bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of return-of-service schemes for human resources for health retention: a retrospective cohort study of four Southern African countries
Authors: Mabunda Sikhumbuzo A , Durbach Andrea , Chitha Wezile W , Phiri Hawor , Phalane Mahlane , Moaletsane Oduetse , Angell Blake , Joshi Rohina 
Published: October 2023

BackgroundGovernments use return-of-service (RoS) schemes to train, employ and retain health professionals in the public sector. We determined the effectiveness of RoS schemes in four Southern African countries.MethodsThis retrospective cohort study used databases of RoS beneficiaries from South Africa, Botswana, Eswatini and Lesotho. We ascertained the period of funding for beneficiaries between 2000 and 2010, study programme, selection criteria, study country and if they completed their studies. Records were sought to track beneficiaries’ service and fulfilment of their RoS obligations. Data were sought at the provincial level in South Africa and nationally for the other three countries. Binomial logistics regression and Kaplan-Meier survival estimates were used to determine risk factors and predictors of defaulting.ResultsMost beneficiary enrolment (eg, decision on why they were funded, socioeconomic status, disability status, high school results) and service data (eg, health facilities where they worked, how long they worked at each health facility, movement between health facilities) were not available. A total of 5616 beneficiaries were drawn from the four countries’ databases. Of those with full data available, 21.7% (229/1056) were retained/served beyond their obligatory period and 20.2% (213/1056) were still serving. A total of 24.3% (95% CI: 21.7% to 26.9%; n=257/1056) of beneficiaries in the final subanalysis of two South African provinces fulfilled their contractual obligations. Only 32.2% (277/861) of beneficiaries undertook internship within their funding provinces. Governments needed to fund six beneficiaries to have one beneficiary complete their contractual obligation if they undertook internship outside their province.ConclusionRecord keeping in all countries was poor, hampering the effectiveness of RoS schemes. Of the units with full data available, the retention rate was below 25%, and internship being undertaken outside the funding province was associated with higher defaulter rates, calling for a policy overhaul.
Evaluation of the efficacy and safety of MRI-guided focused ultrasound (MRgFUS) for focal hand dystonia: study protocol for an open-label non-randomised clinical trial
Authors: Maamary Joel , Peters James , Kyle Kain , Ruge Diane , Jonker Benjamin , Barnett Yael , Tisch Stephen 
Published: October 2023

IntroductionMRI-guided focused ultrasound (MRgFUS) thalamotomy provides an exciting development in the field of minimally invasive stereotactic neurosurgery. Current treatment options for focal hand dystonia are limited, with potentially more effective invasive stereotactic interventions, such as deep brain stimulation or lesional therapies, rarely used. The advent of minimally invasive brain lesioning provides a potentially safe and effective treatment approach with a recent pilot study establishing MRgFUS Vo-complex thalamotomy as an effective treatment option for focal hand dystonia. In this study, we undertake an open-label clinical trial to further establish MRgFUS Vo-complex thalamotomy as an effective treatment for focal hand dystonia with greater attention paid to potential motor costs associated with this treatment. To elucidate pathophysiology of dystonia and treatment mechanisms, neurophysiological and MRI analysis will be performed longitudinally to explore the hypothesis that neuroplastic and structural changes that may underlie this treatment benefit.Methods and analysisA total of 10 participants will be recruited into this open-label clinical trial. All participants will undergo clinical, kinemetric, neurophysiological and radiological testing at baseline, followed by repeated measures at predesignated time points post MRgFUS Vo-complex thalamotomy. Further, to identify any underlying structural or neurophysiological abnormalities present in individuals with focal hand dystonia, 10 age and gender matched control participants will be recruited to undergo comparative investigation. These results will be compared with the intervention participants both at baseline and at 12 months to assess for normalisation of these abnormalities, if present.Ethics and disseminationThis trial was reviewed and approved by the St Vincent’s Health Network Sydney Human Research Ethics Committee (2022/ETH00778). Study results will be published in peer-reviewed journals and presented at both national and international conferences.Trial registration numberCTRN12622000775718.
Simple signage and targeted education can lead to process improvement in acute appendicitis care
Authors: Atwood Rex , Benoit Patrick , Hennrikus William , Kraemer Laura , Gunasingha Rathnayaka Mudiyanselage , Kindvall Angela , Jessie Elliot , Gosztyla Carolyn , Bradley Matthew 
Published: October 2023

IntroductionAn institution-wide protocol for uncomplicated acute appendicitis was created to improve compliance with best practices between the emergency department (ED), radiology and surgery. Awareness of the protocol was spread with the publication of a smartphone application and communication to clinical leadership. On interim review of quality metrics, poor protocol adherence in diagnostic imaging and antimicrobial stewardship was observed. The authors hypothesised that two further simple interventions would result in more efficient radiographic diagnosis and antimicrobial administration.Materials and methodsSurgery residents received targeted in-person education on the appropriate antibiotic choices and diagnostic imaging in the protocol. Signs were placed in the emergency and radiology work areas, immediately adjacent to provider workstations highlighting the preferred imaging for patients with suspected appendicitis and the preferred antibiotic choices for those with proven appendicitis. Protocol adherence was compared before and after each intervention.ResultsTargeted education was associated with improved antibiotic stewardship within the surgical department from 30% to 91% protocol adherence before/after intervention (p<0.005). Visible signs in the ED were associated with expedited antimicrobial administration from 50% to 90% of patients receiving antibiotics in the ED prior to being brought to the operating room before/after intervention (p<0.005). Diagnostic imaging after the placement of signs showed improved protocol adherence from 35% to 75% (p<0.005).ConclusionThis study demonstrates that smartphone-based applications and communication among clinical leadership achieved suboptimal adherence to an institutional protocol. Targeted in-person education reinforcement and visible signage immediately adjacent to provider workstations were associated with significantly increased adherence. This type of initiative can be used in other aspects of acute care general surgery to further improve quality of care and hospital efficiency.
Effect of physical activity counselling on the number of contacts in primary healthcare, specialised healthcare and the related healthcare costs among patients with type 2 diabetes: a register-based evaluation study
Authors: Martiskainen Tuula , Lamidi Marja-Leena , Linna Miika , Venojärvi Mika , Tikkanen Heikki , Laatikainen Tiina 
Published: October 2023

IntroductionThis study evaluated the effect of physical activity (PA) counselling on the number of contacts and related costs in primary healthcare (PHC) and specialised healthcare (SHC) among patients with type 2 diabetes (T2D).MethodsThe study was carried out in North Karelia, Finland, among PHC clients with T2D in 2016–2018. Altogether, 521 patients participated in the counselling. In total, 1382 sex, age, time of diagnosis and intervention time-matched controls were used to assess the effect of the intervention. Information on outpatient nurse and physician appointments in PHC and SHC was collected from October 2016 to December 2019. The reason for the visit was identified with the recorded main diagnosis using both International Classification of Diseases-10 and International Standard Classification of Primary Care-2 diagnoses. Unit costs of SHC visits were based on average diagnosis-related group costs and for PHC unit costs for appointments for physicians, nurses and physiotherapists on the national price list.ResultsThe number of physician and nurse appointments in the PHC related to T2D decreased in the intervention group and increased in the control group with statistically significant differences in mean annual changes between groups (p=0.010 and p<0.001, respectively). In PHC, the number of physician appointments related to musculoskeletal disorders decreased in the intervention group and increased in the control group with a statistically significant difference between groups (p<0.001). In the intervention group, T2D-related costs of appointments per person-year in PHC decreased, while an increase was observed in the control group (p<0.001).ConclusionsThis study shows that PA counselling in PHC offers significant benefits in the treatment of patients with T2D by also improving the use of the resources in healthcare. The PA counselling reduced the number of other appointments and costs of appointments per person-year.
Prevalence of developmental dysplasia of the hip (DDH) in infants: a systematic review and meta-analysis
Authors: Tao Zhongbin , Wang Jie , Li Yanming , Zhou Yongkang , Yan Xiaoli , Yang Junqiang , Liu Huili , Li Bowen , Ling Jizu , Pei Yijie , Zhang Jianglin , Li Yuanyuan 
Published: October 2023

ObjectiveTo estimate the prevalence of developmental dysplasia of the hip (DDH) in infants with a systematic review and meta-analysis.MethodA literature search was conducted in April 2023, using databases such as Cochrane Library, PubMed, MEDLINE, CNKI, and SinoMed, without language restrictions. Eligible studies included cross-sectional studies reporting the prevalence of DDH among infants aged 0–12 months. Two independent reviewers manually selected and coded the studies, with any disagreements resolved by a third reviewer. Meta-analysis was performed using a random-effects model to calculate the prevalence of DDH. Regression analysis examined the trend of DDH prevalence, and stratification analysis explored heterogeneity between studies.ResultsA total of 65 studies involving 3 451 682 infants were included in the meta-analysis. None of the studies were classified as high quality, four were medium-to-high quality, 50 were low-to-medium quality, and eight were low quality. The pooled prevalence of DDH was 1.40% (95% CI: 0.86 to 2.28, I2=100%), and prevalence of dysplasia, subluxation, and dislocation was 1.45% (95% CI: 0.93 to 2.24, I2=97%), 0.37% (95% CI: 0.22 to 0.60, I2=94%), and 0.21% (95% CI: 0.13 to 0.34, I2=92%), respectively. Notably, the overall prevalence has a slight upward trend in the last three decades (β=0.24, p=0.35), but the dysplasia was downward trend (β=−0.48, p<0.01). Girls have higher risk of DDH than boys (1.46% vs 0.66%; Q=5.83, df=1, p=0.02). There were no significant differences based on gender, country, setting, or screening technique.ConclusionThe prevalence of DDH among infants is approximately one in a 100, with girls being at higher risk. Though the prevalence of dysplasia has decreased, there is a slight upward trend in overall DDH. Therefore, routine screening for DDH in infants is recommended to prevent more serious developmental problems.
Body dissatisfaction, disordered eating and exercise behaviours: associations with symptoms of REDs in male and female athletes
Authors: Vardardottir Birna , Olafsdottir Anna Sigridur , Gudmundsdottir Sigridur Lara 
Published: October 2023

ObjectivesDisordered eating and compulsive exercise behaviours are common among athletes and can increase the risk of relative energy deficiency in sport (REDs). Contrarily, the prevalence of muscle dysmorphia and its relationship with REDs are unknown. This cross-sectional study aimed to evaluate associations of all three with REDs symptoms.MethodsElite and subelite Icelandic athletes (n=83, 67.5% females) answered the Low Energy Availability in Females/Males Questionnaires (LEAF-Q/LEAM-Q), Eating Disorder Examination–Questionnaire Short (EDE-QS), Exercise Addiction Inventory (EAI) and Muscle Dysmorphic Disorder Inventory (MDDI). Body composition was assessed via dual-energy X-ray absorptiometry; resting metabolic rate via indirect calorimetry; and blood samples were drawn for analysis of nutrition and hormonal status. Females were compared based on LEAF-Q total score (≥8 (at risk) vs <8). Simple linear regression was applied to evaluate associations of (a) testosterone with other objective measures and LEAM-Q scores in males; and (b) LEAF-Q/LEAM-Q scores with EDE-QS, EAI and MDDI scores.ResultsIn total, 8.4% of participants scored above cut-off on EDE-QS, 19.3% on EAI and 13.3% on MDDI. Females with LEAF-Q total score ≥8 had higher median scores on EDE-QS, EAI and MDDI compared with those scoring <8. Testosterone was positively associated with iron and inversely with total iron-binding capacity but was not associated with scoring on any of the administered questionnaires.ConclusionDrive for muscularity and aesthetic physique may play a role in the complex presentation of REDs. Screening for muscle dysmorphia, in addition to disordered eating and compulsive exercise, could therefore facilitate early detection of REDs.
X as a proxy for tackle safety culture? Sentiment analysis of social media posts on red-carded and yellow-carded tackles during the 2019 Rugby World Cup
Authors: Alexander Firdows , Tucker Ross , Jones Ben , Hendricks Sharief 
Published: October 2023

ObjectivesThis study analysed the overall sentiment of attitudes, opinions, views and emotions expressed in posts on X related to red-carded and yellow-carded tackles during the 2019 Rugby World Cup (RWC).MethodsSentiment analysis was conducted on posts on X about red or yellow cards issued at the 2019 RWC. Posts were classified as ‘agree’, ‘disagree’ and ‘neutral’. The frequency of posts, red cards, yellow cards, all injuries, tackle injuries and total number of tackles per match were also synced to the 45-match playing schedule.ResultsFive tackle-related red cards were issued during the 2019 RWC, and 15 tackle-related yellow cards, with 337 and 302 posts identified for each card decision, respectively. For red cards, 42% of posts (n=158/377) agreed with the referee’s decision, 19% (n=71/377) disagreed and 40% were neutral. For yellow cards, 24% (n=73/302) agreed with the referee’s decision, 33% (n=99/302) disagreed and 43% were neutral.ConclusionsFor red cards, posts were 2.2 times more likely to agree with the referee’s decision than disagree. Posts that agreed with a red card decision were also more likely to be shared (reposted) than posts that disagreed with a red card decision. In contrast, sentiments expressed for yellow card decisions were mixed. This may be related to interpreting the degree of danger and whether mitigation is applied. Within the ecosystem of rugby, sharing sentiments on social media plays a powerful role in creating a positive player welfare narrative.
Reduction of moderate to severe tricuspid regurgitation after catheter ablation for atrial fibrillation
Authors: Cha Myung-Jin , Lee Seung-Ah , Cho Min Soo , Nam Gi-Byoung , Choi Kee-Joon , Kim Jun 
Published: October 2023

ObjectiveTricuspid regurgitation (TR) is a progressive disease with high mortality and limited medical treatment options, and its association with atrial fibrillation (AF) has been documented. This study aimed to investigate whether successful rhythm control through catheter ablation for AF could reduce TR severity.MethodsA total of 106 patients with drug-refractory AF with moderate to severe secondary TR who underwent AF ablation were screened from a single-centre ablation registry. Echocardiographic parameter changes (pre-procedure vs 1 day/1 year post-procedure) were analysed. Holter monitoring was performed at 3/6/12 months to assess AF recurrence. The primary outcome was at least one grade TR reduction with its main determinants evaluated.ResultsAfter excluding 36 patients (prior tricuspid valve surgery, intracardiac devices or insufficient data), 70 patients (aged 63.8±9.7 years, 50% female) were analysed. Of these, 17 (24.3%) had severe TR, 55 (78.6%) persistent AF and all restored sinus rhythm with catheter ablation. The primary outcome was achieved in 53 (75.7%) at 1-year assessment (73.6% of moderate and 82.4% of severe TR). There were significant decreases of vena contracta (6.1→3.2 mm) and tricuspid annular diameter (37.3→32.6 mm) at 1 year. Although 25 patients experienced AF recurrence within 1 year, 56 (80%) patients finally maintained sinus rhythm with medical treatment (87% in patients with TR reduction and 59% without). From the multivariate analysis, sinus rhythm maintenance was the most significant determinant of TR reduction (OR 8.3, 95% CI 1.8 to 37.4).ConclusionIn patients with AF with moderate to severe TR, more than two-thirds of patients experienced reduced TR severity, with notable improvements in echocardiographic parameters. Sinus rhythm maintenance was associated with significant TR reduction.
Interest and competence in leadership and management among newly qualified specialists in Finland
Authors: Parviainen Heli , Kärki Juulia , Kosonen Hanna , Halava Heli 
Published: October 2023

BackgroundMedical faculties in Finland are responsible for the quality and content of continuous medical education programmes that also includes compulsory management studies (10 European Credit Transfer and Accumulation System). The aim of this study is to evaluate medical specialists’ experiences of the compulsory management studies and their attitudes towards leaders and managers.MethodsThe Universities of Turku and Tampere conducted a survey among doctors who completed their specialist training between 1 January 2016 and 1 January 2019. Of these doctors, 83 completed the survey (response rate 25%). The analysis was carried out using a cross-table, and in the visual analysis, a box plot has been used.ResultsOf the respondents, 38% were content with management and leadership studies, and they reported a particular need for improving skills in human resources management, healthcare economy, legislation, organisational management, and social and healthcare systems. Most respondents (83%) showed interest in future leadership roles.ConclusionsThe findings of this study show that newly qualified doctors do wish for added education and training in management and leadership.
Are multidisciplinary consultation meetings for prenatal diagnosis achievable in a low-income country? A descriptive cross-sectional survey in Benin
Authors: Yassegoungbe Monsoia Gildas , Assan Beaudelaire Romulus , Houegban Amoussou Sedjro Clotaire Romeo , Metchihoungbe Codjo Serge , Lecompte Jean-Francois , Aguemon Christine Tschabu , Gbetey Sidoine Bitho , Breaud Jean , Gbenou Antoine Seraphin 
Published: October 2023

ObjectiveThe multidisciplinary antenatal diagnosis staff bring together practitioners who are involved in the management of the antenatal period at birth. This project was designed following the French experience to institute multidisciplinary consultation meetings for prenatal diagnosis (MCMPD) in Benin.MethodsThis is a descriptive cross-sectional study examining the knowledge, attitudes, and practices of Beninese practitioners in the field of MCMPD to develop the pilot phase of the project.ResultsWe collected 108 participants from different specialties. Pediatricians and pediatric surgeons were in the majority at 23.9% and 16.5%, respectively. Sixty-seven percent of participants were from the public sector (n=75). One practitioner felt that it was not a good idea to implement these meetings. Almost all staff (96.2%) agreed that this meeting would have a positive impact on reducing neonatal mortality. Omphalocele (58.5%), spina bifida aperta (43.6%), and gastroschisis (34%) were the most commonly diagnosed antenatal conditions in Benin. No neonatal pathology required medical termination of the pregnancy according to 35.6% of the participants.ConclusionsThe objective of reducing infant mortality due to medical and surgical pathologies is a noble one and deserves to be supported. This innovative project, developed through this study, the first of its kind in the subregion, will contribute inexorably to the achievement of the third Goal Sustainable Development.
Fastensor: Optimise the Tensor I/O Path from SSD to GPU for Deep Learning Training
Authors: Wei Jia , Zhang Xingjun , Wang Longxiang , Wei Zheng 
Published: October 2023

In recent years, benefiting from the increase in model size and complexity, deep learning has achieved tremendous success in computer vision (CV) and (NLP). Training deep learning models using accelerators such as GPUs often requires much iterative data to be transferred from NVMe SSD to GPU memory. Much recent work has focused on data transfer during the pre-processing phase and has introduced techniques such as multiprocessing and GPU Direct Storage (GDS) to accelerate it. However, tensor data during training (such as Checkpoints, logs, and intermediate feature maps), which is also time-consuming, is often transferred using traditional serial, long-I/O-path transfer methods.
In this article, based on GDS technology, we built Fastensor, an efficient tool for tensor data transfer between the NVMe SSDs and GPUs. To achieve higher tensor data I/O throughput, we optimized the traditional data I/O process. We also proposed a data and runtime context-aware tensor I/O algorithm. Fastensor can select the most suitable data transfer tool for the current tensor from a candidate set of tools during model training. The optimal tool is derived from a dictionary generated by our adaptive exploration algorithm in the first few training iterations. We used Fastensor’s unified interface to test the read/write bandwidth and energy consumption of different transfer tools for different sizes of tensor blocks. We found that the execution efficiency of different tensor transfer tools is related to both the tensor block size and the runtime context.

We then deployed Fastensor in the widely applicable Pytorch deep learning framework. We showed that Fastensor could perform superior in typical scenarios of model parameter saving and intermediate feature map transfer with the same hardware configuration. Fastensor achieves a 5.37x read performance improvement compared to
torch.save
() when used for model parameter saving. When used for intermediate feature map transfer, Fastensor can increase the supported training batch size by 20x, while the total read and write speed is increased by 2.96x compared to the torch I/O API.