bluuebunny/crossref_metadata_2025_split huggingface dataset:
P476 TOLERATED SUSTAINED VENTRICULAR FIBRILLATION IN LVAD RECIPIENT: THE WALKING DEAD
Authors: Mauriello A , Maratea A , Amarelli C , Maiello C , Loffredo F , Liccardo B , Golino P 
Published: May 2023

Abstract
A 73–year–old man comes to the cardiac surgery clinic, due to the onset of an arrhythmic storm. In 1999, the patient was diagnosed with dilated cardiomyopathy with finding of a pathogenic mutation of the MYH7 gene by NGS panel analysis. Because of severely reduced systolic function despite OMT and left conduction delay, he underwent CRT–D implant in class IA. The patient‘s course was characterized by multiple exacerbations and a worsening course of ventricular dysfunction (EF 20%), such as to configure a picture of advanced heart failure, INTERMACS III (frequent flyer). Approximately 6 months later, the patient was admitted with signs of hypoperfusion refractory to inotrope therapy and significant congestion. In consideration of age, frailty and irreversible renal dysfunction, the patient was excluded from the transplant list. Therefore, he was a candidate for mechanical support as destination therapy, through the implantation of the Heart Mate III. At admission, the patient was monitored with evidence of ventricular fibrillation (image 1) and relative hemodynamic stability. The vital parameters reported a BP of 90/76 mmHg, FC not evaluable and SpO2 of 80%. For this reason, in anesthesiological assistance, asynchronous external defibrillation (200 J) was performed with restoration of the pacing rhythm. The monitoring of the LVAD showed a series of alerts: a reduction of the Pump Flow and phases of reduction of the Pulse Index (image 2). Event monitoring of the CRT–D revealed that the patient developed an arrhythmic storm, with appropriate but ineffective several shocks. The 8 shocks were followed by the interruption of the device therapies, but the patient, despite the ventricular fibrillation, had preserved perfusion. Medical therapy was optimized (mexiletine add–on) and CRT–D was rescheduled.

Conclusions
The presence of LVAD ensures a satisfactory cardiac output during arrhythmias that would lead to hemodynamic compromise. For this reason it is possible to identify patients who autonomously come to our observation in "cardiac arrest".
P478 HEART TRANSPLANT IN SARS–COV2 POSITIVE RECIPIENT: MANAGEMENT PROTOCOL OF WORLD‘S FIRST CASE
Authors: Giovannico L , D‘errico Ramirez A , Parigino D , Fischetti G , Concetta L , Santeramo V , Giuseppe F , Antonio C , Bavaro D , Saracino A , Grasso S , Bottio T , Milano A 
Published: May 2023

Abstract
During SARS–CoV2 pandemic, transplant programs had to devise strategies to deal with the possibility of COVID–19–positive donors and recipients. In March 2022, a 60–year–old man with dilated cardiomyopathy on the transplant waitlist was admitted to our Unit as a possible donation was presented. On arrival, he tested positive for SARS–CoV2. The patient had no clinical evidence of COVID–19; he had completed the vaccination cycle; chest X–rays did not show interstitial pneumonia. Aware of the increased risk, we proceeded with the transplant. Sotrovimab, a novel anti–viral agent specific for COVID–19, was administered. Prophylactic antibiotics were started. He received anti–thymocyte immunoglobulins 125 mg for 2 days and methylprednisolone 1 g after aortic declamping and then 125 mg TID for 2 days for induction immunosuppression. Maintaining therapy included corticosteroids and tacrolimus. On the 7th day the patient tested negative at SARS–CoV2 swab. As kidney function worsened, hemodialysis was started. On the 17th day signs of cellulitis of the left thigh appeared, and inflammation indices (CRP, PCT) rose. A hemoculture positive for A. baumannii (MDR–AB) was obtained; hence the patient was treated with Cefiderocol and Colistine. A Cytosorb filter was added to the hemodialysis and Pentaglobin was started. After 3 weeks, hemodynamics started to improve, inotrope support was suspended, with reduction of inflammation indices, negative hemocultures, recovering kidney function. After two weeks, the patient abruptly presented fever, marked hypotension and dyspnea. He underwent intubation, inotrope therapy, broad–spectrum antibiotic therapy, intravenous Immunoglobulins and a cycle of Polymyxin B Hemoperfusion. Nevertheless, hemodynamics decidedly failed. Chest X–rays showed bilateral pneumonia. Hemocultures were positive for MDR–AB. Leukopenia developed (WBC 0,10). Three days after the first signs of a new infective episode, the patient had died. Notwithstanding the difficulties of SARS–CoV2 pandemic, tempestive diagnosis and treatment allow transplant programs to proceed unhindered.
P492 NARRATIVE OF PATIENTS WITH ACUTE CORONARY SYNDROME: FROM THE EVENT TO THE END OF A CARDIAC REHABILITATION PROGRAM
Authors: Brugin E , Cordero M 
Published: May 2023

Abstract

Background
Acute Myocardial infarction (AMI) is often a sudden event that requires urgent and invasive therapeutic measures. After AMI, patients enter the world of chronic diseases with strong personal repercussions.

Purpose of the Study
To investigate experience of patients with AMI and how it evolves at different stages of the treatment pathway in order to help health professionals to improve and to individualise different aspects of treatment.

Material and Methods
A semi–structured diary outline and Plutchik‘s wheel of emotions (on which the patient had to underline his three predominant emotions) was proposed to 30 patients affected by AMI: 10 within 48 hours of the event, 10 immediately before and 10 immediately after a cardiac rehabilitation program (CRP). Narrative about the experience related to the IMA moment was collected in each phases, while aspects concerning current situation and CRP were added to the traces proposed before and after cardiac rehabilitation. The texts produced by patients were analysed using specific methods of Narrative Medicine (Kleiman‘s, Lowner/Robinson‘s and Frank‘s classification). Plutchik‘s wheel results were processed as word–cloud.

Results
Negative emotions dominate in narratives collected during acute phase (FIG 1) where themes such as hopelessness, uncertainty, loss of control, guilt are recurrent. Sometimes tendency towards progression is identifiable, but always inside a narrative structure that conveys a precariousness experience. In the phase preceding CRP, most violent negative emotions disappear and positive emotions surface (FIG 2). The desire to understand situation becomes a main narrative theme and trust in health professionals appears as a coping element. Also in still narratives, elements of progression are evident, sometimes predominant. A prevalent restitution component emerges with strong expectations in CRP results. At the end of CRP, a further positive change in emotions is evident (FIG 3). All narratives become in progression and quest elements sometimes appear.

Conclusions
Narratives show an evolution of AMI patients experience from acute event to the end of CRP. Our study allowed to obtain useful elements to improve the approach to the AMI patient during the acute phase, to ameliorate anamnestic collection in the post–acute phase and to individualise rehabilitation pathway making it more customized and effective.
The divergence of mean phenotypes under persistent directional selection
Authors: Devi Archana , Speyer Gil , Lynch Michael 
Published: May 2023

Abstract
Numerous organismal traits, particularly at the cellular level, are likely to be under persistent directional selection across phylogenetic lineages. Unless all mutations affecting such traits have large enough effects to be efficiently selected in all species, gradients in mean phenotypes are expected to arise as a consequence of differences in the power of random genetic drift, which varies by approximately five orders of magnitude across the Tree of Life. Prior theoretical work examining the conditions under which such gradients can arise focused on the simple situation in which all genomic sites affecting the trait have identical and constant mutational effects. Here, we extend this theory to incorporate the more biologically realistic situation in which mutational effects on a trait differ among nucleotide sites. Pursuit of such modifications leads to the development of semi-analytic expressions for the ways in which selective interference arises via linkage effects in single-effects models, which then extend to more complex scenarios. The theory developed clarifies the conditions under which mutations of different selective effects mutually interfere with each others’ fixation and shows how variance in effects among sites can substantially modify and extend the expected scaling relationships between mean phenotypes and effective population sizes.
The Tropical Manin–Mumford Conjecture
Authors: Richman David Harry 
Published: May 2023

Abstract
In analogy with the Manin–Mumford conjecture for algebraic curves, one may ask how a metric graph under the Abel–Jacobi embedding intersects torsion points of its Jacobian. We show that the number of torsion points is finite for metric graphs of genus ${g\geq 2}$, which are biconnected and have edge lengths that are “sufficiently irrational” in a precise sense. Under these assumptions, the number of torsion points is bounded by $3g-3$. Next, we study bounds on the number of torsion points in the image of higher-degree Abel–Jacobi embeddings, which send $d$-tuples of points to the Jacobian. This motivates the definition of the “independent girth” of a graph, a number that is a sharp upper bound for $d$ such that the higher-degree Manin–Mumford property holds.
Relationship Between Gender and Academic and Military Achievement Among USU Medical School Graduates
Authors: McBee Elexis , Dong Ting , Ramani Divya , Durning Steven J , Konopasky Abigail 
Published: May 2023

ABSTRACT

Introduction
Despite increases in the number of female matriculants in medical school, civilian data demonstrate that women still struggle to reach parity in attainment of leadership positions. In military medicine, we have seen a major increase in the number of women graduating from the USU. Yet, we still know little about the representation of female military physicians in leadership positions. The aim of this study is to examine the relationship between gender and academic and military achievement among USU School of Medicine graduates.

Methods
Utilizing the USU alumni survey sent to graduates from the classes of 1980 to 2017, items of interest, such as highest military rank, leadership positions held, academic rank, and time in service, were used to evaluate the relationship between gender and academic and military achievement. Contingency table statistical analysis was conducted to compare the gender distribution on the survey items of interest.

Results
Pairwise comparison demonstrated significant differences between gender in the O-4 (P = .003) and O-6 (P = .0002) groups, with females having a higher-than-expected number of O-4 officers and males having a higher-than-expected number of O-6 officers. These differences persisted in a subsample analysis that excluded those who separated from active duty prior to 20 years of service. There was a significant association between gender and holding the position of commanding officer (χ2(1) = 6.61, P &lt; .05) with fewer females than expected. In addition, there was a significant association between gender and the highest academic rank achieved (χ2(3) = 9.48, P &lt; 0.05) with lower-than-expected number of females reaching the level of full professor, in contrast to males who exceed the expected number.

Conclusions
This study suggests that female graduates of USU School of Medicine have not achieved promotion to the highest levels of rank, military, or academic leadership at the projected rate. Efforts to explore what barriers may impact military medicine’s desire to have more equal representation of women in higher ranks and positions should be undertaken with specific attention to what drives retention versus separation of medical officers and if systematic changes are needed to help promote equity for women in military medicine.
A Comparison of HPSP and USU Graduates’ Preparation for Residency
Authors: Cole Rebekah , Durning Steven J , Reamy Brian V , Stewart Hannah C , Williamson Samantha S , Rudinsky Sherri L 
Published: May 2023

ABSTRACT

Introduction
Military medical students enter residency through two main pathways: (1) The Uniformed Services University (USU) and (2) the Armed Services Health Professions Scholarship Program (HPSP). The purpose of this study was to compare how these two pathways prepare military medical students for residency.

Methods
We conducted semi-structured interviews with 18 experienced military residency program directors (PDs) in order to explore their perceptions of the preparedness of USU and HPSP graduates. We used a transcendental phenomenological qualitative research design to bracket our biases and guide our data analysis. Our research team coded each of the interview transcripts. We then organized these codes into themes, which served as the results of our study.

Results
Five themes emerged from our data regarding the residents’ preparedness: (1) Ability to navigate the military culture, (2) understanding of the military’s medical mission, (3) clinical preparation, (4) ability to navigate the Military Health System (MHS), and (5) teamwork. The PDs described how USU graduates better understand the military’s medical mission and are more easily able to navigate the military culture and the MHS because of their lived experiences during military medical school. They also discussed the various levels of clinical preparation of HPSP graduates, in contrast to the USU graduates’ more consistent skills and abilities. Finally, the PDs believed both groups to be strong team players.

Conclusions
USU students were consistently prepared for a strong start to residency because of their military medical school training. HPSP students often experienced a steep learning curve because of the newness of the military culture and MHS.
Evaluating Intersite Consistency Across 11 Geographically Distinct Pediatric Clerkship Training Sites: Providing Assurance That Educational Comparability Is Possible
Authors: Judd Courtney A , Dong Ting , Foster Christopher , Durning Steven J , Hickey Patrick W 
Published: May 2023

ABSTRACT

Introduction
We compared core pediatric clerkship student assessments across 11 geographically distinct learning environments following a major curriculum change. We sought to determine if intersite consistency existed, which can be used as a marker of program evaluation success.

Methods
We evaluated students’ overall pediatric clerkship performance along with individual assessments that target our clerkship learning objectives. Using the data of graduating classes from 2015 to 2019 (N = 859), we conducted an analysis of covariance and multivariate logistic regression analysis to investigate whether the performance varied across training sites.

Results
Of the students, 833 (97%) were included in the study. The majority of the training sites did not show statistically significant differences from each other. After controlling for the Medical College Admission Test total score and the average pre-clerkship National Board of Medical Examiners final exam score, the clerkship site only explained a 3% additional variance of the clerkship final grade.

Conclusions
Over the ensuing 5-year period after a curriculum overhaul to an 18-month, integrated module pre-clerkship curriculum, we found that student pediatric clerkship performance in clinical knowledge and skills did not differ significantly across 11 varied geographic teaching sites when controlling for students’ pre-clerkship achievement. Specialty-specific curriculum resources, faculty development tools, and assessment of learning objectives may provide a framework for maintaining intersite consistency when faced with an expanding network of teaching facilities and faculty.
LTCOS Data Management: CHPE and PDC
Authors: Lopez Luis C , Dong Ting , Fallis Drew W , Durning Steven J 
Published: May 2023

ABSTRACT
The purpose of this short essay is to describe the data management processes utilized in the Long Term Career Outcome Study at the Center for Health Professions Education and the Postgraduate Dental College of the Uniformed Services University. It includes descriptions of our workflow, how we obtain the data, challenges, and recommendations based on our experience for data managers and institutions to follow. This descriptive writing may help guide practice for other institutions looking to streamline their data management plan.
The Relationship Between Intellectual Property Rights and Competition Laws
Authors: Vinje Thomas , Rooijen Ashwin van 
Published: May 2023

Abstract
This chapter tackles the relationship between intellectual property rights and competition laws. Intellectual property rights emerged from the interest of the sovereign to exert control over the nascent forms of intellectual property rights. Moreover, intellectual property rights can be abridged ‘externally’ through competition laws. The chapter then provides an overview of the mechanisms within intellectual property rights that balance exclusivity with free competition. It explains how the circumstances of the license refusal case depend on the conduct of the right holder and evidence of consumer harm. Courts appear more willing to accept that a refusal to license constitutes abuse in situations such as refusal to license on balance hindering innovation and intellectual property right being essential to compete.
The Overlap Between Trade Secrets and Privacy
Authors: Becker Maximilian 
Published: May 2023

Abstract
This chapter focuses on the overlap between trade secrets and privacy. It mentions how both areas of law have always been part of the right to information. During the age of digitalization, disputes arose regarding who is entitled to a certain amount of data on a certain server, or who is allowed to copy data from whose device. Moreover, data protection law raises questions concerning overlapping rights to data and the background of a fundamentally different understanding of privacy between the laws in the US and in Europe. The chapter elaborates on information theory, which distinguishes between the semantic, syntactic, structural, and sometimes also pragmatic layers of information.
Introduction
Authors: Verellen Thomas 
Published: May 2023

AbstractThe introductory chapter sets the scene. It introduces the theme of the book, the theoretical framework that will structure the analysis, as well as the key concepts of ‘federalism’ and ‘foreign relations’. The conception of federalism on which this book relies draws on the work of Daniel Elazar, who defined federalism as a combination of self-rule and shared rule. To further operationalize Elazar’s definition, the book distinguishes between two aspects of self-rule, and two aspects of shared rule. Self-rule refers to the allocation of powers to the different governments that together constitute the federation, and to the mechanisms the constitution puts in place to prevent and if necessary resolve conflicts between those governments as they exercise the powers allocated to them. Shared rule refers to the political safeguards of foreign relations federalism (ie the, more or less formal, means member unit governments have to influence federal foreign policy-making), and to intergovernmental relations (ie the relations between the various governments that together constitute the federation). The introduction finishes with an overview of the main findings of the book.
Conflict Resolution in the US, Canada, and Belgium
Authors: Verellen Thomas 
Published: May 2023

AbstractChapters 4 and 5 cover the second dimension of self-rule: conflict resolution. This chapter, Chapter 4, looks at how conflicts between the federal and member unit governments in the conduct of foreign relations are resolved in the US, Canada, and Belgium. The next chapter, Chapter 5, looks at how the same issue plays out in the EU. Chapter 4 compares the different conflict resolution mechanisms in terms of their degree of formality, and in terms of the institution that holds responsibility for resolving the conflict (the courts or the political institutions). It shows that in Canada conflict resolution mechanisms are informal and political; in Belgium they are formal and political; and in the US they are formal and judicial. Overall, the chapter demonstrates how conflict resolution plays a central role, in particular in the US where, in keeping with the principles of dual sovereignty, the supremacy of federal law and policy over conflicting state law carries much weight. By contrast, the scarcity of conflict resolution mechanisms in both Canada and Belgium, and their informal nature in Canada, help to explain why intergovernmental relations have become so important in both Belgium and Canada. Because the Belgian and Canadian federal governments cannot easily impose their preferences on the member units, collaboration and cooperation become all the more important.
That Evening
Authors: Wood Michael 
Published: May 2023

Abstract
A comparison with a parodic narrative moment in James Joyce’s Ulysses is the basis for a study of three versions of a story Proust saw as foundational for his life and fiction: that of the night when the hero, as a child, did not (and then did) receive a goodnight kiss from his mother. The story says, differently but emphatically in all versions, that on this night he lost all his willpower for ever. Needless to say, we would not be reading A la recherche du temps perdu if this was true—either for the narrator or for the author.
The Most Important Constitutional Court Proceedings in the European Legal Space
Authors: Grote Rainer 
Published: May 2023

Abstract
The chapter compares constitutional court proceedings in the European legal space as well as in selected non-European countries. The most important function—and defining feature—of constitutional courts in the European legal space is still the review of constitutionality of (primary) legislation, which appears in many variations (ex ante and ex post constitutional review, principal and incidental review). Institutional disputes which enable the different branches and institutions of central government to defend their constitutional prerogatives against each other in constitutional court proceedings have received far less attention, both in constitutional regulation and in constitutional practice, and have achieved major prominence only in Italy and Germany. By contrast, the procedures which allow individuals to defend their constitutional rights directly before the constitutional court have grown dramatically in importance with the ‘rights revolution’ in the late twentieth century. However, as the protection of individual rights is not an exclusive task of constitutional courts, but a responsibility shared with the entire judiciary, this development has given rise to new problems, which concern both the management of steeply rising caseloads and the balancing of the relations between the constitutional and the ordinary judiciary.
Constitutional Jurisdiction and the Separation of Powers in the European Legal Space: A Comparative Analysis
Authors: Farahat Anuscheh 
Published: May 2023

Abstract
This chapter discusses the relationship between constitutional jurisdiction and the separation of powers by analysing how constitutional law juridifies political processes, how the substantive review of legislation against a constitutional standard is exercised, and how constitutional validity is preserved in times of an increasing internationalization and supranationalization of public authority. It compares the solutions found in different constitutional systems in the European legal space to these problems, in particular with regard to the three main systems in place to secure the constitutionality of laws: parliaments, (all) courts, and specialized constitutional courts. The chapter shows how the ongoing Europeanization and internationalization of law granted the ordinary courts new powers, in particular in systems with specialized constitutional courts.