bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of STEM Integrated Project Based Learning (PjBL) to Improve Problem Solving Skills
Authors: Putri Maharani Ayu Nurdiana , Dwikoranto Dwikoranto 
Published: June 2022

The 4Cs are skills that emphasize learning across the 21st century (Critical thinking, Communication, Collaboration, Creativity). Problem-solving, one of the 21st century's skills, developed by implementing PjBL-STEM learning models. PjBL-STEM learning focuses on developing students' ability to be more engaged, innovative, and open to the idea of concepts learnt through project-based activities that incorporate STEM aspects in real life. The study's goal is to examine how PjBL-STEM learning improves problem-solving skills. The research method used was quantitative research through a one-group pre-experimental design with pretest and posttest. A total of 35 students from class XI IPA 2, SMA X Muhammadiyah Surabaya, participated in the study. This study uses purposive sampling to consider students' abilities and conditions of delivery of subject matter. The study's results (N-gain) were 0.59, classified as "medium". According to the findings of this study, Learning the PjBL-STEM model has been sufficient for enhancing problem-solving abilities in dynamic fluid materials. The characteristics of the PjBL-STEM learning model that focuses on the 'student-centred model' significantly influence problem-solving skills. The advantages of this model should be accompanied by improvement of educational facilities and teaching skills in the learning process in order to create a balanced learning environment
An Enhanced Understanding of Culture-Negative Periprosthetic Joint Infection with Next-Generation Sequencing
Authors: Goswami Karan , Clarkson Samuel , Phillips Caleb D. , Dennis Douglas A. , Klatt Brian A. , O’Malley Michael J. , Smith Eric L. , Gililland Jeremy M. , Pelt Christopher E. , Peters Christopher L. , Malkani Arthur L. , Palumbo Brian T. , Lyons Steven T. , Bernasek Thomas L. , Minter Jon , Goyal Nitin , McDonald James F. , Cross Michael B. , Prieto Hernan A. , Lee Gwo-Chin , Hansen Erik N. , Bini Stefano A. , Ward Derek T. , Shohat Noam , Higuera Carlos A. , Nam Dennis , Della Valle Craig J. , Parvizi Javad ,   on behalf of the Orthopedic Genomics Workgroup
Published: June 2022

Background:
The challenges of culture-negative periprosthetic joint infection (PJI) have led to the emergence of molecular methods of pathogen identification, including next-generation sequencing (NGS). While its increased sensitivity compared with traditional culture techniques is well documented, it is not fully known which organisms could be expected to be detected with use of NGS. The aim of this study was to describe the NGS profile of culture-negative PJI.

Methods:
Patients undergoing revision hip or knee arthroplasty from June 2016 to August 2020 at 14 institutions were prospectively recruited. Patients meeting International Consensus Meeting (ICM) criteria for PJI were included in this study. Intraoperative samples were obtained and concurrently sent for both routine culture and NGS. Patients for whom NGS was positive and standard culture was negative were included in our analysis.

Results:
The overall cohort included 301 patients who met the ICM criteria for PJI. Of these patients, 85 (28.2%) were culture-negative. A pathogen could be identified by NGS in 56 (65.9%) of these culture-negative patients. Seventeen species were identified as common based on a study-wide incidence threshold of 5%. NGS revealed a polymicrobial infection in 91.1% of culture-negative PJI cases, with the set of common species contributing to 82.4% of polymicrobial profiles. Escherichia coli, Cutibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus ranked highest in terms of incidence and study-wide mean relative abundance and were most frequently the dominant organism when occurring in polymicrobial infections.

Conclusions:
NGS provides a more comprehensive picture of the microbial profile of infection that is often missed by traditional culture. Examining the profile of PJI in a multicenter cohort using NGS, this study demonstrated that approximately two-thirds of culture-negative PJIs had identifiable opportunistically pathogenic organisms, and furthermore, the majority of infections were polymicrobial.

Level of Evidence:
Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Synovial Fluid and Serum Neutrophil-to-Lymphocyte Ratio
Authors: Varady Nathan H. , Schwab Pierre-Emmanuel , Kheir Michael M. , Dilley Julian E. , Bedair Hany , Chen Antonia F. 
Published: June 2022

Background:
Septic arthritis (SA) is a musculoskeletal emergency for which prompt diagnosis and treatment are critical. However, traditional diagnostic criteria of a synovial fluid (SF) white blood-cell count (WBC) of >50,000 cells/mm3 or >90% polymorphonuclear leukocytes (%PMN) are not particularly sensitive or specific for the diagnosis of SA. Furthermore, prognostic markers are lacking. The purposes of this study were to assess the discriminative ability of the SF neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of SA and of the serum NLR in the prognosis of SA.

Methods:
A multi-institution, retrospective study of 598 patients with native shoulder, hip, or knee SA in 2000 to 2018 was conducted. SF-NLR was calculated from the arthrocentesis cell count with differential. Receiver operating characteristic curves were analyzed, and the optimal threshold of SF-NLR for SA diagnosis was determined using the Youden index. Results were compared with traditional SF diagnostic criteria. Similar analyses assessed the association of serum NLR with 90-day treatment failure and mortality for the subset of patients with confirmed hip or knee SA and with serum complete blood-cell counts with differentials (n = 235). Results were compared with traditional serum prognostic markers (WBC, C-reactive protein [CRP], and erythrocyte sedimentation rate [ESR]).

Results:
The SF-NLR (area under the receiver operating characteristic curve [AUC], 0.85 [95% confidence interval (CI), 0.82 to 0.88]) was significantly more accurate for an SA diagnosis than SF-WBC (AUC, 0.80 [95% CI, 0.76 to 0.83]; p = 0.002) and SF-%PMN (AUC, 0.81 [95% CI, 0.77 to 0.84]; p = 0.01). The optimal threshold of SF-NLR was 25 (78% sensitivity and 81% specificity), compared with >50,000 cells/mm3 for SF-WBC (56% sensitivity and 80% specificity) and >90% for SF-%PMN (65% sensitivity and 78% specificity). Elevated serum NLR was independently associated with 90-day treatment failure (odds ratio [OR], 7.04 [95% CI, 3.78 to 13.14]; p < 0.001) and mortality (OR, 7.33 [95% CI, 2.00 to 26.92]; p = 0.003); elevated serum WBC and CRP were also associated with treatment failure, and WBC, CRP, and ESR were not associated with mortality.

Conclusions:
This study provides compelling data on the superior diagnostic and prognostic ability of serum NLR and SF-NLR for SA compared with current clinical standards. Given that this biomarker requires no additional cost or time to return than current laboratory tests already being performed, pending validation, it can readily be used to aid clinicians in the diagnosis and prognostication of SA.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Long-Term Clinical Outcomes and Implant Survivorship of 151 Total Ankle Arthroplasties Using the HINTEGRA Prosthesis
Authors: Yoon Yeo Kwon , Park Kwang Hwan , Park Jae Han , Lee Wonwoo , Han Seung Hwan , Lee Jin Woo 
Published: June 2022

Background:
Few studies have investigated long-term clinical outcomes of a mobile-bearing total ankle arthroplasty (TAA) system. This study analyzed long-term outcomes of TAA using the HINTEGRA prosthesis at a single, non-developer center.

Methods:
Primary TAAs were performed on 213 ankles in 194 patients, and 151 consecutive ankles [71%] in 136 patients with a minimum follow-up of 10 years after the primary TAA were included in this study. Clinical results were assessed using a visual analog scale (VAS) pain score, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale score, the Ankle Osteoarthritis Scale (AOS) pain and disability subscores, and ankle range of motion. Prosthesis survivorship, reoperations, and risk factors were also evaluated.

Results:
The mean follow-up was 135.5 months (range, 120.0 to 204.0 months). All clinical scores and ankle range of motion improved significantly from preoperatively to 2 years, 4 to 6 years, and ≥10 years after TAA (p < 0.001). A total of 43 ankles (28.5%) required revision procedures, with the most common reason being periprosthetic osteolysis (32 ankles [21.2%]). The overall implant survivorship was 93.5% in Kaplan-Meier survival analysis at the mean follow-up of 11.3 years after the TAA.

Conclusions:
TAA using the HINTEGRA prosthesis with careful follow-up observation and appropriate adjunct procedures for the treatment of end-stage ankle arthritis produced satisfactory clinical results, which were maintained at a follow-up of ≥10 years, and resulted in 93.5% of implant survivorship.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
ACL Reconstruction Patients Have Increased Risk of Knee Arthroplasty at 15 Years of Follow-up
Authors: Visnes Håvard , Gifstad Tone , Persson Andreas , Lygre Stein Håkon Låstad , Engebretsen Lars , Drogset Jon Olav , Furnes Ove 
Published: June 2022

Background:
Anterior cruciate ligament (ACL) injury is considered a risk factor for osteoarthritis. The primary aim of the present study was to investigate the cumulative risk of, and risk factors associated with, a subsequent knee arthroplasty after an ACL reconstruction at up to 15 years of follow-up. The secondary aim was to compare the relative risk of knee arthroplasty after ACL reconstruction compared with that in the general population.

Methods:
Data were analyzed by combining data from 2 national registries, the Norwegian Knee Ligament Register and the Norwegian Arthroplasty Register. The cumulative risk of knee arthroplasty after undergoing ACL reconstruction was calculated as 1 minus the corresponding Kaplan-Meier estimate, and possible risk factors for knee arthroplasty after ACL reconstruction were assessed in a Cox regression model with hazard ratios (HRs) as estimated effect measurements. The relative risk of knee arthroplasty for patients managed with ACL reconstruction as compared with that in the general population was calculated in stratified age groups.

Results:
From the study population of 27,122 knees, 115 knees underwent knee arthroplasty. We found a 1.1% (95% confidence interval [CI], 0.9 to 1.4) cumulative risk of knee arthroplasty 15 years after ACL reconstruction. Deep cartilage injury, ICRS (International Cartilage Repair Society) grade 3 to 4 (HR, 4.8; 95% CI, 3.1 to 7.6), revision of the ACL (HR, 3.9; 95% CI, 2.2 to 7.1), and a 2-year postoperative KOOS Sport/Recreation subscore of <44 (HR, 3.1; 95% CI, 1.5 to 6.2) were important risk factors for knee arthroplasty. We found a higher risk of knee arthroplasty at the age of 30 to 39 years after a previous ACL reconstruction as compared with the general population (relative risk, 3.3; 95% CI, 1.6 to 6.7).

Conclusions:
Fifteen years after an ACL reconstruction, the overall cumulative risk of knee arthroplasty was 1.1%. Cartilage injury at the time of ACL reconstruction, revision ACL reconstruction, and a KOOS Sport/Recreation subscore of <44 (at 2 years postoperatively) were major risk factors for subsequent knee arthroplasty. We found a 3.3-times higher risk of knee arthroplasty at the age of 30 to 39 years after a previous ACL reconstruction as compared with that in the general population.

Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Predicting Model for Delirium in Patients with Cardiovascular Surgery: Development and Validation
Authors: Xu yanghui , meng yunjiao , Qian xuan , Wu honglei , Ji peipei , Liu yanmei , Chen honglin 
Published: June 2022

Abstract
Objective The aim of this study was to construct a Nomogram model for discriminating the risk of delirium in patients with cardiovascular surgery.Methods From January 2017 to June 2020, we collected 838 patients with cardiovascular surgery in Affiliated Hospital of Nantong University. Patients were randomly divided into a training set and a validation set in a 5:5 ratio. Nomogram model was established based on the Logistic regression. The discrimination and calibration were used to evaluate the prediction performance of the model.ResultsThe incidence of delirium was 48.3%. 389 cases were in the modeling group and 449 cases were in the verification group. Logistic regression analysis showed that CPB duration (OR=1.004, 95%CI: 1.001-1.008, P=0.018), Postoperative Serum Sodium(OR=1.112, 95%CI: 1.049-1.178, P＜0.001), age (OR=1.027, 95%CI: 1.006-1.048, P=0.011), postoperative MV(OR=1.019, 95%CI: 1.008-1.030, P＜0.001) were independent risk factors. The results showed that AUCROC was 0.712 and the 95%CI was 0.661-0.762. Hosmer-Lemeshow goodness of fit test showed that the predicted results of the model were in good agreement with the actual situation (χ2=6.200, P=0.625). The results of verification showed that AUCROC was 0.705 and the 95%CI was 0.657-0.752. Hosmer-Lemeshow goodness of fit test results showed that χ2=8.653 and P=0.372, indicating the prediction effect of the model is good.ConclusionsThe establishment of the model provides medical staff with accurate and objective assessment tools, so that medical staff can start to prevent postoperative delirium with a purpose and focus when the patient enters the CSICU after surgery.
Circulating levels of PCSK9, ANGPTL3 and Lp(a) in stage III breast cancers
Authors: Chong Emilie Wong , Joncas France-Hélène , Seidah Nabil G. , Calon Frédéric , Diorio Caroline , Gangloff Anne 
Published: June 2022

Abstract
Background/ Synopsis: Cholesterol plays an important role in sustaining tumor growth and metastasis in a large variety of cancers. New and powerful cholesterol-lowering drugs are being used in combination to treat cardiovascular diseases. Thus, it becomes intuitive to verify whether these drugs could be combined to induce a cholesterol shortage sufficient to impede tumor progression. Circulating levels of the targets of a new generation of lipid-lowering drugs have not been fully investigated in cancers. Given that drugs directed against PCSK9 (evolocumab, alirocumab, inclisiran), ANGPTL3 (evinacumab) and Lp(a) (pelacarsen) are available, it becomes important to assess circulating levels of these drug targets and their role in cancers. Objective/Purpose: To compare circulating levels of PCSK9, ANGPTL3, and Lp(a) in women with stage III breast cancer versus women with premalignant or benign breast lesions. Methods: Twenty-three plasma samples from women diagnosed with a stage III breast cancer (ductal, lobular or mixed) were matched for age with twenty-three plasma samples from women bearing premalignant (stage 0, n=9) or benign (n= 14) breast lesions. The lipid profile (Apo B, total cholesterol, HDL cholesterol and triglycerides levels) and Lp(a) were measured on a Roche Modular analytical platform, whereas LDL levels were calculated with the Friedewald formula. ANGPTL3 and PCSK9 plasma levels were quantitated by ELISA. All statistical analyses were performed using SAS software version 9.4. Results: PCSK9 levels were significantly higher in women with stage III breast cancer compared to age-matched counterparts presenting a benign lesion (95.9 +/- 27.1 ng/mL vs. 78.5 +/- 19.3 ng/mL, p<0.05, n=14). Moreover, PCSK9 levels positively correlated with breast disease severity (benign, stage 0, stage III) (Rho=0.34, p<0.05, n=46). In contrast, ANGPTL3 and Lp(a) plasma levels did not display any association with breast disease status and lipids did not correlate with disease severity. Conclusion: In this cohort of 46 women, PCSK9 levels increased along with the severity of breast disease. Given that PCSK9 plays an important role in maintaining cholesterolemia and has been shown to degrade MHC-I on tumor cells, impeding immune T-cells response to tumors, the association between PCSK9 levels and breast disease severity needs to be further investigated in larger studies.
Rapid epidemic expansion of the SARS-CoV-2 Omicron BA.2 subvariant during China’s largest outbreaks
Authors: Dai Yeyu Freddie , Dai Binxi Gabriel , Chen Mu 
Published: June 2022

Abstract
A complete and accurate statistical analysis of cases of contraction with SARS-CoV-2, under the conditions of strict mandatory quarantine and isolation and of a high rate of full vaccination, during the largest COVID-19 outbreaks driven by the Omicron BA.2 subvariant in China are given. SARS-CoV-2 is still new, and little is known about either its directions of variations or its laws of propagation. No country other than China has been able to disclose every case of infection in every epidemic or outbreak since April of 2020. Here, this study reveals that Omicron BA.2 subvariant can still spread very fast and wide in areas with strict “dynamic zero-COVID strategy”1 in China, that there exist cities twenty fold differences in morbidity rates unrelated to any of the known factors contributing to incidence of infectious diseases, and that Omicron BA.2 subvariant is unpredictable in its virulence, although its severity rate of symptomatic cases is low. This analysis provides first-hand original and valuable information for further research on similar epidemics in the future. It may bring new thoughts for correction of present epidemiological theory and mathematical models. It may also give other countries time to be better prepared for the coming 6th wave driven by Omicron BA.2.
Spatial-temporal characteristics and decoupling effects of China's transportation carbon emissions
Authors: Cai Jie , ma shuyue , ji hongmei , jiang wenyue , bai zhongrong 
Published: June 2022

Abstract
Calculating China’s transportation carbon emissions and exploring its principles are essential for achieving high-quality development of the transportation industry. Firstly, we use a “top-down” method to assess carbon emissions from transportation operations from 2003 to 2019. Secondly, the logarithmic average weight decomposition approach is built to decompose the factors affecting China’s transportation carbon emissions. Thirdly, the Tapio decoupling model examines how transportation carbon emissions are dynamically decoupled in various Chinese provinces. The findings suggest that China's transport carbon emissions are growing at an annual rate of roughly 16 percent. Transportation carbon emissions are increased by GDP per capita, transportation energy intensity, and population size, whereas transportation carbon emissions are reduced by unit turnover energy consumption and transportation intensity. There is a lot of variation in China's carbon emissions decoupling index from year to year.
Effectiveness of sequential embryo transfer in IVF/ICSI: A systematic review and meta-analysis
Authors: Guo Wei , Cui Ling , Wang Fang 
Published: June 2022

Abstract
Purpose
The window of implantation extends 3–6 days within the secretory phase in most normal women. The efficacy of such technique (sequential transfer) is still debatable in IVF/intracytoplasmic sperm injection (ICSI). The purpose of this systematic review was to investigate whether sequential transfer is more beneficial to pregnancy outcomes in IVF/ICSI.
Method
Search terms included “double embryo transfer”, “sequential transfer”, “consecutive transfer”, “IVF”, “ICSI”. The selection criteria were nonrandomized studies and randomized controlled studies. For data collection and analysis, the Review Manager software, Newcastle–Ottowa Quality Assessment Scale and GRADE approach were used.
Results
The clinical pregnancy rate and live birth rate showed that compared to the control protocol, the treatment group (sequential embryo transfer) were higher (RR 1.31, 95% CI (1.15 to 1.48), I2 = 49%, P < 0.0001), (RR 1.65, 95% CI (1.18 to 2.31), I2 = 0%, P = 0.003). The results were statistically significant. The multiple pregnancies rate and miscarriage rate were no statistical significance.
Conclusion
The sequential embryo transfer provided higher clinical pregnancy rate and live birth rate than the control protocol, with the same rate of multiple pregnancies and miscarriage. The sequential embryo transfer could be a safe option as a personalized protocol for infertile patients.
Epidemiological Characteristics and Factors Associated Alzheimer's Disease and Mild Cognitive Impairment among the Elderly in Urban and Rural Areas of Hubei Province
Authors: CHENG Jing , JI XiaoQi , HE Lu , ZHANG YuTong , XIAO TongTong , GENG Qiang , WANG ZhiHui , QI ShiGe , ZHOU Fang , ZHAN JianBo 
Published: June 2022

Abstract
Objective To investigate the prevalence, influencing factors and population distribution of AD and MCI among residents of Hubei province aged 60 years or over. Methods A cross-sectional study was used for recruitment the subjects. The screened patients with AD and MCI were then selected as patients in a case-control study. Results A total of 4,314 subjects were recruited into the study. The prevalence of AD and MCI was 1.44% and 10.04%, respectively. The prevalence of AD and MCI differed significantly as a function of age and gender (P<0.05). The protective factors for AD and MCI separately included a happy marriage (OR=0.69, 95%CI: 0.36-1.35), etc; and higher education (OR=0.65, 95%CI: 0.55-0.78) etc. The risk factors for AD and MCI separately included infrequent participation in social activities (OR=1.00, 95%CI: 0.60-1.66), etc; and infrequent communication with children (OR=1.35, 95%CI: 1.09-1.69), etc. Conclusion The prevalence of AD aged 60 and over in Hubei province was lower than the national average of 3.06%. The prevalence of MCI was within the range nationally (5.2-23.4%). The influencing factors of AD and MCI were associated with their social connections, lifestyle behaviours and somatic diseases and so on. The elderly people should be encouraged to study and communicate with others,take part in regular physical exercise and choose a healthy lifestyle so as to prevent or slow the decline of cognitive ability.