bluuebunny/crossref_metadata_2025_split huggingface dataset:
The status of acetabulum in bipolar HIP replacements in orthopaedics oncology cases
Authors: Ajit Singh Vivek , Ying Jing Ooi , Santharalinggam Rupini Devi , Yasin Nor Faissal 
Published: December 2024

Background: Bipolar hip endoprosthesis replacement is a commonly employed procedure in orthopaedic oncology that requires the resection and reconstruction of the proximal femur. With improving survival rates, issues of implant durability and acetabular wear have become increasingly important. The decision to replace the acetabulum in bipolar hip endoprosthesis replacement procedures remains a topic of debate. Aim: This study aimed to assess the prevalence of secondary osteoarthritis following bipolar hip replacement, the need for revision to total joint replacement post-procedure, the functional status of patients in relation to radiological findings of joint degeneration, and the survivorship of bipolar hip replacements. Methods: Patients with orthopaedic oncology cases who underwent bipolar hip endoprosthesis replacement between 2006 and October 2021, with a minimum follow-up of six months, were included. Both clinical and radiological evaluations were carried out. The clinical evaluation utilised the Musculoskeletal Tumor Society (MSTS), Toronto Extremity Salvage Score (TESS), and modified Harris Hip Score (mHHS) systems. The radiological assessment focused on identifying acetabular erosion. Results: Forty eligible patients were identified. Radiological assessments revealed 21 patients (52.5%) with grade 0, 17 patients (42.5%) with grade 1, and 2 patients (5.0%) with grade 2 acetabular erosion. No patients exhibited grade 3 acetabular erosion. One patient (2.5%) required revision surgery from proximal femoral bipolar replacement to total hip replacement due to recurrent postoperative hip dislocation. There was no statistically significant difference in MSTS and mHHS scores but a significant difference in TESS scores. The ten-year implant survival rate was 77.8%, while the overall patient survivorship at ten years was 72.1%. Conclusion: Bipolar hip replacement is a durable limb-preserving reconstruction that can outlast patients’ lifespans and is well-tolerated by oncology patients. The incidence of acetabular erosion and revision surgery is low. Despite radiological evidence of hip degeneration, functional status in patients is not significantly impacted.
Facility and Regional Variations in Admission and Discharge Patterns Within Step-Up Intermediate Care: A Cross-Sectional Study of Municipal Inpatient Acute Care Services in Norway
Authors: Yang Fan , Burrell Lisa Victoria , Raknes Sogstad Maren Kristine , Skinner Marianne Sundlisæter 
Published: December 2024

Background: Norwegian Municipal Inpatient Acute Care (MIPAC) services were established as part of the 2012 Coordination Reform. The intention was to prevent unnecessary hospital admissions by redirecting and maintaining less urgent patients at the primary care level, which provides inpatient acute healthcare services closer to patients’ home. However, the role MIPAC plays in the patient trajectory and how trajectories vary across different units and settings is less clear. Objective: Therefore, this study aimed to (1) describe the general patient transfer trajectories for MIPAC patients and (2) examine facility and regional variations in MIPAC patients’ sources of admission and discharge destinations. Design: A cross-sectional study using aggregated register data. Methods: The study involved 36 662 admissions across 185 MIPAC units in 2019. Descriptive statistics were used to describe patient transfer trajectories, and a random-effects multinomial logistic model was applied to assess the association between facility and regional factors and patients’ admission sources and discharge destinations. Results: The findings revealed distinct admission and discharge patterns based on facility and regional factors. Notably, intermunicipal units with 5 and more municipalities collaborating had higher relative risk ratios (RRR) for discharging to hospital (RRR = 1.50, 95%CI: 1.30-1.72) compared with independent MIPAC units. Large MIPAC units with more than 5 beds had increased relative risk ratios of patients admitted from the hospital than from home (RRR = 4.29, 95%CI: 1.56-11.78). Additionally, regional disparities existed, with units in the Central (RRR = 2.29, 95%CI: 1.56-3.38) and Western Norway health authorities (RRR:1.58, 95%CI: 1.22-2.06) displaying higher nursing home discharge rates than units in the South-Eastern Norway health authority. Conclusions and implications: This study confirms the Norwegian MIPAC services’ adherence to admission avoidance policies and identifies significant variations in service delivery across regions and facilities. The Norwegian MIPAC model also has potential to inspire other countries in developing admission avoidance services in the primary care setting.
Numerical study on the vehicle exhaust dispersion in a curved tunnel: Effects of the tunnel radius and tilt angle of jet fan
Authors: Song Yuqing , Sun Mengru , Yang Jianzhi , Tao Changfa 
Published: December 2024

In the present work, computational fluid dynamics (CFD) was used to study the dispersion behaviours of vehicle exhaust, including the CO and PM in a curved tunnel with a consideration of the coupling effects of tunnel radius and tilt angle of jet fan. The simulation results showed the variations in the high-speed jet area in the tunnel under different tunnel radii and tilt angles of jet fan. For the pollutant diffusion, concentrations of CO and PM were shown to be inversely proportional to the tilt angle of jet fan and tunnel radius. In the vertical direction, the PM concentration was not always decreased with the increase in the altitude, which is different from distribution of CO concentration. In the horizontal direction, CO was mainly distributed at 20 – 60 m downstream from the fan, while PM accumulation covered the entire downstream of the tunnel. A close relationship between the distribution of pollutant concentration and vortex structures was found. The present work could contribute to knowledge for reducing the energy consumption of jet fans and the pollutant concentration in the curved tunnel and would provide significant guidance for the future design of curved road tunnels.
Medical emergencies in hospital: The role of treatment escalation plans in out-of-hours decision-making
Authors: Gan Tze Yi , Harris Roy , Taylor D Robin 
Published: December 2024

Background: Out-of-hours medical emergencies are common in acute hospitals, and are often attended by staff who are unfamiliar with the patient’s clinical background. Information in the hospital notes may or may not include guidance about how best to deal with clinical deterioration. The use of Treatment Escalation Plans (TEPs) attempts to address these deficiencies. Methods: This was an observational, questionnaire-based evaluation of the experience of trainee hospital doctors who attended out-of-hours medical emergencies. Results: Sixty-five medical emergencies were evaluated by a total of 38 doctors. Thirty patients had a TEP, attended by 20 doctors, and 35 without a TEP were attended by 27 doctors. Information from medical notes to facilitate decision-making was deemed sufficient by the attending doctor in 77% of patients with a TEP, compared to 54% of patients with no TEP. Only 10% of patients with a TEP had their treatment escalated at the time of the call, whereas this occurred in 20% of patients without a TEP (NS). A TEP was deemed ‘somewhat’ or ‘very’ helpful by trainees in 21/30 of the cases who had one. In 27/35 cases who did not have a TEP, trainees deemed that it would have been helpful to have had one. Twelve of 38 participants (32%) considered that there was a discrepancy between what was ‘expected’ and what they considered to be ‘right’ when managing out-of-hours emergencies. Conclusion: TEPs have an important role in delivering key information that shapes out-of-hours decision-making in deteriorating patients. Both objective outcomes and the subjective quality of medical decision-making are enhanced when a TEP is available.
Work as a social determinant of maternal health: A qualitative exploration of college-educated Black women’s experiences at work during pregnancy and postpartum
Authors: Omowale Serwaa S , Mangum Laurenia C , Joseph-McCatty Andrea , Cottrell-Daniels Cherell , Farris Kaiya A , King Rashon , Slatton Brittany C 
Published: December 2024

Background: Black women are disproportionately impacted by higher rates of maternal mortality in the United States (US). Limited research has focused on adverse maternal health outcomes among college-educated Black women, although research has found these outcomes persistent among this population. Objectives: This study aimed to fill a critical gap in current research by elucidating the nuanced experiences of college-educated Black women in the workplace during pregnancy and postpartum. By exploring this under-researched area, our study contributes to the academic discourse on Black maternal health disparities within the scope of occupational health. It offers practical insights for enhancing workplace gender equity, informing healthcare practices, and shaping policies that support equitable maternal health outcomes among Black women. Design: This qualitative study conducted semi-structured interviews with 17 Black mothers between March 2019 and September 2019. Methods: Seventeen in-depth interviews were conducted with college-educated Black women in the US from March 2019 to September 2019. Participants were asked several questions about work stress, discrimination, and other workplace experiences during pregnancy and postpartum. Results: Our analysis identified three themes, including Strong Black Woman/Superwoman, work stress (sub-themes: consciousness of work stress, mental and physical responses to stress, and work–family conflict), and perceived work-related discrimination. Conclusion: For college-educated Black women experiencing pregnancy and postpartum, it is crucial to understand the structural and social determinants of optimal occupational health. It is critical that workplaces enact occupational health equity with attention to racial, gender, and disability-centered considerations to address the unique challenges experienced by Black women.
Quantitative susceptibility mapping of the fear circuit: Associations with silent symptoms in relapsing-remitting multiple sclerosis
Authors: Khormi Ibrahim , Fazlollahi Amir , Al-iedani Oun , Vidyasagar Rishma , Ayton Scott , Alshehri Abdulaziz , Paton Bryan , Ramadan Saadallah , Lechner-Scott Jeannette 
Published: December 2024

Background: Multiple sclerosis (MS) is a long-term autoimmune inflammatory disorder that affects the central nervous system leading to neurodegeneration, and can involve a variety of symptoms. These symptoms can include fatigue, anxiety, depression, and cognitive decline, which may be silent. The objective of this study was to explore changes in brain iron deposition in people with relapsing-remitting MS (pw-RRMS) compared to healthy controls (HCs), with a particular focus on regions of fear circuit. Additionally, the study aimed to evaluate relationship between iron deposition in these areas and clinical measurements. Methods: Pw-RRMS and HCs participants underwent brain MRI scans using quantitative susceptibility mapping (QSM) to assess iron deposition in the fear circuit between the two groups. The study analyzed correlations between brain susceptibility changes and clinical measurements. Results: We recruited 35 pw-RRMS (mean age = 46.7 ± 11 years; median EDSS = 2.5) and 18 HCs (mean age = 40.6 ± 17.8 years). Our research revealed significant increases in QSM signals relating to iron deposition in pw-RRMS compared to HCs, whole fear circuit (β = 5.82, p < 0.001), caudate (β = 21.48, p < 0.001), and putamen (β = 17.53, p = 0.03), showing the greatest difference. The whole fear circuit and particularly the caudate are strongly associated with fatigue in pw-RRMS. QSM values in the anterior cingulate cortex significantly differed between pw-RRMS with normal and abnormal depression scores ( p = 0.007). Conclusions: These results strengthen the relationship between increased iron deposition in fear circuit regions and specific silent symptoms in pw-RRMS. However, further studies are required to confirm these findings and clarify the implications of iron accumulation in MS pathophysiology.
A Cadaver Study: The Relationship of Vital Organs of the Thoracolumbar Junction During a far Lateral Approach Using a T-12 Corpectomy Model
Authors: Lewik Gerrit , Pierre Clifford , Hicks James W. , Rao Gautam K. , Patel Neel T. , Anderson Bryan G. , Davis Donald D , Chapman Jens R. , Oskouian Rod J. 
Published: December 2024

Study Design Human cadaver study. Objectives To provide a qualitative and quantitative evaluation by demonstrating measurements of the proximity of vital structures involved and assessed injuries during a T12-corpectomy and cage implantation via a far lateral approach. Material and Methods Six fresh-frozen adult cadaveric specimens were dissected according to standardized protocol. A formal left-sided far lateral T12-corpectomy was carried out by trained experienced spine fellows. Upon completion of the procedure, a cage was placed between T11 and L1. We then turned the patient supine and performed a formal celiotomy and sternotomy to allow for an open anterior central inspection of all structures concerned. Vital structures as in vessels, diaphragm, pleural membranes, neural elements, important foramina of the diaphragm (Bochdalek, Morgagni) and the thoracic duct were identified. Any injuries to these structures were recorded and proximity to key relevant structures to this exposure were measured. Results We were able to quantify the actual diaphragm excursions and describe its origins to the spine. There was no actual diaphragm injury in any of the cadavers and there were no injuries to the neurovascular structures. We found expected parietal but no visceral pleural injuries. Conclusion Our cadaver study identified the feasibility of performing a T12-corpectomy through a far lateral approach with no violation of the actual diaphragm and expected limited injuries to the parietal pleura only.
30- and 90-Day Readmission Rates Following Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analyses
Authors: Hesari Marjan , Alizadeh Seyed Danial , Malekzadeh Hamid , Tabrizi Reza , Jalalifar Mohammad-Rasoul , Shahmohammadi Alireza , Eskandari Zahra , Ghodsi Zahra , Harrop James , Rahimi-Movaghar Vafa 
Published: December 2024

Study Design Systematic Review and Meta-Analyses. Objective To assess the 30- and 90-day readmission rates after a traumatic spinal cord injury (SCI). Methods A systematic search of MEDLINE and Embase was performed. The period was from inception to June 2022, with no language restrictions. All studies investigating the 30- and/or 90-day readmission rate following traumatic SCI were included. A random-effects model to combine effect sizes in our meta-analysis was applied. Results Seven out of 2959 reports met eligibility. The mean age of the patients was 50.2 ± 19.9, with a male-to-female ratio of 2.4:1. The most common traumatic SCI was cervical injury (55.3%). The meta-analysis model revealed a 30-day readmission rate of 14.2% after traumatic SCI, with heterogeneity in the studies. The 90-day readmission rate was 35.7%, with homogeneity in the studies. The meta-regression analysis found significant positive associations between cervical and thoracolumbar injuries and patient age and the 30-day readmission rate, while male sex demonstrated a negative association with the 30-day readmission rate. The 30-day readmission rate following index admission was 13.1% and the 30-day readmission rate after rehabilitation facilities was 15.8%. The study found that the 30-day readmission rate in the USA was 14.0%. Conclusions There is no doubt that readmission is an adverse health outcome. The outcome is also complex and multifaceted, which makes it difficult to predict. Injury level is 1 of the predictors that affect readmission, making it essential to consider factors during discharge planning for high-risk people to reduce 30-day readmission rates.
Bone Marrow Aspirate Concentrate Injections for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials
Authors: Han Joo Hyung , Jung Min , Chung Kwangho , Jung Se-Han , Choi Chong-Hyuk , Kim Sung-Hwan 
Published: December 2024

Background: Osteoarthritis (OA) poses a significant global burden, with conventional treatments like corticosteroid and hyaluronic acid (HA) injections commonly used. Emerging injectable biologics, including bone marrow aspirate concentrate (BMAC), show promise in OA management. Purpose: To investigate the clinical efficacy of BMAC injection compared with other injection treatments for knee OA. Study Design: Systematic review; Level of evidence, 1. Methods: A systematic review was conducted using PubMed, Embase, Cochrane Library, and Google Scholar to identify randomized controlled trials with Level 1 evidence that compared the clinical efficacy of BMAC with other injections. The visual analog scale for pain and the Pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) were used as clinical scores representing pain. For functional assessment, the Western Ontario and McMaster Universities Osteoarthritis Index and the International Knee Documentation Committee subjective form were used. For studies comparing BMAC with HA, each clinical score was standardized to pain and function scales based on the minimal clinically important difference (MCID). Results: Eight studies, consisting of a total of 937 patients, were included. Patients treated with BMAC showed a significant improvement in clinical scores compared with baseline, starting at 1 month postinjection. For pain scores at 6-month ( P = .033) and 12-month follow-up ( P = .011), BMAC demonstrated favorable results over HA, with a statistically significant difference. However, these differences did not exceed the MCID. When BMAC was compared with other injections, no significant differences were observed in the degree of clinical score improvement. No serious adverse events or events significantly associated with BMAC compared with other treatments were reported. Conclusion: BMAC injections demonstrated effectiveness in providing pain relief and functional improvement for patients with knee OA. When BMAC was compared with other intra-articular injection options, distinct differences surpassing the MCID were not evident. Further research is deemed necessary to investigate the role of BMAC in the treatment of knee OA.
Prevalence of Upper Extremity Volleyball Injuries Within Different Adult Age Groups: A Comprehensive Analysis of National Data From 2013-2022
Authors: Lee Philip M. , Snyder Eli M. , Obana Kyle K. , Trofa David , Lee Lorrin , You Jae 
Published: December 2024

Background: The mean age of volleyball athletes has increased over the past decade, raising concerns about musculoskeletal injuries. There is no literature on how different mechanisms of injury (MOI) affect different adult age groups. Purpose: To evaluate epidemiologic trends, diagnoses, and mechanisms of volleyball-related upper extremity injuries within different adult age groups. Study Design: Descriptive epidemiology study. Methods: Data from the National Electronic Injury Surveillance System for volleyball-related upper extremity injuries in patients aged between 19 and 79 years, between January 1, 2013, and December 31, 2022, were analyzed. Data included body parts, diagnosis, MOI, and disposition. Calculations used corresponding hospital sample weights for national estimates (NEs). Patients were divided into either 20-39, 40-59, or 60+ years age groups. Linear regressions were used to analyze annual trends, chi-square tests were used to analyze categorical variables, and the Holm P value adjustment method was utilized in post hoc analysis. Results: A weighted NE of 41,164 volleyball-related upper extremity injuries occurred in the study period. The mean age was 35.8 ± 14 years, and male patients constituted 49.4% of all patients. The most injured body parts of all age groups were fingers (33.2%), shoulders (28.9%), and wrists (16%). The most common identifiable MOI were impacts with the floor (24%), impacts with the ball (18.7%), and spikes/serves (6.9%). The 20-39 age group experienced shoulder dislocations at the greatest rate of all age groups (NE = 3362 [37%]) and sustained injuries from spike/serve movements at the greatest rates (NE = 2214 [8.2%]; P < .01). Of the 3362 shoulder dislocations in the 20-39 age group, 1445 (43%) were during spikes/serves. The 60+ age group had the greatest rates of sprains/strains (NE = 1353 [41.1%]). Additionally, the 60+ age group suffered from injuries secondary to impacts on the floor (NE = 1242 [37.7%]) and impacts with the ball (NE = 769 [23.4%]) at the greatest rates ( P < .01). Conclusion: Our study demonstrated that adult populations are at risk for volleyball-related upper extremity injuries, specifically affecting the finger, wrist, and shoulder. MOI among age groups differed, as younger adults more often sustained injuries from dynamic movements, whereas older adults sustained injuries from trauma.