bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding Cloud Systems’ Structure and Organization Using a Machine’s Self-Learning Approach
Authors: Chatterjee Dwaipayan , Acquistapace Claudia , Deneke Hartwig , Crewell Susanne 
Published: September 2023

Abstract
In this study, we introduce a self-supervised deep neural network approach to classify satellite images into independent classes of cloud systems. The driving question of the work is to understand whether our algorithm can capture cloud variability and identify distinct cloud regimes. Ultimately, we want to achieve generalization such that the algorithm can be applied to unseen data and thus help automatically extract relevant information important to atmospheric science and renewable energy applications from the ever-increasing satellite data stream. We use cloud optical depth (COD) retrieved from postprocessed high-resolution Meteosat Second Generation (MSG) satellite data as input for the network. The network’s architecture is based on the DeepCluster, version 2, and consists of a convolutional neural network and a multilayer perceptron, followed by a k-means algorithm. We explore the network’s training capabilities by analyzing the centroids and feature vectors found from progressive minimization of the cross-entropy loss function. By making use of additional MSG retrieval products based on multichannel information, we derive the optimum number of classes to determine independent cloud regimes. We test the network capabilities on COD data from 2013 and find that the trained neural network gives insights into the cloud systems’ persistence and transition probability. The generalization on the 2015 data shows good skills of our algorithm with unseen data, but results depend on the spatial scale of cloud systems.

Significance Statement
This study uses a self-supervised deep neural network to identify distinct cloud systems from cloud optical depth satellite images over central Europe. Satellite-retrieved products support the physical interpretation of the identified cloud classes and help optimize the number of identified classes. The trained neural network gives insights into cloud systems’ persistence and transition probability. The generalization capacity of the deep neural network with unseen data is promising but depends on the spatial scale of cloud systems.
Stigmatizing attitudes towards mental illness: A cross-sectional survey of Australian medical students
Authors: Kumar Annora Ai-Wei , Liu Zhao Feng , Han Jessica , Patil Sasha , Tang Lucy , McGurgan Paul , Almeida Osvaldo P 
Published: September 2023

Objectives We aimed to assess the degree of stigmatizing attitudes and psychological distress amongst Australian medical students in order to better understand factors that may impact help-seeking behaviours of students. We hypothesize that sociodemographic factors will not significantly predict stigmatizing attitudes, and increasing levels of psychological distress will be associated with increasing stigma. Methods A cross-sectional online survey was distributed to medical students at Western Australian universities and members of the Australian Medical Students’ Association. Stigma was scored using the Mental Illness Clinicians’ Attitudes (MICA-2) scale. Psychological distress was assessed using the Hospital Anxiety and Depression Scale (HADS). Participants provided information about gender, age, spirituality, financial hardship, treatment for mental illness, and experience in psychiatry. Results There were 598 responses. The mean (Standard Deviation) MICA-2 score was 36.8 (7.5) out of a maximum of 96, and the mean (SD) HADS depression score was 4.7 (3.7). The mean (SD) HADS anxiety score was 9.3 (4.4). Past or current treatment for a mental illness was associated with lower MICA-2 scores. There was no association between MICA-2 and HADS scores, or sociodemographic factors. Conclusions Our results demonstrate relatively low MICA-2 scores and high HADS-A scores overall, with no association between HADS scores and stigma.
Public health literacy in primary users in western Turkey
Authors: Kılınç Ali , Çam Cüneyt , Aydoğan Gedik Sevil , Oktar Didem , Taşcıoğlu Umur , Öznur Muz Feyza Nehir , Önsüz Muhammed Fatih , Metintaş Selma 
Published: September 2023

Background: Public health literacy (PHL) is a novel perspective on health literacy (HL). Differing from HL’s individualist approach, PHL is concerned with public health events and promoting health in the whole society. Objectives: To evaluate PHL, a newly developed concept, and related factors. Methods: In this cross-sectional study, people who visited primary healthcare centers in urban and rural settings were recruited using a questionnaire that includes Public Health Literacy Knowledge Scale (PHLKS) and Adult Health Literacy Scale (AHLS). Out of four Primary Healthcare Centers (PMCs) in western Turkey selected randomly, one PMC was located in a rural setting, while three PMCs were located in an urban setting. Multiple linear regression was used to determine the predictors for PHL. Results: The study group consisted of 1672 people, of which 55.3% were male. The mean age was 40.94 ± 15.22. The median score (min–max) from PHLKS was 13.0 (0–17). Multiple linear regression showed that income level had a negative impact on PHL. Higher education, fondness for reading, hospital admission and HL, however, increased PHL levels. Additionally, living in an urban area and not having auditory problems were positively associated with PHL. Conclusions: Participants had a moderate level of PHL. Improving PHL should be a priority to tackle global and local problems that have an adverse effect on community health. To increase community engagement in public health events, people with low education and HL levels should be targeted in future training programs.
Stress and Resilience of Nursing Students in Clinical Training During the COVID-19 Pandemic: Palestinian Perspective
Authors: Bsharat Fekry 
Published: September 2023

Introduction Stress reduces nursing students’ capacity to think critically, impedes decision-making, and eventually lowers academic performance and limits success. The circumstances surrounding the COVID-19 outbreak drove students into new virtual learning settings, adding stress to their academic responsibilities. Objectives The purpose of this study was to assess the perceived stress and resilience among nursing students in clinical training during the COVID-19 pandemic. Method A cross-sectional study was conducted on 315 students studying nursing. Data collection utilized the Perceived Stress Scale and the Connor–Davidson Resilience Scale. Results The analysis revealed that the stress score mean was 75.2 ± 6.6 and the resilience score mean was 26.0 ± 3.4. Also, there was a weak negative association between nursing students’ stress and their resilience ( p < 0.05). Additionally, the results indicated statistically significant differences between stress and gender, study year level, and age ( p < 0.05). Conclusion Stress was high and resilience was moderate during the COVID-19 pandemic among nursing students.
Medical emergencies at sea: an analysis of ambulance-supported and autonomously performed operations by lifeboat crews
Authors: Messelink Daphne M. , van der Ploeg Gert-Jan , van der Linden Theo , Flameling Roos D. , Bierens Joost J. L. M. 
Published: September 2023

Abstract
Background
Very little data is available about the involvement of lifeboat crews in medical emergencies at sea. The aim of this study is to analyze the medical operations at sea performed by the Royal Netherlands Sea Rescue Institution (KNRM).

Methods
This is a retrospective descriptive analysis of all medical operations at sea performed by the KNRM between January 2017 and January 2020. The operations were divided in three groups: with ambulance crew aboard the lifeboat, ambulance crew on land waiting for the arrival of the lifeboat, and autonomous operations (without ambulance crew involvement). The main outcome measures were circumstances, encountered medical problems, follow-up and crew departure time.

Results
The KNRM performed 282 medical operations, involving 361 persons. Operations with ambulance crew aboard the lifeboat (n = 39; 42 persons) consisted mainly of persons with serious trauma or injuries; 32 persons (76.2%) were transported to a hospital. Operations with ambulance crew on land (n = 153; 188 persons) mainly consisted of situations where time was essential, such as persons who were still in the water, with risk of drowning (n = 45, 23.9%), on-going resuscitations (n = 9, 4.8%) or suicide attempts (n = 7, 3.7%). 101 persons (53,7%) were transported to a hospital. All persons involved in the autonomous operations (n = 90; 131 persons) had minor injuries. 38 persons (29%) needed additional medical care, mainly for (suspected) fractures or stitches. In 115 (40.8%) of all operations lifeboat crews did not know that there was a medical problem at the time of departure. Crew departure time in operations with ambulance crew aboard the lifeboat (13.7 min, min. 0, max. 25, SD 5.74 min.) was significantly longer than in operations with ambulance crew on land (7.7 min, min. 0, max 21, SD 4.82 min., p < 0.001).

Conclusion
This study provides new information about the large variety of medical emergencies at sea and the way that lifeboat and ambulance crews are involved. Crew departure time in operations with ambulance crew aboard the lifeboat was significantly longer than in operations with ambulance crew on land. This study may provide useful indications for improvement of future medical operations at sea, such as triage, because in 40.8% of operations, it was not known at the time of departure that there was a medical problem.
Editorial: Optimizing opioid prescriptions in the emergency department
Authors: Dahaba Ashraf A. , Nannan Panday Rishi S. 
Published: September 2023

AbstractOptimizing opioid prescriptions in the emergency department is essential to address the opioid pandemic while ensuring patient wellbeing. This requires a comprehensive approach that includes exploring alternatives to opioids for pain management, identifying individuals at risk for opioid addiction, implementing evidence-based guidelines, and involving doctors in the management of opioid addiction.
Factors influencing shared decision-making in long-term care facilities
Authors: Kim Da Eun , Kim Min Jung 
Published: September 2023

Abstract
Background
Shared decision-making, a communicative process to reach decisions based on informed preferences, evidence, and co-created goals, improves care satisfaction and patients’ quality of life. However, shared decision-making has not been widely implemented in long-term care facilities, and few studies have examined how to promote the shared decision-making practice. This study aimed to identify the influencing factors of shared decision-making based on the Person-centered Practice Framework in long-term care facilities.

Methods
A total of 300 staff (nursing staff, social workers, and personal care workers) in 13 Korean long-term care facilities participated in this study. Data from 280 respondents were finally analyzed, excluding respondents with missing values. Data were collected using structured questionnaires that included items on shared decision-making, personal factors (e.g., knowledge about dementia, person-centered care education, person-centered attitude, communication behavior, and job tenure), and care environment factors (e.g., person-centered climate, staffing level, effective staff relationships, supportive supervisors, and power-sharing). Multilevel linear regression analyses were performed using Mplus Version 8.8.

Results
The mean shared decision-making score was 35.78 (range 8–45). Staff with experience of person-centered care education (β = 0.198, p = 0.034), a higher person-centered attitude score (β = 0.201, p = 0.007), and a higher communication behavior score (β = 0.242, p < 0.001) were more likely to report a higher shared decision-making score. In addition, staff who viewed their care environment as more person-centered were more likely to report a higher shared decision-making score (β = 0.416, p < 0.001).

Conclusions
This study highlights that personal (e.g., person-centered care education, person-centered attitude, and communication behavior) and care environment (e.g., person-centered climate) factors could influence shared decision-making for long-term care residents. These findings could be foundational evidence for facilitating shared decision-making practice in long-term care settings.
Progression of comorbidities in youth with overweight or obesity during the COVID-19 pandemic
Authors: Wee Erica , Sherman Ashley K. , Farrukh Safa , Clements Mark A. , Halpin Kelsee , Yan Yun 
Published: September 2023

Abstract
Background
Childhood obesity rates have continued to increase with the COVID-19 pandemic. However, data are limited on the impact of increasing obesity on associated comorbidities.

Methods
We evaluated the progression of overweight- or obesity-associated comorbidities by investigating change in laboratory results pre–COVID-19 pandemic and post–COVID-19 pandemic onset in youth with overweight or obesity. We defined progression of comorbidities based on increase in category rather than absolute change in value.

Results
HbA1c progression was seen in 19%, and LDL cholesterol progression was seen in 26%, as defined by categories. HbA1c progression and LDL cholesterol progression were significantly correlated. HbA1c and LDL cholesterol progression were significantly associated with older age and Hispanics, respectively.

Conclusion
The results indicate youths with overweight or obesity have experienced progression of comorbidities during the COVID-19 pandemic. This study emphasizes the importance of early detection of comorbidities among a high-risk pediatric population.
Psychometric properties of an Arabic translation of the short 9-item drive for muscularity scale (DMS-9)
Authors: Fekih-Romdhane Feten , Malaeb Diana , Dabbous Mariam , Hallit Rabih , Obeid Sahar , Hallit Souheil 
Published: September 2023

Abstract
Background
After the original 15-item Drive for Muscularity Scale developed by McCreary et al. in 2004, a more theoretically based scale that replicates the original DMS subscales with a better conceptual clarity and a shorter number of items, i.e., the DMS-9, has recently been developed by Chaba et al. in 2018. We sought to contribute to the literature especially under the Arab context, by investigating the psychometric properties of an Arabic translation of the DMS-9 in a sample of Arabic-speaking Lebanese university students of both genders.

Methods
University students (N = 402; 55.2% females) from multiple universities in Lebanon were invited to fill the survey in this cross-sectional designed study (December 2022 and January 2023). Our sample was chosen using the snowball technique; a soft copy of the questionnaire was created using google forms software, and an online approach was conceived to proceed with the data collection.

Results
Using an Exploratory Factor Analysis-to- Confirmatory Factor Analysis strategy, we found that the original two-factor model of the DMS proposed in the parent study was adequately replicated in our sample. The two DMS-9 factor scores showed very good McDonald’s omega values (ω > 0.8). Findings also showed that gender invariance was achieved at the configural, metric, and scalar levels. Additionally, drive for muscularity scores correlated in the expected way with other study variables, providing support for the convergent and divergent validity of the Arabic DMS-9. Specifically, we found that greater drive for muscularity attitudes and behaviors significantly correlated with more severe muscle dysmorphic symptoms, inappropriate eating attitudes, muscle bias internalization, and lower body appreciation.

Conclusion
Findings preliminarily suggest that the Arabic DMS-9 is psychometrically sound and suitable tool to assess the drive for muscularity construct among Arabic-speaking community adults. Making the Arabic DMS-9 available will hopefully benefit the scientific community working in Arab settings, promote local and international research in this area, and offer descriptive data on how drive for muscularity may interfere with health indicators in the general Arab population.
Sick sinus syndrome diagnosed after a sinus arrest during treatment for zygomatic fracture: a case report
Authors: Hayashi Hiroki , Abe Atsushi , Oguma Tetsushi , Ito Yu , Nakayama Atsushi 
Published: September 2023

Abstract
Background
Intraoperative sinus arrest is rarely seen during zygomatic fracture treatment. The patient was diagnosed with sick sinus syndrome based on repeated postoperative sinus arrest, which could have resulted in death if diagnosed late, making this case very significant to report.

Case presentation
Sick sinus syndrome is an arrhythmia associated with reduced automaticity of the sinoatrial node or impaired sinoatrial node conduction. We report the case of a 67-year-old man diagnosed with the syndrome after a sinus arrest that occurred during a zygomatic fracture treatment. The patient had cheek pain and mouth opening disorder, dizziness after fainting and sustaining a facial injury. Preoperative examination determined that the syncope was due to drug-induced arrhythmia, and surgery was authorized after drug withdrawal. During the operation, sinus arrest was observed due to trigeminal vagal reflex, and heart rate was restarted by stopping the operation and chest compressions. After the surgery, the patient showed symptoms of dizziness and palpitations, and sinus arrest following atrial fibrillation and supraventricular tachycardia, which was diagnosed as sick sinus syndrome, and a pacemaker was implanted. Currently, 8 years have passed since the surgery, and there are no symptoms of mouth opening disorder, dizziness, or palpitations.

Conclusions
In the case of maxillofacial injuries due to syncope, cardiogenic syncope is a possibility, and repeated syncope is a risk for death due to delayed diagnosis. There are no reports of maxillofacial trauma leading to a diagnosis of sick sinus syndrome. The purpose of this case report is to disseminate the importance of diagnosing the cause of syncope as well as injury treatment.
Ovarian hyperstimulation syndrome with carotid artery dissection and cerebral infarction: a case report
Authors: Fan Tianhua , Ma Liansheng 
Published: September 2023

Abstract
Background and purpose
Ovarian hyperstimulation syndrome (OHSS) is one of the most serious iatrogenic complications in assisted reproductive technology, which seem rarely associated with cerebrovascular diseases. We reported a patient diagnosed with OHSS combined with carotid artery dissection and massive cerebral infarction.

Case presentation
We reported a unique case of a 31-year-old woman who experienced abdominal pain, blurred consciousness, and speech inability after 15-day continuous injection of human gonadotropin for infertility. Imaging examination showed hyperacute cerebral infarction in the left frontotemporal island parietal lobe and left internal carotid artery dissection. After therapeutic use of low-molecular-weight heparin calcium anticoagulation and other conventional cerebrovascular treatments, she eventually achieved a good prognosis.

Conclusions
OHSS seemd rarely associated with cerebrovascular diseases, such as infarction and carotid artery dissection. Encountering abdominal symptoms combined with neurologic symptoms, a detailed history and a thorough examination are essential. It is necessary to comprehensively analyze the pathogenesis and formulate individualized therapy according to the specific conditions of patients.
The challenges imposed by artificial intelligence: are we ready in medical education?
Authors: Azer Samy A. , Guerrero Anthony P. S. 
Published: September 2023

AbstractArtificial intelligence (AI) is the science and engineering of making intelligent machines. In medical education, the usefulness of AI and its applications is being explored in training, learning, simulation, curriculum, and developing new assessment tools. This editorial encourages authors to submit their research on AI concerning medical education to enrich our knowledge.
Engineering Comamonas testosteroni for the production of 2-pyrone-4,6-dicarboxylic acid as a promising building block
Authors: Delmulle Tom , Bovijn Stijn , Deketelaere Sari , Castelein Martijn , Erauw Tom , D’hooghe Matthias , Soetaert Wim K. 
Published: September 2023

Abstract
Background
Plastics are an indispensable part of our daily life. However, mismanagement at their end-of-life results in severe environmental consequences. The microbial conversion of these polymers into new value-added products offers a promising alternative. In this study, we engineered the soil-bacterium Comamonas testosteroni KF-1, a natural degrader of terephthalic acid, for the conversion of the latter to the high-value product 2-pyrone-4,6-dicarboxylic acid.

Results
In order to convert terephthalic acid to 2-pyrone-4,6-dicarboxylic acid, we deleted the native PDC hydrolase and observed only a limited amount of product formation. To test whether this was the result of an inhibition of terephthalic acid uptake by the carbon source for growth (i.e. glycolic acid), the consumption of both carbon sources was monitored in the wild-type strain. Both carbon sources were consumed at the same time, indicating that catabolite repression was not the case. Next, we investigated if the activity of pathway enzymes remained the same in the wild-type and mutant strain. Here again, no statistical differences could be observed. Finally, we hypothesized that the presence of a pmdK variant in the degradation operon could be responsible for the observed phenotype and created a double deletion mutant strain. This newly created strain accumulated PDC to a larger extent and again consumed both carbon sources. The double deletion strain was then used in a bioreactor experiment, leading to the accumulation of 6.5 g/L of product in 24 h with an overall productivity of 0.27 g/L/h.

Conclusions
This study shows the production of the chemical building block 2-pyrone-4,6-dicarboxylic acid from terephthalic acid through an engineered C. testosteroni KF-1 strain. It was observed that both a deletion of the native PDC hydrolase as well as a pmdK variant is needed to achieve high conversion yields. A product titer of 6.5 g/L in 24 h with an overall productivity of 0.27 g/L/h was achieved.