bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre-Exposure Prophylaxis for HIV: Bioethical, Clinical, and Epidemiological Considerations
Authors: Markley John D. 
Published: March 2024

Public health authorities are broadly promoting a strategy known as pre-exposure prophylaxis (PrEP) for the prevention of human immunodeficiency virus (HIV) transmission in the context of high-risk sexual activity and injection drug use. However, there are several limitations to this strategy that are underrecognized. This article reviews the primary literature supporting the use of PrEP and explores the unintended consequences associated with its use. Current public health messaging indicates that PrEP reduces the risk of HIV transmission during sex by 99 percent; however, this figure is based on modeling rather than study findings, and real-world efficacy may be significantly lower. PrEP has been associated with increased rates of sexually transmitted infections, risk compensation, HIV drug resistance, low adherence, and drug side effects. To make fully informed decisions, medical professionals and patients should be aware of these pitfalls. Additionally, this article explores the bioethical implications of prescribing PrEP from a Catholic perspective. Although not always morally illicit, PrEP is most often prescribed in the context of sexual activity outside of marriage between a biological male and female, placing the prescriber in cooperation with activity deemed to be immoral by the Catholic Church. While all medical professionals seeking the common good should aim to reduce the transmission of HIV, not all means are morally licit. Conscience protection for medical professionals opposed to this strategy has become increasingly relevant. Thoughtful discernment is necessary when considering PrEP. Summary: The use of CDC material (figure 1) in this article does not imply endorsement by CDC. The material is in the public domain and available on the CDC website free of charge.
‘The worst day of my life’: Foster carers’ experiences of allegations
Authors: Roberts Louisa M , Rees Alyson , Elliott Daisy , Wood Sophie 
Published: March 2024

Appropriate allegation investigations within social care are paramount to protect children. However, many allegations are unsubstantiated ( Biehal et al., 2014 ) and result in stress and anxiety for fostering families ( Adams, Hassett and Lumsden, 2018 ), financial uncertainty ( Boffey, Stanton and Thomas, 2019 ), unplanned endings and foster carers leaving their role ( Adams, Hassett and Lumsden, 2018 ). There is little research into the prevalence, nature and outcomes of allegations against foster carers. This UK-based study uses The Fostering Network’s State of the Nation’s Foster Care (SOTN) 2021 survey and analyses responses from 3,352 UK foster carers and 99 fostering service staff. Qualitative findings reflect six themes: (1) emotional impacts, (2) financial implications, (3) independent support, (4) social services involvement, (5) understanding allegations, and (6) children being removed or foster carers leaving their role. Quantitative findings show only 25% of those experiencing an allegation believed they were sufficiently communicated with, only 20% believed specified timescales were adhered to, 57% did not receive independent support, and 36% said no support was offered to children in their home. Poor information-sharing and lack of support were found to have exacerbated the stress experienced.
Biodegradable composites made from maize flour filled with olive husk fibers
Authors: Sahi Samira , Mouza Nabila 
Published: March 2024

The development of biomaterials based on maize flour reinforced with natural fiber was studied with the aim of replacing conventional polymers of petrochemical origin and to simplify assimilated rubbish managing strategies, which reduces the pollution of the environment. In this study, several composites based on plasticized maize flour (PMF) reinforced by the olive husk flour (OHF) in a range from 10% to 40% (wt.%) have been produced with double screw extruder. 15% (wt.%) of low-density polyethylene (LDPE) and graft polyethylene combined with maleic anhydride (PE-g-MA) bonding substance at 5 (wt.%) were added to obtain high mechanical characteristics and improve blend compatibility. Scanning electron microscope (SEM) analysis showed that the fibers were well dispersed in matrix. The Fourier-transform infrared (FTIR) spectroscopy analysis revealed an increase in the absorption bands characteristic of hydroxyl groups and the anhydroglucose ring O-C stretch by raising OHF amount in composites. Thermal stabilization and density of composites increase with the percentage of fiber. For fiber weights of 10 and 40 (wt.%), the tensile strength increased as of 8.4 to 16.4 MPa and the Young modulus as of 70 to 245%, respectively. The biodegradability of samples was tested by burying them in the soil for 90 days. The weight loss test showed that the biodegradability accelerated with the increase in OHF quantity in the PMF. The latter finding was confirmed by FTIR analysis and deteriorated surface of samples examined by SEM analysis.
Mechanical properties and wear performance of denture base polymethyl methacrylate reinforced with nano Al2O3
Authors: Fouad Ramy A , Ibrahim Amal AA , El-Sayed Seleman Mohamed M , Ataya Sabbah , Habba Mohamed Ibrahim AA 
Published: March 2024

Polymethyl methacrylate (PMMA) has been widely used as a material in dentistry. The deterioration of pure PMMA denture teeth is a significant issue that can alter the vertical dimensions of dentures. This study investigates the effect of aluminum oxide (Al2O3) nano-ceramic addition as reinforcements into the heat-cure acrylic resin denture teeth. The PMMA was reinforced with Al2O3 concentrations of 1, 3, 5, and 10 wt.%. The PMMA without ceramic addition is produced for comparison purposes. The color change, densification, microhardness, and compressive properties of the produced PMMA resin and its composites were investigated to detect the effect of Al2O3 nano ceramic addition on the physical and mechanical properties. Furthermore, the microstructure was also performed using scanning electron microscopy (SEM) analysis. A chewing simulator was utilized to conduct two-body wear testing, employing a human enamel antagonist. The wear behavior of the PMMA and their composites were assessed by measuring the weight loss after submitting them to 37,500 cycles. The SEM microstructure analysis revealed sound specimens of PMMA reinforced with 0, 1, 3, and 5 wt.% Al2O3 without any porosity and micro defects using the applied production procedures. In contrast, the aggregated sites and propagation of cracks were detected for the PMMA/10 wt.% Al2O3 specimen. The densification and hardness properties of the produced PMMA composites improved with increasing the Al2O3 additions. The microhardness of PMMA/10 wt.% Al2O3 improved by around 233% compared to the PMMA matrix. The higher compressive properties were detected for the PMMA/5 wt.% Al2O3 composite specimen with ultimate compressive strength (UCS) of 54.75 MPa and yield strength (YS) of 45.6 MPa and improved than the PMMA matrix by around 98 % and 117 %, respectively. In addition, incorporating Al2O3 nano-ceramic particles into a PMMA matrix revealed a significant improvement in the wear resistance of the produced composites compared to the PMMA matrix.
Initiation of belimumab with higher daily prednisolone is effective for rapid glucocorticoid reduction: A 96-week retrospective study
Authors: Yamane Takashi , Hashiramoto Akira 
Published: March 2024

Objectives For appropriate glucocorticoid (GC) reduction, we investigated the optimal strategy including baseline factors that could reduce GC more than 50% with 96 weeks of belimumab. Methods This is a retrospective cohort study of Kakogawa Central City hospital from 2019 to 2023. We identified SLE patients who were receiving 200 mg of belimumab weekly by subcutaneous injection for 96 weeks. The background at baseline, trends in clinical indicators, and factors involved in GC reduction were statistically analyzed. Finally, univariate and multivariate logistic analyses were carried out to identify baseline factors associated ≥50% GC reduction at 96 weeks. Results Forty-seven patients were enrolled, with a median daily prednisolone of 5 mg. Almost 90% of them received concomitant immunosuppressants and/or hydroxychloroquine. Serological indices, daily GC dose, and SLEDAI-2K scores showed significant improvement in 96 weeks. At baseline, a significant negative correlation has been shown between the daily dose of GC and the duration from onset or last flare, as well as C4 levels. At 96 weeks, GC reduction rate and SLEDAI-2K scores were negatively correlated with duration from onset or last flare to initiation of belimumab. Mycophenolate mofetil use was significantly frequent in patients with lupus nephritis (LN), which also correlated with the frequency of past flares. In addition, LN presence was associated with higher SLEDAI-2K scores at 96 weeks, and baseline SLEDAI-2K ≥10 was associated with significantly higher GC dose at 96 weeks. Univariate analysis of the factor contributing to achieving ≥50% GC reduction at 96 weeks has pointed shorter disease duration and higher daily GC dose at baseline as significant variables. Finally, we performed a multivariate analysis by combining above two items with age, which extracted the higher daily GC dose at baseline as a significant variable (OR (95% CI) 1.25 (1.00 to 1.56), p = .047). Conclusions Our study showed that a delay in belimumab initiation led to higher SLEDAI-2K score and difficulty in achieving a 50% GC reduction at 96 weeks. Since GC-related adverse events increase with long-term administration of GC though with small daily doses, we proposed here that belimumab should be started in combination with higher daily prednisolone.
Maternal risk factors for congenital vertebral formation and mixed defects: A population-based case–control study
Authors: Heiskanen Susanna , Helenius Ilkka , Syvänen Johanna , Kemppainen Teemu , Löyttyniemi Eliisa , Ahonen Matti , Gissler Mika , Raitio Arimatias 
Published: March 2024

Background: The etiology and risk factors of congenital vertebral anomalies are mainly unclear in isolated cases. Also, there are no reports on the risk factors for different subgroups of vertebral anomalies. Therefore, we assessed and identified potential maternal risk factors for these anomalies and hypothesized that diabetes, other chronic diseases, smoking, obesity, and medication in early pregnancy would increase the risk of congenital vertebral anomalies. Methods: All cases with congenital vertebral anomalies were identified in the Finnish Register of Congenital Malformations from 1997 to 2016 for this nationwide register-based case–control study. Five matched controls without vertebral malformations were randomly selected. Analyzed maternal risk factors included maternal age, body mass index, parity, smoking, history of miscarriages, chronic diseases, and prescription drug purchases in early pregnancy. Results: The register search identified 256 cases with congenital vertebral malformations. After excluding 66 syndromic cases, 190 non-syndromic malformations (74 formation defects, 4 segmentation defects, and 112 mixed anomalies) were included in the study. Maternal smoking was a significant risk factor for formation defects (adjusted odds ratio 2.33, 95% confidence interval 1.21–4.47). Also, pregestational diabetes (adjusted odds ratio 8.53, 95% confidence interval 2.33–31.20) and rheumatoid arthritis (adjusted odds ratio 13.19, 95% confidence interval 1.31–132.95) were associated with mixed vertebral anomalies. Conclusion: Maternal pregestational diabetes and rheumatoid arthritis were associated with an increased risk of mixed vertebral anomalies. Maternal smoking increases the risk of formation defects and represents an avoidable risk factor for congenital scoliosis. Level of evidence: III
How Does the Breastfeeding Environment Affect Satisfaction? A Scale Development Study
Authors: Reyhan Feyza Aktaş , Yeşildere Sağlam Havva , Sayiner Fatma Deniz 
Published: March 2024

Background: Women need a safe and comfortable environment to breastfeed their babies. The quality of breastfeeding environments in social areas is important for women’s breastfeeding satisfaction. Aim: The aim of this study was to develop a measurement tool for the evaluation of breastfeeding environments and to examine the impact of the quality of breastfeeding environments in social areas on breastfeeding satisfaction. Method: The first phase of the study was conducted in methodological design and the second phase in cross-sectional design. The draft scale was applied to 365 women who had breastfeeding experiences in social environments during the postpartum 6 months–3 years period. In the first stage, scale development analyses were applied. In the second stage, the developed scale was applied to 255 women. Frequency, percentage, Cronbach’s α coefficient, and correlation analysis were used in the analysis of the data. Results: The Ideal Breastfeeding Environment Assessment Scale, consisting of 23 items and four subdimensions, was obtained in the study. As a result of the application of the scale in the second stage, the mean score of the breastfeeding environments evaluated by the women was 23.43 ± 8.36. A statistically significant moderate–weak correlation was found between the ideality of breastfeeding environments and the satisfaction levels of women ( p < .001). Conclusion: It was determined that the developed scale is a valid and reliable measurement tool that can be used to evaluate breastfeeding environments. As the quality of breastfeeding environments increases, women’s breastfeeding satisfaction increases.
Resection of Calcaneonavicular and Talocalcaneal Coalitions With Surgical Correction of the Hindfoot Valgus Deformity in One Step
Authors: De Pellegrin Maurizio , Marcucci Lorenzo , Brogioni Lorenzo , Fracassetti Dario 
Published: March 2024

Background: Calcaneonavicular (CNC) and talocalcaneal (TCC) coalitions are the most common cause of rigid flatfoot in children. After resection, correction of the most frequent valgus-hindfoot deformity usually requires a second-step surgery. We report results of a retrospective study of patients treated with a one-step correction. Methods: Between 2008 and 2019, data were collected on 26 patients (19 male, 7 female) affected by CNC (n = 18) and TCC (n = 13), all with rigid symptomatic flatfeet. Average age at surgery was 12.5 ± 1.1 (SD) years (range, 9.8-15.2). All patients (26/26) underwent resection, 20 of 26 underwent at the same time subtalar extraarticular screw arthroereisis (SESA) for correction of residual hindfoot valgus deformity. Pre- and postoperative talocalcaneal angle according to Costa Bartani and Talar inclination angle in weightbearing were measured. Twenty-five of 26 patients had postoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Results: Pre- and postoperative talocalcaneal average angle for CNC was respectively 141.5 ± 7.7 degrees and 130.5 ± 5.2 degrees ( P < .0001) and 143.7 ± 7.7 degrees and 129.7 ± 7.0 degrees ( P < .0001) for TCC. Talar inclination average angle for CNC was 29.2 ± 5.3 degrees and 19.3 ± 1.6 degrees ( P < .0001) and 31.2 ± 6.4 degrees and 21.4 ± 3.4 degrees ( P < .0001) for TCC. Average follow-up (FU) was 4.7 ± 3.0 years (range, 6 months–11.9 years, median 4.9 years), with a mean age at FU of 17.2 ± 5.8 (SD) years (min 12.1, max 25.3, median 16.8 years). The mean AOFAS ankle-hindfoot score for CNC and for TCC was 96.6 (range 83-100) for resection and valgus correction as one-step procedure with no statistical difference ( P = .5) between CNC and TCC. No patients had additional surgery for complications or recurrence. Conclusion: Symptomatic rigid flatfeet affected by CNC and TCC treated with coalition resection and minimally invasive subtalar arthroereisis (SESA) for residual hindfoot valgus correction in one step in adolescent age achieved good to excellent results in all cases. Further surgery to correct malalignment was avoided. Level of Evidence: Level IV, retrospective study.
Keratoconus: exploring fundamentals and future perspectives – a comprehensive systematic review
Authors: Niazi Sana , Gatzioufas Zisis , Doroodgar Farideh , Findl Oliver , Baradaran-Rafii Alireza , Liechty Jacob , Moshirfar Majid 
Published: March 2024

Background:New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way.Objectives:This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies.Design:A multidimensional comprehensive systematic narrative review.Data sources and methods:A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed.Results:Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes.Conclusion:The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients.Trial registration:The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338
Healthcare workers’ safety and emotional exhaustion: Exploring the impact of violence and trust in emergency departments
Authors: Özel Mehmet , Balsak Habip , Yıldız Talat 
Published: March 2024

Background In the challenging and often high-stress environment of emergency departments (EDs), healthcare workers (HCWs) frequently encounter a concerning issue of workplace violence (WPV). This study delves into the effects of WPV management and safety on the emotional well-being of ED HCWs. Methods Data collected between 15 March 2023 and 15 May 2023 from 186 HCWs across Obstetrics and Gynecology, Pediatrics, and Adult EDs are analyzed. The survey includes the Safety and Confidence Scale (SCS) to gauge HCWs' perceptions of violence and the Job-Related Emotional Exhaustion Scale (JREES). Results Key findings highlight the prevalence of various forms of WPV in the ED, such as verbal violence (77.4%), threats, and insults (68.8%), with patients and their relatives identified as the primary perpetrators. Male HCWs scored significantly higher on the Violence Management and Safety (VMS) scale compared to their female counterparts. Conclusions In summary, within the demanding ED setting, this study sheds light on the profound impact of WPV on HCWs' emotional exhaustion and their overall sense of safety. It underscores the urgent need to build trust and bolster support mechanisms to alleviate emotional exhaustion among HCWs. Addressing WPV in the ED is paramount for the mental well-being of healthcare workers, particularly when faced with violence from patients and their families.
Endoscopic Repair of Ischial Tuberosity Avulsion Fracture
Authors: Bond Elizabeth C. , Scott Elizabeth J. , Mather Richard C. 
Published: March 2024

Background: The ischial tuberosity apophysis serves as an attachment site for the hamstring muscle complex in the pediatric pelvis. Once the apophysis begins to ossify around age 13 to 15 years, decreasing elasticity makes the physis the weakest part of the hamstring attachment to the pelvis. An avulsion injury of the hamstring muscle group in the adolescent therefore results in a fracture in the adolescent and is the functional equivalent to a 3-tendon proximal hamstring injury in an adult. Ischial tuberosity fractures have a higher rate of non-union than other pelvic apophyseal injuries. Endoscopic surgery offers the advantage of smaller incisions, reduced wound complications, and expedited recovery compared with an open procedure. Indications: Controversy exists over which fractures benefit from surgical fixation. Patients with an ischial tuberosity avulsion fracture that is displaced more than 20 mm or that remains symptomatic despite at least 3 months of conservative management are common indications for surgery. Technique Description: The patient is positioned in the prone position and under fluoroscopic guidance 2 endoscopic portals are created. The sciatic nerve is visualized, neurolysis performed, and then protected throughout the remainder of the case. The ischial tuberosity is located along with the avulsed apophysis and hamstring tendon. The bony surfaces are prepared. The fracture fragment is reduced and 3 partially threaded cannulated screws are percutaneously passed across the fracture. The interval between the semimembranosus and conjoined tendons was closed with a suture. Results: There are no results published specific to this technique. Outcome papers are lacking, but cohort studies show significant displacement increases risk for non-union. Displaced ischial tuberosity fractures are also thought to risk sciatic nerve irritation and decreased hamstring strength. Discussion/Conclusion: Recent advancements in periarticular endoscopic surgery of the hip have enabled this historically open procedure to be performed in a minimally invasive fashion. This technique achieves robust fixation of the avulsed fragment and the benefits of anatomic repair of the hamstring origin while avoiding the larger incision and soft tissue dissection required for an open procedure. In time, this technique may become standard of care much like other sports medicine procedures which have transitioned from open to arthroscopic with the development of suitable tools and techniques. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.