bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of the Risk Factors for Free Flap Necrosis in Soft Tissue Reconstruction of the Lower Limbs
Authors: Liu Hao , Liu Jun , Wu Yongwei , Ma Yunhong , Zhou Ming , Xue Yuan , Rui Yongjun 
Published: April 2023

ObjectiveFree flaps are widely used for the repair of soft tissue defects in the lower limbs, but there is still a specific rate of necrosis. Few clinical retrospective studies have analyzed the nontechnical risk factors for lower limb free flap necrosis. This study aimed to analyze the nontechnical causes of flap necrosis in lower limb soft tissue reconstruction in order to identify risk factors and improve the survival rate of free flaps.MethodsClinical data from 244 cases of soft tissue defects of the leg or foot that were repaired with a free flap from January 2011 to June 2020 were retrospectively analyzed. The flap results were divided into complete survival and necrosis groups. The patients' general information, smoking history, soft tissue defect site, Gustilo‐Anderson classification, shock after injury, type and size of the flap, and time from injury to flap coverage were recorded. A logistic regression model was used to analyze the correlations between flap necrosis and possible risk factors.ResultsOf the 244 flaps, 32 suffered from partial or total necrosis, and 212 completely survived. Univariate analysis showed that age, smoking history, soft tissue defect site, and time from injury to flap coverage were significantly correlated with flap necrosis (p ≤ 0.2). Multivariate logistic regression analysis showed that moderate‐to‐severe smoking history (p < 0.001, odds ratio [OR] = 10.259, 95% confidence interval [CI] = 2.886–36.468), proximal leg defect (p = 0.006, OR = 7.095, 95% CI = 1.731–29.089), and time from injury to flap coverage >7 days (p = 0.003, OR = 12.351, 95% CI = 2.343–65.099) were statistically significant risk factors for flap necrosis (p < 0.05), and age was excluded (p = 0.666; p = 0.924).ConclusionThe risk of flap necrosis was significantly increased when the soft tissue defect was located in the proximal leg, the time from injury to flap coverage was >7 days, and the patient had a moderate‐to‐severe smoking history. These three risk factors have an increased influence on flap necrosis and have guiding significance in predicting flap prognosis.
Plasmodium infection and dysbiosis: A new paradigm in the host–parasite interaction
Authors: Winaris Nuning , Pawestri Aulia Rahmi , Azizah Syafiatul , Alifia Lustyafa Inassani , Asiyah Rokhmatul , Ayuningtyas Tita Rachma , Fitri Loeki Enggar , Sardjono Teguh Wahju 
Published: April 2023

AbstractThe mucosal immune system contributes for the largest component of the tissue immune system due to its massive surface area and constant exposure to the microbiota. The gut microbiota comprises a complex micro‐ecosystem in the intestine and plays a major role in regulating innate and adaptive immunity. Several studies revealed that infectious diseases involve bidirectional interactions in the gut microenvironment, including changes in the gut microbiota composition. During Plasmodium infection, an increase of pro‐inflammatory cells in the lamina propria and a shift in the composition of the gut microbiota contribute to intestinal ecosystem dysbiosis. Although the mechanisms of this dysbiosis is still uncertain, it is thought to be associated with the sequestration of infected red blood cells in the intestinal microvascular system, leading to endothelial villous disruption, and thus activating effector immune cells scattered in the intestinal epithelium and lamina propria. This review provides information on this conjoint interaction which will be beneficial to modulate the host immune response in malaria through manipulation of the gut microbiota composition.
Blockchains for emergency and crisis management
Authors: Chen Wendy D. , Murtazashvili Ilia 
Published: April 2023

AbstractPublic managers and administrators confront the increasing scale and prevalence of crises. Despite some deployments, blockchain applications by governments for emergency management and response management have only begun to scratch the surface. To facilitate greater awareness of the promises and challenges of blockchain applications to the public sector, we consider the ways in which distributed ledger technologies can improve emergency and crisis management across the dimensions of transparency, public trust, and social equity. The article ends with a call for a public administration research agenda on blockchains for emergency and crisis management.
The performance function in local government: Does location impact performance data use?
Authors: Rivenbark William C. , Fasiello Roberta , Tassi Francesco 
Published: April 2023

AbstractResearch has demonstrated that certain drivers increase the probability of performance data use in local government. One performance driver that has received minimal attention is where the performance function is organizationally located, even though prior research has shown that the organizational placement of the performance function can potentially influence the design and use of performance measurement systems. Our study explores how the organizational placement of the performance function in local government influences key drivers of performance data use. We find evidence that performance functions located outside the budget office are more likely to promote the drivers of measurement system maturity, other management processes, and devolved decision‐making, which in turn increases the probability that local officials engage in performance data use. We also identify several research implications to advance the study and practice of performance management in local government and conclude with research limitations and suggestions for future research opportunities.
Early start hemodialysis with a catheter may be associated with greater mortality: A propensity score analysis
Authors: Laham Gustavo , Pujol Gervasio Soler , Guzman Jenny , Boccia Natalia , Abib Anabel , Diaz Carlos H. 
Published: April 2023

AbstractIntroductionDeciding when and how to initiate hemodialysis (HD) is still controversial. An early start (ES) seems to show a lack of benefit. “Lead time bias” and comorbidities have been associated with different outcomes in ES groups. On the other hand, it is well accepted that the impact the type of vascular access (VA) has on patient survival. Our aim was to evaluate survival with early start (ES) versus late start (LS) on HD, taking into account the vascular access (VA) used.MethodsBetween 01/1995 and 06/2018, 503 incidental patients initiated HD at our Dialysis Unit. eGFR was estimated by the CKD‐EPI equation. Diabetes mellitus (DM), coronary disease (CD), and peripheral vascular disease (PVD) were considered comorbid conditions. According to eGFR and VA, patients were divided into four groups: G1: ES (eGFR > 7 mL/min) with catheter (ES + C), G2: ES with fistula or graft (F/G) (ES + F/G), G3: LS (eGFR< 7 mL/min) with catheter (LS + C), and G4: LS with F/G (LS + F/G). The cut‐off value to define ES or LS was based on median eGFR for these 503 patients. We compared patient's survival rates by Kaplan–Meier and log‐rank test. The four groups were compared before and after matching with propensity scores (PS). Cox analysis was performed to determine the impact of predictors of mortality.ResultsMedian eGFR was 7 (5.3–9.5) mL/min/1.73 m2, median follow‐up time was 30.9 (13–50) months, 52.1% had F/G access at entry, and 46.9% died during the observation period. Among the four groups, the ES + C were significantly older, and there were more diabetics and comorbid conditions, while phosphatemia, iPTH, albumin, and hemoglobin were significantly higher in the LS groups. Before propensity score (PS) matching, the ES + C group had a poor survival rate (p < 0.0001), while LS + F/G access had the best survival. After PS, a total of 180 patients were selected in the same four groups and ES + C kept showing a statistically significant poorer survival. Multivariate analysis revealed that ES + C was an independent predictor of mortality.ConclusionIn this retrospective study, ES + C on HD was associated with a higher mortality rate than LS. This association persisted after PS matching.
Geopolitical conflicts, sanctions and international knowledge flows: EU–Russia collaboration during the Ukraine crisis
Authors: Makkonen Teemu , Mitze Timo 
Published: April 2023

AbstractThis article studies the development of scientific co‐publications between EU countries and Russia since the start of the Ukraine crisis in 2014. We investigate if economic sanctions and counter‐sanctions imposed during the crisis affected EU–Russia knowledge flows even before all science collaborations between the EU countries and Russia were eventually suspended as part of the EU sanctions in 2022. Our econometric analysis uses a gravity model framework and a comprehensive dataset covering more than 540 million scientific publications and 8.6 million international co‐publications for 35 countries (EU, BRICS, Belarus and Ukraine) during 1995–2018. Findings indicate that the imposition of EU sanctions and Russian counter‐sanctions from 2014 onwards had a significantly negative effect on EU–Russia co‐publication intensities. As a lower bound estimate, we find that sanctions reduced the EU–Russia scientific co‐publication intensity by 15% at the aggregate level. Effects are higher in specific scientific fields. We uncover transmission channels of this effect, for example, related to dual‐use technologies and growing resentments, and assess the robustness of our estimates. Time–dynamic regressions show that the sanctions effect on scientific collaboration increases over time. This underlines the susceptibility of global knowledge flows to geopolitical conflicts.
Poincaré constant on manifolds with ends
Authors: Grigor'yan Alexander , Ishiwata Satoshi , Saloff‐Coste Laurent 
Published: April 2023

AbstractWe obtain optimal estimates of the Poincaré constant of central balls on manifolds with finitely many ends. Surprisingly enough, the Poincaré constant is determined by the second largest end. The proof is based on the argument by Kusuoka–Stroock where the heat kernel estimates on the central balls play an essential role. For this purpose, we extend earlier heat kernel estimates obtained by the authors to a larger class of parabolic manifolds with ends.
One-field, two-field and five-field handheld retinal imaging compared with standard seven-field Early Treatment Diabetic Retinopathy Study photography for diabetic retinopathy screening
Authors: Salongcay Recivall P , Jacoba Cris Martin P , Salva Claude Michael G , Rageh Abdulrahman , Aquino Lizzie Anne C , Saunar Aileen V , Alog Glenn P , Ashraf Mohamed , Peto Tunde , Silva Paolo S 
Published: April 2023

Background/aimsTo determine agreement of one-field (1F, macula-centred), two-field (2F, disc–macula) and five-field (5F, macula, disc, superior, inferior and nasal) mydriatic handheld retinal imaging protocols for the assessment of diabetic retinopathy (DR) as compared with standard seven-field Early Treatment Diabetic Retinopathy Study (ETDRS) photography.MethodsProspective, comparative instrument validation study. Mydriatic retinal images were taken using three handheld retinal cameras: Aurora (AU; 50° field of view (FOV), 5F), Smartscope (SS; 40° FOV, 5F), and RetinaVue (RV; 60° FOV, 2F) followed by ETDRS photography. Images were evaluated at a centralised reading centre using the international DR classification. Each field protocol (1F, 2F and 5F) was graded independently by masked graders. Weighted kappa (Kw) statistics assessed agreement for DR. Sensitivity (SN) and specificity (SP) for referable diabetic retinopathy (refDR; moderate non-proliferative diabetic retinopathy (NPDR) or worse, or ungradable images) were calculated.ResultsImages from 225 eyes of 116 patients with diabetes were evaluated. Severity by ETDRS photography: no DR, 33.3%; mild NPDR, 20.4%; moderate, 14.2%; severe, 11.6%; proliferative, 20.4%. Ungradable rate for DR: ETDRS, 0%; AU: 1F 2.23%, 2F 1.79%, 5F 0%; SS: 1F 7.6%, 2F 4.0%, 5F 3.6%; RV: 1F 6.7%, 2F 5.8%. Agreement rates of DR grading between handheld retinal imaging and ETDRS photography were (Kw, SN/SP refDR) AU: 1F 0.54, 0.72/0.92; 2F 0.59, 0.74/0.92; 5F 0.75, 0.86/0.97; SS: 1F 0.51, 0.72/0.92; 2F 0.60, 0.75/0.92; 5F 0.73, 0.88/0.92; RV: 1F 0.77, 0.91/0.95; 2F 0.75, 0.87/0.95.ConclusionWhen using handheld devices, the addition of peripheral fields decreased the ungradable rate and increased SN and SP for refDR. These data suggest the benefit of additional peripheral fields in DR screening programmes that use handheld retinal imaging.
Impact assessment of a raw coal ban on maternal and child health outcomes in Ulaanbaatar: a protocol for an interrupted time series study
Authors: Dickinson-Craig Emma , Badarch Jargalsaikhan , Bartington Suzanne , Hemming Karla , Thayakaran Rasiah , Day Rosie , Pope Francis , Chuluunbaatar Bataa , Boldbaatar Damdindorj , Ochir Chimedsuren , Warburton David , Thomas Graham Neil , Manaseki-Holland Semira 
Published: April 2023

IntroductionDespite a decade of policy actions, Ulaanbaatar’s residents continue to be exposed to extreme levels of air pollution, a major public health concern, especially for vulnerable populations such as pregnant women and children. In May 2019, the Mongolian government implemented a raw coal ban (RCB), prohibiting distribution and use of raw coal in households and small businesses in Ulaanbaatar. Here, we present the protocol for an interrupted time series (ITS; a strong quasi-experimental study design for public health interventions) that aims to assess the effectiveness of this coal ban policy on environmental (air quality) and health (maternal and child) outcomes.Methods and analysisRoutinely collected data on pregnancy and child respiratory health outcomes between 2016 and 2022 in Ulaanbaatar will be collected retrospectively from the four main hospitals providing maternal and/or paediatric care as well as the National Statistics Office. Hospital admissions data for childhood diarrhoea, an unrelated outcome to air pollution exposure, will be collected to control for unknown or unmeasured coinciding events. Retrospective air pollution data will be collected from the district weather stations and the US Embassy. An ITS analysis will be conducted to determine the RCB intervention impact on these outcomes. Prior to the ITS, we have proposed an impact model based on a framework of five key factors, which were identified through literature search and qualitative research to potentially influence the intervention impact assessment.Ethics and disseminationEthical approval has been obtained via the Ministry of Health, Mongolia (No.445) and University of Birmingham (ERN_21-1403). To inform relevant stakeholders of our findings, key results will be disseminated on both (inter)national and population levels through publications, scientific conferences and community briefings. These findings are aimed to provide evidence for decision-making in coal pollution mitigation strategies in Mongolia and similar settings throughout the world.
Self-reported sexually transmitted infections among adolescent girls and young women in Mali: analysis of prevalence and predictors
Authors: Appiah Collins Kwame , Dowou Robert Kokou , Balame Samuel Kwaku , Adzigbli Leticia Akua , Yeboah Paa Akonor , Aboagye Richard Gyan , Cadri Abdul 
Published: April 2023

ObjectiveTo examine the prevalence and predictors of self-reported sexually transmitted infections (SR-STIs) among adolescent girls and young women in Mali.DesignWe performed a cross-sectional analysis of data from the Demographic and Health Survey of Mali, which was conducted in 2018. A weighted sample of 2105 adolescent girls and young women aged 15–24 was included. Percentages were used to summarise the results of the prevalence of SR-STIs. We used a multilevel binary logistic regression analysis to examine the predictors of SR-STIs. The results were presented using an adjusted odds ratio (aOR) with 95% confidence interval (CI). Statistical significance was set at p<0.05.SettingMali.ParticipantsAdolescent girls (15–19 years) and young women (20–24 years).Outcome measureSR-STIs.ResultsThe prevalence of SR-STIs among the adolescent girls and young women was 14.1% (95% CI=12.3 to 16.2). Adolescent girls and young women who had ever tested for HIV, those with one parity, those with multiparity, those with two or more sexual partners, those residing in urban areas, and those exposed to mass media were more likely to self-report STIs. However, those residing in Sikasso and Kidal regions were less likely to report STIs.ConclusionOur study has shown that SR-STIs are prevalent among adolescent girls and young women in Mali. Health authorities in Mali and other stakeholders should formulate and implement policies and programmes that increase health education among adolescent girls and young women and encourage free and easy access to STI prevention and treatment services.
Patient and public involvement to inform the protocol of a clinical trial comparing total hip arthroplasty with exercise: an exploratory qualitative case study
Authors: Frydendal Thomas , Thomsen Kristine Sloth , Mechlenburg Inger , Mikkelsen Lone Ramer , Overgaard Søren , Ingwersen Kim Gordon , Myburgh Cornelius 
Published: April 2023

ObjectiveTo explore patient, clinician and decision-maker perceptions on a clinical trial evaluating the effectiveness of total hip arthroplasty (THA) compared with exercise to inform the trial protocol.DesignThis is an exploratory qualitative case study using a constructivist paradigm.Setting and participantsParticipants were enrolled into three key stakeholder groups: patients eligible for THA, clinicians, and decision makers. Focus group interviews were conducted in undisturbed conference rooms at two hospitals in Denmark, according to group status using semi-structured interview guides.AnalysisInterviews were recorded, transcribed verbatim and thematic analysed using an inductive approach.ResultsWe conducted 4 focus group interviews with 14 patients, 1 focus group interview with 4 clinicians (2 orthopaedic surgeons and 2 physiotherapists) and 1 focus group interview with 4 decision-makers. Two main themes were generated. ‘Treatment expectations and beliefs impact management choices’ covered three supporting codes: Treatment without surgery is unlikely to lead to recovery; Clinician authority impacts the management narrative; The ‘surgery vs exercise’ debate. ‘Factors influencing clinical trial integrity and feasibility’ highlighted three supporting codes: Who is considered eligible for surgery?; Facilitators and barriers for surgery and exercise in a clinical trial context; Improvements in hip pain and hip function are the most important outcomes.ConclusionsBased on key stakeholder treatment expectations and beliefs, we implemented three main strategies to improve the methodological rigorousness of our trial protocol. First, we added an observational study investigating the generalisability to address a potential low enrolment rate. Second, we developed an enrolment procedure using generic guidance and balanced narrative conveyed by an independent clinician to facilitate communication of clinical equipoise. Third, we adopted change in hip pain and function as the primary outcome. These findings highlight the value of patient and public involvement in the development of trial protocols to reduce bias in comparative clinical trials evaluating surgical and non-surgical management.Trial registration numberNCT04070027(pre-results).
The SEE-IT Trial: emergency medical servicesStreamingEnabledEvaluationInTrauma: study protocol for an interventional feasibility randomised controlled trial
Authors: Ollis Lucie , Skene Simon S , Williams Julia , Lyon Richard , Taylor Cath 
Published: April 2023

IntroductionAccurate and timely dispatch of emergency medical services (EMS) is vital due to limited resources and patients’ risk of mortality and morbidity increasing with time. Currently, most UK emergency operations centres (EOCs) rely on audio calls and accurate descriptions of the incident and patients’ injuries from lay 999 callers. If dispatchers in the EOCs could see the scene via live video streaming from the caller’s smartphone, this may enhance their decision making and enable quicker and more accurate dispatch of EMS. The main aim of this feasibility randomised controlled trial (RCT) is to assess the feasibility of conducting a definitive RCT to assess the clinical and cost effectiveness of using live streaming to improve targeting of EMS.Methods and analysisThe SEE-IT Trial is a feasibility RCT with a nested process evaluation. The study also has two observational substudies: (1) in an EOC that routinely uses live streaming to assess the acceptability and feasibility of live streaming in a diverse inner-city population and (2) in an EOC that does not currently use live streaming to act as a comparator site regarding the psychological well-being of EOC staff using versus not using live streaming.Ethics and disseminationThe study was approved by the Health Research Authority on 23 March 2022 (ref: 21/LO/0912), which included NHS Confidentiality Advisory Group approval received on 22 March 2022 (ref: 22/CAG/0003). This manuscript refers to V.0.8 of the protocol (7 November 2022). The trial is registered with the ISRCTN (ISRCTN11449333). The first participant was recruited on 18 June 2022.The main output of this feasibility trial will be the knowledge gained to help inform the development of a large multicentre RCT to evaluate the clinical and cost effectiveness of the use of live streaming to aid EMS dispatch for trauma incidents.Trial registration numberISRCTN11449333.
Widening educational inequalities in mortality in more recent birth cohorts: a study of 14 European countries
Authors: Long Di , Mackenbach Johan P , Klokgieters Silvia , Kalėdienė Ramunė , Deboosere Patrick , Martikainen Pekka , Heggebø Kristian , Leinsalu Mall , Bopp Matthias , Brønnum-Hansen Henrik , Costa Giuseppe , Eikemo Terje , Nusselder Wilma J 
Published: April 2023

BackgroundStudies of period changes in educational inequalities in mortality have shown important changes over time. It is unknown whether a birth cohort perspective paints the same picture. We compared changes in inequalities in mortality between a period and cohort perspective and explored mortality trends among low-educated and high-educated birth cohorts.Data and methodsIn 14 European countries, we collected and harmonised all-cause and cause-specific mortality data by education for adults aged 30–79 years in the period 1971–2015. Data reordered by birth cohort cover persons born between 1902 and 1976. Using direct standardisation, we calculated comparative mortality figures and resulting absolute and relative inequalities in mortality between low educated and high educated by birth cohort, sex and period.ResultsUsing a period perspective, absolute educational inequalities in mortality were generally stable or declining, and relative inequalities were mostly increasing. Using a cohort perspective, both absolute and relative inequalities increased in recent birth cohorts in several countries, especially among women. Mortality generally decreased across successive birth cohorts among the high educated, driven by mortality decreases from all causes, with the strongest reductions for cardiovascular disease mortality. Among the low educated, mortality stabilised or increased in cohorts born since the 1930s in particular for mortality from cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease and alcohol-related causes.ConclusionsTrends in mortality inequalities by birth cohort are less favourable than by calendar period. In many European countries, trends among more recently born generations are worrying. If current trends among younger birth cohorts persist, educational inequalities in mortality may further widen.