bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of teacher encouragement on children’s consumption and non-eating behaviour in a Wisconsin elementary school vegetable snack programme
Authors: Chinchanachokchai Sydney , Jamelske Eric M , Vernon Erin 
Published: January 2022

Objective: Schools participating in the US Department of Agriculture (USDA) Fresh Fruit and Vegetable Programme (FFVP) serve more fruit than vegetables and tend not to implement activities designed to increase consumption. This research examines the impact of teacher encouragement on consumption of raw vegetables served through a non-FFVP elementary school snack programme. Method: Twelve teachers and 217 children in Grades K–3 were randomly assigned to one of three conditions. One condition served as the control group (no encouragement), while the other two conditions represented intervention groups (moderate and high encouragement). Three vegetables were served eight times each with teachers in both intervention conditions providing encouragement for the first six servings of each vegetable. All encouragement was discontinued during the final two servings of each vegetable. Average consumption and non-eating behaviour were analysed using differences in means, ordinary least squares and logistic regression analysis. Results: Moderate and high teacher encouragement significantly increased children’s consumption of vegetables compared to the control group. Both encouragement conditions also significantly reduced the likelihood of non-eating behaviour. The positive encouragement impacts were found to persist in the short term even when teacher encouragement had ceased, especially for the high encouragement condition. Conclusion: This study provides evidence that relatively low-cost teacher encouragement can decrease non-eating behaviour and increase children’s consumption of vegetable snacks served in elementary schools. This suggests that schools participating in the FFVP could see benefits from serving more vegetables and implementing encouragement activities. Moreover, these results could be informative to non-FFVP schools in implementing their own vegetable snack programme.
The Safer Culture Framework: An Application to Healthcare Based on a Multi-Industry Review of Safety Culture Literature
Authors: Kilcullen Molly P. , Bisbey Tiffany M. , Ottosen Madelene J. , Tsao Kuojen , Salas Eduardo , Thomas Eric J. 
Published: January 2022

Background Errors and preventable harm to patients remain regrettably common and expensive in healthcare. Improvement requires transforming the culture of the healthcare industry to put a greater emphasis on safety. Safety culture involves holding collective attitudes, values, and behaviors that prioritize safety. The Safer Culture framework, previously established through a narrative review of literature in multiple industries, provides a consensus on what impacts safety culture, how it manifests in behavior, and how it influences safety-related outcomes. Methods Through a theoretical review, we validate, refine, and provide nuance to this framework for the development of safety culture in healthcare contexts. To accomplish this, we conceptually map existing dimensions pulled through the literature onto our Safer Culture framework. Results A total of 360 articles were reviewed. We present specific elements for each dimension in our framework and apply the dimension to healthcare contexts. Conclusion We provide an evidence-based and comprehensive framework that can be used by patient safety leaders and researchers to guide the evaluation of safety culture and develop interventions to foster patient safety culture and improve patient safety outcomes.
A Procedure for Eliciting Women’s Preferences for Breast Cancer Screening Frequency
Authors: Grayek Emily , Yang Yanran , Fischhoff Baruch , Schifferdecker Karen E. , Woloshin Steven , Kerlikowske Karla , Miglioretti Diana L. , Tosteson Anna N. A. 
Published: January 2022

Background We evaluate the construct validity of a proposed procedure for eliciting lay preferences among health care policy options, suited for structured surveys. It is illustrated with breast cancer screening, a domain in which people may have heterogeneous preferences. Methods Our procedure applies behavioral decision research principles to eliciting preferences among policy options expressed in quantitative terms. Three-hundred women older than 18 y without a history of breast cancer were recruited through Amazon MTurk. Participants evaluated 4 screening options for each of 4 groups of women, with varying risk of breast cancer. Each option was characterized by estimates of 3 primary outcomes: breast cancer deaths, false alarms, and overdiagnosis resulting in unnecessary treatment of cancers that would not progress. These estimates were based on those currently being developed by the Breast Cancer Surveillance Consortium. For each risk group, participants stated how frequently they would wish to receive screening, if the predicted outcomes applied to them. Results A preregistered test found that preferences were robust enough to be unaffected by the order of introducing and displaying the outcomes. Other tests of construct validity also suggested that respondents generally understood the task and expressed consistent preferences. Those preferences were related to participants’ age and mammography history but not to measures of their numeracy, subjective numeracy, or demographics. There was considerable heterogeneity in their preferences. Conclusions Members of the public can be engaged more fully in informing future screening guidelines if they evaluate the screening options characterized by the expected health outcomes expressed in quantitative terms. We offer and evaluate such a procedure, in terms of its construct validity with a diverse sample of women. Highlights A novel survey method for eliciting lay preferences for breast cancer screening is proposed and evaluated in terms of its construct validity. Participants were generally insensitive to irrelevant task features (e.g., order of presentation) and sensitive to relevant ones (e.g., quantitative estimates of breast cancer risk, harms from screening). The proposed method elicits lay preferences in terms that can inform future screening guidelines, potentially improving communication between the public and policy makers.
Extracranial Internal Carotid Artery Aneurysm in Pregnancy
Authors: S Prakash Prajwala , Wong Chi Julian Leung , Chan Shiao-Yng , Sidhu Harvinder Raj Singh , Vijayan Sannasi Vikram , Tiwari Alok 
Published: January 2022

Isolated extracranial internal carotid artery aneurysms (EICAAs) are rare, accounting for only about .4–4% of all peripheral artery aneurysms. We present a case of an EICAA in a young pregnant patient. To our knowledge, this is the first case being reported of a true EICAA during pregnancy in a multiparous woman. A 25-year-old pregnant patient presented with a pulsatile left neck swelling. Radiological investigations and subsequent surgery during the first trimester confirmed a true saccular left ICA with a maximum diameter of 3.5 cm. She was treated with aneurysm excision and primary anastomosis. She did not have any underlying diseases predisposing to an EICAA. She has been well for 3 years post procedure. It has been postulated that pregnancy could lead to aneurysm development through multiple mechanisms, including hemodynamic, hormonal, and other physiologic changes of pregnancy. Aggressive treatment with surgical intervention is advocated because of the risk of cerebral ischemic complications associated with non-operative treatment, and because satisfactory long-term outcomes can be achieved from surgery.
Evidence of Potential Discriminatory HIV Pre-Exposure Prophylaxis (PrEP) Prescribing Practices for People Who Inject Drugs Among a Small Percentage of Providers in the U.S.
Authors: Pleuhs Benedikt , Mistler Colleen B. , Quinn Katherine G. , Dickson-Gomez Julia , Walsh Jennifer L. , Petroll Andrew E. , John Steven A. 
Published: January 2022

Introduction: A large percentage of people who inject drugs (PWID) are living with HIV. Yet, rates of HIV pre-exposure prophylaxis (PrEP) use among PWID remain low. Stigma surrounding substance use and PWID have been identified as potential barriers to PrEP. This study examined healthcare providers’ concerns regarding PWID and willingness to prescribe PrEP to PWID. Methods: An online, cross-sectional survey of a diverse group of healthcare providers in the 10 U.S. cities with the greatest HIV prevalence was conducted between July 2014 and May 2015. Participants responded to a patient vignette of a PWID and asked to indicate whether the patient would be a candidate for PrEP and why via free-response text. Descriptive statistics are reported using frequency measures. Bivariate analyses were conducted using chi-squared comparisons and logistical regression. Results: Survey data from 480 providers were included in analyses. Of the 480 responses, 85.5% were classified as PrEP aware, while 14.2% were PrEP unaware. Additionally, 82.6% indicated the patient would be a good candidate for PrEP, 4.4% believed the patient was not a good candidate for PrEP, and 13% were unsure. Among those who were unsure or would not prescribe PrEP (n = 84), open-ended responses indicated lack of knowledge (42.9%), concern about adherence (27.4%), concern about cost (4.8%), and bias (7.1%) as the primary reasons. Conclusions: Although the majority of providers in this study did not demonstrate bias against PWID, our study found that limited PrEP knowledge and bias are barriers to PrEP prescription among PWID for some providers. Interventions are needed that increase PrEP awareness of CDC guidelines and reduce implicit bias among providers.
“I Can be Unapologetically Who I Am”: A Study of Friendship Among Black Undergraduate Women at PWIs
Authors: Leath Seanna , Mims Lauren , Evans Khrysta A. , Parker Ti’Asia , Billingsley Janelle T. 
Published: January 2022

The current study explores Black undergraduate women’s friendships using in-depth interview data from 47 women (18–24 years) attending predominantly white institutions (PWIs) in the United States. Drawing on consensual qualitative research methods, we considered the nature and importance of Black female friendships among Black undergraduate women. We identified the following themes: (a) friendship as a tool to mitigate bias and discrimination; (b) affinity groups as a gateway to friendship; and (c) friendship as a way to navigate intersectional identity development. Two subthemes within the final theme highlighted how Black female friends (1) affirmed their self-image; and (2) honored their unique, intersectional experiences. Our findings demonstrate how Black female friendships are “homeplaces” for Black undergraduate women, particularly in regards to identity development during emerging adulthood. We discuss how friendships with other Black women offer unique forms of support during Black undergraduate women’s journeys in PWI environments that may challenge their wellbeing.
Is First Metatarsal Shortening Correlated with Clinical and Functional Outcomes Following the Lapidus Procedure?
Authors: Nishikawa Danilo Ryuko , Duarte Fernando A. , Saito Guilherme H. , Fenelon Emanoel Jefferson A. , Prado Marcelo P. 
Published: January 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Lapidus procedure (LP) is a powerful technique to correct hallux valgus (HV) deformities, with good long-term outcomes. However, postoperative complications may arise, as undercorrection of the deformity, nonunion, elevation and shortening of the first metatarsal (M1). The objective of this study was to correlate M1 shortening with transfer metatarsalgia, and clinical and functional outcomes in patients who underwent the LP. Methods: a retrospective review of 29 patients (36 feet) who were submitted to the LP for HV correction was performed. The average follow-up was 20 months. M1 length was analyzed using the Relative First Metatarsal Length (RML) measurement (Figure 1). When M1 shortens in relation to the second metatarsal, the RML measurements increase. The intermetatarsal angle (IMA) and hallux valgus angle (HVA) were also measured. Clinical and functional analyses were based on the VAS for pain, AOFAS, LEFS and SF-12 health survey. SF-12 is divided into physical and mental health composite scales (PCS-12 and MCS-12, respectively). Transfer metatarsalgia diagnosis was based on the clinical exam. Radiographic, clinical and functional measurements were compared using paired Wilcoxon signed-rank test and Student t test. Interobserver reliability of RML measurements was calculated using Intraclass Correlation Coefficients (ICC). A linear regression was performed to assess the correlation between RML and the clinical and functional questionnaires. Results: There was a significant M1 shortening of 2.28mm after the LP (p<.001), with mean preoperative RML of 3.06 mm and mean postoperative of 5.34 mm (Table 1). No patient developed transfer metatarsalgia. Intraclass Coefficient Correlation (ICC) of the RML measures showed a excellent reliability of 0.94 and 0.98 in the pre- and postoperative setting, respectively. IMA and HVA presented significant improvements (p<.001) (Table 1). Clinical and functional improvements were observed in all questionnaires applied, except in the MCS-12 (Table 2). In the linear regression, RML was inversely correlated to LEFS (p=<.05), which means that LEFS scores increased as RML measurements decreased (Table 3). There was no significant correlation with the other questionnaires. Conclusion: The present study demonstrated that M1 shortening led to a decreased LEFS following the LP. Comparative studies with prospective design and larger populations are required to assess the role of M1 shortening on clinical and functional outcomes.
Comparison of Medial and Dorsal Approach for Talonavicular Fusion: A Cadaver Study
Authors: Patch David A. , Andrews Nicholas A. , Torrez Timothy. , Sutherland Charles R. , Harrelson Whitt , Agarwal Abhinav , Shah Ashish 
Published: January 2022

Category: Basic Sciences/Biologics; Hindfoot; Other Introduction/Purpose: Talonavicular (TN) joint arthrodesis is a common procedure for end stage arthritis. There are two common operative approaches used to expose the TN joint for articular preparation, the medial and dorsal. Classically, the medial approach has been the preferred method of TN joint fusion, but recent arguments have been made for the use of the dorsal approach. Articular surface preparation is a key tenant required for any joint fusion. To date no physical preparation studies have been done to compare the two approaches in terms of articular surface preparation. Methods: Ten fresh frozen cadaver specimens were obtained. Fluoroscopic radiographs were used to rule out any pre-existing pathology of the talonavicular joint. Specimens were assigned to receive either a dorsal or medial operative approach to the talonavicular joint. After joint preparation, the talonavicular joint was disarticulated and the amount of articular surface preparation was recorded using ImageJ software. Results: A total of 8 male and 2 female specimens were utilized with an average age of 64.5 +- 13.1. The dorsal approach had a higher average percentage of talar, navicular, and total talonavicular joint surface prepared. When examining joint surface area preparation regardless of approach used, the talar head was significantly less prepared than the navicular. The inter-observer correlation coefficient was excellent for both navicular and talar surface area prepared. Conclusion: The amount of articular surface preparation in the dorsal approach was consistently higher on average. Given the high rate of nonunion in isolated talonavicular and triple arthrodesis, surgeons should be aware that the dorsal approach may offer an increased amount of articular surface preparation. Our study adds to the growing body of evidence supporting the investigation and use of the dorsal approach when attempting talonavicular arthrodesis.
Influence of Medical Marijuana on Mesenchymal Stromal Cell Osteogenesis: An in Vitro Study
Authors: Shang Jiangyinzi , Hogan MaCalus V. , Cain Jarrett D. , Lin Hang , Alexander Peter G. , Yan Alan Y. 
Published: January 2022

Category: Basic Sciences/Biologics; Basic Sciences/Biologics; Sports; Other Introduction/Purpose: Recently, purposes of medicinal marijuana including analgesia and reduction in inflammation. The active component activates the CB1 and CB2 receptors, thus mimicking the action of endogenous cannabinoids. CB1 and CB2 are important regulators of bone metabollism. In particular, endocannabinoid signaling has shown to regulate proliferation and differentiation of MSCs and the activities of osteoblasts and osteoclasts. Cannabinoids may be prescribed to patients suffering bone fractures involving prolonged immobilization and discomfort. Thus, there is an important need to understand more completely the role of cannanbinoid signaling in fracture healing. In this study, we examine the influence of a synthetic cannabinoid agonist, Win-55,212-2 (Win) on adult, human MSC-derived osteoblast activity. Cell viability and osteogenic phenotype were assessed by MTS assay, RT-PCR, and alizarin red staining. Methods: With an IRB approved protocol, MSCs were isolated from healthy human bone marrow and expanded to the passage five for experimentation. Cells were then plated at 5,200 cells/cm2 (6-well plate) and osteogenically stimulated for 21 days before treatment with increasing concentrations of Win (0.01, 0.1, or 1 µM) for an additional 48 hours. The MTS assay was employed to determine the half-maximal (50%) inhibitory concentration (IC50) at different time points. The cell phenotype was assessed by real-time PCR and alizarin red staining. Results: We first used the MTS assay (for metabolism and proliferation) to test 7 doses of Win-55, from 0.001µM up to 5 µM and determined that the human osteoblast IC50 of Win-55 over 1-7 days of exposure was ~ 1.5 µM (Figure 1), a dose slightly lower than concentrations found to affect chondrocytes in a previous study. At 1µM Win-55, RT-PCR revealed that the expression of inflammatory cytokines IL-1beta and TNF-alpha was significantly reduced, while that of IL-6 and COX2 was unchanged. The expression of most osteogenic markers was unchanged by Win, but we did observe significant increases in BMP2, RUNX2 and OPN (Figure 2). Alizarin Red staining revealed increased calcium deposition and mineralization in the presence of 1µM Win, corroborating the RT-PCR results (Figure 3). Conclusion: Win-55,212-2 may be beneficial to osteogenesis. 1 µM Win enhanced the osteoblastic phenotype over control, untreated MSC-derived osteoblasts, reduced inflammatory mediators and increased calcium deposition and mineralization. This suggests that cannabidiol treatment might lead to improvements in fracture healing and provide a novel therapeutic option for the bone regeneration. Future studies are aimed at characterizing the CB-1 and CB-2 signaling associated with the changes observed here and the effects of Win on MSC-derived osteoblasts in the context of inflammation.
Safe and Effective Tendoscopy around the Ankle with A 2-mm Diameter Operative System
Authors: Stornebrink Tobias , Stufkens Sjoerd A. , Appelt Daniel , Wijdicks Coen A. , Kerkhoffs Gino 
Published: January 2022

Category: Arthroscopy; Basic Sciences/Biologics Introduction/Purpose: To assess whether 2-mm-diameter operative tendoscopy of the tibialis posterior, peroneal, and Achilles tendons was safe and effective in a cadaveric model. Methods: A 2-mm-diameter arthroscopic system was used to perform a tendoscopic procedure in 10 nonpaired, freshfrozen, human ankles. Standard tendoscopic portals were utilized. Visual examination and operative reach with tailored tendoscopic instruments within the tendon sheaths were recorded and documented. Adhesiolysis and vincula resections were performed. After dissection, distances between portal tracts and neurovascular structures were measured and the tendons were inspected for signs of iatrogenic damage. Results: The entire tendon sheath and tendon of the tibialis posterior, peroneus brevis, and Achilles tendons were visualized and reached with tailored operative instruments. The proximal part of the peroneus longus tendon was visible and reachable from proximally up to the cuboid bone distally. Adhesiolysis and vincula resections were successfully performed in all specimens. The mean distances between portal tracts and local neurovascular structures ranged between 9.4 and 19.2 mm and there were no cases of contact. None of the tendons showed signs of iatrogenic damage. Conclusion: Two-millimeter-diameter operative tendoscopy provided safe and effective visualization and operative reach of the tibialis posterior, peroneal, and Achilles tendons.
Third generation cephalosporin-resistant Klebsiella pneumoniae thriving in patients and in wastewater: what do they have in common?
Authors: Rocha Jaqueline , Ferreira Catarina , Mil-Homens Dalila , Busquets Antonio , Fialho Arsénio M. , Henriques Isabel , Gomila Margarita , Manaia Célia M. 
Published: January 2022

Abstract
Background
Klebsiella pneumoniae are ubiquitous bacteria and recognized multidrug-resistant opportunistic pathogens that can be released into the environment, mainly through sewage, where they can survive even after wastewater treatment. A major question is if once released into wastewater, the selection of lineages missing clinically-relevant traits may occur. Wastewater (n = 25) and clinical (n = 34) 3rd generation cephalosporin-resistant K. pneumoniae isolates were compared based on phenotypic, genotypic and genomic analyses.

Results
Clinical and wastewater isolates were indistinguishable based on phenotypic and genotypic characterization. The analysis of whole genome sequences of 22 isolates showed that antibiotic and metal resistance or virulence genes, were associated with mobile genetic elements, mostly transposons, insertion sequences or integrative and conjugative elements. These features were variable among isolates, according to the respective genetic lineage rather than the origin.

Conclusions
It is suggested that once acquired, clinically relevant features of K. pneumoniae may be preserved in wastewater, even after treatment. This evidence highlights the high capacity of K. pneumoniae for spreading through wastewater, enhancing the risks of transmission back to humans.