bluuebunny/crossref_metadata_2025_split huggingface dataset:
Revisiting the Role of Balloon Atrial Septostomy Prior to the Arterial Switch Operation
Authors: Subramanian Sujata , Jani Sagar , Well Andrew , Mikulski Matthew F. , Agrawal Hitesh , Byron Holt D , Venardos Neil , Mery Carlos M. , Fraser Charles D. 
Published: August 2024

Objectives Patients with dextro-transposition of the great arteries (d-TGA) frequently undergo balloon atrial septostomy (BAS) prior to the arterial switch operation (ASO) to promote atrial-level mixing. Balloon atrial septostomy has inherent risks as an invasive procedure and may not always be necessary. This study revisits the routine utilization of BAS prior to ASO. Methods Single-center, retrospective review of d-TGA patients undergoing the ASO from July 2018 to March 2023. Preoperative patient characteristics, pulse oximetry oxygen saturations (SpO2), cerebral/renal near-infrared spectroscopy (NIRS) readings along with prostaglandin status at the time of the ASO were analyzed with descriptive and univariate statistics. Results Thirty patients underwent the ASO. Of these, 7 (23%) were female, 25 (83%) were white, and median weight at ASO was 3.2 kg (range 0.8-4.2). Twenty-two (73%) patients underwent BAS. There were no demographic differences between BAS and no-BAS patients. Of those who underwent BAS, there was a significant increase in SpO2 (median 83% [range 54-92] to median 87% [range 72-95], P = .007); however, there was no change in NIRS from pre-to-post BAS. Six (27%) patients in the BAS group were prostaglandin-free at ASO. Balloon atrial septostomy patients underwent the ASO later compared with no-BAS patients (median 8 [range 3-32] vs 4 [range 2-10] days old, P = .016) and had a longer hospital length of stay (median 13 [range 7-43] vs 10 [range 8-131] days, P = .108). Conclusions While BAS is an accepted preoperative procedure in d-TGA patients to improve oxygen saturations, it is also an additional invasive procedure, does not guarantee prostaglandin-free status at the time of ASO, and may increase the interval to ASO. Birth to direct early ASO, with prostaglandin support, should be revisited as an alternative, potentially more expeditious strategy.
The Relationship Between Medial Meniscal Extrusion and Outcome Measures for Knee Osteoarthritis: A Systematic Review
Authors: Kahat David H. , Nouraee Cyrus M. , Smith Jesse S. , Santiago Cassiano C. , Floyd Edward R. , Zbyn Stefan , Abbasguliyev Hasan , Kajabi Abdul Wahed , Ellermann Jutta M. 
Published: August 2024

Background: Medial meniscal extrusion (MME) has been associated with knee osteoarthritis (OA). However, there is no standardized method to measure MME. Purpose/Hypothesis: The purpose of this study was to investigate the relationship between MME and outcome measures related to knee OA and discuss different magnetic resonance imaging (MRI) methods of measuring MME. It was hypothesized that MME would be associated with outcome measures of OA and that the distance extruded over the tibial plateau would be the most common MRI method to measure MME. Study Design: Systematic review; Level of evidence, 3. Methods: The MEDLINE, Embase, Cochrane Library, Scopus, Web of Science Core Collection, Global Index Medicus, and ClinicalTrials.gov databases were systematically searched. The inclusion criteria were studies that (1) measured MME on nonoperated knees using MRI; (2) evaluated knee OA with at least 1 knee OA grading scale, outcome measure, or direct characterization of cartilage or bone; (3) statistically evaluated the association between MME and knee OA outcome measure; (4) were randomized controlled trials, nonrandomized controlled trials, cohort studies, or case series; and (5) reported original results. Results: A total of 19 studies were included, of which 14 reported MME as the distance extruded over the tibial plateau, 7 reported MME as the volume extruded over the tibial plateau, and 1 reported MME as the percentage of the tibial plateau covered by the meniscus. All studies reported that MME was significantly associated with at least 1 OA outcome measure—including increased Kellgren-Lawrence grade, osteophytes, cartilage damage, varus alignment, knee pain, bone marrow lesions, and progression to arthroplasty. Eight studies found that MME was associated with worse OA outcomes over time (range, 2-10 years). Conclusion: All 19 reviewed studies reported that MME was associated with at least 1 knee OA outcome measure reflective of worsening arthritis, suggesting a strong association between OA and MME. Future research is needed to investigate this relationship and standardize the methods of measuring MME.
Minijobs as stepping stones to regular employment: overall trends and the role of Midijob reforms
Authors: Collischon Matthias , Herget Anna , Riphahn Regina T. 
Published: August 2024

AbstractMinijobs are subsidized small jobs below a fixed earnings threshold. Since a reform in 2003, they are viewed as stepping stones to the first labor market. However, the Minijob subsidy generates a ‘Minijob trap’ that causes vast bunching at the Minijob earnings threshold. Therefore, Midijobs were designed to reduce this bunching and to eliminate the ‘Minijob trap’. Midijobs are employments that earn between the Minijob earnings threshold and the Midijob earnings threshold. In this range, Midijobs subsidize social insurance contributions on a sliding scale. This paper describes time trends in the propensity to leave Minijobs for regular employment and studies the role of Midijobs for transitions out of Minijobs. We find a strong increase in transitions from Minijobs to regular employment over time. However, there is no convincing evidence that Midijobs are connected to this development. Instead, behavioral changes and aggregate developments such as the business cycle and a booming labor market may have contributed to this development.
Potential antivirulence and antibiofilm activities of sub-MIC of oxacillin against MDR S. aureus isolates: an in-vitro and in-vivo study
Authors: Omar Amira , El-Banna Tarek E. , Sonbol Fatma I. , El-Bouseary Maisra M. 
Published: August 2024

Abstract
Background
Multi-drug resistant Staphylococcus aureus is one of the most common causes of nosocomial and community-acquired infections, with high morbidity and mortality. Treatment of such infections is particularly problematic; hence, it is complicated by antibiotic resistance, and there is currently no reliable vaccine. Furthermore, it is well known that S. aureus produces an exceptionally large number of virulence factors that worsen infection. Consequently, the urgent need for anti-virulent agents that inhibit biofilm formation and virulence factors has gained momentum. Therefore, we focused our attention on an already-approved antibiotic and explored whether changing the dosage would still result in the intended anti-virulence effect.

Methods
In the present study, we determined the antibiotic resistance patterns and the MICs of oxacillin against 70 MDR S. aureus isolates. We also investigated the effect of sub-MICs of oxacillin (at 1/4 and 1/8 MICs) on biofilm formation using the crystal violet assay, the phenol-sulphuric acid method, and confocal laser scanning microscopy (CLSM). We examined the effect of sub-MICs on virulence factors and bacterial morphology using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and electron microscopy, respectively. Moreover, we studied the effect of sub-MICs of oxacillin (OX) in-vivo using a wound infection model.

Results
Oxacillin at 1/2 MIC showed a significant decrease in bacterial viability, while 1/4 and 1/8 MICs had negligible effects on treated bacterial isolates. Treatment of MDR isolates with 1/4 or 1/8 MICs of oxacillin significantly reduced biofilm formation (64% and 40%, respectively). The treated MDR S. aureus with sub-MICs of OX exhibited a dramatic reduction in several virulence factors, including protease, hemolysin, coagulase, and toxic shock syndrome toxin-1 (TSST-1) production. The sub-MICs of OX significantly decreased (P < 0.05) the gene expression of biofilm and virulence-associated genes such as agrA, icaA, coa, and tst. Furthermore, oxacillin at sub-MICs dramatically accelerated wound healing, according to the recorded scoring of histological parameters.

Conclusion
The treatment of MDR S. aureus with sub-MICs of oxacillin can help in combating the bacterial resistance and may be considered a promising approach to attenuating the severity of S. aureus infections due to the unique anti-biofilm and anti-virulence activities.
Preliminary findings on the experiences of care for women who suffered early pregnancy losses during the COVID-19 pandemic: a qualitative study
Authors: Silverio Sergio A. , George-Carey Rhiannon , Memtsa Maria , Kent-Nye Flora E. , Magee Laura A. , Sheen Kayleigh S. , Burgess Karen , Oza Munira , Storey Claire , Sandall Jane ,   The PUDDLES UK Collaboration, Sampson Amy , Haddad Leonie , Payne Elana , Sambrook Laura , Goodhart Venetia , Easter Abigail , von Dadelszen Peter , Jurković Davor 
Published: August 2024

Abstract
Background
Women who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gynaecological care was delivered, as health systems moved to rapidly reconfigure and re-organise services, aiming to reduce the risk and spread of SARS-CoV-2 infection. PUDDLES is an international collaboration investigating the pandemic’s impact on care for people who suffered a perinatal bereavement. Presented here are initial qualitative findings undertaken with UK-based women who suffered early pregnancy losses during the pandemic, about how they navigated the healthcare system and its restrictions, and how they were supported.

Methods
In-keeping with a qualitative research design, in-depth semi-structured interviews were undertaken with an opportunity sample of women (N = 32) who suffered any early pregnancy loss during the COVID-19 pandemic. Data were analysed using a template analysis to understand women’s access to services, care, and networks of support, during the pandemic following their pregnancy loss. The thematic template was based on findings from parents who had suffered a late-miscarriage, stillbirth, or neonatal death in the UK, during the pandemic.

Results
All women had experienced reconfigured maternity and early pregnancy services. Data supported themes of: 1) COVID-19 Restrictions as Impractical & Impersonal; 2) Alone, with Only Staff to Support Them; 3) Reduction in Service Provision Leading to Perceived Devaluation in Care; and 4) Seeking Their Own Support. Results suggest access to early pregnancy loss services was reduced and pandemic-related restrictions were often impractical (i.e., restrictions added to burden of accessing or receiving care). Women often reported being isolated and, concerningly, aspects of early pregnancy loss services were reported as sub-optimal.

Conclusions
These findings provide important insight for the recovery and rebuilding of health services in the post-pandemic period and help us prepare for providing a higher standard of care in the future and through any other health system shocks. Conclusions made can inform future policy and planning to ensure best possible support for women who experience early pregnancy loss.
Frequency of seropositive celiac disease and hypothyroidism among children and adolescents with congenital heart disease: A case-control study
Authors: Edraki Mohammad Reza , Kerachi Ali Jamshidi , Yazdani Negar , Honar Naser , Dehghani Reza , Afshar Zhila , Dehghani Mohsen , Amoozgar Hamid 
Published: August 2024

Abstract
Background
The prevalence of celiac disease (CD) and hypothyroidism exhibit significant variation in different studies among patients with congenital heart disease (CHD). This study evaluated the frequency of laboratory test abnormalities in children and adolescents with CHD in Shiraz, Iran.

Methods
This prospective case-control study was conducted on 223 children and adolescents with CHD and healthy individuals referred to the heart clinic affiliated with Shiraz University of Medical Sciences between February 2019 and December 2021. They were classified into case and control groups. Blood tests were performed for total IgA antibody, anti-tissue transglutaminase IgA antibody (anti-TTG Ab), T4, and thyroid stimulating hormone (TSH) and anti-thyroid peroxidase antibodies in serum, along with transthoracic echocardiography. Likewise, demographic characteristics of patients, including age, sex, weight, height, and body mass index (BMI), were recorded. Also, anti-TTG Ab levels were compared among CHD patients according to cyanosis status, gender, age (above and below five years), and BMI (under and over 18.5).

Results
Ninety-eight CHD patients and 100 healthy individuals with an average age of 5.32 ± 4.05 years (1–18 years) were examined. In children with CHD, atrial septal defect (27%), ventricular septal defect (20%), and tetralogy of Fallot (13%) were the most prevalent disorders. Only one CHD patient had an anti-TTG Ab level of 16.6 unit/mL, considered borderline for seropositive CD diagnosis. There was no difference in anti-TTG Ab levels between age (above and below five years), BMI (under and over 18.5), cyanosis status, and gender groups. Seven CHD patients had high TSH levels, three had cyanotic CHD, and one had Down syndrome. The TSH levels and non-autoimmune hypothyroidism were significantly higher in CHD patients than in normal subjects (p < 0.05).

Conclusions
According to the results of this study, the serum level of TSH and prevalence of non-autoimmune hypothyroidism were higher in patients with CHD than in normal subjects, but the serum level of anti-TTG Ab was not different between the two groups.
Evaluation of the accuracy of cone beam computed tomography (CBCT) in the detection of peri-implant fenestration
Authors: Gholampour Atefeh , Mollaei Melika , Ehsani Hodis , Ghobadi Fatemeh , Hosseinnataj Abolfazl , Yazdani Mehdi 
Published: August 2024

Abstract
Background
Accurate assessment of the bone supporting the implant is crucial. Early detection of bone defects around the implant can prevent the loss of bone support that ultimately leads to the loss of the implant. Therefore, the purpose of this study is to check the accuracy of CBCT in detecting peri-implant fenestrations around the implant.

Materials & methods
In this laboratory study, healthy beef ribs were used. The ribs were divided into three groups of 12 (control group, 1–2 mm fenestration group, and 2–3 mm fenestration group). The blocks were cut to a length of 20 mm and 36 osteotomies with dimensions of 4 × 12 mm were made by the periodontist in order to place the implant in these bone blocks. Then the titanium implant was placed in the holes and the initial scan was performed with CBCT. In the second group, fenestration-like lesions were created on the same buccal side at a distance of 10 mm from the crest with a diameter of 1–2 mm and in the third group with a diameter of 2–3 mm, and the CBCT scan was performed again with the same parameters. Two radiologists evaluated the images twice for the presence and absence of fenestration.

Results
There was no statistically significant difference between direct measurements and CBCT in the fenestration group of 1–2 mm (p < 0.05), but there was a significant difference between direct measurements and CBCT in the fenestration group of 2–3 mm and underestimation was observed in CBCT measurements.

Conclusion
The findings of this study showed that CBCT radiography has a higher accuracy in measuring the fenestration around the implant with a smaller diameter and has an acceptable diagnostic value in detecting bone loss around the implant.
Effect of WhatsApp-based BETTER model sexual counselling on sexual function and sexual quality of life in breast cancer survivors: a randomized control trial
Authors: Nazarzadeh Shirin , Moghaddam-Tabrizi Fatemeh , Haghighi Mahmonir , Gharaaghaji-Asl Rasool 
Published: August 2024

Abstract
Objective
The aim of the study was to determine the effect of WhatsApp-based BETTER sex counselling on sexual function and sexual quality of life in breast cancer survivors in a randomized control trial.

Methods
This is a randomized controlled trial in which a total of 90 breast cancer survivors were recruited using convenience sampling and then randomly assigned to two groups of WhatsApp-based BETTER model counselling and routine care. Data collection tools consisted of a demographic questionnaire, the Sexual Quality of Life-Female (SQOL-F) and the Sexual Function Index (FSFI-BC). Participants in the intervention group were given access to the 6-week program. The program consisted of six consultation and assignment packages covering all six steps of the BETTER model. Data were analyzed using SPSS software version 20. Chi-square test, independent samples t-test and repeated measures analysis of variance were used. The significance level (p-value) was considered to be less than 0.05.

Results
In the control group, the mean score of SQL scale changed from 35.16 ± 10.71 to 35.16 ± 12.97 (P > 0.05) and in the intervention group, it significantly increased from 34.76 ± 10.13 to 68.20 ± 20.48 (P < 0.001). Similarly, the comparison of mean of FSF in the control group showed a none-significant change from 58.13 ± 7.11 to 58.35 ± 6.11 (P > 0.05), and in the intervention group, it significantly improved from 59.49 ± 6.10 to 120.73 ± 25.54 (P < 0.001). The results of rANOVA indicated that there was a significant difference in the mean scores of the SQL and SFS between the two groups from pre- to post-intervention, and then over the 1-month follow-up period in the intervention group (p < 0.001). Considering partial eta squared, the effect of the intervention had the highest interaction effect on both variables of the sexual function index (η2 = 0.73) and sexual quality of life (η2 = 0.41).

Conclusions
The intervention program was a successful model for improving female sexual quality of life and female sexual function in breast cancer survivors.

Trial registration
IRCT20210926052601N1, 7–11-2021.
Exploration of clinical ethics consultation in Uganda: a case study of Uganda Cancer Institute
Authors: Nanyonga Mayi Mayega , Kutyabami Paul , Kituuka Olivia , Sewankambo Nelson K. 
Published: August 2024

Abstract
Introduction
Globally, healthcare providers (HCPs), hospital administrators, patients and their caretakers are increasingly confronted with complex moral, social, cultural, ethical, and legal dilemmas during clinical care. In high-income countries (HICs), formal and informal clinical ethics support services (CESSs) have been used to resolve bioethical conflicts among HCPs, patients, and their families. There is limited evidence about mechanisms used to resolve these issues as well as experiences and perspectives of the stakeholders that utilize them in most African countries including Uganda.

Methods
This phenomenological qualitative study utilized in-depth interviews (IDIs) and focus group discussions (FGDs) to collect data from Uganda Cancer Institute (UCI) staff, patients, and caretakers who were purposively selected. Data was analyzed deductively and inductively yielding themes and sub-themes that were used to develop a codebook.

Results
The study revealed there was no formal committee or mechanism dedicated to resolving ethical dilemmas at the UCI. Instead, ethical dilemmas were addressed in six forums: individual consultations, tumor board meetings, morbidity and mortality meetings (MMMs), core management meetings, rewards and sanctions committee meetings, and clinical departmental meetings. Participants expressed apprehension regarding the efficacy of these fora due to their non-ethics related agendas as well as members lacking training in medical ethics and the necessary experience to effectively resolve ethical dilemmas.

Conclusion
The fora employed at the UCI to address ethical dilemmas were implicit, involving decisions made through various structures without the guidance of personnel well-versed in medical or clinical ethics. There was a strong recommendation from participants to establish a multidisciplinary clinical ethics committee comprising members who are trained, skilled, and experienced in medical and clinical ethics.
Exploring the road to public healthcare accessibility: a qualitative study to understand healthcare utilization among hard-to-reach groups in Kerala, India
Authors: Surendran Surya , Joseph Jaison , Sankar Hari , Benny Gloria , Nambiar Devaki 
Published: August 2024

Abstract
Background
Kerala, a southern state in India, is known to be atypical due to its high literacy rate and advanced social development indicators. Facing competition from a dominant private healthcare system, recent government health system reforms have focused on providing free, high-quality universal healthcare in the public sector. We carried out an analysis to ascertain the initial impacts of these measures among ‘hard to reach groups’ as part of a larger health policy and systems research study, with a focus on public sector health service utilisation.

Methods
We conducted Focus Group Discussions (FGDs) among identified vulnerable groups across four districts of Kerala between March and August of 2022. The FGDs explored community perspectives on the use of public healthcare facilities including enablers and barriers to healthcare access. Transliterated English transcripts were coded using ATLAS.ti software and thematically analyzed using the AAAQ framework, supplemented with inductive code generation.

Results
A total of 34 FGDs were conducted. Availability and cost-effectiveness were major reasons for choosing public healthcare, with the availability of public insurance in inpatient facilities influencing this preference. However, accessibility of public sector facilities posed challenges due to long journeys and queues. Uneven roads and the non-availability of public transport further restricted access. Gaps in acceptability were also observed: participants noted the need for the availability of special treatments available, reduced waiting times for special groups like those from tribal communities or the elderly mindful of their relatively greater travel and need for prompt care. Although quality improvements resulting from health reform measures were acknowledged, participants articulated the need for further enhancements in the availability and accessibility of services so as to make public healthcare systems truly acceptable.

Conclusion
The ‘Kerala Model of Development’ has been applauded internationally for its success in recent years. However, this has not inured the state from the typical barriers to public sector health care use articulated by participants in the study, which match global evidence. In order to deepen the impact of public sector reforms, the state must try to meet service user expectations– especially among those left behind. This requires attention to quality, timeliness, outreach and physical access. Longer term impacts of these reforms – as we move to a post-COVID scenario - should also be evaluated.