bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shareholder Claims for Reflective Loss in Investor-State Dispute Settlement: Proposing Reform Options for States
Authors: Suraweera Anuki 
Published: May 2023

Abstract
The rule against reflective loss claims by shareholders is a fundamental tenet of corporations law, accepted across numerous domestic law jurisdictions and under customary international law. Yet bilateral investment treaties (BITs) have long broken from this conventional approach by allowing shareholders to bring claims for their indirect loss. UNCITRAL Working Group III has identified that this anomalous approach to shareholder claims may be an issue in relation to which reform is desirable. In support of Working Group III’s multilateral reform agenda, this article examines a range of reforms options available to States concerning shareholder reflective loss claims, and suggests that treaty-based derivative claims mechanisms are a suitable choice for reform. Derivative claims mechanisms have been included in a number of international investment agreements (IIAs), although the arbitral practice in relation to such provisions has not previously been the subject of close scrutiny. The examination of this arbitral practice, drawing in particular from past practice applying the North American Free Trade Agreement, reveals that tribunals have not consistently interpreted these mechanisms as precluding shareholder reflective loss claims, indicating that States need to include explicit clarificatory treaty language to render these clauses effective.
All surgical supra-annular aortic valvar tissue prostheses are labelled too large
Authors: van Boxtel Astrid Gerritje Maria , Mariani Massimo Alessandro , Ebels Tjark 
Published: May 2023

Abstract

OBJECTIVES
Surgical supra-annular aortic valvar tissue prostheses are labelled in an inconsistent and confusing manner. If the replaced valve is too small for a given patient, the risk of patient-prosthesis mismatch is increased, which is associated with the risk of morbidity and mortality. The labelled diameter (LD) of these valves should coincide with the inflow orifice diameter (IOD). Therefore, our goal was to measure all relevant IODs.

METHODS
Valvar design was assessed in terms of the intended position of the valve in relation to the patient’s annulus. The IODs of all available supra-annular aortic valvar prostheses were measured using a conical gauge. The IODs were compared to the LDs. We searched for instructions for use, websites, packing boxes and regulatory institutions involved in the process.

RESULTS
Eight valve models from 4 manufacturers were included. None of these valves were clearly labelled as supra-annular on the packing box, although for 3, the supra-annular label could be found in the written specifications. All valves had an IOD smaller than their LD, with a median difference of 15% (range: 4%–25%). The departure from LD differed per valve model and valve size.

CONCLUSIONS
Valve packages should be labelled accurately and clearly so that surgeons can make a well-informed choice. Currently essential information is missing because the intended position in relation to the annulus is not consistently marked on the packing boxes, and valve sizes are labelled incorrectly. We propose a change for the better: relabel all valves according to their true IOD in a structured manner.
Sharp concentration results for heavy-tailed distributions
Authors: Bakhshizadeh Milad , Maleki Arian , de la Pena Victor H 
Published: May 2023

Abstract
We obtain concentration and large deviation for the sums of independent and identically distributed random variables with heavy-tailed distributions. Our concentration results are concerned with random variables whose distributions satisfy $P(X&gt;t) \leq{\text{ e}}^{- I(t)}$, where $I: \mathbb{R} \rightarrow \mathbb{R}$ is an increasing function and $I(t)/t \rightarrow \alpha \in [0, \infty )$ as $t \rightarrow \infty $. Our main theorem can not only recover some of the existing results, such as the concentration of the sum of sub-Weibull random variables, but it can also produce new results for the sum of random variables with heavier tails. We show that the concentration inequalities we obtain are sharp enough to offer large deviation results for the sums of independent random variables as well. Our analyses which are based on standard truncation arguments simplify, unify and generalize the existing results on the concentration and large deviation of heavy-tailed random variables.
T1 Burn Behavioral Health: Development and Preliminary Results of Burn Center-Based Stepped-Care Program for Burn Survivors
Authors: Gavrilova Yulia , Cerre Raleigh , Ficalora Julia , Tatiana Davidson , Ruggiero Kenneth , Lesher Aaron , Kahn Steven A 
Published: May 2023

Abstract

Introduction
Annually, nearly half a million people in the U.S. receive medical treatment for burns, 40,000 of whom are hospitalized. Burn patients experience significant psychological burden during acute burn treatment. Long-term psychiatric problems are highly prevalent compared to patients with other injuries. Undetected or untreated psychiatric symptoms can complicate recovery, increase length of stay, and cause long-term problems and readmission. Burn centers are ideally suited to provide these services to burn patients on an inpatient and outpatient basis; however, few burn centers in the U.S. have mental health programs to address patients’ needs. This presentation will describe the Burn Behavioral Health (BBH) program, a burn center-based technology-enhanced stepped-care model of delivering mental health services for burn survivors, spanning the inpatient to outpatient continuum. This model was adapted from the Trauma Resilience and Recovery Program which has been successful in meeting the needs of traumatic injury patients.

Methods
Data were collected as part of clinical care. BBH includes 4 main steps: (1) initial screening, education, and early intervention; (2) symptom self-monitoring and self-help resources; (3) follow-up screening 30 days post-injury; and (4) provision of best-practice mental health treatment for patients who need it, using both in-person and telehealth modalities, including individual and skill-based group therapy.

Results
Between February 2021 and September 2022, 384 patients were identified as eligible for BBH services. Of these, 342 (90%) were enrolled in BBH and completed initial screening. 50% of patients screened positive for depression/PTSD risk or symptoms and were offered brief intervention. 54% of enrolled survivors received brief intervention, 21% of whom completed more than one session. We reached 84% of patients for the 30-day follow-up, 20% of whom screened positive for depression/PTSD and 29% were connected to mental health services.

Conclusions
This study provides preliminary support demonstrating that BBH is sustainable and capable of reaching and engaging a large proportion of burn patients across the inpatient to outpatient continuum. In the U.S., only 25% of burn centers have structured screening in place for inpatient and 11% for outpatient burn survivors. Data from the traumatic injury population (which includes burns) suggest only 10% of patients received intervention after a positive screen and 42% did not know how or where to get help. Psychological recovery is an essential component of a comprehensive burn program and availability of psychological screening and intervention is a requirement for the ABA verification.

Applicability of Research to Practice
BBH shows promise in increasing access and quality of mental health care to address the unique needs of burn survivors.
T5 Temperature Derangement on Admission Predicts Mortality in Burn Patients—a Nationwide Analysis and Opportunity for Improvement
Authors: Stanton Eloise 
Published: May 2023

Abstract

Introduction
While single-institution studies have described the relationship between hypothermia, burn severity, and complications, there are no national estimates on how temperature on admission impacts hospital mortality. This study aims to evaluate the relationship between admission temperature and complications on a national scale to expose opportunities for improved outcomes.

Methods
The US National Trauma Data Bank (NTDB) was analyzed between 2007-2018. Mortality was modeled using multivariable logistic regression including burn severity variables (% total burn surface area (TBSA), inhalation injury, emergency department (ED) temperature), demographics, and facility variables. Temperature was parsed into three categories: hypothermia ( &lt; 36.0°C), euthermia (36.0-37.9°C), and hyperthermia (≥38.0°C).

Results
116,796 burn encounters were included of which 77.9% were euthermic, 20.6% were hypothermic and 1.45% were hyperthermic on admission. For every 1.0C drop in body temperature from 36.0°C, mortality increased by 5%. Both hypothermia and hyperthermia were independently associated with increased odds of mortality when controlling for age, gender, inhalation injury, number of comorbidities, and %TBSA (p &lt; .001). All temperatures below 36.0°C were significantly associated with increased odds of mortality. Patients with ED temperatures between 32.5-33.5°C had the highest odds of mortality across the cohort (22.0, 95% CI 15.6-31.0, p&lt; .001).

Conclusions
ED hypothermia and hyperthermia are independently associated with mortality even when controlling for known covariates associated with inpatient death. These findings underscore the importance of early warming interventions both at the prehospital stage and upon ED arrival. ED temperature could become a quality metric in benchmarking burn centers to improve mortality.

Applicability of Research to Practice
This study provides national-scale data on the important relationship between ED temperature and mortality that can substantially impact both prehospital and hospital policies and practice and subsequently improve patient care.
38 Burn Prevention and Education for Newcomers to North America
Authors: Bharadia Shyla , Galbraith Andrew , Lamb Alec , Babwani Ali , Gabriel Vincent , Sahota Preet , Chockalingam Keerthana , Sinha Sarthak 
Published: May 2023

Abstract

Introduction
The experience of a city’s fire department suggested regions typically home to immigrant and multigenerational families show increased occurrence of fire calls. This study explored the incidence of fire calls in our city stratified by geographic ward and identified opportunities for fire and thermal injury prevention in immigrants.

Methods
This study was approved by our university’s research ethics board. Fire call data from 2016-2021 was used to characterize adjusted fire totals, civilian injuries, incident descriptions, sources of fire ignition, type of material, area of origin, and contribution to ignition of these fires by ward. ANOVAs were performed to reveal differences in fire characteristics between wards. High fire occurrence wards were classed as at greater risk and probable targets for prevention. To follow, an open ended interview was conducted with a newcomer organization in the city to elucidate factors that contribute to thermal injury risk in immigrants. Interview content was informed by a literature search around the factors and impact of burn injury in immigrants to North America, Europe, and Australia. Interview responses were thematically analyzed.

Results
The city is stratified into 14 wards, within which there are several communities described by income, education, immigration diversity and more. Between wards, total adjusted fire incidents were not significantly different (p = 0.119). Though, fire characteristics did differ regionally. Common fire incident descriptions included vehicle/structure, trash and cooking fires with less variability by ward in the number of cooking fires compared to the two former. Contributions to ignition were frequently human related. The supplementary interview highlighted individual burn risk as multifactorial. Cultural norms (notably cooking practices and equipment such as pressure cookers), inexperience (related to weather and frostbite risk), and participation in entry level jobs (including cooking) may impart increased burn risk to immigrants. Senior immigrants were noted to be specifically at risk for burns given their propensity to retain cultural cooking norms.

Conclusions
Newcomers may face increased fire and thermal injury risk that can be attributed to occupational hazards not specific to immigrants and adjustment to a new way of life. Given that many fires and injuries are connected to cooking, kitchen safety and environmental education becomes important to enable safer engagement in cultural practices. Follow up to this work includes matching high fire incidence wards to their resident immigrant groups for targeted prevention.

Applicability of Research to Practice
Inclusion of race and ethnicity in burn registries may assist in recognizing at risk groups for burn prevention and serve as a retrospective comparator to assess the impact of population specific burn prevention efforts.
41 An Examination of Factors Predicting Inpatient Rehabilitation Stay After Burn Injury
Authors: Turgeon Lori , Dellheim Vanessa , O'Neil Audrey , Schneider Jeffrey , Shepler Lauren J , Bamer Alyssa , Ryan Colleen , Kazis Lewis , Kowalske Karen , Suman-Vejas oscar , Orton Caitlin , Stewart Barclay 
Published: May 2023

Abstract

Introduction
Rehabilitation services improve the functional recovery of people who have experienced burn injury. Therapy services are often initiated during patients’ hospitalization and continue for months to years after discharge. However, numerous factors contribute to a patient’s overall complexity and functional impairments following discharge and need for Inpatient Rehabilitation (IR). Characteristics associated with longer IR stays have not been well explored. This study aimed to examine patient and clinical factors associated with length of IR stay. We hypothesized that burn severity, including size and location, as well as insurance payor will be associated with length of rehabilitation time.

Methods
Adult participants in Burn Model System National Database (1994-2022) who were discharged to IR following their hospital stay were included. A negative binomial regression analysis examined the association between IR days and demographic and injury characteristics including age, gender, burns to critical areas (head and neck, perineum, hand), payor, etiology, circumstance of injury, and range of motion deficits. A p-value less than 0.05 was considered significant.

Results
The study included 585 participants who were 72% male with mean age 46.1 (SD 16.8), and mean burn size 34.6% (20.5) total body surface area (TBSA). Average IR days were 22.8 (19.3). For every 1% increase in TBSA burned there was a 1% increase in IR days. Similarly, each additional 1 ventilator day was associated with an 1% increase in IR days. Electrical injuries were associated with 44% more IR days than flame injuries. Self-inflicted injuries were associated with 55% more IR days, while hand burns were associated with 18% decrease in IR days. Self-pay, philanthropy or other insurance coverage was associated with 37% fewer IR days. Of note, range of motion deficits were not significantly associated with IR days.

Conclusions
Longer IR stays were associated with greater burn severity, etiology (electrical), and circumstance (self-inflicted), all of which are markers of overall case complexity. Shorter IR stays were associated with specific injury location (hand), though reasoning for this needs further investigation. Payor type was also associated with shorter IR stay, which highlights risk of inequity in rehabilitation service delivery.

Applicability of Research to Practice
These findings can help clinicians set expectations regarding IP for patients and families, and advocate for strategies to deliver rehabilitation services more equitably.
45 A Three Year Analysis of a Multi-tiered Orthotic Protocol
Authors: Martinez Andria , Verdugo Selene , Warthman Renee , Islas Claudia , Murray Derek , Foster Kevin 
Published: May 2023

Abstract

Introduction
A variety of factors affect the fit of custom orthoses in those with burn injuries. A resting hand orthosis (RHO) is a common device within burn care, yet fabrication and fitting of this custom orthosis requires precision and expert assessment. However, burn therapists have varying degrees of education and credentials and previously we had noted preventable complications. Our center implemented a multi-tiered protocol focused on custom RHOs and found a marked decrease in complications immediately following implementation. The purpose of this QI project was to evaluate whether these improvements had been sustained over the following three-year period.

Methods
This was a retrospective chart review. Per protocol an RHO could be fabricated by a single certified hand therapist (CHT) or co-fabricated by two (non-CHT) therapists. Incidence of orthosis complications, defined as erythema and/or an orthotic induced partial-thickness injury to the volar second metacarpal head (index finger) was the primary outcome measure. Other data collected were average time to fabricate & modify devices and average refabrication(s) required between CHT vs non-CHT devices. Patients with missing data points was excluded.

Results
Eighty-five patient hands were examined from 2019-2022. Prior to implementation, total erythema occurrences were reported in 23.4% of orthoses (n=18) and total orthotic induced partial thickness injury occurred in 11.7% (n=9) of cases. Post protocol implementation erythema occurred in 5% of cases (n=5), and partial thickness injury in 0% of cases (n=0). This represents a decrease of 95% and 100%, respectively. On average CHTs fabricated RHOs in 59 minutes vs 48 minutes for non CHTs. CHTs had a complication rate of 0.0% vs 10.98% for non-CHTs. Potential complication was also limited to 0.0% for CHTS and 27% of non-CHTs. Modification rates were limited to 18.75% for CHTS vs 47.56% of non-CHTs.

Conclusions
Data from this QI project showed a clinically significant decrease in erythema and decrease in breakdown and number of modifications needed from utilization of either a CHT or two therapists when managing hand orthoses. Since instituting our protocol focusing on RHOs, our center has decreased complications and potential complications to improve patient outcomes. Although, most therapists receive standard education, it can be inferred that CHTs may approach orthotic fabrication through a different lens. The required studying and education required to maintain an advanced practice certification may benefit burn therapy departments. Therapists without this specialty certification can enhance skill and outcomes via co-fabrication and assessment.

Applicability of Research to Practice
Orthotic induced erythema may be decreased by utilizing CHTs or two non-CHTs to manage RHOs. This protocol can be expanded to include other orthoses or with other advanced certifications.
46 Integration of Cutaneous Functional Units Principles in Burn Rehabilitation: A Diffusion of Innovations Assessment
Authors: Yelvington Miranda , Parry Ingrid 
Published: May 2023

Abstract

Introduction
Early recognition of burn scar contractures can lead to a more targeted and effective therapy regimen, potentially preventing loss of range of motion and improving burn survivors' quality of life. In burn rehabilitation, consideration of the principles of cutaneous functional units (CFUs), or fields of skin as they relate to movement at associated joint, can allow occupational and physical therapists to explain and predict limitations and formulate treatment plans individualized to each patient’s pattern of injury. Evidence-based research demonstrates the potential of CFU principles to improve upon the current standard of care, but the consistent use of these principles has been slow to diffuse through burn care. The Diffusion of Innovations theory, by Everett M. Rogers, provides a framework for the examination of the process by which CFU principles (innovation) have been diffused into clinical burn practice (channel) since its emergence in burn literature (time) within the burn therapy network (social system).

Methods
Using purposive sampling survey invitations were sent to occupational and physical therapists who work in burn care and posted to therapy-related social media groups. Responses were collected and demographic variables and trends were analyzed and are reported here.

Results
Respondents (297) were Occupational Therapist (52%) and Physical Therapists (49%) and were inclusive of all practice areas. The majority of respondents work in a burn unit (81%) in North America (70.7%). Most respondents (78.4%) report familiarity with the term CFU as it relates to burn rehabilitation. Of those familiar, the majority of respondents reported their knowledge (66.7%) and ability to apply (65.7%) at an intermediate level or greater. A slight majority (59.3%) responded that the CFU concepts influenced their performance of burn rehab, while 40.7% said the concepts did not influence their practice. 40-69% of respondents correctly answered CFU knowledge questions but only 15% of respondents correctly completed CFU identification questions. Respondents (77%) report barriers to the use of CFUs including difficulty incorporating into practice, time constraints, and the need for more education. Only 5.9% of respondents endorsed no interest in using CFU concepts.

Conclusions
Survey respondents recognize the relative advantage of using CFU concepts and find them compatible with current values and practices. However, barriers in knowledge and applicability exist, suggesting that current educational resources have not enabled the information to be easily understood and applied. Diffusion can be improved by developing tools to assist therapists in understanding and incorporating CFU principles.

Applicability of Research to Practice
This framework can be used to develop a strategy to enhance CFU diffusion within the burn therapy community.