bluuebunny/crossref_metadata_2025_split huggingface dataset:
Informed Random Forest to Model Associations of Epidemiological Priors, Government Policies, and Public Mobility
Authors: Thapelo Tsaone Swaabow , Mpoeleng Dimane , Hillhouse Gregory 
Published: December 2023

Background. Infectious diseases constitute a significant concern worldwide due to their increasing prevalence, associated health risks, and the socioeconomic costs. Machine learning (ML) models and epidemic models formulated using deterministic differential equations are the most dominant tools for analyzing and modeling the transmission of infectious diseases. However, ML models can be inconsistent in extracting the dynamics of a disease in the presence of data drifts. Likewise, the capability of epidemic models is constrained to parameter dimensions and estimation. We aimed at creating a framework of informed ML that integrates a random forest (RF) with an adapted susceptible infectious recovered (SIR) model to account for accuracy and consistency in stochasticity within the dynamics of coronavirus disease 2019 (COVID-19). Methods. An adapted SIR model was used to inform a default RF on predicting new COVID-19 cases (NCCs) at given intervals. We validated the performance of the informed RF (IRF) using real data. We used Botswana’s pharmaceutical interventions (PIs) and non-PIs (NPIs) adopted between February 2020 and August 2022. The discrepancy between predictions and observations is modeled using loss functions, which are minimized, interpreted, and used to assess the IRF. Results. The findings on the real data have revealed the effectiveness of the default RF in modeling and predicting NCCs. The use of the effective reproductive rate to inform the RF yielded an excellent predictive power (84%) compared with 75% by the default RF. Conclusion. This research has potential to inform policy and decision makers in developing systems to evaluate interventions for infectious diseases. Highlights This framework is initiated by incorporating model outputs from an epidemic model to a machine learning model. An informed random forest (RF) is instantiated to model government and public responses to the COVID-19 pandemic. This framework does not require data transformations, and the epidemic model is shown to boost the RF’s performance. This is a baseline knowledge-informed learning framework for assessing public health interventions in Botswana.
An Innovative Teaching Approach for Diabetes Mellitus in Laboratory Medicine Uses the Clinical Laboratory Diagnostic Pathway
Authors: Tong Yongqing , Chen Hongbin , Wang YingYing , Wu Zegang , Gu Jian , Wu Qian , Wang Jingwei , Luo Hongbo , Bao Anyu , Zheng Hongyun 
Published: December 2023

Objectives The routine teaching mode of diabetes mellitus (DM) is divided into various sub-majors of medical laboratory, which is not conducive to clinical laboratory physicians quickly mastering relevant knowledge. A novel DM laboratory testing pathway is established to improve teaching efficiency and enhance the effects of talent cultivation in laboratory medicine. Methods The guidelines and expert consensuses of DM were gathered from professional websites and databases. The clinical laboratory diagnostic pathway was formulated, and the questionnaire and mutual evaluation were used to evaluate the teaching effectiveness of 8-year undergraduate students enrolled in 2018 and enrolled in 2019, respectively. Results Clinical laboratory physicians developed and approved the DM clinical laboratory diagnostic pathway, which included the entire process of DM diagnosis and differential diagnosis, drug selection, treatment impact monitoring, prognosis evaluation, etc. The results of the questionnaires showed that, in comparison to the teaching mode used with the students enrolled in 2018 and enrolled in 2019, the percentages of more improvement and significant improvement were significantly increased ( P < 0.01) and the percentages of no improvement and slight improvement were significantly decreased ( P < 0.01). Following the instruction of the DM clinical laboratory diagnostic route, the results were greatly improved, including points emphasized and the accuracy of responding to questions, among other things, according to the teachers’ and students’ mutual evaluation ( P < 0.05). Conclusions To enhance the teaching quality in laboratory medicine, it is required to build the disease clinical laboratory diagnostic pathway for a novel teaching method. This may boost teachers’ and students’ confidence and broaden their knowledge.
A Student-Designed Multimodal Sex- and Gender-Based Women's Health Elective Program: Advocacy Curriculum for Medical Students
Authors: Conroy Lauren M , Ghafir Danna , Narayan Maitreyi , McSpedden Hunter , Neher Samuel , Hashmi S Shahrukh , Lunstroth Rebecca 
Published: December 2023

OBJECTIVES The objective of this article is to describe the design and implementation of a multimodal, student-driven, sex- and gender-based women's health (SGBWH) elective with a curricular focus on patient and legislative advocacy. In this single arm, pre/post design, interventional study, we detail and evaluate the use of social media, newsletters, and round-table discussions in conjunction with a traditional lecture-based educational format to engage medical students in a virtual learning environment. METHODS We developed a 22-week SGBWH curriculum for pre-clinical and clinical medical students, which included a series of lectures on multi-specialty and gender-inclusive topics related to SGBWH, small group discussions with community leaders and legislators involved in women's health advocacy, and other self-directed resources such as social media, a website, and digital newsletters. Students were surveyed before and after completing the curriculum to assess for increases in self-reported confidence in advocating for their female and gender minority patients. RESULTS AND CONCLUSION One hundred and one students completed the anonymous pre- and post-elective surveys. There was statistically significant improvement in 8 of the 12 self-reported confidence measures. Eight (8%) participants identified their sex as male. Fifty-five (55%) participants stated future interest in primary care specialties (Internal Medicine, Family Medicine, Obstetrics and Gynecology, and Pediatrics). Our curriculum improved medical students’ self-reported confidence in advocating for their female and gender minority patients when controlling for sex and specialty interest of participants. The success of our multimodal approach demonstrates the value in incorporating resources such as social media as tools for education and advocacy in the evolving landscape of medical education.
First Metatarsophalangeal Arthrodesis in Hallux Rigidus and Hallux Valgus: A Comparison of Patient Reported and Clinical Outcomes
Authors: Scheinberg Mila , Sanchez Thomas , Shah Ashish 
Published: December 2023

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: No prior study has compared the patient reported outcomes of first metatarsophalangeal arthrodesis between hallux rigidus and hallux valgus patients. Furthermore, we sought to examine the impact of postoperative radiographic hallux alignment on outcomes scores within each group. Methods: A retrospective review of 98 patients who received primary metatarsophalangeal arthrodesis from January 2010 to March 2020. Clinical complications including non-union were collected. PROMIS Physical Function, PROMIS Pain Interference, and the Foot Function Index Revised Short Form scores were obtained via telephone. Patients were grouped based on preoperative radiographic alignment of the first hallux yielding 43 hallux rigidus and 55 hallux valgus patients. Clinical and patient reported outcomes were compared between these pathologies. Results: No differences in the rate of wound complications, radiographic union, and revision surgery were found. At median of 2.4 years (3.9 IQR) postoperatively, PROMIS and FFI scores did not vary by pathology group. For both groups, PROMIS scores were similar to the general population of the United States. In sub-analysis, the postoperative dorsiflexion angle in the hallux rigidus group and the postoperative hallux valgus angle in the hallux valgus group were correlated with more favorable outcomes scores. Conclusion: We found no differences in the patient reported outcomes of first metatarsophalangeal arthrodesis in hallux rigidus and hallux valgus patients. The radiographic measures of hallux alignment most directly related to the underlying pathology may correlate with patients’ perceived level of pain and function postoperatively.
Fixation in Missed Lisfranc Injuries: Should This Be Attempted?
Authors: Moonot Pradeep , Dakhode Shubham , Karwande Nikhil 
Published: December 2023

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: The Lisfranc injuries are not so uncommon. However, subtle injuries are often either missed or misdiagnosed as “mid foot sprain” during initial assessment. Missed lisfranc injuries causes various problems like chronic pain, fallen medial arch, functional loss etc. The decision regarding whether to fix such missed or chronic injuries or to do an arthrodesis is still a topic of debate. So the purpose of this study was to evaluate the outcomes of delayed fixation of missed lisfranc injuries. Methods: A total of 10 patients with missed lisfranc injuries (more than 6 weeks after injury) were included in the study. Most of the patients had previous history of subtle, low energy injuries to their foot which was treated conservatively. All the patients preoperatively underwent weight bearing radiographs of foot and distance between lateral border of medial cuneiform and medial border of 2nd metatarsal base were measured for degree of displacement. Patients were treated with an open reduction and internal fixation as opposed to arthrodesis. Outcomes were assessed using VAS score, American Orthopaedic Foot & Ankle Society (AOFAS) Mid foot score, post operative radiographic evaluation and return to work time. Out of 10 patients, 70% were female and 30% were male. The average time interval between injury and surgery was 9.6 + 2.50 weeks. The mean age was 41.5 and mean follow up duration was 33.6 + 12.98 months. Results: The average degree of displacement between lateral border of medial cuneiform and medial border of 2nd metatarsal base was 5.14 mm. At final follow up no patients had radiographic signs of a late diastasis at the Lisfranc joint. The pre operative VAS score improved from 7.5 + 1 to 1.6 + 0.69 post operatively. One patient had developed arthritis at 1st and 2nd TMT joints but did not had any symptoms. The average AOFAS mid foot score pre & post operatively was 37.6 + 10.8 & 84.2 + 6.54 respectively, with two patients having excellent outcome, six patients having good outcome and two patients having fair outcome. At final follow up all patients could perform their ADL & recreational activities independently. Conclusion: Subtle, low velocity missed lisfranc injuries can be well managed with open reduction and internal fixation. In our series, delayed fixation resulted in decreased pain scores and a fair to good functional outcome and returned to their pre injury work.
Hindfoot Stability Test: Introduction and Validation of a Diagnostic Test of Subtalar Instability in Deltoid Ligament injury Associated with Ankle Fractures
Authors: Mason Lyndon W. , Philpott Matthew , Bond Alistair P. 
Published: December 2023

Category: Ankle; Trauma Introduction/ Purpose: Deltoid ligament complex (DLC) injury repair in the presence of an ankle fracture remains a topic of controversy in the current literature. No work in the current literature has commented on hindfoot and subtalar instability in the presence DLC injury associated with ankle fracture fixation. Objective Our aim was to introduce and validate a new method for assessment of hindfoot instability, when fixing an ankle fracture with associated DLC injury. Methods: DLC injury, specifically superficial DLC, controls not only the ankle but the subtalar joint and medial longitudinal arch. Valgus stressing can unmask subtalar instability. It was noted by referencing the hindfoot position to a line parallel with the lateral aspect of the fibula, the lateral fibula line, subtalar instability was proabbale. We used six morphologically normal cadaveric specimens to validate the test. Results: Ten cadaveric specimens were used for validation of the hindfoot stability test. Pre-injury, no specimen illustrated bisection5-injury, all specimens showed bisection of the calcaneal tuberosity by the lateral fibular line on hindfoot stability test. Conclusion: The hindfoot stability test assesses hindfoot stability on valgus stressing of the hindfoot using the calcaneal tuberosity bisection of the a line drawn from the lateral border of the fibula as a reference point for instability. This was validated using morphologically normal cadavers.
How Do Causes of Readmission Following Orthopaedic Surgery Differ Between Races? A Five-Year Analysis of the NSQIP Database.
Authors: Bergstein Victoria E. , O’Sullivan Lucy , Levy Kenneth H. , Vulcano Ettore , Aiyer Amiethab A. 
Published: December 2023

Category: Other Introduction/Purpose: Previous studies have reported conflicting data regarding 30-day readmission rates between patients of different races following orthopaedic surgery. Differences in specific reasons for 30-day readmission between races following orthopaedic surgery have yet to be explored. Methods: The ACS-NSQIP database was utilized to identify patients who underwent orthopaedic surgery and were readmitted within 30 days. Data was collected from 2015–2019, and patients were stratified into one of five race groups: American Indian/Alaskan Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, and White. Analysis of variance (ANOVA) with Bonferroni post-hoc analysis for multiple comparisons was used to compare differences in continuous variables between racial groups. Chi-square analysis with post-hoc analysis of adjusted standardized residuals was used to compare differences in categorical variables between racial groups. Results: In total, 975,857 patients from the ACS-NSQIP database were included in the study. All-cause readmission rate was significantly different across races. Asian and Native Hawaiian/Pacific Islander patients had significantly lower readmission rates (2.7% and 2.8%, respectively), whereas Black patients had significantly greater readmission rates (3.9%) (p < 0.01). Black patients had significantly greater readmission rates for deep incisional SSI, wound disruption, renal insufficiency, and pulmonary embolism, and a lower readmission rate for pneumonia compared to other races. Asian patients had a lower readmission rate for pulmonary embolism, wound disruption, superficial incisional SSI, and vein thrombosis requiring therapy. Conclusion: Specific causes of 30-day readmission were significantly different between races, with Black patients experiencing higher readmission rates and Asian and Hawaiian/Pacific Islander patients experiencing lower readmission rates overall. Our findings can inform which complications should be more carefully monitored in certain patient populations, and how peri- and post-operative management can be adjusted accordingly.
How Does Lateral Column Lengthening Correct the Flatfoot? A Cadaveric Study
Authors: Abd-Ella Mohamed Mokhtar 
Published: December 2023

Category: Hindfoot; Basic Sciences/Biologics Introduction/Purpose: Since its description by Evan for correction of overcorrected clubfoot cases, lateral column lengthening ( LCL) has been widely used for correction of pes planovalgus deformity of any etiolog. The main indication is correction of forefoot abduction manifested radiologically as talonavicular uncoverage. It was reported by many authors that LCL improved forefoot abduction and talonavicular uncoverage, but it was also noticed that LCL corrects the flattening of medial longitudinal arch. The mechanism by which LCL corrects the medial longitudinal arch is still not clearly understood. It was also reported that LCL is associated with forefoot supination, but the exact mechanism of supination is not understood. This study aimed to try to understand the mechanism by which LCL changes the shape of the foot. Methods: LCL osteotomy using Hintermann technique was performed in ten fresh frozen below knee cadaveric specimens. After completion of the osteotomy, the talus and leg were removed to monitor how the foot moves under the talus with opening of the osteotomy to change the shape of the foot. The amounts of osteotomy displacement medially, laterally and planetary were observed and measured. After that, the whole plantar skin was removed and plantar ligaments were dissected to study the influence of plantar ligaments on the plane of motion of the osteotomy and the effect of the osteotomy on plantar ligaments. Results: With opening of the osteotomy, the distal portion did not move in pure adduction. Instead, it moved medial and plantar, working as a dorsolateral opening wedge . So, the distal portion was adducted and plantarflexed correcting the forefoot abduction and the flat arch. Because the osteotomy opens dorsally and laterally only, the lateral part of the distal portion was plantar flexed more than the medial part, and this is the cause of forefoot supination. After dissection of plantar ligaments, it was found that the long and short plantar ligaments prevent the osteotomy from opening inferiorly . It was possible to move the distal portion in pure adduction only after cutting the long and short plantar ligaments. Plantar fascia was relaxed after opening of the osteotomy. Conclusion: This mayexplain how the LCL osteotomy corrects the flat medial longitudinal arch and how it causes supination and lateral side overload. Based on this study, Cotton osteotomy should be added to LCL to correct the supination. Also, plantar fascia tightening can not be the cause of medial longitudinal arch correction as it actually becomes more lax after opening of the osteotomy.
Identification and Analysis of The Microbiome in Patients Undergoing Removal of Hardware
Authors: LaRochelle Luke M. , Morningstar Joshua L. , Hoch Caroline , Rodriguez-Materon Solangel , Scott Daniel , Gross Christopher E. 
Published: December 2023

Category: Basic Sciences/Biologics; Ankle Introduction/Purpose: Next-generation DNA sequencing (NGS) technologies have increased the sensitivity of bacterial cultures and helped to better understand the normal flora of different joints. Researchers have utilized NGS to identify organisms associated with reoperations in shoulder surgery, but there is very little data on the field of foot and ankle. This study uses NGS to determine whether there is a unique microbiome that exists on orthopaedic hardware in the foot and ankle. Methods: A prospective study recruited 34 patients undergoing hardware removal surgery from the foot or ankle during 2020- 2023 with one of two fellowship-trained foot and ankle surgeons at an academic medical center. Patients were excluded based on the diagnosis or suspicion of infection prior to surgery. Explanted hardware was sent for analysis at a CLIA-licensed molecular diagnostic laboratory. Demographics, medical comorbidities, surgical indication, postoperative complications, readmission, and reoperation rates were collected from patient records. The majority of patients underwent surgery for diagnosis with painful orthopaedic hardware (70.6%). The cohort was majority female (67.6%) and average age was 53.15 (range 18-78) years. Results: Of the 34 samples sent for NGS, 5 (14.7%) indicated 9 bacteria were present (positive), while the remaining 29 (85.3%) had no bacteria present (negative). The most common organisms were of the genus Staphylococcus, representing 4 bacteria (44.4%), and Corynebacterium, representing 2 bacteria (22.2%). C. acnes was only present in one sample. There was no relationship between bacterial presence and patients undergoing hardware removal for diagnosis of painful orthopaedic hardware. No demographics nor postoperative outcomes were statistically associated with the presence of bacteria on removed hardware samples. The overall rate of complication, reoperation, and readmission were 8.8%, 2.9%, and 2.9%, respectively. Conclusion: This study found that there is no common microbial community present in patients undergoing hardware removal surgery. The most commonly present bacteria were of the genus Staphylococcus, bacteria overall were isolated in 14.7% of specimens. C acnes appeared to be uncommon. Further research should be done with a larger sample to support these findings.
Increased Calcaneal Pitch and Subtalar Instability are Predictors Associated with Surgical Reconstruction for Patients who Develop Chronic Lateral Ankle Instability
Authors: Porter David A. , Poirier Jon-Luc R. , Kulwin Robert , Hartman Margaret , Xu Guang 
Published: December 2023

Category: Ankle; Sports Introduction/Purpose: Most acute lateral ankle sprains are treated non-operatively, however, up to 20% of acute sprains (LAS) develop Chronic Lateral Ankle Instability (CLAI) requiring surgical reconstruction. CLAI risk factors have not been analyzed in the context of a multifactorial system. This study aims to identify a model to identify patients who are at increased risk for CLAI after acute lateral ankle sprains utilizing clinical and radiographic findings, in order to identify patients who may benefit from early surgical intervention (LAR). Methods: This retrospective study identified 78 patients who presented with acute lateral ankle sprains and 50 patients with CLAI who underwent lateral ankle reconstruction (LAR), diagnosed 2010-2020. Patients’ clinical exam findings and radiographic data were collected from direct clinical notes evaluation from a single Orthopedic Foot and Ankle surgeon's records. Descriptive statistics were utilized to determine difference, with a regression model used to determine risk factor significance. Results: A clinical diagnosis of subtalar instability (SI) was made in 32% of CLAI patients as compared to 2.5% (p=0.0001) of acute sprains. Assessment of calcaneal pitch (CP) yielded a significant difference between CLAI [µ:30.7, Median: 30.9] and acute sprains [µ=25.8, p< 0.0001, Median=25.8]. Correlation analysis yielded a predictive model for CLAI; -10.618 + 0.328CP + 3.33SI, indicating both increased calcaneal pitch [OR: 1.388 (95% CI: 1.185-1.625)] and subtalar instability [OR: 27.931 (95% CI: 4.235 – 184.210)] are significant predictors of CLAI. The sensitivity of this model is 62.5% and specificity is 83.3%, with both variables demonstrating a significance (P < 0.001 for both variables). Conclusion: These data indicate subtalar instability and increased calcaneal pitch angle are predictors of CLAI development and a higher risk of requiring LAR after LAS. These predictors can aid clinicians in determining ideal candidates for more aggressive non- operative treatment and those who may necessitate earlier surgical lateral ankle reconstruction. Identification of these patients will assist the clinician in management, counseling, treatment, and evaluation after LAS and after developing more chronic symptoms. Future prospective studies are needed to further characterize these risk factors as indicators for failure of and optimal non- operative management as well as patients who may qualify for early LAR.