bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring what is important during burn recovery: a qualitative study investigating priorities of patients and healthcare professionals over time
Authors: Hoffmann Christin , Davies Philippa , Elliott Daisy , Young Amber 
Published: February 2023

ObjectivesThis qualitative study aimed to investigate: (1) priorities of patients and healthcare professionals during recovery from a burn injury, (2) how priorities change over time and (3) how priorities map to outcomes currently reported in burns research.DesignSemi-structured interviews were conducted. Interviews were audio recorded, transcribed and analysed thematically.Setting, participantsA total of 53 patients and healthcare professionals were recruited from four National Health Service (NHS) burn services across England and Wales across England and Wales. Patient participants (n=32) included adults, adolescents and parents of paediatric patients, with a variety of burn injuries in terms of severity and cause of burn injury. Healthcare professionals (n=21) were NHS staff members involved in burn care and included professionals with a range of clinical experience and roles (eg, nurses, surgeons, occupational therapists, physiotherapist, administration).ResultsTen themes relating to priorities (outcomes) during recovery from a burn injury were identified for patients and professionals. Of those, six were identified for patients and professionals (‘pain and discomfort’, ‘psychological well-being’, ‘healing’, ‘scarring’, ‘function’, ‘infection’), three were unique to professionals (‘patient knowledge, understanding and support’, ‘sense of control’, ’survival’) and one was unique to patients (‘uncertainty’). Results highlighted that importance of these priorities changes over time (eg, ‘survival’ was only a concern in the short term). Likewise, priorities differed between patients and professionals (eg, ‘pain’ was important to patients throughout their recovery, but not for professionals). Seven out of 10 themes overlapped with outcomes commonly assessed in burn research.ConclusionProfessionals’ and patients’ priorities (important outcomes) change over time after burn injury and differ between those groups. Burn care research should consider measuring outcomes at different time points during the recovery from a burn injury to accurately reflect complexity of burn recovery.
Managing blunt cardiac injury
Authors: Nair Lawrence , Winkle Brendan , Senanayake Eshan 
Published: February 2023

AbstractBlunt cardiac injury (BCI) encompasses a spectrum of pathologies ranging from clinically silent, transient arrhythmias to deadly cardiac wall rupture. Of diagnosed BCIs, cardiac contusion is most common. Suggestive symptoms may be unrelated to BCI, while some injuries may be clinically asymptomatic. Cardiac rupture is the most devastating complication of BCI. Most patients who sustain rupture of a heart chamber do not reach the emergency department alive. The incidence of BCI following blunt thoracic trauma remains variable and no gold standard exists to either diagnose cardiac injury or provide management. Diagnostic tests should be limited to identifying those patients who are at risk of developing cardiac complications as a result of cardiac in jury. Therapeutic interventions should be directed to treat the complications of cardiac injury. Prompt, appropriate and well-orchestrated surgical treatment is invaluable in the management of the unstable patients.
Resection of a schwannoma originating from vagus nerve in the right superior mediastinum
Authors: Zhang Ming , Shi Hao , Tu Xiabin , Li Weidong , Wei Zhengliang 
Published: February 2023

Abstract
Background
Schwannoma is the most common mediastinal neurogenic tumor, while schwannoma originating from mediastinal vagus nerve is rare.

Case presentation
This article reported one case of schwannoma originating from vagus nerve in the right superior mediastinum. The mediastinal schwannoma was completely resected through a right-sided video-assisted thoracoscopic thoracotomy. Histologic examination clarified the diagnosis as schwannoma.

Conclusion
Chest CT scan and MRI can be used to determine the location of mediastinal schwannoma and its relationship with adjacent tissue. Histologic examination showing distinctive feature of Antoni A areas and Antoni B areas can help clarify the diagnosis. Complete surgical resection is the first-line treatment option for mediastinal schwannomas.
Efficiency and optimization of government service resource allocation in a cloud computing environment
Authors: Guo Ya-guang , Yin Qian , Wang Yixiong , Xu Jun , Zhu Leqi 
Published: February 2023

AbstractAccording to the connotation and structure of government service resources, data of government service resources in L city from 2019 to 2021 are used to calculate the efficiency of government service resource allocation in each county and region in different periods, particularly by adding the government cloud platform and cloud computing resources to the government service resource data and applying the data envelopment analysis (DEA) method, which has practical significance for the development and innovation of government services. On this basis, patterns and evolutionary trends of government service resource allocation efficiency in each region during the study period are analyzed and discussed. Results are as follows. i) Overall efficiency level in the allocation of government service resources in L city is not high, showing an increasing annual trend among the high and low staggering. ii) Relative difference of allocation efficiency of government service resources is a common phenomenon of regional development, the existence and evolution of which are the direct or indirect influence and reflection of various aspects, such as economic strength and reform effort. iii) Data analysis for the specific points indicates that increased input does not necessarily lead to increased efficiency, some indicators have insufficient input or redundant output. Therefore, optimization of the physical, human, and financial resource allocation methods; and the intelligent online processing of government services achieved by the adoption of government cloud platform and cloud computing resources are the current objective choices to realize maximum efficiency in the allocation of government service resources.
Physicochemical characteristics of Pangasius sp. skin-gelatin-based-edible film enriched with silver nanoparticles
Authors: Nurdiani Rahmi , Prihanto Asep A. , Firdaus Muhamad , Aini Faridatul Nur , Nabilah Fajrin Adin , Talib Rosnita A , Huda Nurul 
Published: February 2023

Background: Edible films intended for food packaging have been produced from hydrocolloids, lipids, resins, and composites, including gelatin. Gelatin is known to have a good filming ability and has been suggested as an alternative to non-biodegradable plastics. Naturally active compounds incorporated into film packaging may not only protect the food product from oxidation and microbial contamination, but they may also alter the physicochemical properties of the film. Silver nanoparticles have been used in food packaging as active agents due to their antibacterial and antifungal properties. The addition may affect the characteristics of the packaging. Therefore, this study aims to determine the effect of the addition of silver nanoparticles on the physicochemical characteristics of edible film from Pangasius sp. skin gelatin Methods: Mangrove extract of Bruguiera gymnorrhiza was used to synthesize silver into nanoparticle size. In this study, silver nanoparticles (AgNPs) with different concentrations (0, 2, 4 and 8%) were added into gelatin-based edible film. The edible films produced were observed for their physicochemical characteristics, including thickness, tensile strength, elongation, water vapour transmission, moisture content, pH, and colour. Results: AgNPs affected the colour of the fish-gelatin-based edible film, as an increased concentration of AgNPs resulted in a darker film. Nevertheless, the addition of AgNPs showed no significant effect on the thickness (145–216 µm), tensile strength (14.58–19.72 MPa), elongation (21.86–54.19%), water vapour transmission (30. 91–42.55 g/m2/day), moisture content (9.57–11.16%) or pH (5.92–6.01) of the fish-gelatin-based edible film. Conclusions: The addition of AgNPs has no significant effect on gelatin-based edible film physicochemical properties except colour. Therefore, the incorporated edible film has the potential to be developed further.
Are doctors and nurses engaging in physical activity and its promotion?
Authors: Bhandari Sara , Watkinson Emma , Fawkner Samantha 
Published: February 2023

Background: Physical activity counselling in health care is inadequate but the reasons for this are not well understood. Aims: To evaluate physical activity participation and counselling perceptions and practices among doctors and nurses in the UK. Methods: This study used two anonymised online questionnaires distributed at different times to doctors and nurses throughout the UK. Findings: 629 responses were obtained; 78.3% of doctors and 73.4% of nurses met the UK guideline for aerobic physical activity. Perceived importance of counselling on physical activity was high but less than 50% of participants were actually providing counselling. Counselling was more likely in primary care and doctors were marginally more likely than nurses to counsel. Conclusion: Doctors and nurses are an active cohort and view counselling on physical activity as important. Despite this, counselling levels are low especially in secondary care. Efforts should be made to improve knowledge and opportunity for physical activity counselling.
CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF SARCOMA: DOES SURGERY AT A SPECIALIZED SARCOMA CENTRE IMPROVE OUTCOMES?
Authors: Sundaram A. , Perianayagam G. , Hong A. , Mar J. , Lo H. , Lawless A. , Carey Smith R.L. 
Published: February 2023

The Australia and New Zealand Sarcoma Association established the Sarcoma Guidelines Working Party to develop national guidelines for the management of Sarcoma. We asked whether surgery at a specialised centre improves outcomes. A systematic review was performed of all available evidence pertaining to paediatric or adult patients treated for bone or soft tissue sarcoma at a specialised centre compared with non-specialised centres. Outcomes assessed included local control, limb salvage rate, 30-day and 90-day surgical mortality, and overall survival.Definitive surgical management at a specialised sarcoma centre improves local control as defined by margin negative surgery, local or locoregional recurrence, and local recurrence free survival. Limb conservation rates are higher at specialised centres, due in part to the depth of surgical experience and immediate availability of multidisciplinary and multimodal therapy. A statistically significant correlation did not exist for 30-day and 90-day mortality between specialised centres and non-specialised centres. The literature is consistent with improved survival when definitive surgical treatment is performed at a specialised sarcoma centre.Evidence-based recommendation: Patients with suspected sarcoma to be referred to a specialised sarcoma centre for surgical management to reduce the risk of local recurrence, surgical complication, and to improve limb conservation and survival.Practice point: Patients with suspected sarcoma should be referred to a specialised sarcoma centre early for management including planned biopsy.
CUSTOM ACETABULAR TRI-FLANGE AND FEMORAL OSSEOINTEGRATION COMPONENTS FOR THE TREATMENT OF SYMPTOMATIC IPSILATERAL HIP AND KNEE ARTHROPATHY IN A PATIENT WITH PROXIMAL FEMORAL FOCAL DEFICIENCY: A NOVEL SOLUTION TO A CHALLENGING PROBLEM
Authors: Sundaram A. , Carey Smith R.L. 
Published: February 2023

Proximal femoral focal deficiency is a congenital disorder of malformation of the proximal femur and/or the acetabulum. Patients present with limb length discrepancy and clinical features along a spectrum of severity. As these patients progress through to skeletal maturity and on to adulthood, altered biomechanical demands lead to progression of arthropathy in any joint within the lower limb. Abnormal anatomy presents a challenge to surgeons and conventional approaches and implants may not necessarily be applicable.We present a case of a 62-year-old lady with unilateral proximal femoral focal deficiency (suspected Aitken Class A) who ambulated with an equinus prosthesis for her entire life. She presented with ipsilateral knee pain and instability due to knee arthritis but could not tolerate a total knee arthroplasty due to poor quadriceps control.A custom osteointegration prosthesis was inserted with a view to converting to the proximal segment to a total hip replacement if required. The patient went on to develop ipsilateral symptomatic hip arthritis but altered acetabular anatomy required a custom tri-flange component (Ossis, Christchurch, New Zealand) and a custom proximal femoral component to link with the existing osseointegration component (Osseointegration Group of Australia, Sydney, Australia) were designed and implanted.The 18 month follow up of the custom hip components showed that the patient had Oxford hip scores that were markedly improved from pre-operatively. Knee joint heights were successfully restored to equal when the patient's prosthesis was attached. The patient describes feeling like “a normal person”, walks unaided for short distances and can ambulate longer distances with crutches.Advances in design and manufacture of implants have empowered surgeons to offer life improving treatments to patients with challenging anatomy. Using a custom acetabular tri-flange and osseointegration components is one possible solution to address symptomatic ipsilateral hip and knee arthropathy in the context of PFFD in adulthood.
THE DOSTAR STUDY: A DOUBLE-BLINDED, RANDOMIZED CONTROLLED TRIAL COMPARING DUAL OR SINGLE HAMSTRING TENDON ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Lawless A.M. , Ebert J. , Edwards P. , Aujla R. , Finsterwald M. , Dalgleish S. , Malik S. , Raymond R. , Giwnewer U. , Simpson A. , Grant M. , Leys T. , D'Alessandro P.A. 
Published: February 2023

Hamstring grafts have been associated with reduced strength, donor site pain and muscle strains following Anterior Cruciate Ligament Reconstruction (ACLR). Traditional graft fixation methods required both semitendinosus and gracilis tendons to achieve a graft of sufficient length and diameter, but newer techniques allow for shorter, broad single tendon grafts.This study seeks to compare the outcomes between Single Tendon (ST) and Dual Tendon (DT) ACLR, given there is no prospective randomised controlled trial (RCT) in the literature comparing outcomes between these options.In this ongoing RCT: (ANZ Clinical Trials Registry ACTRN126200000927921) patients were recruited and randomised into either ST or DT groups. All anaesthetic and surgical techniques were uniform aside from graft technique and tibial fixation. 13 patients were excluded at surgery as their ST graft did not achieve a minimum 8mm diameter. 70 patients (34 ST, 36DT) have been assessed at 6 months, using PROMS including IKDC2000, Lysholm and Modified Cincinnati Knee, visual analog scale for pain frequency (VAS-F) and severity (VAS-S), dedicated donor site morbidity score, KT-1000 assessment, and isokinetic strength.Graft diameters were significantly lesser in the ST group compared to the DT group (8.44mm/9.11mm mean difference [MD],-0.67mm; P<0.001). There was a significant and moderate effect in lower donor site morbidity in the ST group compared to the DT group (effect size [ES], 0.649; P = .01). No differences between groups were observed for knee laxity in the ACLR limb (P=0.362) or any of the patient-reported outcome measures (P>0.05). Between-group differences were observed for hamstrings strength LSI favouring the ST group, though these were small-to-moderate and non-significant (ES, 0.351; P = .147).ST (versus DT) harvest results in significantly less donor site morbidity and this is the first prospective RCT to determine this. There were no differences between ST and DT hamstring ACLR were observed in PROMs, knee laxity and hamstring strength. Younger female patients tend to have inadequate single tendon size to produce a graft of sufficient diameter, and alternative techniques should be considered. Further endpoints include radiological analysis, longer term donor site morbidity, revision rates and return to sport and will continue to be presented in the future.
COMPARING MODERN UNCEMENTED, HYBRID AND CEMENTED IMPLANT COMBINATIONS IN OLDER PATIENTS UNDERGOING PRIMARY TOTAL HIP ARTHROPLASTY: A NEW ZEALAND JOINT REGISTRY STUDY
Authors: Boyle A.B. , Zhu M. , Frampton C. , Poutawera V. , Vane A. 
Published: February 2023

Multiple joint registries have reported better implant survival for patients aged >75 years undergoing total hip arthroplasty (THA) with cemented implant combinations when compared to hybrid or uncemented implant combinations. However, there is considerable variation within these broad implant categories, and it has therefore been suggested that specific implant combinations should be compared. We analysed the most common contemporary uncemented (Corail/Pinnacle), hybrid (Exeter V40/Trident) and cemented (Exeter V40/Exeter X3) implant combinations in the New Zealand Joint Registry (NZJR) for patients aged >75 years.All THAs performed using the selected implants in the NZJR for patients aged >75 years between 1999 and 2018 were included. Demographic data, implant type, and outcome data including implant survival, reason for revision, and post-operative Oxford Hip Scores were obtained from the NZJR, and detailed survival analyses were performed. Primary outcome was revision for any reason. Reason for revision, including femoral or acetabular failure, and time to revision were recorded.5427 THAs were included. There were 1105 implantations in the uncemented implant combination group, 3040 in the hybrid implant combination group and 1282 in the cemented implant combination group. Patient reported outcomes were comparable across all groups. Revision rates were comparable between the cemented implant combination (0.31 revisions/100 component years) and the hybrid implant combination (0.40 revisions/100 component years) but were statistically significantly higher in the uncemented implant combination (0.80/100 component years). Femoral-sided revisions were significantly greater in the uncemented implant combination group.The cemented implant and hybrid implant combinations provide equivalent survival and functional outcomes in patients aged over 75 years. Caution is advised if considering use of the uncemented implant combination in this age group, predominantly due to a higher risk of femoral sided revisions. The authors recommend comparison of individual implants rather than broad categories of implants.
ANTIBITOIC HYDROGEL FOR SINGLE-STAGE REVISION IN ORTHOPAEDIC INFECTION: A PRECLINICAL STUDY
Authors: Foster A.L. , Boot W. , Stenger V. , D'Este M. , Jaiprakash A. , Crawford R. , Schuetz M.A. , Eglin D. , Zeiter S. , Richards R.G. , Moriarty T.F. 
Published: February 2023

Local antimicrobial therapy is an integral aspect of treating orthopaedic device related infection (ODRI), which is conventionally administered via polymethylmethacrylate (PMMA) bone cement. PMMA, however, is limited by a suboptimal antibiotic release profile and a lack of biodegradability.In this study, we compare the efficacy of PMMA versus an antibioticloaded hydrogel in a single- stage revision for chronic methicillin-resistant Staphylococcus aureus (MRSA) ODRI insheep. Antibiofilm activity of the antibiotic combination (gentamicin and vancomycin) was determined in vitro. Swiss alpine sheep underwent a single-stage revision of a tibial intramedullary nail with MRSA infection. Local gentamicin and vancomycin therapy was delivered via hydrogel or PMMA (n = 5 per group), in conjunction with systemic antibiotic therapy. In vivo observations included: local antibiotic tissue concentration, renal and liver function tests, and quantitative microbiology on tissues and hardware post-mortem.There was a nonsignificant reduction in biofilm with an increasing antibiotic concentration in vitro (p = 0.12), confirming the antibiotic tolerance of the MRSA biofilm. In the in vivo study, four out of five sheep from each treatment group were culture negative. Antibiotic delivery via hydrogel resulted in 10–100 times greater local concentrations for the first 2–3 days compared with PMMA and were comparable thereafter. Systemic concentrations of gentamicin were minimal or undetectable in both groups, while renal and liver function tests were within normal limits.This study shows that a single-stage revision with hydrogel or PMMA is equally effective, although the hydrogel offers certain practical benefits over PMMA, which make it an attractive proposition for clinical use.
VANCOMYCIN SOAKING IS HIGHLY COST-EFFECTIVE IN PRIMARY ACLR INFECTION PREVENTION: A COST-EFFECTIVENESS STUDY
Authors: Truong A.P. , Perez-Prieto D. , Byrnes J. , Monllau J.C. , Vertullo C.J. 
Published: February 2023

While pre-soaking grafts in vancomycin has demonstrated to be effective in observational studies for anterior cruciate ligament reconstruction (ACLR) infection prevention, the economic benefit of the technique is uncertain. The primary aim of this study was to determine the cost-effectiveness of vancomycin pre-soaking during primary ACLR to prevent post-operative joint infections. The secondary aims of the study were to establish the breakeven cost-effectiveness threshold of the technique.A Markov model was used to determine cost effectiveness and the incremental cost effectiveness ratio of additional vancomycin pre-soaking compared to intravenous antibiotic prophylaxis alone. A repeated meta-analysis of nine cohort studies (Level III evidence) was completed to determine the odds ratio of infection with vancomycin pre-soaking compared to intravenous antibiotics alone. Estimated costs and transitional probabilities for further surgery were obtained from the literature. Breakeven threshold analysis was performed.The vancomycin soaking technique provides an expected cost saving of $600AUD per patient. There was an improvement in the quality-adjusted life years of 0.007 compared to intravenous antibiotic prophylaxis alone (4.297 versus 4.290). If the infection rate is below 0.023% with intravenous antibiotics alone or the additional intervention cost more than $1000AUD, the vancomycin wrap would no longer be cost-effective.For $30AUD, the vancomycin soaking technique provides a $600AUD cost saving by both reducing the risk of ACLR related infection and economic burden of infection. Treating septic arthritis represents a mean cost per patient of 6 times compared to that of the primary surgery. There has been no previous cost-effectiveness study of the vancomycin wrap technique.The vancomycin pre-soaking technique is a highly cost-effective method to prevent post-operative septic arthritis following primary ACLR.