bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early experience and patient-reported outcomes of 503 INFINITY total ankle arthroplasties
Authors: Townshend David N. , Bing Andrew J. F. , Clough Timothy M. , Sharpe Ian T. , Goldberg Andy ,   On behalf of the UK INFINITY study group
Published: July 2021

Aims This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. Methods Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence. Results In all, 500 patients reached six-month follow-up, 420 reached one-year follow-up, and 188 reached two-year follow-up. The mean age was 67.8 years (23.9 to 88.5). A total of 38 patients (7.5%) presented with inflammatory arthritis. A total of 101 (20.0%) of implantations used patient-specific instrumentation; 167 patients (33.1%) underwent an additional procedure at the time of surgery. A total of seven patients died of unrelated causes, two withdrew, and one was lost to follow-up. The mean follow-up was 16.2 months (6 to 36). There was a significant improvement from baseline across all functional outcome scores at six months, one, and two years. There was no significant difference in outcomes with the use of patient-specific instrumentation, type of arthritis, or COFAS type. Five (1.0%) implants were revised. The overall complication rate was 8.8%. The non-revision reoperation rate was 1.4%. The 30-day readmission rate was 1.2% and the one-year mortality 0.74%. Conclusion The early experience and complications reported in this study support the current use of the INFINITY TAA as a safe and effective implant in the treatment of end-stage ankle arthritis. Cite this article: Bone Joint J 2021;103-B(7):1270–1276.
2021 John Charnley Award: A protocol-based strategy when using hemiarthroplasty or total hip arthroplasty for femoral neck fractures decreases mortality, length of stay, and complications
Authors: Roberts Heather J. , Barry Jeffrey , Nguyen Kevin , Vail Thomas , Kandemir Utku , Rogers Stephanie , Ward Derek 
Published: July 2021

Aims While interdisciplinary protocols and expedited surgical treatment improve the management of hip fractures in the elderly, the impact of such interventions on patients specifically undergoing arthroplasty for a femoral neck fracture is not clear. We sought to evaluate the efficacy of an interdisciplinary protocol for the management of patients with a femoral neck fracture who are treated with an arthroplasty. Methods In 2017, our institution introduced a standardized interdisciplinary hip fracture protocol. We retrospectively reviewed adult patients who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) for femoral neck fracture between July 2012 and March 2020, and compared patient characteristics and outcomes between those treated before and after the introduction of the protocol. Results A total of 157 patients were treated before the introduction of the protocol (35 (22.3%) with a THA), and 114 patients were treated after its introduction (37 (32.5%) with a THA). The demographic details and medical comorbidities were similar in the two groups. Patients treated after the introduction of the protocol had a significantly reduced median time between admission and surgery (22.8 hours (interquartile range (IQR) 18.8 to 27.7) compared with 24.8 hours (IQR 18.4 to 43.3) (p = 0.042), and a trend towards a reduced mean time to surgery (24.1 hours (SD 10.7) compared with 46.5 hours (SD 165.0); p = 0.150), indicating reduction in outliers. Patients treated after the introduction of the protocol had a significantly decreased rate of major complications (4.4% vs 17.2%; p = 0.005), decreased median hospital length of stay in hospital (4.0 days vs 4.8 days; p = 0.008), increased rate of discharge home (26.3% vs 14.7%; p = 0.030), and decreased one-year mortality (14.7% vs 26.3%; p = 0.049). The 90-day readmission rate (18.2% vs 21.7%; p = 0.528) and 30-day mortality (3.7% vs 5.1%; p = 0.767) did not significantly differ. Patients who underwent HA were significantly older than those who underwent THA (82.1 years (SD 10.4) vs 71.1 years (SD 9.5); p < 0.001), more medically complex (mean Charlson Comorbidity Index 6.4 (SD 2.6) vs 4.1 (SD 2.2); p < 0.001), and more likely to develop delirium (8.5% vs 0%; p = 0.024). Conclusion The introduction of an interdisciplinary protocol for the management of elderly patients with a femoral neck fracture was associated with reduced time to surgery, length of stay, complications, and one-year mortality. Such interventions are critical in improving outcomes and reducing costs for an ageing population. Cite this article: Bone Joint J 2021;103-B(7 Supple B):3–8.
Assessment of referral complexity and case acceptance for NHS hospital orthodontic treatment
Authors: Sedgwick Matthew , Nirmal Heena , Bhamrah Gurprit 
Published: July 2021

Introduction NHS orthodontic service provision is restricted to those who present with the highest level of need. By auditing the complexity of referrals received and assessing those accepted by a hospital orthodontic department for treatment, we can quality assure the processes in place and demonstrate compliance with commissioning guidelines. Methods This was a prospective audit carried out over a 12-month period to assess referrals received between March 2019 and February 2020. The participants were all patients referred to the hospital orthodontic department. The index of orthodontic treatment need (IOTN) and index of orthognathic functional treatment need (IOFTN) were recorded, and an evaluation of treatment complexity was made according to current commissioning guidance. The standard set was that ≥80% of patients accepted for treatment should be complexity level 3b. Results A total of 610 patients were seen, with 597 referrals included in the dataset. Thirteen referrals (2%) were excluded owing to missing information. Just under two-thirds (60%) of referrals came from specialist orthodontists in practice, 34% from general dental practitioners, 3% from community dental services and 3% from other hospitals. Over half (56%) were IOTN grade 5, 32% were grade 4, 9% were grade 3 and 3% were grade 2. The majority (79%) of cases met complexity level 3b, 18% were level 3a and 4% were level 2. Overall, 33% were accepted for secondary care and 96% of these met complexity level 3b with 4% at level 3a. Conclusions The gold standard for case acceptance in secondary care was met. This audit demonstrates that cases of appropriate complexity are being accepted for treatment in our department, including training cases for specialty trainees.
Delivery routes in pregnancy with COVID-19 and the risk of intrapartum vertical transmission: a meta-analysis
Authors: Sarastry Razmaeda , Layarta Crismanto , Aladini Ussisti , Pramono Besari Adi 
Published: July 2021

BACKGROUND Mode of delivery has become an important highlight in managing pregnancy with coronavirus disease 2019 (COVID-19) due to the possible risk of viral transmission from mother to baby, especially during the peripartum period. This study aimed to review the mode of delivery and the possible risk of vertical transmission related to delivery routes in pregnant women with COVID-19.
METHODS Literature research was conducted using PubMed, Scopus, Embase, and EBSCO database with the following keywords: SARS-CoV-2, COVID-19, pregnancy, vertical transmission, and delivery. The extracted data were as follows: author, country, study design number of cases, maternal age, mode of delivery, and the SARS-CoV-2 status in neonates.
RESULTS Of 11 studies found, vaginal birth was reported in 218 cases (34.53%) and cesarean delivery was reported in 385 women (65.47%). The indication for cesarean delivery was majority due to COVID-19 related condition (53.61%). In total, 8 neonates who confirmed positive for COVID-19 by real-time polymerase chain reaction assay were reported. The pooled odds ratio (95% confidence interval) for SARS-CoV-2-positive neonates in cesarean delivery compared with vaginal birth was 0.622 (0.237–1.633) with p = 0.335.
CONCLUSIONS Cesarean delivery is more common than vaginal delivery in patient with SARS-CoV-2 infection. Any delivery route is not related to possible risk of intrapartum vertical transmission, and cesarean delivery should be carried out based on the obstetric indication.
Functional and structural analyses of novel Smith-Kingsmore Syndrome-Associated MTOR variants reveal potential new mechanisms and predictors of pathogenicity
Authors: Besterman Aaron D. , Althoff Thorsten , Elfferich Peter , Gutierrez-Mejia Irma , Sadik Joshua , Bernstein Jonathan A. , van Ierland Yvette , Kattentidt-Mouravieva Anja A. , Nellist Mark , Abramson Jeff , Martinez-Agosto Julian A. 
Published: July 2021

Smith-Kingsmore syndrome (SKS) is a rare neurodevelopmental disorder characterized by macrocephaly/megalencephaly, developmental delay, intellectual disability, hypotonia, and seizures. It is caused by dominant missense mutations in MTOR. The pathogenicity of novel variants in MTOR in patients with neurodevelopmental disorders can be difficult to determine and the mechanism by which variants cause disease remains poorly understood. We report 7 patients with SKS with 4 novel MTOR variants and describe their phenotypes. We perform in vitro functional analyses to confirm MTOR activation and interrogate disease mechanisms. We complete structural analyses to understand the 3D properties of pathogenic variants. We examine the accuracy of relative accessible surface area, a quantitative measure of amino acid side-chain accessibility, as a predictor of MTOR variant pathogenicity.
We describe novel clinical features of patients with SKS. We confirm MTOR Complex 1 activation and identify MTOR Complex 2 activation as a new potential mechanism of disease in SKS. We find that pathogenic MTOR variants disproportionately cluster in hotspots in the core of the protein, where they disrupt alpha helix packing due to the insertion of bulky amino acid side chains. We find that relative accessible surface area is significantly lower for SKS-associated variants compared to benign variants. We expand the phenotype of SKS and demonstrate that additional pathways of activation may contribute to disease. Incorporating 3D properties of MTOR variants may help in pathogenicity classification. We hope these findings may contribute to improving the precision of care and therapeutic development for individuals with SKS.
Sales of antibiotics and hydroxychloroquine in India during the COVID-19 epidemic: An interrupted time series analysis
Authors: Sulis Giorgia , Batomen Brice , Kotwani Anita , Pai Madhukar , Gandra Sumanth 
Published: July 2021

Background
We assessed the impact of the coronavirus disease 2019 (COVID-19) epidemic in India on the consumption of antibiotics and hydroxychloroquine (HCQ) in the private sector in 2020 compared to the expected level of use had the epidemic not occurred.

Methods and findings
We performed interrupted time series (ITS) analyses of sales volumes reported in standard units (i.e., doses), collected at regular monthly intervals from January 2018 to December 2020 and obtained from IQVIA, India. As children are less prone to develop symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we hypothesized a predominant increase in non-child-appropriate formulation (non-CAF) sales. COVID-19-attributable changes in the level and trend of monthly sales of total antibiotics, azithromycin, and HCQ were estimated, accounting for seasonality and lockdown period where appropriate. A total of 16,290 million doses of antibiotics were sold in India in 2020, which is slightly less than the amount in 2018 and 2019. However, the proportion of non-CAF antibiotics increased from 72.5% (95% CI: 71.8% to 73.1%) in 2019 to 76.8% (95% CI: 76.2% to 77.5%) in 2020. Our ITS analyses estimated that COVID-19 likely contributed to 216.4 million (95% CI: 68.0 to 364.8 million; P = 0.008) excess doses of non-CAF antibiotics and 38.0 million (95% CI: 26.4 to 49.2 million; P < 0.001) excess doses of non-CAF azithromycin (equivalent to a minimum of 6.2 million azithromycin treatment courses) between June and September 2020, i.e., until the peak of the first epidemic wave, after which a negative change in trend was identified. In March 2020, we estimated a COVID-19-attributable change in level of +11.1 million doses (95% CI: 9.2 to 13.0 million; P < 0.001) for HCQ sales, whereas a weak negative change in monthly trend was found for this drug. Study limitations include the lack of coverage of the public healthcare sector, the inability to distinguish antibiotic and HCQ sales in inpatient versus outpatient care, and the suboptimal number of pre- and post-epidemic data points, which could have prevented an accurate adjustment for seasonal trends despite the robustness of our statistical approaches.

Conclusions
A significant increase in non-CAF antibiotic sales, and particularly azithromycin, occurred during the peak phase of the first COVID-19 epidemic wave in India, indicating the need for urgent antibiotic stewardship measures.
Utilization of target lesion heterogeneity for treatment efficacy assessment in late stage lung cancer
Authors: Chen Dung-Tsa , Chan Wenyaw , Thompson Zachary J. , Thapa Ram , Beg Amer A. , Saltos Andreas N. , Chiappori Alberto A. , Gray Jhanelle E. , Haura Eric B. , Rose Trevor A. , Creelan Ben 
Published: July 2021

Rationale
Recent studies have discovered several unique tumor response subgroups outside of response classification by Response Evaluation Criteria for Solid Tumors (RECIST), such as mixed response and oligometastasis. These subtypes have a distinctive property, lesion heterogeneity defined as diversity of tumor growth profiles in RECIST target lesions. Furthermore, many cancer clinical trials have been activated to evaluate various treatment options for heterogeneity-related subgroups (e.g., 29 trials so far listed in clinicaltrials.gov for cancer patients with oligometastasis). Some of the trials have shown survival benefit by tailored treatment strategies. This evidence presents the unmet need to incorporate lesion heterogeneity to improve RECIST response classification.

Method
An approach for Lesion Heterogeneity Classification (LeHeC) was developed using a contemporary statistical approach to assess target lesion variation, characterize patient treatment response, and translate informative evidence to improving treatment strategy. A mixed effect linear model was used to determine lesion heterogeneity. Further analysis was conducted to classify various types of lesion variation and incorporate with RECIST to enhance response classification. A study cohort of 110 target lesions from 36 lung cancer patients was used for evaluation.

Results
Due to small sample size issue, the result was exploratory in nature. By analyzing RECIST target lesion data, the LeHeC approach detected a high prevalence (n = 21; 58%) of lesion heterogeneity. Subgroup classification revealed several informative distinct subsets in a descending order of lesion heterogeneity: mix of progression and regression (n = 7), mix of progression and stability (n = 9), mix of regression and stability (n = 5), and non-heterogeneity (n = 15). Evaluation for association of lesion heterogeneity and RECIST best response classification showed lesion heterogeneity commonly occurred in each response group (stable disease: 16/27; 59%; partial response: 3/5; 60%; progression disease: 2/4; 50%). Survival analysis showed a differential trend of overall survival between heterogeneity and non-heterogeneity in RECIST response groups.

Conclusion
This is the first study to evaluate lesion heterogeneity, an underappreciated metric, for RECIST application in oncology clinical trials. Results indicated lesion heterogeneity is not an uncommon event. The LeHeC approach could enhance RECIST response classification by utilizing granular lesion level discovery of heterogeneity.
Hospital admission for type 2 diabetes mellitus under the Universal Coverage Scheme in Thailand: A time- and geographical-trend analysis, 2009–2016
Authors: Laowahutanon Tanapat , Nakamura Haruyo , Tachimori Hisateru , Nomura Shuhei , Liabsuetrakul Tippawan , Lim Apiradee , Rawdaree Petch , Suchonwanich Netnapis , Yamamoto Hiroyuki , Ishizuka Aya , Shibuya Kenji , Miyata Hiroaki , Chongsuvivatwong Virasakdi 
Published: July 2021

Background
Descriptive analyses of 2009–2016 were performed using the data of the Universal Coverage Scheme (UCS) which covers nearly 70 percent of the Thai population. The analyses described the time and geographical trends of nationwide admission rates of type 2 diabetes mellitus (T2DM) and its complications, including chronic kidney disease (CKD), myocardial infarction, cerebrovascular diseases, retinopathy, cataract, and diabetic foot amputation.

Methods and findings
The database of T2DM patients aged 15–100 years who were admitted between 2009 and 2016 under the UCS and that of the UCS population were retrieved for the analyses. The admitted cases of T2DM were extracted from the database using disease codes of principal and secondary diagnoses defined by the International Classification of Diseases 9th and 10th Revisions. The T2DM admission rates in 2009–2016 were the number of admissions divided by the number of the UCS population. The standardized admission rates (SARs)were further estimated in contrast to the expected number of admissions considering age and sex composition of the UCS population in each region. A linearly increased trend was found in T2DM admission rates from 2009 to 2016. Female admission rates were persistently higher than that of males. In 2016, an increase in the T2DM admission rates was observed among the older ages relative to that in 2009. Although the SARs of T2DM were generally higher in Bangkok and central regions in 2009, except that with CKD and foot amputation which had higher trends in northeastern regions, the geographical inequalities were fairly reduced by 2016.

Conclusion
Admission rates of T2DM and its major complications increased in Thailand from 2009 to 2016. Although the overall geographical inequalities in the SARs of T2DM were reduced in the country, further efforts are required to improve the health system and policies focusing on risk factors and regions to manage the increasing T2DM.
A cross-sectional study of factors associated with unstable housing among marginalized people who use drugs in Ottawa, Canada
Authors: Rowlands Snyder Ellen C. , Boucher Lisa M. , Bayoumi Ahmed M. , Martin Alana , Marshall Zack , Boyd Rob , LeBlanc Sean , Tyndall Mark , Kendall Claire E. 
Published: July 2021

Introduction
Housing affects an individual’s physical and mental health, particularly among people who use substances. Understanding the association between individual characteristics and housing status can inform housing policy and help optimize the care of people who use drugs. The objective of this study was to explore the factors associated with unstable housing among people who use drugs in Ottawa.

Methods
This is a cross-sectional analysis of data from 782 participants in the Participatory Research in Ottawa: Understanding Drugs (PROUD) Study. PROUD is a prospective cohort study of people who use drugs in Ottawa. Between March and December 2013, participants were recruited through peer-based recruitment on the streets and in social services settings and completed a peer-administered questionnaire that explored socio-demographic information, drug use patterns, community integration, experiences with police and incarceration, and access to health care and harm reduction services. Eligibility criteria included age of 16 years or older, self-reported illicit drug use within the past 12 months and having lived in Ottawa for at least 3 months. Housing status was determined by self-report. “Stable housing” was defined as residence in a house or apartment and “unstable housing” was defined as all other residence types. Exploratory multivariable logistic regression analyses of the association between characteristics of people who use drugs and their housing status were conducted.

Results
Factors that were associated with unstable housing included: recent incarceration; not having a regular doctor; not having received support from a peer worker; low monthly income; income source other than public disability support payments; and younger age. Gender, language, ethnicity, education level, opioid use and injection drug use were not independently associated with housing status.

Conclusions
People who use drugs face significant barriers to stable housing. These results highlight key areas to address in order to improve housing stability among this community.
Libros expandidos: prácticas de lectura de fotocopias y pdfs en las clases de historia
Authors: Massone Marisa 
Published: July 2021

La mayoría de las investigaciones consideraron la lectura de textos escolares en la historia como disciplina escolar. Sin embargo, las fotocopias y pdf de libros de texto y de divulgación tienen hoy una presencia omnipresente entre los materiales de estudio, apoyo e investigación de los estudiantes. Son muy escasos los trabajos que han analizado sus particularidades como material educativo. Las fotocopias y los pdf, un soporte de lectura legitimado en las prácticas escolares, conforman “un nuevo tipo de existencia de libros” cada vez más extendido tanto por razones económicas como pedagógicas. ¿Qué características tienen estos “nuevos” materiales? ¿Cómo se leen fotocopias y pdf para enseñar historia? ¿Cuáles son los sentidos de estas prácticas de lectura? Este artículo analiza las particularidades de estos materiales y los modos y sentidos de las prácticas de lectura en la historia escolar en una investigación cualitativa asociada al paradigma interpretativo.
Gyermekireziliencia- és szülőikompetencia-mérések a magyar gyermekvédelemben
Authors: Homoki Andrea , Rácz Andrea 
Published: July 2021

Hazánkban immár három körben valósult meg (2018–2020) és jelenleg is zajlik (2020–2021) egy olyan modellprogram, mely azt hivatott elősegíteni, hogy a család- és gyermekjóléti szolgáltatásban, gyermekvédelmi szakellátásban dolgozó szakemberek számára olyan kipróbált és hatékony eszközök álljanak rendelkezésre, melyekkel eredményesebben tudják végezni a gondozási tevékenységüket, kezelni a családon belüli problémákat, hatékonyabban tudják motiválni a családot a pozitív irányú változásokra.
Tanulmányunkban bemutatjuk a gyermekireziliencia- és a szülőikompetencia-méréseket, és azt, hogy ezek hogyan tudnak egy-egy program értékelésén túl a gyermekvédelmi munkában széles körben hasznosulni.