bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel LUMNAqSoP approach for prioritising groundwater monitoring stations for implementation of the Nitrates Directive
Authors: Ondrasek G. , Bakić Begić H. , Romić D. , Brkić Ž. , Husnjak S. , Bubalo Kovačić M. 
Published: February 2021

Abstract
Background
The Nitrates Directive (ND) is an EU anti-pollution legislative that, for almost 30 years, has controlled and protected hydro-resources against excessive levels of nitrates originating from agroecosystems, striving to prevent the further exacerbation of the nitrates in aquatic environments. ND sets several principal goals that member states must accomplish, such as performing spatiotemporal nitrate analyses in ground/surface water networks to achieve national water quality monitoring programme.

Results
In this study, using the novel LUMNAqSoP approach, the prioritisation of 151 candidate groundwater stations for ND monitoring in Croatia was performed. The LUMNAqSoP integratively evaluates: (i) the most dominant loads from the agroecosystem (land use and management, net nitrogen application) and (ii) environmental (aquifer and soil) vulnerabilities and sensitivities of groundwater resources to nitrate pollution. By comparing stations which scored the most agro-environmental loads vs. the data from water stations containing elevated mean nitrate concentrations (from existing monitoring programmes) a very good agreement was confirmed. Moreover, deviations close to large urban zones were detected, suggesting that elevated nitrates in groundwaters in those areas likely originated from municipal/industrial rather than agricultural sources; however, further studies are needed for elucidation.

Conclusions
The presented approach can serve as a useful tool to policy makers and regulators for: (i) more efficient and reliable establishment of water monitoring programme pursuant to ND, as well as (ii) better management and shaping (designating/derogating) of nitrate-vulnerable zones, especially in diverse environmental conditions and dynamic agroecosystems as have been confirmed in recent decades across the EU member states.
Pineal gland transcriptomic profiling reveals the differential regulation of lncRNA and mRNA related to prolificacy in STH sheep with two FecB genotypes
Authors: Li Chunyan , He Xiaoyun , Zhang Zijun , Ren Chunhuan , Chu Mingxing 
Published: February 2021

Abstract
Background
Long noncoding RNA (lncRNA) has been identified as important regulator in hypothalamic-pituitary-ovarian axis associated with sheep prolificacy. However, little is known of their expression pattern and potential roles in the pineal gland of sheep. Herein, RNA-Seq was used to detect transcriptome expression pattern in pineal gland between follicular phase (FP) and luteal phase (LP) in FecBBB (MM) and FecB++ (ww) STH sheep, respectively, and differentially expressed (DE) lncRNAs and mRNAs associated with reproduction were identified.

Results
Overall, 135 DE lncRNAs and 1360 DE mRNAs in pineal gland between MM and ww sheep were screened. Wherein, 39 DE lncRNAs and 764 DE mRNAs were identified (FP vs LP) in MM sheep, 96 DE lncRNAs and 596 DE mRNAs were identified (FP vs LP) in ww sheep. Moreover, GO and KEGG enrichment analysis indicated that the targets of DE lncRNAs and DE mRNAs were annotated to multiple biological processes such as phototransduction, circadian rhythm, melanogenesis, GSH metabolism and steroid biosynthesis, which directly or indirectly participate in hormone activities to affect sheep reproductive performance. Additionally, co-expression of lncRNAs-mRNAs and the network construction were performed based on correlation analysis, DE lncRNAs can modulate target genes involved in related pathways to affect sheep fecundity. Specifically, XLOC_466330, XLOC_532771, XLOC_028449 targeting RRM2B and GSTK1, XLOC_391199 targeting STMN1, XLOC_503926 targeting RAG2, XLOC_187711 targeting DLG4 were included.

Conclusion
All of these differential lncRNAs and mRNAs expression profiles in pineal gland provide a novel resource for elucidating regulatory mechanism underlying STH sheep prolificacy.
Intracranial mass lesions and skin discoloration in the armpits as unusual clues to Erdheim-Chester disease: a case report
Authors: Rodrigues Pedro Gustavo Barros , Pereira Isabelle de Sousa , Lima Filho Valter Barbalho , Dias Daniel Aguiar , Nóbrega Paulo Ribeiro , Braga-Neto Pedro 
Published: February 2021

Abstract
Background
Erdheim–Chester disease (ECD) is a non-Langerhans histiocytosis that results in multi-organ disease involving the skin, bones, lungs and kidneys. Central nervous system (CNS) involvement occurs in about 50 % of patients, and diabetes insipidus, visual disturbances, and cerebellar ataxia are the most frequent neurological signs. We report a case of Erdheim-Chester disease with central nervous system involvement in the form of enhancing intracranial mass lesions with massive edema.

Case presentation
The patient presented with vertigo, ataxia, encephalopathy and pyramidal signs. Diagnosis was suggested by xanthomatous skin lesions and a biopsy was compatible with Erdheim-Chester disease demonstrating xanthogranulomas CD68 positive (clone KP1) and CD1a and S100 negative. Testing for BRAF mutation was negative, which precluded treatment with Vemurafenib. Treatment with steroids and interferon resulted in improvement of neurological signs and regression of edema on MRI.

Conclusions
The diagnosis of Erdheim-Chester disease should be considered in intracranial mass lesions. Xanthomatous skin lesions are a clue to the diagnosis.
Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study
Authors: Laitinen Linda , Nurmi Miina , Rautava Päivi , Koivisto Mari , Polo-Kantola Päivi 
Published: February 2021

Abstract
Background
Nausea and vomiting of pregnancy (NVP) deteriorates many aspects of daily lives of women. However, little is known about associations between NVP and sleep quality.

Methods
Women attending to routine mid-pregnancy visits in maternity health care clinics in Turku city area and surrounding municipalities, Finland, during 2011–2014, were invited to participate. A cohort of 1203 volunteers (mean age 30 years, mean gestational week 16.6, mean BMI 24.4 kg/m2, nulliparous 46%) was recruited. The severity of NVP in the worst 12-h period of current pregnancy was assessed with Pregnancy Unique Quantification of Emesis Questionnaire (PUQE) and categorized accordingly into no/mild/moderate and severe NVP. Sleep disturbances during the past 3 months were assessed with selected questions (difficulty falling asleep, night awakenings, too early morning awakenings and sleepiness during the day) from Basic Nordic Sleep Questionnaire (BNSQ). In addition, general sleep quality, as well as physical and mental quality of life (QoL) were rated with three visual analog scales (VAS). Associations between PUQE categories (severity of NVP) and sleep disturbances, general sleep quality, physical QoL and mental QoL were evaluated with multinomial regression analysis.

Results
According to PUQE, NVP was most frequently moderate (n = 629, 52.3%), followed by mild (n = 361, 30.0%) and severe (n = 77, 6.4%). Only 11.3% had no NVP (n = 136). The most frequent sleep disturbance was night awakenings (69.9%, n = 837), followed by sleepiness during the day (35.7%, n = 427), too early morning awakenings (12.0%, n = 143) and difficulty falling asleep (7.1%, n = 81). In adjusted analysis (age, parity, body mass index, smoking, employment), more severe NVP was associated with night awakenings (AOR 3.9, 95% CI 1.79–8.47, P < 0.0001) and sleepiness during the day (AOR 4.7, 95% CI 2.20–9.94, P < 0.0001). In VAS, women with more severe NVP rated worse general sleep quality and worse physical and mental QoL. However, in multivariable analysis, the association between the severity of NVP and physical and mental QoL was stronger than that of sleep .

Conclusions
More severe NVP is associated with sleep disturbances and in close relation to lower physical and mental QoL. Thus, in comprehensive care of women with NVP, also sleep quality should be evaluated.
Activation of WNT7b autocrine eases metastasis of colorectal cancer via epithelial to mesenchymal transition and predicts poor prognosis
Authors: Jiang Shuai , Li Qiwen , Liu Yimin , Zhang Huimin , Wang Qianyu , Chen Yu , Shi Xiaoyang , Li Jun , Zhang Hailing , Zhang Yi , Xia Dongqing , Wu Man , Lin Jiajia , Zhang Chenglin , Pang Suhua , Jiang Jiamin , Wen Yan , Zhang Peipei 
Published: February 2021

Abstract
Background
Aberrant activation of the Wnt/β-catenin signaling pathway is one of the most frequent abnormalities in human cancer, including colorectal cancer (CRC). Previous studies revealed pivotal functions of WNT family members in colorectal cancer, as well as their prognostic values. Nevertheless, the prognostic role and mechanisms underlying WNT7b in colorectal cancer development remains unclear.

Methods
In this study, WNT7b expression was measured by immunohistochemical staining of 100 cases of surgically resected human colorectal cancerous tissues as well as matched adjacent normal tissues constructed as tissue microarrays. In vitro studies, we attempted to substantiate the WNT7b expressional pattern previously found in immunohistochemistry staining. We used the colorectal cancer cell-line HCT116 and normal colorectal cell-line FHC for immunofluorescence staining and nuclear/cytoplasmic separated western blotting. We measured epithelial–mesenchymal transition (EMT) markers and migration capacity of HCT116 in the context of WNT7b knocked-down using short interfering RNA. Finally, clinical and prognostic values of WNT7b activation levels were examined.

Results
WNT7b was expressed in the nucleus in adjacent normal tissues. In CRC tissues, nuclear expression of WNT7b was similar; however, membrane and cytoplasmic expression was strikingly enhanced. Consistently, in vitro analysis confirmed the same expression pattern of WNT7b. Compared with FHC cells, HCT116 cells displayed higher levels of WNT7b membrane and cytoplasmic enrichment, as well as higher migration capacity with a sensitized EMT process. Either partial knockdown of WNT7b or blockade of the Wnt/β-catenin signaling pathway reversed EMT process and inhibited the migration of HCT116 cells. Finally, elevated secretion levels of WNT7b were significantly associated with lymphatic and remote metastasis and predicted worse prognosis in the CRC cohort.

Conclusion
In summary, we demonstrated that the activation of WNT7b autocrine probably contributes to CRC metastasis by triggering EMT process through the Wnt/β-catenin signaling pathway. High levels of WNT7b autocrine secretion predicts poor outcome in patients with CRC. This molecule is a promising candidate for clinical CRC treatments.
Suicidality, function and associated negative life events in an adolescent psychiatric population at 3-year follow-up
Authors: Gårdvik Kari Skulstad , Torgersen Terje , Rygg Marite , Lydersen Stian , Indredavik Marit Sæbø 
Published: February 2021

Abstract
Background
We aimed to examine psychosocial function, suicidality and school dropout in a clinical psychiatric population over a 3-year period from adolescence to young adulthood and explore associations with negative life events.

Methods
This study is part of the Health Survey in Department of Children and Youth, St. Olavs hospital, Norway. In the first study visit (T1), 717 (43.5% of eligible) participated, aged 13–18 years (2009–2011), and 3 years later (T2), 570 answered a questionnaire (school functioning and negative life events), and 549 completed Kiddie SADS as telephone interview assessing DSM-IV diagnoses, psychosocial functioning and suicidality.

Results
Suicidal ideation was more frequent among girls (17.9%) than among boys (5.4%) (risk difference; RD = 12.5%, CI (7.2 to 17.7), p < 0.001), as was suicidal behavior (25.0% vs. 9.5%, RD = 15.5%, CI (9.2 to 21.4), p < 0.001). Girls had lower psychosocial functioning than boys (Children’s Global Assessment Scale; Mean score 68.2 vs. 75.2, Mean difference = − 7.0, CI (− 9.4 to − 4.7), p < 0.001), and more school dropout (22.5% vs. 13.2%, RD = 9.3%, CI (2.8 to 15.5), p = 0.006). For those with a psychiatric disorder, 24.8% of girls had suicidal ideation and 30.0% suicidal behavior, which was larger than for boys (RD = 18.0%, CI (10.8 to 24.7), p < 0.001, and RD = 18.3%, CI (10.2 to 25.8), p < 0.001, respectively). Exposure to negative life events was frequent for both genders, but more girls had experienced sexually uncomfortable or abusive situations, the last 3 years (23.5% vs. 2.9%, RD = 20.6%, CI (15.4 to 25.7), p < 0.001), and ever (44.4% vs. 7.9%, RD = 36.5%, CI (29.9 to 42.7), p < 0.001). Suicidal behavior was associated with having been threatened, physically harassed or violently hurt (RD = 16.7%, CI (9.5 to 23.9), p < 0.001), and for girls been put into sexually uncomfortable or abusive situations (RD = 20.1%, CI (10.4 to 29.9), p < 0.001) and seen others violently hurt (RD = 14.6%, CI (3.4 to 25.8), p = 0.011).

Conclusions
The high frequency of suicidality and school dropout confirms the severity of adolescent psychiatric disorders, especially among girls. Specific life events were associated risk factors and should be target points for prevention and intervention.
The link between problematic internet use, problematic gaming, and psychological distress: does sleep quality matter?
Authors: Wang Qian , Mati Komi , Cai Yong 
Published: February 2021

Abstract
Introduction
This study aimed to examine the mediating role of sleep quality in the association of problematic internet use (PIU) and problematic gaming with psychological distress among college students in China.

Methods
Data of 1040 full-time students from multiple colleges in China were examined. Respondents were asked about their internet use and gaming behaviors, sleep quality, psychological distress, and sociodemographic characteristics. The mediating role of sleep quality in the PIU- and problematic gaming-psychological distress link was examined respectively.

Results
PIU was associated with decreased sleep quality (r = .32, p < .001) and increased psychological distress (r = .46, p < .001). Problematic gaming was also associated with decreased sleep quality (r = .22, p < .001) and increased psychological distress (r = .46, p < .001). Sleep quality accounted for 23.5% of the indirect effect of PIU on psychological distress, and 17.9% of the indirect effect of problematic gaming on psychological distress.

Conclusions
Sleep quality had a meaningful mediating effect on the PIU-psychological distress link, but only exerted a small mediating effect on the problematic gaming-psychological distress link. In addition to promoting healthy internet usage, strategies aimed at mitigating the negative effect of excessive internet use on psychological health might benefit from those aimed at improving sleep quality.
Development of multifactor index for assessing quality of life of a tribal population of India: multilevel analysis approach
Authors: Bagavandas M. 
Published: February 2021

Abstract
Background
The main objective of this study is to develop a multilevel multi-factor index to assess the quality of life of the Malayali tribal population of India at the household and village levels based on nine domains, namely, Demography, Economy, Health, Human Development, Infrastructure Development, Work Participation, Recreation, Social Capital and Self Perception. An attempt is made to classify the individuals as well as villages by the overall scores of a multi-factor -index within a community which will help policymakers to develop concrete policy recommendations for the improvement of the quality of life of this tribal group.

Method
Multilevel factor analysis is utilized to determine uncorrelated meaningful factors and their respective weights using Mplus software from the nested dataset consists of values of nine domains of 1096 individuals collected from 19 villages. A multilevel multi-factor index is constructed using the weights of these factors. The qualities of the lives of different households and different villages are assessed using the scores of this index.

Results
Three different factors are identified at household as well as village levels. The quality of life at Households and Village levels are classified as poor, low, moderate, good, and excellent based on five quintiles of the scores of the multi-factor index, and the contribution of each domain in this classification is ascertained.

Discussion
This study finds that at household as well as at village levels, the quality of life of the individuals of this tribal population increases with an increase in education, income, and occupation status which make them lead a healthy life and also make them to find time and money to spend on recreation. Infrastructure is not important at the household level but not so at the village level.

Conclusion
The main purpose of developing this kind of multi-factor index at different levels is to provide a tool for tribal development based on realistic data that can be used to monitor the key factors that encompass the social, health, environmental, and economic dimensions of quality of lives at the household and community levels of these tribal people.
Safe and effective performance of pediatric spinal deformity surgery in patients unwilling to accept blood transfusion: a clinical study and review of literature
Authors: Mihas Alexander , Ramchandran Subaraman , Rivera Sebastian , Mansour Ali , Asghar Jahangir , Shufflebarger Harry , George Stephen 
Published: February 2021

Abstract
Background
Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah’s witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion.

Methods
After obtaining institutional review board approval, we retrospectively reviewed 20 consecutive patients who underwent spinal deformity surgery and refused blood transfusion at a single institution between 2014 and 2018. We collected pertinent preoperative, intraoperative and most recent clinical and radiological data with latest follow-up (minimum two-year follow-up).

Results
Twenty patients (13 females) with a mean age of 14.1 years were identified. The type of scoliotic deformities were adolescent idiopathic (14), juvenile idiopathic (1), neuromuscular (3) and congenital (2). The major coronal Cobb angle was corrected from 55.4° to 11.2° (80% correction, p <  0.001) at the latest follow-up. A mean of 11.4 levels were fused and 5.6 levels of Pontes osteotomies were performed. One patient underwent L1 hemivertebra resection and three patients had fusion to pelvis. Estimated blood loss, percent estimated blood volume loss, and cell saver returned averaged 307.9 mL, 8.5%, and 80 mL, respectively. Average operative time was 214 min. The average drop in hemoglobin after surgery was 2.9 g/dL. The length of hospital stay averaged 5.1 days. There were no intraoperative complications. Three postoperative complications were identified, none related to their refusal of transfusion. One patient had in-hospital respiratory complication, one patient developed a late infection, and one patient developed asymptomatic radiographic distal junctional kyphosis.

Conclusions
Blood conservation techniques allow for safe and effective spine deformity surgery in pediatric patients refusing blood transfusion without major anesthetic or medical complications, when performed by an experienced multidisciplinary team.

Level of evidence
Level IV.
Comparison of self and simulated patient assessments of first-year medical students’ Interpersonal and Communication Skills (ICS) during Objective Structured Clinical Examinations (OSCE)
Authors: Roshal Joshua A. , Chefitz Dalya , Terregino Carol A. , Petrova Anna 
Published: February 2021

Abstract
Background
Interpersonal and communication skills (ICS) are important core competencies in medical education and certification. In this study, we identified self- and simulated patient (SP)-reported ratings of US first-year medical students’ ICS and the influence of age and gender on performance appraisal during the Objective-Structured Clinical Examination (OSCE).

Methods
OSCE participants, including 172 first-year medical students and 15 SPs were asked to evaluate the students’ ICS using the American Board of Internal Medicine–Patient-Satisfaction Questionnaire (ABIM–PSQ), electronically and via paper, respectively. Self- and SP-reported ratings of students’ ICS were presented as the median on a 5-point Likert-scale and as three categories defined as “good,” “very good,” and “inadequate.”

Results
SPs assessed all 172 students in the OSCE, while 43.6% of students assessed their own performance. The majority of students and SPs evaluated the students’ ICS as very good. 23.3% of SPs and 5.3% of students rated the medical students’ ability to encourage patient question-asking and answer questions as inadequate (P <  0.002). Neither age nor gender influenced the medical students’ self-assessment of ICS. Female SPs assigned lower scores to students in regard to respecting patients and encouraging patient question-asking and answering. Older SPs was more likely to assign lower scores on all survey questions.

Conclusions
In the present study, self- and SP-reported ratings of first-year medical students’ ICS were mainly “very good” with no influence of students’ age or gender. Older age and female gender among the SPs were associated with a reduction in SP-reported ratings of students’ ICS.
Experiences of early graduate medical students working in New York hospitals during the COVID-19 pandemic: a mixed methods study
Authors: Pravder Harrison D. , Langdon-Embry Liana , Hernandez Rafael J. , Berbari Nicholas , Shelov Steven P. , Kinzler Wendy L. 
Published: February 2021

Abstract
Background
The coronavirus disease 2019 (COVID-19) pandemic presented the world with a sudden need for additional medical professionals. Senior medical students were identified as potential workers and many worldwide graduated early to serve as Junior Physicians in hospitals. The authors sought to identify factors that informed the decision to work, describe experiences in this capacity, and elucidate benefits for trainees.

Methods
The investigators conducted a mixed-methods observational cohort study of early medical graduates eligible to work as Junior Physicians at two New York medical centers in April/May 2020 during an initial surge in COVID-19 hospitalizations. Graduates were surveyed, and a sample of Junior Physicians participated in a focus group. Survey responses of those who worked were compared to those who did not. Focus group responses were transcribed, coded, and thematically analyzed.

Results
Fifty-nine graduates completed the study methods and 39 worked as Junior Physicians. Primary reasons for working included duty to help (39 [100%]), financial incentive (32 [82%]), desire to learn about pandemic response (25 [64%]), and educational incentive (24 [62%]). All had direct contact with COVID-19 patients, believed working was beneficial to their medical training, and were glad they worked. None contracted a symptomatic infection while working. Compared with non-Junior Physicians, Junior Physicians reported increased comfort levels in completing medical intern-level actions like transitions of care functions, such as writing transfer notes (P < 0.01), writing discharge orders (P = 0.01), and providing verbal sign out (P = 0.05), and they reported more comfort in managing COVID-19 patients. Sixteen themes emerged from the focus group and were placed into four categories: development of skills, patient care, safety, and wellness.

Conclusions
Senior medical students chose to work as Junior Physicians for both personal and educational reasons. Experiences were beneficial to trainees and can inform future innovations in medical education.