bluuebunny/crossref_metadata_2025_split huggingface dataset:
If We Build It, Why They Do Not Come? An American College of Surgeons National Quality Improvement Collaborative to Understand Barriers to Completion of Cancer Treatment
Authors: Janczewski Lauren M. , Yang Anthony D. , Reilly Eileen , Chan Kelley , Coates Tashae , Scarlett Shayla , Hedlund Susan , Snyder Rebecca A. , Haffty Bruce , Shelton Charles , Kirstein Laurie J. 
Published: February 2025

PURPOSE
Many patients face barriers to cancer care, leading to disparities in cancer-specific outcomes. Specifically, missing multiple radiation treatments can be associated with increased locoregional recurrence. We sought to assess the frequency and reasons for missed radiotherapy among accredited cancer programs participating in a national quality improvement (QI) collaborative addressing barriers to care.

METHODS
The Breaking Barriers National QI Collaborative conducted through the American College of Surgeons Cancer Programs enrolled 342 accredited cancer programs, prospectively recording patients scheduled for a 15-45-day course of radiotherapy over five separate, 60-day data collection periods (March-December 2023). Programs identified those who missed ≥three treatments, referred to as at risk of worse outcomes, and queried reasons for missed radiotherapy. Kruskal-Wallis tests assessed differences in rates of missed treatments.

RESULTS

In total, 332 programs (97.1%) identified at-risk patients, totaling 5,221 patients who missed ≥three treatments. The median percentage of at-risk patients per program was 9.4% (IQR, 4.5-16.5). Programs located in the Northeast (median, 11.3% [IQR, 5.4-17.3]) had the highest proportion of at-risk patients (
P
= .014). Patients with rectal (13.0%) and gynecologic (11.4%) cancers were most frequently at risk (
P
< .001). Overall, 91.0% of hospitals reported missed radiation treatments due to illness unrelated to treatment, 71.7% due to transportation, 54.2% due to conflicting appointments, and 53.0% due to no longer wishing to pursue treatment.

CONCLUSION
Barriers to completing radiotherapy are prevalent among accredited cancer programs nationwide. Future work developing interventions in response to identified barriers in this national QI collaborative may be scalable to other areas of cancer care to improve outcomes.
Creation of a flat universe-antiuniverse pair from nothing
Authors: Kumar Naman 
Published: February 2025

Abstract
In this letter, we show that a universe-antiuniverse (U/AU) pair with zero spatial curvature ($k=0$), consistent with observations, can emerge from "nothing". This provides a novel approach towards the creation of the universe other than Vilenkin's tunnelling and Hartle-Hawking no boundary proposal. The idea discussed in the paper can solve problems associated with these two proposals, namely scalar perturbations (Vilenkin) and a small number of inflationary $e$-folds (Hartle-Hawking). We also discuss various cosmological implications of this idea.
Physical Work in Humid Heat Impairs Postural Balance during Simulated Construction Tasks at Height
Authors: Tan Beverly Wei Lin , Alhadad Sharifah Badriyah , Tan Gerald Zheng Yang , Sze Pearl Tan Min , Lemke Bruno , Lee Jason Kai Wei 
Published: February 2025

ABSTRACT

Purpose
Occupational heat strain can impair construction workers’ motor and cognitive functions, potentially leading to accidents, injuries and lowered productivity. We examined the effects of physical work under various warm and humid tropical conditions on performance in virtual reality (VR)-based construction tasks.

Methods
Eighteen healthy men (age: 29 ± 5 years) completed three randomised, counterbalanced experimental trials comprising ~2.5 h of exposure to wet-bulb globe temperatures of 24.6 ± 0.2 °C (COOL), 28.1 ± 0.3 °C (WARM) and 32.4 ± 0.3 °C (HOT), representing Singapore’s current (COOL and WARM) and projected (HOT) conditions. Participants performed three 30-min bouts of treadmill walking at fixed metabolic heat productions representing light (EX1: 250 W), moderate (EX2: 350 W) and heavy (EX3: 450 W) workloads, each separated by completion of a battery of VR-based construction tasks (welding and plank-walking at height). Task speed and accuracy, postural sway and gait were recorded during the VR tasks, while body core (Tc) and mean skin temperatures (Tsk), and heart rate (HR) were recorded continuously.

Results
Post-trial Tc was higher in HOT (38.6 ± 0.4 °C) compared with WARM (38.1 ± 0.3 °C; P < 0.001) and COOL (37.9 ± 0.3 °C; P < 0.001), while mean Tsk (P < 0.001) and HR (P < 0.001) differed between all conditions (HOT>WARM>COOL). Task speed and accuracy during welding and plank-walking were similar between conditions (all P > 0.05). However, postural sway velocity during welding increased (by 2.08 ± 2.5 mm.s-1; P < 0.05) from baseline to post-trial in HOT but not in WARM or COOL (both P > 0.05).

Conclusions
Although task performance was maintained across environments, postural balance during an attention-demanding task (welding) was impaired following physical work in Singapore’s projected environmental conditions, which could increase the risk of potentially fatal accidents and injuries (e.g., falling from height). Effective workplace interventions are needed to protect workers’ health, safety and productivity against future warming.
Assessment of Air Quality of Karachi on Real-Time Rainfall Data through GIS Analysis
Authors: Kausar Dr. Anila , Khan Dr. Owais Iqbal , Ejaz Ms. Fizza , Lahori Dr. Altaf Hussain , Ambreen Dr. Romana , Hassan Dr. Mehdi 
Published: February 2025

Karachi is a metropolitan city lying on the coastline of the Arabian Sea facing the effects of climate change. Weather patterns are changing and in a transition stage as the world is facing weather variability issues, due to climate change. The existing study was performed based on the real-time rainfall in Karachi held on January 29, 30, February 2, 3, and 4th, 2024. January and February are the month of winter in Pakistan and, in the winter, such continuous rainfall spells have never been witnessed by Karachiites for a long time specifically in February rainfall has never been witnessed on such a large scale. Due to such a long dry and cold season, Karachiites used to face health problems related to Air Quality in winter. Such heavy rain changes the environmental conditions in the winter consequently people feel fresh due to clean air. Pollutants i.e., AQI, PM2.5, and SO2 have been monitored on selected days of 36 locations in Karachi. Interpolation techniques have been used in mapping. Results revealed that before the rain, in the air, all observed pollutants existed in large quantities i.e., AQI, PM2.5, and, SO2 ranged from 158.1-310.5, 70.1-260.5 µg/m³, and 113.5-246.9 ppbV respectively declines dramatically i.e., 69.05- 111.9, 48.3-136.8 5 µg/m³, and 50.04-99.9 ppbV after the rain. Results are analyzed through GIS analysis and further tested through Anova statistical analysis. Tree plantation and enhancing green cover can somehow reduce the contamination level of air. Therefore, instead of waiting for rain which does not usually happen in winter. Karachiites should participate in tree plantation activities/green infrastructure to clean the environment and reduce of health issues of Karachiites.
Advantages of the single-center model in domino transplant processes: Operational planning and management experience
Authors: Huseynov Amil , Kuşlu Çicek Sevim Nuran , Tuncer Murat 
Published: February 2025

BACKGROUND
Kidney transplantation is one of the most effective treatments for patients with end-stage renal disease. However, many regions face low deceased donor rates and limited ABO-compatible transplant availability, which increases reliance on living donors. These regional challenges necessitate the implementation of kidney paired donation (KPD) programs to overcome incompatibilities such as ABO mismatch or positive cross-matching, even when suitable and willing donors are available.
AIM
To evaluate the effectiveness of a single-center domino KPD model in both operational planning and clinical management processes and to assess its impact on clinical outcomes.
METHODS
Between April 2020 and January 2024, we retrospectively evaluated patients enrolled in our center’s domino kidney transplantation program. Donor-recipient pairs unable to proceed due to ABO incompatibility or positive cross-matching with their own living donors were included. Donors and recipients were assessed based on blood group compatibility, HLA tissue typing, and negative cross-match results. A specialized computer algorithm grouped patients into three-way, four-way, and five-way chains. All surgical procedures were performed on the same day at a single center.
RESULTS
A total of 169 kidney transplants were performed, forming 52 domino chains. These domino KPD transplants accounted for a notable proportion of our center’s overall transplant activity, which included both living donor kidney transplants and deceased donor transplants. Among these chains, the primary reasons for participation were ABO incompatibility (74%), positive cross-matching (10%), and the desire to improve HLA mismatch (16%). Improved HLA mismatch profiles and high graft survival (96% at 1 year, 92% at 3 years) and patient survival (98% at 1 year, 94% at 3 years) rates were observed, as well as low acute rejection episodes.
CONCLUSION
The single-center domino KPD model enhanced transplant opportunities for incompatible donor-recipient pairs while maintaining excellent clinical outcomes. By providing a framework that addresses regional challenges, improves operational efficiency, and optimizes clinical management, this model offers actionable insights to reduce waiting lists and improve patient outcomes.
DIABETIC MIDFOOT CHARCOT: WHEN TO OPERATE, A STAGED APPROACH TO DECISION MAKING
Authors: Tiruveedhula Madhu 
Published: February 2025

IntroductionDiabetic midfoot Charcot neuroarthropathy (CN) is a progressive condition which presents as a hot swollen foot to a rocker bottom deformity with ulcer and resultant osteomyelitis. Literature report of a subjective indications for surgery generally after a failed prolonged immobilization in a total contact cast. The aim of this study is to define objective indications of progression of midfoot CN and interventions at each stage of the disease.Patients and MethodsNotes and radiographs of consecutive patients presented to Basildon Diabetic foot unit since 2018 with midfoot CN were reviewed. Inclusion criteria were all patients with midfoot CN and were followed for a minimum 12 months with radiographs. Exclusion criteria were patients lost to follow before 12 months or where inadequate radiographs were available. Patients with ankle/ subtalar Charcot were excluded.ResultsA total of 182 patients with midfoot CN were seen since 2018, of these 88 patients underwent surgical reconstruction. 3 radiographs features: lateral Mearys angle, calcaneal pitch and cuboid height were noted to be diagnostic for diagnosis and monitoring of the progression of the midfoot CN. 5 stages of disease were described (Basildon classification) with stage 1 and 2 were managed with percutaneous tendo-Achilles lengthening (TAL). Progression of above radiological parameters is an indication for surgical stabilisation. Lateral column involvement is indicated by the drop in cuboid height which rapidly progresses to ulcer formation.ConclusionMotor neuropathy induced stiff and contracted muscles results in progressive midfoot CN. The radiological markers described are shown to be reliable and reproducible indices for the progression of the disease process. In-clinic procedures such as TAL has shown to slow or revert the earlier stages of disease, however worsening of these markers are reliable guide for indication for surgical stabilisation.”
CUSTOM 3D-PRINTED IMPLANTS FOR CRITICAL-SIZED BONE DEFECTS IN FOOT AND ANKLE SURGERY: A MULTICENTRE COLLABORATIVE STUDY
Authors: Mangwani Jitendra , See Abbas , Houchen-Wolloff Linzy 
Published: February 2025

IntroductionThe treatment of critical-sized bone defects in foot and ankle surgery remains challenging. Traditional methods, such as bone transport, bulk allograft, vascularized bone graft, and Masquelet procedures carry risks including multiple surgeries, donor site morbidity, infection, and non-union. Recently, custom 3D-printed implants have emerged, offering improved anatomical compatibility, eliminating the need for tissue harvesting, and often requiring only a single operation. This study aims to present the largest UK series of custom 3D-printed implants in foot and ankle surgery.MethodsA retrospective multicentre collaborative study was conducted in 10 NHS Trusts. Demographic, surgical and radiographic variables were recorded including: age; sex; side; type of operation; complications; and postop imaging at 6 weeks, 3 months, 6 months and 12 months. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages.ResultsData was collected on a total of 34 patients. The mean age of patients was 54 years (range 29 to 83). 68% of patients were men. Avascular necrosis was the most common indication for surgery (35%) followed by trauma (21%), total ankle replacement failure (21%), infection (12%), Charcot arthropathy (6%) and AVN and infection (3%). The most common operation performed was a fusion augmented with a truss (44%) and 91% of patients had a combination of regional and general anaesthetic. All patients had an ASA grade of less than 4. Of the patients that had follow-up imaging, the implants were reported intact by 94% at 6 weeks, 78% at 3 months, 68% at 6 months and 67% at 12 months.DiscussionThis is the largest case series of custom-made foot and ankle implants in the UK to date. The clinical and radiographic outcomes at one year Follow-up are satisfactory. Further work is required to assess long term implant survivorship.
A TEN-YEAR FOLLOW-UP OF ARTHROEREISIS SCREWS IN ADULT FLAT FOOT RECONSTRUCTION
Authors: Bhamra Jagmeet , Fell Adam , Hashem Mohamed , Clark Callum 
Published: February 2025

IntroductionThe use of an arthroereisis screw is well described in the paediatric population for the correction of flexible flat feet. There are no long-term studies of its use in adults. We performed a functional and radiographic evaluation of a single centre, single surgeon series following the use of a subtalar arthroereisis screw, to augment reconstruction in adult patients with acquired adult flat foot deformity secondary to spring ligament / tibialis posterior tendon failure.MethodsWe performed a retrospective review of 40 consecutive feet with stage 2 PTTI that underwent flexor digitorum longus transfer, reefing of the spring ligament, translational medialising calcanaeal osteotomy and augmentation with an arthroereisis screw (Kalix, Integra; 22 feet or ProStop, Arthrex; 3 feet), between 2005 and 2021. All arthroereisis screws were electively removed at 6 months. Radiographic values were assessed pre- and post-operatively at 1-year with functional results both at 1-year and average 10-year follow-up.ResultsThe mean age of patients at surgery was 60 years (range 44–77 years). There was a significant improvement p<0.05) in radiographic parameters (calcaneal pitch, Mearys angle, medial column height, talus to 1st and 2nd metatarsal angle and talonavicular coverage). There were no re-operations. Manchester Oxford Foot Questionnaire, EQ-5D and VAS scores at an average of 10.6 years for pain were reported as 2.3 (range 0–64, Likert scale), 0.94 (range -0.59–1) and 0.2 (0–10), respectively. Health TODAY averaged at 91.4%.ConclusionWe conclude that the use of an arthroereisis screw is a promising adjunct to conventional reconstruction in adult PTTI that protects the spring ligament repair and tendon transfer during the initial healing time of the soft tissues. Excellent radiological and functional results were obtained in our cohort with high levels of patient satisfaction at long-term follow-up.
Role of the platelet-lymphocyte ratio as a prognostic indicator in patients with intracranial hemorrhage: A systematic review and meta-analysis
Authors: Yuan Xiang , Zhang Sen , Wan Jun , Yang Jingxian , Deng Yongjie , Feng Yuning , Bao Qingyu , Liu Xin , Shen Yihong , Chen Xian , Zeng Jingyao , Zhang Yu 
Published: February 2025

Background
The prognostic value of platelet-lymphocyte ratio (PLR) in ischemic stroke had been investigated in previous studies. However, the results of studies on PLR in patients with intracranial hemorrhage (ICH) are inconsistent. We aimed to conduct a meta-analysis to determine the prognostic value of PLR in predicting functional outcome and mortality in patients with ICH.

Methods
We searched the databases of PubMed, Embase, the Cochrane Library, and CNKI for relevant studies up to 10th June 2024. The Newcastle Ottawa Quality Assessment Scale (NOS) was applied to evaluate the quality of the included studies. We calculated the pooled odds ratios (OR) with 95% confidence intervals (CI) between PLR and both functional outcome (as measured by the modified Rankin Scale, mRS) as well as mortality. Poor functional outcomes were defined as mRS > 2.

Results
A total of 6 studies with 2992 patients were included. The random effects meta-analysis demonstrated that elevated PLR exhibited an association with poor functional outcome in patients with ICH (OR = 1.69; 95% CI [1.39–2.07]; P<0.0001; I2 = 24%). Similarly, elevated PLR was associated with mortality in patients with ICH (OR = 1.65; 95% CI [1.12–2.43]; P = 0.01; I2 = 31%).

Conclusion
This study suggested that elevated PLR was significantly associated with poor functional outcome (mRS>2) and increased mortality, indicating that elevated PLR could serve as a reliable a prognostic factor for unfavorable clinical outcomes in patients with ICH. It is advisable to conduct extensive prospective investigations across diverse ethnic backgrounds to verify the accuracy of this correlation prior to its utilization in clinical settings.
Implementation research to develop an optimized delivery model for effective implementation of evidence-based interventions to reduce stillbirth in India: A study protocol
Authors: Pathak Gadapani Barsha , Mukherjee Reema , Kandpal Vani , Agarwal Abhishek , Mony Prem , Washington Maryann , Mazumder Sarmila , Arora N. K. 
Published: February 2025

Background
Stillbirth remains a public health concern in India, despite a decrease in reported rates. Inconsistent data collection hampers clear understanding the burden of stillbirth, and interventions for its reduction are scattered across various national programs. This research aims to explore effective strategies to improve the delivery and uptake of high-quality antenatal and intrapartum care services which have the potential to reduce stillbirth rates in various states of India.

Methods
This mixed-method, multi-site study in India will be conducted in three phases: Phase 1: Formative Phase; Phase 2: Development of a Comprehensive Package for Stillbirth Reduction and Optimization of the implementation model and Phase 3: Scale-up of comprehensive package and monitoring of optimized strategy/model. Participants will include pregnant women, women who have recently delivered, family members, respectable community members, healthcare workers and staff, state and district health authorities. The effectiveness of intervention package and optimized implementation model in reducing stillbirth will be evaluated using a pre-post quasi-experimental design. The burden of stillbirth will be estimated through community survey, recording pregnancy outcomes for women who have delivered within the past one year. Various methods including semi-structured questionnaires, verbal autopsies, and in-depth qualitative interview guides, review of clinical case sheets will be used to assess the causes of stillbirth. Additionally, government health facilities will be assessed and strengthened over study period. This study will utilize implementation science theories, models, and frameworks (TMF), including the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators, and the evaluative TMF of RE-AIM (Reach Effectiveness Adoption Implementation and maintenance) to monitor the optimized model. The primary outcome is the development of a scalable, sustainable model of intervention package and delivery strategies to reduce stillbirths. The secondary outcome includes a robust estimation of burden, timing, and risk factors of stillbirths across all study sites. Certain sites will conduct an economic evaluation to assess the incremental cost of implementing comprehensive packages using the optimized implementation model.

Discussion
This innovative study addresses a critical public health gap in context of stillbirth reduction in India. Integrating proven interventions with real-world implementation challenges across diverse regions, this project aims to develop a comprehensive and replicable model. If successful, this model can significantly improve stillbirth prevention in low-resource settings.

Trial registration
ClinicalTrials.gov CTRI-2024/07/069796.
Effects of outdoor play on body composition and physical performance in children: the Yamanashi Adjunct study of the Japan Environment and Children’s Study
Authors: Wako Masanori , Fujimaki Taro , Ichikawa Jiro , Koyama Kensuke , Shinohara Ryoji , Otawa Sanae , Kobayashi Anna , Horiuchi Sayaka , Kushima Megumi , Yamagata Zentaro , Haro Hirotaka ,   on behalf of the Yamanashi Adjunct Study of the Japan Environment and Children’s Study Group
Published: February 2025

Introduction
Childhood is a pivotal developmental stage that substantially affects lifelong habits. Recent research has emphasized the vital role of outdoor play in children’s mental and physical well-being. Despite the World Health Organization recommending 1 hour of daily physical activity for children, a knowledge gap exists regarding the specific link between children’s physical performance, body composition (evaluated through bioelectrical impedance analysis [BIA]), and outdoor play habits.

Methods
Utilizing data from the Japan Environment and Children’s Study, a national birth cohort study, this study included 494 eight-year-old participants. The assessment included body composition (height, weight, body fat percentage, predicted muscle weight, and phase angle using BIA) and physical performance (50 m sprint, standing long jump, 20 m shuttle run, and handgrip strength). Parents provided information on children’s outdoor playtime.

Results
The group with more outdoor play demonstrated superior sports test results, particularly among boys. Girls engaged in increased outdoor play exhibited higher predicted muscle weights, whereas boys showed greater phase angles in the lower limbs. Handgrip strength correlated with phase angle and predicted muscle weight. Notably, the association between body composition and sports test results was more pronounced in boys than in girls, with phase angles exhibiting stronger links to running and jumping.

Conclusion
This pioneering study explored the relationship between outdoor play, body composition, and physical performance in children. Outdoor play positively correlated with improved sports performance, revealing sex disparities in body composition changes. Unlike previous studies focusing on general physical development, this study scrutinized specific physical functions, uncovering correlations between phase angle and muscle quality. Findings suggest that outdoor play positively impacts muscle quality, especially in boys, contributing to enhanced physical performance in children. Understanding these effects on body composition and physical activity is imperative for promoting children’s health.