bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do Patients With Insulin-Dependent and Non–Insulin-Dependent Diabetes Have Different Risks for Complications After Total Ankle Arthroplasty?
Authors: Qureshi Ibraheem , Lin Charles C. , Anil Utkarsh , Butler James J. , Walls Raymond J. 
Published: March 2024

Background: Patients with diabetes undergoing total ankle arthroplasty tend to be at greater risk for complications than those without diabetes. However, the effect of diabetes severity and how it impacts the risk for perioperative complications is less clear. The purpose of this study was to compare (1) complications, (2) length of hospital stay, and (3) readmissions within 30 days for total ankle arthroplasty (TAA) patients without diabetes, patients with non–insulin-dependent diabetes, and patients with insulin-dependent diabetes. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, a total of 1803 patients undergoing TAA between 2007 and 2019 were collected. The relationship between diabetes status (no diabetes [n = 1,589], insulin-dependent [n = 169], and non–insulin-dependent [n = 45]) and outcomes were compared. Multivariate linear regression models were used to adjust for confounding variables such as age, sex, race, body mass index, smoking, steroid use, hypertension, chronic obstructive pulmonary disease, anesthesia type, dyspnea, and outpatient status. Statistical significance was set at P <.05. Results: Insulin-dependent diabetes was an independent risk factor for increased odds of infection within 30 days (odds ratio 6.47, 95% CI 0.79-33.66; P = .043). Hospital length of stay was also increased in patients with non–insulin-dependent diabetes (β = 0.21, 95% CI 0.02-0.40; P = .031) and insulin-dependent diabetes (β = 0.40, 95% CI 0.04-0.76; P = .028). However, neither diabetic state demonstrated a statistically significant increase in readmissions or wound complications within 30 days. Conclusion: Patients with insulin-dependent diabetes included in this cohort were at increased risk of having an infection within 30 days after TAA. Additionally, patients with diabetes status had an increased hospital length of stay. These results can inform patients on their potential outcomes after total ankle arthroplasty based on their diabetes status.
Conventional vs Augmented Reality–Guided Lateral Calcaneal Lengthening Simulated in a Foot Bone Model
Authors: Polt Maksym , Viehöfer Arnd F. , Casari Fabio A. , Imhoff Florian B. , Wirth Stephan H. , Zimmermann Stefan M. 
Published: March 2024

Background: Acquired adult flatfoot deformity (AAFD) results in a loss of the medial longitudinal arch of the foot and dysfunction of the posteromedial soft tissues. Hintermann osteotomy (H-O) is often used to treat stage II AAFD. The procedure is challenging because of variations in the subtalar facets and limited intraoperative visibility. We aimed to assess the impact of augmented reality (AR) guidance on surgical accuracy and the facet violation rate. Methods: Sixty AR-guided and 60 conventional osteotomies were performed on foot bone models. For AR osteotomies, the ideal osteotomy plane was uploaded to a Microsoft HoloLens 1 headset and carried out in strict accordance with the superimposed holographic plane. The conventional osteotomies were performed relying solely on the anatomy of the calcaneal lateral column. The rate and severity of facet joint violation was measured, as well as accuracy of entry and exit points. The results were compared across AR-guided and conventional osteotomies, and between experienced and inexperienced surgeons. Results: Experienced surgeons showed significantly greater accuracy for the osteotomy entry point using AR, with the mean deviation of 1.6 ± 0.9 mm (95% CI 1.26, 1.93) compared to 2.3 ± 1.3 mm (95% CI 1.87, 2.79) in the conventional method ( P = .035). The inexperienced had improved accuracy, although not statistically significant ( P = .064), with the mean deviation of 2.0 ± 1.5 mm (95% CI 1.47, 2.55) using AR compared with 2.7 ± 1.6 mm (95% CI 2.18, 3.32) in the conventional method. AR helped the experienced surgeons avoid full violation of the posterior facet ( P = .011). Inexperienced surgeons had a higher rate of middle and posterior facet injury with both methods ( P = .005 and .021). Conclusion: Application of AR guidance during H-O was associated with improved accuracy for experienced surgeons, demonstrated by a better accuracy of the osteotomy entry point. More crucially, AR guidance prevented full violation of the posterior facet in the experienced group. Further research is needed to address limitations and test this technology on cadaver feet. Ultimately, the use of AR in surgery has the potential to improve patient and surgeon safety while minimizing radiation exposure. Clinical Relevance: Subtalar facet injury during lateral column lengthening osteotomy represents a real problem in clinical orthopaedic practice. Because of limited intraoperative visibility and variable anatomy, it is hard to resolve this issue with conventional means. This study suggests the potential of augmented reality to improve the osteotomy accuracy.
The Beginnings of Attention Deficit in a Dutch 18th Century Medical Treatise
Authors: van Kernebeek Michiel W. , Crunelle Cleo L. 
Published: March 2024

Objective: An early description, possibly the earliest, of attention deficit disorder in a 1753 Dutch medical book by Cornelius Kloekhof is presented. Method: The author of this text is briefly introduced and contextualized. The text is translated from Latin and afterwards, its impact on later scientific literature is discussed. Results and Conclusions: Kloekhofs description of attention deficit was one of the first and thoroughly inspired the subsequent literature, such as Adam Weikard, making this text an important moment in the rich history of ADHD.
Optimizing thermal insulation in building facades: An examination of human-environment dynamics in Nanjing city, Eastern Asia
Authors: Wang Dawei , Wang Panxiu , Ditta A. , Chen Gang 
Published: March 2024

The external building walls are significant in mitigating adverse weather conditions. Current research on the thermal insulation of exterior walls often overlooks crucial factors such as human comfort, seasonal changes and environmental dynamics. This study introduced a performance evaluation approach for external walls that considered the human thermal zone, annual air temperature and solar radiation. Taking Nanjing City as a case study, the thermal insulation performance of five distinct types of building exterior walls was investigated. The findings highlight the impact of various insulated wall systems on thermal insulation. While different insulated walls exhibited significant variations in effectiveness during extreme weather episodes, these variations were minor over the course of the year. Analysis revealed a spectrum of performance for insulated exterior walls, ranging from excellent to poor: Outer Insulated Wall > Inside Insulated Wall = Sandwich Insulated Wall = Self-Insulated Wall > Mortar-Insulated Wall. The disparity in thermal insulation performance amongst four wall types was minimal, with the mortar-insulated wall demonstrating the lowest performance. The highest temperature recorded for the mortar-insulated wall surpassed 32.2°C over 68 days. This research contributes insights into the nuanced performance of various insulated walls, paving the way for decision-making in climate resilience strategies.
Perceptions and digitalisation of outbreak management in UK health services: A cross-sectional survey
Authors: Wynn Matthew 
Published: March 2024

Background Global challenges arise from infectious diseases which represent significant challenges to the provision of healthcare, requiring efficient management procedures to limit transmission. Evaluating current outbreak management processes within UK healthcare services is essential for identifying strengths, weaknesses, and potential improvements. Objectives This study aimed to assess infection prevention and control (IPC) practitioners' access to outbreak management (OM) data. Secondary objectives involved determining IPC practitioners’ perceptions of outbreak management processes and the state of digitalisation of OM in the UK. Methods National cross-sectional survey data were collected to evaluate current outbreak management approaches. To supplement this, information requests were sent to the 10 largest teaching and research NHS hospital trusts in England. Findings The survey received 55 responses with 53 considered for analysis. Out of 10 NHS trusts, nine provided completed FOI responses, while one was unable to provide data. Discussion The study offers unique insights into prevailing outbreak management practices within UK health services. Although positive perceptions surround key outbreak management stages, concerns arise, including varying confidence levels in surveillance processes' robustness, efficacy of management interventions, and communication effectiveness. Conclusions The study highlights challenges with OM processes in the UK, including issues like poor surveillance and delayed outbreak detection. Positive practitioner perceptions contrast with concerns over data collection, follow-up, and limited digitalisation, relying on basic tools like Excel and Word, hindering retrospective learning.
Time in Range Analysis in Automated Insulin Delivery Era: Should Day and Nighttime Targets be the Same?
Authors: Maia Ariana , Subias Andujar David , Yuste Cristina , Albert Lara , Vilaverde Joana , Cardoso Maria Helena , Rigla Mercedes 
Published: March 2024

Introduction: Hybrid closed-loop systems (HCLS) use has shown that time in range (TIR) tends to improve more during the nighttime than during the day. This study aims to compare the conventional TIR, currently accepted as 70 to 180 mg/dL, with a proposed recalculated time in range (RTIR) considering a tighter glucose target of 70 to 140 mg/dL for the nighttime fasting period in T1DM patients under HCLS. Methods: We conducted a retrospective study that included adults patients receiving treatment with Tandem t:slim X2 Control-IQ. Daytime TIR was characterized as glucose values between 70 and 180 mg/dL during the 07:01 to 23:59 time frame. Nighttime fasting TIR was specified as glucose values from 70 to 140 mg/dL between 00:00 and 07:00. The combination of the daytime and nighttime fasting glucose targets results in an RTIR, which was compared with the conventional TIR for each patient. The 14 days Dexcom G6 CGM data were downloaded from Tidepool platform and analyzed. Results: We included 22 patients with a mean age of 49.7 years and diabetes duration of 24.7 years, who had been using automatic insulin delivery (AID) HCLS for a median of 305.3 days. We verified a mean conventional TIR of 68.7% vs a mean RTIR of 60.3%, with a mean percentage difference between these two metrics of −8.4%. A significant decrease in conventional TIR was verified when tighter glucose targets were considered during the nighttime period. No significant correlation was found between the percentage difference values and RTIR, even among the group of patients with the lowest conventional TIR. Conclusions: Currently, meeting the conventional TIR metrics may fall short of achieving an ideal level of glycemic control. An individualized strategy should be adopted until further data become available for a precise definition of optimal glucose targets.
Favorable Clinical Outcomes After Humeral Head Depressor Muscle Coactivation Training With EMG for Patients With Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial
Authors: Kararti Caner , Özüdoğru Anıl , Basat Hakkı Çağdaş , Özsoy İsmail 
Published: March 2024

Background: The coactivation (Co-A) of shoulder muscles that contribute to humeral head depression can lead to mechanical unloading of the subacromial structures during abduction and thus can be beneficial for patients with arthroscopic rotator cuff repair (ARCR). The present study aims to examine the effectiveness of humeral head depressor muscle Co-A (DM-Co-A) training on clinical outcomes in a sample of patients with ARCR. Hypothesis: We hypothesized that DM-Co-A training with medioinferior vector during glenohumeral exercises can improve clinical results in the rehabilitation of ARCR. Study Design: Randomized controlled single-blind study. Level of Evidence: Level 1B. Methods: A total of 27 patients who underwent ARCR after a medium-sized rotator cuff tear and completed their Phase 1 training with ≥80% compliance were included. Together with 14 weeks of conservative treatment (6 weeks of Phase 2 training and 8 weeks of Phase 3 training), synchronized “DM-Co-A Training” was applied to the treatment group with an electromyography (EMG) biofeedback (EMG-BF) device. Patients in the treatment group were asked to voluntarily activate the humeral head depressor muscles guided by visual and auditory feedback of the EMG-BF device during the Phase 2 and Phase 3 conservative treatment exercises performed by the control group. Demographic characteristics of the participants were recorded. Visual analog scale and universal goniometer were used to assess pre- and posttreatment pain severity and joint range of motion, respectively. The Disabilities of Arm, Shoulder and Hand Questionnaire, Revised Oxford Shoulder Score, Modified Constant-Murley Shoulder Score, and the Western-Ontario Rotator Cuff Index were used to assess functionality. Results: There was a clinically meaningful improvement in pain severity, active ROM excluding internal rotation, and functionality in the treatment group compared with the control group ( P < 0.05). Conclusion: A 14-week duration DM-Co-A with EMG may be beneficial in the postoperative rehabilitation of patients after ARCR.
Arthroscopic Implantation of a Cell-Free Bilayer Scaffold for the Treatment of Knee Chondral Lesions: A 2-Year Prospective Study
Authors: Gudas Rimtautas , Staškūnas Mantas , Mačiulaitis Justinas , Gudaitė Emilė , Aleknaite-Dambrauskiene Ieva 
Published: March 2024

Objective The main objective of this study is to assess the safety and clinical efficacy of a cell-free bilayer scaffold (MaioRegen Chondro+ by Fin-Ceramica) in patients affected by chondral knee lesions of different origin and localization. Design Thirty-one patients with focal chondral lesions of the knee were arthroscopically treated with MaioRegen Chondro+. All patients were prospectively evaluated for a minimum of 2 years using the International Knee Documentation Committee (IKDC) Questionnaire and the Tegner Activity Scale. Cartilage repair was assessed based on the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score at 12 months. Follow-up at 36 months was available for 25 out of 31 patients. Results From baseline to 6-, 12-, and 24-month follow-up, IKDC score significantly improved by 19.5 ± 7.27 (95% confidence interval [CI]: 16.9-22.2, P < 0.001), 30.8 ± 7.63 (95% CI: 28.0-33.6, P < 0.001), and 36.2 ± 8.00 points (95% CI: 33.3-39.2, P < 0.001), respectively. Tegner scores documented a substantial clinical improvement as early as 12 months after surgery (change of −0.6 ± 0.62; 95% CI: −0.8 to −0.4, P < 0.001), reaching the preinjury values. There was a statistically significant increase in the MOCART scores ( P < 0.001). Comparable results were observed regardless of preintervention demographic characteristics, lesion site or etiology, or the number of treated sites. Notably, the significant clinical benefit was maintained in a subset of patients who reached 3-year follow-up. No adverse events were reported in the entire analyzed population. Conclusion MaioRegen Chondro+ is a safe and effective device for the treatment of knee chondral lesions, enabling a significant clinical improvement for at least 2 years.
Hydrogel-Based Matrix-Associated Autologous Chondrocyte Implantation Shows Greater Substantial Clinical Benefit at 24 Months Follow-Up than Microfracture: A Propensity Score Matched-Pair Analysis
Authors: Gaissmaier Christoph , Angele Peter , Spiro Robert C. , Köhler Annette , Kirner Alexandra , Niemeyer Philipp 
Published: March 2024

Objective To compare substantial clinical benefit (SCB) of a hydrogel-based, matrix-associated autologous chondrocyte implantation (M-ACI) method versus microfracture (MFx) in the treatment of knee cartilage defects. Design Propensity score matched-pair analysis, using the MFx control group of a phase III study as comparator for M-ACI treatment in a single-arm phase III study, resulting in 144 patients in the matched-pair set. Results Groups were comparable regarding baseline Knee Injury and Osteoarthritis Outcome Score (KOOS), sex, age, body mass index, symptom duration, smoking status, and previous knee surgeries. Defect sizes in the M-ACI group were significantly larger than in the MFx group (6.4 cm2 vs. 3.7 cm2). Other differences concerned location, number, and etiology of defects that were not considered to influence the interpretation of results. At 24 months, significantly more patients in the M-ACI group achieved SCB in KOOS pain (72.2% vs. 48.6%; P = 0.0108), symptoms (84.7% vs. 61.1%, P = 0.0039), sports/recreation (84.7% vs. 56.9%, P = 0.0008), and quality of life (QoL; 72.2% vs. 44.4%, P = 0.0014). The SCBs for KOOS activities in daily living and International Knee Documentation Committee score were higher for M-ACI but not significantly different from MFx. The SCB rates consistently favored M-ACI from 3 months onward. The highest improvements from baseline at 24 months in patients with SCB were observed for KOOS sports/rec. (M-ACI: 60.8 points, MFx: 55.9 points) and QoL (M-ACI: 58.1, MFx: 57.4). Conclusion Hydrogel-based M-ACI demonstrated superior SCB in KOOS pain, symptoms, sports/rec., and QoL compared with MFx in patients with knee cartilage defects through 2 years follow-up.
“Pap smear horror stories, self loathing, feeling like I was less of a woman”: A qualitative content analysis of an online vaginismus forum
Authors: Mettela Swathi , Chima Melissa , Costigan Heather , Stuckey-Peyrot Heather , Baweja Ritika , Riley Kristin 
Published: March 2024

Objective: To understand what concerns and experiences people with vaginismus share online anonymously but may not share with clinicians. Methods: Two researchers compiled all comments and posts made from November 2019 to April 2020 within an online vaginismus forum ( n = 311) for content analysis. Two researchers separately performed inductive coding, categorized quotes into overarching categories and codes, and resolved inconsistencies with a third-party adjudicator. Results: Our analysis highlighted three key categories: “psychosocial concerns” (34%), “discussion of pain” (33%), and “lack of access to vulvovaginal healthcare” (34%). The category “psychosocial concerns” comprised of the codes “shame and/or social isolation” (12%), “mental health comorbidities” (9%), “fear of partner separation” (7%), “cultural/religious stigma” (2%), “partner separation” (2%), and “fear of infertility or vaginal delivery” (1%). The category “discussion of pain” comprised of the codes “successful therapies” (16%), “sexual pain” (9%), “nonsexual pain” (6%), and “unsuccessful therapies” (2%). The category “lack of access to vulvovaginal healthcare” comprised of the codes “lack of standardized therapy guidelines” (8%), “self diagnosis” (7%), “fertility testing and/or treatments limited by vaginismus” (5%), “clinicians dismissing symptoms” (4%), “inadequate clinician knowledge about vaginismus” (2%), “inadequate health and sex education in schools” (2%), “geographical barriers” (2%), and “COVID-19” (2%). Conclusion: This novel qualitative study of an online vaginismus forum highlights the need for a patient-centered approach to inform future research, medical education, and clinical practice. Our findings suggest we reevaluate the standard of care for patients with vaginismus and expand on existing knowledge of the impact of sexual health stigma on social and health outcomes.
Do Lucky People Reciprocate More? The Effect of Outcome Bias on Trustworthiness
Authors: Muchtar Pyan Amin 
Published: March 2024

This study investigates how reciprocity works in a simple trust game when the subjects are framed as either lucky or unlucky. We induce luckiness perception to the second mover by introducing uncertainty with a different combination of possible multipliers, allowing us to observe the effect of outcome bias on trustworthiness while controlling for the wealth effect. We do not find a significantly different level of trustworthiness between lucky second movers and unlucky second movers. The result suggests the null effect of outcome bias on reciprocal behaviour. JEL Classifications: C91, D01, D63, D91
The Cost-Effectiveness of Smoking Cessation Programs for Prevention of Wound Complications Following Total Ankle Arthroplasty: A Break-Even Analysis
Authors: Kim Andrew H. , ElNemer William , Cartagena-Reyes Miguel A. , Marrache Majd , Thompson John M. , Aiyer Amiethab A. 
Published: March 2024

Background: Tobacco use significantly increases the rate of wound complications in patients undergoing total ankle arthroplasty (TAA). Preoperative optimization through smoking cessation programs significantly minimizes the rate of infection and improves wound healing in arthroplasty procedures. Despite its utility, minimal research has examined the cost-effectiveness of preoperative smoking cessation programs to reduce the need for extracapsular irrigation and debridement (I&D) due to wound complications following TAA. Methods: The cost of an I&D procedure was obtained from our institution’s purchasing records. Baseline wound complication rates among tobacco users who have undergone TAA and smoking cessation program cost were obtained from literature. A break-even economic analysis was performed to determine the absolute risk reduction (ARR) to economically justify the implementation of preoperative smoking cessation programs. Different smoking cessation program and I&D costs were tested to account for variations in each factor. ARR was then used to calculate the number needed to treat (NNT) to prevent a single I&D while remaining cost-effective. Results: Smoking cessation programs were determined to be economically justified if it prevents 1 I&D surgery out of 8 TAAs among tobacco users (ARR = 12.66%) in the early postoperative period (<30 days). ARR was the same at the literature high (27.3%) and weighted literature average (13.3%) complication rates when using the cost of I&D surgery at our institution ($1757.13) and the literature value for a smoking cessation program ($222.45). Cost-effectiveness was maintained with higher I&D surgery costs and lower costs of smoking cessation treatment. Conclusion: Our model’s input data suggest that the routine use of smoking cessation programs among tobacco users undergoing TAA is cost-effective for risk reduction of I&D surgery in the early postoperative period. This intervention was also found to be economically warranted with higher I&D costs and lower smoking cessation program costs than those found in the literature and at our institution. Level of Evidence: Level III, economic and decision analysis.