bluuebunny/crossref_metadata_2025_split huggingface dataset:
Age-related differences in clinical and laboratory characteristics of childhood-onset systemic lupus erythematosus: Pre-puberal-onset SLE is prone to delayed diagnosis
Authors: Li Shipeng , Xue Yuan , Kuang Weiying , Deng Jianghong , Zhang Junmei , Tan Xiaohua , Li Chao , Li Caifeng 
Published: October 2023

Objective This study aimed to analyze age-specific characteristics of childhood-onset systemic lupus erythematosus (cSLE) at a health center in China. Methods The children with SLE were grouped based on age at disease-onset: pre-pubertal (≤7 years), peri-pubertal (8–13 years), and adolescence (14–18 years). The retrospective study included patients with cSLE diagnosed at the Beijing Children’s Hospital between 2013 and 2021. Results A total of 675 females and 178 males were eligible for inclusion in this study. Among them, 160 patients were diagnosed during pre-puberty, 635 during peri-puberty, and 58 during adolescence. The female-to-male ratio of pre-pubertal, peri-pubertal, and adolescent diagnosis was 3.5: 1, 3.6: 1, and 7.28:1, respectively. The median time from onset to diagnosis during the pre-puberal period was 3.0 (IQR 1.0–24.0 months), which was longer than that during the peri-puberal period (1.4; IQR 0.7–4) months and adolescence (1.0; IQR 0.4–2) months ( p = <.0001). The proportion of LN in patients diagnosed during the peri-puberal period (304, 46.6%) and during adolescence (27, 47.9%) was higher than that of patients diagnosed during the pre-puberal period (59, 36.9%) ( p = .044). 46 (28.8%), 233 (36.7%), and 32 (55.2%) of children diagnosed during the pre-pubertal period, peri-pubertal period, and adolescence, respectively, suffered from leukopenia. Conclusion The proportion of renal involvement and leukopenia in the pre-pubertal group was lower than that of the pubertal group and adolescent group. More importantly, the younger the age of the patient, the more likely the diagnosis to be delayed.
Live and Let Die - Battle Stories of Gamified Sustainable Consumption App Creators
Authors: Guillen Georgina , Hamari Juho 
Published: October 2023

Background Although gamified sustainable consumption apps (SCAs) have been on the rise, only a few have survived longer than two years. While most existing research focuses on how gamification contributes to engagement and the formation of more sustainable consumption habits, there is little about how their survival is secured. Intervention’s Purpose Twenty-one SCA creators shared their considerations and experiences managing SCAs, providing valuable insights into the field of gamified sustainable consumption and practical insights for their stakeholders. Methods Ideal-type and narrative analyses of the interviews unraveled some relevant survival strategies and lessons learned. Results The creators' motivation and background play a role in the app's survival. Their experiences exposed several aspects affecting their gamification strategies and their relevance for the apps, highlighting traps to avoid and opportunities to improve their standing in an increasingly competitive market. Discussion Most creators shared stories of “learn as you go,” presenting how the flexibility to adjust the apps' business models rather than the creators’ professional background is a critical success factor. Since their apps represent their understanding of sustainability, SCA creators should find practical and emotional ways to engage their users while considering the objectives of their apps. Conclusion Awareness of the risks and pitfalls when creating an SCA may not be enough for successfully undertaking this enterprise. The creators should be capable of strategically plan for all the activities that creating and managing an SCA convey even before the app is conceptualized.
When should factorial designs be used for late-phase randomised controlled trials?
Authors: White Ian R , Szubert Alexander J , Choodari-Oskooei Babak , Walker A Sarah , Parmar Mahesh KB 
Published: October 2023

Background A 2×2 factorial design evaluates two interventions (A versus control and B versus control) by randomising to control, A-only, B-only or both A and B together. Extended factorial designs are also possible (e.g. 3×3 or 2×2×2). Factorial designs often require fewer resources and participants than alternative randomised controlled trials, but they are not widely used. We identified several issues that investigators considering this design need to address, before they use it in a late-phase setting. Methods We surveyed journal articles published in 2000–2022 relating to designing factorial randomised controlled trials. We identified issues to consider based on these and our personal experiences. Results We identified clinical, practical, statistical and external issues that make factorial randomised controlled trials more desirable. Clinical issues are (1) interventions can be easily co-administered; (2) risk of safety issues from co-administration above individual risks of the separate interventions is low; (3) safety or efficacy data are wanted on the combination intervention; (4) potential for interaction (e.g. effect of A differing when B administered) is low; (5) it is important to compare interventions with other interventions balanced, rather than allowing randomised interventions to affect the choice of other interventions; (6) eligibility criteria for different interventions are similar. Practical issues are (7) recruitment is not harmed by testing many interventions; (8) each intervention and associated toxicities is unlikely to reduce either adherence to the other intervention or overall follow-up; (9) blinding is easy to implement or not required. Statistical issues are (10) a suitable scale of analysis can be identified; (11) adjustment for multiplicity is not required; (12) early stopping for efficacy or lack of benefit can be done effectively. External issues are (13) adequate funding is available and (14) the trial is not intended for licensing purposes. An overarching issue (15) is that factorial design should give a lower sample size requirement than alternative designs. Across designs with varying non-adherence, retention, intervention effects and interaction effects, 2×2 factorial designs require lower sample size than a three-arm alternative when one intervention effect is reduced by no more than 24%–48% in the presence of the other intervention compared with in the absence of the other intervention. Conclusions Factorial designs are not widely used and should be considered more often using our issues to consider. Low potential for at most small to modest interaction is key, for example, where the interventions have different mechanisms of action or target different aspects of the disease being studied.
Insulin Pump Alarms During Adverse Events: A Qualitative Descriptive Study
Authors: Estock Jamie L. , Codario Ronald A. , Zupa Margaret F. , Keddem Shimrit , Rodriguez Keri L. 
Published: October 2023

Objective: Explore alarm signals cited in insulin pump-associated adverse events (AEs), describe the clinical consequences and other root cause informing remarks that cooccurred with the alarm signals, and identify opportunities for improvements to patient education, instructional materials, and alarm systems to prevent future AEs. Research Design and Methods: We explored the type, frequency, and associated clinical consequences of alarm signals cited in a pre-coded data set of 2294 insulin pump-associated AEs involving the MiniMed 670G, MiniMed 630G, and t:slim X2. We also explored the clinical consequences and other root cause informing remarks that cooccurred with the top 10 most frequently cited alarm signals. Results: Overall, 403 AEs narratives cited at least one alarm signal. Of the 40 unique alarm signals cited, 42.5% were “alarms,” 25.0% were “alerts,” and 32.5% were not referenced in the instructional materials packaged with the corresponding pump. The top 10 most frequently cited alarm signals included two obstruction of flow alarms, which accounted for 49.9% of all AEs citing at least one alarm, and two unreferenced alarms. The most frequent cooccurring root cause informing remark varied across the top 10 alarm signals and revealed valuable insight into why these alarms may have occurred. Conclusions: Our findings demonstrate the value of analyzing alarm signals cited in insulin pump-associated AEs and reveal multiple opportunities for providers to educate patients on how to respond to alarm signals and manage their pumps to avoid AEs, and for insulin pump manufacturers to update instructional materials and improve alarm systems to support appropriate patient response.
The Synergized Quality Improvement Program in Teacher Education: A Policy for Improving the Quality of China's Rural Teachers
Authors: Zhao (赵健) Jian 
Published: October 2023

Purpose This study elucidates the rationale, implementation, values, and challenges of the Synergized Quality Improvement Program in Teacher Education (SQIPTE)—the first policy specifically dedicated to the development of teaching staff since the founding of the People's Republic of China. Design/Approach/Methods After introducing the primary structure and rationale of the SQIPTE, this study reviews the existing data and research to explain why the program focuses on local normal colleges and determine how it could be implemented more effectively. Findings In establishing group-based assistance under the principle of “1 + M + N” (M ≥ N), the SQIPTE seeks to make normal colleges the primary force in the education of rural teachers and explores a collaborative operating mechanism to this end. Evidence suggests that this innovative program will provide new practical experience for the collaborative development and quality improvement of teachers. Originality/Value This study reviews the SQIPTE as a new Chinese intervention to improve the quality of rural teachers. There is strong evidence to suggest that this innovative program will inspire the construction of collaborative operating mechanisms incorporating multiple resources for teacher education systems across different areas.
Mapping of QTLs and meta-QTLs for Heterodera avenae Woll. resistance in common wheat (Triticum aestivum L.)
Authors: Pundir Saksham , Singh Rakhi , Singh Vikas Kumar , Sharma Shiveta , Balyan Harindra Singh , Gupta Pushpendra Kumar , Sharma Shailendra 
Published: October 2023

Abstract
Background
In hexaploid wheat, quantitative trait loci (QTL) and meta-QTL (MQTL) analyses were conducted to identify genomic regions controlling resistance to cereal cyst nematode (CCN), Heterodera avenae. A mapping population comprising 149 RILs derived from the cross HUW 468 × C 306 was used for composite interval mapping (CIM) and inclusive composite interval mapping (ICIM).

Results
Eight main effect QTLs on three chromosomes (1B, 2A and 3A) were identified using two repeat experiments. One of these QTLs was co-localized with a previously reported wheat gene Cre5 for resistance to CCN. Seven important digenic epistatic interactions (PVE = 5% or more) were also identified, each involving one main effect QTL and another novel E-QTL. Using QTLs earlier reported in literature, two meta-QTLs were also identified, which were also used for identification of 57 candidate genes (CGs). Out of these, 29 CGs have high expression in roots and encoded the following proteins having a role in resistance to plant parasitic nematodes (PPNs): (i) NB-ARC,P-loop containing NTP hydrolase, (ii) Protein Kinase, (iii) serine-threonine/tyrosine-PK, (iv) protein with leucine-rich repeat, (v) virus X resistance protein-like, (vi) zinc finger protein, (vii) RING/FYVE/PHD-type, (viii) glycosyl transferase, family 8 (GT8), (ix) rubisco protein with small subunit domain, (x) protein with SANT/Myb domain and (xi) a protein with a homeobox.

Conclusion
Identification and selection of resistance loci with additive and epistatic effect along with two MQTL and associated CGs, identified in the present study may prove useful for understanding the molecular basis of resistance against H. avenae in wheat and for marker-assisted selection (MAS) for breeding CCN resistant wheat cultivars.
Comparison of anesthetic effects of different doses of alfentanil combined with ciprofol in elderly patients undergoing ERCP: a randomized controlled trial
Authors: Hu Jun , Gu Xiuxia , Zhu Wenhao , Zhu Xiuli , Ji Fanceng , Luo Yanhua , Liu Ning 
Published: October 2023

Abstract
Background and objects
Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) are often old and poor in physical fitness. The purpose of this study was to investigate the anesthetic effect of different doses of alfentanil combined with ciprofol in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).

Methods
In this clinical trial, 137 patients, who were candidates for ERCP were randomly divided into three groups. Group A were given 0.15 μg/kg/min of alfentanil in maintenance stage, Group B were given 0.25 μg/kg/min and Group C were given 0.35 μg/kg/min. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2) of the patients at each time point including the entry into the operation room (T0), at the beginning of surgery(T1), 10 min after surgery(T2), 20 min after surgery(T3), 30 min after surgery(T4),endoscopy withdrawal (T5) were recorded. Adverse events(including respiratory depression, body movement and hypoxemia),the dosage of ciprofol, the time of operation time and awakening were recorded.

Results
Compared with Group A, MAP and HR in Group B and Group C was decreased during T1-T5 (P < 0.05). Compared with group B, MAP and HR in group C was decreased during T1-T5 (P < 0.05). Compared with Group A and Group C,the number of adverse reactions of Group B was decreased(P < 0.05). There was no statistical difference in surgical time among the three groups(P > 0.05),but a statistically significant difference in recovery time (P < 0.05).

Conclusion
The adverse events of alfentanil 0.25μg/kg/min combined with ciprofol were low, and the anesthetic effect was the best.
Impact of body mass index on perioperative mortality of acute stanford type A aortic dissection: a systematic review and meta-analysis
Authors: Song Wenyu , Liu Jiani , Tu Guowei , Pan Lulu , Hong Yixiang , Qin Lieyang , Wei Lai , Chen Jinmiao 
Published: October 2023

AbstractBackgroundObesity may increase perioperative mortality of acute Stanford type A aortic dissection (ATAAD). However, the available evidence was limited. This study aimed to systematically review published literatures about body mass index (BMI) and perioperative mortality of ATAAD.MethodsElectronic literature search was conducted in PubMed, Medline, Embase and Cochrane Library databases. All observational studies that investigated BMI and perioperative mortality of ATAAD were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Meta-regression analysis was performed to assess the effects of different clinical variables on BMI and perioperative mortality of ATAAD. Sensitivity analysis was performed to determine the sources of heterogeneity. Egger’s linear regression method and funnel plot were used to determine the publication bias.ResultsA total of 12 studies with 5,522 patients were eligible and included in this meta-analysis. Pooled analysis showed that perioperative mortality of ATAAD increased by 22% for each 1 kg/m2increase in BMI (OR = 1.22, 95% CI: 1.10–1.35). Univariable meta-regression analysis indicated that age and female gender significantly modified the association between BMI and perioperative mortality of ATAAD in a positive manner (meta-regression on age: coefficient = 0.04,P = 0.04; meta-regression on female gender: coefficient = 0.02,P = 0.03). Neither significant heterogeneity nor publication bias were found among included studies.ConclusionsBMI is closely associated with perioperative mortality of ATAAD. Optimal perioperative management needs to be further explored and individualized for obese patient with ATAAD, especially in elderly and female populations.Trial registrationPROSPERO (CRD42022358619).Graphical AbstractBMI and perioperative mortality of ATAAD.
Iron overload may be critical for liver dysfunction in anorexia nervosa, and the role of haematocrit-adjusted albumin in assessing nutritional status: a case report
Authors: Yoshida Tomohiko , Namiki Toshiki , Yamaga Masaya , Onishi Shunichiro , Takemoto Minoru 
Published: October 2023

AbstractBackgroundAnorexia nervosa (AN) is frequently associated with liver dysfunction, but the precise mechanism remains undefined. Since the nutritional marker albumin has a low correlation with changes in body weight in AN, and patients with AN often have dehydration as a complication, we also examined whether haematocrit (HCT)-adjusted serum albumin could be a better nutritional marker in AN.Case presentationWe describe a 15-year-old girl with severe weight loss and liver damage whose liver enzymes normalized after 1.5 months of hospitalization and weight gain. We found a significant correlation between body weight (BW) and HCT-adjusted serum albumin (Spearman’s rank correlation coefficient (rs) = 0.66,P = 5.28 × 10−3) and between BW and alanine aminotransferase (ALT) (rs= -0.825,P = 8.45 × 10−5). After division by HCT, correlations between serum albumin and ALT (rs= -0.835,P = 5.24 × 10−5) and between the iron-storage protein ferritin and the liver enzyme gamma-glutamyl transferase (rs= 1.0,P = 0.017) were also statistically significant.ConclusionThese results suggest that improvement of the nutritional status in AN could relieve liver dysfunction and facilitate iron transport. Since a decrease in the iron-transport protein transferrin presumably increases labile non-transferrin-bound iron, resulting in excess reactive oxygen species production, a defect in iron transport due to malnutrition could be one of the causes of liver injury in AN. In addition, HCT-adjusted albumin could be a better marker than its raw data to assess changes in nutritional status in AN.
Femoral neck fracture after femoral head necrosis: a case report and review of the literature
Authors: Xia Wenjie , Zhang Aiqi , Qiu Binsong , Chen Yuan , Kong Mingxiang 
Published: October 2023

Abstract
Introduction
Pathological fractures of the femoral neck caused by necrosis of the femoral head are extremely rare. Here, we report a rare case of bilateral femoral head osteonecrosis extending to the femoral neck, with bilateral pathological fractures of the femoral neck occurring within a short period of time.

Case report
A 65-year-old male with a 25-year history of daily consumption of 750 ml of liquor, presented with right hip pain after labor for 1 month. He subsequently sustained a right femoral neck fracture without trauma and underwent a right total hip arthroplasty. Two months later, he suffered a non-traumatic left femoral neck fracture and underwent a left total hip arthroplasty. Histopathological examination revealed osteonecrosis of the femoral head and neck, along with the presence of osteoclasts and granulomatous inflammation. Bone mineral density testing also showed osteoporosis. The bilateral femoral neck fractures were ruled out to be caused by any other pathological factors.

Discussion
This is the first report of pathological fractures of the bilateral femoral neck caused by femoral head necrosis. During the literature review process, we found that this case conforms to the histological characteristics of rapidly destructive hip disease and analyzed the etiology of femoral head necrosis and the pathogenesis of femoral neck fractures.
Factors associated with emergency admission for people dying from cancer in Northern Ireland: an observational data linkage study
Authors: Mitchell H. , Cairnduff V. , O’Hare S. , Simpson L. , White R. , Gavin AT 
Published: October 2023

Abstract
Background
Many people living with cancer are admitted as an emergency, some just prior to diagnosis and others in their last year of life. Factors associated with accessing emergency care for people dying of cancer are complex and not well understood. This can make it difficult to have the resources and staffing in place to best care for individuals in their last year of life and their families.

Methods
This study uses routinely collected administrative data from people who died of cancer in N. Ireland (NI) during 2015 and explores how personal characteristics (e.g., gender, age) and disease related factors (e.g., tumour site, cancer stage at initial diagnosis) were associated with having an emergency admission to hospital in the last year and the last 28 days of their lives, using multivariate logistic regression.

Results
Almost three in four people had at least one emergency admission in the last year of life, and over one in three had an emergency admission the last 28 days of life. Patterns were similar for both time outcomes with males, people with haematological, lung or brain cancers, younger persons, those diagnosed with late-stage cancer, and people diagnosed close to time of death, being significantly more likely to have an emergency admission. While there was no significant association between deprivation and emergency admission rates, those living in urban areas were more likely to have an emergency admission in their last month of life compared to rural dwellers. Late diagnosis was evident with 538 people (12.8% of all deaths from cancer) being diagnosed within one month of death and 1242 (29%) within 3 months of death.

Conclusion
The high level of emergency admissions points to gaps in routine end-of-life care, and the need for additional training for hospital staff including frontline emergency department (ED) staff who are often the ‘gatekeepers’ to emergency inpatient care for people living with cancer. The levels of late diagnosis indicate a need for increased population awareness of cancer symptoms and system change to promote earlier diagnosis.