bluuebunny/crossref_metadata_2025_split huggingface dataset:
Menopause knowledge, attitudes and experiences of women in Saudi Arabia: a qualitative study
Authors: AlSwayied Ghada , Frost Rachael , Hamilton Fiona L. 
Published: November 2024

Abstract
Background
Menopause can be seen as a complex phenomenon influenced by an individual’s cultural norms, belief systems, and lifestyle choices. In conservative societies such as Saudi Arabia, some women silently struggle with menopause due to cultural taboos and social stigma, making their experiences invisible and lowering their quality of life. The aim of this study was to explore in-depth the knowledge, attitudes, and experiences of middle-aged Saudi women with menopause.

Methods
The study employed qualitative methods using semi-structured interviews with middle-aged women undergoing menopause in Saudi Arabia from February to May 2023. The interviews were conducted online in Arabic, recorded and transcribed verbatim. The data were analysed inductively using thematic analysis.

Results
A total of twenty-nine women, aged 40–64 years, were interviewed. Three key themes were identified: mixed emotions towards menopause; experiencing biopsychosocial changes; and adapting to the transition. Overall, most participants had mixed perspectives on menopause. Negative aspects included feelings of uncertainty and the loss of fertility while positive aspects included a sense of relief from menstruation and the newfound freedom to engage in religious activities at any time. Notably, during the interviews, many participants reconsidered their initial negative views and voiced predominantly positive perspectives. Several women reported inconvenient menopausal symptoms, such as hot flashes, night sweats, disturbed sleep, and fatigue. Concerns about being perceived as less attractive led many to keep their symptoms private, and societal expectations played a significant role in influencing how women managed these symptoms and sought help. Many women opted to seek information discreetly online rather than seeking support from others. Self-care practices were favoured for managing menopause, with medical care being undervalued or at times deemed unsatisfactory.

Conclusion
In Saudi Arabia, menopause is generally seen as a natural phase of life. Many women appreciate the positive aspects it brings, such as relief from menstrual pain and an enhanced ability to participate in religious practices. However, they also encounter challenges, including hot flashes and concerns about perceived decreases in attractiveness. A notable trend is the preference for self-care strategies over medical interventions or hormone replacement therapy (HRT). There is a need to raise awareness about menopausal symptoms to reduce negative perceptions and experiences and to develop health promotion and educational interventions to support and empower women during this transition. Future research with healthcare professionals would extend these findings.
Challenges facing physicians in death certification of under-five mortality in Egypt
Authors: Aziz Mirette M , Dous Nevein 
Published: November 2024

Abstract
Background
Improving death certification of Under 5 Mortality (U5M) is an important pre-requisite for improving child health. This study aimed to obtain a clear and comprehensive understanding of the process of death registration of U5M and address the challenges of accurate certification faced by physicians at hospitals and health offices.

Methods
A qualitative descriptive study was performed by conducting 10 Focus Group Discussions (FGDs) with physicians who are actively involved in the certification of U5M. Physicians were invited to participate from primary health care units, health offices, district and general hospitals in Cairo, Giza and Assiut Governorates. Field visits of health offices were performed to observe the procedure of death registration, visualize a sample of the hospitals’ Death Notification Forms (DNFs) and death certificates of U5M, and explore the used electronic system of death registration. Data analysis was performed using inductive thematic analysis.

Results
The study clarified the procedure of death certification of U5M, starting from hospitals and ending at health offices. It was evident that there is a considerable deficiency in the system of registration and coding causes of death. Physicians of hospitals had a negative attitude regarding death registration. They were found to have deficient knowledge about standards of death certification. They had difficulty defining and reporting the chain of events leading to death. Poor diagnostic facilities hindered physicians from accurately reporting COD. Fear of legal accountability was a cause of avoiding detailed COD. For physicians in the health offices, other challenges were mentioned such as assigning junior physicians to manage the task of writing DNFs, poor quality of hospital reports and the unrealistic ICD-10 codes.

Conclusion
Improving the accuracy of writing DNFs in hospitals is essential for providing reliable U5M statistics. Practical training of physicians, especially the junior ones, on ICD-10 classification and on identification and writing direct and indirect COD in the allocated lines in the death certificates is a priority. Establishing an audit system to assess the quality of the process of certification and updating the software of the electronic system for data entry would have a great impact.
Rapid and non-invasive analysis of paracetamol overdose using paper arrow-mass spectrometry: a prospective observational study
Authors: Zhou Yufeng , Dliso Silothabo , Craske Jennie , Gill Andrea , Bracken Louise , Landa Kiran , Arnold Philip , Walker Laura , Grasim Ionela , Seddon Gabrielle , Chen Tao , Davison Andrew S. , Sham Tung-Ting , Smith Barry , Hawcutt Daniel B. , Maher Simon 
Published: November 2024

Abstract
Background
Paracetamol is the most consumed medicine globally. Its accessibility contributes to common overdose. Paracetamol overdose is responsible for > 50% of acute liver failure cases, making it the second most common reason for a liver transplant. Rapid quantitation of paracetamol is crucial to guide treatment of paracetamol overdose. Current tests require invasive sampling and relatively long turnaround times. Paper arrow-mass spectrometry (PA-MS) combines sample collection, extraction, separation, enrichment and ionisation onto a single paper strip, achieving rapid, accurate, cost-effective and eco-friendly analysis direct from raw human saliva.

Methods
To validate PA-MS against an established test, 17 healthy adults were recruited. Samples were collected before and at 15, 30, 60, 120 and 240 min after ingesting 1 g of paracetamol. Plasma measured with an established clinical test served as the reference standard to validate PA-MS with three biofluids—plasma, resting saliva (RS) and stimulated saliva (SS). Participants’ views of blood, RS and SS sampling procedures were assessed qualitatively. Cross-validation was assessed using Lin’s concordance correlation coefficients (CCC), Bland–Altman difference plots, and ratios of PA-MS to the reference standard test.

Results
PA-MS using stimulated saliva offers a reliable alternative to intravenous blood sampling. The CCC is 0.93, the mean difference with the reference test is − 0.14 mg/L, and the ratios compared to the reference test are 0.84–1.27 from correlated samples collected at 5 intervals over 4 h for each participant.

Conclusions
Paracetamol detection from SS with PA-MS provides a reliable result that can aid timely treatment decisions. Differences between paracetamol concentration in resting and stimulated saliva were also identified for the first time, highlighting the importance of standardising saliva collection methods in general. This study marks a major milestone towards rapid and convenient saliva analysis.
Increased cytoplasmic expression of PETase enzymes in E. coli
Authors: Carter Luke M. , MacFarlane Chris E. , Karlock Samuel P. , Sen Tridwip , Kaar Joel L. , Berberich Jason A. , Boock Jason T. 
Published: November 2024

Abstract
Background
Depolymerizing polyethylene terephthalate (PET) plastics using enzymes, such as PETase, offers a sustainable chemical recycling route. To enhance degradation, many groups have sought to engineer PETase for faster catalysis on PET and elevated stability. Considerably less effort has been focused toward expressing large quantities of the enzyme, which is necessary for large-scale application and widespread use. In this work, we evaluated several E. coli strains for their potential to produce soluble, folded, and active IsPETase, and moved the production to a benchtop bioreactor. As PETase is known to require disulfide bonds to be functional, we screened several disulfide-bond promoting strains of E. coli to produce IsPETase, FAST-PETase and Hot-PETase.

Results
We found expression in SHuffle T7 Express results in higher active expression of IsPETase compared to standard E. coli production strains such as BL21(DE3), reaching a purified titer of 20 mg enzyme per L of culture from shake flasks using 2xLB medium. We characterized purified IsPETase on 4-nitrophenyl acetate and PET microplastics, showing the enzyme produced in the disulfide-bond promoting host has high activity. Using a complex medium with glycerol and a controlled bioreactor, IsPETase titer reached 104 mg per L for a 46-h culture. FAST-PETase was found to be produced at similar levels in BL21(DE3) or SHuffle T7 Express, with purified production reaching 65 mg per L culture when made in BL21(DE3). Hot-PETase titers were greatest in BL21(DE3) reaching 77 mg per L culture.

Conclusions
We provide protein expression methods to produce three important PETase variants. Importantly, for IsPETase, changing expression host, medium optimization and movement to a bioreactor resulted in a 50-fold improvement in production amount with a per cell dry weight productivity of 0.45 mgPETase gCDW−1 h−1, which is tenfold greater than that for K. pastoris. We show that the benefit of using SHuffle T7 Express for expression only extends to IsPETase, with FAST-PETase and Hot-PETase better produced and purified from BL21(DE3), which is unexpected given the number of cysteines present. This work represents a systematic evaluation of protein expression and purification conditions for PETase variants to permit further study of these important enzymes.
Intersectional inequalities in mental health by education, income, gender, and age before and during the COVID-19 pandemic in the Netherlands: a longitudinal study
Authors: Verra Sanne E. , Evans Clare , Oude Groeniger Joost , de Wit John , Poelman Maartje P. , Kamphuis Carlijn B. M. 
Published: November 2024

Abstract
Background
It remains unclear how COVID-19 has disproportionately affected the mental health of different vulnerable groups. This study explores how mental health inequalities changed between 2014 (pre-COVID-19) and 2021 (during COVID-19) in the Netherlands across intersectional social strata defined by interplays of educational attainment, income level, gender, and age.

Methods
Using 2014 and 2021 self-reported cohort data on health and living conditions of the adult population of Eindhoven and surroundings (N = 1,157), a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) was applied to explore intersectional inequalities in mental health in 2014, 2021, and in mental health changes (2014–2021). We examined this using the Mental Health Inventory-5 across 53 intersectional social strata based on interplays of education, income, gender, and age in 2014.

Results
There were substantial differences in mental health trajectories across social strata. Between-stratum mental health inequalities were patterned additively, indicating that inequality patterns along one axis (such as income) tended to be consistent across other axes of comparison. Additive trends revealed that women with a low income were at highest risk of poor mental health in 2014 and 2021, and people over 65 were at highest risk of mental health setbacks over time. Nonsignificant educational inequalities were found in 2014 and 2021. Income inequalities persisted, but slightly decreased in 2021 due to stronger mental health setbacks among those with high incomes. Women experienced persisting disadvantages that slightly flattened over time, and the mental health advantages of older age diminished over time.

Conclusions
Inequalities in mental health add up for those who experience multiple axes of disadvantage, such as women and those with low incomes, but no disproportionate intersectional interaction effects were found. Effort is needed to ensure that mental health support is accessible for all, especially those with low incomes. Given the especially strong mental health declines among those over 65, responses to future crises need to include measures to protect the mental health of the elderly. Future research should investigate intersectional inequalities along other axes of disadvantage, such as ethnicity, employment and family status.
Inhalation of itraconazole mitigates bleomycin-induced lung fibrosis via regulating SPP1 and C3 signaling pathway pivotal in the interaction between phagocytic macrophages and diseased fibroblasts
Authors: Pan Caizhe , Wei Hao , Chen Bi , Wu Lei , Song Jiayao , Zhang Qing , Wu Xinglong , Liang Guibai , Chen Wenhao , Wang Yingshuo , Xie Yicheng 
Published: November 2024

Abstract
Background
Idiopathic pulmonary fibrosis (IPF) stands as a significant contributor to global mortality rates. Presently, there exists a dearth of effective anti-fibrotic treatments for this condition. While itraconazole (ITR) has exhibited potential in mitigating pulmonary fibrosis, its oral administration is hampered by unfavorable pharmacokinetics, which elevate the risk of adverse reactions, thus limiting its clinical utility.

Methods
An inhalable formulation of ITR were engineered which aimed at enhancing its pulmonary dispersion. First, pharmacokinetics were conducted to investigate the blood concentration and tissue residue of ITR after inhalation administration. In addition, bleomycin induced mouse pulmonary fibrosis model was used to compare the therapeutic effects of ITR administered by inhalation and intragastric administration. Finally, single-cell RNA sequencing (scRNAseq) was used to explore the mechanism of ITR inhalation administration.

Results
We found that a large amount of drugs accumulated in the lung tissue for a long time after inhalation administration, thus maximizing the therapeutic effect of drugs. Inhalation of ITR daily at for 21 days significantly attenuated bleomycin-induced lung fibrosis and inflammation in murine models. Additionally, our findings revealed that ITR inhalation diminished the proportion of diseased fibroblasts while promoting reparative fibroblast populations in the murine model. Furthermore, it effectively reversed the proportion of activated phagocytic macrophages. Mechanistically, ITR inhalation exerted its effects by regulating SPP1 and C3 signaling pathway pivotal in the interaction between phagocytic macrophages and diseased fibroblasts.

Conclusions
These insights into the molecular mechanisms underlying ITR’s therapeutic effects on IPF underscore the favorable pharmacokinetic profile conferred by inhalation, thus presenting a promising formulation poised for clinical translation.
Age- and sex-associated alterations in hypothalamic mitochondrial bioenergetics and inflammatory-associated signaling in the 3xTg mouse model of Alzheimer’s disease
Authors: Adlimoghaddam Aida , Fontaine Kyle M. , Albensi Benedict C. 
Published: November 2024

AbstractMitochondrial dysfunction and associated inflammatory signaling are pivotal in both aging and in Alzheimer’s disease (AD). Studies have also shown that hypothalamic function is affected in AD. The hypothalamus may be a target for AD drugs given that mitochondrial alterations are observed in the hypothalamus. This study investigated how age and sex affect mitochondrial bioenergetics and inflammatory signaling in the hypothalamic mitochondria of 3xTg and control mice at 2, 6, and 13 months, aiming to enhance our understanding of these processes in aging and AD. Parameters included oxygen consumption rates, expression levels of subunits comprising mitochondrial complexes I-V, the enzymatic activity of cytochrome c oxidase (COX), transcription factors associated with inflammation such as NF-κB, pIκB-α, Nrf2, and other inflammatory biomarkers. Hypothalamic mitochondrial dysfunction was observed in 3xTg females as early as 2 months, but no changes were detected in 3xTg males until 6 months of age. In 3xTg mice, subunit expression levels for mitochondrial complexes I-II were significantly reduced in both sexes. Significant sex-based differences in COX activity were also observed at 13 months of age, with levels being lower in females compared to males. In addition, significant sex differences were indicated in NF-κB, pIκB-α, Nrf2, and other inflammatory biomarkers at different age groups during normal aging and AD progression. These findings highlight important sex differences in hypothalamic bioenergetics and inflammation, offering insights into potential new targets for preventing and/or treating AD.
Investigating EFL instructors’ approaches to classroom-based assessment culture: an explanatory sequential mixed-method approach
Authors: Latif Muhammad Wasim , Wasim Arzoo 
Published: November 2024

AbstractBased on sociocultural theory and pragmatism philosophical underpinnings, this study explores the classroom assessment practices of tertiary EFL practitioners, focusing on their alignment with contemporary constructivist assessment trends, methods, and approaches, rather than psychometrical assessments. The study extends knowledge on language teachers’ preparedness for implementing classroom assessment literacy. Participants were tertiary EFL instructors from four higher educational institutions in Saudi Arabia. Adopting an explanatory sequential mixed-methods research design, data were collected through self-reported questionnaires, classroom observations, and a review of assessment documents and artifacts. Descriptive statistics were used to analyze quantitative data and thematic analysis qualitative data. The dominance of traditional over alternative assessment methods was demonstrated, indicating gaps in teachers’ classroom assessment literacy. The findings highlight the contradiction, discrepancy, and complexity of the relationship between teachers’ articulated and exercised assessment practices. They provide baseline data for L2 classroom assessment policy, a classroom-based assessment framework, and a guide for teachers’ professional development in language assessment literacy.
Comparative evaluation of Artec Leo hand-held scanner and iPad Pro for 3D scanning of cervical and craniofacial data: assessing precision, accuracy, and user experience
Authors: Spears Samuel D. J. , Lester Thomas , Torii Ryo , Kalaskar Deepak M. 
Published: November 2024

Abstract
Aim
This study compares the precision, accuracy, and user experience of 3D body surface scanning of human subjects using the Artec Leo hand-held scanner and the iPad Pro as 3D scanning devices for capturing cervical and craniofacial data. The investigation includes assessing methods for correcting 'dropped head syndrome' during scanning, to demonstrate the ability of the scanner to be used to reconstruct body surface of patients.

Methods
Eighteen volunteers with no prior history of neck weakness were scanned three times in three different positions, using the two different devices. Surface area, scanning time, and participant comfort scores were evaluated for both devices. Precision and accuracy were assessed using Mean Absolute Deviation (MAD), Mean Absolute Percentage Error (MAPE), and Intra-Class Correlation Coefficients (ICC).

Results
Surface area comparisons revealed no significant differences between devices and positions. Scanning times showed no significant difference between devices or positions. Comfort scores varied across positions. MAD analysis identified chin to chest measurements as having the highest variance, especially in scanning position 3. However, no statistical differences were found. MAPE results confirmed accuracy below 5% error for both devices. ICC scores indicated good reliability for both measurement methods, particularly for chin to chest measurements in positions 1 and 3.

Conclusion
The iPad Pro using the Qlone app demonstrates a viable alternative to the Artec Leo, particularly for capturing head and neck surface area within a clinical setting. The scanning resolution, with an error margin within ±5%, is consistent with clinically accepted standards for orthosis design, where padding and final fit adjustments allow for bespoke devices that accommodate patient comfort. This study highlights the comparative performance of the iPad, as well as suggests two methods which can be used within clinics to correct head drop for scanning.
The potentiality of Culex pipiens (Diptera: Culicidae) complex holobiont in transmitting the hepatitis C virus (HCV) with the aid of bacterial microbiota in the midgut
Authors: Abdallah Fatma I. , Merdan Bouthaina A. I. , Shaarawi Fatma A. I. , Mohamed Ali F. , Selim Tharwat A. , Dahesh Salwa M. A. , Rady Magda H. A. 
Published: November 2024

Abstract
Background
The possibility of considering Culex pipiens (Cx. pipiens) as a vector for transmitting the hepatitis C virus (HCV) is controversial and needs further investigation. This work aimed to detect the possibility of transmission of the hepatitis C virus by Cx. pipiens and the role of the bacterial microbiota in their midgut.

Main body
Two groups of symbiotic and aposymbiotic of female Cx. pipiens were infected with the hepatitis C virus using an artificial feeding membrane technique. The viral load was detected in the head region for up to 60 min in the infected symbiotic group and 90 min in the aposymbiotic group. The midgut region can harbor the virus for 5 days after feeding. The absence of gut microbiota increases the potentiality of ten females to carry high titer of infective dose (1.2 × 106 IU/ml) of HCV genotype 4a for 6 days. The bacterial midgut microbiota appears to play a significant role in the transmission of HCV. On the other hand, HCV was not detected in the salivary glands of either symbiotic or aposymbiotic mosquitoes during the detection period. Cx. pipiens can transmit HCV from infected female adult mosquitoes to HCV-negative human blood in vitro. The biological parameters were survival rate, blood feeding, oviposition, hatchability rates, and mean digestion period of Cx. pipiens after infection with HCV showed significant changes. Moreover, an ex vivo assay demonstrated that HCV-infected mosquitoes could transmit the virus RNA into healthy blood.

Conclusion
The results suggested that the mosquitoes’ mechanical transmission of HCV was reasonable. In addition, the mosquito microbiome played a significant role in determining the potentiality of mosquitoes as a vector for disseminating HCV infections.

Graphic abstract