bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Influence of Surgeon Experience and Subspeciality on the Reliability of the AO Spine Sacral Classification System
Authors: Karamian Brian A. , Schroeder Gregory D. , Levy Hanna A. , Canseco Jose A. , Benneker Lorin M. , Kandziora Frank , Rajasekaran Shanmuganathan , Öner F. Cumhur , Schnake Klaus J. , Kepler Christopher K. , Vaccaro Alexander R. 
Published: August 2021

Study Design.
Cross-sectional survey.

Objective.
To determine the influence of surgeons’ level of experience and subspeciality training on the reliability, reproducibility, and accuracy of sacral fracture classification using the Arbeitsgemeinschaft für Osteosynthesefragen Spine Sacral Classification System.

Summary of Background Data.
A surgeons’ level of experience or subspecialty may have a significant effect on the reliability and accuracy of sacral classification given various levels of comfort with imaging assessment required for accurate diagnosis and classification.

Methods.
High-resolution computerized tomography (CT) images from 26 cases were assessed on two separate occasions by 172 investigators representing a diverse array of surgical subspecialities (general orthopedics, neurosurgery, orthopedic spine, orthopedic trauma) and experience (<5, 5–10, 11–20, >20 yrs). Reliability and reproducibility were calculated with Cohen kappa coefficient (k) and gold standard classification agreement was determined for each fracture morphology and subtype and stratified by experience and subspeciality.

Results.
Respondents achieved an overall k = 0.87 for morphology and k = 0.77 for subtype classification, representing excellent and substantial intraobserver reproducibility, respectively. Respondents from all four practice experience groups demonstrated excellent interobserver reliability when classifying overall morphology (k = 0.842/0.850, Assessment 1/Assessment 2) and substantial interobserver reliability in overall subtype (k = 0.719/0.751) in both assessments. General orthopedists, neurosurgeons, and orthopedic spine surgeons exhibited excellent interobserver reliability in overall morphology classification and substantial interobserver reliability in overall subtype classification. Surgeons in each experience category and subspecialty correctly classified fracture morphology in over 90% of cases and fracture subtype in over 80% of cases according to the gold standard. Correct overall classification of fracture morphology (Assessment 1: P = 0.024, Assessment 2: P = 0.006) and subtype (P
2 < 0.001) differed significantly by years of experience but not by subspecialty.

Conclusion.
Overall, the Arbeitsgemeinschaft für Osteosynthesefragen spine sacral classification system appears to be universally applicable among surgeons of various subspecialties and levels of experience with acceptable reliability, reproducibility, and accuracy.

Level of Evidence: 4
Age as a Risk Factor for Complications Following Anterior Cervical Discectomy and Fusion
Authors: Lawless Michael H. , Tong Doris , Claus Chad F. , Hanson Connor , Li Chenxi , Houseman Clifford M. , Bono Peter , Richards Boyd F. , Kelkar Prashant S. , Abdulhak Muwaffak M. , Chang Victor , Carr Daniel A. , Park Paul , Soo Teck M. 
Published: August 2021

Study Design.
Retrospective analysis of prospectively collected registry data using multivariable analyses of imputed data

Objective.
We sought to demonstrate that age would not be associated with complications in patients undergoing anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.
Elderly patients (≥70 yrs) undergoing ACDF are considered a higher risk for complications. However, conclusive evidence is lacking. The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a quality improvement collaborative with 30 hospitals across Michigan.

Methods.
The study included all patients who had 1 to 4 level ACDF (September 2015–August 2019) for 90-day complications. Major and minor complications were defined using a validated classification. Multiple imputations were used to generate complete covariate datasets. Generalized estimating equation model was used to identify associations with complications using the whole cohort and elderly subgroup analyses. Bonferroni correction was used.

Results.
Nine thousand one hundred thirty five patients (11.1% ≥ 70 yrs and 88.9% <70 yrs) with 2266 complications were analyzed. Comparing elderly versus non-elderly, the elderly had a significantly higher rate of any complications (31.5% vs. 24.0%, P < 0.001) and major complications (14.1% vs. 7.0%, P < 0.001). On multivariable analysis, age was not independently associated with any complication. POD#0 ambulation and preop independent ambulation were independently associated with significantly decreased odds of any complication. In the elderly, independent preoperative ambulation was protective for any complication (odds ratio [OR] 0.53, 0.39–0.73 95% confidence interval [CI]), especially major complications (OR 0.41, 0.27–0.61 95% CI).

Conclusion.
Age was not an independent risk factor for complications in patients that underwent ACDF. In the elderly, independent preoperative ambulation was especially protective for major complications.

Level of Evidence: 3
Increasing Cost Efficiency in Adult Spinal Deformity Surgery
Authors: Passias Peter G. , Brown Avery E. , Bortz Cole , Alas Haddy , Pierce Katherine , Ahmad Waleed , Naessig Sara , Lafage Renaud , Lafage Virginie , Hassanzadeh Hamid , Labaran Lawal A. , Ames Christopher , Burton Douglas C. , Gum Jeffrey , Hart Robert , Hostin Richard , Kebaish Khaled M. , Neuman Brian J. , Bess Shay , Line Breton , Shaffrey Christopher , Smith Justin , Schwab Frank , Klineberg Eric 
Published: August 2021

Study Design.
Retrospective study of a prospective multicenter database.

Objective.
The purpose of this study was to identify predictors of lower total surgery costs at 3 years for adult spinal deformity (ASD) patients.

Summary of Background Data.
ASD surgery involves complex deformity correction.

Methods.
Inclusion criteria: surgical ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥25°, or thoracic kyphosis ≥60°) patients >18 years. Total costs for surgery were calculated using the PearlDiver database. Cost per quality-adjusted life year was assessed. A Conditional Variable Importance Table used nonreplacement sampling set of 20,000 Conditional Inference trees to identify top factors associated with lower cost surgery for low (LSVA), moderate (MSVA), and high (HSVA) SRS Schwab SVA grades.

Results.
Three hundred sixtee of 322 ASD patients met inclusion criteria. At 3-year follow up, the potential cost of ASD surgery ranged from $57,606.88 to $116,312.54. The average costs of surgery at 3 years was found to be $72,947.87, with no significant difference in costs between deformity groups (P > 0.05). There were 152 LSVA patients, 53 MSVA patients, and 111 HSVA patients. For all patients, the top predictors of lower costs were frailty scores <0.19, baseline (BL) SRS Activity >1.5, BL Oswestry Disability Index <50 (all P < 0.05). For LSVA patients, no history of osteoporosis, SRS Activity scores >1.5, age <64, were the top predictors of lower costs (all P < 0.05). Among MSVA patients, ASD invasiveness scores <94.16, no past history of cancer, and frailty scores <0.3 trended toward lower total costs (P = 0.071, P = 0.210). For HSVA, no history of smoking and body mass index <27.8 trended toward lower costs (both P = 0.060).

Conclusion.
ASD surgery has the potential for improved cost efficiency, as costs ranged from $57,606.88 to $116,312.54. Predictors of lower costs included higher BL SRS activity, decreased frailty, and not having depression. Additionally, predictors of lower costs were identified for different BL deformity profiles, allowing for the optimization of cost efficiency for all patients.

Level of Evidence: 3
A Randomized Controlled Trial to Evaluate the Clinical Effectiveness of 3D-Printed Orthosis in the Management of Adolescent Idiopathic Scoliosis
Authors: Lin Yangmin , Cheung Jason Pui Yin , Chan Chi Kwan , Wong Sidney Wing Fai , Cheung Kenneth Man Chee , Wong Martin , Wong Wun Ching , Cheung Prudence Wing Hang , Wong Man Sang 
Published: August 2021

Study Design.
Prospective randomized controlled trial.

Objective.
To compare clinical effectiveness and quality of life (QoL) of the 3D-printed orthosis (3O) and conventional orthosis (CO) for adolescent idiopathic scoliosis (AIS).

Summary of Background Data.
Using 3D printing technology to design and fabricate orthoses to manage AIS aiming to improve in-orthosis correction and patients’ compliance that are considered essential factors of effective treatment. Clinical evaluation was conducted to study the effectiveness of this innovative method.

Methods.
Thirty females with AIS who met the criteria (age 10–14, Cobb 20–40°, Risser sign 0–2, ≤12 months after menarche) were recruited. Subjects were randomly allocated to the 3O group (n = 15, age 12.4, Cobb 31.8°) and CO group (n = 15, age 12.0, Cobb 29.3°). All patients were prescribed for full-time wearing (23 hours/d) and follow-up every 4 to 6 months until bone maturity. Compliance was monitored by thermosensors, while QoL was assessed using three validated questionnaires.

Results.
Comparable immediate in-orthosis correction was observed between 3O (−11.6°, P < 0.001) and CO groups (−12.9°, P < 0.001). In the QoL study via SRS-22r, the 3O group got worse results after 3 months in aspects of function, self-image, and mental health (−0.5, −0.6, −0.7, P < 0.05) while the CO group had worse results in aspects of self-image and mental health (−0.3, −0.3, P < 0.05). No significant difference was found in QoL assessments between groups. After 2 years of follow-up, 22 patients were analyzed with 4 dropouts in each group. Comparable angle reduction was observed in both groups (3O: −2.2°, P = 0.364; CO: −3.5°, P = 0.193). There was one subject (9.1%) in the 3O group while two subjects (18.2%) in the CO group had curve progression >5°. Daily wearing hours were 1.9 hours longer in the 3O group than the CO group (17.1 vs. 15.2 hours, P = 0.934).

Conclusion.
The 3O group could provide comparable clinical effects as compared with the CO group while patients with 3O showed similar compliance and QoL compared to those with CO.

Level of Evidence: 1
Peripheral Oxygen Saturation Facilitates Assessment of Respiratory Dysfunction in the Sequential Organ Failure Assessment Score With Implications for the Sepsis-3 Criteria
Authors: Valik John Karlsson , Mellhammar Lisa , Sundén-Cullberg Jonas , Ward Logan , Unge Christian , Dalianis Hercules , Henriksson Aron , Strålin Kristoffer , Linder Adam , Nauclér Pontus 
Published: August 2021

OBJECTIVES:
Sequential Organ Failure Assessment score is the basis of the Sepsis-3 criteria and requires arterial blood gas analysis to assess respiratory function. Peripheral oxygen saturation is a noninvasive alternative but is not included in neither Sequential Organ Failure Assessment score nor Sepsis-3. We aimed to assess the association between worst peripheral oxygen saturation during onset of suspected infection and mortality.

DESIGN:
Cohort study of hospital admissions from a main cohort and emergency department visits from four external validation cohorts between year 2011 and 2018. Data were collected from electronic health records and prospectively by study investigators.

SETTING:
Eight academic and community hospitals in Sweden and Canada.

PATIENTS:
Adult patients with suspected infection episodes.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The main cohort included 19,396 episodes (median age, 67.0 [53.0–77.0]; 9,007 [46.4%] women; 1,044 [5.4%] died). The validation cohorts included 10,586 episodes (range of median age, 61.0–76.0; women 42.1–50.2%; mortality 2.3–13.3%). Peripheral oxygen saturation levels 96–95% were not significantly associated with increased mortality in the main or pooled validation cohorts. At peripheral oxygen saturation 94%, the adjusted odds ratio of death was 1.56 (95% CI, 1.10–2.23) in the main cohort and 1.36 (95% CI, 1.00–1.85) in the pooled validation cohorts and increased gradually below this level. Respiratory assessment using peripheral oxygen saturation 94–91% and less than 91% to generate 1 and 2 Sequential Organ Failure Assessment points, respectively, improved the discrimination of the Sequential Organ Failure Assessment score from area under the receiver operating characteristics 0.75 (95% CI, 0.74–0.77) to 0.78 (95% CI, 0.77–0.80; p < 0.001). Peripheral oxygen saturation/Fio
2 ratio had slightly better predictive performance compared with peripheral oxygen saturation alone, but the clinical impact was minor.

CONCLUSIONS:
These findings provide evidence for assessing respiratory function with peripheral oxygen saturation in the Sequential Organ Failure Assessment score and the Sepsis-3 criteria. Our data support using peripheral oxygen saturation thresholds 94% and 90% to get 1 and 2 Sequential Organ Failure Assessment respiratory points, respectively. This has important implications primarily for emergency practice, rapid response teams, surveillance, research, and resource-limited settings.
Diabetes risk reduction diet and the risk of breast cancer
Authors: Turati Federica , Bravi Francesca , Rossi Marta , Serraino Diego , Mattioli Veronica , Augustin Livia , Crispo Anna , Giacosa Attilio , Negri Eva , La Vecchia Carlo 
Published: August 2021

Objective
Diabetes and insulin levels may increase the risk of postmenopausal breast cancer. In the present investigation, we aimed at evaluating whether adherence to a diabetes risk reduction diet (DRRD) lowers the risk of breast cancer.

Methods
We used data from an Italian, multicentric case-control study (1991–1994) including 2569 incident histologically-confirmed breast cancer cases and 2588 hospital controls. A food frequency questionnaire collected subjects’ usual diet. We derived a DRRD score on the basis of eight items: intake of cereal fiber, total fruit, coffee, polyunsaturated to saturated fats ratio and nuts (higher scores for higher intakes), and dietary glycemic index, red/processed meat and sugar-sweetened beverages/fruit juices (higher scores for lower intakes). The score theoretically ranged 8–37, with higher values indicating greater DRRD adherence. Odds ratios (ORs) of breast cancer according to the DRRD score were estimated using multiple logistic regression models.

Results
The DRRD score was inversely related to the risk of breast cancer. The ORs were 0.93 [95% confidence interval (CI), 0.89–0.98] for a three-point score increment and 0.76 (95% CI, 0.64–0.89) for the highest versus the lowest quartile (P for trend 0.001). Inverse associations were observed in subgroups of covariates.

Conclusions
Higher DRRD adherence may decrease the risk of breast cancer.
Prospective Longitudinal Assessment of Health-related Quality of Life in Patients With Brain Metastases Undergoing Radiation Therapy
Authors: Salans Mia , Yip Anthony , Burkeen Jeffrey , Liu Kevin X. , Lee Euyhyun , Pan-Weisz Tonya , Marshall Deborah , McDuff Susan G.R. , Sharifzadeh Yasamin , Dalia Yoseph , Sanghvi Parag , Simpson Daniel , Xu Ronghui , McDonald Carrie , Hattangadi-Gluth Jona A. 
Published: August 2021

Objective:
We conducted a prospective clinical trial of patients receiving radiation (RT) for brain metastases to identify clinical predictors of pre-RT and post-RT health-related quality of life (hrQoL).

Materials and Methods:
Patients with brain metastases completed overall (European Organisation for Research and Treatment of Cancer QLQ C15-PAL) and brain tumor-specific (QLQ-BN20) hrQoL assessments pre-RT (n=127) and 1 (n=56) and 3 (n=45) months post-RT. Linear and proportional-odds models analyzed patient, disease, and treatment predictors of baseline, 1-, and 3-month hrQoL scores. Generalized estimating equations and repeated measures proportional-odds models assessed predictors of longitudinal hrQoL scores.

Results:
Most patients underwent stereotactic radiosurgery (SRS) (69.3%) and had non−small-cell lung (36.0%) metastases. Compared with SRS, receipt of whole brain RT was associated with a higher odds of appetite loss (baseline P=0.04, 1 mo P=0.02) and greater motor dysfunction (baseline P=0.01, 1 mo P=0.003, 3 mo P=0.02). Receipt of systemic therapy was associated with better emotional functioning after RT (1 mo P=0.03, 3 mo P=0.01). Compared with patients with breast cancer, patients with melanoma had higher odds of better global hrQoL (P=0.01) and less pain (P=0.048), while patients with lung cancer reported lower physical function (P=0.048) 3 months post-RT. Nonmarried patients had greater odds of higher global hrQoL (1 mo P=0.01), while male patients had lower odds of reporting more hair loss (baseline P=0.03, 3 mo P=0.045). Patients 60 years and above had lower odds of more drowsiness (P=0.04) and pain (P=0.049) over time.

Conclusions:
Patients receiving SRS versus whole brain RT and systemic therapy reported better posttreatment hrQoL. In addition, melanoma metastases, nonmarried, male, and older patients with reported better hrQoL in various as well as domains after intracranial RT.
Transvaginal subfascial synthetic sling – “A novel technique” versus trans-obturator mid-urethral sling in female stress urinary incontinence: A comparative study
Authors: Khawaja Abdul Rouf , Rouf Malik Abdul , Khan Farzana Bashir , Bhat Arif Hamid , Dar Yaser Ahmad , Malik Sajad Ahmad , Wani Mohammad Saleem 
Published: August 2021

Abstract

Background:
To assess the treatment outcome and overall efficacy of the novel technique of a transvaginal subfascial synthetic sling (TVSS) in comparison to the standard trans-obturator tape (TOT-O) mid-urethral sling for female stress urinary incontinence (SUI).

Materials and methods:
The study included 206 female SUI patients managed at our institution between March 2015 and December 2019. The patients were randomly distributed into 2 comparable groups (Group A as TOT-O and Group B as TVSS) with respect to age, trouble due to SUI assessed with respect to degree of incontinence (number of episodes and diapers used per day), and body mass index (≤40 kg/m2), with 100 patients in the TOT-O group as group A and 106 patients in TVSS as group B. Preoperative variables related to the number of incontinent episodes and diapers usage were equal in both groups. The procedure was done under spinal anesthesia and results were assessed in terms of improvement in SUI as the primary outcome, any sexual dysfunction, complications, and overall satisfaction as secondary outcomes.

Results:
Symptomatic improvement after the procedure was seen in all patients with complete resolution of symptoms in 91 patients (91.%) in the TOT-O group (group A) versus 96 patients (90.56%) in the TVSS (group B). Postoperative complications included urinary retention in 6% versus 5.6%, increased day time urinary frequency in 8% versus 6.6%, urge incontinence in 4% versus 2.8%, and groin/thigh pain in 12% versus 0.9%, respectively. Mesh incision was done in 1 (1%) versus none (0%), and local mesh excision for mesh erosion in 2 (2%) versus 1 (0.9%) at 3 months after the procedure in the TOT-O group and the TVSS group, respectively. The p value and Chi-Square test with respect to the clinical profile and satisfaction with respect to complete resolution of symptoms was calculated using Open EPI software which were insignificant. Sexual function (SF) was assessed using the Brief Index of SF for Women questionnaire. All the patients were satisfied with respect to SF at 6 months of follow-up.

Conclusions:
The TVSS as a novel technique for female SUI is less invasive, simpler to learn, with less postoperative pain with resolution of SUI, rapid recovery, and good personal satisfaction compared to the standard TOT-O in procedure.
Rapid Review of Social Contact Patterns During the COVID-19 Pandemic
Authors: Liu Carol Y. , Berlin Juliette , Kiti Moses C. , Del Fava Emanuele , Grow André , Zagheni Emilio , Melegaro Alessia , Jenness Samuel M. , Omer Saad B. , Lopman Benjamin , Nelson Kristin 
Published: August 2021

Background:
Physical distancing measures aim to reduce person-to-person contact, a key driver of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. In response to unprecedented restrictions on human contact during the coronavirus disease 2019 (COVID-19) pandemic, studies measured social contact patterns under the implementation of physical distancing measures. This rapid review synthesizes empirical data on the changing social contact patterns during the COVID-19 pandemic.

Method:
We conducted a systematic review using PubMed, Medline, Embase, and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We descriptively compared the distribution of contacts observed during the pandemic to pre-COVID data across countries to explore changes in contact patterns during physical distancing measures.

Results:
We identified 12 studies reporting social contact patterns during the COVID-19 pandemic. Eight studies were conducted in European countries and eleven collected data during the initial mitigation period in the spring of 2020 marked by government-declared lockdowns. Some studies collected additional data after relaxation of initial mitigation. Most study settings reported a mean of between 2 and 5 contacts per person per day, a substantial reduction compared to pre-COVID rates, which ranged from 7 to 26 contacts per day. This reduction was pronounced for contacts outside of the home. Consequently, levels of assortative mixing by age substantially declined. After relaxation of initial mitigation, mean contact rates increased but did not return to pre-COVID levels. Increases in contacts post-relaxation were driven by working-age adults.

Conclusion:
Information on changes in contact patterns during physical distancing measures can guide more realistic representations of contact patterns in mathematical models for SARS-CoV-2 transmission.
Radiation Protection Evaluation of Medical X-ray Imaging Centers in Qazvin, Iran
Authors: Esfahani Azam Janati , Cheraghi Susan 
Published: August 2021

Abstract
Given the potential risks of x rays in imaging, it is necessary to evaluate the radiation safety of medical x-ray imaging rooms and radiation information of radiographers. A descriptive study has been carried out in Qazvin, Iran, in the form of a questionnaire answered by radiography technologists in private and public imaging centers to assess the level of knowledge, attitude, and performance about x-ray exposure and safety against it. Afterward, the radiation doses of public areas of the radiography centers were measured by a survey meter. A checklist was also completed, containing items about availability of ventilation facilities in x-ray rooms, radiation warning signs, radiation work schedules, documents of periodic blood test monitoring, exposure history of radiographers by film badge, and documents of the quality control of x-ray devices. The data analysis was performed by SPSS 16 using descriptive study, t-test, ANOVA, and Pearson’s correlation coefficient test. The mean attitude and knowledge scores were 6.65 ± 1.63 out of 9 and 4.82 ± 2.06 out of 15, respectively. Sex, age, and workplace had no significant effect on the radiographers’ knowledge and attitude, while occupational experience had a negative relationship, and level of education had a significant direct association with knowledge of the participants (p-value<0.05). The performance of the staff was somewhat good. Almost all x-ray imaging centers had good radiation protection conditions. The annual quality control of x-ray imaging devices was ensured. The radiation protection awareness among the medical radiographers in Qazvin city needs to be improved, especially among the experienced staff.