bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of Complications and Risk Factors for Nonunion After Ankle Fracture in Diabetes Mellitus
Authors: Lavery Lawrence A. , Lavery David C. , Green Tyson , Hunt Nathan , Malone Matthew , Wukich Dane 
Published: October 2022

Background: To evaluate complications and risk factors for nonunion in patients with diabetes after ankle fracture.
Methods: We conducted a retrospective study of 139 patients with diabetes and ankle fractures followed for 1 year. We evaluated the incidence of wounds, infections, nonunions, Charcot’s arthropathy, and amputations. We determined Fracture severity (unimalleolar, bimalleolar, trimalleolar), nonunion, and Charcot’s arthropathy from radiographs. Nonunion was defined as a fracture that did not heal within 6 months of fracture. Analysis of variance was used to compare continuous variables, and χ2 tests to compare dichotomous variables, with α = 0.05. Logistic regression was performed with a binary variable representing nonunions as the dependent variable.
Results: Complications were common: nonunion (24.5%), Charcot’s arthropathy (7.9%), wounds (5.2%), wound site infection (17.3%), and leg amputation (2.2%). Patients with nonunions were more likely to be male (55.9% versus 29.5%; P = .005), have sensory neuropathy (76.5% versus 32.4%; P < .001), have end-stage renal disease (17.6% versus 2.9%; P < .001), and use insulin (73.5% versus 40.1%; P < .001), β-blockers (58.8% versus 39.0%; P = .049), and corticosteroids (26.5% versus 9.5%; P = .02). Among patients with nonunion, there was an increased risk of wounds (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.46–7.73), infection (OR, 2.04; 95% CI, 0.72–5.61), amputation (OR, 7.74; 95% CI, 1.01–100.23), and long-term bracing (OR, 9.51; 95% CI, 3.8–23.8). In the logistic regression analysis, four factors were associated with fracture nonunion: dialysis (OR, 7.7; 95% CI, 1.7–35.2), insulin use (OR, 3.3; 95% CI, 1.5–7.4), corticosteroid use (OR, 4.9; 95% CI, 1.4–18.0), and ankle fracture severity (bimalleolar or trimalleolar fracture) (OR, 2.5; 95% CI, 1.1–5.4).
Conclusions: These results demonstrate risk factors for nonunions: dialysis, insulin use, and fracture severity after ankle fracture in patients with diabetes.
Barometric and Spatiotemporal Gait Differences Between Leading and Nonleading Feet of Handball Players
Authors: Ameer Mariam A. , Kamel Mohamed I. , Ali Shaimaa A. 
Published: October 2022

Background: Side-to-side stress imbalance has been suggested as a risk factor for injury in unilateral sports. The leading leg is suggested to be essential in sports rehabilitation for the return of athletes to the playground. The main aim of this study was to evaluate the dynamic pedobarometric and spatiotemporal gait differences between the leading and nonleading feet of male handball players.
Methods: Thirty healthy elite male handball players (mean ± SD: age, 31.7 ± 2.99 years; height, 177.5 ± 6.0 cm; weight, 78.9 ± 6.3 kg; body mass index, 25.0 ± 0.7) participated in this study; all of the participants were backcourt and pivot handball players. The assessments were performed using the Tekscan Walkway pressure sensor to detect and compare the variables of interest between the leading and nonleading feet during normal walking at a self-selected speed.
Results: Maximum force, peak pressure (total and forefoot pressure), foot width, single-limb support time, and step velocity were significantly increased in the leading foot compared with the nonleading foot. In addition, maximum force, foot width, and total peak pressure showed moderate positive significant correlations with body mass index.
Conclusions: The differences in the pedobarometric and spatiotemporal gait parameters may result from the physiologic and mechanical demands that are put on the leading foot of handball players, which need more rehabilitation attention and protection to avoid expected injuries.
Biomechanical Comparison of Headless Compression Screws, Kirschner Wires and Bioabsorbable Pins in Distal Oblique Metatarsal Osteotomy for Correction of Hallux Valgus
Authors: Kuru Tolgahan , Mutlu Ibrahim , Bilge Ali , Nusran Gurdal , Kaymaz Burak , Yilmaz Onur , Kizilay Hasan , Ceviz Emrah , Yaradilmis Y. Ugur , Erken H. Yener 
Published: October 2022

Abstract
Background: Distal osteotomy of the first metatarsal is a widely used method for the correction of mild-to-moderate hallux valgus deformities. The objective of this study was to compare the stability of headless compression screws, kirschner wires and absorbable pins in terms of stiffness and maximum load in distal oblique metatarsal osteotomy.
Methods: A total of 30 4th generation first metatarsal synthetic bone models were divided into three groups according to the fixation techniques. The stiffness of the first metatarsal was calculated as the slope of the linear curve that fit with the first linear part of the force displacement curve. The failure strength was recorded as the maximum load. The stiffness and maximum load values in the axillary and transverse configurations were compared between the three fixation groups.
Results: The stiffness was statistically higher in Group K and Group C compared to Group B in both axial and transverse loading. Similarly, the maximum load was significantly higher in both Group K and Group C compared to Group B in both loading conditions. No significant difference was found between Group K and Group C in stability. The higher failure strength was obtained with headless compression screws (113.34±35.88 N) in the axial loading. The lowest failure strength was found in the absorbable pins technique (16.17±7.72 N) in the transverse loading.
Conclusion: No significant difference was found between the Kirschner wires and headless compression screws techniques, although the highest strength was obtained with headless compression screws that are increasingly used in orthopedic practice.
Mobile phone addiction and non-suicidal self-injury among adolescents in China
Authors: Wang Rui , Yang Runxu , Ran Hailiang , Xu Xiufeng , Yang Guangya , Wang TianLan , Che Yusan , Fang Die , Lu Jin , Xiao Yuanyuan 
Published: October 2022

Background
Non-suicidal self-injury (NSSI) has recently widely discussed. Independently, mobile phone addiction (MPA) has also attracted academic attention. A few research have examined the correlation between the two. However, there is inadequate knowledge to characterize this relationship altogether. This study further explores the correlation between MPA and NSSI, specifically repeated and severe NSSI.

Method
A population-based cross-sectional survey was conducted among 2,719 adolescents in Lincang, Yunnan. The mobile phone addiction index (MPAI) and the Modified Adolescents Self-Harm Survey (MASHS) were administered in combination. The connection between the MPAI and NSSI, as well as both repeated and severe NSSI, was studied using univariate and multivariate logistic regression models. (The copyright holders have permitted the authors to use the MPAI and the MASHS).

Results
The prevalence of NSSI was 47.11% (95% CI [36.2–58.0%]), and the detection rate of MPA was 11.11% (95% CI [6.7–18.0%]). The prevalence of NSSI among those with MPA was 4.280 times (95% CI [3.480–5.266]) that of respondents not exhibiting MPA. In addition, all subscales of the MPAI, except for the feeling anxious and lost subscale (FALS), were positively correlated with NSSI. Risk factors, represented by odds ratios, of repeated NSSI with the inability to control cravings subscale (ICCS), the FALS, and the withdrawal and escape subscale (WES) was 1.052 (95% CI [1.032–1.072]), 1.028 (95% CI [1.006–1.051]), and 1.048 (95% CI [1.019–1.078]) respectively. Risk factors of these same three subscales for severe NSSI, had odds ratios of 1.048 (95% CI [1.029–1.068]), 1.033 (95% CI [1.009–1.057]), and 1.045 (95% CI [1.018–1.073]).

Conclusion
MPA was shown to be a risk factor for NSSI in adolescents. Individuals with high scores on the ICCS, the WES, and the FALS were more prone to experience repeated and severe NSSI. As a result, early assessment using the MPAI to determine the need for intervention can contribute to the prediction and prevention of NSSI.
Association of Adequacy of Broadband Internet Service With Access to Primary Care in the Veterans Health Administration Before and During the COVID-19 Pandemic
Authors: O’Shea Amy M. J. , Baum Aaron , Haraldsson Bjarni , Shahnazi Ariana , Augustine Matthew R. , Mulligan Kailey , Kaboli Peter J. 
Published: October 2022

ImportanceAlthough telemedicine expanded rapidly during the COVID-19 pandemic and is widely available for primary care, required broadband internet speeds may limit access.ObjectiveTo identify disparities in primary care access in the Veterans Health Administration based on the association between broadband availability and primary care visit modality.Design, Setting, and ParticipantsThis cohort study used administrative data on veterans enrolled in Veterans Health Administration primary care to identify visits at 937 primary care clinics providing telemedicine and in-person clinical visits before the COVID-19 pandemic (October 1, 2016, to February 28, 2020) and after the onset of the pandemic (March 1, 2020, to June 30, 2021).ExposuresFederal Communications Commission–reported broadband availability was classified as inadequate (download speed, ≤25 MB/s; upload speed, ≤3 MB/s), adequate (download speed, ≥25 &amp;lt;100 MB/s; upload speed, ≥5 and &amp;lt;100 MB/s), or optimal (download and upload speeds, ≥100 MB/s) based on data reported at the census block by internet providers and was spatially merged to the latitude and longitude of each veteran’s home address using US Census Bureau shapefiles.Main Outcomes and MeasuresAll visits were coded as in-person or virtual (ie, telephone or video) and counted for each patient, quarterly by visit modality. Poisson models with Huber-White robust errors clustered at the census block estimated the association between a patient’s broadband availability category and the quarterly primary care visit count by visit type, adjusted for covariates.ResultsIn primary care, 6 995 545 veterans (91.8% men; mean [SD] age, 63.9 [17.2] years; 71.9% White; and 63.0% residing in an urban area) were seen. Adjusted regression analyses estimated the change after the onset of the pandemic vs before the pandemic in patients’ quarterly primary care visit count; patients living in census blocks with optimal vs inadequate broadband had increased video visit use (incidence rate ratio [IRR], 1.33; 95% CI, 1.21-1.46; P &amp;lt; .001) and decreased in-person visits (IRR, 0.84; 95% CI, 0.84-0.84; P &amp;lt; .001). The increase in the rate of video visits before vs after the onset of the pandemic was greatest among patients in the lowest Area Deprivation Index category (indicating least social disadvantage) with availability of optimal vs inadequate broadband (IRR, 1.73; 95% CI, 1.42-2.09).Conclusions and RelevanceThis cohort study found that patients with optimal vs inadequate broadband availability had more video-based primary care visits and fewer in-person primary care visits after the onset of the COVID-19 pandemic, suggesting that broadband availability was associated with video-based telemedicine use. Future work should assess the association of telemedicine access with clinical outcomes.
Assessment of Risk of Rheumatoid Arthritis Among Underground Hard Rock and Other Mining Industry Workers in Colorado, New Mexico, and Utah
Authors: Blanc Paul D. , Trupin Laura , Yelin Edward H. , Schmajuk Gabriela 
Published: October 2022

ImportanceRespirable silica exposure has been strongly and consistently linked to rheumatoid arthritis (RA) among foundry workers, persons in the construction trades, stone crushers and drillers, and coal miners. However, risk of RA in hard rock mining has not been thoroughly investigated.ObjectiveTo analyze occupational risk of RA in hard rock miners in Colorado, New Mexico, and Utah.Design, Setting, and ParticipantsThis cross-sectional survey study estimated the association between mining industry work and reported RA in a random-digit telephone survey of men 50 years or older living in selected counties with elevated levels of pneumoconiosis mortality (N = 1988). The survey was conducted between January 12 and May 4, 2021.ExposuresUnderground hard rock and other mining and related mineral-processing occupations.Main Outcomes and MeasuresReport of a clinician diagnosis of RA further defined by treatment with corticosteroids or disease-modifying antirheumatic drugs. Risk was estimated using logistic regression.ResultsThe analytic sample of 1988 men (survey response rate, 11.1% of all contacts) had a mean (SD) age of 68.6 (10.1) years. Underground hard rock mining was reported by 118 (5.9%); underground mining of other types, predominantly coal mining (no concomitant hard rock), 62 (3.1%); and surface mining or ore processing (no underground), 262 (13.2%). Adjusting for age and smoking and accounting for nonmining silica exposure, mining employment was associated with increased odds of corticosteroid-treated RA (n = 89) (odds ratio, 4.12 [95%, 2.49-6.81]). The odds were similar for RA treated with disease-modifying antirheumatic drugs (n = 80) (odds ratio, 3.30 [95% CI, 1.93-5.66]).Conclusions and RelevanceIn this cross-sectional survey study, workers in hard rock and other underground mining and surface mining occupations experienced 3- to 4-fold increased odds of RA. These findings suggest that clinicians should consider patients with relevant work exposures as at higher risk for developing RA.
Amyotrophic Lateral Sclerosis Clinical Trials and Interpretation of Functional End Points and Fluid Biomarkers
Authors: Shefner Jeremy M. , Bedlack Richard , Andrews Jinsy A. , Berry James D. , Bowser Robert , Brown Robert , Glass Jonathan D. , Maragakis Nicholas J. , Miller Timothy M. , Rothstein Jeffrey D. , Cudkowicz Merit E. 
Published: October 2022

ImportanceClinical trial activity in amyotrophic lateral sclerosis (ALS) is dramatically increasing; as a result, trial modifications have been introduced to improve efficiency, outcome measures have been reassessed, and considerable discussion about the level of data necessary to advance a drug to approval has occurred. This review discusses what recent pivotal studies can teach the community about these topics.ObservationsBy restricting inclusion and exclusion criteria, recent trials have enrolled populations distinct from previous studies. This has led to efficacy signals being observed in studies that are smaller and shorter than was thought feasible previously. However, such trials raise questions about generalizability of results. Small trials with equivocal clinical results also raise questions about the data necessary to lead to regulatory approval. The ALS Functional Rating Scale–Revised remains the most commonly used primary outcome measure; this review discusses innovations in its use. Blood neurofilament levels can predict prognosis in ALS and may be a sensitive indicator of biologic effect; current knowledge does not yet support its use as a primary outcome.Conclusions and RelevanceIt is now possible to use specific inclusion criteria to recruit a homogeneous patient population progressing at a specific rate; this will likely impact trials in the future. Generalizability of results on limited populations remains a concern. Although clinical outcomes remain the most appropriate primary outcome measures, fluid markers reflecting biologically important processes will assume more importance as more is learned about the association between such markers and clinical end points. The benefit of use of analytic strategies, such as responder analyses, is still uncertain.
The effect of justified video game violence on aggressive behavior and moderated immersion: An experimental approach
Authors: Chen Shuai , Mao Bo , Liu Yanling 
Published: October 2022

AbstractThe effect of violent video games on aggressive behavior is an important topic in the field of game research. Recently, growing evidence suggests that justified game violence decreases feelings of guilt caused by in‐game immoral behavior. However, little is known about the impact on aggressive behavior, and whether other factors moderate this effect. In a two‐factor experiment, we tested the impact of justification of video game violence on aggressive behavior, and whether this effect would be enhanced by game immersion. Pilot experiment 1 (N = 60) and pilot experiment 2 (N = 40) demonstrated that the justification of violence and game immersion was successfully controlled by avatar and graphics quality. In the Main experiment, 123 participants played one of four conditions of a video game (2 [justification: justified vs. unjustified violence] × 2 [immersion: high vs. low immersion]) and it was found that participants who played in the justified violence condition reported greater aggressive behavior than those in the unjustified violence condition. In addition, participants who played in high immersion reported greater aggressive behavior than those in low immersion. However, game immersion did not moderate the effects of justified violence. This unexpected effect is likely due to participants' distancing themselves from and identifying less with their violent avatars.
Cost‐Effectiveness of Weight‐Loss Interventions Prior to Total Knee Replacement for Patients With Class III Obesity
Authors: Kostic Aleksandra M. , Leifer Valia P. , Selzer Faith , Hunter David J. , Paltiel A. David , Chen Antonia F. , Robinson Malcolm K. , Neogi Tuhina , Collins Jamie E. , Messier Stephen P. , Edwards Robert R. , Katz Jeffrey N. , Losina Elena 
Published: October 2022

ObjectiveClass III obesity (body mass index >40 kg/m2) is associated with higher complications following total knee replacement (TKR), and weight loss is recommended. We aimed to establish the cost‐effectiveness of Roux‐en‐Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and lifestyle nonsurgical weight loss (LNSWL) interventions in knee osteoarthritis patients with class III obesity considering TKR.MethodsUsing the Osteoarthritis Policy model and data from published literature to derive model inputs for RYGB, LSG, LNSWL, and TKR, we assessed the long‐term clinical benefits, costs, and cost‐effectiveness of weight‐loss interventions for patients with class III obesity considering TKR. We assessed the following strategies with a health care sector perspective: 1) no weight loss/no TKR, 2) immediate TKR, 3) LNSWL, 4) LSG, and 5) RYGB. Each weight‐loss strategy was followed by annual TKR reevaluation. Primary outcomes were cost, quality‐adjusted life expectancy (QALE), and incremental cost‐effectiveness ratios (ICERs), discounted at 3% per year. We conducted deterministic and probabilistic sensitivity analyses to examine the robustness of conclusions to input uncertainty.ResultsLSG increased QALE by 1.64 quality‐adjusted life‐years (QALYs) and lifetime medical costs by $17,347 compared to no intervention, leading to an ICER of $10,600/QALY. RYGB increased QALE by 0.22 and costs by $4,607 beyond LSG, resulting in an ICER of $20,500/QALY. Relative to immediate TKR, LSG and RYGB delayed and decreased TKR utilization. In the probabilistic sensitivity analysis, RYGB was cost‐effective in 67% of iterations at a willingness‐to‐pay threshold of $50,000/QALY.ConclusionFor patients with class III obesity considering TKR, RYGB provides good value while immediate TKR without weight loss is not economically efficient.
Peptide‐Reinforced Amphiphilic Polymer Conetworks
Authors: Velasquez Sara T. R. , Jang Daseul , Jenkins Peter , Liu Peng , Yang Liu , Korley LaShanda T. J. , Bruns Nico 
Published: October 2022

AbstractAmphiphilic polymer conetworks (APCNs) are polymer networks composed of hydrophilic and hydrophobic chain segments. Their applications range from soft contact lenses to membranes and biomaterials. APCNs based on polydimethylsiloxane (PDMS) and poly(2‐hydroxyethyl acrylate) are flexible and elastic in the dry and swollen state. However, they are not good at resisting deformation under load, i.e., their toughness is low. A bio‐inspired approach to reinforce APCNs is presented based on the incorporation of poly(β‐benzyl‐L‐aspartate) (PBLA) blocks between cross‐linking points and PDMS chain segments. The mechanical properties of the resulting peptide‐reinforced APCNs can be tailored by the secondary structure of the peptide chains (β‐sheets or a mixture of α‐helices and β‐sheets). Compared to non‐reinforced APCNs, the peptide‐reinforced networks have higher extensibility (53 vs. up to 341%), strength (0.71 ± 0.16 vs. 22.28 ± 2.81 MPa), and toughness (0.10 ± 0.04 vs. up to 4.85 ± 1.32 MJ m−3), as measured in their dry state. The PBLA peptides reversibly toughen and reinforce the APCNs, while other key material properties of APCNs are retained, such as optical transparency and swellability in water and organic solvents. This paves the way for applications of APCNs that benefit from significantly increased mechanical properties.
Recent Progress in Advanced Units of Triboelectric Electronic Skin
Authors: Li Weixin , Dong Jianing , Zhang Xiaotong , Fan Feng Ru 
Published: October 2022

AbstractElectronic skin (e‐skin) is facing new challenges owing to the development of artificial intelligence. Among the existing working modes, triboelectric‐based e‐skin (TES) can convert mechanical energy into electrical energy and can be used as a sensor to directly output an electrical signal without additional power supply. Therefore, with the advantages of self‐powering, low cost, and wide application of materials, TES provides a new concept for developing e‐skin and has been extensively studied. Starting from TES, this review describes the working principle and application of triboelectric nanogenerators (TENGs) in e‐skin. Existing materials for TES can be mainly divided into fiber textiles, gels, liquid‐based materials, and degradable materials. Therefore, the material section is divided into four chapters to describe the properties of each material. As for the structure of TES, the transition from single‐channel to multi‐channel for the multifunctionalization of TES is described, and the various links required for a TES‐based closed‐loop system are introduced. Based on these advanced units, the recent progress as well as the current challenges and future development prospects of TES are reviewed.
Rapeseed Cake Valorization into Bioplastics Based on Protein Amyloid Fibrils
Authors: Bagnani Massimo , Ehrengruber Silas , Soon Wei Long , Peydayesh Mohammad , Miserez Ali , Mezzenga Raffaele 
Published: October 2022

AbstractBiodegradable polymers obtained from renewable resources are urgently needed to help mitigating the environmental burden of plastic pollution. Herein, a green process is developed to obtain protein‐based bioplastics through valorization of rapeseed cake. First, the effects of different protein extraction protocols are investigated, including water extraction at pH values from 1 to 12 and salt extraction with isoelectric point precipitation (IP), on proteins profile and sample composition. It is demonstrated that alkaline extraction at pH 12 results in the highest extraction yields of proteins (≈70%) and total solutes (≈50%). The IP results in lower yields but in highest protein purity of ≈80%. Alkaline extraction at pH 10.5 results in the extraction of 36% total solutes and ≈50% of proteins, with a protein profile similar to that obtained by IP, rich in α and β polypeptides chains of cruciferin. AFM analysis shows that samples containing cruciferin allow self‐assembly into mature amyloid fibrils upon incubation. Rapeseed amyloids are blended with polyvinyl alcohol and glycerol to develop bioplastics films that are characterized by decreased water absorption, higher water contact angle, and elongation at break >600%, more than double compared to films obtained from native monomers.