bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sea Turtles Protection in Southeast Asia: Linkages and Role of Soft Law Instruments in the Implementation of the Law of the Sea Convention
Authors: Liliansa Dita 
Published: October 2022

Abstract
This article investigates the role of regional soft law instruments in the implementation of international obligations for the protection of the marine environment through a case study on the protection of endangered sea turtles and their habitats in Southeast Asia. It explores six non-binding instruments adopted within and beyond the aegis of the Association of Southeast Asian Nations. It assesses the extent to which they provide the means to implement international obligations under the United Nations Convention for the Law of the Sea (LOSC). It concludes that these instruments demonstrate a dual role in the implementation of the LOSC: not only can they be key considerations in determining whether States have implemented their duty to cooperate, they can also guide the interpretation of the duty to act with due diligence to protect endangered sea turtles and their habitats.
Transforming Mathematics Instruction Via Primary Historical Sources: A Study of Influential Factors on Implementation of a Curricular Innovation at the Tertiary Level
Authors: Barnett Janet Heine , Clark Kathleen Michelle , Can Cihan 
Published: October 2022

Abstract
The TRansforming Instruction in Undergraduate Mathematics via Primary Historical Sources (TRIUMPHS) project is producing primary source projects (PSPs) for use in teaching core topics from the tertiary mathematics curriculum and investigating the resulting teaching and learning experiences. This article examines factors related to attributes of PSPs, TRIUMPHS’ dissemination and implementation support strategies, and characteristics of individual instructors that have influenced the incorporation of PSPs into their ordinary practice via case studies representative of two types of end users: those who have thus far limited their PSP usage to a single course and those for whom PSP usage has permeated their instructional practice. Findings affirm that pedagogical orientations within individuals’ instructional practices were critical to both initial use and eventual adoption of PSPs, while the observed differences in usage patterns between the cases were influenced by the perceived relative advantages offered by the core features of PSPs and individuals’ intrinsic motivation.
The impact sheet to this article can be accessed at 10.6084/m9.figshare.21205292.
Scheme Design and Pressure-Retaining Performance Analysis of Macrobiological Sampler in the Full-Ocean-Depth Operating Environment
Authors: Liu Guangping , Jin Yongping , Peng Youduo , Liu Deshun , Liu Liang 
Published: October 2022

AbstractA new full-ocean-depth macroorganisms pressure-retaining sampler (FMPS) was designed to collect pressure-retaining macroorganisms samples from the abyssal seafloor. A mathematical model for pressure compensation in the FMPS recovery process was developed. The effects of FMPS structural parameters, pressure compensator structural parameters, and sampling environment on the pressure retention performance of FMPS were analyzed. Using the developed FMPS engineering prototype, FMPS internal pressure test, high-pressure chamber simulation sampling, and pressure-retaining test was carried out. The test results show that the key components of FMPS can carry 115 MPa pressure, FMPS can complete the sampling action in the high-pressure chamber of 115 MPa, the pressure is maintained at 105.5 MPa, and the pressure drop rate (ratio of pressure drop during FMPS recovery to sampling point pressure) is 9.13%; the experimental results are consistent with the theoretical calculation. The test verified the feasibility of FMPS design and the reliability of pressure retention, providing a theoretical basis and technical support for the design and manufacture of full-ocean-depth sampling devices.
Does Climate Change Constitute a Financial Risk to Foreign Direct Investment? An Empirical Analysis on 200 Countries from 1970 to 2020
Authors: Ait Soussane Jihad , Mansouri Dalal , Fakhouri Mohamed Yassine , Mansouri Zahra 
Published: October 2022

Abstract
In this paper, we study the role of climate change as a financial risk for foreign investors. Multinational enterprises seek to internationalize where financial risk is at the minimum level, including the climate change risk on profitability and productivity. Thereby, we conducted an empirical analysis of the effect of climate change on inward foreign direct investment (FDI) net inflows using data from 200 countries and times series from 1970 to 2020 and employing two categories of climate change indicators: Climatology and climate-related natural hazards. Using the estimation methods of fully modified ordinary least squares and robust weighted least squares, we concluded that the rise of climatology indicators (mean annual temperature and precipitations) negatively impacts inward FDI. Second, we conclude that most climate-related natural hazards (coastal/rural/urban floods, landslides, and cyclones) deter FDI while extreme heat and wildfires show no significant effect. In addition, the results show that the negative impact of climate change is more severe when the host economy depends on agricultural activities and there is no significant investment in research and development as compared with countries that depend on service and manufacturing activities and are more innovative and invest in technology infrastructure. Furthermore, we conclude that poorer host countries experience more severe effects of climate change on FDI than rich countries in terms of GDP per capita.

Significance Statement
The purpose of the paper is to investigate the effect of climate change on inflows of cross-border capital in 200 countries. In other words, we see if rising temperature and natural hazards related to climate change affect the decision of firms to invest in a given country. The results show that global warming and unstable meteorological indicators deter firms from investing abroad. Equally, natural hazards linked to climate change (coastal/rural/urban floods, landslides, and cyclones) constitute an investment risk. The finding suggests that the deterring effects of climate change are less severe when a given country depends less on agriculture and more on industrial sectors and when that country is more developed and technologically advanced.
Ultrasound patterns of venous disease in patients with venous leg ulcers and morbid obesity
Authors: Moss Jana-Lee , Pugliese Matthew , Richards Toby 
Published: October 2022

Background/Aims Obesity affects over two-thirds of the Australian population and is associated with increased risk of venous leg ulceration (VLU). Management is challenging to both patients and staff. Surgical treatment of superficial venous incompetence in patients with VLU reduces ulcer healing time and recurrence, but this has not yet been investigated in patients with obesity. We aimed to determine in patients with VLU and morbid obesity if their ultrasound pattern of superficial venous incompetence was like those patients without morbid obesity. Methods Consecutive patients attending the outpatient leg ulcer clinic from January to December 2019 were eligible for inclusion if they had an active or healed VLU. Age, gender, BMI, and ulcer sidedness were collected from the electronic medical record and assessed against findings of venous duplex ultrasound. Primary outcome was the proportion of patients with morbid obesity with superficial venous incompetence. Secondary outcomes included the proportion of patients with morbid obesity who were investigated with a duplex ultrasound, and any presence of deep venous incompetence. Results Of 231 patients that attended 156 were eligible for inclusion. 103 patients had full data and were used for the primary outcome analysis. There were 29 patients (28.2%) with morbid obesity. They were younger than those without morbid obesity (69.0 vs 73.0 years, p .026) with no difference in gender, active or healed ulcer classification (CEAP C5/6), or ulcer sidedness. We found no difference in the proportion of patients with morbid obesity with superficial venous incompetence on ultrasound (72.4% vs 79.7%, p.423). Patients with morbid obesity were equally as likely to undergo ultrasound investigation (73.2% vs 75.8%, p.748). Conclusions In patients with VLU there appeared no difference in the proportion of patients with morbid obesity with superficial venous incompetence. Directed studies are needed to determine the effectiveness of intervention in this patient population.
Analytical Frameworks and Outcome Measures in Economic Evaluations of Digital Health Interventions: A Methodological Systematic Review
Authors: Benedetto Valerio , Filipe Luís , Harris Catherine , Spencer Joseph , Hickson Carmel , Clegg Andrew 
Published: October 2022

Background Digital health interventions (DHIs) can improve the provision of health care services. To fully account for their effects in economic evaluations, traditional methods based on measuring health-related quality of life may not be appropriate, as nonhealth and process outcomes are likely to be relevant too. Purpose This systematic review identifies, assesses, and synthesizes the arguments on the analytical frameworks and outcome measures used in the economic evaluations of DHIs. The results informed recommendations for future economic evaluations. Data Sources We ran searches on multiple databases, complemented by gray literature and backward and forward citation searches. Study Selection We included records containing theoretical and empirical arguments associated with the use of analytical frameworks and outcome measures for economic evaluations of DHIs. Following title/abstract and full-text screening, our final analysis included 15 studies. Data Extraction The arguments we extracted related to analytical frameworks (14 studies), generic outcome measures (5 studies), techniques used to elicit utility values (3 studies), and disease-specific outcome measures and instruments to collect health states data (both from 2 studies). Data Synthesis Rather than assessing the quality of the studies, we critically assessed and synthesized the extracted arguments. Building on this synthesis, we developed a 3-stage set of recommendations in which we encourage the use of impact matrices and analyses of equity impacts to integrate traditional economic evaluation methods. Limitations Our review and recommendations explored but not fully covered other potentially important aspects of economic evaluations that were outside our scope. Conclusions This is the first systematic review that summarizes the arguments on how the effects of DHIs could be measured in economic evaluations. Our recommendations will help design future economic evaluations. Highlights Using traditional outcome measures based on health-related quality of life (such as the quality-adjusted life-year) may not be appropriate in economic evaluations of digital health interventions, which are likely to trigger nonhealth and process outcomes. This is the first systematic review to investigate how the effects of digital health interventions could be measured in economic evaluations. We extracted and synthesized different arguments from the literature, outlining advantages and disadvantages associated with different methods used to measure the effects of digital health interventions. We propose a methodological set of recommendations in which 1) we suggest that researchers consider the use of impact matrices and cost-consequence analysis, 2) we discuss the suitability of analytical frameworks and outcome measures available in economic evaluations, and 3) we highlight the need for analyses of equity impacts.
Soft tissue sarcoma: intravoxel incoherent motion and diffusion kurtosis imaging parameters correlate with the histological grade and Ki-67 expression
Authors: Li Xiangwen , Tao Juan , Zhu Yifeng , Yin Zhenzhen , Zhang Yu , Wang Shaowu 
Published: October 2022

Background Accurate prediction of the histological grade and Ki-67 expression of soft tissue sarcoma (STS) before surgery is essential for the subsequent diagnosis, treatment, and prognostic evaluation of patients. Purpose To evaluate intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) in predicting the histological grade and Ki-67 expression of STS. Material and Methods A total of 40 patients underwent 3-T MRI, including conventional sequences; IVIM and DKI parameters were obtained. All patients were divided into a low-grade (grade 1 and grade 2) group and a high-grade (grade 3) group through pathological analysis. Ki-67 expression of each lesion was calculated. Chi-square test, independent sample t-test, Mann–Whitney U test, Pearson, Spearman, and receiver operating characteristic curve analysis were performed. Results There were 17 patients in the low-grade group and 23 in the high-grade group. Ki-67 expression was in the range of 10%–80%. D value was inversely correlated with Ki-67 expression. MK value showed a moderate positive correlation with Ki-67 expression. Regarding histological grading, only the peritumoral enhancement was statistically different between low- and high-grade STS on conventional MRI ( P=0.024). The high-grade group had significantly higher MK value and lower D and MD value than the low-grade group. MK value showed the best diagnostic performance. The combination of MK and MD yielded the highest specificity (88.24%), and the combination of D, MK, and MD yielded the best area under the curve value (0.841) and sensitivity (95.65%). Conclusion IVIM and DKI parameters were correlated with Ki-67 expression and could help differentiate between low- and high-grade STS.
Predictors of carbapenem-resistant Enterobacteriaceae (CRE) strains in patients with COVID-19 in the ICU ward: a retrospective case–control study
Authors: Vlad Nicoleta-Dorina , Cernat Roxana Carmen , Carp Sorina , Mitan Romelia , Dumitru Andrei , Nemet Codruța , Voidăzan Septimiu , Rugină Sorin , Dumitru Irina-Magdalena 
Published: October 2022

Objective To identify carbapenem-resistant Enterobacteriaceae (CRE) in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) and to determine whether they had different risk factors for the acquisition of CRE than patients without COVID-19. Methods This retrospective single-centre, case–control study enrolled patients with and without COVID-19. The demographic, clinical, infection, colonization and mortality data were compared between the two groups. Results A total of 38 patients with COVID-19 and 26 patients without COVID-19 were enrolled. The majority of isolates detected in COVID-19 patients were Klebsiella spp. Leukopenia at admission (odds ratio [OR] 4.70; 95% confidence interval [CI] 1.37, 16.10), invasive mechanical ventilation (OR 5.74; 95% CI 1.07, 30.63), carbapenem treatment (OR 5.09; 95% CI 1.21, 21.27) and corticosteroid treatment (OR 7.06; 95% CI 1.53, 32.39) were independent risk factors for CRE acquisition in COVID-19 patients. Intensive care unit (ICU) mortality was significantly higher in COVID-19 patients compared with patients without COVID-19 (OR 20.62; 95% CI 5.50, 77.23). Length of ICU stay increased the risk of death in patients with COVID-19 (subdistribution hazard ratio 3.81; 95% CI 1.33, 10.92). Conclusion CRE strains were more common in patients with COVID-19 and they had different risks for CRE compared with patients without COVID-19.
Moral distress to moral success: Strategies to decrease moral distress
Authors: Semler Lindsay R. 
Published: October 2022

Background: Moral distress, which is especially high in critical care nurses, has significant negative implications for nurses, patients, organizations, and healthcare as a whole. Aim: A moral distress workshop and follow-up activities were implemented in an intensive care unit in order to decrease levels of moral distress and increase nurses’ perceived comfort and confidence in ethical decision-making. Design: A quality improvement (QI) initiative was conducted using a pre- and post-intervention design. The program consisted of a four-hour interactive workshop, followed by two individual self-reflection activities at 2–3 weeks and 5–6 weeks after the workshop. Participants: Critical care nurses working in a heart and vascular intensive care unit at a large academic medical center. Ethical Considerations: This study was deemed to be a QI project by the institution’s Institutional Review Board. Participation was voluntary. Findings: Nurses experienced a significant decrease in moral distress. The participants’ average ethical confidence increased in four areas (ability to identify the conflicting values at stake, knowing role expectations, feeling prepared to resolved ethical conflict, and being able to do the right thing), with knowledge of role expectations and feeling prepared to resolve ethical conflict yielding statistically significant increases. Qualitative findings resulted in consistent themes related to causes of moral distress and ways nurses approached addressing moral distress. Discussion: This study reinforces previous evidence on moral distress and its causes in critical care nurses, and provides a mechanism for improving moral distress and ethical confidence. Conclusions: This QI study demonstrates the effectiveness of an evidence-based program for decreasing critical care nurses’ moral distress and increasing their ethical confidence. The strategies described in this paper can replicated by nursing leaders who wish to effect change at their local level, or adapted and expanded to other professions and clinical care units.
Double distress: women healthcare providers and moral distress during COVID-19
Authors: Smith Julia , Korzuchowski Alexander , Memmott Christina , Oveisi Niki , Tan Heang-Lee , Morgan Rosemary 
Published: October 2022

Background: COVID-19 pandemic has led to heightened moral distress among healthcare providers. Despite evidence of gendered differences in experiences, there is limited feminist analysis of moral distress. Objectives: To identify types of moral distress among women healthcare providers during the COVID-19 pandemic; to explore how feminist political economy might be integrated into the study of moral distress. Research Design: This research draws on interviews and focus groups, the transcripts of which were analyzed using framework analysis. Research Participants and Context: 88 healthcare providers, based in British Columbia Canada, participated virtually. Ethical Considerations: The study received ethical approval from Simon Fraser University. Findings: Healthcare providers experienced moral dilemmas related to ability to provide quality and compassionate care while maintaining COVID-19 protocols. Moral constraints were exacerbated by staffing shortages and lack of access to PPE. Moral conflicts emerged when women tried to engage decision-makers to improve care, and moral uncertainty resulted from lack of clear and consistent information. At home, women experienced moral constraints related to inability to support children’s education and wellbeing. Moral conflicts related to lack of flexible work environments and moral dilemmas developed between unpaid care responsibilities and COVID-19 risks. Women healthcare providers resisted moral residue and structural constraints by organizing for better working conditions, childcare, and access to PPE, engaging mental health support and drawing on professional pride. Discussion: COVID-19 has led to new and heightened experiences of moral distress among HCP in response to both paid and unpaid care work. While many of the experiences of moral distress at work were not explicitly gendered, implicit gender norms structured moral events. Women HCP had to take it upon themselves to organize, seek out resources, and resist moral residue. Conclusion: A feminist political economy lens illuminates how women healthcare providers faced and resisted a double layering of moral distress during the pandemic.
Clinical and Neuroimaging Profile of Neonates With Moderate-to-Severe Encephalopathy Treated With Therapeutic Hypothermia
Authors: Diggikar Shivashankar , Venkatagiri Praveen , Kulkarni Srikanth , Sharma Deepa , Chandra Prathap 
Published: October 2022

Objective: To demonstrate the clinical and neuroimaging profile of infants with moderate-to-severe encephalopathy after therapeutic hypothermia (TH) in the Indian setting. The secondary objective was to determine the logistics involved in performing neuroimaging in these infants. Design and Setting: A retrospective descriptive study in 2 tertiary centers. Methods: All infants who underwent cooling in both centers from January 2019 to December 2019 were included. Demographic data, details of cooling, clinical and neuroimaging profile (magnetic resonance imaging [MRI] and magnetic resonance spectroscopy [MRS]), and details of the logistics involved in performing the imaging (sedation, neonatal transport, personnel, distance traveled, and time taken) were collected and analyzed. Results: A total of 44 infants were enrolled of which 37 (84.0%) underwent both TH and neuroimaging (MRI and MRS). A total of 33 (75.0%) of infants were outborn, 20 (45.5%) of them had sentinel events before delivery and 17 (38.6%) were intubated at birth. Apgar score <5 min was seen in 8 (18.2%) and seizures in 23 (52.3%) of infants. A total of 37 (84.1%) survived until discharge and underwent neuroimaging. Neuroimaging was performed between 5 and 14 days after birth. The most common abnormal finding on MRI brain was the signal changes in watershed areas of brain 8 (18.2%) and on MRS was low N-acetyl aspartate and high lactate 13 (29.5%). Midazolam (68.2%) and Triclofos (15.2%) were the sedatives used during neuroimaging these infants. Conclusion: TH for infants with neonatal encephalopathy resulted in excellent survival outcomes in tertiary private sector hospitals.
No Difference in Two-Year Revisions Between Hybrid Fusion and Two-Level Anterior Discectomy and Fusion: A National Database Study
Authors: Raso Jon , Kamalapathy Pramod N. , Mo Kevin , Labaran Lawal , Wang Jesse , Solomon Eric , Hassanzadeh Hamid 
Published: October 2022

Study Design Retrospective Cohort Objective This study utilized a large national database to compare two-year revision rates, in addition to complications and costs, of hybrid surgery (HS) compared to two-level anterior cervical discectomy and fusion (ACDF). Methods This study used the PearlDiver Mariner dataset selecting for patients aged 18 and older who had at least 90-day active longitudinal follow-up who underwent two-level ACDF or two-level Hybrid surgery (single level ACDF and single level CDA). Patients with prior spinal trauma, infection, cancer, or posterior fusion were excluded. Primary outcomes measures were 90-day major and minor medical complications, ED visits, readmissions, as well as two-year revisions. Patients were also assessed for postoperative dysphagia, incidental durotomy, vascular injury, 90-day surgical site, and implant complications. Additionally, hospitalization and postoperative costs were evaluated. Results There were 4570 two-level ACDF surgeries and 888 hybrid surgeries. After matching the cohorts, no statistical differences in demographics were found. There were no differences in reoperation rates at all measured time points nor 2-year complications. HS had a lower incidence of major (1.6% vs 3.1%, P = .003) and minor complications (3.0% vs 4.6%, P = .009) than ACDF. 90-day readmission was lower in the HS cohort (2.8% vs 4.2%), P = .024. HS was associated with reduced hospitalization costs -$2614 (-$3916 to -$904, P < .001). 3516 patients had ACDF, and 699 had HS with at least 2 years of follow-up. Conclusion Hybrid surgery is a safe and effective surgical treatment for cervical disease in appropriately selected patients.