bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficiency and effectiveness of intensive multidisciplinary follow-up of patients with stroke/TIA or myocardial infarction compared to usual monitoring: protocol of a pragmatic randomised clinical trial. DiVa (Dijon vascular) study
Authors: Béjot Yannick , Soilly Anne-Laure , Bardou Marc , Duloquin Gauthier , Pommier Thibaut , Laurent Gabriel , Cottin Yves , Vadot Lucie , Adam Héloïse , Boulin Mathieu , Giroud Maurice 
Published: April 2023

IntroductionThe ongoing ageing population is associated with an increase in the number of patients suffering a stroke, transient ischaemic attack (TIA) or myocardial infarction (MI). In these patients, implementing secondary prevention is a critical challenge and new strategies need to be developed to close the gap between clinical practice and evidence-based recommendations. We describe the protocol of a randomised clinical trial that aims to evaluate the efficiency and effectiveness of an intensive multidisciplinary follow-up of patients compared with standard care.Methods and analysisThe DiVa study is a randomised, prospective, controlled, multicentre trial including patients >18 years old with a first or recurrent stroke (ischaemic or haemorrhagic) or TIA, or a type I or II MI, managed in one of the participating hospitals of the study area, with a survival expectancy >12 months. Patients will be randomised with an allocation ratio of 1:1 in two parallel groups: one group assigned to a multidisciplinary, nurse-based and pharmacist-based 2-year follow-up in association with general practitioners, neurologists and cardiologists versus one group with usual follow-up. In each group for each disease (stroke/TIA or MI), 430 patients will be enrolled (total of 1720 patients) over 3 years. The primary outcome will be the incremental cost–utility ratio at 24 months between intensive and standard follow-up in a society perspective. Secondary outcomes will include the incremental cost–utility ratio at 6 and 12 months, the incremental cost-effectiveness ratio at 24 months, reduction at 6, 12 and 24 months of the rates of death, unscheduled rehospitalisation and iatrogenic complications, changes in quality of life, net budgetary impact at 5 years of the intensive follow-up on the national health insurance perspective and analysis of factors having positive or negative effects on the implementation of the project in the study area.Ethics and disseminationEthical approval was obtained and all patients receive information about the study and give their consent to participate before randomisation. Results of the main trial and each of the secondary analyses will be submitted for publication in a peer-reviewed journal.Trial registration numberClinicalTrials.gov Identifier:NCT04188457. Registered on 6 December 2019.
New prolonged opioid consumption after major surgery in Sweden: a population-based retrospective cohort study
Authors: Lindeberg Felix C B , Bell Max , Larsson Emma , Hallqvist Linn 
Published: April 2023

ObjectiveGiven that long-term opioid usage is an important problem worldwide and postsurgical pain is a common indication for opioid prescription, our primary objective was to describe the frequency of new prolonged opioid consumption after major surgery in Sweden and, second, to evaluate potential associated risk factors.DesignCohort study including data from 1 January 2007 to 31 December 2014. Data regarding surgical procedures, baseline characteristics and outcomes was retrieved from the Orbit surgical planning system, the Swedish national patient register and the Swedish cause of death register.SettingObservational multicentre cohort study with data from 23 Swedish hospitals.ParticipantsWe included 216 877 patients aged ≥18 years, undergoing non-cardiac surgery, not exposed to opioids 180 days before and alive 12 months after surgery.Primary and secondary outcome measuresThe primary endpoint was collection of at least three opioid prescriptions during the first postoperative year; within 90 days, day 91–180 and 181–365 after surgery in a previously opioid-naïve patient. Second, multivariable logistic regression analysis was conducted to explore potential risk factors associated with prolonged opioid use.ResultsOf the 216 877 patients identified to undergo analysis, 15 081 (7.0%) developed new prolonged opioid consumption. Several risk factors were identified. Having a history of psychiatric disease was identified as the strongest risk factor (adjusted odds ratio: 1.94; 95% CI: 1.87 to 2.00).ConclusionIn a large Swedish cohort of surgical patients, 7% developed new prolonged opioid consumption after major surgery. Our data on susceptible patients could help clinicians reduce the number of prolonged opioid users by adapting their analgesic and preventative strategies.
Long-term psychosocial consequences of false-positive screening mammography: a cohort study with follow-up of 12–14 years in Denmark
Authors: Gram Emma Grundtvig , Siersma Volkert , Brodersen John Brandt 
Published: April 2023

ObjectiveTo compare the long-term psychosocial consequences of mammography screening among women with breast cancer, normal results and false-positive results.DesignA matched cohort study with follow-up of 12–14 years.SettingDenmark from 2004 to 2019.Participants1170 women who participated in the Danish mammography screening programme in 2004–2005.InterventionMammography screening for women aged 50–69 years.Outcome measuresWe assessed the psychosocial consequences with the Consequences Of Screening–Breast Cancer, a condition-specific questionnaire that is psychometrically validated and encompasses 14 psychosocial dimensions.ResultsAcross all 14 psychosocial outcomes, women with false-positive results averagely reported higher psychosocial consequences compared with women with normal findings. Mean differences were statistically insignificant except for the existential values scale: 0.61 (95% CI (0.15 to 1.06), p=0.009). Additionally, women with false-positive results and women diagnosed with breast cancer were affected in a dose–response manner, where women diagnosed with breast cancer were more affected than women with false-positive results.ConclusionOur study suggests that a false-positive mammogram is associated with increased psychosocial consequences 12–14 years after the screening. This study adds to the harms of mammography screening. The findings should be used to inform decision-making among the invited women and political and governmental decisions about mammography screening programmes.
External validation of Glasgow-Blatchford, modified Glasgow-Blatchford and CANUKA scores to identify low-risk patients with upper gastrointestinal bleeding in emergency departments: a retrospective cohort study
Authors: Pognonec Célina , Dirhoussi Zidane , Cury Nicolas , Moreau Marie , Billard Charlotte , Yordanov Youri , Thiebaud Pierre-Clément 
Published: April 2023

BackgroundUpper gastrointestinal bleeding (UGIB) is a medical emergency with an approximate mortality of 10%, which results in a high hospitalisation rate. The Glasgow-Blatchford score (GBS) is recommended to identify low-risk patients who can be discharged from the emergency department (ED). A modified GBS (mGBS) and CANUKA score have recently been proposed but have not been well studied. The aim of this study was to assess whether the use of GBS, mGBS or CANUKA score could identify patients at low risk of death or need for intervention.MethodsA single-centre retrospective study was performed including patients with suspected UGIB visiting the ED of Saint-Antoine hospital (Paris, France) from January 2016 to December 2018. Demographic and medical data needed to calculate GBS and CANUKA were collected, as well as outcomes data. Need for intervention was defined as the need for blood transfusion, endoscopic haemostasis or rebleeding within 7 days. In-hospital mortality was also collected. Sensitivity, specificity and predictive values were measured for the score thresholds of interest.ResultsA total of 386 patients were included. Median age was 60 years (38–78), 65.3% (n=252) were male and 60% (n=233) were hospitalised. A GBS≤1, mGBS=0 and CANUKA≤2 categorised 24.9%, 18.2% and 18.9% of patients as low risk, respectively. There was a need for intervention in 2.2%, 4.6% and 0% of those patients categorised as low risk by GBS, mGBS and CANUKA, respectively. No deaths occurred in the patients identified as low risk, regardless of the score used. All scores had a high sensitivity and negative predictive value.ConclusionsIn patients with UGIB, the use of a GBS≤1 or CANUKA score ≤2 appears to be safe for identifying patients at low risk of death or need for intervention.
Predictors for large vessel recanalization before stroke thrombectomy: the HALT score
Authors: Colasurdo Marco , Chen Huanwen , Schrier Chad , Khalid Mazhar , Khunte Mihir , Miller Timothy R , Cherian Jacob , Malhotra Ajay , Gandhi Dheeraj 
Published: April 2023

Background
Large vessel recanalization (LVR) before endovascular therapy (EVT) for acute large vessel ischemic strokes is a poorly understood phenomenon. Better understanding of predictors for LVR is important for optimizing stroke triage and patient selection for bridging thrombolysis.

Methods
In this retrospective cohort study, consecutive patients presenting to a comprehensive stroke center for EVT treatment were identified from 2018 to 2022. Demographic information, clinical characteristics, intravenous thrombolysis (IVT) use, and LVR before EVT were recorded. Factors independently associated with different rates of LVR were identified, and a prediction model for LVR was constructed.

Results
640 patients were identified. 57 (8.9%) patients had LVR before EVT. A minority (36.4%) of LVR patients had significant improvements in National Institutes of Health Stroke Scale. Independent predictors for LVR were identified and used to construct the 8-point HALT score: hyperlipidemia (1 point), atrial fibrillation (1 point), location of vascular occlusion (internal carotid: 0 points, M1: 1 point, M2: 2 points, vertebral/basilar: 3 points), and thrombolysis at least 1.5 hours before angiography (3 points). The HALT score had an area under the receiver-operating curve (AUC) of 0.85 (95% CI 0.81 to 0.90, P<0.001) for predicting LVR. LVR before EVT occurred in only 1 of 302 patients (0.3%) with low (0–2) HALT scores.

Conclusions
IVT at least 1.5 hours before angiography, site of vascular occlusion, atrial fibrillation, and hyperlipidemia are independent predictors for LVR. The 8-point HALT score proposed in this study may be a valuable tool for predicting LVR before EVT.
Innovative approach to medical leadership and management development: clinician secondment to a management consulting firm
Authors: Papalia Francesco , Fung Kenneth , Chen Yang , Thornton George D , Geatches Nick , Cousins Frances , Kirkham Karen , Westwood Mark 
Published: April 2023

Background and aimOpportunities to participate in leadership and management with protected time can be limited for clinical trainees. The aim of this fellowship was to gain experience of gold standard healthcare management by becoming part of multidisciplinary teams working to deliver transformational change in the National Health Service (NHS).MethodsA 6-month pilot fellowship, structured as an Out of Programme Experience was created for two registrars to be seconded to the healthcare division of Deloitte, a leading professional services firm. Competitive selection was jointly administered by the Director of Medical Education at St Bartholomew’s Hospital and Deloitte.ResultsThe successful candidates worked on service-led and digital transformation projects, interfacing with senior NHS executives and directors. Trainees gained direct experience and understanding of high-level decision making in the NHS, tackling complex service delivery problems and the practical realities of delivering change within a constrained budget. One impact of this pilot has been completion of a business case to scale up the fellowship into an established programme that can allow other trainees to apply.ConclusionThis innovative fellowship has allowed interested trainees an opportunity to broaden the relevant skills and experience in leadership and management required in specialty training curriculum with real-life application in the NHS.
TEMPERATURE AND ENERGY SECURITY: WILL FOREST BIOMASS HELP IN THE FUTURE?
Authors: FAVERO ALICE , YOO JONGHYUN , DAIGNEAULT ADAM , BAKER JUSTIN 
Published: April 2023

Despite the numerous technical, logistical, and policy challenges associated with the use of bioenergy to mitigate climate change, the latest IPCC report identifies bioenergy as a high-value and large-scale mitigation option to support the transition to a cleaner energy system. This paper links a climate-economic-energy model and a land model to measure the net mitigation effect of using forest biomass for electricity generation and corresponding implications on global temperature. Through the soft-link, the energy model provides to the land model the cost-effective regional consumption of forest biomass under nine carbon price scenarios and measures the effects of its use on fossil fuel emissions and carbon sequestered in carbon capture and storage (CCS). The land model provides the dynamic supply of forest biomass and measures the change in land management/use under each demand scenario and corresponding changes in carbon sequestered in forests. Results suggest that forest biomass should be part of global mitigation efforts despite the expected small share of electricity sourced from it. The net climate benefits of forest biomass energy vary across scenarios and temporally — in most scenarios increased biomass demand results in near term reductions in global forest carbon stocks, but at carbon prices starting at $40/tCO2e or greater, results show positive net sequestration by 2030. This increased sequestration, coupled with energy emissions displacement and bioenergy with carbon capture and storage (BECCS) implies substantial long-term mitigation potential for forest biomass energy. Our results suggest that high forest biomass demand pathways could also help reduce the magnitude of future temperature growth. Further, we explore the regional effects on energy security of using forest biomass. Results show that its use can have potential large effects on trade dynamics and regional energy security issues, with 4 of the 17 global regions found to be net exporters of forest biomass.
On the Robustness of Dialogue History Representation in
Conversational Question Answering: A Comprehensive Study and a New Prompt-based
Method
Authors: Gekhman Zorik , Oved Nadav , Keller Orgad , Szpektor Idan , Reichart Roi 
Published: April 2023

Abstract
Most work on modeling the conversation history in Conversational Question Answering (CQA) reports a single main result on a common CQA benchmark. While existing models show impressive results on CQA leaderboards, it remains unclear whether they are robust to shifts in setting (sometimes to more realistic ones), training data size (e.g., from large to small sets) and domain. In this work, we design and conduct the first large-scale robustness study of history modeling approaches for CQA. We find that high benchmark scores do not necessarily translate to strong robustness, and that various methods can perform extremely differently under different settings. Equipped with the insights from our study, we design a novel prompt-based history modeling approach and demonstrate its strong robustness across various settings. Our approach is inspired by existing methods that highlight historic answers in the passage. However, instead of highlighting by modifying the passage token embeddings, we add textual prompts directly in the passage text. Our approach is simple, easy to plug into practically any model, and highly effective, thus we recommend it as a starting point for future model developers. We also hope that our study and insights will raise awareness to the importance of robustness-focused evaluation, in addition to obtaining high leaderboard scores, leading to better CQA systems.1
Teaching Law of the Sea from a Critical Perspective
Authors: Kastner Philipp 
Published: April 2023

Abstract
Scholarship on law of the sea has become increasingly critical in recent years, but such a critical perspective is not easily implemented in the teaching of the subject. Given that little to no scholarship has engaged with the teaching practice of law of the sea, it seems timely to consider more carefully the research-teaching nexus in this field of law, which I seek to do through this essay. Drawing on critical pedagogy, I explain how I seek to encourage dialogic learning, to de-emphasise presumably authoritative voices, and to decentre the law in my teaching of law of the sea. I also consider some of the challenges that I have encountered in my efforts to decentre the teacher and the law, which mainly relate to arguably inherent tensions within critical pedagogy and to the contemporary higher education environment.
Delayed Tracheal Perforation After Thyroidectomy: A Case Report and Literature Review
Authors: Heo Da Beom , Son Hyo One , John Sung Han Wool , Koo Bon Seok 
Published: April 2023

Thyroidectomy is a safe procedure that is frequently performed for benign or malignant thyroid disease. Complications after thyroidectomy occur in approximately 3%–5% of patients. Tracheal perforation is a very rare post-thyroidectomy complication, and delayed tracheal perforation without intraoperative tracheal injury is even rarer; only 25 case reports have been published globally, with varied management. We present the case of a 36-year-old man presenting with dyspnea and cough 2 weeks after left thyroidectomy. A defect measuring approximately 2 cm was confirmed on the anterior wall of the trachea by computed tomography and flexible laryngoscopy. The patient’s symptoms improved with conservative treatment including systemic steroids, and surgical treatment was not required. Even in the absence of unusual intraoperative events, delayed tracheal necrosis and perforation should be considered as possible postoperative complications following thyroidectomy.
Emotional Disorders, Dispositional Mindfulness, and Mediating Role of Acceptance in Undergraduate and Postgraduate Students
Authors: Gupta Vibhuti , Sinha Nishit Kumar 
Published: April 2023

‘For after all, the best thing one can do when it is raining is, let it rain.’ ( Longfellow, 1906 ) Mental health conditions, including depression, anxiety, and stress, affect a sizable proportion of university students. Yet, little is known regarding the incidence of mental health issues among Indian university students. These mental health issues are generally caused by a range of factors, including academic demands, interpersonal connections ( Steptoe, 2007 ), future prospects, competitive exams, peer pressure, and professional considerations ( Beiter et al., 2015 ). One of the most important mental health problems impacting a large population across India and the world is depression, leading to physical diseases, suicidal thoughts, and suicide, among other negative outcomes ( Gururaj et al., 2016 ). According to the NCRB Report, 2021, the two age groups most susceptible to suicide were between 18 and 30 and 30 and 44. Suicide rates in both age categories were 34.5% and 31.7%, respectively. Family issues (3,233 victims), romantic relationships (1,495 victims), and illness (1,408 victims) were the three leading factors in suicides below 18 years of age, while the victims that were either students or unemployed made up 8.0% (13,089 victims) and 8.4% (13,714 victims) of all suicides, respectively. The objectives of this study were to understand and add to the body of knowledge on the role of mindfulness concerning depression, anxiety, and stress amongst university students; the role of mindfulness concerning avoidant behaviours amongst university students; and the mediating role of acceptance in the relationship between mindfulness and depression, anxiety, and stress amongst university students. The results of the study revealed that depression, experiential avoidance, and mindfulness are all strongly and negatively connected. The study discovered a strong correlation between experiential avoidance and depression, anxiety, and stress (psychological distress). Mindfulness had a considerable impact on the mediator, experiential avoidance, which was postulated.
Use of the Allium cepa Model to Assess the Cytogenotoxicity of Luffariella herdmani Marine Sponge Extract
Authors: Kuruppuarachchi Sashini U. , Jayawardena Uthpala A. , Gunathilake Varuni K. 
Published: April 2023

Marine sponge extracts are known to contain potentially toxic compounds that have biological activities of possible pharmacological interest. Thus, it is vital that biological models are used for the preliminary toxicity screening of such extracts. The present study reports the use of Allium cepa, a low-cost plant-based in vivo model, to assess the cytotoxicity and genotoxicity of Luffariella herdmani marine sponge crude extract (SCE). Pre-germinated onion bulbs, exposed for 96 hours to different concentrations of SCE (ranging from 0.3125 to 20 μg/ml), were used to determine general cytotoxicity. Root length as well as morphological abnormalities were recorded. Genotoxicity was assessed by exposing the root tips to SCE (0.3125–20 μg/ml) and the appropriate controls for 48 hours, and then staining with acetocarmine. The Mitotic Index (MI), Mitotic Phase Indices (MPIs) and chromosomal aberrations were evaluated and recorded. SCE inhibited A. cepa root growth (EC50 = 10.34 μg/ml) and elicited a mitodepressive effect (LC50 = 1.95 μg/ml) in a dose-dependent and significant manner. In addition, macroscopic alterations as well as chromosomal aberrations were detected. Overall, our findings indicate that L. herdmani crude extract exhibits cytotoxic and genotoxic activity, suggesting that it might contain substances with anti-proliferative/anticancer potential that could be subject to further characterisation.