bluuebunny/crossref_metadata_2025 huggingface dataset:
A dTALE approach demonstrates that induction of common bean OVATE Family Protein 7 promotes resistance to common bacterial blight
Authors: Gaudin Charlotte , Preveaux Anne , Aubineau Nathan , Le Goff Damien , Jacques Marie-Agnès , Chen Nicolas W G
Published: October 2024

Common bacterial blight (CBB) is a devastating seed-transmitted disease of common bean (Phaseolus vulgaris L.), caused by Xanthomonas phaseoli pv. phaseoli and Xanthomonas citri pv. fuscans. The genes responsible for CBB resistance are largely unknown. Moreover, the lack of a reproducible and universal transformation protocol limits the study of genetic traits in common bean. We produced X. phaseoli pv. phaseoli strains expressing artificially designed transcription-activator like effectors (dTALEs) to target 14 candidate genes for resistance to CBB based on previous transcriptomic data. In planta assays in a susceptible common bean genotype showed that induction of PvOFP7, PvAP2-ERF71, or PvExpansinA17 expression by dTALEs resulted in CBB symptom reduction. After PvOFP7 induction, in planta bacterial growth was reduced at early colonization stages, and RNA-seq analysis revealed up-regulation of cell wall formation and primary metabolism, together with major down-regulation of heat shock proteins. Our results demonstrated that PvOFP7 contributes to CBB resistance, and underlined the usefulness of dTALEs for functional validation of genes whose induction impacts Xanthomonas–plant interactions.
A Novel, Low-Fidelity, Low-Cost Residency “Simulation Festival” Competition
Authors: MacKinnon Rene , Boedeker David , Chatfield Lindsay , Owens Amanda
Published: October 2024

Introduction

Simulation has rapidly expanded in obstetrics and gynecology (OB/GYN) for teaching surgical skills, reinforcing medical knowledge and assessing surgical proficiency. Low-fidelity simulations are typically lower cost to produce and have been proven to be beneficial for surgical training. The aim of this study is to describe an innovative simulation competition among residency programs to develop, present, and share low-cost, low-fidelity surgical simulation.

Materials and Methods

We developed and executed a novel simulation competition in October 2022 at our annual military OB/GYN conference. All 9 military residency programs presented a unique, cost-effective simulation relevant to the field of OB/GYN. A 1-hour session was dedicated to showcasing these innovations. Participants were invited to complete a postevent survey. This study was deemed Institutional Review Board exempt.

Results

A total of 111 people registered for our event. Seventy-seven individuals completed our postevent survey (69.4% response rate), comprising medical students (12.99%), residents (58.44%), and staff or fellows (28.57%). Most respondents reported that simulation holds substantial value in OB/GYN training (96.10%). All respondents expressed a desire for the event to be a recurring feature at future meetings. Among resident responders, 97.7% was either “very likely” or “likely” to incorporate one of the showcased simulations into their future resident academics. Fifteen respondents were actively involved in creating simulations for the festival, with the majority deeming the process either very easy (60.00%) or easy (33.33%), and all simulations were deemed highly reproducible (100.00%).

Conclusions

This event succeeded in nurturing innovative, cost-effective, and readily replicable simulations in the field of OB/GYN. This event can be replicated at meetings to foster novel simulation development.
High-dose Probiotic Mix of Lactobacillus spp., Bifidobacterium spp., Bacillus coagulans, and Saccharomyces boulardii to Prevent Antibiotic-associated Diarrhea in Adults: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial (SPAADA)
Authors: Hodzhev Vladimir , Dzhambazov Karen , Sapundziev Nikolay , Encheva Milena , Todorov Spiridon , Youroukova Vania , Benchev Rumen , Nikolov Rosen , Bogov Boris , Momekov Georgi , Hadjiev Veselin
Published: October 2024

Background

Probiotics have been used to prevent antibiotic-associated diarrhea (AAD), but practical guidelines are sparse. This trial evaluated the efficacy and safety of a high-dose, multistrain probiotic mix (Sinquanon), specially designed for prevention of AAD in adults.

Methods

A phase IV, multicenter, randomized, double-blind, placebo-controlled, parallel-group clinical trial was conducted over 5 months. Participants receiving broad-spectrum antibiotics were administered the specialized probiotic mix or placebo from the first dose of antibiotics until 14 days after the last antibiotic dose. The primary outcome measure was the incidence of AAD.

Results

In total, 564 participants were randomized (probiotic mix: 285; placebo: 279), of which 9 participants discontinued the trial early (probiotic mix: 3; placebo: 6), had no efficacy data, and were excluded from the efficacy analysis. The 555 remaining participants completed the trial and were included in the efficacy analysis (probiotic mix: 282; placebo: 273). AAD occurred less frequently in the studied probiotic mix versus placebo group (9.2% vs 25.3%, P < .001), resulting in an absolute risk reduction of 16% and a number needed to treat of 6 (95% confidence interval, 4.55–10.49). A significant improvement in the average gastrointestinal quality of life in the studied probiotic mix versus placebo group was also observed. There were no clinically relevant differences in the incidence of adverse events between the studied probiotic mix and the placebo group.

Conclusions

The specially designed high-dose, multistrain probiotic mix (Sinquanon) demonstrated to be beneficial compared with placebo in the prevention of AAD in adults who received broad–spectrum antibiotics.

ClinicalTrials.gov Identifier and URL

NCT05607056; https://classic.clinicaltrials.gov/ct2/show/NCT05607056.
From Chaos to Clarity? The Quest for Effective Probiotics in Antibiotic-Associated Diarrhea
Authors: Rao Krishna , Garey Kevin W
Published: October 2024

Antibiotic-associated diarrhea (AAD) frequently complicates treatment of infections. A recent randomized, double-blind, placebo-controlled trial tested a proprietary probiotic mixture and found that it reduced the incidence of AAD by 16%. This is encouraging for patients, but future progress on probiotics for AAD and other conditions depends on transparency around strain selection, probiotic design guided by preclinical mechanistic studies, and rigorously conducted human studies.
Etiology of community-acquired bacterial meningitis in children at a tertiary-care centre in Montreal, Canada
Authors: Besner Anne-Sophie , Renaud Christian , Gravel Jocelyn
Published: October 2024

Objectives

This study aimed to identify the bacteria responsible for community-acquired bacterial meningitis in infants and children.

Methods

This was a retrospective cohort study including children aged 1 day to 18 years with confirmed bacterial meningitis, evaluated at a tertiary-care, Canadian emergency department between 2014 and 2022. The primary outcome was the pathogen identified. Other variables of interest were complications, age, and diagnostic method. Medical charts were reviewed by a co-investigator and 25% were assessed in duplicate.

Results

All 79 eligible cases were included. The main causal agents were Group B Streptococcus (GBS) (n = 20; 25%), Streptococcus pneumoniae (n = 16; 20%), Neisseria meningitidis (n = 16; 20%), and Haemophilus influenzae (n = 9; 11%). Etiology exhibited age-dependent variations, with 85% of GBS and 100% of Escherichia coli infections in children under 2 months. All pneumococcal and Group A Streptococcus cases were in children older than 6 months. All children infected by S. pneumoniae were vaccinated but the serotype was not covered by vaccination in 7/8 infections. All children with N. meningitidis were either too young to be vaccinated (n = 10) or infected by a serotype not covered by the given vaccine. Fifty-five bacteria were identified by cerebrospinal fluid culture, 17 by Polymerase Chain Reaction (PCR), and 7 by both methods.

Conclusion

GBS is now the leading etiology of paediatric community-acquired bacterial meningitis at our centre. The etiology of bacterial meningitis varies greatly by age. Future studies should focus on improving the serotype spectrum of vaccines, identifying strategies to lower GBS infection, and improving the use of PCR as a diagnostic tool.
GLABRA3-mediated trichome branching requires transcriptional repression of MICROTUBULE-DESTABILIZING PROTEIN25
Authors: Xie Wenfei , Zhao Yuang , Deng Xianwang , Chen Ruixin , Qiang Zhiquan , García-Caparros Pedro , Mao Tonglin , Qin Tao
Published: October 2024

Microtubules play pivotal roles in establishing trichome branching patterns, which is a model system for studying cell-shape control in Arabidopsis (Arabidopsis thaliana). However, the signaling pathway that regulates microtubule reorganization during trichome branching remains poorly understood. In this study, we report that MICROTUBULE-DESTABILIZING PROTEIN25 (MDP25) is involved in GLABRA3 (GL3)-mediated trichome branching by regulating microtubule stability. Loss of MDP25 function led to excessive trichome branching, and this phenotype in mdp25 could not be rescued by the MDP25 K7A or MDP25 K18A mutated variants. Pharmacological treatment and live-cell imaging revealed increased microtubule stability in the mdp25 mutant. Furthermore, the microtubule collar observed during trichome branching remained more intact in mdp25 compared to the WT under oryzalin treatment. Results of genetic assays further demonstrated that knocking out MDP25 rescued the reduced branching phenotype of gl3 trichomes. In gl3 trichomes, normal microtubule organization was disrupted, and microtubule stability was significantly compromised. Moreover, GL3 physically bound to the MDP25 promoter, thereby inhibiting its expression. Overexpression of GL3 negated the effects of PMDP25-driven MDP25 or its mutant proteins on trichome branching and microtubules in the mdp25 background. Overall, our study uncovers a mechanism by which GL3 inhibits MDP25 transcription, thereby influencing microtubule stability and regulating trichome branching. This mechanism provides a connection between early regulatory components and microtubules during trichome development.
Infliximab vs interferon-α in the treatment of Behçet’s syndrome: clinical data from the BIO-BEHÇET’S randomized controlled trial
Authors: Moots Robert J , Fortune Farida , Jackson Richard , Thornburn Tony , Morgan Ann , Carr Daniel F , Murray Philip I , Wallace Graham R , Situnayake Deva
Published: October 2024

Objectives

Whilst biologic therapy is used for Behçet’s syndrome of all subtypes refractory to first-line immunomodulation, there has been an absence of high-quality evidence and no predictive biomarkers to optimally inform choice. BIO-BEHÇET’S was a randomized, controlled, head-to-head clinical trial comparing the two most frequently used biologics in active refractory Behçet’s.

Methods

This was a Bayesian-designed, pragmatic, standard of care, two-arm, parallel head-to-head trial at four UK centres. Patients with active disease were randomized to infliximab or IFN-α2a, and received follow-up with symptom-directed examination at weeks 12 and 24. The primary outcome was the Behçet’s Disease Activity Index (BDAI) at 12 weeks. Secondary outcomes included BDAI at 24 weeks and significant improvement in individual organ systems, including ocular symptoms, oral and genital ulcers, arthritis pain, quality of life, disease activity and steroid use. Biomarkers were also investigated but are reported elsewhere.

Results

Seventy-nine patients were recruited. Both treatments were equally effective, with a mean difference of 0.13 in BDAI (80% confidence interval: –0.19, 0.46). No significant differences were observed for secondary outcomes, though there were clinically significant within-group reductions for each over time. A modest steroid-sparing effect was observed, with complete cessation of steroids in 20% and 44% of those randomized to infliximab and IFN-α2a, respectively. There was a trend for minor benefit in favour of infliximab in terms of tolerability and persistence.

Conclusion

In this first reported, high-quality, head-to-head trial of two biologics in Behçet’s, both infliximab and IFN-α2a showed comparable short-term clinical efficacy and safety in refractory active disease of all subtypes.

Trial registration

EudraCT: 2014–005390-36; ISRCTN: ISRCTN49793874
Serological and molecular analysis of Leishmania infection in a recent outbreak of visceral leishmaniasis in South Omo Zone, Ethiopia
Authors: Belay Habtamu , Eyelachew Endawek , Abose Ebise , Aklilu Esayas , Gebrewold Gashaw , Tadesse Henok , Tadese Alemayehu , Belay Robel , Belachew Mahlet , van Henten Saskia , Bishaw Tesfahun , Manaye Nigus , Kebede Zeyede , Wossen Mesfin , Tadese Gemechu , Tasew Geremew , van Griensven Johan , Pareyn Myrthe , Erko Berhanu , Abera Adugna
Published: October 2024

Background

Ethiopia has a high burden of visceral leishmaniasis. Recently, there was a significant increase in cases in the South Omo Zone. This study aims to assess the prevalence of Leishmania donovani infection and its associated factors.

Methods

A household-based cross-sectional study was carried out in January 2023 in the South Omo Zone in Ethiopia. Dried blood spot samples were collected from 382 randomly selected study participants. Direct agglutination test (DAT) and kinetoplast DNA real-time PCR tests were performed to detect L. donovani infection. Participants’ sociodemographic, clinical and risk factors for L. donovani infection data were collected using questionnaires. Bivariate and multivariate logistic regressions were used to analyze the data. Febrile cases were checked for malaria with a multiplex PCR assay.

Results

Overall prevalence of L. donovani infection among the sampled population was 32.5% (n=124), of which 41.1% (n=51) was detected by PCR, 33.9% (n=42) by DAT and 25.0% (n=31) by both tests. The majority of the positives were from the Logira (28.2%; n=35) and Dilbayne (29.0%; n=36) villages. Participants residing in Logira (adjusted OR [AOR]: 5.80; 95% CI 1.85 to 18.15) and Dilbayne (AOR: 3.38; 95% CI 1.15 to 9.96) villages and owning cows (AOR: 2.31; 95% CI 1.03 to 5.15) showed an association with Leishmania infection. Plasmodium falciparum was detected in 3.4% (n=2) of 59 febrile participants.

Conclusions

The prevalence of L. donovani infection in the South Omo Zone is high. Further research on the role of cows in the transmission cycle is needed to design the best strategy to control Leishmania infection in the South Omo Zone. Such interventions should focus on the Logira and Dilbayne villages, where most of the infections were identified.
Biphenyl and Dibenzofuran Phytoalexins Differentially Inhibit Root-Associated Microbiota in Apple, Including Fungal and Oomycetal Replant Disease Pathogens
Authors: Busnena Belnaser A. , Beerhues Ludger , Liu Benye
Published: October 2024

Apple replant disease (ARD) is a serious soilborne disease in apple nurseries and orchards worldwide. ARD is the result of an unbalanced soil microbiome in which multiple soilborne plant-pathogenic fungi, oomycetes, and nematodes form a disease complex. Biphenyl and dibenzofuran phytoalexins are found in greater quantities in the roots of apple plants grown in ARD soil compared with disinfected ARD soil. However, the contribution of these compounds to plant health or disease is not yet understood. Here, the antimicrobial activity of 14 chemically synthesized biphenyl and dibenzofuran phytoalexins was tested against eight selected microorganisms isolated from either rhizosphere soils or apple roots. These included five potentially beneficial bacteria ( Rhodococcus pseudokoreensis strain R79T, R. koreensis strain R85, Streptomyces pulveraceus strain ES16, S. ciscaucasicus GS2, and Priestia megaterium strain B1), two ARD fungal pathogens ( Ilyonectria robusta H131 and Dactylonectria torresensis N3), and one oomycete ( Globisporangium terrestre). Two phytoalexin mixtures reflecting the percentages of the individual compounds inside the roots (mixture A) and the root exudate (mixture B) were also tested. The two phytoalexin mixtures demonstrated higher antimicrobial activity than the individual phytoalexins, suggesting a synergistic effect. The minimum inhibitory concentration and the half-maximal effective concentration values determined to be active against the eight microbes were within a range of 2.5-fold the ecologically relevant phytoalexin concentration (approximately 33 and 24 µg ml−1 in roots and exudate, respectively). The results contribute to our understanding of the impact of apple root phytoalexins on ARD and suggest potential strategies for disease management.
The benefits and limitations of establishing the PA profession globally
Authors: Turkewitz Arden R. , Sallen Jane P. , Smith Rachel M. , Pitchford Kandi , Lay Kimberly , Smalley Scott
Published: October 2024

Objective:

Physician associates/assistants (PAs) and their equivalents offer a solution to the supply and demand crisis to alleviate global healthcare needs. This study investigated how PA and PA equivalents address global healthcare needs across different healthcare systems, revealing recommendations for their use. The study also sought to catalog the global healthcare needs that PAs and equivalents are successfully alleviating, the roles in which they function, and the barriers facing implementation.

Methods:

A systematic review was conducted from October 2021 to April 2022 and rerun in June 2023 following PRISMA 2020 guidelines; additionally, supporting interviews were conducted with PAs and global health experts. Primary outcomes were geographic region, economy, healthcare needs, and healthcare systems. Secondary outcomes were PA use, license recognition, and successes or barriers when implementing PAs.

Results:

The literature and interviews focused on the global use of PAs and PA equivalents in six geographic regions, 63 countries, and five US territories where PAs or PA equivalents are employed, have been employed, are volunteering, or are being considered to support global healthcare needs. Most countries have a developing economy and an out-of-pocket healthcare system. PAs and PA equivalents hold 35 different practice titles, and most work in primary care. PAs alleviate healthcare shortages and economic disparities, specifically related to inequitable healthcare access. Globally, the profession is limited by a lack of legislation, regulation, and support.

Conclusions:

PAs and PA equivalents worldwide belong to an adaptable profession that has well-documented success in alleviating the global healthcare shortage and addressing healthcare needs. Countries desiring PAs or PA equivalents should identify their specific needs, train their existing workforce, employ pilot programs, and focus on seeking early legislation and regulation. Broad support for existing PA and PA equivalent international organizations is recommended for global collaboration. This study serves as a guide for those advocating for the continued or future implementation of PAs and PA equivalents in their own country and provides a comprehensive resource to aid in the globalization of this profession. We offer recommendations to address the dire healthcare needs and workforce shortage faced across the globe.
Iron Chelators Augment Large Osteochondral Allograft Osseointegration in a Preclinical Canine Model
Authors: Cook James L. , Drager Justin , Bozynski Chantelle C. , Stoker Aaron M. , Kuroki Keiichi , Stannard James P. , Felice Hilary , Fahs Adam , Cook Cristi R. , Ramírez-GarcíaLuna José L. , Hadidi Lina , Merle Geraldine , Crist Brett D.
Published: October 2024

OBJECTIVES:

Osteochondral allograft transplantation (OCAT) can be a successful joint restoration treatment option for large post-traumatic articular defects but is still associated with significant revision and failure rates. Despite recent advances that have improved OCAT success, insufficient osteochondral allograft (OCA) osseointegration remains a major cause of failure. Deferoxamine (DFO) is an effective angiogenic and osteo-anabolic iron chelator that consistently promotes bone neovascularization and regeneration. This study was designed to investigate local delivery of DFO for augmenting OCA osseointegration using a preclinical canine model for OCAT in the knee and hip as commonly affected joints.

METHODS:

On Institutional Animal Care and Use Committee (IACUC) approval, 12 purpose-bred dogs underwent OCAT of the femoral head or femoral condyles with DFO or DFO-free (controls) microspheres in recipient sites. OCA revascularization, cellular repopulation, and integration were evaluated based on functional, diagnostic imaging, microcomputed tomography, histology, and immunohistochemistry outcome measures.

RESULTS:

Local delivery of DFO into OCAT recipient sites was associated with maintained or improved joint function, superior radiographic appearance, significantly greater trabecular thickness, higher bone volume, and new bone ingrowth compared with DFO-free controls.

CONCLUSION:

OCA osseointegration is dependent on cellular repopulation and neovascularization, resulting in new bone ingrowth through creeping substitution, and insufficient osseointegration with resorption and subsidence of the OCA remains a major cause of failure after transplantation. The results of this study suggest that local delivery of DFO using a controlled microsphere release system may reduce resorption and improve revascularization and cellular repopulation to increase new bone ingrowth, potentially expediting OCA osseointegration after transplantation.
Biomechanical Analysis of a Modified Triangular Osteosynthesis Technique for Treatment of Spinopelvic Dissociation
Authors: Voort Wyatt Vander , O'Donnell Edmond , Haffner Max , Garcia-Nolan Tanya , Simister Samuel K. , Le Hai , Klineberg Eric , Eastman Jonathan G. , Saiz Augustine Mark
Published: October 2024

OBJECTIVES:

The purpose of this study was to evaluate the biomechanical stability of a modified triangular osteosynthesis construct with S1 pedicle screws compared with other described lumbopelvic fixation constructs in a U-type sacral fracture model.

METHODS:

U-type sacral fractures were created in validated fourth-generation spinopelvic models. Four different constructs were cyclically loaded with displacement measured in all planes: (1) bilateral L5 pedicle screws with rods attached to iliac bolts, (2) bilateral L5 and S1 pedicle screws with rods attached to iliac bolts, (3) bilateral L5 pedicle screws with rods attached to iliac bolts with a transsacral–transiliac screw, and (4) bilateral L5 and S1 pedicle screws with rods attached to iliac bolts with a transsacral–transiliac screw.

RESULTS:

The bilateral L5 and S1 pedicle screws with rods attached to iliac bolts with a transsacral–transiliac screw construct had significantly decreased horizontal, vertical, and angular displacement compared with all other constructs.

CONCLUSIONS:

From a biomechanical perspective, a modified triangular osteosynthesis construct with S1 pedicle screws improves stability in fixation of U-type sacral fractures.
Ipsilateral Femoral Neck and Shaft Fractures: Complex Injuries With High Rates of Femoral Shaft Nonunion
Authors: Haase Douglas R. , Saiz Augustine M. , Eastman Jonathan G. , Achor Timothy S. , Choo Andrew M. , Munz John W. , Warner Stephen J.
Published: October 2024

OBJECTIVE:

To investigate nonunion rates and risk factors in patients with ipsilateral femoral neck and shaft fractures.

METHODS:

Design:

Retrospective review.

Setting:

Two Level I trauma centers.

Patient Selection Criteria:

Two hundred seven patients treated for ipsilateral femoral neck (AO/OTA 31-B) and shaft (AO/OTA 32A-C) fractures from 2013 to 2022. Patients with less than 6 months of follow-up were excluded.

Outcome Measures and Comparisons:

The primary outcome of this study was femoral shaft nonunion. Risk factors for nonunion were evaluated, including smoking, open fracture, delay to full weight-bearing, blood transfusions, and AO/OTA classification.

RESULTS:

Two hundred twenty-seven patients were initially identified, but only 154 patients had sufficient follow-up and were included in final analysis. The mean age was 38.9 years (SD = 15.3), and injury severity score was 19.5 (9.7). One hundred ten patients (71%) were male and 69 (45%) required intensive care unit care. Thirty-eight patients (25%) experienced an open fracture, and 44 fractures (29%) were AO/OTA Type C. Thirty patients (20%) underwent initial external fixation, and 88 patients (57%) received a perioperative transfusion. Thirty-four patients (22%) developed a femoral shaft nonunion, and 5 (3%) experienced a surgical site infection. Nonunion was associated with perioperative blood transfusion, AO/OTA Type C fracture, postoperative non-weight-bearing, and delay to full weight-bearing ≥12 weeks. Multivariable regression identified perioperative blood transfusion ≥3 (risk ratio [RR] = 1.91; CI, 1.12–2.72; P = 0.02) and AO/OTA Type C fracture (RR = 2.45; CI, 1.50–3.34; P = 0.001) as independent risk factors.

CONCLUSIONS:

Ipsilateral femoral neck and shaft fractures remain difficult injuries to treat. Much attention is given to diagnosis and treatment of the femoral neck component. These results suggest that successful treatment of the femoral shaft component presents its own challenges with high nonunion rates.

LEVEL OF EVIDENCE:

Prognostic Level III.
Development of a Surgical Difficulty Score for Open Reduction Internal Fixation of Pilon Fractures
Authors: Burns David , Abbas Aazad , Dasari Suhas , Prabhakar Pooja , Hebert-Davies Jonah
Published: October 2024

OBJECTIVES:

To identify characteristics that contribute to surgical complexity in pilon fractures and to develop a machine learning (ML) Pilon Surgical Difficulty Score (PSDS) based on these factors.

METHODS:

Design:

Retrospective cohort study.

Setting:

Academic Level I trauma center.

Patient Selection Criteria:

Pilon fractures (OTA/AO Type 43) in adult patients treated with open reduction internal fixation.

Outcomes Measures and Comparisons:

Various patient, injury, and radiological characteristics were assessed. Surgical difficulty was measured using 2 outcomes: (1) operative time and (2) perceived difficulty. Perceived difficulty was determined using the opinion of 16 fellowship-trained orthopaedic traumatologists on a 10-point scale. Significant predictors of difficulty were determined using univariate analyses. ML models were used to develop a PSDS for both operative time and surgical difficulty.

RESULTS:

One hundred operatively fixed pilon fractures were included. Predictors of operative time were age, OTA/AO classification, articular comminution, articular impaction, bone loss, delay to surgery, poor quality reduction, number of approaches, and number of articular fragments. Predictors of perceived difficulty included OTA/AO classification and delay to surgery. Operative time PSDS had a mean absolute error of 64 minutes and a 60-minute buffer accuracy of 59%. Perceived difficulty PSDS had a mean absolute error of 1.7 points and a 2-point buffer accuracy of 63%.

CONCLUSION:

ML was used to generate accurate PSDSs for operative time and difficulty for pilon fractures. Future work should aim to clinically validate these PSDSs, so they may improve patient outcomes.

LEVEL OF EVIDENCE:

Level III Diagnostic.
Social Disadvantage and Transportation Insecurity in Clubfoot Clinic
Authors: Bent Melissa A. , Jhun Michelle , Beltran Veronica , Fimbres Barbara , Wren Tishya A.L.
Published: October 2024

Objectives:

This study aims to evaluate the association of missing clubfoot clinic visits with transportation barriers and measures of socioeconomic status including the child opportunity index (COI).

Methods:

An 11-question survey was administered to caregivers of patients with clubfoot seen at a single pediatric tertiary hospital between August 2020 and September 2023. A chart review was conducted to obtain zip codes used to determine COI 2.0 scores. The impact of race/ethnicity, income, persons per household, COI, and transportation methods on missing at least one clinic visit was analyzed using descriptive and nonparametric statistics.

Results:

The transportation survey was completed by a total of 99 caregivers. The median travel time to the clinic was 45 minutes (IQR: 33, range: 1 to 180). Most participants reported use of a personal car (108/128, 83%), and 72% took time off work to attend the appointment. Those with lower COI had longer travel time (P=0.02) and were less likely to use personal cars (P=0.05). Missed clubfoot clinic visits were more common for families reliant on transportation other than a personal vehicle (P=0.01) and those with annual income under $30,000 (P=0.02).

Conclusions:

Transportation insecurity was associated with greater social disadvantage as indicated by COI and more missed clinic visits.

Level of Evidence:

Level III.
Practice Patterns Vary Widely in the Care of Pediatric and Adolescent Pelvic and Acetabular Fractures: A CORTICES Survey
Authors: Roper Brennan , Purtell S. Rose , De Sayan , McLaughlin Dell , Truong Walter H. , Miller Mark L. , Swarup Ishaan , Ramalingam Wendy , Sanders Julia S. ,   Children’s Orthopaedic Trauma and Infection Consortium for Evidence-Based Studies (CORTICES)
Published: October 2024

Introduction:

Pediatric pelvic and acetabular fractures are rare but potentially devastating injuries and significant management variation exists across the United States. This study sought to elucidate treatment decision-making trends, involvement of adult trauma fellowship-trained surgeons in pediatric care, and pre- and postoperative transfer patterns.

Methods:

Pediatric orthopaedic surgeons who serve as trauma liaisons at 20 PTCs were surveyed regarding training, practice volume, and factors contributing to institutional management of pelvic and acetabular injuries. Five clinical scenarios of pelvic ring and acetabular fractures that varied by injury pattern, age, and sex were presented. Descriptive statistics were used to summarize the results.

Results:

Eighteen institutions responded to the survey (90% response rate, 16 Level, 1 PTC). All surgeons were pediatric fellowship-trained (77.7% in practice >5 y). The four most common factors affecting whether surgeons independently managed both pelvic ring and acetabular fractures were patient age, fracture characteristics, displacement and need for surgery. The majority reported managing <10 acetabular (72.2%) but >10 pelvic ring (77.8%) injuries per year. In the clinical scenarios, patients <10 were more likely to have treatment decisions made by a pediatric orthopaedic surgeon. Older patients were more likely to be transferred to another institution for surgery but were often transferred back to the PTC postoperatively. In all clinical scenarios other than posterior hip dislocation, a trauma fellowship-trained surgeon was more likely to be the operative surgeon, even when the patient was not transferred.

Conclusions:

There is substantial variation in the management of pediatric and adolescent pelvic and acetabular fractures. Even at tertiary care PTCs, volumes are low, and trauma fellowship-trained surgeons are often involved in decision-making and operative management. Age and injury pattern seem to play a large role in variation, and patient transfers between facilities are common.

Level of Evidence:

V
A survey of attitudes toward and experiences with traditional Chinese medicines among people in Taiwan
Authors: Chuang Cheng-Yu , Chung Hui-Yu , Chen Fu-Shih , Arai Ichiro
Published: October 2024

Background:

Despite numerous surveys on traditional Chinese medicines (TCMs) and their impact on people in Taiwan, only a few directly assessed the perspectives of the users and their experiences with the practice. In this study, we aimed to explore the attitudes, experiences, and understanding of TCMs, and also to identify the TCMs that are commonly preferred among people in Taiwan.

Methods:

We conducted an online survey among people in Taiwan to reflect the viewpoints of the general public on TCMs in 2022. Individuals working in the medical field were excluded. Question topics included experience, impressions, access, and expectations.

Results:

According to the results of the questionnaire survey, of the 518 participants interviewed, more than 95% had used TCMs. "Work gently" was the most common positive impression, and "Take effect slowly" was the most common negative impression. Among the over-the-counter TCMs that were taken by the participants, "Si Wu Tang," which tends to be used for treating female diseases, was the most common. The main expectations for TCMs were to improve daily health and prevent diseases. Although the participants were well informed about TCMs, there was still room for improvement. For example, 30% of the participants still did not know that TCMs might have side effects.

Conclusion:

People in Taiwan who participated in the survey had a relatively positive impression of and experience with TCMs, but there were still some knowledge gaps that need to be filled with additional information. It is essential to strengthen the publicity and education about TCMs and improve the public's understanding and correct use of TCMs.
An Early Snapshot of Attitudes Toward Generative Artificial Intelligence in Physical Therapy Education
Authors: Severin Richard , Gagnon Kendra
Published: October 2024

Introduction.

Generative artificial intelligence (AI) is rapidly gaining popularity across health care, education, and society. The purpose of this study was to assess perceptions and use of generative AI in academic physical therapy (PT).

Review of Literature.

Generative AI became one of the fastest-growing technologies ever after the public release of ChatGPT in November 2022. Early data indicate that attitudes toward generative AI in higher education are mixed and rapidly evolving, with significant ethical concerns around use and potential misuse. There are no published studies investigating perceptions and use of generative AI in PT education.

Subjects.

A total of 175 surveys were completed and analyzed. Respondents included PT educators, administrators, and students.

Methods.

An anonymous, online survey on use and perception of AI was distributed through email and social media. Descriptive statistics and cross-tabulations were performed to analyze respondent characteristics and responses to survey questions.

Results.

Most respondents (61.1%) reported they did not use generative AI during the 2022-2023 academic year, whereas 35.4% were generative AI users. More than 40% of respondents were optimistic or very optimistic toward generative AI. Users of AI were more likely to report an optimistic or very optimistic disposition toward AI compared with nonusers. AI users were more likely to agree or completely agree that generative AI has more benefits than drawbacks compared with nonusers.

Discussion and Conclusion.

Results of this survey suggest that, despite the rapid uptake of generative AI in society, many PT educators and students harbor reservations and uncertainties toward its use. Artificial intelligence users were less likely to hold negative perceptions toward it and were more likely to find it useful. Understanding use and perceptions of generative AI in PT education may inform strategies to promote innovation, policy-making, and ethical integration of this new and rapidly evolving technology.
Distribution of Certified Pelvic Health Physical Therapists Across the United States
Authors: Cline Sarah A. , McLaughlin Kevin , Arnold Nora , Austin Mary M.
Published: October 2024

Purpose: Pelvic floor dysfunction (PFD) describes a range of impairments affecting people of all genders. Pelvic health physical therapy (PHPT), a first-line treatment option for PFD, has been associated with improvements in myriad related conditions. This study aimed to examine the number of PHPT specialists in the United States and each state individually in order to assess distribution of care. We hypothesized that this number is low when compared with the estimated demand for services.

Methods: This descriptive cross-sectional study identified PHPT specialists as those with a Certificate of Achievement in Pelvic Health Physical Therapy (CAPP-Pelvic), a Women’s Health Clinical Specialist (WCS) Board Certification, or a Pelvic Rehabilitation Practitioner Certification (PRPC), as of May 31, 2022. Researchers utilized 3 online databases to identify 1135 PHPT providers across the US and compared statewide data with current state population to determine providers per million people.

Results: The number of PHPT providers per state ranged from 1 (Vermont) to 119 (California). When compared to state population, the lowest PHPT provider ratio was approximately 1 per million people (Alabama) and the highest was approximately 8 per million people (Oregon).

Discussion: The data indicate that the number of PHPT providers available varies by state. The number of PHPT providers in the US is low overall and relative to states’ populations. Given the prevalence of PFD in the US, it is unlikely that the total number of providers in most states is sufficient to meet clinical demands.
Biofeedback Measures of Pelvic Floor Muscle Contraction, Relaxation, and Resting Tone for Males With and Without Chronic Pelvic Pain: A Scoping Review
Authors: Wong Calvin , Ow Nikki , Fagan Matthew James
Published: October 2024

Background:

We sought to identify and explore the utility of biofeedback assessments used to characterize pelvic floor muscles (PFMs) in terms of contraction, relaxation, and resting tone and determine if these methods have identified differences between males diagnosed with chronic pelvic pain (CPP) as opposed to healthy controls.

Methods:

A search strategy was developed with the assistance of a health sciences librarian. Search terms were generated related to key concepts including sex, CPP, and biofeedback. Five electronic databases (PubMed, EMBASE, CINAHL, Medline, and PEDro) were searched for English language articles. This scoping review was completed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, and the protocol was registered with the Open Science Framework.

Results:

Five eligible studies comparing males with CPP to nonpainful controls were identified. Ultrasound imaging, surface electromyography, and anorectal manometry were used in the studies. Identification of increased pelvic floor muscle resting tone and reduced endurance were noted as the most salient pelvic floor muscle findings.

Discussion:

Biofeedback use included males with urologic chronic pelvic pain and chronic anorectal pain. PFMs may behave differently in males with CPP compared to nonpainful controls as measured using biofeedback methods including ultrasound imaging, surface electromyography, and anorectal manometry; however, further research is needed to verify the conclusions of the studies done to date. Biofeedback assessment measures can be useful when PFMs are involved in CPP to identify specific muscle dysfunction and clarify treatment targets for physiotherapists.
A Survey of Pain and Musculoskeletal Dysfunction Prevalence After Gender-Confirming Surgery of the Urogenital System
Authors: Alappattu Meryl J. , Stetten Nichole E. , Rivas Adriana C. , Chim Harvey W.M. , Bishop Mark D.
Published: October 2024

Purpose:

We sought to (1) explore the prevalence of pain, and movement and urogenital dysfunction reported following gender confirming vaginoplasty (V) and phalloplasty (P), (2) identify which providers were consulted for pain, and movement and urogenital dysfunction after surgery, and (3) compare these factors between people receiving V and P surgeries.

Methods:

A custom internet survey, built in REDCap, was distributed through LGBTQIA+ organizations across the US. The survey collected demographic information, types of surgery, postsurgical impairments (pain and urogenital dysfunction), and activity limitations, along with the types of providers seen and interventions provided. Summary statics were calculated and proportions or means and standard deviations based on the data structure. Nonparametric measures were used to test associations between postsurgical care, gender identity, and geographic location.

Results:

584 responses remained after data cleaning of which 89 people reported having vaginoplasty (V) and 118 had phalloplasty (P). The average age of respondents was 28.6 ± 5.2 years. 70% of respondents reported pain, 25% difficulty moving, 23% bowel or bladder dysfunction, and 9% dyspareunia. Significantly more respondents who had V reported dyspareunia, while more respondents who had P reported incontinence. 20%, 29%, 15%, and 13% of included respondents received care from a physical therapist for pain, difficulty moving, incontinence, and dyspareunia, respectively.

Discussion:

These results indicate that both individuals who undergo V or P procedures report musculoskeletal pain, movement problems, and pelvic floor dysfunction following GCS. Notably, these issues are commonly addressed in cisgender patients by physical rehabilitation providers. However, less than half of our sample were referred to a physical therapist.
Role of artificial intelligence in predicting neurological outcomes in postcardiac resuscitation
Authors: Khawar Muhammad Muneeb , Abdus Saboor Hafiz , Eric Rahul , Arain Nimra R. , Bano Saira , Mohamed Abaker Mawada B. , Siddiqui Batool I. , Figueroa Reynaldo R. , Koppula Srija R. , Fatima Hira , Begum Afreen , Anwar Sana , Khalid Muhammad U. , Jamil Usama , Iqbal Javed
Published: October 2024

Being an extremely high mortality rate condition, cardiac arrest cases have rightfully been evaluated via various studies and scoring factors for effective resuscitative practices and neurological outcomes postresuscitation. This narrative review aims to explore the role of artificial intelligence (AI) in predicting neurological outcomes postcardiac resuscitation. The methodology involved a detailed review of all relevant recent studies of AI, different machine learning algorithms, prediction tools, and assessing their benefit in predicting neurological outcomes in postcardiac resuscitation cases as compared to more traditional prognostic scoring systems and tools. Previously, outcome determining clinical, blood, and radiological factors were prone to other influencing factors like limited accuracy and time constraints. Studies conducted also emphasized that to predict poor neurological outcomes, a more multimodal approach helped adjust for confounding factors, interpret diverse datasets, and provide a reliable prognosis, which only demonstrates the need for AI to help overcome challenges faced. Advanced machine learning algorithms like artificial neural networks (ANN) using supervised learning by AI have improved the accuracy of prognostic models outperforming conventional models. Several real-world cases of effective AI-powered algorithm models have been cited here. Studies comparing machine learning tools like XGBoost, AI Watson, hyperspectral imaging, ChatGPT-4, and AI-based gradient boosting have noted their beneficial uses. AI could help reduce workload, healthcare costs, and help personalize care, process vast genetic and lifestyle data and help reduce side effects from treatments. Limitations of AI have been covered extensively in this article, including data quality, bias, privacy issues, and transparency. Our objectives should be to use more diverse data sources, use interpretable data output giving process explanation, validation method, and implement policies to safeguard patient data. Despite the limitations, the advancements already made by AI and its potential in predicting neurological outcomes in postcardiac resuscitation cases has been quite promising and boosts a continually improving system, albeit requiring close human supervision with training and improving models, with plans to educate clinicians, the public and sharing collected data.
Pathway to Excellence
Authors: Pelkowski Jessica N. , Traverse Jennifer M. , Owen Ronnie N. , Meeusen Lindsay L. , Santoro Michelle C. , Ledford Cameron K.
Published: October 2024

As the prevalence of total hip and total knee arthroplasty procedures increase over the next decades, hospitals seek opportunities to improve quality outcomes while simultaneously limiting costs and mitigating risks of complications. The Joint Commission’s Advanced Total Hip and Total Knee Replacement (THKR) certification is one of the highest quality standard certification programs in the nation and is the only one that collaborates with the American Academy of Orthopedic Surgeons. To obtain THKR certification, several requirements based on evidence-based clinical practice guidelines must be met. The process is described from initial identification of stakeholders to ongoing efforts to retain certification. Joint Commission THKR certification was awarded after rigorous review and on-site visit. Compliance with advanced care standards from the time of orthopedic consultation through postsurgical follow-up was reviewed. Joint Commission THKR certification provides supporting evidence of the institutions journey in processes toward delivering high quality clinical care. A multidisciplinary team with ongoing collaboration is necessary to obtain and retain certification.
Unintended Pregnancy After Kidney Transplantation
Authors: Yin Ophelia , Gliwa Catherine , Walia Anjali , Coscia Lisa , Constantinescu Serban , Moritz Michael , Sarkar Monika , Irani Roxanna , Afshar Yalda
Published: October 2024

OBJECTIVE:

To define risk factors, obstetric morbidity, and allograft outcomes associated with an unintended pregnancy after kidney transplant.

METHODS:

This is a retrospective cohort study of pregnancies in women after kidney transplantation enrolled in the Transplant Pregnancy Registry International with births between 1967 and 2019, with cohorts categorized as intended pregnancies and unintended pregnancies. The primary outcome was acute kidney rejection during pregnancy or by 6 weeks postpartum. Secondary outcomes included allograft loss, severe maternal morbidity, and neonatal composite morbidity. Multivariable logistic regression, Kaplan–Meier curves, and Cox proportional hazards regression models were performed, with adjustment for covariates pertinent to allograft function.

RESULTS:

Among 1,723 pregnancies of kidney transplant recipients, 1,081 (62.7%) were intended and 642 (37.3%) were unintended pregnancies. Risk factors for unintended pregnancy included younger age, Black race, nulliparity, chronic hypertension, and transplant from a deceased donor. Exposure to mycophenolate products (16.0% vs 5.7%) and termination (4.7% vs 0.4%) were more common in unintended pregnancies (P<.001). Unintended pregnancy was not associated with acute kidney rejection (2.3% vs 0.9%, adjusted odds ratio [AOR] 2.38, 95% CI, 0.91–6.30, P=.08). Unintended pregnancy was independently associated with allograft loss at 2 years from the end of pregnancy (8.1% vs 3.5%, AOR 2.27, 95% CI, 1.32–3.94, P=.003) but not allograft survival (adjusted hazard ratio 1.22, 95% CI, 1.00–1.49, P=.05). There were no differences in severe maternal morbidity (3.3% vs 3.6%) or neonatal composite morbidity (12.9% vs 14.3%) by pregnancy intention.

CONCLUSION:

Unintended pregnancy was not associated with acute kidney allograft rejection in the peripartum period, but it was associated with mycophenolate exposure and allograft loss at 2 years from pregnancy. The same social vulnerabilities that underlie difficulty in accessing reproductive care may be similarly important for transplant health. We recommend prepregnancy counseling and longitudinal follow-up of transplant recipients to reduce rates of unintended pregnancy and to optimize transplantation success over time.