bluuebunny/crossref_metadata_2025_split huggingface dataset:
A blended learning program focusing on comprehensive opioid management in pain (COMP): A pilot program
Authors: Leong Xin Yu Adeline , Lim Zhen Wei , Li Lydia Weiling , George Jane Mary , Goy Raymond Wee Lip , Chan Diana Xin Hui , Tan Selene Yan Ling , Tan Pei Yu , Yu Xia 
Published: December 2023

Introduction In view of the opioid epidemic and increasing caution surrounding prescription of opioids, addressing the competence of opioid management is important. There is minimal structured opioid education in Singapore. Online opioid education modules are available but lack real-time input, concise objectives, and program evaluation. This pilot online, modular, blended program aimed to efficiently instruct novice doctors on safe and appropriate practical opioid prescribing, optimizing its role in multimodal pain management while minimizing risks to patients and public health. Methods The Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model was used. A multidisciplinary team developed the interactive blended program, “Comprehensive Opioid Management in Pain (COMP)”, consisting of three online modules, one case-based discussion (CBD) session, pre- and post-program evaluations. The program was designed to be concise, clinically relevant and engaging to maximize application of knowledge in clinically deficient areas. All junior anesthetists across Singhealth were invited to participate. We analyzed all self-reported and objective scores, as well as program feedback. Results 33 participants completed the online modules. Despite the moderate to high level of baseline self-reported confidence and competency scores, median scores for all variables increased post-program from pre-program. There was unanimous agreement on the relevance and utility of the training program. Conclusion This pilot achieved the aims of improving the knowledge and confidence levels of opioid management in novice doctors. Participants particularly enjoyed the succinct and interactive features of COMP. Further extension with modules focusing on opioid diversion and its use in high-risk populations would benefit intermediate learners.
Hispanic adults with type 2 diabetes mellitus using lipid-lowering agents have better periodontal health than non-users
Authors: Andriankaja Oelisoa M. , Joshipura Kaumudi J. , Levine Michael A. , Ramirez-Vick Margarita , Rivas-Agosto Julio A. , Duconge Jorge S. , Graves Dana T. 
Published: December 2023

Background: Recent studies suggest that lipid-lowering agents (LLA) may reduce chronic periodontitis, but it is unknown whether this benefit extends to people with type 2 diabetes (T2D). Objective: We assessed the association between LLA use and periodontitis in Hispanic adults with T2D. Design: This was a cross-sectional observational study. Methods: We assessed the association of LLA use and periodontal parameters in 253 Puerto Ricans 40–65 years with T2D who participated in the Lipid-Lowering agents use in Periodontitis and Diabetes Study study. Participants were classified as (a) none- or <1 year, (b) 1–4 years, or (c) >4 years. The primary outcome consists of a tertile percent of sites with probing pocket depth (PPD) ⩾ 4 mm and the secondary outcome includes tertiles of percent sites with clinical attachment loss (CAL) ⩾ 4 mm. Multinomial logistic regression models adjusted for age, gender, smoking status, education, waist circumference, glycosylated hemoglobin A1C (HbA1c), bleeding on probing, examiner, and anti-inflammatory agents were used to estimate the association. Results: LLA (92.5%, statins) was used by 52% of participants. LLA use 1–4 years was associated with lower odds of PPD ⩾ 4 mm (OR: 0.22, p  = 0.005; high versus low tertile) or lower odds of CAL ⩾ 4 mm (OR: 0.33, p  = 0.02, middle versus low tertile), compared to those with LLA minimal or no use. This association was lost for participants who used LLA for >4 years. LLA users for >4 years with periodontal disease had elevated HbA1c (OR: 1.36, p  = 0.05). Conclusion: The use of LLA for 1–4 years was associated with lower values of periodontal parameters versus minimal LLA use. This association was not present among people using LLA > 4 years users, but these participants had poorer glycemic control compared to other participants. In this cross-sectional study, the finding that LLA use 1- 4 years is associated with lower values of periodontal parameters of severity in T2D individuals may help clarify some of the controversies regarding the benefit of these medications in this population.
Uropathogens and their antimicrobial-resistant pattern among suspected urinary tract infections patients in eastern Nepal: A hospital inpatients-based study
Authors: Sah Bikash Kumar , Dahal Prasanna , Mallik Shyam Kumar , Paul A Deevan , Mainali Uttar , Shah Chhaya , Dahal Pragyan 
Published: December 2023

Background: Urinary tract infections are the primary factors that cause mortality and morbidity in patients with underlying comorbid conditions and are responsible for most hospital admissions worldwide. Objectives: The study aims to identify the common bacterial uropathogens and determine their antimicrobial susceptibility pattern, including multidrug-resistant/extensively drug-resistant bacteria. Methods: The descriptive cross-sectional study was conducted among inpatients provisionally suspected of urinary tract infections in the medical ward of Koshi Hospital, Biratnagar, Nepal. Samples were inoculated in a cystine lysine electrolyte-deficient medium, and pure growth of significant bacteria was further subjected Gram staining, biochemical identification, and antimicrobial susceptibility testing as per laboratory standard procedure and Clinical Laboratory Standards Institute guidelines, respectively. Descriptive and inferential statistical analysis was performed to analyze the outcomes and a p-value < 0.05 was considered statistically significant. Results: A total of 305 patients urine specimens were examined, of which 251 (82.29%) samples resulted in significant bacterial growth in the culture. Escherichia coli (62.94%) was the most predominantly isolated organism, followed by Klebsiella pneumoniae (12.35%), Staphylococcus aureus (9.16%), and Pseudomonas aeruginosa (8.76%). Among antimicrobials, colistin had shown absolute susceptibility (100%) toward gram-negative uropathogens followed by carbapenem and aminoglycosides in a majority of uropathogens. Escherichia coli was found to be the leading drug-resistant bacteria (70%) among uropathogens. The presence of multidrug-resistant/extensively drug-resistant bacteria uropathogens was found to be significantly associated with diabetes mellitus and those with combined antimicrobial therapies. Diabetic patients were twice (OR~2) more likely to colonize and develop uropathogens as compared to non-diabetics. Conclusion: Escherichia coli was the most common uropathogens followed by Klebsiella pneumoniae in urinary tract infection patients. The polymyxin group (colistin) of antimicrobials was found to be effective in all multidrug-resistant and extensively drug-resistant uropathogens. The study recommends the need of optimized antimicrobial stewardship program to develop effective strategies in the management of urinary tract infections in diverse healthcare settings.
Do International Trade Frictions Influence the Competitiveness of Entity Enterprises? Evidence from the Perspective of Financialization
Authors: Yu Haiyan , Li Shan , Liu Yiyuan , Liu Qiuping , Lu Yuxin 
Published: December 2023

International trade frictions have changed the business environment of enterprises. However, how do these changes influence the behavioral decisions of enterprises, and will this further affect enterprise competitiveness? Exploring these questions will help determine the influencing mechanism of external negative impacts, such as international trade frictions, on the competitiveness of entity enterprises. In this study, the influences of China-U.S. trade friction, which served as an exogenous research event, on the competitiveness of entity enterprises were empirically analyzed via a difference-in-difference (DID) model with semiannual report information of Chinese nonfinancial A-share listed companies in 2016 to 2020 as research samples. Research results show that the China-U.S. trade friction promotes enterprises to enlarge their financial asset investment by changing the business environment of enterprises. Moreover, this friction further weakens the enterprise competitiveness, an essential element of industrial investments. As revealed by further heterogeneity analysis, the China-U.S. trade friction has generated heterogenous influences on enterprise competitiveness in the aspects of investment motives, industry, competition status, and internal governance mechanism. In this study, two types of enterprise competitiveness elements—environment and resources—were included into the same research framework, and the category of theoretical research on the connotation of enterprise competitiveness was expanded. Moreover, this research provided new scenes and evidence for identifying the causal relationships of the impacts of exogenous negative events with the financial behaviors and competitiveness of entity enterprises, Furthermore, it rendered countermeasure paths and policy suggestions for scientifically coping with international trade frictions and enhancing the competitiveness of entity enterprises. Subject Classification Codes: F51; G31; G32; L25
The Association between Caring Behavior and Death Anxiety among Iranian Nurses Working in Covid-19 Wards
Authors: Seyedfatemi Naiemeh , Abbasi Zahra , Bahrami Raheleh , Siah Mansour Khorin Zahra 
Published: December 2023

Introduction Nurses who are at the forefront of the fight against Covid-19 have faced problems such as anxiety and stress due to the high contagiousness of this disease and the challenges of providing services to infected patients. Death anxiety and the resulting fear following the Covid-19 pandemic can affect caring behaviors and the quality of nursing care services. Objective The present study was conducted with the aim of determining the association between caring behaviors and death anxiety among Iranian nurses working in COVID-19 wards. Methods This cross-sectional study was conducted in 2021 in Tehran. The participants consisted of 233 nurses who were purposively selected from university hospitals in Iran. Data collection tools included Demographic Information Form, Death Anxiety Scale, and Caring Dimension Inventory (CDI-25). Data analysis was done using SPSS (version 16). Results Most of the participants were female (79.4%), had less than 5 years of work experience (50.6%), and had bachelor's degree (88.8%). Based on the results, the level of death anxiety among nurses was moderate (7.05 ± 3.85) and their caring behavior was at optimal level (103.03 ± 13.15). Among the subscales of caring behavior, physical-technical behaviors with mean of 46.43 ± 6.20 got the highest score, and unnecessary behaviors with mean of 4.39 ± 0.73 got the lowest score compared to other subscales. Based on data analysis findings, caring behavior and its dimensions had no significant correlation with nurses’ death anxiety ( p = 0.111). Conclusions Our results showed that despite having a moderate level of anxiety, nurses try to provide good care behaviors to patients with covid-19. However, reducing nurses’ anxiety can improve caring behaviors.
Evaluating Failure Mechanisms for Total Talus Replacement: A Case Series
Authors: Peairs Emily M. , Anastasio Albert T. , Tabarestani Troy Q. , Krez Alexandra , Shaffrey Isabel , Henry Jensen K. , Demetracopoulos Constantine , Adams Samuel 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: Talar collapse can occur from a variety of etiologies and may pose a unique challenge to the foot and ankle surgeon due to the complexity of the deformity and associated adjacent joint degenerative change. Total talus replacement (TTR) has emerged as an attractive option to help patients return to activities sooner than with arthrodesis and improve pain and joint mechanics postoperatively. However, there is limited long-term data on the most recent generation of implants. In this multi- institution case series, we present the severe complications that can occur after TTR, including instability, infection, and adjacent joint osteoarthritis. Methods: We present three cases from Duke University Hospital in Durham, North Carolina, and the Hospital for Special Surgery In New York City, New York. All three patients were treated with a total talus replacement (TTR) during their clinical course and experienced subsequent complications. Clinical data and radiographs were collected from chart review under an IRB-exempt protocol. Results: Case 1 demonstrates the risk of ligamentous insufficiency leading to dislocation following placement of a TTR. This case highlights the posterior instability due to soft tissue mobilization and division. Case 2 highlights the risk for adjacent joint degeneration with TTR. Case 3 presents an instance of non-union following a total ankle and total talus replacement (TATTR) with subtalar arthrodesis. To our knowledge, this represents the first case of nonunion following TTR in the literature. Finally, we discuss our institution’s experience with infection following TTR and possible contributing factors to this specific procedural risk. Conclusion: TTR shows promise in the properly selected patient with end-stage talar collapse. However, heterogeneous surgical techniques, implant composition, indications, and patient demographic variables complicate the interpretation of the literature. Moreover, few studies report mid-to long-term outcomes after this procedure and the occurrence of adjacent joint OA is likely underreported in the literature. Thus, until further, high-quality studies with long-term follow-up validate the positive early outcomes of TTR, we urge extreme caution in patient selection, choice of implants, and surgical techniques.
Evaluation of Mechanical Stress Distribution Across the Calcaneus following Calcaneal Autograft: A Finite Element Analysis
Authors: Azam Mohammad T. , Parody Nicholas , Mosquea Thelma R. Jimenez , Butler James J. , Ubillus Hugo A. , Kennedy John G. , Walls Raymond J. 
Published: December 2023

Category: Other Introduction/Purpose: The purpose of this study was to utilize finite element analysis to evaluate progressive bone removal from the calcaneus at various angles and its effect on the mechanical stress distribution at the calcaneus, and potential increase in fracture risk. Methods: A calcaneus CT scan was imported into Autodesk Fusion360 (Autodesk, v.2.0.14569). After rendering the initial mesh body using tetrahedral elements, a copy of the calcaneus was made. A simulated force equal to the average weight of person (876N) was applied to the middle and posterior talus facets while the calcaneus was oriented in the heel strike position during gait, with constraints applied around the heel. The initial harvest site was modelled as a 6mm diameter 30mm deep cylinder. From this center point, the diameter of the harvest site was increased to 8, and 10mm, with the depth being adjusted such that there was no risk of breaching the cortex on the opposite side. For each iteration, the safety factor, stress (MPa), and strain were recorded. This was repeated at an angle of 90°, 45° and a combination of 45° and 90°. Results: The 90° model demonstrated that as the diameter of the harvest site increased, there was a reciprocal increase in stress across the calcaneus. The number of cycles to failure (fracture) for all diameters was 10^6-10^7. The 45° model demonstrated that as the diameter of the harvest site increased, there was a reciprocal increase in stress applied across the calcaneus with a corresponding decrease in stress at the harvest site. The number of cycles to failure increased from 10^3 at 6mm to 10^4-10^5 at 10mm. The combination of the 45°-90° model demonstrated that as the diameter of the harvest site increased, there was a reciprocal increase in stress applied across the calcaneus. The cycles to failures decreased as the diameter of the harvest site increased. Conclusion: This finite element analysis demonstrated that an increase in the diameter of the harvest site led to an increase in stress along the calcaneus. There was variation in the correlation between size of the diameter and the number of cycles to failure depending on the angle of the harvest. The greatest amount of stress applied at the calcaneus was with the 45°-90° model. It was determined that harvesting at an angle of 45° at 6mm produced the lowest number of cycles to failure.
Evaluation of Patient-Reported Outcome Measures in Patients Receiving Bio-Integrative Screws for Lisfranc Injuries: A Case Series Study
Authors: Ebrahimi Alireza , Lucaciu Andreea R. , Sohn Sora , Ashkani-Esfahani Soheil , Kwon John , Waryasz Gregory 
Published: December 2023

Category: Midfoot/Forefoot; Midfoot/Forefoot Introduction/Purpose: Lisfranc injury consists of a spectrum of injuries affecting the tarsometatarsal joint. Various fixation methods are used to treat Lisfranc injuries and each show different outcomes. Metal implants have been used for open reduction and internal fixation (ORIF) of Lisfranc injuries routinely. However, other than the complications in these patients, such as non- anatomical reduction, implant loosening, breakage, and arthrosis, most of these patients will undergo a second surgery for implant removal. Using bio-degradable and bio-integrative materials in these implants reduces the need for these re-operations; however, whether other complications reported for metal implants occur by using bio-integrative materials has yet to be proven. The aim of our study is to assess patient-reported outcome measures (PROMs) and complications in patients received bio-integrative screws for Lisfranc fixation. Methods: The inclusion criteria were 1) ≥ 18 years old, and 2) had ORIF for Lisfranc injury using bio-integrative (OSSIOfiber ™) screws. The patients’ charts were reviewed, and the variables were gathered, including the type of injury, pain score, and PROMs. The questionnaires used to evaluate PROMs were Patient-Reported Outcome Measurement Information System (PROMIS) surveys for physical function, pain interference, pain intensity, and depression. We also reported the average scores for these PROMs among a randomly sampled population of patients who had ORIF with metal screws for Lisfranc injuries for comparison (n=12). Results: We recruited 12 patients for this study. The minimum follow-up time of the patients in this study was three months. Out of 12 patients, 1 patient showed non-union. The mean (SD) PROMIS scores for physical function, pain interference, pain intensity, and depression were 43.9 (14.9), 56.1 (13.9), 45.9 (10.1), and 43.5 (4.9) in patients who received bio-integrative screws, respectively. In the sampled population treated with metal screws, these PROMs were 42.1 (9.5), 55 (10.1), 46.4 (8.1), and 44.4 (6.4) for physical function, pain interference, pain intensity, and depression, respectively. No significant difference was observed between the two groups regarding physical function (P=0.72), pain interference (P0.82), pain intensity (P=0.88), and depression (P=0.69). Conclusion: The current report showed promising patient-reported outcomes after Lisfranc ORIF with bio-integrative screws. However, longer term follow-ups, as well as comparison with a larger population for both types of instruments, bio-integrative and metal, will shed light on the pros and cons of both materials. Moreover, cost-effective studies are highly suggested to assess the usefulness of these implants against their costs for the healthcare system and the patients.
First Ray Mobility in Hallux Rigidus, Hallux Valgus, and Normal Feet Based on Weightbearing Computed Tomography and Three-Dimensional Analysis
Authors: Kimura Tadashi , Kubota Makoto , Kihara Takumi , Hattori Asaki , Suzuki Naoki , Saito Mitsuru 
Published: December 2023

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: Both hallux rigidus (HR) and hallux valgus (HV) are conditions that occur in the first ray. Although both are believed to originate from hypermobility of the first ray, they each ultimately result in different clinical feature. Hypermobility of the first ray is strongly involved in the pathogenesis of HV. In contrast, several studies have reported an association between HR and hypermobility of the first ray but few have actually analyzed the nature of that association. We hypothesized that in HR, there would be little rotational movement despite the presence of hypermobility of the first ray. The purpose of this study was to evaluate the first ray mobility in feet with HR, HV, and in healthy feet by using weightbearing and non-weightbearing CT and 3D analysis. Methods: In this case-control study, we examined 17 feet of 11 healthy volunteers with no history of foot disorders and no symptoms such as pain in the foot (control group), 16 feet of 16 patients with HV and 16 feet of 11 patients with HR. First, non- weightbearing foot CT imaging was performed with the participant supine on our original loading device, with the legs extended and the ankle in a neutral position, and then weightbearing CT imaging was performed by applying a load equivalent to body weight. Using an iterative closest point algorithm, each joint in the first ray—the talonavicular joint, the medial cuneonavicular joint, and the first tarsometatarsal (TMT) joint—was aligned using its respective proximal bone. Displacement of the distal bone relative to the proximal bone was quantified in 3D under both weightbearing and non-weightbearing conditions. Results: In the talonavicular joint, the HV group showed significantly greater eversion (p = 0.011) than the control group, and greater dorsiflexion (p = 0.027) and eversion (p < 0.01) than the HR group. In the medial cuneiform joint, the HV group showed significantly greater eversion (p < 0.01) and abduction (p = 0.011) than the control group. In the first TMTl joint, the HV group showed significantly greater dorsiflexion (p = 0.014), inversion (p = 0.028), and adduction (p < 0.01) than the control group, and greater inversion (p < 0.01) and adduction (p < 0.01) than the HR group. The HR group showed significantly greater dorsiflexion (p = 0.026) than the control group. Conclusion: In the present study, hypermobility was observed at the first TMT in both HV and HR. However, the changes in HR were mainly in the sagittal plane, whereas those in HV were in all three planes. This difference may explain the different clinical feature ultimately observed in each condition. Future studies involving comparison of various severity levels and postoperative analysis should elucidate the pathophysiology and contribute to selection of appropriate treatment as well as the development of new treatments for HV and HR.