bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategies for Prosecuting Mass Starvation
Authors: Jordash Wayne , Murdoch Catriona , Holmes Joe 
Published: November 2019

Abstract
Every instance of famine or acute food insecurity today is, at its core, man-made, and the current scale of consequential suffering and death is unprecedented in modern history. Deliberate starvation is a crime under international law, including under Article 8(2)(b)(xxv) of the Rome Statute. Notwithstanding, there has been a dearth of prosecutions of those suspected of committing the crime or engaging in any of the underlying conduct. The reasons for this neglect may be many, including a lack of clarity around the elements of the crime and particularly the mental elements that must be established. This article explores the challenges that might exist in investigating and prosecuting the crime of starvation and seeks to clarify its elements with a particular focus on the mens rea requirement under Article 8(2)(b)(xxv). The authors aim to draw a roadmap for practitioners to ensure better international recognition of the deliberate nature of starvation, and in order that attribution of fault and accountability become less elusive.
Metabolic changes in mice cardiac tissue after low-dose irradiation revealed by 1H NMR spectroscopy
Authors: Gramatyka Michalina , Boguszewicz ᴌukasz , Ciszek Mateusz , Gabryś Dorota , Kulik Roland , Sokół Maria 
Published: November 2019

Abstract
Ionizing radiation may cause cardiotoxicity not only at high, but even at low (considered as harmless) doses, yet the molecular mechanisms of the heart’s response to low doses are not clear. In this work, we used high-resolution nuclear magnetic resonance (NMR) spectroscopy to detect the early and late effects of radiation on the metabolism of murine hearts. The hearts of C57Bl/6NCrl female mice were irradiated in vivo with single 0.2 Gy or 2 Gy doses using 6 MV photons, then tissues were collected 48 h and 20 weeks after exposure. The most distinct changes in the profile of polar metabolites were detected 48 h after irradiation with 2 Gy, and included increased levels of pantothenate and glutamate as well as decreased levels of alanine, malonate, acetylcarnitine, glycine and adenosine. Significant effects of the 2 Gy dose were also observed 20 weeks after irradiation and included decreased levels of glutamine and acetylcarnitine when compared with age-matched controls. Moreover, several differences were observed between hearts irradiated with 2 Gy and analyzed either 48 h or 20 weeks after the exposure, which included changes in levels of acetylcarnitine, alanine, glycine, glutamate, glutamine, formate, myo-inositol and trimethylamine. No statistically significant effects induced by the 0.2 Gy dose were observed 20 weeks after irradiation. In general, radiation-affected compounds were associated with energy metabolism, fatty acid beta-oxidation, oxidative stress and damage to cell structures. At the same time, radiation-related effects were not detected at the level of tissue histology, which indicated a higher sensitivity of metabolomics-based tests for cardiac tissue response to radiation.
Voltage-induced penetration effect in liquid metals at room temperature
Authors: Yun Frank F , Yu Zhenwei , He Yahua , Jiang Lei , Wang Zhao , Gu Haoshuang , Wang Xiaolin 
Published: November 2019

Abstract
Room-temperature liquid metal is discovered to be capable of penetrating through macro- and microporous materials by applying a voltage. The liquid metal penetration effects are demonstrated in various porous materials such as tissue paper, thick and fine sponges, fabrics, and meshes. The underlying mechanism is that the high surface tension of liquid metal can be significantly reduced to near-zero due to the voltage-induced oxidation of the liquid metal surface in a solution. It is the extremely low surface tension and gravity that cause the liquid metal to superwet the solid surface, leading to the penetration phenomena. These findings offer new opportunities for novel microfluidic applications and could promote further discovery of more exotic fluid states of liquid metals.
Comparisons of 30-Day Admission and 30-Day Total Healthcare Costs Between Patients Who Were Treated With Oritavancin or Vancomycin for a Skin Infection in the Outpatient Setting
Authors: Lodise Thomas P , Palazzolo Christina , Reksc Kerry , Packnett Elizabeth , Redell Mark 
Published: November 2019

Abstract

Objective
Hospital admission is a key cost driver among patients with skin and soft tissue infections (SSTI). Data suggest that many SSTI patients are hospitalized unnecessarily and can be managed effectively and safely in an outpatient setting at a substantially lower cost. Oritavancin (ORI) is a single-dose treatment that has the potential to shift care from the inpatient to the outpatient setting. This study sought to compare the 30-day hospital admission rates and mean healthcare costs among SSTI patients who received outpatient ORI or vancomycin (VAN).

Method
Over a 1-year period, outpatient prescription claims for VAN and ORI among patients with SSTIs and no hospitalization in past 3 days were for VAN and ORI were analyzed using a retrospective cohort analysis of the Truven Health MarketScan Databases.

Results
During the study period, 120 and 6695 patients who received ORI and VAN, respectively, met inclusion criteria. Groups were well matched at baseline. After covariate adjustment, patients who received ORI had a significantly lower 30- day admission rate versus patients who received VAN (6.1% vs 16.2%, respectively; P = .003). Mean healthcare costs 30-day post index were comparable between ORI and VAN patients ($12 695 vs $12 717, respectively; P = 1.0).

Conclusions
Results suggest that ORI provides a single-dose alternative to multidose VAN for treatment of SSTI in the outpatient setting and may result in lower 30-day hospital admission rates.
Integrated prodrug micelles with two-photon bioimaging and pH-triggered drug delivery for cancer theranostics
Authors: Xu Hong , Ma Boxuan , Jiang Jizhou , Xiao Sutong , Peng Rongrong , Zhuang Weihua , Li Gaocan , Wang Yunbing 
Published: November 2019

Abstract
Nanodrug carriers with fluorescence radiation are widely used in cancer diagnosis and therapy due to their real-time imaging, less side effect, better drug utilization as well as the good bioimaging ability. However, traditional nanocarriers still suffer from unexpectable drug leakage, unsatisfactory tumor-targeted drug delivery and shallow imaging depth, which limit their further application in cancer theranostics. In this study, an integrated nanoplatform is constructed by polymeric prodrug micelles with two-photon and aggregation-induced emission bioimaging, charge reversal and drug delivery triggered by acidic pH. The prodrug micelles can be self-assembled by the TP-PEI (DA/DOX)-PEG prodrug polymer, which consists of the two-photon fluorophore (TP), dimethylmaleic anhydride (DA) grafted polyethyleneimine (PEI) and polyethylene glycol (PEG). The PEG segment, DOX and DA are bridged to polymer by acid cleavable bonds, which provides the micelles a ‘stealth’ property and a satisfactory stability during blood circulation, while the outside PEG segment is abandoned along with the DA protection in the tumor acidic microenvironment, thus leading to charge reversal-mediated accelerated endocytosis and tumor-targeted drug delivery. The great antitumor efficacy and reduced side effect of these pH-sensitive prodrug micelles are confirmed by antitumor assays in vitro and in vivo. Meanwhile, these micelles exhibited great deep-tissue two-photon bioimaging ability up to 150 μm in depth. The great antitumor efficacy, reduced side effect and deep two-photon tissue imaging make the TP-PEI (DA/DOX)-PEG prodrug micelles would be an efficient strategy for theranostic nanoplatform in cancer treatment.
Job satisfaction and workplace stressors among surgical providers at a single institution
Authors: Gates Rebecca , Workman Allison , Collier Bryan 
Published: November 2019

ABSTRACT

Objective:
Job satisfaction and work stress are associated with provider health and patient outcomes. This study aimed to evaluate job satisfaction and workplace stressors in surgical providers (surgeons, physician assistants [PAs], and NPs).

Methods:
A survey was distributed to providers within a single surgical department. Job satisfaction and workplace stressors were evaluated by sex, age, profession, career length, and work hours.

Results:
Providers practicing for 11 to 15 years had greater job satisfaction than those practicing for more than 20 years, with no other differences by demographic group. Females cited supervisory support as a top workplace stressor more than did males (P = .01) and PAs and NPs cited supervisory support (P < .01) and compensation/finances more than surgeons (P = .05). Workplace stressors varied by practice years and work hours.

Conclusions:
Healthcare organizations should be aware of diversity in perceived workplace stressors. A “one size fits all” approach to provider well-being is likely to be ineffective.
How Do Attending Physicians Prepare Residents to Deliver High-Value, Cost-Conscious Care?
Authors: Stammen Lorette A. , Driessen Erik W. , Notermans Celine C.V.I. , Scheele Fedde , Stassen Laurents P.S. , Stalmeijer Renée E. 
Published: November 2019

Purpose
An estimated 20% of health care expenditures are wasteful. Educational interventions aimed at reducing waste by delivering high-value, cost-conscious care (HV3C) often focus on the role of the physician. This study sought to understand how attending physicians, who have a central role in the workplace, prepare residents to provide HV3C.

Method
Researchers from Maastricht University in Maastricht, the Netherlands, conducted semistructured interviews between September 2016 and August 2017 with 12 attending physicians who supervise residents in the workplace. Participants were purposefully sampled from 5 institutions throughout the Netherlands to include surgical and nonsurgical attending physicians and hospital- and nonhospital-based physicians. Data collection and analysis were iterative, using principles of grounded theory.

Results
The attending physician’s approach to providing HV3C was an important factor in preparing residents in the workplace. Three differences became apparent: priority of HV3C training, feedback on HV3C, and obstacles to HV3C delivery. Results indicate that attending physicians use 3 teaching methods to teach HV3C delivery: Socratic questioning, role modeling, and setting limits. Training was often implicit and ad hoc.

Conclusions
How attending physicians deal with HV3C themselves influences how they prepare residents in the workplace. To optimize resident training, it may be important to create a supportive environment for HV3C delivery and training. Delivery could be supported by making HV3C a shared goal for attending physicians and residents, thereby providing insight into clinical practice behavior and minimizing the influence of obstacles. Training could be optimized by supporting a variety of teaching methods suitable for daily teaching to stimulate continuous learning in residents.
The Effectiveness of Teaching Clinical Empathy to Medical Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Fragkos Konstantinos C. , Crampton Paul E.S. 
Published: November 2019

Purpose
Clinical empathy is a necessary trait to provide effective patient care, despite differences in how it is defined and constructed. The aim of this study was to examine whether empathy interventions in medical students are effective and how confounding factors potentially moderate this effect.

Method
The authors performed a systematic review and meta-analysis. They searched the literature published between 1948 and 2018 for randomized controlled trials that examined empathy interventions in medical students. The search (database searching, citation tracking, hand-searching relevant journals) yielded 380 studies, which they culled to 16 that met the inclusion criteria. For the meta-analysis, they used a random effects model to produce a pooled estimate of the standardized mean difference (SMD), then completed subgroup analyses.

Results
The authors found evidence of the possibility of response and reporting bias. The pooled SMD was 0.68 (95% confidence interval 0.43, 0.93), indicating a moderately positive effect of students developing empathy after an intervention compared with those in the control groups. There was no evidence of publication bias, but heterogeneity was significantly high (I
2 = 88.5%, P < .01). Subgroup analyses indicated that significant moderating factors for developing empathy were age, country, scope of empathy measurement, type of empathy intervention, and presence of rehearsal. Moderating factors with limited evidence were sex, study quality, journal impact factor, and intervention characteristics.

Conclusions
Despite heterogeneity and biases, empathy interventions in medical students are effective. These findings reinforce arguments in the literature and add considerable rigor from the meta-analysis. The authors propose a conceptual model for educators to follow when designing empathy interventions in medical students.
Wideband Acoustic Immittance in Cochlear Implant Recipients: Reflectance and Stapedial Reflexes
Authors: Scheperle Rachel A. , Hajicek Joshua J. 
Published: November 2019

Objectives:
to characterize differences in wideband power reflectance for ears with and without cochlear implants (CIs), to describe electrically evoked stapedial reflex (eSR)-induced changes in reflectance, and to evaluate the benefit of a broadband probe for reflex threshold determination for CI recipients. It was hypothesized that reflectance patterns in ears with CIs would be consistent with increased middle ear stiffness and that reflex thresholds measured with a broadband probe would be lower compared with thresholds obtained with a single-frequency probe.

Design:
Eleven CI recipients participated in both wideband reflectance and eSR testing. Ipsilateral reflexes were measured with three probes: a broadband chirp (swept from 200 to 8000 Hz), a 226 Hz tone, and a 678 Hz tone. Wideband reflectance measures acquired from 28 adults without CIs and with normal middle ear function served as a normative data set for comparison.

Results:
Considering the group data, average reflectance was significantly greater for ears with CIs across 250 to 891 Hz and 4238 to 4490 Hz compared with the normative data set, although individual reflectance curves were variable. Some CI recipients also had low 226 Hz admittance, which contributed to the group finding, considering the control group had clinically normal 226 Hz admittance by design. Electrically evoked stapedial reflexes were measurable in nine of 14 ears (64.3%) and in 24 of 46 electrodes (52.5%) tested. Reflex-induced changes in reflectance patterns were unique to the participant/ear, but similar across activators (electrodes) within a given ear. In addition, reflectance values at or above 1000 Hz were affected most by activating the stapedial reflex, even in ears with clinically normal 226 Hz admittance. This is a higher-frequency range than has been reported for acoustically evoked reflex-induced reflectance changes and is consistent with increased middle ear stiffness at rest. Electrically evoked reflexes could be measured more often with the 678 Hz or the broadband probe compared with the 226 Hz probe tone. Although reflex thresholds were lower with the broadband probe compared with the 678 Hz probe in 16 of 24 conditions, this was not a statistically significant finding (Wilcoxon signed-rank test; p = 0.072).

Conclusions:
The applications of wideband acoustic immittance measurements (reflectance and reflexes) should also be considered for ears with CIs. Further work is needed to describe changes across time in ears with CIs to more fully understand the reflectance pattern indicating increased middle ear stiffness and to optimize measuring eSRs with a broadband probe.
Bone Conduction Stimulation Applied Directly to the Otic Capsule: Intraoperative Assessment in Humans
Authors: Lachowska Magdalena , Niemczyk Kazimierz , Kwacz Monika , Małkowska Maria , Sokołowski Jacek 
Published: November 2019

Objectives:
Aim was to investigate the innovative method of direct acoustic bone conduction (BC) stimulation applied directly to the otic capsule and measured intraoperatively by promontory displacement in living humans. The objective was to find the best stimulation site that provides the greatest transmission of vibratory energy in a living human and compare it with the results previously obtained in cadavers.

Design:
The measurements were performed in 4 adult patients referred to our department for vestibular schwannoma removal via translabyrinthine approach. The measurements were performed in the operated site. The cadaver data were obtained in our previous study and here they are reanalyzed for comparison. Promontory displacement was measured using a commercial scanning laser Doppler vibrometer. The laser Doppler vibrometer points located on the promontory were used to analyze the promontory displacement amplitude. Cochlear stimulation was induced with BC stimulation through an implant positioned at three sites. The first site was on the skull surface at the squamous part of the temporal bone (BC No. 1), the second at the bone forming the ampulla of the lateral semicircular canal (BC No. 2), and the third between the superior and lateral semicircular canals (BC No. 3). BC No. 2 and BC No. 3 were located directly on the otic capsule. Four frequencies in total were tested (500, 1000, 2000, and 4000 Hz), one at a time.

Results:
In patients, the detailed analysis of promontory displacement amplitudes revealed the BC No. 1 magnitude to be the smallest and significantly different from BC No. 2 and No. 3 at all measured frequencies. Transmission of vibratory energy at BC No. 2 and BC No. 3 was the most effective and similar with a small and insignificant difference at 500, 1000, and 4000 Hz, and a significant difference at 2000 Hz. The results observed in cadavers were similar to those in living humans. However, a few differences were observed when comparing patients and cadavers. Small and insignificant differences were found for BC No. 1. Almost the same results were obtained for BC No. 2 and BC No. 3 in cadavers as in living humans, with only BC No. 3 measurements results at 500 Hz at the limit of statistical significance, with no other significant differences observed.

Conclusions:
The results of this study indicate that the promontory vibration amplitude increases when the BC stimulation location approaches the cochlea. BC No. 1 stimulation located on the squama caused overall smaller displacement than both BC No. 2 and No. 3 screwed to the ampulla of the lateral semicircular canal and to the midpoint between the semicircular canals, respectively. In our opinion, the results of BC stimulation applied directly to the otic capsule present a potential new stimulation site that could be introduced in the field of BC hearing rehabilitation.
Do Hospital or Surgeon Volume Affect Outcomes After Surgical Management of Tibial Shaft Fractures?
Authors: Clement R. Carter , Strassle Paula D. , Ostrum Robert F. 
Published: November 2019

Objectives:
To determine whether hospital and surgeon volume are associated with outcomes after operative fixation of tibial shaft fractures.

Methods:
Adults (≥18 year old) who underwent operative fixation of diaphyseal tibial fractures were identified in the New York Statewide Planning and Research Cooperative System data set from 2001 to 2015. Reoperation, nonunion, and other adverse event rates were compared across surgeon and hospital volume using multivariable Cox proportional hazards regression, adjusting for clinical and demographic factors. Low-volume providers (lowest 20%) were compared with high-volume providers (highest 20%). Low volume constituted <5 cases/year for hospitals and 1 case/year for surgeons. High volume constituted ≥40 cases/year for hospitals and ≥8 cases/year for surgeons.

Results:
Nine thousand one hundred forty-seven patients were included. Relative to high-volume surgeons, low-volume surgeons experienced slightly higher rates of pneumonia [2% vs. 1%, hazard ratio (HR) 2.50, 95% confidence interval (CI) 1.38–4.53, P = 0.003], and respiratory failure (5% vs. 3%, HR 1.88, 95% CI 1.30–2.71, P = 0.001). Compared with high-volume hospitals, low-volume hospitals experienced slightly lower rates of compartment syndrome (1% vs. 3%, HR 0.45, 95% CI 0.24–0.85, P = 0.01) and fasciotomies (3% vs. 7%, HR 0.57, 95% CI 0.38–0.85, P = 0.005). The rates of all other reoperations and adverse events compared among hospitals and surgeons were not significantly different.

Conclusions:
We did not detect a clinically meaningful volume–outcome relationship for either surgeons or hospitals despite the use of a robust database with rigorous statistical methodology. Of note, these findings should not be applied to rare complex injuries such as those with extensive bone loss or articular extension, which are not well represented by this study population. Therefore, we conclude that typical tibial shaft fracture, including open or closed injuries, can be safely managed in the vast majority of orthopaedic settings and that this care does not necessarily require transfer to a specialty centers. Future research into orthopaedic volume–outcome relationships could be strengthened by the use of functional outcomes (which would likely require well-organized multicenter prospective registries).

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Impact of Resident Training Level on Radiation Exposure During Fixation of Proximal Femur Fractures
Authors: Buxbaum Eric J. , Ponzio Danielle Y. , Griffiths Sean , Wu Eddie S. , Duque Andres F. , Post Zachary D. , Orozco Fabio R. , Ong Alvin C. 
Published: November 2019

Objective:
To identify whether residents are at greater risk of radiation exposure from intraoperative fluoroscopy while earlier in their training and during more complex procedures.

Methods:
We analyzed 852 extracapsular proximal femur fracture fixation cases. We compared fluoroscopy times by various levels of resident training, fracture type, and implant used. Attending-only cases were used as a control group.

Results:
Fluoroscopy times during subtrochanteric fracture fixation (176.1 ± 11.27 seconds) were longer than intertrochanteric (111.4 ± 2.44 seconds) and basicervical fractures (91.49 ± 5.77 seconds). Long nail (150.2 ± 3.75 seconds) times were longer than short (92.3 ± 3.15 seconds) and intermediate (76.45 ± 3.01 seconds) nails. Significantly, more fluoroscopy was used in junior (115.9 ± 4.24 seconds), senior (123.0 ± 6.08 seconds), junior combo (130.6 ± 7.74 seconds), and senior combo cases (131.8 ± 6.11 seconds) compared with the control (94.91 ± 3.91).

Conclusion:
Orthopaedic surgery residents and attendings must remain aware of radiation exposure secondary to intraoperative fluoroscopy. Appropriate personal protective equipment should be worn, and more experienced surgeons should take a more active role in the complex cases to decrease exposure risk.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.