bluuebunny/crossref_metadata_2025_split huggingface dataset:
A qualitative process evaluation of universal free school meal provision in two London secondary schools
Authors: Jessiman Patricia E. , Carlisle Victoria R. , Breheny Katie , Campbell Rona , Jago Russell , Robinson Marcus , Strong Steve , Kidger Judi 
Published: February 2023

Abstract
Background
In the UK, one in five households with children experienced food insecurity in 2022, defined as a household-level economic and social condition of limited or uncertain access to adequate food. Free school meals are a public health intervention aimed at reducing food insecurity amongst children. The provision of universal free school meals (UFSM) to secondary school-aged children is a novel and untested intervention in the UK. This study is a process evaluation of a pilot of UFSM in two secondary schools in England. The aim was to understand the feasibility, acceptability, cost implications and lessons for the implementation of UFSM.

Methods
20 parents, 28 students and 8 school staff from two intervention schools participated in online qualitative interviews, as well as 4 staff from non-intervention schools. The Framework Method of thematic analysis was applied. These data were supplemented with student-led observations of school meal times, and school lunch uptake-data and cost information provided by the local authority delivering the pilot.

Results
UFSM in secondary schools is a feasible and acceptable intervention, with coherent goals of increased access to a healthy meal, reduced food insecurity and better nutrition. All participants perceived these goals were met. Acceptability was further enhanced by the perception that UFSM were supporting a greater proportion of low-income families than the national, targeted Free School Meal scheme, as well as being easier to implement. Potential barriers to implementation include limited school kitchen and dining infrastructure, meal quality and choice, and increased queuing times. Participants’ concerns that UFSM may benefit middle- and high- income families not in need were not as prevalent as the perception that UFSM was an effective way to support all families with secondary-aged children experiencing food insecurity.

Conclusion
This small-scale pilot study suggests that UFSM in secondary schools is feasible and acceptable, but more evidence is required from larger studies on the impact on long-term health, psychosocial and educational outcomes. Future, larger studies should also include detailed economic evaluations so this approach can be compared with other possible interventions.
Predictors of pulmonary hypertension in patients with hypersensitivity pneumonitis
Authors: Elnady Mohamed Abdelhakim , Elkorashy Reem , Nabil Afnan , Ibrahim Eman Kamal 
Published: February 2023

Abstract
Background
Hypersensitivity pneumonitis (HP) is an immunologically induced inflammation of the lung parenchyma that occurs in susceptible individuals in response to a variety of antigens. Repeated exposures to the causative antigens lead to chronic HP. The condition could be complicated with pulmonary hypertension (PH).

Methodology
60 patients with established diagnosis of HP were included, clinical examination, high resolution computed tomography (HRCT) of chest, arterial blood gases, six minute walking test (6MWT), desaturation index, spirometry, echocardiography were performed to all patients and right heart catheter was done for patients with high echo probability of PH.

Results
The mean age of patients was 41.67 ± 13.4 years with female predominance 83.3% of patients had history of raising birds. 71.7% of cases suffered from resting hypoxia with oxygen saturation 89 ± 11% with desaturation index 9% ± 8%, Echo probability of PH ranged from low to high 71.67, 21.67 and 6.67% respectively, mean pulmonary artery systolic pressure was 63.65 (18.48) mmHg. PH was diagnosed in 17 (28.33%) patients. HP with PH patients were significantly more symptomatic with predominant fibrotic pattern in HRCT chest P < 0.001, 82% of them had hypoxia P < 0.001 with significant desaturation after 6MWT P = 0.001. Predictors of PH in study group were fibrotic pattern in HRCT chest and hypoxia OR = 62.22, P < 0.001; 49.2, P < 0.001 respectively.

Conclusion
PH was prevalent in 28.33% of patients with HP, predictors of development of PH were fibrotic pattern in HRCT chest and hypoxia.
Trial registration: Retrospectively registered, registration number is NCT05458635, date of registration 07/12/2022.
Pedicle morphometry analysis of main thoracic apex adolescent idiopathic scoliosis
Authors: Sakti Yudha Mathan , Lanodiyu Zikrina Abyanti , Ichsantyaridha Mahardhika , Wijanarko Sonny , Filza Muhammad Riyad , Taufan Taufan , Susanto Dwi Budhi , Tampubolon Yunus Oksikimbawan , Baskara Anak Agung Ngurah Nata , Nurshal Aidil Akbar , Mustofa Fuad Dheni , Rosfadilla Annissa , Magetsari Rahadyan , Rukmoyo Tedjo 
Published: February 2023

Abstract
Introduction
Screw insertion during scoliosis surgery uses free-hand pedicle screw insertion methods. However, there is a wide variation in pedicle shapes, sizes, and morphometry, especially in scoliosis patients. CT scan pedicle measurements in main thoracic Lenke type 1 adolescent idiopathic scoliosis can help visualize this diversity. This study aimed to highlight the features of pedicle morphometry on the concave and convex sides, including pedicle diameter (width in axial and height in the sagittal plane), the depth to the anterior cortex, and Watanabe Pedicle classification in patients with main thoracic apex adolescent idiopathic scoliosis.

Materials and methods
This study was a cross-sectional observational study of Adolescent Idiopathic Scoliosis (AIS) patients whose apex in the main thoracic patient underwent deformity correction procedures. We used a three-dimensional CT scan to evaluate pedicle morphometry on the apex vertebrae, three consecutive vertebrae above and below the apex.

Results
A total of 6 patients with apex main thoracic AIS with 84 pedicles consisting of 42 pedicles from each concave and convex curve were analyzed. All of the samples were female, with the mean age at the procedure being 21.2 ± 5.56. The mean cobb angle was 62° ± 23°, with the main apex between VT8-VT10. The size of the pedicle was bigger from upper to lower vertebrae. The mean pedicle depth, pedicle width, and pedicle height for the concave side were 36.06 ± 4.31 mm, 3.91 ± 0.66 mm, and 9.16 ± 1.52 mm, respectively. Meanwhile, the convex side is 37.52 ± 1.84 mm, 5.20 ± 0.55 mm, and 11.05 ± 0.70 mm, respectively. We found a significant difference between the concave and convex sides for the pedicle width and height. The concave and convex sides were mainly classified as type C (38%) and type A (50%) Watanabe pedicle.

Conclusion
Pedicle width and pedicle height are significantly different between the concave and the convex side with convex side has better Watanabe pedicle classification. Pre-operative CT evaluation is essential for planning proper pedicle screw placement in AIS patients.
Perceptions, barriers and enablers of salt reduction in Malaysian out-of-home sectors (MySaltOH): from the point of view of policy-makers and food industries
Authors: Harun Zaliha , Shahar Suzana , You Yee Xing , Manaf Zahara Abdul , Majid Hazreen Abdul , Chia Yook Chin , Haron Hasnah , Michael Viola , Sukiman Noor Shahida , Taib Aida Farzana Mohamad , He Feng J. , Brown Mhairi K. 
Published: February 2023

Abstract
Background
High salt intake is a major cause of hypertension and cardiovascular diseases. The out-of-home sectors have been identified as one of the contributors of high salt intake in the population. The National Salt Reduction Policy of Malaysia was initiated in 2015; however, out-of-home sectors are yet to be emphasized and perception by policy-makers and the food industries towards salt reduction are yet unknown. This study aimed to determine the perceptions, barriers and enablers towards salt reduction in the out-of-home sector in Malaysia, as well as among policy-makers and the food industries.

Methods
This is a qualitative study via semi-structured in-depth interviews (IDI) and focus group discussions (FGD) involving several stakeholders consisting of policy-makers from five ministries, five nongovernment organizations (NGOs) and food science/food technology researchers from five regions (West, North, East, and South Peninsular and East Malaysia/Borneo), as well as the food industries. The IDI and FGD sessions were recorded, transcribed verbatim and analysed thematically using Nvivo software version 12.

Results
All participants agreed that salt intake in Malaysia is high and leads to hypertension and cardiovascular diseases. Lack of awareness, poor eating culture and behaviour and frequent eating out were among the causes of high salt intake. Awareness campaigns and education, sodium content labelling and product reformulation were strategies that have been implemented by the government; whilst for the food industries, some of them have tried to reduce salt and labelled the sodium content on their food products. However, there were several barriers including perceived poor consumer acceptance, lack of knowledge and resources, and challenges in reformulation, as well as unavailability of guidelines and salt targets. Hence, several enablers have been suggested, which include prioritizing the salt reduction strategy, creating more awareness, collaboration and engagement, research and technology particularly for reformulation and shelf-life stability, incentives and salt tax.

Conclusions
Salt reduction efforts of the out-of-home sector in Malaysia could be achieved through several measures or enablers that can overcome the barriers currently faced by stakeholders, especially policy-makers, food industries and the consumers themselves. This study will benefit the policy-makers to improve the salt reduction policy of out-of-home sectors and highlight the concerns among the food industries on the policy.
Role of noncoding RNAs in orthodontic tooth movement: new insights into periodontium remodeling
Authors: Chen Yuming , Zhang Chao 
Published: February 2023

AbstractOrthodontic tooth movement (OTM) is biologically based on the spatiotemporal remodeling process in periodontium, the mechanisms of which remain obscure. Noncoding RNAs (ncRNAs), especially microRNAs and long noncoding RNAs, play a pivotal role in maintaining periodontal homeostasis at the transcriptional, post-transcriptional, and epigenetic levels. Under force stimuli, mechanosensitive ncRNAs with altered expression levels transduce mechanical load to modulate intracellular genes. These ncRNAs regulate the biomechanical responses of periodontium in the catabolic, anabolic, and coupling phases throughout OTM. To achieve this, down or upregulated ncRNAs actively participate in cell proliferation, differentiation, autophagy, inflammatory, immune, and neurovascular responses. This review highlights the regulatory mechanism of fine-tuning ncRNAs in periodontium remodeling during OTM, laying the foundation for safe, precise, and personalized orthodontic treatment.
Affordable drug resistance genotyping of HIV-1 reverse transcriptase, protease and integrase genes, for resource limited settings
Authors: Manyana Sontaga , Pillay Melendhran , Gounder Lilishia , Khan Aabida , Moodley Pravi , Naidoo Kogieleum , Chimukangara Benjamin 
Published: February 2023

Abstract
Background
As use of dolutegravir (DTG) becomes more common in resource limited settings (RLS), the demand for integrase resistance testing is increasing. Affordable methods for genotyping all relevant HIV-1 pol genes (i.e., protease (PR), reverse transcriptase (RT) and integrase (IN)) are required to guide choice of future antiretroviral therapy (ART). We designed an in-house HIV-1 drug resistance (HIVDR) genotyping method that is affordable and suitable for use in RLS.

Methods
We obtained remnant plasma samples from CAPRISA 103 study and amplified HIV-1 PR, RT and IN genes, using an innovative PCR assay. We validated the assay using remnant plasma samples from an external quality assessment (EQA) programme. We genotyped samples by Sanger sequencing and assessed HIVDR mutations using the Stanford HIV drug resistance database. We compared drug resistance mutations with previous genotypes and calculated method cost-estimates.

Results
From 96 samples processed, we obtained sequence data for 78 (81%), of which 75 (96%) had a least one HIVDR mutation, with no major-IN mutations observed. Only one sample had an E157Q INSTI-accessory mutation. When compared to previous genotypes, 18/78 (23%) had at least one discordant mutation, but only 2/78 (3%) resulted in different phenotypic predictions that could affect choice of subsequent regimen. All CAPRISA 103 study sequences were HIV-1C as confirmed by phylogenetic analysis. Of the 7 EQA samples, 4 were HIV-1C, 2 were HIV-1D, and 1 was HIV-1A. Genotypic resistance data generated using the IDR method were 100% concordant with EQA panel results. Overall genotyping cost per sample was estimated at ~ US$43–$US49, with a processing time of ~ 2 working days.

Conclusions
We successfully designed an in-house HIVDR method that is suitable for genotyping HIV-1 PR, RT and IN genes, at an affordable cost and shorter turnaround time. This HIVDR genotyping method accommodates changes in ART regimens and will help to guide HIV-1 treatment decisions in RLS.
Pilot and feasibility studies: extending the conceptual framework
Authors: Bond Christine , Lancaster Gillian A. , Campbell Mike , Chan Claire , Eddy Saskia , Hopewell Sally , Mellor Katie , Thabane Lehana , Eldridge Sandra 
Published: February 2023

AbstractIn 2016, we published a conceptual framework outlining the conclusions of our work in defining pilot and feasibility studies. Since then, the CONSORT extension to randomised pilot and feasibility trials has been published and there have been further developments in the pilot study landscape. In this paper, we revisit and extend our framework to incorporate the various feasibility pathways open to researchers, which include internal pilot studies. We consider, with examples, when different approaches to feasibility and pilot studies are more effective and efficient, taking into account the pragmatic decisions that may need to be made. The ethical issues involved in pilot studies are discussed. We end with a consideration of the funders’ perspective in making difficult resource decisions to include feasibility work and the policy implications of these; throughout, we provide examples of the uncertainties and compromises that researchers have to navigate to make progress in the most efficient way.
Sialylation of chitosan to mitigate Aβ toxicity
Authors: Dhavale Dhruva , Lai Hy K. , Warwick Paityn , Henry James E. 
Published: February 2023

Abstract
Background
Amyloid beta peptide (Aβ) is the main component of plaques and is known to play a role in the development of Alzheimer's disease (AD). As a result, structures that can trap Aβ or disrupt the interaction between Aβ and cells have been researched as a way to lessen the pathological effects of Aβ. Particularly, sialylated compounds that exhibit clustering effects could be advantageous.

Results
Through the use of 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide chemistry, sialic acid (N-acetylneuraminic acid) was used to decorate a chitosan backbone. The compounds were characterized using Fourier-transform infrared spectroscopy (FTIR) and colorimetric assays. Using the model neuroblastoma cell line SH-SY5Y, the ability of these compounds to lessen the toxicity of Aβ was examined in vitro. Successful in vitro mitigation of Aβ toxicity was found to be critically dependent on the degree of sialylation. In particular, a balance between the degree of sialylation and molecular flexibility was determined to be the criteria as it allows for natural clustering. Additionally, chitosan alone demonstrated low levels of cellular toxicity with moderate levels of toxicity mitigation (comparable to low degrees of labelling).

Conclusions
Compounds were successfully produced, and they varied in their effectiveness in reducing Aβ's toxicity to cells in culture. The effect of molecular flexibility and clustering on toxicity mitigation is explained in this work. This shows the potential of polymeric sugars for the creation of AD treatments.
Spinal anesthesia is a grossly underutilized gold standard in primary total joint arthroplasty: propensity-matched analysis of a national surgical quality database
Authors: Ferreira Andre C. , Hung Chun Wai , Ghanta Ramesh B. , Harrington Melvyn A. , Halawi Mohamad J. 
Published: February 2023

Abstract
Background
There is currently no consensus regarding the optimal anesthetic technique for total hip and knee arthroplasty (THA, TKA). This study aimed to compare the utilization rates and safety of spinal vs. general anesthesia in contemporary THA/TKA practice.

Methods
Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), a retrospective review of 307,076 patients undergoing total hip or knee arthroplasty under either spinal or general anesthesia between January 2015 and December 2018 was performed. Propensity matching was used to compare differences in operative times, hospital length of stay, discharge destination, and 30-day adverse events. The annual utilization rates for both techniques between 2011 and 2018 were also assessed.

Results
Patients receiving spinal anesthesia had a shorter length of stay (P < 0.001) for TKA while no statistical differences in length of stay were observed for THA. Patients were also less likely to experience any 30-day complication (OR = 0.82, P <0.001 and OR = 0.92, P < 0.001 for THA and TKA, respectively) while being more likely to be discharged to home (OR = 1.46, P < 0.001 and OR = 1.44, P < 0.001 for THA and TKA, respectively). Between 2011 and 2018, spinal anesthesia utilization only increased by 1.4% for THA (P < 0.001) and decreased by 0.2% for TKA (P < 0.001), reaching 38.1% and 40.3%, respectively.

Conclusion
Spinal anesthesia remains a grossly underutilized tool despite providing better perioperative outcomes compared to general anesthesia. As orthopedic surgeons navigate the challenges of value-based care, spinal anesthesia represents an invaluable tool that should be considered the gold standard in elective, primary total hip and knee arthroplasty.
Diagnostic accuracy of ultrasound and alpha-fetoprotein measurement for hepatocellular carcinoma surveillance: a retrospective comparative study
Authors: Abduljabbar Ahmed Haitham 
Published: February 2023

Abstract
Background
Liver cirrhosis and chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) are major risk factors for hepatocellular carcinoma (HCC). International societies guidelines recommend HCC surveillance in patients with cirrhosis and chronic hepatitis. However, the ideal surveillance strategy is still controversial. The aim of this study is to assess and compare the diagnostic accuracy of ultrasound (US) AND alpha-fetoprotein (AFP) measurement in HCC surveillance.

Results
All patients with cirrhosis and/or infection with HBV and HVC, who received HCC surveillance through US and AFP measurement between January 2013 and January 2016, were retrospectively evaluated. The performance of surveillance using AFP, US, and both in HCC detection was compared. After exclusion, a final cohort of 335 patients were included. Thirty-five patients (10.3%) developed HCCs. US showed no focal lesions in 259 patients, 9 benign lesions (3 cysts, 5 hemangiomas, and 1 focal fat), 16 HCCs and 51 indeterminate findings. All indeterminate findings were worked up by CT and/or MRI. For HCC detection, the area under the receiver operator characteristic (ROC) curve for US surveillance was 0.924 (95% confidence interval: 0.866–0.983, P < 0.001). For surveillance, AFP was 0.829 (95% confidence interval: 0.756– 0.902, P < 0.001) and for combined US and AFP was 0.897 (95% confidence interval: 0.854– 0.941, P < 0.001). When the traditional cutoff value of 20 ng/ml was used, the sensitivity and specificity of AFP were 63% and 88.7%, respectively. ROC curve results for AFP levels demonstrated that using 5.6 ng/ml as a cutoff, AFP will have a 77% sensitivity and 78% specificity for HCC detection. US exhibited a sensitivity and specificity of 45.7% and 100%, respectively. When indeterminate findings were considered as positive surveillance test, US exhibited a sensitivity and specificity of 91.4% and 88.3%, respectively. A combination of US and AFP exhibited a sensitivity and specificity of 97% and 87.3%, respectively.

Conclusions
US has better accuracy compared to AFP in HCC surveillance. Combined use of US and AFP improves the sensitivity for HCC detection.
Management of Residual Nonretroperitoneal Disease in Postchemotherapy Nonseminomatous Germ-Cell Tumors
Authors: King Jennifer M. , Cheng Michael , Kesler Kenneth , Ashkar Ryan , Althouse Sandra K. , Hanna Nasser H. , Einhorn Lawrence H. , Adra Nabil 
Published: February 2023

PURPOSE The majority of patients with advanced nonseminomatous germ-cell tumor are cured with combination chemotherapy and surgical resection of residual disease when appropriate. In patients with both retroperitoneal (RP) and non-RP postchemotherapy residual disease, management of the non-RP disease is typically guided by pathologic findings at the time of RP resection. There are limited data to help guide management decisions in patients with non-RP postchemotherapy residual disease alone. MATERIALS AND METHODS The prospectively maintained Indiana University testicular cancer database was queried for patients with metastatic nonseminomatous germ-cell tumor treated between 1990 and 2021 who had residual non-RP disease in the absence of residual RP disease after completing either first-line or salvage chemotherapy. RESULTS One hundred twenty-nine patients met eligibility and were included in this analysis. Seventy-five patients had teratoma in the primary tumor site, while 54 did not. Of those with teratoma in the primary, 55% had at least one postchemotherapy non-RP surgical specimen with teratomatous elements compared with 17% of those without teratoma in the primary ( P < .001). Of those without teratoma in the primary site, 56% had at least one postchemotherapy non-RP surgical specimen with active germ-cell tumor compared with 31% of those with teratoma in the primary ( P = .0046). CONCLUSION The presence of teratoma in the primary tumor site is associated with a higher rate of teratoma in postchemotherapy residual non-RP disease. Patients without teratoma in the primary tumor should still be considered for resection of residual postchemotherapy disease that could harbor teratoma or active germ-cell tumor.