bluuebunny/crossref_metadata_2025_split huggingface dataset:
A service evaluation of a hospital-based specialist postnatal breastfeeding clinic
Authors: McGuinness Denise , Paul Gillian , Murtagh Rosemaree , O'Hagan Lorraine 
Published: November 2020

Background Breastfeeding is described as the gold standard of infant feeding and is beneficial to both infant and maternal health, reducing healthcare costs. Breastfeeding rates are low in Ireland. Interventions that support and protect breastfeeding are required. Aim To conduct a service evaluation of a hospital-based specialist postnatal breastfeeding clinic. Methods A telephone questionnaire was administered to 99 participants who attended a breastfeeding specialist clinic. Descriptive analysis was conducted on the quantitative data. The qualitative data was anonymised and subjected to thematic analysis. Results Of the 99 women, 99% were breastfeeding at 6 weeks, 92% at 3 months and 77% at 6 months, respectively. The majority of women attended with one breastfeeding challenge (63%) while 24% of women attended with two breastfeeding challenges. Conclusions Skilled professional breastfeeding support, in addition to peer support, is an effective and acceptable way to increase breastfeeding among women who present with common breastfeeding challenges.
Destitution in pregnancy: forced migrant women's lived experiences
Authors: Ellul Rosanna , McCarthy Rose , Haith-Cooper Melanie 
Published: November 2020

Background Forced migrant women are increasingly becoming destitute whilst pregnant. Destitution may exacerbate their poor underlying physical and mental health. There is little published research that examines this, and studies are needed to ensure midwifery care addresses the specific needs of these women. This study aimed to explore vulnerable migrant women's lived experience of being pregnant and destitute. Methods Six in-depth individual interviews with forced migrant women who had been destitute during their pregnancy were conducted over one year. Results A lack of food and being homeless impacted on women's physical and mental health. Women relied on support from the voluntary sector to fill the gaps in services not provided by their local authorities. Although midwives were generally kind and helpful, there was a limit to how they could support the women. Conclusions There is a gap in support provided by local authorities working to government policies and destitute migrant pregnant women should not have to wait until 34 weeks gestation before they can apply for support. Home office policy needs to change to ensure pregnant migrant women receive support throughout their pregnancy.
Increasing physical activity in people with COPD
Authors: Armstrong Matthew 
Published: November 2020

Levels of physical activity tend to be reduced in people with COPD. Matthew Armstrong discusses the benefits of improving activity levels in this group of patients It is well acknowledged that levels of physical activity in patients with chronic obstructive pulmonary disease (COPD) are considerably lower than healthy-age matched individuals, with physical inactivity recognised as a key predictor of hospitalisation and mortality. Pulmonary rehabilitation (PR) has become a major tool for managing symptoms of COPD and the associated extra-pulmonary effects. However, inconsistencies surrounding its effectiveness in terms of improving physical activity remain due to the complex nature of physical activity. To overcome these inconsistencies, both pharmacological and behavioural interventions have been documented to aid improvements in physical activity, with behavioural interventions alongside PR found to be the most effective tool to promote levels of physical activity. Health professionals must therefore look to incorporate an interdisciplinary approach in order to best achieve improvements in physical activity levels in patients with COPD.
The role of orthopaedic trainees during the COVID-19 pandemic and impact on post-graduate orthopaedic education
Authors: Gonzi Gianluca , Gwyn Rhodri , Rooney Kathryn , Boktor Joseph , Roy Kunal , Sciberras Nadia C. , Pullen Huw , Mohanty Khitish 
Published: November 2020

Aims The COVID-19 pandemic has had a significant impact on the provision of orthopaedic care across the UK. During the pandemic orthopaedic specialist registrars were redeployed to “frontline” specialties occupying non-surgical roles. The impact of the COVID-19 pandemic on orthopaedic training in the UK is unknown. This paper sought to examine the role of orthopaedic trainees during the COVID-19 and the impact of COVID-19 pandemic on postgraduate orthopaedic education. Methods A 42-point questionnaire was designed, validated, and disseminated via e-mail and an instant-messaging platform. Results A total of 101 orthopaedic trainees, representing the four nations (Wales, England, Scotland, and Northern Ireland), completed the questionnaire. Overall, 23.1% (23/101) of trainees were redeployed to non-surgical roles. Of these, 73% (17/23) were redeployed to intensive treatment units (ITUs), 13% (3/23) to A/E, and 13%(3/23%) to general medicine. Of the trainees redeployed to ITU 100%, (17/17) received formal induction. Non-deployed or returning trainees had a significant reduction in sessions. In total, 42.9% (42/101) % of trainees were not timetabled into fracture clinic, 53% (53/101) of trainees had one allocated theatre list per week, and 63.8%(64/101) of trainees did not feel they obtained enough experience in the attached subspecialty and preferred repeating this. Overall, 93% (93/101) of respondents attended at least one weekly online webinar, with 79% (79/101) of trainees rating these as useful or very useful, while 95% (95/101) trainees attended online deanery teaching which was rated as more useful than online webinars (p = 0.005) Conclusion Orthopaedic specialist trainees occupied an important role during the COVID-19 pandemic. COVID-19 has had a significant impact on orthopaedic training. It is imperative this is properly understood to ensure orthopaedic specialist trainees achieve competencies set out in the training curriculum. Cite this article: Bone Joint Open 2020;1-11:676–682.
Design and implementation of an acute Trauma and Orthopaedic ePlatform (TOP) referral system utilising existing secure technology during the COVID-19 pandemic
Authors: McIntyre Tom Vincent , Kelly Enda Gerard , Clarke Trevor , Green Connor J. 
Published: November 2020

Introduction Virtual fracture clinics (VFCs) are being increasingly used to offer safe and efficient orthopaedic review without the requirement for face-to-face contact. With the onset of the COVID-19 pandemic, we sought to develop an online referral pathway that would allow us to provide definitive orthopaedic management plans and reduce face-to-face contact at the fracture clinics. Methods All patients presenting to the emergency department from 21March 2020 with a musculoskeletal injury or potential musculoskeletal infection deemed to require orthopaedic input were discussed using a secure messaging app. A definitive management plan was communicated by an on-call senior orthopaedic decision-maker. We analyzed the time to decision, if further information was needed, and the referral outcome. An analysis of the orthopaedic referrals for the same period in 2019 was also performed as a comparison. Results During the study period, 295 patients with mean age of 7.93 years (standard error (SE) 0.24) were reviewed. Of these, 25 (9.8%) were admitted, 17 (5.8%) were advised to return for planned surgical intervention, 105 (35.6%) were referred to a face-to-face fracture clinic, 137 (46.4%) were discharged with no follow-up, and seven (2.4%) were referred to other services. The mean time to decision was 20.14 minutes (SE 1.73). There was a significant difference in the time to decision between patients referred to fracture clinic and patients discharged (mean 25.25 minutes (SE 3.18) vs mean 2.63 (SE 1.42); p < 0.005). There were a total of 295 referrals to the fracture clinic for the same period in 2019 with a further 44 emergency admissions. There was a statistically significant difference in the weekly referrals after being triaged by the VFC (mean 59 (SE 5.15) vs mean 21 (SE 2.17); p < 0.001). Conclusion The use of an electronic referral pathway to deliver a point of care virtual fracture clinic allowed for efficient use of scarce resources and definitive management plan delivery in a safe manner. Cite this article: Bone Joint Open 2020;1-6:293–301.
Transformation from a traditional model to a virtual model of care in orthopaedic surgery
Authors: King Dominic , Emara Ahmed K. , Ng Mitchell K. , Evans Peter J. , Estes Kelly , Spindler Kurt P. , Mroz Thomas , Patterson Brendan M. , Krebs Viktor E. , Pinney Stephen , Piuzzi Nicolas S. , Schaffer Jonathan L. 
Published: November 2020

Virtual encounters have experienced an exponential rise amid the current COVID-19 crisis. This abrupt change, seen in response to unprecedented medical and environmental challenges, has been forced upon the orthopaedic community. However, such changes to adopting virtual care and technology were already in the evolution forecast, albeit in an unpredictable timetable impeded by regulatory and financial barriers. This adoption is not meant to replace, but rather augment established, traditional models of care while ensuring patient/provider safety, especially during the pandemic. While our department, like those of other institutions, has performed virtual care for several years, it represented a small fraction of daily care. The pandemic required an accelerated and comprehensive approach to the new reality. Contemporary literature has already shown equivalent safety and patient satisfaction, as well as superior efficiency and reduced expenses with musculoskeletal virtual care (MSKVC) versus traditional models. Nevertheless, current literature detailing operational models of MSKVC is scarce. The current review describes our pre-pandemic MSKVC model and the shift to a MSKVC pandemic workflow that enumerates the conceptual workflow organization (patient triage, from timely care provision based on symptom acuity/severity to a continuum that includes future follow-up). Furthermore, specific setup requirements (both resource/personnel requirements such as hardware, software, and network connectivity requirements, and patient/provider characteristics respectively), and professional expectations are outlined. MSKVC has already become a pivotal element of musculoskeletal care, due to COVID-19, and these changes are confidently here to stay. Readiness to adapt and evolve will be required of individual musculoskeletal clinical teams as well as organizations, as established paradigms evolve. Cite this article: Bone Joint Open 2020;1-6:272–280.
Inpatient and outpatient opioid requirements after total joint replacement are strongly influenced by patient and surgical factors
Authors: Roebke Austin J. , Via Garrhett G. , Everhart Joshua S. , Munsch Maria A. , Goyal Kanu S. , Glassman Andrew H. , Li Mengnai 
Published: November 2020

Aims Currently, there is no single, comprehensive national guideline for analgesic strategies for total joint replacement. We compared inpatient and outpatient opioid requirements following total hip arthroplasty (THA) versus total knee arthroplasty (TKA) in order to determine risk factors for increased inpatient and outpatient opioid requirements following total hip or knee arthroplasty. Methods Outcomes after 92 primary total knee (n = 49) and hip (n = 43) arthroplasties were analyzed. Patients with repeat surgery within 90 days were excluded. Opioid use was recorded while inpatient and 90 days postoperatively. Outcomes included total opioid use, refills, use beyond 90 days, and unplanned clinical encounters for uncontrolled pain. Multivariate modelling determined the effect of surgery, regional nerve block (RNB) or neuraxial anesthesia (NA), and non-opioid medications after adjusting for demographics, ength of stay, and baseline opioid use. Results TKAs had higher daily inpatient opioid use than THAs (in 5 mg oxycodone pill equivalents: median 12.0 vs 7.0; p < 0.001), and greater 90 day use (median 224.0 vs 100.5; p < 0.001). Opioid refills were more likely in TKA (84% vs 33%; p < 0.001). Patient who underwent TKA had higher independent risk of opioid use beyond 90 days than THA (adjusted OR 7.64; 95% SE 1.23 to 47.5; p = 0.01). Inpatient opioid use 24 hours before discharge was the strongest independent predictor of 90-day opioid use (p < 0.001). Surgical procedure, demographics, and baseline opioid use have greater influence on in/outpatient opioid demand than RNB, NA, or non-opioid analgesics. Conclusion Opioid use following TKA and THA is most strongly predicted by surgical and patient factors. TKA was associated with higher postoperative opioid requirements than THA. RNB and NA did not diminish total inpatient or 90-day postoperative opioid consumption. The use of acetaminophen, gabapentin, or NSAIDs did not significantly alter inpatient opioid requirements. Cite this article: Bone Joint Open 2020;1-7:398–404.
30-day outcomes in hip fracture patients during the COVID-19 pandemic compared to the preceding year
Authors: Macey Alistair R. M. , Butler Joanna , Martin Sean C. , Tan Ting Yang , Leach William J. , Jamal Bilal 
Published: November 2020

Aims To establish if COVID-19 has worsened outcomes in patients with AO 31 A or B type hip fractures. Methods Retrospective analysis of prospectively collected data was performed for a five-week period from 20 March 2020 and the same time period in 2019. The primary outcome was mortality at 30 days. Secondary outcomes were COVID-19 infection, perioperative pulmonary complications, time to theatre, type of anaesthesia, operation, grade of surgeon, fracture type, postoperative intensive care admission, venous thromboembolism, dislocation, infection rates, and length of stay. Results In all, 76 patients with hip fractures were identified in each group. All patients had 30-day follow-up. There was no difference in age, sex, American Society of Anesthesiologists (ASA) classification or residence at time of injury. However, three in each group were not fit for surgery. No significant difference was found in 30-day mortality; ten patients (13%) in 2019 and 11 patients (14%) in 2020 (p = 0.341). In the 2020 cohort, ten patients tested positive for COVID-19, two (20%) of whom died. There was no significant increase in postoperative pulmonary complications. Median time to theatre was 20 hours (interquartile range (IQR) 16 to 25) in 2019 versus 23 hours (IQR 18 to 30) in 2020 (p = 0.130). Regional anaesthesia increased from 24 (33%) cases in 2019 to 46 (63%) cases in 2020, but ten (14%) required conversion to general anaesthesia. In both groups, 53 (70%) operations were done by trainees. Hemiarthroplasty for 31 B type fractures was the most common operation. No significant difference was found for intensive care admission or 30-day venous thromboembolism, dislocation or infection, or length of stay. Conclusion Little information exists on mortality and complications after hip fracture during the COVID-19 pandemic. At the time of writing, no other study of outcomes in the UK has been published. Cite this article: Bone Joint Open 2020;1-7:415–419.
Excess Mortality After Liver Transplantation in Young Women With Alcohol-Associated Liver Disease
Authors: Lee Brian P. , Dodge Jennifer L. , Terrault Norah A. 
Published: November 2020

INTRODUCTION:
Young adults with alcohol-associated liver disease (ALD) are the fastest increasing demographic contributing to liver-related deaths; their outcomes after liver transplantation (LT) are understudied.

METHODS:
Using the United Network for Organ Sharing registry, we performed sex-specific analyses because of a significant interaction between sex and the explanatory variable, age. Cox regression was used with overall post-LT death as the primary outcome, adjusted for survival characteristics and center clustering. We calculated the absolute difference in adjusted 5-year post-LT survival between patient groups. Causes of death were supplemented by manual review of free-text entries.

RESULTS:
Among 42,014 LT recipients, 16,190 women (2,782 with ALD and 13,408 without ALD) and 25,824 men (9,502 with ALD and 16,322 without ALD), age of 40–50 years had the lowest risk of death. Women with ALD younger than 40 years had incrementally lower adjusted 5-year survival (95% confidence interval): 74% (63%–88%) for those aged 18–29 years, 82% (78%–87%) for those aged 30–39 years, and 90% (88%–92%) for those aged 40–49 years. Among women without ALD, men with ALD, and men without ALD, adjusted 5-year survival for ages 18–29, 30–39, and 40–49 years was similar. Among women, not men, there were significant interactions between younger age and ALD. Adjusted hazard for mortality for women with ALD vs without ALD was greater for those who aged 18–29 years (2.82 vs 1.09, P = 0.002) and 30–39 years (1.83 vs 1.09, P = 0.007 [reference age 40–49 years]). Among women with ALD, those aged 18–29 and 30–39 years had an absolute 17.7% and 9.5% excess in adjusted 5-year mortality vs similarly aged women without ALD.

DISCUSSION:
Young women (age < 40) with ALD have excess mortality beyond one-year post-LT. Recurrent disease or explicit mention of alcohol was the most common identified cause of death in this demographic.
Ochrana prírody, krajiny a životného prostredia a jej spoločenská reflexia na Slovensku v r. 1990 – 2020
Authors: Huba Mikuláš 
Published: November 2020

Slovenská príroda, krajina a životné prostredie, ako aj organizácie a iniciatívy na ich ochranu prešli za uplynulých 30 rokov zložitým vývojom. Podobne zložito sa vyvíjala aj percepcia tejto problematiky zo strany verejnosti. Vari najvýstižnejšie sa dá tento vývoj charakterizovať slovíčkom nejednoznačný. Pokrok pri znižovaní znečistenia ovzdušia, vôd a ďalších zložiek životného prostredia sprevádzala bezprecedentná neúcta k iným jeho zložkám, najmä k zeleni a úrodným orným pôdam, celkové dlhodobé podfinancovanie starostlivosti o ŽP a zaostávanie v budovaní environmentálnej infraštruktúry (najmä kanalizácií a čistiarní odpadových vôd) ako aj riešenia problematiky starých environmentálnych záťaží.
Príspevok sa zameriava na stručnú charakteristiku stavu a vývoja jednotlivých zložiek životného prostredia, úspechy a neúspechy pri ich ochrane, ako aj na úlohu jednotlivých aktérov tohto procesu. Súčasťou príspevku sú aj výsledky niektorých výskumov, zameraných na reflexiu tejto problematiky zo strany verejnosti.
Morphodynamic conditions of heavy metal concentration in deposits of the Vistula River valley near Kępa Gostecka (central Poland)
Authors: Kałmykow-Piwińska Agnieszka , Falkowska Ewa 
Published: November 2020

Abstract
The influence of morphodynamics of individual river valley zones on the anthropogenically induced distribution of heavy metals in the Małopolska Gorge of the Vistula River near Kępa Gostecka was studied. Based on the analysis of cartographic and geological mapping data, several floodplain features were distinguished. For each feature, lithological analysis of the deposits was carried out. It comprised determination of clay content, organic matter, carbonates and iron oxides and hydroxides, as well as analysis of heavy metal concentration. The investigations show that the concentration of heavy metals in floodplain surface deposits is strictly linked with the variability of depositional environments, which reflected in the intricate feature pattern. The highest contents of heavy metals have been found in the deposits of the contemporary floodplain, stagnation zones of floodwaters, oxbow lakes buried under floodplain or organic deposits and escarpment foot back swamps, while the lowest in deposits of the Pleistocene terrace and slope wash zones. Variability of floodwater dynamics modelling the floodplain surface is associated with the specific geological setting of the Vistula River valley stretch analysed.
Accuracy and functional assessment of an original low-cost fibre-based inclinometer designed for structural monitoring
Authors: Ćmielewski Kazimierz , Karsznia Krzysztof , Kuchmister Janusz , Gołuch Piotr , Wilczyńska Izabela 
Published: November 2020

Abstract
Safe exploitation of a building requires constant monitoring of both the object itself as well as its surrounding through the monitoring system. These tasks find particular applications when operating large construction projects, especially in urbanised areas. Besides the warning function and undertaking reactions, the monitoring system allows for recording changes in object geometries to assess their stability. To conduct monitoring, various sensors and instruments that work within the applied measuring systems can be used. As an example, one can mention precise inclinometers (‘electronic bubbles’) allowing for accurate determination of inclination angles. The paper discusses the precision and functional aspect of the original inclinometer developed and improved by the authors. The working principle of the device is based on optical fibres, light projection and its detection on a CCD camera objective. The presented issue is a low-cost solution offering high measurement accuracy, which may be used in structural monitoring of objects located in the impact zone of a deep excavation or other nearby ongoing investments.
The impacts of diagenetic facies on reservoir quality in tight sandstones
Authors: Ren Dazhong , Sun Liang , Li Rongxi , Liu Dengke 
Published: November 2020

Abstract
The impact of diagenetic minerals and the characteristics of pore structures on reservoir qualities has been studied separately in the past years. However, the difference in the reservoir quality with different pore structures and having same or similar content of diagenesis minerals has not been ascertained. In this study, based on the core samples derived from Chang 6 member in the Ordos basin, various tests were performed to examine the sandstone diagenesis and investigate the pore structure. The results showed that there were five diagenetic facies by diagenetic and pore structure analyses, and the best reservoir quality rocks were found to have relatively low percentage of illite, carbonate cement, pore-filling chlorite, authigenic quartz, and relatively high proportion of intergranular pores. Smectite-to-illite reaction and chemical compaction were main sources for quartz cementation at 60–120°C, and carbonate content was found to increase toward source rocks. The porosity depth trends significantly affected the diagenetic facies. The diagenetic and the pore structure pathways of various diagenetic facies were reconstructed by integrated petrographic, mineralogical, and pore system data. This study provides insights into the porosity evolution and diagenetic pathways of various diagenetic facies of tight sandstones, and the influence of diagenesis minerals and pore structures on their reservoir quality.