bluuebunny/crossref_metadata_2025_split huggingface dataset:
SELF-ADMINISTRATION OR PRACTITIONER ADMINISTRATION? THE SCOPE OF FUTURE GERMAN ASSISTED DYING LEGISLATION
Authors: Braun Kerstin 
Published: September 2022

Abstract
In 2020, the German Federal Constitutional Court declared unconstitutional and void a 2015 criminal law penalising suicide assistance in a recurring fashion and called into existence a right to a self-determined death, including the use of suicide services, where available. Due to subsequent legislative inaction, no holistic assisted dying legislation offering protection for vulnerable individuals is currently in place in Germany. Calls have been made for law reform in this area. This article contemplates the possible scope of a future assisted dying framework in Germany. It does so by focusing on the method of administration and analyses whether such a framework should be limited to allowing eligible persons to self-administer relevant lethal medications, which have been prescribed to them by a medical practitioner or whether, and to what extent, practitioners should be able to administer relevant lethal substances to patients. This is comparatively analysed while also keeping in mind any stipulations made by the German Constitutional Court in its 2020 judgment on the requirements of future assisted dying legislation. The article concludes that an assisted dying framework allowing a free choice between self and practitioner administration in Germany best complies with the guidance provided by the Constitutional Court.
Ion acceleration in Mars’ twisted magnetotail
Authors: Curry Shannon M , Tatum P , Mitchell D , Luhmann J G , McFadden J , Ruhunusiri S , DiBraccio G , Ramstad R , Xu S 
Published: September 2022

ABSTRACT
Mars lacks a global magnetic field and instead has a unique, ‘hybrid’ magnetosphere composed of crustal magnetic fields, which are stronger in the Southern hemisphere than the Northern hemisphere. These crustal fields are believed to drive a twist in the magnetotail at Mars. This is important because heavy ions escape from this induced magnetotail, which is a major source of atmospheric erosion. We present analysis of heavy ions produced in Mars’ upper atmosphere that are transported downtail along the twisted current sheet and observed by the Mars Atmosphere and Volatile EvolutioN (MAVEN) mission. We identified O+, O$_2\, ^+$, and CO$_2\, ^+$ being accelerated to different energies at a range of distances downtail and found that heavy ions in the 10–50 eV energy population have the highest flux. We present tail slices of ion fluxes for different interplanetary magnetic field (IMF) configurations based on the BY component of the IMF and find that the different configurations affect the degree of tail twist and the transport of heavy ions in the induced magnetotail lobes. We find that the total escape rate for O+, O$_2\, ^+$, and CO$_2\, ^+$ is 5.5e24 s-1, with 50% escaping between 2–200 eV.
Potential roles of dietary zeaxanthin and lutein in macular health and function
Authors: Li Xiang , Holt Roberta R , Keen Carl L , Morse Lawrence S , Zivkovic Angela M , Yiu Glenn , Hackman Robert M 
Published: September 2022

Abstract
Lutein, zeaxanthin, and meso-zeaxanthin are three xanthophyll carotenoid pigments that selectively concentrate in the center of the retina. Humans cannot synthesize lutein and zeaxanthin, so these compounds must be obtained from the diet or supplements, with meso-zeaxanthin being converted from lutein in the macula. Xanthophylls are major components of macular pigments that protect the retina through the provision of oxidant defense and filtering of blue light. The accumulation of these three xanthophylls in the central macula can be quantified with non-invasive methods, such as macular pigment optical density (MPOD). MPOD serves as a useful tool for assessing risk for, and progression of, age-related macular degeneration, the third leading cause of blindness worldwide. Dietary surveys suggest that the dietary intakes of lutein and zeaxanthin are decreasing. In addition to low dietary intake, pregnancy and lactation may compromise the lutein and zeaxanthin status of both the mother and infant. Lutein is found in modest amounts in some orange- and yellow-colored vegetables, yellow corn products, and in egg yolks, but rich sources of zeaxanthin are not commonly consumed. Goji berries contain the highest known levels of zeaxanthin of any food, and regular intake of these bright red berries may help protect against the development of age-related macular degeneration through an increase in MPOD. The purpose of this review is to summarize the protective function of macular xanthophylls in the eye, speculate on the compounds’ role in maternal and infant health, suggest the establishment of recommended dietary values for lutein and zeaxanthin, and introduce goji berries as a rich food source of zeaxanthin.
Access to and Affordability of World Health Organization Essential Medicines for Cancer in Sub-Saharan Africa: Examples from Kenya, Rwanda, and Uganda
Authors: Kizub Darya A , Naik Sachin , Abogan Ayokunle A , Pain Debanjan , Sammut Stephen , Shulman Lawrence N , Martei Yehoda M 
Published: September 2022

AbstractBackgroundCancer mortality is high in sub-Saharan Africa (SSA), partly due to inadequate treatment access. We explored access to and affordability of cancer treatment regimens for the top 10 cancers utilizing examples from Kenya, Uganda, and Rwanda.Materials and MethodsPopulation, healthcare financing, minimum wage, and cancer incidence and mortality data were obtained from the WHO, World Bank, public sources, and GLOBOCAN. National Essential Medicines List (NEML) alignment with 2019 WHO EML was assessed as a proportion. Cancer regimen pricing was calculated using public and proprietary sources and methods from prior studies. Affordability through universal healthcare coverage (UHC) was assessed as 1-year cost &lt;3× gross national income per capita; and to patients out-of-pocket (OOP), as 30-day treatment course cost &lt;1 day of minimum wage work.ResultsA total of 93.4% of the WHO EML cancer medicines were listed on the 2019 Kenya NEML, and 70.5% and 41.1% on Uganda (2016) and Rwanda (2015) NEMLs, respectively. Generic chemotherapies were available and affordable to governments through UHC to treat non-Hodgkin’s lymphoma, cervical, breast, prostate, colorectal, ovarian cancers, and select leukemias. Newer targeted agents were not affordable through government UHC purchasing, while some capecitabine-based regimens were not affordable in Uganda and Rwanda. All therapies were not affordable OOP.ConclusionAll cancer treatment regimens were not affordable OOP and some were not covered by governments. Newer targeted drugs were not affordable to all 3 governments. UHC of cancer drugs and improving targeted therapy affordability to LMIC governments in SSA are key to improving treatment access and health outcomes.
Comparison of cytokine mediators in type 2 inflammatory conditions on the skin and ocular surface
Authors: Chen Jamie , Bielory Leonard 
Published: September 2022

Purpose of review
As the conjunctiva is embryologically modified skin, ocular surface involvement can be observed in several atopic skin diseases. The purpose of this review is to highlight and compare the roles of type 2 cytokines in the skin and ocular surface, and their resulting disorders.

Recent findings
Although there have been extensive studies identifying various type 2 cytokine pathways in the skin, there is limited analyses of pathways assessed on the ocular surface. We provide the potential overlapping cytokine impacts on the skin and eye including interleukin (IL)-4, IL-5 IL-13, IL-25, IL-33, thymic stromal lymphopoietin (TSLP), and IL-31 that may provide important immunomodulatory interventions and treatment for the more chronic and sight-threatening ocular disorders.

Summary
Dysregulation of type 2 inflammatory cytokines was found to elicit similar immunopathogenic responses on the skin and ocular surfaces, leading to barrier dysfunction, remodeling, immune cell recruitment, and symptoms such as pruritus.
Predicting Time to Death After Withdrawal of Life-Sustaining Treatment in Children
Authors: Winter Meredith C. , Ledbetter David R. 
Published: September 2022

OBJECTIVES:
Accurately predicting time to death after withdrawal of life-sustaining treatment is valuable for family counseling and for identifying candidates for organ donation after cardiac death. This topic has been well studied in adults, but literature is scant in pediatrics. The purpose of this report is to assess the performance and clinical utility of the available tools for predicting time to death after treatment withdrawal in children.

DATA SOURCES:
Terms related to predicting time to death after treatment withdrawal were searched in PubMed and Embase from 1993 to November 2021.

STUDY SELECTION:
Studies endeavoring to predict time to death or describe factors related to time to death were included. Articles focusing on perceptions or practices of treatment withdrawal were excluded.

DATA EXTRACTION:
Titles, abstracts, and full text of articles were screened to determine eligibility. Data extraction was performed manually. Two-by-two tables were reconstructed with available data from each article to compare performance metrics head to head.

DATA SYNTHESIS:
Three hundred eighteen citations were identified from the initial search, resulting in 22 studies that were retained for full-text review. Among the pediatric studies, predictive models were developed using multiple logistic regression, Cox proportional hazards, and an advanced machine learning algorithm. In each of the original model derivation studies, the models demonstrated a classification accuracy ranging from 75% to 91% and positive predictive value ranging from 0.76 to 0.93.

CONCLUSIONS:
There are few tools to predict time to death after withdrawal of life-sustaining treatment in children. They are limited by small numbers and incomplete validation. Future work includes utilization of advanced machine learning models.
Complications Associated With Venovenous Extracorporeal Membrane Oxygenation—What Can Go Wrong?
Authors: Teijeiro-Paradis Ricardo , Gannon Whitney D. , Fan Eddy 
Published: September 2022

OBJECTIVES:
Despite increasing use and promising outcomes, venovenous extracorporeal membrane oxygenation (V-V ECMO) introduces the risk of a number of complications across the spectrum of ECMO care. This narrative review describes the variety of short- and long-term complications that can occur during treatment with ECMO and how patient selection and management decisions may influence the risk of these complications.

DATA SOURCES:
English language articles were identified in PubMed using phrases related to V-V ECMO, acute respiratory distress syndrome, severe respiratory failure, and complications.

STUDY SELECTION:
Original research, review articles, commentaries, and published guidelines from the Extracorporeal Life support Organization were considered.

DATA EXTRACTION:
Data from relevant literature were identified, reviewed, and integrated into a concise narrative review.

DATA SYNTHESIS:
Selecting patients for V-V ECMO exposes the patient to a number of complications. Adequate knowledge of these risks is needed to weigh them against the anticipated benefit of treatment. Timing of ECMO initiation and transfer to centers capable of providing ECMO affect patient outcomes. Choosing a configuration that insufficiently addresses the patient’s physiologic deficit leads to consequences of inadequate physiologic support. Suboptimal mechanical ventilator management during ECMO may lead to worsening lung injury, delayed lung recovery, or ventilator-associated pneumonia. Premature decannulation from ECMO as lungs recover can lead to clinical worsening, and delayed decannulation can prolong exposure to complications unnecessarily. Short-term complications include bleeding, thrombosis, and hemolysis, renal and neurologic injury, concomitant infections, and technical and mechanical problems. Long-term complications reflect the physical, functional, and neurologic sequelae of critical illness. ECMO can introduce ethical and emotional challenges, particularly when bridging strategies fail.

CONCLUSIONS:
V-V ECMO is associated with a number of complications. ECMO selection, timing of initiation, and management decisions impact the presence and severity of these potential harms.
Distribution of ventilation and oxygenation in surgical obese patients ventilated with high versus low positive end-expiratory pressure
Authors: Ellenberger Christoph , Pelosi Paolo , de Abreu Marcelo Gama , Wrigge Hermann , Diaper John , Hagerman Andres , Adam Yannick , Schultz Marcus J. , Licker Marc 
Published: September 2022

BACKGROUND
Intra-operative ventilation using low/physiological tidal volume and positive end-expiratory pressure (PEEP) with periodic alveolar recruitment manoeuvres (ARMs) is recommended in obese surgery patients.

OBJECTIVES
To investigate the effects of PEEP levels and ARMs on ventilation distribution, oxygenation, haemodynamic parameters and cerebral oximetry.

DESIGN
A substudy of a randomised controlled trial.

SETTING
Tertiary medical centre in Geneva, Switzerland, between 2015 and 2018.

PATIENTS
One hundred and sixty-two patients with a BMI at least 35 kg per square metre undergoing elective open or laparoscopic surgery lasting at least 120 min.

INTERVENTION
Patients were randomised to PEEP of 4 cmH2O (n = 79) or PEEP of 12 cmH2O with hourly ARMs (n = 83).

MAIN OUTCOME MEASURES
The primary endpoint was the fraction of ventilation in the dependent lung as measured by electrical impedance tomography. Secondary endpoints were the oxygen saturation index (SaO2/FIO2 ratio), respiratory and haemodynamic parameters, and cerebral tissue oximetry.

RESULTS
Compared with low PEEP, high PEEP was associated with smaller intra-operative decreases in dependent lung ventilation [-11.2%; 95% confidence interval (CI) -8.7 to -13.7 vs. -13.9%; 95% CI -11.7 to -16.5; P = 0.029], oxygen saturation index (-49.6%; 95% CI -48.0 to -51.3 vs. -51.3%; 95% CI -49.6 to -53.1; P < 0.001) and a lower driving pressure (-6.3 cmH2O; 95% CI -5.7 to -7.0). Haemodynamic parameters did not differ between the groups, except at the end of ARMs when arterial pressure and cardiac index decreased on average by -13.7 mmHg (95% CI -12.5 to -14.9) and by -0.54 l min-1 m-2 (95% CI -0.49 to -0.59) along with increased cerebral tissue oximetry (3.0 and 3.2% on left and right front brain, respectively).

CONCLUSION
In obese patients undergoing abdominal surgery, intra-operative PEEP of 12 cmH2O with periodic ARMs, compared with intra-operative PEEP of 4 cmH2O without ARMs, slightly redistributed ventilation to dependent lung zones with minor improvements in peripheral and cerebral oxygenation.

TRIAL REGISTRATION
NCT02148692, https://clinicaltrials.gov/ct2
Impact of donor hypertension on graft survival and function in living and deceased donor kidney transplantation: a nationwide prospective cohort study
Authors: Lee Yu Ho , Kim Jin Sug , Song Sang Heon , Song Seung Hwan , Shin Ho Sik , Yang Jaeseok , Ahn Curie , Jeong Kyung Hwan , Hwang Hyeon Seok 
Published: September 2022

Objectives:
Hypertensive living donors are potential candidates to expand the kidney donor pool. However, the impact of donor hypertension on graft survival and function remains to be clarified.

Methods:
We analyzed 3907 kidney transplant recipients registered in a nationwide prospective cohort from 2014 to 2018. Patients were divided by donor types and the presence of donor hypertension. The primary and secondary outcome was the occurrence of death-censored graft failure and renal allograft function, respectively.

Results:
The prevalence of hypertension was 9.4% (258/2740) and 19.9% (232/1167) in living and deceased donors, respectively. During a median follow-up of 21.8 months, death-censored graft survival rate was significantly worse in recipients of hypertensive living donors than in those of normotensive living donors (P = 0.008). In multivariable analysis, recipients of hypertensive living donors had a significantly increased risk of graft loss (adjusted hazard ratio 2.91; P = 0.009). The risk of allograft loss was not different between recipients of hypertensive living and normotensive deceased donors. Propensity score-matched analyses had consistent worse graft survival rate in recipients of hypertensive living donors compared to those of normotensive living donors (P = 0.027), while it was not different between recipients of hypertensive living and normotensive deceased donors. Hypertension in living donors had a significant negative impact on one-year graft function (adjusted unstandardized β −3.64; P = 0.011).

Conclusions:
Hypertensive living donor recipients have significantly higher risks of renal allograft loss than normotensive living donor recipients, and showed similar outcomes compared to recipients of normotensive deceased donors.
An overview of peripapillary hyperreflective ovoid mass-like structures
Authors: Chapman Jacqueline J. , Heidary Gena , Gise Ryan 
Published: September 2022

Purpose of review
The purpose of this review is to provide an overview of the ophthalmic findings associated with peripapillary hyperreflective ovoid mass-like structures (PHOMS) in both adult and pediatric patients.

Recent findings
PHOMS have recently been identified in a number of different ophthalmic disease entities ranging from nonpathologic to pathologic, including but not limited to anatomic abnormalities (tilting in myopia), optic nerve head drusen, optic disc edema from inflammation (optic neuritis, white dot syndromes), vascular insults (ischemic optic neuropathy, retinal vascular occlusion), and papilledema. The mechanism underlying the formation of PHOMS has not been fully elucidated although it has been hypothesized that PHOMS occur secondary to axoplasmic stasis from crowding at the optic nerve head.

Summary
Although the clinical significance of the presence of PHOMS remains unclear, PHOMS are associated with several disease processes. Understanding the mechanism behind their formation and their impact on optic nerve head structure and visual function may be relevant in patients with optic nerve head pathology. The presence of PHOMS may also correlate with disease severity and duration. Future studies to evaluate whether the formation of PHOMS may be useful as an early indicator of disease or a prognostic tool are warranted.
Recent Stressful Life Events, Lifetime Traumatic Events, Missed Visits, and Antiretroviral Adherence Among Black Women With HIV in the Southeastern United States: A Cross-sectional Study
Authors: Chapman Lambert Crystal , Wright Nicole C. , Elopre Latesha , Fazeli Pariya , King Kiko , Raper James L. , Holstad Marcia M. , Azuero Andres , Turan Janet M. , Mugavero Michael J. 
Published: September 2022

Abstract
Lifetime traumatic events are prevalent among people with HIV and consistently associated with deleterious HIV outcomes. Yet, little is known about the impact of recent stressful events on health outcomes among Black women with HIV (WWH). This cross-sectional study assessed the prevalence of recent stressful events and lifetime traumatic events and their association with HIV outcomes in Black WWH (n = 200) in the Southeastern United States. We evaluated the association between stressful events and HIV outcomes using chi-square tests and unadjusted and adjusted logistic regression analyses. In the unadjusted analyses, missed visits were associated with higher odds of recent stressful events (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.04–1.16) and lifetime traumatic events (OR 1.15, 95% CI 1.05–1.26). In the adjusted analysis, exposure to recent stressful events was independently associated with missed visits (adjusted OR 1.08, 95% CI 1.01–1.15). Interventions addressing recent stressful events are warranted.
Nonsteroidal Anti-inflammatory Drugs Are Not Associated With Increased Bleeding in Blunt Solid Organ Injury
Authors: Hill Joshua H. , Kuhlman Jamie , LaRiccia Aimee , Ngo Anna , Hyland Sara Jordan , Spalding Marshall C. 
Published: September 2022

BACKGROUND:
Nonsteroidal anti-inflammatory drugs are an effective nonopiate option for pain control. However, the antiplatelet aggregation of cyclooxygenase-1 (COX-1) inhibitors presents a concern in that they may exacerbate bleeding in patients with solid organ injuries.

OBJECTIVE:
The aim of the study is to evaluate the impact of nonsteroidal anti-inflammatory drugs on blunt solid organ injury. We hypothesized that nonsteroidal anti-inflammatory drugs would not contribute to intra-abdominal bleed progression.

METHODS:
This is a retrospective cohort study of blunt solid organ injury evaluated from June 1, 2015, to June 30, 2019, at an urban midwestern Level I trauma center. Patients receiving and those not receiving nonsterioidal anti-inflammatory drugs were compared on intra-abdominal bleeding progression as assessed by surgical intervention, angioembolization, and blood transfusions.

RESULTS:
We analyzed 706 patients, of whom 206 were given nonsteroidal anti-inflammatory drugs during their hospital course. Compared with those who were not given nonsteroidal anti-inflammatory drugs, patients given nonsteroidal anti-inflammatory drugs were less likely to have an operation (odds ratio, OR 0.46, 95% confidence interval, CI [0.25, 0.85], p = .012) and were less likely to have an embolization (OR 0.27, 95% CI [0.11, 0.70], p = .004). There was no difference in the need for packed red blood cell transfusion between the nonsteroidal anti-inflammatory drug and non- nonsteroidal anti-inflammatory drug groups (95% CI [0.91, 1.99], p = .13).

CONCLUSION:
Patients given nonsteroidal anti-inflammatory drugs had a decreased likelihood of receiving an organ-specific procedure or needing a blood transfusion and had no difference in mortality. Our findings indicate that nonsteroidal anti-inflammatory drugs in patients with blunt solid organ injuries were not associated with an increased risk of adverse events related to intra-abdominal bleeding.
Validation of the Nelson Tool: A Scoring Tool for Nonsurgical Service Admission of Injured Patients
Authors: Cofran Jessica M. , Teasley-Bennett Jamie M. , McFann Kim , Dunn Julie A. , Martin Kathleen D. 
Published: September 2022

BACKGROUND:
Trauma performance improvement programs are required by the American College of Surgeons to review all nonsurgical admissions if the annual rate exceeds 10%. These reviews can have varying consistency between reviewers, are time consuming, and the consequent aggregate data are difficult to evaluate for trends.

OBJECTIVE:
This study set forth to standardize nonsurgical admission review through validation of the Nelson tool, which is a published objective scoring tool to determine the appropriateness of nonsurgical admissions. We hypothesized that implementation of this tool would facilitate earlier identification of events resulting in meaningful intervention and a reduction of inappropriate nonsurgical admissions.

METHODS:
The Nelson tool and scoring was integrated into the nonsurgical admission review process. A customized audit filter and report were built in the trauma registry. Data were reviewed with respect to scores and admitting service. Statistical analysis included using analysis of variance and t tests to examine differences between admitting services, χ2 test of independence or Fisher's exact to test the association of categorical variables, and ordinal logistic regression to test the ability of the total Nelson tool to predict appropriateness of admission.

RESULTS:
Using the Nelson tool, scores resulted in appropriate admission service in over 90% of cases. Implementation of the tool resulted in a decreased performance improvement workload with a 78% reduction in nonsurgical admission cases required to go to secondary level of review.

CONCLUSIONS:
Utilization of a validated scoring tool decreases performance improvement workload without compromising patient safety.