bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative sedation and time to death in home palliative care: retrospective analysis
Authors: Marinelli Daniele , Ravoni Giulio , Fusilli Maria , Colpani Emilia , Filetti Marco , Santini Daniele , Porzio Giampiero , Giusti Raffaele 
Published: June 2023

ObjectivesWe described time to death and rates of palliative sedation during home palliative care leveraging a retrospective cohort of patients with advanced cancer.MethodsThe cohort consists of 143 patients with solid or haematological malignancies admitted to home palliative care in the Tuscany region in central Italy. Only patients for whom a date of death was available were included. The outcome measures were time from admission to home palliative care to death and receipt of palliative sedation.Results143 patients were included in this report. Lower Eastern Cooperative Oncology Group (ECOG) performance status (PS) scores were significantly associated with anticancer treatment at admission, as was younger age. Increasing ECOG PS scores were associated with lower survival time. Women and patients on anticancer treatment had longer survival time. Thirty-eight per cent of patients underwent palliative sedation at home; palliative sedation was more frequent among younger patients and among patients with brain or lung cancer. The most common reasons for palliative sedation were delirium and dyspnoea.ConclusionsECOG PS, sex and anticancer treatment had a significant impact on survival time. Thirty-eight per cent of patients in our cohort underwent home palliative sedation for refractory symptoms, most often delirium and dyspnoea.
Association between length of hospital stay and fractures in the spine, pelvis, and lower extremity among patients after intentional fall from a height: an analysis of the Japan Trauma Databank
Authors: Terayama Takero , Toda Hiroyuki , Nagamine Masanori , Tanaka Yoshihiro , Saitoh Daizoh , Yoshino Aihide 
Published: June 2023

ObjectiveThis study investigated the association between the number of regions with fractures in the spine, pelvis, and lower extremity (NRF) and the proportion of patients with a length of hospital stay (LOS) ≥30 days among those who attempted suicide by falling from a height.MethodsData recorded between January 1, 2004 and May 31, 2019 in the Japan Trauma Databank of patients aged ≥18 years injured by suicidal falls from a height and with ≥72 hours of LOS (period from admission to discharge home or to another hospital) were analyzed. Patients with an Abbreviated Injury Scale score ≥5 in the head region or those who died after admission were excluded. Multivariate analyses including clinically relevant variables as covariates were performed to determine the association, expressed as risk ratio with 95% CI, between NRF and LOS.ResultsAmong 4724 participants, the multivariate analysis revealed significant factors related to LOS ≥30 days, including NRF=1 (1.64, 95% CI 1.41 to 1.91), NRF=2 (2.00, 95% CI 1.72 to 2.33), NRF=3 (2.01, 95% CI 1.70 to 2.38), systolic blood pressure in the emergency department (ED; 0.999, 95% CI 0.998 to 0.9997), heart rate in the ED (1.002, 95% CI 1.00 to 1.004), Injury Severity Score (1.007, 95% CI 1.00 to 1.01), and intubation in the ED (1.21, 95% CI 1.10 to 1.34). However, history of psychiatric diseases was not a significant factor.ConclusionAn increase in NRF was associated with an increase in LOS of patients injured by intentional falls from a height. This finding can help both emergency physicians and psychiatrists in acute care hospitals to develop better treatment strategies with attention to time constraints. Further investigation of the association between LOS and both trauma and psychiatric treatment is required to evaluate the effect of NRF on treatment in acute care hospitals.Level of evidenceLevel III, retrospective study with up to two negative criteria.
Evolutionary phases of the accelerating universe in modified gravity and its solar system test
Authors: Achi Tame , Singh Heisnam Shanjit 
Published: June 2023

Einstein’s gravity is modified to explain an accelerating universe’s present and past scenarios by numerically exploring different cosmological parameters. A new f ( R) gravity model constrained with coupling constants is introduced in the Einstein–Hilbert action to explain current issues and open up new possibilities in gravity physics by fitting the model with newly collected data from observations. It is proposed that the current universe is undergoing an accelerating expansion that behaves as Chaplygin Gas-type dark energy. The values of the coupling constants involved in f ( R) gravity are chosen so that the current value of the effective equation of state (ωeff0) is shown within the observational approximation, that is, between −0.8 and −1.0. Cosmological parameters such as deceleration, cosmic jerk, and snap are consistent with the fundamental observational constraint, and their relevance in terms of coupling constant is also emphasized. The viability of the model as well as the existence and origin of scalaron mass are also investigated.
Do poverty and wealth look the same the world over? A comparative study of 12 cities from five high-income countries using street images
Authors: Suel Esra , Muller Emily , Bennett James E. , Blakely Tony , Doyle Yvonne , Lynch John , Mackenbach Joreintje D. , Middel Ariane , Mizdrak Anja , Nathvani Ricky , Brauer Michael , Ezzati Majid 
Published: June 2023

AbstractUrbanization and inequalities are two of the major policy themes of our time, intersecting in large cities where social and economic inequalities are particularly pronounced. Large scale street-level images are a source of city-wide visual information and allow for comparative analyses of multiple cities. Computer vision methods based on deep learning applied to street images have been shown to successfully measure inequalities in socioeconomic and environmental features, yet existing work has been within specific geographies and have not looked at how visual environments compare across different cities and countries. In this study, we aim to apply existing methods to understand whether, and to what extent, poor and wealthy groups live in visually similar neighborhoods across cities and countries. We present novel insights on similarity of neighborhoods using street-level images and deep learning methods. We analyzed 7.2 million images from 12 cities in five high-income countries, home to more than 85 million people: Auckland (New Zealand), Sydney (Australia), Toronto and Vancouver (Canada), Atlanta, Boston, Chicago, Los Angeles, New York, San Francisco, and Washington D.C. (United States of America), and London (United Kingdom). Visual features associated with neighborhood disadvantage are more distinct and unique to each city than those associated with affluence. For example, from what is visible from street images, high density poor neighborhoods located near the city center (e.g., in London) are visually distinct from poor suburban neighborhoods characterized by lower density and lower accessibility (e.g., in Atlanta). This suggests that differences between two cities is also driven by historical factors, policies, and local geography. Our results also have implications for image-based measures of inequality in cities especially when trained on data from cities that are visually distinct from target cities. We showed that these are more prone to errors for disadvantaged areas especially when transferring across cities, suggesting more attention needs to be paid to improving methods for capturing heterogeneity in poor environment across cities around the world.
Prevalence of Venous Infarction in Patients With Cerebral Venous Thrombosis: Baseline Diffusion-Weighted MRI and Follow-Up MRI
Authors: Alajmi Eiman , Zung Jeremy , Duquet-Armand Marie , Coutinho Jonathan M. , Mandell Daniel M. 
Published: June 2023

BACKGROUND:
A venous pattern of infarction on neuroimaging is used as a clue to undiagnosed cerebral venous thrombosis (CVT); prevention of venous infarction is a goal of CVT management; and venous infarction is a factor used for clinical prognostication. Despite widespread use of the term venous infarct, the prevalence of true venous infarction is unclear. Our primary aim was to determine the prevalence of venous infarction in patients with CVT. We also measured the prevalence of diffusion abnormality without infarction, vasogenic edema, and intracranial hemorrhage.

METHODS:
Single-center, retrospective cohort study using a registry of 110 consecutive patients admitted to hospital with cerebral venous thrombosis between 2004 and 2014. Inclusion criteria were brain magnetic resonance imaging (MRI) and contrast-enhanced venography at presentation, and repeat brain MRI ≥1 month later. Exclusion criteria were dural arteriovenous fistula, arteriovenous malformation, cavernous sinus thrombosis, or previous neurosurgical procedure. Main outcome was proportion of patients with venous infarction (irreversible ischemic injury) diagnosed using diffusion-weighted MRI at presentation, confirmed using T2-weighted fluid-attenuated inversion recovery MRI ≥1 month later, and reported with 95% CI using the Wilson score interval method. We also report the prevalence of transient diffusion MRI abnormality without infarction, vasogenic edema, and intracranial hemorrhage.

RESULTS:
Seventy-three patients met the inclusion criteria, and after exclusions, the final study population was 59 patients with median age 41 years (interquartile range, 32–57). Venous infarction occurred in 12% (7/59 [95% CI, 6%–23%]) of patients, and final infarct volume was >1 mL in only 5.1% (3/59) of patients. An additional 8% (5/59 [95% CI, 4%–18%]) of patients had a transient diffusion MRI abnormality without infarction. Prevalence of cerebral vasogenic edema and intracranial hemorrhage were 66% (39/59 [95% CI, 53%–77%]) and 54% (32/59 [95% CI, 41%–66%]), respectively.

CONCLUSIONS:
In patients with CVT, venous infarction is uncommon and venous infarcts are typically very small. Vasogenic edema and hemorrhage are more common consequences of CVT.
Emerging State Practice on Maritime Limits: A Grotian Moment Unveiling a Hidden Truth?
Authors: Árnadóttir Snjólaug 
Published: June 2023

Abstract
The legal order of the oceans has seen rapid developments and paradigm shifts. At least one of them has been described as a textbook example of a Grotian Moment: the emergence of the customary international law on the continental shelf, stemming from increased demand for oil and gas, coupled with technological advances and the Truman Proclamation of 1945. Now, eighty years later, the law of the sea is again faced with fundamental changes as the basis for maritime limits is eroded by sea level rise. State practice, going back at least a century, has demonstrated that maritime limits normally fluctuate with physical changes to the coast. This understanding has not caused significant changes to the extent or location of maritime entitlements in a historical context. However, sea level rise stands to have catastrophic impacts as the submergence of individual coastal features can cause the loss of maritime areas spanning hundreds of thousands of square kilometres.
This realisation has ignited a movement to change the law on maritime limits. Around 2010, the first States began to declare that their maritime limits would be stable, notwithstanding subsequent sea level rise. Several States and a coalition of States have since made similar declarations and the study of the ila Committee on International Law and Sea Level Rise indicates that the practice is in a phase of crystallisation. That suggests that new customary international law may be developing and the events leading to these developments might justify the use of the term Grotian Moment, leading to accelerated formation of customary international law or revised interpretation of the current law. The traditional requirements of State practice and opinio juris are not satisfied at present. However, the impacts of sea level rise on maritime limits may represent a moment of discovery that unveils a hidden truth about the law, overriding the traditional interpretation that renders maritime limits ambulatory.
Amphibious Diplomacy
Authors: Wang Earl 
Published: June 2023

Abstract
The European Union (EU) and Taiwan (officially the Republic of China) are both non-conventional polities in international relations and the study of diplomacy. On the one hand, the EU is a ‘unique economic and political union between 27 European countries’. On the other hand, Taiwan is able to concurrently carry out two distinct forms of foreign relations. First, diplomacy as a sovereign country with states that it maintains formal diplomatic relations. Second, in the relations with states and other polities without diplomatic ties, and under their divergent ‘One China’ policies, Taiwan operates as a paradiplomatic actor or one that is within the intervals of diplomacy and paradiplomacy. Observing such a phenomenon, this article proposes the notion of ‘amphibious diplomacy’ and empirically studies the notion through how, in practice, the EU and Taiwan have been carrying out their negotiation of the Bilateral Investment Agreement (bia) given the constraints of an absence of diplomatic relations and the EU’s ‘One China’ policy. The article incorporates first-hand material from semi-structured interviews with interlocutors whose work allows them to obtain practical knowledge about the EU-Taiwan bia.
Access and Emergence: A Case Study of a Working-Class Journey into Studying Medicine
Authors: Wilson Alastair , Hunter Katie 
Published: June 2023

Abstract
Analysis of data on school leavers in Scotland points towards considerable inequality in access to higher education. This is highlighted in terms of participation in higher education by young people from lower-income households or identifying as first in their families to consider going to university. The situation is more acute in terms of access to the most competitive courses leading to careers in medicine, veterinary medicine, dentistry and law. This paper draws on data from an ongoing research and development project in the area of mentoring to present a case study of a young woman progressing an application to study medicine. Drawing on the concept of Academic Capital Formation it illuminates the ways in which institutional practices advance or impede access to higher education and particularly, to those courses which facilitate entry into high status professional occupations. The findings in this research problematise current thinking about how to widen participation in higher education and the most competitive professions.
Operative Management of Aerodigestive Injuries: Improved Survival Over two Decades
Authors: Walker Patrick F. , Galvagno Samuel M. , Sachdeva Ashutosh , Feliciano David V. , Scalea Thomas M. , O’Connor James V. 
Published: June 2023

Introduction Non-iatrogenic aerodigestive injuries are infrequent but potentially fatal. We hypothesize that advances in management and adoption of innovative therapies resulted in improved survival. Methods Trauma registry review at a university Level 1 center from 2000 to 2020 that identified adults with aerodigestive injuries requiring operative or endoluminal intervention. Demographics, injuries, operations, and outcomes were abstracted. Univariate analysis was performed, P < .05 was statistically significant. Results 95 patients had 105 injuries: 68 tracheal and 37 esophageal (including 10 combined). Mean age 30.9 (± 14), 87.4% male, 82.1% penetrating, and 28.4% with vascular injuries. Median ISS, chest AIS, admission BP, Shock Index, and lactate were 26 (16-34), 4 (3-4), 132 (113-149) mmHg, .8 (.7-1.1), and 3.1 (2.4-5.6) mmol/L, respectively . There were 46 cervical and 22 thoracic airway injuries; 5 patients in extremis required preoperative ECMO. 66 airway injuries were surgically repaired and 2 definitively managed with endobronchial stents. There were 24 cervical, 11 thoracic, 2 abdominal esophageal injuries—all repaired surgically. Combined tracheoesophageal injuries were individually managed and buttressed. 4 airway complications were successfully managed, and 11 esophageal complications managed conservatively, stented, or resected. Mortality was 9.6%, half from intraoperative hemorrhage. Specific mortality: tracheobronchial 8.8%, esophageal 10.8%, and combined 20%. Mortality was significantly associated with higher ISS (P = .01), vascular injury (P = .007), blunt mechanism (P = .01), bronchial injury (P = .01), and years 2000-2010 (P = .03), but not combined tracheobronchial injury. Conclusion Mortality is associated with several variables, including vascular trauma and years 2000-2010. The use of ECMO and endoluminal stents in highly selected patients and institutional experience may account for 97.8% survival over the past decade.
Cricothyrotomy Online: Quality Assessment of Educational Videos on YouTube
Authors: Day Margot E. , Zwemer Catherine H. , Pierce Ayal Z. , Wanersdorfer Karen , Kartiko Susan , LaPorta Matthew , Sarani Babak , Jackson Hope T. , Estroff Jordan M. 
Published: June 2023

Background Medical learners may use YouTube® videos to prepare for procedures. Videos are convenient and readily available, but without any uploading standards, their accuracy and quality for education are uncertain. We assessed the quality of emergency cricothyrotomy videos on YouTube through an expert panel of surgeons with objective quality metrics. Methods A YouTube® search for “emergency cricothyrotomy” was performed and results were filtered to remove animations and lectures. The 4 most-viewed videos were sent to a panel of trauma surgeons for evaluation. An educational quality (EQ) score was generated for each video based on its ability to explain the procedure indications, orient the viewer to the patient, provide accurate narration, provide clear views of procedure, identify relevant instrumentation and anatomy, and explain critical maneuvers. Reviewers were also asked if safety concerns were present and encouraged to give feedback in a free-response field. Results Four surgical attendings completed the survey. The median EQ score was 6 on a 7-point scale (95% CI [6, 6]). All but one of the individual parameters had a median EQ score of 6 (95% CI: indications [3, 7], orientation [5, 7], narration [6, 7], clarity [6, 7], instruments [6, 7], anatomy [6, 6], critical maneuvers [5, 6]). Safety received a lower EQ score (5.5, 95% CI [2, 6]). Conclusions The most-viewed cricothyrotomy videos were rated positively by surgical attendings. Still, it is necessary to know if medical learners can distinguish high from low quality videos. If not, this suggests a need for surgical societies to create high-quality videos that can be reliably and efficiently accessed on YouTube®.
Goalsetting is Mindsetting: Guided Reflection on Life Goals Taps Into the Plasticity of Motivational Mindsets
Authors: Hudig Job , Scheepers Ad W. A. , Schippers Michaéla C. , Smeets Guus 
Published: June 2023

The working mechanism of an effective online lifegoal-setting intervention was recently proposed by means of the motivational mindset model (MMM). The MMM contains four types of mindset profiles (high-impact, low-impact, social-impact, and self-impact) based on multiple, co-occurring motives that students hold for studying. The present paper aims to qualitatively investigate the mechanism and explores whether the goal-setting intervention fosters a favorable change in mindset. To this end, a deductive content analysis was used to examine the life goal motives in the written goal-setting essays of 48 first-year university students (33% female; 8.3% ethnic minority; Mage = 19.5, age range 17–30 years). Life goal motives were coded according to four dimensions along two distinctions (self-oriented versus self-transcendent, and intrinsic versus extrinsic) and analyses were focused on comparisons between changed and stable mindsets. Results show that students who changed from a low-impact mindset to a social-impact mindset expressed intrinsic self-oriented and intrinsic self-transcendent motives to a similar extent as stable social-impact mindset students. This pattern indicates that the positive change in mindset already occurred during the reflection assignment and substantiates the proposed mechanism of the goal-setting intervention. The implications of the findings are discussed as well as directions for future research.
A systematic review of variations in circadian rhythm genes and type 2 diabetes
Authors: Stevens Harry , Verdone Giulia , Lang Leonie , Graham Catherine , Pilic Leta , Mavrommatis Yiannis 
Published: June 2023

Background Type 2 diabetes is a chronic disease that has severe individual and societal consequences, which is forecast to worsen in the future. A new field of investigation is variations in circadian rhythm genes, in conjunction with diet and sleep variables, associations with, and effects on, type 2 diabetes development. Objective This systematic review aimed to analyse all current literature regarding circadian rhythm gene variations and type 2 diabetes, and explore their interplay with diet and sleep variables on type 2 diabetes outcomes. This review was registered with PROSPERO (CRD42021259682). Methodology Embase and Pubmed were searched on 6/8/2021/11/8/2021 for studies of all designs, including participants from both sexes, all ethnicities, ages, and geographic locations. Participants with risk alleles/genotypes were compared with the wildtype regarding type 2 diabetes outcomes. Studies risk of bias were scored according to the risk of bias in non-randomised studies – interventions/exposures criteria. Results In total, 31 studies were found (association n  =  29/intervention n  =  2) including >600,000 participants from various ethnicities, sexes, and ages. Variations in the melatonin receptor 1B, brain and muscle arnt-like 1 and period circadian regulator (PER) genes were consistently associated with type 2 diabetes outcomes. Conclusions Individuals with variations in melatonin receptor 1B, brain and muscle arnt-like 1 and PER may be at higher risk of type 2 diabetes. Further research is needed regarding other circadian rhythm genes. More longitudinal studies and randomised trials are required before clinical recommendations can be made.