bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enabling mothers of young children in a low SES area to co-design the support they are seeking for the adoption of healthy behaviours
Authors: Wittels P , Kay T , Mansfield L 
Published: October 2023

Aims: There is a need for interventions that meet the needs of low socioeconomic status (SES) groups, to encourage the adoption of healthy diets and physical activity, in line with current public health guidance. This qualitative research used co-production, a method which actively involves the relevant community, to identify and describe public health interventions to support a group of mothers of young children living in a low SES area. Methods: A group of 20 mothers took part in three in-depth qualitative interviews to discuss in detail the type of support that would be of value to them for the adoption and maintenance of healthy behaviours. The mothers were subsequently invited to take part in a public engagement project, a community-based self-help group. Results: Four themes explained the principles of interventions that would be of value in supporting the mothers with the adoption of healthy behaviours, namely, a community-based self-help group, support for the whole family and support in the home and influencing the environment. These were then further developed into two types of intervention (1) learning for self-help and family care, which encompassed the first three learning-based themes and (2) community of support, which covered influencing the environment and the experience of the community-based self-help group. Conclusion: Co-production enabled a group of mothers of young children, from a low SES area, to describe the type of support that would help them with the establishment and maintenance of healthy lifestyle behaviours. A community-based self-help group warrants further research.
Discovery of a suburban wetland refuge for a depleted American crocodile (Crocodylus acutus) population in northwestern Mexico, using a commercial Unmanned Aerial Vehicle
Authors: Marín-Enríquez Emigdio , Charruau Pierre , Félix-Salazar Luis Adán 
Published: October 2023

Background and Research Aims The Urías Coastal Lagoon (UCL) is a heavily modified and polluted lagoon near Mazatlán, in northwestern Mexico. Once abundant in the UCL, the American crocodile ( Crocodylus acutus) is now rarely seen in the area. A healthy population of apex predators is essential to maintain the trophic balance of ecosystems. Our research aim was to lay the groundwork for studies of American crocodile population ecology in the UCL. Methods Traditional boat surveys (day and night) of crocodiles were undertaken in the UCL in May-July 2022. Two exploratory aerial (∼ 30 m altitude) surveys of a small wetland located close to a habitational complex in the vicinity of the UCL were performed in June and December 2022, using a commercial Unmanned Aerial Vehicle (UAV). We used images obtained with the UAV to estimate the size of the crocodiles detected in the wetland. Results This study confirms the presence of American crocodiles in the UCL and presents the first information on individuals of this species for this area. Aerial surveys revealed the presence of 17 individuals in the wetland; the mean size of nine of those individuals was 183.3 ± 60 cm (range: 130-310 cm). Two yearlings (∼37 cm length), possibly born in June 2022, were captured in the same wetland in September 2022. We also surveyed 50.7 km of UCL coastline by boat, but no crocodiles were sighted. Conclusion The crocodiles seem to avoid the human-impacted UCL and likely use the less impacted surrounding wetlands as a refuge area, which they also use to reproduce. The presence of both yearlings and adults is a good sign for the survival of this vulnerable population. Implications for Conservation We believe that the surveyed wetland should be closely monitored for conservation purposes because it might be one of the last crocodile breeding refuges in the heavily modified and polluted coastal environment of the UCL. We summarize our results with a series of recommendations for local and federal authorities. These recommendations would likely help the conservation of the American crocodile population in the UCL.
A Novel Update on the Management of Müller-Weiss Disease: Presentation of a Treatment Algorithm
Authors: Angthong Chayanin , Younger Alastair S.E. , Chuckpaiwong Bavornrit , Harnroongroj Thos , Veljkovic Andrea 
Published: October 2023

Objective Müller-Weiss disease (MWD) is a challenging condition involving the perinavicular region in the initial stages and subsequently the entire foot in the later stages. The goal of this article is to describe the pathomechanics, clinical evaluation, and nonoperative and operative treatment, including a treatment algorithm, based on current evidence and the combined authors’ experience. Design We review the related articles and summarize the information about this condition. Results A number of related articles reveal that the treatments should focus on the management of degenerative regions and deformity correction to restore normal foot alignment and provide pain relief. Conclusion This systematic review proposes a treatment algorithm that is comprehensive and practical to apply for the management of MWD.
Rilzabrutinib versus placebo in adults and adolescents with persistent or chronic immune thrombocytopenia: LUNA 3 phase III study
Authors: Kuter David J. , Bussel James B. , Ghanima Waleed , Cooper Nichola , Gernsheimer Terry , Lambert Michele P. , Liebman Howard A. , Tarantino Michael D. , Lee Michelle , Guo Hailing , Daak Ahmed 
Published: October 2023

Background: Immune thrombocytopenia (ITP) is characterized by primarily autoantibody-mediated platelet destruction and impaired platelet production resulting in thrombocytopenia and an increased risk of bleeding. Other manifestations include increased risk of thrombosis and diminished quality of life. Current treatment approaches are directed toward lowering the rate of platelet destruction or stimulating platelet production to prevent bleeding. Rilzabrutinib is an oral, reversible, potent Bruton tyrosine kinase inhibitor that was specifically designed to treat immune-mediated diseases and mediates its therapeutic effect through a dual mechanism of action: (1) inhibiting B-cell activation and (2) interrupting antibody-coated cell phagocytosis by Fc gamma receptor in spleen and liver. A 24-week dose-finding phase I/II study of rilzabrutinib in patients with ITP showed a 40% platelet response (⩾2 consecutive platelet counts of ⩾50 × 109/L and increase from baseline ⩾20 × 109/L without rescue medication use) and a well-tolerated safety profile with only grade 1/2 transient adverse events across dose levels. Objectives: Assess the efficacy and safety of oral rilzabrutinib in adult and adolescent patients with persistent or chronic ITP. Design: Rilzabrutinib 400 mg BID is being evaluated in the ongoing LUNA 3 multicenter, double-blind, placebo-controlled phase III study. Methods and analysis: The primary endpoint is durable platelet response, defined as achieving platelet counts of ⩾50 × 109/L for at least two-thirds of ⩾8 available weekly scheduled platelet measurements during the last 12 weeks (including ⩾2 available measurements within the last 6 weeks) of the 24-week blinded treatment period in the absence of rescue therapy. Ethics: Ethical guidelines and informed consent are followed. Discussion: The LUNA 3 trial will further investigate rilzabrutinib’s safety and efficacy in adult and adolescent patients, with the primary goal of addressing a major objective in treating patients with ITP: durability of platelet response. Trail Registration: ClinicalTrials.gov NCT04562766: https://clinicaltrials.gov/ct2/show/NCT04562766 ; EU Clinical Trials Register EudraCT 2020-002063-60: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2020-002063-60 .
Analysis of the learning curve for Retzius-sparing robot-assisted radical prostatectomy for a single surgeon
Authors: Hussein Hany , Maitra Neil , Tay Li June , Saxionis Ioannis , Makin Robert , Sivathasan Sailantra , Smart Sonny , Warren Anne , Shah Nimish , Lamb Benjamin Wilfrid 
Published: October 2023

Background: The learning curve for Retzius-sparing robotic radical prostatectomy is not fully understood. Objective: This study attempts to identify the learning curve across the first 130 cases of a single surgeon. Design, Setting and Participants: All Retzius-sparing robotic radical prostatectomy cases performed by a single surgeon at a high-volume tertiary hospital between April 2019 and July 2022 were included. Outcome Measurements and Statistical Analysis: Outcome measures included positive surgical margin rate, complication rates and unplanned readmission to hospital, postoperative urinary continence, erectile function and prostate-specific antigen (PSA) measurement. Cases were divided chronologically into three groups and differences between groups assessed. Results and Limitation: A total of 130 Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) cases were identified. Differences were found between groups in several areas. Positive surgical margin rate fell between Group 1 (30.2%) and Group 3 (9.1%). Safety, postoperative continence, erectile function and PSA remained stable. Median patient age increased between Group 1 (59 years) and Group 3 (66.5 years) ( p = 0.04). Proportion of patients with stage >T2 increased between Group 1 (27.9%) and Group 2 (41.9%) ( p = 0.036). Median console time increased between Group 1 (120 minutes) and Group 2 (150 minutes) ( p = 0.01). Median gland weight increased between Group 1 (28 g) and Group 3 (35.5 g) ( p < 0.001). Conclusions: The positive surgical margin rate improved over the learning curve, despite the complexity of cases increasing, reflected in older patients, larger prostates and higher stage disease. Safety and functional outcomes are excellent throughout. The learning curve might be facilitated by careful case selection favouring smaller prostates with less advanced disease. Patient Summary: We analysed the learning curve for Retzius-sparing robotic radical prostatectomy. Across the first 130 cases, positive surgical margin rate fell; safety and continence remained excellent. Selection of smaller and less advanced cases may facilitate learning. Level of evidence: III
Atypical ADPKD Due to a DNAJB11 Pathogenic Variant: An Educational Case Report
Authors: Kachmar Jessica , El-Haffaf Zaki , Bollée Guillaume 
Published: October 2023

Rationale: Due to next-generation sequencing, variants in new genes such as DNAJB11 are recently being identified as causing atypical autosomal dominant polycystic kidney disease (ADPKD). It is important to describe phenotypes associated with these variants in order to increase awareness among clinicians, especially since genetic variability affects ADPKD severity. Presenting Concerns of the Patient: We describe a 55-year-old female patient of Haitian origin who presented with slowly deteriorating kidney function, microscopic hematuria, proteinuria, enlarged kidneys with innumerable small cysts, and a family history of chronic kidney disease and cysts. The phenotype was atypical for ADPKD caused by PKD1 or PKD2 variants, since cysts were of small size, kidneys were only moderately enlarged, and the patient had no extra-renal involvement suggestive of typical ADPKD such as liver cysts, pancreatic cysts, cranial aneurysms, or cardiac abnormalities. Diagnoses: A panel of genes was analyzed by next-generation massive sequencing techniques, including DNAJB11, DZIP1L, GANAB, HNF1B, PKD1, PKD2, and PKHD1. Genetic testing revealed a heterozygous variant in the DNAJB11 gene (c.123 dup), which is predicted to result in premature protein termination (p. Lys42*) and was classified by the laboratory as likely pathogenic. Interventions: She was treated with candesartan 16 mg once daily to address her proteinuria. Outcomes: At the time of the most recent follow-up, her proteinuria has increased, and her kidney function continues to slowly deteriorate. Teaching Points: DNAJB11 variants are a rare cause of atypical ADPKD. It is important to recognize the clinical features that help distinguish DNAJB11 from PKD1 and PKD2 variants. Atypical ADPKD due to DNAJB11 variants is usually characterized by small cysts, normal kidney size, proteinuria, progressive chronic kidney disease, and phenotypic overlap with autosomal dominant tubulointerstitial kidney disease (ADTKD). It may, however, present itself with enlarged kidneys as was seen in our patient. Genetic testing should be offered whenever a patient presents atypical features of ADPKD, which also requires increased awareness among clinicians regarding the various phenotypes of atypical ADPKD.
An Assessment of the World’s Contribution to Spine Trauma Care: A Bibliometric Analysis of Classifications and Surgical Management; An AO Spine Knowledge Forum Trauma Initiative
Authors: Chhabra Harvinder Singh , Phadke Vandana , Manghwani Jitesh , El-Sharkawi Mohammad , Butler Joseph S. , Benneker Lorin M. , Vialle Emiliano , Hazenbiller Olesja , Bransford Richard 
Published: October 2023

Study Design Bibliometric analysis. Objectives An analysis of the literature related to the assessment and management of spinal trauma was undertaken to allow the identification of top contributors, collaborations and research trends. Methods A search to identify original articles published in English between 2011 and 2020 was done using specific keywords in the Web of Science database. After screening, the top 300 most cited articles were analyzed using Biblioshiny R software. Results The highest number of contributions were from the Thomas Jefferson University, USA, University of Toronto and University of British Columbia, Canada. The top 3 most prolific authors were Vaccaro AR, Arabi B, and Oner FC. The USA and Canada were among the top contributing countries; Switzerland and Brazil had most multiple country co-authored articles. The most relevant journals were the European Spine Journal, Spine and Spine Journal. Three of the 5 most cited articles were about classification systems of fractures. The keyword analysis included clusters for different spinal regions, spinal cord injury, classification agreement and reliability studies, imaging related studies, surgical techniques and outcomes. Conclusions The study identified the most impactful authors and affiliations, and determined the journals where most impactful research is published in the field. Study also compared the productivity and collaborations across countries. The study highlighted the impact of development of new classification systems, and identified research trends including instrumentation, fixation and decompression techniques, epidemiology and recovery after spinal trauma.
Early Postoperative Complications and Associated Variables After Tibial Tubercle Osteotomy: A 15-Year Experience From a Single Academic Institution
Authors: Berk Alexander N. , Gachigi Kennedy K. , Trofa David P. , Piasecki Dana P. , Fleischli James E. , Saltzman Bryan M. 
Published: October 2023

Background: Tibial tubercle osteotomy (TTO) is a well-established surgical treatment option for patients with patellofemoral disorders. Purpose: To determine the rate of early (≤90 day) postoperative complications after TTO and variables related to postoperative complications. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent TTO at a single academic institution within a 15-year period (2008-2022) were identified. All patients with a minimum 90-day follow-up were considered for study inclusion. Exclusion criteria were age younger than 14 years and revision surgery. Patient characteristics, surgical history, and concomitant procedures were identified, and risk factor analysis was performed to identify variables associated with early postoperative complications. Results: A total of 344 knees in 313 patients met eligibility criteria and were included in the final analysis. One intraoperative complication (0.3%), a premature closure of the incision before repair of the vastus medialis, was identified. There were 141 postoperative complications (138 surgical, 3 medical) in 118 patients for a complication rate of 34.3%. The most common complications were stiffness requiring a nonstandard-of-care intervention (16.3%), superficial wound infection/wound dehiscence (8.1%), and hemarthrosis/effusion requiring aspiration (5.8%). Patients experiencing postoperative complications were older (mean difference, 3.49 years; 95% CI, 1.26-5.73 years; P = .002), had a higher mean Charlson Comorbidity Index (mean difference, 0.26; 95% CI, 0.08-0.45; P = .006), and were more likely to be current smokers ( P = .015) compared with patients with no complications. Inpatient surgery (defined as surgery in a hospital setting with at least 1 overnight stay) was associated with postoperative complications (odds ratio [OR], 2.29; 95% CI, 1.39-3.77; P = .001); this association remained significant generation of a multivariate model (OR, 2.07; 95% CI, 1.19-3.58; P = .010). Previous surgery on the ipsilateral knee ( P < .001) and concomitant autologous chondrocyte implantation ( P = .046) were also associated with postoperative complications. Conclusion: The study findings indicated a low intraoperative complication rate (0.3%) and a relatively high early postoperative (≤90 day) complication rate (34.3%) after TTO. Variables associated with postoperative complications included greater age, higher Charlson Comorbidity Index, surgery in an inpatient setting, previous surgery on the ipsilateral knee, and concomitant autologous chondrocyte implantation.
Assessing an Online Patient Decision Aid about Upper Extremity Reconstructive Surgery for Cervical Spinal Cord Injury: Pilot Testing Knowledge, Decisional Conflict, and Acceptability
Authors: Moritz William , Westman Amanda M. , Politi Mary C. , DOD Working Group  , Fox Ida K. 
Published: October 2023

Background. While nerve and tendon transfer surgery can restore upper extremity function and independence after midcervical spinal cord injury, few individuals (∼14%) undergo surgery. There is limited information regarding these complex and time-sensitive treatment options. Patient decision aids (PtDAs) convey complex health information and help individuals make informed, preference-consistent choices. The purpose of this study is to evaluate a newly created PtDA for people with spinal cord injury who are considering options to optimize upper extremity function. Methods. The PtDA was developed by our multidisciplinary group based on clinical evidence and the Ottawa Decision Support Framework. A prospective pilot study enrolled adults with midcervical spinal cord injury to evaluate the PtDA. Participants completed surveys about knowledge and decisional conflict before and after viewing the PtDA. Acceptability measures and suggestions for further improvement were also solicited. Results. Forty-two individuals were enrolled and completed study procedures. Participants had a 20% increase in knowledge after using the PtDA ( P < 0.001). The number of participants experiencing decisional conflict decreased after viewing the PtDA (33 v. 18, P = 0.001). Acceptability was high. To improve the PtDA, participants suggested adding details about specific surgeries and outcomes. Limitations. Due to the COVID-19 pandemic, we used an entirely virtual study methodology and recruited participants from national networks and organizations. Most participants were older than the general population with a new spinal cord injury and may have different injury causes than typical surgical candidates. Conclusions. A de novo PtDA improved knowledge of treatment options and reduced decisional conflict about reconstructive surgery among people with cervical spinal cord injury. Future work should explore PtDA use for improving knowledge and decisional conflict in the nonresearch, clinical setting. Highlights People with cervical spinal cord injury prioritize gaining upper extremity function after injury, but few individuals receive information about treatment options. A newly created patient decision aid (PtDA) provides information about recovery after spinal cord injury and the role of traditional tendon and newer nerve transfer surgery to improve upper extremity upper extremity function. The PtDA improved knowledge and decreased decisional conflict in this pilot study. Future work should focus on studying dissemination and implementation of the ptDA into clinical practice.
Effects of a Designated Note Writing Hour on Pediatric Intern Adherence to Duty Hours
Authors: Adamiak William , Graessle William , Goulet Natasha , Kushnir Alla 
Published: October 2023

Objectives Interns spend an inordinate amount of the workday writing notes, leading to less time in direct patient care. Since the introduction of the 80-h workweek, it has been shown that interns spend 12% of the workday in direct patient care, compared to 40% at the computer. A dedicated note-writing hour was introduced into the pediatric intern shift to evaluate its effects on note writing behaviors. Within 1 year of implementation in July 2019, we aimed to establish that 80% of all pediatric intern notes were completed prior to the end of their shift. Methods Time stamps from EPIC electronic health record (EHR) database were reviewed for all notes written by pediatric interns during three periods of interest: prior to the implementation of the hour (Jan-May 2019), immediately after implementation (July-Nov 2019), and a year after (May-Aug 2020). Results Prior to implementation, 67.9% of notes were completed by sign out. In the period immediately following implementation, and at a year post implementation, percentages increased to 72.5% and 73.5%, respectively. The percentage of notes completed prior to the end of the protected hour improved from 34.0% to 49.5% and 53.7%, respectively. The percentage of notes completed in less than 1 h also increased from 13.9% to 50.6% and 24.9%, respectively. Conclusion These results indicate that a designated note writing hour for interns offer an effective intervention to improve note writing efficiency, however, the goal of 80% note completion by sign out was not met.