bluuebunny/crossref_metadata_2025_split huggingface dataset:
PREDICTING MINIMAL CLINICALLY IMPORTANT DIFFERENCE USING IHOT-12 AT ONE YEAR FOLLOWING ARTHROSCOPIC TREATMENT FOR FEMOROACETABULAR IMPINGEMENT USING MACHINE LEARNING
Authors: Green Justin , Khanduja Vikas , Malviya Ajay 
Published: May 2024

Femoroacetabular Impingement (FAI) syndrome, characterised by abnormal hip contact causing symptoms and osteoarthritis, is measured using the International Hip Outcome Tool (iHOT). This study uses machine learning to predict patient outcomes post-treatment for FAI, focusing on achieving a minimally clinically important difference (MCID) at 52 weeks.A retrospective analysis of 6133 patients from the NAHR who underwent hip arthroscopic treatment for FAI between November 2013 and March 2022 was conducted. MCID was defined as half a standard deviation (13.61) from the mean change in iHOT score at 12 months. SKLearn Maximum Absolute Scaler and Logistic Regression were applied to predict achieving MCID, using baseline and 6-month follow-up data. The model's performance was evaluated by accuracy, area under the curve, and recall, using pre-operative and up to 6-month postoperative variables.A total of 23.1% (1422) of patients completed both baseline and 1-year follow-up iHOT surveys. The best results were obtained using both pre and postoperative variables. The machine learning model achieved 88.1% balanced accuracy, 89.6% recall, and 92.3% AUC. Sensitivity was 83.7% and specificity 93.5%. Key variables determining outcomes included MCID achievement at 6 months, baseline iHOT score, 6-month iHOT scores for pain, and difficulty in walking or using stairs.The study confirmed the utility of machine learning in predicting long-term outcomes following arthroscopic treatment for FAI. MCID, based on the iHOT 12 tools, indicates meaningful clinical changes. Machine learning demonstrated high accuracy and recall in distinguishing between patients achieving MCID and those who did not. This approach could help early identification of patients at risk of not meeting the MCID threshold one year after treatment.
ACETABULAR FRACTURES IN OLDER PATIENTS INTERVENTION TRIAL (ACEFIT): A FEASIBILITY TRIPLE-ARM RANDOMIZED CONTROLLED STUDY
Authors: Martin Alexander , Alsousou Joe , Chou Daud , Costa Matt , Carrothers Andrew 
Published: May 2024

Current treatment options for displaced acetabular fractures in elderly patients include non-surgical management, surgical fixation and surgical fixation with simultaneous hip replacement, the so-called “fix-and-replace”™. There remains a paucity of evidence to guide surgeons in decision making for these difficult injuries. The aim of this study was to assess the feasibility of performing an appropriately powered RCT between treatment options for acetabular fractures in older patients.This was an NIHR funded feasibility triple-arm RCT with participation from 7 NHS MTCs. Patients older than 60 were recruited if they had an acetabular fracture deemed sufficiently displaced for the treating surgeon to consider surgical fixation. Randomisation was performed on a 1:1:1 basis. The three treatment arms were non-surgical management, surgical fixation and fix-and-replace. Feasibility was assessed by willingness of patients to participate and clinicians to recruit, drop out rate, estimates of standard deviation to inform the sample size calculation for the full trial and completion rates to inform design of a future definitive trial. EQ-5D was the primary outcome measure at 6 months, OHS and Disability Rating Index were secondary outcome measures.Of 117 eligible patients, 60 were randomised whilst 50 declined study participation. Nine patients did not receive their allocated intervention. Analysis was performed on an intention to treat basis. During the study period 4 patients withdrew before final review, 4 patients died and 1 was lost to follow-up. The estimated sample size for a full scale study was calculated to be 1474 participants for an EQ-5D MCID of 0.06 with a power of 0.8.This feasibility study suggests a full scale trial would require international collaboration. This study also has provided observed safety data regarding mortality and morbidity for the fix-and-replace procedure to aid surgeons in the decision-making process when considering treatment options.
PREDICTING LENGTH OF STAY OF JOINT REPLACEMENT PATIENTS AT ASHFORD AND ST. PETER'S HOSPITAL USING ARTIFICIAL INTELLIGENCE AND MACHINE LEARNING
Authors: Adla Sreekanteshwar Reddy , Ameer Ashna , Silva Mitul D , Unnithan Ashwin 
Published: May 2024

Arthroplasties are widely performed to improve mobility and quality of life for symptomatic knee/hip osteoarthritis patients. With increasing rates of Total Joint Replacements in the United Kingdom, predicting length of stay is vital for hospitals to control costs, manage resources, and prevent postoperative complications. A longer Length of stay has been shown to negatively affect the quality of care, outcomes and patient satisfaction.Â Thus, predicting LOS enables us to make full use of medical resources.Clinical characteristics were retrospectively collected from 1,303 patients who received TKA and THR. A total of 21 variables were included, to develop predictive models for LOS by multiple machine learning (ML) algorithms, including Random Forest Classifier (RFC), K-Nearest Neighbour (KNN), Extreme Gradient Boost (XgBoost), and Na¯ve Bayes (NB). These models were evaluated by the receiver operating characteristic (ROC) curve for predictive performance. A feature selection approach was used to identify optimal predictive factors. Based on the ROC of Training result, XgBoost algorithm was selected to be applied to the Test set.The areas under the ROC curve (AUCs) of the 4 models ranged from 0.730 to 0.966, where higher AUC values generally indicate better predictive performance. All the ML-based models performed better than conventional statistical methods in ROC curves. The XgBoost algorithm with 21 variables was identified as the best predictive model. The feature selection indicated the top six predictors: Age, Operation Duration, Primary Procedure, BMI, creatinine and Month of Surgery.By analysing clinical characteristics, it is feasible to develop ML-based models for the preoperative prediction of LOS for patients who received TKA and THR, and the XgBoost algorithm performed the best, in terms of accuracy of predictive performance. As this model was originally crafted at Ashford and St. Peters Hospital, we have naturally named it as THE ASHFORD OUTCOME.
Development of Ozone Generator Mini with DDBD (Double Dielectric Barrier Discharge) Technology at Atmospheric Air Pressure
Authors: Sudarmanto Agus , Yulianto Eko , Nur Muhammad 
Published: May 2024

<p class="Abstract">Pesticide residues in fruits and vegetables pose a danger to human health if consumed for a certain period. This requires appropriate technology for household scale and is environmentally friendly. Ozone is a strong oxidizing agent capable of degrading pesticide residues in fruits and vegetables. Ozone is a green chemical compound because it does not produce harmful derivative compounds, and is even friendly to the environment. The development of a mini ozone generator with DBD technology has been successfully carried out. The DDBD reactor is made of Pyrex glass with a length of 10 cm and an outer diameter of 4 cm. The reactor uses electrodes made of copper plates. The outer electrode is 13 cm long and 5 cm wide, while the inner electrode is 10 cm long and 5 cm wide. Optimization of the mini ozone generator is carried out using high voltage AC pulses whose pulse frequency can be varied from 30 to 60 Hz with 10 Hz intervals. The free air flow rate was varied at 0.2 – 0.8 lpm with an interval of 0.2 lpm. The optimum ozone production of 480 mg/l was obtained at a voltage setting of 2.8 kV and a frequency of 50 Hz and a flow rate of 0.2 lpm. In this setting, the DDBD reactor consumes 9.32 watts of power. The development of mini ozone generator technology has the potential to be applied on a household scale because of the small reactor size and low power consumption. </p>
Patterned microsphere-lens projection lithography using an electrohydrodynamic-jet-printing-assisted assembly
Authors: Zhong Ya , Yu Haibo , Zhou Peilin , Guo Hongji , Zhao Tianming , Luo Hao , Wen Yangdong , Wang Xiaoduo , Liu Lianqing 
Published: May 2024

Microlens arrays have been widely used in the fields of micro-optics and micro- and nanofabrication. Traditional preparation methods utilize commercial photoresists and thermosetting materials, thereby restricting the optical properties of microlenses. In recent years, significant advancements have been achieved in near-field super-resolution imaging by utilizing microspheres and forming arrays of microsphere lenses via self-assembly. However, self-assembly approaches lack flexibility in terms of pattern selection. This study proposes a method that utilizes electrohydrodynamic jet (E-jet) printing to code ultraviolet (UV)-curable adhesives and assist in the assembly of patterned microsphere-lens arrays. Simulation results demonstrate that the UV-curable adhesive has little impact on the optical properties of the microsphere lens. Moreover, the microsphere lens exhibits a superior imaging resolution compared with traditional microlenses. A projection-lithography system is developed to achieve an accurate alignment between the focal plane of the microsphere lenses and the plane of the photoresist, facilitating the fabrication of patterned nanostructures. The lithographic nanostructures have a minimum feature size of 850 nm. This method enables the fabrication of arrays of microsphere lenses with arbitrary patterns and presents an inexpensive and simple strategy for fabricating micro- and nanostructure arrays with submicrometer features.
Adverse outcomes in patients hospitalized with pneumonia at age 60 or more: A prospective multi-centric hospital-based study in India
Authors: Kanungo Suman , Bhattacharjee Uttaran , Prabhakaran Aslesh O. , Kumar Rakesh , Rajkumar Prabu , Bhardwaj Sumit Dutt , Chakrabarti Alok Kumar , Kumar C. P. Girish , Potdar Varsha , Manna Byomkesh , Amarchand Ritvik , Choudekar Avinash , Gopal Giridara , Sarda Krishna , Lafond Kathryn E. , Azziz-Baumgartner Eduardo , Saha Siddhartha , Dar Lalit , Krishnan Anand 
Published: May 2024

Background
Limited data exists regarding risk factors for adverse outcomes in older adults hospitalized with Community-Acquired Pneumonia (CAP) in low- and middle-income countries such as India. This multisite study aimed to assess outcomes and associated risk factors among adults aged ≥60 years hospitalized with pneumonia.

Methods
Between December 2018 and March 2020, we enrolled ≥60-year-old adults admitted within 48 hours for CAP treatment across 16 public and private facilities in four sites. Clinical data and nasal/oropharyngeal specimens were collected by trained nurses and tested for influenza, respiratory syncytial virus (RSV), and other respiratory viruses (ORV) using the qPCR. Participants were evaluated regularly until discharge, as well as on the 7th and 30th days post-discharge. Outcomes included ICU admission and in-hospital or 30-day post-discharge mortality. A hierarchical framework for multivariable logistic regression and Cox proportional hazard models identified risk factors (e.g., demographics, clinical features, etiologic agents) associated with critical care or death.

Findings
Of 1,090 CAP patients, the median age was 69 years; 38.4% were female. Influenza viruses were detected in 12.3%, RSV in 2.2%, and ORV in 6.3% of participants. Critical care was required for 39.4%, with 9.9% in-hospital mortality and 5% 30-day post-discharge mortality. Only 41% of influenza CAP patients received antiviral treatment. Admission factors independently associated with ICU admission included respiratory rate >30/min, blood urea nitrogen>19mg/dl, altered sensorium, anemia, oxygen saturation <90%, prior cardiovascular diseases, chronic respiratory diseases, and private hospital admission. Diabetes, anemia, low oxygen saturation at admission, ICU admission, and mechanical ventilation were associated with 30-day mortality.

Conclusion
High ICU admission and 30-day mortality rates were observed among older adults with pneumonia, with a significant proportion linked to influenza and RSV infections. Comprehensive guidelines for CAP prevention and management in older adults are needed, especially with the co-circulation of SARS-CoV-2.
Predictors of infective endocarditis associated in-hospital mortality in Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia: Microbiological,clinical features, and management profiles
Authors: Tesfay Hagazi , Weldu Yemane , Ebrahim Mohamedawel Mohamedniguss , Hailu Abraha , Gidey Kibreab , Gebrehaweria Teklay , Berhane Samuel , Gessesse Zekarias , Kahsay Hagos , Mezmur Daniel , Fisseha Kidan , Haileselassie Aregawi , Bayray Alemayehu 
Published: May 2024

Background
Infective endocarditis (IE) is a continuously evolving disease with a high mortality rate despite different advances in treatment. In Ethiopia, there is a paucity of data regarding IE. Therefore, this study is aimed at assessing IE-related in-hospital mortality and characterization of IE patients based on their microbiological, clinical features, and management profiles in the Ayder Comprehensive Specified Hospital (ACSH).

Methods
We conducted a hospital-based prospective follow-up study with all consecutive sampling techniques for suspected infective endocarditis patients admitted to ACSH from January 2020 to February 2022. Echocardiography was performed, and three sets of blood samples for blood culture were taken as per the standard protocol. We also performed isolation of microbial etiologies and antimicrobial susceptibility tests. The data was analyzed using STATA version 16. Stepwise logistic regression was run to identify predictors of in-hospital mortality. Effects were measured through the odds ratio at the 5% level of significance.

Results
Seventy-four cases of suspected infective endocarditis were investigated; of these, 54 episodes fulfilled modified Duke’s criteria. Rheumatic heart disease (RHD) (85.2%) was the most common underlying heart disease. Murmur (94.4%), fever (68.5%), and pallor (57.4%) were the most common clinical findings. Vegetation was present in 96.3% of episodes. Blood culture was positive only in 7 (13%) episodes. Complications occurred in 41 (75.9%) cases, with congestive heart failure being the most common. All patients were managed medically, with no surgical intervention. The in-hospital mortality was 14 (25.9%). IE-related in-hospital mortality was significantly associated with surgery recommendation and myalgia clinical symptoms.

Conclusion
IE occurred relatively in a younger population, with RHD as the most common underlying heart disease. There was a high rate of culture-negative endocarditis, and the majority of patients were treated empirically. Mortality was high. The establishment of cardiac surgery and strengthening microbiology services should be given top priority.
A model-based cost-utility analysis of an automated notification system for deteriorating patients on general wards
Authors: Holmes Emily , Lloyd Williams Huw , Hughes Dyfrig , Naujokat Elke , Duller Bernd , Subbe Christian P. 
Published: May 2024

Background
Delayed response to clinical deterioration of hospital inpatients is common. Deployment of an electronic automated advisory vital signs monitoring and notification system to signal clinical deterioration is associated with significant improvements in clinical outcomes but there is no evidence on the cost-effectiveness compared with routine monitoring, in the National Health Service (NHS) in the United Kingdom (UK).

Methods
A decision analytic model was developed to estimate the cost-effectiveness of an electronic automated advisory notification system versus standard care, in adults admitted to a district general hospital. Analyses considered: (1) the cost-effectiveness of the technology based on secondary analysis of patient level data of 3787 inpatients in a before-and-after study; and (2) the cost-utility (cost per quality-adjusted life-year (QALY)) over a lifetime horizon, extrapolated using published data. Analysis was conducted from the perspective of the NHS. Uncertainty in the model was assessed using a range of sensitivity analyses.

Results
The study population had a mean age of 68 years, 48% male, with a median inpatient stay of 6 days. Expected life expectancy at discharge was assumed to be 17.74 years.
(1) Cost-effectiveness analysis: The automated notification system was more effective (-0.027 reduction in mean events per patient) and provided a cost saving of -£12.17 (-182.07 to 154.80) per patient admission.
(2) Cost-utility analysis: Over a lifetime horizon the automated notification system was dominant, demonstrating a positive incremental QALY gain (0.0287 QALYs, equivalent to ~10 days of perfect health) and a cost saving of £55.35. At a threshold of £20,000 per QALY, the probability of automated monitoring being cost-effective in the NHS was 81%. Increased use of cableless sensors may reduce cost-savings, however, the intervention remains cost-effective at 100% usage (ICER: £3,107/QALY). Stratified cost-effectiveness analysis by age, National Early Warning Score (NEWS) on admission, and primary diagnosis indicated the automated notification system was cost-effective for most strategies and that use representative of the patient population studied was the most cost-saving strategy.

Conclusion
Automated notification system for adult patients admitted to general wards appears to be a cost-effective use in the NHS; adopting this technology could be good use of scarce resources with significance for patient safety.
Effect of the early diastolic blood pressure response to the head-up tilt test on the recurrence of benign paroxysmal positional vertigo
Authors: Rhim Guil , Kim Moon Jung 
Published: May 2024

Background
Otolith organ acts complementarily with the autonomic nervous system to maintain blood pressure. However, the effect of blood pressure variability in the autonomic nervous system on otolith organ has not yet been determined. This study aimed to verify the hypothesis that blood pressure variability in the autonomic nervous system affects the recurrence of benign paroxysmal positional vertigo (BPPV), which is the most common disease of the vestibular organs, by using the head-up tilt test (HUTT).

Methods
This study included 432 patients diagnosed with idiopathic BPPV. The follow-up period for all patients was 12 months. Age, sex, hypertension, diabetes and recurrence were analyzed. The HUTT parameters were divided into a group of patients whose average diastolic blood pressure increased in the upright position compared to supine position during the HUTT (DBP1) and a group of patients whose average diastolic blood pressure decreased in the upright position compared to supine position during the HUTT (DBP2). Model selection, general loglinear analysis, and logit loglinear analysis were performed using a hierarchically progressing loglinear analysis.

Results
In summary, the group with increased average diastolic blood pressure (DBP1) showed a higher tendency for BPPV recurrence compared to the group with decreased diastolic blood pressure (DBP2) in the upright position during the HUTT, although the difference was not statistically significant (p = 0.080). However, in males, the DBP1 group demonstrated a significantly higher recurrence rate of BPPV than the DBP2 group during the HUTT (95% CI, -20.021 to -16.200; p < 0.001).

Conclusions
It is presumed that poor autonomic nervous system response through vestibulosympathetic reflex maintains elevated diastolic blood pressure in the upright position during the HUTT. This variability is assumed to affect the recurrence of BPPV.
Knowledge of female genital schistosomiasis and urinary schistosomiasis among final-year midwifery students in the Volta Region of Ghana
Authors: Azanu Wisdom Klutse , Osarfo Joseph , Appiah Gideon , Godonu Yvonne Sefadzi , Ampofo Gifty Dufie , Orish Verner , Amoh Michael , Agbeno Evans Kofi , Morhe Emmanuel Senanu Komla , Gyapong Margaret 
Published: May 2024

Background
Female genital schistosomiasis (FGS) is a gynaecological complication of urinary schistosomiasis (US) with an estimated burden of 20–120 million cases in endemic areas. A neglected sexual and reproductive health disease in sub-Saharan Africa, FGS increases susceptibility to sexually transmitted infections including cervical cancer and infertility among other morbidities. However, there appears to be limited FGS knowledge among practicing and pre-service health providers with implications for control. We assessed FGS awareness among final-year midwifery students who would soon be delivering primary maternal and reproductive health care.

Methods
A cross-sectional study was conducted among 193 randomly selected final-year students from all three midwifery training institutions in the Volta region of Ghana in August/September, 2022. Data on participants’ demographics and knowledge of the transmission, signs and symptoms, complications, treatment and prevention of both FGS and US were collected using structured questionnaires. Summary statistics were presented as frequencies, proportions and percentages.

Results
Only 23.3% (44/189) of participants had heard about FGS compared to 64% (123/192) for US. Of the former, 42 (95%), 40 (91%) and 36 (81.8%) respectively identified genital itching/burning sensation, bloody vaginal discharge and pelvic pain/pain during intercourse as part of the symptoms of FGS. Less than a third (13/44) and about half (25/44) of those who indicated hearing about FGS knew it can be a risk for ectopic pregnancies and infertility respectively. Majority of these participants, 40 (91%), wrongly selected antibiotics as treatment for FGS while 9 indicated it is prevented by sleeping in insecticide-treated nets.

Conclusion
Awareness of FGS was limited among the study participants. The high prevalence of knowledge of some FGS symptoms related to the genitalia needs cautious interpretation. Health care training institutions must make deliberate efforts to highlight FGS in the training of midwives as the condition has diagnostic and management implications for some sexual and reproductive health conditions.
Cecal Metastasis of Clear Cell Renal Cell Carcinoma After Previous Nephrectomy
Authors: Lin Rick Y. , Shen Steve , Donabedian Patrick L. , Kiani Calvin , Kresak Jesse L. , Chatzkel Jonathan A. , Dakhoul Lara 
Published: May 2024

ABSTRACT
Metastasis of renal cell carcinoma (RCC) to the gastrointestinal (GI) tract is exceedingly rare. We present a case of a man in his 40s with a history of RCC that had metastasized to his abdominal wall and brain who then presented with abdominal pain and melena. On presentation, imaging showed new bone metastases and a colonic mass in the ascending colon. The biopsy of the mass from colonoscopy demonstrated RCC primary. Although rare, this case report highlights the importance of a thorough evaluation of patients with a history of RCC and considers GI tract involvement in those presenting with GI bleeding.