bluuebunny/crossref_metadata_2025_split huggingface dataset:
PROPHYLAXIS OF PERIPROSTHETIC JOINT INFECTION IN MEGAPROSTHESIS: IS THE USE OF ANTIBIOTIC-LOADED CALCIUM SULPHATE BEADS BENEFICIAL?
Authors: Madeira Guilherme , Mateus Rui Braz , Catelas Diogo , Contente Joana , Rocha Miguel , Lucas João , Nelas João , Oliveira Vânia , Cardoso Pedro , Sousa Ricardo 
Published: November 2024

AimMegaprosthesis have become a standard option in limb preserving surgery after bone resection in musculoskeletal tumors. Recently they have also been used in complex revision arthroplasty in cases with massive bone loss. The aim of this study was to analyze the incidence of periprosthetic joint infection (PJI) both in primary oncology cases and aseptic revision cases and analyze which are the significant risk factors for PJI with a special interest on the use of prophylactic antibiotic loaded calcium sulfate beadsMethodAll patients undergoing surgery with the use of megaprosthesis in our institution between January/2012 and December/2022 were retrospectively reviewed. Data was collected from electronic medical records. We identified 108 procedures involving megaprosthesis in 90 patients with an average follow-up of 37 months. Indications were 79 primary musculoskeletal tumors and 29 aseptic complex revision arthroplasty.ResultsTable 1 shows relevant clinical information. No significant risk factor was found either in uni or multivariate analysis. PJI rate was 15% (12/79) for primary musculoskeletal surgery and 31% (9/29) for complex revision surgery. The use of antibiotic loaded calcium sulfate beads did not show an advantage – 22% (9/41) with vs. 18% (12/67) without.ConclusionsIn this relatively small series it was not possible to show a significal association between PJI and certain known risk factors such as gender, ASA score, site of surgery (knee) and revision surgery. The use of antibiotic loaded calcium sulfate beads as prophylaxis was not beneficial in reducing PJI rates in our cohort. We acknowledge the limitations of our study: a small sample group, in a single institution with heterogeneity in terms of diagnosis and surgical site. We recognize the need for a multicentric study with a larger cohort to validate these findings.For any tables or figures, please contact the authors directly.
IN VITRO EFFICACY OF DIFFERENT IRRIGATION SOLUTIONS AGAINST BIOFILM IN ORTHOPAEDIC SURGERY: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS
Authors: Alonso Marcos Gonzalez , González Adrián Guerra , Suárez Vega Villar , Lázaro Jaime Sánchez 
Published: November 2024

AimIrrigation and debridement with an irrigation solution are essential components of the surgical management of acute and chronic periprosthetic joint infection (PJI). Nevertheless, there is a lack of agreement regarding the most effective solution to use. The aim of the study was to perform a systematic review and meta-analysis of the current literature concerning the efficacy of different irrigation solutions over bacterial biofilm.MethodThis study was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Network meta-analysis (PRISMA-NMA) checklist for systematic reviews and meta-analyses. A comprehensive literature search of PubMed, Cochrane Library, Web of Science and Scopus databases from inception to September 1, 2023. We combined terms related to PJI, biofilm and irrigation solutions studied in vitro. We performed a network meta-analysis to analyze which irrigation solution achieved a higher reduction of colony forming units (CFU) after specific exposure times, always with a maximum of five minutes, replicating intraoperative conditions. Effect-size was summarized with logarithmic response ratio (logRR) and 95% confidence intervals (95% CI). The rank probability for each treatment was calculated using the p-scores.ResultsWe screened 233 potential sources. Following deduplication, screening and full-text review, four studies with ten irrigation solutions for different duration of exposures were included, always less than five minutes, replicating intraoperative conditions. Solutions were studied over mature biofilms of most frequent bacteria grown over metal, bone cement or polyethylene surfaces. The highest effect was achieved with povidone iodine 10% during 5 minutes (logRR: −12.02; 95% CI: −14.04, −9.99). The best ranked solutions were povidone iodine 10% during five, three and one minute (respective p-scores: 0.977, 0.932, 0.887) and its combination with hydrogen peroxide for 3 minutes (p-score: 0.836). Povidone iodine 0.3% acting for 5 minutes completed the top 5 best ranked solutions in this study (p-score: 0.761). We assumed that there were no inconsistencies in our network because after examining both scenarios, with and without inconsistencies, the results were not significantly different.ConclusionsOur results show that 10% povidone-iodine is the best antiseptic solution when studied in vitro in the context of prosthetic joint infection. However, the included studies did not evaluate the possible cytotoxic effects of these solutions. This should also be taken into account before choosing the most appropriate antiseptic solution.
SETTING THE STAGE FOR TAILORING CEFUROXIME DOSING AS PROPHYLAXIS AND TREATMENT OF PERIPROSTHETIC JOINT INFECTIONS USING PHARMACOKINETIC MODELLING
Authors: de Waard Gerbert , Veltman Wout , van Oldenrijk Jakob , Bos Koen , Koch Birgit 
Published: November 2024

AimProsthetic joint infections (PJI) are a common reason for revisions in patients that underwent total arthroplasty of the hip (THA) or knee (TKA). Extensive antibiotic treatment follows while a clear understanding of target site concentrations is lacking. The aim is to investigate the target site concentrations, like bone and synovial tissue concentrations, which consequently may lead to an optimisation of the dosing regiments of cefuroxime of PJI patients suffering from pain and immobility. Dosing optimisation may lead to a reduced risk of (re-)infection and adverse effects like renal-insufficiency and therefore lower health-care costs.MethodPatients (n=26) with PJI of hip or knee undergoing a one- or two-stage revision treated with cefuroxime were included as part of the ASTERICS study. During implant removal two samples were collected 15-30 and 60-120 minutes after IV infusion of plasma, bone tissue and synovial tissue and one synovial fluid sample. Samples were analysed using a UltraPerformance Convergence Chromotography – quadruple mass spectrometry system (UPC2-MS/MS). Bone tissue and synovial tissue were pulverized before analysis acquiring for bone tissue a homogenate of cortical and cancellous bone. Using nonlinear mixed effect modelling (NONMEM) a base model was developed to analyse the bone to plasma ratio of cefuroxime in osteomyelitis patients.ResultsMean bone concentrations (mg/L) of cefuroxime at 30-60 min after IV administration in the knee and hip are 21.29 (SD:11.86) and 19.06 (SD: 11.79) respectively and 8.23 (SD:4.90) and 9.67 (SD:9.75) respectively at 90-120 min after IV administration. The penetration of cefuroxime described by the bone:plasma ratio into knee and hip affected by osteomyelitis is 0.3 and 0.4 respectively within 1 hour and 0.1 for both joints within 2 hours. The results mentioned here were collected during knee operations without blood void conditions. Concentration data was used to develop a base pharmacokinetic model using NONMEM and was best described by a two-compartment model.ConclusionsCefuroxime penetrates osteomyelitis affected bone tissue within the hour proving the usefulness of cefuroxime as prophylaxis of orthopaedic surgery and as treatment option for PJI. However, PK modelling and further simulations need to prove whether repeated cefuroxime dosing in this population is required to reach minimal inhibitory concentrations in target tissue.
DOES ANTIBIOTIC-LOADED CEMENT REDUCE THE RISK OF PERIPROSTHETIC INFECTION IN PRIMARY TOTAL KNEE ARTHROPLASTY? ANALYSIS OF THE CATALAN ARTHROPLASTY REGISTRY
Authors: Sayol Roger Rojas , Lopez Xavi Pelfort , Regulez Borja Velasco , Bueno Jesus Cerquides , Garcia Joan Carles Monllau , Álvarez Joan Murias , Fernández Joel Sánchez , Gonzalez Sergi Gil 
Published: November 2024

AimThere is controversy regarding the use of Antibiotic-loaded cement (ALBC) as compared to non-antibiotic-loaded cement (NALBC) to reduce the overall infection rate without affecting implant survival or adding additional risks on fixation for primary total knee arthroplasty (TKA).MethodTo conduct the analysis, we utilized the Catalan Arthroplasty Registry (RACat) for the TKAs implanted between 2005 and 2017. The primary variable recorded was the use of cement with or without antibiotics. Other recorded variables included were age, sex, diabetes mellitus, obesity, Charlson index and type of hospital. We analyzed the effect of ALBC vs. NALBC in reducing the risk of prosthetic infection at 3, 6, 12, and 24 months as well as prosthetic survival due to mechanical causes at 1, 5, and 10 years. Univariate and multivariable analyses of risk factors were conducted. Thereby, an interactive predictive model that determines the risk of prosthetic infection based on each patient's characteristics was created.ResultsA total of 28,287 TKAs from the RACat were analyzed. In that total, there were 19,788 NALBC and 8,499 ALBC. The infection rates for TKAs with NALBC vs. those with ALBC at 3, 6, 12, and 24 months were respectively: 1.69% vs. 1.39% (p=0.132); 1.81% vs. 1.56% (p=0.147); 2.14% vs. 1.73% (p=0.030); 2.51% vs. 1.86% (p=0.001). A statistically significant reduction in periprosthetic infection rate was observed in the ALBC group at 12 and 24 months. No differences were observed between the two groups in terms of prosthetic mechanical survival. Being younger, male and having had previous knee surgery or having a high comorbidity index all led to a higher risk of prosthetic revision due to infection.ConclusionsThe use of ALBC as a fixation method for TKA leads to a reduction in the risk of prosthetic infection without altering the mechanical survival of the implant. The creation of a predictive model helps determine the individualized risk of prosthetic infection based on the patient's characteristics.
Nurturing humanism and professionalism in a clinical setting: A multicenter study to develop a framework for a learning module for clinical students
Authors: Mustika Rita , Pinasthika Anyta , Greviana Nadia , Pamungkasari Eti Poncorini , Moelyo Annang Giri , Zhuhra Rahma Tsania 
Published: November 2024

Introduction
Professionalism represents a contract between physicians and society, with humanism at its core. Humanism must be developed in medical education, especially in clinical settings, as students meet real-life professional situations. However, dynamic and unpredictable clinical settings might expose students to authentic yet unexpected far-from-ideal situations that might hinder the humanism and professionalism process. Furthermore, culture plays an influential role, highlighting the importance of developing an appropriate and contextual learning strategy. Hence, this study aims to conceptualize strategies to teach humanism and professionalism in high-power distance and collectivistic settings.

Methods
This multicenter qualitative phenomenological study used maximum variation sampling to recruit participants, consisting of clinical students, teachers, and coordinators from three medical schools in Indonesia. Data were collected through focus group discussions (FGDs) and in-depth interviews. Thematic analysis was conducted using the steps of coding and theorization methods.

Results
A total of 15 FGDs and one in-depth interview were conducted with 57 students, 39 teachers, and 18 coordinators. Socialization theory was used to analyze themes, leading to a culturally related approach to learning. Professional identity formation (PIF) was highlighted as the center of learning humanism and professionalism, with character building as the main principle. Designing a curriculum for humanism and professionalism for clinical learning should consider the longitudinal nature of PIF and ensure that professionalism explicitly exists in the curricula. As cultural impact might pose challenges, it must also be acknowledged and addressed. Meaningful integrated learning experiences, patient exposure, and reflection serve as the cornerstones of teaching–learning strategies while considering longitudinally explicit assessments.

Conclusion
Nurturing humanism and professionalism in undergraduate clinical settings is a longitudinal character-building process, with PIF as its center. Longitudinal, explicit, and dynamic strategies should be considered as part of the framework of teaching–learning and assessment of humanism and professionalism, as well as faculty development efforts with close attention to cultural factors.
Artificial Intelligence Integration in Academic Writing
Authors: Abdulah Deldar M. , Zaman Burhan A. , Mustafa Zuhair R. , Hassan Lokman H. 
Published: November 2024

This study investigates the use of artificial intelligence (AI) technologies among academics at the University of Duhok (UoD), focusing on their perspectives, preferences, and intentions toward integrating AI within academic and research environments. A survey was conducted through Google Forms, targeting postgraduate students, recent alumni (since 2020), and faculty members of UoD in the Kurdistan region of Iraq. A total of 674 participants, aged 22–70 years, responded. The findings indicate that only 36.94% had employed AI technologies. Among AI users (n = 249), primary sources of information were friends or colleagues (46.59%) and social media (35.74%). Younger individuals and those holding master’s degrees exhibited a stronger tendency toward AI usage (p < 0.0001), whereas gender and academic discipline had minimal influence. ChatGPT was the most widely used tool (70.68%), followed by Quill Bot (42.17%), Grammarly (34.94%), and Google Bard (29.32%). The main AI applications were text paraphrasing (33.73%) and information retrieval (15.26%). Notably, 47.58% of respondents recommended AI for various academic tasks, including scientific research and idea generation. In conclusion, the study shows that only one-third of UoD faculty members utilize AI, predominantly for text paraphrasing. Nearly half of the participants suggested the adoption of AI by postgraduate students and academic staff.
Should we Distinguish Between Repugnant and Non-Repugnant Unreasonable Views?
Authors: Nuti Alasia 
Published: November 2024

Abstract
Shmuel Nili’s Philosophizing the Indefensible: Strategic Political Theory is a thought-provoking book, calling philosophers to arms in the effort of containing the spread of ‘unreasonable’ views characterising many contemporary societies. Nili argues that philosophers can play a distinctive role by arguing from premises they reject to show how those presumptions do not lead to upholding the ‘repugnant’ policies their interlocutors back up. This paper focuses on a distinction that is key to Nili’s argument, i.e. that between ‘repugnant’ and ‘non-repugnant’ unreasonable policies. According to Nili, philosophers should be under no obligation to engage discursively in the way he envisions when their interlocutors support policies that are repugnant, i.e. they clearly violate universal human equality. The paper argues that it does not make sense to treat repugnant unreasonable views as normatively different from non-repugnant premises. The repugnant/non-repugnant distinction is untenable and too subject to ‘reasonable’ disagreement to offer concrete normative guidance.
Response to My Critics
Authors: Valentini Laura 
Published: November 2024

Abstract
In Morality and Socially Constructed Norms, I argue that norms that exist as a matter of social fact have moral force, when they do, by virtue of what I call the ‘agency-respect principle.’ In what follows, I address the comments and criticisms of my view kindly offered by N. P. Adams, Åsa Burman, George Klosko, Katharina Nieswandt, and Titus Stahl, and which have appeared in a previous issue of this journal. My responses, just like the corresponding criticisms, will address some of the core themes of the book, including: the nature of socially constructed norms, the plausibility of the agency-respect principle, how to best understand and ground political obligation, and, in general, whether we should think that socially constructed norms have (primarily) moral normativity, as opposed to some other type of normativity.
Proportionality and Necessity in Israel’s Invasion of Gaza, 2023–2024
Authors: McMahan Jeff 
Published: November 2024

Abstract
This article seeks to show that Israel’s war in Gaza in 2023 and 2024 has been an unjust war because it has violated both the requirement of proportionality and the requirement of necessity. The article explains the nature of proportionality, arguing that the main form of proportionality in war is simply the limit to the amount of harm inflicted on innocent people that can be justified either as the lesser evil or, more plausibly, on the basis of the special relations between combatants and their fellow citizens. The argument of the article is that, even on the basis of assumptions about moral justification and the numbers of innocent people who have been killed or saved by the war that are highly favorable to Israel, the war has nevertheless been highly disproportionate and morally unnecessary.
Sediment accumulation in an 8 inch sewer pipe for a sample of various particles obtained from the streets of Karbala city, Iraq
Authors: Kokaz Mohammed Aswad , Nile Basim K. , Hassan Waqed H. 
Published: November 2024

Abstract
This work investigates the intricate interplay between particle size and water flow velocity in connection to sedimentation within the sewage systems. The experimental design involves simulating the sedimentation process in a laboratory setup using an 8 inch unplasticized polyvinyl chloride pipe with a controlled slope. Three factors of flow and discharge velocity detailed in this work are particle size, velocity, and sedimentation rate, which are determined through calculations based on the Manning equation. For the numerical simulations, the software packages Fluent and Rocky were used. Sediment transportation under laminar flow conditions can be analyzed by means of numerical simulation. The size, shape, and velocity of the fluid in which the particles are suspended are only a few of the variables taken into consideration while assessing the drag force acting on the particles. The results show that the smaller particles escape the entry further because they are more movable within the conduit. Conversely, it is demonstrated that increased settling pressures near the entrance increase the probability of larger particle sizes settling. Higher water velocities have been found to have a favorable effect on the sediment mobility, which decreases the particle accumulation. This study presents practical methods to mitigate sedimentation in sewage systems, including increasing water flow rates and employing filtration methods to keep larger particles out of the system. This work adds a great deal to the body of information previously known on sedimentation behavior in these systems with its incisive finds that may boost the longevity and efficiency of sewage systems. More research is required to determine the value of the proposed treatments.
Preparation of hydrophobic silicone rubber composite insulators and the research of anti-aging performance
Authors: Zhang Zhaohua 
Published: November 2024

Abstract
Series of Si75/nZ/tZ@SRHTV materials are prepared by dip-coating method to improve the hydrophobicity and breakage-resistant ability of high-temperature vulcanization silicone rubber (SRHTV) using ZnO particles as UV absorbent and bis(triethoxysilylpropyl) disulfide (Si75) as consolidant. The introduction of tetrapod ZnO can build a bramble structure and endow the SRHTV materials with excellent hydrophobicity. The combined utilization of nano-ZnO and tetrapod-ZnO can endow the SRHTV material well with anti-UV ability, while using Si75 gives the SRHTV materials favorable thermal reparability due to its reconfigurable disulfide bond. The optimal parameters are 10%-Si75, 1%-nZnO, and 50%-tZnO. After longtime UV radiation, this material still shows good hydrophobicity and intact surface. The FTIR and X-Ray diffraction analysis indicate the breakage of Si–O molecular chains and the exposure of inorganic fillers for SRHTV. Compared with the neat SRHTV, the mechanical property of the Si75/nZ/tZ@SRHTV material has no significant change. The research indicates the excellent comprehensive performance of Si75/nZ/tZ@SRHTV materials.
Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients
Authors: Yang Sirui , Cai Hongyan , Hu Zhao , Huang Wei , Fu Qin , Xia Ping , Gu Wenyi , Shi Tao , Yang Fazhi , Chen Lixing 
Published: November 2024

Abstract
Heart failure (HF) is a common cardiovascular disease that is related to systemic inflammation. This study aimed to assess the role of C-reactive protein (CRP) combined with fibrinogen-to-albumin ratio (C-FAR) on the prognosis of all-cause mortality in different types of HF. A total of 1,221 hospitalized HF patients from the First Affiliated Hospital of Kunming Medical University between January 2017 and October 2021 were retrospectively analyzed. Patients were categorized into a low C-FAR group (C-FAR < 0.69) and a high C-FAR group (C-FAR ≥ 0.69) according to the median C-FAR value. We used Kaplan–Meier plots, restricted cubic spline regression, Cox survival analyses, and time-dependent receiver operating characteristic (ROC) analyses to evaluate the prognostic role of C-FAR on all-cause mortality in different types of HF. After excluding patients lost to follow-up and those with missing data, we ultimately included 1,196 patients with HF. The Kaplan–Meier plots showed that HF patients with high C-FAR levels had a significantly greater risk of all-cause mortality. In all four Cox proportional risk models, C-FAR was an independent predictor of all-cause mortality. Based on the ROC curve, the area under the curve (AUC) for C-FAR was greater than the AUC for Lg BNP. In the subgroup analyses, patients had the highest risk of all-cause mortality when FAR ≥ 0.091 and CRP ≥ 7.470. Regardless of the type of HF, C-FAR can be a good predictor of prognosis for all-cause mortality in HF patients, and patients with high C-FAR had a significantly increased risk of death compared to those with low C-FAR.