bluuebunny/crossref_metadata_2025 huggingface dataset:
12. Market abuse
Authors: French Derek
Published: September 2021

This chapter deals with abuses committed in the trading of shares, with particular reference to insider dealing and market manipulation, and the laws intended to control them. The chapter considers forms of control to prevent market abuse under three key pieces of legislation: Regulation (EU) No 596/2014, the Criminal Justice Act 1993 and the Financial Services Act 2012. It looks at regulations governing disclosure to regulated markets and the fiduciary duty of directors, and offences involving insider dealing and creating a false market. The chapter analyses a particularly significant case: Percival v Wright [1902] 2 Ch 421.
19. Acting for a company: agency and attribution
Authors: French Derek
Published: September 2021

This chapter deals with the legal relationship of agency that exists between the company and the agent, explaining the process involved in an agent’s authentication and the execution of documents for the company they represent. It considers two ways in which a company may become contractually bound to another person (a ‘contractor’) under the provisions of the Companies Act 2006: through a written contract to which the company’s common seal is affixed, or when someone has made a contract on behalf of the company. It also discusses the company’s capacity to enter into contracts, including the ultra vires rule, and attribution by a court so as to impose criminal liability on a company. A number of court cases relevant to the discussion are cited.
3. The features and sources of the UK constitution
Authors: Dennett Anne
Published: September 2021

This chapter examines the characteristics of the UK constitution. The main features of the UK constitution are that it is uncodified; flexible; traditionally unitary but now debatably a union state; monarchical; parliamentary; and based on a bedrock of important constitutional doctrines and principles: parliamentary sovereignty, the rule of law, separation of powers; the courts are also basing some decisions on bedrock principles of the common law. Meanwhile, the laws, rules, and practices of the UK constitution can be found in constitutional statutes; judicial decisions; constitutional conventions; international treaties; the royal prerogative; the law and custom of Parliament; and works of authoritative writers. The chapter then looks at the arguments for and against codifying the UK constitution.
4. The European Courts: composition, functions, jurisdiction; preliminary rulings
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: September 2021

This chapter discusses the composition, functions and jurisdiction of the European Courts. It discusses indirect actions (preliminary rulings) and direct actions, i.e. actions brought by or against the European Institutions and the Member States, and between the Member States. The Courts are the CJEU, which includes the Court of Justice, the General Court, and specialised courts. The chapter explains the role of the Advocate General (AG), and further discusses rules of procedure, judicial activism, preliminary rulings, the jurisdiction of national courts, discretionary and mandatory references, when national courts should refer, interim measures, effect of preliminary rulings, and the future of preliminary rulings. The chapter also explains the role of the EFTA Court.
5. The European Union legal system
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: September 2021

This chapter discusses the EU system’s sources of law covering: primary legislation, secondary Union legislation and other sources of law, including ‘soft law’. It also discusses the legislative procedures, decision-making procedure of the Commission and legislative powers and implied powers. The chapter concludes with a discussion on the application of the principle of subsidiarity and proportionality.
6. General principles of law and the Charter of Fundamental Rights
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: September 2021

This chapter discusses the overarching principles of the Union legal order, e.g. subsidiarity, proportionality, sustainability and equality; fundamental human rights in the Union (Court of Justice jurisdiction over Member State acts and rights against Union institutions or agents); and principles of administrative justice and good governance (legal certainty, non-retroactivity and legitimate expectations, rights of process and natural justice, transparency and legal professional privilege).
7. Doctrines of European Union law: direct effect, supremacy, state liability for breach of EU law and other remedies
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: September 2021

This chapter examines the main doctrines or principles of EU law. It is divided into three sections. It starts with a discussion on the principle of direct effect and indirect effect, with reference to regulations, directives and international agreements. It then considers the doctrine of supremacy or primacy of EU law with reference to a selection of Member States and the UK. The chapter also considers state liability for breach of EU law, and other remedies.
9. Free movement of goods (I): the abolition of customs duties and internal taxation
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: September 2021

This chapter introduces the law on the free movement of goods in the EU. It discusses the following: the customs union; the free movement of goods provisions in the TFEU; customs duties and common customs tariffs; charges having equivalent effect to a customs duty, and charges falling within the scope of internal taxation.
15. Environmental law and policy
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: September 2021

This chapter examines environmental law and policy in the European Union, considering Union powers and the international context. It discusses the framework for Union environmental law and policy; environmental principles; European Union environmental law by sector; trade in endangered species; nature conservation; environmental protection implementation and enforcement; and environmental litigation.
16. Discrimination law: from sex discrimination in employment to a general equality principle
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: September 2021

This chapter focuses on discrimination prohibited in employment. It first looks at sex discrimination, which, as it developed both in respect of abundant case law and of legislation, has contributed much to the development of the more general principle of equal treatment. It then considers other forms of discrimination included in the directives made under Article 19 of the TFEU.
2. Agreement
Authors: Taylor Richard , Taylor Damian
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. Questions, diagrams and exercises help readers to engage fully with each subject and check their understanding as they progress. A contract requires that the parties reach an agreement which normally consists of a matching offer and acceptance. This chapter discusses the following: the objective test of agreement; identifying an offer and acceptance; rejection, counter-offers and inquiries; communication of acceptance including the postal rule and the contrasting rule for revocation; mode of acceptance; the death of an offer; and unilateral contracts.
8. Mistake
Authors: Taylor Richard , Taylor Damian
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. Questions, diagrams and exercises help readers to engage fully with each subject and check their understanding as they progress. This chapter discusses the various ways of classifying mistakes including communication mistakes, mistakes of fact, common mistake and unilateral mistake. It then looks at the case law on mistaken identity and the distinctions between face-to-face and correspondence contracts. Finally, it looks at the restrictive rules on common mistake, including the difference between fundamental mistake and mistake as to quality, and their relationship with the doctrine of frustration and the demise of the category of equitable mistake.
13. Privity and the interests of third parties
Authors: Taylor Richard , Taylor Damian
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. Questions, diagrams and exercises help readers to engage fully with each subject and check their understanding as they progress. This chapter examines the privity rule, which states that only a party to the contract can sue upon it. It discusses the development of the privity rule, distinguishing the privity rule from the consideration rule, evading the privity rule, techniques for giving a right directly to a third party or apparent third party, specific performance in favour of a third party and damages for a third party’s loss, and the Contracts (Rights of Third Parties) Act 1999.
1. Employment status
Authors: Jefferson Michael
Published: September 2021

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. This chapter discusses the concept of employment status. Topics covered include the reasons for distinguishing employees from other types of worker; statutory definitions of employee and worker; and the courts’ and tribunals’ approach to identifying employees. The tests for employment status are stated, concentrating on mutuality of obligations and personal service. Discussion centres on zero hours contracts, agency workers, and the gig economy.
3. Pay
Authors: Jefferson Michael
Published: September 2021

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. This chapter discusses the law on employee wages. An employer may be required to pay wages even if there is no work for the employee to do. Part II of Employment Rights Act 1996 deals with the protection of wages. The National Minimum Wage Act 1998 (NMWA) provides a minimum hourly wage for workers. A higher minimum wage for those over 23 (until 2021, this was 25), the National Living Wage, was introduced in 2016.
5. Discrimination at work, prohibited conduct, and enforcement
Authors: Jefferson Michael
Published: September 2021

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. This chapter focuses on the provisions of the Equality Act 2010. Applicants for jobs must not be asked about their health or disability in the recruitment process. Prohibited conduct refers to direct and indirect discrimination, harassment, and victimisation. Segregation on racial grounds is also prohibited. In addition, there is no minimum period of employment needed before one can make a discrimination claim.
6. Convention law: pervasive themes
Authors: Davis Howard
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. Questions, discussion points and thinking points help readers to engage fully with each subject and check their understanding as they progress and knowledge can be tested by self-test questions and exam questions at the chapter end. This chapter discusses the various concepts that pervade the way the European Convention on Human Rights (ECHR) is interpreted and, therefore, how Convention rights under the HRA are applied. The chapter considers the internal and external sources used to interpret the text. It goes on to consider the concepts that the European Court of Human Rights has developed when applying the Convention. In particular the ‘living instrument’ doctrine, the idea of the rule of law, the margin of appreciation, proportionality, and democracy (in a Convention context) are considered and explored.
9. Article 3: prohibition of torture
Authors: Davis Howard
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. It discusses European Convention law and relates it to domestic law under the HRA. Questions, discussion points, and thinking points help readers to engage fully with each subject and check their understanding as they progress and knowledge can be tested by self-test questions and exam questions at the chapter end. This chapter the absolute ban on torture and inhuman or degrading treatment that Article 3 requires. The basic terms (torture and inhuman and degrading treatment and punishment) are defined. The absolute nature of the ban is discussed. The chapter also discusses the broad nature of state responsibility to prevent suffering that is severe enough to violate Article 3. Article 3 creates limits to what is acceptable as punishment and, more importantly, applies in a wide range of situations for which the state has responsibility in respect to otherwise lawful activity not involving an intention to harm.
20. Applications: police powers
Authors: Davis Howard
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. It discusses European Convention law and relates it to domestic law under the HRA. Questions, discussion points, and thinking points help readers to engage fully with each subject and check their understanding as they progress and knowledge can be tested by self-test questions and exam questions at the chapter end. This chapter focuses on the authority of the police in the United Kingdom and on issues which are affected by human rights law under the HRA. Police powers are exercised with the authority of both common law and statute—the latter (e.g. the Police and Public Evidence Act 1984) must be interpreted for compatibility with Convention rights so far as section 3 HRA allows. The police are considered a ‘core’ public authority, and policing is self-evidently a public function. The following sections also discuss the extensive powers of the police in relation to, in particular, Article 5, regarding arrest and detention, and Article 8, regarding searches and seizure. English and Welsh courts adjudicating on these powers have generally found them to be compatible with Convention rights at the general level. Some important cases, such as over the retention, storage and use of personal data, have led to disagreements with Strasbourg and consequential changes to the law.
22. Applications: media law and privacy
Authors: Davis Howard
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. It discusses European Convention law and relates it to domestic law under the HRA. Questions, discussion points, and thinking points help readers to engage fully with each subject and check their understanding as they progress and knowledge can be tested by self-test questions and exam questions at the chapter end. This chapter deals with human rights and the media. It considers the widespread tension between, on the one hand, the importance in a democratic society of freedom of expression and, on the other, the rights of persons to protect their various interests, particularly when these involve matters of privacy and confidentiality. The importance of the media is fully recognised by the European Court of Human Rights, and Convention rights have had a significant impact, both directly and indirectly, on media law. However, the issue often involves balancing the clear commitment to media freedom derived from Article 10 with other rights such as those in Article 8.
23. Article 1 of the First Protocol: protection of property
Authors: Davis Howard
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. It discusses European Convention law and relates it to domestic law under the HRA. Questions, discussion points, and thinking points help readers to engage fully with each subject and check their understanding as they progress and knowledge can be tested by self-test questions and exam questions at the chapter end. This chapter discusses Article 1 of the First Protocol. The right to property is controversial. On the one hand, this right can be seen as essential to human flourishing; on the other, property can be seen as representing social and political power, which is distributed unequally. Given the relationship between property and power, it is not surprising that governments have often sought the constitutional freedom to control the production and distribution of wealth in society, which may at times require limiting the right to property. Article 1 of the First Protocol uses terms that seem to accept wide powers of states to control property in the ‘public’ or ‘general’ interest. As discussed in the chapter, the European Court of Human Rights has narrowed this power considerably in the way the Article has been interpreted.
Medical Law Concentrate
Authors: Samanta Jo , Samanta Ash
Published: September 2021

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. Medical Law Concentrate provides a study and revision guide aiming to cover the essential aspects of this rapidly changing field of law. Topics covered include: the contemporary healthcare environment; medical negligence; consent; confidentiality; and access to medical records. The volume also looks at abortion and prenatal harm, assisted reproduction, clinical research, and organ transplantation. Finally, it covers mental health law and the end-of-life decisions. The work is underpinned by reference to statutory provisions and the common law. Where appropriate, pertinent bioethical and moral principles that often underpin the law in this area are discussed, as well as the influence of quasi-law. Reference is made to key points of comparison with other jurisdictions, as well as some socio-legal considerations.
6. Assisted reproduction
Authors: Samanta Jo , Samanta Ash
Published: September 2021

This chapter deals with the statutory provisions governing assisted reproduction, with particular reference to the Human Fertilisation and Embryology Act 1990 (as amended) and the Human Fertilisation and Embryology Authority. It also explores the issue of access to services and whether these are available on the National Health Service, together with the ethical and legal issues surrounding the use and storage of gametes and embryos, surrogacy arrangements, and screening of embryos. Relevant cases are considered, where appropriate.
7. Organ transplantation
Authors: Samanta Jo , Samanta Ash
Published: September 2021

This chapter deals with statutory provisions governing human tissue and organ transplantation, with particular reference to the Human Tissue Act 2004. It first considers the position at common law with regards to property in the human body, followed by a discussion of appropriate consent given by potential donors prior to their death or by deceased donors. It also considers the change in law to presumed consent under the Organ Donation (Deemed Consent) Act 2019. Organ donation from living persons and ethical issues surrounding organ transplantation are then explored. The chapter concludes by looking at alternative sources of organs, including xenotransplantation and artificial organs. Relevant court cases are cited, where appropriate.
9. The end of life
Authors: Samanta Jo , Samanta Ash
Published: September 2021

This chapter deals with key legal and ethical issues surrounding end-of-life decisions, with particular reference to physician-assisted death, such as euthanasia. Suicide and assisted suicide, administration of pain relief, and futility are considered. Relevant legislation such as the Suicide Act 1961 (as amended by the Coroners and Justice Act 2009), the Human Rights Act 1998, and the Mental Capacity Act 2005 are discussed. The chapter examines several bioethical principles, including sanctity-of-life and quality-of-life debates; autonomy, beneficence, and medical paternalism; personhood, palliative care, and the double effect doctrine. Finally, it considers human rights issues, treatment requests, incompetent patients, prolonged disorders of consciousness, and locked-in syndrome. Recent cases are considered.
6. Climate Change and Atmospheric Pollution
Authors: Boyle Alan , Redgwell Catherine
Published: September 2021

This chapter looks, inter alia, at how international law has been used or could be used to help tackle the most significant environmental challenge of our time. This challenge is global climate change. Not many topics provide a good illustration of the importance of a globally inclusive regulatory regime focused on preventive and precautionary approaches to environmental harm—or of the problems of negotiating one on such a complex subject. Solutions to global climate change have not been easily forthcoming. The chapter looks at the efforts of the international regulatory regime to address these challenges by recourse to novel ‘market based’ mechanisms and differential treatment. An example is the post-Kyoto scheme for reducing greenhouse gas emissions through ‘nationally determined contributions’. In the end, the chapter argues, it is likely to be technology that enables us to grapple with the causes of climate change, not law, but law can drive technological change, as it has with ozone depletion and acid rain.
7. Nuclear Energy and the Environment
Authors: Boyle Alan , Redgwell Catherine
Published: September 2021

This chapter gives the example of the Chernobyl reactor accident in 1986 to show that nuclear power creates risks for all states, irrespective of whether they choose this type of energy. Every state, and the global environment, is potentially affected by the possibility of radioactive contamination, the spread of toxic substances derived from nuclear energy, and the long-term health hazards consequent on exposure to radiation. Whether the nuclear power industry has now attained acceptable levels of risk to international society cannot be answered in the abstract, the chapter argues, or solely by reference to regulatory standards and technical capabilities, but must take into account public perceptions of risk, as well as the alternatives and the competing risks, such as climate change. The chapter notes that for all governments there are inevitably difficult policy choices in which there are few electoral advantages.
Competition law and digital ecosystems: Learning to walk before we run
Authors: Jenny Frederic
Published: September 2021

The paper analyzes the challenges faced by competition authorities with respect to the digital sector. Borrowing insights from the business policy literature and from the economic literature, the paper first analyzes the specificities of digital firms (multi-sided platforms and ecosystems) with respect to their development and competitive strategies. Building on this foundation the paper explores some of the challenges of applying traditional competition analysis to competition in the business sector. We then discuss a number of issues relevant to competition law enforcement in the digital sector starting with the role of data, competition within ecosystems and between ecosystems, consumer biases, and the role of gatekeepers. We conclude with a research agenda for economists and competition authorities.
COVID-19: Military Nurses Leading Innovation Through Research, Clinical Care, Education, and Collaboration
Authors: King Heather C , Talbot Laura A
Published: September 2021

Military nurses have been placed in the forefront of clinical and leadership roles during the COVID-19 pandemic. Serving in critical roles, military nurses have spearheaded innovations in clinical practice, conducted research, and implemented evidence-based practice projects that have advanced the capabilities of the Armed Forces Nurse Corps. This collection captures and highlights many of these military nursing contributions combating the COVID-19 pandemic.
Nurse Leader Expertise for Pandemic Management: Highlighting the Essentials
Authors: Hopkinson Susan G , Jennings Bonnie Mowinski
Published: September 2021

The COVID-19 pandemic requires military nurse leaders in various patient care settings to engage in disaster response. Evidence supports essential leadership attributes for nurses that include skilled communication, organizational influence, and personnel management. Yet, nursing expertise that shapes nurse leader responsibilities during disaster management remains unclear. A description of how military nurse leaders contributed their nursing expertise during the COVID-19 pandemic response at one U.S. Military health care facility is provided to begin to delineate disaster management responsibilities.
Practical Structure and Moral Skill
Authors: Shepherd Joshua
Published: September 2021

I argue that moral skill is limited and precarious. It is limited because global moral skill—the capacity for morally excellent behaviour within an über action domain, such as the domain of living, or of all-things-considered decisions, or the same kind of capacity applied across a superset of more specific action domains—is not to be found in humans. It is precarious because relatively local moral skill, while possible, is prone to misfire. My arguments depend upon the diversity of practical structures confronting human agents, the limitations of human skill learning and reason-sensitivity, and the failure of moral considerations to respect the social and institutional boundaries we develop to structure our practical lives.
Using a Community-Based Participatory Approach to Address Gender Equity in Academic Medicine: The Center for Women in Medicine and Science at the University of Minnesota
Authors: Berge Jerica M. , Macheledt Kait , Watson Sophie , Dorr Heather , Pusalavidyasagar Snigdha , Kunin-Batson Alicia , Pratt Rebekah , Zimmer Sara L. , Tolar Jakub , Termuhlen Amanda
Published: September 2021

Many medical schools are instituting gender equity initiatives to address long-standing inequities (e.g., salary, leadership positions, resource distribution) between women and men in academic medicine. However, few theory-driven models exist with built-in metrics to assess the impact of gender equity initiatives. The authors describe the theory- and metric-driven process used to create the Center for Women in Medicine and Science (CWIMS) at the University of Minnesota (UMN) Medical School. An innovative theory-driven approach using community-based participatory research (CBPR) was used to create and organize CWIMS. CBPR acknowledges community members (e.g., faculty members, staff), academic organizational representatives (e.g., department heads, center directors), and administrative leaders (e.g., deans) as equal contributors in carrying out all aspects of gender equity work. CBPR values collaborative approaches that empower faculty, promote co-learning and co-creation of initiatives among all university partners, and build upon already existing community strengths and resources. Four CWIMS action groups were created using CBPR principles. The action groups are retention and recruitment; mentoring; salary, resource, and leadership equity; and strategic communications and collaborations. Faculty members across all medical school departments joined these 4 action groups to co-create and carry out all CWIMS gender equity initiatives. The process of developing the CWIMS center and action groups, the CBPR theoretical model guiding the approach, the initiatives developed by the action groups and metrics created, and the outcomes achieved to date are described. In addition, 4 lessons learned from the development of the CWIMS—use of theoretically driven and evidence-based models is key to building a sustainable organization; bottom-up and top-down engagement of partners is crucial for sustainability; passion and innovation are critical for long-term momentum; and not all faculty members and leaders will be enthusiastic about gender equity issues—are shared for the benefit of other medical schools wanting to develop similar centers.
Surgical Outcomes of Obese Patients With Adolescent Idiopathic Scoliosis From Endemic Areas of Obesity in the United States
Authors: McDonald Tyler C. , Heffernan Michael J. , Ramo Brandon , Haber Lawrence , Sheffer Benjamin , Murphy Joshua , Murphy Robert , Fletcher Nicholas , Coyne Killian , Lubicky John , Bumpass David B. , Crawford Charles , Carreon Leah , Toner Sarah , Stafford William H. , Poppino Kiley , Adams Tyler , Song Bryant M. , Gidwani Simran , Taillac Heather , Cornaghie Mary , Sukkarieh Hamdi , Wright Patrick B. , Conklin Michael , Gilbert Shawn , Thimothee Josny , Bhanat Eldrin , Brooks Jaysson T.
Published: September 2021

Background:

Obesity rates continue to rise among children and adolescents across the globe. A multicenter research consortium composed of institutions in the Southern US, located in states endemic for childhood obesity, was formed to evaluate the effect of obesity on pediatric musculoskeletal disorders. This study evaluates the effect of body mass index (BMI) percentile and socioeconomic status (SES) on surgical site infections (SSIs) and perioperative complications in patients with adolescent idiopathic scoliosis (AIS) treated with posterior spinal fusion (PSF).

Methods:

Eleven centers in the Southern US retrospectively reviewed postoperative AIS patients after PSF between 2011 and 2017. Each center contributed data to a centralized database from patients in the following BMI-for-age groups: normal weight (NW, 5th to <85th percentile), overweight (OW, 85th to <95th percentile), and obese (OB, ≥95th percentile). The primary outcome variable was the occurrence of an SSI. SES was measured by the Area Deprivation Index (ADI), with higher scores indicating a lower SES.

Results:

Seven hundred fifty-one patients were included in this study (256 NW, 235 OW, and 260 OB). OB and OW patients presented with significantly higher ADIs indicating a lower SES (P<0.001). In addition, SSI rates were significantly different between BMI groups (0.8% NW, 4.3% OW, and 5.4% OB, P=0.012). Further analysis showed that superficial and not deep SSIs were significantly different between BMI groups. These differences in SSI rates persisted even while controlling for ADI. Wound dehiscence and readmission rates were significantly different between groups (P=0.004 and 0.03, respectively), with OB patients demonstrating the highest rates. EBL and cell saver return were significantly higher in overweight patients (P=0.007 and 0.002, respectively).

Conclusion:

OB and OW AIS patients have significantly greater superficial SSI rates than NW patients, even after controlling for SES.

Level of Evidence:

Level III.
Mechanical Complications in Adult Spinal Deformity Surgery
Authors: Teles Alisson R. , Aldebeyan Sultan , Aoude Ahmed , Swamy Ganesh , Nicholls Fred H. , Thomas Kenneth C. , Jacobs W. Bradley
Published: September 2021

Study Design.

Cohort study.

Objective.

Our goal was to verify the validity of the global alignment and proportion (GAP) score, SRS-Schwab, and Roussouly theoretical apex of lordosis in predicting mechanical complications in adult spinal deformity (ASD).

Summary of Background Data.

Achieving adequate sagittal alignment is critical to obtain favorable outcomes in ASD surgery. It has been proposed that mechanical complications are largely secondary to postoperative spinal alignment.

Methods.

Retrospective review of consecutive primary ASD cases that underwent deformity correction in the same institution over a 5-year period. Association between the 6-week postoperative spinal alignment classification and occurrence of mechanical complications on the last follow-up was assessed using logistic regressions. The discriminant capacity was assessed using the receiver operating characteristic (ROC) curve analysis.

Results.

58.3% (N = 49/84) of patients presented with mechanical complications and 32.1% (N = 27/84) underwent revision surgery. GAP score did not show discriminant ability to predict complications (AUC = 0.53, 95% confidence interval [CI] = 0.40–0.66, P = 0.58). Conversely, the SRS-Schwab sagittal modifier score demonstrated a statistically significant (although modest) predictive value for mechanical complications (AUC = 0.67, 95% CI = 0.54–0.79, P = 0.008). There was a significant association between pelvic tilt (PT) (P = 0.03) and sagittal vertical axis (SVA) (P = 0.01) at 6 weeks postoperatively and the occurrence of later mechanical complications. There was no significant association between matched Roussouly theoretical apex of lordosis and final outcome (P = 0.47).

Conclusion.

The results point to the complexity of mechanical failure and the high likelihood that causative factors are multifactorial and not limited to alignment measures. GAP score should be used with caution as it may not explain or predict mechanical failure based on alignment in all populations as originally expected. Future studies should focus on etiology, surgical technique, and patient factors in order to generate a more universal score that can be applied to all populations.

Level of Evidence: 4
Treatment Effect and Pain During Treatment With Intense Pulsed-Light Therapy According to the Light Guide in Patients With Meibomian Gland Dysfunction
Authors: Min Ji Sang , Yoon Sook Hyun , Kim Kang Yoon , Jun Ikhyun , Kim Eung Kweon , Kim Tae-im , Seo Kyoung Yul
Published: September 2021

Purpose:

We investigated whether there is a difference in the treatment effect and pain during the treatment of meibomian gland dysfunction (MGD) with intense pulsed-light (IPL) between new light guide and conventional light guide.

Methods:

We retrospectively reviewed medical records of 85 patients (170 eyes) who underwent IPL treatment of the upper and lower eyelids 3 times, at 3-week intervals, for MGD. Patients treated with the 6-mm or 8 × 15-mm cylindrical light guide were designated as group A or group B, respectively. The ocular surface disease index (OSDI), dry eye (DE), and MGD parameters were obtained before the first and after the third IPL treatments. Visual analog scale (VAS) scores were obtained at every IPL treatment. OSDI, DE, and MGD parameters and VAS scores were compared between the groups.

Results:

VAS scores at the first, second, and third IPL treatments were lower in group A than in group B. OSDI, DE, and MGD parameters were improved after 3 IPL treatments in both groups. There were no significant differences in OSDI, DE symptoms, and MGD parameters between before the first IPL treatment and after the third IPL treatment between the groups.

Conclusions:

Using the new 6-mm cylindrical light guide for IPL treatment in patients with MGD induced less pain during treatment and had similar treatment effects to the conventional 8 × 15-mm light guide. The new 6-mm cylindrical light guide can be useful when treating patients with dark or hyperpigmented skin and for pediatric patients with low compliance.
Systematic Review of Smartphone Apps as a mHealth Intervention to Address Substance Abuse in Adolescents and Adults
Authors: Kazemi Donna M. , Li Shaoyu , Levine Maureen J. , Auten Beth , Granson Matthew
Published: September 2021

Background

Substance abuse represents a foremost national concern for adolescents and adults; investigators have implemented a variety of interventions, delivered with both in-person and mobile-based apps' modalities. The electronic techniques could be more effective because they avoid the cost, privacy, and accessibility issues associated with in-person intervention. To address this issue, a systematic review of the scientific evidence relative to the efficacy of app-based interventions delivered by mobile devices (smartphones) to reduce substance abuse in adolescents and adults was carried out.

Methods

To identify relevant studies published from 2005 to 2019, a comprehensive search was conducted. Databases that were searched include CINAHL, Cochrane CENTRAL, Embase, PsycINFO, PubMed, and Web of Science. Keywords and relevant controlled vocabulary terms related to substance abuse and technology were included. Studies were included if they had examined reductions in substance abuse and problem behaviors as a primary outcome with app-based interventions delivered to adolescents and adults.

Results

The initial search yielded 21,641 articles, duplicates were removed, and 14,797 citations remained; title/abstract screening yielded 190 full-text articles. One hundred seventy-three were excluded because they did not meet the inclusion criteria, leaving 17 final articles to be analyzed in this review. Use of app-based interventions showed some evidence of effectiveness in reducing substance abuse in the adolescent adult population.

Conclusion

Most intervention studies analyzed focused on alcohol reduction. Further research is needed on diverse substance abuse utilizing larger sample sizes, longitudinal studies, and theoretical foundations on the practice of delivering interventions using mobile-based apps.
A 28-Day Challenge to Help Quit Smoking Using Telephone Follow-Ups Combined With the WeChat App
Authors: Zhang Sisi , Ding Qian , Shen Jun , Qu Heming , Meng Xiaoping
Published: September 2021

The study aims to assess the effectiveness of telephone follow-ups combined with a smartphone app (e.g., WeChat [Tencent], which is one of the most widely used communication apps in China), as a smoking cessation intervention. Social volunteers were recruited on March 1, 2017, and randomized to supervision groups with five participants in each group. Every day, the specialists shared some information related to smoking cessation including the videos, songs, and scientific knowledge in WeChat groups and conducted telephone follow-ups on the third, fifth, seventh, ninth, 12th, 17th, 22nd, 27th, and 30th day in March and on April 1. Ultimately, a comparison was made of the self-reported smoking abstinence and self-reported average number of cigarettes smoked between the participants. One hundred ten volunteers participated in the study, with 105 who completed follow-up. Self-reported smoking abstinence in the past 7 days occurred in 65.7% of the participants (n = 69) compared with 34.3% (n = 36) in whom smoking abstinence did not occur. The mean age of those who failed was 40.15 years (range: 22–70 years), and 55.5% (n = 20) attributed their failure to personal reasons. However, the self-reported average number of cigarettes smoked every day was less than that before the study (on average, 10.34 ± 8.17 per day), and this difference was statistically significant (95% CI [8.312, 12.364], p < .01). It was effective to deliver a telephone follow-up combined with a smartphone app follow-up as an intervention for smoking cessation.
How Total Performance Scores of Medicare Value-Based Purchasing Program Hospitals Change Over Time
Authors: Ramirez Adriana G. , Marsh Katherine M. , McMurry Timothy L. , Turrentine Florence E. , Tracci Margaret A. , Jones Rayford S.
Published: September 2021

Background and Purpose:

The Medicare Value-Based Purchasing (VBP) program established performance-based financial incentives for hospitals. We hypothesized that total performance scores (TPS) would vary by hospital type.

Methods:

Value-Based Purchasing reports were collected from 2015 to 2017 and merged with the Centers for Medicare and Medicaid Services (CMS) Impact File data. A total of 3,005 hospitals were grouped into physician-owned surgical hospitals (POSH), accountable care organizations (ACO), Kaiser, Vizient, and General hospitals. Longitudinal linear mixed-effects models compared temporal differences of TPS and secondary composite outcome, process, patient satisfaction, safety, and cost efficiency measures between hospital types.

Results:

Total performance scores decreased across all hospital types (p < .001). Physician-owned surgical hospitals had the highest TPS (59.9), followed by Kaiser (49.2), ACO (36.7), General (34.8), and Vizient (30.7) (p < .001). Hospital types differed significantly in size, geography, mean case-mix index, Medicare patient discharges, percent Medicare days to inpatient days, Disproportionate Share Hospital payments, and uncompensated care per claim. Scores improved in 84% of POSH and 14.6% of Kaiser hospitals using score reallocations.

Conclusion:

In comparison with General hospitals, the TPS was higher for POSH and Kaiser and lower for Vizient in part due to weighting reallocation and individual domain scores.

Implications:

Centers for Medicare and Medicaid Services scoring system changes have not addressed the methodological biases favoring certain hospital types.
Preventing Postoperative Opioid-Induced Respiratory Depression Through Implementation of an Enhanced Monitoring Program
Authors: Kozub Elizabeth , Uttermark Anne , Skoog Richard , Dickey William
Published: September 2021

Background:

Opioid-induced respiratory depression (OIRD) is a serious complication that can lead to negative outcomes. There are known risk factors for OIRD; however, a lack of national guidelines for the prevention and early detection of OIRD exists.

Methods:

An evidence-based practice study was conducted to create an enhanced monitoring (EM) program. The EM program consisted of risk stratification of surgical spine patients, including the use of STOP-BANG screening for obstructive sleep apnea, capnography monitoring, use of home positive airway pressure therapy, capnography alarm optimization, hospitalist consultation, nursing education, and patient education.

Results:

Approximately 17% (N = 937/5,462) of surgical spine patients were enrolled in the EM program. Fifty-six percent of EM patients were monitored with capnography and had out of range end-tidal carbon dioxide levels 17% of the time. The rate of transfers to the intensive care unit (ICU) for OIRD decreased, though not statistically significant (p = .151).

Conclusions:

The EM program with risk stratification was found to reduce transfers to the ICU for OIRD. Although not statistically significant, the decreased number of transfers was clinically significant. Engagement of the interprofessional team and capnography alarm parameter optimization helped to reduce nonactionable alarms.
Associations Between Work-Zone Groups and Compensation Claims: Experience From a Poultry Meat Processing Plant
Authors: Donovan Michael , Khan Asaduzzaman , Johnston Venerina
Published: September 2021

Objective:

At a poultry meat processing plant, work-zone group was an influencing factor upon an intervention program aimed at reducing musculoskeletal disorders (MSD), and also upon safety climate and disability management practices. This study aimed to explore if compensation claim outcomes also differed across work-zones in this plant.

Methods:

De-identified workers’ compensation claims data from the processor were categorized according to three main work-zones (kill, process, and despatch). Multivariable generalized linear modeling explored the compensation claims costs across these work-zones, adjusted for age, shift, and claim type.

Results:

For MSDs, costs per claim were 3.5 times lower in the kill-zone compared to the despatch-zone. Shift worked and claim type were significant covariates in the modeling.

Conclusion:

Organizations should prioritize interventions within work-zones with poorer compensation outcomes and consider the association of organizational microclimates upon these claims.
Management of Cardiometabolic Complications in Patients With Nonalcoholic Fatty Liver Disease
Authors: Dennis Brittany B. , Sallam Sandy , Perumpail Brandon J. , Shah Neha D. , Kim Donghee , Cholankeril George , Ahmed Aijaz
Published: September 2021

Nonalcoholic fatty liver disease (NAFLD) comprises a spectrum of liver conditions characterized by significant lipid deposition within hepatocytes. As an overarching diagnosis, NAFLD contains a continuum of progressive liver diseases ranging from isolated liver steatosis to necroinflammatory states leading to end-stage liver disease. Nonalcoholic fatty liver and nonalcoholic steatohepatitis are distinguished by their histologic patterns, with the former exhibiting steatosis without fibrosis or inflammation. This important distinction provides clinicians a timeline within the NAFLD staging to target appropriate interventions against modifiable risk factors. NAFLD is likely formed in response to metabolic imbalances that damage the livers adaptive capacity. Metabolic conditions leading to steatosis mirror common cardiovascular risk factors, including dyslipidemia, diabetes mellitus, and obesity. Acknowledging the common risk factors for development and progression of NAFLD, it is unsurprising the first-line management focuses on the treatment of metabolic syndrome with an emphasis on weight reduction in obese populations. The purpose of this review is to provide a detailed summary of the literature as well as outline the current treatment recommendations for patients with NAFLD with a detailed focus on pharmacologic antiobesity interventions.
Decision-Making Involvement, Self-Efficacy, and Transition Readiness in Youth With Sickle Cell Disease
Authors: Varty Maureen , Speller-Brown Barbara , Wakefield Bonnie J. , Ravert Russell D. , Kelly Katherine Patterson , Popejoy Lori L.
Published: September 2021

Background

Transition to adult healthcare is a critical time for adolescents and young adults (AYAs) with sickle cell disease, and preparation for transition is important to reducing morbidity and mortality risks associated with transition.

Objective

We explored the relationships between decision-making involvement, self-efficacy, healthcare responsibility, and overall transition readiness in AYAs with sickle cell disease prior to transition.

Methods

This cross-sectional, correlational study was conducted with 50 family caregivers–AYAs dyads receiving care from a large comprehensive sickle cell clinic between October 2019 and February 2020. Participants completed the Decision-Making Involvement Scale, the Sickle Cell Self-Efficacy Scale, and the Readiness to Transition Questionnaire. Multiple linear regression was used to assess the relationships between decision-making involvement, self-efficacy, healthcare responsibility, and overall transition readiness in AYAs with sickle cell disease prior to transition to adult healthcare.

Results

Whereas higher levels of expressive behaviors, such as sharing opinions and ideas in decision-making, were associated with higher levels of AYA healthcare responsibility, those behaviors were inversely associated with feelings of overall transition readiness. Self-efficacy was positively associated with overall transition readiness but inversely related to AYA healthcare responsibility. Parent involvement was negatively associated with AYA healthcare responsibility and overall transition readiness.

Discussion

While increasing AYAs’ decision-making involvement may improve AYAs’ healthcare responsibility, it may not reduce barriers of feeling unprepared for the transition to adult healthcare. Facilitating active AYA involvement in decision-making regarding disease management, increasing self-efficacy, and safely reducing parent involvement may positively influence their confidence and capacity for self-management.