bluuebunny/crossref_metadata_2025_split huggingface dataset:
UN Peacekeeping Operations in a Multipolar Era
Authors: Karlsrud John 
Published: June 2023

Abstract
How is multipolarity impacting on UN peacekeeping operations? This article sets out to answer this question by examining the ongoing decline in UN peacekeeping operations and the concurrent rise of regional and ad hoc coalitions in an era of increasing geopolitical competition. The article argues that coalitions have significantly less focus on human rights, international humanitarian law, and the protection of civilians. They thus represent a shift away from the liberal values that have marked UN peacekeeping operations, and are coherent with current geopolitical shifts where China is chipping away at human rights at the UN and African states are increasingly voicing a need for more robust operations. The article concludes that the likely outcome of these trends is a continued decline of UN multidimensional peacekeeping, but that coalitions may receive logistical and administrative support from the UN peace operations machinery.
Crucial Technologies for the Protection of Civilians by UN Peace Operations
Authors: Dorn A. Walter 
Published: June 2023

Abstract
To protect people under attack, what kinds of tools do peacekeepers need? The United Nations is gradually gaining valuable experience with sophisticated technologies for protection of civilians (POC). However, most remain underused and underevaluated, especially attack helicopters, night vision devices, and nonlethal weapons. This article presents case studies of these three crucial tools to examine their utility and to identify their shortcomings. Attack helicopters are demonstrated as a powerful through ironic symbol and an important means of robust peacekeeping in Central African Republic. Night vision devices proved essential for POC in protecting Haitians from gangs in 2007. Nonlethal weapons, like those developed on the spur of the moment in the Democratic Republic of Congo, helped the UN deal with civilian threats without recourse to lethal force. All these proven technologies have helped peace operations save lives and thus need detailed study to gain lessons. Some novel but untested technologies are also introduced, including laser signaling and digital simulation.
CONUS404: The NCAR–USGS 4-km Long-Term Regional Hydroclimate Reanalysis over the CONUS
Authors: Rasmussen R. M. , Chen F. , Liu C.H. , Ikeda K. , Prein A. , Kim J. , Schneider T. , Dai A. , Gochis D. , Dugger A. , Zhang Y. , Jaye A. , Dudhia J. , He C. , Harrold M. , Xue L. , Chen S. , Newman A. , Dougherty E. , Abolafia-Rosenzweig R. , Lybarger N. D. , Viger R. , Lesmes D. , Skalak K. , Brakebill J. , Cline D. , Dunne K. , Rasmussen K. , Miguez-Macho G. 
Published: June 2023

Abstract
A unique, high-resolution, hydroclimate reanalysis, 40-plus-year (October 1979–September 2021), 4 km (named as CONUS404), has been created using the Weather Research and Forecasting Model by dynamically downscaling of the fifth-generation European Centre for Medium-Range Weather Forecasts (ECMWF) atmospheric reanalysis of the global climate dataset (ERA5) over the conterminous United States. The paper describes the approach for generating the dataset, provides an initial evaluation, including biases, and indicates how interested users can access the data. The motivation for creating this National Center for Atmospheric Research (NCAR)–U.S. Geological Survey (USGS) collaborative dataset is to provide research and end-user communities with a high-resolution, self-consistent, long-term, continental-scale hydroclimate dataset appropriate for forcing hydrological models and conducting hydroclimate scientific analyses over the conterminous United States. The data are archived and accessible on the USGS Black Pearl tape system and on the NCAR supercomputer Campaign storage system.
Treatment outcomes of lobectomy with and without mediastinal lymph node dissection in older patients with clinical N0 non-small cell lung cancer
Authors: Fujita Tomohiro , Koyanagi Akira , Kishimoto Koji 
Published: June 2023

Background To reduce surgical stress, we omit mediastinal lymph node dissection (MLND) in patients with non-small cell lung cancer aged ≥80 years without N1 metastasis, as confirmed via surgery. This study examined the effect of MLND omission on prognosis. Methods Altogether, 212 eligible patients with clinical N0 non-small cell lung cancer underwent video-assisted thoracoscopic lobectomy between 2007 and 2017. Patients were classified into two groups as follows: patients aged 75–79 years who underwent MLND group, and patients aged ≥80 years in whom MLND was omitted (non-MLND group). Propensity score matching was performed between the two groups. Results There were 86 patients after matching. The non-MLND group showed shorter operative time (237.5 min vs. 207.5 min, p  =  0.018). No differences in postoperative complications were noted between the two groups. Between the MLND group and non-MLND group, the 5-year overall survival rates were 84.0% and 84.7% ( p  =  0.989), relapse-free survival rates were 69.8% and 74.7% ( p  =  0.855), and cancer-specific survival rates were 91.4% and 91.6% ( p  =  0.700), respectively. These results did not differ significantly. Conclusion This study demonstrated that MLND does not affect the prognosis of patients with non-small cell lung cancer aged ≥80 years. Lobectomy without MLND is one of the surgical treatment options in older patients with clinical N0 non-small cell lung cancer. Naturally, the clinical stage of patients must be carefully evaluated before surgery.
Implementing Promising Strategies to Reduce the Risk for Viral Hepatitis and Liver Cancer Among People Who Inject Drugs
Authors: Momin Behnoosh , Mezzo Jennifer , Nielsen Danielle , Richardson Ayasha , Conners Erin E. 
Published: June 2023

Purpose To describe a 3-year demonstration project with selected Centers for Disease Control and Prevention National Comprehensive Cancer Control Program (NCCCP) award recipients to build partnerships with local organizations to improve knowledge and awareness of the association between injecting drugs and the risk for viral hepatitis and liver cancer, improve delivery of viral hepatitis services, and implement comprehensive syringe services programs. Design A mixed-methods descriptive evaluation of selected evidence-based interventions or promising strategies that each award recipient implemented based on the needs of their population. Setting Selected provider and patient populations served by NCCCP award recipients in Iowa, Minnesota (American Indian Cancer Foundation), Mississippi, and West Virginia. Subjects Four award recipients that implemented individually-tailored strategies and activities. Measures Processes were assessed through monitoring and tracking tools. Challenges, lessons learned, and recommendations were collected via qualitative interviews. Analysis We used descriptive statistics to analyze quantitative data. We analyzed award recipient interviews using thematic analysis. Results Activities were implemented across four strategies. Strong public-private partnerships, ongoing technical assistance, a deep understanding of individual populations, and a shared commitment to remaining flexible were main factors. Conclusion While challenges existed, award recipients implemented key strategies and activities in their populations. Findings contribute to the scaling of best practices to the larger cancer control community especially those whose populations are at higher risk for viral hepatitis.
Optimization of Extraction Process and Anti-Hemorrhoidal Activity of Blumea lacera (Burm.f.) DC. Leaves in Croton Oil-induced Hemorrhoid Model
Authors: Dubey Tarkeshwar , Bhanukiran Kancharla , Prasad Satyendra K. , Hemalatha Siva 
Published: June 2023

Background and Objectives Blumea lacera (Burm.f.) DC. (Family—Asteraceae) is widely used for treating hemorrhoids by several ethnomedicinal practitioners and tribes in India. Thus, the main objective of the present investigation was to evaluate the potential of B. lacera leaf extract in the treatment of hemorrhoids using a croton oil-induced hemorrhoid rat model. Materials and Methods Ethanol extract of B. lacera (EBL) leaves was prepared using Soxhlet extraction, optimized using Box–Behnken design (BBD), and quantified using high-pressure liquid chromatography (HPLC). Furthermore, the vasoactive ions were estimated using ion-exchange chromatography. Hemorrhoids were induced in the recto-anal portion of experimental rats, followed by treatment with EBL (100, 200, and 400 mg/kg; par oral (p.o.)) and Pilex granules as a standard anti-hemorrhoid drug for 7 days. The anti-hemorrhoid potential was evaluated on the eighth day by assessing the severity of hemorrhoids, biochemical parameters, and histology of recto-anal tissue. Results Upon treatment with EBL and Pilex, there was a significant ( p < 0.05) reduction in the inflammatory severity index, concentration of Evans blue dye, recto-anal coefficient (RAC), elevated cytokines level, and restoration of altered antioxidant status. Furthermore, the histopathological results revealed a marked reduction in the inflammatory zones along with minimally dilated blood vessels. Conclusion The present study confirmed the traditional claims of the plant B. lacera in the treatment of hemorrhoids, which may be attributed to its anti-inflammatory and antioxidant potential in EBL, where quercetin could be considered the main contributor.
A Systematic Review of the Efficacy of Haemostatic Interventions in Primary Cleft Palate Repair
Authors: Sheil Fiachra , Theopold Christoph , Orr David J A , de Blacam Catherine 
Published: June 2023

Objective To evaluate the effectiveness of adrenaline infiltration, topical adrenaline, systemic tranexamic acid, fibrin tissue sealants and alginate-based topical coagulants at reducing blood loss and post-operative bleeding in primary cleft palate repair. Design Systematic review according to PRISMA-P guidelines, using Covidence systematic review software to facilitate 3-stage screening and data extraction by two reviewers. Setting Academic cleft surgery center. Interventions Any peri-operative intervention to reduce intra-operative and post-operative bleeding. Main Outcome Measures Estimated blood loss, rate of post-operative bleeding, rate of return to theatre for haemostasis. Results Sixteen relevant studies were identified, with a total of 1469 study participants. Nine studies examined efficacy of infiltrating vasoconstrictors and all concluded that 1:100,000–1:400,000 adrenaline infiltration reduced intra-operative blood loss, to the range of 12-60 ml. Secondary bleeding and re-operation for haemostasis were uncommon. Tranexamic acid was studied in five randomised controlled trials, two of which demonstrated a significant reduction in blood loss compared to a control group. Use of fibrin and gelatin sponge products was examined in 3 studies, all of which reported no or minimal bleeding, but did not have quantifiable outcome measures. Conclusions Infiltration with vasoconstricting agents, administration of systemic tranexamic acid and application of fibrin sealants have a well-studied and favorable safety profile in pediatric cases, and likely contribute to the relatively low incidence of post-operative bleeding and intra-operative blood loss in primary cleft palate repair.
Patency of arteriovenous fistulas and grafts for dialysis access: An analysis using the Korean National Health Insurance Service database from 2008 to 2019
Authors: Mo Hyejin , Kwon Sukyung , Kim Daehwan , Kim Ye Jee , Kim Hyangkyoung , Yang Seung Boo , Kwon Young Joo 
Published: June 2023

Background: Arteriovenous (AV) access practice and its outcomes vary internationally. To provide a better understanding of the patterns and outcomes of AV access creation, we investigated the patency and risk factors of arteriovenous fistulas (AVFs) and grafts (AVGs) as initial AV access in the Korean adult population using data from the last 10 years. Methods: The National Health Insurance Service database was queried retrospectively to identify patients undergoing hemodialysis with AVFs and AVGs as well as their clinical characteristics and outcomes from 2008 to 2019. AV access patency and its associated risk factors were evaluated. Results: During the study period, 64,179 AVFs and 21,857 AVGs were placed. The mean patient age was 62.6 ± 13.6 years (21.5% were ⩾75 years old), and 39.3% patients were women. More than half of the patients underwent AV access creation at tertiary care hospitals. At 1 year, the primary, primary assisted, and secondary patency rates were 62.2%, 80.7%, and 94.2% for AVFs, and 46.0%, 68.4%, and 86.8% for AVGs, respectively. AVG, older age, female sex, diabetes, and creation at general hospitals (vs tertiary hospitals) were associated with decreased patency outcomes (all, p < 0.05). Conclusion: This study using national data showed that three quarters of patients with AV access had AVF and AVF showed superior performance to AVG and identified several patient and center factors related to AV access patency in Korea.
ECTRIMS/EAN consensus on vaccination in people with multiple sclerosis: Improving immunization strategies in the era of highly active immunotherapeutic drugs
Authors: Otero-Romero Susana , Lebrun-Frénay Christine , Reyes Saúl , Amato Maria Pia , Campins Magda , Farez Mauricio , Filippi Massimo , Hacohen Yael , Hemmer Bernhard , Juuti Rosa , Magyari Melinda , Oreja-Guevara Celia , Siva Aksel , Vukusic Sandra , Tintoré Mar 
Published: June 2023

Background: With the new highly active drugs available for people with multiple sclerosis (pwMS), vaccination becomes an essential part of the risk management strategy Objective: To develop a European evidence-based consensus for the vaccination strategy of pwMS who are candidates for disease-modifying therapies (DMTs). Methods: This work was conducted by a multidisciplinary working group using formal consensus methodology. Clinical questions (defined as population, interventions, and outcomes) considered all authorized DMTs and vaccines. A systematic literature search was conducted and quality of evidence was defined according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. The recommendations were formulated based on the quality of evidence and the risk–benefit balance. Results: Seven questions, encompassing vaccine safety, vaccine effectiveness, global vaccination strategy and vaccination in sub-populations (pediatric, pregnant women, elderly and international travelers) were considered. A narrative description of the evidence considering published studies, guidelines, and position statements is presented. A total of 53 recommendations were agreed by the working group after three rounds of consensus. Conclusion: This first European consensus on vaccination in pwMS proposes the best vaccination strategy according to current evidence and expert knowledge, with the goal of homogenizing the immunization practices in pwMS.
One Year Outcomes of Zilver PTX Versus Eluvia for Femoropopliteal Disease in Real-World Practice: REALDES Study
Authors: Shibata Tsuyoshi , Iba Yutaka , Shingaki Masami , Yamashita Osamu , Tsubakimoto Yoshinori , Kimura Fumiaki , Hatada Atsutoshi , Kasashima Fuminori , Ueno Kyohei , Nakanishi Keitaro , Morishita Kiyofumi , Nakajima Tomohiro , Nakazawa Junji , Ohkawa Akihito , Hosaka Itaru , Arihara Ayaka , Tsushima Shingo , Kawaharada Nobuyoshi 
Published: June 2023

Purpose: This multicenter, prospective, observational study aimed to compare Zilver PTX and Eluvia stents in real-world settings for treating femoropopliteal lesions as the differences in the 1-year outcomes of these stents have not been elucidated. Materials and Methods: Overall, 200 limbs with native femoropopliteal artery disease were treated with Zilver PTX (96 limbs) or Eluvia (104 limbs) at 8 Japanese hospitals between February 2019 and September 2020. The primary outcome measure of this study was primary patency at 12 months, defined as a peak systolic velocity ratio of ≤2.4, without clinically-driven target lesion revascularization (TLR) or stenosis ≤50% based on angiographic findings. Results: The baseline clinical and lesion characteristics of Zilver PTX and Eluvia groups were roughly comparable (of all limbs analyzed, approximately 30% presented with critical limb-threatening ischemia, approximately 60% presented with Trans-Atlantic Inter-Society Consensus II C-D, and approximately half had total occlusion), except for the longer lesion lengths in the Zilver PTX group (185.7±92.0 mm vs 160.0±98.5 mm, p=0.030). The Kaplan–Meier estimates of primary patency at 12 months were 84.9% and 88.1% for Zilver PTX and Eluvia, respectively (log-rank p=0.417). Freedom from clinically-driven TLR rates were 88.8% and 90.9% for Zilver PTX and Eluvia, respectively (log-rank p=0.812). Conclusions: The results of the Zilver PTX and Eluvia stents were not different regarding primary patency and freedom from clinically-driven TLR at 12 months after treating patients with femoropopliteal peripheral artery disease in real-world settings. Clinical Impact This is the first study to reveal that the Zilver PTX and Eluvia have similar results in real-world practice when the proper vessel preparation is performed. However, the type of restenosis in the Eluvia stent may differ from that in the Zilver PTX stent. Therefore, the results of this study may influence the selection of DES for femoropopliteal lesions in routine clinical practice.
A Randomized Sham-Controlled Mixed Methods Pilot Study of the Feasibility of Acupuncture for Chemotherapy-Induced Neuropathy: Lessons Learned From Patient Experiences in Integrative Cancer Care
Authors: Lagerstedt Kristina , Efverman Anna 
Published: June 2023

Objective Since there is a lack of effective pharmacological therapies for chemotherapy-induced neuropathy and many patients ask for integrative cancer therapies such as acupuncture, the objective of this pilot study was to describe patients’ experiences, and to study the feasibility and short-term effects of genuine acupuncture for chemotherapy-induced neuropathic pain and unpleasant sensations compared to sham acupuncture. Methods: The pilot study used mixed methods, collecting quantitative and qualitative data. Patients (n = 12) with chemotherapy-induced neuropathy after colorectal cancer were blindly randomized to genuine acupuncture or telescopic sham acupuncture. Individual interviews were conducted, and were analyzed using qualitative content analysis. The patients registered pain and unpleasant sensations (100 mm Visual Analog Scales) before and after n = 120 sessions, n = 60 genuine and n = 60 sham acupuncture sessions. Results: Five categories of patient experiences were described. The neuropathy negatively affected life. Physical activity was perceived to be important for health, but neuropathy was a barrier. The neuropathy required symptom-managing strategies. Acupuncture was pleasant and valuable, but some patients presented doubts regarding its effect mechanisms. After the genuine acupuncture sessions, pain (mean −2.0 steps relief during each session) and unpleasant sensations (−2.4) in the face was reduced more than after sham acupuncture (+0.1 steps worse pain, P = .018, +0.1 steps worse unpleasant sensations, P = .036). After genuine acupuncture, unpleasant sensations in the hands were reduced less (−0.23) compared to after sham acupuncture (−5.5, P = .002). Pain or unpleasant sensations in the feet did not change. Conclusions: Patients experienced that the neuropathy negatively changed their life and that acupuncture was pleasant and valuable. Patients receiving genuine acupuncture had short-term effects regarding pain and unpleasant sensations in the face compared to patients receiving sham acupuncture, while hands and feet did not improve. The patients were successfully blinded and complied with the acupuncture. We welcome future full-scaled randomized sham-controlled acupuncture studies.
Learning Curve of Thoracoscopic Nonrobotic Harvest of the Left Internal Mammary Artery in Minimally Invasive Coronary Artery Bypass Grafting
Authors: Akca Ferdi , ter Woorst Joost 
Published: June 2023

Objective: Harvest of the left internal mammary artery (LIMA) is a technically demanding element of minimally invasive coronary surgery. We aimed to evaluate the learning curve of thoracoscopic, nonrobotic LIMA harvest during endoscopic coronary artery bypass (Endo-CAB) surgery. Methods: Eighty patients undergoing Endo-CAB surgery were included. LIMA harvest was performed using commonly available video-assisted thoracoscopic instruments. Time from incision until heparin administration was defined as total LIMA harvest time (this includes opening of the pericardium and identification of coronary targets). LIMA harvest times ( N = 80) and total procedure times for single-vessel grafting ( n = 51) were analyzed. Results: The mean LIMA harvest time was 58 ± 19 min, ranging from 15 to 113 min. The mean procedure time was 150 ± 39 min. Significant reductions in both LIMA harvest and total Endo-CAB procedure times were observed with increasing experience (logarithmic regression Y = 109 − 14.9*log(x), P < 0.001; Y = 227 − 24.4*log(x), P < 0.001, respectively). No damage to the LIMA occurred during thoracoscopic harvesting. Conclusions: Total thoracoscopic (nonrobotic) LIMA harvest is an efficient technique with a steep learning curve using routine instruments. More patients might benefit from minimally invasive coronary surgery using thoracoscopic LIMA harvest techniques.
Giant renal angiomyolipomas – Can they be managed safely through minimally invasive selective angioembolisation? Case series and literature review
Authors: Combes Alexander , Palma Catalina Alejandra , March Brayden , Eisinger David , Waugh Richard 
Published: June 2023

Objective: The objective was to determine whether giant renal angiomyolipomas (AMLs) can be managed through selective angioembolisation (SA) and compare outcomes to nephron-sparing surgery (NSS) and nephrectomy. Methods: A retrospective case series was compiled from a prospectively maintained database, commenced in 2011 of renal AMLs that underwent SA. We extracted patient demographics, size of AMLs, intervention and outcomes. A literature review of case reports and case series was performed on the management of giant renal AMLs managed through SA, NSS or nephrectomy. Results: Of 30 AMLs that underwent SA, 6 patients met the inclusion criteria. The mean diameter of AMLs prior to embolisation was 14.3 cm. All embolised AMLs decreased in size post-embolisation by an average of 18% (mean: 39-month follow-up). There were no complications in our cohort’s follow-up period, including no rise in any patients’ creatinine associated with SA. Our literature review of 284 articles found 82 articles pertaining to 102 giant renal AMLs. Our review identified SA, NSS and nephrectomy to all be effective management pathways for giant AMLs with minimal complications. Total nephrectomy did result in five patients requiring dialysis post-procedure. Conclusions: SA is an effective intervention for giant AMLs with comparable outcomes to NSS and nephrectomy and should be considered a suitable management option for giant renal AMLs. Level of evidence: Not applicable