bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of atrial arrhythmias identified by cardiac devices
Authors: Stazi Filippo 
Published: April 2024

Abstract
Implantable cardiac devices have shown that atrial fibrillation (AF) is more frequent than previously assumed, with subclinical, asymptomatic, self-limiting manifestations called atrial high-rate events (AHREs) or subclinical AF. The clinical significance and correct therapeutic management of these episodes of subclinical AF is less well defined than in the case of clinically manifest AF. Two important randomized studies on the topic have recently been published, NOAH-AFNET 6 and ARTESIA, which, however, have not definitively clarified the topic. In patients with AHRE or subclinical AF, the average thrombo-embolic risk is lower than that in patients with clinically manifest AF and is ∼1%. For this reason, in these patients, the possibility that the benefit of anticoagulant therapy is overshadowed by the risk of bleeding is very high. Therefore, while waiting for new tools that allow a better stratification of low-risk patients, we must rely on individual clinical evaluation and overcome the qualitative dichotomy (AHRE yes vs. AHRE no), preferring instead an approach that is as quantitative as possible and takes into account the number of episodes, their duration, and the patient’s CHADSVASC score, before deciding, in each individual case, whether or not to use anticoagulant therapy.
Simultaneous magnitude and slip distribution characterization from high-rate GNSS using deep learning: case studies of the 2021 Mw 7.4 Maduo and 2023 Turkey doublet events
Authors: Cui Wenfeng , Chen Kejie , Wei Guoguang , Lyu Mingzhe , Zhu Feng 
Published: April 2024

SUMMARY
Rapid and accurate characterization of earthquake sources is crucial for mitigating seismic hazards. In this study, based on 18 000 scenario ruptures ranging from Mw 6.4 to Mw 8.3 and corresponding synthetic high-rate Global Navigation Satellite System (HR-GNSS) waveforms, we developed a multibranch neural network framework, the continental large earthquake agile response (CLEAR), to simultaneously determine the magnitude and slip distributions. We apply CLEAR to recent large strike-slip events, including the 2021 Mw 7.4 Maduo earthquake and the 2023 Mw 7.8 and Mw 7.6 Turkey doublet. The model generally estimates the magnitudes successfully at 32 s with errors of less than 0.15, and predicts the slip distributions acceptably at 64 s, requiring only approximately 30 ms on a single CPU (Central Processing Unit). With optimal azimuthal coverage of stations, the system is relatively robust to the number of stations and the time length of the received data.
“Train the World”: Examining the Logics of US Foreign Military Training
Authors: Joyce Renanah Miles , McLauchlin Theodore , Seymour Lee 
Published: April 2024

Abstracts
Foreign military training has become a key component of the United States’ security policy. What explains the variation in US training allocation across countries and over time? Past work on security assistance, such as training, focuses on its effectiveness and consequences, largely overlooking questions about which countries receive it in the first place. To understand what drives US military training partnerships, we conducted a global statistical analysis of training from 1999 to 2018, structured around four logics: building relationships through defense diplomacy, deterrence against external, interstate threats, capacity-building in fragile states, and promoting democratic norms to advance democracy around the world. We find that the four logics receive support, with relationship-building and response to interstate and internal threats most consistently so. This analysis demonstrates the different ways the United States has used training in support of the US-led global order and raises questions about how to achieve accountability given these multiple logics. More broadly, the findings also have relevance for understanding how other states allocate training in conjunction with, in emulation of, or in opposition to the United States.
Dialectics of International Interventions through Scale, Space, and Time
Authors: Fagioli Monica , Malito Debora V 
Published: April 2024

AbstractThis Special Issue questions the problem of international interventions’ persistence and multidimensionality by asking what makes interventions still relevant and for whom. In this introduction, we advance a dialectical understanding of interventions to study their diverse modalities and enduring mechanisms of order-making, with specific attention to space, time, and scale. We elaborate on Laura Doyle's interimperial method to highlight interventions' relational, transformative, and durable aspects. We interpret interventions as coconstituted by diverse, overlapping, and contradictory rationales and modalities. We stress the intertwined histories and practices of interventions as integral components of colonial modernity in relation to empires, imperialism, and their contemporary rearticulations. As a method, we identify three key historical processes for a dialectical understanding of intervention: the coformation of interventions’ state-building, economic development, and cultural practices; the coproduction of institutions and infrastructural systems; and the cumulative accretion of interventions’ infrastructures and imaginaries.
Peace with Adjectives: Conceptual Fragmentation or Conceptual Innovation?
Authors: Boulanger Martel Simon Pierre , Jarstad Anna , Olivius Elisabeth , Söderström Johanna , Zahar Marie-Joëlle , Åkebo Malin 
Published: April 2024

Abstract
What strategies can be employed to conceptualize peace? In recent years, scholars have introduced an impressive array of “peace with adjectives” in order to make sense of some of the normative and empirical underpinnings of peace. Negative, positive, everyday, virtual, illiberal, partial, insecure, relational, emancipatory, agonistic, and feminist are some of the qualifiers that have been associated with the concept. While the growing attention to conceptualization is a welcomed development, we argue that the proliferation of new terms has led to increased fragmentation in the field of peace studies. Conceptual fragmentation impedes cumulative knowledge production and generates missed opportunities for fruitful discussions across theoretical and conceptual divides. In this article, we aim to provide more clarity to our field by mapping existing peace conceptualizations and identifying the strategies employed by scholars to construct innovative new terms. In our review, we identify 61 concepts and suggest that these conceptual innovations in peace research belong to one of three analytical strategies: developing diminished subtypes, conceptual narrowing, and conceptual expansion. Building on this categorization, we make recommendations for how peace researchers can enhance clarity and deepen constructive discussions between different conceptual approaches.
2 Differential Transcriptomic Responses Among Burn Injury Outcomes Related to Morality and Hospital Length of Stay
Authors: Misganaw Burook , Levi Benjamin , Pinto Desiree , Le Tuan D , Pusateri Anthony , Gautam Arti , Moffatt Lauren T , Shupp Jeffrey W , Hammamieh Rasha 
Published: April 2024

Abstract

Introduction
Severe burn injury induces a profound systemic molecular response. Yet, the various molecular mechanisms mediating clinical outcomes after burn injury are not well characterized. Using longitudinal global gene expression data, we investigate the evolution of transcriptomic responses to thermal injury. We hypothesized that burn patients with differing clinical outcomes will show diverging transcriptomic alterations over time.

Methods
This prospective observational study included patients from a regional burn center from 2013 to 2017. Patient demographics, burn injury characteristics, and blood samples for mRNA extraction and microarray whole genome gene expression profiling were collected at admission and set timepoints until 30 days. Patients were divided into 4 groups based on mortality status and hospital length of stay (LOS); G1 - died within 7 days, G2 - died after 7 days, G3 - discharged after 7 days, and G4 - discharged within 7 days. Transcriptomic abundances were compared between groups to identify differences in gene profiling. Pathway enrichment analysis was performed to determine the top significant pathways in each group.

Results
A total of 116 patients were analyzed. Most patients were male (72.4%) with a median age of 39 and TBSA of 12.3%. Overall mortality rate was 12.9%. The distribution of patients in G1 to G4 was 8%, 5%, 60%, and 27% respectively. A total of 1,245 blood samples and 17,289 transcripts were quantified. At admission, genes were differentially expressed in G1, G2 and G3 compared to G4 (FDR-corrected P &lt; 0.05 and magnitude of log fold-change &gt; 1). Significant gene sets were largely nonoverlapping, with only a few immune response related genes being activated across all groups. Pathway enrichment analysis showed significant up-regulated protein folding pathways in G1, and significant up-regulated pathways related to oxidative stress and temperature homeostasis in G3. Intra-individual transcriptomic changes from admission to 30 days showed distinct group- and time-dependent patterns. G4 showed the least pronounced transcriptomic response without any noticeable change over time, while G3 mounted a transcriptomic response that increased over time.

Conclusions
We identified transcriptomic alterations associated with distinct outcomes related to mortality and hospital LOS after burn injury. Alterations among groups were present at admission and persisted for 30 days. Connecting transcriptomic alterations to molecular mechanisms continues to evolve.

Applicability of Research to Practice
Enhanced understanding of transcriptomic alterations and molecular mechanisms of burn injury trajectories will allow for the development of early biomarkers, prognostic tools and novel intervention strategies.
54 A Retrospective Review of Copper and Zinc Levels in Burn Injured Patients
Authors: Taylor Billy Jay , Islas Claudia , Bay Curt C , Quan Asia N , Richey Karen J , Foster Kevin N 
Published: April 2024

Abstract

Introduction
Micronutrient deficiencies are common in critically ill patients. Both zinc (Zn) and copper (Cu) are important for wound healing and are commonly deficient in severely burned patients. Zn and Cu compete for the same absorption pathways and the simultaneous oral supplementation of both may severely hinder the body’s ability to absorb Cu. The purpose of this study was to better understand serum Zn and Cu levels in patients with a burn injury of ≥ 20% TBSA and the effect of Zn replacement on Cu levels.

Methods
This was a retrospective chart review of adult patients admitted over a 3-year period who had copper and zinc levels drawn as part of their routine and usual care. Descriptive statistics were calculated for demographic and clinical characteristic Spearman’s rank correlation was computed to assess the relationship between Zinc and Copper levels.

Results
A total of 85 patients met inclusion/exclusion criteria. Mean age was 44 years, mean total body surface area (TBSA) was 36%, mean BMI was 28.3. The population was predominantly male 77% (n=65), mean length of stay 47.7 days, mean ICU days 36, mean ventilator days 36. Mortality for the group was 26% (n=21). There was a positive correlation between Cu and Zn for the first two lab draws (p &lt; .01). At the time of the third serum level, this correlation was diminished, and at tests 4 and 5 there was a negative correlation between Cu and Zn, that did not reach significance. When copper levels were correlated over time, there was a positive correlation between the first two levels (p &lt; .01), levels 3 and 4 (p &lt; .01) and levels 4 and 5 (p &lt; .01). Beyond level 5 statistical power was inadequate to support hypothesis testing.

Conclusions
Initially, copper and zinc were positively correlated but over time, this relationship reversed and became negative. This may suggest a shift in the receptor binding competition between the two micronutrients secondary to zinc supplementation beyond that provided by enteral and oral nutrition. Larger scale research is warranted to ensure statistical power and better understand these relationships.

Applicability of Research to Practice
Zinc and copper levels should continue to be monitored until evidence-based protocols can be developed to further guide testing.
64 Higher Levels of Social Participation Are Associated with HRQOL Two Years Post Burn Injury
Authors: Turner Emma D , Le Vanessa , Solis-Beach Kyra , Bamer Alyssa M , McMullen Kara , Yenikomshian Haig A , Stoycos Sarah A , Schneider Jeffrey C , Ryan Colleen M , Kazis Lewis E , Orton Caitlin M , Roaten Kimberly 
Published: April 2024

Abstract

Introduction
Burn survivors experience lower levels of health-related quality of life (HRQOL) compared to U.S. population norms even one year post-injury. Research suggests that social support predicts functional outcomes, and while studies comparing life satisfaction pre-burn and at follow-up can begin to elucidate HRQOL following burn injury, there is a paucity of research focusing on the role of social participation in HRQOL. The current study sought to examine the roles of social participation and satisfaction with life pre-injury on HRQOL at two years post-injury.

Methods
Analyses were completed using data from a large national multi-center database. A total of 139 participants enrolled from October 2018 to May 2022 were included (34% female, mean age ± SD = 46.3 ± 16.9, mean TBSA burned ± SD = 19.4% ± 19.7). Measures of social participation included: LIBRE (Life Impact Burn Recovery Evaluation) Social Activities (SA) and Social Interaction (SI) subscales collected at 24-months post-injury. Measure of HRQOL included: VR-12 mental component summary score (MCS) and physical component summary score (PCS) collected at 24-months post-injury. Additional measures included: Satisfaction with Life Scale (SWLS) and Community Integration Questionnaire (CIQ) collected at discharge for pre-injury recall. Four regression models with an interaction term were run to analyze how SWLS pre-injury impacts the relationships amongst LIBRE-SA, LIBRE-SI, VR-12 MCS, and VR-12 PCS while controlling for pre-injury community participation (CIQ).

Results
After adjusting for preinjury CIQ, LIBRE-SI and LIBRE-SA were both positively associated with MCS (p &lt; 0.001). While LIBRE-SA was positively associated with PCS (p &lt; 0.001), LIBRE-SI was not significant. There was no evidence to support an interaction/moderation effect of the relationship between LIBRE-SA or LIBRE-SI and VR-12 MCS or VR-12 PCS by SWLS pre-injury.

Conclusions
Findings suggest higher levels of social participation are associated with increased mental HRQOL. However, only higher levels of social activities were related to increased physical HRQOL. The impact of increased social participation on improvements in both mental and physical HRQOL should be further investigated to inform program development and education for burn survivors on avenues to improve overall HRQOL. Further investigation is warranted to confirm the impact of life satisfaction pre-injury on these results.

Applicability of Research to Practice
These results reinforce the importance of social participation during recovery from burn injury, particularly as it relates to mental health.
130 Comparing Artificial Intelligence Guided Image Assessment to Current Methods of Burn Assessment
Authors: Lee Justin J , Abdolahnejad Mahla , Morzycki Alexander , Chan Hannah O , Joshi Rakesh , Hong Collin , Wong Joshua N 
Published: April 2024

Abstract

Introduction
Appropriate identification of burn depth and size is paramount. Despite the development of assessment aids [e.g., laser doppler imaging (LDI)], clinical assessment remains a gold standard, which assesses partial thickness burn depth with ~67% accuracy. We sought to develop an image-based artificial intelligence system that predicts burn severity and wound margins for use as a triaging tool in the community.

Methods
Modified EfficientNet architecture trained by 1684 mobile-device-captured burn datasets of different burn depths were previously utilized to create a convoluted neural network (CNN). The CNN was modified to a novel Boundary-Attention Mapping (BAM) algorithm using elements of saliency mapping, which was utilized to recognize the boundaries of burns. For validation, 144 patient charts that included clinical assessment, burn location, total body surface area, and LDI assessment were retrieved for a retrospective study at an academic burn center. The clinical images underwent CNN-BAM assessment and were directly compared with the LDI assessment.

Results
A CNN using a four-level burn severity classification achieved an accuracy of 85% (micro/macro-averaged ROC scores). The CNN-BAM system can successfully highlight burns from surrounding tissue with high confidence. Our method's burn area segmentations attained an accuracy of 91.60%, sensitivity of 78.17%, and specificity of 93.37%, when compared to LDI methodology and conducting a pixel-wise comparison of LDI’s from 104 patients (Figure 1). Results comparing the CNN-BAM outputs to clinical and LDI assessments have shown a high degree of correlation between the CNN-BAM burn severity predictions to those extrapolated from LDI healing potential (66% agreement Cohen’s Kappa analysis). This is in comparison to clinical vs LDI assessment, which had 28% agreement, and clinical vs CNN-BAM, which had 32% agreement (Figure 2).

Conclusions
CNN-BAM algorithm gives equivalent accuracy in detecting burn depth as LDI with a more economical and accessible application when embedded in a mobile device.

Applicability of Research to Practice
CNN-BAM algorithm can be embedded in a mobile application, which can be easily accessible to healthcare providers to rapidly assess burn depth. This can be especially useful in rural communities to accurately assess and transfer patients to specialized burn centres and reduce unnecessary transfers when injuries are less severe.
500 Anticoagulant Use Is Associated with Different Outcomes in Pediatric and Adult Burn Patients
Authors: Kleinhapl Julia , Knappskog Kristine , ayadi Amina E I , Song Juquan , Suman-Vejas oscar E , Branski Ludwik K , Wolf Steven E 
Published: April 2024

Abstract

Introduction
Anticoagulation therapy in pediatric burn patients remains an under-researched area of burn medicine lacking guidelines or scores to establish standardized therapy. The aim of this study is to evaluate the use of anticoagulants in pediatric compared to adult burn patients and to identify the most frequently used drug classes.

Methods
A large database was searched to create two cohorts of burn patients with more than 10% TBSA. Pediatric patients (age 0-17) were compared to adult burn patients (18-100) after propensity score matching was carried out for gender, ethnicity, and race.
Venous thromboembolic events (VTE), mortality, and bleeding events were defined as outcome variables. Data analysis was performed with the tools of descriptive statistics. Risk and odds ratios were presented with significance set at p&lt; 0.05. We also examined and compared the number of cases in which burn victims were treated with anticoagulants and the frequency distribution of different anticoagulant classes. Anticoagulants were divided into 4 groups: heparins, factor Xa-inhibitors, vitamin K antagonists, and thrombin inhibitors.

Results
After propensity score matching, each of the cohorts included 5630 patients. 5.5% and therefore significantly (p&lt; 0.001) more adult patients showed thromboembolic complications compared to 1.4% of pediatric patients, with RR 0.26 (95% CI 0.20-0.33) and OR 0.24 (95% CI 0.19-0.31). Bleeding events occurred in 4.9% of adult patients, which is more than twice as common as in pediatric patients (2.1%), with RR 0.42 (95% CI 0.34-0.52) and OR 0.41 (95% CI 0.33-0.51). With 5.8% vs. 1.5% deaths in adults compared to pediatrics, mortality was also significantly higher (p&lt; 0.001) in the adult cohort, showing RR of 0.27 (95% CI 0.21-0.34) and OR of 0.26 (95% CI 0.20-0.32).
While 33.4% of adult burn patients were treated with anticoagulants within the first week after burn, only 6.7% of the pediatric burn population were treated. Further, the most frequently used drug group in both adult and pediatric burn patients was heparins, given in over 90% of the cases. Other drug classes were used in less than 10% of cases.

Conclusions
Anticoagulant treatment within the first 7 days after burn is more likely administered to adults than to pediatric patients. However, in most cases, heparins were the drug of choice in both groups. Bleeding events, the occurrence of VTE, and mortality was significantly higher in adult burn patients.

Applicability of Research to Practice
The discrepancy in the use of anticoagulants between adults and pediatrics in burn care highlights the need for larger studies to develop standardized guidelines for the use of different anticoagulants in pediatric burn patients.
511 Hydroxocobalamin Not the Clear Culprit of Nephrotoxicity After Cyanide Poisoning
Authors: Mann Elise M , Boyd Allison N , Walroth Todd A , Whitten Jessica , McIntire Allyson M , Dine Serena , Howell Molly M , Rhew Taylor , Hartman Brett C 
Published: April 2024

Abstract

Introduction
Inhalation injury (IHI) and cyanide poisoning are often observed in burn patients, but they may also present without cutaneous injury. If cyanide toxicity is suspected, the antidote, hydroxocobalamin, is indicated. Although a lifesaving drug, hydroxocobalamin has been associated with acute kidney injury (AKI) and oxalate nephropathy in recent literature. It remains unclear whether the renal issues observed after hydroxocobalamin administration are due to the drug itself or are influenced by other confounding variables. The objective of this study was to compare patients with IHI who either do or do not receive hydroxocobalamin and to assess whether there is a difference in incidence of nephrotoxicity.

Methods
This single-center, retrospective, matched, cohort study included adults 18 years or older admitted to the Medical ICU or Burn ICU for at least 72 hours between 10/2016 and 12/2022 with a documented diagnosis of IHI. The primary outcome was the incidence of AKI, defined per KDIGO criteria, within 72 hours of admission. Secondary outcomes included initiation of continuous renal replacement therapy (CRRT) within 72 hours, CRRT within 7 days, length of stay, and vasopressor requirements. A power calculation was not performed a priori as this was a convenience sample of all eligible patients. A post hoc analysis was conducted to assess the correlation of AKI after hydroxocobalamin administration in those with IHI and cutaneous injury vs. IHI only.

Results
A total of 100 patients, 50 who received hydroxocobalamin and 50 who did not, were matched based on TBSA and age and included in the analysis. Primary and secondary outcomes are included in Table 1 and Table 2. The was no difference in the incidence of AKI between the two groups. There were no differences in length of stay, Parkland Formula use, vasopressor requirement, or inpatient administration of nephrotoxic agents. Those who received hydroxocobalamin were found to have a higher median grade of IHI and had a higher incidence of CRRT initiation at 7 days. In the post-hoc analysis, there was no difference in AKI after hydroxocobalamin administration in those with IHI and cutaneous injury vs. IHI only.

Conclusions
This study did not demonstrate a difference in the incidence of AKI in patients with IHI who did or did not receive hydroxocobalamin. This outcome was not changed by the presence or lack of concurrent cutaneous injury.

Applicability of Research to Practice
To our knowledge, this is the first study that was controlled for hydroxocobalamin administration and evaluated clinical outcomes in both burn and non-burn IHI patients. Our findings differ from previous literature and suggest that hydroxocobalamin alone is not the clear culprit of nephrotoxicity in patients with IHI.