bluuebunny/crossref_metadata_2025 huggingface dataset:
The Papal Bulls Dividing the Americas between Spain and Portugal: A Reappraisal
Authors: McNeil Kent
Published: December 2024

The papacy recently repudiated the doctrine of discovery that was relied upon by European nations when they colonized lands inhabited by Indigenous peoples. However, the Vatican did not repeal the papal bulls that authorized and provided canon law support for colonization of West Africa and the Americas by Portugal and Spain. This article examines these bulls and questions the Pope’s legal authority to issue them. It contends that the bulls bound only the Christian monarchs who accepted the Pope’s authority in this regard. They had no legal force insofar as the Indigenous peoples were concerned. Moreover, the historical record reveals that other colonizing European powers, such as France and England, rejected the validity of the bulls. In fact, Spain and Portugal acquired their overseas empires in the fifteen and sixteenth centuries, not by means of discovery or papal bulls, but by subduing Indigenous peoples and forcibly occupying their territories.
The Jus ad Bellum and the War in Gaza
Authors: Gill T.D.
Published: December 2024

This article examines some of the main arguments relating to the applicability and relevance of the right of self-defence to the ongoing war in Gaza. It starts by discussing the question whether Israel has the right to invoke self-defence in response to the attack by Hamas of 7 October 2023. Questions examined include the relevance of the Wall advisory opinion of 2004 to the invocation of self-defence, the status of Gaza as occupied territory in October 2007 and the applicability of self-defence to attacks by non-State actors. It then goes on to discuss how the principles of necessity and proportionality in the context of the exercise of self-defence regulate the application of force and whether Israel’s conduct of the war meets those criteria and focuses particular attention on the impact of obstruction of relief supplies on the right of self-defence. This piece was submitted in May 2024 and does not examine or discuss events that have occurred since then.
Gaza and the Rise of the “Humanitarian Council”
Authors: Gowan Richard
Published: December 2024

The United Nations Security Council often compensates for failing to agree on political solutions to conflicts by engaging on their humanitarian consequences, as this essay shows with reference to Gaza, Syria, Myanmar and Ethiopia. The elected members of the Council in particular frequently focus on humanitarian topics in attempts to forge compromises with and among the permanent members. This humanitarian turn in Council diplomacy allows diplomats to paper over their differences, and insist the institution is still relevant but involves moral hazards. The Council risks becoming overly involved in the technicalities of aid operations, and members can use thematic and country-specific debates to relitigate aspects of International Humanitarian Law (ihl). The short-term benefits of agreement on humanitarian resolutions and Council statements must be weighed against these long-term risks, and Council members should pursue a policy of “do no harm” in their humanitarian diplomacy.
Withdrawal from UN Peacekeeping? Germany’s Role in UN Peacekeeping and Its Lessons from minusma
Authors: Rosenow Patrick
Published: December 2024

The closure of the United Nations Multidimensional Integrated Stabilization Mission in Mali (minusma) in December 2023 marked the end of Germany’s largest personnel contribution to a UN peace mission in a decade. Given Germany’s post-war history, its role as a middle power, and its status as the world’s third-largest economy, multilateral action plays a crucial role in its foreign policy. The UN, as a global organization, is an indispensable pillar of Germany’s multilateral orientation. Germany’s generally cautious participation in UN peacekeeping occurs against the backdrop of a mixed record of UN missions and recurring reform discussions within the UN system. The German experiences from minusma—including its abrupt end at the behest of the Malian government without improving civilian security—will influence future national mandate debates on German involvement in UN operations. This article analyzes the reasons for Germany’s withdrawal from UN peacekeeping using the minusma mission as a case study, within the context of the concept of multilateralism.
African-Led Stabilisation: a Normative Framework or Organised Practical Response to Insecurity?
Authors: Tchie Andrew E. Yaw
Published: December 2024

Over two decades, the African Union (au), complemented by Regional Economic Communities and Regional Mechanisms (rec s/rm s) have carried out and managed activities which can conceptually be viewed as distinctive African-led stabilisation effort(s) designed to stabilise states, environments, and regions. These African-led stabilisation efforts have led to the deployment of the au peace enforcement efforts in Somalia, the au Regional Stabilisation Strategy for the Lake Chad Basin Region with support from the Multinational Joint Task Force; the au’s mission to the Gambia; the G5 Sahel Force; the Southern African Development Community mission to Mozambique and others. Despite this increase African institutions do not have a coherent conceptualisation and framework to understand and clarify these emerging African-led stabilisation efforts. The analysis examines the rise of African-led stabilisation efforts and explains how African-led stabilisation efforts can adopt an adaptive stabilisation approach to improve these interventions.
The Dilemma of Troop Contribution to International Peace Missions: a Case of the Kenya Police Deployment to Haiti
Authors: Onyango James Tindi , Agwanda Billy , Nyadera Israel Nyaburi
Published: December 2024

This paper explores the dilemma states face when choosing between domestic concerns and international obligations in international Peacekeeping operations (pko s) and peace support operations (pso s). Most of the existing literature focuses on the nature, number, distribution, success, and failures of pko s and pso s. However, little attention has been directed to the delicate balance contributing countries face due to competing domestic and international interests. Using a qualitative method approach, this study examines efforts by Kenya to deploy a contingent of National Police Service (nps) officers to Haiti as part of an international peace support intervention. The authors argue that weaponization of information is increasingly posing a serious dilemma for countries involved in peacekeeping. By looking at the controversies that have engulfed Kenya’s deployment of its national police to Haiti, the study analyses how the framing of peacekeeping operations is likely to affect the legitimacy, trust and increase polarization.
Reinventing Leadership for Sustainable Development in Africa: Student Perceptions of Leadership in Selected African Countries
Authors: Chiome Chrispen
Published: December 2024

In Africa,1 new forms of leadership have emerged at various social levels to drive a development agenda based on peer learning and knowledge sharing. Despite this, Africa remains confronted with many challenges on its path to sustained growth and development. This research sought to characterise leadership for sustainable development using students’ lenses. It is a multiple-case study informed by a purposive sample of 30 mba students from five business schools. The findings reveal, among other things, that rather than leadership that is embodied in a sole heroic individual, Africa needs diffuse, pluralistic, collective and facilitative leadership that promotes sustainable development. Leaders should demonstrate attributes of cooperation, understanding, pluralistic knowing and seeking union, as this aligns more closely with the work required to develop more sophisticated, encompassing and collaborative efforts. Leaders should have intimate knowledge of sustainable development, creating and sustaining relations, and accommodating the heterogeneity and diversity of localities and regions. The paper argues that the foundational building block for leaders is the ability to make decisions from a long-term perspective that leads Africa towards economic prosperity, social cohesion and environmental sustainability.
When Democratic Transition Leads to Anarchy: Lessons from Ethiopia
Authors: Gebreyesus Terefe
Published: December 2024

Ethiopia has tried to transit to democracy, in 1991 and 2018. In both attempts, it was not that successful. This paper tries to explain why democratic transition in Ethiopia has not been successful and what lessons can be drawn from these experiences. Democratic transition and consolidation require certain social, economic, cultural and external preconditions. An attempt at democratic transition may not succeed if these preconditions do not exist in the society that attempts it. Ethiopia does not have any of these preconditions. Contrarily, its ethnic diversity, poverty, absence of strong political institutions, polarisation, and culture of solving political differences with conflict and violence make democratic transition and consolidation almost impossible. The Ethiopian experience provides that for states like Ethiopia, democratic transition is hard and sustaining it is even harder. For states like Ethiopia, the best way to transit to democracy is to first develop the democratic preconditions, such as political compromise and fidelity to peaceful resolution of political conflict, before an attempt at democratic transition can be made.
A Systematic Review of Research on Cooperative/Collaborative Learning in Science and Engineering Education in the Republic of Korea
Authors: Lee Gyeonggeon , Kang Da Yeon
Published: December 2024

Constructivist learning theories have emphasized learners’ interactions with the environment, which includes their peers. Therefore, student cooperation/collaboration has been considered crucial in science education. However, although there have been many science cooperative/collaborative learning (CCL) studies reported in Korea, there has been a lack of review studies done to delineate trends and elicit implications for future science education research. This study systematically reviewed empirical science and engineering CCL studies reported in Korea. The researchers collected literature via the Korea Citation Index repository and selected 121 papers to be reviewed. The analytical framework was adapted from the cultural-historical activity theory (CHAT). The results of a review by two science education experts showed patterns revealed in each component of CHAT, which led to a discussion aimed at comprehensively understanding Korean science and engineering CCL research. Implications for future research and teaching were elicited.
Enhancing Scientific Research Competencies of Vietnamese High School Students through STEM Education
Authors: Vu Ngoc-Oanh , Luu Hoai-Thu , Nhu Van-Cuong , Vu Trung-Quoc , Do Quynh Mai Thi
Published: December 2024

Science, technology, engineering, and mathematics (STEM) education offers a valuable approach for developing scientific research competencies (SRC) in students, yet it remains underutilized for this purpose in Vietnamese high schools. Additionally, no suitable tools currently exist to assess SRCs effectively. This study explores a model for applying STEM education to enhance SRCs among high school students in Vietnam and introduces tools to measure performance gains. The research was conducted in four stages: administering surveys to 71 chemistry teachers and 860 students across Vietnam to assess current practices and select participants; developing SRC assessment tools; conducting an experiment on making smart epoxy lamps; and conducting an experiment on the synthesis of glucosamine hydrochloride. Data from tests and rubrics showed measurable increases in students’ SRCs. This study is the first in Vietnam to present a model integrating STEM education and competency assessment tools to both enhance and measure SRCs in high school students.
From Medical Feminism to Conservatism? Changing French Attitudes Towards Women Doctors and their Views on the Female Body: The Reception of Woman as Family Doctor between 1905 and the 1920s
Authors: Fauvel Aude , Puche Amélie
Published: December 2024

In this article, we examine the contrasting reception of the book Woman as Family Doctor in France between 1905 and the 1920s. Written by Dr Anna Fischer-Dückelmann, one of the first female doctors of the modern era, the book was an international bestseller. When first translated from German into French in 1905, it was well received; in 1911 it even won a prize at a state-sponsored exhibition. But a sudden outcry greeted its republication in 1922. Drawing on a wide range of sources, this paper shows that this reversal reflected changing attitudes towards women doctors. During the Belle Époque, the French authorities had been proud of their “medical feminism” and this was reflected in their support for books such as Woman as Family Doctor, which argued that women should have more control over their bodies, especially sexually. But after the war, this discourse disappeared. The authorities now had a single objective: to repopulate the nation, even if it meant restricting women’s autonomy. The analysis of the reception of Woman as Family Doctor thus provides a prism through which to shed light on a little-known page of French history: the history of “medical feminism” and the first women physicians of the Belle Époque, their impact on women’s emancipation, and the reasons for their oblivion.
Review of rope coating research: Mechanism, application, and future directions
Authors: Bao Jingwen , Hu Wenfeng , Gao Yantao , Lu Zan
Published: December 2024

This article first introduces several different types of coating mechanisms and their application environments, including wear-resistant coatings, anticorrosive coatings, waterproof coatings, and flame-retardant coatings. It then introduces several fiber materials used for ropes, including carbon fiber, ultra-high molecular weight polyethylene pipe (UHMWPE) fiber, aramid fiber, and steel wire, and gives an analysis and summary of their properties and applications. Furthermore, the current progress of coating research on these four fiber ropes is discussed in detail. Finally, the article summarizes the deficiencies in the relevant research fields and looks forward to their future development directions.
Intersectionality, Decoloniality, Indigenous Localism: A Critique
Authors: Kapoor Ilan
Published: December 2024

This article claims that, despite their critical-political stances, three current and influential theoretical frameworks – intersectionality, decoloniality, and ‘Indigenous localism’ – unconsciously accept global capitalism. The article focuses on the work of Crenshaw, Mignolo, Coulthard, and Tuck and Yang, respectively, to argue that, by ascribing to identity politics (intersectionality), a pluriversal politics of authenticity (decoloniality), and a decentralized ‘incommensurability’ (Indigenous localism), each engages in the culturalization and/or localization of politics – one that disavows the dimension of political economy, and because of that, one that conforms well with, and poses no threat to, capitalist liberal globalization. The article concludes by reflecting on what such disavowal says about our late capitalist times, as well as the potentialities and perils of a contemporary subaltern anti-capitalist politics.
Concordance and discordance of anticoagulation assays in children supported by ECMO: The truth is out there
Authors: Carmona Carlos A , Bain Jesse , Karam Oliver
Published: December 2024

Introduction

Extracorporeal membrane oxygenation (ECMO) provides critical support to patients in severe cardiac and respiratory failure, but it requires anticoagulation to prevent complications like bleeding and thrombosis. Heparin, the primary anticoagulant utilized, is monitored by activated partial thromboplastin time (aPTT) and anti-Factor Xa (AntiXa) levels. Discordance between the two assays complicates its titration and the impact on patient outcomes is not well-established. This study examines the prevalence of discordance, its impact on heparin dosing, and the association of bleeding, thrombosis, ICU-free days, and mortality in pediatric ECMO patients.

Methods

This secondary analysis of the Bleeding and Thrombosis on Extracorporeal Membrane Oxygenation study consisted of 511 patients under 19 years. Demographics, laboratory results, ECMO indications, daily heparin doses, and clinical outcomes were collected. Discordance was categorized as major or minor, and adjustments to heparin dosing were analyzed for appropriateness based on normal ranges of aPTT and AntiXa. Logistic regression models assessed the impact of heparin titration strategies on bleeding, clotting, ICU-free days, and mortality.

Results

Major discordance occurred on 17.5% of days with high aPTT and low AntiXa being most common. Titrating heparin based on AntiXa in scenarios of discordance was associated with an 11% lower incidence of bleeding compared to aPTT ( p = .02). Higher proportion of concordance was independently associated with increased bleeding and/or clotting, but not significantly affect ICU-free days or mortality.

Conclusion

Discordance is common in pediatric ECMO patients. AntiXa-guided heparin titration, notably during discordant periods, is associated with fewer bleeding and clotting events. This emphasizes the need for improved anticoagulation protocols since discordance does not demonstrate worse ICU-free days or mortality.
Climate Action Framework for Libraries: Empowering response to climate crisis
Authors: Saini Anupama
Published: December 2024

The urgency of addressing climate change and promoting climate literacy within communities underscores the importance of this research. Despite the pivotal role libraries play in climate action, a noticeable research gap exists in the absence of an easily applicable Climate Action Framework for Libraries (CAFL). This paper aims to fill this void by presenting a globally adaptable CAFL that addresses the unique needs and challenges faced by libraries worldwide. The framework was developed through a comprehensive review of existing literature, theoretical inputs from experts through key publications and focused group discussions with librarians. In alignment with UN Sustainable Development Goal (SDG) 13, CAFL offers a structured yet flexible approach, supporting libraries to enhance climate literacy among patrons and contribute meaningfully to broader climate change initiatives. This framework empowers libraries to become leaders in sustainability, fostering informed and engaged communities capable of responding effectively to the climate crisis.
Income and Geographic Distribution of a Vehicle Miles Traveled Fee: Case Study of Four States
Authors: Rahman Musfira , Ju HyeMin , Burris Mark
Published: December 2024

The transportation sector in the United States has faced funding challenges owing to a stagnant federal fuel tax rate and rising vehicle fuel economy. To address this issue, policy makers have explored the potential of a vehicle miles traveled (VMT) fee as an alternative funding method. However, equity concerns remain across income and geographic groups. This study explored equity issues with a VMT fee for different income levels and two geographic groups (urban and rural), in four states (California [CA], Iowa [IA], New York [NY], and Texas [TX]). Using 2009 and 2017 National Household Travel Survey data, the study analyzed VMT demand elasticity using structural equation modeling and applied it to VMT fee scenarios. The results showed that the current fuel tax system charges higher-income and urban households more than lower-income and rural households, whereas the VMT fee system reduced these differences a small amount. Households in CA, IA, NY, and TX paid, on average, $10, $5, $2, and $2 less per year with the VMT fee, respectively, compared with the current fuel tax system. This is primarily since electric vehicles will also pay the VMT fee. Most importantly, the difference in the amount paid changed very little under a VMT fee for the different income and geographic traveler segments, potentially alleviating some equity concerns.
Why Did the Inflection Point of Bus Ridership Occur in China in 2014? Origins from the Effect of the Ride-Hailing Service
Authors: Yang Yuhang , Zhang Shuyang , Li Jingru , Chen Guojun
Published: December 2024

Although rapid construction of public transit infrastructure has continued in China in recent years, there has been a significant decline in bus ridership since 2014. To investigate this trend, we conducted a statistical analysis for 24 cities in China, using fixed-effects panel regression to examine the relationships between bus ridership and significant factors from 2000 to 2019. Our analysis revealed that the emergence of ride-hailing services was probably the most significant contributor to the decline in bus ridership, reducing it by 33% from 2014 to 2019. This finding suggests that ride-hailing services have caused an inflection point in bus ridership. Furthermore, we found that gross domestic product (GDP) negatively moderates the effect of ride-hailing services on bus ridership, with cities of lower economic status experiencing a more significant decline in ridership, owing to the development of ride-hailing services. Our research provides valuable insights for policymakers and relevant departments when addressing transit ridership loss and transit system development issues.
Traumatic life events as sources of Big Five personality trait change: The moderating role of control beliefs
Authors: Bucciol Alessandro , Zarri Luca , Wagner Jenny
Published: December 2024

Although prior research has shed light on the impact of selected life events on personality trait change, less is known about the role of traumatic life events as sources of personality trait change. Furthermore, we shed light on the role of person-specific control beliefs that possibly function as resources in developmental processes and, thus, might buffer (or amplify) the impact of challenging and largely uncontrollable life events. Using US secondary data from the Health and Retirement Study ( N = 3,232, Mage = 66.66, range 50–100 years of age, 61% females), a large-scale, nationally representative prospective panel study, we estimated latent change score models to examine effects of traumatic life events on personality trait development in middle and late adulthood. Overall, we detect small to medium-sized significant effects of three traumatic events: The death of a child relates to less pronounced increases in Openness to Experience, Conscientiousness, and Agreeableness, whereas the experience of a physical attack relates to less pronounced increases in Conscientiousness. In contrast, the experience of an own life-threatening illness is linked to more positive changes in Conscientiousness. Furthermore, results suggest that perceived constraints in control could be beneficial in dealing with severe life events.
Compressive Properties of Rigid Polyurethane Foams
Authors: Tate Philip C. Miller , Talal Sina
Published: December 2024

We have investigated the compressive stress-strain properties, and long-term compression set properties of highly crosslinked, rigid, polyurethane foams ranging in density from 100 kg m-3 to 810 kg nr-3. Samples were maintained under a range of compressive strains for periods ranging from three days to one year, and their dimensional recovery followed after release.

The compressive strength and moduli of the samples were found to vary as the square of the foam density. The compression set study revealed that recovery of all samples following release occurs in two stages, with very different rates, which we believe to he associated with the independent recovery of the polymer molecules and the cellular structure of the foam. The results also show that the long-term recovery from compression demonstrated by a particular sample is largely independent of sample density, and only slightly dependent on the time period of constraint, but mainly influenced by the degree of deformation during the confinement period.
Management of Acute Liver Failure in Children
Authors: Kaur Jaswinder , Malhotra Smita , Kumar Karunesh , Sibal Anupam
Published: December 2024

Introduction:

Pediatric Acute Liver Failure (PALF) incidence has been increasing in recent times. It is an emergency and needs appropriate management in a specialized center with availability for liver transplant.

Methods:

In this article, we shall provide an overview of etiologies and approach to the management of PALF.

Conclusions:

Various known etiologies for pediatric acute liver failure involve infections, immunologic disorders, and metabolic and drug/toxin-mediated illnesses. However, a known etiology for liver failure may be lacking in approximately 30–50% of cases. In developing countries like India, infections still dominate as the leading cause of pediatric ALF, with the hepatitis A virus (HAV) being the most identified etiology. Metabolic disorders account for approximately 23–30 percent of the PALF in infancy or early childhood (less than 5 years). Around 9–52% of children with PALF have indeterminate etiology. Management requires a multidisciplinary approach involving hepatologists, pediatric intensive care specialists, nephrologists, and a liver transplant surgery team. Cerebral edema is the most frightful complication of acute liver failure, which may progress rapidly, leading to irreversible brain damage, so every possible measure should be taken to identify as well as prevent the progression of cerebral edema and raised intracranial pressure. Elective intubation and mechanical ventilation should be started in patients with significant encephalopathy (Grade II). Identification of the need for liver transplantation and early referral for the same before irreversible brain damage sets in. Extracorporeal liver assist devices have shown promising results in bridging these children to native liver survival or liver transplantation, but continuous careful monitoring should be done to assess for treatment failure and the need for liver transplantation. Liver transplantation is the only definite treatment that improves survival in PALF, and with several advances in surgical techniques and good intensive care, the overall survival after LT for ALF has improved significantly.
“I thought we were useless”: K-skateboarding and socio-material pollution in Nanjido, Seoul
Authors: Hölsgens Sander
Published: December 2024

This article discusses the enmeshment of skateboarding and pollution from an ethnographic perspective. It advances recent scholarship on “polluted leisure” by zooming in on Nanjido, Seoul. A former landfill and brownfield, the island was transformed into an ecological park in the lead-up to the 2002 FIFA World Cup. Performing athletic tricks on top of decades of chemical and radiating waste, skateboarders must attend to and live alongside the hidden anthropogenic materialities and invisible social histories of the eco-park. This ethnography provides evidence of the tactics that skateboarders use to navigate and mitigate the socio-material repercussions of pollution—from denial to fact-finding. The skatepark also marks a shift in the social discourse on skateboarding in South Korea. Historically, the practice is considered an ing-yeo-jit: a “useless” and wasteful youth activity—a social pollutant. Encapsulated in gentrification strategies masked as environmentalism, skateboarding is presented as a “useful” and “healthy” practice used to push the park's green and salubrious image.
Effects of 3 Cycles of Increasing Botulinum Toxin Doses on Functional Parameters of Post-stroke Spastic Gait: A Prospective Cohort Study
Authors: Selves Clara , Dehem Stéphanie , Lejeune Thierry , Deltombe Thierry , Stoquart Gaëtan
Published: December 2024

Background

Single botulinum toxin type A (BT-A) injections reduce spasticity, but the effects of repeated injections on walking activities remain unclear.

Objectives

To demonstrate cumulative effectiveness of progressively higher doses of BT-A on walking activities (primary outcome) and spasticity reduction.

Methods

32 individuals with lower-limb spasticity impairing gait post-stroke were included in this prospective cohort study. Participants received 3 injections of increasing doses of Inco BT-A (400–600–800 U) in both upper and lower limbs and were followed for 7 months. Activity evaluations included the 10 MWT, 6MWT, TUG, and a timed stairs test (TST). Spasticity was assessed using the Modified Ashworth (MAS) and Modified Tardieu (MTS) scales.

Results

Activities remained stable after the 1st injection but improved after the 2nd and 3rd cycles on the 6MWT (+0.07 and +0.12 m/s, respectively, p < 0.05) and TST (−13.7 s and −14.8 s, respectively, p < 0.05). Spasticity significantly reduced after each injection cycle, with greater reductions after the 2nd and 3rd cycles.

Conclusions

Repeated, progressively higher doses of Inco BT-A in lower-limb spasticity post-stroke improved walking activities and reduced spasticity, more so after successive cycles and higher doses. This could suggest cumulative effects, better effects due to higher doses, or both. This supports the use of progressively higher doses to thoroughly treat spasticity patterns. clinicaltrials.gov : NCT04544280.
Perceived clinical challenges when treating patients from different cultures: A study among psychiatry trainees in Norway
Authors: Sandbu Morten , Javo Anne Cecilie , Thapa Suraj Bahadur , Rø Karin Isaksson , Preljevic Valjbona , Tyssen Reidar
Published: December 2024

The growing number of migrant patients in western countries calls for better cross-cultural competence among health providers. As workplaces, hospitals have become increasingly multicultural, and many doctors are themselves of foreign origin, including psychiatrists. The aims of this study were to explore what clinical challenges International Medical Graduates (IMGs) and native-born Norwegian doctors training in psychiatry perceived when treating patients from other cultures, and what factors might be associated with such cross-cultural challenges. We developed a six-item inventory of perceived cross-cultural clinical challenges (PCC), to assess what cross-cultural problems trainees in psychiatry found most challenging. The PCC was completed by 216 trainees who also reported on individual- and work-related background factors. Comparisons of PCC between the two groups were done by one-way analysis of variance, and associations between PCC and background factors were analyzed by linear multiple regression. The overall response rate was 93%. Native -born Norwegian doctors reported higher levels of PCC than did IMGs. Both native-born Norwegian doctors and IMGs rated “assessing psychosis,” “assessing suicide risk,” and “lacking tools in cross-cultural consultations” as the most demanding challenges in cross-cultural consultations. Independent factors associated with higher PCC included being a native-born Norwegian doctor and experiencing high levels of work–home conflict. The findings suggest that trainees in psychiatry may need more training and better tools in cross-cultural assessment of mental disorders. Possible differences in PCC between native-born doctors and IMGs should be taken into consideration when developing mentoring programs, as should the doctors’ work–home conflict level, which might impact the PCC.
Benchmarking the most popular XAI used for explaining clinical predictive models: Untrustworthy but could be useful
Authors: Brankovic Aida , Cook David , Rahman Jessica , Khanna Sankalp , Huang Wenjie
Published: December 2024

Objective

This study aimed to assess the practicality and trustworthiness of explainable artificial intelligence (XAI) methods used for explaining clinical predictive models.

Methods

Two popular XAIs used for explaining clinical predictive models were evaluated based on their ability to generate domain-appropriate representations, impact clinical workflow, and consistency. Explanations were benchmarked against true clinical deterioration triggers recorded in the data system and agreement was quantified. The evaluation was conducted using two Electronic Medical Records datasets from major hospitals in Australia. Results were examined and commented on by a senior clinician.

Results

Findings demonstrate a violation of consistency criteria and moderate concordance (0.47-0.8) with true triggers, undermining reliability and actionability, criteria for clinicians’ trust in XAI.

Conclusion

Explanations are not trustworthy to guide clinical interventions, though they may offer useful insights and help model troubleshooting. Clinician-informed XAI development and presentation, clear disclaimers on limitations, and critical clinical judgment can promote informed decisions and prevent over-reliance.
Improvement of lubrication performance in misaligned journal bearings using grooves and rubber under large impact loads
Authors: Hong Sung-Ho
Published: December 2024

Journal bearings can suffer damage and reduced performance due to misalignment and impact loads, potentially leading to operational failures. This study addresses the issue by integrating a groove-type flexible structure and rubber into the bearing design to enhance lubrication characteristics under such conditions. The research evaluated various factors, including shaft center trajectory, minimum oil film thickness, maximum deformation, oil film pressure distribution, and deformation distribution under static and dynamic impact loads of varying magnitudes and directions. The results showed that the combination of the flexible structure and rubber significantly improved the lubrication characteristics, particularly under large impact loads and static load conditions. The use of rubber with a low elastic modulus alongside the flexible structure resulted in at least five times increase in the minimum oil film thickness compared to using the flexible structure alone. This enhancement is due to the elastic deformation of the lubricating surface driven by oil film pressure, ensuring sufficient oil film thickness even under substantial impact loads. The findings suggest that this design approach can significantly contribute to stable lubrication in mechanical systems frequently subjected to impact loads, thereby improving their reliability and operational performance. These numerical results are expected to significantly aid in maintaining stable lubrication in mechanical systems that frequently experience impact loads, thereby enhancing their reliability and performance.
Prediction of Acute Kidney Injury After Cardiac Surgery With Combined Arterial and Venous Intrarenal Doppler
Authors: Giles Cameron , Huard Karel , Denault André , Beaubien-Souligny William
Published: December 2024

Background:

Acute kidney injury (AKI) occurs in up to 50% of cardiac surgical patients and is often hemodynamically mediated. Point-of-care ultrasound is a non-invasive tool that has the potential to characterize intrarenal hemodynamics and predict the risk of AKI.

Objectives:

We aimed to determine the predictive characteristics of intrarenal arterial and venous Doppler markers for postoperative AKI in cardiac surgical patients.

Design:

This study is the secondary analysis of a prospective cohort study.

Setting:

This study is carried out in a care academic cardiac surgical center in Montreal, Quebec, Canada.

Patients:

Adult patients undergoing cardiac surgery with the use of cardiopulmonary bypass.

Measurements:

Point-of-care ultrasound assessments were performed preoperatively and at intensive care unit admission. Arterial measurements included the renal resistive index (RRI) and intrarenal artery velocity-time integral normalized to peak systolic velocity (VTI/PSV). Venous measurements included intrarenal venous flow (IRVF) pattern and renal venous stasis index (RVSI).

Methods:

We used area under the receiving operating characteristic curves (AUCs) with net reclassification index (NRI) and multivariable logistic regression to determine predictive characteristics for postoperative AKI. Furthermore, we used hierarchical clustering to identify potential groups with similar Doppler parameters and performed comparisons of patients’ characteristics and outcomes between groups.

Results:

We included 136 patients with 47 (34.6%) developing postoperative AKI. At intensive care unit admission, arterial indices showed similar discrimination for the prediction of AKI (RRI: AUC = 0.64; 95% confidence interval (CI) = 0.55 to 0.74; and VTI/PSV: AUC = 0.67; 95% CI = 0.57 to 0.77). Venous Doppler indices including IRVF patterns (AUC = 0.64; 95% CI = 0.53 to 0.74) and RVSI (AUC = 0.60; 95% CI = 0.50 to 0.71) also showed similar performance. The combined model of RRI and IRVF pattern (AUC = 0.69; 95% CI = 0.59 to 0.78) improved the prediction of AKI compared to either RRI (NRI = 0.50; 95% CI = 0.17 to 0.84) or IRVF pattern (NRI = 0.38; 95% CI = 0.04 to 0.70) alone. Through hierarchical clustering, we identified 3 groups (1: low RRI, 2: high RRI/low RVSI, and 3: high RRI/high RVSI) with different patient characteristics and outcomes. The patient in group 3 had a higher risk of AKI and worse clinical outcomes compared with other groups.

Limitations:

Single-center design in cardiac surgical patients limits generalizability.

Conclusions:

Although more complex indices of intrarenal Doppler indices including the VTI/PSV and RVSI did not improve prediction of postoperative AKI, combining RRI and IRVF pattern improved risk prediction for AKI. Intrarenal arteriovenous Doppler subphenotypes identified patient groups at high risk of postoperative AKI.
Application of artificial intelligence in gastrointestinal endoscopy in Vietnam: a narrative review
Authors: Dao Hang Viet , Nguyen Binh Phuc , Nguyen Tung Thanh , Lam Hoa Ngoc , Nguyen Trang Thi Huyen , Dang Thao Thi , Hoang Long Bao , Le Hung Quang , Dao Long Van
Published: December 2024

The utilization of artificial intelligence (AI) in gastrointestinal (GI) endoscopy has witnessed significant progress and promising results in recent years worldwide. From 2019 to 2023, the European Society of Gastrointestinal Endoscopy has released multiple guidelines/consensus with recommendations on integrating AI for detecting and classifying lesions in practical endoscopy. In Vietnam, since 2019, several preliminary studies have been conducted to develop AI algorithms for GI endoscopy, focusing on lesion detection. These studies have yielded high accuracy results ranging from 86% to 92%. For upper GI endoscopy, ongoing research directions comprise image quality assessment, detection of anatomical landmarks, simulating image-enhanced endoscopy, and semi-automated tools supporting the delineation of GI lesions on endoscopic images. For lower GI endoscopy, most studies focus on developing AI algorithms for colorectal polyps’ detection and classification based on the risk of malignancy. In conclusion, the application of AI in this field represents a promising research direction, presenting challenges and opportunities for real-world implementation within the Vietnamese healthcare context.
Multicultural doula support and obstetric and neonatal outcomes: a multi-centre comparative study in Norway
Authors: Oommen Hanna , Sagedal Linda Reme , Infanti Jennifer J. , Byrskog Ulrika , Severinsen Marit Stene , Lukasse Mirjam
Published: December 2024

Background

Migrant women face an increased risk of poor obstetric and neonatal outcomes. Norway implemented a multicultural doula (MCD) program in 2018, which was designed to improve pregnancy care for this group in vulnerable circumstances. This study aimed to assess the impact of MCD support, provided in addition to standard care, on obstetric and neonatal outcomes for selected newly arrived migrants.

Methods

This was a multi-centre case–control study involving all nine hospitals actively running the MCD program, which covers four of Norway’s five regions. Women who received MCD support at the time of childbirth (n = 339), from 2018–2023, were compared to similar newly arrived immigrant women who did not receive MCD support (n = 339) and gave birth within the same timeframe. Hospital records were reviewed, and outcomes were analysed using binary logistic regression. The results are expressed as crude and adjusted associations with 95% confidence intervals (CIs).

Results

Women receiving MCD support exhibited a 41% lower likelihood of undergoing emergency caesarean sections (adjusted odds ratio [aOR] 0.59, 95% Cl 0.34–0.98) and those giving birth vaginally had a 75% lower risk of estimated blood loss ≥1000 ml (aOR 0.25, 95% Cl 0.12–0.52) compared with women without MCD support. Additionally, MCD support was associated with more use of pain-relief (aOR 2.88, 95% Cl 1.93–4.30) in labour and increased rates of exclusive breastfeeding at discharge (aOR 2.26, 95% Cl 1.53–3.36).

Conclusions

Our study suggests that MCD support may contribute to improved outcomes for migrants in vulnerable circumstances, potentially impacting their future reproductive health and children’s well-being.
Correlation of annual prevalence between cephems resistance and blaCMY-2 in Salmonella enterica isolated from retail meat sources in the United States
Authors: Rahman Md. Kaisar , Awosile Babafela
Published: December 2024

The objective of this study was to correlate the annual prevalence of cephems resistance and blaCMY-2 in Salmonella enterica using surveillance data in the United States. Using datasets retrieved from the surveillance programs of the United States National Antimicrobial Resistance Monitoring System (NARMS) for Enteric Bacteria from 2002 to 2018, we performed Spearman’s correlation analysis to correlate the annual prevalence data. We observed a near-perfect positive correlation in the annual prevalence between cefoxitin (ρ = 0.97, P < 0.0001), ceftiofur (ρ = 0.96, P < 0.0001), ceftriaxone (ρ = 0.95, P < 0.0001) resistance and blaCMY-2 in S. enterica recovered from chicken retail meat. Similarly, we observed a very high positive correlation in the annual prevalence between cefoxitin (ρ = 0.94, P < 0.0001), ceftiofur (ρ = 0.91, P < 0.0001), ceftriaxone (ρ = 0.82, P < 0.0001) resistance and blaCMY-2 in S. enterica recovered from turkey retail meat. Using Autoregressive Integrated Moving Average (ARIMA) modeling, the forecasted annual prevalence of beta-lactam resistance for the years 2019–2021 was similar to the NARMS-reported data for these periods. Correlation between the annual prevalence of cephems resistance and blaCMY-2 suggests either data can be used as a proxy for decision-making in retail meat surveillance programs.
Severe gastrointestinal symptoms during first year after laparoscopic cholecystectomy
Authors: AlMulhim Abdulrahman Saleh , Saleh Abdulrahman Almulhim  , Mounther Mohammed AlNaim  , Abdul Qadeer Memon  , Abdulrhman Khalid Aldrweesh  , Omar Ahmed Aldamigh  , Faisal Abdulaziz Alhadi  , Shahd Salah Albooshal  , Abdullah Ahmed Alabdrabulridha  , Ahmed Hassan Kamal
Published: December 2024

Background & Objective: Many patients after cholecystectomy, develop gastrointestinal (GI) symptoms and are worried. The objective of this study was to find out the risk factors for severe GI symptoms following laparoscopic cholecystectomy (LC) during first year of follow-up.
Methods: It is a multi-center prospective observational study. In this study, patients who underwent LC for gallstones as elective or emergency at different hospitals of Al-Ahsa region of the Kingdom of Saudi Arabia from January 2020 to December 2021were evaluated for the development of severe GI symptoms postoperatively. They were followed-up for one year after the surgery.
Results: One thousand and two patients who underwent LC, 139(13.87%) developed severe GI symptoms after LC. The patients affected were mostly females 103(74.1%). After LC, the GI symptoms observed were increased frequency of defecation 113(81.3%), loose stools 102 (73.4%), urgency 63(45.3%) and bloating 60 (43.16%) patients. Forty-seven (33.8%) patients had two GI symptoms at a time, followed by 36 (25.9%) who had three. The median time of the start of GI symptoms was two weeks after surgery and the symptoms ended at 12 weeks after surgery. Forty-five (32.4%) patients had less than three-weeks’ duration, followed by 35(25%) having less than 15 weeks. A BMI more than 40 showed a significant association. A higher frequency of cholecystitis attacks and a delayed onset of GI symptoms showed a significant severity of GI symptoms, resulting in delayed resolution. The bowel symptoms were more prominent in the emergency group. Age and gender had no significance.
Conclusion: Early laparoscopic cholecystectomy of patients with cholelithiasis who have a smaller number of attacks of cholecystitis have less frequency of severe GI symptoms after the surgery.
doi: https://doi.org/10.12669/pjms.41.1.10125
How to cite this: Almulhim SA, AlNaim MM, Memon AQ, Aldrweesh AK, Aldamigh OA, Alhadi FA, et al. Severe gastrointestinal symptoms during first year after laparoscopic cholecystectomy. Pak J Med Sci. 2025;41(1):107-112. doi: https://doi.org/10.12669/pjms.41.1.10125
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Relationship between oxidative stress and endometrial polyps in pre-and postmenopausal women
Authors: Tas Emre Erdem , Ozgen Eyup , Yilmaz Gamze , Senat Almila
Published: December 2024

Objective: This study aimed to investigate the relationship between oxidative stress (OS) and endometrial polyps (EP) in pre- versus postmenopausal women with abnormal uterine bleeding.
Methods: This prospective case control study was conducted in the Gynecology Department of Ankara Bilkent City Hospital between January and December 2019. In this study, the EP and control groups included 45 participants each (30 pre- and 15 postmenopausal women). Demographics (age, gravidity, parity, and body mass index), serum complete blood count parameters, serum total antioxidant status, total oxidant status (TOS), oxidative stress index (OSI), and thiol/disulfide balance were compared between groups. Subsequently, all women were stratified based on menopausal status, and the investigated parameters were investigated separately in the pre- and postmenopausal participants between groups.
Results: There were no significant intergroup differences in the investigated parameters among all participants (P>0.05). However, unlike in the control group, the age distribution in the EP group was bimodal, peaking in the early 40s and late 50s. Stratification based on menopausal status revealed no significant intergroup differences in the investigated parameters among the premenopausal participants. However, among the postmenopausal participants, serum TOS and OSI levels were significantly higher in the EP versus control group (9.0 vs. 7.2 μmol H2O2 Equiv/L and 0.8 vs. 0.6 AU; P=0.01).
Conclusions: Serum OS may play a role in the development of EP, particularly among postmenopausal women. Further investigations are required in this area.
doi: https://doi.org/10.12669/pjms.41.1.10170
How to cite this: Tas EE, Ozgen E, Yilmaz G, Senat A. Relationship between oxidative stress and endometrial polyps in pre-and postmenopausal women. Pak J Med Sci. 2025;41(1):130-135. doi: https://doi.org/10.12669/pjms.41.1.10170
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.