bluuebunny/crossref_metadata_2025_split huggingface dataset:
Estimation of two-year hospital costs of hip and knee periprosthetic joint infection treatments using activity-based costing
Authors: Hammat Aaron S. , Nelson Renjy , Davis Joshua S. , Manning Laurens , Campbell David , Solomon Lucian B. , Gnanamanickam Emmanuel S. , Callary Stuart A. 
Published: October 2024

AimsOur aim was to estimate the total costs of all hospitalizations for treating periprosthetic joint infection (PJI) by main management strategy within 24 months post-diagnosis using activity-based costing. Additionally, we investigated the influence of individual PJI treatment pathways on hospital costs within the first 24 months.MethodsUsing admission and procedure data from a prospective observational cohort in Australia and New Zealand, Australian Refined Diagnosis Related Groups were assigned to each admitted patient episode of care for activity-based costing estimates of 273 hip PJI patients and 377 knee PJI patients. Costs were aggregated at 24 months post-diagnosis, and are presented in Australian dollars.ResultsThe mean cost per hip and knee PJI patient was $64,585 (SD $53,550). Single-stage revision mean costs were $67,029 (SD $47,116) and $80,063 (SD $42,438) for hip and knee, respectively. Two-stage revision costs were $113,226 (SD $66,724) and $122,425 (SD $60,874) for hip and knee, respectively. Debridement, antibiotics, and implant retention in hips and knees mean costs were $53,537 (SD$ 39,342) and $48,463 (SD $33,179), respectively. Suppressive antibiotic therapy without surgical management mean costs were $20,296 (SD $8,875) for hip patients and $16,481 (SD $6,712) for knee patients. Hip patients had 16 different treatment pathways and knee patients had 18 treatment pathways. Additional treatment, episodes of care, and length of stay contributed to substantially increased costs up to a maximum of $369,948.ConclusionTreating PJI incurs a substantial cost burden, which is substantially influenced by management strategy. With an annual PJI incidence of 3,900, the cost burden would be in excess of $250 million to the Australian healthcare system. Treatment pathways with additional surgery, more episodes of care, and a longer length of stay substantially increase the associated hospital costs. Prospectively monitoring individual patient treatment pathways beyond initial management is important when quantifying PJI treatment cost. Our study highlights the importance of optimizing initial surgical treatment, and informs treating hospitals of the resources required to provide care for PJI patients.Cite this article: Bone Joint J 2024;106-B(10):1084–1092.
Ultrasound-guided infiltration with hyaluronic acid compared with corticosteroid for the treatment of Morton’s neuroma
Authors: Ferreira Gabriel F. , Lewis Thomas L. , Fernandes Tifani D. , Pedroso João P. , Arliani Gustavo G. , Ray Robbie , Patriarcha Vitor A. , Filho Miguel V. 
Published: October 2024

AimsA local injection may be used as an early option in the treatment of Morton’s neuroma, and can be performed using various medications. The aim of this study was to compare the effects of injections of hyaluronic acid compared with corticosteroid in the treatment of this condition.MethodsA total of 91 patients were assessed for this trial, of whom 45 were subsequently included and randomized into two groups. One patient was lost to follow-up, leaving 22 patients (24 feet) in each group. The patients in the hyaluronic acid group were treated with three ultrasound-guided injections (one per week) of hyaluronic acid (Osteonil Plus). Those in the corticosteroid group were treated with three ultrasound-guided injections (also one per week) of triamcinolone (Triancil). The patients were evaluated before treatment and at one, three, six, and 12 months after treatment. The primary outcome measure was the visual analogue scale for pain (VAS). Secondary outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score, and complications.ResultsBoth groups showed significant improvement in VAS and AOFAS scores (p < 0.05) after 12 months. The corticosteroid group had a significantly greater reduction in VAS and increase in AOFAS scores compared with the hyaluronic acid group, at one, three, and six months, but with no significant difference at 12 months. There were no complications in the hyaluronic acid group. There were minor local complications in six patients (six feet) (25.0%) in the corticosteroid group, all with discolouration of the skin at the site of the injection. These minor complications might have been due to the three weekly injections of a relatively high dose of corticosteroid. No patient subsequently underwent excision of the neuroma.ConclusionAn ultrasound-guided corticosteroid injection showed statistically significantly better functional and pain outcomes than an ultrasound-guided injection of hyaluronic acid for the treatment of a Morton’s neuroma at many timepoints. Thus, a corticosteroid injection should be regarded as a primary option in the treatment of these patients, and the only indication for an injection of hyaluronic acid might be in patients in whom corticosteroid is contraindicated.Cite this article: Bone Joint J 2024;106-B(10):1093–1099.
Factors associated with the choice of treatment for coronoid fractures
Authors: de Klerk Huub H. , Verweij Lukas P. E. , Doornberg Job N. , Jaarsma Ruurd L. , Murase Tsuyoshi , Chen Neal C. , van den Bekerom Michel P. J. 
Published: October 2024

AimsThis study aimed to gather insights from elbow experts using the Delphi method to evaluate the influence of patient characteristics and fracture morphology on the choice between operative and nonoperative treatment for coronoid fractures.MethodsA three-round electronic (e-)modified Delphi survey study was performed between March and December 2023. A total of 55 elbow surgeons from Asia, Australia, Europe, and North America participated, with 48 completing all questionnaires (87%). The panellists evaluated the factors identified as important in literature for treatment decision-making, using a Likert scale ranging from "strongly influences me to recommend nonoperative treatment" (1) to "strongly influences me to recommend operative treatment" (5). Factors achieving Likert scores ≤ 2.0 or ≥ 4.0 were deemed influential for treatment recommendation. Stable consensus is defined as an agreement of ≥ 80% in the second and third rounds.ResultsOf 68 factors considered important in the literature for treatment choice for coronoid fractures, 18 achieved a stable consensus to be influential. Influential factors with stable consensus that advocate for operative treatment were being a professional athlete, playing overhead sports, a history of subjective dislocation or subluxation during trauma, open fracture, crepitation with range of movement, > 2 mm opening during varus stress on radiological imaging, and having an anteromedial facet or basal coronoid fracture (O’Driscoll type 2 or 3). An anterolateral coronoid tip fracture ≤ 2 mm was the only influential factor with a stable consensus that advocates for nonoperative treatment. Most disagreement existed regarding the treatment for the terrible triad injury with an anterolateral coronoid tip fracture fragment ≤ 2 mm (O’Driscoll type 1 subtype 1).ConclusionThis study gives insights into areas of consensus among surveyed elbow surgeons in choosing between operative and nonoperative management of coronoid fractures. These findings should be used in conjunction with previous patient cohort studies when discussing treatment options with patients.Cite this article: Bone Joint J 2024;106-B(10):1150–1157.
The impact of closed suction wound drainage on chronic pain and health-related quality of life after posterior spinal fusion in patients with adolescent idiopathic scoliosis
Authors: Helenius Linda , Gerdhem Paul , Ahonen Matti , Syvänen Johanna , Jalkanen Jenni , Nietosvaara Yrjänä , Helenius Ilkka 
Published: October 2024

AimsClosed suction subfascial drainage is widely used after instrumented posterior spinal fusion in patients with a spinal deformity. The aim of this study was to determine the effect of this wound drainage on the outcomes in patients with adolescent idiopathic scoliosis (AIS). This was a further analysis of a randomized, multicentre clinical trial reporting on patients after posterior spinal fusion using segmental pedicle screw instrumentation. In this study the incidence of deep surgical site infection (SSI) and chronic postoperative pain at two years’ follow-up are reported.MethodsWe conducted a randomized, multicentre clinical trial on adolescents undergoing posterior spinal fusion for AIS using segmental pedicle screw instrumentation. A total of 90 consecutive patients were randomized into a ‘drain’ or ‘no drain’ group at the time of wound closure, using the sealed envelope technique (1:1). The primary outcomes in the initial study were the change in the level of haemoglobin in the blood postoperatively and total blood loss. A secondary outcome was the opioid consumption immediately after surgery. The aim of this further study was to report the rate of deep SSI and persistent postoperative pain, at two years' follow-up.ResultsAs previously reported, the mean 48-hour opioid consumption was significantly higher in the no drain group (2.0 mg/kg (SD 0.8) vs 1.4 mg/kg (SD 0.7); p = 0.005). There were no delayed deep SSIs. At two years’ follow-up, the mean Scoliosis Research Society 24-item questionnaire (SRS-24) total score did not differ between the groups (4.11 (SD 0.47) vs 4.16 (SD 0.33); p = 0.910). The mean SRS-24 pain score was 4.28 (SD 0.48) in the no drain group compared with 4.33 (SD 0.66) in the drain group (p = 0.245). Seven patients (19%) in the no drain group and six in the drain group (14%) reported moderate to severe pain (numerical rating scale ≥ 4) at two years’ follow-up (p = 0.484). The general self-image domain score was significantly higher in the no drain group compared with the drain group (4.02 (SD 0.74) vs 4.59 (SD 0.54); p < 0.001).ConclusionThe main finding in this study was that more severe pain immediately after surgery did not result in a higher incidence of chronic pain in the no drain group compared with the drain group. Back pain and health-related quality of life at two years’ follow-up did not differ between the groups. The patient-reported self-image domain was significantly better in the no drain group compared with the drain group.Cite this article: Bone Joint J 2024;106-B(10):1176–1181.
The management of idiopathic toe walking
Authors: Gelfer Yael , McNee Anne E. , Harris Jennifer D. , Mavrotas Jason , Deriu Laura , Cashman John , Wright Jonathan , Kothari Alpesh 
Published: October 2024

AimsThe aim of this study was to gain a consensus for best practice of the assessment and management of children with idiopathic toe walking (ITW) in order to provide a benchmark for practitioners and guide the best consistent care.MethodsAn established Delphi approach with predetermined steps and degree of agreement based on a standardized protocol was used to determine consensus. The steering group members and Delphi survey participants included members from the British Society of Children’s Orthopaedic Surgery (BSCOS) and the Association of Paediatric Chartered Physiotherapists (APCP). The statements included definition, assessment, treatment indications, nonoperative and operative interventions, and outcomes. Descriptive statistics were used for analysis of the Delphi survey results. The AGREE checklist was followed for reporting the results.ResultsA total of 227 participants (54% APCP and 46% BSCOS members) completed the first round, and 222 participants (98%) completed the second round. Out of 54 proposed statements included in the first round Delphi, 17 reached ‘consensus in’, no statements reached ‘consensus out’, and 37 reached ‘no consensus’. These 37 statements were then discussed, reworded, amalgamated, or deleted before the second round Delphi of 29 statements. A total of 12 statements reached ‘consensus in’, four ‘consensus out’, and 13 ‘no consensus’. In the final consensus meeting, 13 statements were voted upon. Five were accepted, resulting in a total of 31 approved statements.ConclusionIn the aspects of practice where sufficient evidence is not available, a consensus statement can provide a strong body of opinion that acts as a benchmark for excellence in clinical care. This statement can assist clinicians managing children with ITW to ensure consistent and reliable practice, and reduce geographical variability in practice and outcomes. It will enable those treating ITW to share the published consensus document with both carers and patient groups.Cite this article: Bone Joint J 2024;106-B(10):1190–1196.
Association between dietary copper intake and bone mineral density in children and adolescents aged 8–19 years: A cross-sectional study
Authors: Cui Aiyong , Yan Juan , Li Haoran , Fan Zhiqiang , Wei Xing , Wang Hu , Zhuang Yan 
Published: October 2024

PurposeSome studies showed the possible role of copper intake on bone mineral density (BMD) in adults or the elderly, but the association remained uncertain in children and adolescents. Our research explored the association between copper intake and BMD in individuals aged 8–19 years from the National Health and Nutrition Examination Survey (NHANES) 2011–2016.MethodsIn the present study, 6,965 individuals aged 8–19 (mean age 13.18 ± 3.38 years) were enrolled from the NHANES 2011–2016. Copper intake was evaluated by averaging two 24-hour copper dietary intake recalls. Multivariate linear regression analyses were used to explore the association between copper intake and total BMD, subtotal BMD, and total spine BMD in children and adolescents. Stratified analyses and interaction tests were performed by age, gender, and race.ResultsParticipants of the higher quartile of copper intake were more likely to be older, men, Non-Hispanic White, and Other Hispanic. They have higher values of poverty income ratio (PIR), serum phosphorus, blood urea nitrogen, serum vitamin D, and BMD and lower values of body mass index (BMI), cholesterol, total protein, and serum cotinine. In the fully adjusted model, we found positive associations between copper intake and total BMD (β = 0.013, 95CI: 0.006, 0.019)), subtotal BMD (β = 0.020, 95CI: 0.015, 0.024), and total spine BMD (β = 0.014, 95CI: 0.009, 0.019). Stratified analyses showed that the association was stronger in men, individuals aged 14–19, Non-Hispanic White, and Other Hispanic.ConclusionsOur study suggests that copper intake is positively associated with BMD in U.S. children and adolescents. The study emphasizes the role of copper intake on bone health in the early stages of life. However, more investigations are needed to verify our findings and their underlying mechanisms.
Effects of anodal transcranial direct current stimulation on postural stability in subacute stroke: A randomized control trial
Authors: Shakeb Somia , Obaid Baig Mirza , Abualait Turki , Obaid Sumaiyah , Yoo Woo‐Kyoung , Bashir Shahid 
Published: October 2024

AbstractAnodal transcranial direct current stimulation (tDCS) promotes neuromodulation and neuroplasticity in the brain. The aim of this study was to determine the long‐term effects of the anodal tDCS on postural and trunk stability, physical performance, anticipatory postural adjustment and quality of life in sub‐acute stroke patients. Thirty‐six participants with sub‐acute stroke were divided into experimental and control groups using sealed envelope randomization. Outcome measures comprised the Postural Assessment Scale for Stroke, Trunk Impairment Scale, Time Up and Go Test, Functional Reach Test, and Stroke‐Specific Quality of Life Scale. Assessments were conducted at 0, 3, 6, 9, and 12 weeks. Within‐group analysis revealed significant improvement in both the experimental (p‐value < 0.05) and control groups (p‐value < 0.005). Notably, significant effects were observed in postural stability after intervention, and during one of the detraining assessments, the experimental group showed superior results compared to the control group in subacute stroke. Anodal tDCS yield significant short‐ and long‐term effects on postural stability, while short term effects on trunk stability. Additionally, long term effects were observed on the physical performance and anticipatory postural adjustments while no effects at quality of life either short or long term basis among the subacute stroke patients.
On Plaintiffs’ Strategic Information Acquisition and Disclosure during Discovery
Authors: Ayouni Mehdi , Friehe Tim , Gabuthy Yannick 
Published: October 2024

Abstract
We analyze how a plaintiff acquires damage-level information and discloses it to the defendant during the discovery process when the plaintiff knows that the defendant is privately informed about the plaintiff’s probability of winning at trial. The plaintiff can design the process for generating the damage-level information but cannot omit or misrepresent it. She does this with an understanding of how the defendant’s updated beliefs after the discovery stage will impact pretrial negotiations. We find that the plaintiff prefers full disclosure when deciding between a pooling or a screening settlement demand depends on the damages level. In other scenarios, she is indifferent to how much information the discovery stage conveys about the damage level to the defendant.
Conceptualisation of event roles in L1 and L2 by Japanese learners of English: a cross-linguistic comparison of perspectives of event construal
Authors: Qu Jiashen , Miwa Koji 
Published: October 2024

Abstract
Events can be perceived from different perspectives. Langacker, Ronald W. (1990. Subjectification. Cognitive Linguistics 1. 5–38) typologically categorised the perspectives in event construal as subjective construal and objective construal based on how egocentric a perspective is. Compared with Western languages, such as English, Japanese is argued to be a language that favours subjective construal. However, little empirical work has tested this assumption directly. We investigated whether Japanese and English construe events from different perspectives by focusing on the linguistic encodings of event roles “agent” and “patient”. Our findings show that when selecting event roles as sentence subjects, Japanese speakers prioritised animacy over agency whereas English speakers emphasised agency (while also considering animacy). This can be attributed to the different preferences of the two languages for the degree of egocentricity in event construal. Furthermore, we explored how L1-based conceptualisation of event roles influences the linguistic expressions of event roles in L2. Our results demonstrate that Japanese learners of English had difficulty reconceptualising event roles in L2 English. This study adds a piece of quantitative evidence to the cognitive linguistics theory on subjective construal in Japanese and questions the universality of the agent-first hypothesis in the Thematic Hierarchy.
Rings whose clean elements are uniquely strongly clean
Authors: Danchev Peter V. , Hasanzadeh Omid , Javan Arash , Moussavi Ahmad 
Published: October 2024

Abstract
We define the class of CUSC rings, which are rings whose clean elements are uniquely strongly clean. These rings are a common generalization of the so-called USC rings, introduced by Chen–Wang–Zhou in J. Pure Appl. Algebra (2009), which are rings whose elements are uniquely strongly clean. These rings also generalize the so-called CUC rings, defined by Călugăreanu and Zhou in Mediterranean J. Math. (2023), which are rings whose clean elements are uniquely clean. We establish that a ring is USC if and only if it is simultaneously CUSC and potent. Some other interesting relationships with CUC rings are obtained as well.
Tangerine fruit peel extract mediated biogenic synthesized silver nanoparticles and their potential antimicrobial, antioxidant, and cytotoxic assessments
Authors: Al hamza Hasoon Buthenia Abd , Mahmood Bassam Shaker , Mohamed Erieg Abdulwahab , Jabir Majid Sakhi , Jawad Kareem Hussein , Hussein Nehia Neama , Sulaiman Ghassan Mohammad , Dewir Yaser Hassan , Mendler-Drienyovszki Nóra 
Published: October 2024

Abstract
The utilization of plant bioactive composites has concerned substantial attention due to their possible use in the development of novel antibiotics, containing the environmentally sustainable synthesis of nanoparticles. In the current study, a green and eco-friendly process was employed to synthesize silver nanoparticles (Ag-NPs) and to evaluate their anti-bacterial, anti-oxidant, and anti-cancer potentials. The characterization of the Ag-NPs involved UV-vis spectroscopy, Fourier-transform infrared spectroscopy (FTIR), energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), and transmission electron microscopy (TEM). The UV-vis spectrum of Ag-NPs was 437 nm. The FTIR absorption peaks detected at 685.48 cm−1 confirmed their characteristics. The FESEM displayed that Ag-NPs have an average size of 30 nm. The TEM revealed that the Ag-NPs have an irregular spherical shape with 16 nm size distribution. The XRD results provided a strong indication that the green synthesized Ag-NPs was of high purity with crystalline nature. The anti-bacterial properties were investigated at different concentrations for both the ethanolic tangerine peel extract and Ag-NPs. The results of anti-bacterial activity showed that 100 µg·mL−1 was potent concentration, but the Ag-NPs were more effective than the ethanolic tangerine peel extract. For the ethanolic extract, the inhibition zone was 17.50 ± 0.20 mm for K. pneumoniae and 14.40 ± 0.20 mm for B. cereus. For the Ag-NPs, the inhibition zone was 25.50 mm for K. pneumoniae and 20.50 mm for B. cereus. Furthermore, the antioxidant examination revealed more potent free radical scavenging activity of the Ag-NPs than the ethanolic peel extract alone. The ethanolic extract ranged 46–77% while the Ag-NPs ranged 57–88%. Additionally, the anti-proliferative of the Ag-NPs against the lung cancer cell line (A549) was more potent than the ethanolic extract alone. The cytotoxic activity was 90.03% and 78.50%, respectively. The anti-proliferative effect of Ag-NPs is attributed to cell death, induced apoptosis, and enhanced generation of reactive oxygen species. Our findings highlight the potential and further utilization of Ag-NPs in medicinal applications particularly for cancer therapeutics.