bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subjective and objective assessment of sleep quality during each trimester of pregnancy: a prospective observational study
Authors: Kiyoko Miyauchi , Takayuki Abe , Kaoru Fujimoto , Junko Tabata , Kiwamu Ohtaka , Kazuya Makita 
Published: December 2022

Abstract
Background
Sleep disturbances due to hormonal imbalance are common during pregnancy. Studies have suggested that poor sleep quality in pregnant women can lead to perinatal abnormalities; therefore, the need of the hour is to determine the actual circumstances of sleep during pregnancy from an early stage, and provide support for better sleep quality. Therefore, the present study aimed to assess sleep quality by objective assessment using an actigraph and subjective assessment using a questionnaire for sleep during each trimester of pregnancy, and to elucidate how sleep quality changed from the first to the third trimester of pregnancy.
Methods
A longitudinal questionnaire survey and sleep measurements using actigraph were conducted at three time points, during the first, second, and third trimester, of pregnancy for primiparous women who had conceived naturally.
Results
During the first trimester of pregnancy, there was no “feeling of being refreshed when waking up in the morning,” and there was a decline in mental function. During the second trimester of pregnancy, a positive correlation between morning sickness and sleep quality (r = 0.59, p = 0.001) was observed. Sleep quality was the worst during the third trimester, with the shortest total sleep time (382.6 ± 26.3 min, F = 11.7, p = 0.0001) and poor sleep efficiency (93.9%±3.2%, F = 4.1, p = 0.0029). Physical function score was also poor. Regarding minor troubles that affected sleep efficiency, back pain (r = 0.47, p = 0.03) and leg cramps (r = 0.57, p = 0.01) exhibited significant correlation with sleep efficiency in the third trimester of pregnancy.
Conclusions
Poor sleep during pregnancy begins from the first trimester; if minor troubles such as morning sickness continue in the second trimester, sleep quality is greatly affected. Furthermore, during the third trimester of pregnancy, low back pain and leg cramps are more likely to occur due to the increase in the abdominal area, and may interfere with sleep.
A pilot study to assess the impact of Aboriginal and Torres Strait Islander cultural humility webinars on Australian medical school students
Authors: Buhagiar Ryan , Lu Anton , Liu Sue , Sahadevan Shrida , Schulz Lucy May , Ghosh Joydeep , Yeoh Alexandra 
Published: December 2022

Abstract
Background
The Aboriginal and Torres Strait Islander Health Curriculum Framework has provided evidence-based support to higher education providers to deliver safe and well-informed cultural humility education. However, there is currently a scarcity of evidence surrounding the efficacy and impact of cultural humility education. This study will contribute to a quality evidence base assessing the impact of cultural humility and responsiveness interventions on Australian medical students.
Methods
A pilot study was conducted following a group of Australian medical students who attended an educational Indigenous health (IH) culturally responsive webinar. Recruitment was conducted via the webinar hosts’ social media pages. One pre-webinar and two post-webinar questionnaires were sent to attendees. To assess participants’ retention of information one post-webinar survey was sent out immediately after the webinar and another three months after the webinar. These questionnaires were designed to reflect pre-determined learning objectives for the webinar. A focus group was selected from the pool of participants for a qualitative analysis of the webinar’s impact.
Results
Twenty-six participants were included in the final analysis. Most of the participants were clinical students between 18–24 years old who did not identify as Aboriginal and/or Torres Strait Islander. There was an insignificant increase (p = 0.196) in mean participant total score from pre-intervention (M = 0.45, SD = 0.11) to the immediate post-intervention score (M = 0.48, SD = 0.13). However, stratification based on learning outcomes showed some improvement between pre- and immediate post-webinar knowledge for one learning outcome exploring the links between health and education.
Conclusions
There was a significant increase in knowledge and understanding for the learning outcome that explored the links between health and education. We attribute this partly to the engaging and conversational delivery style of the webinar presenters. The importance of facilitators that encourage reflective teaching should not be understated. Our results highlight the unequivocal potential that cultural humility webinars can have on medical students’ understanding of the Aboriginal and/or Torres Strait Islander health landscape. This pilot study warrants further research on a larger population.
Gamification in laparoscopic training: a randomized, controlled study
Authors: Zwimpfer Tibor Andrea , Wismer Claudine , Geissler Franziska , Oehler Robert , Geiger James , Schötzau Andreas , Fellmann-Fischer Bernhard , Heinzelmann-Schwarz Viola 
Published: December 2022

Abstract
Background: The gamification of laparoscopy using physical computing is an attempt to incentivize training and generate data for analysis. Here, we evaluate a laparoscopic dexterity game box (LDGB) in a pelvitrainer model for laparoscopic training by comparing the performance of the validated Laparoscopic Skills Training and Testing 3 (LASTT 3) exercise from the Gynaecological Endoscopic Surgical Education and Assessment (GESEA) program.
Methods: Sixty medical students with no experience in laparoscopy were randomized into three groups with 20 participants in each. All three groups performed four runs of the validated LASTT 3 exercise. Group A completed 40 runs with the LDGB, Group B completed 20 runs, and Group C completed no runs. Task completion time and the number of errors made were recorded. The Wilcoxon test and mixed-effects models were used to analyze the results. After completing the exercises, participants answered questions concerning the LDGB and their performance.
Results: The students improved their performance after using the LDGB. They were significantly faster at performing the LASTT 3 exercise using the LDGB, with a mean difference of 40s (P=0.013) between Group A (185s) and Group C (225s), and 26s (P=0.105) between Group B (199s) and Group C (225s). There were no significant differences between the mistakes made. The students were significantly faster (P<0.001) in completing the LDGB exercise during a second repetition, with fewer mistakes made (P<0.001). The LDGB was rated as intuitive by 86.4% of the participants.
Conclusions: Students using the LDGB achieved better results in the GESEA exercise. These benefits were accompanied by subjective advantages noted by the students. Gamification presents an opportunity to improve laparoscopic performance.
Integrative analysis the characterization of LAMBs in predicting the prognosis and the immunotherapy response of cancers
Authors: Tao Yong , Yuan Danping , Shi Yijiu , Cao Yuepeng , Liu Minmin 
Published: December 2022

Abstract
Background:
Laminin subunit betas (LAMBs) are the major noncollagenous constituent of basement membranes that implicated in biological functions such as cell adhesion, metastasis. However, few studies have systematically analyzed the prognostic value and immune characteristics of LAMBs in pan-cancer types.
Methods:
A pan-cancer comprehensive analysis of LAMBs in expression levels, protein localization, structure, mutations and methylation were explored. Next, Cox regression and Kaplan-Meier method were applied to analyze the prognostic role of LAMBs in pan-cancer. Protein-Protein Interaction (PPI) analysis was performed in the GeneMANIA database, and enrichment analysis was predicted signaling pathways were identifified by using Gene Ontology (GO), Kyoto Encyclopedia of Genes (KEGG) and gene set variation analysis (GSVA) analysis. The immune characteristics of LAMBs in the tumor microenvironment were evaluated via ImmuCellAI and TIMER 2.0. was the main platform to investigate the tumor associated macrophages (TAMs) related to LAMBs in pan-cancer, especially M2-like TAMs. In addition, single-cell sequencing analysis and tracking tumor immunophenotype (TIP) were also conducted to validate the interaction immune role of LAMBs with macrophages in cancers. Furthermore, the immunoregulators, tumour mutational burden (TMB) and microsatellite instability (MSI) was performed to evaluate the immune response role of LAMBs in cancers. Finally, the immunotherapy response and drug sensitive small molecule drugs based on LAMBs expression were predicted.
Results:
The expression, mutation and methylation of LAMBs was aberrantly expressed in most cancer types and exhibited prognosis predictive ability in various cancers. In addition, our results also showed that LAMBs was signifificantly correlated with immune-activated (including pathways and biological processes), immune cell infifiltrations, immunoregulator expressions, TMB and MSI. Importantly, analysis of an independent immunotherapy cohorts revealed that low-risk patients had better immunotherapy responses and prognosis than high-risk patients in some cancers. Furthermore, the immunotherapy response and sensitive small molecule drugs which correlate with LAMBs expression in different cancer types, had a potent capability to predict immunotherapy response in pan-cancers.
Conclusions:
LAMBs expression may contribute to increased infiltration of TAMs, which not only acted as a potent prognostic factor to predict the clinical outcomes of cancer patients but was also a promising immunotherapy predictive biomarker for cancer patients treated with immune-checkpoint inhibitors (ICIs).
Risk factors for poor outcomes of mechanical thrombectomy after anterior circulation large vessel occlusion-related acute ischemic strokes
Authors: Li Jinze , Duan Jinfeng , Zhang Luojin , Xu Zhihua , Yang Benqiang , Li Xiaoqiu , Duan Yang 
Published: December 2022

Abstract
METHODS
Patients (N = 313) undergoing MT within a specified time window after onset of ACLVO-related AIS provided clinical and radiologic data for analysis. Clinical endpoints were symptomatic intracranial hemorrhage (sICH) and 90-day functional outcome (scored by modified Rankin Scale [mRS]). Logistic regression was invoked to identify links between clinical/radiologic parameters and clinical outcomes.
RESULTS
Mean age of patients was 64.0 ± 12.2 years, and women accounted for 29.4%. The median National Institute of Health Stroke Scale [NIHSS] score was 15.2 (interquartile range [IQR]: 12–18). In multivariable analysis, initial Alberta Stroke Program Early CT Score (ASPECTS) determination (odds ratio [OR] = 0.748, 95% confidence interval [CI]: 0.604–0.926; p = 0.008), hyperdense middle cerebral artery sign (HMCAS) (OR = 0.463, 95% CI: 0.238–0.899; p = 0.023), early imaging signs of infarct (OR = 2.837, 95% CI: 1.285–6.263; p = 0.01), baseline NIHSS score (OR = 1.195,95% CI: 1.091–1.309; p < 0.001), age (OR = 1.082,95% CI:1.047–1.118; p < 0.001), and glycosylated hemoglobin (HbA1c) concentration (OR = 1.293, 95% CI: 1.084–1.543; p = 0.004) proved independently predictive of poor clinical outcomes (mRS scores > 2).
CONCLUSIONS
A number of factors, including initially determined ASPECTS, HMCAS, early imaging signs of infarct, baseline NIHSS score, age, and HbA1c concentration, appear to predict poor outcomes of MT after ACLVO-related AIS.
Uncertainty and probability in neonatal end-of-life decision-making: A mixed method study analysing conversations with families of critically ill newborns
Authors: Limacher Regula , Fauchère Jean-Claude , Gubler Deborah , Hendriks Manya Jerina 
Published: December 2022

Abstract
Background: A significant number of critically ill neonates face potentially adverse prognoses and fulfil the criteria for perinatal palliative care. When counselling parents about the critical health condition of their child, neonatal healthcare professionals require extensive skills and competencies in palliative care and communication. Thus, this study aimed to investigate the communication patterns and contents between neonatal healthcare professionals and parents of neonates with life-limiting or life-threatening conditions regarding treatment options such as curative and palliative care in the decision-making process.
Methods: A mixed methods research design was employed with a qualitative and quantitative approach to analysing audio-recorded conversations between neonatal team and parents.Eight critically ill neonates and a total of 16 conversations from two Swiss level III neonatal intensive care units were included.
Results:Three main themes were identified: the weight of uncertainty in diagnosis and prognosis, the decision-making process, and palliative care. Uncertainty was observed to impede the discussion about all options of care, including palliative care. Regarding decision-making, neonatologists oftentimes conveyed to parents that this was a shared endeavour. However, parental preferences were not ascertained in the conversations analysed. In most cases, healthcare professionals were leading the discussion and parents expressed their opinion reactively to the information or options received. Only few couples proactively participated in decision-making. With regards to palliative care, oftentimes the continuation of therapy was the preferred course of action of the healthcare team and the option of palliative care was not mentioned. However, once the option for palliative care was raised, the parents' wishes and needs regarding the end-of-life care of their child were obtained, respected, and implemented by the team.
Conclusion: Although shared decision-making was a familiar concept in Swiss neonatal intensive care units, parental involvement in the decision-making process illustrated a somewhat different and complex picture. Strict adherence to the concept of certainty might impede the process of decision-making, thereby not discussing palliation and missing opportunities to include parental values and preferences.
Fragile X Messenger Ribonucleoprotein 1 (FMR1), a novel inhibitor of osteoblast/osteocyte differentiation, regulates bone formation, mass, and strength in young and aged male and female mice.
Authors: Plotkin Lilian , Deosthale Padmini , Balanta-Melo Julian , Creecy Amy , Liu Chongshan , Marcial Alejandro , Morales Laura , Cridlin Julita , Robertson Sylvia , Okpara Chiebuka , Sanchez David , Ayoubi Madhi , Lugo Joaquin , Hernandez Christopher , Wallace Joseph 
Published: December 2022

Abstract
Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene premutations lead to fragile X syndrome, cognitive disorders, and, in some individuals, scoliosis and craniofacial abnormalities. Four-month-old male FMR1-deficient mice exhibit a mild increase in cortical and cancellous femoral bone mass. However, consequences of FMR1-deficiency in bone of young and aged and of male and female mice and the cellular basis of the skeletal phenotype remain unknown. We found that FMR1-deficiency results in improved bone properties with higher bone mineral density in both sexes and in 2- and 9-month-old mice. But cancellous bone mass is higher only in females, whereas, cortical bone mass is higher in 2- and 9-mo males, but higher in 2- and lower in 9-month-old female FMR1-deficient mice. Further, male bones show higher biomechanical properties in 2-month-old, and females at both ages. FMR1-deficiency increases osteoblast number, mineralization, and bone formation and osteocyte dendricity and gene expression in vivo, ex vivo, and in vitro, without affecting osteoclasts in vivo or ex vivo. Thus, FMR1 is a novel osteoblast/osteocyte differentiation inhibitor, and its absence leads to age-, site- and sex-dependent higher bone mass and strength.
Post Introduction Evaluation of the Malaria Vaccine Implementation Programme in Ghana, 2021
Authors: Adjei Michael Rockson , Amponsa-Achiano Kwame , Okine Rafiq , Tweneboah Peter Ofori , Sally Emmanuel Tetteh , Dadzie John Frederick , Osei-Sarpong Fred , Adjabeng Michael Jeroen , Bawa John Tanko , Bonsu George , Antwi-Agyei Kwadwo Odei , Kaburi Basil Benduri , Owusu-Antwi Felicia , Juma Elizabeth , Kasolo Francis Chisaka , Asiedu-Bekoe Franklin , Kuma-Aboagye Patrick 
Published: December 2022

Abstract
Background
Malaria remains a public health challenge in Sub-Saharan Africa with the region contributing to more than 90% of global cases in 2020. In Ghana, the malaria vaccine was piloted to assess the feasibility, safety, and its impact in the context of routine use alongside the existing recommended malaria control measures. To obtain context-specific evidence that could inform future strategies of introducing new vaccines, a standardized post-introduction evaluation (PIE) of the successes and challenges of the malaria vaccine implementation programme (MVIP) was conducted.
Methods
From September to December 2021, the WHO Post-Introduction Evaluation (PIE) tool was used to conduct a mix method evaluation of the pilot introduction of the malaria vaccine in Ghana. To ensure representativeness, study sites and participants from the national level, 18 vaccinating districts, and 54 facilities from the seven pilot regions were purposively selected. Data was collected using a questionnaire based on the PIE tool. We performed summary descriptive statistics on quantitative data, thematic analysis on qualitative data, and triangulation of the results from both sets of analyses.
Results
About 90.7% (49/54) of health workers stated that the vaccine introduction process was smooth and contributed to an overall improvement of routine immunization services. About 87.5% (47/54) of healthcare workers, and 95.8% (90/94) of caregivers accepted RTS,S malaria vaccine. Less than half [46.3%; (25/54)] of the healthcare workers received training prior to the introduction but almost all [94.4%; (51/54)] were able to constitute and administer the vaccine appropriately. About 92.5% (87/94) of caregivers were aware of the RTS,S introduction but only 44.0% (44/94) knew the number of doses needed for maximum protection. The initial phase was characterized by low vaccine uptake due to caregiver hesitancy, but coverage improved steadily over the pilot period.
Conclusions
The malaria vaccine has been piloted successfully in Ghana. Intensive advocacy; community engagement, and social mobilization; and regular onsite supportive supervision are critical enablers for successful introduction of new vaccines. Stakeholders are convinced of the feasibility of a nationwide scale up using a phased subnational approach taking into consideration malaria epidemiology and global availability of vaccines.
Seasonal Evaluation of Eastern Mediterranean Basin Ephemeroptera (Insecta) Fauna and Water Quality with Physicochemical Parameters and Benthic Metrics
Authors: ÖZTÜRK Selda , ÇİÇEK Erdoğan , NEGİZ Mehmet Güvenç , KOYUNCUOĞLU Serdar 
Published: December 2022

Abstract
In this study, it is aimed to reveal the ecological water quality of the stations by evaluating the Eastern Mediterranean Basin Ephemeroptera fauna and water quality through the physicochemical variables at the determined stations and the benthic metrics developed for the Eastern Mediterranean Basin. For this purpose, field studies were carried out by determining 20 different localities in the spring, summer and autumn seasons in 2019. A total of 965 individuals were examined and 17 species belonging to seven families were identified. Species diversity at stations is highest and lowest, respectively, according to Shannon-Wiener (H) values; in the spring period at the 6th (1.55) and 9th (0.15) stations, in the summer period at the 15th (1.46) and 9th (0.29) stations, in the autumn period at the 12th (1.01) and 3rd (0.22) stations were calculated. According to cluster cluster analysis; while the highest similarities were calculated (100%) between the 1st, 2nd, 8th stations and the 10th and 19th stations, including the same species, it was determined that the 18th station differed from all other stations. According to ANOSIM results; while a significant difference was observed between the spring and summer and autumn seasons in terms of the distribution of the species, no significant difference was found between the summer and autumn seasons. According to the MANOVA result, while there was no significant difference between the spring and autumn seasons in terms of temperature variable, it was found to be significant in other seasons combinations. While the pH variable created a significant difference between summer and autumn seasons, it did not make a difference in other seasons combinations. Dissolved oxygen and total nitrogen variables showed significant differences in all season combinations. In terms of the final index results calculated on benthic metrics; determined the 1st, 9th, 11th, 13th, 18th and 20th stations were moderate, the 7th and 8th stations were poor, while all other stations were good or high water quality.
Customizing the structure and chemical composition of ultralight carbon foams for superior microwave absorption performance
Authors: Cheng Tingting , Guo Yuying , Xie Yuxin , Zhao Laibin , Wang Ting , Meng Alan , Li Zhenjiang , Zhang Meng 
Published: December 2022

Abstract
Developing biomass-derived three-dimensional porous carbon materials (porous carbon foam, PCF) has become a common strategy to obtain lightweight and efficient electromagnetic microwave-absorbing materials. Without the introduction of a template and subsequent activation process, several ultra-lightweight honeycomb PCF samples were successfully prepared from dried ballonflower (DB) by simple calcination, and the calcination temperature plays a decisive role in regulating the pore size, composition and microwave absorption properties of PCF samples. Furthermore, it is worth noting that different cutting directions also affected the hole size of the PCF sample as well as the microwave absorption performances. Under the combined effects of multiple reflections and scattering of PCF porous structure, dipole polarization of abundant heterogeneous atoms and good conductive loss of carbon material, the vertical cutting sample PCF-900V exhibits optimal microwave absorption performances with the minimal reflection loss (RLmin) value of -46.95 dB at 1.46 mm thickness and the effective absorption bandwidth (EAB) value of 5.52 GHz at 1.72 mm matching thickness respectively, indicating its great potential application as a promising lightweight and efficient microwave absorbing material.
Clinical Observation of Tear Film Breakup Time with A Novel Smartphone-Attachable Technology
Authors: Zhang Xiaoran , Shen Jiawei , Kang Zhen , Chene Andrew , Cao Qian , Xue Chunyan 
Published: December 2022

Abstract
Purpose
To demonstrate the practicability of a portable instrument in assessing tear film breakup time (TFBUT): a lens attachment for smartphones (LAS).
Methods
By applying LAS in combination with the iPhone 12 pro, and a recordable slit-lamp microscope, we obtained TFBUT videos from 58 volunteers. The comparison between the conventional slit-lamp microscope and LAS by an experienced ophthalmologist. Moreover, we also invited an ophthalmic postgraduate student and an undergraduate student with no clinical experience to assess TFBUT in those videos. The inter-observer reliability was assessed using intraclass correlation coefficients (ICC).
Results
The TFBUT of 116 eyes in total was recorded. Reliability indexes were adequate. The Spearman’s correlation analysis suggested a strong correlation between the 2 modalities (Spearman’s r = 0.941, 95% confidence interval [CI] = 0.906–0.963). The average intraclass correlation coefficient showed a substantial agreement among the 3 observers (LAS ICC = 0.911, p < 0.005; slit-lamp microscope ICC = 0.895, p < 0.005). A high concordance was observed in TFBUT, when assessed by an ophthalmologist and an ophthalmic postgraduate student (LAS ICC = 0.949, p < 0.005; slit-lamp microscope ICC = 0.940, p < 0.005).
Conclusions
Compared with the conventional slit-lamp microscope, the LAS has sufficient validity for evaluating TFBUT in clinics or at home.