bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modelling the lifetime cost-effectiveness of radical prostatectomy, radiotherapy and active monitoring for men with clinically localised prostate cancer from median 10-year outcomes in the ProtecT randomised trial
Authors: Sanghera S. , Mohiuddin S. , Coast J. , Garfield K. , Noble S. , Metcalfe C. , Lane J. A. , Turner E. L. , Neal D. , Hamdy F. C. , Martin R. M. , Donovan J. L. ,   for the ProtecT study group, Bollina Prasad , Doble Andrew , Doherty Alan , Gillatt David , Gnanapragasam Vincent , Hughes Owen , Kockelbergh Roger , Kynaston Howard , Paul Alan , Paez Edgar , Rowe Edward 
Published: October 2020

Abstract
Background
Optimal management strategies for clinically localised prostate cancer are debated. Using median 10-year data from the largest randomised controlled trial to date (ProtecT), the lifetime cost-effectiveness of three major treatments (radical radiotherapy, radical prostatectomy and active monitoring) was explored according to age and risk subgroups.

Methods
A decision-analytic (Markov) model was developed and informed by clinical input. The economic evaluation adopted a UK NHS perspective and the outcome was cost per Quality-Adjusted Life Year (QALY) gained (reported in UK£), estimated using EQ-5D-3L.

Results
Costs and QALYs extrapolated over the lifetime were mostly similar between the three randomised strategies and their subgroups, but with some important differences. Across all analyses, active monitoring was associated with higher costs, probably associated with higher rates of metastatic disease and changes to radical treatments.
When comparing the value of the strategies (QALY gains and costs) in monetary terms, for both low-risk prostate cancer subgroups, radiotherapy generated the greatest net monetary benefit (£293,446 [95% CI £282,811 to £299,451] by D’Amico and £292,736 [95% CI £284,074 to £297,719] by Grade group 1). However, the sensitivity analysis highlighted uncertainty in the finding when stratified by Grade group, as radiotherapy had 53% probability of cost-effectiveness and prostatectomy had 43%. In intermediate/high risk groups, using D’Amico and Grade group > = 2, prostatectomy generated the greatest net monetary benefit (£275,977 [95% CI £258,630 to £285,474] by D’Amico and £271,933 [95% CI £237,864 to £287,784] by Grade group). This finding was supported by the sensitivity analysis.
Prostatectomy had the greatest net benefit (£290,487 [95% CI £280,781 to £296,281]) for men younger than 65 and radical radiotherapy (£201,311 [95% CI £195,161 to £205,049]) for men older than 65, but sensitivity analysis showed considerable uncertainty in both findings.

Conclusion
Over the lifetime, extrapolating from the ProtecT trial, radical radiotherapy and prostatectomy appeared to be cost-effective for low risk prostate cancer, and radical prostatectomy for intermediate/high risk prostate cancer, but there was uncertainty in some estimates. Longer ProtecT trial follow-up is required to reduce uncertainty in the model.

Trial registration
Current Controlled Trials number, ISRCTN20141297: http://isrctn.org (14/10/2002); ClinicalTrials.gov number, NCT02044172: http://www.clinicaltrials.gov (23/01/2014).
Short-term changes in the anterior segment and retina after small incision lenticule extraction
Authors: Chen Yanwei , Liao Huaping , Sun Yue , Shen Xi 
Published: October 2020

Abstract
Background
To analyse short-term changes in the anterior segment and retina after small incision lenticule extraction (SMILE).

Methods
Patients with myopia scheduled for SMILE were recruited from Ruijin Hospital, Shanghai, China. Basic patient information such as age, sex, and refractive errors was recorded. Ocular measurements were taken before surgery, and 1 day and 1 week after surgery; they included axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white to white (WTW), pupil diameter (PD), macular thickness (MT), ganglion cell layer thickness (GCL), retinal nerve fiber layer thickness (RNFL), choroidal thickness (CT), macular vessel density, and optic disc vessel density.

Results
Sixty-one eyes of 31 patients were selected for this study. AL, CCT, ACD, and postoperative PD were significantly reduced (p < 0.05), while LT was thickened after surgery (p < 0.05). MT at the fovea decreased 1 day and 1 week after surgery (p < 0.05). GCL showed no significant changes after surgery. RNFL was unchanged 1 day after surgery, but the inferior sector was thickened 1 week after surgery. CT was thicker at the fovea 1 day after surgery and 1.0 mm from the fovea in the nasal sector 1 week after surgery. Macular vessel density was significantly decreased 1 day after surgery and most recovered in 1 week. Optic disc vessel density decreased at the peripapillary part 1 day after surgery and recovered after 1 week. ΔACD and ΔLT showed no significant correlation 1 day after surgery. ΔACD was negatively correlated with ΔLT and sphere 1 week after surgery (r = − 0.847, p < 0.000; r = − 0.398, p = 0.002). ΔLT was positively correlated with the sphere 1 week after surgery (r = 0.256, p = 0.048).

Conclusion
The anterior segment was the most affected, while the retina also underwent changes with regard to MT, RNFL, CT, macular vessel density, and peripapillary vessel density.
A case of tractional retinal detachment associated with congenital retinal vascular hypoplasia in the superotemporal quadrant treated by vitreous surgery
Authors: Miyamoto Tomomi , Kobayashi Takatoshi , Kida Teruyo , Sato Takaki , Fukumoto Masanori , Ikeda Tsunehiko 
Published: October 2020

Abstract
Background
Here we report a case of traction retinal detachment (TRD) associated with congenital retinal vascular hypoplasia localized in the superotemporal quadrant that was treated with vitrectomy.

Case presentations
A 58 year-old female presented with a gradual decrease of visual acuity (VA) and distorted vision in her left eye. She had a past history of amblyopia in her left eye from early childhood, and a previous examination performed at a nearby hospital revealed that the corrected visual acuity (VA) in that eye was 0.15. Upon initial examination, no abnormal findings were observed in her right eye, yet optic-disc traction and macular rotation with a folded TRD extending superotemporally from the macular region was observed in her left eye. Fluorescein fundus angiography showed a retinal nonperfused area localized in the superotemporal quadrant surrounded by a retinal avascular area. The optic disc in her left eye was smaller than that in her right eye. Vitrectomy was performed to remove the proliferative membrane and created an artificial posterior vitreous detachment (PVD). Following surgery, the patient’s corrected VA improved from 0.04 to 0.1.

Conclusions
The present case was likely to be TRD caused by PVD in the presence of localized congenital retinal vascular hypoplasia secondary to optic-disc hypoplasia.
A scoping review of physical activity and screen time guidelines for use in Outside School Hours Care
Authors: Virgara Rosa , Lewis Lucy , Phillips Anna , Richardson Mandy , Maher Carol 
Published: October 2020

Abstract
Background
Globally, millions of children attend Outside School Hours Care. Children’s activity in this setting is critical to meeting daily physical activity recommendations. Guidelines are evidence-based statements intended to optimise practice. This study aimed to identify guidelines used in Outside School Hours Care for physical activity and screen time and summarise their content and methods of development.

Methods
Outside School Hours Care guidelines for children aged 5 to 12 years were identified by systematically searching Medline, Emcare, Embase, Scopus, ERIC, Sportsdiscus, TROVE, ProQuest, UpToDate, NICE, SIGN and Google in accordance with PRISMA-ScR guidelines. The search was conducted in March 2019 and results screened independently by two authors. Data were synthesized narratively.

Results
Nine guideline documents were identified from grey literature only (n = 8 USA, n = 1 Canada). The included guidelines focused predominantly on the after school care period (n = 9 vs n = 2 for the before school period). All had recommendations for physical activity, whilst 7 included screen time recommendations. There was considerable variability across the physical activity and screen time recommendations, though taken together, they recommended 30–60 min of moderate- to- vigorous physical activity and less than 60 min of recreational screen time per session. All guidelines were developed by expert/stakeholder panels, but none followed rigorous guideline development methods.

Conclusions
Limited published guidelines for physical activity and screen time in Outside School Hours Care exist. There is a variation in duration and intensity of physical activity recommended, whilst screen time recommendations are more consistent. Guidelines designed with rigorous tools and for other world regions are warranted.
Effects of guided counseling during pregnancy on birth weight of newborns in West Gojjam Zone, Ethiopia: a cluster-randomized controlled trial
Authors: Demilew Yeshalem Mulugeta , Alene Getu Degu , Belachew Tefera 
Published: October 2020

Abstract
Background
The high proportion of birth weight in Ethiopia is hypothesized to be due to inadequate maternal diet which is associated with poor nutrition education during pregnancy. There was no study that evaluated the effect of nutrition education on birth weight in the study area. This study aimed to assess the effects (overall, direct and indirect effects) of guided counseling on the birth weight of neonates.

Methods
A two-arm parallel cluster randomized controlled community trial was conducted from May 1, 2018, to April 30, 2019, in West Gojjam Zone, Northwest Ethiopia. At the baseline, 346 pregnant women in the 11 intervention clusters and 348 pregnant women in the 11 control clusters were recruited. However, birth weight was measured from 258 and 272 newborns in the intervention and control groups, respectively.
In the intervention group, counseling was given monthly for four consecutive months in the participant’s homes. Besides, leaflets with key counseling messages were distributed to each woman in the intervention arm. Pregnant women who attended routine nutrition education given by the health system were recruited as control. Dietary practice, nutritional status, and birth weight were the primary, secondary and tertiary outcomes of this intervention. Data were collected using a structured data collection tool. Birth weight was measured within 48 h after birth. Independent sample t-test, linear mixed-effects model, and path analysis were fitted to assess effects of the intervention.

Results
The intra-cluster correlation coefficient was 0.095. The average birth weight of newborns in the intervention group was 0.257 kg higher compared with their counterparts in the control arm (β = 0.257, P < 0.001). The direct effect of this intervention on birth weight was 0.17 (β = 0.17, P<0.001 ) whereas the indirect effect of this intervention was 0.08 (β = 0.08, P<0.001 ).

Conclusion
Counseling using the health belief model and the theory of planned behavior has a positive effect on improving birth weight. The findings suggest the need for enhancing nutrition education of pregnant women through the application of theories to improve birth weight.

Trial registration
Clinical Trials.gov NCT03627156, “Retrospectively registered Jun, 13, 2018”.
An exploratory study investigating the effect of foot type and foot orthoses on gluteus medius muscle activity
Authors: Sadler Sean , Spink Martin , de Jonge Xanne Janse , Chuter Vivienne 
Published: October 2020

Abstract
Background
Abnormal gluteus medius muscle activity is associated with a number of musculoskeletal conditions. Research investigating the effect of foot type and foot orthoses on gluteus medius muscle activity is both conflicting and limited. The primary aim was to investigate the relationship between foot type and gluteus medius muscle activity during shod walking. The secondary aims of this study were to explore the effect and amount of usage of a pair of unmodified prefabricated foot orthoses on gluteus medius muscle activity during shod walking.

Methods
Foot type was determined using the foot posture index and gluteus medius muscle activity was measured with surface electromyography in 50 healthy adults during shod walking. Participants were then fitted with prefabricated foot orthoses and required to return after 4 weeks. Pearson’s correlation and one-way ANOVA were used to determine effect of foot type. Paired t-tests and ANCOVA were used to determine effect of foot orthoses.

Results
Participants with a cavus foot type demonstrated significantly more gluteus medius mean (p = 0.04) and peak amplitude (p = 0.01), and a greater range in amplitude (p = 0.01) compared to participants with a neutral foot type. Compared to a planus foot type, participants with a cavus foot type demonstrated significantly larger mean (p = 0.02) and peak amplitude (p = 0.01), and a greater range in amplitude (p = 0.01). Prefabricated foot orthoses did not change the gluteus medius muscle activity.

Conclusion
When assessing healthy adults with a cavus foot type, clinicians and researchers should be aware that these participants may display higher levels of gluteus medius muscle activity during gait compared to neutral and planus type feet. Additionally, clinicians and researchers should be aware that the type of prefabricated foot orthoses used did not change gluteus medius muscle activity over 4 weeks. Future research should aim to explore this relationship between foot type and gluteus medius muscle activity in larger sample sizes, consider the potential role of other lower extremity muscles and biomechanical variables, and investigate if these findings also occur in people with pathology.
Two-component surface replacement implants compared with perichondrium transplantation for restoration of Metacarpophalangeal and proximal Interphalangeal joints: a retrospective cohort study with a mean follow-up time of 6 respectively 26 years
Authors: Muder Daniel , Hailer Nils P. , Vedung Torbjörn 
Published: October 2020

Abstract
Background
The aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints.

Methods
We evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint.

Results
The median follow-up time was 6 years (0–21) for the SR implants and 26 years (1–37) for the perichondrium transplants. Median age at index surgery was 64 years (24–82) for SR implants and 45 years (18–61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4–100.0) than in the SR implant group (75%; CI 53.8–96.1), but not statistically significantly so (p = 0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55–100) than in the SR implant group (74.7%; CI 66.6–82.7), but below the threshold of statistical significance (p = 0.8).

Conclusion
In conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants.

Level of evidence
III (Therapeutic).
Comparison of robot-assisted retroperitoneal laparoscopic adrenalectomy versus retroperitoneal laparoscopic adrenalectomy for large pheochromocytoma: a single-centre retrospective study
Authors: Fu Sheng-Qiang , Zhuang Chang-Shui , Yang Xiao-Rong , Xie Wen-Jie , Gong Bin-Bin , Liu Yi-Fu , Liu Ji , Sun Ting , Ma Ming 
Published: October 2020

Abstract
Background
To evaluate the feasibility and safety of robot-assisted retroperitoneal laparoscopic adrenalectomy (RARLA) for large pheochromocytomas (PHEOs; size≥6 cm) compared with retroperitoneal laparoscopic adrenalectomy (RLA).

Methods
Fifty-one patients who underwent adrenalectomy for large PHEOs between March 2016 and January 2019 were enrolled and divided into two groups, including 32 RLA cases and 19 RARLA cases. We compared the perioperative efficacy and long-term follow-up results between the two groups.

Results
Preoperative data, including demographics, comorbidities and tumour characteristics, were similar between the groups. Intraoperatively, the RARLA group had a lower incidence of haemodynamic instability (26.3% vs. 56.2%, P = 0.038) and less intraoperative blood loss (100 ml vs. Two hundred milliliter, P = 0.042) than the RLA group. The groups showed no significant differences in operative time or transfusion rates. Postoperatively, the time to diet resumption, time to ambulation, time to drainage removal and postoperative hospital stay were shorter in the RARLA group than in the RLA group (1 d vs. 2 d, P = 0.027; 1 d vs. 2 d, P = 0.034; 3 d vs. 5 d, P = 0.002; 5 d vs. 6 d, P = 0.02, respectively). The groups exhibited no significant differences in the duration of anaesthetic use, complications, or long-term follow-up results for the blood pressure (BP) improvement rate.

Conclusions
Compared with RLA, RARLA is a safe, feasible and even optimized procedure for large PHEOs.
Robotic adrenalectomy in the pediatric population: initial experience case series from a tertiary center
Authors: Mitra Anirban P. , Vasquez Evalynn , Kokorowski Paul , Chang Andy Y. 
Published: October 2020

Abstract
Background
Laparoscopic resection is the most well described minimally-invasive approach for adrenalectomy. While it allows for improved cosmesis, faster recovery and decreased length of hospital stay compared with the open approach, instrument articulation limitations can hamper surgical dexterity in pediatric patients. Use of robotic assistance can greatly enhance operative field visualization and instrument control, and is in the early stages of adoption in academic centers for pediatric populations.

Case presentation
We present a single-institution series of pediatric adrenalectomy cases. The da Vinci Xi surgical system was used to perform adrenalectomies on three consecutive patients (ages, 2–13 years) at our center. Final pathology revealed ganglioneuroblastoma (n = 2) and pheochromocytoma (n = 1). Median operating time was 244 min (range, 244–265 min); median blood loss was estimated at 100 ml (range, 15–175 ml). Specimens were delivered intact and all margins were negative. Median post-operative hospital stay was 2 days (range, 1–6 days). All patients remain disease-free at median follow-up of 19 months (range, 12–30 months).

Conclusion
Our experience continues to evolve, and suggests that robotic surgery is safe, feasible and oncologically effective for resection of adrenal masses in well-selected pediatric patients.
Dynamics of forage and land cover changes in Teltele district of Borana rangelands, southern Ethiopia: using geospatial and field survey data
Authors: Fenetahun Yeneayehu , Yong-dong Wang , You Yuan , Xinwen Xu 
Published: October 2020

Abstract
Background
The gradual conversion of rangelands into other land use types is one of the main challenges affecting the sustainable management of rangelands in Teltele. This study aimed to examine the changes, drivers, trends in land use and land cover (LULC), to determine the link between the Normalized Difference Vegetation Index (NDVI) and forage biomass and the associated impacts of forage biomass production dynamics on the Teltele rangelands in Southern Ethiopia. A Combination of remote sensing data, field interviews, discussion and observations data were used to examine the dynamics of LULC between 1992 and 2019 and forage biomass production.

Results
The result indicate that there is a marked increase in farm land (35.3%), bare land (13.8%) and shrub land (4.8%), while the reduction found in grass land (54.5%), wet land (69.3%) and forest land (10.5%). The larger change in land observed in both grassland and wetland part was observed during the period from 1995–2000 and 2015–2019, this is due to climate change impact (El-Niño) happened in Teltele rangeland during the year 1999 and 2016 respectively. The quantity of forage in different land use/cover types, grass land had the highest average amount of forage biomass of 2092.3 kg/ha, followed by wetland with 1231 kg/ha, forest land with 1191.3 kg/ha, shrub land with 180 kg/ha, agricultural land with 139.5 kg/ha and bare land with 58.1 kg/ha.

Conclusions
The significant linkage observed between NDVI and LULC change types (when a high NDVI value, the LULC changes also shows positive value or an increasing trend). In addition, NDVI value directly related to the greenness status of vegetation occurred on each LULC change types and its value directly linkage forage biomass production pattern with grassland land use types. 64.8% (grass land), 43.3% (agricultural land), 75.1% (forest land), 50.6% (shrub land), 80.5% (bare land) and 75.5% (wet land) more or higher dry biomass production in the wet season compared to the dry season.
Reference letters for subspecialty medicine residency positions: are they valuable for decision-making? Results from a Canadian study
Authors: Chopra Deepti , Joneja Mala , Sandhu Gurjit , Smith Christopher A. , Spagnuolo Catherine M. , Hookey Lawrence 
Published: October 2020

Abstract
Background
The letter of recommendation is currently an integral part of applicant selection for residency programs. Internal medicine residents will spend much time and expense completing sub-specialty away electives to obtain a letter of recommendation. The purpose of this study was 1) to examine a large sample of reference letters in order to define essential components of a high-quality letter, and 2) to elucidate the relationship between quality of reference letter and the letter writer.

Methods
We conducted a two-phase study. In phase one, a large sample of letters of recommendation was examined using an audit tool as a coding framework. A 5-point composite endpoint of high-quality letter components was subsequently developed. In phase two, program director letters were compared to non-program director home institution and non-home institution elective letters based on inclusion of components of the 5-point composite endpoint using Chi square testing.

Results
715 letters were examined (398 non-program director home institution letters, 201 program director letters, and 116 non-home institution elective letters). High-quality letter components were: nature of relationship, duration of relationship, In Training Evaluation Report information, research involvement and comments on areas for improvement. Program director letters had a significantly higher proportion (10.4%) of all 5 high-quality components, compared to 0% in both non-program director home institution letters and elective letters (p < 0.001). A significantly higher proportion of program director letters had 4–5 high-quality components (62.5%) compared to 2% of non-program director home institution letters and 0% of elective letters (p < 0.0001).

Conclusions
Letters of recommendation from elective rotations are of the poorest quality and such rotations should not be pursued for the sole purpose of obtaining a letter. The low quality of elective letters leads to the recommendation that writers should decline to write them, programs should not require them and trainees should not request them. Program directors write the highest quality letters and should be a resource for faculty development. Clinical supervisors can use the 5-point composite endpoint as a guide when writing letters for applicants.