bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOES RETURN TO PHYSICAL ACTIVITY DIFFER BETWEEN ANKLE ARTHRODESIS AND TOTAL ANKLE ARTHROPLASTY: ONE-YEAR FOLLOW-UP STUDY
Authors: Jabbar Faizan , Nicolas Andrea , Chambers Simon , Torres Paulo , Qasim Sultan , Siddique Malik , Ramaskandhan Jayasree 
Published: February 2025

BackgroundThe ability to return to physical activity is an important indicator of surgical success for end-stage ankle arthritis. There is paucity of literature comparing outcomes between surgical procedures. This study aimed to compare outcomes for physical activity and return to function between total ankle replacement (TAR) and ankle arthrodesis (AA) at 1-year follow-up.MethodsThis was a single-centre prospective follow-up study. Patients who underwent TAR (n=33) or AA (n=25) between 2022–2023 completed questionnaires on FAOS scores (Pain, Symptoms, ADL and QOL domains), International Physical Activity Questionnaire (IPAQ), satisfaction scores and return to work/driving. IPAQ physical activities were compared across domains of work, transportation, domestic and leisure activities.ResultsAA patients were younger (59.1 vs. 65.8). The AA group had better average FAOS scores for pain, symptoms, ADL, and QOL compared to TAR (51.2 vs. 29.2; 40.6 vs. 67.8, 46.8 vs. 66.4, 31.3 vs. 48.3) (p=0.526), but the TAR group reported higher overall satisfaction (77% vs. 66.6%). Earliest return to work was reported at 2 weeks (TAR) vs. 3 weeks (AA) group and driving at 3 weeks (TAR) vs. 4 weeks (AA). More TAR patients returned to vigorous (25%) and moderate (17.6%) physical activity versus AA (0% and 0%). For transport, 4 AA patients vs. 12 TAR patients returned to this activity. AA patients travelled 30 minutes to 2 hours per week, while TAR patients travelled 30 minutes to 5 hours. For household activities, 15.7% of TAR patients reported vigorous activity versus 0% in AA. AA patients spent less time on average leisure walking (1.25 hrs vs. 2 hrs), and more time sitting per day (9.2 hrs vs. 5.9 hrs).ConclusionThe TAR group demonstrated earlier return to work, driving, and higher levels of physical activity compared to AA patients at 1-year follow-up, despite the AA group having better FAOS scores.
SINGLE-STAGE REVISION TOTAL ANKLE ARTHROPLASTY: IS IT SAFE?
Authors: Pekhale Parikshit , Raglan Martin , Dhar Sunil 
Published: February 2025

BackgroundThe number of total ankle replacements (TAR) is increasing each year and with that an associated rise in the burden of revision ankle arthroplasty (RAA). The preferred option in our center, following network discussion, is to convert the failing TAR to a RAA. There is uncertainty whether this is best done in a single staged approach or two stages.The aim of this review was to assess the safety of single to two staged approaches in RAAMethodA review was carried out of the prospectively collected data of all RAA performed in our center between Nov 2016 and Jan 2024. We reviewed; preoperative micro sampling, intraop micro and histology results, infection rate, tourniquet time, length of hospital stay, wound complications and PROMS of all patients who had undergone single staged RAA, compared to two staged.ResultsWe identified 88 RAA patients, with mean age of 71.4 (38–88) with a minimum of 2 year follow up, range 2 – 6 years. There were 44 Left and 44 Right failing total ankle replacements. 14 were two staged procedures and 74 were single staged. Neither group had any significant intraoperative microbiology growth. There was a significant difference in tourniquet times but with no associated significant complication rate in single stage group. There was one infection in the single staged group that went onto have a successful DAIR. There was no difference in wound complications post op. Both groups showed improvement in PROMS, with no difference between the groups or in increase in length of hospital stay.ConclusionIn our series, which is the largest in the literature, we have found single staged revision arthroplasty to be safe and effective compared to two stage in patients where there is a low index of suspicion of infection.
MORTALITY, RE-AMPUTATION, AND POSTOPERATIVE COMPLICATION RATES FOLLOWING 28,000 BELOW-KNEE AMPUTATIONS IN DIABETIC PATIENTS IN ENGLAND: A NATIONAL POPULATION STUDY, 2002–2022
Authors: Hennessy Conor , Abram Simon , Loizou Con , Brown Rick , Sharp Bob , Kendal Adrian 
Published: February 2025

IntroductionGlobal data on BKA mortality is dominated by US Veterans population studies, while smaller single-centre UK cohorts observe a wide range of 1 year mortality (13.8%-61.1%). There is no consensus on mortality rates, perioperative complications and at-risk groups post diabetic BKA in England.MethodsEngland Hospital Episodes Statistics (HES) data was combined with ONS mortality data (2000–2022) and cleaned using STATA 18. The primary outcome was the rate of all cause mortality. Secondary outcomes were causes of death, re-amputation rates, temporal variation in mortality, and 90 day peri-operative complications.Mortality and amputation free survival was calculated with Kaplan-Meier curve analysis using R, STATA 18. Multivariate logistic regression stratified patient variables associated with mortality and/or re-amputation rate.Results28,045 BKA were performed for diabetes in the 20-year period; decreasing from 8.1/100,000 (2002) to 6.5/100,000 (2022). The rates were significantly higher in white males aged 60–79 years old (14/100,000 in 2023).The mortality rates following BKA for diabetic foot disease were 7.1% at 30 days, 12.7% at 90 days, 24.6% at 1 year, and 61.2% at 5 years. Only 17% of patients survived to 10 years post BKA.The 90-day reoperation rate for any cause was 20.7%. The ipsilateral re-amputation rate at any time was 10.4% (n=2909), and the contralateral amputation rate was 8.2% (n=2304). Additional 90-day complications included PE (0.75%, n=211), MI (3.6%, n=1019) and Stroke (1.1%, n=316).Multi-regression analysis demonstrated significantly higher BKA associated mortality rates at all time points in male, British-Asians with higher deprivation status.ConclusionsThis landmark 20-year England diabetic population study has revealed high rates of death, further amputation and peri-operative morbidity post BKA. Asian Males in their 60s have the highest mortality rates and represent an at-risk group. Overall, there has been little improvement in post BKA mortality over the last 20 years.
VR-Based Workplace Training and Spaces of Learning: A Social Space Study of VR Training for Apprentice Electricians
Authors: Kraus Katrin , Berger Martin , Keller Thomas , Brucker-Kley Elke 
Published: February 2025

Context: This study uses a social space approach to investigate Virtual Reality (VR)-based workplace learning in the context of apprenticeship training in the electronics industry in Switzerland. It was one part of a project which developed a prototype VR environment that enables apprentices to practice testing an electrical installation in a virtual garage using VR headsets. The study uses a spatial theory perspective to understand how the apprentices use the VR environment to develop their vocational competence and how spaces of learning are created through this process.
Approach: The study applies a socio-spatial perspective to a triangulation of the results of a qualitative content analysis of structured interviews with 16 apprentices and their 11 trainers and a quantitative analysis of a close-ended apprentice survey questionnaire (N = 16).
Results: When a VR environment is used for workplace learning, spaces of learning are created from the interplay of four spatial dimensions: The regulation and practices of use of the VR environment, the locality of use, the educational potential of the VR environment, and a mental representation of the real workplace represented in the VR environment. The VR headset acts as a boundary object in the training relationship. Other important findings of the study are: Automated access to learning opportunities reduces pressure on the teaching-learning relationship; the haptic dimension of work is important for competence development; the VR environment enables personalized learning with unlimited opportunities for practice; the lack of variety in the operational scenario enables apprentices to focus on practicing and perfecting procedures but does not reflect the complexity of the real world.
Conclusion: Our socio-spatial analysis shows that when VR environments are used in workplace training the interplay of physical, mental, and virtual spatial dimensions leads to the emergence of learning spaces. The access to the VR environment, the location where it is used, and the active use of its learning features interact with the mental representations of the depicted environment. Spaces of learning created using a VR environment can complement traditional workplace training by facilitating the development of specific aspects of vocational competence.
Mapping the learning curves of deep learning networks
Authors: Jiang Yanru , Dale Rick 
Published: February 2025

There is an important challenge in systematically interpreting the internal representations of deep neural networks (DNNs). Existing techniques are often less effective for non-tabular tasks, or they primarily focus on qualitative, ad-hoc interpretations of models. In response, this study introduces a cognitive science-inspired, multi-dimensional quantification and visualization approach that captures two temporal dimensions of model learning: the “information-processing trajectory” and the “developmental trajectory.” The former represents the influence of incoming signals on an agent’s decision-making, while the latter conceptualizes the gradual improvement in an agent’s performance throughout its lifespan. Tracking the learning curves of DNNs enables researchers to explicitly identify the model appropriateness of a given task, examine the properties of the underlying input signals, and assess the model’s alignment (or lack thereof) with human learning experiences. To illustrate this method, we conducted 750 runs of simulations on two temporal tasks: gesture detection and sentence classification, showcasing its applicability across different types of deep learning tasks. Using four descriptive metrics to quantify the mapped learning curves—start, end - start, max, tmax—, we identified significant differences in learning patterns based on data sources and class distinctions (all p’s < .0001), the prominent role of spatial semantics in gesture learning, and larger information gains in language learning. We highlight three key insights gained from mapping learning curves: non-monotonic progress, pairwise comparisons, and domain distinctions. We reflect on the theoretical implications of this method for cognitive processing, language models and representations from multiple modalities.
Clinical features of puff adder envenoming: case series of Bitis arietans snakebites in Kenya and a scoping review of the literature
Authors: Tianyi Frank-Leonel , Ngari Cecilia , Wilkinson Mark , Parkurito Stanley , Chebet Elizabeth , Mumo Evans , Trelfa Anna , Otundo Denis , Crittenden Edouard , Kephah Geoffrey Maranga , Harrison Robert A. , Stienstra Ymkje , Casewell Nicholas R. , Lalloo David G. , Oluoch George O. 
Published: February 2025

Introduction
The puff adder (Bitis arietans) is a medically important snake species found across much of Africa, yet there is limited literature on the clinical features and pathophysiology of envenoming after a puff adder bite.

Methods
We conducted a case-series study to describe the clinical features of patients with puff adder bites who were treated in two primary healthcare facilities in Kenya and complemented our case-series with a scoping review of all published cases of puff adder envenoming that contained sufficient clinical details to highlight the major features.

Results
Between December 2020 and September 2021, 15 patients were admitted with a suspected puff adder bite (based on the patient’s description of the biting snake or confirmed in patients who brought the dead snake or a picture of the biting snake for identification) at the Chemolingot and Mwingi sub-county hospitals in Baringo and Kitui counties, central Kenya. Common local and systemic features on admission included pain (n=15, 100%), swelling (n=14, 93%), and haemorrhage (n=9, 60%). Coagulopathy (n=2, 13%), blistering (n=1, 8%) and shock (n=1, 8%) were less common. In addition, we conducted a literature review and identified 23 studies with detailed descriptions of the clinical features of puff adder envenoming from 37 patients. Local features were common and consistent across cases—swelling (100%, n=37) and pain (95%, n=35). Systemic features were less consistent, with 10 (27%) patients exhibiting hypotension on admission, 10 (27%) patients reporting a fever, and 13 (35%) developing anaemia. Some complications were more common in patients with bites by captive snakes (amputations), compared to patients with bites by wild snakes (hypotension). Snake identification was easier and more accurate after bites by captive snakes, but more challenging for patients bitten in community settings.

Conclusion
We combined clinical cases and a literature review to describe the common and less common clinical features of puff adder envenoming. Further clinical research incorporating serial laboratory assays of patients with definitively identified puff adder bites is crucial to better understand the pathophysiology of envenoming by this medically important snake species.
Modelling the impact of behavioural interventions during pandemics: A systematic review
Authors: Gebretekle Tsega Kahsay , Albers Casper 
Published: February 2025

Background
Many studies examined the impact of behavioural interventions on COVID-19 outcomes. We conducted a systematic review to gain insight into transmission models, following PRISMA 2020 guidelines. We included peer-reviewed studies published in English until December 31, 2022, focusing on human subjects, modelling, and examining behavioural interventions during COVID-19 using real data across diverse geographical regions.

Methods
We searched seven databases. We used descriptive analysis, network analysis for textual synthesis, and regression analysis to identify the relationship between the basic reproduction number R0 and various characteristics. From 30, 114 articles gathered, 15, 781 met the inclusion criteria. After deduplication, 7, 616 articles remained. The titles and abstracts screening reduced these to 1, 764 articles. Full-text screening reduced this to 270, and risk-of-bias assessment narrowed it to 245 articles. We employed combined criteria for risk of bias assessment, incorporating domains from ROBINS-I and principles for modeling.

Results
Primary outcomes focused on R0, COVID-19 cases, and transmission rates. The average R0 was 3.184. The vast majority of studies (90.3%) used compartmental models, particularly SEIR models. Social distancing, mask-wearing, and lockdowns were frequently analyzed interventions. Early and strict implementation of these interventions significantly reduced transmission rates. Risk of bias assessment revealed that 62.6% of studies were of low risk, 24.1% moderate, and 9.3% high risks. Common issues included transparency, attrition bias, and confounding factors.

Conclusions
This comprehensive review highlights the importance of behavioural interventions in reducing COVID-19 transmission and areas for improving future research transparency and robustness. Our risk of bias criteria offers an important framework for future systematic reviews in modeling studies of interventions. We recommend that future studies enhance transparency in reporting and address common biases such as attrition and confounding.
Research on the construction of a sustainable scientific research capability evaluation model for university teachers based on the T-S fuzzy neural network
Authors: Wen Jia , Zeng Pinhong 
Published: February 2025

Introduction
This study aims to enhance educational quality and academic standards by proposing a model based on critical research ability indicators to objectively evaluate the sustainable scientific research capabilities of university teachers.

Methods
Using T-S fuzzy neural network technology, we developed an evaluation model to measure the sustainability of university teachers’ research capabilities. We collected data from 126 university teachers, using 90 samples for training and 36 for testing, to ascertain the model’s applicability and accuracy.

Results
The T-S fuzzy neural network showcased exceptional learning efficiency and achieved a 98.15% accuracy rate in assessing the sustainable scientific research capabilities of university teachers, outperforming both Naive Bayes and BP neural networks in effectiveness.

Conclusion
The research successfully constructs a T-S fuzzy neural network-based evaluation model for assessing the sustainable scientific research capabilities of university teachers. With high accuracy and broad applicability, this model is an effective tool for objectively evaluating university teachers’ research capabilities, clearly achieving the study’s objective.
Family correlates of behavioral problems among adolescents in Rwanda
Authors: Harerimana Eugene , Muziki Jean d’Amour , Nshimyumuremyi Eric , Uwera Thaoussi , Nshimiyimana Augustin , Mutabaruka Jean 
Published: February 2025

Background
Globally, 20% of adolescents exhibit behavioral problems. Behavioral problems are associated with individual and environmental factors. However, little is known about the contribution of the nuclear family to the development of behavioral problems in adolescents from sub-Saharan Africa. This study aimed to explore family-based correlates influencing behavioral problems among adolescents in Rwanda.

Methods
With an institutional-based cross-sectional study design, a convenience sample of 158 participants {107 males and 51 females; Mean age (M) = 16.96, Standard Deviation (SD) = 1.86; age ranging from 13 to 23 years} was selected in secondary schools in the Nyarugenge district. Participants filled out Behavioral Problems Scale (BPS), Child and Adolescent Trauma Screen (CATS), University of California, Los Angeles Loneliness Scale (UCLA Loneliness Scale), Multidimensionality of Perceived Social Support Scale (MSPSS), Multidimensional Neglectful Behavior Scale (MNBS), and Paediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q) to record pertinent scores. Socio-demographic information was also collected. SPSS version 24 was used for statistical analysis.

Results
Females exhibited more behavioral problems than males. Child and adolescent trauma (β = 0.705, t = 8.21, p < .001) and neglect (β = 0.147 t = 2.15, p < .05) were two significant family correlates in our sample. Poor quality of life enjoyment and satisfaction, loneliness, and poor parental perceived social support were not identified as family-based factors that influence behavioral problems in our sample.

Conclusions
Results highlighted the importance of implementing family and community-based interventions to sustain family well-being, change parenting behaviors, and help children and adolescents adopt positive behaviors.
Digital assessment of walking ability: Validity and reliability of the automated figure-of-eight walk test in older adults
Authors: Kong Hyun-Ho , Shin Kwangsoo , Yang Dong-Seok , Gu Hye-Young , Joo Hyeon-Seong , Shon Hyun-Chul 
Published: February 2025

Background
The Figure-of-Eight Walk Test (F8WT) can assess straight- and curved-path walking ability, but the validity and reliability of automated measurement of the F8WT using digital device has not yet been studied. The aim of this study was to verify the validity (method comparison) and test-retest reliability of the automated FW8T (aFW8T) using a digital device based on image analysis by comparing the results of the aF8WT with those of the manual F8WT (mF8WT).

Methods
Community-dwelling older adults underwent the mF8WT performed by a physiotherapist and the aF8WT using the Digital Senior Fitness Test system. To verify the test-retest reliability, the aF8WT was administered again to a randomly selected group of participants one week after the baseline test. The intraclass correlation coefficient (ICC) and Pearson’s correlation analysis were used to verify the degree of agreement between the results of and correlation between the mF8WT and aF8WT, respectively. The 95% confidence interval (CI) of the limits of agreement (LoA) was obtained using Bland–Altman analysis.

Results
The analysis included 83 participants (mean age 71.6 ± 4.7 years). The participants’ mF8WT and aF8WT results were 29.1 ± 4.9 and 29.8 ± 4.9 seconds, respectively. Pearson’s correlation analysis showed a very strong correlation between the mF8WT and aF8WT results with r = 0.91 (p < 0.001), and the ICC between the mF8WT and aF8WT results was 0.95 (0.91–0.97), showing excellent agreement. The 95% CI of the LoA was ˗0.7 (˗4.8 to 3.3) seconds in the Bland–Altman analysis. In an analysis of the test-retest reliability of the aF8WT, participants’ aF8WT results were 30.9 ± 4.7 seconds (baseline) and 29.6 ± 4.9 seconds (retest), with an ICC of 0.94 (0.81–0.98, p < 0.001), indicating excellent reliability.

Conclusion
Automated measurement of the F8WT using a digital device showed excellent validity and reliability. The aF8WT can be used to assess and monitor the walking ability of community-dwelling older adults.
Bivariate multilevel modeling of antenatal care contacts and place of delivery among reproductive-aged women in Ethiopia
Authors: Belay Denekew Bitew , Mulat Seniat , Birhan Nigussie Adam , Chen Ding-Geng 
Published: February 2025

Background
Antenatal care (ANC) contacts, along with enhanced health facilities for delivery, are essential components of maternal and child healthcare, as these significantly contribute to both mothers and their newborn child’s health. Antennal care contacts primarily help women maintain normal pregnancies by detecting pre-existing conditions and preventing complications that may arise during childbirth. This study intended to determine possible factors that affect both ANC contact and place of delivery among women in Ethiopia.

Methods
The 2019 Ethiopian Mini Demographic and Health Survey data were used for this study. A total weighted sample of 3,926 women nested within 68 zones was used. The bivariate multilevel logistic regression model was utilized to assess the association between antenatal care contact and place of delivery and determinant factors among reproductive-aged women in Ethiopia.

Results
In this study, 57% and 47.5% of women had no ANC contacts and home delivery respectively. Similarly, about 36.73% of women delivered at home and didn’t utilize the recommended ANC contacts. Only 32.99% of women have both health facility delivery and at least four ANC contacts during their pregnancy. Women who reside in rural areas were 0.612 and 0.352 times less likely to have ANC and health facility delivery compared to women who reside in urban areas. Whereas, the estimated odds of women with higher education levels were 3.803 and 8.406 times the estimated odds of women with no education.

Conclusion
A high proportion of women are still delivering their new child at home and still don’t have at least four ANC contacts during their pregnancy. Women’s age, women education level, marital status, wealth status, sex of household head, place of residence, and region were significant predictors of antenatal care visits and place of delivery simultaneously in Ethiopia. Although the country tried to maximize these services, it still requires expansion of health facilities media campaigns, and women’s literacy to reduce maternal and newborn child mortality in Ethiopia.