bluuebunny/crossref_metadata_2025_split huggingface dataset:
Explainable Machine Learning to Predict Anchored Reentry Substrate Created by Persistent Atrial Fibrillation Ablation in Computational Models
Authors: Bifulco Savannah F. , Macheret Fima , Scott Griffin D. , Akoum Nazem , Boyle Patrick M. 
Published: August 2023

Background
Postablation arrhythmia recurrence occurs in ~40% of patients with persistent atrial fibrillation. Fibrotic remodeling exacerbates arrhythmic activity in persistent atrial fibrillation and can play a key role in reentrant arrhythmia, but emergent interaction between nonconductive ablation‐induced scar and native fibrosis (ie, residual fibrosis) is poorly understood.

Methods and Results
We conducted computational simulations in pre‐ and postablation left atrial models reconstructed from late gadolinium enhanced magnetic resonance imaging scans to test the hypothesis that ablation in patients with persistent atrial fibrillation creates new substrate conducive to recurrent arrhythmia mediated by anchored reentry. We trained a random forest machine learning classifier to accurately pinpoint specific nonconductive tissue regions (ie, areas of ablation‐delivered scar or vein/valve boundaries) with the capacity to serve as substrate for anchored reentry‐driven recurrent arrhythmia (area under the curve: 0.91±0.03). Our analysis suggests there is a distinctive nonconductive tissue pattern prone to serving as arrhythmogenic substrate in postablation models, defined by a specific size and proximity to residual fibrosis.

Conclusions
Overall, this suggests persistent atrial fibrillation ablation transforms substrate that favors functional reentry (ie, rotors meandering in excitable tissue) into an arrhythmogenic milieu more conducive to anchored reentry. Our work also indicates that explainable machine learning and computational simulations can be combined to effectively probe mechanisms of recurrent arrhythmia.
The Principle of Separation of Powers: the Case of Lithuania
Authors: Šinkūnas Haroldas , Pūraitė-Andrikienė Dovilė 
Published: August 2023

Abstract
The principle of separation of powers is one of the most important constitutional principles underlying the organization of public power. In interpreting this principle, the Lithuanian Constitutional Court has defined it is a fundamental principle of the organization and functioning of a democratic state governed by the rule of law, which requires not only separation of the branches of government but also ensuring a balance between them. The constitutional rule stating that ‘in Lithuania, State power is executed by the Seimas, the President of the Republic and the Government, and the Judiciary’ is the starting point for revealing the content of the principle of separation of powers enshrined in the Constitution. This article discusses the exercise of legislative, executive and judicial powers by the public authorities specified in the Constitution and presents some cases of violation of the constitutional principle of separation of powers that have been examined by the Lithuanian Constitutional Court. These issues are analyzed in the context of challenges to the principle of separation of powers in other Central and Eastern European countries.
The European Convention on Human Rights and the Lithuanian Constitutional Court: the echr’s Formal Status, Impact and Interaction Between the Court and the ECtHR
Authors: Bubnytė-Širmenė Karolina 
Published: August 2023

Abstract
The article explores the attitude of the Lithuanian Constitutional Court to the European Convention on Human Rights, revealing its evolution from the establishment of the Court in 1993 until today. It is assumed that the most significant impact of the Convention was perceived in earlier constitutional jurisprudence, while its increased quality and quantity brought changes in the Court’s attitude to the Convention, also influencing its relationship with the European Court of Human Rights. The author undertakes the following tasks: 1) to define the formal legal status of the Convention within the Lithuanian legal system; 2) to reveal the impact of the Convention on Lithuanian constitutional jurisprudence and to identify related changes; 3) to discuss the relationship between the Constitutional Court and the European Court of Human Rights as it has evolved and 4) to find out whether there is room for domestic development of the rights guaranteed under the Convention and how this manifests.
Bridging Between an Effective Economy and Environmental Protection Under the Lithuanian Constitution
Authors: Juškevičiūtė-Vilienė Agnė 
Published: August 2023

Abstract
In 1992, the Lithuanian Constitution created the preconditions for the stable and successful economic development of the state and laid down foundations for regulating economic relationships that ensure the predictability of economic, social, and legal relationships. The article analyzes how the concept of social justice as chosen by the drafters of the Constitution influences Lithuanian economic policy, as well as what foundations are consolidated in the Constitution for the economic system and freedom of individual economic activity. A brief study is presented in order to reveal the patterns of regulation of the Lithuanian economy in constitutional law, as well as the jurisprudence of the Constitutional Court in relation to freedom of individual economic activity over the thirty years that the Constitution has been in force. Study of this jurisprudence shows that, in the first decade of restored Lithuanian independence, freedom of economic activity was particularly encouraged by the Constitutional Court, with the aim of creating the foundations for a market economy as soon as possible. Later, the main aim of the state was to ensure Lithuania’s energy independence, while in the third decade of independence constitutional jurisprudence increasingly analyzed the possibilities of finding a balance between environmental protection requirements and economic freedom. The second part of the article examines the constitutional foundations for environmental protection and the constitutional doctrine interpreting them; it is maintained that environmental protection can, in accordance with the provisions of the Constitution, be recognized as an important public interest, which may justify restrictions on freedom of individual economic activity; however, these restrictions must guarantee a balance between the two constitutional values of environmental protection and freedom of individual economic activity.
Puzzles and Patronage in the Persian Cosmopolis: Moʿin al-Din Esfezāri’s Acrostic Letter to Mahmud Gāvān
Authors: Walravens Meia 
Published: August 2023

Abstract
This article studies a literary puzzle, a maktub-e movashshah or acrostic letter, that is among the Persian monshaʾāt (stylized literary letters) of the Herat-based historian and secretary Moʿin al-Din Mohammad Zamji Esfezāri (fl. 1468–94/873–99). Created in praise of the Bahmani vizier Mahmud Gāvān (d. 1481/886), Esfezāri’s composition fits within a corpus of letters that testifies to the existence of epistolary contacts between Gāvān and the élites of the court of Soltān-Hosayn Bāyqarā (r. 1469–1506/873–911). Esfezāri’s letter is especially valuable because it elucidates Timurid intellectuals’ interests in such relations in the second half of the fifteenth/ninth century. An analysis of its message shows that Timurid literati could pursue long-distance patronage in the Deccan, without necessarily migrating to the region. The letter’s acrostic form, moreover, is an interesting case of how authors of Persian texts could strike a balance between local expectations and transregional aspirations in the Persian cosmopolis.
Meeting Lofty Aspirations? English National Planning Policy, International Law, and Climate Change
Authors: Mills Alistair 
Published: August 2023

Abstract
The National Planning Policy Framework (nppf) is the primary expression of central government planning policy for England. Given the importance of the planning system for a transition to a more sustainable future, including seeking to reduce and avoid greenhouse gas emissions, the nppf is a highly significant document. The nppf refers to the ideas of sustainable development and intergenerational equity, important in international environmental law. However, intergenerational equity has scarcely featured in the many legal challenges regarding the interpretation of the nppf. Having considered the extent to which the nppf achieves the aspirations set out in the instruments to which it refers, this article suggests potential changes to policy so as to provide greater support to the aim of reducing greenhouse gas emissions.
The Two Times Problem: Where Is the Problem?
Authors: Herzog Michael H. 
Published: August 2023

Abstract
Gruber et al. (2022) offered a framework how to explain “Physical time within human time”, solving the ‘two times problem’. Here, I am asking whether such a problem exists at all. To question the question, I will appeal to neurobiological, evolutionary, and philosophical arguments suggesting that human time does not need to be reconciled with physical time.
Diagnostic Accuracy of Hyperdense Artery Sign in Early Detection of Middle Cerebral Artery Infarction: A Cross-Sectional Validation Study
Authors: Waheed Yusra , Rangwala Hussain Sohail , Fatima Hareer , Riaz Faiza , Mubarak Fatima 
Published: August 2023

Background Hyperdense middle cerebral artery sign (HMCAS) on a non-enhanced multidetector computed tomography (MDCT) scan is considered an important radiological marker in detecting acute arterial thrombotic occlusion, and it is one of the earliest signs of ischemic cerebrovascular accident (CVA). This finding has been observed within 90 min of symptom onset. Modern approaches to patients with cerebral infarction emphasize early diagnosis and management. Purpose To determine the diagnostic accuracy of hyperdense artery signs in early detection of middle cerebral artery (MCA) infarction on non-contrast-enhanced MDCT scan using Magnetic Resonance Angiography (MRA) within 24 h as the gold standard for definitive diagnosis. Method A total of 140 patients aged 35–70 years, referred to the radiology department of Aga Khan University Hospital with clinical suspicion of acute cerebral infarction, were included. After clinical suspicion of acute infarction, the patient underwent an initial complete MDCT scan of the brain, which was performed using Aquilion ONE 640 slice MDCT (Toshiba Medical Systems, Japan). Consultant radiologists, with a minimum of 5 years of experience in MDCT brain imaging, interpreted the images. Follow-up examination with MRA within 24 h was performed to confirm the diagnosis of MCA infarction. Results Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of HMCAS in the early detection of MCA infarction on non-contrast-enhanced MDCT scan using MRA as the gold standard for definitive diagnosis was 96.20%, 93.44%, 95.0%, 95.0%, and 95.0%, respectively. Conclusion This study concluded that the diagnostic accuracy of hyperdense artery signs in the early detection of MCA infarction on non-contrast-enhanced MDCT scans is very high.
The Effect of Fear of Happiness as a Cultural Phenomenon on Anxiety and Self-Efficacy in the Puerperae
Authors: Türkmen Hülya , Sezer Fatma 
Published: August 2023

Introduction: Individuals who believe that experiencing positive emotions such as happiness could lead to negative results can suppress their authentic positive feelings to prevent undesired consequences. The aim of this study was to determine the levels of fear of happiness as a cultural phenomenon among puerperal women and the effects of fear of happiness on anxiety and self-efficacy in these women. Method: This cross-sectional study was conducted in the puerperal service of a hospital in Turkey between September 2021 and June 2022 ( n = 287). The study data were collected through State-Trait Anxiety Inventory Scale (STAI-I and STAI-II), General Self-Efficacy (GSE) Scale, and Fear of Happiness Scale (FHS). Results: There was a significant relationship between STAI-II and GSE and FHS scores, which explained 43.4% ( R2 = .434) of the variance ( p < .001). Also, a significant relationship of GSE with working at an income-generating job, STAI-I, and STAI-II was found ( p = .008, p = .040, p < .001, respectively). It was found that the puerperae who stated that they needed training on the postpartum process and baby care had high levels of fear of happiness ( p = .007). Discussion: Screening puerperae in terms of fear of happiness is important for determining their psychological well-being. Health care professionals should be aware that fear of happiness as a cultural approach negatively affects anxiety and therefore self-efficacy levels of puerperae. Providing a comprehensive training to the puerperae on parenthood and self-efficacy as well as mental health support is important for them to cope with fear of happiness.
Participant diversity in clinical trials of rehabilitation interventions for people with multiple sclerosis: A scoping review
Authors: Finlayson Marcia , Al-Mashita Leyan , Sandhu Rebekah 
Published: August 2023

Background: The selection and description of participants in clinical trials enables health care providers to determine generalizability of findings to the populations they serve. Limited diversity of participants in trials restricts evidence-based decision-making. Objectives: To determine the extent to which diverse participants are being included in clinical trials of rehabilitation interventions for people with multiple sclerosis (MS). Methods: We conducted a scoping review of MS rehabilitation trials published since January 2002 using MEDLINE, CINAHL, and Web of Science. Covidence was used to facilitate the review. Article selection required randomized control design, a rehabilitation intervention, and a functional status outcome. Data extracted included details of intervention(s), outcomes, and participant selection and description using a social determinants of health framework. Result: A total of 243 studies were included. Exercise interventions and impairment-focused outcomes were most common. Most studies used only a MS Clinic for recruitment. Common exclusion criteria were physical or mental comorbidities, disability, age, and cognitive impairment. Participant age and sex were reported for almost all trials; reporting of other social determinants of health was atypical. Conclusion: MS rehabilitation trials have used limited recruitment methods, restricted samples, and reported few participant descriptors. Changes are required to enhance participant diversity and the descriptions of participant characteristics.
Intermediate outcomes for clinical trials of multiple sclerosis rehabilitation interventions: Conceptual and practical considerations
Authors: Finlayson Marcia , Feys Peter , Dalgas Ulrik , Kos Daphne 
Published: August 2023

Background: Rehabilitation is an essential health care service and a critical component of comprehensive multiple sclerosis (MS) care. Objective: As part of a 2-day meeting hosted by the International Advisory Committee on Clinical Trials in MS in December 2022, a panel initiated a discussion on the conceptual and practical issues related to selecting intermediate outcomes for clinical trials of MS rehabilitation interventions. Results: The overarching goal of rehabilitation – optimal functioning – was acknowledged as a complex biopsychosocial phenomenon that varies with patient priorities and environmental context. This complexity means that multiple causal pathways and potential intermediate outcomes must be carefully considered during the design of clinical trials in MS rehabilitation that aim to improve functioning. In addition, practical issues must be considered such as psychometric properties of outcome measures, measure type, and characteristics of the target population, including severity of dysfunction. Conclusion: This article uses the International Classification of Functioning, Disability and Health as a foundation for determining relevant intermediate outcomes for clinical trials of MS rehabilitation interventions.
Robot-assisted pelvic and renal surgery compared with laparoscopic or open surgery: Literature review of cost-effectiveness and clinical outcomes
Authors: Davidson Thomas , Sjödahl Rune , Aldman Åke , Lennmarken Claes , Kammerlind Ann-Sofi , Theodorsson Elvar 
Published: August 2023

Background and aim: The purpose of this study was to evaluate clinical experiences and cost-effectiveness by comparing robot-assisted surgery with laparoscopic- or open surgery for pelvic and renal operations. Methods: A narrative review was carried out. Results: When using robotic-assisted surgery, oncological and functional results are similar to after laparoscopic or open surgery. One exception may be a shorter survival in cancer of the cervix uteri. In addition, postoperative complications after robotic-assisted surgery are similar, bleeding and transfusion needs are less, and the hospital stay is shorter but the preparation of the operating theater before and after surgery and the operation times are longer. Finally, robot-assisted surgery has, in several studies, been reported to be not cost-effective primarily due to high investment costs. However, more recent studies provide improved cost-effectiveness estimates due to more effective preparation of the operating theater before surgery, improved surgeon experience, and decreased investment costs. Conclusions: Complications and functional and oncological outcomes after robot-assisted surgery are similar to open surgery and laparoscopic surgery. The cost-effectiveness of robot-assisted surgery is likely to equal or surpass the alternatives.
Magnesium sulfate enhances lipopolysaccharide tolerance
Authors: Chang Ya-Ying , Jean Wei-Horng , Lu Cheng-Wei , Lin Tzu-Yu 
Published: August 2023

Introduction Lipopolysaccharide (LPS) tolerance is the downregulation of LPS signaling after pre-exposure to LPS, and it provides protection against hyperactive inflammation. Cytokine production decreases during LPS tolerance, and the phenotype of LPS-tolerant monocytes shifts toward M2 (anti-inflammatory) type. Magnesium sulfate (MgSO4) is a widely used anti-inflammatory agent. Although MgSO4 inhibits LPS signaling, the effect of MgSO4 on LPS tolerance is unknown. In the present study, we investigated the in vitro effects of MgSO4 on LPS tolerance. Methods To induce LPS tolerance, THP-1 cells were stimulated with LPS (200 ng/mL, 2 h) after pre-exposure to LPS (200 ng/mL, 24 h) with or without pre-treatment of MgSO4 (20 mM, 24 h). Results Our results revealed that MgSO4 enhanced LPS tolerance by downregulating nuclear factor-κB (NF-κB)-induced tumor necrosis factor-α or interleukin-6, and upregulating cluster of differentiation 163 (a M2-associated marker). Furthermore, the LPS-triggered upregulation of phosphoinositide 3-kinase (PI3K) was significantly increased during LPS tolerance. MgSO4 activated PI3K, but inhibited NF-κB in LPS-stimulated cells. Notably, MgSO4 mitigated the signaling of both PI3K and NF-κB in LPS-tolerant cells, suggesting the effect of MgSO4 on LPS tolerance relies on the modulation of the crosstalk between PI3K and NF-κB. Conclusion MgSO4 enhanced LSP tolerance, thus providing evidence for a novel underlying mechanism of the anti-inflammatory effects of MgSO4.
Anesthesia Workspaces for Safe Medication Practices: Design Guidelines
Authors: MohammadiGorji Soheyla , Joseph Anjali , Mihandoust Sahar , Ahmadshahi Seyedmohammad , Allison David , Catchpole Ken , Neyens David , Abernathy James H. 
Published: August 2023

Background: Studies show that workspace for the anesthesia providers is prone to interruptions and distractions. Anesthesia providers experience difficulties while performing critical medication tasks such as medication preparation and administration due to poor ergonomics and configurations of workspace, equipment clutter, and limited space which ultimately may impact patient safety, length of surgery, and cost of care delivery. Therefore, improving design of anesthesia workspace for supporting safe and efficient medication practices is paramount. Objectives: The objective of this study was to develop a set of evidence-based design guidelines focusing on design of anesthesia workspace to support safer anesthesia medication tasks in operating rooms (ORs). Methods: Data collection was based on literature review, observation, and coding of more than 30 prerecorded videos of outpatient surgical procedures to identify challenges experienced by anesthesia providers while performing medication tasks. Guidelines were then reviewed and validated using short survey. Results: Findings are summarized into seven evidence-based design guidelines, including (1) locate critical tasks within a primary field of vision, (2) eliminate travel into and through the anesthesia zone (for other staff), (3) identify and demarcate a distinct anesthesia zone with adequate space for the anesthesia provider, (4) optimize the ability to reposition/reconfigure the anesthesia workspace, (5) minimize clutter from equipment, (6) provide adequate and appropriately positioned surfaces for medication preparation and administration, and (7) optimize task and surface lighting. Conclusion: This study finds many areas for improving design of ORs. Improvements of anesthesia work area will call for contribution and cooperation of entire surgical team.
Long-Term Results of Primary Reverse Shoulder Arthroplasty for Massive, Irreparable Rotator Cuff Tears Without Glenohumeral Arthritis with a Mean Follow up of 9.4 Years
Authors: Varvitsiotis Dimitrios , Kokkineli Stefania , Feroussis Christopher , Apostolopoulos Nikos , Zakilas Dimitrios , Feroussis John 
Published: August 2023

Background The aim of this single-center study was to analyze the long-term clinical results of reverse shoulder arthroplasty in patients with massive, irreparable rotator cuff tears without glenohumeral arthritis. Methods A retrospective cohort study of 105 patients (115 shoulders) was conducted. The mean age of the patient group was 76 years (range, 65 to 87 years). The mean clinical follow-up was 9.4 years (range, 5 to 17 years). Pain, range of motion, and complication rates were analyzed pre-operatively and at the last follow-up. Results The mean Constant-Murley score increased from 29 points (range, 21 to 34 points) preoperatively to 68.1 points (range, 57 to 81 points) postoperatively (p&lt;0.05). Scapular notching was present in 50 shoulders (43.5%) and it was grade 1 or 2 in 47 of 115 cases (40.9%) and grade 3 or 4 in 3 of 115 cases (2.6%). Complications occurred in 19 patients (17%). Seven patients (6%) underwent revision surgery. The mean satisfaction rate was 94%. Conclusions Reverse shoulder arthroplasty is a viable treatment for massive, irreparable rotator cuff tears without glenohumeral arthritis with satisfactory clinical outcomes and low complication and reoperation rates with a mean follow up of 9.4 years after surgery.