bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variation, coordination, and trade-offs between needle structures and photosynthetic-related traits across five Picea species: consequences on plant growth
Authors: Wang Junchen , Ouyang Fangqun , An Sanping , Wang Lifang , Xu Na , Ma Jianwei , Wang Junhui , Zhang Hanguo , Kong Lisheng 
Published: May 2022

Abstract
Background
Picea species are distributed and planted world-wide due to their great ecological and economic values. It has been reported that Picea species vary widely in growth traits in a given environment, which reflects genetic and phenotypic differences among species. However, key physiological processes underlying tree growth and the influencing factors on them are still unknown.

Results
Here, we examined needle structures, needle chemical components, physiological characteristics and growth traits across five Picea species in a common garden in Tianshui, Gansu province in China: Picea glauca, P. mariana, P. likiangensis, P. koraiensis, and P. crassifolia, among which P. glauca and P. mariana were introduced from North America, P. likiangensis was from Lijiang, Yunan province in China, P. koraiensis was from Yichun, Heilongjiang province in China, and P. crassifolia was native to the experimental site. It was found that nearly all traits varied significantly among species. Tissue-level anatomical characteristics and leaf mass per area (LMA) were affected by needle size, but the variations of them were not associated with the variations in photosynthetic and biochemical capacity among species. Variations in area-based maximum photosynthesis (Pnmax) were affected by stomatal conductance (gs), mesophyll conductance (gm) and biochemical parameters including maximum carboxylation rate (Vcmax), and maximum electron transport rate (Jmax). The fraction of N allocated to different photosynthetic apparatus displayed contrasting values among species, which contributed to the species variations in photosynthetic nitrogen use efficiency (PNUE) and Pnmax. Additionally, all growth traits were positively correlated with Pnmax and PNUE.

Conclusion
Needle structures are less important than needle biochemical parameters in determining the variations in photosynthetic capacity across the five Picea species. Pnmax and PNUE are closedly associated with the fraction of N allocated to photosynthetic apparatus (Pphoto) compared with leaf N content per area (Narea). The tremendous growth differences among the five Picea species were substantially related to the interspecies variation in Pnmax and PNUE.
Association of neutrophil to lymphocyte ratio with preterm necrotizing enterocolitis: a retrospective case-control study
Authors: Mu Yuju , Wang Hua 
Published: May 2022

Abstract
Background
There have been few studies on the relationship between the neutrophil to lymphocyte ratio (NLR) and necrotizing enterocolitis (NEC). We conducted a retrospective case-control study to investigate this relationship in preterm neonates.

Methods
A total of 199 preterm neonates diagnosed with NEC between January 2018 and January 2020 were included in this study. For each preterm infant with NEC that was admitted to the neonatal intensive care unit (NICU), controls were preterm neonates (matched for gestation and year of birth) who were not diagnosed with NEC. Exclusion criteria were post-maturity, small or large for gestational age (week of pregnancy), congenital major anomalies, and cyanotic congenital heart disease. Univariate and multivariate logistic regression analyses were used to identify the association between NLR and preterm NEC.

Results
This study included 93 preterm neonates with NEC and 106 matched controls. There were no significant differences in gestational age (GA), birth weight (BW), age, sex, vaginal delivery (VD), chorioamnionitis (CA), and gestational diabetes mellitus (GDM) between the groups. Compared with the control group, the lower and higher NLR levels in the NEC group were statistically different. Following univariate analysis, NLR was a risk factor for NEC (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.00–1.90; P = 0.042), and according to multivariate analysis, risk factors for NEC were NLR ≥ 3.20 and NLR < 1.60, within 1 week before NEC diagnosis. Thus, NLR values of ≥ 1.60 and < 3.20 were determined as the predictive cut-off values for protecting preterm infants from NEC (Model I: OR, 0.20; 95% CI, 0.10–0.40; P < 0.001) and (Model II: OR, 0.10; 95% CI, 0.00–0.40; P < 0.001].

Conclusions
NLR ≥ 1.60 and NLR < 3.20 were associated with a decreased risk of NEC in preterm infants.
The assistance gaps in combating COVID-19 in Brazil: for whom, where and when vaccination occurs
Authors: Moreira Rafael da Silveira , Costa Emilly Guaris , dos Santos Lucas Fernando Rodrigues , Miranda Luiz Henrique Lélis , de Oliveira Raiany Rodrigues , Romão Ricardo Fusano , Cozer Rodolfo Ferreira , Guedes Sarah Cavalcanti 
Published: May 2022

Abstract
Background
Following the emergence of the COVID-19 pandemic, the number of infected Brazilian people has increased dramatically since February 2020, with Brazil being amongst the countries with the highest number of cases and deaths. Brazilian vaccination began in January 2021, aimed at priority groups. This study analysed the spatial and temporal evolution of vaccination in Brazil between the 3rd and 21st epidemiological weeks (EW) of 2021.

Methods
Spatial and temporal analyses were performed comprising 19 EW. Cases were structured into priority groups—elderly population (EP); healthcare workers (HW); indigenous and quilombola populations (I/Q), dose, vaccine (CoronaVac or AstraZeneca), and place of vaccination. A sweep test was performed to identify vaccination rate clusters. Vaccination rates (VR) were calculated according to a spatial window for each Health Region, indicating clusters above/below expected VR. Based on the discrete Poisson probability model, spatial analysis was performed to detect high/low VR clusters, which were converted into Kernel maps. Points were generated from SaTScan analyses associated with Health Region centroids. Temporal analysis of VR was carried out to identify significant trends, and results were converted into temporal cluster graphs. P-value ≤ 0.05 was adopted.

Results
Southeast region concentrated most of the vaccines of EP and HW, followed by the Northeast. The latter region had the largest contingent of I/Q vaccinated. In all priority age groups and all regions, a higher percentage of complete CoronaVac vaccination schedules were observed compared with AstraZeneca. The temporal analysis identified high VR clusters of CoronaVac first and second dose in the early weeks, except for the EP; of AstraZeneca first dose, only for HW in the early weeks, and for EP and I/Q in the final weeks; of AstraZeneca second dose for all priority groups in the final weeks. I/Q populations had the lowest general VR. The spatial profile of VR indicated significant regional cluster differences between the priority groups.

Conclusion
This study highlights the importance of establishing vaccination priority groups, considering the asymmetries that a pandemic can trigger, notably in vast geographic areas, to contemplate the main objective of vaccination: to prevent casualties.
Comparison of reader agreement, correlation with liver biopsy, and time-burden sampling strategies for liver proton density fat fraction measured using magnetic resonance imaging in patients with obesity: a secondary cross-sectional study
Authors: Cao Di , Li Mengyi , Liu Yang , Jin He , Yang Dawei , Xu Hui , Lv Han , Liu JIa , Zhang Peng , Zhang Zhongtao , Yang Zhenghan 
Published: May 2022

Abstract
Background
The magnetic resonance imaging (MRI)-based proton density fat fraction (PDFF) has become popular for quantifying liver fat content. However, the variability of the region-of-interest (ROI) sampling strategy may result in a lack of standardisation of this technology. In an effort to establish an accurate and effective PDFF measurement scheme, this study assessed the pathological correlation, the reader agreement, and time-burden of different sampling strategies with variable ROI size, location, and number.

Methods
Six-echo spoiled gradient-recalled-echo magnitude-based fat quantification was performed for 50 patients with obesity, using a 3.0-T MRI scanner. Two readers used different ROI sampling strategies to measure liver PDFF, three times. Intra-reader and inter-reader agreement was evaluated using intra-class correlation coefficients and Bland‒Altman analysis. Pearson correlations were used to assess the correlation between PDFFs and liver biopsy. Time-burden was recorded.

Results
For pathological correlations, the correlations for the strategy of using three large ROIs in Couinaud segment 3 (S3 3L-ROI) were significantly greater than those for all sampling strategies at the whole-liver level (P < 0.05). For inter-reader agreement, the sampling strategies at the segmental level for S3 3L-ROI and using three large ROIs in Couinaud segment 6 (S6 3L-ROI) and the sampling strategies at the whole-liver level for three small ROIs per Couinaud segment (27S-ROI), one large ROI per Couinaud segment (9L-ROI), and three large ROIs per Couinaud segment (27S-ROI) had limits of agreement (LOA) < 1.5%. For intra-reader agreement, the sampling strategies at the whole-liver level for 27S-ROI, 9L-ROI, and 27L-ROI had both intraclass coefficients > 0.995 and LOAs < 1.5%. The change in the time-burden was the largest (100.80 s) when 9L-ROI was changed to 27L-ROI.

Conclusions
For hepatic PDFF measurement without liver puncture biopsy as the gold standard, and for general hepatic PDFF assessment, 9L-ROI sampling strategy at the whole-liver level should be used preferentially. For hepatic PDFF with liver puncture biopsy as the gold standard, 3L-ROI sampling strategy at the puncture site segment is recommended.
Between commitment and avoidance – working age stroke survivors’ perceptions of physical activity and sedentary behaviour: a qualitative study
Authors: Roaldsen Kirsti S. , Walter Charlotte , Gäverth Johan , Dohrn Ing-Mari 
Published: May 2022

Abstract
Background
It is critical for stroke survivors in working age to develop skills and confidence for long-term self-management of physical activity and exercise training to maintain a healthy lifestyle and decrease the risk of recurrent stroke and other cardiovascular diseases. Still, knowledge is scarce about concerns and experiences of physical activity and sedentary behaviour after stroke in working age, and further qualitative studies are required. The aim of this study was to explore and describe perceptions of physical activity and sedentary behaviour in stroke survivors under 65 years who are living with disability.

Methods
A qualitative design with individual semi-structured interviews was selected to generate rich data. Ten informants aged 36–61 years were interviewed 0.5–25 years after their stroke. The interviews were analysed with qualitative content analysis, with an inductive and interpretive approach.

Results
A two-sided contradictory relationship to physical activity and sedentary behaviour was identified. The overarching theme found was “Physical activity and sedentary behaviour – between commitment and avoidance”, comprising three main themes; “Physical activity – medicine for body and mind”, “Physical activity reminds of limitations”, and “Sedentary behaviour – risk, rest, and alternative”. The informants perceived physical activity as medicine, important for both physical and mental functioning, but also as a constant reminder of having a body that no longer functions as it used to. These mixed perceptions and feelings influenced the informants’ behaviours related to physical activity and sedentary behaviour, and both commitment and avoidance were clear strategies.

Conclusions
Working age stroke survivors expressed a clear positive perception of the importance of physical activity for health. However, physical activity was also described as a strong reminder of limitations which paradoxically could lead to sedentary behaviour. To support a physically active lifestyle post stroke, effective interventions as well as health promotion, counselling and patient education are imperative. These should be delivered by appropriately skilled health care professionals.
Hypertension in obese children is associated with vitamin D deficiency and serotonin dysregulation
Authors: Krivošíková Katarína , Krivošíková Zora , Wsolová Ladislava , Seeman Tomáš , Podracká Ľudmila 
Published: May 2022

Abstract
Background
Obesity and hypertension represent serious health issues affecting the pediatric population with increasing prevalence. Hypovitaminosis D has been suggested to be associated with arterial hypertension. Serotonin by modulating nitric oxide synthase affect blood pressure regulation. The biological mechanism by which vitamin D specifically regulates serotonin synthesis was recently described. The aim of this paper is to determine the associations between vitamin D, serotonin, and blood pressure in obese children.

Methods
One hundred and seventy-one children were enrolled in the prospective cross-sectional study. Two groups of children divided according to body mass index status to obese (BMI ≥95th percentile; n = 120) and non-obese (n = 51) were set. All children underwent office and ambulatory blood pressure monitoring and biochemical analysis of vitamin D and serotonin. Data on fasting glucose, insulin, HOMA, uric acid, and complete lipid profile were obtained in obese children.

Results
Hypertension was found only in the group of obese children. Compared to the control group, obese children had lower vitamin D and serotonin, especially in winter. The vitamin D seasonality and BMI-SDS were shown as the most significant predictors of systolic blood pressure changes, while diastolic blood pressure was predicted mostly by insulin and serotonin. The presence of hypertension and high-normal blood pressure in obese children was most significantly affected by vitamin D deficiency and increased BMI-SDS.

Conclusions
Dysregulation of vitamin D and serotonin can pose a risk of the onset and development of hypertension in obese children; therefore, their optimization together with reducing body weight may improve the long-term cardiovascular health of these children.
Epidemiology and lifestyle survey of non-alcoholic fatty liver disease in school-age children and adolescents in Shenyang, Liaoning
Authors: Lin Guan , Xinhe Zhang , Haoyu Tian , Xing Jin , Dan Li , Ningning Wang , Jing Sun , Xue Wang , Zilu Zeng , Yiling Li 
Published: May 2022

Abstract
Background
Non-alcoholic fatty liver disease (NAFLD) is diagnosed increasingly in children and adolescents. We aimed to investigate the prevalence and related influencing factors of NAFLD in school-aged children and adolescents in Shenyang, Liaoning Province. Furthermore, we analyzed the relationship between lifestyle and fatty liver.

Methods
We conducted aprospective cohort study of 1309 school-aged children and adolescents between the ages of 7 and 18 years who underwent physical examination from November to December 2019. In addition, they were collected age, gender, learning stage, height, weight, BMI, waist circumference, hip circumference, and waist-hip ratio. Finally, a portion of the population was selected to complete a questionnaire survey to explore the impact of lifestyle habits on fatty liver disease.

Results
NAFLD was present in 23.83% of subjects. The prevalence of children and adolescents was 22.73% and 24.43%, respectively. Fatty liver prevalence differs significantly by gender and learning stages. The highest rate of fatty liver was seen in obese children (71.68%). Moreover, exercise, diet, and parental factors can affect children with fatty liver.

Conclusions
NAFLD is very prevalent in children and adolescents in Shenyang city. Due to the close relationship between NAFLD and obesity, lifestyle plays a major role in the occurrence of NAFLD.

Trial registration
The First Affiliated Hospital of China Medical University, [2020] 2020–258-2. Registered 6 June 2020—Retrospectively registered.
Early-onset neonatal sepsis and antibiotic use in Indonesia: a descriptive, cross-sectional study
Authors: Salsabila Khansa , Toha Nadira Mohammad Ali , Rundjan Lily , Pattanittum Porjai , Sirikarn Prapassara , Rohsiswatmo Rinawati , Wandita Setya , Hakimi Mohammad , Lumbiganon Pagakrong , Green Sally , Turner Tari 
Published: May 2022

Abstract
Background
Early diagnosis and prompt antibiotic treatment are crucial to reducing morbidity and mortality of early-onset sepsis (EOS) in neonates. However, this strategy remains challenging due to non-specific clinical findings and limited facilities. Inappropriate antibiotics use is associated with ineffective therapy and adverse outcomes. This study aims to determine the characteristics of EOS and use of antibiotics in the neonatal-intensive care units (NICUs) in Indonesia, informing efforts to drive improvements in the prevention, diagnosis, and treatment of EOS.

Methods
A descriptive study was conducted based on pre-intervention data of the South East Asia-Using Research for Change in Hospital-acquired Infection in Neonates project. Our study population consisted of neonates admitted within 72 h of life to the three participating NICUs. Neonates who presented with three or more clinical signs or laboratory results consistent with sepsis and who received antibiotics for 5 consecutive days were considered to have EOS. Culture-proven EOS was defined as positive blood or cerebrospinal fluid culture. Type and duration of antibiotics used were also documented.

Results
Of 2,509 neonates, 242 cases were suspected of having EOS (9.6%) with culture-proven sepsis in 83 cases (5.0% of neonatal admissions in hospitals with culture facilities). The causative organisms were mostly gram-negative bacteria (85/94; 90.4%). Ampicillin / amoxicillin and amikacin were the most frequently prescribed antibiotics in hospitals with culture facilities, while a third-generation cephalosporin was mostly administered in hospital without culture facilities. The median durations of antibiotic therapy were 19 and 9 days in culture-proven and culture-negative EOS groups, respectively.

Conclusions
The overall incidence of EOS and culture-proven EOS was high in Indonesia, with diverse and prolonged use of antibiotics. Prospective antibiotic surveillance and stewardship interventions are required.
Healthcare professionals’ experiences with education in short term medical missions: an inductive thematic analysis
Authors: Novak Milanka , Drummond Katharine , Kumar Arunaz 
Published: May 2022

Abstract
Background
Short-term medical mission (STMM) providers supplement healthcare delivery and education in low- and middle-income countries (LMIC). Despite numerous providers working in this space, the views of volunteers who contribute their time and skills to these programs are rarely sought.

Method
A qualitative study of 24 volunteers for Pangea Global Health Education (Pangea) was undertaken using semi-structured interviews to better understand their perspectives on program design and delivery, personal and professional outcomes of their volunteer experiences and the resulting implications for STMM program design. An inductive thematic analysis of their responses was completed. Social constructionist theory was utilised to contextualise themes and implications for program design.

Results
Participants highlighted the importance of co-creation with local learners and staff, the necessity to understand clinical context and the importance of relating to culture in the advancement of patient care. They reported personal growth, including a better understanding of others, and identifying commonalities between people. Professionally, participants reported learning from their colleagues, including new medical content, as well as refining their teaching practices. They also reported learning from those they taught and respecting the resourcefulness of medical and nursing staff working in LMIC.

Conclusion
STMM providers may benefit from co-creation with their learners in the development of health professional education programs. A deep understanding of local context and culture provides for a richer learning environment and enables sustainable long-term program delivery. Utilising a social constructionist framework enables a better understanding of cultural barriers, which inhibit group learning, including the tendency to maintain hierarchical divides; addressing these will allow for optimised patient care.
Current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China: a cross-sectional study
Authors: Liu Siqi , Zhao Hongyan , Fu Jingjing , Kong Dehui , Zhong Zhu , Hong Yan , Tan Jing , Luo Yu 
Published: May 2022

Abstract
Background
The rapid development of digital health has reduced the time and cost of medical treatment, bringing efficient and economical benefits. However, older adults all over the world are deficient in digital health knowledge and skills to varying degrees. This study intends to investigate the current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China, so as to provide theoretical reference for global digital health researches and the construction of gerontological digital health service models.

Methods
A cross-sectional survey was conducted from September 2020 to April 2021 in Chongqing, China. 572 community-dwelling older adults (≥ 65 years) were surveyed by stratified sampling. Data on sociodemographic characteristics, Internet usage, attitude towards Internet health information and digital health literacy were collected. Wherein, the digital health literacy assessment adopted the Digital Health Literacy Assessment Scale for community-dwelling older adults, which was developed by the research group, proven to be with good internal consistency (0.941), split-half reliability (0.889), test–retest reliability (0.941), content validity (0.967), criterion validity (0.938) and construct validity. The influencing factors were explored by univariate analysis and multiple linear regression analysis.

Results
The average score of digital health literacy was 37.10 (SD 18.65). Univariate analysis showed that there were statistically significant differences in the comparison of digital health literacy according to 16 variables, such as different age and education levels. Multiple linear regression analysis showed that education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health literacy, while age and perceived risk were negatively correlated with digital health literacy.

Conclusion
The overall digital health literacy of community-dwelling older adults in Southwest China is relatively low. In the future, health professionals should fully consider the diverse influencing factors of digital health literacy, assess individual differences and provide targeted intervention programs. Meanwhile, global public health authorities should integrate health resources effectively, and seek health service models for older adults in line with the development of the digital age to narrow the digital divide.