bluuebunny/crossref_metadata_2025_split huggingface dataset:
1203 Early Surgery on Patients with Aneurysmal Subarachnoid Haemorrhage WFNS Grades 4 and 5
Authors: Noureldin F 
Published: July 2024

Abstract

Aim
This review aims to evaluate timing and approach of management of poor-grade aneurysmal subarachnoid haemorrhage, WFNS grade IV and V.

Method
We used PubMed, Cochrane Library, and the reviews and reference lists of relevant articles to search for studies published from 1999 till 2018 to review 16 articles, with a total of 2032 patients, for ultra-early, early, or late timing of surgery and 7 articles, with a total of 1294 patients, for surgical clipping or endovascular coiling.

Results
Studying the outcome of timing of surgery of total population revealed, 50.6% of patients had favourable outcome: 18.4% receiving ultra-early surgery, 20.5% early and 11.8% late surgery. While 42.6% of patients had poor outcome: 20.2% undergoing ultra-early surgery, 14.3% early surgery and 8% late surgery. Analysing the total population for modality of choice revealed, 25.6% of patients who underwent surgical clipping had favourable outcome compared to 15.8% who received endovascular coiling, while 32.1% and 20.9% of patients had unfavourable outcome. In addition to 3.9% of patients refusing the aneurysmal treatment, all suffered poor outcome.

Conclusions
All the reviewed articles agreed on the consensus that management within 24 hours from ictus is the timing of choice in managing poor grade SAH, which can reduce the increased intracranial pressure and increase cerebral perfusion to improve outcomes. Outcomes of both neurosurgical clipping and endovascular coiling were not appreciably different. However, clipping is preferred in small aneurysm with wide neck and MCA aneurysms. Coiling is preferred in larger aneurysms and aneurysms in ICA and posterior circulation.
1152 Soft Tissue Infections of the Hand – Reducing Inpatient Cost and Duration of Stay in a London Plastic Surgery Department
Authors: Sagoo H , Vinayachandran G , Kazzazi F , Pywell M 
Published: July 2024

Abstract

Introduction
Soft tissue infections of the upper limb referred to plastic surgery units often require hospital admission for intravenous antibiotics, irrespective of surgical intervention.

Aim
We explored approaches to reducing the cost and duration of inpatient admission for antibiotic treatment for soft tissue infections.

Method
We sampled data over a two-month period in 2023 to explore the number, type, and severity of soft tissue infections of the upper limb seen in London Plastic Surgery department.

Results
35 patients with soft tissue infections of the upper limb were included. We found no correlation between age; white cell counts or c-reactive protein levels on day of presentation with duration of inpatient stay. Our studies showed that 78% of patients were discharged within 72 hours of admission or procedure, with a greater number of inpatient bed-days for patients receiving intravenous antibiotics without surgery, compared to patients receiving antibiotics and discharge within 3 days of receiving surgical intervention (36 days vs 25 days). 84% of patients were not located within post-codes accessible to existing outpatient antibiotic therapy (OPAT) services. By extending outpatient antibiotic cover for these patients, we projected a total 568 bed-day saving through 202 bed days annual avoidable inpatient bed-stay savings (3+ days, non-OPAT post-codes) and 366 bed days for additional annual avoidable short inpatient bed-stay savings (≤3 days admission, all post-codes), with projected annual cost savings of £319,558.

Conclusions
Our study projects a possible reduction in inpatient cost and duration of stay through extended OPAT cover in patients requiring intravenous antibiotics for soft-tissue infections of the upper limb.
378 Workload Assessment of Suturing Tasks and AI-Task Classification Using Electromyography
Authors: Karaiossifides H , Naik R , Rubio-Solis A , Jin K , Mylonas G 
Published: July 2024

Abstract

Aim
It is well established that excess surgeon workload results in poorer performance. Workload can be divided into physical workload (PWL) and cognitive workload (CWL). The study aims are twofold: 1. Assess how the subjective PWL of suturing is affected by varying PWL and CWL 2. Develop an AI-classification algorithm for task detection using electromyography (EMG).

Method
Novices were trained in interrupted suturing and asked to suture under four conditions of varied workload. Tasks included were: 1. Control, 2. Different suture material (Silk), 3. Simultaneously undertaking a neurocognitive task and 4. Suturing at depth. Subjective workload was recorded using a validated workload questionnaire (SURG-TLX). EMG sensors recorded physiological data from the biceps brachii and extensor ulnar carpi. A convolutional neural network (CNN) was created for AI-task classification using EMG data.

Results
The depth task had the highest subjective workload. Subjective depth raw workload was significantly higher than Control (p=&lt;0.01) and Silk (p=&lt;0.001) but comparable to the neurocognitive task. Subjective depth weighted workload was significantly higher than the neurocognitive task (p=&lt;0.05). Subjective depth adjusted workload was significantly higher than the neurocognitive and silk tasks (both p=&lt;0.05). The CNN training accuracy was 76.4% (95%CI 75.5-77.4) and had a classification accuracy of 76.5% (95%CI 75.7-77.2).

Conclusions
The relationship between PWL and CWL on subjective PWL is complex. Despite this, the CNN was able to differentiate between tasks using objective EMG data with good accuracy. This CNN has potential to characterise CWL which can be further developed to detect excess workload to improve surgical training through objective benchmarks.
898 Is Primary Total Hip Arthroplasty Safe in Recipients of Solid Organ Transplants, and What Are the Considerations? a Systematic Review and Meta-analysis
Authors: Ahmed S , Lakha A , Remtulla M , Malik S , O’Callaghan J 
Published: July 2024

Abstract

Aim
Solid organ transplantation (SOT) is rising, with improvements in surgical technique and immunosuppressive therapy increasing patient survival. Age-related degeneration and long-term steroid therapy in SOT recipients lead to higher incidence of osteoarthritis and osteonecrosis. Total hip arthroplasty (THA) is offered electively for these indications. This meta-analysis assessed THA-related complications in SOT versus non-SOT recipients, reporting revision, infection rates, and all-cause mortality.

Method
This review was carried out using the PRISMA framework. A literature search of Medline, Embase, Transplant library, and Cochrane Library was carried out. Full text articles were screened. Summary statistics for outcomes of interest underwent meta-analyses to a confidence interval (CI) of 95% and are presented as Forest plots for Odds Ratio (OR).

Results
Literature search returned 1164 unique titles/s. 36 met inclusion criteria; 6 were retrospective cohort-studies. Meta-analysis of 5 studies showed no evidence of significant increase in revision rates with prior SOT, OR=0.67 (95%CI: 0.36-1.23, p=0.19). Meta-analysis of 6 studies showed no significant increase in infection (joint/surgical site) infection with prior SOT, OR=1.18 (95%CI: 0.40-3.50, p=0.77). Meta-analysis of 3 studies showed significant increase in all-cause mortality over 12 months post-arthroplasty, OR=1.99 (95%CI: 0.99-3.99, p=0.05). We report these summary statistics for the remaining case series.

Conclusions
We conclude that there is no significant increase in revision and infection rates for THA in SOT recipients. Consideration of a significant increase in all-cause mortality must be noted prior to offering this procedure to SOT recipients. Prospective studies are needed to assess risks/benefits of THA in SOT recipients.
1087 Factors That Impact Cold Ischaemia Time for Deceased Donor Kidney Transplants: Results of a National Transplant Access to Theatre Audit (NTACT)
Authors: Mujeeb M , Borbas B , Tanase A , Aroori S 
Published: July 2024

Abstract

Aim
Deceased donor kidney utilisation confronts challenges leading to prolonged cold ischemia time (CIT), affecting graft survival. Despite these challenges, an understanding of the obstacles remains unclear. This audit aims to identify the factors that prolong CIT.

Method
A multicentre, prospective audit of adult deceased donor kidney-only transplants spanned 14 UK transplant centres from February to September 2022. Data, encompassing time intervals between important checkpoints pre-transplantation and perceived reasons for delays, were collected through RedCap. Descriptive statistics was used for analysis.

Results
Data from 476 kidney-only transplants were gathered (29 excluded for incomplete/incorrect data). Of these, 230 were donations after brainstem death (DBD) organs, and 202 were donations after circulatory death (DCD) organs. Median CIT was 10:55 (IQR:08:11-15:13) for DBD organs and 11:19 (IQR:08:31-15:10) for DCD organs, with 42% of DCD and 15% of DBD organs surpassing national CIT recommendations. Median time from organ arrival to knife to skin was 04:02 (IQR:02:35-07:35). Full and virtual crossmatches constituted 35% and 65%, respectively, with 16% of results arriving after the organ arrives at centre. Anaesthetic time had a median duration of 00:55 (IQR:00:39-01:10) and Knife to skin to organ perfusion was 01:25 (01:10-01:51). Delays reported in 34% of transplant cases, most common causes were the availability of surgical and anaesthetic teams, porters, and the operating theatre.

Conclusions
This audit allowed us to uncover the factors that prolong CIT at each stage of the transplantation post-arrival. These findings will guide the establishment of realistic targets for optimizing processes in the future.
9 Early vs Late Definitive Fixation of Pelvic Ring Fractures in Polytraumatized Patients. a Systematic Review and Meta-Analysis
Authors: Oochit K , Imran A , Marsh A 
Published: July 2024

Abstract

Aim
The aim of this systematic review is to compare the short-term clinical outcomes between early (EDF) and late definitive fixation (LDF) in polytraumatized patients with pelvic ring fractures (PRF).

Method
The following databases: Embase, Medline and Cochrane Library were searched until June 2022. Studies comparing EDF and LDF for PRF in polytrauma patients defined as ISS &gt;15 were included. The methodological quality of studies was assessed using the Newcastle Ottawa Scale.

Results
Out of 869 studies screened, 10 were included in the meta-analysis with a total of 2918 patients. The most common time point used to define EDF was within 24 hours of hospital admission and LDF (&gt;24hr). The most common reasons for LDF were surgeon’s choice, availability of pelvic surgeon and transfer from other hospitals. Our meta-analysis revealed that EDF was associated with a reduced length of hospital stay (WMD=-3.52 days; 95% CI: [-5.43 to -1.62], p&lt;0.0003) and lower incidence of ARDS (RR=0.48; 95% CI: [0.20 to 1.18], p=0.04). No significant association was found in mortality, length of ICU stays, multi-organ failure, sepsis and surgical site infection between EDF and LDF.

Conclusions
These findings suggest that early definitive fixation may be a safe and viable option with no increased risk of complications and mortality. However, the adequacy of resuscitation and the estimate of physiologic reserve should be balanced with the risks of operative fixation in all patients. Further prospective validation studies are warranted to test the predictive ability of the various proposed trauma care models and stratify patients for EDF.
803 Outcomes of Radical Nephroureterectomy: An Australian Multicentre Experience Using a Dedicated Upper Tract Data Registry
Authors: Harrington C I , Chui W , Kealey J , Picardo A , Hayne D , McCombie S , Sengupta S 
Published: July 2024

Abstract

Introduction
Radical nephroureterectomy (RNU) is used for the treatment of upper tract urothelial carcinoma (UTUC). It is a procedure with considerable morbidity. Australian data on UTUC is limited, and we have recently developed the ACCEPT-U database to try and address this. This study aims to examine the surgical and oncological outcomes in patients who have undergone RNU.

Method
We collected data using the ACCEPT-U database on patients who underwent (RNU) across two tertiary centres in Victoria and Western Australia between 2013 and 2022. Our primary outcomes were overall survival at one, two, and five years. Our secondary outcomes included postoperative complications and recurrence data.

Results
One hundred and one patients underwent RNU during the study period. The median age was 73 (IQR 64.0 to 80.5) years. The median hospital length of stay was 7 days (IQR 5-11) overall. Neither operative technique, CCI nor age affected hospital length of stay (p &gt;0.05). The 30-day post-operative complication rate was 35% (n=35), with a median Clavien Dindo of II. Overall survival rates at one, two, and five years were 89%. (95% CI 81.4 - 94.0%); 79% (95% CI 70.2 - 86.1%) and 73% (95% CI 63.9 – 81.0%). Advanced pathological stage was associated with reduced overall 5-year survival (Pearson Chi-Squared = 10.40, p=0.006).

Conclusions
Radical nephroureterectomy in patients with UTUC has considerable morbidity and mortality in Australian centres but this appears comparable to published rates. The ACCEPT-U database will facilitate larger and prospective data collection, hopefully across multiple institutions, to further assess peri-operative outcomes and their determinants in the future.
1103 Gait Analysis Using Wearables and AI in Predicting Peripheral Arterial Disease: A Systematic Review
Authors: Abuchi-Ogbonda S , Ahmad M , Davies A H 
Published: July 2024

Abstract

Introduction
Peripheral arterial disease (PAD) affects over 230 million people globally. The trajectory of this disease process can culminate in major amputation. These patients demonstrate statistically significant changes in gait including changes in stride length, plantarflexion and other spatiotemporal parameters.

Aim
To determine if alterations in gait parameters can be detected and measured accurately by wearables and AI in PAD patients and if these measurements are predictive of PAD progression.

Method
A systematic review was performed in line with PRISMA guidelines. MEDLINE, Embase, Web of Science and Scopus were used for database searches. A combination of medical subject headings (MeSH) regarding ‘PAD’, ‘gait’, ‘kinetics’, ‘biomechanics’, ‘ambulation’, ‘artificial intelligence’, ‘sensors’ and ‘smartphone data’ were employed in the primary search string. Screening, full text reviews and data extraction was conducted by 2 reviewers using Covidence. Bias was assessed using the Newcastle-Ottawa scale.

Results
4719 studies were identified. 3873 were screened after de-duplication. 5 studies were included in the final review. The main methods of gait measurements included smartphones (iPhone and Samsung Galaxy), wearable sensors and motion sensor technology. Gait initiation parameters were sensitive in detecting gait impairment. iPhone pedometer demonstrated accuracy measuring steps comparable to reference Actigraph but was inaccurate measuring distance. Machine learning models including Random Forest algorithms and extreme gradient boosting, detected PAD patients with 89% and 92% accuracy respectively.

Conclusions
Wearables and AI algorithms can detect gait changes and differentiate PAD from non-PAD gait. All studies showed detective capability, however none demonstrated predictability of PAD. Limitations include accuracy and validation of measurement methods.
What politics does to the economic analysis of the employment relationship: a critical perspective on personnel economics
Authors: Bailly Franck , Dubrion Benjamin 
Published: July 2024

Abstract
Personnel economics has undoubtedly been one of the major developments in mainstream labour economics in recent decades. Its aim is not simply to report on firms’ actual labour management practices but also to prescribe the optimal practices for managers to adopt. The pursuit of this goal has led it to close itself off from other approaches to the analysis of the employment relationship. Drawing on concepts from political science, we show that personnel economics is imbued with a particular conception of politics, even though it goes unacknowledged. Making this point visible enables us to show that other conceptions of politics than that to which personnel economics refers are possible and leads to the acknowledgement of the legitimacy of other points of view in matters of labour management.
Reduction in kidney function decline and risk of severe clinical events in agalsidase beta–treated Fabry disease patients: a matched analysis from the Fabry Registry
Authors: Batista Julie L , Hariri Ali , Maski Manish , Richards Susan , Gudivada Badari , Raynor Lewis A , Ponce Elvira , Wanner Christoph , Desnick Robert J 
Published: July 2024

ABSTRACT

Background
Patients with Fabry disease (FD, α-galactosidase A deficiency or absence) accumulate glycosphingolipids, leading to progressive dysfunction of kidneys, heart and nervous system. Generalizable real-world outcomes following agalsidase beta treatment initiation outside trials are limited. We investigated the associations of long-term agalsidase beta treatment with estimated glomerular filtration rate (eGFR) changes over time and the risk of developing a composite clinical event in a matched analysis of treated and untreated patients with FD.

Methods
Agalsidase beta–treated adult patients (aged ≥16 years) from the Fabry Registry and adult untreated patients from a natural history cohort were matched 1:1 and X:X (with one occurrence and multiple occurrences of each untreated patient, respectively) by sex, phenotype, age and (for eGFR slope analysis) baseline eGFR. Outcomes included eGFR slope over 5 years and composite clinical event risk (cardiovascular, cerebrovascular or renal event, or death) over 10+ years. As a surrogate indicator of therapeutic response in paediatric patients, the percentage experiencing normalization in plasma globotriaosylceramide (GL-3) from treatment initiation was assessed in patients aged 2 to &lt;16 years.

Results
Overall, eGFR slopes for 1:1-matched untreated and treated adult patients [122 pairs (72.1% male)] were −3.19 and −1.47 mL/min/1.73 m2/year, respectively (reduction in rate of decline = 53.9%, P = .007), and for X:X-matched [122 untreated/950 treated (59.4% male)] were −3.29 and −1.56 mL/min/1.73 m2/year, respectively (reduction in rate of decline = 52.6%, P &lt; .001). Agalsidase beta treatment was associated with lower risk of clinical events, with hazard ratios of 0.41 (P = .003) and 0.67 (P = .008) for 1:1-matched and X:X-matched analyses, respectively. Plasma GL-3 declined markedly in paediatric patients and normalized in most within 6 months of treatment initiation.

Conclusion
Agalsidase beta treatment preserves kidney function and delays progression to severe clinical events among adult patients with FD. Plasma GL-3 levels analysed in paediatric patients showed normalization of elevated pre-treatment levels in most patients.
High premature atrial complex burden and risk of renal function decline
Authors: Chen Chao-Yu , Yu Chih-Hen , Lee Po-Tseng , Huang Mu-Shiang , Chiu Pin-Hsuan , Su Pei-Fang , Liu Ping-Yen , Huang Ting-Chun 
Published: July 2024

ABSTRACT

Background
Atrial arrhythmia, particularly atrial fibrillation (AF), is known to be associated with renal function decline and increased risk of end-stage kidney disease. In recent years, premature atrial complexes (PACs) as subclinical arrhythmia have been proposed to be a marker of atrial cardiomyopathy and associated with poor clinical outcomes. However, the relationship between excessive daily PAC burden and renal outcomes remains unexplored.

Methods
This retrospective, all-comers cohort study analyzed 30 488 consecutive Holter monitoring records obtained from a validated Holter databank at a referral medical center in Taiwan between 2011 and 2018. After exclusion, 10 981 patients were categorized into three groups: high daily PAC burden (≥100 beats per day), low PAC burden (&lt;100 beats per day) and the AF group. We used parallel propensity score matching to balance confounding factors between groups. The primary study interest was major adverse kidney events, including an estimated glomerular filtration rate (eGFR) decline of 40%, eGFR &lt;15 mL/min/1.73 m2 or the initiation of hemodialysis.

Results
After a mean follow-up of 4.07 ± 3.03 years, patients with high PAC burden had a 1.24-fold higher incidence of major adverse kidney events compared with the low PAC burden group [95% confidence interval (CI) 1.03–1.50]. The risk of major adverse kidney events was similar between patients with AF and those with high PAC burden [adjusted hazard ratio (HR) 1.05, 95% CI 0.87–1.25], but significantly higher in the AF group than in the low PAC burden group (adjusted HR 1.29, 95% CI 1.07–1.56).

Conclusion
Excessive daily PAC burden is associated with a higher risk of major adverse kidney events and has a comparable impact as AF.
Spatial, social, and environmental factors influencing natal dispersal in the colonial griffon vulture
Authors: Martínez Félix , Carrete Martina , Blanco Guillermo 
Published: July 2024

AbstractNatal dispersal is a critical trait for individual fitness and the viability, structure, and genetic identity of populations. However, there is a pronounced information gap for large and long-lived species due to the difficulty of monitoring individuals at appropriate spatio-temporal scales. Here we study how individual traits and social and environmental characteristics influence natal dispersal decisions of griffon vultures (Gyps fulvus) using long-term (30 years) monitoring of a large number of individuals marked as nestlings in Spain. Our results show a strong philopatry in both sexes, with some individuals recruiting as breeders on the same cliffs, and even the same nests, where they were born. This philopatric tendency was modulated by the effect of conspecific density on individual parameters and emphasized the importance of conspecific attraction and changes in food availability that may have influenced the increment in colony size and the colonization of new areas. Although further research is needed considering smaller colonies and more isolated population nuclei, our results highlight the importance of long-term studies on long-lived species to understand the factors that determine their population dynamics and their relationship with anthropogenic activities, whose effects should be predicted and managed using conservation criteria.
Probabilistic programming for embedding theory and quantifying uncertainty in econometric analysis
Authors: Storm Hugo , Heckelei Thomas , Baylis Kathy 
Published: July 2024

Abstract
The replication crisis in empirical research calls for a more mindful approach to how we apply and report statistical models. For empirical research to have a lasting (policy) impact, these concerns are crucial. In this paper, we present Probabilistic Programming (PP) as a way forward. The PP workflow with an explicit data-generating process enhances the communication of model assumptions, code testing and consistency between theory and estimation. By simplifying Bayesian analysis, it also offers advantages for the interpretation, communication and modelling of uncertainty. We outline the advantages of PP to encourage its adoption in our community.