bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nursing Students' Eating Habits, Subjective, and Mediterranean Nutrition Knowledge During the COVID-19 Pandemic
Authors: Green Gizell 
Published: September 2021

Background Mediterranean nutrition knowledge, healthy eating habits, and subjective nutritional knowledge are crucially important to nursing students’ health. The study strives to examine, during the COVID-19 pandemic period: (a) nursing students' eating habits and their subjective nutritional knowledge according to three groups: novice, advanced, and senior; and (b) subjective knowledge and its role as a mediator between Mediterranean nutritional knowledge and nursing students’ eating habits. Methods A cross-sectional study design with a convenience sample consisting of 212 university nursing students. Participants volunteered to complete a questionnaire that examined their eating habits, subjective nutritional knowledge, and Mediterranean diet knowledge. The university's institutional review board provided permission to conduct the current study. Results Nursing students from the novice group had better eating habits than the advanced and senior groups, and no significant differences were found between the advanced and senior groups regarding eating habits. Additionally, Mediterranean nutritional knowledge had a positive indirect effect on eating habits through subjective nutritional knowledge. Therefore, subjective nutritional knowledge partially mediated the relationship between Mediterranean nutritional knowledge and eating habits. Conclusion First, especially for the advanced and senior groups, it is important to create opportunities for learning via seminars, symposia, and webinars. Interprofessional teams, such as clinical nutritionists or a registered certified dietitian and nursing student, can engage with important, authentic information. Second, since subjective nutritional knowledge was found to be a partial mediator, it may be assumed that there are other mediating variables that we did not examine in this study. Therefore, it is necessary to conduct further research to examine other factors that can serve as mediators for eating habits, in addition to subjective knowledge, especially during COVID-19 times.
Blood–brain barrier permeability in survivors of immune-mediated thrombotic thrombocytopenic purpura: a pilot study
Authors: Huang Shih-Han Susan , Pavenski Katerina , Lee Ting-Yim , Jurkiewicz Michael T. , Bharatha Aditya , Thiessen Jonathan Dale , St. Lawrence Keith , Théberge Jean , Mandzia Jennifer , Barth David , Licht Christoph , Patriquin Christopher Jordan 
Published: September 2021

Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening disorder of systemic microthrombosis and organ ischemia. The etiology of chronic cerebrovascular outcomes in iTTP survivors is largely unknown. In this pilot study, we measured blood–brain barrier (BBB) permeability in patients with iTTP at the start of remission and 6 months later. This prospective pilot study included 7 adult patients with incident iTTP. Eligibility criteria included ADAMTS13 activity &lt; 10% and detectable inhibitor at diagnosis. Patients were recruited from London Health Sciences Centre in Canada (2017-2019) within 3 days of hospital admission and followed for 6 months after remission (defined as normalization of platelet count and lactate dehydrogenase with no clinical signs or symptoms of microvascular injury for more than 30 days after the last plasma exchange). All patients had cerebral computed tomography perfusion scans with BBB permeability surface product measurements. Patients (5 women, 2 men) had a mean age of 48 years (range, 21-77 years). At diagnosis, patients had a mean platelet count of 22 (standard deviation [SD], 25) × 109/L. At the start of remission, mean BBB permeability surface product was 0.91 (0.30) mL/min/100 g. Six months later, the mean permeability surface product was 0.56 (0.22) mL/min/100 g, with a mean difference of −0.312 mL/min/100 g (95% confidence interval: −0.4729 to −0.1510; P = .0032). In this pilot study of patients with iTTP, pathologically increased BBB permeability was evident, and although there was some improvement, this persisted 6 months after remission. Future work will explore the chronicity of these findings and their clinical implications.
Optimization on the Crosswind Stability of Trains Using Neural Network Surrogate Model
Authors: Zhang Le , Li Tian , Zhang Jiye , Piao Ronghuan 
Published: September 2021

AbstractUnder the influence of crosswinds, the running safety of trains will decrease sharply, so it is necessary to optimize the suspension parameters of trains. This paper studies the dynamic performance of high-speed trains under crosswind conditions, and optimizes the running safety of train. A computational fluid dynamics simulation was used to determine the aerodynamic loads and moments experienced by a train. A series of dynamic models of a train, with different dynamic parameters were constructed, and analyzed, with safety metrics for these being determined. Finally, a surrogate model was built and an optimization algorithm was used upon this surrogate model, to find the minimum possible values for: derailment coefficient, vertical wheel-rail contact force, wheel load reduction ratio, wheel lateral force and overturning coefficient. There were 9 design variables, all associated with the dynamic parameters of the bogie. When the train was running with the speed of 350 km/h, under a crosswind speed of 15 m/s, the benchmark dynamic model performed poorly. The derailment coefficient was 1.31. The vertical wheel-rail contact force was 133.30 kN. The wheel load reduction rate was 0.643. The wheel lateral force was 85.67 kN, and the overturning coefficient was 0.425. After optimization, under the same running conditions, the metrics of the train were 0.268, 100.44 kN, 0.474, 34.36 kN, and 0.421, respectively. This paper show that by combining train aerodynamics, vehicle system dynamics and many-objective optimization theory, a train’s stability can be more comprehensively analyzed, with more safety metrics being considered.
PathFams: statistical detection of pathogen-associated protein domains
Authors: Lobb Briallen , Tremblay Benjamin Jean-Marie , Moreno-Hagelsieb Gabriel , Doxey Andrew C. 
Published: September 2021

Abstract
Background
A substantial fraction of genes identified within bacterial genomes encode proteins of unknown function. Identifying which of these proteins represent potential virulence factors, and mapping their key virulence determinants, is a challenging but important goal.

Results
To facilitate virulence factor discovery, we performed a comprehensive analysis of 17,929 protein domain families within the Pfam database, and scored them based on their overrepresentation in pathogenic versus non-pathogenic species, taxonomic distribution, relative abundance in metagenomic datasets, and other factors.

Conclusions
We identify pathogen-associated domain families, candidate virulence factors in the human gut, and eukaryotic-like mimicry domains with likely roles in virulence. Furthermore, we provide an interactive database called PathFams to allow users to explore pathogen-associated domains as well as identify pathogen-associated domains and domain architectures in user-uploaded sequences of interest. PathFams is freely available at https://pathfams.uwaterloo.ca.
Diazepam induced sleep spindle increase correlates with cognitive recovery in a child with epileptic encephalopathy
Authors: Stoyell S. M. , Baxter B. S. , McLaren J. , Kwon H. , Chinappen D. M. , Ostrowski L. , Zhu L. , Grieco J. A. , Kramer M. A. , Morgan A. K. , Emerton B. C. , Manoach D. S. , Chu C. J. 
Published: September 2021

Abstract
Background
Continuous spike and wave of sleep with encephalopathy (CSWS) is a rare and severe developmental electroclinical epileptic encephalopathy characterized by seizures, abundant sleep activated interictal epileptiform discharges, and cognitive regression or deceleration of expected cognitive growth. The cause of the cognitive symptoms is unknown, and efforts to link epileptiform activity to cognitive function have been unrevealing. Converging lines of evidence implicate thalamocortical circuits in these disorders. Sleep spindles are generated and propagated by the same thalamocortical circuits that can generate spikes and, in healthy sleep, support memory consolidation. As such, sleep spindle deficits may provide a physiologically relevant mechanistic biomarker for cognitive dysfunction in epileptic encephalopathies.

Case presentation
We describe the longitudinal course of a child with CSWS with initial cognitive regression followed by dramatic cognitive improvement after treatment. Using validated automated detection algorithms, we analyzed electroencephalograms for epileptiform discharges and sleep spindles alongside contemporaneous neuropsychological evaluations over the course of the patient’s disease. We found that sleep spindles increased dramatically with high-dose diazepam treatment, corresponding with marked improvements in cognitive performance. We also found that the sleep spindle rate was anticorrelated to spike rate, consistent with a competitively shared underlying thalamocortical circuitry.

Conclusions
Epileptic encephalopathies are challenging electroclinical syndromes characterized by combined seizures and a deceleration or regression in cognitive skills over childhood. This report identifies thalamocortical circuit dysfunction in a case of epileptic encephalopathy and motivates future investigations of sleep spindles as a biomarker of cognitive function and a potential therapeutic target in this challenging disease.
Cross-talk and clinical value of m[superscript 6]A regulatory gene in bladder cancer
Authors: Zhou Ben-zheng , Luo Qin , Zhang Ye 
Published: September 2021

Abstract
Background
RNA modification is a regulation at the post-transcriptional level. RNA methylation modification accounts for more than 60% of all RNA modifications, and m[superscript 6]A(6-methyladenine) is the most common type of RNA methylation modification on mRNA of higher organisms. The modification level of transcription m[superscript 6]A is dynamically regulated by methyltransferase (reader), binding protein (writer) and demethylase (eraser). Furthermore, m[superscript 6]A methylation has been found to have an impact on tumor initiation and progression through various mechanisms.

Methods
13 genes related m[superscript 6]A from all the gene expressions in The Cancer Genome Atlas (TCGA) were screened. Gene Ontology (GO) and KEGG analysis were applied to explore the functions of genes identified in study. We clustered the related regulators of m[superscript 6]A into three subgroups with “ConsensusClusterPlus”. 13 genes were used for univariate Cox analysis to find genes associated with prognosis, and the risk model was constructed based on lasso regression. According to the median risk score of each patient, the patients were divided into high and low risk groups for survival analysis. The ROC curve evaluates the model. Then the risk group and clinical characteristics were analyzed.

Results
The three subgroups had different clinical characteristics. Our tumor clusters were related to grade, survival status. Moreover, we observed a significantly longer overall survival (OS) in the cluster 1 than the cluster 2 and cluster 3. Three m[superscript 6]A-related genes related to prognosis were used to construct a prognostic risk model. We found age are independent prognostic marker. What’s more, risk score can also be an independent prognostic factor.

Conclusion
Revealing the regulation and functional mechanism of cross-talk among m[superscript 6]A writers, erasers, and readers, and determine its role in bladder cancer may help in developing novel and efficient strategies for the diagnosis, prognosis and treatment of bladder cancer.
Associations of early childhood caries with salivary beta defensin-3 and childhood anemia: a case–control study
Authors: Faheem Sanam , Maqsood Shahida , Hasan Arshad , Imtiaz Fouzia , Shaikh Faheem , Farooqui Waqas Ahmed 
Published: September 2021

Abstract
Background
Human beta defensin-3 (HβD-3) is an antimicrobial peptide present in saliva that protects tooth surfaces from microbial attack. These peptides are part of innate immunity so levels may be affected by different systemic diseases like anemia. Therefore, anemia may predispose an affected child to an increased risk of dental caries. The objectives of this study were to determine the association of early childhood caries (ECC) with HβD-3 levels and observe the association of HβD-3 levels with childhood anemia.

Methods
A total of 80 children admitted in a pediatric medical ward, age 48–71 months, of either sex were included in the study. The included children were categorized as cases (children with ECC n = 40) and controls (children without ECC n = 40). Children were further segregated into the anemic and non-anemic sub-groups based on the hospital record of hemoglobin level. The salivary concentration of HβD-3 was measured by Enzyme-Linked Immuno-sorbent assay (ELISA). IBM SPSS version 20 software was used for statistical analysis. Two sample t-test and one-way ANOVA were used to compare mean values while spearman was used for correlations at p < 0.05.

Results
The mean Salivary HβD-3 level in cases (8.87 ± 4.30) was significantly higher (p = 0.042) as compared to controls (7.23 ± 2.57). Salivary HβD-3 level in patients with caries and without anemia was highest (10.80 ± 4.50) whereas salivary HβD-3 level in the presence of caries and anemia was lowest (6.94 ± 3.13) amongst all groups. This difference was statistically significant (p = 0.001). Salivary HβD-3 level was found to be moderately correlated with cases (p = 0.002). An inverse correlation was found between salivary HβD-3 level and anemia (r = -0.479, p = 0.002).

Conclusion
Anemia may affect the innate immunity of children, and may result in a decreased level of salivary HβD3, thus increasing vulnerability to decay.
Addressing challenges in information-provision: a qualitative study among oncologists and women with advanced breast cancer
Authors: van Vliet Liesbeth M. , Meijers Maartje C. , van Dulmen Sandra , van der Wall Elsken , Plum Nicole , Stouthard Jacqueline , Francke Anneke L. 
Published: September 2021

AbstractBackgroundThere is a need for more insight into how to address challenges of information-provision for women with advanced breast cancer. We aimed to explore oncologists’ and patients’ views on (i) the challenges of information-provision, and (ii) possible strategies to address these challenges, meanwhile (iii) exploring the possible facilitating role of positive expectations and empathy.MethodsSemi-structured interviews were held with oncologists (n = 10) and women with advanced breast cancer (n = 14). Principles of Thematic Analysis were followed, with two researchers analyzing transcribed data, supported by Atlas.ti software.ResultsTaken together the data from oncologists and patients, we found that when communicating with patients with advanced cancer, oncologists face challenges, including handling patients’ unrealistic disease (status) beliefs, and choosing approaches for discussing available treatment options and their side effects. Possible strategies to address these challenges include balancing information with acceptance of denial, and using medical expertise to guide treatment discussions. A sensitive issue is whether to discuss the option of no anti-cancer treatment. Meanwhile, approaches and preferences for discussions of side effects vary. Positive expectations and empathy can facilitate information-provision by creating space and helping patients to open up more.ConclusionsIntegrating oncologists’ and patients’ views, oncologists can provide realistic information while also, temporarily, accepting denial, and can use their medical expertise to address challenges around unrealistic beliefs and discussion of treatment options. Finding ways to tailor discussions of no anti-cancer treatment and side-effect information are needed. Positive expectations and empathy might facilitate – tailored – information-provision, leading ultimately to patient-centered care lying at the heart of medicine.
Home care workers’ experiences of work conditions related to their occupational health: a qualitative study
Authors: Grasmo Sunniva Grønoset , Liaset Ingeborg Frostad , Redzovic Skender Elez 
Published: September 2021

Abstract
Background
The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing.

Methods
A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors.

Results
HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users’ homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting.

Conclusions
This study suggests that unpredictable working conditions at users’ home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users’ homes, HCWs’ perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.
Factors to improve quality for older patients in the emergency department: a qualitative study of patient trajectory
Authors: De Brauwer Isabelle , Cornette Pascale , D’Hoore William , Lorant Vincent , Verschuren Franck , Thys Frédéric , Aujoulat Isabelle 
Published: September 2021

AbstractBackgroundManaging older people in the emergency department remains a challenge. We aimed to identify the factors influencing the care quality of older patients in the emergency department, to fine-tune future interventions for older people, considering the naturalistic context of the ED.MethodsThis is a qualitative study of some 450 h of observations performed in three emergency departments selected for their diverse contexts. We performed seventy observations of older patient trajectories admitted to the emergency department. Themes were extracted from the material using an inductive reasoning approach, to highlight factors positively or negatively influencing management of patient’s trajectories, in particular those presenting with typically geriatric syndromes.ResultsFour themes were developed: no geriatric flow routine; risk of discontinuity of care; unmet basic needs and patient-centered care; complex older patients are unwelcome in EDs.ConclusionsThe overall process of care was based on an organ- and flow-centered paradigm, which ignored older people’s specific needs and exposed them to discontinuity of care. Their basic needs were neglected and, when their management slowed the emergency department flow, older people were perceived as unwelcome. Findings of our study can inform the development of interventions about the influence of context and organizational factors.
Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study
Authors: Heikkala Eveliina , Mikkola Ilona , Jokelainen Jari , Timonen Markku , Hagnäs Maria 
Published: September 2021

Abstract
Background
Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP).

Methods
The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets.

Results
Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72).

Conclusions
Multimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.