bluuebunny/crossref_metadata_2025_split huggingface dataset:
Burnout, grit and resilience among Jordanian orthopedic surgeons: a cross-sectional study
Authors: Hamdan Mohammad , Haddad Bassem I. , Alshrouf Mohammad Ali , Al-Ani Abdallah , Alisi Mohammed S , Hammad Yazan , Alelaumi Ahmad , Al Hawamdeh Hashem , Halaweh Ahmad Abu , Alshabatat Lara , Kawasmi Sanad 
Published: August 2023

Abstract
Background
Burnout is a serious issue that affects physicians more than the general population; however, those with higher levels of grit and resilience have been shown to experience lower levels of burnout. The primary aim was to determine the prevalence of burnout among Jordanian orthopedic surgeons, explore its risk factors, and investigate the relationship between burnout and grit and resilience.

Methods
We conducted a questionnaire-based cross-sectional study targeting a total of 180 orthopedic surgeons attending the yearly Jordanian National Orthopedic Conference (JNOC). Non-random sampling (i.e., convenience) was utilized to recruit participants. The abbreviated Maslach Burnout Inventory, short grit scale, and Connor-Davidson Resilience Scale were used. Scores were examined using the Mann–Whitney U, Kruskal–Wallis H, and Spearman’s rho tests, of which results were corrected using the Bonferroni method.

Results
Among 135 respondents, 62.2% were specialists and 37.8% were residents. About 52.0% practiced in public hospitals. Approximately 69.0% worked for more than 50 h weekly. The prevalence of burnout among all participants was 45.2% with more frequency among residents (66.7%). Burnout and the participants’ grit and resilience showed an inverse relationship (ρ = -0.441 and ρ = -0.312, respectively). Age (ρ = 0.337), number of children (ρ = 0.245), and years of experience (ρ = 0.331) were positively correlated with grit. The median score for grit was higher in physicians who had or are having their residency outside Jordan (p < 0.001). Age (ρ = 0.233) and years of experience (ρ = 0.269) were positively correlated with resilience.

Conclusion
Jordanian orthopedic surgeons face significant rates of burnout. Institutional efforts should be taken to detect and prevent burnout in addition to enhancing the grit and resilience among orthopedic professionals.
The development of a core outcome set for studies of pregnant women with multimorbidity
Authors: Lee Siang Ing , Hanley Stephanie , Vowles Zoe , Plachcinski Rachel , Moss Ngawai , Singh Megha , Gale Chris , Fagbamigbe Adeniyi Francis , Azcoaga-Lorenzo Amaya , Subramanian Anuradhaa , Taylor Beck , Nelson-Piercy Catherine , Damase-Michel Christine , Yau Christopher , McCowan Colin , O’Reilly Dermot , Santorelli Gillian , Dolk Helen , Hope Holly , Phillips Katherine , Abel Kathryn M. , Eastwood Kelly-Ann , Kent Lisa , Locock Louise , Loane Maria , Mhereeg Mohamed , Brocklehurst Peter , McCann Sharon , Brophy Sinead , Wambua Steven , Hemali Sudasinghe Sudasing Pathirannehelage Buddhika , Thangaratinam Shakila , Nirantharakumar Krishnarajah , Black Mairead ,   on behalf of the MuM-PreDiCT Group
Published: August 2023

Abstract
Background
Heterogeneity in reported outcomes can limit the synthesis of research evidence. A core outcome set informs what outcomes are important and should be measured as a minimum in all future studies. We report the development of a core outcome set applicable to observational and interventional studies of pregnant women with multimorbidity.

Methods
We developed the core outcome set in four stages: (i) a systematic literature search, (ii) three focus groups with UK stakeholders, (iii) two rounds of Delphi surveys with international stakeholders and (iv) two international virtual consensus meetings. Stakeholders included women with multimorbidity and experience of pregnancy in the last 5 years, or are planning a pregnancy, their partners, health or social care professionals and researchers. Study adverts were shared through stakeholder charities and organisations.

Results
Twenty-six studies were included in the systematic literature search (2017 to 2021) reporting 185 outcomes. Thematic analysis of the focus groups added a further 28 outcomes. Two hundred and nine stakeholders completed the first Delphi survey. One hundred and sixteen stakeholders completed the second Delphi survey where 45 outcomes reached Consensus In (≥70% of all participants rating an outcome as Critically Important). Thirteen stakeholders reviewed 15 Borderline outcomes in the first consensus meeting and included seven additional outcomes. Seventeen stakeholders reviewed these 52 outcomes in a second consensus meeting, the threshold was ≥80% of all participants voting for inclusion. The final core outcome set included 11 outcomes. The five maternal outcomes were as follows: maternal death, severe maternal morbidity, change in existing long-term conditions (physical and mental), quality and experience of care and development of new mental health conditions. The six child outcomes were as follows: survival of baby, gestational age at birth, neurodevelopmental conditions/impairment, quality of life, birth weight and separation of baby from mother for health care needs.

Conclusions
Multimorbidity in pregnancy is a new and complex clinical research area. Following a rigorous process, this complexity was meaningfully reduced to a core outcome set that balances the views of a diverse stakeholder group.
An atlas of associations between 14 micronutrients and 22 cancer outcomes: Mendelian randomization analyses
Authors: Kim Jong Yeob , Song Minku , Kim Min Seo , Natarajan Pradeep , Do Ron , Myung Woojae , Won Hong-Hee 
Published: August 2023

Abstract
Background
Micronutrients, namely vitamins and minerals, are associated with cancer outcomes; however, their reported effects have been inconsistent across studies. We aimed to identify the causally estimated effects of micronutrients on cancer by applying the Mendelian randomization (MR) method, using single-nucleotide polymorphisms associated with micronutrient levels as instrumental variables.

Methods
We obtained instrumental variables of 14 genetically predicted micronutrient levels and applied two-sample MR to estimate their causal effects on 22 cancer outcomes from a meta-analysis of the UK Biobank (UKB) and FinnGen cohorts (overall cancer and 21 site-specific cancers, including breast, colorectal, lung, and prostate cancer), in addition to six major cancer outcomes and 20 cancer subset outcomes from cancer consortia. We used sensitivity MR methods, including weighted median, MR-Egger, and MR-PRESSO, to assess potential horizontal pleiotropy or heterogeneity. Genome-wide association summary statistical data of European descent were used for both exposure and outcome data, including up to 940,633 participants of European descent with 133,384 cancer cases.

Results
In total, 672 MR tests (14 micronutrients × 48 cancer outcomes) were performed. The following two associations met Bonferroni significance by the number of associations (P < 0.00016) in the UKB plus FinnGen cohorts: increased risk of breast cancer with magnesium levels (odds ratio [OR] = 1.281 per 1 standard deviation [SD] higher magnesium level, 95% confidence interval [CI] = 1.151 to 1.426, P < 0.0001) and increased risk of colorectal cancer with vitamin B12 level (OR = 1.22 per 1 SD higher vitamin B12 level, 95% CI = 1.107 to 1.345, P < 0.0001). These two associations remained significant in the analysis of the cancer consortia. No significant heterogeneity or horizontal pleiotropy was observed. Micronutrient levels were not associated with overall cancer risk.

Conclusions
Our results may aid clinicians in deciding whether to regulate the intake of certain micronutrients, particularly in high-risk groups without nutritional deficiencies, and may help in the design of future clinical trials.
Mitochondrial impairment and synaptic dysfunction are associated with neurological defects in iPSCs-derived cortical neurons of MERRF patients
Authors: Wu Yu-Ting , Tay Hui-Yi , Yang Jung-Tse , Liao Hsiao-Hui , Ma Yi-Shing , Wei Yau-Huei 
Published: August 2023

Abstract
Background
Myoclonic epilepsy with ragged-red fibers (MERRF) syndrome is a rare inherited mitochondrial disease mainly caused by the m.8344A > G mutation in mitochondrial tRNALys gene, and usually manifested as complex neurological disorders and muscle weakness. Currently, the pathogenic mechanism of this disease has not yet been resolved, and there is no effective therapy for MERRF syndrome. In this study, MERRF patients-derived iPSCs were used to model patient-specific neurons for investigation of the pathogenic mechanism of neurological disorders in mitochondrial disease.

Methods
MERRF patient-derived iPSCs were differentiated into excitatory glutamatergic neurons to unravel the effects of the m.8344A > G mutation on mitochondrial bioenergetic function, neural-lineage differentiation and neuronal function. By the well-established differentiation protocol and electrophysiological activity assay platform, we examined the pathophysiological behaviors in cortical neurons of MERRF patients.

Results
We have successfully established the iPSCs-derived neural progenitor cells and cortical-like neurons of patients with MERRF syndrome that retained the heteroplasmy of the m.8344A > G mutation from the patients’ skin fibroblasts and exhibited the phenotype of the mitochondrial disease. MERRF neural cells harboring the m.8344A > G mutation exhibited impaired mitochondrial bioenergetic function, elevated ROS levels and imbalanced expression of antioxidant enzymes. Our findings indicate that neural immaturity and synaptic protein loss led to the impairment of neuronal activity and plasticity in MERRF neurons harboring the m.8344A > G mutation. By electrophysiological recordings, we monitored the in vivo neuronal behaviors of MERRF neurons and found that neurons harboring a high level of the m.8344A > G mutation exhibited impairment of the spontaneous and evoked potential-stimulated neuronal activities.

Conclusions
We demonstrated for the first time the link of mitochondrial impairment and synaptic dysfunction to neurological defects through impeding synaptic plasticity in excitatory neurons derived from iPSCs of MERRF patients harboring the m.8344A > G mutation. This study has provided new insight into the pathogenic mechanism of the tRNALys gene mutation of mtDNA, which is useful for the development of a patient-specific iPSCs platform for disease modeling and screening of new drugs to treat patients with MERRF syndrome.
Sodium pyruvate exerts protective effects against cigarette smoke extract-induced ferroptosis in alveolar and bronchial epithelial cells through the GPX4/Nrf2 axis
Authors: Zhao Ziwen , Xu Zhao , Chang Jingwen , He Liwei , Zhang Zijin , Song Xiaoyu , Hou Xianbang , Fan Fangtian , Jiang Zhijun 
Published: August 2023

Abstract

Background
Ferroptosis in alveolar and bronchial epithelial cells is one of the main mechanisms underlying the development of chronic obstructive pulmonary disease (COPD). Sodium pyruvate (NaPyr) is a natural antioxidant in the body, exhibiting anti-inflammatory and antioxidant activities. NaPyr has been used in a Phase II clinical trial as a novel therapy for COPD; however, the mechanism underlying NaPyr-mediated therapeutic benefits in COPD is not well understood.

Objective
We aimed to assess the protective effects of NaPyr and elucidate its potential mechanism in cigarette smoke extract (CSE)-induced ferroptosis.To minic the inflammatory response and ferroptosis triggered by cigarette smoke in COPD in an invitro cell based system, we expose a human bronchial epithelial cells to CSE.

Methods
To minic the inflammatory response and ferroptosis triggered by cigarette smoke in COPD in an invitro cell based system, the A549 (human lung carcinoma epithelial cells) and BEAS-2B (bronchial epithelial cells) cell lines were cultured, followed by treatment with CSE. To measure cellular viability and iron levels, we determined the levels of malondialdehyde (MDA), glutathione (GSH), reactive oxygen species (ROS), mitochondrial superoxide (MitoSOX), membrane potential (MMP), and inflammatory factors (tumor necrosis factor [TNF] and interleukin [IL]-8), and examined CSE-induced pulmonary inflammation and ferroptosis. To clarify the molecular mechanisms of NaPyr in COPD therapy, we performed western blotting and real-time PCR (qPCR) to determine the expression of glutathione peroxidase 4 (GPX4), nuclear factor E2-related factor 2 (Nrf2), and cyclooxygenase 2 (COX2).

Results
We found that NaPyr effectively mitigated CSE-induced apoptosis and improved apoptosis induced by erastin, a ferroptosis inducer. NaPyr significantly decreased iron and MDA levels and increased GSH levels in CSE-induced cells. Furthermore, NaPyr suppressed ferroptosis characteristics, such as decreased levels of ROS, MitoSOX, and MMP. NaPyr significantly increases the expression levels of GPX4 and Nrf2, indicating that activation of the GPX4/Nrf2 axis could inhibit ferroptosis in alveolar and bronchial epithelial cells. More importantly, NaPyr inhibited the secretion of downstream inflammatory factors, including TNF and IL-8, by decreasing COX2 expression levels to suppress CSE-induced inflammation.

Conclusion
Accordingly, NaPyr could mitigate CSE-induced ferroptosis in alveolar and bronchial epithelial cells by activating the GPX4/Nrf2 axis and decreasing COX2 expression levels. In addition, NaPyr reduced the secretion of inflammatory factors (TNF and IL-8), affording a novel therapeutic candidate for COPD.

Graphical Abstract
Impact of COVID-19 pandemic on the health-related quality of life of frontline workers: the case of seven low-income Eastern African countries
Authors: Nizigiyimana Alexis , Acharya Dilaram , Poder Thomas G. 
Published: August 2023

Abstract
Purpose
This study aimed to explore the potential impact of the COVID-19 pandemic on the health-related quality of life (HRQoL) of humanitarian and healthcare workers and its related factors in seven Eastern African countries (EAC).

Methods
A sample of frontline workers filled out an online cross-sectional survey questionnaire comprising socio-demographic, degree of symptoms of depression, anxiety, insomnia, and distress, alcohol and tobacco consumption, health-related quality of life (HRQoL) using Short Form 6-Dimension version 2 (SF-6Dv2) and Clinical Outcomes in Routine Evaluation 6-Dimension (CORE-6D), and fear of COVID-19 (FCV-19S) questionnaires. Multivariate regressions were conducted to identify independent factors associated with HRQoL.

Results
Of total 721 study participants, mean (standard deviation) scores for SF-6Dv2 and CORE-6D were 0.87 (0.18) and 0.81 (0.14), respectively. Participants with an education level below a university degree, having chronic diseases, been tested positive to COVID-19, with traumatic memories, depression, insomnia, distress, and stress were found to have lower HRQoL likelihood in terms of SF-6Dv2 scores during the COVID-19 pandemic. Similarly, participants with chronic diseases, exposure to COVID-19 patients, depression, insomnia, distress, stress, tested positive with COVID-19, and high level of fear of COVID-19, had lower HRQoL likelihood in terms of CORE-6D scores. Participants who were married had higher HRQoL likelihoods in terms of SF-6Dv2 scores.

Conclusion
Some personal and mental health characteristics, and COVID-19 related factors, were predictors of lower HRQoL of frontline workers in EAC. These findings should be meaningful while designing sustainable interventions and guidelines aiming to improve the HRQoL of frontline workers during a pandemic situation.
Validity and reliability of the WHOQOL-BREF in a pregnant population
Authors: Rondung Elisabet , Oliveira Sandra , Esteves Francisco 
Published: August 2023

Abstract
Background
Physical end emotional changes during pregnancy may not only affect pregnant womens’ quality of life, but also how instruments assessing quality of life perform in such populations. To date, there is insufficient evidence on psychometric properties for both generic and condition-specific instruments measuring quality of life during pregnancy. The aim of this study was thus to examine the structural validity, internal consistency, and construct validity of the WHOQOL-BREF in a sample of pregnant women.

Methods
A convenience sample of 1015 pregnant women in Sweden completed the WHOQOL-BREF online. We examined the psychometric properties of the instrument using principal component analysis (PCA), confirmatory factor analysis (CFA), Cronbach’s alpha, item-domain correlations, correlations with overall QOL and general health, and multiple linear regression with items on overall QOL and general health as outcomes.

Results
Principal Component Analysis in a random subsample (n = 502) supported a four-factor model, encompassing the domains physical, psychological, social and environmental quality of life, but with four of the items originally in the environmental domain relocated to the other domains. The proposed domain structure showed good fit in confirmatory factor analysis in the other random subsample (n = 513). The physical and psychological domains showed good internal consistency (Cronbach’s alpha = 0.885 and 0.826 respectively), while the social and environmental domains were weaker in this regard. All domains showed significant positive correlations with items on overall QOL and general health. The physical and psychological domains were the most evident predictors in the regression models.

Conclusions
We find the Swedish version of the WHOQOL-BREF to have good psychometric properties to be used in samples of pregnant women, and propose an alternative domain structure that might be even more useful for assessing quality of life during pregnancy. The physical and psychological domains showed good internal consistency and construct validity.
Effect of sp3/sp2 carbon ratio and hydrodynamic size on the biodistribution kinetics of nanodiamonds in mice via intravenous injection
Authors: Jeong Jiyoung , Jeon Soyeon , Kim Songyeon , Lee Sinuk , Kim Gyuri , Bae Eunsol , Ha Yeonjeong , Lee Seung Whan , Kim Ji-Su , Kim Dong-Jae , Cho Wan-Seob 
Published: August 2023

Abstract
Background
Nanodiamonds (NDs) have gained a rapidly growing interest in biomedical applications; however, little is known regarding their biokinetics owing to difficulties in measurements and limited synthesis/purification technologies. In this study, we investigated the distribution kinetics of detonation-synthesized NDs in mice via intravenous injection to evaluate the parameters that determine the behavior of the particles. We prepared two distinctive NDs that controlled the sp3/sp2 carbon ratio and particle size by coating them with serum proteins. The four control samples were intravenously injected into mice, and tissue distribution and clearance were evaluated at 30 min and 1, 7, and 28 days post-injection.

Results
The sp3/sp2 carbon ratio showed no correlation with the organ distribution of the NDs. However, hydrodynamic size showed an excellent correlation with organ distribution levels: a negative correlation in the liver and positive correlations in the spleen and lungs. Furthermore, the deposition levels of NDs in the lung suggest that particles smaller than 300 nm could avoid lung deposition. Finally, a similar organ distribution pattern was observed in mice injected with carbon black nanoparticles controlled hydrodynamic size.

Conclusions
In conclusion, the tissue distribution of NDs is modulated not by the sp3/sp2 carbon ratio but by the hydrodynamic size, which can provide helpful information for targeting the tissue of NDs. Furthermore, the organ distribution pattern of the NDs may not be specific to NDs but also can apply to other nanoparticles, such as carbon black.
RGB image-based method for phenotyping rust disease progress in pea leaves using R
Authors: Osuna-Caballero Salvador , Olivoto Tiago , Jiménez-Vaquero Manuel A. , Rubiales Diego , Rispail Nicolas 
Published: August 2023

Abstract
Background
Rust is a damaging disease affecting vital crops, including pea, and identifying highly resistant genotypes remains a challenge. Accurate measurement of infection levels in large germplasm collections is crucial for finding new resistance sources. Current evaluation methods rely on visual estimation of disease severity and infection type under field or controlled conditions. While they identify some resistance sources, they are error-prone and time-consuming. An image analysis system proves useful, providing an easy-to-use and affordable way to quickly count and measure rust-induced pustules on pea samples. This study aimed to develop an automated image analysis pipeline for accurately calculating rust disease progression parameters under controlled conditions, ensuring reliable data collection.

Results
A highly efficient and automatic image-based method for assessing rust disease in pea leaves was developed using R. The method’s optimization and validation involved testing different segmentation indices and image resolutions on 600 pea leaflets with rust symptoms. The approach allows automatic estimation of parameters like pustule number, pustule size, leaf area, and percentage of pustule coverage. It reconstructs time series data for each leaf and integrates daily estimates into disease progression parameters, including latency period and area under the disease progression curve. Significant variation in disease responses was observed between genotypes using both visual ratings and image-based analysis. Among assessed segmentation indices, the Normalized Green Red Difference Index (NGRDI) proved fastest, analysing 600 leaflets at 60% resolution in 62 s with parallel processing. Lin’s concordance correlation coefficient between image-based and visual pustule counting showed over 0.98 accuracy at full resolution. While lower resolution slightly reduced accuracy, differences were statistically insignificant for most disease progression parameters, significantly reducing processing time and storage space. NGRDI was optimal at all time points, providing highly accurate estimations with minimal accumulated error.

Conclusions
A new image-based method for monitoring pea rust disease in detached leaves, using RGB spectral indices segmentation and pixel value thresholding, improves resolution and precision. It rapidly analyses hundreds of images with accuracy comparable to visual methods and higher than other image-based approaches. This method evaluates rust progression in pea, eliminating rater-induced errors from traditional methods. Implementing this approach to evaluate large germplasm collections will improve our understanding of plant-pathogen interactions and aid future breeding for novel pea cultivars with increased rust resistance.