bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing two autologous bone grafting techniques to treat clavicular midshaft atrophic nonunion: a retrospective study
Authors: Ma Teng , Huang Qiang , Wang Chaofeng , Ren Cheng , Xu Yibo , Lin Hua , Zhang Kun , Zhang Congming , Li Zhao 
Published: February 2025

Abstract

Background
Open reduction, superior plate (SP) fixation, and autologous cancellous granular bone grafting (ACGBG) are common strategies for treating clavicular midshaft atrophic nonunion (CMAN). We aimed to compare the radiological findings and clinical effects of two autologous cancellous bone grafts (ACBGs) and those of single SP fixation, to treat CMAN.

Methods
This retrospective study comprised 62 patients admitted to our hospital with CMAN (ACGBG with single SP fixation between March 2012 and October 2017, 32 patients; autologous cancellous structured bone grafting [ACSBG] with single SP fixation between November 2017 and May 2021, 30 patients). Patient visual analog scale (VAS) scores for pain and disability of the arm, shoulder, and hand (DASH) scores, obtained preoperatively and at final follow-up, were recorded and analyzed. Statistical differences between the ACGBG and ACSBG groups were assessed using Fisher’s exact and two-sample independent t tests.

Results
No statistically significant differences were observed between the two groups in terms of patient demographics or the incidence of complications. VAS and DASH scores decreased significantly from the preoperative day to 9 months postoperatively in both groups, but this difference was not statistically significant at final follow-up. However, at 3 and 6 months postoperatively, compared with mean VAS and DASH scores in the ACGBG group, the ACSBG group showed lower pain and dysfunction scores (p < 0.05). The mean fracture healing times were 15.2 (range, 12–20) and 18.6 (range, 12–32) weeks in the ACSBG and ACGBG groups, respectively (p = 0.01). One case of plate breakage occurred in the ACGBG group at 5 months postoperatively, with recovery following ACSBG revision with single SP fixation.

Conclusions
ACSBG combined with single SP fixation is a promising and effective alternative technique for promoting bone union and postoperative early functional rehabilitation in treating CMAN.

Level of evidence
Level 3.
217 closed Salmonella reference genomes using PacBio sequencing
Authors: Luo Yan , Jang Jae Hee , Balkey Maria , Hoffmann Maria 
Published: February 2025

Abstract

Objectives
Whole Genome Sequencing (WGS) is widely used in food safety for the detection, investigation, and control of foodborne bacterial pathogens. However, the WGS data in most public databases, such as the National Center for Biotechnology Information (NCBI), primarily consist of Illumina short reads which lack some important information for repetitive regions, structural variations, and mobile genetic elements, and the genomic location of certain important genes like antimicrobial resistance genes (AMR) and virulence genes. To address this limitation, we have contributed 217 closed circular Salmonella enterica genomes that were generated using PacBio sequencing to the NCBI Pathogen Detection (PD) database and GenBank. This dataset provides a higher level of accuracy to genome representations in the database.

Data description
High-quality complete reference genomes generated from PacBio long reads can provide essential details that are not available in draft genomes from short reads. A complete reference genome allows for more accurate data analysis and researchers to establish connections between genome variations and known genes, regulatory elements, and other genomic features. The addition of 217 complete genomes from 78 different Salmonella serovars, each representing either a distinct SNP cluster within the NCBI PD database or a unique strain, significantly enriches the diversity of the reference genome database.
Boosting hypochlorite’s disinfection power through pH modulation
Authors: Sil Timir Baran , Malyshev Dmitry , Aspholm Marina , Andersson Magnus 
Published: February 2025

Abstract

Purpose
Hypochlorite-based formulations are widely used for surface disinfection. However, the efficacy of hypochlorite against spore-forming bacteria varies significantly in the literature. Although neutral or low pH hypochlorite solutions are effective sporicides due to the formation of hypochlorous acid (HOCl), their optimal conditions and the specific role of pH in disinfection remain unclear. These conditions also increase the solution’s corrosiveness and compromise its shelf life. Therefore, further research is needed to identify the pH conditions that balance solution stability and effective hypochlorite-based spore disinfection.

Results
This study investigates the impact of neutral to alkaline pH on the sporicidal efficiency of hypochlorite against a pathogenic Bacillus cereus strain. We apply a 5,000 ppm hypochlorite formulation for 10-min across a pH range of 7.0-12.0, simulating common surface decontamination practices. Our results demonstrate that hypochlorite is largely ineffective at pH levels above 11.0, showing less than 1-log reduction in spore viability. However, there is a significant increase in sporicidal efficiency between pH 11.0 and 9.5, with a 4-log reduction in viability. This pH level corresponds to 2 - 55 ppm of the HOCl ionic form of hypochlorite. Further reduction in pH slightly improves the disinfection efficacy. However, the shelf life of hypochlorite solution decreases exponentially below pH 8.5. To explore the pH-dependent efficacy of hypochlorite, Raman spectroscopy and fluorescence imaging were used to investigate the biochemical mechanisms of spore decontamination. Results showed that lower pH enhances spore permeability and promotes calcium dipicolinic acid (CaDPA) release from the core.

Conclusion
Our results highlight the complex relationship between pH, sporicidal efficacy of hypochlorite, and its shelf life. While lower pH enhances the sporicidal efficiency, it compromises the solution’s shelf life. A pH of 9.5 offers a balance, significantly improving shelf life compared to previously suggested pH ranges 7.0-8.0 while maintaining effective spore inactivation. Our findings challenge the common practice of diluting sodium hypochlorite with water to a 5,000 ppm solution, as this highly alkaline solution (pH of 11.9), is insufficient for eliminating B. cereus spores, even after a 10-min exposure. These findings are critical for improving disinfection practices, highlighting the importance of optimizing sodium hypochlorite effectiveness through pH adjustments before application.
Digitally supported physical activity counselling for people with chronic back pain: a randomised controlled parallel feasibility study
Authors: Lindner Nicole , Kornder Nele , Heisig Julia , Becker Annette , der Wardt Veronika van , Viniol Annika 
Published: February 2025

Abstract

Background
Guiding individuals with chronic back pain (CBP) to initiate and adhere to physical activity (PA) remains challenging. The study rationale is based on the need for innovative strategies, like digital tools, to better promote PA. The aim of this study was to evaluate the feasibility and acceptability of using the digital consultation app ExPa (Exercise against Pain) to support PA consultations for CBP and its potential for a future effectiveness trial. The ExPa app shows the effect of PA on pain and provides individually tailored support to increase PA.

Methods
In a 2-arm randomised controlled feasibility study, we recruited 9 physicians and 37 CBP patients in Hesse (Germany). Using computer assisted cluster randomisation, 14 patients received ExPa counselling from their physician, while 17 patients received standard treatment. Main outcomes focused on study procedures and software use, with secondary outcome including pre- and post-intervention measurements of PA (International Physical Activity Questionnaire (IPAQ), pain and mood (Short Form-12 (SF-12), Von Korff pain intensity and disability score and Hospital Anxiety and Depression Scale (HADS)). Additionally, project-tailored questionnaires and qualitative interviews assessed study procedures and software performance.

Results
Study procedures were generally feasible. However, they took more time and dropouts as well as missing data presented challenges. This provided valuable insights for planning an effectiveness trial. Quantitative and qualitative data indicated that ExPa could have benefits for increasing PA and reducing pain.

Conclusions
Results from the feasibility study indicate that improved procedures are necessary for a larger RCT. ExPa shows potential for positively impacting pain and PA.
Group-based trajectory modeling to describe the geographical distribution of tuberculosis notifications
Authors: Dagnew Alemnew F. , Hanrahan Colleen F. , Dowdy David W. , Martinson Neil A. , Lebina Limakatso , Nonyane Bareng A. S. 
Published: February 2025

Abstract

Background
Tuberculosis (TB) is a major public health problem, and understanding the geographic distribution of the disease is critical in planning and evaluating intervention strategies. This manuscript illustrates the application of Group-Based Trajectory Modeling (GBTM), a statistical method that analyzes the evolution of an outcome over time to identify groups with similar trajectories. Specifically, we apply GBTM to identify the evolution of the number of TB notifications over time across various geographic locations, aiming to identify groups of locations with similar trajectories. Locations sharing the same trajectory may be considered geographic TB clusters, indicating areas with similar TB notifications. We used data abstracted from clinic records in Limpopo province, South Africa, treating the clinics as a proxy for the spatial location of their respective catchment areas.

Methods
Data for this analysis were obtained as part of a cluster-randomized trial involving 56 clinics to evaluate two active TB patient-finding strategies in South Africa. We utilized GBTM to identify groups of clinics with similar trajectories of the number of TB patients.

Results
We identified three trajectory groups: Groups 1, comprising 57.8% of clinics; Group 2, 33.9%; and Group 3, 8.3%. These groups accounted for 30.8%, 44.4%, and 24.8% of total TB-diagnosed patients, respectively. The estimated mean number of TB-diagnosed patients was highest in trajectory group 3 followed by trajectory group 2 across the 12 months, with no overlap in the corresponding 95% confidence intervals. The estimated mean number of TB-diagnosed patients over time was fairly constant for trajectory groups 1 and 2 with exponentiated slopes of 0.979 (95% CI: 0.950, 1.004) and 1.004 (95% CI: 0.977, 1.044), respectively. In contrast, there was a statistically significant 3.8% decrease in the number of TB patients per month for trajectory group 3 with an exponentiated slope of 0.962 (95% CI: 0.901, 0.985) per month.

Conclusions
GBTM is a powerful tool for identifying geographic clusters of varying levels of TB notification when longitudinal data on the number of TB diagnoses are available. This analysis can inform the planning and evaluation of intervention strategies.
Axillary lymph node metastasis in breast cancer: from historical axillary surgery to updated advances in the preoperative diagnosis and axillary management
Authors: Wu Tong , Long Qian , Zeng Liyun , Zhu Jinfeng , Gao Hongyu , Deng Yueqiong , Han Yi , Qu Limeng , Yi Wenjun 
Published: February 2025

Abstract
Axillary lymph node status, which was routinely assessed by axillary lymph node dissection (ALND) until the 1990s, is a crucial factor in determining the stage, prognosis, and therapeutic strategy used for breast cancer patients. Axillary surgery for breast cancer patients has evolved from ALND to minimally invasive approaches. Over the decades, the application of noninvasive imaging techniques, machine learning approaches and emerging clinical prediction models for the detection of axillary lymph node metastasis greatly improves clinical diagnostic efficacy and provides optimal surgical selection. In this work, we summarize the historical axillary surgery and updated perspectives of axillary management for breast cancer patients.
The Pre-Medical Health Coach (PHC) program: pre-medical students as volunteer health coaches at a safety-net hospital in California, 2016–2020
Authors: Shak Emma B. , Berry Lyn , Chow Bryant , Abramowitz Sharone , Mehta Kala M. 
Published: February 2025

Abstract

Background
The volunteer Pre-Medical Health Coach (PHC) program engages student volunteers, in team-based primary care providing self-management support to patients with chronic conditions. Both the PHCs and the patients they serve are diverse. The aims of this study are to assess the impact of the PHC program on student outcomes and patient biomarkers.

Methods
All PHCs were students recruited from local universities, interviewed, then trained in motivational interviewing and evidence-based chronic disease self-management support. The 22 PHCs were diverse – 8 (36.3%) were underrepresented in medicine and 2 (9%) were first generation in college. The study setting was a public safety-net adult medicine outpatient clinic in Oakland, California. PHCs spent 5 h weekly, for 1–3 years, volunteering alongside primary care residents and faculty. Duties included: (1) observing the doctor-patient interview, (2) on-site health coaching, and (3) telephone follow-up. An internal medicine physician and a licensed clinical social worker supervised the program. Surveys were implemented to understand program impacts and career trajectories of the 22 PHCs and health action plans were reviewed over 4 years. In addition, a focus group was conducted with the PHCs using a deductive approach.

Results
Two years after completing the program, 90.9% of the PHCs were still on the path to health professions programs, 50% had applied to medical school, and 18.2% started medical training. Qualitative impacts on coaches included significant clinical exposure, meaningful connection with patients, ‘bridging’ between the community and health care system and having a more holistic view on health. Patient biomarkers included a decrease in hemoglobin A1c level by 1% point in diabetic patients with diabetes-focused action plans, and smoking-focused action plans led to decreased smoking or cessation.

Conclusions
The Pre-Medical Health Coach (PHC) program may benefit both PHCs and patients. PHCs were diverse and providing chronic disease self-management support to patients in a safety-net health care system. This program could be readily adapted in health care systems nationwide to increase diverse entrants to the healthcare workforce.
Effects of self-controlled feedback on learning range of motion measurement techniques and self-efficacy among physical therapy students: a preliminary study
Authors: Yamamoto Ryohei , Imai Takaki , Yoshizato Yushin , Akizuki Kazunori 
Published: February 2025

Abstract

Background
Measuring range of motion (ROM) accurately using a universal goniometer or visual estimation is challenging for physical therapy students. Self-controlled (SC) feedback, where learners decide whether to receive feedback, can enhance learning and foster self-efficacy (SE) by promoting self-regulation. However, the impact of SC feedback on skill acquisition in ROM measurement technique and SE in physical therapy students remains unclear. This study investigates the effects of SC feedback on skill acquisition in ROM measurement techniques and students’ SE.

Methods
Thirty physical therapy students were quasi-randomly assigned to an SC group, which chose feedback during practice, or a Yoked (Yk) group, which received feedback based on the SC group’s schedule. A goniometric measurement task, in which participants measure the ROM of left knee flexion using a universal goniometer, and a visual estimation task, in which they estimate it visually, were set as the learning tasks. After a pretest, they completed the practice (3 trials × 4 blocks) followed by short-term retention test (STRT) and LTRT (LTRT). All tests consisted of 3 trials. Measurement accuracy and time were used as test performance for both tasks. SE of ROM measurements was measured before the start of each test using a 10-point Likert scale. Feedback related to measurement errors were provided during practice in line with each group’s conditions.

Results
The SC group maintained high feedback frequency (80.0 ± 30.3%) during the practice. Both groups improved measurement accuracy and reduced time for goniometric measurement and visual estimation tasks, but no significant group differences were found. Goniometric accuracy exceeded visual estimation in both groups. SE before the pretest did not correlate with pretest accuracy. However, SE before the STRT correlated with accuracy at that time in both groups. In the SC group, SE before the LTRT test was related to the accuracy at the STRT.

Conclusion
SC feedback did not demonstrate superior effectiveness, but external feedback improved ROM measurement accuracy and reduced measurement time. Moreover, SE after the practice was temporarily associated with accuracy, suggesting a potential link between SE and performance in skill acquisition.
Why downsizing may increase sickness absence: longitudinal fixed effects analyses of the importance of the work environment
Authors: Grønstad Anniken , Bernstrøm Vilde Hoff 
Published: February 2025

Abstract

Background
Downsizing can often have a detrimental effect on employee health and increase sickness absence. Earlier research has theoretically argued that such negative consequences are due to taxing alterations in the work environment, but research efforts to empirically test this argument remain limited.

Methods
In this study, we investigate whether the environment for control, role clarity, and commitment in different work units can explain the relationship between unit-level downsizing and sickness absence. We combined register- and self-reported data from 19,173 employees in a large Norwegian health trust in the period 2011–2015 and conducted a longitudinal fixed effects analysis.

Results
Unit-level downsizing was found to be significantly related to increased short-term sickness absence, reduced organizational commitment, and reduced control. Reduced commitment explained a small part of the increase in short-term sickness absence after unit-level downsizing. There was no mediating effect of either control or role clarity.

Conclusion
The study contributes to a better understanding of the underlying mechanisms that help explain why downsizing leads to adverse health consequences and sickness absence by highlighting the complexity of this relationship and introducing organizational commitment as a relevant mediator.
Vascular remodeling and TSLP/angiogenin overexpression in severe mixed asthma
Authors: Bertolini Francesca , Carriero Vitina M.A. , Arrigo Elisa , Guida Giuseppe , Levra Stefano , Pizzimenti Stefano , Profita Mirella , Gnemmi Isabella , Di Stefano Antonino , Ricciardolo Fabio L.M. 
Published: February 2025

Abstract

Background
Asthma with neutrophilic/mixed inflammation is a difficult-to-control clinical phenotype. Currently, vascular and matrix airway remodeling in asthma with neutrophilic/mixed inflammation is not well known. We aimed to evaluate the differences in vascular/smooth muscle/matrix related asthma remodeling in eosinophilic (EOS) and mixed/neutrophilic (MIXED) bronchial phenotypes in relation to asthma severity and exacerbation frequency.

Methods
In this cross-sectional study, α-SMA+ cells (100µM beneath the basement membrane [BM]), BM thickness, vascular remodeling-related biomarkers (angiogenin, vascular endothelial growth factor [VEGF], CD31 and Protease-activated receptor 2 [PAR2]), alarmins (TSLP and Interleukin (IL)-33) were evaluated in bronchial sections from 40 mild-to-severe asthmatics (EOS: N = 19 and mixed/neutrophilic: N = 19/2) and 7 control subjects (CTRL).

Results
The number of CD31+ and angiogenin+ cells was higher in MIXED than in EOS asthmatics (p < 0.05). In severe MIXED CD31+, TSLP+, α-SMA+, and angiogenin+ cells increased compared to mild MIXED/EOS or severe EOS (p < 0.05), but BM thickness was higher in severe vs. mild EOS (p < 0.05). MIXED frequent exacerbators had higher numbers of CD31+ and TSLP+ cells, whereas MIXED non-exacerbators had increased PAR2+ cells. CD31+ cells correlated with impairment of pulmonary functions, number of exacerbations, ICS dose, bronchial neutrophils, angiogenin, α-SMA, TSLP and IL-33 (p < 0.05). Finally, CD31 > 97.17 cells/mm2, angiogenin > 35.36 cells/mm2, and functional parameters such as FEV1, FEV1/FVC, TLC and FRC (%pred.) were found to be predictors of severe MIXED asthma.

Conclusion
The severe or frequent exacerbator asthmatics with bronchial mixed inflammatory profile are characterized by increased number of vessels and overexpression of TSLP and angiogenin, suggesting a pathogenetic link between mixed eosinophilic and neutrophilic inflammation and vascular remodeling.
Severe malaria readmissions in Northern Uganda: a cross-sectional study
Authors: Olum James , Mukunya David , Nambozo Brendah , Nantale Ritah , Oguttu Faith , Epuitai Joshua , Lume Ivan , Wanume Benon , Olupot-Olupot Peter , Amanya Daphine , Kakuru Abel 
Published: February 2025

Abstract

Background
Malaria is a critical global health issue, particularly for children in endemic regions. However, factors associated with recurrent severe malaria in children under 5 years of age in Northern Uganda are poorly understood. This study aimed to identify factors associated with readmission due to severe malaria within six months post-discharge among children in this age group.

Methods
A cross-sectional study was conducted in Otuke district, encompassing twelve health facilities. A total of 760 caregivers of children admitted with severe malaria were interviewed, and hospital records were reviewed to verify the readmission data. The primary outcome assessed was readmission with severe malaria within six months after initial discharge. Data analysis was performed via Stata version 15.0.

Results
The prevalence of readmission with severe malaria among children under 5 years of age was 26.8% (198/739). Factors significantly associated with readmission included having sickle cell anaemia [adjusted prevalence ratio (aPR) 1.72; 95% confidence interval (CI) (1.95–3.14)], living in houses constructed with straw and thatch walls [(aPR 2.10; 95% CI (1.19–3.69)] and seeking care after 12 h when the child has a fever [aPR 2.01; 95% CI (1.23–3.29)].

Conclusion
The findings indicate a high proportion of severe malaria readmissions in children under 5 years of age. Sickle cell anaemia, living in houses built using straw and thatch walls and seeking care after 12 h when a child has fever were the key risk factors for readmission with severe malaria. This study highlights the importance of targeted post-discharge interventions, such as prophylactic anti-malarials in addition to bed nets, to prevent recurrent infections especially among children with sickle cell disease. In addition, improvements in housing quality and timely treatment of children with malaria are essential for reducing the burden of malaria, particularly in endemic regions.