International Definition Research Articles

A review of the evolving conceptualization of internationalization from a global value chain perspective

PurposeThe purpose of this paper is to reveal the assumptive concept of internationalization because it is discussed and understood in the international business (IB) literature. This paper develops a framework to reconceptualize internationalization in the context of global value chain (GVC) and sustainability. Based on this conceptual framework, this paper aims to formulate interrelated propositions to define internationalization.Design/methodology/approachThis paper reviews the assumptive conceptualization process based on empirical evidence obtained through qualitative, illustrative and descriptive content analysis methods. Through the collection and qualitative content analysis of milestone papers, this paper demonstrates the fragmentation of the concept of internationalization. This paper reviews the evolving nature of the concept of internationalization, analyzing the accumulative issues associated with defining internationalization, as well as its potential future development.FindingsThis paper introduces a dynamic perspective on the evolving nature of the concept of internationalization and argue there is a need to reconceptualize internationalization in the context of the GVC and sustainability.Originality/valueAfter reviewing the context in which the term “internationalization” has been applied and taking into consideration the current trends in the IB, this paper formulates an updated definition of the term internationalization. This paper offers a viewpoint on the future direction of the concept of internationalization in light of the growing importance of sustainability within IB.

Determination of sensitivity coefficients and their uncertainties in Rockwell hardness measurement: a Monte Carlo method for multiple linear regression

In the last few decades, many researchers have been studying how hardness measurements can be affected by possible influence variables (i.e. velocity of the indenter, dwell times, temperature, etc). This interest is particularly motivated by the newly adopted international definitions for the realization of Rockwell superficial hardness scales (HR45N, HR30N and HR15N) provided by the Consultative Committee for Mass and Related Quantities of Bureau International des Poids et Mesures, which deal with all the above-mentioned parameters. In this paper, the effect of two such parameters, namely the velocity of the final load application and the time interval of the force variation from the preliminary force value to the total force value, on superficial Rockwell hardness scales at different levels is studied and the related sensitivity coefficients are determined. The coefficients obtained are in the order of 10−3 HR s μm−1 and 10−2 HR s−1, respectively, in agreement with other National Metrology Institutes (NMIs), i.e. NIST and NPL. However, the uncertainties associated by the other NMIs are usually underestimated since they are simply given as the standard deviation calculated from the ordinary least squares method for the multiple linear regression, or, in other cases, not reported. For this reason, we propose a methodology for calculating the uncertainties of the sensitivity coefficients via a Monte Carlo method applied to multiple linear regression in order to consider the variability of both input and output quantities: with this method, the squared uncertainties are given as the squared sum of the standard deviation calculated from the ordinary least squares method and the uncertainty contribution due to the repeatability obtained via the proposed Monte Carlo method. The proposed method yields uncertainties of about 10−2 HR, while the uncertainties reported in other related published papers are in the order of 10−3 HR.

Cerebrospinal fluid lactate as a predictive biomarker for tuberculous meningitis diagnosis.

The definitive diagnosis of tuberculous meningitis (TBM) is achieved by identifying Mycobacterium tuberculosis (MTb) in cerebrospinal fluid (CSF); however, diagnostic confirmation is difficult due to the inability ofcurrent tests for an effective diagnosis. Our objective was to retrospectively assess the characteristics of CSF lactate (CSF-LA) as an adjunct biomarker in the diagnosis of TBM. 608 CSF laboratory reports were assessed. Of these, 560 had clinically suspected TBM. These were classified as definite (n=36), probable (23), possible (278),or non-TBM (223) according to the international consensus TBM case definitions. An additional 48 CSF samples were negative controls with normal CSF. Against a reference standard of definite TBM, the cut-off value for CSF-LA was 4.0mmol/L, the area under the ROC curve was 0.88 (95% CI, 0.82-0.94; p=0.0001), sensitivity was 69%, specificity 90%, negative predictive value 98%. These diagnostic parameters decreased when calculated against those of the other categories of TBM. CSF-LA exhibited high specificity, efficiency, negative predictive value, and clinical utility index in all the groups studied. CSF-LA is a useful diagnostic marker to rule out TBM when associated with conventional microbiology tests, nucleic acid amplification assays, and clinical algorithms, particularly in endemic areas.

Children and Drug Trafficking in Brazil: Can International Humanitarian Law Provide Protections for Children Involved in Drug Trafficking?

Brazil has seen a rise in children in narco-trafficking due to increased conflicts between factions and local law enforcement. Mainstream media and scholars tend to frame actions of these factions as organized crime, ignoring the generalized violence the communities and children experience. The aim of this study is to conduct a scoping review to consider whether or not Brazilian children involved in drug trafficking can be classified as child soldiers. Drawing from the international definition of Armed Conflict in Article 3 of the Geneva Convention of 1949 and Article 1 of the Additional Protocol II, and comparing situations of realities faced by Brazilian children involved in narco-trafficking, we argue that their reality is analogous to that of child soldiers, as defined by the Paris Principles on the Involvement of Children in Armed Conflict 2007; thus, going beyond the organized crime definition. In characterizing them as child soldiers, we argue for improving the children’s ability to be reintegrated into society, with the collective help of the international community.

Pregnant, miserable, and starving in 21st century America

Severe nausea and vomiting of pregnancy is too common and devastating to be trivialized any longer. Authors of recent studies observed that children exposed in utero to severe nausea and vomiting of pregnancy had an increased risk for autism spectrum disorder, a decreased brain cortical volume, and developmental deficits. Research on severe nausea and vomiting of pregnancy and hyperemesis gravidarum has been disturbingly slow. It was not until 2021 that an international consensus definition was published. Hyperemesis gravidarum starts before 16 weeks' gestation, is characterized by severe nausea with or without vomiting and an inability to eat and drink normally, and greatly limits daily activities. Maternal misery is caused by unrelenting nausea, intractable retching or vomiting, ptyalism, dehydration, reflux, malnutrition, and social isolation. Hyperemesis gravidarum is the second most common reason for hospitalization in pregnancy. Symptoms can persist until delivery in one-third of individuals who experience extreme weight loss. Significant associations have been identified between hyperemesis gravidarum and multiple adverse outcomes. Maternal deaths owing to hyperemesis gravidarum continue to be reported, and hyperemesis gravidarum is associated with high fetal loss and termination rates. These grim findings highlight the critical public health importance of treating severe nausea and vomiting of pregnancy early to mitigate serious complications that compromise maternal and offspring health during pregnancy and beyond. Despite suffering extreme debility, individuals with hyperemesis gravidarum report feeling that their experiences were dismissed by healthcare professionals, contributing to therapeutic termination, suicidal ideation, perinatal depression, and posttraumatic stress disorder. Hyperemesis gravidarum must be recognized early and treated aggressively with frequent monitoring. Although medications can be effective in reducing symptoms, many patients do not gain adequate relief, and new treatments are needed. A promising new avenue for treatment comes from genetic discoveries. The gene, growth differentiation factor-15, which codes for a nausea and vomiting hormone produced by the placenta, is the greatest genetic risk factor for hyperemesis gravidarum, and therapies are currently in clinical trials in cancer. However, until treatment is universally effective, abortion access must be available for refractory hyperemesis gravidarum. Herein, we emphasize data published since the most recent American College of Obstetrics and Gynecology report (2018), such as long-term neuropsychiatric consequences in offspring exposed to hyperemesis gravidarum and suggest interventions anticipated to prevent progression of early symptoms to hyperemesis gravidarum.

Characteristics and sensory assessment of extra virgin olive oils produced in two different zones of Brazil

AbstractThe Brazilian olive oil production has been growing in recent decades and largest plantations are on two different zones, from Serra da Mantiqueira (states of Minas Gerais and São Paulo) and Campanha Gaúcha (state of Rio Grande do Sul). The total planted area, in 2022, reached approximately 6500 hectares. The aim of the present study was to characterize the sensory and analytical parameters of extra virgin olive oils (EVOO) from Southwestern (Serra da Mantiqueira) and Southern (Campanha Gaúcha) Brazil regions. Twenty‐two EVOO samples were obtained from different cultivars of unlike regions. Quality parameters, oxidative stability, phenolic compounds ortho‐diphenols and fatty acids were analyzed and relationships with olive variety or region. From the chemical perspective, the EVOO exhibited all parameters within the necessary to be qualified as extra virgin, according to international standard definitions. All samples showed a good quality of sensory perceptions and a high level of polyphenols, which are varied among samples but was more intense in Campanha Gaúcha olive oils.

Coping strategies and considerations regarding low anterior resection syndrome and quality of life among patients with rectal cancer; a qualitative interview study.

Low anterior resection syndrome (LARS) is defined as disordered bowel function following rectal resection, which is detrimental to quality of life (QoL). A recent international consensus definition of LARS stresses the importance of focusing on both the symptoms and the consequences that the symptoms have for the individual patient as studies indicate that LARS has a negative impact on patients' QoL. However, an ongoing PROM study investigating late sequelae after rectal cancer finds that a minor proportion of patients scoring major LARS experience none or only little impact on quality of life. The aim of this study was to identify patients' considerations and coping strategies to establish why the burden caused by major LARS had little or no influence on their QoL. This was a qualitative interview study based on 21 semi-structured individual telephone interviews with patients treated for rectal cancer. Data were analysed using a hermeneutic inspired thematic analysis. Three themes emerged from the analysis; Adapting new life situation, Altering life perception and the Importance of relationships. Major LARS and its consequences following rectal cancer may be managed or altered by adopting problem-focused and emotion-focused coping strategies. Maintaining a positive attitude and having a good network of family and friends constitute a surplus, allowing patients to cope with the need for changed behaviour and appreciate the life that they have been given. Accepting that major LARS and its consequences cause limitations in life allowed patients to change their normality threshold over time.

Anaphylaxis: Revision of the Brighton collaboration case definition

The Brighton Collaboration (BC) has formulated a number of case definitions which have primarily been applied to adverse events of special interest in the context of vaccine safety surveillance. This is a revision of the 2007 BC case definition for anaphylaxis. Recently, the BC definition has been widely used for evaluating reports of suspected anaphylaxis following COVID-19 vaccination. This has led to debate about the performance of the BC definition in comparison with those from the US National Institute of Allergy and Infectious Disease/Food Allergy Anaphylaxis Network (NIAID/FAAN) and the World Allergy Organization (WAO). BC convened an expert working group to revise the case definition based on their usual process of literature review and expert consensus. This manuscript presents the outcome of this process and proposes a revised case definition for anaphylaxis. Major and minor criteria have been re-evaluated with an emphasis on the reporting of observable clinical signs, rather than subjective symptoms, and a clearer approach to the ascertainment of levels of certainty is provided. The BC case definition has also been aligned with other contemporary and international case definitions for anaphylaxis.

P137 Diagnosis of nocturnal hypoventilation in children with neuromuscular disorders by polysomnography – a survey of clinical practice in Australia and New Zealand

Abstract Background Diagnosis of nocturnal hypoventilation requires measurement of pCO2 during sleep, which can occur via exhaled gas (capnography) or transcutaneous methods. Different national and international definitions of hypoventilation exist, which may contribute to significant variation in clinical practice. Methods An electronic survey was completed by pediatric sleep physicians in Australia and New Zealand to determine how pCO2 was measured during polysomnography, what pCO2 data was available to reporting physicians/included in the report and which definitions of hypoventilation physicians use. Results More than two thirds (70%) of physicians indicated that in their centre pCO2 was collected via transcutaneous measurement only and 30% by both transcutaneous and end-tidal measurement. Twelve definitions of hypoventilation were used, including published definitions from the American Academy of Sleep Medicine manual and the pediatric Australasian Sleep Association/Australasian Sleep Technologists Association recommendations. The most commonly used definition was an increase in pCO2 >50mmHg for >25% total sleep time. The percentage of total sleep time with pCO2 >50mmHg was routinely included in the report and/or easily available in the raw data for 70% of physicians. Discussion There was significant variation and lack of standardisation within Australia and New Zealand when measuring and reporting pCO2 during polysomnography as well as definitions of hypoventilation used by pediatric sleep physicians. The Australasian Sleep Association/Australasian Sleep Technologists Association recommendations were not frequently used, possibly due to relevant information not being available to reporting physicians, recommendations being irrelevant and/or outdated and excessive cognitive load associated with remembering multiple definitions.

Przemilczane ludobójstwo – „operacja polska NKWD” 1937–1938

The Order No. 00485 that was given by the head of the NKVD, Nikolai Yezhov, resulted in carring out the Polish Operation during the Great Purge. Political repression against Poles that took place in 1937-1938 in the Soviet Union, resulted in executions of 111 thousand Poles and sentencing nearly 30 thousand people to labor camps. Institutions associated with Polishness, such as the Roman Catholic Church, became the target of repression. According to international definitions, it was an act qualified as genocide and resulted in depolonization of further Easter Borderlands.

Patient‐derived pancreatic tumour organoid implantation establishes novel pre‐cachexia mouse models

AbstractBackgroundThe poor survival of pancreatic cancer patients is largely attributable to cachexia, a syndrome of severe weight and muscle loss. To investigate the aetiology of cancer cachexia, preclinical models that closely recapitulate the human disease process are essential. Patient derived tumour organoids are promising novel cancer models, but their ability to induce cachexia in mice has not been investigated. We developed two pancreatic tumour organoid‐based mouse models and demonstrate their potential for cancer cachexia research.MethodsTwo patients with pancreatic cancer, from whom tumour organoid cultures were previously established, were selected based on their cachexia phenotype. Patient 09 was characterized as cachectic according to the international consensus definition of cancer cachexia, whereas patient 12 was classified as non‐cachectic. Organoid cultures PANCO‐09b and PANCO‐12a in basement membrane extract (BME) were injected subcutaneously into the flanks of 9‐weeks old NMRI‐Foxn1nu mice (n = 8/group). A control group was injected with BME only (n = 4). Body weight was monitored every 2–3 days for 38 days. Hind limb muscle wet and dry weights were measured. Adipocyte size in inguinal white adipose tissue was measured using haematoxylin and eosin‐stained sections. Expression of genes associated with cancer cachexia in muscle and liver tissue was analysed using qPCR.ResultsEngraftment of tumour organoids was successful in 87.5% of PANCO‐09b implanted mice and in 50% of PANCO‐12a mice, with similar average tumour weights at endpoint (34.4 ± 25.1 mg vs. 32.8 ± 40.2 mg, respectively, P = 0.450). All groups initially gained weight, but PANCO‐12a implanted mice progressively lost an average body weight of 1.7 ± 0.8 g from day 28 onwards. PANCO‐12a‐implanted mice gained significantly less weight from baseline than controls (0.7 ± 0.6 g, P = 0.027). Overall body weight gain of PANCO‐09b mice was also lower but not significantly different from controls (2.0 ± 1.2 g vs. 2.9 ± 1.6 g, P = 0.961). Wet weights of hind leg muscles were negatively correlated with tumour weight but did not differ between groups. Adipocytes of PANCO‐12a implanted mice were smaller compared to SHAM as well as PANCO09b mice (P < 0.0001), indicative of white adipose tissue wasting.ConclusionsImplantation of human pancreatic tumour organoids into mice negatively affects their body weight, but does not recapitulate body weight loss of donor patients. The reduced adipocyte size and inverse correlation between tumour weights and muscle weights in these mice are consistent with early‐stage cachexia or pre‐cachexia. This study shows that implantation of tumour organoids into mice provides a valuable model to investigate the processes underlying the heterogeneous presentation of cancer cachexia.

Perspectives of Health Care Professionals on Multimodal Interventions for Cancer Cachexia.

Holistic multimodal interventions have not been established for cancer cachexia. The beliefs and perceptions of health care professionals (HCPs) based on their experiences influence the interventions. HCPs' knowledge, perceptions, and practices in cancer cachexia management were evaluated. A nationwide questionnaire survey was conducted that focused on the perspectives of HCPs on interventions in 451 designated cancer hospitals across Japan. Descriptive statistics were applied. Among 2255 participants, 1320 responded (58.5%), and 1188 in 258 institutes were included in the analysis. The current international definition of cancer cachexia is not commonly known and recent clinical practice guidelines have not been widely adopted. More than 50% of participants considered ≥5% weight loss in six months and ECOG PS (Eastern Cooperative Oncology Group Performance Status) 2-4 to be cancer cachexia, whereas 50% answered that there was no relationship between life expectancy and cancer cachexia. Participants tended to consider it important to initiate nutritional and exercise interventions before cancer cachexia becomes apparent. The majority of participants recognized the importance of holistic multimodal interventions, particularly for the management of physical and psychological symptoms; however, only 20% reported that they educated patients and families. Furthermore, 33% of participants considered themselves to have provided patients and families with sufficient nutritional and exercise interventions and evidence-based information. The results reveal that HCPs are not regularly providing education and emotional support to patients and families suffering from cancer cachexia. The results also show the need for education for HCPs to enhance implementation of holistic multimodal interventions for cancer cachexia.

Association of whole blood metals/metalloids with severity in sepsis patients: A prospective, single-center, pilot study

BackgroundTrace metals/metalloids were important for the biological functions of both the eukaryotic host and the microorganism. Their concentrations and variations may associate with the critical illness in sepsis, which still needs to be investigated. MethodsWe performed a prospective cohort study on the patients with sepsis admitted to Tongji hospital (Wuhan, China) from Jul 01 to Dec 31, 2021. Sepsis was diagnosed in accordance with the third international consensus definitions for sepsis and septic shock (Sepsis-3). The concentrations of metals/metalloids including magnesium (Mg), calcium (Ca), chromium (Cr), manganese (Mn), iron (Fe), copper (Cu), zinc (Zn), arsenic (As), cadmium (Cd), mercury (Hg), thallium (Tl) and lead (Pb) in whole blood were analyzed by ICP-MS based methods. ResultsCompared to the healthy controls, patients with sepsis showed higher levels of Ca, Cr and Cu, and lower levels of Mg, Mn, Fe, Zn, As, Hg and Pb. Further analysis between the critical illness and noncritical illness, revealed the Mn, Fe were significantly lower in the critically-ill sepsis. The longitudinal profile of the two metals show the differences appeared to exist almost throughout the clinical course. By performing the binary regression logistic analysis, we determined the Fe, Mn as independently risk factors for critical illness in sepsis, with effect sizes (β) of 17.14 (95%CI: 1.79–163.81) and 10.83 (1.96–59.83), respectively, which collectively discriminated 83.3% of all cases between critical-illness and non-critically illness. ConclusionsThe variations of whole blood metals/metalloids were associated with the critically-ill sepsis.

Nursing informatics and undergraduate nursing curricula: A scoping review protocol

AimThis scoping review aims to review contemporary published literature on Nursing Informatics education in undergraduate nursing education. IntroductionNursing is the largest workforce in health care and nurses are increasingly required to work with digital information systems. The need for nurses to understand and embrace information technology is closely linked with the ability to function in the contemporary healthcare workplace. However, despite the early adoption of Nursing Informatics in Australia in the 1980 s, there remain barriers to Nursing Informatics engagement and proficiency, including poor computer literacy, limited professional development and a lack of undergraduate informatics education. DesignThis scoping review will be developed in adherence with the JBI Manual for Evidence Synthesis: Scoping Reviews and the PRISMA-ScR Checklist. MethodsTo be included in this scoping review, papers need to include Nursing Informatics education for undergraduate nursing students in a Bachelor of Nursing program. Undergraduate nursing students are defined as individuals enrolled in a recognised nursing program leading to registration as a Nurse. To meet the requirements for registration as a Registered Nurse, in Australia, individuals are required to complete a Bachelor of Nursing program at a university (Australian Qualifications Framework Level 7) For the purpose of this scoping review, undergraduate nursing students are defined as those individuals undertaking a three year Bachelor of Nursing program at a university. Equivalent international definitions will be also used in the scoping review procedure. Sources of information will be included if they were published between 2015 and 2022 and describe curriculum recommendations (including barriers to implementing Nursing Informatics education). The purpose of the identified timespan is to reflect the rapidly evolving nature of health informatics and digital technologies. The requirement for curriculum recommendations is to reflect the purpose of the scoping review as the basis for a Delphi study, where Nursing Informatics and its integration into Bachelor of Nursing curricula will be explored and described in collaboration with domain experts. Ethics and disseminationEthics approval has been obtained for this scoping review (Project ID: 2156) from the Flinders University’s Human Research Ethics Committee and has been determined to be low risk.

Sarcopenia definition, diagnosis and treatment: consensus is growing.

Sarcopenia is a skeletal muscle disorder that commonly occurs with advancing age as well as with a number of long-term conditions. Recognition in clinical practice is relatively recent but important because of the association between sarcopenia and a range of adverse effects on health including impaired mobility, increased morbidity and mortality. Originally characterised as loss of muscle mass, the definition has evolved to focus on loss of skeletal muscle function, particularly strength, through a number of international definitions such as that of the European Working Group on Sarcopenia in Older People most recently revised in 2019. Progress in the decades ahead is likely to be seen with regard to use of routine health data, prescription of resistance exercise, translation of biology and epidemiology into first in man studies for new treatments, and focus on sarcopenia in low and middle-income countries. Immediate next steps include the newly formed Global Leadership Initiative on Sarcopenia to develop international consensus on definition and diagnosis.

Perceptions of surgical never events among interdisciplinary clinicians: Implications of a qualitative study for practice

BackgroundNever Events are serious, preventable, and clearly identifiable medical errors with the potential for causing patients significant morbidity and mortality. Despite extensive efforts to eliminate them, Never Events persist. AimTo assess whether interdisciplinary clinicians (nurses, surgeons, and anaesthesiologists) and risk managers have different mental models about three aspects of the definition of surgical Never Events: incidence, severity, and preventability. MethodsSemi-structured interviews were conducted with 25 operating room clinicians and hospital risk managers in Israel from September to December 2019. Verbatim transcripts were analysed using six-phase inductive thematic analysis. FindingsMental models of Never Events varied by profession. Surgeons described them as rare and nurses saw them as common. While agreeing on their severity, mental models about preventability were mixed, with surgeons and nurses thinking that training and/or safety standards could prevent them, and anaesthesiologists and risk managers considering them to be unpreventable. DiscussionThe common definition of Surgical Never Events characterises them as severe and preventable events. Different mental models characterise interdisciplinary views about the definition. These differences challenge the utility of a single international consensus definition of Never Events. ConclusionGiven differences in mental models among clinicians and risk managers, approaches to eliminating Never Events may benefit from identifying and addressing these differences in order to improve teamwork and implementation of safety protocols.

Documentosophy as the philosophical conceptualization of document entity

The author continues to substantiate the goal set by Arkady Sokolov to conceptualize the document entity. As the initial point, he took Sokolov’s definition of documentosophy as the segment of sociocultural space to build, transfer, preserve and user meaningful communication messages referred to as documents. Sokolov also refers to the sphere of sociocultural production where the documents emerge, circulate and are preserved, as the documentosphere. The author argues that the adequate definition of the document is possible in its dialectic object-subject perception according to the international definition: the document is an object or recorded information provided that in the given documentation process (rather than generally!) it can be considered (by a subject) as a discrete whole. This results in the need to specify restrictions and to formulate narrower definition of the document specifically for each individual documentation process. The fundamental provision of relativity, conformity and conventionality of the concept “document” is explained; the author criticizes the mediaology claiming to replace documentive concepts with medialogical structures. In fact, the subject of documentology coincides with that of mediaology. However, firstly, each science has its own term, and, secondly, these are just their approaches that differ, i. e. the ontological approach is applied in documentology, and the communicative one in mediaology. The mediaology has been diligently though unreasonably avoiding the concepts of “document” and “information”. Thirdly, as opposed to documentology, the mediaology has been still unable to propose any brand-new and valuable insight into the document phenomenon.

Stent-Associated Infectious Complications After Pancreatoduodenectomies Can Be Prevented by Perioperative Antibiotic Therapy: An Analysis of Single-Center Standards.

Perioperative morbidity after pancreatoduodenectomies is still high. One potentially responsible factor is the insertion of bile duct stents before surgery. In our single-center study, we evaluated the influence of preoperative bile duct stenting combined with perioperative antibiotic therapy versus primary surgery in carcinoma patients. Clinical data of 973 patients undergoing pancreatoduodenectomy at the University Hospital Freiburg from 2002 to 2018 were explored retrospectively. Postoperative pancreatic fistula, delayed gastric emptying (DGE), and postpancreatectomy hemorrhage (PPH) were graded by current international definitions. Patients with pancreatic ductal adenocarcinoma or periampullary carcinoma were included. We included 634 patients of whom 372 (58.7%) were treated with preoperative bile duct stenting. No difference concerning postoperative pancreatic fistula was observed (P = 0.479). We found more wound infections (stent 18.4%, no stent 11.1%, P = 0.008) but a significantly lower rate of PPH and DGE in stented patients (PPH 7.5% vs 11.9%, P = 0.044; DGE 16.5% vs 22.5%, P = 0.039). Surprisingly, intra-abdominal abscesses were reduced in stented patients (9.4% vs 15.0%, P = 0.022), just as insufficiencies of the biliodigestive anastomosis (P = 0.021). Perioperative antibiotic therapy seems to reduce the risk for severe intra-abdominal infectious complications in stent-bearing patients.

Crossing the Threshold of General Public Relations Practices: Assessing Malaysia’s Experience in the First Quarter of the Millennium

Public Relations (PR) is nothing new to the present day global community. In fact, mankind had exercised PR since the day they first decided to live together. Since then, an essential beacon of wisdom in the history of mankind was planted. The birth of the modern PR began in 1948 when the Public Relations Society of America and the Institute of Public Relations in Britain were founded. Today, the influence of this communication field has engulfed almost all professions of global organizations. Majority of these organizations apply the PR principles and practices into their organizational structures. This paper begins with the historical backgrounds of the international PR culture, studies, and definitions. From there, the discussion penetrates deeper into the realm of the Malaysian PR culture. This analysis deals with many aspects of the PR, i.e. professional ethics, social and legal contracts, aimed at giving a considerably critical understanding of the Malaysian PR culture, which differs in definitions and practices. At the end of this paper, readers are presented with an overview of contemporary threats and challenges facing the field. This concept paper deals with the past, the present, and the future uncertainties of the PR field. Whether we are aware or not, PR today has been tremendously used for managing social stress in view of globalization. Yet, the forces of tolerance and brotherhood grant the country confidence in facing future challenges and threats. Indeed, the world of global PR is changing inconsiderately. Come what may, Malaysian has chosen to toughen up for a journey of her own in the wake of PR uncertainties.

Trends in pancreatic surgery in Switzerland: a survey and nationwide analysis over two decades.

Centralisation of highly specialised medicine (HSM) has changed practice and outcome in pancreatic surgery (PS) also in Switzerland. Fewer hospitals are allowed to perform pancreatic surgery according to nationally defined cut-offs. We aimed to examine trends in PS in Switzerland. First, to assess opinions and expected trends among Swiss pancreatic surgeons in regard of PS practice and second, to assess the evolution of PS performance in Switzerland by a nationwide retrospective analysis. First, a 26-item survey among all surgeons who performed PS in 2016 in Switzerland was performed. Then, nationwide data from 1998 to 2018 from all hospitals performing PS was analysed including centre volume, perioperative morbidity and mortality, surgical indications and utilisation of minimally invasive pancreatic surgery (MIPS). The national cut-off for regulatory accredited volume centres (AVC) was ≥ 12. Additionally, an international benchmark definition for high volume (≥ 20 surgeries/year) was used. Among 25 surgeons from 15 centres (response rate 51%), the survey revealed agreement that centralisation is important to improve perioperative outcomes. Respondents agreed on a minimum case load per surgeon or centre. Within the nationwide database, 8534 pancreatic resections were identified. Most resections were performed for pancreatic ductal adenocarcinoma (58.9%). There was a significant trend towards centralisation of PS with fewer non-accredited volume centres (nAVC) (36 in 1998 and 17 in 2018, p < 0.001) and more AVC (2 in 1998 and 18 in 2018, p < 0.001). A significantly higher adjusted mortality after pancreatoduodenectomy (PD) was observed in low-volume compared to high-volume hospitals (OR 1.45 [95% CI 1.15-1.84], p = 0.002) and a similar trend compared among AVC and nAVC (OR 1.25 [95% CI 0.98-1.60], p = 0.072), while mortality after distal pancreatectomy (DP) was not influenced by centre volume. Over the last two decades, centralisation of PS towards higher-volume centres was observed in Switzerland with a decrease of mortality after PD and low mortality after DP. Further centralisation is supported by most pancreatic surgeons. However, the ideal metric and outcome measures for the allocation of highly specialised medicine need further discussion to allow a fair and outcome-focused allocation.