bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-term prediction of clinical and radiographic contralateral hip osteoarthritis after index total hip arthroplasty
Authors: Ocokoljic Ana , Krivec Lukas , Alimy Assil-Ramin , Simon Alexander , Strahl André , Beil Frank Timo , Rolvien Tim
Published: December 2024

Introduction

Patients with primary hip osteoarthritis undergoing unilateral total hip arthroplasty (THA) often face uncertainty about the future need for arthroplasty in the contralateral hip. We aimed to identify parameters that have predictive value with regard to the necessity for contralateral THA or the development of contralateral radiographic osteoarthritis (OA) phenotypes following index surgery.

Materials and methods

In this retrospective study, we analyzed 220 patients undergoing THA. Of these, 24.1% required contralateral THA at a mean follow-up of 18.3months. Our assessments included preoperative and follow-up pelvis radiographs as well as bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry prior to index THA. Comprehensive radiological measurements such as the Kellgren-Lawrence OA grade, osteophyte evaluation as well as joint shape and alignment (including alpha and CE angles) were performed.

Results

We identified three indicators at the initial assessment for predicting the need for contralateral THA: higher BMI (odds ratio (OR) 1.1 [95%-CI 1.0-1.2], p = 0.033), higher alpha angles (> 61.5°) (OR 2.5 [95%-CI 1.0-6.3], p = 0.045) and the presence of multiple osteophytes (OR 2.6 [95%-CI 1.4–4.9], p = 0.004). Moreover, higher alpha angles were linked to more severe radiographic OA, especially osteophytosis. Higher BMD T-scores were also associated with progressive formation of multiple and large osteophytes but not joint space narrowing.

Conclusion

Three factors - BMI, alpha angle, and osteophyte number - are key short-term predictors for contralateral THA after index THA. We also identified BMD as a surrogate for osteophyte formation. These findings provide novel and valuable insights for patients and surgeons regarding risks and counseling for contralateral OA and THA.
Anterior femoral offset is a flawed measurement of patellofemoral overstuffing
Authors: Klasan Antonio , Heyse Thomas Jan , Nedopil Alexander Johannes
Published: December 2024

Background

Patellofemoral joint (PFJ) issues after total knee arthroplasty (TKA) are becoming a topic of interest once again. Due to the complex three-dimensional shape of the trochlea, various two-dimensional proxy measurements on plain X-rays have been described. One of these measurements is the anterior femoral offset (AFO). It is the distance between the anterior femoral cortex and the trochlea’s most anterior point (MAP) on a true lateral X-ray after TKA. Because the relationship between the trochlea’s MAP and its groove, which is the primary joint surface articulating with the patella, is unknown, the purpose of this study was to measure the distance between the MAP and the trochlear groove.

Methods

After femoral component implantation, the surgeon identified the trochlea’s MAP and the trochlear groove in ten consecutive TKAs and measured their distance. Measurements were performed with a ruler on a true lateral photograph and with a radiographic marker on a lateral radiograph in four different knee flexion angles, according to a previously published protocol.

Results

The trochlear groove had a mean distance from the MAP between 2.09 ± 0.15 and 5.50 ± 0.17 mm, depending on the position. In no case is the trochlear groove visible on a true lateral view.

Conclusion

On a true lateral X-ray, the trochlea’s MAP omits the trochlear groove. Because the patella primarily articulates with the trochlear groove and because the relationship between the MAP and the trochlear groove is variable depending on the knee flexion angle, any conclusions regarding overstuffing based on a postoperative lateral knee X-ray are flawed.
Comparison of pain, functional and psychological trajectories between total and unicompartmental knee arthroplasties: secondary analysis of a 6-month prospective observational study
Authors: Terradas-Monllor Marc , Rierola-Fochs Sandra , Merchan-Baeza Jose Antonio , Parés-Martinez Carles , Font-Jutglà Cristina , Hernández-Hermoso José A. , Ochandorena-Acha Mirari
Published: December 2024

Introduction

Unicompartmental knee arthroplasty (UKA) treats osteoarthritis in one knee compartment, while total knee arthroplasty (TKA) addresses all compartments. The debate focuses on UKA's advantages of quicker recovery and fewer complications versus TKA's lower long-term revision rates, emphasizing the need for thorough outcome evaluations. The aim of the present study is to describe and compare the pain, functional and psychological trajectories during a 6-month postoperative rehabilitation period between total and unicompartmental knee arthroplasties.

Materials and Methods

115 participants who had undergone either TKA or UKA were recruited. Outcome measurements were performed at 1, 4, 12 and 24 weeks post-surgery. Measurements included pain intensity (Visual Analog Scale), range of motion, walking speed (4 m walking test), physical performance (30-s chair stand test), health functioning (Western Ontario and McMaster Universities Osteoarthritis Index), pain catastrophizing (pain catastrophizing scale), fear of movement (Tampa Scale of Kinesiophobia), anxiety and depression (Hospital Anxiety and Depression Scale). A mixed-effects model was used to estimate the influence of type of surgery (either unicompartmental or total knee arthroplasty) to pain, function, and psychological trajectories.

Results

Both TKA and UKA groups showed significant improvements across the six-month rehabilitation period except for anxiety symptoms in the TKA group, and fear of movement and depression in the UKA group. Between group analysis revealed that in the acute phase UKA patients showed improved range of motion and TKA patients displayed faster walking speed but higher fear of movement. Overall, the type of surgery does not significantly influence the overall rehabilitation pain, functional and psychological trajectories.

Conclusions

Despite differences in the acute phase, there are no differences in pain, functional and psychological trajectories throughout the six-month rehabilitation period. These results should be acknowledged to better inform patients and to improve patient education during the perioperative period.

Trial registration number

NCT03378440 (2017-12-18), retrospectively registered.

Level of evidence

Level II.
Determination of activities of 210Pb in Slovak tobacco and cigarettes: a study on radiological risks
Authors: Dulanská Silvia , Silliková Veronika Demovics , Goneková Zuzana , Ticháková Michaela , Gebeová Klára , Trnka Michal , Kosnáč Daniel , Pánik Ján
Published: December 2024

This study investigates the 210Pb activity concentrations in tobacco and cigarettes available in Slovakia, utilizing two specific extraction methods including the Sr Resin sorbent used in extraction chromatography, and the AnaLig Sr01 sorbent, which operates based on molecular recognition principles. The findings revealed significant variations in 210Pb activity concentrations, with concentrations ranging from 13.3 to 33.8 mBq/g in tobacco, and from 16.8 to 28.5 mBq/g in cigarettes. The average 210Pb activity per cigarette was 14.4 mBq ± 1.7 mBq. Annual effective doses for smokers were calculated, with values for tobacco ranging from 27.9 to 126.7 µSv and for cigarettes from 25.5 to 115.7 µSv. The study highlights the importance of comparing these two methods to ensure an accurate assessment of 210Pb exposure and evaluation of radiological risks associated with smoking in Slovakia.
The diagnostic journey of patients being investigated for myopathy in a tertiary centre in England
Authors: Qiang Zekai , Barnett Laura , Bingham Georgia , Han Oscar , Walsh Annabel , Conwill Martin , McDonough Harry E. , McDermott Christopher J. , Shaw Pamela J. , Alix James J. P.
Published: December 2024

Myopathies are heterogenous and can provide a diagnostic puzzle. Many patients investigated for myopathy will go on to other diagnoses. An overall understanding of how patients are investigated for suspected myopathy is lacking. Our aim was to understand how patients were investigated for myopathy in our tertiary centre and the timeline of their diagnostic journey. Through local database searches over a 5-year period (2015–2019), we identified a final total of 770 patients investigated for myopathy. Of these, 29.7% went on to a diagnosis of myopathy. The top non-myopathy diagnoses were neuropathy, spinal pathology and ataxia. Both the myopathy and non-myopathy groups had symptoms for an extended period before reaching specialist services (both groups 104 weeks). Following a first hospital visit, median time to diagnosis was not significantly different (myopathy 46.9 weeks, non-myopathy 40.7 weeks, p > 0.05). Data on the diagnostic journey for specific myopathies was also collected, with inflammatory myopathies diagnosed most quickly and muscular dystrophies most slowly. Muscle MRI and biopsy had the best positive predictive values (82.7% and 83.1%, respectively), while EMG had the best negative predictive value (89.3%). A combination of CK, EMG and neuroaxis MRI (brain and spinal cord) yielded at least one correct test result with respect to final diagnosis in 98.9% of cases. In conclusion, patients in whom a muscle disease is considered experience significant diagnostic delay. The first step in the diagnostic journey should be able to identify both myopathy and non-myopathy cases.
Myelin basic protein and TREM2 quantification in the CSF of patients with Multiple System Atrophy and other Parkinsonian conditions
Authors: Maass Fabian , Canaslan Sezgi , van Riesen Christoph , Hermann Peter , Schmitz Matthias , Schulte Claudia , Brockmann Kathrin , Synofzik Matthis , Bähr Mathias , Zerr Inga
Published: December 2024

Background

It is well known that myelin disruption and neuroinflammation are early and distinct pathological hallmarks in multiple system atrophy (MSA) as well as in idiopathic Parkinson’s disease and in other atypical Parkinsonian syndromes. The objective of this study was to assess the value of non-neuronal biomarker candidates that reflect myelin disruption and neuroinflammation.

Methods

Myelin basic protein (MBP) and the soluble form of TREM2 were quantified in a comprehensive movement disorder cohort from two different neurological centers, comprising a total of 171 CSF samples. Commercially available ELISA systems were employed for quantification.

Results

The results of the MBP analysis revealed a significant increase in cerebrospinal fluid (CSF) MBP levels in all atypical Parkinsonian conditions compared to PD. This differentiation was more pronounced in the MSA-c subtype compared to MSA-p. Receiver operating characteristic (ROC) analysis revealed a significant discrimination between PD and MSA (p = 0.032, AUC = 0.70), PD and DLB (p = 0.006, AUC = 0.79) and PD and tauopathies (p = 0.006, AUC = 0.74). The results of the TREM2 analysis demonstrated no significant differences between the PD and atypical Parkinsonian groups if not adjusted for confounders. After adjusting for age, sex, and disease duration, the PD group exhibited significantly higher TREM2 levels compared to the DLB group (p = 0.002).

Conclusions

In conclusion, MBP, but not TREM2, is elevated in the CSF of not only MSA but in all atypical Parkinsonian conditions compared to idiopathic Parkinson’s disease. This highlights the value of the evaluation of myelin/oligodendrocyte-associated markers in neurodegenerative movement disorders.
Medical costs of treating myasthenia gravis in patients who need intravenous immunoglobulin (IVIg) – a register-based study
Authors: Bugge Christoffer , Engebretsen Ingrid , Kristiansen Ivar Sønbø , Sæther Erik Magnus , Lindberg-Schager Ingrid , Arneberg Fredrik , Gilhus Nils Erik
Published: December 2024

Background

Several innovative treatments are expected for myasthenia gravis (MG) in the coming years. Healthcare payers usually require cost-effectiveness analyses before reimbursement. We aimed to investigate resource utilization and direct medical costs for patients with MG treated with intravenous immunoglobulin (IVIg) to inform such analyses.

Methods

We identified patients with MG in the Norwegian Patient Registry based on at least two hospital encounters with an MG diagnosis (ICD-10 G70.0) from 1 Jan 2010 to 31 Dec 2021. IVIg treatment was identified by medical procedure and Anatomical Therapeutic Chemical (ATC) codes (RPGM05 and J06BA02). Using Diagnosis-Related Group (DRG) cost weights, we estimated direct medical costs for each year following the first MG diagnosis.

Results

Over the study period, 1083 patients were diagnosed with MG in Norway, of whom 155 (14.3%) were treated with IVIg. No significant differences in age or sex were observed between IVIg and non-IVIg patients. Compared with non-IVIg patients, IVIg-patients had 2.3 times higher direct medical costs during the first year after MG diagnosis (EUR 35,714 vs. EUR 15,457) and 3.1 times higher costs during the second year (EUR 19,119 vs. EUR 6256). In the fifth year after diagnosis, IVIg-patients still had higher costs and resource utilization than non-IVIg patients (EUR 9953 vs. EUR 5634).

Conclusion

IVIg treatment represents an important marker for high direct medical costs among patients with MG. The costs continue to be high during the first five years after MG diagnosis.
Exploring clinical chemistry markers in amyotrophic lateral sclerosis: insights into survival and disease trajectories
Authors: Psychogios Ioannis , Hu Yihan , Seitz Christina , Joyce Emily E. , Lovik Anikó , Ingre Caroline , Fang Fang
Published: December 2024

Objective

Commonly measured clinical chemistry markers might be indicative of survival and disease progression in amyotrophic lateral sclerosis (ALS).

Methods

In a cohort study of 270 ALS patients diagnosed from April 2014 to May 2021 in Stockholm, Sweden, we examined the link between 29 clinical chemistry markers at diagnosis and mortality risk at 6 months, 1 year, and 3 years after diagnosis. Summary variables from exploratory factor analysis (EFA) assessed the markers’ collective impact on survival. We integrated ALS functional rating scale-revised (ALSFRS-R) scores with survival data using a joint latent class model to identify patterns of functional decline. Multinomial logistic regression determined how the EFA-derived factors predicted the decline trajectories post-diagnosis.

Results

Higher levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C), apolipoprotein B, and albumin at diagnosis were linked to lower mortality in ALS patients, while increased neurofilament light chain (NfL), leukocyte count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and carbon dioxide (CO2) levels indicated higher mortality. The ‘Red blood cell profile’ factor, derived from EFA, emerged as a significant predictor of survival, independent of other prognostic indicators. The joint latent class model identified three distinct patient groups based on functional decline, with ‘Red blood cell profile’ suggesting a lower likelihood of being in the groups with slower progression.

Conclusion

Clinical chemistry markers, including NfL, lipids, albumin, leukocyte count, MCV, MCH, CO2, and the ‘Red blood cell profile,’ were associated with ALS survival. As these markers represent broader bodily functions, integrating them in ALS patient care could improve disease management.
Balance and gait disorders in de novo Parkinson’s disease: support for early rehabilitation
Authors: Lindholm Beata , Hagell Peter , Odin Per , Hansson Oskar , Siennicki-Lantz Arkadiusz , Elmståhl Sölve , Dahlin Lars B. , Franzén Erika
Published: December 2024

Background

Postural instability is considered a late complication of Parkinson’s disease (PD). However, growing evidence shows that balance and gait problems may occur early in the disease.

Objective

To describe balance, gait, and falls/near falls in persons with newly diagnosed, untreated PD (“de novo”), and to compare this with persons with mild-moderate PD (Later PD). In addition, we evaluated differences relative to PD subtypes in de novo PD.

Methods

De novo (n = 54) and Later (n = 58) PD were assessed regarding motor symptoms, balance, gait, and falls/near falls.

Results

At least 25% of de novo PD had impaired reactive balance and/or comfortable gait speed ≤ 1.0 m/s. At least 50% had abnormal dynamic balance. A third reported balance problems during dual-tasking. Five persons (9%) reported falls/near falls. The median (q1–q3) motor symptom score was 21 (14–28) in de novo PD and 13.5 (9–20) in Later PD (p < 0.001). Later PD performed worse on more balance-demanding tests and a higher percentage of individuals reported falls/near falls (p ≤ 0.048). De novo PIGD PD (n = 10) exhibited worse motor symptoms, reactive and dynamic balance, gait speed, mobility, and freezing of gait as compared to the non-PIGD de novo PD (n = 37) (p ≤ 0.049).

Conclusion

Balance and gait were impaired in de novo PD and most pronounced in PIGD subtype. In addition, balance difficulties during dual-tasking and falls/near falls were evident during this early stage. The lower scores of motor symptoms in Later PD did not result in better mobility, balance, or less falls/near falls indicating that medications have less effect on these symptoms.
Eptinezumab treatment was associated with longer interictal headache/migraine periods which corresponded to greater improvements in patient-reported quality of life measures
Authors: Tepper Stewart J. , Diamond Merle L. , Hirman Joe , Asher Divya , Fiore Damian , Cady Roger
Published: December 2024

Introduction

Longer periods between headache episodes (interictal periods) may provide greater time for the nervous system to reset from a previous episode, potentially improving disease status and health-related quality of life. This post hoc analysis evaluated this hypothesis by associating patients’ longest interictal periods with improvements in patient-reported outcomes.

Methods

PROMISE-2 (NCT02974153) was a double-blind, placebo-controlled study evaluating eptinezumab for preventive treatment of chronic migraine (N = 1072). Daily electronic diary data from Weeks 1–12 and Weeks 1–24 were used to identify interictal periods, defined as days between headache episodes. For each patient, the longest interictal period within these intervals was identified and categorized (1–4, 5–9, 10–14, > 14, and > 21 days). For each category, the following patient-reported outcomes were assessed: 6-item Headache Impact Test (HIT-6), Patient Global Impression of Change (PGIC), and patient-identified most bothersome symptom (PI-MBS).

Results

Excluding interictal periods with > 10% missing data (resulting in 1010 patients with sufficient data), the mean (SD) of longest interictal periods over Weeks 1–12 was 9.4 (11.0) days. A ≥6-point HIT-6 reduction was observed in 78% (56/72) vs 26% (91/351) of patients with a > 21-day vs 1–4-day longest interictal period, respectively; much or very much improvement per PGIC was reported in 90% (65/72) vs 25% (87/348), respectively, and per PI-MBS was reported in 88% (63/72) vs 26% (92/348), respectively. Similar results were observed for Weeks 1–24.

Conclusion

Longer interictal periods were associated with more patients indicating positive changes in headache-related life impact, disease status, and symptomology.

Trial registration: ClinicalTrials.gov (identifier: NCT02974153; registered: 2016-11-23)
Frequency and neuropathology of HTT repeat expansions in FTD/ALS: co-existence rather than causation
Authors: Zimmermann Milan , Mengel David , Raupach Katrin , Haack Tobias , Neumann Manuela , Synofzik Matthis
Published: December 2024

Introduction

While ≥ 40 CAG repeat expansions in HTT present a well-established cause of Huntington’s disease (HD), an enrichment of HTT repeat expansions was recently reported also in patients with amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD), including FTD/ALS patients with additional HD neuropathology. This raises the question whether the phenotypic spectrum of HTT expansions can be extended to ALS and FTD, and whether HTT should be considered as a new causative gene of FTD/ALS. If HTT repeat expansions were indeed systematically related to FTD/ALS, one would expect an increased frequency of HTT carriers in FTD/ALS, who can clinically/neuropathologically not be explained better than by the presence of the HTT repeat expansions.

Methods

Screening of HTT repeat expansions in 249 consecutive patients with ALS or FTD by short-read genome sequencing took place. The post-mortem neuropathological examination was performed in the identified HTT repeat expansion carrier.

Results

One HTT repeat expansion [40/22 repeats (± 1)] was identified in an ALS patient, giving a frequency of 0.4% (1/249) (frequency in the general population: 0.03–0.18%). This patient showed a classic ALS phenotype, but no clinical or imaging signs of HD. Post-mortem brain examination revealed—in addition to ALS-typical degeneration of upper and lower motor neurons with TDP-43 inclusions—HD-typical polyQ-aggregates in gyrus cinguli, striatum and frontal lobe, yet without evidence of striatal degeneration.

Conclusions

Our study does not support the notion of an increased frequency of HTT repeat expansions in FTD/ALS. Moreover, the phenotype of the HTT carrier identified can be better explained by two co-existent, but independent diseases: (i) ALS and (ii) presymptomatic HD, which—given the low repeat number—is likely to become manifest only later in life. These findings corroborate the concept that HTT repeat expansions are likely co-existent/coincidental, but not causative in FTD/ALS.
Effects of a scoring aid on glasgow coma score assessment and physicians’ comprehension: a simulator-based randomized clinical trial
Authors: Kliem Paulina S. C. , Tisljar Kai , Grzonka Pascale , Berger Sebastian , Amacher Simon A. , De Marchis Gian Marco , Dittrich Tolga D. , Hunziker Sabina , Rüegg Stephan , Bassetti Stefano , Bingisser Roland , Marsch Stephan , Sutter Raoul
Published: December 2024

Purpose

Examining the impact of scoring aids on the accuracy of assessing the Glasgow Coma Score (GCS) in a standardized trauma scenario (primary outcome). Evaluating physicians’ understanding of the GCS assessment and clinical application (secondary outcome).

Materials and methods

This randomized trial was performed at the simulator center of a Swiss tertiary academic medical hospital. Participants included intensivists, emergency physicians, internists, and neurologists. The setting involved a trauma patient portraying a GCS of 8 (eyes 1, verbal 2, motor 5). Participants were randomized to receiving or not receiving a scoring aid. Video/audio recordings of the assessments and questionnaires were analyzed by two investigators.

Results

Among 109 participants, 55 received a scoring aid. Overall, 52% scored correctly (score interquartile range 7–8); 43% scored too low and 90% scored within a range of ± 1. A scoring aid increased accuracy (62% vs. 43%, p = 0.045) and participants’ confidence, whilst decreasing assessment duration. Clinical experience further improved reliability. 89% found assessing a GCS of 8 most challenging, particularly with motor response evaluation (64%). 26% indicated tracheal intubation to be mandatory with a score of GCS ≤ 8.

Conclusions

GCS assessment is improved by professional experience and a scoring aid, the use of which needs to be promoted in daily clinical practice. Frequent inaccuracy and misunderstanding regarding clinical applications may alter patient management and misguide treatment and prognosis.

Trial registration

ISRCTN registry (IDISRCTN12257237) https://www.isrctn.com/ISRCTN12257237 Retrospectively registered (last amendment 08/22/2023).
Translation, adaptation, and psychometric evaluation of the Quality of Life in a Child’s Chronic Disease Questionnaire for the Swedish context
Authors: Blomberg Karin , Farnik Małgorzata , Eriksson Mats
Published: December 2024

The aim of this study was to translate, adapt, and psychometrically evaluate the Quality of Life in a Child’s Chronic Disease Questionnaire (QLCCDQ) for the Swedish context. The QLCCDQ was translated into Swedish and adapted to the Swedish context. Data for psychometric testing were obtained through a survey of parents of children and adolescents (n = 627) with chronic diseases: asthma and type 1 diabetes mellitus, with a total of 173 responses (27.6%). Face and content validity of the instrument was assessed, and floor and ceiling effects were measured. Internal consistency was measured with Cronbach’s alpha and an exploratory factor analysis (EFA) was conducted. The EFA gave a two-factor solution with an eigenvalue > 1 explaining 73.9% of total variance for the Swedish version. The new subscales are family life and activities (eight questions) and emotions and symptoms (four questions). Three questions concerning anxiety, worry, and guilt loaded < 0.6 and were excluded.

Conclusion: The study concludes that the Swedish version of the QLCCDQ is a reliable and valid questionnaire. The instrument may be useful for clinical screening of families who have the greatest need for supportive interventions. However, this should be further evaluated.

What is known:
• A child's chronic disease influences quality of life of its family members.
• Few instruments are designed to measure the impact on families.
What is new:
• 
The Swedish version of the Quality of Life in a Child’s Chronic Disease Questionnaire has two subscales 
compared to the original's five.
• 
The instrument may potentially be useful for clinical screening of families who have the greatest need for 
supportive interventions.
Long-term reoperation risk of thoracic to pelvis instrumentation for spinal deformity: a longitudinal study of 7,062 patients
Authors: Nilssen Paal K. , Narendran Nakul , Skaggs David L. , Walker Corey T. , Mikhail Christopher M. , Nomoto Edward , Tuchman Alexander
Published: December 2024

Purpose

To perform a large-scale assessment of reoperation risk among spine deformity patients undergoing thoracic to pelvis surgery.

Methods

The PearlDiver database was queried for spinal deformity patients (scoliosis, kyphosis, spondylolisthesis, sagittal plane deformity) undergoing at minimum, a T12-pelvis operation (2010–2020). CPT codes identified lumbar arthrodesis procedures that included pelvic fixation and ≥ 7 levels of posterior instrumentation on the same day. Minimum follow-up was 2 years. Reoperations included subsequent arthrodesis, decompression, osteotomy, device insertion, and pelvic fixation procedures. Multivariable regression analysis described associations between variables and reoperation risk.

Results

7,062 patients met criteria. Overall reoperation rate was 23.2%. Reoperation rate at 2- and 5-year was 16.9% and 22.1% respectively. 10-year reoperation-free probability was 73.7% (95% CI: 72.4–74.9%). Multivariable analysis revealed higher reoperation risk for patients with kyphosis and ≥ 13 levels of posterior instrumentation. Patients who received interbody cages had a lower reoperation risk. No association was found between the presence or absence of osteotomy procedures and reoperation risk. Lastly, linear regression analyses revealed no significant relationship between age or ECI and risk for subsequent operations did not independently influence reoperation.

Conclusions

This study, representing a real-world cohort of over six times the largest current prospective data set, found a 2-year reoperation rate of 17%, similar to previous studies, suggesting study group findings are applicable to a broader population. Preoperative kyphosis and ≥ 13 levels of posterior instrumentation was associated with higher reoperation risk, while the use of interbody cages was protective. Age, medical comorbidities, and osteotomies did not predict reoperations.
Integrating youth mental health practice nurses into general practice: effects on outpatient mental health care utilization among children and adolescents
Authors: Koet Lukas B. M. , Verhoog Sanne , Erdem Özcan , Gerger Heike , Bindels Patrick J. E. , de Schepper Evelien I. T. , Jansen Wilma
Published: December 2024

Integration of child mental health services in general practice may improve early detection and treatment and reduce strain on specialized services. In this study we investigated whether outpatient mental health care utilization and associated costs in children and adolescents were affected by the introduction of youth mental health practice nurses (YMHPNs) in general practice. We linked healthcare data of the Rijnmond Primary Care Database to municipal registry data on child outpatient mental health care expenditures between 2019 and 2022. Using mixed models, we assessed if the presence of a YMHPN in practices was associated with outpatient mental health care utilization. Our cohort consisted of 33,971 children aged 0–17 years registered in 38 general practices in Rotterdam, the Netherlands. 5.5% of these children attended outpatient mental health services between 2019 and 2022. The proportion of children utilizing outpatient mental health care and associated costs increased over time. After correction for practice demographics and trends over time, the presence of a YMHPN in a practice was associated with small non-significant reductions in the number of children receiving outpatient care (Rate Ratio = 0.99, 95%CI 0.92 to 1.06) and associated costs (-395.80 euros 95%CI -1431.27 to 639.67) compared with practices without YMHPN. Considering the study limitations, we cautiously concluded that the introduction of YMHPNs in general practice was not associated with significant changes in outpatient mental health care utilization one to four years after implementation. Future studies should elucidate the long-term impact and underlying changes in pathways to care due to the introduction of the YMHPN.
Political arenas of infrastructure development—the case of a dam project in Kenya
Authors: Rieber Arne , Müller-Mahn Detlef
Published: December 2024

State-led infrastructure development plays an increasingly important role in social transformation, especially in the Global South, which is also pushing the topic on research agendas in the social sciences in general and in development geography in particular. However, large infrastructure projects are often not completed as originally planned, and they may even end before implementation. This raises the question of how infrastructure and social transformation are related, especially if plans do not materialize. The paper presents an empirical approach to capturing the co-evolution of these two spheres of change in terms of a ‘political arena of infrastructure development’. The arena is defined as a socially constructed space of contestation and strategic collaboration at an intermediate scale, characterized by a specific composition of temporality, spatiality, and performativity. Its focal point is the infrastructure development project, which characterizes the arena as a site of future-making. By conceptualizing the co-evolution of infrastructure and society in terms of a political arena, we highlight the contestation and strategic alliances of infrastructural futures. The concept offers insights into the contentious politics of infrastructure development, resource conflicts and land-use interventions from a political ecology perspective. We apply the concept to the case of the Crocodile Jaw Dam project in Kenya, which was repeatedly proposed in development plans, but has never materialized to date. Serving as a heuristic, the concept of political arenas of infrastructure development guides the research process, helping to identify key topics and dynamics within the socio-political landscape of infrastructure projects.
Analysis of chemical-looping method for production of hydrogen gas from sewage sludge
Authors: Shiraki Toshiyuki , Okumura Satoshi , Uehara Satoshi , Harada Hiroki , Takaoka Masaki
Published: December 2024

The objective of this study is to develop a highly efficient technology for producing hydrogen from sewage sludge using chemical-looping technology. In this study, laboratory-scale gasification experiments were conducted on sewage sludge samples. The effects of CaO as a carrier of oxygen or carbon (C) and as a gasification accelerator were evaluated. Lab-scale tests using a tube-type electric furnace showed that gasification of CaO-mixed dry sludge with steam resulted in substantial absorption of CO2 by CaO at 600 ℃ and 700 ℃ and the concentration of H2 in the gas reached 70 vol.%. The gasification was significantly accelerated in CaO-mixed steam gasification compared with pyrolysis gasification and steam gasification of dry sludge in the absence of the CaO mixture. The hydrogen gas (H2) recovery rate also increased, and tar with a high C weight ratio and high calorific value was recovered. Almost the entire C in the sewage sludge was gasified at 800 ℃. Therefore, this method (pyrolysis with steam and CaO) was shown to be effective as one of the hydrogen production methods from sewage sludge.
Relation Between 3 and 2D Wrinkling Factors in Turbulent Premixed Flames
Authors: Klein Markus , Chakraborty Nilanjan
Published: December 2024

The magnitude of the wrinkled flame surface area in turbulent premixed flames divided by its projection in the direction of flame propagation, known as the wrinkling factor, is a fundamental quantity for the purpose of analysis and modelling premixed combustion, for example, in flame surface density based modelling approaches. According to Damköhler’s hypothesis it is closely related to the turbulent burning velocity, an equally important measure of the overall burning rate of a wrinkled flame. Three-dimensional evaluation of the area of highly wrinkled flames remains difficult and experiments are often based on planar measurements. As a result of this, model development and calibration require an extension of 2D measurements to 3D data. Different relations between 2D and 3D wrinkling factors are known in literature and will be discussed in the present work using a variety of direct numerical simulation (DNS) databases combined with theoretical arguments. It is shown, based on an earlier analysis, that the isotropic distribution of the surface area weighted probability density function of the angle between the normal vectors on the measurement plane and the flame surface, provides a very simple relationship, stating that the ratio between 3D and 2D flame surface area is given by

$$4/\pi $$

4
/
π

, which is found to be in excellent agreement with DNS data of statistically planar turbulent premixed flames.
Precedent-based reasoning with incomplete information for human-in-the-loop decision support
Authors: Odekerken Daphne , Bex Floris , Prakken Henry
Published: December 2024

We define and study the notions of stability and relevance for precedent-based reasoning, focusing on Horty’s result model of precedential constraint. According to this model, precedents constrain the possible outcomes for a focus case, which is a yet undecided case, where precedents and the focus case are compared on their characteristics (called dimensions). In this paper, we refer to the enforced outcome for the focus case as its justification status. In contrast to earlier work, we do not assume that all dimension values of the focus case or the precedent cases have been established with certainty: rather, each dimension is assigned a set of possible values. We define a focus case as stable if its justification status is the same for every choice of the possible values. For focus cases that are not stable, we study the task of identifying relevance: which possible values should be excluded to make the focus case stable? In addition, we introduce the notion of possibility to verify if a user can assign an outcome to an unstable focus case without making the case base of precedents inconsistent. We show how the tasks of identifying justification, stability, relevance and possibility can be applied for human-in-the-loop decision support. Finally, we discuss the computational complexity of these tasks and provide efficient algorithms.
Understanding observable historical pest dynamics through a data rescue approach
Authors: O’Donnell Ultan , McGee Conor Francis , Bourke Andy , M Yearsley Jon
Published: December 2024

Long-term historical data on the presence of invasive pests can inform current pest management. By examining correlations between shifts in pest occurrences and various potential drivers, we can better inform decision-making and management strategies. However, the availability of such long-term data is often limited. We apply a data rescue protocol to recover difficult-to-access pest information from periodical annual forestry reports on the island of Ireland from 1970 to 2020, resulting in an open-access dataset of pest dynamics and their management for the island. We combined the pest dataset with auxiliary weather data to estimate the effects of surveying effort, control measures and weather upon observed pest outbreak dynamics. A first-order auto-logistic regression model was used to model rates of transition between observed presences and absences of non-native insects, fungi, chromista, and bacteria. The results provide evidence that multi-year systematic surveillance efforts have improved the detection of pest species before they have arrived and help towards preventing false absences of invaded species being recorded. We provide reporting recommendations for invasive species which would improve the usability of reported data to better understand observed pest dynamics going forward. Our methodology for data collection and analysis serves as a blueprint for other regions of the world and other invasive species assemblages where data is physically available but not ready for analysis.
Self-Compassion Mediates the Associations of Mindfulness with Physical, Psychological, and Occupational Well-Being Among Chinese Kindergarten Teachers
Authors: Leung Tuen Yung , Lam Chun Bun , Chung Kevin Kien Hoa
Published: December 2024

As the caregivers and educators of young children, kindergarten teachers often have to make spontaneous decisions and deal with challenging situations on a daily basis. The well-being of kindergarten teachers is of interest to parents, teacher trainers, and policymakers, as whether kindergarten teachers do well physically, psychologically, and occupationally has important implications for young children—the future pillars of society. Therefore, it is important to examine factors that may contribute to our understanding of the well-being of kindergarten teachers. This cross-sectional study examined whether mindfulness was linked to Chinese kindergarten teachers’ physical, psychological, and occupational well-being and tested self-compassion as a mediator. Online questionnaire data were collected from 336 kindergarten teachers working in Hong Kong, China (mean age = 31.6 years; 86% of them were women). Kindergarten teachers rated their physical well-being (indicated by physical health and voice disorder symptoms), psychological well-being (indicated by life satisfaction and depressive symptoms), and occupational well-being (indicated by job satisfaction and turnover intentions) as well as their mindfulness and self-compassion. Structural equational modeling revealed that mindfulness was associated with all three aspects of well-being and self-compassion mediated such associations. Theoretically, findings highlighted the multidimensional nature of kindergarten teachers’ well-being and the roles of intrapersonal factors—such as mindfulness and self-compassion—in understanding it. Practically, findings pointed to the potential utility of supporting kindergarten teachers’ well-being by targeting their mindfulness and self-compassion.
Psychometric Evaluation of the Parental Overprotective Measure: Toward a Reliable and Practical Assessment Tool
Authors: Elfström Sigrid , Åhlen Johan
Published: December 2024

Parental overprotection is thought to be a risk factor for childhood anxiety disorders. The Parental Overprotection Measure (POM) is a self-assessment scale that has been used in many studies, however, no article has comprehensively explored its psychometric properties. The aim of this study was to evaluate the POM to secure reliable, replicable, and comparable results. Using an item-response theoretical framework, we aimed to address five basic criteria of psychometric quality: one-dimensionality, ordered response categories, invariance, targeting, and reliability. Furthermore, we aimed to identify and exclude any items that did not contribute significantly, to create a concise and practical scale. A total of 1092 parents of children aged 4–12 years were recruited through an online advertisement and completed an anonymous online survey during September and October 2020. Out of the 19 items of the original scale, eight were excluded due to unsatisfactory psychometric properties and/or because of not being judged by experts as harmonious with the concept of parental overprotection. The retained items constituted the POM-11, a brief scale with sound psychometric properties that has the potential for use in both research and clinical settings.
Design and synthesis of a new chiral macrocyclic dilactam and its characterization by NMR and single-crystal X-ray diffraction
Authors: Sanchez-Perez Divina P. , Gómez-Calvario Victor , Jiménez Jacqueline , Velasco Manuel , Mendoza Angel , Juárez Jorge R.
Published: December 2024

In this study, we report the synthesis and structural characterization of a new chiral macrocyclic dilactam (1) using (R)-phenylglycinol as a key building block. Macrocyclic polyether dilactams, such as this compound, have garnered attention for their ability to form complexes with cations, anions, heavy-metal ions, and neutral organic molecules, displaying potential biological applications as molecular or ion receptors and antibiotics. Building on our expertise in synthesizing chiral piperidine derivatives for alkaloid synthesis, we employed efficient diastereoselective strategies to develop this macrocycle. The complete structural assignment, crucial for correlating structural patterns with biological activity, was achieved through two-dimensional NMR spectroscopy and X-ray diffraction analysis. This work provides valuable insights into the design of diaza-crown ethers with potential applications in supramolecular systems and medicinal chemistry.
In varietate concordia – cluster analysis of EQ-5D-5L value sets in European Union countries
Authors: Pinheiro Vera , Feldens Tallys , Haagsma Juanita A. , Santos João Vasco
Published: December 2024

Background

The transferability of health policies in the European Union (EU) faces challenges due to economic, political, and healthcare system factors, including cross-country differences in health preferences. In order to aid policymaking, previous research has grouped EU countries based on geographical proximity or literature-based criteria, but not on health preference data. The EQ-5D-5L instrument, which measures health-related quality of life and reflects unique national health preferences shaped by cultural and social factors, is used to evaluate policies, technologies and interventions, but has not been used to group countries. Thus, this study aims to identify clusters of EU-27 countries with similar preference patterns using published EQ-5D-5L value sets.

Methods

Hierarchical agglomerative clustering was employed on 13 EU-27 countries’ EQ-5D-5L value sets, first analyzing regression coefficients for each dimension-level and then creating a simulated coefficient distribution considering uncertainty.

Findings

Five clusters of EU-27 countries emerged: (1) Belgium, Netherlands, Sweden, Germany); (2) Hungary, Italy, Portugal; (3) Poland, Romania; (4) France, Spain; (5) Denmark, Ireland. All clusters except cluster 5 gave higher importance to “Pain and Discomfort”; all clusters except cluster 1 gave less importance to “Usual Activities”. “Anxiety and Depression” and “Pain and Discomfort” had the largest heterogeneity in valuation across severity level.

Interpretation

Identified clusters of countries with distinct health preferences provide insights for health policy transferability in the EU. Recognizing countries with similar health preferences can aid EU policymaking and transferability efforts, particularly in early-stage policymaking, while also fostering closer collaboration on health policy decisions and best practice sharing. Further development of national value sets within the EU is necessary for a more accurate representation.
A regional analysis of the impact of remittances on health expenditures: evidence from Mexico
Authors: Mora-Rivera Jorge , García-Amador Martha Cecilia , van Gameren Edwin
Published: December 2024

Using a quasi-experimental technique and data from the 2020 National Household Income and Expenditure Survey, we not only provide evidence that both internal and international remittances have a positive impact on various categories of health expenditures in Mexican households, but also highlight regionally heterogeneous effects. International remittances have a larger impact at the household level, whereas internal remittances impact a greater number of households. In western Mexico, with its long-standing international migratory tradition, remittances from abroad have more pronounced impacts. Internal remittances are more relevant in the poorer south-southeast, a region known for having inadequate access to healthcare services. These findings are associated with structural socioeconomic disparities that characterize Mexico, and are also linked to whether the additional income is perceived permanent or transitory.
An autotuning approach to select the inter-GPU communication library on heterogeneous systems
Authors: Cámara Jesús , Cuenca Javier , Galindo Victor , Vicente Arturo , Boratto Murilo
Published: December 2024

In this work, an automatic optimisation approach for parallel routines on multi-GPU systems is presented. Several inter-GPU communication libraries (such as CUDA-Aware MPI or NCCL) are used with a set of routines to perform the numerical operations among the GPUs located on the compute nodes. The main objective is the selection of the most appropriate communication library, the number of GPUs to be used and the workload to be distributed among them in order to reduce the cost of data movements, which represent a large percentage of the total execution time. To this end, a hierarchical modelling of the execution time of each routine to be optimised is proposed, combining experimental and theoretical approaches. The results show that near-optimal decisions are taken in all the scenarios analysed.