bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving fragility hip fracture care through data: a multicentre experience from a country with an emerging economy during the COVID-19 pandemic
Authors: Tabu Irewin A , Araneta Karla Teresa S , Alpuerto Bernardino B , Delgado Giorgio D , Lai Joseph Garvy L , San Juan Jose Antonio G , Ho, Alexander , Reyes Ma. Ramona B , De Vera Jose , Syquia Jose Fernando C , Manalastas Rene Edgardo C , Tablante Adrian Joseph C , Brabante Allan Michael T , Dimayuga Cesar Cipriano D , Pacheco Deejay M , Baclig Phillipe Y , Co Andrew Steven T , Yap John Alfred D 
Published: October 2023

IntroductionIn low-to-middle-income countries (LMIC), the orthogeriatric model of care is still in its early stages of development. This study describes the initial results of the first online fragility hip fracture database to be setup in the Philippines using a modified minimum common dataset to generate outcomes data based on current hospital practices.MethodsA multicentre prospective cohort study among 12 Philippine hospitals was conducted from June 2020 to February 2021. Thirty-day mortality, morbidity and mobility were measured. Significant factors associated with mortality were determined.Results158 elderly patients with fragility hip fractures were included in the study. Nine patients (5.7%) were confirmed or suspected to have COVID-19 infection. Median time of injury to admission was at least 3 days (IQR: 1.0–13.7). Overall, 80% of patients underwent surgical intervention with a median time from admission to surgery of at least 5 days (IQR: 2.5–13.6). Thirty-day mortality and morbidity rates for acute fragility fractures were 3.7%. Factors significantly associated with early mortality were poor prefracture mobility, COVID-19 infection, radiograph of the abnormal chest and conservative treatment. Non-surgical patients had no functional mobility or were wheelchair users and had a significantly higher morbidity rate than surgically treated patients (13.6% vs 1.8%; p=0.031).ConclusionDespite treatment delays unique to an LMIC, short-term outcomes remain favourable for non-COVID-19 fragility hip fracture patients treated with surgery. Prompt admission and multidisciplinary care for elderly hip fracture patients while maintaining protective measures for COVID-19 infection control are recommended. The quality of data collected illustrates how this online database can provide a framework for a sustainable audit or registry as well as provide a platform for the introduction of orthogeriatric concepts at a multiregional scale.
Primary care teams’ reported actions to improve medication safety: a qualitative study with insights in high reliability organising
Authors: Young Richard A , Gurses Ayse P , Fulda Kimberly G , Espinoza Anna , Daniel Kathryn M , Hendrix Zachary N , Sutcliffe Kathleen M , Xiao Yan 
Published: September 2023

BackgroundOur aim was to understand actions by primary care teams to improve medication safety.MethodsThis was a qualitative study using one-on-one, semistructured interviews with the questions guided by concepts from collaborative care and systems engineering models, and with references to the care of older adults. We interviewed 21 primary care physicians and their team members at four primary care sites serving patients with mostly low socioeconomic status in Southwest US during 2019–2020. We used thematic analysis with a combination of inductive and deductive coding. First, codes capturing safety actions were incrementally developed and revised iteratively by a team of multidisciplinary analysts using the inductive approach. Themes that emerged from the coded safety actions taken by primary care professionals to improve medication safety were then mapped to key principles from the high reliability organisation framework using a deductive approach.ResultsPrimary care teams described their actions in medication safety mainly in making standard-of-care medical decisions, patient-shared decision-making, educating patients and their caregivers, providing asynchronous care separate from office visits and providing clinical infrastructure. Most of the actions required customisation at the individual level, such as limiting the supply of certain medications prescribed and simplifying medication regimens in certain patients. Primary care teams enacted high reliability organisation principles by anticipating and mitigating risks and taking actions to build resilience in patient work systems. The primary care teams’ actions reflected their safety organising efforts as responses to many other agents in multiple settings that they could not control nor easily coordinate.ConclusionsPrimary care teams take many actions to shape medication safety outcomes in community settings, and these actions demonstrated that primary care teams are a reservoir of resilience for medication safety in the overall healthcare system. To improve medication safety, primary care work systems require different strategies than those often used in more self-contained systems such as hospital inpatient or surgical services.
Are there differences in the relationship between respiratory rate and oxygen saturation between patients with COVID-19 and those without COVID-19? Insights from a cohort-based correlational study
Authors: Laredo Mikael , Vandiedonck Claire , Miró Òscar , González del Castillo Juan , Alquézar-Arbé Aitor , Jacob Javier , Piñera Pascual , Mégarbane Bruno 
Published: October 2023

BackgroundPhysicians have observed patients with COVID-19 without respiratory distress despite marked hypoxaemia and extensive radiographic abnormalities, a controversial phenomenon called ‘silent hypoxaemia’. We aimed to compare the relationship between RR and peripheral oxygen saturation (SpO2) in patients with COVID-19 versus patients without COVID-19 when breathing air on admission.MethodsWe conducted a retrospective multicentre ED cohort correlational study.We used the Spanish Investigators on Emergency Situations TeAm network cohort of patients with COVID-19 admitted to 61 Spanish EDs between March and April 2020. The non-COVID-19 cohort included patients with lower respiratory tract bacterial infections admitted between January 2016 and April 2018.We built a multivariable linear model to investigate the independent predictive factors related to RR and a logistic multivariate regression model to analyse the presence of ‘silent hypoxaemia’.ResultsWe included 1094 patients with COVID-19 and 477 patients without COVID-19. On admission, RR was lower (20±7 vs 24±8/min, p<0.0001), while SpO2higher (95±5% vs 90±7%, p<0.0001) in patients with COVID-19 versus patients without COVID-19. RR was negatively associated with SpO2(RR decreasing with increasing age, beta=−0.37, 95% CI (−0.43; −0.31), p<0.0001), positively associated with age (RR increasing with increasing age, beta=0.05, 95% CI (0.03; 0.07), p<0.0001) and negatively associated with COVID-19 status (RR lower in patients with COVID-19, beta=−1.90, 95% CI (−2.65; −1.15), p<0.0001). The negative RR/SpO2correlation differed between patients with COVID-19 aged <80 and ≥80 years old (p=0.04). Patients with COVID-19 aged ≥80 years old had lower RR than patients without COVID-19 aged ≥80 years old at SpO2values <95% (22±7 vs 24±8/min, p=0.004). ‘Silent hypoxaemia’ defined as RR <20/min with SpO2<95% was observed in 162 (14.8%) patients with COVID-19 and in 79 (16.6%) patients without COVID-19 (p=0.4). ‘Silent hypoxaemia’ was associated with age ≥80 years (OR=1.01 (1.01; 1.03), p<0.0001) but not with gender, comorbidities and COVID-19 status.ConclusionThe RR/SpO2relationship before oxygen administration does not differ between patients with COVID-19 and those without COVID-19, except in elderly patients.
Population frailty trends by education and income levels over a period of 30 years: findings from Swedish registry data
Authors: Wennberg Alexandra , Tao Yining , Ek Stina , Modig Karin 
Published: October 2023

BackgroundFrailty is an age-related health condition affecting an estimated 18% of older adults in Europe and past evidence has shown a relationship between socioeconomic factors and frailty. We examined population frailty trends and the association between frailty and 5-year mortality by education tertiles and income quartiles at ages 75, 85 and 95 in Swedish registry data.MethodsAll Swedish residents born in 1895–1945 and in the Total Population Register from 1990 to 2020 were included. Frailty was assessed with the Hospital Frailty Risk Score (HFRS), which sums 109 weighted International Classification of Diseases (ICD codes), collected from the National Patient Register.ResultsRegardless of education and income, frailty increased over time, though the association between frailty and 5-year mortality remained stable. Particularly in earlier birth cohorts, although the highest education and income levels had the highest mean HFRS scores, the lowest education and income levels accounted for greater proportions among the frail. These trends varied slightly by sex and age. Men and women had similar levels of frailty, but frailty was more strongly associated with mortality among men.ConclusionOver time, education and income levels were more equally represented among the frail population in more recent years. More equitable distribution over time may suggest improvement in health disparities, though more work is needed. The overall increase in frailty and unchanged association with mortality indicates that additional research is needed to better understand how to best support the growing ageing population. This would then support the long-term viability of the healthcare system.
One-year direct and indirect costs of ischaemic stroke in China
Authors: Lv Wei , Wang Anxin , Wang Qianyi , Wang Ruimin , Xu Qin , Wu Shuqing , Han Yi , Jiang Yong , Lin Jinxi , Jing Jing , Li Hao , Wang Yongjun , Meng Xia 
Published: October 2023

BackgroundThis is the first real-world study to estimate the direct costs and indirect costs of first-ever ischaemic stroke with 1-year follow-up in China, based on a nationally representative sample.MethodsPatients were chosen from 20 geographically diverse sites from the nationally representative database China National Stroke Registry-III (CNSR-III). The inclusion criteria were surviving patients who were hospitalised with first-ever ischaemic stroke from February 2017 to February 2018 (the index event); aged 18–80 during the index event; no history of other stroke types. The primary endpoints were direct medical costs, direct non-medical costs, indirect costs and total cost (ie, the sum of all cost components). Patient characteristics and clinical data were extracted from CNSR-III. Stroke-related in-hospital direct medical costs were collected from hospital electronic medical records. The patient survey collected data related to out-of-hospital direct medical costs, direct non-medical costs and indirect costs. The secondary objective was to explore clinical factors associated with cost outcomes through univariate analysis and multiple regression.ResultsThe study enrolled 520 patients. The total cost was 57 567.48 CNY, with 26 612.67 CNY direct medical costs, 2 787.56 CNY direct non-medical costs and 28 167.25 CNY indirect costs. Univariate analysis showed that longer lengths of stay during the index event, higher National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale scores were associated with higher costs in all categories. Conversely, EuroQol 5 Dimension utility scores were associated with decreased costs except direct non-medical costs. Multiple regressions showed that higher admission NIHSS scores were independently associated with higher direct medical costs, indirect costs and total cost. Higher 3-month utilities were associated with lower total cost.ConclusionThis real-world study showed substantial 1-year economic burden following first-ever ischaemic stroke in China, and that indirect costs are a non-negligible driver of costs.
ℤ-gradings on the Grassmann algebra over infinite fields: Graded identities and central polynomials
Authors: Fideles Claudemir , Guimarães Alan 
Published: September 2023

Let E be the infinite-dimensional Grassmann algebra over an infinite field F of characteristic different from 2. The main purpose of this paper is to describe the [Formula: see text]-ideal of the graded polynomial identities and the [Formula: see text]-space of the central polynomials of E equipped with its [Formula: see text] and 3-induced [Formula: see text]-gradings. Therefore, we generalize the results of [A. Brandão, C. Fidelis and A. Guimarães, [Formula: see text]-gradings of full support on the Grassmann algebra, J. Algebra 601 (2022) 332–353; C. Fidelis, A. Guimarães and P. Koshlukov, A note on [Formula: see text]-gradings on the Grassmann algebra and elementary number theory, Linear Multilinear Algebra 71(7) (2023) 1244–1264] in the PI theory context.
Only Half the Truth. Proclus on Aristotle’s Deficient Metaphysics
Authors: Marinescu Rareș Ilie 
Published: September 2023

Abstract
In this paper I argue that Proclus’ criticism of the causality of Aristotle’s intellect is part of a general attack on Aristotle’s metaphysics. I show how Proclus criticises Aristotle for rejecting the One as a metaphysical principle and the metaphysical confusion that arises from this. Additionally, I claim that for Proclus Aristotle’s understanding of efficient causality differs from Plato’s and I discuss two of his arguments that Aristotle should have accepted the intellect as an efficient cause. As I show throughout, Proclus differs in his approach to Aristotle from the harmonising agenda of Ammonius and Simplicius.
Ontogeny of sleeping behaviour in four solitary species of Anolis lizard
Authors: Barnett Joseph , Poe Steven 
Published: September 2023

Abstract
Despite the nearly ubiquitous nature of sleep in the animal kingdom, behavioural research on sleep has focused on a few model organisms and widespread behaviours studied in artificial laboratory settings. In this study, we examine the ontogeny of sleeping perch selection in four closely related species of arboreal lizard in situ. The study species each occupy similar habitats and share ‘solitary’ ecology wherein potential lizard competitors are absent, thus providing four partially independent replicates with which to test hypotheses. We find that structural niche, analysed as perch height, varies by age and sex. Males sleep higher than females and adults sleep higher than juveniles in three of four species. Adults exhibit greater variability in sleep site selection. These patterns may reflect diurnal behaviour or indicate selective differences in sleeping perch variability across sex and ontogeny.
Applying Pillar Three of the Responsibility to Protect in Sudan
Authors: Wood Mark J. 
Published: October 2023

Abstract
With a prolonged war being played out in Sudan at the expense of civilian lives it is time to revisit the framework of the Responsibility to Protect and assess its merits in the new Sudan context. This article argues that through the structures of the United Nations, the Responsibility to Protect framework, the African Union and the African Union Constitutive Act, legal instruments can and should be implemented to stop the atrocities occurring. It provides examples from recent history that serve as a reference for deploying a peacekeeping stabilisation force in Sudan.
The Partisans: Civilian Support & Indirect Violence
Authors: Barter Shane Joshua 
Published: September 2023

Abstract
Although also victims, there is a growing appreciation that civilians are actors in civil wars. Scholarship on civilian agency shows how their decisions impact well-being and shape conflict dynamics. Civilians are increasingly framed as impartial forces resisting armed groups and cultivating peace. However, civilians are as likely to support armed groups and deepen violence. This paper seeks to better understand civilian partisanship. I frame forms of civilian support that enhance the coercive capacities of armed groups as ‘indirect violence’. Some forms of support, such as refusing to provide information or protesting enemy abuses, may reduce violence, while providing food or medicine is more neutral. Other actions, such as contributing funds, intelligence, recruits, and weapons, enable armed groups to carry out violence. That civilians contribute indirect violence does not mean they are not victims, but may call their innocence into question, providing a sober account of civilians in civil war.
The Impact of Ketamine for Treatment of Post-Traumatic Stress Disorder: A Systematic Review With Meta-Analyses
Authors: Sicignano Dakota J. , Kurschner Ryan , Weisman Nissen , Sedensky Ava , Hernandez Adrian V. , White C. Michael 
Published: September 2023

Background: Ketamine has been used in anesthesia, pain management, and major depressive disorder. It has recently been studied in patients with post-traumatic stress disorder (PTSD). Objective: To determine the impact of ketamine on PTSD symptomatology and depression scores. Methods: We conducted a literature search of Medline 1960 to May 20, 2023, and found 6 randomized controlled trials that met our inclusion criteria. We extracted data on the Clinician-Administered PTSD (CAPS), PTSD Checklist (PCL), or Montgomery-Asberg Depression Rating (MADRS) scales. Results: The use of ketamine significantly reduced CAPS scores (n = 5, MD: −10.63 [95% CI −14.95 to −6.32]), PCL scores (n = 3, MD: −6.13 [95% CI −8.61 to −3.64]), and MADRS scores (n = 3, MD: −6.33 [95% CI −8.97 to −3.69]) at the maximal follow-up times versus control. Significant benefits were found at day 1 and weeks 1, 2, and 4 for CAPS and PCL scores as well as MADRS scores at day 1, week 1, and week 4 for ketamine versus control. The time to PTSD relapse was prolonged in the patients receiving ketamine versus control (n = 2, 15.74 days [95% CI 3.57 to 29.91 days]). More dry mouth (n = 2, OR 5.85 [95% CI 1.32 to 25.95]), dizziness (n = 2, OR 3.83 [95% CI 1.28 to 11.41]), and blurred vision (n = 2, OR 7.57 [1.00 to 57.10]) occurred with ketamine than control therapy. Conclusions and Relevance: Ketamine modestly reduced PTSD and depression scores as early as 1 day of therapy, but the longevity of effect needs to be determined. Given similar magnitude of benefit with SSRIs and venlafaxine, ketamine would not supplant these traditional options for chronic use.
Tracking Needs-Based Community and Specialized Services of Young Adults and Their Parents Before and During a First Episode of Psychosis (FEP): Highlighting Intervention Trajectories in FEP
Authors: Morin Marie-Hélène , Proulx Maryse 
Published: September 2023

Aim: This article aims to document 10 service trajectories of young adults (YA) and their parents, informed by healthcare professionals (HP), before and during a first episode of psychosis (FEP). Design: Based on a crisis model perspective of the Life Course Theory (Elder; Elder and Shanahan) developed by Carpentier and White, and adapted to the current context to track community and specialized services trajectories. Thematic analysis was used to code responses to open-ended questions around the need for help and accessing services by young adults affected by a psychotic disorder, and their parents. Setting: In collaboration with FEP clinics, setting of choice by YA and their parents. Participants: 5 YA, 12 parents, and 6 HP. Results: 10 individual service trajectories grouped into 3 distinct types of trajectories (optimal, typical, and complex) based on grouping 5 similar characteristics, highlighting service access complexity and early intervention in FEP. Conclusion: This study is the first of its kind to examine the experiences of those who seek needs-based community and specialized services leading up to and during a FEP. Findings provide key insights related to early intervention in FEP and recommendations on improving access to such services in Quebec.
Pregnant and lactating people’s strategies to mitigate the risk of cannabis consumption
Authors: Popoola Anuoluwa , Panday Janelle , Taneja Shipra , Greyson Devon , McDonald Sarah D. , Patel Tejal , Darling Elizabeth , Vanstone Meredith 
Published: September 2023

Background: Multiple studies have demonstrated that pregnant and lactating people who use cannabis perceive a variety of benefits from that use, offering some explanation of why rates of use continue to increase. Objectives: The aim of this study was to explore pregnant and lactating people’s perceptions of the risks of cannabis use and understand what steps, if any, they take to mitigate these risks. Design: Qualitative description. Methods: We analyzed semi-structured interviews with 52 Canadians who made the decision to start, stop, or continue using cannabis during pregnancy or lactation between 2019 and 2021. Data collection iterated with analysis. We used a conventional (inductive) approach to content analysis. Results: Perception of risk was found to be an essential component of decision-making about cannabis use. We identified a cycle of “risk identification,” “management,” and “observation” of effects. First, the pregnant or lactating person assesses the risks and weighs them against the perceived benefits of cannabis use. Second, they take action to minimize risks, with some choosing abstinence. Others, often those who were using cannabis to manage symptoms, continued cannabis use but devised a variety of other risk mitigation strategies such as, decreasing the amount or frequency of their use, changing the form of cannabis, and strategically timing their use with caregiving responsibilities. The final stage of the cycle involves seeking information about whether or not the initial perceived risk has manifested after implementing mitigation strategies, through observations and clinical information about the pregnancy or child. Conclusion: Participants consistently engaged in deliberation about the risks and benefits associated with their perinatal cannabis use. Nearly all implemented strategies intended to minimize risk. Our results highlight the need for more research to inform clear public health messaging about risk mitigation to minimize the potential harms of perinatal cannabis use. This work informs clinicians about patient-perceived risks and mitigation strategies which could in turn help inform shared decision-making conversations.
Self-Management of Long-Term Physical Conditions During Emerging Adulthood: A Systematic Review
Authors: Mooney Orla , Lambert Veronica , Gallagher Pamela 
Published: September 2023

The aim of this mixed-studies systematic review was to synthesise existing research to identify if the five features of emerging adulthood (identity exploration; instability; self-focus; feeling in-between; possibilities) were evident in the self-management of long-term physical conditions by emerging adults (aged 18 – 29 years old). Five databases were systematically searched. Thirty papers met the eligibility criteria and were included. The synthesis identified that the five features of emerging adulthood are present in the self-management strategies and tasks of emerging adults living with long-term physical conditions. Due to numerous transitions, that characterise this unstable developmental period, emerging adults encounter specific self-management challenges. However, a greater understanding of the extent to which each of the five features are present and the challenges posed to the self-management of a long-term physical condition in emerging adults is required. This will inform targeted self-management supports and interventions in the future.