bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of an Intensive Nurse Home Visiting Program on Postpartum Contraceptive Use and Birth Spacing
Authors: Steenland Maria W. , Oviedo Dea , Bates Mary Ann , Zhou Annetta , Zera Chloe , Baicker Katherine , McConnell Margaret A. 
Published: November 2024

OBJECTIVE:
To evaluate the effect of an intensive nurse home visiting program on postpartum contraceptive use and birth spacing among individuals with a first pregnancy who were eligible for Medicaid insurance in South Carolina.

METHODS:
We conducted a nonblinded, randomized controlled trial of the Nurse-Family Partnership (NFP), an established intensive home visiting program that provides prenatal and postpartum home visits through 2 years after childbirth. The trial included patients who were eligible for Medicaid insurance with a first pregnancy at less than 28 weeks of gestation between April 1, 2016, and March 17, 2020, who were followed up through 2 years after childbirth. Participants were randomized 2:1 to NFP compared with standard of care treatment. The primary outcome was a birth interval of less than 21 months between the index pregnancy and a subsequent birth. The secondary outcomes were birth intervals of less than 15 and 24 months, receipt of a contraceptive implant or intrauterine device (IUD) immediately postpartum, any contraceptive use and receipt of a family planning visit (at both 6 weeks and 1 year postpartum), and IUD receipt at 1 year postpartum. We assessed outcomes using linked birth certificate records and Medicaid claims data.

RESULTS:
A total of 4,932 trial participants (3,295 in the intervention group and 1,637 in the control group) were included in the study analysis. Within 21 months of the study index birth, 11.0% of individuals in the NFP group and 12.2% of the usual care group had a subsequent birth. The NFP did not have a statistically significant effect on birth intervals of less than 21 months (adjusted coefficient −1.1, 95% CI, −2.9 to 0.8). There were no statistically significant differences between the NFP and control groups for any of the study's eight secondary outcomes related to birth spacing and postpartum contraceptive use.

CONCLUSION:
Home visits with a registered nurse did not affect postpartum contraceptive use or birth spacing.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03360539.
Infertility amid the COVID-19 pandemic: Emotion rules
Authors: Carneiro Márcia M. , Bossi Renata , Xavier Ana C. , Hurtado Rodrigo , Mattos Tatiana , Alvarenga Debora , Sampaio Marcos 
Published: November 2024

Introduction:
People struggling with infertility are increasingly turning to social media for infertility-related content and support. The COVID-19 pandemic fuelled interest on social media as fertility treatments were canceled worldwide. Instagram became a source of information and support but data on the topic are scarce.

Objective:
Identify the topics of greatest interest in the posts of a reproductive medicine clinic (ORIGEN) during the pandemic by evaluating engagement measured through Instagram metrics: number of likes, comments, and other interactions.

Methods:
This study involved publicly available posts in the Instagram ORIGEN account published between March 16, 2020, and December 31, 2020. Posts were categorized according to content into educational/scientific, informative (about the clinic and staff), and emotional (“cute post,” maternity/pregnancy, patient testimonials, tips, and motivational). For each category, the 5 most frequent in terms of likes, reach (number of Instagram accounts that saw the posts), and interaction (amount of comments, likes, and saves) were included in the analysis. The study involved only publicly available data, so there was no need for ethical approval. The Mann-Whitney test was used to compare scientific and emotional posts, and P<0.05 was considered significant.

Results:
Three hundred forty-seven posts were published: 155 emotional, 189 scientific, and 3 informative. The most frequent topics were commemorative days (n=66), fertility/infertility (n=36), good news about the pandemic (n=22), maternity/pregnancy (n=20), tips (n=19), “cute post” (n=15), motivational message (n=13), egg freezing (n=13), and endometriosis (n=9). During the study period, there was a 13% increase in followers. Brazilians aged 35–44 comprised the majority of followers (46% women; 41.3% men). Posts with emotional content had significantly more likes (P<0.05), reach (P<0.05), and interactions (P<0.05).

Conclusions:
Public interest in infertility-related themes grew during the pandemic with a 13% increase in ORIGEN account followers, consisting mainly of Brazilian reproductive-age women. Although scientific posts were the majority, emotional posts attracted significantly more attention in terms of the main Instagram metrics: likes, reach, and interactions.
Activation of the kynurenine pathway identified in individuals with covert hepatic encephalopathy
Authors: Zeng Georgia , Krishnamurthy Shivani , Staats Pires Ananda , Guller Anna , Chaganti Joga , Tun Nway , Lockart Ian , Montagnese Sara , Brew Bruce , Guillemin Gilles J , Danta Mark , Heng Benjamin 
Published: November 2024

Background:
HE is a neuropsychiatric complication of liver disease characterized by systemic elevation in ammonia and proinflammatory cytokines. These neurotoxins cross the blood-brain barrier and cause neuroinflammation, which can activate the kynurenine pathway (KP). This results in dysregulated production of neuroactive KP metabolites, such as quinolinic acid, which is known to cause astrocyte and neuronal death. Our aim was to compare KP activity between patients with covert HE (CHE), patients without encephalopathic cirrhosis (NHE), and healthy controls (HCs).

Methods:
This was a single-center prospective cohort study conducted between 2018 and 2021 at St Vincent’s Hospital, Sydney. Overall, 13 patients with CHE, 10 patients with NHE, and 12 with HC were recruited. Patients with cirrhosis were diagnosed with CHE if they scored ≤−4 on the Psychometric Hepatic Encephalopathy Score. KP metabolite levels were quantified on plasma samples via HPLC and gas chromatography/mass spectrometry. One-way Kruskal-Wallis test was used to compare the expression levels of KP enzymes.

Results:
KP was highly activated in patients with cirrhosis, demonstrated by higher levels of activity in the rate-limiting enzymes, indoleamine 2,3-dioxygenase, and tryptophan-2,3-dioxygenase in both CHE (65.04±20.72, p=0.003) and patients with NHE (64.85±22.10, p=0.015) compared to HC (40.95±7.301). Higher quinolinic acid concentrations were demonstrated in CHE (3726 nM±3385, p<0.001) and patients with NHE (1788 nM±632.3, p=0.032) compared to HC (624 nM±457). KP activation was positively correlated with inflammatory marker C-reactive protein in patients with CHE (Rs=0.721, p≤0.01).

Conclusions:
KP is highly activated in patients with CHE, resulting in heightened production of neurotoxic metabolites. Dysregulation of the pathway is demonstrable in patients who do not yet show clinical signs of neurocognitive impairment. Therapeutic agents that modulate KP activity may be able to alleviate symptoms of patients with CHE.
Clinical predictors and noninvasive imaging in Fontan-associated liver disease: A systematic review and meta-analysis
Authors: Seol Jae Hee , Song Jinyoung , Kim Soo Jin , Ko Hoon , Na Jae Yoon , Cho Min Jung , Choi Hee Joung , Lee Jue Seong , Oh Kyung Jin , Jung Jo Won , Jung Se Yong 
Published: November 2024

Background:
Despite the development of several imaging modalities for diagnosing Fontan-associated liver disease (FALD), there is no optimal protocol for the follow-up of FALD. We conducted a systematic review and meta-analysis to identify factors related to liver fibrosis using biopsy reports and to identify alternative noninvasive modalities that could better reflect liver histological changes in FALD.

Methods:
A systematic review and meta-analysis were conducted following the PRISMA guidelines Table S2. We searched Embase, PubMed, and Cochrane databases for studies on FALD, focusing on those assessing clinical factors associated with liver fibrosis severity through liver biopsy and noninvasive imaging techniques.

Results:
A total of 42 studies were identified, of which 12 conducted meta-analyses and subgroup analyses of the severity of liver fibrosis using liver biopsies. Liver biopsy results showed a weak positive correlation between Fontan duration and fibrosis severity (R = 0.36). Subgroup analyses revealed significant differences in hemodynamic parameters, such as Fontan pressure, between patients with mild and severe fibrosis. Platelet count, aspartate aminotransferase to platelet ratio index, and fibrosis-4 index were significantly associated with fibrosis severity, with severe fibrosis showing lower platelet counts and higher aspartate aminotransferase to platelet ratio index and fibrosis-4 index levels. Noninvasive imaging modalities, particularly magnetic resonance elastography and shear wave elastography, demonstrated strong correlations with biopsy-confirmed fibrosis severity.

Conclusions:
This study identifies key clinical factors, and noninvasive modalities accurately reflect liver fibrosis severity in patients with FALD. Clinical factors such as platelet count, aspartate aminotransferase to platelet ratio index, and fibrosis-4 index may aid in identifying patients at risk for severe fibrosis. In addition, magnetic resonance elastography and shear wave elastography are promising tools for noninvasive assessment in our study. Further research is needed to refine these diagnostic approaches and improve patient management.
Long-Term Impact of an Online Physician Group-Coaching Program to Improve Burnout and Self-Compassion in Trainees
Authors: Fainstad Tyra , Syed Adnan , Thibodeau Pari Shah , Vinaithirthan Vall , Jones Christine D. , Mann Adrienne 
Published: November 2024

SUMMARY

Goal
To evaluate long-term outcomes of Better Together Physician Coaching, a digital life-coaching program to improve resident well-being.

Methods
We performed a secondary analysis of survey data from the pilot program implementation between January 2021 and June 2022. An intention-to-treat analysis was completed for baseline versus post-6 months and baseline versus post-12 months for all outcome measures.

Principal Findings
Of 101 participants, 95 completed a baseline survey (94%), 66 completed a 6-month survey (65%) and 36 completed a 12-month survey (35%). There were no significant differences in burnout scale scores between baseline to 6 or 12 months. Self-compassion scores (i.e., means) improved after 6 months, from 33.2 to 38.2 (p < .001) and remained improved after 12 months at 36.7 (p = .020). Impostor syndrome score means decreased after 6 months, from 5.41 to 4.38 (p = .005) but were not sustained after 12 months (4.66, p = .081). Moral injury score means decreased from baseline to 6 months from 41.2 to 37.0 (p = .018), but reductions were not sustained at 12 months (38.1, p = .166).

Practical Applications
This study showed significant, sustained improvement in self-compassion for coaching program participants.
Beyond the Bottom Line: Assessing Charity Care, Community Benefits, and Tax Exemptions in Nonprofit Hospitals
Authors: Zare Hossein , Anderson Gerard 
Published: November 2024

SUMMARY

Goal
This study aimed to compare the value of tax exemptions and community benefits across various nonprofit hospitals and show how hospital and geographical characteristics can explain the values.

Methods
Data from 2017 to 2021 Internal Revenue Service Form 990s were used to evaluate 17 types of community benefits in nonprofit hospitals and assess six categories of tax benefits. Descriptive analyses compared charity care, community benefits, and estimated tax exemptions among nonprofit hospitals while considering variations in teaching status, location (rurality), and US region. Additionally, random effect regression analyses, both unadjusted and adjusted, explored the connection between the community benefit-to-expense ratio and a range of hospital and geographical features.

Principal Findings
Between 2017 and 2021, nonprofit hospitals allocated, on average, 8.8% of their total expenses to 17 types of community benefits, with 1.8% of their expenses dedicated to charity care; 5.2% benefited from tax exemptions. There were significant disparities among nonprofit hospitals, as 24.0% received more tax benefits than they spent on community benefits, and 81.0% received more than their charity care expenditures. The characteristics and location of nonprofit hospitals influenced the provision and composition of community benefits. Teaching hospitals allocated a higher percentage of total community benefits compared to nonteaching hospitals (9.2% vs. 8.6%). The top three categories in teaching hospitals were Medicaid shortfall, charity care, and unreimbursed education, whereas nonteaching hospitals focused more on charity care and subsidized health services, in addition to Medicaid shortfall. Furthermore, the location of a nonprofit hospital impacted the distribution of community benefits. Rural hospitals prioritized Medicaid shortfall, subsidized health services, and charity care, while urban hospitals concentrated more on Medicaid shortfall, charity care, and subsidized health service (in that order). The regression results showed that system affiliation and location in the Southern region of the United States were positive predictors of charity care spending at nonprofits.

Practical Applications
Lack of transparency and explicit requirements from federal agencies and states for what is necessary to receive tax benefits results in wide variations in community benefits spending by nonprofit hospitals. Some receive more in tax benefits than they provide in community benefits, and three-quarters of all nonprofit hospitals receive more in tax benefits than they provide in charity care. Developing a more explicit definition of community benefits can make all nonprofit hospitals more accountable.
Knowledge, attitude and practice towards coronavirus disease 2019 among Indian residents – an online cross-sectional survey
Authors: Manokaran Kalaivani , U. Saritha Kamath , Varghese Aneena , N. Ravi Shankar , Kaushik Siddharth , Ahmed Shiek Fareeth , Selvam Robert , Paramasivam Prabu , M. Anju 
Published: November 2024

Introduction:
Coronavirus disease 2019 (COVID-19) pandemic is posing challenge to the public health sector. The present study assessed knowledge, attitude, and practice (KAP) towards this COVID-19 among Indian population.

Methods:
The online cross-sectional survey for evaluating KAP towards COVID-19 was conducted (n = 2059) among Indian residents. Choropleth maps analysis was carried out to present the state-wise distribution, and Moran's I tool to assess KAP's overall spatial autocorrelation.

Results:
Our results demonstrated an average KAP score of 16.9 ± 2.0 (1.0, 22.0), 9.5 ± 2.0 (0.0, 12.0) and 4.0 ± (4.0, 4.0) (0.0, 5.0). The Moran's I tool for KAP's spatial autocorrelations observed as low as −0.04, −0.06, and 0.004.

Conclusion:
The interventional programs have to be encouraged for disease spread, and improving the public's practice for a better quality of life. Adherence to precautionary measures as per the standard guidelines is essential to prevent the spread of the disease, which might be subjective to the general population's knowledge and attitudes towards COVID-19.
Prevalence of vanA, B, C and cfr resistance genes among clinical isolates of Staphylococcus aureus and their role in biofilm formation
Authors: Salman Istabreq Muhammed Ali , Khazaal Saba Saadoon , Al-Alak Shaymaa Khudhr 
Published: November 2024

Background:
The increasement in the resistance to methicillin and the ineffectiveness of β-lactams among methicillin-resistant Staphylococcus aureus (MRSA) has led vancomycin and linezoli to be as selective drugs for treating Staphylococcal infections, in particular MRSA. The aim of this study was to explore the vancomycin and linezolid resistance in clinical isolates of S. aureus that produce biofilm.

Materials and methods:
Standard microbiology methods were applied to identify 270 S. aureus isolates. Both were confirmed by the femA gene. Resistance to methicillin and linezolid was investigated by disc diffusion and agar dilution methods, and it was confirmed by E-test and biofilm formation was determined. All isolates were examined for mecA gene for MRSA. Specific primers were used to detect vancomycin (vanA, B, C), and linezolid resistance (cfr gene) and next the PCR products.

Results:
One-hundred and fifty-two (56.3%) isolates were resistant to methicillin (MRSA) and 6 (1.2%) of them were nonsusceptible to vancomycin and likewise 10 (3.7%) isolates were resistant to linezolid. About 243(90%) isolates of S. aureus were positive for biofilm production. Additionally, 144 isolates (53.3%) were MRSA by mecA gene. The vanA gene was detected in two isolates (0.7%), but none of them has amplified the cfr gene.

Conclusion:
Resistance to methicillin was high and vancomycin resistance via vanA gene was detected, which enhances the risk of spreading vancomycin resistance. However, resistance to linezolid was not associated with the cfr gene. Therefore, linezolid is yet a valuable antimicrobial in the eradication of S. aureus infections. Our study showed there is an association between Staphylococcus aureus resistance and biofilm production of our isolates.
Identification and prevalence of type II toxin–antitoxin genes in Acinetobacter baumannii isolates from clinical samples
Authors: Dashtbin Shirin , Mirkalantari Shiva 
Published: November 2024

Introduction:
The toxin–antitoxin (TA) system is a prevalent genetic module found in prokaryotes and plays a significant role in their survival. Mobile genetic elements (MGEs) contribute to the dissemination of antibiotic resistance genes (ARGs), making TA systems critical in this aspect. However, the extent of diversity and abundance of TA systems in Acinetobacter baumannii, a bacterial species that harbors ARGs, remains incompletely characterized.

Method:
In this cross-sectional study, a total of 70 A. baumannii isolates were collected from different clinical samples in microbiology laboratory of different hospitals of Tehran Hospital in six months. Antibacterial resistance of the isolates was determined using disk diffusion method. The prevalence of toxin-antitoxin systems in isolates was also determined by PCR method. Fischer and Chi-square statistical analysis tests were used to determine the association between the presence of these genes and the source of the isolate and antibacterial resistance, respectively.

Results and Discussion:
The results obtained from PCR analysis targeting TAs system loci revealed a high prevalence of TA genes. The gnat/XRE-like genes were detected in all isolates, while the hipA/hipB gene was present in 27.1% of them. The remaining genes, hicA/hicB, were found in 44.2% of the isolates. Significant correlations were found between the presence of hipA/hipB genes and resistance to ceftazidime, meropenem, imipenem, and cefepime (P < 0.05). Additionally, we found a significant association between the presence of the hicA/hicB genes and resistance to gentamycin, ciprofloxacin, amikacin, meropenem, imipenem, and cefepime. Due to the high prevalence of TA systems in A. baumannii, particularly the GCN5-related N-acetyltransferases/XRE-like system, we suggest that these systems may serve as promising targets for the development of antimicrobial drugs to treat infections caused by this pathogen.
Gut microbiota and geriatric health
Authors: Nayak Kusumakshi , Gopan Adithya , Priyanka  , Muraleedharan Anju , Varghese Aneena , Patil Asha , Manokaran Kalaivani 
Published: November 2024

Background:
Each individual has a distinct gut microbiota composition that serves a variety of important roles in the metabolism of the host's nutrients, immunomodulation, and maintains immunity and inflammatory response and influences the gut–brain axis (GBA). In addition to modulating the immune system, the hypothalamic–pituitary–adrenal (HPA) axis, and tryptophan metabolism, microorganisms can synthesize several neurotransmitters and generate metabolites, such as short-chain fatty acids (SCFAs), that have neuroactive features. The gut microbiome is highly susceptible to lifestyle modifications, diet and xenobiotics, which leads to dysbiosis. Dysbiosis in the geriatric population can cause numerous disease conditions like Alzheimer's and Parkinson's disease, cardiovascular disease, gastrointestinal disease, and cancer. Dysbiosis of the gut microbiota has been associated with behavioural and neurological disorders such as depression, Alzheimer's, Parkinson's, and autism spectrum disorder. Furthermore, SCFA administration and microbiota alteration have been suggested as therapy objectives for these illnesses. DNA-based culture-independent methods, including next-generation sequencing, which provide quantitative information on the human gut microbiota are used to define the entire gut health and its relation to various disorders. The current review aims to summarize the available literature on the role of gut microbiota in ageing and dysbiosis in disease conditions.
Public Health Accreditation Board Accreditation and Pathways Recognition Among Small Health Departments: Motivation, Communication, and Celebration
Authors: Fifolt Matthew , Allen Peg , Crenshaw Andrew N. , Erwin Paul C. , Lang Britt , Belflower Thomas Amy , Brownson Ross C. 
Published: November 2024

This paper explores how small local health departments (LHDs) motivated staff members, communicated progress toward Public Health Accreditation Board accreditation or Pathways Recognition, and celebrated interim and final accreditation accomplishments. Qualitative key informant interviews were conducted with 22 employees and affiliates of 4 LHDs with jurisdiction populations <50 000. LHDs motivated staff through ownership, creative strategies to monitor and record progress, and meaningful no- or low-cost incentives. Participants communicated accreditation progress internally and externally through in-person and electronic communication. Individuals described small rituals and large, community-wide celebrations to express collective investment in and ownership of the accreditation process. Strategies to motivate staff were top-down and bottom-up, and accreditation status updates were communicated through multiple channels. Participants viewed celebrations as valuable aspects of the accreditation process. Reaccreditation participants deemed Public Health Accreditation Board accreditation worthy of celebration and an accomplishment to share with the community.