bluuebunny/crossref_metadata_2025_split huggingface dataset:
Five‐Year Hospital Readmission After Coronary Artery Bypass Surgery and the Association With Off‐Pump Surgery and Sex
Authors: Dimagli Arnaldo , Gaudino Mario , An Kevin R. , Olaria Roberto Perezgrovas , Soletti Giovanni Jr , Cancelli Gianmarco , Harik Lamia , Noiseux Nicolas , Stevens Louis‐Mathieu , Lamy André ,   the CORONARY investigators
Published: April 2023

Background
Limited data exist on long‐term readmission and its association with patient and procedural characteristics after coronary artery bypass grafting. We aimed to investigate 5‐year readmission after coronary artery bypass grafting and specifically focus on the role of sex and off‐pump surgery.

Methods and Results
We performed a post hoc analysis of the CORONARY (Coronary Artery Bypass Grafting [CABG] Off or On Pump Revascularization) trial, involving 4623 patients. The primary outcome was all‐cause readmission, and the secondary outcome was cardiac readmission. Cox models were used to investigate the association of outcomes with sex and off‐pump surgery. Hazard function for sex was studied over time using a flexible, fully parametric model, and time‐segmented analyses were performed accordingly. Rho coefficient was calculated for the correlation between readmission and long‐term mortality.

Median follow‐up was 4.4 years (interquartile range, 2.9–5.4 years). The cumulative incidence rates of all‐cause and cardiac readmission were 29.4% and 8.2% at 5 years, respectively. Off‐pump surgery was not associated with either all‐cause or cardiac readmission. The hazard for all‐cause readmission in women over time was constantly higher than the hazard for men (hazard ratio [HR], 1.21 [95% CI, 1.04–1.40];
P
=0.011). Time‐segmented analyses confirmed the higher risk for all‐cause (HR, 1.21 [95% CI, 1.05–1.40];
P
<0.001) and cardiac (HR, 1.26 [95% CI, 1.03–1.69];
P
=0.033) readmission in women after the first 3 years of follow‐up. All‐cause readmission was strongly correlated with long‐term all‐cause mortality (Rho, 0.60 [95% CI, 0.48–0.66]), whereas cardiac readmission was strongly correlated with long‐term cardiovascular mortality (Rho, 0.60 [95% CI, 0.13–0.86]).

Conclusions
Readmission rates are substantial at 5 years after coronary artery bypass grafting and are higher in women but not with off‐pump surgery.

Registration

URL:
http://www.clinicaltrials.gov/
; Unique identifier: NCT00463294.
No deal: German researchers’ publishing and citing behaviors after Big Deal negotiations with Elsevier
Authors: Fraser Nicholas , Hobert Anne , Jahn Najko , Mayr Philipp , Peters Isabella 
Published: April 2023

Abstract
In 2014, a union of German research organizations established Projekt DEAL, a national-level project to negotiate licensing agreements with large scientific publishers. Negotiations between DEAL and Elsevier began in 2016, and broke down without a successful agreement in 2018; during this time, around 200 German research institutions canceled their license agreements with Elsevier, leading Elsevier to restrict journal access at those institutions. We investigated the effect on researchers’ publishing and citing behaviors from a bibliometric perspective, using a data set of ∼400,000 articles published by researchers at DEAL institutions during 2012–2020. We further investigated these effects with respect to the timing of contract cancellations, research disciplines, collaboration patterns, and article open-access status. We find evidence for a decrease in Elsevier’s market share of articles from DEAL institutions, with the largest year-on-year market share decreases occurring from 2018 to 2020 following the implementation of access restrictions. We also observe year-on-year decreases in the proportion of citations, although the decrease is smaller. We conclude that negotiations with Elsevier and access restrictions have led to some reduced willingness to publish in Elsevier journals, but that researchers are not strongly affected in their ability to cite Elsevier articles, implying that researchers use other methods to access scientific literature.
Synoptic Atmospheric Patterns Responsible for Summer Extreme High-Temperature Events over Northern Asia: Evolution, Precursor, and Long-Term Change
Authors: Hong Haixu , Sun Jianqi , Wang Huijun 
Published: April 2023

Abstract
In this study, the synoptic atmospheric patterns responsible for regional extreme high-temperature events (REHEs) over northern Asia (NA) are investigated. First, a hybrid regionalization approach is applied to the daily maximum temperature (Tmax), and three subregions of NA can be identified: western NA, central NA, and southeastern NA. To better understand the mechanism for the NA REHE formation, the REHE-related synoptic circulation patterns over each subregion are further categorized into two types. These six synoptic circulation patterns influence the NA REHE occurrence through different radiation and advection processes. Generally, the radiation process dominates the NA REHE occurrence, while the horizontal temperature advection plays a more important role in the synoptic dipole patterns than in the monopole high patterns. The heatwaves associated with the six synoptic patterns can last more than 3.8 days, with a maximum of 2 weeks. From the forecasting perspective, six wave trains are explored as the precursors of these six synoptic circulation patterns, separately. The wave trains originate from the North Atlantic Ocean and Europe with at least a 3-day lead and then propagate eastward to NA, exerting influences on the pronounced six synoptic circulation patterns and consequently affecting the NA REHEs. In terms of long-term change, the REHEs over the three subregions show significant increasing trends over 1960–2018 and significant interdecadal increases around the mid-1990s, in which the contribution of each synoptic pattern–related REHE is different.
External Validation of the KOOS-ACL in the MOON Group Cohort of Young Athletes Followed for 10 Postoperative Years
Authors: Marmura Hana , Tremblay Paul F. , Bryant Dianne M. , Spindler Kurt P. , Huston Laura J. , Getgood Alan M.J. 
Published: April 2023

Background: The Knee injury and Osteoarthritis Outcome Score–Anterior Cruciate Ligament (KOOS-ACL) is a short form version of the KOOS, developed to target populations of young active patients with ACL tears. The KOOS-ACL consists of 2 subscales: Function (8 items) and Sport (4 items). The KOOS-ACL was developed and validated using data from the Stability 1 study from baseline to postoperative 2 years. Purpose: To validate the KOOS-ACL in an external sample of patients matching the outcome’s target population. Study Design: Cohort study (diagnosis); Level of evidence, 1. Methods: The Multicenter Orthopaedic Outcomes Network group cohort of 839 patients aged 14 to 22 years who tore their ACLs while playing sports was used to assess internal consistency reliability, structural validity, convergent validity, responsiveness to change, and floor/ceiling effects of the KOOS-ACL at 4 time points: baseline and postoperative 2, 6, and 10 years. Detection of treatment effects between graft type (hamstring tendon vs bone–patellar tendon–bone) were also compared between the full-length KOOS and KOOS-ACL. Results: The KOOS-ACL demonstrated acceptable internal consistency reliability (α = .82-.89), structural validity (Tucker-Lewis index and comparative fit index = 0.98-0.99; standardized root mean square residual and root mean square error of approximation = 0.04-0.07), convergent validity (Spearman correlation with International Knee Documentation Committee subjective knee form = 0.66-0.85; Western Ontario and McMaster Universities Osteoarthritis Index function = 0.84-0.95), and responsiveness to change across time (large effect sizes from baseline to postoperative 2 years; d = 0.94 [Function] and d = 1.54 [Sport]). Stable scores and significant ceiling effects were seen from 2 to 10 years. No significant differences in KOOS or KOOS-ACL scores were detected between patients with different graft types. Conclusion: The KOOS-ACL shows improved structural validity when compared with the full-length KOOS and adequate psychometric properties in a large external sample of high school and college athletes. This strengthens the argument to use the KOOS-ACL to assess young active patients with ACL tears in clinical research and practice.
Outcomes of Open Versus Arthroscopic Treatment of HAGL Tears
Authors: Lee Simon , Krych Aaron J. , Peebles Annalise M. , Rider Danielle , Dekker Travis J. , Arner Justin W. , Ernat Justin J. , Whalen Ryan J. , Provencher Matthew T. 
Published: April 2023

Background: Lesions that involve humeral avulsions of the glenohumeral ligament (HAGLs), although less common, are primary contributors to recurrent events of dislocation and subluxation of the glenohumeral joint. Purpose: To describe the clinical presentation, examination, and surgical outcomes of patients presenting with HAGL lesions who underwent repair using an arthroscopic or open technique. Study Design: Cohort study; Level of evidence, 3. Methods: A multicenter retrospective review of prospectively collected data was performed of skeletally mature patients without glenohumeral arthritis who presented with HAGL lesions and subsequently underwent arthroscopic or open repair between 2005 and 2017. Independent variables included patient characteristics, clinical presentation, physical examination findings, and arthroscopic findings. Dependent variables included pre- and postoperative Single Assessment Numeric Evaluation (SANE) score, Western Ontario Shoulder Instability Index (WOSI) score, and range of motion outcomes. Results: Eighteen patients diagnosed with a HAGL lesion who underwent primary arthroscopic repair (n = 7) or open repair (n = 11) were included. There were 17 male patients and 1 female patient with a mean age of 24.9 years (range, 16-38 years). Mean follow-up duration was 50.9 months (range, 24-160 months). Seventeen patients (94.4%) reported pain as the most common symptom, and 7 (38.9%) reported sensation of instability. Scores significantly improved from pre- to postoperative for the arthroscopic and open groups ( P < .001): SANE (mean ± SD; arthroscopic, 30.7 ± 15.7 to 92.1 ± 12.2; open, 45.5 ± 8.50 to 90.7 ± 5.24) and WOSI (arthroscopic, 51.4 ± 11.4 to 2.49 ± 3.70; open, 45.5 ± 7.37 to 11.5 ± 5.76). The magnitude of improvement in SANE scores was significantly higher for patients treated arthroscopically (Δ60.0; open, Δ46.5; P = .012). Postoperative WOSI scores were also significantly better in the arthroscopic cohort (2.49 ± 3.70; open, 11.5 ± 5.76; P = .00094). Conclusion: Symptomatic HAGL tears present primarily with pain as opposed to instability, necessitating a high index of suspicion for injury. The tears may be treated successfully with an arthroscopic or open technique with significant improvements in patient-reported outcomes and stability.
Ambulance clinicians’ responsibility when encountering patients in a suicidal process
Authors: Hammarbäck Staffan , Holmberg Mats , Wiklund Gustin Lena , Bremer Anders 
Published: April 2023

Background Even though the traditional focus in emergency care is on life-threatening medical crisis, ambulance clinicians frequently encounter patients with mental illness, including suicidal ideation. A suicide is preceded by a complex process where most of the suicidal ideation is invisible to others. However, as most patients seek healthcare in the year before suicide, ambulance clinicians could have an important part to play in preventing suicide, as they encounter patients in different phases of the suicidal process. Aim The aim of this study was to describe ambulance clinicians’ conceptions of responsibility when encountering patients in a suicidal process. Research design A qualitative inductive design using a phenomenographic approach was used. Participants and research context Twenty-seven ambulance clinicians from two regions in southern Sweden were interviewed. Ethical considerations The study was approved by the Swedish Ethical Review Authority. Findings Three categories of descriptions captured a movement from responding to a biological being to responding to a social being. Conventional responsibility was perceived as a primary responsibility for emergency care. In conditional responsibility, the patient’s mental illness was given only limited importance and only if certain conditions were met. Ethical responsibility was perceived to have its primary focus on the encounter with the patient and listening to the patient’s life story. Conclusions An ethical responsibility is favourable regarding suicide prevention in ambulance care, and competence development in mental illness and conversation skills could enable ambulance clinicians to have conversations with patients about suicidal ideation.
Sacituzumab Govitecan as a Second-Line Treatment in Relapsed/Refractory Metastatic Triple-Negative Breast Cancer Patients: A Systematic Review and Meta-analysis
Authors: Kathpalia Meghavi , Sharma Anurag , Kaur Navkiran 
Published: April 2023

Background: Chemotherapy, the only treatment option for metastatic triple-negative breast cancer (mTNBC), showed decreased survival rates. Trophoblast cell surface antigen-2 (Trop-2) could be a possible target for antibody-drug conjugates (ADCs). Objective: Sacituzumab govitecan (SG), an anti-Trop-2 ADC for pretreating relapsed/refractory mTNBC patients, was studied to know the efficacy and safety profile of the drug in mTNBC. Methods: The present review searched MEDLINE (via PubMed), WHO Clinical Trial Registry, Clinical Trials.gov, and Cochrane Central Register of Controlled Trials until December 25, 2022. The studies searched comprised randomized trials and observational studies (retrospective [case-control, cross-sectional] and prospective [cohort designs]). Efficacy assessment was performed in terms of complete response (CR), partial response (PR), objective response rate (ORR), stable disease (SD), progressive disease (PD), and clinical benefit rate (CBR), and safety in terms of adverse events. Results: The overall random-effects pooled prevalence of CR was 4.9 (95% CI: 3.2-7.1), PR was 35.6 (95% CI: 31.5-39.9), ORR was 6.8 (95% CI: 5.9-7.8), SD was 8.0 (95% CI: 6.7-9.4), PD was 5.1 (95% CI: 4.1-6.3), and CBR was 13.4 (95% CI: 11.8-15.1). Adverse events associated with the drug were neutropenia, fatigue, anemia, nausea, and others. Conclusion and Relevance: This is the first meta-analysis conducted in relapsed/refractory mTNBC patients and found that SG is efficacious but associated with some adverse effects that are related to exposure to the drug. The application of these results will allow clinicians to use SG in the management of patients with mTNBC.
Management of spontaneous coronary artery dissection: Trends over time
Authors: Feldbaum Elliot , Thompson Elizabeth W , Cook Tessa S , Sanghavi Monika , Wilensky Robert L , Fiorilli Paul N , Lewey Jennifer 
Published: April 2023

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome. Guidance regarding the optimal management of patients with SCAD has been published over the past 10 years, but the impact on clinical practice has not been evaluated. The present study aims to examine if approaches to invasive management, medical therapy, and vascular imaging have changed over time. Methods: This is a retrospective cohort study of 157 patients treated for SCAD between 2005 and 2019 at an academic health system in Philadelphia, Pennsylvania. We aimed to examine change in management over time, including rates of coronary revascularization, discharge medications, and vascular imaging. Results: Conservative management of SCAD increased over time from 35% before 2013 to 89% in 2019, p < 0.001. Revascularization was associated with younger age, pregnancy-associated SCAD, and lesions of the left main artery, left anterior descending artery, and multiple vessels, p < 0.05 for all. Partial imaging for extracoronary vascular abnormalities ranged from 33% before 2013 to 71% in 2018, p = 0.146. The rate of comprehensive vascular imaging (cross-sectional head to pelvis imaging) remained low in all time categories (10–18%) and did not change over time. Patients who underwent comprehensive imaging were more likely to be diagnosed with fibromuscular dysplasia (FMD) compared to those with partial imaging (63% vs 15%, p < 0.001). Conclusion: Management of spontaneous coronary artery dissection has changed over time. More patients are being managed conservatively and undergo screening for extracoronary vascular abnormalities such as FMD. Future efforts should focus on improving rates of comprehensive vascular screening.
An Exploratory Study of Primary Care Clinicians’ Perspectives on 2021 New and Updated Cancer Screening Guidelines
Authors: Angier Heather , Bonuck Kathryn J. , McCrimmon Sara , Wiser Amy L. , Huguet Nathalie , Carney Patricia A. 
Published: April 2023

Background and Objective: Cancer screening rates remain low in rural, racial and ethnic minority, low-income, and uninsured populations. Prior studies showed that cancer screening recommendations vary based on clinicians’ factors. We conducted an exploratory study on primary care clinicians’ beliefs about new or updated cancer screening guidelines according to clinician demographics. Methods: This cross-sectional study involved administering a web-based survey in July and August of 2021 to primary care clinicians practicing in diverse ambulatory settings in the Pacific Northwest belonging to the same health system. The survey assessed clinician demographics, attitudes about the impact of cancer screening on mortality, and how clinicians stay up-to-date with guidelines. Results: Of the 191 clinicians, 81 responded (42.4%), after removing 13 incomplete surveys, we analyzed 68 (35.6%). The majority agreed/strongly agreed that breast (76.1%), colorectal (95.5%), and cervical (90.9%) cancer screening, and HPV vaccination (85.1%) prevent early cancer mortality: there were no differences according to clinician gender or years in practice. Female compared to male clinicians were more likely to agree/strongly agree that tobacco smoking cessation (female: 100% vs male: 86.4%, P = .01) prevents early cancer mortality, whereas male compared to female clinicians were more likely to agree/strongly agree that lung cancer screening (male: 86.4% vs female: 57.8%, P = .04) prevents early cancer mortality. One-third (33.3%) of clinicians were unaware of the 2021 update on lung cancer screening and females were more likely than males to say they did not know about this change (females: 43.2% vs males: 13.6%, P = .02). Conclusions: This study suggests that clinicians’ attitudes are not likely the primary factor affecting low cancer screening rates in some populations and that few differences exist in beliefs based on gender, and none based on years in practice.
Outcomes of Secondary Arthroscopic Distal Clavicle Resection for Shoulders With Symptomatic Acromioclavicular Joint Arthropathy After Isolated Rotator Cuff Repair With Complete Tendon Healing
Authors: Bismuth Yaniv , Beckers Joris , van Rooij Floris , Saffarini Mo , Godenèche Arnaud 
Published: April 2023

Background: Recent meta-analyses have advised against distal clavicle resection (DCR) as an adjuvant procedure during rotator cuff repair (RCR), whether performed routinely or in shoulders diagnosed with symptomatic acromioclavicular joint (ACJ) arthropathy. However, the efficacy of DCR as a secondary procedure in patients with persistent pain attributed to symptomatic ACJ arthropathy remains unknown. Purpose: To evaluate outcomes of secondary DCR in patients with failed nonoperative treatment of symptomatic ACJ arthropathy after isolated RCR with complete tendon healing. Study Design: Case series; Level of evidence, 4. Methods: Between 2008 and 2018, the senior surgeon performed isolated RCR in 1935 patients, of which 23 (1.2%) presented with ACJ pain and discomfort at ≥12 months after the index RCR, despite complete healing of repaired tendons. Those 23 patients underwent secondary DCR, as ACJ arthropathy was confirmed clinically and radiographically. Clinical assessment before DCR included the Subjective Shoulder Value (SSV) and pain at rest. Clinical assessment at >12 months after DCR included the SSV, pain at rest, Constant-Murley score, range of motion, and satisfaction. Pre- and post-DCR SSV and pain scores were compared. Results: Of the initial cohort, 5 patients did not consent to the use of their data, leaving 18 patients aged 53.3 ± 7.6 years (mean ± SD; range, 39-68 years) for outcome assessment. At a mean follow-up of 7.0 ± 3.1 years after DCR, the SSV significantly improved from 58.7 ± 17.2 to 76.1 ± 20.2 ( P < .001), and the pain at rest significantly decreased from 4.7 ± 1.5 to 2.8 ± 1.9 ( P < .001). At final follow-up, the Constant-Murley score was 70.2 ± 21.0. Of 18 patients, 15 had none or mild residual pain (0-2; 83%), while 3 had substantial residual pain (5 or 6; 17%). Only 1 of the 3 patients with substantial residual pain had a poor SSV score (20 points) and was against opting for DCR in retrospect. No patient had infections or gross ACJ instability after DCR. Conclusion: Secondary DCR for cases of symptomatic ACJ arthropathy after isolated RCR with complete tendon healing reduced pain in 83% of patients, and 94% were satisfied and would undergo secondary DCR again.
Gear Pitting Measurement by Multi-Scale Splicing Attention U-Net
Authors: Qin Yi , Xi Dejun , Chen Weiwei , Wang Yi 
Published: April 2023

AbstractThe judgment of gear failure is based on the pitting area ratio of gear. Traditional gear pitting calculation method mainly rely on manual visual inspection. This method is greatly affected by human factors, and is greatly affected by the working experience, training degree and fatigue degree of the detection personnel, so the detection results may be biased. The non-contact computer vision measurement can carry out non-destructive testing and monitoring under the working condition of the machine, and has high detection accuracy. To improve the measurement accuracy of gear pitting, a novel multi-scale splicing attention U-Net (MSSA U-Net) is explored in this study. An image splicing module is first proposed for concatenating the output feature maps of multiple convolutional layers into a splicing feature map with more semantic information. Then, an attention module is applied to select the key features of the splicing feature map. Given that MSSA U-Net adequately uses multi-scale semantic features, it has better segmentation performance on irregular small objects than U-Net and attention U-Net. On the basis of the designed visual detection platform and MSSA U-Net, a methodology for measuring the area ratio of gear pitting is proposed. With three datasets, experimental results show that MSSA U-Net is superior to existing typical image segmentation methods and can accurately segment different levels of pitting due to its strong segmentation ability. Therefore, the proposed methodology can be effectively applied in measuring the pitting area ratio and determining the level of gear pitting.