bluuebunny/crossref_metadata_2025_split huggingface dataset:
Musculoskeletal Tuberculosis
Authors: Chapuis Elisa , Benali Khadija , Silbermann-Hoffman Olivia , Berleur Marie , Ottaviani Sébastien , van Gysel Damien , Goulenok Tiphaine , Papo Thomas , Sacre Karim 
Published: March 2022

Background/ Objective
Skeletal tuberculosis (TB) is rare. We aimed to report on diagnostic strategy and treatment of skeletal TB.

Methods
In this multidisciplinary single-center medical records review study, all adult patients admitted between January 2009 and December 2019 with microbiologically proven skeletal TB were included. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records.

Results
Among 184 patients identified with TB, 21 (16 women, 42 years [27, 48 years]) had skeletal involvement. Skeletal TB included spondylitis (n = 11), lytic bone lesions (n = 7), sacroiliitis (n = 5), arthritis (n = 3), osteitis (n = 2), and diffuse muscle abscesses without bone lesion (n = 1). Lytic lesions involved both axial and peripheral skeleton at multiple sites in most cases. 18F-fluorodeoxyglucose positron emission tomography was performed in 13 patients and helped to detect multifocal asymptomatic lesions and to target biopsy. All patients were treated with anti-TB therapy for 7 to 18 months. Fifteen patients (71.4%) received steroids as an adjunct therapy. Eleven patients needed an orthopedic immobilization corset, and 3 patients underwent surgery. All patients clinically improved under treatment, but 2 relapsed over a median follow-up of 24 months (12–30 months). No patient died or suffered long-term disabilities.

Conclusion
Our study emphasizes the diversity of skeletal involvement in TB. 18F-fluorodeoxyglucose positron emission tomography scanner at diagnosis is key to assess the extension of skeletal involvement and guide extraskeletal biopsy. Neurological complications might be prevented by adding corticosteroids to anti-TB therapy.
Impact of a Musculoskeletal “Mini-Residency” Professional Development Program on Knee Magnetic Resonance Imaging Orders by Primary Care Providers
Authors: Mulcaire-Jones Erica , Barker Andrea M. , Beck J. Peter , Lawrence Phillip , Cannon Grant W. , Battistone Michael J. 
Published: March 2022

Background
The US Department of Veterans Affairs has created a portfolio of educational programs to train primary care providers (PCPs) in the evaluation and management of common musculoskeletal (MSK) conditions. Appropriate resource utilization for evaluation of knee pain, including limiting unnecessary magnetic resonance imaging (MRI) studies, is an important theme of these initiatives. The objective of this study was to report the utilization of knee MRI by PCP providers before and after the MSK education program and to determine the appropriateness of these MRI orders.

Methods
Twenty-six PCPs participated in the MSK Mini-Residency educational program held in Salt Lake City between April 2012 and October 2014. Knee MRI orders submitted by these providers 12 months before and 12 months after their participation were reviewed. Magnetic resonance imaging orders were categorized as “inappropriate,” “probably inappropriate,” or “possibly appropriate,” based on accepted guidelines for knee MRI utilization. Differences in the numbers of precourse and postcourse MRI orders for each of these categories were compared using Student t test.

Results
Following our program, MRI orders decreased from 130 (precourse) to 93 (postcourse), a reduction of 28% (p = 0.04). This reduction was observed entirely within the “inappropriate” and “probably inappropriate” categories; the number of orders categorized as “possibly appropriate” increased, but not significantly.

Conclusions
The MSK Mini-Residency training program was a successful educational intervention and was associated with a reduction in inappropriate knee MRI utilization for some participants, while keeping appropriate MRI utilization stable.
Data Resources for Evaluating the Economic and Financial Consequences of Surgical Care in the United States
Authors: Scott John W. , Ayoung-Chee Patricia , Lester Erica L.W. , Bruns Brandon R. , Davis Kimberly A. , Gore Amy , Knowlton Lisa Marie , Liu Charles , Martin R. Shayn , Oh Esther Jiin , Ross Samuel Wade , Wandling Michael , Minei Joseph P. , Staudenmayer Kristan ,   on behalf of the AAST Healthcare Economics Subcommittee
Published: March 2022

ABSTRACT
Evaluating the relationship between healthcare costs and quality is paramount in the current healthcare economic climate, as an understanding of value is needed to drive policy decisions. While many policy analyses are focused on the larger healthcare system, there is a pressing need for surgically-focused economic analyses. Surgical care is costly, innovative technology is constantly introduced into the operating room, and surgical care impacts patients’ short- and long-term physical and economic wellbeing. Unfortunately, significant knowledge gaps exist regarding the relationship between cost, value, and economic impact of surgical interventions. Despite the plethora of healthcare data available in the forms of claims databases, discharge databases, and national surveys, no single source of data contains all the information needed for every policy-relevant analysis of surgical care. For this reason, it is important to understand which data are available and what can be accomplished with each of the datasets. In this article, we provide an overview of databases commonly used in surgical health services research. We focus our review on the following five categories of data: governmental claims databases, commercial claims databases, hospital-based clinical databases, state and national discharge databases, and national surveys. For each, we present a summary of the database sampling frame, clinically relevant variables, variables relevant to economic analyses, strengths, weaknesses, and examples of surgically-relevant analyses. This review is intended to improve understanding of the current landscape of data available as well as stimulate novel analyses among surgical populations. Ongoing debates over national health policy reforms may shape the delivery of surgical care for decades to come. Appropriate use of available data resources can improve our understanding of the economic impact of surgical care on our health care system and our patients.

Level of Evidence
V
Tranexamic acid is not inferior to placebo with respect to adverse events in suspected traumatic brain injury patients not in shock with a normal head computed tomography scan: A retrospective study of a randomized trial
Authors: Harmer Jordan W. , Dewey Elizabeth N. , Meier Eric N. , Rowell Susan E. , Schreiber Martin A. 
Published: March 2022

BACKGROUND
A 2-g bolus of tranexamic acid (TXA) has been shown to reduce 28-day mortality in a randomized controlled trial. This study investigates whether out-of-hospital TXA use is associated with adverse events or unfavorable outcomes in suspected traumatic brain injury (TBI) when intracranial hemorrhage (ICH) is absent on initial computed tomography.

METHODS
This study used data from a 2015 to 2017, multicenter, randomized trial studying the effect of the following TXA doses on moderate to severe TBI: 2-g bolus, 1-g bolus plus 1-g infusion over 8 hours, and a placebo bolus with placebo infusion. Of the 966 participants enrolled, 395 with an initial computed tomography negative for ICH were included in this analysis. Fifteen adverse events (28-day incidence) were studied: myocardial infarction, deep vein thrombosis, seizure, pulmonary embolism, acute respiratory distress syndrome, cardiac failure, liver failure, renal failure, cerebrovascular accident, cardiac arrest, cerebral vasospasm, “any thromboembolism,” hypernatremia, acute kidney injury, and infection. Other unfavorable outcomes analyzed include mortality at 28 days and 6 months, Glasgow Outcome Scale—Extended score of ≤4 at discharge and 6 months, intensive care unit–free days, ventilator-free days, hospital-free days, and combined unfavorable outcomes. In both study drug groups, the incidence of dichotomous outcomes and quantity of ordinal outcomes were compared with placebo.

RESULTS
No statistically significant increase in adverse events or unfavorable outcomes was found between either TXA dosing regimen and placebo. Demographics and injury scores were not statistically different other than two methods of injury, which were overrepresented in the 1-g TXA bolus plus 1-g TXA infusion.

CONCLUSION
Administration of either a 2-g TXA bolus or a 1-g TXA bolus plus 1-g TXA 8-hour infusion in suspected TBIs without ICH is not associated with increased adverse events or unfavorable outcomes. Because the out-of-hospital 2-g bolus is associated with a mortality benefit, it should be administered in suspected TBI.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level II.
Predominance of community-associated, methicillin-susceptible Staphylococcus aureus infections among hospitalized children and adolescents
Authors: Tsirigotaki Maria , Giormezis Nikolaos , Maraki Sofia , Spiliopoulou Iris , Galanakis Emmanouil 
Published: March 2022

Introduction.

Staphylococcus aureus

infections cause significant morbidity and mortality in children and adolescents.

Gap Statement. There is limited data on the characteristics of

S. aureus

infections requiring hospitalization in childhood.

Aim.To investigate the molecular epidemiology and antibiotic resistance of

S. aureus

clinical isolates from children and adolescents.

Methodology.All

S. aureus

isolates recovered from patients aged <18 years, admitted to a referral hospital, with culture-proven invasive or non-invasive infections during the 4 year period 2015 to 2018 were analysed for antimicrobial resistance, virulence genes, PFGE and multilocus sequence typing (MLST). Cases were assigned to community-associated, community-onset healthcare-associated or hospital-associated infections based on epidemiological case definitions.

Results.Among 139

S. aureus

infections, 88.5 % (123/139) were caused by methicillin-susceptible isolates (MSSA) and 73.4 % (102/139) were classified as community-associated infections. tst and lukS/lukF-PV genes were more common among MRSA as compared to MSSA isolates (tst, p 0.04; lukS/lukF-PV, p 0.007). Invasive disease was noted in 22/139 patients (15.8 %). Staphylococcal scalded skin syndrome caused by fusidic-resistant MSSA increased over time (22.8 % in 2017–2018 vs 8.3 % in 2015–2016, OR 3.24; 95 % CI 1.10–8.36; P 0.03). By PFGE genotyping, 22 pulsotypes were identified. A total of five sequence types (STs) were identified among 58 isolates analysed by MLST. More than one third of MSSA isolates (40/123, 32.5 %) and 13/23 (56.5 %) of SSSS isolates belonged to pulsotype 1, classified as sequence type 121 (ST121). MRSA isolates were equally distributed to pulsotypes A (ST30), B (ST239), C (ST80), H (ST225). ST121 isolates carried fnbA (40/40), eta/etb genes (29/40), exhibited high resistance to fusidic acid and were increasingly resistant to mupirocin.

Conclusion.In our population, community-associated MSSA was the predominant cause of

S. aureus

infections characterized by polyclonality, increasing resistance to fusidic acid and mupirocin. PFGE type 1 ST121 clone, harboured exfoliative toxin genes and was associated with rising trends of SSSS.
Nationwide Effectiveness of First and Second SARS-CoV2 Booster Vaccines during the Delta and Omicron Pandemic Waves in Hungary (HUN-VE 2 Study)
Authors: Kiss Zoltán , Wittmann István , Polivka Lőrinc , Surján György , Surján Orsolya , Barcza Zsófia , Molnár Gergő Attila , Nagy Dávid , Müller Veronika , Bogos Krisztina , Nagy Péter , Kenessey István , Wéber András , Pálosi Mihály , Szlávik János , Schaff Zsuzsa , Szekanecz Zoltán , Müller Cecília , Kásler Miklós , Vokó Zoltán 
Published: March 2022

AbstractBackgroundIn Hungary, the pandemic waves in late 2021 and early 2022 were dominated by the Delta and Omicron SARS-CoV-2 variants, respectively. Booster vaccines were offered with one or two doses for the vulnerable population during these periods.Methods and FindingsThe nationwide HUN-VE 2 study examined the effectiveness of primary immunization, single booster, and double booster vaccination in the prevention of Covid-19 related mortality during the Delta and Omicron waves, compared to an unvaccinated control population without prior SARS-CoV-2 infection during the same study periods.The risk of Covid-19 related death was 55% lower during the Omicron vs. Delta wave in the whole study population (n=9,569,648 and n=9,581,927, respectively; rate ratio [RR]: 0.45, 95% confidence interval [CI]: 0.44–0.48). During the Delta wave, the risk of Covid-19 related death was 74% lower in the primary immunized population (RR: 0.26; 95% CI: 0.25–0.28) and 96% lower in the booster immunized population (RR: 0.04; 95% CI: 0.04–0.05), vs. the unvaccinated control group. During the Omicron wave, the risk of Covid-19 related death was 40% lower in the primary immunized population (RR: 0.60; 95% CI: 0.55–0.65) and 82% lower in the booster immunized population (RR: 0.18; 95% CI: 0.16–0.2) vs. the unvaccinated control group. The double booster immunized population had a 93% lower risk of Covid-19 related death compared to those with only one booster dose (RR: 0.07; 95% CI. 0.01–0.46). The benefit of the second booster was slightly more pronounced in older age groups.ConclusionsThe HUN-VE 2 study demonstrated the significantly lower risk of Covid-19 related mortality associated with the Omicron vs. Delta variant and confirmed the benefit of single and double booster vaccination against Covid-19 related death. Furthermore, the results showed the additional benefit of a second booster dose in terms of SARS-CoV-2 infection and Covid-19 related mortality.
Feeding practices and cost of diet of six-month-old HIV exposed uninfected compared to HIV unexposed uninfected infants in a peri-urban community in South Africa
Authors: Nyofane Mothusi , Hoffman Marinel , Botha Tanita , Feucht Ute 
Published: March 2022

AbstractBackgroundThe increasing population of HIV-exposed-uninfected (HEU) infants are known to be at risk of poor nutritional status and suboptimal growth, with biological risk factors implicated, yet the cost to families of feeding infants is often overlooked.ObjectiveThe study compared the infant feeding practices and costs and macronutrient intake of HEU vs HIV-unexposed-uninfected (HUU) six-month-old infants in the Gauteng Province of South Africa.MethodsA cross-sectional study investigated 46 HEU and 55 HUU infants aged six months and utilised a single quantified 24-hr recall and the FoodFinder™ program for meal analysis. The estimation of diet cost utilised supermarket food prices based on the 24-hr recall method.ResultsMothers of HEU infants had significantly lower income (p<0.01) and educational attainment (p=0.03). The infant feeding practices differed between HEU vs HUU infants (p=0.05): exclusive breastfeeding (50.0% vs 34.0%) and mixed breastfeeding (38.1% vs 64.2%). Common complementary foods for HEU versus HUU infants included commercial infant cereals (CIC) (48.7% vs 70.9%; p=0.04); fruits and vegetables (33.3% vs 15.7%; p=0.05) and maize meal porridge (25.6% vs 15.7%; p=0.24), respectively. The mean daily cost of diet of HEU vs HUU infants was 8.55±7.35ZAR ($0.68±0.59USD) vs 10.97±7.92ZAR($0.88±0.63 USD); (p=0.10). Regarding the complementary feeding, there were non-significant differences in protein, fat, and carbohydrate intakes (p>0.05) and their costs per daily intake (p>0.05) between the groups.ConclusionThere are no significant differences in cost, feeding and macronutrient intakes between HEU and HUU. Suboptimal breastfeeding practices remains an issue within the first six months. More sustained effort is required to support and promote exclusive breastfeeding.
Age and product dependent vaccine effectiveness against SARS-CoV-2 infection and hospitalisation among adults in Norway: a national cohort study, July – November 2021
Authors: Starrfelt Jostein , Danielsen Anders Skyrud , Buanes Eirik Alnes , Juvet Lene Kristine , Lyngstad Trude Marie , Isaksson Rø Gunnar Øyvind , Veneti Lamprini , Watle Sara Viksmoen , Meijerink Hinta 
Published: March 2022

AbstractBackgroundCOVID-19 vaccines have been crucial in the pandemic response and understanding changes in vaccines effectiveness is essential to guide vaccine policies. Though the Delta variant is no longer dominant, understanding vaccines effectiveness properties will provide essential knowledge to comprehend the development of the pandemic and estimate potential changes over time.MethodsIn this population-based cohort study, we estimated vaccine effectiveness against SARS-CoV-2 infections, hospitalisations, intensive care admissions, and death using Cox proportional hazard models, across different vaccine product regimens and age groups, between 15 July and 31 November 2021 (Delta variant period). Vaccine status is included as a time-varying covariate and all models were adjusted for age, sex, comorbidities, county of residence, country of birth, and living conditions. Data from the entire adult Norwegian population were collated from the National Preparedness Register for COVID-19 (Beredt C19).ResultsThe overall adjusted vaccine effectiveness against infection decreased from 81.3% (confidence interval (CI): 80.7 to 81.9) in the first two to nine weeks after receiving a second dose to 8.6% (CI:4.0 to 13.1) after more than 33 weeks, compared to 98.6% (CI: 97.5 to 99.2) and 66.6% (CI: 57.9 to 73.6) against hospitalisation respectively. After the third dose (booster), the effectiveness was 75.9% (CI: 73.4 to 78.1) against infection and 95.0% (CI: 92.6 to 96.6) against hospitalisation. Spikevax or a combination of mRNA products provided the highest protection, but the vaccine effectiveness decreased with time since vaccination for all vaccine regimens.ConclusionsEven though the vaccine effectiveness against infection wanes over time, all vaccine regimens remained effective against hospitalisation after the second vaccine dose. For all vaccine regimens, a booster facilitated recovery of effectiveness. The results from this support the use of heterologous schedules, increasing flexibility in vaccination policy.Fundingno external funding
Reproductive health needs of Human papillomavirus (HPV) Positive women: A systematic review
Authors: Galeshi Mina , Shirafkan Hoda , Yazdani Shahla , Motaghi Zahra 
Published: March 2022

AbstractBackgroundHuman papillomavirus is one of the most important transmitted viruses that causes of cervical cancer.In women undergoing cervical screening, it is important to be aware of ways to reduce anxiety. The present systematic review conducted to determine the reproductive health needs of women with HPV.MethodsIn this systematic review, articles without time constraints searched in PubMed, Scopus, Web of Science, Google Scholar and Iranian Magiran, SID and Iranmedex.Keywords used: HPV, Information, Want, Need, Know, etc. and their Persian equivalents in the title and abstract of the articles.Papers after identification by two researchers Contradictions evaluated and discussed with the third author.ResultsAt first 1056articles retrieved which after removing,13articles published between2004-2021were entered. The studies were qualitative(N=9),quantitative(N=3), and one was unclear.Most qualitative studies collected data using individual interviews(N=7), two qualitative studies, narratives of HPV patients from a website of patient experiences and questions. The quality evaluation showed that good=8, Average=2, and one was of poor. There is not enough information about Friedman AL etal and Garland SM articles to check the quality, but since these studies were valuable, they included in the study according to the opinion of the research team.ConclusionSurveys showed that the majority of women had unanswered questions about their HPV test results. The information that women thought was helpful in interpreting their test results included having a high-risk type of HPV, the risk of short-term and long-term cancer, and cancer survival statistics for the virus. Women also needed information about sexual transmission, how HPV tested positive in a long-term relationship, and the potential consequences for their partners and the risk of re-infection. Younger women had questions about whether HPV could affect fertility.
The complex relationship of air pollution and neighborhood socioeconomic deprivation and their association with cognitive decline
Authors: Christensen Grace , Li Zhenjiang , Pearce John , Marcus Michele , Lah James J. , Waller Lance A. , Ebelt Stefanie , Huels Anke 
Published: March 2022

AbstractBackgroundAir pollution and neighborhood socioeconomic status (nSES) have been shown to affect cognitive decline in older adults. In previous studies, nSES acts as both a confounder and an effect modifier between air pollution and cognitive decline.ObjectivesThis study aims to examine the individual and joint effects of air pollution and nSES on cognitive decline on adults 50 years and older in Metro Atlanta, USA.MethodsPerceived memory and cognitive decline was assessed in 11,897 participants aged 50+ years from the Emory Healthy Aging Study (EHAS) using the cognitive function instrument (CFI). Three-year average air pollution concentrations for 12 pollutants and 16 nSES characteristics were matched to participants using census tracts. Individual exposure linear regression and LASSO models explore individual exposure effects. Environmental mixture modeling methods including, self-organizing maps (SOM), Bayesian kernel machine regression (BKMR), and quantile-based G-computation explore joint effects, and effect modification between air pollutants and nSES characteristics on cognitive decline.ResultsParticipants living in areas with higher air pollution concentrations and lower nSES experienced higher CFI scores (beta: 0.121; 95% CI: 0.076, 0.167) compared to participants living in areas with low air pollution and high nSES. Additionally, the BKMR model showed a significant overall mixture effect on cognitive decline, indicating synergy between air pollution and nSES. These joint effects explain protective effects observed in single-pollutant linear regression models, even after adjustment for confounding by nSES (e.g., an IQR increase in CO was associated with a 0.038-point decrease (95% CI: -0.06, -0.01) in CFI score).DiscussionObserved protective effects of single air pollutants on cognitive decline can be explained by joint effects and effect modification of air pollutants and nSES. Researchers must consider nSES as an effect modifier if not a co-exposure to better understand the complex relationships between air pollution and nSES in urban settings.