bluuebunny/crossref_metadata_2025_split huggingface dataset:
INTER-RATER AND INTRARATER RELIABILITY OF THREE COMMON CLASSIFICATION SYSTEMS FOR POSTERIOR MALLEOLUS FRACTURES: A MULTICENTRE STUDY
Authors: Rashid M. , Islam R. , Marsden S. , Trompeter A. , Teoh K.H. 
Published: July 2023

A number of classification systems exist for posterior malleolus fractures of the ankle. The reliability of these classification systems remains unclear. The primary aim of this study was to evaluate the reliability of three commonly utilised fracture classification systems of the posterior malleolus.60 patients across 2 hospitals sustaining an unstable ankle fracture with a posterior malleolus fragment were identified. All patients underwent radiographs and computed tomography of their injured ankle. 9 surgeons including pre-ST3 level, ST3-8 level, and consultant level applied the Haraguchi, Rammelt, and Mason & Molloy classifications to these patients, at two timepoints, at least 4 weeks apart. The order was randomised between assessments. Inter-rater reliability was assessed using Fleiss’ kappa and 95% confidence intervals (CI). Intra-rater reliability was assessed using Cohen's Kappa and standard error (SE).Inter-rater reliability (Fleiss’ Kappa) was calculated for the Haraguchi classification as 0.522 (95% CI 0.490 – 0.553), for the Rammelt classification as 0.626 (95% CI 0.600 – 0.652), and the Mason & Molloy classification as 0.541 (95% CI 0.514 – 0.569). Intra-rater reliability (Cohen's Kappa) was 0.764 (SE 0.034) for the Haraguchi, 0.763 (SE 0.031) for the Rammelt, 0.688 (SE 0.035) for the Mason & Molloy classification.This study reports the inter-rater and intra-rater reliability for three classification systems for posterior malleolus fractures. Based on definitions by Landis & Koch (1977), inter-rater reliability was rated as ‘moderate’ for the Haraguchi and Mason & Molloy classifications; and ‘substantial’ for the Rammelt classification. Similarly, the intra-rater reliability was rated as ‘substantial’ for all three classifications.
ANKLE FUSION WITH TIBIOTALOCALCANEAL RETROGRADE NAIL FOR FRAGILITY ANKLE FRACTURES: OUTCOMES AT A MAJOR TRAUMA CENTRE
Authors: Lu V. , Tennyson M. , Zhang J. , Zhou A. , Thahir A. , Krkovic M. 
Published: July 2023

Fragility ankles fractures in the geriatric population are challenging to manage, due to fracture instability, soft tissue compromise, patient co-morbidities. Traditional management options include open reduction internal fixation, or conservative treatment, both of which are fraught with high complication rates. We aimed to present functional outcomes of elderly patients with fragility ankle fractures treated with tibiotalocalcaneal nails.171 patients received a tibiotalocalcaneal nail over a six-year period, but only twenty met the inclusion criteria of being over sixty and having poor bone stock, verified by radiological evidence of osteopenia or history of fragility fractures. Primary outcome was mortality risk from co-morbidities, according to the Charlson co-morbidity index (CCI), and patients’ post-operative mobility status compared to pre-operative mobility. Secondary outcomes include intra-operative and post-operative complications, six-month mortality rate, time to mobilisation and union.The mean age was 77.82 years old, five of whom are type 2 diabetics. The average CCI was 5.05. Thirteen patients returned to their pre-operative mobility state. Patients with low CCI are more likely to return to pre-operative mobility status (p=0.16; OR=4.00).Average time to bone union and mobilisation were 92.5 days and 7.63 days, respectively. Mean post-operative AOFAS ankle-hindfoot and Olerud-Molander scores were 53.0 (range 17-88) and 50.9 (range 20-85), respectively. There were four cases of broken distal locking screws, and four cases of superficial infection. Patients with high CCI were more likely to acquire superficial infections (p=0.264, OR=3.857). There were no deep infections, periprosthetic fractures, nail breakages, non-unions.TTC nailing is an effective treatment methodology for low-demand geriatric patients with fragility ankle fractures. This technique leads to low complication rates and early mobilisation. It is not a life-changing procedure, with many able to return to their pre-operative mobility status, which is important for preventing the loss of socioeconomic independence.
DEVELOPMENT OF A HUMAN EX VIVO FEMORAL HEAD MODEL TO ASSESS MESENCHYMAL STROMAL CELL REGENERATION OF ARTICULAR CARTILAGE
Authors: Styczynska-Soczka K. , Cawley W. , Samuel K. , Campbell J. , Amin A. , Hall A. 
Published: July 2023

Articular cartilage has poor repair potential and the tissue formed is mechanically incompetent. Mesenchymal stromal cells (MSCs) show chondrogenic properties and the ability to re-grow cartilage, however a viable human model for testing cartilage regeneration and repair is lacking. Here, we describe an ex vivo pre-clinical femoral head model for studying human cartilage repair using MSCs.Human femoral heads (FHs) were obtained following femoral neck fracture with ethical permission/patient consent and full-depth cartilage wells made using a 3mm biopsy punch. Pancreas-derived mesenchymal stromal cells (P-MSC) were prepared in culture media at ~5000 cells/20µl and added to each well and leakage prevented with fibrin sealant. After 24hrs, the sealant was removed and medium replaced with StemProTM chondrogenesis differentiation medium. The FHs were incubated (37oC;5% CO2) for 3wks, followed by a further 3wks in standard medium with 10% human serum with regular medium changes throughout. Compared to wells with medium only, A-MSCs produced a thin film across the wells which was excised en-block, fixed with 4% paraformaldehyde and frozen for cryo-sectioning.The cell/tissue films varied in thickness ranging over 20-440µm (82±21µm; mean±SEM; N=3 FHs). The thickness of MSC films abutting the cartilage wells was variable but generally greater (15-1880µm) than across the wells, suggesting an attachment to native articular cartilage. Staining of the films using safranin O (for glycosaminoglycans; quantified using ImageJ) was variable (3±8%; mean±SEM; N=3) but in one experiment reached 20% of the adjacent cartilage. A preliminary assessment of the repair tissue gave an O'Driscoll score of 10/24 (24 is best).These preliminary results suggest the ex vivo femoral head model has promise for studying the capacity of MSCs to repair cartilage directly in human tissue, although optimising MSCs to produce hyaline-like tissue is essential.Supported by the CSO (TCS/17/32).
EFFECTS OF TRIPS AND SLIPS ON AGONIST AND ANTAGONIST MUSCLE FORCES POST-PERTURBATION
Authors: Namayeshi T. , Lee P. 
Published: July 2023

Falls in adults are a major problem and can lead to injuries and death. In order to better understand falls and successful recoveries, identifying kinematics, kinetics, and muscle forces during recovery from loss of balance is crucial. To obtain reactive gait patterns, participants must be subjected to unexpected perturbations such as trips and slips. Previous researchers have reported kinetics recovery data following stumbling; however, the muscle force recovery patterns remain unknown. To better target exercises to reduce the risk of falls, we must first understand which muscles, their magnitude, and their coordination patterns, play a role in a successful recovery from a trip and a slip. Additionally, knowing the successful patterns of lower limb function can help with the diagnosis of faulty movements.A total of 20 healthy adults in their twenties with similar athletic backgrounds were perturbed on a split-belt treadmill using Computer-Assisted Rehabilitation Environment (Motkforce Link) at a preset speed of 1.1m/s. Two kinds of perturbations were administered: slip and trip. Slips were simulated by accelerating one belt, whereas trips were simulated by decelerating one belt. Both perturbations had similar intensity and only differed in the direction. Computational modeling was used to obtain lower-limb function during the compensatory step. SPM paired t-test was used to compare differences in recovery strategies between slip and trip through magnitude and patterns of joints.There were no significant differences in joint angles post tripping vs post-slipping. Results of net joint moments showed that compensating for the loss of balance due to tripping required a higher ankle plantarflexion moment than slipping (at 22-52%; 1.2± 0.3vs0.4±0.2, p<0.001). Additionally, larger gluteus maximus (at 40-50%;8.7±3.8vs2.7±1.1N/kg, p=0.001), gluteus medius (at23~33%; 22.6±5.7vs6.8±3.6N/kg, p<0.001) were generated than post-slipping, respectively.These findings suggested that greater GMAX and GMED forces are required post-trip recovery than slip. Future analysis of trip recovery showed the importance of ankle joint in recovering from forward and backward fall. These results can be used as references in remote diagnosis of joint and muscle weakness and assessment of the risk of falls with the use of accelerometers.
HOW DOES COVID-19 IMPACT THE HEALTH SYSTEM? A PERSPECTIVE OF HEALTH SERVICE PROVIDERS AND THE HEALTH INDUSTRY
Authors: Reimers N. , Huynh T. , Schulz A.P. 
Published: July 2023

The objectives of this study are to evaluate the impact of the CoVID-19 pandemic on the development of relevant emerging digital healthcare trends and to explore which digital healthcare trend does the health industry need most to support HCPs.A web survey using 39 questions facilitating Five-Point Likert scales was performed from 1.8.2020 – 31.10.2020. Of 260 participants invited, 90 participants answered the questionnaire. The participants were located in the Hospital/HCP sector in 11.9%, in other healthcare sectors in 22.2%, in the pharmaceutical sector in 11.1%, in the medical device and equipment industry in 43.3%. The Five-Point Likert scales were in all cases fashioned as from 1 (strongly disagree) to 5 (strongly agree).As the top 3 most impacted digital health care trends strongly impacted by CoVID-19, respondents named:- remote management of patients by telemedicine, mean answer 4.44- shared data governance under patient control, mean answer 3.80- new virtual interaction between HCP´s and medical industry, mean answer 3.76Respondents were asked which level of readiness of the healthcare system currently possess to cope with the current trend impacted by CoVID-19.- Digital and efficient healthcare logistics, mean answer 1.54- Integrated health care, mean answer 1.73- Use of big data and artificial intelligence, mean answer 2.03Asked if collaborative research in the form of digital data platforms for research data sharing and increasing collaboration with multi-centric consortia would have a positive impact on the healthcare sector, the agreement was high with a value of mean 4.10 on the scale.We can conclude that the impact of COVID-19 appears to be a high agreement of necessary advances in digitalization in the health care sector and in the collaboration of HCPs with the health care industry. Health care professional are unsure, in how far the national health care sector is capable of transformation in healthcare logistics and integrated health care.
AN INVESTIGATION OF PATELLAR HEIGHT AND KNEE FLEXION ANGLE
Authors: Al-Musawi H. , Sammouelle E. , Manara J. , Clark D. , Eldridge J. 
Published: July 2023

The aim is to investigate if there is a relation between patellar height and knee flexion angle. For this purpose we retrospectively evaluated the radiographs of 500 knees presented for a variety of reasons.We measure knee flexion angle using a computer-generated goniometer. Patellar height was determined using computer generated measurement for the selected ratios, namely, the Insall–Salvati (I/S), Caton–Deschamps (C/D) and Blackburne–Peel (B/P) indices and Modified I/S Ratio.A search of an NHS hospital database was made to identify the knee x rays for patients who were below the age of forty. A senior knee surgeon (DC) supervised three trainee trauma and orthopaedics doctors (HA, JM, ES) working on this research. Measurements were made on the Insall–Salvati (I/S), Caton–Deschamps (C/D) and Blackburne–Peel (B/P) indices and Modified I/S Ratio. The team leader then categorised the experimental measurement of patients’ knee flexion angle into three groups. This categorisation was according to the extent of knee flexion. The angles were specifically, 10.1 to 20, 20.1 to 30, and 30.1 to 40 degrees of knee flexion.Out of the five-hundred at the start of the investigation, four hundred and eighteen patients were excluded because they had had either an operation on the knee or traumatic fracture that was treated conservatively.
Characteristics of laser-induced steel plasmas generated with different focusing conditions
Authors: Liang Fangyuan , Wang Jingge , Fu Xiaoqing , Wang Hui 
Published: July 2023

Laser focusing is an important parameter that affects the characteristics of laser-induced plasma. Focusing lenses with different F-numbers form different energy density distributions near the surface of a sample, thus affecting the characteristics of plasma. In this study, the plasma generated by a nanosecond laser ablation of a micro-alloy steel certified sample at 1 atm of air was investigated. We compare the spectrally integrated plasma images obtained at different defocusing distances for short- and long-focus lenses and investigate the optical emission spectra of laser-induced plasma on steel alloy by using focusing lenses with different F-numbers. With an increase in the defocusing distance, the plasma plume changes from flat to hemispherical and then splitting occurs. The spectral line intensity increases first and then decreases, then increases slightly, and finally decreases gradually. For the long-focus lens, when the focal point is above the sample surface, the laser beam strongly interacts with air over a longer distance, leading to longer air plasma and weaker sample plasma compared with the short-focus lens. Thus, the relative intensity of the second peak in the spectral line intensity, according to the defocusing distance, gradually decreases with increasing F-number. We also obtain two-dimensional spatial distributions of the spectral line intensity according to the F-number and defocusing distance. The optimal defocusing distances for all focusing lenses occur when the focal point is below the sample surface. The relation between the optimal defocusing distance and F-number follows a single- exponential decay function.
Terahertz angle-independent photonic bandgap in a one-dimensional photonic crystal containing InSb-based hyperbolic metamaterials: erratum
Authors: Wu Feng , Yu Xi , Panda Abinash , Liu Dejun 
Published: July 2023

This erratum corrects the typing errors in Eq. (6) and the
caption of Fig. 4 of the original paper, Appl. Opt.
61, 7677 (2022).APOPAI0003-693510.1364/AO.470923 The
correction does not affect the results of the original paper.
The efficacy and safety of 0.01% atropine alone or combined with orthokeratology for children with myopia: A meta-analysis
Authors: Wang Zengying , Wang Pengfei , Jiang Bohua , Meng Yifei , Qie Sufang , Yan Zhipeng 
Published: July 2023

Objective
To evaluate the efficacy and safety of 0.01% atropine alone and in combination with orthokeratology for myopia control using a meta-analysis.

Methods
PubMed, Cochrane Library, and EMBASE were searched. We included eligible randomized controlled trials (RCTs), non-RCTs, and retrospective cohort studies, published up to August 1, 2022. We calculated the weighted mean difference (WMD) and 95% confidence interval (CI) for all outcomes and plotted them in forest plots.

Results
Fourteen studies were included; 4 and 11 in the 0.01% atropine monotherapy and atropine-orthokeratology (AOK) groups, respectively. Compared with orthokeratology (OK) alone, 0.01% atropine alone had similar effects on slowing the axial elongation (WMD: −0.00 mm; 95% CI: −0.05–0.04, p<0.31), while AOK significantly lowered axial growth. Moreover, the baseline myopic degree and duration of treatment were influential for the change in axial elongation (WMD: −0.12 mm; 95% CI: −0.17–−0.07, p = 0.00001 and WMD: −0.11 mm; 95% CI: −0.15–−0.108, p<0.00001, respectively). Additionally, the AOK may reduce the change rate of the spherical equivalent refraction and the accommodation amplitude (WMD: −0.13 D; 95% CI: 0.07–0.19, p<0.001 and WMD: −1.08 mm; 95% CI: −1.73–−0.43, p<0.0001, respectively), and cause a slight increase in the diameter of the pupil (WMD: 0.56 mm; 95% CI: 0.43–0.70, p = 0.007). No significant differences in the uncorrected distant visual acuity, best corrected visual acuity, intraocular pressure, tear film break-up time, lipid layer thickness, and corneal endothelial cell density were found between the OK and AOK groups.

Conclusion
In slowing the axial elongation, 0.01% atropine alone and OK alone have similar effects, while AOK is more effective than OK alone in slowing down the axial elongation. Furthermore, the baseline degree of myopia and treatment duration may affect changes in axial elongation.
Primary health care utilization in the first year after arrival by refugee sponsorship model in Ontario, Canada: A population-based cohort study
Authors: Wanigaratne Susitha , Rayner Jennifer , Glazier Richard H. , Stukel Therese A. , Lu Hong , Gandhi Sima , Saunders Natasha R. , Hynie Michaela , Kilibarda Anja , Guttmann Astrid 
Published: July 2023

BackgroundCanada’s approach to refugee resettlement includes government sponsorship, a pioneering private sponsorship model and a third blended approach. Refugees are selected and supported differently in each approach including healthcare navigation. Little is known about how well private sponsors facilitate primary care navigation and whether this changed during the large-scale 2015 Syrian resettlement initiative characterized by civic and healthcare systems engagement.Methods and findingsPopulation-based cohort study of resettled refugees arriving in Ontario between April 1, 2008 and March 31, 2017, with one-year follow-up, using linked health and demographic administrative databases. We evaluated associations of resettlement model (GARs, Privately Sponsored Refugees [PSRs], and Blended-Visa Office Referred [BVORs]) by era of arrival (pre-Syrian and Syrian era) and by country cohort, on measures of primary care (PC) navigation using adjusted Cox proportional hazards and logistic regression. There were 34,591 (pre-Syrian) and 24,757 (Syrian era) resettled refugees, approximately half of whom were GARs. Compared with the reference group pre-Syrian era PSRs, Syrian PSRs had slightly earlier PC visits (mean = 116 days [SD = 90]) (adjusted hazard ratios [aHR] = 1.19, 95% CI 1.14–1.23). Syrian GARs (mean = 72 days [SD = 65]) and BVORs (mean = 73 days [SD = 76]) had their first PC visit sooner than pre-Syrian era PSRs (mean = 149 days [SD = 86]), with respective aHRs 2.27, 95% CI 2.19–2.35 and 1.89, 95% CI 1.79–1.99. Compared to pre-Syrian PSRs, Syrian GARs and BVORs had much greater odds of a CHC visit (adjusted odds ratios 14.69, 95% CI 12.98–16.63 and 14.08, 95% 12.05–16.44 respectively) and Syrian PSRs had twice the odds of a CHC visit.ConclusionsLess timely primary care and lower odds of a CHC visit among PSRs in the first year may be attributed to selection factors and gaps in sponsors’ knowledge of healthcare navigation. Improved primary care navigation outcomes in the Syrian era suggests successful health systems engagement.
Trends in cancer-free working life expectancy based on health insurance data from Germany–Is the increase as strong as in working life expectancy?
Authors: Tetzlaff Fabian , Nowossadeck Enno , Epping Jelena , di Lego Vanessa , Muszynska-Spielauer Magdalena , Beller Johannes , Sperlich Stefanie , Tetzlaff Juliane 
Published: July 2023

BackgroundAgainst the backdrop of population ageing, governments are facing the need to raise the statutory retirement age. In this context, the question arises whether these extra years added to working life would be spent in good health. As cancer represents a main contributor to premature retirement this study focuses on time trends and educational inequalities in cancer-free working life expectancy (WLE).MethodsThe analyses are based on the data of a large German health insurer covering annually about 2 million individuals. Cancer-free WLE is calculated based on multistate life tables and reported for three periods: 2006–2008, 2011–2013, and 2016–2018. Educational inequalities in 2011–2013 were assessed by two educational levels (8 to 11 years and 12 to 13 years of schooling).ResultsWhile labour force participation increased, cancer incidence rates decreased over time. Cancer-free WLE at age 18 increased by 2.5 years in men and 6.3 years in women (age 50: 1.3 years in men, 2.4 years in women) between the first and third period while increases in WLE after a cancer diagnosis remained limited. Furthermore, educational inequalities are substantial, with lower groups having lower cancer-free WLE. The proportion of cancer-free WLE in total WLE remained constant in women and younger men, while it decreased in men at higher working age.ConclusionThe increase in WLE is accompanied by an increase in cancer-free WLE. However, the subgroups considered have not benefitted equally from this positive development. Among men at higher working age, WLE increased at a faster pace than cancer-free WLE. Particular attention should be paid to individuals with lower education and older men, as the general level and time trends in cancer-free WLE are less favourable.