bluuebunny/crossref_metadata_2025_split huggingface dataset:
Color Doppler Ultrasound Assessment of Subclinical Activity With Scoring of Morphea
Authors: Parra-Cares Julio , Wortsman Ximena , Alfaro-Sepúlveda Daniela , Mellado-Francisco Gonzalo , Ramírez-Cornejo Cristian , Vera-Kellet Cristián 
Published: August 2023

Background Detection of activity in morphea is paramount for adequately managing the disease. Subclinical ultrasound involvement on inactive lesions or healthy skin areas adjacent to morphea has not been described to date. Objectives The study aimed to detect morphea’s subclinical activity by Color Doppler ultrasound not identified with the clinical scorings. Materials & Methods This cross-sectional retrospective study was done from January 2014 to July 2019 in patients with a clinicopathological diagnosis of morphea. The modified Localized Scleroderma Skin Severity Index (mLoSSI) and The Ultrasound Morphea Activity Score (US-MAS) were used to correlate clinical and subclinical activity. Results A total of 36 patients met the inclusion criteria. 54% of cases presented subclinical activity in areas adjacent to the clinically active lesion, 23% in nonadjacent regions, and 23% demonstrated activity at a clinically inactive lesion site. 100% of patients with morphea “en coup de sabre” involving the frontal region of the face concomitantly presented both subclinical activities of morphea on the frontal facial region and the scalp following the same axis. A positive relationship was observed between the degree of clinical activity measured by mLoSSI and US-MAS scoring. The main limitations of our study were the low number of patients and the inability to detect alterations < 0.1 mm. Conclusions Subclinical activity is frequent in morphea, can extend beyond the lesional areas, including apparently noninvolved adjacent and distant corporal regions, and can be detected by color Doppler ultrasound.
Threats to personhood from within the family? A study of family caregivers of people with dementia in the Chinese context
Authors: Chan On-Fung , Chui Cheryl Hiu-Kwan , Wong Gloria Hoi-Yan , Lum Terry Yat-Sang 
Published: August 2023

Background and Objectives Dementia care creates ethical and legal dilemmas due to the struggle to balance the quality of care and personhood. Disagreement and conflict in caregiving relationships are common. However, limited attention has been given to particular stressful circumstances, such as care practice and decision disagreements. Moreover, the cultural context of personhood has been overlooked. This study drew on Hong Kong family caregivers’ reports of their cargiving practice and disagreements with care recipients about care-related decisions and their implications for personhood to identify person-centered family care support needs. Research Design and Methods We conducted 18 semi-structured interviews with family caregivers of people with dementia in Hong Kong, China. Participants were asked to share their family dementia caregiving experience and practice, specifically regarding decisions and practices that elicited disagreement. We used thematic analysis to analyze data generated from interviews. Results Six caregiver practices were identified: exchange for mutual agreement, a foot-in-the-door approach, acceptance of requests/behaviors contrary to the caregivers’ views, infantilization, treachery, and exclusion and imposition. Discussion and Implications These findings highlight the importance of providing support and guidelines for person-centered care to promote personhood in the family caregiving context in dementia care.
Ultrasound Assessment of the Ulnar Nerve Around the Elbow and Diagnosis of Cubital Tunnel Syndrome, Clinical Outcomes
Authors: Catanzaro Michael , Santangelo Gabrielle , Speach David , Ketonis Constantinos 
Published: August 2023

Background: There is increased interest in ultrasound (US) for the diagnosis of cubital tunnel syndrome (CuTS). We hypothesize that ulnar nerve cross-sectional area (CSA) correlates with disease severity and electrodiagnostic studies (EDX). Methods: ARetrospective review was performed at a tertiary medical center. One hundred seventeen patients (166 ulnar nerves) were evaluated. Maximum CSA at 3 points around the elbow (proximal, groove, and distal) and EDX results (American Board of Electrodiagnostic Medicine-certified physiatrist’s interpretations) were collected. Results: US was positive (CSA > 0.1 cm2) in 95/117 cases (81.20%) versus 84/117 (71.79%) positive for EDX. CuTS patients treated surgically had significantly greater (0.13 cm2, standard deviation [SD] 0.038) preoperative CSA than non-operative patients (0.10 cm2, SD 0.033) ( p = .003). CSA increased as EDX increased in severity; mild (0.116 cm2, SD 0.031), moderate (0.121 cm2, SD 0.035), and severe (0.163 cm2, SD 0.047) with a significant difference between the mild and severe groups ( P = .001) and between the moderate and severe groups ( p = .01). Significant differences were seen between patients with positive US and EDX studies compared to those with negative US and EDX in the average physical function scores (57.26, SD 8.57 versus 43.18, SD 7.70; p < .001); average sleep scores (50.14, SD 9.53 versus 56.62, SD 7.31; p = .02); average physical function scores (43.04, SD 8.68 versus 57.08, SD 6.34; p < .001) and average depression scores (49.10, SD 10.88 versus 45.043, SD 7.06; p = .02). Conclusions: US is a reliable tool for diagnosis and surgical decision-making for CuTS. Type of Study/Level of Evidence: Diagnostic/III.
Psychological stressors and needs among essential workers at a Singapore hospital during the COVID-19 pandemic
Authors: Ho Ezra , Oh Hong Choon , Lim Chau Sian , Soon Siew Peng , Ei Ei Khaing Nang 
Published: August 2023

Background Hospital workers have borne a large burden of the COVID-19 pandemic, exposed to risks of infection, while enduring elevated workloads, increased workplace stress, prolonged hours in uncomfortable working conditions, and public stigmatisation. Objectives In this cross-sectional study, we examined the psychological stressors of COVID-19 on hospital essential services workers and their needs at a tertiary hospital in Singapore. Methods: We conducted a study of 246 outsourced essential workers comprising housekeeping, maintenance staff, and porting staff. Psychological distress was measured by the Kessler-6 scale. We also surveyed respondents through a questionnaire on the main concerns that worried them, supportive resources available, and additional resources that would most help them. Results Among the survey respondents, concerns related to employment, finances, accommodation, transportation, and likelihood of receiving medical attention for COVID-19 were significantly associated with moderate to severe psychological distress ( p<0.05). Stress from isolation and fear of COVID-19 infection constituted the greatest psychosocial burdens. Respondents felt that main supportive resources came from their employers and social circles. They also listed enhanced individual ability to cope, and additional financial aid from their employers and the government would help them the most. Conclusions Financial and accommodation-related stressors reflect structural factors that exacerbated the psychosocial burdens faced by non-medical hospital workers. Most respondents tended to individualise their coping strategies, which point towards the need for stronger social protections and mental health provisions for hospital essential services workers.
Teaching as Learning: Etymological Investigation, Canonical Analysis, and Experiential Reflection in the Chinese Cultural Context
Authors: Li Lin 
Published: August 2023

Purpose This study re-examines the relationship between jiao (lit. teaching) and xue (lit. learning)—the foundational education concepts in the traditional Chinese cultural context—to enlighten our contemporary understandings of education and educational research. Design/Approach/Methods This study first lays its foundation on an etymological investigation. It then integrates two mutually connected approaches— the classics and the self as method—to present a comprehensive analysis. Finally, it critically reviews the methodology used in this study. Findings The interdependency of xue and jiao has an etymological foundation, supported by canonical doctrines and verified by individualized experiences. The interpretation of xue as xiao (to imitate) describes the origin and process of education in which the junior imitated and followed the elder, while the extended interpretation of xue as jue (to awaken) stresses the effects and functions of education. In the classical Chinese context, greater significance was placed on xue—the keyword concurrently connoting the meaning of teaching and learning in the modern sense. It is misleading to narrowly render the originally meaningful word group xuexi as learning in modern English. Originality/Value This study consults sources in multiple languages and integrates both the classics and the self as method. Based on this, the etymological investigation, canonical analysis, and experiential reflection are collated to provide a rich and deep discussion. By focusing on the core characteristics and the concepts they imply, this study also touches on the key characteristics of the hieroglyphic system and the unique way of thinking it represents.
Reliability of the Single-Arm and Double-Arm Jobe Test for the Diagnosis of Full-Thickness Supraspinatus Tendon Tear
Authors: Katepun Surangkana , Boonsun Phanuwat , Boonsaeng Waraporn Srikhum , Apivatgaroon Adinun 
Published: August 2023

Background: The Jobe test is commonly used to diagnose full-thickness (FT) supraspinatus (SSP) tendon tear. The original Jobe test used single-arm testing, although the double-arm Jobe test has also been used in clinical practice. Purpose: To evaluate the reliability, accuracy, and diagnostic value of the single-arm and double-arm Jobe test for diagnosis of FT SSP tear. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients with shoulder pain requiring magnetic resonance imaging (MRI) of the shoulder between March 1, 2021, and March 31, 2022, were enrolled. Each patient underwent both single-arm and double-arm Jobe tests by 2 orthopaedic surgeons independently, and the presence of pain, weakness, or both during the test was documented. Diagnosis of FT SSP tear on MRI scan was used as the gold standard to compare the diagnostic value of the Jobe test. The interrater reliability of the Jobe test, and the inter- and intrarater reliability of the MRI evaluation (patients with vs without FT SSP tear) was performed using the kappa (κ) coefficient. Results: A total of 80 patients (57 females [71%]; mean age, 61.46 ± 9.61 years) were included. MRI scans revealed FT SSP tears in 32 (40%) of the patients. Both single- and double-arm Jobe tests had low diagnostic values (accuracy, 46.25% to 60%; sensitivity, 46.9% to 84.4%; specificity, 25% to 66.7%). The single-arm test with weakness revealed the highest sensitivity (84.4%). The double-arm test with weakness plus pain revealed the highest specificity (66.7%). Double-arm testing with pain had the highest accuracy (60%), with the highest positive likelihood ratio (1.5). The interrater reliability of the Jobe test indicated substantial agreement (double-arm vs single-arm, κ = 0.771 and 0.716, respectively, agreement 85%; P < .05). The interrater reliability of MRI scan evaluation of the FT SSP tear indicated substantial agreement (κ = 0.750, agreement 85%; P < .05), while the intrarater reliability indicated almost perfect agreement (κ = 0.917, agreement 96%; P < .05). Conclusion: The Jobe test, either single- or double-arm, had low accuracy and diagnostic value in diagnosing FT SSP tear. The concern with a single-arm examination for weakness is that it may be an inappropriate diagnostic test for ruling out FT SSP with 84% sensitivity, while a double-arm examination provides a higher specificity.
Investigating the Prevalence of Computer Vision Syndrome (CVS) Among Undergraduate Nursing Students: A Cross-Sectional Study
Authors: Mrayyan Majd T. , Alseid Abdel Rahman Hasan , Ghoolah Tasneem Sameer , Al-Shaikh Ali Marwan H. , Mrayan Manar 
Published: August 2023

Introduction During the pandemic, health issues associated with using digital devices and exploring social media, such as Computer Vision Syndrome (CVS), have increased considerably. Objectives This study looked into CVS and its significance in Jordan and the CVS outcomes of undergraduate nursing students who used digital devices to surf social media during COVID-19. Methods To assess CVS, a quantitative cross-sectional research design was used. Data were collected in 2022 through an online diagnostic and formative survey utilizing the CVS-Questionnaire (CVS-Q) with 310 undergraduate nursing students from a government and a private university in Jordan. Descriptive statistics and the univariate general linear model were used to analyze the collected data. Results To report the prevalence of CVS among the studied sample, the median score was 1.80. The median prevalence score was 24.50 (range = 13–31), and 26.75% of participants reported having intense social media searches. For a student in this study to be diagnosed with CVS, they must receive a score of at least 5, and the current sample score was around 2, indicating they didn’t have a CVS; however, it was moderate when it occurred. About 26.75% of participants reported having problematic social media searches. Back and neck pain and headaches were the typical signs of CVS. The average daily hours spent using digital devices for social media searches increased during the pandemic utilizing mobile phones, especially among male nursing students. Being a junior student with no social media account and unable to balance study and social media were among the predictors of CVS. Most students used protective tools on their digital devices, such as protective films and phone screens, to prevent or accommodate CVS. Conclusion There were no prior collected data about CVS in Jordan, and based on the international trend, the COVID-19 pandemic didn’t directly contribute to the prevalence of CVS. However, when the CVS occurred, it was moderate, which mandates proactive and prophylactic redesigning of our educational system.
The modified Borg/6-min walk distance ratio: a method to assess exertional breathlessness and leg discomfort using the 6-min walk test
Authors: Ekström Magnus , Li Pei Zhi , Lewthwaite Hayley , Bourbeau Jean , Tan Wan C. , Jensen Dennis 
Published: August 2023

BackgroundThe 6-min walk test (6MWT) is widely used to assess exercise capacity across chronic health conditions, but is currently not useful to assess symptoms, as the scores do not account for the 6-min walk distance (6MWD). We aimed to 1) develop normative reference equations for breathlessness and leg discomfort intensity expressed as modified Borg (mBorg)/6MWD ratios; and 2) validate the equations in people with COPD.MethodsAnalysis of people aged ≥40 years who performed two 6MWTs (on a 20-m course) in the Canadian Cohort Obstructive Lung Disease (CanCOLD) study: a healthy cohort (n=291; mean±sdage 67.5±9.4 years; 54% male) with normal 6MWD and lung function, and a COPD cohort (n=156; age 66.2±9.0 years; 56% male; forced expiratory volume in 1 s (FEV1)/forced vital capacity 56.6±8.2%; FEV174.4±18.6% pred). The mBorg score was calculated as the Borg 0–10 category ratio intensity rating of breathlessness or leg discomfort recorded at the end of the 6MWT +1 (range 1–11), to avoid zeros and yield ratios proportional to the symptom score and 6MWD−1.ResultsUsing data from the healthy cohort, sex-specific normative reference equations for breathlessness and leg discomfort mBorg/6MWD ratios were developed using multivariable linear regression, accounting for age, and body mass or body mass index. In the COPD cohort, abnormal breathlessness and leg discomfort (mBorg/6MWD>upper limit of normal) showed strong concurrent validity with worse airflow limitation, Medical Research Council breathlessness and COPD Assessment Test scores.ConclusionNormative references for the mBorg/6MWD ratio are presented to assess breathlessness and leg discomfort responses to the 6MWT in COPD.
Transcriptome profiling analysis of uterus during chicken laying periods
Authors: Sun Tiantian , Xiao Cong , Yang Zhuliang , Deng Jixian , Yang Xiurong 
Published: August 2023

AbstractThe avian eggshell is formed in the uterus. Changes in uterine function may have a significant effect on eggshell quality. To identify the vital genes impacting uterine functional maintenance in the chicken, uteri in three different periods (22W, 31W, 51W) were selected for RNA sequencing and bioinformatics analysis. In our study, 520, 706 and 736 differentially expressed genes (DEGs) were respectively detected in the W31 vs W22 group, W51 vs W31 group and W51 vs W22 group. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis indicated DEGs were enriched in the extracellular matrix, extracellular region part, extracellular region, extracellular matrix structural constituent, ECM receptor interaction, collagen-containing extracellular matrix and collagen trimer in the uterus (P < 0.05). Protein–protein interaction analysis revealed that FN1, LOX, THBS2, COL1A1, COL1A2, COL5A1, COL5A2, POSTN, MMP13, VANGL2, RAD54B, SPP1, SDC1, BTC, ANGPTL3 might be key candidate genes for uterine functional maintenance in chicken. This study discovered dominant genes and pathways which enhanced our knowledge of chicken uterine functional maintenance.
Genome-wide identification and expression analyses of the pectate lyase (PL) gene family in Fragaria vesca
Authors: Huang Xiaolong , Sun Guilian , Wu Zongmin , Jiang Yu , Li Qiaohong , Yi Yin , Yan Huiqing 
Published: August 2023

Abstract
Background
Pectate lyase (PL, EC 4.2.2.2), as an endo-acting depolymerizing enzyme, cleaves α-1,4-glycosidic linkages in esterified pectin and involves a broad range of cell wall modifications. However, the knowledge concerning the genome-wide analysis of the PL gene family in Fragaria vesca has not been thoroughly elucidated.

Results
In this study, sixteen PLs members in F. vesca were identified based on a genome-wide investigation. Substantial divergences existed among FvePLs in gene duplication, cis-acting elements, and tissue expression patterns. Four clusters were classified according to phylogenetic analysis. FvePL6, 8 and 13 in cluster II significantly contributed to the significant expansions during evolution by comparing orthologous PL genes from Malus domestica, Solanum lycopersicum, Arabidopsis thaliana, and Fragaria×ananassa. The cis-acting elements implicated in the abscisic acid signaling pathway were abundant in the regions of FvePLs promoters. The RNA-seq data and in situ hybridization revealed that FvePL1, 4, and 7 exhibited maximum expression in fruits at twenty days after pollination, whereas FvePL8 and FvePL13 were preferentially and prominently expressed in mature anthers and pollens. Additionally, the co-expression networks displayed that FvePLs had tight correlations with transcription factors and genes implicated in plant development, abiotic/biotic stresses, ions/Ca2+, and hormones, suggesting the potential roles of FvePLs during strawberry development. Besides, histological observations suggested that FvePL1, 4 and 7 enhanced cell division and expansion of the cortex, thus negatively influencing fruit firmness. Finally, FvePL1-RNAi reduced leaf size, altered petal architectures, disrupted normal pollen development, and rendered partial male sterility.

Conclusion
These results provide valuable information for characterizing the evolution, expansion, expression patterns and functional analysis, which help to understand the molecular mechanisms of the FvePLs in the development of strawberries.
Sequential viral introductions and spread of BA.1 across Pakistan provinces during the Omicron wave
Authors: Bukhari Ali Raza , Ashraf Javaria , Kanji Akbar , Rahman Yusra Abdul , Trovão Nídia S. , Thielen Peter M. , Yameen Maliha , Kanwar Samiah , Khan Waqasuddin , Kabir Furqan , Nisar Muhammad Imran , Merritt Brian , Hasan Rumina , Spiro David , Rasmussen Zeba , Aamir Uzma Bashir , Hasan Zahra 
Published: August 2023

Abstract
Background
COVID-19 waves caused by specific SARS-CoV-2 variants have occurred globally at different times. We focused on Omicron variants to understand the genomic diversity and phylogenetic relatedness of SARS-CoV-2 strains in various regions of Pakistan.

Methods
We studied 276,525 COVID-19 cases and 1,031 genomes sequenced from December 2021 to August 2022. Sequences were analyzed and visualized using phylogenetic trees.

Results
The highest case numbers and deaths were recorded in Sindh and Punjab, the most populous provinces in Pakistan. Omicron variants comprised 93% of all genomes, with BA.2 (32.6%) and BA.5 (38.4%) predominating. The first Omicron wave was associated with the sequential identification of BA.1 in Sindh, then Islamabad Capital Territory, Punjab, Khyber Pakhtunkhwa (KP), Azad Jammu Kashmir (AJK), Gilgit-Baltistan (GB) and Balochistan. Phylogenetic analysis revealed Sindh to be the source of BA.1 and BA.2 introductions into Punjab and Balochistan during early 2022. BA.4 was first introduced in AJK and BA.5 in Punjab. Most recent common ancestor (MRCA) analysis revealed relatedness between the earliest BA.1 genome from Sindh with Balochistan, AJK, Punjab and ICT, and that of first BA.1 from Punjab with strains from KPK and GB.

Conclusions
Phylogenetic analysis provides insights into the introduction and transmission dynamics of the Omicron variant in Pakistan, identifying Sindh as a hotspot for viral dissemination. Such data linked with public health efforts can help limit surges of new infections.
Cesarean sections and early-term births according to Robson classification: a population-based study with more than 17 million births in Brazil
Authors: Rocha Aline S. , Paixao Enny S. , Alves Flavia Jôse O. , Falcão Ila R. , Silva Natanael J. , Teixeira Camila S. S. , Ortelan Naiá , Fiaccone Rosemeire L. , Rodrigues Laura C. , Ichihara Maria Yury , Barreto Mauricio L. , de Almeida Marcia F. , de Cássia Ribeiro-Silva Rita 
Published: August 2023

Abstract
Background
Cesarean section (CS) rates are increasing worldwide and are associated with negative maternal and child health outcomes when performed without medical indication. However, there is still limited knowledge about the association between high CS rates and early-term births. This study explored the association between CSs and early-term births according to the Robson classification.

Methods
A population-based, cross-sectional study was performed with routine registration data of live births in Brazil between 2012 and 2019. We used the Robson classification system to compare groups with expected high and low CS rates. We used propensity scores to compare CSs to vaginal deliveries (1:1) and estimated associations with early-term births using logistic regression.

Results
A total of 17,081,685 live births were included. Births via CS had higher odds of early-term birth (OR 1.32; 95% CI 1.32–1.32) compared to vaginal deliveries. Births by CS to women in Group 2 (OR 1.50; 95% CI 1.49–1.51) and 4 (OR 1.57; 95% CI 1.56–1.58) showed the highest odds of early-term birth, compared to vaginal deliveries. Increased odds of an early-term birth were also observed among births by CS to women in Group 3 (OR 1.30, 95% CI 1.29–1.31), compared to vaginal deliveries. In addition, live births by CS to women with a previous CS (Group 5 - OR 1.36, 95% CI 1.35–1.37), a single breech pregnancy (Group 6 - OR 1.16; 95% CI 1.11–1.21, and Group 7 - OR 1.19; 95% CI 1.16–1.23), and multiple pregnancies (Group 8 - OR 1.46; 95% CI 1.40–1.52) had high odds of an early-term birth, compared to live births by vaginal delivery.

Conclusions
CSs were associated with increased odds of early-term births. The highest odds of early-term birth were observed among those births by CS in Robson Groups 2 and 4.