bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical features, management and outcomes of gastrointestinal bleeding in patients treated with oral anticoagulants
Authors: Marti Sanchez D , Biscotti Rodil B , Delgado Calva F , Duarte Torres J , Marschall A , Dejuan Bitria C , Rueda Linares A , Rodriguez Torres D , Del Castillo Carnevali H , Alvarez Anton S 
Published: October 2021

Abstract

Background
Gastrointestinal (GI) bleeding with the different antithrombotics may present peculiarities in terms of location, precipitating factors, clinical management and prognosis.

Purpose
Our objective was to compare the profile and clinical course of GI bleeding with direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA).

Methods
We carried out a retrospective study of all consecutive patients treated in a tertiary hospital during 2018 and 2019, and who met the following selection criteria: 1) diagnosis of confirmed or probable GI bleeding; 2) red blood cell transfusion; 3) treatment with an oral anticoagulant; 4) absence of concomitant antiplatelet therapy. We collected information on comorbidities, bleeding risk scores, baseline treatments, and clinical course of bleeding. We compared adjusted all-cause mortality at 12-months between DOACs and VKAs groups.

Results
We identified 115 patients with GI bleeding, mean age 83±9 years, 63% women, 50.4% on DOACs and 49.6% on VKAs. NOACs group showed more recent anticoagulation history, and more complex clinical profile, with older age (85 vs. 82 years, p=0.026), number of comorbidities (2.7 vs. 2.1, p=0.049), CHA2DS2VASc score (5.2 vs. 4.2, p=0.001) and ORBIT score (3.9 vs. 3.3, p=0.047). There were no differences in the location of bleeding (60.5% lower GI tract), number of units transfused (mean 2.6), or hemoglobin nadir (mean 7.6 g/dL). Notably, 42% of the patients on DOACs were receiving the high dose at the time of bleeding, 63% of them had some risk criterion for overdose (age&gt;80 years, weight &lt;60 kg, moderate P-glycoprotein inhibitors), and 37% had &gt;1 of these criteria. 12-month cumulative mortality was high, but significantly lower in the DOACs group (15.5% vs. 35.7%, adjusted HR 0.31, p=0.002).

Conclusions
Patients who experience GI bleeding with anticoagulants represent a therapeutic challenge, with both high age and prevalence of comorbidities. One-year mortality is remarkably high, particularly in the VKA group. Our findings emphasize the need for close monitoring and optimization of preventive strategies in this complex clinical scenario.

Funding Acknowledgement
Type of funding sources: None.
Necessity 20 Years On: The Limits of Article 25
Authors: Paddeu Federica , Waibel Michael 
Published: October 2021

Abstract
Investment tribunals have fleshed out the requirements of the defence of necessity in Article 25 of the Articles on State Responsibility. This article considers the impact of necessity in international investment law and in general international law. The decided cases of the early twenty-first century have revealed three difficulties in Article 25 and in the defence of necessity. First, rather than assessing necessity from the vantage point of the State invoking necessity, they assess it ex post with hindsight bias. Second, the standard of proof required to demonstrate the existence of a grave and imminent peril is infeasible for many situations of risk and uncertainty. Third, the ‘only way’ criterion is not only unduly strict and virtually impossible to prove, but is wholly unrealistic for macro-level crises, such as pandemics or financial crises. To account for these difficulties, tribunals should avoid hindsight bias, especially with respect to ‘grave and imminent peril’ and the ‘only way’ criterion. The defence of necessity is a blunt instrument and has not afforded States a significant ‘safety valve’. As a result, States have begun to reconsider the substantive standards in investment treaties and to include internal exceptions in their investment treaties.
Clinical and Epidemiological Changes in French Soldiers After Deployment: Impact of Doxycycline Malaria Prophylaxis on Body Weight
Authors: Javelle Emilie , Mayet Aurélie , Allodji Rodrigue S , Marimoutou Catherine , Lavagna Chrystel , Desplans Jérôme , Million Matthieu , Raoult Didier , Texier Gaëtan 
Published: October 2021

ABSTRACTBackgroundAntibiotics are growth promotors used in animal farming. Doxycycline (DOXY) is a tetracycline antibiotic taken daily and continued 1 month after return to protect against malaria during travel and deployment in endemic areas. We evaluated DOXY impact on body weight in military international travelers.Materiel and MethodsA prospective cohort analysis was conducted in 2016-2018, recruiting 170 French soldiers before a 4-month assignment overseas. Many clinical data including anthropometric measures by an investigator were collected before and after deployment. Weight gain was defined by an increase of 2% from baseline. The study protocol was supported by the French Armed Forces Health Services and approved by the French ethics committee (IRB no. 2015–A01961–48, ref promoter 2015RC0). Written, informed consent was obtained with signature from each volunteer before inclusion.ResultsAfter deployment, 84 soldiers were followed up. Overall, 38/84 (45%) were deployed to Mali with DOXY malaria prophylaxis, and others were deployed to Iraq or Lebanon without malaria prophylaxis according to international recommendations. Body weight increased in 24/84 (30%), of whom 14/24 (58%) were exposed to DOXY. In bivariate analysis, DOXY had a positive but not significant effect on weight gain (P-value = .4). In the final logistic regression model (Fig. 3), weight gain after deployment positively correlated with an increase in waist circumference (odds ratio [OR] 1.23 with 95% CI [1.06-1.47]) suggesting fat gain; with sedentary work (OR 5.34; 95% CI [1.07-31.90]); and with probiotic intake (OR 5.27; 95% CI [1.51-20.40]). Weight impact of probiotics was more important when associated with DOXY intake (OR 6.86; 95% CI [1.52-38.1]; P-value = .016).ConclusionsDoxycycline (DOXY) malaria prophylaxis during several months did not cause significant weight gain in soldiers. Further studies are required in older and less sportive traveling populations, and to investigate a cumulative effect over time and recurrent DOXY exposure. Doxycycline (DOXY) may enhance other growth-promoting factors including fatty food, sedentariness, and strain-specific probiotics contained in fermented dairy products which are also used as growth promotors.
Dynamic phenotypic heterogeneity and the evolution of multiple RNA subtypes in hepatocellular carcinoma: the PLANET study
Authors: Zhai Weiwei , Lai Hannah , Kaya Neslihan Arife , Chen Jianbin , Yang Hechuan , Lu Bingxin , Lim Jia Qi , Ma Siming , Chew Sin Chi , Chua Khi Pin , Alvarez Jacob Josiah Santiago , Chen Pauline Jieqi , Chang Mei Mei , Wu Lingyan , Goh Brian K P , Chung Alexander Yaw-Fui , Chan Chung Yip , Cheow Peng Chung , Lee Ser Yee , Kam Juinn Huar , Kow Alfred Wei-Chieh , Ganpathi Iyer Shridhar , Chanwat Rawisak , Thammasiri Jidapa , Yoong Boon Koon , Ong Diana Bee-Lan , de Villa Vanessa H , Dela Cruz Rouchelle D , Loh Tracy Jiezhen , Wan Wei Keat , Zeng Zeng , Skanderup Anders Jacobsen , Pang Yin Huei , Madhavan Krishnakumar , Lim Tony Kiat-Hon , Bonney Glenn , Leow Wei Qiang , Chew Valerie , Dan Yock Young , Tam Wai Leong , Toh Han Chong , Foo Roger Sik-Yin , Chow Pierce Kah-Hoe 
Published: October 2021

Abstract
Intra-tumor heterogeneity (ITH) is a key challenge in cancer treatment, but previous studies have focused mainly on the genomic alterations without exploring phenotypic (transcriptomic and immune) heterogeneity. Using one of the largest prospective surgical cohorts for hepatocellular carcinoma (HCC) with multi-region sampling, we sequenced whole genomes and paired transcriptomes from 67 HCC patients (331 samples). We found that while genomic ITH was rather constant across stages, phenotypic ITH had a very different trajectory and quickly diversified in stage II patients. Most strikingly, 30% of patients were found to contain more than one transcriptomic subtype within a single tumor. Such phenotypic ITH was found to be much more informative in predicting patient survival than genomic ITH and explains the poor efficacy of single-target systemic therapies in HCC. Taken together, we not only revealed an unprecedentedly dynamic landscape of phenotypic heterogeneity in HCC, but also highlighted the importance of studying phenotypic evolution across cancer types.
The Crown and the Constitution
Authors: Kim Marie Seong-Hak 
Published: October 2021

Abstract
This chapter discusses the operation of the early modern French monarchy from the perspectives of civil law and constitutional law. Exploration of the sale of offices at the nexus of the law of obligations and constitutional principles sheds important light on the state as enterprise. When venality is viewed as a royal commercial venture, the significance of extending the king’s dominion to private law becomes evident. The reformation of customs was carried out with the support of legal professionals who entered the royal bureaucracy by purchasing offices. The evolving relationship between judges and the crown over venality spurred Jean Bodin’s theory of royal sovereignty. A lawful government ruled by the sovereign with the established law became the crux of the new constitutional consciousness.
Introduction
Authors: Wiebe Gregory D. 
Published: October 2021

Abstract
The Introduction sets the context of the project within scholarly suspicion that demons are an archaic holdover from the Christianity of Augustine’s historical setting. It proceeds to suggest that before demons are dismissed in this manner, a greater effort should be made to understand what Augustine means in the first place when he speaks of demons, and that this is the principle goal of the work as a whole. Following an overview of the chapter structure of the work, some notes on sources are offered to provide additional context for the project. First, the principal works of Augustine’s consulted throughout the study are identified, with particular attention paid to the City of God. After this, the principle sources Augustine himself used for his demonology are highlighted, especially Apuleius of Madaura and Porphyry of Tyre.
Context
Authors: Banerjee Mukulika 
Published: October 2021

Abstract
Chapter 2 provides a detailed account of the three key stories of change that form the backdrop to this study—in paddy cultivation, electoral politics, and the practice of Islam. The two villages of Madanpur and Chishti (pseudonyms) are described. The changing dynamics of paddy cultivation and the challenges of the Green Revolution are introduced, as are the basic programs of land reform undertaken by communist governments. The story of huge electoral change from near-complete dominance of the communist parties of the Left Front from 1977 to their rout by Trinamool Congress in 2013 thirty four years later is outlined. The particular story of Islam, the origin of the elite Syeds from an Iranian ancestor, and present-day dynamics with reformist Islam are presented. Charles Taylor’s idea of “social imaginaries”—a key concept in the book—is discussed here.
A modern view of placebo and placebo-related effects
Authors: Benedetti Fabrizio 
Published: October 2021

Abstract
This chapter approaches the placebo effect from a modern point of view, namely, as a psychobiological phenomenon worthy of scientific inquiry. By definition, the placebo effect is the effect that follows the administration of an inert treatment (the placebo), whereas in a placebo-related effect no placebo is given but similar mechanisms are at work. Today, the placebo effect, or placebo response, is considered a psychobiological phenomenon that must not be confounded with other phenomena such as spontaneous remission and statistical regression to the mean. The nocebo effect, or nocebo response, is a negative placebo effect which goes in the opposite direction. There is not a single but many placebo effects across different medical conditions and therapeutic interventions, and different biological mechanisms are involved. Expectation of a future outcome plays a central role but learning is important as well.
Prevalent, incident, and persistent insomnia in a population-based cohort tested before (2018) and during the first-wave of COVID-19 pandemic (2020)
Authors: Morin Charles M , Vézina-Im Lydi-Anne , Ivers Hans , Micoulaud-Franchi Jean-Arthur , Philip Pierre , Lamy Manon , Savard Josée 
Published: October 2021

AbstractStudy ObjectivesHigh rates of sleep and mental health problems have been reported during the COVID-19 pandemic, but most of the evidence is retrospective without pre-pandemic data. This study documented rates of prevalent, incident, and persistent insomnia and psychological symptoms during the COVID-19 pandemic (2020) compared to pre-pandemic data (2018).MethodsData were derived from a longitudinal, population-based study of insomnia in Canada. When the first lockdown started in the province of Quebec, a subsample of participants who had completed the latest 2018 follow-up were surveyed (April to May 2020) about their sleep, insomnia, and psychological symptoms since the beginning of the pandemic. Prevalence, incidence, and persistence rates of insomnia, and severity of stress, anxiety, and depressive symptoms were estimated, as well as their associations with confinement, loneliness, social support, use of electronics, and other lifestyle changes occurring during the pandemic. A sleep/health survey and validated questionnaires of insomnia, sleep quality, stress, fatigue, anxiety, and depression were administered at both assessments.ResultsThe sample consisted of 594 adults (mean age: 48.3 ± 13.1 years; 64.0% women). Prevalence of insomnia increased from 25.4% to 32.2% (symptoms) and from 16.8% to 19% (syndrome) from 2018 to 2020, for an overall 26.7% increase in insomnia rates. Of those classified as good sleepers in 2018 (n = 343), 32.6% (n = 112) had developed new insomnia during the COVID-19 pandemic. Among participants who had insomnia in 2018, the persistence rate was 76.5% 2 years later. There was a significant worsening of sleep quality, fatigue, anxiety, and depression (all ps &lt; .005) during the COVID-19 pandemic compared to 2018. Significant associations were found between sleep and psychological symptoms and with living alone and being in confinement, lower social support, increased time using electronic devices, reduced physical exercise, and higher financial stress.ConclusionsThe COVID-19 pandemic is associated with significant increases in insomnia and psychological symptoms compared to the pre-pandemic period. Large scale public sleep and mental health intervention programs should be prioritized during and after a pandemic such as the COVID-19.
Sex Differences in Common Measures of Concussion in College Athletes
Authors: Teramoto Masaru , Grover Eliza Banchoff , Cornwell Jordan , Zhang Rachel , Boo Marie , Ghajar Jamshid , Lumba-Brown Angela 
Published: October 2021

Objective:
Female athletes may be more likely to sustain a concussion and may vary in symptom presentation and neurocognitive impairments as compared with males. Scientific literature is limited by subjective assessments and underproportioned representation of women—the scope and etiology of sex-based differences are unknown. This study investigates sex-based differences in sports concussion assessments among college varsity athletes.

Design and Setting:
Retrospective study of an institution's athletic head injury database.

Participants:
Acute postinjury and baseline data from 111 college athletes sustaining concussions between 2016 and 2018, diagnosed by a concussion specialist physician.

Main Outcome Measures:
Concussion assessments examined included the Sports Concussion Assessment Tool (SCAT5) and Vestibular Oculomotor Screening (VOMS) performed within 3 days (24-72 hours) of injury.

Results:
No significant difference by sex was observed in the SCAT5 total symptom evaluation scores or severity scores, Standardized Assessment of Concussion, or Balance Error Scoring System (P > .05) within 3 days of head injury. Females did report more “pressure in the head” severity scores from baseline to postconcussion (2.7 ± 1.5 increased symptomatology in females vs 1.8 ± 1.3 increase in males, P = .007). The VOMS test resulted in significant sex differences in smooth pursuit [0.6 ± 1.4 increase in females (P < .001) vs 0.2 ± 0.6 increase in males (P = .364)], horizontal saccades [0.6 ± 1.2 increase in females (P < .001) vs 0.2 ± 0.5 increase in males (P = .149)], and vertical saccades [0.9 ± 1.9 increase in females (P < .001) vs 0.3 ± 0.7 increase in males (P = .206)].

Conclusion:
Our study did not show sex-based differences in baseline or acute postconcussive symptom reporting in most concussion assessment parameters, challenging previous research suggesting that females report more symptoms than males. Females did have significant differences in symptom provocation using the VOMS.
Postconcussion Symptoms After an Uncomplicated Mild Traumatic Brain Injury in Older Adults: Frequency, Risk Factors, and Impact on Quality of Life
Authors: Chung Jia-Wei , Liu Doresses , Wei Li , Wen Ya-Ting , Lin Hsin-Ying , Chen Huan-Chieh , Chiu Hsiao-Yean 
Published: October 2021

Background:
Postconcussion symptoms (PCSs) are common complaints reported by patients after a mild traumatic brain injury (TBI), and these symptoms may lower quality of life. Previous investigations have primarily focused on PCSs in children, adults, and athletes. The frequency, and risk factors, and effects of PCSs for older adults with mild TBIs are unclear.

Purpose:
To investigate the frequency and risk factors of PCSs, and investigate their effects on quality of life over time after mild TBI in older adults.

Methods:
A prospective longitudinal study was performed. All participants were enrolled from the emergency department or neurosurgical outpatient clinics of a medical center. The measurement tools were the Rivermead Post-Concussion Symptoms Questionnaire and the Quality of Life after Traumatic Brain Injury. Measurements were performed on the seventh day, at the first month, and at the sixth month after the head injury. A generalized estimating equation model was used for data analyses.

Results:
One hundred and one older adults (mean age of 76.0 years) with mild TBIs with negative neuroimaging findings were included. Overall, 32.7%, 4%, and 15.8% of the sample reported PCS after 7 days, 1 month, and 6 months of head injury, respectively, revealing a U-shaped trend. We observed that comorbidity measured using the modified Charlson Comorbidity Index was associated with differences in PCSs (P < .05). PCSs were an independent predictor of changes in postinjury quality of life (P < .001).

Conclusions:
The results indicate that PCS after a mild TBI in older adults is prevalent, even in the chronic phase after a TBI, and PCSs significantly affected the quality of life of our cohort. Therefore, to improve patient quality of life, healthcare providers should employ effective interventions to manage PCSs at different phases after a TBI.
Overground and Virtual Reality Gait Speed Are Associated With Atypical Symptom Reporting in Active Duty Service Members With a History of Mild to Moderate Traumatic Brain Injury
Authors: Lippa Sara M. , Rosen Kerry B. , Delpy Kathleen B. , Pape Marcy M. , Kruger Sarah E. 
Published: October 2021

Objective:
Physical therapy following traumatic brain injury (TBI) can be negatively impacted by psychological symptoms, atypical symptom reporting, and response bias. We examined rates of Symptom Validity Test (SVT) failure in active duty military service members with a history of mild-moderate TBI and its impact on gait speed.

Setting:
Intensive Outpatient Program at the National Intrepid Center of Excellence at Walter Reed National Military Medical Center.

Participants:
Participants were 84 active duty service members with a history of mild-moderate TBI classified as SVT pass (n = 49) or SVT fail (n = 35).

Design:
Retrospective study.

Main Measures:
Overground preferred and fast walking speed as well as Computer Assisted Rehabilitation Environment (CAREN) gait speed were recorded. Participants completed the Neurobehavioral Symptom Inventory and the Validity-10 was used to assign patients into the SVT pass and SVT fail groups. Gait speed metrics were compared across these groups and test operating characteristics were calculated.

Results:
Approximately 42% of the sample was classified into the SVT fail group. All 3 gait speed measures were significantly slower in the SVT fail group than in the SVT pass group (Ps < .001, ds = 0.60-0.80). Gait speed cutoffs for screeners or indicators of atypical reporting were identified.

Conclusions:
The potential for response bias is a critical area for the clinician to consider when conducting physical therapy evaluations. Participants in the SVT fail group had slower walking speed on all 3 measures assessed. Several useful cutoffs were identified to serve as screeners or indicators of SVT failure, though these preliminary findings have limitations and need to be replicated.
Association Between TBI-Related Hearing Impairment and Cognition: A TRACK-TBI Study
Authors: Hwang Phillip H. , Nelson Lindsay D. , Sharon Jeffrey D. , McCrea Michael A. , Dikmen Sureyya S. , Markowitz Amy J. , Manley Geoff T. , Temkin Nancy R. 
Published: October 2021

Objective:
To examine the association between hearing impairment and cognitive function after traumatic brain injury (TBI).

Setting:
A total of 18 level I trauma centers throughout the United States in the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study.

Participants:
From February 2014 to June 2018, a total of 2697 participants with TBI were enrolled in TRACK-TBI. Key eligibility criteria included external force trauma to the head, presentation to a participating level I trauma center, and receipt of a clinically indicated head computed tomographic (CT) scan within 24 hours of injury. A total of 1267 participants were evaluated in the study, with 216 participants with hearing impairment and 1051 participants without hearing impairment. Those with missing or unknown hearing status or cognitive assessment were excluded from analysis.

Design:
Prospective, observational cohort study.

Main Measures:
Hearing impairment at 2 weeks post-TBI was based on self-report. Participants who indicated worse hearing in one or both ears were defined as having hearing impairment, whereas those who denied worse hearing in either ear were defined as not having hearing impairment and served as the reference group. Cognitive outcomes at 6 months post-TBI included executive functioning and processing speed, as measured by the Trail Making Test (TMT) B/A and the Wechsler Adult Intelligence Scale, Fourth Edition, Processing Speed Index subscale (WAIS-IV PSI), respectively.

Results:
TBI-related hearing impairment had a small but significantly greater TMT B/A ratio than without TBI-related hearing impairment: mean difference (B) = 0.25; 95% CI, 0.07 to 0.43; P = .005. No significant mean differences on WAIS-IV PSI scores were found between participants with and without TBI-related hearing impairment: B = 0.36; 95% CI, −2.07 to 2.60; P = .825.

Conclusion:
We conclude that TBI-related hearing impairment at 6 months postinjury was significantly associated with worse executive functioning but not cognitive processing speed.