bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sexual dimorphism in cortisol metabolism throughout pubertal development: a longitudinal study
Authors: van Keulen Britt J , Dolan Conor V , van der Voorn Bibian , Andrew Ruth , Walker Brian R , Hulshoff Pol Hilleke , Boomsma Dorret I , Rotteveel Joost , Finken Martijn J J 
Published: May 2020

Objective
Sex differences in disease susceptibility might be explained by sexual dimorphism in hypothalamic-pituitary-adrenal axis activity, which has been postulated to emerge during puberty. However, studies conducted thus far lacked an assessment of Tanner pubertal stage. This study aimed to assess the contribution of pubertal development to sexual dimorphism in cortisol production and metabolism.

Methods
Participants (n = 218) were enrolled from a population-based Netherlands Twin Register. At the ages of 9, 12 and 17 years, Tanner pubertal stage was assessed and early morning urine samples were collected. Cortisol metabolites were measured with GC-MS/MS and ratios were calculated, representing cortisol metabolism enzyme activities, such as A-ring reductases, 11β-HSDs and CYP3A4. Cortisol production and metabolism parameters were compared between sexes for pre-pubertal (Tanner stage 1), early pubertal (Tanner stage 2–3) and late-pubertal (Tanner stage 4–5) stages.

Results
Cortisol metabolite excretion rate decreased with pubertal maturation in both sexes, but did not significantly differ between sexes at any pubertal stage, although in girls a considerable decrease was observed between early and late-pubertal stage (P < 0.001). A-ring reductase activity was similar between sexes at pre- and early pubertal stages and was lower in girls than in boys at late-pubertal stage. Activities of 11β-HSDs were similar between sexes at pre-pubertal stage and favored cortisone in girls at early and late-pubertal stages. Cytochrome P450 3A4 activity did not differ between sexes.

Conclusions
Prepubertally, sexes were similar in cortisol parameters. During puberty, as compared to boys, in girls the activities of A-ring reductases declined and the balance between 11β-HSDs progressively favored cortisone. In addition, girls showed a considerable decrease in cortisol metabolite excretion rate between early and late-pubertal stages. Our findings suggest that the sexual dimorphism in cortisol may either be explained by rising concentrations of sex steroids or by puberty-induced changes in body composition.
Random ‘spot’ urinary metanephrines compared with 24-h-urinary and plasma results in phaeochromocytomas and paragangliomas
Authors: Sbardella Emilia , Maunsell Zoe , May Christine J H , Tadman Michael , James Tim , Jafar-Mohammadi Bahram , Isidori Andrea M , Grossman Ashley B , Shine Brian 
Published: May 2020

Background
In patients with phaeochromocytomas or paragangliomas (PPGLs), 24-h urine collections for metanephrines (uMNs) are cumbersome.

Objective
To evaluate the diagnostic utility of ratios to creatinine of ‘spot’ uMNs.

Methods
Concentrations of uMNs and plasma metanephrines (pMNs) were measured by HPLC-mass-spectrometry. We retrospectively compared correlations of 24-h-urine output and ratio to creatinine in historical specimens and prospectively assessed 24-h and contemporaneous spot urines and, where possible, pMNs. Using trimmed log-transformed values, we derived reference intervals based on age and sex for spot urines. We used multiples of upper limit of normal (ULNs) to compare areas under curves (AUCs) for receiver-operator characteristic curves of individual, and sum and product of, components.

Results
In 3143 24-h-urine specimens on 2416 patients, the correlation coefficients between the ratios and outputs of metanephrine, normetanephrine and 3-methoxytyramine in 24-h urines were 0.983, 0.905 and 0.875, respectively. In 96 patients, the correlations between plasma concentrations, urine output and ratios in spot specimens were similar to those for raw output or ratios in 24-h specimens. Of the 160 patients with PPGLs, the CIs for AUCs for individual metabolites overlapped for all four types of measurement, as did those for the sum of the multiple ULNs although these were slightly higher (AUC for spot urine: 0.838 (0.529–1), plasma: 0.929 (0.874–0.984) and output: 0.858 (0.764–0.952)).

Conclusions
Ratios of fractionated metanephrines to creatinine in spot urine samples appear to have a similar diagnostic power to other measurements. The ease of spot urine collection may facilitate diagnosis and follow-up of PPGLs through improved patient compliance.
Mortalidad materna institucional en Caldas 1990 - 1994
Authors: Vélez Arango Jorge Eduardo , Dávila Arias Liliana 
Published: May 2020

La presente investigación analiza las muertes maternas institucionales que se presentaron en el Departamento de Caldas entre enero 1" de 1990 y diciembre 31 de 1994. Se registraron durante dicho período un total de 62 muertes, con un porcentaje de muerte por causa directa del 82,26% y de causa indirecta del 17,74%. La tasa de mortalidad obtenida es del 7,27 x 10.000 nacidos vivos, superior a la reportada por países desarrollados. La edad promedio de las pacientes fue de 27,87 ± 7,63 años, con un promedio de escolaridad de 5,26 ± 7,63 años. Se demuestran además bajas frecuencias de control prenatal y altos porcentajes de inestabilidad marital. Los trastornos hipertensivos del embarazo son la primera causa de muerte materna directa, seguidos por la infección y los transtornos hemorrágicos de la gestación.
Midwives' Experiences of Transitioning Into Private Practice With Visiting Access in Australia: A Qualitative Descriptive Study
Authors: Barker Megan , Fenwick Jennifer , Gamble Jenny 
Published: May 2020

BACKGROUNDA national review of maternity services in Australia in 2009 resulted in legislative changes which provided midwives with an unprecedented opportunity to offer continuity of care as a private practitioner with visiting access to a public maternity hospital. However, very few midwives have taken up this opportunity.AIMTo explore the experiences of midwives who transitioned into private practice with visiting access to a public hospital.METHODUsing a qualitative descriptive approach, six midwives participated in digitally recorded in-depth interviews. Data was analyzed using thematic analysis.FINDINGSTransitioning to private practice enabled midwives to align their core midwifery values with their practice. Midwives reported taking “a leap of faith” by venturing into private practice. Although seeking visiting access and running a small business was initially daunting, midwives were rewarded by being able to practice autonomously and provide continuity of woman centered care within a caseload model. The legislative restrictions, especially around employing other midwives posed significant challenges.DISCUSSION AND CONCLUSIONSPrivate practice with visiting access provided midwives with a service model that aligned their core midwifery values with their clinical practice. The model facilitated their ability to work as lead care professionals, provide woman centered care, and access a collaborative network of healthcare professions. However, the midwives continued to experience structural barriers that threaten the scalability and sustainability of the model. Structural barriers to midwives working to their full scope of practice and in alignment with a midwifery philosophy are a global issue. Further reforms are needed.
Acute Heart Failure Comorbidome: The Impact of Everything Else
Authors: Meireles Mariana Alves , Golçalves João , Neves João 
Published: May 2020

Introduction: Heart failure frequently coexists with several comorbidities. Our aim is to evaluate the prognostic role of various comorbidities in the risk of acute heart failure development.Material and Methods: Comorbidities of patients with acute heart failure were, retrospectively, compared to a control group of patients with chronic heart failure admitted to an Internal Medicine unit in a 2-year period. Logistic regression models were constructed to determine their association with acute heart failure and to develop a comorbidome.Results: We identified 229 patients with acute heart failure and 201 patients with chronic heart failure. Age and female gender were higher in acute heart failure group (p < 0.001) as was the number of comorbidities (4.0 ± 3.0 vs 4.0 ± 2.0, p = 0.044). Hyperuricemia (odds ratio 2.46, confidence interval 95% 1.41 - 4.31, p = 0.002), obesity (odds ratio 2.22, confidence interval 95% 1.31 - 3.76, p = 0.003), atrial fibrillation (odds ratio 1.93, confidence interval 95% 1.31 - 2.87, p = 0.001), peripheral artery disease (odds ratio 2.12, confidence interval 95% 1.01 - 4.42, p = 0.046) and chronic kidney disease (odds ratio 2.47, confidence interval 95% 1.65 - 3.71, p < 0.001) were associated with acute heart failure. Obesity, atrial fibrillation, peripheral artery disease and chronic kidney disease were identified as independent risk factors. Patients with multiple comorbidities had a superior risk of hospitalization due to heart failure: zero comorbidities – odds ratio 0.43, 95% confidence interval 0.28 - 0.67, p < 0.001; one comorbidity – odds ratio 0.69, 95% confidence interval 0.47 - 1.01, p = 0.057; two comorbidities – odds ratio 1.85, 95% confidence interval 1.11 - 3.08, p = 0.019; ≥ three comorbidities – odds ratio 5.81, 95% confidence interval 2.77 - 12.16, p < 0.001.Discussion: This study shows an association between several comorbidities and hospital admission due to acute heart failure. The association seems to strengthen in the presence of multiple comorbidities.Conclusion: A comorbidome is a useful tool to identify comorbidities associated with higher risk of acute heart failure. The identification of vulnerable patients may allow multidimensional interventions to minimize future hospital admissions.
STAND-ALONE CERVICAL CAGE FOR CERVICAL RADICULOPATHY: A RETROSPECTIVE STUDY
Authors: Martiana I Ketut , Tumbelaka Reyner Valiant 
Published: May 2020

Introduction: Cervical radiculopathy is a clinical condition characterized by unilateral arm pain, numbness and tingling in a dermatomal distribution in the hand, and weakness in specific muscle groups that can be treated with nonsurgical or surgical method. This study aims to evaluate the outcome of the stand-alone cervical cage surgical method for cervical radiculopathy in our hospital institution from 2013 to 2017Methods: This is a retrospective observational study on every patient who undergoes a stand-alone cervical cage for cervical radiculopathy in our hospital institution from 2013 to 2017. The study runs from December 2017 until April 2018. We evaluated the clinical outcome with the Neck Disability Index (NDI). The data were collected from medical records, and postoperative follow up is done by house visits, phone calls, and outpatient visits.Results: Five male and one female subjects with a mean age of 58 years old (45–65 years old) underwent the procedure; one patient passed away on three year postoperative due to other events not related to operation procedure; one patient could no longer be reached. Four patient has an increasing score of NDI postoperative. There is no postoperative complicationConclusion: Stand-alone cervical cage is an excellent treatment for cervical radiculopathy in our hospital institution from 2013 to 2017.
Mid and Late Holocene evolution of Brateș Lake region (Danube floodplain) based on the multiproxy analysis
Authors: ȚUȚUIANU Laurențiu , VESPREMEANU–STROE Alfred , PENDEA Florin , SAVA Tiberiu 
Published: May 2020

This study proposes a local paleo–landscape reconstruction of the Danube floodplain based on a stratigraphic sequence retrieved from Brateș Lake which, by its emplacement near the confluence of Danube – Prut rivers, was fully receptive to changes associated to hydrological, geomorphological or anthropogenic driven events. Due to its intermediate position within the Lower Danube valley Brateș Lake is a proxy for the evolution of Cotul Dunării area (the region of Danube valley turning from S–N to W–E direction) and provide valuable information about the timing of Danube river advancement to the Black Sea after its reconnection to World Ocean. The sediments were analysed to get the history of their deposition by means of accelerator mass spectrometry (AMS) 14C dating, grain–size parameters, organic matter and carbonate content, magnetic susceptibility together with paleo–fauna and pollen content which altogether led to the identification of main stages: i) delta front advance into Danube estuary (before 8000 BP), ii) shoreline foreshore deposits which describe shoreline position (8000–7900 yrs BP), iii) river floodplain development (7900–5300/5000 yrs BP), iv) lake formation (5300/5000 yrs BP – present).
Simplifying a deltaic labyrinth: anthropogenic imprint on river deltas
Authors: CONSTANTINESCU Ștefan , TĂNĂSESCU Mihnea 
Published: May 2020

The information contained by historical maps provides a good source of understanding the complex transformation of a deltaic environment by human activity. Using the Danube delta as an example, here we show that a artographic diagnosis for river deltas is based on four main steps that outline the learning stages for every similar area: 1) exploring coasts (for the early stages of the portolan and Ptolemaic maps); 2) exploring depths (for the succeeding imperial and military maps which focused on the access along the deltaic distributaries); 3) exploring deltaic networks (when economic and ecological reasons led to detailed topographic maps based on field measurements and aerial photos); 4) ecological protectionism (when ecological reasons dictate land use patterns and determine land use change). This synopsis is applicable to other river deltas with some adaptations imposed by the local context. We interpret the four stages in the description of the Delta as resting on and further reinforcing the power of the centre to dictate the uses of the periphery. We further argue that the way the territory is lived by local inhabitants is continuously marginalized and effaced. This stands in the way of future adaptive strategies.
Developing a neuro–fuzzy system to classify drainage sub-basins according to erosion processes on the Island of Lefkas, Greece
Authors: EVELPIDOU Niki , GOURNELOS Theodoros , KARKANI Anna , KARDARA Eirini 
Published: May 2020

In this paper we attempt to classify drainage sub-basins according to their erosion risk. We have adopted a multistep procedure to face this problem. The input variables were introduced into a GIS – platform. These variables were the vulnerability of the surface rocks to erosion, topographic variations, vegetation cover, land use and drainage basin characteristics. We constructed a fuzzy inference mechanism to pre-process the input variables. Next we used neural–network technology to process the input variables. The system was trained to ‘learn’ and classify the input data. The output of this procedure was a classification of the sub-drainage basins related to their risk of erosion. This neuro–fuzzy system was applied to the island of Lefkas (Greece).
Submarine-fan development revealed by integrated high-resolution datasets from La Jolla Fan, offshore California, U.S.A.
Authors: Maier Katherine L. , Paull Charles K. , Caress David W. , Anderson Krystle , Nieminski Nora M. , Lundsten Eve , Erwin Benjamin E. , Gwiazda Roberto , Fildani Andrea 
Published: May 2020

ABSTRACT
New high-resolution datasets across La Jolla submarine fan, offshore California, illuminate low-relief, down-dip widening conduits emanating from a deep-sea channel that deposited a combination of laterally extensive sand strata seemingly crisscrossed by distributary patterns. Extensive coverage of this sector of the seafloor shows submarine-fan architecture and morphologies essentially different than distributary channelized patterns characteristic of subaerial systems and previous conceptual models of submarine fans. The main La Jolla channel, connected to La Jolla Canyon, loses confinement by widening, decreasing in relief, and developing scoured margins across kilometers-long down-slope and lateral distances. Two scales of distributary patterns are associated with sand-rich deposits down-system from, and outside of, fully formed channels. A larger-scale distributary pattern is identified in backscatter and bathymetry from trains of preferential erosion associated with laterally continuous repetitive steps that extend for kilometers outside channel confinement and may represent net erosional upper-flow-regime transitional bedforms. Smaller-scale distributary backscatter patterns in unconfined sand-rich deposits originate from the wide, low-relief channel. We suggest that the newly imaged La Jolla seascape displays sedimentary features that may be common on deep-sea fans but missed in previous lower resolution studies of submarine fans. Thus, La Jolla provides the basis for integrating previously enigmatic and (or) incomplete images of submarine fans. High-resolution seafloor, subsurface, and sample datasets highlight the importance of channel widening, headward erosion, and unconfined flows in La Jolla submarine-fan development, and may be relevant to other sandy submarine fan systems.
How methodological frameworks are being developed: Evidence from a scoping review
Authors: McMeekin Nicola , Wu Olivia , Germeni Evi , Briggs A 
Published: May 2020

Abstract
Background: A methodological framework is a structured guide to completing a process or procedure. Although the benefits of using methodological frameworks are increasingly recognised, to date, there is no formal definition of what constitutes a ‘methodological framework’, nor is there any published guidance on how to develop one. This study’s aims are to: (a) map the existing landscape on the use of methodological frameworks; (b) identify approaches used for the development of methodological frameworks and terminology used; and (c) provide suggestions for developing future methodological frameworks. We took a broad view and did not limit our study to methodological frameworks in research and academia.Methods: A scoping review was conducted, drawing on Arksey and O’Malley’s methods and more recent guidance. We systematically searched two major electronic databases (MEDLINE and Web of Science), as well as grey literature sources and the reference lists and citations of all relevant papers. Study characteristics and approaches used for development of methodological frameworks were extracted from included studies. Descriptive analysis was conducted.Results: We included a total of 30 studies, representing a wide range of subject areas. The most commonly reported approach for developing a methodological framework was ‘Based on existing methods and guidelines’ (66.7%), followed by ‘Refined and validated’ (33.3%), ‘Experience and expertise’ (30.0%), ‘Literature review’ (26.7%), ‘Data synthesis and amalgamation’ (23.3%), ‘Data extraction’ (10.0%), ‘Iteratively developed’ (6.7%) and ‘Lab work results’ (3.3%). There was no consistent use of terminology; the studies included a range of terms for ‘methodological framework’, which were also used interchangeably within studies.Conclusions: Although no formal guidance exists on how to develop a methodological framework, this scoping review found an overall consensus in approaches used, which can be broadly divided into three phases: (a) identifying data to inform the methodological framework; (b) developing the methodological framework; and (c) validating, testing and refining the methodological framework. Based on these phases, we provide suggestions to facilitate the development of future methodological frameworks.Trial registration: Not applicable
Evaluationof Integrated Modular Teaching in Chinese Ophthalmology Trainee Courses
Authors: Xin Wei , Zou Yuxian , Ao Yong , Cai Yu , Huang Zheqian , Li Miaoling , Xu Chaochao , Jia Yu , Yang Ying , Yang Yangfan , Lin Haotian 
Published: May 2020

Abstract
Background: Before attending ophthalmology trainee courses in Zhongshan Ophthalmic Centre, the medical students from Sun Yat-sen University had finished two years of premedical education after the six-year medical courses including basic medical courses, clinical medical courses, clerkship, and research training in medical college. Integrated modular teaching using different problem-based teaching methods in ophthalmology was designed by the teaching steering committee of Zhongshan Ophthalmic Centre. This study aimed to evaluate the effectiveness and satisfaction scales of the integrated modular teaching among the trainee students. Methods: A total of 100 medical students attending ophthalmology trainee courses in Zhongshan Ophthalmic Centre were enrolled and randomly allocated into 4 groups according to the teaching arrangement. The trainee courses consisted of several sessions delivered in multiple methods, such as "flipped classroom" session and team-based learning session. The pre- and post-class tests were delivered to evaluate the effectiveness of the integrated modular teaching. The satisfaction survey questionnaire was collected from all participants to investigate the degree of satisfaction. Results: Compared with the first-day-test score, the total last-day-test score was significantly improved by a paired t-test (t=3.288, P=0.001). Nineteen students obtained a significant improvement in ranking increased by more than 10 in the last-day-test, whereas they failed to obtain a higher average score for daily performance than other students (t=0.469, P=0.654). According to the participant satisfaction questionnaires, these innovative teaching methods were considered as effective and satisfactory. Conclusions: Integrated modular teaching in ophthalmology trainee courses is effective and widely recognized by the medical college students.
Institutional Delivery Service Utilization and Associated Factors in Ethiopia: A Systematic Review and Meta Analysis
Authors: Nigusie Adane , Azale Telake , Yitayal Mezgebu 
Published: May 2020

Abstract
Background: Different primary studies in Ethiopia showed the weight of institutional delivery service utilization and the factors associated with it. However, variation among those studies was seen. This study was aimed to estimate the pooled national prevalence and associated factors of Institutional delivery service utilization in Ethiopia. Methods: PubMed, Cochrane library, Web of Science, and Google Scholar were searched. A funnel plot and Egger’s regression test were used to see publication bias. I-squared statistic was applied to check heterogeneity of studies. A weighted Dersimonian laired random effect model was applied to estimate the pooled national prevalence and the effect size of associated factors. Result: A total of twenty four studies were included in this review. The pooled prevalence of Institutional delivery service utilization was 31% (95% Confidence interval (CI): 30%, 31.2%; I 2 = 0.00%). Attitude towards institutional delivery of 3 studies(Adjusted Odd Ratio (AOR)=2.83; 95% CI 1.35,5.92 ), maternal age at first pregnancy of 4 studies(AOR= 3.59; 95% CI 2.27,5.69 ), residence setting of 7 studies (AOR= 3.84; 95% CI 1.31, 11.25), educational status of 5 studies(AOR=2.91;95% 1.88,4.52), availability of information source of 6 studies(AOR= 1.80;95% CI 1.16,2.78), ANC follow-up of 13 studies((AOR= 2.57 95% CI 1.46,4.54 )), frequency of ANC follow up of 4 studies(AOR= 4.04;95% CI 1.21,13.46), knowledge of institutional delivery & danger signs during pregnancy of 11 studies((AOR=3.04;95% CI 1.76 ,5.24 )) and place of birth the most recent birth of 4 studies(AOR=8.44;95% CI 5.75,12.39) were identified factors of institutional delivery service utilization. Conclusions: The findings of this review found several modifiable factors such as empowering women through education, promoting antenatal care to prevent home delivery, increasing awareness of women through mass media and making services more accessible would likely to increase utilization of institutional delivery.