bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis journey for children with juvenile idiopathic arthritis: a qualitative study
Authors: Chausset Aurelie , Freychet Caroline , Lohse Anne , Belot Alexandre , Merlin Etienne , Echaubard Stephane , Schott Anne-Marie , Lachal Jonathan 
Published: August 2024

Objective
The objective is to explore the journey to diagnosis and referral pathway from the onset of symptoms to the initial assessments at paediatric rheumatology (PR) centres, based on the experience of children with juvenile idiopathic arthritis (JIA) and their parents.

Design
We conducted a qualitative study with semistructured interviews. Our qualitative and phenomenological procedure applied interpretative phenomenological analysis.

Participants
19 families of children diagnosed with JIA 4–24 months before the study began (22 parents, 12 children>11 years), across 4 PR centres.

Main outcome measures
The results highlight the contrasting feelings of children and their parents on the referral pathway and interactions with primary care physicians (PCPs).

Results
Four superordinate themes emerged: (1) the journey undertaken by families from initially trivialising the first symptoms to a growing sense of urgency, (2) the perception gap between the families’ growing disquiet and first medical interventions, (3) the lack of guidance from physicians prompting parents to initiate action and (4) the various elements of the care pathway that influenced the way the diagnosis was experienced and its impact.

Conclusion
The psychosocial consequences of delayed diagnosis in JIA should not be underestimated, especially for adolescents. The views and experiences of children and their parents on the diagnostic journey should be implemented in training programmes and guidelines for PCPs. The development of online supports, integrating the latest medical knowledge with testimonials from families about their experiences, with a common language for physicians and the general population, can facilitate communication and empower families to navigate the healthcare system.

Trial registration number

NCT05696340
.
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Analgesic effectiveness of methoxyflurane inhaler during genicular nerve block in knee osteoarthritis: a randomized controlled trial
Authors: Sawang Saowanee , Kimpee Pretimon , Itthichaikulthol Wichai , Tontisirin Nuj , Limpoon Suwimon , Seangrung Rattaphol , Pasutharnchat Koravee , Cohen Steven Paul 
Published: August 2024

BackgroundUp to 30% of patients with knee osteoarthritis (KOA) have evidence of sensitization, with a similar proportion experiencing severe pain during procedures. Most patients with KOA are elderly and often develop side effects from intravenous sedation. Our study investigated the effectiveness of a methoxyflurane inhaler combined with local anesthesia in reducing procedural pain from genicular nerve block compared with local anesthesia alone.Methods42 adults with refractory KOA were randomized into two groups. Methoxyflurane group received a self-titrated methoxyflurane inhaler with local anesthesia whereas lidocaine group received local anesthesia only. The primary outcome was pain score on a 0–10 verbal numerical rating scale (VNRS) during the procedure. Secondary outcomes included changes in VNRS and behavioral pain scale (critical care pain observational tool) during the procedure, hemodynamic changes, anxiety level, sedation score, and adverse events.Results42 patients with a mean age of 66±12 years participated in this study. There were no significant baseline differences. During the procedure, the methoxyflurane group experienced a significantly greater VNRS pain reduction from baseline (2 (1, 4) vs −1 (−2, 0); p<0.01) and greater VNRS reduction over time (p=0.01) compared with the lidocaine group, with a higher sedation score (p<0.01). Immediately postprocedure, anxiety levels were lower in the methoxyflurane group compared with the lidocaine group (median State-Trait Anxiety Inventory score 21 (IQR 20, 24) vs 27 (23, 29); p=0.02), but the median reduction in anxiety level was not significant (6 (1, 12) vs 5 (0, 14); p=0.61). There were no differences in behavioral pain scores, hemodynamic parameters, recovery or discharge times, and adverse effects between the two groups.ConclusionA methoxyflurane inhaler combined with local anesthesia provided better procedural pain control than local anesthesia alone with no observable differences in adverse effects. Future studies evaluating the impact of a methoxyflurane inhaler on different types of painful procedures are warranted.
Consensus palliative care referral criteria for people with chronic obstructive pulmonary disease
Authors: Philip Jennifer , Chang Yuchieh Kathryn , Collins Anna , Smallwood Natasha , Sullivan Donald Richard , Yawn Barbara P , Mularski Richard , Ekström Magnus , Yang Ian A , McDonald Christine F , Mori Masanori , Perez-Cruz Pedro , Halpin David M G , Cheng Shao-Yi , Hui David 
Published: August 2024

Objective
People with advanced chronic obstructive pulmonary disease (COPD) have substantial palliative care needs, but uncertainty exists around appropriate identification of patients for palliative care referral.
We conducted a Delphi study of international experts to identify consensus referral criteria for specialist outpatient palliative care for people with COPD.

Methods
Clinicians in the fields of respiratory medicine, palliative and primary care from five continents with expertise in respiratory medicine and palliative care rated 81 criteria over three Delphi rounds. Consensus was defined a priori as ≥70% agreement. A criterion was considered ‘major’ if experts endorsed meeting that criterion alone justified palliative care referral.

Results
Response rates from the 57 panellists were 86% (49), 84% (48) and 91% (52) over first, second and third rounds, respectively. Panellists reached consensus on 17 major criteria for specialist outpatient palliative care referral, categorised under: (1) ‘Health service use and need for advanced respiratory therapies’ (six criteria, eg, need for home non-invasive ventilation); (2) ‘Presence of symptoms, psychosocial and decision-making needs’ (eight criteria, eg, severe (7–10 on a 10 point scale) chronic breathlessness); and (3) ‘Prognostic estimate and performance status’ (three criteria, eg, physician-estimated life expectancy of 6 months or less).

Conclusions
International experts evaluated 81 potential referral criteria, reaching consensus on 17 major criteria for referral to specialist outpatient palliative care for people with COPD. Evaluation of the feasibility of these criteria in practice is required to improve standardised palliative care delivery for people with COPD.
Analyzing Thermal Runaway Propagation in Lithium-Ion Battery Modules with Reduced Flammability Electrolyte Cells
Authors: Sorensen Alexander , Belt Jeffrey 
Published: August 2024

A thorough analysis of thermal runaway propagation was conducted, focusing on both module and cell levels, using a range of standard flammability and reduced flammability electrolytes in 18650 cells sourced from Eagle-Picher Technologies. Utilizing techniques such as accelerated rate calorimetry; cell enthalpy, maximum thermal runaway temperature, and thermal runaway onset and initiation temperatures were evaluated, consistently demonstrating their reliability. Employing the NASA X-57 module billet as a strategy for mitigating thermal runaway propagation, the absorption of cell energy during failure events was observed, effectively preventing the spread of thermal runaway between cells. Notably, the use of reduced flammability electrolyte resulted in an average reduction of 104 °C in maximum thermal runaway temperature at the module level, thereby offering decreased risk in preventing thermal runaway propagation during failures. Note the relatively modest 51 °C difference observed between reduced flammability and standard flammability cells during individual cell tests. This underscores the importance of conducting tests at both the cell and module levels in the development of systems for certification, where the cell-level data indicate a 51 °C discrepancy, while the module-level analysis shows a more substantial 104 °C differentiation.
Perirenal Fat Thickness Is Associated With Contrast‐Induced Nephropathy in Type 2 Diabetic Patients Undergoing Coronary Catheterization
Authors: Tang Xixiang , Wang Jiafu , Wu Yuman , Huang Zhuoshan , Ouyang Xiaolan , Wu Hongxing , Chen Qian , Zhong Junlin , Peng Long , Lu Yan , Wu Bingyuan , Ling Yesheng , Li Suhua 
Published: August 2024

Background: Deposition of adipose tissue may have a promoting role in the development of diabetic complications. This study is aimed at investigating the relationship between adipose tissue thickness and risk of contrast‐induced nephropathy (CIN) in patients with Type 2 diabetes mellitus (T2DM).Methods: A total of 603 T2DM patients undergoing percutaneous coronary angiography or angioplasty with suspicious or confirmed stable coronary artery disease were enrolled in this study. The thicknesses of perirenal fat (PRF), subcutaneous fat (SCF), intraperitoneal fat (IPF), and epicardial fat (ECF) were measured by color Doppler ultrasound, respectively. The association of various adipose tissues with CIN was analyzed.Results: Seventy‐seven patients (12.8%) developed CIN in this cohort. Patients who developed CIN had significantly thicker PRF (13.7 ± 4.0 mm vs. 8.9 ± 3.6 mm, p < 0.001), slightly thicker IPF (p = 0.046), and similar thicknesses of SCF (p = 0.782) and ECF (p = 0.749) compared to those who did not develop CIN. Correlation analysis showed that only PRF was positively associated with postoperation maximal serum creatinine (sCr) (r = 0.18, p = 0.012), maximal absolute change in sCr (r = 0.33, p < 0.001), and maximal percentage of change in sCr (r = 0.36, p < 0.001). In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) of PRF (0.809) for CIN was significantly higher than those of SCF (0.490), IPF (0.594), and ECF (0.512). Multivariate logistic regression analysis further confirmed that thickness of PRF, rather than other adipose tissues, was independently associated with the development of CIN after adjusted for confounding factors (odds ratio (OR) = 1.53, 95% CI: 1.38–1.71, p < 0.001).Conclusions: PRF is independently associated with the development of CIN in T2DM patients undergoing coronary catheterization.
Is John Stuart Mill's On Liberty Obsolete?
Authors: Blasi Vincent 
Published: August 2024

Abstract
In On Liberty, published in 1859, John Stuart Mill argues for the “absolute” protection of the “liberty of thought and discussion.” Ever the empiricist, he maintains that such uncompromised freedom, not for all communication or self-expression but for the subset of those activities that qualifies as thought and discussion, would generate the best overall consequences for societies such as Great Britain and the United States. The advent of digital technology has altered how thought and discussion is generated, distributed, and received in ways that might problematize some of the empirical assumptions upon which Mill's argument in On Liberty is based. This essay explores whether the reasons he advances for the absolute liberty of thought and discussion continue to have purchase in the face of the changed empirical domain in which Mill's cherished activities of inquiry and persuasion now operate.
The Free Speech Clause as a Deregulatory Tool
Authors: Tsesis Alexander 
Published: August 2024

Abstract
The U-S. Supreme Court increasingly leverages a rigid interpretation of the Free Speech Clause to strike regulations that address campaign financing, health care warnings, tax disclosures, collective bargaining agreements, and consumer protections. History has become little more than a slogan that the majority periodically invokes but seldom accurately evaluates. That lack of nuance augments the justices ’ authority to articulate absolutist-sounding rules to the detriment of legislatures’ exercise of traditional governmental functions. Jurists would do better to rely on a more proportionate and less categorical approach to decide whether laws impose direct or peripheral burdens on communications. The level of safeguards enjoyed by expressions should be gauged by their value to political self-determination, personal development, or informational contribution. The degree of protections that speech enjoys should be balanced against countervailing government interests, alternatives available to speakers, fit between law and public ends, and relevant history.
Preoperative Hypoalbuminemia is Associated With Higher 30-day Mortality and Complications After Esophagectomy
Authors: Li Renxi , Zhu Yueyao 
Published: August 2024

Background Serum albumin level is routinely screened during preoperative assessments as a biomarker for poor nutritional status and/or concurrent inflammation. In esophagectomy, while early postoperative hypoalbuminemia is associated with a higher risk of adverse surgical outcomes, the effects of preoperative hypoalbuminemia on esophagectomy outcomes were conflicting. This study aimed to examine the effect of preoperative hypoalbuminemia on 30-day outcomes following esophagectomy. Methods National Surgical Quality Improvement Program (NSQIP) esophagectomy targeted database from 2016 to 2022 was used. Patients with preoperative serum albumin <3.4 g/L were defined as having hypoalbuminemia. Patients with and without hypoalbuminemia were propensity-score matched (1:3 ratio) for demographics, baseline characteristics, neoadjuvant therapy, surgical approaches, tumor diagnosis, and pathologic staging of the malignancy. Thirty-day postoperative outcomes were examined. Results There were 803 (10.24%) and 7046 (89.76%) patients with and without preoperative hypoalbuminemia who underwent esophagectomy, respectively. After propensity-score matching, all patients with hypoalbuminemia were matched to 2170 controls. After propensity-matching, patients with hypoalbuminemia had higher risks of mortality (4.48% vs 3.00%, P = 0.04), sepsis (14.94% vs 10.92%, P < 0.01), and bleeding requiring transfusion (21.30% vs 13.50%, P < 0.01). Also, patients with hypoalbuminemia had a higher rate of discharge not to home (42.65% vs 34.81%, P < 0.01) and longer LOS (12.69 ± 9.09 vs 11.39 ± 8.16 days, P < 0.01). Conclusion Patients with preoperative hypoalbuminemia had increased risks of mortality and complications after esophagectomy. Thus, preoperative hypoalbuminemia could be a useful and cost-effective tool for preoperative risk stratification for patients undergoing esophagectomy, and correcting the underlying cause of hypoalbuminemia may help decrease the risk of adverse postoperative outcomes.
How I treat adult Ph+ ALL
Authors: Chiaretti Sabina , Foà Robin 
Published: August 2024

Abstract
The Philadelphia (Ph) chromosome is one of the few genetic aberrations in which a casualty has been proven and, as such, represents a success in the history of medicine. This is also evident in the setting of Ph+ acute lymphoblastic leukemia (ALL), the most frequent genetic subgroup in adult ALL, whose incidence increases with age and whose prognosis, before the advent of tyrosine kinase inhibitors (TKIs), was particularly poor. The outcome and management of patients with Ph+ ALL have greatly improved since the incorporation of first-, second-, and third-generation TKIs in the therapeutic backbone and is further changing with the more recent introduction of immunotherapy. This allows for long-term survival rates currently ranging between 75% and 80%. The clinical scenario of adult Ph+ ALL has thus changed profoundly, and new challenges are emerging. In this article, illustrative clinical cases are used to discuss the current role of systemic chemotherapy and allogeneic stem cell transplant, the difficulty in treating central nervous system relapses and, more in general, relapses in the current therapeutic era, and the possibility of stopping TKIs. Finally, the challenges related to an optimal management of these patients are discussed.
Baseline tebuconazole sensitivity and potential resistant risk in Fusarium graminearum
Authors: Zhou Feng , Zhou Xiaoli , Yan Jiao  , Han Aohui , Zhou Huanhuan , Chen Zeyuan , Li Weiguo , Liu Runqiang 
Published: August 2024

Abstract
Background
The Fusarium head blight caused by Fusarium graminearum results in reduced crop yields and the potential for vomitoxin contamination, which poses a risk to both human and livestock health. The primary method of control relies on the application of chemical fungicides.

Results
The current study found that the tebuconazole sensitivity of 165 F. graminearum isolates collected from the Huang-Huai-Hai region of China between 2019 and 2023 ranged from 0.005 to 2.029 µg/mL, with an average EC50 value of 0.33 ± 0.03 µg/mL. The frequency distribution conformed to a unimodal curve around the mean, and therefore provides a useful reference for monitoring the emergence of tebuconazole resistance in field populations of F. graminearum. No cross-resistance was detected between tebuconazole and other unrelated fungicides such as flutriafol, propiconazole and fluazinam, but there was a clear negative cross-resistance with triazole fungicides including fludioxonil, epoxiconazole, hexaconazole, and metconazole. Analysis of five tebuconazole-resistant mutants produced under laboratory conditions indicated that although the mycelial growth of the mutants were significantly (p < 0.05) reduced, spore production and germination rates could be significantly (p < 0.05) increased. However, pathogenicity tests confirmed a severe fitness cost associated with tebuconazole resistance, as all of the mutants completely loss the ability to infect host tissue. Furthermore, in general the resistant mutants were found to have increased sensitivity to abiotic stress, such as ionic and osmotic stress, though not to Congo red and oxidative stress, to which they were more tolerant. Meanwhile, molecular analysis identified several point mutations in the CYP51 genes of the mutants, which resulted in two substitutions (I281T, and T314A) in the predicted sequence of the FgCYP51A subunit, as well as seven (S195F, Q332V, V333L, L334G, M399T, E507G, and E267G) in the FgCYP51C subunit. In addition, it was also noted that the expression of the CYP51 genes in one of the mutants, which lacked point mutations, was significantly up-regulated in response to tebuconazole treatment.

Conclusions
These results provide useful data that allow for more rational use of tebuconazole in the control of F. graminearum, as well as for more effective monitoring of fungicide resistance in the field.
Factors affecting COVID-19 vaccine uptake in populations with higher education: insights from a cross-sectional study among university students in Malawi
Authors: Madhlopa Qebo Kornelio , Mtumbuka Matthews , Kumwenda Joel , Illingworth Thomas Arron , Van Hout Marie-Claire , Mfutso-Bengo Joseph , Mikeka Chomora , Shawa Isaac Thom 
Published: August 2024

Abstract
Background
The Coronavirus disease-2019 (COVID-19) vaccines were rolled out in many countries; however, sub-optimal COVID-19 vaccine uptake remains a major public health concern globally. This study aimed at assessing the factors that affected the uptake, hesitancy, and resistance of the COVID-19 vaccine among university undergraduate students in Malawi, a least developed country in Africa.

Methods
A descriptive cross-sectional study design was conducted using an online semi-structured questionnaire. A total of 343 University undergraduate students in Blantyre participated in this study after obtaining ethical clearance. Data was exported from Survey Monkey to Microsoft Excel version-21 for cleaning and was analysed using SPSS version-29. Descriptive statistics, including percentages, were performed to define the sample characteristics. Pearson Chi-square and Fisher’s exact test were performed to identify significant relationships between vaccine uptake and demographics. A 95% confidence interval was set, and a p-value of < 0.05 was considered statistically significant.

Results
Of the 343 participants, 43% were vaccinated. Among the vaccinated, the majority (47.3%, n = 69/146) received Johnson & Johnson vaccine followed by AstraZeneca (46.6%, n = 68/146). The commonly reported reason for vaccine acceptance was ‘to protect me against getting COVID-19’ (49%); whereas vaccine hesitancy was attributed to ‘lack of knowledge (34%), and concerns about vaccine safety (25%).

Conclusions
This study found that adequate knowledge about benefits and safety of COVID-19 vaccine could potentially increase uptake. Lack of credible information or misinformation contributed to vaccine hesitancy. The findings provide insights for design of strategies to increase future vaccine uptake and reduce determinants of vaccine hesitancy. To reduce vaccination hesitancy in any population with or without higher education, we recommend that institutions entrusted with vaccine management must optimise health messaging, and reduce mis-information and dis-information.
Understanding barriers, enablers and motivational factors for Australian healthcare educators teaching university students on clinical placement using the validated Physician Teaching Motivation Questionnaire
Authors: Watt Natalie Ann , Backhouse Simon , Ansari Saba , Dwyer Karen Maree , McLeod Janet , Phelps Grant , Leach Deborah , Armitage James Andrew 
Published: August 2024

Abstract
Background
In Australia, university clinical programs rely heavily on external healthcare professionals to provide a range of authentic clinical training and professional development opportunities for students. There is, however, a limited understanding of the factors that motivate these professionals to be educators and whether this varies across different healthcare disciplines within Australia. As the demand for clinical placements continues to increase, it is critical for the ongoing success of these programs that universities identify both the barriers associated with teaching and the benefits that enhance job satisfaction.

Methods
A two-part questionnaire was emailed to 849 external healthcare educators teaching predominantly in Medicine, Medical Imaging, and Optometry programs at Deakin University. Part-one surveyed the socio-demographics, perceived benefits, and barriers to teaching, plus the utilisation of entitlements offered by the university. Part-two was modelled on Dybowski and Harendza’s validated Physician Teaching Motivation Questionnaire (PTMQ) and adapted to an Australian audience.

Results
Overall, 776 out of the 849 questionnaires were considered in the final participant pool. The response rate for part-one was 19.7% (n = 153/776) and 18.3% (n = 142/776) for part-two. Across all professions, altruism was the primary source of motivation for teaching in Deakin University’s healthcare programs. Medical Imaging educators placed a higher value on career-related teaching aspects compared to those in Medicine and Optometry (p < 0.003). The resources and benefits associated with teaching were generally perceived to be of minimal importance. External healthcare educators most commonly reported that there were no barriers to teaching (41.3%, n = 78) however, increased workloads and time constraints were the next most likely factors to affect teaching participation (31.8%, n = 60).

Conclusion
Our validated adaptation of the PTMQ successfully targeted healthcare professions not focussed on by Dybowski and Harendza. Altruistic motivation was the overarching theme for why Australian external healthcare educators contribute to teaching with some differences in career-driven motivation additionally acknowledged. Despite there being no key benefits or barriers to teaching participation, universities must remain cognisant of the factors that influence the recruitment and retention of external healthcare educators and how to optimise these for the ongoing success and sustainability of their teaching programs.