bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regulation of the Legal Profession in China: A Historical Overview
Authors: Ohnesorge John 
Published: September 2023

Abstract
Understanding a legal system requires understanding of its legal service providers. The Chinese legal system has undergone major transformations since the late nineteenth century, and a series of approaches to regulating China’s lawyers has accompanied those transformations. This article offers a historical overview of those approaches, discussing the regulation of the Chinese legal profession and the foreign lawyers operating in the Chinese environment. The Chinese legal profession has never achieved significant self-regulation or autonomy from the state, and, during the Mao era (1949–1976) it was nearly obliterated. In the late 1970s, China began to rehabilitate its legal profession and create a space in which foreign law firms can operate legally. To a remarkable degree, that effort succeeded: Chinese law firms now operate around the world, and many major international firms operate successfully in China. In the first decade of the twenty-first century, there were signs that China’s leaders were willing to allow the legal system more autonomy and that part of that would comprise liberalizing the regulation of the legal profession. Instead, under Xi Jinping (China’s leader since 2012), political control over the Chinese legal profession has tightened, and foreign firms face new regulations that make it increasingly difficult for them to operate successfully. Going forward, Chinese firms might be supported to the extent they further the Xi regime’s economic aspirations, but they will be subject to closer oversight by the Chinese Communist Party. Foreign firms are no longer considered necessary for China’s economic rise, and they will be able to remain in China only if they are willing to abide by significant new restrictions.
Subseasonal Predictability of Early and Late Summer Rainfall over East Asia
Authors: Li Xiaojing 
Published: September 2023

Abstract
Considering the significant differences in the rainfall characteristics over East Asia between the early [May–June (MJ)] and late [July–August (JA)] summer, this study investigates the subseasonal predictability of the rainfall over East Asia in early and late summer, respectively. Distinctions are obvious for both the spatial distribution of the prediction skill and the most predictable patterns, that is, the leading pattern of the average predictable time (APT1) between the MJ and JA rainfall. Further analysis found that the distinct APT1s of MJ and JA rainfall are attributable to their different predictability sources. The predictability of the MJ rainfall APT1 is mainly from the boreal intraseasonal oscillation signal, whereas that of the JA rainfall APT1 is provided by the Pacific–Japan teleconnection pattern. This study sheds light on the temporal variation of predictability sources of summer precipitation over East Asia, offering a possibility to improve the summer precipitation prediction skill over East Asia through separate predictions for early and late summer, respectively.
Predictors of postpartum depression and its association with sleep quality among mothers in Qassim, Saudi Arabia: A descriptive cross-sectional study
Authors: Aljhani Sumayah A , Almeshal Razan A , Almeshal Emtenan A , Alofea Alhanuf M , Alenizi Adim S 
Published: September 2023

Objective This cross-sectional study aims to examine the prevalence of postpartum depression (PPD) and sleep problems, their relationship, and the characteristics associated with depression/insomnia in Qassim, Saudi Arabia. Methods An online survey was administered to a convenience sample of 395 mothers who had given birth within the preceding year. The survey comprised demographic characteristics, pregnancy and childbirth characteristics, depression (via the Edinburgh Postnatal Depression Scale; EPDS), and sleep quality (via the Pittsburgh Sleep Quality Index; PSQI). Results Nearly two-thirds of respondents (62.3%) had PPD, while 92.2% experienced poor sleep quality. Both scales demonstrated a statistically significant positive correlation. Participants with previous PPD, peripartum depression, a personal or family history of other depression, those bottle-feeding their infants, or who had a change in sleep pattern scored significantly higher on the EPDS and had poorer PSQI scores. Respondents with a history of mental illness, pregnancy or delivery complications, those who lacked support, or gave birth to unhealthy newborns also had significantly higher EPDS scores. Conclusions PPD and poor sleep quality were highly prevalent among mothers living in the Qassim region of Saudi Arabia. Not surprisingly, PPD was strongly correlated with poor sleep quality. Postpartum counseling for mothers during the first year after delivery is necessary to decrease the risk of developing depressive symptoms and poor sleep quality. Screening for sleep-related difficulties and depression in prenatal and postnatal programs may help prevent the development of depressive disorder among postpartum women in this region of Saudi Arabia (or other areas of the Middle East).
A Prospective Cohort Study of Medical Decision-Making Roles and Their Associations with Patient Characteristics and Patient-Reported Outcomes among Patients with Heart Failure
Authors: Ozdemir Semra , Lee Jia Jia , Yeo Khung Keong , Sim Kheng Leng David , Finkelstein Eric Andrew , Malhotra Chetna 
Published: September 2023

Objective Among patients with heart failure (HF), we examined 1) the evolution of patient involvement in decision making over 2 y, 2) the association of patient characteristics with decision-making roles, and 3) the association of decision-making roles with distress, spiritual well-being, and quality of physician communication. Methods We administered the survey every 4 mo over 24 mo to patients with New York Heart Association class 3/4 symptoms recruited from inpatient clinics. The decision-making roles were categorized as no patient involvement, physician/family-led, joint (with family and/or physicians), patient-led, or patient-alone decision making. The associations between patient characteristics and decision-making roles were assessed using a mixed-effects ordered logistic regression, whereas those between patient outcomes and decision-making roles were investigated using mixed-effects linear regressions. Results Of the 557 patients invited, 251 participated in the study. The most common roles in decision making at baseline assessment were “no involvement” (27.53%) and “patient-alone decision making” (25.10%). The proportions of different decision-making roles did not change over 2 y ( P = 0.37). Older age (odds ratio [OR] = 0.97; P = 0.003) and being married (OR = 0.63; P = 0.035) were associated with lower involvement in decision making. Chinese ethnicity (OR = 1.91; P = 0.003), higher education (OR = 1.87; P = 0.003), awareness of terminal condition (OR = 2.00; P < 0.001), and adequate self-care confidence (OR = 1.74; P < 0.001) were associated with greater involvement. Compared with no patient involvement, joint (β = −0.58; P = 0.026) and patient-led (β = −0.59; P = 0.014) decision making were associated with lower distress, while family/physician-led (β = 4.37; P = 0.001), joint (β = 3.86; P < 0.001), patient-led (β = 3.46; P < 0.001), and patient-alone (β = 3.99; P < 0.001) decision making were associated with better spiritual well-being. Conclusion A substantial proportion of patients was not involved in decision making. Patients should be encouraged to participate in decision making since it is associated with lower distress and better spiritual well-being. Highlights The level of involvement in medical decision making did not change over time among patients with heart failure. A substantial proportion of patients were not involved in decision making throughout the 24-mo study period. Patients’ involvement in decision making varied by age, ethnicity, education level, marital status, awareness of the terminal condition, and confidence in self-care. Compared with no patient involvement in decision making, joint and patient-led decision making were associated with lower distress, and any level of patient involvement in decision making was associated with better spiritual well-being.
Cardiac Output and Stroke Volume Assessments by Transthoracic Echocardiography and Pulse index Continuous Cardiac Output Monitor in Critically ill Adult Patients: A Comparative Study
Authors: Gomes Flávia K.A. , Fagundes Antônio A. de P. , Amorim Fábio F. 
Published: September 2023

Purpose Bedside transthoracic echocardiography (TTEcho) is a noninvasive cardiac output (CO) monitoring method that has grown recently. However, there are questions regarding its accuracy compared to invasive methods. We aimed to evaluate the agreement and correlation of TTEcho and pulse index continuous CO (PiCCO) monitor measurements for CO and systolic volume (SV) in critically ill patients. Methods This prospective experimental study included consecutive adult patients who required invasive hemodynamic monitoring admitted at an intensive care unit in the Federal District, Brazil, from January/2019 to January/2021. Correlation and agreement between SV and CO measurements by PiCCO and TTEcho were performed using the Spearman correlation and the Bland–Altman analysis. Results The study enrolled 29 patients, with adequate TTEcho evaluations in all patients. There were very strong correlations between CO-TTEcho and CO-PiCCO ( r = 0.845, P < .001) and SV-TTEcho and SV-PiCCO ( r = 0.800, P < .001). TTEcho estimations for CO and SV were feasible within the limits of agreement in 96.6% (28/29) compared to PiCCO. The mean difference between CO-PiCCO and CO-TTEcho was 0.250 L/min (limits of agreement: −1.083 to 1.583 L/min, percentage error: 21.0%), and between SV-PiCCO and SV-TTEcho was 2.000 mL (limits of agreement: −16.960 to 20.960, percentage error: 24.3%). The reduced cardiac index (CI) measurements by TTEcho showed an accuracy of 89.7% (95% IC: 72.6%–97.8%) and an F1 score of 92.7% (95% IC: 75.0%–98.0%), considering the CI-PiCCO as the gold standard. Conclusion Echocardiographic measurements of CO and SV are comparable to measurements by PiCCO. These results reinforce echocardiography as a reliable tool to evaluate hemodynamics in critically ill patients.
Ethical issues in the operating room: A scoping review
Authors: Jeon Heejung , Kim Sanghee , Shon Yuha 
Published: September 2023

Background For the patients receiving care in the operating room, it emphasizes that the ethical behavior and attitude of health professionals should be aligned with patients’ basic human rights. Surgical ethics may provide an ethical alternative in a specific operating room context. However, it is unclear how actively research is being conducted in this regard. Aim This study determines the direction of future research by identifying ethical issues experienced in the operating room. Method This scoping review is based on the methodological framework suggested by Arksey and O’Malley in 2005. PubMed, CINAHL, EMBASE, WOS, Cochrane, KISS, and KMbase databases were searched from January 2012 to May 2022. Two researchers independently screened the searched articles by reviewing the titles, abstracts, and full texts. Consequently, 19 studies were selected. Findings Five categories were identified: Professional ethics, Organizational ethics, Patients’ rights, Patient safety, and Allocating resources. The derived categories covered all the same content as the International Council of Nurses’ (ICN) code of ethics, with the exception of one element, that is, global health. Conclusions This study highlights ethical issues in the operating theatre and emphasizes the need for individual and organizational strategies aligned with the ICN code of ethics. Future research should cover a wider range of issues, employ diverse perspectives and methodologies, and enhance ethical practices to improve understanding and ethical practices in the field.
Aberrant Right Subclavian Artery: Demographics, Morphological Features and Follow up CT Scans Dynamics
Authors: Shehab Maysam , Kosykh Stanislav , Wolf Ammie , Haddad Menashe , Fajer Simone , Hoffman Roetm Sivan , Bachar Adi R. 
Published: September 2023

Introduction: Aberrant right subclavian artery (ARSA) is the most common of the aortic arch anomalies, occurring in .5% to 1% of the population. There is no standardized follow up protocol, especially in the asymptomatic cases. The purpose of the present study was to evaluate the natural history of ARSA and the role of serial CT scans. Methods: This is a single-center retrospective study of patients with ARSA depicted on chest computed tomography (CT) scans between February 2013 and July 2022. Data were collected from their medical records. Measurements of the aorta at different segments including the aortic diameter at the orifice of ARSA, and ARSA at ostium followed by 1 cm intervals were collected, as well as for follow-up CT scans. Results: 65 patients were diagnosed with ARSA, 70.8% of whom were women. The average age for the cohort was 58.569 ± 16.99 years. The median follow up time was 4 years (range 0-10 years), KM estimated survival after ARSA diagnosis at 1 and 5 years as 97% and 93%, respectively. Nineteen patients had a second CT scan and were included in the morphological CT dynamic analysis, on average of 29 ± 27 months apart (range 7-108). The mean ARSA diameter at origin was larger in the second scan 16.91 ± 4.31 mm compared to the initial scan 16.31 ± 4.96 mm, ( P = .04).The mean aortic arch diameter in the first and second CT were 28.54 ± 4.24 and 29.64 ± 5.14 ( P = .10), respectively. All other measurements did not disclose any significant enlargement over time. Conclusions: Our cohort demonstrate a benign natural history of ARSA with slow growth rates. However, due to our small sample size we can’t draw a clinically sound recommendation on the need for imaging follow up, and further larger cohort with longer follow up interval are required.
The reliability of clinical tools with and without ultrasound guidance to measure leg-length inequality
Authors: Cahanin Richard , Fallavollita Andre , Burley Troy , McQuiston Samuel 
Published: September 2023

Purpose: To determine and compare the reliability and efficiency of various methods of leg-length measurement. Methods: A total of 88 leg-lengths were measured among 50 subjects (79%–84% female, mean age = 30–33 years). Leg-lengths were measured in both supine and standing positions using multiple devices, including a tape measure, a LASER distance meter, and diagnostic ultrasound. Results: All methods of leg-length measurement using the middle of the femoral head as a reference point, identified via ultrasound, demonstrated excellent reliability (intraclass correlation coefficient = 0.95–1.00). Measurements performed in supine, using the anterior superior iliac spine as a reference point, with a tape measure, demonstrated good-to-excellent reliability (intraclass correlation coefficient = 0.86–0.95, standard error of the measurement = 16.1–19.9 cm). Standing measurements using the anterior superior iliac spine as a reference point, using a tape measure, demonstrated fair-to-excellent reliability (intraclass correlation coefficient = 0.71–0.95). Conclusion: Ultrasound-guided landmark identification appear to be a more reliable method compared to palpation of the anterior superior iliac spine for measurement of leg-length using clinical tools. When coupled with ultrasound guidance, a hand-held LASER distance meter/pitch locator apparatus or a retractable tape measure appears to be acceptable alternatives to a fixed LASER distance meter on a linear actuator for leg-length measurement.
High flow nasal oxygen versus usual care in improving pulmonary rehabilitation outcomes of chronic obstructive pulmonary disease patients after an exacerbation - a pilot randomized controlled trial
Authors: Mok Yingjuan , Foong Jing Wen , Wong Hang Siang , Soh Amanda , Tan Shi Hua , Tan Poh Choo , Choo Bryan Peide , Wong Keith Keat Huat 
Published: September 2023

Introduction Early pulmonary rehabilitation (PR) is guideline-recommended for all chronic obstructive pulmonary disease (COPD) patients post-hospitalization for COPD exacerbation but many patients experience difficulties participating in early PR due to significant breathlessness. High flow nasal oxygen (HFO) has been shown to improve ventilatory efficiency in stable COPD patients, but there is little data on HFO use during exercise training in PR post-COPD exacerbation. Methods We conducted a pilot randomized controlled trial (RCT) to explore the feasibility of a prospective large-scale RCT to evaluate the impact of HFO in improving PR outcomes of COPD patients post-exacerbation. Patients recently hospitalized for COPD exacerbation were enrolled and randomized to either HFO or usual care during an early 6-weeks, outpatient PR program. Results Twenty two patients were randomized between May 2019 to Dec 2019 and 18 patients completed the study. The HFO arm achieved a greater improvement in exercise capacity than the usual care arm, with the mean difference in 6-min walk distance (6MWD) being 30 m (95% CI: −23 m to 84 m), although this was not statistically significant. All 18 patients in both arms were compliant to the pulmonary rehabilitation program (defined by attending ≥75% of exercise sessions). HFO was well tolerated with no adverse events reported. Conclusion This pilot RCT has shown preliminary evidence of the feasibility and high patient acceptability of HFO during early PR on improving exercise capacity in COPD patients post-exacerbation These promising results would justify a larger RCT to confirm HFO’s benefits and has the potential to change PR practice.
Osteosarcoma of the hyoid bone in a cat
Authors: Nakaichi Munekazu , Itamoto Takuya , Nemoto Yuki , Sunahara Hiroshi , Itoh Harumichi , Itamoto Kazuhito , Tani Kenji 
Published: September 2023

Case summary A 10-year-old male neutered Abyssinian cat was presented with the chief complaint of a right pharyngeal mass. On palpation, the mass was easily palpable; it appeared well demarcated and mobile, and oval in shape. Radiographic examination showed a radiopaque pharyngeal mass, which was revealed to be a well-demarcated mass lesion with a radiopaque marginal area on CT examination. The inside of the mass was uniformly well enhanced on contrast CT examination. A three-dimensional image reconstructed from the CT images strongly suggested that the mass originated from the right stylohyoid bone. No abnormal lesions were observed in the thoracic and abdominal CT examinations. Surgical excision of the mass was scheduled 3 weeks after the first admission. The mass was bluntly separated from the surrounding musculature and resected together with the ipsilateral epihyoid bone adjacent to the mass. Histopathological examination of the resected mass showed neoplastic cells with osteoid formation, and the mass was histopathologically diagnosed as an osteosarcoma. The postoperative recovery from anaesthesia was uneventful, and the cat began feeding on its own from the third postoperative day. The 3-month postoperative CT evaluation revealed no local recurrence or distant metastasis. The cat showed no abnormal findings at the time of writing (6 months postoperatively). Relevance and novel information Although osteosarcoma derived from the hyoid bone has rarely been reported in the veterinary field, this report suggests that such tumours may occur in cats. In addition, partial excision of the hyoid apparatus seems to be well tolerated in cats.
Automated versus manual prior authorization for diabetes mellitus drugs: A retrospective study from Israel
Authors: Moshel Shai , Klang Shmeul , Nikname Revital , Bar Shalom Katy , Albukrek Dov , Zacay Galia 
Published: September 2023

Introduction Drug prior authorization (PA) imposes a bureaucratic and economic burden on healthcare service providers and payers. A novel automated PA system may improve these drawbacks. Methods An historical cohort study from a large health maintenance organization in Israel, comparing manual versus automated PA mechanisms for diabetes mellitus (DM) drugs: sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 analogs (GLP1-A). We compared patients with DM, whose first drug applications were approved using the automated system, with similar patients whose first drug applications were approved by manual PA. The primary endpoint was the time elapsed from application approval to prescription filling (accessibility time). Secondary endpoints included the prescription filling rate at 7 and 30 days. Results In total, 1371 automated approved prescriptions and 1240 manually approved prescriptions were included in the analysis. Median accessibility time was one day (interquartile range (IQR) 0–5) with automated PA for both GLP1-A and SGLT2i, compared with four days (IQR 1–9) and three days (IQR 1–8), respectively, with the manual PA ( p < 0.001). Eighty-four percent of GLP1-A automated PA approvals were filled within seven days compared with 70% with manual PA ( p < 0.001). Similar results were seen with SGLT2i (80% vs. 72%, p < 0.008). No differences were observed at 30 days post-approval. Using logistic regression, odds for GLP1-A and SGLT2i prescription filling within seven days were 2.36 and 1.53 folds higher (respectively) with automated PA ( p < 0.01). Conclusions Automated PA system improved access time to SGLT2i/GLP1-A seven days post-approval compared to manual PA.
Evaluation of Support, a self-guided online type 1 diabetes self-management education and support web application—a mixed methods study
Authors: Xie Li Feng , Housni Asmaa , Roy-Fleming Amélie , Bandini Aude , Delormier Treena , Costa Deborah Da , Brazeau Anne-Sophie 
Published: September 2023

Background Type 1 diabetes requires making numerous daily decisions to maintain normoglycemia. Support is an evidence-based self-guided web application for type 1 diabetes diabetes self-management. Objective Evaluate users’ satisfaction with Support and investigate changes in self-reported frequency of-, fear of- hypoglycemia, and diabetes-related self-efficacy. Methods Adults from a Quebec type 1 diabetes registry used Support. Data was collected through online surveys or extracted from the registry at 0, 6, and 12 months (number of episodes and fear of hypoglycemia). At 6 months, participants reported satisfaction with Support and diabetes-related self-efficacy. A sub-group of 16 users was interviewed about their experience . Transcripts were analyzed using inductive and deductive approaches. Results In total, 207 accounts were created (35% men, 96% White, mean age and diabetes duration: 49.3 ± 13.8 and 25.2 ± 14.7 years). At 6 months, the median [Q1; Q3] satisfaction was 40/49 [35; 45] with a mean decrease in hypoglycemia frequency of 0.43 episodes over 3 days (95% CI: −0.86; 0.00, p = 0.051) and of −1.98 score for fear (95% CI: −3.76; −0.20, p = 0.030). Half of the participants reported increased diabetes-related self-efficacy. Conclusions Participants reported a high level of satisfaction with Support. Its use has the potential to facilitate hypoglycemia management and increase diabetes-related self-efficacy. Trial registration This study is registered on ClinicalTrials.gov NCT04233138.