bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimizing Outpatient Radiation Oncology Consult Workflow by Using Time-Driven Activity-Based Costing: Efficiency and Financial Impacts
Authors: Weng Julius , Mesko Shane , Chronowski Gregory , Lee Percy , Choi Seungtaek , Das Prajnan , Koong Albert C. , French Katy , Aloia Thomas , Ehlers Richie , Elrod-Joplin Dorothy , Kerr Ashley , Smith Regina , Martinez Wendi , Bloom Elizabeth , Shah Shalin J. , Ning Matthew S. , Liao Zhongxing , Herman Joseph , Moningi Shalini , Moreno Amy C. , Nguyen Quynh-Nhu 
Published: February 2024

PURPOSE Clinical efficiency is a key component of value-based health care. Our objective here was to identify workflow inefficiencies by using time-driven activity-based costing (TDABC) and evaluate the implementation of a new clinical workflow in high-volume outpatient radiation oncology clinics. METHODS Our quality improvement study was conducted with the Departments of GI, Genitourinary (GU), and Thoracic Radiation Oncology at a large academic cancer center and four community network sites. TDABC was used to create process maps and optimize workflow for outpatient consults. Patient encounter metrics were captured with a real-time status function in the electronic medical record. Time metrics were compared using Mann-Whitney U tests. RESULTS Individual patient encounter data for 1,328 consults before the intervention and 1,234 afterward across all sections were included. The median overall cycle time was reduced by 21% in GI (19 minutes), 18% in GU (16 minutes), and 12% at the community sites (9 minutes). The median financial savings per consult were $52 in US dollars (USD) for the GI, $33 USD for GU, $30 USD for thoracic, and $42 USD for the community sites. Patient satisfaction surveys (from 127 of 228 patients) showed that 99% of patients reported that their providers spent adequate time with them and 91% reported being seen by a care provider in a timely manner. CONCLUSION TDABC can effectively identify opportunities to improve clinical efficiency. Implementing workflow changes on the basis of our findings led to substantial reductions in overall encounter cycle times across several departments, as well as high patient satisfaction and significant financial savings.
Machine Learning Identifies Metabolic Dysfunction–Associated Steatotic Liver Disease in Patients With Diabetes Mellitus
Authors: Nabrdalik Katarzyna , Kwiendacz Hanna , Irlik Krzysztof , Hendel Mirela , Drożdż Karolina , Wijata Agata M , Nalepa Jakub , Janota Oliwia , Wójcik Wiktoria , Gumprecht Janusz , Lip Gregory Y H 
Published: February 2024

AbstractContextThe presence of metabolic dysfunction–associated steatotic liver disease (MASLD) in patients with diabetes mellitus (DM) is associated with a high risk of cardiovascular disease, but is often underdiagnosed.ObjectiveTo develop machine learning (ML) models for risk assessment of MASLD occurrence in patients with DM.MethodsFeature selection determined the discriminative parameters, utilized to classify DM patients as those with and without MASLD. The performance of the multiple logistic regression model was quantified by sensitivity, specificity, and percentage of correctly classified patients, and receiver operating characteristic (ROC) curve analysis. Decision curve analysis (DCA) assessed the model's net benefit for alternative treatments.ResultsWe studied 2000 patients with DM (mean age 58.85 ± 17.37 years; 48% women). Eight parameters: age, body mass index, type of DM, alanine aminotransferase, aspartate aminotransferase, platelet count, hyperuricaemia, and treatment with metformin were identified as discriminative. The experiments for 1735 patients show that 744/991 (75.08%) and 586/744 (78.76%) patients with/without MASLD were correctly identified (sensitivity/specificity: 0.75/0.79). The area under ROC (AUC) was 0.84 (95% CI, 0.82-0.86), while DCA showed a higher clinical utility of the model, ranging from 30% to 84% threshold probability. Results for 265 test patients confirm the model's generalizability (sensitivity/specificity: 0.80/0.74; AUC: 0.81 [95% CI, 0.76-0.87]), whereas unsupervised clustering identified high-risk patients.ConclusionA ML approach demonstrated high performance in identifying MASLD in patients with DM. This approach may facilitate better risk stratification and cardiovascular risk prevention strategies for high-risk patients with DM at risk of MASLD.
European Health Data Space: A New Era in EU Health
Authors: Kotsareli Kalliopi , Tsachouridis Petros 
Published: February 2024

After the COVID-19 pandemic, the European Union (EU) put in action the plan to create a European Health Union, the structural pillar of which is the creation of the European Health Data Space (EHDS). In 2022, the European Commission presented the proposal for a regulation for its creation. Its purpose is to enable European citizens to control their health data and to strengthen health research and innovation in the EU. The EHDS is a key step in the transition to digital health in the EU. Digital health is the means to enhance the resilience of healthcare systems in the EU as it will strengthen healthcare. For this reason, the "MyHealth@EU" platform is being created, which will contribute both to the transfer of primary data and to checking the validity of digital health documents. On the research and innovation side, the “HealthData@EU” platform is being developed, which will bring together a plethora of health data. The EHDS Board will play a coordinating role in the EHDS project. The policy brief concludes with the need for an immediate adoption of the proposed EHDS Regulation, which will contribute to improving healthcare provision while completing the single internal market and achieving the free circulation of health data.
Sentinel-2 water indexes application for the underground water level analyses in Ovidiopol area of Odessa region
Authors: Kadurin S. , Shatalin S. , Oprits G. , Fedoronchuk N. , Potapov A. 
Published: February 2024

Studied area has a high level of agricultural development. There are different irrigation and drainage systems located there. Significant part of the supplied water losses from the irrigation network because of filtration and reaches the groundwater level, which begins to rise. Control and analyses of groundwater level changes with remote sensing methods for Ovidiopol area is the main goal of that work. The object of study is the groundwater level regime in the territory of Lower Dniester irrigation system in Ovidiopol district, Odessa region. The subject of research is water indexes application for analyses of groundwater level changes. The local system of groundwater observation includes 7 drillholes in Nadlimanskoe village and around. These drillholes located in different geomorphological, hydrogeological and technogenic conditions. The groundwater level was surveyed monthly in 2017. Sentinel-2 2A images for each month from March 2017 to December 2017 were used for studied area. All satellite images has atmospheric correction. Three water indexes NDWI, MNDWI, NDPI were calculated for drillhole points for each month in 2017 year. Significant correlation coefficients obtained in comparison between groundwater level changes and water indexes in some drillholes points. The highest numbers of correlation connected with free of construction areas and for drillholes, which are located outside of villages.
Political Influence, Bank Capital, and Credit Allocation
Authors: Huang Sheng , Thakor Anjan V. 
Published: February 2024

Political influence on bank credit allocation is often viewed as being necessary to address social problems like income inequality. We hypothesize that such influence elicits bank capital responses. Our hypothesis yields three testable predictions for which we find supporting evidence. First, when banks observe election outcomes that suggest greater impending political credit-allocation influence, they reduce capital to increase fragility and deter political influence. Second, banks subject to greater political influence nonetheless increase lending that politicians favor, and household consumption consequently increases. Third, these banks exhibit poorer post-lending performance. Our study has implications for the interaction between politics, household consumption, and bank risk through a specific channel—the interplay between credit-allocation regulation and bank capital structure. This paper was accepted by Victoria Ivashina, finance. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2022.04056 .
Impact of haemoglobin A1c on wound infection in patients with diabetes with implanted synthetic graft
Authors: Matić Predrag , Atanasijević Igor , Stojković Vera Maravić , Soldatović Ivan , Tanasković Slobodan , Babić Srđan , Gajin Predrag , Lozuk Branko , Vučurević Goran , Đoković Aleksandra , Živić Rastko , Đulejić Vuk , Nešković Mihailo , Babić Aleksandar , Ilijevski Nenad 
Published: February 2024

Objective: The aim of this study was to assess the relationship between haemoglobin A1c (HbA1c) values and operative wound infection Method: During the period from 2013–2016, consecutive patients with type 2 diabetes were prospectively evaluated. Data were retrospectively analysed. All included patients were admitted for an elective surgical procedure, requiring the use of prosthetic graft in a groin wound. The patients were divided into two groups according to their preoperative HbA1c values. The main outcome was groin wound infection. The association between preoperative long-term glycoregulation and wound infection was evaluated, as well as the impact of postoperative glycaemic values, regardless of the level of HbA1c. Results: Of the 93 participating patients, wound infection occurred in 20 (21.5%). Wound infection occurred in 28.2% of patients with uncontrolled diabetes (HbA1c >7%) and 16.7% of patients with controlled diabetes (HbA1c <7%); however, the difference did not reach statistical significance (p=0.181). In regression modelling, operative time (p=0.042) was a significant predictor of wound infection, while patients' age (p=0.056) was on the borderline of statistical significance. Females had a higher probability for wound infection (odds ratio (OR): 1.739; 95% confidence interval (CI):0.483–6.265), but there was no statistical significance (p=0.397). Patients with elevated levels of HbA1c had a higher chance of wound infection compared with patients with controlled diabetes (OR: 2.243; 95% CI: 0.749–6.716), nevertheless, this was not statistically significant (p=0.149). Conclusion: We found no statistically significant correlation between elevated values of preoperative HbA1c and postoperative groin wound infection.
TOTAL HIP ARTHROPLASTY OR HIP HEMIARTHROPLASTY: WHAT IS THE CORRECT CHOICE IN ALCOHOLICS AGED 40 TO 65 YEARS?
Authors: Gunia D. M. , Pethers D. , Mackenzie N. , Stark A. , Jones B. 
Published: February 2024

NICE Guidelines suggest patients should be offered a Total Hip Replacement (THR) rather than Hemiarthroplasty for a displaced intracapsular hip fracture. We investigated outcomes of patients aged 40–65 who received a THR or Hemiarthroplasty following a traumatic intracapsular hip fracture and had either high-risk (Group 1) or low-risk (Group 2) alcohol consumption (>14 or <14 units/week respectively).This was a retrospective study (April 2008 – December 2018) evaluating patients who underwent THR or Hemiarthroplasty in Greater Glasgow and Clyde. Atraumatic injuries, acetabular fractures, patients with previous procedures on the affected side and those lost to follow up were excluded. Analysis of length of admission, dislocation risk, periprosthetic fractures, infection risk, and mortality was conducted between both cohorts.Survival time post-operatively of Group 1 patients with a THR (61.9 months) and Hemiarthroplasty (42.3 months) were comparable to Group 2 patients with a THR (59 months) and Hemiarthroplasty(42.4 months). Group 1 patients with THR had increased risk of dislocation (12.9%; p=0.04) compared to those that received Hemiarthroplasty (2.5%). Group 1 Hemiarthroplasty patients had increased wound infection risk (11.6%) compared to Group 2 (3.7%).In conclusion, we found that amongst our population the life expectancy of a post-operative patient was short irrespective of whether they had high or low-risk alcohol consumption. A hip fracture may represent increased frailty in our study population. The Group 1 THR cohort presented a higher risk of hip dislocation and periprosthetic fracture. With this in mind, Hemiarthroplasty is a more cost-effective and shorter operation which produces similar results.
MEDIUM-TERM OUTCOMES FOLLOWING STEMLESS ANATOMIC TOTAL SHOULDER ARTHROPLASTY: CLINICAL AND RADIOLOGICAL FINDINGS (MINIMUM FIVE-YEAR FOLLOW-UP)
Authors: Dixon J. E. , Rankin I. A. , Sciberras N. , Khan L. A. K. , Barker S. L. , Cairns D. A. , Kumar K. 
Published: February 2024

In recent years, use of anatomic stemless total shoulder arthroplasty (AsTSA) has increased. Despite evidence to suggest good mid-term results at 2-year follow-up there is a paucity of evidence for longer term follow-up. This study aimed to investigate outcomes at a minimum of 5 years post-operatively following primary AsTSA.This study is a retrospective case series of all patients who underwent a Mathys Affinis AsTSA from July 2010 (first case) to August 2018 (to allow minimum 5-year follow-up). Clinical outcomes included revision rate, range of motion and patient reported outcomes (Oxford Shoulder Score and Numerical Satisfaction Score). Radiological outcome was assessment of radiolucent lines for Lazarus grading.A total of 105 stemless TSAs were implanted. Five patients underwent revision (4.8%). Seventy-five AsTSA's were included in the final study for analysis of 5-year outcomes. Median follow-up time was 6.1 years. Median age was 69 years old and 81% were female. Oxford shoulder score showed a range of 18 to 48, with a median score of 47. Satisfied or very Satisfied was selected in 94.37%. Median range of motion assessments showed forward elevation 160°, abduction 150°, external rotation 40°, and mode internal rotation was to the lumbar spine. No glenoid lucency was present in 79.7%. There were 9.5% with Lazarus Grade 1 lucency, 5.4% with Lazarus Grade 2, and 5.4% Lazarus Grade 3. No humeral lucency was observed.This cohort study demonstrates promising clinical and radiological outcomes for the Mathys Affinis Stemless TSA at minimum 5 years post-operatively.
A PROSPECTIVE RANDOMIZED TRIAL OF OPERATIVE VERSUS NONOPERATIVE MANAGEMENT OF FRACTURES OF THE HUMERAL DIAPHYSIS: THE HUMERAL SHAFT FRACTURE FIXATION (HU-FIX) STUDY
Authors: Oliver W. M. , Bell K. R. , Carter T. H. , White T. O. , Clement N. D. , Duckworth A. D. , Molyneux S. G. 
Published: February 2024

This single-centre prospective randomised trial aimed to assess the superiority of operative fixation compared with non-operative management for adults with an isolated, closed humeral shaft fracture.70 patients were randomly allocated to either open reduction and internal fixation (51%, n=36/70) or functional bracing (49%, n=34/70). 7 patients did not receive their assigned treatment (operative n=5/32, non-operative n=2/32); results were analysed based upon intention-to-treat. The primary outcome measure was the DASH score at 3 months. Secondary outcomes included treatment complications, union/nonunion, shoulder/elbow range of motion, pain and health-related quality of life (HRQoL).At 3 months, 66 patients (94%) were available for follow-up; the mean DASH favoured surgery (operative 24.5, non-operative 39.4; p=0.006) and the difference (14.9 points) exceeded the MCID. Surgery was also associated with a superior DASH at 6wks (operative 38.4, non-operative 53.1; p=0.005) but not at 6 months or 1yr. Brace-related dermatitis affected 7 patients (operative 3%, non-operative 18%; OR 7.8, p=0.049) but there were no differences in other complications. 8 patients (11%) developed a nonunion (operative 6%, non-operative 18%; OR 3.8, p=0.140). Surgery was associated with superior early shoulder/elbow range of motion, and pain, EuroQol and SF-12 Mental Component Summary scores. There were no other differences in outcomes between groups.Surgery confers early advantages over bracing, in terms of upper limb function, shoulder/elbow range of motion, pain and HRQoL. However, these benefits should be considered in the context of potential operative risks and the absence of any difference in patient-reported outcomes at 1yr.
CEPHALOMEDULLARY NAILING FOR SUBTROCHANTERIC FEMORAL SHAFT FRACTURES: A COMPARISON OF SINGLE LAG SCREW WITH A DUAL LAG SCREW DEVICE
Authors: Ablett A. D. , McCann C. , Feng T. , Macaskill V. , Oliver W. M. , Keating J. F. 
Published: February 2024

This study compares outcomes of fixation of subtrochanteric femoral fractures using a single lag screw (Gamma3 nail, GN) with a dual lag screw device (InterTAN nail, IN). The primary outcome was mechanical failure, defined as lag screw cut-out, back-out, nail breakage or peri-implant fracture. Technical factors associated with mechanical failure were also identified.All adult patients (>18yrs) with a subtrochanteric femoral fracture treated in a single centre were retrospectively identified using electronic records. Included patients underwent surgical fixation using either a long GN (2010–2017) or IN (2017–2022). Cox regression analysis was used to determine the risk of mechanical failure and technical predictors of failure.The study included 587 patients, 336 in the GN group (median age 82yrs, 73% female) and 251 in the IN group (median age 82yrs, 71% female). The IN group exhibited a higher prevalence of osteoporosis (p=0.002) and CKD□3 (p=0.007). There were no other baseline differences between groups. The risk of any mechanical failure was increased two-fold in the GN group (HR 2.51, p=0.020). Mechanical failure comprising screw cut-out (p=0.040), back-out (p=0.040) and nail breakage (p=0.51) was only observed in the GN group. The risk of peri-implant fracture was similar between the groups (HR 1.10, p=0.84). Technical predictors of mechanical included varus >5° for cut-out (HR 15.61, p=0.016), TAD>25mm for back-out (HR 9.41, p=0.020) and shortening >1cm for peri-implant fracture (HR 6.50, p=<0.001).Dual lag screw designs may reduce the risk of mechanical complications for patients with subtrochanteric femoral fractures.
A NATIONWIDE MULTICENTRE STUDY EVALUATING THE PREVALENCE, CASEMIX, AND MANAGEMENT OF PERIPROSTHETIC FEMUR FRACTURES: THE SCOTTISH NATIONAL AUDIT OF PERIPROSTHETIC FEMUR FRACTURES (SNAP FEMUR) INITIAL REPORT
Authors: Hall A. J. , Clement N. D. , Farrow L. , Kennedy J. W. , Harding T. , Duckworth A. D. , Maclullich A. M. J. , Walmsley P. 
Published: February 2024

Periprosthetic femur fracture (PPF) are heterogeneous, complex, and thought to be increasingly prevalent. The aims were to evaluate PPF prevalence, casemix, management, and outcomes.This nationwide study included all PPF patients aged >50 years from 16 Scottish hospitals in 2019. Variables included: demographics; implant and fracture factors; management factors, and outcomes.There were 332 patients, mean age 79.5 years, and 220/332 (66.3%) were female. One-third (37.3%) were ASA1-2 and two-thirds (62.3%) were ASA3+, 91.0% were from home/sheltered housing, and median Clinical Frailty Score was 4.0 (IQR 3.0). Acute medical issues featured in 87/332 (26.2%) and 19/332 (5.7%) had associated injuries. There were 251/332 (75.6%) associated with a proximal femoral implant, of which 232/251 (92.4%) were arthroplasty devices (194/251 [77.3%] total hip, 35/251 [13.9%] hemiarthroplasty, 3/251 [1.2%] resurfacing). There were 81/332 (24.4%) associated with a distal femoral implant (76/81 [93.8%] were total knee arthroplasties). In 38/332 (11.4%) there were implants proximally and distally. Most patients (268/332; 80.7%) were treated surgically, with 174/268 (64.9%) requiring fixation only and 104/268 (38.8%) requiring an arthroplasty or combined solution. Median time to theatre was longer for arthroplasty versus fixation procedures (120 vs 46 hours), and those requiring inter-hospital transfer waited longer (94 vs 48 hours).Barriers to investigating PPF include varied classification, coding challenges, and limitations of existing registries. This is the first study to examine a national PPF cohort and presents important data to guide service design and research. Additional findings relating to fracture patterns, implant types, surgeon skill-mix, and outcomes are reported herein.
Photonic crystal fiber sensors to excite surface plasmon resonance based on elliptical detection channels are used for highly sensitive magnetic sensing
Authors: Tang Hujun , Sun Feifei , Shen Tao , Feng Yue , Liu Chi , Liu Xin , Wang Chao 
Published: February 2024

To improve the detection performance of fiber optic magnetic field sensors a new photonic crystal fiber (PCF) based on surface plasmon resonance (SPR) was designed and investigated. The designed sensor uses an elliptical detection channel, and the modal transmission characteristics and magnetic field sensing characteristics of this fiber optic sensor are analyzed using the full vector finite element method (FVFEM). In addition, the effect of the detection channel on the detection accuracy at different curvatures was investigated. Compared with previous optical fiber magnetic field (MF) sensors, the designed sensor meets the requirements of both refractive index (RI) and MF measurements, and the MF sensitivity, RI sensitivity, and amplitude sensitivity (AS) of the sensor reach 0.739 nm/Oe, 12043.8 nm/RIU, and 754.88RIU−1, respectively. The designed sensor expands the application range of optical fiber sensors and reduces the cost. It has great potential for application in complex environments.
Ultra-broadband magneto-optical isolators and circulators on a silicon nitride photonics platform
Authors: Yan Wei , Wei Zixuan , Yang Yucong , Wu Di , Zhang Zijian , Song Xiaoyi , Qin Jun , Bi Lei 
Published: February 2024

Broadband optical isolators and circulators are highly desirable for wavelength-division multiplexing, light detection, and ranging systems. However, the silicon-integrated optical isolators and circulators reported so far have a limited isolation bandwidth of only several nanometers, due to waveguide and material dispersion. In this paper, we report the development of broadband magneto-optical isolators on silicon nitride waveguides. We proposed a general method of dispersion compensation to achieve a constant phase difference between reciprocal and nonreciprocal phase shifts in a Mach–Zehnder interferometer over a wide frequency range. This method enabled a theoretical 30 dB isolation/circulation bandwidth of more than 240 nm, which covers the S, C, L, and U bands. The fabricated devices showed a maximum isolation ratio of 28 dB, crosstalk of −28dB, high 20-dB isolation bandwidth of 29 nm (3.48 THz), and a relatively low loss of 2.7 dB in the wavelength range of 1520–1610 nm. By further heating the reciprocal phase shifter based on the thermo-optic effect, the experimental 20 dB isolation bandwidth of the device increased to 90 nm (11.03 THz). This method has also been applied to the design of broadband, low-loss isolators, and O/C dual-band isolators/circulators. Our work experimentally demonstrated broadband-integrated optical isolators and circulators on silicon, paving the way for their use in optical communication, data communication, and LiDAR applications.