bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation and Psychometric Evaluation of Diabetes Literacy, Numeracy, and Knowledge Tools in the Arabic Context
Authors: Hasan Sanah , Alzubaidi Hamzah , Samorinha Catarina , Al Radhaideh Ahmed 
Published: October 2023

Purpose: The purpose of this study was to validate the Literacy Assessment for Diabetes (LAD), the Diabetes Numeracy Test (DNT), and the Simplified Diabetes Knowledge Test (DKT) in the Arabic language and context. Methods: Three hundred eighty four, ≥18-year-old patients with type 1, type 2, or gestational diabetes mellitus were recruited from 3 endocrinology clinics in the United Arab Emirates. Exploratory factor analysis using principal component was performed. Achieved scores were compared using Pearson bivariate correlation. Results: All 60 LAD items loaded on 1 factor accounting for 66.7% of the variance, with internal consistency α = .991. Average score = 68.7%. Nineteen out of 26 items were retained on the DNT and grouped into 4 factors, prescription reading and directions, proper dose coverage, nutrition, and insulin, with good internal consistency (α = .721). Average score = 73.2%. All 20 DKT items loaded on 3 factors accounting for 41.2% of the variance, causes and consequences of the high blood sugar level, prevention of the disease, and misconceptions about diabetes self-management, with good internal consistency (α = .799). Average score = 71.9%. A moderate and significant correlation between the DKT and DNT ( r = .56, P < .001) was observed. Conclusions: Three tools to assess diabetes literacy, numeracy, and knowledge were psychometrically tested to establish their validity and reliability in the Arabic language and context. The tools could be used to assess patient skills and competence in navigating the health care system and managing their diabetes.
Hydrogen sulfide priming enhanced salinity tolerance in sunflower by modulating ion hemostasis, cellular redox balance, and gene expression
Authors: Younis Abeer Abdelrazk , Mansour Mohamed Magdy F. 
Published: October 2023

Abstract
Background
The salinity threat represents an environmental challenge that drastically affects plant growth and yield. Besides salinity stress, the escalating world population will greatly influence the world’s food security in the future. Therefore, searching for effective strategies to improve crop salinity resilience and sustain agricultural productivity under high salinity is a must. Seed priming is a reliable, simple, low-risk, and low-cost technique. Therefore, this work aimed to evaluate the impact of seed priming with 0.5 mM NaHS, as a donor of H2S, in mitigating salinity effects on sunflower seedlings. Primed and nonprime seeds were established in nonsaline soil irrigated with tape water for 14 d, and then exposed to 150 mM NaCl for 7 d.

Results
Salinity stress significantly reduced the seedling growth, biomass accumulation, K+, Ca2+, and salinity tolerance index while elevating Na+ uptake and translocation. Salinity-induced adverse effects were significantly alleviated by H2S priming. Upregulation in gene expression (HaSOS2, HaGST) under NaCl stress was further enhanced by H2S priming. Also, H2S reduced lipid peroxidation, electrolyte leakage, and H2O2 content, but elevated the antioxidant defense system. NaCl-induced levels of ascorbate, glutathione, and α tocopherol, as well as the activities of AsA-GSH cycle enzymes: ascorbate peroxidase, monodehydroascorbate reductase, dehydroascorbate reductase, glutathione reductase, and glutathione S-transferase, were further enhanced by H2S priming. Increased level of H2S and total thiol by NaCl was also further stimulated by H2S priming.

Conclusion
H2S priming has proved to be an efficient strategy to improve sunflower seedlings’ salinity tolerance by retaining ion homeostasis, detoxifying oxidative damage, modulating gene expression involved in ion homeostasis and ROS scavenging, and boosting endogenous H2S. These findings suggested that H2S acts as a regulatory molecule activating the functional processes responsible for sunflower adaptive mechanisms and could be adopted as a crucial crop management strategy to combat saline conditions. However, it would be of great interest to conduct further studies in the natural saline field to broaden our understanding of crop adaptive mechanisms and to support our claims.
Prevalence and predictors of acute respiratory infection among children under-five years in Tigray regional state, northern Ethiopia: a cross sectional study
Authors: Gebrerufael Gebru Gebremeskel , Hagos Bsrat Tesfay 
Published: October 2023

Abstract
Background
Acute respiratory infection is still one of the leading causes of child morbidity and mortality worldwide. Developing countries, especially in Sub-Saharan Africa including Ethiopia continue to share an overburden of this infection. Studies showed that different predictor factors were associated with the occurrence of childhood acute respiratory infection. Therefore, the main aim of this study was to assess the prevalence and associated predictor factors of acute respiratory infection among children under-five years in the Tigray Regional State, northern Ethiopia.

Methods
A retrospective cross-sectional study design was done from January 18, 2016, to June 27, 2016. A total of 986 children under-five years were selected for this study. The logistic regression model analysis was employed to examine the predictor factors of childhood acute respiratory infection. Both bi-variable and multivariable data analysis was performed using STATA version 14.0.

Results
Overall, the study showed that the two weeks prevalence of acute respiratory infection among children under-five years was 16.10% [95%CI: 13.80–18.40]. According to the multivariable logistic regression model analysis, children aged (24–60) months (AOR: 0.59, 95%CI: 0.352–0.98), rich wealth index of households (AOR: 0.60, 95%CI: 0.378–0.959), diarrhea status of children (AOR: 3, 95%CI: 1.97–4.73), and mothers smoking cigarettes (AOR: 4, 95%CI: 1.15–16.50), were significant predictors of acute respiratory infection.

Conclusion
The prevalence of ARI displays that Tigray regional state was experiencing a higher ARI rate than the national level. The current study identified the low wealth index of households, children aged (24–60 months), mothers smoking cigarettes, and diarrhea status of the children as crucial predictor factors for ARI. Interventions should be improved to these modifiable major predictor factors that significantly decrease the ARI problem among under-five children.
Trends in sexually transmitted and blood-borne infections in China from 2005 to 2021: a joinpoint regression model
Authors: Wang Shuyuan , Chen Jialu , Li Yuansheng , Zhang Beibei , Li Xiang , Han Ying , Zhang Junhui 
Published: October 2023

Abstract
Background
Sexually transmitted and blood-borne infections (STBBIs) is a major public health concern in China. This study assessed the overall trends in STBBIs to improve the comprehensive understanding of the burden of STBBIs and provide evidence for their prevention and control.

Methods
Data for the period from 2005 to 2021 were analyzed across China on infections with hepatitis B or C; syphilis; gonorrhea; and HIV infection. Trends, annual percent change (APC), and average annual percent change (AAPC) in diagnosis rate was analyzed using joinpoint regression models for the five STBBIs together or individually.

Results
From 2005 to 2021, the overall diagnosis rate of all five STBBIs increased, with an AAPC of 1.3% [95% confidence interval (CI) -0.5% to 3.1%]. Diagnosis rates of HIV, syphilis and hepatitis C increased individually, but it decreased for infections of hepatitis B and gonorrhea. Joinpoint analysis identified four phases in diagnosis rate of hepatitis C; three phases in diagnosis rate of hepatitis B, HIV infection, and syphilis; two in diagnosis rate of gonorrhea infection.

Conclusion
Despite national efforts to prevent and control STBBIs, their overall diagnosis rate has continued to rise in China, and they remain an important public health challenge. Further efforts should be made to educate the general population about STBBIs, particularly HIV. Interventions targeting vulnerable groups should be adopted and their efficacy monitored through regular analysis of trends.
Brain tumor image segmentation based on improved FPN
Authors: Sun Haitao , Yang Shuai , Chen Lijuan , Liao Pingyan , Liu Xiangping , Liu Ying , Wang Ning 
Published: October 2023

Abstract
Purpose
Automatic segmentation of brain tumors by deep learning algorithm is one of the research hotspots in the field of medical image segmentation. An improved FPN network for brain tumor segmentation is proposed to improve the segmentation effect of brain tumor.

Materials and methods
Aiming at the problem that the traditional full convolutional neural network (FCN) has weak processing ability, which leads to the loss of details in tumor segmentation, this paper proposes a brain tumor image segmentation method based on the improved feature pyramid networks (FPN) convolutional neural network. In order to improve the segmentation effect of brain tumors, we improved the model, introduced the FPN structure into the U-Net structure, captured the context multi-scale information by using the different scale information in the U-Net model and the multi receptive field high-level features in the FPN convolutional neural network, and improved the adaptability of the model to different scale features.

Results
Performance evaluation indicators show that the proposed improved FPN model has 99.1% accuracy, 92% DICE rating and 86% Jaccard index. The performance of the proposed method outperforms other segmentation models in each metric. In addition, the schematic diagram of the segmentation results shows that the segmentation results of our algorithm are closer to the ground truth, showing more brain tumour details, while the segmentation results of other algorithms are smoother.

Conclusions
The experimental results show that this method can effectively segment brain tumor regions and has certain generalization, and the segmentation effect is better than other networks. It has positive significance for clinical diagnosis of brain tumors.
Functional and structural MRI based obsessive-compulsive disorder diagnosis using machine learning methods
Authors: Huang Fang-Fang , Yang Xiang-Yun , Luo Jia , Yang Xiao-Jie , Meng Fan-Qiang , Wang Peng-Chong , Li Zhan-Jiang 
Published: October 2023

Abstract
Background
The success of neuroimaging in revealing neural correlates of obsessive-compulsive disorder (OCD) has raised hopes of using magnetic resonance imaging (MRI) indices to discriminate patients with OCD and the healthy. The aim of this study was to explore MRI based OCD diagnosis using machine learning methods.

Methods
Fifty patients with OCD and fifty healthy subjects were allocated into training and testing set by eight to two. Functional MRI (fMRI) indices, including amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), degree of centrality (DC), and structural MRI (sMRI) indices, including volume of gray matter, cortical thickness and sulcal depth, were extracted in each brain region as features. The features were reduced using least absolute shrinkage and selection operator regression on training set. Diagnosis models based on single MRI index / combined MRI indices were established on training set using support vector machine (SVM), logistic regression and random forest, and validated on testing set.

Results
SVM model based on combined fMRI indices, including ALFF, fALFF, ReHo and DC, achieved the optimal performance, with a cross-validation accuracy of 94%; on testing set, the area under the receiver operating characteristic curve was 0.90 and the validation accuracy was 85%. The selected features were located both within and outside the cortico-striato-thalamo-cortical (CSTC) circuit of OCD. Models based on single MRI index / combined fMRI and sMRI indices underperformed on the classification, with a largest validation accuracy of 75% from SVM model of ALFF on testing set.

Conclusion
SVM model of combined fMRI indices has the greatest potential to discriminate patients with OCD and the healthy, suggesting a complementary effect of fMRI indices on the classification; the features were located within and outside the CSTC circuit, indicating an importance of including various brain regions in the model.
Age at job initiation and risk of coronary heart disease: findings from the UK biobank cohort study
Authors: Zhang Zenghui , Zeng Chuanrui , Chen Zhiteng , Liu Pinming , Gao Jingwei , Guo Qi , Wu Maoxiong , He Wanbing , Gao Qingyuan , Guo Dachuan , Liang Xiaotian , Huang Zegui , Wang Jingfeng , Zhang Haifeng , Chen Yangxin 
Published: October 2023

Abstract
Background
Commencing work at an early age has been linked to various risk factors for coronary heart disease (CHD), such as shift work and intensive job strain. However, the relationship between starting work too early and CHD risk remains largely unclear. We examined the association between age at job initiation and the risk of CHD.

Methods
UK Biobank participants aged 38 to 70 years without cardiovascular disease who provided data on their age at job initiation were included. The primary outcome was CHD, which was ascertained using hospital and death records. The hazard ratios (HRs) and 95% confidence interval (CIs) for the association between age at job initiation and CHD were calculated using multivariable Cox regression.

Results
Of the 501,971 participants, 114,418 eligible participants were included in the final analysis. The median age at job initiation was 19.0 years. During the mean follow-up of 12.6 years, 6,130 (5.4%) first CHD events occurred. We observed that age at job initiation was inversely associated with CHD (HR 0.98, 95% CI 0.97–0.99), and the association was potentially J-shaped. The HRs for the < 17-year, 17–18-year, and 19–21-year age groups were 1.29 (95%CI 1.18–1.41), 1.12 (95% CI 1.03–1.22) and 1.05 (95% CI 0.97–1.14), respectively, compared with those of the ≥ 22-year group.

Conclusions
Age at job initiation was associated with incident CHD, which was independent of socioeconomic status. Participants who commenced employment before the age of 19 years exhibited a higher risk of developing CHD later in adulthood.
Healthcare-seeking of medical students: the effect of socio-demographic factors, health behaviour and health status – a cross-sectional study in Hungary
Authors: Umami Afriza , Zsiros Viktória , Maróti-Nagy Ágnes , Máté Zsuzsanna , Sudalhar Sudalhar , Molnár Regina , Paulik Edit 
Published: October 2023

Abstract
Background
Medical students are more likely to have various physical and psychological issues, but less information is available about the healthcare-seeking behaviour for physical and mental health issues. The aim of this study is to determine the factors affecting medical students’ healthcare-seeking when visiting a general practitioner (GP) and/or psychologist.

Methods
688 medical students (326 International and 362 Hungarian,) participated in a cross-sectional study. The information was gathered using a self-administered online questionnaire and covered socio-demographic background, health behaviour, general and mental health status and healthcare-seeking. For analysing adjusted associations, multivariable logistic regression models were used.

Results
Overall, 56.8% of medical students visit the GP; and 17.2%, the psychologist. Hungarian medical students visited the GP with chronic diseases, International medical students were more likely to visit a GP when they encountered sexual activity and had chronic diseases. Moreover, there was a significant correlation between sex, alcohol consumption, and perceived stress in the total sample of psychologist visits. When Hungarian medical students were in their clinical years and had a poor self-rated mental health, they were more likely to visit a psychologist. Whereas female international medical students and those who had poor self-rated mental health were more likely to seek psychological help.

Conclusion
Students visit a GP and/or psychologist is associated with a variety of factors, including socio-demographic background, health behaviours, and health issues. Medical schools should encourage help-seeking behaviours and early disclosure of medical students. Their ability to grasp healthcare attitudes and designing treatments will be important for both their academic success and future profession.
Evaluation of the nutrition literacy assessment questionnaire for college students and identification of the influencing factors of their nutrition literacy
Authors: Yan Wang , Caihong Hu , Xuefeng Yang , Jiayu Zhang 
Published: October 2023

Abstract
Background
Nutrition health has become a major public health issue in both high and middle-income countries. Nutrition literacy is an important indicator to evaluate the effect of public health intervention and one of the important concepts in health promotion. Thus, this study aimed to verify the reliability and validity of a nutrition literacy assessment questionnaire (NLAQ) and investigate the associated factors of nutrition literacy among college students.

Methods
We conducted a cross-sectional online survey of college students from April to November 2022 in Wuhan (N = 774). We employed the Cronbach’s alpha coefficient, exploratory and confirmatory factor analysis to evaluate the reliability and validity. We used latent profile analysis to classify the nutrition literacy. We conducted Chi-square test and binary logistic regression to identify the influencing factors.

Results
The Cronbach’s alpha coefficient of the NLAQ and its dimension was ranging from 0.837 to 0.909. The common factors were consistent with the original dimensions. All indicators met the requirements (χ2/df = 6.16 < 8, GFI = 0.929, NFI = 0.939, CFI = 0.948, RMSEA = 0.082 < 0.1). College students’ disciplines (χ2 = 7.769, P = 0.021), mothers’ education level (χ2 = 26.599, P < 0.001), and fathers’ occupation type (χ2 = 11.218, P = 0.024) had impacts on nutrition literacy.

Conclusion
The NLAQ has good reliability and validity, and could be used as a measurement tool to evaluate college students’ nutrition literacy. Schools and families should take targeted measures to improve the college students’ nutrition literacy.
Phase transformation and mechanical properties of heat-treated nickel-titanium rotary endodontic instruments at room and body temperatures
Authors: Kasuga Yuka , Kimura Shunsuke , Maki Keiichiro , Unno Hayate , Omori Satoshi , Hirano Keiko , Ebihara Arata , Okiji Takashi 
Published: October 2023

AbstractBackgroundThe aim of this study was to evaluate the phase composition, phase transformation temperatures, bending property, and cyclic fatigue resistance of different heat-treated nickel-titanium (NiTi) rotary instruments with the same tip diameter and taper at room (RT; 25 ± 1 °C) and body (BT; 37 ± 1 °C) temperatures.MethodsFive heat-treated NiTi rotary instruments, HyFlex EDM (EDM), HyFlex CM (CM), Vortex Blue (VB), RE file CT (RE) and JIZAI, and a non-heat-treated NiTi rotary instrument (Mtwo) with a size 40, 0.04 taper were investigated. Temperature-dependent phase transformation was examined with differential scanning calorimetry (DSC). The bending loads of the instruments at RT and BT were evaluated using a cantilever-bending test. Cyclic fatigue resistance at RT and BT was measured using a dynamic test, during which the instruments were rotated in combination with a 2-mm back-and-forth motion in an artificial curved canal, and the number of cycles to failure (NCF) was determined. The results were analyzed using two-way repeated measures analysis of variance, a simple main effect test, and the Bonferroni test (α = 0.05).ResultsDSC results indicated that EDM and Mtwo were primarily composed of martensite/R-phase and austenite, respectively, while the other heat-treated instruments were composed of a mix of martensite/R-phase and austenite at the tested temperatures. Regardless of the temperature setting, the bending loads of heat-treated instruments were significantly lower than those of Mtwo (p < 0.05). EDM showed the lowest bending loads and highest NCF at both temperatures (p < 0.05). CM, VB, and JIZAI showed significantly higher bending loads at BT than at RT (p < 0.05). The NCF of all the heat-treated instruments, except VB, was lower at BT than at RT (p < 0.05). At BT, the NCF of CM, VB, RE, and JIZAI were not significantly higher than that of Mtwo (p > 0.05).ConclusionsHeat-treated NiTi instruments exhibited lower bending loads and higher NCF values than Mtwo. However, this tendency was less pronounced at BT than at RT, especially in the NCF values of instruments with a mixture of martensite/R-phase and austenite phases at the tested temperatures.
Clinical feasibility evaluation of a digital workflow of prosthetically oriented onlay bone grafting for horizontal alveolar augmentation: a prospective pilot study
Authors: Tang Yiman , Zhai Shuyong , Yu Huajie , Qiu Lixin 
Published: October 2023

Abstract
Background
Onlay bone grafting is considered highly reliable for reconstructing severe horizontal bone defects. A critical problem is how to achieve precise position of the bone block to control alveolar ridge dimensions. This research aims to establish a digital workflow for prosthetically oriented onlay bone grafting and evaluate its accuracy and efficiency.

Methods
This prospective pilot study investigated eight patients who required implant restoration in the esthetic area with horizontal alveolar bone defects. The workflow includes preoperative virtual planning, design and manufacture of patient-specific templates, bone grafting surgery, and implant insertion. Primary outcomes were graft accuracy, defined by root mean square estimate (RMSE) values between preoperatively designed and actual implanted outer contours of bone blocks. Secondary outcomes were bone graft and implant success rates. Besides, the surgeons used the visual analog scale (VAS) to rate the intuitiveness, ease of understanding, and helpfulness of the workflow.

Results
No bone grafts or implants failed in any of the eight patients, resulting in a 100% success rate. The RMSE values between the preoperative design and the implanted outer contour of bone blocks were 0.41 ± 0.15 mm. The digital approach showed advantages in intuitiveness (9.3 ± 0.5), understanding (9.0 ± 0.5), and helpfulness (8.4 ± 1.1) according to surgeons' VAS scores.

Conclusions
A digital workflow provided encouraging results, in terms of accuracy and efficacy, for horizontal bone augmentation.

Trial registration
This study was registered in the National Clinical Trials Registry in 16/02/2023 under the identification number ChiCTR2300068361.