bluuebunny/crossref_metadata_2025_split huggingface dataset:
Which “weigh” to Go? Alternative Vancomycin Dosing Strategies in Obese Patients
Authors: Wright Lauren , Childress Darrell T. , Brown Matthew L. , Wilkerson Wes , Maldonado Ricardo , Durham Spencer H. 
Published: April 2022

Purpose This study aims to compare the performance of alternative weight-based vancomycin dosing strategies to traditional dosing in obese patients using area under the curve (AUC) monitoring. Methods: This retrospective study compared target attainment of an AUC between 400–600mcg*H/mL using alternative vancomycin dosing strategies. All patients received allometrically dosed vancomycin, with patient-specific AUCs calculated using 2 post-infusion steady-state vancomycin serum concentrations using the trapezoidal rule. Predicted AUCs were calculated using the following: 15 mg/kg total body weight (TBW), 15 mg/kg corrected body weight (CBW), and 12.5 mg/kg TBW. Predicted AUCs from the traditional 15 mg/kg TBW dosing were then compared to alternative dosing strategies using the predicted AUCs from 12.5 mg/kg TBW, 15 mg/kg CBW, and the actual AUCs calculated using allometrically scaled vancomycin dosing. The primary outcome was attainment of initial AUC within the target range of 400–600mcg*H/mL for each dosing method. Results: Eighty-four patients were included. When AUCs were compared to traditional 15 mg/kg dosing strategy, the CBW, 12.5 mg/kg, and allometric dosing strategies were significantly more likely to result in initial attainment of an AUC within a target range of 400–600 mcg*H/mL (P = 0.0003, 0.0135, and 0.0088, respectively). No significant differences were seen between each of the alternative dosing methods (P = 0.73). Conclusion: The 3 alternative vancomycin dosing strategies examined were all significantly more likely to achieve an initial AUC within the target range compared to traditional vancomycin dosing in obese patients. Clinicians should strongly consider one of these alternative dosing strategies for obese patients as opposed to traditional vancomycin dosing.
Lakshya Food India Limited (LFIL): Finding the Right Position in Dairy Business
Authors: Chhabra Sakhhi , Chhikara Ritu , Garg Ruchi 
Published: April 2022

Laxman and Joel, managing directors of Lakshya Foods India Ltd., faced a positioning issue for their milk brand. The young entrepreneurs had acquired a stake from Mr Redu, the founder and owner of Lakshya, a regional dairy company based out of Haryana, India, in 2012. While designing their annual marketing plan for 2019, they were not able to figure out what made Lakshya different from its competitors. The dairy market dynamics were changing with varying consumption patterns, people becoming more health-conscious, a rise in disposable income and consumer demand for variety in the product range. Due to these changes, the competition was growing intense in the dairy business. From renowned national brands such as Amul, Mother dairy, Madhusudan etc., establishing foothold to various app-based online milk vendors such as Daily Ninja, Milk Basket and Country Delight entering dairy space, everyone was fighting for more market share. There was a substantial unorganized market that had a loyal customer base. Different brands were using different value propositions to compete in the market, such as quality, purity or attractiveness of the packaging to pull consumers. The two young entrepreneurs were unsure about what would work better with the Indian buyers; purity, freshness, taste or health. These milkpreneurs wanted to convey a proposition that was deeper and moved Lakshya from mundane milk to a preferred choice of every household. Until now, there was no clear communication strategy, and various channels were used at any time of the year to reach customers, which led to target bullets in the air and wasting marketing effort. They wanted to make Lakshya a national dairy brand, but they were uncertain how to differentiate their dairy brand. They had to decide a value proposition that would help Lakshya position itself firmly in the dairy market.
Early screening outcomes among non-immigrants and immigrants targeted by BreastScreen Norway, 2010–2019
Authors: Thy Jonas E. , Bhargava Sameer , Larsen Marthe , Akslen Lars A. , Hofvind Solveig 
Published: April 2022

Aims: This study aimed to analyse results on early screening outcomes, including recall and cancer rates, and histopathological tumour characteristics among non-immigrants and immigrants invited to BreastScreen Norway. Methods: We included information about 2, 763,230 invitations and 2,087,222 screening examinations from 805,543 women aged 50–69 years who were invited to BreastScreen Norway between 2010 and 2019. Women were stratified into three groups based on their birth country: non-immigrants, immigrants born in Western countries and immigrants born in non-Western countries. Age-adjusted regression models were used to analyse early screening outcomes. A random intercept effect was included in models where women underwent several screening examinations. Results: The overall attendance was 77.5% for non-immigrants, 68% for immigrants from Western countries and 51.5% for immigrants from non-Western countries. The rate of screen-detected cancers was 5.9/1000 screening examinations for non-immigrants, 6.3/1000 for immigrants from Western countries and 5.1/1000 for immigrants from non-Western countries. Adjusted for age, the rate did not differ statistically between the groups ( p=0.091). The interval cancer rate was 1.7/1000 screening examinations for non-immigrants, 2.4/1000 for immigrants from Western countries and 1.6/1000 for non-Western countries ( p<0.001). Histological grade was less favourable for screen-detected cancers, and subtype was less favourable for interval cancers among immigrants from non-Western countries versus non-immigrants. Conclusions: There were no differences in age-adjusted rate of screen-detected cancer among non-immigrants and immigrants from Western countries or non-Western countries among women attending BreastScreen Norway between 2010 and 2019. Small but clinically relevant differences in histopathological tumour characteristics were observed between the three groups.
Restoration of the joint geometry after stemless shoulder arthroplasty
Authors: Chawla Lokesh , Kumar Kapil , Barker Scott , Ismail Azzain 
Published: April 2022

Aim This study aims to evaluate restoration of anatomy following Total Shoulder Arthroplasty (TSA) with the Mathys Affinis Short prosthesis. Background Over the last decade stemless shoulder arthroplasty has increased in popularity. One of the reported advantages of the stemless designs is the ability to restore anatomy following surgery. However, very few studies have evaluated restoration of anatomy following stemless shoulder arthroplasty. Methods The study included all patients who had undergone TSA using the Affinis Short (Mathys Ltd, Bettlach, Switzerland) prosthesis for primary osteoarthritis between 2010 and 2016. The mean follow up was 42.8 months (range 9.4 to 83.4 months). Pre and post-operative radiographs were assessed for Centre of Rotation (COR), Humeral Head Height (HHH), Humeral Head Diameter (HHD), Humeral Height (HH) and, Neck Shaft Angle (NSA) using the best fit circle method on PACS software. Measurements were scored and compared to assess the accuracy of the implant in restoring the native geometry, including the intraobserver variability. The same data was collected by another experienced observer to measure the interobserver variability. Results The deviation of COR of the prosthesis from the anatomical centre was less than 3 mm in 58 cases (85%). Humeral head height and humeral head diameter showed a variation of less than 3 mm in 66 cases (97%) and 43 cases (63%) respectively. Humeral height followed a similar trend, with 62 cases (91.2%) showing a difference of less than 5 mm. The neck shaft angle showed a variation of more than 8 degrees in 38 cases (55%), and 29 cases (42.6%) had a postoperative angle of less than 130 degrees. Conclusion Overall, stemless total shoulder arthroplasty with the Affinis Short prosthesis allows excellent restoration of anatomy confirmed by most of the measured radiographic parameters. The variability in neck shaft angle might be due to differing surgical techniques, with some surgeons preferring a slightly vertical neck cut to protect the rotator cuff insertion.
Post-operative rehabilitation following traumatic anterior shoulder dislocation: A systematic scoping review
Authors: Coyle Martha , Jaggi Anju , Weatherburn Lewis , DanielI Helena , Chester Rachel 
Published: April 2022

Background This systematic scoping review aimed to describe the content of post-operative rehabilitation programmes, and outcome measures selection following stabilisation surgery for traumatic anterior shoulder dislocation (TASD). Methods An electronic search of Medline, EMBASE, CINAHL and AMED was conducted (2000–2021). Any cohort or clinical trial of patients receiving post-operative TASD rehabilitation were included. Study selection, data extraction and quality appraisal were undertaken by two independent reviewers. Results Twelve studies including fourteen treatment programmes were eligible. Period of post-operative immobilisation ranged from 1 day to 6 weeks, with exercise introduced between 1 and 7 weeks. Strengthening exercises were introduced between 1 and 12 weeks. Two studies described “accelerated” rehabilitation programmes, differing in immobilisation period and exercise milestones. No increased recurrence was reported in professional footballers. Two studies compared rehabilitation programmes, one not randomised, the other 18 years old. There was variability in selected outcomes measures, with only 4 studies using a common measure. Discussion There is minimal evidence to guide post-operative rehabilitation, variability in immobilisation periods and when exercise is introduced. There is no consensus on the definition of accelerated rehabilitation, or outcome measure selection. Clinical consensus of standardised terminology and stages of rehabilitation is required prior to efficacy studies.
Short-Term Outcomes After Treatment of Isolated Hidden Meniscal Ramp Lesions
Authors: Karaca Mustafa Onur , Özbek Emre Anıl , Ertan Mehmet Batu , Terzi Mustafa Mert , Akmeşe Ramazan 
Published: April 2022

Background: Ramp lesions are encountered in 16% to 24% of all anterior cruciate ligament (ACL) ruptures. However, isolated ramp lesions without a ruptured ACL have also been reported. Purpose: To evaluate outcomes after type 3 hidden ramp lesions without ACL rupture were treated with all-inside sutures passed through the standard anterior portal. Study Design: Case series, Level of evidence, 4. Methods: Included were 41 patients (26 female; 63.4%) with isolated type 3 ramp lesions who underwent surgery between January 2017 and January 2019. Patients with concomitant lateral meniscal injuries and revision meniscal surgeries were excluded. We retrospectively recorded patient age, sex, and body mass index (BMI), as well as follow-up periods, comorbidities, and postoperative and early midterm complications. The Lysholm, visual analog scale (VAS) for pain, and International Knee Documentation Committee (IKDC) scores were compared preoperatively to final follow-up. In addition, patients were classified as having either a sedentary or active lifestyle according to Sedentary Behavior Research Network (SBRN) criteria. The Shapiro-Wilk test was used to evaluate the normality of the data, and the Wilcoxon and Mann-Whitney U tests were used to compare preoperative and postoperative outcome scores. The Spearman test was employed to evaluate the correlation between patient variables. Results: The mean follow-up period was at 37.6 (range, 25-49) months. A total of 17 patients (41.46%) had a sedentary lifestyle based on SBRN criteria. All scores improved significantly from preoperatively to final follow-up (VAS, from 8.43 ± 1.53 to 2.34 ± 2.9; Lysholm, from 47.73 ± 17.02 to 85.37 ± 14.01; and IKDC, from 27.12 ± 14.81 to 85.32 ± 8.78; P < .001 for all). Although no significant relationship was established between patient activity level and postoperative Lysholm and IKDC scores, an inverse correlation was observed between BMI and Lysholm ( r =–0.9906) and BMI and IKDC ( r =–0.9402). Conclusion: Satisfactory postoperative clinical results were obtained in patients with type 3 ramp lesions not accompanied by ACL rupture who were treated with all-inside suturing through standard anterior portals.
Design and Experimental Study of Pressure Compensation System for Full-Ocean-Depth Gas-Tight Sediment Sampler
Authors: Liu Guangping , Jin Yongping , Peng Youduo , Wan Buyan 
Published: April 2022

AbstractAiming at the requirement of the full-ocean-depth (operating water depth 11000 m) manned submersible to carry out the gas-tight sampling operation of the abyss seabed sediment, a kind of full-ocean-depth carrier submersible mechanical hand-held, full-ocean-depth gas-tight sediment sampler (GTSS) with the function of pressure-retaining and coring is designed. Firstly, the volume change model of pressure compensator is established, and it is pointed out that the volume of pressure compensator is about 16.14% equal to the volume of gas-tight sediment sampler (GTSS). Secondly, the pressure compensator is analyzed and calculated, and the relationship between the precharge pressure of the pressure compensator, the nominal volume of the pressure compensator and the pressure holding effect of the gas-tight sediment sampler (GTSS) is studied. The results show that with the increase of gas precharge pressure in the pressure compensator, the final pressure of the sampler also increases. Under the same precharge pressure condition, the larger the nominal volume of the pressure compensator, the greater the final pressure of the sampler. Finally, the air tightness test method is designed by using the developed gas tightness sampler of the full-ocean-depth product, and the change of the final pressure in the gas tight sampler under different precharge pressure is observed. The test results are consistent with the simulation results, indicating the correctness of the pressure compensation system (PCS) model.
Assessment of the dynamics of concentration and competitive positions of the Baltic cruise port system
Authors: Esteve-Pérez Jerónimo , Gutiérrez-Romero José Enrique 
Published: April 2022

Abstract
Objective
This study aims to investigate the degree of concentration and the competitive positions of the Baltic cruise port network.

Methods
A set of 29 Baltic ports are analysed, market concentration is evaluated using the analytical technique of the Herfindahl–Hirschman index, and competitive positions are determined through portfolio analysis based on the Boston Consulting Group matrix from 2000 to 2019.

Results
The Herfindahl–Hirschman index indicates that the Baltic cruise port system is unconcentrated with an average score of 0.11 for the analysed period, suggesting that eight of the twenty-nine ports are the dominant ports in the Baltic. Portfolio analysis results suggest that the hierarchy picture of competitive positions is dynamic and has changed over time. The Baltic cruise port system has a wide range of competitive positions. Kiel and Rostock becoming mature leaders is one of the most relevant changes in competitive positions.

Implications of the research
This study contributes to the literature not only by investigating the competitive positions of the second most important European operational area for cruise ships but also by filling the gap in research on the concentration and competitive strategic positions of Baltic cruise ports. This research allows seaport operators to visualise the position and progress of selected ports and predict the possible future seaport developments.
The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities: a retrospective cohort study using routinely collected data
Authors: Wabe Nasir , Siette Joyce , Seaman Karla L. , Nguyen Amy D. , Raban Magdalena Z. , Close Jacqueline C. T. , Lord Stephen R. , Westbrook Johanna I. 
Published: April 2022

Abstract
Background
The Peninsula Health Falls Risk Assessment Tool (PH-FRAT) is a validated and widely applied tool in residential aged care facilities (RACFs) in Australia. However, research regarding its use and predictive performance is limited. This study aimed to determine the use and performance of PH-FRAT in predicting falls in RACF residents.

Methods
A retrospective cohort study using routinely-collected data from 25 RACFs in metropolitan Sydney, Australia from Jul 2014-Dec 2019. A total of 5888 residents aged ≥65 years who were assessed at least once using the PH-FRAT were included in the study. The PH-FRAT risk score ranges from 5 to 20 with a score > 14 indicating fallers and ≤ 14 non-fallers. The predictive performance of PH-FRAT was determined using metrics including area under receiver operating characteristics curve (AUROC), sensitivity, specificity, sensitivityEvent Rate(ER) and specificityER.

Results
A total of 27,696 falls were reported over 3,689,561 resident days (a crude incident rate of 7.5 falls /1000 resident days). A total of 38,931 PH-FRAT assessments were conducted with a median of 4 assessments per resident, a median of 43.8 days between assessments, and an overall median fall risk score of 14. Residents with multiple assessments had increased risk scores over time. The baseline PH-FRAT demonstrated a low AUROC of 0.57, sensitivity of 26.0% (sensitivityER 33.6%) and specificity of 88.8% (specificityER 82.0%). The follow-up PH-FRAT assessments increased sensitivityER values although the specificityER decreased. The performance of PH-FRAT improved using a lower risk score cut-off of 10 with AUROC of 0.61, sensitivity of 67.5% (sensitivityER 74.4%) and specificity of 55.2% (specificityER 45.6%).

Conclusions
Although PH-FRAT is frequently used in RACFs, it demonstrated poor predictive performance raising concerns about its value. Introducing a lower PH-FRAT cut-off score of 10 marginally enhanced its predictive performance. Future research should focus on understanding the feasibility and accuracy of dynamic fall risk predictive tools, which may serve to better identify residents at risk of falls.
Modifiable and non-modifiable risk factors for obstetric anal sphincter injury in a Norwegian Region: a case–control study
Authors: Klokk Ragnhild , Bakken Kjersti S. , Markestad Trond , Holten-Andersen Mads N. 
Published: April 2022

Abstract
Background
Obstetric anal sphincter injury (OASI) is a common and severe complication of vaginal delivery and may have short- and long-term consequences, including anal incontinence, sexual dysfunction and reduced quality of life. The rate of OASI varies substantially between studies and national birth statistics, and a recent meta-analysis concluded that there is a need to identify unrecognized risk factors. Our aim was therefore to explore both potential modifiable and non-modifiable risk factors for OASI.

Methods
We performed a case–control study in a single center maternity clinic in South-Eastern Norway. Data were extracted retrospectively from an institutional birth registry. The main outcome measure was the occurrence of the woman’s first-time 3rd or 4th degree perineal lesion (OASI) following singleton vaginal birth after 30 weeks’ gestation. For each woman with OASI the first subsequent vaginal singleton delivery matched for parity was elected as control. The study population included 421 women with OASI and 421 matched controls who gave birth during 1990–2002. Potential risk factors for OASI were assessed by conditional logistic regression analyses.

Results
The mean incidence of OASI was 3.4% of vaginal deliveries, but it increased from 1.9% to 5.8% during the study period. In the final multivariate regression model, higher maternal age and birthweight for primiparous women, and higher birthweight for the multiparous women, were the only non-modifiable variables associated with OASI. Amniotomy was the strongest modifiable risk factor for OASI in both primi- (odds ratio [OR] 4.84; 95% confidence interval [CI] 2.60–9.02) and multiparous (OR 3.76; 95% CI 1.45–9.76) women, followed by augmentation with oxytocin (primiparous: OR 1.63; 95% CI 1.08–2.46, multiparous: OR 3.70; 95% CI 1.79–7.67). Vacuum extraction and forceps delivery were only significant risk factors in primiparous women (vacuum: OR 1.91; 95% CI 1.03–3.57, forceps: OR 2.37; 95% CI 1.14–4.92), and episiotomy in multiparous women (OR 2.64; 95% CI 1.36–5.14).

Conclusions
Amniotomy may be an unrecognized independent modifiable risk factor for OASI and should be further investigated for its potential role in preventive strategies.
Clustering of countries according to the COVID-19 incidence and mortality rates
Authors: Gohari Kimiya , Kazemnejad Anoshirvan , Sheidaei Ali , Hajari Sarah 
Published: April 2022

Abstract
Background
Two years after the beginning of the COVID-19 pandemic on December 29, 2021, there have been 281,808,270 confirmed cases of COVID-19, including 5,411,759 deaths. This information belongs to almost 216 Countries, areas, or territories facing COVID-19. The disease trend was not homogeneous across these locations, and studying this variation is a crucial source of information for policymakers and researchers. Therefore, we address different patterns in mortality and incidence of COVID-19 across countries using a clustering approach.

Methods
The daily records of new cases and deaths of 216 countries were available on the WHO online COVID-19 dashboard. We used a three-step approach for identifying longitudinal patterns of change in quantitative COVID-19 incidence and mortality rates. At the first, we calculated 27 summary measurements for each trajectory. Then we used factor analysis as a dimension reduction method to capture the correlation between measurements. Finally, we applied a K-means algorithm on the factor scores and clustered the trajectories.

Results
We determined three different patterns for the trajectories of COVID-19 incidence and the three different ones for mortality rates. According to incidence rates, among 206 countries the 133 (64.56) countries belong to the second cluster, and 15 (7.28%) and 58 (28.16%) belong to the first and 3rd clusters, respectively. All clusters seem to show an increased rate in the study period, but there are several different patterns. The first one exhibited a mild increasing trend; however, the 3rd and the second clusters followed the severe and moderate increasing trend. According to mortality clusters, the frequency of sets is 37 (18.22%) for the first cluster with moderate increases, 157 (77.34%) for the second one with a mild rise, and 9 (4.34%) for the 3rd one with severe increase.

Conclusions
We determined that besides all variations within the countries, the pattern of a contagious disease follows three different trajectories. This variation looks to be a function of the government’s health policies more than geographical distribution. Comparing this trajectory to others declares that death is highly related to the nature of epidemy.