bluuebunny/crossref_metadata_2025_split huggingface dataset:
FEMORAL SHAFT-NAIL RADIUS OF CURVATURE DISCREPANCY: PREOPERATIVE ANALYSIS OF FEMORAL SHAFT ANTERIOR RADIUS OF CURVATURE USING IMAGING AND ITS ASSOCIATION WITH ANTERIOR CORTICAL IMPINGEMENT DURING FIXATION OF FEMORAL PATHOLOGY
Authors: O'Donnell T.G. , Chung T. , Bingham R. 
Published: February 2023

Long femoral nails for neck of femur fractures and prophylactic fixation have a risk of anterior cortex perforation. Previous studies have demonstrated the radius of curvature (ROC) of a femoral nail influencing the finishing point of a nail and the risk of anterior cortex perforation. This study aims to calculate a patients femoral ROC using preoperative XR and CT and therefore nail finishing position.We conducted a retrospective study review of patients with long femoral cephalomedullary nailing for proximal femur fractures (OTA/AO 31(A) and OTA/AO 32) or impending pathological fractures at a level 1 trauma centre between January 1, 2015 and December 31, 2020 with both full length lateral X-ray and CT imaging. Femoral ROC was calculated on both imaging modalities. Outcomes measured including nail finishing position, anterior cortex encroachment and impingement. The mean femoral ROC was 1026mm on CT and 1244mm on XR. CT femoral ROC strongly correlated with nail finishing point with a spearmans coefficient of 0.77. Additionally, femurs with a ROC <1000mm were associated with a higher risk of anterior encroachment (OR 6.12) and femurs with a ROC <900mm were associated with a higher risk of anterior cortex impingement (OR 6.47).To our knowledge this is the first study to compare a measured femoral ROC to nail finishing position. The use of CT to measure femoral ROC and to a lesser extent XR was able to predict both nail finishing position and risk of anterior cortex encroachment. Preoperative XRs and CTs were able to identify patients with a small femoral ROC. This predicted patients at risk of anterior cortex impingement, anterior cortex encroachment and nail finishing position. We may be able to select femoral nails that resemble the native femoral ROC and mitigate the risk of anterior cortex perforation.
CEMENTED THA WITH THE EXETER CONTEMPORARY FLANGED CUP IN PRIMARY TOTAL HIP ARTHROPLASTY: MINIMUM TEN-YEAR FOLLOW-UP OF FULLY CEMENTED TOTAL HIP ARTHROPLASTIES WITH CONVENTIONAL POLYETHYLENE
Authors: Lamberton T. D. , Whitehouse S. L. , Timperley A. J. 
Published: February 2023

We report the outcome of 320 primary Total Hip Arthroplasties (THA) with minimum 10-year follow-up (range 10-17 years, mean 12.6 years), performed by a single surgeon in Tauranga New Zealand, with the Exeter Contemporary Flanged all-polyethylene cup and Exeter femoral stem via a posterior approach. The aim of the study is to compare the results with the published results from the design centre and create a baseline cohort for further outcomes research in this centre.All patients were prospectively followed at 6 weeks, 1 year, 5 years, 10 years, (and 15 years when available). Of 333 cases that matched the inclusion criteria, 13 procedures in 12 patents were excluded because of concomitant bone grafting and/or supplementary cage fixation, leaving 320 primary THA procedures in 280 patients, including 26 bilateral procedures in 13 patients.Mean follow-up of the surviving cases was 12.6 (range 5.0-17.1) years. There were 12 revisions – 2 for fracture, 5 for instability, 1 for impingement pain and 4 for infection. There were no revisions for aseptic cup loosening. Kaplan-Meier survivorship with revision for aseptic loosening as the endpoint was 100% at 15.0 years (with minimum 40 cases remaining at risk). All-cause acetabular revision in 12 cases result in a Kaplan-Meier survival of 95.9% (95% CI: 93.5 to 98.3%).Cemented THA with the Exeter Contemporary Flanged cup and the Exeter stem is a durable combination with results that can be replicated outside of the design centre. The Exeter Contemporary Flanged cup has excellent survivorship at 15 years when used with the Exeter stem. Cemented THA with well-proven components should be considered the benchmark against which newer designs and materials should be compared.
THE ROLE OF ERRORS IN LEARNING NEW SURGICAL SKILLS
Authors: He W. , Masters R. , Baker J. 
Published: February 2023

The minimisation of errors incurred during the learning process is thought to enhance motor learning and improve performance under pressure or in multitasking situations. If this is proven in surgical skills learning, it has the potential to enhance the delivery of surgical education. We aimed to compare errorless and errorful learning using the high-speed burr.Medical students (n=30) were recruited and allocated randomly to an errorless or errorful group. The errorless learning group progressively learnt tasks from easy to difficult on cedar boards simulating bone. The errorful learning group also progressed through the same tasks but not in order of difficulty.Transfer tasks assessed students’ performance of cervical laminoplasty on saw bone models to assess their level of learning from previous stages. During transfer task 2, students completed the procedure under time pressure and in the presence of distractors, in order to simulate real-life stressors in theatre. Accuracy, precision and safety of the procedure were scored by expert opinions from spine surgeons blinded to the grouping of the participants.Both errorless and errorful learners demonstrated improvements in performance with increasing amounts of practice (demonstrated by the decreased time taken for the task as well as improvement in accuracy of the cuts (depth, width and smoothness). The performance of both groups was not impaired by the incorporation of a secondary task which required participants to multitask. No statistically significant difference in performance was noted between the two groups.In contrast to previous research, there was no significant difference between errorless or errorful learning to develop skills with a high-speed, side-cutting burr. In both groups, practical learning during the session has led to improvement in overall performance with the burr relevant to cervical laminoplasty.
IS POTENTIAL MALNUTRITION ASSOCIATED WITH INCREASED MORBIDITY IN TOTAL HIP AND KNEE ARTHROPLASTY?
Authors: Caughey W.J. , Zaidi F. , Shepherd C.J. , Rodriguez C.R. , Pitto R.P. 
Published: February 2023

Malnutrition is considered a risk factor for postoperative complications in total hip and knee arthroplasty, though prospective studies investigating this assumption are lacking. The aim of this study was to prospectively analyse the 90-day postoperative complications, postoperative length of stay (LOS) and readmission rates of patients undergoing primary total hip and total kneearthroplasty using albumin, total lymphocyte count (TLC) and transferrin as serum markers of potential malnutrition.603 primary hip and 823 primary knee arthroplasties over a 3-year period from a single centre wereprospectively analysed. BMI, demographic and comorbidity data were recorded. Complications werecategorised as surgical site infection, venous thromboembolism (deep vein thrombosis andpulmonary embolus), implant related (such as dislocation), and non-implant related (such aspneumonia). Outcomes were compared between groups, with malnutrition defined as serumalbumin <3.5g/dL, transferrin <200 mg/dL, or TLC <1,500 cells/mm³.Potential malnutrition was present in 9.3% of the study population. This group experienced a longeraverage LOS at 6.5 days compared to the normal albumin group at 5.0 days (p=0.003). Surgical siteinfection rate was higher in the malnourished group (12.5 vs 7.8%, p=0.02). There was no differencebetween the two groups in implant related complications (0.8 vs 1.0%, p=0.95) medicalcomplications (7.8 vs 13.3%, p=0.17), rate of venous thromboembolism (2.3 vs 2.7%) or 90-dayreadmission rate (14.1 vs 17.0%, p=0.56). TLC and transferrin were not predictive of any of theprimary outcomes measured (p<0.05). Pacific Island (p<0.001), Indian (p=0.02) and Asian (p=0.02) patients had lower albumin than NZ European.This study demonstrates an association between low albumin levels and increased postoperativeLOS and surgical site infection in total joint arthroplasty, providing rationale for consideration ofpreoperative nutritional screening and optimisation.
EARLY RESULTS OF THE FEMORAL NECK SYSTEM IN FIXATION OF FEMORAL NECK FRACTURES
Authors: Lee W.C. , Kiang W.W. , Chen Y.D. , Yeoh C.S.N. , Teo W.W.T. , Tang Z.H. 
Published: February 2023

The Femoral Neck System (FNS) was introduced as an alternative device for the fixation of neck of femur fractures (NOFFs). The purported advantages include superior angular and rotatory stability compared to multiple cancellous screws, via a minimally invasive instrumentation that is simpler than conventional fixed angle devices. There were limited clinical studies regarding the utility of this device. We aimed to study the outcomes of NOFFs fixed with the FNS.This was a single-institution, retrospective review of all undisplaced elderly (≥60 years old) undisplaced young, and displaced young NOFFs fixed with the FNS. Demographics, surgical parameters, radiographic parameters, and clinical outcomes including complications were reviewed.Thirty-six subjects with a median age of 75 [44,89] years old, had NOFF fixation using the FNS. Thirty-one (86.1%) had undisplaced fractures. There were 6 (16.7%), 26 (72.2%), and 4 (11.1%) subjects with Pauwels types 1, 2, and 3 respectively. Thirty-two (88.9%) had posterior tilt of <20º. The mean duration of surgery was 71±18 minutes. Excluding 4 patients whom required revision surgery, 2 patients whom demised, and 10 patients whom defaulted reviews, the mean follow-up duration was 55±13 weeks. Four complications were recorded, namely implant cut out at the femoral head at week 8, breaking of the locking screw at the run-off region at week 22, avascular necrosis at week 25, and a refracture following near fall, causing the fracture to fail in varus at week 7 postoperation.While reasonably fast to instrument, failures still occur and it is likely multifactorial. However, the rate of reoperation is lower than what has been reported for NOFFs fixed with the a fixed-angle device or 3 cancellous screws. In conclusion, the FNS is a reasonably safe instrument to use. Surgeons’ discretion is still needed in patient selection, keeping in mind the need for satisfactory radiological parameters.
RADIOLUCENT LINE ASSESSMENT IN CEMENTED STEMMED TOTAL KNEE (RISK) ARTHROPLASTY: VALIDATION OF A MODERNIZED CLASSIFICATION SYSTEM
Authors: Francis S.L. , Murphy B.PDS. , Elsiwy Y. , Babazadeh S. , Clement N.D. , Stoney J.D. , Stevens J.M. 
Published: February 2023

This study aims to implement and assess the inter and intra-reliability of a modernised radiolucency assessment system; the Radiolucency In cemented Stemmed Knee (RISK) arthroplasty classification. Furthermore, we assessed the distribution of regions affected by radiolucency in patients undergoing stemmed cemented knee arthroplasty.Stemmed knee arthroplasty cases over 7-year period at a single institution were retrospectively identified and reviewed. The RISK classification system identifies five zones in the femur and five zones in the tibia in both the anteroposterior (AP) and lateral planes. Post-operative and follow-up radiographs were scored for radiolucency by four blinded reviewers at two distinct time points four weeks apart. Reliability was assessed using the kappa statistic. A heat map was generated to demonstrate the reported regions of radiolucency.29 cases (63 radiographs) of stemmed knee arthroplasty were examined radiographically using the RISK system. Intra-reliability (0.83) and Inter-reliability (0.80) scores were both consistent with a strong level of agreement using the kappa scoring system. Radiolucency was more commonly associated with the tibial component (76.6%) compared to the femoral component (23.3%), and the tibial anterior-posterior (AP) region 1 (medial plateau) was the most affected (14.9%).The RISK classification system is a reliable assessment tool for evaluating radiolucency around stemmed knee arthroplasty using defined zones on both AP and lateral radiographs. Zones of radiolucency identified in this study may be relevant to implant survival and corresponded well with zones of fixation, which may help inform future research.
THE “GOOD DOCTOR” PERFORMANCE OF RADIOLOGICAL ANNOTATION: MEASURING PELVIC TILT AS AN EXAMPLE
Authors: Chai Y. , Boudali A.M. , Farey J. , Walter W.L. 
Published: February 2023

Human error is usually evaluated using statistical descriptions during radiographic annotation. The technological advances popularized the “non-human” landmarking techniques, such as deep learning, in which the error is presented in a confidence format that is not comparable to that of the human method. The region-based landmark definition makes an arbitrary “ground truth” point impossible. The differences in patients’ anatomies, radiograph qualities, and scales make the horizontal comparison difficult. There is a demand to quantify the manual landmarking error in a probability format.Taking the measurement of pelvic tilt (PT) as an example, this study recruited 115 sagittal pelvic radiographs for the measurement of two PTs. We proposed a method to unify the scale of images that allows horizontal comparisons of landmarks and calculated the maximum possible error using a density vector. Traditional descriptive statistics were also applied.All measurements showed excellent reliabilities (intraclass correlation coefficients > 0.9). Eighty-four measurements (6.09%) were qualified as wrong landmarks that failed to label the correct locations. Directional bias (systematic error) was identified due to cognitive differences between observers. By removing wrong labels and rotated pelves, the analysis quantified the error density as a “good doctor” performance and found 6.77°-11.76° maximum PT disagreement with 95% data points.The landmarks with excellent reliability still have a chance (at least 6.09% in our case) of making wrong landmark decisions. Identifying skeletal contours is at least 24.64% more accurate than estimating landmark locations. The landmark at a clear skeletal contour is more likely to generate systematic errors. Due to landmark ambiguity, a very careful surgeon measuring PT could make a maximum 11.76° random difference in 95% of cases, serving as a “good doctor benchmark” to qualify good landmarking techniques.
DEVELOPING AND EVALUATING THE SMART CHOICE (KNEE): A PATIENT-FOCUSED TOOL TO PREDICT HEALTH-RELATED QUALITY OF LIFE OUTCOMES AFTER TOTAL KNEE ARTHROPLASTY
Authors: Zhou Y , Dowsey M , Spelman T , Choong P , Schilling C 
Published: February 2023

Approximately 20% of patients feel unsatisfied 12 months after primary total knee arthroplasty (TKA). Current predictive tools for TKA focus on the clinician as the intended user rather than the patient. The aim of this study is to develop a tool that can be used by patients without clinician assistance, to predict health-related quality of life (HRQoL) outcomes 12 months after total knee arthroplasty (TKA).All patients with primary TKAs for osteoarthritis between 2012 and 2019 at a tertiary institutional registry were analysed. The predictive outcome was improvement in Veterans-RAND 12 utility score at 12 months after surgery. Potential predictors included patient demographics, co-morbidities, and patient reported outcome scores at baseline. Logistic regression and three machine learning algorithms were used. Models were evaluated using both discrimination and calibration metrics. Predictive outcomes were categorised into deciles from 1 being the least likely to improve to 10 being the most likely to improve.3703 eligible patients were included in the analysis. The logistic regression model performed the best in out-of-sample evaluation for both discrimination (AUC = 0.712) and calibration (gradient = 1.176, intercept = −0.116, Brier score = 0.201) metrics. Machine learning algorithms were not superior to logistic regression in any performance metric. Patients in the lowest decile (1) had a 29% probability for improvement and patients in the highest decile (10) had an 86% probability for improvement.Logistic regression outperformed machine learning algorithms in this study. The final model performed well enough with calibration metrics to accurately predict improvement after TKA using deciles. An ongoing randomised controlled trial (ACTRN12622000072718) is evaluating the effect of this tool on patient willingness for surgery. Full results of this trial are expected to be available by April 2023.A free-to-use online version of the tool is available at smartchoice.org.au.
User and resource allocation in latency constrained Xhaul via reinforcement learning
Authors: Chughtai Mohsan Niaz , Noor Shabnam , Laurinavicius Ignas , Assimakopoulos Philippos , Gomes Nathan J. , Zhu Huiling , Wang Jiangzhou , Zheng Xi , Yan Qi 
Published: February 2023

The Flexible Ethernet (FlexE) is envisioned for the provisioning of different services and hard slicing of the Xhaul in 5G and beyond networks. For efficient bandwidth utilization in the Xhaul, traffic prediction for slot allocation in FlexE calendars is required. Further, if coordinated multipoint (CoMP) is used, the allocation of users to remote units (RUs) with an Xhaul path of lower latency to the distributed unit/central unit will increase the achievable user bit rate. In this paper, the use of multi-agent deep reinforcement learning (DRL) for optimal slot allocations in a FlexE-enabled Xhaul, for traffic generated through CoMP, and for offloading users among different RUs is explored. In simulation results, the DRL agent can learn to predict input traffic patterns and allocate slots with the necessary granularity of 5 Gbps in the FlexE calendar. The resulting gains are expressed in terms of the reduction of mean over-allocation of slots in the FlexE calendar in comparison to the prediction obtained from an autoregressive integrated moving average (ARIMA) model. Simulations indicate that DRL outperforms ARIMA-based prediction by up to 11.6%
Self Assembly SLM for Molecular Computing
Authors: Szu Harold , Tate Ann , Cullin David , Walch Marianne , Demske David , Garcia Joseph , Phuvan Sonlinh , Caviris Nicholas 
Published: February 2023

Spatial Light Modulator (SLM) useful Molecular Computing is made on a bacteriorhodopsin (BR) molecule film suspended in a viscous liquid medium, similar to a wet photograph but having adaptive and finer pixels.
The natural synergism between the thermal diffusion of BR molecule (induced externally by a write-laser) and its photochromism (generated internally by electronic transitions) is demonstrated in an edge-enhanced laser-image application.
Soft X-Ray Lenses with 400 Å Outer Zone Width
Authors: Vladimirsky Y. , Kern D. , Chang T.H.P. , Meyer-Ilse W. , Guttmann P. , Greinke B. , Attwood D. 
Published: February 2023

Fresnel zone plate lenses for focussing and imaging radiation in the 10-50 Å wavelength region have been fabricated with outer zone widths as small as 400 Å. The zone plates were fabricated by electron beam lithography using a high resolution vector scan system designed specifically for nanometer pattern writing. A special circular pattern generation technique, utilizing high speed polar/cartesian conversion was utilized. Field size was calibrated for squareness and orthogonality using electron beam lithography calibration marks and laser interferometry. Patterns were written in a 180-200 nm thick PMMA resist on a 30 nm gold electroplating base. The substrate was a 100 nm silicon nitride film. The pattern received a dose of 250 μC/cm2 at 25 KeV. Special patterns requiring a thick central stop region, received a doubled dose, followed by a double development/double plating technique.
A method utilizing the phenomenon of form birefringence was used for monitoring the development of the fine features. In the optical microscope with polarized light and crossed analyzer, a distinct change of the reflected intensity is observed during the final stages of development.
Text patterns imaged at 45 Å wavelength demonstrate a spatial resolution approaching 500 Å. Measurements of zone plate efficiency are also described.
Time Resolved Dynamics in Large Molecular Cluster Ions
Authors: Nadal M. , Vorsa V. , Papanikolas J. M. , Campagnola P. J. , Parson R. , Lineberger W. Carl 
Published: February 2023

Photoabsorption in large mass-selected cluster ions is detected via evaporation of molecules from the cluster. The shape and size evolution of the absorption spectrum with cluster size provides a mechanism to identify the chromophore and to detect the extent of charge delocalization in the cluster ion. Photofragment mass spectra have been obtained for
Br2−(CO2)n,I2−(CO2)n and ICl−(CO2)n cluster ions following photoexcitation of the
12g (2Πg,1/2)←12u(2Σu+) transition in
I2− and Br2− and the analogous transition in ICl-. Photodissociation of
X2− within the cluster results in the production of both X-- and
X2−-based ionic photofragments:
Acute otitis media symptoms and symptom scales in research with Aboriginal and Torres Strait Islander children
Authors: Abbott Penelope , Frede Caitlin , Hu Wendy C. Y. , Lujic Sanja , Trankle Steven , Campbell Letitia , Gunasekera Hasantha , Walsh Robyn , Leach Amanda J. , Morris Peter , Kong Kelvin , Reath Jennifer 
Published: February 2023

Background
Aboriginal and Torres Strait Islander children experience a high burden of otitis media. We collected data on symptoms associated with acute otitis media (AOM) in a clinical trial involving children receiving primary care at urban Aboriginal Medical Services. Two scales were employed to monitor symptoms over time: the AOM-Severity of Symptoms scale (AOM-SOS) and the AOM-Faces Scale (AOM-FS). This study took place at a mid-point of the un-blinded trial.

Methods
We examined symptoms at enrolment and day 7, and compared the scales for trends, and bivariate correlation (Spearman’s rho) over 14 days. Responsiveness of the scales to clinical change was determined by Friedman’s test of trend in two subgroups stratified by day 7 AOM status. We interviewed parents/carers and research officers regarding their experience of the scales and analysed data thematically.

Results
Data derived from 224 children (18 months to 16 years; median 3.6 years). Common symptoms associated with AOM at baseline were runny nose (40%), cough (38%) and irritability (36%). More than one third had no or minimal symptoms at baseline according to AOM-SOS (1-2/10) and AOM-FS scores (1-2/7). The scales performed similarly, and were moderately correlated, at all study points. Although scores decreased from day 0 to 14, trends and mean scores were the same whether AOM was persistent or resolved at day 7. Users preferred the simplicity of the AOM-FS but encountered challenges when interpreting it.

Conclusion
We found minimally symptomatic AOM was common among Aboriginal and Torres Strait Islander children in urban settings. The AOM-SOS and AOM-FS functioned similarly. However, it is likely the scales measured concurrent symptoms related to upper respiratory tract infections, given they did not differentiate children with persistent or resolved AOM based on stringent diagnostic criteria. This appears to limit the research and clinical value of the scales in monitoring AOM treatment among Aboriginal and Torres Strait Islander children.