bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lupus nephritis randomised controlled trials: evidence gaps and under-represented groups
Authors: Nordmann-Gomes Alberto , Cojuc-Konigsberg Gabriel , Hernández-Andrade Adriana , Navarro-Sánchez Valeria , Ramírez-Sandoval Juan Carlos , Rovin Brad , Mejia-Vilet Juan M 
Published: December 2024

ObjectiveWe performed a scoping review of randomised clinical trials (RCTs) assessing pharmacological therapies for the initial management of lupus nephritis (LN), focusing on study design, included populations and outcome definitions, to assess the generalisability of their results and identify gaps in the evidence.MethodsRCTs evaluating pharmacological interventions for the initial therapy of LN published between 2000 and 2024 were evaluated. Extracted variables included study design, selection criteria, outcome definitions, populations recruited and clinical characteristics of participants. Each study arm was included as intervention and segregated into guideline-recommended regimens (cyclophosphamide (CYC), mycophenolic acid analogues (MPAAs), calcineurin inhibitors and belimumab) or other regimens. Data were analysed by descriptive statistics, and Fragility Index (FI) was estimated to assess robustness of studies.ResultsWe included 124 intervention arms within 61 RCT, involving 7058 participants. Seventy-nine arms (63.7%) corresponded to guideline-recommended therapies: 33 (26.6%) MPAA, 28 (22.6%) NIH-CYC and 7 (5.6%) triple-drug therapies. While 100% of triple-drug therapies RCT were multinational, only 7.1% of NIH-CYC and 0% of tacrolimus RCTs were conducted in more than one country. Only 9 (14.8%) had follow-up ≥24 months. Ten (16.4%) RCTs exclusively included participants with severe or refractory LN. Only 29 (47.5%) reported serious adverse events, and few described patient-reported outcomes. Black and other race participants were under-represented, as well as participants from Middle East, North Africa, and the sub-Saharan African region. Response was variably defined and assessed at different intervals. Robustness of RCTs evaluating double-drug guideline-recommended therapies were mostly low, with FI ranging from 1 to 3.ConclusionsConsidering new recommendations for the management of LN, we call for broader inclusion of under-represented populations and homogenisation of study design. This study provides the rationale for evaluating unexplored treatment comparisons and conducting research on newer interventions in clinical settings where evidence is currently lacking.
Generalized uncertainty principle corrections in Rastall–Rainbow Casimir wormholes
Authors: Battista Emmanuele , Capozziello Salvatore , Errehymy Abdelghani 
Published: December 2024

Abstract
We explore wormhole solutions sourced by Casimir energy density involving generalized uncertainty principle corrections within the framework of Rastall–Rainbow gravity. The questions of traversability and stability, as well as the presence of exotic matter, are carefully investigated. In particular, the stability issue is addressed via an approach that has not been previously employed in the context of wormholes. This method, which represents an improved version of the so-called Herrera cracking technique, has the potential to yield novel insights in the field of wormhole geometries.
Case 336
Authors: Boitsios Grammatina , Aeby Alec , Andrei Alina Mihaela 
Published: December 2024

History A 10-month-old female infant, who was second-born, was referred for progressive macrocephaly, axial hypotonia, developmental delay, and limb stiffness. Birth had occurred at 41 weeks, after an uneventful pregnancy and delivery, to nonconsanguineous parents. Noticeably, the child could not hold her head up at 4 months or sit at 10 months of age. Her vocalizations were modulated to express contentment or anger, without developmentally appropriate babbling. Neurologic examination revealed poor visual contact, progressive macrocephaly, substantial axial hypotonia, and limb stiffness with brisk osteotendinous reflexes, suggestive of spastic diplegia. No swallowing difficulties or seizures were reported, and long-term electroencephalographic monitoring revealed no abnormalities. The patient underwent 3-T MRI (Siemens Healthineers) of the brain, including morphologic sequences and spectroscopy ( Figs 1 – 4 ), under general anesthesia with and without gadolinium-based contrast media administration (Dotarem; Guerbet).
Self‐Expandable Metal Stent for Palliation of Dysphagia in Cancer Esophagus at a Tertiary Care Center of North‐East India: A Prospective Study
Authors: Kundalia Rohin , Kodali Revanth Kumar , Deka Dibyajyoti , Talukdar Abhijit , Jyoti kalita Deep , Das Gaurav , Sharma Shivaji , Malhotra Mohit 
Published: December 2024

Background and Aim: Esophageal cancer is the sixth most common cancer in India with a incidence of around 4.5%. Dysphagia is the primary manifestation of advanced esophageal cancer in 80%–90% of patients. Dysphagia is one of the most distressing and debilitating symptom for the patients. The use of self‐expanding metallic stents (SEMS) has revolutionized the treatment of dysphagia in esophageal cancer patients. This study aims to assess the role of SEMS in the palliation of dysphagia in patients with esophageal cancer.Methods: This was a single‐center, prospective observational study conducted in the Department of Surgical Oncology at Dr. B. Borooah Cancer Institute in Guwahati, India, from April 2019 to March 2020. Patients were assessed after stent placement for improvements in dysphagia, pain relief, nutritional status, and associated complications.Results: One week after stent placement, 65.3% of patients were able to tolerate semisolid food and 6.1% could tolerate solids. Prior to stent insertion, 87.8% had Grade 4 dysphagia, but at 6 months post‐SEMS placement, 90.2% had only Grade 1 dysphagia. This represented a statistically significant improvement in the dysphagia grade, with a p value less than 0.0001. Further analysis using ANOVA and paired t‐tests showed significant improvements in weight, body mass index (BMI), and serum albumin at 1, 3, and 6 months after stent placement, with p values less than 0.001.Conclusion: The results of this study demonstrated that the placement of SEMS is a safe and effective palliative intervention for management of dysphagia in carcinoma esophagus, leading to improvements in patient nutrition and quality of life, with relatively few associated complications.
Modeling the Mutation and Competition of Certain Nutrient-Producing Protocells by Means of Specific Turing Machines
Authors: Kicsiny Richárd , Hufnagel Levente , Lóczi Lajos , Székely László , Varga Zoltán 
Published: December 2024

Abstract
It is very important to model the behavior of protocells as basic lifelike artificial organisms more and more accurately from the level of genomes to the level of populations. A better understanding of basic protocell communities may help us in describing more complex ecological systems accurately. In this article, we propose a new comprehensive, bilevel mathematical model of a community of three protocell species (one generalist and two specialists). The aim is to achieve a model that is as basic/fundamental as possible while already displaying mutation, selection, and complex population dynamics phenomena (like competitive exclusion and keystone species). At the microlevel of genetic codes, the protocells and their mutations are modeled with Turing machines (TMs). The specialists arise from the generalist by means of mutation. Then the species are put into a common habitat, where, at the macrolevel of populations, they have to compete for the available nutrients, a part of which they themselves can produce. Because of different kinds of mutations, the running times of the species as TMs (algorithms) are different. This feature is passed on to the macrolevel as different reproduction times. At the macrolevel, a discrete-time dynamic model describes the competition. The model displays complex lifelike behavior known from population ecology, including the so-called competitive exclusion principle and the effect of keystone species. In future works, the bilevel model will have a good chance of serving as a simple and useful tool for studying more lifelike phenomena (like evolution) in their pure/abstract form.
Effects of Migration on Farm Labour among Rice Farmers in Mamou Prefecture, Guinea Conakry
Authors: Thomas Kehinde Adesina , Oyebode Lukman Abiodun , Toure Siaka 
Published: December 2024

Abstract
One of the critical assets directed at agricultural production is labour. In this context, the effects of migration on farm labour among rice farmers in Mamou Prefecture, Guinea Conakry, were assessed. To achieve this goal, 140 respondents were sampled using a multi-stage sampling procedure. Both descriptive and inferential statistics were used to analyse the data to present results and test for correlation between ranked variables. Prominent among the push factors responsible for farm labour migration were poverty (

, sd = 0.83), poor healthcare services (

, sd = 0.74) and unemployment

sd = 0.61),) while good government policies (

, sd = 0.75) and food security (

, sd = 0.63) were the pull factors. The highest-ranked migration types with effects on farm labour migration were short term (

, sd = 0.45), internal (

, sd = 0.78) and individual (

, sd = 1.45) migration. Farm labour was unavailable (77.1%) in the study area on a cumulative scale. There was an inverse relationship between unemployment (rho = −0.019, p = 0.024), method of land preparation (rho = −0.219, p = 0.009), marital status (rho = −0.178, p = 0.036), family/friends (rho = −0.184, p = 0.030) and farm labour availability, whereas the relationship was direct for the availability of raw materials for production (rho = 0.240, p = 0.004) and farm labour availability. The enacting and sustaining of enabling government policies to improve the livelihoods and the intensifying of agricultural mechanisation are recommended in order to stem migration and sustain farm labour availability.
AI Integration in Biology Education: Comparative Insights into Perceived Benefits and TPACK among South African and Indonesian Pre-service Teachers
Authors: Mnguni Lindelani , Nuangchalerm Prasart , El Islami R. Ahmad Zaky , Sibanda Doras , Ramulumo Moleboheng , Sari Indah Juwita 
Published: December 2024

Abstract
The integration of Artificial Intelligence (AI) in biology education offers transformative potential, yet teacher preparedness for AI remains under-researched. This study explores the perceived benefits of AI integration and self-reported Technological Pedagogical Content Knowledge (TPACK) among pre-service biology teachers from a South African university (n = 62) and an Indonesian university (n = 51). Using a comparative survey design, data were collected via an online questionnaire. Indonesian participants reported higher Technological Knowledge and Technological Pedagogical Knowledge levels, though both groups viewed AI integration positively, with no significant differences in perceived benefits. Among Indonesian participants, Technological Knowledge strongly correlated with perceived benefits, especially for peer collaboration. These findings highlight the importance of tailored teacher training and equitable technological resource allocation to enhance AI integration in biology education. The study underscores the critical role of technological and pedagogical knowledge in fostering positive attitudes toward AI adoption in diverse educational settings.
The Use of Educational Technology (Ed Tech) to Improve Student’s Learning Rational Functions: Conceptual and Procedural Understanding
Authors: Bekene Bedada Tola 
Published: December 2024

Abstract
The purpose of this study was to ascertain how teaching rational function to students using the GeoGebra and cycle model affected their conceptual and procedural comprehension. To achieve the purpose, the study used a quasi-experimental pre-posttest design with a quantitative methodology. Thirty four learners in grade eleven in Ethiopia school comprised the study’s sample, of which sixteen were in the experimental (eg) and eighteen were in the control groups (cg). The data obtained from pretest and post-test were analyzed using spss v.20. The study showed that difference between the eg’s and cg’s achievement was statistically significant, with the eg’s effect size being 0.38 and the cg’s being 0.544 following procedural and conceptual interventions, respectively. The study advise Ethiopian schools should embrace GeoGebra software in conjunction with the three theories through a continuous special capacity building approach, keeping in mind the software’s limitations and constraints as these results are in line with international research.
Benchtop centrifugation: An effective method for reducing lipaemia associated interference in grossly lipaemic samples?
Authors: Hall James L. , Carlton Henry C. , Shipman Kate E. 
Published: December 2024

Background Grossly lipaemic samples are a significant cause of analytical errors, potentially impacting patient care. The causes of lipaemia are varied and often unavoidable, while methods to reduce lipaemia through gold-standard ultracentrifugation are limited by availability, transportation and cost. Benchtop centrifugation has been proposed as an alternative method to reduce lipaemia. Methods Fifty-three grossly lipaemic serum samples (lipaemia >201.8 mg/dL) that were unsuitable for analysis were selected and centrifugated at 18840 g for different time-periods with lipaemia measured prior to and after centrifugation. Core analytes were measured on serum samples free of lipaemia before and after 30 min of centrifugation at 18840 g to assess the effect of the centrifugation process. Results After centrifugation for 5 min, 90% of grossly lipaemic samples were either ideal (lipaemia <50 mg/dL) or adequate (lipaemia 50.1–201.7 mg/dL) for analyte testing. All samples were either adequate or ideal for testing following centrifugation for 30 min. Although some analytes showed a statistically significant change in the measured concentration post high-speed centrifugation, none had clinically significant changes according to analyte specific reference change value (RCV) analysis. Aspartate aminotransferase (AST) and creatine kinase (CK) demonstrated the most notable reductions in activity, but these did not exceed their RCV. Conclusions Benchtop centrifugation shows potential laboratory utility in reducing lipaemia whilst maintaining clinically reliable results, however small sample sizes preclude firm conclusions. Further research is warranted to increase the sample size with finer time-point tuning, sub-group analysis and temperature analysis, due to the potential for sample heat injury, to balance practicality and accuracy.
An Evaluation of a Jordanian Version of the Bruininks-Oseretsky Test of Motor Proficiency Second Edition Brief Form (BOT-2BF) for Use with Children with Autism Spectrum Disorder
Authors: Al-Zboon Eman Khleif Ali , Abdel Latif Moukhles Aljaiuossi Noof 
Published: December 2024

In the current study, we tested a Jordanian version of the Bruininks-Oseretsky Test of Motor Proficiency - Second Edition, Brief Form (BOT2-BF) for use with children with autism. Study participants were a convenience sample of 140 children in Jordan, aged 4–8 years, including70 children with autism spectrum disorder (ASD) and 70 children without disabilities. The BOT 2-BF consists of 12 items divided into eight main areas: fine motor skills, fine motor integration, manual dexterity, bilateral coordination, balance, speed and agility, coordination of the upper extremities, and strength. We administered the Jordanian version of the scale individually to all the participants and found it to have acceptable construct validity, internal item consistency, internal sub-scale correlations, discriminant validity for our two groups, and factorial validity on confirmatory factor analysis. The scale also had acceptable split-half reliability. This study is the first Arabic adaptation of the BOT-2BF, and it is the first study to show utility of this instrument for children with ASD. We present further recommendations for research and practice.
Uncovering Patterns in Overdose Deaths: An Analysis of Spike Identification in Fatal Drug Overdose Data in Massachusetts, 2017-2023
Authors: Lee Hannah , Otero-Leon Daniel , Dong Huiru , Stringfellow Erin J. , Jalali Mohammad S. 
Published: December 2024

Objectives: Yearly rolling aggregate trends or rates are commonly used to analyze trends in overdose deaths, but focusing on long-term trends can obscure short-term fluctuations (eg, daily spikes). We analyzed data on spikes in daily fatal overdoses and how various spike detection thresholds influence the identification of spikes. Materials and Methods: We used a spike detection algorithm to identify spikes among 16 660 drug-related overdose deaths (from any drug) reported in Massachusetts’ vital statistics from 2017 through 2023. We adjusted the parameters of the algorithm to define spikes in 3 distinct scenarios: deaths exceeding 2 adjusted moving SDs above the 7-, 30-, and 90-day adjusted moving average. Results: Our results confirmed the on-the-ground observation that there are days when many more people die of overdoses than would be expected based on fluctuations due to differences among people alone. We identified spikes on 5.8% to 20.6% of the days across the 3 scenarios, annually, constituting 11.1% to 31.6% of all overdose deaths. The absolute difference in percentage points of days identified as spikes varied from 5.2 to 11.5 between 7- and 30-day lags and from 0 to 4.6 between 30- and 90-day lags across years. When compared with the adjusted moving average across the 3 scenarios, in 2017 an average of 3.9 to 5.5 additional deaths occurred on spike days, while in 2023 the range was 3.7 to 6.0. Practice Implications: A substantial percentage of deaths occurred annually on spike days, highlighting the need for effectively monitoring short-term overdose trends. Moreover, our study serves as a foundational analysis for future research into exogenous events that may contribute to spikes in overdose deaths, aiming to prevent future deaths.
Orally dissolving pilocarpine tablets for xerostomia in advanced cancer: A pilot N-of-1 feasibility study
Authors: Foster Karyn , Mitchell Geoff , Richard Evan , Steadman Kathryn J , Senior Hugh , Estafanos Rose , Hardy Janet 
Published: December 2024

Background: Xerostomia is a common and difficult symptom experienced by patients with cancer. Pilocarpine is a cholinergic agent that stimulates salivation. Aim: To assess the feasibility of conducting a N-of-1 trial to determine the efficacy of pilocarpine orally dissolving tablets in patients with xerostomia. Design: Double-blind, crossover, placebo-controlled N-of-1 trials of 5 mg pilocarpine tablets vs placebo. Each trial consisted of three 6-day cycles containing pilocarpine (3 days) and placebo (3 days) in random order. Setting/participants: Participants with advanced cancer and xerostomia (scoring >3 on an 11-point numerical rating scale) from any cause, were recruited from an inpatient and outpatient palliative care unit in Brisbane, Australia. Results: Eighteen people were recruited in 17 months. Nine withdrew, seven before or during the first 4 days. Three withdrew due to unacceptable side effects. Two participants met the definition of response (⩾2 point reduction in mean scores active vs placebo cycles). When assessing individual cycles, 15 out of 27 cycles (56%) met the definition of response. More people reported at least one mild episode during pilocarpine than placebo of nausea (6 vs 3), vomiting (3 vs 0) and sweating (3 vs 2). About 48% of adverse event classifications were reported in placebo cycles only. Conclusion: Recruitment to an N-of-1 trial for xerostomia is feasible but attrition was high (50%). Early dropout may have been due to the trial length, complexity, appropriateness or number of questionnaires. Adverse events were generally mild. Two of 10 participants were considered to have benefited from pilocarpine warranting ongoing treatment.
Development of Nipple Trauma Evaluation System With Deep Learning
Authors: Nakamura Maya , Sugimori Hiroyuki , Ebina Yasuhiko 
Published: December 2024

Background: No research has been conducted on the use of deep learning for breastfeeding support. Research Aim: This study aims to develop a nipple trauma evaluation system using deep learning. Methods: We used an exploratory data analysis approach to develop a deep-learning model for medical imaging. Employing object detection and classification, this Japanese study retrieved 753 images from a previous study. The classification protocol, based on the “seven signs of nipple trauma associated with breastfeeding,” categorized the images into eight classes. For practical purposes, the eight original classes were consolidated into four broader categories: “None,” “Minor,” “Moderate,” and “Severe,” using data augmentation procedures that were consistent with the original classification system. The Precision, Recall, Overall Accuracy, and Area Under the Curve (AUC) were calculated, and the model’s efficiency was evaluated using Frames Per Second (FPS). Results: The object detector’s high mean average precision and frames per second rate for nipple and areola detection, confirmed exceptional accuracy. The eight-class image classifier returned notable AUC values, with fissures, peeling, purpura, and scabbing exceeding 0.8. The highest average recall and precision was for scabbing, and the lowest for blistering. The four-class classifier accurately predicted severe conditions, with an average AUC > 0.7, whereas categories without classifications and those deemed minor had lower recall and precision rates. Conclusions: A sophisticated deep learning system detects and classifies nipple trauma automatically, potentially aiding breastfeeding caregivers through objective image assessment and operational improvements. Abstract in Japanese 背景： 母乳育児支援における深層学習の活用に関する研究は行われていない。 目的： 本研究は、深層学習を用いた乳頭損傷評価システムの開発を目的とした。 方法： 本研究では、医療画像を用いた深層学習モデルを開発するため、探索的データ分析アプローチを用いた。物体検出および画像分類の技術を用い、日本で行われた先行研究で撮影された753枚の画像を二次解析した。「授乳に伴う乳頭組織の７所見」に基づき、画像を8クラスに分類した。実用性を考慮し、4つの主要カテゴリ「なし」、「軽度」、「中等度」、「重度」の4つのカテゴリに統合し、元の分類システムに一致するデータ拡張を行った。精度、再現率、Overall Accuracy、AUC（曲線下面積）を算出し、モデルの効率はFPS（Frames Per Second）で評価した。 結果： 物体検出における高いmAP（平均精度）とFPSが示され、乳頭および乳輪の検出精度が確認された。8クラスの画像分類は、亀裂、皮膚剝離、紫斑、痂皮で0.8を超える顕著なAUC値が得られた。再現率と精度が最も高かったのは痂皮であり、水疱で最も低かった。4クラスの画像分類は重度の状態を正確に予測し、平均AUCは0.7を超えたが、傷なしや軽度とされるカテゴリは再現率と精度が低い結果となった。 結論： 深層学習を活用したこの高度なシステムは、乳頭損傷の検出と分類を自動で行うことができ、客観的な画像評価を通じて、母乳育児支援者の教育と業務改善をサポートする有望なツールとなり得る。 Back Translation Completed by Hiroko Hongo, MSW, PhD, IBCLC