establishment of the European Political Community and the relaunch of the North Atlantic Treaty Organization and the Council of Europe, and discusses how they create new opportunities for the UK to reconnect with the EU. Finally, the chapter considers how transformations in the EU constitutional framework and the process of enlargement to Ukraine impact on European integration, with possible consequences for the position of the UK. The chapter is of help to academics and policy-makers in thinking about the future of Europe and the EU-UK relationship.
Foundations
Authors: Craig Paul
Published: May 2024

Part II deals with the regulatory and administrative state from the mid-16th to the end of the 19th centuries, coupled with reflection as to the position in the 20th and 21st centuries. It provides the foundation for understanding administrative law doctrine that developed during this period. This is addressed in Part III, which covers Courts and Doctrine, and Part IV, where the focus is on Remedies and Review. This chapter introduces Parts III and IV and addresses four foundational issues that underpin particular topics. The discussion begins with courts, with explanation of the superior common law courts, and the other principal judicial organs, which are the prerogative courts, Chancery, and ecclesiastical courts. The focus then shifts to statute, with discussion of temporal particularity, temporal continuity, and conceptual continuity, the meaning of which is explained in the chapter. This is followed by discussion of doctrine and values.
A Puzzle in Aristotle’s Theory of Definition
Authors: Bronstein David
Published: May 2024

One important theme in David Charles’ work is his emphasis on two requirements Aristotle places on definition: the unity requirement (a definition must be unified and not an accidental conjunction) and the explanatory requirement (a definition must be able to serve as a starting-point for explanations of certain features of the definiendum). There is, however, a prima facie tension between these two requirements. Given the broad range of features a definition must help explain, a definition will seem to have to contain several terms. But if it contains several terms, what unifies them? This chapter argues that this tension can be seen in Aristotle’s discussion of definition by division in Posterior Analytics 2.13. Aristotle presents two different and incompatible conceptions of definition. According to the first, all of the terms in a definition must be of a specific sort. According to the second, all of the terms in a definition must stand to each other in a relation of a specific sort. However, not all of the terms required by the first conception can stand to each other in the relation required by the second. This difficulty is symptomatic of the broader tension in Aristotle’s account between the unity and explanatory requirements.
Essential Predication in Aristotle’s Categories
Authors: Rapp Christof
Published: May 2024

Aristotle’s Categories is a treatise that is mostly concerned with classifications. Many ancient commentators saw the Categories as closely connected with the Topics and some of the earliest mentions of this treatise in antiquity even used the title Before the Topics instead of Categories, thus indicating that it was seen as a sort of propaedeutic to the Topics, and thus as closely related to Aristotle’s method of dialectic. This is the background to why authors have come to doubt whether one should associate a small, mostly classificatory, dialectically oriented project like the Categories with the burden of ‘heavy metaphysical baggage’ or the ‘ontologically loaded’ notion of essential predication. This chapter argues that the Categories, its peculiar status and its kinship to the Topics notwithstanding, demarcates a kind of predication that is meant to be an essential one—even though the essentialism we find in the Categories is (still) a far cry from the metaphysical theory of the Metaphysics, according to which forms as constituents of hylomorphic compounds are the essences and causes of being of sensible things.
Aristotelian Matter and ‘the Underlier’
Authors: Judson Lindsay
Published: May 2024

This chapter owes much to David Charles’ masterly discussions of Aristotelian matter. It considers two related questions raised by Physics I.7, On Generation and Corruption I.3, and Metaphysics Θ.7–8, and offers different answers from those proposed by Charles. The first is, what is the status of the claim that what underlies (to hupokeimenon) persists through the change? The chapter agrees with Charles that Aristotle thinks that the claim is true even in the case of substantial generation, and offers some defence of this; and it agrees that it is not, in Aristotle’s view, an empirical truth. The issue is whether it is definitional of what underlies (Charles’ view), in such a way that what underlies is not characterized independently—or whether (as the author of this chapter argues) what underlies is introduced independently on the basis of the idea of the subject of the change, and the claim that it persists is a substantive one based on general considerations about the nature of change. The second question concerns the underlier and potentiality. In the case of the substantial generation and development of an F: is the persistence of what is potentially an F always grounded in some other matter, or, as Charles maintains, is the sameness of what is potentially F the explanatory bedrock for the unity of the generation in question? Here the issues are partly textual and partly metaphysical.
What the Cluster View Can Do for You
Authors: Fogal Daniel , Worsnip Alex
Published: May 2024

Despite myriad controversies about reasons, two theses are frequently taken for granted: (i) reasons are sources of normative support for actions, attitudes, etc.; and (ii) reasons, at least in simple, paradigmatic cases, consist in atomic facts. Call this conjunction “the atomic view.” Against this, the authors advocate what they call “the cluster view,” on which even in the simplest cases, the normative support for an action or attitude is typically provided by a whole cluster of facts. Moreover, many of these facts are on an explanatory par—they each play the same kind of role in explaining why there is normative support for the action or attitude in question. The chapter argues that presupposition of the atomic view generates unnecessary (pseudo-)puzzles that can be largely (dis)solved with the cluster view in place. The cluster view’s ability to do this constitutes an argument in its favor, beyond intuitive considerations that are also adduced.
Expressivists Should Be Reductive Naturalists
Authors: Bex-Priestley Graham
Published: May 2024

Quasi-realists claim there are moral facts and properties, but they don’t always make it clear what kind of facts and properties they are. This chapter argues for two things. First, making sense of these claims requires expressivists to go hybrid. Second, if expressivism is true, there is no way to believe moral properties are irreducibly normative without believing something untrue. Expressivists are effectively compelled to reject non-reductivism. Instead, they should believe moral properties are natural and can be referred to with non-moral terms. This is not a bad thing; the combination of expressivism and reductive naturalism is an independently appealing metaethical theory.
Moral Occasionalism
Authors: Killoren David , Sparks Jacob
Published: May 2024

This chapter develops Moral Occasionalism, according to which moral facts are grounded in certain natural facts, which are called sub-moral grounds, and these sub-moral grounds influence us in such a way as to induce largely correct moral beliefs. Moral Occasionalism is designed to explain the correlation of moral beliefs with the moral facts—and to do so in a way that is consistent with non-interactionist views, according to which moral facts neither influence nor are influenced by moral beliefs. It is argued that moral non-naturalists and others who are committed to non-interactionist views ought to be in the business of defending Moral Occasionalism. The chapter shows that Moral Occasionalism has major advantages over its chief non-interactionist rival, namely David Enoch’s “godless pre-established harmony” view. The chapter anticipates and responds to several objections.
Introduction
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter identifies the key factors which will be relevant in deciding whether to caution, conditionally caution, or charge a youth for an offence. The first question to ask is ‘do they admit the offence?’. It is also important to consider the seriousness of the offence, the age of the person arrested, and their previous offending history. The next questions to ask are ‘does the proposed disposal adequately address, support, and reduce the risk of offending?’ and ‘is it in the public interest to prosecute?’. Ultimately, it is especially important to ensure the welfare of the person arrested.
Bail Refused
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter discusses the refusal of bail for youth defendants. Where a youth defendant is refused bail, they are not automatically remanded into prison or a remand centre. Instead, the court must go on to consider the nature of the remand. The remand will ordinarily be to local authority accommodation unless the court orders that the remand is to youth detention accommodation. The child or young person becomes a ‘looked after’ child once bail is refused, whether the remand is to local authority accommodation or youth detention accommodation. The local authority’s duties under the Children Act 1989 will apply. The chapter then looks at the provisions under the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LAPSO 2012).
Sentence
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter looks into the nuances of a relevant age for sentencing. It explains that the relevant age for a sentence is the age on the date of conviction regardless of whether by guilty plea or conviction after trial. The court has several appropriate sentences if the offender was aged 17 on the date of conviction. For offenders under the age of 18 on the date of conviction, there are no statutory purposes of sentencing as there are for adults. The chapter elaborates on s 57 of the Sentencing Code before presenting the sentences available to any court dealing with an offender who has reached the age of 18 by the date of conviction. It considers the possibility of remittal to the adult court for sentence as well.
Parenting Order
Authors: Ashford Mark , Branston Gareth , Redhouse Naomi
Published: May 2024

This chapter explains that a parenting order may be made upon conviction by any criminal court. A parenting order may also be made when a criminal court makes a criminal behaviour order or sexual harm prevention order while also being available in respect of certain attendance offences under the Education Act 1996. The chapter then presents the provisions relating to parenting orders in the Sentencing Code, including when the offender is under 18 years old. It discusses that the order is expected to last for up to 12 months while including a requirement to attend a counselling or guidance programme. A breach of order is punishable on summary conviction with a fine not exceeding level 3.
Corruption Based on Pre-Ottoman Jurisprudential Sources
Authors: Ergene Boğaç A.
Published: May 2024

This chapter examines the concepts and terminology related to corruption as found in the primary sources of the Islamic tradition and as discussed in scholarship on early Islamic legal history. The chapter also surveys how pre-Ottoman jurists used this material to create a discursive space offering systematic formulations and prescriptions. Classical legal discourse on corruption focuses primarily on the office of the qadi and his actions that can be loosely characterized as bribery. Other state and legal authorities and many types of transgressions related to corruption are not as well represented. Moreover, this discourse provides only a limited basis for condemning and punishing predatory, self-interested behavior by public officials. As a result, Muslim polities adopted practices and institutions borrowed from pre-Islamic settings to monitor and control corruption effectively.
Abuse and Predation in State Documents
Authors: Ergene Boğaç A.
Published: May 2024

This chapter considers the broader ideological claims of the Ottoman polity that are rooted outside the jurisprudential traditions, and examines the articulations of corruption in state-generated documents, especially the legal codes (kanunnames) and judicial rescripts (adaletnames). In particular, the chapter examines how imperial documents characterized abuses of power by government officials and how certain terms in these documents may or may not correspond to modern characterizations of corruption. In terms of specific acts and actors, state-generated documents paid the most attention to crimes related to excessive and illegal extraction by military-administrative authorities and extrajudicial transgressions by judicial officials, topics of interest generally overlooked in jurisprudential texts.
Conclusion
Authors: Ergene Boğaç A.
Published: May 2024

The conclusion first considers the perspectives of those guilty of corruption in their attempts to rationalize their transgressions. In the relative absence of historical sources that inform us of such perspectives, the chapter engages with other disciplines that provide insights into possible justifications for corruption crimes. The effort highlights multiple justifications that might have been popular in the premodern Ottoman polity, including economic, legalistic, and religious ones. The conclusion then recapitulates the findings and arguments presented in the previous chapters and briefly relates them to broader issues, including how perceptions of corruption may have changed during the Ottoman transition to modernity in the nineteenth century.
Market Structure and Extortion: Evidence from 50,000 Extortion Payments
Authors: Brown Zach Y , Montero Eduardo , Schmidt-Padilla Carlos , Sviatschi Maria Micaela
Published: May 2024

How does gang competition affect extortion? Using detailed data on individual extortion payments to gangs and sales from a leading wholesale distributor of consumer goods and pharmaceuticals in El Salvador, we document evidence on the determinants of extortion payments and the effects of extortion on firms and consumers. We exploit a 2016 non-aggression pact between gangs to examine how collusion affects extortion in areas where gangs previously competed. While the pact led to a large reduction in competition and violence, we find that it increased the amount paid in extortion by approximately 20%. Much of this increase was passed through to retailers and consumers: retailers experienced an increase in delivery fees, leading to an increase in consumer prices. In particular, we find an increase in prices for pharmaceutical drugs and a corresponding increase in hospital visits for chronic illnesses. The results point to an unintended consequence of policies that reduce competition between criminal organisations.
Treatment of psoriasis with different classes of biologics reduces the likelihood of peripheral and axial psoriatic arthritis development
Authors: Floris Alberto , Mugheddu Cristina , Sichi Leonardo , Anedda Jasmine , Frau Alessia , Sorgia Jessica , Li Volsi Laura , Paladino Maria Teresa , Congia Mattia , Chessa Elisabetta , Angioni Maria Maddalena , Naitza Micaela , Ferreli Caterina , Piga Matteo , Atzori Laura , Cauli Alberto
Published: May 2024

Objective

To assess the potential role of biologic treatment for psoriasis (PsO) in reducing the likelihood of psoriatic arthritis (PsA) development, through a detailed analysis that considered the different historical phases in PsA management, the different biologic classes and the different patterns of articular involvement.

Methods

A monocentric cohort of 1023 PsO patients underwent a rheumatological assessment in which clinical and therapeutic data were recorded. A chi-squared test and multivariate logistic regression analysis (adjusted for the main PsA risk factors) were performed to compare the likelihood of PsA development in different treatment groups.

Results

The PsA prevalence in PsO patients treated at least once with biologics was significantly lower than in patients never treated with biologics (8.9% vs 26.1%, P < 0.001). In multivariate analysis, a significantly (P < 0.01) lower likelihood of PsA development in biologic-treated patients was confirmed in the whole cohort (adjusted odds ratio [adjOR] 0.228), as well as in the subgroups of patients with PsO onset after 2005 (adjOR 0.264) and after 2014 (adjOR 0.179). Separately analysing the different biologic classes, the TNF (adjOR 0.206), IL-17 (adjOR 0.051) and IL-23 or 12/23 (adjOR 0.167) inhibitors were significantly (P < 0.01) associated with a lower likelihood of PsA development. Finally, patients treated with biologics had a significantly (P < 0.04) lower prevalence of both pure peripheral PsA (adjOR 0.182) and peripheral PsA with axial involvement (adjOR 0.115).

Conclusions

This study provides meaningful and concordant evidence supporting the significant role of different classes of biologics in reducing the likelihood of peripheral and axial PsA development.
Food Transfers, Cash Transfers, Behavior Change Communication and Child Nutrition: Evidence from Bangladesh
Authors: Ahmed Akhter , Hoddinott John , Roy Shalini
Published: May 2024

This paper reports the results of two 2-year randomized control trials in two poor rural areas of Bangladesh. Treatment arms included monthly cash transfers, monthly food rations of equivalent value to the cash transfers, and mixed monthly cash and food transfers, and treatment arms—one with food and one with cash—that combined transfers with nutrition-behavior communication change (BCC). This design enables a comparison of transfer modalities within the same experiment. Intent-to-treat estimators show that cash transfers and nutrition BCC had a large impact on nutritional status, a 0.25 standard deviation increase in height-for-age z-scores and a 7.8 percentage point decrease in stunting prevalence. No other treatment arm affected anthropometric outcomes. Mechanisms underlying these impacts are explored. Improved diets—particularly increased intake of animal source foods in the cash plus BCC arm—are consistent with the improvements observed in this paper.
Identification of Candidate Avirulence and Virulence Genes Corresponding to Stem Rust (Puccinia graminis f. sp. tritici) Resistance Genes in Wheat
Authors: Upadhaya Arjun , Upadhaya Sudha G. C. , Brueggeman Robert
Published: May 2024

Stem rust, caused by the biotrophic fungal pathogen Puccinia graminis f. sp. tritici ( Pgt), is an important disease of wheat. However, the majority of Pgt virulence/avirulence loci and underlying genes remain uncharacterized due to the constraints of developing bi-parental populations with this obligate biotroph. Genome-wide association studies (GWAS) using a sexual Pgt population mainly collected from the Pacific Northwestern United States were used to identify candidate virulence/avirulence effector genes corresponding to the six wheat Sr genes: Sr5, Sr21, Sr8a, Sr17, Sr9a, and Sr9d. The Pgt isolates were genotyped using whole-genome shotgun sequencing that identified approximately 1.2 million single nucleotide polymorphisms (SNPs) and were phenotyped at the seedling stage on six Sr gene differential lines. Association mapping analyses identified 17 Pgt loci associated with virulence or avirulence phenotypes on six Pgt resistance genes. Among these loci, 16 interacted with a specific Sr gene, indicating Sr-gene specific interactions. However, one avirulence locus interacted with two separate Sr genes ( Sr9a and Sr17), suggesting two distinct Sr genes identifying a single avirulence effector. A total of 24 unique effector gene candidates were identified, and haplotype analysis suggests that within this population, AvrSr5, AvrSr21, AvrSr8a, AvrSr17, and AvrSr9a are dominant avirulence genes, while avrSr9d is a dominant virulence gene. The putative effector genes will be fundamental for future effector gene cloning efforts, allowing for further understanding of rust effector biology and the mechanisms underlying virulence evolution in Pgt with respect to race-specific R-genes.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Limited English Proficiency Is an Overlooked Research Demographic
Authors: Sliwinski Kathy , Squires Allison P.
Published: May 2024

Excluding this population perpetuates health inequities.
COVID Fallout Continues to Dog Nursing Homes
Authors: Roush Karen
Published: May 2024

Staffing and other issues persist but care innovations gained traction.
Female Genital Mutilation Isn't Going Away
Authors: Roush Karen
Published: May 2024

The practice persists in sub-Saharan Africa, Asia, and Arab states.
Improving Compliance with a Nurse-Driven Protocol for Unfractionated Heparin Infusions in Patients with Venous Thromboembolism
Authors: Toale Katy M. , Butler Gina , Richardson Goley , Beno Jeff , Jawe Neetha
Published: May 2024

Background:

Unfractionated heparin (UFH) is a high-risk medication that can cause bleeding and/or thrombotic complications if not managed appropriately. Between January and July 2019, our institution experienced a high number of patient safety events related to UFH infusion for the treatment of venous thromboembolism (VTE).

Purpose:

The aim of this quality improvement (QI) initiative was to prevent these safety events by improving compliance with our institution's nurse-driven VTE UFH infusion protocol.

Methods:

Baseline data for patients on the VTE UFH protocol were collected to identify improvement opportunities. Compliance with eight standards of care related to the VTE UFH infusion protocol was measured. Time to first therapeutic activated partial thromboplastin time (aPTT) was recorded to assess the benefit of improved compliance.

Interventions:

Institutional policy updates were made to clarify the management of UFH infusions and documentation in the electronic health record. A multidisciplinary workgroup implemented order set changes, nursing communication orders, UFH infusion reports, and a nursing education module to promote compliance with the protocol.

Results:

The overall rate of compliance with the VTE UFH infusion protocol increased from 79.4% at baseline to 85.2% following implementation of the QI initiative, and the median time to first therapeutic aPTT decreased from 831.5 minutes to 808 minutes over the same period.

Conclusions:

A multidisciplinary initiative to address improvement opportunities in a nurse-driven UFH protocol for VTE treatment increased compliance with the protocol and decreased the time to first therapeutic aPTT.
Bias Found in Race-Based GFR Equations that Estimate Kidney Function
Authors: Rosenberg Karen
Published: May 2024

According to this study:

A systematic review and meta-analysis demonstrated bias in the race-based estimated glomerular filtration rate equations used for the diagnosis and management of kidney disease.

A multifaceted approach is needed to mitigate racial disparities in chronic kidney disease outcomes.
Multicomponent Intervention Is an Effective Treatment Option for Overactive Bladder in Women
Authors: Rosenberg Karen
Published: May 2024

According to this study:

A randomized clinical trial showed that a multicomponent intervention with cognitive components improved health-related quality of life in women with moderate-to-severe overactive bladder.
Optimizing Resuscitation of the Donation after Circulatory Death Heart by Mitochondrial Protection in a Female Porcine Model
Authors: Wang Fulin , Lucchinetti Eliana , Lou Phing-How , Hatami Sanaz , Chakravarty Akash , Hersberger Martin , Freed Darren H. , Zaugg Michael
Published: May 2024

Background

Due to the shortage of donor organs, an increasing number of transplant organs are harvested after circulatory arrest (donation after circulatory death [DCD]). Using a translational porcine model of DCD, this study developed and evaluated a protocol based on cardioprotection by multidrug postconditioning to optimize resuscitation of DCD hearts during ex situ heart perfusion (ESHP).

Methods

Hearts of female pigs (45.0 ± 4.5 kg) were procured following a clinically identical DCD protocol, consisting of the termination of ventilator support and confirmation of circulatory arrest, followed by a 15-min standoff period. DCD hearts were randomly allocated to ESHP (38.4°C) in the absence (untreated, N = 5) or presence (treated, N = 5) of a postconditioning treatment added to the perfusate, consisting of Intralipid (1%), sevoflurane (2% v/v), and remifentanil (3 nM). All hearts were perfused with blood and Krebs–Henseleit solution (1:1) for 60 min in Langendorff mode and for an additional 300 min in working mode for a total perfusion time of 6 h. Oxidative capacity and detailed left ventricular mechanical function under an increasing workload (left atrial pressure, 6 to 12 mmHg) were assessed hourly. Left ventricular tissue was snap-frozen at the end of ESHP and used for molecular analyses.

Results

Left ventricular inotropy (LVdP/dtmax) did not decline over time in treated DCD hearts and was significantly higher at the end of the protocol as compared with untreated DCD hearts (ΔLVdP/dtmax = 440 mmHg/s; P = 0.009). Treated DCD hearts exhibited persistently higher left ventricular stroke work index during the 6-h period of ESHP, whereas untreated DCD hearts displayed a significant decline (change in left ventricular stroke work index = −3.10 ml · mmHg/g; P(time within untreated group) < 0.001). Treated DCD hearts displayed higher metabolic activity as measured by oxygen consumption (ΔO2 = 3.11 ml O2 · min−1 · 100 g−1; P = 0.004) and released lower amounts of cell-free mitochondrial DNA into the perfusate, a marker of potential graft dysfunction. Treated hearts also used fatty acids from Intralipid as an energy source, whereas untreated DCD hearts showed glyceroneogenesis with triglyceride accumulation and depletion of tricarboxylic acid cycle intermediates; reduced mitochondrial complex I, II, and III activities with accumulation of mitochondrial NADH, and signs of ultrastructural damage.

Conclusions

A translationally relevant protective ESHP protocol consisting of treatment with Intralipid, sevoflurane, and remifentanil markedly accelerated functional recovery and improved viability of DCD hearts.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
24-Hour Compared With 12-Hour Mifepristone–Misoprostol Interval for Second-Trimester Abortion
Authors: Meyer Raanan , Toussia-Cohen Shlomi , Shats Maya , Segal Omri , Mohr-Sasson Aya , Peretz-Bookstein Shiran , Amitai-Komem Daphna , Sindel Ofra , Levin Gabriel , Mashiach Roy , Blumenthal Paul D.
Published: May 2024

OBJECTIVE:

To compare 24-hour and 12-hour mifepristone-to-misoprostol intervals for second-trimester medication abortion.

METHODS:

We conducted a prospective randomized controlled trial. Participants were allocated to receive mifepristone either 24 hours or 12 hours before misoprostol administration. The primary outcome was the time from the first misoprostol administration to abortion (induction time). Secondary outcomes included the time from mifepristone to abortion (total abortion time); fetal expulsion percentages at 12, 24, and 48 hours after the first misoprostol dose; side effects proportion; and pain and satisfaction scores. A sample size of 40 per group (N=80) was planned to compare the 24- and 12-hour regimens.

RESULTS:

Eighty patients were enrolled between July 2020 and June 2023, with 40 patients per group. Baseline characteristics were comparable between groups. Median induction time was 9.5 hours (95% CI, 10.3–17.8 hours) and 12.5 hours (95% CI, 13.5–20.2 hours) in the 24- and 12-hour interval arms, respectively (P=.028). Median total abortion time was 33.0 hours (95% CI, 34.2–41.9 hours) and 24.5 hours (95% CI, 25.7–32.4 hours) in the 24- and 12-hour interval groups, respectively (P<.001). At 12 hours from misoprostol administration, 25 patients (62.5%) in the 24-hour arm and 18 patients (45.0%) in the 12-hour arm completed abortion (P=.178). At 24 hours from misoprostol administration, 36 patients (90.0%) in the 24-hour arm and 30 patients (75.0%) in the 12-hour arm had complete abortion (P=.139). The need for additional medication or surgical treatment for uterine evacuation, pain scores, side effects, and satisfaction levels were not different between groups.

CONCLUSION:

A 24-hour mifepristone-to-misoprostol regimen for medication abortion in the second trimester provides a median 3-hour shorter induction time compared with the 12-hour interval. However, the median total abortion time was 8.5-hours longer in the 24-hour interval regimen. These findings can aid in shared decision making before medication abortion in the second trimester.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04160221.
Evaluation of Financial Interventions in Breast Cancer Care Worldwide: A Systematic Review
Authors: Ehsan Anam N. , Wu Catherine A. , Minasian Alexandra , Bass Michelle , Sana Hamaiyal , Patel Aastha , Pace Lydia , Mekary Rania A. , Ranganathan Kavitha
Published: May 2024

Background:

Out-of-pocket costs are burdensome for breast cancer patients. Cost-reducing interventions, though implemented, have unclear comparative efficacy. This study aimed to critically evaluate characteristics of successful versus unsuccessful interventions designed to decrease out-of-pocket costs for breast cancer patients.

Methods:

A systematic review was conducted in accordance with the PRISMA checklist. Embase, PubMed, Global Index Medicus, and Global Health were queried from inception to February 2021. Articles describing a financial intervention targeting costs for breast cancer screening, diagnosis, or treatment and addressing clinical or patient-level financial outcomes were included. Methodological quality was evaluated using the QualSyst tool. Interventions were organized in accordance with timing of implementation, with narrative description of intervention type, success, and outcomes.

Results:

Of the 11,086 articles retrieved, 21 were included in this review. Of these, 14 consisted of interventions during screening, and seven during diagnosis or treatment. Free/subsidized screening mammography was the most common screening intervention; 91% of these programs documented successful outcomes. Patient navigation and gift voucher programs demonstrated mixed success. The most successful intervention implemented during diagnosis/treatment was reducing medication costs. Low-cost programs and direct patient financial assistance were also successful. Limitations included lack of standardization in outcome metrics across studies.

Conclusions:

Financial interventions reducing prices through free screening mammography and decreasing medication costs were most successful. Less successful interventions were not contextually tailored, including gift card incentivization and low-cost treatment modalities. These findings can facilitate implementation of broader, more generalizable programs to reduce costs and improve outcomes during evaluation and management of breast cancer.
Shared Decision-making in Breast Cancer Reconstructive Surgery: Experience in a Leading Hospital
Authors: Herrera de la Muela María , Sanz Medrano Santiago , Leyva Francisco , Masa Jurado Inmaculada , Membrilla Ortiz Ana I. , Brenes Sánchez Juana , de la Puente Yagüe Miriam , Ruiz Rodríguez Jorge , Buendía Pérez Javier
Published: May 2024

Background:

The paradigm of healthcare has evolved toward patient-centered approaches, where shared decision-making (SDM) plays a pivotal role. This study aimed to explore the implementation of SDM during breast cancer reconstruction consultations and assess its impact on patient satisfaction and the decision-making process as a whole.

Methods:

A total of 102 female patients undergoing breast reconstruction were included in a multidisciplinary breast pathology unit. A streamlined SDM model involving choice introduction, option description, and preference exploration was implemented. A validated Spanish version of the nine-item Shared Decision Making Questionnaire was used alongside a complementary questionnaire. Data analysis was carried out using electronic data capture software.

Results:

The nine-item Shared Decision Making Questionnaire results indicate strong agreement in presenting various options and explaining their advantages and disadvantages. Patients were less confident about their participation in decision-making. The Complementary Shared Decision Making Questionnaire highlighted high satisfaction with interview times and language clarity but areas for improvement in consultation space and therapeutic choice participation.

Conclusions:

Integrating SDM into breast reconstruction consultations empowers patients in the decision-making process and enhances satisfaction. Decision aids prove effective in this context, facilitating patients’ comprehension and reducing decisional conflict. There are areas for improvement within the SDM strategy, and they are detectable through scales. Although challenges in information transmission and patient involvement persist, adopting an SDM model has potential benefits that warrant further investigation.
Revolutionizing Schedules: The Power of AI in Physician Practices
Authors: Liebowitz Stephen H. , Robertson Matthew
Published: May 2024

Since the early 2000s, artificial intelligence (AI) has raised concerns regarding its use in healthcare to manage vast amounts of patient data, ensure proper handling, and maintain robust security measures. Nevertheless, contemporary healthcare organizations are exploring ways AI can safely enhance operational efficiency and support their patient populations. Successful, evidence-based utilization relies on a well-defined ambulatory strategy, and operational efficiency must be foundational to that strategy. Patient no-shows and appointment compliance, especially in the context of social determinants of health such as access, present inherent obstacles to patient and provider satisfaction, continuity of care, practice productivity, and the financial sustainability of an organization. To address these obstacles, Berkeley Research Group has been working with Phoebe Physician Group. Their shared objective is twofold: enhance patient encounter volume and the associated revenue. This article provides insights into the steps taken to integrate AI and machine learning to mitigate the problem of no-shows by automatically double-booking appointments for patients with a high probability of not showing up. A glimpse into the outcomes achieved and lessons learned throughout the process also is presented.
Evidence-Based Management, Reconsidered
Authors: Kovner Anthony R. , Rundall Thomas G.
Published: May 2024

Reports of medical mistakes have splashed across newspapers and magazines in the United States. At the same time, instances of overuse, underuse, and misuse of management tactics and strategies receive far less attention. Tactics to increase health systems managers’ participation in management research include training in evidence-based management, investment in management research projects, and implementing knowledge management systems. To help in understanding and applying an evidenced-based approach to decision-making, the article excerpt provides practical tools and strategies to develop a questioning organizational culture.
How a System Is Closing the Evidence-Based Data Management Gap
Authors: Steelman Anna Rose , Anagnostis Tracy
Published: May 2024

To translate raw data into information that is understandable and actionable, healthcare leaders must leverage decision-making tools that can drive strategic innovation, improve processes, and shape the future of healthcare. Continuous changes in healthcare delivery require constant monitoring of an expanding range of data. Population demographics, psychographics, and availability of care all must be considered, as well as provider practice patterns, patient utilization, clinical and service quality, costs, and many other key variables over time. RWJBarnabas Health is navigating significant changes in its approach to managing data. A unified operating model is driving standardization, continuous quality improvement, and cost reductions across the system. The solution is based on an electronic health record system designed to meet the needs of the entire system, an array of carefully selected external data sources, and a business intelligence tool to enable leaders to quickly draw insights from all the available data.
The burden of significant pain in the cirrhosis population: Risk factors, analgesic use, and impact on health care utilization and clinical outcomes
Authors: Rubin Jessica B. , Loeb Rebecca , Fenton Cynthia , Huang Chiung-Yu , Keyhani Salomeh , Seal Karen H. , Lai Jennifer C.
Published: May 2024

Background:

We aimed to characterize pain and analgesic use in a large contemporary cohort of patients with cirrhosis and to associate pain with unplanned health care utilization and clinical outcomes in this population.

Methods:

We included all patients with cirrhosis seen in UCSF hepatology clinics from 2013 to 2020. Pain severity and location were determined using documented pain scores at the initial visit; “significant pain” was defined as moderate or severe using established cutoffs. Demographic, clinical, and medication data were abstracted from electronic medical records. Associations between significant pain and our primary outcome of 1-year unplanned health care utilization (ie, emergency department visit or hospitalization) and our secondary outcomes of mortality and liver transplantation were explored in multivariable models.

Results:

Among 5333 patients with cirrhosis, 32% had a nonzero pain score at their initial visit and 25% had significant (ie moderate/severe) pain. Sixty percent of patients with significant pain used ≥1 analgesic; 34% used opioids. Patients with cirrhosis with significant pain had similar Model for End-Stage Liver Disease-Sodium scores (14 vs. 13), but higher rates of decompensation (65% vs. 55%). The most common pain location was the abdomen (44%). Patients with abdominal pain, compared to pain in other locations, were more likely to have decompensation (72% vs. 56%). Significant pain was independently associated with unplanned health care utilization (adjusted odds ratio: 1.3, 95% CI: 1.1–1.5) and mortality (adjusted hazard ratio: 1.4, 95% CI: 1.2–1.6).

Conclusions:

Pain among patients with cirrhosis is often not well-controlled despite analgesic use, and significant pain is associated with unplanned health care utilization and mortality in this population. Effectively identifying and treating pain are essential in reducing costs and improving quality of life and outcomes among patients with cirrhosis.