bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative outcomes in patients operated for extra- and intracapsular hip fractures – a secondary analysis of two randomized controlled trials
Authors: Dakhil Shams , Djuv Ane , Saltvedt Ingvild , Wyller Torgeir Bruun , Frihagen Frede , Johnsen Lars Gunnar , Taraldsen Kristin , Helbostad Jorunn L. , Watne Leiv Otto , Paulsen Aksel 
Published: February 2025

Abstract

Background
Hip fractures are among the most common and serious injuries in older adults. There has been a perception that extracapsular hip fractures have worse outcome than intracapsular hip fractures. We aimed to examine postoperative outcomes in patients operated for extra- and intracapsular hip fractures.

Methods
This is a secondary analysis of data from two randomized controlled trials evaluating the effect of orthogeriatric care. Bivariate analyses were conducted, comparing patients with extracapsular fracture to patients with intracapsular fracture. Mortality, length of hospital stay (LOS), new nursing home admissions, operative data and measures of functional and cognitive performance were assessed as endpoints.

Results
The primary analysis included 711 patients; 283 patients had an extracapsular fracture and 428 an intracapsular fracture. At four months follow-up, the intracapsular fracture group had significantly better Short Physical Performance Battery (SPPB) (5.0 vs. 4.0, p = 0.007), personal Activities of Daily Living (p-ADL) (17.0 vs. 16.0, p = 0.007) and instrumental ADL (i-ADL) (32.5 vs. 28.0, p = 0.049). There were no statistically significant differences between the groups at 12 months.

Conclusions
Patients with an extracapsular fracture had worse mobility and ADL levels four months postoperatively, but there were no clinically relevant differences at 12 months postoperatively.
Painful considerations in exercise-management for rotator cuff related shoulder pain: a scoping review on pain-related prescription parameters
Authors: Raulline Ullern Kaspar , Richardsen Magnus , Weerasekara Ishanka , Bogen Bård Erik 
Published: February 2025

Abstract

Background
Resistance exercise is recommended as the first line of treatment for rotator cuff related shoulder pain (RCRSP), but with conflicting evidence supporting the superiority of specific prescription parameters. Particularly, the role of pain-related prescription parameters remains poorly understood, despite their wide clinical application and potential impact on treatment outcomes. This review aims to investigate how pain-related prescription parameters, such as pain allowance and intensity limits, are reported, described, and applied in clinical trials assessing resistance exercise interventions for RCRSP.

Methods
Guided by PRISMA-ScR, this scoping review followed a comprehensive and systematic search in MEDLINE (Ovid), MEDLINE (EMBASE), Central (Cochrane), PEDro and CINAHL (EBSCO). Two authors independently performed title and abstract screening, and full text screening on eligible records. Randomized clinical trials (RCTs) published in English between 2018 and 2023, applying resistance exercise for RCRSP were included. Both quantitative and qualitative approaches to data analysis were conducted.

Results
The literature search identified 7500 records, of which 4588 titles and abstracts were screened after duplicate removal. Altogether, 304 full texts were screened leaving a total of 86 records in the final analysis. Fifty-eight (67%) studies did not mention the use of any pain-related prescription parameters, resulting in data extraction from the 28 remaining studies. Applied parameters were widely heterogenic, but three categories of pain allowance styles were identified and categorized into “yes”, “no” or “ambiguous”. These categories were commonly guided by specific Numerical Rating Scale (NRS)/Visual Analog Scale (VAS) limits or individual pain tolerance, used for pain monitoring and exercise progression. Citations and/or justifications for the chosen pain-related prescription parameters were reported by 10 (36%) studies, in which 5 main themes for justifications, and 3 key papers for the citations were identified.

Conclusion
This review reveals substantial reporting deficiencies regarding pain-related prescription parameters in RCTs addressing RCRSP with resistance exercise. The identified parameters varied widely, reflecting a lack of consensus and evidence-based guidance in the literature and in a clinical setting. To advance our understanding on the role of pain-related prescription parameters, more consistent reporting of these parameters in future research is warranted.

Trial registration
Published on the Open Science Framework 28.02.24: osf.io/a52kn.
Forms of distributed leadership – a case study of six workplaces in eldercare
Authors: Eriksson Andrea , Andersson Bäck Monica , Elmersjö Magdalena , Gillberg Gunnar 
Published: February 2025

Abstract

Background
The concept of distributed leadership has been addressed in previous research, but few studies link their analysis to current and comparative empirical studies on processes and conditions enabling or hindering the development of distributed leadership. This specific study aims to identify and analyze mechanisms that enable or hinder the development of distributed leadership among employees in eldercare.

Methods
This is a case study based on six specific workplaces in eldercare in Sweden in different ways aiming to work toward an organization that emphasizes trust and distribution of power. A realistic evaluation framework was used to understand the different workplace program theories regarding distributed leadership. Key mechanisms and how they interact with contextual factors in each case were analyzed. Comparative analyses were performed, identifying key processes in terms of realizing distributed leadership.

Results
Analyzing the program theories in the respective cases showed that they have different orientations influenced by different motives for distributed leadership, which also interact with how distributed leadership was manifested and realized. The results point specifically to the importance of the mechanism formalization processes, participatory approaches to implementation, vertical sense-making, and horizontal sense-making for the development of distributed leadership.

Conclusions
The result points to that regardless of the path for achieving distributed leadership adopted by the various workplaces studied, the common denominator for those succeeding in distributing leadership is the development of a relational agency based on shared visions, a shared understanding of roles, and responsibilities, a learning approach and a dialogue-oriented relationship between management and employees. Another critical aspect is having sufficient resources to make taking on more responsibilities attractive.
Improving relationship-centered care through evaluation meetings with the resident-family-caregiver triad in nursing homes: a qualitative study
Authors: Rutten Johanna E. R. , Backhaus Ramona , Verbeek Hilde , de Vries Erica , Hamers Jan P. H. , Sion Katya Y. J. 
Published: February 2025

Abstract

Background
Providing and improving relationship-centered care has gained increased importance in long-term care. However, quality improvement strategies are predominantly based on quantitative quality measures for care professionals. Therefore, the aim of this study was to explore how narrative data collected with Connecting Conversations is used in evaluation meetings to improve RCC.

Methods
A qualitative approach using structured observations was used. The participants were care professionals, residents and family members from two nursing home wards. The participating wards organized evaluation meetings to discuss the experienced quality of care based on narrative data collected with Connecting Conversations. To analyze the process of improving RCC, the organization of these meetings and the content were observed by independent researchers, and detailed notes were taken. The data were analyzed thematically by using conventional content analysis.

Results
In total, three evaluation meetings were organized. Primarily, care professionals were invited to discuss the results of the interviews. One ward organized a meeting for care professionals, residents and family members, and the other decided not to invite them. The discussion of themes related to experienced quality of care within the evaluation meetings was less profound than during the interviews. In total, 12 overarching themes concerning experienced quality of care were discussed in the Connecting Conversations' interviews. Nine themes were also mentioned in one or more evaluation meetings (i.e., activities for residents, personalized attention and preferences of residents, feeling at home and communication within the care triad).

Conclusion
When using narrative data on quality of care to improve relationship-centered care, the full potential of narrative data is underutilized as discussions focussed on incidental problem solving rather than deeper reflections on the meaning of events in providing relationship-centered care. Establishing trust within the care triad of care professionals, family members, and residents is essential to improve relationship-centered care collaboratively.
Comparative Efficiency Analysis of OECD Health Systems: FDH vs. Machine Learning Approaches with Efficiency Analysis Trees (EAT and RFEAT)
Authors: Joo Yejin 
Published: February 2025

Abstract

Background
As health expenditure continues to rise due to income growth, technological advancements, and an aging population, it has become increasingly important to accurately measure and improve the efficiency of health systems. This is because financial resources are limited, and the allocation of resources can significantly influence the quality of health systems and health outcomes.

Methods
This study applies machine learning techniques—Efficiency Analysis Trees (EAT) and Random Forest for Efficiency Analysis Trees (RFEAT)—to evaluate the efficiency of health systems in 36 OECD countries, comparing the results with those from the traditional free disposal hull (FDH) method.

Results
Analysis shows high discrimination power in the order of RFEAT, EAT, and FDH. The correlation in efficiency rankings shows more than 80% similarity between RFEAT and EAT, while both show less than 80% similarity with FDH. According to RFEAT estimates, the countries with the highest efficiency are South Korea, Switzerland, and Costa Rica, whereas the United States, Lithuania, and Latvia are identified as the least efficient. The group-level analysis reveals that Asian countries, on average, perform more efficiently followed by Oceania, Europe, and the Americas. The groups with higher out-of-pocket healthcare expenditures per capita tend to show slightly better efficiency and the group with the smallest elderly population proportion exhibits the highest average health system efficiency.

Conclusion
Traditional methods like FDH are prone to inefficiency underestimation, especially in small samples with multiple variables. This study demonstrates the potential of machine learning approaches like EAT and RFEAT to provide more reliable efficiency estimates. These methods can help policymakers make better resource allocation decisions by mitigating inefficiency underestimation and offering greater discrimination power.
Reassessing socioeconomic inequalities in mortality via distributional similarities
Authors: Gómez-Ugarte Ana C. , Basellini Ugofilippo , Camarda Carlo G. , Janssen Fanny , Zagheni Emilio 
Published: February 2025

Abstract
Commonly used measures of socioeconomic inequalities in mortality, such as the slope and the relative index of inequality, are based on summary measures of the group-specific age-at-death distributions (e.g. standardized mortality rate or life expectancy). While this approach is informative, it ignores valuable information contained in the group-specific distributions. A recent approach applied a measure of distributional dissimilarity (the non-overlap index) to measure lifespan stratification. In this paper, we rigorously evaluate and further implement the multi-group extension of the non-overlap index (

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) to measure socioeconomic inequalities in mortality across a number of groups, and assess whether differences across countries and over time are driven by mortality or compositional changes in two applications with different data availability: educational groups (Sweden and Denmark) and groups defined by an area-level deprivation measure (England). Our findings suggest that the multi-group

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is sensitive not only to changes in the means or variances, but also to broader mortality changes that affect distributional shapes. The method can be employed to any context where mortality rates by age are available by sub-groups. Furthermore, levels and trends in mortality inequalities computed with the multigroup

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often differ compared to other conventional summary-based measures. Moreover, we find that the contribution of mortality changes to changes in inequalities is generally greater than that of the changes in the population composition. Whereas levels and trends of inequalities may depend on whether life expectancy- or lifespan variation-based measures are employed, the multi-group

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provides a holistic perspective by capturing both dimensions simultaneously.
Toward digitally supported self-assessment of patients with idiopathic inflammatory myopathies
Authors: Seese Felix Kurt , Roscher Pia , Coppers Birte , Greenfield Julia , Grahammer Manuel , Kuhn Sebastian , Gupta Latika , Schett Georg , Knitza Johannes , Liphardt Anna-Maria 
Published: February 2025

Abstract

Background
Manual muscle testing (MMT8), the current gold standard for assessing muscle function in patients with idiopathic inflammatory myopathies (IIM), has notable limitations. This study had three aims (1) to compare MMT8 with inertial sensor-based gait analysis, (2) to evaluate patient-performed functional tests guided by shared decision-making (SDM), and (3) to investigate adherence to electronic patient-reported outcomes (ePROs).

Methods
Gold standard muscle function assessment (MMT8) was performed at baseline (T0) and three months (T1). Additionally, inertial-sensor-based gait analysis was completed at T0 and two standardized upper extremity (Modified Barré test; 10-time arm lift test) and two lower extremity muscle endurance tests (60-second Sit-to-Stand (STS) test; Mingazzini test) were presented to patients to choose from. Through shared decision-making, each patient selected one test for lower and upper extremities and opted to record weekly results on paper or through a medical app. Correlations between gait parameters, functional tests, and MMT8 were analyzed, while agreement between patient- and healthcare professional (HCP)-recorded results at T0 and T1 was assessed. Responsiveness to change was also evaluated.

Results
A total of 28 IIM patients (67.9% female; mean age 57.4 ± 12.9 years) were enrolled. Moderate correlations were observed between gait parameters and MMT8, such as walking speed (r = 0.545, p = 0.004) and stride length (r = 0.580, p = 0.002). All patients selected the Modified Barré test for assessing upper extremity function and 60.7% of patients chose the Mingazzini test for lower extremity function. Agreement between patient- and HCP-recorded functional test results was excellent at baseline and after three months (ICC 0.99–1.00). Functional tests demonstrated strong correlations with MMT8, particularly for the Mingazzini test (r = 0.762, p = 0.002). Patients preferred app-based recording (82.1%) over paper-based methods and weekly ePROs were completed on average 6.9 out of 12 weeks (57.5%).

Conclusion
Patient-performed functional tests are reliable, scalable alternatives to MMT8, with gait analysis providing complementary insights. Digitally supported self-assessments can enhance clinical workflows, remote monitoring, and treat-to-target strategies, empowering patients and improving disease management.
Enhanced exosome secretion regulated by microglial P2X7R in the medullary dorsal horn contributes to pulpitis-induced pain
Authors: Zhang Jing , Yu Zhuo , Wang Mingjun , Kang Xiaoning , Wu Xiaoke , Yang Fengjiao , Yang Lu , Sun Shukai , Wu Li-an 
Published: February 2025

Abstract

Background
Pulpitis is a prevalent oral disease characterized by severe pain. The activation of microglia in the medullary dorsal horn (MDH) is reportedly essential for the central sensitization mechanism associated with pulpitis. The P2X7 receptor (P2X7R) on microglia can trigger the secretion of exosomes enriched with IL-1β, which is involved in inflammation. Thus, we hypothesized that the enhanced exosome secretion regulated by microglial P2X7R in the MDH contributes to pulpitis-induced pain.

Methods
An experimental pulpitis model was established in male SD rats to observe pain behaviors. Immunofluorescence staining, western blotting and quantitative real-time PCR were used to analyze the expression of IL-1β and Rab27a, a key protein secreted by exosomes during nociceptive processes. The effects of the exosome inhibitor GW4869 and the P2X7R antagonist Brilliant Blue G (BBG) on microglial P2X7R, exosome secretion and inflammation in the pulpitis model were analyzed. In vitro, microglial cells were cultured to collect exosomes, and stimulation with lipopolysaccharide (LPS), oxidized ATP (oxATP) and GW4869 altered the secretion of exosomes containing IL-1β.

Results
In the experimental pulpitis model, the microglial exosome secretion and inflammatory factor release in the MDH were both correlated with the extent of pulpitis-induced pain, with the highest expression occurring on the 7th day. GW4869 and BBG inhibited Rab27a and IL-1β expression, reducing pulpitis-induced pain. In addition, exosomes were successfully extracted by ultracentrifugation in vitro, wherein LPS treatment promoted exosome secretion but GW4869 had the opposite effects on the secretion of exosomes and the IL-1β. Moreover, P2X7R inhibition by oxATP diminished exosome secretion, leading to a reduction in inflammatory responses.

Conclusion
This study highlights the regulatory role of microglial P2X7R in increased exosome secretion, indicating the potential utility of P2X7R as a promising target for pulpitis therapy. Our research highlights a new pulpitis mechanism in which exosomes enriched with IL-1β contribute to pulpitis-induced pain, suggesting the crucial roles of exosomes as pain biomarkers and harmful signaling molecules during pulpitis.
Unlocking opportunities to transform patient care: an expert insight on limitations and opportunities in patient monitoring
Authors: Cecconi Maurizio , Hutanu Ana L. , Beard John , Gonzalez-Pizarro Patricio , Ostermann Marlies , Batchelor Anna , Latour Jos M. , Grensemann Jörn , Mondino Michele Giovanni , Caballero Jesus , Blobner Manfred , Radtke Finn M. 
Published: February 2025

Abstract

Background
Current patient monitoring technologies are crucial for delivering personalised and timely care and are critical in achieving the best health outcomes while maintaining high care standards. However, these technologies also present several challenges affecting patients and healthcare professionals.

Information overload
Healthcare providers often deal with excess data, making it challenging to identify the most critical patient information quickly. This may lead to delays in necessary interventions and potentially poorer patient outcomes.

Alarm fatigue
Many patient monitoring systems trigger frequent false alarms. This high incidence can cause healthcare providers to become desensitised, potentially leading to slower response times or overlooked important alerts.

Integration challenges
Current systems often need more seamless integration with other healthcare technologies, making it difficult for healthcare providers to have a cohesive view of the patient’s health. This lack of integration can impair care coordination and increase workloads. This paper presents the findings from a group of experts who described the state of the art of patient monitoring and discussed potential solutions and new pathways for developing these technologies.
Modeling and prediction of embankment dam displacement under earthquake loading using artificial neural networks and swarm optimization algorithm
Authors: Mostafaei Yashar , Soleimani Kutanaei Saman 
Published: February 2025

Abstract
Evaluation of embankment dam displacement (D) under earthquake loading can contribute to the safe design of the dam. Due to the complexities of modeling this problem, soft computing is an appropriate solution for predicting the embankment dam displacement under earthquake loading. In this research, Artificial Neural Networks (ANN) and Swarm Optimization Algorithm (PSOA) were integrated in an attempt to present a relationship for predicting the displacement of embankment dam (D). For this purpose, data from 102 real cases was utilized. Input parameters included the height (H) and natural period of the dam (Td), minimum required yield acceleration to slide a block of the dam body (ay), magnitude (Mw), dominant frequency (Tp), and peak acceleration (amax) of the earthquake. It was figured out that PSOA-ANN outperforms PSOA in estimating earthquake-induced dam displacement. Compared to other soft-computing methods for predicting embankment dam displacement under earthquake loading, the hybrid PSOA-ANN is more powerful and suitable.