bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined Clinical, Epidemiological, and Genome-Based Analysis Identified a Nationwide Outbreak of Burkholderia cepacia Complex Infections Caused by Contaminated Mouthwash Solutions
Authors: Bender Jennifer K , Haller Sebastian , Pfeifer Yvonne , Hogardt Michael , Hunfeld Klaus-Peter , Thürmer Andrea , Zanuzdana Arina , Werner Markus , Kunz Bernd , Eisenberger David , Pfennigwerth Niels , Kempf Volkhard A J , Werner Guido , Eckmanns Tim 
Published: March 2022

Abstract

Background
In September 2018, Burkholderia cepacia complex (BCC) infections in 3 patients associated with exposure to a mouthwash solution (MWS) were reported to the Robert Koch Institute (RKI). As the product was still on the market and the scale of the outbreak was unclear, a nation-wide investigation was initiated.

Methods
We aimed to investigate BCC infections/colonizations associated with MWS. Hospitals, laboratories, and public health services were informed that BCC isolates should be sent to the RKI. These isolates were typed by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) including development of an ad hoc core genome MLST (cgMLST) scheme.

Results
In total, 36 patients from 6 hospitals met the case definition, the last patient in November 2018. Twenty-nine isolates from 26 of these patients were available for typing. WGS analysis revealed 2 distinct cgMLST clusters. Cluster 1 (Burkholderia arboris) contained isolates from patients and MWS obtained from 4 hospitals and isolates provided by the manufacturer. Patient and MWS isolates from another hospital were assigned to cluster 2 (B. cepacia).

Conclusions
The combined clinical, epidemiological, and microbiological investigation, including whole-genome analysis, allowed for uncovering a supraregional BCC outbreak in health care settings. Strains of B. arboris and B. cepacia were identified as contaminating species of MWS bottles and subsequent colonization and putative infection of patients in several hospitals. Despite a recall of the product by the manufacturer in August 2018, the outbreak lasted until December 2018. Reporting of contaminated medical products and recalls should be optimized to protect patients.
Alfalfa biotypes with putative enhanced cell wall digestibility and effects on performance of growing beef steers
Authors: Karls Caleb W , Combs David K , Liou M , Schaefer Daniel M 
Published: March 2022

Abstract
Three alfalfa biotypes were chosen based on the presumption that they would be sources of alfalfa herbage that differed in lignin concentration and therefore cell wall digestibility. The hypothesis was that a lesser lignin concentration would result in greater alfalfa neutral detergent fiber (NDF) digestibility and greater beef steer growth performance. The three alfalfa biotypes were HarvXtra (Forage Genetics International), Hi-Gest 360 (Alforex Seeds), and a control alfalfa, LegenDairy XHD (Winfield Solutions LLC). High-moisture wrapped bales were prepared from second-harvest, d 30 crops. Digestibility of NDF was determined using in vitro incubations and a steer digestibility trial. Alfalfa baleage and trace mineral salt were fed to Angus steers (300 kg initial body weight, 4 pens/treatment) in an 83-day growing-phase trial. Alfalfa acid detergent lignin concentrations were 75.6, 71.8, and 63.0 g/kg dry matter (P = 0.34) for LegenDairy, Hi-Gest and HarvXtra, respectively. Based on in vitro total-tract NDF digestibility coefficients, HarvXtra tended (P ≥ 0.09) to have the highest NDF digestibility. Alfalfa biotype affected in vivo apparent total tract digestibility of NDF (P &lt; 0.001) and there was a trend for an effect on acid detergent fiber digestibility (P = 0.051). Hi-Gest and HarvXtra had similar in vivo apparent NDF digestibilities, which were greater than for LegenDairy (P &lt; 0.05). There was no alfalfa biotype effect on daily alfalfa dry matter intake (DMI; P = 0.51) or average daily gain (P = 0.25) by growing steers. The absence of an effect by the novel alfalfa biotypes on DMI by growing steers suggests that the compositional and digestibility differences of the novel alfalfa biotypes compared to LegenDairy were not sufficient to alleviate the limitation of physical fill (if evident) on DMI. If more disparity in cell wall composition and NDF digestibility were to exist between control and reduced-lignin biotypes, then perhaps an advantage in cattle growth performance for a reduced-lignin alfalfa biotype would be detectable.
Quality metrics and outcomes among critically ill patients in China: results of the national clinical quality control indicators for critical care medicine survey 2015–2019
Authors: Rui Xi , Dong Fen , Ma Xudong , Su Longxiang , Shan Guangliang , Guo Yanhong , Long Yun , Liu Dawei , Zhou Xiang ,   on behalf of China-NCCQC Group
Published: March 2022

Background:
It is crucial to improve the quality of care provided to ICU patient, therefore a national survey of the medical quality of intensive care units (ICUs) was conducted to analyze adherence to quality metrics and outcomes among critically ill patients in China from 2015 to 2019.

Methods:
This was an ICU-level study based on a 15-indicator online survey conducted in China. Considering that ICU care quality may vary between secondary and tertiary hospitals, direct standardization was adopted to compare the rates of ICU quality indicators among provinces/regions. Multivariate analysis was performed to identify potential factors for in-hospital mortality and factors related to ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSIs), and catheter-associated urinary tract infections (CAUTIs).

Results:
From the survey, the proportions of structural indicators were 1.83% for the number of ICU inpatients relative to the total number of inpatients, 1.44% for ICU bed occupancy relative to the total inpatient bed occupancy, and 51.08% for inpatients with Acute Physiology and Chronic Health Evaluation II scores ≥15. The proportions of procedural indicators were 74.37% and 76.60% for 3-hour and 6-hour surviving sepsis campaign bundle compliance, respectively, 62.93% for microbiology detection, 58.24% for deep vein thrombosis prophylaxis, 1.49% for unplanned endotracheal extubations, 1.99% for extubated inpatients reintubated within 48 hours, 6.38% for unplanned transfer to the ICU, and 1.20% for 48-hour ICU readmission. The proportions of outcome indicators were 1.28‰ for VAP, 3.06‰ for CRBSI, 3.65‰ for CAUTI, and 10.19% for in-hospital mortality. Although the indicators varied greatly across provinces and regions, the treatment level of ICUs in China has been stable and improved based on various quality control indicators in the past 5 years. The overall mortality rate has dropped from 10.19% to approximately 8%.

Conclusions:
The quality indicators of medical care in China's ICUs are heterogeneous, which is reflected in geographic disparities and grades of hospitals. This study is of great significance for improving the homogeneity of ICUs in China.
Multicenter study of the clinicopathological features and recurrence risk prediction model of early-stage breast cancer with low-positive human epidermal growth factor receptor 2 expression in China (Chinese Society of Breast Surgery 021)
Authors: Xin Ling , Wu Qian , Zhan Chongming , Qin Hongyan , Xiang Hongyu , Xu Ling , Ye Jingming , Duan Xuening , Liu Yinhua 
Published: March 2022

Abstract

Background
: Breast cancer with low-positive human epidermal growth factor receptor 2 (HER2) expression has triggered further refinement of evaluation criteria for HER2 expression. We studied the clinicopathological features of early-stage breast cancer with low-positive HER2 expression in China and analyzed prognostic factors.

Methods
: Clinical and pathological data and prognostic information of patients with early-stage breast cancer with low-positive HER2 expression treated by the member units of the Chinese Society of Breast Surgery and Chinese Society of Surgery of Chinese Medical Association, from January 2015 to December 2016 were collected. The prognostic factors of these patients were analyzed.

Results
: Twenty-nine hospitals provided valid cases. From 2015 to 2016, a total of 25,096 cases of early-stage breast cancer were treated, 7642 (30.5%) of which had low-positive HER2 expression and were included in the study. After ineligible cases were excluded, 6486 patients were included in the study. The median follow-up time was 57 months (4–76 months). The disease-free survival rate was 92.1% at 5 years, and the overall survival rate was 97.4% at 5 years. At the follow-up, 506 (7.8%) cases of metastasis and 167 (2.6%) deaths were noted. Multivariate Cox regression analysis showed that tumor stage, lymphvascular invasion, and the Ki67 index were related to recurrence and metastasis (P < 0.05). The recurrence risk prediction model was established using a machine learning model and showed that the area under the receiving operator characteristic curve was 0.815 (95% confidence interval: 0.750–0.880).

Conclusions
: Early-stage breast cancer patients with low-positive HER2 expression account for 30.5% of all patients. Tumor stage, lymphvascular invasion, and the Ki67 index are factors affecting prognosis. The recurrence prediction model for breast cancer with low-positive HER2 expression based on a machine learning model had a good clinical reference value for predicting the recurrence risk at 5 years.

Trial registration
: ChiCTR.org.cn, ChiCTR2100046766.
VITRECTOMY FOR DIABETIC COMPLICATIONS
Authors: Rush Ryan B. , Rush Sloan W. , Reinauer Robert M. , Bastar Pedro Gomez , Browning David J. 
Published: March 2022

Purpose:
To report updated clinical outcomes in subjects undergoing pars plana vitrectomy (PPV) using modern techniques and equipment for the treatment of proliferative diabetic retinopathy–related complications. Pooled analysis of five randomized clinical trials conducted at the same institution and included both study and control subjects from the trials.

Methods:
There were 943 subjects who prospectively underwent small-gauge PPV with antivascular endothelial growth factor pretreatment for proliferative diabetic retinopathy–related complications and completed 6-month follow-up.

Results:
The visual acuity of the study population improved from median 2.00 (interquartile range 1.3, 2.3) at baseline to median 1.00 (interquartile range 0.5, 1.3) at 6 months. One hundred and eighty-four patients (19.5%) achieved 20/50 or better acuity, and 652 patients (69.1%) achieved 20/200 or better acuity at 6 months. The vision improved or remained stable in 901 patients (95.5%), and 11 patients (1.2%) developed no light perception at 6 months. Intraoperative complications occurred in 343 cases (36.4%), and 199 cases (21.1%) experienced a postoperative complication. The most common postoperative complication was vitreous hemorrhage in 124 cases (62.3% of all complications). Unplanned secondary PPV was necessary in 86 cases (9.1%).

Conclusion:
This study reports updated clinical outcomes in patients undergoing PPV for proliferative diabetic retinopathy–related complications which compares favorably with the age before small-gauge PPV and antivascular endothelial growth factor pretreatment.
Anterior segment OCT findings and atypical refractive changes secondary to Epstein-Barr virus–associated nummular keratitis
Authors: Khan Asher , Murphy David A. , John Finny T. , Dastjerdi Mohammad H. , Riaz Kamran M. 
Published: March 2022

Introduction:
This case study described refractive changes that can occur in the setting of Epstein-Barr virus (EBV)-associated nummular keratitis (NK) and highlighted the role that anterior segment optical coherence tomography can serve in diagnosis and management of this disease.

Patient and Clinical Findings:
A 15-year-old girl developed subepithelial and anterior stromal corneal lesions and experienced progressive decline in the corrected distance visual acuity. She also developed a significant myopic shift with increased keratometric and refractive astigmatism.

Diagnosis, Intervention, and Outcomes
Targeted laboratory testing was performed. A diagnosis of chronic EBV-associated NK was made, and the patient was treated with systemic valacyclovir and topical steroids. Clinical appearance of lesions and corrected distance visual acuity improved, although refractive and keratometric changes persisted.

Conclusions:
Significant and persistent refractive changes can occur in the setting of EBV-associated NK, similar to those seen after conductive keratoplasty. Anterior segment optical coherence tomography can be a potentially helpful supplementary diagnostic imaging modality to avoid invasive testing in such cases.
The Pennsylvania Rural Health Model: Hospitals’ Early Experiences With Global Payment for Rural Communities
Authors: Scanlon Dennis , Sciegaj Mark , Wolf Laura J. , Vanderbrink Jocelyn , Johannes Bobbie , Shaw Bethany , Shumaker Kassidy , Farley Diane , Kitt-Lewis Erin , Davis Lisa 
Published: March 2022

SUMMARY

Goal:
In January 2019, the first cohort of rural hospitals began to operate under the Pennsylvania Rural Health Model for all-payer prospective global budget reimbursement as part of a demonstration funded by the Center for Medicare and Medicaid Innovation. Using information from primary source documents and interviews with key stakeholders, we sought to identify challenges and lessons learned throughout the design, development, and early implementation stages of the model.

Methods:
We relied on two qualitative research approaches: (1) review of primary source documents such as peer-reviewed publications and news accounts related to the model and (2) semistructured interviews with key staff and stakeholders, including current and former members of the Pennsylvania Department of Health, first-year applicant hospitals, technical assistance providers, and members of state and federal organizations and agencies familiar with the Pennsylvania and Maryland payment reform efforts for rural health and rural hospitals (N = 20).

Principal Findings:
We identified four primary attributes that innovative projects such as the model need: (1) a champion at the state and hospital level, significant cooperation across state agencies and between federal and state agencies, and support from nongovernment stakeholders; (2) ongoing engagement and education of all stakeholders, particularly related to rural health disparities, the challenges faced by rural hospitals (especially resource limitations), and the differences between rural and urban health and health service delivery; (3) realistic time lines, noting that stakeholder relationships with hospital leadership develop over many months; and (4) multistakeholder collaboration, because participating hospitals must have ongoing engagement with community members (i.e., consumers of healthcare), nonacute community partners, and other rural hospitals to foster a “rural health movement.”

Applications to Practice:
A successful Pennsylvania model holds promise for other states seeking to address the needs of rural populations and the hospitals that are vital to those communities. The lessons in this article can assist others in making the transition from volume to value in rural healthcare.
Is Maximum Available Hip Extension Range of Motion of the Residual Limb Reached During Passive Prone Lying in the Acute Stage After Dysvascular Transtibial Amputation?
Authors: Shaw Jason L. , Hackney James M. , Vandeloecht Kristi Shook , Newton Sean C. , Rainey Matthew A. , Reed Joshua J. , Suess Dani J. , Tinker Jennifer N. 
Published: March 2022

ABSTRACT

Introduction
Individuals after a transtibial amputation (TTA) are at risk to develop a hip flexion contracture, which may adversely affect future ambulation with a prosthesis. Although patients have traditionally been advised to lie prone to maintain or improve hip extension, compensatory pelvic tilting may occur in prone lying (PL). We sought to compare hip extension range of motion (ROM) in PL to the modified Thomas test (MTT) position, because research implies that, in the MTT, patients are better able to control for compensatory pelvic tilting. We hypothesized that individuals after a TTA would have a greater peak hip extension angle in the MTT position compared with the PL position.

Methods
Ten individuals after a dysvascular TTA, mean age of 60 ± 8.42 years, participated in this study. The same physical therapist marked the femur and pelvis for goniometric measurement of peak hip extension angle by 12 raters blinded to each other's measurements. The markers remained unchanged as six raters measured all participants in PL and six different raters measured all participants in the MTT position.

Results and Discussion
The intraclass correlation (ICC) indicated high interrater reliability between the raters for the PL and MTT positions (ICC = 0.985 for PL and 0.976 for MTT). The average peak hip extension angle in PL was −14.0° ± 13.3°, standard error of mean = 4.3°; and in the MTT position was −8.6° ± 15.3°, standard error of mean = 4.8° (the negative mean connotes that, on average, participants did not have hip extension to neutral for either condition). We found a mean of 5.4° ± 6.6° more hip extension ROM for the MTT position compared with PL (P = 0.028).

Conclusions
Our findings show that, on average, patients after a TTA have significantly greater peak hip extension angle in the MTT position compared with the PL position. Thus, passive PL may not be as effective of a stretching position for preventing a hip flexion contracture after a TTA, because PL does not always extend the patient's hip to its maximum available ROM, due to the reduced ability to control the pelvis from tilting anteriorly.

Clinical Relevance
Adequate hip flexor length is positively correlated with gait parameters, which include increased velocity and step length in people using a prosthesis after transtibial amputation. This study implies that the MTT position may be a better method for improving and maintaining hip flexor length over the traditional strategy of passive PL.
Development of a Length-Actuated Lower Limb Prosthesis: Functional Prototype and Pilot Study
Authors: Parr Therese E. , Hippensteal Alan R. , DesJardins John D. 
Published: March 2022

ABSTRACT

Introduction
The functional goal for unilateral transfemoral prosthesis users during ambulation is to restore the proper biomechanics and minimize the compensatory actions caused by limb asymmetries. These goals can often lead to embedded design elements that assume the prosthetic limb to look and move like the intact limb. An unconventional artificial limb design can transfer the focus from mimicking the skeletal structure to producing functional symmetry between limbs. In this pilot study, we introduce a length-actuated prosthesis design with the goal of functional biomimicry and collect qualitative feedback from two prosthesis users.

Materials and Methods
The length-actuated apparatus is attached to the distal end of a transfemoral prosthetic socket and consists of an external motor and a cam and Bowden cable system for powering and dynamically adjusting the prosthesis' length in synchronization with the gait cycle. Two transfemoral prosthesis users ambulated on a treadmill with the length-actuated prosthesis and gave anecdotal feedback.

Results
The prosthesis was able to support the patient's full weight and adjust to the lengths needed during the gait cycle, including toe clearance. The overall response to the prosthesis and concept was positive; prosthesis users stated that the prosthesis and the action of the knee seemed “comfortable,” and physicians concluded a sufficient and confident ambulation by the prosthesis users. The next iteration will address specific concerns of the prosthesis users by incorporating a more compact electromechanical system with sensors. This will aid in matching and continuously adjusting the prosthesis' length change timing with the cadence of the user's ambulation.

Conclusions
Overall, the prototype and study proved that linear motion could replace the leg shortening functions of lower-joint rotations, with anecdotal improvements in kinematics and comfort. Future work will consist of a quantitative evaluation of center of gravity displacement, ground reaction forces, toe clearance distance, and the possibilities of knee buckling.

Clinical Relevance
There are no commercially available lower-limb prostheses that control leg length with dynamic linear motion rather than user flexion and extension of a knee joint. Possible benefits that may come from a length-actuated prosthesis include improved loading symmetry and balance, as well as decreased muscle activity.
Evaluation of Hepatitis in Pediatric Patients With Presumed Nonalcoholic Fatty Liver Disease
Authors: Al-Harthy Fat’hiya , Kamath Neha , Hill Lee , Popov Jelena , Bossert Allison , Brill Herbert , Pai Nikhil 
Published: March 2022

Objectives:
In 2017, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition published clinical practice guidelines for the assessment and diagnosis of nonalcoholic fatty liver disease (NAFLD). We determined how frequently these investigations suggest an alternate etiology for chronic hepatitis in 8- to 17-year-old patients with body mass index >85%, elevated alanine aminotransferase and radiographic steatosis, and rates of adherence to 2017 guidelines.

Methods:
We conducted a retrospective chart review of patients presenting to McMaster Children’s Hospital from 2017–2020 for evaluation of suspected NAFLD. Bloodwork was reviewed.

Results:
Ninety-five patients met inclusion criteria. Abnormal bloodwork that required further testing was found in 28.4%; a different chronic liver disease was ultimately diagnosed in 11.6%. Only 9.5% received comprehensive, additional bloodwork for other causes of liver disease.

Conclusion:
A high proportion of patients evaluated for suspected NAFLD had bloodwork possibly suggesting an alternate diagnosis. Comprehensive testing was infrequently performed. These results reinforce the importance of maintaining a differential diagnosis among children presumed to have NAFLD.
Extensive Biventricular Cardiac Sarcoidosis Detected on FDG PET/CT Using a 72-Hour Ketogenic Diet Preparation Protocol
Authors: Lu Yang 
Published: March 2022

Abstract
A 49-year-old man had right bundle-branch block, with decreased left ventricle ejection fraction of 43%. Cardiac MRI demonstrated abnormal multifocal delayed gadolinium enhancement involving both ventricles. Cardiac sarcoidosis was further confirmed at cardiac biopsy. Dedicated FDG PET/CT with 72-hour ketogenic diet preparation to suppress physiological myocardial uptake of FDG was performed for disease evaluation. PET/CT revealed multifocal abnormal uptake in both ventricles concordant with cardiac MRI findings, in addition to hypermetabolic lymphadenopathy. Six months later, posttreatment PET/CT with the same 72-hour ketogenic diet preparation showed good response with resolution of active inflammation.