bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mortality After Total Knee Arthroplasty
Authors: Berstock James R. , Beswick Andrew D. , López-López José A. , Whitehouse Michael R. , Blom Ashley W. 
Published: June 2018

Background:
The capacity for total knee arthroplasty to improve pain, quality of life, and functional outcomes is widely recognized. Postoperative mortality is rare but of paramount importance, and needs to be accurately quantified and conveyed to patients in order to support decision-making prior to surgery. The purpose of this study was to determine a contemporary estimate of the risk of mortality following total knee arthroplasty, including the identification of temporal trends, common causes, and modifiable and nonmodifiable risk factors.

Methods:
We performed a systematic review with searches of MEDLINE, AMED, CAB Abstracts, and Embase. Studies in any language published from 2006 to 2016 reporting 30 or 90-day mortality following total knee arthroplasty were included, supplemented by contact with authors. Meta-analysis and meta-regression were performed for quantitative data.

Results:
Thirty-seven studies with mortality data from 15 different countries following over 1.75 million total knee arthroplasties formed the basis of this review. The pooled Poisson-normal random-effects meta-analysis estimates of 30 and 90-day mortality were 0.20% (95% confidence interval [CI], 0.17% to 0.24%) and 0.39% (95% CI, 0.32% to 0.49%). Both estimates have fallen over the 10-year study period (p < 0.001). Meta-regression using the median year of surgery as a moderator showed that 30 and 90-day mortality following total knee arthroplasty fell to 0.10% (95% CI, 0.07% to 0.14%) and 0.19% (95% CI, 0.15% to 0.23%), respectively, in 2015. The leading cause of death was cardiovascular disease.

Conclusions:
There is an ongoing worldwide temporal decline in mortality following total knee arthroplasty. Improved patient selection and perioperative care and a healthy-population effect may account for this observation. Efforts to further reduce mortality should be targeted primarily at reducing cardiovascular events following total knee arthroplasty.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Robustness of Trials That Guide Evidence-Based Orthopaedic Surgery
Authors: Checketts Jake Xavier , Scott Jared T. , Meyer Chase , Horn Jarryd , Jones Jaclyn , Vassar Matt 
Published: June 2018

Background:The fragility index (FI) may prove to be a powerful metric of trial robustness. The FI is the minimum number of patient events that would need to become nonevents in order to nullify a significant result. The fragility quotient (FQ) is the FI divided by the total sample size. This study evaluates the robustness of the 20% of orthopaedic clinical trials that were cited as having strong evidence in the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines and that could be analyzed with these indices.Methods:From the AAOS recommendations with strong evidence, we extracted the randomized controlled trials that were cited as having supporting evidence that could be analyzed with the FI. Each trial’s FI was calculated using the fragility calculator (www.fragilityindex.com). With use of the Cochrane Risk of Bias Tool 2.0, we evaluated the likelihood of bias. We also performed a post hoc power analysis of eligible studies.Results:The median FI for the 72 trials was 2 events, and the median FQ was 0.022. Of the 72 trials, only 3 (4.2%) were at a low risk of bias, and 35 (48.6%) were at a high risk of bias. Thirty-eight (53%) of the trials were underpowered. We identified a strong correlation between a trial’s FI or FQ and the trial’s power.Conclusions:Our study found that trials that provided strong evidence for orthopaedic surgery guidelines were largely fragile, underpowered, and at risk of bias.
One-Stage Revision Anterior Cruciate Ligament Reconstruction: Results According to Preoperative Bone Tunnel Diameter
Authors: Yoon Kyoung Ho , Kim Jung Suk , Park Soo Yeon , Park Sang Eon 
Published: June 2018

Background:
Bone tunnel enlargement is one of the important factors that determine whether a revision anterior cruciate ligament reconstruction (ACLR) should be performed in 1 or 2 stages. The goal of this retrospective cohort study was to compare the mid-term to long-term outcomes of 1-stage revision ACLR according to the amount of preoperative tunnel enlargement.

Methods:
Between January 2002 and January 2012, 88 patients who underwent revision ACLR were enrolled. The patients were divided into 2 groups based on the tunnel diameter (group A, <12 mm; group B, ≥12 mm). Clinical scores (International Knee Documentation Committee [IKDC] subjective score, Lysholm score, and Tegner score) and knee joint stability (as measured with the anterior drawer test, Lachman test, pivot-shift test, and measurement of the side-to-side difference in anterior tibial translation on Telos stress radiographs) were evaluated preoperatively and 5 to 15 years postoperatively. The failure rate and survivorship were compared between groups A and B.

Results:
The mean time to final follow-up was 7.9 ± 2.6 years. There were 44 patients in each of the 2 groups. There were no significant differences in the postoperative IKDC subjective scores, Lysholm scores, or Tegner activity scores between the groups. However, group A showed superior results on all knee joint stability tests except for the anterior drawer test. There were 3 failures in group A (7%) and 6 in group B (14%). The overall survival rates with failure as the end point were 93.1% and 84.6%, respectively, at 15 years.

Conclusions:
The 5 to 15-year clinical scores following revision ACLR did not differ significantly according to the preoperative amount of tunnel widening. However, the results of the postoperative Lachman and pivot-shift tests as well as the side-to-side difference in anterior tibial translation on Telos stress radiographs were significantly superior in the group with a preoperative tunnel diameter of <12 mm compared with the group with a tunnel diameter of ≥12 mm.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Modern Surgical Treatment of Recurrent Posterior Dislocation of the Native Hip
Authors: Carlson Bayard C. , Desy Nicholas M. , Johnson Joshua D. , Trousdale Robert T. , Leunig Michael , Ganz Reinhold , Sierra Rafael J. 
Published: June 2018

Background:
Redislocation of the native hip is rare. An anterior fulcrum between the proximal part of the femur and the pelvis must be present for a posterior dislocation to occur. The purpose of this study is to describe the cases of 9 patients with posterior redislocation or recurrent subluxation of the native hip that was treated with hip preservation surgery.

Methods:
We retrospectively identified the cases of 9 patients, from 2 institutions, who had undergone hip preservation surgery for the management of posterior redislocation or recurrent subluxation of the native hip after a dislocation. The mean number of dislocations prior to surgery was 3.2 (range, 1 to 7). Pelvic radiographs were used to classify the acetabular morphology, sufficiency of acetabular containment, and structural anatomy of the proximal part of the femur. Radiographic identification of impinging structures was used to guide surgical treatment, which involved either femoral correction alone or the combination of femoral correction and an anteverting periacetabular osteotomy.

Results:
At a mean follow-up of 73.8 months (range, 10 to 192 months), there had been no subsequent episodes of dislocation or subluxation in any of the hips treated with correction of the anatomic pivot point. An algorithmic approach is presented.

Conclusions:
In patients who have episodes of redislocation or recurrent subluxation of the native hip, the identification of anatomic abnormalities that create a fulcrum between the proximal part of the femur and the pelvis is critical for making appropriate treatment decisions.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Surgically Relevant Patterns in Triplane Fractures
Authors: Hadad Matthew J. , Sullivan Brian T. , Sponseller Paul D. 
Published: June 2018

Background:
Triplane ankle fractures are complex transitional fractures that often necessitate surgical treatment. Axial fracture lines determine optimal screw trajectories for fixation. The purpose of our study was to identify fracture patterns in triplane fractures by illustrating fracture lines in the axial plane of the distal tibial metaphysis and epiphysis.

Methods:
We retrospectively reviewed records of children presenting with ankle fractures at 1 center from January 2007 through June 2017. Thirty-three cases of triplane fractures with available computed tomographic (CT) scans were identified. Fractures in the axial plane of the metaphysis were identified 10 mm proximal to the physis, and fractures in the epiphysis were identified midway between the physis and distal tibial articular surface. Fracture lines were drawn and were superimposed on unfractured bone templates to generate fracture maps, and heat maps were then created to show areas of high and low fracture densities.

Results:
In the metaphysis, the most common fracture pattern was medial-lateral lines in the posterior metaphysis. This metaphyseal pattern was consistent across 2, 3, 4, and 5-part fractures. There were clear zones of rare fracture involvement in the anterior and anterolateral metaphysis. In the epiphysis, anterior-to-posterior fracture lines were common in the anterior epiphysis. All cases had an epiphyseal fracture exit through the anterior epiphysis. Fracture extension into the posteromedial epiphysis was a feature of all fracture classes.

Conclusions:
Fracture mapping of triplane fractures suggests consistent axial fracture patterns in the metaphysis and epiphysis with additional class-dependent fractures in the epiphysis. This study provides visual guidelines to assist surgeons in understanding the axial fracture patterns of individual triplane fractures for surgical planning.
SİGORTA KOOPERATİFÇİLİĞİ: TÜRKİYE UYGULAMASI
Authors: Demirci Serdar 
Published: June 2018

Sigorta,
bir sosyal dayanışma mekanizmasıdır. Kooperatifler ise ortaklarının ekonomik
menfaatlerini koruyup, kollamak ve güçlendirmek amacıyla kurulan, bu amaç
çerçevesinde de ortakları arasında yardımlaşma, dayanışma ve kefalet
fonksiyonlarını" “karşılıklılık” prensibi bağlamında hayata geçiren
ortaklıklardır. Gerek sigortacılık
gerekse kooperatifçilik, münferit güçlerin birleştirilerek sosyal ve ekonomik
olarak dayanışma halinde sorunların ortaklaşa
ve karşılıklı olarak çözümlenmesinin hedeflendiği benzer modellerdir.
Sigortacılık ve kooperatifçiliğin, bu çerçevede kesiştiği ortak nokta
karşılıklı (mütüel) sigortadır. Karşılıklı sigorta, aynı sahada ticari
faaliyette bulunan grup üyelerinin, birbirlerinin sigortacısı olmasını ve
herhangi bir hasar durumunda, grup üyelerinin katkılarıyla oluşturulmuş fonun,
hasarın karşılanmasında kullanılması esasına dayanan özel bir sigorta
sözleşmesidir. Karşılıklı sigortanın temel karakteristiğini ortaya koyan
"karşılıklılık" (mutuality); ortak menfaatleri için, sigorta fonuna
prim ödemek suretiyle katkı sağlayanların, gerek sigortacılık faaliyeti
sonucunda oluşan ihtiyaç fazlasından pay alabilme gerekse hasar bedelini temin
edebilme hakkına sahip olmalarını ifade etmektedir. Ülkemizde karşılıklı
sigortanın "kooperatif" çatısı altında yürütülmesi tercih edilmiştir.
Bu çalışmada da özetle, karşılıklı sigorta faaliyetinin icra edildiği sigorta
kooperatiflerine ve ülkemizdeki mevcut durumuna değinilmiştir.
Membrane-based pretreatment to mitigate variations in desalination plants
Authors: Arevalo J. , Sandin R. , Kennedy M. D. , Salinas Rodriguez S. G. , Rogalla F. , Monsalvo V. M. 
Published: June 2018

Abstract
The main source of potable water in high water-stress areas is commonly produced in brackish and seawater desalination plants. Owing to the presence of high concentration of suspended solids, organic matter and colloidal particles in raw water, pretreatment processes are needed for a stable operation of desalination plants. A submerged membrane ultrafiltration pilot plant has been operated as pretreatment of complex brackish surface water to study the filtration performance. The results show the membrane performance, chemical reagent requirements, water quality and cleaning procedures efficiency of an ultrafiltration pilot plant used as pretreatment for a reverse osmosis system. Alternative chemical cleaning procedures have been satisfactorily implemented, which maximize permeability recovery and allow a stable operation.
Characterization CYP1A2, CYP2C9, CYP2C19 and CYP2D6 Polymorphisms Using HRMA in Psychiatry Patients with Schizophrenia and Bipolar Disease for Personalized Medicine
Authors: Yenilmez Ebru Dundar , Tamam Lut , Karaytug Onur , Tuli Abdullah 
Published: June 2018

Background:
The interindividual genetic variations in drug metabolizing enzymes effects
the impact and toxicity in plenty of drugs.

Objective:
CYP1A2, CYP2C9, CYP2C19 and CYP2D6 gene polymorphisms were characterized
using high resolution melting analysis (HRMA) in follow-up patients in psychiatry clinic as a
preliminary preparation for personalized medicine.

Method:
Genotyping of CYP1A2*1F, CYP2C9 *2, *3, CYP2C19 *2, *3 and *17 and CYP2D6 *3,
*4 was conducted in 101 patients using HRMA. Genotype and allele frequencies of the CYP variants
were found to be in equilibrium with the Hardy-Weinberg equation.

Results:
The frequency of the CYP1A2*1F allele in schizophrenia and bipolar disease was 0.694 and
0.255, respectively. The CYP2C9 allele frequencies were 0.087 (CYP2C9*2), and 0.549
(CYP2C9*3) for bipolar; 0.278 (CYP2C9*2) and 0.648 (CYP2C9*3) in schizophrenias. The
CYP2C19*2 and *17 allele frequencies was 0.111 and 0.185 in schizophrenia and variant *2 was
0.117 and variant *17 was 0.255 in bipolar group. The frequency of the CYP2D6*3 allele was 0.027
in schizophrenias. The frequencies for the CYP2D6*4 variant were 0.092 and 0.096 in schizophrenia
and bipolar groups, respectively.

Conclusion:
The knowledge in pharmacogenomic and also the developments in molecular genetics
are growing rapidly. In future, this can be expected to provide new methodologies in the prediction
of the activity in drug metabolizing enzymes. The HRMA is a rapid and useful technique to identify
the genotypes for drug dosage adjustment before therapy in psychiatry patients.
Unconsented linkage between dormant trials and administrative data: practical and regulatory implications
Authors: Verfuerden Maximiliane , Fewtrell Mary , Kennedy Kathy , Lucas Alan , Jerrim John , Harron Katie , Gilbert Ruth 
Published: June 2018

Half of all infants are fed formula milk. However, attrition biases evidence on the long-term safety of formula ingredients. We used unconsented linkage between administrative education and health records of 3,500 young people who were randomised as infants to formula milks, to determine long-term safety and efficacy.
We discuss the steps that were implemented to safeguard the participants' privacy and achieve ethical and multi-institutional approvals.
Achieving provisional ethical approval took 41 days. Achieving agreement-in-principle to match trial data to individual-level education records took 4 months and 2 weeks, while agreement to match trial data to individual level hospital records is still underway (5.5 months so far). Delays in institutional approval were largely due to unharmonised data security certificates between the two government departments holding the health and education records. Digitising all handwritten participant identifiers prior to linkage took 9 months. Results on the success of linkage between trial and education records will be presented at the conference.
While directly contributing to the evidence around infant-formula-composition, this project will also act as a proof-of-concept study. Unconsented linkage between dormant RCTs and administrative data could be a novel and cost-effective method to generate evidence on the long-term efficacy and safety of interventions.
Research Transparency and Data Privacy – a fine balance
Authors: Tilbrook Amy 
Published: June 2018

Preserving the confidentiality of information is of paramount importance to data controllers sharing data for research use. Work within the Administrative Data Research Network is built upon strict information governance and assurance protocols to minimise any privacy risks and maximise public benefit. However, research funders and publishers are ever more requiring research to be as transparent and open as possible, with increasing pressure to publish datasets underpinning the research. This is seen as crucial for both verification and to maintain the integrity of the research.
While Safe Havens and data repositories provide some reassurance in terms of storage and citation, how can researchers prepare to walk this fine line between publisher and funder requirements and the need to protect privacy?
This presentation will explore the issue of privacy vs research transparency from the viewpoints of researchers, safe haven providers and research co-ordinators. Examining such issues as disclosure control, statistical packages updating, public opinion and the potential impact of the new European data protection legislation, it will outline challenges and provide potential guidelines for researchers and administrators involved in administrative data research.
Linking the National Down Syndrome Cytogenetic Register to Hospital Episode Statistics: Methods and challenges
Authors: Doidge James , Morris Joan , Gilbert Ruth 
Published: June 2018

BackgroundLinking national disease and congenital anomaly registers to other routinely collected data could provide multiple benefits. It could allow researchers to examine long-term outcomes for people with registered conditions and to explore synergies between services that are provided in different sectors, such as health and education. Linkage could also allow for the quality of diagnostic codes in electronic health records to be assessed using the national registers coverage and, conversely, for coverage of the national registers to be assessed using diagnostic codes.
ObjectivesTo demonstrate the feasibility and value of creating a linked data resource to support research on health, social and educational services and outcomes for children with Down’s Syndrome.
MethodsWe are currently linking the National Down’s Syndrome Cytogenetic Register (NDSCR), which includes all births with Down’s syndrome from 1989 to 2014 in England and Wales, to Hospital Episode Statistics (HES) for England and ONS Mortality data, and to the National Pupil Database (NPD). This requires a complex sequence of new linkages: (1) linkage of mothers to babies in HES, (2) linkage of mother-baby pairs to the NDSCR to identify a population cohort, (3) linkage of the cohort to the Personal Demographic Service to update address histories, and (4) linkage of updated cohort to NPD.
FindingsEstablishment of this linked data resource has met with significant challenges. The main administrative challenge has been incompatible accreditation of information governance across government departments. Technical challenges have included overcoming issues with the internal linkage of contributing datasets, requiring additional linkage steps to be added, and the propagation of error and uncertainty across multiple linkages, which involves complex data structures that require novel ethods for analysis.
ConclusionsWe hope this project will demonstrate that while the challenges to intersectoral data linkage are great, they are surmountable and the benefits outweigh the costs.
Challenges of Analysing Case-Control Datasets: A Health and Homelessness Case Study
Authors: Waugh Andrew , Rowley David , Clarke Auren 
Published: June 2018

BackgroundWe discuss the methodological challenges of analysing a casecontrol dataset.
ObjectivesThe study seeks to explore the relationship between health activity and homelessness in Scotland.
MethodsOur study involved 430,000 people with experience of homelessness, each matched with two controls of the same age and sex: one from each of the 20% least deprived and 20% most deprived areas. This gives 1.3 million people in total. We aimed to compare health service usage among the different groups to ascertain whether the health needs of the homeless group exceeded that of the general population, and in particular those of non-homeless deprived people.However, as the cases were defined individually, and the controls were defined only by proxy (via datazone of residence), observed differences between the groups could simply result from differences in the proportion of the group that were deprived, rather than specifically relating homelessness itself.To address this we compare the timing of health activity with the timing of the homelessness assessment to more directly isolate the relationship between homelessness and health. This temporal analysis also allows discussion of causation.This method raised further difficulties: effectively being a convolution of complicated functions. However as each group has the same age–sex structure the complexity applies equally. Thus direct comparisons can be made between the groups resulting in more-straightforward analysis.
FindingsFindings of the study are presented in a separate talk (The Relationship Between Health and Homelessness in Scotland) at this conference.
ConclusionsIdentifying the causal relationships involved in correlations can be difficult. However by comparing the case cohort to the control cohort, and more specifically comparing the time of activity of these relative to the identifying event of the casegroup (the homelessness assessment), it is possible to identify some causal relationships.
Enhancing the collection and analysis of survey and administrative data by linking
Authors: Smith Peter , Moore Jamie , Durrant Gabriele 
Published: June 2018

BackgroundLinking survey and administrative data can enhance their collection and analysis. By linking the issued sample to administrative data, the representativeness of a survey can be assessed during and at the end of data collection. An understanding of the (lack of) representativeness can inform adaptive and responsive survey designs to improve representativeness and/or reduce survey costs. It can also aid the assessment of potential survey non-response bias and the implementation of strategies to adjust for such bias during analysis. Comparison of responses to the same question in two linked datasets can help identify problematic questions. This information can then be used to improve question wording to reduce measurement error in future surveys and to account for such error during analysis.
ObjectivesTo assess how the representativeness of a survey changes after each attempt to contact the interviewees, and to assess the nature and extent of differential reporting between a face-to-face survey and the self-completion 2011 UK Census.
Methods (including data)We present our recent research developing representativeness indicators based on the coefficient of variation of the response propensities calculated after each attempt to contact the interviewees and illustrate their use using Labour Force Survey (LFS) data linked to contemporaneous data from the 2011 Census. We also describe our work on differential reporting between the LFS and the Census, focussing on the reporting of highest qualification and ethnicity.
Findings and ConclusionsOur results suggest that considerable savings can be made by reducing the number of attempts to obtain a response without a detrimental effect on representativeness and that face-to-face interviews obtain more accurate information than self-completion questionnaires.