bluuebunny/crossref_metadata_2025_split huggingface dataset:
Custom as a Source of International Law
Authors: Wood Michael , Sender Omri 
Published: November 2024

Abstract
This chapter provides an overview of custom as a principal source of international law. It discusses customary international law’s long history as the older and original source of international law and the place secured for it in the Statute of the International Court of Justice. It also explains the continuing importance of customary international law in the present era, even in highly codified fields, as well as its great advantages in being able to evolve rapidly when the need arises and to bring under one legal regime all members of a large and heterogeneous international community. The chapter moreover discusses the limits of analogy with custom in domestic law, the relationship between customary international law and ‘the general principles of law’, and the availability of evidence of customary international law. customary international law
The International Law Commission’s Work on Identification of Customary International Law
Authors: Wood Michael , Sender Omri 
Published: November 2024

Abstract
This chapter discusses the work of the International Law Commission (ILC) on ‘Identification of customary international law’, detailing the various stages leading up to the adoption of the Commission’s final draft conclusions on the topic. The chapter then elaborates on the reception of this output by the Member States of the United Nations and offers an assessment of its impact and utility in providing authoritative guidance to all those who are called upon to determine rules of customary international law. customary international law
The Two-element Approach
Authors: Wood Michael , Sender Omri 
Published: November 2024

Abstract
This chapter elaborates on the two-element approach to the determination of rules of customary international law. It demonstrates that this approach, which provides a uniform yet flexible methodology for the identification of all rules of customary international law, is deeply rooted in international legal practice, including that of the International Court of Justice (ICJ). The chapter moreover explains that alternative approaches proposed by individual writers are essentially policy proposals that have not been adopted by States or in the case law. The process of change of customary international law is also discussed, as is the controversial notion ‘interpretation’ of customary international law.customary international law
Particular Customary International Law
Authors: Wood Michael , Sender Omri 
Published: November 2024

Abstract
This chapter focuses on rules of customary international law that are not of general application but are applicable among some States only. It explains the place and scope of these rules of particular customary international law, including by reference to several cases before courts and tribunalst in which such rules have been invoked; it also notes that these rules may not necessarily be based on a geographical relationship. The chapter further discusses the stricter application of the two-element approach as regards rules of particular customary international law as well as the burden of proof that is laid upon those who seek to rely on them.
Compact object populations over cosmic time II. Compact object merger rates and masses over redshift from varying initial conditions
Authors: de Sá Lucas M , Rocha Lívia S , Bernardo Antônio , Bachega Riis R A , Horvath Jorge E 
Published: November 2024

ABSTRACT
We perform a first study of the impact of varying two components of the initial conditions in binary population synthesis of compact binary mergers – the initial mass function, which is made metallicity- and star formation rate-dependent, and the orbital parameter (orbital period, mass ratio, and eccentricity) distributions, which are assumed to be correlated – within a larger grid of initial condition models also including alternatives for the primary mass-dependent binary fraction and the metallicity-specific cosmic star formation history. We generate the initial populations with the sampling code bossa and evolve them with the rapid population synthesis code compas. We find strong suggestions that the main role of initial conditions models is to set the relative weights of key features defined by the evolution models. In the two models we compare, black hole–black hole (BHBH) mergers are the most strongly affected, which we connect to a shift from the common envelope to the stable Roche lobe overflow formation channels with decreasing redshift. We also characterize variations in the black hole–neutron star (BHNS) and neutron star–neutron star (NSNS) final parameter distributions. We obtain the merger rate evolution for BHBH, BHNS, and NSNS mergers up to $z=10$, and find a variation by a factor of $\sim 50\textnormal {--}60$ in the local BHBH and BHNS merger rates, suggesting a more important contribution from initial conditions than previously thought, and calling for a complete exploration of the initial conditions model permutations.
Alternative lengthening of telomere-based immortalization renders H3G34R-mutant diffuse hemispheric glioma hypersensitive to PARP inhibitor combination regimens
Authors: Laemmerer Anna , Lehmann Christian , Mayr Lisa , Bruckner Katharina , Gabler Lisa , Senfter Daniel , Meyer Philipp , Balber Theresa , Pirker Christine , Jaunecker Carola N , Kirchhofer Dominik , Vician Petra , Griesser Michelle , Spiegl-Kreinecker Sabine , Schmook Maria T , Traub-Weidinger Tatjana , Kuess Peter , Eckert Franziska , Federico Aniello , Madlener Sibylle , Stepien Natalia , Robl Bernhard , Baumgartner Alicia , Hainfellner Johannes A , Dieckmann Karin , Dorfer Christian , Roessler Karl , Corsini Nina S , Holzmann Klaus , Schmidt Wolfgang M , Peyrl Andreas , Azizi Amedeo A , Haberler Christine , Beck Alexander , Pfister Stefan M , Schueler Julia , Lötsch-Gojo Daniela , Knoblich Jürgen A , Berger Walter , Gojo Johannes 
Published: November 2024

Abstract

Background
Diffuse hemispheric glioma, H3 G34R/V-mutant (DHG-H3G34) is characterized by poor prognosis and lack of effective treatment options. DHG-H3G34R further harbor deactivation of alpha-thalassemia/mental retardation syndrome X-linked protein (ATRX; DHG-H3G34R_ATRX) suggesting a unique interaction of these 2 oncogenic alterations. In this study, we dissect their cell biological interplay, investigate the impact on telomere stabilization, and consequently validate a targeted therapy approach.

Methods
We characterized patient-derived primary pediatric high-grade glioma (pHGG) models for telomere-maintenance mechanisms, DNA damage stress (including protein expression, pH2AX/Rad51 foci, cell-cycle arrest) and their sensitivity towards poly-ADP ribose polymerase inhibitor (PARPi) combinations. Human induced pluripotent stem cells (iPSCs) were used for modeling the disease. The anticancer activity of PARPi combinations in vivo was studied in Chorioallantoic Membrane (CAM) and orthotopic in vivo experiments. Finally, we treated a DHG-H3G34R_ATRX patient with PARPi combination therapy.

Results
We elaborate that alternative lengthening of telomeres (ALT) is a key characteristic of DHG-H3G34R_ATRX. A dominant cooperative effect between H3G34R and ATRX loss in ALT activation also became apparent in iPSCs, which endogenously exert telomerase activity. In both, patient-derived DHG-H3G34R_ATRX models and H3G34R+/ATRX- iPSCs, the ALT-phenotype was associated with increased basal DNA damage stress, mediating synergistic susceptibility towards PARPi (talazoparib, niraparib) combinations with topoisomerase-I inhibitors (topotecan, irinotecan). In a first-of-its-kind case, treatment of a DHG-H3G34R_ATRX patient with the brain-penetrant PARP inhibitor niraparib and topotecan resulted in significant tumor reduction.

Conclusions
Our preclinical and clinical data strongly support the further development of PARPi together with DNA damage stress-inducing treatment regimens for DHG-H3G34R_ATRX.
Moral uncertainty for consequentialists
Authors: Bukoski Michael 
Published: November 2024

Abstract
How might an agent's moral uncertainty affect what they ought to do? One approach posits principles independent of all first-order moral theories to provide impartial guidance to those uncertain about which moral theory is true; a popular candidate is the principle of maximizing expected choiceworthiness (MEC). Another approach focuses on what first-order moral theories themselves might say about the moral implications of moral uncertainty. This paper considers the latter question in the context of consequentialism by exploring how two consequentialist strategies for dealing with non-moral uncertainty could be extended to moral uncertainty. My conclusion is that a consequentialist could plausibly adopt maximizing expected goodness as a standard of rightness, but not MEC, and that neither is likely to be part of the best consequentialist decision procedure. This result refutes the common suspicion that MEC represents a distinctively consequentialist approach to moral uncertainty.
Virtual Reality Therapy for Chronic Pain: A Scoping Review on Indications, Mechanisms of Action, and Effectiveness
Authors: Kim Richard W. , Chitneni Ahish , Rubin John Edwin , White Robert , Jotwani Rohan 
Published: November 2024

Background:
The application of virtual reality (VR) technology as a nonpharmacologic treatment option for chronic pain has been increasingly studied. However, the mechanisms underlying this treatment modality's potential positive effects and appropriate indications are not well understood or summarized in the literature.

Objectives:
This scoping review aims to better understand the chronic pain populations best indicated for head-mounted display-based VR interventions, explore their efficacy on pain score reduction, and characterize the mechanisms of action underlying their efficacy.

Methods:
PubMed database systematic searches were conducted including articles from January 2010 to August 2023 with primary qualifying criteria including but not limited to use of head-mounted display VR and adequate VR treatment dosage. Mechanisms of action(s) were deduced via an exploratory approach whereby characteristics of VR treatment interventions were analyzed and categorized.

Results:
Fourteen studies met qualifying criteria, representing a total treatment group of 327. Study data extracted were solely relative to VR treatment group participants. VR intervention mechanisms of action were best characterized via 2 broad but distinct categories: addressing kinesiophobia and psychobehavioral modulation. Three studies investigating chronic neck pain used addressing kinesiophobia as a mechanism of action and demonstrated a significant improvement [weighted average numerical rating scale (NRS): 4.6 at baseline, 2.5 post-intervention, and 2.5 3 months post-intervention]. Six studies investigated chronic low back pain, for which 5 studies, representing 99% of the subgroup, used psychobehavioral modulation. Each demonstrated significant reduction in pain (weighted average NRS: 5.1 baseline and 3.2 post-intervention).

Conclusion:
This large-scale within-group analysis review proposes 2 broad mechanisms of action underlying the efficacy of VR interventions for chronic pain indications. VR interventions addressing kinesiophobia seem to be significantly effective in nontraumatic chronic neck pain patients. Psychobehavioral VR interventions demonstrate significant efficacy in the chronic low back pain population. Studies with interventions targeting nonspecific chronic pain populations did not show significant results.
How Does the Novice Become the Expert? An Instrumental Case Study of Procedural Educators
Authors: Krumm Ilana Roberts , Strait Adrienne , Santhosh Lekshmi 
Published: November 2024

Abstract

Purpose
The classic paradigm of procedural education in medical training has involved trainees learning and performing invasive bedside procedures and subsequently teaching these procedures to more junior trainees. Many existing resident-as-teacher curricula focus on cognitive domains; there has been a lack of literature examining the transition from learner to teacher in procedural education. This hypothesis-generating instrumental case study explored how expert procedural educators transitioned from novice procedural educators to experts.

Method
A constructivist approach with semistructured interviews was used to explore the individual narratives and experiences of faculty of the Hospitalist Procedure Service at the University of California San Francisco as they reflected on their journey from learners to teachers, focusing on the faculty of the hospitalist procedure team at the University of California San Francisco. All 12 Hospitalist Procedure Service faculty members received invitations to be interviewed, and 9 agreed to participate. Interviews were conducted between July and October 2023.

Results
The 9 interviews created a rich and complex picture of the individual experiences and perceptions of procedural teaching. The faculty members varied in experience, ranging from 2 years on the procedure service faculty to more than 15 years of experience. Four main themes emerged from the interviews: methods for building teaching skills, tools that facilitate further educator growth, essential behaviors of effective educators, and common challenges. Inductive thematic analysis revealed trial and error as a major means of building procedural pedagogy and the use of precise communication as a crucial skill to manage learner cognitive load and the emotional challenges associated with learning and teaching procedures.

Conclusions
The use of precise communication as a tool for both educator and learner to navigate the complexities of procedural teaching highlights the essential role of clear instruction and feedback in the learning process.
Unveiling Potential: Achieving Mission by Integrating Enrollment Management With Identity-Masked Holistic Admissions Practices
Authors: Bryce Crystal I. , Abron Gisele Armond , Lynn Amanda M. , Willis Brigham C. , Nakae Sunny 
Published: November 2024

Abstract

Purpose
Holistic review for admissions is designed to mitigate the common systemic barriers applicants may face in their medical school application journey and the common mistakes committed by admissions committees, but limited literature outlines how this can be modeled. This study examined a blinded holistic admissions approach that emphasized mission and value alignment and the resulting characteristics of applicants by admission status.

Method
Application data from 2,027 applicants to The University of Texas at Tyler School of Medicine with complete secondary applications for the 2022 to 2023 cycle were analyzed. Applicants were categorized by the most advanced stage they reached in the admissions process: not selected for interview (n = 1,742), interviewed (n = 239), or accepted (n = 46). Data included information on students' geographic ties to East Texas, institutional mission alignment, academic preparation information, and Computer-Based Assessment for Sampling Personal Characteristics (CASPer) test results.

Results
In the not selected for interview and interviewed groups, mission commitment was significantly negatively associated with geographic ties (r = –0.189 and –0.209., respectively) and academic preparation (r = –0.195 and –0.241, respectively). In the not selected for interview group, higher mission commitment scores were significantly associated with lower CASPer scores (r = –0.110). In the interviewed group, higher geographic ties were significantly associated with lower academic preparation (r = –0.143) and lower CASPer scores (r = –0.280). Demographically, the accepted group had higher than expected counts of individuals who reported free or reduced lunch eligibility (14 vs 8), Pell Grant eligibility (22 vs 12), and family incomes of less than $50,000 per year (14 vs 6).

Conclusions
This study demonstrates successful and effective implementation of a mission-aligned holistic admissions process, with accepted students exemplifying the mission of the institution and representing traditionally underrepresented groups.
The Expanding Role of Designated Institutional Officials in Graduate Medical Education
Authors: Berns Jeffrey S. , Goldstein Joshua L. , Hartmann Diane M. , Simons Kenneth , Opas Lawrence 
Published: November 2024

Abstract
The Accreditation Council for Graduate Medical Education (ACGME) plays a pivotal role in ensuring the quality of graduate medical education (GME) training across the United States. Central to the success of this mission are designated institutional officials (DIOs), who usually serve as chief GME officers within the ACGME-accredited sponsoring institutions (SIs). Despite the critical role of DIOs, the qualifications, level of administrative support, and responsibilities of DIOs are not defined and vary significantly among SIs. Although responsibilities mandated by ACGME Institutional Requirements provide a framework, the actual scope of work of DIOs often extends far beyond what is outlined in the ACGME Institutional Requirements, involving collaboration with a wide variety of institutional stakeholders and harnessing the GME enterprise to achieve institutional goals. Nearly all DIOs face a multitude of challenges, including adapting to new ACGME requirements and initiatives, addressing resident and fellow wellness concerns, promoting health equity, nurturing scholarly endeavors, and advocating for their residents and fellows. Additionally, emerging technologies and innovations as well as the changing financial climate for SIs and the health care facilities that host GME learners can present both educational opportunities and new challenges for DIOs in ensuring trainees are prepared for their roles as the next generation of physicians. As the health care landscape evolves, DIOs will continue to play a vital role in shaping the educational experiences of physicians in training while balancing institutional priorities and ensuring high-quality patient care.
Using the PROMOTE Screener to Identify Psychosocial Risk Factors for Prenatal Substance Use
Authors: Azeem Ayesha , Lobel Marci , Heiselman Cassandra , Preis Heidi 
Published: November 2024

Introduction
There is an urgent need to improve the identification of psychosocial vulnerabilities in clinical practice (eg, stress, unstable living conditions) and examine their contribution to prenatal substance use, especially for legal substances such as alcohol, tobacco, and recently, cannabis.

Methods
We conducted a retrospective chart review of 1842 patients who completed the PROMOTE screening instrument during their first prenatal visit to outpatient clinics of a New York State health system in 6/2019–11/2020. The PROMOTE includes 18 core items to assess psychosocial vulnerabilities including the NIDA Quick Screen assessing past year substance use. Outcomes were tobacco, cannabis, and alcohol use during pregnancy based on electronic medical record abstraction including clinical notes, self-report, or urine toxicology.

Results
A total of 188 (10.2%) patients used at least 1 substance prenatally, including 132 (7.2%) tobacco, 50 (2.7%) cannabis, and 45 (2.4%) alcohol. Two of the NIDA Quick Screen items (past year tobacco use and past year illegal drug use) were associated in the bivariate analysis with greater use risk of all 3 substances. Additional risk factors uniquely associated with specific prenatal substance use variables include low education predicting tobacco use (adjusted odds ratio [AOR] = 2.74, 95% confidence interval [CI] = 1.43–5.23), being unpartnered predicting cannabis use (AOR = 3.37, 95% CI = 1.21–9.39), and major life events predicting alcohol use (AOR = 3.25, 95% CI = 1.439–7.38).

Conclusions
Utilizing brief psychosocial self-screening instruments such as the PROMOTE can help identify and refer at-risk patients to appropriate care. Particular attention should be paid to life context including partner support, emotional health, stress, and past year substance use.
Anatomy of the Ribs, Sternum, and Costal Margin
Authors: Haase Douglas R. , Shaikh Humza S. 
Published: November 2024

Summary:
The ribs, sternum, and costal margin provide a rigid, but flexible chest wall that functions to provide protection to the vital cardiothoracic organs, while also allowing for varying levels of respiration based on physiologic need. The latter function is accomplished through various muscular attachments and rib articulations with both the axial spine posteriorly and the sternum anteriorly. The accessory muscles of inspiration rely on the downward slope and outward curve of each rib, which when contracted move the ribs upward and outward, in turn forcing the sternum anterior and increasing the thoracic volume. Ribs are also classified as true, false, or floating based on their attachment anteriorly to the costal cartilage and sternum. Ribs 1–7 are considered true ribs as their costal cartilage directly articulates with the manubrium and sternum. Ribs 8–10 are considered false ribs because their costal cartilage connects to the cartilage of the immediately superior rib instead of the sternum itself. This complex cartilaginous structure is referred to as the costal margin, which provides attachments for the diaphragm and various abdominal muscles. Although historically thought to be a consistent structure, its variable nature has recently been defined in cadaveric studies. Ribs 11 and 12 are considered floating ribs because they have rudimentary cartilage caps and are not attached to the sternum at all. The sternum comprises the manubrium, body, and xiphoid process. Each component has differing mobility, muscle attachment, and function.
Pediatric Scaphoid Nonunions: Does Insurance Status Play a Role?
Authors: Lin James S. , MacDonald James , Balch Samora Julie 
Published: November 2024

Objective:
There are no studies that evaluate the effects that insurance or socioeconomic status may have on treatment and outcomes of scaphoid nonunions in children. We evaluated whether there is an association between insurance status and (1) time from injury to hand surgeon evaluation, (2) time from specialist evaluation to surgery, and (3) postoperative outcomes of scaphoid fracture nonunions in children.

Methods:
A chart review was performed for patients who underwent surgical treatment of scaphoid fracture nonunion from January 2015 and April 2021 at a large tertiary care pediatric hospital. Underinsured patients were defined as those with no medical insurance or Medicaid/state-funded insurance.

Results:
There were 21 privately insured patients and 17 patients who were underinsured. There was no difference in age, race, or fracture characteristics between the two groups. The mean time between injury and hand surgeon evaluation was 192 SD 195 days for the privately insured group compared with 155 SD 205 days for the underinsured group (P = 0.57). The mean time between specialist evaluation and surgical treatment was 35 SD 54 days for the privately insured group and 31 SD 31 days for the underinsured group (P = 0.82). Union was achieved in 80% of patients with private insurance compared with 88% of underinsured patients after primary surgery (P = 0.67). There was no difference detected in the proportion of patients who had residual pain (15% vs 19%), range of motion deficits (38% vs 40%), strength deficit (6% vs 7%), and return to activity (94% vs 93%) between privately insured and underinsured patients, respectively (P = 1.00).

Conclusions:
There was no difference in time from injury to specialist evaluation, time from evaluation to surgery, or postoperative outcomes based on insurance status for pediatric patients with scaphoid fracture nonunions. Although insurance status was not associated with access to care for pediatric scaphoid fracture nonunions at our institution, this information may not be generalizable to other populations, including patients who sustain primary scaphoid fractures and who have not yet developed nonunions.

Level of Evidence:
Level III—retrospective cohort study.