bluuebunny/crossref_metadata_2025_split huggingface dataset:
795. A Bayesian Spatial-temporal Modelling Approach for Prevalence Estimation of a VRE Outbreak in a Tertiary Care Hospital
Authors: Atkinson Andrew , Ellenberger Benjamin , Endrich Olga , Kaspar Tanja , Hardegger Maria , Steiger Walter , Piezzi Vanja , Leichtle Alexandra , Marschall Jonas 
Published: December 2021

Abstract

Background
There was a nosocomial outbreak of vancomycin-resistant enterococci (VRE) in our hospital group from 2018-19. The goals of the study were to describe the prevalence trajectory and explore risk factors associated with putative room colonization during the outbreak.

Methods
We performed a room centric analysis of 12 floors (floors F to R, 264 rooms) of the main bed tower of the hospital, including data on 37’458 patients (23’050 person weeks) over the 104 week period. Patients were assumed to be colonized in the week prior to their first positive test, and thereafter throughout the remainder of their stay until discharge. Poisson Bayesian Hierarchical models were fitted to estimate prevalence per room, including both spatial (conditional autoregressive) and temporal (random walk) random effects terms. Model M1 estimated prevalence for each floor and then used meta-analysis to combine the estimates, whereas model M2 estimated prevalence for “all-floors” simultaneously.

Results
The oncology department, where the outbreak was thought to have started, experienced slightly higher prevalence (floors O and R; adjusted incidence rate ratio (aIRR) 4.8 [2.6, 8.9], p&lt; 0.001; reference is general medicine; see Figure Panel A), as did both the cardiac surgery (floors G, N, O; aIRR 3.8 [2.0, 7.3], p&lt; 0.001) and abdominal surgery departments (floors H and Q; 3.7 [1.8, 7.6], p&lt; 0.001). There was no discernible difference in prevalence between floors with single and multiple department occupancy. Furthermore, departments spread across multiple floors had similar prevalence on all constituent floors – perhaps indicating transmission by people or devices moving between floors.
The “single floor meta-analysis” model (M1) more closely followed the estimated trajectory for the crude prevalence, whereas the “all floors” model (M2) dampened the amplitude of the peaks somewhat, but better estimated periods of low prevalence (Figure Panel B).
Figure: Estimates from the Bayesian Hierarchical Models

Panel A. Random effect prevalence estimates for each floor (from model M2). Panel B. Crude prevalence (black) and estimates from the “single floor meta-analysis” approach (M1, dashed red) with 95% credible intervals shaded (shaded red), and “all-floors” model (M2, blue ).

Conclusion
We applied a room centric approach that took into account spatial and temporal dependencies apparent in the nosocomial VRE outbreak. Despite additional complexity, Bayesian Hierarchical Models provide a more flexible platform for studying transmission dynamics and performing hypothesis testing, compared to more traditional methods.

Disclosures
All Authors: No reported disclosures
797. Infection Prevention and Control Training Needs and Preferences Among Frontline Health Professionals
Authors: Stream Sarah , Salman Ashraf M , Fadul Nada , German Dan K , Soma Mounica , Tyner Kate , Cortes-Penfield Nicolas W , Cortes-Penfield Nicolas W 
Published: December 2021

Abstract

Background
In 2020, the Nebraska Infection Control Assessment and Promotion program began collaborating with the Nebraska Department of Health and Human Services (NE DHHS) and the CDC to distribute infection prevention and control (IPC) training to frontline healthcare professionals (HCPs), focusing on nursing assistants (NAs), dentists, and other groups not traditionally targeted by IPC training. We conducted a learning needs assessment of these workers to plan high-yield curricula for each group.

Methods
We distributed an online survey to Nebraska’s frontline HCPs via local professional society email lists and the NE DHHS’s weekly newsletter. The survey asked respondents to identify their professional role, practice setting (urban vs suburban vs rural), preferred sources and formats of training, and perceived need for additional training across multiple IPC topics.

Results
456 HCPs completed our survey, including 177 NAs, 72 nurses, and 59 dentists; most HCPs practiced in a rural setting (62%). HCPs viewed the CDC as the most trustworthy source of IPC training (92% trusted, vs 71% for local health authorities, 64% for professional societies, and 43% for academic institutions); versus other respondents, NAs had substantially lower trust in all groups except the CDC. Respondents were more often interested in self-paced learning (63%) or interactive discussion with experts (53%) versus peer discussions (40%) or lectures (34%). Compared with other respondents, dentists were least interested in peer discussions (27%) and NAs in lectures (15%). Triage and screening was the only IPC training topic a majority of all respondents (51%) requested, though majorities of nurses (58%) and dentists (51%) also wanted training on environmental cleaning. Hand hygiene (12%) and personal protective equipment use (27%) were the least requested IPC topics, especially among NAs (5% and 18%).

Conclusion
Nebraska’s frontline healthcare workers express high confidence in the CDC as a source of IPC training and prefer self-paced and expert discussion learning modalities. Key between-group differences indicate that individualizing curricula for NAs, dentists, and other HCPs may improve IPC training quality.

Disclosures
M. Salman Ashraf, MBBS, Merck & Co. Inc (Grant/Research Support, I have recieved grant funding for an investigator initiated research project from Merck & Con. Inc. However, I do not see any direct conflict of interest related to the submitted abstract) Nicolas W. Cortes-Penfield, MD, Nothing to disclose
A Randomized, Placebo-Controlled Trial Assessing the Effect of VISBIOME ES Probiotic in People With HIV on Antiretroviral Therapy
Authors: Presti Rachel M , Yeh Eunice , Williams Brett , Landay Alan , Jacobson Jeffrey M , Wilson Cara , Fichtenbaum Carl J , Utay Netanya S , Dube Michael P , Klingman Karin L , Estes Jacob D , Flynn Jacob K , Loftin Amanda , Brenchley Jason M , Andrade Adriana , Kitch Douglas W , Overton Edgar T 
Published: December 2021

Abstract

Background
A5350, a phase II, randomized, double-blind study, evaluated the safety and tolerability of the probiotic Visbiome Extra Strength (ES) over 24 weeks and measured effects on inflammation and intestinal barrier function.

Methods
The primary outcome was change in soluble CD14 (sCD14) levels; secondary outcomes included safety and tolerability, markers of inflammation and cellular activation, and microbiome. In a substudy, gut permeability was assessed by paired colonic biopsies measuring the area of lamina propria occupied by CD4+ cells, interleukin (IL)-17+ cells, and myeloperoxidase (MPO). Changes between arms were compared with the 2-sample t test with equal variance or the Wilcoxon rank-sum test. For safety, the highest graded adverse events (AEs) were compared between arms using the Fisher exact test.

Results
Overall, 93 participants enrolled: 86% male, median age 51 years, median CD4 count 712 cells/mm3. Visbiome ES was safe and well tolerated. There was no difference in mean change in sCD14 from baseline to week 25/26 between placebo (mean change, 92.3 µg/L; 95% CI, –48.5 to 233 µg/L) and Visbiome ES (mean change, 41.0 µg/L; 95% CI, –94.1 to 176.2 µg/L; P=.60). Similarly, no statistically significant differences between arms in inflammatory marker changes were identified. In substudy participants, no statistical differences between arms for change in cellular marker expression or gut permeability were observed (P&gt;.05 for all). The microbiome demonstrated increased probiotic species and a significant decrease in Gammaproteobacteria (P=.044) in the Visbiome ES arm.

Conclusions
Visbiome ES was safe and altered the microbiome but demonstrated no effect on systemic inflammatory markers, pathology, or gut permeability in antiretroviral therapy–treated people with HIV.
The Chlamydomonas bZIP transcription factor BLZ8 confers oxidative stress tolerance by inducing the carbon-concentrating mechanism
Authors: Choi Bae Young , Kim Hanul , Shim Donghwan , Jang Sunghoon , Yamaoka Yasuyo , Shin Seungjun , Yamano Takashi , Kajikawa Masataka , Jin EonSeon , Fukuzawa Hideya , Lee Youngsook 
Published: December 2021

Abstract
Photosynthetic organisms are exposed to various environmental sources of oxidative stress. Land plants have diverse mechanisms to withstand oxidative stress, but how microalgae do so remains unclear. Here, we characterized the Chlamydomonas reinhardtii basic leucine zipper (bZIP) transcription factor BLZ8, which is highly induced by oxidative stress. Oxidative stress tolerance increased with increasing BLZ8 expression levels. BLZ8 regulated the expression of genes likely involved in the carbon-concentrating mechanism (CCM): HIGH-LIGHT ACTIVATED 3 (HLA3), CARBONIC ANHYDRASE 7 (CAH7), and CARBONIC ANHYDRASE 8 (CAH8). BLZ8 expression increased the photosynthetic affinity for inorganic carbon under alkaline stress conditions, suggesting that BLZ8 induces the CCM. BLZ8 expression also increased the photosynthetic linear electron transfer rate, reducing the excitation pressure of the photosynthetic electron transport chain and in turn suppressing reactive oxygen species (ROS) production under oxidative stress conditions. A carbonic anhydrase inhibitor, ethoxzolamide, abolished the enhanced tolerance to alkaline stress conferred by BLZ8 overexpression. BLZ8 directly regulated the expression of the three target genes and required bZIP2 as a dimerization partner in activating CAH8 and HLA3. Our results suggest that a CCM-mediated increase in the CO2 supply for photosynthesis is critical to minimize oxidative damage in microalgae, since slow gas diffusion in aqueous environments limits CO2 availability for photosynthesis, which can trigger ROS formation.
Study of the Unit-3 nuclear reactor of Fukushima Daiichi by cosmic muon radiography
Authors: Fujii Hirofumi , Hara Kazuhiko , Hayashi Kohei , Kakuno Hidekazu , Kodama Hideyo , Nagamine Kanetada , Sato Kotaro , Kim Shin-Hong , Suzuki Atsuto , Sumiyoshi Takayuki , Takasaki Fumihiko , Tanaka Shuji , Yamashita Satoru , Mizokami Shinya , Yamada Daichi 
Published: December 2021

Abstract
We have investigated the status of the nuclear debris in the Unit-3 nuclear reactor of the Fukushima Daiichi nuclear power plant by the method called cosmic muon radiography. We used the same telescope system which was used to study the Unit-2 reactor. As in the previous studies, we succeeded in identifying the inner structure of the reactor, such as the containment vessel and other structures of the reactor complex, through the thick concrete wall of the reactor building. We evaluated the amount of material remaining in the fuel loading zone, and conclude that most of the original fuel materials have melted and dropped from the loading zone.
Diagonal reflection symmetries, four-zero texture, and trimaximal mixing with predicted θ13 in an A4 symmetric model
Authors: Yang Masaki J S 
Published: December 2021

Abstract
In this paper, we impose a magic symmetry on the neutrino mass matrix mν with universal four-zero texture and diagonal reflection symmetries. Due to the magic symmetry, the Maki–Nakagawa–Sakata matrix inevitably has trimaximal mixing. Since the lepton sector has only six free parameters, the physical observables of leptons are all determined from the charged lepton masses mei, the neutrino mass differences $\Delta m_{i1}^{2}$, and the mixing angle θ23. This scheme predicts sin θ13 = 0.149, which is almost equal to the latest best fit, as a function of the lepton masses me, μ and the mass differences $\Delta m_{i1}^{2}$. Moreover, even if the mass matrix has perturbations that break the magic symmetry, the prediction of sin θ13 is retained with good accuracy for the four-zero texture with diagonal reflection symmetries.
Role and Regulation of Poly-3-Hydroxybutyrate in Nitrogen Fixation in Azorhizobium caulinodans
Authors: Crang Nick , Borah Khushboo , James Euan K. , Jorrín Beatriz , Green Patrick , Tkacz Andrzej , East Alison K. , Poole Philip S. 
Published: December 2021

An Azorhizobium caulinodans phaC mutant (OPS0865) unable to make poly-3-hydroxybutyrate (PHB), grows poorly on many carbon sources and cannot fix nitrogen in laboratory culture. However, when inoculated onto its host plant, Sesbania rostrata, the phaC mutant consistently fixed nitrogen. Upon reisolation from S. rostrata root nodules, a suppressor strain (OPS0921) was isolated that has significantly improved growth on a variety of carbon sources and also fixes nitrogen in laboratory culture. The suppressor retains the original mutation and is unable to synthesize PHB. Genome sequencing revealed a suppressor transition mutation, G to A (position 357,354), 13 bases upstream of the ATG start codon of phaR in its putative ribosome binding site (RBS). PhaR is the global regulator of PHB synthesis but also has other roles in regulation within the cell. In comparison with the wild type, translation from the phaR native RBS is increased approximately sixfold in the phaC mutant background, suggesting that the level of PhaR is controlled by PHB. Translation from the phaR mutated RBS (RBS*) of the suppressor mutant strain (OPS0921) is locked at a low basal rate and unaffected by the phaC mutation, suggesting that RBS* renders the level of PhaR insensitive to regulation by PHB. In the original phaC mutant (OPS0865), the lack of nitrogen fixation and poor growth on many carbon sources is likely to be due to increased levels of PhaR causing dysregulation of its complex regulon, because PHB formation, per se, is not required for effective nitrogen fixation in A. caulinodans. [Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Orthoplastic Reconstruction of Type IIIB Open Tibial Shaft Fractures Using Debrided, Devitalized Cortical Segments: Health-Related Quality-of-Life Outcomes
Authors: Al-Hourani Khalid , Pearce Oliver , Stoddart Michael , Riddick Andrew , Khan Umraz , Kelly Michael B. 
Published: December 2021

Objective:
To determine health-related quality of life (HRQoL) in patients who sustained type IIIB open tibial diaphyseal (OTA/AO-42) fractures and underwent orthoplastic reconstruction using mechanically relevant devitalized bone (ORDB) versus those who did not require the use of devitalized bone as part of their orthoplastic reconstruction.

Design:
Consecutive cohort study.

Patients/Participants:
The study included 74 patients who sustained a type IIIB open tibial diaphyseal fracture requiring orthoplastic reconstruction over a 4-year period in a major trauma center. All patients underwent a two-stage orthoplastic reconstruction protocol, with the second stage consisting of definitive fixation and flap coverage (free fascial anterolateral thigh flap) in a single sitting. Patients were contacted at a minimum of 30 months to measure HRQoL.

Intervention:
Patients requiring ORDB versus those who did not require the use of devitalized bone as part of their orthoplastic reconstruction.

Main Outcome Measurements:
The primary outcome measure was HRQoL ascertained using Euro-Qol (EQ)-5D and Short-Form (SF)-36 scores.

Results:
Thirty (n = 30) patients underwent ORDB with the remaining 44 not requiring devitalized bone as part of their reconstruction. The median age was 46.5 years [interquartile range (IQR) 29.0], with a median follow-up of 3.8 years (IQR 1.5). The median cohort EQ-5D was 0.743 (IQR 0.222), ORDB 0.743 (IQR 0.195) versus non-ORDB 0.748 (IQR 0.285), P = 0.71. The median physical component SF-36 score was 80 (IQR 50), ORDB 80 (IQR 34.5) versus non-ORDB 77.5 (IQR 58.75), P = 0.72. The median mental component SF-36 score was 80 (IQR 28), ORDB 80 (IQR 21) versus non-ORDB 80 (IQR 36), P = 0.29.

Conclusions:
In patients who sustained a type IIIB open tibial shaft fracture and who underwent a 2-stage orthoplastic reconstruction, ORDB does not seem to be associated with inferior health-related quality of life based on EQ-5D or SF-36 scores. The results of this approach should be considered within the strict combined orthoplastic approach in the study unit.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Comparison of the Prevalence of, Demographics of, and Effects on Outcomes of Bilateral Versus Unilateral Femoral Shaft Fractures: A Retrospective Cohort Analysis From the National Trauma Data Bank
Authors: Cosgrove Christopher T. , Wolinsky Philip R. , Berkes Marschall B. , McAndrew Christopher M. , Stwalley Dustin L. , Miller Anna N. 
Published: December 2021

Objectives:
To document the prevalence of, and the effect on outcomes, operatively treated bilateral femur fractures treated using contemporary treatments.

Design:
A retrospective cohort using data from the National Trauma Data Bank.

Participants:
In total, 119,213 patients in the National Trauma Data Bank between the years 2007 and 2015 who had operatively treated femoral shaft fractures.

Main Outcome Measurements:
Complication rates, hospital length of stay (LOS), days in the intensive care unit (ICU LOS), days on a ventilator, and mortality rates.

Results:
Patients with bilateral femur fractures had increased overall complications (0.74 vs. 0.50, P < 0.0001), a longer LOS (14.3 vs. 9.2, P < 0.0001), an increased ICU LOS (5.3 vs. 2.4, P < 0.0001), and more days on a ventilator (3.1 vs. 1.3, P < 0.0001), when compared with unilateral fractures. Bilateral femoral shaft fractures were independently associated with worse outcomes in all primary domains when adjusted by Injury Severity Score (P < 0.0001), apart from mortality rates. Age-adjusted bilateral injuries were independently associated with worse outcomes in all primary domains (P < 0.0001) except for the overall complication rate. A delay in fracture fixation beyond 24 hours was associated with increased mortality (P < 0.0001) and worse outcomes for all other primary measures (P < 0.0001 to P = 0.0278) for all patients.

Conclusions:
Bilateral femoral shaft fractures are an independent marker for increased hospital and ICU LOS, number of days on a ventilator, and increased complication rates, when compared with unilateral injuries and adjusted for age and Injury Severity Score. Timely definitive fixation, in a physiologically appropriate patient, is critical because a delay is associated with worse inpatient outcome measures and higher mortality rates.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Serum metabolomic profiling reveals potential biomarkers in assessing the management of women with polycystic ovary syndrome: a randomized controlled trial
Authors: Ding Xuesong , Deng Yan , Wang Yanfang , Xue Wei , Zhu Shiyang , Ma Xiao , Ma Ruilin , Sun Aijun 
Published: December 2021

Abstract

Background:
As one of the most common endocrinal disorders for women at childbearing age, the diagnostic criteria of polycystic ovary syndrome (PCOS) have been defined differently among different international health organizations. Phenotypic heterogeneity of PCOS also brings about difficulties for its diagnosis and management assessment. Therefore, more efficient biomarkers representing the progression of PCOS are expected to be integrated into the monitoring of management process using metabolomic approaches.

Methods:
In this prospective randomized controlled trial, 117 PCOS patients were enrolled from December 2016 to September 2017. Classical diagnostic parameters, blood glucose, and metabolome were measured in these patients before and at 2 months and 3 months of different medical interventions. The receiver operating characteristic (ROC) curves were built based on multivariate statistical analysis using data at baseline and 3 months’ management, and combinational biomarkers with appreciable sensitivity and specificity were selected, which then validated with data collected at 2 months.

Results:
A set of metabolites including glutamic acid, aspartic acid, 1-methylnicotinamide, acetylcarnitine, glycerophosphocholine, and oleamide were filtered out with high performance in representing the improvement through 3-month management of PCOS with high sensitivity and specificity in ROC analysis and validation with other two groups showed an appreciable area under the curve over 0.96.

Conclusions:
The six metabolites were representative of the remission of PCOS through medical intervention, making them a set of potential biomarkers for assessing the outcome of PCOS management.

Trial Registration:
ClinicalTrials.gov, NCT03264638.
Visual guidelines and tutoring in pediatric urological surgery
Authors: Kotcherov Stanislav , Rotem Shahar , Jaber Jawdat , Avraham Galit , Lev Gennady , Darmon Michal , Gabay Yudith , Chertin Boris 
Published: December 2021

Abstract

Background
The aim of this prospective randomized study was to evaluate the impact of visual guidelines (picture book) and parents tutoring on pediatric urological surgery on parent’s stress and anxiety, the number of postoperative contacts, and complications.

Materials and methods
Following institutional ethical committee approval, a special picture book reflecting different stages of the convalescent period following multiple types of pediatric urological surgery was developed. Parents were randomly divided into 2 groups in which 33 parents in Group 1 received the picture book in addition to routine instructions prior to the surgery and 31 in Group 2 received only routine postoperative instructions. The parents were asked to answer a questionnaire (Amsterdam Preoperative Anxiety and Information Scale) regarding the level of anxiety before surgery and immediately after surgery in the recovery room. The number of postoperative parent’s calls, nonplaned emergency room visits, and complications were recorded.

Results
No statistically significant difference in perioperative parental anxiety was found (p = 0.88). The visual tutoring group had a significantly lower rate of emergency room admissions (6.6% vs. 18.6%, p = 0.0433), however parents from this group made a higher number of postoperative calls (9.9% vs. 3.1%, p = 0.38). Two (6.6%) from the tutoring group expressed their desire to omit visual counseling in future surgical preparation and 4 (13.2%) did not have an opinion. Overall satisfaction with regards to the preoperative counseling and information and the number of postoperative complications was similar in both groups.

Conclusions
Visual tutoring does not add any value to parental anxiety but seems helpful in reducing postoperative emergency room visits. Some parents preferred to exclude visual information from future preoperative counseling.