bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between severity of prenatally diagnosed hydronephrosis and receipt of surgical intervention postnatally among patients seen at a fetal-maternal center
Authors: Baker Zoë G. , Hannallah Arthi , Trabold Melissa , Estell Danielle , Deng Cherry , Chang Andy Y. , Sparks S. Scott , De Filippo Roger , Vasquez Evalynn 
Published: April 2021

Abstract
Background
Hydronephrosis (HN) is the most common abnormality detected on prenatal ultrasound. This study sought to stratify outcomes of patients by severity of prenatal HN with postnatal outcomes.

Methods
This was a retrospective review of patients referred to a tertiary care fetal-maternal clinic with diagnosis of prenatal HN from 2004 to 2019. HN severity was categorized as mild, moderate, or severe. Data were analyzed to determine the association between HN severity and surgical intervention. Decision for surgery was based on factors including history of multiple urinary tract infections, evidence of renal scarring, and/or reduced renal function. Surgery-free survival time was represented by the Kaplan–Meier method, and hazard ratios were calculated using the log-rank test.

Results
131 kidneys among 101 infants were prenatally diagnosed with hydronephrosis; 35.9% had mild HN, 29.0% had moderate HN, and 35.1% had severe HN. 8.5% of patients with mild HN, 26.3% of patients with moderate HN, and 65.2% of patients with severe HN required surgery. Patients with severe HN were 12.2 (95% CI 6.1–24.4; p < 0.001) times more likely to undergo surgery for HN than patients with mild HN and 2.9 (95% CI 1.5–5.3; p = 0.003) times more likely to undergo surgery than patients with moderate HN. Patients with moderate HN were 4.3 times more likely to require surgery than patients with mild HN (95% CI 1.5–12.9; p = 0.01). Median age at surgery was 11.8 months among patients with mild HN (IQR 11.7–14.1 months), 6.6 months among patients with moderate HN (IQR 4.2–16.4 months), and 5.4 months among patients with severe HN (3.7–12.4 months).

Conclusion
Among this cohort of referrals from a fetal-maternal clinic, severity of HN correlated with increased likelihood of surgical intervention. Continued assessment of patients with prenatal HN should be evaluated to best determine the role of the pediatric urologist in cases of prenatal HN.
An experimental intraradicular biofilm model in the pig for evaluating irrigation techniques
Authors: Tanaka Toshinori , Yahata Yoshio , Handa Keisuke , Venkataiah Suresh V. , Njuguna Mary M. , Kanehira Masafumi , Hasegawa Tatsuya , Noiri Yuichiro , Saito Masahiro 
Published: April 2021

Abstract
Background
We established an in vivo intraradicular biofilm model of apical periodontitis in pigs in which we compared the efficacy of different irrigant activation techniques for biofilm removal.

Methods
Twenty roots from the deciduous mandibular second premolar of 5 male pigs were used. After pulpectomy, canals were left open for 2 weeks and then sealed for 4 weeks to enable the development of an intracanal biofilm. The intraradicular biofilms was evaluated using SEM and bacterial 16S rRNA gene-sequencing. To investigate the efficacy of biofilm removal, root canal irrigations were performed using conventional needle, passive ultrasonic, subsonic, or laser-activated irrigation. Real-time PCR was conducted to quantitate the remaining biofilm components. Statistical analysis was performed using ANOVA followed by a Tukey kramer post-hoc test with α = 0.05.

Results
The pulp exposure model was effective in inducing apical periodontitis and SEM analysis revealed a multi-layer biofilm formation inside the root canal. 16S rRNA sequence analysis identified Firmicutes, Bacteroidetes, and Fusobacteria as the predominant bacterial phyla components, which is similar to the microbiome profile seen in humans. None of the tested irrigation techniques completely eradicated the biofilm components from the root canal, but the subsonic and laser-activated irrigation methods produced the lowest bacterial counts (p < 0.05).

Conclusions
An experimental intraradicular biofilm model has been successfully established in pigs. Within the limitations of the study, subsonic or laser-activated irrigation demonstrated the best biofilm removal results in the pig system.
Analysis of oral microbial dysbiosis associated with early childhood caries
Authors: Zheng Hui , Xie Tengfei , Li Shaokai , Qiao Xiaotong , Lu Youguang , Feng Yan 
Published: April 2021

Abstract
Background
"Core microbes" play a key role in the development of caries and lead to microbial disorders. Our goal was to detect the core microbes associated with the microbiota imbalance in early childhood caries (ECC).

Methods
Fifteen caries-free children and fifteen high-caries (DMFT ≥ 10) children aged 4–6 years old were recruited according to the diagnostic criteria of caries suggested by the WHO. The 16S rRNA genes from samples of plaque in saliva were amplified by PCR, and the PCR products were sequenced by the Illumina Miseq platform. The sequencing results were analyzed by professional software to determine the composition and structure of the saliva microorganisms.

Results
There were statistically significant differences between the groups regarding the relative abundance of Streptococcus mutans (Wilcoxon rank-sum test, P < 0.05). No significant difference was found between the groups regarding other species or functional genes.

Conclusion
S. mutans, together with other pathogens, may play a prominent role and act as "core microbes" in the occurrence and development of early childhood caries.
Surgery for fibroadenoma arising from axillary accessory breast
Authors: Lee Sung Ryul 
Published: April 2021

Abstract
Background
Patients with fibroadenomas in axillary accessory breasts (AABs) have a palpable mass, cyclic axillary pain, and aesthetic concerns that must be addressed. We compared the baseline patient characteristics, AAB characteristics, and surgical outcomes of patients with AABs with and without fibroadenomas undergoing surgical excision. We also monitored the patients for recurrence of axillary fibroadenomas.

Methods
This retrospective study involved 2310 women who underwent AAB excision from 2014 to 2019. Patients with and without a palpable fibroadenoma were divided into a fibroadenoma group and non-fibroadenoma group, respectively. All patients underwent complete excision of accessory mammary gland (AMG) tissue, including fibroadenomas in the AABs. We removed the fibroadenoma and the AMG tissue with a minimal axillary incision.

Results
Thirty-nine patients had a palpable fibroadenoma in the AAB, and all patients in the fibroadenoma group had cyclic axillary pain and a palpable axillary mass. There were no significant differences in the patients’ age, weight of the AMG tissue, liposuction volume, or fibroadenoma laterality between the two groups. The body mass index in the fibroadenoma group was lower than that in the non-fibroadenoma group (19.9 vs. 22.3 kg/m2, respectively; P < 0.000). Concurrent fibroadenoma excision in a normal breast on the chest was performed more often in the fibroadenoma group than in the non-fibroadenoma group (35.9% (14/39) vs. 4.1% (92/2271), respectively; P < 0.000). The mean fibroadenoma size was 2.1 cm (range, 1.1–9.1 cm). All patients were satisfied with the degree of postoperative pain relief, disappearance of palpable lesions, and cosmetic improvement. No patients developed fibroadenoma recurrence.

Conclusions
Complete excision of the AMG tissue and fibroadenoma is appropriate in patients with an AAB with a fibroadenoma. Surgeons should also consider the high incidence of concurrent fibroadenomas in the normal breasts on the chest.
Measuring barriers to fistula care: investigating composite measures for targeted fistula programming in Nigeria and Uganda
Authors: Sripad Pooja , Arnoff Elly , Warren Charlotte , Tripathi Vandana 
Published: April 2021

Abstract
Background
Accessing surgical repair poses challenges to women living with female genital fistula who experience intersectional vulnerabilities including poverty, gender, stigma and geography. Barriers to fistula care have been described qualitatively in several low- and middle-income countries, but limited effort has been made to quantify these factors. This study aimed to develop and validate composite measures to assess barriers to accessing fistula repair in Nigeria and Uganda.

Methods
This quantitative study built on qualitative findings to content validate composite measures and investigates post-repair client surveys conducted at tertiary hospitals in Northern and Southern Nigeria and Central Uganda asking women about the degree to which a range of barriers affected their access. An iterative scale development approach included exploratory and confirmatory factor analyses of two samples (n = 315 and n = 142, respectively) using STATA 13 software. Reliability, goodness-of-fit, and convergent and predictive validity were assessed.

Results
A preliminary 43-item list demonstrated face and content validity, triangulated with qualitative data collected prior to and concurrently with survey data. The iterative item reduction approach resulted in the validation of a set of composite measures, including two indices and three sub-scales. These include a Financial/Transport Inaccessibility Index (6 items) and a multidimensional Barriers to Fistula Care Index of 17 items comprised of three latent sub-scales: Limited awareness (4 items), Social abandonment (6 items), and Internalized stigma (7 items). Factor analyses resulted in favorable psychometric properties and good reliability across measures (ordinal thetas: 0.70–0.91). Higher levels of barriers to fistula care are associated with a woman living with fistula for longer periods of time, with age and geographic settings as potential confounders.

Conclusions
This set of composite measures that quantitatively captures barriers to fistula care can be used separately or together in research and programming in low- and middle-income countries.
Lateral decubitus position to facilitate pelvic examination of the patient with severe obesity
Authors: Breitkopf Daniel M. 
Published: April 2021

Abstract
Background
Patients with elevated BMI pose a number of challenges for the gynecologist. Pelvic examination may be more difficult due to adiposity in the perineum and labia, increasing the distance between the vulva and cervix. The objective of the current work was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity.

Methods
A case series was collected. From 7/1/2010 until 1/31/2020, all records of patients with obesity and unsuccessful cervical visualization during pelvic exam in the dorsal lithotomy position in the author’s clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. For the lateral decubitus position, the patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent. An assistant elevated the upper bent leg 45 degrees from horizontal, exposing the perineum. A vaginal speculum was then placed in the vagina with the posterior blade toward the anus. The speculum was opened gently as would be done with examination in dorsal lithotomy position until the cervix was visualized.

Results
Eleven patients with severe obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. In all but one case the cervix was successfully visualized in the lateral decubitus position and all intended intrauterine procedures were successfully performed.

Conclusions
In this case series, the use of the lateral decubitus position appears to improve visualization of the cervix in the outpatient setting among women with severe obesity. Consideration should be given to use of the lateral decubitus position when the cervix cannot be visualized in the dorsal lithotomy position.
Standardizing clinical culture specimen collection in Ethiopia: a training‐of‐trainers
Authors: Kue Jennifer , Bersani Ashley , Stevenson Kurt , Yimer Getnet , Wang Shu-Hua , Gebreyes Wondwossen , Hazim Carmen , Westercamp Matthew , Omondi Michael , Amare Berhanu , Alebachew Gebrie , Abubeker Rajiha , Fentaw Surafel , Tigabu Eyasu , Kirley Denise , Vanderende Daniel , Bancroft Elizabeth , Gallagher Kathleen M. , Kanter Theresa , Balada-Llasat Joan-Miquel 
Published: April 2021

Abstract
Background
Proper specimen collection is central to improving patient care by ensuring optimal yield of diagnostic tests, guiding appropriate management, and targeting treatment. The purpose of this article is to describe the development and implementation of a training-of-trainers educational program designed to improve clinical culture specimen collection among healthcare personnel (HCP) in Ethiopia.

Methods
A Clinical Specimen Collection training package was created consisting of a Trainer’s Manual, Reference Manual, Assessment Tools, Step-by-Step Instruction Guides (i.e., job aides), and Core Module PowerPoint Slides.

Results
A two-day course was used in training 16 master trainers and 47 facility-based trainers responsible for cascading trainings on clinical specimen collection to HCP at the pre-service, in-service, or national-levels. The Clinical Specimen Collection Package is offered online via The Ohio State University’s CANVAS online platform.

Conclusions
The training-of-trainers approach may be an effective model for development of enhanced specimen collection practices in low-resource countries.
Regulatory, scientific, and ethical issues arising from institutional activity in one of the 90 Italian Research Ethics Committees
Authors: Benfatto G. ,   Regulatory Group, Longo Laura , Mansueto Silvana , Gozzo Lucia , Vitale Daniela C. ,   Ethics Committee Catania 1 (Group), Amato Salvatore , Basile Francesco , Blanco Adele , Borzì Vito , Cavallaro Patrizia , Cilia Sonia , Conti Mario , Cristaudo Concetto , Daidone Letterio D. , Di Fazzio Salvatore , Di Mauro Maurizio , Garozzo Rosaria , Giardina Gaetano , Gulino Antonio , Iachelli Liliana , La Bella Maria L. , La Rosa Agata , Lazzara Antonio , Leonardi Francesco , Monaco Francesca Lo , Malatino Lorenzo , Mattina Teresa , Negro Matteo , Palermo Filippo , Puleo Stefano , Raciti Rosa , Ruggieri Martino , Sapuppo Antonio , Scillieri Renato , Squatrito Sebastiano , Tanasi Francesco , Drago F. 
Published: April 2021

Abstract
Background
This paper highlights the issues that one of the 90 Italian Research Ethics Committees (RECs) might encounter during the approval phase of a clinical trial to identify corrective and preventive actions for promoting a more efficient review process and ensuring review quality. Publications on the subject from Italy and the rest of Europe are limited; encouraging constructive debate can improve RECs’ service to the subject of the clinical trial.

Methods
We retrospectively reviewed a cohort of 822 clinical trial protocols, initially reviewed by REC, from June 2014 to December 2018. Data collected for each protocol were type of trial, sample size, use of placebo, number and kind of revisions requested by the REC before approval, and time taken for approval. Data for each protocol were collected by a trained clinical research assistant using the REC’s files and electronic archives.

Results
Almost 45% of the reviewed studies (374/822) required clarifications, significant changes to the documentation, or minor changes before final approval.

Conclusions
Preventive measures are needed to reduce the number of requested corrections and thus also the time required for approval, while maintaining review quality. All critical points and proposals presented in this paper require harmonization through updates to European regulations, as regulatory harmonization produces better compliance with rules and reduces the number of changes required before the trials’ final approval. Such updates include the development of standardized formats for informed consent, the verification of any evidence in favor of using off-label treatments over placebo as comparators, using multidisciplinary staff in clinical trials with children and adolescents, improving the legal definition of RECs to assign responsibilities and ensure independence, and providing guidance for RECs to engage clinical research assistants in internal audits.
Ethical concerns in suicide research: thematic analysis of the views of human research ethics committees in Australia
Authors: Barnard Emma , Dempster Georgia , Krysinska Karolina , Reifels Lennart , Robinson Jo , Pirkis Jane , Andriessen Karl 
Published: April 2021

Abstract
Background
Suicide research aims to contribute to a better understanding of suicidal behaviour and its prevention. However, there are many ethical challenges in this research field, for example, regarding consent and potential risks to participants. While studies to-date have focused on the perspective of the researchers, this study aimed to investigate the views and experiences of members of Human Research Ethics Committees (HRECs) in dealing with suicide-related study applications.

Methods
This qualitative study entailed a thematic analysis using an inductive approach. We conducted semi-structured interviews with a purposive sample (N = 15) of HREC Chairs or their delegates from Australian research-intensive universities. The interview guide included questions regarding the ethical concerns and challenges in suicide-related research raised by HREC members, how they dealt with those challenges and what advice they could give to researchers.

Results
The analysis identified four main themes: (1) HREC members’ experiences of reviewing suicide-related study applications, (2) HREC members’ perceptions of suicide, suicide research, and study participants, (3) Complexity in HREC members’ decision-making processes, and (4) HREC members’ relationships with researchers.

Conclusions
Reliance on ethical guidelines and dialogue with researchers are crucial in the assessment of suicide-related study applications. Both researchers and HREC members may benefit from guidance and resources on how to conduct ethically sound suicide-related studies. Developing working relationships will be likely to help HRECs to facilitate high quality, ethical suicide-related research and researchers to conduct such research.
Knowledge of mothers and fathers’ experiences of the early in-home care of premature infants supported by video consultations with a neonatal nurse
Authors: Hägi-Pedersen Mai-Britt , Kronborg Hanne , Norlyk Annelise 
Published: April 2021

Abstract
Aim
To gain in-depth knowledge of mothers’ and fathers’ experiences of the whole trajectory of an early in-home care programme supported by video consultations with a neonatal nurse.

Design
A qualitative interview study.

Methods
Data were collected through dyadic semi-structured interviews with mothers and fathers participating in virtual early in-home care programmes and were subjected to inductive content analysis.

Findings
The mothers and fathers were anxious about mastering the care of their premature infants at the start of the early in-home care phase but gradually developed confidence by the completion of the early in-home care programme. Being at home during the early in-home care programme gave the mothers and fathers an opportunity to test their decision making concerning the care of the infant while having the ability to obtain support from nurses when needed.

Conclusion
Our findings indicate that the trajectory of early in-home care programmes combined with video consultations contributes to parents’ increased confidence as mothers and fathers.

Trial registration
Clinical trial registration: REG-113-2014 and SJ-431.
Students’ perspectives of factors related to delayed completion of online RN-BSN programs
Authors: Iheduru-Anderson Kechinyere C. 
Published: April 2021

Abstract
Background
There are multiple educational programs for individuals to become registered nurses (RNs), and the transition from an associate degree or diploma to a Bachelor of Science in Nursing (BSN) degree is vital to healthcare. This study examined the factors contributing to delayed completion or withdrawal from online RN-BSN nursing programs from students’ perspectives.

Method
Thematic content analyses were conducted on qualitative data obtained from semi-structured interviews (N = 26).

Results
Complex factors contributed to delayed completion of online RN-BSN programs, including student-, institutional-, and faculty-related factors.

Conclusion
This study validated and extends previous studies without delineating students in fully online programs from hybrid and face-to-face programs. Students, faculty, and institutions all have a role to play in facilitating on-time program completion. Recognizing and mitigating the barriers that delay on-time program completion is required to foster nurses to obtain a BSN degree.
Healthcare services utilization among international students in Ankara, Turkey: a cross-sectional study
Authors: Masai Abednego Nzyuko , Güçiz-Doğan Bahar , Ouma Polet Njeri , Nyadera Israel Nyaburi , Ruto Victor Kipkoech 
Published: April 2021

Abstract
Background
While international students form an increasing population of higher education students in Turkey, there is limited empirical evidence about their health services utilization. The study aim was to investigate healthcare access among a group of international students studying in Ankara city and identify potential barriers that affect full healthcare utilization.

Method
A total of 535 international students from 83 countries completed an online-based questionnaire. The survey was conducted from September until October 2020. Variables between groups within the study sample were compared using ANOVA and Chi-square tests (with Fisher’s exact test). Logistic regression analysis was used to evaluate the relationships between variables related to access to health services.

Results
Of the study population, 80.6% accessed the general practitioner (GP), 40% accessed the student health centres, and 11.4% were admitted to the hospital at least once. About 80% of international students reported changing their views to access healthcare more because of the COVID-19 pandemic.

Conclusion
Lack of awareness of healthcare support systems, perceived stigma associated with mental health services, and language barriers were the main barriers affecting healthcare access by international students.

Implications
Study findings indicate the need for education of international students on available healthcare, targeted health promotion, and training of health providers on effective communication.