bluuebunny/crossref_metadata_2025_split huggingface dataset:
Molecular Characterization of ESBLs and QnrS Producers From Selected Enterobacteriaceae Strains Isolated From Commercial Poultry Production Systems in Kiambu County, Kenya
Authors: Ndukui James G , Gikunju Joseph K , Aboge Gabriel O , Mwaniki John K , Maina John N , Mbaria James M 
Published: May 2022

Background: The emergence and spread of Extended-spectrum β-lactamases (ESBLs) in Enterobacteriaceae through the plasmid-mediated exchange have become a major threat to public health by complicating the treatment of severe infections in both animals and humans. Therefore, the current study focused on evaluating the manifestation of ESBLs production from the fecal isolates of E. coli, Shigella spp, Salmonella spp, and Klebsiella spps in commercial poultry production systems of Kiambu County, Kenya. Materials and methods: Out of 591 isolates identified as E. coli, Shigella spp, Salmonella spp, and Klebsiella spps from 437 fecal samples, only 78 were phenotypically suggestive to be ESBL producers. The possible ESBL producers were screened for the presence of blaTEM, blaCTX-M, blaOXA, and blaSHV using the PCR technique. These isolates were also screened for carriage of the QnrS gene that confers resistance to the fluoroquinolone class of drugs. Results: The most detected ESBL gene from the isolates was blaOXA (n = 20; 26%), followed by blaTEM (n = 16, 21%), with the majority of them detected in E. coli. The blaCTX-M was identified in all the 4 enteric’s bacteria-type isolates tested. Three E. coli and Salmonella spp respectively were found to harbor all the 5 antimicrobial resistance (AMR) gene types. The blaTEM, blaOXA, blaSHV, and QnrS genes were not detected from Klebsiella and Shigella spps. Additionally, most of the AMR gene co-carriage was detected in both E. coli and Salmonella spps as follows blaTEM + blaOXA (n = 4); blaTEM + QnrS (n = 3); blaTEM + blaOXA + QnrS (n = 3), concurrently. Conclusion: Our findings highlight the significance of commercial poultry production in disseminating transferable antibiotic resistance genes that act as potential sources of extensive drug resistance in livestock, humans, and the environment, leaving limited therapeutic options in infection management.
Distance to Neurovascular Bundle During Iliotibial Band Acl Graft Passage: A Cadaveric Study
Authors: Thomas Nicholas , Sanchez Mark , Gupta Anshal , Rohde Matt , Ayala Sal , Tompkins Marc , Wilson Phil , Ellis Henry , Sherman Seth , Green Daniel , Ganley Ted , Shea Kevin G 
Published: May 2022

Background: For patients with significant growth remaining, the Micheli-Kocher (iliotibial band) ACL reconstruction technique has proven to be a reliable procedure with minimal risk for growth disturbance. Recent cadaveric studies have demonstrated that graft passage over the top of the femur may bring the graft and instrument close to the critical neurovascular structures. Purpose: The purpose of this study was to evaluate the over-the-top graft passage technique using pediatric cadaveric knees, and measure the distance between instruments and the peroneal nerve, tibial nerve, popliteal artery. Methods: Seventeen skeletally immature cadaveric knees between the ages of 4 and 12 years old were dissected and prepared for visualization of iliotibial band graft passage procedure. A curved hemostat clamp was used, creating a path through the posterior capsule. To avoid neurovascular injury, the tip of the instrument was kept close to the posterior and lateral cortex of the femur. Once the clamp was safely positioned in the posterior knee joint, photographs were taken. Digital imaging software was used to measure the distance in centimeters from clamp tip to peroneal nerve laterally, and the popliteal artery and tibial nerve medially for all specimens, FIGURE 1. Distances were averaged and stratified to assess differences in age, FIGURE 2. Results: The average distances from clamp to neurovascular bundle were 0.875cm (range: 0.468-1.737cm), 0.968cm (range: 0.312-1.819cm), and 1.149cm (range: 0.202-2.409cm) for tibial nerve, popliteal artery and peroneal nerve, respectfully. Means were further calculated for age groups ≤8, 9-10, and 11-12 years old. Conclusion: Iliotibial band graft ACL reconstruction is one of the best options in the skeletally immature, as it has the lowest risk of growth plate complications and growth arrest. The neurovascular structures are very close to the path for over-the-top graft clamp placement with distances <1 cm in many subjects. The current study provides detailed measurements of instrument proximity to the neurovascular bundle in the posterior compartment of the knee. This knowledge is important to help surgeons who perform the Micheli-Kocher pediatric ACL reconstruction avoid damage to the nerves and vessels in this region. Careful instrument and graft passage, with awareness of proximity to critical structures, are important to reduce the risk of neurovascular injury. [Figure: see text][Figure: see text]
Demographic, Injury Characteristics, and Comorbidity Differences Between Youth with >28 Day and >90 Day Recovery from Concussion
Authors: Young Julie A. , Maki Aaron , Feiss Robyn , Yang Jinzhen , Cuff Steven C. 
Published: May 2022

Background: The identification and comparison of risk factors between concussed children with symptom resolution >28 days and those with symptom resolution >90 days may aid in clinical care. Purpose: The objective of this study was to identify demographic, comorbidity, and injury factors associated with prolonged (>28 days) and extended (>90 days) concussion recovery among children aged 10 to 18 years with concussions. Methods: Demographics, injury characteristics and comorbidities were recorded in patients aged 10-18. We assessed the associations of patients’ demographics, comorbidities, and injury characteristics with the outcome variable of concussion symptom resolution >28 days post-injury using two-level, Generalized Linear Mixed model (GLMM). We repeated the analysis for concussion symptom resolution >90 days post-injury. Odds ratios(OR) and 95% confidence intervals(CI) were reported. Results: A total of 4,937 concussions were analyzed. Of these, 32.6% had resolution >28 days and an additional 20.1% had resolution >90 days after injury. Risk factors for symptom resolution >28 days included female sex, (OR=1.22, 95% CI=1.03, 1.44), ADD/ADHD diagnosis (OR=1.31, 95% CI=1.00, 1.72), those with one (OR=1.41, 95% CI=1.17, 1.71), two (OR=1.41, 95% CI=1.02, 1.95), or three or more previous concussions (OR=2.08, 95% CI=1.42, 3.05), higher initial symptom score (OR=1.04, 95% CI=1.04, 1.05), and greater days from injury to first visit (OR=2.80, 95% CI=2.53, 3.09). Risk factors for >90 days to recovery included older age group (OR=1.66, 95% CI=1.18, 2.32) in 15-18 year olds compared to 10-14 year olds, two (OR=1.84, 95% CI=1.10, 3.07), or three or more (OR=2.30, 95% CI=1.27, 4.19) previous concussions, history of headaches (OR=0.65, 95% CI=0.46, 0.93), anxiety disorder diagnosis (OR=1.66, 95% CI=1.04, 2.64), higher symptom scores at first visit, (OR=1.01, 95% CI=1.00-1.01), and a greater number of days from injury to first visit (OR=1.29, 95% CI=1.20-1.39). Discussion: Female sex and ADD/ADHD diagnosis were unique risk factors for >28 day recovery and history of headaches, anxiety diagnosis, and age were unique risk factors for >90 day recovery. For both groups, higher initial symptom scores and longer time to initial evaluation resulted in longer recovery. Future studies are needed to screen and detect children at risk for prolonged recovery during the acute phase post-injury so that appropriate clinical care can be provided to expedite concussion recovery.
Quantifying Head Impact Exposure, Mechanisms and Kinematics Using an Instrumented Mouthguard in Female High School Lacrosse
Authors: Huber Colin M. , Patton Declan A. , Margulies Susan S. , Master Christina L. , Arbogast Kristy B. 
Published: May 2022

Background: There is growing concern for the neurological effects of repetitive head impacts in sports, and girls’ lacrosse represents a popular but understudied sport regarding head impact exposure. Current debate exists over the need for enhanced protective equipment, and it is important to quantify head impact exposure and biomechanics to inform policy discussions and rule changes for improved protection. Purpose: To quantify the head impact biomechanics, by impact mechanism and direction, of female high school lacrosse players during games using an instrumented mouthguard. Methods: A female high school varsity lacrosse team wore the Stanford Instrumented Mouthguard during competitive games for the 2019 season. Video footage was reviewed to confirm head impact events and remove false-positive recordings. For each impact event, the mechanism was coded as stick contact, player contact, fall, or ball contact, and the site was coded as face/jaw, forehead, crown, side, rear or indirect (i.e. body impact with no head contact). Head impact rates were calculated per athlete exposure (AE, defined as a single player participating in a game). Results: Sensor data were recorded for 15 players for 14 games and 97 AEs. During games, 31 sensor-recorded head impacts were video-confirmed resulting in a pooled average head impact rate of 0.32 impacts/AE. The 31 video-confirmed impacts were distributed among stick contacts (17, 54.8%), player contacts (12, 38.7%), and falls (2, 6.5%). There were no ball impacts. The associated peak kinematics are presented in Figure 1.1. The most common impact site was the side (11, 35.5%), followed by face/jaw (8, 25.8%), forehead (2, 6.5%), and crown (2, 6.5%). There were no impacts to the rear of the head and 8 (25.8%) impacts were indirect. The associated peak kinematics are presented in Figure 1.2. Conclusion: Stick impacts were the most common impact mechanism and resulted in the highest peak linear and angular kinematics, which may help explain why they are the most common cause of head injury in female lacrosse. By quantifying the head impact exposure, kinematics and mechanisms in female high school lacrosse, targeted injury preventions can be developed, such as rule changes and protective equipment. [Figure: see text][Figure: see text]
Clinical Features and Operative Treatments of Discoid Medial Meniscus in Children
Authors: Anderson Kathryn G. , Carsen Sasha , Stinson Zachary , Kushare Indranil , Finlayson Craig , Nault Marie-Lyne , Lee R. Jay , Haus Brian ,   PRiSM Meniscus Research Interest Group, Schmale Gregory A. 
Published: May 2022

Background: The discoid medial meniscus is a rare congenital anomaly of the knee. The literature on discoid medial menisci is limited, with few reported cases in children. Purpose: To report the clinical manifestations and operative treatments of discoid medial menisci in children from multiple centers in North America. Methods: A retrospective review of medical records including operative reports was performed to identify patients diagnosed with a discoid medial meniscus confirmed via direct surgical observation across eight children’s hospitals between January 2000 and March 2020. Results: Twenty-one patients (9 female, 12 male) with 22 discoid medial menisci were identified, one with bilateral discoid medial menisci. The mean age at time of diagnosis was 12.7 years (range, 3-18 years). One patient had discoid medial and discoid lateral menisci in the same knee. The most common symptoms and signs of patients with a discoid medial meniscus were locking and/or clunking, present in over 50% of patients. Twelve discoid medial menisci were complete (55%), 8 were incomplete (36%), and two were indeterminate (9%). Tears were present in 13 knees. Of those with tears, 7 were horizontal tears (4 posterior, 1 anterior, and 2 mid-body), 5 were complex (3 posterior, 1 anterior, and 1 mid-body), and 1 was a posterior vertical tear. Five of these discoid medial menisci were unstable (23%). The average time between initial diagnosis and treatment was 13 months (range, 0-121 months). All knees underwent arthroscopic saucerization, and of the 13 torn discoid medial menisci, 7 were repaired (54%). The mean length of clinical follow-up postoperatively was 24 months (range, 1-82 months). Four of these discoid medial menisci underwent re-operation, most commonly for persistent symptoms. All knees which required re-treatment initially presented with a tear, all of which had been repaired. There was a significant association between initial presence of a tear and need for re-operation, [χ2 = 4.1, p = 0.044]. Conclusions: In this multicenter study of patients treated for a discoid medial meniscus, symptoms and signs at presentation and findings at arthroscopy were similar with those commonly seen in patients with a discoid lateral meniscus. Tears were present in more than half of knees, and reoperation was more common in knees identified with tears of their discoid medial menisci than those without tears. Future studies should seek to determine the long-term functional and patient-reported outcomes following treatment of discoid medial menisci.
Reliability of a Qualitative Movement Assessment Tool During a Single Leg Triple Hop
Authors: Epstein Eli , Huse Casey , Link Meredith , Witte Katherine , Pontis Veronica , Verdoni Ryder , Greenberg Elliot 
Published: May 2022

Background: Single leg hop tests are commonly used to determine readiness for return to sport following anterior cruciate ligament reconstruction (ACLR). A common criticism of hop tests is their inability to account for quality of movement errors, which may be associated with increased risk of re-injury. The Qualitative Analysis of Single Leg Squat (QASLS) tool was originally developed to score quality of movement during a single leg squat. The usefulness of this tool for identifying quality of movement errors during single leg hopping has not been assessed. Hypothesis/Purpose: The purpose of this study was to determine the inter and intra-rater reliability of the QASLS tool during a single leg triple hop and explore if differences in reliability existed between novice and experienced clinicians. Methods: Subjects 10-24 years-old and ≥6-months post ACLR were eligible for this study. Subjects were recorded performing a maximal effort single leg triple hop on each limb. Recordings were viewed individually by five raters, two board-certified sports clinical specialists, and three doctor of physical therapy students in their 2nd year of education. All raters were trained in the use of the QASLS tool during a single online training presentation. Raters were blinded to surgical limb and utilized the QASLS to rate the final landing of the triple hop task. Intraclass correlation coefficient (ICC) was calculated to measure reliability of the QASLS on the surgical limb. Wilcoxon signed-rank test was utilized to assess if differences in QASLS scores existed between limbs. Results: 20 subjects (mean age 16.5, 60% female) participated in this study. The cumulative inter-rater reliability of the surgical limb was moderate (ICC: 0.703) and little difference was seen between experienced and novice raters with ICCs of 0.703 and 0.603, respectively. Intra-rater reliability was better, with a cumulative ICC of 0.857 and with experienced clinicians demonstrating slightly higher reliability (ICC 0.891) than novice clinicians (ICC 0.831). The mean QASLS scores for the surgical limb and nonsurgical limbs were 5.2 and 5.4, respectively, and there was no statistically significant difference between scores (P=0.64). Conclusions: The QASLS tool offers moderate to good inter and intra-rater reliability for evaluating quality of movement errors during a single leg triple hop, regardless of rater experience level. Interestingly, surgical limb did not show any difference in quality of movement compared to the nonsurgical limb. [Table: see text][Table: see text]
Sex and Age Comparisons of Pediatric Track & Field Hurdle Injuries
Authors: Jones Jacob , Radel Luke , Garcia Kyle , Soma David , Sugimoto Dai 
Published: May 2022

Background: Track & field has more participants compared to any other high school sport and continues to gain popularity among middle school aged kids. Among many events, hurdles is unique because there is continued running with repeated jumping over an apparatus. Although serious injury has been anecdotally reported, there are few studies describing pediatric hurdle injuries including sex and age differences. Purpose: To investigate hurdle-related injury types and body locations based on age and sex among children and adolescents. Methods: Hurdle related injury data was extracted from the National Electronic Injury Surveillance System (NEISS), which represents emergency room visits. The search period was a 10-years (2008-2017). The eligibility criteria was < 18 years of age. Injuries were then classified based upon injury type and body location(s) involved. A chi-square (x2) analysis was employed to assess proportional differences of top three hurdle related injury types and body locations by age (<14 years vs. >15 years) and sex (male vs. female). Statistical significance was set as p<0.05. Results: A total of 749 cases related to hurdle injuries were extracted. Among recorded 749 injuries, traumatic fractures (N=218, 29.1%), joint sprain (N=191, 25.5%), and contusion/hematoma/bruise (N=78, 10.4%) were found as the top three most commonly sustained injuries. Chi-square (x2)analysis found more traumatic fractures in <14 years (34.1%) compared to >15 years (21.5%, p=0.001) while more joint sprain was identified in >15 years (29.6%) than <14 years (22.8%, p=0.036). Regarding sex comparisons, males had more traumatic fractures (35.1%) than females (24.3%, p=0.001). Conversely, females sustained more joint sprains (29.1%) and contusion/hematoma/bruise (12.7%) than males (joint sprain, 21.0%, p=0.012; contusion/hematoma/bruise, 7.5%, p=0.020). The top 3 injured body locations were ankle (N=140, 18.7%), knee (N=120, 16.0%), and wrist (N=69, 9.2%). No differences were found between body locations and age; however, statistical differences were detected by sex comparisons. Ankle injury was more common in females (24.0%) than males (12.0%, p=0.001). Yet, injury at wrist was more prevalent in males (11.7%) compared to females (7.2%, p=0.034). Conclusion: Findings of this study suggest that hurdle injury types seen in the emergency room differ by sex and age: more fractures are seen in males and younger pediatric populations while more sprains are seen in females and older adolescents. These findings may be helpful in event planning and may also play a role in injury prevention.
Diagnostic and Predictive Ability of Reaction Time Assessments for Adolescent Concussion
Authors: Wingerson Mathew J. , Seehusen Corrine N. , Wilson Julie C. , Smulligan Katherine L. , Reinking Sarah E. , Magliato Samantha N. , Howell David R. 
Published: May 2022

Background: Concussed individuals demonstrate significantly slower reaction time than that of healthy controls, particularly in the acute post-injury timeframe. In addition, post-injury reaction time may predict concussion recovery timing. Given that multiple measurement methods exist to assess reaction time post-injury, clinicians treating concussion may desire more information regarding the clinical utility of these methods. Purpose: To determine the clinical utility of two reaction time assessments and identify the ability of each to predict persistent post-concussion symptoms (PPCS), defined as symptoms lasting >28 days post-concussion. Methods: Concussed participants, within 14 days of injury, and healthy controls aged 12 to 18 years completed measures of clinical and smartphone-recorded reaction time. For clinical reaction time testing, participants completed 8 trials of a drop-stick protocol in which participants caught a weighted measuring stick dropped from a standard height between the thumb and palm of the dominant hand. Reaction time was calculated as the distance the stick fell before being caught. Three clinical reaction time outcomes were calculated: mean time, fastest trial, and coefficient of variance among all 8 trials. Smartphone reaction time was assessed through a smartphone application (Reaction Test Pro), which measured the speed at which patients responded to a simple on-screen stimulus. Participants were instructed to tap the phone as quickly as possible when an on-screen button changed color for 30 trials, an approximate test time of 2-3 minutes. Smartphone reaction time was output automatically by the application as the mean of all completed trials. Results: Concussion participants (n=54; 15.1±1.68 years of age; 50% female) assessed 7.0±3.05 days post-injury demonstrated worse performance than healthy controls (n=17; 16.3±1.13 years of age, 47% female) on all measures of reaction time (Table 1). Smartphone-recorded reaction time provided the largest mean difference between groups to distinguish concussed vs control participants. After controlling for age and concussion history, measures of mean clinical and smartphone reaction time were significant predictors of developing PPCS (Table 2). Conclusion: Smartphone-recorded reaction time within 2 weeks of concussion provide the greatest mean difference between concussed and control participants and predicted PPCS development in adolescents. Given the simplicity of smartphone-based measurements in comparison to other options for assessing reaction time, as well as the ubiquity and accessibility of smartphone technology, this technique may be preferred by physicians looking for direct measures of post-concussion reaction time. These assessments may also be used for early identification of patients at increased risk of developing PPCS. [Table: see text][Table: see text]