bluuebunny/crossref_metadata_2025 huggingface dataset:
An Equivalent to Article 8(2)(b)(xx) icc Statute for Non-International Armed Conflicts? Is it Warranted on the Basis of International Customary Law?
Authors: de Vries Barry
Published: June 2021

The Rome Statute has often been criticized for not following international customary law, with calls to more closely resemble this being relatively frequent. This is especially the case in the distinction made between international and non-international armed conflicts and the significant fewer war crimes applicable to non-international armed conflicts. One of the most apparent differences is in the lack of a provision criminalizing the employment of weapons that go against the general principles of weapons law in humanitarian law. This article seeks to address this critique by determining whether the lack of this criminalization in non-international armed conflicts is contrary to customary international law and if this divergence should be amended.
Structural Injustice and the Tyranny of Scales
Authors: Sankaran Kirun
Published: June 2021

What features of structural injustice distinguish it from mere collections of injustices committed by individuals? I argue that the standard model of moral judgment that centers agents and actions fails to adequately articulate what’s gone wrong in cases of structural injustice. It fails because features of the social world that arise only at large scale are normatively salient, but unaccounted for by the standard model. I illustrate these features with historical examples of normatively-different outcomes driven by institutional structure rather, holding fixed characteristics of agents’ motivations. I then defend the view from reductionist objections.
Debate: Donald Trump and Fascism Studies
Authors: Jackson Paul Nicholas
Published: June 2021

Since coming to prominence, Donald Trump’s politics has regularly been likened to fascism. Many experts within fascism studies have tried to engage with wider media and political debates on the relevance (or otherwise) of such comparisons. In the debate ‘Donald Trump and Fascism Studies’ we have invited leading academics with connections to the journal and those who are familiar with debates within fascism studies, to offer thoughts on how to consider the complex relationship between fascism, the politics of Donald Trump, and the wider maga movement. Contributors to this debat are: Mattias Gardell, Ruth Wodak, Benjamin R. Teitelbaum, David Renton, Nigel Copsey, Raul Cârstocea, Maria Bucur, Brian Hughes, and Roger Griffin.
Codification of Civil Legislation: At the Turn of the Era
Authors: Dovgert Anatolii S. , Kalakura Viktor Ya. , Vasylyna Nataliia V.
Published: June 2021

The article examines the recodification of the Civil Code of Ukraine as a new stage in the codification of civil law in Ukraine, and identifies the presence and sufficiency of certain factors and prerequisites for starting this process. The purpose of this article is to clarify the presence and sufficiency of certain factors and prerequisites for initiating the process of upgrading the Civil Code of Ukraine. In this research, the authors relied on a dialectical method of cognition and the formal-legal method. A large regulatory framework was used to write this article – international treaties, acts of the EU, the Civil Code of Ukraine and other countries. This article may be useful for scholars who study the theoretical foundations of the codification of law in general and the codification of civil law in particular. Ideas of the article can be used by judges, lawyers and practising lawyers in their activities.
The State as a Party to Private Law Relations
Authors: Оnishchenko Nataliya M. , Tarakhonych Tatyana I. , Bohinich Oleh L.
Published: June 2021

The purpose of the study is to cover the analysis of the legal position of the state in private law relations. Particular attention is paid to the dualistic nature of the state – as a sovereign and as a horizontal participant in civil law relations. The study employs the following methods: dialectical, technical and comparative law. Results of the systematic interpretation suggest that the state does not have the status of a person, which complicates the application of some legal structures. It is concluded that the state is a multi-stage entity that includes the state of Ukraine, the Autonomous Republic of Crimea and territorial communities. This paper will be useful for advocates, judges, academics whose area of expertise is the problematics of the liability law, as well as the issue of harmonisation of the civil legislation of Ukraine with the civil legislation of the EU countries.
The Problems of Determining the Time and Legal Consequences of the Occurrence of the Human Right to Life and Health in the Context of Recoding the Civil Law of Ukraine
Authors: Yarotskiy Vitaly L. , Fedorchenko Nataliia V. , Puchkovska Iryna I.
Published: June 2021

The article is devoted to the consideration of the problem of determining the time when a person’s right to life and health arises. Excluding from the criteria the point at which a person acquires the right to life would strengthen the civil legal protection of the relevant subjective civil law. This may lead to the need to recognise, as the time of occurrence of the right to inheritance, that the accumulation of the composition of these circumstances cannot exist without legal capacity. It is proposed to introduce into the categorical apparatus of civil law the concept of ‘special civil capacity’. The emergence of special civil capacity and a subjective civil right to life will be linked to the above circumstances; the ability to have other subjective civil rights will be associated with the fact of birth.
Trends in the Development of Property Law: The Civil Law of Ukraine and the Experience of European Union Countries
Authors: Tashian Roman I. , Karnaukh Bohdan P. , Dzera Iryna O.
Published: June 2021

The article deals with the problems of the development of property law in the legislation of Ukraine considering the experience of the countries of the European Union (EU). It is emphasised that the development of property law of Ukraine is determined primarily by the European tendencies of harmonisation, convergence and Europeanisation of the rights of EU Member States. The scientific doctrine of EU countries in the field of development and improvement of property law has been researched. The authors extrapolate the experience of regulation of property law in the EU countries on the development of the legal system of Ukraine. The principles of European property law are analysed: these are the principles of specificity, openness and transparency. It is concluded that recognising the existence of an EU system of substantive law will allow introducing appropriate substantive remedies that can successfully exist in addition to legal obligations.
The Reform of Civil Legislation on Legal Liability
Authors: Prytyka Yurii D. , Khomenko Mykhailo M. , Bulat Ievgeniia A.
Published: June 2021

The article is devoted to the research of the institute of civil liability through the prism of recoding of the civil legislation of Ukraine. Particular attention is paid to the experience of a number of European Union countries in reforming civil legislation. The study used the following methods: dialectical, formal and legal, comparative legal. In the process of future recoding of the civil legislation of Ukraine, it is proposed to focus the attention of the expert community on the following problems: defining a system of non-contractual obligations; overcoming the dominance of blanket norms in the main act of civil law; revision of fundamental approaches to terms of exemption from civil liability; full revision of the rules governing liability for breach of monetary obligations; the need to enshrine pre-contractual liability rules; the implementation of institution of collective redress in substantive civil law; rethinking of approaches to the regulation of conditioning obligations.
Threading the Sovereign’s Needle
Authors: Leventhal Alexander G.
Published: June 2021

An investor-State tribunal enjoys significant authority once a dispute is referred to it. Among a tribunal’s unquestioned powers is the power to order interim relief—including with respect to the most sovereign of a State’s conduct: its enforcement of its criminal law. In exercising these powers, an investor-State tribunal goes beyond the role traditionally assigned to it—i.e. to award damages for prejudice caused by a treaty breach—and dictates sovereign conduct. While the applicable treaty, arbitral rules, or law of the seat may not offer specific instructions, arbitral tribunals deciding on such interim relief requests can rely on a significant body of case law. That case law reflects a coherent approach to a thorny question, even though outcomes may vary. This article will deconstruct that coherent approach—from the foundations of the tribunal’s authority to order interim relief in respect to pendant criminal proceedings, to the rights that such relief may protect, to the requirements for ordering such relief, as well the effect of such relief and its duration in addition to any recourse for non-compliance.
Paradictyocheirospora tectonae, a novel genus in the family Dictyosporiaceae from India
Authors: RAJESHKUMAR KUNHIRAMAN C. , VERMA RAJNISH K. , BOONMEE SARANYAPHAT , CHANDRASIRI SAJINI , HYDE KEVIN D. , ASHTEKAR NIKHIL , LAD SNEHA , WIJAYAWARDENE NALIN N.
Published: June 2021

This study introduces, Paradictyocheirospora, a new genus, belonging to the family Dictyosporiaceae with evidence from morphology and phylogenetic analysis of a combined ITS, LSU and TEF1α sequence data. Paradictyocheirospora can be distinguished from allied taxa based on dictyosporous, cheiroid conidia with suprabasal bubble-like hyaline appendages and cylindrical, reduced conidiophores. The new genus is similar to Dictyocheirospora; however, the conidia are smaller with fewer rows (3–6) and have globose, supra-basal appendages. Paradictyocheirospora tectonae forms a distinct lineage basal to Digitodesmium and Dictyocheirospora. Additional new collections from Thane, Maharashtra were morphologically identical and phylogenetically related to Dictyocheirospora nabanheensis, and the latter is a new record from India.
Cunninghamella saisamornae (Cunninghamellaceae, Mucorales), a new soil fungus from northern Thailand
Authors: SUWANNARACH NAKARIN , KUMLA JATURONG , SUPO CHANTANA , HONDA YOICHI , NAKAZAWA TAKEHITO , KHANONGNUCH CHARTCHAI , WONGPUTTISIN PAIROTE
Published: June 2021

A new endophytic fungus, described herein as Cunninghamella saisamornae, was isolated from soil collected from Chiang Mai Province, Thailand. This species was distinguished from the previously described Cunninghamella species by the presence of a chlamydospore formation, the lack of a zygospore stage and a maximum growth temperature of 45°C. Multi-gene phylogenetic analysis of internal transcribed spacers (ITS) and large subunit (LSU) of the nuclear ribosomal DNA (rDNA), along with the translation elongation factor 1-alpha (tef-1) genes, support the finding that C. saisamornae is distinct from other species within the genus Cunninghamella. A full description, color photographs, illustrations and a phylogenetic tree showing the position of C. saisamornae are provided.
Psolidium kharlamenkoi—a new species of holothurian (Holothuroidea: Dendrochirotida: Psolidae) from the Kuril Islands
Authors: PANINA ELENA G. , STEPANOV VADIM G. , MARTYNOV ALEXANDER V.
Published: June 2021

A new species, Psolidium kharlamenkoi n. sp. (Echinodermata: Dendrochirotida: Psolidae) is described from the Kuril Islands. The new species is distinguished from all previously described species of the genus Psolidium by combination of the external features, ossicles morphology and coloration.
Two new earthworms of the Pheretima sangirensis species group (Clitellata: Megascolecidae) from Mountain Province, Philippines
Authors: HONG YONG , JAMES SAMUEL W.
Published: June 2021

Two new species of the genus Pheretima are described from Mt. Amuyao and Mt. Lamagan, Mountain Province, Philippines, namely Pheretima riparianensis sp. nov. and Pheretima bontocensis sp. nov. Both new species belong to the P. sangirensis species group characterized by having only one pair of spermathecal pores in 7/8. Pheretima riparianensis sp. nov. has distance between spermathecal pores 1–2 mm; copulatory bursae openings 0.11 circumference ventrally apart. Pheretima bontocensis sp. nov. has distance between spermathecal pores 1.4 mm; copulatory bursae openings 0.10 circumference ventrally apart.
Data-driven analysis of climate change in Saudi Arabia: trends in temperature extremes and human comfort indicators
Authors: Odnoletkova Natalia , Patzek Tadeusz W.
Published: June 2021

We have analyzed the long-term temperature trends and extreme temperature events in Saudi Arabia between 1979 and 2019. Our study relies on the high resolution, consistent and complete ERA5 reanalysis data from the European Centre for Medium-Range Weather Forecasts (ECMWF). We evaluated linear trends in several climate descriptors, including temperature, dewpoint temperature, thermal comfort and extreme event indices. Previous works on this topic used data from weather station observations over limited time intervals and did not include temperature data for recent years. The years 2010-2019 have been the warmest decade ever observed by instrumental temperature monitoring and comprise the eight warmest years on record. Therefore the earlier results may be incomplete and their results no longer relevant. Our findings indicate that over the past four decades, Saudi Arabia has warmed up at a rate that is 50% higher than the rest of land mass in the Northern Hemisphere. Moreover, moisture content of the air has significantly increased in the region. The increases of temperature and humidity have resulted in the soaring of dew point temperature and thermal discomfort across the country. These increases are more substantial during summers, which are already very hot compared to winters. Such changes may be dangerous to people over vast areas of the country. If the current trend persists into the future, human survival in the region will be impossible without continuous access to air conditioning.
A calculation method and experiment study of high-pressure common rail injection rate with solenoid injectors
Authors: Gao Ziguang , Li Guoxiu , Xu Chunlong , Li Hongmeng , Wang Min
Published: June 2021

The high-pressure common rail system has been widely used owing to its precise control of fuel injection rate profile, which plays a decisive role in cylinder combustion, atomization, and emission. The fuel injection rate profile of high-pressure common rail system was studied, and a fuel injection rate profile calculation model is proposed. The model treats the injector as a black box. Some measured data are needed to calculate the parameters in the model. The rise and fall of injection rate is regarded as trigonometric function to reduce the complexity and increase the accuracy. The model was verified using two different types of fuel injectors. The model calculation results were evaluated under various data input conditions. The results show that the model has good applicability to different input data and injectors. In addition, because the model building requires a large amount of experimental data, a comprehensive analysis of various input data was also conducted. The injection profile was analyzed from a new perspective and the regularity of injection rate profile was established.
Impact of Parthanatos on the Increased Risk of Onset and Mortality in Male Patients With Pulmonary Hypertension
Authors: Lv Zhen-Chun , Li Fei , Wang Lan , Zhao Qin-Hua , Gang Gong-Su , Wu Yue , Miao Yu-Qing , Yuan Ping
Published: June 2021

There have been no studies as to whether parthanatos, a poly (adenosine diphosphate-ribose) polymerase-1 (PARP-1)-dependent and apoptosis-inducing factor (AIF)-mediated caspase-independent programmed cell death, is present in pulmonary hypertension (PH). Basic studies have, however, been conducted on several of the key molecules in parthanatos, such as PARP-1, AIF, and macrophage migration inhibitory factor (MIF). For this study, we collected blood samples from 88 incident male patients with PH and 50 healthy controls at the Shanghai Pulmonary Hospital. We measured the key factors of parthanatos (PARP-1, PAR, AIF, and MIF) by enzyme-linked immunosorbent assay and performed a logistic regression, Cox proportional hazards analysis, and Kaplan–Meier test to assess the prognostic value of the key molecules in diagnosing and predicting survival. The patients who ultimately died had a significantly poorer clinical status during the study than those who survived. The PARP-1, PAR, AIF, and MIF levels were significantly higher in the patients than in the controls (all p < .0001), and the PARP-1, PAR, and AIF levels were higher in the nonsurvivors than in the survivors (all p < .0001). PARP-1 and AIF levels served as independent predictors of disease onset and mortality in these patients (all p < .005). Patients with PARP-1 levels <11.24 ng/mL or AIF levels <1.459 pg/mL had significantly better survival than those with higher PARP-1 or AIF levels ( p < .0001). Circulating levels of PARP-1 and AIF were independent predictors for PH onset and mortality, which indicated that parthanatos might be associated with the pathogenesis of PH.
Assessment of the anti-norovirus activity in cell culture using the mouse norovirus: Identification of active compounds
Authors: Van Dycke Jana , Rymenants Jasper , Neyts Johan , Rocha-Pereira Joana
Published: June 2021

Human norovirus is the main cause of viral gastroenteritis, resulting annually in ∼ 700 million infections and 200,000 deaths, of whom most are children <5 years. Mouse norovirus-infected macrophages are the most widely used in vitro system to screen and characterize the antiviral effect of norovirus-targeting small molecules. We have previously established antiviral assays using this system, identified novel inhibitors and performed additional studies in order to have a first insight into their mechanism of action. As potent and safe anti-norovirus small molecules are urgently needed, we here describe the detailed protocol for a set of assays that will allow the identification of novel norovirus inhibitors.
Continuous flow insufflation of oxygen compared with manual ventilation during out-of-hospital cardiac arrest: A survey of the paramedics
Authors: Groulx Mathieu , Nadeau Alexandra , Émond Marcel , Harrisson Jessica , Blanchard Pierre-Gilles , Eramian Douglas , Mercier Eric
Published: June 2021

Introduction:

In 2018, a continuous flow insufflation of oxygen (CFIO) device (b-card™, Vygon (USA)) placed on a supraglottic airway (SGA) became the standard of care to ventilate patients during adult out-of-hospital cardiac arrest (OHCA) care in Quebec–Capitale-Nationale region, Canada. This study aims to assess the paramedics’ perception as well as the disadvantages and the benefits relative to the use of CFIO during OHCA management.

Methods:

An invitation to complete an online survey (Survey Monkey™) was sent to all 560 paramedics who are working in our region. The survey included 22 questions of which 9 aimed to compare the traditional manual ventilation with a bag to the CFIO using a 5-point Likert-type scale.

Results:

A total of 244 paramedics completed the survey, of which 189 (77.5%) had used the CFIO device during an OHCA at least once. Most respondents felt that the intervention was faster (70.2%) and easier (86.5%) with the CFIO device compared with manual ventilation. CFIO was also associated with perceived increased patient safety (64.4%) as well as paramedic safety during the evacuation (88.9%) and the ambulance transport (88.9%). Paramedics reported that physical (48.1%) and cognitive (52.9%) fatigue were also improved with CFIO. The main reported barriers were the bending of the external SGA tube and the loss of capnography values.

Conclusion:

The use of CFIO during adult OHCA care allows a simplified approach and was perceived as safer for the patient and the paramedics compared with manual ventilation. Its impact on patient-centred outcomes needs to be assessed.
Varieties of citizenship in regional organisations: A cross-regional comparison of rights, access, and belonging
Authors: Weinrich Amalie Ravn
Published: June 2021

This paper explores the variation of citizenship in eight regional organisations (ROs). Since the 1980s, ROs have increasingly served as spaces for developing, regulating, and providing citizenship. However, current literature primarily takes a rights-based approach and focuses on a narrow set of cases without providing an account for the variation of citizenship in ROs. This paper offers a broad, conceptual approach to the study of regional citizenship and deploys a three-tiered conceptual framework consisting of rights, access, and belonging, to analyse how citizenship varies across different ROs. It challenges the current theorisation of regional citizenship, which is primarily rooted in the study of the EU’s rights-based approach. The analysis contributes to citizenship studies and comparative regionalism. It shows how citizenship varies across ROs, thus providing the first comprehensive cross-regional comparison. The empirical findings lead to the following insights. First, citizenship in regional organisations can be conceptualised as constitutional or practice-based. Second, there are different pathways to regional citizenship where practices might precede law or where citizenship in ROs remains a practice-based concept. Third, there is variation in the link between national and regional citizenship and how ROs provide access to regional citizenship.
Amish Burn Treatment Meets a Major Trauma Centre: Success With Cooperation
Authors: Weber Christina , Corneman Alex , Cin Arianna Dal
Published: June 2021

The Canadian Charter of Freedom and Rights asks us to be mindful of cultural or religious requests when providing healthcare, however alternative medicine is not commonly considered during acute burn resuscitation despite the value patients may place in it. We present a case study of a 46-year-old Amish gentleman with 22% TBSA (TotalBody Surface Area) deep thermal burns who requested traditional Amish burn wound treatment administered by his community elders while an inpatient at our academic burn centre. This case report illustrates the possibility of successful burn wound healing while respecting the traditional cultural beliefs of a patient and his community. Very little is found in the literature to date that describes the blending of traditional and novel treatments in an academic centre, and this largely unstudied area of medicine may present an opportunity for innovation and further discussion about the incorporation of alternative medicine in burn care.
CGRP induces migraine-like symptoms in mice during both the active and inactive phases
Authors: Wattiez Anne-Sophie , Gaul Olivia J. , Kuburas Adisa , Zorrilla Erik , Waite Jayme S. , Mason Bianca N. , Castonguay William C. , Wang Mengya , Robertson Bennett R. , Russo Andrew F.
Published: June 2021

Background

Circadian patterns of migraine attacks have been reported by patients but remain understudied. In animal models, circadian phases are generally not taken into consideration. In particular, rodents are nocturnal animals, yet they are most often tested during their inactive phase during the day. This study aims to test the validity of CGRP-induced behavioral changes in mice by comparing responses during the active and inactive phases.

Methods

Male and female mice of the outbred CD1 strain were administered vehicle (PBS) or CGRP (0.1 mg/kg, i.p.) to induce migraine-like symptoms. Animals were tested for activity (homecage movement and voluntary wheel running), light aversive behavior, and spontaneous pain at different times of the day and night.

Results

Peripheral administration of CGRP decreased the activity of mice during the first hour after administration, induced light aversive behavior, and spontaneous pain during that same period of time. Both phenotypes were observed no matter what time of the day or night they were assessed.

Conclusions

A decrease in wheel activity is an additional clinically relevant phenotype observed in this model, which is reminiscent of the reduction in normal physical activity observed in migraine patients. The ability of peripheral CGRP to induce migraine-like symptoms in mice is independent of the phase of the circadian cycle. Therefore, preclinical assessment of migraine-like phenotypes can likely be done during the more convenient inactive phase of mice.
Severe pantothenic acid deficiency induces alterations in the intestinal mucosal proteome of starter Pekin ducks
Authors: Tang Jing , Feng Yulong , Zhang Bo , Wu Yongbao , Guo Zhanbao , Liang Suyun , Zhou Zhengkui , Xie Ming , Hou Shuisheng
Published: June 2021

Background

Pantothenic acid deficiency (PAD) results in growth depression and intestinal hypofunction of animals. However, the underlying molecular mechanisms remain to be elucidated. Mucosal proteome might reflect dietary influences on physiological processes.

Results

A total of 128 white Pekin ducks of one-day-old were randomly assigned to two groups, fed either a PAD or a pantothenic acid adequate (control, CON) diet. After a 16-day feeding period, two ducks from each replicate were sampled to measure plasma parameters, intestinal morphology, and mucosal proteome. Compared to the CON group, high mortality, growth retardation, fasting hypoglycemia, reduced plasma insulin, and oxidative stress were observed in the PAD group. Furthermore, PAD induced morphological alterations of the small intestine indicated by reduced villus height and villus surface area of duodenum, jejunum, and ileum. The duodenum mucosal proteome of ducks showed that 198 proteins were up-regulated and 223 proteins were down-regulated (> 1.5-fold change) in the PAD group compared to those in the CON group. Selected proteins were confirmed by Western blotting. Pathway analysis of these proteins exhibited the suppression of glycolysis and gluconeogenesis, fatty acid beta oxidation, tricarboxylic acid cycle, oxidative phosphorylation, oxidative stress, and intestinal absorption in the PAD group, indicating impaired energy generation and abnormal intestinal absorption. We also show that nine out of eleven proteins involved in regulation of actin cytoskeleton were up-regulated by PAD, probably indicates reduced intestinal integrity.

Conclusion

PAD leads to growth depression and intestinal hypofunction of ducks, which are associated with impaired energy generation, abnormal intestinal absorption, and regulation of actin cytoskeleton processes. These findings provide insights into the mechanisms of intestinal hypofunction induced by PAD.
Contemporary procedure characteristics and outcomes of accessory atrioventricular pathway ablations in an integrated community-based health care system using a tiered approach
Authors: Young Charlie , Kwan Annie , Yepez Lisa , McCarty Meghan , Chan Amanda , Hsu Dora , Han Jennifer , Taneja Taresh , Park Shirley , Hayward Robert , Liu Taylor I.
Published: June 2021

Background

Since the early descriptions of large series of accessory atrioventricular pathway ablations in adults and adolescents over 20 years ago, there have been limited published reports based on more recent experiences of large referral centers. We aimed to characterize accessory pathway distribution and features in a large community-based population that influence ablation outcomes using a tiered approach to ablation.

Methods

Retrospective analysis of 289 patients (age 14–81) who underwent accessory ablation from 2015–2019 was performed. Pathways were categorized into anteroseptal, left freewall, posteroseptal, and right freewall locations. We analyzed patient and pathway features to identify factors associated with prolonged procedure time parameters.

Results

Initial ablation success rate was 94.7% with long-term success rate of 93.4% and median follow-up of 931 days. Accessory pathways were in left freewall (61.6%), posteroseptal (24.6%), right freewall (9.6%), and anteroseptal (4.3%) locations. Procedure outcome was dependent on pathway location. Acute success was highest for left freewall pathways (97.1%) with lowest case times (144 ± 68 min) and fluoroscopy times (15 ± 19 min). Longest procedure time parameters were seen with anteroseptal, left anterolateral, epicardial-coronary sinus, and right anterolateral pathway ablations.

Conclusions

In this community-based adult and adolescent population, majority of the accessory pathways are in the left freewall and posteroseptal region and tend to be more easily ablated. A tiered approach with initial use of standard ablation equipment before the deployment of more advance tools, such as irrigated tips and 3D mapping, is cost effective without sacrificing overall efficacy.
Incidence rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries: a retrospective cohort study
Authors: Abboud Anna-Eliane , Boudabbous Sana , Andereggen Elisabeth , de Foy Michaël , Ansorge Alexandre , Gamulin Axel
Published: June 2021

Background

The aim of this study was to determine the rate and topography of intra-pelvic arterial lesions associated with high-energy blunt pelvic ring injuries (PRI).

Methods

This retrospective cohort study was conducted in a level I trauma center serving 500,000 inhabitants. A total of 127 consecutive patients with high-energy blunt PRI were included between January 1st, 2014 and December 31st, 2017. Every patient had a total body or thoraco-abdominal computed tomography scan including contrast enhanced arterial sequences. A board-certified radiologist reviewed all the vascular images and precisely described every intra-pelvic arterial lesion in terms of localization. Complete pelvic series (standard radiographs and fine cut computed tomography images) were reviewed by three board-certified orthopedic surgeons experienced in PRI management, and Young and Burgess and AO/OTA classifications were determined. Demographic, clinical, therapeutic and outcome data were extracted from the institutional severely injured patients’ registry.

Results

Patients’ mean age was 45.3 years and 58.3% were males. Fifteen (11.8%) had a total of 21 intra-pelvic arterial lesions: seven lesions of the obturator artery, four of the superior gluteal artery, three of the inferior gluteal artery, two of the vesical artery, and one of each of the following arteries: internal iliac, internal pudendal, fifth lumbar, lateral sacral, ilio-lumbar. These lesions occurred in 8.6% of lateral compression injuries, 33.3% of anteroposterior compression injuries and 23.5% of vertical shear and combined mechanism injuries (Young and Burgess classification, p = 0.003); and in 0% of type A injuries, 9.9% of type B injuries and 35% of type C injuries (AO/OTA classification, p = 0.001). Patients with an intra-pelvic arterial lesion were more likely to present with pre-hospital hemodynamic instability (p = 0.046) and to need packed red blood cells transfusion within the first 24 h (p = 0.023; they needed a mean of 7.53 units vs. 1.88, p = 0.0016); however, they did not have a worst outcome in terms of complications or mortality.

Conclusions

This systematic study found an 11.8% rate of intra-pelvic arterial lesion related to high-energy blunt PRI. The obturator, superior gluteal and inferior gluteal arteries were most often injured. These findings are important for the aggressive management of high-energy blunt PRI.
Knowledge, attitude and practice of dentists toward providing care to the geriatric patients
Authors: Tahani Bahareh , Manesh Skekoufeh Sedaghat
Published: June 2021

Background

Tooth loss, systemic diseases and medications add to the complexity of the oral conditions in geriatric popuation, making this age group a special group in need of specific preventive and curative oral health care. Therefore, the dental teams need to be equipped with specific knowledge and skills to provide the appropriate dental care. This study was iaimed to assess the knowledge, attitude, practice and willingness of general dentists to provide dental care to geriatric patients.

Methods

This cross-sectional study was conducted on 231 dentists using a questionnaire including demographic characteristics, knowledge, attitude and practice sections. The availability of the facilities for providing services to the older people in the office was also evaluated. Data were fed into SPSS-22 and analysed using descriptive statistics, t-test, Chi-squared, ANOVA and correlation coefficient tests (α = 0.05).

Results

62.8% of the participants were women and their mean age was 34. 4±8. 1 years. The knowledge mean score was 13.3± 2.9 (out of 30). 86. 5% of the participants had moderate knowledge, and 2.6% displayed good knowledge. The mean score related to the attitudes toward geriatric was 55.8 ± 6. 1 (out of 85), which was not significantly different based on gender. The mean score of practice was 21. 4± 4.3. There was a significantly positive correlation between knowledge and attitude. Dentists with a higher knowledge score had moderately a more positive attitude towards the older people (R = 0.33,p_ value < 0.001). However, over 60% preferred to provide care to the young patients. Significant correlation was observed between their practice and attitude (R = 0. 2,P-value = 0.006). Nearly 30% of the dentists found their knowledge and experience insufficient in treating the older people with complex medical problems. 40% believed that the current dental education in dental schools did not provide adequate training in geriatric dental care.

Conclusion

Although the dentists in this study had average knowledge and capacity, they mostly displayed a positive attitude towards the old. A high percentage of them were unsatisfied with the sufficiency of geriatric dental education in dental schools.
Psychometric properties and diagnostic accuracy of the short form of the geriatric anxiety scale (GAS-10)
Authors: Carlucci Leonardo , Balestrieri Matteo , Maso Elisa , Marini Alessia , Conte Nadia , Balsamo Michela
Published: June 2021

Background

Anxious symptoms have a negative impact on different aspects of the elderly’s quality of life, ranging from the adoption of unhealthy lifestyle behaviours to an increased functional impairment and a greater physical disability. Different brief assessment instruments have been developed as efficacy measures of geriatric anxiety in order to overcome psychometric weaknesses of its long form. Among these, the 10-item Geriatric Anxiety Scale (GAS-10) showed strong psychometric properties in community-dwelling samples. However, its diagnostic accuracy is still unexplored, as well as its discriminative power in clinical samples.

Methods

In the present study, we explored the psychometric performance of the GAS-10 in the elderly through Item Response Theory in a sample of 1200 Italian community-dwelling middle-aged and elderly adults (53.8% males, mean age = 65.21 ± 9.19 years). Concurrent validity, as well as diagnostic accuracy, was examined in a non-clinical sample (N = 229; 46.72% males) and clinical sample composed of 35 elderly outpatients (74.28% females) with Generalized Anxiety Disorder (GAD).

Results

The GAS-10 displayed good internal construct validity, with unidimensional structure and no local dependency, good accuracy, and no signs of Differential Item Functioning (DIF) or measurement bias due to gender, but negligible due to the age. Differences in concurrent validity and diagnostic accuracy among the long form version of the GAS and the GAS-10 were not found significant. The GAS-10 may be more useful than the longer versions in many clinical and research applications, when time constraints or fatigue are issues.

Conclusion

Using the ROC curve, the GAS-10 showed good discriminant validity in categorizing outpatients with GAD disorder, and high anxiety symptoms as measured by the GAS-SF cut-off. The stable cut-off point provided could enhance the clinical usefulness of the GAS-10, which seems to be a promising valid and reliable tool for maximize diagnostic accuracy of geriatric anxiety symptoms.
Comparisons of clinical characteristics, brain MRI findings, and responses to epidural blood patch between spontaneous intracranial hypotension and post-dural puncture headache: retrospective study
Authors: Lee Gha-Hyun , Kim Jiyoung , Kim Hyun-Woo , Cho Jae Wook
Published: June 2021

Background

Spontaneous intracranial hypotension and post-dural puncture headache are both caused by a loss of cerebrospinal fluid but present with different pathogeneses. We compared these two conditions concerning their clinical characteristics, brain imaging findings, and responses to epidural blood patch treatment.

Methods

We retrospectively reviewed the records of patients with intracranial hypotension admitted to the Neurology ward of the Pusan National University Hospital between January 1, 2011, and December 31, 2019, and collected information regarding age, sex, disease duration, hospital course, headache intensity, time to the appearance of a headache after sitting, associated phenomena (nausea, vomiting, auditory symptoms, dizziness), number of epidural blood patch treatments, and prognosis. The brain MRI signs of intracranial hypotension were recorded, including three qualitative signs (diffuse pachymeningeal enhancement, venous distention of the lateral sinus, subdural fluid collection), and six quantitative signs (pituitary height, suprasellar cistern, prepontine cistern, mamillopontine distance, the midbrain-pons angle, and the angle between the vein of Galen and the straight sinus).

Results

A total of 105 patients (61 spontaneous intracranial hypotension patients and 44 post-dural puncture headache patients) who met the inclusion criteria were reviewed. More patients with spontaneous intracranial hypotension required epidural blood patch treatment than those with post-dural puncture headache (70.5% (43/61) vs. 45.5% (20/44); p = 0.01) and the spontaneous intracranial hypotension group included a higher proportion of patients who underwent epidural blood patch treatment more than once (37.7% (23/61) vs. 13.6% (6/44); p = 0.007). Brain MRI showed signs of intracranial hypotension in both groups, although the angle between the vein of Galen and the straight sinus was greater in the post-dural puncture headache group (median [95% Confidence Interval]: 85° [68°-79°] vs. 74° [76°-96°], p = 0.02).

Conclusions

Patients with spontaneous intracranial hypotension received more epidural blood patch treatments and more often needed multiple epidural blood patch treatments. Although both groups showed similar brain MRI findings, the angle between the vein of Galen and the straight sinus differed significantly between the groups.
High-level of anxiety and depressive symptoms among patients with general medical conditions and community residents: a comparative study
Authors: Misgan Eyaya , Belete Habte
Published: June 2021

Background

The global burden of anxiety and depressive symptoms become increasing, specifically accounts for high burden of morbidity among patients with medical conditions in low-income countries. The aim was to compare the level of anxiety and depressive symptoms in participants with general medical conditions and community residents in northwest Ethiopia.

Methods

Comparatively 2625 adults in the community and 1363 patients at health center in Mecha Demographic Surveillance and Field Research Center (MDSFRC) had interviewed. Level of anxiety and depressive symptoms was assessed by Hospital Anxiety and Depression Scale (HADS) and logistic regression analysis was employed with corresponding adjusted OR (AOR) and 95% confidence interval (CI) at p-value less than 0.05 declaration of significant.

Results

A higher prevalence of high-level anxiety and depressive symptoms, 12.6% with 95% CI; 11.0%, 14.0% and 10.1%, 95% CI; 8.0%, 12% were found among participants at health center compared to community residents, 6.8%, 95% CI; 7.0%, 8.0% and 5.2%, 95% CI; 4.0%, 6.0% at (p value < .0001), respectively. Social support, loss of a parent before age of 18 years, physical/verbal abuse, and having general medical conditions were significantly associated with both high-level anxiety and depressive symptoms. However, factors such as advanced age, perceived relative wealth, living alone, and having a family history of mental illness were associated with high-level of anxiety symptoms, but not with depressive symptoms.

Conclusions

Proportion of high-level of anxiety and depressive symptoms were found a two-fold higher in patients with medical condition than healthy residents in the community. Patients with medical illnesses should be assess for anxiety and depressive symptoms at health center.
Family characteristics associated with rural households’ willingness to renew the family doctor contract services: a cross-sectional study in Shandong, China
Authors: Li Wenjuan , Li Jie , Fu Peipei , Chen Yan , Yuan Yemin , Yang Shijun , Li Jie , Li Zhixian , Yan Chen , Gui Zhen , Zhou Chengchao
Published: June 2021

Background

In China, some previous studies have investigated the signing rate and willingness of residents to sign the family doctor contract services (FDCS). Few studies have explored residents’ willingness to renew the FDCS. This study is designed to understand the family characteristics difference towards rural households’ willingness of maintaining the FDCS.

Methods

A total of 823 rural households were included in the analysis. A descriptive analysis was conducted to describe the sample characteristics. The binary logistic regression model was used to explore the family characteristics that influence the renewal willingness for FDCS among rural households in Shandong province, China.

Results

Our study found that about 95.5% rural households had willingness to maintain the FDCS in Shandong, China. Those households with catastrophic health expenditures (CHE) (OR = 0.328, 95%CI = 0.153–0.703), with highest level of education at graduate or above (OR = 0.303, 95%CI = 0.123–0.747) were less willing to maintain the FDCS. Those whose households have more than half of the labor force (OR = 0.403, 95%CI = 0.173–0.941) and those households living in economically higher condition were less willing to maintain the FDCS.

Conclusions

This study demonstrates a significant association between family characteristics (CHE, highest education in households, proportion of the household labor force) and willingness to maintain FDCS among rural households in Shandong, China. Targeted policies should be made for rural residents of identified at-risk families.
Facilitators and barriers to the clinical administration of herbal medicine in Ghana: a qualitative study
Authors: Asare Comfort , Aziato Lydia , Boamah Daniel
Published: June 2021

Background

Herbal medicine administration in conventional health care services is gaining popularity lately. Much has not been documented on the perceived enhancers and challenges to herbal medicine administration at the hospital. The study sought to explore the facilitators and barriers to the clinical administration of herbal medicine in Ghana.

Method

Qualitative descriptive exploratory design was employed. Fourteen participants among the consented and purposively sampled nurses were interviewed. Data was transcribed and analysed using content analysis.

Results

The participants disclosed that facilitators to the clinical administration of herbal medicine include doctors’ prescription, affordability of herbal medications by patients, patients’ willingness to use herbal medicine and availability of herbal medicine. Barriers to the clinical administration of herbal medicine were inadequate knowledge on herbal medicine, lack of publicity, unclear integration, lack of collaboration and policies on herbal medicine administration at the hospital. Other barriers were negative mindset of patients and lack of national health insurance scheme (NHIS) coverage.

Conclusion

Clinical administration of herbal medicine is faced with an array of challenges. Doctor’s prescription, nursing education on herbal medicine and NHIS coverage of herbal medicine are imperative to improve herbal medicine administration in hospitals.

Plain English summary

Herbal medicine addition into mainstream health care services is surging high in many countries. This study aimed at finding out what nurses consider as the issues that make it easy or difficult to serve herbal medicine in the hospital.

Qualitative method was employed, in-depth face-to-face interviews were conducted and data collected was typed verbatim. The typed data was content analysed and findings supported with the nurses’ statements.

The findings of the study showed that facilitators to the clinical use of herbal medicine include doctors’ prescription, affordability of the herbal drug, patient’s willingness to use the herbal medication, patient’s belief about herbal medicine and availability of herbal medicine. Challenges to the clinical use of herbal medicine disclosed were lack of knowledge on herbal medicine, lack of publicity, unclear integration, lack of collaboration between health professionals and herbal medicine providers. Other barriers include negative mindset of patients and lack of national health insurance (NHIS) coverage.

The researchers came to a consensus that nurses need further training on herbal medicine to enhance herbal medicine use at the hospital. Health professionals need to collaborate with herbal medicine service providers and NHIS must be reviewed to cover herbal medications.
Different approaches to selection of surgical trainees in the European Union
Authors: Hagelsteen Kristine , Pedersen Hanne , Bergenfelz Anders , Mathieu Chris
Published: June 2021

Background

There is an increasing global interest in selection processes for candidates to surgical training. The aim of the present study is to compare selection processes to specialist surgeon training in the European Union (EU). A secondary goal is to provide guidance for evidence-based methods by a proposed minimum standard that would align countries within the EU.

Methods

Publications and grey literature describing selection strategies were sought. Correspondence with Union Européenne des Médecins Specialists (UEMS) Section of Surgery delegates was undertaken to solicit current information on national selection processes. Content analysis of 13 semi-structured interviews with experienced Swedish surgeons on the selection process. Two field trips to Ireland, a country with a centralized selection process were conducted. Based on collated information typical cases of selection in a centralized and decentralized setting, Ireland and Sweden, are described and compared.

Results

A multitude of methods for selection to surgical training programs were documented in the 27 investigated countries, ranging from locally run processes with unstructured interviews to national systems for selection of trainees with elaborate structured interviews, and non-technical and technical skills assessments. Associated with the difference between centralized and decentralized selection systems is whether surgical training is primarily governed by an employment or educational logic. Ireland had the most centralized and elaborate system, conducting a double selection process using evidence-based methods along an educational logic. On the opposite end of the scale Sweden has a decentralized, local selection process with a paucity of evidence-based methods, no national guidelines and operates along an employment logic, and Spain that rely solely on examination tests to rank candidates.

Conclusion

The studied European countries all have different processes for selection of surgical trainees and the use of evidence-based methods for selection is variable despite similar educational systems. Selection in decentralized systems is currently often conducted non-transparent and subjectively. A suggested improvement towards an evidence-based framework for selection applicable in centralized and decentralized systems as well as educational and employer logics is suggested.