bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fines Imposed for Substantive Infringements of Articles 101 and 102 TFEU
Authors: Garrido Tatiana López , Papanikolaou Alexandros 
Published: June 2020

Abstract
This chapter details the methodology of setting fines for substantive infringements under the Fining Guidelines and describes various adjustment factors that may apply in a particular case. Article 23(2)(a) of Regulation 1/2003 empowers the European Commission to adopt decisions imposing monetary fines on undertakings or associations of undertakings having committed infringements of Article 101 or 102 TFEU, either intentionally or by negligence. However, Regulation 1/2003 does not contain detailed prescriptive provisions relating to how the Commission must assess and impose fines. Hence, the Regulation grants the Commission a wide margin of discretion in relation to the imposition of fines for substantive infringements of the competition rules. The Commission follows a two-step method for setting fines. First, a ‘basic amount’ is calculated for each undertaking or association of undertakings by reference to the value of sales and the duration. Second, the basic amount is adjusted upwards or downwards based on various factors.
Infringements of the Antitrust Rules by the EU Member States
Authors: Mamdaniová Eliška 
Published: June 2020

Abstract
This chapter looks at the procedure for the enforcement of antitrust rules in case of infringements by Member States. The ability of Member States to distort competition has been accordingly reflected in the EU legal system. Member States are subject to a specific obligation to respect the provisions of the Treaty under Article 106 TFEU; they are obliged to adhere to the principle of sincere cooperation as reflected in Article 4(3) TEU; and any support to companies they wish to grant is subject to state aid control. Furthermore, the general infringement procedure pursuant to Article 258 TFEU can be used to hold a Member State liable for any breach of the Treaty rules. The chapter deals with procedural rules relating to the former two forms of state behaviour captured by Article 106 TFEU and Article 4(3) TFEU—in conjunction with Articles 101 or 102 TFEU.
Cooperation Between the Commission and the Courts of the EU Member States
Authors: Holzwarth Johannes 
Published: June 2020

Abstract
This chapter explores the cooperation between the European Commission and Member States’ courts that apply Articles 101 and 102 TFEU. The risk of inconsistent interpretations of EU competition rules renders cooperation between the Commission and Member State courts crucial, particularly due to the role that such courts play when it comes to the effective enforcement of Articles 101 and 102 TFEU at the national level: in the era of decentralisation, it is the national courts that will ultimately be called upon to apply Articles 101 and 102 TFEU either directly, or when reviewing national authorities’ decisions based on those provisions. The central role that the Commission retains for the enforcement of EU competition law means that it has a particularly strong interest in ensuring effective cooperation with national courts. Moreover, the importance of cooperation between the Commission and Member State courts is further increasing due to the rise of private enforcement. This type of enforcement is generally associated with civil actions and damages awarded by national courts or tribunals.
International Cooperation
Authors: Smijter Eddy De , Gasparon Philipp , Berghe Pascal 
Published: June 2020

Abstract
This chapter studies the cooperation between the European Commission and competition authorities and courts outside the EU, at both bilateral and multilateral level, and highlights the importance of that cooperation in the context of proliferation of competition regimes and the continual increase in cross-border business activities. In more than half of its enforcement activities, the Commission cooperates with one or more foreign jurisdictions, obviously with varying degrees of intensity. The bulk of this international cooperation, in the fields of both merger control and anticompetitive practices, is with the U.S. and the Canadian competition authorities. The chapter then sets out the legal framework for international cooperation and explains the principles determining the Commission’s jurisdiction in cases having an international dimension. It also considers cooperation in antitrust enforcement, with particular attention given to the exchange of information and disclosure of evidence.
Embedded Mental Health in the United States Marine Corps
Authors: Pierce Katherine E , Broderick David , Johnston Scott , Holloway Kathryn J 
Published: June 2020

Abstract

Introduction
Despite the rich history and progression of mental health assets and their utilization within the Marine Corps, the implementation of these assets has been varied and inconsistent. This article strives to take the lessons learned from the past and improve on them. The goal is to develop a consistent program focused on resiliency and retention, and propose an integrated organized structure across all the Marine Expeditionary Forces (MEF).

Means and Methods
Review of the literature, current practices, and future recommendations.

Results
This article demonstrates that continuing to utilize mental health resources at the Regimental level with a focus on community mental health principles rather than the medical model allows for proximity to members and leadership of their primary command, immediate access to them as their Special Staff Officer, the ability to set the expectation of recovery, resiliency, and readiness, and the capability to implement simple principles of nonmedical recuperation and advisement.

Conclusions
Improving on the organizational structure of mental health in the Marine Corps by placing a mental health Special Staff Officer at the MEF level and focusing on the principles of community mental health will shift the focus back to the primary and secondary prevention care efforts across all levels of the Marine Corps and provide clinical and leadership oversight as it relates to the philosophy, role, and implementation of organic mental health Officers.
Impact of Risk Adjustment Using Clinical vs Administrative Data on Hospital Sepsis Mortality Comparisons
Authors: Rhee Chanu , Li Zhonghe , Wang Rui , Song Yue , Kadri Sameer S , Septimus Edward J , Chen Huai-Chun , Fram David , Jin Robert , Poland Russell , Sands Kenneth , Klompas Michael 
Published: June 2020

Abstract

Background
A reliable risk-adjusted sepsis outcome measure could complement current national process metrics by identifying outlier hospitals and catalyzing additional improvements in care. However, it is unclear whether integrating clinical data into risk adjustment models identifies similar high- and low-performing hospitals compared with administrative data alone, which are simpler to acquire and analyze.

Methods
We ranked 200 US hospitals by their Centers for Disease Control and Prevention Adult Sepsis Event (ASE) mortality rates and assessed how rankings changed after applying (1) an administrative risk adjustment model incorporating demographics, comorbidities, and codes for severe illness and (2) an integrated clinical and administrative model replacing severity-of-illness codes with laboratory results, vasopressors, and mechanical ventilation. We assessed agreement between hospitals’ risk-adjusted ASE mortality rates when ranked into quartiles using weighted kappa statistics (к).

Results
The cohort included 4 009 631 hospitalizations, of which 245 808 met ASE criteria. Risk-adjustment had a large effect on rankings: 22/50 hospitals (44%) in the worst quartile using crude mortality rates shifted into better quartiles after administrative risk adjustment, and a further 21/50 (42%) of hospitals in the worst quartile using administrative risk adjustment shifted to better quartiles after incorporating clinical data. Conversely, 14/50 (28%) hospitals in the best quartile using administrative risk adjustment shifted to worse quartiles with clinical data. Overall agreement between hospital quartile rankings when risk-adjusted using administrative vs clinical data was moderate (к = 0.55).

Conclusions
Incorporating clinical data into risk adjustment substantially changes rankings of hospitals’ sepsis mortality rates compared with using administrative data alone. Comprehensive risk adjustment using both administrative and clinical data is necessary before comparing hospitals by sepsis mortality rates.
Illustrated Guide to the Transradial Approach for Neuroendovascular Surgery: A Step-by-Step Description Gleaned From Over 500 Cases at an Early Adopter Single Center
Authors: Sattur Mithun G , Almallouhi Eyad , Lena Jonathan R , Spiotta Alejandro M 
Published: June 2020

Abstract

BACKGROUND
Traditionally, neuroangiography for diagnosis and therapy has been achieved via the transfemoral route. Femoral access, however, has been associated with catastrophic complications. Although transradial access (TRA) has been adopted late by the field of neuroendovascular surgery, several groups have recently demonstrated a dramatically safe and rapid learning curve with a radial-first approach. However, there is a need for a detailed illustrative approach on the transradial technique.

OBJECTIVE
To provide a detailed description of the operative technique with step-by-step illustrations derived from our single center series of 506 cases, as an early adopter.

METHODS
A step-by-step illustrated approach to our technique of transradial angiography is provided, based on our clinical experience of an early radial-first approach. Prospective review of patients undergoing transradial angiography and interventions from April 1 to November 30, 2019, at our institution was performed. We included all cases that received radial-first arterial access for diagnostic and interventional neuroangiography. Efficacy, complications, catheter use, and radiation metrics of TRA for the entire cohort were noted. The radial approach was described in 4 stages beginning from the wrist (Stage I) and ending with distal access to target vessel of interest (Stage IV).

RESULTS
A total of 506 patients underwent TRA over the 7-mo period. Procedural success was achieved in 92.3% of patients (93.7% for diagnostic and 88.5% for interventional). Crossover to the femoral route occurred in 33 (6.5%) cases (25 diagnostic and 8 interventional). The majority occurred in Stage I. No major complications were noted.

CONCLUSION
Our preferred technique for the transradial approach provides excellent safety and efficacy in performing diagnostic and interventional neuroangiography. The illustrated technical steps are expected to provide guidance for early adopters of TRA.
Double-Barrel Superficial Temporal Artery-M2 Middle Cerebral Artery Bypass and Creation of a Middle Communicating Artery via M2-M2 End-to-End Reimplantation for Trapping of a Dolichoectatic Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video
Authors: Catapano Joshua S , Frisoli Fabio A , Cadigan Megan S , Farhadi Dara S , Nguyen Candice L , Lawton Michael T 
Published: June 2020

Abstract
Large dolichoectatic aneurysms of middle cerebral artery (MCA) trifurcations are rare and often require trapping and revascularization of the region with a bypass.
1-9
This video describes the treatment of an MCA trifurcation aneurysm by clip trapping and double-barrel superficial temporal artery (STA) to M2-MCA bypass followed by M2-M2 end-to-end reimplantation to create a middle communicating artery (MCoA). The patient, a 60-yr-old woman, presented with headache, a history of smoking, and a family history of ruptured aneurysms. Angiography demonstrated a 1.7-cm dolichoectatic aneurysm of the MCA trifurcation. While the natural history of these lesions is unclear, the aneurysm size and family history of aneurysmal subarachnoid hemorrhage were factors in proceeding with treatment. Informed written consent was obtained from the patient and her family.
The STA branches were harvested microsurgically, a pterional craniotomy was performed, and the aneurysm was exposed through a transsylvian approach. The two STA branches were anastomosed end-to-side to the middle and inferior trunks of the MCA. Due to the significant mismatch between the donor and recipient vessel calibers, we were concerned that the donors might provide insufficient flow in isolation. Therefore, we decided to transect both M2 trunks from the aneurysm, proximal to the inflow of the bypass, and reimplant them end-to-end. This reimplantation created an MCoA, allowing the two donor arteries to supply the new communication between the inferior and middle trunks, redistributing blood flow through the MCoA according to cerebral demand.
Bypass patency and aneurysm obliteration were confirmed on postoperative angiography. At the 6-mo follow-up, the patient's modified Rankin Scale (mRS) score was 0. The MCoA is a novel construct that, like natural communicating arteries, redistributes flow in response to shifting demand, without the need for additional ischemia time during the bypass. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Politics and Youth in the 1980s
Authors: Bridger Emily 
Published: June 2020

Abstract
As popular resistance against apartheid swelled in many townships during the mid-1980s, it was the country’s youth who rose to the forefront of the struggle, engaging in both nonviolent resistance and militant confrontation with the apartheid state. Initial academic work on South African youth politics sought to document their centrality to the liberation movement and counter state-sponsored stereotypes of them as destructive and violent. Research stressed that the youth were not a monolithic “lost generation” but an incredibly diverse group, who included everyone from precocious activists to opportunist criminals. Today, the youth of South Africa’s past have once again become a key topic of academic inquiry, as many of the structural condition [stet] that led to the youth uprising of the 1980s, such as unemployment, poor-quality education, and high rates of violent crime, did not disappear with the end of apartheid and continue to inflame contemporary politics. Yet our understanding of the youth of the 1980s remains incomplete, particularly when it comes to their involvement in violence, gender, and female youth, and those who were not involved in the liberation struggle.
Key considerations for designing capacity-building interventions to support evidence-based programming in underserved communities: a qualitative exploration
Authors: Ramanadhan Shoba , Galbraith-Gyan Kayoll , Revette Anna , Foti Alisa , Rackard James Charlotte , Martinez-Dominguez Vilma , Miller Elecia , Tappin Jamiah , Tracy Natalicia , Bruff Carmenza , Donaldson S Tiffany , Minsky Sara , Sempasa Doris , Siqueira Carlos , Viswanath Kasisomayajula 
Published: June 2020

Abstract
Increasing the use of evidence-based programs (EBPs) in community settings is critical for improving health and reducing disparities. Community-based organizations (CBOs) and faith-based organizations (FBOs) have tremendous reach and trust within underserved communities, but their impact is constrained by limited staff capacity to use EBPs. This exploratory study sought to identify design and delivery considerations that could increase the impact of capacity-building interventions for CBOs and FBOs working with underserved communities. Data come from a community-based participatory research project addressing cancer disparities in Black, Latino, and Brazilian communities from Greater Boston and Greater Lawrence, Massachusetts. We conducted four focus group discussions with program coordinators in CBOs and FBOs (n = 27) and key informant interviews with CBO and FBO leaders (n = 15). Three researchers analyzed the data using a multi-stage coding process that included both prefigured and emergent codes. Key design considerations included embedding customized capacity-building interventions into community networks with local experts, supporting ongoing engagement with the intervention via a range of resources and communication channels, and addressing resource constraints. Regarding the contextual factors that should influence capacity-building intervention content, participants highlighted resource constraints, environments in which EBP use is not the norm, and challenges linking available programs with the multi-level barriers to good health faced by community members. Overall, the study highlights the need for integrated, long-term capacity-building efforts developed in partnership with, and ultimately sustained by, local organizations.
Hope After TBI Begins with Rehabilitation
Authors: Armstrong Tiffany , Murtaugh Brooke M. 
Published: June 2020

ABSTRACT:
Traumatic brain injury (TBI) is one of the leading causes of long-term disability in the United States. Persons with TBI can experience numerous alterations in functional status, self-care ability, and cognitive, emotional, and social functioning. Understanding TBI features, treatment, and rehabilitation is imperative for nurses in every setting. Trauma, intensive and acute care, and rehabilitation nurses are an essential part of the interprofessional team that promotes optimum outcomes through specific interventions to foster hope for TBI patients and families.
Incidence and Risk Factors for Delirium in Older Patients Following Intensive Care Unit Admission: A Prospective Observational Study
Authors: LI Xiao , ZHANG Lina , GONG Fang , AI Yuhang 
Published: June 2020

ABSTRACT

Background
Both high prevalence and incidence rates of delirium occur frequently among patients aged 65 years or older in intensive care units (ICUs) and are accompanied by adverse outcomes. Because of lack of nursing staff resources and imperfect humanistic care, delirium is easily overlooked by both physicians and nurses in the ICU in Mainland China.

Purpose
This study aimed to explore the incidence rate of delirium and to determine the risk factors among critically ill older patients.

Methods
A prospective observational study was conducted on patients aged 65 years and older who were admitted consecutively to two ICUs of a university-affiliated hospital in China. The Confusion Assessment Method for the Intensive Care Unit and the Richmond Agitation–Sedation Scale were used to assess delirium status twice daily. Patient demographic, laboratory, medical, therapeutic, and prognostic data were collected.

Results
One hundred fifteen patients were included as participants, with a median age of 70 years (range 65–93 years). Seventy-six (66.1%) patients presented with delirium. Half of the sample had a hypoactive subtype. Patients who developed delirium had a longer mean length of ICU stay, greater chance of physical restraints use, greater use of fentanyl, and poorer sleep quality. A logistic regression analysis revealed that poor sleep quality (OR = 10.74, 95% CI [1.59, 72.47]) and physical restraints (OR = 13.04, 95% CI [1.57, 107.94]) were significantly associated with delirium.

Conclusions/Implications for Practice
Delirium is a common aggravation in older patients following ICU admission. The factors found in this study to be independently associated with delirium include poor sleep quality and physical restraints. Both critical care physicians and nurses should pay greater attention to the quality of the ICU stay experienced by their older patients.
Low glutamate dehydrogenase levels are associated with colonization in Clostridium difficile PCR-only positive patients with inflammatory bowel disease
Authors: Desai Meeta , Knight Kristin , Gray James M. , Nguyen Vu , Boone James , Sorrentino Dario 
Published: June 2020

Background/aims

Clostridioides difficile infection (CDI) remains a diagnostic challenge in patients with inflammatory bowel disease (IBD). We tested novel biomarkers to differentiate CDI from colonization in patients without (CDI-only) and with IBD (IBD-CDI).

Methods
Samples were enzyme immunoassay (EIA)-tested for glutamate dehydrogenase (GDH) and toxin, followed by reflex PCR. Quantitative GDH [(qGDH) – a novel indicator of Clostridium difficile load] and stool lactoferrin were tested at days 0, 3 and 10 during antibiotic treatment. Samples were also analyzed for toxin B cytotoxicity neutralization assay (CNA) and toxigenic culture, gold standards to detect free toxin and virulent bacteria, respectively.

Results
Forty-five symptomatic patients (28 CDI-only, 13 with Crohn’s disease, 4 with ulcerative colitis) were recruited with 3 sequential samples available for 36 (21 CDI-only, 15 IBD-CDI). Thirty-nine of 45 (87%) cases were toxigenic culture-positive. In the CDI-only group, 78.6% were positive for EIA-toxin, 21.4% were PCR-positive while 82.1% were CNA-positive. In the IBD-CDI group, only one patient (6%) was EIA-toxin positive and 17.6% CNA-positive. The median qGDH level at day 0 was higher in CNA-positive patients compared to CNA-negative patients (1111 vs. 146 ng/g, P = 0.004) and dropped together with lactoferrin from day 0 to 10. CDI eradication improved symptoms in 72.2% of patients with CDI-only. In 60% of patients with IBD-CDI, eradication was ineffective, with symptoms improving in 89% of them after IBD therapy intensification.

Conclusion
In patients with IBD-CDI, PCR-only positivity might mainly reflect colonization rather than disease. C. difficile load by qGDH correlates with CNA-detected toxin and together with stool lactoferrin might differentiate CDI from colonization in patients with IBD.
Freeze-dried microspheres for selective intra-arterial radionuclide therapy: an affordable solution
Authors: Shukla Jaya , Kalra Naveen , Mittal Bhagwant Rai , Duseja Ajay , Kumar Rajender , Singh Harmandeep , Chaluvashetty Sreedhara Bettadahally , Parmar Madan , Krishnan Swathy , Kumar Ganesh , Vatsa Rakhee , Chhabra Anupriya , Bansal Kavita , Rathore Yogesh , Pandey Somit 
Published: June 2020

Objective
Selective intra-arterial radionuclide therapy (SIRT) using radiolabelled microspheres is for the delivery of therapeutic radioisotope to liver cancers and thus, sparing healthy liver. Several radiolabelled microspheres are commercially available. The main issue associated with these microspheres is affordability. Re-188 is a generator produced radionuclide, emits high energy therapeutic beta particle and imageable gamma photons for pre- and post-therapy dosimetry.

Methods
Tc-99m/Re-188 labelled microspheres have been developed and quality control tests have been performed for suitable clinical use. The clinical studies with Re-188 microspheres for SIRT have been performed. Post-therapy images were acquired for dosimetry.

Results
The microspheres were found to possess spherical morphology of less than 20 µm size. The quality control revealed the suitability of microspheres for intravenous administration. The preliminary studies in thirty patients demonstrated good retention in tumor and high tumor to normal liver ratio. Re-188 microspheres were well tolerated by patients. Same microspheres labelled with either Tc-99m or Re-188 were used for pretherapy dosimetry and Re-188 labeled microspheres for therapy (SIRT) as a single-day procedure.

Conclusion
The freeze-dried microspheres may emerge as highly cost-effective candidates for both pre-therapy dosimetry and SIRT and may benefit a large population with inoperable liver cancer.