bluuebunny/crossref_metadata_2025_split huggingface dataset:
4. Biased Preferences Equilibrium
Authors: Richter Michael , Rubinstein Ariel 
Published: April 2024

This chapter follows Rubinstein and Wolinsky (2022) who propose a biased preferences equilibrium solution concept in which agents' preference relations are systematically biased. The bias does not affect the agents' opportunity sets, but rather their preferences, which are systematically biased in such a way that the profile of agents' biased optimal choices is feasible.
We envision biases as a mechanism for bringing harmony to a multi-agent economy. These biases, like prices, apply uniformly to all agents. Every agent's final preferences are determined by his initial preferences and the commonly shared bias.
We apply the concept to three types of economies: the give-and-take, market economies with fixed prices and housing-type economies.
Back on the Streets: Examining Emergency Department Return Rates for Unhoused Patients Discharged After Trauma
Authors: Park Stephen , Kim Sean , Kim Hye Kwang , Tabarsi Emiliano , Hom Brian , Gallagher Shea , Ugarte Chaiss , Clark Damon , Schellenberg Morgan , Martin Matthew , Inaba Kenji , Matsushima Kazuhide 
Published: April 2024

Background The unhoused population is at high risk for traumatic injuries and faces unique challenges in accessing follow-up care. However, there is scarce data regarding differences in Emergency Department (ED) return rates and reasons for return between unhoused and housed patients. Methods We conducted a 3-year retrospective cohort study at a level-1 trauma center in a large metropolitan area. All patients who presented to the ED with traumatic injuries and were discharged without hospital admission were included in the study. The primary outcome was ED returns for trauma-related complications or new traumatic events <6 months after discharge. Patient characteristics and study outcomes were compared between housed and unhoused groups. Results A total of 4184 patients were identified, of which 20.3% were unhoused. Compared to housed, unhoused patients were more likely to return to the ED (18.8% vs 13.9%, P < .001), more likely to return for trauma-related complications (4.6% vs 3.1%, P = .045), more likely to return with new trauma (7.1% vs 2.8%, P < .001), and less likely to return for scheduled wound checks (2.5% vs 4.3%, P = .012). Of the patients who returned with trauma-related complications, unhoused patients had a higher proportion of wound infection (20.5% vs 5.7%, P = .008). In the regression analysis, unhoused status was associated with increased odds of ED return with new trauma and decreased odds of return for scheduled wound checks. Conclusions This study observed significant disparities between unhoused and housed patients after trauma. Our results suggest that inadequate follow-up in unhoused patients may contribute to further ED return.
Emergency Surgical Treatment and Triage: Targeting Optimal Outcomes for Emergency Surgical Patients From Index Encounter Through Definitive Care
Authors: Kliewer Jaclyn , Luque Ilko , Javier Mariel A. , Moorefield Amanda , Mendez Hector , Martinez Zulmari , Oster Jacob , Rangel Alexis , Morejón Orlando 
Published: April 2024

Background Patients with emergency surgical conditions (ESCs) experience higher complication rates than those without emergency conditions. Our purpose was to improve time-based key performance indicators (KPIs) of care for ESC patients, including diagnostic workup, empiric stabilization, and referral to definitive care. Methods A rapid response program (ESTAT) was developed to screen for and coordinate optimal, timely care for a spectrum of high-risk ESCs, from the patient’s index clinical encounter up to definitive care. The Mann-Whitney test assessed whether any differences in KPIs were statistically significant ( P < .05) before compared to after the implementation of ESTAT. Results 98 patients were identified: 44 in ESTAT group (70% age ≥55, 57% male); 54 in control group (57% age ≥55, 44% male). There were significant decreases from time of index clinical encounter to resuscitation (5 min. vs 34 min., P < .001), to diagnostic imaging (52 min. vs 1 hr. 19 min., P = .004), and to definitive care (2 hr. 17 min. vs 3 hr. 51 min., P = .007) in the ESTAT group compared to the control group, respectively. Discussion Improving time-based KPIs for delivery of clinical services is a common goal of medical emergency response systems (MERS) in numerous specialties. Implementation of an ESTAT program provides a screening tool for at-risk patients and reduces time to stabilize, diagnose and triage to definitive surgical intervention. These time benefits may ultimately translate to reduced complication rates for ESC patients. ESTAT may also represent a patient onboarding mechanism for surgical specialty verification programs promoted by quality improvement committees of various professional societies.
Ballistic behaviour of hybride carbon/basalt fiber reinforced epoxy-hBN composite
Authors: Bakal Gumus Fatma , Yapici Ahmet 
Published: April 2024

Ballistic behaviours of hybrid composite armors were investigated through experiments. The effects of hexagonal boron nitride (h-BN) nanopowders and number of layers on ballistic performance were examined. Four types of armors were manufactured by hand lay-up and vacuum bagging technique: 60 layers of fabric (30 layers carbon and 30 layers basalt fabrics) with 0% h-BN (1-A) and 1% h-BN (1-B), also 100 layers of fabric (50 layers carbon and 50 layers basalt fabrics) with 0% h-BN (2-A) and 1% h-BN (2-B) with epoxy resin. Ballistic impact tests were performed on the armors using a 9 mm full metal jacket projectile. The densities of the ballistic plates are 1.53, 1.56, 1.61 and 1.65 respectively. After three shots to each plate, the average hole depths were 5.55 mm on the 1-A coded plate, 4.34 mm on the 1-B armor, 4.68 mm on the 2-A plate, and 4.69 mm on the 2-B armor. All of the armors were able to confront for the velocities between [Formula: see text] m/s successfully. However, the h-BN showed a significant influence on the overall ballistic performance of composite armors. It has been found that the penetration depth decreases with the addition of h-BN. Also SEM-EDS mapping and XRD analysis were used to characterize the hybrid composites.
Perceived Spousal Support and Activities of Daily Living in Individuals With COPD
Authors: Efil Sevda , Kalkan Ugurlu Yasemin , Akça Doğan Derya , Budak Dilek 
Published: April 2024

Background: The relationship between perceived spousal support and activities of daily living in patients with chronic obstructive pulmonary disease (COPD) is unclear. Purpose: The aim of this study was to explore the relationship between spousal support perceived by those with COPD and their activities of daily living. Methods: This study was a cross-sectional and descriptive study. Data collection was conducted between September 2022 and April 2023. A Data Gathering Form, the Spousal Support Scale, and the London Chest Activity of Daily Living Scale were used to collect data. A total of 132 adults were included in this study. Results: The mean (SD) scores of individuals with COPD for perceived spousal support and activities of daily living were 62.40 (14.66) and 32.91 (15.72), respectively. Levels of perceived spousal support and activities of daily living varied according to sex, employment status, admission to the emergency service or hospitalization, use of antidepressants, and the severity of the illness ( P < .05). Those with better spousal support felt less dyspnea when performing the activities of daily living ( r = −0.205, P < .05). Conclusions: Knowing the potential factors affecting perceived spousal support and activities of daily living can provide an opportunity to determine appropriate strategies to increase the level of independence of individuals with COPD. Educational interventions to help spouses understand COPD may help increase spousal support.
Return to Sports in Patients Aged 50 Years or Younger After Robotic-Assisted Patellofemoral Arthroplasty: A 10-Year Experience Reporting High Clinical Benefits and High Patient Satisfaction With Return to an Active Lifestyle
Authors: Noyes Frank R. , Fleckenstein Cassie M. , Nolan Joseph 
Published: April 2024

Background: Limited data are available on return to sports and patient psychometric ratings of success after patellofemoral arthroplasty (PFA) in younger patients with high expectations to return to an active lifestyle. Purpose/Hypothesis: The purpose of this article was to determine the role of PFA and its success in meeting patient expectations regarding the return to low-impact recreational sports and an active lifestyle in younger, active patients. It was hypothesized that PFA would allow younger patients to return to low-impact sports and an active lifestyle and achieve high patient psychometric ratings. Study Design: Case series; Level of evidence, 4. Methods: In this 10-year prospective study (2009-2018), robotic-assisted PFA was performed on 44 patients (32 women and 12 men; n = 51 consecutive knees), with a mean age of 37.2 years (range, 21-50 years). The follow-up rate was 98%, with a mean of 5.3 years (range, 2-9.3 years). Primary clinical outcomes were as follows: the validated Cincinnati Knee Rating System sports activity and symptom rating scales, patient psychometric ratings of the substantial clinical benefit (SCB), and the Patient Acceptable Symptom State (PASS). Secondary outcomes were the Cincinnati Knee Rating System occupational rating, visual analog pain scale, and the 12-Item Short Form Health Survey. Survivorship was defined by conversion to total knee replacement (TKR). Results: Before PFA, 78% of patients (35/45 knees) were symptomatic and unable to perform recreational sports, with only 20% of patients (9/45 knees) performing some low-impact sports. After PFA, 80% of patients (36/45 knees) were able to perform low-impact sports, and 7% (3/45 knees) performed jumping-pivoting sports ( P < .001). The SCB scored by the patient showed 87% of knees as good, very good, or normal. On the PASS analysis, 89% of patients (95% CI, 76%-96%) were “pleased,” and 93% (95% CI, 82%-99%) would undergo surgery again. There were clinically relevant improvements in symptoms of pain, swelling, and giving way ( P = .0001). Preoperatively, 91% of knees had moderate to severe pain with activities of daily living, and only 11% of knees had pain at the follow-up. Five of the 50 knees (10%) underwent TKR conversion with one patient lost to follow-up. Conclusion: PFA resulted in a high return of patients to low-impact sports with high SCB and PASS psychometric ratings. The robotic-assisted 3-dimensional preoperative planning allowed precise intraoperative trochlear implant alignment in knees with severe trochlear dysplasia. PFA is recommended as an alternative treatment in younger patients with end-stage symptomatic patellofemoral arthritis. Registration: NCT02738476 (ClinicalTrials.gov identifier).
Can Patients Rely on ChatGPT to Answer Hand Pathology–Related Medical Questions?
Authors: Jagiella-Lodise Olivia , Suh Nina , Zelenski Nicole A. 
Published: April 2024

Background: In recent years, ChatGPT has become a popular source of information online. Physicians need to be aware of the resources their patients are using to self-inform of their conditions. This study investigates physician-graded accuracy and completeness of ChatGPT regarding various questions patients are likely to ask the artificial intelligence (AI) system concerning common upper limb orthopedic conditions. Methods: ChatGPT 3.5 was interrogated concerning 5 common orthopedic hand conditions: carpal tunnel syndrome, Dupuytren contracture, De Quervain tenosynovitis, trigger finger, and carpal metacarpal arthritis. Questions evaluated conditions’ symptoms, pathology, management, surgical indications, recovery time, insurance coverage, and workers’ compensation possibility. Each topic had 12 to 15 questions and was established as its own ChatGPT conversation. All questions regarding the same diagnosis were presented to the AI, and its answers were recorded. Each question was then graded for both accuracy (Likert scale of 1-6) and completeness (Likert scale of 1-3) by 10 fellowship trained hand surgeons. Descriptive statistics were performed. Results: Overall, the mean accuracy score for ChatGPT’s answers to common orthopedic hand diagnoses was 4.83 out of 6 ± 0.95. The mean completeness of answers was 2 out of 3 ± 0.59. Conclusions: Easily accessible online AI such as ChatGPT is becoming more advanced and thus more reliable in its ability to answer common medical questions. Physicians can anticipate such online resources being mostly correct, however incomplete. Patients should beware of relying on such resources in isolation.
Total hip replacement in a cat with contralateral pelvic limb amputation
Authors: Bourbos Alexandros , Piana Francesco , Langley-Hobbs Sorrel Judith 
Published: April 2024

Case summary A 10-year-old male neutered domestic shorthair cat, which had previously had its contralateral pelvic limb amputated, was treated for coxofemoral degenerative joint disease (DJD) with a total hip replacement. The long-term outcome was favourable and no complications were recorded. Interestingly, the contralateral coxofemoral joint left at the time of the previous amputation developed DJD and became a source of pain for the cat and was subsequently excised. Relevance and novel information This case report shows that total hip replacement is a viable option in cats with coxofemoral DJD and a contralateral limb amputation. Retained joints in amputated limbs may develop osteoarthritis and be a source of pain for a cat.
Critical success factors for creating sustainable digital health applications: A systematic review of the German case
Authors: Schramm Lukas , Carbon Claus-Christian 
Published: April 2024

Objective The Covid-19 pandemic has accelerated the adoption of digital technologies to address social needs, leading to increased investments in digital healthcare applications. Germany implemented a special law called the “Digitales Versorgungsgesetz” (DVG—Digital Supply Act) in 2019, which enables the reimbursement of digital health applications, including digital therapeutics (DTx), through a fast-track process. The Federal Institute for Drugs and Medical Devices (BfArM), the German federal authority responsible for overseeing digital health applications, has implemented legislative adjustments since the law's introduction, which have increased requirements for these applications and potentially led to the removal of some from the directory as well as a slowdown in the addition of new ones. To counteract this trend, this work aimed to identify key success factors for digital health applications (DiGAs). Methods This research identifies critical success factors through a structured literature review for developing sustainable digital health applications within the European healthcare systems, specifically DiGAs. The study aims to support the ongoing digital transformation in healthcare. Results The identified success factors that significantly impact the sustainability of DiGAs include patient-centered design, application effectiveness, user-friendliness, and adherence to data protection and information security regulations using standardized approaches. These factors are crucial in preventing the failure of DiGA manufacturers in European countries. Conclusion By considering and implementing these critical success factors, DiGA manufacturers can enhance their chances of long-term success and contribute to the digital transformation of the healthcare system in Europe.
Does Transparency of Ankle Implant Costs Influence Surgeon Behavior?
Authors: Swenson Riley , Paull Thomas , Moua Gaonhia , Weatherby David , Azzam Khalid , Wojahn Robert , Anderson Sarah , Cole Peter A. , Nguyen Mai 
Published: April 2024

Background: Ankle fractures are a common injury treated by orthopaedic surgeons. Unstable, displaced ankle fractures are often fixed with open reduction internal fixation (ORIF) using different implant constructs at various cost. No study to date has looked at transparency in ankle implant costs to surgeon behavior. Our surgeons self-identified that the biggest barrier for lowering implant cost was the lack of cost transparency. This was a surgeon-led-study to evaluate whether increased transparency in implant costs affected surgeon behavior. Methods: Monthly operative logs from December 2021 to September 2022 were reviewed at our level 1 trauma center for operative fixation of ankle fractures. The cost data of each fixation construct was reported to trauma-trained surgeons at the end of each month from March 2022 to June 2022. Average costs of implants were compared before and after education. A linear mixed model was used to explore what factors were associated with changes in costs. Surgeons also participated in a poststudy survey. Results: The implant costs of 110 ankle fracture fixations were reviewed over the period before education (n = 60), during education (n = 30), and after education (n = 20). The mean implant cost difference for unimalleolar fractures was −$204.80 ( P = .68), whereas the mean cost difference for bimalleolar fractures was −$9.82 ( P = .98). Trimalleolar fractures had a mean cost difference of +$94.47 ( P = .84). Linear mixed model demonstrated fracture pattern as the only factor significantly associated with implant costs ( P < .01). Post-education surgeon survey revealed that 6 of 7 surgeons felt that monthly updates affected their implant selection. However, only 2 surgeons demonstrated a change in practice with decreased implant costs during the study. Conclusion: The majority of surgeons self-reported being influenced by the implant cost education, but the detected change in implant cost was only observed in less than one-third of surgeons. Our results suggest implant selection and related costs are not influenced by increased cost transparency education alone. Level of Evidence: Level III, case control study.
Facile preparation of sepiolite-based composites and their antibacterial/rheological properties
Authors: Jiang Yizhi , Peng Zongfan , Yang Yongwen , Li Yuqin , Tang Yufang , Ding Yanhuai 
Published: April 2024

AbstractNatural sepiolite has great potential for application in wound healing, haemostasis and medicines. This paper introduces a versatile solid-state sintering technique for preparing sepiolite-based nanocomposites with enhanced antibacterial properties, and the physical, structural, rheological and antibacterial properties of which were determined to be enhanced. The incorporation of nanosized Ag and metal oxides into sepiolite composites results in a notable improvement in their antibacterial efficacy against Escherichia coli and Staphylococcus aureus in comparison to the unmodified sepiolite. With a low silver content of just 5%, the sepiolite–Ag composite achieves an antibacterial rate of ~100%. Furthermore, the rheological properties exhibited by the sepiolite composites are noteworthy, suggesting their suitability for use in wound-dressing applications due to their exceptional workability. The methodology employed in this research has the potential to offer a viable substitute for the production of economical and effective natural antibacterial nanocomposites.
The ATF4-RPS19BP1 axis modulates ribosome biogenesis to promote erythropoiesis
Authors: Zheng Zhaofeng , Yang Shangda , Gou Fanglin , Tang Chao , Zhang Zhaoru , Gu Quan , Sun Guohuan , Jiang Penglei , Wang Nini , Zhao Xiangnan , Kang Junnan , Wang Yifei , He Yicheng , Yang Meng , Lu Ting , Lu Shihong , Qian Pengxu , Zhu Ping , Cheng Hui , Cheng Tao 
Published: April 2024

Abstract
Hematopoietic differentiation is controlled by intrinsic regulators and the extrinsic hematopoietic niche. Activating transcription factor 4 (ATF4) plays a crucial role in the function of fetal and adult hematopoietic stem cell maintenance. However, the precise function of ATF4 in the bone marrow (BM) niche and the mechanism by which ATF4 regulates adult hematopoiesis remain largely unknown. Here, we used 4 cell-type-specific mouse Cre lines to achieve conditional knockout of Atf4 in Cdh5+ endothelial cells, Prx1+ BM stromal cells, Osx+ osteoprogenitor cells, and Mx1+ hematopoietic cells and uncovered the role of Atf4 in niche cells and hematopoiesis. Intriguingly, depletion of Atf4 in niche cells did not affect hematopoiesis; however, Atf4-deficient hematopoietic cells exhibited erythroid differentiation defects, leading to hypoplastic anemia. Mechanistically, ATF4 mediated direct regulation of Rps19bp1 transcription, which is, in turn, involved in 40 S ribosomal subunit assembly to coordinate ribosome biogenesis and promote erythropoiesis. Finally, we demonstrate that under conditions of 5-fluorouracil–induced stress, Atf4 depletion impedes the recovery of hematopoietic lineages, which requires efficient ribosome biogenesis. Taken together, our findings highlight the indispensable role of the ATF4-RPS19BP1 axis in the regulation of erythropoiesis.
Gait differences between COPD and healthy controls: systematic review and meta-analysis
Authors: Buekers Joren , Delgado-Ortiz Laura , Megaritis Dimitrios , Polhemus Ashley , Breuls Sofie , Buttery Sara C. , Chynkiamis Nikolaos , Demeyer Heleen , Gimeno-Santos Elena , Hume Emily , Koch Sarah , Williams Parris , Wuyts Marieke , Hopkinson Nicholas S. , Vogiatzis Ioannis , Troosters Thierry , Frei Anja , Garcia-Aymerich Judith 
Published: April 2024

BackgroundDespite the importance of gait as a determinant of falls, disability and mortality in older people, understanding of gait impairment in COPD is limited. This study aimed to identify differences in gait characteristics during supervised walking tests between people with COPD and healthy controls.MethodsWe searched 11 electronic databases, supplemented by Google Scholar searches and manual collation of references, in November 2019 and updated the search in July 2021. Record screening and information extraction were performed independently by one reviewer and checked for accuracy by a second. Meta-analyses were performed in studies not considered at a high risk of bias.ResultsSearches yielded 21 085 unique records, of which 25 were included in the systematic review (including 1015 people with COPD and 2229 healthy controls). Gait speed was assessed in 17 studies (usual speed: 12; fast speed: three; both speeds: two), step length in nine, step duration in seven, cadence in six, and step width in five. Five studies were considered at a high risk of bias. Low-quality evidence indicated that people with COPD walk more slowly than healthy controls at their usual speed (mean difference (MD) −19 cm·s−1, 95% CI −28 to −11 cm·s−1) and at a fast speed (MD −30 cm·s−1, 95% CI −47 to −13 cm·s−1). Alterations in other gait characteristics were not statistically significant.ConclusionLow-quality evidence shows that people with COPD walk more slowly than healthy controls, which could contribute to an increased falls risk. The evidence for alterations in spatial and temporal components of gait was inconclusive. Gait impairment appears to be an important but understudied area in COPD.