bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Outcomes of a Decentralized, Nurse-Led, Statewide Model of Care for Hepatitis C Among People in Prison in Victoria, Australia
Authors: MacIsaac Michael B , Papaluca Timothy , McDonald Lucy , Craigie Anne , Edwards Amy , Layton Chloe , Gibson Annabelle , Winter Rebecca J , Iyer Kiran , Sim Abigail , Evans Sophia , Kumaragama Kavindu , Howell Jessica , Desmond Paul , Iser David , Scott Nick , Hellard Margaret , Stoové Mark , Wilson David , Pedrana Alisa , Doyle Joseph S , Holmes Jacinta A , Thompson Alexander J
Published: September 2024

Background

Prisons provide a key strategic opportunity to upscale hepatitis C testing and treatment in a high-prevalence setting and are crucial for elimination efforts.

Methods

A decentralized, statewide, nurse-led model of care offering hepatitis C treatment for people in prison was implemented in Victoria, Australia, in 2015. The program provides hepatitis C care at all 14 adult prisons in the jurisdiction. We prospectively evaluated treatment uptake between 1 November 2015 and 31 December 2021. Data on all people in prison who were treated were recorded in a clinical database. Primary outcomes were the number of people in prison who completed hepatitis C treatment with direct-acting antiviral (DAA) therapy and the proportion who achieved sustained virologic response (SVR12).

Results

A total of 3133 DAA treatment courses were prescribed to 2768 people in prison. The proportion of total Victoria DAA prescriptions the program was responsible for increased from 6% in 2016 to a peak of 23% in 2020. The median age was 39 years, 91% were male, and 9% had cirrhosis. Few (20%) had previously engaged in hepatitis C care in the community only 6% were treatment experienced. Complete follow-up data were available for 1757 of 2768 (63%) treated, with 1627 of 1757 (93%) achieving SVR12.

Conclusions

A decentralized, nurse-led, statewide model of care was highly effective in treating large numbers of people in prison with hepatitis C and achieved high rates of SVR12. Nurse-led prison programs are playing a crucial role in eliminating hepatitis C as a public health threat in Australia.
Quality control of cardiac magnetic resonance imaging segmentation, feature tracking, aortic flow, and native T1 analysis using automated batch processing in the UK Biobank study
Authors: Chadalavada Sucharitha , Rauseo Elisa , Salih Ahmed , Naderi Hafiz , Khanji Mohammed , Vargas Jose D , Lee Aaron M , Amir-Kalili Alborz , Lockhart Lisette , Graham Ben , Chirvasa Mihaela , Fung Kenneth , Paiva Jose , Sanghvi Mihir M , Slabaugh Gregory G , Jensen Magnus T , Aung Nay , Petersen Steffen E
Published: September 2024

Aims

Automated algorithms are regularly used to analyse cardiac magnetic resonance (CMR) images. Validating data output reliability from this method is crucial for enabling widespread adoption. We outline a visual quality control (VQC) process for image analysis using automated batch processing. We assess the performance of automated analysis and the reliability of replacing visual checks with statistical outlier (SO) removal approach in UK Biobank CMR scans.

Methods and results

We included 1987 CMR scans from the UK Biobank COVID-19 imaging study. We used batch processing software (Circle Cardiovascular Imaging Inc.—CVI42) to automatically extract chamber volumetric data, strain, native T1, and aortic flow data. The automated analysis outputs (∼62 000 videos and 2000 images) were visually checked by six experienced clinicians using a standardized approach and a custom-built R Shiny app. Inter-observer variability was assessed. Data from scans passing VQC were compared with a SO removal QC method in a subset of healthy individuals (n = 1069). Automated segmentation was highly rated, with over 95% of scans passing VQC. Overall inter-observer agreement was very good (Gwet’s AC2 0.91; 95% confidence interval 0.84, 0.94). No difference in overall data derived from VQC or SO removal in healthy individuals was observed.

Conclusion

Automated image analysis using CVI42 prototypes for UK Biobank CMR scans demonstrated high quality. Larger UK Biobank data sets analysed using these automated algorithms do not require in-depth VQC. SO removal is sufficient as a QC measure, with operator discretion for visual checks based on population or research objectives.
Revisiting the role of light signaling in plant responses to salt stress
Authors: Peng Yinxia , Zhu Haiyan , Wang Yiting , Kang Jin , Hu Lixia , Li Ling , Zhu Kangyou , Yan Jiarong , Bu Xin , Wang Xiujie , Zhang Ying , Sun Xin , Ahammed Golam Jalal , Jiang Chao , Meng Sida , Liu Yufeng , Sun Zhouping , Qi Mingfang , Li Tianlai , Wang Feng
Published: September 2024

As one of the grave environmental hazards, soil salinization seriously limits crop productivity, growth, and development. When plants are exposed to salt stress, they suffer a sequence of damage mainly caused by osmotic stress, ion toxicity, and subsequently oxidative stress. As sessile organisms, plants have developed many physiological and biochemical strategies to mitigate the impact of salt stress. These strategies include altering root development direction, shortening the life cycle, accelerating dormancy, closing stomata to reduce transpiration, and decreasing biomass. Apart from being a prime energy source, light is an environmental signal that profoundly influences plant growth and development and also participates in plants' response to salt stress. This review summarizes the regulatory network of salt tolerance by light signals in plants, which is vital to further understanding plants' adaptation to high salinity. In addition, the review highlights potential future uses of genetic engineering and light supplement technology by light-emitting diode (LED) to improve crop growth in saline–alkali environments in order to make full use of the vast saline land.
Outcomes of patients hospitalized in ward settings for COVID-19 pneumonia with or without early empirical antibiotics
Authors: Kopp-Derouet A , Diamantis S , Chevret S , Tazi A , Burlacu R , Kevorkian J P , Julla J B , Molina J M , Sellier P
Published: September 2024

Background

During the first pandemic of COVID-19, early empirical antibiotic use rates for pneumonia varied widely. The benefit remains hypothetical.

Methods

We assessed the benefit of empirical antibiotic use at admission in patients hospitalized with COVID-19 pneumonia. We enrolled all adults admitted from 1 March to 30 April 2020 with symptoms for ≤14 days, a positive nasopharyngeal PCR or a highly suggestive CT scan. The primary outcome was mortality at Day 28. The secondary outcomes were transfer to the ICU, mechanical ventilation and length of hospital stay. To handle confounding-by-indication bias, we used a propensity score analysis, expressing the outcomes in the original and overlap weighted populations.

Results

Among 616 analysed patients, 402 (65%) received antibiotics. At Day 28, 102 patients (17%) had died, 90 (15%) had been transferred to the ICU and 24 (4%) had required mechanical ventilation. Mortality in patients who received antibiotics was higher before but not after weighting (OR 2.7, 95% CI 1.5–5.0, P < 0.001 and OR 1.4, 95% CI 0.8–2.5, P = 0.28, respectively. Antibiotic use had no benefit on: transfer to ICU before and after weighting (OR 1.3, 95% CI 0.8–2.3, P = 0.30 and OR 1.1, 95% CI 0.6–1.9, P = 0.78, respectively); mechanical ventilation before and after weighting (OR 0.5, 95% CI 0.2–1.1, P = 0.079 and OR 0.75, 95% CI 0.3–2.0, P = 0.55, respectively); and length of hospital stay before and after weighting (mean difference −0.02 ± 0.5 days, P = 0.97 and mean difference 0.54 ± 0.75 days, P = 0.48, respectively).

Conclusions

We did not find any benefit of antibiotic use in patients hospitalized with COVID-19 pneumonia.
Experimental evolution reveals that males evolving within warmer thermal regimes improve reproductive performance under heatwave conditions in a model insect
Authors: Sales Kris , Gage M J G , Vasudeva R
Published: September 2024

Climate change is increasing mean temperatures, and intensifying heatwaves. Natural populations may respond to stress through shorter-term acclimation via plasticity and/or longer-term inter-generational evolution. However, if the pace and/or extent of thermal change is too great, local extinctions occur; one potential cause in ectotherms is identified to be the heat-liability of male reproductive biology. Recent data from several species, including the beetle Tribolium castaneum, confirmed that male reproductive biology is vulnerable to heatwaves, which may constrain populations. However, such reproductive-damage may be overestimated, if there is potential to adapt to elevated mean temperatures associated with climate change via evolution and/or acclimation. Here, we tested this to evaluate whether pre-exposures could improve heatwave tolerance (adaptation or acclimation), by experimentally evolving Tribolium castaneum populations to divergent thermal regimes (30 °C vs. 38 °C). Findings across assays revealed that relative to 30 °C-regime males, males from the 38 °C regime, maintained constantly at 8 °C warmer for 25 generations, displayed an increase; (i) in post heatwave (42 °C) reproductive fitness by 55%, (ii) survival by 33%, and (iii) 32% larger testes volumes. Unexpectedly, in the acclimation assay, warm-adapted males’ post-heatwave survival and reproduction were best if they experienced cool developmental acclimation beforehand, suggesting a cost to adapting to 38 °C. These results help progress knowledge of the potential for survival and reproduction to adapt to climate change; trait specific adaptation to divergent thermal regimes can occur over relatively few generations, but this capacity depended on the interaction of evolutionary and thermal acclimatory processes.
Article 2 Introduction and Chapeau
Authors: Paulus Andreas
Published: September 2024

This chapter evaluates Art 2 of the UN Charter. While the Preamble and Art 1 contain the goals, ends, and purposes of the United Nations, Art 2 covers the principles by which to achieve them. It provides legal ‘principles’ that create binding obligations of both the Organization and its members which, in the area of international peace and security, are also applied to non-members with regard to peace and security. These principles also delineate, to a certain extent, the jurisdiction of the Organization from the freedom of action of the ‘sovereign equals’. In practice, these principles may amount to a substantive foundation of the United Nations, but also of general international law, be it pursuant to the Charter as a treaty binding the UN membership or by way of custom or as general principles of law for non-members and international legal subjects that are not a State, in particular international organizations.
Article 2 (4)
Authors: Tams Christian
Published: September 2024

This chapter describes Art 2 (4) of the UN Charter. Article 2 (4) provides that ‘all Members shall refrain in their international relations from the threat or use of force against the territorial integrity or political independence of any state, or in any other manner inconsistent with the purposes of the United Nations’. The chapter outlines pre-Charter rules against force, highlighting that Art 2 (4) marked a new beginning, and summarizes the drafting history of the provision. It also analyses the scope and normative context of Art 2 (4). This attempt must remain selective, but it covers three central aspects: the relationship between the ban on force and its exceptions; the status of the ban as a customary rule of jus cogens; and core features of the legal regime governing breaches of Art 2 (4).
Article 5
Authors: Tams Christian
Published: September 2024

This chapter covers Art 5 of the UN Charter, which provides for the suspension of the rights and privileges of membership of member States against which enforcement or preventative action has been taken by the Security Council. Suspension is one of the ‘membership sanctions’ available to the United Nations and is thus regulated as part of Chapter II of the Charter (‘Membership’). Article 5 enables the UN to discipline a member State, so as to ensure that it does not prevent the Organization from discharging its function. In the view of the drafters, the Organization had to be able to exercise its powers against a State which posed a threat to or had breached international peace and security or committed an act of aggression without ‘procedural manoeuvring’ from that State. Article 5 was intended to ensure this; it thus serves a very specific, instrumental function but is not intended to permit the punishment of a member for past violation of Charter obligations. While Art 5 gives rise to some intricate problems of interpretation, it has played a limited role in practice.
Article 13
Authors: Reinisch August , Tropper Johannes
Published: September 2024

This chapter discusses Art 13 of the UN Charter. Pursuant to Art 13, the General Assembly has the power to initiate studies or make recommendations for promoting cooperation in the political, economic, social, and other fields, assisting in the realization of human rights and encouraging the progressive development of international law and its codification. By expressly conferring upon the GA the task of encouraging the progressive development of international law and its codification, Art 13 has become the starting point for the vast efforts deployed by the UN in this field. Codification and progressive development under the auspices of the GA cater to the practical needs of the community of States and the products of these processes, as well as the processes themselves, therefore also have diplomatic features in their nature and content. Apart from the progressive development of international law and its codification, Art 13 does not add much to the tasks which other Articles of the Charter confer upon the GA.
Article 18
Authors: Vöneky Silja
Published: September 2024

This chapter assesses Art 18 of the UN Charter, which is the central norm for the adoption of decisions by the General Assembly. It deals with both the voting rights of each member State as well as the majorities required. With regard to the latter, it differentiates between decisions on ‘important questions’ that require a two-thirds majority of the members present and voting, and decisions on ‘other questions’ that require a majority of the members present and voting. A further relevant source for the decision-making process within the GA are the Rules of Procedure which, inter alia, regulate the modalities of voting and reproduce the wording of the three paragraphs of Art 18. Ultimately, the general rule laid down in Art 18 applies to all decisions the GA is competent to make pursuant to the Charter, unless Articles that are more specific provide otherwise.
Article 21
Authors: Iwata Tomoko , Okimoto Keiichiro
Published: September 2024

This chapter explores Art 21 of the UN Charter. In any legislative organ, rules that govern the way in which the organ conducts its work and the procedural rights of its members are necessary in order for it to discharge its functions in an orderly manner. The General Assembly is no exception in this regard. Thus, Art 21 provides as follows: ‘The General Assembly shall adopt its own rules of procedure. It shall elect its President for each session’. The term ‘rules of procedure’ refers not only to the instrument entitled ‘Rules of procedure of the General Assembly’, but also to a number of other rules concerning procedure contained in GA resolutions and decisions. These rules of procedure are also supplemented by the practice of the GA concerning procedure.
Article 27
Authors: Zimmermann Andreas
Published: September 2024

This chapter details Art 27 of the UN Charter. Article 27 (1) provides that, subject to the veto power enshrined in Art 27 (3), each member of the Security Council has equal voting rights within the SC and thus excludes any (other) form of weighted voting. The exercise of the voting right in the SC depends on membership in the SC, as defined in Art 23, which in turn depends on membership in the Organization at large. The right under Art 27 (1) is thus automatically brought to an end where the State concerned loses its membership in the Organization by virtue of Art 6 or otherwise. Meanwhile, Art 27 (2) provides that the ‘decisions of the Security Council on procedural matters shall be made by an affirmative vote of nine members’.
Article 34
Authors: Schmalenbach Kirsten
Published: September 2024

This chapter covers Art 34 of the UN Charter. In Art 34, the UN Charter recognizes that the Security Council should know the facts underlying a dispute or conflict-prone situation before deciding on the next steps best suited to maintain international peace and security. Investigation, i.e. the systematic and formal searching for, as well as examining and ascertaining, of relevant facts from which a dispute or situation arises is an important precursor and assistive means of dispute settlement and conflict prevention. Indeed, factual clarity is a vital factor in any dispute-resolution strategy and, with respect to the SC, insufficient knowledge of the factual situation may jeopardize the legitimacy, authority, and effectiveness of any recommended settlement or enforcement measures. In practice, the UN uses the terms ‘investigations’, ‘fact-finding’, and ‘inquiry’ to a large extent as synonyms. As a matter of principle, the UN avoids using the term ‘intelligence’ as it implies undercover activities.
Article 35
Authors: Schmalenbach Kirsten
Published: September 2024

This chapter covers Art 35 of the UN Charter, which grants UN member and non-member States the right to communicate to the Security Council SC or General Assembly GA disputes or situations deemed necessary to be addressed by the two UN organs. It explains that Art 35 gives UN member States a comprehensive right of referral as they have a collective interest in the prevention and resolution of conflicts under the UN Charter. It also points out that non-member States can only have a comprehensive right of referral with respect to disputes to which they are a party. The chapter details how the right of referral turns into a duty for member States if they fail to peacefully settle their dispute. It discusses States vested with the right to make a referral under Art 35 that have the option to address either the SC or the GA.
Article 38
Authors: Giegerich Thomas
Published: September 2024

This chapter covers the recommendations of the Security Council to the parties with a view to pacific settlement of a dispute. It focuses on Art 38 which constitutes part of a compromise between the opposing concepts of the United States and of the Commonwealth States as to the proper role of the SC in dispute settlement. It also points out that Art 38 was based on an agreement among the governments of the Commonwealth States that the SC should have the power to recommend terms of settlement in serious disputes. The chapter explains how Art 38 extends the powers of the SC, including those that are not likely to endanger the maintenance of international peace and security. It identifies mediation by the SC as a peaceful means of dispute settlement available to the parties at their request.
Article 43
Authors: Krisch Nico , de Wet Erika
Published: September 2024

This chapter considers Art 43 of the UN Charter as one of the cornerstones of the new, centralized system of collective security. It discusses the members of the UN that must make armed forces available to the Security Council and to render assistance and accord relief for the maintenance of international peace and security. It also details the duty to render assistance in one or more agreements that contain specific provisions concerning the armed forces to be made available to the SC. The chapter reviews agreements that govern the numbers and types of forces, their degree of readiness and general location, and the nature of the facilities and assistance to be provided. It points out that agreements are concluded between the SC and the member States and are subject to ratification by the signatory States.
Article 45
Authors: Novak Gregor , Reinisch August
Published: September 2024

This chapter highlights Art 45 of the UN Charter that can only be understood against the background of the experiences of what was then a recent World War. It looks at the practice of the need for member States to contribute to or otherwise support the peacekeeping operations that have developed in parallel and can indirectly inform an interpretation of Art 45. It also explores the experience of the decisive role of air power in World War II that led to considerations in Dumbarton Oaks to put military force at the service of the system of collective security. The chapter discusses Western delegations that wanted the need for emergency air forces as envisaged by Art 45 to influence the content of the agreements to be concluded under Art 43. It reviews SC debates that concerned the need for member States to contribute or support peacekeeping operations.
Article 47
Authors: Novak Gregor , Reinisch August
Published: September 2024

This chapter highlights Art 47 of the UN Charter that creates the Military Staff Committee of the UN and regulates its composition and functions. It recounts how the Military Staff Committee ceased to play a meaningful role with the onset of the Cold War after some initial work on the implementation of the system. It also discusses the uncertain reactivation of the Military Staff Committee’s role in the broader context of the UN’s peacekeeping operations, which occurred in parallel with various discussions about the role of the Military Staff Committee and a proposal for its elimination. The chapter examines the Dumbarton Oaks Proposals that contained a provision on the Military Staff Committee that was fairly similar to Art 47. It looks at the discussion of regional representatives that led to the inclusion of Art 47 (4), enabling the Military Staff Committee to create regional sub-committees.
Article 48
Authors: Novak Gregor , Reinisch August
Published: September 2024

This chapter looks at Art 48 of the UN Charter, which constitutes an affirmation of members’ obligations to accept and carry out binding decisions of the Security Council. It explains how the SC has regularly adopted resolutions and issued presidential statements that invoke the obligations found in Art 48. It also considers Art 48 as the legal basis for various types of specific obligations required of member States to carry out decisions adopted by the SC. The chapter notes Art 48 (1), which allows the SC to limit duties to selected members, while Art 48 (2) makes an attempt to co-opt other international organizations into the UN peacekeeping system. It reviews the text of Art 48 which is limited to member States and indirectly refers to international agencies.
Article 49
Authors: Novak Gregor , Reinisch August
Published: September 2024

This chapter focuses on Art 49 of the UN Charter, which addresses the mutual assistance member States owe in carrying out decisions of the Security Council. It discusses Art 49 in UN practice that has acquired a meaning transcending Chapter VII. It also points out how the SC has frequently called on member States to cooperate with one another with respect to measures under Art 41 and requested mutual assistance from member States in respect of measures under Art 42. The chapter covers numerous SC decisions, resolutions, and discussions that can inform an interpretation of Art 49. It details how the SC has addressed its calls for mutual assistance to individual member States, all Member States, and member States acting through international, regional, and subregional organizations.
Article 51
Authors: Aust Helmut Philipp
Published: September 2024

This chapter discusses the prohibition of the use of force that is subject to two generally recognized exceptions: enforcement measures under Chapter VII of the Charter and the right to self-defence under Art 51 of the UN Charter. It analyses the requirements and conditions for the exercise of self-defence that are subject to significant debates among States and commentators. It also mentions international practice since 1945 that is contrary to the intentions of the drafters of the Charter and has continued to see a significant amount of the use of force by States. The chapter shows how, in principle, Art 51 allows individual States the threat or use of force only under certain stipulated conditions. It covers the right of self-defence laid down in Art 51 that has become the pivotal point on which disputes concerning the lawfulness of the use of force in interstate relations usually concentrate.
Article 60
Authors: Nesi Nicola , Waibel Michael
Published: September 2024

This chapter discusses Art 60 of the UN Charter, which allocates the competence for discharging the UN’s functions in the field of international economic and social cooperation squarely on the General Assembly. It emphasizes that Art 60 provides that the Economic and Social Council’s (ECOSOC) powers for the purposes of Chapter IX are coextensive with the powers set out in Chapter X on ECOSOC. It also looks at the text of Art 60 that expressly subordinates ECOSOC, one of the principal organs of the UN, to the GA. The chapter recounts the formulation of Art 60, which goes back to the Dumbarton Oaks Proposals that conceived ECOSOC as subordinate to the GA, rather than as a principal organ of the UN. It refers to ECOSOC as a residual legatee that operates in areas where no agency exists to avoid duplication.
Article 67
Authors: Röben Volker
Published: September 2024

This chapter discusses Art 67 of the UN Charter, which specifies eligibility to vote in the Economic and Social Council (ECOSOC), the object of voting, and the voting procedure. It discusses the fifty-four members of ECOSOC that are elected by the General Assembly for a three-year term that will have one vote in accordance with Art 67 (1). It also explains the equal weight of each member’s vote as provided in Art 67, which excludes weighted voting rights. The chapter looks at Art 67 (2) that specifies the object of the right to vote as decisions and resembles Art 89 that deals with the Trusteeship Council. It details the application of Art 67 to decisions of ECOSOC and of its committees and sessional bodies.
Article 69
Authors: Chaitidou Eleni , Landwehr Oliver
Published: September 2024

This chapter discusses the mechanism enshrined in Art 69 of the UN Charter by which members of the UN may participate in the deliberations of this principal organ of the UN. It explains how Art 69 systematically distinguishes the participation of members of the UN in the deliberations of ECOSOC from participation with respect to the specialized agencies. It also notes the Rules of Procedure of ECOSOC that provide for the participation of non-members of the UN in its deliberations and for the participation of non-members of its subsidiary organs in the deliberations of such bodies. The chapter reviews the power of Art 69 that allows ECOSOC to invite any member of the UN to participate in its deliberations on any matter of particular concern to that member. It highlights the intention of Art 69 to protect the interests of the members of the UN in deliberations of ECOSOC.
Article 72
Authors: Iwata Tomoko , Okimoto Keiichiro
Published: September 2024

This chapter focuses on Art 72 of the Charter of the United Nations. According to Art 72 (1) of the Charter, the Economic and Social Council (ECOSOC) shall adopt its own Rules of Procedure, including the method of selecting its President. The aforementioned Rules of Procedure are also supplemented by the practice of the Council concerning its working methods and other procedural matters. Meanwhile, the General Assembly has taken a series of decisions that have brought about major changes to the function of the Council, which started with resolution 68/1. The chapter also considers the effects of the Covid-19 pandemic on the proceedings of ECOSOC.
Article 73
Authors: Fastenrath Ulrich
Published: September 2024

This chapter discusses Chapter XI of the UN Charter. Chapter XI establishes the fundamental regulations for all territories whose peoples have not yet attained a full measure of self-government. Moreover, Art 73 of the Charter highlights the interests of a non-self-governing territory’s population. Although referred to as distinct peoples in Art 73 (b), the principle of equal rights and the right to self-determination in the form of independent statehood does not apply to inhabitants of these territories. The chapter then looks into the obligations of the administering powers, which includes the declaration regarding non-self-governing territories as a legally binding commitment.
Article 81
Authors: Goldmann Matthias
Published: September 2024

This chapter discusses Art 81 of the UN Charter. It outlines the content of the trust agreement in correlation with the designation of an authority and the terms of administration. As regards the administering authority, Art 81 regulates that a State, a group of States, and even the UN itself may serve as an administering authority. The chapter notes that the most heavily debated issue regarding trusteeship agreements was about the questions of administrative unions and provisions for the termination of trusteeship. It explains that trusteeship agreements left it to the discretion of the administering authority to apply those international conventions that it deemed appropriate to the trust territory in question.
Article 85
Authors: Goldmann Matthias
Published: September 2024

This chapter examines Art 85 of the Charter of the UN. It explains that the General Assembly regulated decisions concerning the trust territories and, in particular, approved the terms of the trusteeship agreements for all areas not designated as strategic. The GA lacked the competence to terminate trusteeships unilaterally without the consent of the administering authority; however, the SC, acting under Chapter VII, would have had the necessary powers to do so. The administration of the trust territory itself was under the supervision of the Trusteeship Council, which discussed reports from the administering authorities as well as any submitted petitions.
Article 93
Authors: d‘Argent Pierre
Published: September 2024

This chapter covers Art 93 of the UN Charter. It considers the parties to the ICJ Statute under Art 93 (1) and (2). The Statute is an integral part of the UN Charter as jurisdiction may be recognized according to the conditions determined therein. The ICJ is open to States which are not party to the Statute on conditions laid down by the Security Council, subject to the special provisions contained in treaties in force. The chapter explains that Art 93 of the UN Charter cannot be considered as having fallen in desuetude even if it only concerns conditions for acceding to the Statute.
Article 109
Authors: Vöneky Silja
Published: September 2024

This chapter covers Art 109 of the Charter of the UN. It clarifies that Art 109, according to its express wording, governs formal reviews and alteration of the Charter. Article 109 provides an extraordinary procedure for amendments requiring particular measures. The chapter elaborates on how Art 109 (3) provided special measures to facilitate the convocation of a conference in the event that none had been held before the tenth annual session of the General Assembly. It considers the argument that Art 109(3) has historical importance but that there is no actual need to delete it due to the lack of any legal implications.
Article 110
Authors: Vedder Christoph
Published: September 2024

This chapter explores Art 110 of the UN Charter. Article 110 establishes the three conditions under which the UN Charter becomes legally binding for the original members under international law: signature, ratification, and entry into force. Prescribing the procedures regulating the stages until the entry into force, the provision of Art 110 becomes legally binding upon signature of the Charter. The chapter highlights how Art 110(1) insists that the original UN Charter requires ratification. It discusses the continuation and termination of the original membership before looking into the impact of the EU’s observer status on the original membership of certain EU Member States.
Article 11
Authors: Schmahl Stefanie
Published: September 2024

This chapter studies Art 11 of the UN Charter, which defines in more detail the general authority of the General Assembly laid down in Art 10. Under Art 11 (1), ‘the General Assembly may consider the general principles of cooperation in the maintenance of international peace and security, including the principles governing disarmament and the regulation of armaments, and may make recommendations with regard to such principles to the Members or to the Security Council or to both’. Article 11 (2) deals with the powers of the GA in specific matters of maintenance of international peace and security and Art 11 (3) deals with the power of the GA to call the attention of the SC to situations likely to endanger international peace and security. Finally, Art 11 (4) attributes a general power of discussion and recommendation to the GA.
Direct and indirect effects of copepod grazers on community structure
Authors: Rigby Kristie , Berdalet Elisa , Berglund Carina , Roger Fabian , Steinke Michael , Saha Mahasweta , Grebner Wiebke , Brown Emily , John Uwe , Gamfeldt Lars , Fink Patrick , Berggren Fredrick , Selander Erik
Published: September 2024

Ecological theory and empirical research show that both direct lethal effects and indirect non-lethal effects can structure the composition of communities. While the direct effects of grazers on marine phytoplankton communities are well studied, their indirect effects are still poorly understood. Direct and indirect effects are inherently difficult to disentangle in plankton food webs. In this study we evaluate the indirect effects of copepod grazers on community function and structure using isolated chemical alarm signals, copepodamides. We expose intact summer and spring communities to direct grazing from copepods, or to chemical alarm cues without the presence of grazers in controlled experiments. The effects of direct grazing on ecosystem function were moderate in both experiments as indicated by levels of chlorophyll and primary production. Indirect and direct effects resulted in changes in the composition of both the eukaryote and prokaryote communities as shown by metabarcoding of 18S and 16S rRNA. Size structure analysis suggests that direct grazing and copepodamide exposure both favoured smaller organisms (< 10–15 μm) corroborating the size-structuring effect of copepod grazers. We conclude that the well-established effect of copepods on phytoplankton communities results from a combination of direct and indirect effects. This is a first attempt to isolate indirect effects of copepods on community structure and the results suggest that a full mechanistic understanding of the structuring effect of copepods will require insights to both direct and indirect effects of consumers as demonstrated for other ecosystems components.
Field kinematics of intermittent swimming in bluegill sunfish (Lepomis macrochirus)—pelagic locomotion and littoral maneuverability
Authors: Coughlin David J , Morris Catherine , Postupaka Dasha , Gee Paige , Reynolds Zoë , Wood Bradley
Published: September 2024

Objectives

Locomotion is essential for the survival of animals. Fishes have evolved mechanisms to minimize the cost of transport. For example, Bluegill Sunfish (Lepomis macrochirus) employ intermittent swimming, which involves swimming at relatively slow speeds with short propulsive bursts alternating with gliding episodes. This typically involves axial undulation powered by slow-twitch muscle, either with or without pectoral fin usage. The propulsive bursts are at higher tailbeat frequencies than observed for a given average speed with constant propulsion, and muscle physiology experiments show that the propulsive bursts produce relatively high power, while the glide reduces fatigue relative to continuous activity. However, Bluegill encounter complex 3D in-shore habitats, in which an intermittent swimming gait may enable successful capture of habitat-specific prey.

Methods

Field observations of Bluegill Sunfish were made via underwater videography in Lake Waban, Massachusetts.

Key Findings

In both pelagic and littoral habitats, Bluegill employed intermittent swimming. This provided the maneuverability and muscle activity needed to capture prey items suspended in the water column and enabled effective prey detection and maneuverability for feeding on sessile invertebrates in dense vegetation. Radio telemetry studies demonstrated that bluegill moved regularly between the pelagic and the littoral.

Conclusion

In both zones, intermittent swimming may provide both energetic and foraging advantages.
Short-term Outcomes in Infants after General Anesthesia with Low-dose Sevoflurane/Dexmedetomidine/Remifentanil versus Standard-dose Sevoflurane (the TREX Trial)
Authors: Saynhalath Rita , Disma Nicola , Taverner Fiona J. , von Ungern-Sternberg Britta S. , Andropoulos Dean , Ng Ann S. , Shields Benjamin B. , Izzo Francesca , Lee-Archer Paul , McCann Mary Ellen , Montagnini Luigi , Kuppers Beate , Lenares Elena , Sheppard Suzette , de Graaff Jurgen C. , Lee Katherine J. , Wang Xiaofang , Szmuk Peter , Davidson Andrew J. , Skowno Justin J. ,   on behalf of the TREX (Trial Remifentanil DEXmedetomidine) Consortium
Published: September 2024

Background:

The Trial Remifentanil DEXmedetomidine (TREX) trial aimed to determine whether, in children less than 2 yr old, low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia is superior to standard-dose sevoflurane anesthesia in terms of global cognitive function at 3 yr of age. The aim of the current secondary analyses was to compare incidence of intraoperative hypotension and bradycardia, postoperative pain, time to recovery, need for treatment of intraoperative hypotension and bradycardia, incidence of light anesthesia and need for treatment, need for postoperative pain medications, and morbidity and mortality outcomes at 5 days between the two arms.

Methods:

This phase III randomized active controlled, parallel group, assessor blinded, multicenter, superiority trial was performed in 20 centers in Australia, Italy, and the United States. A total of 455 infants less than 2 yr of age expected to undergo general anesthesia for at least 2 h were enrolled. They were randomized between low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia and standard-dose sevoflurane. The short-term perioperative outcomes noted above were compared between these two groups.

Results:

There was less hypotension (risk difference, −11.6%; 95% CI, −18.9 to −4.3%) and more bradycardia (risk difference, 18.2%; 95% CI, 8.8 to 27.7%) in the low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia compared to the standard-dose sevoflurane arm. There were more patients with episodes of light anesthesia (89 vs. 4), and protocol abandonments (1 vs. 0) in the low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia arm. Time from eye opening to postanesthesia care unit discharge was similar in both arms, as were morbidity and mortality. One patient in each arm suffered a life-threatening event, but neither suffered long-term sequelae.

Conclusions:

These early postoperative results suggest that in children less than 2 yr of age receiving greater than 2 h of general anesthesia, the low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia technique and the standard sevoflurane anesthesia technique are broadly clinically similar, with no clear evidence to support choosing one technique over the other.
Efficacy of Virtual Visitation in ICU During COVID-19 Pandemic: The ICU Visits Randomized Controlled Trial
Authors: Woo Hye Young , Oh Seung-Young , Lim Leerang , Im Hyunjae , Lee Hannah , Ha Eun Jin , Ryu Ho Geol
Published: September 2024

OBJECTIVES:

This study aimed to demonstrate the impact of virtual visits on the satisfaction of family members and the anxiety and depression of patients in the ICU during the COVID-19 pandemic.

DESIGN:

A single-center, randomized controlled trial.

SETTING:

This study was conducted from July 2021 to May 2022, in the Seoul National University Hospital

PATIENTS:

A total of 40 patients eligible for virtual visitation whose Richmond Agitation-Sedation Scale score was –2 or above were recruited and randomized into virtual visitation and usual care groups.

INTERVENTIONS:

Virtual visitation began on the first day after ICU admission and continued until ICU discharge, lasting for a maximum of 7 days.

MEASUREMENTS AND MAIN RESULTS:

The primary outcome was the satisfaction level of the family members with care and decision-making in the ICU, assessed using the Family Satisfaction-ICU (FS-ICU) 24-survey questionnaire. Secondary outcomes included patient anxiety and depression levels assessed using the Hospital Anxiety and Depression Scale (HADS), at the study enrollment after ICU admission and at the end of the study. After two patients were excluded due to clinical deterioration, 38 patients were ultimately analyzed, including 18 patients in the virtual visitation group and 20 patients in the usual care group. The FS-ICU 24 survey score was significantly higher in the virtual visitation group (89.1 ± 13.0 vs. 75.1 ± 17.7; p = 0.030). The reduction in HADS-Anxiety (59.4% vs. 15.39; p < 0.001) and HADS-Depression (64.5% vs. 24.2%; p < 0.001) scores between the two time points, from study enrollment after ICU admission to the end of the study was significantly larger in the virtual visitation group.

CONCLUSIONS:

In the COVID-19 pandemic era, virtual visits to ICU patients helped reduce depression and anxiety levels of patients and increase the satisfaction of their family members. Enhancing access to virtual visits for family members and developing a consistent approach may improve the quality of care during another pandemic.
Robotic-assisted Lymphovenous Anastomosis of the Central Lymphatic System
Authors: Grünherz Lisanne , Weinzierl Andrea , Gutschow Christian Alexander , Puippe Gilbert Dominique , Gnannt Ralph , von Reibnitz Donata , Gousopoulos Epameinondas , Barbon Carlotta , Giovanoli Pietro , Pieper Claus Christian , Lindenblatt Nicole
Published: September 2024

Background:

Recent advances in robotic microsurgery have enabled the application of robotic technology in central lymphatic reconstruction. Although the use of microsurgical robots demands careful consideration of associated costs and potentially prolonged operating times, it may offer improved surgical approaches and enhanced accessibility to deeper anatomical structures such as the thoracic duct (TD).

Methods:

We report on successful reconstruction of the central lymphatic system using the Symani Surgical System in four patients with lesions of the central lymphatic system. The patients were of different age (range: 8 mo–60 y) and had variable conditions, including central conducting lymphatic anomaly and other rare anomalies of the central lymphatic pathways.

Results:

Depending on the underlying pathology, a cervical access (n = 1) or median laparotomy (n = 3) was chosen to access the TD and perform anastomosis with a nearby vein. In all patients, anastomoses were patent, and chyle leakage decreased postoperatively. From a surgical perspective, the Symani Surgical System improved the precision of the microsurgeon and accessibility to the deep-lying TD.

Conclusion:

Considering the high morbidity and rarity of pathologies of the central lymphatic system, robotic-assisted microsurgery holds substantial promise in expanding and improving the microsurgical treatment for central lymphatic anomalies.
Clinical characteristics and prognosis of pancreatic metastases: a 10-year retrospective study.
Authors: Yu Yichen , Wu Jiahao , Guo Wenyi , Li Chengqing , Wang Lei , Xu Jianwei
Published: September 2024

Background:

Pancreatic metastasis is rare. Its characteristics have primarily been described in autopsy studies and case reports, which may not accurately reflect the actual clinical profiles. Moreover, few studies have addressed the prognostic feature in patients with pancreatic metastasis.

Methods:

Cases of pancreatic metastases that were diagnosed by the multidisciplinary tumor board from September 2013 to July 2023 at our hospital were collected and analyzed.

Results:

A total of 77 cases were collected. The most common primary tumor sites were the lung (35.1%) and kidney (23.4%). Clear cell renal carcinoma (CCRC) accounted for 23.4% of cases, making it the most common histological type, followed by small cell lung cancer (SCLC, 16.9%). Among the cases, 36.4% (28 cases) presented with organ-related symptoms, and 70.4% (57 cases) were solitary metastases. Metachronous metastases accounted for 70.1% (54 cases), with an average interval of 62.7 ± 74.4 months between the diagnosis of the primary tumor and metastasis. The overall survival (OS) of the collected cases was 42 months. The overall survival (OS) for all cases was 42 months. OS varied by primary tumor type, with pancreatic metastases secondary to lung, kidney, digestive tract, and gynecological cancers showing OS of 23, 81, 11, and 32 months, respectively. Subgroup analysis indicated that 15 cases secondary to the CRCC were metachronous with an average interval of 132.4 ± 83.9 months from initial diagnosis to metastasis, who had an OS of 80 months. Radical resection was performed in 10 of these cases, increasing the OS to 91 months.

Conclusion:

Pancreatic metastasis was uncommon and imperceptible. The prognosis of patients depended on the primary tumor type and the timing of metastasis. Pancreatic metastases secondary to CCRC were the most frequent and had the most favorable prognosis. Radical resection of the metachronous metastases prolonged survival. This study described the real-world clinical profiles of pancreatic metastases, providing valuable insights to reduce misdiagnosis and guide treatment decisions.
Smoking and sudden cardiac death in patients with previous coronary artery disease
Authors: Järvensivu-Koivunen Minna , Hernesniemi Jussi , Tynkkynen Juho
Published: September 2024

Background

Smoking is a known risk for sudden cardiac death (SCD) in the general population. However, its significance in patients with acute coronary syndrome (ACS), a condition that also elevates the risk of SCD, is disputable.

Methods

A total of 9704 consecutive ACS patients with available smoking data were included in the analysis. Comprehensive patient data were obtained from the Mass Data in Detection and Prevention of Serious Adverse Events in Cardiovascular Disease research database. A composite endpoint of SCD, SCD aborted by successful resuscitation and accurate implantable cardioverter defibrillator therapy to otherwise potentially fatal ventricular fibrillation/ventricular tachycardia was used. Univariate, age- and sex-adjusted, and a multivariate fine-gray competing risk regression with adjustment to traditional risk factors was conducted.

Results

Median follow-up time was 6.8 years (IQR, 4.1–10.2), and 454 (4.7%) SCD cases were identified. At the baseline, 23.7% (N = 2444) were active smokers, and 20.8% (N = 2146) were ex-smokers. In the multivariate model, active smokers had an elevated risk of 1.79 (95% CI, 1.41–2.27; P < 0.001) for future SCD. Ex-smokers had no elevated risk for SCD in fine-gray subdistribution hazard. Also, active smokers were notably younger (mean age 58.7 years) than non- or ex-smokers (71.1 years and 68.9 years, respectively, P < 0.001 for both comparisons).

Conclusion

Active smokers had a 79% higher risk of SCD when compared with nonsmokers. Smoking cessation should be heavily encouraged after ACS. Also, a person’s smoking status should be considered in further studies developing SCD and implantable cardioverter defibrillator-benefit risk scores.