bluuebunny/crossref_metadata_2025_split huggingface dataset:
OUTCOMES OF PRIMARY JOINT REPLACEMENT IN PATIENTS WHO ARE INTRAVENOUS DRUG USERS: A SYSTEMATIC REVIEW
Authors: Stedman Tobias , Hatfield Thomas , McWilliams Anthony 
Published: May 2024

Arthroplasty in patients who are intravenous drug abusers presents a complex challenge, frequently requiring intervention at a younger age. The cohort suffer increased complication rates due to significant co-morbidities and poor engagement in medical services, in comparison to other patients undergoing lower limb arthroplasty. Multiple small studies show arthroplasty in this patient cohort is associated with high complication and mortality rates.A search of electronic databases were undertaken with the assistance of the library services from the Rotherham NHS Foundation Trust, including Chocraine, SCOPUS and PubMed.Abstracts were reviewed and relevant studies extracted for full review. Full text articles were reviewed based on strict inclusion and exclusion criteria.Searches identified Two thousand and forty-four papers; twenty-seven studies were identified for full review of the paper based on the inclusion criteria above. From this, nine studies were deemed appropriate to for data extraction.These nine papers present one hundred and thirty-two cases of lower limb arthroplasty, fifty nine Total Knee Arthroplasty and seventy three Total Hip Arthroplasty. From this the authors examined incidences of implant failure due to infection, revision, mortality, dislocation, aseptic loosening, peri-prosthetic fracture, or other causes. Of these, 58% of patients (n = 77) with a history of intravenous drug abuse suffered some form of significant complication; 4% of this cohort (n = 5) were lost to follow up. Infection was reported in 32% of cases and a mortality rate of 4.7%.The rising demand of lower limb arthroplasty for intra-venous drug abusers presents a very real problem for the modern Orthopaedic surgeon. Within the studies examined, more than half report implant failure. This study synthesises the available literature regarding treatment of these patients to help facilitate decision making and informed consent.
RELIABILITY AND VALIDITY OF THE REVISION HIP COMPLEXITY CLASSIFICATION
Authors: Buadooh Kwame Junior , Holmes Benjamin , Ng Aaron 
Published: May 2024

The Revision Hip Complexity Classification (RHCC) was developed by modified Delphi system in 2022 to provide a comprehensive, reproducible framework for the multidisciplinary discussion of complex revision hip surgery. The aim of this study was to assess the validity, intra-relater and inter-relater reliability of the RHCC.Radiographs and clinical vignettes of 20 consecutive patients who had undergone revision of Total Hip Arthroplasty (THA) at our unit during the previous 12-month period were provided to observers. Five observers, comprising 3 revision hip consultants, 1 hip fellow and 1 ST3-8 registrar were familiarised with the RHCC. Each revision THA case was classified on two separate occasions by each observer, with a mean time between assessments of 42.6 days (24–57). Inter-observer reliability was assessed using the Fleiss™ Kappa statistic and percentage agreement. Intra-observer reliability was assessed using the Cohen Kappa statistic. Validity was assessed using percentage agreement and Cohen Kappa comparing observers to the RHCC web-based application result.All observers were blinded to patient notes, operation notes and post-operative radiographs throughout the process.Inter-observer reliability showed fair agreement in both rounds 1 and 2 of the survey (0.296 and 0.353 respectively), with a percentage agreement of 69% and 75%.Inter-observer reliability was highest in H3-type revisions with kappa values of 0.577 and 0.441.Mean intra-observer reliability showed moderate agreement with a kappa value of 0.446 (0.369 to 0.773).Validity percentage agreement was 44% and 39% respectively, with mean kappa values of 0.125 and 0.046 representing only slight agreement.This study demonstrates that classification using the RHCC without utilisation of the web-based application is unsatisfactory, showing low validity and reliability. Reliability was higher for more complex H3-type cases. The use of the RHCC web app is recommended to ensure the accurate and reliable classification of revision THA cases.
ASSOCIATION BETWEEN SURGEON AND CENTRE VOLUME AND OUTCOME OF FIRST-TIME REVISION HIP ARTHROPLASTY FOR ASEPTIC LOOSENING: A STUDY USING THE NJR DATASET
Authors: Holleyman Richard , Jameson Simon , Reed Mike , Meek Dominic , Khanduja Vikas , Judge Andy , Board Tim 
Published: May 2024

This study evaluates the association between consultant and hospital volume and the risk of re-revision and 90-day mortality following first-time revision of primary hip replacement for aseptic loosening.We conducted a cohort study of first-time, single-stage revision hip replacements (RHR) performed for aseptic loosening and recorded in the National Joint Registry (NJR) data for England, Wales, Northern Ireland, and the Isle of Man between 2003 and 2019. Patient identifiers were used to link records to national mortality data, and to NJR data to identify subsequent re-revision procedures. Multivariable Cox proportional hazard models with restricted cubic splines were used to define associations between volume and outcome.Among 12,676 RHR there were 513 re-revisions within two years, and 95 deaths within 90 days of surgery. The risk of re-revision was highest for a consultant's first RHR (Hazard Ratio (HR) 1·58 (95%CI 1·16 to 2·15)) and remained significantly elevated for their first 26 cases (HR 1·26 (95%CI 1·00 to 1·58)). Annual consultant volumes of five/year were associated with an almost 30% greater risk of re-revision (HR 1·28 (95%CI 1·00 to 1·64)) and 80% greater risk of 90-day mortality (HR 1·81 (95%CI 1·02 to 3·21)) compared to volumes of 20/year. RHR performed at hospitals which had cumulatively undertaken fewer than 168 RHR were at up to 70% greater risk of re-revision (HR 1·70 (95% CI 1·12 to 2·60)), and those having undertaken fewer than 309 RHR were at up to three times greater risk of 90-day mortality (HR 3·06 (95% CI 1·19 to 7·86)).This study found a significantly higher risk of re-revision and early postoperative mortality following first-time single-stage RHR for aseptic loosening when performed by lower-volume consultants and at lower-volume institutions, supporting the move towards the centralisation of such cases towards higher-volume units and surgeons.
CEPHALOMEDULLARY NAILING FOR SUBTROCHANTERIC FEMORAL SHAFT FRACTURES: A COMPARISON OF SINGLE LAG SCREW DEVICE WITH AN INTERCALATED DUAL SCREW DEVICE
Authors: McCann Conor , Ablett Andrew , Feng Tony , Macaskill Victoria , Oliver William , Keating John 
Published: May 2024

Subtrochanteric femoral fractures are a subset of hip fractures generally treated with cephalomedullary nail fixation\[1\]. Single lag screw devices are most commonly-used, but integrated dual screw constructs have become increasingly popular\[2,3\]. The aim of this study was to compare outcomes of fixation of subtrochanteric femoral fractures using a single lag screw (Gamma3 nail, GN) with a dual screw device (InterTAN nail, IN). The primary outcome was mechanical failure, defined as lag screw cut-out, back-out, nail breakage or peri-implant fracture.Consecutive adult patients (18yrs) with subtrochanteric femoral fracture treated in a single centre were retrospectively identified using electronic records. Patients that underwent surgical fixation using either a long GN (2010–2017) or IN (2017–2022) were included. Medical records and radiographs were reviewed to identify complications of fixation. Cox regression analysis was used to determine the risk of mechanical failure and secondary outcomes by implant design. Multivariable regression models were used to identify predictors of mechanical failure.The study included 622 patients, 354 in the GN group (median age 82yrs, 72% female) and 268 in the IN group (median age 82yrs, 69% female). The risk of any mechanical failure was increased two-fold in the GN group (HR 2.44 \[95%CI 1.13 to 5.26\]; _p=0.024_). Mechanical failure comprising screw cut-out (_p=0.032_), back-out (_p=0.032_) and nail breakage (_p=0.26_) was only observed in the GN group. Technical predictors of failure included varus >5° for cut-out (OR 19.98 \[2.06 to 193.88\]; _p=0.01_), TAD;25mm for back-out (8.96 \[1.36 to 58.86\]; p=0.022) and shortening 1cm for peri-implant fracture (7.81 \[2.92 to 20.91\]; _p=<0.001_).Our results demonstrate that an intercalated screw construct is associated with a lower risk of mechanical failure compared with the a single lag screw device. Intercalated screw designs may reduce the risk of mechanical complications for patients with subtrochanteric femoral fractures.
The Speech without Doors: A Genre, 1627–1769
Authors: Lowe Ruby 
Published: May 2024

Abstract: In 1644 George Wither stood outside or without the doors of the House of Commons and delivered a speech to Parliament and the nation simultaneously. Not only did this “print oration” function as a prototype for Areopagitica, A Speech of John Milton [. . .] to the Parliament of England , but it inspired a genre of print pamphlets that would extend well into the eighteenth century. This article identifies and argues for the popular consequences of the genre, detailing its contribution to England’s developing structure of political communication and representation.
Relapses of juvenile idiopathic arthritis in adulthood: A monocentric experience
Authors: Scagnellato Laura , Cozzi Giacomo , Prosepe Ilaria , Lorenzin Mariagrazia , Doria Andrea , Martini Giorgia , Zulian Francesco , Ramonda Roberta 
Published: May 2024

Introduction
Our aim was to describe a monocentric cohort of young adult patients with juvenile idiopathic arthritis (JIA), assessing the risk of relapse after transition to adult care.

Methods
We conducted a retrospective study and collected clinical, serological, and demographic data of young adult patients (18–30 years old) referred to the Transition Clinic of a single Italian centre between January 2020 and March 2023. Patients with systemic-onset JIA were excluded. Primary outcome was disease relapse, defined by Wallace criteria. Risk factors were analysed by Cox proportional hazards regression.

Results
Fifty patients with age 18–30 years old were enrolled in the study and followed for a median 30 months. The median disease duration at transition was 15 years. Twenty (40%) patients were on conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and 38 (76%) were on biological DMARDs through adulthood. Twenty-three patients relapsed after transitioning to adult care for a median 9-month follow-up (IQR 0–46.5). Most relapses involved the knees (69.6%). The univariate analysis identified monoarthritis (HR 4.67, CI 1.069–20.41, p value = 0.041) as the main risk factor for relapse within the first 36 months of follow-up. Early onset, ANA positivity, past and ongoing treatment with csDMARDs or bDMARDs, therapeutic withdrawal, and disease activity within 12 months before transition did not significantly influence the risk of relapse.

Conclusion
In JIA patients, the risk of relapse after transitioning to adult care remains high, irrespective of disease subtype and treatment. The main risk factor for the early occurrence of articular activity is monoarticular involvement.
Development and evaluation of a usable blastocyst predictive model using the biomechanical properties of human oocytes
Authors: Meyer Daniel , Kort Jonathan , Chen Ching Hung , Zhao Huan , Yi Xiaoling , Lai Shin-Yu , Lu Farn , Yang Wen Jui , Hsieh I-Chiao , Chiang Chung-Li , Chen Wei-Ming , Huang Jack Yu Jen , Camarillo David , Behr Barry 
Published: May 2024

Purpose
The purposes of this study were to determine whether biomechanical properties of mature oocytes could predict usable blastocyst formation better than morphological information or maternal factors, and to demonstrate the safety of the aspiration measurement procedure used to determine the biomechanical properties of oocytes.

Methods
A prospective split cohort study was conducted with patients from two IVF clinics who underwent in vitro fertilization. Each patient’s oocytes were randomly divided into a measurement group and a control group. The aspiration depth into a micropipette was measured, and the biomechanical properties were derived. Oocyte fertilization, day 3 morphology, and blastocyst development were observed and compared between measured and unmeasured cohorts. A predictive classifier was trained to predict usable blastocyst formation and compared to the predictions of four experienced embryologists.

Results
68 patients and their corresponding 1252 oocytes were included in the study. In the safety analyses, there was no significant difference between the cohorts for fertilization, while the day 3 and 5 embryo development were not negatively affected. Four embryologists predicted usable blastocyst development based on oocyte morphology with an average accuracy of 44% while the predictive classifier achieved an accuracy of 71%. Retaining the variables necessary for normal fertilization, only data from successfully fertilized oocytes were used, resulting in a classifier an accuracy of 81%.

Conclusions
To date, there is no standard guideline or technique to aid in the selection of oocytes that have a higher likelihood of developing into usable blastocysts, which are chosen for transfer or vitrification. This study provides a comprehensive workflow of extracting biomechanical properties and building a predictive classifier using these properties to predict mature oocytes’ developmental potential. The classifier has greater accuracy in predicting the formation of usable blastocysts than the predictions provided by morphological information or maternal factors. The measurement procedure did not negatively affect embryo culture outcomes. While further analysis is necessary, this study shows the potential of using biomechanical properties of oocytes to predict embryo developmental outcomes.
Urban-rural disparities in COVID-19 hospitalisations and mortality: A population-based study on national surveillance data from Germany and Italy
Authors: Assche Simona Bignami-Van , Ferraccioli Federico , Riccetti Nicola , Gomez-Ramirez Jaime , Ghio Daniela , Stilianakis Nikolaos I. 
Published: May 2024

Purpose
Recent literature has highlighted the overlapping contribution of demographic characteristics and spatial factors to urban-rural disparities in SARS-CoV-2 transmission and outcomes. Yet the interplay between individual characteristics, hospitalisation, and spatial factors for urban-rural disparities in COVID-19 mortality have received limited attention.

Methods
To fill this gap, we use national surveillance data collected by the European Centre for Disease Prevention and Control and we fit a generalized linear model to estimate the association between COVID-19 mortality and the individuals’ age, sex, hospitalisation status, population density, share of the population over the age of 60, and pandemic wave across urban, intermediate and rural territories.

Findings
We find that in what type of territory individuals live (urban-intermediate-rural) accounts for a significant difference in their probability of dying given SARS-COV-2 infection. Hospitalisation has a large and positive effect on the probability of dying given SARS-CoV-2 infection, but with a gradient across urban, intermediate and rural territories. For those living in rural areas, the risk of dying is lower than in urban areas but only if hospitalisation was not needed; while for those who were hospitalised in rural areas the risk of dying was higher than in urban areas.

Conclusions
Together with individuals’ demographic characteristics (notably age), hospitalisation has the largest effect on urban-rural disparities in COVID-19 mortality net of other individual and regional characteristics, including population density and the share of the population over 60.
Population-based study of eclampsia: Lessons learnt to improve maternity care
Authors: Korb Diane , Azria Elie , Sauvegrain Priscille , Carbillon Lionel , Langer Bruno , Seco Aurélien , Chiesa-Dubruille Coralie , Bouvier-Colle Marie Hélène ,   Epimoms study group, Deneux-Tharaux Catherine 
Published: May 2024

Background
Among hypertensive disorders of pregnancy (HDP), eclampsia is a rare but serious event, often considered avoidable. Detailed assessment of the adequacy of care for the women who have eclampsia can help identify opportunities for improvement and for prevention of the associated adverse maternal and neonatal outcomes.

Objective
1/ To estimate the incidence and describe the characteristics of women with eclampsia and to compare them with those of women with non-eclamptic hypertensive disorders of pregnancy (HDP)-related severe maternal morbidity (SMM) and of control women without SMM 2/ To analyse the quality of management in women who had eclampsia, at various stages of their care pathway.

Methods
It was a planned ancillary analysis of the EPIMOMS population-based study, conducted in six French regions in 2012–2013. Among the 182,309 maternities of the source population, all women with eclampsia (n = 51), with non-eclamptic HDP-related SMM (n = 351) and a 2% representative sample of women without SMM (n = 3,651) were included. Main outcome was the quality of care for eclampsia assessed by an independent expert panel at three different stages of management: antenatal care, care for pre-eclampsia and care for eclampsia.

Results
The eclampsia incidence was 2.8 per 10,000 (95%CI 2.0–4.0). Antenatal care was considered completely inadequate or substandard in 39% of women, as was pre-eclampsia care in 76%. Care for eclampsia was judged completely inadequate or substandard in 50% (21/42), mainly due to inadequate use of magnesium sulphate.

Conclusion
The high proportion of inadequate quality of care underlines the need for an evidence-based standardisation of care for HDP.
Study on the therapeutic effect of Kirschner wire tension band combined with anchor cross-stitch technique in the treatment of comminuted patellar inferopolar fractures
Authors: Duan SiYu , Zhang He , Liang HaiRui , Xu RongDa , Sun Ming , Liu Hanfei , Zhou XueTing , Wen Hang , Cai ZhenCun 
Published: May 2024

Purposes
Fractures of the inferior patellar pole, unlike other patellar fractures, present challenges for traditional surgical fixation methods. This article introduces the clinical technique and outcomes of using Kirschner wire tension band combined with anchor screw cross-stitch fixation for comminuted inferior patellar pole fractures.

Methods
This retrospective case series study included 14 patients with comminuted inferior patellar pole fractures treated at our institution from September 1, 2020, to April 30, 2022. All patients underwent surgery using the Kirschner wire tension band with anchor screw cross-stitch technique. Follow-up assessments involved postoperative X-rays to evaluate fracture healing, as well as clinical parameters such as healing time, Visual Analog Scale (VAS) scores, range of motion (ROM), and Bostman scores.

Results
All patients were followed for an average of over 12 months, with no cases of internal fixation failure. Knee joint stability and function were excellent. X-rays revealed an average healing time of approximately 10.79 ± 1.53 weeks, hospitalization lasted 5.64 ± 1.15 days, surgery took approximately 37.86 ± 5.32 minutes, and intraoperative blood loss was 33.29 ± 8.15 ml. One patient experienced irritation from the internal fixation material. At the final follow-up, the Bostman score averaged 28.29 ± 0.83, knee joint flexion reached 131.07° ± 4.88°, all patients achieved full knee extension, and the VAS score was 0.36 ± 0.63.

Conclusion
Kirschner wire tension band with anchor screw cross-stitch fixation for comminuted inferior patellar pole fractures delivered satisfactory clinical outcomes. This surgical method, characterized by its simplicity and reliability, is a valuable addition to clinical practice.
Insurer-Mandated Medication Utilization Barriers are Associated With Decreased Insurance Satisfaction and Adverse Clinical Outcomes: An Inflammatory Bowel Disease Partners Survey
Authors: Constant Brad D. , Long Millie D. , Scott Frank I. , Higgins Peter D.R. 
Published: May 2024

INTRODUCTION:
Insurer-mandated barriers to timely initiation of advanced therapies used to treat inflammatory bowel disease (IBD) have been shown to worsen clinical outcomes and increase healthcare utilization, yet rarely alter the medication ultimately prescribed.

METHODS:
We conducted a survey within the IBD Partners longitudinal cohort to evaluate the frequency and patient-reported impacts of medication utilization barriers on insurance satisfaction and clinical outcomes. Barriers included medication denials, prior authorizations, and forced medication switches. Variables associated with insurance satisfaction, measured on a 1–7 Likert scale, were identified. The association between insurance-related barriers and downstream clinical outcomes (surgery, corticosteroid requirement, and disease activity) were evaluated.

RESULTS:
Two thousand seventeen patients (age 45 [interquartile range 34–58] years, 73% female) were included. Seventy-two percent experienced an insurer-mandated barrier, most commonly prior authorizations (51%). Fifteen percent were denied an IBD medication by their insurer, 22% experienced an insurance-related gap in therapy, and 8% were forced by their insurer to switch from an effective medication. Insurance satisfaction was negatively associated with medication denials, prior authorization-related delays, gaps in therapy, and high-deductible health plan coverage. In the year following the initial survey, several insurance barriers were linked to negative downstream clinical outcomes, including prior authorizations associated with corticosteroid rescue (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.25–4.00), forced medication switches associated with continued disease activity (OR 3.28, 95% CI 1.56–6.89), and medication denials associated with IBD-related surgery (OR 8.92, 95% CI 1.97–40.39).

DISCUSSION:
These data illustrate the frequency and negative impacts of insurer-mandated medication barriers on patients with IBD, including decreased insurance satisfaction and negative downstream clinical outcomes.
Peningkatan Kompetensi Guru MAN 2 Kulon Progo Dalam Menyusun Rencana Pelaksanaan Pembelajaran Kurikulum Merdeka Melalui Teknik Coaching and Mentoring
Authors: Kalimah  
Published: May 2024

Tujuan – Penelitian ini bertujuan untuk mengetahui peningkatan kompetensi guru dalam menyusun perangkat pembelajaran Kurikulum Merdeka melalui teknik coaching and mentoring di MAN 2 Kulon Progo.
Metode – Jenis Penelitian ini adalah penelitian tindakan yang menggunakan model penelitian Kemis dan Mc Taggart. Model Mc Taggart ini terdiri dari empat komponen yang berurutan yaitu perencanaan, tindakan, pengamatan dan refleksi, yang dalam pelaksanaan dan pengamatannya dilakukan secara bersamaan. Subjek dalam penelitian ini adalah seluruh guru MAN 2 Kulon Progo yang berjumlah 63 guru. Analisis data dalam penelitian ini menggunakan analisis statistik deskriptif. Adapun indikator keberhasilan penelitian tindakan ini adalah terjadinya peningkatan skor rata-rata hasil pemberian tindakan kepada seluruh guru pada tiap siklus, indikator, dan mencapai ketuntasan klasikal ≥80%.
Hasil – Temuan dari penelitian ini yaitu penyusunan perangkat pembelajaran Kurikulum Merdeka untuk meningkatkan kompetensi guru MAN 2 Kulon Progo dengan menggunakan teknik coaching and mentoring dikatakan berhasil. Untuk simpulan hasil tindakan adalah pada siklus I yaitu diperoleh jumlah guru yang paham dengan rata-rata nilai sebesar 21%. Adapun guru yang tidak paham sebesar 79%. Adapun rerata nilai untuk guru yang paham pada siklus II sebesar 85,7%, dan tidak paham sebesar 14,3%. Oleh karena itu, pemberian tindakan ini dapat dikatakan berhasil