bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutritional consistency of macroalgae across a sea ice cover gradient along the Western Antarctic Peninsula
Authors: Oswalt Hannah E. , Amsler Margaret O. , Amsler Charles D. , Iken Katrin , McClintock James B. , Klein Andrew G. , Galloway Aaron W. E.
Published: January 2025

Sea ice can profoundly influence photosynthetic organisms by altering subsurface irradiance, but it is susceptible to changes in the climate. The patterns and timing of sea ice cover can vary on a monthly to annual timescale in small sub‐regions of the Western Antarctic Peninsula (WAP). During the latter part of the 20th century, sea ice coverage significantly decreased in the WAP, a trend that aligns with warming in this area. Macroalgal biochemical components are impacted by light availability, often showing a close relationship between photosynthesis and biochemical compositions. We used satellite imagery of annual sea ice duration and extent as well as water turbidity during ice‐free periods to identify 14 study sites that differed dramatically in sea ice coverage but were similar in terms of turbidity along the central WAP between 68° S and 64° S. The common macroalgal species Desmarestia menziesii, Himantothallus grandifolius, Sarcopeltis antarctica, and Iridaea sp. were collected by scuba divers between 5 m and 35 m depth at each site where they occurred, for later biochemical analyses. Overall percentages of major biochemical components as well as carbon and nitrogen percentages and C:N were determined and correlated with four different sea ice indices. Surprisingly, most of the chemical components were not significantly correlated with sea ice cover. The few significant correlations varied between species and chemical components. This indicates that although patterns of sea ice coverage have major implications for macroalgal abundance, on a per‐biomass basis, sea ice coverage does not impact the nutritional contributions of macroalgae to food webs.
5‐FU Weakens Defensive Functions of the Junctional Epithelium
Authors: Aellos Fabiana , Ramos Amarissa , Civit‐Balta Alba , Grauer Joseph A. , Cuevas Pedro L. , Rao Samyak , Yuan Xue , Liu Bo , Helms Jill A.
Published: January 2025

Aim

To investigate additional factors contributing to the pathophysiology of chemotherapy‐induced oral mucositis and periodontitis beyond the systemic immune suppression caused by the chemotherapeutic agent 5‐Fluorouracil (5‐FU).

Methods

5‐Fluorouracil was topically delivered to the non‐keratinized, rapidly proliferating junctional epithelium (JE) surrounding the dentition, and acts as an immunologic and functional barrier to bacterial ingression. Various techniques, including EdU incorporation, quantitative immunohistochemistry (qIHC), histology, enzymatic activity assays, and micro‐computed tomographic (μCT) imaging, were employed to analyze the JE at multiple time points following topical 5‐FU treatment. Systemic 5‐FU delivery was used for comparison, and all 5‐FU treated tissues were compared to vehicle‐treated controls.

Results

We first showed that systemic 5‐FU blocked mitotic activity that rapidly led to JE atrophy. This atrophy was accompanied by suppression of the immune system. We then demonstrated that topical 5‐FU delivery effectively inhibited cell proliferation in the JE. Quantitative immunohistochemical (qIHC) analyses further demonstrated a progressive breakdown in JE barrier functions following topical 5‐FU. CBC analyses confirmed that topical 5‐FU did not alter the innate immune system but did suppress the local immune response of the JE. The longer‐term consequences of this disruption in JE barrier functions were significant alveolar bone loss and an increase in porosity. Together, these results document the essential requirement for rapid JE cell proliferation to maintain homeostasis of the periodontium.

Conclusions

The reduction of cell division in the JE due to 5‐FU treatment directly compromises both its structural integrity and immune surveillance capabilities, contributing to the destruction of periodontal hard tissues.
High‐Frequency Ultrasound for Detecting Periodontal Inflammation: A Preclinical Diagnostic Accuracy Study
Authors: Samal Ankita , Majzoub Jad , Rodriguez Betancourt Amanda , Webber Liana , Mazzocco John , Wang Hom‐Lay , Castilho Rogerio , Fenno J. Christopher , Chan Hsun‐Liang , Kripfgans Oliver D.
Published: January 2025

Aim

Ultrasonography (US) has shown accuracy in imaging healthy periodontium. This study aims to evaluate the feasibility and accuracy of US for estimating dimensions of inflamed periodontium induced by ligature and bacteria.

Methods

Periodontal tissues of maxillary as well as mandibular premolars and molars in six female mini pigs were treated with ligature and three strains of bacteria for 4–10 weeks. Before euthanization, the periodontium was imaged with US. After euthanization, cone‐beam computed tomography (CBCT) scans and histology were performed. Soft and hard tissue measurements by calibrated and masked examiners from US, CBCT, and histology were statistically compared.

Results

Seventy‐one histological samples with corresponding CBCT and US scans were available for analysis. Overall, there was a good to excellent agreement between histology and US (ICC: 0.77–0.96) for parameters such as Soft Tissue Thickness (STT), Gingival Recession, Crestal Bone Thickness (CBT), and the bone‐to‐cemento‐enamel junction (B‐CEJ) distance. However, discrepancies were observed for STT at 3 mm below the CEJ and Soft Tissue Height (STH) (ICC: 0.44 and 0.54, respectively). CBCT showed lower agreement with histology, particularly for thin CBT (< 1 mm), with an ICC of 0.20, compared to 0.90 for US vs. histology. CBCT failed to identify crestal bone in 14 cases when the crestal bone was thin. Notably, CBCT results differed more from histological measurements than US in assessing B‐CEJ and thin CBT.

Conclusion

US demonstrated substantial potential as a transformative tool for periodontal diagnostics, exhibiting high agreement with histology in determining critical parameters. Compared to CBCT, US offered advantages, particularly in cases with thin crestal bone.
Crosslinked Versus Non‐Crosslinked Resorbable Collagen Membranes for Periodontal Regeneration: A Multicenter, Randomized, Double‐Blind, Non‐Inferiority Clinical Trial
Authors: Wang Yiwei , Yan Fuhua , Chen Lili , Zhao Lei , Liu Mo , Ge Shaohua , Chen Chia‐Yu , Kim David M. , Shu Rong
Published: January 2025

Aim

This study aimed to evaluate and compare the results of combination therapy involving bone grafting and two different resorbable collagen membranes in 1‐, 2‐ and 3‐wall infrabony defects.

Methods

A total of 174 patients with infrabony defects (≥ 7 mm periodontal probing depth) were randomized to receive deproteinized bovine bone mineral (DBBM) with either a native porcine non‐crosslinked collagen membrane (N‐CM, control, n = 87) or a novel porcine crosslinked collagen membrane (C‐CM, test, n = 87). Clinical parameters, including periodontal probing depth (PPD), clinical attachment level (CAL), and gingival recession (GR), were recorded at baseline, 12 weeks, and 24 weeks. Radiographic evaluations measured linear bone gain (LBG) and percentage of bone fill (%BF) at baseline and 24 weeks. Generalized Estimating Equations (GEE) were used to identify predictors of clinical outcomes. The primary outcome was the total effectiveness rate based on a composite outcome score integrating clinical and radiographic parameters at 24 weeks.

Results

One hundred seventy three patients completed the study. At 24 weeks, mean improvements in PPD were 4.17 ± 1.48 mm and 4.16 ± 0.97 mm for the control and test groups, respectively, while CAL gains were 3.69 ± 1.32 mm and 3.60 ± 1.81 mm. Radiographic linear bone gain was 3.12 ± 2.19 mm in the control group and 3.00 ± 1.92 mm in the test group. Subgroup analysis showed trends favoring the test group for PPD (p = 0.046) and CAL (p = 0.042) improvements in 1‐wall defects. The total effectiveness rate was 96.55% in the control group and 95.35% in the test group, with a difference of −1.2% (95% CI: −5.88% to 3.47%). Among those with effective results, the test group had a higher proportion achieving significantly effective outcomes compared to the control group (96.5% vs. 86.2%, p = 0.032). Regression analysis identified treatment group, defect morphology, and baseline defect depth as significant predictors of PPD and CAL outcomes.

Conclusion

The novel porcine crosslinked collagen membrane demonstrated non‐inferiority to the native non‐crosslinked membrane in periodontal regeneration. Regression analysis highlighted defect morphology and baseline defect depth as key predictors of outcomes, while subgroup analysis suggested potential advantages of the C‐CM in challenging defect morphologies, such as 1‐wall defects. These findings provide valuable insights into clinical decision‐making. However, the findings are limited by the short‐term nature of the study (24 weeks), and further long‐term investigations are needed to confirm these preliminary results and assess their clinical relevance.

Trial Registration

ClinicalTrials.gov identifier: NCT04851847
Sarcopenic obesity and brain health: A critical appraisal of the current evidence
Authors: Booranasuksakul Uraiporn , Guan Zhongyang , Macdonald Ian A. , Tsintzas Kostas , Stephan Blossom C. M. , Siervo Mario
Published: January 2025

Sarcopenic obesity (SO) is a body composition phenotype derived from the simultaneous presence in the same individual of an increase in fat mass and a decrease in skeletal muscle mass and/or function. Several protocols for the diagnosis of SO have been proposed in the last two decades making prevalence and disease risk estimates of SO heterogeneous and challenging to interpret. Dementia is a complex neurological disorder that significantly impacts patients, carers and healthcare systems. The identification of risk factors for early cognitive impairment and dementia is key to mitigating the forecasted trends of a 2‐fold increase in dementia case numbers over the next two decades worldwide. Excess adiposity and sarcopenia have both been independently associated with risk of cognitive impairment and dementia. Whether SO is associated with a greater risk of cognitive impairment and dementia is currently uncertain. This review critically appraises the current evidence on the association between SO with cognitive outcomes and dementia risk. It also discusses some of the putative biological mechanisms that may link the SO phenotype with alteration of brain functions.
The Effect of Nurses' Professional Values on Missed Nursing Care: The Mediating Role of Moral Sensitivity
Authors: Taskiran Eskici Gülcan , Tiryaki Sen Hanife , Yurtsever Demet , Ozer Candan Esra
Published: January 2025

The aim of this study is to determine the mediating role of moral sensitivity in the effect of nurses' professional values on missed nursing care. A descriptive and correlational study was conducted with 640 nurses working in the inpatient units of a public and a private hospital with the MISSCARE Survey‐Turkish, the Moral Sensitivity Questionnaire, and the Revised Nursing Professional Values Scale. Data analyses were performed using the Statistical Package for Social Sciences 26.0, Hayes' PROCESS macro for SPSS v4.0, and the Analysis of Moment Structures 24.0. It was determined that nurses' professional values had a significant and positive effect on moral sensitivity, and nurses' moral sensitivity had a significant and negative effect on missed nursing care. In addition, the direct and indirect effects of nurses' professional values on missed nursing care were statistically significant. The research model showed that increasing nurses' professional values and moral sensitivity decreased missed nursing care, and moral sensitivity significantly mediated the interaction between nurses' professional values and missed nursing care.
Second Generation Fiscal Rules, the Swiss Debt Brake, and a US Constitution Article V Amendment Convention
Authors: Poulson Barry W.
Published: January 2025

This essay explores new constitutional fiscal rules and their potential impact on the economy. Solving the debt crisis after many years of debt fatigue is clearly a difficult but not impossible task. The federal government is not likely to default on debt in the short term, but allowing debt to increase at an unsustainable rate exposes the country to increasing risk of default in the long term. Before the country falls off this fiscal cliff, we must enact more effective fiscal rules; and learning to live with effective fiscal rules will require some fundamental reforms in fiscal policy and fiscal institutions.
Engineering an optimized hypercompact CRISPR/Cas12j‐8 system for efficient genome editing in plants
Authors: Bai Shasha , Cao Xingyu , Hu Lizhe , Hu Danling , Li Dongming , Sun Yongwei
Published: January 2025

The Cas12j‐8 nuclease, derived from the type V CRISPR system, is approximately half the size of Cas9 and recognizes a 5′‐TTN‐3′ protospacer adjacent motif sequence, thus potentially having broad application in genome editing for crop improvement. However, its editing efficiency remains low in plants. In this study, we rationally engineered both the crRNA and the Cas12j‐8 nuclease. The engineered crRNA and Cas12j‐8 markedly improved genome editing efficiency in plants. When combined, they exhibited robust editing activity in soybean and rice, enabling the editing of target sites that were previously uneditable. Notably, for certain target sequences, the editing activity was comparable to that of SpCas9 when targeting identical sequences, and it outperformed the Cas12j‐2 variant, nCas12j‐2, across all tested targets. Additionally, we developed cytosine base editors based on the engineered crRNA and Cas12j‐8, demonstrating an average increase of 5.36‐ to 6.85‐fold in base‐editing efficiency (C to T) compared with the unengineered system in plants, with no insertions or deletions (indels) observed. Collectively, these findings indicate that the engineered hypercompact CRISPR/Cas12j‐8 system serves as an efficient tool for genome editing mediated by both nuclease cleavage and base editing in plants.
Korea–China Trade Dynamics: Exploring the Role of Crude Oil Prices
Authors: Baek Jungho , Nam Soojoong
Published: January 2025

This research examines the short‐ and long‐term impacts of macroeconomic variables, such as real income levels and exchange rates, on Korea's trade flows with China, focusing on 33 specific commodity groups. By employing the Autoregressive Distributed Lag (ARDL) methodology, this study incorporates oil‐related factors – namely crude oil prices and their volatility – into traditional export and import models. The results demonstrate that real income levels in Korea and China considerably influence trade dynamics, affecting exports and imports across various periods. The bilateral exchange rate has a significant impact, with its effects being more pronounced on exports in the long term and imports in the short term. Furthermore, the research highlights that crude oil prices and their volatility significantly, yet varied, affect trade flows, contingent on the trade's nature and duration. These findings offer valuable insights for policymakers, particularly in understanding the recent shifts in Korea's trade balance with China and in formulating economic and trade strategies to manage fluctuations in the trade balance.
Antenatal betamethasone augments lung perfusion but lowers upper body blood flow and O2 delivery with delayed cord clamping at birth in preterm lambs
Authors: Smolich Joseph J. , Kenna Kelly R.
Published: January 2025

Although the corticosteroid betamethasone is routinely administered to accelerate lung and cardiovascular maturation in the preterm fetus prior to birth, and use of delayed cord clamping (DCC) is recommended at birth by professional bodies, it is unknown whether antenatal betamethasone alters perinatal pulmonary or systemic arterial blood flow accompaniments of DCC. To address this issue, preterm fetal lambs [gestation 127 (1) days, term = 147 days] with (n = 10) or without (n = 10) antenatal betamethasone treatment were acutely instrumented under general anaesthesia with flow probes to obtain left (LV) and right ventricular (RV) outputs, major central arterial blood flows and shunt flow across both the ductus arteriosus and foramen ovale (FO). After delivery, lambs underwent initial ventilation for 2 min prior to DCC. During initial ventilation and after DCC, betamethasone (1) augmented rises in pulmonary arterial blood flow, with this greater increase supported during initial ventilation by enhanced pulmonary distribution of a higher RV output that was largely underpinned by newly emergent and substantial left‐to‐right (L → R) shunting across the FO, and after DCC, by an added contribution from more pronounced L → R ductal shunting; (2) increased a redistribution of LV output away from the upper body region, accompanied by lowering of upper body blood flow and O2 delivery; and (3) accentuated a progressive systemic‐to‐pulmonary arterial shift in the distribution of the combined LV and RV output that occurred in conjunction with more pronounced perinatal L → R shunting. These findings suggest that antenatal betamethasone substantially alters arterial blood flow effects of initial ventilation and DCC in the preterm birth transition.

image

Key points

Betamethasone is given to increase fetal lung and cardiovascular maturation prior to preterm birth, while delayed cord clamping (DCC) is recommended at birth.

Whether antenatal betamethasone alters perinatal arterial blood flow responses to DCC is unknown.

Anaesthetized preterm fetal lambs with or without betamethasone pretreatment were instrumented with central arterial flow probes and, at birth, underwent ∼2 min of ventilation before DCC.

Betamethasone augmented perinatal rises in pulmonary arterial blood flow, related to enhanced pulmonary distribution during initial ventilation of a higher right ventricular output largely underpinned by left‐to‐right (L → R) shunting across the foramen ovale, with an added contribution from more pronounced L → R ductal shunting after DCC.

Betamethasone increased a redistribution of left ventricular output away from the upper body region, with lowering of upper body blood flow and O2 delivery.

Betamethasone accentuated a systemic‐to‐pulmonary arterial shift in the distribution of combined ventricular output occurring with greater perinatal L → R shunting.
The endothelium at the interface between tissues and
Staphylococcus aureus
in the bloodstream
Authors: Speziale Pietro , Foster Timothy J. , Arciola Carla Renata
Published: January 2025

Staphylococcus aureus
is a major human pathogen. It can cause many types of infections, in particular bacteremia, which frequently leads to infective endocarditis, osteomyelitis, sepsis, and other debilitating diseases. The development of secondary infections is based on the bacterium’s ability to associate with endothelial cells lining blood vessels. The success of endothelial colonization and infection by
S. aureus
relies on its ability to express a wide array of cell wall-anchored and secreted virulence factors. Establishment of endothelial infection by the pathogen is a multistep process involving adhesion, invasion, extravasation, and dissemination of the bacterium into surrounding tissues. The process is dependent on the type of endothelium in different organs (tissues) and pathogenetic potential of the individual strains. In this review, we report an update on the organization of the endothelium in the vessels, the structure and function of the virulence factors of S.
aureus
, and the several aspects of bacteria-endothelial cell interactions. After these sections, we will discuss recent advances in understanding the specific mechanisms of infections that develop in the heart, bone and joints, lung, and brain. Finally, we describe how neutrophils bind to endothelial cells, migrate to the site of infection to kill bacteria in the tissues, and how staphylococci counteract neutrophils’ actions. Knowledge of the molecular details of
S. aureus
-endothelial cell interactions will promote the development of new therapeutic strategies and tools to combat this formidable pathogen.
Health and economic impact of oral PrEP provision across subgroups in western Kenya: a modelling analysis
Authors: Wittenauer Rachel , Wu Linxuan , Cox Sarah , Pfau Brian , Sharma Monisha
Published: January 2025

Introduction

Oral pre-exposure prophylaxis (PrEP) is a priority intervention for scale-up in countries with high HIV prevalence. Policymakers must decide how to optimise PrEP allocation to maximise health benefits within limited budgets. We assessed the health and economic impact of PrEP scale-up among different subgroups and regions in western Kenya.

Methods

We adapted an agent-based network model, EMOD-HIV, to simulate PrEP uptake in six counties of western Kenya across seven subgroups including serodiscordant couples (SDCs), adolescent girls and young women (AGYW), adolescent boys and young men, women with multiple partners and men with multiple partners. We modelled 5 years of PrEP provision assuming 90% PrEP uptake in the prioritised subgroups and evaluated outcomes over 20 years compared with a no PrEP scenario. All results are presented in 2021 USD$.

Results

Population PrEP coverage was highest in the broad AGYW scenario (8.3%, ~2 fold higher than the next highest coverage scenario) and lowest in the SDC scenario (0.37%). Across scenarios, PrEP averted 4.5%–21.3% of infections over the 5-year implementation. PrEP provision to SDCs was associated with the lowest incremental cost-effectiveness ratio (ICER), $245 per disability-adjusted life year (DALY) averted (CI $179 to $435), followed by women and men with multiple partners ($1898 (CI $1002 to $6771) and $2351 (CI $1 831 to $3494) per DALY averted, respectively). Targeted strategies were more efficient than broad provision even in high HIV prevalence counties; PrEP scale-up for AGYW with multiple partners had an ICER per DALY averted of $4745 (CI $2059 to $22 515) compared with $12 351 for broad AGYW (CI $7 050 to $33,955). In general, ICERs were lower in counties with higher HIV prevalence.

Conclusions

PrEP scale-up can avert substantial HIV infections and increasing PrEP demand for subgroups at higher risk can increase efficiency of PrEP programmes. Our results on health and cost impact of PrEP across geographic regions in western Kenya can be used for budgetary planning and priority setting.
Stewarding COVID-19 health systems response in Pakistan: what more can be done for a primary health care approach to future pandemics?
Authors: Zaidi Shehla , Zaidi Raza , Hussain Shujaat , Safi Malik Muhammad
Published: January 2025

We apply a primary healthcare (PHC) perspective to gauge Pakistan’s health systems response to COVID-19, to identify stewardship lessons for integrating the PHC pandemic response. Analysis of Pakistan’s response against the Astana PHC framework shows that the imperative for national survival helped mobilise an agile response across a fragmented health security context. The findings show effective multisector governance in responding to the health and social aspects of the pandemic, as well as the rapid roll-out of several public health functions and emergency care. However, we found weak maintenance of essential health services and ad hoc, short-lived efforts for community engagement.

Critical enablers that helped steward the response across complex power-sharing arrangements included solidarity across society, collaborative data-driven decision-making, leveraging of siloed domestic resources and private sector coordination. At the same time, a more PHC-centric response was constrained by weak political prioritisation of essential health services, uneven services, weak direction to civil society volunteerism for community engagement and weak regulation of private sector contribution.

We conclude that a mindset shift is required from short-term tactical measures to long-term investment in PHC-oriented transformative stewardship. Future preparedness must build attention to essential service package for emergencies, mobilisation of both private and public primary care providers, effective community engagement vision across societal actors and market regulation, within a collaborative governance framework.
Evolution and effectiveness of bilateral and multilateral development assistance for health: a mixed-methods review of trends and strategic shifts (1990–2022)
Authors: Xie Siwei , Du Sijin , Huang Yuxin , Luo Yan , Chen Ying , Zheng Zhijie , Yuan Beibei , Xu Ming , Zhou Shuduo
Published: January 2025

Background

Development assistance for health (DAH) plays a vital role in supporting health programmes in low- and middle-income countries. While DAH has historically focused on infectious diseases and maternal and child health, there is a lack of comprehensive analysis of DAH trends, strategic shifts and their impact on health systems and outcomes. This study aims to provide a comprehensive review of DAH from 1990 to 2022, examining its evolution and funding allocation shifts.

Methods

We conducted a mixed-methods review, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search was performed across PubMed, Embase, Web of Science and the Cochrane databases, yielding 102 eligible studies. Quantitative data were obtained from the Institute for Health Metrics and Evaluation database, covering DAH data from 1990 to 2022. Qualitative data were analysed through thematic synthesis based on the WHO’s six health system building blocks.

Results

The DAH has predominantly focused on HIV/AIDS and maternal and child health. Despite the increasing global burden of non-communicable diseases (NCDs), the proportion of DAH allocated to NCDs remained low, increasing only from 1% in 1990 to 2% in 2022. Similarly, the overall funding for health system strengthening decreased from 19% in 1990 to 7% in 2022. Major contributors to DAH included the USA, the UK and the Bill & Melinda Gates Foundation. While associations between DAH and improvements in certain health outcomes were observed, establishing causality is challenging due to multiple influencing factors. The COVID-19 pandemic underscored the importance of robust health systems. However, DAH allocation did not show any substantial shift towards health system strengthening during this period. Economic evaluations calculated the median incremental cost-effectiveness ratio of DAH interventions,

Conclusions

This study reviews DAH trends from 1990 to 2022, showing a predominant focus on HIV/AIDS and maternal and child health, with insufficient attention to NCDs and health system strengthening. Despite the increasing burden of NCDs and the impact of COVID-19, DAH priorities have not significantly shifted, highlighting the need for ongoing evaluation and strategic adjustments. To enhance DAH effectiveness, it is crucial to adopt a more balanced approach and also align interventions with needs from recipient countries and implement evidence-based strategies with continuous monitoring and evaluation.
Optimising early detection of degenerative cervical myelopathy: a systematic review of quantitative screening tools for primary care
Authors: Inzerillo Sean , Jagtiani Pemla , Jones Salazar
Published: January 2025

Background

Early diagnosis of degenerative cervical myelopathy (DCM) is often challenging due to subtle, non-specific symptoms, limited disease awareness and a lack of definitive diagnostic criteria. As primary care physicians are typically the first to encounter patients with early DCM, equipping them with effective screening tools is crucial for reducing diagnostic delays and improving patient outcomes. This systematic review evaluates the efficacy of quantitative screening methods for DCM that can be implemented in primary care settings.

Methods

A systematic search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted across PubMed, Embase and Cochrane Library up to July 2024 using keywords relevant to DCM screening. Studies were included if they evaluated the sensitivity and specificity of DCM screening tools applicable to primary care settings. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Results

The search identified 14 studies evaluating 18 screening methods for DCM. Questionnaires consistently showed high diagnostic accuracy, with Youden indices exceeding 0.60, while only three out of nine conventional physical performance tests met the same threshold. Sensor-assisted tests, particularly those using advanced technology like finger-wearable gyro sensors, exhibited the highest diagnostic accuracy but present challenges related to accessibility and learning curves.

Conclusion

This review highlights the potential of quantitative screening methods for early DCM detection in primary care. While questionnaires and conventional tests are effective and accessible, sensor-assisted tests offer greater accuracy but face implementation challenges. A tailored, multifaceted approach is crucial for improving outcomes. Future research should focus on validating these tools in diverse populations and standardising diagnostic criteria.
Daily iron supplementation does not impact on prevalence of exclusive breastfeeding or growth in young breastfed Gambian infants
Authors: Stelle Isabella , Bah Mamadou , Verhoef Hans , Moore Sophie , Cerami Carla
Published: January 2025

Background

In a randomised placebo-controlled trial among exclusively breastfed rural Gambian infants aged 6–10 weeks at randomisation, daily iron supplementation for 14 weeks improved iron status. This secondary analysis explores the impact of iron supplementation on duration of exclusive breastfeeding and growth.

Methods

Breastfed 6–10 week-old infants were supplemented for 14 weeks with either daily iron or placebo (n=101). Infant feeding practices were assessed weekly through questionnaires. Survival analysis was used to measure the effect of iron supplementation on age at and time to cessation of exclusive breastfeeding. Groups were also compared regarding the change in anthropometric z-scores between baseline and endline.

Results

At endline, 31% (n=31/101) of infants were exclusively breastfed. There was no evidence that iron supplementation reduced the time to cessation of exclusive breastfeeding (median: 70 days (range: 7–105 days), iron: 67 days; placebo 71 days; Kaplan-Meier, log-rank test: p=0.15; Cox regression, crude HR: 1.42, 95% CI: 0.86 to 2.34, p=0.17; HR adjusting for infant age and sex: 1.40, 95% CI: 0.85 to 2.31, p=0.19) or age at cessation of exclusive breastfeeding (median time: 18 weeks (range:1–24 weeks), iron: 16 weeks; placebo 18 weeks; Kaplan-Meier, log-rank test: p=0.13; crude HR=1.47, 95% CI: 0.89, 2.43; p=0.13; HR adjusting for infant age and sex=1.44, 95% CI: 0.87, 2.39 p=0.16) There was no evidence that iron supplementation affected infant weight (p=0.79) or length (p=0.64) at endline or change in z-scores during the intervention period for weight-for-age (p=0.99), length-for-age (p=0.70) and weight-for-length (p=0.89). There was no evidence that duration of exclusive breastfeeding impacted endline anthropometric outcomes.

Conclusion

Although requiring replication in larger trials, these findings do not raise concerns about iron supplementations’ effect on feeding or growth in exclusively breastfed infants.
Community health system capacities and capabilities within an evolving community health policy framework: mixed methods study of stakeholders in central Uganda
Authors: Kabanda Richard , Ocaatre Ronald Miria , Atwine Diana , Kim Bounggui , Waiswa Simon Erisa , Kavuma Prichard Denzel , Lee Yeni , Mutoni Loretah , Kim Solyi , Park Yein , Okuga Monica , Tweheyo Raymond
Published: January 2025

Objectives

Empowering communities through identifying and unlocking community capacities and capabilities is vital for improving community health systems. This study assessed the community health system’s status quo and readiness for implementing a government-led, partner-supported community health worker project.

Design

A mixed methods cross-sectional study.

Setting

Two districts and one city in central Uganda.

Participants

21 key informants (KIIs) with district leaders, 4 focus group discussions (FGDs) with community health workers (CHWs) termed as village health teams in the Ugandan setting and a survey of 487 CHWs and 419 pregnant women who had childbirth 12 months before.

Study measures

KIIs and FGDs explored community health system resources using the WHO health systems building blocks and the UNICEF health system strengthening maturation model. However, the surveys explored the work-related attributes and services delivered by the CHWs and to the community, respectively.

Analysis

A framework analysis was used for qualitative data in NVivo 14. While descriptive and stratified analyses were conducted for quantitative data in Stata I/C 15.0: proportions for the varied geographical entities were compared using the t-test with p values <0.05 considered significant, one-way ANOVA was used to compare means.

Results

Overall, all sites had relatively strong governance of community health only challenged by multiple implementing partners that were weakly coordinated. There was an exclusive paper-based information management system that linked to the national DHIS-2 software. Community reporting rates varied between 20% and 80%. Community health financing was weak, similarly to commodities availability. The mean age of the community health workforce was high at 50.9 (SD 11.9); the majority reported adequate skills in service delivery except for community first aid, Kangaroo mother care and noncommunicable diseases. Households’ most received CHW services included home visits, treatment for sick under-five children and child immunisation.

Conclusions

The existing CHW system has governance and reporting strengths but could be enhanced through revitalization, enhanced coordination of stakeholders, providing appropriate training, work tools, supervision and engaging the community for accountability of results.
Systematic review of health and social outcomes among Indigenous People exposed to the child welfare system: a protocol
Authors: Schwartz Flint D. , Pride Tara M. , Stewart Sherry H. , Mackinnon Sean P. , Robinson Margaret
Published: January 2025

Introduction

The link between parent-child separation through child welfare systems and negative health and social outcomes is well documented. In contrast, despite the over-representation of Indigenous children and youth in child welfare systems, the relationship between child welfare system involvement and health and social outcomes among Indigenous populations has not been systematically reviewed. Our objective is to assess whether Indigenous People who have been exposed to a child welfare system personally or intergenerationally (ie, parents and/or grandparents) within Canada, Australia, New Zealand and the USA (CANZUS countries) and the circumpolar region are at an increased risk for negative health and social outcomes compared with other exposed and non-exposed groups.

Methods and analysis

We will undertake a comprehensive exploration of literature documenting health and social outcomes for Indigenous individuals with personal or intergenerational exposure to a child welfare system. The search will encompass nine databases, including Ovid MEDLINE, APA PsycINFO, Bibliography of Native North Americans, CINAHL, EMBASE, Public Affairs Index, Scopus, Social Work Abstracts and Sociological Abstracts. Additionally, reference lists of included studies will be examined. The literature search will include studies up to 4 October 2024 and will adhere to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Findings will be presented in summary tables through narrative synthesis, and if feasible, a meta-analysis will quantify the impact of child welfare exposure on health and social outcomes.

Ethics and dissemination

The results of this systematic review will synthesise current evidence regarding health and social outcomes related to personal and intergenerational child welfare exposure among Indigenous populations in CANZUS countries and circumpolar regions. This information could help support future policy and practice decision-making. Findings will be widely disseminated through peer-review publications and community presentations aimed at various interested parties, including policymakers, professional practitioners and clinicians, and service users (ie, clients, family members, caregivers).

PROSPERO registration number

CRD42023434543
Global regional and national burden of cataract attributable to high body mass index from 1990 to 2019
Authors: Zhang Baodong , Ding Yuxi , Lan Xiaowen
Published: January 2025

Objectives

In order to estimate long-term trends of the years lived with disability (YLDs) for cataract due to high body mass index (BMI).

Design and participants

Data were retrieved from the Global Burden of Disease (GBD) 2019. The global cases, age-standardised rates (ASR) of YLDs for cataract attributable to high BMI were described by age, sex, geographical location and sociodemographic index (SDI). The estimated average annual percentage change (AAPC) was analysed to quantify the trends of ASR of YLD from 1990 to 2019.

Primary outcome measures

Years lived with disability.

Results

Globally, there were 370.4 (95% UI: 163.2 to 689.3) YLDs due to cataract attributed to high BMI in 2019, more than triple the number in 1990. Moreover, the ASR of YLD increased during 1990–2019, with AAPC of 1.54 (95% CI: 1.41 to 1.66). In 2019, the burden of cataract due to high BMI was higher in females and the elderly population. North Africa and the Middle East were the high-risk areas of cataract attributable to high BMI in 2019, with Saudi Arabia being the country with the heaviest burden. In terms of SDI, low-middle SDI regions had the greatest number of cataract-related YLDs due to high BMI in 2019.

Conclusion

The global YLDs for cataract due to high BMI have shown a notable increase from 1990 to 2019. Addressing BMI control may contribute to cataract prevention, highlighting a potential public health impact, particularly in low-SDI locations and among the elderly.
Protocol for the development of a global core outcome set for the surgical treatment of differentiated thyroid cancer: a literature review and international Delphi survey
Authors: van de Berg Daniël J , Mooij Christiaan F , van Trotsenburg A S Paul , Jamaludin Faridi S , van Santen Hanneke M , Clement Sarah C , Vriens Menno R , Bruinstroop Eveline , Kruijff Schelto , Peeters Robin P , Verburg Frederik A , Netea-Maier Romana T , Seur Angelique , Nieveen van Dijkum Els J M , Engelsman Anton F , Derikx Joep P M
Published: January 2025

Introduction

There is a lack of consensus on the optimal surgical strategy for differentiated thyroid cancer (DTC), partly due to inconsistent reporting of outcomes. This limits the ability to compare study results, hindering the ability to draw conclusions regarding novel treatment strategies. The development of a core outcome set (COS) reduces heterogeneity in the selection and reporting of clinical trial outcomes. Currently, there is no COS for the surgical treatment of DTC. We aim to reach a global consensus among patients and physicians on the COS for the surgical treatment for patients with DTC of all ages.

Methods and analysis

The DTC-COS development will consist of three phases: first, an extensive literature review will be performed to identify reported outcomes in studies regarding surgical treatment for DTC in patients of all ages. Second, a 2-step or 3-step Delphi procedure will be performed to identify a final set of core outcomes out of the selected outcomes from the literature review. For this Delphi survey, both healthcare professionals and patients will be invited. Third, an (online) expert meeting with participants from every stakeholder group is organised to ratify the final core outcome set. The final COS will be reported in accordance with the COS-Standards for Reporting statement.

Ethics and dissemination

The medical research ethics committee of the Amsterdam UMC confirmed that the Dutch Medical Research Involving Human Subjects Act (WMO) does not apply to this study and that full approval by the committee is not required. The study is registered in the COMET initiative database (registration number 2597). Results will be presented in peer-reviewed academic journals and at (international) conferences.

Trial registration number

COMET initiative database 2597
Missed opportunity for nasal continuous positive airway pressure in preterm neonates admitted at a tertiary-level hospital newborn unit in Kenya: a mixed method study
Authors: Kakibibi Peace , Marangu-Boore Diana , Murila Florence
Published: January 2025

Background

Respiratory Distress Syndrome (RDS) is the most common complication of preterm neonates. It remains one of the major public health concerns that contribute to neonatal mortality and morbidity, especially in Africa, where 80% of neonatal mortality is estimated to be caused by preterm complications. Nasal Continuous Positive Airway Pressure (NCPAP) ventilation is the preferred mode of RDS treatment. However, NCPAP is not easily accessible to every preterm neonate in low- and middle-income countries, and this is the case in Kenya.

Objectives

To determine the proportion of preterm neonates admitted to the newborn unit (NBU) at Kenyatta National Hospital (KNH), a tertiary referral hospital in Kenya, with a missed opportunity for NCPAP and to determine the barriers and facilitators of NCPAP utilisation.

Design and setting

We conducted a hospital-based cross-sectional study that employed interactive explanatory concurrent mixed methods. The quantitative approach determined the proportion of missed opportunities for NCPAP in preterm neonates admitted to the KNH newborn unit, while the qualitative approach explored the barriers and facilitators of NCPAP utilisation.

Participants

Preterm neonates of gestation less than 37 weeks in the first 48 hours of life who met the criteria for NCPAP. The key informants were mainly different staff cadres from the newborn unit, a procurement officer and a biomedical engineer.

Primary and secondary outcome measures

The proportion of preterm infants admitted to the newborn unit with a missed opportunity for NCPAP, and the barriers and facilitators of NCPAP utilisation.

Results

167 preterm neonates were reviewed from July to November 2021 and analysed of whom 33.5% (95% CI 26.8% to 41.0%) missed the opportunity to receive NCPAP. 20 key informants were interviewed from September to October 2021. Facilitators of NCPAP use reported were (1) training of health workers, (2) availability of NCPAP machines, (3) KNH being a national and tertiary referral hospital able to receive neonates referred with RDS, (4) global evidence that NCPAP use is beneficial and (5) technology development. Barriers to NCPAP use were mainly (1) inadequate number of NCPAP machines, (2) inadequate training and mentorship, (3) inadequate and inappropriate size of NCPAP consumables, (4) staff shortage, (5) long servicing turnaround time, (6) long cleaning turnaround time, (7) infrastructure challenges and (8) insufficient utilities.

Conclusion

The missed opportunity for NCPAP in preterm neonates in Kenya is high. Barriers to NCPAP are related to medical products and technologies, health workforce-related challenges and service delivery. We recommend the provision of more NCPAP machines including supporting infrastructure and appropriate consumables, human resource support, frequent training and mentorship on NCPAP use.
Association between endostatin and mortality in patients with acute dyspnoea, with or without congestive heart failure: a single-centre, prospective, observational study
Authors: Yaghoubi Alexander , Heijl Caroline , Khoshnood Ardavan M , Wändell Per Erik , Carlsson Axel C , Wessman Torgny
Published: January 2025

Objective

The aim of this study was to assess associations between endostatin levels and short-term mortality in unsorted acute hospitalised dyspnoea patients with or without congestive heart failure (CHF), adjusted for common cardiovascular risk factors.

Design, setting and participants

In this prospective observational study, 723 hospitalised patients who visited the emergency department at Skåne University Hospital, Sweden, between 2013 and 2018 were included. Of these, 276 had a history of CHF. The association between endostatin levels and 1 month and 3-month mortality was evaluated, stratified by whether patients had a history of CHF or not.

Results

Patients with prior CHF had higher endostatin levels, higher short-term mortality and were more likely to have CHF as discharge diagnosis. In a fully adjusted model, endostatin was independently associated with 3-month mortality (HR=1.01 per 1 ng/mL increment of endostatin; 95% CI 1.00 to 1.02; p=0.016). No evidence of association was identified with 1-month mortality.

Conclusions

Endostatins are potential biomarkers for 3 months’ mortality in patients hospitalised with CHF seeking emergency care with acute dyspnoea. Further studies are needed in different settings to assess the predictive value of endostatins in patients with CHF.
Long-term outcome of oesophageal atresia in adolescence (TransEAsome): a national French cohort study protocol
Authors: Leroy Mélanie , Aumar Madeleine , Duhamel Marie , Dauchet Luc , Figeac Martin , Gaillard Segolene , Hankard Regis , Labreuche Julien , Marot Guillemette , Reversat Julie , Armand Viviane , Salzet Michel , Sfeir Rony , Vandel Jimmy , Gottrand Frédéric
Published: January 2025

Introduction

TheTransEAsomeproject, funded by the Agence Nationale de la Recherche, aims to evaluate the long-term outcomes of patients with oesophageal atresia (OA) between 13 and 14 years old and establish multiomics profiles using data from the world’s biggest OA registry.

Methods and analysis

TransEAsomeis a national multicentre population-based cohort study recruiting participants from all qualified French centres for OA surgery at birth. The primary objective is to assess the prevalence of gastro-oesophageal reflux disease in adolescence among patients with OA, with several secondary objectives including the identification of risk factors and multiomic profiles from oesophageal biopsies and blood samples collected between 13 and 14 years old, compared with a control group. This comprehensive characterisation of phenotype and omic profiles aims to enhance the understanding of disease evolution in patients with OA and inform tailored care management strategies.

Ethics and dissemination

The study, coconstructed with input from patients, parents and research-expert adolescents, has obtained approval from the ethics research committee: Comité de protection des personnes Est II. Findings will be disseminated to various target audiences, including the scientific community, research participants, the patient community, the general public, regulatory authorities and policymakers. Data will be made available in a Findable, Accessible, Interoperable, Reusable format on the France Cohortes platform on study completion.

Trial registration number

NCT05995171:Clinical trial