bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lack of evidence-based maternal care practices in a governmental hospital in the middle region of Jordan
Authors: Abuidhail Jamila , Mrayan Lina , Abujilban Sanaa , Hasan Amanda , Damra Kholod , Hani Zayzan , Khaled Sameera 
Published: September 2021

Background In Jordan, there is an overuse of treatments that were originally designed to manage complications of labour and birth. Aim To explore the reasons for the non-application of evidence-based practices in maternal care in a Jordanian governmental hospital from the healthcare professionals' perspective. Methods A descriptive qualitative method was employed in one selected Jordanian governmental hospital. Data were collected by conducting one-to-one, semi-structured interviews with 11 participants, which were subjected to a thematic and content analysis. Findings There were four main themes: limited human, financial, infrastructural resources and hospital environment; midwives are not autonomous; lack of motivation to apply evidence-based practices; and socio-cultural pressures hinder the usage of new evidence-based practices. Conclusion There is a weak application of evidence-based practices in maternal care in a governmental hospital in Jordan. So, it is important to modify maternal healthcare policy to allow greater midwife autonomy, and raise awareness of maternal evidence-based practice.
Effect of obstacles/tips card on breastfeeding drop-off
Authors: Comerford David A , McGillivray Tracy 
Published: September 2021

Background Many mothers report having stopped breastfeeding sooner than they would have liked. Aim We test whether a planning card reduces breastfeeding drop-off. Method We recruited 81 women who were at least 36 weeks pregnant at antenatal classes in Lothian, Scotland. By systematic assignment, participants received no card; an obstacles/tips card, which details common breastfeeding obstacles and tips to overcome them; or an enhanced obstacles/tips card, which additionally featured an intentions prompt on its reverse side. Between 10–14 days after the due date, we measured rates of exclusive and any breastfeeding. Findings On discharge, feeding methods were similar across all three groups. At 10-14 days, drop-off was four-fold higher in the control group than in either of the two card groups (p=0.026). Conclusion The obstacles/tips cards offer potential as a means to achieve reductions in breastfeeding drop-off.
Experiences of maternity care during the COVID-19 pandemic in the North of England
Authors: Stacey Tomasina , Darwin Zoe , Keely Alice , Smith Anna , Farmer Dáša , Heighway Kate 
Published: September 2021

Background During 2020, UK maternity services made changes to service delivery in response to the COVID-19 pandemic. Aims To explore service users' and their partners' experiences of maternity services in the North of England during the COVID-19 pandemic. Methods Respondents (n=606) completed a co-produced survey during August 2020. Data were analysed using descriptive statistics and content analysis. Findings Five major categories were identified: valuing support from health professionals, feeling lost in and let down by the system, the impact of restrictions to partners and others, virtual contact is not the same as in-person contact, and the need for emotional and psychological wellbeing support. Conclusion The changes implemented may have compromised mental health and wellbeing in a critical period of vulnerability. Bringing stakeholders together can maximise learning from the emergency measures, to better inform future service provision. Work is needed to better hear from minoritised groups and ensure they are not further marginalised by changes.
Assessing hip fracture risk in type-2 diabetic patients using CT-based autonomous finite element methods
Authors: Rotman Dani , Ariel Gal , Rojas Lievano Jorge , Schermann Haggai , Trabelsi Nir , Salai Moshe , Yosibash Zohar , Sternheim Amir 
Published: September 2021

AimsType 2 diabetes mellitus (T2DM) impairs bone strength and is a significant risk factor for hip fracture, yet currently there is no reliable tool to assess this risk. Most risk stratification methods rely on bone mineral density, which is not impaired by diabetes, rendering current tests ineffective. CT-based finite element analysis (CTFEA) calculates the mechanical response of bone to load and uses the yield strain, which is reduced in T2DM patients, to measure bone strength. The purpose of this feasibility study was to examine whether CTFEA could be used to assess the hip fracture risk for T2DM patients.MethodsA retrospective cohort study was undertaken using autonomous CTFEA performed on existing abdominal or pelvic CT data comparing two groups of T2DM patients: a study group of 27 patients who had sustained a hip fracture within the year following the CT scan and a control group of 24 patients who did not have a hip fracture within one year. The main outcome of the CTFEA is a novel measure of hip bone strength termed the Hip Strength Score (HSS).ResultsThe HSS was significantly lower in the study group (1.76 (SD 0.46)) than in the control group (2.31 (SD 0.74); p = 0.002). A multivariate model showed the odds of having a hip fracture were 17 times greater in patients who had an HSS ≤ 2.2. The CTFEA has a sensitivity of 89%, a specificity of 76%, and an area under the curve of 0.90.ConclusionThis preliminary study demonstrates the feasibility of using a CTFEA-based bone strength parameter to assess hip fracture risk in a population of T2DM patients. Cite this article: Bone Joint J 2021;103-B(9):1497–1504.
The diagnostic and prognostic value of artificial intelligence and artificial neural networks in spinal surgery
Authors: McDonnell Jake M. , Evans Shane Richard , McCarthy Laura , Temperley Hugo , Waters Caitlin , Ahern Daniel , Cunniffe Gráinne , Morris Seamus , Synnott Keith , Birch Nick , Butler Joseph S. 
Published: September 2021

In recent years, machine learning (ML) and artificial neural networks (ANNs), a particular subset of ML, have been adopted by various areas of healthcare. A number of diagnostic and prognostic algorithms have been designed and implemented across a range of orthopaedic sub-specialties to date, with many positive results. However, the methodology of many of these studies is flawed, and few compare the use of ML with the current approach in clinical practice. Spinal surgery has advanced rapidly over the past three decades, particularly in the areas of implant technology, advanced surgical techniques, biologics, and enhanced recovery protocols. It is therefore regarded an innovative field. Inevitably, spinal surgeons will wish to incorporate ML into their practice should models prove effective in diagnostic or prognostic terms. The purpose of this article is to review published studies that describe the application of neural networks to spinal surgery and which actively compare ANN models to contemporary clinical standards allowing evaluation of their efficacy, accuracy, and relatability. It also explores some of the limitations of the technology, which act to constrain the widespread adoption of neural networks for diagnostic and prognostic use in spinal care. Finally, it describes the necessary considerations should institutions wish to incorporate ANNs into their practices. In doing so, the aim of this review is to provide a practical approach for spinal surgeons to understand the relevant aspects of neural networks. Cite this article: Bone Joint J 2021;103-B(9):1442–1448.
Impact of concomitant injuries in geriatric patients with proximal femur fracture
Authors: Schoeneberg Carsten , Pass Bastian , Oberkircher Ludwig , Rascher Katherine , Knobe Matthias , Neuerburg Carl , Lendemans Sven , Aigner Rene ,   On behalf of the Registry for Geriatric Trauma DGU
Published: September 2021

Aims The impact of concomitant injuries in patients with proximal femoral fractures has rarely been studied. To date, the few studies published have been mostly single-centre research focusing on the influence of upper limb fractures. A retrospective cohort analysis was, therefore, conducted to identify the impact and distribution of concomitant injuries in patients with proximal femoral fractures. Methods A retrospective, multicentre registry-based study was undertaken. Between 1 January 2016 and 31 December 2019, data for 24,919 patients from 100 hospitals were collected in the Registry for Geriatric Trauma. This information was queried and patient groups with and without concomitant injury were compared using linear and logistic regression models. In addition, we analyzed the influence of the different types of additional injuries. Results A total of 22,602 patients met the inclusion criteria. The overall prevalence of a concomitant injury was 8.2% with a predominance of female patients (8.7% vs 6.9%; p < 0.001). Most common were fractures of the ipsilateral upper limb. Concomitant injuries resulted in prolonged time-to-surgery (by 3.4 hours (95 confidence interval (CI) 2.14 to 4.69)) and extended length of stay in hospital by 2.2 days (95% CI 1.74 to 2.61). Mortality during the admission was significantly higher in the concomitant injury group (7.4% vs 5.3%; p < 0.001). Additionally, walking ability and quality of life were reduced in these patients at discharge. More patients were discharged to a nursing home instead of their own home compared to patients without additional injuries (25.8% vs 30.3%; p < 0.001). Conclusion With a prevalence of 8.2%, the appearance of a concomitant injury is common in elderly patients with hip fracture. These patients are at a greater risk for death during the admission, longer hospital stays, and delayed surgery. This knowledge is clinically important for all who are involved in the treatment of proximal femur fractures. Cite this article: Bone Joint J 2021;103-B(9):1526–1533.
Using an asymmetric crosslinked polyethylene liner in primary total hip arthroplasty is associated with a lower risk of revision surgery
Authors: Davis Edward T. , Pagkalos Joseph , Kopjar Branko 
Published: September 2021

Aims The aim of our study was to investigate the effect of asymmetric crosslinked polyethylene liner use on the risk of revision of cementless and hybrid total hip arthroplasties (THAs). Methods We undertook a registry study combining the National Joint Registry dataset with polyethylene manufacturing characteristics as supplied by the manufacturers. The primary endpoint was revision for any reason. We performed further analyses on other reasons including instability, aseptic loosening, wear, and liner dissociation. The primary analytic approach was Cox proportional hazard regression. Results A total of 213,146 THAs were included in the analysis. Overall, 2,997 revisions were recorded, 1,569 in THAs with a flat liner and 1,428 in THAs using an asymmetric liner. Flat liner THAs had a higher risk of revision for any reason than asymmetric liner THAs when implanted through a Hardinge/anterolateral approach (hazard ratio (HR) 1.169, 95% confidence interval (CI) 1.022 to 1.337) and through a posterior approach (HR 1.122, 95% CI 1.108 to 1.346). There was no increased risk of revision for aseptic loosening when asymmetric liners were used for any surgical approach. A separate analysis of the three most frequently used crosslinked polyethylene liners was in agreement with this finding. When analyzing THAs with flat liners only, THAs implanted through a Hardinge/anterolateral approach were associated with a reduced risk of revision for instability compared to posterior approach THAs (HR 0.561 (95% CI 0.446 to 0.706)). When analyzing THAs with an asymmetric liner, there was no significant difference in the risk of revision for instability between the two approaches (HR 0.838 (95% CI 0.633 to 1.110)). Conclusion For THAs implanted through the posterior approach, the use of asymmetric liners reduces the risk of revision for instability and revision for any reason. In THAs implanted through a Hardinge/anterolateral approach, the use of an asymmetric liner was associated with a reduced risk of revision. The effect on revision for instability was less pronounced than in the posterior approach. Cite this article: Bone Joint J 2021;103-B(9):1479–1487.
September 2021 Pulmonary Case of the Month: A 45­-Year-Old Woman with Multiple Lung Cysts
Authors:   Mayo Clinic Arizona, Scottsdale, AZ USA, Wesselius Lewis 
Published: September 2021

No abstract available. Article truncated after the first 150 words. History of Present Illness A 45-year-old woman presented with increasing dyspnea on exertion and a history of recurrent pneumothoraces. In March 2018 she had laparoscopic ovarian cyst removal and noted some subsequent shortness of breath. In August 2018 she developed a right pneumothorax requiring chest tube placement. In September 2018 she had recurrent right pneumothorax and had video-assisted thoracoscopic surgery (VATS) with a right pleurodesis. The operative note from the outside VATS indicates a RUL bleb was removed and a wedge biopsy was done from posterior segment of the RUL. Pathology from the wedge biopsy reported “minimal emphysematous disease without other diagnostic abnormality”. She continued to be short of breath after the operation. PMH, SH, and FH •	In 1975 she reportedly had pulmonary tuberculosis. •	In 2018 the pneumothoraces, pleurodesis and the right ovarian cyst resection noted above. She is a never smoker and has no family history…
Theoretical model considering optimal ranging performance and energy efficiency for photon-counting lidars with multiple detectors
Authors: Yang Jian , Ma Yue , Li Song , Liu Xinyuan , Zhang Wenhao , Zhang Zhiyu 
Published: September 2021

With an orbital speed of several kilometers per second, space-borne photon-counting lidars can only perform several to a few tens of measurements on the same target. The ranging uncertainty can exceed tens of centimeters with a pulse width of several nanoseconds and has a great impact on the total ranging error. When multiple photons are recorded (using multiple detectors) in a single laser shot, the ranging uncertainty can be effectively suppressed by the average method. Higher signal levels (receiving more photons) introduce a better ranging uncertainty, but a worse ranging bias is caused by the dead time effect of photon-counting detectors. In this study, a theoretical ranging performance model is proposed to address that question: What signal levels and how many detectors are the optimum selection to achieve a better ranging performance? A photon-counting lidar system with four photomultiplier tubes is used to verify the proposed ranging performance model. Experiments are conducted under nine sets of different signal levels, and the ranging performance of experiment results agree well with the theoretical predictions. The average residual error is 0.31 cm and all error ratios are less than 10%. The energy efficiency and ranging uncertainty are further quantitatively analyzed. When multiple detectors are employed, the total ranging error (i.e., the root sum square of the ranging bias and ranging uncertainty) has the minimum value. For a space-borne photon-counting lidar, the expected signal photon number in each detector is recommended as

0.5

∼

1

(wasting a small part of the received energy). With a

4

×

4

detector array and a received pulse width of 1.5 ns, the total ranging error can reach approximately 5 cm when the expected signal photon number is close to 10. This theoretical model is essential in estimating the ranging performance for a give photon-counting lidar and in optimizing the design of lidar system parameters.
Measuring the accuracy of gridded human population density surfaces: A case study in Bioko Island, Equatorial Guinea
Authors: Fries Brendan , Guerra Carlos A. , García Guillermo A. , Wu Sean L. , Smith Jordan M. , Oyono Jeremías Nzamio Mba , Donfack Olivier T. , Nfumu José Osá Osá , Hay Simon I. , Smith David L. , Dolgert Andrew J. 
Published: September 2021

Background
Geospatial datasets of population are becoming more common in models used for health policy. Publicly-available maps of human population make a consistent picture from inconsistent census data, and the techniques they use to impute data makes each population map unique. Each mapping model explains its methods, but it can be difficult to know which map is appropriate for which policy work. High quality census datasets, where available, are a unique opportunity to characterize maps by comparing them with truth.

Methods
We use census data from a bed-net mass-distribution campaign on Bioko Island, Equatorial Guinea, conducted by the Bioko Island Malaria Elimination Program as a gold standard to evaluate LandScan (LS), WorldPop Constrained (WP-C) and WorldPop Unconstrained (WP-U), Gridded Population of the World (GPW), and the High-Resolution Settlement Layer (HRSL). Each layer is compared to the gold-standard using statistical measures to evaluate distribution, error, and bias. We investigated how map choice affects burden estimates from a malaria prevalence model.

Results
Specific population layers were able to match the gold-standard distribution at different population densities. LandScan was able to most accurately capture highly urban distribution, HRSL and WP-C matched best at all other lower population densities. GPW and WP-U performed poorly everywhere. Correctly capturing empty pixels is key, and smaller pixel sizes (100 m vs 1 km) improve this. Normalizing areas based on known district populations increased performance. The use of differing population layers in a malaria model showed a disparity in results around transition points between endemicity levels.

Discussion
The metrics in this paper, some of them novel in this context, characterize how these population maps differ from the gold standard census and from each other. We show that the metrics help understand the performance of a population map within a malaria model. The closest match to the census data would combine LandScan within urban areas and the HRSL for rural areas. Researchers should prefer particular maps if health calculations have a strong dependency on knowing where people are not, or if it is important to categorize variation in density within a city.
A systematic review and narrative synthesis of the research provisions under the Mental Capacity Act (2005) in England and Wales: Recruitment of adults with capacity and communication difficulties
Authors: Jimoh Oluseyi Florence , Ryan Hayley , Killett Anne , Shiggins Ciara , Langdon Peter E. , Heywood Rob , Bunning Karen 
Published: September 2021

Background
The Mental Capacity Act (MCA, 2005) and its accompanying Code of Practice (2007), govern research participation for adults with capacity and communication difficulties in England and Wales. We conducted a systematic review and narrative synthesis to investigate the application of these provisions from 2007 to 2019.

Methods and findings
We included studies with mental capacity in their criteria, involving participants aged 16 years and above, with capacity-affecting conditions and conducted in England and Wales after the implementation of the MCA. Clinical trials of medicines were excluded. We searched seven databases: Academic Search Complete, ASSIA, MEDLINE, CINAHL, PsycArticles, PsycINFO and Science Direct. We used narrative synthesis to report our results. Our review follows Preferred Reporting Items for Systematic Reviews and is registered on PROSPERO, CRD42020195652.
28 studies of various research designs met our eligibility criteria: 14 (50.0%) were quantitative, 12 (42.9%) qualitative and 2 (7.1%) mixed methods. Included participants were adults with intellectual disabilities (n = 12), dementia (n = 9), mental health disorders (n = 2), autism (n = 3) and aphasia after stroke (n = 2). We found no studies involving adults with acquired brain injury. Diverse strategies were used in the recruitment of adults with capacity and communication difficulties with seven studies excluding individuals deemed to lack capacity.

Conclusions
We found relatively few studies including adults with capacity and communication difficulties with existing regulations interpreted variably. Limited use of consultees and exclusions on the basis of capacity and communication difficulties indicate that this group continue to be under-represented in research. If health and social interventions are to be effective for this population, they need to be included in primary research. The use of strategic adaptations and accommodations during the recruitment process, may serve to support their inclusion.
High Sustained Virologic Response Rates of Glecaprevir/Pibrentasvir in Patients With Dosing Interruption or Suboptimal Adherence
Authors: Zamor Philippe J. , Brown Ashley , Dylla Douglas E. , Dillon John F. , Luetkemeyer Anne F. , Feld Jordan J. , Mutimer David , Ghalib Reem , Crown Eric , Lovell Sandra S. , Hu Yiran , Moreno Christophe , Nelson David R. , Colombo Massimo , Papatheodoridis Georgios , Rockstroh Juergen K. , Skoien Richard , Lawitz Eric , Jacobson Ira M. 
Published: September 2021

INTRODUCTION:
Pangenotypic, all-oral direct-acting antivirals, such as glecaprevir/pibrentasvir (G/P), are recommended for treatment of hepatitis C virus (HCV) infection. Concerns exist about the impact on efficacy in patients with suboptimal adherence, particularly with shorter treatment durations. These post hoc analyses evaluated adherence (based on pill count) in patients prescribed 8- or 12-week G/P, the impact of nonadherence on sustained virologic response at post-treatment week 12 (SVR12), factors associated with nonadherence, and efficacy in patients interrupting G/P treatment.

METHODS:
Data were pooled from 10 phase 3 clinical trials of treatment-naive patients with HCV genotype 1–6 without cirrhosis/with compensated cirrhosis (treatment adherence analysis) and 13 phase 3 clinical trials of all patients with HCV (interruption analysis).

RESULTS:
Among 2,149 patients included, overall mean adherence was 99.4%. Over the treatment duration, adherence decreased (weeks 0–4: 100%; weeks 5–8: 98.3%; and weeks 9–12: 97.1%) and the percentage of patients with ≥80% or ≥90% adherence declined. SVR12 rate in the intention-to-treat (ITT) population was 97.7% (modified ITT SVR12 99.3%) and remained high in nonadherent patients in the modified ITT population (<90%: 94.4%–100%; <80%: 83.3%–100%). Psychiatric disorders were associated with <80% adherence, and shorter treatment duration was associated with ≥80% adherence. Among 2,902 patients in the interruption analysis, 33 (1.1%) had a G/P treatment interruption of ≥1 day, with an SVR12 rate of 93.9% (31/33). No virologic failures occurred.

DISCUSSION:
These findings support the impact of treatment duration on adherence rates and further reinforce the concept of “treatment forgiveness” with direct-acting antivirals.