bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary Care Physicians’ Preferences Regarding Communication from Orthopaedic Providers
Authors: Chiodo Christopher P. , Striano Brendan M. , Parker Emily Belle , Bluman Eric M. , Smith Jeremy , Martin Elizabeth A. , Greco Julia M. , Healey Michael J. 
Published: December 2023

Category: Other Introduction/Purpose: Musculoskeletal consultations constitute a growing portion of primary care physician (PCP) referrals. Optimization of communication between PCPs and orthopaedists can potentially reduce the time PCPs spend in the electronic medical record (EMR). This, in turn, may help reduce burnout. However, little is known about the preferences of PCPs regarding communication from orthopaedic specialists. The current study therefore investigated the preferences of PCPs across a large health network regarding communication from orthopaedists. Methods: One hundred and seventy-five PCPs across 15 practices within our health network were surveyed. These providers universally used the Epic Systems EMR. PCPs were asked to report their years in practice, panel size, typical number of electronic clinical messages received each day, time spent in the EMR after normal clinical hours, and burnout level. Likert scales and top-box scores were used to assess the PCPs’ perceived importance of communication from orthopedists in specific clinical scenarios. PCPs were further asked to report their preferred method of communication in each scenario and overall interest in communication from orthopaedists. Regression analyses were performed to determine if any PCP characteristics are associated with communication preferences and overall PCP interest in communication from orthopaedists. Results: A total of 107 (61%) PCPs completed the survey. PCPs most commonly rated communication from orthopaedists as highly important when the orthopaedist needed information from the PCP. In this scenario, PCPs preferred to receive an Epic Staff Message. Other scenarios rated as important included: the decision for surgery, hospitalization, and a major clinical change. In these scenarios, a CC’d Chart rather than Staff Message was preferred. Increased EMR use after-hours was associated with diminished odds of having high interest in communication from orthopaedists (odds ratio=0.65, 95% confidence interval: 0.48-0.88, P=0.005). Ninety-three PCPs (86.9%) reported spending at least 1 hour a day in Epic after normal clinical hours. Twenty-seven (25.2%) spent more than 3 hours. Forty-six PCPs (42.9%) reported experiencing at least one symptom of burnout. Conclusion: In the current study, there were distinct preferences among PCPs regarding clinical communication from orthopaedic surgeons. In addition, there was evidence of substantial burnout and after-hours work effort by PCPs. Our results may be helpful in optimizing communication between PCPs and orthopaedists, while also reducing time spent in the EMR by PCPs.
Retrospective Review of Double vs Triple Hindfoot Arthrodesis: Clinical and Radiographic Comparison
Authors: Walsh Devin F. , Graham George Dillon , Haynes William B. , Ellington Kent , Shawen Scott B. , Davis Hodges , Cohen Bruce , Irwin Todd A. , Jones Carroll 
Published: December 2023

Category: Hindfoot; Other Introduction/Purpose: Triple arthrodesis of the subtalar, talonavicular, and calcaneocuboid joints is a commonly performed procedure to treat hindfoot deformity. Debate exists regarding the need to include the calcaneocuboid joint in the arthrodesis, leading some surgeons to perform double arthrodesis of the subtalar and talonavicular joints to treat similar pathology. Differences in clinical, radiographic and patient reported outcomes between the two procedures have not been thoroughly reported. The purpose of this study is to evaluate the clinical and radiographic outcomes of double versus triple arthrodesis for the correction of symptomatic hindfoot deformity. Methods: A retrospective cohort study reviewed all patients who underwent double or triple arthrodesis to correct hindfoot pathology between January 2016 and April 2019 at our institution. Patients were identified using CPT codes. Inclusion criteria included patients greater than 18 years old who underwent hindfoot correction by a primary double or triple arthrodesis with a minimum 3 month clinical and radiographic follow up. Exclusion criteria included prior hindfoot arthrodesis and peripheral neuropathy. The primary outcome was union at each arthrodesis site. Secondary outcomes included deformity correction, operative times, re-operation rates, complications, and patient reported outcomes. Chi-squared or Fisher’s Exact tests were used as appropriate to compare categorical variables and t-tests were used to compare numerical variables. Results: One hundred fourteen procedures met inclusion criteria. There were 86 double (75%) and 28 triple arthrodeses (25%). Eleven talonavicular non-unions were identified in the double arthrodesis group (12.7%) compared to 5 in the triple arthrodesis group (17.9%, p =0.54). There were 2 (7.1%) calcaneocuboid non-unions in the triple group. Subtalar arthrodesis was achieved 100% in both groups. Operative time was shorter for doubles compared to triples, but this did not reach statistical significance (104 min vs 117 min, p = 0.089). The only deformity correction parameter to reach significance was post operative cuboid height being higher in the double group (19.1mm vs 16.7mm, p = 0.012). Pre-operative deformity, overall union rates, reoperation rate, and post operative complications were not statistically different between the two procedures. Conclusion: In this study double arthrodesis was shown to result in shorter operative times with similar deformity correction, union rates, and post operative complications when compared to triple arthrodesis. The double arthrodesis is a viable alternative to treat hindfoot pathology. More research is warranted to further compare the long term outcomes between the two procedures.
Statistical Shape Modeling Enables Identification of Subtalar Contact Stress Differences Following Tibiotalar Arthrodesis and Total Ankle Replacement
Authors: Lisonbee Rich , Dibbern Kevin , Anderson Andrew E. , Kruger Karen , Lenz Amy 
Published: December 2023

Category: Hindfoot; Ankle Arthritis Introduction/Purpose: Clinical studies have shown 32% of patients with a TAR progress to subtalar OA within 5 years, whereas 78% of patients with a tibiotalar arthrodesis presented with subtalar OA by 7.5 years. Higher rates of subtalar OA after arthrodesis may be explained by a transfer of ankle forces and stress through the adjacent subtalar joint while TAR may mitigate these changes. The objective of this study was to compare subtalar joint contact stresses between patients treated with tibiotalar arthrodesis and total ankle replacement (TAR) during an overground walking activity using correspondence particles to enable regional analysis. Methods: With IRB approval, ten individuals with unilateral tibiotalar arthrodesis and six individuals with unilateral TAR were imaged with biplane fluoroscopy during overground walking. Discrete element analysis (DEA) was performed to estimate subtalar joint contact stress using the tracked bone models. Cartilage was modeled using linear-elastic material properties (E=12 MPa, v=0.42) and uniformly extruded compressible surfaces from rigid subchondral bone (0.98 mm talar side, 0.75 mm calcaneal side1). A calcaneal statistical shape model (SSM) was created and resulting correspondence particles served as registered locations for comparison of cumulative stress across three phases of normalized stance (loading-response 0-24%, mid 25-54%, and terminal 55- 87%). Two-sample t-tests or Wilcoxon rank-sum tests were used to evaluate differences (p < 0.05) in cumulative contact stresses at each correspondence particle within the 3 phases based upon Shapiro-Wilk findings of normality. Results: There were significant differences in contact stress exposure across all three phases of gait. Differences were identified along the superior-medial aspect of the posterior facet and within the anterior facet (Figure 1). Higher cumulative stresses were observed along the border of the posterior facet and in the medial facet. This model is limited by a lack of validation, uniform cartilage thickness assumptions applied across groups, and that DEA only estimates contact stress without consideration of shear. Conclusion: This study was the first to localize regional differences in subtalar joint stress for patients having undergone TAR and tibiotalar arthrodesis. Interestingly, TAR patients experienced higher stress in this study compared to those with arthrodeses. These ostensibly counterintuitive findings of higher TAR stress may relate to the pre-existence of subtalar OA which is a common indication of TAR versus fusion.
Tibial Cortex Transverse Transport: A Novel Treatment of Large Area of Deep Wounds in the Patient's Lower Extremities
Authors: Hou Jun , Nie Xinyu , Su HongJie , Hua Qikai , Ding Yi 
Published: December 2023

Category: Trauma; Other Introduction/Purpose: Large area of deep wounds (LADW) usually undergoes flap grafting, in this study, we propose an innovative treatment for LADW. The objective of our study was to evaluate the efficacy of TTT for the treatment of LADW in the lower extremities and provide indications for the TTT. Methods: A retrospective review of consecutive patients with Large Area of Deep Wounds in the lower extremities who underwent reconstruction using the TTT procedure from 2018.1 to 2021.6 was conducted. Inpatient follow-up was performed at 1 month after surgery and outpatient follow-up at 3, 6, and 12 months after surgery. Ulcer healing and healing time, recurrence rate, major amputation rate, and complications were assessed during this 1-year follow-up. All patients were evaluated by computed tomography angiography (CTA) 1 month after surgery for changes in the small blood vessels of the lower extremities. Results: A total of 36 patients, including 21 males and 15 females, with a mean age of 62.5 years, were in this study. These included infected skin defects (20 cases), traumatic skin defects (9 cases), tumor resection skin defects (6 cases), and burns (1 case). Among them, the healing rate was 94.4% and the average healing time was 6 months without recurrence, nail tract infection, osteomyelitis, incisional infection, and related complications. Conclusion: The results showed that TTT can safely and effectively treat total skin defects of the lower extremity. TTT is relatively simple to perform without grafting, making it an effective method for treating total skin defects of the lower extremity.
Evaluation of Leg-foot Range of Motion: Which Measurement Method is Most Reliable?
Authors: Costa Marco Tulio , Tejerina Javier Felipe Salinas , Silva Cesar Augusto Lima , Rego Itallo , Bergamasco Jordanna , De Marchi Neto Noé 
Published: December 2023

Category: Ankle Introduction/Purpose: The measurement of the ankle's range of motion is now considered of great importance for the diagnosis, therapeutic choice, and follow-up of the evolution of the treatment in patients with pathologies, both of the ankle and the whole hindfoot. However, there is no established method of choice for the safety assessment of talocrural mobility. Therefore, to evaluate the methods of measuring leg-foot movement in normal ankles and feet by comparing the results of clinical measurements with those of radiographic measurement and to determine the range of leg-foot movement considered normal. Methods: The leg-foot movement was measured in 44 patients (60 feet) using a traditional goniometer, digital goniometer, inclinometer, smartphone application, and radiographic measurement (considered gold standard). Maximum dorsiﬂexion was achieved by asking the patient to take a step forward with the contralateral foot and perform as much dorsiﬂexion as possible in the ankle studied without removing the heel from the ground. For maximum plantar ﬂexion, the patient was asked to take a step back with the contralateral foot and make as much plantar ﬂexion as possible without removing the studied forefoot from the ground. Results: The values obtained in radiographic measurement were higher than those obtained with clinical measurement. When we compared only the results of clinical measurement, the traditional goniometer was inaccurate. According to the radiographic method, the mean leg-foot range of motion was 65.6 degrees. The mean maximum plantar ﬂexion was 34.9 degrees, and the mean maximum dorsiﬂexion was 30.7 degrees. Conclusion: The most appropriate method for evaluating the leg-foot range of motion is the radiographic one. The traditional goniometer proved to be the most imprecise clinical method. The mean leg-foot range of motion in healthy young adults was 65 degrees.
Elevated Serum Macrophage Migration Inhibitory Factor Levels are Associated With Major Depressive Disorder
Authors: Supti Kaniz Farzana , Asaduzzaman Md. , Suhee Farhana Islam , Shahriar Mohammad , Islam Sardar Mohammad Ashraful , Bhuiyan Mohiuddin Ahmed , Qusar MMA Shalahuddin , Islam Md. Rabiul 
Published: December 2023

Background: Previous studies have suggested the involvement of an activated inflammatory process in major depressive disorder (MDD), as altered expression of inflammatory cytokines is observed in depression. This alteration can be the cause or a consequence of MDD. However, acknowledging inflammatory cytokines as prospective biomarkers would aid in diagnosing or guiding better therapeutic options. Therefore, we designed this study to assess the macrophage migration inhibitory factor (MIF) in depression. Method: We collected blood samples from 115 MDD patients and 113 healthy controls (HCs) matched by age and sex. MDD patients were diagnosed by a qualified psychiatrist based on the symptoms mentioned in the diagnostic and statistical manual of mental disorders (DSM-5). We applied the Hamilton depression (Ham-D) rating scale to assess the severity of depression. We assessed serum levels of MIF using ELISA kit (Boster Bio, USA). Result: We detected increased serum MIF levels in MDD patients compared to HCs (6.15 ± 0.23 ng/mL vs 3.95 ± 0.21 ng/mL, P < 0.001). Moreover, this increase is more among female patients than female controls. Also, we noticed a positive correlation between altered MIF levels and the Ham-D scores ( r = 0.233; P = 0.012), where we found that patients who scored higher on the Ham-D scale had higher MIF levels in serum. Moreover, the area under the curve (AUC) of receiver operating characteristic (ROC) curve represented the good diagnostic performance of altered serum MIF. Conclusion: Our study findings indicate the association of pro-inflammatory cytokine MIF in the pathophysiology of depression as we identified elevated serum MIF levels in depressive patients compared to HCs. However, more researches are required to confirm whether this alteration of cytokine is the causative factor or a consequence of depression. We recommend conducting further studies to understand the pattern of this alteration of MIF levels in MDD patients.
Characterization of animal shells-derived hydroxyapatite reinforced epoxy bio-composites
Authors: Oladele Isiaka Oluwole , Taiwo Anuoluwapo Samuel , Onuh Linus N , Adelani Samson Oluwagbenga , Balogun Samuel Olufemi , Lephuthing Senzeni Sipho , Olubambi Peter Apata 
Published: December 2023

Environmental issues have geared the interest of researchers toward the use of naturally occurring materials for various applications in recent times. Hydroxyapatite particles (HAp) for biomedical applications were synthesized from egg and snail shells and used for the fabrication of bio-composites in this research. The shells were prepared by thoroughly cleaning before subjecting to calcination as well as wet-chemical precipitation treatment to obtain 50 µ sized hydroxyapatite particles that were used for the development of the bio-composites. The composites were fabricated with an open mold stir casting technique after mixing the constituents in predetermined proportions. Mechanical, wear, and physical properties evaluations were carried out on the composites and control samples while the images of the fractured surfaces were examined using a scanning electron microscope. It was revealed from the results that the addition of hydroxyapatite to epoxy improved the properties of the composite where most of the optimal values emerged from 15 wt% HAp-reinforced samples. It was discovered that snail shell HAp-based composites had superior enhancements than the eggshell HAp-based composites which showed that the source of the animal shell influences the characteristics of the ensuing properties. Flexural strength and modulus were 63.95 and 774.64 MPa, respectively; hardness was 40.25 HS, wear index was 0.07, and thermal conductivity was 0.545 W/mK for the snail shell HAp-based composites. Hence, synthesized HAp from snail shells is more structurally stable than eggshell-based and can be used for biomedical applications.
The Effect of Smoking, Gender, Age, and the Body Mass Index on the Measurements of the Portal Vein Diameter
Authors: Babiker Mahmoud S. , Alharbi Yasser Awad , Alruwaythi Amjad Abdullah , Alamri Waleed Abbad 
Published: December 2023

Objective: This study aimed to explore the effects of age, sex, body mass index (BMI), and smoking on the diameter of the portal vein (PV). Materials and Methods: This quantitative descriptive study included 113 participants (61.9% males and 38.1% females) who underwent sonography. The participants were selected via convenience sampling. Patients with known cardiac, liver, or biliary diseases were excluded. The PV of each participant was evaluated and measured using a 3.5 MHz transducer and a standard liver sonography imaging protocol. Statistical analyses were performed using descriptive statistics, chi-square test, independent t-test, and Pearson correlations. Statistical significance was set at P < .05. Results: The mean age of the participants was 38 ± 16 years (range = 15–86 years). The mean PV diameter and BMI were 9.6 ± 2 mm (range = 4.9–16 mm) and 26.22 ± 8.5 (range = 15.2–39.7), respectively. The mean PV diameter of the participants who did and did not smoke was 10.5 ± 2.3 mm and 9.25 ± 1.8 mm, respectively. The PV diameter showed statistically significant associations with smoking status, age, and BMI ( P = .01, .007, and .022, respectively). Conclusion: The findings of this study suggest that the PV diameter may increase with smoking, age, and BMI; however, no correlation was observed between the PV diameter and sex.
THE OLD IRISH POET: MAGICIAN, SEER OR STORYTELLER
Authors: Ilgova Daria A. 
Published: December 2023

The purpose of the study is to consider the structure of Old Irish poetry by the example of several principles of its division: by time, the function of the poet and the addressee of the poetic message.
The main research materials used are Old Irish sagas, which contain poetic elements, as well as foreign and Russian research in the field of Celtology, affecting the development of Old Irish poetry.
The relevance of the research is due to the fact that the relationship of druids, filids and bards in Old Irish poetry is not clearly established and is the subject of scientific discussion and many interpretations.
The methodology of the research consists in using the method of comparative analysis of Old Irish poetry, during which the change of influence of poetic groups (druids, filids and bards) is considered. Understanding this shift is also impossible without analyzing the historical and cultural context (the Christianization of Ireland, Viking raids, the weakening of the monastic way of life and other social and cultural aspects).
As a result of the conducted research, it was found that along with the change in influence, the recipient of the poetic text also changes: from appeals to the higher powers of the druids – to the visionary rituals of the filids – and further to a wider audience of bards.
The results of the research allow us to take a broader look at the problem of the formation of Old Irish poetry not only in literary terms, but also from the point of view of cultural development.
As posições paraguaias sobre as renegociações do Anexo C do Tratado de Itaipu (2023): uma visão divergente, crítica e brasileira | Paraguayan Positions On The Renegotiations Of Annex C Of Itaipu Treaty (2023): A Divergent, Critical Brazilian View
Authors: Espósito Neto Tomaz 
Published: December 2023

RESUMO
A usina de Itaipu é de suma importância para seus dois sócios equânimes, Brasil e Paraguai. Em 2023 o Tratado de Itaipu completou 50 anos, assinalando o fim da dívida da construção da barragem e o momento de renegociar as bases político-financeiras do acordo. No lado paraguaio, é presente e forte a narrativa de que, a despeito dos ganhos obtidos, foi um mau negócio para seu povo, fruto do (sub)imperialismo brasileiro e responsável pelas mazelas políticas, econômicas e sociais do país. Assim sendo, pretende-se aqui responder à seguinte questão: em que argumentos se apoia essa narrativa para embasar a renegociação do Anexo C do Tratado de Itaipu? O presente artigo traz dois objetivos específicos: (i) expor os principais argumentos que sustentam a posição paraguaia; (ii) examinar seus pontos fortes e suas fragilidades. Esta é uma pesquisa de corte qualitativo utilizando o método indutivo-dedutivo, que contou com uma análise de documentos e dados oficiais brasileiros e paraguaios e uma revisão bibliográfica selecionada. Por fim, foram utilizados elementos do modelo dos “jogos de dois níveis”, além de instrumentos de análise da política externa paraguaia.
ABSTRACT
The Itaipu is of paramount importance to its two equal partners, Brazil and Paraguay. In 2023, the Itaipu Treaty has completed 50 years, marking the end of the dam construction debt and the time to renegotiate the political-financial bases of the agreement. On the Paraguayan side, there is a strong narrative saying that, despite the gains obtained, it was a bad deal for their people, result of Brazilian (sub)imperialism and responsible for the political, economic and social problems of the country. Therefore, the intention here is to answer the following question: on which arguments is this narrative based so that it could substantiate the renegotiation of Annex C of Itaipu Treaty? This article has two specific objectives: (i) expose the main arguments that support the Paraguayan position; (ii) examine its strengths and weaknesses. This is a qualitative research using the inductive-deductive method, which included an analysis of official Brazilian and Paraguayan documents and data and a selected bibliographic review. Finally, elements of the “two-level games” model were also used, in addition to instruments of analysis of Paraguayan foreign policy.