bluuebunny/crossref_metadata_2025_split huggingface dataset:
International Law in the Russian Legal System
Authors: Butler William E 
Published: December 2020

Abstract
This addition to the Elements of International Law series explores the role of international law as an integral part of the Russian legal system, with particular reference to the role of international treaties and of generally-recognized principles and norms of international law. Following a discussion of the historical place of treaties in Russian legal history and the sources of the Russian law of treaties, the book strikes new ground in exploring contemporary treaty-making in the Russian Federation by drawing upon sources not believed to have been previously used in Russian or western doctrinal writings. Special attention is devoted to investment protection treaties. The importance of publishing treaties as a condition of their application by Russian courts is explored. For the first time a detailed account is given of the constitutional history of treaty ratification in Russia, the outcome being that present constitutional practice is inconsistent with the drafting history of the relevant constitutional provisions. The volume gives attention to the role of the Russian Supreme Court in developing treaty practice through the issuance of "guiding documents" binding on lower courts, the reaction of the Russian Constitutional Court to judgments of the European Court of Human Rights, and the place of treaties as an integral part of the Russian legal system. Butler further explores the hierarchy of sources of law, together with other facets of Russian arbitral and judicial practice with respect to treaties and other sources of international law. He concludes with a consideration of the 'generally-recognized principles and norms of international law' and their role as part of the Russian system.
Towards a proof theory for Henkin quantifiers
Authors: Baaz Matthias , Lolic Anela 
Published: December 2020

Abstract
This paper presents a methodology to construct globally sound but possibly locally unsound analytic calculi for partial theories of Henkin quantifiers. It is demonstrated that usual locally sound analytic calculi do not exist for any reasonable fragment of the full theory of Henkin quantifiers. This is due to the combination of strong and weak quantifier inferences in one quantifier rule.
Moral Injury Among Nigerian Soldiers Following Combat: Case Reports and a Review of the Literature
Authors: Okulate Gbenga Taiwo , Akinsanmi Mojisola Abosede , Oguntuase Rufus Akinwande , Majebi Michael Adeiza 
Published: December 2020

ABSTRACTMoral injury is a phenomenon in which unpleasant psychological consequences such as guilt and shame follow exposure to activities that transgress one’s deeply held moral beliefs and expectations. Combat engagement places service members at a heightened risk on account of exposure to potentially morally injurious experiences (PMIEs). It remains a more recent construct in comparison with posttraumatic stress disorder (PTSD) despite several studies. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) effectively subsumed moral injury as a part of PTSD, recognizing moral injury as symptoms rather than events that are followed by specific symptoms. Nothing has been reported on moral injury, its prevalence, and associated factors among Nigerian soldiers despite exposure to PMIE in combat and abundance of literature worldwide. Unlike PTSD, moral injury is often under-recognized by clinicians and military and nonmilitary health personnel, and particularly, in our setting where nonmilitary mental health personnel sometimes have to treat postcombat military patients. Failure of recognition of moral injury (and not addressing it) can adversely affect overall mental health and may increase the risk of suicide. We report three cases of personnel of the Nigerian Army referred to our clinic after combat in northeastern Nigeria and following exposure to PMIE, the circumstances of exposure to morally injurious situations and subsequent reactions. Our study brought up several findings including the effect of exposure to multiple potentially injurious events, apparent frequent co-occurrence of moral injury with PTSD, and the complicating unpleasant mental health outcomes. Being a report of cases, this implies that generalizations might not be warranted but serve as possible questions for future research.
Super-Utilization of the Emergency Department in a Universally Insured Population
Authors: Andriotti Tomas , Dalton Michael K , Jarman Molly P , Lipsitz Stuart , Chaudhary Muhammad Ali , Tilley Laura , Learn Peter A , Schoenfeld Andrew J , Goralnick Eric 
Published: December 2020

ABSTRACT

Introduction
Super-utilizers (patients with 4 or more emergency department [ED] visits a year) account for 10% to 26% of all ED visits and are responsible for a growing proportion of healthcare expenditures. Patients recognize the ED as a reliable provider of acute care, as well as a timely resource for diagnosis and treatment. The value of ED care is indisputable in critical and emergent conditions, but in the case of non-urgent conditions, ED utilization may represent an inefficiency in the healthcare system. We sought to identify patient and clinical characteristics associated with ED super-utilization in a universally insured population.

Material and Methods
We performed a retrospective cohort study using TRICARE claims data from the Military Health System Data Repository (2011-2015). We reviewed the claims data of all adult patients (aged 18-64 years) who had at least one encounter at the ED for any cause. Multivariable logistic regression was used to determine independent factors associated with ED super-utilization.

Results
Factors associated with increased odds of ED super-utilization included Charlson Score ≥2 (adjusted odds ratio [aOR] 1.98, 95% confidence interval [CI]: 1.90-2.06), being eligible for Medicare (aOR 1.95, 95% CI: 1.90-2.01), and female sex (aOR 1.35, 95% CI: 1.33-1.37). Active duty service members (aOR 0.69, 95% CI 0.68-0.72) and beneficiaries with higher sponsor-rank (Officers: aOR 0.50, 95% CI: 0.55-0.57; Senior enlisted: aOR 0.82, 95% CI: 0.81-0.83) had lower odds of ED super-utilization. The most common primary diagnoses for ED visits among super-utilizers were abdominal pain, headache and migraine, chest pain, urinary tract infection, nausea and vomiting, and low back pain.

Conclusions
Risk of ED super-utilization appears to increase with age and diminished health status. Patient demographic and clinical characteristics of ED super-utilization identified in this study can be used to formulate healthcare policies addressing gaps in primary care in diagnoses associated with ED super-utilization and develop interventions to address modifiable risk factors of ED utilization.
Interstitial Lung Disease and Myositis in a Patient With Antisynthetase Syndrome and PL12 and Ro52 Co-positivity in a Retired Medical Officer
Authors: Loncharich Michael F , Anderson Caleb W , Collins Jeannette , Edison Jess 
Published: December 2020

Abstract

Antisynthetase syndrome (ASS) is an idiopathic inflammatory myopathy characterized by myositis, arthritis, interstitial lung disease (ILD), Raynaud’s phenomenon, and distinctive cutaneous manifestations. Anti-PL12 is a rare myositis-specific autoantibody classically associated with an amyopathic presentation and rapidly progressive ILD. Anti-Ro52 is a myositis-associated antibody that has been postulated to be directly pathogenic in inflammatory myopathy patients. The disease phenotype, course, and response to treatment associated with anti-PL12 and anti-Ro52 co-positivity is not well described.

A 58-year-old man with anti-PL12 and anti-Ro52 ASS presented with rapidly progressive ILD and myositis refractory to high-dose prednisone. He ultimately required a dexamethasone burst with intravenous immunoglobulin and mycophenolate mofetil for disease control.

Severe and rapidly progressive myositis is infrequently reported in anti-PL12 ASS. This case suggests that concurrent anti-Ro52 positivity predicts a more aggressive disease phenotype and may require more initial immunosuppression. If rapid progression of this disease were to occur in an active duty service member, it would have significant implications for readiness and potentially catastrophic outcomes in the deployed setting. Early identification and treatment of the disease are imperative. The question must also be raised of an occupational exposure from military service.
Depression Screening During Pregnancy: Compliance and Effectiveness in a Military Population
Authors: Gisseman Jordan , Fletcher Tara , Schmolze Abigail , Cooper Devin , Aden James , Cox-Bauer Callie 
Published: December 2020

ABSTRACT

Introduction
Perinatal and postpartum depression are common, affecting 13% to 24% of pregnant women through the first year postpartum. Depression screening is recommended by the American College of Obstetrics and Gynecology as an effective and low-cost intervention to improve patient outcomes; however, no nationwide screening rate is reported in the literature. This study was designed to assess the rate and effectiveness of screening in a major military medical center.

Materials and methods
Institutional review board (IRB) approval was obtained before beginning the study. The facility where this study was performed has a universal depression screening policy in which all patients should be screened using the Edinburgh Postnatal Depression Scale (EPDS) at the initial obstetric visit, the 28-week visit, and the postpartum visit. The EPDS scores and demographic data were collected by chart review of patients seen between May 2015 and April 2017.

Results
Ninety-six percent of patients completed EPDS at their first appointment with a mean score of 3.8. At 28 weeks, 60% of patients were screened with a mean score of 3.8, and at the postpartum appointment, 84% were screened with a mean score of 3.5. Veterans Affairs (VA) patients and dependent daughters had significantly higher EPDS scores than active duty women and dependent wives (mean 7.91, 5.78, 3.19, 3.70, P &lt; .0001). Eight-eight percent of patients with scores of ≥12 were offered the appropriate treatment.

Conclusions
First trimester screening rates are excellent; however, 28-week and postpartum screening rates need improvement. Standardization of clinic screening procedures may be necessary to increase the screening rates. Veterans Affairs patients and dependent daughters have a higher-than-average risk for depression and should be monitored closely. This study demonstrates that a universal postpartum depression screening program is an important part of obstetric care.
Mortality Among Male U.S. Army Soldiers Within 18 Months of Separation
Authors: Abdur-Rahman Ihsan T , Watkins Eren Y , Jarvis Brantley P , Beymer Matthew R , Schoenbaum Michael , Bossarte Robert M , Pecko Joseph A , Cox Kenneth L 
Published: December 2020

ABSTRACT

Introduction
Understanding how soldiers die after separation from military service, particularly those who die shortly after separating from service, may help to identify opportunities to ease transitions to civilian life.

Materials and Methods
Mortality data were analyzed for male U.S. Army soldiers who died within 18 months of their separation from service (from 1999 to 2011). Descriptive statistics were calculated for natural, accidental, suicidal, homicidal, undetermined, and legal/operation of war deaths and were stratified by age, component, time in service, and type of discharge. Crude and age-adjusted mortality rates, standardized for all years using the 2004 Regular Army population, were also calculated. The Public Health Review Board of the U.S. Army Public Health Center approved this study as Public Health Practice.

Results
Of the 1,884,653 male soldiers who separated from service during the study period, 3,819 died within 18 months of separation. A majority of all separations were Reserve or National Guard (58%), and 62% of decedents were in the Reserve or National Guard. Deaths from natural causes (38%) were the most common, followed by accident deaths (34%), suicides (20%), homicides (6%), undetermined deaths (2%), and legal/operation of war deaths (&lt;1%). For overall mortality, age-adjusted rates were higher among the male U.S. population when compared to male soldiers who had separated from the Army.

Conclusions
The time period immediately following separation from the Army presents a unique challenge for many soldiers. Developing more effective pre-separation prevention programs that target specific risks requires knowing the causes of death for natural deaths, suicides, and accidents. Over half of all deaths occurring shortly after separation from service are preventable. Continued surveillance of specific causes of preventable deaths following separation can improve pre-separation prevention programs and transitions to post-service care.
Cholera Presenting With Hyperkalemia, Rhabdomyolysis, and Acute Renal Failure
Authors: Grubb Seth M , Riddle Mark 
Published: December 2020

ABSTRACT
Cholera is a well known cause of significant disease, particularly in resource-poor nations, but it is very rare in developed countries. The morbidity and mortality of cholera is resultant from large-volume diarrhea, hypovolemia, and electrolyte derangement. In the following case, a 60-year-old man with no recent travel history presented to the emergency department with muscle cramping, abdominal pain, and gastrointestinal distress. It was later confirmed that he was suffering from cholera. On presentation, he was hyperkalemic with ECG changes and soon went into a hypovolemic shock. After a complicated hospital course, he fortunately made a complete recovery. This case demonstrates that common complaints may result in uncommon diagnoses. It is important to pay attention to the clinical situation and intervene accordingly.
Transpacific Aeromedical Evacuation for a Ruptured Brain Arteriovenous Malformation During the COVID-19 Pandemic
Authors: Ikeda Daniel S , Dryden John R , Van Gent Jan-Michael , Benzer Emily , Praske Steven P , Ravindra Vijay M , Miller Charles A , Curry Brian P , Bell Randy S 
Published: December 2020

ABSTRACT
The COVID-19 pandemic has altered preexisting patient treatment algorithms and referral patterns, which has affected neurosurgical care worldwide. Brain arteriovenous malformations are complex vascular lesions that frequently present with intracerebral hemorrhage. Care for these patients is best performed at large medical centers by specialists with high volumes. The authors describe the care of a patient who presented in extremis to a resource-limited, community-sized military treatment facility (MTF) in Southeast Asia. In the MTF, the patient underwent emergent neurosurgical therapy. However, given newly implemented restrictions enacted to mitigate COVID-19 spread, local transfer for definitive care to a tertiary care facility was not possible. In order to attain definitive care for the patient, a transpacific aeromedical evacuation augmented with a critical care air transport team was utilized for transfer to a tertiary care, teaching hospital. This case demonstrates the safe treatment of a patient with hemorrhagic arteriovenous malformations and postoperative management under limited conditions in an MTF outside the CONUS. Given the unique circumstances and challenges the pandemic presented, the authors feel that this patient’s outcome was only possible by leveraging all the capability military medicine has to offer.
The ultraluminous X-ray source bubble in NGC 5585
Authors: Soria R , Pakull M W , Motch C , Miller-Jones J C A , Schwope A D , Urquhart R T , Ryan M S 
Published: December 2020

ABSTRACT
Some ultraluminous X-ray sources (ULXs) are surrounded by collisionally ionized bubbles, larger and more energetic than supernova remnants: they are evidence of the powerful outflows associated with super-Eddington X-ray sources. We illustrate the most recent addition to this class: a huge (350 pc × 220 pc in diameter) bubble around a ULX in NGC 5585. We modelled the X-ray properties of the ULX (a broadened-disc source with LX ≈ 2–4 × 1039 erg s−1) from Chandra and XMM–Newton, and identified its likely optical counterpart in Hubble Space Telescope images. We used the Large Binocular Telescope to study the optical emission from the ionized bubble. We show that the line emission spectrum is indicative of collisional ionization. We refine the method for inferring the shock velocity from the width of the optical lines. We derive an average shock velocity ≈125 km s−1, which corresponds to a dynamical age of ∼600 000 yr for the bubble, and an average mechanical power Pw ∼ 1040 erg s−1; thus, the mechanical power is a few times higher than the current photon luminosity. With Very Large Array observations, we discovered and resolved a powerful radio bubble with the same size as the optical bubble, and a 1.4-GHz luminosity ∼1035 erg s−1, at the upper end of the luminosity range for this type of source. We explain why ULX bubbles tend to become more radio luminous as they expand while radio supernova remnants tend to fade.
BIOM-17. BRAF MUTATION IS AN EARLY EVENT IN THE EVOLUTION OF A SUBSET OF GLIOBLASTOMAS AND IS ASSOCIATED WITH INCREASED PD-L1 EXPRESSION
Authors: Walsh Kyle , Xiu Joanne , López Giselle , Landi Daniel , Reitman Zachary , Mittal Sandeep , Brenner Andrew , Fonkem Ekokobe , Kesari Santosh , Phuphanich Surasak , Newton Herbert , Pandey Manjari , Lou Emil , Glantz Michael , Sumrall Ashley , Dunbar Erin , De La Fuente Macarena , Korn W Michael , Khasraw Mustafa , Ashley David 
Published: December 2020

Abstract

INTRODUCTION
BRAF is a RAF-family kinase that regulates MAPK/ERK signaling. Activating BRAF mutations, including V600E, are common in circumscribed low-grade gliomas of childhood and young adulthood, but are uncommon in infiltrative astrocytomas, including glioblastoma. Their role in glioblastoma initiation and progression requires analysis of large datasets given the low frequency (1.0%) in TCGA IDH-wild-type glioblastomas.

METHODS
Molecular profiling was done on 4679 FFPE gliomas by next-generation sequencing at Caris Life Sciences, of which 3170 underwent RNA-sequencing for gene fusion and 4603 DNA-sequencing for mutations. MGMT promoter methylation was tested by pyrosequencing and PD-L1 IHC was performed using the SP142 clone.

RESULTS
Excluding variants of uncertain significance, BRAF mutations/fusions were most common in pleomorphic xanthoastrocytoma (PXA; N=12/24, 50%), glioneuronal tumors (N=6/13, 46%), pilocytic astrocytoma (PA; N=15/48, 31%), and ganglioglioma (n=5/18, 28%). BRAF fusions were uncommon (N=17), most frequent in PA (N=8/31, 26%) where they were associated with older age at daignosis (P=0.043), and typically involved KIAA1549 as fusion partner (70%). BRAF-mutated/fused glioblastoma patients (N=59/3126, 2%) were younger than BRAF-wild-type glioblastoma patients (54 versus 59 years, P=3.5x10-3); more likely to be MGMT-unmethylated (75% versus 56%, P=5.0x10-3); and 3x more likely to express PD-L1 (55% versus 17%, P=2.1x10-10). In tumors harboring a V600E mutation, the variant allele frequency (VAF) was similar in glioblastoma as in PXA, PA, ganglioglioma, and glioneuronal tumors (median VAF=35%).

CONCLUSIONS
BRAF-mutated glioblastoma were 3x more likely to express PD-L1 than BRAF-wild-type glioblastoma. We observed no differences in BRAF V600E clonality in BRAF-mutated glioblastoma compared to BRAF-mutated PXA, PA, ganglioglioma, and glioneuronal tumors, suggesting BRAF mutation is an initiating event in the clonal evolution of a subset of glioblastoma. There is rationale to evaluate combined BRAF inhibition with checkpoint inhibition in BRAF-mutated glioblastoma, potentially synergizing the complete response profile of the former with the durable response profile of the latter.
COVD-07. THE IMPACT OF COVID-19 ON PATIENTS AND CAREGIVERS AFFECTED BY BRAIN TUMORS: THE PATIENT NAVIGATOR PERSPECTIVE
Authors: Walsh Kyle 
Published: December 2020

Abstract

BACKGROUND
Preliminary evidence indicates that glioma patients are at higher risk for COVID-19 complications due to systemic immunosuppression. Interruptions in cancer care may exacerbate patient and caregiver anxiety, but surveying patients/caregivers about their COVID-19 experiences is often limited by attainable sample sizes and over-reliance upon single-institution experiences.

METHODS
To explore how COVID-19 is impacting brain tumor patients/caregivers across the U.S., we performed semi-structured interviews with brain tumor patient navigators employed by two different 501(c)3 nonprofit organizations. A semi-structured interview guide was used, utilizing prompts and open-ended questions to facilitate dialogue. A core set of COVID-19 topics were covered, including: financial issues, coping strategies, geographic variability, variability by tumor grade/histology, disruptions in care continuity, accessing clinical trials, psychosocial issues, and end-of-life care. Interviews were audio-recorded, transcribed, and organized by discussion topic to identify emerging themes. Inductive sub-coding was completed using the constant comparison method, within and between transcripts.

RESULTS/CONCLUSIONS
Ten patient navigators were interviewed between April 15th and May 8th, with interviews lasting approximately one hour (range 38-77minutes). Navigators reported having contact with 183 unique brain tumor families during the pandemic (range 7–38 families per navigator). High concordance emerged across narratives, revealing important considerations for the neuro-oncology workforce. The most prominent theme was increased caregiver burden, attributed to maintaining social distancing by reducing visits from home-health aides and friends/family. A related theme that applied to both patients and caregivers was increased social isolation due to social distancing, suspension of in-person support groups, and church/temple closures. Accessing clinical trials was a recurrent issue, exacerbated by patients’ increasing unwillingness to travel. Glioblastoma patients, especially those with recurrent tumors, expressed greater reluctance to travel. Access to standard-of-care treatment was rarely interrupted, but reduced access to supportive services – especially physical and occupational therapy – was identified as an emerging COVID-related deficiency in clinical care.
CTIM-01. GLIOBLASTOMA RE-IRRADIATION: IMPACT OF CONCOMITANT CHEMOTHERAPY
Authors: Epaillard Nicolas , Hammoudi Nassim , Faron Matthieu , ammari Samy , Pallud Johan , Louvel Guillaume , Lezghed Naima , Garcia Gabriel , Bockel Sophie , Copaciu Razvan , Dezami Edouard , Knafo Steven , Benadhou Lyna , Abbar Baptiste , Seknazi Lauren , Abdayem Pamela , Simonaggio Audrey , Bourcier Kevin , Dhermain Frederic , Dumont Sarah 
Published: December 2020

Abstract

PURPOSE
Although the standard of initial treatment is well defined for glioblastoma, no recommendation exists in the relapse setting. This work focuses on the optimal strategy for recurrent glioblastoma.

METHODS
Retrospective monocentric analysis of all recurrent glioblastoma adult patients treated since 2000 in one center by re-irradiation, alone or combined with chemotherapy and/or surgery at first or second relapse.

RESULTS
Patient (n=61) median age was 55 (27 to 76), 44% were women. At diagnosis, 77% underwent surgical resection and 23% were biopsied. Most (95%) received a Stupp regimen. After a median follow-up of 31.1 months, 44 patients (72%) had died, median overall survival (mOS) was 39.8 months. Regardless of the time of treatment, patients treated with radiotherapy concomitant to bevacizumab (RTbev) showed superior survival data compared to patients treated with radiotherapy alone (RTalone). At first relapse, median progression free survival (mPFS) of RTbev was 9.9 versus 3.6 months for RTalone (OR=3.98 (3.14–61.81); p=0.001). At second relapse, mPFS of RTbev was 9.2 versus 5.4 months for RTalone (OR=2.31 (1.18–7.75); p=0.029), and mOS of RTbev was 15.2 versus 9.1 months for RTalone (OR=3.60 (2.17–18.13); p=0.001).

CONCLUSION
This retrospective monocentric analysis reports a favourable impact of bevacizumab adjunction to re-irradiation.