bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lumbar Bone Stress Injuries and Nonunited Defects in Elite Australian Cricket Players
Authors: Saw Anna , Eales Brent , Jones Nick , Obst Alan , Smith Martin , Kountouris Alex , Saw Richard 
Published: February 2023

Objective:
To describe the presentation and management of lumbar bone stress injuries (LBSI), recurrent LBSI, and lumbar nonunited defects in elite Australian male and female cricket players.

Design:
Retrospective case series.

Setting:
Professional domestic and international cricket teams over 13 seasons.

Participants:
Elite Australian cricket players.

Independent variables:
Symptomatic LBSI requiring time off cricket and lumbar nonunited defects, both confirmed by imaging.

Main outcome measures:
Incidence, presentation, history, healing, and management.

Results:
211 LBSI were identified at an average incidence of 5.4 per 100 players per season. LBSI were most common in male pace bowlers younger than 20 years of age (58.1 per 100 players per season), however, were also observed in older players, females, and non-pace bowlers. Recurrent LBSI accounted for 33% (27%-40%) of all LBSI. Median days to return to match availability was 182 (128-251) days for all LBSI, with a shorter time frame observed for new and less severe injuries, and male spin bowlers. Healing was demonstrated in 87% (81%-91%) of all LBSI cases. 29 nonunited defects were identified and predisposed subsequent pain, LBSI, and spondylolisthesis.

Conclusions:
LBSI are experienced by approximately 5.4 in every 100 elite Australian cricket players per season, with a high time cost of approximately 4 to 8 months. Nonunited defects also have a high time cost with associated subsequent lumbar spine issues. The findings of this study reinforce the importance of early detection and conservative management of LBSI, particularly for younger male pace bowlers and players with recurrent LBSI, which may be supported by MRI.
In Vitro Testing of Trichomonas vaginalis Drug Susceptibility: Evaluation of Minimal Lethal Concentrations for Metronidazole and Tinidazole That Correspond With Treatment Failure
Authors: Augostini Peter , Bradley Erin L. P. , Raphael Brian H. , Secor W. Evan 
Published: February 2023

Background
The only drugs approved by the US Food and Drug Administration for oral treatment of trichomoniasis belong to the 5-nitroimidazole group. Most individuals infected with Trichomonas vaginalis can be cured with a standard treatment of metronidazole or tinidazole, but it is estimated that more than 159,000 people fail treatment each year. Although a minimal lethal concentration (MLC) corresponding to treatment failure has been reported for metronidazole, the MLC for tinidazole associated with treatment failure has not been determined. We conducted a study using T. vaginalis isolates from women with reported treatment success or failure to determine these values.

Methods
We measured MLCs of 47 isolates obtained from women who had failed metronidazole treatment, 33 isolates from women who had failed tinidazole treatment, and 48 isolates from women successfully cured with metronidazole. The cutoff was calculated as the 95th percentile of MLCs of susceptible isolates for each drug.

Results
Our data confirmed that the MLC previously associated with metronidazole treatment failure is ≥50 μg/mL and identified the MLC associated with tinidazole treatment failure as ≥6.3 μg/mL. For metronidazole, the agreement between laboratory result and treatment outcome was 93.7%; for tinidazole, this agreement was 88.9%.

Conclusions
The T. vaginalis susceptibility assay is useful for determining whether 5-nitroimidazole treatment failure in persons with trichomoniasis can be attributed to drug resistance. These results are useful for establishing interpretive guidance of test results, and MLC levels can help guide appropriate patient treatment.
Improving the Quality of Maternity Care: Learning From Malpractice
Authors: Shi Meihong , Zhang Hua , Huang Siyuan , Zhang Mingfeng , Hu Xiuying 
Published: February 2023

Objective
This study aimed to depict the characteristics, injury outcomes, and payment of obstetric malpractice lawsuits to better understand the medicolegal burden in obstetrics and categorize the causes of obstetric malpractice lawsuits using The National Health Service Litigation Authority coding taxonomy for further quality improvement in maternity care.

Methods
We reviewed and retrieved key information on court records of legal trials from China Judgment Online between 2013 and 2021.

Results
A total of 3441 obstetric malpractice lawsuits successfully claimed were reviewed in this study, with a total indemnity payment of $139,875,375. After peaking in 2017, the number of obstetric malpractice claims begins to decline. Of the 2424 hospitals that were sued, 8.3% (201/2424) were referred to as “repeat defendant” because they were involved in multiple lawsuits. Death and injury were the outcomes in 53.4% and 46.6% of the cases, respectively. The most common outcome type was neonatal death, which made up 29.8% of all cases. The median indemnity payment for death was higher compared with injury (P < 0.05). In terms of detailed injury outcomes, the major neonatal injury had higher median indemnity payments than neonatal death and fetal death (P < 0.05). The median indemnity payment of the major maternal injury was higher than that of maternal death (P < 0.05). The leading causes of obstetric malpractice were the management of birth complications and adverse events (23.3%), management of labor (14.4%), career decision making (13.7%), fetal surveillance (11.0%), and cesarean section management (9.5%). The cause for 8.7% of cases was high payment (≥$100, 000). As indicated by the results of the multivariate analysis, the hospitals in the midland of China (odds ratio [OR], 0.476; 95% confidence interval [CI], 0.348–0.651), the hospitals in the west of China (OR, 0.523; 95% CI, 0.357–0.767), and the secondary hospitals (OR, 0.587; 95% CI, 0.356–0.967) had lower risks of high payment. Hospitals with ultimate liability (OR, 9.695; 95% CI, 4.072–23.803), full liability (OR, 16.442; 95% CI, 6.231–43.391), major neonatal injury (OR, 12.326; 95% CI, 5.836–26.033), major maternal injury (OR, 20.885; 95% CI, 7.929–55.011), maternal death (OR, 18.783; 95% CI, 8.887–39.697), maternal death with child injury (OR, 54.682; 95% CI, 10.900–274.319), maternal injury with child death (OR, 6.935; 95% CI, 2.773–17.344), and deaths of both mother and child (OR, 12.770; 95% CI, 5.136–31.754) had higher risks of high payment. In the causative domain, only anesthetics had a higher risk of high payment (OR, 5.605; 95% CI, 1.347–23.320), but anesthetic-related lawsuits made up just 1.4% of all cases.

Conclusions
The healthcare systems had to pay a significant amount as a result of obstetric malpractice lawsuits. Greater efforts are required to minimize serious injury outcomes and improve obstetric quality in the risky domains.
Proactive Patient Safety: Focusing on What Goes Right in the Perioperative Environment
Authors: Duffy Caoimhe , Menon Neil , Horak David , Bass Geoffrey D. , Talwar Ruchika , Lorenzi Cara , Taing Vo Christina , Chaing Chienhui , Ziemba Justin B. 
Published: February 2023

Objective
Adverse events in the perioperative environment, a potential risk to patients, may be mitigated by nurturing staff adaptability and resiliency. An activity called “One Safe Act” (OSA) was developed to capture and highlight proactive safety behaviors that staff use in their daily practice to promote safe patient care.

Methods
One Safe Act is conducted in-person in the perioperative environment by a facilitator. The facilitator gathers an ad hoc group of perioperative staff in the work unit. The activity is run as follows: staff introductions, purpose/instructions of the activity, participants self-reflect about their OSA (proactive safety behavior) and record it as free text in an online survey tool, the group debriefs with each person sharing their OSA, and the activity is concluded by summarizing behavioral themes. Each participant completed an attitudinal assessment to understand changes in safety culture perception.

Results
From December 2020 to July 2021, a total of 140 perioperative staff participated (21%, 140/657) over 28 OSA sessions with 136 (97%, 140/136) completing the attitudinal assessment. A total of 82% (112/136), 88% (120/136), and 90% (122/136) agreed that this activity would change their practices related to patient safety, improve their work unit’s ability to deliver safe care, and demonstrated their colleagues’ commitment to patient safety, respectively.

Conclusions
The OSA activity is participatory and collaborative to build shared, new knowledge, and community practices focused on proactive safety behaviors. The OSA activity achieved this goal with a near universal acceptance of the activity in promoting an intent to change personal practice and increasing engagement and commitment to safety culture.
Prevention and treatment of recurrent cellulitis
Authors: Peghin Maddalena , Graziano Elena , Rovelli Cristina , Grossi Paolo Antonio 
Published: February 2023

Purpose of review
Recurrent cellulitis is a challenging clinical condition affecting up to 47% of patients after the first episode, especially those with predisposing risk factors. The purpose of this review is to describe the state of the art of literature evidence and to highlight recent developments in its management.

Recent findings
Recurrent cellulitis can occur after successful treatment of cellulitis. Conditions that commonly increase the risk of cellulitis include local and systemic modifiable and nonmodifiable factors. A rigorous approach to the management of risk factors and treatment of acute infection is important as the risk of recurrence rises with repeated episodes. Risk factors, if present, need to be targeted in association with antibiotic prophylaxis. Penicillin V is the preferred antibiotic for prevention but other antibiotics and new drugs can be considered in cases of β-lactam allergy, intolerance, or failure.

Summary
Recurrent cellulitis is associated with short term and long-term morbidity as well as significant healthcare costs. Management of underlying predisposing conditions is crucial to prevent recurrence in addition with evaluation of pharmacological measures, but specialized and multidisciplinary skills are needed. More efforts are needed to prevent and treat this underestimated problem.
Postoperative Nasal Conformers in Cleft Rhinoplasty: Are They Efficacious?
Authors: Rossell-Perry Percy , Romero-Narvaez Carolina , Gavino-Gutierrez Arquimedes , Figallo-Hudtwalcker Olga 
Published: February 2023

Background:
Lip and nose symmetry the goal of repair of unilateral cleft lip and different preoperative and postoperative treatments have been developed with this purpose. The objective of this study was to compare 2 techniques used for primary cleft lip nose repair.

Materials and Methods:
This is an retrospective study between 2 groups of patients with unilateral cleft lip and palate who underwent primary nasolabial repair either with or without postoperative nasal conformers. Data collection was accomplished by evaluation of nasal symmetry through anthropometric measurements under general anesthesia during primary cleft palate repair.

Results:
Our comparative study did not find a statistically significant difference regarding percentile indexes of nasal asymmetry between the 2 groups. Major revision requirement (>3 mm of asymmetry in any of the nose measurements) was observed in 3.84% of nasal conformer group and 4.65% of the group without nasal conformers.

Conclusions:
The results obtained from this study provides showed that placement of postoperative nasal conformers did not improve nasal symmetry in patients with unilateral cleft lip and palate. Based on these findings and available scientific evidence, definitive conclusions about the effectiveness of these devices on nasal symmetry after unilateral cleft lip nose repair cannot be drawn.
Malposition of the Resorbable Sheet in Medial Orbital Wall Fractures: Frequency and Techniques for Prevention
Authors: Hwang Kun , Ma Sung Hwan 
Published: February 2023

The aim of this report is to discuss malposition of the resorbable sheet in medial orbital wall fractures and how to prevent this problem. After making an incision through the skin and orbicularis oculi muscle, a skin-muscle flap was elevated just superficial to the orbital septum, extending to the arcus marginalis. Dissection was extended just below the anterior lacrimal crest to increase the exposure. Fracture site in medial orbital wall was visualized. A resorbable sheet (poly-l-lactide, d-lactide sheet, 0.5-mm thickness) was trimmed and molded in an L shape, with the vertical portion used to cover the medial wall defect and the horizontal portion for stability in the orbital floor. An extended part, measuring roughly 1 cm, was bent across on the infraorbital rim, and this part was fixed with absorbable screws to prevent the sheet from crumpling. After the molded plate was put in position, the periosteum and skin were closed. From 2011 to 2021, the authors operated on 152 orbital floor or medial wall fractures. Among 152 patients who underwent surgery to reconstruct orbital floor or medial wall fracture, of whom 27 patients had both floor and medial wall fractures, the authors experienced 2 cases of medial orbital wall fractures where the resorbable sheet was malpositioned, requiring reoperation. To prevent malposition of the sheet in medial wall reconstruction, the inferomedial angle of the vertical portion and the horizontal portion of the sheet should be about 135°. Before fixing the sheet on the bony part, a complete tension-free forced-duction test is mandatory.
CAN POLYETHYLENE GLYCOL-20K REPLACE ALBUMIN FOR PREHOSPITAL TREATMENT OF HEMORRHAGIC SHOCK WHEN FULL RESUSCITATION IS UNAVAILABLE?
Authors: Xiang Lusha , Calderon Alfredo S. , Ryan Kathy L. , Klemcke Harold G. , Mdaki Kennedy S. , Hudson Ian L. , Meledeo Michael A. 
Published: February 2023

ABSTRACT
A solution of high concentration albumin has been used for temporal volume expansion when timely resuscitation was unavailable after hemorrhagic shock. However, during prolonged hemorrhagic shock, cell edema and interstitial dehydration can occur and impede the volume expansion effect of albumin. Polyethylene glycol-20K (PEG) can establish an osmotic gradient from swollen cells to capillary lumens and thus facilitate capillary fluid shift and volume expansion. We hypothesized that with similar osmolality, 7.5% PEG elicits more rapid and profound compensatory responses after hemorrhagic shock than 25% albumin. Rats were randomized into three groups (n = 8/group) based on treatment: saline (vehicle), PEG (7.5%), and albumin (25%). Trauma was induced in anesthetized rats with muscle injury and fibula fracture, followed by pressure-controlled hemorrhagic shock (MAP = 55 mm Hg) for 45 min. Animals then received an intravenous injection (0.3 mL/kg) of saline, PEG, or albumin. MAP, heart rate, blood gases, hematocrit, skeletal muscle capillary flow, renal blood flow, glomerular filtration rate, urinary flow, urinary sodium concentration, and mortality were monitored for another 2 hours. Polyethylene glycol-20K and albumin both improved MAP, renal and capillary blood flow, and renal oxygen delivery, and decreased hyperkalemia, hyperlactatemia, hematocrit, and mortality (saline: 100% PEG: 12.5%; albumin: 38%) over saline treatment. Compared with albumin, PEG had a more rapid decrease in hematocrit and more profound increases in MAP, diastolic pressure, renal blood flow, glomerular filtration rate, and urinary flow. These results suggest that PEG may be a better option than albumin for prolonged prehospital care of hemorrhagic shock.
Social Vulnerability Index is strongly associated with urban pediatric firearm violence: An analysis of five major US cities
Authors: Polcari Ann M. , Hoefer Lea E. , Callier Kylie M. , Zakrison Tanya L. , Rogers Selwyn O. , Henry Marion C.W. , Slidell Mark B. , Benjamin Andrew J. 
Published: February 2023

BACKGROUND
Firearm-related injury in children is a public health crisis. The Social Vulnerability Index (SVI) identifies communities at risk for adverse effects due to natural or human-caused crises. We sought to determine if SVI was associated with pediatric firearm-related injury and thus could assist in prevention planning.

METHODS
The Centers for Disease Control and Prevention's 2018 SVI data were merged on census tract with 2015 to 2022 open-access shooting incident data in children 19 years or younger from Baltimore, Chicago, Los Angeles, New York City, and Philadelphia. Regression analyses were performed to uncover associations between firearm violence, SVI, SVI themes, and social factors at the census tract level.

RESULTS
Of 11,654 shooting incidents involving children, 52% occurred in just 6.7% of census tracts, which were on average in the highest quartile of SVI. A decile increase in SVI was associated with a 45% increase in pediatric firearm-related injury in all cities combined (incidence rate ratio, 1.45; 95% confidence interval, 1.41–1.49; p < 0.001). A similar relationship was found in each city: 30% in Baltimore, 51% in Chicago, 29% in Los Angeles, 37% in New York City, and 35% in Philadelphia (all p < 0.001). Socioeconomic status and household composition were SVI themes positively associated with shootings in children, as well as the social factors below poverty, lacking a high school diploma, civilian with a disability, single-parent household, minority, and no vehicle access. Living in areas with multi-unit structures, populations 17 years or younger, and speaking English less than well were negatively associated.

CONCLUSION
Geospatial disparities exist in pediatric firearm-related injury and are significantly associated with neighborhood vulnerability. We demonstrate a strong association between SVI and pediatric shooting incidents in multiple major US cities. Social Vulnerability Index can help identify social and structural factors, as well as geographic areas, to assist in developing meaningful and targeted intervention and prevention efforts.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level III.
Association of blood product ratios with early mortality in pediatric trauma resuscitation: A time-dependent analysis from the National Trauma Databank
Authors: Snyder Christopher W. , Neff Lucas P. , Chandler Nicole M. , Kerby Jeffrey D. , Josephson Cassandra D. , Russell Robert T. 
Published: February 2023

BACKGROUND
Injured children with severe hemorrhage often receive blood product transfusions with ratios of plasma and platelets to packed red blood cells (PRBCs) approaching 1:1:1. Whether blood product ratios vary during pediatric resuscitation is unknown. This study (1) described precise timing of pediatric blood product administration, (2) characterized changes in blood product ratios over time, and (3) evaluated the association of blood products with early mortality while incorporating time-varying factors.

METHODS
Pediatric (younger than 18 years) trauma patients receiving high-volume transfusion (>40 mL/kg total products or >2 U PRBC or whole blood, during first 4 hours) were obtained from the 2017 to 2019 Trauma Quality Improvement Program database. The time of each individual product transfusion was recorded, along with demographics, injury details, and times of death. Patients were assigned to blood product groups at 15-minute intervals: high plasma/PRBC ratio (>1:1) with platelets, high plasma/PRBC ratio (>1:1) without platelets, low plasma/PRBC ratio (<1:1), PRBC only, and whole blood. Cox proportional hazards modeling for 24-hour mortality was performed, including blood product group as a time-varying variable and adjusting for relevant covariates.

RESULTS
Of 1,152 included patients (median age, 15 years; 32% penetrating, 28% severe traumatic brain injury [sTBI]), 18% died within 24 hours. During the resuscitation period, the number of patients in high-ratio groups increased over time, and patients switched blood product groups up to six times. There was no significant difference in mortality by blood product group. Among patients with sTBI, there was a strong trend toward lower mortality among high plasma/PRBC without platelets versus high plasma/PRBC with platelets (hazard ratio, 0.55; p = 0.07).

CONCLUSION
No significant association of high ratios or whole blood with mortality was seen when time-varying factors were incorporated. The impact of balanced resuscitation strategies, particularly platelet transfusion, may be greatest among patients with sTBI. Optimizing balanced resuscitation for children requires appropriately designed prospective studies.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Prehospital triage of intracranial hemorrhage and anterior large vessel occlusion ischemic stroke: the value of the rapid arterial occlusion evalution
Authors: Dekker Luuk , Geraedts Victor J. , Hubert Jeroen , Duijndam Dion , Durieux Marcel D.J. , Janssens Loes , Moojen Wouter A. , van Zwet Erik W. , Wermer M.J.H. , Kruyt Nyika D. , van den Wijngaard Ido R. 
Published: February 2023

ABSTRACTBackgroundThe Rapid Arterial oCclusion Evaluation (RACE) score can identify patients with anterior circulation large vessel occlusion (aLVO) ischemic stroke for transportation to a comprehensive stroke center for endovascular thrombectomy. However, patients with intracranial hemorrhage (ICH) may also benefit from direct transportation to a comprehensive stroke center for neurosurgical treatment. We aimed to assess if the RACE score can distinguish patients with ICH in addition to aLVO stroke from other suspected stroke patients.MethodsWe analyzed data from the Leiden Prehospital Stroke Study: a multicenter, prospective, observational cohort study in two Dutch ambulance regions. Ambulance paramedics documented prehospital observations in all patients ≥18 years with suspected stroke. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a positive RACE score (≥5 points) for a diagnosis of ICH or aLVO stroke, compared to patients with non-aLVO stroke, TIA, or stroke mimic. Additionally, we performed a multivariable logistic regression analysis and calculated adjusted odds ratios (aOR).ResultsWe included 2004 stroke code patients, of whom 149 had an ICH, 153 an aLVO stroke, 687 a non-aLVO stroke, 262 a TIA and 753 a stroke mimic. Patients with ICH and aLVO stroke more often had a positive RACE score than other suspected stroke patients (respectively 46.2% and 58.0% vs. 6.4%, p<0.01). A positive RACE score had a sensitivity of 52.7%, specificity of 93.6%, PPV of 55.4% and NPV of 92.9% for a diagnosis of ICH or aLVO stroke. In multivariable analysis, a positive RACE score had the strongest association with ICH or aLVO stroke (aOR 10.11, 95% CI 6.84-14.93).Conclusions and RelevanceOur study shows that the RACE score can also identify patients with ICH in addition to aLVO stroke. This emphasizes the potential of the RACE for improving prehospital triage and allocation of stroke patients.