bluuebunny/crossref_metadata_2025_split huggingface dataset:
Process-Structure-Property Relationships of Laser Powder Bed Fusion Lattice Structures
Authors: Jost Elliott W. , Pegues Jonathan , Moore David , Saldaña Christopher 
Published: May 2023

Abstract
Lattice structure metamaterials offer a variety of unique and tailorable properties, yet industrial adoption is slowed by manufacturability and inspection-related difficulties. Despite recent advances in laser powder bed fusion additive manufacturing, the sub-millimeter features of lattices are at the edge of process capabilities and suffer from low geometric quality. To better understand their complex process-structure-property (PSP) relationships, octahedron structures were manufactured across a power spectrum, inspected, and mechanically tested. X-ray computed tomography was used to characterize lattice geometry, and demonstrated that lattice strut geometry measures, increased significantly as a function of laser power. Furthermore, lattices are shown to exhibit a direct correlation between laser power and mechanical performance metrics. Performance variations up to 60% are shown as a function of process parameters despite nominally identical geometry. Significant geometry variations are found to be the cause of performance variation, while material properties as measured by microindentation hardness are constant across the studied parameter range. PSP relationships are modeled, and the limitations of these models are explored. It was found that resulting models can predict mechanical performance based on geometric characteristics with R2 values of up to 0.86. Finally, mechanistic causes of observed performance changes are discussed.
An Efficient Reliability Analysis Method Based on the Improved Radial Basis Function Neural Network
Authors: Zhang Dequan , Zhao Zida , Ouyang Heng , Wu Zeping , Han Xu 
Published: May 2023

Abstract
This paper develops an efficient reliability analysis method based on the improved radial basis function neural network (RBFNN) to increase the accuracy and efficiency of structural reliability analysis. To solve the problems of low computational accuracy and efficiency of the RBFNN, an improved RBFNN method is developed by transferring the sampling center of Latin hypercube sampling (LHS) from the mean values of random variables to the most probable point (MPP) in the sampling step. Then, the particle swarm optimization algorithm is adopted to optimize the shape parameters of RBFNN, and the RBFNN model is assessed by the cross-validation method for subsequent reliability analysis using Monte Carlo simulation (MCS). Four numerical examples are investigated to demonstrate the correctness and effectiveness of the proposed method. To compare the computational accuracy and efficiency of the proposed method, the traditional radial basis function method, hybrid radial basis neural network method, first-order reliability method (FORM), second-order reliability method (SORM), and MCS method are applied to solve each example. All the results demonstrate that the proposed method has higher accuracy and efficiency for structural reliability analysis. Importantly, one practical example of an industrial robot is provided here, which demonstrates that the developed method also has good applicability and effectiveness for complex engineering problems.
Planning management for complex colorectal polyps: a qualitative assessment of factors influencing decision-making among colonoscopists
Authors: Parker Jody , Semedo Lenira , Shenbagaraj Lavanya , Torkington Jared , Dolwani Sunil 
Published: May 2023

ObjectiveEndoscopic therapy is the recommended primary treatment for most complex colorectal polyps, but high colonic resection rates are reported. The aim of this qualitative study was to understand and compare between specialities, the clinical and non-clinical factors influencing decision making when planning management.DesignSemi-structured interviews were performed among colonoscopists across the UK. Interviews were conducted virtually and transcribed verbatim. Complex polyps were defined as lesions requiring further management planning rather than those treatable at the time of endoscopy. A thematic analysis was performed. Findings were coded to identify themes and reported narratively.ResultsTwenty colonoscopists were interviewed. Four major themes were identified including gathering information regarding the patient and their polyp, aids to decision making, barriers in achieving optimal management and improving services. Participants advocated endoscopic management where possible. Factors such as younger age, suspicion of malignancy, right colon or difficult polyp location lead towards surgical intervention and were similar between surgical and medical specialties. Availability of expertise, timely endoscopy and challenges in referral pathways were reported barriers to optimal management. Experiences of team decision-making strategies were positive and advocated in improving complex polyp management. Recommendations based on these findings to improve complex polyp management are provided.ConclusionThe increasing recognition of complex colorectal polyps requires consistency in decision making and access to a full range of treatment options. Colonoscopists advocated the availability of clinical expertise, timely treatment and education in avoiding surgical intervention and providing good patient outcomes. Team decision-making strategies for complex polyps may provide an opportunity to coordinate and improve these issues.
5 A new animal model for infected fracture non-union after external fixation of tibia with real-time in-vivo monitoring of infection
Authors: Robiati Louise , Hindle Paul , Stapley Sarah , Simpson Hamish 
Published: May 2023

BackgroundNon-union is a well-recognised complication after open fractures. Fifty percent of open extremity trauma returning from military operations developed non-union. Aetiology of non-union is multi- factorial, with infection reported as major contributory factor. The aim of this study was to develop an in-vivo model of infected fracture non-union managed with external fixation which allowed real time in-vivo monitoring of infection to evaluate potential therapeutic strategies.MethodTen male Wistar rats underwent application of external fixator and midshaft tibia osteotomy. Osteotomy sites were inoculated with bioluminescent Staphylococcus aureus Xen36 (infected group; n=6); or phosphate buffer solution (control group; n=4). Animals were monitored for infection with invivo bioluminescent imaging and fracture healing with plain radiographs. Animals were sacrificed at eight weeks. Post-mortem micro-computed tomography (uCT) was used to assess fracture union; in-vivo bioluminescent imaging to assess persistence of Xen36 infection; tissue samples were processed for bacterial colony forming unit counts and histology to assess for fracture healing and infection.ResultsEight animals reached experiment endpoint (infected=5, control=3). All five infected animals demonstrated radiographic non-union on x-ray and uCT. Bioluminescence, at fracture site in infected cohort, peaked at week two and reduced to chronic baseline of 105 photons per second for duration of experiment. At experiment endpoint bioluminescence was confirmed at fracture site and bioluminescent bacteria was cultured from fracture site tissue samples in all of the infected cohort. Two of three control animals demonstrated radiographic non-union, none luminesced, one grew bacteria from tissue samples but was not bioluminescent.ConclusionsThis study has developed an infected fracture non-union animal model. Use of bioluminescent bacteria allows for non-invasive and real-time monitoring of infection. This model is more representative of the military casualty than previously reported models and could be used to evaluate therapeutic strategies for prevention and management of infected fracture non-union.
6 Beyond the default male: exploring sex differences in the acute physiological response to trauma and associated clinical outcomes
Authors: Ross Jennifer , Bocchetta Natasha , Hickey Hayden , Lindsay Charlotte , Cole Elaine 
Published: May 2023

BackgroundFemale patients are consistently outnumbered by males in trauma studies. This bias towards male physiology may influence research outputs and result in females receiving less efficacious care. This study looks at male and female patients with comparable injury severities (as assessed by ISS), observing acute physiological responses to injury and subsequent clinical outcomes.MethodData from over 2000 patients enrolled in the Activation of Coagulation and Inflammation in Trauma (ACIT-II) prospective cohort study (REC: 07/Q0603/29) at the Royal London Hospital was sex disaggregated. Patients are eligible for inclusion into ACIT-II if they arrive in ED within 2 hours of injury and meet the local criteria for a trauma team activation. In order to look at males and females with comparable injury severities, Injury Severity Scores (ISS) were grouped into ‘control’ (ISS 0-3), ‘mild’ (ISS 4-8), ‘moderate’ (ISS 9-15), ‘severe’ (ISS 16-25), ‘critical’ (ISS ≥25).ResultsIn the total study cohort, females were significantly more likely to be older, to have experienced blunt rather than penetrating injury, and to have a severe (AIS≥4) head injury. To mitigate the potential influence of these factors, a cohort of 757 patients aged <50 years with only blunt injury and without severe head injury was identified. In this group we showed that females were significantly more shocked and had different coagulation profiles at presentation to ED. There were minimal differences between males and females regarding blood product administration, time to first TXA or length of stay. Notably, however, females had a significantly worse survival rate at both 24hrs (p = 0.009 overall) and 28days (p = <0.001 overall).ConclusionsEven when the confounding influences of age, mechanism and severe head injury are removed, females with comparable injury severities have different physiological responses and worse outcomes following trauma. Further work is needed to establish the underlying causes for this.
Validating the InterVA-5 cause of death analytical tool: using mortality data from the Comprehensive Health and Epidemiological Surveillance System in Papua New Guinea
Authors: Pham Bang Nguyen , Abori Norah , Maraga Seri , Jorry Ronny , Jaukae Gasowo S , Silas Vinson D , Aga Tess , Okely Tony , Pomat William 
Published: May 2023

ObjectiveInterVA-5 is a new version of an analytical tool for cause of death (COD) analysis at the population level. This study validates the InterVA-5 against the medical review method, using mortality data in Papua New Guinea (PNG).Design and settingThis study used mortality data collected from January 2018 to December 2020 in eight surveillance sites of the Comprehensive Health and Epidemiological Surveillance System (CHESS), established by the PNG Institute of Medical Research in six major provinces.MethodsThe CHESS demographic team conducted verbal autopsy (VA) interviews with close relatives of the deceased, who died in communities within the catchment areas of CHESS, using the WHO 2016 VA instrument. COD of the deceased was assigned by InterVA-5 tool, and independently certified by the medical team. Consistency, difference and agreement between the InterVA-5 model and medical review were assessed. Sensitivity and positive predictive value (PPV) of the InterVA-5 tool were calculated with reference to the medical review method.ResultsSpecific COD of 926 deceased people was included in the validation. Agreement between the InterVA-5 tool and medical review was high (kappa test: 0.72; p<0.01). Sensitivity and PPV of the InterVA-5 were 93% and 72% for cardiovascular diseases, 84% and 86% for neoplasms, 65% and 100% for other chronic non-communicable diseases (NCDs), and 78% and 64% for maternal deaths, respectively. For infectious diseases and external CODs, sensitivity and PPV of the InterVA-5 were 94% and 90%, respectively, while the sensitivity and PPV of the medical review method were both 54% for classifying neonatal CODs.ConclusionThe InterVA-5 tool works well in the PNG context to assign specific CODs of infectious diseases, cardiovascular diseases, neoplasms and injuries. Further improvements with respect to chronic NCDs, maternal deaths and neonatal deaths are needed.
Patient perceptions and experiences with medication-related activities in the emergency department: a qualitative study
Authors: Zahl-Holmstad Birgitte , Garcia Beate Hennie , Johnsgård Tine , Ofstad Eirik Hugaas , Lehnbom Elin Christina , Svendsen Kristian , Risør Torsten , Holis Renata Vesela , Elenjord Renate 
Published: May 2023

BackgroundEmergency department (ED) pharmacists reduce medication errors and improve quality of medication use. Patient perceptions and experiences with ED pharmacists have not been studied. The aim of this study was to explore patients’ perceptions of and experiences with medication-related activities in the ED, with and without an ED pharmacist present.MethodsWe conducted 24 semistructured individual interviews with patients admitted to one ED in Norway, 12 before and 12 during an intervention, where pharmacists performed medication-related tasks close to patients and in collaboration with ED staff. Interviews were transcribed and analysed applying thematic analysis.ResultsFrom our five developed themes, we identified that: (1) Our informants had low awareness and few expectations of the ED pharmacist, both with and without the pharmacist present. However, they were positive to the ED pharmacist. (2) Our informants expressed a variation of trust in the healthcare system, healthcare professionals and electronic systems, though the majority expressed a high level of trust. They believed that their medication list was automatically updated and assumed to get the correct medication. (3) Some informants felt responsible to have an overview of their medication use, while others expressed low interest in taking responsibility regarding their medication. (4) Some informants did not want involvement from healthcare professionals in medication administration, while others expressed no problems with giving up control. (5) Medication information was important for all informants to feel confident in medication use, but the need for information differed.ConclusionDespite being positive to pharmacists, it did not seem important to our informants who performed the medication-related tasks, as long as they received the help they needed. The degree of trust, responsibility, control and information varied among ED patients. These dimensions can be applied by healthcare professionals to tailor medication-related activities to patients’ individual needs.
Baseline symptoms of depression and anxiety negatively impact the effectiveness of CBTi in treating acute insomnia among young adults
Authors: Zhang Chenxi , Zeng Shufei , Xu Yan , Liu Shuai , Du Shixu , Fang Leqin , Lv Zhihong , Zhang Lili , Zhang Bin 
Published: May 2023

BackgroundCognitive–behavioural therapy for insomnia (CBTi) is the first-line treatment for those with this sleep disorder. However, depressive and anxiety symptoms often co-occur with acute insomnia, which may affect the effectiveness of CBTi treatment.AimsThis study aimed to determine the impact of depressive and anxiety symptoms on the efficacy of CBTi in treating acute insomnia.MethodsA single-arm clinical trial was conducted among individuals who have acute insomnia. Participants underwent self-guided CBTi for 1-week. Their insomnia, depressive symptoms and anxiety symptoms were evaluated using the Insomnia Severity Index and the Hospital Anxiety and Depression Scale at baseline, post-treatment and 3-month follow-up. Repeated measures analysis of variance was used to assess the effectiveness of CBTi in treating insomnia, depressive symptoms and anxiety symptoms. A multivariate Cox regression model was used to determine the impact of depressive and anxiety symptoms on insomnia.ResultsThe study found significant reductions in insomnia, depressive symptoms and anxiety symptoms at both post-treatment and 3-month follow-up (F=17.45, p<0.001; F=36.37, p=0.001; and F=81.51, p<0.001, respectively). The duration of CBTi treatment had a positive impact on insomnia recovery (hazard ratio (HR)=0.94, p=0.018). However, baseline depressive symptoms (HR=1.83, p=0.004) and baseline anxiety symptoms (HR=1.99, p=0.001) had significant negative effects on insomnia recovery.ConclusionsThe study showed that a 1-week self-guided CBTi treatment is effective in treating acute insomnia and comorbid depressive and anxiety symptoms. However, baseline depressive and anxiety symptoms negatively impact treatment effectiveness. Therefore, clinicians should assess for depressive and anxiety symptoms before treating acute insomnia with monotherapy CBTi.
Quasi-experimental evaluation of municipal ice cleat distribution programmes for older adults in Sweden
Authors: Eklund Elin , Holmberg Robin , Svensson Mikael , Gustavsson Johanna , Bonander Carl 
Published: May 2023

IntroductionFall injuries caused by icy road conditions are a prevalent public health problem during winters in Sweden, especially in older populations. To combat this problem, many Swedish municipalities have distributed ice cleats to older adults. While previous research has shown promising results, there is a lack of comprehensive empirical data on the effectiveness of ice cleat distribution. We address this gap by investigating the impact of these distribution programmes on ice-related fall injuries among older adults.MethodsWe combined survey data on ice cleat distribution in Swedish municipalities with injury data from the Swedish National Patient Register (NPR). The survey was used to identify municipalities that have distributed ice cleats to older adults at some point between 2001 and 2019. Data from NPR were used to identify municipality-level data on patients who have been treated for injuries related to snow and ice. We used a triple differences design—a generalisation of difference in differences—that compared ice-related fall injury rates before and after intervention in 73 treatment and 200 control municipalities, with unexposed age groups serving as within-municipality controls.ResultsWe estimate that the average ice cleat distribution programmes reduced ice-related fall injury rates by −0.24 (95% CI −0.49 to 0.02) per 1000 person-winters. The impact estimate was larger in municipalities that distributed more ice cleats (−0.38 (95% CI −0.76 to –0.09)). No similar patterns were found for fall injuries unrelated to snow and ice.ConclusionOur results suggest that ice cleat distribution can decrease the incidence of ice-related injuries among older adults.
Long-term follow-up of anti-PD-1 naïve patients with metastatic melanoma treated with IDO/PD-L1 targeting peptide vaccine and nivolumab
Authors: Lorentzen Cathrine Lund , Kjeldsen Julie Westerlin , Ehrnrooth Eva , Andersen Mads Hald , Marie Svane Inge 
Published: May 2023

BackgroundWe have previously published initial efficacy of the indoleamine 2,3-dioxygenase (IDO)/anti-programmed death ligand 1 (PD-L1) vaccine in combination with nivolumab in 30 anti-PD-1 therapy naïve patients with metastatic melanoma (cohort A). We now report long-term follow-up of patients in cohort A. Further, we report results from cohort B, where the peptide vaccine was added to anti-PD-1 therapy for patients with progressive disease during anti-PD-1 treatment.MethodsAll patients were treated with a therapeutic peptide vaccine in Montanide targeting IDO and PD-L1 combined with nivolumab (NCT03047928). A long-term follow-up of safety, response rates, and survival rates were performed in cohort A including patient subgroup analyses. Safety and clinical responses were analyzed for cohort B.ResultsCohort A: At data cut-off, January 5, 2023, the overall response rate (ORR) was 80%, and 50% of the 30 patients obtained a complete response (CR). The median progression-free survival (mPFS) was 25.5 months (95% CI 8.8 to 39), and median overall survival (mOS) was not reached (NR) (95% CI 36.4 to NR). The minimum follow-up time was 29.8 months, and the median follow-up was 45.3 months (IQR 34.8–59.2). A subgroup evaluation further revealed that cohort A patients with unfavorable baseline characteristics, including either PD-L1 negative tumors (n=13), elevated lactate dehydrogenase (LDH) levels (n=11), or M1c (n=17) obtained both favorable response rates and durable responses. The ORR was 61.5%, 79%, and 88% for patients with PD-L1−tumors, elevated LDH, and M1c, respectively. The mPFS was 7.1 months for patients with PD-L1−tumors, 30.9 months for patients with elevated LDH, and 27.9 months for M1c patients. Cohort B: At data cut-off, the best overall response was stable disease for 2 of the 10 evaluable patients. The mPFS was 2.4 months (95% CI 1.38 to 2.52), and the mOS was 16.7 months (95% CI 4.13 to NR).ConclusionThis long-term follow-up confirms the promising and durable responses in cohort A. Subgroup analyses of patients with unfavorable baseline characteristics revealed that high response rates and survival rates were also found in patients with either PD-L1 negative tumors, elevated LDH levels, or M1c. No meaningful clinical effect was demonstrated in cohort B patients.Trial registration numberNCT03047928.
3 Management of a major medical incident – a multi national challenge
Authors:   Lt Col Jon Walker
Published: May 2023

Major Medical Incidents on deployed operations are increasingly likely with the utilisation of small DHC facilities with limited clinical personnel and resources. In June 2021 a Suicide Vehicle Borne IED was detonated against a DEU callsign resulting in 13 casualties. A multinational response working from the DEU Role 1+ facility was undertaken and personnel from the DEU, UK and SWE formed ‘Flash’ teams and utilised senior clinical SMEs to deliver care to all 13 patients, 9 directly from the incident and 4 after initial treatment at FRA and CHN facilities. 6 surgical cases were performed over 15 hours along with 2 critical care transfers being undertaken. There were no fatalities and all casualties were repatriated in a stable condition to allow immediate reconstruction.The success of this undertaking was due to the acceptance from all of ‘Right Person, Right Role’ regardless of service or nationality. Recognising operational and clinical experience, combined with a shared approach to casualty management requires an adaptable mindset in order to find the best ways to deliver casualty care.From this incident a number of key learning points were recognised:Have a plan, but be prepared to adapt it as the situation changes.Early meetings and understanding of other nations capabilities is key to being able to create multi–national flash teams with the right skill compositions.Have equipment, medications and blood stored together and ready to deploy at short notice.Be able to adapt and utilise other nations equipment and medications.Always re–review the patients and re–prioritise as required.It is not over until all the patients have been evacuated and the equipment and personnel are reconditioned.