bluuebunny/crossref_metadata_2025 huggingface dataset:
Malpractice Liability Exposure and the Sports Medicine Team Physician: Caring for Professional Athletes in the National Football League, Major League Baseball, and National Hockey League
Authors: Pang Michael , Hasan Sayyida S. , Woo Joshua J. , Olsen Reena J. , Ramkumar Prem N.
Published: January 2025

Background:

Orthopaedic surgeons play a critical role in ensuring the health and safety of professional athletes. Despite the privilege of treating elite athletes, there exists great financial exposure to individual physicians in the event of a malpractice lawsuit.

Hypothesis/Purpose:

The purpose of this study was to evaluate and model malpractice liability exposure of the sports medicine surgeon caring for athletes in the National Football League (NFL), Major League Baseball (MLB), and National Hockey League (NHL) with respect to player position and additional supplemental malpractice insurance needs. It was hypothesized that routine liability coverage cannot adequately address the demands of caring for elite athletes in professional sports leagues.

Study Design:

Economic and Decision Analysis; Level of evidence, 3.

Methods:

In total, 2447 NFL, 992 MLB, and 980 NHL player contracts from the 2022-2023 season were aggregated from a publicly available online database. Position, team, total contract value, and mean yearly salary were noted. Risk ratios were calculated with respect to 1 million US dollars (USD) and 3 million USD of annual occurrence-based malpractice liability awards and used to generate a “covered-to-treat” analysis. Supplemental malpractice liability insurance was quantified.

Results:

Assuming 1 million and 3 million USD occurrence-based awards covered by malpractice liability insurance, team physicians can fully treat 17.3% and 50.0% of NFL players, 43.2% and 59.7% of MLB players, and 13.6% and 41.0% of NHL players, without incurring additional personal financial risk, from a risk-based medicolegal model. Liability policies of 52.6 million, 108.1 million, and 64.1 million USD are required to treat 95% of NFL, MLB, and NHL players, respectively. Positions carrying the greatest risk ratios are quarterback (QB) (9.9) in the NFL, right field (15.1) in the MLB, and center (5.7) in the NHL.

Conclusion:

Sports medicine specialists caring for elite athletes face potential personal financial risk due to insufficient medicolegal coverage. While coverage may vary among different practice settings including private, academic, or public state institutions, medical malpractice risk is crucial in partnerships between sports franchises, hospitals, players, agents, and physicians to protect sports medicine physicians and offer the highest-quality care.
The Different Associations Between Dimensions of Daytime Sleepiness and Subjective Well-Being in Community-Dwelling Older Adults: The Yilan Study, Taiwan
Authors: Ni Shih-Ying , Hsu Nai-Wei , Chen Hsi-Chung
Published: January 2025

This study aimed to examine the associations between the different constructs of daytime sleepiness and subjective well-being (SWB), and to investigate whether physical disability moderated these associations in community-dwelling older adults. We examined daytime sleepiness using the Epworth Sleepiness Scale (ESS) and SWB was evaluated in terms of self-rated health and happiness. Exploratory factor analysis (EFA) was used to determine latent constructs of ESS, yielding two primary factors, which were designated as active and passive factors. The active factor was positively correlated with self-rated health and self-rated happiness. By contrast, the passive factor was negatively correlated with self-rated health but not with self-rated happiness. Physical disability was evaluated using the Groningen Activity Restriction Scale (GARS). By examining the interaction terms between the ESS factors and GARS, we demonstrated that the physical disability moderated the associations of active and passive factors with self-rated health.
Implementation of O-RADS Ultrasound Reporting System: A Quality Improvement Initiative
Authors: Bouchard-Fortier Genevieve , Glanc Phyllis , Ferguson Sarah E. , Elman Debbie , Kupets Rachel , Po Leslie , Taleghani Sarah , Lo Lisha , Hack Kalesha
Published: January 2025

Objectives: To determine the feasibility of implementing Ovarian-Adnexal Reporting & Data System (O-RADS) ultrasound (US) for reporting of adnexal masses at our institution, with a specific goal of increasing the use of O-RADS from a baseline of <5% to at least 75% over a 16-month period. Methods: A prospective interrupted time series quality improvement study was undertaken over a 16-month period. Plan, do, study, act cycles included: (1) Engagement of interested parties, (2) Targeted educational sessions, (3) Development of reporting templates, (4) Weekly audit-feedback. Inter-reader variability assessment was performed on 70% of O-RADS risk-category 2 to 5. The primary outcome was the reporting of an O-RADS risk category. Results: A total of 635 female pelvic US were performed at our centre between July 2022 and April 2023. An O-RADS risk category was provided on the final radiology report by the radiologist for 489/635 (77%) US. From November 2022 to April 2023, the weekly rate of O-RADS risk category reporting reached 88%. The O-RADS score was concordant between readers for 83/103 (81%) of US reports with kappa score of 0.69 corresponding to good agreement. Conclusions: The reporting of O-RADS risk category increased from <5% to 88% over a 16-month period with a high level of agreement among readers in assigning O-RADS risk category. Implementation of a standardizing reporting ultrasound system at a tertiary cancer centre is feasible with rapid learning and uptake curves.
Cytokine Profiles Associated With Clinical Outcomes in Pediatric Patients With Meningitis: A Systematic Review and Meta-Analysis
Authors: Teixeira Daniela Caldas , Lodi Jimenez Ana Luisa , França Tales Godinho , Rocha Kelvin Oliveira , Bentes Aline Almeida , Simões e Silva Ana Cristina , Oliveira Diniz Lilian Martins , Maia de Castro Romanelli Roberta
Published: January 2025

This review evaluated the correlation between inflammatory response and clinical outcomes in pediatric patients with meningitis. PubMed, Scopus, and Web of Science were searched for relevant studies published until March 2024. A total of 139 articles were identified; 7 studies were eligible, and 3 provided data for the meta-analysis. All included articles comprised one of the following cohorts: children with bacterial meningitis, those with aseptic meningitis, or febrile children without evidence of central nervous system infection. The following cytokines and chemocytokines were assessed: interleukin IL-1β, IL-6, IL-17, tumor necrosis factor-alpha, and transforming growth factor-beta 1. Studies on children with bacterial meningitis confirmed by culture found that acute complications and neurologic sequelae were associated with higher concentrations of IL-1β, IL-6, and IL-17. Although this review could not definitively correlate individual inflammatory responses with the prognosis of children with central nervous system infections, IL-6 from cerebrospinal fluid may potentially predict the prognosis of children with bacterial meningitis.
Transtracheal Ultrasound as a Preventive Tool for ETT Related Adverse Events and Malpositioning in the ICU
Authors: Yamane David , Dela Cruz Philip , Wilby Mary Heekin , Ivanovic Sasa , Munoz Mark , Hawkins Katrina , Davison Danielle
Published: January 2025

Introduction

Endotracheal tube (ETT) malpositioning can result in a myriad of complications. Daily chest radiographs (CXR) is the gold standard in monitoring these complications. Point-of-care transtracheal ultrasound (TTUS) is an emerging imaging modality for ETT positioning. We compared ETT malpositioning related adverse events and diagnostic accuracy of ETT malpositioning of a combined TTUS and CXR surveillance protocol to CXR alone.

Methods

We performed a randomized control trial of mechanically ventilated patients in an academic multidisciplinary ICU. In the intervention group, the clinical team was provided the results of the TTUS with CXR results to aid in clinical decision making. In the control group only CXR results were used. Adverse events included bronchial migration, vocal cord herniation, balloon rupture, unplanned extubation, and the development of aspiration pneumonia. Data was analyzed via Fisher's Exact Test. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated.
Machine Learning Approach for Sepsis Risk Assessment in Ischemic Stroke Patients
Authors: Mao Fengkai , Lin Leqing , Liang Dongcheng , Cheng Weiling , Zhang Ning , Li Ji , Wu Siming
Published: January 2025

Background

Ischemic stroke is a critical neurological condition, with infection representing a significant aspect of its clinical management. Sepsis, a life-threatening organ dysfunction resulting from infection, is among the most dangerous complications in the intensive care unit (ICU). Currently, no model exists to predict the onset of sepsis in ischemic stroke patients. This study aimed to develop the first predictive model for sepsis in ischemic stroke patients using data from the MIMIC-IV database, leveraging machine learning techniques.

Methods

A total of 2238 adult patients with a diagnosis of ischemic stroke, admitted to the ICU for the first time, were included from the MIMIC-IV database. The outcome of interest was the development of sepsis. Model development adhered to the TRIPOD guidelines. Feature selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression, identifying 28 key variables. Multiple machine learning algorithms, including logistic regression, k-nearest neighbors, support vector machines, decision trees, and XGBoost, were trained and internally validated. Performance metrics were assessed, and XGBoost was selected as the optimal model. The SHAP method was used to interpret the XGBoost model, revealing the impact of individual features on predictions. The model was also deployed on a user-friendly platform for practical use in clinical settings.

Results

The XGBoost model demonstrated superior performance in the validation set, achieving an area under the curve (AUC) of 0.863 and offering greater net benefit compared to other models. SHAP analysis identified key factors influencing sepsis risk, including the use of invasive mechanical ventilation on the first day, excessive body weight, a Glasgow Coma Scale verbal score below 3, age, and elevated body temperature (>37.5 °C). A user interface had been developed to enable clinicians to easily access and utilize the model.

Conclusions

This study developed the first machine learning-based model to predict sepsis in ischemic stroke patients. The model exhibited high accuracy and holds potential as a clinical decision support tool, enabling earlier identification of high-risk patients and facilitating preventive measures to reduce sepsis incidence and mortality in this population.
Typology of Social Participation and Network and Health in Older Adults: Results From the Canadian Longitudinal Study on Aging
Authors: Deslauriers Véronique , Levasseur Mélanie
Published: January 2025

This study aimed to document the typology of social participation and network among older Canadians and examine their associations with health. Using 2011–2015 cross-sectional data from the Canadian Longitudinal Study on Aging, a latent profile analysis was conducted to identify patterns of social participation and network, and multinomial logistic regressions examined associations with self-rated health. Four types of social participation and networks characterized older Canadians: diverse (74.0%), childless (12.1%), restricted (9.7%), and very socially active (4.3%). Compared to the diverse group and excellent/very good health, belonging to the restricted group was associated with higher probabilities of reporting fair or poor health, both general (1.95; p < .001) and mental (2.18; p < .001). Still comparing to the diverse group and excellent/very good health, the very socially active group presented lower likelihood of reporting good general health (0.82; p = .03). These results suggest that the social participation and network are associated with health inequalities in older Canadians. Future studies should look at the role of virtual interactions in the health of older adults.
Analysis of microstructure and hardness of a double-layered AA7075 build developed by friction stir additive manufacturing
Authors: Girish G
Published: January 2025

In this work, a double-layered AA7075 build was formed using the friction stir additive manufacturing technique, and the microstructural evolution along the build and hardness were investigated. Build cross-section and microstructural evolution were conducted using optical macroscopy, electron backscattered diffraction, and transmission electron microscopy, while hardness measurement was conducted using a Vickers hardness tester. Solid-state deformation resulted in a defect-free build with a basin-shaped cross-section. Recrystallized microstructures were observed along the build due to dynamic recrystallization, with grain sizes measuring 2.32, 2.70, and 2.82 μm at the top, center, and bottom, respectively. Maximum hardness of 146.3 HV was observed at the top of the build, and the values dropped at the overlapped and bottom zones due to grain growth caused by excess thermal cycle. Enhancement in hardness is attributed to strain hardening, grain boundary strengthening, and Orowan strengthening mechanisms.
Comparison of evaluation methods for the dynamic characteristics of railway hydraulic dampers
Authors: Huang Caihong , Shi Mingchao , Zeng Jing
Published: January 2025

The EN and Area methods are commonly reported procedures for evaluating dynamic damper characteristics, both predominantly relying on time-domain data of damper force and displacement, with the EN method established as a standard in EN13802. However, these time-domain approaches do not fully utilize all experimental data and have inherent limitations that can impact the accuracy of the results. To address this challenge, this study introduces a calculation method based on the Fast Fourier Transform (FFT), which shifts the analysis from the time domain to the frequency domain, allowing for more reliable determination of phase angle, dynamic stiffness, and damping. Comparative analysis of dynamic test results on typical hydraulic dampers reveals that traditional time-domain methods lead to abnormal fluctuations in dynamic stiffness at low frequencies due to inaccuracies in phase angle calculations. In contrast, the frequency-domain method delivers more reliable results. Among the tested methods (EN, Area, and FFT), the FFT method aligns most closely with the standard EN method, showing discrepancies of less than 10%, and demonstrates greater robustness under noisy conditions. In comparison, the Area method exhibits higher sensitivity to sampling frequency variations, resulting in less reliable outcomes. This study provides practical insights for enhancing damper performance evaluation and recommends the frequency-domain method as a reliable tool for dynamic characteristic analysis, particularly in applications where noise resilience is required, while the EN method remains suitable for low-noise conditions.
Emerging sexually transmitted infections outbreak: Dermatophytosis among men who have sex with men in Milan, Italy
Authors: Maci Chiara , Raccagni Angelo Roberto , Lolatto Riccardo , Messina Emanuela , Canetti Diana , Tassan Din Chiara , Garcia Martearena Maria del Carmen , Torkjazi Golnaz , Bottanelli Martina , Candela Caterina , Castagna Antonella , Nozza Silvia
Published: January 2025

Background

Dermatophytosis is an infection of the skin or adnexa, which is extremely widespread in the environment. Sexually transmitted infections (STIs) are an increasing global public health threat, especially among men who have sex with men (MSM). This study aims to describe an outbreak of sexually transmitted dermatophytosis among MSM in our cohort between April 2022 and October 2023.

Methods

This is a retrospective monocentric study including outpatients who were diagnosed with at least one episode of dermatophytosis between March 2010 and October 2023 at the Infectious Diseases Unit of San Raffaele Scientific Institute, Milan, Italy. Mycosis diagnosis was mainly clinical following the medical visit and physical examination.

Results

Overall, 107 people were diagnosed with dermatophytosis between March 2010 and October 2023. All 56 cases observed since April 2022 included 55 MSM and 1 female; compared to before 2022 there was a total diagnosis of 51 cases.

Conclusions

These results highlight the evident increase in the incidence of mycotic infections among MSM, followed in our center. We are dealing with a new entity of sexually transmissible infections, in addition to the existing diseases that are being studied.
Synergistic mechanism of the energy dissipation and sediment erosion in pump turbine under sand-laden water based on entropy production theory
Authors: Song Xijie , Presas Alexandre , Valentín David , Zhao Weiqiang , Wang Zhengwei , Lu Yonggang
Published: January 2025

Sediment erosion of hydraulic machinery can cause a lot of energy loss, thereby affecting their operational stability. Herein, solid–liquid two-phase flow simulations are conducted on a pump turbine using the Euler–Lagrangian model to predict the sediment-laden flow and sediment erosion. The predicted results are verified through experiments. The correlation between the energy loss characteristics and sediment erosion in hydraulic turbines is analysed using the entropy production and vorticity theories. Results show that the total vorticity in the runner area increases with the guide vane opening. The entropy production corresponds to a high-vorticity region. Energy dissipation is positively correlated with the degree of turbulence in the flow regime. Certain phenomena, such as vortex flow, impact, and friction in the runner area, are important causes of energy loss. Vortices can also cause local sediment erosion on runner blade walls. Severe wall sediment erosion typically occurs at locations with high entropy production. The total entropy production along the particle flow path is consistent with the variation law of the wall sediment erosion rate.
Transmedia library shelf experience: Innovative research approaches
Authors: Dinotola Sara , Testa Roberto
Published: January 2025

How do people behave and interact with a new arrangement of a public library shelf? The ways in which users access and discover both digital and physical content in libraries are dynamic and constantly changing. This exploratory study employs qualitative tools to examine different search strategies and appeal elements concerning a new arrangement of content on the shelves. This paper introduces the concept model of a new library shelf, defined as a narrative and transmedia shelf, where resources are organized to enhance serendipity and facilitate user experience and browsing. Furthermore, the paper illustrates the initial phases of the pre-prototype shelf experiment. The findings highlight the relevance of research aimed at renewing spatial configuration models of collections, broadening their concept from a transmedia perspective, restoring the centrality of reading in its many forms, and strengthening the cultural and social role of public libraries.
Marcello Malpighi's failing health, death, and the remarkable story of his mortal remains
Authors: Nicosia Roberto F
Published: January 2025

Marcello Malpighi, renowned as the founder of microscopic anatomy, faced many challenges throughout his life. Among these was his frail health, which deteriorated in his early 40s when he developed kidney stones. He struggled with arthritic pain and heart palpitations, which, along with his renal condition, gradually became worse as he got older. His clinical history and autopsy findings also suggest he may have suffered from hypertension, a disease unknown in the seventeenth century. Toward the end, his declining health was complicated by cardiovascular failure. After he died from a stroke, his mortal remains lay unburied for months due to a dispute over the ownership of the burial place. They were finally entombed but relocated multiple times over the next three centuries. An examination of the bones currently housed in his memorial, conducted on the tercentenary of his birth and critically revisited years later, raised doubts about their authenticity. In this paper, I review the causes of Malpighi's poor health and death and delve into the intriguing story of his mortal remains.
BRICS Revolution: The Global Agrarian Shift Sparked by Emerging Economies
Authors: Bamidele Seun
Published: January 2025

The rise of BRICS (Brazil, Russia, India, China and South Africa) has significantly shifted the global economic and geopolitical landscape, profoundly impacting agriculture. As these emerging economies grow in power, they are reshaping global agrarian systems through substantial changes in production, trade and policy. This article explores how BRICS nations are influencing global agriculture by investing in agrarian technologies, altering trade patterns and reconfiguring supply chains. It also examines their approaches to food security and sustainability challenges, highlighting how their evolving agricultural strategies are affecting global market dynamics. The article investigates the economic impacts of BRICS on global agriculture, focusing on how these nations’ economic activities influence agricultural markets and systems. It also analyses how technological advancements and innovations within BRICS countries are transforming agricultural practices and productivity. Additionally, the piece looks at shifts in agricultural trade flows involving BRICS nations and their strategies for addressing food security and self-sufficiency. The implications of BRICS’ agricultural practices on environmental sustainability and resource management are considered, along with the socio-economic impacts on rural communities. Finally, it evaluates how the policy and regulatory frameworks adopted by BRICS nations affect the broader global agricultural landscape. By examining these trends, the article provides valuable insights into the opportunities and challenges presented by the BRICS revolution for global food systems, emphasising the need for adaptive strategies in agricultural policies and practices.
Skill-based dualisation in latecomer economies? Analysing core employment in South Korean firms
Authors: Yoon Francis K
Published: January 2025

The labour market dualisation thesis posits a clear division between low-skill, nonstandard jobs and high-skill, standard jobs, largely driven by firm demands for skill-based quality production. This study interrogates this assumed linkage by analysing firm-level employment patterns in South Korea. Using establishment-based surveys and workplace interviews, the findings largely support the dualisation thesis but reveal a deviation: high-skill jobs can also be assigned to nonstandard employment forms. Notably, ‘core work’ is frequently outsourced to subcontractors, reflecting the enduring influence of institutions initially structured for a low-cost export strategy. This study suggests that South Korea’s latecomer institutions, including hierarchical interfirm relationships dominated by conglomerates ( Chaebols) and a history of adversarial industrial relations, complicate the dualisation scenarios observed in other advanced coordinated economies. This study highlights how South Korea’s latecomer institutions shape skill-based employment inclusivity, ultimately demonstrating limited labour market inclusiveness in a country known for its remarkable industrial growth.
Suspected fenugreek (Trigonella foenum-graecum L.) toxicosis in a herd of Saskatchewan beef cattle
Authors: Cowan Vanessa E. , Koziy Roman V. , Zemlak Laurie , Campbell John R.
Published: January 2025

An apparent outbreak of fenugreek forage toxicosis occurred in a beef cattle herd near Moose Jaw, Saskatchewan in February–May 2022. The herd had consumed fenugreek hay from late fall to early winter. Clinical signs included various degrees of weakness, ataxia, knuckling, walking on hocks, and recumbency. All adult cattle in the herd eventually died or were euthanized. Feed analysis did not reveal nutritional deficiencies or mycotoxin contamination. Liver mineral and vitamin status of affected animals did not indicate any consistent abnormality. The last live cow in the herd was presented to a veterinary teaching hospital for evaluation and subsequent postmortem examination. Major postmortem findings included emaciation, and sciatic nerve and spinal cord axonal degeneration. Histologic examination of the sciatic nerve showed Wallerian-like axonal degeneration, increased Schwann cell nuclei, and endoneurial fibrosis. Histologic examination of the spinal cord showed infrequent myelin sheath dilation and digestion chambers within white matter. These results are consistent with other reports of natural and experimental outbreaks of fenugreek poisoning in livestock. To our knowledge, fenugreek toxicosis has not been reported previously in Canada. We conclude that caution should be taken when feeding fenugreek hay to cattle.
Topology optimization method of facesheet-to-skeleton connection area’s distribution design for alleviating strain concentration of flexible skins
Authors: Wei Zhaodong , Gao Renjing , Liu Shutian
Published: January 2025

During the morphing of flexible skins, local strain concentration may occur in the face-sheet due to different bonding methods between the face-sheet and the skeleton. To overcome this problem, we propose a strategy to improve the uniformity of the strain distribution through rationally distributing the connection areas between the face-sheet and skeleton of the sandwich-flexible-skin, and develop a topology optimization method for determining the optimal distribution of the connection areas. In this method, the connection areas between the face-sheet and the support skeleton are considered as the virtual adhesion layer comprising of adhesion materials. Based on the topology optimization idea, the distribution of connection areas is described by allocating the presence and absence of the adhesion material. The optimization model is established with minimizing the globe stress of the face-sheet as the objective function, the volume fraction of the design domain as the constraint. The effectiveness of the proposed method is verified through examples involving tensile and rotational states of the sandwich-flexible-skin with Ω-shaped honeycomb structure, and the results show that the optimization method can significantly improve the strain distribution of the face-sheet. Finally, a variable-sweep structure for unmanned aerial vehicles (UAVs) is designed to explore the practical value of the proposed method.
Effectiveness of ultrasound-guided hip injections on pain and functioning in patients with hip osteoarthritis: A systematic review
Authors: Bernetti Andrea , Agostini Francesco , Finamore Nikolaos , Dal Borgo Marco , Mangone Massimiliano , Ammendolia Antonio , Paoloni Marco , de Sire Alessandro
Published: January 2025

Background

Osteoarthritis is the most common form of arthritis, causing pain, functional disability, and a reduction in terms of quality of life. Minimally invasive treatments like intra-articular hip injections are a therapeutic option and ultrasound guidance might improve the results of these injections.

Objective

To summarize the evidence about the effectiveness of ultrasound-guided hip injections in terms of pain and functioning in patients affected by hip osteoarthritis.

Methods

A systematic search of the literature was performed on three electronic databases: PubMed, Cochrane and PEDro, using a specific search strategy. We evaluated for inclusion all articles according to the following participants, intervention, comparison, and outcomes (PICO) model: P) Population: human patients affected by hip osteoarthritis; I) Intervention: intra-articular hip injections performed with a ultrasound-guidance; C) Comparator: sham therapy or every other conservative or oral, non-invasive, minimally invasive or surgical technique; O) Outcome measures: pain assessed by Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS); functional outcomes.

Results

At the end of the search, 43 articles were included in the review. Several drugs have been considered in the included studies: hyaluronic acid, platelet-rich plasma, corticosteroids, micro-fragmented adipose tissue, bone marrow concentrates, amniotic suspension allograft.

Conclusion

Ultrasound-guided injections of hyaluronic acid might be effective on pain relief and functioning in patients affected by hip osteoarthritis. Also, other rehabilitative infiltrative techniques (i.e., corticosteroids and platelet-rich plasma) showed a positive effect in the short-term period.
Comparison of clinical efficacy between femoral neck system and cannulated screw in Pauwels type III femoral neck fracture: A meta-analysis
Authors: Zhuang Kailun , Wu Jingyi , Yang Yusen , Bai Tianmo , Li Baofeng
Published: January 2025

Background

In recent years, the femoral neck system (FNS) has become increasingly widely used for Pauwels type III femoral neck fractures.

Objective

We performed a meta-analysis to investigate the safety and efficacy of FNS and the mainstream internal fixation method, cannulated screw (CS), in the treatment of Pauwels type III femoral neck fractures.

Methods

We systematically searched all research studies from PubMed, Embase, Web of Science, Cochrane, WANFANG, and the Chinese Academic Journal Full-Text Database (CNKI) from 2018 to July 2024 and conducted data extraction. The study was conducted on July 26, 2024. We used the PRISMA guidelines to assess the quality of the results of all included studies. In addition, we searched for references to relevant articles. After completing the literature search, we performed a manual literature screening to obtain studies that met the inclusion criteria. The outcomes were Harris Hip Score, operation duration, intraoperative blood loss, hospital stay, healing time, and postoperative complications.

Results

This meta-analysis ultimately included nine studies (n = 524) and conducted quality evaluations. All nine articles were retrospective cohort studies. The study exhibited statistically significant variations between the FNS and CS groups in relation to total complications (95% confidence interval (CI)= [0.11, 0.40], odds ratio (OR) = 0.21, P < 0.001), Harris Hip Score (95%CI = [2.14, 3.65], mean difference (MD) = 2.89, P < 0.001), Femoral head necrosis (95%CI = [0.17, 0.86], OR = 0.38, P = 0.02), Internal fixation failure (95%CI = [0.06, 0.50], OR = 0.17, P = 0.001), Medium femoral neck shortening (95%CI = [0.17, 0.53], OR = 0.30, P < 0.001), intraoperative blood loss (95%CI = [11.57, 26.80], MD = 19.19, P < 0.001), Operation duration (95%CI = [−15.20, −2.17], MD = −8.69, P = 0.009), and healing time (95%CI = [−1.30, −0.32], MD = −0.81, P = 0.001).

Conclusion

This meta-analysis showed that in Pauwels type III femoral neck fractures, the femoral neck system has a shorter operative time, a lower rate of postoperative complications, a shorter healing time, less shortening of the femoral neck, and a higher Harris Hip Score compared with cannulated screws, but increases intraoperative blood loss. However, more clinical studies are needed to confirm our conclusions due to our small sample size and lack of randomized controlled trials.
The statistical stability of clavicle fracture management: A systematic review of randomized controlled trials with fragility analysis
Authors: Megafu Michael N. , Point Du Jour Elisabeth , Nguyen Janet , Megafu Emmanuel , Mian Hassan , Singhal Sulabh , Tornetta Paul , Parisien Robert L.
Published: January 2025

Background

Randomized controlled trials (RCTs) represent the highest level of evidence in guiding the management of clavicle fractures. They are conducted to ensure that evidence drives the basis of treatment algorithms. Relying solely on P values to assess orthopedic RCTs may be deceptive and challenge the validity of the studies.

Objective

To evaluate the degree of statistical fragility in the clavicle fracture literature using the fragility index (FI) and fragility quotient (FQ).

Methods

A systematic search strategy using the Medline, PubMed, and Embase databases was used to find all dichotomous data for randomized controlled trials (RCTs) in clavicle fracture research from 2000 to 2024. The FI of each outcome was calculated by reversing a single outcome event until significance was reversed. The FQ was calculated by dividing each fragility index by the study sample size. The interquartile range (IQR) was also calculated for the FI and FQ.

Results

Of the 3646 articles screened, 81 met the search criteria, with 30 RCTs evaluating clavicle fractures included for analysis. There were 250 total outcomes, where 62 significant and 188 nonsignificant outcomes were identified. The overall FI and FQ were 4 (IQR 3–5) and 0.045 (IQR 0.024–0.080). Statistically significant and nonsignificant outcomes had an FI of 3.5 (IQR 2–7) and 4 (IQR 3–5), respectively. Regarding loss to follow-up (LTF), 63.3% (19) reported LTF greater or equal to the overall FI of 4.

Conclusion

When scrutinizing management algorithms relying on statistical analysis, we recommend including the FI and FQ alongside the P value.
Comparative retrospective analysis of magnetic field therapy and extracorporeal shock wave therapy in pain management for heel spur
Authors: Akkoyun Sert Ozlem , Yilmaz Kamil
Published: January 2025

Background

Heel spurs, caused by inflammation and overstretching of the plantar fascia, are a common source of heel pain. Although various conservative and invasive treatments are used, evidence on their effectiveness remains limited.

Objective

This study aims to evaluate the effect of extracorporeal shock wave therapy (ESWT) and magnetic field application on pain levels in heel spur patients.

Methods

The files of 80 patients diagnosed with heel spurs were accessed. Patients with missing demographic information in the files, incomplete Visual Analogue Scale (VAS) values, and patients with heel pain complaints for less than 5 months were excluded from the study. A total of 39 patients who met the study criteria were included in the study. While ESWT was applied to 21 of these patients (ESWT group), magnetic field was applied to 18 patients (MA group). All patients were given plantar fascia stretching exercises as a home program. Pain scores before and after treatment were evaluated with VAS.

Results

A significant decrease was found in VAS values after the 5th session and 2 months later in both the ESWT group and the magnetic field group (p < 0.001). On the other hand, neither treatment method was found to be superior to each other (p > 0.05).

Conclusion

It was observed that the pain of the patients decreased in both the early and late periods in both applications.
A study of effective exercise methods and resistance intensity for selective strengthening of the infraspinatus muscle
Authors: Kim Tae-Gyu , Ma Rui , Yu Il-Young
Published: January 2025

Background

To selectively strengthen target muscles, resistance intensity as well as limb position should be considered.

Objective

This study aimed to identify the most effective exercise positions and the optimal resistance intensity to selectively strengthen the infraspinatus muscle.

Methods

This study included 18 healthy men who underwent four different external rotation (ER) exercises in prone external rotation (PER), side-lying wiper, sitting external rotation, and standing external rotation (STER) exercise by varying the shoulder positions under low, medium, and high resistance intensity conditions randomly. Infraspinatus and posterior deltoid muscle activities and the infraspinatus to posterior deltoid activity ratio were measured based on ER exercise positions and resistance intensities.

Results

This study revealed a significant interaction and main effects of exercise position and resistance intensity on muscle activity and muscle activity ratio. Both muscle activities were increased as the resistance intensity increased, but the muscle activity ratio was decreased. Infraspinatus muscle activity and muscle activity ratio were higher in the PER and STER exercises than in other exercises.

Conclusion

We indicate that PER and STER are effective exercises to selectively strengthen the infraspinatus muscle. Additionally, performing the exercise at low or medium resistance intensity rather than high resistance intensity is recommended to activate the infraspinatus selectively while minimizing the involvement of the posterior deltoid.
Functional Capacity Incorporating Dynamic Ventilation in Systemic Sclerosis: Agreement Analysis Between Performance on the 6-Minute Walk Test and Glittre–ADL Test
Authors: Reis Filipe da Silva , Reis Luis Felipe da Fonseca , Ferreira Isabelle da Nobrega , Farias Iasmim de Oliveira , Pessoa Laura Franco , Costa Lohana Resende da , Olímpio Júnior Hebert , Ferreira Arthur de Sá , Lopes Agnaldo José
Published: January 2025

Background

Functional capacity at submaximal exercise levels has become more popular as an outcome measure in systemic sclerosis (SSc). However, it is necessary to know the ventilatory requirements of the different field tests.

Objectives

To verify the agreement of the ventilatory dynamics measured at submaximal exercise between the the Glittre-ADL test (TGlittre) and the 6-min walk test (6MWT) and, secondarily, to evaluate the correlations of these measurements with clinical and functional variables in women with SSc (wwSSc).

Methods

This was a cross-sectional study in which 30 wwSSc underwent the 6MWT and TGlittre while hooked to a device reading their ventilatory demand. Physical function was assessed on the Health Assessment Questionnaire Disability Index (HAQ-DI), and lung function was assessed by spirometry.

Results

The median 6-min walking distance (6MWD) was 344 (282–410) metres, and 25 (83.3%) participants did not reach 80% of the predicted distance. The median TGlittre time was 147 (107–188) seconds, and 18 (60%) participants exceeded 120% of the predicted time. There was agreement between the two tests on the following variables: heart rate (ICC = 0.883, P < 0.0001), breathing reserve (ICC = 0.816, P < 0.0001), peripheral oxygen saturation (ICC = 0.752, P = 0.0009), inspiratory capacity (ICC = 0.690, P < 0.0001), and peak minute ventilation (ICC = 0.433, P = 0.007). There was a weak correlation between 6MWD and TGlittre time ( rs=–0.353, P = 0.05). 6MWD correlated significantly with the HAQ-DI score ( rs=–0.606, P = 0.0004) and forced vital capacity (FVC, rs = 0.427, P = 0.018). TGlittre time correlated significantly with HAQ-DI ( rs = 0.440, P = 0.015) and FVC ( rs=–0.404, P = 0.026).

Conclusion

In wwSSc, the 6MWT and TGlittre have almost the same ventilatory requirements, although these patients perform worse in the 6MWT. 6MWD and TGlittre time are weakly correlated. Both 6MWD and TGlittre time are associated with physical function and lung function. Therefore, both tests should be used in clinical practice for the monitoring of these patients as they are complementary.
Adolescent idiopathic scoliosis causes pelvic floor dysfunction: A cross-sectional study
Authors: Dericioğlu Batuhan İbrahim , Özgören Adile Öniz , Angın Salih
Published: January 2025

Background

Scoliosis is a complex three-dimensional deformity of the spine and causes spinal misalignment and pelvic structure changes.

Objective

This cross-sectional study was designed to investigate the relationship between postural deviation, scoliosis angle and pelvic floor dysfunctions in individuals with adolescent idiopathic scoliosis (AIS).

Methods

Twelve AIS aged between 12 and 18 years were included in the study. Standard scoliosis radiography was used for Cobb angle measurement. The posture screen mobile (PSM) application was used for determining postural deviation, and a real-time ultrasound image was obtained for pelvic floor muscle activity. The pelvic floor distress inventory was used for the evaluation of pelvic floor dysfunctions.

Results

There was a significant negative correlation between bladder base elevation and the following variables, including thoracic and lumbar Cobb angles (r = −0.640, p < 0.05; r = −0.779, p < 0.05), Dysfunctional Voiding Scoring System (DVSS) (r = −0.753, p < 0.05), Pelvic Floor Distress Inventory (PFDI) (r = −0.722, p < 0.05) and Urinary Distress Inventory (UDI) (r = −0.585, p < 0.05). The apical shift in the frontal plane was found to be positively correlated with DVSS (r = 0.701, p < 0.05), UDI (r = 0.641, p < 0.05) and PFDI-20 (r = 0.628, p < 0.05) and negatively correlated with bladder base elevation (r = −0,615, p < 0.05). The average pelvic shift in frontal plan was found to be positively correlated with DVSS (r = 0.810, p < 0.05), PFDI-20 (r = 0.722, p < 0.05), Pelvic Organ Prolapse Distress Inventory (POPDI) and UDI (r = 0.626, p < 0.05) and negatively correlated with bladder base elevation (r = −0.626, p < 0.05).

Conclusion

Scoliosis negatively affects pelvic floor muscle activity, and pelvic floor functions, resulting in urinary dysfunction. Pelvic floor assessment may be added to the evaluation process in patients with AIS.
Evaluating the Use of a 3D Exoscope to Improve Ergonomics in Cleft Surgery
Authors: Lee Kwang Chear , Frearson Benjamin , Alagbe Bashirat Adedoyin , ElSafti Mohamed Gamal Abdelazim Salem , Nightingale Craig , Cooke Jane , Panagamuwa Channa , Echlin Kezia , Khan Khurram
Published: January 2025

The aim of this study was to investigate and compare the technical feasibility, ergonomics, and educational value of the 3D exoscope in comparison with traditional and prism loupes in cleft surgery.

A variety of cleft and pharyngeal operations were performed with the VITOM® 3D exoscope (Karl Storz GmbH, Tuttlingen, Germany), traditional/prism loupes, and microscope. The cervical neck angulation of the operating surgeon was recorded in real-time with an inertia measurement unit system (Mbient, San Francisco, USA) and experiences of the surgeon and assistant were prospectively evaluated with 5-point Likert scales.

National Health Service, England.

Eleven patients were recruited in whom 12 procedures were performed. Two main surgeons, 3 assistant surgeons, and 3 scrub nurses were recruited into the study.

Four procedures were performed with the VITOM® 3D exoscope, and as the comparison groups, 5 procedures were performed with normal loupes, 3 with prism loupes, and 2 were done in combination with a microscope and analyzed separately.

Neck angle measurements and feedback from surgeons, assistants, and scrub nurses.

The VITOM® system improved surgeon ergonomics with reduced procedure time in cervical flexion when compared to the other visualization methods (versus loupes, P < .01, and prism, P < .01). The VITOM® system also scored favorably in terms of image-related fields, ergonomics, and ease of use.

Use of the 3D exoscope in cleft surgery yielded improved experiences for both surgeons, assistants, and nurses in comparison with loupes and microscopes without increasing operating time.
Variant Pseudocystic Desmoplastic Small Round Cell Tumor With Heterologous Mullerian Cysts
Authors: Nayman Eric I. , Brathwaite Carole , Pedroso Felipe , Fader Maggie E. , Obeidin Farres , Dehner Louis P.
Published: January 2025

A desmoplastic small round cell tumor (DSRCT) presented in a 13-year-old female with an acute abdomen due to torsion of a fallopian tube cyst. She was found to have an incidental 2 cm pedunculated, solid, and multicystic mass attached to the pelvic floor on laparoscopy. The neoplasm had a variably myxoid and spindle cell pattern with nests and cords of small cells, forming pseudocysts, and true cysts lined by ciliated epithelium which were PAX-8+ and ER+/PR+. The tumor had the EWSR1::WT1 fusion. Numerous peritoneal nodules less than 1 cm were noted on repeat laparoscopy 3 months later. These had similar features including the ciliated epithelial cysts. Our case illustrates yet another potential variant pattern of DSRCT with Mullerian-like ciliated epithelial cysts.
Preparing MPICH for exascale
Authors: Guo Yanfei , Raffenetti Ken , Zhou Hui , Balaji Pavan , Si Min , Amer Abdelhalim , Iwasaki Shintaro , Seo Sangmin , Congiu Giuseppe , Latham Robert , Oden Lena , Gillis Thomas , Zambre Rohit , Ouyang Kaiming , Archer Charles , Bland Wesley , Jose Jithin , Sur Sayantan , Fujita Hajime , Durnov Dmitry , Chuvelev Michael , Zheng Gengbin , Brooks Alex , Thapaliya Sagar , Doodi Taru , Garazan Maria , Oyanagi Steve , Snir Marc , Thakur Rajeev
Published: January 2025

The advent of exascale supercomputers heralds a new era of scientific discovery, yet it introduces significant architectural challenges that must be overcome for MPI applications to fully exploit its potential. Among these challenges is the adoption of heterogeneous architectures, particularly the integration of GPUs to accelerate computation. Additionally, the complexity of multithreaded programming models has also become a critical factor in achieving performance at scale. The efficient utilization of hardware acceleration for communication, provided by modern NICs, is also essential for achieving low latency and high throughput communication in such complex systems. In response to these challenges, the MPICH library, a high-performance and widely used Message Passing Interface (MPI) implementation, has undergone significant enhancements. This paper presents four major contributions that prepare MPICH for the exascale transition. First, we describe a lightweight communication stack that leverages the advanced features of modern NICs to maximize hardware acceleration. Second, our work showcases a highly scalable multithreaded communication model that addresses the complexities of concurrent environments. Third, we introduce GPU-aware communication capabilities that optimize data movement in GPU-integrated systems. Finally, we present a new datatype engine aimed at accelerating the use of MPI derived datatypes on GPUs. These improvements in the MPICH library not only address the immediate needs of exascale computing architectures but also set a foundation for exploiting future innovations in high-performance computing. By embracing these new designs and approaches, MPICH-derived libraries from HPE Cray and Intel were able to achieve real exascale performance on OLCF Frontier and ALCF Aurora respectively.