bluuebunny/crossref_metadata_2025_split huggingface dataset:
Linking morphology, performance, and habitat utilization: adaptation across biologically relevant ‘levels’ in tamarins
Authors: Berles Patricia , Wölfer Jan , Alfieri Fabio , Botton-Divet Léo , Guéry Jean-Pascal , Nyakatura John A. 
Published: February 2024

Abstract
Background
Biological adaptation manifests itself at the interface of different biologically relevant ‘levels’, such as ecology, performance, and morphology. Integrated studies at this interface are scarce due to practical difficulties in study design. We present a multilevel analysis, in which we combine evidence from habitat utilization, leaping performance and limb bone morphology of four species of tamarins to elucidate correlations between these ‘levels’.

Results
We conducted studies of leaping behavior in the field and in a naturalistic park and found significant differences in support use and leaping performance. Leontocebus nigrifrons leaps primarily on vertical, inflexible supports, with vertical body postures, and covers greater leaping distances on average. In contrast, Saguinus midas and S. imperator use vertical and horizontal supports for leaping with a relatively similar frequency. S. mystax is similar to S. midas and S. imperator in the use of supports, but covers greater leaping distances on average, which are nevertheless shorter than those of L. nigrifrons.
We assumed these differences to be reflected in the locomotor morphology, too, and compared various morphological features of the long bones of the limbs. According to our performance and habitat utilization data, we expected the long bone morphology of L. nigrifrons to reflect the largest potential for joint torque generation and stress resistance, because we assume longer leaps on vertical supports to exert larger forces on the bones. For S. mystax, based on our performance data, we expected the potential for torque generation to be intermediate between L. nigrifrons and the other two Saguinus species. Surprisingly, we found S. midas and S. imperator having relatively more robust morphological structures as well as relatively larger muscle in-levers, and thus appearing better adapted to the stresses involved in leaping than the other two.

Conclusion
This study demonstrates the complex ways in which behavioral and morphological ‘levels’ map onto each other, cautioning against oversimplification of ecological profiles when using large interspecific eco-morphological studies to make adaptive evolutionary inferences.
Integrated metabolomic and transcriptomic dynamic profiles of endopleura coloration during fruit maturation in three walnut cultivars
Authors: Liu Hengzhao , Zhou Huijuan , Ye Hang , Gen Fangdong , Lei Mengfan , Li Jinhan , Wei Wenjun , Liu Zhanlin , Hou Na , Zhao Peng 
Published: February 2024

Abstract
Background
The color of endopleura is a vital factor in determining the economic value and aesthetics appeal of nut. Walnuts (Juglans) are a key source of edible nuts, high in proteins, amino acids, lipids, carbohydrates. Walnut had a variety endopleura color as yellow, red, and purple. However, the regulation of walnut endopleura color remains little known.

Results
To understand the process of coloration in endopleura, we performed the integrative analysis of transcriptomes and metabolomes at two developmental stages of walnut endopleura. We obtained total of 4,950 differentially expressed genes (DEGs) and 794 metabolites from walnut endopleura, which are involved in flavonoid and phenolic biosynthesis pathways. The enrichment analysis revealed that the cinnamic acid, coniferyl alcohol, naringenin, and naringenin-7-O-glucoside were important metabolites in the development process of walnut endopleura. Transcriptome and metabolome analyses revealed that the DEGs and differentially regulated metabolites (DRMs) were significantly enriched in flavonoid biosynthesis and phenolic metabolic pathways. Through co-expression analysis, CHS (chalcone synthase), CHI (chalcone isomerase), CCR (cinnamoyl CoA reductase), CAD (cinnamyl alcohol dehydrogenase), COMT (catechol-Omethyl transferase), and 4CL (4-coumaroyl: CoA-ligase) may be the key genes that potentially regulate walnut endopleura color in flavonoid biosynthesis and phenolic metabolic pathways.

Conclusions
This study illuminates the metabolic pathways and candidate genes that underlie the endopleura coloration in walnuts, lay the foundation for further study and provides insights into controlling nut’s colour.
Emergency physician personnel crisis: a survey on attitudes of new generations in Slovenia
Authors: Petravić Luka , Bajec Boštjan , Burger Evgenija , Tiefengraber Eva , Slavec Ana , Strnad Matej 
Published: February 2024

Abstract
Background
Emergency departments globally are overburdened, and emergency medicine residency is losing popularity among students and physicians. This raises concerns about the collapse of a life-saving system. Our goal was to identify the key workforce reasoning and question medical staff employment behavior.

Methods
This was a prospective cross-sectional study. In December 2022, medical students and pre-residency doctors in Slovenia were invited to complete a web-based questionnaire. The data were analyzed using T-test, chi-square test, Mann‒Whitney-Wilcoxon tests, and principal component analysis. Open-ended questions were hand-categorized.

Results
There were 686 participatns who clicked on the first page and 436 of those finished the survey. 4% of participants gave a clear positive response, while 11% responded positively regarding their decision to pursue emergency medicine residency. The popularity of emergency medicine decreases significantly among recent medical school graduates upon their initial employment. People who choose emergency medicine are less concerned about its complexity and pressure compared to others. Most respondents preferred 12-hour shift lengths. The preferred base salary range for residents was I$ 3623–4529, and for specialists, it was I$ 5435–6341. The sample’s primary personal priorities are achieving a satisfactory work-life balance, earning respect from colleagues, and engaging in academic activities. Factors that attract individuals to choose emergency medicine include high hourly wages, establishment of standards and norms, and reduced working hours.

Conclusions
Our findings indicate that enhancing compensation, establishing achievable standards and norms, facilitating a beneficial work-life equilibrium, providing assistance with initial property acquisition, stimulating participation in deficit residency programs, fostering collegiality among peers, restricting the duration of shifts, and enabling pension accrual may be imperative in attracting more individuals to pursue emergency medicine residency.
Healthcare risk stratification model for emergency departments based on drugs, income and comorbidities: the DICER-score
Authors: Ruiz-Ramos Jesús , Vela Emili , Monterde David , Blazquez-Andion Marta , Puig-Campmany Mireia , Piera-Jiménez Jordi , Carot Gerard , Juanes-Borrego Ana María 
Published: February 2024

Abstract
Background
During the last decade, the progressive increase in age and associated chronic comorbidities and polypharmacy. However, assessments of the risk of emergency department (ED) revisiting published to date often neglect patients’ pharmacotherapy plans, thus overseeing the Drug-related problems (DRP) risks associated with the therapy burden. The aim of this study is to develop a predictive model for ED revisit, hospital admission, and mortality based on patient’s characteristics and pharmacotherapy.

Methods
Retrospective cohort study including adult patients visited in the ED (triage 1, 2, or 3) of multiple hospitals in Catalonia (Spain) during 2019. The primary endpoint was a composite of ED visits, hospital admission, or mortality 30 days after ED discharge. The study population was randomly split into a model development (60%) and validation (40%) datasets. The model included age, sex, income level, comorbidity burden, measured with the Adjusted Morbidity Groups (GMA), and number of medications. Forty-four medication groups, associated with medication-related health problems, were assessed using ATC codes. To assess the performance of the different variables, logistic regression was used to build multivariate models for ED revisits. The models were created using a “stepwise-forward” approach based on the Bayesian Information Criterion (BIC). Area under the curve of the receiving operating characteristics (AUCROC) curve for the primary endpoint was calculated.

Results
851.649 patients were included; 134.560 (15.8%) revisited the ED within 30 days from discharge, 15.2% were hospitalized and 9.1% died within 30 days from discharge. Four factors (sex, age, GMA, and income level) and 30 ATC groups were identified as risk factors and combined into a final score. The model showed an AUCROC values of 0.720 (95%CI:0.718–0.721) in the development cohort and 0.719 (95%CI.0.717–0.721) in the validation cohort. Three risk categories were generated, with the following scores and estimated risks: low risk: 18.3%; intermediate risk: 40.0%; and high risk: 62.6%.

Conclusion
The DICER score allows identifying patients at high risk for ED revisit within 30 days based on sociodemographic, clinical, and pharmacotherapeutic characteristics, being a valuable tool to prioritize interventions on discharge.
Histoplasmosis peritonitis in an immunocompetent patient: case report
Authors: Jaugey Thomas , Schneider Michael , Bellini Cristina , Yerly Stephane , Sotiriadis Charalampos , Pezzetta Edgardo 
Published: February 2024

AbstractHistoplasmosis is a fungal infection most frequently seen in immunocompromised patients. It is endemic in Central and South America and in Africa. The infection is usually asymptomatic in a healthy individual. Extrapulmonary dissemination can be seen in immunocompromised hosts. Gastrointestinal manifestations frequently involve the terminal ileum and cecum, mimicking Crohn’s disease or malignancy. We describe the case of a 36-year-old healthy man from Cameroon, living in Switzerland for 13 years and without any medical nor surgical history, who presented peritonitis not responding to antibiotics. CT-scan showed bowel obstruction and signs of peritonitis. We opted for an explorative laparoscopy, which was converted to laparotomy with extensive adhesiolysis. Diagnostic of histoplasmosis was confirmed by histology and PCR analysis on biopsy. To our knowledge, this is the first described case of peritonitis as main outcome of a disseminated histoplasmosis involving the peritoneum in an immunocompetent patient.
Correlation between a low serum free triiodothyronine level and mortality of severe pulmonary tuberculosis patients
Authors: Yang Yan , Huang Xiaoqing 
Published: February 2024

Abstract
Background
This study aimed to assess the relationship between a low serum free triiodothyronine (FT3) level and the mortality of severe pulmonary tuberculosis (TB) patients.

Methods
We performed a retrospective study and reviewed the medical records of patients with severe pulmonary TB between January 2016 and June 2022. The patient demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, survival or death at 28 and 90 days after hospital admission, and serum FT3 level were recorded. Bivariate regression analysis was performed to study the relationship between mortality and the FT3 level. The Kaplan–Meier method and the log-rank test were used to compare the survival rates between patients with different serum FT3 levels.

Results
Our study included 495 severe pulmonary TB patients, with 383 (77.4%) patients having a low serum FT3 level. The low-serum FT3 group had high 28-day and 90-day mortalities. The patients who had died by 28 or 90 days after hospital admission had a low FT3 level. Survival analysis showed that the patients with a low serum FT3 level had a low probability of survival at 28 days and at 90 days after hospital admission.

Conclusion
The serum FT3 level was correlated with the 28-day and 90-day mortalities in patients with severe pulmonary TB. The serum FT3 level should be monitored in these patients to help manage their disease.
Large-scale analysis of interobserver agreement and reliability in cardiotocography interpretation during labor using an online tool
Authors: Ben M’Barek Imane , Ben M’Barek Badr , Jauvion Grégoire , Holmström Emilia , Agman Antoine , Merrer Jade , Ceccaldi Pierre-François 
Published: February 2024

Abstract
Background
While the effectiveness of cardiotocography in reducing neonatal morbidity is still debated, it remains the primary method for assessing fetal well-being during labor. Evaluating how accurately professionals interpret cardiotocography signals is essential for its effective use. The objective was to evaluate the accuracy of fetal hypoxia prediction by practitioners through the interpretation of cardiotocography signals and clinical variables during labor.

Material and methods
We conducted a cross-sectional online survey, involving 120 obstetric healthcare providers from several countries. One hundred cases, including fifty cases of fetal hypoxia, were randomly assigned to participants who were invited to predict the fetal outcome (binary criterion of pH with a threshold of 7.15) based on the cardiotocography signals and clinical variables. After describing the participants, we calculated (with a 95% confidence interval) the success rate, sensitivity and specificity to predict the fetal outcome for the whole population and according to pH ranges, professional groups and number of years of experience. Interobserver agreement and reliability were evaluated using the proportion of agreement and Cohen’s kappa respectively.

Results
The overall ability to predict a pH level below 7.15 yielded a success rate of 0.58 (95% CI 0.56-0.60), a sensitivity of 0.58 (95% CI 0.56-0.60) and a specificity of 0.63 (95% CI 0.61-0.65). No significant difference in the success rates was observed with respect to profession and number of years of experience. The success rate was higher for the cases with a pH level below 7.05 (0.69) and above 7.20 (0.66) compared to those falling between 7.05 and 7.20 (0.48). The proportion of agreement between participants was good (0.82), with an overall kappa coefficient indicating substantial reliability (0.63).

Conclusions
The use of an online tool enabled us to collect a large amount of data to analyze how practitioners interpret cardiotocography data during labor. Despite a good level of agreement and reliability among practitioners, the overall accuracy is poor, particularly for cases with a neonatal pH between 7.05 and 7.20. Factors such as profession and experience level do not present notable impact on the accuracy of the annotations. The implementation and use of a computerized cardiotocography analysis software has the potential to enhance the accuracy to detect fetal hypoxia, especially for ambiguous cardiotocography tracings.
Analyzing socio-environmental determinants of bone and soft tissue cancer in Indonesia
Authors: Romadhon Yusuf Alam , Kurniati Yuni Prastyo , Jumadi Jumadi , Alesheikh Ali Asghar , Lotfata Aynaz 
Published: February 2024

Abstract
Background
This study is designed to explore the potential impact of individual and environmental residential factors as risk determinants for bone and soft tissue cancers, with a particular focus on the Indonesian context. While it is widely recognized that our living environment can significantly influence cancer development, there has been a notable scarcity of research into how specific living environment characteristics relate to the risk of bone and soft tissue cancers.

Methods
In a cross-sectional study, we analyzed the medical records of oncology patients treated at Prof. Suharso National Referral Orthopedic Hospital. The study aimed to assess tumor malignancy levels and explore the relationships with socio-environmental variables, including gender, distance from the sea, sunrise time, altitude, and population density. Data were gathered in 2020 from diverse sources, including medical records, Google Earth, and local statistical centers. The statistical analyses employed Chi-square and logistic regression techniques with the support of Predictive Analytics SoftWare (PASW) Statistics 18.

Results
Both bivariate and multivariate analyses revealed two significant factors associated with the occurrence of bone and soft tissue cancer. Age exhibited a statistically significant influence (OR of 5.345 and a p-value of 0.000 < 0.05), indicating a robust connection between cancer development and age. Additionally, residing within a distance of less than 14 km from the sea significantly affected the likelihood of bone and soft tissue cancers OR 5.604 and p-value (0.001 < 0.05).

Conclusions
The study underscores the strong association between age and the development of these cancers, emphasizing the need for heightened vigilance and screening measures in older populations. Moreover, proximity to the sea emerges as another noteworthy factor influencing cancer risk, suggesting potential environmental factors at play. These results highlight the multifaceted nature of cancer causation and underscore the importance of considering socio-environmental variables when assessing cancer risk factors. Such insights can inform more targeted prevention and early detection strategies, ultimately contributing to improved cancer management and patient outcomes.
The distribution characteristics of strabismus surgery types in a tertiary hospital in the Central Plains region during the COVID-19 epidemic
Authors: Lang Lijuan , Guo Kexin , Zhang Luxi , Zhang Jiong , Liu Yujie , Rong Junbo , Xu Limin , Li Zhigang 
Published: February 2024

Abstract
Objective
This study aimed to analyze the distribution of different types of strabismus surgery in a tertiary hospital in Central China during the three-year period of the COVID-19 pandemic.

Methods
A retrospective analysis was conducted on the clinical data of strabismus patients who underwent surgery and were admitted to the Department of Strabismus and Pediatric Ophthalmology at the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2022.

Results
A total of 3939 strabismus surgery patients were collected, including 1357 in 2020, 1451 in 2021, and 1131 in 2022. The number of surgeries decreased significantly in February 2020, August 2021, and November and December 2022. Patients aged 0–6 years accounted for 37% of the total number of strabismus surgery patientsr. The majority (60%) of all strabismus surgery patients were diagnosed with exotropia, with intermittent exotropia accounting for the highest proportion (53%). There was no statistically significant difference in the proportion of intermittent exotropia and constant exotropia during the three-year period (χ2 = 2.642, P = 0.267 and χ2 = 3.012, P = 0.221, respectively). Among patients with intermittent exotropia, insufficient convergence type was the most common form of strabismus (accounting for over 70%). Non-accommodative esotropia accounted for more than 50% of all internal strabismus cases.

Conclusion
During the period from 2020 to 2022, the total number of strabismus surgeries in our hospital did not show significant fluctuations, but there was a noticeable decrease in the number of surgeries during months affected by the pandemic. Exotropia accounted for the highest proportion among strabismus surgery patients. Intermittent exotropia was the most common type among patients undergoing surgery for exotropia, and the most prevalent subtype was the insufficient convergence type. The age distribution of patients varied in different months, with a concentration of surgeries for strabismus patients in the 7–12 years old age group during the months of July and August each year.
Knowledge, attitude, and practices of parents regarding the red flags of developmental milestones in children aged 0–5 years in Karachi, Pakistan: a cross-sectional study
Authors: Kumar Raman , Ali Malaika , Pasha Muhammad Saad , Ansari Haya Waseem , Durrani Noureen 
Published: February 2024

AbstractBackgroundDevelopmental delays in children are assessed in four basic domains: gross motor, fine motor, social, and language. Early years of life are crucial in a child’s development, so it is imperative that parents be aware of developmental milestones to facilitate early diagnosis and treatment in case of a developmental delay. This study assessed parental knowledge, attitude, and practices regarding children’s developmental milestones and associated “red flags”.MethodsA cross-sectional study was conducted at the Department of Pediatrics at Liaquat National Hospital, Karachi. 390 parents, who had at least one child under 5 years of age, with no diagnosed developmental delay, were interviewed during outpatient clinic visits. The questionnaire consisted of three components to assess parental knowledge, attitude, and practices.Results59% and 54% of parents had poor knowledge of gross and fine motor milestones respectively; In the social domain, 56% of the respondents had inadequate knowledge. 42% had inadequate knowledge of language milestones; 29% of parents strongly agreed that their pediatricians provide satisfactory information regarding red flags of developmental milestones. 60% of parents strongly agreed that their child’s developmental delay would be a cause of concern for them. In the case of developmental delay, 55% of parents said they would consult a general pediatrician, 11% preferred a pediatric neurologist, 21% opted for a developmental pediatrician and 13% opted for a family physician. Residence and family systems were found to be associated with language-related milestones with significantly higher odds of knowledge among urban residents than rural ones and a significantly lower likelihood of language milestones knowledge among joint families than nuclear families. Female gender was found to be significantly associated with positive attitude.ConclusionThe majority of our respondents showed considerably poor knowledge regarding developmental milestones. This highlights the need to devise ways to educate parents on this subject to enable them to vigilantly monitor their child’s developmental status and any associated abnormalities and ultimately facilitate the right course of action.